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<1>
Accession Number
631654384
Title
The effect of ultrasound-guided erector spinae plane block on postsurgical
pain: A meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 20 (1) (no pagination), 2020. Article Number: 99. Date
of Publication: 01 May 2020.
Author
Kendall M.C.; Alves L.; Traill L.L.; De Oliveira G.S.
Institution
(Kendall, Alves, Traill, De Oliveira) Department of Anesthesiology, Warren
Alpert Medical School, Brown University, Providence, RI, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The effect of erector spinae plane block has been evaluated by
clinical trials leading to a diversity of results. The main objective of
the current investigation is to compare the analgesic efficacy of erector
spinae plane block to no block intervention in patients undergoing
surgical procedures. <br/>Method(s): We performed a quantitative
systematic review of randomized controlled trials in PubMed, Embase,
Cochrane Library, and Google Scholar electronic databases from their
inception through July 2019. Included trials reported either on opioid
consumption or pain scores as postoperative pain outcomes. Methodological
quality of included studies was evaluated using Cochrane Collaboration's
tool. <br/>Result(s): Thirteen randomized controlled trials evaluating 679
patients across different surgical procedures were included. The
aggregated effect of erector spinae plane block on postoperative opioid
consumption revealed a significant effect, weighted mean difference
of-8.84 (95% CI:-12.54 to-5.14), (P < 0.001) IV mg morphine equivalents.
The effect of erector spinae plane block on post surgical pain at 6 h
compared to control revealed a significant effect weighted mean difference
of-1.31 (95% CI:-2.40 to-0.23), P < 0.02. At 12 h, the weighted mean
difference was of-0.46 (95% CI:-1.01 to 0.09), P = 0.10. No block related
complications were reported. <br/>Conclusion(s): Our results provide
moderate quality evidence that erector spinae plane block is an effective
strategy to improve postsurgical analgesia.<br/>Copyright &#xa9; 2020 The
Author(s).

<2>
Accession Number
2005502175
Title
Observed versus Expected Ischemic and Bleeding Events Following Left
Atrial Appendage Occlusion.
Source
American Journal of Cardiology. 125 (11) (pp 1644-1650), 2020. Date of
Publication: 1 June 2020.
Author
Busu T.; Khan S.U.; Alhajji M.; Alqahtani F.; Holmes D.R.; Alkhouli M.
Institution
(Busu, Khan) Department of Medicine, West Virginia University, Morgantown,
United States
(Alhajji) Northside Hospital-Gwinnett, Department of Internal Medicine,
Jonesboro, United States
(Alqahtani) Department of Medicine, Division of Cardiology, University of
Kentucky, Lexington, United States
(Holmes, Alkhouli) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Data on the efficacy of left atrial appendage occlusion (LAAO) in clinical
practice are limited. We performed a systematic review and meta-analysis
of observational studies that reported observed versus expected rates of
ischemic strokes and/or major bleeding following LAAO. Our primary end
points were the pooled relative risk reduction (RRR) in ischemic stroke
and major bleeding with corresponding 95% confidence intervals compared
with what was expected by the CHA2DS2-VASc and HASBLED scores,
respectively. Twenty-nine studies including 11,071 patients (age 74.0 +/-
8.7 years, 60% males) met the inclusion criteria. The mean CHA2DS2-VASc
score was 4.22 +/- 1.48, and the mean HASBLED score was 3.04 +/- 1.16.
During 19,567 patient-year follow-up, 290 of 11,071 patients (2.62%)
suffered an acute ischemic stroke. This represented a 73.6% (95%
confidence interval 68.9-78.2%) RRR in ischemic strokes compared with what
was expected based on the CHA2DS2-VASc score. A total of 26 studies
reported observed versus expected major bleeding (10,056 patients; age
74.0 +/- 8.7, 60% males). During 16,967 patient-year follow-up, 404 of
10,056 patients (4.0%) suffered a major bleeding event. This represented a
55% (95% confidence interval 44.2% to -65.9%) RRR in major bleeding
compared with what was expected based on the HASBLED score. These
estimates were consistent across subgroups stratified according to age,
CHADS2VASc, HASBLED scores and type of LAAO device used. In conclusion,
LAAO is associated with a favorable observed/expected ratio with regards
to ischemic stroke and major bleeding in clinical practice. Future
clinical trials remain essential to further assess the efficacy of LAAO
via a direct comparison with oral anticoagulation.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<3>
Accession Number
2005018017
Title
"BAX602" in Preventing Surgical Adhesion after Extracorporeal Ventricular
Assist Device Implantation for Refractory Congestive Heart Failure: Study
Protocol for a Multicenter Randomized Clinical Trial.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2020. Date of
Publication: 2020.
Author
Fukushima S.; Asakura K.; Hamasaki T.; Onda K.; Watanabe T.; Shiose A.;
Ono M.; Fukushima N.; Yamamoto H.; Fujita T.
Institution
(Fukushima, Fujita) Department of Cardiac Surgery, National Cerebral and
Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka 564-8565, Japan
(Asakura, Onda, Yamamoto) Department of Data Science, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Hamasaki) The Biostatistics Center and Department of Biostatistics and
Bioinformatics, George Washington University, Washington, DC, United
States
(Watanabe, Fukushima) Department of Transplant Medicine, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Shiose) Department of Cardiovascular Surgery, Kyushu University Hospital,
Fukuoka, Japan
(Ono) Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan
Publisher
Springer
Abstract
Background: The high surgical risk in redo cardiac surgery is largely
attributed to adhesions around the epicardium and the great vessels.
BAX602 is an adhesion prevention reagent composed of two synthetic
polyethylene glycols. Spraying BAX602 over the epicardium and the great
vessels reportedly contributes to adhesion prevention after pediatric
cardiac surgery. The present study aims to evaluate the safety and
effectiveness of BAX602 spray in patients undergoing extracorporeal
ventricular assist device implantation surgery to treat refractory
congestive heart failure. Methods and Design: This investigator-initiated,
multicenter, pivotal, two-arm, open-label, randomized trial will include a
total of 30 patients. The primary outcome measure is the severity of
adhesions, which will be evaluated during re-sternotomy surgery performed
2-12 weeks after the primary extracorporeal ventricular assist device
implantation surgery. The adhesion severity will be evaluated at five
predefined sites using a four-grade adhesion evaluation score (0 = no
adhesion; 1 = filmy and avascular adhesion; 2 = dense/vascular adhesion; 3
= cohesive adhesion). This measure will be summarized in two ways to
evaluate the effect of BAX602: (1) the total score of the severity of
adhesions at all five sites (ranging from 0 to 15), and (2) the total
number of sites with dense/vascular or cohesive adhesions (ranging from 0
to 5). Ethics and Dissemination: The study findings will be disseminated
at regional, national, and international conferences and through
peer-reviewed scientific journals. Trial Registration: The trial was
registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000038998)
on 6 January 2020.<br/>Copyright &#xa9; 2020, The Author(s).

<4>
Accession Number
2004270080
Title
High-dose nitroglycerin administered during rewarming preserves
erythrocyte deformability in cardiac surgery with cardiopulmonary bypass.
Source
Microcirculation. 27 (4) (no pagination), 2020. Article Number: e12608.
Date of Publication: 01 May 2020.
Author
Tai Y.-H.; Chu Y.-H.; Wu H.-L.; Lin S.-M.; Tsou M.-Y.; Huang C.-H.; Chang
H.-H.; Lu C.-C.
Institution
(Tai, Chu, Wu, Lin, Tsou, Lu) Department of Anesthesiology, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Tai, Wu, Lin, Tsou, Huang) School of Medicine, National Yang-Ming
University, Taipei, Taiwan (Republic of China)
(Tai) Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical
University, New Taipei City, Taiwan (Republic of China)
(Tai) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chu, Lu) Graduate Institute of Life Sciences, National Defense Medical
Center, Taipei, Taiwan (Republic of China)
(Huang, Chang) Division of Cardiovascular Surgery, Department of Surgery,
Taipei Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Lu) Institute of Aerospace Medicine, National Defense Medical Center,
Taipei, Taiwan (Republic of China)
Publisher
Wiley Blackwell (E-mail: info@wiley.com)
Abstract
Objective: We aimed to determine whether high-dose nitroglycerin, a nitric
oxide donor, preserves erythrocyte deformability during cardiopulmonary
bypass and examines the signaling pathway of nitric oxide in erythrocytes.
<br/>Method(s): In a randomized and controlled fashion, forty-two patients
undergoing cardiac surgery with hypothermic cardiopulmonary bypass were
allocated to high-dose (N = 21) and low-dose groups (N = 21). During
rewarming period, patients were given intravenous nitroglycerin with an
infusion rate 5 and 1 micro&#32;g.kg^-1.min^-1 in
high-dose and low-dose groups, respectively. Tyrosine phosphorylation
level of non-muscle myosin IIA in erythrocyte membrane was used as an
index of erythrocyte deformability and analyzed using immunoblotting.
<br/>Result(s): Tyrosine phosphorylation of non-muscle myosin IIA was
significantly enhanced after bypass in high-dose group (3.729 +/- 1.700
folds, P =.011) but not low-dose group (1.545 +/- 0.595 folds, P =.076).
Phosphorylation of aquaporin 1, vasodilator-stimulated phosphoprotein, and
focal adhesion kinase in erythrocyte membrane was also upregulated in
high-dose group after bypass. Besides, plasma nitric oxide level was
highly correlated with fold change of non-muscle myosin IIA
phosphorylation (Pearson's correlation coefficient.871).
<br/>Conclusion(s): High-dose nitroglycerin administered during
cardiopulmonary bypass improves erythrocyte deformability through
activating phosphorylation of aquaporin 1, vasodilator-stimulated
phosphoprotein, and focal adhesion kinase in erythrocytes.<br/>Copyright
&#xa9; 2020 John Wiley & Sons Ltd

<5>
Accession Number
2004168856
Title
Impact of leaflet thrombosis on hemodynamics and clinical outcomes after
bioprosthetic aortic valve replacement: A meta-analysis.
Source
Clinical Cardiology. 43 (5) (pp 468-474), 2020. Date of Publication: 01
May 2020.
Author
Tian Z.; Li T.; Ma S.
Institution
(Tian, Li, Ma) Department of Cardiology, Shengjing Hospital of China
Medical University, Shengyang, Liaoning Province, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Leaflet thrombosis (LT, also called cusp thrombosis) detected
by multidetector computed tomography (MDCT) is common in bioprosthetic
aortic valve replacement (bAVR). However, it remains contradictory whether
MDCT-defined LT following bAVR is associated with hemodynamic
deterioration and stroke. Thus, we performed the first meta-analysis to
assess hemodynamic outcomes and updated the latest researches on the
clinical outcomes of MDCT-defined LT after bAVR. Hypothesis: MDCT-defined
LT might be associated with worse hemodynamic and clinical outcomes after
bAVR. <br/>Method(s): MEDLINE, EMBASE, Cochrane Library, and
ClinicalTrial.gov were searched from inception to 15th April 2019. The
fix-effect model was utilized to calculate odds ratio (OR) and 95%
confidence interval (CI). The primary outcomes were hemodynamic stability
indexes, including mean pressure gradient (MPG), left ventricular ejection
fraction (LVEF), paravalvular leak (PVL), and clinical heart failure. The
secondary endpoints were major adverse cardiovascular and cerebrovascular
events (MACCEs), which consisted of myocardial infarction, all-cause
death, stroke, and transient ischemic attack (TIA). <br/>Result(s): Twelve
studies with 4820 patients were included. The total prevalence of
MDCT-defined LT was 9.7%. MDCT-defined LT was associated with a
significantly increased risk of MPG (inverse variance 0.43, 95% CI: [0.30,
0.57]), MACCEs (OR 2.43, 95% CI: [1.45, 4.06]), stroke (OR 1.79, 95% CI:
[1.03, 3.11]), and TIA (OR 4.09, 95% CI: [1.59, 10.54]). There were no
differences for other outcomes. <br/>Conclusion(s): MDCT-defined LT after
bAVR is associated with increased MPG and increased risk of adverse
cerebrovascular events, including TIA and stroke. While LVEF, PVL, and
clinical heart failure were similar between patient with and without
LT.<br/>Copyright &#xa9; 2020 The Authors. Clinical Cardiology published
by Wiley Periodicals, Inc.

<6>
Accession Number
2005899379
Title
Long-term outcomes in the management of left main disease: An updated
meta-analysis of randomized controlled trials.
Source
Hellenic Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Terentes-Printzios D.; Kotronias R.A.; De Maria G.L.; Scarsini R.; Banning
A.P.
Institution
(Terentes-Printzios, Kotronias, De Maria, Scarsini, Banning) Oxford Heart
Centre, NIHR Biomedical Research Centre, Oxford University Hospitals,
Oxford, United Kingdom
Publisher
Hellenic Cardiological Society

<7>
Accession Number
2005859666
Title
Effects of protective controlled coronary reperfusion on left ventricular
remodeling in dogs with acute myocardial infarction: A pilot study.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Reshef E.; Sabbah H.N.; Nussinovitch U.
Institution
(Reshef, Nussinovitch) InVatin Technologies, Ltd., Kazrin, Israel
(Sabbah) Department of Medicine, Division of Cardiovascular Medicine,
Henry Ford Hospital, Detroit, MI, United States
(Nussinovitch) Applicative Cardiovascular Research Center (ACRC) and
Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
(Nussinovitch) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary artery obstruction causes ischemia of cardiac tissue,
leading to acute myocardial infarction (AMI). The treatment of choice for
reducing acute myocardial ischemic injury is early, effective vascular
reperfusion using thrombolytic therapy or primary percutaneous coronary
intervention. However, reperfusion can cause cardiomyocyte injury.
Currently, there is no effective therapy to prevent cardiac
reperfusion-related tissue damage. This study evaluated whether Protective
Controlled Coronary Reperfusion (PCCR), selectively delivered to ischemic
tissue, is associated with decreased myocardial scarring, contractile
deterioration and reperfusion-associated myocardial edema. <br/>Method(s):
Three hours of cardiac ischemia was induced in 10 mongrel dogs, and
followed by either 30-minute PCCR or sham treatment. Cardiac performance
was evaluated 2, 4 and 6 months later. Trichrome staining was used to
distinguish collagen from viable myocardial tissue and to evaluate mean
scar area. <br/>Result(s): One hour following reperfusion, PCCR
significantly attenuated the relative increase (edema) in left ventricular
end diastolic posterior wall thickness compared with sham treatment. At 6
months follow-up, the PCCR group showed a modest corrected increase in
left ventricular ejection fraction (cLVEF) in comparison to the sham group
where it deteriorated (2.3 +/- 10.5% vs. -16.4 +/- 10.3%, respectively, p
= 0.043). Histomorphometric assessments of the hearts showed the PCCR
group had smaller area of scarring, as compared to sham-treated animals
(9.0 +/- 2.4% vs. 14.0 +/- 3.3%, p = 0.047). <br/>Conclusion(s): In this
pilot study, PCCR reduced myocardial edema, modestly increased in cLVEF
and resulted in a smaller scar area. Further studies are needed to fully
ascertain the mechanisms that underlie the potential benefits of PCCR
therapy prior to initiating clinical trials in human subjects with
AMI.<br/>Copyright &#xa9; 2020

<8>
Accession Number
2005033251
Title
Comparison of infective endocarditis risk between balloon and
self-expandable valves following transcatheter aortic valve replacement:
systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2020. Date
of Publication: 2020.
Author
Prasitlumkum N.; Thangjui S.; Leesutipornchai T.; Kewcharoen J.;
Limpruttidham N.; Pai R.G.
Institution
(Prasitlumkum, Kewcharoen, Limpruttidham) University of Hawaii Internal
Medicine Residency Program, 1356 Lusitana St, Honolulu, HI 96813, United
States
(Thangjui, Leesutipornchai) Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
(Pai) Department of Cardiology, University of California Riverside,
Riverside, CA, United States
Publisher
Springer
Abstract
This study aimed to compare incidence of IE between BE and SE valves by
performing a systematic review and meta-analysis of the literature. We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to November 2019. Included studies were published observational
studies that compared the risk of IE among patients undergoing TAVR
employing BE versus SE valves, using the random-effects to calculate risk
ratios and 95% confidence intervals (CIs).Ten cohort studies from April
2013 to November 2019 were included in this meta-analysis involving 13,478
subjects (6289 SE and 7189 BE types). Our study showed no statistical
difference in IE rates between each type of valves (pooled OR 0.96, 95%
CI: 0.68-1.35, p = 0.801 with I2 = 14.7%). There was no difference in IE
rate between BE and SE valves following TAVR. Further studies are
warranted to confirm our findings.<br/>Copyright &#xa9; 2020, Japanese
Association of Cardiovascular Intervention and Therapeutics.

<9>
Accession Number
2004975778
Title
Pleural Effusions After Congenital Cardiac Surgery Requiring Readmission:
A Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Hughes A.; Carter K.; Cyrus J.; Karam O.
Institution
(Hughes, Carter) Division of Pediatric Cardiology, Children's Hospital of
Richmond at VCU, Richmond, VA, United States
(Cyrus) Tompkins-McCaw Library for the Health Sciences, VCU Libraries,
Virginia Commonwealth University, Richmond, VA, United States
(Karam) Division of Pediatric Critical Care Medicine, Children's Hospital
of Richmond at VCU, Richmond, VA, United States
Publisher
Springer
Abstract
Patients with congenital heart disease (CHD) are surviving longer thanks
to improved surgical techniques and increasing knowledge of natural
history. Pleural effusions continue to be a complication that affect many
surgical patients and are associated with increased morbidity, many times
requiring readmission and additional invasive procedures. The risks for
development of pleural effusion after hospital discharge are ill-defined,
which leads to uncertainty related to strategies for prevention. Our
primary objective was to determine, in patients with CHD requiring
cardiopulmonary bypass, the prevalence of post-surgical pleural effusions
leading to readmission. The secondary objective was to identify risk
factors associated with post-surgical pleural effusions requiring
readmission. We identified 4417 citations; 10 full-text articles were
included in the final review. Of the included studies, eight focused on
single-ventricle palliation, one looked at Tetralogy of Fallot patients,
and another on pleural effusion in the setting of post-pericardiotomy
syndrome. Using a random-effect model, the overall prevalence of pleural
effusion requiring readmission was 10.2% (95% CI 4.6; 17.6). Heterogeneity
was high (I² = 91%). In a subpopulation of patients after
single-ventricle palliation, the prevalence was 13.0% (95% CI 6.0;21.0),
whereas it was 3.0% (95% CI 0.4;6.75) in patients mostly with
biventricular physiology. We were unable to accurately assess risk
factors. A better understanding of this complication with a focus on
single-ventricle physiology will allow for improved risk stratification,
family counseling, and earlier recognition of pleural effusion in this
patient population.<br/>Copyright &#xa9; 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<10>
Accession Number
631863550
Title
Is aortic valve replacement with a minimally invasive extracorporeal
circuit a contemporary option for octogenarians?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 23 May 2020.
Author
El-Essawi A.; Follis M.; Brouwer R.; Breitenbach I.; Groeger S.; Anssar
M.; Harringer W.
Institution
(El-Essawi, Follis, Brouwer, Breitenbach, Groeger, Anssar, Harringer)
Department of Thoracic and Cardiovascular Surgery, Braunschweig, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Minimally invasive extracorporeal circuits have been
introduced to cardiac surgery in an attempt to reduce the negative effects
of cardiopulmonary bypass on patient outcome. On the other hand,
transcatheter aortic valve replacement (TAVR) provides an excellent option
to replace the aortic valve without the need for cardiopulmonary bypass.
Several studies have compared TAVR to surgical aortic valve replacement
(SAVR) but none have utilized a minimally invasive extracorporeal circuit.
<br/>METHOD(S): We retrospectively analysed the results of both procedures
among octogenarians operated in our department from 2003 to 2016. Excluded
were patients with an active endocarditis, a history of previous cardiac
surgery, as well as those who had a minimally invasive surgical approach.
This yielded 81 and 142 octogenarians in the SAVR and TAVR groups,
respectively. To compensate for a lack of randomization, we performed a
propensity score analysis, which yielded 68 patient pairs for the final
analysis. <br/>RESULT(S): The 30-day postoperative mortality was lower in
the SAVR group (1.5% vs 5.9%) but not statistically significant (P = 0.4).
In contrast, the incidence of postoperative atrial fibrillation was lower
in the TAVR group (13% vs 29%) but also non-significant (P = 0.2).
Finally, the incidence of paravalvular leakage was in favour of the SAVR
group (2.9% vs 52%; P = 0.001) while the transfusion requirement was
significantly lower in the TAVR group (29% vs 72%; P<0.001).
<br/>CONCLUSION(S): SAVR utilizing a minimally invasive extracorporeal
circuit improves the quality of patient care and can offer an alternative
to TAVR in octogenarians.<br/>Copyright &#xa9; The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<11>
Accession Number
631860738
Title
Cholesterol-lowering with EVOLocumab to prevent cardiac allograft
Vasculopathy in De-novo heart transplant recipients: Design of the
randomized controlled EVOLVD trial.
Source
Clinical transplantation. (pp e13984), 2020. Date of Publication: 23 May
2020.
Author
Broch K.; Gude E.; Karason K.; Dellgren G.; Radegran G.; Gjesdal G.;
Gustafsson F.; Eiskjaer H.; Lommi J.; Lemstrom K.B.; Andreassen A.K.;
Gullestad L.
Institution
(Broch, Gude, Andreassen, Gullestad) Department of Cardiology, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Karason, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Radegran, Gjesdal) Clinic for Heart Failure and Valvular Disease, Skane
University Hospital, Sweden
(Radegran) Lund University, Lund, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Lommi, Lemstrom) Helsinki University Hospital Heart and Lung Center,
Helsinki, Finland
(Gullestad) University of Oslo, Oslo, Norway
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is characterized by
diffuse thickening of the arterial intima. Statins reduce the incidence of
CAV, but despite the use of statins, CAV remains one of the leading causes
of long-term death after heart transplant. Inhibitors of proprotein
convertase subtilisin-kexin type 9 (PCSK9) substantially reduce
cholesterol levels but have not been tested in heart transplant
recipients. <br/>METHOD(S): The Cholesterol lowering with EVOLocumab to
prevent cardiac allograft Vasculopathy in De-novo heart transplant
recipients (EVOLVD) trial (ClinicalTrials.gov Identifier: NCT03734211) is
a randomized, double-blind trial designed to test the effect of the PCSK9
inhibitor evolocumab on coronary intima thickness in heart transplant
recipients. Adults who have received a cardiac transplant within the past
4 - 8 weeks are eligible. Exclusion criteria include an estimated
glomerular filtration rate < 20 mL/min/1.73 m2 , renal replacement
therapy, or contraindications to coronary angiography with intravascular
ultrasound. 130 patients will be randomized (1:1) to 12-months' treatment
with evolocumab or matching placebo. The primary endpoint is the coronary
artery intima thickness as measured by intravascular ultrasound.
<br/>CONCLUSION(S): The EVOLVD trial is a randomized clinical trial
designed to show whether treatment with the PCSK9 inhibitor evolocumab can
ameliorate CAV over the first year after heart transplant.<br/>Copyright
This article is protected by copyright. All rights reserved.

<12>
Accession Number
631770503
Title
Towards integrative neuromonitoring of the surgical newborn: A systematic
review.
Source
European journal of anaesthesiology. (no pagination), 2020. Date of
Publication: 13 May 2020.
Author
Costerus S.A.; van Hoorn C.E.; Hendrikx D.; Kortenbout J.; Hunfeld M.;
Vlot J.; Naulaers G.; Tibboel D.; de Graaff J.C.
Institution
(Costerus) From the Department of Pediatric Surgery, Erasmus University
Medical Center-Sophia Children's Hospital (SAC, JV, DT), Department of
Anesthesiology, Erasmus University Medical Center, Rotterdam, The
Netherlands (CvH, JCdG), Department of Electrical Engineering, KU Leuven,
Leuven, Belgium (DH), Department of Biomedical Engineering, Erasmus
University Medical Center (JK), Department of Pediatric Neurology, Erasmus
University Medical Center-Sophia Children's Hospital, Rotterdam, The
Netherlands (MH) and Department of Neonatal Intensive Care Unit,
University Hospitals Leuven, Leuven, Belgium (GN)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The altered neurodevelopment of children operated on during
the neonatal period might be due to peri-operative changes in the
homeostasis of brain perfusion. Monitoring of vital signs is a standard of
care, but it does not usually include monitoring of the brain.
<br/>OBJECTIVE(S): To evaluate methods of monitoring the brain that might
be of value. We also wanted to clarify if there are specific risk factors
that result in peri-operative changes and how this might be evaluated.
DESIGN: Systematic review. DATA SOURCES: A structured literature search
was performed in MEDLINE in Ovid, Embase, Cochrane CENTRAL, Web of Science
and Google Scholar. ELIGIBILITY CRITERIA: Studies in neonates who received
peri-operative neuromonitoring were eligible for inclusion; studies on
neurosurgical procedures or cardiac surgery with cardiopulmonary bypass
and/or deep hypothermia cardiac arrest were excluded. <br/>RESULT(S):
Nineteen of the 24 included studies, totalling 374 infants, reported the
use of near-infrared spectroscopy. Baseline values of cerebral oxygenation
greatly varied (mean 53 to 91%) and consequently, no coherent results were
found. Two studies found a correlation between cerebral oxygenation and
mean arterial blood pressure. Five studies, with in total 388 infants,
used (amplitude-integrated) electro-encephalography to study
peri-operative brain activity. Overall, the brain activity decreased
during anaesthesia and epileptic activity was more frequent in the
peri-operative phase. The association between intra-operative cerebral
saturation or activity and neuro-imaging abnormalities and/or
neurodevelopmental outcome was investigated in six studies, but no
association was found. <br/>CONCLUSION(S): Neuromonitoring with the
techniques currently used will neither help our understanding of the
altered neonatal pathophysiology, nor enable early detection of deviation
from the norm. The modalities lack specificity and are not related to
clinical (long-term) outcome or prognosis. Accordingly, we were unable to
draw up a monitoring guideline.

<13>
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

<14>
Accession Number
624077339
Title
Six-month outcomes after restrictive or liberal transfusion for cardiac
surgery.
Source
New England Journal of Medicine. 379 (13) (pp 1224-1233), 2018. Date of
Publication: 27 Sep 2018.
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Belley-Cote E.; Connolly K.;
Khanykin B.; Gregory A.J.; De Medicis E.; Carrier F.M.; McGuinness S.;
Young P.J.; Byrne K.; Villar J.C.; Royse A.; Grocott H.P.; Seeberger M.D.;
Mehta C.; Lellouche F.; Hare G.M.T.; Painter T.W.; Fremes S.; Syed S.;
Bagshaw S.M.; Hwang N.-C.; Royse C.; Hall J.; Dai D.; Mistry N.; Thorpe
K.; Verma S.; Juni P.; Shehata N.
Institution
(Mazer, Hare, Mistry) Department of Anesthesia, St. Michael's Hospital,
University of Toronto, 30 Bond St., Toronto, ON M5B 1W8, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Canada
(Mazer, Hare, Thorpe, Verma, Juni) St. Michael's Hospital, Keenan Research
Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Canada
(Hall, Dai, Thorpe, Verma, Juni) Applied Health Research Centre,
University of Toronto, Canadian Blood Services, Toronto, Canada
(Fremes) Sunnybrook Health Sciences Centre, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Shehata) Division of Hematology, Mount Sinai Hospital, University of
Toronto, Canadian Blood Services, Toronto, Canada
(Juni, Shehata) Department of Medicine, University of Toronto, Canadian
Blood Services, Toronto, Canada
(Mazer, Hare) Department of Physiology, University of Toronto, Canadian
Blood Services, Toronto, Canada
(Shehata) Laboratory Medicine and Pathobiology, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Canadian Blood Services, Toronto, Canada
(Shehata) Institute of Health Policy, Management and Evaluation,
University of Toronto, Canadian Blood Services, Toronto, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
ON, Canada
(Whitlock, Belley-Cote, Connolly, Syed) Hamilton Health Sciences Center,
Hamilton, ON, Canada
(Whitlock, Belley-Cote, Connolly, Syed) McMaster University, Hamilton, ON,
Canada
(Fergusson) Ottawa Hospital Research Institute, University of Ottawa,
Ottawa, Canada
(Gregory) Cumming School of Medicine, Libin Cardiovascular Institute,
University of Calgary, Calgary, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Canada
(De Medicis) CHUS-Centre Hospitalier Universitaire de Sherbrooke,
Sherbrooke, Canada
(Lellouche) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Laval, QC, Canada
(Carrier) Departments of Anesthesia and Medicine, Division of Critical
Care, Centre Hospitalier de L'Universite de Montreal, Montreal, Canada
(Grocott) Department of Anesthesia, Perioperative and Pain Medicine, St.
Boniface Hospital, University of Manitoba, Winnipeg, Canada
(Khanykin) Department of Cardiothoracic Anesthesia, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Canada
(McGuinness, Young) Medical Research Institute of New Zealand, Wellington,
New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Villar) Fundacion Cardioinfantil-Instituto de Cardiologia, Universidad
Autonoma de Bucaramanga, Bucaramanga, Colombia
(Royse, Royse) Department of Surgery, University of Melbourne, Melbourne,
VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Painter) Department of Anaesthesia, Royal Adelaide Hospital, Discipline
of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
(Seeberger) University of Basel, Department of Anesthesia, Surgical
Intensive Care, Prehospital Emergency Medicine and Pain Therapy,
University Hospital Basel, Basel, Switzerland
(Seeberger) Klinik Hirslanden Zurich, Zurich, Switzerland
(Mehta) Heart Care Associates, SAL Hospital, Gujarat, India
(Hwang) Department of Cardiothoracic Anaesthesia, National Heart Center,
Singapore, Singapore
(Hwang) Department of Anaesthesiology, Singapore General Hospital,
Singapore, Singapore
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We reported previously that, in patients undergoing cardiac
surgery who were at moderate-to-high risk for death, a restrictive
transfusion strategy was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis by hospital discharge or
28 days after surgery, whichever came first. We now report the clinical
outcomes at 6 months after surgery. METHODS We randomly assigned 5243
adults undergoing cardiac surgery to a restrictive red-cell transfusion
strategy (transfusion if the hemoglobin concentration was <7.5 g per
deciliter intraoperatively or postoperatively) or a liberal red-cell
transfusion strategy (transfusion if the hemoglobin concentration was <9.5
g per deciliter intraoperatively or postoperatively when the patient was
in the intensive care unit [ICU] or was <8.5 g per deciliter when the
patient was in the non-ICU ward). The primary composite outcome was death
from any cause, myocardial infarction, stroke, or newonset renal failure
with dialysis occurring within 6 months after the initial surgery. An
expanded secondary composite outcome included all the components of the
primary outcome as well as emergency department visit, hospital
readmission, or coronary revascularization occurring within 6 months after
the index surgery. The secondary outcomes included the individual
components of the two composite outcomes. RESULTS At 6 months after
surgery, the primary composite outcome had occurred in 402 of 2317
patients (17.4%) in the restrictive-threshold group and in 402 of 2347
patients (17.1%) in the liberal-threshold group (absolute risk difference
before rounding, 0.22 percentage points; 95% confidence interval [CI],
-1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to 1.18; P = 0.006 for
noninferiority). Mortality was 6.2% in the restrictive-threshold group and
6.4% in the liberal-threshold group (odds ratio, 0.95; 95% CI, 0.75 to
1.21). There were no significant between-group differences in the
secondary outcomes. CONCLUSIONS In patients undergoing cardiac surgery who
were at moderate-to-high risk for death, a restrictive strategy for
red-cell transfusion was noninferior to a liberal strategy with respect to
the composite outcome of death from any cause, myocardial infarction,
stroke, or new-onset renal failure with dialysis at 6 months after
surgery.<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<15>
Accession Number
631796766
Title
The effect of 8 weeks of combined yoga and rehabilitation training on
salivary levels of alpha-amylase and cortisol in patients after coronary
artery bypass grafting.
Source
Research in Cardiovascular Medicine. 9 (1) (pp 16-22), 2020. Date of
Publication: January-March 2020.
Author
Fakharirad F.; Ghazalian F.; Nikbakht H.; Lotfian S.; Nikpajouh A.
Institution
(Fakharirad, Ghazalian, Nikbakht) Department of Physical Education and
Sport Sciences, Science and Research Branch, Islamic Azad University,
Tehran, Iran, Islamic Republic of
(Lotfian, Nikpajouh) Rajaie Cardiovascular Medical and Research Center,
Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: The purpose of this study was to investigate the effects of
combined rehabilitation and yoga training on salivary levels of
alpha-amylase and cortisol in patients after coronary artery bypass graft
(CABG). <br/>Method(s): In this quasi-experimental study, 20 CABG patients
were randomly divided into two groups of cardiac rehabilitation training
group (CRT, n = 10) and combined training group (yoga-cardiac
rehabilitation) (computed tomography [CT], n = 10). After initial clinical
evaluation, exercise test, and salivation with 12 h fasting, individuals
were referred to the rehabilitation ward of Shahid Rajaie Heart Hospital
in Tehran and performed their exercise program for 8 weeks and three
sessions per week then their evaluations were made again. A dependent
t-test was used for intra-group changes and an independent t-test was used
to compare the two groups at a significant level of 0.05. <br/>Result(s):
The CT group showed a significant effect on salivary cortisol (P = 0.028),
but these interventions did not show a significant effect on salivary
alpha-amylase (P = 0.193). Furthermore, CRT alone had a significant effect
on salivary cortisol indices (P = 0.011), there was no significant
difference between groups (P <= 0.05). <br/>Conclusion(s): The results
showed that combined yoga and rehabilitation training had beneficial
effects on the salivary levels of the stress factors that have been
studied. Therefore, this type of rehabilitation exercise is recommended
for secondary prevention of cardiovascular disease.<br/>Copyright &#xa9;
2020 Wolters Kluwer Medknow Publications. All rights reserved.

<16>
Accession Number
2005874574
Title
Machine perfusion of circulatory determined death hearts: A scoping
review.
Source
Transplantation Reviews. 34 (3) (no pagination), 2020. Article Number:
100551. Date of Publication: July 2020.
Author
Saemann L.; Guo Y.; Ding Q.; Zhou P.; Karck M.; Szabo G.; Wenzel F.
Institution
(Saemann, Guo, Ding, Zhou, Karck, Szabo) Department of Cardiac Surgery,
University Hospital Heidelberg, Im Neuenheimer Feld 326, Heidelberg 69120,
Germany
(Saemann, Wenzel) Faculty Medical and Life Sciences, Furtwangen
University, Jakob-Kienzle-Strase 17, Villingen-Schwenningen 78054, Germany
Publisher
W.B. Saunders
Abstract
Background: Ex vivo machine perfusion (EVMP) is reported to can
successfully be applied for donor heart preservation. To respond to the
organ shortage, some centres also accept hearts from marginal donors such
as non-heart beating donors (NHBD) or hearts donated after cardiac death
(DCD) for heart transplantation (HTx). Clinical as well as preclinical
science on EVMP of DCD hearts seems to be promising but the ideal
perfusion practice itself appears unclear. <br/>Objective(s): In
accordance with the Preferred Reporting Items for Systematic reviews and
Meta-Analyses extension for Scoping Reviews (PRISMA), this systematic
review scopes all EVMP techniques for human and animal DCD heart
preservation and addresses three specific questions, which refer to (a)
the perfusion solutions, (b) the perfusion parameters and respective
target values and (c) if possible, a direct comparison between cold static
storage (CSS) and EVMP. <br/>Result(s): Search results predominantly
consisted of animal studies. Either perfusion with a crystalloid or
blood-based solution, each with cardioplegic or non-cardioplegic
properties was used. Some perfusates were supplemented with specific
pharmacological medication to block pathophysiological pathways, which are
involved in ischemia/reperfusion injury or edema formation. Besides
normothermic EVMP with oxygenated blood, a wide range of temperature was
applied in all approaches, with the lowest temperature at 4 degreeC.
Pressure controlled anterograde Langendorff perfusion was applied mostly.
If investigated, crystalloid machine perfusion was presented superior to
CSS. <br/>Conclusion(s): Only blood based EVMP was introduced into
clinical practice. More research, clinical as well as preclinical, is
needed to develop the ideal EVMP technique, in terms of blood or
crystalloid perfusion.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<17>
Accession Number
631588959
Title
The learning curve in transcatheter aortic valve implantation clinical
studies: A systematic review.
Source
International Journal of Technology Assessment in Health Care. 36 (2) (pp
152-161), 2020. Date of Publication: 01 Apr 2020.
Author
Thivilliers A.-P.; Ladarre R.; Merabti O.; Francois C.; Fontenay S.; Van
Den Brink H.; Pineau J.; Prognon P.; Borget I.; Martelli N.
Institution
(Thivilliers, Ladarre, Merabti, Francois, Fontenay, Pineau, Prognon,
Martelli) Pharmacy Department, Georges Pompidou European Hospital, AP-HP,
20 Rue Leblanc, Paris 75015, France
(Borget) Department of Health Economics, Gustave Roussy Institute, 114,
Rue Edouard-Vaillant, Villejuif 94805, France
(Van Den Brink, Borget, Martelli) Faculty of Pharmacy, University
Paris-Sud, GRADES, 5 Rue Jean-Baptiste Clement, Chatenay-Malabry 92290,
France
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background Transcatheter aortic-valve implantation (TAVI) has become an
essential alternative to surgical aortic-valve replacement in the
treatment of symptomatic severe aortic stenosis, and this procedure
requires technical expertise. The aim of this study was to identify
prospective studies on TAVI from the past 10 years, and then to analyze
the quality of information reported about the learning curve.Materials and
methods A systematic review of articles published between 2007 and 2017
was performed using PubMed and the EMBASE database. Prospective studies
regarding TAVI were included. The quality of information reported about
the learning curve was evaluated using the following criteria: mention of
the learning curve, the description of a roll-in phase, the involvement of
a proctor, and the number of patients suggested to maintain skills.Results
A total of sixty-eight studies met the selection criteria and were
suitable for analysis. The learning curve was addressed in approximately
half of the articles (n = 37, 54 percent). However, the roll-in period was
mentioned by only eight studies (12 percent) and with very few details.
Furthermore, a proctorship was disclosed in three articles (4 percent)
whereas twenty-five studies (37 percent) included authors that were
proctors for manufacturers of TAVI.Conclusion Many prospective studies on
TAVI over the past 10 years mention learning curves as a core component of
successful TAVI procedures. However, the quality of information reported
about the learning curve is relatively poor, and uniform guidance on how
to properly assess the learning curve is still missing.<br/>Copyright
&#xa9; 2020 Cambridge University Press.

<18>
Accession Number
630928239
Title
Comparison of newer generation self-expandable vs. balloon-expandable
valves in transcatheter aortic valve implantation: the randomized
SOLVE-TAVI trial.
Source
European heart journal. 41 (20) (pp 1890-1899), 2020. Date of Publication:
21 May 2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Eitel I.;
Marquetand C.; Nef H.; Doerr O.; Lauten A.; Landmesser U.; Abdel-Wahab M.;
Sandri M.; Holzhey D.; Borger M.; Ince H.; Oner A.; Meyer-Saraei R.;
Wienbergen H.; Fach A.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.;
Funkat A.-K.; de Waha-Thiele S.; Desch S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Abdel-Wahab, Sandri, Holzhey,
Borger, Desch) Heart Center Leipzig at University of Leipzig,
Strumpellstr. 39, Leipzig 04289, Germany
(Thiele, Feistritzer, Stachel, Hartung, Abdel-Wahab, Sandri, Holzhey,
Borger, Ruckert, Funkat, Desch) Leipzig Heart Institute, Leipzig D-04289,
Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, de Waha-Thiele) University Clinic
Schleswig-Holstein and University Heart Center Lubeck, Ratzeburger Allee
160, D-23538 Lubeck, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Frey, Konig,
de Waha-Thiele, Desch) German Center for Cardiovascular Research (DZHK),
Ratzeburger Allee 160, D-23538 Lubeck, Germany
(Nef, Doerr) Abteilung fur Kardiologie, Medizinische Klinik IKlinikstr.
33, Germany
(Lauten, Landmesser) Universitatsklinikum Charite, Campus Benjamin
Franklin, Hindenburgdamm 30, Berlin D-12200, Germany
(Ince, Oner) Universitatsklinikum Rostock, Ernst-Heydemann-Str. 6, Germany
(Wienbergen, Fach) Klinikum Links der Weser, Herzzentrum Bremen, D-28277
Bremen, Germany
(Frey) Department of Cardiology, University Clinic Schleswig-Holstein,
Campus Kiel ,Schittenhelmstr. 12, Kiel D-24105, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
Universitat zu Lubeck, Universitatsklinikum Schleswig-Holstein, Campus
Lubeck ,Ratzeburger Allee 160, D-23562 Lubeck, Germany
Publisher
NLM (Medline)
Abstract
AIMS: Transcatheter aortic valve implantation (TAVI) has emerged as
established treatment option in patients with symptomatic aortic stenosis.
Technical developments in valve design have addressed previous limitations
such as suboptimal deployment, conduction disturbances, and paravalvular
leakage. However, there are only limited data available for the comparison
of newer generation self-expandable valve (SEV) and balloon-expandable
valve (BEV). METHODS AND RESULTS: SOLVE-TAVI is a multicentre, open-label,
2 x 2 factorial, randomized trial of 447 patients with aortic stenosis
undergoing transfemoral TAVI comparing SEV (Evolut R, Medtronic Inc.,
Minneapolis, MN, USA) with BEV (Sapien 3, Edwards Lifesciences, Irvine,
CA, USA). The primary efficacy composite endpoint of all-cause mortality,
stroke, moderate/severe prosthetic valve regurgitation, and permanent
pacemaker implantation at 30days was powered for equivalence (equivalence
margin 10% with significance level 0.05). The primary composite endpoint
occurred in 28.4% of SEV patients and 26.1% of BEV patients meeting the
prespecified criteria of equivalence [rate difference -2.39 (90%
confidence interval, CI -9.45 to 4.66); Pequivalence=0.04]. Event rates
for the individual components were as follows: all-cause mortality 3.2%
vs. 2.3% [rate difference -0.93 (90% CI -4.78 to 2.92);
Pequivalence<0.001], stroke 0.5% vs. 4.7% [rate difference 4.20 (90% CI
0.12 to 8.27); Pequivalence=0.003], moderate/severe paravalvular leak 3.4%
vs. 1.5% [rate difference -1.89 (90% CI -5.86 to 2.08);
Pequivalence=0.0001], and permanent pacemaker implantation 23.0% vs. 19.2%
[rate difference -3.85 (90% CI -10.41 to 2.72) in SEV vs. BEV patients;
Pequivalence=0.06]. <br/>CONCLUSION(S): In patients with aortic stenosis
undergoing transfemoral TAVI, newer generation SEV and BEV are equivalent
for the primary valve-related efficacy endpoint. These findings support
the safe application of these newer generation percutaneous valves in the
majority of patients with some specific preferences based on individual
valve anatomy.<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.

<19>
Accession Number
2005924501
Title
The Use of Topical Nitroglycerin to Facilitate Radial Arterial Catheter
Insertion in Children: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Hasanin A.; Aboelela A.; Mostafa M.; Mansour R.M.; Kareem A.
Institution
(Hasanin, Aboelela, Mostafa, Mansour, Kareem) Department of Anesthesia and
Critical Care Medicine, Cairo University, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether the use of topical nitroglycerin patch
increases radial artery diameter and facilitate cannulation in children.
<br/>Design(s): Randomized controlled trial. <br/>Setting(s): Cairo
University Hospital. <br/>Participant(s): Children ages 2 to 8 years old
scheduled for cardiac surgery. <br/>Intervention(s): In the nitroglycerin
group (n = 20), a gauze-covered, half-sized nitroglycerin patch (5 mg) was
applied at the site of radial pulsation 1 hour before induction of
anesthesia. In the control group (n = 20), a gauze pad was applied to the
bare skin at the site of radial pulsation with no intervention.
<br/>Measurements and Main Results: The primary outcome was the diameter
of the radial artery in both limbs using ultrasonography. Other outcomes
included the degree of arterial palpability, number of arterial punctures,
and incidence of successful first puncture cannulation. The radial artery
diameter increased after 30 minutes and 60 minutes compared with the
baseline value in the nitroglycerin group in both limbs, whereas no change
was reported in the radial artery diameter in the control group. The
nitroglycerin group showed a greater incidence of successful first
cannulation trial, a fewer number of trials, and a shorter cannulation
time compared with the control group. There were no significant
hypotensive episodes in any patient. <br/>Conclusion(s): Local application
of a half-sized, 5 mg nitroglycerin patch for 60 minutes in children
increased the radial artery diameter bilaterally, increased the rate of
first trial success, and decreased the time needed for arterial
cannulation without significant hypotensive episodes.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<20>
Accession Number
2004752807
Title
Vitamin D Treatment Attenuates Heart Apoptosis After Coronary Artery
Bypass Surgery: A Double-Blind, Randomized, Placebo-Controlled Clinical
Trial.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 25 (4) (pp
338-345), 2020. Date of Publication: 01 Jul 2020.
Author
Tasdighi E.; Hekmat M.; Beheshti M.; Baghaei R.; Mirhosseini S.M.; Torbati
P.; Pourmotahari F.; Foroughi M.
Institution
(Tasdighi, Hekmat, Beheshti) Cardiovascular Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Baghaei, Mirhosseini, Pourmotahari, Foroughi) Clinical Research and
Development Center, Shahid Modarres Hospital, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Torbati) Department of Pathology, School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Vitamin D plays an important role in immune system and in the
regulation of inflammatory cytokines. Coronary artery bypass graft (CABG)
with cardiopulmonary bypass (CPB) is associated with an extensive
inflammatory response. The aim of this study is to examine the effect of
vitamin D treatment on the apoptosis and inflammatory changes developed
after CABG. <br/>Method(s): This trial was conducted on 70 patients
undergoing CABG with CPB. Patients were randomly administered either in
placebo or in the group of orally consuming 150 000 IU vitamin D daily for
3 consecutive days before surgery. The right atrium sample was taken to
assess caspases 2, 3, and 7 activity using immunohistochemistry method.
The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1
(IGF-1) were compared at intervals. <br/>Result(s): The average number of
positive cells for caspases 2 and 3 were less in vitamin D group (P =.006
and P <.001, respectively). There was an increase in serum levels of IL-10
after 3 days from vitamin D treatment before surgery (vitamin D group =
4.4 +/- 4.9 ng/mL and control group = 1 +/- 0.5 ng/mL, P =.001). After
operation, IL-10 increased in both groups, higher level in vitamin D group
(P <.001). The comparison of serum IGF-1 showed significant difference
after 3 days (P =.006) and remained higher in vitamin D group after CPB (P
<.001). <br/>Conclusion(s): These findings suggest the apoptosis rate
after CPB can be reduced by vitamin D. Vitamin D treatment may improve the
inflammatory status before and after surgery. Further studies are needed
to confirm the antiapoptotic property of vitamin D and clinical
implication.<br/>Copyright &#xa9; The Author(s) 2020.

<21>
Accession Number
631832852
Title
Outcomes of left atrial appendage occlusion using the atriclip device-a
systematic review.
Source
Irish Journal of Medical Science. Conference: Irish Thoracic Society
Annual Scientific Meeting. Ireland. 188 (Supplement 10) (pp S313-S314),
2019. Date of Publication: 2019.
Author
Toale C.; Higgins P.; Fitzmaurice G.; Eaton D.; Lyne J.; Redmond K.
Institution
(Toale, Higgins, Fitzmaurice, Eaton, Redmond) Department of Thoracic
Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin,
Ireland
(Lyne) Department of Cardiology, Blackrock Clinic, Dublin, Ireland
Publisher
Springer
Abstract
Atrial fibrillation (AF) increases lifetime stroke risk. The left atrial
appendage (LAA) is thought to be the source of embolic strokes in up to
90% of case, and occlusion of the LAA may be safer than the alternative of
oral anticoagulation. Occlusion devices such as the AtriclipTM (AtriCure,
Mason, USA) enable safe and reproducible epicardial clipping of the LAA. A
systematic review was performed inMay 2018, based on the Preferred
Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)
guidelines, using the keyword 'Atriclip'. A total of 68 papers were
identified and reviewed; 11 studies were included. Data including
demographics, medical history intervention(s) performed, peri-procedural
outcomes and follow-up was assessed and analyzed. A total of 922 patients
were identified. LAA occlusion was achieved in 936 out of 956 patients
(97.8%). No device-related adverse events were reported across the
studies. The reported incidence of stroke or transient ischaemic attack
(TIA) post-clip placement ranged from0.2-1.5/100 patient-years. 477 of 798
patients (59.7%) had ceased anticoagulation on follow-up. The AtriclipTM
device is safe and effective in the management of patients with atrial
fibrillation, either as an adjunct in patients undergoing cardiac surgery
or as a stand-alone thoracoscopic procedure.

<22>
Accession Number
2005962732
Title
Ultrathin Bioresorbable-Polymer Sirolimus-Eluting Stents Versus Thin
Durable-Polymer Everolimus-Eluting Stents for Coronary Revascularization:
3-Year Outcomes From the Randomized BIOFLOW V Trial.
Source
JACC: Cardiovascular Interventions. 13 (11) (pp 1343-1353), 2020. Date of
Publication: 8 June 2020.
Author
Kandzari D.E.; Koolen J.J.; Doros G.; Garcia-Garcia H.M.; Bennett J.;
Roguin A.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Baim Institute for Clinical Research, Boston, MA,
United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Hillel Yaffe Medical Center, Hadera,
Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare late-term clinical
outcomes among patients treated with ultrathin-strut (60-mum)
bioresorbable-polymer sirolimus-eluting stents (BP SES) and thin-strut
(81mum) durable-polymer everolimus-eluting stents (DP EES).
<br/>Background(s): Emerging evidence from comparative studies of
drug-eluting stents demonstrates improved safety and efficacy with
ultrathin-strut drug-eluting stents, but limited insight exists regarding
late-term outcomes. <br/>Method(s): BIOFLOW V (Biotronik Prospective
Randomized Multicenter Study to Assess the Safety and Effectiveness of the
Orsiro Sirolimus Eluting Coronary Stent System in the Treatment of
Subjects With Up to Three De Novo or Restenotic Coronary Artery Lesions V)
is an international randomized trial comparing coronary revascularization
with BP SES and DP EES regarding the primary endpoint of 12-month target
lesion failure. Analysis of pre-specified 3-year clinical outcomes was
performed. <br/>Result(s): Among 1,334 patients randomized to treatment
with BP SES (n = 884) or DP EES (n = 450), the 3-year rate of target
lesion failure was 8.2% for BP SES and 13.6% for DP EES (p = 0.002),
driven by differences in both target vessel myocardial infarction (MI)
(5.0% vs. 9.2%; p = 0.003) and clinically driven target lesion
revascularization (3.2% vs. 6.7%; p = 0.006). In landmark analysis,
significant differences in target vessel MI and target lesion
revascularization were observed favoring treatment with BP SES. Definite
or probable late or very late stent thrombosis was significantly lower
with BP SES (0.1% vs. 1.2%; p = 0.018). Cardiac death or MI rates were
7.7% and 11.7% (p = 0.017) for BP SES and DP EES, respectively.
<br/>Conclusion(s): In a large randomized trial, both target lesion
failure and the outcomes of target vessel MI, clinically driven target
lesion revascularization, and late or very late stent thrombosis at 3
years were significantly lower among patients treated with BP SES versus
DP EES. The results endorse the continued superiority of ultrathin-strut
BP SES compared with DP EES. (Safety and Effectiveness of the Orsiro
Sirolimus Eluting Coronary Stent System in Subjects With Coronary Artery
Lesions [BIOFLOW-V]; NCT02389946)<br/>Copyright &#xa9; 2020 The Authors

<23>
Accession Number
2005962730
Title
Quantitative Assessment of Acute Regurgitation Following TAVR: A
Multicenter Pooled Analysis of 2,258 Valves.
Source
JACC: Cardiovascular Interventions. 13 (11) (pp 1303-1311), 2020. Date of
Publication: 8 June 2020.
Author
Modolo R.; Chang C.C.; Abdelghani M.; Kawashima H.; Ono M.; Tateishi H.;
Miyazaki Y.; Pighi M.; Wykrzykowska J.J.; de Winter R.J.; Ruck A.; Chieffo
A.; van Mourik M.S.; Yamaji K.; Richardt G.; de Brito F.S.; Lemos P.A.;
Al-Kassou B.; Piazza N.; Tchetche D.; Sinning J.-M.; Abdel-Wahab M.;
Soliman O.; Sondergaard L.; Mylotte D.; Onuma Y.; Van Mieghem N.M.;
Serruys P.W.
Institution
(Modolo, Abdelghani, Kawashima, Ono, Wykrzykowska, de Winter, van Mourik)
Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular
Sciences, University of Amsterdam, Amsterdam, Netherlands
(Modolo) Department of Internal Medicine, Cardiology Division. University
of Campinas, Campinas, Brazil
(Chang, Miyazaki, Van Mieghem) Department of Cardiology, Erasmus Medical
Center, Rotterdam, Netherlands
(Abdelghani, Richardt, Abdel-Wahab) The Heart Center, Segeberger Kliniken,
Bad Segeberg, Germany
(Tateishi, Miyazaki, Piazza) Division of Cardiology, Department of
Clinical Science and Medicine, Yamaguchi University Graduate School of
Medicine, Ube, Yamaguchi, Japan
(Pighi) Division of Cardiology, McGill University Health Centre, Montreal,
Quebec, Canada
(Ruck) Department of Aortic Valve Disease, Karolinska University Hospital,
Stockholm, Sweden
(Chieffo) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Yamaji) Department of Cardiology, Kokura Memorial Hospital,
Kokurakita-ku, Kitakyushu, Japan
(de Brito, Lemos) The Heart Institute, University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Lemos) Department of Interventional Cardiology, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Al-Kassou, Sinning) Medizinische Klinik und Poliklinik II,
Universitatsklinikum Bonn, Bonn, Germany
(Tchetche) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
(Abdel-Wahab) Cardiology Department, Heart Center Leipzig at the
University of Leipzig, Leipzig, Germany
(Soliman, Mylotte, Onuma, Serruys) Galway University Hospital, SAOLTA
Health Care Group, and National University of Ireland, Galway, Ireland
(Sondergaard) The Heart Center, Rigshospitalet, University of Copenhagen,
Denmark
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to assess acute regurgitation
following transcatheter aortic valve replacement, comparing different
implanted transcatheter heart valves. <br/>Background(s): Regurgitation
following transcatheter aortic valve replacement influences all-cause
mortality. Thus far, no quantitative comparison of regurgitation among
multiple commercially available transcatheter heart valves has been
performed. <br/>Method(s): Aortograms from a multicenter cohort of
consecutive 3,976 transcatheter aortic valve replacements were evaluated
in this pooled analysis. A total of 2,258 (58.3%) were considered
analyzable by an independent academic core laboratory using video
densitometry. Results of quantitative regurgitation are shown as
percentages. The valves evaluated were the ACURATE (n = 115), Centera (n =
11), CoreValve (n = 532), Direct Flow Medical (n = 21), Evolut PRO (n =
95), Evolut R (n = 295), Inovare (n = 4), Lotus (n = 546), Lotus Edge (n =
3), SAPIEN XT (n = 239), and SAPIEN 3 (n = 397). For the main analysis,
only valves with more than 50 procedures (7 types) were used.
<br/>Result(s): The Lotus valve had the lowest mean regurgitation (3.5 +/-
4.4%), followed by Evolut PRO (7.4 +/- 6.5%), SAPIEN 3 (7.6 +/- 7.1%),
Evolut R (7.9 +/- 7.4%), SAPIEN XT (8.8 +/- 7.5%), ACURATE (9.6 +/- 9.2%)
and CoreValve (13.7 +/- 10.7%) (analysis of variance p < 0.001). The only
valves that statistically differed from all their counterparts were Lotus
(as the lowest regurgitation) and CoreValve (the highest). The proportion
of patients presenting with moderate or severe regurgitation followed the
same ranking order: Lotus (2.2%), Evolut PRO (5.3%), SAPIEN 3 (8.3%),
Evolut R (8.8%), SAPIEN XT (10.9%), ACURATE (11.3%), and CoreValve (30.1%)
(chi-square p < 0.001). <br/>Conclusion(s): In this pooled analysis
stemming from daily clinical practice, the Lotus valve was shown to have
the best immediate sealing. This analysis reflects the objective
evaluation of regurgitation by an academic core laboratory (nonsponsored)
in a real-world cohort of patients using a quantitative
technique.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<24>
Accession Number
2004931382
Title
Preoperative Anemia Management: What's New in 2020?.
Source
Current Anesthesiology Reports. 10 (2) (pp 166-175), 2020. Date of
Publication: 01 Jun 2020.
Author
Rubinger D.A.; Cahill C.; Ngo A.; Gloff M.; Refaai M.A.
Institution
(Rubinger, Gloff) Department of Anesthesia, University of Rochester
Medical Center, Rochester, NY, United States
(Cahill, Ngo, Refaai) Department of Pathology and Laboratory Medicine,
University of Rochester Medical Center, 601 Elmwood Avenue, Box-608,
Rochester, NY 14642, United States
Publisher
Springer
Abstract
Purpose of Review: The purpose of this article is to review the relevant
evidence regarding the clinical impact of preoperative anemia, current
methods of identifying anemia in the surgical population, and the current
and upcoming evidence for the treatment modalities targeting preoperative
anemia. Recent Findings: Preoperative anemia continues to be identified as
a contributor to poor outcomes in the surgical population. Identifying
anemia typically starts with hemoglobin and mean corpuscular volume.
Recent laboratories have also started using iron studies with serum
ferritin and transferrin saturation. Oral and IV iron have demonstrated
efficacy in treating preoperative anemia in terms of increasing hemoglobin
preoperatively and reducing allogeneic blood transfusions. However, few
studies have demonstrated an impact on patient outcomes, morbidity, and
mortality. Additionally, several meta-analyses have demonstrated the
benefit of adding erythropoietin-stimulating agents to improve anemia.
<br/>Summary: Preoperative anemia is very common and is thought to be a
contributor to poor outcomes. IV iron is currently recommended by several
guidelines as the primary treatment modality for preoperative anemia. Two
ongoing studies hope to provide clarity on the effect of IV iron on
patient outcomes including morbidity and mortality in cardiac and
non-cardiac surgical populations.<br/>Copyright &#xa9; 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<25>
Accession Number
2005978425
Title
Growth of cardiac infants with post-surgical chylothorax can be supported
using modified fat breast milk with proactive nutrient-enrichment and
advancement feeding protocols; an open-label trial.
Source
Clinical Nutrition ESPEN. (no pagination), 2020. Date of Publication:
2020.
Author
DiLauro S.; Russell J.; McCrindle B.W.; Tomlinson C.; Unger S.; O'Connor
D.L.
Institution
(DiLauro, McCrindle, Tomlinson, Unger, O'Connor) Department of Nutritional
Sciences, University of Toronto, Medical Sciences Building, 5th Floor,
Room 5253, 1 King's College Circle, Toronto M5S 1A8, Canada
(DiLauro, Russell, McCrindle) Labatt Family Heart Centre, The Hospital for
Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
(DiLauro, O'Connor) Translational Medicine Program, The Hospital for Sick
Children, 686 Bay Street, Toronto M5G 0A4, Canada
(Russell, McCrindle, Tomlinson) Department of Pediatrics, Faculty of
Medicine, University of Toronto, Toronto M5G 1X8, Canada
(Tomlinson, Unger) Department of Neonatology, The Hospital for Sick
Children, 555 University Avenue, Toronto M5G 1X8, Canada
(Unger, O'Connor) Rogers Hixon Ontario Human Milk Bank, Mount Sinai
Hospital, 600 University Ave, Toronto M5G 1X5, Canada
(Unger, O'Connor) Department of Pediatrics, Mount Sinai Hospital, 600
University Avenue, Toronto M5G 1X5, Canada
Publisher
Elsevier Ltd
Abstract
Background & aim: Previously we showed that modified fat breast milk
(MFBM) facilitated resolution of post-surgical chylothorax in cardiac
infants, but their weight-for-age and length-for-age z-scores declined
over the >=6-week treatment duration. Our aim was to evaluate the growth
of infants diagnosed with post-surgical chylothorax and fed according to
one of two proactive feeding protocols using MFBM or a high medium
triglyceride (MCT)-containing formula (standard of care). <br/>Method(s):
In this open-label trial, infants who were receiving >50% of their enteral
feeds as breast milk prior to chylothorax diagnosis were randomized to
receive their enteral feeds according to one of two proactive MFBM
protocols: Target Fortification (n = 8), where the protein concentration
of defatted breast milk was measured weekly and multi- and single-nutrient
modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial
Concentration (n = 8), where defatted breast milk was initially fortified
to an energy and nutrient level higher than that of unmodified breast milk
(80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of
infants (n = 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml
protein). The intervention lasted for a minimum of 6-weeks after chest
tube removal and continued after discharge. Weekly weight, length and head
circumference (HC) measurements were completed. <br/>Result(s): At
enrolment, there was no statistically significant differences in mean
(+/-SD) weight-for-age (-1.6 +/- 0.9, n = 24), length-for-age (-1.3 +/-
0.8), or HC-for-age (-0.9 +/- 1.0) z-scores among groups. Changes in mean
weight- (-0.3 +/- 0.9, n = 23), length- (0.1 +/- 0.6) and HC-for-age (0.2
+/- 0.6) z-scores did not differ among groups over the treatment period.
There was no difference in duration or volume of chest tube drainage
across groups. <br/>Conclusion(s): Use of proactive MFBM feeding protocols
both resolve chylothorax and support growth in infants following
cardiothoracic surgery. Trial registration: ClinicalTrials.gov
(NCT02577419).<br/>Copyright &#xa9; 2020 The Authors

<26>
Accession Number
2004937022
Title
Mitraclip Plus Medical Therapy Versus Medical Therapy Alone for Functional
Mitral Regurgitation: A Meta-Analysis.
Source
Cardiology and Therapy. (no pagination), 2019. Date of Publication: 2019.
Author
Goel S.; Pasam R.T.; Wats K.; Chava S.; Gotesman J.; Sharma A.; Malik
B.A.; Ayzenberg S.; Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Gidwani) Department of Cardiology, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Pasam, Wats, Chava, Gotesman, Malik, Ayzenberg, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, United
States
(Sharma) Division of Cardiology, Gundersen Health System, La Crosse, WI,
United States
(Sharma) Institute of Cardiovascular Science and Technology, New York, NY,
United States
Publisher
Adis
Abstract
Introduction: The purpose of this meta-analysis is to compare the efficacy
of MitraClip plus medical therapy versus medical therapy alone in patients
with functional mitral regurgitation (FMR). FMR caused by left ventricular
dysfunction is associated with poor prognosis. Whether MitraClip improves
clinical outcomes in this patient population remains controversial.
<br/>Method(s): We conducted an electronic database search of PubMed,
CINAHL, Cochrane Central, Scopus, Google Scholar, and Web of Science
databases for randomized control trials (RCTs) and observational studies
with propensity score matching (PSM) that compared MitraClip plus medical
therapy with medical therapy alone for patients with FMR and reported on
subsequent mortality, heart failure re-hospitalization, and other outcomes
of interest. Event rates were compared using a random-effects model with
odds ratio as the effect size. <br/>Result(s): Five studies (n = 1513;
MitraClip = 796, medical therapy = 717) were included in the final
analysis. MitraClip plus medical therapy compared to medical therapy alone
was associated with a significant reduction in overall mortality (OR =
0.66, 95% CI = 0.44-0.99, P = 0.04) and heart failure (HF)
re-hospitalization rates (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (OR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (OR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the MitraClip
group. No effect was observed on cardiac mortality (P = 0.42) between the
two groups. <br/>Conclusion(s): MitraClip plus medical therapy improves
overall mortality and reduces HF re-hospitalization rates compared to
medical therapy alone in patients with FMR.<br/>Copyright &#xa9; 2019, The
Author(s).

<27>
[Use Link to view the full text]
Accession Number
631831161
Title
Continuous Lactate Measurement Devices and Implications for Critical Care:
A Literature Review.
Source
Critical care nursing quarterly. 43 (3) (pp 269-273), 2020. Date of
Publication: 01 Jul 2020.
Author
Chavez J.; Glaser S.; Krom Z.
Institution
(Chavez) Critical Care Services, Cedars-Sinai Medical Center, Los Angeles,
California (Messrs Chavez and Krom); and SSG Nurse Anesthesia
Incorporated, Los Angeles, California (Ms Glaser)
Publisher
NLM (Medline)
Abstract
The aim of this article is to review the literature on lactate
measurements in critical care and the current devices used to measure
noninvasively and invasively. Lactate measurements are currently being
used as a way to measure the severity of sepsis. Intravascular and
subcutaneous devices are some of the ways that these measurements can be
continuously gathered as well as point-of-care blood tests. New devices
that are being currently used with athletes can measure lactate
noninvasively. As the advance of technology continues to move at a fast
speed, an evaluation of literature is needed to assess the continued
support of lactate and the ability to move to noninvasive devices in
critical care. A literature search was conducted in February 2020, using
PubMed, CINAHL, MEDLINE, and Cochrane databases. There remains support for
the use of lactate and continuous lactate monitoring; however, currently,
noninvasive devices are not available for the critical care environment.
There are invasive techniques that are being used to measure lactate
continuously in critical care and are beneficial for the cardiac surgery
population. The review of the literature on continuous lactate
measurements produced evidence that supports prediction of morbidity and
mortality. There are no current noninvasive lactate measurement devices
that can be used in critical care, but they are being currently used in
the athletic community. Invasive continuous lactate measurement devices
are currently being used and beneficial.

<28>
Accession Number
631766725
Title
Physiologic perfusion monitoring methods during endovascular
revascularization for atherosclerotic peripheral arterial disease:
Protocol for a systematic review.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 107. Date
of Publication: 08 May 2020.
Author
Rockley M.; Jetty P.; Wells G.
Institution
(Rockley, Jetty) Division of Vascular and Endovascular Surgery, Department
of Surgery, University of Ottawa, Ottawa Hospital-Civic Campus, Ottawa
K1Y4E9, Canada
(Wells) School of Epidemiology and Public Health, Cardiovascular Research
Methods Centre, University of Ottawa Heart Institute, Ottawa K1Y4W7,
Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Endovascular therapy is a fundamental treatment for peripheral
arterial disease. However, the success rate of endovascular therapy
remains poor, as a third of patients with critical limb ischemia
ultimately require a major amputation for gangrene despite endovascular
treatment. This failure rate has prompted investigation into methods of
determining physiologic procedural success before and after treatment,
before clinically apparent outcomes occur such as gangrene. The aim of
this systematic review is to evaluate if in patients undergoing
endovascular surgery for lower extremity atherosclerotic peripheral
arterial disease, do changes in physiologic measures of perfusion during
surgery correlate with clinical outcomes. <br/>Method(s): We registered
and designed a study protocol for a systematic review. Literature searches
will be conducted in MEDLINE, EMBASE, and CENTRAL (from January 1977
onwards). Grey literature will be identified through OpenGrey and clinical
trial registries, and supplemented by citation searches. We will include
randomized controlled trials, quasi-experimental trials, and observational
(cohort, case-control) studies conducted in human adults (age 18 or older)
who received elective arterial angioplasty for atherosclerotic peripheral
vascular disease. The primary outcome of interest will be major adverse
limb events. Two investigators will independently screen all citation,
full-text articles, and abstract data. The study quality (risk of bias)
will be appraised appropriate tools. Data analysis and synthesis will be
qualitative; no meta-analysis is planned, as the anticipated homogeneity
of measurement and outcome reporting standardization is low.
<br/>Discussion(s): The treatment of peripheral arterial disease is unique
in that the tissue of the ischemic leg is easily accessible for direct
monitoring during procedures. This is contrasted with cardiac and
neurologic monitoring during cardiac and cerebral procedures, where
indirect or invasive measures are required to monitor organ perfusion.
Currently synthesized evidence describing limb perfusion focuses on static
states of ischemia, and does not evaluate the value of change in perfusion
measurement as an indicator of endovascular treatment success. These
methods could potentially be applied to optimize procedural outcomes by
guiding perfusion-based decision-making during surgery. Systematic review
registration: PROSPERO CRD42019138192.<br/>Copyright &#xa9; 2020 The
Author(s).

<29>
Accession Number
631854365
Title
A systematic review of donor serum sodium level and its impact on
transplant recipients.
Source
International Journal of Organ Transplantation Medicine. 11 (2) (pp
43-54), 2020. Date of Publication: 2020.
Author
Basmaji J.; Hornby L.; Rochwerg B.; Luke P.; Ball I.M.
Institution
(Basmaji, Ball) Department of Medicine, Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
(Hornby) Children's Hospital of Eastern Ontario Research Institute,
Ottawa, ON, Canada
(Hornby) Canadian Blood Services, Ottawa, ON, Canada
(Rochwerg) Division of Critical Care, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rochwerg) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
(Luke) Division of Urology, Department of Surgery, Western University,
London, ON, Canada
(Luke) Matthew Mailing Centre for Translational Transplant Studies, Lawson
Research Institute, London Health Sciences Centre, London, ON, Canada
Publisher
Iranian Society for Organ Transplantation (E-mail: info@ijotm.com)
Abstract
Background: An important aspect of donor management is the optimization of
serum sodium levels. <br/>Objective(s): To perform a systematic review to
determine the effects of donor sodium levels on heart, lung, kidney, and
pancreas graft function, recipient mortality, and to identify the optimal
donor serum sodium target. <br/>Method(s): We searched MEDLINE, Cochrane,
Guideline databases, and trial registries from 1946 to May 2019 for
studies investigating the effects of donor serum sodium levels on
transplant outcomes in all nonhepatic organs. A two-step independent
review process was used to identify relevant articles based on
inclusion/exclusion criteria. We describe the results narratively, assess
the risk of bias, and apply GRADE methodology to evaluate the certainty in
the evidence. <br/>Result(s): We included 18 cohort studies in our final
analysis (n=28,007). 3 of 4 studies demonstrated an association between
donor serum sodium and successful organ transplantation. 5 studies
reported no association with graft function, while 6 studies did. 5
studies reported on recipient survival, 3 of which suggested donor sodium
is unlikely to be associated with recipient survival. The included studies
had serious risk of bias, and the certainty in evidence was deemed to be
very low. <br/>Conclusion(s): In low risk of bias studies, donor sodium
dysregulation is unlikely to affect kidney graft function or mortality of
heart and kidney recipients, but the certainty in the evidence is very low
due to inconsistency and imprecision. Further research is required to
refine the serum sodium target range, quantify the dose-response curve,
and identify organs most vulnerable to sodium dysregulation.<br/>Copyright
&#xa9; Iranian Society for Organ Transplantation.

<30>
[Use Link to view the full text]
Accession Number
631846339
Title
Use of Coagulation Point-of-Care Tests in the Management of
Anticoagulation and Bleeding in Pediatric Cardiac Surgery: A Systematic
Review.
Source
Anesthesia and Analgesia. (pp 1594-1604), 2020. Date of Publication: 2020.
Author
Bianchi P.; Beccaris C.; Norbert M.; Dunlop B.; Ranucci M.
Institution
(Bianchi) Department of Anesthesia and Intensive Care, Royal Brompton and
Harefield Nhs Foundation Trust, London, United Kingdom
(Beccaris) Great Ormond Street Hospital Nhs Foundation Trust, Cardiac
Intensive Care Unit, London, United Kingdom
(Norbert, Dunlop) Brunel University, London, United Kingdom
(Ranucci) Department of Cardiothoracic, Vascular Anesthesia and Intensive
Care, Irccs Policlinico San Donato, Milan, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Bleeding and coagulation management are essential aspects in the
management of neonates and children undergoing cardiac surgery. The use of
point-of-care tests (POCTs) in a pediatric setting is not as widely used
as in the adult setting. This systematic review aims to summarize the
evidence showed by the literature regarding the use of POCTs in children
undergoing cardiac surgery. We included all studies examining the
pediatric population (<18 years old) undergoing cardiac surgery in which
the coagulation profile was assessed with POCTs. Three electronic
databases (PubMed, Embase, and the Cochrane Controlled Clinical Trials
register) were searched. Tests involved were heparin effect tests,
viscoelastic tests, and platelet function tests. Due to the wide
heterogeneity of the patients and tests studied, a formal meta-analysis
was impossible, and the results are therefore presented through a
systematic review. Eighty articles were found, of which 47 are presented
in this review. At present, literature data are too weak to define POCTs
as a "gold standard" for the treatment of perioperative bleeding in
pediatric cardiac surgery. Nevertheless, introduction of POCTs into
postoperative algorithms has shown to improve bleeding management, patient
outcome, and cost efficiency.<br/>Copyright &#xa9; 2020 CSIRO. All rights
reserved.

<31>
Accession Number
631839002
Title
Characteristics and Outcomes Of Gastrointestinal Bleeding In Patients With
Continuous-Flow Left Ventricular Assist Devices: A Systematic Review.
Source
Artificial organs. (no pagination), 2020. Date of Publication: 16 May
2020.
Author
Carlson L.; Maynes E.; Choi J.H.; Hallett A.; Horan D.; Weber M.; Deb A.;
Patel S.; Samuels L.; Morris R.; Entwistle J.; Massey H.;
Tchantchaleishvili V.
Publisher
NLM (Medline)
Abstract
Gastrointestinal bleeding (GIB) is a common adverse event after
continuous-flow left ventricular assist device (CF-LVAD) implantation. We
sought to evaluate patterns of GIB development and related outcomes in
CF-LVAD recipients. An electronic search was performed to identify all
articles related to GIB in the setting of CF-LVAD implantation. A total of
34 studies involving 1,087 patients were pooled for analysis. Mean patient
age was 60 years (95% CI 57-64) and 24% (95% CI 21-28%) were female. The
mean time from CF-LVAD implantation to the first GIB was 54 days (95% CI
24-84) with 40% (95% CI 34-45%) of patients having multiple episodes of
GIB. Anemia was present in 75% (95% CI 41-93%) and the most common
etiology of bleeding was arteriovenous malformations [36% (95% CI
24-50%)]. The mean duration of follow-up was 14.6 months (95% CI 6.9-22.3)
during which the all-cause mortality rate was 21% (95% CI 12-36%) and the
mortality rate from GIB was 4% (95% CI 2-9%). Thromboembolic events
occurred in 32% (95% CI 22-44%) of patients with an ischemic stroke rate
of 16% (95% CI 3-51%) and a pump thrombosis rate of 8% (95%CI 3-22%).
Heart transplantation was performed in 31% (95% CI 18-47%) of patients,
after which 0% (95% CI 0-10%) experienced recurrent GIB. GIB is a major
source of morbidity among CF-LVAD recipients. While death due to GIB is
rare, cessation of anticoagulation during treatment increases the risk of
subsequent thrombotic events. Heart transplant in these patients appears
to reliably resolve the risk of future GIB.<br/>Copyright This article is
protected by copyright. All rights reserved.

<32>
Accession Number
631838536
Title
The Quality of Peer-Reviewed Publications on Surgery for Early Stage Lung
Cancer within the Veterans Health Administration.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2020.
Date of Publication: 17 May 2020.
Author
Welp A.M.; Abbott S.E.; Samson P.; Cameron R.B.; Cornwell L.D.; Harpole
D.; Moghanaki D.
Institution
(Welp) Virginia Commonwealth University School of Medicine, VA, Richmond
23298
(Abbott) Hunter Holmes McGuire VA Medical Center, VA, Richmond 23249
(Samson) Department of Radiation Oncology, Washington University in St.
Louis/Barnes-Jewish Hospital, St. Louis, MO 63110, United States
(Cameron) Division of Cardiothoracic Surgery, Department of Surgery,
University of California Los Angeles, Los Angeles, CA, 90095; Department
of Cardiothoracic Surgery, West Los Angeles VA Medical Center, Los
Angeles, CA 90073
(Cornwell) Division of Cardiothoracic Surgery, Department of Surgery,
Baylor College of Medicine, Houston, TX, 77030; Operative Care Line,
Michael E. DeBakey VA Medical Center, Houston, TX, 77030
(Harpole) Department of Surgery, Duke University Medical Center, Durham,
NC, 27710; Department of Cardiothoracic Surgery, Durham VA Medical Center,
Durham, NC, 22705
(Moghanaki) Department of Radiation Oncology, Emory University School of
Medicine, Atlanta, GA, 30322; Department of Radiation Oncology, Atlanta VA
Health Care System, Decatur, GA, 30333
Publisher
NLM (Medline)
Abstract
The peer-reviewed literature is often referenced to generalize outcomes
for lung cancer surgeries performed within the Veterans Health
Administration (VHA) and include assessments following resection of early
stage non-small cell lung cancer. We sought to determine the reliability
of these reports that are publicly available. A systematic review was
undertaken to identify PubMed indexed articles that report post-operative
outcomes following surgical resections for stage I NSCLC within the VHA.
Only studies that reported American Joint Committee on Cancer (AJCC)
staging were included. Eleven studies spanning 49 years (1966-2015) met
the inclusion criteria. Two reported findings from national VHA databases
while nine reported outcomes from single institutions. Reporting of
outcomes and prognostic factors varied widely between studies and were
frequently omitted. This made it difficult to evaluate prognostic factors
that may be associated with a wide range of 30- and 90-day perioperative
mortality (0-3.8% and 0-6.4%), 3- and 5-year cause specific survival
(72-92% and 32-84%), and 3- and 5- year overall survival (47-85.7% and
24-74%). The quality of peer-reviewed literature that reports outcomes
following thoracic surgery for stage I NSCLC in the VHA is inconsistent
and precludes accurate assessments for generalizations about the quality
of care in this healthcare system. Efforts to develop a dedicated outcome
tracking and registry system can provide more meaningful evidence to
identify areas for improvement for this often-curable
malignancy.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<33>
Accession Number
631834943
Title
Use of Administrative Claims to Assess Outcomes and Treatment Effect in
Randomized Clinical Trials for Transcatheter Aortic Valve Replacement:
Findings from the Extending Trial-Based Evaluations of Medical Therapies
Using Novel Sources of Data (EXTEND) Study.
Source
Circulation. (no pagination), 2020. Date of Publication: 21 May 2020.
Author
Strom J.B.; Faridi K.F.; Butala N.M.; Zhao Y.; Tamez H.; Valsdottir L.R.;
Brennan J.M.; Shen C.; Popma J.J.; Kazi D.S.; Yeh R.W.
Institution
(Strom, Faridi, Zhao, Tamez, Valsdottir, Shen, Kazi) Richard A. and Susan
F. Smith Center for Outcomes Research in Cardiology, Boston, MA; Division
of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston,
MA; Harvard Medical School, Boston, MA
(Butala) Harvard Medical School, Boston, MA; Division of Cardiology,
Massachusetts General Hospital, Boston, MA
(Brennan) Duke Clinical Research Institute, Durham
(Popma) Division of Cardiovascular Medicine, Beth Israel Deaconess Medical
Center, Boston, MA; Harvard Medical School, Boston, MA; Baim Institute for
Clinical Research, Boston, MA
(Yeh) Richard A. and Susan F. Smith Center for Outcomes Research in
Cardiology, Boston, MA; Division of Cardiovascular Medicine, Beth Israel
Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA;
Baim Institute for Clinical Research, Boston, MABaim Institute for
Clinical Research, Boston, MA
Publisher
NLM (Medline)
Abstract
Background: Whether passively collected data can substitute for
adjudicated outcomes to reproduce the magnitude and direction of treatment
effect observed in cardiovascular clinical trials is not well known.
<br/>Method(s): We linked adults aged >=65 in the US CoreValve Pivotal
High Risk (HiR) and Surgical or Transcatheter Aortic Valve Replacement in
Intermediate-Risk Patients (SURTAVI) Trials to 100% Medicare inpatient
claims, 1/1/2003-12/31/2016. Primary (e.g. death and stroke) and secondary
trial endpoints, were compared across treatment arms (e.g. TAVR vs. SAVR)
using trial-adjudicated outcomes versus outcomes derived from claims at
1-year (HiR) or 2-years (SURTAVI). <br/>Result(s): Among 600 linked
CoreValve HiR participants (linkage rate 80.0%), the rate of the trial's
primary endpoint of all-cause mortality occurred in 13.7% of patients
receiving TAVR and 16.4% of patients receiving SAVR at 1-year using both
trial data (HR 0.84, 95% CI 0.65-1.09; p= 0.33) and claims data (HR 0.86,
95% CI 0.66-1.11; p = 0.34; interaction p-value = 0.80). Noninferiority of
TAVR relative to SAVR was seen using both trial and claims-based outcomes
(pnoninferiority < 0.001 for both). Among 1005 linked SURTAVI trial
participants (linkage rate 60.5%), the trial's primary endpoint was 12.9%
for TAVR and 13.1% for SAVR using trial data (HR 1.08, 95% CI 0.79-1.48, p
= 0.90), and 11.3% for TAVR and 12.5% for SAVR patients using claims data
(HR 1.02, 95% CI 0.73-1.41, p = 0.58; interaction p-value = 0.89). TAVR
was noninferior to SAVR when compared using both trial and claims
(pnon-inferiority < 0.001 for both). Rates of procedural secondary
outcomes (e.g. aortic valve reintervention, pacemaker rates) were more
closely concordant between trial and claims data than non-procedural
outcomes (e.g., stroke, bleeding, cardiogenic shock). <br/>Conclusion(s):
In the CoreValve HiR and SURTAVI trials, ascertainment of trial primary
endpoints using claims reproduced both the magnitude and direction of
treatment effect compared with adjudicated event data, but non-fatal and
non-procedural secondary outcomes were not as well reproduced. Use of
claims to substitute for adjudicated outcomes in traditional trial
treatment comparisons may be valid and feasible for all-cause mortality
and certain procedural outcomes, but may be less suitable for other
endpoints.

<34>
[Use Link to view the full text]
Accession Number
631834644
Title
Volatile Anesthetics versus Propofol for Cardiac Surgery with
Cardiopulmonary Bypass: Meta-analysis of Randomized Trials.
Source
Anesthesiology. (pp 1429-1446), 2020. Date of Publication: 2020.
Author
Bonanni A.; Signori A.; Alicino C.; Mannucci I.; Grasso M.A.; Martinelli
L.; Deferrari G.
Institution
(Bonanni, Mannucci, Deferrari) Departments of Cardionephrology, Clinical
Ligurian Institute of High Specialty, Villa Maria Group (GVM) Care and
Research, Rapallo, Italy
(Grasso) Intensive Care Unit, Clinical Ligurian Institute of High
Specialty, Villa Maria Group (GVM) Care and Research, Rapallo, Italy
(Martinelli) Cardiac Surgery, Clinical Ligurian Institute of High
Specialty, Villa Maria Group (GVM) Care and Research, Rapallo, Italy
(Bonanni) Division of Internal Medicine, International Evangelical
Hospital, Genoa, Italy
(Signori) Departments of Health Scienc, University of Genoa, Italy
(Deferrari) Departments of Internal Medicine, University of Genoa, Italy
(Alicino) ASL-2-Regional Health System of Liguria, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
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- A nd 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.<br/>Copyright &#xa9; 2020, the American Society of
Anesthesiologists, Inc.

<35>
Accession Number
631830796
Title
Efficacy of Evolocumab on Cardiovascular Outcomes in Patients With Recent
Myocardial Infarction: A Prespecified Secondary Analysis From the FOURIER
Trial.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 20 May 2020.
Author
Gencer B.; Mach F.; Murphy S.A.; De Ferrari G.M.; Huber K.; Lewis B.S.;
Ferreira J.; Kurtz C.E.; Wang H.; Honarpour N.; Keech A.C.; Sever P.S.;
Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Gencer, Murphy, Sabatine, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, Boston, MA
(Gencer, Mach) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(De Ferrari) Division of Cardiology Citta della Salute e della Scienza,
Department of Medical Sciences, University of Torino, Turin, Italy
(Huber) Department of Medicine, Cardiology and Intensive Care Medicine and
Sigmund Freud University, Medical School, Vienna, Austria
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ferreira) Hospital de Santa Cruz, Lisbon, Portugal
(Kurtz, Wang, Honarpour) Amgen, Thousand Oaks, CA
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(Sabatine) Deputy Editor
Publisher
NLM (Medline)
Abstract
Importance: The 2018 American Heart Association/American College of
Cardiology Multisociety Guideline on the Management of Blood Cholesterol
identified patients with recent (past 12 months) myocardial infarction
(MI) as very high risk, in whom a PCSK9 inhibitor is reasonable to add to
maximally tolerated statin combined with ezetimibe if their low-density
lipoprotein cholesterol level is 70 mg/dL or greater or non-high-density
lipoprotein cholesterol level is 100 mg/dL or greater. <br/>Objective(s):
To examine the clinical efficacy of evolocumab in patients with recent MI.
<br/>Design, Setting, and Participant(s): This was a prespecified
secondary analysis of the Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, in which
27 564 patients with atherosclerotic cardiovascular disease treated with a
statin were randomized to evolocumab vs placebo. Patients with prior MI
with a known date (n=22320) were stratified as having a recent MI (within
12 months of randomization) or a remote MI (more than 12 months prior to
randomization). Per protocol, patients with MI within 4 weeks prior to
randomization were excluded from the FOURIER trial. Data were collected
from February 2013 to November 2016, and data were analyzed from May 2019
to February 2020. <br/>Main Outcomes and Measures: The primary composite
end point was cardiovascular death, MI, stroke, hospitalization for
unstable angina, or coronary revascularization. The key secondary
composite end point was cardiovascular death, MI, or stroke.
<br/>Result(s): Of 22320 included patients, 17516 (78.5%) were male, and
the mean (SD) age was 62.2 (9.0) years. Compared with 16609 patients with
a remote MI, 5711 patients with a recent MI were younger and more likely
to be treated with high-intensity statin (77.3% [4415] vs 69.3% [11506]).
In the placebo arm, the 3-year Kaplan-Meier rate for the primary end point
was 17.2% in patients with recent MI compared with 14.4% in those with
remote MI (adjusted HR, 1.45; 95% CI, 1.29-1.64; P<.001). Similarly, the
3-year Kaplan-Meier rates for the key secondary end point was also higher
in those with recent MI (10.9% vs 9.5%; adjusted HR, 1.45; 95% CI,
1.24-1.69; P<.001). In patients with a recent MI, evolocumab reduced the
risk of the primary and key secondary end points by 19% (hazard ratio
[HR], 0.81; 95% CI, 0.70-0.93) and 25% (HR, 0.75; 95% CI, 0.62-0.91),
respectively. In patients with a remote MI, evolocumab reduced the risk of
the primary and key secondary end points by 8% (HR, 0.92; 95% CI,
0.84-1.01; P for interaction=.13) and 15% (HR, 0.85; 95% CI, 0.76-0.96; P
for interaction=.24), respectively. Given the higher event rates in
patients with a recent MI, the absolute risk reductions over 3 years with
evolocumab were 3.7% in those with recent MI vs 1.1% in those with remote
MI for the primary end point and 3.2% vs 1.3%, respectively, for the key
secondary end point. <br/>Conclusions and Relevance: Patients with a
recent MI were at higher risk of cardiovascular events and tended to
experience greater absolute risk reductions with evolocumab than those
with remote MIs. These findings support the concept in US and European
guidelines to aggressively lower low-density lipoprotein cholesterol
levels in very high-risk patients, such as those with a recent MI. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633.

<36>
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

<37>
Accession Number
630597551
Title
Early postoperative statin administration does not affect the rate of
atrial fibrillation after cardiac surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (6) (pp 1154-1159),
2020. Date of Publication: 01 Jun 2020.
Author
Khan J.A.; Laurikka J.O.; Jarvinen O.H.; Khan N.K.; Jarvela K.M.
Institution
(Khan, Laurikka, Jarvela) Department of Cardio-Thoracic Surgery, Tays
Heart Hospital, Tampere University Hospital, Tampere, Finland
(Laurikka, Jarvinen) Faculty of Medicine and Health Technology, Tampere
University, Tampere, Finland
(Khan) Centre for Vascular Surgery and Interventional Radiology, Tampere
University Hospital, Tampere, Finland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Postoperative atrial fibrillation is the most frequent
complication after cardiac surgery, and the use of statins in preventing
them is being extensively studied. The aim of this study was to
investigate whether a pause in the administration of statins affects the
occurrence of atrial fibrillation after cardiac surgery in a prospective
randomized and controlled setting. <br/>METHOD(S): A total of 301 patients
without chronic atrial fibrillation with prior statin medication scheduled
for elective or urgent cardiac surgery involving the coronary arteries
and/or heart valves were prospectively recruited and randomized for statin
re-initiation on either the first (immediate statin group) or the fifth
(late statin group) postoperative day, using the original medication and
dosage. The immediate statin group comprised 146 patients and the late
statin group 155 patients. Except for a somewhat higher rate of males (85%
vs 73%, P=0.016) in the immediate statin group, the baseline
characteristics and the distribution of procedures performed within the
groups were comparable. The occurrence of postoperative atrial
fibrillation and the clinical course of the patients were compared between
the groups. <br/>RESULT(S): The incidence of atrial fibrillation was 46%
and the median delay after surgery before the onset of atrial fibrillation
was 3 days in both groups (P=NS). No differences were observed in the
frequency of the arrhythmia in any subgroup analyses or in other major
complications or clinical parameters. No adverse effects related to early
statin administration were detected. <br/>CONCLUSION(S): Early
re-initiation of statins does not appear to affect the occurrence of
postoperative atrial fibrillation. CLINICAL TRIAL REGISTRATION: European
Union Drug Regulating Authorities Clinical Trials Database
(EudraCT)-2016-001655-44.<br/>Copyright &#xa9; The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<38>
Accession Number
628954670
Title
Long-term and short-term duration of thienopyridine therapy after coronary
stenting in patients with chronic kidney disease a meta-analysis of
literature studies.
Source
Platelets. 31 (4) (pp 483-489), 2020. Date of Publication: 18 May 2020.
Author
Wu Y.; Song Y.; Pan Y.; Gong Y.; Zhou Y.
Institution
(Wu, Gong, Zhou) Department of Nephrology, Beijing Tiantan hospital,
Capital Medical University, Beijing, China
(Song) School of Economics, Central University of Finance and Economics,
Beijing, China
(Pan) Department of Epidemiology and Health Statistics, School of Public
Health, Capital Medical University, Beijing, China
(Pan) China National Clinical Research Center for Neurological Diseases
(NCRC-ND), Beijing, China
Publisher
NLM (Medline)
Abstract
The study aimed to compare the efficacy and safety outcome associated with
a short and a prolonged duration of thienopyridine therapy in patients
with chronic kidney disease (CKD) after coronary stenting. We
systematically searched PubMed, EMBASE and the Cochrane Library from their
inception to 1 January 2019 for studies comparing short and prolonged
thienopyridine therapy in patients with CKD. Ischemic and bleeding events
were considered as the clinical endpoints in this analysis. Odds Ratios
(OR) with 95% confidence intervals (CIs) were used as estimates of effect
size in random-effect models. Seven studies comprising a total of 17,628
CKD patients were included in the evaluation. Prolonged duration of
thienopyridine use, when compared to short-term thienopyridine, was
associated with reduced risk of all-cause mortality (odds ratio 0.75, 95%
confidence interval: 0.70-0.81, P< .001) and stent thrombosis (OR: 0.54,
95% CI 0.32 to 0.89; P< .001), but the odds of myocardial infarction (OR:
0.91, 95% CI: 0.77-1.07; P = .23) and stroke (OR: 0.91, 95% CI 0.73 to
1.13; P = .38) did not differ according to different duration of
thienopyridine. As for bleeding events, long-term thienopyridine therapy
did not significantly increase the bleeding (OR: 0.95, 95% CI 0.79 to
1.14; P = .58). In these patients with CKD following PCI, prolonged
thienopyridine therapy compared with short-term therapy, was associated
with reduced all-cause mortality and stent thrombosis, without any
significant difference in myocardial infarction, stroke, and bleeding.
Thienopyridine prolongation decisions for CKD patients should be
individualized after careful consideration of the benefit-risk balance.

<39>
Accession Number
630804089
Title
Impact of minimally invasive extracorporeal circulation on coagulation-a
randomized trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (6) (pp 1145-1153),
2020. Date of Publication: 01 Jun 2020.
Author
Modrau I.S.; Halle D.R.; Nielsen P.H.; Kimose H.H.; Greisen J.R.; Kremke
M.; Hvas A.-M.
Institution
(Modrau, Halle, Nielsen, Kimose) Department of Cardiothoracic and Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Modrau, Kimose, Greisen, Hvas) Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark
(Greisen, Kremke) Department of Anaesthesiology and Intensive Care, Aarhus
University Hospital, Aarhus, Denmark
(Hvas) Department of Clinical Biochemistry, Aarhus University Hospital,
Aarhus, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Minimally invasive extracorporeal circulation (MiECC) is
suggested to have favourable impact on blood loss compared to conventional
extracorporeal circulation. We aimed to compare the impact of both systems
on coagulation. <br/>METHOD(S): Randomized trial comparing endogenous
thrombin-generating potential early after elective coronary surgery
employing either MiECC group (n=30) or conventional extracorporeal
circulation group (n=30). Secondary outcomes were in vivo thrombin
generation, bleeding end points and haemodilution, as well as morbidity
and mortality up to 30-day follow-up. <br/>RESULT(S): Compared to the
conventional extracorporeal circulation group, the MiECC group showed (i)
a trend towards a higher early postoperative endogenous
thrombin-generating potential (P=0.06), (ii) lower intraoperative levels
of thrombin-antithrombin complex and prothrombin fragment 1+2 (P<0.001),
(iii) less haemodilution early postoperatively as measured by haematocrit
and weight gain, but without correlation to coagulation factors or
bleeding end points. Moreover, half as many patients required
postoperative blood transfusion in the MiECC group (17% vs 37%, P=0.14),
although postoperative blood loss did not differ between groups (P=0.84).
Thrombin-antithrombin complex levels (rs=0.36, P=0.005) and prothrombin
fragment 1+2 (rs=0.45, P<0.001), but not early postoperative endogenous
thrombin-generating potential (rs=0.05, P=0.72), showed significant
correlation to increased transfusion requirements. The MiECC group
demonstrated significantly lower levels of creatine kinase-MB, lactate
dehydrogenase and free haemoglobin indicating superior myocardial
protection, less tissue damage and less haemolysis, respectively.
Perioperative morbidity and 30-day mortality did not differ between
groups. <br/>CONCLUSION(S): Conventional but not MiECC is associated with
significant intraoperative thrombin generation despite full
heparinization. No correlation between coagulation factors or bleeding end
points with the degree of haemodilution could be ascertained.
CLINICALTRIALS.GOV IDENTIFIER: NCT03216720.<br/>Copyright &#xa9; The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<40>
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

<41>
Accession Number
2005001732
Title
Novel, digital, chest drainage system in cardiac surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Barozzi L.; Biagio L.S.; Meneguzzi M.; Courvoisier D.S.; Walpoth B.H.;
Faggian G.
Institution
(Barozzi, Biagio, Meneguzzi, Faggian) Division of Cardiac Surgery,
University of Verona, Verona, Italy
(Courvoisier) Quality of Care Unit, University Hospital, Geneva,
Switzerland
(Walpoth) Department of Cardiovascular Surgery, University Hospital,
Geneva, Switzerland
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: A new, self-contained, digital, continuous pump-driven chest
drainage system is compared in a randomized control trial to a traditional
wall-suction system in cardiac surgery. <br/>Method(s): One hundred and
twenty adult elective cardiac patients undergoing coronary artery bypass
graft and/or valve surgery were randomized to the study or control group.
Both groups had similar pre/intra-operative demographics: age 67.8 vs 67.0
years, Euroscore 2.3 vs 2.2, and body surface area 1.92 vs 1.91
m². Additionally, a satisfaction assessment score (0-10) was
performed by 52 staff members. <br/>Result(s): Given homogenous
intra-operative variables, total chest-tube drainage was comparable among
groups (566 vs 640 mL; ns), but the study group showed more efficient
fluid collection during the early postoperative phase due to continuous
suction (P =.01). Blood, cell saver transfusions and postoperative
hemoglobin values were similar in both groups. The study group experienced
drain removal after 29.8 vs 38.4 hours in the control group (ns). Seven
crossovers from the Study to the Control group were registered but no
patient had drain-related complications. The Personnel Satisfaction
Assessment scored above 5 for all questions asked. <br/>Conclusion(s): The
new, digital, chest drainage system showed better early drainage of the
chest cavity and was as reliable as conventional systems. Quicker drain
removal might impact on intensive care unit (ICU) stay and reduce costs.
Additional advantages are portable size, battery operation, patient
mobility, noiseless function, digital indications and alarms. The
satisfaction assessment of the new system by the staff revealed a higher
score when compared to the traditional wall suction chest drainage
system.<br/>Copyright &#xa9; 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<42>
Accession Number
2003930760
Title
Transcatheter versus surgical aortic valve replacement in low-risk
patients: a meta-analysis of randomized trials.
Source
Clinical Research in Cardiology. 109 (6) (pp 761-775), 2020. Date of
Publication: 01 Jun 2020.
Author
Hofer F.; Hengstenberg C.; Goliasch G.; Grygier M.; Mascherbauer J.;
Siller-Matula J.M.
Institution
(Hofer, Hengstenberg, Goliasch, Mascherbauer, Siller-Matula) Division of
Cardiology, Department of Internal Medicine II, Medical University of
Vienna, Vienna, Austria
(Grygier) 1st Department of Cardiology, Poznan University of Medical
Sciences, Poznan, Poland
(Siller-Matula) Department of Experimental and Clinical Pharmacology,
Centre for Preclinical Research and Technology (CEPT), Medical University
of Warsaw, Warsaw, Poland
Publisher
Springer
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as a
treatment option for severe aortic stenosis in patients at intermediate or
high surgical risk. However, until recently there was insufficient
evidence regarding the outcomes of TAVR compared to surgical aortic valve
replacement (SAVR) for patients at low risk. <br/>Method(s): We conducted
a meta-analysis and systematic review of all randomized trials comparing
the efficacy and safety of TAVR versus SAVR in patients at low surgical
risk. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated,
using fixed- or random-effects model. <br/>Result(s): Four trials were
eligible for analysis and comprised a total of 2887 patients (1497
allocated to TAVR and 1390 allocated to SAVR group). TAVR was associated
with a 39% relative risk reduction (RRR) of major adverse cardiac events
(MACE) (absolute risk reduction ARR of 3.7%; RR 0.61; 95% CI 0.47-0.79);
39% RRR of overall mortality (ARR of 1.4%; RR 0.61; 95% CI 0.39-0.96) and
45% RRR of cardiovascular mortality (ARR of 1.3%; RR 0.55; 95% CI
0.33-0.90), 69% RRR of life threatening or disabling bleeding (ARR of
7.0%; RR 0.31; 95% CI 0.22-0.44), 73% RRR of new-onset atrial fibrillation
(ARR of 29%; RR 0.27; 95% CI 0.20-0.35) and 73% RRR of acute kidney injury
(ARR of 2.1%; RR 0.27; 95% CI 0.14-0.56) as compared with SAVR. In
contrast, TAVR was associated with a 4.7-fold increased risk of new
pacemaker (PM) implantation (RR 4.72; 95% CI 1.83-12.15), which was driven
by use of self-expanding valves. <br/>Conclusion(s): TAVR in low-risk
patients is superior to SAVR for the majority of outcomes. Graphical
abstract: [Figure not available: see fulltext.].<br/>Copyright &#xa9;
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<43>
Accession Number
631756594
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. 22 (1) (no pagination),
2020. Article Number: 34. 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, United
States
(Nguyen, Sosnovik) Cardiovascular Research Center, Massachusetts General
Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129,
United States
(Sosnovik) Division of Health Sciences and Technology, Harvard-MIT, 7
Massachusetts Avenue, Cambridge, MA 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,
Dienstweg 1, Enschede 7522 ND, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The clinical application of cardiovascular magnetic resonance
(CMR) T<inf>2</inf> and T<inf>2</inf>^* 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
T<inf>2</inf> and T<inf>2</inf>^* 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 T<inf>2</inf> or
T<inf>2</inf>^* 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. T<inf>2</inf> 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. T<inf>2</inf> 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. T<inf>2</inf>^* values were lower in
patients with MI and iron overload (SMD of-1.99 and-2.39, respectively, P
< 0.01) compared with controls. T<inf>2</inf>^* 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 T<inf>2</inf> and T<inf>2</inf>^* 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 T<inf>2</inf> and T<inf>2</inf>^* values of most
cardiomyopathies are similar.<br/>Copyright &#xa9; 2020 The Author(s).

<44>
Accession Number
631734631
Title
Development and validation of the DIabetes Severity SCOre (DISSCO) in 139
626 individuals with type 2 diabetes: A retrospective cohort study.
Source
BMJ Open Diabetes Research and Care. 8 (1) (no pagination), 2020. Article
Number: e000962. Date of Publication: 07 May 2020.
Author
Zghebi S.S.; Mamas M.A.; Ashcroft D.M.; Salisbury C.; Mallen C.D.;
Chew-Graham C.A.; Reeves D.; Van Marwijk H.; Qureshi N.; Weng S.; Holt T.;
Buchan I.; Peek N.; Giles S.; Rutter M.K.; Kontopantelis E.
Institution
(Zghebi, Ashcroft, Reeves, Kontopantelis) NIHR School for Primary Care
Research, Centre for Primary Care and Health Services Research, Manchester
Academic Health Science Centre (MAHSC), University of Manchester,
Manchester, United Kingdom
(Zghebi, Mamas, Reeves, Buchan, Giles, Kontopantelis) Division of
Population Health, Health Services Research and Primary Care, School of
Health Sciences, Faculty of Biology Medicine and Health, Manchester
Academic Health Science Centre (MAHSC), University of Manchester,
Manchester, United Kingdom
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, School of Primary Community and Social Care, Keele University,
Stoke-on-Trent, United Kingdom
(Ashcroft) Division of Pharmacy and Optometry, School of Health Sciences,
Faculty of Biology Medicine and Health, Manchester Academic Health Science
Centre (MAHSC), University of Manchester, Manchester, United Kingdom
(Ashcroft, Peek, Giles) NIHR Greater Manchester Patient Safety
Translational Research Centre, University of Manchester, Manchester,
United Kingdom
(Ashcroft, Peek) NIHR Manchester Biomedical Research Centre, Manchester
Academic Health Science Centre (MAHSC), Manchester, United Kingdom
(Salisbury) Centre for Academic Primary Care, Population Health Sciences,
Bristol Medical School, University of Bristol, Bristol, United Kingdom
(Mallen, Chew-Graham) School of Primary Community and Social Care, Faculty
of Medicine and Health Sciences, Keele University, Staffordshire, United
Kingdom
(Reeves) Centre for Biostatistics, School of Health Sciences, Faculty of
Biology Medicine and Health, Manchester Academic Health Science Centre
(MAHSC), University of Manchester, Manchester, United Kingdom
(Van Marwijk) Department of Primary Care and Public Health, Brighton and
Sussex Medical School, University of Sussex, Falmer, United Kingdom
(Qureshi, Weng) Primary Care Stratified Medicine (PRISM) Research Group,
Division of Primary Care, School of Medicine, University of Nottingham,
Nottingham, United Kingdom
(Holt) Nuffield Department of Primary Care Health Sciences, University of
Oxford, Oxford, United Kingdom
(Buchan) Institute of Population Health, University of Liverpool,
Liverpool, United Kingdom
(Buchan, Peek, Kontopantelis) Division of Informatics Imaging and Data
Sciences, School of Health Sciences, Faculty of Biology Medicine and
Health, Manchester Academic Health Science Centre (MAHSC), University of
Manchester, Manchester, United Kingdom
(Rutter) Manchester Diabetes Centre, Manchester University NHS Foundation
Trust, Manchester Academic Health Science Centre (MAHSC), Manchester,
United Kingdom
(Rutter) Division of Diabetes Endocrinology and Gastroenterology, School
of Medical Sciences, Faculty of Biology Medicine and Health, Manchester
Academic Health Science Centre (MAHSC), University of Manchester,
Manchester, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Clinically applicable diabetes severity measures are lacking,
with no previous studies comparing their predictive value with glycated
hemoglobin (HbA 1c). We developed and validated a type 2 diabetes severity
score (the DIabetes Severity SCOre, DISSCO) and evaluated its association
with risks of hospitalization and mortality, assessing its additional risk
information to sociodemographic factors and HbA 1c. Research design and
methods We used UK primary and secondary care data for 139 626 individuals
with type 2 diabetes between 2007 and 2017, aged >=35 years, and
registered in general practices in England. The study cohort was randomly
divided into a training cohort (n=111 748, 80%) to develop the severity
tool and a validation cohort (n=27 878). We developed baseline and
longitudinal severity scores using 34 diabetes-related domains. Cox
regression models (adjusted for age, gender, ethnicity, deprivation, and
HbA 1c) were used for primary (all-cause mortality) and secondary
(hospitalization due to any cause, diabetes, hypoglycemia, or
cardiovascular disease or procedures) outcomes. Likelihood ratio (LR)
tests were fitted to assess the significance of adding DISSCO to the
sociodemographics and HbA 1c models. Results A total of 139 626 patients
registered in 400 general practices, aged 63+/-12 years were included, 45%
of whom were women, 83% were White, and 18% were from deprived areas. The
mean baseline severity score was 1.3+/-2.0. Overall, 27 362 (20%) people
died and 99 951 (72%) had >=1 hospitalization. In the training cohort, a
one-unit increase in baseline DISSCO was associated with higher hazard of
mortality (HR: 1.14, 95% CI 1.13 to 1.15, area under the receiver
operating characteristics curve (AUROC)=0.76) and cardiovascular
hospitalization (HR: 1.45, 95% CI 1.43 to 1.46, AUROC=0.73). The LR tests
showed that adding DISSCO to sociodemographic variables significantly
improved the predictive value of survival models, outperforming the added
value of HbA 1c for all outcomes. Findings were consistent in the
validation cohort. Conclusions Higher levels of DISSCO are associated with
higher risks for hospital admissions and mortality. The new severity score
had higher predictive value than the proxy used in clinical practice, HbA
1c. This reproducible algorithm can help practitioners stratify clinical
care of patients with type 2 diabetes.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

<45>
Accession Number
631709685
Title
Does concurrent use of intra-aortic balloon pumps improve survival in
patients with cardiogenic shock requiring venoarterial extracorporeal
membrane oxygenation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (2) (pp 312-315),
2020. Date of Publication: 01 Feb 2020.
Author
Wang D.; Chao V.; Yap K.H.; Tan T.E.
Institution
(Wang, Chao, Yap, Tan) Department of Cardiothoracic Surgery, National
Heart Centre Singapore, Singapore, Singapore
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does concurrent use of
intra-aortic balloon pump (IABP) improve survival in patients with
cardiogenic shock requiring venoarterial extracorporeal membrane
oxygenation (VA-ECMO)?'. Altogether 472 papers were found using the
reported search, of which 3 level 2 systematic reviews represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. The reported
comparative outcomes were mortality, weaning off extracorporeal membrane
oxygenation (ECMO), vascular complications and non-vascular complications.
One systematic review demonstrated significantly lower in-hospital
mortality with concurrent use of IABP and VA-ECMO, while the other 2
studies showed no difference in mortality. One paper reported on the
weaning success from ECMO and demonstrated significantly higher weaning
success with concurrent IABP usage. Another paper reported on the
complications and showed no differences in vascular and non-vascular
complications. We conclude that there was no significant improvement in
survival with the concurrent use of IABP and VA-ECMO for a cardiogenic
shock as compared to the use of VA-ECMO alone. However, the concurrent use
of IABP with VA-ECMO improved weaning success from VA-ECMO. The incidence
of vascular and non-vascular complications was similar with or without
IABP usage.<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.

<46>
Accession Number
2004958511
Title
Direct vs preimplantation balloon valvuloplasty in transcatheter aortic
valve replacement-Systematic review and meta-analysis of randomized
controlled trials and prospective-matched cohorts.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Pranata R.; Vania R.; Alkatiri A.A.; Firman D.
Institution
(Pranata, Vania) Department of Medicine, Faculty of Medicine, Universitas
Pelita Harapan, Tangerang, Indonesia
(Alkatiri, Firman) Department of Cardiology and Vascular Medicine, Faculty
of Medicine, National Cardiovascular Center Harapan Kita, Universitas
Indonesia, Jakarta, Indonesia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: This systematic review and meta-analysis aimed to evaluate the
efficacy and safety of direct vs preimplantation balloon valvuloplasty
(predilatation) before transcatheter aortic valve replacement (TAVR).
<br/>Method(s): We performed a systematic literature search up until March
2020 from PubMed, SCOPUS, EuropePMC, Cochrane Central Database, ProQuest,
and ClinicalTrials.gov. We included randomized controlled trial (RCT) and
prospective-matched cohorts that compared direct TAVR and preimplantation
balloon valvuloplasty before TAVR. The primary outcome was the device
success as defined by Valve Academic Research Consortium 2. The secondary
outcome was a patient-prosthesis mismatch, the need for balloon
postdilatation, composite adverse events, and 1-year mortality.
<br/>Result(s): There were a total of 3078 patients from eight studies.
This meta-analysis showed that direct TAVR has a similar device success
rate (P =.63), the need for postdilatation (P =.82), and composite adverse
events (P =.98) compared with preimplantation balloon valvuloplasty.
Subgroup analysis for balloon-expandable valves showed lower need for
balloon postdilatation (risk ratio [RR], 0.63 [0.47, 0.84]; P =.002;
I², 0%) in direct TAVR group but higher incidence of acute
kidney injury (RR, 3.23 [1.25, 8.40]; P =.02; I², 0%) and
major/life-threatening bleeding (RR, 1.54 [1.17, 2.02]; P =.002;
I², 0%). Subgroup analysis for the RCTs alone and RCTs +
propensity-matched cohorts showed similar device success and composite
adverse events in both groups. However, pooled RCTs showed a higher need
for balloon postdilatation in direct TAVR (RR, 1.83 [1.03, 3.24]; P =.04;
I², 0%). <br/>Conclusion(s): Direct TAVR has similar efficacy
and safety to preimplantation balloon valvuloplasty. However,
better-designed RCTs are required before drawing a definite
conclusion.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<47>
Accession Number
2004630460
Title
Extending inferences from a randomized trial to a new target population.
Source
Statistics in Medicine. (no pagination), 2020. Date of Publication: 2020.
Author
Dahabreh I.J.; Robertson S.E.; Steingrimsson J.A.; Stuart E.A.; Hernan
M.A.
Institution
(Dahabreh, Robertson) Center for Evidence Synthesis in Health, Brown
University, Providence, RI, United States
(Dahabreh, Robertson) Department of Health Services, Policy & Practice,
Brown University, Providence, RI, United States
(Dahabreh) Department of Epidemiology, Brown University, Providence, RI,
United States
(Dahabreh, Hernan) Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA, United States
(Steingrimsson) Department of Biostatistics, School of Public Health,
Brown University, Providence, RI, United States
(Stuart) Departments of Mental Health, Biostatistics, and Health Policy
and Management, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, United States
(Hernan) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Hernan) Harvard-MIT Division of Health Sciences and Technology, Boston,
MA, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
When treatment effect modifiers influence the decision to participate in a
randomized trial, the average treatment effect in the population
represented by the randomized individuals will differ from the effect in
other populations. In this tutorial, we consider methods for extending
causal inferences about time-fixed treatments from a trial to a new target
population of nonparticipants, using data from a completed randomized
trial and baseline covariate data from a sample from the target
population. We examine methods based on modeling the expectation of the
outcome, the probability of participation, or both (doubly robust). We
compare the methods in a simulation study and show how they can be
implemented in software. We apply the methods to a randomized trial nested
within a cohort of trial-eligible patients to compare coronary artery
surgery plus medical therapy versus medical therapy alone for patients
with chronic coronary artery disease. We conclude by discussing issues
that arise when using the methods in applied analyses.<br/>Copyright
&#xa9; 2020 John Wiley & Sons, Ltd.

<48>
Accession Number
631831092
Title
Corrigendum to 'Mortality in trials on transcatheter aortic valve
implantation versus surgical aortic valve replacement: a pooled
meta-analysis of Kaplan-Meier-derived individual patient data' Eur J
Cardiothorac Surg 2020, doi:10.1093/ejcts/ezaa087.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 16 May 2020.
Author
Barili F.; Freemantle N.; Casado A.P.; Rinaldi M.; Folliguet T.; Musumeci
F.; Gerosa G.; Parolari A.
Institution
(Barili, Casado) Department of Cardiac Surgery, S. Croce Hospital, Cuneo,
Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta` della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
NLM (Medline)

<49>
[Use Link to view the full text]
Accession Number
631823672
Title
Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve
Replacement in Low-Risk Patients: The PARTNER 3 Trial.
Source
Circulation. (pp 1527-1537), 2020. Date of Publication: 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,
2725 Chemin Sainte-Foy, Quebec, Canada
(Dahou, Avenatti, Alu, Leon, Hahn) Cardiovascular Research Foundation, New
York, NY, United States
(Ong) St Michael's Hospital, University of Toronto, Canada
(Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, GA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Kodali, Alu, Smith, Leon, Hahn) Columbia University Irving Medical
Center, New York-Presbyterian Hospital, New York, United States
(Russo) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Kapadia) Cleveland Clinic, OH, United States
(Malaisrie) Feinberg School of Medicine, Northwestern University, Chicago,
IL, United States
(Cohen) University of Missouri-Kansas City, United States
(Leipsic, Blanke, Webb) St Paul's Hospital, Vancouver, Canada
(Williams) NYU-Langone Medical Center, New York, NY, United States
(McCabe) University of Washington, Seattle, United States
(Brown, Mack) Baylor Scott and White Healthcare, Plano, TX, United States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Goldman) Lankenau Medical Center, Wynnewood, PA, United States
(Szeto) University of Pennsylvania, Philadelphia, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center, NJ,
United States
(Pershad) Banner University Medical Center, Phoenix, AZ, United States
(Xu, Rogers) Edwards Lifesciences, Irvine, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
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 mm Hg; 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
(Z<inf>va</inf>), 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 mm Hg/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
Z<inf>va</inf> 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 Z<inf>va</inf> 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.<br/>Copyright &#xa9; 2020 BMJ Publishing Group. All rights
reserved.

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

<51>
Accession Number
2004055079
Title
Early outcome of tricuspid valve repair using prosthetic ring annuloplasty
versus suture annuloplasty.
Source
Indian Journal of Public Health Research and Development. 10 (12) (pp
1526-1532), 2019. Date of Publication: December 2019.
Author
El-Zayadi M.M.; Mahmoud M.A.-D.; Osama A.; Helal A.
Institution
(El-Zayadi, Mahmoud, Osama, Helal) Cardiothoracic Surgery Department,
Faculty of Medicine, Cairo University, Egypt
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India)
Abstract
The purpose of this study is to compare the early outcome of tricuspid
valve repair using prosthetic ring annuloplasty versus suture
annuloplasty. <br/>Method(s): In the period between March 2016 and
September 2017, 40 patients with severe functional tricuspid regurgitation
(TR) secondary to rheumatic mitral with or without aortic valve pathology
divided into two equal groups underwent open heart surgery at Kasr Al-Aini
Hospitals, Cardiothoracic surgery department. Group (1) had tricuspid
valve repair using suture annuloplasty, while Group (2) had tricuspid
valve repair using prosthetic ring annuloplasty. All patients were
evaluated thoroughly preoperative, intra-operative, and post-operative.
Particular attention was paid to clinical and echocardiographic findings
of presence of tricuspid regurgitation (TR), its nature and degree,
postoperative intensive care unit (ICU) events, ICU stay, hospital stay
and follow up of the degree of TR post-operatively. <br/>Result(s):
Evaluation showed that there is no significant difference between results
of suture annuloplasty and prosthetic ring annuloplasty early
postoperative, while late postoperative studies had proven significantly
better outcomes with prosthetic ring annuloplasty than with suture
annuloplasty techniques concerning low rate of recurrent TR.
<br/>Conclusion(s): we concluded that using prosthetic ring for tricuspid
valve repair was better than suture annuloplasty techniques as it was
associated with less frequent rates of late postoperative recurrent
TR.<br/>Copyright &#xa9; 2019, Indian Journal of Public Health Research
and Development. All rights reserved.

<52>
[Use Link to view the full text]
Accession Number
608560984
Title
Microalbuminuria predicts the recurrence of cardiovascular events in
patients with essential hypertension.
Source
Journal of Hypertension. 34 (4) (pp 646-653), 2016. Date of Publication:
01 Apr 2016.
Author
Meccariello A.; Buono F.; Verrengia E.; Orefice G.; Grieco F.; Romeo F.;
Trimarco B.; Morisco C.
Institution
(Meccariello, Buono, Verrengia, Orefice, Grieco, Morisco) Dipartimento di
Scienze Mediche Traslazionali, Universita FEDERICO II, Via S. Pansini n.
5, Naples 80131, Italy
(Trimarco) Dipartimento di Scienze Biomediche Avanzate, Universita
FEDERICO II, Naples, Italy
(Romeo) Daichi Sankyo Italia SPA, Rome, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives: Microalbuminuria (MAU) is associated with an enhanced risk of
cardiovascular events. The prevalence of MAU and its prognostic impact has
an important role in the stratification of cardiovascular risk in patients
with essential hypertension. This is an observational, prospective study
performed by 13 general practitioners aiming at assessing the prevalence
and prognostic relevance of MAU in essential hypertension. <br/>Method(s):
Patients with essential hypertension and with recent determination of MAU
were enrolled into the study by general practitioners, and were followed
up for 3 years. Primary end point was the occurrence of major
cardiovascular events during the follow-up. <br/>Result(s): Out of 1024
unselected patients, consecutively enrolled from January 2009 to March
2010, 804 completed the 3-year follow-up. Patients were categorized into
two groups according to the absence (n=523, 65%) or presence (n=281, 35%)
of MAU. During the follow-up, 41 cardiovascular events (1.69events/100
patient-years) were reported. The presence of MAU was not associated with
increased risk of cardiovascular events (adjusted hazard ratio=1.32; 95%
confidence interval 0.290-4.340, P=0.097). When the analysis was
restricted to the patients with previous cardiovascular event, MAU
(adjusted hazard ratio=2.18; 95% confidence interval 0.42-2.43, P=0.031),
together with age, metabolic syndrome, diabetes, and smoking,
independently predicted the occurrence of cardiovascular events.
<br/>Conclusion(s): Presence of MAU in patients with essential
hypertension is not associated with increased risks of cardiovascular
events. At the variance, in patients with previous cardiovascular events,
MAU was found to predict recurrent events. Thus, the assessment of MAU
could be considered a useful tool in secondary prevention.<br/>Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc.

<53>
[Use Link to view the full text]
Accession Number
354831976
Title
Antihypertensive therapy and the benefits of atorvastatin in the
Anglo-Scandinavian Cardiac Outcomes Trial: Lipid-lowering arm extension.
Source
Journal of Hypertension. 27 (5) (pp 947-954), 2009. Date of Publication:
May 2009.
Author
Sever P.S.; Poulter N.R.; Dahlof B.; Wedel H.
Institution
(Sever, Poulter) Imperial College London, International Centre for
Circulatory Health, 59 North Wharf Road, London W2 1LA, United Kingdom
(Dahlof) Department of Medicine, Clinical Trial Unit, Ostra Hospital,
Sweden
(Wedel) Nordic School of Public Health, Goteborg, Sweden
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective To determine the cardiovascular benefits of atorvastatin
stratified by blood pressure-lowering regimen, 2.2 years after closure of
the lipid-lowering arm (LLA) of the Anglo-Scandinavian Cardiac Outcomes
Trial (ASCOT-LLA). Methods In ASCOT-LLA, 10305 hypertensive patients
randomized to amlodipine-based or atenolol-based therapy and with a total
cholesterol 6.5 mmol/l or less were further randomized to atorvastatin or
placebo. ASCOT-LLA was terminated after 3.3 years median follow-up.
Cardiovascular outcomes in these patients were further evaluated 2.2 years
later, at the end of the blood pressure-lowering arm (BPLA). Results By
the end of BPLA in both groups originally assigned statin or placebo,
approximately 65% were receiving a statin, and lipid levels had equalized.
The benefits of atorvastatin observed in LLA were sustained throughout
BPLA. At the end of BPLA, in those assigned amlodipine-based therapy,
atorvastatin reduced coronary heart disease deaths and nonfatal myocardial
infarction (MI) by 46% [hazard ratio 0.54, confidence interval (CI)
0.40-0.72, P<0.0001], stroke by 37% [hazard ratio 0.63, CI 0.46-0.87, P =
0.004] and total cardiovascular events and procedures by 27% [hazard ratio
0.73, CI 0.63-0.86, P< 0.0001]. In the atenolol-based group, atorvastatin
reduced coronary heart disease death and nonfatal MI by 25% [hazard ratio
0.75, CI 0.57-0.97, P=0.03], stroke by 10% [hazard ratio 0.90, CI
0.69-1.18, P=0.43] and total cardiovascular events and procedures by 13%
[hazard ratio 0.87, CI 0.76-1.0, P = 0.05]. Pvalues for heterogeneity were
low, but failed to achieve statistical significance (0.10, 0.10 and 0.11
for chronic heart disease, stroke and total cardiovascular events,
respectively). Conclusion Although not statistically significant, the
benefits of atorvastatin appeared greater among those on amlodipine-based
compared with atenolol-based therapy. These data provide supporting
evidence that coassignment to atorvastatin may have generated differential
effects on coronary and other cardiovascular outcomes by amlodipine-based
and atenolol-based treatment in ASCOT-BPLA. &#xa9; 2009 Wolters Kluwer
Health <br/> Lippincott Williams & Wilkins.

<54>
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.

<55>
Accession Number
631621821
Title
Design and rationale of a randomized control trial testing the
effectiveness of combined therapy with STAtin plus FENOfibrate and statin
alone in non-diabetic, combined dyslipidemia patients with non-intervened
intermediate coronary artery disease - STAFENO study.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 353. Date of
Publication: 22 Apr 2020.
Author
Kwon T.-G.; Jang A.Y.; Kim S.W.; Hong Y.J.; Bae J.-H.; Lee S.Y.; Kim
S.-H.; Han S.H.
Institution
(Kwon, Bae) Division of Cardiology, Department of Internal Medicine,
College of Medicine, Konyang University Hospital, Daejeon, South Korea
(Jang, Han) Division of Cardiology, Department of Internal Medicine,
Gachon University College of Medicine, Gil Hospital, Incheon, South Korea
(Kim) Division of Cardiology, Department of Internal Medicine,
Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul,
South Korea
(Hong) Division of Cardiology, Department of Internal Medicine, Chonnam
National University Hospital, Gwangju, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Inje
University Ilsan Paik Hospital, Goyang, South Korea
(Kim) Division of Cardiology, Department of Internal Medicine,
Cardiovascular Center, Seoul National University College of Medicine,
Boramae Medical Center, Seoul, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite the chronicled success of low-density lipoprotein
cholesterol (LDLc)-lowering statin therapy, substantial residual
cardiovascular (CV) disease risk remains a problem worldwide, highlighting
the need to for combination therapies targeting non-LDLc factors, such as
with fenofibrate. Methods/design: The STAFENO trial is a prospective,
randomized, open-label, multi-center trial to compare the effect of statin
plus fenofibrate with statin alone on the reduction and stabilization of
plaque in non-diabetic, combined dyslipidemia patients with
non-intervened, intermediate coronary artery disease (CAD) using virtual
histology-intravascular ultrasound at 12 months. A total of 106 eligible
patients are planned to be randomized to receive either a combination
therapy (rosuvastatin 10 mg plus fenofibrate 160 mg/day) or monotherapy
(rosuvastatin 10 mg/day) for 12 months. The primary endpoint of this study
is the percentage change in the necrotic core volume. Secondary endpoints
include changes in tissue characteristics and 1-year major CV events,
including all-cause mortality, CV mortality, nonfatal myocardial
infarction, stroke, and revascularization of the intervened and
non-intervened lesions. <br/>Discussion(s): The STAFENO trial will address
whether combination treatment of statin and fenofibrate has an additive
beneficial effect compared to statin alone on the reduction and
stabilization of plaque and CV events in non-diabetic, combined
dyslipidemia patients with non-intervened intermediate CAD. Trial
registration: ClinicalTrials.gov, NCT02232360. Registered 9 February 2014.
https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000
4ULE&selectaction=Edit&uid=U00023SZ&ts=2&cx=juppd2<br/>Copyright &#xa9;
2020 The Author(s).

<56>
Accession Number
2002392323
Title
Levosimendan in patients with reduced left ventricular function undergoing
isolated coronary or valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 159 (6) (pp 2302-2309.e6),
2020. Date of Publication: June 2020.
Author
van Diepen S.; Mehta R.H.; Leimberger J.D.; Goodman S.G.; Fremes S.;
Jankowich R.; Heringlake M.; Anstrom K.J.; Levy J.H.; Luber J.; Nagpal
A.D.; Duncan A.E.; Argenziano M.; Toller W.; Teoh K.; Knight J.D.; Lopes
R.D.; Cowper P.A.; Mark D.B.; Alexander J.H.
Institution
(van Diepen) Division of Cardiology, Departments of Critical Care and
Medicine, University of Alberta, Edmonton, Alberta, Canada
(van Diepen, Goodman) Canadian VIGOUR Center, University of Alberta,
Edmonton, Alberta, Canada
(Mehta, Leimberger, Anstrom, Levy, Knight, Lopes, Cowper, Mark, Alexander)
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, United States
(Goodman) Terrence Donnelly Heart Centre, Division of Cardiology, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Fremes) Schulich Heart Center, University of Toronto, Toronto, Ontario,
Canada
(Jankowich) Tenax Therapeutics, Morrisville, NC, United States
(Heringlake) University of Lubeck, Lubeck, Germany
(Luber) Franciscan Health System, Tacoma, Wash, United States
(Nagpal) London Health Sciences Centre, London, Ontario, Canada
(Duncan) Cleveland Clinic, Cleveland, OH, United States
(Argenziano) Columbia University Medical Center, New York, NY, United
States
(Toller) Medical University of Graz, Graz, Austria
(Teoh) Southlake Regional Health Center, Newmarket, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In the Levosimendan in Patients with Left Ventricular Systolic
Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass
(LEVO-CTS) trial, no differences in clinical outcomes were observed
between levosimendan and placebo in a broad population of patients
undergoing cardiac surgery. In previous studies, the benefits of
levosimendan were most clearly evident in patients undergoing isolated
coronary artery bypass grafting (CABG) surgery. In a prespecified analysis
of LEVO-CTS, we compared treatment-related outcomes and costs across types
of cardiac surgical procedures. <br/>Method(s): Overall, 563 (66.4%)
patients underwent isolated CABG, 97 (11.4%) isolated valve, and 188
(22.2%) combined CABG/valve surgery. Outcomes included the co-primary
4-component composite (30-day mortality, 30-day renal replacement, 5-day
myocardial infarction, or 5-day mechanical circulatory support), the
2-component composite (30-day mortality or 5-day mechanical circulatory
support), 90-day mortality, low cardiac output syndrome (LCOS), and 30-day
medical costs. <br/>Result(s): The 4- and 2-component outcomes were not
significantly different with levosimendan and placebo in patients
undergoing CABG (15.2% vs 19.3% and 7.8% vs 10.4%), valve (49.0% vs 33.3%
and 22.4% vs 2.1%), or combined procedures (39.6% vs 35.9% and 24.0% vs
19.6%). Ninety-day mortality was lower with levosimendan in isolated CABG
(2.1% vs 7.9%; hazard ratio [HR], 0.26; 95% confidence interval [CI],
0.11-0.64), but not significantly different in valve (8.3% vs 2.0%; HR,
4.10; 95% CI, 0.46-36.72) or combined procedures (10.4% vs 7.6%; HR, 1.39;
95% CI, 0.53-3.64; interaction P = .011). LCOS (12.0% vs 22.1%; odds
ratio, 0.48; 95% CI, 0.30-0.76; interaction P = .118) was significantly
lower in levosimendan-treated patients undergoing isolated CABG. Excluding
study drug costs, median and mean 30-day costs were $53,707 and $65,852
for levosimendan and $54,636 and $67,122 for placebo, with a 30-day mean
difference (levosimendan - placebo) of -$1270 (bootstrap 95% CI, -$8722 to
$6165). <br/>Conclusion(s): Levosimendan was associated with lower 90-day
mortality and LCOS in patients undergoing isolated CABG, but not in those
undergoing isolated valve or combined CABG/valve procedures.<br/>Copyright
&#xa9; 2019 The American Association for Thoracic Surgery

<57>
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

<58>
Accession Number
2004376616
Title
Patient-specific three-dimensional printing in cardiovascular disease.
Source
Australasian Medical Journal. 13 (4) (pp 136-141), 2020. Date of
Publication: 2020.
Author
Sun Z.
Institution
(Sun) Discipline of Medical Radiation Sciences, School of Molecular and
Life Sciences, Curtin University, Perth, WA 6845, Australia
Publisher
Australasian Medical Journal Pty Ltd (12 Lancett Crt, Sorrento, WA 6020
WA, Australia)
Abstract
Three-dimensional (3D) printing has become a widely used technique showing
great promise in medical applications. In recent years, patient-specific
3D printed models are shown to play an important role in the domain of
cardiovascular disease, ranging from medical education to presurgical
planning and simulation of complex cardiovascular procedures, as well as
development of optimal computed tomography (CT) imaging protocols. This
review article provides a summary of the current applications of using 3D
printed cardiovascular models with future research directions
highlighted.<br/>Copyright &#xa9; 2020, Australasian Medical Journal Pty
Ltd. All rights reserved.

<59>
Accession Number
2004225719
Title
The effects of granulocyte colony-stimulating factor in patients with a
large anterior wall acute myocardial infarction to prevent left
ventricular remodeling: A 10-year follow-up of the rigenera study.
Source
Journal of Clinical Medicine. 9 (4) (no pagination), 2020. Article Number:
1214. Date of Publication: April 2020.
Author
Leone A.M.; D'amario D.; Cannata F.; Graziani F.; Borovac J.A.; Leone G.;
De Stefano V.; Basile E.; Siracusano A.; Galiuto L.; Locorotondo G.; Porto
I.; Vergallo R.; Canonico F.; Restivo A.; Rebuzzi A.G.; Crea F.
Institution
(Leone, D'amario, Graziani, Locorotondo, Porto) Department of
Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino
Gemelli, IRCCS, Universita Cattolica del Sacro Cuore, Largo A. Gemelli 8,
Rome 00168, Italy
(Cannata, Borovac, Leone, De Stefano, Basile, Siracusano, Galiuto,
Vergallo, Canonico, Restivo, Rebuzzi, Crea) Universita Cattolica del Sacro
Cuore, Rome 00168, Italy
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Background: the RIGENERA trial assessed the efficacy of granulocyte-colony
stimulating factor (G-CSF) in the improvement of clinical outcomes in
patients with severe acute myocardial infarction. However, there is no
evidence available regarding the long-term safety and efficacy of this
treatment. <br/>Method(s): in order to evaluate the long-term effects on
the incidence of major adverse events, on the symptom burden, on the
quality of life and the mean life expectancy and on the left ventricular
(LV) function, we performed a clinical and echocardiographic evaluation
together with an assessment using the Minnesota Living with Heart Failure
Questionnaire (MLHFQ) and the Seattle Heart Failure Model (SHFM) at
10-years follow-up, in the patients cohorts enrolled in the RIGENERA
trial. <br/>Result(s): thirty-two patients were eligible for the
prospective clinical and echocardiography analyses. A significant
reduction in adverse LV remodeling was observed in G-CSF group compared to
controls, 9% vs. 48% (p = 0.030). The New York Heart Association (NYHA)
functional class was lower in G-CSF group vs. controls (p = 0.040), with
lower burden of symptoms and higher quality of life (p = 0.049). The mean
life expectancy was significantly higher in G-CSF group compared to
controls (15 +/- 4 years vs. 12 +/- 4 years, p = 0.046. No difference was
found in the incidence of major adverse events. <br/>Conclusion(s): this
longest available follow-up on G-CSF treatment in patients with severe
acute myocardial infarction (AMI) showed that this treatment was safe and
associated with a reduction of adverse LV remodeling and higher quality of
life, in comparison with standard-of-care treatment.<br/>Copyright &#xa9;
2020 by the authors. Licensee MDPI, Basel, Switzerland.

<60>
[Use Link to view the full text]
Accession Number
631561131
Title
Feasibility of shockwave coronary intravascular lithotripsy for the
treatment of calcified coronary stenoses first description.
Source
Circulation. 139 (6) (pp 834-836), 2019. Date of Publication: 2019.
Author
Brinton T.J.; Ali Z.A.; Hill J.M.; Meredith I.T.; Maehara A.; Illindala
U.; Lansky A.; Gotberg M.; van Mieghem N.M.; Whitbourn R.; Fajadet J.; Di
Mario C.
Institution
(Brinton) Stanford University, James Clark Center E-100, 318 Campus Dr,
Stanford, CA 94305, United States
(Ali) NewYork-Presbyterian Hospital, Columbia University Medical Center,
New York, United States
(Ali, Maehara) Cardiovascular Research Foundation, New York, United States
(Hill) King's College Hospital, London, United Kingdom
(Meredith) Monash University, Melbourne, Australia
(Illindala) Shockwave Medical, Fremont, CA, United States
(Lansky) Yale University School of Medicine, New Haven, CT, United States
(Lansky) St. Bartholomew's Heart Center, London, United Kingdom
(Lansky) William Harvey Research Institute, Queen Mary University of
London, United Kingdom
(Gotberg) Skane University Hospital, Lund, Sweden
(van Mieghem) Erasmus University, Rotterdam, Netherlands
(Whitbourn) St Vincent's Hospital, Melbourne, Australia
(Fajadet) Clinique Pasteur, Toulouse, France
(Di Mario) University Hospital Careggi, Florence, Italy
(Di Mario) Royal Brompton Hospital, London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<61>
Accession Number
2005700310
Title
Safety and Haemodynamic Outcomes of Currently Available Suture-less Aortic
Valves in Patients With Aortic Stenosis: A Meta-analysis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Amer M.; Al Jawad M.A.; Omar A.; Metwaly H.
Institution
(Amer) Mahala Cardiac Center, El Gharbeya, Egypt
(Al Jawad, Omar, Metwaly) Department of Cardio-Thoracic Surgery, Faculty
of Medicine, Ain Shams University, Cairo, Egypt
Publisher
Elsevier Ltd
Abstract
Background: Suture-less aortic valves aim to achieve better outcomes and
to aid and facilitate the minimally invasive aortic valve replacement
procedure by tackling the issue of cross-clamp time, which is an
independent predictor of postoperative outcomes, especially in patients
with serious comorbidities. By reducing the number of sutures, the time
for suture placement is reduced. Our meta-analysis tried to assess the
safety and haemodynamic performance of the suture-less aortic valve
prostheses to ascertain their benefits as a viable alternative to current
established measures. <br/>Method(s): From their inceptions to February
2017, six electronic databases were searched. Relevant studies using
commercially accessible suture-free valves to replace the aortic valve
have been recognised. Based on the predefined end points, data were
collected and analysed. <br/>Result(s): For incorporation in qualitative
and quantitative analyses, 24 studies were recognised, with a total number
of 5,073 patients undergoing suture-less aortic valve replacement.
Mortality incidence at the 30-day and 12-month follow-ups were 2.5% and
2.7%, respectively, while the incidences of thromboembolic events (1.6%)
and paravalvular leak (0.5%) were acceptable. <br/>Conclusion(s): Current
available evidence indicates that sutureless aortic valve replacement is a
safe operation showing low mortality and complication rates, with
satisfactory haemodynamic performance.<br/>Copyright &#xa9; 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<62>
Accession Number
2005685110
Title
Effects of sugammadex on postoperative respiratory management in children
with congenital heart disease: a randomized controlled study.
Source
Biomedicine and Pharmacotherapy. 127 (no pagination), 2020. Article
Number: 110180. Date of Publication: July 2020.
Author
Xiaobing L.; Yan J.; Wangping Z.; Rufang Z.; Jia L.; Rong W.
Institution
(Xiaobing, Rufang, Jia) Department of Cardiothoracic Surgery, Shanghai
Children's Hospital, Shanghai JiaoTong University, Shanghai 200062, China
(Yan, Rong) Department of Anesthesiology, Shanghai Children's Hospital,
Shanghai JiaoTong University, Shanghai 200062, China
(Wangping) Department of Anesthesiology, Women and Children's Hospital of
Jiaxing University, Jiaxing 314000, China
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Early extubation can reduce pulmonary complications in
children undergoing cardiac surgery. The aim of this study is to evaluate
the effects of sugammadex for postoperative respiratory management in
children with congenital heart disease. <br/>Method(s): Sixty children
with congenital heart disease undergoing elective cardiac surgery were
divided into group S and group C (30 children in each group). When post
tetanic twitches count (PTC) = 1-2 and train-of-four (TOF) = 0, the
children in group S received sugammadex4 mg/kg for reversal of
neuromuscular block at the end of surgery, and the children in group C
received the same volume of normal saline. The recovery time to TOF of
0.9, the mechanical ventilation and extubation times were recorded. On the
other side, the hemodynamic parameters before and 5 min after
administration, and side effects were also recorded. The levels of
C-reactive protein (CRP) and procalcitonin (PCT) before and 24 h after
surgery were measured. <br/>Result(s): The recovery time to TOF of 0.9 and
extubation time were significantly shorter in the group S than in the
group C (4.2 +/- 1.4 vs 108.2 +/- 26.7 min, 66.3 +/- 6.5 vs 171.6 +/- 23.1
min, respectively, P < 0.01). The CRP and PCT levels were found to be
increased in both groups at postoperative 24 h than before surgery.
Further, the levels of PCT and CRP at postoperative 24 h were lower in
group S when compared to group C (median, 7 vs 17.5 mg/ml, 1.76 vs 5.22
ng/ml, respectively, P < 0.05). There were no statistical differences
observed between the two groups (P> 0.05) with respect to side effects.
<br/>Conclusion(s): Sugammadex is rapid and effective in reversing
rocuronium-induced neuromuscular block, and significantly reduces the
extubation time and the release of postoperative CRP and PCT in children
with congenital heart diseases.<br/>Copyright &#xa9; 2020 The Author(s)

<63>
Accession Number
2004534000
Title
Repair of ischemic ventricular septal defect with and without coronary
artery bypass grafting.
Source
Journal of Cardiac Surgery. 35 (5) (pp 1062-1071), 2020. Date of
Publication: 01 May 2020.
Author
Horan D.P.; O'Malley T.J.; Weber M.P.; Maynes E.J.; Choi J.H.; Patel S.;
Challapalli J.; Luc J.G.Y.; Entwistle J.W.; Todd Massey H.; Morris R.J.;
Tchantchaleishvili V.
Institution
(Horan, O'Malley, Weber, Maynes, Choi, Patel, Challapalli, Luc, Entwistle,
Todd Massey, Morris, Tchantchaleishvili) Division of Cardiac Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: Ventricular septal defect (VSD) following
myocardial infarction (MI) is a relatively infrequent complication with
high mortality. We sought to investigate the effect of concomitant
coronary artery bypass graft (CABG) on outcomes following post-MI VSD
repair. <br/>Method(s): Electronic search was performed to identify all
relevant studies published from 2000 to 2018. Sixty-seven studies were
selected for the analysis comprising 2174 patients with post-MI VSD.
Demographic information, perioperative variables, and outcomes including
survival data were extracted and pooled for systematic review and
meta-analysis. <br/>Result(s): Single-vessel disease was most common (47%,
95% confidence interval [CI], 42-52), left anterior descending coronary
artery was the most commonly involved vessel (55%, 95% CI, 46-63), and
anterior wall was the most commonly affected territory (57%, 95% CI,
51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients.
Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82).
A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients.
Of these, surgical repair was performed in 35% (95% CI, 28-41) and
transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30%
(95% CI, 26-35) in patients who had preoperative coronary angiogram, and
58% (95% CI, 43-71) in those who did not (P <.01). No significant survival
difference observed between those who had concomitant CABG vs those
without CABG. <br/>Conclusion(s): Concomitant CABG did not have a
significant effect on survival following VSD repair. Revascularization
should be weighed against the risks associated with prolonged
cardiopulmonary bypass.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<64>
Accession Number
2004436110
Title
Sodium nitroprusside versus nicardipine for hypertension management after
surgery: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 35 (5) (pp 1021-1028), 2020. Date of
Publication: 01 May 2020.
Author
Villarreal E.G.; Flores S.; Kriz C.; Iranpour N.; Bronicki R.A.; Loomba
R.S.
Institution
(Villarreal, Flores, Bronicki) Cardiac Intensive Care Unit, Division of
Critical Care, Texas Children's Hospital/Baylor College of Medicine,
Houston, TX, United States
(Villarreal) Tecnologico de Monterrey, Escuela de Medicina y Ciencias de
la Salud, Monterrey, Nuevo Leon, Mexico
(Kriz, Loomba) Cardiology, Advocate Children's Hospital/Chicago Medical
School, Chicago, IL, United States
(Iranpour) Baylor College of Medicine, Houston, TX, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Vasoactive medications are commonly administered for afterload
reduction and arterial hypertension treatment in patients after cardiac
surgery. A systematic review and meta-analysis were conducted to determine
the effects of sodium nitroprusside and nicardipine on hemodynamics and
cardiac performance in this population. <br/>Method(s): A systematic
review of published manuscripts was performed to identify studies of
patients who received sodium nitroprusside and nicardipine as part of the
treatment for arterial hypertension or afterload reduction after cardiac
surgery. A meta-analysis was then conducted to determine the effects of
sodium nitroprusside and nicardipine on hemodynamics and cardiac
performance. The following parameters were captured: blood pressure, heart
rate, right atrial pressure, systemic vascular resistance, and stroke
volume. <br/>Result(s): In total, five studies with 571 patients were
pooled for these analyses. Systolic blood pressure, diastolic blood
pressure, and mean arterial blood pressure were similar in both groups.
The cardiac index was greater with nicardipine while mean pulmonary artery
pressure was lower with sodium nitroprusside. <br/>Conclusion(s):
Nicardipine and sodium nitroprusside have similar abilities in reducing
afterload in the postoperative cardiac population. Statistically
significant differences were found in pulmonary artery pressure and
cardiac index. It may be beneficial to consider nicardipine for afterload
reduction in patients with a low cardiac index.<br/>Copyright &#xa9; 2020
Wiley Periodicals, Inc.

<65>
Accession Number
2004400997
Title
Prognostic impact of baseline C-reactive protein levels on mortality after
transcatheter aortic valve implantation.
Source
Journal of Cardiac Surgery. 35 (5) (pp 974-980), 2020. Date of
Publication: 01 May 2020.
Author
Takagi H.; Kuno T.; Hari Y.; Nakashima K.; Yokoyama Y.; Ueyama H.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno, Ueyama) Department of Medicine, Mount Sinai Beth Israel Medical
Center, New York, NY, United States
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA, United
States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York-Presbyterian Hospital, Columbia University Medical Center, New
York, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To determine whether baseline C-reactive protein (CRP) levels
can predict mortality after transcatheter aortic valve implantation
(TAVI), we performed a meta-analysis of currently available studies.
<br/>Method(s): All studies investigating the prognostic impact of
baseline (preprocedural) CRP levels on all-cause mortality after TAVI were
identified by means of searching PubMed and Google Scholar through May
2019. For each study, (preferentially, adjusted rather than unadjusted)
odds/hazard ratios (ORs/HRs) with corresponding 95% confidence intervals
of mortality per standard-deviation (SD) (or unit) increase in CRP levels
or those for high vs low CRP levels. <br/>Result(s): Our search identified
14 eligible studies including a total of 3449 patients undergoing TAVI and
reporting early (in-hospital to 3-month) and midterm (1-year to 3-year)
all-cause mortality after TAVI. Pooled analyses demonstrated associations
of high-baseline CRP levels with a marginal, but statistically
nonsignificant increase in early mortality (pooled OR/HR per SD increase
in CRP levels, 2.72; P =.09 and pooled OR/HR for high vs low CRP levels,
3.32; P =.07) and a statistically significant increase in midterm
mortality after TAVI (pooled OR/HR per SD increase in CRP levels, 1.45; P
<.0001 and pooled OR/HR for high vs low CRP levels, 1.78; P <.00001).
Excluding HRs for high-sensitivity CRP, combining ORs/HRs of 1-year
mortality, pooling HRs of >=2-year mortality, and combining adjusted HRs
did not alter the primary results. <br/>Conclusion(s): High-baseline CRP
levels may predict increased midterm, but not early, mortality after
TAVI.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<66>
Accession Number
630100695
Title
Long-term ticagrelor for secondary prevention in patients with prior
myocardial infarction and no history of coronary stenting: insights from
PEGASUS-TIMI 54.
Source
European heart journal. 41 (17) (pp 1625-1632), 2020. Date of Publication:
01 May 2020.
Author
Furtado R.H.M.; Nicolau J.C.; Magnani G.; Im K.; Bhatt D.L.; Storey R.F.;
Steg P.G.; Spinar J.; Budaj A.; Kontny F.; Corbalan R.; Kiss R.G.; Abola
M.T.; Johanson P.; Jensen E.C.; Braunwald E.; Sabatine M.S.; Bonaca M.P.
Institution
(Furtado, Im, Bhatt, Braunwald, Sabatine, Bonaca) TIMI Study Group,
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical
School, Boston, United States
(Furtado, Nicolau) Instituto do Coracao (InCor), Hospital das Clinicas da
Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Eneas de Carvalho
Aguiar 44, Sao Paulo 05403, Brazil
(Magnani) University Hospital of Parma, Via Gramsci ,14, Italy
(Storey) University of Sheffield, Western Bank, Sheffield S10 2TN, United
Kingdom
(Steg) Assistance Publique-Hopitaux de Paris ,3 Avenue Victoria, Paris
75004, France
(Spinar) University Hospital Brno, Brno, Czechia
(Budaj) Centre of Postgraduate Medical Education, Grochowski Hospital,
Grenadierow 51/59, Warsaw 04-073, Poland
(Kontny) Department of Cardiology, Stavanger University Hospital, Gerd
Ragna Bloch Thorsens gate 8, Stavanger, Norway
(Kontny) Drammen Heart Center, Drammen 3004, Norway
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Lira, Santiago 40, Chile
(Kiss) Department of Cardiology, Military Hospital, Budapest 1134, Hungary
(Abola) College of Medicine, University of the Philippines/Philippine
Heart Center, East, Quezon City, Metro Manila, Philippines
(Johanson, Jensen) AstraZeneca, Sweden
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
13199 E Montview Blvd Suite 200, CO, Aurora, United States
Publisher
NLM (Medline)
Abstract
AIMS: PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet
therapy (DAPT) with aspirin and ticagrelor reduced the risk of major
adverse cardiovascular events (MACE), with an acceptable increase in
bleeding, in patients with prior myocardial infarction (MI). While much of
the discussion around prolonged DAPT has been focused on stented patients,
patients with prior MI without prior coronary stenting comprise a
clinically important subgroup. METHODS AND RESULTS: This was a
pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162
patients with prior MI (1-3years) and additional high-risk features to
ticagrelor 60mg, 90mg, or placebo twice daily in addition to aspirin. A
total of 4199 patients had no history of coronary stenting at baseline.
The primary efficacy outcome (MACE) was the composite of cardiovascular
death, MI, or stroke. Patients without history of coronary stenting had
higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR)
1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. The
relative risk reduction in MACE with ticagrelor (pooled doses) was similar
in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting
(HR 0.85, 95% CI 0.75-0.96; P for interaction = 0.76). <br/>CONCLUSION(S):
Long-term ticagrelor reduces thrombotic events in patients with prior MI
regardless of whether they had prior coronary stenting. These data
highlight the benefits of DAPT in prevention of spontaneous
atherothrombotic events and indicate that long-term ticagrelor may be
considered in high-risk patients with prior MI even if they have not been
treated with stenting. CLINICALTRIALS.GOV IDENTIFIER:
NCT01225562.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2019. For
permissions, please email: journals.permissions@oup.com.

<67>
[Use Link to view the full text]
Accession Number
631649375
Title
Remote Management of Pacemaker Patients With Biennial In-Clinic
Evaluation: Continuous Home Monitoring in the Japanese At-Home Study: A
Randomized Clinical Trial.
Source
Circulation. Arrhythmia and electrophysiology. 13 (5) (pp e007734), 2020.
Date of Publication: 01 May 2020.
Author
Watanabe E.; Yamazaki F.; Goto T.; Asai T.; Yamamoto T.; Hirooka K.; Sato
T.; Kasai A.; Ueda M.; Yamakawa T.; Ueda Y.; Yamamoto K.; Tokunaga T.;
Sugai Y.; Tanaka K.; Hiramatsu S.; Arakawa T.; Schrader J.; Varma N.; Ando
K.
Institution
(Watanabe) Department of Cardiology, Fujita Health University School of
Medicine
(Yamazaki) Department of Cardiovascular Surgery, Shizuoka City Shizuoka
Hospital (F.Y.)
(Goto) Department of Cardiology, Nagoya City University Hospital (T.G.),
Aichi, Japan
(Asai) Department of Cardiology, Ichinomiya Municipal Hospital (T. Asai),
Aichi, Japan
(Yamamoto) Department of Cardiology, Handa City Hospital (T. Yamamoto),
Aichi, Japan
(Hirooka) Department of Cardiology, National Hospital Organization Osaka
National Hospital (K.H.), Tokyo, Japan
(Sato) Department of Cardiology, Kyorin University Hospital (T.S.), Tokyo,
Japan
(Kasai) Department of Cardiology, Japanese Red Cross Ise Hospital
(Ueda) Department of Cardiology, Chiba University Hospital (M.U.), Tokyo,
Japan
(Yamakawa) Department of Cardiology, Teikyo University Hospital (T.
Yamakawa), Tokyo, Japan
(Ueda) Department of Cardiology, Osaka Police Hospital, Japan (Y.U.)
(Yamamoto) Department of Cardiology, Kochi Health Sciences Center, Japan
(K.Y.)
(Tokunaga) Department of Cardiology, JA Toride Medical Ctr, Japan (T.T.),
Ibaraki, Japan
(Sugai) Department of Cardiology, Hiraka General Hospital, Japan (Y.S.),
Akita, Japan
(Tanaka) Department of Cardiology, Kasukabe Chuo General Hospital, Japan
(K.T.), Saitama, Japan
(Hiramatsu) Department of Cardiology, Fukuyama Cardiovascular Hospital,
Japan (S.H.), Hiroshima, Japan
(Arakawa) Department of Cardiology, Daido Hospital, Japan (T. Arakawa),
Aichi, Japan
(Schrader) Biotronik, Germany (J.S.), Berlin, Germany
(Varma) Cleveland Clinic, Heart & Vascular Institute
(Ando) Department of Cardiology, Kokura Memorial Hospital, Japan (K.A.),
Fukuoka, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Current expert consensus recommends remote monitoring for
cardiac implantable electronic devices, with at least annual in-office
follow-up. We studied safety and resource consumption of exclusive remote
follow-up (RFU) in pacemaker patients for 2 years. <br/>METHOD(S): In
Japan, consecutive pacemaker patients committed to remote monitoring were
randomized to either RFU or conventional in-office follow-up (conventional
follow-up) at twice yearly intervals. RFU patients were only seen if
indicated by remote monitoring. All returned to hospital after 2 years.
The primary end point was a composite of death, stroke, or cardiovascular
events requiring surgery, and the primary hypothesis was noninferiority
with 5% margin. <br/>RESULT(S): Of 1274 randomized patients (50.4% female,
age 77+/-10 years), 558 (RFU) and 550 (Conventional follow-up) patients
reached either the primary end point or 24 months follow-up. The primary
end point occurred in 10.9% and 11.8%, respectively (P=0.0012 for
noninferiority). The median (interquartile range) number of in-office
follow-ups was 0.50 (0.50-0.63) in RFU and 2.01 (1.93-2.05) in
conventional follow-up per patient-year (P<0.001). Insurance claims for
follow-ups and directly related diagnostic procedures were 18800 Yen
(16500-20700 Yen) in RFU and 21400 Yen (16700-25900 Yen) in conventional
follow-up (P<0.001). Only 1.4% of remote follow-ups triggered an
unscheduled in-office follow-up, and only 1.5% of scheduled in-office
follow-ups were considered actionable. <br/>CONCLUSION(S): Replacing
periodic in-office follow-ups with remote follow-ups for 2 years in
pacemaker patients committed to remote monitoring does not increase the
occurrence of major cardiovascular events and reduces resource
consumption. Registration: URL: https://clinicaltrials.gov; Unique
identifier: NCT01523704.

<68>
Accession Number
631814820
Title
Does the adaptive support ventilation have advantages in the postoperative
period after uncomplicated cardiac surgery?.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Komnov R.; Eremenko A.
Institution
(Komnov) Cardiac Intencive Care Unit, Petrovsky Russian Research Center of
Surgery, Moscow, Russian Federation
(Eremenko) Intensive Care Unit, Russian Research Center of Surgery,
Moscow, Russian Federation
Publisher
Springer
Abstract
INTRODUCTION. Respiratory support plays an important role in patient's
recovery after cardiovascular surgery. Adaptive support ventilation (ASV)
is an automatic closed-loop ventilation mode where minute volume is
controlled by a combination of tidal volume (Vt) and respiratory rate
settings based on patient's respiratory mechanics. There is an ability to
reduce workload for physicians without compromising patient's safety with
using intellectual modes of mandatory ventilation. OBJECTIVES. To compare
the effect(s) of ASV and conventional ventilation modes. METHODS. In this
randomized controlled trial 40 adult patients were ventilated with ASV and
38 with conventional ventilation modes after uncomplicated cardiac
surgery. Hamilton G5 ventilators were used and 8 physicians were involved
into the study. All actions of physician's, ventilator settings and
changes were monitored and recorded during mechanical ventilation and
weaning. Care of both groups was standardized, except modes of
postoperative ventilation. We compared the physician's workload, through
accounting number of manual ventilator settings made before tracheal
extubation and time, which they spent near the ventilator in every group.
The secondary endpoints were duration of tracheal intubation in ICU, the
frequency of undesirable events and the length of ICU and hospital stay.
RESULTS. There were no significant differences in the duration of
respiratory support in ICU: 267,6+/-76,6 min (ASV) vs 270,5+/-80 min
(control). In ASV group the number of manual ventilator settings and time
spent near the ventilator before tracheal extubation was lower: 2 (1- 4)
vs 4 (2-6), (p=0,0000) and 99+/-35 sec vs 166+/-70 sec (p=0,0001)
respectively. In the control group the time from changing mandatory to
spontaneous mode after restoration of patient's respiratory activity took
36,5(12-76) min. In ASV group spontaneous breathing began immediately
after recover of patient's respiratory drive, which meant less risk of
patient-ventilator asynchrony. ASV provided more protective ventilation:
the driving pressure was significantly lower - DELTAP on mechanical
ventilation was 7,2+/- 1,6 cm H2O vs 9,3+/-2,1 cm H2O (p=0,000001) and on
pressure support - 5,5+/-1 cm H2O vs 7,9+/-1,5 cm H2O (p=0,0000). There
were no significant differences between the groups in Vt values: 7,0
(6-8,5) ml/kg (ASV) vs 7 (6-10) ml/kg (control) during mechanical
ventilation and 7,5 (6,6-9,5) ml/kg in ASV vs 8 (7- 10) ml/kg in control
group during pressure support ventilation as well as in undesirable events
and duration of ICU and hospital stay. CONCLUSION. Application of ASV mode
after uncomplicated cardiac surgery provides more protective mechanical
ventilation and reduces the physician's workload without compromising the
quality of respiratory support and safety of patients.

<69>
Accession Number
631808898
Title
The use of a machine-learning based algorithm to reduce hypotension during
surgery: A randomised clinical trial.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Wijnberge M.; Geerts B.; Lemmers N.; Hol L.; Hollmann M.; Vlaar A.; Veelo
D.
Institution
(Wijnberge, Geerts, Lemmers, Hol, Hollmann, Veelo) Department of
Anaesthesia, Academic Medical Centre, Amsterdam, Netherlands
(Vlaar) Department of Intensive Care Medicine, Academic Medical Centre,
Amsterdam, Netherlands
Publisher
Springer
Abstract
INTRODUCTION. Intraoperative hypotension (IOH) is a frequently occurring
event associated with an increased morbidity and mortality.[ 1,2] Current
treatment of IOH is mostly reactive. A machinelearning algorithm was
developed to predict IOH minutes before the blood pressure actually
decreases. This algorithm, the hypotension prediction index (HPI), was
internally and externally validated with good sensitivity and
specificity.[3] However, no randomised studies testing the effectivity of
HPI to prevent IOH have been performed. We hypothesise, that use of IOH
will reduce the time weighted average (TWA) spent in hypotension during
surgery. OBJECTIVES. Our primary objective was to determine whether the
use of a machine-learning based algorithm can reduce IOH, measured as the
TWA during surgery. TWA combines both the time and depth of IOH.[4] Our
secondary objectives were to assess whether the use of this algorithm
increases the TWA of hypertension and whether it increases the cumulative
dose of vasopressors and fluids given during anaesthesia. We also assessed
the compliance with the algorithm by the number of protocol violations.
METHODS. This was a single center trial in a tertiary academic center
consisting of two phases, an observational phase and a randomised clinical
trial phase. Adult patients (aged 18 years and older) scheduled to undergo
an elective non-cardiac surgical procedure under general anaesthesia and
requiring an arterial line were eligible for inclusion. IOH was defined as
a MAP < 65 mmHg for more than 1 minute. A HPI alarm was defined as a HPI
value above 85%. RESULTS. A total of 100 patients were included between
November 2017 and January 2019. The TWA of IOH in the intervention group
was 0.13 compared to 0.46 in the control group, p=0.001. Patients suffered
from IOH 3.3% versus 10.5 %, p<0.001 of their duration of surgery. The TWA
of hypertension was 0.09 versus 0.06, p=0.548. Patients experienced
hypertension 1.67% versus 0.98%, p=0.379 of their duration of surgery.
Neither the cumulative dose of vasoactive medication given nor fluid
balance was significantly different between groups. 80% of all HPI alarms
were treated according to protocol. CONCLUSION. This is the first
randomised clinical trial employing a machine-learning based tool in the
field of anaesthesia. Use of the algorithm resulted in less hypotension
without an increase in hypertension or the cumulative of vasoactive
medication and fluids given during anaesthesia. Future studies should
assess clinical endpoints.

<70>
Accession Number
631810809
Title
Efficacy of prothrombin complex concentrate (PCC) for the treatment of
bleeding: A systematic review and meta-analysis.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Van Den Brink D.; Wirtz M.; Serpa Neto A.; Viersen V.; Binnekade J.;
Juffermans N.P.
Institution
(Van Den Brink, Binnekade, Juffermans) Department of Intensive Care
Medicine, Amsterdam UMC, locatie AMC, Amsterdam, Netherlands
(Wirtz) Deparment of Trauma Surgery/Intensive Care Medicine, Amsterdam
UMC, locatie AMC, Amsterdam, Netherlands
(Serpa Neto) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Viersen) Department of Anesthesiology, Amsterdam UMC, locatie AMC,
Amsterdam, Netherlands
Publisher
Springer
Abstract
INTRODUCTION. Bleeding often results in coagulopathy through several
mechanisms, including consumption of clotting factors. Prothrombin complex
concentrate (PCC) contains either three or four of the vitamin K-dependent
coagulation factors and is increasingly being used to correct coagulopathy
in bleeding patients. However, a summary of the efficacy of PCC to treat
bleeding is lacking. OBJECTIVES. The aim of this systematic review and
meta-analysis is to evaluate the efficacy of PCC administration in
bleeding patients. METHODS. PubMed, EMBASE and CINAHL were searched for
studies investigating the efficacy of PCC to treat bleeding in adult
patients and providing data on either mortality, red blood cell (RBC)
utilization, blood loss or thromboembolic (TE) events. Data were pooled
using Mantel-Haenszel random effects meta-analysis or inverse variance
random effects meta-analysis. RESULTS. From 3944 identified studies, 14
observational studies were included (with a total of 2187 patients). Of
these, 7 studies included patients undergoing cardiac surgery, 4 included
trauma patients, 2 included patients undergoing liver surgery and 1 study
included bleeding patients due to various causes. In all patient groups
taken together, PCC administration was not associated with reduced
mortality (odds ratio = 0.95; CI = 0.71 - 1.28; p = 0.75; I2 = 0%).
Patients receiving PCC required significantly less RBC units (mean
difference = -1.80; CI = -3.22 - -0.38; p = 0.01; I2 = 92%) compared to
patients not receiving PCC. Cardiac surgery patients had significantly
lower volumes of blood loss (mean difference = -384; CI = -640 - -128, p =
0.003, I2 = 81%) when receiving PCC. In all patient groups together, PCC
administration was not associated with TE event rate (odds ratio = 1.13;
CI 0.80 -1.60; p = 0.48, I2 = 0%). CONCLUSION. PCC was associated with a
reduction in blood loss in cardiac surgery patients and with a decreased
RBC transfusion rate across a wide range of bleeding patients, without
effecting mortality.

<71>
Accession Number
631810716
Title
Diagnosis of acute myocardial infarction after coronary artery bypass
graft (CABG) surgery: A systematic review.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Shoala A.
Institution
(Shoala) Cardiac ICU, National Heart Institute, Cairo, Egypt
Publisher
Springer
Abstract
INTRODUCTION. Myocardial infarction after coronary artery bypass grafting
is a serious complication and one of the most common causes of
perioperative morbidity and mortality. Multiple mechanisms have been
proposed to explain myocardial injury after CABG. Diagnosis will be
established according to creatine kinase (CK) values more than five times
the 99th percentile of the normal reference range during the first 72
hours following CABG, (or Troponin or CKMB more than ten time increase)
when associated with the appearance of new pathological Q-waves or new
left bundle-branch block (LBBB), or angiographically documented new graft
or native coronary artery occlusion, or imaging evidence of new loss of
viable myocardium, should be considered as diagnostic of a CABG related
MI. OBJECTIVES. : to identify the methods of diagnosis of post coronary
artery bypass graft (CABG) acute myocardial infarction. METHODS. Data
sources: MEDLLINE (PubMed), EMBASE, Google Scholar and the Cochrane
Library and all materials available in the internet till 2017. Study
selection: this search presented 23 eligible studies which studied the
diagnostic methods for acute myocardial infarction after coronary artery
bypass graft (CABG) surgery. Data extraction: if the studies did not
fulfill the inclusion criteria, they were excluded. The methodological
quality of included studies was assessed using an adjusted QUADAS-tool.
Data synthesis: comparisons was made by structured review with the results
tabulated. RESULTS. Troponin I and T can both be used to indicate
myocardial damage, with the level correlating well with the level of
injury. However until issues such as a 'gold standard' for peri-operative
MI are addressed, one single cut-off point cannot be recommended for
either test. CONCLUSION. Troponin I and T can both be used to indicate
myocardial damage, with the level correlating well with the level of
injury. However until issues such as a 'gold standard' for peri-operative
MI are addressed, one single cut-off point cannot be recommended for
either test.

<72>
Accession Number
631809348
Title
Assement of analgesic potency and feasability of serratus plane block in
chest trauma patients.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Brunet P.; Cogne K.; Pottecher J.; Diemunsch P.
Institution
(Brunet, Cogne, Pottecher, Diemunsch) Anesthesie - Reanimation
Chirurgicale, Hospital Hautepierre Hospitals Academics De Strasbourg,
Strasbourg, France
Publisher
Springer
Abstract
INTRODUCTION. Locoregional analgesia is one of the cornerstones of chest
trauma management (epidural and paravertebral block)1. The serratus plane
block is a regional analgesia method targeting the thoracic wall2. Several
case reports described sustained pain relief in chest trauma patients. In
a series of consecutive trauma patients presenting with rib fractures,
admitted in an intensive care unit, we studied the effectiveness of the
serratus plane block on analgesia, its feasibility and the incidence of
complications. METHODS. After the approval from the local ethics committee
and informed consent we retrospectively studied the medical records of all
consecutive patients presenting with a chest trauma and who benefitted
from a serratus plane block according to the local practice between
January 2018 and February 2019. The serratus plane block was performed in
the supine or lateral position under ultrasound guidance. First, the local
anesthetic (Ropivacaine 0.2%) was instilled in the deep serratus plane
followed by the insertion of a perineural catheter. Another instillation
was performed in the superficial serratus plane. An elastomeric pump was
then connected to the perineural catheter for continous infusion
(Ropivacaine 0.2% 10 mL/h). RESULTS. The records of 13 patients were
retrospectively analysed. The median age was 57 years [44;71], all
patients were male. The trauma was the result of a car accident for 7
patients and of a fall for 5 patients. The rib fractures were bilateral
for 7 patients, 9 patients presented a flail chest, 9 a pneumothorax, 5 an
hemothorax. A chest tube was in place for 7 patients. 4 patients benefited
from thoracic surgery. All a patients presented with an associated trauma,
8 orthopedic trauma, 4 neurosurgical trauma and 4 abdominal trauma. 9
patients required a surgical procedure. 10 patients received systemic
analgesic alone before the serratus plane block, while 3 were under
sedation. The values of Visual Analog Scale and morphine consumption are
presented in Figure 1.No complication was observed. CONCLUSION. Our
results suggest that the serratus plane block is an effective locoregional
analgesia method for pain management in chest trauma patients. A
randomized clinical trial comparing the serratus plane block with the
standard locoregional analgesia methods is needed to define the place of
this new analgesic technique in the management of chest trauma patients.
(Figure Presented).

<73>
Accession Number
631810537
Title
Single-dose ketamine has long-lasting effects on EEG.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Moll V.; Kreuzer M.; Garcia P.
Institution
(Moll) Department of Anesthesiology, Emory University Hospital Midtown,
Atlanta, United States
(Kreuzer) Department of Anesthesiology And Critical Care, Technische
Universitat Munchen, Munchen, Germany
(Garcia) Department of Anesthesiology, Columbia University, New York,
United States
Publisher
Springer
Abstract
INTRODUCTION. As a WHO essential medication, ketamine remains clinically
significant for sedation, anesthesia, and analgesia. Although ketamine has
shown promise in treating psychiatric illness, and for acute treatment of
delirium 1-4 its utility for preventing postoperative delirium is
controversial. It has been shown in one small RCT in cardiac surgery
patients to reduce the incidents of delirium5; a larger RCT in a
heterogeneous group of surgical patients failed to reproduce this effect6.
Spectral features of the electroencephalogram, EEG have recently been
associated with delirium7 yet, the effects of ketamine on these features
remain largely unexplored. OBJECTIVES. We present an initial
characterization of the neurophysiologic effects of single-dose ketamine
in patients undergoing extensive surgery with general anesthesia for
treatment of head/neck cancer. This is the initial exploration of
preliminary EEG results from a larger study intended to investigate
postoperative delirium in these patients. METHODS. We prospectively
randomized patients into a placebo, 0.5mg/kg (low) and 1mg/kg (high)
ketamine group. Patients received the study drug after induction.
5-channel EEG was recorded using a SEDLine monitor (Masimo, Irvine, CA)
from frontal positions at a sample rate of 250 Hz. In order to evaluate
the influence of single dose ketamine we only analyzed the EEG from 4h
after the start of EEG recording at induction until 15 minutes before the
end of the EEG recording at the end of the procedure. RESULTS. Out of 29
enrolled patients, 8 were excluded due to persistent EEG signal
distortion. The analysis included 3 groups: placebo- 10, low-ketamine
(LK)- 6 and high-ketamine (HK) 5 patients. We found a significant effect
of the HK on spectral EEG features for up to 4h. Alpha and beta band total
power were significantly higher in the HK group compared to the placebo
group (alpha KW: p=0.014, Chi-Sq=8.53; beta KW: p=0.031, Chi-Sq=7.01,
Fig1A-B) Examination of relative band power (normalized to total power)
showed a significant difference for the relative alpha power (KW:
p=0.0259; Chi-sq: 7.31), but not for the relative beta-band (KW: p=0.0852;
Chi-sq: 4.39) (Fig1C-D). The power spectral density (PSD) and normalized
power spectral density (nPSD) plots in Fig2A-B show the difference in the
spectral power (PSD, A) and composition (nPSD, B) between the placebo and
the HK group. AUC graph presents the AUC (o) and the 95% confidence
interval (x). Black dots indicate a significant effect, defined by a 95%
Ci not containing 0.5. Grey dots indicate a (nonsignificant) AUC<0.3, but
an AUC <0.3 may indicate a clinically relevant effect8. CONCLUSION. Our
preliminary results of a prospective randomized study investigating the
effects of ketamine on EEG and delirium reveal that a single dose of
subanesthetic ketamine has lasting effects on the EEG (240 min). As
enrollment progresses the effects of these spectral features on delirium
risk will be determined. (Figure Presented) .

<74>
Accession Number
631810492
Title
Protein kinase C expression and cardioprotective effects of remote
ischemic preconditioning in cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Tashkhanov D.; Bautin A.; Datsenko S.; Marichev A.; Radovskiy A.
Institution
(Tashkhanov, Bautin, Datsenko, Marichev, Radovskiy) Anesthesiology and
Intensive Care Medicine, National Medical Research Center. VA Almazov,
Sankt-Peterburg, Russian Federation
Publisher
Springer
Abstract
INTRODUCTION. Remote ischemic preconditioning is a perspective method of
cardioprotection. OBJECTIVES. To evaluate cardioprotective effects of
remote ischemic preconditioning (RIPC) and myocardial protein kinase C
epsilon (PKCIntensive ) release in patients undergoing aortic valve
replacement under different types of anesthesia. METHODS. In prospective
randomized study we enrolled 48 patients, aged 64(56;69) years, which were
scheduled for elective aortic valve replacement using cardiopulmonary
bypass (CPB). We divided them into 4 groups: 1) RIPC performed during
propofol anesthesia (RIPC prop, n=12), 2) RIPC performed during
sevoflurane anesthesia (RIPC sevo, n=12), 3) propofol anesthesia without
RIPC (CONTROL prop, n= 12), 4) sevoflurane anesthesia without RIPC
(CONTROL sev, n=12). Initial data of participants was similar in all
groups. RIPC protocol consisted of 3 simultaneous 5-min ischemic episodes
of both lower limbs with 5-min reperfusion intervals. Right atrium
myocardium incision biopsy was performed for PKC- expression assessment
using Western immunoblot. Troponin I levels (cTnI) were measured before
anesthesia induction, after 30 min, 6, 12, 24, 48 hours after CPB
completion. Data were assessed using Mann-Whitney U-test and Newman-Keuls
method for multigroup comparison. p<0.05 was considered significant. The
data are presented as median (25th;75th percentile). RESULTS. RIPC showed
cardioprotective effects only after sevoflurane anesthesia: significant
differences in cTnI were found between RIPC sevo and CONTROL sevo groups
at 6, 12 and 24 hours: 1.68(1.28;2.09) ng/ml vs 3.66(2.07;4.49) ng/ml,
respectively at 6 hours (p=0.04); 1.89(1.59;2.36) ng/ml vs 3.66(2.91;5.64)
ng/ml, respectively at 12 hours (p=0.001); 1.68(1.55;2.23) ng/ml vs
3.32(2.10;5.46) ng/ml, respectively at 24 hours (p=0.01). There were no
differences found in cTnI between RIPC prop and CONTROL prop groups in all
timepoints. RIPC applied during sevoflurane anesthesia also significantly
increased PKC- expression: 1221(921;1438)Units in CONTROL sev group vs
1882(1564; 2131)Units in RIPC sevo group (p<0.05). Performing RIPC during
propofol anesthesia was not associated with any significant difference in
PKC- expression compared with control group: 620(436;782)Units in CONTROL
prop versus 788(574;1063)Units in RIPC prop group. PKC- expression between
control groups was significantly higher in sevoflurane anesthesia than
propofol anesthesia. CONCLUSION. RIPC showed cardioprotective effects only
during sevoflurane anesthesia. This was confirmed by PKC- expression
increase and lower value of cTnI.

<75>
Accession Number
631810837
Title
The use of central venous to arterial carbon dioxide tension gap for
outcome prediction in critically ill patients. A systematic review and
meta-analysis.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Al Duhailib Z.; Lalli R.; Fiorini K.; Priestap F.; Hegazy A.; Slessarev M.
Institution
(Al Duhailib, Slessarev) Adult Critical Care Medicine, University of
Western Ontario, London, ON, Canada
(Lalli) Paediatric Department, University of Western Ontario, London, ON,
Canada
(Fiorini) Internal Medicine, University of Western Ontario, London, ON,
Canada
(Priestap) Clinical Epidemiology and Biostatistics, University of Western
Ontario, London, ON, Canada
(Hegazy) Adult Critical Care Medicine and Anaesthesia, University of
Western Ontario, London, ON, Canada
Publisher
Springer
Abstract
INTRODUCTION. Circulatory shock is common, accounting for one third of all
ICU admissions. Despite current resuscitative practices aimed at restoring
macro-hemodynamics, mortality remains high at over 50%. (1) This residual
mortality has been attributed to microcirculatory failure, yet clinical
monitoring of microcirculatory function remains elusive.
Venous-to-arterial carbon dioxide difference (PcvaCO2 gap) has emerged as
potential clinical marker of microcirculatory function, with some studies
suggesting that values greater than 6 mmHg are predictive of poor
outcomes. (2,3) OBJECTIVES. We carried out a systematic review and
quantitative meta-analysis to determine if high Pcv-aCO2 gap is associated
with increased mortality in adult critically ill patients presenting with
circulatory shock admitted to medical, cardiovascular and surgical ICUs.
METHODS. We conducted a systematic search using MEDLINE and EMBASE
electronic databases, using OvidSP search interface, from inception
through October 2017. Searches were restricted to studies published in
English language. The MOOSE checklist was followed and methodological
quality was assessed using Newcastle-Ottawa Scale (NOS). RESULTS. We
included 50 studies (n=3948 patients) from medical (n=26), cardiovascular
(n=15), surgical (n=5) and mixed (n=4) ICUs. The majority of studies were
observational with prospective (n=40) or retrospective (n=8) designs, and
two were randomised controlled trials (RCT). Eighteen studies reported the
primary outcome (either hospital or 28-day mortality). In these studies,
high Pcv-aCO2 gap (> 6mmHg) was associated with higher hospital mortality
with an odds ratio of death of 2.6 (95% CI [1.6, 4.4], P<0.001). Subgroup
analysis, showed that Pcv-aCO2 gap may be a stronger predictor of
mortality in the medical ICU patients in comparison to cardiac and
surgical population. This occurred on the background of similar cardiac
index (0 hr: P=0.07; 6 hrs: P=0.2; 24 hrs: P= 0.96), lactate (0 hr:
P=0.15; 6 hr: P=0.06; 24 hrs: P=0.49), and central venous oxygen
saturation (0 hr: P=0.5; 6 hr: P=0.41; 24 hrs: P=0.93) between high and
low Pcv-aCO2 gap groups. Meta-regression showed that the high gap has a
predictive power even if the differences in the established predictors of
mortality (APACHE II and SOFA) are accounted for (P= 0.0296, R2 = 0.60 and
P= 0.0151, R2 = 0.83, respectively). There was no statistical difference
in terms of secondary outcomes such as ICU and hospital length of stay,
mechanical ventilation days and requirements for vasopressors and
inotropes between the two groups. However, a high Pcv-aCO2 gap was
associated with an increased odds of requiring renal replacement therapy
(odds ratio: 1.95, 95% CI [1.32, 2.9], P= 0.001). CONCLUSION. In patients
with circulatory shock, high Pcv-aCO2 adds predictive power over
established predictors of hospital mortality despite similar indices of
macro-circulation and tissue perfusion. Future studies should evaluate
whether resuscitation aimed at closing the Pcv-aCO2 gap Improves mortality
in shock.

<76>
Accession Number
631811184
Title
Central venous-to-arterial carbon dioxide difference and pulse pressure
variation as therapeutic targets during elective major gastrointestinal
surgeries does impact survival.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Prado L.; Lobo F.; Espada D.; Salvetti B.A.G.S.; Neves B.; De Oliveira N.;
Lobo S.M.
Institution
(Prado, Lobo, Espada, Salvetti, Neves) Anesthesiologist, Hospital De Base,
Sao Jose do Rio Preto, Brazil
(De Oliveira, Lobo) Intensivist, Hospital De Base, Sao Jose do Rio Preto,
Brazil
Publisher
Springer
Abstract
INTRODUCTION. In the next decades an expansion of surgical services to
address unmet needs is likely to increase total global deaths, of which
1.9 million would be in low-middle income countries[1]. Current evidence
suggests that intraoperative management of major elective gastrointestinal
surgery should consider cardiac output (CO) monitoring and goal-directed
therapy[2]. However, cost restrains may determine low adherence to these
practices in low resource settings. We hypothesized that central
veno-arterial difference of CO2 [P(v-a)CO2] could serve as a surrogate for
CO monitoring during GDT. OBJECTIVES. We aimed to evaluate the impact of
the use of P(va) CO2 as a surrogate of cardiac output in an algorithm of
GDT on major complications and 90-day mortality. METHODS. The study was a
quasi-randomized controlled and explanatory trial performed in a tertiary
university hospital in patients undergoing elective major gastrointestinal
surgeries. In the interventional group a treatment algorithm aiming to
keep mean arterial pressure > 65 mmHg, SpO2 > 94%, CO2 gap lower than 6
mmHg and pulse-pressure variation (PPV) lower than 13% using fluids,
dobutamine and noradrenaline was applied in addition to the standard
practice. The control group comprised all the consecutive patients that
received traditional standard of care from the same team of surgeons and
anesthesiologists in the period before the intervention phase. RESULTS. A
total of 204 patients were included in this study; 102 in each group.
Measurements of P(v-a)CO2 were lower in the GDT group than in Control
group at T0 (30-60 min after induction): 5.9 +/- 2.1 vs. 6.7 +/- 2.7 mmHg,
p=0.031; T1 (2 h +/- 30min): 6.4 +/- 2.6 vs. 7.0 +/- 2.3 mmHg, p = 0.033
and T2 (4 h +/- 30min):5.9 +/- 2.1 vs. 7.1 +/- 3.4 mmHg, p = 0.036.
Central venous saturation (ScvO2) was significantly higher throughout the
intraoperative period in the GDT group, and there was a moderate
correlation between P(v-a)CO2 and ScvO2 (P<0.001 at all-time points and at
ICU admission). The number of patients with major complications was lower
in GDT group than in the control group and there was a significant
decrease in 90-day mortality in the GDT group (22.5% vs. 9.8%, p=0.014).
CONCLUSION. Minimization of P(v-a)CO2 and PPV as therapeutic targets
during elective major gastrointestinal surgeries seems to determine better
postoperative outcomes. Testing lower cost alternatives during GDT is
extremely important for low-resource settings and countries and its value
should be evaluated in prospective randomized trials.

<77>
Accession Number
631811169
Title
Diaphragm dysfunction from phrenic nerve injuries during cardiac
procedures: The evolving positive role of diaphragm pacing to improve
nerve and diaphragm function.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Onders R.; Elmo M.
Institution
(Onders, Elmo) Surgery, University Hospitals Cleveland Medical Center,
Cleveland, United States
Publisher
Springer
Abstract
INTRODUCTION. Phrenic nerve damage from cardiac surgery occurs in 1 to 60%
of cases depending on the procedure and methods of diaphragm evaluation.
During atrial fibrillation ablation procedures it occurs in up to 20% of
patients. Phrenic injures can results in symptoms of mild dyspnea,
dependency on non-invasive ventilation (NIV) and failure to wean off
mechanical ventilation (MV) with associated morbidity and mortality. Data
on spontaneous recovery post injury is sparse and historically nerve
recover can take up to 18 months. OBJECTIVES. Report on the use of
diaphragm pacing (DP) as a modality to improve diaphragm function post
phrenic nerve injury. METHODS. This is a retrospective review of a
compassionate off label use of an FDA approved humanitarian use device
under IRB approval (#02-10-18). Patients with diaphragm dysfunction (DD)
from phrenic nerve injury underwent laparoscopic direct evaluation of the
diaphragm. If the diaphragm was stimulateable, two intramuscular
electrodes were placed in each diaphragm and electrical stimulation was
begun to facilitate diaphragm strengthening and phrenic nerve recovery.
Electrical stimulation therapy to strengthen the diaphragm ensued. Serial
diaphragmatic electromyography (dEMG) through the implanted electrodes,
chest radiographs (CXR), ventilation use and patient reported symptoms
were obtained. RESULTS. Twenty-three of 115 patients in the database had
DD post cardiac procedure. Three developed DD post ablation and 1 after
pericardial effusion procedure. Nineteen had median sternotomies: 3 left
ventricular assist devices, 3 heart transplants, 2 atrial myxoma
resections and 9 valve or coronary bypass isolated or combined cases. Nine
were dependent on invasive MV with 8 tracheostomis. Nine used NIV with 5
continuous full-time NIV. Average age was 66.7 years (47-85). Time from
insult to implant was 2 weeks to 15.5 years( median 2 months). Eight of
the nine MV were weaned with five tracheostomy decannulations. Complete
weaning averaged between 1 to 35 days (13.45 average). Initial dEMG data,
available for 19, showed minimal to no activity on the affected side.
Seventeen had significant improvement in dEMG. Overall survival is 23.6
months(2 weeks-7.5 years) with 6 deaths. Twenty patients had demonstrated
diaphragm and phrenic nerve improvement (86.9%). CONCLUSION. Patients
requiring prolonged MV post cardiac procedure have significant morbidity
with only a 30% one year survival. Reported spontaneous improvement of
diaphragm paralysis is less than 45%. In this report DP showed improvement
in 86.9% of patients utilizing diaphragm electrical stimulation as
physical therapy to overcome the atrophied diaphragm and help nerve
recovery. Early use of DP can help prevent the elevated diaphragm from
paradoxical movement that can lead to lung collapse which would increase
pneumonia risk. Early use may decrease the morbidity of tracheostomies.
Future randomized trials will elucidate the role of early diaphragm pacing
in preventing prolonged MV.

<78>
Accession Number
631811745
Title
An equation to estimate glomerular filtration rate in critically ill
patients using the novel biomarker proenkephalin.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Beunders R.; Van Groenendael R.; Vart P.; Joachim S.; Pickkers P.
Institution
(Beunders, Pickkers) Intensive Care, Radboud University Medical Center,
Nijmegen, Netherlands
(Van Groenendael) Anesthesiology,Pain and Palliative Medicine, Radboud
University Medical Center, Nijmegen, Netherlands
(Vart) Department for Health Evidence, Radboud University Medical Center,
Nijmegen, Netherlands
(Joachim) Sphingotec GMBH, Sphingotec GmbH, Hennigsdorf, Germany
Publisher
Springer
Abstract
INTRODUCTION. Deterioration of kidney function in critically ill patients
is independently associated with impaired outcome. Diagnosis of acute
kidney injury (AKI) is currently hampered by the lack of accurate markers
for timely assessment of kidney function. Conventional creatinine-based
methods to estimate glomerular filtration rate (GFR) are notoriously
insensitive, late, and inaccurate. The gold standard methods to measure
GFR using exogenously administered substances, such as inulin or iohexol,
are not used in clinical practice because they are labour-intensive and
expensive. A promising novel candidate to assess kidney function is plasma
proenkephalin (PENK), a stable byproduct of the endogenous opioid
enkephalin. OBJECTIVES. 1) To determine to what extent PENK reflects the
GFR in a cohort of critically ill post cardiac surgery patients that are
prone to develop AKI. 2) To develop an equation to estimate the GFR using
PENK plasma concentration. METHODS. We prospectively included 180 patients
undergoing cardiac surgery. Post surgery, patients received an intravenous
bolus of iohexol, and plasma iohexol concentrations were determined in
four samples obtained during the subsequent hours. The true GFR was
determined using the slope-intercept method and the Brochner-Mortensen
correction [1]. Plasma PENK concentrations were determined using the
Sphingotec immunoassay [2]. Using linear regression model, three equations
were developed in a block randomized training sample of the cardiac
surgery cohort. 1) PENK only; 2) age, gender and PENK; 3) age, gender,
PENK and creatinine. Bias, precision and accuracy were assessed and
results were compared with the currently used Modification of Diet in
Renal Disease (MDRD) equation. RESULTS. Median of the true GFR was 81
[IQR: 69-90] mL/min/1.73m². Results of the equations are listed
in Table 1. The mean bias of the MDRD was significantly different compared
to the true GFR (p<0.0001), while the mean bias of the equation of PENK
was not (p=0.47). The equation using only PENK was significantly more
accurate compared to the MDRD (p=0.02), when the covariates age, gender
and creatinine were added, accuracy improved (p=0.0003). CONCLUSION. Our
study underscores the inaccuracy of conventional creatinine-based methods
to estimate GFR in critically ill patients, causing misclassification of
kidney function. Furthermore, we demonstrate that a single plasma PENK
determination correlates with the true GFR in cardiac surgery patients and
the PENK equation to estimate GFR performs better compared to the MDRD.
Therefore, PENK has potential as an accurate and feasible marker to assess
kidney function in critically ill patients. External validation in
additional critically ill patient cohorts is warranted. (Figure
Presented).

<79>
Accession Number
631813573
Title
Atrial fibrillation after cardiac surgery; impact of dexmedetomidine.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Petroulaki A.; Lazopoulos G.; Kalogerakos P.; Palioudakis S.; Kiparakis
M.; Pavlopoulos D.; Ioannou C.
Institution
(Petroulaki, Lazopoulos, Kalogerakos, Palioudakis, Kiparakis, Pavlopoulos,
Ioannou) Cardio-Thoracic Surgery Division, University Hospital of
Heraklion, Iraklio, Greece
Publisher
Springer
Abstract
INTRODUCTION. Atrial fibrillation is the most common arrhythmia following
cardiac surgery, with a percentage up to 50%. It is associated with
increased morbidity and mortality. Dexmedetomidine is a highly selective
a2 adrenergic agonist. Considering its sympathoinhibitory action,
dexmedetomidine could be associated with postoperative atrial fibrillation
reduction. OBJECTIVES. The present study aims to evaluate the effect of
postoperative dexmedetomidine on the incidence of atrial fibrillation
after cardiac surgery. METHODS. This prospective, randomized, controlled,
clinical trial was carried out at the cardiac surgery unit of a tertiary
care university hospital. 164 patients, undergoing on pump cardiac
surgery, were evaluated. 21 were excluded due to preoperative atrial
fibrillation or flutter. 143 patients were enrolled. After arrival to the
cardiac intensive care unit, patients were randomized in two groups,
dexmedetomidine and control group. Patients in dexmedetomidine group
received an infusion of dexmedetomidine (0.7 mg/kg/h) during the early
postoperative period. Primary endpoint was the incidence of postoperative
atrial fibrillation within the first three postoperative days. RESULTS.
There were no differences in atrial fibrillation risk factors between the
two groups. There were also no differences in postoperative parameters
except for catecholamine (44.4% vs 55.6%, p=0.675) and beta-blocker use
(45.2% vs 54.8%, p=0.967) in dexmedetomidine and non-dexmedetomidine group
respectively. Our results revealed that the dexmedetomidine group was
associated with an increased incidence of atrial fibrillation compared to
the control. Prevalence of atrial fibrillation in dexmedetomidine group
(n=70) was 26 patients (37.1%) and non-dexmedetomidine group (n=73) 16
patients (21.9%). Subgroup analysis indicated that postoperative augmented
diuresis and low potassium levels (p<0.001) have an increased influence on
occurrence of atrial fibrillation in patients after cardiac surgery.
CONCLUSION. In our study, dexmedetomidine use after cardiac surgery was
associated with a higher incidence of postoperative atrial fibrillation.
More studies are required to determine the dexmedetomidine effect on
atrial fibrillation after cardiac surgery.

<80>
Accession Number
631813925
Title
A multi-center survey of current status for postoperative application of
vasoactive agents in children undergoing congenital heart surgery with
cardiopulmonary bypass.
Source
Intensive Care Medicine Experimental. Conference: 32nd European Society of
Intensive Care Medicine Annual Congress, ESICM 2019. Germany. 7
(Supplement 3) (no pagination), 2019. Date of Publication: September 2019.
Author
Zhu L.
Institution
(Zhu) Cardiac ICU, Shanghai Children's Medical Center, Shanghai, China
Publisher
Springer
Abstract
INTRODUCTION. The aims of this survey is to know the current status and
specialty of postoperative hemodynamic monitoring and perioperative
application vasoactive agents in 17 pediatric heart centers in China, and
to establish some basics for further investigations. METHODS. A survey was
raised with perioperative hemodynamic monitoring, prophylactic using of
vasoactive agents during surgery with cardiopulmonary bypass and
postoperative application of vasoactive agents according some articles and
surveys published recently. RESULTS. Basic hemodynamic monitoring can be
100% implemented, but only 77% and 41% of the centers measured cardiac
output and microcirculation. Dopamine was preferred by most centers for
preventing low cardiac output syndrome (LCOS) following heart surgeries.
Patients suffering from LCOS with high systemic vascular resistance (SVR)
, LCOS with low SVR and LCOS with high pulmonary vascular resistance were
more likely be treated with Milrinone, Dopamine or Adrenaline and
Milrinone+Catecholamines+Pulmonary vasodilators, which was similar to the
results in western countries. CONCLUSION. Basic hemodynamic monitoring can
be implemented well in Chinese pediatric heart centers, but the
application of advanced hemodynamic monitoring still has a great disparity
comparing to some centers abroad. The using of vasoactive drugs was
similar to foreign centers but differs obviously, lacking symposiums or
guidelines. More randomized control tests and clinical guidelines were
prospected to instruct intensivists to utilize vasoactive agents in the
future.

<81>
Accession Number
2005976376
Title
Perioperative probiotic treatment decreased the incidence of postoperative
cognitive impairment in elderly patients following non-cardiac surgery: A
randomised double-blind and placebo-controlled trial.
Source
Clinical Nutrition. (no pagination), 2020. Date of Publication: 2020.
Author
Wang P.; Yin X.; Chen G.; Li L.; Le Y.; Xie Z.; Ouyang W.; Tong J.
Institution
(Wang, Yin, Chen, Li, Le, Ouyang, Tong) Department of Anesthesiology, The
Third Xiangya Hospital of Central South University, Changsha, Hunan, China
(Wang, Tong) Hunan Province Key Laboratory of Brain Homeostasis, Third
Xiangya Hospital, Central South University, Changsha, Hunan, China
(Tong) Center for Experimental Medicine, Third Xiangya Hospital, Central
South University, Changsha, Hunan, China
(Xie) Geriatric Anesthesia Research Unit, Department of Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital and
Harvard Medical School, Charlestown, United States
Publisher
Churchill Livingstone
Abstract
Background: Given that population aging is a global health challenge, the
high prevalence of postoperative neurocognitive impairment in elderly
patients necessitates the development of novel simple and effective
prevention methods. <br/>Objective(s): To evaluate the effects of
perioperative application of oral probiotic as a prophylaxis for cognitive
impairment in elderly patients following non-cardiac surgery.
<br/>Method(s): This randomised double-blind and placebo-controlled trial
included 120 elderly patients (in a modified intention-to-treat analysis)
scheduled for elective orthopaedic or colorectal surgery. Patients were
assigned to receive either probiotics or a placebo from hospital admission
until discharge. The primary endpoint was the incidence of postoperative
cognitive impairment, defined as a decrease of >=3 points in the
Mini-Mental State Examination (MMSE) scores from admission baseline to the
7th day post-surgery. Secondary endpoints included changes in plasma
interleukin-6 (IL-6) and cortisol, postoperative pain intensity,
postoperative sleep quality, gastrointestinal function recovery, and
faecal microbiota composition. <br/>Result(s): The incidence of
postoperative cognitive impairment in the probiotic group was
significantly lower than in the control group (3 of 59 patients [5.1%] vs.
10 of 61 patients [16.4%], P = 0.046). In addition, compared to
pre-surgery, the levels of plasma IL-6 and cortisol in the probiotic group
decreased more than in the control group 5-7 days after surgery (IL-6:
-117.90 +/- 49.15 vs. -14.93 +/- 15.21, P = 0.044; cortisol: -158.70 +/-
53.52 vs. 40.98 +/- 72.48, P = 0.010). Relative abundance at the genus
level in the faeces of the probiotic group also changed more than in that
of the control group during the perioperative period. In contrast,
postoperative pain intensity, sleep quality, and gastrointestinal function
recovery did not differ significantly between the two groups.
<br/>Conclusion(s): Perioperative application of oral probiotic prevents
postoperative cognitive impairment in elderly patients following
non-cardiac surgery, possibly via the limitation of peripheral
inflammation and the stress response.<br/>Copyright &#xa9; 2020 Elsevier
Ltd and European Society for Clinical Nutrition and Metabolism

<82>
Accession Number
2004931392
Title
Preoperative Evaluation for Lung Resection Surgery.
Source
Current Anesthesiology Reports. 10 (2) (pp 176-184), 2020. Date of
Publication: 01 Jun 2020.
Author
Blanch A.; Costescu F.; Slinger P.
Institution
(Blanch) Department of Anesthesia, University of Chile, Santiago, Chile
(Costescu) Department of Anesthesia, McGill University Health Centre -
Montreal General Hospital, Montreal, Canada
(Slinger) Department of Anesthesia and Pain Management, University Health
Network - Toronto General Hospital, Toronto, Canada
Publisher
Springer
Abstract
Purpose of Review: The purpose of this article is to review the literature
surrounding preoperative assessment and management of patients undergoing
lung resection surgery. Recent Findings: The traditional preoperative
cardiovascular risk assessment can be further refined in patients
undergoing lung resection surgery with the Thoracic Revised Cardiac Risk
Index and cardiac biomarkers such as B-type natriuretic peptide.
Cardiorespiratory exercise testing parameters such as the maximal achieved
oxygen consumption (VO<inf>2</inf> peak) and the minute ventilation to
carbon dioxide output (VE/VCO<inf>2</inf>) slope are strong preoperative
prognosticators in patients with borderline lung function. Preoperative
pulmonary rehabilitation holds promising benefits in improving surgical
candidacy and postoperative outcomes. <br/>Summary: The preoperative
assessment of lung resection candidates must evaluate perioperative
cardiorespiratory risk. The patient's comorbidities should be optimized as
time permits. A clear perioperative plan should be established and may
include cardiology consultation, prevention strategies for arrhythmias,
preoperative pulmonary rehabilitation, smoking cessation, intensive
perioperative monitoring, and enhanced recovery protocols.<br/>Copyright
&#xa9; 2020, Springer Science+Business Media, LLC, part of Springer
Nature.

<83>
Accession Number
2004977983
Title
The bicuspid aortic valve: Still a toothy problem.
Source
Catheterization and Cardiovascular Interventions. 95 (6) (pp 1193-1194),
2020. Date of Publication: 01 May 2020.
Author
Lisko J.; Block P.C.
Institution
(Lisko, Block) Department of Medicine/Cardiology, Emory University School
of Medicine, Atlanta, GA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Transcatheter aortic valve replacement (TAVR) is an acceptable treatment
alternative to surgical aortic valve replacement in selected patients with
a bicuspid aortic valve. TAVR appears to have acceptable mid-term outcomes
in patients with bicuspid aortic stenosis. A large-scale, randomized,
clinical trial is necessary to better define the role of TAVR for patients
with bicuspid aortic stenosis.<br/>Copyright &#xa9; 2020 Wiley
Periodicals, Inc.

<84>
Accession Number
2005791315
Title
Evaluation of cognitive behaviour combined with biofeedback therapy based
on the fusion of normed space and banach space on the emotional state of
patients with coronary artery bypass grafting.
Source
Indian Journal of Pharmaceutical Sciences. 82 (pp 7-13), 2020. Date of
Publication: 2020.
Author
Wang X.; Yuan Q.
Institution
(Wang, Yuan) Tangshan Workers' Hospital, Tangshan, Hebei Province 063000,
China
Publisher
Indian Pharmaceutical Association (E-mail: editor@ijpsonline.com)
Abstract
In this paper, the effect of the cognitive behaviour combined with the
biofeedback therapy on the evaluation of the emotional status in patients
with coronary artery bypass grafting was evaluated. Fifty-two hospitalized
patients who are planned to undergo coronary artery bypass grafting were
randomly divided into the rehabilitation group and the control group under
the normed space and the Banach space. The rehabilitation group was
treated by the cognitive behaviour combined with the biofeedback therapy.
Compared with the control group, the patients in the rehabilitation group
have decreased significantly under the normed space and the Banach space
after the operation; while the 6 min walking distance of the patients in
the rehabilitation group was increased significantly. The concentration of
TNF-a of the patients in the rehabilitation group was significantly
decreased and the time of the ventilator-assisted ventilation and the time
of intensive care for the patients in the rehabilitation group was shorter
than that in the control group. Compared to the preoperative conditions,
the left ventricular ejection fraction of the patients in the
rehabilitation group was significantly improved. Correlation analysis is
carried out on the aforementioned observation indexes for the patients in
the rehabilitation group. The results show that the decline in the normed
space and the Banach space has significant positive correlation with the
extension of the 6 min walking distance, respectively. Cognitive behaviour
combined with the biofeedback therapy could improve the anxiety and
depression of the patients after undergoing the coronary artery bypass
grafting, improve the exercise capacity and promote the recovery of the
cardiac function.<br/>Copyright &#xa9; 2020 Indian Pharmaceutical
Association. All rights reserved.

<85>
Accession Number
2005786485
Title
Osteopathic treatment leads to significantly greater reductions in chronic
thoracic pain after CABG surgery: A randomised controlled trial.
Source
Journal of Bodywork and Movement Therapies. 24 (3) (pp 202-211), 2020.
Date of Publication: July 2020.
Author
Roncada G.
Institution
(Roncada) Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
(Roncada) Commission for Osteopathic Research, Practice and Promotion,
Mechelen, Belgium
Publisher
Churchill Livingstone
Abstract
Background: There are a number of long-term postoperative complications
after coronary artery bypass graft (CABG) surgery. Pulmonary function is
decreased by 12% and 30%-50% of the patients have chronic thoracic pain.
<br/>Method(s): This randomised controlled trial with two parallel groups
aimed to explore the effectiveness of osteopathic treatments (OTs) on
these conditions. The standard care (SC) group and the and OT group
received a 12-week standard cardiac rehabilitation programme, which was
supplemented with four OTs for the OT group only. The outcome assessors
were blinded to the patients' allocation. <br/>Result(s): Eighty-two
patients with median sternotomy after CABG surgery were randomly allocated
in a 1:1 ratio (SC: n = 42, OT: n = 42). Slow vital capacity and pain
intensity were measured at baseline and at 12 weeks and 52 weeks after
surgery. Pain intensity was significantly lower in the OT group 12 weeks
after surgery (3.6-0.80 vs. 2.6 to 1.2, p = 0.030). One year after
surgery, there still was a significantly lower pain intensity in the OT
group (3.6-0.56, vs. 2.6 to 1.2, p = 0.014). No significant changes
between groups were found in pulmonary function. There were no adverse
events reported. <br/>Conclusion(s): From this study, it can be concluded
that the addition of OT to exercise-based cardiac rehabilitation may lead
to significantly greater reductions in thoracic pain after CABG surgery.
Trial registration: This study was registered on ClinicalTrials.gov
(NCT01714791).<br/>Copyright &#xa9; 2020 Elsevier Ltd

<86>
Accession Number
2005774074
Title
Clinical guidelines for perioperative hemodynamic management of non
cardiac surgical adult patients.
Source
Minerva Anestesiologica. 85 (12) (pp 1315-1333), 2019. Date of
Publication: 01 Dec 2019.
Author
Brienza N.; Biancofiore G.; Cavaliere F.; Corcione A.; de Gasperi A.; de
Rosa R.C.; Fumagalli R.; Giglio M.T.; Locatelli A.; Lorini F.L.; Romagnoli
S.; Scolletta S.; Tritapepe L.
Institution
(Brienza, Giglio) Unit of Anesthesia and Resuscitation, Department of
Emergencies and Organ Transplantations, Aldo Moro University, Bari, Italy
(Biancofiore) Operative Unit of Anesthesia and Transplant Resuscitation,
University of Pisa, Pisa, Italy
(Cavaliere) Unit of Cardiac Anesthesia and Cardiosurgical Intensive
Therapy, A. Gemelli University Polyclinic, Sacred Heart Catholic
University, Rome, Italy
(Corcione, de Rosa) Operative Unit of Anesthesia and Intensive
Postoperative Therapy, Department of Critical Area, Colli-Monaldi
Hospital, Naples, Italy
(de Gasperi) Operative Unit of Anesthesia and Resuscitation II, Niguarda
Ca' Granda Hospital, Milan, Italy
(Fumagalli) Operative Unit of Anesthesia and Resuscitation i, Milano
Bicocca University, Niguarda Ca' Granda Hospital, Milan, Italy
(Locatelli) Service of Anesthesia and Cardiovascular Intensive Therapy,
Department of Emergency and Critical Area, Santa Croce e Carle Hospital,
Cuneo, Italy
(Lorini) Department of Emergency, Urgency and Critical Area, Papa Giovanni
Xxiii Hospital, Bergamo, Italy
(Romagnoli) Department of Anesthesia and Resuscitation, University of
Florence, Careggi University Hospital, Florence, Italy
(Scolletta) Unit of Resuscitation and Critical Medicine, Department of
Medicine, Surgery and Neurosciences, University Hospital of Siena, Siena,
Italy
(Tritapepe) Operative Unit of Anesthesia and Intensive Therapy in
Cardiosurgery, Department of Emergency and Admission, Anesthesia and
Critical Areas, Umberto i Policlinic, Sapienza University, Rome, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Perioperative hemodynamic management, through monitoring and intervention
on physiological parameters to improve cardiac output and oxygen delivery
(goal-directed therapy, GDT), may improve outcome. However, an italian
survey has revealed that hemodynamic protocols are applied by only 29.1%
of anesthesiologists. aim of this paper is to provide clinical guidelines
for a rationale use of perioperative hemodynamic management in non cardiac
surgical adult patients, oriented for Italy and updated with most recent
studies. Guidelines were elaborated according to NICE (National Institute
for Health and Care Excellence) and GRADE system (Grading of
Recommendations of Assessment Development and Evaluations). Key questions
were formulated according to PICO system (Population, Intervention,
Comparators, Outcome). Guidelines and systematic reviews were identified
on main research databases and strategy was updated to June 2018. There is
not enough good quality evidence to support the adoption of a GDT protocol
in order to reduce mortality, although it may be useful in high risk
patients. Perioperative GDT protocol to guide fluid therapy is recommended
to reduce morbidity. continuous monitoring of arterial pressure may help
to identify short periods of hemodynamic instability and hypotension.
Fluid strategy should aim to a near zero balance in normovolemic patients
at the beginning of surgery, and a slight positive fluid balance may be
allowed to protect renal function. Drugs such as inotropes,
vasocostrictors, and vasodilatator should be used only when fluids alone
are not sufficient to optimize hemodynamics. Perioperative GDT protocols
are associated with a reduction in costs, although no economic study has
been performed in Italy.<br/>Copyright &#xa9; 2019 Edizioni Minerva
Medica.

<87>
Accession Number
2005961590
Title
Randomized trial of bupivacaine with epinephrine versus bupivacaine
liposome suspension in patients undergoing minimally invasive lung
resection.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Weksler B.; Sullivan J.L.; Schumacher L.Y.
Institution
(Weksler, Schumacher) Division of Thoracic and Esophageal Surgery,
Department of Thoracic and Cardiovascular Surgery, Allegheny General
Hospital, Pittsburgh, Pa, United States
(Sullivan) Division of Thoracic Surgery, Department of Surgery, Sinai
Hospital, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Thoracic surgery can cause significant pain, and multiple
strategies have been developed to control pain after surgery. We compared
2 bupivacaine formulations given intraoperatively: bupivacaine with
epinephrine (1,200,000) or liposomal bupivacaine. <br/>Method(s): This was
a randomized, open-label study (NCT03560362). Eligible patients were
adults scheduled for a minimally invasive lung procedure. Incision sites
were injected with bupivacaine with epinephrine or liposomal bupivacaine
before incision, and each intercostal space was injected with 1 mL of
bupivacaine with epinephrine or liposomal bupivacaine entering the
thoracic cavity. Patient-controlled analgesia was initiated in the
recovery room. Pain was recorded using a visual analog scale. The primary
outcome was the amount of narcotics taken during the postoperative
hospital stay. <br/>Result(s): We recruited 50 patients; 25 received
bupivacaine with epinephrine, and 25 received liposomal bupivacaine. The
treatment groups were similar in age, histology, and procedure performed.
There were no statistical differences between the treatment groups in the
amount of narcotics required during the hospital stay (36.3 mg for
bupivacaine and 38 mg for liposomal bupivacaine) or in pain assessed the
day of surgery (5 and 5), the first day (3.5 and 2.3), second day (3 and
2.6), 2 weeks (0 and 1), or 3 months (0 and 0) postoperatively. Hospital
length of stay and complications were also similar. <br/>Conclusion(s): In
a small, randomized study, we did not find significant differences between
bupivacaine with epinephrine or liposomal bupivacaine in mitigating pain
after minimally invasive lung resection. We currently favor using the less
expensive nonliposomal bupivacaine preparations until additional data are
available.<br/>Copyright &#xa9; 2020 The American Association for Thoracic
Surgery

<88>
Accession Number
2005950418
Title
Possible differential benefits of edetate disodium in post-myocardial
infarction patients with diabetes treated with different hypoglycemic
strategies in the Trial to Assess Chelation Therapy (TACT).
Source
Journal of Diabetes and its Complications. (no pagination), 2020. Article
Number: 107616. Date of Publication: 2020.
Author
Escolar E.; Ujueta F.; Kim H.; Mark D.B.; Boineau R.; Nahin R.L.; Goertz
C.; Lee K.L.; Anstrom K.J.; Lamas G.A.
Institution
(Escolar, Ujueta, Lamas) Columbia University Division of Cardiology at
Mount Sinai Medical Center, Miami, FL, United States
(Kim, Mark, Lee, Anstrom) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Kim, Mark, Lee, Anstrom) Duke University, Durham, NC, United States
(Boineau, Nahin) National Heart, Lung, and Blood Institute, Bethesda, MD,
United States
(Goertz) Duke Department of Orthopaedic Surgery, Duke University, Durham,
NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The NIH-funded Trial to Assess Chelation Therapy (TACT)
randomized 1708 stable patients age >=50 who were >=6 months post
myocardial infarction to 40 infusions of an edetate disodium-based regimen
or placebo. In 633 patients with diabetes, edetate disodium significantly
reduced the primary composite endpoint of mortality, recurrent myocardial
infarction, stroke, coronary revascularization, or hospitalization for
angina (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.44-0.79, p
< 0.001). The principal secondary endpoint of a composite of
cardiovascular death, myocardial infarction, or stroke was also reduced
(HR 0.60, 95% CI 0.39-0.91, p = 0.017). It is unknown if the treatment
effect differs by diabetes therapy. <br/>Method(s): We grouped the subset
of 633 patients with diabetes according to glucose-lowering therapy at
time of randomization. The log-rank test was used to compare active
therapy versus placebo. All treatment comparisons were performed using
2-sided significance tests at the significance level of 0.05 and were as
randomized. Relative risks were expressed as HR with associated 95% CI,
calculated using the Cox proportional hazards model. <br/>Result(s): There
were 162 (25.7%) patients treated with insulin; 301 (47.5%) with oral
hypoglycemics only; and 170 (26.8%) receiving no pharmacologic treatment
for diabetes. Patients on insulin reached the primary endpoint more
frequently than patients on no pharmacologic treatment [61 (38%) vs 49
(29%) (HR 1.56, 95% CI 1.07-2.27, p = 0.022)] or oral hypoglycemics [61
(38%) vs 87 (29%) (HR 1.46, 1.05-2.03, p = 0.024)]. The primary endpoint
occurred less frequently with edetate disodium based therapy versus
placebo in patients on insulin [19 (26%) vs 42 (48%) (HR 0.42, 95% CI
0.25-0.74, log-rank p = 0.002)], marginally in patients on oral
hypoglycemics [38 (25%) vs 49 (34%) (HR 0.66, 95% CI 0.43-1.01, log-rank p
= 0.041)], and no significant difference in patients not treated with a
pharmacologic therapy [23 (25%) vs 26 (34%) (HR 0.69, 95% CI 0.39-1.20,
log-rank p = 0.225)]. The interaction between randomized intravenous
treatment and type of diabetes therapy was not statistically significant
(p = 0.203). <br/>Conclusion(s): Edetate disodium treatment in stable,
post-myocardial infarction patients with diabetes suggests that patients
on insulin therapy at baseline may accrue the greatest benefit. Clinical
Trial Registration: clinicaltrials.gov identifier:
http://clinicaltrials.gov/ct2/show/NCT00044213?term=TACT&rank=7 identifier
Trial to Assess Chelation Therapy (TACT), NCT00044213.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<89>
Accession Number
2004988775
Title
Euthyroid sick syndrome in paediatric and adult patients requiring
extracorporeal circulatory support and the role of thyroid hormone
supplementation: a review.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Nistal-Nuno B.
Institution
(Nistal-Nuno) Department of Anesthesiology, Complejo Hospitalario
Universitario de Santiago de Compostela, Santiago de Compostela, Spain
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Non-thyroid disorders may modify thyroid hormone metabolism, resulting in
an 'euthyroid sick syndrome'. Studies determining the association of
cardiopulmonary bypass to thyroid function showed changes in line with
this euthyroid sick syndrome. In some cases, cardiovascular dysfunction
after cardiac surgery with cardiopulmonary bypass is comparable to that
noticed in hypothyroidism associated with low cardiac output and elevated
systemic vascular resistance. Numerous lines of research have proposed
that triiodothyronine can behave acutely as a positive inotropic and
vasodilator agent. The aim of this review is to present an update on the
current literature about in what clinical situations the use of thyroid
supplementation during the perioperative period of extracorporeal
circulation in the adult and paediatric populations may impact outcome to
any appreciable degree. The contribution of thyroid function in patients
undergoing a ventricular assist device implantation is additionally
reviewed and future study directions are proposed. This is a narrative
review, where the search strategy consisted on retrieving the articles
through an extensive literature search performed using electronic
databases from January 1978 up to September 2019. All controlled trials
randomly allocating to perioperative thyroid hormone administration in
children and adults undergoing extracorporeal circulation for cardiac
surgery were considered. Thyroid hormone supplementation may be
recommended particularly in selected paediatric sub-populations. There is
currently no firm evidence regarding the benefits of routine use of
thyroid hormone administration in cardiac adult patients. Further studies
are required to assess the beneficial effect of thyroid hormone on
patients with end-stage heart failure supported by ventricular assist
devices.<br/>Copyright &#xa9; The Author(s) 2020.

<90>
Accession Number
2004851609
Title
Preventive effect of low-dose landiolol on postoperative atrial
fibrillation study (PELTA study).
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2020. Date
of Publication: 2020.
Author
Sasaki K.; Kumagai K.; Maeda K.; Akiyama M.; Ito K.; Matsuo S.; Katahira
S.; Suzuki T.; Suzuki Y.; Kaiho Y.; Sugawara Y.; Tsuji I.; Saiki Y.
Institution
(Sasaki, Maeda, Akiyama, Ito, Matsuo, Katahira, Suzuki, Suzuki, Saiki)
Division of Cardiovascular Surgery, Tohoku University Graduate School of
Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
(Kumagai, Saiki) Research Division of Sciences for Aortic Disease, Tohoku
University Graduate School of Medicine, Sendai, Japan
(Kaiho, Sugawara, Tsuji) Division of Epidemiology, Department of Health
Informatics and Public Health, Tohoku University School of Public Health,
Graduate School of Medicine, Sendai, Japan
Publisher
Springer
Abstract
Objective: To investigate the efficacy of prophylactic administration of
low-dose landiolol on postoperative atrial fibrillation (POAF) in patients
after cardiovascular surgery. <br/>Method(s): Consecutive 150 patients
over 70 years of age who underwent cardiovascular surgery for valvular,
ischemic heart, and aortic diseases were enrolled in this single-center
prospective randomized control study from 2010 to 2014. They were assigned
to three treatment groups: 1gamma group (landiolol at 1 mug/kg/min),
2gamma group (landiolol at 2 mug/kg/min), or control group (no landiolol).
In the two landiolol groups, landiolol hydrochloride was intravenously
administered for a period of 4 days postoperatively. Electrocardiography
was continuously monitored during the study period, and cardiologists
eventually assessed whether POAF occurred or not. <br/>Result(s): POAF
occurred in 24.4% of patients in the control group, 18.2% in 1gamma group,
and 11.1% in 2gamma group (p = 0.256). Multivariate logistic regression
analysis showed that the incidence of POAF tended to decrease depending on
the dose of landiolol (trend-p = 0.120; 1gamma group: OR = 0.786, 95% CI
0.257-2.404; 2gamma group: OR = 0.379, 95% CI 0.112-1.287). Subgroup
analysis showed a significant dose-dependent reduction in POAF among
categories of female sex, non-use of angiotensin II receptor blockers
(ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and
0.004). <br/>Conclusion(s): These findings indicate that prophylactic
administration of low-dose landiolol may not be effective for preventing
the occurrence of POAF in overall patients after cardiovascular surgery,
but the administration could be beneficial to female patients, patients
not using ARBs preoperatively, and those after valvular
surgery.<br/>Copyright &#xa9; 2020, The Author(s).

<91>
Accession Number
631756782
Title
Microcirculatory perfusion disturbances following cardiopulmonary bypass:
A systematic review.
Source
Critical Care. 24 (1) (no pagination), 2020. Article Number: 218. 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,
Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular
Sciences, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands
(Van Den Brom, Van Leeuwen, Dekker) Department of Physiology, Amsterdam
UMC, Vrije Universiteit Amsterdam, Cardiovascular Sciences, Amsterdam,
Netherlands
(Van Leeuwen) Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije
Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam,
Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
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 24 h. 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 24 h 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<br/>Copyright &#xa9; 2020 The
Author(s).

<92>
Accession Number
631801704
Title
The effects of preoperative education of cardiac patients on haemodynamic
parameters, comfort, anxiety and patient-ventilator synchrony: A
randomised, controlled trial.
Source
Intensive & critical care nursing. 58 (pp 102799), 2020. Date of
Publication: 01 Jun 2020.
Author
Pazar B.; Iyigun E.
Institution
(Pazar) Department of Health, General Staff, Ankara, Turkey
(Iyigun) University of Health Sciences Turkey, Gulhane Faculty of Nursing,
Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients on mechanical ventilation are likely to suffer
stress, which may lead to problems of patient-ventilator synchrony,
anxiety, haemodynamic instability and decrease in comfort levels.
<br/>OBJECTIVE(S): The aim of this study is to evaluate the effects of
preoperative education regarding haemodynamic parameters, patient comfort
and anxiety, and patient-ventilator synchrony provided to patients before
they undergo cardiac surgery. <br/>METHOD(S): The study is a randomised,
controlled clinical study, it was conducted at the cardiovascular surgery
clinic of a teaching hospital in Turkey. The study was conducted on 200
patients who underwent cardiac surgery and received mechanical
ventilation. Using the block randomisation method, the patients were
grouped into intervention and control groups, with 100 patients in each
group. The patients in the intervention group received preoperative
education on mechanical ventilation and the usage of the communication
panel that patients under mechanical ventilation use to communicate with
health personnel, the control group received no education. Data was
collected while the patients were on mechanical ventilation support in the
intensive care unit on their second postoperative day. <br/>RESULT(S): The
difference between the patient-ventilator synchrony levels of the patients
to the mechanical ventilation treatment in the intervention and control
groups was found statistically significant (p<0.05). The differences
between the haemodynamic measurements of the patients in both groups,
which were measured after the patients woke up and before extubation, were
also statistically significant (p<0.05). Median scores obtained by the
patients in the intervention group on the Perianaesthesia Comfort
Questionnaire and the Tension-Anxiety subscale of the Profile of Mood
Scale were 5.7 and 2.0, respectively. The median scores obtained by the
patients in the control group on the same scales were 4.1 and 24.0,
respectively. <br/>CONCLUSION(S): Compared to the participants in the
control group, the participants in the intervention group who received
education had higher patient-ventilator synchrony, comfort and
haemodynamic stability levels, as well as lower anxiety levels when they
were under mechanical ventilation, showing that results were better in the
intervention group than the control group.<br/>Copyright &#xa9; 2020.
Published by Elsevier Ltd.

<93>
Accession Number
631793569
Title
In unprotected left main CAD, revascularization with PCI and DES increased
risk for MACCE vs CABG at 5 years.
Source
Annals of internal medicine. 172 (10) (pp JC55), 2020. Date of
Publication: 19 May 2020.
Author
Vallabhajosyula S.; Bell M.R.
Institution
(Vallabhajosyula, Bell) Mayo Clinic, Rochester, MN
Publisher
NLM (Medline)
Abstract
SOURCE CITATION: Holm NR, Makikallio T, Lindsay MM, et al. Percutaneous
coronary angioplasty versus coronary artery bypass grafting in the
treatment of unprotected left main stenosis: updated 5-year outcomes from
the randomised, non-inferiority NOBLE trial. Lancet. 2019;395:191-9.
31879028.

<94>
Accession Number
631756592
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) (no pagination), 2020. Article
Number: 193. 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, Orebro, Sweden
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
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<br/>Copyright &#xa9; 2020 The Author(s).

<95>
Accession Number
2004838338
Title
Validation process of a high-resolution database in a paediatric intensive
care unit-Describing the perpetual patient's validation.
Source
Journal of Evaluation in Clinical Practice. (no pagination), 2020. Date of
Publication: 2020.
Author
Mathieu A.; Sauthier M.; Jouvet P.; Emeriaud G.; Brossier D.
Institution
(Mathieu, Sauthier, Jouvet, Emeriaud, Brossier) Pediatric Intensive Care
Unit, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
(Mathieu, Sauthier, Jouvet, Emeriaud, Brossier) CHU Sainte Justine
Research Institute, CHU Sainte Justine, Montreal, QC, Canada
(Brossier) CHU de Caen, Pediatric Intensive Care Unit, Caen, France
(Brossier) Universite Caen Normandie, school of medicine, Caen, France
(Brossier) Laboratoire de Psychologie Caen Normandie, Universite Caen
Normandie, Caen, France
Publisher
Blackwell Publishing Ltd
Abstract
Rationale: High data quality is essential to ensure the validity of
clinical and research inferences based on it. However, these data quality
assessments are often missing even though these data are used in daily
practice and research. Aims and objectives: Our objective was to evaluate
the data quality of our high-resolution electronic database (HRDB)
implemented in our paediatric intensive care unit (PICU). <br/>Method(s):
We conducted a prospective validation study of a HRDB in a 32-bed
paediatric medical, surgical, and cardiac PICU in a tertiary care
freestanding maternal-child health centre in Canada. All patients admitted
to the PICU with at least one vital sign monitored using a
cardiorespiratory monitor connected to the central monitoring station.
<br/>Result(s): Between June 2017 and August 2018, data from 295 patient
days were recorded from medical devices and 4645 data points were video
recorded and compared to the corresponding data collected in the HRDB.
Statistical analysis showed an excellent overall correlation
(R² = 1), accuracy (100%), agreement (bias = 0, limits of
agreement = 0), completeness (2% missing data), and reliability (ICC = 1)
between recorded and collected data within clinically significant
pre-defined limits of agreement. Divergent points could all be explained.
<br/>Conclusion(s): This prospective validation of a representative sample
showed an excellent overall data quality.<br/>Copyright &#xa9; 2020 John
Wiley & Sons, Ltd.

<96>
Accession Number
2004823188
Title
Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials.
Source
Advances in Therapy. (no pagination), 2020. Date of Publication: 2020.
Author
Linden K.; Mailey J.; Kearney A.; Menown I.B.A.
Institution
(Linden, Mailey, Kearney, Menown) Southern Health and Social Care Trust,
Craigavon Area Hospital, Craigavon, United Kingdom
Publisher
Adis
Abstract
Introduction: A large number of important clinical trials in cardiology
were published or presented at major international conferences during
2019. This paper aims to offer a concise overview of these significant
advances and to put them into clinical context. <br/>Method(s): Trials
presented at the major international cardiology meetings during 2019 were
reviewed including The American College of Cardiology (ACC), Euro PCR, The
European Society of Cardiology (ESC), Transcatheter Cardiovascular
Therapeutics (TCT), and the American Heart Association (AHA). In addition
to this a literature search identified several other publications eligible
for inclusion based on their relevance to clinical cardiology, their
potential impact on clinical practice and on future guidelines.
<br/>Result(s): A total of 70 trials met the inclusion criteria. New
interventional and structural data include trials examining use of
drug-coated balloons in patients with acute myocardial infarction (MI),
interventions following shockable cardiac arrest, mechanical circulatory
support in cardiogenic shock complicating MI, intervention in stable
coronary artery disease, surgical or percutaneous revascularisation
strategies in left main coronary artery disease, revascularisation
strategy in ST elevation MI, transcatheter aortic valve replacement in
low-risk patients, and percutaneous mitral or tricuspid valve
interventions. Preventative cardiology data included the use of
sodium-glucose cotransporter 2 (SGLT2) inhibitors (dapagliflozin),
proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors
(evolocumab), bempedoic acid, and novel approaches to the management of
hypertension. Antiplatelet data included trials evaluating both the
optimal length of course and combination of antiplatelet agents and
regimes including combination antithrombotic therapies for patients with
atrial fibrillation. Heart failure data included trials of
sacubitril-valsartan in heart failure with preserved ejection fraction and
the use of SGLT2 inhibitors in patients with heart failure but without
diabetes. Electrophysiology data included trials examining alcohol in
atrial fibrillation and the use of wearable fitness devices for
identifying atrial fibrillation. <br/>Conclusion(s): This article presents
key clinical trials completed during 2019 and should be valuable to
clinicians and researchers working in cardiology.<br/>Copyright &#xa9;
2020, The Author(s).

<97>
Accession Number
2004814474
Title
Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist
Device-Case Series and Review of Literature.
Source
Obesity Surgery. (no pagination), 2020. Date of Publication: 2020.
Author
Van Aelst P.; Deleus E.; Van der Schueren B.; Meyns B.; Vandersmissen K.;
Lannoo M.
Institution
(Van Aelst, Deleus, Lannoo) Department of Abdominal Surgery, University
Hospitals Leuven, Leuven, Belgium
(Van der Schueren) Department of Endocrinology, University Hospitals
Leuven, Leuven, Belgium
(Meyns, Vandersmissen) Department of Clinical Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
Publisher
Springer
Abstract
For patients with advanced heart failure, left ventricular assist device
(LVAD) can serve as a bridge to heart transplantation. Patients with class
II obesity are eligible for implantation of LVAD but do not meet criteria
for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is
proposed as weight losing modality in order to reach the New York Heart
Association (NYHA) criteria for listing. In our center, three patients on
LVAD with need for weight-reducing therapy were treated with laparoscopic
sleeve gastrectomy. We reviewed our data retrospectively and compared it
with the literature. Successful weight loss was achieved in all patients,
without postoperative adverse events. Two out of three were listed on
transplant waiting list. Our results are similar to those described in
other series.<br/>Copyright &#xa9; 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<98>
Accession Number
631793999
Title
Right Ventricular Systolic Assessment by Transesophageal Versus
Transthoracic Echocardiography: Displacement, Velocity, and Myocardial
Deformation.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2020.
Date of Publication: 13 Mar 2020.
Author
Mauermann E.; Vandenheuvel M.; Francois K.; Bouchez S.; Wouters P.
Institution
(Mauermann) Department of Anesthesiology and Perioperative Medicine, Ghent
University Hospital, Ghent, Belgium; Department of Anesthesiology,
University Hospital Basel, Basel, Switzerland
(Vandenheuvel, Bouchez, Wouters) Department of Anesthesiology and
Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
(Francois) Department of Cardiac Surgery, Ghent University Hospital,
Ghent, Belgium
Publisher
NLM (Medline)
Abstract
OBJECTIVE: First, to compare tricuspid annular displacement and velocity
in transthoracic and transesophageal echocardiography (TTE, TEE) using
conventional angle-dependent technologies. Second, to evaluate both
alternative TEE views as well as an alternative technology (speckle
tracking) for overcoming proposed differences in TTE and TEE. DESIGN:
Prospective, comparative, cross-over study with a randomized order of
image acquisition. SETTING: University hospital. PARTICIPANTS: Adults
undergoing cardiac surgery. INTERVENTIONS: Postinduction standardized
image acquisition and analysis in TTE and TEE by 2 echocardiographers.
MEASUREMENTS AND MAIN RESULTS: The authors measured tricuspid annular
plane systolic excursion (TAPSE) by M-mode and velocity by tissue Doppler
(S') in the apical 4-chamber TTE view and midesophageal 4-chamber TEE view
(AP4C, ME4C). They then examined (1) the same measurements in alternative
TEE views with proposed better ultrasound angulation; and (2) speckle
tracking-based endpoints (TAPSE by speckle tracking, strain, and strain
rate). Data were available in 24 of 25 patients. Conventional TAPSE by
M-mode and velocity by tissue Doppler (TDI) were underestimated in the
ME4C compared with the AP4C reference (mean +/- standard deviation: TAPSE:
13.1 +/- 3.8 mm v 17.3 +/- 4.0 mm; S': 6.7 +/- 2.1 cm/s v 9.1 +/- 2.2
cm/s; both p < 0.001). Neither a modified deep transgastric view (TAPSE
14.5 +/- 4.7 mm, p=0.017; S' 6.8 +/- 1.8 cm/s, p < 0.001) nor a
transgastric right ventricular inflow view (TAPSE 12.3 +/- 4.0 mm,
p=0.001; S' 6.0 +/- 1.3 cm/s, p < 0.001) was similar to the AP4C. Speckle
tracking TAPSE was unbiased but with high variability (mean bias=-0.3 mm,
95% limits of agreement=-9.1 to 8.4); strain and strain rate were higher
in TEE than for TTE (-17.7 +/- 3.6 v -12.6 +/- 2.1, p < 0.001; -1.0 +/-
0.2/s v -0.7 +/- 0.1/s, p < 0.001). <br/>CONCLUSION(S): Right ventricular
displacement, velocity, and myocardial deformation measured by TEE versus
TTE are different. Neither alternative transesophageal echocardiography
views nor speckle tracking-based deformation is promising; TAPSE by
speckle tracking is unbiased but imprecise.<br/>Copyright &#xa9; 2020
Elsevier Inc. All rights reserved.

<99>
Accession Number
631793030
Title
A Randomized Trial to Compare Serratus Anterior Plane Block and Erector
Spinae Plane Block for Pain Management Following Thoracoscopic Surgery.
Source
Pain medicine (Malden, Mass.). (no pagination), 2020. Date of Publication:
17 May 2020.
Author
Ekinci M.; Ciftci B.; Golboyu B.E.; Demiraran Y.; Bayrak Y.; Tulgar S.
Institution
(Ekinci, Ciftci, Demiraran) Department of Anesthesiology and Reanimation,
Istanbul Medipol University, School of Medicine, Mega Medipol University
Hospital, Istanbul, Turkey
(Golboyu) Department of Anesthesiology and Reanimation, Manisa State
Hospital, Manisa, Turkey
(Bayrak) Department of Thoracic Surgery, Istanbul Medipol University, Mega
Medipol University Hospital, Istanbul, Turkey
(Tulgar) Department of Anesthesiology, Faculty of Medicine, Maltepe
University, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Comparison of ultrasound (US)-guided erector spinae plane block
(ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic
surgery (VATS) patients. The primary outcome was to compare perioperative
and postoperative (48 hours) opioid consumption. <br/>METHOD(S): A total
of 60 patients were randomized into two groups (N=30): an ESPB group and
an SAPB group. All the patients received intravenous patient-controlled
postoperative analgesia and ibuprofen 400mg intravenously every eight
hours. Visual analog scale (VAS) scores, opioid consumption, and adverse
events were recorded. <br/>RESULT(S): Intraoperative and postoperative
opioid consumption at 0-8, 8-16, and 16-24hours and rescue analgesic use
were significantly lower in the ESPB group (P<0.05). Static/dynamic VAS
scores were significantly lower in the ESPB group (P<0.05). There was no
significant difference between static VAS scores at the fourth hour. There
were no differences between adverse effects. Block procedure time and
one-time puncture success were similar between groups (P >0.05 each).
<br/>CONCLUSION(S): US-guided ESPB may provide better pain control than
SAPB after VATS. QUESTION: Even though there are studies about analgesia
management after VATS, clinicians want to perform the technique that is
both less invasive and more effective. FINDINGS: This randomized trial
showed that US-guided ESPB provides effective analgesia compared with
SAPB. MEANING: Performing single-injection ESPB reduces VAS scores and
opioid consumption compared with SAPB.<br/>Copyright &#xa9; The Author(s)
2020. Published by Oxford University Press on behalf of the American
Academy of Pain Medicine. All rights reserved. For permissions, please
e-mail: journals.permissions@oup.com.

<100>
Accession Number
2005929682
Title
Magnetic Resonance-Based Diagnostics for Bleeding Assessment in Neonatal
Cardiac Surgery.
Source
Annals of Thoracic Surgery. 109 (6) (pp 1931-1936), 2020. Date of
Publication: June 2020.
Author
Choi P.S.; Ibla J.C.; Marturano J.E.; Lowery T.J.; Emani S.
Institution
(Choi, Emani, Emani) Department of Cardiovascular Surgery, Boston
Children's Hospital, Boston, MA, United States
(Ibla) Department of Anesthesiology, Critical Care, and Pain Medicine,
Boston Children's Hospital, Boston, MA, United States
(Marturano, Lowery) T2 Biosystems, Lexington, MA, United States
Publisher
Elsevier USA
Abstract
Purpose: Infants undergoing a cardiac operation are at high risk for
postsurgical bleeding. To date, there are no highly predictive models for
postsurgical bleeding in this population. This study's objective was to
assess the predictive ability of T2 magnetic resonance (T2MR).
Description: T2MR uses magnetic resonance to detect clot formation
characteristics on a small blood sample and provides hemostatic indicators
that can assess bleeding risk. Evaluation: This prospective,
single-institution study enrolled 100 patients younger than 12 months old
undergoing a cardiac operation from April 27, 2015, to September 21, 2016.
The primary end point was postsurgical bleeding within 24 hours after the
procedure. T2MR data were modeled with a binary recursive partitioning
algorithm with randomized cross-validation. The tight clot metric produced
the highest univariate discrimination of bleeding (receiver operator
characteristic curve, 0.64; classification accuracy, 72%), and along with
the platelet function metric, demonstrated highest relative importance
based on Gini index splitting (Salford Systems, San Diego, CA).
Multivariate modeling with cross-validation showed mean receiver operator
characteristic curve area of 0.74 and classification accuracy of 82%.
<br/>Conclusion(s): T2MR tight clot and platelet function metrics were
associated with bleeding events.<br/>Copyright &#xa9; 2020 The Society of
Thoracic Surgeons

<101>
Accession Number
2003713325
Title
Transcatheter aortic valve replacement with self-expandable ACURATE neo as
compared to balloon-expandable SAPIEN 3 in patients with severe aortic
stenosis: Meta-analysis of randomized and propensity-matched studies.
Source
Journal of Clinical Medicine. 9 (2) (no pagination), 2020. Article Number:
397. Date of Publication: February 2020.
Author
Gozdek M.; Zielinski K.; Pasierski M.; Matteucci M.; Fina D.; Jiritano F.;
Meani P.; Raffa G.M.; Malvindi P.G.; Pilato M.; Paparella D.; Slomka A.;
Kubica J.; Jagielak D.; Lorusso R.; Suwalski P.; Kowalewski M.
Institution
(Gozdek, Kubica) Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University, Collegium Medicum, Bydgoszcz 85067, Poland
(Gozdek, Zielinski, Pasierski, Slomka, Kowalewski) Thoracic Research
Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz,
Innovative Medical Forum, Bydgoszcz 85067, Poland
(Zielinski) Department of Cardiology, Warsaw Medical University, Warsaw
02091, Poland
(Pasierski, Suwalski, Kowalewski) Clinical Department of Cardiac Surgery,
Central Clinical Hospital of the Ministry of Interior and Administration,
Centre of Postgraduate Medical Education, Warsaw 02607, Poland
(Matteucci, Fina, Jiritano, Meani, Lorusso, Kowalewski) Department of
Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University
Medical Centre, Maastricht 6229 HX, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese 21100, Italy
(Fina) Department of Cardiology, IRCCS Policlinico San Donato, University
of Milan, Milan 20097, Italy
(Jiritano) Department of Cardiac Surgery, University Magna Graecia of
Catanzaro, Catanzaro 88100, Italy
(Meani) Department of Intensive Care Unit, Maastricht University Medical
Centre (MUMC+), Maastricht 6229 HX, Netherlands
(Raffa, Pilato) Department for the Treatment and Study of Cardiothoracic
Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto
Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo
90127, Italy
(Malvindi) Wessex Cardiothoracic Centre, University Hospital Southampton,
Southampton SO16 6YD, United Kingdom
(Paparella) GVM Care & Research, Department of Cardiovascular Surgery,
Santa Maria Hospital, Bari 70124, Italy
(Paparella) Department of Emergency and Organ Transplant, University of
Bari Aldo Moro, Bari 70121, Italy
(Slomka) Department of Pathophysiology, Nicolaus Copernicus University,
Collegium Medicum, Bydgoszcz 85067, Poland
(Jagielak) Department of Cardiac Surgery, Gdansk Medical University,
Gdansk 80210, Poland
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic
valve replacement (TAVR) was the main concern with earlier-generation
devices. Current meta-analysis compared outcomes of TAVR with
next-generation devices: ACURATE neo and SAPIEN 3. In random-effects
meta-analysis, the pooled incidence rates of procedural, clinical and
functional outcomes according to VARC-2 definitions were assessed. One
randomized controlled trial and five observational studies including 2818
patients (ACURATE neo n = 1256 vs. SAPIEN 3 n = 1562) met inclusion
criteria. ACURATE neo was associated with a 3.7-fold increase of
moderate-to-severe PVL (RR (risk ratio): 3.70 (2.04-6.70); P < 0.0001),
which was indirectly related to higher observed 30-day mortality with
ACURATE valve (RR: 1.77 (1.03-3.04); P = 0.04). Major vascular
complications, acute kidney injury, periprocedural myocardial infarction,
stroke and serious bleeding events were similar between devices. ACURATE
neo demonstrated lower transvalvular pressure gradients both at discharge
(P < 0.00001) and at 30 days (P < 0.00001), along with lower risk of
patient-prosthesis mismatch (RR: 0.29 (0.10-0.87); P = 0.03) and pacemaker
implantation (RR: 0.64 (0.50-0.81); P = 0.0002), but no differences were
observed regarding composite endpoints early safety and device success. In
conclusion, ACURATE neo, as compared with SAPIEN 3, was associated with
higher rates of moderate-to-severe PVL, which were indirectly linked with
increased observed 30-day all-cause mortality.<br/>Copyright &#xa9; 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<102>
Accession Number
631636768
Title
Association between post-percutaneous coronary intervention bivalirudin
infusion and net adverse clinical events: A post hoc analysis of the
GLOBAL LEADERS study.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 6 (1) (pp 22-30),
2020. Date of Publication: 01 Jan 2020.
Author
Chang C.C.; Chichareon P.; Modolo R.; Takahashi K.; Kogame N.; Tomaniak
M.; Gao C.; Royaards K.-J.; Cequier A.; Oldroyd K.; Steg P.G.; Hamm C.;
Juni P.; Valgimigli M.; Windecker S.; Onuma Y.; Stables R.H.; Jan Van
Geuns R.; Serruys P.W.
Institution
(Chang, Tomaniak, Onuma, Jan Van Geuns) Department of Cardiology,
Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40,
GD Rotterdam, Netherlands
(Chang) Division of Cardiology, Department of Medicine, Taipei Veterans
General Hospital, Beitou 11217, Taipei, Taiwan (Republic of China)
(Chang) Institute of Clinical Medicine, National Yang Ming University,
Beitou 11221, Taipei, Taiwan (Republic of China)
(Chichareon, Modolo, Takahashi, Kogame) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105
AZ, Netherlands
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
(Gao, Jan Van Geuns) Cardiology Department, Radboudumc, Comeniuslaan 4,
Nijmegen 6525 HP, Netherlands
(Royaards) Department of Cardiology, Maasstad Hospital, Maasstadweg 21,
Rotterdam 3079 DZ, Netherlands
(Cequier) Department of Cardiology, Bellvitge University Hospital,
L'Hospitalet de Llobregat, Barcelona, Spain
(Oldroyd) West of Scotland Heart and Lung Centre, Golden Jubilee National
Hospital, Clydebank, United Kingdom
(Steg) Cardiology Department, AP-HP, Hospital, Bichat Paris 75018, France
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Nauheim 61231Bad,
Germany
(Juni) Department of Medicine and Institute of Health Policy, Management
and Evaluation, University of Toronto, Toronto, ON M4P 1A6, Canada
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern 3010, Switzerland
(Onuma) Cardialysis B.V., Rotterdam 3012 KM, Netherlands
(Stables) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: The efficacy and safety of continued bivalirudin infusion after
percutaneous coronary intervention (PCI) remains uncertain. We sought to
investigate the association between post-PCI bivalirudin infusion and the
risk of net adverse clinical events (NACE) at 30 days. <br/>Methods and
Results: In the GLOBAL LEADERS study, all patients who received
bivalirudin during PCI were categorized according to the use of
bivalirudin infusion after the procedure. The primary endpoint of the
present analysis was NACE [a composite of all-cause death, any stroke, any
myocardial infarction, all revascularization, and bleeding assessed
according to the Bleeding Academic Research Consortium (BARC) criteria
Type 3 or 5] at 30 days. The key safety endpoint was BARC Type 3 or 5
bleeding and definite stent thrombosis. Of 15 968 patients, 13 870
underwent PCI with the use of bivalirudin. In total, 7148 patients
received continued bivalirudin infusion after procedure, while 6722
patients received standard care. After propensity score covariate
adjustment, the risk of NACE did not significantly differ between two
treatments after PCI [continued bivalirudin infusion vs. no bivalirudin
infusion: 3.2% vs. 3.1%, adjusted hazard ratio (aHR) 1.35, 95% confidence
interval (CI) 0.99-1.84, P = 0.06] nor the BARC Type 3 or 5 bleeding (0.7%
vs. 0.7%, aHR 0.89, 95% CI 0.44-1.79; P = 0.743) and definite stent
thrombosis (0.5% vs. 0.3%, aHR 1.71, 95% CI 0.77-3.81, P = 0.189).
However, continued bivalirudin infusion was associated with an increased
risk of NACE and definite stent thrombosis in ST-elevation myocardial
infarction (STEMI) patients. <br/>Conclusion(s): In an all-comers
population undergoing PCI, there was no significant difference in the risk
of NACE at 30 days between continued bivalirudin infusion vs. no
bivalirudin infusion after procedure but continued bivalirudin infusion
was associated with a higher risk of NACE in STEMI patients when compared
with no infusion.<br/>Copyright &#xa9; 2019 Published on behalf of the
European Society of Cardiology. All rights reserved. &#xa9; The Author(s)
2019. For permissions, please email: journals.permissions@oup.com.

<103>
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.

<104>
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).

<105>
Accession Number
2004735920
Title
European guidelines on chronic mesenteric ischaemia - joint United
European Gastroenterology, European Association for Gastroenterology,
Endoscopy and Nutrition, European Society of Gastrointestinal and
Abdominal Radiology, Netherlands Association of Hepatogastroenterologists,
Hellenic Society of Gastroenterology, Cardiovascular and Interventional
Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group
clinical guidelines on the diagnosis and treatment of patients with
chronic mesenteric ischaemia.
Source
United European Gastroenterology Journal. 8 (4) (pp 371-395), 2020. Date
of Publication: 01 May 2020.
Author
Terlouw L.G.; Moelker A.; Abrahamsen J.; Acosta S.; Bakker O.J.;
Baumgartner I.; Boyer L.; Corcos O.; van Dijk L.J.D.; Duran M.; Geelkerken
R.H.; Illuminati G.; Jackson R.W.; Karkkainen J.M.; Kolkman J.J.; Lonn L.;
Mazzei M.A.; Nuzzo A.; Pecoraro F.; Raupach J.; Verhagen H.J.M.; Zech
C.J.; van Noord D.; Bruno M.J.
Institution
(Terlouw, van Dijk, Bruno) Department of Gastroenterology and Hepatology,
Erasmus MC University Medical Center, Rotterdam, Netherlands
(Terlouw, Moelker) Department of Radiology, Erasmus MC University Medical
Center, Rotterdam, Netherlands
(Abrahamsen) Department of Clinical Physiology, Viborg Regional Hospital,
Viborg, Denmark
(Acosta) Department of Clinical Sciences Malmo, Lund University, Lund,
Sweden
(Acosta) Department of Cardio, -, Thoracic and Vascular Surgery, Skane
University Hospital, Malmo, Sweden
(Bakker) Department of Vascular Surgery, Sint Antonius hospital,
Nieuwegein, Netherlands
(Bakker) Department of Vascular Surgery, University Hospital Leipzig,
Leipzig, Germany
(Baumgartner) Division of Angiology, Swiss Cardiovascular Center,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Boyer) Department of Diagnostic and Interventional Radiology, Montpied
University Hospital, Clermont, -, Ferrand, France
(Corcos) Department of Gastroenterology, Intestinal Stroke Center, Hopital
Beaujon APHP, Clichy, France
(Duran) Department of Vascular and Endovascular Surgery, Marienhospital
Gelsenkirchen, Gelsenkirchen, Germany
(Geelkerken) Department of Vascular Surgery, Medisch Spectrum Twente,
Enschede, Netherlands
(Geelkerken) Multi-modality Medical Imaging (M3I) group, Faculty of
Science and Technology, Technical Medical Centre, University of Twente,
Enschede, Netherlands
(Illuminati) Department of Surgical Sciences, University of Rome La
Sapienza, Rome, Italy
(Jackson) Department of Interventional Radiology, Newcastle upon Tyne
Hospitals NHS Foundation Trust, United Kingdom
(Karkkainen) Heart Center, Kuopio University Hospital, Kuopio, Finland
(Karkkainen) Department of Vascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Kolkman) Department of Gastroenterology and Hepatology, Medisch Spectrum
Twente, Enschede, Netherlands
(Kolkman) Department of Gastroenterology and Hepatology, University
Medical Center Groningen, Groningen, Netherlands
(Lonn) Department of Radiology, University of Copenhagen, Copenhagen,
Denmark
(Mazzei) Department of Medical, Surgical and Neuro Sciences, Diagnostic
Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese,
Siena, Italy
(Pecoraro) Department of Surgical Oncological and Oral Sciences,
University of Palermo, Vascular Surgery Unit, AOUP 'P. Giaccone' Palermo,
Palermo, Italy
(Raupach) Department of Radiology, University Hospital Hradec Kralove,
Hradec Kralove, Czechia
(Verhagen) Department of Vascular Surgery, Erasmus MC University Medical
Center, Rotterdam, Netherlands
(Zech) Radiology and Nuclear Medicine, University of Basel, Basel,
Switzerland
(van Noord) Department of Gastroenterology and Hepatology, Franciscus
Gasthuis and Vlietland, Rotterdam, Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Chronic mesenteric ischaemia is a severe and incapacitating disease,
causing complaints of post-prandial pain, fear of eating and weight loss.
Even though chronic mesenteric ischaemia may progress to acute mesenteric
ischaemia, chronic mesenteric ischaemia remains an underappreciated and
undertreated disease entity. Probable explanations are the lack of
knowledge and awareness among physicians and the lack of a gold standard
diagnostic test. The underappreciation of this disease results in
diagnostic delays, underdiagnosis and undertreating of patients with
chronic mesenteric ischaemia, potentially resulting in fatal acute
mesenteric ischaemia. This guideline provides a comprehensive overview and
repository of the current evidence and multidisciplinary expert agreement
on pertinent issues regarding diagnosis and treatment, and provides
guidance in the multidisciplinary field of chronic mesenteric
ischaemia.<br/>Copyright &#xa9; Author(s) 2020.

<106>
Accession Number
2004340497
Title
Effects of vascular morphological features and ultrasound-guided vascular
cannulation techniques on the success of femoral artery catheterisation in
newborns.
Source
Journal of Clinical Monitoring and Computing. 34 (3) (pp 607-614), 2020.
Date of Publication: 01 Jun 2020.
Author
Boran O.F.; Urfalioglu A.; Arslan M.; Yazar F.M.; Bilal B.; Orak Y.;
Eroglu E.
Institution
(Boran, Urfalioglu, Arslan, Bilal, Orak) Department of Anesthesiology and
Reanimation, Sutcu Imam University School of Medicine, C Blok Kat 5, Daire
11, Kahramanmaras 46100, Turkey
(Yazar) Department of General Surgery, Sutcu Imam University School of
Medicine, Kahramanmaras, Turkey
(Eroglu) Department of Cardiovascular Surgery, Sutcu Imam University
School of Medicine, Kahramanmaras, Turkey
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Ultrasound-guided vascular access is a technique that can increase safety
as well as technical and procedural success when performing invasive
cardiovascular procedures. The aim of this study was to evaluate the
effects of two cannulation techniques and vascular morphological
properties on the success of femoral artery catheterisation in neonatal
patients. We recruited 65 consecutive patients requiring femoral artery
catheterisation and randomly divided them into two groups: Group 1,
in-plane technique (n = 31) and Group 2, out-of-plane technique (n = 34).
We compared the preparation duration, puncture duration, number of
punctures, number of arterial punctures, number of unsuccessful
interventions, hematoma incidence and vascular morphological
characteristics between the groups. The mean age of Group 1 was 17.16 +/-
7.04 days, and the mean age of Group 2 was 17.20 +/- 7.40 days, with no
difference observed between the groups (p > 0.05). Four patients in Group
1 and nine patients in Group 2 developed hematoma (p = 0.172). Hematoma
was strongly correlated with the number of venous punctures (r = 0.632; p
= 0.001) and the number of needle advancements (r = 0.415; p = 0.001). In
terms of artery-vein position, patients whose artery overlapped the vein
by > 50% required clearly longer artery cannulation durations than the
other patients (p < 0.001). Although the in-plane technique has a steep
learning curve, it was found superior in terms of procedure-related
factors such as the number of trials, the incidence of hematoma and
arterial puncture counts, as it offers advantages such as the ability to
evaluate the lumen and a better control of the needle advancement
direction.<br/>Copyright &#xa9; 2020, Springer Nature B.V.

<107>
[Use Link to view the full text]
Accession Number
631645780
Title
Comparative effectiveness of different contemporary drug-eluting stents in
routine clinical practice: A multigroup propensity score analysis using
data from the stent-specific, multicenter, prospective registries.
Source
Coronary Artery Disease. 30 (4) (pp 255-262), 2019. Date of Publication:
2019.
Author
Kwon O.; Kang S.H.; Lee J.-B.; Ahn J.-M.; Lee C.H.; Kang D.-Y.; Lee P.H.;
Kang S.-J.; Lee S.-W.; Kim Y.-H.; Lee C.W.; Park S.-W.; Park D.-W.; Park
S.-J.
Institution
(Kwon, Ahn, Lee, Kang, Lee, Kang, Lee, Kim, Lee, Park, Park, Park)
Department of Internal Medicine, Division of Cardiology, Asan Medical
Center, University of Ulsan, College of Medicine, Seoul, South Korea
(Lee) Department of Biostatistics, Asan Medical Center, University of
Ulsan, College of Medicine, Seoul, South Korea
(Kang) Department of Cardiology, CHA Bundang Medical Center, CHA
University, Seongnam, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Data on the comparative effectiveness of contemporary
drug-eluting stents (DES) in the unrestricted, real-world setting are
limited. We investigated the long-term effectiveness and safety of
contemporary different drugeluting stents by means of multiple treatment
propensity score weighting. Patients and methods From seven
stent-specific, prospective DES registries conducted between July 2007 and
July 2015, we evaluated 17 196 patients who received several contemporary
DES and first-generation DES: 3053 treated with cobalt-chromium
everolimus-eluting stents (CoCr-EES), 2985 with platinum-chromium EES
(PtCr- EES), 2922 with Resolute zotarolimus-eluting stents (Re- ZES), 789
with Biomatrix biolimus-eluting stents (Bi-BES), 1907 with Nobori
biolimus-eluting stents (No-BES), 1970 with Xience Prime cobalt-chromium
everolimus-eluting stents (Pr-CoCr-EES), and 3570 with sirolimus-eluting
stents (SES). The primary outcome was target-vessel failure (a composite
of cardiac death, target-vessel myocardial infarction, or target-vessel
revascularization) at 3 years of follow-up and major cardiovascular
adverse events (a composite of all-cause death, any myocardial infarction,
or any revascularization) was also evaluated. Results The observed 3-year
rates of target-vessel failure were not significantly different among
different secondgeneration DES and SES (CoCr-EES 9.8%, PtCr-EES 9.5%,
Re-ZES 9.3%, Bi-BES 9.8%, No-BES 7.7%, Pr-CoCr-EES 10.4%, SES 10.2%;
overall P=0.07). In multiple treatment propensity score analysis, adjusted
hazard ratios for targetvessel failure were similar in between-group
comparisons of several contemporary DES. In addition, no significant
differences were observed with respect of the adjusted risk of major
adverse cardiac events. Conclusion In this comparative effectiveness
research using stent-specific, clinical practice registries involving
unrestricted use of several contemporary DES, there were no significant
between-group differences in the 3-year rates of target-vessel
failure.<br/>Copyright &#xa9; 2019 Wolters Kluwer Health, Inc.

<108>
[Use Link to view the full text]
Accession Number
631561161
Title
Lipoprotein(a), PCSK9 inhibition, and cardiovascular risk insights from
the FOURIER trial.
Source
Circulation. 139 (12) (pp 1483-1492), 2019. Date of Publication: 2019.
Author
O'Donoghue M.L.; Fazio S.; Giugliano R.P.; Stroes E.S.G.; Kanevsky E.;
Gouni-Berthold I.; Im K.; Pineda A.L.; Wasserman S.M.; Ceska R.; Ezhov
M.V.; Jukema J.W.; Jensen H.K.; Tokgozoglu S.L.; Mach F.; Huber K.; Sever
P.S.; Keech A.C.; Pedersen T.R.; Sabatine M.S.
Institution
(O'Donoghue, Giugliano, Kanevsky, Im, Sabatine) TIMI Study Group,
Cardiovascular Division, Brigham and Women's Hospital, 60 Fenwood Rd,
Boston, MA 02115, United States
(Fazio) Center for Preventive Cardiology, Knight Cardiovascular Institute,
Oregon Health and Science University, Portland, United States
(Stroes) Department of Vascular Medicine, Academic Medical Center,
Amsterdam, Netherlands
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Germany
(Pineda, Wasserman) Amgen, Thousand Oaks, CA, United States
(Ceska) Center for Preventive Cardiology, 3rd Internal Medicine Clinic,
University General Hospital and Charles University 1st Medical Faculty,
Prague, Czechia
(Ezhov) National Cardiology Research Center, Moscow, Russian Federation
(Jukema) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Jensen) Department of Cardiology, Aarhus University Hospital, Department
of Clinical Medicine,, Health, Aarhus University, Denmark
(Tokgozoglu) Cardiovascular Division, Hacettepe University, Ankara, Turkey
(Mach) Cardiology Division, University of Geneva, Switzerland
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital and Sigmund Freud University, Medical
Faculty, Vienna, Austria
(Sever) Imperial College, London, United Kingdom
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Australia
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Norway
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Lipoprotein(a) [Lp(a)] may play a causal role in
atherosclerosis. PCSK9 (proprotein convertase subtilisin/kexin 9)
inhibitors have been shown to significantly reduce plasma Lp(a)
concentration. However, the relationship between Lp(a) levels, PCSK9
inhibition, and cardiovascular risk reduction remains undefined.
<br/>METHOD(S): Lp(a) was measured in 25 096 patients in the FOURIER trial
(Further Cardiovascular Outcomes Research with PCSK9 Inhibition in
Subjects with Elevated Risk), a randomized trial of evolocumab versus
placebo in patients with established atherosclerotic cardiovascular
disease (median follow-up, 2.2 years). Cox models were used to assess the
independent prognostic value of Lp(a) and the efficacy of evolocumab for
coronary risk reduction by baseline Lp(a) concentration. <br/>RESULT(S):
The median (interquartile range) baseline Lp(a) concentration was 37
(13-165) nmol/L. In the placebo arm, patients with baseline Lp(a) in the
highest quartile had a higher risk of coronary heart disease death,
myocardial infarction, or urgent revascularization (adjusted hazard ratio
quartile 4: quartile 1, 1.22; 95% CI, 1.01-1.48) independent of
low-density lipoprotein cholesterol. At 48 weeks, evolocumab significantly
reduced Lp(a) by a median (interquartile range) of 26.9% (6.2%-46.7%). The
percent change in Lp(a) and low-density lipoprotein cholesterol at 48
weeks in patients taking evolocumab was moderately positively correlated
(r=0.37; 95% CI, 0.36-0.39; P<0.001). Evolocumab reduced the risk of
coronary heart disease death, myocardial infarction, or urgent
revascularization by 23% (hazard ratio, 0.77; 95% CI, 0.67-0.88) in
patients with a baseline Lp(a) >median, and by 7% (hazard ratio, 0.93; 95%
CI, 0.80-1.08; P interaction=0.07) in those <=median. Coupled with the
higher baseline risk, the absolute risk reductions, and number needed to
treat over 3 years were 2.49% and 40 versus 0.95% and 105, respectively.
<br/>CONCLUSION(S): Higher levels of Lp(a) are associated with an
increased risk of cardiovascular events in patients with established
cardiovascular disease irrespective of low-density lipoprotein
cholesterol. Evolocumab significantly reduced Lp(a) levels, and patients
with higher baseline Lp(a) levels experienced greater absolute reductions
in Lp(a) and tended to derive greater coronary benefit from PCSK9
inhibition.<br/>Copyright &#xa9; 2019 Lippincott Williams and Wilkins. All
rights reserved.

<109>
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.

<110>
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.

<111>
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

<112>
Accession Number
631778648
Title
Effect of ulinastatin on post-operative blood loss and allogeneic
transfusion in patients receiving cardiac surgery with cardiopulmonary
bypass: a prospective randomized controlled study with 10-year follow-up.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 98), 2020. Date of
Publication: 14 May 2020.
Author
Zhang P.; Lv H.; Qi X.; Xiao W.; Xue Q.; Zhang L.; Li L.; Shi J.
Institution
(Zhang) Department of Surgery, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, 167 Beilishi Rd., Xicheng District, Beijing 100037,
China
(Lv, Xiao, Xue, Zhang, Li, Shi) Department of Anaesthesiology, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, 167 Beilishi Rd., Xicheng District, Beijing 100037,
China
(Qi) Department of Anaesthesiology, People's Hospital of Ningxia Hui
Autonomous Region, 148 Huaiyuanxi Rd. Xixia District, Yinchuan, Ningxia
Hui Autonomous Region 750021, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Major bleeding and allogeneic transfusion leads to negative
outcomes in patients receiving cardiac surgery with cardiopulmonary bypass
(CPB). Ulinastatin, a urine trypsin inhibitor, relieves systemic
inflammation and improves coagulation profiles with however sparse
evidence of its effects on blood loss and allogeneic transfusion in this
specific population. <br/>METHOD(S): In this prospective randomized
controlled trial, 426 consecutive patients receiving open heart surgery
with CPB were randomly assigned into three groups to receive ulinastatin
(group U, n=142), tranexamic acid (group T, n=143) or normal saline (group
C, n=141). The primary outcome was the total volume of post-operative
bleeding and the secondary outcome included the volume and exposure of
allogeneic transfusion, the incidence of stroke, post-operative myocardial
infarction, renal failure, respiratory failure and all-cause mortality. A
ten-year follow-up was carried on to evaluate long-term safety.
<br/>RESULT(S): Compared with placebo, ulinastatin significantly reduced
the volume of post-operative blood loss within 24h (688.39+/-393.55ml vs
854.33+/-434.03ml MD -165.95ml, 95%CI -262.88ml to -69.01ml, p<0.001) and
the volume of allogeneic erythrocyte transfusion (2.57+/-3.15 unit vs
3.73+/-4.21 unit, MD-1.16 unit, 95%CI -2.06units to -0.26units, p=0.002).
The bleeding and transfusion outcomes were comparable between the
ulinastatin group and the tranexamic acid group. In-hospital outcomes and
10-year follow-up showed no statistical difference in mortality and major
morbidity among groups. <br/>CONCLUSION(S): Ulinastatin reduced
post-operative blood loss and allogeneic erythrocyte transfusion in heart
surgery with CPB. The mortality and major morbidity was comparable among
the groups shown by the 10-year follow-up. TRIAL REGISTRATION: The trial
was retrospectively registered on February 2, 2010. TRIAL REGISTRATION
NUMBER: https://www.clinicaltrials.gov Identifier: NCT01060189.

<113>
Accession Number
631778606
Title
A comparison of different antibiotic regimens for the treatment of
infective endocarditis.
Source
The Cochrane database of systematic reviews. 5 (pp CD009880), 2020. Date
of Publication: 14 May 2020.
Author
Marti-Carvajal A.J.; Dayer M.; Conterno L.O.; Gonzalez Garay A.G.;
Marti-Amarista C.E.
Institution
(Marti-Carvajal) Facultad de Ciencias de la Salud Eugenio Espejo,
Universidad UTE (Cochrane Ecuador), Quito, Ecuador
(Marti-Carvajal) School of Medicine, Universidad Francisco de Vitoria
(Cochrane Madrid), Madrid, Spain
(Dayer) Department of Cardiology, Taunton and Somerset NHS Trust, Taunton,
United Kingdom
(Conterno) Medical School, Department of Internal Medicine, Infectious
Diseases Division, State University of Campinas (UNICAMP), Campinas,
Brazil
(Gonzalez Garay) Methodology Research Unit, Instituto Nacional de
Pediatria, Mexico City, Mexico
(Marti-Amarista) Department of Family Medicine, Northwell Health Southside
Hospital, Bay Shore, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Infective endocarditis is a microbial infection of the
endocardial surface of the heart. Antibiotics are the cornerstone of
treatment, but due to the differences in presentation, populations
affected, and the wide variety of micro-organisms that can be responsible,
their use is not standardised. This is an update of a review previously
published in 2016. <br/>OBJECTIVE(S): To assess the existing evidence
about the clinical benefits and harms of different antibiotics regimens
used to treat people with infective endocarditis. <br/>SEARCH METHOD(S):
We searched the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference
Proceedings Citation Index - Science on 6 January 2020. We also searched
three trials registers and handsearched the reference lists of included
papers. We applied no language restrictions. SELECTION CRITERIA: We
included randomised controlled trials (RCTs) assessing the effects of
antibiotic regimens for treating definitive infective endocarditis
diagnosed according to modified Duke's criteria. We considered all-cause
mortality, cure rates, and adverse events as the primary outcomes. We
excluded people with possible infective endocarditis and pregnant women.
DATA COLLECTION AND ANALYSIS: Two review authors independently performed
study selection, 'Risk of bias' assessment, and data extraction in
duplicate. We constructed 'Summary of findings' tables and used GRADE
methodology to assess the quality of the evidence. We described the
included studies narratively. MAIN RESULTS: Six small RCTs involving 1143
allocated/632 analysed participants met the inclusion criteria of this
first update. The included trials had a high risk of bias. Three trials
were sponsored by drug companies. Due to heterogeneity in outcome
definitions and different antibiotics used data could not be pooled. The
included trials compared miscellaneous antibiotic schedules having
uncertain effects for all of the prespecified outcomes in this review.
Evidence was either low or very low quality due to high risk of bias and
very low number of events and small sample size. The results for all-cause
mortality were as follows: one trial compared quinolone (levofloxacin)
plus standard treatment (antistaphylococcal penicillin (cloxacillin or
dicloxacillin), aminoglycoside (tobramycin or netilmicin), and rifampicin)
versus standard treatment alone and reported 8/31 (26%) with levofloxacin
plus standard treatment versus 9/39 (23%) with standard treatment alone;
risk ratio (RR) 1.12, 95% confidence interval (CI) 0.49 to 2.56. One trial
compared fosfomycin plus imipenem 3/4 (75%) versus vancomycin 0/4 (0%) (RR
7.00, 95% CI 0.47 to 103.27), and one trial compared partial oral
treatment 7/201 (3.5%) versus conventional intravenous treatment 13/199
(6.53%) (RR 0.53, 95% CI 0.22 to 1.31). The results for rates of cure with
or without surgery were as follows: one trial compared daptomycin versus
low-dose gentamicin plus an antistaphylococcal penicillin (nafcillin,
oxacillin, or flucloxacillin) or vancomycin and reported 9/28 (32.1%) with
daptomycin versus 9/25 (36%) with low-dose gentamicin plus
antistaphylococcal penicillin or vancomycin; RR 0.89, 95% CI 0.42 to 1.89.
One trial compared glycopeptide (vancomycin or teicoplanin) plus
gentamicin with cloxacillin plus gentamicin (13/23 (56%) versus 11/11
(100%); RR 0.59, 95% CI 0.40 to 0.85). One trial compared ceftriaxone plus
gentamicin versus ceftriaxone alone (15/34 (44%) versus 21/33 (64%); RR
0.69, 95% CI 0.44 to 1.10), and one trial compared fosfomycin plus
imipenem versus vancomycin (1/4 (25%) versus 2/4 (50%); RR 0.50, 95% CI
0.07 to 3.55). The included trials reported adverse events, the need for
cardiac surgical interventions, and rates of uncontrolled infection,
congestive heart failure, relapse of endocarditis, and septic emboli, and
found no conclusive differences between groups (very low-quality
evidence). No trials assessed quality of life. AUTHORS'
<br/>CONCLUSION(S): This first update confirms the findings of the
original version of the review. Limited and low to very low-quality
evidence suggests that the comparative effects of different antibiotic
regimens in terms of cure rates or other relevant clinical outcomes are
uncertain. The conclusions of this updated Cochrane Review were based on
few RCTs with a high risk of bias. Accordingly, current evidence does not
support or reject any regimen of antibiotic therapy for the treatment of
infective endocarditis.<br/>Copyright &#xa9; 2020 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<114>
Accession Number
2004376710
Title
Post-coronary artery bypass graft surgery and associated rehabilitation.
Source
Critical Reviews in Physical and Rehabilitation Medicine. 31 (3) (pp
197-216), 2019. Date of Publication: 2019.
Author
Radadia N.; Patel V.
Institution
(Radadia) Department of Science, McMaster University, Michael G. DeGroote
School of Medicine, 10b Victoria St South, Kitchener, ON N2G 1C5, Canada
(Patel) Department of Medicine, McMaster University, Michael G. DeGroote
School of Medicine, 10b Victoria St South, Kitchener, ON N2G 1C5, Canada
Publisher
Begell House Inc. (E-mail: orders@begellhouse.com)
Abstract
Coronary artery bypass graft (CABG) surgery is one of the most common
cardiac surgeries performed in Canada and the United States. Every year,
nearly 500,000 CABG surgeries are performed in the USA. After surgery,
patients are in the intensive care unit for 2-3 days, where blood
pressure, heart rate, oxygen levels, and pulmonary function are constantly
monitored. In some instances, an exercise protocol (called phase I) may be
implemented in the ICU; however, its effectiveness is not certain. In
phase II, rehabilitation consists of medically supervised exercises and
education on stress reduction and healthy living. In this review,
randomized clinical trial studies in the last 10 years will be analyzed to
determine (1) optimal exercises in phase I and phase II to improve
physical function capacity, (2) medications to help reduce postoperative
complications and manage comorbidities, (3) management of psychological
function to increase health-related quality of life, and (4) comparing
home-based to supervised hospital treatment.<br/>Copyright &#xa9; 2019 by
Begell House, Inc.

<115>
Accession Number
631789798
Title
Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia
in adult and paediatric cardiac surgery: a systematic review and
meta-analysis.
Source
Perfusion. (pp 267659120919350), 2020. Date of Publication: 18 May 2020.
Author
Ler A.; Sazzad F.; Ong G.S.; Kofidis T.
Institution
(Ler, Sazzad, Ong, Kofidis) Department of Cardiac, Thoracic and Vascular
Surgery, National University Heart Centre, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Kofidis) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
NLM (Medline)
Abstract
BACKGROUND: In recent years, the use of del Nido cardioplegia, initially
intended for paediatric cardiac surgery, has been extended to adult
cardiac surgery in many institutions. Our aim was thus to compare the
outcomes of the use of del Nido cardioplegia with that of conventional
cardioplegia and discuss its role in both adult and paediatric cardiac
surgery. <br/>METHOD(S): A systematic literature search was conducted in
August 2019 on Medline (via PubMed), Embase and Cochrane electronic
databases according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Any retrospective studies and
randomised controlled trials that reported findings comparing the outcomes
of the use of del Nido cardioplegia with that of St. Thomas cardioplegia
were included. <br/>RESULT(S): We observed shorter aortic cross-clamp time
(mean difference: -15.18, confidence interval: -27.21 to -3.15, p=0.01)
and cardiopulmonary bypass time (mean difference: -13.52, confidence
interval: -20.64 to -6.39, p=0.0002) associated with the use of del Nido
cardioplegia in adult cardiac surgery as compared to St. Thomas
cardioplegia. Defibrillation rates were significantly lower in patients
who had been given del Nido cardioplegia, in both adult (relative risk:
0.28, confidence interval: 0.12 to 0.64, p=0.003) and paediatric patients
(relative risk: 0.25, confidence interval: 0.08 to 0.79, p=0.02).
<br/>CONCLUSION(S): Del Nido cardioplegia may be a viable alternative to
the use of St. Thomas cardioplegia in both adult and paediatric patients,
providing similar postoperative outcomes while also affording the
additional advantage of shorter aortic cross-clamp time and
cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates
of defibrillation (in both adult and paediatric cardiac surgery).

<116>
Accession Number
631787564
Title
Safety and benefit of tee in liver transplant: A position paper from the
society for the advancement of transplant anesthesia.
Source
Liver transplantation : official publication of the American Association
for the Study of Liver Diseases and the International Liver
Transplantation Society. (no pagination), 2020. Date of Publication: 19
May 2020.
Author
De Marchi L.; Wang C.J.; Skubas N.J.; Kothari R.; Zerillo J.; Kathirvel
S.; Efune G.E.; Braunfeld M.Y.C.; Mandel S.
Institution
(De Marchi) Department of Anesthesiology, MedStar-Georgetown University
Hospital, DC, WA, United States
(Wang) US Anesthesia Partners -Washington, Seattle, WA / Swedish Heart and
Vascular Institute, Seattle, WA, United States
(Skubas) Cardiothoracic Anesthesiology, Anesthesiology Institute Cleveland
Clinic, Cleveland, OH, United States
(Kothari) Department of Anesthesia and Perioperative Care, University of
California San Francisco, San Francisco, CA, United States
(Zerillo) Department of Anesthesiology, Perioperative and Pain Medicine,
Icahn School of Medicine at Mount Sinai, NY, NY, United States
(Kathirvel) Department of Anesthesiology, University of Pittsburgh School
of Medicine, Pittsburgh, United States
(Efune) Department of Anesthesiology and Pain Management, University of
Texas Southwestern Medical Center, TX, Dallas, United States
(Braunfeld) Department of Anesthesiology & Perioperative Medicine,
University of California Los Angeles, Los Angeles, CA, United States
(Mandel) Department of Anesthesia, University of Colorado, CO, Aurora,
United States
Publisher
NLM (Medline)
Abstract
More anesthesiologists are routinely using Transesophageal
Echocardiography (TEE) during liver transplant surgery but the effects on
patient outcome are unknown. Transplant anesthesiologists are therefore
uncertain if they should undergo additional training and adopt TEE. In
response to these clinical questions, the Society for the Advancement of
Transplant Anesthesia appointed experts in liver transplantation and
certified in TEE to evaluate all available published evidence on the
topic. The aim was to produce a summary with greater explanatory power
than individual reports to guide transplant anesthesiologists in their
decision to use TEE. An exhaustive search recovered 51 papers of
uncontrolled clinical observations. Topics chosen for this study were
effectiveness and safety because they were a major or minor topic in all
papers. Pattern of clinical use was a common topic and included to provide
contextual information. Summarized observations showed effectiveness as
the ability to make a new and unexpected diagnosis and to direct the
choice of clinical management. These were reported in each stage of liver
transplant surgery. There were observations that TEE facilitated rapid
diagnosis of life-threatening conditions difficult to identify with other
types of monitoring commonly used in the operating room. Real time
diagnosis by TEE images made anesthesiologists confident in their choice
of interventions, especially those with a high risk of complications such
as use of anticoagulants for intracardiac thrombosis. <br/>Conclusion(s):
The summarized observations in this systematic review suggest TEE is an
effective form of monitoring with a safety profile similar to that in
cardiac surgery patients.<br/>Copyright This article is protected by
copyright. All rights reserved.

<117>
Accession Number
631785822
Title
The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain
Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.
Source
Journal of Alzheimer's disease : JAD. (no pagination), 2020. Date of
Publication: 11 May 2020.
Author
VanDusen K.W.; Eleswarpu S.; Moretti E.W.; Devinney M.J.; Crabtree D.M.;
Laskowitz D.T.; Woldorff M.G.; Roberts K.C.; Whittle J.; Browndyke J.N.;
Cooter M.; Rockhold F.W.; Anakwenze O.; Bolognesi M.P.; Easley M.E.;
Ferrandino M.N.; Jiranek W.A.; Berger M.
Institution
(VanDusen, Eleswarpu, Moretti, Devinney, Whittle, Cooter, Berger)
Department of Anesthesiology, Duke University, Durham, United States
(Crabtree) Duke Office of Clinical Research, Duke University, Durham,
United States
(Laskowitz) Department of Neurology, Duke University, Durham, United
States
(Woldorff, Browndyke) Department of Psychiatry and Behavioral Sciences,
Duke University Medical Center, Durham, United States
(Woldorff) Department of Psychology and Neuroscience, Duke University,
Durham, United States
(Roberts, Berger) Center for Cognitive Neuroscience, Duke University
Medical Center, Durham, United States
(Rockhold) Duke Clinical Research Institute, Durham, United States
(Anakwenze, Bolognesi, Easley) Department of Orthopaedic Surgery, Duke
University, Durham, United States
(Ferrandino, Jiranek) Department of Surgery, Duke University, Durham,
United States
(Berger) Center for the Study of Aging and Human Development, Duke
University Medical Center, Durham, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative neurocognitive disorders (PND) are common
complications in older adults associated with increased 1-year mortality
and long-term cognitive decline. One risk factor for worsened long-term
postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic
risk factor APOE4. APOE4 is thought to elevate AD risk partly by
increasing neuroinflammation, which is also a theorized mechanism for PND.
Yet, it is unclear whether modulating apoE4 protein signaling in older
surgical patients would reduce PND risk or severity. <br/>OBJECTIVE(S):
MARBLE is a randomized, blinded, placebo-controlled phase II sequential
dose escalation trial designed to evaluate perioperative administration of
an apoE mimetic peptide drug, CN-105, in older adults (age>=60 years). The
primary aim is evaluating the safety of CN-105 administration, as measured
by adverse event rates in CN-105 versus placebo-treated patients.
Secondary aims include assessing perioperative CN-105 administration
feasibility and its efficacy for reducing postoperative neuroinflammation
and PND severity. <br/>METHOD(S): 201 patients undergoing non-cardiac,
non-neurological surgery will be randomized to control or CN-105 treatment
groups and receive drug or placebo before and every six hours after
surgery, for up to three days after surgery. Chart reviews, pre- and
postoperative cognitive testing, delirium screening, and blood and CSF
analyses will be performed to examine effects of CN-105 on perioperative
adverse event rates, cognition, and neuroinflammation. Trial results will
be disseminated by presentations at conferences and peer-reviewed
publications. <br/>CONCLUSION(S): MARBLE is a transdisciplinary study
designed to measure CN-105 safety and efficacy for preventing PND in older
adults and to provide insight into the pathogenesis of these geriatric
syndromes.

<118>
Accession Number
631782024
Title
Postoperative Mortality of Indigenous Populations Compared with
Nonindigenous Populations: A Systematic Review.
Source
JAMA Surgery. (no pagination), 2020. Date of Publication: 2020.
Author
McLeod M.; Signal V.; Gurney J.; Sarfati D.
Institution
(McLeod, Signal, Gurney, Sarfati) Department of Public Health, University
of Otago Wellington, 23A Mein St, PO Box 7343, Wellington 6021, New
Zealand
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: A range of factors have been identified as possible
contributors to racial/ethnic differences in postoperative mortality that
are also likely to hold true for indigenous populations. Yet despite its
severity as an outcome, death in the period following a surgical procedure
is underresearched for indigenous populations. <br/>Objective(s): To
describe postoperative mortality experiences for minority indigenous
populations compared with numerically dominant nonindigenous populations
and examine the factors that drive any differences observed. Evidence
Review: This review was conducted according to PRIMSA guidelines and
registered on PROSPERO. Articles were identified through searches of the
Embase, Ovid MEDLINE, Scopus, and Cumulative Index to Nursing and Allied
Health Literature databases, with manual review of references and gray
literature searches conducted. Eligible articles included those that
reported associations between ethnicity/indigeneity and mortality up to 90
days following surgery and published in English between January 1, 1990,
and March 26, 2019. Data on the study design, setting, participants
(including indigeneity), and results were extracted. A modified
Newcastle-Ottawa Quality Assessment Scale was used to determine study
quality. <br/>Finding(s): A total of 442 abstracts were screened, 92
articles were reviewed in full text, and 21 articles (from 20 studies) and
7 reports underwent data extraction. All included studies were cohort
studies (3 prospective and the remainder retrospective) investigating a
wide range of surgical procedures in the US, Australia, or New Zealand.
Seven studies were from single facilities, while the remainder used data
from national databases. Sample sizes ranged, with indigenous sample sizes
ranging from 20 to 3052 patients and a number of studies reporting less
than 10 indigenous deaths. The postoperative mortality experience for
minority indigenous populations compared with the nonindigenous
populations was mixed. There was evidence from several studies that
indigenous populations may be more likely to die following cardiac
procedures. However, the available evidence has overall poor study
quality, with methods to identify the indigenous populations being a major
limitation of most of the studies. <br/>Conclusions and Relevance:
Postoperative mortality experiences for indigenous populations should not
be interpreted in isolation from the broader context of inequities across
the health care pathway and must take into account the quality of data
used for indigenous identification.<br/>Copyright &#xa9; 2020 American
Medical Association. All rights reserved.

<119>
Accession Number
631780850
Title
Selected 2019 Highlights in Congenital Cardiac Anesthesia.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2020.
Date of Publication: 28 Apr 2020.
Author
Ross F.J.; Vu E.L.; Fang Z.A.; Resheidat A.; Mossad E.B.; Mittnacht A.J.C.
Institution
(Ross) Department of Anesthesiology, Seattle Children's Hospital,
University of Washington, Seattle, WA
(Vu) Department of Anesthesiology, Lurie Children's Hospital, Northwestern
University Feinberg School of Medicine, Chicago, Mexico
(Fang) Department of Anesthesia and Pain Medicine, Hospital for Sick
Children Toronto, ON, Canada
(Resheidat, Mossad) Division of Pediatric Cardiovascular Anesthesia,
Baylor College of Medicine, Texas Children's Hospital, TX, Houston
(Mittnacht) Department of Anesthesiology, Westchester Medical Center, New
York Medical College, Valhalla, NY
Publisher
NLM (Medline)
Abstract
This article is a review of the highlights of pertinent literature
published in 2019, which is of interest to the pediatric cardiac
anesthesiologist. After a search of the United States National Library of
Medicine PubMed database, several topics emerged in which significant
contributions were made in 2019. The authors of this manuscript considered
the following topics noteworthy and were included in this review: advances
in pediatric heart transplantation, blood management in pediatric cardiac
surgery, the impact of nutrition on outcomes in congenital heart surgery,
and the use of vasopressin in patients after Fontan
palliation.<br/>Copyright &#xa9; 2020 Elsevier Inc. All rights reserved.

<120>
Accession Number
631779902
Title
Outcomes of Valve-In-Valve Transcatheter Aortic Valve Replacement in
Patients with Failed Bioprosthetic Aortic Valves: Systematic Review and
Meta-analysis of Observational Evidence.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2020. Date of Publication: 19 May 2020.
Author
Mahmoud A.N.; Gad M.M.; Elgendy I.Y.; Mahmoud A.A.; Taha Y.; Elgendy A.Y.;
Ahuja K.R.; Saad A.M.; Simonato M.; McCabe J.M.; Reisman M.; Kapadia S.R.;
Dvir D.
Institution
(Mahmoud) Division of Cardiology, University of Washington, DC, Seattle,
WA, United States
Publisher
NLM (Medline)
Abstract
AIMS: To evaluate the evidence regarding the rates of procedural success
and incidence of adverse outcomes following valve-in-valve (VIV)
transcatheter aortic valve replacement (TAVR) in patients with failed
bioprosthetic aortic valves. METHODS AND RESULTS: A systematic search of
major electronic databases was conducted, for studies relevant to patients
with failed bioprosthetic aortic valves undergoing VIV-TAVR. The primary
outcome was procedural success. A total of 5,553 patients from 24 studies
were included. The mean Society of Thoracic Surgery (STS) score was 7.84
+/- 5.14. The procedural success rate was high (97 %, 95% confidence
interval [CI]: 94 - 98%). At 30-day, of all-cause mortality was 5% (95%
CI: 3 - 6%), stroke 2% (95% CI: 1 - 2%), myocardial infarction 1% (95% CI:
1 - 2%), permanent pacemaker placement 6% (95% CI: 5 - 8%), and aortic
regurgitation 7% (95% CI: 5 - 10%) at 30-days. At 1-year, incidence of
all-cause mortality was 12% (95% CI: 10 - 14%), stroke 3% (95% CI: 2 -
4%), myocardial infarction 1% (95% CI: 0 - 2%), and permanent pacemaker
placement 7% (95% CI: 5 - 11%). At three years, the incidence of all-cause
mortality was 29% (95% CI: 25 - 34%) and stroke 6% (95% CI: 5 - 9%).
<br/>CONCLUSION(S): VIV-TAVR appears to be associated with high procedural
success rates and low adverse outcomes during the short and mid-term
follow-up period.

<121>
Accession Number
631777767
Title
Cost-Effectiveness of Low-Dose Colchicine after Myocardial Infarction in
the Colchicine Cardiovascular Outcomes Trial (COLCOT).
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2020. Date of Publication: 14 May 2020.
Author
Samuel M.; Tardif J.-C.; Khairy P.; Roubille F.; Waters D.D.; Gregoire
J.C.; Pinto F.J.; Maggioni A.P.; Diaz R.; Berry C.; Koenig W.; Ostadal P.;
Lopez-Sendon J.; Gamra H.; Kiwan G.S.; Dube M.-P.; Provencher M.; Orfanos
A.; Blondeau L.; Kouz S.; L'Allier P.L.; Ibrahim R.; Bouabdallaoui N.;
Mitchell D.; Guertin M.-C.; Lelorier J.
Institution
(Samuel, Tardif, Khairy, Gregoire, Maggioni, Diaz, Dube, L'Allier,
Ibrahim, Bouabdallaoui, Lelorier) MontrealCanada
(Roubille) Universite de Montpellier, INSERM, CNRS, CHU de Montpellier,
France
(Waters) San Francisco General Hospital, CA
(Pinto) Santa Maria University Hospital (CHULN); CAML, CCUL, Faculdade de
Medicina da Universidade de Lisboa, Lisboa, Portugal
(Maggioni) ANMCO Research Center, Firenze, Italy
(Diaz) Estudios Clinicos Latinoamerica; Rosario, Argentina
(Berry) University of Glasgow and NHS Glasgow Clinical Research Facility,
Glasgow, United Kingdom
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Institute of Epidemiology and Medical Biometry, University of Ulm, Munich,
Germany
(Ostadal) Cardiovascular Center, Na Homolce Hospital, Prague, Czechia
(Lopez-Sendon) IdiPaz, UAM, Spain
(Gamra) Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Kiwan) Bellevue Medical Center, Beirut, Lebanon
(Provencher, Orfanos, Blondeau, Guertin) Montreal Health Innovations
Coordinating Center Montreal, Canada
(Orfanos) Institut de Cardiologie et Pneumologie de Quebec, Quebec City,
Canada
(Kouz) Centre Hospitalier Regional de Lanaudiere, Joliette, Canada
(Mitchell) CHRU de Tours and EA4245 T2I Loire Valley Cardiovascular
Collaboration, Tours University, Tours, France
(Mitchell) Logimetrix Inc, Canada Canada
(Lelorier) Centre de recherche du Centre hospitalier de l'Universite de
Montreal, Canada
Publisher
NLM (Medline)
Abstract
AIMS: In the randomized, placebo-controlled Colchicine Cardiovascular
Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after
myocardial infarction, low-dose colchicine (0.5mg once daily) reduced the
incidence of the primary composite endpoint of cardiovascular death,
resuscitated cardiac arrest, myocardial infarction (MI), stroke, or urgent
hospitalization for angina leading to coronary revascularization. To
assess the in-trial period and lifetime cost-effectiveness of low-dose
colchicine therapy compared to placebo in post-MI patients on
standard-of-care therapy. METHODS AND RESULTS: A multistate Markov model
was developed incorporating the primary efficacy and safety results from
COLCOT, as well as healthcare costs and utilities from the Canadian
healthcare system perspective. All components of the primary outcome,
non-cardiovascular deaths, and pneumonia were included as health states in
the model as both primary and recurrent events. In the main analysis, a
deterministic approach was used to estimate the incremental
cost-effectiveness ratio (ICER) for the trial period (24 months) and
lifetime (20 years). Over the in-trial period, the addition of colchicine
to post-MI standard-of-care treatment decreased the mean overall per
patient costs by 47%, from $502 to $265 CAD, and increased the quality
adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per patient
costs were further reduced (69%) and QALYs increased with colchicine
therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime
ICERs indicated colchicine therapy was a dominant strategy.
<br/>CONCLUSION(S): Cost-effectiveness analyses indicate that the addition
of colchicine to standard-of-care therapy after myocardial infarction is
economically dominant and therefore generates cost savings.<br/>Copyright
&#xa9; The Author(s) 2020. Published by Oxford University Press on behalf
of the European Society of Cardiology.