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<1>
Accession Number
2005992264
Title
Evaluation of safety and efficacy of coronary intravascular lithotripsy
for treatment of severely calcified coronary stenoses: Design and
rationale for the Disrupt CAD III trial.
Source
American Heart Journal. 225 (pp 10-18), 2020. Date of Publication: July
2020.
Author
Kereiakes D.J.; Hill J.M.; Ben-Yehuda O.; Maehara A.; Alexander B.; Stone
G.W.
Institution
(Kereiakes) The Christ Hospital and Lindner Research Center, Cincinnati,
OH, United States
(Hill) Royal Brompton Hospital, London, United Kingdom
(Ben-Yehuda, Maehara, Stone) Clinical Trials Center, Cardiovascular
Research Foundation, New York, NY; New York-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Alexander) Shockwave Medical, Santa Clara, CA, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Coronary calcification limits optimal stent expansion and apposition and
worsens safety and effectiveness outcomes of percutaneous coronary
intervention (PCI). Current ablative technologies that modify calcium to
optimize stent deployment are limited by guidewire bias and periprocedural
complications related to atheroembolization, coronary dissection, and
perforation. Intravascular lithotripsy (IVL) delivers pulsatile ultrasonic
pressure waves through a fluid-filled balloon into the vessel wall to
modify calcium and enhance vessel compliance, reduce fibroelastic recoil,
and decrease the need for high-pressure balloon (barotrauma) inflations.
IVL has been used in peripheral arteries as stand-alone revascularization
or as an adjunct to optimize stent deployment. Study design and
objectives: Disrupt CAD III (clinicaltrials.gov identifier: NCT03595176)
is a prospective, multicenter, single-arm study designed to assess safety
and efficacy of the Shockwave coronary IVL catheter to optimize coronary
stent deployment in patients with de novo calcified coronary stenoses. The
primary safety end point is freedom from major adverse cardiovascular
events (composite of cardiac death, myocardial infarction, and target
vessel revascularization) at 30 days compared to a prespecified
performance goal. The primary effectiveness end point is procedural
success without in-hospital major adverse cardiovascular events.
Enrollment will complete early in 2020 with clinical follow-up ongoing for
2 years. Conclusion(s): Disrupt CAD III will evaluate the safety and
effectiveness of the Shockwave coronary IVL catheter to optimize coronary
stent deployment in patients with calcified coronary
stenoses. Copyright © 2020 Elsevier Inc.

<2>
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Accession Number
614735343
Title
Prediction of waitlist mortality in adult heart transplant candidates: The
candidate risk score.
Source
Transplantation. 101 (9) (pp 2175-2182), 2017. Date of Publication: 2017.
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent)
Direction Prelevement Greffe Organes-Tissus, Saint-Denis La Plaine 93212,
France
(Leprince) Service de Chirurgie Cardio-vasculaire, Hopital de la Pitie
Salpetriere, Paris, France
(Porcher) Centre d'Epidemiologie Clinique, Universite Paris Descartes,
Paris U1153, France
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The cardiac allocation system in France is currently based on urgency and
geography.Medical urgency is defined by therapies without considering
objective patient mortality risk factors. This study aimed to develop a
waitlist mortality risk score from commonly available candidate variables.
Methods. The study included all patients, aged 16 years or older,
registered on the national registry CRISTAL for first single-organ heart
transplantation between January 2010 and December 2014. This population
was randomly divided in a 2:1 ratio into derivation and validation
cohorts. The association of variables at listing with 1-year waitlist
death or delisting for worsening medical condition was assessed within the
derivation cohort. The predictors were used to generate a candidate risk
score (CRS). Validation of the CRS was performed in the validation cohort.
Concordance probability estimation (CPE) was used to evaluate the
discriminative capacity of the models. Results. During the study period,
2333 patients were newly listed. The derivation (n =1 555) and the
validation cohorts (n = 778) were similar. Short-term mechanical
circulatory support, natriuretic peptide decile, glomerular filtration
rate, and total bilirubin level were included in a simplified model and
incorporated into the score. The Concordance probability estimation of the
CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort.
The correlation between observed and expected 1-year waitlist mortality in
the validation cohort was 0.87. Conclusions. The candidate risk score
provides an accurate objective prediction of waitlist mortality. It is
currently being used to develop a modified cardiac allocation system in
France. Copyright © 2017 Wolters Kluwer.

<3>
Accession Number
605030732
Title
Efficacy assessment of CRYO storage of donor hearts by imagej based image
analysis.
Source
Russian Journal of Cardiology. 105 (1) (pp 45-48), 2014. Date of
Publication: 2014.
Author
Lin B.-Q.; Yang S.-S.; Zeng Z.-Y.; Zhuang C.-W.
Institution
(Lin, Yang, Zeng, Zhuang) Division of Cardiothoracic Surgery, Fuzhou
General Hospital of PLA, Fuzhou, China
Publisher
Silicea-Poligraf
Abstract
Aim. Donor organ injury during cold preservation before transplantation
negatively impacts graft survival. The current study was to examine
available evidences for the efficacy of different cold storage solutions
that are used to preserve donor hearts in vitro prior to orthotopic
transplantation. Material and methods. A systematic search of full-length
articles published from 1980 to August 2012 was performed in PubMed and
Google Scholar. Detailed searches were also made for availability of any
sourceware for histopathology images of endomyocardial biopsies of stored
hearts. Results. Not even a single controlled trial has been published
relating to this topic. However, we assessed all available literature
pertaining to this topic, and performed original, simple yet innovative
analyses using ImageJ, a Java based image analyses program, to show the
tremendous power to objectively examine the efficacy of the storage
solution. Our analysis suggest that ImageJ may be conveniently used to
obtain evidences (or lack of it) of ischemic injury of donor hearts during
cold storage. Conclusions. Even the UNOS database does not provide
histopathological evidences of cardiac biopsies of orthotopically
transplanted hearts. We, however, make the case of the need for image
analyses and making availability of images to allow establishing evidence
of the usefulness of these storage solutions. We recommend obtaining
endomyocardial biopsy prior to orthotopic transplantation and create a
registry of H&E stained slides. This is the only step that will direct us
towards evidence based care of such highly critical patients who need the
equally challenging surgical intervention of cardiac
transplantation. Copyright © Russian Journal of Cardiology.

<4>
Accession Number
2004400997
Title
Prognostic impact of baseline C-reactive protein levels on mortality after
transcatheter aortic valve implantation.
Source
Journal of Cardiac Surgery. 35 (5) (pp 974-980), 2020. Date of
Publication: 01 May 2020.
Author
Takagi H.; Kuno T.; Hari Y.; Nakashima K.; Yokoyama Y.; Ueyama H.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno, Ueyama) Department of Medicine, Mount Sinai Beth Israel Medical
Center, New York, NY, United States
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA, United
States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York-Presbyterian Hospital, Columbia University Medical Center, New
York, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To determine whether baseline C-reactive protein (CRP) levels
can predict mortality after transcatheter aortic valve implantation
(TAVI), we performed a meta-analysis of currently available studies.
 Method(s): All studies investigating the prognostic impact of
baseline (preprocedural) CRP levels on all-cause mortality after TAVI were
identified by means of searching PubMed and Google Scholar through May
2019. For each study, (preferentially, adjusted rather than unadjusted)
odds/hazard ratios (ORs/HRs) with corresponding 95% confidence intervals
of mortality per standard-deviation (SD) (or unit) increase in CRP levels
or those for high vs low CRP levels. Result(s): Our search identified
14 eligible studies including a total of 3449 patients undergoing TAVI and
reporting early (in-hospital to 3-month) and midterm (1-year to 3-year)
all-cause mortality after TAVI. Pooled analyses demonstrated associations
of high-baseline CRP levels with a marginal, but statistically
nonsignificant increase in early mortality (pooled OR/HR per SD increase
in CRP levels, 2.72; P =.09 and pooled OR/HR for high vs low CRP levels,
3.32; P =.07) and a statistically significant increase in midterm
mortality after TAVI (pooled OR/HR per SD increase in CRP levels, 1.45; P
<.0001 and pooled OR/HR for high vs low CRP levels, 1.78; P <.00001).
Excluding HRs for high-sensitivity CRP, combining ORs/HRs of 1-year
mortality, pooling HRs of >=2-year mortality, and combining adjusted HRs
did not alter the primary results. Conclusion(s): High-baseline CRP
levels may predict increased midterm, but not early, mortality after
TAVI. Copyright © 2020 Wiley Periodicals, Inc.

<5>
Accession Number
2006007067
Title
Blunting periprocedural myocardial necrosis: Rationale and design of the
randomized ALPHEUS study.
Source
American Heart Journal. 225 (pp 27-37), 2020. Date of Publication: July
2020.
Author
Silvain J.; Cayla G.; Beygui F.; Range G.; Lattuca B.; Collet J.-P.;
Dillinger J.-G.; Boueri Z.; Brunel P.; Pouillot C.; Boccara F.;
Christiaens L.; Labeque J.-N.; Lhermusier T.; Georges J.-L.;
Bellemain-Appaix A.; Le Breton H.; Hauguel-Moreau M.; Saint-Etienne C.;
Caussin C.; Jourda F.; Motovska Z.; Guedeney P.; El Kasty M.; Laredo M.;
Dumaine R.; Ducrocq G.; Vicaut E.; Montalescot G.
Institution
(Silvain, Collet, Guedeney, Laredo, Montalescot) Sorbonne Universite,
ACTION Study Group, INSERM UMRS1166, Hopital Pitie-Salpetriere (AP-HP),
Paris, France
(Cayla, Lattuca) Cardiology department, Nimes university Hospital,
Montpellier University, ACTION study group, Nimes, France
(Beygui) CHU de Caen-Departement de Cardiologie, Caen, France
(Range) CH de Chartres-Departement de Cardiologie, Chartes, France
(Dillinger) Department of Cardiology, Inserm U942, Lariboisiere Hospital,
Assistance Publique-Hopitaux de Paris, University of Paris, Paris, France
(Boueri) CH de Bastia-Departement de Cardiologie, Bastia, France
(Brunel) Hopital Prive Dijon Bourgogne-Cardiologie Interventionelle GCIDB
VALMY, Dijon, France
(Pouillot) Clinique Sainte Clotilde, La Reunion-Departement de
Cardiologie, La Reunion, France
(Boccara) AP-HP, Hopitaux de l'Est Parisien, Hopital Saint-Antoine,
Department of Cardiology, Sorbonne Universite-INSERM UMR S_938, Centre de
Recherche Saint-Antoine, Paris, France
(Christiaens) CHU de Poitiers-Service de Cardiologie, Poitiers, France
(Labeque) GCS de Cardiologie de la Cote Basque, CH Bayonne, Bayonne,
France
(Lhermusier) CHU de Toulouse-Departement de Cardiologie, Toulouse, France
(Georges) CH de Versailles-Service de Cardiologie, Hopital A. Mignot, Le
Chesnay, France
(Bellemain-Appaix) CH d'Antibes Juan-Les-Pins-Departement de Cardiologie,
Antibes, Juan-Les-Pins, France
(Le Breton) Univ Rennes, CHU Rennes, Inserm LTSI U1099, Rennes, France
(Hauguel-Moreau) CHU Ambroise Pare (APHP), Universite Versailles-Saint
Quentin, ACTION study Group, INSERM-U1018 CESP, Boulogne, France
(Saint-Etienne) CHU Trousseau, Departement de Cardiologie, Tours, France
(Caussin) Institut Mutualiste Montsouris, Departement de Cardiologie,
Paris, France
(Jourda) CH Auxerre-Departement de Cardiologie, Auxerre, France
(Motovska) 3rd Faculty of Medicine, Charles University and Cardiocentre
Kralovske Vinohrady, Prague, Czechia
(El Kasty) Grand Hopital de l'Est Francilien site Marne-La-Vallee -
Departement de Cardiologie, Marne La Vallee, France
(Dumaine) Les Grands Pres Cardiac Rehabilitation center, Villeneuve St
Denis, France
(Ducrocq) FACT (French Alliance for Cardiovascular Trials), DHU FIRE,
Hopital Bichat, AP-HP, Universite de Paris, Inserm U-1148, Paris, France
(Vicaut) Unite de Recherche Clinique, ACTION Study Group, Hopital Fernand
Widal (AP-HP), Paris, France
(Vicaut) SAMM - Statistique, Analyse et Modelisation Multidisciplinaire EA
4543, Universite Paris 1 Pantheon Sorbonne, Paris, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Clopidogrel associated with aspirin is the recommended
treatment for patients undergoing elective percutaneous coronary
intervention (PCI). Although severe PCI-related events are rare, evidence
suggests that PCI-related myocardial infarction and myocardial injury are
frequent complications that can impact the clinical prognosis of the
patients. Antiplatelet therapy with a potent P2Y<inf>12</inf> receptor
inhibitor such as ticagrelor may reduce periprocedural ischemic
complications while maintaining a similar safety profile as compared with
conventional dual antiplatelet therapy by aspirin and clopidogrel in this
setting. Method(s): Assessment of Loading with the P2Y<inf>12</inf>
inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients
Undergoing elective coronary Stenting (ALPHEUS) (NCT02617290) is an
international, multicenter, randomized, parallel-group, open-label study
in patients with stable coronary artery disease who are planned for an
elective PCI. In total, 1,900 patients will be randomized before a planned
PCI to a loading dose of ticagrelor 180 mg or a loading dose of
clopidogrel (300 or 600 mg) in addition to aspirin. Patients will then
receive a dual antiplatelet therapy with aspirin and ticagrelor 90 mg
twice daily or clopidogrel 75 mg once daily for 30 days. The primary
ischemic end point is PCI-related myocardial infarction (myocardial
infarction type 4a or 4b) or major myocardial injury within 48 hours (or
at hospital discharge if earlier) after elective PCI/stent. Safety will be
evaluated by major bleeding events (Bleeding Academic Research Consortium
type 3 or 5) at 48 hours (or discharge if it occurs earlier).
 Conclusion(s): ALPHEUS is the first properly sized trial comparing
ticagrelor to clopidogrel in the setting of elective PCI and is especially
designed to show a reduction in periprocedural events, a surrogate end
point for mortality. Copyright © 2020 Elsevier Inc.

<6>
Accession Number
2005115335
Title
Coronary artery disease in dialysis patients: evidence synthesis,
controversies and proposed management strategies.
Source
Journal of Nephrology. (no pagination), 2020. Date of Publication: 2020.
Author
Burlacu A.; Genovesi S.; Basile C.; Ortiz A.; Mitra S.; Kirmizis D.;
Kanbay M.; Davenport A.; van der Sande F.; Covic A.
Institution
(Burlacu) Department of Interventional Cardiology, Cardiovascular Diseases
Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
(Genovesi) Nephrology Unit, San Gerardo Hospital, Monza, Italy, University
of Milan-Bicocca, Milan, Italy
(Basile) Division of Nephrology, Miulli General Hospital, Via Battisti
192, Acquaviva delle Fonti, Taranto 74121, Italy
(Basile) Associazione Nefrologica Gabriella Sebastio, Martina Franca,
Italy
(Ortiz) FRIAT and REDINREN, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
(Mitra) Manchester Academy of Health Sciences Centre, Manchester
University Hospitals Foundation Trust and University of Manchester, Oxford
Road, Manchester, United Kingdom
(Kirmizis) Department of Nephrology, Colchester General Hospital, Essex,
United Kingdom
(Kanbay) Department of Medicine, Division of Nephrology, Koc University
School of Medicine, Istanbul, Turkey
(Davenport) Division of Medicine, UCL Centre for Nephrology, Royal Free
Hospital, University College London, London, United Kingdom
(van der Sande) Division of Nephrology, Department of Internal Medicine,
University Hospital Maastricht, Maastricht, Netherlands
(Covic) Nephrology Clinic, Dialysis and Renal Transplant Center-'C.I.
Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine,
Iasi, Romania
(Covic) The Academy of Romanian Scientists (AOSR), Bucharest, Romania
Publisher
Springer
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and
mortality among patients with end-stage renal disease (ESRD). Clustering
of traditional atherosclerotic and non-traditional risk factors drive the
excess rates of coronary and non-coronary CVD in this population. The
incidence, severity and mortality of coronary artery disease (CAD) as well
as the number of complications of its therapy is higher in dialysis
patients than in non-chronic kidney disease patients. Given the lack of
randomized clinical trial evidence in this population, current practice is
informed by observational data with a significant potential for bias.
Furthermore, guidelines lack any recommendation for these patients or
extrapolate them from trials performed in non-dialysis patients. Patients
with ESRD are more likely to be asymptomatic, posing a challenge to the
correct identification of CAD, which is essential for appropriate risk
stratification and management. This may lead to "therapeutic nihilism",
which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL
Working Group reviews the diagnostic work-up and therapy of chronic
coronary syndromes, unstable angina/non-ST elevation and ST-elevation
myocardial infarction in dialysis patients, outlining unclear issues and
controversies, discussing recent evidence, and proposing management
strategies. Indications of antiplatelet and anticoagulant therapies,
percutaneous coronary intervention and coronary artery bypass grafting are
discussed. The issue of the interaction between dialysis session and
myocardial damage is also addressed. Copyright © 2020, Italian
Society of Nephrology.

<7>
Accession Number
2005088982
Title
Global cardiovascular care: an overview of high-level political
commitment.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Vervoort D.; Parikh U.M.; Raj A.; Swain J.D.
Institution
(Vervoort) Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
United States
(Parikh) Baylor College of Medicine, Houston, TX, United States
(Raj) Kasturba Medical College, Manipal, India
(Swain) Division of Cardiovascular Surgery, Department of Surgery,
Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Six billion people worldwide lack access to safe, timely, and
affordable cardiac surgical and interventional care when needed.
Cardiovascular diseases are the leading cause of mortality and morbidity
around the world, and include a significant surgical backlog of rheumatic
and congenital heart diseases. Here, we review the political commitment by
the WHO, the UN, and the World Bank to build and strengthen healthcare
services for cardiovascular diseases, with a particular focus on cardiac
surgical and interventional cardiology services around the world.
 Method(s): A literature search was performed in the WHO, UN, and
World Bank Governing Body databases to identify policy documents
mentioning curative cardiovascular disease care. The Governing Body
documentation, the Institutional Repository for Information Sharing
database of the WHO, and the Official Document System of the UN were used.
Documents only discussing prevention of cardiovascular diseases were
excluded. Result(s): Fifty-nine unique documents were identified,
including 56 from the WHO, 3 from the World Bank, and none from the UN; 12
(20.4%) documents mentioned cardiac surgery, and 6 (10.2%) contained some
actionable language to incorporate cardiac surgical services, but none was
explicitly dedicated to cardiac surgical services. Conclusion(s):
Although growing, high-level political commitment for curative
cardiovascular health services remains minimal. Increased awareness is
needed to develop comprehensive cardiovascular care that is necessary to
mitigate the increasing burden of premature morbidity and mortality from
cardiac disease, and to work towards the Sustainable Development Goals and
Universal Health Coverage. Copyright © The Author(s) 2020.

<8>
Accession Number
631848986
Title
Prognostic performance of the Society of Thoracic Surgeons risk score in
patients with left main coronary artery disease undergoing
revascularisation: a post hoc analysis of the EXCEL trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
16 (1) (pp 36-43), 2020. Date of Publication: 20 May 2020.
Author
Thuijs D.J.F.M.; Habib R.H.; Head S.J.; Puskas J.D.; Taggart D.P.; Stone
G.W.; Zhang Z.; Serruys P.W.; Sabik J.F.; Kappetein A.P.
Institution
(Thuijs) Department of Cardiothoracic Surgery, Erasmus University Medical
Centre, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Accurate risk prediction in patients undergoing revascularisation is
essential. We aimed to assess the predictive performance of Society of
Thoracic Surgeons (STS) risk models in patients with left main coronary
artery disease (LMCAD) undergoing coronary artery bypass grafting (CABG)
or percutaneous coronary intervention with everolimus-eluting stents
(PCI-EES). METHODS AND RESULTS: The predictive performance of STS risk
models for perioperative mortality, stroke and renal failure was evaluated
for their discriminative ability (C statistic) and calibration
(Hosmer-Lemeshow goodness-of-fit-test; chi2 and p-values) among patients
with LMCAD undergoing PCI-EES (n=935) and CABG (n=923) from the randomised
EXCEL trial. STS risk scores, in CABG patients, showed good discrimination
for 30-day mortality and average discrimination for stroke (C statistic
0.730 and 0.629, respectively) with average calibration. For PCI, STS risk
scores had no discrimination for mortality (C statistic 0.507), yet good
discrimination (C statistic 0.751) and calibration for stroke. The
predictive performance for renal failure was good for CABG (C statistic
0.82), yet poor for PCI (C statistic 0.59). CONCLUSION(S): In
selected patients with LMCAD from the EXCEL trial, STS risk models showed
good predictive performance for CABG yet lacked predictive performance for
PCI for perioperative mortality and renal failure. The STS stroke risk
model was surprisingly more discriminating in PCI compared to CABG.
Improved and procedure-specific risk prediction instruments are needed to
accurately estimate adverse events after LMCAD revascularisation by CABG
and PCI. ClinicalTrials.gov Identifier: NCT01205776.

<9>
Accession Number
631141942
Title
External Stents for Vein Grafts in Coronary Artery Bypass Grafting:
Targeting Intimal Hyperplasia.
Source
Surgical technology international. 35 (pp 197-201), 2020. Date of
Publication: 28 May 2020.
Author
Weltert L.P.; Wolf L.G.; Garufi L.; Scaffa R.; Salica A.; Ricci A.; Irace
F.G.; Fusca S.; D'Aleo S.; Chirichilli I.; Bellisario A.; de Paulis R.
Institution
(Weltert) Heart Surgery Unit, European Hospital, Department of Statistics,
San Camillus International University for Health Sciences, Rome, Italy
(Wolf, Scaffa, Salica, Ricci, Irace, Fusca, D'Aleo, Bellisario, de Paulis)
Heart Surgery Unit, European Hospital, Rome, Italy
(Garufi) Cardiac Surgery, Department of Cardiac, Thoracic and Vascular
Sciences, University of Padua, Padova, Italy
(Chirichilli) Department of Cardiac Surgery and Heart Transplantation, San
Camillo Forlanini Hospital Rome, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Progressive saphenous vein graft (SVG) failure remains a key
limitation to the long-term success of coronary artery bypass grafting
(CABG). SVG disease after the first year is dominated by intimal
hyperplasia, which predisposes the SVG to thrombosis and accelerated
atherosclerosis. The objective of this study was to review and summarize
the latest experimental and clinical data on the use of mechanical
external stents for vein grafts. METHOD(S): In January 2020, the
PubMed database was searched using the terms "external stent", "CABG",
"saphenous vein graft" and "intimal hyperplasia". The results were
reviewed and only randomized experimental and clinical studies that
analyzed the effect of external stenting on venous intimal hyperplasia
were included in the analysis, together with studies that investigated the
clinical benefit of external stenting. RESULT(S): Eight experimental
and four clinical trials met the search criteria. Controlled trials in
different large animal models concluded that external stenting
significantly reduced intimal hyperplasia 3-6 months post implantation,
and reduced both thrombosis rates and the development of lumen
irregularities. Data from randomized controlled trials with a follow-up
period of 1-4.5 years supported the pre-clinical findings and demonstrated
that external stents significantly reduced vein graft disease.
 CONCLUSION(S): Strong evidence indicates that supporting the vein
with external stents is safe and leads to clear advantages at both the
anatomical and cellular levels. With the further accumulation of
consistent positive results, external stenting of SVG may become the
standard of care in future CABG.

<10>
Accession Number
631930643
Title
Benefits of High-Intensity Interval Training in a Young and in an Older De
Novo Heart Transplant Recipient- Cases from the HITTS Study.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S491-S492), 2020. Date of Publication: 01 Apr 2020.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Bjorkelund E.; Authen A.R.; Grov
I.; Gude E.; Karason K.; Broch K.; Gullestad L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Bjorkelund, Authen, Grov, Gude, Broch,
Gullestad, Nytroen) Department of Cardiology, Oslo University Hospital,
Oslo, Norway
(Karason) Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
PURPOSE: High-intensity interval training (HIT) is an effective method to
increase exercise capacity in de novo heart transplant recipients, as
shown in the recently published HITTS study (High-intensity Interval
Training in de novo Heart Transplant recipients in Scandinavia). We were
interested to scrutinize the potential effect of HIT in different age
categories. The main effects of HIT in one young and one older medically
stable de novo heart transplant recipients are reported. METHOD(S):
The HITTS study is a randomized controlled study comparing HIT versus
moderate intensity continuous training (MICT) in de novo heart transplant
recipients (mean 11 weeks after heart transplantation). Eighty-one
participants were randomized (1:1) to 9 months of HIT or MICT. The primary
endpoint was the change in VO2peak. Secondary endpoints included: Heart
rate response, muscle strength and self-reported physical function
measured by the Short-Form-36. One of the youngest and one of the oldest
participants with the highest changes in VO2peak in the HIT intervention
group were selected for this case report. RESULT(S): The youngest
male (< 25 years old) increased his VO2peak with 15.3 mL/kg/min from
baseline to follow-up (from 23.5 to 38.8 mL/kg/min), while the older male
(> 55 years old) increased his VO2peak with 12.6 mL/kg/min (from 15.6 to
28.3 mL/kg/min). Muscle strength, heart rate response, O2 pulse and
self-reported physical function also increased substantially (Table). The
young heart transplant recipient completed 51 exercise sessions whereas
the older heart transplant recipient completed 72 sessions.
 CONCLUSION(S): Both the young and the older de novo heart transplant
recipient increased their VO2peak with at least 4 METS (> 12 mL/kg/min)
after a 9-month long HIT intervention. The results show that both young
and older individuals can derive substantial benefit from HIT soon after
heart transplantation. Copyright © 2020. Published by Elsevier
Inc.

<11>
Accession Number
631930624
Title
Effect of High-Intensity Interval Training in De Novo Heart Transplant
Recipients - 3-year Results from the HITTS Randomized Controlled Trial.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S224-S225), 2020. Date of Publication: 01 Apr 2020.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Bjorkelund E.; Authen A.R.; Grov
I.; Gude E.; Broch K.; Gullestad L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Bjorkelund, Authen, Grov, Gude, Broch,
Gullestad, Nytroen) Department of Cardiology, Oslo University Hospital,
Oslo, Norway
Publisher
NLM (Medline)
Abstract
OF OBJECTIVES: The HITTS study (High -intensity Interval Training in de
novo Heart Transplant Recipients in Scandinavia) is a randomized
controlled trial designed to assess the effect of high-intensity interval
training (HIT) versus moderate intensity continuous training (MICT) on
exercise capacity in de novo heart transplant recipients. The primary
endpoint was the change in oxygen consumption (VO2peak) at the end of the
intervention period, which began 3 months after heart transplantation
(HTx). After the 9-month long intervention period, we reported a
between-group difference in VO2peak of 1.8 ml/kg/min in favor of HIT
(p=0.04).We found that HIT was safe, well tolerated and efficient. The
HITTS study is the first randomized controlled trial to assess the
effectiveness of HIT in de novo heart transplant recipients. However,
long-term effects of commencing HIT soon after HTx remain unknown. In this
extension of the HITTS trial, our aim was to examine whether the benefits
of 9 months of supervised HIT training persist two years after the end of
the intervention. METHOD(S): In the HITTS study, we randomized 81
adult de novo heart transplant recipients to 9 months of HIT (4x4 min
intervals at 85-95% of peak heart rate (HR) or 9 months of MICT (60-80% of
peak HR). The mean +/- SD age was 49 +/-13 and 73 % were men. Before the
start of the intervention and at follow-up shortly after the intervention,
we measured VO2peak, isokinetic muscle strength, body composition, left
ventricular function by echo, biomarkers, and health-related quality of
life (HRQoL). For the extension study, the measurements will be repeated 3
years after enrollment. VO2peak is measured with breath-by-breath gas
exchange on a treadmill or bicycle ergometer. The last patient is
scheduled to complete his/her 3-year follow-up at Nov 14th, 2019. Data
will be available for presentation at ISHLT 2020. ENDPOINTS: The primary
outcome is the long-term effect of HIT vs MICT on aerobic exercise
capacity as assessed by VO2peak. Secondary outcomes are: Isokinetic
muscular strength in the lower limbs by a dynamometer, body composition
(bio-impedance analysis), left ventricular function by echo, heart rate
response during the cardiopulmonary exercise test, relevant circulation
biomarkers (renal function, NT-proBNP and cardiac troponins), HRQoL,
tolerability, safety and adverse events. Copyright © 2020.
Published by Elsevier Inc.

<12>
Accession Number
631930391
Title
Protective Effects of Combined Heart Transplantation on Cardiac Allograft
Vasculopathy: A Systematic Review and Meta-Analysis.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S251), 2020. Date of Publication: 01 Apr 2020.
Author
Maning J.; Blumer V.; Chaparro S.
Institution
(Maning) Department of Internal Medicine, University of Miami Miller
School of Medicine, FL, Miami, United States
(Blumer) Division of Cardiology, Duke University Medical Center, Durham
(Chaparro) Division of Cardiovascular Medicine, University of Miami Miller
School of Medicine, FL, Miami, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: Despite significant advances in the field of heart
transplantation, cardiac allograft vasculopathy (CAV) continues to be a
major limitation of long-term survival. Previous studies have suggested
that compared with isolated heart transplant (HTx) recipients, those who
receive multiorgan heart transplants (HTxC) have superior clinical
outcomes. We conducted a systematic review and meta-analysis to
investigate the effects of combined organ transplantation on the incidence
of CAV. METHOD(S): We searched Medline, Embase, and the Cochrane
Library for studies evaluating outcomes after combined heart
transplantation, in particular the incidence of CAV. We identified 1207
potential eligible publications. Outcomes were compared using the
random-effects model and heterogenicity examined via X2 and I2 statistics.
 RESULT(S): Six retrospective studies were included in our analysis
for a total of 1383 heart transplant recipients. Of these, 190 (16%)
underwent HTxC: 50 heart-kidney transplant (HKTx), 103 heart-lung
transplant (HLTx), and 37 heart-liver transplant (HLvTx). Multiorgan heart
transplantation was associated with less incidence of CAV (OR 0.19; 95% CI
0.07-0.51; p=0.0009) and acute cardiac rejection (OR 0.18; 95% CI
0.07-0.47; p=0.0005). Survival at 1 year was not significantly different
among HTxC and HTx recipients (OR 0.68, 95% CI 0.42-1.10; p=0.12).
 CONCLUSION(S): Multiorgan heart transplantation appears to be
associated with a protective effect against CAV and acute cardiac
rejection. Short term survival after combined heart transplant is
comparable to isolated heart transplantation. Copyright © 2020.
Published by Elsevier Inc.

<13>
Accession Number
631928096
Title
Non-Ischemic Heart Preservation versus Static Cold Storage in Human Heart
Transplantation.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S135), 2020. Date of Publication: 01 Apr 2020.
Author
Nilsson J.; Jernryd V.; Qin G.; Paskevicius A.; Metzsch C.; Medved D.;
Sjoberg T.; Steen S.
Institution
(Nilsson, Qin, Paskevicius, Metzsch, Medved, Sjoberg, Steen) Clinical
Sciences in Lund, Cardiothoracic Surgery, Lund University and Skanes
University Hospital, Lund, Sweden
(Jernryd) Clinical Sciences in Lund, Cardiothoracic Surgery, Lund
University and Skane University Hospital, Lund, Sweden
Publisher
NLM (Medline)
Abstract
PURPOSE: Pre-clinical studies have shown that ex vivo non-ischemic heart
preservation (NIHP) method can be safely used for 24 hours. This
state-of-the-art method has never been applied on humans. The primary
objective of the study was to evaluate the efficacy and safety of the NIHP
method on early and late human heart allograft function compared with
static cold storage (SCS). METHOD(S): We performed a prospective,
open-label, non-randomised phase II study. All adult recipients listed for
heart transplantation were included, unless they met any exclusion
criteria. The primary endpoint was a composite of survival free of severe
primary graft dysfunction, free of ECMO use within 7 days, and free of
acute cellular rejection >=2R within 180 days. Secondary endpoints were
I/R-tissue injury, immediate graft function, and adverse event. Of the 37
eligible patients, nine were assigned to the NIHP method and 28 to SCS.
 RESULT(S): The median age was 51 years (interquartile range (IQR),
37-58) for the donors and 56 years (IQR, 46 - 63) for the recipients. The
median preservation time was significant longer for the NIHP group, 251
min (IQR, 219-269) compared with the SCS group, 199 min (IQR, 164 - 227),
P=0.008. Over the first three months, all of the patients assigned to the
NIHP group achieved event-free survival, compared with 21 (75%) of those
assigned to the SCS group (Kaplan-Meier estimate of event free survival
75% (95% CI 55-87%); P=0.124). CK-MB assessed 6+/-2 h after ending
perfusion was 77 (IQR, 54-101) ng/mL for the NIHP group compared with 137
(IQR, 73-196) ng/mL for the SCS group, P=0.030. Four (16%) death within
six months after transplantation and three (12%) cardiac-related adverse
events were reported in the SCS group compared with no deaths or
cardiac-related adverse events in the NIHP group. CONCLUSION(S): This
first-in-human study shows the NIHP method's feasibility and safety for
use in the clinic of heart transplantation. Copyright © 2020.
Published by Elsevier Inc.

<14>
Accession Number
631927548
Title
Incidence and Impact of Primary Graft Dysfunction in Adult Heart
Transplant Recipients: A Systematic Review and Meta-Analysis.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S144), 2020. Date of Publication: 01 Apr 2020.
Author
Buchan T.A.; Moayedi Y.; Truby L.K.; Posada J.D.; Ross H.J.; Alba A.C.;
Foroutan F.
Institution
(Buchan, Moayedi, Posada, Ross, Alba, Foroutan) Cardiology, Toronto
General Hospital, ON, University Health Network, Toronto, Canada
(Truby) Cardiology, Duke University Medical Center, Durham
Publisher
NLM (Medline)
Abstract
PURPOSE: Primary graft dysfunction (PGD) is a life-threatening
complication and a leading cause of early mortality post heart transplant
(HTx). Recent studies evaluating the incidence and prognosis of PGD have
benefited from the ISHLT 2014 Consensus Report which clearly defines this
condition. Our objective was to systematically review all studies that
reported the incidence of PGD in adult HTX recipients since 2014 to more
accurately identify its incidence and impact on mortality. METHOD(S):
We conducted a systematic search of the literature in Medline in October
2019. We included studies that reported the incidence of PGD in adult HTx
recipients, based on the 2014 ISHLT Consensus Report. Two independent
reviewers screened citations and performed data abstraction. We used a
random effects meta-analysis to pool the incidence among HTx recipients,
as well as the rate of mortality among those who developed PGD. We applied
the GRADE instrument for incidence and mortality separately to determine
our certainty in the pooled estimates. RESULT(S): Of 127 publications
screened, we included 36 observational studies. HTx recipient age ranged
from 24-69 years and 24% were female. Donor age ranged from 23-50 years,
sex mismatch occurred in 21% and ischemic time ranged from 86-273 minutes.
We observed similar incidence for each severity of PGD but increasing risk
of 1-year mortality (Table 1). Estimates of 30-day mortality were only
available for severe PGD: 39% (95% CI 32% - 46%, 9 studies, high
certainty). CONCLUSION(S): Based on the 2014 ISHLT criteria, the
published pooled incidence of PGD is low, and its prognosis is poor. The
extensive heterogeneity in incidence and mortality suggests
inconsistencies in the recognition and/or management of PGD. This
represents an opportunity for improved risk stratification, prevention and
management strategies. Copyright © 2020. Published by Elsevier
Inc.

<15>
Accession Number
631925609
Title
Follow-Up Phone Calls are Effective in Increasing Compliance with
Screening for De Novo Cancer among Heart Transplant Recipients.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S494), 2020. Date of Publication: 01 Apr 2020.
Author
Mabasa A.C.; Kleet A.C.; Gaine M.; Lee J.C.; Jackson R.; Fanek T.;
Czarnecki A.; Farr M.J.; Colombo P.C.
Institution
(Mabasa, Kleet, Gaine, Lee, Jackson, Fanek, Czarnecki, Farr, Colombo)
Surgery, Columbia University Medical Center, NY, NY
Publisher
NLM (Medline)
Abstract
PURPOSE: We aimed to examine the effectiveness of serial follow-up phone
calls as an intervention after clinic visits to enhance compliance with
cancer surveillance among heart transplant (HT) patients. METHOD(S):
41 HT cancer-free patients were randomized to intervention (n=21) vs.
control (n=20) groups. Time Series Design was used; the intervention group
received 4 calls post clinic visits within 31 days at different point
intervals between 7-10 days, addressing the patient's specific needs for
cancer screening based on immunotherapy and medical issues. The control
group received 1 phone call at the end of the study. Chi-Square Statistics
was used to compare screening rates between intervention and control
groups. RESULT(S): Mean age was 60.3 years, 78% male, and 24% had
prior malignancy. 39% of patients were studied 1-5 years post HT, 20% 5-10
years; 26% 10-14 years; and 15% 15-20 years. Main reasons for
non-compliance reported by patients were: "too busy", "family issues", and
"I forgot". At the end of the study, 50% of patients were fully compliant
with cancer screening recommendations in the intervention group vs. 15% in
the control group. This difference was statistically significant: (X2 (1)=
4.062, p= 0.044) (Fig. 1a). Compliance rates after each phone call are
shown in Fig. 1b. CONCLUSION(S): A nurse practitioner-led follow-up
phone calls program is a feasible and effective strategy to increase
compliance with de novo cancer screening among adult heart transplant
recipients. Additional studies are needed to validate the usefulness of
this approach in this unique patient population. Copyright ©
2020. Published by Elsevier Inc.

<16>
Accession Number
2006071707
Title
Xinyue Capsule in patients with stable coronary artery disease after
percutaneous coronary intervention: a multicenter, randomized,
placebo-controlled trial.
Source
Pharmacological Research. 158 (no pagination), 2020. Article Number:
104883. Date of Publication: August 2020.
Author
Guo M.; Wang P.; Du J.; Fu C.; Yang Q.; Gao Z.; Zhu M.; Lv S.; Deng Y.; Li
T.; Shi D.; Working Group F.T.X.
Institution
(Guo, Wang, Du, Fu, Yang, Gao, Shi, Working Group) Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing 100091, China
(Zhu) The First Affiliated Hospital of the Henan University of Chinese
Medicine, Henan 450046, China
(Lv) Beijing Anzhen Hospital, Beijing Institute of Respiratory Medicine,
Capital Medical University, Beijing 10029, China
(Deng) The First Affiliated Hospital of Jilin University of Traditional
Chinese Medicine, Changchun 130021, China
(Li) Naval General Hospital, Beijing 100048, China
Publisher
Academic Press
Abstract
Background: Xinyue capsule, a patented Chinese herbal medicine, has been
used to manage coronary artery disease (CAD) for over a decade in China,
but whether it can further reduce risk of cardiovascular events beyond
conventional treatment is unknown. Method(s): In this multicenter,
randomized, placebo-controlled trial, we randomly assigned patients with
stable CAD who underwent percutaneous coronary intervention (PCI) within
the preceding 3-12 months to receive Xinyue capsule (100 mg panax
quinquefolius saponins, three times a day) or placebo for 24 weeks in
addition to conventional treatment. The primary endpoint was a composite
that included cardiac death, nonfatal myocardial infarction and urgent
revascularization with either PCI or coronary artery bypass grafting. The
secondary composite endpoints included stroke, re-hospitalization due to
acute coronary syndrome (ACS), pulmonary embolism, peripheral vascular
events and all-cause mortality. Quality of life was assessed using a
36-item Short-Form Health Survey (SF-36). Result(s): A total of 1054
participants were included in the analyses. The median follow up was 1
year. The primary endpoint events occurred in 16 patients (3.02%) in the
Xinyue group and 34 patients (6.49%) in the placebo group (hazard ratio
[HR] 0.455, 95% confidence interval [CI] 0.25 to 0.825; P = 0.009).
Secondary end-point events occurred in 5.47% of patients in the Xinyue
group and 10.31% in the placebo group (HR 0.515, 95% CI 0.328 to 0.809; P
= 0.004). SF-36 subscale scores at 12 months were significantly higher in
the Xinyue group than placebo group for general health (P = 0.048) and
vitality (P = 0.008). Conclusion(s): In patients with stable CAD
after PCI within the preceding 3 to 12 months, Xinyue capsule added on
conventional treatment reduced the incidence of primary composite endpoint
(cardiac death, nonfatal myocardial infarction and urgent
revascularization). Copyright © 2020 Elsevier Ltd

<17>
Accession Number
2006058403
Title
Effects of erythropoietin on lung injury induced by cardiopulmonary bypass
after cardiac surgery.
Source
Medical Science Monitor. 26 (no pagination), 2020. Article Number:
e920039. 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
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
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/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)-1beta, 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.
 Result(s): EPO significantly decreased the level of TNF-alpha and
IL-1beta, 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. Conclusion(s): 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. Copyright © Med Sci Monit, 2020.

<18>
Accession Number
2006006524
Title
Comparison of fiberoptic bronchoscope and disposcope endoscope in cohen
endobronchial blocker placement.
Source
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 26 (1) (pp
10-16), 2020. Date of Publication: 2020.
Author
Kara U.; Ince E.; Ozkan G.; Senkal S.
Institution
(Kara, Ince, Ozkan, Senkal) Gulhane Egitim Ve Arastirma Hastanesi,
Anesteziyoloji Ve Reanimasyon Klinigi, Dogu Blok 3. Kat, Etlik/Kecioren,
Ankara 06010, Turkey
Publisher
Turkish Anaesthesiology and Intensive Care Society (Yildiz Posta Caddesi,
Sinan Apt. No; 36 D: 66/67, Gayrettepe-Istanbul 34349, Turkey)
Abstract
Objective: In this study, we aimed to compare fiberoptic bronchoscope
(FOB) and Disposcope endoscope (DE),which is one of the optical imaging
methods used in Cohen flexitip bronchial blocker placement.
 Method(s): In this study, a total of 40 patients in whom a bronchial
blocker was inserted for one-lung ventilation were randomly assigned into
two groups as FOB (n=20) and DE (n=20). Data including demographic and
clinical characteristics of the patients, Cormack-Lehane grade, duration
and ease of bronchial blocker placement were recorded. Result(s): The
mean bronchial blocker insertion time in the DE group (196+/-32 sec) was
shorter than the mean BB insertion time in the FOB group (244+/-21 sec)
with a statistically significant intergroup difference (p<0.05). In both
FOB and DE groups, it was found that placement of DE, and BB into the
right main bronchus was easier when compared with the left main bronchus
(p<0.05). Conclusion(s): Disposcope endoscope-guided Cohen flexitip
bronchial blocker placement is a suitable option for one- lung ventilation
in thoracic surgery with its easy placement within a shorter
time. Copyright © 2020 Turkish Anaesthesiology and Intensive Care
Society. All rights reserved.

<19>
Accession Number
2006080385
Title
Percutaneous coronary intervention versus coronary artery bypass graft for
left main coronary artery disease: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Gallo M.; Blitzer D.; Laforgia P.L.; Doulamis I.P.; Perrin N.; Bortolussi
G.; Guariento A.; Putzu A.
Institution
(Gallo) Department of Cardiac Surgery, Cardiocentro Ticino, Lugano,
Switzerland
(Blitzer) Department of Surgery, New York Presbyterian Hospital, Columbia
University, New York, NY, United States
(Laforgia) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Doulamis, Guariento) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, Mass, United States
(Perrin) Department of Cardiology, Geneva University Hospitals, Geneva,
Switzerland
(Bortolussi) Department of Cardiac Surgery, IRCCS Policlinico San Donato,
Milan, Italy
(Putzu) Division of Anesthesiology, Department of Anesthesiology,
Pharmacology, Intensive Care, and Emergency Medicine, Geneva University
Hospitals, Geneva, Switzerland
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The optimal revascularization strategy for patients with left
main coronary artery disease is still controversial. This is systematic
review and meta-analysis aims to evaluate the outcomes of percutaneous
coronary intervention (PCI) with drug-eluting stents compared with
coronary artery bypass graft (CABG) for LM disease. Method(s): Online
electronic databases were systematically reviewed until January 2020 for
randomized trials comparing PCI with drug-eluting stents and CABG. Primary
outcomes were: all-cause mortality, myocardial infarction (MI), stroke,
and repeated revascularization. Secondary outcomes included periprocedural
and nonperiprocedural MI. The period of follow-up included 30 days, 1
year, and 5 years. Odds ratio and 95% confidence interval were calculated
with a fixed-effects model. Result(s): A total of 4595 patients (5
randomized trials) with left main coronary artery disease were included.
At 30 days and 1 year, PCI was associated with lower incidence of stroke,
higher repeated revascularization, and similar odds of mortality and MI
compared with CABG. At 5 years, PCI was associated with higher rates of MI
(odds ratio, 1.43; 95% confidence interval, 1.13-1.79; P = .003) and
repeat revascularization (odds ratio, 1.89; 95% CI, 1.58-2.26; P < .001)
than CABG. PCI was associated with lower periprocedural MI at 30 days,
whereas at 5 years PCI was associated with higher nonperiprocedural MI
(odds ratio, 2.32; 95% confidence interval, 1.62-3.31; P < .001).
Mortality and stroke rate did not differ at 5-year follow-up.
 Conclusion(s): Patients with left main coronary artery disease
treated with either PCI or CABG do not show significant difference in
early or 5-year mortality. Although CABG was associated with higher stroke
rates at 30 days and 1 year, PCI was associated with an increase in MI and
need for repeat revascularization at 5 years. Copyright © 2020
The American Association for Thoracic Surgery

<20>
Accession Number
631937977
Title
Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac
Surgery-A Pilot Study.
Source
Medicina (Kaunas, Lithuania). 56 (6) (no pagination), 2020. Date of
Publication: 27 May 2020.
Author
Saller T.; Peterss S.; Scheiermann P.; Eser-Valeri D.; Ehler J.; Bruegger
D.; Chappell D.; Kofler O.; Hagl C.; Hofmann-Kiefer K.
Institution
(Saller, Scheiermann, Bruegger, Kofler, Hofmann-Kiefer) Department of
Anaesthesiology, University Hospital, LMU Munich, Munich 81377, Germany
(Peterss, Hagl) Department of Cardiac Surgery, University Hospital, LMU
Munich, Munich 81377, Germany
(Eser-Valeri) Department of Psychiatry, University Hospital, LMU Munich,
Munich 80336, Germany
(Ehler) Department of Anaesthesiology and Intensive Care Medicine,
University Medical Center, Germany
(Chappell) Surgical Intensive Care, Emergency Medicine and Pain Therapy,
Klinikum Frankfurt Hoechst, Germany
Publisher
NLM (Medline)
Abstract
Background and Objectives: Delirium is a common and major complication
subsequent to cardiac surgery. Despite scientific efforts, there are no
parameters which reliably predict postoperative delirium. In delirium
pathology, natriuretic peptides (NPs) interfere with the blood-brain
barrier and thus promote delirium. Therefore, we aimed to assess whether
NPs may predict postoperative delirium and long-term outcomes. Materials
andMethods: To evaluate the predictive value of NPs for delirium we
retrospectively analyzed data from a prospective, randomized study for
serum levels of atrial natriuretic peptide (ANP) and the precursor of
C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary
artery bypass grafting (CABG) with or without cardiopulmonary bypass
(off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a
validated chart-based method. Long-term outcomes were assessed 10 years
after surgery by a telephone interview. Result(s): The overall
incidence of delirium in the total cohort was 48% regardless of the
surgical approach (CABG vs. OPCAB). Serum ANP levels >64.6 pg/mL predicted
delirium with a sensitivity (95% confidence interval) of 100% (75.3-100)
and specificity of 42.9% (17.7-71.1). Serum NT-proCNP levels >1.7 pg/mL
predicted delirium with a sensitivity (95% confidence interval) of 92.3%
(64.0-99.8) and specificity of 42.9% (17.7-71.1). Both NPs could not
predict postoperative survival or long-term cognitive decline.
 Conclusion(s): We found a positive correlation between delirium and
preoperative plasma levels of ANP and NT-proCNP. A well-powered and
prospective study might identify NPs as biomarkers indicating the risk of
delirium and postoperative cognitive decline in patients at risk for
postoperative delirium.

<21>
Accession Number
631937834
Title
A meta-analysis on the prevalence, associated factors and diagnostic
methods of mental stress induced myocardial ischemia.
Source
Journal of translational medicine. 18 (1) (pp 218), 2020. Date of
Publication: 29 May 2020.
Author
Zhang L.; Bao Y.; Wang X.; Zhou Y.; Tao S.; Xu W.; Liu M.
Institution
(Zhang, Wang, Tao, Xu, Liu) Cardiology Department, Beijing Anzhen
Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang
District, Beijing 100029, China
(Bao) National Institute on Drug Dependence, Peking University, No. 38,
Xueyuan Road, Beijing 10091, China
(Zhou) Department of Anatomy and Neurobiology, Boston University, Boston,
United States
(Tao) School of Basic Medical Sciences, Henan University, Kaifeng, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The high prevalence of mental stress induced myocardial
ischemia (MSIMI) causes double risk of adverse cardiac events in patients
with MSIMI. However, multiple types of mental stress, diagnostic
techniques, and diagnostic measurements may increase the complexity and
heterogeneity in the assessment of MSIMI. Therefore, we performed this
meta-analysis to assess the prevalence, associated factors, and diagnostic
methods of MSIMI. METHOD(S): We systematically searched PubMed,
EMBACE, Web of Science, CNKI, Wanfang through 1 Feb 2020 in English and
Chinese. Review Manager (RevMan) Version 5.3 and Stata 12.0 were used for
data analyses. RESULT(S): Twenty articles were enrolled. The pooled
estimates for the prevalence of MSIMI in CAD patients was 32%. Potential
associated factors of MSIMI involved history of post myocardial infarction
(MI), or coronary artery bypass graft (CABG) (RR: 1.29, 95% CI 1.00-1.66,
P=0.05; RR: 1.59, 95% CI 1.00-2.52, P=0.05). Evidence supported that
diagnostic methods could influence the prevalence of MSIMI. Significant
differences of MSIMI prevalence were found in different types of mental
stress (Public Speaking: 22%; Mental arithmetic: 26%; Anger recall: 34%;
Two types: 37%; Three or more than three types: 43%, P=0.02), diagnostic
techniques (SPECT: 26%; RNV: 38%; ECG: 16%; Echocardiography: 41%; Two
types: 43%, P<0.0001), and diagnostic measurements (LVEF decrease: 19%;
WMA: 51%; ST depression: 16%; MPD: 26%; Two or more than two measurements:
45%, P<0.00001). Moreover, univariate meta-regression demonstrated that
MSIMI was linked with mental stress (exp(b): 1.0508, SE: 0.0201, P:
0.018). CONCLUSION(S): This meta-analysis implicated that patients
with diabetes, post MI or CABG might be more vulnerable to MSIMI. However,
the prevalence of MSIMI could be influenced by diagnostic methods,
especially the adopted types of mental stress, diagnostic techniques and
measurements. Therefore, it is necessary to formulate a standard
diagnostic method for MSIMI, which should be adequate, assessable, and
affordable worldwide. Registration PROSPERO. Online Protocol:
CRD42020162822.

<22>
Accession Number
631937063
Title
Incidence, predictors and outcomes of valve-in-valve TAVI: A systematic
review and meta-analysis.
Source
International journal of cardiology. (no pagination), 2020. Date of
Publication: 26 May 2020.
Author
Giordana F.; Bruno F.; Conrotto F.; Saglietto A.; D'Ascenzo F.; Marra
W.G.; Dvir D.; Webb J.; D'Onofrio A.; Camboni D.; Grubitzsch H.; Duncan
A.; Kaneko T.; Toggweiler S.; Latib A.; Nerla R.; Salizzoni S.; La Torre
M.; Trompeo A.; D'Amico M.; Rinaldi M.; De Ferrari G.M.
Institution
(Giordana, Bruno, Conrotto, Saglietto, D'Ascenzo, Marra, D'Amico, De
Ferrari) Division of Cardiology, Cardiovascular and Thoracic Department,
Citta della Salute e della Scienza Hospital and University of Turin, Italy
(Dvir) University of Washington, Seattle, WA, United States
(Webb) Centre for Heart Valve Innovation, St Paul's Hospital, University
of British Columbia, Vancouver, BC, Canada
(D'Onofrio) Division of Cardiology, Monaldi Hospital, Naples, Italy
(Camboni) Department of Cardio-Thoracic Surgery, University Medical Center
Regensburg, Germany
(Grubitzsch) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
(Duncan) Royal Brompton Hospital, London, United Kingdom
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Switzerland
(Latib) Interventional Cardiology Unit, San Raffaele Scientific Institute,
Milan, Italy; Department of Cardiology, Montefiore Medical Centre, New
York, USA
(Nerla) Cardiovascular Department, Humanities Gavazzeni, Bergamo, Italy
(Salizzoni, La Torre, Trompeo, Rinaldi) Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital and University of
Turin, Italy
Publisher
NLM (Medline)
Abstract
AIMS: Surgical aortic valve replacement has been the treatment of choice
for patients with aortic valve disease before the arrival of transcatheter
aortic valve replacement (TAVI), although limited by degeneration of the
bioprosthesis. "Redo" intervention itself is burdened by high risk of
complications and valve-in-valve (ViV) TAVI could be a valid strategy of
redo for patients with comorbidities. METHODS AND RESULTS: Two independent
reviewers screened all studies investigating patients undergoing ViV TAVI.
Mortality at 30days and at 1year was the primary end point. Of 286 studies
identified, 26 articles were included in this review with a total of 1448
patients. Median age was 78.8years, 57.7% male. Median STS score and
Logistic EuroSCORE were 9.4% and 31.3% respectively. Stenosis (45%) was
the leading cause of prosthesis failure. Transfemoral approach was
preferred (76%), with a prevalence of balloon expandable valves (73.3%).
Mean follow up was 376days. Overall and cardiovascular mortality at 30days
was 6.5% and 5.5% respectively, while at 1year it was 14.5% and 8.9%
respectively. At meta-regression analysis study year (p<.001), Logistic
EuroSCORE (p<.01) and valve diameter<=21mm (p<.05) at 30days, and stenosis
as reason for failure (p=.05) at 1year were identified as possible
predictors of survival. CONCLUSION(S): ViV TAVI offers a valid
strategy to treat high risk patients with a failure of bioprosthesis with
satisfying results in terms of short and mid-term mortality. Future
studies are needed to find predictors of long term survival and outcomes
in lower risk patients. Copyright © 2020. Published by Elsevier
B.V.

<23>
Accession Number
631935536
Title
Endocarditis risk with bioprosthetic and mechanical valves: systematic
review and meta-analysis.
Source
Heart (British Cardiac Society). (no pagination), 2020. Date of
Publication: 29 May 2020.
Author
Anantha-Narayanan M.; Reddy Y.N.V.; Sundaram V.; Murad M.H.; Erwin P.J.;
Baddour L.; Schaff H.V.; Nishimura R.A.
Institution
(Anantha-Narayanan) Section of Cardiovascular Diseases, Yale-New Haven
Hospital, New Haven, CT, United States
(Reddy, Erwin, Nishimura) Division of Cardiovascular Diseases, Mayo Clinic
College of Medicine, Rochester, MN, United States
(Sundaram) Harrington Heart and Vascular Institute, University Hospitals
Case Medical Center, Cleveland, OH, United States
(Sundaram) Division of Population Science, National Heart and Lung
Institute, London, United Kingdom
(Murad) Knowledge and Evaluation Research, Mayo Clinic, Rochester, MN,
United States
(Baddour) Division of Infectious Diseases, Mayo Clinic Department of
Health Sciences Research, Rochester, MN, United States
(Schaff) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Bioprosthetic valves are being used with increased frequency
for valve replacement, with controversy regarding risk:benefit ratio
compared with mechanical valves in younger patients. However, prior
studies have been too small to provide comparative estimates of less
common but serious adverse events such as infective endocarditis. We aimed
to compare the incidence of infective endocarditis between bioprosthetic
valves and mechanical valves. METHOD(S): We searched PubMed,
Cochrane, EMBASE, Scopus and Web of Science from inception to April 2018
for studies comparing left-sided aortic and mitral bioprosthetic to
mechanical valves for randomised trials or observational studies with
propensity matching. We used random-effects model for our meta-analysis.
Our primary outcome of interest was the rate of infective endocarditis at
follow-up. RESULT(S): 13 comparison groups with 43941 patients were
included. Mean age was 59+/-7 years with a mean follow-up of 10.4+/-5.0
years. Patients with bioprosthetic valves had a higher risk of infective
endocarditis compared with patients receiving mechanical valves (OR 1.59,
95%CI 1.35 to 1.88, p<0.001) with an absolute risk reduction of 9 per 1000
(95% CI 6 to 14). Heterogeneity within the included studies was low
(I2=0%). Exclusion of the study with maximum weight did not change the
results of the analysis (OR 1.57, 95%CI 1.14 to 2.17, p=0.006). A
meta-regression of follow-up time on incidence of infective endocarditis
was not statistically significant (p=0.788) indicating difference in
follow-up times did not alter the pooled risk of infective endocarditis.
 CONCLUSION(S): Bioprosthetic valves may be associated with a higher
risk of infective endocarditis. These data should help guide the
discussion when deciding between bioprosthetic and mechanical valves in
individual patients. Copyright © Author(s) (or their employer(s))
2020. No commercial re-use. See rights and permissions. Published by BMJ.

<24>
Accession Number
631935270
Title
Music Intervention in Pain Relief of Cardiovascular Patients in Cardiac
Procedures: A Systematic Review and Meta-analysis.
Source
Pain medicine (Malden, Mass.). (no pagination), 2020. Date of Publication:
29 May 2020.
Author
Wang Y.; Wei J.; Guan X.; Zhang Y.; Zhang N.; Mao M.; Du W.; Ren Y.; Shen
H.; Liu P.
Institution
(Wang, Guan, Zhang, Zhang, Zhang, Mao, Du, Ren, Shen, Liu) Longhua
Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai,
China
(Wang, Guan, Zhang, Mao, Shen) Shanghai University of Traditional Chinese
Medicine, Shanghai, China
(Wei) Shanghai Xuhui Central Hospital, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Numerous meta-analyses have been conducted on music and pain,
but no studies have investigated music and cardiac procedural pain.
 OBJECTIVE(S): To assess the effects of music intervention on pain in
cardiac procedures in the published randomized controlled trials.
 METHOD(S): This study was conducted according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All
the included randomized controlled studies were published between 1999 and
2016. Studies were obtained from electronic databases or by hand-searching
of related journals and reference lists. The main outcome was pain
intensity, and the secondary outcomes were vital signs such as heart rate,
respiration rate, systolic blood pressure, and diastolic blood pressure.
Risk of bias of the included studies was evaluated according to the
Cochrane Collaboration guidelines. RESULT(S): Analysis of 14 studies
indicated that music interventions had statistically significant effects
on decreasing pain scales (mean deviation [MD] = -1.84), heart rate (MD =
-2.62), respiration rate (MD = -2.57), systolic blood pressure (MD =
-5.11), and diastolic blood pressure (MD = 0.44). The subgroup analysis
method was used in all five outcomes. CONCLUSION(S): Considering all
the possible benefits, music intervention may provide an effective
complement for the relief of cardiac procedural pain. Copyright ©
The Author(s) 2020. Published by Oxford University Press on behalf of the
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.

<25>
Accession Number
631934748
Title
Ramipril in High Risk Patients with COVID-19.
Source
Journal of the American College of Cardiology. (no pagination), 2020. Date
of Publication: 22 May 2020.
Author
Amat-Santos I.J.; Santos-Martinez S.; Lopez-Otero D.; Nombela-Franco L.;
Gutierrez-Ibanes E.; Del Valle R.; Munoz-Garcia E.; Jimenez-Diaz V.A.;
Regueiro A.; Gonzalez-Ferreiro R.; Benito T.; Sanmartin-Pena X.C.; Catala
P.; Rodriguez-Gabella T.; Delgado-Arana J.R.; Carrasco-Moraleja M.; Ibanez
B.; San Roman J.A.
Institution
(Amat-Santos) Hospital Clinico Universitario, Valladolid, Spain
(Santos-Martinez, Catala, Rodriguez-Gabella, Delgado-Arana,
Carrasco-Moraleja, San Roman) Hospital Clinico Universitario, Valladolid,
Spain
(Lopez-Otero, Sanmartin-Pena) Hospital Clinico Universitario de Santiago,
Santiago de Compostela, Spain
(Nombela-Franco) Cardiovascular Institute, Hospital Clinico San Carlos,
Spain
(Gutierrez-Ibanes) Hospital General Gregorio Maranon and Universidad
Carlos III, Madrid, Spain
(Del Valle) Hospital Universitario Central de Asturias, Oviedo, Spain
(Munoz-Garcia) Hospital Virgen de la Victoria, Malaga, Spain
(Jimenez-Diaz) Hospital Universitario de Vigo, Vigo, Spain
(Regueiro) Hospital Clinic Univeristari, Barcelona, Spain
(Gonzalez-Ferreiro) Hospital Clinico Universitario, Salamanca, Spain
(Benito) Hospital Universitario de Leon, Leon, Spain
(Ibanez) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by SARS-CoV2
that interfaces with the renin-angiotensin-aldosterone system (RAAS)
through angiotensin-converting enzyme 2 (ACE-2). This interaction has been
proposed as a potential risk factor in patients treated with
RAAS-inhibitors. OBJECTIVE(S): To analyze if RAAS-inhibitors modify
the risk for COVID-19. METHOD(S): RASTAVI (NCT03201185) is an ongoing
randomized clinical trial randomly allocating Ramipril or control after
successful transcatheter aortic valve replacement at 14 centers is Spain.
We performed a non-pre-specified interim analysis to evaluate its impact
on COVID-19 risk in this vulnerable population. RESULT(S): As in
April 1st 2020, 102 patients (50 Ramipril and 52 controls) were included
in the trial. Mean age was 82.3+/-6.1 years, 56.9% males. Median time of
Ramipril treatment was 6 months [IQR:2.9-11.4]. Eleven patients (10.8%)
have been diagnosed with COVID-19 (6 in control group and 5 receiving
Ramipril, HR=1.150 [95%CI: 0.351-3.768]). The risk of COVID-19 was
increased in older patients (p=0.019), those with atrial fibrillation
(p=0.066), lower hematocrit (p=0.084), and more comorbidities according to
Society of thoracic surgeons score (p=0.065). Admission and oxygen supply
was required in 4.9% (2 patients in the Ramipril and 3 in control), and 4
of them died (two in each randomized group). A higher body mass index was
the only factor increasing the mortality rate (p=0.039).
 CONCLUSION(S): In a high risk population of old patients with
cardiovascular disease, randomization to Ramipril had no impact in the
incidence or severity of COVID-19. This analysis supports the maintenance
of RAAS-inhibitor treatment during COVID-19 crisis. Copyright ©
2020. Published by Elsevier Inc.

<26>
Accession Number
631932845
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. (pp 418-426), 2020. Date of
Publication: 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, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192,
Japan
(Yamazaki) Department of Cardiovascular Surgery, Shizuoka City Shizuoka
Hospital, 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, Tokyo, 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, Tokyo, Japan
(Yamakawa) Department of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Ueda) Department of Cardiology, Osaka Police Hospital, Japan
(Yamamoto) Department of Cardiology, Kochi Health Sciences Center, Japan
(Tokunaga) Department of Cardiology, JA Toride Medical Ctr, 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, OH, United States
(Ando) Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Current expert consensus recommends remote monitoring for
cardiac implantable electronic devices, with at least annual in-office
follow-up. We studied safety and resource consumption of exclusive remote
follow-up (RFU) in pacemaker patients for 2 years. Method(s): In
Japan, consecutive pacemaker patients committed to remote monitoring were
randomized to either RFU or conventional in-office follow-up (conventional
follow-up) at twice yearly intervals. RFU patients were only seen if
indicated by remote monitoring. All returned to hospital after 2 years.
The primary end point was a composite of death, stroke, or cardiovascular
events requiring surgery, and the primary hypothesis was noninferiority
with 5% margin. Result(s): Of 1274 randomized patients (50.4% female,
age 77+/-10 years), 558 (RFU) and 550 (Conventional follow-up) patients
reached either the primary end point or 24 months follow-up. The primary
end point occurred in 10.9% and 11.8%, respectively (P=0.0012 for
noninferiority). The median (interquartile range) number of in-office
follow-ups was 0.50 (0.50-0.63) in RFU and 2.01 (1.93-2.05) in
conventional follow-up per patient-year (P<0.001). Insurance claims for
follow-ups and directly related diagnostic procedures were 18 800 Yen (16
500-20 700 Yen) in RFU and 21 400 Yen (16 700-25 900 Yen) in conventional
follow-up (P<0.001). Only 1.4% of remote follow-ups triggered an
unscheduled in-office follow-up, and only 1.5% of scheduled in-office
follow-ups were considered actionable. Conclusion(s): Replacing
periodic in-office follow-ups with remote follow-ups for 2 years in
pacemaker patients committed to remote monitoring does not increase the
occurrence of major cardiovascular events and reduces resource
consumption. Registration: URL: https://clinicaltrials.gov; Unique
identifier: NCT01523704. Copyright © 2020 The Authors

<27>
Accession Number
631922898
Title
Effects of erector spinae plane block on postoperative pain and
side-effects in adult patients underwent surgery: A systematic review and
meta-analysis of randomized controlled trials.
Source
International journal of surgery (London, England). (no pagination), 2020.
Date of Publication: 24 May 2020.
Author
Cai Q.; Liu G.-Q.; Huang L.-S.; Yang Z.-X.; Gao M.-L.; Jing R.; Liu Z.;
Pan L.-H.
Institution
(Cai) Department of Anesthesiology, Guangxi Medical University Cancer
Hospital, Nanning, Guangxi 530021, China
(Liu) School of Basic Medicine at Guangxi Medical University, Nanning,
Guangxi 530021, China
(Huang) Department of Hepatobiliary Surgery, Taihe Hospital, Hubei
University of Medicine, Shiyan, Hubei 442000, China
(Yang) School of Basic Medicine at Guangxi Medical University, Nanning,
Guangxi 530021, China
(Gao) Department of Anesthesiology, Taihe Hospital, Hubei University of
Medicine, Shiyan, Hubei 442000, China
(Jing, Pan) Department of Anesthesiology, Guangxi Medical University
Cancer Hospital, Nanning, Guangxi 530021, China
(Liu) Department of Anesthesiology, Guangxi Medical University Cancer
Hospital, Nanning, Guangxi 530021, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recently, the effects of erector spinae plane block on
postoperative pain have become increasingly controversial. This
meta-analysis compared the effects of ESP block versus placebo on
postoperative analgesia and side effects to determine whether the new
technique is a reliable alternative for pain management. METHOD(S):
PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure
(CNKI), and Wanfang Database were searched for clinical studies
investigating the analgesic effect of ESP block versus placebo. The
primary outcomes included the visual analogue scale (VAS) at rest and
during movement, as well as the postoperative morphine consumption in 24
h, and the secondary outcome was the rate of postoperative nausea and
vomiting (PONV). The choice of using the fixed or random-effects model
depended on whether the heterogeneity tested by I2 statistic was more than
50%. Seeking sources of heterogeneity and exploring the effect of clinical
details on the final result were performed by subgroup analysis.
Additionally, the test for stability of the pooled result was realized by
sensitivity analysis. Finally, we evaluated the quality of the evidence
for the outcomes. STATA 13.0 software was selected as the main analysis
software in the meta-analysis. RESULT(S): Eighteen randomized
controlled trials (RCTs) comprising 1041 patients were reviewed. This
meta-analysis showed that ESP block could significantly reduce patients'
pain scores at 1 h, 6 h, 12 h, and 24 h after surgery at rest or during
movement; 24-h postoperative morphine consumption; and the incidence of
PONV. CONCLUSION(S): ESP block as a novel technique exhibited
superior postoperative analgesic effects, reducing the postoperative
complications in spinal, thoracic, and abdominal surgeries during the
early postoperative period. However, as a new nerve block technique,
numerous large-sized RCTs are needed for further research. Copyright
© 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All
rights reserved.

<28>
Accession Number
631797817
Title
Behavioural and pharmaceutical interventions for the prevention of skin
cancers in solid organ transplant recipients: A systematic review of
randomised controlled trials.
Source
BMJ Open. 10 (5) (no pagination), 2020. Article Number: e029265. Date of
Publication: 17 May 2020.
Author
James L.J.; Saglimbene V.; Wong G.; Tong A.; Luu L.D.W.; Craig J.; Howard
K.; Howell M.
Institution
(James, Saglimbene, Wong, Tong, Luu, Howard, Howell) Sydney School of
Public Health, University of Sydney, Sydney, NSW, Australia
(James, Saglimbene, Wong, Tong, Luu, Howell) Centre for Kidney Research,
Children's Hospital at Westmead, Westmead, NSW, Australia
(Wong) Centre for Transplant and Renal Research, Westmead Hospital,
Westmead, NSW, Australia
(Craig) College of Medicine and Public Health, Flinders University Faculty
of Medicine Nursing and Health Sciences, Adelaide, SA, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Solid organ transplant recipients are at increased risk of skin
cancer, affecting more than 50% of recipients. We aimed to determine the
effectiveness of interventions for behavioural change for sun protection
or skin cancer prevention in solid organ transplant recipients. Design
Systematic review. Data sources We searched MEDLINE, Embase, the Cochrane
Central Register of Controlled Trials (CENTRAL) and CINAHL from inception
to November 2019. Eligibility criteria We included randomised controlled
trials that evaluated the effect of behavioural or pharmaceutical
interventions on behavioural change or skin cancer prevention in solid
organ transplant recipients. Data extraction and synthesis Risks of bias
and evidence certainty were assessed using Cochrane and the Grading of
Recommendations Assessment Development and Evaluation framework. Results
Twenty trials (n=2295 participants) were included. It is uncertain whether
behavioural interventions improve sun protection behaviour (n=3, n=414,
standardised mean difference (SMD) 0.89, 95% CI -0.84 to 2.62, I 2 =98%)
and knowledge (n=4, n=489, SMD 0.50, 95% CI 0.12 to 0.87, I 2= 76%) as the
quality of evidence is very low. We are uncertain of the effects of
mammalian target of rapamaycin inhibitors on the incidence of
non-melanocytic skin cancer (n=5, n=1080, relative risk 0.46, 95% CI 0.28
to 0.75, I 2 = 72%) as the quality of evidence is very low. Conclusions
Behavioural and pharmaceutical preventive interventions may improve sun
protective behaviour and knowledge, and reduce the incidence of
non-melanocytic skin cancer, but the overall quality of the evidence is
very low and insufficient to guide decision-making and clinical practice.
PROSPERO registration number CRD42017063962. 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.

<29>
Accession Number
631756592
Title
The impact of glutamate infusion on postoperative NT-proBNP in patients
undergoing coronary artery bypass surgery: A randomized study.
Source
Journal of Translational Medicine. 18 (1) (no pagination), 2020. Article
Number: 193. Date of Publication: 11 May 2020.
Author
Jiang H.; Holm J.; Vidlund M.; Vanky F.; Friberg O.; Yang Y.; Svedjeholm
R.
Institution
(Jiang, Holm, Vanky, Yang, Svedjeholm) Department of Cardiothoracic
Surgery, Faculty of Medicine and Health Sciences, Unit of Cardiovascular
Sciences, Linkoping University, Linkoping, Sweden
(Jiang, Yang) Department of Cardiothoracic Surgery, Sun Yat-Sen Memorial
Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
(Vidlund, Friberg) Department of Cardiothoracic and Vascular Surgery,
Faculty of Medicine and Health, Orebro University, Orebro, Sweden
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Glutamate, a key intermediate in myocardial metabolism, may
enhance myocardial recovery after ischemia and possibly reduce the
incidence and severity of postoperative heart failure in coronary artery
bypass surgery (CABG). N-terminal pro-B-type natriuretic peptide
(NT-proBNP) can be used to assess postoperative heart failure (PHF) after
CABG. Our hypothesis was that glutamate enhances myocardial recovery in
post-ischemic heart failure and, therefore, will be accompanied by a
mitigated postoperative increase of NT-proBNP. Method(s): Substudy of
the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS)
trial (ClinicalTrials.gov Identifier: NCT00489827) a prospective
triple-center double-blind randomized clinical trial on 399 patients
undergoing CABG with or without concomitant procedure for acute coronary
syndrome at three Swedish Cardiac Surgery centres (Linkoping, Orebro, and
Karlskrona) from May 30, 2007 to November 12, 2009. Patients were randomly
assigned to intravenous infusion of 0.125 M l-glutamic acid or saline
(1.65 mL/kg of body weight per hour) intraoperatively and postoperatively.
Plasma NT-proBNP was measured preoperatively, the first (POD1) and third
postoperative morning (POD3). A Clinical Endpoints Committee, blinded to
both intervention and NT-proBNP used prespecified criteria to diagnose
PHF. The primary endpoints were the absolute levels of postoperative
NT-proBNP and the difference between preoperative and postoperative levels
of NT-proBNP. Result(s): Overall no significant difference was
detected in postoperative NT-proBNP levels between groups. However, in
high-risk patients (upper quartile of EuroSCORE II >= 4.15; glutamate
group n = 56; control group n = 45) glutamate was associated with
significantly lower postoperative increase of NT-proBNP (POD3-Pre: 3900
[2995-6260] vs. 6745 [3455-12,687] ng*L-1, p = 0.012) and lower
NT-proBNP POD3 (POD3: 4845 [3426-7423] vs. 8430 [5370-14,100]
ng*L-1, p = 0.001). After adjusting for significant differences
in preoperative demographics, NT-proBNP POD3 in the glutamate group was
0.62 times of that in the control group (p = 0.002). Patients in the
glutamate group also had shorter ICU stay (21 [19-26] vs. 25 [22-46] h, p
= 0.025) and less signs of myocardial injury (Troponin T POD3 (300
[170-500] vs. 560 [210-910] ng*L-1, p = 0.025).
 Conclusion(s): Post hoc analysis of postoperative NT-proBNP suggests
that intravenous infusion of glutamate may prevent or mitigate myocardial
dysfunction in high-risk patients undergoing CABG. Further studies are
necessary to confirm these findings. Trial registration Swedish Medical
Products Agency 151:2003/70403 (prospectively registered with amendment
about this substudy filed March 17, 2007). ClinicalTrials.gov Identifier:
NCT00489827 (retrospectively registered)
https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=1&rank
=1 Copyright © 2020 The Author(s).

<30>
Accession Number
631707386
Title
Preoperative VolumE Replacement therapy in DIabetic patients undergoing
coronary artery bypass grafting surgery: Results from an open parallel
group randomized Controlled Trial (VeRDiCT).
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (1) (pp 54-63), 2020.
Date of Publication: 01 Jan 2020.
Author
Sarkar K.; Harris R.A.; Wells S.; Harris T.; Clout M.; Taylor J.;
Culliford L.; Angelini G.D.; Pike K.; Ashton K.; Narayan P.; Reeves B.;
Hillier J.; Rogers C.A.; Ascione R.
Institution
(Sarkar, Narayan) Rabindranath Tagore International Institute of Cardiac
Sciences (RTIICS), Kolkata, India
(Harris, Wells, Harris, Clout, Taylor, Culliford, Pike, Ashton, Reeves,
Rogers) Clinical Trials and Evaluation Unit, Bristol Trials Centre,
University of Bristol, Bristol, United Kingdom
(Angelini, Hillier, Ascione) Faculty of Health Sciences, Bristol Heart
Institute, University of Bristol, Bristol BS2 8HW, United Kingdom
Publisher
Oxford University Press
Abstract
To investigate the effect of preoperative volume replacement therapy (VRT)
on renal function, health outcome and time to fitness for discharge in
diabetic patients undergoing coronary artery bypass grafting (CABG).
 METHOD(S): In 2 parallel randomized controlled trials, diabetic
patients were allocated to preoperative VRT (1 ml/kg/h of Hartmann's
solution for 12 h) or usual care. Primary outcome was time to fitness for
discharge. Secondary outcomes included acute kidney injury, postoperative
complications, patient-reported quality of life (QoL), hospital resource
use and markers of renal, cardiac and inflammatory injury. RESULT(S):
In total, 169 patients were randomized (84 VRT, 85 usual care; mean age 64
years; 88% male). Time to fitness for discharge was similar between groups
[median 6 days; interquartile range 5.0-9.0 in both groups; hazard ratio
0.95, 95% confidence interval (CI) 0.65-1.38; P = 0.78]. Postoperative
acute kidney injury was not statistically different (VRT: 27.7% vs usual
care: 18.8%, odds ratio 1.72, 95% CI 0.82-3.59; P = 0.15). Estimated
glomerular filtration rate (mean difference -0.92, 95% CI -4.18 to 2.25; P
= 0.56), microalbumin/creatinine ratio [geometric mean ratio (GMR) 1.16,
95% CI 0.94-1.42; P = 0.16], N-acetyl-beta-d-glucosaminidase (GMR 1.08,
95% CI 0.83-1.40; P = 0.57), C-reactive protein (GMR 1.00, 95% CI
0.88-1.13; P = 0.94), troponin T (Trop-T; GMR 1.18, 95% CI 0.78-1.79; P =
0.39) and other secondary health outcomes were similar between groups. QoL
improved in both groups at 3 months with no difference observed.
 CONCLUSION(S): The use of preoperative VRT is not superior to usual
care in diabetic patients undergoing CABG. Clinical trial registration
number: ISRCTN02159606. Copyright © 2019 The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<31>
Accession Number
2005962732
Title
Ultrathin Bioresorbable-Polymer Sirolimus-Eluting Stents Versus Thin
Durable-Polymer Everolimus-Eluting Stents for Coronary Revascularization:
3-Year Outcomes From the Randomized BIOFLOW V Trial.
Source
JACC: Cardiovascular Interventions. 13 (11) (pp 1343-1353), 2020. Date of
Publication: 8 June 2020.
Author
Kandzari D.E.; Koolen J.J.; Doros G.; Garcia-Garcia H.M.; Bennett J.;
Roguin A.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Baim Institute for Clinical Research, Boston, MA,
United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Hillel Yaffe Medical Center, Hadera,
Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare late-term clinical
outcomes among patients treated with ultrathin-strut (60-mum)
bioresorbable-polymer sirolimus-eluting stents (BP SES) and thin-strut
(81mum) durable-polymer everolimus-eluting stents (DP EES).
 Background(s): Emerging evidence from comparative studies of
drug-eluting stents demonstrates improved safety and efficacy with
ultrathin-strut drug-eluting stents, but limited insight exists regarding
late-term outcomes. Method(s): BIOFLOW V (Biotronik Prospective
Randomized Multicenter Study to Assess the Safety and Effectiveness of the
Orsiro Sirolimus Eluting Coronary Stent System in the Treatment of
Subjects With Up to Three De Novo or Restenotic Coronary Artery Lesions V)
is an international randomized trial comparing coronary revascularization
with BP SES and DP EES regarding the primary endpoint of 12-month target
lesion failure. Analysis of pre-specified 3-year clinical outcomes was
performed. Result(s): Among 1,334 patients randomized to treatment
with BP SES (n = 884) or DP EES (n = 450), the 3-year rate of target
lesion failure was 8.2% for BP SES and 13.6% for DP EES (p = 0.002),
driven by differences in both target vessel myocardial infarction (MI)
(5.0% vs. 9.2%; p = 0.003) and clinically driven target lesion
revascularization (3.2% vs. 6.7%; p = 0.006). In landmark analysis,
significant differences in target vessel MI and target lesion
revascularization were observed favoring treatment with BP SES. Definite
or probable late or very late stent thrombosis was significantly lower
with BP SES (0.1% vs. 1.2%; p = 0.018). Cardiac death or MI rates were
7.7% and 11.7% (p = 0.017) for BP SES and DP EES, respectively.
 Conclusion(s): In a large randomized trial, both target lesion
failure and the outcomes of target vessel MI, clinically driven target
lesion revascularization, and late or very late stent thrombosis at 3
years were significantly lower among patients treated with BP SES versus
DP EES. The results endorse the continued superiority of ultrathin-strut
BP SES compared with DP EES. (Safety and Effectiveness of the Orsiro
Sirolimus Eluting Coronary Stent System in Subjects With Coronary Artery
Lesions [BIOFLOW-V]; NCT02389946) Copyright © 2020 The Authors

<32>
Accession Number
2005932325
Title
Pressure-controlled ventilation-volume guaranteed mode combined with an
open-lung approach improves lung mechanics, oxygenation parameters, and
the inflammatory response during one-lung ventilation: A randomized
controlled trial.
Source
BioMed Research International. 2020 (no pagination), 2020. Article Number:
1403053. Date of Publication: 2020.
Author
Li J.; Cai B.; Yu D.; Liu M.; Wu X.; Rong J.
Institution
(Li, Cai, Yu, Liu, Wu, Rong) Department of Anesthesiology, Hebei General
Hospital, Shijiazhuang 050051, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
We evaluated the effectiveness of pressure-controlled ventilation-volume
guaranteed (PCV-VG) mode combined with open-lung approach (OLA) in
patients during one-lung ventilation (OLV). First, 176 patients undergoing
thoracoscopic surgery were allocated randomly to four groups: PCV+OLA (45
cases, PCV-VG mode plus OLA involving application of individualized
positive end-expiratory pressure (PEEP) after a recruitment maneuver), PCV
(44 cases, PCV-VG mode plus standard lung-protective ventilation with
fixed PEEP of 5 cmH<inf>2</inf>O), VCV+OLA (45 cases, volume-controlled
ventilation (VCV) plus OLA), and VCV (42 cases, VCV plus standard
lung-protective ventilation). Mean airway pressure (Pmean), dynamic
compliance (Cdyn), PaO<inf>2</inf>/FiO<inf>2</inf> ratio, intrapulmonary
shunt ratio (Qs/Qt), dead space fraction (VD/VT), and plasma concentration
of neutrophil elastase were obtained to assess the effects of four
lung-protective ventilation strategies. At 45 min after OLV, the median
(interquartile range (IQR)) Pmean was higher in the PCV+OLA group (13.00
(12.00, 13.00) cmH<inf>2</inf>O) and the VCV+OLA group (12.00 (12.00,
14.00) cmH<inf>2</inf>O) than in the PCV group (11.00 (10.00, 12.00)
cmH<inf>2</inf>O) and the VCV group (11.00 (10.00, 12.00)
cmH<inf>2</inf>O) (P<0.05); the median (IQR) Cdyn was higher in the
PCV+OLA group (27.00 (24.00, 32.00) mL/cmH<inf>2</inf>O) and the VCV+OLA
group (27.00 (22.00, 30.00) mL/cmH<inf>2</inf>O) than in the PCV group
(23.00 (21.00, 25.00) mL/cmH<inf>2</inf>O) and the VCV group (20.00
(18.75, 21.00) mL/cmH<inf>2</inf>O) (P<0.05); the median (IQR) Qs/Qt in
the PCV+OLA group (0.17 (0.16, 0.19)) was significantly lower than that in
the PCV group (0.19 (0.18, 0.20)) and the VCV group (0.19 (0.17, 0.20))
(P<0.05); VD/VT was lower in the PCV+OLA group (0.18+/-0.05) and the
VCV+OLA group (0.19+/-0.07) than in the PCV group (0.21+/-0.07) and the
VCV group (0.22+/-0.06) (P<0.05). The concentration of neutrophil elastase
was lower in the PCV+OLA group than in the PCV, VCV+OLA, and VCV groups at
total-lung ventilation 10 min after OLV (162.47+/-25.71, 198.58+/-41.99,
200.84+/-22.17, and 286.95+/-21.10 ng/mL, resp.) (P<0.05). In conclusion,
PCV-VG mode combined with an OLA strategy leads to favorable effects upon
lung mechanics, oxygenation parameters, and the inflammatory response
during OLV. Copyright © 2020 Jianli Li et al.

<33>
Accession Number
2004823188
Title
Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials.
Source
Advances in Therapy. 37 (6) (pp 2620-2645), 2020. Date of Publication: 01
Jun 2020.
Author
Linden K.; Mailey J.; Kearney A.; Menown I.B.A.
Institution
(Linden, Mailey, Kearney, Menown) Southern Health and Social Care Trust,
Craigavon Area Hospital, Craigavon, United Kingdom
Publisher
Adis
Abstract
Introduction: A large number of important clinical trials in cardiology
were published or presented at major international conferences during
2019. This paper aims to offer a concise overview of these significant
advances and to put them into clinical context. Method(s): Trials
presented at the major international cardiology meetings during 2019 were
reviewed including The American College of Cardiology (ACC), Euro PCR, The
European Society of Cardiology (ESC), Transcatheter Cardiovascular
Therapeutics (TCT), and the American Heart Association (AHA). In addition
to this a literature search identified several other publications eligible
for inclusion based on their relevance to clinical cardiology, their
potential impact on clinical practice and on future guidelines.
 Result(s): A total of 70 trials met the inclusion criteria. New
interventional and structural data include trials examining use of
drug-coated balloons in patients with acute myocardial infarction (MI),
interventions following shockable cardiac arrest, mechanical circulatory
support in cardiogenic shock complicating MI, intervention in stable
coronary artery disease, surgical or percutaneous revascularisation
strategies in left main coronary artery disease, revascularisation
strategy in ST elevation MI, transcatheter aortic valve replacement in
low-risk patients, and percutaneous mitral or tricuspid valve
interventions. Preventative cardiology data included the use of
sodium-glucose cotransporter 2 (SGLT2) inhibitors (dapagliflozin),
proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors
(evolocumab), bempedoic acid, and novel approaches to the management of
hypertension. Antiplatelet data included trials evaluating both the
optimal length of course and combination of antiplatelet agents and
regimes including combination antithrombotic therapies for patients with
atrial fibrillation. Heart failure data included trials of
sacubitril-valsartan in heart failure with preserved ejection fraction and
the use of SGLT2 inhibitors in patients with heart failure but without
diabetes. Electrophysiology data included trials examining alcohol in
atrial fibrillation and the use of wearable fitness devices for
identifying atrial fibrillation. Conclusion(s): This article presents
key clinical trials completed during 2019 and should be valuable to
clinicians and researchers working in cardiology. Copyright ©
2020, The Author(s).

<34>
Accession Number
628462578
Title
Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic
Review.
Source
Anatomical sciences education. 13 (3) (pp 413-425), 2020. Date of
Publication: 01 May 2020.
Author
Robinson D.A.; Piekut D.T.; Hasman L.; Knight P.A.
Institution
(Robinson, Knight) Division of Cardiac Surgery, Department of Surgery,
School of Medicine and Dentistry, University of Rochester, Rochester, NY
(Piekut) Department of Neuroscience, School of Medicine and Dentistry,
University of Rochester, Rochester, NY
(Hasman) Division of Research and Clinical Information Services,
University of Rochester, Rochester, NY
Publisher
NLM (Medline)
Abstract
Simulation training has become increasingly relevant in the educational
curriculum of surgical trainees. The types of simulation models used,
goals of simulation training, and an objective assessment of its utility
and effectiveness are highly variable. The role and effectiveness of
cadaveric simulation in cardiothoracic surgical training has not been well
established. The objective of this study was to evaluate the current
medical literature available on the utility and the effectiveness of
cadaveric simulation in cardiothoracic surgical residency training. A
literature search was performed using PubMed, Cochrane Library, Embase,
Scopus, and CINAHL from inception to February 2019. Of the 362 citations
obtained, 23 articles were identified and retrieved for full review,
yielding ten eligible articles that were included for analysis. One
additional study was identified and included in the analysis. Extraction
of data from the selected articles was performed using predetermined data
fields, including study design, study participants, simulation task,
performance metrics, and costs. Most of these studies were only
descriptive of a cadaveric or perfused cadaveric simulation model that
could be used to augment clinical operative training in cardiothoracic
surgery. There is a paucity of evidence in the literature that
specifically evaluates the utility and the efficacy of cadavers in
cardiothoracic surgery training. Of the few studies that have been
published in the literature, cadaveric simulation does seem to have a role
in cardiothoracic surgery training beyond simply learning basic skills.
Additional research in this area is needed. Copyright © 2019
American Association of Anatomists.

<35>
Accession Number
630129452
Title
Pulmonary Valve Replacement for Pulmonary Regurgitation in Adults With
Tetralogy of Fallot: A Meta-analysis-A Report for the Writing Committee of
the 2019 Update of the Canadian Cardiovascular Society Guidelines for the
Management of Adults With Congenital Heart Disease.
Source
The Canadian journal of cardiology. 35 (12) (pp 1772-1783), 2019. Date of
Publication: 01 Dec 2019.
Author
Mongeon F.-P.; Ben Ali W.; Khairy P.; Bouhout I.; Therrien J.; Wald R.M.;
Dallaire F.; Bernier P.-L.; Poirier N.; Dore A.; Silversides C.; Marelli
A.
Institution
(Mongeon, Khairy, Dore) Adult Congenital Heart Center, Department of
Specialized Medicine, Montreal Heart Institute, Universite de Montreal,
Montreal, Quebec, Canada
(Ben Ali, Bouhout) Department of surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Therrien) Jewish General Hospital, McGill University, Montreal, Quebec,
Canada
(Wald, Silversides) Peter Munk Cardiac Centre, University Health Network,
Toronto, ON, Canada
(Dallaire) Division of Pediatric and Fetal Cardiology, Centre Hospitalier
Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Quebec,
Canada
(Bernier) Department of surgery, McGill University Health Center, McGill
University, Montreal, Quebec, Canada
(Poirier) Department of surgery, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada; Department of surgery,
CHU-Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
(Marelli) McGill Adult Unit for Congenital Heart Disease (MAUDE Unit),
McGill University, Montreal, Quebec, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is no systematic evidence review of the long-term
results of surgical pulmonary valve replacement (PVR) dedicated to adults
with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation.
 METHOD(S): Our primary objective was to determine whether PVR reduced
long-term mortality in adults with rTOF compared with conservative
therapy. Secondary objectives were to determine the postoperative
incidence rate of death, the changes in functional capacity and in right
ventricular (RV) volumes and ejection fraction after PVR, and the
postoperative incidence rate of sustained ventricular arrhythmias. A
systematic search of multiple databases for studies was conducted without
limits. RESULT(S): No eligible randomized controlled trial or cohort
study compared outcomes of PVR and conservative therapy in adults with
rTOF. We selected 10 cohort studies (total 657 patients) reporting
secondary outcomes. After PVR, the pooled incidence rate of death was 1%
per year (95% confidence interval [CI] 0-1% per year) and the pooled
incidence rate of sustained ventricular arrhythmias was 1% per year (95%
CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative
New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24).
Indexed RV end-diastolic (-61.29 mL/m2, -43.64 to -78.94 mL/m2) and
end-systolic (-37.20 mL/m2, -25.58 to -48.82 mL/m2) volumes decreased
after PVR, but RV ejection fraction did not change (0.19%, -2.36% to
2.74%). The effect of PVR on RV volumes remained constant regardless of
functional status. CONCLUSION(S): Studies comparing PVR and
conservative therapy exclusively in adults with rTOF are lacking. After
PVR, the incidence rates of death and ventricular tachycardia are both 1
per 100 patient-years. Pooled analyses demonstrated an improved functional
status and a reduction in RV volumes. Copyright © 2019 Canadian
Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

<36>
[Use Link to view the full text]
Accession Number
628941195
Title
Donor Simvastatin Treatment in Heart Transplantation.
Source
Circulation. 140 (8) (pp 627-640), 2019. Date of Publication: 20 Aug 2019.
Author
Nykanen A.I.; Holmstrom E.J.; Tuuminen R.; Krebs R.; Dhaygude K.;
Kankainen M.; Jokinen J.J.; Lommi J.; Helantera I.; Raisanen-Sokolowski
A.; Syrjala S.O.; Lemstrom K.B.
Institution
(Nykanen, Holmstrom, Tuuminen, Krebs, Dhaygude, Syrjala, Lemstrom)
Transplantation Laboratory (A.I.N., R.T., University of Helsinki and
Helsinki University Hospital, S.O.S, Finland
(Nykanen, Syrjala, Lemstrom) Department of Cardiothoracic Surgery (A.I.N.,
University of Helsinki and Helsinki University Hospital, S.O.S, Finland
(Nykanen, Holmstrom, Tuuminen, Krebs, Dhaygude, Kankainen, Syrjala,
Lemstrom) Translational Immunology Program Research Programs Unit (A.I.N.,
R.T., University of Helsinki and Helsinki University Hospital, S.O.S,
Finland
(Kankainen) Medical and Clinical Genetics (M.K.), University of Helsinki
and Helsinki University Hospital, Finland
(Kankainen) Institute for Molecular Medicine Finland, University of
Helsinki (M.K.)
(Jokinen) Department of Cardiology (J.L.), University of Helsinki and
Helsinki University Hospital, Finland
(Jokinen) Paijat-Hame Central Hospital, Department of Surgery, Finland
(J.J.J.), Lahti, Finland
(Helantera) Transplantation and Liver Surgery (I.H.), University of
Helsinki and Helsinki University Hospital, Finland
(Raisanen-Sokolowski) Pathology (A.R.-S.), University of Helsinki and
Helsinki University Hospital, Finland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ischemia-reperfusion injury may compromise the short-term and
long-term prognosis after heart transplantation. Experimental studies show
that simvastatin administered to the organ donor is vasculoprotective and
inhibits cardiac allograft ischemia-reperfusion injury. METHOD(S):
Eighty-four multiorgan donors were randomly assigned to receive 80 mg of
simvastatin (42 donors) via nasogastric tube after declaration of brain
death and upon acceptance as a cardiac donor, or to receive no simvastatin
(42 donors). The primary efficacy end point was postoperative plasma
troponin T and I levels during the first 24 hours after heart
transplantation. Secondary end points included postoperative hemodynamics,
inflammation, allograft function, rejections and rejection treatments, and
mortality. Results: Organ donor simvastatin treatment significantly
reduced the heart recipient plasma levels of troponin T by 34% (14900 +/-
12100 ng/L to 9800 +/- 7900 ng/L, P=0.047), and troponin I by 40% (171000
+/- 151000 ng/L to 103000 +/- 109000 ng/L, P=0.023) at 6 hours after
reperfusion, the levels of NT-proBNP (N-terminal pro-B-type natriuretic
peptide) by 36% (32800 +/- 24300 ng/L to 20900 +/- 15900 ng/L; P=0.011) at
1 week, and the number of rejection treatments with hemodynamic compromise
by 53% within the first 30 days (P=0.046). Donor simvastatin treatment did
not affect donor lipid levels but was associated with a specific
transplant myocardial biopsy gene expression profile, and a decrease in
recipient postoperative plasma levels of CXCL10 (C-X-C motif chemokine
10), interleukin-1alpha, placental growth factor, and platelet-derived
growth factor-BB. Postoperative hemodynamics, biopsy-proven acute
rejections, and mortality were similar. No adverse effects were seen in
recipients receiving noncardiac solid organ transplants from
simvastatin-treated donors. CONCLUSION(S): Donor simvastatin
treatment reduces biomarkers of myocardial injury after heart
transplantation, and-also considering its documented general safety
profile-may be used as a novel, safe, and inexpensive adjunct therapy in
multiorgan donation. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier: NCT01160978.

<37>
Accession Number
631925484
Title
Incentive spirometry inspiratory capacity changes and predictors after
open heart surgery: a 5-day prospective study.
Source
The Medical journal of Malaysia. 75 (3) (pp 226-234), 2020. Date of
Publication: 01 May 2020.
Author
Leela T.N.; Syed Rasul G.S.H.
Institution
(Leela) Universiti Teknologi Malaysia, Faculty of Engineering, School of
Biomedical Engineering and Health Science, Skudai, Johor, Malaysia
(Syed Rasul) Hospital Sultanah Aminah, Cardiothoracic Surgery Department,
Johor Bahru, Johor, Malaysia
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Incentive spirometry (IS) is commonly used for increasing
postoperative IS inspiratory capacity (ISIC) after open heart surgery
(OHS). However, little is known about the serial changes in ISIC and their
predictive factors. OBJECTIVE(S): The aim of this study is to
identify the postoperative ISIC changes relative to preoperative ISIC
after OHS, and determine their predictors, including patient
characteristics factors and IS performance parameters such as inspiration
volumes (ISv) and frequencies (ISf). METHOD(S): This is a prospective
study with blinding procedures involving 95 OHS patients, aged 52.8+/-11.5
years, whose ISIC was measured preoperatively (PreopISIC) until fifth
postoperative day (POD), while ISv and ISf monitored with an electronic
device from POD1-POD4. Regression models were used to identify predictors
of POD1 ISIC, POD2- POD5 ISIC increments, and the odds of attaining
PreopISIC by POD5. RESULT(S): The ISIC reduced to 41% on POD1,
increasing thereafter to 57%, 75%, 91%, and 106% from POD2-POD5
respectively. Higher PreopISIC (B=-0.01) significantly predicted lower
POD1 ISIC, and, together with hyperlipedemia (B=11.52), which
significantly predicted higher POD1 ISIC, explained 13% of variance. ISv
at relative percentages of PreopISIC from POD1-POD4 (BPOD1=0.60,
BPOD2=0.56, BPOD3=0.49, BPOD4=0.50) significantly predicted ISIC of
subsequent PODs with variances at 23%, 24%, 17% and 25% respectively, but
no association was elicited for ISf. IS performance findings facilitated
proposal of a postoperative IS therapy target guideline. Higher ISv
(B=0.05) also increased odds of patients recovering to preoperative ISIC
on POD5 while higher PreopISIC (B=- 0.002), pain (B=-0.72) and being of
Indian race (B=-1.73) decreased its odds. CONCLUSION(S): ISv appears
integral to IS therapy efficacy after OHS and the proposed therapy targets
need further verification through randomized controlled trials.

<38>
Accession Number
631925334
Title
Effect of Donor Simvastatin Treatment on Gene Expression Profiles in Human
Cardiac Allografts during Ischemia-Reperfusion Injury.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S88), 2020. Date of Publication: 01 Apr 2020.
Author
Krebs R.; Holmstrom E.; Dhaygude K.; Kankainen M.; Syrjala S.; Lukac J.;
Mattila P.; Nykanen A.; Lemstrom K.
Institution
(Krebs, Holmstrom, Dhaygude, Syrjala, Lukac, Nykanen, Lemstrom)
Transplantation Laboratory, University of Helsinki, Helsinki, Finland
(Kankainen, Mattila) Institute for Molecular Medicine Finland, University
of Helsinki, Helsinki, Finland
Publisher
NLM (Medline)
Abstract
PURPOSE: Numerous studies have shown that statin therapy initiated early
after heart transplantation has beneficial effects on the development of
cardiac allograft vasculopathy. Recently, we were able to show in a
randomized clinical trial that simvastatin treatment of brain-dead donors
conditions the heart transplant to withstand ischemia-reperfusion injury
and to reduce the need for rejection treatments early after
transplantation. In this study, we analyzed myocardial gene expression
profiles in cardiac allografts after donor simvastatin treatment.
 METHOD(S): 84 heart transplant donors received 80 mg of simvastatin
via nasogastric tube (n=42), or no treatment (n=42) in a prospective,
double-blinded randomized controlled trial. Transmural Tru-Cut biopsies
were taken from the apex of the donor heart's left ventricle immediately
before reperfusion and 1 hour after reperfusion. The transcriptome of the
biopsies will be analyzed with RNA sequencing. RESULT(S): The
preliminary analysis of RNA sequencing data from myocardial biopsies of
20+20 patients revealed altogether 137 significantly differentially
expressed genes in all pairwise comparisons. The overall biological
functions of these genes were related to gene ontology terms such as
response to toxic substance, leukocyte migration, neutrophil mediated
immunity, response to lipopolysaccharide, and response to oxidative
stress. Enrichment pathway analysis indicated alterations in Th17,
TGF-beta, and muscle repair signaling pathways. At time of abstract
submission, data of the remaining samples is about to enter the sequencing
data analysis pipeline. CONCLUSION(S): We have shown in previous
studies that donor simvastatin treatment induces protective effects
against IRI in heart transplant recipients. In this study, we were able to
detect significantly differentially expressed genes related to effects of
simvastatin treatment. In order to single out genes that show beneficial
effects of simvastatin treatment, further analysis will be conducted by
exploring gene expression changes in specific biological functional
categories, such as interleukin signaling and neutrophil degranulation.
The complete analysis will be presented at the ISHLT 2020
congress. Copyright © 2020. Published by Elsevier Inc.

<39>
Accession Number
631925219
Title
Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant
Recipients (IronIC) - A Randomized, Double Blind, Controlled Trial.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S144), 2020. Date of Publication: 01 Apr 2020.
Author
Brautaset Englund K.V.; Ostby C.M.; Vartdal T.; Rolid K.; Gude E.;
Andreassen A.K.; Gullestad L.L.; Broch K.
Institution
(Brautaset Englund, Ostby, Vartdal, Rolid, Gude, Andreassen, Gullestad,
Broch) Department of Cardiology, Oslo University Hospital, Rikshospitalet,
Oslo, Norway
Publisher
NLM (Medline)
Abstract
OF OBJECTIVES: Heart transplant recipients have reduced exercise capacity
despite preserved graft function. Numerous mechanisms may contribute to
this impaired exercise tolerance, one of which may be iron deficiency
(ID). Among our heart transplant survivors, 48 % have ID. The IronIC trial
(NCT03662789) was designed to test the hypothesis that intravenous (i.v.)
iron therapy will improve exercise capacity assessed by peak oxygen
consumption. METHOD(S): 102 stable, cardiac transplant recipients
with ID, defined as serum ferritin <100 micro g/l, or ferritin between
100 and 300 micro g/l in combination with transferrin saturation <20
%, have been randomized in a 1:1 manner to treatment with intravenous iron
isomaltoside, 20 mg/kg, or NaCl. Care was taken to blind patients and
personnel to the color of the infusate. All participants provided written,
informed consent. Exclusion criteria included hemoglobin <100 g/l, red
blood cell disorders, end-stage kidney failure, intolerance to iron
isomaltoside, and ongoing infections or rejections. Prior to the
intervention, all patients underwent a treadmill test to measure peak
oxygen consumption. Muscle strength by a hand grip test, cognitive
function, and self-reported quality of life were also measured. All tests
are repeated at follow-up 6 months after intervention. The trial is
powered to detect a 1.5 ml/kg/min between-group difference in the change
in peak oxygen consumption. Last patient is scheduled for follow-up
February 2020. ENDPOINTS: The primary objective is to assess
baseline-adjusted peak oxygen consumption, six months after one single
dose of iron isomaltoside. Secondary objectives are to assess the impact
of treatment on iron stores, muscle strength, cognitive function, quality
of life, safety and tolerability. This study will give insight to whether
heart transplant recipients with ID can benefit from intravenous iron
supplement. Results will be ready for presentation at the 2020 ISHLT
conference. Copyright © 2020. Published by Elsevier Inc.

<40>
Accession Number
2006071140
Title
Erector spinae plane block for postoperative analgesia in breast and
thoracic surgery: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 66 (no pagination), 2020. Article Number:
109900. Date of Publication: November 2020.
Author
Huang W.; Wang W.; Xie W.; Chen Z.; Liu Y.
Institution
(Huang, Wang, Xie, Chen, Liu) Department of Critical Care Medicine,
Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
(Huang, Wang) The First School of Clinical Medicine, Southern Medical
University, Guangzhou 510515, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: The erector spinae plane block (ESPB) is a newly defined
regional anesthesia technique first introduced in 2016. The aim of this
study is to determine its analgesic efficacy compared with non-block care
and thoracic paravertebral block (TPVB). Design(s): We systematically
searched PubMed, Web of Science citation index, Embase, the Cochrane
Library, Google Scholar, and ClinicalTrials.gov register searched up to
March 2020. We conducted a meta-analysis of randomized controlled trials
(RCTs) that compared an ESPB to non-block care or TPVB for postoperative
analgesia in breast and thoracic surgery patients. Primary outcome was
24-hour postoperative opioid consumption. Risk of bias was assessed using
Cochrane methodology. Result(s): 14 RCTs that comprised 1018 patients
were included. Seven trials involved thoracic surgery patients and seven
included breast surgery patients. Meta-analysis revealed that ESPB
significantly reduced 24-hour opioid consumption compared with the
non-block groups (-10.5 mg; 95% CI: -16.49 to -3.81; p = 0.002;
I2 = 99%). Similarly, the finding was consistent in subgroup
analysis between the breast surgery (-7.75 mg; 95%CI -13.98 to -1.51; p =
0.01; I2 = 97%) and thoracic surgery (-14.81 mg; 95%CI -21.18
to -8.44; p < 0.001; I2 = 96%) subgroups. The ESPB
significantly reduced pain scores at rest or movement at various time
points postoperatively compared with non-block group, and reduced the rate
of postoperative nausea and vomiting (OR 0.48; 95%CI 0.27 to 0.86; p =
0.01; I2 = 0%). In contrast, there were no significative
differences reported in any of the outcomes for ESPB versus TPVB strata.
 Conclusion(s): ESPB improved analgesic efficacy in breast and
thoracic surgery patients compared with non-block care. Furthermore,
current literature supported the ESPB offered comparable analgesic
efficacy to a TPVB. Copyright © 2020

<41>
Accession Number
2006069930
Title
Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac
Surgery: A Sequential Matched Case-Controlled Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Osawa E.A.; Cutuli S.L.; Cioccari L.; Bitker L.; Peck L.; Young H.;
Hessels L.; Yanase F.; Fukushima J.T.; Hajjar L.A.; Seevanayagam S.;
Matalanis G.; Eastwood G.M.; Bellomo R.
Institution
(Osawa, Bitker, Peck, Young, Hessels, Yanase, Eastwood, Bellomo)
Department of Intensive Care, Austin Hospital, Melbourne, Australia
(Cutuli) Department of Anesthesiology and Intensive Care, Fondazione
Policlinico Universitario A. Gemelli, Universita Cattolica del Sacro
Cuore, Rome, Italy
(Cioccari) Department of Intensive Care Medicine, University Hospital,
University of Bern, Bern, Switzerland
(Yanase) Australian and New Zealand Intensive Care Research Centre, Monash
University, School of Public Health and Preventive Medicine, Melbourne,
Australia
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center, Groningen, Netherlands
(Osawa, Fukushima, Hajjar) Department of Cardiology, Heart Institute
(InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de
Sao Paulo, Sao Paulo, Brazil
(Seevanayagam, Matalanis) Department of Cardiac Surgery, Austin Hospital,
Heidelberg, Melbourne, Australia
(Bellomo) Centre for Integrated Critical Care, School of Medicine, The
University of Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to test whether a bolus of magnesium followed
by continuous intravenous infusion might prevent the development of atrial
fibrillation (AF) after cardiac surgery. Design(s): Sequential,
matched, case-controlled pilot study. Setting(s): Tertiary university
hospital. Participant(s): Matched cohort of 99 patients before and
intervention cohort of 99 consecutive patients after the introduction of a
continuous magnesium infusion protocol. Intervention(s): The
magnesium infusion protocol consisted of a 10 mmol loading dose of
magnesium sulphate followed by a continuous infusion of 3 mmol/h over a
maximum duration of 96 hours or until intensive care unit discharge.
 Measurements and Main Results: The study groups were balanced except
for a lower cardiac index in the intervention cohort. The mean duration of
magnesium infusion was 27.93 hours (95% confidence interval [CI]:
24.10-31.76 hours). The intervention group had greater serum peak
magnesium levels: 1.72 mmol/L +/- 0.34 on day 1, 1.32 +/- 0.36 on day 2
versus 1.01 +/- 1.14 and 0.97 +/- 0.13, respectively, in the control group
(p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the
intervention group and 40 patients (40.4%) in the control group (odds
ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox
proportional hazards model, the hazard ratio for the development of AF was
significantly less in the intervention group (hazard ratio 0.45, 95% CI,
0.26-0.77; p = 0.004). Conclusion(s): The magnesium delivery strategy
was associated with a decreased incidence of postoperative AF in cardiac
surgery patients. These findings provide a rationale and preliminary data
for the design of future randomized controlled trials. Copyright
© 2020 Elsevier Inc.

<42>
Accession Number
2005116112
Title
Impact of age on clinical outcomes of antihypertensive therapy in patients
with hypertension and coronary artery disease: A sub-analysis of the Heart
Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary
Artery Disease.
Source
Journal of Clinical Hypertension. (no pagination), 2020. Date of
Publication: 2020.
Author
Kikuchi N.; Ogawa H.; Kawada-Watanabe E.; Arashi H.; Jujo K.; Sekiguchi
H.; Yamaguchi J.; Hagiwara N.
Institution
(Kikuchi, Ogawa, Kawada-Watanabe, Arashi, Jujo, Sekiguchi, Yamaguchi,
Hagiwara) Department of Cardiology, The Heart Institute of Japan, Tokyo
Women's Medical University, Tokyo, Japan
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
This study aimed to determine whether different systolic blood pressure
(SBP) measurements achieved with antihypertensive therapy impact clinical
outcomes by age in patients with hypertension and coronary artery disease
(CAD). This post hoc analysis from the Heart Institute of Japan
Candesartan Randomized Trial for Evaluation in Coronary Heart Disease
(HIJ-CREATE) trial included 2048 patients with hypertension and
angiographically documented CAD. Participants were divided into three
groups based on age at enrollment: middle-aged (<60 years, n = 570),
pre-elderly (>=60-<70 years, n = 730), and elderly (>=70 years, n = 748).
Among the 2,048 patients, 1695 (82.7%) underwent percutaneous coronary
intervention. The primary end point was the time to first occurrence of a
major adverse cardiac event (MACE). During a median follow-up of 4.2
years, the MACE rate was 19.8%, 28.1%, and 31.1% in the middle-aged,
pre-elderly, and elderly groups, respectively. Achieved BP was defined as
the mean BP during scheduled visits. Patients with higher achieved SBP had
a higher occurrence of MACE in all age groups. An unadjusted quadratic
proportional hazard model was used to evaluate the relationship between
achieved BP during follow-up and risk for MACE. In each age group,
participants were divided into quartiles based on the achieved BP during
follow-up. The relationship between achieved SBP and the incidence of MACE
did not follow a J-shaped curve in any age group. In conclusion, in the
contemporary era of aggressive coronary revascularization, a lower SBP
target may be appropriate even in elderly patients with hypertension and
CAD. Copyright © 2020 Wiley Periodicals LLC

<43>
Accession Number
624586127
Title
Systematic review of shared decision-making in surgery.
Source
British Journal of Surgery. 105 (13) (pp 1721-1730), 2018. Date of
Publication: December 2018.
Author
de Mik S.M.L.; Stubenrouch F.E.; Balm R.; Ubbink D.T.
Institution
(de Mik, Stubenrouch, Balm, Ubbink) Department of Surgery, Amsterdam
Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Multiple treatment options are generally available for most
diseases. Shared decision-making (SDM) helps patients and physicians
choose the treatment option that best fits a patient's preferences. This
review aimed to assess the extent to which SDM is applied during surgical
consultations, and the metrics used to measure SDM and SDM-related
outcomes. Method(s): This was a systematic review of observational
studies and clinical trials that measured SDM during consultations in
which surgery was a treatment option. Embase, MEDLINE and CENTRAL were
searched. Study selection, quality assessment and data extraction were
conducted by two investigators independently. Result(s): Thirty-two
articles were included. SDM was measured using nine different metrics.
Thirty-six per cent of 13 176 patients and surgeons perceived their
consultation as SDM, as opposed to patient- or surgeon-driven. Surgeons
more often perceived the decision-making process as SDM than patients
(43.6 versus 29.3 per cent respectively). SDM levels scored objectively
using the OPTION and Decision Analysis System for Oncology instruments
ranged from 7 to 39 per cent. Subjective SDM levels as perceived by
surgeons and patients ranged from 54 to 93 per cent. Patients experienced
a higher level of SDM during consultations than surgeons (93 versus 84 per
cent). Twenty-five different SDM-related outcomes were reported.
 Conclusion(s): At present, SDM in surgery is still in its infancy,
although surgeons and patients both think of it favourably. Future studies
should evaluate the effect of new interventions to improve SDM during
surgical consultations, and its assessment using available standardized
and validated metrics. Copyright © 2018 The Authors. BJS
published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

<44>
Accession Number
2004339017
Title
A randomized comparison of plasma levobupivacaine concentrations following
thoracic epidural analgesia and subpleural paravertebral analgesia in open
thoracic surgery.
Source
Journal of Clinical Medicine. 9 (5) (no pagination), 2020. Article Number:
1395. Date of Publication: May 2020.
Author
Matek J.; Cernohorsky S.; Trca S.; Krska Z.; Hoskovec D.; Bruthans J.;
Sima M.; Michalek P.
Institution
(Matek, Cernohorsky, Trca, Krska, Hoskovec) 1st Department of
Surgery-Department of Abdominal, Thoracic Surgery and Traumatology, First
Faculty of Medicine, Charles University in Prague and General University
Hospital in Prague, Prague 128 00, Czechia
(Matek) Medical Faculty, Masaryk University, Brno 625 00, Czechia
(Bruthans, Michalek) Department of Anaesthesia and Intensive Care, First
Faculty of Medicine, Charles University in Prague and General University
Hospital in Prague, Prague 128 00, Czechia
(Sima) Institute of Pharmacology, First Faculty of Medicine, Charles
University in Prague and General University Hospital in Prague, Prague 128
00, Czechia
(Michalek) Department of Anaesthesia, Antrim Area Hospital, Antrim BT41
2RL, United Kingdom
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Background: The aim of this study was to compare plasma levobupivacaine
concentrations in thoracic epidural and subpleural paravertebral
analgesia. Method(s): Forty-four patients indicated for open lung
resection had an epidural catheter inserted preoperatively or a subpleural
catheter surgically. A bolus of 0.25% levobupivacaine at a dosage of 0.5
mg x kg-1 was given after the thoracotomy closure. Plasma
levobupivacaine level at 30 min was the primary outcome. Pharmacokinetic
modeling was performed subsequently. Secondary outcomes included the
quality of analgesia, complications, and patients'mobility.
 Result(s): Plasma concentrations were similar 30 min after
application-0.389 mg x L-1 in the epidural and 0.318 mg x
L-1 in the subpleural group (p = 0.33) and lower in the
subpleural group at 120 min (p = 0.03). The areas under the curve but not
maximum concentrations were lower in the subpleural group. The time to
reach maximum plasma level was similar in both groups-27.6 vs. 24.2 min.
No clinical symptoms of local anesthetic toxicity were recorded.
 Conclusion(s): Levobupivacaine systemic concentrations were low in
both groups without the symptoms of toxicity. This dosage should be safe
for postoperative analgesia after thoracotomy. Copyright © 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<45>
Accession Number
2005051033
Title
Outcomes of percutaneous temporary biventricular mechanical support: a
systematic review.
Source
Heart Failure Reviews. (no pagination), 2020. Date of Publication: 2020.
Author
Weber M.P.; O'Malley T.J.; Choi J.H.; Maynes E.J.; Prochno K.W.; Austin
M.A.; Wood C.T.; Patel S.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Weber, O'Malley, Choi, Maynes, Prochno, Austin, Wood, Patel, Morris,
Massey, Tchantchaleishvili) Division of Cardiac Surgery, Sidney Kimmel
Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 607,
Philadelphia, PA 19107, United States
Publisher
Springer
Abstract
Percutaneous biventricular assist devices (BiVAD) are a recently developed
treatment option for severe cardiogenic shock. This systematic review
sought to identify indications and outcomes of patients placed on
percutaneous BiVAD support. An electronic search was performed to identify
all appropriate studies utilizing a percutaneous BiVAD configuration.
Fifteen studies comprising of 20 patients were identified. Individual
patient survival and outcomes data were combined for statistical analysis.
All 20 patients were supported with a microaxial LVAD, 12/20 (60%) of
those patients were supported with a microaxial (RMA) right ventricular
assist device (RVAD), and the remaining 8/20 (40%) patients were supported
with a centrifugal extracorporeal RVAD (RCF). All patients presented with
cardiogenic shock, and of these, 12/20 (60%) presented with a non-ischemic
etiology vs 8/20 (40%) with ischemic disease. For the RMA group, RVAD
support was significantly longer [RMA 5 (IQR 4-7) days vs RCF 1 (IQR 1-2)
days, p = 0.03]. Intravascular hemolysis post-BiVAD occurred in three
patients (27.3%) [RMA 3 (33.3%) vs RCF 0 (0%), p = 0.94]. Five patients
received a durable left ventricular assist device, one patient received a
total artificial heart, and one patient underwent a heart transplantation.
Estimated 30-day mortality was 15.0%, and 78.6% were discharged alive.
Both strategies for percutaneous BiVAD support appear to be viable options
for severe cardiogenic shock. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<46>
Accession Number
605946015
Title
Meta-analysis of the association between preoperative anaemia and
mortality after surgery.
Source
British Journal of Surgery. 102 (11) (pp 1314-1324), 2015. Date of
Publication: 01 Oct 2015.
Author
Fowler A.J.; Ahmad T.; Phull M.K.; Allard S.; Gillies M.A.; Pearse R.M.
Institution
(Fowler, Ahmad, Pearse) Barts and the London School of Medicine and
Dentistry, Queen Mary University of London, London, United Kingdom
(Phull) Department of Anaesthesia, Royal London Hospital, Barts Health NHS
Trust, London, United Kingdom
(Allard) Department of Haematology, Royal London Hospital, Barts Health
NHS Trust, London, United Kingdom
(Gillies) Department of Anaesthesia, Critical Care and Pain Medicine,
Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background Numerous published studies have explored associations between
anaemia and adverse outcomes after surgery. However, there are no evidence
syntheses describing the impact of preoperative anaemia on postoperative
outcomes. Methods A systematic review and meta-analysis of observational
studies exploring associations between preoperative anaemia and
postoperative outcomes was performed. Studies investigating trauma, burns,
transplant, paediatric and obstetric populations were excluded. The
primary outcome was 30-day or in-hospital mortality. Secondary outcomes
were acute kidney injury, stroke and myocardial infarction. Predefined
analyses were performed for the cardiac and non-cardiac surgery subgroups.
A post hoc analysis was undertaken to evaluate the relationship between
anaemia and infection. Data are presented as odds ratios (ORs) with 95 per
cent c.i. Results From 8973 records, 24 eligible studies including 949 445
patients were identified. Some 371 594 patients (39.1 per cent) were
anaemic. Anaemia was associated with increased mortality (OR 2.90, 2.30 to
3.68; I2 = 97 per cent; P < 0.001), acute kidney injury (OR
3.75, 2.95 to 4.76; I2 = 60 per cent; P < 0.001) and infection
(OR 1.93, 1.17 to 3.18; I2 = 99 per cent; P = 0.01). Among
cardiac surgical patients, anaemia was associated with stroke (OR 1.28,
1.06 to 1.55; I2 = 0 per cent; P = 0.009) but not myocardial
infarction (OR 1.11, 0.68 to 1.82; I2 = 13 per cent; P = 0.67).
Anaemia was associated with an increased incidence of red cell transfusion
(OR 5.04, 4.12 to 6.17; I2 = 96 per cent; P < 0.001). Similar
findings were observed in the cardiac and non-cardiac subgroups.
Conclusion Preoperative anaemia is associated with poor outcomes after
surgery, although heterogeneity between studies was significant. It
remains unclear whether anaemia is an independent risk factor for poor
outcome or simply a marker of underlying chronic disease. However, red
cell transfusion is much more frequent amongst anaemic
patients. Copyright © 2015 BJS Society Ltd Published by John
Wiley & Sons Ltd.

<47>
Accession Number
601796531
Title
Systematic review of surgery and outcomes in patients with primary
aldosteronism.
Source
British Journal of Surgery. 102 (4) (pp 307-317 and e190), 2015. Date of
Publication: 01 Mar 2015.
Author
Muth A.; Ragnarsson O.; Johannsson G.; Wangberg B.
Institution
(Muth, Wangberg) Section for Endocrine Surgery and Abdominal Sarcoma,
Department of Surgery, Institute of Clinical Sciences, Gothenburg, Sweden
(Ragnarsson, Johannsson) Section for Endocrinology, Department of
Medicine, University of Gothenburg, Gothenburg, Sweden
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Primary aldosteronism (PA) is the most common cause of
secondary hypertension. The main aims of this paper were to review outcome
after surgical versus medical treatment of PA and partial versus total
adrenalectomy in patients with PA. Method(s): Relevant medical
literature from PubMed, the Cochrane Library and Embase OvidSP from 1985
to June 2014 was reviewed. Result(s): Of 2036 records, 43 articles
were included in the final analysis. Twenty-one addressed surgical versus
medical treatment of PA, four considered partial versus total
adrenalectomy for unilateral PA, and 18 series reported on surgical
outcomes. Owing to the heterogeneity of protocols and reported outcomes,
only a qualitative analysis was performed. In six studies, surgical and
medical treatment had comparable outcomes concerning blood pressure,
whereas six showed better outcome after surgery. No differences were seen
in cardiovascular complications, but surgery was associated with the use
of fewer antihypertensive medications after surgery, improved quality of
life, and (possibly) lower all-cause mortality compared with medical
treatment. Randomized studies indicate a role for partial adrenalectomy in
PA, but the high rate of multiple adenomas or adenoma combined with
hyperplasia in localized disease is disconcerting. Surgery for unilateral
dominant PA normalized BP in a mean of 42 (range 20-72) per cent and the
biochemical profile in 96-100 per cent of patients. The mean complication
rate in 1056 patients was 4.7 per cent. Conclusion(s):
Recommendations for treatment of PA are hampered by the lack of randomized
trials, but support surgical resection of unilateral disease. Partial
adrenalectomy may be an option in selected patients. Copyright ©
2015 BJS Society Ltd.

<48>
Accession Number
631709528
Title
2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult
cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (2) (pp 161-202),
2020. Date of Publication: 01 Feb 2020.
Author
Puis L.; Milojevic M.; Boer C.; De Somer F.M.J.J.; Gudbjartsson T.; Van
Den Goor J.; Jones T.J.; Lomivorotov V.; Merkle F.; Ranucci M.; Kunst G.;
Wahba A.; Alston P.; Fitzgerald D.; Nikolic A.; Onorati F.; Steen
Rasmussen B.; Svenmarker S.
Institution
(Puis) Department of Perfusion, University Hospital Brussels, Jette,
Belgium
(Milojevic) Department of Cardiovascular Anaesthesia, Intensive Care Unit,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Milojevic) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Boer) Department of Anaesthesiology, Amsterdam UMC, VU University,
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
(De Somer) Department of Cardiac Surgery, Ghent University Hospital,
Ghent, Belgium
(Gudbjartsson) Department of Cardiothoracic Surgery, Faculty of Medicine,
Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
(Van Den Goor) Department of Cardiothoracic Surgery, Academic Medical
Centre, University of Amsterdam, Amsterdam, Netherlands
(Jones) Department of Paediatric Cardiac Surgery, Birmingham Women's and
Children's Hospital, Birmingham, United Kingdom
(Lomivorotov) Department of Anesthesiology and Intensive Care, E.
Meshalkin National Medical Research Center, Novosibirsk State University,
Novosibirsk, Russian Federation
(Merkle) Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
(Ranucci) Department of Cardiovascular Anaesthesia, Intensive Care Unit,
IRCCS Policlinico San Donato, Milan, Italy
(Kunst) Department of Anaesthetics and Pain Medicine, King's College
Hospital NHS Foundation Trust, School of Cardiovascular Medicine and
Sciences, King's College London British Heart Foundation Centre of
Excellence, London, United Kingdom
(Wahba) Department of Cardio-Thoracic Surgery, St Olav S University
Hospital, Trondheim, Norway
(Wahba) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
(Alston) Department of Anaesthesia Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, SC, United States
(Nikolic) Department of Cardiac Surgery, Acibadem Sistina Hospital,
Skopje, North Macedonia
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, Verona, Italy
(Steen Rasmussen) Department of Anaesthesia and Intensive Care, Aalborg
University Hospital, Aalborg, Denmark
(Svenmarker) Department of Public Health and Clinical Medicine, Heart
Centre, Umea University, Umea, Sweden
Publisher
Oxford University Press
Abstract
Disclaimer 2019: The EACTS/EACTA/EBCP Guidelines represent the views of
the EACTS, the EACTA and EBCP and were produced after careful
consideration of the scientific and medical knowledge and the evidence
available at the time of their dating. The EACTS, EACTA and EBCP are not
responsible in the event of any contradiction, discrepancy and/or
ambiguity between the EACTS, EACTA and EBCP Guidelines and any other
official recommendations or guidelines issued by the relevant public
health authorities, in particular in relation to good use of healthcare or
therapeutic strategies. Health professionals are encouraged to take the
EACTS, EACTA and EBCP Guidelines fully into account when exercising their
clinical judgement as well as in the determination and the implementation
of preventive, diagnostic or therapeutic medical strategies; however, the
EACTS, EACTA and EBCP Guidelines do not, in any way whatsoever, override
the individual responsibility of health professionals to make appropriate
and accurate decisions in consideration of each patient's health condition
and, where appropriate and/or necessary, in consultation with that patient
and the patient's care provider. Nor do the EACTS, EACTA and EBCP
Guidelines exempt health professionals from giving full and careful
consideration to the relevant official, updated recommendations or
guidelines issued by the competent public health authorities, in order to
manage each patient's case in light of the scientifically accepted data
pursuant to their respective ethical and professional obligations. It is
also the health professional's responsibility to verify the applicable
rules and regulations relating to drugs and medical devices at the time of
prescription. The article has been co-published with permission in the
British Journal of Anaesthesia, the European Journal of Cardio-Thoracic
Surgery and the Interactive CardioVascular and Thoracic
Surgery. Copyright © 2020 Oxford University Press. All rights
reserved.

<49>
Accession Number
631740264
Title
Prevalence of hypertension in cardiovascular disease in Iran: Systematic
review and meta-analysis.
Source
International Journal of Preventive Medicine. 11 (1) (no pagination),
2020. Article Number: 56. Date of Publication: 01 Jan 2020.
Author
Fakhri M.; Sarokhani D.; Ghiasi B.; Dehkordi A.
Institution
(Fakhri) Traditional and Complementary Medicine Research Center, Addiction
Institute, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Sarokhani) Psychosocial Injuries Research Center, Ilam University of
Medical Sciences, Ilam, Iran, Islamic Republic of
(Ghiasi) Department of Nephrology, Faculty of Medicine, Ilam University of
Medical Sciences, Ilam, Iran, Islamic Republic of
(Dehkordi) Social Determinants of Health Research Center, School of Allied
Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord,
Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Hypertension is a major cause of noncommunicable diseases such
as cardiovascular disease. Therefore, this study aimed to estimate the
prevalence of hypertension in cardiovascular patients in Iran by
meta-analysis. Method(s): The search was carried out using authentic
Persian and English keywords in national and international databases
including IranMedex, Scientific Information Database (SID), Magiran,
IranDoc, Medlib, ScienceDirect, PubMed , Scopus, Cochrane, Embase, Web of
Science, and Google Scholar search engine without any time limitation
until 2017. Heterogeneity of studies was assessed using I2 statistic. Data
were analyzed using STATA 11.1. Result(s): In 66 reviewed studies
with a sample of 111,406 participants, the prevalence of hypertension was
44% in Iranian patients with cardiovascular disease 67%(95%CI: 38%-49%) in
women and 42% in men. The prevalence of systolic hypertension in cardiac
patients was 25%, diastolic 20%, diabetes 27%, and overexposure 43%. The
prevalence of hypertension was 44% in patients with coronary artery
disease, 50% in myocardial infarction, 33% in aortic aneurysm, and 44% in
cardiac failure. Conclusion(s): Hypertension has a higher prevalence
in women with cardiovascular disease than men, and it increases with age.
Among patients with cardiovascular disease, myocardial infarction patients
have the highest levels of hypertension. The prevalence of systolic
hypertension in cardiac patients is higher than diastolic
hypertension. Copyright © 2020 BMJ Publishing Group. All rights
reserved.

<50>
Accession Number
2003930760
Title
Transcatheter versus surgical aortic valve replacement in low-risk
patients: a meta-analysis of randomized trials.
Source
Clinical Research in Cardiology. 109 (6) (pp 761-775), 2020. Date of
Publication: 01 Jun 2020.
Author
Hofer F.; Hengstenberg C.; Goliasch G.; Grygier M.; Mascherbauer J.;
Siller-Matula J.M.
Institution
(Hofer, Hengstenberg, Goliasch, Mascherbauer, Siller-Matula) Division of
Cardiology, Department of Internal Medicine II, Medical University of
Vienna, Vienna, Austria
(Grygier) 1st Department of Cardiology, Poznan University of Medical
Sciences, Poznan, Poland
(Siller-Matula) Department of Experimental and Clinical Pharmacology,
Centre for Preclinical Research and Technology (CEPT), Medical University
of Warsaw, Warsaw, Poland
Publisher
Springer
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as a
treatment option for severe aortic stenosis in patients at intermediate or
high surgical risk. However, until recently there was insufficient
evidence regarding the outcomes of TAVR compared to surgical aortic valve
replacement (SAVR) for patients at low risk. Method(s): We conducted
a meta-analysis and systematic review of all randomized trials comparing
the efficacy and safety of TAVR versus SAVR in patients at low surgical
risk. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated,
using fixed- or random-effects model. Result(s): Four trials were
eligible for analysis and comprised a total of 2887 patients (1497
allocated to TAVR and 1390 allocated to SAVR group). TAVR was associated
with a 39% relative risk reduction (RRR) of major adverse cardiac events
(MACE) (absolute risk reduction ARR of 3.7%; RR 0.61; 95% CI 0.47-0.79);
39% RRR of overall mortality (ARR of 1.4%; RR 0.61; 95% CI 0.39-0.96) and
45% RRR of cardiovascular mortality (ARR of 1.3%; RR 0.55; 95% CI
0.33-0.90), 69% RRR of life threatening or disabling bleeding (ARR of
7.0%; RR 0.31; 95% CI 0.22-0.44), 73% RRR of new-onset atrial fibrillation
(ARR of 29%; RR 0.27; 95% CI 0.20-0.35) and 73% RRR of acute kidney injury
(ARR of 2.1%; RR 0.27; 95% CI 0.14-0.56) as compared with SAVR. In
contrast, TAVR was associated with a 4.7-fold increased risk of new
pacemaker (PM) implantation (RR 4.72; 95% CI 1.83-12.15), which was driven
by use of self-expanding valves. Conclusion(s): TAVR in low-risk
patients is superior to SAVR for the majority of outcomes. Graphical
abstract: [Figure not available: see fulltext.]. Copyright ©
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<51>
Accession Number
2002522015
Title
Interpretability of coronary CT angiography performed with a novel
whole-heart coverage high-definition CT scanner in 300 consecutive
patients with coronary artery bypass grafts.
Source
Journal of Cardiovascular Computed Tomography. 14 (2) (pp 137-143), 2020.
Date of Publication: March - April 2020.
Author
Mushtaq S.; Conte E.; Pontone G.; Pompilio G.; Guglielmo M.; Annoni A.;
Baggiano A.; Formenti A.; Mancini M.E.; Muscogiuri G.; Nicoli F.;
Giannitto C.; Magatelli M.; Tanzilli A.; Consiglio E.; Fiorentini C.;
Bartorelli A.L.; Pirillo S.P.; Pepi M.; Andreini D.
Institution
(Mushtaq, Conte, Pontone, Pompilio, Guglielmo, Annoni, Baggiano, Formenti,
Mancini, Muscogiuri, Nicoli, Giannitto, Consiglio, Fiorentini, Bartorelli,
Pepi, Andreini) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Fiorentini, Andreini) Department of Clinical Sciences and Community
Health, Cardiovascular Section, University of Milan, Milan, Italy
(Magatelli) University of Brescia, Italy
(Tanzilli, Bartorelli) Department of Cardiovascular Sciences, Sapienza
University, Rome, Italy
(Pirillo) Department of Radiology, Azienda Ospedaliera San Giovanni
Addolorata, Rome, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for
the evaluation of coronary artery bypass graft (CABG). However, inability
to sustain a long breath-hold, high heart rate (HR) and atrial
fibrillation may affect image quality. Moreover, radiation exposure is
still a matter of some concern. A scanner combining 0.23-mm spatial
resolution, new iterative reconstruction and fast gantry rotation time has
been recently introduced in the clinical field. The aims of our study were
to evaluate interpretability, radiation exposure and diagnostic accuracy
of CCTA performed with the latest generation of cardiac-CT scanners
compared to invasive coronary angiography (ICA) in the assessment of
bypass grafts, and non-grafted and post-anastomotic native coronary
arteries. Methods and Results: We prospectively enrolled 300 patients
undergoing clinically indicated CCTA with a 16-cm z-axis coverage,
256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary
artery and graft interpretability, image quality and effective dose (ED)
were assessed in all patients and diagnostic accuracy was evaluated in a
subgroup of 100 patients who underwent ICA. Mean HR during the scan was
69.6 +/- 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm
and in 112 patients with HR >= 75 bpm, while 70 patients had atrial
fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was
able to correctly detecting occlusions or significant stenoses of all CABG
segments. Overall interpretability of native coronary segments was 95.6%.
Sensitivity, specificity, positive predictive value, negative predictive
value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3%
and 96.5%, respectively. The diagnostic accuracy in a patient based
analysis was 95.2%. Mean ED was 3.14 +/- 1.7 mSv. Conclusion(s): The
novel whole-heart coverage CT scanner allows to evaluating CABG and native
coronary arteries with excellent interpretability and low radiation
exposure even in the presence of unfavorable heart rhythm. Copyright
© 2020 Society of Cardiovascular Computed Tomography

<52>
Accession Number
2005929682
Title
Magnetic Resonance-Based Diagnostics for Bleeding Assessment in Neonatal
Cardiac Surgery.
Source
Annals of Thoracic Surgery. 109 (6) (pp 1931-1936), 2020. Date of
Publication: June 2020.
Author
Choi P.S.; Ibla J.C.; Marturano J.E.; Lowery T.J.; Emani S.
Institution
(Choi, Emani, Emani) Department of Cardiovascular Surgery, Boston
Children's Hospital, Boston, MA, United States
(Ibla) Department of Anesthesiology, Critical Care, and Pain Medicine,
Boston Children's Hospital, Boston, MA, United States
(Marturano, Lowery) T2 Biosystems, Lexington, MA, United States
Publisher
Elsevier USA
Abstract
Purpose: Infants undergoing a cardiac operation are at high risk for
postsurgical bleeding. To date, there are no highly predictive models for
postsurgical bleeding in this population. This study's objective was to
assess the predictive ability of T2 magnetic resonance (T2MR).
Description: T2MR uses magnetic resonance to detect clot formation
characteristics on a small blood sample and provides hemostatic indicators
that can assess bleeding risk. Evaluation: This prospective,
single-institution study enrolled 100 patients younger than 12 months old
undergoing a cardiac operation from April 27, 2015, to September 21, 2016.
The primary end point was postsurgical bleeding within 24 hours after the
procedure. T2MR data were modeled with a binary recursive partitioning
algorithm with randomized cross-validation. The tight clot metric produced
the highest univariate discrimination of bleeding (receiver operator
characteristic curve, 0.64; classification accuracy, 72%), and along with
the platelet function metric, demonstrated highest relative importance
based on Gini index splitting (Salford Systems, San Diego, CA).
Multivariate modeling with cross-validation showed mean receiver operator
characteristic curve area of 0.74 and classification accuracy of 82%.
 Conclusion(s): T2MR tight clot and platelet function metrics were
associated with bleeding events. Copyright © 2020 The Society of
Thoracic Surgeons

<53>
Accession Number
2005907951
Title
Biomarkers of muscle metabolism in peripheral artery disease: A dynamic
NIRS-assisted study to detect adaptations following revascularization and
exercise training.
Source
Diagnostics. 10 (5) (no pagination), 2020. Article Number:
diagnostics10050312. Date of Publication: 01 May 2020.
Author
Manfredini F.; Lamberti N.; Ficarra V.; Tsolaki E.; Straudi S.; Zamboni
P.; Basaglia N.; Gasbarro V.
Institution
(Manfredini, Lamberti) Section of Sports Sciences, Department of
Biomedical and Surgical Specialties Sciences, University of Ferrara,
Italy-Via Luigi Borsari 46, Ferrara 44121, Italy
(Manfredini, Straudi, Basaglia) Unit of Physical Medicine and
Rehabilitation, Department of Neurosciences/Rehabilitation, University
Hospital of Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy
(Ficarra, Tsolaki, Gasbarro) Unit of Vascular and Endovascular Surgery,
University Hospital of Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy
(Zamboni) Vascular Diseases Center, University of Ferrara, Italy-Via Aldo
Moro 8, Ferrara 44124, Italy
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
We assessed whether muscle metabolism biomarkers (MMb) identified by
near-infrared spectroscopy (NIRS) are valid for determining adaptations
following revascularization or exercise training in peripheral artery
disease (PAD). Eighteen patients (males n = 13; 69 +/- 7 years) were
randomized to receive revascularization (Rev = 6) or pain-free home-based
exercise (Ex = 12). MMb were safely collected via a NIRS-assisted
treadmill test as area-under-curve for the spectra of oxygenated (-oxy),
deoxygenated (-deoxy), differential (-diff) and total (-tot) hemoglobin
traces. MMb, ankle-brachial index (ABI), pain-free (PFWD) and 6-minute
(6MWD) walking distances were assessed at baseline and after four months.
MMb were correlated at baseline with ABI (MMb-oxy r = 0.46) and 6MWD
(MMb-tot r = 0.51). After treatments, MMb-oxy showed an expected increase,
which was more relevant for Rev group than the Ex (56% vs. 20%), with
trends towards normalization for the other MMb. These changes were
significantly correlated with variations in ABI (MMb-oxy r = 0.71; p =
0.002) and 6MWD (MMb-tot r = 0.58; p = 0.003). The MMb-diff in Rev group
and MMb-deoxy in Ex group at baseline predicted clinical outcomes being
correlated with PFWD improvements after 4-month (r=-0.94; p = 0.005 and r
= -0.57; p = 0.05, respectively). A noninvasive NIRS-based test, feasible
in a clinical setting, identified muscle metabolism biomarkers in PAD. The
novel MMb were associated with validated outcome measures, selectively
modified after different interventions and able to predict long-term
functional improvements after surgery or exercise training. Copyright
© 2020 by the authors.

<54>
Accession Number
2005440947
Title
Mediterranean-style diet for the primary and secondary prevention of
cardiovascular disease: Summary of a Cochrane review.
Source
Explore. 16 (3) (pp 201-202), 2020. Date of Publication: May - June 2020.
Author
Wermers J.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<55>
Accession Number
2004931382
Title
Preoperative Anemia Management: What's New in 2020?.
Source
Current Anesthesiology Reports. 10 (2) (pp 166-175), 2020. Date of
Publication: 01 Jun 2020.
Author
Rubinger D.A.; Cahill C.; Ngo A.; Gloff M.; Refaai M.A.
Institution
(Rubinger, Gloff) Department of Anesthesia, University of Rochester
Medical Center, Rochester, NY, United States
(Cahill, Ngo, Refaai) Department of Pathology and Laboratory Medicine,
University of Rochester Medical Center, 601 Elmwood Avenue, Box-608,
Rochester, NY 14642, United States
Publisher
Springer
Abstract
Purpose of Review: The purpose of this article is to review the relevant
evidence regarding the clinical impact of preoperative anemia, current
methods of identifying anemia in the surgical population, and the current
and upcoming evidence for the treatment modalities targeting preoperative
anemia. Recent Findings: Preoperative anemia continues to be identified as
a contributor to poor outcomes in the surgical population. Identifying
anemia typically starts with hemoglobin and mean corpuscular volume.
Recent laboratories have also started using iron studies with serum
ferritin and transferrin saturation. Oral and IV iron have demonstrated
efficacy in treating preoperative anemia in terms of increasing hemoglobin
preoperatively and reducing allogeneic blood transfusions. However, few
studies have demonstrated an impact on patient outcomes, morbidity, and
mortality. Additionally, several meta-analyses have demonstrated the
benefit of adding erythropoietin-stimulating agents to improve anemia.
 Summary: Preoperative anemia is very common and is thought to be a
contributor to poor outcomes. IV iron is currently recommended by several
guidelines as the primary treatment modality for preoperative anemia. Two
ongoing studies hope to provide clarity on the effect of IV iron on
patient outcomes including morbidity and mortality in cardiac and
non-cardiac surgical populations. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<56>
Accession Number
2004534000
Title
Repair of ischemic ventricular septal defect with and without coronary
artery bypass grafting.
Source
Journal of Cardiac Surgery. 35 (5) (pp 1062-1071), 2020. Date of
Publication: 01 May 2020.
Author
Horan D.P.; O'Malley T.J.; Weber M.P.; Maynes E.J.; Choi J.H.; Patel S.;
Challapalli J.; Luc J.G.Y.; Entwistle J.W.; Todd Massey H.; Morris R.J.;
Tchantchaleishvili V.
Institution
(Horan, O'Malley, Weber, Maynes, Choi, Patel, Challapalli, Luc, Entwistle,
Todd Massey, Morris, Tchantchaleishvili) Division of Cardiac Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: Ventricular septal defect (VSD) following
myocardial infarction (MI) is a relatively infrequent complication with
high mortality. We sought to investigate the effect of concomitant
coronary artery bypass graft (CABG) on outcomes following post-MI VSD
repair. Method(s): Electronic search was performed to identify all
relevant studies published from 2000 to 2018. Sixty-seven studies were
selected for the analysis comprising 2174 patients with post-MI VSD.
Demographic information, perioperative variables, and outcomes including
survival data were extracted and pooled for systematic review and
meta-analysis. Result(s): Single-vessel disease was most common (47%,
95% confidence interval [CI], 42-52), left anterior descending coronary
artery was the most commonly involved vessel (55%, 95% CI, 46-63), and
anterior wall was the most commonly affected territory (57%, 95% CI,
51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients.
Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82).
A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients.
Of these, surgical repair was performed in 35% (95% CI, 28-41) and
transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30%
(95% CI, 26-35) in patients who had preoperative coronary angiogram, and
58% (95% CI, 43-71) in those who did not (P <.01). No significant survival
difference observed between those who had concomitant CABG vs those
without CABG. Conclusion(s): Concomitant CABG did not have a
significant effect on survival following VSD repair. Revascularization
should be weighed against the risks associated with prolonged
cardiopulmonary bypass. Copyright © 2020 Wiley Periodicals, Inc.

<57>
Accession Number
2004472083
Title
Prognostic Value of Abnormal Ankle-Brachial Index in Patients With
Coronary Artery Disease: A Meta-Analysis.
Source
Angiology. 71 (6) (pp 491-497), 2020. Date of Publication: 01 Jul 2020.
Author
Liu L.; Sun H.; Nie F.; Hu X.
Institution
(Liu, Sun, Nie, Hu) Department of Vascular and Thyroid Surgery, The First
Affiliated Hospital, China Medical University, Shenyang, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The prognostic value of the ankle-brachial index (ABI) in patients with
coronary artery disease (CAD) remains undefined. This meta-analysis sought
to investigate the association of abnormal ABI and adverse outcomes in
patients with CAD. PubMed, Embase, China National Knowledge
Infrastructure, VIP, and Wanfang databases were comprehensively searched
for studies published from inception to September 10, 2019. All
observational studies investigating the association of abnormal baseline
ABI and risk of major adverse cardiovascular events (MACE) or all-cause
mortality were selected. Normal ABI is usually defined as between 0.9 and
1.4. The prognostic values were summarized by pooling risk ratio (RR) with
95% confidence intervals (CIs) for abnormal versus normal ABI category.
Nine (9384 patients with CAD) studies were included. Abnormal ABI was
independently associated with MACE (RR: 2.46; 95% CI: 2.02-2.99) and
all-cause mortality (RR: 1.74; 95% CI: 1.32-2.30). Subgroup analysis
showed that the pooled RR for MACE was 2.34 (95% CI: 1.73-3.16) for an
abnormal low ABI. Abnormal ABI predicts MACE and all-cause mortality in
patients with CAD, even after adjusting conventional confounding factors.
However, the prognostic value of abnormal ABI is mainly dominated by a low
ABI rather than a high ABI. Copyright © The Author(s) 2020.

<58>
Accession Number
2005961590
Title
Randomized trial of bupivacaine with epinephrine versus bupivacaine
liposome suspension in patients undergoing minimally invasive lung
resection.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Weksler B.; Sullivan J.L.; Schumacher L.Y.
Institution
(Weksler, Schumacher) Division of Thoracic and Esophageal Surgery,
Department of Thoracic and Cardiovascular Surgery, Allegheny General
Hospital, Pittsburgh, Pa, United States
(Sullivan) Division of Thoracic Surgery, Department of Surgery, Sinai
Hospital, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Thoracic surgery can cause significant pain, and multiple
strategies have been developed to control pain after surgery. We compared
2 bupivacaine formulations given intraoperatively: bupivacaine with
epinephrine (1,200,000) or liposomal bupivacaine. Method(s): This was
a randomized, open-label study (NCT03560362). Eligible patients were
adults scheduled for a minimally invasive lung procedure. Incision sites
were injected with bupivacaine with epinephrine or liposomal bupivacaine
before incision, and each intercostal space was injected with 1 mL of
bupivacaine with epinephrine or liposomal bupivacaine entering the
thoracic cavity. Patient-controlled analgesia was initiated in the
recovery room. Pain was recorded using a visual analog scale. The primary
outcome was the amount of narcotics taken during the postoperative
hospital stay. Result(s): We recruited 50 patients; 25 received
bupivacaine with epinephrine, and 25 received liposomal bupivacaine. The
treatment groups were similar in age, histology, and procedure performed.
There were no statistical differences between the treatment groups in the
amount of narcotics required during the hospital stay (36.3 mg for
bupivacaine and 38 mg for liposomal bupivacaine) or in pain assessed the
day of surgery (5 and 5), the first day (3.5 and 2.3), second day (3 and
2.6), 2 weeks (0 and 1), or 3 months (0 and 0) postoperatively. Hospital
length of stay and complications were also similar. Conclusion(s): In
a small, randomized study, we did not find significant differences between
bupivacaine with epinephrine or liposomal bupivacaine in mitigating pain
after minimally invasive lung resection. We currently favor using the less
expensive nonliposomal bupivacaine preparations until additional data are
available. Copyright © 2020 The American Association for Thoracic
Surgery

<59>
Accession Number
2005950418
Title
Possible differential benefits of edetate disodium in post-myocardial
infarction patients with diabetes treated with different hypoglycemic
strategies in the Trial to Assess Chelation Therapy (TACT).
Source
Journal of Diabetes and its Complications. (no pagination), 2020. Article
Number: 107616. Date of Publication: 2020.
Author
Escolar E.; Ujueta F.; Kim H.; Mark D.B.; Boineau R.; Nahin R.L.; Goertz
C.; Lee K.L.; Anstrom K.J.; Lamas G.A.
Institution
(Escolar, Ujueta, Lamas) Columbia University Division of Cardiology at
Mount Sinai Medical Center, Miami, FL, United States
(Kim, Mark, Lee, Anstrom) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Kim, Mark, Lee, Anstrom) Duke University, Durham, NC, United States
(Boineau, Nahin) National Heart, Lung, and Blood Institute, Bethesda, MD,
United States
(Goertz) Duke Department of Orthopaedic Surgery, Duke University, Durham,
NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The NIH-funded Trial to Assess Chelation Therapy (TACT)
randomized 1708 stable patients age >=50 who were >=6 months post
myocardial infarction to 40 infusions of an edetate disodium-based regimen
or placebo. In 633 patients with diabetes, edetate disodium significantly
reduced the primary composite endpoint of mortality, recurrent myocardial
infarction, stroke, coronary revascularization, or hospitalization for
angina (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.44-0.79, p
< 0.001). The principal secondary endpoint of a composite of
cardiovascular death, myocardial infarction, or stroke was also reduced
(HR 0.60, 95% CI 0.39-0.91, p = 0.017). It is unknown if the treatment
effect differs by diabetes therapy. Method(s): We grouped the subset
of 633 patients with diabetes according to glucose-lowering therapy at
time of randomization. The log-rank test was used to compare active
therapy versus placebo. All treatment comparisons were performed using
2-sided significance tests at the significance level of 0.05 and were as
randomized. Relative risks were expressed as HR with associated 95% CI,
calculated using the Cox proportional hazards model. Result(s): There
were 162 (25.7%) patients treated with insulin; 301 (47.5%) with oral
hypoglycemics only; and 170 (26.8%) receiving no pharmacologic treatment
for diabetes. Patients on insulin reached the primary endpoint more
frequently than patients on no pharmacologic treatment [61 (38%) vs 49
(29%) (HR 1.56, 95% CI 1.07-2.27, p = 0.022)] or oral hypoglycemics [61
(38%) vs 87 (29%) (HR 1.46, 1.05-2.03, p = 0.024)]. The primary endpoint
occurred less frequently with edetate disodium based therapy versus
placebo in patients on insulin [19 (26%) vs 42 (48%) (HR 0.42, 95% CI
0.25-0.74, log-rank p = 0.002)], marginally in patients on oral
hypoglycemics [38 (25%) vs 49 (34%) (HR 0.66, 95% CI 0.43-1.01, log-rank p
= 0.041)], and no significant difference in patients not treated with a
pharmacologic therapy [23 (25%) vs 26 (34%) (HR 0.69, 95% CI 0.39-1.20,
log-rank p = 0.225)]. The interaction between randomized intravenous
treatment and type of diabetes therapy was not statistically significant
(p = 0.203). Conclusion(s): Edetate disodium treatment in stable,
post-myocardial infarction patients with diabetes suggests that patients
on insulin therapy at baseline may accrue the greatest benefit. Clinical
Trial Registration: clinicaltrials.gov identifier:
http://clinicaltrials.gov/ct2/show/NCT00044213?term=TACT&rank=7 identifier
Trial to Assess Chelation Therapy (TACT), NCT00044213. Copyright
© 2020 Elsevier Inc.

<60>
Accession Number
2005033251
Title
Comparison of infective endocarditis risk between balloon and
self-expandable valves following transcatheter aortic valve replacement:
systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2020. Date
of Publication: 2020.
Author
Prasitlumkum N.; Thangjui S.; Leesutipornchai T.; Kewcharoen J.;
Limpruttidham N.; Pai R.G.
Institution
(Prasitlumkum, Kewcharoen, Limpruttidham) University of Hawaii Internal
Medicine Residency Program, 1356 Lusitana St, Honolulu, HI 96813, United
States
(Thangjui, Leesutipornchai) Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
(Pai) Department of Cardiology, University of California Riverside,
Riverside, CA, United States
Publisher
Springer
Abstract
This study aimed to compare incidence of IE between BE and SE valves by
performing a systematic review and meta-analysis of the literature. We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to November 2019. Included studies were published observational
studies that compared the risk of IE among patients undergoing TAVR
employing BE versus SE valves, using the random-effects to calculate risk
ratios and 95% confidence intervals (CIs).Ten cohort studies from April
2013 to November 2019 were included in this meta-analysis involving 13,478
subjects (6289 SE and 7189 BE types). Our study showed no statistical
difference in IE rates between each type of valves (pooled OR 0.96, 95%
CI: 0.68-1.35, p = 0.801 with I2 = 14.7%). There was no difference in IE
rate between BE and SE valves following TAVR. Further studies are
warranted to confirm our findings. Copyright © 2020, Japanese
Association of Cardiovascular Intervention and Therapeutics.

<61>
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. 182 (6) (pp 1342-1350),
2020. Date of Publication: 01 Jun 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.

<62>
Accession Number
2004243557
Title
Impact of left ventricular ejection fraction on clinical outcomes after
left main coronary artery revascularization: results from the randomized
EXCEL trial.
Source
European Journal of Heart Failure. 22 (5) (pp 871-879), 2020. Date of
Publication: 01 May 2020.
Author
Thuijs D.J.F.M.; Milojevic M.; Stone G.W.; Puskas J.D.; Serruys P.W.;
Sabik J.F.; Dressler O.; Crowley A.; Head S.J.; Kappetein A.P.
Institution
(Thuijs, Milojevic, Head, Kappetein) Department of Cardiothoracic Surgery,
Erasmus MC, University Medical Centre, Rotterdam, Netherlands
(Stone) Division of Cardiology, New York-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Stone, Dressler, Crowley) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Heart at Mount
Saint Luke's, New York, NY, United States
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aim: To evaluate the impact of left ventricular ejection fraction (LVEF)
on 3-year outcomes in patients with left main coronary artery disease
(LMCAD) undergoing percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) in the EXCEL trial. Methods and
Results: The EXCEL trial randomized patients with LMCAD to PCI with
everolimus-eluting stents (n = 948) or CABG (n = 957). Among 1804 patients
with known baseline LVEF, 74 (4.1%) had LVEF <40% [heart failure with
reduced ejection fraction (HFrEF)], 152 (8.4%) LVEF 40-49% [heart failure
with mid-range ejection fraction (HFmrEF)] and 1578 (87.5%) LVEF >=50%
(heart failure with preserved ejection fraction). Patients with HFrEF vs.
HFmrEF vs. preserved LVEF experienced a longer postoperative hospital stay
(9.0 vs. 7.0 vs. 6.0 days, P = 0.02) with greater peri-procedural
complications after CABG, while hospital stay after PCI was unaffected by
LVEF (1.5 vs. 2.0 vs. 1.0 days, P = 0.20). The composite primary endpoint
of death, stroke, or myocardial infarction at 3 years was 29.3% (PCI) vs.
27.6% (CABG) in patients with HFrEF, 16.2% vs. 15.0% in patients with
HFmrEF, and 14.5% vs. 14.6% in those with preserved LVEF, respectively
(P<inf>interaction</inf> = 0.90). Smoothing spline analysis demonstrated
that the 3-year risk of all-cause death increased when LVEF decreased,
both in patients undergoing CABG and PCI. Conclusion(s): In the EXCEL
trial, the composite rate of death, stroke or myocardial infarction at 3
years was significantly higher in patients with HFrEF compared with HFmrEF
or preserved LVEF, driven by an increased rate of all-cause death. No
significant differences after PCI vs. CABG were observed among patients
with HFrEF, HFmrEF and preserved LVEF. Longer-term follow-up could provide
important insights on differences in clinical outcomes that might emerge
over time. Clinical Trial Registration: ClinicalTrials.gov Identifier
NCT01205776. Copyright © 2020 The Authors. European Journal of
Heart Failure published by John Wiley & Sons Ltd on behalf of European
Society of Cardiology.

<63>
Accession Number
631415431
Title
A randomized trial comparing the effects of sternal band and plate
fixation of the sternum with that of figure-of-8 wires on sternal edge
motion and quality of recovery after cardiac surgery.
Source
Interactive cardiovascular and thoracic surgery. 30 (6) (pp 863-870),
2020. Date of Publication: 01 Jun 2020.
Author
Royse A.G.; El-Ansary D.; Hoang W.; Lui E.; McCusker M.; Tivendale L.;
Yang Y.; Canty D.J.; Royse C.F.
Institution
(Royse, El-Ansary, Tivendale, Yang, Canty, Royse) Department of Surgery,
The University of Melbourne, Parkville, VIC, Australia
(Royse, El-Ansary, Hoang, Tivendale, Royse) Department of Surgery, The
Royal Melbourne Hospital, Melbourne, VIC, Australia
(Royse, El-Ansary, Royse) Department of Health Professions, Faculty of
Art, Design and Health, Swinburne University of Technology, Melbourne,
VIC, Australia
(Lui, McCusker) Department of Radiology, The University of Melbourne,
Parkville, VIC, Australia
(Yang) Department of Intensive Care, Western Hospital, Melbourne, VIC,
Australia
(Canty) Department of Anaesthesia and Pain Management, Monash Medical
Centre, Melbourne, VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Royse) Outcomes Research Consortium, The Cleveland Clinic, Cleveland, OH,
USA
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to compare the effects of conventional wire cerclage
with that of the band and plate fixation of the sternum. METHOD(S): A
parallel randomized open-label trial with 1:1 allocation ratio compared
healing after adult cardiac surgery using 'figure-of-8' stainless steel
wire cerclage or a band and plate system (plates). The primary end point
was maximal sternal edge displacement during active coughing of >=2mm in
>=2 of 4 sites measured with ultrasound by 2 assessors blinded to the
other at 6weeks postoperatively. Secondary end points at 12weeks included
ultrasound assessment, computed tomography (CT) scan and multidimensional
assessment of quality of recovery using the Postoperative Quality of
Recovery Scale. RESULT(S): Of 50 patients, 26 received plates and 24
wires. Two patients died and 1 withdrew consent leaving 25 plates and 22
wires for primary end point analysis. Operations included 37 coronary, 5
valve and 8 combined coronary and valve procedures. At 6weeks, less
sternal movement was observed in patients with plates than those with
wires, 4% (1/25) vs 32% (7/22), P=0.018. Agreement between observers was
high, kappa=0.850. At 12weeks, less ultrasound motion was seen in patients
with plates, 0% (0/23) than those with wires, 25% (5/20), P=0.014.
Recovery from pain was higher for patients with plates 92% (22/24) than
those with wires 67% (14/21), P=0.004. CT bone edge separation was less
for plates 38% (9/24) than wires 71% (15/21), P=0.036. CT mild bone
synthesis or greater was similar between patients with plates 21% (5/24)
and wires 14% (3/21), P=0.71. CONCLUSION(S): Patients receiving the
band and plate system had significantly less sternal edge motion than
those receiving wires, 6 and 12weeks after cardiac surgery and experienced
less pain. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov
NCT03282578. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<64>
Accession Number
631413632
Title
Is it safe and effective to reduce the target anticoagulation range for
patients with mechanical prosthetic aortic valves?.
Source
Interactive cardiovascular and thoracic surgery. 30 (6) (pp 904-909),
2020. Date of Publication: 01 Jun 2020.
Author
Mohamed W.; Asimakopoulos G.
Institution
(Mohamed) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Asimakopoulos) Department of Cardiac Surgery, Royal Brompton Hospital,
London, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Is it safe and effective
to reduce the target anticoagulation range for patients with mechanical
aortic valves?' Altogether 922 papers were found using the reported
search, of which 7 represented the best evidence to answer the clinical
question. Only studies that compared high (target international normalized
ratio 2-3) versus low (target international normalized ratio <2-3)
intensity anticoagulation were included. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. We conclude that there
is growing evidence for the reduction of the target anticoagulation range
for patients with mechanical prosthetic aortic valves, especially
bileaflet valves with presumed better haemodynamic properties. Several
large randomized controlled trials and a meta-analysis have concluded that
reducing the target international normalized ratio range (below the
conventional range of 2-3) for mechanical aortic valves in patients with
no thrombogenic risk factors produces less bleeding and does not increase
thromboembolic events. Copyright © The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<65>
Accession Number
631719720
Title
Does percutaneous transthoracic needle biopsy increase the risk of pleural
recurrence in patients with stage I lung cancer?.
Source
Interactive cardiovascular and thoracic surgery. 30 (6) (pp 834-838),
2020. Date of Publication: 01 Jun 2020.
Author
Cheng D.; Wang Z.; Cui J.; Liu L.
Institution
(Cheng, Wang, Cui, Liu) West China School of Medicine, Sichuan University,
Chengdu, China
(Wang, Liu) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: does percutaneous
transthoracic needle biopsy (PTNB) increase the risk of pleural recurrence
in patients with stage I lung cancer? Altogether, 298 papers were found
using the reported search, of which 7 cohort studies and 1 meta-analysis
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers were tabulated.
Four cohort studies suggested an association between PTNB and pleural
recurrence in patients with stage I lung cancer, while the other 3 cohort
studies found that PTNB had no impact. One meta-analysis (the largest
study) including 5 of the cohort studies above concluded that PTNB
increased the risk of pleural recurrence among patients with stage I lung
cancer with subpleural lesions. Based on the available evidence, it was
suggested that there may be an association between PTNB and pleural
recurrence in patients with stage I lung cancer, especially for patients
with subpleural lesion. Copyright © The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<66>
Accession Number
631895358
Title
Iodine-based contrast neurotoxicity following endovascular procedures: A
systematic review.
Source
Neuroradiology. Conference: 15. Congresso SPNR. Portugal. 62 (1) (pp 117),
2020. Date of Publication: 2020.
Author
Neves M.Q.; Xavier S.A.; Silva V.C.; Amorim J.M.; Rocha J.
Institution
(Neves, Xavier, Silva, Amorim, Rocha) Neuroradiology Department, Hospital
de Braga
Publisher
Springer
Abstract
Background: Neurotoxicity following iodine-based contrast administration
is a welldocumented but poorly understood disorder that can be associated
with endovascular procedures. Purpose(s): To review the literature in
order to establish homogenous conclusions, assess potential differences
between patients submitted to neurovascular versus cardiovascular
procedures, and determine a potential relation between the side of
contrast media injections and lateralized symptom development.
 Method(s): A PubMed database search was conducted to review case
reports of this disorder. Inclusion criteria: reports with information
regarding angiographic procedures and related clinical data. Exclusion
criteria: reports in languages other than English and not conducted in
humans. Result(s): Sixty-three case reports were included, with 55
patients submitted to cardiovascular, 29 to neurovascular and 3 to
peripheral procedures. More than half (n = 49; 56.3%) of the patients had
hypertension. The most frequently used contrast medium was iopromide (n =
19; 21.8% of cases) with an average volume of 166.8 +/- 69.7 mL. Cortical
blindness and headaches were more frequent in the cardiovascular cohort
(50.9% vs 34.5%, and 25.5% vs 6.9%, respectively) whereas incomplete
resolution of symptoms and positive brain imaging findings were more
frequent in the neurovascular cohort (17.2% vs 9.1%, and 86.2% vs 52.7%,
respectively). The latter was also associated with a longer average time
to clinical resolution (7.7 +/- 9.2 days vs 1.5 +/- 1.7 days). A congruent
relation between the vessel(s)/side(s) of contrast injection and
lateralized symptom development was mainly observed in the neurovascular
cohort (66.7% vs 15.4%). Conclusion(s): If a patient with chronic
hypertension submitted to an angiographic procedure develops a sudden
visual disturbance, headache and/or altered mental state (with brain
imaging excluding thromboembolic or hemorrhagic events),
contrast-associated neurotoxicity should be considered. Although most
cases are reversible, a few exhibit persistent deficits, a fact that
vascular interventionists should always bear in mind.

<67>
Accession Number
631904168
Title
New onset left bundle branch block after TAVR: EP study guided pacemaker
implantation.
Source
Journal of Arrhythmia. Conference: 12th Asia Pacific Heart Rhythm Society
Session, APHRS 2019. Thailand. 35 (Supplement 1) (pp 61-62), 2019. Date of
Publication: December 2019.
Author
Chanda A.
Institution
(Chanda) Mary Washington Hospital, United States
Publisher
Wiley-Blackwell
Abstract
Introduction: Transcatheter Aortic Valve Replacement (TAVR) has now become
the dominant method of aortic valve replacement in the United States, with
excellent outcomes. New onset LBBB (NLBBB) is seen in up to 20% of
patients post TAVR. There has not been a broad consensus about protocols
regarding permanent pacemaker (PPM) placement in these cases, though the
death and urgent pacemaker placement in this group is about 23%. The
question remains, how do we evaluate the need for PPM placement in these
patients. We developed an EP study guided protocol with administration of
procainamide. PPM was implanted if the baseline HV interval is >= 80 ms
during the EP study, if not, then patients were administered 1000 mg of
procainamide over 10 minutes infusion, if the HV interval prolonged to 80
ms or greater then PPM was implanted. Here we report our findings Methods:
Retrospective data was collected about patients with new onset LBBB post
TAVR between 2017 and 2019. Baseline characteristics, including valve
type, age, gender, ECG findings, EF, HV interval pre and post procainamide
infusion was recorded. Outcomes assessed were, need for future pacemaker
placement, survival and follow up Ejection Fraction (EF). Result(s):
Total of 81 patients underwent TAVR during this time period, 11 patients
had NLBBB (13.6%). Baseline QRS duration was 99 +/- 11 ms. Post TAVR QRS
duration was 141 +/- 12, HV interval was 61.9 +/- 9 ms, HV interval post
procainamide was 66.8 +/- 14 ms. PPM was placed in 9% of the patients.
Follow up was 11.8 +/- 7 months. There were no deaths, no additional or
urgent need for PPM, EF remained steady at 60 +/- 9.7%.
 Conclusion(s): Our study shows that EP study guided PPM placement in
NLBBB leads to lower rate of PPM placement post TAVR (9% compared to 23%
in the standard published literature) and also has excellent long-term
outcome, with no death or additional need for PPM placement. Data
collected in larger group of patients and/or randomized study is needed to
solidify these findings.

<68>
Accession Number
631902174
Title
Comparison of ross procedure versus non-ross procedure in children with
congenital aortic stenosis who undergo aortic valve replacement-A
systematic review.
Source
Journal of Arrhythmia. Conference: 12th Asia Pacific Heart Rhythm Society
Session, APHRS 2019. Thailand. 35 (Supplement 1) (pp 707), 2019. Date of
Publication: December 2019.
Author
Aswan S.A.J.; Hadisurya A.; Liono N.; Bertha B.; Wiharja W.; Suwandi J.
Institution
(Aswan, Hadisurya, Liono, Bertha, Wiharja, Suwandi) Universitas Pelita
Harapan, Indonesia
Publisher
Wiley-Blackwell
Abstract
Introduction: Prevalence of Aortic Valve disease covers 6% of all
congenital heart disease (3.8 of 10.000 births), and Aortic Stenosis is
more prevalent (71%-86%). There are several surgical methods for this
condition, like Aortic valve repair and Aortic valve replacement. This
systematic review aims to compare incidence of re-operation, mortality,
and survival rate between ROSS procedure and Non-ROSS Procedures.
 Method(s): Searching was done in online resourced: PubMed, Google
Scholar, and Science Direct. "PICO" was used as analytical design method,
and all literatures will be filtered using inclusion and exclusion
criteria. Result(s): There were 13 literatures from PubMed, 120 from
Google Scholar, and 42 from Science Direct. After filtered using inclusion
and exclusion criteria, 5 literatures were decided to be analyzed. Alsoufi
et.al (2009): Re-operation on ROSS vs Mechanical (13% vs 6%). Mortality of
ROSS vs Mechanical (2.3% vs 6.1%). Sharabiani et al (2016): Re-operation
on ROSS vs Mechanical AVR vs Bioprosthetic AVR vs Homograft AVR (5.2% vs
8.2% vs 25% vs 41.5%). Survival rate of ROSS vs Mechanical AVR vs
Bioprosthetic AVR vs Homograft AVR (97.3% vs 90.6% vs 92.6% vs 93.4%).
Brown et.al (2016): Re-operation on ROSS vs Non-ROSS (28% vs 29%).
Mortality of ROSS vs Non-ROSS (4% vs 17%). Survival rate of ROSS vs
Non-ROSS (94% vs 81%). Wilder et.al (2015): Re-operation on ROSS vs AoV
Repair vs Mechanical AVR (14.28% vs 28.% vs 26%). Khan et al (2013):
Re-operation on ROSS vs AoV repair vs Homograft AVR vs Mechanical AVR vs
Bioprosthetic AVR (4% vs 17% vs 36% vs 3% vs 0%). Mortality of ROSS vs AoV
repair vs Homograft AVR vs Mechanical AVR vs Bioprosthetic AVR (2.9% vs
3.1% vs 7.7% vs 3% vs 0%) Conclusion(s): Systematical analysis from
all 5 literatures showed differences in re-operation incidence, mortality,
and survival rate, with superiority in ROSS procedure outweigh the
Non-ROSS procedures.

<69>
Accession Number
631901533
Title
Radiofrequency ablation of deep seated outflow tract ventricular
tachycardia using custom modified bipolar irrigated radiofrequency
ablation setup.
Source
Journal of Arrhythmia. Conference: 12th Asia Pacific Heart Rhythm Society
Session, APHRS 2019. Thailand. 35 (Supplement 1) (pp 542-543), 2019. Date
of Publication: December 2019.
Author
Pandian J.
Institution
(Pandian) Meenakshi Mission Hospital and Research Centre, India
Publisher
Wiley-Blackwell
Abstract
Introduction: Trans-catheter radio frequency ablation (RFA) of outflow
tract ventricular tachycardia has a decent success rate of up to 82%. But
the recurrences are possible in half of patients on long term follow-up. 1
Improvement in mapping and RFA technologies try to increase both acute and
long-term success rates. 2 RFA catheter with the capacity to show real
time tip to tissue contact force has been reported recently in outflow
tract tachycardia to create a transmural lesion. 3 Deep seated intramural
arrhythmic sources often not reachable by the standard RFA catheters.
Failure to ablate such foci even by the irrigated RFA catheters is not
uncommon. Bipolar RFA (bRFA) is necessary in such scenarios. But it is not
widely used because of the non-availability of the equipment in all
cardiac electrophysiology laboratories (EP-lab). 4 We describe the
feasibility of bRFA in a standard EP-lab by simple modification of the
existing RFA circuit. Method(s): A 38 years old lady with the history
of recurrent episodes of drug refractory palpitations and presyncopal
episodes was referred for RFA. The echocardiogram revealed
tachycardiomyopathy with the left ventricular ejection fraction of 46%. At
baseline, electrocardiogram showed ventricular trigeminy. The focus of
origin was suspected from right ventricular outflow tract (RVOT) as the
morphology was LBBB with an axis of +110degree. Transition was noted in V4
and the QRS in Lead I was positive which suggested the RVOT postero-septal
region as the exit point. With the decapolar catheter in coronary sinus
(CS), rowing catheter (4 mm open irrigated RFA catheter) was used for
mapping the RVOT was mapped using impedance based 3 dimensional electro
anatomical mapping system 3D-EAMS. 3D-EAMS showed the RVOT postero-septal
region as the earliest point, 28 ms ahead of the surface QRS. Pace mapping
from the same point showed 12/12 match. Hence radiofrequency energy (RF)
was delivered with - - - - temperature, - - - - - - power for - - - - -
seconds. The premature ventricular complexes (PVC) disappear after - - - -
seconds of ablation. Within 3 minutes PVC started to reappear. - - - - -
more episodes of RF energies were delivered at the same settings. As the
PVC once again reappeared left ventricular outflow tract was mapped
retrogradely with the same open irrigated rowing catheter. During 3D
mapping rowing catheter was accidentally entered left main coronary artery
(LMCA) and the moment was used for mapping the LMCA. The earliest point
was found to arise from left coronary cusp (LCC), 30 ms ahead of surface
QRS. Few RF energies were delivered at the earliest point after the
confirmation of safe distance of LMCA location from the RFA site by
angiogram. During ablation PVC were accelerated and terminated, yet
recurrence happened in few minutes. Hence a try to search for other areas
like anterior mitral commissure (which was late) was done but failed to
identify the earliest region. Maximum deflection index (MDI) was measured
to rule out the epicardial origin. As the MDI was 0.68, left ventricular
summit was tried for mapping through CS but failed because of small
anterior interventricular vein. Epicardial mapping was in the plan through
pericardial sheath. But one another reason for MDI > 0.55 was deep seated
focus apart from epicardial site. Hence a bRFA of outflow tract was
considered before epicardial mapping. As the EP-Lab did not have the bRFA
hardware it was decided to use custom made setup as described below.
Bipolar RFA setup Irrigated RFA catheter (TherapyTM Cool flexTM) catheter
was placed in RVOT and another open irrigated RFA catheter (FlexabilityTM)
was placed in LCC at the corresponding earliest points. RVOT catheter was
irrigated using the standard circuit and LVOT was irrigated using 50 mL
syringe manually. LVOT catheter was connected to the anodal end of ablator
via an 85641 ablation cable and the cathode port of ablator was connected
to the jumper cable via a custom made cable for grounding. Jumper cable
was connected to the junction box. The other end of the jumper cable was
connected to the RVOT catheter through an Inquiry decapolar cable and the
circuit was completed. First the bipolar RF energies were delivered using
RVOT end as active ablation point and the LVOT end as the ground but not
succeeded. When the bRFA was done using LVOT end as active ablation point
and RVOT end as grounding using 20 watt power at 43 degree Celsius, RVOT
ventricular tachycardia was accelerated immediately and terminated.
Vigorous induction protocol was used post RFA to check the recurrence but
PVC did not recur. At 3 months follow-up LVEF was normalized and neither
24 hours Holter nor exercise ECG reveals any PVC. Result(s): Unipolar
configuration is used in standard RFA, between the ablation catheter tip
and a ground patch placed on the body surface of the patient. Outflow
tract tachycardia is usually ablated using unipolar radio frequency
ablation (uRFA) with a good success and less recurrence. Poor contact of
the ablation catheter, incomplete mapping and deep seated foci in the
outflow septum are generally considered as the reasons for recurrence.
Recently contact force catheter has been used to overcome the contact
issue as the reason for failure. The deep seated foci are generally dealt
with irrigated cooled ablation catheter in order to enhance the energy
delivery into the deep tissue. Steam pop is a problem during ablation of
the deep seated foci higher energy. RFA from both side of the outflow
septum can be the option either alternately using single uRFA or double
uRFA simultaneously, but the later requires two ablators. The
configuration of uRFA circuit was custom modified into bRFA circuit, such
that instead of the impedance patch, a second ablation catheter was
designated as the grounding connection for the active RFA catheter. But
the connection requires a distal port of a decapolar cable and a jumper
cable. This report demonstrates the feasibility of bipolar ablation across
outflow tract septum in a resistant scenario using easily available
decapolar and jumper cables. As the mapping system EnSite Precision,
Abbott is impedance based open system both the active and grounding RFA
catheters can be visualized in the 3D-EAM as well as associated EGMs
simultaneously. Usually the size and depth of the lesion on the active
catheter side is bigger than the grounding catheter site. Hence changing
the active and grounding vice versa should be tried in case if first one
fails. In our case success was achieved while switching the active
ablation end as LVOT and grounding end as RVOT. Sauer PJ et al reported
successful ablation of midmyocardial septal outflow tract VT using custom
modified bipolar ablation setup. They used a T-cable that was used to
refine recordings from an RFA catheter with an old RF generator and NavX
system. The distal pin of the T-cable was connected to the jumper cable
and which in turn connected to the grounding port. 4 We used the decapolar
cable in place of the T-cable as we did not have the inventory. To our
knowledge after the extensive literature search, this is the first case
report of bipolar ablation in India. Currently an investigational device
is under evaluation to assess safety and efficacy of bRFA, in which not
only the simultaneous visualization of both the catheters but also
intercatheter distances and active catheter force registration is possible
(ClinicalTrials.gov; Clinical Study Identifier: NCT02374476).
 Limitation(s): Surrogate points for contact and stability of the
ablation catheter which is considered as grounding is not possible.
Off-label use of custom modified equipment requires specific informed
consent from the patient. The risks of charring, steam pop and fistula
formation were not studied yet. During bRFA temperature and impedance data
are only available from the active RFA catheter site, hence char formation
or steam pop at the grounding catheter site could not be monitored. Intra
cardiac echocardiography may be useful for monitoring the grounding
catheter site. Conclusion(s): Deep seated septal origin of foci,
where energy delivery is not reaching even with the standard open
irrigated RFA catheter, bRFA may give success. The setup of bRFA can be
easily made from the standard inventory in any one of the EP lab in our
country. Not to forget large randomized study is required to prove the
safety, feasibility and outcome of bRFA. (Figure Presented).

<70>
Accession Number
631900433
Title
The physiological understanding of Coenzyme Q10 treatment in patients
undergoing cardiac surgery: Could an antioxidant reduce the incidence of
reperfusion arrhythmia?.
Source
Journal of Arrhythmia. Conference: 12th Asia Pacific Heart Rhythm Society
Session, APHRS 2019. Thailand. 35 (Supplement 1) (pp 507), 2019. Date of
Publication: December 2019.
Author
Wardhani L.F.K.; Dewi I.P.; Soemantri D.
Institution
(Wardhani, Dewi, Soemantri) Universitas Airlangga, Indonesia
Publisher
Wiley-Blackwell
Abstract
Introduction: Reperfusion arrhythmia, as part of myocardial injury, during
cardiac operation has long been investigated. Oxygen free radicals,
identified in re-oxygenated myocardium, are belief to play a significant
role in reperfusion injury. Reactive oxygen intermediates arrhythmogenic
oscillation in membrane potential. Coenzyme Q10, a lipid-soluble
antioxidant, inhibiting lipid peroxidation in biological membranes and
supplying ATP cell production, that is necessary as the basic energy
source for the organism. This mechanism explains the role of CoQ10 in
membrane stabilization and metabolite essential depletion prevention,
which further induces the incidence of reperfusion arrhythmia.
 Method(s): The aim of this study is to determine the effect of
coenzyme Q10 treatment in reducing reperfusion arrhythmia among patients
undergoing cardiac surgery. We searched Pubmed database using the
following keywords: Coenzyme Q10, CoQ10, Ubiquinone, Heart Surgery,
Cardiac Surgery, Arrhythmia, and Reperfusion Injury. Articles were then
systematically collected, assessed, and analyzed for this review. Two good
quality clinical studies met our inclusion criteria with total of 70
patients for analysis. Result(s): Both studies showed pre-cardiac
surgery adjunctive treatment using Coenzyme Q10 were significantly
associated with good outcome. Patients undertake Coenzyme Q10 were less
likely to have reperfusion arrhythmia [OR (95% CI) 0.03 (0.00-0.16); P <
.0001]. Conclusion(s): These conclude that coenzyme Q10 could reduce
the incidence of reperfusion arrhythmia in patients undergoing cardiac
surgery. (Figure Presented).

<71>
Accession Number
631894745
Title
Cerebral air embolism associated with transcatheter aortic valve
replacement.
Source
Neurocritical Care. Conference: 16th Annual Meeting of the Neurocritical
Care Society, NCS 2018. United States. 29 (1 Supplement) (pp S199), 2018.
Date of Publication: 2018.
Author
Bershad E.; Surendranath A.; Garg T.; Kazmi S.O.
Institution
(Bershad, Surendranath, Garg, Kazmi) Baylor College of Medicine, Houston,
TX, United States
Publisher
Springer
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) is being
employed for aortic stenosis for high risk cases in recent years. As with
any invasive procedure, air embolism remains a rare yet potential
complication that may lead to morbidity and mortality. We report a case of
an ischemic stroke secondary to an air embolus after a TAVR. Methods Case
report and review of the literature Results A 75 year-old man with a
history of severe aortic stenosis was admitted to the hospital for chest
pain and shortness of breath. He subsequently underwent TAVR after which
he developed an acute left facial droop, hence neurological consultation
was obtained. He was noted to have left sided hemiparesis, left visual
field defect and dysarthria. The NIHSS score was a 10, and CT of the brain
along with CT angiography of the head and neck was pursued to evaluate for
any large vessel occlusion amenable to acute endovascular intervention.
Imaging revealed no thrombus but an air embolus in the right P2 division
of the posterior cerebral artery was apparent which was more clearly
visible on CT angiography. Repeat CTH revealed moderate volume right
posterior cerebral artery distribution infarction without hemorrhagic
transformation with resolution of the air embolus previously seen.
Appropriate supportive care was provided and he was subsequently
transferred to inpatient rehabilitation at which time his NIHSS had
improved to a 6. Conclusions Air embolism can lead to ischemic stroke
after any invasive procedure including TAVR. There should be a high index
of suspicion for air embolism as etiologies of stroke in such cases.

<72>
Accession Number
631894651
Title
Full dose thrombolysis for a right middle cerebral artery stroke after an
acute aortic dissection.
Source
Neurocritical Care. Conference: 16th Annual Meeting of the Neurocritical
Care Society, NCS 2018. United States. 29 (1 Supplement) (pp S197), 2018.
Date of Publication: 2018.
Author
Kazmi S.O.; Achi O.; Damani R.
Institution
(Kazmi, Achi, Damani) Baylor College of Medicine, Houston, TX, United
States
Publisher
Springer
Abstract
Introduction Aortic dissections are an infrequent cause of acute ischemic
stroke, which are often missed on initial evaluation. Administration of
thrombolysis in such patients can be associated with poor outcomes. We
report a case of an acute ischemic stroke due to an acute aortic
dissection who was treated with full dose IV r-tpa resulting in a good
outcome. Methods Case report and review of the literature Results A
72-year-old Japanese female with hypertension presented with symptoms of
acute onset left hemiparesis and dysarthria. IV r-tpa was administered by
the mobile stroke unit after a non-contrast CT head. Her initial NIHSS was
6 but improved to 3 by the time she arrived to the emergency room. Shortly
thereafter she had a seizure with worsening of her symptoms to a NIHSS of
23. CT angiography was obtained which showed a Type A aortic arch
dissection. Cardiothoracic surgery was emergently consulted and given her
low volume infarction in the right MCA distribution on brain MRI, she was
taken to the operating room for repair. Post operatively she had a
prolonged hospitalization and subsequently underwent successful
tracheostomy and percutaneous endoscopic gastrostomy tube placement. She
was discharged to inpatient rehabilitation on post-operative day thirty.
Conclusions Aortic dissection should always be in the back of one's mind
when dealing with thrombolysis in the setting of acute stroke care.
Emergent surgery should be offered after weighing the risks and benefits
with the patient and family, as these patients can have good outcomes.

<73>
Accession Number
2006032569
Title
The Use of Virtual Reality to Reduce Preoperative Anxiety in First-Time
Sternotomy Patients: A Randomized Controlled Pilot Trial.
Source
Mayo Clinic Proceedings. 95 (6) (pp 1148-1157), 2020. Date of Publication:
June 2020.
Author
Hendricks T.M.; Gutierrez C.N.; Stulak J.M.; Dearani J.A.; Miller J.D.
Institution
(Hendricks, Gutierrez) Mayo Clinic Alix School of Medicine, Mayo Clinic,
Rochester, MN, United States
(Stulak, Dearani, Miller) Department of Cardiovascular Surgery, Mayo
Clinic, Rochester, MN, United States
(Miller) Departments of Surgery and Physiology & Biomedical Engineering,
Mayo Clinic, Rochester, MN, United States
Publisher
Elsevier Ltd
Abstract
Objective: To report the first randomized controlled trial to investigate
if immersive virtual reality (VR) treatment can reduce patient perceptions
of anxiety compared with a tablet-based control treatment in adults
undergoing a first-time sternotomy. Method(s): Twenty first-time
sternotomy patients were prospectively randomized (blinded to
investigator) to a control or VR intervention. The VR intervention was a
game module "Bear Blast" (AppliedVR) displayed using a Samsung Gear Oculus
VR headset. The control intervention was a tablet-based game with
comparable audio, visual, and tactile components. The State-Trait Anxiety
Inventory was administered before and after the assigned intervention.
Self-reported anxiety measures between the control and VR groups were
evaluated using an unpaired t test. Changes in self-reported anxiety
measures pre- and post-intervention were evaluated with a paired t test
for both the control and VR groups. The study took place from May 1, 2017,
through January 1, 2019 (Institutional Review Board 16-009784).
 Result(s): Both control and VR groups were 90.0% male, with a mean
+/- SD age of 63.4 +/- 9.11 and 69.5 +/- 6.9 years, respectively. VR users
experienced significant reductions in feeling tense and strained, and
significant improvements in feeling calm when compared with tablet
controls (P<0.05). They also experienced significant reductions in feeling
strained, upset, and tense when compared with their own self-reported
anxiety measure pre- and post-intervention (P<0.05). Critically, control
patients had no change in these categories. Conclusion(s): Immersive
VR is an effective, nonpharmacologic approach to reducing preoperative
anxiety in adults undergoing cardiac surgery and shows the validity and
utility of this technology in adult patients. Copyright © 2020

<74>
Accession Number
631887534
Title
Effects of auricular acupressure on the quality of sleep and anxiety in
patients undergoing cardiac surgery: A single-blind, randomized controlled
trial.
Source
Applied nursing research : ANR. 53 (pp 151269), 2020. Date of Publication:
01 Jun 2020.
Author
Bang Y.Y.; Park H.
Institution
(Bang) Department of Nursing, KyungBok University, Gyeonggi-do, South
Korea
(Park) College of Nursing, Ewha Womans University, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
AIM: This study aimed to evaluate the effects of auricular acupressure
(AA), a non-invasive type of reflexotherapy, on sleep quality and anxiety
in patients after cardiac surgery. BACKGROUND: Sleep disturbances and
anxiety hinder the recovery of patients after cardiac surgery; thus,
appropriate and adequate nursing interventions must be pursued. AA is a
complementary therapy suitable for patients with limited pharmacological
therapy options. METHOD(S): A single-blind, randomized controlled
trial with a pretest-posttest control group design was applied. The study
consisted of 42 patients, comprising an experimental group (n = 21) and a
control group (n = 21). AA was applied for six days per trial for a total
of 2 trials, while sleep (sleep score, sleep satisfaction) and anxiety
(state, trait) were measured at three time points (pre-op, 7 days post-op,
and 14 days post-op). RESULT(S): The sleep and sleep satisfaction
scores of the experimental group were significantly higher than those of
the control group. No significant difference was found in anxiety
state/trait between the two groups. CONCLUSION(S): We conclude that
AA is a safe, effective, noninvasive, and low-risk nursing intervention
that can improve sleep quality in patients after cardiac
surgery. Copyright © 2020 Elsevier Inc. All rights reserved.

<75>
Accession Number
2005021798
Title
Ticagrelor Removal by CytoSorb in Patients Requiring Emergent
or Urgent Cardiac Surgery: A UK-Based Cost-Utility Analysis.
Source
PharmacoEconomics - Open. 4 (2) (pp 307-319), 2020. Date of Publication:
01 Jun 2020.
Author
Javanbakht M.; Trevor M.; Rezaei Hemami M.; Rahimi K.; Branagan-Harris M.;
Degener F.; Adam D.; Preissing F.; Scheier J.; Cook S.F.; Mortensen E.
Institution
(Javanbakht) Optimax Access UK Ltd, Market Access Consultancy, 20 Forth
Banks Tower, Newcastle upon Tyne NE1 3PN, United Kingdom
(Trevor) Newcastle University, Newcastle upon Tyne, United Kingdom
(Rezaei Hemami) PenTAG Health Technology Assessment, University of Exeter,
Exeter, United Kingdom
(Rahimi) The George Institute for Global Health, University of Oxford,
Oxford, United Kingdom
(Javanbakht, Branagan-Harris) Device Access UK Ltd, Market Access
Consultancy, University of Southampton Science Park, Chilworth Hampshire,
United Kingdom
(Degener, Adam, Preissing, Scheier) CytoSorbents Europe GmbH, Berlin,
Germany
(Cook) CERobs Consulting LLC, Chapel Hill, NC, United States
(Mortensen) CytoSorbents Corporation, Monmouth Junction, NJ, United States
Publisher
Adis
Abstract
Background: Acute coronary syndrome patients receiving dual antiplatelet
therapy who need emergent or urgent cardiac surgery are at high risk of
major bleeding, which can impair postoperative outcomes.
CytoSorb, a blood purification technology based on adsorbent
polymer, has been demonstrated to remove ticagrelor from blood during
on-pump cardiac surgery. Objective(s): The aim of this study was to
evaluate the cost utility of intraoperative removal of ticagrelor using
CytoSorb versus usual care among patients requiring emergent or urgent
cardiac surgery in the UK. Method(s): A de novo decision analytic
model, based on current treatment pathways, was developed to estimate the
short- and long-term costs and outcomes. Results from randomised clinical
trials and national standard sources such as National Health Service (NHS)
reference costs were used to inform the model. Costs were estimated from
the NHS and Personal Social Services perspective. Deterministic and
probabilistic sensitivity analyses (PSAs) explored the uncertainty
surrounding the input parameters. Result(s): In emergent cardiac
surgery, intraoperative removal of ticagrelor using CytoSorb was less
costly (12,933 vs. 16,874) and more effective (0.06201vs. 0.06091
quality-adjusted life-years) than cardiac surgery without physiologic
clearance of ticagrelor over a 30-day time horizon. For urgent cardiac
surgery, the use of CytoSorb was less costly than any of the three
comparators-delaying surgery for natural washout without adjunctive
therapy, adjunctive therapy with short-acting antiplatelet agents, or
adjunctive therapy with low-molecular-weight heparin. Results from the
PSAs showed that CytoSorb has a high probability of being cost saving (99%
in emergent cardiac surgery and 53-77% in urgent cardiac surgery,
depending on the comparators). Cost savings derive from fewer transfusions
of blood products and re-thoracotomies, and shorter stay in the
hospital/intensive care unit. Conclusion(s): The implementation of
CytoSorb as an intraoperative intervention for patients receiving
ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving
strategy, yielding improvement in perioperative and postoperative outcomes
and decreased health resource use. Copyright © 2019, The
Author(s).

<76>
Accession Number
2004449445
Title
Comparative study between effects of epidural magnesium sulphate on
intraoperative and postoperative analgesic requirements in cancer thoracic
surgery: A randomized controlled trial.
Source
Indian Journal of Public Health Research and Development. 11 (3) (pp
1404-1410), 2020. Date of Publication: March 2020.
Author
Hussein A.A.; Ghobrial H.Z.; Kamel M.A.; Saied A.M.A.; Khattab M.;
Mohammed A.T.; Elhalwagy A.M.A.
Institution
(Hussein) Department of Anesthesiology, ICU,and Pain Management, Faculty
of Medicine, Cairo University, Cairo, Egypt
(Ghobrial, Khattab, Mohammed) Department of Anesthesiology, ICU and Pain
Management, Faculty of Medicine, Al Azhar University for Boys, Cairo,
Egypt
(Kamel, Saied, Elhalwagy) Department of Anesthesiology, ICU and Pain
Management, Faculty of Medicine, Sohag University, Sohag, Egypt
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India)
Abstract
Background: The epidural infusion of local anesthetic and opioid achieves
effective postoperative analgesia in thoracic surgery patients.
Nevertheless, high dose of opioids my induce dose-dependent undesired
effects. Recent reports showed that adjuvantepidural magnesium
administration significantly improve intra and postoperative analgesic
outcomes.T he present randomized trial aimed to assess the intra and
postoperative analgesic effect of continuousepidural infusion of magnesium
sulphate in patients undergoing elective cancer thoracic surgery.
 Method(s): Sixty ASA III patients undergoing elective cancer thoracic
surgery were randomized in 1:1 ratio to receive adjuvant epidural
magnesium sulphate or 0.9% sodium chloride solution. The primary outcomes
in the present study were intra and postoperative analgesic requirements,
and postoperative pain score. Result(s): The magnesium sulphate group
showed a statistically significant lower number of required fenanyl doses
than the control group (74.3% needed two or more doses in magnesium
sulphate group versus 94.4% in the control group, p =0.026). A similar
findings was observed for need for ketorolac 30mg (p =0.017). The
postoperative VAS was significantly lower inmagnesium sulphate groupfrom
the 12th hour (p =0.033) to the 48th hour
postoperatively (p <0.001). The magnesium sulphate group showed more
stable hemodynamics. No major side-effects were observed in any of the
study groups. Conclusion(s): Epidural magnesium sulphate is a potent
adjuvant analgesic thatreduced opioid consumption and postoperative pain
in patients undergoing thoracic surgery. Copyright © 2020, Indian
Journal of Public Health Research and Development. All rights reserved.

<77>
Accession Number
2004441896
Title
Single-arm meta-analysis of Argentine studies reporting 30-day mortality
after transcatheter aortic valve implantation in intermediate-risk
patients.
Source
Revista Argentina de Cardiologia. 88 (2) (pp 111-117), 2020. Date of
Publication: 2020.
Author
Borracci R.A.; Amrein E.; Higa C.C.
Institution
(Borracci) School of Biomedical Sciences, Universidad Austral, Argentina
(Amrein, Higa) Cardiology Service, Herzzentrum, Hospital Aleman, Buenos
Aires, Argentina
Publisher
Sociedad Argentina de Cardiologia (E-mail: info@sac.org.ar)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has proved to
be beneficial in intermediate-risk patients; however, there is no analysis
reporting overall TAVI results in our country. Objective(s): The aim
of this investigation was to conduct a meta-analysis of single-arm local
studies reporting in-hospital TAVI outcomes in intermediate-risk patients
in Argentina. Method(s): A systematic review was performed including
observational TAVI studies identified in MEDLINE, Embase, SCOPUS and
Cochrane to August 2019. Result(s): Among 59 articles identified
through the database search, only 4 local observational studies reported
30-day mortality and complications after TAVI in moderate-risk patients,
with Society of Thoracic Surgeons (STS) score ranging between 4% and 7%.
In 494 patients, 30-day mortality was 4.8%. Weighted pooled estimates of
the studies were: stroke 2.7%, myocardial infarction 1.0%, need for
definitive pacemaker 24.8%, moderate or severe periprosthetic leak 16.7%,
and major bleeding 5.5%. Conclusion(s): The proven efficacy of TAVI
is expanding its indication to intermediate and low-risk patients.
However, this shift should be supported by local evidence of its benefit
over traditional valve surgery. This single-arm meta-analysis of Argentine
studies presents 30-day mortality and complications after TAVI in
intermediate-risk patients. The updated information of local TAVI outcomes
will serve as a standard in our setting. Copyright © 2020,
Sociedad Argentina de Cardiologia. All rights reserved.

<78>
Accession Number
2004441045
Title
Effect of dexmedetomidine combined with inhalation of isoflurane on
oxygenation following one-lung ventilation in thoracic surgery.
Source
Anesthesiology and Pain Medicine. 10 (1) (no pagination), 2020. Article
Number: e95287. Date of Publication: 2020.
Author
Asri S.; Hosseinzadeh H.; Eydi M.; Marahem M.; Dehghani A.; Soleimanpour
H.
Institution
(Asri, Hosseinzadeh, Eydi, Dehghani) Department of Anesthesiology, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Marahem) Department of Physiology, Tabriz University of Medical Sciences,
Tabriz, Iran, Islamic Republic of
(Soleimanpour) Emergency Medicine Department, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: library@kowsarpub.com)
Abstract
Background: One-lung ventilation (OLV) is commonly used during thoracic
surgery. At this time, hypoxemia is considered one of the remarkable
consequences of the anesthesia management. Hypoxic pulmonary
vasoconstriction (HPV) is the defense mecha-nism against hypoxia.
 Objective(s): The aim of the present study was to investigate the
effect of infusion of dexmedetomidine on improving the oxygenation during
OLV among the adult patients undergoing thoracic surgery. Method(s):
A total of 42 patients undergoing OLV by general anesthesia with
isoflurane inhalation were randomly assigned into two groups: IV infusion
of dexmedetomidine at 0.3 microgram/kg/h (DISO) and IV infusion of normal
saline (NISO). Three Arterial Blood Gas (ABG) samples were obtained
throughout the surgery. Hemodynamic parameters, PaO<inf>2</inf>,
PaCO<inf>2</inf>, and complications at recovery phase were recorded. The
collected information was analyzed using SPSS software version 22.
 Result(s): In the dexmedetomidine group, the mean hemodynamic
parameters had a significant reduction at 30 and 60 minutes following OLV.
Administration of dexmedetomidine resulted in a significant increase in
the PaCO<inf>2</inf> and a reduction in the PaO<inf>2</inf> when changing
from two-lung ventilation to OLV, where PaO<inf>2</inf> reached its
maximum value within 10 minutes after OLV in the DISO group, and it began
to gradually increase to the end of operation. The duration of the
recovery phase, also complications at the recovery phase decreased
significantly in DISO group. Conclusion(s): The results of the study
showed that, dexmedetomidine may improve arterial oxygenation during OLV
in adult patients undergoing thoracic surgery, and can be a suitable
anesthetic agent for thoracic surgery. Copyright © 2020,
Author(s).

<79>
Accession Number
2004441040
Title
Slow positive end-expiratory pressure titration during general anesthesia
with muscle paralysis improves lung function without compromising
hemodynamic stability in preschool children: A randomized control clinical
trial.
Source
Iranian Journal of Pediatrics. 29 (6) (no pagination), 2019. Article
Number: e92269. Date of Publication: 2019.
Author
Mandras A.D.; Soldatovic I.; Sujica M.; Stevanovic V.; Markovic D.;
Paunovic Z.; Minic P.
Institution
(Mandras, Sujica, Stevanovic) Department of Anesthesiology and Intensive
Care Therapy, Institute for Mother and Child Health Care, Belgrade, Serbia
(Soldatovic) Institute for Medical Statistics and Informatics, Medical
Faculty, University of Belgrade, Belgrade, Serbia
(Markovic) Department of Anesthesiology, Clinic for Cardiovascular
Surgery, Clinical Center of Serbia, Belgrade, Serbia
(Paunovic) Department of Orthopedics, Institute for Mother and Child
Health Care, Belgrade, Serbia
(Minic) Depratment of Pulmonolgy, Institute for Mother and Child Health
Care, Belgrade, Serbia
Publisher
Kowsar Medical Publishing Company (E-mail: library@kowsarpub.com)
Abstract
Background: Mechanical ventilation impairs oxygenation and increases
intrapulmonary shunt. Positive end-expiratory pressure (PEEP) slows
derecruitment, improves lung function but can compromise hemodynamics.
 Objective(s): To asses slow PEEP titration effect on intrapulmonary
shunt, oxygenation and hemodynamics in preschool children on mechanical
ventilation under general anesthesia. Method(s): This was a single
tertiary care center an open-label, randomized parallel group controlled
clinical trial. Study included 70 children, 3-7 years, ASA I and II, under
general anesthesia for non-cardiothoracic surgery. Children were randomly
allocated either to receive PEEP titration 5-11 cmH<inf>2</inf>O 20
minutes before the end of anesthesia (intervention group) or to be
ventilated until the end of anesthesia with constant positive
end-expiratory pressure of 3 cmH<inf>2</inf>O (control group). Main
outcome measures were changes in oxygenation index
(PaO<inf>2</inf>/FiO<inf>2</inf>) and alveolar-arterial gradient
(P(A-a)O<inf>2</inf>) between and within groups and changes in systolic
blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) in
interventional group during PEEP trial. Result(s): Seventy children
were recruited and analyzed. P(A-a)O<inf>2</inf> and
PaO<inf>2</inf>/FiO<inf>2</inf> improved in interventional group comparing
to control as consequence of PEEP titration
(PaO<inf>2</inf>/FiO<inf>2</inf>-30.3 vs. 0.52; P < 0.001;
P(A-a)O<inf>2</inf> 6.7 vs.-1.0; P < 0.001) and within interven-tional
group before and after PEEP titration (PaO<inf>2</inf>/FiO<inf>2</inf>
522.0 vs. 552.3; P < 0.01; P(A-a)O<inf>2</inf> 20.1 vs. 13.3; P < 0.001).
Hypotension and bradycardia were not documented. Conclusion(s): Slow
PEEP titration up to 11 cmH<inf>2</inf>O improves oxygenation, reduces
intrapulmonary shunt without causing hemodynamic instability in preschool
children during general anesthesia. Copyright © 2019, Author(s).

<80>
Accession Number
2005084633
Title
Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia
in adult and paediatric cardiac surgery: a systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Ler A.; Sazzad F.; Ong G.S.; Kofidis T.
Institution
(Ler, Sazzad, Ong, Kofidis) Department of Cardiac, Thoracic and Vascular
Surgery, National University Heart Centre, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Kofidis) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: In recent years, the use of del Nido cardioplegia, initially
intended for paediatric cardiac surgery, has been extended to adult
cardiac surgery in many institutions. Our aim was thus to compare the
outcomes of the use of del Nido cardioplegia with that of conventional
cardioplegia and discuss its role in both adult and paediatric cardiac
surgery. Method(s): A systematic literature search was conducted in
August 2019 on Medline (via PubMed), Embase and Cochrane electronic
databases according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Any retrospective studies and
randomised controlled trials that reported findings comparing the outcomes
of the use of del Nido cardioplegia with that of St. Thomas cardioplegia
were included. Result(s): We observed shorter aortic cross-clamp time
(mean difference: -15.18, confidence interval: -27.21 to -3.15, p = 0.01)
and cardiopulmonary bypass time (mean difference: -13.52, confidence
interval: -20.64 to -6.39, p = 0.0002) associated with the use of del Nido
cardioplegia in adult cardiac surgery as compared to St. Thomas
cardioplegia. Defibrillation rates were significantly lower in patients
who had been given del Nido cardioplegia, in both adult (relative risk:
0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric
patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p =
0.02). Conclusion(s): Del Nido cardioplegia may be a viable
alternative to the use of St. Thomas cardioplegia in both adult and
paediatric patients, providing similar postoperative outcomes while also
affording the additional advantage of shorter aortic cross-clamp time and
cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates
of defibrillation (in both adult and paediatric cardiac
surgery). Copyright © The Author(s) 2020.

<81>
Accession Number
631894406
Title
Coronary Computed Tomography Angiography in the Clinical Workflow of
Athletes with Anomalous Origin of Coronary Arteries from the Contralateral
Valsalva Sinus.
Source
Journal of Thoracic Imaging. (no pagination), 2020. Date of Publication:
2020.
Author
Marano R.; Merlino B.; Savino G.; Natale L.; Rovere G.; Paciolla F.;
Muciaccia M.; Flammia F.C.; Larici A.R.; Palmieri V.; Zeppilli P.;
Manfredi R.
Institution
(Marano, Merlino, Savino, Larici, Manfredi) Department of Diagnostic
Imaging, Oncological Radiotherapy and Hematology, Diagnostic Imaging Area,
Rome, Italy
(Natale) Sports Medicine Unit-Orthopedics, Aging and Rehabilitation Area,
Rome, Italy
(Palmieri, Zeppilli) Fondazione Policlinico Universitario Agostino Gemelli
Irccs, Rome, Italy
(Rovere, Paciolla, Muciaccia, Flammia) Universita Cattolica Del Sacro
Cuore, Universita Cattolica Del Sacro Cuore, Rome, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: This study aimed to assess the role of coronary computed
tomography-angiography (CCTA) in the workflow of competitive sports
eligibility in a cohort of athletes with anomalous origin of the
left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery
(AORCA) in an attempt to outline relevant computed tomography features
likely to impact diagnostic assessment and clinic management.
 Material(s) and Method(s): Patients with suspected AOLCA/AORCA at
transthoracic echocardiography or with inconclusive transthoracic
echocardiography underwent CCTA to rule out/confirm and characterize the
anatomic findings: Partially interarterial course or full-INT,
high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural
course (IM), interarterial-course-length, and lumen-reduction/hypoplasia
(HYPO). Result(s): CCTA identified 28 athletes: 6 AOLCA (3 males;
20.3+/-11.0 y) and 22 AORCA (18 males; 29.1+/-16.5 y). Symptoms were
present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had
abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal
stress-electrocardiogram. The INT course was observed in 15 athletes
(53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in
7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA
(50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No
statistically significant differences were found between
asymptomatic/symptomatic patients in the prevalence of partially INT/INT
courses, high-take-off/ATO, and slit-like ostium. A slightly significant
relationship between suspected proximal-IM (r=0.47, P<0.05) and
proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and
was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO).
All AOLCA/AORCA athletes were disqualified from competitive sports and
warned to avoid vigorous physical efforts. Surgery was recommended to all
AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent
surgery. No major cardiovascular event/ischemic symptoms/signs developed
during a mean follow-up of 49.6+/-39.5 months. Conclusion(s): CCTA
provides essential information for safe/effective clinical management of
athletes, with important prognostic/sport-activity
implications. Copyright © 2020 Cambridge University Press. All
rights reserved.

<82>
Accession Number
631887149
Title
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural
mesothelioma.
Source
The European respiratory journal. (no pagination), 2020. Date of
Publication: 25 May 2020.
Author
Scherpereel A.; Opitz I.; Berghmans T.; Psallidas I.; Glatzer M.; Rigau
D.; Astoul P.; Bolukbas S.; Boyd J.; Coolen J.; De Bondt C.; De Ruysscher
D.; Durieux V.; Faivre-Finn C.; Fennell D.; Galateau-Salle F.; Greillier
L.; Hoda M.A.; Klepetko W.; Lacourt A.; McElnay P.; Maskell N.A.; Mutti
L.; Pairon J.-C.; Van Schil P.; van Meerbeeck J.P.; Waller D.; Weder W.;
Cardillo G.; Putora P.M.
Institution
(Scherpereel) Pulmonary and Thoracic Oncology, Univ. Lille, INSERM U1189,
OncoThAI, CHU Lille, Lille, France
(Scherpereel) French National Network of Clinical Expert Centers for
Malignant Pleural Mesothelioma Management (Mesoclin), Lille, France
(Opitz, Weder) Dept of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Berghmans) Thoracic Oncology Clinic, Institut Jules Bordet, Brussels,
Belgium
(Psallidas) Oxford Centre for Respiratory Medicine, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Glatzer, Putora) Dept of Radiation Oncology, Kantonsspital St Gallen, St
Gallen, Switzerland
(Rigau) Iberoamerican Cochrane Center, Barcelona, Spain
(Astoul) Dept of Thoracic Oncology, Pleural Diseases and Interventional
Pulmonology, Aix-Marseille University, Hopital Nord, Marseille, France
(Bolukbas) Dept of Thoracic Surgery, Kliniken Essen-Mitte, Essen, Germany
(Boyd) European Lung Foundation, Sheffield, United Kingdom
(Coolen) Dept of Imaging and Pathology, KU Leuven, Leuven, Belgium
(De Bondt, van Meerbeeck) Dept of Pulmonology and Thoracic Oncology,
Antwerp University and Antwerp University Hospital, Antwerp, Belgium
(De Ruysscher) Dept of Radiation Oncology (Maastro Clinic), Maastricht
University Medical Center+, GROW Research Institute, Maastricht,
Netherlands
(Durieux) Bibliotheque des Sciences de la Sante, Universite libre de
Bruxelles (ULB), Brussels, Belgium
(Faivre-Finn) Christie NHS Foundation Trust, University of Manchester,
Manchester, United Kingdom
(Fennell) Leicester Cancer Research Centre, University of Leicester and
University of Leicester Hospitals NHS Trust, Leicester, United Kingdom
(Galateau-Salle) National Reference Center for Pleural Malignant
Mesothelioma and Rare Peritoneal Tumors MESOPATH, Dept of Biopathology,
Centre Leon Berard, Lyon, France
(Greillier) Aix Marseille University, Assistance Publique Hopitaux de
Marseille, Inserm UMR1068, CNRS UMR7258, Dept of Multidisciplinary
Oncology and Therapeutic Innovations, Marseille, France
(Hoda, Klepetko) Dept of Thoracic Surgery, Medical University of Vienna,
Vienna, Austria
(Lacourt) Univ. Bordeaux, INSERM, Bordeaux Population Health Research
Center, Bordeaux, France
(McElnay) Newcastle University, Newcastle upon Tyne, United Kingdom
(Maskell) Academic Respiratory Unit, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Mutti) Teaching Hosp. Vercelli/Gruppo Italiano Mesotelioma, Italy
(Pairon) Universite Paris-Est Creteil, Service de Pathologies
professionnelles et de l'Environnement, CHI Creteil, Equipe 4, Creteil
INSERM U955, France
(Van Schil) Dept Thoracic and Vascular Surgery, Antwerp University and
Antwerp University Hospital, Antwerp, Belgium
(Waller) Barts Thorax Centre, St Bartholomew's Hospital, London, United
Kingdom
(Cardillo) Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
(Putora) Dept of Radiation Oncology, University of Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic
Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery
(EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force
brought together experts to update previous 2009 ERS/ESTS guidelines on
management of malignant pleural mesothelioma (MPM), a rare cancer with
globally poor outcome, after a systematic review of the 2009-2018
literature. The evidence was appraised using the Grading of
Recommendations, Assessment, Development and Evaluation approach. The
evidence syntheses were discussed and recommendations formulated by this
multidisciplinary group of experts. Diagnosis: pleural biopsies remain the
gold standard to confirm the diagnosis, usually obtained by thoracoscopy
but occasionally via image-guided percutaneous needle biopsy in cases of
pleural symphysis or poor performance status. Pathology: standard staining
procedures are insufficient in ~10% of cases, justifying the use of
specific markers, including BAP-1 and CDKN2A (p16) for the separation of
atypical mesothelial proliferation from MPM. Staging: in the absence of a
uniform, robust and validated staging system, we advise using the most
recent 2016 8th TNM (tumour, node, metastasis) classification, with an
algorithm for pre-therapeutic assessment. Monitoring: patient's
performance status, histological subtype and tumour volume are the main
prognostic factors of clinical importance in routine MPM management. Other
potential parameters should be recorded at baseline and reported in
clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM
patients and only selected patients are candidates for radical surgery.
New promising targeted therapies, immunotherapies and strategies have been
reviewed. Because of limited data on the best combination treatment, we
emphasise that patients who are considered candidates for a multimodal
approach, including radical surgery, should be treated as part of clinical
trials in MPM-dedicated centres. Copyright The article has been
co-published with permission in the European Respiratory Journal and the
European Journal of Cardio-Thoracic Surgery. All rights reserved in
respect of European Respiratory Journal, © European Respiratory
Society 2020 and European Journal of Cardio-Thoracic Surgery, ©
European Association for Cardio-Thoracic Surgery 2020. The articles are
identical except for minor stylistic

<83>
Accession Number
631873597
Title
Effect of preparative rehabilitation on recovery after cardiac surgery: a
systematic review.
Source
Annals of physical and rehabilitation medicine. (no pagination), 2020.
Date of Publication: 21 May 2020.
Author
Yau D.K.W.; Underwood M.J.; Joynt G.M.; Lee A.
Institution
(Yau, Joynt, Lee) Department of Anaesthesia and Intensive Care, The
Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma
Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong,
China
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery, The
Chinese University of Hong Kong, 7/F Main Clinical Block and Trauma
Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Physical prehabilitation (preparative rehabilitation) programs
may have beneficial effects on enhancing physical strength and functional
status before surgery, but their effects on postoperative recovery are
unclear. OBJECTIVE(S): This systematic review investigated the
effectiveness of physical prehabilitation programs before cardiac surgery
on postoperative recovery and other perioperative outcomes.
 METHOD(S): We searched for reports of randomised controlled trials of
any prehabilitation programs that included physical activity or an
exercise training component in adults undergoing elective cardiac surgery,
published in any language, from six bibliographic databases (last search
on June 20, 2019). We assessed trials for risk of bias, overall certainty
of evidence and quality of intervention reporting using the Cochrane Risk
of Bias Assessment Tool, GRADE system and the Template for Intervention
Description and Replication checklist and guide, respectively.
 RESULT(S): All 7 studies (726 participants) were at high risk of bias
because of lack of blinding. The quality of prehabilitation reporting was
moderate because program adherence was rarely assessed. The timing of
prehabilitation ranged from 5 days to 16 weeks before surgery and from
face-to-face exercise prescription to telephone counselling and
monitoring. We found uncertain effects of prehabilitation on postoperative
clinical outcomes (among the many outcomes assessed): perioperative
mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to
5.95; I2=0%; low-certainty evidence) and postoperative atrial fibrillation
(relative risk 0.75, 95% CI 0.38 to 1.46; I2=50%; very low-certainty
evidence). However, prehabilitation may improve postoperative functional
capacity and slightly shorten the hospital stay (mean difference -0.66
days, 95% CI -1.29 to -0.03; I2=45%; low-certainty evidence).
 CONCLUSION(S): Despite the high heterogeneity among physical
prehabilitation trials and the uncertainty regarding robust clinical
outcomes, physical prehabilitation before cardiac surgery seems to enhance
selected postoperative functional performance measures and slightly reduce
the hospital length of stay after cardiac surgery. Copyright ©
2020 Elsevier Masson SAS. All rights reserved.

<84>
Accession Number
626725484
Title
Myocardial protection and clinical outcomes in Tetralogy of Fallot
patients undergoing intracardiac repair: a randomized study of two
cardioplegic techniques.
Source
Perfusion (United Kingdom). 34 (6) (pp 495-502), 2019. Date of
Publication: 01 Sep 2019.
Author
Negi S.L.; Mandal B.; Singh R.S.; Puri G.D.
Institution
(Negi, Mandal, Puri) Department of Anaesthesia and Intensive Care,
Postgraduate Institute of Medical Education and Research, Chandigarh,
India
(Singh) Department of Cardiothoracic and Vascular Surgery, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Myocardial protection in Tetralogy of Fallot patients
undergoing intracardiac repair is suboptimal due to hypertrophied right
ventricle. Hypertrophied myocardium is more susceptible to poor myocardial
preservation because of inadequate capillary density as compared to the
myocytes. There is a capillary to myocyte ratio mismatch. But del Nido
Cardioplegia owing to its less viscosity is able to get more evenly
distributed under hypothermic cardiopulmonary bypass as opposed to blood
Cardioplegia. We hypothesized that the del Nido Cardioplegia technique,
would be beneficial in myocardial protection because of its composition
and method of delivery, leading into better early and late clinical
outcomes in patients undergoing Tetralogy of Fallot repair as compared to
blood cardioplegia reconstituted using St Thomas Cardioplegia solution.
The objective of the study was to identify a better technique of
myocardial preservation in Tetralogy of Fallot patient. Method(s): In
total, 56 Tetralogy of Fallot patients undergoing intracardiac repair
under mild hypothermic cardiopulmonary bypass were randomly allocated to
receive antegrade Cardioplegia with either standard blood Cardioplegia
(Group I) or del Nido Cardioplegia (Group II). Preoperative as well as
postoperative data including echocardiographic parameters for right
ventricle functions, creatine kinase MB level, inotropic requirement,
mechanical ventilation duration, intensive care unit stay and hospital
mortality were evaluated. Result(s): Inotropic score in the first 24
hours postoperatively was significantly lower in Group II compared to
Group I (13.4 +/- 7.2 vs. 21.2 +/- 9.6, p = 0.003). Creatine kinase MB
level (ng/mL) was comparable between the groups. Echocardiographic
parameters for right ventricle functions were also comparable between the
groups during early as well as after 3 to 6 months postoperatively.
 Conclusion(s): Del Nido Cardioplegia is equally efficacious in
providing myocardial protection during intracardiac repair under mild
hypothermic cardiopulmonary bypass in Tetralogy of Fallot patients as
compared to blood Cardioplegia solution with the added benefit of reducing
inotropic requirement in first 24 hours postoperative
period. Copyright © The Author(s) 2019.

<85>
Accession Number
625678747
Title
Sex-related response to bivalirudin and unfractionated heparin in patients
with acute myocardial infarction undergoing percutaneous coronary
intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial.
Source
European Heart Journal: Acute Cardiovascular Care. 8 (6) (pp 502-509),
2019. Date of Publication: 01 Sep 2019.
Author
Venetsanos D.; Sederholm Lawesson S.; Frobert O.; Omerovic E.; Henareh L.;
Robertsson L.; Linder R.; Gotberg M.; James S.; Alfredsson J.; Erlinge D.;
Swahn E.
Institution
(Venetsanos, Sederholm Lawesson, Alfredsson, Swahn) Department of
Cardiology and Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden
(Frobert) Department of Cardiology, Orebro University, Sweden
(Omerovic) Department of Cardiology, Sahlgrenska University Hospital,
Sweden
(Henareh) Department of Medicine, Karolinska Institute, Sweden
(Robertsson) Department of Cardiology, Sodra Alvsborgs Sjukhus, Sweden
(Linder) Department of Cardiology, Danderyd Hospital, Sweden
(Gotberg, Erlinge) Department of Cardiology, Skane University Hospital,
Sweden
(James) Department of Medical Sciences, Uppsala University, Sweden
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims: Our aim was to study the impact of sex on anticoagulant treatment
outcomes during percutaneous coronary intervention in acute myocardial
infarction patients. Method(s): This study was a prespecified
analysis of the Bivalirudin versus Heparin in ST-Segment and Non
ST-Segment Elevation Myocardial Infarction in Patients on Modern
Antiplatelet Therapy in the Swedish Web System for Enhancement and
Development of Evidence-based Care in Heart Disease Evaluated according to
Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART) trial, in which
patients with myocardial infarction were randomised to bivalirudin or
unfractionated heparin during percutaneous coronary intervention. The
primary outcome was the composite of death, myocardial infarction or major
bleeding at 180 days. Result(s): There was a lower risk of the
primary outcome in women assigned to bivalirudin than to unfractionated
heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval
(0.60-1.00)) with no significant difference in men (11.8% vs 11.2%, hazard
ratio 1.06 (0.89-1.26), p for interaction 0.05). The observed difference
was primarily due to lower risk of major bleeding (Bleeding Academic
Research Consortium definition 2, 3 or 5) associated with bivalirudin in
women (8.9% vs 11.8%, hazard ratio 0.74 (0.54-1.01)) but not in men (8.5%
vs 7.3%, hazard ratio 1.16 (0.94-1.43) in men, p for interaction 0.02).
Conversely, no significant difference in the risk of Bleeding Academic
Research Consortium 3 or 5 bleeding, associated with bivalirudin, was
found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54-1.31)) or men 2.9% vs
2.1% (hazard ratio 1.36 (0.93-1.99)). Bleeding Academic Research
Consortium 2 bleeding occurred significantly less often in women assigned
to bivalirudin than to unfractionated heparin. The risk of death or
myocardial infarction did not significantly differ between randomised
treatments in men or women. Conclusion(s): In women, bivalirudin was
associated with a lower risk of adverse outcomes, compared to
unfractionated heparin, primarily due to a significant reduction in
Bleeding Academic Research Consortium 2 bleeds. Copyright © The
European Society of Cardiology 2018.

<86>
Accession Number
631757998
Title
Determining optimal strategies for primary prevention of cardiovascular
disease: Systematic review, cost-effectiveness review and network
meta-analysis protocol.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 105. Date
of Publication: 07 May 2020.
Author
Uthman O.A.; Al-Khudairy L.; Nduka C.U.; Court R.; Mistry H.;
Melendez-Torres G.J.; Taylor-Phillips S.; Clarke A.
Institution
(Uthman, Al-Khudairy, Nduka, Court, Mistry, Taylor-Phillips, Clarke)
Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division
of Health Sciences, Warwick Medical School, University of Warwick,
Coventry CV4 7AL, United Kingdom
(Melendez-Torres) Peninsula Technology Assessment Group (PenTAG), College
of Medicine and Health, University of Exeter, England, United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite recent improvements in the burden of cardiovascular
disease (CVD) in the UK, deaths from CVD are relatively high compared with
other high-income countries. An estimated 7 million people in the UK are
living with CVD, and the healthcare cost is approximately 11 billion
annually. In more than 90% of cases, the risk of a first heart attack is
thought to be related to modifiable risk factors including smoking, poor
diet, lipidemia, high blood pressure, inactivity, obesity and excess
alcohol consumption. The aim of the study is to synthesise evidence for
the comparative effectiveness and cost-effectiveness of different
interventions for the primary prevention of CVD. Method(s): We will
systematically search databases (for example, MEDLINE (Ovid), Embase
(Ovid), Cochrane Library) and the reference lists of previous systematic
reviews for randomised controlled trials that assess the effectiveness and
cost-effectiveness of any form of intervention aimed at adult populations
for the primary prevention of CVD, including but not limited to lipid
lowering medications, blood pressure lowering medications, antiplatelet
agents, nutritional supplements, dietary interventions, health promotion
programmes, physical activity interventions or structural and policy
interventions. Interventions may or may not be targeted at high-risk
groups. Publications from any year will be considered for inclusion. The
primary outcome will be all cause mortality. Secondary outcomes will be
cardiovascular diseases related mortality, major cardiovascular events,
coronary heart disease, incremental costs per quality-adjusted life years
gained. If data permits, we will use network meta-analysis to compare and
rank effectiveness of different interventions, and test effect
modification of intervention effectiveness using subgroup analyses and
meta-regression analyses. Discussion(s): The results will be
important for policymakers when making decisions between multiple possible
alternative strategies to prevent CVD. Compared to results from existing
multiple separate pairwise meta-analyses, this overarching synthesis of
all relevant work will enhance decision-making. The findings will be
crucial to inform evidence-based priorities and guidelines for policies
and planning prevention strategies of CVD. Systematic review registration:
PROSPERO CRD42019123940. Copyright © 2020 The Author(s).

<87>
Accession Number
2004153841
Title
Intracoronary injection of autologous CD34+ cells improves one-year left
ventricular systolic function in patients with diffuse coronary artery
disease and preserved cardiac performance-a randomized, open-label,
controlled phase ii clinical trial.
Source
Journal of Clinical Medicine. 9 (4) (no pagination), 2020. Article Number:
1043. Date of Publication: April 2020.
Author
Sung P.-H.; Li Y.-C.; Lee M.S.; Hsiao H.-Y.; Ma M.-C.; Pei S.-N.; Chiang
H.-J.; Lee F.-Y.; Yip H.-K.
Institution
(Sung, Li, Hsiao, Yip) Division of Cardiology, Department of Internal
Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University,
College of Medicine, Kaohsiung 83301, Taiwan (Republic of China)
(Sung, Yip) Center for Shockwave Medicine and Tissue Engineering,
Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan (Republic
of China)
(Lee) Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital,
Chang Gung University, College of Medicine, Kaohsiung 83301, Taiwan
(Republic of China)
(Ma) Division of Hema-Oncology, Department of Internal Medicine, Kaohsiung
Chang Gung Memorial Hospital, Chang Gung University College of Medicine,
Kaohsiung 83301, Taiwan (Republic of China)
(Pei) Department of Hematology Oncology, E-Da Cancer Hospital, I-Shou
University, College of Medicine, Kaohsiung 82445, Taiwan (Republic of
China)
(Chiang) Department of Obstetrics and Gynecology, Kaohsiung Chang Gung
Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
83301, Taiwan (Republic of China)
(Chiang) Chung Shan Medical University School of Medicine, Taichung 40201,
Taiwan (Republic of China)
(Lee) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
College of Medicine, Kaohsiung 83301, Taiwan (Republic of China)
(Lee) Division of Cardiovascular Surgery, Department of Surgery,
Tri-Service General Hospital, National Defense Medical Center, Taipei
11490, Taiwan (Republic of China)
(Yip) Department of Nursing, Asia University, Taichung 41354, Taiwan
(Republic of China)
(Yip) Institute for Translational Research in Biomedicine, Kaohsiung Chang
Gung Memorial Hospital, Chang Gung University, College of Medicine,
Kaohsiung 83301, Taiwan (Republic of China)
(Yip) Department of Medical Research, China Medical University Hospital,
China Medical University, Taichung 40402, Taiwan (Republic of China)
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
This phase II randomized controlled trial tested whether intracoronary
autologous CD34+ cell therapy could further improve left ventricular (LV)
systolic function in patients with diffuse coronary artery disease (CAD)
with relatively preserved LV ejection fraction (defined as LVEF >40%)
unsuitable for coronary intervention. Between December 2013 and November
2017, 60 consecutive patients were randomly allocated into group 1 (CD34+
cells, 3.0 x 107/vessel/n = 30) and group 2 (optimal medical
therapy; n = 30). All patients were followed for one year, and preclinical
and clinical parameters were compared between two groups.
Three-dimensional echocardiography demonstrated no significant difference
in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295)
at 12 months. However, compared with baseline, 12-month LVEF was
significantly increased in group 1 (p < 0.001) but not in group 2 (p =
0.297). From baseline, there were gradual increases in LVEF in group 1
compared to those in group 2 at 1-month, 3-months, 6-months and 12 months
(+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. -1.6%, -1.5%, -1.4% and
-0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis
(2.8 +/- 0.9 vs. 1.3 +/- 1.1), angina (0.4 +/- 0.8 vs. 1.8 +/- 0.9) and HF
(0.7 +/- 0.8 vs. 1.8 +/- 0.6) scores were significantly improved in group
1 compared to those in group 2 (all p < 0.001). In conclusion, autologous
CD34+ cell therapy gradually and effectively improved LV systolic function
in patients with diffuse CAD and preserved LVEF who were non-candidates
for coronary intervention (Trial registration: ISRCTN26002902 on the
website of ISRCTN registry). Copyright © 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<88>
Accession Number
2004436110
Title
Sodium nitroprusside versus nicardipine for hypertension management after
surgery: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 35 (5) (pp 1021-1028), 2020. Date of
Publication: 01 May 2020.
Author
Villarreal E.G.; Flores S.; Kriz C.; Iranpour N.; Bronicki R.A.; Loomba
R.S.
Institution
(Villarreal, Flores, Bronicki) Cardiac Intensive Care Unit, Division of
Critical Care, Texas Children's Hospital/Baylor College of Medicine,
Houston, TX, United States
(Villarreal) Tecnologico de Monterrey, Escuela de Medicina y Ciencias de
la Salud, Monterrey, Nuevo Leon, Mexico
(Kriz, Loomba) Cardiology, Advocate Children's Hospital/Chicago Medical
School, Chicago, IL, United States
(Iranpour) Baylor College of Medicine, Houston, TX, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Vasoactive medications are commonly administered for afterload
reduction and arterial hypertension treatment in patients after cardiac
surgery. A systematic review and meta-analysis were conducted to determine
the effects of sodium nitroprusside and nicardipine on hemodynamics and
cardiac performance in this population. Method(s): A systematic
review of published manuscripts was performed to identify studies of
patients who received sodium nitroprusside and nicardipine as part of the
treatment for arterial hypertension or afterload reduction after cardiac
surgery. A meta-analysis was then conducted to determine the effects of
sodium nitroprusside and nicardipine on hemodynamics and cardiac
performance. The following parameters were captured: blood pressure, heart
rate, right atrial pressure, systemic vascular resistance, and stroke
volume. Result(s): In total, five studies with 571 patients were
pooled for these analyses. Systolic blood pressure, diastolic blood
pressure, and mean arterial blood pressure were similar in both groups.
The cardiac index was greater with nicardipine while mean pulmonary artery
pressure was lower with sodium nitroprusside. Conclusion(s):
Nicardipine and sodium nitroprusside have similar abilities in reducing
afterload in the postoperative cardiac population. Statistically
significant differences were found in pulmonary artery pressure and
cardiac index. It may be beneficial to consider nicardipine for afterload
reduction in patients with a low cardiac index. Copyright © 2020
Wiley Periodicals, Inc.

<89>
Accession Number
2005976376
Title
Perioperative probiotic treatment decreased the incidence of postoperative
cognitive impairment in elderly patients following non-cardiac surgery: A
randomised double-blind and placebo-controlled trial.
Source
Clinical Nutrition. (no pagination), 2020. Date of Publication: 2020.
Author
Wang P.; Yin X.; Chen G.; Li L.; Le Y.; Xie Z.; Ouyang W.; Tong J.
Institution
(Wang, Yin, Chen, Li, Le, Ouyang, Tong) Department of Anesthesiology, The
Third Xiangya Hospital of Central South University, Changsha, Hunan, China
(Wang, Tong) Hunan Province Key Laboratory of Brain Homeostasis, Third
Xiangya Hospital, Central South University, Changsha, Hunan, China
(Tong) Center for Experimental Medicine, Third Xiangya Hospital, Central
South University, Changsha, Hunan, China
(Xie) Geriatric Anesthesia Research Unit, Department of Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital and
Harvard Medical School, Charlestown, United States
Publisher
Churchill Livingstone
Abstract
Background: Given that population aging is a global health challenge, the
high prevalence of postoperative neurocognitive impairment in elderly
patients necessitates the development of novel simple and effective
prevention methods. Objective(s): To evaluate the effects of
perioperative application of oral probiotic as a prophylaxis for cognitive
impairment in elderly patients following non-cardiac surgery.
 Method(s): This randomised double-blind and placebo-controlled trial
included 120 elderly patients (in a modified intention-to-treat analysis)
scheduled for elective orthopaedic or colorectal surgery. Patients were
assigned to receive either probiotics or a placebo from hospital admission
until discharge. The primary endpoint was the incidence of postoperative
cognitive impairment, defined as a decrease of >=3 points in the
Mini-Mental State Examination (MMSE) scores from admission baseline to the
7th day post-surgery. Secondary endpoints included changes in plasma
interleukin-6 (IL-6) and cortisol, postoperative pain intensity,
postoperative sleep quality, gastrointestinal function recovery, and
faecal microbiota composition. Result(s): The incidence of
postoperative cognitive impairment in the probiotic group was
significantly lower than in the control group (3 of 59 patients [5.1%] vs.
10 of 61 patients [16.4%], P = 0.046). In addition, compared to
pre-surgery, the levels of plasma IL-6 and cortisol in the probiotic group
decreased more than in the control group 5-7 days after surgery (IL-6:
-117.90 +/- 49.15 vs. -14.93 +/- 15.21, P = 0.044; cortisol: -158.70 +/-
53.52 vs. 40.98 +/- 72.48, P = 0.010). Relative abundance at the genus
level in the faeces of the probiotic group also changed more than in that
of the control group during the perioperative period. In contrast,
postoperative pain intensity, sleep quality, and gastrointestinal function
recovery did not differ significantly between the two groups.
 Conclusion(s): Perioperative application of oral probiotic prevents
postoperative cognitive impairment in elderly patients following
non-cardiac surgery, possibly via the limitation of peripheral
inflammation and the stress response. Copyright © 2020 Elsevier
Ltd and European Society for Clinical Nutrition and Metabolism

<90>
Accession Number
631867081
Title
The effectiveness of small-bore intercostal catheters versus large-bore
chest tubes in the management of pleural disease with the systematic
review of literature.
Source
Lung India. 37 (3) (pp 198-203), 2020. Date of Publication: 2020.
Author
Mehra S.; Heraganahally S.; Sajkov D.; Morton S.; Bowden J.
Institution
(Mehra, Sajkov, Morton, Bowden) Flinders Medical Centre, Adelaide, SA
SA-5042, Australia
(Heraganahally) Department of Respiratory Medicine, Royal Darwin Hospital,
Darwin, NT, Australia
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The purpose of this study was to compare the effectiveness of small-bore
intercostal catheters (SB ICCs; 10-14 Fr) to large-bore intercostal tubes
(LB ICTs; >20 Fr) in the management of pleural diseases. Method(s): A
total of 52 patients (42 males) with a mean age of 55 +/- 23 years
undergoing pleural intervention were included in the analysis. Twenty-five
patients (48.1%) had pneumothorax and rest (51.9%) had pleural effusion.
Half of the patients underwent SB ICC (mean age: 63 +/- 20 years) and the
remaining 26 underwent LB ICT (mean age: 47 +/- 25 years). Result(s):
SB ICCs were predominantly used in patients with primary pleural effusion
and LB ICTs in patients presenting with pneumothorax. Failures were in
<20% of SB ICC patients (mainly from loculation) and in <30% with LB ICT
patients (from persistent airleak) - difference that was not statistically
significant. In both groups, no deaths or major complications directly
related to the procedure were observed. However, the proportion that
needed surgery was significantly different in two cohorts (18.5% OF SB ICC
and 42.3% of LB ICT cohorts). The ICC dwell time was less in SB ICC (5 +/-
4 days), compared to LB ICT (8 +/- 6 days). SB ICCs were associated with
less pain and seem to be tolerated better by the patients.
 Conclusion(s): In well-supervised tertiary hospital setting, SB ICCs
are as effective as LB ICTs with better patient tolerance, reduced dwell
time, and reduced likelihood for surgical intervention. Copyright
© 2020 Indian Chest Society Published by Wolters Kluwer -
Medknow.

<91>
Accession Number
631870907
Title
Cardiogenic shock: role of invasive cardiology.
Source
Current opinion in critical care. (no pagination), 2020. Date of
Publication: 20 May 2020.
Author
Feistritzer H.-J.; Thiele H.; Desch S.
Institution
(Feistritzer) Department of Internal Medicine/Cardiology, Heart Center
Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig,
Germany
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Early revascularization significantly improved the
outcome of patients with cardiogenic shock following acute myocardial
infarction (AMI). Nevertheless, the mortality remains substantial, ranging
between 40 and 50% after 30 days. The present review summarizes the
current evidence regarding revascularization strategies, vascular access
site and concomitant antiplatelet and antithrombotic treatment in
infarct-related cardiogenic shock. RECENT FINDINGS: On the basis of the
SHOCK trial, early revascularization is the most relevant procedure to
improve the outcome of patients with infarct-related cardiogenic shock.
The majority of these patients present with multivessel coronary disease.
The randomized CULPRIT-SHOCK trial showed that in the emergency setting,
percutaneous coronary intervention (PCI) should be confined to the culprit
lesion. Regarding vascular access site, no data derived from randomized
controlled trials in cardiogenic shock are available. Emergency coronary
artery bypass grafting (CABG) is nowadays rarely performed in cardiogenic
shock with rates less than 5% but is still a treatment option if coronary
anatomy is not amenable to PCI. Regarding antiplatelet treatment, a
randomized trial testing the intravenous P2Y12 inhibitor cangrelor versus
an oral P2Y12 inhibitor in infarct-related cardiogenic shock is currently
being performed. SUMMARY: Early revascularization is the cornerstone of
treatment of infarct-related cardiogenic shock and should be confined to
the culprit lesion in the emergency setting.

<92>
Accession Number
631869019
Title
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural
mesothelioma.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 25 May 2020.
Author
Opitz I.; Scherpereel A.; Berghmans T.; Psallidas I.; Glatzer M.; Rigau
D.; Astoul P.; Bolukbas S.; Boyd J.; Coolen J.; De Bondt C.; De Ruysscher
D.; Durieux V.; Faivre-Finn C.; Fennell D.A.; Galateau-Salle F.; Greillier
L.; Hoda M.A.; Klepetko W.; Lacourt A.; McElnay P.; Maskell N.A.; Mutti
L.; Pairon J.-C.; Van Schil P.; van Meerbeeck J.P.; Waller D.; Weder W.;
Putora P.M.; Cardillo G.
Institution
(Opitz, Weder) Department of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Scherpereel) Department of Pulmonary and Thoracic Oncology, French
National Network of Clinical Expert Centers for Malignant Pleural
Mesothelioma Management (Mesoclin), Lille, France
(Scherpereel) Department of Pulmonary and Thoracic Oncology, University
Lille, INSERM U1189, OncoThAI, CHU Lille, Lille, France
(Berghmans) Thoracic Oncology Clinic, Institut Jules Bordet, Brussels,
Belgium
(Psallidas) Oxford Centre for Respiratory Medicine, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Glatzer, Putora) Department of Radiation Oncology, Kantonsspital St.
Gallen, St. Gallen, Switzerland
(Rigau) Iberoamerican Cochrane Center, Barcelona, Spain
(Astoul) Department of Thoracic Oncology, Pleural Diseases and
Interventional Pulmonology, Aix-Marseille University, Hopital Nord,
Marseille, France
(Bolukbas) Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen,
Germany
(Boyd) European Lung Foundation, Sheffield, United Kingdom
(Coolen) Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
(De Bondt, van Meerbeeck) Department of Pulmonology and Thoracic Oncology,
Antwerp University and Antwerp University Hospital, Antwerp, Belgium
(De Ruysscher) Department of Radiation Oncology (Maastro Clinic),
Maastricht University Medical Center+, GROW Research Institute,
Maastricht, Netherlands
(Durieux) Bibliotheque des Sciences de la Sante, Universite Libre de
Bruxelles (ULB), Brussels, Belgium
(Faivre-Finn) Christie NHS Foundation Trust, University of Manchester,
Manchester, United Kingdom
(Fennell) Leicester Cancer Research Centre, University of Leicester and
University of Leicester Hospitals NHS Trust, Leicester, United Kingdom
(Galateau-Salle) Department of Biopathology, National Reference Center for
Pleural Malignant Mesothelioma and Rare Peritoneal Tumors MESOPATH, Centre
Leon Berard, Lyon, France
(Greillier) Department of Multidisciplinary Oncology and Therapeutic
Innovations, Aix Marseille University, Assistance Publique Hopitaux de
Marseille, Inserm UMR1068, CNRS UMR7258, Marseille, France
(Hoda, Klepetko) Department of Thoracic Surgery, Medical University of
Vienna, Vienna, Austria
(Lacourt) University Bordeaux, INSERM, Bordeaux Population Health Research
Center, Bordeaux, France
(McElnay) Newcastle University, Newcastle upon Tyne, United Kingdom
(Maskell) Academic Respiratory Unit, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Mutti) Teaching Hospital Vercelli/Gruppo Italiano, Vercelli, Italy
(Pairon) Universite Paris-Est Creteil, Service de Pathologies
professionnelles et de l'Environnement, CHI Creteil, Creteil INSERM U955,
France
(Van Schil) Department of Thoracic and Vascular Surgery, Antwerp
University and Antwerp University Hospital, Antwerp, Belgium
(Waller) Barts Thorax Centre, St Bartholomew's Hospital, London, United
Kingdom
(Putora) Department of Radiation Oncology, University of Bern, Bern,
Switzerland
Publisher
NLM (Medline)
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic
Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery
(EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force
brought together experts to update previous 2009 ERS/ESTS guidelines on
management of malignant pleural mesothelioma (MPM), a rare cancer with
globally poor outcome, after a systematic review of the 2009-2018
literature. The evidence was appraised using the Grading of
Recommendations, Assessment, Development and Evaluation approach. The
evidence syntheses were discussed and recommendations formulated by this
multidisciplinary group of experts. Diagnosis: pleural biopsies remain the
gold standard to confirm the diagnosis, usually obtained by thoracoscopy
but occasionally via image-guided percutaneous needle biopsy in cases of
pleural symphysis or poor performance status. Pathology: standard staining
procedures are insufficient in ~10% of cases, justifying the use of
specific markers, including BAP-1 and CDKN2A (p16) for the separation of
atypical mesothelial proliferation from MPM. Staging: in the absence of a
uniform, robust and validated staging system, we advise using the most
recent 2016 8th TNM (tumour, node, metastasis) classification, with an
algorithm for pretherapeutic assessment. Monitoring: patient's performance
status, histological subtype and tumour volume are the main prognostic
factors of clinical importance in routine MPM management. Other potential
parameters should be recorded at baseline and reported in clinical trials.
Treatment: (chemo)therapy has limited efficacy in MPM patients and only
selected patients are candidates for radical surgery. New promising
targeted therapies, immunotherapies and strategies have been reviewed.
Because of limited data on the best combination treatment, we emphasize
that patients who are considered candidates for a multimodal approach,
including radical surgery, should be treated as part of clinical trials in
MPM-dedicated centres. Copyright © The article has been
co-published with permission in the European Journal of Cardio-Thoracic
Surgery and the European Respiratory Journal. All rights reserved in
respect of European Journal of Cardio-Thoracic Surgery, © European
Association for Cardio-Thoracic Surgery 2020 and European Respiratory
Journal, © European Respiratory Society 2020. The articles are
identical except for minor stylist

<93>
Accession Number
631867997
Title
Efficacy of Evolocumab on Cardiovascular Outcomes in Patients with Recent
Myocardial Infarction: A Prespecified Secondary Analysis from the FOURIER
Trial.
Source
JAMA Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Gencer B.; Mach F.; Murphy S.A.; De Ferrari G.M.; Huber K.; Lewis B.S.;
Ferreira J.; Kurtz C.E.; Wang H.; Honarpour N.; Keech A.C.; Sever P.S.;
Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Gencer, Murphy, Sabatine, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, Hale Building, 60 Fenwood Rd, Boston, MA 02115, United States
(Gencer, Mach) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(De Ferrari) Division of Cardiology Citta della Salute e della Scienza,
Department of Medical Sciences, University of Torino, Turin, Italy
(Huber) Department of Medicine, Cardiology and Intensive Care Medicine and
Sigmund Freud University, Medical School, Vienna, Austria
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ferreira) Hospital de Santa Cruz, Lisbon, Portugal
(Kurtz, Wang, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(Sabatine) JAMA Cardiology, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The 2018 American Heart Association/American College of
Cardiology Multisociety Guideline on the Management of Blood Cholesterol
identified patients with recent (past 12 months) myocardial infarction
(MI) as very high risk, in whom a PCSK9 inhibitor is reasonable to add to
maximally tolerated statin combined with ezetimibe if their low-density
lipoprotein cholesterol level is 70 mg/dL or greater or non-high-density
lipoprotein cholesterol level is 100 mg/dL or greater. Objective(s):
To examine the clinical efficacy of evolocumab in patients with recent MI.
 Design, Setting, and Participant(s): This was a prespecified
secondary analysis of the Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, in which
27 564 patients with atherosclerotic cardiovascular disease treated with a
statin were randomized to evolocumab vs placebo. Patients with prior MI
with a known date (n = 22320) were stratified as having a recent MI
(within 12 months of randomization) or a remote MI (more than 12 months
prior to randomization). Per protocol, patients with MI within 4 weeks
prior to randomization were excluded from the FOURIER trial. Data were
collected from February 2013 to November 2016, and data were analyzed from
May 2019 to February 2020. Main Outcomes and Measures: The primary
composite end point was cardiovascular death, MI, stroke, hospitalization
for unstable angina, or coronary revascularization. The key secondary
composite end point was cardiovascular death, MI, or stroke.
 Result(s): Of 22320 included patients, 17516 (78.5%) were male, and
the mean (SD) age was 62.2 (9.0) years. Compared with 16609 patients with
a remote MI, 5711 patients with a recent MI were younger and more likely
to be treated with high-intensity statin (77.3% [4415] vs 69.3% [11506]).
In the placebo arm, the 3-year Kaplan-Meier rate for the primary end point
was 17.2% in patients with recent MI compared with 14.4% in those with
remote MI (adjusted HR, 1.45; 95% CI, 1.29-1.64; P <.001). Similarly, the
3-year Kaplan-Meier rates for the key secondary end point was also higher
in those with recent MI (10.9% vs 9.5%; adjusted HR, 1.45; 95% CI,
1.24-1.69; P <.001). In patients with a recent MI, evolocumab reduced the
risk of the primary and key secondary end points by 19% (hazard ratio
[HR], 0.81; 95% CI, 0.70-0.93) and 25% (HR, 0.75; 95% CI, 0.62-0.91),
respectively. In patients with a remote MI, evolocumab reduced the risk of
the primary and key secondary end points by 8% (HR, 0.92; 95% CI,
0.84-1.01; P for interaction =.13) and 15% (HR, 0.85; 95% CI, 0.76-0.96; P
for interaction =.24), respectively. Given the higher event rates in
patients with a recent MI, the absolute risk reductions over 3 years with
evolocumab were 3.7% in those with recent MI vs 1.1% in those with remote
MI for the primary end point and 3.2% vs 1.3%, respectively, for the key
secondary end point. Conclusions and Relevance: Patients with a
recent MI were at higher risk of cardiovascular events and tended to
experience greater absolute risk reductions with evolocumab than those
with remote MIs. These findings support the concept in US and European
guidelines to aggressively lower low-density lipoprotein cholesterol
levels in very high-risk patients, such as those with a recent MI. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633. Copyright
© 2020 American Medical Association. All rights reserved.

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