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<1>
Accession Number
625413596
Title
Safety and efficacy of aerobic exercise commenced early after cardiac
surgery: A systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 26 (1) (pp 36-45), 2019. Date
of Publication: 01 Jan 2019.
Author
Doyle M.P.; Indraratna P.; Tardo D.T.; Peeceeyen S.C.S.; Peoples G.E.
Institution
(Doyle, Peoples) School of Medicine, University of Wollongong, Wollongong,
Australia
(Doyle, Peeceeyen) Department of Cardiothoracic Surgery, St George
Hospital, Sydney, Australia
(Indraratna, Tardo) Department of Cardiology, St George Hospital, Sydney,
Australia
(Indraratna) Faculty of Medicine, University of New South Wales, Sydney,
Australia
(Tardo) School of Medicine, University of Notre Dame, Sydney, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aerobic exercise is a critical component of cardiac
rehabilitation following cardiac surgery. Aerobic exercise is
traditionally commenced 2-6 weeks following hospital discharge and most
commonly includes stationary cycling or treadmill walking. The initiation
of aerobic exercise within this early postoperative period not only
introduces the benefits associated with aerobic activity sooner, but also
ameliorates the negative effects of immobilization associated with the
early postoperative period. Method(s): A systematic review identified
all studies reporting safety and efficacy outcomes of aerobic exercise
commenced within two weeks of cardiac surgery. A meta-analysis was
performed comparing functional, aerobic and safety outcomes in patients
receiving early postoperative aerobic exercise compared with usual
postoperative care. Result(s): Six-minute walk test distance at
hospital discharge was 419 +/- 88 m in early aerobic exercise patients
versus 341 +/- 81 m in those receiving usual care (mean difference 69.5 m,
95% confidence interval (CI) 39.2-99.7 m, p < 0.00001). Peak aerobic power
was 18.6 +/- 3.8 ml.kg-1.min-1 in those receiving
early exercise versus 15.0 +/- 2.1 ml.kg-1.min-1 in
usual care (mean difference 3.20 ml.kg-1.min-1, 95%
CI 1.45-4.95, p = 0.0003). There was no significant difference in adverse
events rates between the two groups (odds ratio 0.41, 95% CI 0.12-1.42, p
= 0.16). Conclusion(s): Aerobic exercise commenced early after
cardiac surgery significantly improves functional and aerobic capacity
following cardiac surgery. While adverse event rates did not differ
significantly, patients included were very low risk. Further studies are
required to adequately assess safety outcomes of aerobic exercise
commenced early after cardiac surgery. Copyright © The European
Society of Cardiology 2018.

<2>
Accession Number
631471259
Title
Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. 68 (3) (pp 212-218), 2020. Date of
Publication: 01 Apr 2020.
Author
Habbab L.M.; Semelhago L.; Lamy A.
Institution
(Habbab, Semelhago, Lamy) Division of Cardiac Surgery, Hamilton General
Hospital, McMaster University, McMaster Clinic, 237 Barton Street East,
Hamilton, ON L8L 22, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background This meta-analysis was conducted to investigate the evidence
for the efficacy and safety of intrapericardial tranexamic acid (TXA) in
cardiac surgery. Methods We searched MEDLINE from 2000 to 2017 for
randomized controlled trials that compared intrapericardial TXA to
placebo. We performed a meta-analysis for the eligible trials that focused
on chest tube drainage measured during the first 24 hours after surgery as
a primary outcome. We also examined the secondary outcome measures of
these trials such as the incidence of transfusion requirements following
surgery and the evidence for any increase in complication rates. Results
A total of seven randomized controlled trials (six on-pump and one
off-pump) comparing topical application of TXA to placebo in 692 patients
were eligible for the blood loss outcome data. These trials randomized 372
patients to receive TXA and 320 patients as controls. The use of
intrapericardial TXA was associated with a considerable reduction in
24-hour blood loss in all seven studies and a weighted mean difference of
-343.56 mL (95% confidence interval: -316.41, -370.72) significantly
differed from zero (p = 0.005) with a heterogeneity of I 2 =
0%. The incidence of packed RBC transfusion in TXA patients was
significantly lower in one study and was not significant but with trend in
favor of TXA in five out of the six studies in which it was reported. In
one trial, TXA was not detected in any patient and in another the studied
groups were similar in postoperative complications, such as graft patency,
myocardial infarction, cerebral infarction, atrial fibrillation, seizures,
and infections. Conclusions Findings from this meta-analysis suggest that
intrapericardial use of TXA in patients undergoing cardiac surgery can
decrease postoperative bleeding without increasing the risk of
postoperative seizures. Future large randomized, double-blind, controlled
clinical trials are needed to confirm these promising
findings. Copyright © 2020 EDP Sciences. All rights reserved.

<3>
Accession Number
2003422642
Title
Moderate ischemic mitral incompetence: does it worth more ischemic time?.
Source
General Thoracic and Cardiovascular Surgery. 68 (5) (pp 492-498), 2020.
Date of Publication: 01 May 2020.
Author
El-Hag-Aly M.A.; El swaf Y.F.; Elkassas M.H.; Hagag M.G.; Allam H.K.
Institution
(El-Hag-Aly, Hagag) Cardiothoracic Surgery Department, Faculty of
Medicine, Menoufia University, Yassin Abdel Ghaffar Street, Shebin El-Kom,
Menoufia 32511, Egypt
(El swaf) Cardiothoracic Surgery Department, Mahalla Cardiac Institute,
Mahalla, Gharbia, Egypt
(Elkassas) Cardiothoracic Surgery Department, Faculty of Medicine, Suez
Canal University, Suez, Egypt
(Allam) Public Health and Community Medicine Department, Faculty of
Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
Publisher
Springer
Abstract
Objectives: Ischemic mitral regurgitation (IMR) is a common finding
following myocardial infarction or ischemia. Management of moderate IMR is
still a hot topic. Adding mitral valve repair (MVr) to coronary artery
bypass grafting (CABG) is questionable. The goal of this study was to
assess and compare short-term clinical and echocardiographic results of
moderate IMR treated by CABG alone versus another group of patients
treated by CABG plus MVr. Method(s): Eighty consecutive patients with
ischemic heart disease (IHD) and moderate IMR were divided randomly into
two equal groups: group I (40) had only CABG and group II (40) had CABG
plus MVr. Patients were evaluated at 1-week, 3-months and 1-year intervals
postoperatively. Result(s): After 1-year follow-up, our study
revealed statistically significant improvement in the grade of mitral
regurgitation (MR) in group II than group I. The mean value for effective
regurgitant orifice area (EROA) was 0.22 +/- 0.13 for group I versus 0.03
+/- 0.03 for group II (P = 0.001) and for vena contracta (VC), it was 3.8
+/- 2.24 for group I versus 0.4 +/- 0.49 for group II (P = 0.000). There
was also a significant reduction in the New York Heart Association (NYHA)
functional class in both groups. Conclusion(s): MVr can be performed
safely and concomitantly with CABG in patients having moderate IMR, and
its addition to CABG have significant short-term impact on clinical or
echocardiographic outcome of patients. Copyright © 2019, The
Japanese Association for Thoracic Surgery.

<4>
Accession Number
2004479112
Title
Melatonin and its analogues for the prevention of postoperative delirium:
A systematic review and meta-analysis.
Source
Journal of Pineal Research. 68 (4) (no pagination), 2020. Article Number:
e12644. Date of Publication: 01 May 2020.
Author
Han Y.; Wu J.; Qin Z.; Fu W.; Zhao B.; Li X.; Wang W.; Sha T.; Sun M.; Li
J.; Zeng Z.; Chen Z.
Institution
(Han, Qin, Zhao) Department of Anaesthesiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Wu, Fu, Wang, Sha, Sun, Li, Zeng, Chen) Department of Critical Care
Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
(Li) Department of Anaesthesiology, People's Hospital of Ningxia Hui
Autonomous Region, Northwest University for Nationalities, Yinchuan, China
Publisher
Blackwell Publishing Ltd
Abstract
It remains unclear whether melatonin and its analogues prevent
postoperative delirium (POD). Therefore, we conducted a systematic review
and meta-analysis to evaluate the effect of melatonin and its analogues on
POD prevention. PubMed, Cochrane Library, Web of Science, Embase and
CINAHL databases were searched. Primary outcome was the incidence of POD.
Six randomized controlled trials, 2 cohort studies and 1 case-control
study were included in this meta-analysis. Results showed that melatonin
and its analogue ramelteon decreased the incidence of POD in the entire
adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval
[CI] 0.24-0.84, P =.01). When administered at a higher dose (5 mg),
melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI
0.20-0.52, P <.00001). Melatonin administered less than 5 elimination
half-lives before the surgery significantly reduced the POD incidence (OR
= 0.31, 95% CI 0.19-0.49, P <.00001). Current literature supports the
effectiveness of melatonin and its analogue ramelteon in POD prevention.
However, the present study was limited by the significant heterogeneity of
the included studies. More studies are needed to ascertain the preventive
effect of melatonin and its analogues on the incidence of delirium after
cardiac and noncardiac surgeries. Copyright © 2020 John Wiley &
Sons A/S. Published by John Wiley & Sons Ltd

<5>
Accession Number
631561613
Title
Feasibility of planning coronary artery bypass grafting based only on
coronary computed tomography angiography and CT-derived fractional flow
reserve: A pilot survey of the surgeons involved in the randomized SYNTAX
III Revolution trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (2) (pp 209-216),
2019. Date of Publication: 01 Aug 2019.
Author
Sonck J.; Miyazaki Y.; Collet C.; Onuma Y.; Asano T.; Takahashi K.; Kogame
N.; Katagiri Y.; Modolo R.; Serruys P.W.; Bartorelli A.L.; Andreini D.;
Doenst T.; Maureira J.P.; Plass A.; La Meir M.; Pompillio G.
Institution
(Sonck, Collet, La Meir) Department of Cardiology and Cardiovascular
Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
(Sonck) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Miyazaki, Onuma) Department of Interventional Cardiology, Thoraxcenter,
Erasmus University Medical Center, Rotterdam, Netherlands
(Collet, Asano, Takahashi, Kogame, Katagiri, Modolo) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Onuma, Serruys) Cardialysis BV, Rotterdam, Netherlands
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
(Bartorelli) Department of Biomedical and Clinical Sciences Luigi Sacco,
University of Milan, Milan, Italy
(Bartorelli, Andreini, Pompillio) Centro Cardiologico Monzino, IRCCS,
Milan, Italy
(Andreini, Pompillio) Department of Clinical Sciences and Community
Health, University of Milan, Milan, Italy
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich Schiller University of Jena, Jena, Germany
(Maureira) Department of Cardiovascular Surgery, CHRU Nancy, Nancy, France
(Plass) Division of Cardiovascular Surgery, University Hospital Zurich,
Zurich, Switzerland
Publisher
Oxford University Press
Abstract
OBJECTIVES: Invasive coronary angiography has been the preferred
diagnostic method to guide the decision-making process between coronary
artery bypass grafting (CABG) and percutaneous coronary intervention and
plan a surgical revascularization procedure. Guidelines recommend a heart
team approach and assessment of coronary artery disease (CAD) complexity,
objectively quantified by the anatomical SYNTAX score. Coronary computed
tomography angiography (CCTA) and CT-derived fractional flow reserve
(FFR<inf>CT</inf>) are emerging technologies in the diagnosis of stable
CAD. In this study, data from patients with left main or 3-vessel CAD who
underwent CABG were evaluated to assess the feasibility of developing a
surgical plan based on CCTA integrated with FFR<inf>CT</inf>. The primary
objective was to assess the theoretical feasibility of surgical
decision-making and treatment planning based only on non-invasive imaging.
 METHOD(S): This study represents a survey of surgeons involved in the
SYNTAX III Revolution trial. In this trial, heart teams were randomized to
make treatment decisions using CTA. CCTAs and FFR<inf>CT</inf> results of
20 patients were presented to 5 cardiac surgeons. RESULT(S): Surgical
treatment decision-making based on CCTA with FFR<inf>CT</inf> was
considered feasible by a panel of surgeons in 84% of the cases with an
excellent agreement on the number of anastomoses to be made in each
patient (intraclass correlation coefficient 0.77, 95% confidence interval
0.35-0.96). CONCLUSION(S): Using non-invasive imaging only in
patients with left main or 3-vessel CAD, an excellent agreement on
treatment planning and the number of anastomoses was found among cardiac
surgeons. Thus, CABG planning based on non-invasive imaging appears
feasible. Further investigation is warranted to determine the safety and
feasibility in clinical practice. Copyright © 2019 The Author(s)
2019. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2005667080
Title
Continuous postoperative pericardial flushing method versus standard care
for wound drainage after adult cardiac surgery: A randomized controlled
trial.
Source
EBioMedicine. 55 (no pagination), 2020. Article Number: 102744. Date of
Publication: May 2020.
Author
Diephuis E.; de Borgie C.; Tomsic A.; Winkelman J.; van Boven W.J.; Bouma
B.; Eberl S.; Juffermans N.; Schultz M.; Henriques J.P.; Koolbergen D.
Institution
(Diephuis, Winkelman, van Boven, Koolbergen) Department of Cardiothoracic
Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef
9, Amsterdam, AZ 1105, Netherlands
(Tomsic, Koolbergen) Department of Cardiothoracic Surgery, Leiden
University Medical Center (LUMC), Leiden, Netherlands
(de Borgie) Clinical Research Unit, Amsterdam University Medical Center,
Location AMC, Amsterdam, Netherlands
(Bouma, Henriques) Department of Cardiology, Amsterdam University Medical
Center, Location AMC, Amsterdam, Netherlands
(Eberl) Department of Anesthesiology, Amsterdam University Medical Center,
Location AMC, Amsterdam, Netherlands
(Juffermans, Schultz) Department of Intensive Care Medicine, Amsterdam
University Medical Center, Location AMC, Amsterdam, Netherlands
Publisher
Elsevier B.V.
Abstract
Background: Excessive bleeding, incomplete wound drainage, and subsequent
accumulation of blood and clots in the pericardium have been associated
with a broad spectrum of bleeding-related complications after cardiac
surgery. We developed and studied the continuous postoperative pericardial
flushing (CPPF) method to improve wound drainage and reduce blood loss and
bleeding-related complications. Method(s): We conducted a
single-center, open-label, ITT, randomized controlled trial at the
Academic Medical Center Amstserdam. Adults undergoing cardiac surgery for
non-emergent valvular or congenital heart disease (CHD) were randomly
assigned (1:1) to receive CPPF method or standard care. The primary
outcome was actual blood loss after 12-hour stay in the intensive care
unit (ICU). Secondary outcomes included bleeding-related complications and
clinical outcome after six months follow-up. Finding(s): Between May
2013 and February 2016, 170 patients were randomly allocated to CPPF
method (study group; n = 80) or to standard care (control group; n = 90).
CPPF significantly reduced blood loss after 12-hour stay in the ICU (-41%)
when compared to standard care (median differences -155 ml, 95% confidence
interval (CI) -310 to 0; p=<=0.001). Cardiac tamponade and reoperation for
bleeding did not occur in the study group versus one and three in the
control group, respectively. At discharge from hospital, patients in the
study group were less likely to have pleural effusion in a surgically
opened pleural cavity (22% vs. 36%; p = 0.043). Interpretation(s):
Our study results indicate that CPPF is a safe and effective method to
improve chest tube patency and reduce blood loss after cardiac surgery.
Larger trials are needed to draw final conclusions concerning the
effectiveness of CPPF on clinically relevant outcomes. Copyright
© 2020 The Author(s)

<7>
Accession Number
628877126
Title
Venoarterial Extracorporeal Membrane Oxygenation With Concomitant Impella
Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic
Shock.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 66
(5) (pp 497-503), 2020. Date of Publication: 01 May 2020.
Author
O'Horo J.C.; Antharam P.; Ananthaneni S.; Vallabhajosyula S.; Stulak J.M.;
Dunlay S.M.; Holmes D.R.; Barsness G.W.
Institution
(Vallabhajosyula, Ananthaneni, Vallabhajosyula, Dunlay, Holmes, Barsness)
From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
(Vallabhajosyula, O'Horo, Antharam) Division of Pulmonary and Critical
Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
(O'Horo) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN
(Stulak) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
(Dunlay) Department of Health Science Research, Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN
Publisher
NLM (Medline)
Abstract
There are contrasting data on concomitant Impella device in cardiogenic
shock patients treated with venoarterial extracorporeal membrane
oxygenation (VA ECMO) (ECPELLA). This study sought to compare early
mortality in patients with cardiogenic shock treated with ECPELLA in
comparison to VA ECMO alone. We reviewed the published literature from
2000 to 2018 for randomized, cohort, case-control, and case series studies
evaluating adult patients requiring VA ECMO for cardiogenic shock. Five
retrospective observational studies, representing 425 patients, were
included. Venoarterial extracorporeal membrane oxygenation with
concomitant Impella strategy was used in 27% of the patients. Median age
across studies varied between 51 and 63 years with 59-88% patients being
male. Use of ECPELLA was associated with higher weaning from VA ECMO and
bridging to permanent ventricular assist device or cardiac transplant in
three and four studies, respectively. The studies showed moderate
heterogeneity with possible publication bias. The two studies that
accounted for differences in baseline characteristics between treatment
groups reported lower 30 day mortality with ECPELLA versus VA ECMO. The
remaining three studies did not adjust for potential confounding and were
at high risk for selection bias. In conclusion, ECPELLA is being
increasingly used as a strategy in patients with cardiogenic shock.
Additional large, high-quality studies are needed to evaluate clinical
outcomes with ECPELLA.

<8>
Accession Number
631644554
Title
A systematic review and meta-analysis of surgical outcomes in indigenous
populations.
Source
Canadian Journal of Anesthesia. Conference: 2018 Canadian
Anesthesiologists Society Annual Meeting. Canada. 66 (2 Supplement) (pp
S224-S225), 2019. Date of Publication: 2019.
Author
Poon A.; Ahmad N.; McVicar J.; McIsaac D.I.
Institution
(Poon, McVicar) Departments of Anesthesiology, Ottawa Hospital, University
of Ottawa
(Ahmad) Faculty of Medicine, University of Ottawa
(McIsaac) University of Ottawa
Publisher
Springer
Abstract
INTRODUCTION: Approximately 1.67 million Canadians (4.9%) have Indigenous
identity (1). Among the Indigenous population, several well documented
health inequities exist compared to the non-Indigenous Canadian population
(2-5). However, literature describing the differences in surgical outcomes
between Indigenous and nonindigenous Canadians has not been systematically
reviewed. The objective of this study was to conduct a systematic review
and meta-analysis of available literature to determine if there is a
difference in surgical outcomes between patients of Indigenous identity in
Canada, compared to the non-Indigenous Canadian population.
 Method(s): Research ethics board approval was not required for this
meta-analysis. Indigenous community members and organizations representing
Indigenous people were included from the time of study inception. A
systematic literature search was conducted using Medline, EMBASE,
Cochrane, and CINAHL. All phases of study selection and data extraction
were conducted by two independent reviewers in accordance with a
pre-registered protocol (CRD42018098757). Mortality was the primary
outcome. Risk of bias assessment is ongoing using the ROBINS-I tool.
Metaanalysis, following the recommendations of the Meta-Analysis of
Observational Studies in Epidemiology group, is ongoing. Result(s):
We identified 707 titles and abstracts for full text review of which 29
studies met all inclusion criteria. Four large studies reported a
significant association between Indigenous identity and increased post
operative mortality (hazard ratios 1.09 for liver transplant recipients,
1.93 for renal transplant recipients, 1.37, 1.53 and 1.3 for surgical
management of hip, wrist and vertebral fracture respectively, and 1.38
post percutaneous intervention for acute myocardial infarction). 21
studies reported on outcomes related to access to surgical care in
Indigenous populations. Indigenous patients were found to be significantly
less likely than non-Indigenous patients to receive renal transplant for
end stage renal disease, angiography and revascularization for acute
myocardial infarction, hip or knee arthroplasty for osteoarthritis, and
caesarian section. Indigenous identity was associated with significantly
increased rates of amputation for diabetic complications.
 Discussion(s): The majority of studies identified in this systematic
review provide pre operative data only - specifically differences in rates
of surgery between Indigenous and non-Indigenous patients. The remaining
studies which do provide post operative outcome data are limited to very
specific surgical procedures - cardiac revascularization, peripheral
vascular bypass, orthopedic surgery for fractures and lower extremity
amputation, cholecystectomy, orthodontic surgery for malocclusion and
liver and kidney transplants. Meta-analysis of mortality data is ongoing
and may reveal an association between Indigenous identity and
post-operative mortality. This systematic review reveals that there is a
paucity of data and a need for further research on post operative outcomes
in Indigenous populations for most surgical procedures.

<9>
Accession Number
631644501
Title
Impact of invasive versus conservative treatment strategies on left
ventricular functional recovery.
Source
Canadian Journal of Anesthesia. Conference: 2018 Canadian
Anesthesiologists Society Annual Meeting. Canada. 66 (2 Supplement) (pp
S195-S197), 2019. Date of Publication: 2019.
Author
Wharmby G.; Ngu J.; Rodgers J.; Vo P.; Guo M.; Visintini S.; Wells G.; Sun
L.
Institution
(Wharmby, Ngu, Rodgers, Vo, Guo, Visintini, Wells, Sun) University of
Ottawa Heart Institute
Publisher
Springer
Abstract
INTRODUCTION: Coronary artery disease (CAD) is the most common cause of
death globally. The prevalence of CAD with reduced left ventricular
ejection fraction (LVEF) is rising, but the optimal treatment remains
unclear, as this patient group has routinely been excluded from randomized
clinical trials (RCTs). The present study aims to investigate the impact
of invasive (i.e., coronary artery bypass grafting; CABG) versus
conservative treatment strategies (i.e., percutaneous coronary
intervention (PCI), or medical therapy (MT) alone) on LVEF recovery in
patients with CAD and LVEF <= 40%. Method(s): A systematic literature
search up to May 31, 2017 was performed on MEDLINE, EMBASE and the
Cochrane Library in Ovid (PROSPERO: CRD42017069849). The search identified
a total of 6,192 studies for review. Title and abstract screening removed
5,552 articles for failing to meet inclusion criteria, leaving 640 studies
for full text screening. Detailed review of these articles lead to the
exclusion of 563 papers, leaving 77 studies for final analysis. We
performed random effect meta-analysis on available studies of patients
undergoing CABG, PCI or MT. The primary outcome was the mean difference
(MD) in LVEF before and after the intervention. Risk of bias assessment
was performed using the Newcastle-Ottawa Scale for cohort studies.
 Result(s): Seventy-seven observational studies (CABG = 69; PCI = 4;
MT = 4) including 20 single-armed cohort studies (1,855 patients) and 57
case series (4,832 patients) were included (Figure 1). In the
meta-analysis, there was a statistically significant increase in LVEF
following CABG that was greater than that found with either MT or PCI (MD
7.66; 95% CI: 6.69 - 8.63; p less than 0.00001; I2=99%). There was no
significant improvement in LVEF following medical therapy (MD 5.25; 95%
CI: -2.74 - 13.23; p = 0.20; I2=99%), but an increase in LVEF was seen
following PCI (MD 6.01; 95% CI: 3.96 - 8.06; p less than 0.00001; I2=91%).
 Discussion(s): Among common treatment strategies for patients with
CAD and reduced left ventricular systolic function, CABG was associated
with the greatest improvement in LVEF compared to PCI and MT. Improvement
in LVEF may be associated with a reduction in fatal arrhythmias and
improved quality of life, future prospective studies are needed to address
this important clinical outcome.

<10>
Accession Number
631644493
Title
The effect of ketamine on pain control post-coronary artery bypass
surgery.
Source
Canadian Journal of Anesthesia. Conference: 2018 Canadian
Anesthesiologists Society Annual Meeting. Canada. 66 (2 Supplement) (pp
S192-S194), 2019. Date of Publication: 2019.
Author
Tam K.; Cameron M.; Beique F.; Charghi R.; Wahaibi K.A.
Institution
(Tam, Wahaibi) McGill University
(Cameron, Beique, Charghi) Jewish General Hospital, McGill University
Publisher
Springer
Abstract
INTRODUCTION: Pain control following coronary artery bypass surgery (CABG)
is an essential element to hasten patient recovery. Multimodal analgesia
options are often limited, leaving opioids as the main analgesic option.
Ketamine is an N-Methyl-D-Aspartate receptor (NMDA) receptor antagonist
that has been shown to improve postoperative analgesia in other types of
surgery. The primary objective of this study was to quantify the effect of
ketamine on the postoperative opioid requirement in the first 48 hours
after coronary artery bypass surgery. The hypothesis was that Ketamine
would reduce opioid consumption by at least 25%. Method(s): This was
a prospective, randomized, double-blind placebo-controlled trial. Ethics
approval was obtained from the local ethics review board. Inclusion
criteria were patients undergoing CABG surgery at our institution.
Patients were randomized to receive either Ketamine 0.5 mg/kg as a bolus
prior to skin incision, followed by 0.5 mg/kg/hr until the end of surgery,
or a normal saline placebo at the same rate for a given weight.
Postoperative pain and opioid requirements were tracked for 48 hours after
surgery, along with other relevant variables. Patients were also contacted
at three months and six months postoperatively to determine whether any
persistent pain was present at the operative site. Result(s): A total
of 80 patients were randomized. Descriptive statistics of each group can
be found in Table 1. The primary outcome of total Dilaudid consumption
over the first 48 hours postoperatively was 9.78mg (8.58-10.99mg) in the
intervention group, and 10.23mg (8.81-11.65mg) in the placebo group.
Visual analog scale of maximum pain on postoperative day one was 5 (1-9)
in the intervention group and 5 (1-9) in the placebo group, and on day two
was 1 (0-3) in the intervention group and 1 (0-3) in the placebo group.
Visual analog scale of average pain on postoperative day one was 3 (0-6)
in the intervention group and 2 (0-6) in the placebo group, and on day two
was 2 (0-4) in the intervention group and 2 (0-5) in the placebo group.
Discussion/Conclusion: The intraoperative administration of Ketamine, with
a bolus of 0.5mg/kg and an infusion of 0.5mg/kg/hr, during coronary artery
bypass surgery did not result in a decrease in postoperative opioid use,
or reported pain levels over the first 48 hours postoperatively.

<11>
Accession Number
631644447
Title
Anesthetic management of patients post heart transplant having cesarean
delivery: Case study and literature review.
Source
Canadian Journal of Anesthesia. Conference: 2018 Canadian
Anesthesiologists Society Annual Meeting. Canada. 66 (2 Supplement) (pp
S268-S269), 2019. Date of Publication: 2019.
Author
Terlecki M.; Symons Y.T.; Singh I.; McConachie I.
Institution
(Terlecki, Symons) Schulich Medicine and Dentistry, Western University
(Singh, McConachie) Schulich School of Medicine and Dentistry
Publisher
Springer
Abstract
PURPOSE: Anesthetic management of parturients post heart transplant (HT)is
challenging. Preload dependence, the need for direct vasoactive drugs,
immunocompromise, and additional comorbidities must be recognized. We
report our experience of CD in a patient post HT and review similar
published cases. CLINICAL FEATURES: Informed patient consent was obtained
in accordance with local institutional guidelines. A 36 yo G1P0 woman with
a known HT secondary to viral dilated cardiomyopathy, recent PE,
hypertension, asthma and chronic kidney disease was admitted at 35 weeks
with increasing dyspnea. Medications included tinzaparin, ASA, methyldopa,
lansoprazole, salbutamol, escitalopram, azathioprine and tacrolimus. After
multidisciplinary planning, elective CD was performed at 36 weeks
gestation because of severe anxiety. After application of monitors,
aspiration prophylaxis, Lactated Ringer's co-load, and a phenylephrine
infusion were administered. Combined spinal-epidural (CSE) anesthesia was
performed under strict asepsis. Anesthesia was achieved with Bupivacaine
0.75% 1.0mL, morphine 200mcg, and fentanyl 15mcg intrathecally. A T4 block
was achieved and the infant was delivered uneventfully. Carbetocin 100mcg
was given slowly. Hemodynamic parameters were followed closely. Two doses
of 5mL Lidocaine 2% with epinephrine were given via epidural. Blood loss
was 500mL. The patient was admitted to the ICU for 24 hour monitoring and
was discharged on post-operative day 4. LITERATURE REVIEW: Pubmed was
searched for reports of anesthetic management of parturients post HT
having CD. Three reports were identified describing 5 cases. All described
a multidisciplinary approach. All patients received neuraxial anesthesia,
two had spinals, two had epidurals, and one had a CSE. Only one patient
had an arterial line. None had central venous access. Post-operatively,
three had a planned ICU admission. All patients recovered well and were
discharged home within one week. Neonatal outcomes were good.
 CONCLUSION(S): Reports of these cases are rare. With careful
titration, neuraxial anesthesia appears to be well tolerated in
parturients with HT undergoing CD. Standard monitoring is usually
adequate. ICU for post-partum monitoring should be available. A
multidisciplinary approach is advised.

<12>
Accession Number
631618405
Title
Australian and New Zealand Intensive Care Society/Australian College of
Critical Care Nurses Annual Scientific Meeting.
Source
Anaesthesia and Intensive Care. Conference: Australian and New Zealand
Intensive Care Society/Australian College of Critical Care Nurses Annual
Scientific Meeting. Australia. 46 (2) (no pagination), 2018. Date of
Publication: March 2018.
Author
Anonymous
Publisher
SAGE Publications Inc.
Abstract
The proceedings contain 55 papers. The topics discussed include: early use
of extracorporeal life support (ECLS) in the treatment of severe primary
graft failure post lung transplantation; challenging the concept of fluid
responsiveness in ICU patients with acute circulatory failure: a
systematic overview of recent evidence; an observational study into the
reproducibility of four methods of assessing ventilation using electrical
impedance tomography; the hemodynamic effects of a 500 ml bolus of
Hartmann's in post-cardiac surgery ICU patients: an observational study;
obstacles to long-term follow-up studies of quality of life (qol) after
extracorporeal life support (ECLS); a systematic literature review of
blood product usage in adult extracorporeal life support (ECLS);
pharmacokinetics of intravenous bolus versus continuous magnesium infusion
after cardiac surgery: a before-and-after study; and predictors of
survival after initiation of veno-arterial extra corporeal membrane
oxygenation (VA-ECMO) in post cardiac surgery patients.

<13>
Accession Number
631643575
Title
Probucol Trial for Secondary Prevention of Atherosclerotic Events in
Patients with Coronary Heart Disease (PROSPECTIVE).
Source
Journal of atherosclerosis and thrombosis. (no pagination), 2020. Date of
Publication: 24 Apr 2020.
Author
Yamashita S.; Arai H.; Bujo H.; Masuda D.; Ohama T.; Ishibashi T.; Yanagi
K.; Doi Y.; Nakagawa S.; Yamashiro K.; Tanabe K.; Kita T.; Matsuzaki M.;
Saito Y.; Fukushima M.; Matsuzawa Y.
Institution
(Yamashita, Masuda, Ohama) Department of Cardiovascular Medicine, Osaka
University Graduate School of Medicine
(Yamashita) Department of Community Medicine, Osaka University Graduate
School of Medicine
(Arai) National Center for Geriatrics and Gerontology
(Bujo) Department of Clinical Laboratory and Experimental Research
Medicine, Toho University, Sakura Medical Center
(Ohama) Department of Dental Anesthesiology, Osaka University Graduate
School of Dentistry
(Ishibashi) Ohara General Hospital
(Yanagi) Kenporen Osaka Central Hospital
(Doi) Saiseikai Senri Hospital
(Nakagawa, Yamashiro, Tanabe, Fukushima) Translational Research Center for
Medical Innovation, Foundation for Biomedical Research and Innovation at
Kobe
(Kita) Kobe City College of Nursing
(Matsuzaki) St. Hill Hospital
(Saito) Chiba University Graduate School of Medicine
(Matsuzawa) Sumitomo Hospital
Publisher
NLM (Medline)
Abstract
AIMS: Although intensive statin therapy reduced cardiovascular risks,
cardiovascular events have not been completely prevented. Probucol is a
potent antioxidant and reduces tendon xanthomas in familial
hypercholesterolemia patients despite reduction of high-density
lipoprotein (HDL)-cholesterol (HDL-C). We investigated whether probucol
can reduce cardiovascular events on top of conventional lipid-lowering
therapy in patients with coronary heart disease (CHD). METHOD(S):
PROSPECTIVE is a multicenter, randomized, prospective study that recruited
876 Japanese patients with CHD and dyslipidemia with an low-density
lipoprotein (LDL)-cholesterol (HDL-C) level of >= 140 mg/dL without
medication or those treated with lipid-lowering drugs. Lipid-lowering
agents were administered during the study period in the control group
(n=438), and probucol 500 mg/day was added to lipid-lowering therapy in
the probucol group (n=438). Patients were randomly assigned to two
treatment groups by adjusting the LDL-C level and presence of diabetes and
hypertension and followed up for more than 3 years. The primary end point
was a composite of cerebrovascular and cardiovascular events
(cardiovascular disease death including sudden death, nonfatal myocardial
infarction, nonfatal stroke, hospitalization for unstable angina,
hospitalization for heart failure, or coronary revascularization). The
secondary end point was carotid intima-media thickness in a subset of
patients. RESULT(S): The incidence of the primary end point showed a
trend to be lower in the probucol group compared with that in the control
group despite reduced HDL-C without serious adverse events.
Anti-atherogenic effects of probucol may be attributed to its potent
antioxidative function and enhancement of reverse cholesterol transport.
 CONCLUSION(S): Since there was no statistical significance between
the probucol and control groups despite a marked reduction of HDL-C,
further studies on the clinical outcomes of probucol on top of
conventional therapy may be necessary in the future (UMIN000003307).

<14>
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. (no pagination), 2020. Date
of Publication: 28 Apr 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, Aichi, Japan
(Yamazaki) Department of Cardiovascular Surgery, Shizuoka City Shizuoka
Hospital, Shizuoka, Japan
(Goto) Department of Cardiology, Nagoya City University Hospital, Aichi,
Japan
(Asai) Department of Cardiology, Ichinomiya Municipal Hospital, Aichi,
Japan
(Yamamoto) Department of Cardiology, Handa City Hospital, Aichi, Japan
(Hirooka) Department of Cardiology, National Hospital Organization Osaka
National Hospital, Osaka, Japan
(Sato) Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
(Kasai) Department of Cardiology, Japanese Red Cross Ise Hospital, Mie,
Japan
(Ueda) Department of Cardiology, Chiba University Hospital, Chiba, Japan
(Yamakawa) Department of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Ueda) Department of Cardiology, Osaka Police Hospital, Osaka, Japan
(Yamamoto) Department of Cardiology, Kochi Health Sciences Center, Kochi,
Japan
(Tokunaga) Department of Cardiology, JA Toride Medical Center, Ibaraki,
Japan
(Sugai) Department of Cardiology, Hiraka General Hospital, Akita, Japan
(Tanaka) Department of Cardiology, Kasukabe Chuo General Hospital,
Saitama, Japan
(Hiramatsu) Department of Cardiology, Fukuyama Cardiovascular Hospital,
Hiroshima, Japan
(Arakawa) Department of Cardiology, Daido Hospital, Aichi, Japan
(Schrader) Biotronik, Berlin, Germany
(Varma) Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH
(Ando) Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
Publisher
NLM (Medline)
Abstract
Background - Current expert consensus recommends remote monitoring (RM)
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 two years. Methods - In Japan,
consecutive pacemaker patients committed to RM were randomized to either
RFU or conventional in-office follow-up (CFU) at twice-yearly intervals.
RFU patients were only seen if indicated by remote monitoring. All
returned to hospital after two years. The primary endpoint was a composite
of death, stroke, or cardiovascular events requiring surgery, and the
primary hypothesis was non-inferiority with 5% margin. Results - Of 1274
randomized patients (50.4% female, age 77+/-10 years), 558 (RFU) and 550
(CFU) patients reached either the primary endpoint or 24 months follow-up.
The primary endpoint occurred in 10.9% and 11.8%, resp. (P=0.0012 for
non-inferiority). The median (IQR) number of in-office follow-ups was 0.50
(0.50 - 0.63) in RFU and 2.01 (1.93 - 2.05) in CFU per patient-year
(P<0.001). Insurance claims for follow-ups and directly related diagnostic
procedures were 18,800 Yen (16,500 - 20,700 Yen) in RFU and 21,400 Yen
(16,700 - 25,900 Yen) in CFU (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. Conclusions - Replacing
periodic in-office follow-ups with remote follow-ups for 2 years in
pacemaker patients committed to RM does not increase the occurrence of
major cardiovascular events and reduces resource consumption. Clinical
Trial Registration - The trial was registered at
https://clinicaltrials.gov; Unique Identifier: NCT01523704.

<15>
Accession Number
2005729357
Title
The clinical utility of remote ischemic preconditioning in protecting
against cardiac surgery-associated acute kidney injury: A pilot randomized
clinical trial.
Source
Advances in Clinical and Experimental Medicine. 29 (2) (pp 189-196), 2020.
Date of Publication: 01 Feb 2020.
Author
Stokfisz K.; Ledakowicz-Polak A.; Zagorski M.; Jander S.; Przybylak K.;
Zielinska M.
Institution
(Stokfisz, Ledakowicz-Polak, Przybylak, Zielinska) Intensive Cardiac
Therapy Clinic, Department of Invasive Cardiology and Electrocardiology,
Medical University of Lodz, Lodz, Poland
(Zagorski, Jander) Cardiosurgery Clinic, Department of Cardiology and
Cardiosurgery, Medical University of Lodz, Lodz, Poland
Publisher
Wroclaw University of Medicine
Abstract
Background. Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-known, serious complication and a well-recognized independent risk
factor for higher morbidity and mortality among patients undergoing
cardiac surgery. Objectives. The aim of the study was to assess the
efficacy of remote ischemic preconditioning (RIPC) in reducing the
incidence of CSA-AKI, measured with the standard creatinine technique and
using neutrophil gelatinase-associated lipocalin (NGAL) serum
concentrations as a potential new biomarker of kidney damage. The ethics
committee of the Medical University of Lodz prospectively approved the
protocol (approval No. RNN/286/13/KE). The study was retrospectively
registered with the U.S. National Institutes of Health - NIH (29 June
2017; ClinicalTrials.gov identifier: NCT03205410). Material and methods.
We conducted a prospective single-center double-blind randomized and
controlled tudy. Data was collected from patients admitted to the
Cardiosurgery Clinic at the Medical University of Lodz (Poland) between
January and December 2014, scheduled for elective cardiac surgery (an
off-pump coronary artery bypass). A total of 28 patients were randomized
to receive either RIPC (n = 14) or sham RIPC (n = 14). After the induction
of anesthesia, the patients assigned to the RIPC group underwent 3 cycles
of 5-minute inflation to 200 mm Hg and 5-minute deflation of the upper-arm
cuff. The control group had a deflated cuff placed on the upper arm for 30
min. The authors measured the patients' serum creatinine concentration to
check for the occurrence of a CSA-AKI within 48 h after cardiac surgery,
and NGAL serum concentration to check its level within 3 h after the
operation. Results. Fewer patients in RIPC group developed CSA-AKI within
48 h after cardiac surgery than in the control group (29% vs 93%; p =
0.003). Fewer patients in the RIPC group presented an increase in NGAL 3 h
after surgery (medians: 124 vs 176.7; p = 0.0003). Conclusions. In
patients undergoing an off-pump coronary artery bypass, RIPC significantly
reduces the occurrence of CSA-AKI and protects against increased
postoperative NGAL levels. Copyright © 2020 by Wroclaw Medical
University.

<16>
Accession Number
631611116
Title
Negative pressure wound therapy for surgical wounds healing by primary
closure.
Source
Cochrane Database of Systematic Reviews. 2020 (5) (no pagination), 2020.
Article Number: CD009261. Date of Publication: 01 May 2020.
Author
Norman G.; Goh E.L.; Dumville J.C.; Shi C.; Liu Z.; Chiverton L.;
Stankiewicz M.; Reid A.
Institution
(Norman, Dumville, Shi) Division of Nursing, Midwifery and Social Work,
School of Health Sciences, Faculty of Biology, Medicine and Health,
University of Manchester, Manchester Academic Health Science Centre,
Manchester, United Kingdom
(Goh) Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Oxford, United Kingdom
(Liu) West China School of Public Health and West China Fourth Hospital,
Sichuan University, Chengdu, China
(Chiverton) NIHR Clinical Research Facility, Great Ormond Street Hospital,
London, United Kingdom
(Stankiewicz) Chermside Community Health Centre, Community and Oral Health
Directorate, Brisbane, Australia
(Reid) School of Biological Sciences, Faculty of Biology, Medicine &
Health, Manchester, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Indications for the use of negative pressure wound therapy
(NPWT) are broad and include prophylaxis for surgical site infections
(SSIs). Existing evidence for the effectiveness of NPWT on postoperative
wounds healing by primary closure remains uncertain. Objective(s): To
assess the effects of NPWT for preventing SSI in wounds healing through
primary closure, and to assess the cost-effectiveness of NPWT in wounds
healing through primary closure. Search Method(s): In June 2019, we
searched the Cochrane Wounds Specialised Register; the Cochrane Central
Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including
In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL
Plus. We also searched clinical trials registries and references of
included studies, systematic reviews and health technology reports. There
were no restrictions on language, publication date or study setting.
 Selection Criteria: We included trials if they allocated participants
to treatment randomly and compared NPWT with any other type of wound
dressing, or compared one type of NPWT with another type of NPWT.
 Data Collection and Analysis: At least two review authors
independently assessed trials using predetermined inclusion criteria. We
carried out data extraction, assessment using the Cochrane 'Risk of bias'
tool, and quality assessment according to Grading of Recommendations,
Assessment, Development and Evaluations methodology. Main Result(s):
In this third update, we added 15 new randomised controlled trials (RCTs)
and three new economic studies, resulting in a total of 44 RCTs (7447
included participants) and five economic studies. Studies evaluated NPWT
in the context of a wide range of surgeries including orthopaedic,
obstetric, vascular and general procedures. Economic studies assessed NPWT
in orthopaedic, obstetric and general surgical settings. All studies
compared NPWT with standard dressings. Most studies had unclear or high
risk of bias for at least one key domain. Primary outcomes. Four studies
(2107 participants) reported mortality. There is low-certainty evidence
(downgraded twice for imprecision) showing no clear difference in the risk
of death after surgery for people treated with NPWT (2.3%) compared with
standard dressings (2.7%) (risk ratio (RR) 0.86; 95% confidence interval
(CI) 0.50 to 1.47; I2 = 0%). Thirty-nine studies reported SSI;
31 of these (6204 participants), were included in meta-analysis. There is
moderate-certainty evidence (downgraded once for risk of bias) that NPWT
probably results in fewer SSI (8.8% of participants) than treatment with
standard dressings (13.0% of participants) after surgery; RR 0.66 (95% CI
0.55 to 0.80; I2 = 23%). Eighteen studies reported dehiscence;
14 of these (3809 participants) were included in meta-analysis. There is
low-certainty evidence (downgraded once for risk of bias and once for
imprecision) showing no clear difference in the risk of dehiscence after
surgery for NPWT (5.3% of participants) compared with standard dressings
(6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13; I2 = 0%).
Secondary outcomes. There is low-certainty evidence showing no clear
difference between NPWT and standard treatment for the outcomes of
reoperation and incidence of seroma. For reoperation, the RR was 1.04 (95%
CI 0.78 to 1.41; I2 = 13%; 12 trials; 3523 participants); for
seroma, the RR was 0.72 (95% CI 0.50 to 1.05; I2 = 0%; seven
trials; 729 participants). The effect of NPWT on occurrence of haematoma
or skin blisters is uncertain (very low-certainty evidence); for
haematoma, the RR was 0.67 (95% CI 0.28 to 1.59; I2 = 0%; nine
trials; 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65
to 10.68; I2 = 69%; seven trials; 796 participants). The
overall effect of NPWT on pain is uncertain (very low-certainty evidence
from seven trials (2218 participants) which reported disparate measures of
pain); but moderate-certainty evidence suggests there is probably little
difference between the groups in pain after three or six months following
surgery for lower limb fracture (one trial, 1549 participants). There is
also moderate-certainty evidence for women undergoing caesarean sections
(one trial, 876 participants) and people having surgery for lower limb
fractures (one trial, 1549 participants) that there is probably little
difference in quality of life scores at 30 days or 3 or 6 months,
respectively. Cost-effectiveness. Five economic studies, based wholly or
partially on trials included in our review, assessed the
cost-effectiveness of NPWT compared with standard care. They considered
NPWT in four indications: caesarean sections in obese women; surgery for
lower limb fracture; knee/hip arthroplasty and coronary artery bypass
graft surgery. They calculated quality-adjusted life-years for treatment
groups and produced estimates of the treatments' relative
cost-effectiveness. The reporting quality was good but the grade of the
evidence varied from moderate to very low. There is moderate-certainty
evidence that NPWT in surgery for lower limb fracture was not
cost-effective at any threshold of willingness-to-pay and that NPWT is
probably cost-effective in obese women undergoing caesarean section. Other
studies found low or very low-certainty evidence indicating that NPWT may
be cost-effective for the indications assessed. Authors' conclusions:
People experiencing primary wound closure of their surgical wound and
treated prophylactically with NPWT following surgery probably experience
fewer SSI than people treated with standard dressings (moderate-certainty
evidence). There is no clear difference in number of deaths or wound
dehiscence between people treated with NPWT and standard dressings
(low-certainty evidence). There are also no clear differences in secondary
outcomes where all evidence was low or very low-certainty. In caesarean
section in obese women and surgery for lower limb fracture, there is
probably little difference in quality of life scores (moderate-certainty
evidence). Most evidence on pain is very low-certainty, but there is
probably no difference in pain between NPWT and standard dressings after
surgery for lower limb fracture (moderate-certainty evidence). Assessments
of cost-effectiveness of NPWT produced differing results in different
indications. There is a large number of ongoing studies, the results of
which may change the findings of this review. Decisions about use of NPWT
should take into account surgical indication and setting and consider
evidence for all outcomes. Copyright © 2020 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<17>
Accession Number
2004786683
Title
Efficacy of quadruple treatment on different types of pre-operative
anaemia: secondary analysis of a randomised controlled trial.
Source
Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Rossler J.; Hegemann I.; Schoenrath F.; Seifert B.; Kaserer A.; Spahn
G.H.; Falk V.; Spahn D.R.
Institution
(Rossler, Kaserer, Spahn, Spahn) Institute of Anesthesiology, University
of Zurich and University Hospital Zurich, Zurich, Switzerland
(Hegemann) Department of Medical Oncology and Haematology, University of
Zurich and University Hospital Zurich, Zurich, Switzerland
(Schoenrath, Falk) Department of Cardiothoracic and Vascular Surgery,
German Heart Centre Berlin, German Centre for Cardiovascular Research,
Berlin, Germany
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Switzerland
(Falk) Department of Cardiothoracic Surgery, Charite - Universitatsmedizin
Berlin, Germany
(Falk) Department of Health Science and Technology, Swiss Federal
Institute of Technology, Zurich, Switzerland
Publisher
Blackwell Publishing Ltd
Abstract
In patients with pre-operative anaemia undergoing cardiac surgery,
combination treatment with intravenous iron, subcutaneous erythropoietin
alpha, vitamin B12 and oral folic acid reduces allogeneic blood product
transfusions. It is unclear if certain types of anaemia particularly
benefit from this treatment. We performed a post-hoc analysis of anaemic
patients from a randomised trial on the 'Effect of ultra-short-term
treatment of patients with iron deficiency or anaemia undergoing cardiac
surgery'. We used linear regression analyses to examine the efficacy of a
combination anaemia treatment compared with placebo on the following
deficiencies, each representing a part of the combination treatment:
ferritin and transferrin saturation; endogenous erythropoietin;
holotranscobalamine; and folic acid in erythrocytes. Efficacy was defined
as change in reticulocyte count from baseline to the first, third and
fifth postoperative days and represented erythropoietic activity in the
immediate peri-operative recovery phase. In all 253 anaemic patients, iron
deficiency was the most common cause of anaemia. Treatment significantly
increased reticulocyte count in all regression analyses on postoperative
days 1, 3 and 5 (all p < 0.001). Baseline ferritin and endogenous
erythropoietin were negatively associated with change in reticulocyte
count on postoperative day 5, with an unstandardised regression
coefficient B of -0.08 (95%CI -0.14 to -0.02) and -0.14 (95%CI -0.23 to
-0.06), respectively. Quadruple anaemia treatment was effective regardless
of the cause of anaemia and its effect manifested early in the
peri-operative recovery phase. The more pronounced a deficiency was, the
stronger the subsequent boost to erythropoiesis may have
been. Copyright © 2020 Association of Anaesthetists

<18>
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. (no pagination),
2020. Date of Publication: 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. 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. 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). 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. Copyright © The Author(s) 2020.

<19>
Accession Number
2005431615
Title
Diagnostic Accuracy of FDG PET/CT in Suspected LVAD Infections: A Case
Series, Systematic Review, and Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 13 (5) (pp 1191-1202), 2020. Date of
Publication: May 2020.
Author
Tam M.C.; Patel V.N.; Weinberg R.L.; Hulten E.A.; Aaronson K.D.; Pagani
F.D.; Corbett J.R.; Murthy V.L.
Institution
(Tam, Patel, Weinberg, Aaronson, Corbett, Murthy) Division of
Cardiovascular Medicine, Department of Medicine, University of Michigan,
Ann Arbor, MI, United States
(Hulten) Department of Medicine, Fort Belvoir Community Hospital, Fort
Belvoir, VA, United States
(Hulten) Department of Medicine, Uniformed Services University, Bethesda,
MD, United States
(Pagani) Department of Cardiac Surgery, University of Michigan, Ann Arbor,
MI, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of this study was to describe our experience with
fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography computed
tomography (PET/CT) in diagnosing left ventricular assist device (LVAD)
infections and perform a meta-analysis of published studies to determine
overall diagnostic accuracy. Background(s): Device-related infections
are a common complication of LVADs and are linked to worse outcomes.
Diagnosis of LVAD infections remains challenging. FDG PET/CT has
demonstrated good diagnostic accuracy in several other infectious
conditions. Method(s): This was a single-center, retrospective case
series of FDG PET/CT scans in suspected LVAD infection between September
2015 and February 2018. A systematic review of PubMed from database
inception through March 2018 was also conducted to identify additional
studies. Result(s): Nineteen FDG PET/CT scans were identified for the
retrospective case series. The systematic review identified an additional
3 publications, for a total of 4 studies involving 119 scans assessing
diagnostic performance. Axial (n = 36) and centrifugal (n = 83) flow LVADs
were represented. Pooled sensitivity was 92% (95% confidence interval
[CI]: 82% to 97%) and specificity was 83% (95% CI: 24% to 99%) for FDG
PET/CT in diagnosing LVAD infections. Summary receiver-operating
characteristic curve analysis demonstrated an AUC of 0.94 (95% CI: 0.91 to
0.95). Conclusion(s): FDG PET/CT for suspected LVAD infections
demonstrates good diagnostic accuracy, with overall high sensitivity but
variable specificity. Copyright © 2020 American College of
Cardiology Foundation

<20>
Accession Number
2004502243
Title
Can we reduce conduction disturbances following transcatheter aortic valve
replacement?.
Source
Expert Review of Medical Devices. 17 (4) (pp 309-322), 2020. Date of
Publication: 02 Apr 2020.
Author
Alperi Garcia A.; Muntane-Carol G.; Junquera L.; del Val D.; Faroux L.;
Philippon F.; Rodes-Cabau J.
Institution
(Alperi Garcia, Muntane-Carol, Junquera, del Val, Faroux, Philippon,
Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, Quebec City,
QC, Canada
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has been
demonstrated to be a good alternative to surgery for treating severe
aortic stenosis (AS) across the whole range of surgical risk patients.
Whereas most periprocedural TAVR complications have significantly
decreased over time, conduction disturbances remain high. Approaches to
decrease this shortcoming are under continuous investigation. Areas
covered: Overview of the actual evidence regarding conduction disturbances
in the TAVR setting, focusing on modifiable factors. PubMed and Embase
databases were used for literature search. Expert opinion: Several factors
have been associated with an increased risk of conduction disturbances
post-TAVR, and some of them may be modifiable. While some transcatheter
valve systems have been associated with higher rates of conduction
disturbances, additional randomized data are needed to draw definite
conclusions about newer generation transcatheter valve systems. Nowadays,
good hemodynamic valve function can be obtained without excessive valve
oversizing, which has been associated with an increased risk of conduction
disturbances in some studies. Also, contemporary data regarding valve
implantation depth and new anatomical landmarks such as membranous septum
length have provided valuable insights for procedural planning. Finally,
homogenization of the management of conduction abnormalities post-TAVR
should be emphasized to allow a better understanding and generalization of
available evidence. Copyright © 2020, © 2020 Informa UK
Limited, trading as Taylor & Francis Group.

<21>
Accession Number
2003429932
Title
Effects of high-dose vitamin D supplementation on the occurrence of
post-operative atrial fibrillation after coronary artery bypass grafting:
randomized controlled trial.
Source
General Thoracic and Cardiovascular Surgery. 68 (5) (pp 477-484), 2020.
Date of Publication: 01 May 2020.
Author
Kara H.; Yasim A.
Institution
(Kara) Department of Cardiovascular Surgery, Giresun Ada Hospital,
Giresun, Turkey
(Yasim) Department of Cardiovascular Surgery, Kahramanmaras Sutcu Imam
University, Kahramanmaras, Turkey
Publisher
Springer
Abstract
Objective: This study aimed to investigate the preventive effects of a
high-dose vitamin D administered preoperatively on the post-operative
atrial fibrillation (POAF) occurrence in patients with insufficient or
deficient serum vitamin D levels who underwent coronary artery bypass
grafting (CABG) surgery. Method(s): The study was a randomized
controlled, blinded and parallel-arm trial conducted on 116 who had
vitamin D deficiency or insufficiency during the pre-operative evaluation
were included in the study conducted between January 2018 and January
2019. Patients were divided into those who received oral vitamin D
(treatment group; n = 58) and those who did not (control group; n = 58) 48
h before CABG surgery. In the treatment group, patients with vitamin D
deficiency were administered 300.000 IU vitamin D orally and those with
vitamin D insufficiency 150.000 IU 48 h preoperatively. Patients were
followed up during hospitalisation process with respect to POAF.
 Result(s): Both groups showed no significant differences with regard
to age, gender, body mass index, creatine level, left atrial diameter,
pre-operative drug use, calcium level, ejection fraction, diabetes
mellitus and hypertension. The ratio of POAF occurrence found in the
treatment and control groups were 12.07% and 27.59%, respectively. Vitamin
D treatment was found to reduce the risk of POAF development by 0.24 times
(p = 0.034). Conclusion(s): In this study with sufficient sample
size, preoperative short-term high-dose vitamin D supplementation was
found to be significantly preventive to the occurrence of POAF in patients
with vitamin D insufficiency and deficiency who underwent CABG
surgery. Copyright © 2019, The Japanese Association for Thoracic
Surgery.

<22>
Accession Number
2003429931
Title
Right pericardial window opening: a method of preventing pericardial
effusion.
Source
General Thoracic and Cardiovascular Surgery. 68 (5) (pp 485-491), 2020.
Date of Publication: 01 May 2020.
Author
Sen O.; Aydin U.; Iyigun T.; Reyhancan A.; Timur B.; Kadirogullari E.;
Gode S.; Kutluk E.; Onan B.
Institution
(Sen, Aydin, Iyigun, Reyhancan, Timur, Kadirogullari, Gode, Kutluk, Onan)
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istasyon Mah.
Turgut Ozal Bulvari No: 11 Kucukcekmece, Istanbul, Turkey
Publisher
Springer
Abstract
Aim: In this study, we aimed to investigate the superiority of right
pericardial window (RPW) versus posterior pericardial drain placing for
the parameters of pericardial effusion and the postoperative complications
at the patients who has undergone cardiac surgery. Material(s) and
Method(s): Between July and September 2018, 120 adult patients (mean age
50.30 +/- 14.61) who underwent cardiac surgery without the necessity of
opening the pleura were included in the study. In Group 1, the RPW was
opened (n = 60), and Group 2 posterior pericardial drainage tube was
placed without RPW (n = 60). Risk factors and postoperative complication
were evaluated and compared between the Groups. Result(s): Cardiac
tamponade occurrence was not significantly different between the Groups
(Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative
transthoracic echocardiographic controls revealed significant pericardial
effusion in Group 2 (6.90 mm +/- 13.02 mm) compared to Group 1 (2.30 mm
+/- 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 +/-
0.26 in Group 1 and 0.88 +/- 0.36 in Group 2 (p = 0.022). A significant
decrease in glomerular filtration rate was observed in Group 2 (102.7 +/-
24.5 and 91.2 +/- 28, p = 0.019). Postoperative acute renal failure was
significantly higher in Group 2 compared to Group 1 (p < 0.001).
Postoperative new onset atrial fibrillation occurred in 4 patients in
Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit
stay was 36.00 +/- 22.31 h in Group 1 and 53.60 +/- 59.50 h in Group 2 (p
= 0.034). Development of pneumothorax, pneumonia and pleural effusion were
not statistically different between the Groups (p = 0.079, 0.171, 0.509).
 Conclusion(s): RPW application is more effective on preventing
postoperative complications in cardiac surgery instead of placing drains
in posterior pericardium. Copyright © 2019, The Japanese
Association for Thoracic Surgery.

<23>
Accession Number
2005646449
Title
Testosterone concentrations and risk of cardiovascular events in
androgen-deficient men with atherosclerotic cardiovascular disease.
Source
American Heart Journal. 224 (pp 65-76), 2020. Date of Publication: June
2020.
Author
Boden W.E.; Miller M.G.; McBride R.; Harvey C.; Snabes M.C.; Schmidt J.;
McGovern M.E.; Fleg J.L.; Desvigne-Nickens P.; Anderson T.; Kashyap M.;
Probstfield J.L.
Institution
(Boden, McGovern) VA Boston Healthcare System, Boston University School of
Medicine, Boston, MA, United States
(Miller, Snabes, Schmidt) AbbVie, Chicago, IL, United States
(McBride, Harvey, Desvigne-Nickens) Axio Research, LLC, Seattle, WA,
United States
(Fleg) National Heart, Lung and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
(Anderson) Libin Cardiovascular Institute, University of Calgary, Calgary,
Alberta, Canada
(Kashyap) Long Beach VA Healthcare System, Los Angeles, CA, United States
(Probstfield) University of Washington, Seattle, WA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Whether androgen deficiency among men increases the risk of
cardiovascular (CV) events or is merely a disease marker remains a subject
of intense scientific interest. Objective(s): Among male subjects in
the AIM-HIGH Trial with metabolic syndrome and low baseline levels of
high-density lipoprotein (HDL)-cholesterol who were randomized to niacin
or placebo plus simvastatin, we examined the relationship between low
baseline testosterone (T) concentrations and subsequent CV outcomes during
a mean 3-year follow-up. Method(s): In this post hoc analysis of men
with available baseline plasma T concentrations, we examined the
relationship between clinical/demographic characteristics and T
concentrations both as a continuous and dichotomous variable (<300 ng/dL
["low T"] vs. >=300 ng/dL ["normal T"]) on rates of pre-specified CV
outcomes, using Cox proportional hazards models. Result(s): Among
2118 male participants in whom T concentrations were measured, 643 (30%)
had low T and 1475 had normal T concentrations at baseline. The low T
group had higher rates of diabetes mellitus, hypertension, elevated body
mass index, metabolic syndrome, higher blood glucose, hemoglobin A1c, and
triglyceride levels, but lower levels of both low-density lipoprotein and
HDL-cholesterol, and a lower rate of prior myocardial infarction (MI). Men
with low T had a higher risk of the primary composite outcome of coronary
heart disease (CHD) death, MI, stroke, hospitalization for acute coronary
syndrome, or coronary or cerebral revascularization (20.1%) compared with
the normal T group (15.2%); final adjusted HR 1.23, P = .07, and a higher
risk of the CHD death, MI, and stroke composite endpoint (11.8% vs. 8.2%;
final adjusted HR 1.37, P = .04), respectively. Conclusion(s): In
this post hoc analysis, there was an association between low baseline
testosterone concentrations and increased risk of subsequent CV events in
androgen-deficient men with established CV disease and metabolic syndrome,
particularly for the composite secondary endpoint of CHD death, MI, and
stroke. Condensed Abstract: In this AIM-HIGH Trial post hoc analysis of
2118 men with metabolic syndrome and low HDL-cholesterol with available
baseline plasma testosterone (T) samples, 643 males (30%) had low T (mean:
229 ng/dL) and 1475 (70%) had normal T (mean: 444 ng/dL) concentrations.
The "low T" group had a 24% higher risk of the primary 5-component
endpoint (20.1%) compared with the normal T group (15.2%); final adjusted
HR 1.23, P = .07). There was also a 31% higher risk of the secondary
composite endpoint: coronary heart disease death, myocardial infarction,
and stroke (11.8% vs. 8.2%, final adjusted HR 1.37, P = .04) in the low
vs. normal T group, respectively. Copyright © 2020

<24>
Accession Number
631561879
Title
Is microwave ablation more effective than radiofrequency ablation in
achieving local control for primary pulmonary malignancy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (2) (pp 283-286),
2019. Date of Publication: 01 Aug 2019.
Author
Tsakok M.T.; Jones D.; MacNeill A.; Gleeson F.V.
Institution
(Tsakok, Gleeson) Department of Radiology, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Tsakok, Jones, MacNeill) Medical Sciences Division, University of Oxford,
Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Is microwave ablation
(MWA) more effective than radiofrequency ablation (RFA) in achieving local
control for primary lung cancer?'. Altogether, 439 papers were found, of
which 7 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.
Both are thermal ablative techniques, with microwave ablation (MWA) the
newer technique and radiofrequency ablation (RFA) with a longer track
record. Lack of consensus with regard to definitions of technical success
and efficacy and heterogeneity of study inclusions limits studies for
both. The only direct comparison study does not demonstrate a difference
with either technique in achieving local control. The quality of evidence
for MWA is very limited by retrospective nature and heterogeneity in
technique, power settings and tumour type. Tumour size and late-stage
cancer were shown to be associated with higher rates of local recurrence
in 1 MWA study. RFA studies were generally of a higher level of evidence
comprising prospective trials, systematic review and meta-analysis. The
recurrence rates for MWA and RFA overlapped, and for the included studies
ranged between 16% and 44% for MWA and 9% and 58% for RFA. The current
evidence, therefore, does not clearly demonstrate a benefit of MWA over
RFA in achieving local control in primary lung cancer. Copyright
© 2019 The Author(s) 2019. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<25>
Accession Number
631561634
Title
Preoperative pulmonary function in all comers for cardiac surgery predicts
mortality.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (2) (pp 244-251),
2019. Date of Publication: 01 Aug 2019.
Author
Risom E.C.; Buggeskov K.B.; Mogensen U.B.; Sundskard M.; Mortensen J.;
Ravn H.B.
Institution
(Risom, Buggeskov, Sundskard, Ravn) Department of Cardiothoracic
Anesthesiology, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Mogensen) Department of Biostatistics, University of Copenhagen,
Copenhagen, Denmark
(Mortensen) Department of Clinical Physiology, Nuclear Medicine and PET,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
OBJECTIVES: Although reduced lung function and chronic obstructive
pulmonary disease (COPD) is associated with higher risk of death following
cardiac surgery, preoperative spirometry is not performed routinely. The
aim of this study was to investigate the relationship between preoperative
lung function and postoperative complications in all comers for cardiac
surgery irrespective of smoking or COPD history. METHOD(S):
Preoperative spirometry was performed in elective adult cardiac surgery
patients. Airflow obstruction was defined as the ratio of forced
expiratory volume in 1 s (FEV<inf>1</inf>)/forced vital capacity ratio
below the lower limit of normal (LLN) and reduced forced ventilatory
capacity defined as FEV<inf>1</inf> <LLN. RESULT(S): A history of
COPD was reported by 132 (19%) patients; however, only 74 (56%) had
spirometry-verified airflow obstruction. Conversely, 64 (12%) of the 551
patients not reporting a history of COPD had spirometry-verified airflow
obstruction. The probability of death was significantly higher in patients
with airflow obstruction (8.8% vs 4.5%, P = 0.04) and in patients with a
FEV<inf>1</inf> <LLN (8.7% vs 3.7%, P = 0.007). In the multivariate
analysis were age [hazard ratio (HR) 1.6, 95% confidence interval (CI)
1.0-2.5; P = 0.04], prolonged cardiopulmonary bypass time (HR 1.2, 95% CI
1.02-1.3; P = 0.03), reduced kidney function (HR 2.5, 95% CI 1.2-5.6; P =
0.02) and FEV<inf>1</inf> <LLN (HR 2.4, 95% CI 1.1-5.2; P = 0.03) all
independently associated with an increased risk of death.
 CONCLUSION(S): Preoperative spirometry reclassified 18% of the
patients. A reduced FEV<inf>1</inf> independently doubled the risk of
death. Inclusion of preoperative spirometry in routine screening of
cardiac surgical patients may improve risk prediction and identify
high-risk patients. Clinical trial registration number: NCT01614951
(ClinicalTrials.gov). Copyright © 2019 The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
631508410
Title
Interventional cardiology practice.
Source
European Heart Journal. 40 (3) (pp 234-235), 2019. Date of Publication: 14
Jan 2019.
Author
Tofield A.
Institution
(Tofield) ESC Press Office
Publisher
Oxford University Press

<27>
Accession Number
2005645066
Title
Long-term atrial arrhythmias incidence after heart transplantation.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Anselmino M.; Matta M.; Saglietto A.; Gallo C.; Gaita F.; Marchetto G.;
Rinaldi M.; De Ferrari G.M.; Boffini M.
Institution
(Anselmino, Saglietto, Gallo, De Ferrari) Division of Cardiology,
Department of Medical Sciences, "Citta della Salute e della Scienza di
Torino" Hospital, University of Turin, Turin, Italy
(Matta) Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
(Gaita) Cardiovascular Department, Clinica Pinna Pintor, Policlinico di
Monza, Turin, Italy
(Marchetto, Rinaldi, Boffini) Division of Cardiac Surgery, Department of
Surgical Sciences, Citta della Salute e della Scienza, University of
Turin, Turin, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: Atrial arrhythmias after heart transplantation have rarely
been investigated. The aim of this study is to assess incidence, type and
predictors of atrial arrhythmias during a long-term follow-up in a large
population of heart-transplanted patients. Method(s): Consecutive
patients undergone to heart transplantation at our Centre from 1990 to
2017 were enrolled. All documented atrial arrhythmias were systematically
reviewed during a long-term follow-up after heart transplantation. Atrial
fibrillation (AF), atrial flutter and tachycardias were defined according
to current guidelines. Result(s): Overall, 364 patients were included
and followed for 120 +/- 70 months. During the follow-up period 108
(29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus
rhythm was present in 355 (97.5%) patients. Nine patients had persistent
atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%)
patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%)
patients, always atrial flutters. At univariate analysis several
echocardiographic (left ventricular end-diastolic diameter, TEI index,
mitral and tricuspid regurgitation grade) hemodynamic (systolic and
diastolic pulmonary pressure, capillary wedge pressure) and clinical
(dyslipidaemia, weight, pacemaker implantation) parameters related to
higher incidence of atrial arrhythmias. Conclusion(s): Persistent
atrial arrhythmias, and most of all AF, are rare among heart
transplantation carriers, despite substantial comorbidities resulting in
significant mortality. It can be speculated that the lesion set provided
by the surgical technique, a complete and transmural electrical isolation
of the posterior left atrium wall, represents an effective lesion set to
prevent persistent AF. Copyright © 2018

<28>
Accession Number
631634625
Title
Genotype-guided warfarin dosing may benefit patients with mechanical
aortic valve replacements: randomized controlled study.
Source
Scientific reports. 10 (1) (pp 6988), 2020. Date of Publication: 24 Apr
2020.
Author
Lee K.E.; Yee J.; Lee G.Y.; Chung J.E.; Seong J.M.; Chang B.C.; Gwak H.S.
Institution
(Lee) College of Pharmacy, Chungbuk National University, 660-1, Yeonje-ri,
Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Korea
(Yee, Lee, Seong, Gwak) College of Pharmacy and Graduate School of
Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil
,Seodaemun-gu, Seoul 03760, South Korea
(Chung) College of Pharmacy, Hanyang University, Sangnok-gu, Ansan 15588,
South Korea
(Chang) Department of Thoracic and Cardiovascular Surgery, Bundang CHA
Medical Center, CHA University, Seongnam, 59 ,Bundang-gu 13496, South
Korea
(Chang) Department of Thoracic & Cardiovascular Surgery, Yonsei University
Medical Center, 50-1 Yonsei-ro ,Seodaemun-gu, Seoul 03722, South Korea
Publisher
NLM (Medline)
Abstract
This prospective, single-blind, randomized study was designed to evaluate
the effect of genotype-based warfarin dosing compared with standard
warfarin dosing in Korean patients with mechanical cardiac valves.
Patients were assigned to either the genotype-based dosing group or the
standard dosing group using stratified block randomization. The
genotype-based dosing equation was adopted from a previous study which
included VKORC1 rs9934438, CYP2C9 rs1057910, CYP4F2 rs2108622, and age.
Primary outcomes included the percentage of time in the therapeutic range
(pTTR): (i) during the first week following initiation of warfarin
therapy, (ii) during hospitalization and (iii) until the first outpatient
visit. A total of 91 patients were included in the analysis, 42 treated
with genotype-based warfarin dosing and 49 treated with standard warfarin
dosing. The genotype frequency differences of the three SNPs included in
this study (ie, VKORC1, CYP2C9, CYP4F2), between the genotype-based dosing
and standard dosing groups were not different. The genotype-based dosing
group trended toward higher pTTR when compared with the standard dosing
group, although this difference was not statistically significant. In
patients with aortic valve replacement, TTRTraditional and TTRRosendaal
were significantly higher in the genotype-based dosing group when compared
with the standard dosing group during the first week following treatment
initiation [ie, 58.5% vs. 38.1% (p=0.009) and 64.0% vs. 44.6% (p=0.012),
respectively]. Based on the results, the genotype-guided dosing did not
offer a significant clinical advantage, but a possible benefit in patients
with aortic valve replacement has been suggested.

<29>
Accession Number
631414366
Title
Do perioperative protocols of enhanced recovery after cardiac surgery
improve postoperative outcome?.
Source
Interactive cardiovascular and thoracic surgery. 30 (5) (pp 706-710),
2020. Date of Publication: 01 May 2020.
Author
Kamal Y.A.; Hassanein A.
Institution
(Kamal) Department of Cardiothoracic Surgery, Minia University, Egypt
(Hassanein) Department of Anaesthesia and intensive care, Minia
University, Egypt
Publisher
NLM (Medline)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether the application of an enhanced recovery
protocol or pathway improves patient outcomes after cardiac surgery. A
total of 3091 papers were found using the reported search. Finally, 12
papers represented the best available evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. Six studies referred to enhanced recovery protocol as fast
track (FT) and another 6 studies referred to it as enhanced recovery after
surgery (ERAS). Significant differences from conventional care were
reported for time to extubation or intubation time in 4 studies (3 FT, 1
ERAS), duration of intensive care unit stay in 6 studies (4 FT, 2 ERAS),
length of hospital stay (LOS) in 8 studies (5 FT, 3 ERAS), cost in 5
studies (4 FT, 1 ERAS), pain scores in 2 studies (2 ERAS) and opioid use
in 3 studies (3 ERAS). We conclude that FT or ERAS improve postoperative
outcomes including length of stay and pain control, without increasing
morbidity, mortality or readmission. However, there is a need for
prospective studies and standardized protocols. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<30>
Accession Number
631238863
Title
The role of fractional flow reserve in coronary artery bypass graft
surgery: a meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 30 (5) (pp 671-678),
2020. Date of Publication: 01 May 2020.
Author
Jayakumar S.; Bilkhu R.; Ayis S.; Nowell J.; Bogle R.; Jahangiri M.
Institution
(Jayakumar, Bilkhu, Nowell, Jahangiri) Department of Cardiothoracic
Surgery, St George's Hospital, London, United Kingdom
(Ayis) Department of Biostatistics, King's College London, London, United
Kingdom
(Bogle) Department of Cardiology, Clinical Academic Group, St George's
Hospital, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Fractional flow reserve (FFR) measures the drop in perfusion
pressure across a stenosis, therefore representing its physiological
effect on myocardial blood flow. Its use is widespread in percutaneous
coronary interventions, though its role in coronary artery bypass graft
(CABG) surgery remains uncertain. This systematic review and meta-analysis
aims to evaluate current evidence on outcomes following FFR-guided CABG
compared to angiography-guided CABG. METHOD(S): A literature search
was conducted following PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) guidelines to identify all relevant articles.
Patient demographics and characteristics were extracted. The following
outcomes were analysed: repeat revascularization, myocardial infarction
(MI) and all-cause mortality. Pooled relative risks were analysed and
their 95% confidence intervals (CIs) were estimated using random-effects
models; P-value <0.05 was considered statistically significant.
Heterogeneity was assessed with Cochran's Q score and quantified by I2
index. RESULT(S): Nine studies with 1146 patients (FFR: 574,
angiography: 572) were included. There was no difference in MI or repeat
revascularization between the 2 groups (relative risk 0.76, 95% CI
0.41-1.43; P=0.40, and relative risk 1.28, 95% CI 0.75-2.19; P=0.36,
respectively). There was a significant reduction in all-cause mortality in
the FFR-guided CABG group compared to angiography-guided CABG, which was
not specifically cardiac related (relative risk 0.58, 95% CI 0.38-0.90;
P=0.02). CONCLUSION(S): There was no reduction in repeat
revascularization or postoperative MI with FFR. In this fairly small
cohort, FFR-guided CABG provided a reduction in mortality, but this was
not reported to be due to cardiac causes. There may be a role for FFR in
CABG, but large-scale randomized trials are required to establish its
value. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<31>
Accession Number
631625020
Title
Threat-related motivational disengagement: Integrating blunted
cardiovascular reactivity to stress into the biopsychosocial model of
challenge and threat.
Source
Anxiety, stress, and coping. (pp 1-15), 2020. Date of Publication: 24 Apr
2020.
Author
Hase A.; Aan Het Rot M.; de Miranda Azevedo R.; Freeman P.
Institution
(Hase) Faculty Branch in Poznan, SWPS University of Social Sciences and
Humanities, Poznan, Poland
(Aan Het Rot) Department of Psychology, University of Groningen,
Groningen, Netherlands
(de Miranda Azevedo) Institute of Data Science, Maastricht University,
Maastricht, Netherlands
(Freeman) School of Sport, Rehabilitation and Exercise Sciences,
University of Essex, Colchester, United Kingdom
Publisher
NLM (Medline)
Abstract
Background: The biopsychosocial model of challenge and threat specifies a
challenge-threat continuum where favorable demand-resource evaluations,
efficient cardiovascular responses, and superior performance characterize
challenge; and maladaptive outcomes like clinical depression characterize
threat states. The model also specifies task engagement, operationalized
as heart rate and ventricular contractility increases, as a prerequisite
for challenge and threat states. The blunted cardiovascular reactivity to
stress literature describes reductions of these increases and associates
them with problems like clinical depression. Objective(s): To
determine whether blunted cardiovascular reactivity to stress has
implications for challenge and threat theory. Method(s): We review
and synthesize the literatures on blunted cardiovascular reactivity to
stress and the biopsychosocial model. Result(s): Blunted
cardiovascular reactivity appears not to reflect a physiological inability
to respond to stress. Rather, it reflects a contextually dependent
motivational dysregulation and reduced reactivity to stress consistent
with deficient task engagement in the biopsychosocial model.
 Conclusion(s): We argue that blunted cardiovascular reactivity
represents deficient task engagement, and more generally, motivational
disengagement due to threat states. Our biopsychosocial model-based
approach conceptualizes this motivational disengagement as a tendency to
avoid motivated performance situations. This tendency may represent a
defense mechanism against subsequent threat and might explain associations
with disorders like clinical depression.

<32>
Accession Number
631634383
Title
Full sternotomy and minimal access approaches for surgical aortic valve
replacement: A multicentre propensity-matched study.
Source
European Journal of Cardio-thoracic Surgery. 57 (4) (pp 709-716), 2020.
Date of Publication: 01 Apr 2020.
Author
Paparella D.; Malvindi P.G.; Santarpino G.; Moscarelli M.; Guida P.;
Fattouch K.; Margari V.; Martinelli L.; Albertini A.; Speziale G.
Institution
(Paparella, Malvindi, Margari) Department of Cardiac Surgery, Santa Maria
Hospital, GVM Care and Research, Bari, Italy
(Paparella) Department of Emergency and Organ Transplant, University of
Bari Aldo Moro, Piazza Giulio Cesare 11, Bari 70124, Italy
(Santarpino) Department of Cardiac Surgery, Citta di Lecce Hospital, GVM
Care and Research, Lecce, Italy
(Santarpino) Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus
Medical University, Nuremberg, Germany
(Moscarelli, Speziale) Department of Cardiac Surgery, Anthea Hospital, GVM
Care and Research, Bari, Italy
(Moscarelli, Albertini, Speziale) Department of Cardiac Surgery, Maria
Cecilia Hospital, GVM Care and Research, Cotignola, Italy
(Guida) Maugeri Foundation, Cassano delle Murge, Bari, Italy
(Fattouch) Department of Cardiac Surgery, Maria Eleonora Hospital, GVM
Care and Research, Palermo, Italy
(Martinelli) Department of Cardiac Surgery, ICLAS, GVM Care and Research,
Rapallo, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Surgical aortic valve replacement (AVR) can be performed via a
full sternotomy or a minimal access approach (mini-AVR). Despite long-term
experience with the procedure, mini-AVR is not routinely adopted. Our goal
was to compare contemporary outcomes of mini-AVR and conventional AVR in a
large multi-institutional national cohort. METHOD(S): A total of 5801
patients from 10 different centres who had a mini-AVR (2851) or AVR (2950)
from 2011 to 2017 were evaluated retrospectively. Standard aortic
prostheses were used in all cases. The use of the minimally invasive
approach has increased over the years. The primary outcome is the
incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes
are the occurrence of major complications following both procedures.
Propensity-matched comparisons were performed based on the multivariable
logistic regression model. RESULT(S): In the overall population
patients who had AVR had an increased surgical risk based on the
EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in
mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified
2257 patients per group with similar baseline profiles. In the matched
groups, patients who had mini-AVR, despite longer cardiopulmonary bypass
(81 +/- 32 vs 76 +/- 28 min; P = 0.004) and cross-clamp (64 +/- 24 vs 59
+/- 21 min; P <= 0.001) times, had lower 30-day mortality rates (1.2% vs
2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and
reduced postoperative length of stay (9 +/- 8 vs 10 +/- 7 days; P =
0.004). Blood transfusions (36.4% vs 30.8%; P <= 0.001) and atrial
fibrillation (26.0% vs 21.5%, P <= 0.001) were higher in patients who had
the mini-AVR. CONCLUSION(S): In a large multi-institutional recent
cohort, minimal access approach aortic valve replacement is associated
with reduced 30-day mortality rates and shorter postoperative lengths of
stay compared to standard sternotomy. A prospective randomized trial is
needed to overcome the possible biases of a retrospective
study. Copyright © 2019 The Author(s).

<33>
Accession Number
631634368
Title
Impact of non-respect of SYNTAX score II recommendation for surgery in
patients with left main coronary artery disease treated by percutaneous
coronary intervention: An EXCEL substudy.
Source
European Journal of Cardio-thoracic Surgery. 57 (4) (pp 676-683), 2020.
Date of Publication: 01 Apr 2020.
Author
Modolo R.; Chichareon P.; Van Klaveren D.; Dressler O.; Zhang Y.; Sabik
J.F.; Onuma Y.; Kappetein A.P.; Stone G.W.; Serruys P.W.
Institution
(Modolo, Chichareon) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Modolo) Cardiology Division, Department of Internal Medicine, University
of Campinas (UNICAMP), Campinas, Brazil
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Van Klaveren) Department of Biomedical Data Sciences, Leiden University
Medical Center, Leiden, Netherlands
(Dressler, Zhang, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Onuma) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Serruys) Imperial College London, London, United Kingdom
(Serruys) Erasmus University Medical Center, PO Box 2125, Rotterdam, CC
3000, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The SYNTAX score II (SSII) was developed from the SYNTAX trial
to predict the 4-year all-cause mortality after left main or multivessel
disease revascularization and to facilitate the decision-making process.
The SSII provides the following treatment recommendations: (i) coronary
artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
(equipoise risk), (ii) CABG preferred (excessive risk for PCI) or (iii)
PCI preferred (excessive risk for CABG). We sought to externally validate
SSII and to investigate the impact of not abiding by the SSII
recommendations in the randomized EXCEL trial of PCI versus CABG for left
main disease. METHOD(S): The calibration plot of predicted versus
observed 4-year mortality was constructed from individual values of SSII
in EXCEL. To assess overestimation versus underestimation of predicted
mortality risk, an optimal fit regression line with slope and intercept
was determined. Prospective treatment recommendations based on SSII were
compared with actual treatments and all-cause mortality at 4 years.
 RESULT(S): SSII variables were available from EXCEL trial in
1807/1905 (95%) patients. For the entire cohort, discrimination was
possibly helpful (C statistic = 0.670). SSII-predicted all-cause mortality
at 4 years overestimated the observed mortality, particularly in the
highest-risk percentiles, as confirmed by the fit regression line
[intercept 2.37 (1.51-3.24), P = 0.003; slope 0.67 (0.61-0.74), P <
0.001]. When the SSII-recommended treatment was CABG, randomized EXCEL
patients treated with PCI had a trend towards higher mortality compared
with those treated with CABG (14.1% vs 5.3%, P = 0.07) in the as-treat
population. In the intention-to-treat population, patients randomized to
PCI had higher mortality compared with those randomized to CABG (15.1% vs
4.1%, P = 0.02), when SSII recommended CABG. CONCLUSION(S): In the
EXCEL trial of patients with left main disease, the SSII-predicted 4-year
mortality overestimated the 4-year observed mortality with a possibly
helpful discrimination. Non-compliance with SSII CABG treatment
recommendations (i.e. randomized to PCI) was associated with higher 4-year
all-cause mortality. Copyright © 2019 The Author(s).

<34>
Accession Number
631634338
Title
The efficacy and safety of prophylactic corticosteroids for the prevention
of adverse outcomes in patients undergoing heart surgery using
cardiopulmonary bypass: A systematic review and meta-analysis of
randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 57 (4) (pp 620-627), 2020.
Date of Publication: 01 Apr 2020.
Author
Ng K.T.; Van Paassen J.; Langan C.; Sarode D.P.; Arbous M.S.; Alston R.P.;
Dekkers O.M.
Institution
(Ng) Department of Anaesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur 50603, Malaysia
(Van Paassen, Arbous) Department of Intensive Care, Leiden University
Medical Center, Leiden, Netherlands
(Langan, Sarode) Department of General Surgery, NHS Greater Glasgow and
Clyde, United Kingdom
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
(Arbous, Dekkers) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Corticosteroids are often administered prophylactically to attenuate the
inflammatory response associated with cardiac surgery using
cardiopulmonary bypass (CPB). However, the efficacy and safety profile of
corticosteroids remain uncertain. The primary aim of this systematic
review and meta-analysis was to investigate the effect of corticosteroids
on mortality in adult cardiac surgery using CPB. Secondary aims were to
examine the effect of corticosteroids on myocardial adverse events,
pulmonary adverse events, atrial fibrillation, surgical site infection,
gastrointestinal bleeding and duration of stay in the intensive care unit
and hospital. Randomized controlled trials (RCTs) were systematically
searched in electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL and Web
of Science) from their inception until March 2019. Observational studies,
case reports, case series and literature reviews were excluded. Sixty-two
studies (n = 16 457 patients) were included in this meta-analysis. There
was no significant difference in mortality between the corticosteroid and
placebo groups [odds ratio (OR) 0.96, 95% confidence interval (CI)
0.81-1.14; P = 0.65, participants = 14 693, studies = 24, evidence of
certainty: Moderate]. Compared to those receiving a placebo, patients who
were given corticosteroids had a significantly higher incidence of
myocardial adverse events (OR 1.17, 95% CI 1.03-1.33; P = 0.01,
participants = 14 512, studies = 23) and a lower incidence of pulmonary
adverse events (OR 0.86, 95% CI 0.75-0.98; P = 0.02, participants = 13
426, studies = 17). The incidences of atrial fibrillation (OR 0.87, 95% CI
0.81-0.94; P < 0.001, participants = 14 148, studies = 24) and surgical
site infection (OR 0.81, 95% CI 0.73-0.90; P < 0.001, participants = 13
946; studies = 22) were all lower in patients who were given
corticosteroids. In the present meta-analysis of 62 RCTs (16 457
patients), including the 2 major RCTs (SIRS and DECS trials: 12 001
patients), we found that prophylactic corticosteroids in cardiac surgery
did not reduce mortality. The clinical significance of an increase in
myocardial adverse events remains unclear as the definition of a relevant
myocardial end point following cardiac surgery varied greatly between
RCTs. Copyright © 2020 The Author(s).

<35>
Accession Number
2005726961
Title
Volatile Anesthesia Versus Total Intravenous Anesthesia During
Cardiopulmonary Bypass: A Narrative Review on the Technical Challenges and
Considerations.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Yeoh C.J.; Hwang N.C.
Institution
(Yeoh, Hwang) Department of Anaesthesiology, Singapore General Hospital,
Singapore
(Yeoh, Hwang) Department of Cardiothoracic Anaesthesia, National Heart
Centre, Singapore
Publisher
W.B. Saunders
Abstract
The Mortality in Cardiac Surgery Randomized Controlled Trial of Volatile
Anesthetics (MYRIAD) demonstrated that cardiac surgery with either
volatile anesthesia or intravenous anesthesia techniques can be comparable
with respect to morbidity and mortality. Maintaining anesthesia during
cardiopulmonary bypass (CPB) with either approach requires appreciation of
the nuances that are unique to each. This narrative review addresses these
technical challenges and other considerations. Copyright © 2020
Elsevier Inc.

<36>
Accession Number
2004735583
Title
Inadvertent aortocoronary arteriovenous fistula after CABG: Systematic
review of case reports.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Chen K.; Scridon T.; Chait R.
Institution
(Chen) Division of Internal Medicine, University of Miami/JFK Medical
Center, Atlantis, FL, United States
(Scridon) Division of Cardiology, Florida State University College of
Medicine, Tallahassee, FL, United States
(Chait) Division of Cardiology, University of Miami/JFK Medical Center,
Atlantis, FL, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To summarize published case reports of aortocoronary
arteriovenous fistula (ACAVF) after coronary artery bypass grafting
surgery (CABG). Background(s): Inadvertent ACAVF is a rare
complication following CABG. However, the incidence continues to rise, and
its management details and clinical outcomes have not been well described.
 Method(s): To identify all published cases of ACAVF following CABG,
PubMed, EMBASE, and Scopus were searched through November 2019. We defined
ACAVF as inadvertent attachment of the grafting vessel onto a cardiac vein
instead of targeted coronary artery. A systematic review was performed to
identify the incidence, clinical features, and management outcomes.
 Result(s): A total of 48 post-CABG ACAVF cases were gathered. Among
these patients, the mean age was 61.9 years and 79.2% were men. Most
common presenting symptoms were chest pain (60.4%) and dyspnea (27.1%).
The average onset of symptoms was 3 years; however, 54.2% of patients
developed symptoms within the first year. The majority of cases reported
targeted native vessel LAD during CABG (62.5%). Of these cases, 9 (18.8%)
were managed conservatively, 8 (16.7%) chose to undergo surgery including
ligation of fistula and repeat CABG, and 27 (56.3%) underwent percutaneous
closure. Among these patients 13 cases (27.1%) were managed with coil
embolization, 5 (10.4%) with balloon embolization, 5 (10.4%) were treated
with a covered stent, and 4 (8.3%) used a vascular plug. There were no
reported complications following treatment in this group.
 Conclusion(s): Inadvertent ACAVF are rare following CABG.
Percutaneous closure was feasible and safe in treating these
patients. Copyright © 2020 Wiley Periodicals, Inc.

<37>
Accession Number
2005605317
Title
Evaluation of a Powered Vascular Stapler in Video-Assisted Thoracic
Surgery Lobectomy.
Source
Journal of Surgical Research. 253 (pp 26-33), 2020. Date of Publication:
September 2020.
Author
Molins L.; Lanuti M.; Force S.; Woolley S.; Krantz S.; Creedon E.E.;
Schwiers M.L.; Singleton D.W.; Waggoner J.R.; Fryrear R.; Licht P.
Institution
(Molins) Department of Thoracic Surgery, Barcelona University, Barcelona,
Spain
(Lanuti) Division of Thoracic Surgery, Massachusetts General Hospital,
Boston, MA, United States
(Force) Department of Surgery, The Emory Clinic, Atlanta, GA, United
States
(Woolley) Consultant Thoracic Surgeon, Liverpool Heart & Chest Hospital,
Liverpool, United Kingdom
(Krantz) Division of Thoracic Surgery, Northshore University Health
System, Evanston, IL, United States
(Creedon, Schwiers, Singleton, Waggoner, Fryrear) Ethicon Endo-Surgery,
Inc., Cincinnati, OH, United States
(Licht) Department of Cardiothoracic Surgery, Odense University Hospital,
Odense, Denmark
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: A narrow-profile powered vascular stapler (PVS) was developed
to provide superior access and precise staple placement in thoracic
procedures. The objective of this study was to determine if the PVS would
yield an equivalent rate of hemostatic interventions compared with
standard of care (SOC) staplers in video-assisted thoracoscopic surgery
lobectomy. Material(s) and Method(s): A randomized, controlled,
multicenter study was conducted comparing PVS with SOC staplers in
lobectomies performed for non-small cell lung cancer. The primary
performance endpoint was the incidence of intraoperative hemostatic
interventions, and the primary safety endpoint was the frequency of
postoperative bleeding-related interventions. Result(s): A total of
98 subjects participated in the SOC group and 103 in the PVS group. Rates
of intraoperative hemostatic interventions were 5.3% and 8.3% for the SOC
and PVS groups, respectively. These rates were not statistically different
(P = 0.137), although the upper bound of the 95% confidence interval for
the difference in intervention rates between PVC and SOC exceeded a
predefined 3% criterion for equivalence. Simple compressions were
performed more frequently in the PVS subjects, which accounted for the
higher intervention rate in this group. Postoperative interventions for
bleeding were required in one SOC subject (1.0%) and one subject from the
PVS group (0.9%). Procedure-related adverse events occurred in 21 (21.9%)
SOC subjects and 23 (21.9%) PVS subjects, with no adverse events related
to use of the study devices. Conclusion(s): The PVS exhibited similar
overall safety and effectiveness to SOC staplers in video-assisted
thoracoscopic surgery lobectomy. Copyright © 2020 Elsevier Inc.

<38>
Accession Number
2005532460
Title
Optimal Timing of Intervention in NSTE-ACS Without Pre-Treatment: The
EARLY Randomized Trial.
Source
JACC: Cardiovascular Interventions. 13 (8) (pp 907-917), 2020. Date of
Publication: 27 April 2020.
Author
Lemesle G.; Laine M.; Pankert M.; Boueri Z.; Motreff P.; Paganelli F.;
Baumstarck K.; Roch A.; Kerbaul F.; Puymirat E.; Bonello L.
Institution
(Lemesle) USIC et Centre Hemodynamique, Institut Coeur Poumon, Centre
Hospitalier Universitaire de Lille, Lille, France
(Lemesle) Faculte de Medecine de l'Universite de Lille, Lille, France
(Lemesle) INSERM UMR 1011, Institut Pasteur de Lille, Lille, France
(Lemesle) French Alliance for Cardiovascular Trials, Paris, France
(Laine, Paganelli, Bonello) Aix-Marseille Universite, Intensive Care Unit,
Department of Cardiology, Assistance Publique-Hopitaux de Marseille,
Hopital Nord, Marseille, France
(Laine, Paganelli, Bonello) Mediterranean Association for Research and
Studies in Cardiology, Marseille, France
(Laine, Paganelli, Bonello) Centre for CardioVascular and Nutrition
Research, INSERM 1263, INRA 1260, Marseille, France
(Pankert) Service de Cardiologie, Centre Hospitalier Henri Duffaut,
Avignon, France
(Boueri) Service de Cardiologie, Centre Hospitalier de Bastia, Bastia,
France
(Motreff) Departement de Cardiologie, Centre Hospitalier Universitaire
Gabriel Montpied, Clermont-Ferrand, France
(Baumstarck) Unite d'Aide Methodologique a la Recherche Clinique, EA 3279,
Laboratoire de Sante Publique, Aix-Marseille Universite, Marseille, France
(Roch) Hopital Nord, Marseille, France
(Roch) Service d'Accueil des Urgences, Hopital Nord, Marseille, France
(Kerbaul) Pole RUSH, Assistance-Publique Hopitaux de Marseille, UMR MD2 -
Aix-Marseille Universite, Marseille, France
(Puymirat) Departement de Cardiologie, Hopital Europeen Georges Pompidou,
Assistance Publique des Hopitaux de Paris, Paris, France
(Puymirat) Universite Paris Descartes, INSERM U-970, Paris, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare a delayed and a very
early invasive strategy in patients with non-ST-segment elevation acute
coronary syndromes (NSTE-ACS) without pre-treatment. Background(s):
The optimal delay of the invasive strategy in patients with NSTE-ACS
remains debated and has never been investigated in patients not
pre-treated with P2Y<inf>12</inf>-adenosine diphosphate receptor
antagonists. Method(s): A prospective, open-label, randomized
controlled trial was conducted. Altogether, 741 patients presenting with
intermediate- or high-risk NSTE-ACS intended for an invasive strategy were
included. The modified intention-to-treat analysis was composed of 709
patients after 32 withdrew consent. Patients were randomized 1:1 to the
delayed invasive group (DG) (n = 363) with coronary angiography (CA)
performed 12 to 72 h after randomization or the very early invasive group
(EG) (n = 346) with CA within 2 h. No pre-treatment with a loading dose of
a P2Y<inf>12</inf>-adenosine diphosphate receptor antagonist was allowed
before CA. The primary endpoint was the composite of cardiovascular death
and recurrent ischemic events at 1 month, as determined by a blinded
adjudication committee. Result(s): Most patients had high-risk
NSTE-ACS in both groups (93% in the EG vs. 92.5% in the DG). The median
time between randomization and CA was 0 h (interquartile range [IQR]: 0 to
1 h) in the EG group and 18 h (IQR: 11 to 23 h) in the DG. The primary
endpoint rate was significantly lower in the EG (4.4% vs. 21.3% in the DG;
hazard ratio: 0.20; 95% confidence interval: 0.11 to 0.34; p < 0.001),
driven by a reduction in recurrent ischemic events (19.8% vs. 2.9%; p <
0.001). No difference was observed for cardiovascular death.
 Conclusion(s): Without pre-treatment, a very early invasive strategy
was associated with a significant reduction in ischemic events at the time
of percutaneous coronary intervention in patients with intermediate- and
high-risk NSTE-ACS. (Early or Delayed Revascularization for Intermediate
and High-Risk Non ST-Elevation Acute Coronary Syndromes;
NCT02750579) Copyright © 2020 American College of Cardiology
Foundation

<39>
Accession Number
2004421235
Title
The effect of restrictive versus liberal transfusion strategies on
longer-term outcomes after cardiac surgery: a systematic review and
meta-analysis with trial sequential analysis.
Source
Canadian Journal of Anesthesia. 67 (5) (pp 577-587), 2020. Date of
Publication: 01 May 2020.
Author
Kashani H.H.; Lodewyks C.; Kavosh M.S.; Jeyaraman M.M.; Neilson C.; Okoli
G.; Rabbani R.; Abou-Setta A.M.; Zarychanski R.; Grocott H.P.
Institution
(Kashani, Kavosh, Grocott) Department of Anesthesiology, Perioperative and
Pain Medicine, St. Boniface Hospital, University of Manitoba, CR3008-369
Tache Ave, Winnipeg, MB R2H 2A6, Canada
(Lodewyks) Section of Cardiac Surgery, Department of Surgery, University
of Manitoba, Winnipeg, MB, Canada
(Jeyaraman, Okoli, Rabbani, Abou-Setta) The George & Fay Yee Center for
Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
(Jeyaraman, Okoli, Rabbani, Abou-Setta, Zarychanski) Department of
Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
(Neilson) Neil John Maclean Health Sciences Library, University of
Manitoba, Winnipeg, MB, Canada
(Zarychanski) Department of Internal Medicine, University of Manitoba,
Winnipeg, MB, Canada
(Zarychanski) Department of Medical Oncology and Hematology, Cancer Care
Manitoba, Winnipeg, MB, Canada
Publisher
Springer
Abstract
Purpose: Blood transfusions are frequently administered in cardiac
surgery. Despite a large number of published studies comparing a
"restrictive" strategy with a "liberal" strategy, no clear consensus has
emerged to guide blood transfusion practice in cardiac surgery patients.
The purpose of this study was to identify, critically appraise, and
summarize the evidence on the overall effect of restrictive transfusion
strategies compared with liberal transfusion strategies on mortality,
other clinical outcomes, and transfusion-related outcomes in adult
patients undergoing cardiac surgery. Source: We searched MEDLINE (OvidSP),
EMBASE (OvidSP) and Cochrane CENTRAL (Wiley) from inception to 1 December
2017 and queried clinical trial registries and conference proceedings for
randomized-controlled trials of liberal vs restrictive transfusion
strategies in cardiac surgery. Principal findings: From 7,908 citations,
we included ten trials (9,101 patients) and eight companion publications.
Overall, we found no significant difference in mortality between
restrictive and liberal transfusion strategies (risk ratio [RR], 1.08; 95%
confidence interval [CI], 0.76 to 1.54; I2 = 33%; seven trials;
8,661 patients). The use of a restrictive transfusion strategy did not
appear to adversely impact any of the secondary clinical outcomes. As
expected, the proportion of patients who received red blood cells (RBCs)
in the restrictive group was significantly lower than in the liberal group
(RR, 0.68; 95% CI, 0.64 to 0.73; I2 = 56%; 5 trials; 8,534
patients). Among transfused patients, a restrictive transfusion strategy
was associated with fewer transfused RBC units per patient than a liberal
transfusion strategy. Conclusion(s): In adult patients undergoing
cardiac surgery, a restrictive transfusion strategy reduces RBC
transfusion without impacting mortality rate or the incidence of other
perioperative complications. Nevertheless, further large trials in
subgroups of patients, potentially of differing age, are needed to
establish firm evidence to guide transfusion in cardiac surgery. Trial
registration: PROSPERO (CRD42017071440); registered 20 April,
2018. Copyright © 2020, Canadian Anesthesiologists' Society.

<40>
Accession Number
2004227552
Title
Mild acute cellular rejection and development of cardiac allograft
vasculopathy assessed by intravascular ultrasound and coronary angiography
in heart transplant recipients-a SCHEDULE trial substudy.
Source
Transplant International. 33 (5) (pp 517-528), 2020. Date of Publication:
01 May 2020.
Author
Nelson L.M.; Andreassen A.K.; Arora S.; Andersson B.; Gude E.; Eiskjaer
H.; Radegran G.; Dellgren G.; Gullestad L.; Gustafsson F.
Institution
(Nelson, Gustafsson) Department of Cardiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Andreassen, Arora, Gude, Gullestad) Department of Cardiology, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Arora, Gullestad) K.G. Jebsen Cardiac Research Centre and Center for
Heart Failure Research, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, Skane
University Hospital, Lund, Sweden
(Radegran) Department of Clinical Sciences Lund, Cardiology, Lund
University, Lund, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
(Gustafsson) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
To evaluate the association between mild acute cellular rejection (ACR)
and the development of cardiac allograft vasculopathy (CAV) after heart
transplantation (HTx). Substudy of the SCHEDULE trial (n = 115), where de
novo HTx recipients were randomized to (i) everolimus with early CNI
elimination or (ii) CNI-based immunosuppression. Seventy-six patients
(66%) were included based on matched intravascular ultrasound (IVUS)
examinations at baseline and year 3 post-HTx. Biopsy-proven ACR within
year 1 post-HTx was recorded and graded (1R, 2R, 3R). Development of CAV
was assessed by IVUS and coronary angiography at year 3 post-HTx. Median
age was 53 years (45-61), and 71% were male. ACR was recorded in 67%, and
patients were grouped by rejection profile: no ACR (33%), only 1R (42%),
and >=2R (25%). Median MIT (maximal intimal thickness)<inf>BL-3Y</inf> was
not significantly different between groups (P = 0.84). The incidence of
CAV was 49% by IVUS and 26% by coronary angiography with no significant
differences between groups. No correlation was found between number of 1R
and MIT<inf>BL-3Y</inf> (r = -0.025, P = 0.83). The number of 1R was not a
significant predictor of MIT<inf>BL-3Y</inf> (P = 0.58), and no
significant interaction with treatment was found (P = 0.98). The burden of
mild ACR was not associated with CAV development. Copyright ©
2020 Steunstichting ESOT

<41>
Accession Number
2002365716
Title
Epicardial Application of Hydrogel with Amiodarone for Prevention of
Postoperative Atrial Fibrillation in Patients After Coronary Artery Bypass
Grafting.
Source
Journal of Cardiovascular Translational Research. 13 (2) (pp 191-198),
2020. Date of Publication: 01 Apr 2020.
Author
Bockeria O.L.; Kanametov T.N.; Shvartz V.A.; Sokolskaya M.A.; Zhuginisov
D.S.; Sanakoev M.K.; Bockeria L.A.
Institution
(Bockeria, Kanametov, Shvartz, Sokolskaya, Zhuginisov, Sanakoev, Bockeria)
Bakulev National Medical Research Center for Cardiovascular Surgery,
Moscow, Russian Federation
(Bockeria, Kanametov, Shvartz, Sokolskaya, Zhuginisov, Sanakoev, Bockeria)
Department of Surgical Treatment for Interactive Pathology, Bakulev
National Medical Research Center for Cardiovascular Surgery, Moscow,
Russian Federation
Publisher
Springer
Abstract
The objective of this study was to assess the safety and efficacy of local
epicardial application of amiodarone-releasing hydrogel for prevention of
postoperative atrial fibrillation (POAF) in patients after coronary artery
bypass grafting. Patients were randomized into two groups: with the
application of amiodarone-releasing hydrogel and the control group. It
included 60 patients (47 males, 13 females) (mean age of 62 +/- 8.5). POAF
incidence differences were statistically significant between two groups:
in the study group, the POAF incidence was 3.3%, while in the control
group, the POAF incidence was 37% (p < 0.001). Statistically significant
differences were revealed in the PQ interval duration. The risk of POAF
incidence was calculated using the Cox regression model: the age and the
application of amiodarone-releasing hydrogel application were
statistically significant. Hospital length of stay in two groups was also
different (p < 0.001). The age and the application of amiodarone-releasing
hydrogel were statistically significant for POAF incidence. Copyright
© 2019, Springer Science+Business Media, LLC, part of Springer
Nature.

<42>
Accession Number
2005432654
Title
Validation of the long-term prognostic capability of the SYNTAX score II
in patients undergoing biodegradable polymer-based Sirolimus-eluting
stents: 2-year outcomes from the PANDA III trial.
Source
International Journal of Cardiology. 309 (pp 27-32), 2020. Date of
Publication: 15 June 2020.
Author
Song Y.; Guan C.; Cao X.; Qin L.; Li Y.; Li Z.; Nie S.; Hou S.; Zhang M.;
Gao R.; Yuan J.; Xu B.
Institution
(Song, Gao, Yuan) Fu Wai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Beijing, China
(Guan, Xu) Catheterization Laboratories, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing,
China
(Cao) Chinese PLA 252 Hospital, Baoding, China
(Qin) Kaifeng Central Hospital, Kaifeng, China
(Li) Yunnan St. John's Hospital, Kunming, China
(Li) Liaoning Provincial People's Hospital, Shenyang, China
(Nie) Affiliated Anzhen Hospital of Capital Medical University, Beijing,
China
(Hou, Zhang) China Cardiovascular Research Foundation Inc, Beijing, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: This study aimed to assess the prognostic ability of SYNTAX
(Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac
Surgery) Score II (SS-II) in LM and/or TVD patients undergoing
biodegradable polymer-based drug-eluting stents (BP-DES) in the
multi-central randomized PANDA III trial. Method(s): A total of 723
patients in PANDA III population were enrolled in this study. According to
SS-II tertiles, patients were stratified as follow: SS-II <= 23 (n = 224),
23 < SS II <= 31 (n = 255), SS II > 31 (n = 244). The predictive abilities
for 2-year cardiac death were compared between angiographic scores and
scores combining both angiographic and clinical variables. Result(s):
Mean anatomic SS was 20.6 +/- 9.4, SS-II for PCI was 28.7 +/- 8.6. During
2-year follow up, cardiac death (0.00% vs. 1.7% vs. 4.3%, p = 0.003) and
target lesion failure (5.9% vs. 9.1% vs. 13.6%, p = 0.020) was
significantly higher in the upper tertile group than in intermedian and
low tertile. At multivariate analysis, SS-II for PCI was an independent
risk factor of cardiac death (Hazard ratio: 2.41, 95%CI: 1.47-3.97, p <
0.005) and TLF (Hazard ratio: 1.29, 95%CI: 1.01-1.65, p = 0.040). The ROC
curve analysis showed that SS-II for PCI had better ability than other
SYNTAX scoring systems to predict cardiac death (AUC: 0.746,
95%CI:0.63-0.87, p = 0.010). Conclusion(s): The SS-II had superiority
than other SYNTAX scoring systems in predicting 2-year cardiac death in LM
and/or TVD patients undergoing PCI with biodegradable polymer drug-eluting
stents. Copyright © 2020

<43>
Accession Number
2004862044
Title
Impact of coronary bypass or stenting on mortality and myocardial
infarction in stable coronary artery disease.
Source
International Journal of Cardiology. 309 (pp 63-69), 2020. Date of
Publication: 15 June 2020.
Author
Taglieri N.; Bruno A.G.; Bacchi Reggiani M.L.; D'Angelo E.C.; Ghetti G.;
Bruno M.; Palmerini T.; Rapezzi C.; Galie N.; Saia F.
Institution
(Taglieri, Bruno, Bacchi Reggiani, D'Angelo, Ghetti, Bruno, Palmerini,
Galie, Saia) Dipartimento di Medicina Specialistica, Diagnostica e
Sperimentale, Alma Mater Studiorum Universita di Bologna, Italy
(Rapezzi) Cardiologia, Universita di Ferrara, Italy and Maria Cecilia
Hospital GVM, Care and Research, Cotignola, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: To assess whether coronary bypass (CABG) or stenting reduce
the risk of mortality and myocardial infarction (MI) compared with optimal
medical therapy (OMT) in stable coronary artery disease (CAD).
 Method(s): We performed a systematic review and network meta-analysis
of contemporary randomized controlled trials comparing OMT, CABG and
different stent types in stable CAD. All-comer trials were included if the
rate of patients with acute myocardial infarction (AMI) was<=20%.
Endpoints were all-cause mortality and MI. Result(s): Ninety-seven
trials including 75,754 patients were analyzed at a weighted mean follow
up of 42.5 months. Compared to OMT, CABG was associated with a lower risk
of death (OR = 0.84; 95%CI:0.71-0.97). After exclusion of trials in left
main and/or multivessel disease(LM/MVD) this benefit was not statistically
significant (OR = 0.89; 95%CI:0.74-1.06). CABG was associated with a lower
risk of MI (OR = 0.67;95%CI: 0.49-0.91) showing, however, a certain degree
of inconsistency (p=0.10). None of the stent types included was associated
with a lower risk of death. However,
durable-polymer-CoCr-everolimus-eluting stent, by mixed evidence, after
exclusion of either LM/MVD (OR = 0.73;95%CI: 0.54-0.98) or
all-comer/post-MI trials (OR = 0.62;95%CI:0.39-0.98) was associated with a
lower risk of MI than OMT. Similar findings, by indirect evidence, were
confirmed for bio-absorbable-polymer-CoCr-sirolimus eluting stent (LMV/MVD
trials excluded OR = 0.46; 95%CI = 0.29-0.74, all-comer/post-MI trials
excluded: OR = 0.41;95%CI:0.22-0.79). Conclusion(s): In stable CAD,
CABG reduces the risk of mortality and MI compared to OMT, especially in
patients with higher extent of CAD. Our study suggests that some of second
and latest-generation drug-eluting stents may reduce the risk of MI.
Future research should confirm these latter findings. Copyright ©
2020 Elsevier B.V.

<44>
Accession Number
2005459747
Title
Meta-analysis Comparing Valve-In-Valve Transcatheter Aortic Valve
Implantation With Self-Expanding Versus Balloon-Expandable Valves.
Source
American Journal of Cardiology. 125 (10) (pp 1558-1565), 2020. Date of
Publication: 15 May 2020.
Author
Hamilton G.W.; Koshy A.N.; Fulcher J.; Tang G.H.L.; Bapat V.; Murphy A.;
Horrigan M.; Farouque O.; Yudi M.B.
Institution
(Hamilton, Koshy, Fulcher, Murphy, Horrigan, Farouque, Yudi) Department of
Cardiology, Austin Health, Melbourne, Victoria, Australia
(Koshy, Farouque, Yudi) Department of Medicine, The University of
Melbourne, Victoria, Australia
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
(Bapat) Department of Cardiothoracic Surgery, New York Presbyterian
Hospital, Columbia University Medical Centre, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an
alternative to redo-surgery in patients with failed surgical
bioprostheses. It remains unclear whether outcomes vary when using either
self-expanding (SE) or balloon-expandable (BE) valves. The aim of this
study was to compare outcomes between SE and BE transcatheter heart valves
when used for ViV TAVI. A systematic review of PubMed, MEDLINE, and EMBASE
was performed identifying studies reporting outcomes following ViV TAVI.
Event rates were pooled for meta-analysis using a random-effects model.
The primary outcome was all-cause mortality at 12 months. Secondary
outcomes included 30-day and 3-year mortality in addition to standard
safety outcomes after the procedure as per the Valve Academic Research
Consortium criteria. Nineteen studies reporting outcomes for 1,772
patients were included: 924 in the SE group and 848 patients in the BE
group. There was no significant difference in all-cause mortality at 12
months (SE 10.3% vs BE 12.6%, p = 0.165, I2 = 0%), or 3 years
(SE 21.2% vs BE 31.2%, p = 0.407, I2 = 63.79). SE valves had
lower transvalvular gradients after procedure and acute kidney injury, but
higher rates of pacemaker insertion, moderate or severe paravalvular
regurgitation and need for >=2 valves (all p < 0.05). There were no
differences in stroke, coronary obstruction, bleeding, or vascular
complications. Despite significant differences in key procedural outcomes
between SE and BE valves when used for ViV TAVI, we found no difference in
12-month mortality. Tailored device selection may further reduce the risk
of adverse procedural outcomes, particularly over the longer
term. Copyright © 2020

<45>
Accession Number
631422376
Title
Cardiac rehabilitation to improve health-related quality of life following
trans-catheter aortic valve implantation: A randomised controlled
feasibility study RECOVER-TAVI Pilot, ORCA 4, for the Optimal Restoration
of Cardiac Activity Group.
Source
Pilot and Feasibility Studies. 4 (1) (no pagination), 2018. Article
Number: 154. Date of Publication: 25 Apr 2018.
Author
Rogers P.; Al-Aidrous S.; Banya W.; Haley S.R.; Mittal T.; Kabir T.;
Panoulas V.; Raja S.; Bhudia S.; Probert H.; Prendergast C.; Spence M.S.;
Davies S.; Moat N.; Taylor R.S.; Dalby M.
Institution
(Rogers, Al-Aidrous, Banya, Haley, Mittal, Kabir, Panoulas, Raja, Bhudia,
Probert, Prendergast, Davies, Moat, Dalby) Royal Brompton and Harefield
NHS Foundation Trust London, Imperial College, London, United Kingdom
(Rogers, Al-Aidrous, Banya, Haley, Mittal, Kabir, Panoulas, Raja, Bhudia,
Probert, Prendergast, Spence, Davies, Moat, Dalby) Royal Victoria
Hospital, Belfast, United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter and the School of Medicine Dentistry and Nursing,
University of Glasgow, Glasgow, United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Objectives: Transcatheter aortic valve implantation (TAVI) is often
undertaken in the oldest frailest cohort of patients undergoing cardiac
interventions. We plan to investigate the potential benefit of cardiac
rehabilitation (CR) in this vulnerable population. Design(s): We
undertook a pilot randomised trial of CR following TAVI to inform the
feasibility and design of a future randomised clinical trial (RCT).
 Participant(s): We screened patients undergoing TAVI at a single
institution between June 2016 and February 2017. Intervention(s):
Participants were randomised post-TAVI to standard of care (control group)
or standard of care plus exercise-based CR (intervention group).
 Outcome(s): We assessed recruitment and attrition rates, uptake of
CR, and explored changes in 6-min walk test, Nottingham Activities of
Daily Living, Fried and Edmonton Frailty scores and Hospital Anxiety and
Depression Score, from baseline (30 days post TAVI) to 3 and 6 months post
randomisation. We also undertook a parallel study to assess the use of the
Kansas City Cardiomyopathy Questionnaire (KCCQ) in the post-TAVI
population. Result(s): Of 82 patients screened, 52 met the inclusion
criteria and 27 were recruited (3 patients/month). In the intervention
group, 10/13 (77%) completed the prescribed course of 6 sessions of CR
(mean number of sessions attended 7.5, SD 4.25) over 6 weeks. At 6 months,
all participants were retained for follow-up. There was apparent
improvement in outcome scores at 3 and 6 months in control and CR groups.
There were no recorded adverse events associated with the intervention of
CR. The KCCQ was well accepted in 38 post-TAVI patients: Mean summary
score 72.6 (SD 22.6). Conclusion(s): We have demonstrated the
feasibility of recruiting post-TAVI patients into a randomised trial of
CR. We will use the findings of this pilot trial to design a fully powered
multicentre RCT to inform the provision of CR and support guideline
development to optimise health-related quality of life outcomes in this
vulnerable population. Copyright © The Author(s) 2018.

<46>
Accession Number
630465792
Title
Comparative efficacy and safety of antithrombotic therapy for
transcatheter aortic valve replacement: a systematic review and network
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (5) (pp 965-976),
2020. Date of Publication: 01 May 2020.
Author
Zhu Y.; Zou Z.; Huang Y.; Zhang L.; Chen H.; Li Y.; Liu C.; Li X.; Xu D.;
Zeng Q.
Institution
(Zhu, Zou, Huang, Zhang, Chen, Li, Li, Xu, Zeng) First Clinical Medical
College, State Key Laboratory of Organ Failure Research, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Zhu, Huang, Xu, Zeng) Guangzhou Regenerative Medicine and Health
Guangdong Laboratory, Guangzhou, China
(Liu) Department of Cardiology, Guangzhou First People's Hospital, School
of Medicine, South China University of Technology, Guangzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to determine the optimal antithrombotic therapy
after transcatheter aortic valve replacement. METHOD(S): Related
scientific databases were searched until December 2018. We conducted a
pairwise and a network meta-analysis within a frequentist framework,
measuring 30-day bleeding, stroke and all-cause mortality. The surface
under the cumulative ranking (SUCRA) curve was estimated to rank the
therapies. The Grading of Recommendations Assessment, Development and
Evaluation (GRADE) approach was performed. The protocol was registered
with PROSPERO (CRD42018111163). RESULT(S): Eight studies comprising
2173 patients were analysed. The risk of 30-day bleeding was higher for
dual antiplatelet therapy (DAPT) than single antiplatelet therapy (SAPT)
[odds ratio (OR) 1.90 (1.10-3.28); P=0.02], whereas there was no
difference in the risk of 30-day stroke [OR 1.27 (0.38-4.20); P=0.69] and
mortality [OR 1.46 (0.67-3.22); P=0.34] between DAPT and SAPT. In the
network meta-analysis, DAPT+oral anticoagulant (OAC) increased the risk of
30-day bleeding compared with SAPT [OR 6.21 (1.74-22.17); P=0.005], DAPT
[OR 3.27 (1.04-10.32); P=0.043], SAPT+OAC [OR 4.87 (2.51-9.45); P<0.001]
and OAC [OR 14.4 (1.3-154.7); P=0.028]. Additionally, patients receiving
DAPT + OAC had the highest risks for 30-day bleeding (SUCRA 1.0%). OAC
seemed to be superior to SAPT and DAPT in terms of 30-day bleeding (SUCRA
OAC: 86.3%, SAPT: 72.3%, DAPT: 32.3%) and stroke (SUCRA 54.2%, 47.4%,
40.5%), but not mortality (SUCRA 69.6%, 74.1%, 43.4%). CONCLUSION(S):
There is a trend towards less bleeding with the application of SAPT, but
no mortality benefit with the application of DAPT is shown. The comparison
of SAPT, DAPT and OAC shows that OAC may improve the balance between
stroke and bleeding, which can reduce the risk of mortality. In addition,
the application of DAPT+OAC was ranked the worst amongst all treatment
modalities and should be avoided due to an increased risk of bleeding.
CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO (International Prospective
Register of Systematic Reviews, CRD42018111163). Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<47>
Accession Number
630098216
Title
Consolidated quality improvements following benchmarking with
cardiothoracic surgery registries-a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 57 (5) (pp 817-825),
2020. Date of Publication: 01 May 2020.
Author
de By T.M.M.H.; Muslem R.; Caliskan K.; Bortolussi G.; Philipsen T.;
Friberg O.; Bogers A.J.J.C.; Pagano D.
Institution
(de By) European Association for Cardio-Thoracic Surgery, Windsor, United
Kingdom
(de By, Muslem, Bogers) Department of Cardiothoracic Surgery, Erasmus
Medical Center, Rotterdam, Netherlands
(Caliskan) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Bortolussi) Department of Cardiac Thoracic Vascular Sciences and Public
Health, Padua University Hospital, Padua, Italy
(Philipsen) Department of Cardiac Surgery, Universitair Ziekenhuis Gent,
Gent, Belgium
(Friberg) Department of Cardiothoracic and Vascular Surgery, Orebro
University Hospital, Sweden
(Pagano) Department of Cardiothoracic Surgery, University of Birmingham,
University Hospital Birmingham, Birmingham, United Kingdom
Publisher
NLM (Medline)
Abstract
The influence of registries in medicine is large. However, there has been
no systematic assessment conducted to quantify the impact of benchmarking
with registries focused on cardiothoracic surgery. Numerous publications
conclude that registry participation leads to improvement of outcomes for
patients. A large number of registries provide evidence sub-structured by
statistics that show decreases in morbidity and mortality in the
participants' clinical units. Many authors praise the benchmarking method
making use of databases of registries as having a positive effect on
outcome of care. However, studies proving the direct causal relation
between the use of cardiothoracic surgery-oriented registries and
improvement of clinical in-hospital outcomes are extremely scarce. We
aimed to analyse the causal relation between the use of cardiothoracic
surgery-oriented registries and improvement of clinical outcomes. In a
systematic literature review, publications demonstrating the use of
registry data to obtain consolidated quality improvements were selected.
After analysis of 2990 scientific publications, 6 studies filled the
inclusion criteria. The selected studies acknowledged that benchmarking of
data against registries was used for a focused and methodologically
organized improvement in cardiothoracic departments. In conjunction with
the impact of the applied methods on healthcare, their results demonstrate
quantifiable enhanced local outcomes over time. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<48>
Accession Number
2005634061
Title
New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Indja B.; Woldendorp K.; Vallely M.P.; Grieve S.M.
Institution
(Indja, Grieve) Sydney Translational Imaging Laboratory, Heart Research
Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW,
Australia
(Indja, Woldendorp, Grieve) Faculty of Medicine and Health, The University
of Sydney, Sydney, NSW, Australia
(Vallely) Division of Cardiac Surgery, The Ohio State University,
Columbus, OH, United States
(Grieve) Department of Radiology, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: New-onset atrial fibrillation (NOAF) is a well-recognised,
although variably reported complication following surgical aortic valve
replacement (SAVR). Rates of NOAF following transcatheter aortic valve
implantation (TAVI) seem to be notably less than SAVR, even though this
population is typically older and of higher risk. The aim of this study
was to determine the prevalence of NOAF in both these populations and
associated postoperative outcomes. Method(s): We conducted a
systematic review and meta-analysis of studies reporting rates of NOAF
post SAVR or TAVI, along with early postoperative outcomes. Twenty-five
(25) studies with a total of 13,010 patients were included in the final
analysis. Result(s): The prevalence of NOAF post SAVR was 0.4 (95% CI
0.36-0.44) and post TAVI 0.15 (95% CI 0.11-0.18). NOAF was associated with
an increased risk of postoperative cerebrovascular accident (CVA) for SAVR
and TAVI (RR 1.44 95% CI 1.01-2.06 and RR 2.24 95% CI 1.46-3.45
respectively). NOAF was associated with increased mortality in the TAVI
group (RR 3.02 95% CI 1.55-5.9) but not the SAVR group (RR 1.00, 95% CI
0.54-1.84). Hospital length of stay was increased for both TAVI and SAVR
patients with NOAF (MD 2.54 days, 95% CI 2.0-3.00) and (MD 1.64 days, 95%
CI 0.04-3.24 respectively). Conclusion(s): The prevalence of NOAF is
significantly less following TAVI, as compared to SAVR. While NOAF is
associated with increased risk of postoperative stroke for both groups,
for TAVI alone NOAF confers increased risk of early
mortality. Copyright © 2020 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<49>
Accession Number
2004590425
Title
Randomised comparison of a balloon-expandable and self-expandable valve
with quantitative assessment of aortic regurgitation using magnetic
resonance imaging.
Source
Netherlands Heart Journal. 28 (5) (pp 253-265), 2020. Date of Publication:
01 May 2020.
Author
Kooistra N.H.M.; Abawi M.; Voskuil M.; Urgel K.; Samim M.; Nijhoff F.;
Nathoe H.M.; Doevendans P.A.F.M.; Chamuleau S.A.J.; Leenders G.E.H.;
Leiner T.; Abrahams A.C.; van der Worp H.B.; Agostoni P.; Stella P.R.
Institution
(Kooistra, Abawi, Voskuil, Urgel, Samim, Nijhoff, Nathoe, Doevendans,
Chamuleau, Leenders, Agostoni, Stella) Department of Cardiology,
University Medical Centre Utrecht, Utrecht, Netherlands
(Samim, Agostoni) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Doevendans) Netherlands Heart Institute (ICIN), Utrecht, Netherlands
(Leiner) Department of Radiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Abrahams) Department of Nephrology and Hypertension, University Medical
Centre Utrecht, Utrecht, Netherlands
(van der Worp) Department of Neurology and Neurosurgery, Brain Centre
Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is a safe and
effective treatment for inoperable, intermediate- or high-risk patients
with severe symptomatic aortic stenosis and has been associated with
excellent clinical outcomes. A clinically relevant remaining problem is
aortic regurgitation (AR) post-TAVI, which is associated with increased
mortality. Therefore, we conducted a prospective randomised trial to
assess the safety and efficacy of a first-generation self-expandable valve
(SEV; CoreValve) and a third-generation balloon-expandable valve (BEV;
Sapien 3) with respect to clinical outcomes and AR as determined
quantitatively by magnetic resonance imaging (MRI). Method(s): The
ELECT study was an investigator-initiated, single-centre trial involving
patients with severe symptomatic aortic stenosis and with a clinical
indication for transfemoral TAVI. Fifty-six patients were randomly
assigned to the BEV or SEV group. Result(s): AR determined
quantitatively by MRI was lower in the BEV than in the SEV group
[regurgitant fraction: 1.1% (0-8.0) vs 8.7% (3.0-14.8) for SEV; p= 0.01].
Secondary endpoints according to the criteria of the Second Valve Academic
Research Consortium (VARC-2) showed BEV to have better early safety [0
(0%) vs 8 (30%); p= 0.002] at 30 days and a lower risk of stroke [0 (0%)
vs 5 (21%); p= 0.01], major adverse cardiac and cerebrovascular events [0
(0%) vs 10 (38%); p< 0.001] or death [0 (0%) vs 5 (19%); p= 0.02] in the
1st year compared with SEV. Conclusion(s): The use of the latest
generation of BEV was associated with less AR as quantitatively assessed
by MRI. Although the use of MRI to quantify AR is not feasible in daily
clinical practice, it should be considered as a surrogate endpoint for
clinical outcomes in comparative studies of valves for TAVI.
ClinicalTrials.gov number NCT01982032. Copyright © 2020, The
Author(s).

<50>
Accession Number
2004474916
Title
Percutaneous mitral valve repair: the necessity to redefine secondary
mitral regurgitation.
Source
Netherlands Heart Journal. 28 (5) (pp 272-279), 2020. Date of Publication:
01 May 2020.
Author
Halim J.; Van den Branden B.; Coussement P.; Kedhi E.; Van der Heyden J.
Institution
(Halim, Coussement, Kedhi, Van der Heyden) Department of Cardiology,
Sint-Jan Hospital, Bruges, Belgium
(Van den Branden) Department of Cardiology, Amphia Hospital, Breda,
Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Interest in percutaneous mitral valve repair has increased during recent
years. This is mainly driven by the significant number of patients being
declined for mitral valve surgery because of a high risk of
surgery-related complications or death. In this subset of patients,
percutaneous edge-to-edge repair using the MitraClip device (Abbott, Menlo
Park, CA, USA) has become an established treatment option, proven to be
safe, efficient and associated with improved functional status. In
contrast to primary mitral regurgitation (MR), clinical outcomes after
mitral valve surgery appear to be less favourable as regards secondary MR
due to heart failure. In the MITRA-FR and COAPT trials, patients with
moderate to severe and severe secondary MR with reduced left ventricular
function received either medical treatment (control group) or MitraClip
implantation plus medical treatment (device group). Results were
conflicting, with only the COAPT trial showing better clinical outcomes in
the device group. However, both trials are now seen as complementary and
provide useful information especially regarding patient selection for
MitraClip therapy. The goal of this review is to delineate which subset of
patients with secondary MR will potentially benefit from percutaneous
mitral valve repair. Copyright © 2020, The Author(s).

<51>
Accession Number
2004465444
Title
Preoperative frailty parameters as predictors for outcomes after
transcatheter aortic valve implantation: a systematic review and
meta-analysis.
Source
Netherlands Heart Journal. 28 (5) (pp 280-292), 2020. Date of Publication:
01 May 2020.
Author
van Mourik M.S.; Velu J.F.; Lanting V.R.; Limpens J.; Bouma B.J.; Piek
J.J.; Baan J.; Henriques J.P.S.; Vis M.M.
Institution
(van Mourik, Velu, Lanting, Bouma, Piek, Baan, Henriques, Vis) Department
of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam
Cardiovascular Sciences, Amsterdam, Netherlands
(Limpens) Medical Library, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Guidelines suggest using frailty characteristics in the work-up for a
transcatheter aortic valve implantation (TAVI). There are many
frailty-screening tools with different components. The prognostic value of
the individual parameters in frailty is as yet unclear. The objective of
this systematic review and meta-analysis was to find and pool predictors
for 1-year mortality after TAVI. We followed a two-step approach. First,
we searched for randomised controlled trials on TAVI to identify frailty
parameters used in these studies. Second, we searched for publications on
these frailty parameters. Articles were included for pooled analysis if
the studied frailty parameters were dichotomised with clear cut-off values
based on common standards or clinical practice and reported adjusted
hazard ratios (HR) of 1-year mortality after TAVI. We calculated pooled
effect estimates of 49 studies based on dichotomised frailty scores (HR:
2.16, 95% CI: 1.57-3.00), chronic lung disease (HR: 1.57, 95% CI:
1.45-1.70), estimated glomerular filtration rate <30ml/min (HR: 1.95, 95%
CI: 1.68-2.29), body mass index <20kg/m2 (HR: 1.49, 95% CI:
1.09-2.03), hypoalbuminaemia (HR: 1.77, 95% CI: 1.38-2.25), anaemia (HR:
2.08, 95% CI: 0.93-4.66), low gait speed (HR: 13.33, 95% CI: 1.75-101.49)
and Katz activities of daily living (ADL) score of 1 or more deficits (HR:
5.16, 95% CI: 0.77-34.47). Chronic lung disease, chronic kidney disease,
underweight, hypoalbuminaemia, a low frailty score, anaemia, low gait
speed and an ADL deficiency were associated with worse 1-year outcomes
after TAVI. Copyright © 2020, The Author(s).

<52>
Accession Number
630760634
Title
A meta-analysis of perventricular device closure of doubly committed
subarterial ventricular septal defects.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 28), 2020. Date of
Publication: 28 Jan 2020.
Author
Huang J.-S.; Sun K.-P.; Huang S.-T.; Chen Q.; Chen L.-W.; Kuo Y.-R.
Institution
(Huang, Sun, Huang, Chen, Chen) Department of Cardiovascular Surgery,
Union Hospital, Fujian Medical University, Fuzhou 350001, China
(Huang, Sun, Huang) Department of Cardiac Surgery, Fujian Provincial
Maternity and Children's Hospital, affiliated hospital of Fujian Medical
University, Fuzhou 350001, China
(Kuo) Division of Plastic Surgery, Department of Surgery, Kaohsiung
Medical University Hospital, 100 TzYou 1st Rd ,Kaohsiung City 80756,
Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: To investigate the safety and efficacy of perventricular
device closure of doubly committed subarterial ventricular septal defects
(dcsVSDs). METHOD(S): PubMed and Scopus were searched for studies in
English that focused on perventricular device closure of dcsVSDs and were
published up to the end of September 2019. We used a random-effects model
to obtain pooled estimates of the success and complication rates.
 RESULT(S): A total of 9 publications including 459 patients with
dcsVSDs were included. The median follow-up duration ranged from 2months
to 5years, with the mean age of patients ranging from 6.1months to
4.5years. The pooled estimate of the overall success rate of device
closure in the 9 studies was 0.89 (95% CI: 0.86-0.93, I2 =26.5%, P=0.208).
Further meta-regression analysis indicated no significant correlation
between the success rate and the following factors: publication year,
sample size, study type, mean age, mean weight, mean VSD size, and ratio
of device size/weight. The pooled rate of postoperative aortic
regurgitation was 0.045 (95% CI: 0.018-0.071, I2 =50.96%, P=0.000). The
pooled rate of follow-up aortic regurgitation (AR) was 0.001 (95% CI,
-0.003-0.004, I2 =63.00%, P=0.009.) The pooled estimated rate of severe
intraoperative complications was 0.106 (0.073-0.140, I2 =70.7%, P=0.208).
Postoperative and follow-up complications were rare. No occurrence of a
complete atrioventricular block was reported up to the last follow-up
visit. CONCLUSION(S): Perventricular device closure may be an
alternative to conventional surgical repair in selected patients with
dcsVSDs. The success rate was stable regarding the publication year and
sample size, suggesting a relatively short learning curve and the
technique's potential for application.

<53>
Accession Number
631612789
Title
Effect of preoperative education and ICU tour on patient and family
satisfaction and anxiety in the intensive care unit after elective cardiac
surgery: a randomised controlled trial.
Source
BMJ quality & safety. (no pagination), 2020. Date of Publication: 22 Apr
2020.
Author
Lai V.K.W.; Ho K.M.; Wong W.T.; Leung P.; Gomersall C.D.; Underwood M.J.;
Joynt G.M.; Lee A.
Institution
(Lai, Wong, Leung, Gomersall, Joynt, Lee) Department of Anaesthesia and
Intensive Care, Chinese University of Hong Kong, Shatin, New Territories,
Hong Kong
(Ho) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, Shatin, New Territories, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
Publisher
NLM (Medline)
Abstract
BACKGROUND: Preoperative education may help participants to
psychologically prepare themselves for surgery, but the outcomes of such
preparation have rarely been assessed in patients requiring postoperative
care in the intensive care unit (ICU) as well as in family members.
 OBJECTIVE(S): To assess the effect of a preoperative multifaceted
education intervention on patient and family satisfaction levels in the
ICU and measures of perioperative patients' anxiety and depression. TRIAL
DESIGN: Single-centre, two-armed, parallel, superiority, randomised
controlled trial. Healthcare professionals in ICU and outcome assessor
were blinded to treatment allocation. PARTICIPANTS: 100 elective coronary
artery bypass grafting+/-valve surgery patients and their family members.
INTERVENTIONS: Preoperative education comprising of a video and ICU tour
in addition to standard care (treatment), versus standard care (control).
 OUTCOME(S): Patient and family satisfaction levels with ICU using
validated PS-ICU23 and FS-ICU24 questionnaires (0-100), respectively;
change in perioperative anxiety and depression scores between 1day
presurgery and 3days postsurgery. RESULT(S): Among 100 (50 treatment,
50 control) patients and 98 (49 treatment, 49 control) family members, 94
(48 treatment, 46 control) patients and 94 (47 treatment, 47 control)
family members completed the trial. Preoperative education was associated
with higher overall patient (mean difference (MD) 6.7, 95%CI 0.2 to 13.2)
and family (MD 10.0, 95%CI 3.8 to 16.3) satisfaction scores. There was a
weak association between preoperative education and a reduction in
patient's anxiety scores over time (MD -1.7, 95%CI -3.5 to 0.0). However,
there was no evidence of a treatment effect on patient's depression scores
over time (MD -0.6, 95%CI -2.3 to 1.2). CONCLUSION(S): Providing
comprehensive preoperative information about ICU to elective cardiac
surgical patients improved patient and family satisfaction levels and may
decrease patients' anxiety levels. TRIAL REGISTRATION NUMBER:
ChiCTR-IOR-15006971. Copyright © Author(s) (or their employer(s))
2020. No commercial re-use. See rights and permissions. Published by BMJ.

<54>
Accession Number
631611610
Title
The role of 18FDG PET/CT in the assessment of endocarditis, myocarditis
and pericarditis.
Source
Current radiopharmaceuticals. (no pagination), 2020. Date of Publication:
21 Apr 2020.
Author
Giorgetti A.; Genovesi D.; Emdin M.
Institution
(Giorgetti, Genovesi, Emdin) Italy. 2. Institute of Life Sciences, Scuola
Superiore Sant'Anna, Pisa, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Endocarditis, myocarditis and pericarditis are a heterogeneous
group of phenotypic syndromes where the culprit area of inflammation is
the heart. Inflammation may be determined by an infective agent, toxins,
drugs or an activated immune system. Clinical manifestations can be subtle
and diagnosis remains a challenge for cardiologists, requires high level
of suspicion and advanced multimodal cardiac imaging to avoid
life-threatening consequences. OBJECTIVE(S): The purpose of this
review is to report the recent advances of PET/CT imaging with 18FDG in
helping the management of patients affected by inflammatory heart disease.
 METHOD(S): Two independent reviewers searched in PubMed articles
published before or on June 2019 and final decisions on the inclusion of
references were done in consensus with a third reviewer. At the end of the
selection process were included 23/206 articles on "cardiac inflammation";
26/235 articles on "endocarditis", "prosthetic heart valve", "pacemaker",
"implantable cardiac device"; 7/103 articles on "myocarditis"; 13/330
articles on sarcoidosis" and 2/19 articles on "pericarditis".
 CONCLUSION(S): Compared with conventional methods, molecular imaging
has the advantage to noninvasively and directly trace the inflammatory
process, and to early identify the presence and the extent of
intra-cardiac and extra-cardiac involvement, to enable quantification of
disease activity, guide therapeutic interventions, and monitor treatment
success. Copyright© Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

<55>
Accession Number
2005684581
Title
Effects of bisoprolol transdermal patches for prevention of perioperative
myocardial injury in high-risk patients undergoing non-cardiac surgery -
multicenter randomized controlled study -.
Source
Circulation Journal. 84 (4) (pp 642-649), 2020. Date of Publication: 2020.
Author
Toda H.; Nakamura K.; Shimizu K.; Ejiri K.; Iwano T.; Miyoshi T.; Nakagawa
K.; Yoshida M.; Watanabe A.; Nishii N.; Hikasa Y.; Hayashi M.; Morita H.;
Morimatsu H.; Ito H.
Institution
(Toda, Nakamura, Ejiri, Iwano, Miyoshi, Nakagawa, Yoshida, Watanabe,
Nishii, Morita, Ito) Department of Cardiovascular Medicine, Okayama
University, Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Shimizu, Hikasa, Hayashi, Morimatsu) Department of Anesthesiology,
Okayama University, Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences, Okayama, Japan
(Morita) Department of Cardiovascular Therapeutics, Okayama University,
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,
Okayama, Japan
Publisher
Japanese Circulation Society
Abstract
Background: The aim of this study was to evaluate the efficacy and safety
of transdermal beta-blocker patches, which offer stable blood
concentration and easy availability during operation, for prevention of
perioperative myocardial injury (PMI) in high-risk patients. Methods
and Results: In this randomized controlled trial, patients aged >60 years
with hypertension and high revised cardiac risk index (>=2) undergoing
non-cardiac surgery were randomly assigned to a bisoprolol patch or
control group. Primary efficacy outcome was incidence of PMI, defined as
postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL
and relative hs-cTnT change >=20%. Secondary efficacy outcomes were number
of cardiovascular events and 30-day mortality. From November 2014 to
February 2019, 240 patients from 5 hospitals were enrolled in this study.
The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in
the control group (P=0.18). Incidence of major adverse cardiac events
including non-critical myocardial infarction, strokes, decompensated heart
failure and tachyarrhythmia was similar between the 2 groups.
Tachyarrhythmia tended to be higher in the control group. There were no
significant differences in safety outcomes including significant
hypotension and bradycardia requiring any treatment between the 2 groups.
 Conclusion(s): Bisoprolol patches do not influence the incidence of
PMI and cardiovascular events in high-risk patients undergoing non-cardiac
surgery, but perioperative use of these patches is safe. Copyright
© 2020 Japanese Circulation Society. All rights reserved.

<56>
Accession Number
2005684548
Title
Long-term outcomes of absorb bioresorbable vascular scaffold vs.
Everolimus-eluting metallic stent - a randomized comparison through 5
years in Japan -.
Source
Circulation Journal. 84 (5) (pp 733-741), 2020. Date of Publication: 2020.
Author
Kozuma K.; Tanabe K.; Hamazaki Y.; Okamura T.; Ando J.; Ikari Y.; Nakagawa
Y.; Kusano H.; Ediebah D.; Kimura T.
Institution
(Kozuma) Department of Cardiology, Teikyo University, Tokyo, Japan
(Tanabe) Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Hamazaki) Division of Cardiology, Ootakanomori Hospital, Chiba, Japan
(Okamura) Department of Medicine and Clinical Science, Yamaguchi
University, Graduate School of Medicine, Yamaguchi, Japan
(Ando) Department of Cardiovascular Medicine, University of Tokyo
Hospital, Tokyo, Japan
(Ikari) Department of Cardiology, Tokai University Hospital, Kanagawa,
Japan
(Nakagawa) Department of Cardiovascular Medicine, Shiga University of
Medical Science, Shiga, Japan
(Kusano, Ediebah) Abbott Vascular, Santa Clara, CA, United States
(Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
Publisher
Japanese Circulation Society
Abstract
Background: Bioresorbable vascular scaffolds (BVS) are promising
alternatives to metallic drug-eluting stents (DES) in percutaneous
coronary interventions. Absorb BVS was comparable to XIENCE (DES) for
patient- and device-oriented composite endpoints through 1 year
post-procedure. Mid-term results showed increased rates of device-oriented
events with Absorb. The objective of this study was to evaluate the
long-term safety and effectiveness of Absorb BVS compared with XIENCE
metallic DES when implanted in patients in Japan with de novo coronary
artery lesions. Methods and Results: ABSORB Japan randomized 400
patients into either Absorb (n=266) or XIENCE (n=134) treatment arm.
Through 5-year follow-up, the composite endpoints of DMR (death,
myocardial infarction [MI], and all revascularization), target vessel
failure (TVF), major adverse cardiac events (MACE), target lesion failure
(TLF), and cardiac death/all MI were evaluated. Individual endpoints
included death, MI, coronary revascularization, and scaffold/stent
thrombosis. There were no significant differences in the composite or
individual endpoint outcomes between the Absorb and XIENCE arms through 5
years or between 3 and 5 years. Numerically lower TVF, MACE, and all MI
rates were observed for the Absorb vs. XIENCE arm after 3 years. No
scaffold/stent thrombosis was reported beyond 3 years. Post-procedure
imaging subgroups showed comparable event rates. Conclusion(s):
Following resorption of the scaffold, between 3 and 5 years
post-procedure, the Absorb BVS performed comparably to XIENCE in all
patient- and device-oriented endpoints (ClinicalTrials.gov,
#NCT01844284). Copyright © 2020 Japanese Circulation Society. All
rights reserved.

<57>
Accession Number
631486048
Title
Can hypnosis and virtual reality reduce anxiety, pain and fatigue among
patients who undergo cardiac surgery: A randomised controlled trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 330. Date of
Publication: 15 Apr 2020.
Author
Rousseaux F.; Faymonville M.-E.; Nyssen A.-S.; Dardenne N.; Ledoux D.;
Massion P.B.; Vanhaudenhuyse A.
Institution
(Rousseaux, Nyssen) Laboratory of Cognitive Ergonomics and Work
Intervention, University of Liege, ULiege (B32), Quartier Agora-Place des
Orateurs, 2, Liege 4000, Belgium
(Rousseaux, Faymonville, Vanhaudenhuyse) Algology Department, University
Hospital of Liege, CHU Sart Tilman Domaine Universitaire du Sart Tilman
B35, Liege 4000, Belgium
(Rousseaux, Faymonville, Nyssen, Vanhaudenhuyse) Sensation and Perception
Research Group, Giga Consciousness, University of Liege, GIGA (B34),
Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000, Belgium
(Dardenne) Public Health Department, Biostatistics, University of Liege,
CHU (B35) Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000, Belgium
(Ledoux, Massion) Intensive Care Units, University Hospital of Liege, CHU
(B35)Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000, Belgium
(Ledoux) Anesthesia and Intensive Care, Giga Consciousness, University of
Liege, GIGA (B34)Quartier Hopital-Avenue de l'Hopital, 11, Liege 4000,
Belgium
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Different non-pharmacological techniques, including hypnosis
and virtual reality (VR) are currently used as complementary tools in the
treatment of anxiety, acute and chronic pain. A new technique called
virtual reality hypnosis (VRH), which encompasses a combination of both
tools, is regularly used although its benefits and underlying mechanisms
remain unknown to date. With the goal to improve our understanding of VRH
combination effects, it is necessary to conduct randomised and controlled
research trials in order to understand their clinical interest and
potential benefits. Method(s): Patients (n = 100) undergoing cardiac
surgery at the Liege University Hospital will be randomly assigned to one
of four conditions (control, hypnosis, VR or VRH). Each patient will
receive two sessions of one of the techniques: One the day before the
surgery and one the day after. Physiological assessments will be made on
the monitor and patients will rate their levels of anxiety, fatigue, pain,
absorption and dissociation. Discussion(s): This study will help to
expand knowledge on the application of virtual reality, hypnosis and VRH
in the specific context of cardiac and intensive care procedures, and the
influence of these non-pharmacological techniques on patient's anxiety,
fatigue, pain and phenomenological experience. Trial registration:
ClinicalTrials.gov: NCT03820700. Date registered on 29 January 2019. Study
recruitment date: October 6, 2018. Study anticipated completion date:
December 28, 2020. Copyright © 2020 The Author(s).

<58>
Accession Number
2004242524
Title
Effect of single-dose crystalloid cardioplegic agent compared to bloody
cardioplegic agent in cardiac surgery in children with tetralogy of
fallot.
Source
ARYA Atherosclerosis. 16 (1) (pp 24-32), 2020. Date of Publication: 2020.
Author
Bigdelian H.; Hosseini A.
Institution
(Bigdelian) Department of Cardiac Surgery, School of Medicine, Cardiac
Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Hosseini) Department of Cardiac Surgery, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Cardioplegia is one of the main post-operative cardiac
protective factors widely used in recent decades in the form of
crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose
of this study was to compare the effect of a crystalloid cardioplegic
agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in
pediatric cardiac surgery among children with Tetralogy of Fallot (TOF).
 METHOD(S): This study was performed on 60 children with TOF, who were
candidates for heart repair surgery. The participants were randomly
divided into two groups of crystalloid cardioplegic agent and bloody
cardioplegic agent. Operative outcomes such as required time for onset of
heart arrest, duration of returning to normal heart rhythm, and
cardiopulmonary bypass (CPB) time, and operative complications were
compared between the two groups. RESULT(S): The duration of returning
to normal heart rhythm (50.43 +/- 10.93 seconds vs. 43.03 +/- 16.35
seconds; P = 0.044) and duration of inotropy (80.40 +/- 27.14 hours vs.
63.20 +/- 26.91 hours; P = 0.017) were significantly higher in the DN
group compared to the St. Thomas group. However, there were no significant
differences between the two groups in terms of heart arrest time,
cross-clamp time, CPB time, supplementary lasix time, duration of
intubation, and intensive care unit (ICU) and hospital length of stay
(LOS) (P > 0.050). CONCLUSION(S): The use of St. Thomas cardioplegic
solution was more effective in reducing the duration of returning to
normal heart rhythm and inotropy compared with DN cardioplegic agent, and
a single dose of these two cardioplegic agents can keep the mean cardiac
arrest duration within the range of 50-70 minutes. It seems that the use
of St. Thomas cardioplegic solution can be suggested in pediatric heart
surgery. Copyright © 2020, Isfahan University of Medical
Sciences(IUMS). All rights reserved.

<59>
Accession Number
2004253870
Title
The prognostic value of late gadolinium enhancement in myocarditis and
clinically suspected myocarditis: systematic review and meta-analysis.
Source
European Radiology. 30 (5) (pp 2616-2626), 2020. Date of Publication: 01
May 2020.
Author
Yang F.; Wang J.; Li W.; Xu Y.; Wan K.; Zeng R.; Chen Y.
Institution
(Yang, Wang, Li, Xu, Zeng, Chen) Department of Cardiology, West China
Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan
610041, China
(Wan) Department of Geriatrics, West China Hospital, Sichuan University,
Chengdu, Sichuan Province 610041, China
(Chen) Center of Rare diseases, West China Hospital, Sichuan University,
Chengdu, Sichuan Province 610041, China
Publisher
Springer
Abstract
Objective: To evaluate the prognostic value of late gadolinium enhancement
(LGE) in myocarditis and clinically suspected myocarditis. Method(s):
The study was registered in PROSPERO (CRD42019144976). A systematic search
of PubMed, Ovid Medline, Embase, Web of Science and the Cochrane Central
Register of Controlled Trials was completed. Major adverse cardiac event
(MACE) was defined as the combination of all-cause mortality or
cardiovascular death, resuscitated cardiac arrest, heart transplantation,
appropriate implantable cardioverter-defibrillator shock,
rehospitalisation following a cardiac event and recurrent acute
myocarditis. Combined outcome was defined as the combination of all
adverse events. Pooled odds ratios (ORs) and 95% confidence intervals
(CIs) were calculated to evaluate the prognostic value of LGE.
 Result(s): Eight articles including 1319 patients (mean age, 38.8 +/-
12.9 years) were included in the meta-analysis. The study showed that
positive LGE was strongly associated with an increased risk of combined
outcome (pooled OR, 5.85; 95% CI, 2.88 to 11.86; p < 0.001) and of MACE
(pooled OR, 4.57; 95% CI, 2.18 to 9.59; p < 0.001). Additionally, in a
subgroup analysis with mean ejection fraction (EF) point of 50%, the
pooled ORs for the combined outcome were 6.46 for left ventricular EF
(LVEF) > 50% and 7.90 for LVEF <= 50%, and the pooled ORs for MACE were
9.03 and 3.45, respectively. After 3 years of follow-up, the worse
outcomes occurred mainly in patients with positive LGE.
 Conclusion(s): Positive LGE is a powerful prognosticator of adverse
outcome in myocarditis and clinically suspected myocarditis, irrespective
of LVEF. Key Points: * Forty-four percent to 100% of myocarditis patients
have positive late gadolinium enhancement. * Positive LGE was a powerful
prognosticator of adverse outcome in myocarditis and clinically suspected
myocarditis, irrespective of LVEF. * LGE-CMR is important tool for risk
stratification in myocarditis and clinically suspected
myocarditis. Copyright © 2020, European Society of Radiology.

<60>
Accession Number
2005127868
Title
Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in
Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1457-1463),
2020. Date of Publication: June 2020.
Author
van Klarenbosch J.; van den Heuvel E.R.; van Oeveren W.; de Vries A.J.
Institution
(van Klarenbosch) Department of Anesthesiology, University Medical Center
Utrecht, Utrecht, Netherlands
(van den Heuvel) Department of Mathematics & Computer Science, Eindhoven
University of Technology, Eindhoven, Netherlands
(van Oeveren) HaemoScan BV, Groningen, Netherlands
(de Vries) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Primary outcome was the risk for infections after cell salvage
in cardiac surgery. Design(s): Data of a randomized controlled trial
on cell salvage and filter use (ISRCTN58333401). Setting(s): Six
cardiac surgery centers in the Netherlands. Participant(s): All 716
patients undergoing elective coronary artery bypass grafting, valve
surgery, or combined procedures over a 4-year period who completed the
trial. Intervention(s): Postoperative infection data were assessed
according to Centre of Disease Control and Prevention/National Healthcare
Safety Network surveillance definitions. Measurements and Main
Results: Fifty-eight (15.9%) patients with cell salvage had infections,
compared with 46 (13.1%) control patients. Mediation analysis was
performed to estimate the direct effect of cell salvage on infections (OR
2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic
transfusion and processed cell salvage blood on infections. Correction for
confounders, including age, seks and body mass index was performed.
Allogeneic transfusion had a direct effect on infections (OR = 2.082
[1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR =
0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of
cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p <
0.001), but a negative direct effect of processed cell salvage blood
(1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there
was a positive direct effect of cell salvage on the amount of processed
blood. Conclusion(s): Cell salvage was directly associated with
higher infection rates, but this direct effect was almost completely
eliminated by its indirect protective effect through reduced allogeneic
blood transfusion. Copyright © 2020 The Authors

<61>
Accession Number
2004868838
Title
Reduction of Inflammation by High-Dose Methylprednisolone Does not
Attenuate Oxidative Stress in Children Undergoing Bidirectional Glenn
Procedure With or Without Aortic Arch or Pulmonary Arterial Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1542-1547),
2020. Date of Publication: June 2020.
Author
Keski-Nisula J.; Arvola O.; Jahnukainen T.; Andersson S.; Pesonen E.
Institution
(Keski-Nisula) Division of Anaesthesiology, Department of Anaesthesiology,
Intensive Care and Pain Medicine, Children's Hospital, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Arvola) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Jahnukainen) Department of Pediatric Nephrology and Transplantation,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Andersson) Department of Neonatology, Pediatric Research Center,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Pesonen) Division of Anaesthesiology, Department of Anaesthesiology,
Intensive Care and Pain Medicine, Kirurginen sairaala, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids attenuate an inflammatory reaction in pediatric
heart surgery. Inflammation is a source of free oxygen radicals. Children
with a cyanotic heart defect are prone to increased radical stress during
heart surgery. The authors hypothesized that high-dose methylprednisolone
reduces inflammatory reaction and thereby also oxidative stress in infants
with a univentricular heart defect undergoing the bidirectional Glenn
procedure. Design(s): A double-blind, placebo-controlled, randomized
clinical trial. Setting(s): Operating room and pediatric intensive
care unit of a university hospital. Participant(s): The study
comprised 29 infants undergoing the bidirectional Glenn procedure with or
without aortic arch or pulmonary arterial repair. Intervention(s):
After anesthesia induction, the patients received intravenously either 30
mg/kg of methylprednisolone (n = 15) or the same volume of saline as
placebo (n = 14). Measurements and Main Results: Plasma
interleukin-6, interleukin-8, interleukin-10 (biomarkers of inflammation),
and 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative
stress) were measured at the following 4 time points: preoperatively,
during cardiopulmonary bypass, after protamine administration, and 6 hours
postoperatively. The study parameters did not differ between the study
groups preoperatively. Methylprednisolone reduced the proinflammatory
cytokines interleukin-6 and interleukin-8 and increased the
anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced
inflammation, there were no differences in 8-hydroxydeoxyguanosine between
the methylprednisolone and placebo groups. Conclusion(s): The
proinflammatory reaction and increase in free radical stress were not
interrelated during congenital heart surgery in cyanotic infants with a
univentricular heart defect undergoing the bidirectional Glenn procedure.
High-dose methylprednisolone was ineffective in attenuating free radical
stress. Copyright © 2019 Elsevier Inc.

<62>
Accession Number
2004846084
Title
Lack of Association Between Gaseous Microembolisms Assessed by a Single
Detection Device and Cerebral Complications in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1496-1503),
2020. Date of Publication: June 2020.
Author
Wiberg S.; Vedel A.G.; Holmgaard F.; Kjaergaard J.; Langkilde A.R.;
Hassager C.; Steensgaard J.; Rasmussen L.S.; Nilsson J.-C.
Institution
(Wiberg, Kjaergaard, Hassager) Department of Cardiology, Copenhagen
University Hospital Rigshospitalet, Copenhagen, Denmark
(Vedel, Holmgaard, Steensgaard, Nilsson) Department of Cardiothoracic
Anesthesia, Copenhagen University Hospital Rigshospitalet, Copenhagen,
Denmark
(Langkilde) Department of Radiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Hassager, Rasmussen) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Publisher
W.B. Saunders
Abstract
Objective: To assess the association between total volume and number of
gaseous microemboli (GME) in the cardiopulmonary bypass (CPB) circuit and
the occurrence of new postoperative cerebral infarctions and postoperative
cognitive dysfunction (POCD) in patients undergoing cardiac surgery.
 Design(s): Predefined subanalyses of the randomized controlled
Perfusion Pressure Cerebral Infarcts (PPCI) trial. Setting(s):
Primary heart center in a university hospital. Participant(s): A
total of 143 adult patients undergoing cardiac surgery with CPB.
 Intervention(s): Patients were allocated 1:1 to a low-target mean
arterial pressure (MAP) of 40 to 50 mmHg or a high-target MAP of 70 to 80
mmHg during CPB with a fixed pump flow of 2.4 liters per minute per square
meter body surface area plus 10% to 20%. Measurements and Main
Results: The total volume and number of GME in the CPB circuit were
assessed by the Bubble Counter Clinical 200 (GAMPT GmbH). New cerebral
infarcts were identified by diffusion-weighted magnetic resonance imaging
(DWI) 3 to 6 days after surgery. The median number of GME per patient was
8069 (range 1,523-204,095) with a median total volume of 1.2 muL (range
0.07-48 muL). A total of 66 (46%) patients had DWI detected cerebral
infarcts postoperatively, and 36 (28%) patients had POCD after 7 days. The
authors found no significant association between volume or number of GME
with MAP target allocation, presence of cerebral infarction, or POCD.
 Conclusion(s): The authors found no significant associations between
volume or number of GME with the occurrence of cerebral infarction or
cognitive dysfunction in cardiac surgery patients. Copyright ©
2019 Elsevier Inc.

<63>
Accession Number
2004724161
Title
Differences in morbidity and mortality in Down syndrome are related to the
type of congenital heart defect.
Source
American Journal of Medical Genetics, Part A. (no pagination), 2020. Date
of Publication: 2020.
Author
Baban A.; Olivini N.; Cantarutti N.; Cali F.; Vitello C.; Valentini D.;
Adorisio R.; Calcagni G.; Alesi V.; Di Mambro C.; Villani A.; Dallapiccola
B.; Digilio M.C.; Marino B.; Carotti A.; Drago F.
Institution
(Baban, Olivini, Cantarutti, Cali, Vitello, Adorisio, Calcagni, Di Mambro,
Drago) Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of
Pediatric Cardiology and Cardiac Surgery, Bambino Gesu Children's
Hospital, IRCCS, Rome, Italy
(Valentini, Villani) Pediatric and Infectious Disease Unit, Bambino Gesu
Children's Hospital, IRCCS, Rome, Italy
(Alesi, Digilio) Medical Genetics Unit, Medical Genetics Laboratory,
Pediatric Cardiology, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
(Dallapiccola) Scientific Directorate, Bambino Gesu Children's Hospital,
IRCCS, Rome, Italy
(Marino) Department of Pediatrics, Sapienza University of Rome, Rome,
Italy
(Carotti) Pediatric Cardiac Surgery Unit, Department of Pediatric
Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, IRCCS,
Rome, Italy
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Morbidity and mortality in Down syndrome (DS) are mainly related to
congenital heart defects (CHDs). While CHDs with high prevalence in DS
(typical CHDs), such as endocardial cushion defects, have been extensively
described, little is known about the impact of less common CHDs (atypical
CHDs), such as aortic coarctation and univentricular hearts. In our
single-center study, we analyzed, in observational, retrospective manner,
data regarding cardiac features, surgical management, and outcomes of a
cohort of DS patients. Literature review was performed to investigate
previously reported studies on atypical CHDs in DS. Patients with CHDs
were subclassified as having typical or atypical CHDs. Statistical
analysis was performed for comparison between the groups. The study
population encompassed 859 DS patients, 72.2% with CHDs, of which 4.7%
were atypical. Statistical analysis showed a significant excess in
multiple surgeries, all-cause mortality and cardiac mortality in patients
with atypical CHDs (p =.0067, p =.0038, p =.0001, respectively). According
to the Kaplan-Meier method, survival at 10 and 40 years was significantly
higher in typical CHDs (99 and 98% vs. 91 and 84%, log rank <0.05). Among
atypical CHDs, it seems that particularly multiple complex defects in
univentricular physiology associate with a worse outcome. This may be due
to the surgical difficulty in managing univentricular hearts with multiple
defects concurring to the clinical picture or to the severity of
associated defects themselves. Further studies need to address this
specific issue, also considering the higher pulmonary pressures, infective
complications, and potential comorbidities in DS patients. Copyright
© 2020 Wiley Periodicals, Inc.

<64>
Accession Number
2003450587
Title
Trials Focusing on Prevention and Treatment of Delirium After Cardiac
Surgery: A systematic Review of Randomized Evidence.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (6) (pp 1641-1654),
2020. Date of Publication: June 2020.
Author
Pieri M.; De Simone A.; Rose S.; De Domenico P.; Lembo R.; Denaro G.;
Landoni G.; Monaco F.
Institution
(Pieri, De Domenico, Lembo, Denaro, Landoni, Monaco) Department of
Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(De Simone) Department of Neonatal Intensive Care Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Rose) Department of Neurology Rehabilitation, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Publisher
W.B. Saunders
Abstract
Background: Delirium after cardiac surgery is associated with adverse
outcomes, including prolonged hospital stay, prolonged intensive care unit
stay, and increased mortality. Effective preventive interventions and
treatments still are largely unknown. Aim(s): This systematic review
aimed to gather and summarize the existing evidence from randomized trials
concerning interventions studied in the prevention or treatment of
delirium in adult patients undergoing cardiac surgery. Method(s): A
systematic review of the literature using a key word strategy and Boolean
operators was performed. PubMed and the Cochrane and Scopus databases were
searched for pertinent studies until July 2018 (no inception limit).
 Result(s): Of 2,556 articles identified, 56 studies met the inclusion
criteria and were included in the review-39 addressed pharmacologic
strategies and 17 nonpharmacologic interventions. Interestingly, 51 (91%)
trials focused on delirium prevention and only 5 (9%) on delirium
treatment. Most of the analyzed studies were recent double-blind,
single-center trials conducted in Europe or North America, with a low risk
of bias. Overall, 38 different interventions were identified: 15 (26%)
interventions were performed before surgery, 20 (36%) in the operating
room, and 21 (38%) after surgery. The most frequently analyzed strategies
were the administration of dexmedetomidine, ketamine, antipsychotics,
glucocorticoids, propofol, opioids, volatile anesthetics, local
anesthetics, and remote ischemic preconditioning. The analyzed strategies
were extremely heterogenous, and dexmedetomidine was the most promising
measure able to prevent the development of postoperative delirium.
 Conclusion(s): In the present systematic review of 56 randomized
controlled trials that examined 38 interventions, the authors found that
dexmedetomidine was the most frequently studied agent and that it might
reduce the occurrence of delirium after cardiac surgery. Copyright
© 2019 Elsevier Inc.

<65>
Accession Number
631605952
Title
Rationale and design of reduce-it: Reduction of cardiovascular events with
icosapent ethyl-intervention trial.
Source
Clinical Cardiology. Conference: 2017 Congress on Cardiovascular Disease
Prevention. United States. 40 (Supplement 1) (pp 14), 2017. Date of
Publication: September 2017.
Author
Bhatt D.; Steg G.; Brinton E.; Jacobson T.; Miller M.; Tardif J.-C.;
Ketchum S.; Doyle R.; Murphy S.; Soni P.; Braeckman R.; Juliano R.;
Ballantyne C.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Synopsis: Residual cardiovascular (CV) risk persists in some
patients despite optimal statin use and has been associated in part to
elevated triglycerides (TG). Despite the fact that elevated TG represent
an independent risk factor for CV events, CV outcomes studies of
TG-lowering therapies added to statins have not demonstrated benefit.
Further, low-dose omega-3 CV outcome trials have demonstrated mixed
results and no CV outcomes trial has yet been completed in patients
prospectively selected based on elevated TG despite statin therapy. The
omega-3 fatty acid eicosapentaenoic acid (EPA) reduces TG without raising
LDL-C when administered in prescription-strength doses. EPA has also been
demonstrated to have potentially cardioprotective pleiotropic effects
beyond TG lowering. Objective/Purpose: The Reduction of Cardiovascular
Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT; NCT01492361) is
examining whether icosapent ethyl (highly purified ethyl ester of EPA)
reduces ischemic CV events in statin-treated patients with high TG at
elevated CV risk. Method(s): REDUCE-IT is a phase 3b, multinational,
double-blind trial that randomized patients to prescription-strength
icosapent ethyl (4 g/day) or placebo control. REDUCE-IT enrolled men or
women age >=45 years with established CV disease (approximately 70% of
patients) or who were at high CV risk, defined as age >=50 years with
diabetes mellitus and >=1 additional risk factor (approximately 30% of
patients). Patients were required to have fasting TG >=150 mg/dL and <500
mg/dL and LDL-C >40 mg/dL and <=100 mg/dL with stable statin (ezetimibe)
>=4 weeks prior to qualifying measurements. The primary endpoint is a
composite of CV death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina. The key secondary endpoint
is a composite of CV death, nonfatal myocardial infarction, or nonfatal
stroke. Several secondary, tertiary, and exploratory endpoints will also
be assessed. Result(s): Approximately 8,000 patients have been
randomized at approximately 470 centers worldwide. Follow-up will continue
until approximately 1,612 adjudicated primary efficacy endpoint events
occur. Conclusion(s): REDUCE-IT will address a long-standing
scientific gap by testing the effectiveness of icosapent ethyl to reduce
CV events in patients with elevated TG and residual CV risk despite statin
therapy.

<66>
Accession Number
631561943
Title
Annual case volume on mortality after coronary artery bypass grafting: A
dose-response meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (4) (pp 568-575),
2019. Date of Publication: 01 Oct 2019.
Author
Tie H.-T.; Shi R.; Zhou Q.; Wang K.; Zheng X.-Q.; Wu Q.-C.
Institution
(Tie, Wu) Department of Cardiothoracic Surgery, First Affiliated Hospital
of Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District,
Chongqing 400016, China
(Shi) Department of Cardiology, First Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Zhou) Department of Science and Education, First People's Hospital of
Changde City, Hunan, China
(Wang) Department of Endocrine and Breast Surgery, First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Zheng) Department of Chemical Biology, School of Pharmaceutical Science,
Peking University Health Science Center, Beijing, China
Publisher
Oxford University Press
Abstract
OBJECTIVES: This study evaluated the effect of both hospital and surgeon
annual case volumes on patient mortality following coronary artery bypass
grafting (CABG). METHOD(S): PubMed and Embase databases were searched
for clinical studies on CABG. The outcome was mortality, including
operative mortality, in-hospital mortality and 30-day mortality.
 RESULT(S): Twenty-five studies involving 3 492 101 participants and
143 951 deaths were included for hospital volume, and 4 studies involving
108 356 participants and 2811 deaths were included for surgeon volume. The
pooled estimate revealed that both hospital and surgeon annual case
volumes were inversely associated with mortality in patients after CABG
[odds ratio (OR) for hospital: 0.62, 95% confidence interval (CI)
0.56-0.69; P < 0.001; OR for surgeon: 0.51, 95% CI 0.31-0.83; P < 0.001]
with high heterogeneity (hospital: I2 = 90.6%,
P<inf>heterogeneity</inf> < 0.001; surgeon: I2 = 86.8%,
P<inf>heterogeneity</inf> < 0.001). The relationship remained consistent
and robust in most subgroup and sensitivity analyses. Our meta-regression
analysis of time suggested that the strength of the negative associations
between volume and mortality for both hospitals and surgeons remained
unattenuated over time even though the CABG mortality gradually decreased
over time. The dose-response analysis suggested a non-linear relationship
between both hospital and surgeon annual case volumes and mortality (both
P<inf>non-linearity</inf> = 0.001). CONCLUSION(S): Both higher
hospital and surgeon annual case volumes are associated with lower
mortality in patients undergoing CABG, and the negative associations
remain unattenuated over time. Clinical registration number: The study was
registered at PROSPERO as CRD42017067912. Copyright © 2019 The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<67>
Accession Number
631593392
Title
Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass
After Cardiac Surgery.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 26 (pp e920039), 2020. Date of Publication: 20 Apr
2020.
Author
Lin X.; Ma X.; Cui X.; Zhang R.; Pan H.; Gao W.
Institution
(Lin, Ma, Cui, Zhang, Pan, Gao) Department of Anesthesiology, Second
Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND Lung injury after cardiopulmonary bypass (CPB) is a serious
postoperative complication and can affect the postoperative recovery. The
purpose of this study was to explore whether erythropoietin (EPO) has an
effect on lung injury caused by CPB. MATERIAL AND METHODS Sixty patients
who received the CPB were randomly divided into a saline group and the EPO
group. All the patients received saline or EPO preoperatively,
respectively. The ventilation function, including dynamic compliance, peak
airway pressure, and plateau pressure, were recorded. The level of tumor
necrosis factor (TNF)-alpha, interleukin (IL)-1s, and IL-10 in serum and
arterial blood gas were analyzed. The mechanical ventilation time in the
intensive care unit (ICU), the length of time spent in the ICU, the time
from operation to discharge, and the total time of hospitalization were
recorded. Adverse events in the ICU were monitored and recorded. RESULTS
EPO significantly decreased the level of TNF-alpha and IL-1s, but
increased the level of IL-10 after CPB. EPO significantly improved
pulmonary ventilated function and gas exchange function after CPB. EPO
significantly shortened the mechanical ventilation time and stay in the
ICU. CONCLUSIONS Preoperative EPO injection reduced lung injury and
promoted lung function in patients who underwent CPB. The protection
effect of EPO may be associated with inhibition of inflammatory response.

<68>
Accession Number
631593388
Title
Comparison of third generation balloon-expandable Edwards Sapien 3 versus
self-expandable Evolut R in transcatheter aortic valve implantation: a
meta-analysis.
Source
Annals of palliative medicine. (no pagination), 2020. Date of Publication:
20 Apr 2020.
Author
Li Y.-M.; Tsauo J.-Y.; Liao Y.-B.; Zhao Z.-G.; Chen M.
Institution
(Li, Tsauo, Liao, Zhao, Chen) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu 610041, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The 3rd generations of transcatheter heart valve system,
including Edwards SAPIEN S3 (ES3) and Medtronic's Evolut R, has been
developed to specifically improve the safety of transcatheter aortic valve
implantation (TAVI). The aim of this work was to provide a summary effect
estimate of the peri-procedural characteristics and clinical outcome of
patients treated with ES3 versus the Evolut R. METHOD(S): We
conducted a literature search of PubMed, Ovid and EMBASE (2002 to 2018).
Two authors extracted the data independently. The safety and feasibility
of Sapien 3 and Evolut R were compared by odds ratios (ORs) with 95%
confidence intervals (CIs) in inverse variance method. RESULT(S):
After a multi-step assessment, a total 6 studies were finally included,
yielding 1,664 patients, of which, 768 (46%) used ES3 and 896 (54%) used
Evolut R. There was no statistical difference with device success rate (OR
1.15, 95% CI: 0.70-1.91, I2 =0%), 30-day mortality [OR: 0.72 (0.33-1.57),
I2 =0%], pre-dilation rate, 30-day stroke, bleeding complication (BC)
(major and life-threating), major vascular complication (VC), and
paravalvular leakage between the two groups. However, the ES3 group was
associated with a higher risk of acute kidney injury (AKI), higher mean
aortic valve gradient and better mean left ventricular ejection fraction
(LVEF) after TAVR procedure. Moreover, the Evolut R group had a higher
rate of post-dilation and new permanent pacemaker implantation (PPMI).
 CONCLUSION(S): Both devices had demonstrated excellent procedural
success rate and short-term safety. At 30-day follow-up, both devices
shared similar rates of mortality, BC, VC, stroke, and paravalvular
leakage (PVL). However, the rate of AKI was higher in the ES3 group, and
the rate of PPM was higher in the Evolut R group.

<69>
Accession Number
631599532
Title
The Effect of Acupressure on Acute Pain During Venipuncture in Children:
Implications for Evidence-Based Practice.
Source
Worldviews on evidence-based nursing. (no pagination), 2020. Date of
Publication: 22 Apr 2020.
Author
Koc Ozkan T.; Balci S.
Institution
(Koc Ozkan) Midwifery Department, Adiyaman University Faculty of Health
Sciences, Adiyaman, Turkey
(Balci) Department of Child Health and Diseases Nursing, Florence
Nightingale Faculty of Nursing, Istanbul University, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
AIMS: The study was conducted as a randomized controlled trial in order to
determine the effects of acupressure on acute pain during venipuncture in
children. METHOD(S): The population of the study consisted of
children, aged between 9 and 12 years, who received venipuncture between
September 2015 and June 2016 at a university hospital in Istanbul. The
sample consisted of a total of 90 children, including 45 children in the
acupressure group and 45 children in the control group, who met the sample
inclusion criteria. The results of the study were obtained by using an
information form, the State Anxiety Inventory for Children (STAIC), the
visual analog scale (VAS), and the Faces Pain Scale-Revised (FPS-R).
Acupressure was applied to the children in the acupressure group for 10
min before the venipuncture procedure. Pain, heart rate, and oxygen
saturation levels of the children in the acupressure and control groups
were evaluated both before and after the venipuncture procedure.
 RESULT(S): The children in the acupressure and control groups were
found to be similar in terms of age, gender, parents' educational levels
and working status, number of venipuncture procedures, and mean anxiety
scores. In the evaluation that was conducted before the venipuncture
procedure, no statistically significant differences were observed between
the heat rates, oxygen saturation levels, and expected pain scores from
the venipuncture procedure in the children in the acupressure and control
groups. On the other hand, it was observed that the children in the
acupressure group (VAS: 19.51 +/- 4.98; FPS-R: 2.08 +/- 0.41) experienced
less pain than the children in the control group (VAS: 47.37 +/- 9.89;
FPS-R: 4.84 +/- 1.08), and there was a significant difference between the
two groups (p< .000). LINKING EVIDENCE TO ACTION: Acupressure
administration is effective in reducing the pain that is experienced by
children during a venipuncture procedure. Copyright © 2020 Sigma
Theta Tau International.

<70>
Accession Number
631561862
Title
Outcomes of left atrial appendage occlusion using the AtriClip device: A
systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (5) (pp 655-662),
2019. Date of Publication: 01 Nov 2019.
Author
Toale C.; Fitzmaurice G.J.; Eaton D.; Lyne J.; Redmond K.C.
Institution
(Toale, Fitzmaurice, Eaton, Redmond) Department of Thoracic Surgery, Mater
Misericordiae University Hospital, Dublin, Ireland
(Lyne) Department of Cardiology, Blackrock Clinic, Dublin, Ireland
Publisher
Oxford University Press
Abstract
Atrial fibrillation increases lifetime stroke risk. The left atrial
appendage (LAA) is thought to be the source of embolic strokes in up to
90% of cases, and occlusion of the LAA may be safer than the alternative
of oral anticoagulation. Occlusion devices, such as the
AtriClipTM (AtriCure, Mason, OH, USA) enable safe and
reproducible epicardial clipping of the LAA. A systematic review was
performed in May 2018, based on the Preferred Reporting Items for
Systematic Reviews and Meta-analyses guidelines, using the keyword
'AtriClip'. A total of 68 papers were identified and reviewed; 11 studies
were included. Data including demographics, medical history
intervention(s) performed, periprocedural outcomes and follow-up were
assessed and analysed. A total of 922 patients were identified. LAA
occlusion was achieved in 902 out of 922 patients (97.8%). No
device-related adverse events were reported across the studies. The
reported incidence of stroke or transient ischaemic attack post-clip
placement ranged from 0.2 to 1.5/100 patient-years. Four hundred and
seventy-seven of 798 patients (59.7%) had ceased anticoagulation on
follow-up. The AtriClip device is safe and effective in the management of
patients with atrial fibrillation, either as an adjunct in patients
undergoing cardiac surgery or as a stand-alone thoracoscopic
procedure. Copyright © 2019 The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<71>
Accession Number
631561299
Title
Does transatrial-transpulmonary approach improve outcomes compared with
transventricular approach in non-neonatal patients undergoing tetralogy of
Fallot repair?.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (6) (pp 960-966),
2019. Date of Publication: 01 Dec 2019.
Author
Ye X.T.; Buratto E.; Konstantinov I.E.; D'Udekem Y.
Institution
(Ye, Buratto, Konstantinov, D'Udekem) Cardiac Surgery Unit, Royal
Children's Hospital, Melbourne, VIC, Australia
(Ye, Buratto, Konstantinov, D'Udekem) Department of Paediatrics,
University of Melbourne, Melbourne, VIC, Australia
(Ye, Buratto, Konstantinov, D'Udekem) Murdoch Children's Research
Institute, Melbourne, VIC, Australia
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether the
transatrial-transpulmonary approach to tetralogy of Fallot repair in
non-neonatal patients provides superior outcomes compared with the
transventricular approach. Altogether, 175 papers were found using the
reported search, of which 11 represented the best evidence to answer the
clinical question. Two randomized controlled trials (RCTs) and 3
observational studies showed that the transatrial approach resulted in
better preservation of right ventricular (RV) function, whereas 4
observational studies showed no significant difference. Three
observational studies showed better attenuation of RV dilatation, whereas
3 showed no difference. One RCT and 2 observational studies showed lower
incidence of postoperative ventricular arrhythmias, while 1 RCT and 4
observational studies showed no difference. Two observational studies
demonstrated greater freedom from reoperation, 1 RCT and 2 observational
studies showed no difference, while 1 retrospective study observed a
higher incidence of residual RV outflow tract obstruction and lower
freedom from reoperation in infants. Two observational studies reported
lower risk of requiring pulmonary valve replacement, whereas 2 reported no
difference. Three observational studies reported superior exercise
capacity, while 1 reported no difference. No difference in long-term
survival was demonstrated. The results presented suggest that transatrial
repair of tetralogy of Fallot confers superior or equivalent outcomes in
terms of preservation of RV function and volume, ventricular arrhythmias,
need for pulmonary valve replacement, and exercise capacity compared with
transventricular repair. However, the incidence of residual RV outflow
tract obstruction may be higher in infants undergoing transatrial
repair. Copyright © 2019 The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<72>
Accession Number
631555688
Title
A meta-analysis of the performance of small tissue versus mechanical
aortic valve prostheses.
Source
European Journal of Cardio-thoracic Surgery. 56 (3) (pp 510-517), 2019.
Date of Publication: 01 Sep 2019.
Author
Moscarelli M.; Fattouch K.; Speziale G.; Nasso G.; Santarpino G.; Gaudino
M.; Athanasiou T.
Institution
(Moscarelli) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Moscarelli, Fattouch, Speziale, Nasso, Santarpino) Department of Cardiac
Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Athanasiou) Department of Surgery and Cancer, Imperial College,
Paddington, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Small aortic prosthetic valves have been associated with
suboptimal performance due to patient-prosthesis mismatch (PPM). This
meta-analysis compared the outcomes of patients with a small root who
received tissue versus mechanical aortic valves. METHOD(S): A
systematic literature review identified 7 candidate studies+ADs- of these,
5 met the meta-analysis criteria. We analysed outcomes for a total of 680
patients (227 tissue valves and 453 mechanical valves) using random
effects modelling. Each study was assessed for heterogeneity and quality.
The primary end point was mortality at follow-up. Secondary end points
included intraoperative and postoperative outcomes, the rate of PPM and
left ventricle mass regression and major cardiac and prosthesis-related
adverse events at follow-up. RESULT(S): There was no between-group
difference in mortality at follow-up +AFs-incidence rate ratio 1, 95+ACU-
confidence interval (CI) 0.50-2.01+ADs- P +AD0- 0.99+AF0-. The tissue
group had a higher rate of PPM (odds ratio 17.19, 95+ACU- CI
8.6-25.78+ADs- P +AD0- 0.002) and significantly less reduction in
ventricular mass (weighted mean difference 40.79, 95+ACU- CI
4.62-76.96+ADs- P +AD0- 0.02). There were no significant differences in
the incidence of structural valve disease at follow-up compared to that in
the mechanical valve group. There was also no between-group difference in
aggregated adverse events at follow-up (P +AD0- 0.68). CONCLUSION(S):
Tissue and mechanical valves were associated with similar mortality
rates+ADs- however, patients receiving tissue valves had a higher rate of
PPM and significantly less left ventricle mass regression. These findings
indicate that patients receiving small tissue valves may require closer
clinical surveillance than those receiving mechanical valves.
+ACY-copy+ADs- 2019 The Author(s). Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved. Copyright © 2019 Oxford University Press. All rights
reserved.

<73>
Accession Number
631551084
Title
Incidence, predictors and cerebrovascular consequences of leaflet
thrombosis after transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (3) (pp 488-494), 2019.
Date of Publication: 01 Sep 2019.
Author
D'Ascenzo F.; Salizzoni S.; Saglietto A.; Cortese M.; Latib A.; Franzone
A.; Barbanti M.; Nietlispach F.; Holy E.W.; Burriesci G.; De Paoli A.;
Fonio P.; Atzeni F.; Moretti C.; Perl L.; D'Amico M.; Rinaldi M.; Conrotto
F.
Institution
(D'Ascenzo, Saglietto, Cortese, Moretti, D'Amico, Conrotto) Division of
Cardiology, Department of Medical Sciences, University of Turin, Turin,
Italy
(Salizzoni, Atzeni, Rinaldi) Division of Cardiac Surgery, Cardiovascular
and Thoracic Department, University of Turin, Turin, Italy
(Latib) Interventional Cardiology Unit, Cardiothoracic and Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Franzone) Department of Cardiology, Swiss Cardiovascular Center Bern,
Bern University Hospital, Bern, Switzerland
(Barbanti) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Nietlispach, Holy) Cardiology Clinic, University Hospital of Zurich,
Zurich, Switzerland
(Burriesci) UCL Mechanical Engineering, University College London, London,
United Kingdom
(Burriesci) Ri.MED Foundation, Palermo, Italy
(De Paoli, Fonio) Radiology Unit, Department of Surgical Science,
University of Turin, Turin, Italy
(Perl) Department of Cardiology, Rabin Medical Center, Petach-Tikva,
Israel
(Perl) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We examined the incidence, the impact of subsequent
cerebrovascular events and the clinical or procedural predictors of
leaflet thrombosis (LT) in patients undergoing transcatheter aortic valve
implantation (TAVI). METHOD(S): MEDLINE/PubMed was systematically
screened for studies reporting on LT in TAVI patients. Incidence [both
clinical and subclinical, i.e. detected with computed tomography (CT)] of
LT was the primary end point of the study. Predictors of LT evaluated at
multivariable analysis and impact of LT on stroke were the secondary ones.
 RESULT(S): Eighteen studies encompassing 11 124 patients evaluating
incidence of LT were included. Pooled incidence of LT was 0.43% per month
[5.16% per year, 95% confidence interval (CI) 0.21-0.72, I2 =
98%]. Pooled incidence of subclinical LT was 1.36% per month (16.32% per
year, 95% CI 0.71-2.19, I2 = 94%). Clinical LT was less
frequent (0.04% per month, 0.48% per year, 95% CI 0.00-0.19, I2
= 93%). LT increased the risk of stroke [odds ratio (OR) 4.21, 95% CI
1.27-13.98], and was more frequent in patients with a valve diameter of
28-mm (OR 2.89: 1.55-5.8), for balloon-expandable (OR 8: 2.1-9.7) or after
valve-in-valve procedures (OR 17.1: 3.1-84.9). Oral anticoagulation
therapy reduced the risk of LT (OR 0.43, 95% CI: 0.22-0.84, I2
= 64%), as well as the mean transvalvular gradient. CONCLUSION(S): LT
represents an infrequent event after TAVI, despite increasing risk of
stroke. Given its full reversal with warfarin, in high-risk patients
(those with valve-in-valve procedures, balloon expandable or large-sized
devices), a protocol which includes a control CT appears
reasonable. Copyright © 2019 The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<74>
Accession Number
2005726977
Title
Impact of the time interval between diagnosis and symptoms on survival of
surgical patients with left-sided infective endocarditis: A propensity
score analysis.
Source
Medicina Clinica. (no pagination), 2020. Date of Publication: 2020.
Author
Urso S.; Tena M.A.; Gonzalez-Barbeito M.; Paredes F.; Quevedo V.; Portela
F.
Institution
(Urso, Tena, Gonzalez-Barbeito, Paredes, Portela) Cardiac Surgery
Department, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria,
Spain
(Quevedo) Cardiology Department, Hospital Universitario Dr. Negrin, Las
Palmas de Gran Canaria, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Objectives: We aimed to explore the impact of the time interval between
symptoms and diagnosis on post-operative infective endocarditis (IE)
survival. Method(s): From 2014 to 2019, data from 93 consecutive
patients undergoing cardiac surgery due to left-sided +/- right-sided IE
were prospectively recorded in our specific electronic database. Patients
were classified into 2 groups according to time interval between first
clinical symptoms and definitive endocarditis diagnosis: patients with
early diagnosis (<=8 days) and patients with late diagnosis (>8 days).
Follow-up was 100% complete, and follow-up mean time was 471 days.
 Result(s): Among the 93 patients undergoing cardiac surgery due to
definite left-sided IE, 48 (51.6%) had early-diagnosed IE whereas 45
(48.4%) presented with a late-diagnosed IE. Unadjusted and propensity
score adjusted mid-term survival Kaplan-Meier analysis showed
significantly worse survival of patients belonging to the early-diagnosis
group (p .019 and .049 respectively). Multivariable Cox regression
analysis identified only one predictor of mid-term mortality: EuroSCORE II
(Hazard ratio 1.03, 95% CI 1.01-1.05, p .0008). Conclusion(s): The
association in the Kaplan-Meier analysis between "early-diagnosis group"
and mortality suggests that this group of patients presents clinical
characteristics of severity that, on the one hand, speed up the diagnostic
process and on the other, converge in the determination of a higher
euroSCORE II value, which is the only independent predictor of mid-term
mortality according to our analysis. Copyright © 2020 Elsevier
Espana, S.L.U.

<75>
Accession Number
2005726644
Title
Outcomes After Left Main Coronary Artery Revascularization by Percutaneous
Coronary Intervention or Coronary Artery Bypass Grafting According to
Smoking Status.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Shahim B.; Redfors B.; Chen S.; Morice M.-C.; Gersh B.J.; Puskas J.D.;
Kandzari D.E.; Merkely B.; Horkay F.; Crowley A.; Serruys P.W.; Kappetein
A.P.; Sabik J.F.; Ben-Yehuda O.; Stone G.W.
Institution
(Shahim, Redfors, Chen, Crowley, Ben-Yehuda, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors, Chen, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Morice) Hopital prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Merkely, Horkay) Heart and Vascular Center, Semmelweis University,
Budapest, Hungary
(Serruys) Department of Cardiology, NUIG, National University of Ireland,
Galway, Ireland
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Thorax Center, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cigarette smoking is a well-known risk factor for coronary artery disease
(CAD). However, the impact of smoking on outcomes after coronary
revascularization, especially in patients with left main CAD (LMCAD) is
less well understood. The EXCEL trial randomized 1,905 patients with LMCAD
and visually assessed low or intermediate anatomical complexity (SYNTAX
score <=32) to PCI with everolimus-eluting stents or CABG. Patients were
categorized according to smoking status (current, former, or never), and
their outcomes at 5 years were compared by logistic regression with
follow-up time included as a log-transformed offset variable. The primary
endpoint was a composite of death, myocardial infarction, or stroke. Among
1893 patients with known smoking status at baseline, 416 (22%) were
current smokers and 774 (41%) were former smokers. The crude rates of the
primary endpoint were 19.5% for never smokers, 20.5% for former smokers (p
= 0.61 vs never smokers), and 23.1% for smokers (p = 0.15 vs never
smokers). Compared with never smokers, the adjusted risk of the primary
endpoint was higher for current smokers (adjOR 1.82, 95% confidence
interval [CI] 1.126 to 2.63; p = 0.001), but not for former smokers (adjOR
1.00, 95% CI 0.75 to 1.33, p = 0.10). The relative efficacy of PCI versus
CABG for the 5-year primary endpoint was similar irrespective of smoking
status (P<inf>interaction</inf> = 0.22). In conclusion, current smokers in
the EXCEL trial had a higher adjusted 5-year risk of the primary composite
endpoint of death, myocardial infarction, or stroke than never smokers,
whereas former smokers were not at increased risk. Active smoking was a
risk factor after LMCAD revascularization irrespective of
revascularization method. Copyright © 2020 Elsevier Inc.

<76>
Accession Number
2005726487
Title
Influence of lipoproteins and antiplatelet agents on vein graft patency 1
year after coronary artery bypass grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Zhu J.; Zhu Y.; Zhang M.; Xue Q.; Hu J.; Liu H.; Wang R.; Wang X.; Zhao Q.
Institution
(Zhu, Zhu, Zhao) Department of Cardiovascular Surgery, Ruijin Hospital
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Zhang) Department of Cancer Control and Prevention, Shanghai Municipal
Center for Disease Control and Prevention, Shanghai, China
(Xue) Department of Cardiovascular Surgery, Changhai Hospital of Shanghai,
Shanghai, China
(Hu) Department of Cardiovascular Surgery, Fuwai Central China
Cardiovascular Hospital, Zhengzhou, China
(Liu) Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Wang) Department of Cardiovascular Surgery, Nanjing First Hospital,
Nanjing, China
(Wang) Department of Cardiovascular Surgery, Jiangsu Province Hospital,
Nanjing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: It remains unclear whether aggressive low-density lipoprotein
cholesterol (LDL-C) management (<1.8 mmol/L) can slow the process of vein
graft stenosis. This study aimed to explore the impact of baseline LDL-C
levels on vein graft patency in patients on ticagrelor with or without
aspirin 1 year after coronary artery bypass grafting (CABG).
 Method(s): This was a post hoc analysis of the DACAB (Different
Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery)
trial (NCT02201771), a randomized controlled trial (ticagrelor + aspirin
or ticagrelor vs aspirin) of patients undergoing CABG in China. The study
subjects were stratified as LDL-low (baseline LDL-C <1.8 mmol/L, 148
patients with 430 vein grafts) versus LDL-high (baseline LDL-C >=1.8
mmol/L, 352 patients with 1030 vein grafts). The primary outcome was the
1-year vein graft patency (Fitzgibbon grade A) assessed by coronary
computed tomographic angiography or coronary angiography. Result(s):
Baseline/1-year LDL-C were 1.4/1.6 and 2.6/2.4 mmol/L in the LDL-low and
LDL-high subgroups, respectively. Regardless of antiplatelet regimen, no
significant inter-subgroup difference was observed for 1-year graft
patency (LDL-low: 83.8% [359/430 grafts]; LDL-high: 82.3% [848/1030
grafts]; adjusted OR for non-patency [OR<inf>adj</inf>], 0.96; 95%
confidence interval [CI], 0.62-1.50, P = .857). For both subgroups, the
1-year graft patency rates were greater with ticagrelor + aspirin versus
aspirin (LDL-low: OR<inf>adj</inf>, 0.41; 95% CI, 0.17-0.97; LDL-high:
OR<inf>adj</inf>, 0.38; 95% CI, 0.20-0.71; inter P = .679).
 Conclusion(s): In general, baseline LDL-C is not associated with
1-year vein graft patency after CABG. Regardless of the baseline LDL-C
levels, ticagrelor + aspirin was superior to aspirin alone in maintaining
vein graft patency. The primary factor causing early vein graft disease
might not be atherosclerosis but thrombosis. Copyright © 2020 The
American Association for Thoracic Surgery

<77>
Accession Number
2005714493
Title
Transcatheter mitral valve repair for functional mitral regurgitation:
Evaluating the evidence.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Gelijns A.C.; Moskowitz A.J.; O'Gara P.T.; Giustino G.; Mack M.J.; Mancini
D.M.; Bagiella E.; Hung J.; Ailawadi G.; Leon M.B.; Acker M.A.; Alexander
J.H.; Dickert N.W.; Taddei-Peters W.C.; Miller M.A.
Institution
(Gelijns, Moskowitz, Giustino, Mancini, Bagiella) Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, NY, United
States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
Mass, United States
(Mack) Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott &
White Health, Plano, Tex, United States
(Hung) Division of Cardiology, Massachusetts General Hospital, Boston,
Mass, United States
(Ailawadi) Section of Adult Cardiac Surgery, University of Virginia,
Charlottesville, Va, United States
(Leon) Center for Interventional Vascular Therapy, Columbia University
Medical Center/New York-Presbyterian Hospital and Cardiovascular Research
Foundation, New York, NY, United States
(Acker) Cardiovascular Surgery, Surgery, University of Pennsylvania School
of Medicine, Philadelphia, Pa, United States
(Alexander) Division of Cardiology, Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Dickert) Division of Cardiology, Emory University School of Medicine,
Atlanta, Ga, United States
(Taddei-Peters, Miller) Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Two trials (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients with Functional
Mitral Regurgitation Trial and Percutaneous Repair with the MitraClip
Device for Severe Functional/Secondary Mitral Regurgitation Trial) were
published in 2018 evaluating the effectiveness and safety of transcatheter
repair for patients with heart failure with significant functional mitral
regurgitation, which yielded different results. This article reviews the
strength of the evidence, differences in trial designs, ethical and
implementation implications, and delineates future research needs to help
guide the appropriate dissemination of transcatheter repair for functional
patients with mitral regurgitation. Method(s): The National Heart,
Lung, and Blood Institute convened a workshop of interdisciplinary experts
to address these objectives. Result(s): Transcatheter repair of
functional mitral regurgitation can provide significant benefits in terms
of heart failure hospitalizations, survival, and quality of life when
appropriate heart failure candidates with moderate to severe or severe
mitral regurgitation while on optimal guideline-directed medical therapy
can be identified. Key ingredients for success are preoperative evaluation
and management and postoperative care by an interdisciplinary heart team.
 Conclusion(s): Given the discordance observed between trials, ongoing
innovation in patient management, and potential expansion of indications
for use, the evidence base must be expanded to optimize appropriate
implementation of this complex therapy. This will require more complete
capture of outcome data in real-world settings for all eligible candidates
whether or not they receive this therapy. Inevitably, the indications for
use of this therapy will expand, as will the devices and therapeutic
approaches for this population, necessitating the study of comparative
effectiveness through randomized trials or observational studies.
Moreover, given the substantial variations in care delivery, conducting
implementation research to delineate characteristics of the optimal care
model would be of benefit. Copyright © 2020

<78>
Accession Number
2004750697
Title
Meta-analysis of randomised trials compares mortality after transcatheter
versus surgical aortic valve replacement.
Source
Netherlands Heart Journal. (no pagination), 2020. Date of Publication:
2020.
Author
Vendrik J.; BaanJr J.
Institution
(Vendrik, Baan Jr) Heart Centre, Amsterdam University Medical Centres
(location AMC), Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)

<79>
Accession Number
631606219
Title
Sex-Specific Management in Patients with Acute Myocardial Infarction and
Cardiogenic Shock: A Substudy of the CULPRIT-SHOCK Trial.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2020. Article
Number: e008537. Date of Publication: 2020.
Author
Rubini Gimenez M.; Zeymer U.; Desch S.; De Waha-Thiele S.; Ouarrak T.;
Poess J.; Meyer-Saraei R.; Schneider S.; Fuernau G.; Stepinska J.; Huber
K.; Windecker S.; Montalescot G.; Savonitto S.; Jeger R.V.; Thiele H.
Institution
(Rubini Gimenez, Desch, Thiele) Department of Internal
Medicine/Cardiology, Heart Center Leipzig, University of Leipzig,
Strumpellstrase 39, Leipzig 04289, Germany
(Rubini Gimenez, Jeger) Cardiology Department, University Hospital Basel,
Switzerland
(Zeymer) Klinikum Ludwigshafen, Germany
(Meyer-Saraei, Fuernau) German Center for Cardiovascular Research, Berlin,
Germany
(De Waha-Thiele, Poess) Department of Internal
Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart
Center, Lubeck, Germany
(Ouarrak, Schneider) Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Stepinska) Institute of Cardiology, Warsaw, Poland
(Huber) 3rd Department of Internal Medicine, Cardiology and Intensive Care
Medicine, Wilhelminen Hospital, Sigmund Freud University, Medical School,
Vienna, Austria
(Windecker) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Switzerland
(Montalescot) Department of Cardiology, Sorbonne Universite, Institut de
Cardiologie (AP-HP), Hopital Pitie Salpetriere, Paris, France
(Savonitto) Department of Cardiology, Manzoni Hospital, Lecco, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Women are more likely to suffer and die from cardiogenic shock
(CS) as the most severe complication of acute myocardial infarction. Data
concerning optimal management for women with CS are scarce. Aim of this
study was to better define characteristics of women experiencing CS and to
the influence of sex on different treatment strategies. Method(s): In
the CULPRIT-SHOCK trial (The Culprit Lesion Only PCI Versus Multivessel
PCI in Cardiogenic Shock), patients with CS complicating acute myocardial
infarction and multivessel coronary artery disease were randomly assigned
to one of the following revascularization strategies: Either percutaneous
coronary intervention of the culprit-lesion-only or immediate multivessel
percutaneous coronary intervention. Primary end point was composite of
death from any cause or severe renal failure leading to renal replacement
therapy within 30 days. We investigated sex-specific differences in
general and according to the revascularization strategies. Result(s):
Among all 686 randomized patients included in the analysis, 24% were
women. Women were older and had more often diabetes mellitus and renal
insufficiency, whereas they had less often history of previous acute
myocardial infarction and smoking. After 30 days, the primary clinical end
point was not significantly different between groups (56% women versus 49%
men; odds ratio, 1.29 [95% CI, 0.91-1.84]; P=0.15). There was no
interaction between sex and coronary revascularization strategy regarding
mortality and renal failure (P<inf>interaction</inf>=0.11). The primary
end point occurred in 56% of women treated by the culprit-lesion-only
strategy versus 42% men, whereas 55% of women and 55% of men in the
multivessel percutaneous coronary intervention group. Conclusion(s):
Although women presented with a different risk profile, mortality and
renal replacement were similar to men. Sex did not influence mortality and
renal failure according to the different coronary revascularization
strategies. Based on these data, women and men presenting with CS
complicating acute myocardial infarction and multivessel coronary artery
disease should not be treated differently. However, further randomized
trials powered to address potential sex-specific differences in CS are
still necessary. Copyright © 2020 American Heart Association,
Inc.

<80>
Accession Number
631606061
Title
Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous
Vein Graft Percutaneous Coronary Intervention: Insights from DIVA Trial.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2020. Article
Number: e008494. Date of Publication: 2020.
Author
Latif F.; Uyeda L.; Edson R.; Bhatt D.L.; Goldman S.; Holmes D.R.; Rao
S.V.; Shunk K.; Aggarwal K.; Uretsky B.; Bolad I.; Ziada K.; McFalls E.;
Irimpen A.; Truong H.T.; Kinlay S.; Papademetriou V.; Velagaleti R.S.;
Rangan B.V.; Mavromatis K.; Shih M.-C.; Banerjee S.; Brilakis E.S.
Institution
(Latif) Va Medical Center Oklahoma City, United States
(Latif) University of Oklahoma, Oklahoma City, United States
(Uyeda, Edson, Kinlay, Shih) Va Cooperative Studies Program Coordinating
Center, Mountain View, CA, United States
(Bhatt, Velagaleti) Va Boston Healthcare System, MA, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Boston,
MA, United States
(Bhatt) Harvard Medical School, Boston, MA, United States
(Goldman) University of Arizona Sarver Heart Center, Tucson, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Rao) Durham Va Medical Center, NC, United States
(Shunk) San Francisco Va Medical Center, CA, United States
(Aggarwal) Harry S Truman Va Hospital, Columbia, MO, United States
(Aggarwal) University of Missouri Healthcare, Columbia, United States
(Uretsky) Central Arkansas Veterans Health System, Little Rock, United
States
(Uretsky) University of Arkansas for Medical Sciences, Little Rock, United
States
(Bolad) Indiana University School of Medicine, Indianapolis, United States
(Bolad) Roudebush Va Medical Center, Indianapolis, United States
(Ziada) University of Kentucky, Lexington, United States
(McFalls) Va Medical Center, Minneapolis, MN, United States
(McFalls) University of Minnesota, Minneapolis, United States
(Irimpen) Southeast Louisiana Veterans Health Care System, New
OrleansUnited States
(Irimpen) Tulane University Heart and Vascular Institute, New Orleans, LA,
United States
(Truong) Va Loma Linda Medical Center, CA, United States
(Papademetriou) Va Medical Center, Washington, DC, United States
(Papademetriou) Georgetown University, Washington, DC, United States
(Rangan, Brilakis) Minneapolis Heart Institute Foundation, MN, United
States
(Mavromatis) Atlanta Va Healthcare System, GA, United States
(Mavromatis) Emory University, Atlanta, GA, United States
(Banerjee) Dallas Va Medical Center, TX, United States
(Banerjee) University of Texas Southwestern Medical Center, Dallas, United
States
(Brilakis) Minneapolis Heart Institute, MN, United States
(Brilakis) Abbott Northwestern Hospital, Minneapolis, MN, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Direct stenting without pre-dilation or post-dilation has been
advocated for saphenous vein graft percutaneous coronary intervention to
decrease the incidence of distal embolization, periprocedural myocardial
infarction, and target lesion revascularization. Method(s): We
performed a post hoc analysis of patients enrolled in the DIVA
(Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft
Angioplasty; NCT 01121224) prospective, double-blind, randomized
controlled trial. Patients were stratified into stent-only and
balloon-stent groups. Primary end point was 12-month incidence of target
vessel failure (defined as the composite of cardiac death, target vessel
myocardial infarction, or target vessel revascularization). Secondary end
points included all-cause death, stent thrombosis, myocardial infarction,
and target lesion revascularization during follow-up. Result(s): Of
the 575 patients included in this substudy, 185 (32%) patients underwent
stent-only percutaneous coronary intervention. Patients in the stent-only
versus balloon-stent group had similar baseline characteristics and
similar incidence of target vessel failure at 12-months (15% versus 19%;
hazard ratio, 1.34 [95% CI, 0.86-2.08]; P=0.19). During long-term
follow-up (median of 2.7 years), the incidence of definite stent
thrombosis (1% versus 5%; hazard ratio, 9.20 [95% CI, 1.23-68.92];
P=0.0085), the composite of definite or probable stent thrombosis (5%
versus 11%; hazard ratio, 2.52 [95% CI, 1.23-5.18]; P=0.009), and target
vessel myocardial infarction (8% versus 14%; hazard ratio, 1.92 [95% CI,
1.08-3.40]; P=0.023) was lower in the stent-only group. Multivariable
analysis showed that a higher number of years since coronary artery bypass
grafting and >1 target saphenous vein graft lesions were associated with
increased target vessel failure during entire follow-up, while
preintervention Thrombolysis in Myocardial Infarction-3 flow was
protective. Conclusion(s): In patients undergoing percutaneous
coronary intervention of de novo saphenous vein graft lesions, there was
no difference in target vessel failure at 12 months and long-term
follow-up in the stent-only versus the balloon-stent group; however, the
incidence of stent thrombosis was lower in the stent-only group, as was
target vessel myocardial infarction. Registration: URL:
Https://www.clinicaltrials.gov. Unique identifier: NCT
01121224. Copyright © 2020 American Heart Association, Inc.

<81>
Accession Number
2005600963
Title
Treatment of Severe TRIcuspid regurgitation in patients with advanced
heart failure with caval vein implantation of the edwards sapien XT valve
(TRICAVAL): A randomised controlled trial.
Source
EuroIntervention. 15 (17) (pp 1506-1513), 2020. Date of Publication: April
2020.
Author
Dreger H.; Mattig I.; Hewing B.; Knebel F.; Lauten A.; Lembcke A.; Thoenes
M.; Roehle R.; Stangl V.; Landmesser U.; Grubitzsch H.; Stangl K.; Laule
M.
Institution
(Dreger, Mattig, Hewing, Knebel, Stangl, Stangl, Laule) Medizinische
Klinik fur Kardiologie und Angiologie, Campus Charite Mitte, Charite -
Universitatsmedizin Berlin, Chariteplatz 1, Berlin D-10117, Germany
(Dreger, Hewing, Knebel, Stangl, Landmesser, Stangl) DZHK (German Centre
for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
(Hewing, Knebel, Roehle, Landmesser, Laule) Berlin Institute of Health
(BIH), Berlin, Germany
(Lauten, Landmesser) Medizinische Klinik fur Kardiologie, Campus Benjamin
Franklin, Charite - Universitatsmedizin Berlin, Berlin, Germany
(Lembcke) Institut fur Radiologie, Campus Charite Mitte, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Thoenes) Edwards Lifesciences, Nyon, Switzerland
(Roehle) Coordinating Center for Clinical Studies, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Roehle) Institute of Biometry and Clinical Epidemiology, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Grubitzsch) Klinik fur Kardiovaskulare Chirurgie, Charite -
Universitatsmedizin Berlin, Berlin, Germany
Publisher
Europa Group
Abstract
Aims: The aim of our study was to compare the impact of implantation of a
balloon-expandable transcatheter valve into the inferior vena cava (CAVI)
on exercise capacity with optimal medical therapy (OMT) in patients with
severe tricuspid regurgitation (TR) and high surgical risk. Methods
and Results: Twenty-eight patients were randomised to OMT (n=14) or CAVI
(n=14). The primary endpoint was maximal oxygen uptake at the three-month
follow-up. Secondary endpoints included six-minute walk test, NYHA class,
NT-proBNP levels, right heart function, unscheduled heart failure
hospitalisation, and quality of life as assessed by the Minnesota Living
with Heart Failure Questionnaire (MLHFQ). Patients underwent follow-up
examinations one, three, six, and twelve months after randomisation.
Maximal oxygen uptake did not change significantly in either group after
three months and there was no difference between the OMT and CAVI groups
(-0.1+/-1.8 ml kg-1 min-1 vs -1.0+/-1.6 ml kg-1 min-1, p=0.4995). Compared
to baseline, CAVI improved NYHA class, dyspnoea, and quality of life after
three months. However, there were no statistically significant differences
in the secondary endpoints between the groups. Four periprocedural
complications occurred after CAVI, resulting in open heart surgery. Four
patients in the OMT group and eight patients (including four after
conversion to surgery) in the CAVI group died from right heart failure,
sepsis or haemorrhage. Conclusion(s): CAVI did not result in a
superior functional outcome compared to OMT. Due to an unexpectedly high
rate of valve dislocations, the study was stopped for safety
reasons. Copyright © Europa Digital & Publishing 2020.

<82>
Accession Number
631457606
Title
Biomarker-guided implementation of the KDIGO guidelines to reduce the
occurrence of acute kidney injury in patients after cardiac surgery
(PrevAKI-multicentre): protocol for a multicentre, observational study
followed by randomised controlled feasibility trial.
Source
BMJ Open. 10 (4) (no pagination), 2020. Article Number: e034201. Date of
Publication: 06 Apr 2020.
Author
Kullmar M.; Massoth C.; Ostermann M.; Campos S.; Grau Novellas N.; Thomson
G.; Haffner M.; Arndt C.; Wulf H.; Irqsusi M.; Monaco F.; Di Prima A.;
Garcia Alvarez M.; Italiano S.; Cegarra Sanmartin V.; Kunst G.; Nair S.;
L'acqua C.; Hoste E.A.J.; Vandenberghe W.; Honore P.; Kellum J.; Forni L.;
Grieshaber P.; Weiss R.; Gerss J.; Wempe C.; Meersch M.; Zarbock A.
Institution
(Kullmar, Massoth, Wempe, Meersch, Zarbock) Anesthesiology, Intensive Care
and Pain Medicine, Universitatsklinikum Munster, Munster,
Nordrhein-Westfalen, Germany
(Ostermann, Campos, Grau Novellas, Thomson, Haffner) Department of
Critical Care, King's College London, Guy's and St Thomas' Hospital,
London, United Kingdom
(Arndt) Department of Anesthesiology and Operative Intensive Care,
University Hospital Marburg, United Kingdom
(Wulf) Anesthesiology and Intensive Care Medicine, Philipps-Universitat
Marburg Fachbereich Medizin, Marburg, Germany
(Irqsusi) Department of Cardiothoracic Surgery, Philipps-Universitat
Marburg Fachbereich Medizin, Marburg, Germany
(Monaco, Di Prima) Intensive Care and Anesthesia Unit, Scientific
Institute San Raffaele, Milano, Italy
(Garcia Alvarez, Italiano, Cegarra Sanmartin) Department of
Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona,
Catalunya, Spain
(Kunst, Nair) Department of Anesthesia, Critical Care and Pain, King's
College London, London, United Kingdom
(L'acqua) Department of Anesthesia and Critical Care, Centro Cardiologico
Monzino IRCCS, Milano, Lombardia, Italy
(Hoste, Vandenberghe) ICU, Universiteit Gent, Gent, Belgium
(Honore) Department of Intensive Care, CHU Brugmann, Brussels, Belgium
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Forni) Department of Intensive Care Medicine, Royal Surrey County
Hospital NHS Trust, Guildford, Surrey, United Kingdom
(Grieshaber) Department of Cardiac Surgery, Justus Liebig Universitat
Giessen Fachbereich Medizin, Giessen, Hessen, Germany
(Weiss) Department of Anaesthesiology, University Hospital Munster,
Munster, Germany
(Gerss) Institute of Biostatistics and Clinical Research, Westfalische
Wilhelms-Universitat Munster, Munster, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Acute kidney injury (AKI) is a frequent complication after
cardiac surgery with adverse short-term and long-term outcomes. Although
prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy
is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO)
guideline recommended a bundle of supportive measures in high-risk
patients. In a single-centre trial, we recently demonstrated that the
strict implementation of the KDIGO bundle significantly reduced the
occurrence of AKI after cardiac surgery. In this feasibility study, we aim
to evaluate whether the study protocol can be implemented in a multicentre
setting in preparation for a large multicentre trial. Methods and analysis
We plan to conduct a prospective, observational survey followed by a
randomised controlled, multicentre, multinational clinical trial including
280 patients undergoing cardiac surgery with cardiopulmonary bypass. The
purpose of the observational survey is to explore the adherence to the
KDIGO recommendations in routine clinical practice. The second phase is a
randomised controlled trial. The objective is to investigate whether the
trial protocol is implementable in a large multicentre, multinational
setting. The primary endpoint of the interventional part is the compliance
rate with the protocol. Secondary endpoints include the occurrence of any
AKI and moderate/severe AKI as defined by the KDIGO criteria within 72
hours after surgery, renal recovery at day 90, use of renal replacement
therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint
major adverse kidney events consisting of persistent renal dysfunction,
RRT and mortality at day 90 and safety outcomes. Ethics and dissemination
The PrevAKI multicentre study has been approved by the leading Research
Ethics Committee of the University of Munster and the respective Research
Ethics Committee at each participating site. The results will be used to
design a large, definitive trial. Trial registration number
NCT03244514. Copyright © Author(s) (or their employer(s)) 2020.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<83>
Accession Number
631457509
Title
Initial invasive or conservative strategy for stable coronary disease.
Source
New England Journal of Medicine. 382 (15) (pp 1395-1407), 2020. Date of
Publication: 09 Apr 2020.
Author
Maron D.J.; Hochman J.S.; Reynolds H.R.; Bangalore S.; O'Brien S.M.; Boden
W.E.; Chaitman B.R.; Senior R.; Lopez-Sendon J.; Alexander K.P.; Lopes
R.D.; Shaw L.J.; Berger J.S.; Newman J.D.; Sidhu M.S.; Goodman S.G.;
Ruzyllo W.; Gosselin G.; Maggioni A.P.; White H.D.; Bhargava B.; Min J.K.;
John Mancini G.B.; Berman D.S.; Picard M.H.; Kwong R.Y.; Ali Z.A.; Mark
D.B.; Spertus J.A.; Krishnan M.N.; Elghamaz A.; Moorthy N.; Hueb W.A.;
Demkow M.; Mavromatis K.; Bockeria O.; Peteiro J.; Miller T.D.; Szwed H.;
Doerr R.; Keltai M.; Selvanayagam J.B.; Gabriel Steg P.; Held C.; Kohsaka
S.; Mavromichalis S.; Kirby R.; Jeffries N.O.; Harrell F.E.; Rockhold
F.W.; Broderick S.; Bruce Ferguson T.; Williams D.O.; Harrington R.A.;
Stone G.W.; Rosenberg Y.
Institution
(Hochman) New York University, Grossman School of Medicine, New York
University Langone Health, 530 First Ave., Skirball 9R, New York, NY
10016, United States
(Maron, Harrington) Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Hochman, Reynolds, Bangalore, Berger, Newman, Mavromichalis) New York
University, Grossman School of Medicine, New York, United States
(Shaw) Weill Cornell Medicine, New York-Presbyterian Hospital, New York,
United States
(Min) CleerlyNYUnited States
(Ali, Stone) Cardiovascular Research Foundation, New York, United States
(Ali) Columbia University Irving Medical Center, New York-Presbyterian
Hospital, New York, United States
(Stone) Icahn School of Medicine at Mount Sinai, NY, United States
(Sidhu) Albany Medical College, Albany Medical Center, Albany, NY, United
States
(Ali) St. Francis Hospital, Roslyn, NY, United States
(O'Brien, Alexander, Lopes, Mark, Rockhold, Broderick) Duke Clinical
Research Institute, Durham, NC, United States
(Bruce Ferguson) Brody School of Medicine, East Carolina University,
Greenville, NC, United States
(Boden) Veterans Affairs (VA) New England Healthcare System, Boston
University School of Medicine, Boston, United States
(Picard) Massachusetts General Hospital, Harvard Medical School, Boston,
United States
(Williams, Harrington) Brigham and Women's Hospital, Boston, United States
(Chaitman) Saint Louis University School of Medicine, St. Louis, United
States
(Spertus) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City School of Medicine, Kansas City, United States
(Senior, Berger) Northwick Park Hospital, London, United Kingdom
(Senior) Imperial College London, Royal Brompton Hospital, London, United
Kingdom
(Lopez-Sendon) Hospital Universitario La Paz, Instituto de Investigacion
de La Paz, Centro de Investigacion Biomedica en Red Cardiovascular,
Madrid, Spain
(Peteiro) Complejo Hospitalario Universitario A Coruna, Centro de
Investigacion Biomedica en Red Cardiovascular, A Coruna, Spain
(Goodman) Canadian Heart Research Centre, St. Michael's Hospital,
University of Toronto, Toronto, Canada
(Gosselin) Montreal Heart Institute Research Center, Montreal, Canada
(John Mancini) University of British Columbia, Vancouver, Canada
(Demkow) Department of Coronary and Structural Heart Diseases
(Ruzyllo, Demkow, Szwed) National Institute of Cardiology, Warsaw, Poland
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri, Florence,
Italy
(White) Auckland Hospital Green Lane Cardiovascular Services, Auckland,
New Zealand
(Bhargava) All India Institute of Medical Sciences, New Delhi, India
(Krishnan) Government Medical College Kozhikode, Kerala, India
(Moorthy) Sri Jayadeva Institute of Cardiovascular Sciences and Research,
Bangalore, India
(Hueb) Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina
da Universidade de Sao Paulo, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, Brazil
(Mavromatis) Emory University School of Medicine, Atlanta VA Medical
Center, Decatur, GA, United States
(Bockeria) National Research Center for Cardiovascular Surgery, Moscow,
Russian Federation
(Miller) Mayo Clinic, Rochester, MN, United States
(Doerr) Praxisklinik Herz und Gefaesse, Dresden, Germany
(Keltai) Semmelweis University, Budapest, Hungary
(Selvanayagam) Flinders University, Flinders Medical Centre, Adelaide, SA,
Australia
(Gabriel Steg) Universite de Paris, Assistance Publique-Hopitaux de Paris,
INSERM Unite 1148, Paris, France
(Held) Department of Medical Sciences, Department of Cardiology, Uppsala
Clinical Research Center, Uppsala University, Uppsala, Sweden
(Kohsaka) Keio University School of Medicine, Shinjuku, Tokyo, Japan
(Kirby, Jeffries, Rosenberg) National Institutes of Health, Bethesda, MD,
United States
(Harrell) Vanderbilt University School of Medicine, Nashville, United
States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Among patients with stable coronary disease and moderate or
severe ischemia, whether clinical outcomes are better in those who receive
an invasive intervention plus medical therapy than in those who receive
medical therapy alone is uncertain. METHODS We randomly assigned 5179
patients with moderate or severe ischemia to an initial invasive strategy
(angiography and revascularization when feasible) and medical therapy or
to an initial conservative strategy of medical therapy alone and
angiography if medical therapy failed. The primary outcome was a composite
of death from cardiovascular causes, myocardial infarction, or
hospitalization for unstable angina, heart failure, or resuscitated
cardiac arrest. A key secondary outcome was death from cardiovascular
causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318
primary outcome events occurred in the invasive-strategy group and 352
occurred in the conservative-strategy group. At 6 months, the cumulative
event rate was 5.3% in the invasive-strategy group and 3.4% in the
conservative-strategy group (difference, 1.9 percentage points; 95%
confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event
rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage
points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key
secondary outcome. The incidence of the primary outcome was sensitive to
the definition of myocardial infarction; a secondary analysis yielded more
procedural myocardial infarctions of uncertain clinical importance. There
were 145 deaths in the invasive-strategy group and 144 deaths in the
conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).
CONCLUSIONS Among patients with stable coronary disease and moderate or
severe ischemia, we did not find evidence that an initial invasive
strategy, as compared with an initial conservative strategy, reduced the
risk of ischemic cardiovascular events or death from any cause over a
median of 3.2 years. The trial findings were sensitive to the definition
of myocardial infarction that was used. Copyright © 2020
Massachusetts Medical Society.

<84>
Accession Number
2005636838
Title
"Beta-blocker exposure for short-term outcomes following non-cardiac
surgery: A meta-analysis of observational studies" Int J Surg. 2020 Mar
10. pii: S1743-9191(20)30206-5. doi: 10.1016/j.ijsu.2020.02.041. [Epub
ahead of print].
Source
International Journal of Surgery. 78 (pp 46-47), 2020. Date of
Publication: June 2020.
Author
Baram A.
Institution
(Baram) Cardiovascular and Thoracic Surgery, Department of Surgery, School
of Medicine, Faculty of Medical Sciences, University of Sulaimani, Iraq
(Baram) Department of Thoracic and Cardiovascular Surgery, Sulaimani
Teaching Hospital, Al Sulaymaniyah 46001, Iraq
Publisher
Elsevier Ltd

<85>
Accession Number
2004244391
Title
Invasive haemodynamics in de novo everolimus vs. calcineurin inhibitor
heart transplant recipients.
Source
ESC Heart Failure. 7 (2) (pp 567-576), 2020. Date of Publication: 01 Apr
2020.
Author
Bergh N.; Gude E.; Bartfay S.-E.; K Andreassen A.; Arora S.; Dahlberg P.;
Dellgren G.; Gullestad L.; Gustafsson F.; Karasson K.; Radegran G.;
Bollano E.; Andersson B.
Institution
(Bergh, Bartfay, Dahlberg, Bollano, Andersson) Department of Cardiology,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Bergh, Bartfay, Dahlberg, Karasson, Bollano) Institute of Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Gude, K Andreassen, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Gustafsson) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO Heart
and Lung Medicine, Skane University Hospital, Lund, Sweden
(Dellgren, Radegran) Department of Clinical Sciences, Lund University,
Lund, SwedenTransplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(K Andreassen, Arora, Gullestad) KG Jebsen Center for Cardiac Research,
University of Oslo, Oslo, Norway
(K Andreassen, Arora, Gullestad) Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims: Invasive haemodynamic profiles at rest and during exercise after
heart transplantation (HTx) have never been described in a randomized
trial where de novo everolimus (EVR)-based therapy with early calcineurin
inhibitor (CNI) withdrawal has been compared with conventional CNI
treatment. We report central invasive haemodynamic parameters at rest and
exercise during a 3 year follow-up after HTx in a sub-study of the
SCandiavian Heart transplant Everolimus De novo stUdy with earLy
calcineurin inhibitor avoidancE trial. We hypothesized that the
nephroprotective properties, the less development of cardiac allograft
vasculopathy (CAV), and the antifibrotic properties of EVR, in comparison
with CNI-based immunosuppression, would demonstrate favourable invasive
haemodynamic profiles in patients at rest and during exercise.
 Methods and Results: Ninety of 115 HTx recipients randomized to EVR
or CNI treatment performed right heart catheterization at rest and 68
performed right heart catheterization at exercise up to 3 years after HTx.
Haemodynamic profiles were compared between EVR and CNI treatment groups.
Resting haemodynamics improved in both groups from pre-HTx to the first
follow-up at 7-11 weeks post-HTx and thereafter remained unchanged up to 3
years of follow-up. During follow-up, cardiac reserve during exercise
increased with higher levels of maximum heart rate (118 to 148 b.p.m., P <
0.001), mean arterial pressure (103 to 128 mmHg, P < 0.001), and cardiac
output (10.3 to 12.2 l/min, P < 0.001). No significant differences in
haemodynamic parameters were observed between the EVR and CNI groups at
rest or exercise. Isolated post-capillary pulmonary hypertension (mean
pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure
>= 15 mmHg, and pulmonary vascular resistance <3) were measured in 11% of
the patients at 7-11 weeks, 5% at 12 months, and 6% at 36 months after
HTx. The EVR group had significantly better kidney function (76 mL/min/1
vs. 60 mL/min/1, P < 0.001) and reduced CAV (P < 0.01) but an increased
rate of early biopsy-proven treated rejections (21.2% vs 5.7%, P < 0.01)
compared with the CNI group at any time point. The differences in renal
function, CAV, or early biopsy-proven treated acute rejections were not
associated with altered haemodynamics. Conclusion(s): De novo EVR
treatment with early CNI withdrawal compared with conventional CNI therapy
did not result in differences in haemodynamics at rest or during exercise
up to 3 years after HTx despite significant differences in renal function,
reduced CAV, and number of early biopsy-proven treated
rejections. Copyright © 2020 The Authors. ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of the European Society of
Cardiology

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