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<1>
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)

<2>
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.

<3>
Accession Number
2002651999
Title
Immune checkpoint inhibitor therapy in solid organ transplant recipients:
A patient-centered systematic review.
Source
Journal of the American Academy of Dermatology. 82 (6) (pp 1490-1500),
2020. Date of Publication: June 2020.
Author
Fisher J.; Zeitouni N.; Fan W.; Samie F.H.
Institution
(Fisher, Samie) Department of Dermatology, Columbia University Irving
Medical Center, New York, NY, United States
(Zeitouni) Department of Dermatology, University of Arizona College of
Medicine, Phoenix, AZ, United States
(Fan) Department of Biostatistics, Columbia University Irving Medical
Center, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The use of immunotherapies in the treatment of metastatic
cancers has significantly advanced oncology. However, due to safety
concerns, solid organ transplant recipients (SOTRs) are routinely excluded
from immunotherapy trials; thus, there is limited data for these agents in
this population. <br/>Method(s): A systematic review was performed to
evaluate the safety and efficacy of immunotherapies in SOTRs with
metastatic cancers. Fisher's exact test and Kruskal-Wallis test were used
for analysis. <br/>Result(s): In total, 37% of patients experienced organ
rejection, and 14% died as a result of graft rejection. Nivolumab was
associated with the highest rejection rate (52.2%), followed by
pembrolizumab (26.7%) and ipilimumab (25%; P = .1774). The highest
rejection rate was seen in patients with kidney transplants (40.1%), then
liver (35%) and heart (20%) transplants (P = .775), and 64% of patients
succumbed to the progression of malignancy. For all cases, rates of
progression or death secondary to disease were highest for ipilimumab
(75%), followed by nivolumab (43%) and pembrolizumab (40%; P = .1892). The
overall response rate was highest for pembrolizumab (40%), followed by
nivolumab (30%) and ipilimumab (25%; P = .7929). <br/>Limitation(s): The
small sample size. <br/>Conclusion(s): Physicians must be cautious when
administering immunotherapy to SOTRs. However, rejection is not the most
common cause for death in this population.<br/>Copyright &#xa9; 2019
American Academy of Dermatology, Inc.

<4>
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.

<5>
Accession Number
2004925503
Title
Systematic Review: Treatment for Addictive Disorder in Transplant
Patients.
Source
American Journal on Addictions. (no pagination), 2020. Date of
Publication: 2020.
Author
Luchsinger W.; Zimbrean P.
Institution
(Luchsinger, Zimbrean) Yale University School of Medicine, New Haven, CT,
United States
(Zimbrean) Yale New Haven Hospital, New Haven, CT, United States
Publisher
Wiley Blackwell (E-mail: info@wiley.com)
Abstract
Background and Objectives: The number of patients with substance use
disorders in need for organ transplantation is expected to increase.
Patients with addictive disorders are considered a higher risk of negative
outcomes after organ transplantation due to the impact of substance use
upon medical status and adherence with treatment. The goal of this
systematic review was to assess the current literature on treatment for
addiction transplant candidates and recipients. <br/>Method(s): We
conducted a literature search within four databases PubMed, MEDLINE,
EMBASE, and PsycINFO for publications dated 1/1/1988 to 12/31/2018.
<br/>Result(s): Out of 3108 articles identified through database
screening, 39 were included in the qualitative synthesis. Sixteen studies
described addiction treatment in groups over five patients. All the
articles included liver transplant patients, with only two studies
including patients who needed a kidney or a heart transplant. Nine
articles described treatment of alcohol use disorder exclusively, five
focused on treatment of opioid use disorders. Although 9 of 16 studies
were prospective, the variability of the treatment intervention, outcome
measures, and control group when applicable prohibited a meaningful
meta-analysis of the results. Eight articles that described the case
reports are analyzed separately. Discussion and <br/>Conclusion(s):
Promising treatment options for alcohol use disorder have been reported
but more studies are needed to confirm their effectiveness and their
feasibility. Methadone appears effective for opioid disorder in transplant
patients. Scientific Significance: To the best of our knowledge, this is
the first systematic review on the treatment of addictive disorders in
transplant patients. (Am J Addict 2020;00:00-00).<br/>Copyright &#xa9;
2020 American Academy of Addiction Psychiatry

<6>
Accession Number
631707386
Title
Preoperative VolumE Replacement therapy in DIabetic patients undergoing
coronary artery bypass grafting surgery: Results from an open parallel
group randomized Controlled Trial (VeRDiCT).
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (1) (pp 54-63), 2020.
Date of Publication: 01 Jan 2020.
Author
Sarkar K.; Harris R.A.; Wells S.; Harris T.; Clout M.; Taylor J.;
Culliford L.; Angelini G.D.; Pike K.; Ashton K.; Narayan P.; Reeves B.;
Hillier J.; Rogers C.A.; Ascione R.
Institution
(Sarkar, Narayan) Rabindranath Tagore International Institute of Cardiac
Sciences (RTIICS), Kolkata, India
(Harris, Wells, Harris, Clout, Taylor, Culliford, Pike, Ashton, Reeves,
Rogers) Clinical Trials and Evaluation Unit, Bristol Trials Centre,
University of Bristol, Bristol, United Kingdom
(Angelini, Hillier, Ascione) Faculty of Health Sciences, Bristol Heart
Institute, University of Bristol, Bristol BS2 8HW, United Kingdom
Publisher
Oxford University Press
Abstract
To investigate the effect of preoperative volume replacement therapy (VRT)
on renal function, health outcome and time to fitness for discharge in
diabetic patients undergoing coronary artery bypass grafting (CABG).
<br/>METHOD(S): In 2 parallel randomized controlled trials, diabetic
patients were allocated to preoperative VRT (1 ml/kg/h of Hartmann's
solution for 12 h) or usual care. Primary outcome was time to fitness for
discharge. Secondary outcomes included acute kidney injury, postoperative
complications, patient-reported quality of life (QoL), hospital resource
use and markers of renal, cardiac and inflammatory injury. <br/>RESULT(S):
In total, 169 patients were randomized (84 VRT, 85 usual care; mean age 64
years; 88% male). Time to fitness for discharge was similar between groups
[median 6 days; interquartile range 5.0-9.0 in both groups; hazard ratio
0.95, 95% confidence interval (CI) 0.65-1.38; P = 0.78]. Postoperative
acute kidney injury was not statistically different (VRT: 27.7% vs usual
care: 18.8%, odds ratio 1.72, 95% CI 0.82-3.59; P = 0.15). Estimated
glomerular filtration rate (mean difference -0.92, 95% CI -4.18 to 2.25; P
= 0.56), microalbumin/creatinine ratio [geometric mean ratio (GMR) 1.16,
95% CI 0.94-1.42; P = 0.16], N-acetyl-beta-d-glucosaminidase (GMR 1.08,
95% CI 0.83-1.40; P = 0.57), C-reactive protein (GMR 1.00, 95% CI
0.88-1.13; P = 0.94), troponin T (Trop-T; GMR 1.18, 95% CI 0.78-1.79; P =
0.39) and other secondary health outcomes were similar between groups. QoL
improved in both groups at 3 months with no difference observed.
<br/>CONCLUSION(S): The use of preoperative VRT is not superior to usual
care in diabetic patients undergoing CABG. Clinical trial registration
number: ISRCTN02159606.<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.

<7>
Accession Number
2005924536
Title
Predictive model of in-hospital mortality in left-sided infective
endocarditis.
Source
Revista Espanola de Cardiologia. (no pagination), 2020. Date of
Publication: 2020.
Author
Garcia-Granja P.E.; Lopez J.; Vilacosta I.; Sarria C.; Dominguez F.;
Ladron R.; Olmos C.; Saez C.; Vilches S.; Garcia-Arribas D.; Cobo-Marcos
M.; Ramos A.; Maroto L.; Gomez I.; Carrasco M.; Garcia-Pavia P.; San Roman
J.A.
Institution
(Garcia-Granja, Lopez, Ladron, Gomez, Carrasco, San Roman) Servicio de
Cardiologia, Instituto de Ciencias del Corazon (ICICOR), Hospital Clinico
Universitario Valladolid, Valladolid, Spain
(Garcia-Granja, Lopez, Dominguez, Cobo-Marcos, Garcia-Pavia, San Roman)
CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
(Vilacosta, Olmos, Garcia-Arribas) Servicio de Cardiologia, Instituto
Cardiovascular, Hospital Clinico San Carlos, Instituto de Investigacion
Sanitaria del Hospital Clinico San Carlos (IdSSC), Madrid, Spain
(Sarria, Saez) Servicio de Medicina Interna, Hospital Universitario La
Princesa, Madrid, Spain
(Dominguez, Vilches, Cobo-Marcos, Garcia-Pavia) Unidad de Insuficiencia
Cardiaca y Cardiopatias Familiares, Servicio de Cardiologia, Hospital
Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
(Ramos) Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna,
Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
(Maroto) Servicio de Cirugia Cardiaca, Instituto Cardiovascular, Hospital
Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital
Clinico San Carlos (IdSSC), Madrid, Spain
(Garcia-Pavia) Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon,
Madrid, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Infective endocarditis (IE) is a complex
disease with high in-hospital mortality. Prognostic assessment is
essential to select the most appropriate therapeutic approach; however,
international IE guidelines do not provide objective assessment of the
individual risk in each patient. We aimed to design a predictive model of
in-hospital mortality in left-sided IE combining the prognostic variables
proposed by the European guidelines. <br/>Method(s): Two prospective
cohorts of consecutive patients with left-sided IE were used. Cohort 1 (n
= 1002) was randomized in a 2:1 ratio to obtain 2 samples: an adjustment
sample to derive the model (n = 688), and a validation sample for internal
validation (n = 314). Cohort 2 (n = 133) was used for external validation.
<br/>Result(s): The model included age, prosthetic valve IE,
comorbidities, heart failure, renal failure, septic shock, Staphylococcus
aureus, fungi, periannular complications, ventricular dysfunction, and
vegetations as independent predictors of in-hospital mortality. The model
showed good discrimination (area under the ROC curve = 0.855; 95%CI,
0.825-0.885) and calibration (P value in Hosmer-Lemeshow test = 0.409),
which were ratified in the internal (area under the ROC curve = 0.823;
95%CI, 0.774-0.873) and external validations (area under the ROC curve =
0.753; 95%CI, 0.659-0.847). For the internal validation sample (observed
mortality: 29.9%) the model predicted an in-hospital mortality of 30.7%
(95%CI, 27.7-33.7), and for the external validation cohort (observed
mortality: 27.1%) the value was 26.4% (95%CI, 22.2-30.5).
<br/>Conclusion(s): A predictive model of in-hospital mortality in
left-sided IE based on the prognostic variables proposed by the European
Society of Cardiology IE guidelines has high discriminatory
ability.<br/>Copyright &#xa9; 2019 Sociedad Espanola de Cardiologia

<8>
Accession Number
2005883997
Title
Postcardiac Surgery Acute Stroke Therapies: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Kashani H.H.; Mosienko L.; Grocott B.B.; Glezerson B.A.; Grocott H.P.
Institution
(Kashani, Mosienko, Grocott, Grocott) Department of Anesthesiology,
Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB,
Canada
(Glezerson) Department of Anesthesiology and Pain Medicine, University of
Ottawa, Ottawa, ON, Canada
Publisher
W.B. Saunders
Abstract
Objective: To identify interventions for the treatment of acute ischemic
stroke after cardiac surgery and to report the efficacy of these
treatments. <br/>Design(s): Systematic review and narrative synthesis
Participants: Patients with ischemic stroke after cardiac surgery.
<br/>Intervention(s): Treatment efficacy of intra-arterial thrombolysis
(IAT) and/or endovascular mechanical thrombectomy (EMT). Methods and Main
Results: The MEDLINE (Ovid), Embase (Ovid), Scopus (Elsevier), and
Cochrane Central Register of Controlled Trials (Wiley) databases were
searched from January 1, 1990, until September 20, 2018. After reviewing
5,231 records, 8 case reports/series and 2 retrospective studies were
included (n = 33). Three of these reports (n = 19) published between 2001
and 2003 described IAT, and 6 studies (n = 14) published between 2015 and
2019 reported the use of EMT. In the 19 patients who received IAT, 3 (16%)
had good, 8 (42%) had moderate, and 8 (42%) had poor neurologic outcomes.
In the 14 patients who received EMT, 7 (50%) had good, 5 (36%) had
moderate, and 2 (14%) had poor neurologic outcomes. <br/>Conclusion(s):
Endovascular thrombectomy, with or without IAT, is being used increasingly
with success in patients presenting with postcardiac surgery stroke.
However, the number of patients reported is too small to confidently
understand its overall effect on neurologic outcomes in this
setting.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<9>
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

<10>
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.

<11>
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

<12>
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.

<13>
Accession Number
2004724161
Title
Differences in morbidity and mortality in Down syndrome are related to the
type of congenital heart defect.
Source
American Journal of Medical Genetics, Part A. (no pagination), 2020. Date
of Publication: 2020.
Author
Baban A.; Olivini N.; Cantarutti N.; Cali F.; Vitello C.; Valentini D.;
Adorisio R.; Calcagni G.; Alesi V.; Di Mambro C.; Villani A.; Dallapiccola
B.; Digilio M.C.; Marino B.; Carotti A.; Drago F.
Institution
(Baban, Olivini, Cantarutti, Cali, Vitello, Adorisio, Calcagni, Di Mambro,
Drago) Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of
Pediatric Cardiology and Cardiac Surgery, Bambino Gesu Children's
Hospital, IRCCS, Rome, Italy
(Valentini, Villani) Pediatric and Infectious Disease Unit, Bambino Gesu
Children's Hospital, IRCCS, Rome, Italy
(Alesi, Digilio) Medical Genetics Unit, Medical Genetics Laboratory,
Pediatric Cardiology, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
(Dallapiccola) Scientific Directorate, Bambino Gesu Children's Hospital,
IRCCS, Rome, Italy
(Marino) Department of Pediatrics, Sapienza University of Rome, Rome,
Italy
(Carotti) Pediatric Cardiac Surgery Unit, Department of Pediatric
Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, IRCCS,
Rome, Italy
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Morbidity and mortality in Down syndrome (DS) are mainly related to
congenital heart defects (CHDs). While CHDs with high prevalence in DS
(typical CHDs), such as endocardial cushion defects, have been extensively
described, little is known about the impact of less common CHDs (atypical
CHDs), such as aortic coarctation and univentricular hearts. In our
single-center study, we analyzed, in observational, retrospective manner,
data regarding cardiac features, surgical management, and outcomes of a
cohort of DS patients. Literature review was performed to investigate
previously reported studies on atypical CHDs in DS. Patients with CHDs
were subclassified as having typical or atypical CHDs. Statistical
analysis was performed for comparison between the groups. The study
population encompassed 859 DS patients, 72.2% with CHDs, of which 4.7%
were atypical. Statistical analysis showed a significant excess in
multiple surgeries, all-cause mortality and cardiac mortality in patients
with atypical CHDs (p =.0067, p =.0038, p =.0001, respectively). According
to the Kaplan-Meier method, survival at 10 and 40 years was significantly
higher in typical CHDs (99 and 98% vs. 91 and 84%, log rank <0.05). Among
atypical CHDs, it seems that particularly multiple complex defects in
univentricular physiology associate with a worse outcome. This may be due
to the surgical difficulty in managing univentricular hearts with multiple
defects concurring to the clinical picture or to the severity of
associated defects themselves. Further studies need to address this
specific issue, also considering the higher pulmonary pressures, infective
complications, and potential comorbidities in DS patients.<br/>Copyright
&#xa9; 2020 Wiley Periodicals, Inc.

<14>
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.

<15>
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.

<16>
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.

<17>
Accession Number
2003748570
Title
Staged Carotid Artery Stenting and Coronary Artery Bypass Grafting
Procedures: A Word of Caution.
Source
Annals of Vascular Surgery. 65 (pp e306-e307), 2020. Date of Publication:
May 2020.
Author
Paraskevas K.I.
Institution
(Paraskevas) Department of Surgery, Central Clinic of Athens, Athens,
Greece
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<18>
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

<19>
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.

<20>
[Use Link to view the full text]
Accession Number
629716439
Title
Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass
Circuit in Pediatric Surgery: A Randomized Clinical Trial.
Source
Anesthesiology. 132 (1) (pp 95-106), 2020. Date of Publication: 01 Jan
2020.
Author
Dieu A.; Rosal Martins M.; Eeckhoudt S.; Matta A.; Kahn D.; Khalifa C.;
Rubay J.; Poncelet A.; Haenecour A.; Derycke E.; Thiry D.; Gregoire A.;
Momeni M.
Institution
(Dieu) From the Departments of Anesthesiology (A.D., M.R.M., C.K., M.M.)
Hematology (S.E.) Cardiac Surgery (J.R., A.P.) Perfusion Services (D.T.,
A.G.) the Pediatric Intensive Care Unit (A.H., University Hospital Saint
Luc, Catholic University of Louvain (Cliniques Universitaires Saint Luc,
Universite Catholique de Louvain), A.M., Brussels, Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: In congenital cardiac surgery, priming cardiopulmonary bypass
(CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation
abnormalities. The hypothesis was that CPB priming with crystalloids would
be different compared with FFP in terms of bleeding and/or need for blood
product transfusion. <br/>METHOD(S): In this parallel-arm double-blinded
study, patients weighing between 7 and 15 kg were randomly assigned to a
CPB priming with 15 ml . kg PlasmaLyte or 15 ml . kg FFP in addition to a
predefined amount of packed red blood cells used in all patients. The
decision to transfuse was clinical and guided by point-of-care tests. The
primary endpoints included postoperative bleeding tracked by chest tubes,
number of patients transfused with any additional blood products, and the
total number of additional blood products administered intra- and
postoperatively. The postoperative period included the first 6 h after
intensive care unit arrival. <br/>RESULT(S): Respectively, 30 and 29
patients in the FFP and in the crystalloid group were analyzed in an
intention-to-treat basis. Median postoperative blood loss was 7.1 ml . kg
(5.1, 9.4) in the FFP group and 5.7 ml . kg (3.8, 8.5) in the crystalloid
group (P = 0.219); difference (95% CI): 1.2 (-0.7 to 3.2). The proportion
of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of
29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds
ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products
transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and
crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to
0]). There were no study-related adverse events. <br/>CONCLUSION(S): The
results demonstrate that in infants and children, priming CPB with
crystalloids does not result in a different risk of postoperative bleeding
and need for transfusion of allogeneic blood products.

<21>
Accession Number
2005845373
Title
Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and
Improvement After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Ghezzi E.S.; Ross T.J.; Davis D.; Psaltis P.J.; Loetscher T.; Keage H.A.D.
Institution
(Ghezzi, Ross, Loetscher, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, Justice and Society, University of South
Australia, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing Unit at UCL, London,
United Kingdom
(Psaltis) Vascular Research Centre, Lifelong Health Theme, South
Australian Health and Medical Research Institute, Adelaide, Australia
(Psaltis) Adelaide University Medical School, University of Adelaide,
Adelaide, Australia
(Psaltis) Department of Cardiology, Central Adelaide Local Health Network,
Adelaide, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Changes to cognition, both decline and improvement, are commonly reported
after transcatheter aortic valve implantation (TAVI). However, previous
systematic reviews and meta-analyses have missed these subgroups by
assessing whole-group-averages for cognitive outcomes. We sought to pool
estimates to identify the prevalence of cognitive decline and improvement
after TAVI, as well as associated factors for these outcomes. A systematic
review identified 15 articles appropriate for meta-analysis. When robust
cognitive change definitions were employed, the pooled prevalence of
incident cognitive impairment up to 1-, 1 to 6-, and >=6-months post-TAVI
was 7%, 14%, and 12%, respectively. For cognitive improvement, the
prevalence from 1 to 6 months and >=6 months after TAVI was estimated to
be 19% and 11%, respectively. Two factors were associated with these
cognitive outcomes: (1) using a cerebral embolic protection device was
associated with decreased prevalence of cognitive decline up to 1-week
post-TAVI; (2) baseline cognitive impairment had a large association with
post-TAVI cognitive improvement. In conclusion, cognitive decline and
cognitive improvement are experienced by approximately 7% to 19% of
patients after TAVI, respectively. Those with the lowest cognitive
performance pre-TAVI appear to have the most to gain in terms of cognitive
improvement post-TAVI. Identifying further predictive factors for
cognitive decline and improvement post-TAVI will facilitate a
personalized-medicine approach for cognitive care and
prognosis.<br/>Copyright &#xa9; 2020 The Author(s)

<22>
Accession Number
2004269128
Title
Septal flash is a prevalent and early dyssynchrony marker in transcatheter
aortic valve replacement-induced left bundle branch block.
Source
International Journal of Cardiovascular Imaging. 36 (6) (pp 1041-1050),
2020. Date of Publication: 01 Jun 2020.
Author
Calle S.; Coeman M.; Desmet K.; De Backer T.; De Buyzere M.; De Pooter J.;
Timmermans F.
Institution
(Calle, Coeman, Desmet, De Backer, De Buyzere, De Pooter, Timmermans)
Department of Cardiology, University Hospital Ghent, Corneel Heymanslaan
10, Ghent 9000, Belgium
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
New-onset left bundle branch block (LBBB) is a frequent complication after
transcatheter aortic valve replacement (TAVR) and provides an opportunity
to study dyssynchrony immediately following acute LBBB. This study aims to
(1) assess echocardiographic dyssynchrony in acute TAVR-induced LBBB
(TAVR-LBBB), and (2) compare dyssynchrony parameters among different
patient groups with LBBB. The study enrolled all TAVR-LBBB patients at
Ghent University Hospital between 2013 and 2019. First, acute TAVR-LBBB
dyssynchrony was assessed by: (1) septal flash (SF); (2) interventricular
mechanical delay (IVMD; cut-off >= 40 ms) and (3) presence of 'classical
dyssynchronous strain pattern' assessed with speckle tracking. Secondly,
acute TAVR-LBBB patients with SF (LBBB<inf>TAVR+SF</inf>) were compared to
randomly selected LBBB-SF patients with preserved (LBBB<inf>SF+PEF</inf>)
and reduced ejection fraction (LBBB<inf>SF+REF</inf>). In TAVR-LBBB
patients (n = 25), SF was detected in 72% of patients, whereas only 5% of
TAVR-LBBB patients showed a classical dyssynchronous strain pattern. IVMD
in these TAVR-LBBB patients was 39 ms. In 90% of LBBB<inf>TAVR+SF</inf>
patients, SF was observed within 24 h after LBBB onset. Among LBBB-SF
patients, a classical strain pattern was more prevalent in
LBBB<inf>SF+REF</inf> patients compared to LBBB<inf>TAVR+SF</inf> patients
(80% vs. 7%; p < 0.001). IVMD was significantly longer in
LBBB<inf>SF+PEF</inf> patients (52 ms; p = 0.002) and
LBBB<inf>SF+REF</inf> patients (57 ms; p = 0.009) compared to
LBBB<inf>TAVR+SF</inf> patients (37 ms). SF is an early and prevalent
marker of LV dyssynchrony in acute TAVR-LBBB, whereas strain-based
measures and IVMD do not appear to capture dyssynchrony at this early
stage. Our findings from the comparative analysis generate the hypothesis
that progressive LBBB-induced LV remodeling may be required for a
'classical dyssynchrony strain pattern' or significant IVMD to occur in
TAVR-LBBB patients.<br/>Copyright &#xa9; 2020, Springer Nature B.V.

<23>
Accession Number
631332170
Title
Volatile Anesthetics versus Propofol for Cardiac Surgery with
Cardiopulmonary Bypass: Meta-analysis of Randomized Trials.
Source
Anesthesiology. 132 (6) (pp 1429-1446), 2020. Date of Publication: 01 Jun
2020.
Author
Bonanni A.; Signori A.; Alicino C.; Mannucci I.; Grasso M.A.; Martinelli
L.; Deferrari G.
Institution
(Bonanni) From the Departments of Cardionephrology, (A.B., l.M., G.D.)
Intensive Care Unit (M.A.G.) Cardiac Surgery (L.M.), Clinical Ligurian
Institute of High Specialty, Villa Maria Group (GVM) Care and Research,
Rapallo, Italy the Division of Internal Medicine, International
Evangelical Hospital, Genoa, Italy (A.B.) the Departments of Health
Science (A.S.) of Internal Medicine (G.D.), University of Genoa, Italy the
ASL-2-Regional Health System of Liguria, Italy (C.A.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this systematic review and meta-analysis was to
assess the effect of anesthesia maintenance with volatile agents compared
with propofol on both short- and long-term mortality (primary outcomes)
and major clinical events in adults undergoing cardiac surgery with
cardiopulmonary bypass. <br/>METHOD(S): Randomized clinical trials on the
effects of current volatile anesthetics versus propofol in adults
undergoing cardiac surgery with cardiopulmonary bypass were searched (1965
to September 30, 2019) in PubMed, the Cochrane Library, and article
reference lists. A random effect model on standardized mean difference for
continuous outcomes and odds ratio for dichotomous outcomes were used to
meta-analyze data. <br/>RESULT(S): In total, 37 full-text articles (42
studies, 8,197 participants) were included. The class of volatile
anesthetics compared with propofol was associated with lower 1-yr
mortality (5.5 vs. 6.8%; odds ratio, 0.76 [95% CI, 0.60 to 0.96]; P =
0.023), myocardial infarction (odds ratio, 0.60 [95% CI, 0.39 to 0.92]; P
= 0.023), cardiac troponin release (standardized mean difference, -0.39
[95% CI, -0.59 to -0.18], P = 0.0002), need for inotropic medications
(odds ratio, 0.40 [95% CI, 0.24 to 0.67]; P = 0.0004), extubation time
(standardized mean difference, -0.35 [95% CI, -0.68 to -0.02]; P = 0.038),
and with higher cardiac index/output (standardized mean difference, 0.70
[95% CI, 0.37 to 1.04]; P < 0.0001). The class of volatile anesthetics was
not associated with changes in short-term mortality (1.63 vs. 1.65%; odds
ratio, 1.04 [95% CI, 0.73 to 1.49]; P = 0.820) and acute kidney injury
(odds ratio, 1.25 [95% CI, 0.77 to 2.03]; P = 0.358). <br/>CONCLUSION(S):
In adults undergoing cardiac surgery with cardiopulmonary bypass, the
class of volatile anesthetics was superior to propofol with regard to
long-term mortality, as well as to many secondary outcomes indicating
myocardial protection.

<24>
Accession Number
2005868416
Title
PCV72 DIFFERENTIAL USE OF TRANSCATHETER AORTIC VALVE IMPLANTS (TAVI).
PERSONALIZATION STUDY.
Source
Value in Health. Conference: ISPOR 2020. United States. 23 (Supplement 1)
(pp S104), 2020. Date of Publication: May 2020.
Author
Novella B.; Jurado-Lopez A.; Rodriguez Salvanes F.; Arriola Bolado P.
Institution
(Novella) SERMAS, Madrid, M, Spain
(Jurado-Lopez, Rodriguez Salvanes, Arriola Bolado) SERMAS, Madrid, Spain
Publisher
Elsevier Ltd
Abstract
Objectives: The implantation of a transcatheter aortic prosthesis (TAVI)
is a reliable alternative to surgical valvular replacement in many
patients. TAVI indications increase has been followed by an increase of
these devices. The aim of this paper is to provide criteria for the
appropriate devices' use according to personal and clinical patient's
characteristics, among those available in Spain at the beginning of 2017
Methods: RAND / UCLA method was used. In first phase, relative risks found
in the systematic review of the literature table was elaborated. After
then different clinical scenarios in which the choice of a device could be
decisive was define. In second, phase 22 experts in two scoring rounds,
evaluated whether the devices were appropriate or not for each scenario.
<br/>Result(s): 27 clinical scenarios were considered. Edwards was
considered appropriate in 20 and indifferent in seven, Medtronic in 23 and
4 respectively. Lotus was found appropriate in 13, indifferent in 12 and
in 2 inappropriate. Portico and Acurate were considered appropriate in 7
scenarios and in 20 indifferent. In the set of the associations of 27
scenarios and 5 devices (135 associations), 52% of them were considered
appropriate. In only two associations (1.48%) a device was judged as
inappropriate and 45.9% as indifferent to the proposed scenario
<br/>Conclusion(s): There are differential characteristics among the
different devices that make them appropriate, indifferent or inappropriate
for some specific clinical scenarios according to the experts' criteria
Key words: Transcatheter Valvular Replacement. Percutaneous prostheses.
Aortic stenosis. Personalization. Type of prosthesis. RAND /
UCLA.<br/>Copyright &#xa9; 2020

<25>
Accession Number
631768386
Title
Microcirculatory perfusion disturbances following cardiopulmonary bypass:
a systematic review.
Source
Critical care (London, England). 24 (1) (pp 218), 2020. Date of
Publication: 13 May 2020.
Author
den Os M.M.; van den Brom C.E.; van Leeuwen A.L.I.; Dekker N.A.M.
Institution
(den Os, van den Brom, van Leeuwen, Dekker) Department of Anesthesiology,
Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De
Boelelaan 1117, Amsterdam 1081 HV, Netherlands
(van den Brom, van Leeuwen, Dekker) Department of Physiology, Vrije
Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam,
Netherlands
(van Leeuwen) Department of Cardiothoracic surgery, Vrije Universiteit
Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Microcirculatory perfusion disturbances are associated with
increased morbidity and mortality in patients undergoing cardiac surgery
with cardiopulmonary bypass (CPB). Technological advancements made it
possible to monitor sublingual microcirculatory perfusion over time. The
goal of this review is to provide an overview of the course of alterations
in sublingual microcirculatory perfusion following CPB. The secondary goal
is to identify which parameter of sublingual microcirculatory perfusion is
most profoundly affected by CPB. <br/>METHOD(S): PubMed and Embase
databases were systematically searched according to PRISMA guidelines and
as registered in PROSPERO. Studies that reported sublingual
microcirculatory perfusion measurements before and after onset of CPB in
adult patients undergoing cardiac surgery were included. The primary
outcome was sublingual microcirculatory perfusion, represented by
functional capillary density (FCD), perfused vessel density (PVD), total
vessel density (TVD), proportion of perfused vessels (PPV), and
microvascular flow index (MFI). <br/>RESULT(S): The search identified 277
studies, of which 19 fulfilled all eligibility criteria. Initiation of CPB
had a profound effect on FCD, PVD, or PPV. Seventeen studies (89%)
reported one or more of these parameters, and in 11 of those studies
(65%), there was a significant decrease in these parameters during cardiac
surgery; the other 6 studies (35%) reported no effect. In 29% of the
studies, FCD, PVD, or PPV normalized by the end of cardiac surgery, and in
24% percent of the studies, this effect lasted at least 24h. There was no
clear effect of CPB on TVD and a mixed effect on MFI. <br/>CONCLUSION(S):
CPB during cardiac surgery impaired sublingual microcirculatory perfusion
as reflected by reduced FCD, PVD, and PPV. Four studies reported this
effect at least 24h after surgery. Further research is warranted to
conclude on the duration of CPB-induced microcirculatory perfusion
disturbances and the relationship with clinical outcome. TRIAL
REGISTRATION: PROSPERO, CRD42019127798.

<26>
Accession Number
631766863
Title
Long-term outcome of perioperative low cardiac output syndrome in cardiac
surgery: 1-year results of a multicenter randomized trial.
Source
Journal of critical care. 58 (pp 89-95), 2020. Date of Publication: 17 Apr
2020.
Author
Zangrillo A.; Lomivorotov V.V.; Pisano A.; Calabro M.G.; Belletti A.;
Brazzi L.; Grigoryev E.V.; Guarracino F.; Monaco F.; Garofalo E.;
Crivellari M.; Likhvantsev V.V.; Fominskiy E.V.; Paternoster G.;
Yavorovskiy A.; Pasyuga V.V.; Oriani A.; Lembo R.; Bianchi A.; Scandroglio
A.M.; Abubakirov M.N.; Di Tomasso N.; Landoni G.
Institution
(Zangrillo, Landoni) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele
University, Milan, Italy
(Lomivorotov) Department of Anesthesiology and Intensive Care, E.
Meshalkin National Medical Research Center, Novosibirsk, Russia;
Novosibirsk State University, Novosibirsk, Russia
(Pisano) Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei
Colli - Monaldi Hospital, Naples, Italy
(Calabro, Belletti, Monaco, Crivellari, Fominskiy, Oriani, Lembo,
Scandroglio, Di Tomasso) Department of Anesthesia and Intensive Care,
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Brazzi) Department of Anesthesia, Intensive Care and Emergency, Citta
della Salute e della Scienza Hospital, Turin, Italy; Department of
Surgical Sciences, University of Turin, Turin, Italy
(Grigoryev) Intensive Care Unit, Scientific Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Guarracino) Division of Cardiothoracic Anesthesia and Intensive Care,
Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa,
Italy
(Garofalo) Department of Anesthesia and Intensive Care, AOU Mater Domini
Germaneto, Catanzaro, Italy
(Likhvantsev) Department of Anesthesiology and Intensive Care, First
Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology
Research Institute, Moscow, Russia
(Paternoster) Department of Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy
(Yavorovskiy) Department of Anesthesiology and Intensive Care, First
Moscow State Medical University, Moscow, Russian Federation
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Bianchi) Department of Cardiovascular Anesthesia and Intensive Care, AO
Ordine Mauriziano, Turin, Italy
(Abubakirov) Department of Anesthesiology and Intensive Care, E. Meshalkin
National Medical Research Center, Novosibirsk, Russian Federation
Publisher
NLM (Medline)
Abstract
PURPOSE: Perioperative myocardial dysfunction occurs frequently in cardiac
surgery, and is a risk factor for morbidity and mortality. Levosimendan
has been suggested to reduce mortality of patients with perioperative
myocardial dysfunction. However, long-term outcome data on its efficacy in
cardiac surgery are lacking. MATERIALS AND METHODS: Cardiac surgery
patients with perioperative myocardial dysfunction were randomized to
levosimendan or placebo, in addition to standard inotropic care. One-year
mortality data were collected. <br/>RESULT(S): We randomized 506 patients
(248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients
(16.5%) died in the levosimendan group, while 47 (18.3%) died in the
placebo group (absolute risk difference -1.8; 95% CI -8.4 to 4.9; P=.60).
Female sex, history of chronic obstructive pulmonary disease, previous
myocardial infarction, serum creatinine, hematocrit, mean arterial
pressure, and duration of cardiopulmonary bypass were independently
associated with 1-year mortality. <br/>CONCLUSION(S): Levosimendan
administration does not improve 1-year survival in cardiac surgery
patients with perioperative myocardial dysfunction. One-year mortality in
these patients is 17%. Six predictive factors for long-term mortality were
identified. STUDY REGISTRATION NUMBER: NCT00994825
(ClinicalTrials.gov).<br/>Copyright &#xa9; 2020 Elsevier Inc. All rights
reserved.

<27>
Accession Number
631754914
Title
Perioperative outcomes of robot-assisted vs video-assisted and traditional
open thoracic surgery for lung cancer: A systematic review and network
meta-analysis.
Source
The international journal of medical robotics + computer assisted surgery
: MRCAS. (no pagination), 2020. Date of Publication: 13 May 2020.
Author
Hu J.; Chen Y.; Dai J.; Zhu X.; Gonzalez-Rivas D.; Jiang G.; Li H.; Zhang
P.
Institution
(Hu, Chen, Dai, Zhu, Gonzalez-Rivas, Jiang, Zhang) Department of Thoracic
Surgery, Shanghai Pulmonary Hospital, Tongji University School of
Medicine, Shanghai, China
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, Coruna, Spain
(Li) Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The superiority of robot-assisted thoracic surgery (RATS) over
video-assisted thoracic surgery (VATS) and thoracotomy remains
controversial for lung cancer. <br/>METHOD(S): A network meta-analysis
(NMA) and pairwise meta-analysis (PMA) were performed to evaluate the
perioperative outcomes using 5 databases. <br/>RESULT(S): Thirty-two
studies involving 6593 patients were included for analysis. The NMA showed
that RATS had similar operative time, conversion rate to thoracotomy,
number of lymph node, post-operative morbidity and length of hospital stay
with VATS, except for lower 30-day mortality. Compared to thoracotomy,
longer operative time and shorter hospital stay were observed in RATS, but
no significant difference was observed in number of lymph node,
post-operative morbidity, 30-day mortality in both NMA and PMA. In
lobectomy/segmentectomy subgroup, all outcomes, except for operative time
of RATS vs VATS and number of lymph node, were similar with overall
analyses. <br/>CONCLUSION(S): RATS had comparable perioperative outcomes
with VATS and open surgery. This article is protected by copyright. All
rights reserved.

<28>
Accession Number
631754068
Title
Endothelial function in obesity and effects of bariatric and metabolic
surgery.
Source
Expert review of cardiovascular therapy. (no pagination), 2020. Date of
Publication: 13 May 2020.
Author
Sanches E.; Topal B.; Proczko M.; Stepaniak P.S.; Severin R.; Philips
S.A.; Sabbahi A.; Pujol Rafols J.; Pouwels S.
Institution
(Sanches) Department of Surgery, Haaglanden Medical Center, The Hague,
Netherlands
(Topal) Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Proczko) Department of General, Endocrine and Transplant Surgery,
University Medical Center, Gdansk University, Gdansk, Poland
(Stepaniak) Department of Operating Rooms, Catharina Hospital, Eindhoven,
Netherlands
(Severin, Sabbahi) Department of Physical Therapy, College of Applied
Health Sciences, University of Illinois at Chicago, Chicago. IL, United
States
(Severin) Doctor of Physical Therapy Program, Robbins College of Health
and Human Sciences, Baylor University, TX, Waco, United States
(Philips, Sabbahi) Department of Physical Therapy, Integrative Physiologic
Laboratory, College of Applied Health Sciences, University of Illinois at
Chicago, Chicago, United States
(Pujol Rafols) Department of Surgery, Barcelona, Spain
(Pouwels) Department of Intensive Care Medicine, Elisabeth-Tweesteden
Hospital, Tilburg, Netherlands
Publisher
NLM (Medline)
Abstract
IntroductionDue to the lifestyle changes and the on-going urbanization
waves there is obesity pandemic. The visceral fatty tissue of patients
with obesity, in comparison with subcutaneous fat, has more gene
expression related to inflammation, oxidative stress, cytokine production
and angiogenesis. The abovementioned leads to a decrease in arteriolar
function and also an impaired endothelial vasodilatation and eventually
endothelial dysfunction.Areas CoveredThis review aims to provide an
overview of the pathophysiology of obesity and endothelial dysfunction and
the effects after bariatric and metabolic surgery and the consequences of
surgery for the endothelial function. In this review we focussed and
searched for literature in Pubmed and The Cochrane library, (from the
earliest date of each database until February 2020) regarding endothelial
function, obesity and effects of bariatric and metabolic surgery.Expert
opinionWithin cardiovascular research, the endothelium and its function
have a prominent role and it is the responsibility of the researchers to
unravel the pathophysiological mechanisms and potential new targets for
treatment of cardiovascular diseases.

<29>
Accession Number
631753911
Title
Hypertension in cardiac transplant recipients: tackling a new face of an
old foe.
Source
Current opinion in cardiology. (no pagination), 2020. Date of Publication:
07 May 2020.
Author
Campbell P.T.; Krim S.R.
Institution
(Campbell) Division of Cardiology, Baptist Health Medical Center, Little
Rock, AR
(Krim) Division of Cardiology, John Ochsner Heart and Vascular Institute
(Krim) Section of Cardiomyopathy and Heart Transplantation, John Ochsner
Heart and Vascular Institute, Ochsner Clinic Foundation
(Krim) University of Queensland School of Medicine, Ochsner Clinical
School, New Orleans, LA, United States
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Systemic hypertension (HTN) is a common complication
arising in the heart transplant recipient. This article aims to review the
most current literature and update readers on the epidemiology,
pathophysiology and management of HTN in heart transplant patients. RECENT
FINDINGS: In contrast to the general nontransplant hypertensive patient
population, traditional risk factors, including family history of HTN,
obesity and diabetes, play a minor role in the genesis of posttransplant
HTN. Dysregulation in sodium and water balance, vascular stiffness,
endothelial dysfunction, abnormal cardiorenal neural reflexes resulting
from immunosuppression and cardiac denervation seem to be the predominant
factors leading to postheart transplant HTN. Calcineurin inhibitors
induced nephrotoxicity and steroid use further contributes to
posttransplant HTN. SUMMARY: Owing to the paucity of data, particularly
randomized controlled trials to guide the evaluation and management of HTN
in the cardiac transplant patients, much of the available data come from
the renal transplant population. The choice of antihypertensive should be
based on timing related to transplantation and patient's comorbidities.
Although calcium channel blockers and loop diuretics are the preferred
agents in the early postheart transplant period,
angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers
may be beneficial in the late postheart transplant period especially in
the setting of diabetes and in the presence of proteinuria.

<30>
Accession Number
2005910008
Title
Assessing the safety and efficacy of TAVR compared to SAVR in
low-to-intermediate surgical risk patients with aortic valve stenosis: An
overview of reviews.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Mc Morrow R.; Kriza C.; Urban P.; Amenta V.; Amaro J.A.B.; Panidis D.;
Chassaigne H.; Griesinger C.B.
Institution
(Mc Morrow, Kriza, Urban, Amenta, Amaro, Panidis, Chassaigne, Griesinger)
European Commission, Joint Research Centre (JRC), Ispra, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) was initially
introduced to treat patients with aortic valve stenosis (AS) at high-risk
for surgical aortic valve replacement (SAVR). Today, there is ample
evidence supporting TAVR in high-risk groups. However, in recent years
TAVR has been extended to low-to intermediate risk groups and relevant
clinical evidence is still emerging, leaving some uncertainties.
<br/>Method(s): To obtain information on TAVR versus SAVR in low-to
intermediate risk groups, we conducted an overview of systematic reviews
following PRISMA guidelines and based on a systematic search of EMBASE,
MEDLINE, Cochrane and CRD databases. We focused on systematic reviews
assessing mortality and VARC 2 as clinical outcomes. <br/>Result(s): The
majority of the 11 systematic reviews included in our study reported no
differences in mortality between TAVR and SAVR at short and long-term
follow-up times. Two reviews that included the most recent RCTs on
low-risk patients reported a decreased mortality risk with TAVR at
one-year follow-up. Regarding the secondary endpoints of stroke and MI,
the majority of studies presented similar results for TAVR and SAVR. Acute
Kidney Injury, Bleeding Complications, Atrial Fibrillation were less
frequent with TAVR, with lower risk of Permanent Pacemaker Implantation
and Aortic Regurgitation with SAVR. <br/>Conclusion(s): Our overview
indicated that TAVR is a promising intervention for low-to-intermediate
surgical risk patients; however additional evidence from longer term
follow-up is needed to confirm these findings. This overview highlights
inconsistencies about reporting and presentation of data, most notably
limited clarity on effects of risk of bias on trial results.<br/>Copyright
&#xa9; 2020 The Authors

<31>
Accession Number
2005884191
Title
CPAP Effects on Oxygen Delivery in One-Lung Ventilation During Minimally
Invasive Surgical Ablation for Atrial Fibrillation in The Supine Position.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
L'Acqua C.; Meli A.; Rondello N.; Polvani G.; Salvi L.
Institution
(L'Acqua, Rondello, Salvi) Department of Anesthesia and Intensive Care,
Centro Cardiologico Monzino IRCCS, Milano, Italy
(Meli) Department of Medical Surgical Pathophysiology and Organ
Transplantation, Universita' Degli Studi Di Milano Statale, Milano, Italy
(Polvani) Department of Cardiac Surgery, Centro Cardiologico Monzino
IRCCS, Milano, Italy
Publisher
W.B. Saunders
Abstract
Objective: In minimally invasive surgical ablation for atrial fibrillation
during video-assisted thoracoscopy surgery, one-lung ventilation (OLV)
with a double- lumen tube is commonly employed. In contrast with the
majority of thoracic procedures, the patient lies supine; thus, the
protective effect of gravity is lost and intrapulmonary shunt remains
high. To decrease intrapulmonary shunt and to increase oxygenation, many
strategies are utilized: high inspiratory fraction of oxygen
(F<inf>I</inf>O<inf>2</inf>), positive end-expiratory pressure on the
ventilated lung, and continuous positive airway pressure (CPAP) on the
deflated lung. <br/>Design(s): The authors performed a prospective,
single- center, randomized study to evaluate the effect of additional CPAP
in the nonventilated lung on oxygen delivery during surgical ablation for
atrial fibrillation via video-assisted thoracoscopy in the supine
position. <br/>Setting(s): University hospital Centro Cardiologico Monzino
IRCCS, Milano, Italy. <br/>Participant(s): Twenty-two patients scheduled
for minimally invasive surgical ablation for atrial fibrillation.
<br/>Intervention(s): The patients underwent pressure-controlled
ventilation, adjusting inspiratory pressure to obtain a tidal volume of 7
mL/kg while keeping F<inf>I</inf>O<inf>2</inf> constantly 1.0, a
respiratory rate to maintain arterial partial pressure of carbon dioxide
(PaCO<inf>2</inf>) between 35 and 40 mmHg, and positive end-expiratory
pressure of 5 cmH<inf>2</inf>O. During OLV, inspiratory pressure was
reduced to obtain a tidal volume of 5 mL/kg, maintaining
F<inf>I</inf>O<inf>2</inf> of 1.0, a respiratory rate to maintain
PaCO<inf>2</inf> between 35 and 40 mmHg with capnothorax of 10
cmH<inf>2</inf>O. The patients were then randomized into the CPAP group
(CPAP 10 cmH<inf>2</inf>0 on deflated lung) and NO CPAP group. Inotropic
agents (dopamine or dobutamine) were used if cardiac index fell below 1.5
L/min/m². <br/>Measurements and Main Results: Twenty-two
patients were enrolled, randomized, and completed the study. Median age
was 62 years. The difference in arterial partial pressure of oxygen
between the 2 groups was shy of significance, p = 0.16. Cardiac index
progressively increased during OLV until the end of the procedure in both
groups (p < 0.01) and was maintained above 1.5 mL/min/m² during
the whole study time. Arterial oxygen content remained stable during the
entire procedure in both groups (p = 0.27). Oxygen delivery index
(DO<inf>2</inf>I) increased significantly during the procedure (p < 0.01);
nevertheless, the difference in DO<inf>2</inf>I between the CPAP and NO
CPAP group was nonsignificant (p = 0.61). Intrapulmonary shunt
(Q<inf>s</inf>/Q<inf>t</inf>) increased during OLV (p < 0.01 for the time
effect) and remained high until total lung ventilation was reintroduced.
No difference in Q<inf>s</inf>/Q<inf>t</inf> was observed between the CPAP
and NO CPAP groups (p = 0.98). Similarly, mean pulmonary artery pressure
increased significantly during OLV and remained high at the end of the
procedure in both groups (time effect p < 0.01). <br/>Conclusion(s):
During OLV for atrial fibrillation surgical ablation in the supine
position, CPAP on the deflated lung seemed to be ineffective to reduce
Q<inf>s</inf>/Q<inf>t</inf> or to increase arterial partial pressure of
oxygen and DO<inf>2</inf>I, provided cardiac output was maintained above
1.5 L/min/m².<br/>Copyright &#xa9; 2020 Elsevier Inc.

<32>
Accession Number
631759650
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: 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, 75 Francis St, Boston, MA 02115,
United States
(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, United States
(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, United States
(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, Oslo, Norway
(Sabatine) JAMA Cardiology
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
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.<br/>Copyright
&#xa9; 2020 World Scientific Publishing Co. Pte Ltd. All rights reserved.

<33>
Accession Number
631759595
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: 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, Harvard
Medical School, 60 Fenwood Rd, Boston, MA 02115, United States
(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
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
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.<br/>Copyright &#xa9; 2020 World Scientific Publishing Co. Pte
Ltd. All rights reserved.

<34>
Accession Number
631731594
Title
Saphenous vein harvesting techniques for coronary artery bypass surgery:
Decades of competition-, which technique offer better outcomes? An updated
systematic review and network meta-analysis of randomized controlled
trials.
Source
British Journal of Surgery. Conference: Association of Surgeons in
Training International Surgical Conference, ASiT 2019. United Kingdom. 106
(SUPPL, 6) (pp 28-29), 2019. Date of Publication: September 2019.
Author
Lam Vuong N.; Ashraf Mokhtar M.; Khaled Elfaituri M.; Fathi Eldoadoa M.;
Samuel P.; Reda M.; Mostafa Zaki M.; Aboelhossen M.M.; Hesham Bendary A.;
Abo Elghar H.; Radwan I.; Atef N.; Alaa Ibrahim D.; Tien Huy N.
Institution
(Lam Vuong) University of Medicine and Pharmacy at Ho Chi Minh City, Ho
Chi Minh City, Vietnam
(Ashraf Mokhtar) Faculty of Medicine, Sohag University, Sohag, Egypt
(Khaled Elfaituri) Faculty of Medicine, University of Tripoli, Tripoli,
Libyan Arab Jamahiriya
(Fathi Eldoadoa) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Samuel, Radwan) Faculty ofMedicine, Ain Shams University, Cairo, Egypt
(Reda) Faculty of Medicine, Tanta University, Tanta, Egypt
(Mostafa Zaki) Faculty of Clinical Pharmacy, Fayoum University, Fayoum,
Egypt
(Aboelhossen, Atef) Faculty of medicine, Aswan University, Aswan, Egypt
(Hesham Bendary) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Abo Elghar) Faculty of Medicine, Menofia University, Menofia, Egypt
(Alaa Ibrahim) Faculty of medicine, Ain Shams University, Cairo, Egypt
(Tien Huy) Department of Clinical Product Development, Institute of
Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
Publisher
John Wiley and Sons Ltd
Abstract
Aim: Evaluating the short-term and long-term outcomes of all available GSV
harvesting techniques. <br/>Method(s): 12 electronic databases were
searched for randomized-controlled trials (RCTs) of any great saphenous
vein (GSV) harvesting technique, including conventional vein harvesting
(CVH), no-touch (NT), standard bridging technique (SBT), and endoscopic
vein harvesting (EVH) techniques. The outcomes were technical
characteristics, safety outcomes, and long-term efficacy. All outcomes
were analyzed using network meta-analysis. <br/>Result(s): 6064 patients
of 31 RCTs were included. EVH and SBT reduced the length of skin incision
for approximately 24-44 cm, compared to NT and CVH techniques. Regarding
safety outcomes, EVH and SBT reduced 3.6 and 4.5 times of the risk of
postoperative wound infection; EVH and SBT decreased the risks of
postoperative sensibility disorder, pain, and other complications,
compared to NT and CVH. These techniques were not significantly different
regarding efficacy outcomes, including the length of postoperative
hospital stay, and long-term death, postoperative hematoma, myocardial
infarction (MI), and graft patency. <br/>Conclusion(s): For GSV harvesting
for coronary-artery-bypass-graft (CABG), the minimally invasive
techniques, including EVH and SBT, reduce the risks of in-situ
complications, the length of skin incision, and postoperative pain, with
the comparable quality of vein and long-term death, MI, and graft patency,
compared to NT and CVH techniques.

<35>
Accession Number
631731574
Title
Minimally invasive robotic cardiac surgery Vs. Traditional sternotomy:
Which is better? a systematic review of cardiac surgical approach.
Source
British Journal of Surgery. Conference: Association of Surgeons in
Training International Surgical Conference, ASiT 2019. United Kingdom. 106
(SUPPL, 6) (pp 28), 2019. Date of Publication: September 2019.
Author
Usman Faiz A.; Fallows S.
Institution
(Usman Faiz, Fallows) University of Chester, Chester, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Aim: Robotic surgery has been increasingly used in recent times for both
CABG and MVS. The purpose of this systematic review is to evaluate the
effectiveness and safety of using robotic approach compared to a
traditional sternotomy technique. <br/>Method(s): Comprehensive electronic
search was performed using PubMed, MedLine, CINAHL and Google Scholar
databases to identify robotic vs. sternotomy approach studies based on
selection criteria. <br/>Result(s): This review identified four
comparative studies each for coronary artery bypass graft and mitral valve
surgery; robotic group in both CABG and MVS showed reduced hospital and
ICU length of stay along with additional benefits of increased patient
satisfaction, better recovery and cosmetic results. Decreased length of
surgery time was appreciated in the sternotomy group. No significant
difference in total costs (excluding capital costs), mortality and post-op
complications was seen, however, incidence of MACCE was higher in the
sternotomy group at a longer follow-up of one year for CABG (p= .008).
<br/>Conclusion(s): Robotic cardiac surgery using Da Vinci surgical system
can produce comparable results to the sternotomy approach, but more
rigorous research is still needed in the form of randomised trials to
determine the true potential of this approach for its wider recommended
implementation in the cardiac surgical arena.

<36>
Accession Number
631731554
Title
The top 100 manuscripts related to emergency cardiac surgery. The impact
of research and its potential role in cardiothoracic training. a
bibliometric analysis.
Source
British Journal of Surgery. Conference: Association of Surgeons in
Training International Surgical Conference, ASiT 2019. United Kingdom. 106
(SUPPL, 6) (pp 28), 2019. Date of Publication: September 2019.
Author
Karsan R.; Powell A.; Nanjahai P.; Mehta D.; Valtzoglou V.
Institution
(Karsan, Nanjahai, Mehta, Valtzoglou) Department of Cardiothoracic
Surgery, University Hospital ofWales, Cardiff, United Kingdom
(Powell) Department of Upper GI Surgery, University Hospital of Wales,
Cardiff, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Aim: Emergency Cardiac Surgery (ECS) is a fundamental component in Cardiac
Surgery training. Manuscript citations are considered to represent its
influence in the scientific community. We aim to highlight the key
research themes within ECS and determine their potential training impact
and scope for future research. <br/>Method(s): TheWeb of Science database
was searched using terms [Emergency AND Card* AND Surg*]. Results were
ranked by citation, and the top 100 papers reviewed by a panel of Cardiac
Surgeons. The search was analysed by topic, journal, author and scientific
impact. A regression analysis was used to ascertain a link between impact
factor and scientific impact. <br/>Result(s): 3823 papers were identified.
Median citations for the top 100 was 88. The paper with the highest impact
was by Nashef et al. looking at the use of EuroSCORE (2043 citations). The
most ubiquitous topics were; risk stratification, circulatory support and
aortic surgery. A positive relationship between journal impact fact and
the scientific impact of manuscripts in ECS (p=0.043) was deduced.
Conclusion; This study identified the papers which contribute most to
training and understanding of ECS. The analysis highlights this is a
growth area with cardiac surgery and that a papers influence is partially
determined by journal impact factor.

<37>
Accession Number
2005762011
Title
Ticagrelor With or Without Aspirin After Complex PCI.
Source
Journal of the American College of Cardiology. 75 (19) (pp 2414-2424),
2020. Date of Publication: 19 May 2020.
Author
Dangas G.; Baber U.; Sharma S.; Giustino G.; Mehta S.; Cohen D.J.;
Angiolillo D.J.; Sartori S.; Chandiramani R.; Briguori C.; Dudek D.;
Escaned J.; Huber K.; Collier T.; Kornowski R.; Kunadian V.; Kaul U.;
Oldroyd K.; Sardella G.; Shlofmitz R.; Witzenbichler B.; Ya-Ling H.;
Pocock S.; Gibson C.M.; Mehran R.
Institution
(Dangas, Baber, Sharma, Giustino, Sartori, Chandiramani, Mehran) The Zena
and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine
at Mount Sinai, New York, NY, United States
(Mehta) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, Ontario, Canada
(Cohen) University of Missouri-Kansas City, Kansas City, MO, United States
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Briguori) Mediterranea Cardiocentro, Naples, Italy
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Dudek) Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
(Escaned) Hospital Clinico San Carlos IDISCC, Complutense University of
Madrid, Madrid, Spain
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical
Faculty, Vienna, Austria
(Collier, Pocock) Department of Medical Statistics, London School of
Hygiene and Tropical Medicine, London, United Kingdom
(Kornowski) Cardiology Department, Rabin Medical Center, Petach Tikva,
Israel
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University and Freeman Hospital, Newcastle
upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United
Kingdom
(Kaul) Batra Hospital and Medical Research Center, New Delhi, India
(Oldroyd) West of Scotland Heart and Lung Centre, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Sardella) Department of Cardiology, Policlinico Umberto I, Sapienza
University of Rome, Rome, Italy
(Shlofmitz) St. Francis Hospital, Roslyn, NY, United States
(Witzenbichler) Department of Cardiology and Pneumology, Helios
Amper-Klinikum, Dachau, Germany
(Ya-Ling) Department of Cardiology, General Hospital of Shenyang Military
Region, Shenyang, Liaoning, China
(Gibson) Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: Whether a regimen of ticagrelor monotherapy attenuates
bleeding complications without increasing ischemic risk in patients
undergoing complex percutaneous coronary intervention (PCI) is unknown.
<br/>Objective(s): The purpose of this study was to evaluate the effect of
ticagrelor monotherapy versus ticagrelor plus aspirin in patients
undergoing complex PCI from the randomized, double-blind,
placebo-controlled TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk
Patients after Coronary Intervention) trial. <br/>Method(s): In the
TWILIGHT trial, after 3 months of ticagrelor plus aspirin, event-free and
adherent patients remained on ticagrelor and were randomly assigned to
receive aspirin or placebo for 1 year. Complex PCI was defined as any of
the following: 3 vessels treated, >=3 lesions treated, total stent length
>60 mm, bifurcation with 2 stents implanted, atherectomy device use, left
main PCI, surgical bypass graft or chronic total occlusion as target
lesions. Bleeding and ischemic endpoints were evaluated at 1 year after
randomization. <br/>Result(s): Among 7,119 patients randomized in the main
trial, complex PCI was performed in 2,342 patients. Compared to ticagrelor
plus aspirin, ticagrelor plus placebo resulted in significantly lower
rates of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5
bleeding (4.2% vs. 7.7%; hazard ratio [HR]: 0.54; 95% confidence interval
[CI]: 0.38 to 0.76). BARC type 3 or 5 bleeding was also significantly
reduced (1.1% vs. 2.6%; HR: 0.41; 95% CI: 0.21 to 0.80). There were no
significant between-group differences in death, myocardial infarction, or
stroke (3.8% vs. 4.9%; HR: 0.77; 95% CI: 0.52 to 1.15), nor in stent
thrombosis. <br/>Conclusion(s): Among patients undergoing complex PCI who
initially completed 3 months of ticagrelor plus aspirin, continuation of
ticagrelor monotherapy was associated with lower incidence of bleeding
without increasing the risk of ischemic events compared to continuing
ticagrelor plus aspirin. (Ticagrelor With Aspirin or Alone in High-Risk
Patients After Coronary Intervention [TWILIGHT];
NCT02270242)<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<38>
Accession Number
2005667080
Title
Continuous postoperative pericardial flushing method versus standard care
for wound drainage after adult cardiac surgery: A randomized controlled
trial.
Source
EBioMedicine. 55 (no pagination), 2020. Article Number: 102744. Date of
Publication: May 2020.
Author
Diephuis E.; de Borgie C.; Tomsic A.; Winkelman J.; van Boven W.J.; Bouma
B.; Eberl S.; Juffermans N.; Schultz M.; Henriques J.P.; Koolbergen D.
Institution
(Diephuis, Winkelman, van Boven, Koolbergen) Department of Cardiothoracic
Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef
9, Amsterdam, AZ 1105, Netherlands
(Tomsic, Koolbergen) Department of Cardiothoracic Surgery, Leiden
University Medical Center (LUMC), Leiden, Netherlands
(de Borgie) Clinical Research Unit, Amsterdam University Medical Center,
Location AMC, Amsterdam, Netherlands
(Bouma, Henriques) Department of Cardiology, Amsterdam University Medical
Center, Location AMC, Amsterdam, Netherlands
(Eberl) Department of Anesthesiology, Amsterdam University Medical Center,
Location AMC, Amsterdam, Netherlands
(Juffermans, Schultz) Department of Intensive Care Medicine, Amsterdam
University Medical Center, Location AMC, Amsterdam, Netherlands
Publisher
Elsevier B.V.
Abstract
Background: Excessive bleeding, incomplete wound drainage, and subsequent
accumulation of blood and clots in the pericardium have been associated
with a broad spectrum of bleeding-related complications after cardiac
surgery. We developed and studied the continuous postoperative pericardial
flushing (CPPF) method to improve wound drainage and reduce blood loss and
bleeding-related complications. <br/>Method(s): We conducted a
single-center, open-label, ITT, randomized controlled trial at the
Academic Medical Center Amstserdam. Adults undergoing cardiac surgery for
non-emergent valvular or congenital heart disease (CHD) were randomly
assigned (1:1) to receive CPPF method or standard care. The primary
outcome was actual blood loss after 12-hour stay in the intensive care
unit (ICU). Secondary outcomes included bleeding-related complications and
clinical outcome after six months follow-up. <br/>Finding(s): Between May
2013 and February 2016, 170 patients were randomly allocated to CPPF
method (study group; n = 80) or to standard care (control group; n = 90).
CPPF significantly reduced blood loss after 12-hour stay in the ICU (-41%)
when compared to standard care (median differences -155 ml, 95% confidence
interval (CI) -310 to 0; p=<=0.001). Cardiac tamponade and reoperation for
bleeding did not occur in the study group versus one and three in the
control group, respectively. At discharge from hospital, patients in the
study group were less likely to have pleural effusion in a surgically
opened pleural cavity (22% vs. 36%; p = 0.043). <br/>Interpretation(s):
Our study results indicate that CPPF is a safe and effective method to
improve chest tube patency and reduce blood loss after cardiac surgery.
Larger trials are needed to draw final conclusions concerning the
effectiveness of CPPF on clinically relevant outcomes.<br/>Copyright
&#xa9; 2020 The Author(s)

<39>
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).

<40>
Accession Number
631653371
Title
Cardiac masses in echocardiography: A pragmatic review.
Source
Journal of Cardiovascular Echography. 30 (1) (pp 5-14), 2020. Date of
Publication: January-March 2020.
Author
L'Angiocola P.D.; Donati R.
Institution
(L'Angiocola) Department of Cardiology, San Giovanni di Dio Hospital,
Gorizia, Italy
(Donati) Department of Cardiology, Giovan Battista Grassi Hospital, Rome,
Italy
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Transthoracic echocardiography is a useful diagnostic technique for the
identification of intracardiac and extracardiac masses, which can evaluate
morphologic properties of the masses such as their location, attachment,
shape, size, mobility, and possible hemodynamic-related implications.
Apart from physiological variants and structural normal mimickers,
echocardiography can detect principal intracardiac masses such as
neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic
lesions. Moreover, transesophageal echocardiography can provide further
details and provide higher accuracy in case a deeper examination of the
mass is needed. This review will focus on the systematic evaluation of
intra-/extracardiac masses including epidemiology and morphological and
echocardiographic features, providing practical and technical tips to
health-care professionals to achieve correct identification of the masses.
General data on cardiac masses were extracted via PubMed/MEDLINE search
engine from indexed reviews, original studies, and clinical case reports.
The echocardiographic features of cardiac masses were reviewed according
to the most relevant international cardiology and echocardiography
scientific societies' position statements.<br/>Copyright &#xa9; 2020
Journal of Cardiovascular Echography <br/> Published by Wolters
Kluwer-Medknow.

<41>
Accession Number
2004207313
Title
Patient Risk Factors for Bioprosthetic Aortic Valve Degeneration: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 29 (5) (pp 668-678), 2020. Date of
Publication: May 2020.
Author
Ochi A.; Cheng K.; Zhao B.; Hardikar A.A.; Negishi K.
Institution
(Ochi, Zhao, Hardikar, Negishi) Menzies Institute for Medical Research,
University of Tasmania, Hobart, Tas, Australia
(Cheng, Negishi) Department of Cardiology, Royal Hobart Hospital, Hobart,
Tas, Australia
(Hardikar) Department of Cardiothoracic Surgery, Royal Hobart Hospital,
Hobart, Tas, Australia
(Negishi) Faculty of Medicine and Health, Sydney Medical School Nepean,
University of Sydney, Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
The choice of valve type for aortic valve replacement surgery is sometimes
challenging. The main risk for bioprostheses is structural valve
degeneration (SVD); however, little is known about what the most important
risk factors are. We conducted a systematic review and meta-analysis to
identify the risk factors and estimate their pooled effect sizes to aid
the prosthesis choice for replacement. We followed PRISMA guidelines and
systematically searched three electronic databases (PubMed, Scopus, and
Web of Science) using appropriate key terms: 'aortic valve',
'bioprosthesis', 'degeneration', 'durability', 'prosthesis failure', etc.
Hazard ratio (HR) and odds ratio (OR) and associated 95% confidence
intervals (CI) were extracted. Pooled risk estimates were calculated using
a random-effects model. Twenty-nine (29) observational studies were
included with a total of 25,490 patients, 981 of whom developed SVD over a
mean follow-up time of 18.5 years. Four (4) factors influencing
bioprosthetic SVD were identified: increasing age was a protective factor
(per 1-yr increase, HR: 0.91 [95% CI 0.89, 0.94], p<0.0001), whereas
increased body surface area (HR 1.77 [1.04, 3.01], p=0.034),
patient-prosthesis mismatch (HR 1.95 [1.56, 2.43], p<0.001), and smoking
(HR 2.28 [1.37, 3.79], p=0.0015) were risk factors for SVD. We found
younger age, patient-prosthesis mismatch, body surface area, and smoking,
as risk factors for aortic SVD, which should be considered for valve
selection. This study generates a further hypothesis that accelerated flow
across the valve is a shared key component in the pathophysiology of SVD,
thus future research should consider other high cardiac output
states.<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)

<42>
Accession Number
631607984
Title
Management of coronary disease in patients with advanced kidney disease.
Source
New England Journal of Medicine. 382 (17) (pp 1608-1618), 2020. Date of
Publication: 23 Apr 2020.
Author
Bangalore S.; Maron D.J.; O'Brien S.M.; Fleg J.L.; Kretov E.I.; Briguori
C.; Kaul U.; Reynolds H.R.; Mazurek T.; Sidhu M.S.; Berger J.S.; Mathew
R.O.; Bockeria O.; Broderick S.; Pracon R.; Herzog C.A.; Huang Z.; Stone
G.W.; Boden W.E.; Newman J.D.; Ali Z.A.; Mark D.B.; Spertus J.A.;
Alexander K.P.; Chaitman B.R.; Chertow G.M.; Hochman J.S.
Institution
(Bangalore, Reynolds, Berger, Newman, Hochman) New York University,
Grossman School of Medicine, New York, United States
(Stone) Mount Sinai Hospital, New York, United States
(Ali) Cardiovascular Research Foundation, New York, United States
(Ali) Columbia University, Irving Medical Center, New York Presbyterian
Hospital, New York, United States
(Sidhu) Albany Medical College, Albany Medical Center, Albany, NY, United
States
(Ali) St. Francis Hospital, Roslyn, NY, United States
(Maron, Chertow) Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
(O'Brien, Broderick, Huang, Mark, Alexander) Duke Clinical Research
Institute, Durham, NC, United States
(Fleg) National, Heart, Lung and Blood Institute, Bethesda, MD, United
States
(Kretov) E.N. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Bockeria) Bakulev National Medical Research Center for Cardiovascular
Surgery, Moscow, Russian Federation
(Briguori) Mediterranea Cardiocentro, Naples, Italy
(Kaul) Batra Hospital and Medical Research Centre, New Delhi, India
(Mazurek) Medical University of Warsaw, Warsaw, Poland
(Pracon) Department of Coronary and Structural Heart Diseases, Institute
of Cardiology, Warsaw, Poland
(Mathew) Columbia Veterans Affairs (VA) Health Care System, Columbia, SC,
United States
(Herzog) Hennepin Healthcare, University of Minnesota, Minneapolis, United
States
(Boden) VA New England Healthcare System, Boston University School of
Medicine, Boston, United States
(Spertus) Saint Luke's Mid America Heart Institute, University of
Missouri, Kansas City, United States
(Chaitman) St. Louis University, School of Medicine Center for
Comprehensive Cardiovascular Care, St. Louis, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Clinical trials that have assessed the effect of
revascularization in patients with stable coronary disease have routinely
excluded those with advanced chronic kidney disease. METHODS We randomly
assigned 777 patients with advanced kidney disease and moderate or severe
ischemia on stress testing to be treated with an initial invasive strategy
consisting of coronary angiography and revascularization (if appropriate)
added to medical therapy or an initial conservative strategy consisting of
medical therapy alone and angiography reserved for those in whom medical
therapy had failed. The primary outcome was a composite of death or
nonfatal myocardial infarction. A key secondary outcome was a composite of
death, nonfatal myocardial infarction, or hospitalization for unstable
angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median
follow-up of 2.2 years, a primary outcome event had occurred in 123
patients in the invasive-strategy group and in 129 patients in the
conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%;
adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29;
P=0.95). Results for the key secondary outcome were similar (38.5% vs.
39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy
was associated with a higher incidence of stroke than the conservative
strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a
higher incidence of death or initiation of dialysis (hazard ratio, 1.48;
95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable
coronary disease, advanced chronic kidney disease, and moderate or severe
ischemia, we did not find evidence that an initial invasive strategy, as
compared with an initial conservative strategy, reduced the risk of death
or nonfatal myocardial infarction.<br/>Copyright &#xa9; 2020 Massachusetts
Medical Society.

<43>
Accession Number
2004159031
Title
Antithrombotic strategies in patients with atrial fibrillation following
percutaneous coronary intervention: A systemic review and network
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Medicine. 9 (4) (no pagination), 2020. Article Number:
1062. Date of Publication: April 2020.
Author
Chua S.-K.; Chen L.-C.; Shyu K.-G.; Cheng J.-J.; Hung H.-F.; Chiu C.-Z.;
Lin C.-M.
Institution
(Chua, Lin) School of Medicine, Fu Jen Catholic University, New Taipei
City 242, Taiwan (Republic of China)
(Chua, Chen, Shyu, Cheng, Hung, Chiu) Division of Cardiology, Department
of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111,
Taiwan (Republic of China)
(Chua, Chen, Shyu, Cheng, Hung, Chiu) Department of Internal Medicine,
Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan (Republic of
China)
(Lin) Department of Emergency Medicine, Shin Kong Wu Ho-Su Memorial
Hospital, Taipei 111, Taiwan (Republic of China)
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous
coronary intervention (PCI). A systematic review and network meta-analysis
were conducted by searching PubMed, Embase, and the Cochrane database of
systematic reviews for randomized control trials that studied the safety
and efficacy of different antithrombotic strategies in these patients. Six
studies, including 12,158 patients were included. Compared to that in the
triple antithrombotic therapy group (vitamin K antagonist (VKA) plus P2Y12
inhibitor and aspirin), thrombolysis in myocardial infarction (TIMI) major
bleeding was significantly reduced in the dual antithrombotic therapy
(non-vitamin K oral anticoagulants (NOACs) plus P2Y<inf>12</inf>
inhibitor) group by 47% (Odds ratio (OR), 0.53; 95% credible interval
[CrI], 0.35-0.78; I<inf>2</inf> = 0%). Besides, NOAC plus a
P2Y<inf>12</inf> inhibitor was associated with less intracranial
hemorrhage compared to VKA plus single antiplatelet therapy (OR: 0.20, 95%
CrI: 0.05-0.77). There was no significant difference in the trial-defined
major adverse cardiac events or the individual outcomes of all-cause
mortality, cardiovascular death, myocardial infarction, stroke or stent
thrombosis among all antithrombotic strategies. In conclusion,
antithrombotic strategy of NOACs plus P2Y<inf>12</inf> inhibitor is safer
than, and as effective as, the strategies including aspirin when used in
AF patients undergoing PCI.<br/>Copyright &#xa9; 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<44>
Accession Number
2003988451
Title
Extracorporeal membrane oxygenation for cardiac indications in adults: A
health technology assessment.
Source
Ontario Health Technology Assessment Series. 20 (8) (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: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy
used to stabilize patients with hemodynamic compromise such as refractory
cardiogenic shock or cardiac arrest. When used for cardiac arrest, ECMO is
also known as extracorporeal cardiopulmonary resuscitation (ECPR). We
conducted a health technology assessment of venoarterial ECMO for adults
(aged >= 18 years) with cardiac arrest refractory to conventional
cardiopulmonary resuscitation (CPR) or with cardiogenic shock refractory
to conventional medical management (i.e., drugs, mechanical support such
as intra-aortic balloon pump and temporary ventricular assist devices).
Our assessment included an evaluation of effectiveness, safety,
cost-effectiveness, the budget impact of publicly funding ECMO for these
indications, and patient preferences and values. <br/>Method(s): We
performed a systematic literature search of the clinical evidence. We
assessed the risk of bias of each included study using the Risk of Bias in
Systematic Reviews (ROBIS) tool for systematic reviews and the Risk of
Bias Among Nonrandomized Trials (ROBINS-I) tool for observational studies,
and the quality of the body of evidence according to the Grading of
Recommendations Assessment, Development, and Evaluation (GRADE) Working
Group criteria. We performed a systematic economic literature search and
conducted a cost-effectiveness analysis with a lifetime horizon from a
public payer perspective. We also analyzed the budget impact of publicly
funding ECMO in Ontario for patients with refractory cardiogenic shock or
cardiac arrest. To contextualize the potential value of ECMO for cardiac
indications, we spoke with patients and caregivers with direct experience
with the procedure. <br/>Result(s): We included one systematic review
(with 13 observational studies) and two additional observational studies
in the clinical review. Compared with traditional CPR for patients with
refractory cardiac arrest, ECPR was associated with significantly improved
30-day survival (pooled risk ratio [RR] 1.54; 95% CI 1.03 to 2.30) (GRADE:
Very Low) and significantly improved long-term survival (pooled RR 2.17;
95% CI 1.37 to 3.44) (GRADE: Low). Overall, ECPR was associated with
significantly improved 30-day favourable neurological outcome in patients
with refractory cardiac arrest compared with traditional CPR; pooled RR
2.02 (95% CI 1.29 to 3.16) (GRADE: Very Low). For patients with
cardiogenic shock, ECMO was associated with a significant improvement in
30-day survival compared with intra-aortic balloon pump (pooled RR 2.11;
95% CI 1.23 to 3.61) (GRADE: Very Low). Compared with temporary
percutaneous ventricular assist devices, ECMO was not associated with
improved survival (pooled risk ratio 0.94; 95% CI 0.67 to 1.30) (GRADE:
Very Low). We estimated the incremental cost-effectiveness ratio of ECPR
compared with conventional CPR is $18,722 and $28,792 per life-year gained
(LYG) for in-hospital and out-of-hospital cardiac arrest, respectively. We
estimated the probability of ECPR being cost-effective versus conventional
CPR is 93% and 60% at a willingness-to-pay of $50,000 per LYG for
in-hospital and out-of-hospital cardiac arrest, respectively. We estimate
that publicly funding ECMO in Ontario over the next 5 years would result
in additional total costs of $1,673,811 for cardiogenic shock (treating
314 people), $2,195,517 for in-hospital cardiac arrest (treating 126
people), and $3,762,117 for out-of-hospital cardiac arrest (treating 247
people). The eight patients and family members with whom we spoke had
limited ability to assess the impact of ECMO or report their impressions
because of their critical medical situations when they encountered the
procedure. All had been in hospital with acute hemodynamic instability. In
the decision to receive the procedure, participants generally relied on
the expertise and judgment of physicians. <br/>Conclusion(s): For adults
treated for refractory cardiac arrest, ECPR may improve survival and
likely improves long-term neurological outcomes compared with conventional
cardiopulmonary resuscitation. For patients treated for cardiogenic shock,
ECMO may improve 30-day survival compared with intra-aortic balloon pump,
but there is considerable uncertainty. For adults with refractory cardiac
arrest, ECPR may be cost-effective compared with conventional CPR. We
estimate that publicly funding ECMO for people with cardiac arrest and
cardiogenic shock in Ontario over the next 5 years would cost about
$845,000 to $2.2 million per year. People with experience of ECMO for
cardiac indications viewed it as a life-saving device and expressed
gratitude that it was available and able to help stabilize their acute
medical condition.<br/>Copyright &#xa9; Queen's Printer for Ontario, 2020.

<45>
Accession Number
2003854062
Title
A systematic exposition of methods used for quantification of heart
regeneration after apex resection in Zebrafish.
Source
Cells. 9 (3) (no pagination), 2020. Article Number: 548. Date of
Publication: March 2020.
Author
Belling H.J.; Hofmeister W.; Andersen D.C.
Institution
(Belling, Hofmeister, Andersen) Laboratory of Molecular and Cellular
Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense
University Hospital, Odense C 5000, Denmark
(Belling, Hofmeister, Andersen) Clinical Institute, University of Southern
Denmark, Winsloewparken 25, 1. floor, Odense C 5000, Denmark
(Hofmeister) Faculty of Health and Medical Sciences, DanStem, Novo Nordisk
Foundation Center for Stem Cell Biology, Kobenhavn H 2200, Denmark
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Myocardial infarction (MI) is a worldwide condition that affects millions
of people. This is mainly caused by the adult human heart lacking the
ability to regenerate upon injury, whereas zebrafish have the capacity
through cardiomyocyte proliferation to fully regenerate the heart
following injury such as apex resection (AR). But a systematic overview of
the methods used to evidence heart regrowth and regeneration in the
zebrafish is lacking. Herein, we conducted a systematical search in Embase
and Pubmed for studies on heart regeneration in the zebrafish following
injury and identified 47 AR studies meeting the inclusion criteria.
Overall, three different methods were used to assess heart regeneration in
zebrafish AR hearts. 45 out of 47 studies performed qualitative (37) and
quantitative (8) histology, whereas immunohistochemistry for various cell
cycle markers combined with cardiomyocyte specific proteins was used in 34
out of 47 studies to determine cardiomyocyte proliferation qualitatively
(6 studies) or quantitatively (28 studies). For both methods, analysis was
based on selected heart sections and not the whole heart, which may bias
interpretations. Likewise, interstudy comparison of reported cardiomyocyte
proliferation indexes seems complicated by distinct study designs and
reporting manners. Finally, six studies performed functional analysis to
determine heart function, a hallmark of human heart injury after MI. In
conclusion, our data implies that future studies should consider more
quantitative methods eventually taking the 3D of the zebrafish heart into
consideration when evidencing myocardial regrowth after AR. Furthermore,
standardized guidelines for reporting cardiomyocyte proliferation and sham
surgery details may be considered to enable inter study comparisons and
robustly determine the effect of given genes on the process of heart
regeneration.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI,
Basel, Switzerland.

<46>
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)

<47>
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)

<48>
Accession Number
2005848388
Title
The Relation between Volume and Outcome of Transcatheter and Surgical
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Therapeutics. 2020 (no pagination), 2020. Article Number:
2601340. Date of Publication: 2020.
Author
He J.; Zhang Z.; Wang H.; Cai L.
Institution
(He, Zhang, Wang, Cai) Department of Cardiology, Third People's Hospital
of Chengdu, Affiliated Hospital, Southwest Jiaotong University, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve
replacement (SAVR) are standard procedures for dealing with severe aortic
stenosis patients. Researchers have not carried out a systematic review of
the volume-outcome relationship in TAVR and SAVR. Our study is intended to
address this problem. We systemically searched databases through MEDLINE,
EMBASE, PUBMED, and the Cochrane Library up to September 2019. Two
reviewers independently screened for the studies and evaluated bias. We
used short-term mortality (in-hospital or 30-day mortality) as an outcome.
A meta-analysis of TAVR with 115,596 patients ranging from 2005 to 2016
showed a result significantly in favor of high-volume hospitals (OR 0.43
(CI 0.36-0.51)). The subgroup of population period, region, data type, and
cut-off value did not show any difference. A meta-analysis of SAVR
comprising 418,384 patients ranging from 1994 to 2011 revealed that the OR
of short-term mortality for a high-volume hospital compared with that of a
low-volume hospital was 0.73 (CI 0.71, 0.74). No difference was observed
in subgroups based on population period and cut-off. In conclusion, we
found that short-term mortality was lower in high-volume hospitals for
both TAVR and SAVR.<br/>Copyright &#xa9; 2020 Jialing He et al.

<49>
Accession Number
2004903931
Title
Noteworthy Literature in Cardiac Anesthesia for 2019.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 24 (2) (pp 138-148),
2020. Date of Publication: 01 Jun 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, Aurora, CO, United States
(Mosca) University of Colorado Hospital, Aurora, CO, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
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.<br/>Copyright &#xa9; The Author(s) 2020.

<50>
Accession Number
2005869402
Title
PMU20 A DEVICE CATEGORY-BASED ECONOMIC MODEL EXPLORING ELECTROSURGERY
TECHNOLOGIES ACROSS PROCEDURE TYPES: A UNITED STATES ANALYSIS.
Source
Value in Health. Conference: ISPOR 2020. United States. 23 (Supplement 1)
(pp S236), 2020. Date of Publication: May 2020.
Author
Ferko N.; Wright G.; Syed I.; Gangoli G.
Institution
(Ferko, Wright, Syed) EVERSANA, Burlington, ON, Canada
(Gangoli) Johnson & Johnson Medical Devices Companies, Somerville, NJ,
United States
Publisher
Elsevier Ltd
Abstract
Objectives: Given medical device growth, there is a need to optimize
efficiencies in health system value analysis decision-making. Holistic
evaluations of device categories may be more efficient and practical than
traditional item-by-item comparisons. This study aimed to develop a model
that evaluates the economic value of introducing the class of interrelated
electrosurgical devices into U.S. hospitals. <br/>Method(s): An economic
model was developed including hospital resource use and costs of the CEP
(comprehensive electrosurgical portfolio; manufactured by Ethicon, Inc.)
vs. IEC (individual electrosurgical components; manufactured by Medtronic
plc and respective manufacturers). CEP comprised complementary devices
that enable safe and effective electrosurgery: reusable patient return
electrodes, handheld smoke evacuation, advanced bipolar and ultrasonic
devices. Comparator IEC was defined as the individual devices within this
category: single-use patient return electrodes, conventional smoke
evacuation methods (e.g., masks, wall suction), advanced bipolar and
ultrasonic devices. Hospital resources included device costs, operating
time, length of stay, blood loss and transfusions, and surgical
complications. Price parity was assumed between advanced electrosurgical
devices. Model inputs were derived from randomized trials, indirect
treatment comparisons, and literature-reported U.S. unit costs.
<br/>Result(s): In thoracic procedures, the model predicted $186-$439 USD
per patient cost savings with CEP vs. IEC, for advanced bipolar or
ultrasonic devices, respectively. In gynecological and bariatric
procedures, CEP yielded $31-$86 USD per patient cost savings,
respectively. Also, when including reusable return electrodes, economic
value with CEP showed an additional $1,658 per unit savings per year.
Incremental economic benefits may also be realized with complementary use
of handheld smoke evacuation devices, via optimized procedure workflow and
HCP productivity. <br/>Conclusion(s): Introducing effective
electrosurgical devices can lead to optimized hospital resources and cost
savings, particularly with a category-wide evaluation. Future studies
should further examine electrosurgical resource use to more accurately
quantify economic value across procedure types and outcomes.<br/>Copyright
&#xa9; 2020

<51>
Accession Number
2005868884
Title
PMU117 IN BETWEEN TWO WORLDS: PATIENT EXPERIENCES IN THE TRANSITION FROM
ADOLESCENT TO YOUNG ADULT HEALTHCARE SERVICES AND IMPLICATIONS FOR HEALTH
OUTCOMES ASSESSMENT.
Source
Value in Health. Conference: ISPOR 2020. United States. 23 (Supplement 1)
(pp S255), 2020. Date of Publication: May 2020.
Author
Turner-Bowker D.; Chatterton K.; Mossman B.; Yaworsky A.; Krohe M.
Institution
(Turner-Bowker, Chatterton, Mossman, Yaworsky, Krohe) Adelphi Values,
Boston, MA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: Adolescents (10-17 years) and young adults (18-25 years) make
up approximately 24% of the population worldwide. The objective of this
research was to explore and summarize the barriers to and facilitators of
successful transition from adolescent to young adult healthcare services,
and possible implications for health outcomes assessment. <br/>Method(s):
A targeted systematic search of published review articles over the past 10
years was performed in Medline via PubMed, followed by a grey literature
search. Publications were included if they described the experiences of
patients transitioning from adolescent to adult healthcare services and
excluded if transition was not a central focus. Selected articles were
reviewed in full and barriers to (personal, relational, system) and
facilitators of (plans, services, interventions) transition were
documented. <br/>Result(s): The PubMed search yielded 53 abstracts which
were reviewed for relevance; 43 were selected for full-text review, and 23
additional articles were selected from the grey literature search.
Commonly reported condition categories were: immunological (n=14);
unspecified chronic conditions (n=8); HIV (n=7); hematological (n=5);
cardiovascular (n=4); surgical transplants (n=4); and musculoskeletal
(n=4). Articles reporting other conditions (e.g., transgender, low
birthweight, psychiatric conditions) were mentioned by <=3 articles.
Findings identified barriers to healthcare transition including
adolescents' lack of confidence in their ability to communicate with
providers and/or manage medication; lack of trust in new medical team;
emotional/developmental issues; and inadequate preparation. Facilitators
to healthcare transition included a well-planned, multidisciplinary
approach; active communication between patient and adult providers;
cultivating medical independence; and family/financial support.
<br/>Conclusion(s): Across conditions, common barriers exist for
adolescents as they transition to adult healthcare services. A
well-defined plan and effective communication strategies facilitate
successful transition. Clinical outcome assessments (COAs) support patient
self-monitoring and -management, patient engagement, and patient-provider
communications. The potential applications of COAs should be explored to
support adolescents as they transition to adult healthcare
services.<br/>Copyright &#xa9; 2020

<52>
Accession Number
2005867896
Title
PMU32 A DEVICE CATEGORY-BASED ECONOMIC MODEL EXPLORING ELECTROSURGERY
TECHNOLOGIES ACROSS PROCEDURE TYPES: A CHINESE ANALYSIS.
Source
Value in Health. Conference: ISPOR 2020. United States. 23 (Supplement 1)
(pp S239), 2020. Date of Publication: May 2020.
Author
Ferko N.; Wright G.; Syed I.; Gangoli G.
Institution
(Ferko, Wright, Syed) EVERSANA, Burlington, ON, Canada
(Gangoli) Johnson & Johnson Medical Devices Companies, Bridgewater, NJ,
United States
Publisher
Elsevier Ltd
Abstract
Objectives: Advances in electrosurgical technologies may improve clinical
outcomes and economic value across various procedure types. Holistic
evaluations of devices may be more pragmatic and efficient than
product-by-product comparisons, especially important in cost-constrained
environments. This study aimed to develop a model that evaluates the
economic value of introducing a category of electrosurgical devices into
Chinese hospitals. <br/>Method(s): An economic model was developed
including hospital resource use and costs of a CEP (comprehensive
electrosurgical portfolio; manufactured by Ethicon, Inc.) vs. IEC
(individual electrosurgical components; manufactured by Medtronic plc and
respective manufacturers). The CEP comprised complementary devices that
enable safe and effective electrosurgery: reusable patient return
electrodes, handheld smoke evacuation, advanced bipolar and ultrasonic
devices. Comparator IEC comprised single-use return electrodes,
conventional smoke evacuation methods (e.g., masks, wall suction), and
conventional electrosurgical modalities (mechanical, monopolar, basic
bipolar). Hospital resources included device costs, operating time, length
of stay, blood loss and transfusions, and surgical complications. Model
inputs were derived from randomized trials and literature-reported Chinese
unit costs, converted to USD. <br/>Result(s): For thoracic procedures, the
model predicted cost savings with CEP compared with IEC, from $617-$1,512
USD per patient, with advanced bipolar or ultrasonic devices,
respectively. For gynecological, colorectal, and hepato-pancreato-biliary
surgical specialties, CEP implementation resulted in cost savings from
$219-$9,457 USD per patient, depending on procedure type. Also, when
including reusable return electrodes, economic value with CEP showed an
additional $1,658 per unit savings per year. Further economic benefits may
be realized with complementary use of handheld smoke evacuation devices,
via optimized procedure workflow and surgeon/nurse productivity.
<br/>Conclusion(s): Introducing effective electrosurgical devices with a
holistic view of this category's interconnected technologies can save
hospital resources and lead to cost savings. Future studies should further
examine electrosurgery resource use to allow more accurate quantification
of economic value across surgery types and outcomes.<br/>Copyright &#xa9;
2020

<53>
Accession Number
2005867833
Title
PPM3 COST-BENEFIT OF PERSONALIZING INTRAOPERATIVE PAIN MANAGEMENT.
Source
Value in Health. Conference: ISPOR 2020. United States. 23 (Supplement 1)
(pp S326), 2020. Date of Publication: May 2020.
Author
Saunders R.; Weissbrod R.
Institution
(Saunders) Coreva Scientific, Konigswinter, NW, Germany
(Weissbrod) Medasense Biometrics, Ramat Gan, Israel
Publisher
Elsevier Ltd
Abstract
Objectives: Optimizing pain management during surgery is a major
challenge. Personalizing analgesia to provide optimal pain control may
reduce the risk of patient harm and facilitate a smooth procedure with
improved recovery. The nociception level index (NOL) measures the
patients' pain response (nociception) when under general anesthesia. Here
we assess the cost-benefit of NOL from a provider perspective.
<br/>Method(s): Device-specific clinical study data were supplemented with
costs and outcomes data identified via a structured, PubMed review.
Outcomes of interest were intraoperative hypotension (IOH), opioid use,
and postoperative myocardial injury (MI) and acute kidney injury (AKI).
The population was 1,000 patients undergoing non-cardiac, surgical
procedures requiring general anesthesia. An Excel-based health-economic,
decision-tree model estimated the incremental cost of hospital ownership,
change in adverse patient outcomes, and time to return on investment
(ROI). Costs are reported in 2019 USD ($). Variance was assessed via the
interquartile range (IQR) following 200 simulations. <br/>Result(s): A
large retrospective analysis found that 3.1% and 5.6% of US patients
developed MI and AKI, respectively. Overall, 33.4% of patients had
intraoperative hypotension. In 1,000 patients from this group,
personalized analgesia management is expected to reduce remifentanil use
by 347 mug per patient and prevent 243 patients from experiencing IOH.
Model estimates predict this could reduce adverse outcomes by 20 events
(IQR 16-23). This was made up of 8 MIs and 12 AKIs, saving 83 (IQR 65-94)
inpatient days. Assuming all purchase costs for monitoring for the year
were upfront, ROI should be achieved in 2-5 months. After 12 months,
hospitals are expected to have saved $325,980 ($218,000 to $417,000).
<br/>Conclusion(s): Clinical outcomes data suggest that personalized and
optimized analgesia management can prevent intraoperative adverse events
and improve outcomes. Not only beneficial to patients, improved outcomes
will likely reduce the burden of care on hospitals.<br/>Copyright &#xa9;
2020

<54>
Accession Number
2004701251
Title
Carbon-dioxide versus saline flushing of thoracic aortic stents-grafts to
reduce vascular brain infarcts: An observational study.
Source
European Journal of Vascular and Endovascular Surgery. Conference: BSET
Annual Meeting. Tortworth Court Hotel, United Kingdom. 59 (5) (pp e32),
2020. Date of Publication: May 2020.
Author
Hanna L.; Grover G.; Perera A.; Chaudhery M.; Abdullah A.; Singh A.;
Bicknell C.; Modarai B.; Hamady M.; Gibbs R.
Institution
(Hanna, Grover, Abdullah, Singh, Hamady, Gibbs) Imperial Vascular Unit,
Imperial College Healthcare NHS Trust, London, United Kingdom
(Hanna, Perera, Abdullah, Bicknell, Gibbs) Department of Surgery and
Cancer, Imperial College, London, United Kingdom
(Chaudhery, Modarai) Guy's and St Thomas's NHS Foundation Trust, London,
United Kingdom
(Hamady) Department of Interventional Radiology, Imperial College, London,
United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Background:Vascular brain infarcts (VBI) formerly known as 'silent'
cerebral infarction detected on neuroimaging have been shown to occur in
up to 70% following thoracic endovascular aortic repair (TEVAR).
Inadequately de-aired delivery devices following standard saline flushing
may contribute to cerebral embolization during TEVAR. Carbon-Dioxide (CO2)
is heavier than air and has been shown to effectively displace air from
the surgical field in cardiac surgery. <br/>Method(s): A prospective
observational study was conducted between 2015 and 2018 at two tertiary
vascular units in London comparing the rate of VBI in patients undergoing
TEVAR with standard saline versus CO2 flushing. All patients suitable for
TEVAR with no adjunctive revascularisation procedures for all aortic
pathology were eligible. In the first half of the study period consecutive
patients underwent TEVAR with standard saline flushing according to IFU
(TEVAR-S group). In the second half of the study period consecutive
patients underwent TEVAR with 100% CO2 flushing at 2.8bar for 1-minute
(TEVAR-CO2 group). TEVAR-S patients were randomly selected and compared to
the TEVAR-CO2 group. <br/>Result(s): Pre and post-operative
diffusion-weighted MRI was performed in 57 patients undergoing TEVAR.
Total VBI rate was 61% (35/57). In 25 TEVAR-S patients the VBI rate was
56% (14/25) versus 25% (4/16) in 16 TEVAR-CO2 patients. Median number of
lesions in TEVAR-S group was 1 (range 0-5) versus 0 (range 0-3) in
TEVAR-CO2 (p=0.044). <br/>Conclusion(s): CO2 flushing of TEVAR
stent-grafts resulted in significant reduction in VBI following TEVAR. A
multi-centre randomised controlled trial is currently underway to validate
these findings.<br/>Copyright &#xa9; 2019

<55>
Accession Number
631740801
Title
Lifelong genetically lowered sclerostin and risk of cardiovascular
disease.
Source
European Journal of Human Genetics. Conference: 52nd European Society of
Human Genetics Conference, ESHG 2019. Sweden. 27 (Supplement 2) (pp
1120-1121), 2019. Date of Publication: 2019.
Author
Bovijn J.; Krebs K.; Chen C.; Boxall R.; Censin J.C.; Ferreira T.; Pulit
S.L.; Glastonbury C.A.; Laber S.; Millwood I.Y.; Lin K.; Li L.; Chen Z.;
Milani L.; Walters R.G.; Magi R.; Neale B.M.; Lindgren C.M.; Holmes M.V.
Institution
(Bovijn, Censin, Ferreira, Pulit, Glastonbury, Laber, Lindgren, Holmes)
Big Data Institute, University of Oxford, Oxford, United Kingdom
(Bovijn, Censin, Laber, Lindgren) Wellcome Centre for Human Genetics,
Nuffield Department of Medicine, University of Oxford, Oxford, United
Kingdom
(Krebs, Milani, Magi) Estonian Genome Center, Institute of Genomics,
University of Tartu, Tartu, Estonia
(Chen, Neale) Analytic and Translational Genetics Unit, Massachusetts
General Hospital, Boston, MA, United States
(Chen) Psychiatric and Neurodevelopmental Genetics Unit, Boston, MA,
United States
(Chen, Neale) Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, MA, United States
(Boxall, Millwood, Lin, Chen, Walters, Holmes) Clinical Trial Service Unit
and Epidemiological Studies Unit (CTSU), Nuffield Department of Population
Health, University of Oxford, Oxford, United Kingdom
(Boxall, Millwood, Walters, Holmes) Medical Research Council Population
Health Research Unit (MRC PHRU), Nuffield Department of Population Health,
University of Oxford, Oxford, United Kingdom
(Pulit, Lindgren) Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, United States
(Pulit) Department of Genetics, University Medical Center Utrecht,
Utrecht, Netherlands
(Li) Department of Epidemiology and Biostatistics, Peking University
Health Science Centre, Peking University, Bejing, China
(Lindgren, Holmes) National Institute for Health Research Oxford
Biomedical Research Centre, Oxford University Hospitals NHS Foundation
Trust, John Radcliffe Hospital, Oxford, United Kingdom
Publisher
Springer Nature
Abstract
Introduction: Inhibition of sclerostin is a novel therapeutic approach to
lowering fracture risk. However, phase III randomised controlled trials
(RCTs) of romosozumab, a sclerostin inhibitor, suggest an imbalance of
serious cardiovascular events. <br/>Method(s): We used two independent
variants in SOST (encoding sclerostin) associated with bone mineral
density (BMD) as proxies for therapeutic inhibition of sclerostin. We
estimated the effects on risk of osteoporosis, fracture, coronary heart
disease (CHD) and a further 22 cardiometabolic traits, by combining data
from 478,967 participants from three cohorts and up to 1,030,836
participants from nine GWAS consortia. In addition, we performed
metaanalysis of cardiovascular outcomes from RCTs of romosozumab.
<br/>Result(s): RCT meta-analysis identified a higher risk of cardiac
ischaemic events in patients randomised to romosozumab (25 events among
4,298 individuals; odds ratio [OR] 2.98; 95% confidence interval [CI],
1.18-7.55; P = 0.017). Scaled to the equivalent dose of romosozumab
(210mg/month; 0.09 g/cm2 higher BMD), the SOST variants associated with
lower risk of fracture (OR, 0.59; 95% CI, 0.54-0.66; P = 1.4 x 10-24), and
osteoporosis (OR, 0.43; 95% CI, 0.36-0.52; P = 2.4 x 10-18). The SOST
variants associated with higher risk of myocardial infarction and/or
coronary revascularisation (69,649 cases; OR, 1.18; 95% CI, 1.06-1.32; P =
0.003) and type 2 diabetes (OR 1.15; 95% CI, 1.05-1.27; P = 0.003), higher
systolic blood pressure (1.3mmHg; 95% CI 0.8-1.9; P = 5.9 x 10-6) and
waist-to-hip-ratio adjusted for BMI (0.05 SDs; 95% CI, 0.02-0.08; P = 8.5
x 10-4). <br/>Conclusion(s): Genetically and therapeutically lowered
sclerostin leads to higher risk of cardiovascular events. Rigorous
evaluation of the cardiovascular safety of romosozumab and other
sclerostin inhibitors is warranted.

<56>
Accession Number
631732602
Title
Percutaneous coronary intervention versus coronary artery bypass graft
surgery for revascularisation of left main coronary artery disease. An
updated systematic review and meta-analysis of randomised controlled
trials.
Source
Irish Journal of Medical Science. Conference: Intern Section of the Royal
Academy of Medicine in Ireland, RAMI 2019. Ireland. 188 (Supplement 7) (pp
S52), 2019. Date of Publication: 2019.
Author
Hayes N.; Kyithar M.
Institution
(Hayes, Kyithar) Midlands Regional Hospital Portlaoise
Publisher
Springer
Abstract
Background: Coronary Artery Bypass Grafting (CABG) is the established
treatment for left main coronary artery disease (LMCAD). The introduction
of PCI with DES lowered inherent risk. Raising the debate, whether PCI
represents a viable alternative to CABG. <br/>Aim(s): To perform updated
systematic review and meta-analysis of randomized controlled trials (RCTs)
comparing PCI and CABG outcomes in LMCAD. <br/>Method(s): I systematically
searched, BioMedCentral, PubMed, Cochrane, databases for published RCT
comparing PCI and CABG for LMCAD. I performed meta-analysis using
random-effects model. Odds ratio and 95% CI, for each outcome. P value of
<0.05 for statistical significance. Cochrane Q and I-squared index
assessed heterogeneity. Endpoints were Major Adverse Cardiovascular and
Cerebrovascular Events (MAACE). All-Cause Mortality (ACM), Myocardial
Infarction (MI), Stroke, Revascularization Rate, at 30 days, 1 year, >=
3-5 years and subgroup analysis MAACE risk associated with Syntaxscore at
3-5 years. <br/>Result(s): I performed meta-analysis on six RCTs, total
population 2349 PCI, 2351 CABG for these outcomes and time intervals.
MAACE and ACM were substantially equivalent for PCI and CABG at all
intervals. Lowered risk of MI with CABG at >= 5 years but substantial
equivalence at 30 days, 1 and >= 3 years. Lower stroke rate with PCI at 30
days and 1 year but substantial equivalence >= 5 and >=3 years. Higher PCI
revascularisation risk at 1, >= 5, and >= 3 years but statistical
equivalence at 30 days.MAACE outcome for high Syntaxscore favored CABG
with a trend toward favorable outcome in low and intermediate group.
<br/>Conclusion(s): PCI with DES is a viable alternative to CABG in low to
intermediate Syntaxscore LMCAD.PCI decreased short term stroke risk,
conversely increasing long-termrevascularisation risk,MI risk at 5 years
andMAACE risk for High Syntaxscore. Cardiology teams should individually
asses patients, those with highly complex lesions recommended for CABG.

<57>
Accession Number
631731500
Title
The 100 most influential manuscripts in minimally-invasive cardiac
surgery: A bibliometric analysis.
Source
British Journal of Surgery. Conference: Association of Surgeons in
Training International Surgical Conference, ASiT 2019. United Kingdom. 106
(SUPPL, 6) (pp 27), 2019. Date of Publication: September 2019.
Author
Allen R.; Karsan R.; Powell A.; Mehta D.
Institution
(Allen) University Hospital of Wales, Cardiff, United Kingdom
(Karsan, Mehta) Cardiothoracic Surgery Unit, University Hospital of Wales,
Cardiff, United Kingdom
(Powell) Upper GI Surgery Unit, University Hospital of Wales, Cardiff,
United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Citations an article receives is considered amarker of
influence. Cardiac Surgery has seen advances in approach to increasingly
complex cases with a shift towards minimally invasive surgery. We
conducted a bibliometric analysis of the top 100 cited manuscripts in
Minimally-invasive Cardiac Surgery aiming to identify key topics and
potential for future research. <br/>Method(s): The Thompson Reuters Web of
Science database was searched using terms: [Minimal*AND Invasive*AND
Cardiac*AND Surg*]. Papers were ranked by citation and reviewed by a panel
of Cardiac Surgeons to recognise the 100 most relevant manuscripts.
Further analysis was performed by subject, journal, institution and
country. <br/>Result(s): The search identified 2613 manuscripts. Of the
top 100 papers, median citation number was 101(414-51). The most cited
paper (414) by Lichtenstein (2006) focused on transapical aortic valve
implantation as an alternative to surgical aortic valve replacement in
aortic stenosis patients. Annals of Thoracic Surgery published most
papers, (n=35;3036 citations). Minimally-invasive valve and coronary
artery bypass surgeries were the most frequented topics (n=42&30).
<br/>Conclusion(s): Valve and coronary artery bypass surgeries were the
main area of focus. This bibliometric analysis of the most influential
publications outlines what constitutes a citable article and recognises
key contributors in minimally-invasive cardiac surgery.

<58>
Accession Number
631731393
Title
Critical appraisal on the impact of pre-operative rehabilitation and
outcomes following major abdominal and cardiothoracic surgery: A
systematic review and meta-analysis.
Source
British Journal of Surgery. Conference: Association of Surgeons in
Training International Surgical Conference, ASiT 2019. United Kingdom. 106
(SUPPL, 6) (pp 150), 2019. Date of Publication: September 2019.
Author
Kamarajah S.; Bundred J.; Weblin J.; Tan B.
Institution
(Kamarajah) Institute of Cellular Medicine, University of Newcastle,
Newcastle, United Kingdom
(Kamarajah) Department of Hepatobiliary, Pancreatic and Transplant
Surgery, Freeman Hospital, Newcastle University Trust Hospitals, New,
United Kingdom
(Bundred) College of Medical and Dental Sciences, University of
Birmingham, Birmingham, United Kingdom
(Weblin) Department of Physiotherapy, Queen Elizabeth Hospital Birmingham,
Birmingham, United Kingdom
(Tan) Department of Upper Gastrointestinal Surgery, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: This systematic review and meta-analysis aims to evaluate
the current literature on prehabilitation in major abdominal surgery and
cardiothoracic surgery Method: A systematic literature search was
conducted for studies reporting prehabilitation in patients undergoing
major abdominal and cardiothoracic surgery. Meta-analysis of postoperative
outcomes (overall and major complications, pulmonary and cardiac
complications, post-operative pneumonia, length of hospital stay) was
performed. <br/>Result(s): Fifty studies reported prehabilitation in 5504
patients, of which 24 studies (n=2485) were in major abdominal surgery.
Only 39 studies compared impact of prehabilitation on post-operative
outcomes (abdominal, n=20). Patients receiving prehabilitation have
significantly lower rates of overall complications (n=10,OR:
0.69,CI95%:0.49-0.96,p=0.03), pulmonary complications
(n=24,OR:0.32,CI95%:0.22-0.46,p<0.001), and postoperative pneumonia
(n=17,OR:0.47,CI95%:0.33-0.67,p<0.001) but no difference in major
complications. Meta-analysis of ten studies reporting 6-minute walk test
(6MWT) after prehabilitation identified significant improvement
in6MWT(76.6, CI95%: 29.3-123.9,p=0.002). Subset analysis of patients
undergoing major abdominal surgery highlighted prehabilitation was
associated with significantly lower pulmonary complications (n=13, OR:
0.30, CI95%: 0.17-0.55, p<0.001) and pneumonia (n=8, OR: 0.36, CI95%:
0.21-0.61, p<0.001). <br/>Conclusion(s): Prehabilitation has potential to
improve surgical outcomes in patients undergoing major abdominal and
cardiothoracic surgery. However, current evidence from randomised studies
remain weak due to variation in prehabilitation regimes, limiting
assessment of current post-operative outcomes.

<59>
Accession Number
631730926
Title
Predicting readmission to intensive care after cardiac surgery: A
systematic review.
Source
British Journal of Surgery. Conference: Association of Surgeons in
Training International Surgical Conference, ASiT 2019. United Kingdom. 106
(SUPPL, 6) (pp 30), 2019. Date of Publication: September 2019.
Author
Kimani L.; Tennyson C.; Howitt S.; Venkateswaran R.; Grant S.; McCollum C.
Institution
(Kimani, Howitt, Grant, McCollum) University of Manchester, Manchester,
United Kingdom
(Tennyson, Venkateswaran) Manchester University Foundation Trust,
Manchester, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Aim: Readmission to intensive care after cardiac surgery is related to
increased mortality, prolonged admission and significant morbidity. This
study aims to systematically identify independent perioperative variables
for readmission and risk prediction scores. <br/>Method(s): We performed
searches in the following databases; PubMed, MEDLINE, EMBASE from January
2000 to January 2019. We included studies in adult cardiac surgery that
utilised multivariable analyses to identify independent predictors. Two
reviewers independently extracted the data. <br/>Result(s): The search
yielded 28 studies and 9 fulfilled the criteria. The recurring predictors
for readmission were; Age >70, Diabetes, COPD, Elevated creatinine,
Ejection fraction<30%, Type and urgency of surgery, Prolonged bypass time,
Prolonged ventilation, Anaemia and neurological dysfunction. Additional
predictors used to derive risk scores, in four studies were; the
Parsonnet, Euroscore and the ICNARC scores. In all 28 studies, in-hospital
mortality and mean duration of hospital stay was higher in the readmitted
group. <br/>Conclusion(s): Overall readmission to intensive care after
cardiac surgery is associated with an increased risk of mortality and
prolonged length of stay. This study has identified several perioperative
risk factors and a number of risk scores requiring external validation.
These findings could potentially be used to identify patients at high risk
of readmission.

<60>
Accession Number
631752946
Title
Improvement in Health-Related Quality of Life After Total Ankle
Arthroplasty Compares Well With Other Successful Orthopaedic and
Nonorthopaedic Procedures.
Source
Foot & ankle specialist. (pp 1938640020917782), 2020. Date of Publication:
12 May 2020.
Author
Lachman J.R.; Green C.L.; Adams S.B.; Nunley J.A.; DeOrio J.K.; Easley
M.E.
Institution
(Lachman, Green, Adams, Nunley, DeOrio, Easley) St Luke's University
Health Network, Quakertown, Pennsylvania (JRL), United States
(Lachman, Green, Adams, Nunley, DeOrio, Easley) Duke University Department
of Biostatistics and Bioinformatics, Durham, North Carolina (CLG), United
States
(Lachman, Green, Adams, Nunley, DeOrio, Easley) Duke University School of
Medicine, North Carolina (SBA, Durham
Publisher
NLM (Medline)
Abstract
Background. Ankle arthritis is a major cause of disability. Orthopaedic
literature suggests improvement in health-related quality of life (HRQOL)
after total ankle arthroplasty (TAA). This has not been compared with
improvements observed in successful orthopaedic and nonorthopaedic
procedures, including anterior cervical discectomy/fusion (ACDF), total
knee arthroplasty (TKA), coronary artery bypass grafting (CABG), and
orthotopic liver transplant (OLT). We hypothesize that the effects after
TAA are comparable to several successful surgical procedures. Methods. 500
consecutive TAA patients were included and grouped with 2 other large
series. Short Form-36 (SF36) were collected at standardized intervals. A
systematic literature review identified studies comparing preoperative and
postoperative SF36 physical (PCS) and mental component summary (MCS)
scores. Using meta-analyses, we pooled the data for each procedure to
compare with the TAA group. Results. Patients in all cohorts had
preoperative SF36 MCS and PCS scores that were significantly lower than
that in the general population. Improvements in HRQOL after TAA were not
statistically different from improvements reported in PCS and MCS after
ACDF, TKA, and OLT. However, improvement in PCS after TAA was better than
that observed after CABG. Conclusions. Disability with ankle arthritis is
severe. Disability associated with cervical disc disease, knee arthrosis,
coronary artery disease, and liver failure is also severe, with surgical
intervention providing major improvements in HRQOL postoperatively. The
improvement in HRQOL after TAA did not differ statistically from ACDF,
TKA, CABG, and OLT. Our investigation suggests that the HRQOL benefits of
TAA meet benchmarks set by some of modern medicine's best. Levels of
Evidence: Level III: Systematic review.

<61>
Accession Number
631738040
Title
Percutaneous vs. surgical revascularization for patients with unprotected
left main stenosis: a meta-analysis of 5 years follow-up RCTs.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2020. Date of Publication: 11 May 2020.
Author
D'Ascenzo F.; De Filippo O.; Elia E.; Doronzo M.P.; Omede P.; Montefusco
A.; Pennone M.; Salizzoni S.; Conrotto F.; Gallone G.; Angelini F.;
Franchin L.; Bruno F.; Boffini M.; Gaudino M.; Rinaldi M.; De Ferrari G.M.
Institution
(D'Ascenzo, De Filippo, Elia, Doronzo, Omede, Montefusco, Pennone,
Conrotto, Gallone, Angelini, Franchin, Bruno, De Ferrari) Division of
Cardiology, Department of Medical Sciences, Citta della Salute e della
Scienza, Turin, Italy
(Salizzoni, Boffini, Rinaldi) Division of Cardiac Surgery, Department of
Surgical Sciences, Citta della Salute e della Scienza, Turin, Italy
(Gaudino) Department of Cardiothoracic Surgery, Cornell Medicine, NY, NY,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: 5-year survival of patients with Unprotected left main (ULM)
stenosis according to the choice of revascularization (percutaneous vs.
surgical) remains to be defined. METHODS AND RESULTS: Randomized
Controlled Trials (RTCs) comparing Percutaneous Coronary Intervention
(PCI) vs. Coronary Artery Bypass Graft (CABG) with a follow-up of at least
5 years were included. All-cause death was the primary endpoint. MACCE (a
composite endpoint of all-cause mortality, myocardial infarction [MI],
stroke and repeat revascularization) along with its single components and
cardiovascular (CV) death were the secondary ones. Analyses were
stratified according to use of first vs. last generation coronary stents.
Subgroup comparisons were performed according to Syntax Score (below or
above 33) and to age (using cutoffs of each trial's subgroup analysis). 4
RCTs with 4394 patients were identified: 2197 were treated with CABG, 657
with first generation and 1540 with last generation stents. At 5 years
rates of all-cause death did not differ (OR 0.93:0.71-1.21), as those of
CV death and stroke. CABG reduced rates of MACCE (OR 0.69:0.60-0.79),
mainly driven by MI (OR 0.48:0.36-0.65) and revascularization (OR
0.53:0.45-0.64). Benefit of CABG for MACCE was consistent, although with
different extent, across values of Syntax Score (OR 0.76:0.59-0.97 for
values<32 and OR 0.63:0.47-0.84 for values>=33) while was not evident for
"younger" patients (OR 0.83:0.65-1.07 vs. OR 0.65:0.51-0.84 for "older"
patients, all CI 95%). <br/>CONCLUSION(S): For patients with ULM disease
followed up for five years, no significant difference was observed in
all-cause and cardiovascular death between PCI and CABG. CABG reduced risk
of MI, revascularization and MACCE especially in older patients and in
those with complex coronary disease and a high syntax score.<br/>Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. &#xa9; The Author(s) 2020. For permissions please email:
journals.permissions@oup.com.

<62>
Accession Number
631737670
Title
The impact of glutamate infusion on postoperative NT-proBNP in patients
undergoing coronary artery bypass surgery: a randomized study.
Source
Journal of translational medicine. 18 (1) (pp 193), 2020. Date of
Publication: 11 May 2020.
Author
Jiang H.; Holm J.; Vidlund M.; Vanky F.; Friberg O.; Yang Y.; Svedjeholm
R.
Institution
(Jiang, Holm, Vanky, Yang, Svedjeholm) Department of Cardiothoracic
Surgery, Faculty of Medicine and Health Sciences, Unit of Cardiovascular
Sciences, Linkoping University, Linkoping, Sweden
(Jiang, Yang) Department of Cardiothoracic Surgery, Sun Yat-Sen Memorial
Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
(Vidlund, Friberg) Department of Cardiothoracic and Vascular Surgery,
Faculty of Medicine and Health, Orebro University, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: Glutamate, a key intermediate in myocardial metabolism, may
enhance myocardial recovery after ischemia and possibly reduce the
incidence and severity of postoperative heart failure in coronary artery
bypass surgery (CABG). N-terminal pro-B-type natriuretic peptide
(NT-proBNP) can be used to assess postoperative heart failure (PHF) after
CABG. Our hypothesis was that glutamate enhances myocardial recovery in
post-ischemic heart failure and, therefore, will be accompanied by a
mitigated postoperative increase of NT-proBNP. <br/>METHOD(S): Substudy of
the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS)
trial (ClinicalTrials.gov Identifier: NCT00489827) a prospective
triple-center double-blind randomized clinical trial on 399 patients
undergoing CABG with or without concomitant procedure for acute coronary
syndrome at three Swedish Cardiac Surgery centres (Linkoping, Orebro, and
Karlskrona) from May 30, 2007 to November 12, 2009. Patients were randomly
assigned to intravenous infusion of 0.125 M L-glutamic acid or saline
(1.65 mL/kg of body weight per hour) intraoperatively and postoperatively.
Plasma NT-proBNP was measured preoperatively, the first (POD1) and third
postoperative morning (POD3). A Clinical Endpoints Committee, blinded to
both intervention and NT-proBNP used prespecified criteria to diagnose
PHF. The primary endpoints were the absolute levels of postoperative
NT-proBNP and the difference between preoperative and postoperative levels
of NT-proBNP. <br/>RESULT(S): Overall no significant difference was
detected in postoperative NT-proBNP levels between groups. However, in
high-risk patients (upper quartile of EuroSCORE II>=4.15; glutamate group
n=56; control group n=45) glutamate was associated with significantly
lower postoperative increase of NT-proBNP (POD3-Pre: 3900 [2995-6260] vs.
6745 [3455-12,687] ng*L-1, p=0.012) and lower NT-proBNP POD3 (POD3: 4845
[3426-7423] vs. 8430 [5370-14,100] ng*L-1, p=0.001). After adjusting for
significant differences in preoperative demographics, NT-proBNP POD3 in
the glutamate group was 0.62 times of that in the control group (p=0.002).
Patients in the glutamate group also had shorter ICU stay (21 [19-26] vs.
25 [22-46] h, p=0.025) and less signs of myocardial injury (Troponin T
POD3 (300 [170-500] vs. 560 [210-910] ng*L-1, p=0.025).
<br/>CONCLUSION(S): Post hoc analysis of postoperative NT-proBNP suggests
that intravenous infusion of glutamate may prevent or mitigate myocardial
dysfunction in high-risk patients undergoing CABG. Further studies are
necessary to confirm these findings. Trial registration Swedish Medical
Products Agency 151:2003/70403 (prospectively registered with amendment
about this substudy filed March 17, 2007). ClinicalTrials.gov Identifier:
NCT00489827 (retrospectively registered)
https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=1&rank
=1.

<63>
Accession Number
631736906
Title
Short-term outcomes of on- vs off-pump coronary artery bypass grafting in
patients with left ventricular dysfunction: a systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 84), 2020. Date of
Publication: 11 May 2020.
Author
Guan Z.; Guan X.; Gu K.; Lin X.; Lin J.; Zhou W.; Xu M.; Wan F.; Zhang Z.;
Song C.
Institution
(Guan, Gu, Lin, Zhou, Zhang) Department of Cardiology surgery, Peking
University Third Hospital, 49 North Garden Rd., Beijing 100191, China
(Guan) Peking University, Beijing 100871, China
(Lin) Beijing University of Technology, Beijing 100124, China
(Xu) Department of Cardiology, Peking University Third Hospital, NHC Key
Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,
Beijing 100191, China
(Wan) Shanghai East Hospital, Tongji University, 150 Jimo Rd., Shanghai
100124, China
(Song) Department of Orthopedics, Peking University Third Hospital, 49
North Garden Rd., Beijing 100191, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Does the manipulation of the off-pump CABG (OPCAB) in patient
with depressed left ventricular function is better than on-pump CABG
(ONCAB) approach in in-hospital mortality and morbidities? Here we
undertook a meta-analysis of the best evidence available on the comparison
of primary and second clinical outcomes of the off-pump and on-pump CABG.
DESIGN: Systematic literature reviewer and meta-analysis. DATA SOURCES:
PubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled
Trials were searched the studies which comparing the use of the off-pump
CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January
1990.1 to January 2018. ELIGIBILITY CRITERIA: All observation studies and
randomized controlled trials comparing on-pump and off-pump as main
technique for multi-vessel coronary artery disease (defined as severe
stenosis (>70%) in at least 2 major diseased coronary arteries) with left
ventricular dysfunction(defined as ejection fraction (EF) 40% or less)
were included. DATA EXTRACTION AND SYNTHESIS: Authors will screen and
select the studies extract the following data, first author, year of
publication, trial characters, study design, inclusion and exclusion
criteria, graft type, clinical outcome, assess the risk of bias and
heterogeneity. Study-specific estimates will pool through the modification
of the Newcastle-Ottawa scale for the quality of study and while
leave-one-out analysis will be used to detect the impact of individual
studies on the robustness of outcomes. <br/>RESULT(S): Among the 987
screened articles, a total of 16 studies (32,354 patients) were included.
A significant relationship between patient risk profile and benefits from
OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84;
95% confidence interval [CI], 0.73-0.97; P=0.02), stroke (OR, 0.69; 95%
CI, 0.55-0.86; P=0.00), myocardial infarction (MI) (OR, 0.71; 95% CI,
0.53-0.96; P=0.02), renal failure (OR, 0.71; 95% CI, 0.55-0.93; P=0.01),
pulmonary complication (OR, 0.68; 95% CI, 0.52-0.90; P=0.01), infection
(OR, 0.67; 95% CI, 0.49-0.91; P=0.00),postoperative transfusion (OR, 0.25;
95% CI, 0.08-0.84; P=0.02) and reoperation for bleeding (OR, 0.56; 95% CI,
0.41-0.75; P=0.00). There was no significant difference in atrial
fibrillation (AF) (OR, 0.96;95%; CI, 0.78-1.41; P=0.56) and neurological
dysfunction (OR, 0.88; 95% CI, 0.49-1.57; P=0.65). <br/>CONCLUSION(S):
Compared with the on-pump CABG with LVD, using the off-pump CABG is a
better choice for patients with lower mortality, stroke, MI, RF, pulmonary
complication, infection, postoperative transfusion and reoperation for
bleeding. Further randomized studies are warranted to corroborate these
observational data.

<64>
Accession Number
631735645
Title
Comparing the effects of ketorolac and Paracetamol on postoperative pain
relief after coronary artery bypass graft surgery. A randomized clinical
trial.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 80), 2020. Date of
Publication: 11 May 2020.
Author
Javaherforooshzadeh F.; Abdalbeygi H.; Janatmakan F.; Gholizadeh B.
Institution
(Javaherforooshzadeh) Department of Cardiac Anesthesia, Ahvaz
Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Abdalbeygi, Janatmakan) Department of Anesthesia, Ahvaz Anesthesiology
and Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Gholizadeh) Atherosclerosis Research Center, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Pain management after coronary artery bypass graft (CABG)
surgery remains challenging. <br/>OBJECTIVE(S): This study aimed to
compare the effects of Ketorolac and Paracetamol on postoperative CABG
pain relief. <br/>METHOD(S): This double-blind randomized clinical trial
study was conducted in Ahvaz, Iran, from September 2018-December 2019. Two
consecutive groups of 60 patients undergoing elective on-pump coronary
artery bypass graft surgery. INTERVENTION: The patients were divided into
0.5mg/kg of ketorolac mg/dl and 10mg/kg of Paracetamol after surgery for
pain management. Primary outcomes were: visual analog pain scale (VAS) at
the time point immediately after extubation (baseline) and at 6, 12, 24
and 48h and the total dose of morphine consumption. Secondary outcomes
included the hemodynamic variables, weaning time, chest tube derange,
in-hospital mortality and myocardial infarction. STATISTICAL ANALYSIS: The
data were analyzed using SPSS version 22(SPSS, Chicago, IL). The
Mann-Whitney U-test was used to compare demographic data, VAS scores,
vital signs, and side effects. Repeated measurements were tested within
groups using Friedman's ANOVA and the Wilcoxon rank-sum test. Values were
expressed as means +/- standard deviations. Statistical significance was
defined as a p-value <0.05. <br/>RESULT(S): Compared with baseline scores,
there were significant declines in VAS scores in both groups throughout
the time sequence (P< 0.05). The statistical VAS score was slightly higher
in the Paracetamol group at most time points, except for the time of 6h.
However, at 24 and 48h, the VAS score in group Paracetamol was
significantly higher than in group Ketorolac. There were no significant
differences between groups about hemodynamic variables.
<br/>CONCLUSION(S): The efficacy of ketorolac is comparable to that of
Paracetamol in postoperative CABG pain relief. TRIAL REGISTRY:
IRCT20150216021098N5. Registered at 2019-09-12.

<65>
Accession Number
631735521
Title
Cardiovascular magnetic resonance native T<inf>2</inf> and T<inf>2</inf>
^* quantitative values for cardiomyopathies and heart
transplantations: a systematic review and meta-analysis.
Source
Journal of cardiovascular magnetic resonance : official journal of the
Society for Cardiovascular Magnetic Resonance. 22 (1) (pp 34), 2020. Date
of Publication: 11 May 2020.
Author
Snel G.J.H.; van den Boomen M.; Hernandez L.M.; Nguyen C.T.; Sosnovik
D.E.; Velthuis B.K.; Slart R.H.J.A.; Borra R.J.H.; Prakken N.H.J.
Institution
(Snel, van den Boomen, Hernandez, Borra, Prakken) Department of Radiology,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, Groningen 9713 GZ, Netherlands
(van den Boomen, Nguyen, Sosnovik) Department of Radiology, Athinoula A.
Martinos Center for Biomedical Imaging, Massachusetts General Hospital,
Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
(Nguyen, Sosnovik) Cardiovascular Research Center, Massachusetts General
Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129,
USA
(Sosnovik) Division of Health Sciences and Technology, Harvard-MIT,
Massachusetts Avenue, MA, Cambridge 02139, United States
(Velthuis) Department of Radiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht 3584 CX, Netherlands
(Slart, Borra) Department of Nuclear Medicine and Molecular Imaging,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, Groningen 9713 GZ, Netherlands
(Slart) Department of Biomedical Photonic Imaging, University of Twente,
Enschede 7522 ND, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: The clinical application of cardiovascular magnetic resonance
(CMR) T2 and T2* mapping is currently limited as ranges for healthy and
cardiac diseases are poorly defined. In this meta-analysis we aimed to
determine the weighted mean of T2 and T2* mapping values in patients with
myocardial infarction (MI), heart transplantation, non-ischemic
cardiomyopathies (NICM) and hypertension, and the standardized mean
difference (SMD) of each population with healthy controls. Additionally,
the variation of mapping outcomes between studies was investigated.
<br/>METHOD(S): The PRISMA guidelines were followed after literature
searches on PubMed and Embase. Studies reporting CMR T2 or T2* values
measured in patients were included. The SMD was calculated using a random
effects model and a meta-regression analysis was performed for populations
with sufficient published data. <br/>RESULT(S): One hundred fifty-four
studies, including 13,804 patient and 4392 control measurements, were
included. T2 values were higher in patients with MI, heart
transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis,
hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and
myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33,
respectively, P< 0.01) compared with controls. T2 values in iron overload
patients (SMD=-0.54, P=0.30) and Anderson-Fabry disease patients
(SMD=0.52, P=0.17) did both not differ from controls. T2* values were
lower in patients with MI and iron overload (SMD of -1.99 and-2.39,
respectively, P< 0.01) compared with controls. T2* values in HCM patients
(SMD=-0.61, P=0.22), DCM patients (SMD=-0.54, P=0.06) and hypertension
patients (SMD=-1.46, P=0.10) did not differ from controls. Multiple CMR
acquisition and patient demographic factors were assessed as significant
covariates, thereby influencing the mapping outcomes and causing variation
between studies. <br/>CONCLUSION(S): The clinical utility of T2 and T2*
mapping to distinguish affected myocardium in patients with
cardiomyopathies or heart transplantation from healthy myocardium seemed
to be confirmed based on this meta-analysis. Nevertheless, variation of
mapping values between studies complicates comparison with external values
and therefore require local healthy reference values to clinically
interpret quantitative values. Furthermore, disease differentiation seems
limited, since changes in T2 and T2* values of most cardiomyopathies are
similar.

<66>
[Use Link to view the full text]
Accession Number
631733928
Title
Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve
Replacement in Low-Risk Patients: The PARTNER 3 Trial.
Source
Circulation. 141 (19) (pp 1527-1537), 2020. Date of Publication: 12 May
2020.
Author
Pibarot P.; Salaun E.; Dahou A.; Avenatti E.; Guzzetti E.; Annabi M.-S.;
Toubal O.; Bernier M.; Beaudoin J.; Ong G.; Ternacle J.; Krapf L.;
Thourani V.H.; Makkar R.; Kodali S.K.; Russo M.; Kapadia S.R.; Malaisrie
S.C.; Cohen D.J.; Leipsic J.; Blanke P.; Williams M.R.; McCabe J.M.; Brown
D.L.; Babaliaros V.; Goldman S.; Szeto W.Y.; Genereux P.; Pershad A.; Alu
M.C.; Xu K.; Rogers E.; Webb J.G.; Smith C.R.; Mack M.J.; Leon M.B.; Hahn
R.T.
Institution
(Pibarot, Salaun, Guzzetti, Annabi, Toubal, Bernier, Beaudoin, Ternacle,
Krapf) Institut Universitaire de Cardiologie et de Pneumologie de Quebec,
E.G., M.-S.A., M.B., J.T., E.S
(Dahou, Avenatti, Alu, Leon, Hahn) Cardiovascular Research Foundation,
M.C.A., E.A, NY
(Ong) St Michael's Hospital, University of Toronto
(Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, Mexico
(Kodali, Alu, Smith, Leon, Hahn) Columbia University Irving Medical
Center/New York-Presbyterian Hospital, M.C.A., C.R.S.
(Russo) Rutgers Robert Wood Johnson Medical School, NB
(Kapadia) Cleveland Clinic
(Malaisrie) Feinberg School of Medicine, Northwestern University, Chicago,
Mexico
(Cohen) University of Missouri-Kansas City (D.J.C.)
(Leipsic, Blanke, Webb) St Paul's Hospital, Vancouver, Canada
(Williams) NYU-Langone Medical Center, NY
(McCabe) University of Washington
(Brown, Mack) Baylor Scott & White Healthcare, Plano, United States
(Babaliaros) Emory University School of Medicine, Atlanta, United States
(Goldman) Lankenau Medical Center, Wynnewood, United States
(Szeto) University of Pennsylvania
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center
(Pershad) Banner University Medical Center, Phoenix, United States
(Xu, Rogers) Edwards Lifesciences, Irvine
Publisher
NLM (Medline)
Abstract
BACKGROUND: This study aimed to compare echocardiographic findings in
low-risk patients with severe aortic stenosis after surgical aortic valve
replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
<br/>METHOD(S): The PARTNER 3 trial (Placement of Aortic Transcatheter
Valves) randomized 1000 patients with severe aortic stenosis and low
surgical risk to undergo either transfemoral TAVR with the
balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms
obtained at baseline and at 30 days and 1 year after the procedure were
analyzed by a consortium of 2 echocardiography core laboratories.
<br/>RESULT(S): The percentage of moderate or severe aortic regurgitation
(AR) was low and not statistically different between the TAVR and SAVR
groups at 30 days (0.8% versus 0.2%; P=0.38). Mild AR was more frequent
after TAVR than SAVR at 30 days (28.8% versus 4.2%; P<0.001). At 1 year,
mean transvalvular gradient (13.7+/-5.6 versus 11.6+/-5.0 mmHg; P=0.12)
and aortic valve area (1.72+/-0.37 versus 1.76+/-0.42 cm2; P=0.12) were
similar in TAVR and SAVR. The percentage of severe prosthesis-patient
mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus
6.3%; P=0.30). Valvulo-arterial impedance (Zva), which reflects total left
ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year
(3.7+/-0.8 versus 3.9+/-0.9 mmHg/mL/m2; P<0.001). Tricuspid annulus plane
systolic excursion decreased and the percentage of moderate or severe
tricuspid regurgitation increased from baseline to 1 year in SAVR but
remained unchanged in TAVR. Irrespective of treatment arm, high Zva and
low tricuspid annulus plane systolic excursion, but not moderate to severe
AR or severe prosthesis-patient mismatch, were associated with increased
risk of the composite end point of mortality, stroke, and
rehospitalization at 1 year. <br/>CONCLUSION(S): In patients with severe
aortic stenosis and low surgical risk, TAVR with the SAPIEN 3 valve was
associated with similar percentage of moderate or severe AR compared with
SAVR but higher percentage of mild AR. Transprosthetic gradients, valve
areas, percentage of severe prosthesis-patient mismatch, and left
ventricular mass regression were similar in TAVR and SAVR. SAVR was
associated with significant deterioration of right ventricular systolic
function and greater tricuspid regurgitation, which persisted at 1 year.
High Zva and low tricuspid annulus plane systolic excursion were
associated with worse outcome at 1 year whereas AR and severe
prosthesis-patient mismatch were not. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT02675114.

<67>
[Use Link to view the full text]
Accession Number
631733896
Title
Ultrasound-guided continuous thoracic paravertebral block alleviates
postoperative delirium in elderly patients undergoing esophagectomy: A
randomized controlled trial.
Source
Medicine. 99 (17) (pp e19896), 2020. Date of Publication: 01 Apr 2020.
Author
Jin L.; Yao R.; Heng L.; Pang B.; Sun F.-G.; Shen Y.; Zhong J.-F.; Zhao
P.-P.; Wu C.-Y.; Li B.-P.
Institution
(Jin, Pang, Sun) Department of Anesthesiology, People's Hospital of
Leshan, Leshan
(Yao, Zhao, Li) Department of Anesthesiology, Affiliated Xuzhou City
Hospital of Xuzhou Medical University
(Heng) Department of Anesthesiology, Xuzhou Tumor Hospital, Xuzhou
(Sun) Department of Anesthesiology, Sichuan Provincial Corps Hospital,
Chinese People's Armed Police Forces, Leshan
(Shen) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical
University, Xuzhou
(Zhong) Department of Anesthesiology, People's Hospital of Shaoxing,
Shaoxing
(Wu) Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Delirium is a common postoperative complication in older
patients undergoing thoracic surgery and presages poor outcomes.
Postoperative pain is an important factor in the progression of delirium.
The purpose of this study was to test whether continuous thoracic
paravertebral block (PVB), a more effective approach for analgesia, could
decrease the incidence of delirium in elderly patients undergoing
esophagectomy. <br/>METHOD(S): A total of 180 geriatric patients
undergoing esophagectomy were randomly divided into 2 groups and treated
with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP,
IL-1beta, IL-6, and TNF-alpha levels were detected in all patients. Pain
intensity was measured by a numerical rating scale. Delirium was assessed
using the confusion assessment method. <br/>RESULT(S): The incidence of
postoperative delirium was significantly lower in the PVB group than in
the PCA group. Patients in the PVB group had lower plasma CRP, IL-1beta,
IL-6, and TNF-alpha levels and less pain when coughing after surgery.
<br/>CONCLUSION(S): Ultrasound-guided continuous thoracic paravertebral
block improved analgesia, reduced the inflammatory reaction and decreased
the occurrence of delirium after surgery.

<68>
Accession Number
631611135
Title
Estimated oxygen extraction versus dynamic parameters of
fluid-responsiveness for perioperative hemodynamic optimization of
patients undergoing non-cardiac surgery: A non-inferiority randomized
controlled trial.
Source
BMC Anesthesiology. 20 (1) (no pagination), 2020. Article Number: 87. Date
of Publication: 18 Apr 2020.
Author
Carsetti A.; Amici M.; Bernacconi T.; Brancaleoni P.; Cerutti E.;
Chiarello M.; Cingolani D.; Cola L.; Corsi D.; Forlini G.; Giampieri M.;
Iuorio S.; Principi T.; Tappata G.; Tempesta M.; Adrario E.; Donati A.
Institution
(Carsetti, Adrario, Donati) Department of Biomedical Sciences and Public
Health, Universita Politecnica Delle Marche, Ancona, Italy
(Carsetti, Adrario, Donati) Anesthesia and Intensive Care Unit, Azienda
Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
(Amici) Pediatric Anesthesia and Intensive Care Unit, Azienda Ospedaliero
Universitaria Ospedali Riuniti, Ancona, Italy
(Bernacconi) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta
n. 2, Jesi, Italy
(Brancaleoni) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta
n. 1, Urbino, Italy
(Cerutti) Anesthesia and Post-operative Intensive Care Unit, Azienda
Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
(Chiarello) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n.
3, Camerino, Italy
(Cingolani) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n.
2, Senigallia, Italy
(Cola) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n. 4,
Fermo, Italy
(Corsi) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n. 3,
Civitanova Marche, Italy
(Forlini) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n.
5, Ascoli Piceno, Italy
(Giampieri) Anesthesia and Intensive Care Unit, IRCCS-INRCA, Ancona, Italy
(Iuorio) Anesthesia and Intensive Care Unit, IRCCS-INRCA, Osimo, Italy
(Principi) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n.
5, San Benedetto del Tronto, Italy
(Tappata) Anesthesia and Intensive Care Unit, ASUR Marche, area vasta n.
3, Macerata, Italy
(Tempesta) Anesthesia and Intensive Care Unit, Azienda Ospedaliera Marche
Nord, Pesaro, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Goal directed therapy (GDT) is able to improve mortality and
reduce complications in selected high-risk patients undergoing major
surgery. The aim of this study is to compare two different strategies of
perioperative hemodynamic optimization: one based on optimization of
preload using dynamic parameters of fluid-responsiveness and the other one
based on estimated oxygen extraction rate (O<inf>2</inf>ER) as target of
hemodynamic manipulation. <br/>Method(s): This is a multicenter randomized
controlled trial. Adult patients undergoing elective major open abdominal
surgery will be allocated to receive a protocol based on dynamic
parameters of fluid-responsiveness or a protocol based on estimated
O<inf>2</inf>ER. The hemodynamic optimization will be continued for 6 h
postoperatively. The primary outcome is difference in overall
postoperative complications rate between the two protocol groups. Fluids
administered, fluid balance, utilization of vasoactive drugs, hospital
length of stay and mortality at 28 day will also be assessed.
<br/>Discussion(s): As a predefined target of cardiac output (CO) or
oxygen delivery (DO<inf>2</inf>) seems to be not adequate for every
patient, a personalized therapy is likely more appropriate. Following this
concept, dynamic parameters of fluid-responsiveness allow to titrate fluid
administration aiming CO increase but avoiding fluid overload. This
approach has the advantage of personalized fluid therapy, but it does not
consider if CO is adequate or not. A protocol based on O<inf>2</inf>ER
considers this second important aspect. Although positive effects of
perioperative GDT have been clearly demonstrated, currently studies
comparing different strategies of hemodynamic optimization are lacking.
Trial registration: ClinicalTrials.gov, NCT04053595. Registered on
12/08/2019.<br/>Copyright &#xa9; 2020 The Author(s).

<69>
Accession Number
2004910051
Title
Cyanoacrylate Dermal Closure in Spine Surgery: Systematic Review and
Pooled Analysis.
Source
Global Spine Journal. 10 (4) (pp 493-498), 2020. Date of Publication: 01
Jun 2020.
Author
Tan T.; Rutges J.; Marion T.; Hunn M.; Tee J.
Institution
(Tan, Hunn, Tee) The Alfred Hospital, Melbourne, VIC, Australia
(Tan, Tee) National Trauma Research Institute Melbourne, VIC, Australia
(Rutges) Erasmus MC, Rotterdam, Netherlands
(Marion) Northern Ontario School of Medicine, Thunder Bay, ON, Canada
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Study Design: Systematic review. <br/>Objective(s): Cyanoacrylate glue
closure has been utilized for dermal closure in surgical incisions. Its
safety and efficacy in spine surgery are not established. The authors
perform a systematic review to determine the rate of surgical site
infection (SSI), wound dehiscence, and wound erythema with cyanoacrylate
dermal closure in spine surgery. <br/>Method(s): A systematic review
adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines was performed utilizing the PubMed/MEDLINE,
EMBASE, and Cochrane databases on patients undergoing spine surgery with
cyanoacrylate dermal closure. Pooled analysis was performed with
stratification of patients according to spinal level and the
presence/absence of instrumentation. Risk-of-bias and methodological
quality was appraised using 17 prespecified criteria. <br/>Result(s): Five
articles (1 retrospective cohort study, 4 cases series) with a total of
1282 patients were included. A total of 967 patients, all diagnosed with
degenerative spine disease, were suitable for pooled analysis. In 290
patients who underwent anterior cervical discectomy and fusion, and in 23
patients with posterior cervical decompression (without instrumentation),
there was 0% rate of SSI, wound dehiscence, and erythema. In 489 patients
who underwent lumbar microdiscectomy, there was 0.41% rate of SSI, 0.20%
rate of wound dehiscence, and 0.20% rate of wound erythema. In 165 lumbar
laminectomy patients, there was a 1.82% rate of SSI, 0.61% rate of wound
dehiscence, and 0% rate of wound erythema. <br/>Conclusion(s):
Cyanoacrylate dermal closure for the aforementioned procedures is
associated with low rates of wound complications (SSI, dehiscence, and
erythema). Further studies should be performed, especially in
nondegenerative surgery, instrumented thoracic and lumbar spine
surgery.<br/>Copyright &#xa9; The Author(s) 2019.

<70>
Accession Number
2004909887
Title
Evaluation of Serratus Anterior Plane Block for Pain Relief in Patients
Undergoing MIDCAB Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 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) Department of Anesthesiology,
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
(Pande, Agarwal) Department of Cardiovascular and Thoracic Surgery, Sanjay
Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
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.<br/>Copyright &#xa9; The Author(s) 2020.

<71>
Accession Number
2004346001
Title
Effects of eight weeks of aerobic exercises on the cardiac function and
inflammatory markers of male patients with heart failure after coronary
artery bypass grafting.
Source
Journal of Kermanshah University of Medical Sciences. 24 (1) (no
pagination), 2020. Article Number: e98429. Date of Publication: March
2020.
Author
Omidi S.; Delavar S.H.; Amiripour A.; Heydarpoor B.
Institution
(Omidi, Delavar) Sport Physiology Department, Kermanshah Branch, Islamic
Azad University, Kermanshah, Iran, Islamic Republic of
(Amiripour) Cardiology Department, Research Center of Imam Reza Hospital,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
(Heydarpoor) Sport Medicine Department, Kermanshah University of Medical
Sciences, Kermanshah, Iran, Islamic Republic of
Publisher
Kermanshah University of Medical Sciences (E-mail: jivr@jivresearch.org)
Abstract
Background: Cardiovascular diseases are the leading cause of mortality
across the world. Coronary artery bypass grafting (CABG) is frequently
performed on patients with cardiac diseases, the outcomes of which are
closely associated with lifestyle modification, especially physical
exercise. <br/>Objective(s): The present study aimed to evaluate the
impact of aerobic exercises on the cardiac function and inflammatory
markers of male patients with heart failure after CABG. <br/>Method(s):
This clinical trial was conducted on 20 male patients with heart failure
after CABG, who were randomly divided into the intervention and control
groups (10 per each). In total, 24 aerobic exercise sessions were
performed in the form of three 60-minutes weekly sessions with 60%-70%
maximal heart rate (MaxHR). Cardiac function was evaluated, and the levels
of interleukin 6 (IL-6) high-sensitivity C-reactive protein (hsCRP) were
measured before and after the intervention. Data analysis was performed in
the PRISM software using independent and Paired t-test. <br/>Result(s):
After the intervention, left ventricular ejection fraction significantly
increased in the intervention group, while no changes were observed in the
control group (P = 0.0039). However, no significant changes were observed
in the diastolic function of the groups after the intervention (P > 0.05).
IL-6 had no significant changes in the control group, while it
significantly reduced in the intervention group (P = 0.002). Furthermore,
the hsCRP significantly decreased in the intervention group (P = 0.036),
while no significant changes were observed in the control group in this
regard (P < 0.05). <br/>Conclusion(s): According to the results, aerobic
exercises could improve systolic cardiac function and decrease IL-6 and
hsCRP in the patients with cardiac failure. Therefore, these exercises are
recommended following CABG.<br/>Copyright &#xa9; 2020, Journal of
Kermanshah University of Medical Sciences.

<72>
Accession Number
2005819780
Title
Impact of dexmedetomidine on the incidence of delirium in elderly patients
after cardiac surgery: A randomized controlled trial.
Source
PLoS ONE. 12 (2) (no pagination), 2017. Article Number: e0170757. Date of
Publication: 01 Feb 2017.
Author
Li X.; Yang J.; Nie X.-L.; Zhang Y.; Li X.-Y.; Li L.-H.; Wang D.-X.; Ma D.
Institution
(Li, Zhang, Wang) Department of Anesthesiology and Critical Care Medicine,
Peking University First Hospital, Beijing, China
(Yang, Li) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing, China
(Nie) Center for Clinical Epidemiology and Evidence-Based Medicine,
Beijing Children's Hospital, Capital Medical University, Beijing, China
(Li) Department of Biostatistics, Peking University, First Hospital,
Beijing, China
(Ma) Section of Anaesthetics, Pain Management and Intensive Care,
Department of Surgery and Cancer, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Delirium is a frequent complication after cardiac surgery and
its occurrence is associated with poor outcomes. The purpose of this study
was to investigate the impact of perioperative dexmedetomidine
administration on the incidence of delirium in elderly patients after
cardiac surgery. Methods This randomized, double-blinded, and
placebo-controlled trial was conducted in two tertiary hospitals in
Beijing between December 1, 2014 and July 19, 2015. Eligible patients were
randomized into two groups. Dexmedetomidine (DEX) was administered during
anesthesia and early postoperative period for patients in the DEX group,
whereas normal saline was administered in the same rate for the same
duration for patients in the control (CTRL) group. The primary endpoint
was the incidence of delirium during the first five days after surgery.
Secondary endpoints included the cognitive function assessed on
postoperative days 6 and 30, the overall incidence of non-delirium
complications within 30 days after surgery, and the all-cause 30-day
mortality. Results Two hundred eighty-five patients were enrolled and
randomized. Dexmedetomidine did not decrease the incidence of delirium
(4.9% [7/142] in the DEX group vs 7.7% [11/143] in the CTRL group; OR
0.62, 95% CI 0.23 to 1.65, p = 0.341). Secondary endpoints were similar
between the two groups; however, the incidence of pulmonary complications
was slightly decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the
percentage of early extubation was significantly increased (OR 3.32, 95%
CI 1.36 to 8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased
the required treatment for intraoperative tachycardia (21.1% [30/142] in
the DEX group vs 33.6% [48/143] in the CTRL group, p = 0.019), but
increased the required treatment for postoperative hypotension (84.5%
[120/142] in the DEX group vs 69.9% [100/143] in the CTRL group, p =
0.003). Conclusions Dexmedetomidine administered during anesthesia and
early postoperative period did not decrease the incidence of postoperative
delirium in elderly patients undergoing elective cardiac surgery. However,
considering the low delirium incidence, the trial might have been
underpowered.<br/>Copyright &#xa9; 2017 Li et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<73>
Accession Number
2005869927
Title
Transcatheter Versus Surgical Pulmonary Valve Replacement: A Systemic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Ribeiro J.M.; Teixeira R.; Lopes J.; Costa M.; Pires A.; Goncalves L.
Institution
(Ribeiro, Teixeira, Lopes, Costa, Goncalves) Servico de Cardiologia,
Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
(Teixeira, Pires, Goncalves) Faculdade de Medicina da Universidade de
Coimbra, Coimbra, Portugal
(Pires) Servico de Cardiologia Pediatrica, Centro Hospitalar e
Universitario de Coimbra, Coimbra, Portugal
Publisher
Elsevier USA
Abstract
Background: Transcatheter pulmonary valve replacement (TPVR) has emerged
as an alternative to surgery in patients with pulmonary valve dysfunction.
<br/>Method(s): We searched the Medline and Cochrane databases since their
inception to January 2019 as well as references from article, for all
publications comparing TPVR with surgical PVR (SPVR). Studies were
considered for inclusion if they reported comparative data regarding any
of the study endpoints. The primary endpoint was early mortality after
PVR. Secondary endpoints included procedure-related complications, length
of hospital stay, mortality during follow-up, infective endocarditis, need
for reintervention, post-PVR transpulmonary peak systolic gradient, and
significant pulmonary regurgitation. <br/>Result(s): There were no
differences in perioperative mortality between groups (0.2% vs 1.2%;
pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27,
I² = 0%). However TPVR conferred a significant reduction in
procedure-related complications and length of hospital stay compared with
SPVR. Midterm mortality and the need for repeat intervention were similar
with both techniques, but pooled infective endocarditis was significantly
more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95%
confidence interval, 1.89-5.06; P < .001, I² = 0%). TPVR was
associated with less significant PR and a trend towards a lower
transpulmonary systolic gradient during follow-up. <br/>Conclusion(s):
TPVR is a safe alternative to SPVR in selected patients and is associated
with a shorter length of hospital stay and fewer procedure-related
complications. At midterm follow-up TPVR was comparable with SPVR in terms
of mortality and repeat intervention but was associated with an increased
risk of infective endocarditis.<br/>Copyright &#xa9; 2020

<74>
Accession Number
2005859673
Title
Restricted versus liberal intraoperative benzodiazepine use in cardiac
anaesthesia for reducing delirium (B-Free Pilot): a pilot, multicentre,
randomised, cluster crossover trial.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Spence J.; Belley-Cote E.; Jacobsohn E.; Lee S.F.; Whitlock R.; Bangdiwala
S.; Syed S.; Sarkaria A.; MacIsaac S.; Lengyel A.; Long S.; Um K.;
McIntyre W.F.; Kavosh M.; Fast I.; Arora R.; Lamy A.; Connolly S.;
Devereaux P.J.
Institution
(Spence, Syed, Long) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock) Department of Critical Care, McMaster
University, Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock, Lamy, Devereaux) Department of Health
Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON,
Canada
(Spence, Belley-Cote, Lee, Whitlock, Bangdiwala, McIntyre, Lamy, Connolly,
Devereaux) Population Health Research Institute, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Connolly, Devereaux) Department of Medicine
(Cardiology), McMaster University, Hamilton, ON, Canada
(Jacobsohn, Kavosh, Fast) Department of Anesthesia and Perioperative
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Jacobsohn, Arora) Department of Critical Care, University of Manitoba,
Winnipeg, MB, Canada
(Whitlock, Lamy) Department of Surgery (Cardiac Surgery), McMaster
University, Hamilton, ON, Canada
(Sarkaria) Department of Family and Community Medicine, University of
Toronto, Toronto, ON, Canada
(MacIsaac) School of Medicine, Faculty of Medicine, Royal College of
Surgeons, Dublin, Ireland
(Lengyel) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Um) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Arora) Department of Surgery (Cardiac Surgery), University of Manitoba,
Winnipeg, MB, Canada
Publisher
Elsevier Ltd
Abstract
Background: Delirium is common after cardiac surgery and is associated
with adverse outcomes. Perioperative benzodiazepine use is associated with
delirium and is common during cardiac surgery, which may increase the risk
of postoperative delirium. We undertook a pilot study to inform the
feasibility of a large randomised cluster crossover trial examining
whether an institutional policy of restricted benzodiazepine
administration during cardiac surgery (compared with liberal
administration) would reduce delirium. <br/>Method(s): We conducted a
two-centre, pilot, randomised cluster crossover trial with four 4 week
crossover periods. Each centre was randomised to a policy of restricted or
liberal use, and then alternated between the two policies during the
remaining three periods. Our feasibility outcomes were adherence to each
policy (goal >=80%) and outcome assessment (one delirium assessment per
day in the ICU in >=90% of participants). We also evaluated the incidence
of intraoperative awareness in one site using serial Brice questionnaires.
<br/>Result(s): Of 800 patients undergoing cardiac surgery during the
trial period, 127/800 (15.9%) had delirium. Of these, 355/389 (91.3%)
received benzodiazepines during the liberal benzodiazepine periods and
363/411 (88.3%) did not receive benzodiazepines during the restricted
benzodiazepine periods. Amongst the 800 patients, 740 (92.5%) had >=1
postoperative delirium assessment per day in the ICU. Of 521 patients
screened for intraoperative awareness, one patient (0.2%), managed during
the restricted benzodiazepine period (but who received benzodiazepine),
experienced intraoperative awareness. <br/>Conclusion(s): This pilot study
demonstrates the feasibility of a large, multicentre, randomised, cluster
crossover trial examining whether an institutional policy of restricted vs
liberal benzodiazepine use during cardiac surgery will reduce
postoperative delirium. Clinical trial registration:
NCT03053869.<br/>Copyright &#xa9; 2020 British Journal of Anaesthesia

<75>
[Use Link to view the full text]
Accession Number
631740702
Title
Venoarterial Extracorporeal Membrane Oxygenation with Concomitant Impella
Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic
Shock.
Source
ASAIO Journal. (pp 497-503), 2020. Date of Publication: 2020.
Author
O'Horo J.C.; Antharam P.; Ananthaneni S.; Vallabhajosyula S.; Stulak J.M.;
Dunlay S.M.; Holmes D.R.; Barsness G.W.
Institution
(Vallabhajosyula, Ananthaneni, Vallabhajosyula, Dunlay, Holmes, Barsness)
Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW,
Rochester, MN 55905, United States
(Vallabhajosyula, O'Horo, Antharam) Division of Pulmonary and Critical
Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United
States
(O'Horo) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
(Stulak) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Dunlay) Department of Health Science Research, Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
There are contrasting data on concomitant Impella device in cardiogenic
shock patients treated with venoarterial extracorporeal membrane
oxygenation (VA ECMO) (ECPELLA). This study sought to compare early
mortality in patients with cardiogenic shock treated with ECPELLA in
comparison to VA ECMO alone. We reviewed the published literature from
2000 to 2018 for randomized, cohort, case-control, and case series studies
evaluating adult patients requiring VA ECMO for cardiogenic shock. Five
retrospective observational studies, representing 425 patients, were
included. Venoarterial extracorporeal membrane oxygenation with
concomitant Impella strategy was used in 27% of the patients. Median age
across studies varied between 51 and 63 years with 59-88% patients being
male. Use of ECPELLA was associated with higher weaning from VA ECMO and
bridging to permanent ventricular assist device or cardiac transplant in
three and four studies, respectively. The studies showed moderate
heterogeneity with possible publication bias. The two studies that
accounted for differences in baseline characteristics between treatment
groups reported lower 30 day mortality with ECPELLA versus VA ECMO. The
remaining three studies did not adjust for potential confounding and were
at high risk for selection bias. In conclusion, ECPELLA is being
increasingly used as a strategy in patients with cardiogenic shock.
Additional large, high-quality studies are needed to evaluate clinical
outcomes with ECPELLA.<br/>Copyright &#xa9; 2020 Hogrefe Publishing GmbH.
All rights reserved.

<76>
Accession Number
2001386254
Title
Motivational interviewing to support LDL-C therapeutic goals and
lipid-lowering therapy compliance in patients with acute coronary
syndromes (IDEAL-LDL) study: rationale and design.
Source
Hellenic Journal of Cardiology. 60 (4) (pp 249-253), 2019. Date of
Publication: July - August 2019.
Author
Boulmpou A.; Kartas A.; Farmakis I.; Zafeiropoulos S.; Nevras V.;
Papadimitriou I.; Tampaki A.; Vlachou A.; Lillis L.; Koutsakis A.;
Karvounis H.; Giannakoulas G.
Institution
(Boulmpou, Kartas, Farmakis, Zafeiropoulos, Nevras, Papadimitriou,
Tampaki, Vlachou, Lillis, Koutsakis, Karvounis, Giannakoulas) Department
of Cardiology, AHEPA University Hospital, Aristotle University of
Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
Publisher
Hellenic Cardiological Society
Abstract
Background: Achieving low-density lipoprotein cholesterol (LDL-C) target
levels after an acute coronary syndrome (ACS) is of paramount importance,
and is often burdened by undertreatment and medication or lifestyle
non-adherence issues. <br/>Objective(s): We examined the effect of a
patient-centered, physician-led motivational intervention following ACS on
relevant secondary prevention aspects. Methods-design: The IDEAL-LDL is a
single-center, randomized controlled clinical trial, conducted among
patients hospitalized due to an ACS. Following discharge, all patients
undergo a baseline assessment of lipid profile. Patients in the
intervention group receive an in-person educational session and an
informative leaflet, and also undergo two phone-based, motivational
interviewing sessions at 1 and 6 months. These interventions emphasize on
LDL-C goals, adherence to lipid-lowering medication, and healthy
dietary-lifestyle habits, and are not provided to patients in the control
group, who receive usual care. At 12 months after each patient's
discharge, an in-person interview and lipid profile reassessment are
performed. The primary outcomes are the assessment of LDL-C goal
achievement (<70 mg/dL or >50% reduction from baseline levels) from
baseline to 1 year and changes in medication adherence. Secondary outcomes
relate to the incidence of the composite outcome of cardiovascular death,
nonfatal myocardial infarction/stroke, need for myocardial
revascularization, and recurrent hospitalization during the follow-up
period. <br/>Discussion(s): This paper describes the protocol, design, and
rationale for key methodology for an ongoing clinical trial featuring a
simple and feasible intervention. Similar adherence efficacy trials have
not led to sufficient improvements, and there remains a gap regarding how
adherence interventions should be implemented into clinical
care.<br/>Copyright &#xa9; 2018 Hellenic Society of Cardiology

<77>
Accession Number
2005127868
Title
Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in
Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1457-1463),
2020. Date of Publication: June 2020.
Author
van Klarenbosch J.; van den Heuvel E.R.; van Oeveren W.; de Vries A.J.
Institution
(van Klarenbosch) Department of Anesthesiology, University Medical Center
Utrecht, Utrecht, Netherlands
(van den Heuvel) Department of Mathematics & Computer Science, Eindhoven
University of Technology, Eindhoven, Netherlands
(van Oeveren) HaemoScan BV, Groningen, Netherlands
(de Vries) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Primary outcome was the risk for infections after cell salvage
in cardiac surgery. <br/>Design(s): Data of a randomized controlled trial
on cell salvage and filter use (ISRCTN58333401). <br/>Setting(s): Six
cardiac surgery centers in the Netherlands. <br/>Participant(s): All 716
patients undergoing elective coronary artery bypass grafting, valve
surgery, or combined procedures over a 4-year period who completed the
trial. <br/>Intervention(s): Postoperative infection data were assessed
according to Centre of Disease Control and Prevention/National Healthcare
Safety Network surveillance definitions. <br/>Measurements and Main
Results: Fifty-eight (15.9%) patients with cell salvage had infections,
compared with 46 (13.1%) control patients. Mediation analysis was
performed to estimate the direct effect of cell salvage on infections (OR
2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic
transfusion and processed cell salvage blood on infections. Correction for
confounders, including age, seks and body mass index was performed.
Allogeneic transfusion had a direct effect on infections (OR = 2.082
[1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR =
0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of
cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p <
0.001), but a negative direct effect of processed cell salvage blood
(1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there
was a positive direct effect of cell salvage on the amount of processed
blood. <br/>Conclusion(s): Cell salvage was directly associated with
higher infection rates, but this direct effect was almost completely
eliminated by its indirect protective effect through reduced allogeneic
blood transfusion.<br/>Copyright &#xa9; 2020 The Authors

<78>
Accession Number
2004868838
Title
Reduction of Inflammation by High-Dose Methylprednisolone Does not
Attenuate Oxidative Stress in Children Undergoing Bidirectional Glenn
Procedure With or Without Aortic Arch or Pulmonary Arterial Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1542-1547),
2020. Date of Publication: June 2020.
Author
Keski-Nisula J.; Arvola O.; Jahnukainen T.; Andersson S.; Pesonen E.
Institution
(Keski-Nisula) Division of Anaesthesiology, Department of Anaesthesiology,
Intensive Care and Pain Medicine, Children's Hospital, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Arvola) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Jahnukainen) Department of Pediatric Nephrology and Transplantation,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Andersson) Department of Neonatology, Pediatric Research Center,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Pesonen) Division of Anaesthesiology, Department of Anaesthesiology,
Intensive Care and Pain Medicine, Kirurginen sairaala, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids attenuate an inflammatory reaction in pediatric
heart surgery. Inflammation is a source of free oxygen radicals. Children
with a cyanotic heart defect are prone to increased radical stress during
heart surgery. The authors hypothesized that high-dose methylprednisolone
reduces inflammatory reaction and thereby also oxidative stress in infants
with a univentricular heart defect undergoing the bidirectional Glenn
procedure. <br/>Design(s): A double-blind, placebo-controlled, randomized
clinical trial. <br/>Setting(s): Operating room and pediatric intensive
care unit of a university hospital. <br/>Participant(s): The study
comprised 29 infants undergoing the bidirectional Glenn procedure with or
without aortic arch or pulmonary arterial repair. <br/>Intervention(s):
After anesthesia induction, the patients received intravenously either 30
mg/kg of methylprednisolone (n = 15) or the same volume of saline as
placebo (n = 14). <br/>Measurements and Main Results: Plasma
interleukin-6, interleukin-8, interleukin-10 (biomarkers of inflammation),
and 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative
stress) were measured at the following 4 time points: preoperatively,
during cardiopulmonary bypass, after protamine administration, and 6 hours
postoperatively. The study parameters did not differ between the study
groups preoperatively. Methylprednisolone reduced the proinflammatory
cytokines interleukin-6 and interleukin-8 and increased the
anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced
inflammation, there were no differences in 8-hydroxydeoxyguanosine between
the methylprednisolone and placebo groups. <br/>Conclusion(s): The
proinflammatory reaction and increase in free radical stress were not
interrelated during congenital heart surgery in cyanotic infants with a
univentricular heart defect undergoing the bidirectional Glenn procedure.
High-dose methylprednisolone was ineffective in attenuating free radical
stress.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<79>
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

<80>
Accession Number
2005698517
Title
Low-dose colchicine after MI reduced a composite ischemic cardiovascular
outcome vs placebo.
Source
Annals of Internal Medicine. 172 (8) (pp JC39), 2020. Date of Publication:
21 Apr 2020.
Author
Bach R.G.
Institution
(Bach) Washington University School of Medicine, St. Louis, MO, United
States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<81>
Accession Number
2003450587
Title
Trials Focusing on Prevention and Treatment of Delirium After Cardiac
Surgery: A systematic Review of Randomized Evidence.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1641-1654),
2020. Date of Publication: June 2020.
Author
Pieri M.; De Simone A.; Rose S.; De Domenico P.; Lembo R.; Denaro G.;
Landoni G.; Monaco F.
Institution
(Pieri, De Domenico, Lembo, Denaro, Landoni, Monaco) Department of
Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(De Simone) Department of Neonatal Intensive Care Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Rose) Department of Neurology Rehabilitation, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Publisher
W.B. Saunders
Abstract
Background: Delirium after cardiac surgery is associated with adverse
outcomes, including prolonged hospital stay, prolonged intensive care unit
stay, and increased mortality. Effective preventive interventions and
treatments still are largely unknown. <br/>Aim(s): This systematic review
aimed to gather and summarize the existing evidence from randomized trials
concerning interventions studied in the prevention or treatment of
delirium in adult patients undergoing cardiac surgery. <br/>Method(s): A
systematic review of the literature using a key word strategy and Boolean
operators was performed. PubMed and the Cochrane and Scopus databases were
searched for pertinent studies until July 2018 (no inception limit).
<br/>Result(s): Of 2,556 articles identified, 56 studies met the inclusion
criteria and were included in the review-39 addressed pharmacologic
strategies and 17 nonpharmacologic interventions. Interestingly, 51 (91%)
trials focused on delirium prevention and only 5 (9%) on delirium
treatment. Most of the analyzed studies were recent double-blind,
single-center trials conducted in Europe or North America, with a low risk
of bias. Overall, 38 different interventions were identified: 15 (26%)
interventions were performed before surgery, 20 (36%) in the operating
room, and 21 (38%) after surgery. The most frequently analyzed strategies
were the administration of dexmedetomidine, ketamine, antipsychotics,
glucocorticoids, propofol, opioids, volatile anesthetics, local
anesthetics, and remote ischemic preconditioning. The analyzed strategies
were extremely heterogenous, and dexmedetomidine was the most promising
measure able to prevent the development of postoperative delirium.
<br/>Conclusion(s): In the present systematic review of 56 randomized
controlled trials that examined 38 interventions, the authors found that
dexmedetomidine was the most frequently studied agent and that it might
reduce the occurrence of delirium after cardiac surgery.<br/>Copyright
&#xa9; 2019 Elsevier Inc.

<82>
Accession Number
2002448855
Title
Bilateral or unilateral antegrade cerebral perfusion during surgery for
acute type A dissection.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (6) (pp 2159-2167.e2),
2020. Date of Publication: June 2020.
Author
Angleitner P.; Stelzmueller M.-E.; Mahr S.; Kaider A.; Laufer G.; Ehrlich
M.
Institution
(Angleitner, Stelzmueller, Mahr, Laufer, Ehrlich) Division of Cardiac
Surgery, Department of Surgery, Medical University of Vienna, Vienna,
Austria
(Kaider) Center for Medical Statistics, Informatics, and Intelligent
Systems, Medical University of Vienna, Vienna, Austria
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to investigate outcomes associated with
the application of bilateral or unilateral antegrade cerebral perfusion
during surgery for acute type A dissection. <br/>Method(s): Patients who
underwent surgery for type A dissection with the application of antegrade
cerebral perfusion between 2009 and 2017 at the Division of Cardiac
Surgery, Medical University of Vienna were analyzed retrospectively
(bilateral antegrade cerebral perfusion: n = 91, 49.5%; unilateral
antegrade cerebral perfusion: n = 93, 50.5%). The primary outcome variable
was overall survival. Subgroup analyses were performed in patients
requiring antegrade cerebral perfusion durations of 50 minutes or more and
less than 50 minutes. Secondary outcome variables were 30-day mortality,
adverse outcome, permanent and temporary neurologic deficits, renal
replacement therapy, prolonged ventilation, intensive care unit stay, and
hospital stay. <br/>Result(s): Multivariable Cox proportional hazards
analysis demonstrated no significant association of bilateral antegrade
cerebral perfusion with overall survival (hazard ratio, 0.63; 95%
confidence interval, 0.34-1.14, P = .126). Propensity score modeling using
the method of inverse probability of treatment weighting confirmed this
result (hazard ratio, 0.73; 95% confidence interval, 0.33-1.60, P = .428).
Bilateral antegrade cerebral perfusion was associated with significantly
improved overall survival in patients requiring antegrade cerebral
perfusion durations of 50 minutes or more (P = .017). The bilateral
antegrade cerebral perfusion and unilateral antegrade cerebral perfusion
groups showed comparable rates of secondary outcome variables.
<br/>Conclusion(s): In the present study, bilateral antegrade cerebral
perfusion and unilateral antegrade cerebral perfusion are associated with
comparable outcomes after surgery for type A dissection. Subgroup analyses
suggest that bilateral antegrade cerebral perfusion is associated with
superior overall survival in patients requiring antegrade cerebral
perfusion durations of 50 minutes or more. An adequately powered
prospective randomized controlled trial is required to validate these
results.<br/>Copyright &#xa9; 2019 The American Association for Thoracic
Surgery

<83>
Accession Number
2002392296
Title
The del Nido versus cold blood cardioplegia in aortic valve replacement: A
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (6) (pp 2275-2283.e1),
2020. Date of Publication: June 2020.
Author
Sanetra K.; Gerber W.; Shrestha R.; Domaradzki W.; Krzych L.; Zembala M.;
Cisowski M.
Institution
(Sanetra, Gerber, Shrestha, Domaradzki, Cisowski) 1st Department of
Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland
(Sanetra, Gerber, Shrestha, Domaradzki, Cisowski) Center for
Cardiovascular Research and Development, American Heart of Poland,
Bielsko-Biala, Poland
(Krzych) Department of Anesthesiology and Intensive Therapy, Medical
University of Silesia, Katowice, Poland
(Zembala, Cisowski) Department of Cardiac, Vascular and Endovascular
Surgery and Transplantology, Zabrze, Poland
(Zembala, Cisowski) Medical University of Silesia, Katowice, Poland
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To compare the cardioprotective efficacy of a solution that
requires only a single infusion at the start of the ischemic duration
versus a solution that requires multiple infusions. <br/>Method(s): Aortic
valve replacement was performed for 150 patients, who were randomized into
the del Nido (DN) cardioplegia group or the cold blood (CB) cardioplegia
group. The DN cardioplegia was delivered every 90 minutes and the CB
cardioplegia was delivered every 20 to 30 minutes, or whenever cardiac
activity was observed. The primary endpoints were electrical cardiac
activity during crossclamp, ventricular fibrillation during reperfusion,
and postoperative troponin and creatine kinase (CK-MB isoenzyme) at 24 and
48 hours. <br/>Result(s): Electrical activity during crossclamp occurred
in 29 (39.7%) patients in the DN group versus 34 (45.3%) patients in the
CB group (adjusted P = 1.0). The number of procedures with ventricular
fibrillation after removing the crossclamp was 41 (54.7%) in the CB group
versus 17 (22.7%) in the DN group (adjusted P = .001; relative risk,
2.41). Troponin values appeared to be lower in the DN group (median,
223.10; interquartile range, 168.35-364.77 pg/mL vs 285.5; 196.20-419.45
pg/mL at 24 hours and 159.60; 125.42-217.20 pg/mL vs 201.60; 160.62-268.45
pg/mL at 48 hours) and CK-MB (median, 14.94; interquartile range,
12.16-20.39 ng/mL vs 17.43; 13.66-22.43 ng/mL at 24 hours and 6.19;
4.41-7.63 ng/mL vs 7.38; 4.74-10.20 ng/mL at 48 hours), but no
significance was found. <br/>Conclusion(s): The del Nido cardioplegia
protocol is an acceptable alternative for cold blood cardioplegia in
patients undergoing aortic valve replacement.<br/>Copyright &#xa9; 2019
The American Association for Thoracic Surgery

<84>
Accession Number
631727120
Title
A systematic review of the aortic arch branching pattern variants. Their
clinical impact.
Source
Journal of Anatomy. Conference: 19th International Federation of
Associations of Anatomists Congress. United Kingdom. 236 (Supplement 1)
(pp 328-329), 2020. Date of Publication: April 2020.
Author
Natsis K.; Loukas M.; Lazaridis N.; Kalamatianos T.; Piagkou M.
Institution
(Natsis, Lazaridis) Department of Anatomy and Surgical Anatomy, School of
Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
(Loukas) Department of Anatomical Sciences, St. George's University, St.
George's, Grenada
(Kalamatianos) Athens Microneurosurgery Laboratory, Department of
Neurosurgery, Evangelismos Hospital, Athens, Greece
(Piagkou) Department of Anatomy, School of Medicine, National and
Kapodistrian University of Athens, Athens, Greece
Publisher
Blackwell Publishing Ltd
Abstract
The typical branching pattern of the aortic arch (AA) consists of three
main branches from right to left; the brachiocephalic trunk (BCT) followed
by the left common carotid artery (LCCA) and the left subclavian artery
(LSCA). Differences among the AA branching patterns arise from alterations
in the development of the embryologic pharyngeal arch arteries during the
gestational period. The current systematic review highlights the
prevalence data of the AA variants and provides the incidence of the most
common and uncommon types. Moreover, it classifies all detected variants
in types and underlines their clinical impact. A systematic search of the
electronic databases PubMed, Embase, Scopus, ScienceDirect, Web of Science
and SciELO was performed for detecting the incidence of AA variants.
Studies including prevalence data on cadavers were collected and analyzed.
A total of 20 articles were included (N = 4610 arches). The typical
branching pattern was detected in 3502 cadavers (76%), while the AA
branching pattern variants were detected in 1086 cadavers (23.6%). The
origin of the LCCA from the BCT was detected in 625 cases (13.6%), the
left vertebral artery variant origin from the AA was detected in 184 cases
(4%) and the common origin BCT and LCCA was found in 159 cases (3.45%).
The aberrant right subclavian artery (ARSCA) was detected in 40 cases
(0.87%), the bi-BCT in 25 cases (0.54%), a thyroidea ima artery
originating from the AA in 13 cases (0.28%), while the other variants were
less than 0.67%. Although patients with AA variants are often
asymptomatic, they constitute a significant part of the population and
pose a high risk of hemorrhage and ischemia during thoracic surgery.
Because of the possibility of encountering such variants, surgeons should
consider potential variations when planning endovascular procedures in the
thorax.

<85>
Accession Number
631725032
Title
Utility of positron emission tomography imaging in the diagnosis of
chronic Q fever - A review of the literature.
Source
Journal of Medical Imaging and Radiation Oncology. Conference: 70th Annual
Scientific Meeting of the Royal Australian and New Zealand College of
Radiologists, RANZCR 2019. New Zealand. 63 (Supplement 1) (pp 43-44),
2019. Date of Publication: October 2019.
Author
Visvalingam R.; Sivabalan P.; Norton R.
Institution
(Visvalingam) Logan Hospital, QLD, Australia
(Sivabalan) University of Queensland, St Lucia, QLD, Australia
(Sivabalan, Norton) Townsville Hospital, Queensland, Australia
(Norton) James Cook University, Townsville, QLD, Australia
Publisher
Blackwell Publishing
Abstract
Purpose: Diagnosing chronic Q fever is a challenging clinical problem
caused by the intracellular gram-negative coccobacillus Coxiella burnetii,
an organism very difficult to culture. Diagnosis therefore usually relies
on serology and/or the detection of DNA via a direct tissue sample.
Positron emission tomography/computed tomography (PET/CT) is an imaging
technique that identifies tissues with increased metabolism and can
identify a focus of infection in suspected chronic Q fever. PET/CT has
therefore potentially evolved the term chronic Q fever to Coxiella
burnetii persistent focalised infection (1). Our aim was to review the
existing literature on the use of PET/CT to diagnose chronic Q fever
radiologically. Methods and Materials: A literature search was conducted
in PubMed and Google Scholar and the terms "Positron Emission Tomography"
and "PET CT" in combination with subheadings "chronic Q fever" or
"Coxiella burnetii" were used with 231 articles initially attained. After
application of the exclusion criteria, 28 articles were included into the
study. The 28 articles consisted of case reports (20), case series (1) and
observational studies (7). <br/>Result(s): The majority of literature
found were case studies that discussed how PET/CT was useful to identify a
focus of infection in a particular individual. Of the 20 case reports, 9
were cases where the focus of infection was in a vascular prosthesis
(including valve replacements and vascular grafts), 4 were cases of native
vascular infection (either endocarditis or an infected aneurysm) and 3
were cases of osteoarticular infection. The remaining 3 case reports and 1
case series used PET/CT to screen for infection but no focus was found.
Four retrospective studies looked at the percentage of patients who had a
PET/CT in proven chronic Q fever. Within these studies, PET/CT identified
the focus of infection in approximately 50- 80% of cases (1-4). Two other
studies also identified that 13.5-25% of patients who had PET/CT during
the work-up of their chronic Q fever benefitted due to change in diagnosis
or identification of a focus of infection (5, 6). <br/>Conclusion(s):
PET/CT is a clinically useful tool in the diagnosis of chronic Q fever.
Literature suggests that the most valuable implementation is in detecting
both native and prosthetic vascular infections both at an individual case
based level and in a wider population. It is also useful to diagnose a
focus of infection and guide clinicians when no symptoms or other clinical
features are present.

<86>
Accession Number
631724768
Title
Preferable strategies of lad revascularization: Early results of
randomized trial.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 22nd Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic and Vascular Surgery, ISMICS, 2019.
United States. 14 (2 Supplement) (pp 155S), 2019. Date of Publication:
2019.
Author
Popov V.; Malyshenko E.; Novikov M.; Edzhibiya G.; Revishvili A.
Institution
(Popov, Malyshenko, Novikov, Edzhibiya, Revishvili) A.V. Vishnevsky
National Medical Research Center of Surgery, Moscow, Russian Federation
Publisher
SAGE Publications Ltd
Abstract
Background: To evaluate in-hospital results of prospective randomized
controlled trial (RCT) ENPILA (endoscopic- assisted coronary artery bypass
[EndoACAB] vs. percutaneous intervention [PCI] for left anterior
descending artery [LAD] revascularization). <br/>Method(s): Our
prospective RCT is maintained in A.V. Vishnevsky National Medical Research
Center of Surgery, Moscow, Russia. Trial includes 100 patients. Inclusion
criterion is isolated critical LAD lesions, suitable for either EndoACAB,
or PCI revascularization. EndoACAB consists of harvesting internal mammary
artery with endoscopic techniques and LAD direct vision anastomosis
formation through the anterolateral minithoracotomy 3-4 cm with myocardium
stabilizer. Patients were divided into 2 groups, 50 patients each. First
group includes patients, who underwent LAD EndoACAB. Second group includes
patients, who underwent PCI to LAD. Check points of postoperative
examination in both groups were evaluated in 24 and 48 weeks. As an
evaluation of myocardial revascularization primal endpoints were analyzed,
including major adverse cardiovascular events, such as death, non-lethal
myocardial infarction, recurrent revascularization; and secondary
endpoints: conversion, bleeding in perioperative period, pain, quality of
life. To date, this trial includes 52 patients, 25 patients in the 1st
group and 27 patients in the 2nd. <br/>Result(s): In the 1st group
EndoACAB procedure was successfully performed in all cases (100%). In the
2nd group all PCIs were performed without any complications. During
in-hospital period in both groups, there were no significant differences
in primary and secondary endpoints. All patients in early in-hospital
period underwent coronary angiography and shuntography. Incomplete
myocardial revascularization, technical difficulties, and other
complications did not occur. <br/>Conclusion(s): Minimally invasive
endoscopic-assisted myocardial revascularization showed good results,
comparable with the PCI results during in-hospital period.

<87>
Accession Number
631724624
Title
Outcomes of surgical aortic valve replacement with pulmonary hypertension:
A systematic review and meta-analysis.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 22nd Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic and Vascular Surgery, ISMICS, 2019.
United States. 14 (2 Supplement) (pp 123S-124S), 2019. Date of
Publication: 2019.
Author
Rocha R.V.; Friedrich J.O.; Hong K.; Lee J.; Verma S.; Cheema A.; Bagai
A.; Yanagawa B.
Institution
(Rocha, Friedrich, Hong, Lee, Verma, Cheema, Bagai, Yanagawa) St Michaels
Hospital, University of Toronto, Toronto, ON, Canada
Publisher
SAGE Publications Ltd
Abstract
Objective: Pulmonary hypertension (PHT) is frequently associated with
aortic stenosis and can complicate the outcome of surgical aortic valve
replacement (SAVR). We sought to evaluate the prognostic impact of PHT on
the outcomes of SAVR. <br/>Method(s): We searched MEDLINE and EMBASE
databases for studies reporting the results of patients with PHT
undergoing SAVR. We identified 13 observational studies. Data were
subjected to a meta-analysis using a random-effects model. <br/>Result(s):
Compared to patients with mild-moderate PHT, patients with severe PHT
undergoing SAVR were older (mean difference [MD] 2.31 years [95%
confidence interval {CI}: 1.38, 3.23], p < 0.01, I² = 71%) with
reduced left ventricle ejection fraction (MD -9.48 years [95% CI: -13.09,
-5.88], p < 0.01, I² = 64%). Patients with severe PHT, compared
to patients with mild-moderate PHT, have higher in-hospital mortality
(5.0% vs. 2.6%) (RR 2.29 [95% CI: 1.52, 3.46], p < 0.01, I² =
0%) (Figure P12-1) as well as acute renal failure (12.6% vs. 6.4%) (RR
2.05 [95% CI: 1.57-2.67], p < 0.01, I² = 0%), prolonged
ventilation (15.8% vs. 9.0%) (RR 1.91 [95% CI: 1.50-2.45], p < 0.01,
I² = 0%), and longer hospital length of stay (MD 1.93 days [95%
CI: 0.12, 3.74], p = 0.04, I² = 96%). <br/>Conclusion(s):
Patients with severe PHT were older with greater comorbidities and were at
a higher risk of mortality and adverse outcomes following SAVR. Such
patients may benefit from less-invasive transcatheter aortic valve
replacement. (Figure Presented).

<88>
Accession Number
631725511
Title
Cable closure versus conventional wire cerclage for sternotomy after
cardiac surgery: A systematic review and meta-analysis.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 22nd Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic and Vascular Surgery, ISMICS, 2019.
United States. 14 (2 Supplement) (pp 183S-184S), 2019. Date of
Publication: 2019.
Author
Tam D.; Dixit A.; Yu M.; Lam T.; Fremes S.
Institution
(Tam, Dixit, Yu, Lam, Fremes) University of Toronto, Toronto, ON, Canada
Publisher
SAGE Publications Ltd
Abstract
Objective: The median sternotomy is one the most commonly performed
osteotomies globally, allowing for quick access and excellent exposure to
the mediastinum. There are some studies to suggest that a cable closure
technique may be superior to conventional wire cerclage (WC) in providing
a stable sternal closure. Individual studies may be underpowered to detect
for differences in important clinical endpoints. Thus, a study level
meta-analysis compared CC to WC is necessary to determine the potential
benefits of this novel technique in sternal closure. <br/>Method(s): A
systematic review of the literature for all studies comparing CC to WC was
performed. The primary outcome was sternal wound infection, the secondary
outcomes were mortality, dehiscence, deep sternal wound infection (DSWI),
post-operative pain scores, and hospital length of stay. Crude event rates
were aggregated. Binary outcomes and continuous outcomes were analyzed as
risk ratios (RR) and mean differences (MD), respectively, in a
random-effects meta-analysis. <br/>Result(s): From 387 unique citations
found, six studies were included (n = 2702). There were three randomized
clinical trials (RCTs, n = 716), one adjusted (n = 784) and two unadjusted
(n = 1202) observational studies. There was no difference in the primary
outcome between CC and WC (3.9% vs. 4.1%, RR: 0.83, 95% confidence
interval (95%CI): 0.48, 1.46, p = 0.28). The rate of dehiscence was
decreased with CC (0.2% vs. 2.6%, RR: 0.12, 95% CI: 0.02, 0.66, p = 0.01).
There was no difference in DSWI or mortality between the two groups (Table
P114-1). Mean pain score was reduced with CC compared to WC (MD: -1.04,
95% CI: -1.89, -0.19, p = 0.02) while total hospital length of stay was
similar between the two groups. <br/>Conclusion(s): Individual studies
comparing CC to WC were underpowered to detect for differences in key
clinical outcomes. Our analysis shows that the use of CC may reduce the
risk of sternal dehiscence and reduce post-operative pain. Further work in
the form of large multi-centered RCTs is required to confirm these
findings. (Table Presented).

<89>
Accession Number
631726503
Title
Does prophylactic pulmonary vein isolation decrease the incidence of
atrial fibrillation after cabg?.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 22nd Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic and Vascular Surgery, ISMICS, 2019.
United States. 14 (2 Supplement) (pp 72S), 2019. Date of Publication:
2019.
Author
Revishvili A.S.; Popov V.A.; Malyshenko E.S.; Anishchenko M.M.
Institution
(Revishvili, Popov, Malyshenko, Anishchenko) A.V. Vishnevsky Institute of
Surgery, Moscow, Russian Federation
Publisher
SAGE Publications Ltd
Abstract
Background: To evaluate early results in prospective randomized controlled
trial (RCT) prophylactic pulmonary vein ablation (PULVAB) for coronary
artery bypass grafting (CABG). <br/>Method(s): The RCT including 96
patients with coronary artery disease was conducted. There were 3 groups:
group 1 (n = 34) was the controlled group of the conventional CABG without
ablation. In group 2 (n = 29), conventional CABG was combined with
prophylactic pulmonary bipolar radiofrequency ablation (RFA). In group 3,
conventional CABG and prophylactic PULVAB were added with the
administration of amiodarone in the postoperative period. <br/>Result(s):
Concomitant ablation did not lead to the increase of the operation's main
stages' length. The time of operation was 251 +/- 37.7 minutes in group 1,
250.4 +/- 42.5 minutes in group 2, and 244.2 +/- 29 minutes in group 3 (p
= 0.114) and did not differ in the cardiopulmonary bypass time (88.6 +/-
19.2; 92 +/- 18.4 and 84.8 +/- 17.3 minutes; p = 0.08). In-hospital
mortality was 0 among the studied groups. Wound complications, bleeding,
perioperative myocardial infarction, and stroke were not also noted.
Postoperative atrial fibrillation (AF) was registered in 11 (32.4%)
patients from the 1st group, in 6 (20.7%) from the 2nd group, and in 2
(6.1%) from the 3rd group. There was no significant difference between
groups 1 and 2 (p = 0.298) and also between groups 2 and 3 (p = 0.086).
Statistically significant difference was registered between patients from
groups 1 and 3 (p = 0.0065), which indicates the effectiveness of the
combined methods for preventing AF. AF in 91% of patients occurred at 2-4
days of the postoperative period. Sinus rhythm at discharge was recorded
in 97.1% (group 1), 96.7% (group 2), and 97% (group 3), respectively (p =
0.293). <br/>Conclusion(s): There was a tendency to a decrease in the
frequency of AF in patients undergoing preventive bipolar RFA of the
pulmonary veins. The combination of prophylactic bipolar RFA and
amiodarone usage revealed significantly positive results in the
postoperative AF prevention.

<90>
Accession Number
631726481
Title
Effectiveness of minimally invasive left atrial appendage exclusion on
stroke reduction.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 22nd Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic and Vascular Surgery, ISMICS, 2019.
United States. 14 (2 Supplement) (pp 71S-72S), 2019. Date of Publication:
2019.
Author
Digiorgi P.L.; Yeager N.; Deily J.; Buss R.; Defrain M.; Hummel B.
Institution
(Digiorgi, Yeager, Deily, Buss, Defrain, Hummel) Lee Health, Fort Myers,
FL, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Thromboembolic (TE) stroke remains a common and morbid
complication of atrial fibrillation (AF) despite maximal medical therapy.
Open surgical control of the left atrial appendage, in patients with AF,
has been associated with a reduction in the incidence of stroke. Minimally
invasive surgical approaches to the left atrial appendage provide an
attractive option facilitating increased access for patients. We sought to
investigate the incidence of TE stroke in our patients who underwent left
atrial appendage exclusion and compare those outcomes to expected stroke
rates based on CHA2DS2-VASc scoring. <br/>Method(s): All adult cardiac
surgical patients who underwent left atrial appendage exclusion at our
institution were retrospectively studied. Baseline clinical data including
age, type of surgery, approach, and CHA2DS2-VASc score were evaluated. The
incidence of stroke was calculated at the most recent follow-up. The
observed stroke rate was compared to the expected stroke rate base on
CHA2DS2-VASc scoring. <br/>Result(s): Between September 2011 and June
2017, 241 patients underwent left atrial appendage exclusion as a
stand-alone procedure or with other concomitant cardiac surgical
procedures. Two hundred thirty patients (95%) were available for
follow-up. One hundred sixty-eight patients (73%) of these patients had
the procedure performed minimally invasively either by a right
minithoracotomy, upper sternotomy, or via a video-assisted approach.
Median age was 72 (range 43-89 years), percent male was 68, median
baseline CHA2DS2-VASc was 3. One hundred ten patients (48%) were on oral
anticoagulation at the time of follow-up. At an average of 21 months
follow-up, the incidence of embolic stroke was 0.9% vs. an expected stroke
rate of 5.6% based on their CHA2DS2-VASc (p < 0.05). <br/>Conclusion(s):
Various minimally invasive approaches are feasible for left atrial
appendage exclusion. These approaches to left atrial appendage exclusion
are associated with a reduction in stroke incidence. Randomized,
prospective trials may help clarify the benefits of surgical left atrial
appendage exclusion.

<91>
Accession Number
631724458
Title
Partial upper sternotomy versus full sternotomy for mitral valve surgery:
A propensity score-matched analysis.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 22nd Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic and Vascular Surgery, ISMICS, 2019.
United States. 14 (2 Supplement) (pp 121S), 2019. Date of Publication:
2019.
Author
Oezpeker C.U.; Hoefer D.; Barbieri F.; Bonaros N.; Grimm M.; Mueller L.
Institution
(Oezpeker, Hoefer, Barbieri, Bonaros, Grimm, Mueller) Medical University
of Innsbruck, Innsbruck, Austria
Publisher
SAGE Publications Ltd
Abstract
Background: Minimally invasive mitral valve surgery through anterolateral
minithoracotomy (MT) has become the standard therapy for isolated mitral
valve disease in experienced centers. Multiple valve disease or other
anatomical and certain clinical conditions, however, make this access not
suitable for some patients and conventional full sternotomy (FS) is the
mostly preferred alternative approach. For those patients partial upper
sternotomy (PS) can be used as a less-invasive access. Whereas FS has been
widely investigated, there are not enough insights to the PS approach for
mitral valve surgery (MVS). Therefore, we compared the data of both
accesses. <br/>Method(s): This retrospective analysis includes data on
1,639 patients, who underwent either isolated or combined primary MVS at
our department from May 2011 to August 2017. Out of these, 1,191 patients
were excluded from this analysis due to MT access (n = 663) and due to
concomitant coronary artery bypass surgery but also because of redo cases,
concomitant aortic surgery or urgent/salvage MVS (n = 528). Finally, 99
patients had been judged suitable for PS. In addition, 349 patients with
FS for primary MVS were included in our study. To reduce the possibility
of selection bias, a 1:1 propensity-score matchmaking was performed, which
resulted in 98 pairs. <br/>Result(s): During a median follow-up time of
1,491 days (478-2186; PS 1,103 [331-1,806 days], FS 2,180 days [841-3054])
all-cause mortality was 15.90% (70 of 439 patients). In the propensity
score paired model, PS showed statistically significant superior survival
compared to FS at 30 days (p = 0.044, hazard ratio [HR] 7.525, 95%
confidence interval [CI] 1.06-53.56). Furthermore, 90- and 365-day
survival after surgery showed a similar trend, but without reaching
statistical significance (p = 0.096 and p = 0.077). As secondary endpoints
number of second pump runs and hospital length of stay were significantly
less (p = 0.016, p < 0.001) in PS patients. <br/>Conclusion(s): The
less-invasive PS approach for MVS seems to have short- and long-term
survival benefits. Patients who are not candidates for MT PS seem a
favorable approach although prospective randomized-controlled trials are
necessary for confirmation.

<92>
Accession Number
631646885
Title
Anticoagulation with or without clopidogrel after transcatheter
aortic-valve implantation.
Source
New England Journal of Medicine. 382 (18) (pp 1696-1707), 2020. Date of
Publication: 30 Apr 2020.
Author
Nijenhuis V.J.; Brouwer J.; Delewi R.; Hermanides R.S.; Holvoet W.; Dubois
C.L.F.; Frambach P.; de Bruyne B.; van Houwelingen G.K.; van der Heyden
J.A.S.; Tousek P.; van der Kley F.; Buysschaert I.; Schotborgh C.E.;
Ferdinande B.; van der Harst P.; Roosen J.; Peper J.; Thielen F.W.F.;
Veenstra L.; Chan D.R.P.P.; Yin P.; Swaans M.J.; Rensing B.J.W.M.; van't
Hof A.W.J.; Timmers L.; Kelder J.C.; Stella P.R.; Baan J.; ten Berg J.M.
Institution
(Nijenhuis, Brouwer, Peper, Chan, Yin, Swaans, Rensing, Timmers, Kelder,
ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Delewi, Baan) Department of Cardiology, Amsterdam University Medical
Centers, Location AMC, Amsterdam, Netherlands
(Hermanides) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Holvoet, Veenstra, van't Hof) Department of Cardiology, Maastricht
University Medical Center, Cardiovascular Research Institute, Maastricht,
Netherlands
(van Houwelingen) Department of Cardiology, Medisch Spectrum Twente,
Enschede, Netherlands
(van der Kley) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(van der Harst) Department of Cardiology, University Medical Center
Groningen, Groningen, Netherlands
(Thielen) Erasmus School of Health Policy and Management, Erasmus
University, Rotterdam, Netherlands
(van't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
(Stella) Department of Cardiology, Division of Heart and Lungs, University
Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
(Dubois) Department of Cardiology, University Hospital Leuven, Leuven,
Belgium
(de Bruyne) Department of Cardiology, Onze Lieve Vrouwe Hospital,
Netherlands
(Buysschaert) Department of Cardiology, Algemeen Stedelijk Hospital Aalst,
Aalst, Belgium
(van der Heyden) Department of Cardiology, Sint-Jan Hospital, Brugge,
Belgium
(Ferdinande) Department of Cardiology, Hospital Oost-Limburg, Genk,
Belgium
(Roosen) Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
(Frambach) Department of Cardiology, Institut National de Chirurgie
Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
(Tousek) Department of Cardiology, University Hospital Kralovske Vinohrady
and Third Medical Faculty, Charles University, Prague, Czechia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The roles of anticoagulation alone or with an antiplatelet
agent after transcatheter aortic-valve implantation (TAVI) have not been
well studied. METHODS We performed a randomized trial of clopidogrel in
patients undergoing TAVI who were receiving oral anticoagulation for
appropriate indications. Patients were assigned before TAVI in a 1:1 ratio
not to receive clopidogrel or to receive clopidogrel for 3 months. The two
primary outcomes were all bleeding and non-procedure-related bleeding over
a period of 12 months. Procedure-related bleeding was defined as Bleeding
Academic Research Consortium type 4 severe bleeding, and therefore most
bleeding at the puncture site was counted as non-procedure-related. The
two secondary outcomes were a composite of death from cardiovascular
causes, non-procedure-related bleeding, stroke, or myocardial infarction
at 12 months (secondary composite 1) and a composite of death from
cardiovascular causes, ischemic stroke, or myocardial infarction
(secondary composite 2), both tested for noninferiority (noninferiority
margin, 7.5 percentage points) and superiority. RESULTS Bleeding occurred
in 34 of the 157 patients (21.7%) receiving oral anticoagulation alone and
in 54 of the 156 (34.6%) receiving oral anticoagulation plus clopidogrel
(risk ratio, 0.63; 95% confidence interval [CI], 0.43 to 0.90; P=0.01);
most bleeding events were at the TAVI access site. Non-procedure-related
bleeding occurred in 34 patients (21.7%) and in 53 (34.0%), respectively
(risk ratio, 0.64; 95% CI, 0.44 to 0.92; P=0.02). Most bleeding occurred
in the first month and was minor. A secondary composite 1 event occurred
in 49 patients (31.2%) receiving oral anticoagulation alone and in 71
(45.5%) receiving oral anticoagulation plus clopidogrel (difference, -14.3
percentage points; 95% CI for noninferiority, -25.0 to -3.6; risk ratio,
0.69; 95% CI for superiority, 0.51 to 0.92). A secondary composite 2 event
occurred in 21 patients (13.4%) and in 27 (17.3%), respectively
(difference, -3.9 percentage points; 95% CI for noninferiority, -11.9 to
4.0; risk ratio, 0.77; 95% CI for superiority, 0.46 to 1.31). CONCLUSIONS
In patients undergoing TAVI who were receiving oral anticoagulation, the
incidence of serious bleeding over a period of 1 month or 1 year was lower
with oral anticoagulation alone than with oral anticoagulation plus
clopidogrel.<br/>Copyright &#xa9; 2020 Massachusetts Medical Society.

<93>
Accession Number
2004888468
Title
Landiolol hydrochloride for prevention of atrial fibrillation during
esophagectomy: a randomized controlled trial.
Source
JA Clinical Reports. 6 (1) (no pagination), 2020. Article Number: 34. Date
of Publication: 01 Dec 2020.
Author
Aoki Y.; Kawasaki Y.; Ide K.; Shimizu Y.; Sato S.; Yokoyama J.
Institution
(Aoki) Department of Anesthesiology and Intensive Care Medicine, Hamamatsu
University School of Medicine, 1-20-1 Handayama, Higashi-Ku,
Hamamatsu-shi, Shizuoka 431-3192, Japan
(Aoki, Shimizu, Yokoyama) Department of Anesthesiology, Shizuoka General
Hospital, Shizuoka, Japan
(Kawasaki) Biostatistics Section, Clinical Research Centre, Chiba
University Hospital, Chiba, Japan
(Kawasaki) Faculty of Nursing, Japanese Red Cross College of Nursing,
Tokyo, Japan
(Ide) Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell
Research and Application, Kyoto University, Kyoto, Japan
(Sato) Department of Gastroenterological Surgery, Shizuoka General
Hospital, Shizuoka, Japan
Publisher
Springer
Abstract
Introduction: Landiolol hydrochloride reduces the incidence of
perioperative atrial fibrillation (AF) in cardiac surgery; however, little
evidence is available regarding its effects in other types of surgery,
including esophagectomy. We assessed the hypothesis that landiolol reduces
perioperative AF and other complications associated with esophagectomy.
<br/>Method(s): This single-center, randomized, double-blind,
parallel-group study enrolled patients scheduled for esophagectomy.
Patients were divided into those given landiolol at 3 mug/kg/min or
placebo for 24 h. The primary outcome was the proportion of patients who
developed AF within 96 h starting at 9:00 am on the day of surgery. The
secondary outcomes were the proportion of patients whose AF appeared
within 24 h, other complications based on the Clavien-Dindo
classification, and the intensive care unit and hospital stays.
<br/>Result(s): Despite early study termination, 80 patients were
screened, and 56 were enrolled (28/group) from September 2016 to June
2018. AF occurred within 96 h of surgery in six (21.4%) patients in the
landiolol group and five (17.9%) patients in the placebo group (odds
ratio, 1.26; 95% confidence interval, 0.33-4.7) and within 24 h of surgery
in three (10.7%) patients in the landiolol group and two (7.1%) patients
in the placebo group. There were no significant differences in the
incidence of complications or in the number of intensive care unit or
hospital stays between the groups. <br/>Conclusion(s): Although our small
sample size prevents definitive conclusions, landiolol might not reduce
the occurrence of AF or other complications. Trial registration: UMIN,
UMIN000024040. Registered 13 September 2016,
http://www.umin.ac.jp/ctr/index/htm.<br/>Copyright &#xa9; 2020, The
Author(s).

<94>
Accession Number
2004339017
Title
A randomized comparison of plasma levobupivacaine concentrations following
thoracic epidural analgesia and subpleural paravertebral analgesia in open
thoracic surgery.
Source
Journal of Clinical Medicine. 9 (5) (no pagination), 2020. Article Number:
1395. Date of Publication: May 2020.
Author
Matek J.; Cernohorsky S.; Trca S.; Krska Z.; Hoskovec D.; Bruthans J.;
Sima M.; Michalek P.
Institution
(Matek, Cernohorsky, Trca, Krska, Hoskovec) 1^st Department of
Surgery-Department of Abdominal, Thoracic Surgery and Traumatology, First
Faculty of Medicine, Charles University in Prague and General University
Hospital in Prague, Prague 128 00, Czechia
(Matek) Medical Faculty, Masaryk University, Brno 625 00, Czechia
(Bruthans, Michalek) Department of Anaesthesia and Intensive Care, First
Faculty of Medicine, Charles University in Prague and General University
Hospital in Prague, Prague 128 00, Czechia
(Sima) Institute of Pharmacology, First Faculty of Medicine, Charles
University in Prague and General University Hospital in Prague, Prague 128
00, Czechia
(Michalek) Department of Anaesthesia, Antrim Area Hospital, Antrim BT41
2RL, United Kingdom
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Background: The aim of this study was to compare plasma levobupivacaine
concentrations in thoracic epidural and subpleural paravertebral
analgesia. <br/>Method(s): Forty-four patients indicated for open lung
resection had an epidural catheter inserted preoperatively or a subpleural
catheter surgically. A bolus of 0.25% levobupivacaine at a dosage of 0.5
mg x kg^-1 was given after the thoracotomy closure. Plasma
levobupivacaine level at 30 min was the primary outcome. Pharmacokinetic
modeling was performed subsequently. Secondary outcomes included the
quality of analgesia, complications, and patients'mobility.
<br/>Result(s): Plasma concentrations were similar 30 min after
application-0.389 mg x L^-1 in the epidural and 0.318 mg x
L^-1 in the subpleural group (p = 0.33) and lower in the
subpleural group at 120 min (p = 0.03). The areas under the curve but not
maximum concentrations were lower in the subpleural group. The time to
reach maximum plasma level was similar in both groups-27.6 vs. 24.2 min.
No clinical symptoms of local anesthetic toxicity were recorded.
<br/>Conclusion(s): Levobupivacaine systemic concentrations were low in
both groups without the symptoms of toxicity. This dosage should be safe
for postoperative analgesia after thoracotomy.<br/>Copyright &#xa9; 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<95>
Accession Number
2005844445
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: 2020.
Author
Khidr A.M.; Khalil M.A.; Abdulfattah D.; El Tahan M.R.
Institution
(Khidr, El Tahan) 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
(Khalil) Faculty of Medicine, Cairo University, Cairo, Egypt
(Abdulfattah) Clinical Nursing Supervisor Operating Room, Day Surgery,
CSSD, Hemodialysis, and PDU, King Fahd Hospital of the Imam Abdulrahman
Bin Faisal University, Al Khobar, Saudi Arabia
Publisher
W.B. Saunders
Abstract
Objectives: Assess different remifentanil effect-site concentrations (Ce)
for readiness for extubation time after cardiac surgery. <br/>Design(s):
Prospective, randomized, blinded, controlled study. <br/>Design(s): Single
university hospital. <br/>Participant(s): Seventy-three patients scheduled
for cardiac surgery. <br/>Intervention(s): 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). <br/>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.

<96>
Accession Number
2004886305
Title
Resource utilization associated with hospital and office-based insertion
of a miniaturized insertable cardiac monitor: results from the RIO 2
randomized US study.
Source
Journal of Medical Economics. (no pagination), 2020. Date of Publication:
2020.
Author
Rogers J.D.; Piorkowski C.; Sohail M.R.; Anand R.; Kowalski M.; Rosemas
S.; Stromberg K.; Sanders P.
Institution
(Rogers) Department of Cardiology, Scripps Green Hospital, La Jolla, CA,
United States
(Piorkowski) Department of Electrophysiology, Herzzentrum Dresden,
Dresden, Germany
(Sohail) Divisions of Infectious Diseases and Cardiovascular Diseases,
Mayo Clinic College of Medicine, Rochester, MN, United States
(Anand) Electrophysiology Laboratory, Holy Cross Hospital, Fort
Lauderdale, FL, United States
(Kowalski) Division of Electrophysiology, Department of Cardiology, Staten
Island University Hospital and Northwell Health System, Manhasset, NY,
United States
(Rosemas, Stromberg) Cardiac Rhythm and Heart Failure, Medtronic, Inc,
Mounds View, MN, United States
(Sanders) Department of Cardiology, Royal Adelaide Hospital, Centre for
Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
Publisher
Taylor and Francis Ltd
Abstract
Background: Previous studies support operational benefits when moving
insertable cardiac monitor (ICM) insertions outside the cardiac
catheterization/electrophysiology laboratories, but this has not been
directly assessed in a randomized trial or when the procedure is
specifically moved to the office setting. To gain insight, the RIO 2 US
study collected resource utilization and procedure time intervals for ICM
insertion in-office and in-hospital and these data were used to calculate
costs associated with staff time and supply use in each setting.
<br/>Methods and Results: The Reveal LINQ In-Office 2 US study (randomized
[1:1], multicenter, unblinded) included 482 patients to undergo insertion
of the ICM in-hospital (in an operating room or CATH/EP laboratory) (n =
251) or in-office (n = 231). Detailed information on resource utilization
was collected prospectively by the study and used to compare resource
utilization and procedure time intervals during ICM insertion procedures
performed in-office vs. in-hospital. In addition, costs associated with
staff time and supply use in each setting were calculated retrospectively.
Total visit duration (check-in to discharge) was 107 min shorter in-office
vs. in-hospital (95% CI = 97-116 min; p < 0.001). Patient preparation and
education in-office were more likely to occur in the same room as the
procedure, compared with in-hospital (91.6% vs. 34.2%, p < 0.001 and 87.3%
vs. 22.1%, p < 0.001, respectively). There was a reduction in registered
nurse and cardiovascular/operating room technologist involvement
in-office, accompanied by higher physician and medical assistant
participation. Overall staff time spent per case was 75% higher
in-hospital, leading to 50% higher staffing costs compared to in-office.
<br/>Conclusion(s): ICM insertion in a physician's office vs. a hospital
setting resulted in reduced patient visit time and reduced overall staff
time, with a consequent reduction in staffing costs. Clinical trial
registration: ClinicalTrials.gov NCT02395536.<br/>Copyright &#xa9; 2020,
&#xa9; 2020 The Author(s). Published by Informa UK Limited, trading as
Taylor & Francis Group.