EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 72

Results Generated From:
Embase <1980 to 2020 Week 24>
Embase (updates since 2020-06-05)

<1>
Accession Number
631999076
Title
Preoperative individualized education intervention reduces delirium after
cardiac surgery: A randomized controlled study.
Source
Journal of Thoracic Disease. 12 (5) (pp 2188-2196), 2020. Date of
Publication: 01 May 2020.
Author
Xue X.; Pei W.; Jingjing W.; Li X.; Peng F.; Zhinong W.
Institution
(Xue, Pei, Jingjing, Li, Zhinong) Center for Comprehensive Treatment of
Atrial Fibrillation, Department of Cardiothoracic Surgery, Second Military
Medical University, Shanghai 200003, China
(Jingjing, Li, Peng) Department of Nursing, Changzheng Hospital, Second
Military Medical University, Shanghai 200003, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Postoperative delirium dramatically increases the mortality
and morbidity of patients undergoing cardiac surgery. Preoperative
education has been proven to be effective in improving recovery and
reducing complications. However, there is rare evidence of individualized
education for the delirium. This study aimed to investigate the effect of
preoperative personalized education on postoperative delirium of patients
undergoing cardiac surgery. Method(s): A total of 133 adult patients
receiving cardiac surgery in a single center were enrolled in this study
and randomized into the experimental group (n=67) and the control group
(n=66), who were given the preoperative individualized education
intervention and routine care respectively. The primary endpoint of
delirium and other clinical outcomes were observed and compared.
 Result(s): All patients completed this trial without a significant
difference between the two groups in baseline characteristics. The
incidence of the delirium of the experimental group was significantly
lower than that of the control group (10.4% vs. 24.2%, P=0.038). There was
no statistical difference between two groups in hospital-stay and other
complications, while the mechanical ventilation time and ICU stay of the
experimental group was significantly lower (MV time: 13.7+/-7.6 vs.
18.6+/-9.8 h, P=0.002; ICU stay: 31.3+/-9.1 vs. 36.5+/-10.4 h, P=0.003).
 Conclusion(s): Preoperative individualized education intervention can
reduce the incidence of postoperative delirium and promote the recovery of
patients receiving cardiac surgery. Copyright © Journal of
Thoracic Disease. All rights reserved.

<2>
Accession Number
631998922
Title
Path to precision: Prevention of post-operative atrial fibrillation.
Source
Journal of Thoracic Disease. 12 (5) (pp 2735-2746), 2020. Date of
Publication: 01 May 2020.
Author
Skaria R.; Parvaneh S.; Zhou S.; Kim J.; Wanjiru S.; Devers G.; Konhilas
J.; Khalpey Z.
Institution
(Skaria, Kim, Wanjiru, Konhilas) University of Arizona, College of
Medicine, Tucson, AZ, United States
(Parvaneh, Zhou) Philips Research North America, Cambridge, MA, United
States
(Devers) Nihon Kohden America, Washington, DC, United States
(Khalpey) Northwest Allied Physicians, Tucson, AZ, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Development of post-operative atrial fibrillation (POAF) following
open-heart surgery is a significant clinical and economic burden. Despite
advancements in medical therapies, the incidence of POAF remains elevated
at 25-40%. Early work focused on detecting arrhythmias from
electrocardiograms as well as identifying pre-operative risk factors from
medical records. However, further progress has been stagnant, and a deeper
understanding of pathogenesis and significant influences is warranted.
With the advent of more complex machine learning (ML) algorithms and
high-throughput sequencing, we have an unprecedented ability to capture
and predict POAF in real-time. Integration of multimodal heterogeneous
data and application of ML can generate a paradigm shift for diagnosis and
treatment. This will require a concerted effort to consolidate and
streamline real-time data. Herein, we will review the current literature
and emerging opportunities aimed at predictive targets and new insights
into the mechanisms underlying long-term sequelae of POAF. Copyright
© Journal of Thoracic Disease. All rights reserved.

<3>
Accession Number
2006141430
Title
Evolution of Transcatheter Aortic Valve Replacement , Review of
Literature.
Source
Current Problems in Cardiology. (no pagination), 2020. Article Number:
100600. Date of Publication: 2020.
Author
Jiang T.; Hasan S.M.; Faluk M.; Patel J.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Aortic valve stenosis is the most common primary valvular heart disease
leading to either surgical or transcatheter valve replacement in the
United States with its prevalence on the rise due to the elderly
population. Over the recent years, the rise of transcatheter aortic valve
replacement has been exponential due to technologic developments and
randomized control trials. In this review article, we aim to review
current literature on transcatheter aortic valve
replacements. Copyright © 2020 Elsevier Inc.

<4>
Accession Number
2006130111
Title
Intraoperative transesophageal echocardiography in cardiovascular surgery.
Consensus document from the Spanish Society of Anesthesia and Critical
Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular
Surgery (SECCE).
Source
Cirugia Cardiovascular. (no pagination), 2020. Date of Publication: 2020.
Author
Carmona Garcia P.; Garcia Fuster R.; Mateo E.; Badia Gamarra S.; Lopez
Cantero M.; Gutierrez Carretero E.; Maestre M.L.; Legname V.; Fita G.;
Vives M.; Koller Bernhard T.; Sanchez Perez E.; Miralles Bagan J.;
Italiano S.; Darias-Delbey B.; Barrio J.M.; Hortal J.; Saez de Ibarra
J.I.; Hernandez A.
Institution
(Carmona Garcia) Servicio de Anestesiologia y Reanimacion, Hospital
Universitario la Fe, Valencia, Espana. Miembro del grupo de trabajo en
Ecografia de la Seccion de Cuidados Criticos de la SEDAR. Coordinadora del
grupo de trabajo en Ecocardiografia, transesofagica intraoperatoria de la
SEDAR
(Garcia Fuster) Servicio de Cirugia Cardiaca, Consorcio Hospital General
Universitario de Valencia, Espana. Coordinador del grupo de trabajo en
Ecocardiografia, transesofagica intraoperatoria de la SECCE
(Mateo) Servicio de Anestesiologia y Reanimacion, Consorcio Hospital
General Universitario de Valencia, Valencia, Spain
(Badia Gamarra) Servicio de Cirugia Cardiaca, Hospital Universitario Trias
y Pujol, Badalona, Spain
(Lopez Cantero) Servicio de Anestesiologia y Reanimacion, Hospital
Universitario la Fe, Valencia, Spain
(Gutierrez Carretero) Servicio de Cirugia Cardiaca, Hospital,
Universitario Virgen del Rocio, Sevilla, Spain
(Maestre) Seccion Cardiotoracica, Servicio de Anestesiologia y
Reanimacion, Hospital Sant Pau, Barcelona, Spain
(Legname) Servicio de Cirugia Cardiaca, Centro Medico Teknon, Barcelona,
Spain
(Fita) Seccion Cardiotoracica, Servicio de Anestesiologia y Reanimacion.
Hospital Clinic, Barcelona, Spain
(Vives) DESA. Seccion Cardiotoracica, Servicio de Anestesiologia y
Reanimacion, Hospital Universitario Dr Josep Trueta de Girona, Espana.
Miembro del grupo de trabajo en Ecografia de la Seccion de Cuidados
Criticos de la SEDAR
(Koller Bernhard, Italiano) Seccion Cardiotoracica, Servicio de
Anestesiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Sanchez Perez) EDAIC. Seccion de Cirugia Cardiaca, Servicio de Anestesia
y Reanimacion, Hospital General Universitario Gregorio Maranon, Madrid,
Espana. Miembro del grupo de trabajo en Ecografia de la Seccion de
Cuidados Criticos de la SEDAR
(Miralles Bagan) Seccion Cardiotoracica, Servicio Anestesiologia y
Reanimacion, Hospital Sant Pau, Barcelona, Spain
(Darias-Delbey) Servicio Anestesiologia y Reanimacion, Proceso del
Paciente, Cardioquirurgico, Complejo Hospitalario Universitario de
Canarias, Santa Cruz de Tenerife, Spain
(Barrio) Seccion Anestesia y Reanimacion Cardiovascular, Servicio de
Anestesia y Reanimacion, Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Hortal) Servicio de Anestesiologia y Reanimacion, Hospital General.
Universitario Gregorio Maranon, Madrid, Spain
(Saez de Ibarra) Servicio de Cirugia Cardiaca, Hospital Universitario Son
Espases, Palma de Mallorca, Spain
(Hernandez) Departamento de Anestesia y Cuidados Intensivos, Grupo
Policlinica, Ibiza, Espana. Miembro del grupo de trabajo en Ecografia de
la Seccion de Cuidados Criticos, de la SEDAR Representante del subcomite
de Educacion de EACTA, EDAIC, Codirector grupo EchoSim
Publisher
Elsevier Doyma
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows
an evaluation of cardiac morphology and function in real time and it is a
quality standard in cardiovascular surgery. It has become a fundamental
tool for both monitoring and diagnosis in the intraoperative period that
allows decide the correct surgical planning and pharmacological
management. The goal of this document is to answer the questions of when
and how the perioperative TEE should be performed in cardiovascular
surgery, what are their applications in the intraoperative, who should
perform it and how the information should be transmitted. The authors made
a systematic review of international guidelines, review articles and
clinical trials to answer by consensus to these questions. Copyright
© 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular

<5>
Accession Number
2005154667
Title
Will high-dose heparin affect blood loss and inflammatory response in
patients undergoing cardiopulmonary bypass?.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Braatz E.; Sesartic V.; Liska J.
Institution
(Braatz, Sesartic) Department of Perioperative Medicine Intensive Care,
Karolinska University Hospital, Stockholm, Sweden
(Liska) Department of Cardiothoracic Surgery, Karolinska University
Hospital, Stockholm, Sweden
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: We performed a randomized study to investigate if a high
versus a standard dose of heparin dose during cardiopulmonary bypass could
affect intra- and post-operative bleeding and reduce the inflammatory
response. Method(s): A total of 30 patients undergoing elective
coronary artery bypass grafting were randomized into high or standard dose
of heparin during cardiopulmonary bypass. Blood loss was documented peri-
and post-operatively, and interleukin-6, tumor necrosis factor-alpha, and
C3 were measured in conjunction with cardiopulmonary bypass.
 Result(s): Data from 29 patients were analyzed after exclusion of one
patient. The mean initial bolus and total heparin doses were 43,000 +/-
5,800 IU versus 35,000 +/- 4,100 IU, (p < 0.001), and 58,000 +/- 9,500 IU
versus 45,000 +/- 7,900 IU, (p < 0.001) in the intervention and the
control group, respectively. The median intra-operative bleeding was 150
mL (interquartile range 100-325) in the control versus 225 mL (IQR
200-350) in the intervention group, p = 0.15. The median chest tube blood
loss 12 hour post-operatively was 300 mL (interquartile range 250-385) in
the control versus 450 mL (IQR 315-505) in the intervention group, p =
0.029. There was no significant difference between the control group and
the intervention group during cardiopulmonary bypass for the measured
inflammatory markers interleukin-6 (p = 0.98), tumor necrosis factor-alpha
(p = 0.72), or C3 (p = 0.13). Conclusion(s): This small study showed
a small increase of post-operative bleeding associated with higher heparin
dosage in conjunction with cardiopulmonary bypass but did not demonstrate
an effect of heparin on the inflammatory response to cardiopulmonary
bypass. Copyright © The Author(s) 2020.

<6>
Accession Number
2005147427
Title
Prevention of intra-thoracic recurrent laryngeal nerve injury with
robot-assisted esophagectomy.
Source
Langenbeck's Archives of Surgery. (no pagination), 2020. Date of
Publication: 2020.
Author
Hosoda K.; Niihara M.; Ushiku H.; Harada H.; Sakuraya M.; Washio M.;
Yamashita K.; Hiki N.
Institution
(Hosoda, Niihara, Ushiku, Harada, Sakuraya, Washio, Yamashita, Hiki)
Department of Upper Gastrointestinal Surgery, Kitasato University School
of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa 252-0374,
Japan
(Yamashita) Division of Advanced Surgical Oncology, Research and
Development Center for New Medical Frontiers, Kitasato University School
of Medicine, Sagamihara, Japan
Publisher
Springer
Abstract
Purpose: Transthoracic esophagectomy for esophageal cancer is one of the
most invasive procedures in surgery for gastrointestinal cancer. Serious
complications sometimes occur after esophageal cancer surgery, including
recurrent laryngeal nerve injury and pneumonia. The purpose of this study
was to access the possibility of robot-assisted thoracoscopic
esophagectomy for esophageal cancer in terms of preventing recurrent
laryngeal nerve injury. Method(s): Operations in thoracic part were
performed in prone position with bilateral ventilation. During dissection
of the recurrent laryngeal nerve lymph nodes, thin blood vessels were
coagulated with Maryland bipolar forceps in the left hand and then
dissected with monopolar scissors in the right hand. Especially when
dissecting left recurrent laryngeal nerve lymph nodes, the nerve was left
unisolated from the vascular sheath that involves the aortic arch.
Short-term outcomes including operative time, estimated blood loss, and
postoperative complications including recurrent laryngeal nerve injury
were accessed. Result(s): From November 2018 to January 2020, 20
patients underwent robot-assisted thoracoscopic esophagectomy for
esophageal cancer. Thoracic operative time was 242 min, estimated blood
loss in the thoracic part was minimal, the number of dissected mediastinal
lymph nodes was 19 (all median), and the incidence rates of recurrent
laryngeal nerve injury and pneumonia were 10% (2 case) and 10% (2 cases),
respectively. Conclusion(s): Robot-assisted thoracoscopic
esophagectomy for esophageal cancer has the possibility of reducing
recurrent laryngeal nerve injury even in the introductory period.
Randomized controlled trials are required to confirm this advantage of the
robotic surgery. Copyright © 2020, Springer-Verlag GmbH Germany,
part of Springer Nature.

<7>
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

<8>
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

<9>
Accession Number
2005874574
Title
Machine perfusion of circulatory determined death hearts: A scoping
review.
Source
Transplantation Reviews. 34 (3) (no pagination), 2020. Article Number:
100551. Date of Publication: July 2020.
Author
Saemann L.; Guo Y.; Ding Q.; Zhou P.; Karck M.; Szabo G.; Wenzel F.
Institution
(Saemann, Guo, Ding, Zhou, Karck, Szabo) Department of Cardiac Surgery,
University Hospital Heidelberg, Im Neuenheimer Feld 326, Heidelberg 69120,
Germany
(Saemann, Wenzel) Faculty Medical and Life Sciences, Furtwangen
University, Jakob-Kienzle-Strase 17, Villingen-Schwenningen 78054, Germany
Publisher
W.B. Saunders
Abstract
Background: Ex vivo machine perfusion (EVMP) is reported to can
successfully be applied for donor heart preservation. To respond to the
organ shortage, some centres also accept hearts from marginal donors such
as non-heart beating donors (NHBD) or hearts donated after cardiac death
(DCD) for heart transplantation (HTx). Clinical as well as preclinical
science on EVMP of DCD hearts seems to be promising but the ideal
perfusion practice itself appears unclear. Objective(s): In
accordance with the Preferred Reporting Items for Systematic reviews and
Meta-Analyses extension for Scoping Reviews (PRISMA), this systematic
review scopes all EVMP techniques for human and animal DCD heart
preservation and addresses three specific questions, which refer to (a)
the perfusion solutions, (b) the perfusion parameters and respective
target values and (c) if possible, a direct comparison between cold static
storage (CSS) and EVMP. Result(s): Search results predominantly
consisted of animal studies. Either perfusion with a crystalloid or
blood-based solution, each with cardioplegic or non-cardioplegic
properties was used. Some perfusates were supplemented with specific
pharmacological medication to block pathophysiological pathways, which are
involved in ischemia/reperfusion injury or edema formation. Besides
normothermic EVMP with oxygenated blood, a wide range of temperature was
applied in all approaches, with the lowest temperature at 4 degreeC.
Pressure controlled anterograde Langendorff perfusion was applied mostly.
If investigated, crystalloid machine perfusion was presented superior to
CSS. Conclusion(s): Only blood based EVMP was introduced into
clinical practice. More research, clinical as well as preclinical, is
needed to develop the ideal EVMP technique, in terms of blood or
crystalloid perfusion. Copyright © 2020 Elsevier Inc.

<10>
[Use Link to view the full text]
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:
September 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.

<11>
Accession Number
2004937022
Title
Mitraclip Plus Medical Therapy Versus Medical Therapy Alone for Functional
Mitral Regurgitation: A Meta-Analysis.
Source
Cardiology and Therapy. 9 (1) (pp 5-17), 2020. Date of Publication: 01 Jun
2020.
Author
Goel S.; Pasam R.T.; Wats K.; Chava S.; Gotesman J.; Sharma A.; Malik
B.A.; Ayzenberg S.; Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Gidwani) Department of Cardiology, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Pasam, Wats, Chava, Gotesman, Malik, Ayzenberg, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, New York,
NY, United States
(Sharma) Division of Cardiology, Gundersen Health System, La Crosse, WI,
United States
(Sharma) Institute of Cardiovascular Science and Technology, New York, NY,
United States
Publisher
Adis
Abstract
Introduction: The purpose of this meta-analysis is to compare the efficacy
of MitraClip plus medical therapy versus medical therapy alone in patients
with functional mitral regurgitation (FMR). FMR caused by left ventricular
dysfunction is associated with poor prognosis. Whether MitraClip improves
clinical outcomes in this patient population remains controversial.
 Method(s): We conducted an electronic database search of PubMed,
CINAHL, Cochrane Central, Scopus, Google Scholar, and Web of Science
databases for randomized control trials (RCTs) and observational studies
with propensity score matching (PSM) that compared MitraClip plus medical
therapy with medical therapy alone for patients with FMR and reported on
subsequent mortality, heart failure re-hospitalization, and other outcomes
of interest. Event rates were compared using a random-effects model with
odds ratio as the effect size. Result(s): Five studies (n = 1513;
MitraClip = 796, medical therapy = 717) were included in the final
analysis. MitraClip plus medical therapy compared to medical therapy alone
was associated with a significant reduction in overall mortality (OR =
0.66, 95% CI = 0.44-0.99, P = 0.04) and heart failure (HF)
re-hospitalization rates (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (OR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (OR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the MitraClip
group. No effect was observed on cardiac mortality (P = 0.42) between the
two groups. Conclusion(s): MitraClip plus medical therapy improves
overall mortality and reduces HF re-hospitalization rates compared to
medical therapy alone in patients with FMR. Copyright © 2019, The
Author(s).

<12>
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

<13>
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.

<14>
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

<15>
Accession Number
2005154469
Title
Synchronous versus staged carotid artery stenting and coronary artery
bypass graft for patients with concomitant severe coronary and carotid
artery stenosis: A systematic review and meta-analysis.
Source
Vascular. (no pagination), 2020. Date of Publication: 2020.
Author
Tzoumas A.; Giannopoulos S.; Charisis N.; Texakalidis P.; Kokkinidis D.G.;
Zisis S.N.; Machinis T.; Koullias G.J.
Institution
(Tzoumas) Fourth Department of Surgery, Medical School, Aristotle
University, Thessaloniki, Greece
(Giannopoulos) Division of Cardiology, Rocky Mountain Regional VA Medical
Center, Aurora, CO, United States
(Charisis) Department of Surgery, Stonybrook University, Stonybrook, NY,
United States
(Texakalidis) Department of Neurosurgery, Emory University, Atlanta, GA,
United States
(Kokkinidis) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, New York, NY, United States
(Zisis) Fourth Department of Surgery, National and Kapodistrian University
of Athens, Attikon University Hospital, Athens, Greece
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Coronary artery disease requiring coronary artery bypass graft
(CABG) frequently coexists with critical carotid stenosis. The most
optimized strategy for treating concomitant carotid and coronary artery
disease remains debatable. Objective(s): The aim of this
meta-analysis was to compare synchronous CAS and CABG versus staged CAS
and CABG for patients with concomitant coronary artery disease and carotid
artery stenosis in terms of peri-operative (30-day) and long-term clinical
outcomes. Method(s): This study was performed according to the PRISMA
guidelines. Eligible studies were identified through a search of PubMed,
Scopus and Cochrane database until December 2019. A meta-analysis was
conducted with the use of a random effects model. The I-square statistic
was used to assess heterogeneity. Result(s): Four studies comprising
357 patients were included in this meta-analysis. Patients who were
treated with the synchronous approach had a statistically significant
higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00-13.69;
I2 = 0%) compared tomicron the staged group. Peri-operative
mortality (OR: 4.50; 95% CI: 0.88-23.01; I2 = 0%), myocardial
infarction (MI) (OR: 1.54; 95% CI: 0.18- 13.09; I2 = 0%),
postoperative bleeding (OR: 0.27;95% CI: 0.02-3.12; I2 = 0%),
transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04- 9.20;
I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI:
0.03-4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27;
95% CI: 0.02-3.12; I2 = 0.0%) were similar between the two
groups. Synchronous CAS-CABG and staged CAS followed by CABG were
associated with similar rates of late mortality (OR: 3.75; 95% CI:
0.50-27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01-12.03;
I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84-15.20;
I2 = 0.0%) after a mean follow-up of 47 months.
 Conclusion(s): The simultaneous approach was associated with an
increased risk of 30-day stroke compared to staged CAS and CABG. However,
no statistically significant difference was found in long-term results of
mortality, MI and stroke between the two approaches. Future studies are
warranted to validate our results. Copyright © The Author(s)
2020.

<16>
Accession Number
2004750697
Title
Meta-analysis of randomised trials compares mortality after transcatheter
versus surgical aortic valve replacement.
Source
Netherlands Heart Journal. 28 (6) (pp 309-311), 2020. Date of Publication:
01 Jun 2020.
Author
Vendrik J.; BaanJr J.
Institution
(Vendrik, Baan Jr) Heart Centre, Amsterdam University Medical Centres
(location AMC), Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)

<17>
Accession Number
2005953128
Title
Comparison of surgical versus transcatheter aortic valve replacement for
patients with aortic stenosis at low-intermediate risk.
Source
Cardiovascular Diagnosis and Therapy. 10 (2) (pp 135-144), 2020. Date of
Publication: 01 Apr 2020.
Author
Khan M.R.; Kayani W.T.; Manan M.; Munir A.; Hamzeh I.; Virani S.S.;
Birnbaum Y.; Jneid H.; Alam M.
Institution
(Khan, Munir) Division of Cardiology, McLaren-Flint/Michigan State
University, Flint, MI, United States
(Kayani, Hamzeh, Virani, Birnbaum, Jneid, Alam) Section of Cardiology,
Department of Internal Medicine, Baylor College of Medicine, Houston, TX,
United States
(Manan) King Edward Medical University, Lahore, Pakistan
(Virani, Jneid) Section of Cardiology, Michael E. DeBakey Veterans Affairs
Medical Center, Houston, TX, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: To compare safety and efficacy of transcatheter aortic valve
replacement (TAVR) with surgical aortic valve replacement (SAVR) in
patients at low-intermediate risk, given the paucity of robust data.
 Method(s): We performed an aggregate data meta-analysis of 7
randomized controlled trials (RCTs) and 6,778 patients comparing TAVR with
SAVR for aortic stenosis (AS) in low-intermediate risk patients (Society
of Thoracic Surgeons risk-score <=8%) using the random-effects model.
Primary outcome was all-cause mortality at 30-day, 1-year and 2-year of
follow-up. Secondary outcomes included cardiac-mortality, stroke, acute
kidney injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM)
implantation, major-bleeding, moderate-severe paravalvular regurgitation
(PVR) and rehospitalization. Result(s): All-cause mortality,
cardiac-mortality and stroke were comparable between the two groups. AF
was higher with SAVR at 30-day [odds ratio (OR) 0.17, 95% confidence
intervals (CI): 0.12-0.24] thorough to 2-year (OR 0.34, 95% CI:
0.21-0.55), while PPM implantation was higher with TAVR (30-day: OR 3.31,
95% CI: 1.64-6.66, 2-year: OR 3.17, 95% CI: 1.02-9.86). Moderate-severe
PVR was more prevalent with TAVR at all follow-ups. On inter-group
comparison, patients in the low-risk group had an even lower risk of AF,
but a higher risk of PPM implantation as compared to the patients in the
intermediate-risk group undergoing TAVR. Conclusion(s): Compared to
SAVR, TAVR had comparable all-cause mortality and stroke, lower-risk of
AF, but was associated with a higher risk of PPM implantation and
moderate-severe PVR in low-intermediate-risk patients. Thus, highlighting
the need for longer-term follow-up before robust inferences are
drawn. Copyright © Cardiovascular Diagnosis and Therapy. All
rights reserved.

<18>
Accession Number
631987033
Title
Effects of non-invasive ventilation in subjects undergoing cardiac surgery
on length of hospital stay and cardiac-pulmonary complications: A
systematic review and meta-analysis.
Source
Journal of Thoracic Disease. 12 (4) (pp 1507-1519), 2020. Date of
Publication: 01 Apr 2020.
Author
Wu Q.; Xiang G.; Song J.; Xie L.; Hao S.; Wu X.; Liu Z.; Li S.
Institution
(Wu, Xiang, Song, Xie, Wu, Hao, Wu, Liu, Li) Department of Pulmonary
Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai
200032, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Cardiac surgery often leads to pulmonary complications.
Non-invasive ventilation (NIV) is a mechanical ventilation modality that
may help to prevent the pulmonary complications, and the role of the
prophylactic use of NIV in patients after cardiac surgery remains
controversial. Method(s): We searched PubMed, Embase, Web of Science
and Cochrane Central for randomized controlled trials comparing the use of
NIV (continues positive airway pressure or bi-level positive airway
pressure) with standard treatment in post-cardiac surgery subjects without
language restriction. Two investigators screened the eligible studies up
to July, 2019. Meta-analysis using random effect model or fixed effect
model was conducted for pulmonary complications, mortality, rate of
reintubation and cardiac complications, and mean difference (MD) or
standard mean difference for length of hospital stay and length of ICU
stay. Result(s): We included nine randomized controlled trails with
830 subjects. The use of NIV failed to reduce the risk of pulmonary
complications, including atelectasis [risk rate (RR) 0.60; 95% confidence
interval (CI): 0.28 to 1.28, P=0.19] and pneumonia (RR 0.27; 95% CI: 0.05
to 1.64, P=0.16). However, it has shortened the length of ICU stay (MD
-1.00 h, 95% CI: -1.38 to -0.63, P<0.00001) and the length of hospital
stay (MD -1.00 d, 95% CI: -1.12 to -0.87, P<0.00001). NIV also failed to
reduce the rate of reintubation (RR 0.68; 95% CI: 0.21 to 2.26, P=0.53) or
the risk of cardiac complications (RR 0.81; 95% CI: 0.59 to 1.13, P=0.22).
 Conclusion(s): The prophylactic use of NIV immediately in
post-cardiac subjects who underwent cardiac surgery might be able to
shorten the length of hospital stay and the length of ICU stay, but it has
no significant effect on pulmonary complications, rate of reintubation or
cardiac complications. Copyright © 2020 Journal of Thoracic
Disease.

<19>
Accession Number
631987012
Title
Improving outcomes of percutaneous coronary interventions in patients with
stable ischemic heart disease.
Source
Journal of Thoracic Disease. 12 (4) (pp 1740-1749), 2020. Date of
Publication: 01 Apr 2020.
Author
Patel D.B.; Shah R.; Jovin I.S.
Institution
(Patel, Shah, Jovin) Department of Medicine, McGuire Veterans' Affairs
Medical Center, Virginia Commonwealth University, Richmond, VA, United
States
(Shah) Heart Health Center, North Alabama Medical Center, Florence, AL,
United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Percutaneous coronary intervention (PCI) is a common cardiac procedure and
there have been significant advances in the technologies over past decades
that have improved the safety of these procedures. Various clinical trials
and meta-analyses have shown that PCIs are associated with improved
outcomes, especially among patients with acute coronary syndromes.
However, the clinical benefit of PCIs among patients with stable ischemic
heart disease (SIHD) other than improvement in anginal symptoms is less
well established. The patients who have a significant burden of ischemia
may benefit the most from revascularization. The achievement of complete
revascularization, appropriate technique for stent deployment and
intracoronary imaging during these procedures also can have a significant
impact on the clinical outcomes. Moreover, patients with coronary artery
disease should be managed with appropriate medical therapy after the PCIs.
The procedural and non-procedural factors should be taken into
consideration in order to optimize outcomes for patients with SIHD being
treated with PCIs. Copyright © 2020 Journal of Thoracic Disease.

<20>
Accession Number
631940689
Title
Safety and efficacy of direct Cardiac Shockwave Therapy in patients with
ischemic cardiomyopathy undergoing coronary artery bypass grafting (the
CAST-HF trial): Study protocol for a randomized controlled trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 447. Date of
Publication: 30 May 2020.
Author
Polzl L.; Nagele F.; Graber M.; Hirsch J.; Lobenwein D.; Mitrovic M.; Mayr
A.; Theurl M.; Schreinlechner M.; Pamminger M.; Dorfmuller C.; Grimm M.;
Gollmann-Tepekoylu C.; Holfeld J.
Institution
(Polzl, Nagele, Graber, Hirsch, Lobenwein, Grimm, Gollmann-Tepekoylu,
Holfeld) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Innsbruck, Austria
(Mitrovic) Clinical Trial Center, Medical University of Innsbruck, Innrain
52, Innsbruck 6020, Austria
(Mayr, Pamminger) University Clinic of Radiology, Medical University of
Innsbruck, Innsbruck, Austria
(Theurl, Schreinlechner) University Clinic of Internal Medicine III,
Medical University of Innsbruck, Innsbruck, Austria
(Dorfmuller) Heart Regeneration Technologies GmbH, Innsbruck, Austria
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary artery diseases (CAD) remains a severe socio-economic
burden in the Western world. Coronary obstruction and subsequent
myocardial ischemia result in progressive replacement of contractile
myocardium with dysfunctional, fibrotic scar tissue. Post-infarctional
remodeling is causal for the concomitant decline of left-ventricular
function and the fatal syndrome of heart failure. Available neurohumoral
treatment strategies aim at the improvement of symptoms. Despite extensive
research, therapeutic options for myocardial regeneration, including
(stem)-cell therapy, gene therapy, cellular reprogramming or tissue
engineering, remain purely experimental. Thus, there is an urgent clinical
need for novel treatment options for inducing myocardial regeneration and
improving left-ventricular function in ischemic cardiomyopathy. Shockwave
Therapy (SWT) is a well-established regenerative tool that is effective
for the treatment of chronic tendonitis, long-bone non-union and
wound-healing disorders. In preclinical trials, SWT regenerated ischemic
myocardium via the induction of angiogenesis and the reduction of fibrotic
scar tissue, resulting in improved left-ventricular function.
Methods/design: In this prospective, randomized controlled, single-blind,
monocentric study, 80 patients with reduced left-ventricular ejection
fraction (LVEF<= 40%) are subjected to coronary-artery bypass-graft
surgery (CABG) surgery and randomized in a 1:1 ratio to receive additional
cardiac SWT (intervention group; 40 patients) or CABG surgery with sham
treatment (control group; 40 patients). This study aims to evaluate (1)
the safety and (2) the efficacy of cardiac SWT as adjunctive treatment
during CABG surgery for the regeneration of ischemic myocardium. The
primary endpoints of the study represent (1) major cardiac events and (2)
changes in left-ventricular function 12 months after treatment. Secondary
endpoints include 6-min Walk Test distance, improvement of symptoms and
assessment of quality of life. Discussion(s): This study aims to
investigate the safety and efficacy of cardiac SWT during CABG surgery for
myocardial regeneration. The induction of angiogenesis, decrease of
fibrotic scar tissue formation and, thus, improvement of left-ventricular
function could lead to improved quality of life and prognosis for patients
with ischemic heart failure. Thus, it could become the first clinically
available treatment strategy for the regeneration of ischemic myocardium
alleviating the socio-economic burden of heart failure. Trial
registration: ClinicalTrials.gov, ID: NCT03859466. Registered on 1 March
2019. Copyright © 2020 The Author(s).

<21>
Accession Number
2006130020
Title
The efficacy of early postoperative enteral immunonutrition on
T-lymphocyte count: A randomised control study in low-risk cardiac surgery
patients.
Source
Clinical Nutrition. (no pagination), 2020. Date of Publication: 2020.
Author
Svetikiene M.; Ringaitiene D.; Vezeliene J.; Isajevas V.; Trybe D.; Vicka
V.; Malickaite R.; Jurgauskiene L.; Norkuniene J.; Serpytis M.; Sipylaite
J.
Institution
(Svetikiene, Ringaitiene, Isajevas, Serpytis, Sipylaite) Department of
Anaesthesiology and Intensive Care, Institute of Clinical Medicine,
Faculty of Medicine, Vilnius University, Lithuania
(Svetikiene, Ringaitiene, Vezeliene, Isajevas, Vicka, Serpytis, Sipylaite)
Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
(Trybe, Vicka) Faculty of Medicine, Vilnius University, Vilnius, Lithuania
(Malickaite, Jurgauskiene) Clinic of Cardiac and Vascular Diseases,
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University,
Vilnius, Lithuania
(Norkuniene) Department of Mathematical Statistics, Faculty of Fundamental
Sciences, Vilnius Gediminas Technical University, Vilnius, Lithuania
Publisher
Churchill Livingstone
Abstract
Background: Patients undergoing cardiac surgery have a pronounced immune
response that leads to a reduction in cellular immunity. Immune-modulating
nutritional supplements are considered to be beneficial for patients
undergoing major surgery. However, due to the lack of studies in the
cardiac surgery population, the effect of immunonutrition remains unclear
in this patient group. Objective(s): Our purpose was to research the
efficacy of early postoperative enteral immunonutrition on T-lymphocyte
count in the cardiac surgery population. Method(s): This was a
randomised control study of low operative risk adult patients, who
underwent elective cardiac surgery. These patients were randomised into
immunonutrition and control groups. The immunonutrition group was
supplemented with immune nutrients for five postoperative days. The counts
of T-lymphocytes, as well as the counts for the CD4+ and CD8+ cell
subpopulations were determined on the day of surgery and on the sixth
postoperative day. Result(s): Fifty-five patients were enrolled in
the study, the mean age was 69.7 +/- 6.3 years, 28 (50.9%) of them were
males, the median operative risk was 1.75%. Twenty-seven (49.1%) were
randomised into the immunonutrition group. The control and the
immunonutrition groups were similar before the intervention. The counts of
the CD3+ T cells and CD4+ T cells on the sixth postoperative day were
significantly higher in the immunonutrition group compared to the control
group with 1.42 +/- 0.49 vs. 1.12 +/- 0.56 (*109/l), p = 0.035
and 1.02 +/- 0.36 vs. 0.80 +/- 0.43 (*109/l), p = 0.048,
respectively. Regression analysis was performed to determine the efficacy
of the immunonutrition on the counts of the CD3+ and CD4+ T cells; CD3+ T
and CD4+ T cell counts were increased to 0.264 (*109/l), p =
0.039 and 0.232 (*109/l), p = 0.021, respectively.
 Conclusion(s): Early postoperative immunonutrition increases the
count of the CD3+ and CD4+ T cells in cardiac surgical patients. Clinical
trials identifier number: NCT04047095 Copyright © 2020 Elsevier
Ltd and European Society for Clinical Nutrition and Metabolism

<22>
Accession Number
631990957
Title
Long-term and Temporal Outcomes of Transcatheter Versus Surgical
Aortic-valve Replacement in Severe Aortic Stenosis: A Meta-analysis.
Source
Annals of surgery. (no pagination), 2020. Date of Publication: 03 Jun
2020.
Author
Zhang X.-L.; Zhang X.-W.; Lan R.-F.; Chen Z.; Wang L.; Xu W.; Xu B.
Institution
(Zhang, Lan, Chen, Wang, Xu, Xu) Department of Cardiology, Affiliated Drum
Tower Hospital, Nanjing University School of Medicine, Nanjing, China
(Zhang) Department of Endocrinology, Affiliated Drum Tower Hospital,
Nanjing University School of Medicine, Nanjing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the 5-year and temporal performance of TAVR versus
SAVR. BACKGROUND: TAVR has become a valuable treatment for severe aortic
stenosis but the long-term safety and efficacy remain unclear.
 METHOD(S): Databases were searched until October 6, 2019 for
randomized trials with >=5 years' follow-up. Primary outcome was all-cause
mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were
pooled with random-effects models. RESULT(S): We included 4 trials
with 3,758 patients. TAVR was associated with a significantly higher
5-year all-cause mortality than SAVR (OR, 1.19; 95% CI, 1.03-1.37; P =
0.02). Landmark analysis showed no significant difference within 2 years
(OR, 0.92; 95% CI, 0.79-1.08; P = 0.33) but a statistically higher
mortality in TAVR between 2 and 5 years (OR, 1.32; 95% CI, 1.14-1.52; P =
0.0002), with significant difference between these 2 temporal phases (P
for interaction = 0.001). Similar interaction was found for cardiovascular
mortality and several other outcomes. Rates of all-cause mortality or
disabling stroke, permanent pacemaker implantation, aortic-valve
rehospitalization, and reintervention were higher, but rates of major
bleeding and new-onset fibrillation were lower in TAVR at 5 years. The
incidences of myocardial infarction, stroke, and transient ischemic attack
were not statistically different between TAVR and SAVR.
 CONCLUSION(S): TAVR was associated with a significantly higher
all-cause mortality at 5 years compared with SAVR. Of note, all-cause
mortality presented a characteristic temporal pattern showing increased
risk between 2 and 5 years but not within 2 years. Longer-term follow-up
data are warranted.

<23>
Accession Number
631985451
Title
Mechanical assist devices for acute cardiogenic shock.
Source
The Cochrane database of systematic reviews. 6 (pp CD013002), 2020. Date
of Publication: 04 Jun 2020.
Author
Ni hIci T.; Boardman H.M.; Baig K.; Stafford J.L.; Cernei C.; Bodger O.;
Westaby S.
Institution
(Ni hIci) Cardiothoracic Surgery, Morriston Hospital, Swansea, United
Kingdom
(Boardman) Radcliffe Department of Medicine, John Radcliffe Hospital,
Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Baig) Department of Cardiac Surgery, Guy's and St Thomas' NHS Foundation
Trust, London, United Kingdom
(Stafford) Perfusion/Cardiothoracic Surgery, University Hospital of Wales,
Cardiff, United Kingdom
(Cernei, Bodger) Swansea University Medical School, Swansea University,
Swansea, United Kingdom
(Westaby) Cardiothoracic Surgery, John Radcliffe Hospital, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiogenic shock (CS) is a state of critical end-organ
hypoperfusion due to a primary cardiac disorder. For people with
refractory CS despite maximal vasopressors, inotropic support and
intra-aortic balloon pump, mortality approaches 100%. Mechanical assist
devices provide mechanical circulatory support (MCS) which has the ability
to maintain vital organ perfusion, to unload the failing ventricle thus
reduce intracardiac filling pressures which reduces pulmonary congestion,
myocardial wall stress and myocardial oxygen consumption. This has been
hypothesised to allow time for myocardial recovery (bridge to recovery) or
allow time to come to a decision as to whether the person is a candidate
for a longer-term ventricular assist device (VAD) either as a bridge to
heart transplantation or as a destination therapy with a long-term VAD.
 OBJECTIVE(S): To assess whether mechanical assist devices improve
survival in people with acute cardiogenic shock. SEARCH METHOD(S): We
searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and Web of Science Core
Collection in November 2019. In addition, we searched three trials
registers in August 2019. We scanned reference lists and contacted experts
in the field to obtain further information. There were no language
restrictions. SELECTION CRITERIA: Randomised controlled trials on people
with acute CS comparing mechanical assist devices with best current
intensive care management, including intra-aortic balloon pump and
inotropic support. DATA COLLECTION AND ANALYSIS: We performed data
collection and analysis according to the published protocol. Primary
outcomes were survival to discharge, 30 days, 1 year and secondary
outcomes included, quality of life, major adverse cardiovascular events
(30 days/end of follow-up), dialysis-dependent (30 days/end of follow-up),
length of hospital stay and length of intensive care unit stay and major
adverse events. We used the five GRADE considerations (study limitations,
consistency of effect, imprecision, indirectness, and publication bias) to
assess the quality of a body of evidence as it relates to the studies
which contribute data to the meta-analyses for the prespecified outcomes
Summary statistics for the primary endpoints were risk ratios (RR), hazard
ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs).
MAIN RESULTS: The search identified five studies from 4534 original
citations reviewed. Two studies included acute CS of all causes randomised
to treatment using TandemHeart percutaneous VAD and three studies included
people with CS secondary to acute myocardial infarction who were
randomised to Impella CP or best medical management. Meta-analysis was
performed only to assess the 30-day survival as there were insufficient
data to perform any further meta-analyses. The results from the five
studies with 162 participants showed mechanical assist devices may have
little or no effect on 30-day survival (RR of 1.01 95% CI 0.76 to 1.35)
but the evidence is very uncertain. Complications such as sepsis,
thromboembolic phenomena, bleeding and major adverse cardiovascular events
were not infrequent in both the MAD and control group across the studies,
but these could not be pooled due to inconsistencies in adverse event
definitions and reporting. We identified four randomised control trials
assessing mechanical assist devices in acute CS that are currently
ongoing. AUTHORS' CONCLUSION(S): There is no evidence from this
review of a benefit from MCS in improving survival for people with acute
CS. Further use of the technology, risk stratification and optimising the
use protocols have been highlighted as potential reasons for lack of
benefit and are being addressed in the current ongoing clinical
trials. Copyright © 2020 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<24>
Accession Number
2004659832
Title
Could fluorescence-guided surgery be an efficient and sustainable option?
A SICE (Italian Society of Endoscopic Surgery) health technology
assessment summary.
Source
Surgical Endoscopy. 34 (7) (pp 3270-3284), 2020. Date of Publication: 01
Jul 2020.
Author
Vettoretto N.; Foglia E.; Ferrario L.; Gerardi C.; Molteni B.; Nocco U.;
Lettieri E.; Molfino S.; Baiocchi G.L.; Elmore U.; Rosati R.; Curro G.;
Cassinotti E.; Boni L.; Cirocchi R.; Marano A.; Petz W.L.; Arezzo A.;
Bonino M.A.; Davini F.; Biondi A.; Anania G.; Agresta F.; Silecchia G.
Institution
(Vettoretto) Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale
Degli Spedali Civili, V.le Ciotti 154, Montichiari, Brescia 25018, Italy
(Foglia, Ferrario) LIUC - Universita Cattaneo, Castellanza, VA, Italy
(Gerardi) Centro di Politiche Regolatorie, Istituto di Ricerche
Farmacologiche "Mario Negri" IRCCS, Milan, Italy
(Molteni, Molfino, Baiocchi) Department of Clinical and Experimental
Surgery, University of Brescia, Brescia, Italy
(Nocco) Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette
Laghi, Varese, Italy
(Lettieri) School of Management, Department of Management, Economics and
Industrial Engineering, Politecnico, Milano, Italy
(Elmore, Rosati) Department of Gastrointestinal Surgery, IRCCS San
Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan,
Italy
(Curro) Department of Human Pathology of Adult and Evolutive Age,
University Hospital of Messina, Messina, Italy
(Cassinotti, Boni) Chirurgia Generale, Fondazione IRCCS - Ca' Granda -
Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
(Cirocchi) Department of Surgical Sciences, University of Perugia,
Perugia, Italy
(Marano) Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e
Carle, Cuneo, Italy
(Petz) Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy
(Arezzo, Bonino) Department of Surgical Sciences, University of Torino,
Turin, Italy
(Davini) Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica
mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa,
Italy
(Biondi) Chirurgia Generale, Fondazione Policlinico Universitario A.
Gemelli IRCSS, Rome, Italy
(Anania) Chirurgia Generale, University of Ferrara, Ferrara, Italy
(Agresta) Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of
Adria, Adria, RO, Italy
(Silecchia) Department of Medical-Surgical Sciences and Biotechnologies,
Sapienza University of Rome-Polo Pontino, Rome, Italy
Publisher
Springer
Abstract
Background: Indocyanine green fluorescence vision is an upcoming
technology in surgery. It can be used in three ways: angiographic and
biliary tree visualization and lymphatic spreading studies. The present
paper shows the most outstanding results from an health technology
assessment study design, conducted on fluorescence-guided compared with
standard vision surgery. Method(s): A health technology assessment
approach was implemented to investigate the economic, social, ethical, and
organizational implications related to the adoption of the innovative
fluorescence-guided view, with a focus on minimally invasive approach.
With the support of a multidisciplinary team, qualitative and quantitative
data were collected, by means of literature evidence, validated
questionnaires and self-reported interviews, considering the dimensions
resulting from the EUnetHTA Core Model. Result(s): From a systematic
search of literature, we retrieved the following studies: 6 on hepatic, 1
on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on
thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric
surgery. Fluorescence guide has shown advantages on the length of
hospitalization particularly in colorectal surgery, with a reduction of
the rate of leakages and re-do anastomoses, in spite of a slight increase
in operating time, and is confirmed to be a safe, efficacious, and
sustainable vision technology. Clinical applications are still presenting
a low evidence in the literature. Conclusion(s): The present paper,
under the patronage of Italian Society of Endoscopic Surgery, based on an
HTA approach, sustains the use of fluorescence-guided vision in minimally
invasive surgery, in the fields of general, gynecologic, urologic, and
thoracic surgery, as an efficient and economically sustainable
technology. Copyright © 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<25>
Accession Number
2004562105
Title
Pharmacokinetics of an intravenous bolus dose of clonidine in children
undergoing surgery.
Source
Paediatric Anaesthesia. 30 (5) (pp 607-613), 2020. Date of Publication: 01
May 2020.
Author
Nielsen B.N.; Anderson B.J.; Falcon L.; Henneberg S.W.; Lauritsen T.;
Lomstein E.; Ydemann M.; Afshari A.
Institution
(Nielsen, Falcon, Henneberg, Lauritsen, Afshari) Department of
Anaesthesia, The Juliane Marie Centre, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Anderson) Department of Anaesthesiology, University of Auckland,
Auckland, New Zealand
(Lomstein) Center for Laboratory, Food and Environmental Technology, The
Business Academy Aarhus, Aarhus, Denmark
(Ydemann) Department of Neuroanaethestesiology, Copenhagen University
Hospital, Copenhagen, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Background: Clonidine is used off-label in children but only limited
pediatric pharmacokinetic data are available for intravenously
administered clonidine. Objective(s): To determine pharmacokinetic
parameter estimates of clonidine in healthy children undergoing surgery
and to investigate age-related differences. Furthermore, to investigate
possible pharmacokinetic differences of clonidine between this group of
children and a cohort with cardiac diseases. Method(s): In a
randomized placebo-controlled trial (The PREVENT AGITATION trial), blood
samples for clonidine pharmacokinetic analysis were collected in a
proportion of the enrolled patients. Healthy children with ASA score 1-2
in the age-groups 1 to <2 years and 2-5 years were randomized for blood
sampling. Clonidine was administered as a single intravenous bolus of 3
micro g/kg intraoperatively. Blood samples were drawn at baseline, 5,
10, 15, 30, 60 minutes after dosing and additionally every hour until
discharge from the PACU. Clonidine analysis was performed on liquid
chromatography-mass spectrometry. Result(s): Data form eighteen
children were available for pharmacokinetic analysis (ASA I; male/female:
17/1; age: 1-5 years; weight 8.7-24 kg). Population parameter estimates
for the 2-compartment model were similar to previous published data for
children who underwent cardiac surgery. A pooled analysis including data
from 59 children indicated clearance of 14.4 L h-1 70
kg-1 and volume of distribution of 192.6 L 70 kg-1.
No age-related pharmacokinetic differences and no difference in time from
administration of study medication to awakening were found. Children 1 to
<2 years had a shorter PACU stay than children 2-5 years (mean difference
17% 95% CI:3%-34%, P =.02). Conclusion(s): Pharmacokinetic parameter
estimates were similar for children undergoing general surgery and cardiac
surgery given a single dose of intravenous clonidine. These results
indicated that no dose reduction is needed in children aged 1 to <2 years
compared with those 2-5 years, which was supported by pharmacodynamic
observations. Copyright © 2020 John Wiley & Sons Ltd

<26>
Accession Number
2004112484
Title
Adjusted tight control blood glucose management in diabetic patients
undergoing on pump coronary artery bypass graft. A randomized clinical
trial.
Source
Journal of Diabetes and Metabolic Disorders. 19 (1) (pp 423-430), 2020.
Date of Publication: 01 Jun 2020.
Author
Javaherforoosh zadeh F.; Azemati S.
Institution
(Javaherforoosh zadeh) Department of Anesthesia, Ahvaz Anesthesiology and
Pain Research Center, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran, Islamic Republic of
(Azemati) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Springer
Abstract
Background: Many of the patients who are undergoing Coronary Artery Bypass
Graft have diabetes mellitus or metabolic syndrome and are at risk for
hyperglycemia events. Objective(s): The present study aimed to
compare conventional glucose control with adjusted tight control in
patients undergoing on-pump CABG. Method(s): This double -blind
randomized clinical trial study was conducted in Shiraz, Iran, from
September 2017-March 2018. Two consecutive groups of 75 patients
undergoing elective on- pump coronary artery bypass graft surgery.
 Intervention(s): The patients were divided into adjusted tight
control of the blood glucose between 100 and 120 mg/dl and conventional
method that the blood glucose maintained <=200 mg/dl. Primary outcomes
were: mortality, sternal wound infection, cardiac arrhythmia,
cerebrovascular attack, and acute renal failure. Secondary outcomes
included: duration of mechanical ventilation and length of ICU staying.
The same main outcomes were evaluated after one month. Statistical
analysis: The data were analyzed using SPSS version 20(SPSS, Chicago, IL).
Group comparisons were performed using t-tests and Chi-square tests.
Repeated measurement test was used for comparing blood glucose in two
groups. Mann Whitney U test was compared duration of the mechanical
ventilation and length of ICU staying. Statistical significance was
defined as a p value <0.05. Result(s): There were no significant
differences between main and secondary outcomes. About late outcomes,
sternal wound infection was in the control group (7 patients) more than
intervention (1 patient) (P < 0.05). No differences between other
complications in both groups were observed. The occurrence of hypoglycemia
was low in both groups. Hypokalemia was significantly higher in the
intervention than in control (P < 0.001). Conclusion(s): The findings
showed using adjusted tight glycemic control to a level that is nearby to
normal values during cardiac surgery may reduce episodes of hypoglycemia
and thus reduces its side effects. As well as reduce hyperglycemic
complications such as sternal wound infection. Trial registration number:
IRCT2013041713052N1). 2013-07-09. Copyright © 2020, Springer
Nature Switzerland AG.

<27>
Accession Number
631972139
Title
Developing Appropriateness Criteria for Pediatric Vascular Access.
Source
Pediatrics. 145 (Supplement 3) (pp S233-S242), 2020. Date of Publication:
01 Jun 2020.
Author
Ullman A.J.; Chopra V.; Brown E.; Kleidon T.; Cooke M.; Rickard C.M.;
Bernstein S.J.
Institution
(Ullman, Brown, Kleidon, Cooke, Rickard) Alliance for Vascular Access
Teaching and Research, Menzies Health Institute Queensland and
(Ullman, Cooke, Rickard) School of Nursing and Midwifery, Griffith
University, Nathan, QLD, Australia
(Ullman, Kleidon) Queensland Children's Hospital, Brisbane, QLD, Australia
(Chopra) Divisions of Hospital Medicine and
(Chopra, Bernstein) Patient Safety Enhancement Program and Center for
Clinical Management Research, Veterans Affair Ann Arbor Healthcare System,
Ann Arbor, Michigan; and
(Brown) Child Health Research Centre, Faculty of Medicine, University of
Queensland, Brisbane, QLD, Australia
(Bernstein) General Medicine, Department of Internal Medicine, Medical
School, University of Michigan, Ann Arbor, MI, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To describe the methodology undertaken to provide guidance on
the appropriateness, as well as inappropriateness, of vascular access
device selection, characteristics, and insertion technique for pediatric
patients. METHOD(S): The RAND Corporation-University of California,
Los Angeles Appropriateness Method was used. After definition of key terms
and scope, a systematic review of the pediatric vascular access literature
was undertaken. Clinical scenarios were developed to reflect the common
indications for vascular access across pediatric health care. These were
sectioned according to (1) device selection, (2) device characteristics,
and (3) insertion technique. An interdisciplinary panel of experts (N =
14) consisting of leading experts representing diverse pediatric clinical
disciplines including anesthesiology, cardiology and cardiac surgery,
critical care and emergency, general surgery, hematology and oncology,
hospital medicine, infectious disease, interventional radiology,
pharmacology, regional pediatric hospitalist, and vascular access nursing
specialties was convened. The scenarios were rated for appropriateness by
the panel over 2 rounds (1 [highly inappropriate] to 9 [highly
appropriate]). Round 1 ratings were completed anonymously and
independently by panel members and classified into 3 levels of
appropriateness: appropriate, uncertain, and inappropriate, or
disagreement. For round 2, panelists met in-person to discuss the round 1
ratings and independently rerated the indications. All indications were
reclassified into 3 levels of appropriateness or disagreement.
 CONCLUSION(S): The RAND Corporation-University of California, Los
Angeles Appropriateness Method provides a rigorous, in-depth and
transparent methodology to develop the first appropriateness criteria for
the selection of pediatric vascular access devices in a range of patient
groups. Copyright © 2020 by the American Academy of Pediatrics.

<28>
Accession Number
631934264
Title
Comparing transcatheter aortic valve replacement (AVR) with surgical AVR
in lower risk patients: A comprehensive meta-analysis and systematic
review.
Source
Cardiology Research. 11 (3) (pp 168-178), 2020. Article Number: 1046. Date
of Publication: 01 Jun 2020.
Author
Khan M.S.; Mir T.; Ullah W.; Ali Z.; Idris O.; Khan G.; Ur Rashid M.;
Salman; Mehmood M.; Ali S.S.
Institution
(Khan, Salman) Department of Internal Medicine, Mercy St Vincent Medical
Center, Toledo, OH 43608, United States
(Mir) Department of Internal Medicine, Detroit Medical Center, Wayne State
University, Detroit, MI 48201, United States
(Ullah, Ali) Department of Internal Medicine, Abington Jefferson Health,
Abington, PA 19001, United States
(Idris, Mehmood, Ali) Department of Cardiology, Mercy Saint Vincent
Medical Center, Toledo, OH 43608, United States
(Khan) University of Missouri, Kansas City, MO 64110, United States
(Ur Rashid) Department of Internal Medicine, Advent Health, Orlando, FL
32803, United States
(Khan) Department of Internal Medicine, Mercy Saint Vincent Medical
Center, Toledo, OH 43608, United States
Publisher
Elmer Press (E-mail: production@elmerpress.com)
Abstract
Background: Transcutaneous aortic valve replacement (TAVR) is a novel
percutaneous procedure for severe aortic stenosis and has been recently
approved by Food and Drug Administration in lower risk patients. We
performed the first ever meta-analysis and literature review of clinical
trials comparing both 30-day and 1-year outcomes in lower risk patients
undergoing TAVR vs. surgical aortic valve replacement (SAVR, having
Society of Thoracic Surgeons score < 4% or equivalent). Method(s):
Using predefined selection criteria as above, 68 articles were identified.
Seven eligible articles were selected after extensive review. Primary
effect outcomes were 30-day and 1-year all-cause mortality using risk
ratio (RR) with significant P value of < 0.05. Result(s): A total of
4,859 subjects were included. Risk of 30-day all-cause mortality was 40.1%
less in TAVR group, RR 0.59 (95% confidence interval (CI): 0.38-0.92, P =
0.02) with no significant heterogeneity. Six studies except Schymik et al
also reported 1-year risk. This was, however, not statistically
significant with a 21% decrease in the TAVR group, RR 0.79 (95% CI:
0.57-1.09, P = 0.15). Six studies reported 30-day risk of secondary
outcomes. The risk of 30-day stroke was 36% less in TAVR group, although
this was not statistically significant, RR 0.64 (95% CI: 0.38-1.9, P =
0.10). The risk of acute kidney injury (AKI) stage 2 and above was 56%
less in post-TAVR patients, RR 0.43 (95% CI: 0.35-0.54, P < 0.001) with no
heterogeneity. For vascular complications, RR was high in TAVR group 4.62
(95% CI: 1.42-15.18, P = 0.01). Significant heterogeneity was demonstrated
though (I2 = 81). The risks for permanent pacemaker (PPM) were also higher
in the TAVR group, RR 3.30 (95% CI: 2.04-5.33, P < 0.001) and significant
heterogeneity was observed. After removing Thyregod et al and Partner 3
trial from the analysis, heterogeneity was removed, but the RR was still
high 3.21 (95% CI: 2.54-4.068, P < 0.001). Post-operative incidence of
endocarditis among TAVR patients was low but not statistically
significant. The 30-day risk for infective endocarditis was RR 0.67 (95%
CI: 0.13-3.48, P = 0.63). The 1-year risk was similarly low but not
significant, RR 0.73 (95% CI: 0.28-1.92, P = 0.53). Conclusion(s):
Among low risk patients, TAVR was found to be superior in short-term
all-cause mortality and 1-year stroke, a result that was statistically
significant for TAVR and close to significance for stroke. TAVR patients
were also less likely to have post-operative bleeding and AKI stage 2 and
beyond. Post-operative incidence of endocarditis among TAVR patients was
low but not statistically significant. However, the rates of PPM and
vascular complications are higher in TAVR patients. The results of TAVR in
low risk population are thus extremely encouraging. However, the issue of
long-term valve durability in this group needs further studies. Also,
caution needs to be exercised while extending the indications to extremely
young patients due to lack of enough studies. Copyright © The
authors.

<29>
Accession Number
631976063
Title
Vasopressor use in cardiogenic shock.
Source
Current opinion in critical care. (no pagination), 2020. Date of
Publication: 01 Jun 2020.
Author
Levy B.; Klein T.; Kimmoun A.
Institution
(Levy, Klein, Kimmoun) Service de Reanimation Medicale Brabois, CHRU Nancy
(Levy, Klein, Kimmoun) INSERM U1116, Vandoeuvre-les-Nancy, Faculte de
Medecine
(Levy, Klein, Kimmoun) Universite de Lorraine, Nancy, France
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Data and interventional trials on vasopressor use
during cardiogenic shock are scarce. Their use is limited by their
side-effects and the lack of solid evidence regarding their effectiveness
in improving outcomes. In the present article, we review the current use
of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two
recent Cochrane analyses concluded that there was insufficient evidence to
prove that any one vasopressor was superior to others in terms of
mortality. A recent RCT and a meta-analysis on individual data suggested
that norepinephrine may be preferred over epinephrine in patients with
cardiogenic shock, in particular, after myocardial infarction. In patients
with right ventricular failure and pulmonary hypertension, the use of
vasopressin may be advocated under advanced monitoring. SUMMARY: When
blood pressure needs to be restored, norepinephrine is a reasonable
first-line agent. Information regarding comparative effective outcomes is
sparse and their use should be limited to a temporary measure as a bridge
to recovery, mechanical circulatory support or heart transplantation.

<30>
Accession Number
631968819
Title
Cardiac Rehabilitation Programs for Chronic Heart Disease: A Bayesian
Network Meta-analysis.
Source
The Canadian journal of cardiology. (no pagination), 2020. Date of
Publication: 19 Feb 2020.
Author
Huang R.; Palmer S.C.; Cao Y.; Zhang H.; Sun Y.; Su W.; Liang L.; Wang S.;
Wang Y.; Xu Y.; Melgiri N.D.; Jiang L.; Strippoli G.F.M.; Li X.
Institution
(Huang, Li) Department of Gerontology, Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Palmer) Department of Medicine, University of Otago - Christchurch,
Christchurch, New Zealand
(Cao, Jiang) Department of Cardiothoracic Surgery, First People's Hospital
of Yunnan Province, Yunnan Province, Kunming, China
(Zhang, Su, Liang) Department of Cardiology, First People's Hospital of
Yunnan Province, Yunnan Province, Kunming, China
(Sun) Institute of Ultrasound Imaging, Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Wang, Wang) Department of Rehabilitation Medicine, Second Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Xu) Statistical Laboratory, Chongqing, China
(Melgiri) Impactys Foundation for Biomedical Research, San Diego, CA,
United States
(Strippoli) Department of Emergency and Organ Transplantation, University
of Bari, Bari, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac rehabilitation is a medically supervised program after
coronary events that involves exercise and dietary modification. We
evaluated the comparative benefits and harms of cardiac rehabilitation
strategies via a network meta-analysis. METHOD(S): We followed a
pre-specified protocol (PROSPERO: CRD42018094998). We searched Embase,
MEDLINE, and Cochrane Central Register of Randomized Trials databases for
randomized controlled trials that evaluated cardiac rehabilitation vs a
second form of rehabilitation or standard/usual care in adults after
myocardial infarction, coronary artery bypass grafting, percutaneous
coronary intervention, or angiography. Risk of bias and evidence quality
was evaluated using the Cochrane tool and Grading of Recommendations
Assessment, Development and Evaluation (GRADE), respectively. Pairwise and
Bayesian network meta-analyses were performed for 11 clinical outcomes.
 RESULT(S): We included 134 randomized controlled trials involving
62,322 participants. Compared with standard care, exercise-only cardiac
rehabilitation reduced the odds of cardiovascular mortality (odds ratio
[OR], 0.70; 95% credibility interval [CrI], 0.51-0.96; moderate-quality
evidence), major adverse cardiovascular events (OR, 0.57; 95% CrI,
0.40-0.78; low-quality evidence), nonfatal myocardial infarction (OR,
0.71; 95% CrI, 0.54-0.93; moderate-quality evidence), all-cause
hospitalization (OR, 0.74; 95% CrI, 0.54-0.98; moderate-quality evidence),
and cardiovascular hospitalization (OR, 0.69; 95% CrI, 0.51-0.88;
moderate-quality evidence). Exercise-only cardiac rehabilitation was
associated with lower cardiovascular hospitalization risk relative to
cardiac rehabilitation without exercise (OR, 0.68; 95% CrI, 0.48-0.97;
moderate-quality evidence). CONCLUSION(S): Cardiac rehabilitation
programs containing exercise might provide broader cardiovascular benefits
compared with those without exercise. Copyright © 2020 Canadian
Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

<31>
Accession Number
2004466562
Title
Heart transplantation and the "the secret chamber": How echocardiographic
assessment of the right ventricle can reveal acute cell rejection.
Source
Arquivos Brasileiros de Cardiologia. 114 (4) (pp 645-646), 2020. Date of
Publication: April 2020.
Author
Moreira H.T.; Romano M.M.D.
Institution
(Moreira, Romano) Faculdade de Medicina de Ribeirao Preto USP, Ribeirao
Preto, SP, Brazil
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)

<32>
Accession Number
2005600988
Title
Regular drug-eluting stents versus dedicated bifurcation drug-eluting
BiOSS stents for coronary bifurcation treatment: Four-year results of the
randomised POLBOS i and POLBOS II clinical trials.
Source
EuroIntervention. 14 (16) (pp 1460-1463), 2020. Date of Publication: March
2020.
Author
Gil R.J.; Bil J.; Kern A.; Garcia L.A.I.; Formuszewicz R.; Dobrzycki S.;
Vassilev D.; Segiet A.
Institution
(Gil, Bil) Department of Invasive Cardiology, Centre of Postgraduate
Medical Education, Central Clinical Hospital of the Ministry of Interior
and Administration, Warsaw, Poland
(Gil) Mossakowski Medical Research Center, Polish Academy of Science,
Warsaw, Poland
(Kern) Department of Cardiology and Cardiosurgery, University of Warmia
and Masury, Olsztyn, Poland
(Garcia) Costa Del Sol Hospital, Marbella, Spain
(Formuszewicz) 10th Clinical Military Hospital, Bydgoszcz, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University in
Bialystok, Bialystok, Poland
(Vassilev) Alexandrovska University Hospital, Sofia, Bulgaria
(Segiet) Warsaw Medical University, Warsaw, Poland
Publisher
Europa Group

<33>
Accession Number
631756594
Title
Cardiovascular magnetic resonance native T<inf>2</inf> and T<inf>2</inf>
* quantitative values for cardiomyopathies and heart
transplantations: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Magnetic Resonance. 22 (1) (no pagination),
2020. Article Number: 34. Date of Publication: 11 May 2020.
Author
Snel G.J.H.; Van Den Boomen M.; Hernandez L.M.; Nguyen C.T.; Sosnovik
D.E.; Velthuis B.K.; Slart R.H.J.A.; Borra R.J.H.; Prakken N.H.J.
Institution
(Snel, Van Den Boomen, Hernandez, Borra, Prakken) Department of Radiology,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, Groningen 9713 GZ, Netherlands
(Van Den Boomen, Nguyen, Sosnovik) Department of Radiology, Athinoula A.
Martinos Center for Biomedical Imaging, Massachusetts General Hospital,
Harvard Medical School, 149 13th Street, Charlestown, MA 02129, United
States
(Nguyen, Sosnovik) Cardiovascular Research Center, Massachusetts General
Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129,
United States
(Sosnovik) Division of Health Sciences and Technology, Harvard-MIT, 7
Massachusetts Avenue, Cambridge, MA 02139, United States
(Velthuis) Department of Radiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht 3584 CX, Netherlands
(Slart, Borra) Department of Nuclear Medicine and Molecular Imaging,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, Groningen 9713 GZ, Netherlands
(Slart) Department of Biomedical Photonic Imaging, University of Twente,
Dienstweg 1, Enschede 7522 ND, Netherlands
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The clinical application of cardiovascular magnetic resonance
(CMR) T<inf>2</inf> and T<inf>2</inf> * mapping is currently
limited as ranges for healthy and cardiac diseases are poorly defined. In
this meta-analysis we aimed to determine the weighted mean of
T<inf>2</inf> and T<inf>2</inf> * mapping values in patients
with myocardial infarction (MI), heart transplantation, non-ischemic
cardiomyopathies (NICM) and hypertension, and the standardized mean
difference (SMD) of each population with healthy controls. Additionally,
the variation of mapping outcomes between studies was investigated.
 Method(s): The PRISMA guidelines were followed after literature
searches on PubMed and Embase. Studies reporting CMR T<inf>2</inf> or
T<inf>2</inf> * values measured in patients were included. The
SMD was calculated using a random effects model and a meta-regression
analysis was performed for populations with sufficient published data.
 Result(s): One hundred fifty-four studies, including 13,804 patient
and 4392 control measurements, were included. T<inf>2</inf> values were
higher in patients with MI, heart transplantation, sarcoidosis, systemic
lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM),
dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87,
1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with
controls. T<inf>2</inf> values in iron overload patients (SMD =-0.54, P =
0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both
not differ from controls. T<inf>2</inf> * values were lower in
patients with MI and iron overload (SMD of-1.99 and-2.39, respectively, P
< 0.01) compared with controls. T<inf>2</inf> * values in HCM
patients (SMD =-0.61, P = 0.22), DCM patients (SMD =-0.54, P = 0.06) and
hypertension patients (SMD =-1.46, P = 0.10) did not differ from controls.
Multiple CMR acquisition and patient demographic factors were assessed as
significant covariates, thereby influencing the mapping outcomes and
causing variation between studies. Conclusion(s): The clinical
utility of T<inf>2</inf> and T<inf>2</inf> * mapping to
distinguish affected myocardium in patients with cardiomyopathies or heart
transplantation from healthy myocardium seemed to be confirmed based on
this meta-analysis. Nevertheless, variation of mapping values between
studies complicates comparison with external values and therefore require
local healthy reference values to clinically interpret quantitative
values. Furthermore, disease differentiation seems limited, since changes
in T<inf>2</inf> and T<inf>2</inf> * values of most
cardiomyopathies are similar. Copyright © 2020 The Author(s).

<34>
Accession Number
2005786485
Title
Osteopathic treatment leads to significantly greater reductions in chronic
thoracic pain after CABG surgery: A randomised controlled trial.
Source
Journal of Bodywork and Movement Therapies. 24 (3) (pp 202-211), 2020.
Date of Publication: July 2020.
Author
Roncada G.
Institution
(Roncada) Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
(Roncada) Commission for Osteopathic Research, Practice and Promotion,
Mechelen, Belgium
Publisher
Churchill Livingstone
Abstract
Background: There are a number of long-term postoperative complications
after coronary artery bypass graft (CABG) surgery. Pulmonary function is
decreased by 12% and 30%-50% of the patients have chronic thoracic pain.
 Method(s): This randomised controlled trial with two parallel groups
aimed to explore the effectiveness of osteopathic treatments (OTs) on
these conditions. The standard care (SC) group and the and OT group
received a 12-week standard cardiac rehabilitation programme, which was
supplemented with four OTs for the OT group only. The outcome assessors
were blinded to the patients' allocation. Result(s): Eighty-two
patients with median sternotomy after CABG surgery were randomly allocated
in a 1:1 ratio (SC: n = 42, OT: n = 42). Slow vital capacity and pain
intensity were measured at baseline and at 12 weeks and 52 weeks after
surgery. Pain intensity was significantly lower in the OT group 12 weeks
after surgery (3.6-0.80 vs. 2.6 to 1.2, p = 0.030). One year after
surgery, there still was a significantly lower pain intensity in the OT
group (3.6-0.56, vs. 2.6 to 1.2, p = 0.014). No significant changes
between groups were found in pulmonary function. There were no adverse
events reported. Conclusion(s): From this study, it can be concluded
that the addition of OT to exercise-based cardiac rehabilitation may lead
to significantly greater reductions in thoracic pain after CABG surgery.
Trial registration: This study was registered on ClinicalTrials.gov
(NCT01714791). Copyright © 2020 Elsevier Ltd

<35>
Accession Number
2004168856
Title
Impact of leaflet thrombosis on hemodynamics and clinical outcomes after
bioprosthetic aortic valve replacement: A meta-analysis.
Source
Clinical Cardiology. 43 (5) (pp 468-474), 2020. Date of Publication: 01
May 2020.
Author
Tian Z.; Li T.; Ma S.
Institution
(Tian, Li, Ma) Department of Cardiology, Shengjing Hospital of China
Medical University, Shengyang, Liaoning Province, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Leaflet thrombosis (LT, also called cusp thrombosis) detected
by multidetector computed tomography (MDCT) is common in bioprosthetic
aortic valve replacement (bAVR). However, it remains contradictory whether
MDCT-defined LT following bAVR is associated with hemodynamic
deterioration and stroke. Thus, we performed the first meta-analysis to
assess hemodynamic outcomes and updated the latest researches on the
clinical outcomes of MDCT-defined LT after bAVR. Hypothesis: MDCT-defined
LT might be associated with worse hemodynamic and clinical outcomes after
bAVR. Method(s): MEDLINE, EMBASE, Cochrane Library, and
ClinicalTrial.gov were searched from inception to 15th April 2019. The
fix-effect model was utilized to calculate odds ratio (OR) and 95%
confidence interval (CI). The primary outcomes were hemodynamic stability
indexes, including mean pressure gradient (MPG), left ventricular ejection
fraction (LVEF), paravalvular leak (PVL), and clinical heart failure. The
secondary endpoints were major adverse cardiovascular and cerebrovascular
events (MACCEs), which consisted of myocardial infarction, all-cause
death, stroke, and transient ischemic attack (TIA). Result(s): Twelve
studies with 4820 patients were included. The total prevalence of
MDCT-defined LT was 9.7%. MDCT-defined LT was associated with a
significantly increased risk of MPG (inverse variance 0.43, 95% CI: [0.30,
0.57]), MACCEs (OR 2.43, 95% CI: [1.45, 4.06]), stroke (OR 1.79, 95% CI:
[1.03, 3.11]), and TIA (OR 4.09, 95% CI: [1.59, 10.54]). There were no
differences for other outcomes. Conclusion(s): MDCT-defined LT after
bAVR is associated with increased MPG and increased risk of adverse
cerebrovascular events, including TIA and stroke. While LVEF, PVL, and
clinical heart failure were similar between patient with and without
LT. Copyright © 2020 The Authors. Clinical Cardiology published
by Wiley Periodicals, Inc.

<36>
Accession Number
2006016177
Title
Lower levels of high-density lipoprotein cholesterol are associated with
increased cardiovascular events in patients with acute coronary syndrome.
Source
Atherosclerosis. 303 (pp 21-28), 2020. Date of Publication: June 2020.
Author
Nakazawa M.; Arashi H.; Yamaguchi J.; Ogawa H.; Hagiwara N.
Institution
(Nakazawa, Arashi, Yamaguchi, Ogawa, Hagiwara) Department of Cardiology,
The Heart Institute of Japan, Tokyo Women's Medical University, 8-1
Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: This study aimed to elucidate whether high-density
lipoprotein cholesterol (HDL-C) at 3-month follow-up for patients
receiving contemporary lipid-lowering therapy after acute coronary
syndrome (ACS) could predict cardiac events. Method(s): The
HIJ-PROPER study was a multicenter, prospective, randomized trial
comparing intensive lipid-lowering therapy (pitavastatin + ezetimibe) and
conventional lipid-lowering therapy (pitavastatin monotherapy) after ACS.
The entire cohort was divided into three groups according to tertiles of
HDL-C levels at 3-month follow-up (Group 1, HDL-C <=43 mg/dL; Group 2,
HDL-C >43, <53.6 mg/dL; Group 3; HDL-C >=53.6 mg/dL). Baseline
characteristics and incidence of the primary endpoint (a composite of
all-cause death, non-fatal myocardial infarction, non-fatal stroke,
unstable angina pectoris, or ischemia-driven revascularization) were
compared among the three groups. Result(s): The primary endpoint
event occurred in 34.8%, 30.1%, and 24.6% of patients in Groups 1, 2, and
3, respectively, and its incidence was significantly higher in Group 1
than in Group 3 (hazard ratio [HR], 1.5; 95% confidence interval [CI],
1.19-1.9; p = 0.001). Irrespective of the treatment regimen, Group 1 had
significantly higher rates of the primary endpoint than Group 3
(pitavastatin + ezetimibe therapy: HR, 1.6; 95% CI, 1.12-2.22; p = 0.01
and pitavastatin monotherapy: HR, 1.4; 95% CI, 1.05-1.98; p = 0.02). These
trends remained even after adjustment for baseline characteristics and
lipid profiles. Multivariate analysis revealed that lower body mass index,
prevalence of diabetes mellitus, higher levels of high-sensitivity C
reactive protein at baseline, and lower levels of HDL-C at 3-month
follow-up were independent predictors of the incidence of primary
endpoint. Conclusion(s): Lower levels of HDL-C at 3-month follow-up
are independently associated with higher incidence of cardiovascular
events in ACS patients receiving contemporary lipid-lowering
therapy. Copyright © 2020 Elsevier B.V.

<37>
Accession Number
2005957383
Title
Adding Alirocumab to Rosuvastatin Helps Reduce the Vulnerability of
Thin-Cap Fibroatheroma: An ALTAIR Trial Report.
Source
JACC: Cardiovascular Imaging. 13 (6) (pp 1452-1454), 2020. Date of
Publication: June 2020.
Author
Sugizaki Y.; Otake H.; Kawamori H.; Toba T.; Nagano Y.; Tsukiyama Y.;
Yanaka K.-I.; Yamamoto H.; Nagasawa A.; Onishi H.; Takeshige R.; Nakano
S.; Matsuoka Y.; Tanimura K.; Takahashi Y.; Fukuyama Y.; Shinke T.; Ishida
T.; Hirata K.-I.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<38>
Accession Number
2004752807
Title
Vitamin D Treatment Attenuates Heart Apoptosis After Coronary Artery
Bypass Surgery: A Double-Blind, Randomized, Placebo-Controlled Clinical
Trial.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 25 (4) (pp
338-345), 2020. Date of Publication: 01 Jul 2020.
Author
Tasdighi E.; Hekmat M.; Beheshti M.; Baghaei R.; Mirhosseini S.M.; Torbati
P.; Pourmotahari F.; Foroughi M.
Institution
(Tasdighi, Hekmat, Beheshti) Cardiovascular Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Baghaei, Mirhosseini, Pourmotahari, Foroughi) Clinical Research and
Development Center, Shahid Modarres Hospital, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Torbati) Department of Pathology, School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Vitamin D plays an important role in immune system and in the
regulation of inflammatory cytokines. Coronary artery bypass graft (CABG)
with cardiopulmonary bypass (CPB) is associated with an extensive
inflammatory response. The aim of this study is to examine the effect of
vitamin D treatment on the apoptosis and inflammatory changes developed
after CABG. Method(s): This trial was conducted on 70 patients
undergoing CABG with CPB. Patients were randomly administered either in
placebo or in the group of orally consuming 150 000 IU vitamin D daily for
3 consecutive days before surgery. The right atrium sample was taken to
assess caspases 2, 3, and 7 activity using immunohistochemistry method.
The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1
(IGF-1) were compared at intervals. Result(s): The average number of
positive cells for caspases 2 and 3 were less in vitamin D group (P =.006
and P <.001, respectively). There was an increase in serum levels of IL-10
after 3 days from vitamin D treatment before surgery (vitamin D group =
4.4 +/- 4.9 ng/mL and control group = 1 +/- 0.5 ng/mL, P =.001). After
operation, IL-10 increased in both groups, higher level in vitamin D group
(P <.001). The comparison of serum IGF-1 showed significant difference
after 3 days (P =.006) and remained higher in vitamin D group after CPB (P
<.001). Conclusion(s): These findings suggest the apoptosis rate
after CPB can be reduced by vitamin D. Vitamin D treatment may improve the
inflammatory status before and after surgery. Further studies are needed
to confirm the antiapoptotic property of vitamin D and clinical
implication. Copyright © The Author(s) 2020.

<39>
Accession Number
2005126876
Title
Comparison of Anticoagulants for Postoperative Atrial Fibrillation After
Coronary Artery Bypass Grafting: A Pilot Study.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. (no pagination),
2020. Date of Publication: 2020.
Author
Chapin T.W.; Leedahl D.D.; Brown A.B.; Pasek A.M.; Sand M.G.; Loy M.L.;
Dyke C.M.
Institution
(Chapin, Leedahl) Pharmacy Services, Sanford Health, Fargo, ND, United
States
(Brown, Pasek, Sand, Dyke) University of North, Dakota School of Medicine
and Health Sciences, Grand Forks, ND, United States
(Loy) Pharmacy Services, Essentia Health, Fargo, ND, United States
(Dyke) Cardiothoracic Surgery, Sanford Health, Fargo, ND, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Direct-acting oral anticoagulants are indicated for the
treatment of nonvalvular atrial fibrillation, but their use in patients
after undergoing cardiac surgery is poorly defined despite a high
prevalence of postoperative atrial fibrillation in this population.
 Method(s): Patients diagnosed with postoperative atrial fibrillation
were prospectively randomized to warfarin or apixaban. Safety, efficacy,
and economic outcomes were evaluated until their 4- to 6-week
postoperative appointment. Result(s): While this pilot study was not
powered to determine a difference in safety or efficacy, adverse event
rates were similar to the published literature. It was noted that a
patient's course of therapy when utilizing apixaban was significantly less
costly than warfarin when including medication, bridging, and laboratory
expenses. Conclusion(s): Apixaban and warfarin both appeared to be
safe and effective for anticoagulation throughout the duration of this
pilot study in treating postoperative atrial fibrillation after coronary
artery bypass grafting. Apixaban was associated with significantly less
expense when bridging and monitoring costs were included in addition to
medication expense. Copyright © The Author(s) 2020.

<40>
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.

<41>
Accession Number
2004975778
Title
Pleural Effusions After Congenital Cardiac Surgery Requiring Readmission:
A Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Hughes A.; Carter K.; Cyrus J.; Karam O.
Institution
(Hughes, Carter) Division of Pediatric Cardiology, Children's Hospital of
Richmond at VCU, Richmond, VA, United States
(Cyrus) Tompkins-McCaw Library for the Health Sciences, VCU Libraries,
Virginia Commonwealth University, Richmond, VA, United States
(Karam) Division of Pediatric Critical Care Medicine, Children's Hospital
of Richmond at VCU, Richmond, VA, United States
Publisher
Springer
Abstract
Patients with congenital heart disease (CHD) are surviving longer thanks
to improved surgical techniques and increasing knowledge of natural
history. Pleural effusions continue to be a complication that affect many
surgical patients and are associated with increased morbidity, many times
requiring readmission and additional invasive procedures. The risks for
development of pleural effusion after hospital discharge are ill-defined,
which leads to uncertainty related to strategies for prevention. Our
primary objective was to determine, in patients with CHD requiring
cardiopulmonary bypass, the prevalence of post-surgical pleural effusions
leading to readmission. The secondary objective was to identify risk
factors associated with post-surgical pleural effusions requiring
readmission. We identified 4417 citations; 10 full-text articles were
included in the final review. Of the included studies, eight focused on
single-ventricle palliation, one looked at Tetralogy of Fallot patients,
and another on pleural effusion in the setting of post-pericardiotomy
syndrome. Using a random-effect model, the overall prevalence of pleural
effusion requiring readmission was 10.2% (95% CI 4.6; 17.6). Heterogeneity
was high (I2 = 91%). In a subpopulation of patients after
single-ventricle palliation, the prevalence was 13.0% (95% CI 6.0;21.0),
whereas it was 3.0% (95% CI 0.4;6.75) in patients mostly with
biventricular physiology. We were unable to accurately assess risk
factors. A better understanding of this complication with a focus on
single-ventricle physiology will allow for improved risk stratification,
family counseling, and earlier recognition of pleural effusion in this
patient population. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<42>
Accession Number
2004601742
Title
Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical
Patients.
Source
Annals of Thoracic Surgery. 109 (6) (pp 1804-1810), 2020. Date of
Publication: June 2020.
Author
Khoury H.; Lyons R.; Sanaiha Y.; Rudasill S.; Shemin R.J.; Benharash P.
Institution
(Khoury, Sanaiha, Rudasill, Benharash) Cardiovascular Outcomes Research
Laboratories (CORELAB), University of California Los Angeles, Los Angeles,
CA, United States
(Lyons, Sanaiha, Shemin, Benharash) Division of Cardiac Surgery,
University of California Los Angeles, Los Angeles, CA, United States
Publisher
Elsevier USA
Abstract
Background: Deep venous thrombosis and pulmonary embolism are
life-threatening complications after surgery, warranting prophylaxis.
However prophylaxis is not uniformly practiced among cardiac surgical
patients. This study aimed to characterize the national incidence,
mortality, and costs associated with thromboembolism after cardiac
surgery. Method(s): The 2005 to 2015 National Inpatient Sample was
used to identify all adult patients undergoing coronary artery bypass
grafting or valve surgery. International Classification of Disease codes
were used to identify patients with deep venous thrombosis and pulmonary
embolism. Result(s): Of approximately 3 million patients undergoing
cardiac surgery, 1.62% developed deep venous thrombosis and 0.38%
pulmonary embolism. Those with deep venous thrombosis and pulmonary
embolism were more commonly women (33.2% and 36.2 vs 31.2%, P < .001),
older (68.1 and 66.0% vs 65.7 years, P < .001), and had a higher
Elixhauser comorbidity index (4.0 and 4.7 vs 3.7, P < .001). Deep venous
thrombosis and pulmonary embolism were associated with increased mortality
(4.95% and 14.8% vs 2.67%, P < .001). After adjustment for baseline
differences, deep venous thrombosis was associated with an incremental
increase in cost of $12,308, whereas pulmonary embolism was associated
with $13,879 cost increase after cardiac surgery. Pulmonary embolism was
an independent predictor of mortality (adjusted odds ratio, 3.39; 95%
confidence interval, 2.74-4.18). Conclusion(s): The mortality and
financial burden related to thromboembolism in cardiac surgery are
significant. Prophylaxis may be indicated in cardiac surgery patients to
improve quality of care and reduce healthcare costs. Future controlled
randomized trials investigating the benefit of thromboembolism prophylaxis
in cardiac surgery are warranted. Copyright © 2020 The Society of
Thoracic Surgeons

<43>
Accession Number
2004416980
Title
Mortality after transcatheter versus surgical aortic valve replacement: an
updated meta-analysis of randomised trials.
Source
Netherlands Heart Journal. 28 (6) (pp 320-333), 2020. Date of Publication:
01 Jun 2020.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: To determine whether transcatheter aortic valve implantation
(TAVI) improves early (30-day) and midterm (1-year) mortality compared
with surgical aortic valve replacement (SAVR), we performed an updated
meta-analysis of all the currently available randomised controlled trials
(RCTs). Method(s): To identify all RCTs providing both 30-day and
1-year mortality after TAVI versus SAVR, PubMed and ClinicalTrials.gov
were searched up to and including July 2019. A risk difference (RD) and
its 95% confidence interval were generated using data of prespecified
outcomes in both the TAVI and SAVR groups. Study-specific estimates were
pooled using inverse variance-weighted averages of RDs in the
random-effects model. Result(s): We identified seven eligible
high-quality RCTs including a total of 7631 as-treated patients. Pooled
analyses demonstrated significantly lower 30-day (RD -0.60%; p= 0.046) and
1-year all-cause mortality (RD -1.12%; p= 0.03) after TAVI than after
SAVR. No funnel plot asymmetry was detected for 30-day and 1-year
mortality. Meta-regression analyses indicated that RDs of 30-day and
1-year mortality between TAVI and SAVR were not modulated by mean Society
of Thoracic Surgeons Predicted Risk of Mortality score. Bleeding
complications at 30 days and 1 year and stage 2/3 acute kidney injury at
30 days were significantly less frequent after TAVI than after SAVR,
whereas major vascular complications and new permanent pacemaker
implantation at 30 days and 1 year were significantly more frequent after
TAVI than after SAVR. Conclusion(s): The best evidence from the
present meta-analysis of all the currently available RCTs suggests that
TAVI may reduce 30-day and 1-year all-cause mortality compared with
SAVR. Copyright © 2020, The Author(s).

<44>
Accession Number
2003813919
Title
Aminoglycosides for infective endocarditis: time to say goodbye?.
Source
Clinical Microbiology and Infection. 26 (6) (pp 723-728), 2020. Date of
Publication: June 2020.
Author
Lebeaux D.; Fernandez-Hidalgo N.; Pilmis B.; Tattevin P.; Mainardi J.-L.
Institution
(Lebeaux, Mainardi) Service de Microbiologie, Unite Mobile
d'Infectiologie, AP-HP, Hopital Europeen Georges Pompidou, Centre
Universite de Paris, Universite de Paris, Paris, France
(Fernandez-Hidalgo) Servei de Malalties Infeccioses, Hospital Universitari
Vall d'Hebron, Universitat Autonoma de Barcelona. Barcelona, Spain
(Fernandez-Hidalgo) Spanish Network for Research in Infectious Diseases
(REIPI), Instituto de Salud Carlos III, Madrid, Spain
(Pilmis) Service de Microbiologie et Plateforme de dosage des
Anti-infectieux, Equipe Mobile de Microbiologie Clinique, Groupe
Hospitalier Paris Saint-Joseph, Paris, France
(Tattevin) Infectious Diseases and Intensive Care Unit, Pontchaillou
University Hospital, Rennes, France
Publisher
Elsevier B.V.
Abstract
Background: Based on experimental studies showing synergism with
beta-lactams and glycopeptides, aminoglycosides have long been considered
essential in the treatment of infective endocarditis (IE). However, their
use is associated with a high risk of renal failure, especially in elderly
patients. Aim(s): The aim of this narrative review was to summarize
the evidence to support reducing or even avoiding the use of
aminoglycosides for the treatment of IE. We also analysed data supporting
the use of aminoglycosides in specific subgroup of IE patients. Sources:
PubMed database was searched up to July 2019 to identify relevant studies.
Contents: Recent European Guidelines reduced the use of aminoglycosides in
IE, no longer recommended in Staphylococcus aureus native-valve IE, and
shortened to 2 weeks for IE related to Enterococcus faecalis and
streptococci with penicillin MIC >0.125 mug/mL. In addition, an
alternative regimen without aminoglycosides (ampicillin or amoxicillin
plus ceftriaxone) is proposed for E. faecalis. Observational studies
suggested that gentamicin would not be necessary in the case of
staphylococcal prosthetic valve IE as long as rifampicin is maintained.
Recent clinical studies showed that for streptococcal IE, gentamicin could
be restricted to isolates with penicillin MIC >0.5 mug/mL. For the
empirical and definitive treatment of E. faecalis IE, amoxicillin or
ampicillin plus ceftriaxone may be considered, irrespective of high-level
of aminoglycoside resistance. Implications: In a scenario of progressive
increase in the age and frailty of IE patients, the use of aminoglycosides
can be reduced or avoided in ~90% cases. This should result in reduced
incidence of renal failure, an important prognostic factor in
IE. Copyright © 2019 European Society of Clinical Microbiology
and Infectious Diseases

<45>
Accession Number
2003637598
Title
Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A
Meta-Analysis of Randomized Controlled Trials.
Source
American Journal of Cardiovascular Drugs. 20 (3) (pp 271-281), 2020. Date
of Publication: 01 Jun 2020.
Author
Liu Y.; Zhang L.; Wang S.; Lu F.; Zhen J.; Chen W.
Institution
(Liu, Wang, Lu, Zhen, Chen) Department of Intensive Care Unit, Beijing
Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian
District, Beijing 100038, China
(Zhang) Department of anesthesiology, Beijing Daxing Maternal and Child
Care Hospital, Beijing, China
Publisher
Adis
Abstract
Background: Dexmedetomidine has been shown to have antiarrhythmic effects
by exhibiting sympatholytic properties and activating the vagus nerve in
preclinical studies. Results from clinical trials of dexmedetomidine on
atrial fibrillation (AF) following adult cardiac surgery are
controversial. Material(s) and Method(s): We searched EMBASE, PubMed
and Cochrane CENTRAL databases for randomized controlled trials (RCTs)
comparing the antiarrhythmic effect of dexmedetomidine versus placebo or
other anesthetic drugs in adult patients undergoing cardiac surgery. The
primary outcome was the incidence of AF. The secondary outcomes were
ventricular arrhythmias [ventricular fibrillation (VF), ventricular
tachycardia (VT)], mechanical ventilation (MV) duration, intensive care
unit (ICU) length of stay, and hospital length of stay, and all-cause
mortality. Result(s): Thirteen trials with a total of 1684 study
patients were selected. Compared with controls, dexmedetomidine
significantly reduced the incidence of postoperative AF [odds ratio (OR)
0.75; 95% confidence interval (CI) 0.58-0.97; P = 0.03] and VT (OR 0.23;
95% CI 0.11-0.48; P < 0.0001). No significant difference for the incidence
of VF existed (OR 0.80; 95% CI 0.21-3.03; P = 0.74). There was no
significant difference between groups in MV duration [weighted mean
difference (WMD) - 0.10; 95% CI - 0.42 to 0.21; P = 0.52], postoperative
ICU stay (WMD - 0.49; 95% CI - 2.64 to 1.66; P = 0.65), hospital stay (WMD
- 0.01; 95% CI - 0.16 to 0.13; P = 0.88) and mortality (OR 0.59; 95% CI
0.15-2.37; P = 0.46). Conclusion(s): Perioperative administration of
dexmedetomidine in adult patients undergoing cardiac surgery reduced the
incidence of postoperative AF and VT. But there was no significant
difference in incidence of VF, MV duration, ICU stay, hospital stay and
mortality. Copyright © 2019, Springer Nature Switzerland AG.

<46>
Accession Number
631942871
Title
Transitions in critical care: Evaluating the implementation of a handover
tool for postoperative cardiac surgery patients.
Source
Canadian Journal of Anesthesia. Conference: Critical Care Canada Forum,
CCCF 2018. Canada. 66 (1 Supplement) (pp S117-S118), 2019. Date of
Publication: 2019.
Author
Denomme J.; Isac M.; Syed S.; Yu J.; Centofanti J.
Institution
(Denomme, Isac, Syed) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Yu) Undergraduate Medical Program, McMaster University, Hamilton, ON,
Canada
(Centofanti) Department of Anesthesia and Department of Critical Care,
McMaster University, Hamilton, ON, Canada
Publisher
Springer
Abstract
Introduction: Accurate and efficient handover is critical in the transfer
of postoperative surgical patients by anesthesiology to the cardiac
intensive care unit (CVICU). A systematic review of postoperative handover
identified an association between the quality of patient handover and
patient harm1. One strategy to improve handover and prevent adverse events
is the application of checklists to standardize communication and minimize
omissions2. Our academic centre recently implemented a standardized
handover tool for the transfer of postoperative cardiac surgery patients
to the CVICU. Objective(s): To assess completion of a novel handover
tool 6-months postimplementation, and elicit attitudes and perceptions of
anesthesiologists and members of the CVICU team about perioperative
patient handover. Method(s): Ethics review was completed via the
local REB. Chart review began 6- months post-implementation of the
handover tool and included 373 consecutive patients who underwent cardiac
surgery over a 3-month period. Completion of the 59 parameters on the
handover tool was assessed for adherence, and compared to the anesthetic
record and preoperative investigations to assess for quality and accuracy
of information. Using an online database, a self-administered survey was
created regarding perioperative handover of CVICU patients. The survey was
pilot tested and broadly disseminated to all cardiac anesthesiologists as
well as healthcare professionals working in the CVICU. Questions were
designed using a 5-point Likert scale with opportunity for free text
commentary. Result(s): 357 (96%) of the charts reviewed included a
copy of the handover tool. The parameters most frequently completed (>80%
of charts) included medical history, airway management, arterial lines,
cardiac bypass duration, drug dosing, and the transferring
anesthesiologist's name. Documentation regarding pacing, recent bloodwork,
central lines, peripheral IVs, and time of transfer were completed in less
than 80% of charts. The response rate to the survey was 111 of 154
stakeholders (72%). 72% of respondents felt the handover tool improved the
handover process and 62% felt it improved handover efficiency. No
respondents felt the tool worsened handover. The majority felt the tool
improved the transfer of important details of intraoperative care. The
tool also enhanced verbal communication by anesthesiology trainees,
standardized handover among anesthesia providers, and allowed access to
important perioperative details after handover was completed. Barriers to
success of the handover tool included a lack of awareness of its existence
and nominal completion. Barriers to the effectiveness of overall patient
transition included: insufficient clearance of physical space during
patient transfer, lack of attendance of the cardiac surgeon and ICU
attending during handover, and difficulty hearing verbal handover at the
bedside. Conclusion(s): The introduction of a handover tool for
cardiac surgical patients has improved handover from the perspective of
its users, and continues to be used with promising adherence 6-months
post-implementation. It is a useful resource detailing important patient
and surgical information, and continues to be used even after verbal
handover was completed. Barriers to effective transition of patients into
the ICU with high-quality handover were identified and can be targeted for
continuous quality improvement interventions.

<47>
Accession Number
2006116483
Title
Evidence-based thoracic epidural nerve block: A systematic review.
Source
International Journal of Surgery Open. 24 (pp 151-155), 2020. Date of
Publication: 2020.
Author
Chekol W.B.; Melesse D.Y.; Denu Z.A.; Tawuye H.Y.
Institution
(Chekol, Melesse, Denu, Tawuye) Department of Anesthesia, College of
Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Publisher
Elsevier Ltd
Abstract
Background: Thoracic epidural nerve block (TENB) is a technique in which
analgesia is produced by injecting local anesthetic agent by itself or
combined with additives or alone into the epidural space. This systematic
review was designed to improve the quality of pain management and to form
a common consensus for TENB based on the current evidences.
 Method(s): PubMed through HINARI was used to get access for current
and updated evidences on TENB for cardio-thoracic and major abdominal
surgeries. The flow diagram was used to show the filtration methods of
suitable literature. Discussion(s): TENB should be started after
checking baseline vital signs and after preparation of emergent
phenomenon. The prominent part of C7, T3 scapular spine and the inferior
border of T7 are used to localize the intended segment during performing
the procedures. Skin infiltration with aseptic technique of 2-3 ml of 2%
lidocaine, test dose of 3 ml of lidocaine with 1:200,000 epinephrine, and
loading dose of 3-5 ml of 0.25-0.5% bupivacaine are recommended for TENB.
The maintenance dose is 3-5 ml of 0.1-0.25% of bupivacaine. The thoracic
epidural catheter will not stay for more than 4 days. Post-procedural care
and monitoring should be performed for patients on thoracic epidural
catheter. Conclusion(s): Generally, appropriate preoperative patient
evaluation, pre-procedural preparation of the necessary materials, and
consideration of the possible options should be mandatory. Anesthetists
should be familiar with the landmark techniques, troubleshooting,
administration of safe doses of the drug, and post-epidural catheter
insertion care. Copyright © 2020 The Author(s)

<48>
Accession Number
631957769
Title
Effects of interval training on post-coronary artery bypass grafting
hemodynamic indices.
Source
Crescent Journal of Medical and Biological Sciences. 7 (2) (pp 274-278),
2020. Date of Publication: 01 Apr 2020.
Author
Hashemzadeh K.; Dehdilani M.; Gol M.K.
Institution
(Hashemzadeh) Department of Heart Surgery, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Dehdilani) Department of Anesthesiology, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Gol) Responsible for the Nursing Research Committee of Imam Reza
Hospital, Nursing and Midwifery Faculty, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
Aras Part Medical International Press (E-mail: Publish@pmcaras.com)
Abstract
Objectives: There are conflicting reports on post-coronary artery bypass
grafting (CABG) training programs that could have the most favorable
impact on the hemodynamic state of patients. Therefore, the purpose of
this study was to explore the effects of interval training on hemodynamic
indices of patients following CABG. Material(s) and Method(s): In
this prospective quasi-experimental study (over the 4 months leading to
July 2019), 24 patients were randomly selected based on a similar study.
Among these patients, 12 cases (the training group) referring to Shahid
Madani hospital of Tabriz received twelve 20-minute sessions of interval
training over a month and their hemodynamic indices were measured before
and after the intervention. The indices were then analyzed using the
Shapiro-Wilk test, correlated t-test, and independent t test and P values
lower than 0.05 were considered statistically significant. Result(s):
The intergroup comparison of hemodynamic indices between training and
control groups showed a significant difference (P = 0.019). In addition,
the intragroup comparison of pre- and post-intervention results
demonstrated significant improvements in all hemodynamic indices of the
training group after the intervention (P = 0.010) while the changes were
not significant in the control group (P <= 0.118). Conclusion(s): In
general, the interval training program in the post-CABG period improved
hemodynamic indices and patient rehabilitation. Copyright © 2020
Aras Part Medical International Press. All rights reserved.

<49>
Accession Number
631955079
Title
Cardiac structural changes after transcatheter aortic valve replacement:
systematic review and meta-analysis of cardiovascular magnetic resonance
studies.
Source
Journal of cardiovascular magnetic resonance : official journal of the
Society for Cardiovascular Magnetic Resonance. 22 (1) (pp 41), 2020. Date
of Publication: 01 Jun 2020.
Author
Mehdipoor G.; Chen S.; Chatterjee S.; Torkian P.; Ben-Yehuda O.; Leon
M.B.; Stone G.W.; Prince M.R.
Institution
(Mehdipoor, Chen, Ben-Yehuda, Leon, Stone) Cardiovascular Research
Foundation, NY, NY, United States
(Chen, Ben-Yehuda, Leon) Department of Cardiology, Columbia University
College of Physicians and Surgeons, NY, NY, United States
(Chatterjee) Saint Francis Hospital of the University of Connecticut, CT,
Hartford, United States
(Torkian) Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, NY, NY, United States
(Prince) Department of Radiology, Weill Cornell Medical College& New York
Presbyterian Hospital, 416 East 55th Street, NY, NY 10022, United States
(Prince) Department of Radiology, Columbia University College of
Physicians and Surgeons, NY, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly
used to treat patients with severe aortic stenosis (AS). Cardiovascular
magnetic resonance imaging (CMR) provides reliable and reproducible
estimates for assessment of cardiac structure and function after TAVR. The
goal of this study was to conduct a systematic review and meta-analysis of
the literature to assess left ventricular (LV) volumes, mass and function
by CMR after TAVR. METHOD(S): Using Meta-analysis of Observational
Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase
for studies reporting CMR findings before and at least 1month after TAVR.
Main factors of interest were LV end-diastolic volume index (LVEDVi), LV
end-systolic volume index (LVESVi), LV mass index (LVMi), and left
ventricular ejection fraction (LVEF). Standardized mean differences (SMD)
were pooled by random effects meta-analytic techniques. RESULT(S): Of
453 screened publications, 10 studies (published between 2012 and 2018)
were included. A total of 305 patients completed pre- and post-TAVR
follow-up CMR (mean age range 78.6-85.0years, follow-up range 6-15months).
Random effects analysis showed TAVR resulted in reduced LVEDVi (SMD:
-0.25, 95% CI: -0.43 to -0.07, P=0.006), LVESVi (SMD: -0.24, 95% CI: -0.44
to -0.05, P=0.01), LVMi (SMD: -0.82, 95% CI: -1.0 to -0.63, P<0.001) and
increased LVEF (SMD: 22, 95% CI: 6 to 38%, P =0.006). Heterogeneity across
studies was low (I2: 0%, Pheterogeneity>0.05 for all). The median
reduction was 4ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5ml/m2 (IQR: 3.0 to
6.0) for LVESVi, and 15.1g/m2 (IQR: 11.8 to 18.3) for LVMi. The median
increase for LVEF was 3.4% (IQR 1.0 to 4.6%). CONCLUSION(S): CMR
demonstrates reverse LV remodeling occurrs within 6-15months after TAVR,
with reductions in LVEDVi, LVESVi and LVMi, and increased LVEF.

<50>
Accession Number
631939888
Title
The TEAMMATE Trial: Study Design and Rationale of the First Pediatric
Heart Transplant Randomized Clinical Trial.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S207-S208), 2020. Date of Publication: 01 Apr 2020.
Author
Almond C.; Sleeper L.A.; Rossano J.W.; Pahl E.; Lal A.K.; Castleberry
C.D.; Lee J.; Hollander S.; Klein G.; Barkoff L.M.; Bock M.; Fenton M.;
Daly K.P.
Institution
(Almond) Pediatric Cardiology, Stanford University School of Medicine,
Palo Alto, CA
(Sleeper, Klein) Boston Children's Hospital, MA, Boston
(Rossano) Children's Hospital of Philadelphia, Philadelphia, United States
(Pahl) Ann & Robert H. Lurie Children's Hospital, Chicago, Mexico
(Lal) of Utah Primary Children's Hospital, UT, Salt Lake City, United
States
(Castleberry) Washington University in St. Louis, St. Louis, MO
(Lee, Barkoff) Lucile Packard Children's Hospital Stanford, Palo Alto, CA
(Hollander) Stanford University School of Medicine, Palo Alto, CA
(Bock) Loma Linda University Children's Hospital, Loma Linda, CA
(Fenton) Great Ormond Street Hospital, London, United Kingdom
(Daly) Children's Hospital Boston, MA, Boston
Publisher
NLM (Medline)
Abstract
PURPOSE: Currently there are no-FDA approved immunosuppressants specific
to pediatric heart transplantation (HT). In recent years, everolimus (EVL)
has emerged as an alternative to tacrolimus (TAC) as a primary
immunosuppressant to prevent rejection that may also prevent kidney and
coronary disease. However, the two regimens have never been evaluated
systematically. METHOD(S): The TEAMMATE Trial (IND 127980) is
designed to evaluate the safety and efficacy of EVL and low-dose (LD-TAC)
compared to standard-therapy TAC and mycophenolate mofetil (MMF). The
study design and rationale are reviewed in light of challenges inherent in
rare disease research. RESULT(S): The TEAMMATE trial is the first
multicenter randomized clinical trial (RCT) in pediatric HT. The primary
purpose is to evaluate the risk-benefit profile of the two regimens to
prevent major adverse transplant events (MATE), and to support FDA
approval of 1 or both regimens for pediatric HT. Children <21 years at HT
will be randomized (1:1 ratio) at 6 mo. post-HT to either regimen for 30
months (Figure). Children with recurrent rejection or a GFR <60
ml/min/1.73m2 are excluded. The primary efficacy hypothesis is that
compared to TAC/MMF, EVL/LD-TAC is more effective in preventing 3 MATEs:
cellular rejection, CKD and CAV. The primary safety hypothesis is that
EVL/LD-TAC does not have a higher cumulative burden of 6 MATE (AMR,
infection, and PTLD+the 3 above). The primary endpoint is the MATE Score,
a surrogate endpoint reflecting the frequency and severity of MATEs and
validated against graft loss. The study will enroll 210 patients across 26
sites and is powered to demonstrate superior efficacy of EVL/LDTAC. The
trial is projected to be completed in 2022. CONCLUSION(S): The
TEAMMATE trial is the first RCT in pediatric HT. It is anticipated that
the study will provide important information about the safety and
effectiveness of EVL and TAC and provide valuable lessons into the design
and conduct of future trials in pediatric HT. Copyright © 2020.
Published by Elsevier Inc.

<51>
Accession Number
631939757
Title
Outcomes of Mechanical Circulatory Support after Giant Cell Myocarditis: A
Systematic Review.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S185), 2020. Date of Publication: 01 Apr 2020.
Author
Patel P.M.; Wood C.T.; O'Malley T.J.; Maynes E.J.; Pirlamarla P.R.;
Alvarez R.J.; Morris R.J.; Entwistle J.W.; Massey H.T.; Tchantchaleishvili
V.
Institution
(Patel, Wood, O'Malley, Maynes, Morris, Entwistle, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, United States
(Pirlamarla, Alvarez) Division of Cardiology, Thomas Jefferson University,
Philadelphia, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: Giant cell myocarditis (GCM) is a rare, serious form of
myocarditis that can require bridging to orthotopic heart transplant (OHT)
with mechanical circulatory support (MCS). Given that the roles of MCS and
immunosuppressive therapy have not been well defined in this patient
population, we sought to analyze the outcomes of patients with GCM who
required MCS. METHOD(S): A systematic search was performed in June
2019 to identify all studies of biopsy-proven GCM requiring MCS in the
English literature after 2009. 27 studies were identified consisting of 43
patients. Patient-level data were extracted for statistical analysis.
 RESULT(S): Median patient age was 45 [IQR: 32 - 57] years, and 42.1%
(16/38) of patients were female. 34.9% (15/43) of patients presented with
symptoms of acute heart failure, and 20.9% (9/43) presented in cardiogenic
shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases.
The final diagnosis of GCM was made using endomyocardial biopsy in 72.1%
(31/43) of cases, left ventricular apical core biopsy in 23.3% (10/43) of
cases, and biopsy of the explanted heart in 2.3% (1/43) of cases. An
immunosuppressive regimen was used in 62.8% (27/43) of cases. Of these
patients, 81.5% (22/27) received steroids in combination with at least one
other immunosuppressant, of which cyclosporine was the most common,
administered to 40.7% (11/27) of patients. Immunosuppression was initiated
before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27) of cases,
and not specified in 11.1% (3/27) of cases. Survival stratified by
immunosuppression (Panel A) and mode of MCS (Panel B) is shown. 58.5%
(24/41) underwent OHT with a median time to transplant of 104 [58 - 255]
days from diagnosis, and 46 [18 - 201] days from the initiation of MCS.
Recurrence of GCM after OHT was reported in 8.3% (2/24) of cases.
 CONCLUSION(S): Non-dischargeable BiVAD predominates in mechanically
supported patients with GCM. Survival appears to be better in patients on
immunosuppression, especially if initiated before MCS. Copyright
© 2020. Published by Elsevier Inc.

<52>
Accession Number
2004483066
Title
Effects of adding dexmedetomidine to local infiltration of bupivacaine on
postoperative pain in pediatric herniorrhaphy: A randomized clinical
trial.
Source
Korean Journal of Anesthesiology. 73 (3) (pp 212-218), 2020. Date of
Publication: June 2020.
Author
Azemati S.; Pourali A.; Aghazadeh S.
Institution
(Azemati, Pourali, Aghazadeh) Department of Anesthesiology and Intensive
Care Unit, Medical College, Shiraz University of Medical Sciences, Shiraz,
Iran, Islamic Republic of
Publisher
Korean Society of Anesthesiologists
Abstract
Background: Postoperative pain is a major problem, especially in children,
as their toler-ance level is lower and several drugs are contraindicated
in childhood. This study aimed to compare the effect of dexmedetomidine
added to local infiltration of bupivacaine for postoperative pain relief
in children undergoing inguinal herniorrhaphy. Method(s): This
double-blind, randomized clinical trial included 60 children aged 6-72
months undergoing unilateral herniorrhaphy at selected hospitals in
Shiraz, Iran, ran-domly allocated into two groups, 30 in each group. One
group received 1 micro g/kg dexme-detomidine plus local infiltration
of 0.2 ml/kg bupivacaine 0.5% at the incision site before surgery (BD),
and the other group received bupivacaine and normal saline (BO). Analgesic
requirements, emergence time, and nausea/vomiting, postoperative pain and
sedation scores were assessed for 4 h after the operation. Heart rate
(HR), systolic blood pressure (SBP), and oxygen saturation
(SaO<inf>2</inf>) were recorded at baseline, and at 10 and 20 min after
injection. Result(s): Eighty percent were boy in each group; mean age
was 22.75 +/- 18.63 months. SaO<inf>2</inf> and SBP were not different
between the groups, while HR was significantly lower in the Group BD at 10
and 20 min after injection (P < 0.05). Group BD had a lower pain score at
1 and 2 h after the operation, a higher sedation score at the first three
time inter-vals, and longer emergence time than Group BO (all P < 0.001).
Group BD had a lower pain score at 1 and 2 h after the operation (P <
0.001, P < 0.047 respectively). Conclusion(s): Addition of
dexmedetomidine to local infiltration of bupivacaine in children
undergoing herniorrhaphy significantly reduced postoperative pain and
increased sedation. Copyright © The Korean Society of
Anesthesiologists, 2020.

<53>
Accession Number
2005127274
Title
Expanding Use of New Technology Creates New Challenges in Preventing and
Managing Infections: a Review of Diagnostic and Management Considerations
for Infections Among Patients with Long-Term Invasive Devices for Advanced
Heart Failure.
Source
Current Infectious Disease Reports. 22 (6) (no pagination), 2020. Article
Number: 16. Date of Publication: 01 Jun 2020.
Author
Lee M.S.L.; Altman N.L.; Branch-Elliman W.
Institution
(Lee) Division of Infectious Diseases, Beth Israel Deaconess Medical
Center, Harvard Medical School, 110 Francis Street - Suite GB, Boston, MA
02215, United States
(Lee, Branch-Elliman) Harvard Medical School, Boston, MA, United States
(Altman) Division of Cardiology - Section of Advanced Heart Failure and
Transplantation, University of Colorado Anschutz Medical Campus,
University of Colorado School of Medicine, Aurora, CO, United States
(Branch-Elliman) Department of Medicine, VA Boston Healthcare System,
Harvard Medical School, 1400West Roxbury, Boston, MA 02132, United States
Publisher
Springer
Abstract
Purpose of the Review: Although still a relatively new technology,
long-term left ventricular assist devices (LVADs) for management of
advanced heart failure is rapidly increasing. Initially designed as a
bridge to transplant, these invasive devices are increasingly used as a
destination therapy, creating unique and long-term infection risks. The
aim of this comprehensive review is to highlight current evidence about
the prevention, diagnosis, and management of LVAD-specific infections.
Recent Findings: There are two recent, major societal guidelines (The
International Society for Heart and Lung Transplantation, 2017, and the
American Society of Transplantation, 2019) specifically on the diagnosis
and management of infections in LVAD patients. A third guideline from the
European Association for Cardio-Thoracic Surgery (2019) on general LVAD
management contains a section on infection management. Recommendations
tend to be concordant across the guidelines without major disagreements
and suggest that for superficial infections, limited-course durations of
antimicrobials are acceptable. For infections of deeper portions of the
device, long-term antimicrobial regimens, often with chronic suppressive
strategies remain the mainstay of treatment; however, this recommendation
is based primarily on expert opinion as high-quality evidence to support
best practices remains limited. The role of surgical management remains
unknown. Summary: Management of long-term, device-related infections
in patients with advanced heart failure is challenging and should include
input from a multi-disciplinary team of providers to determine the best
management strategy. A strong emphasis on best prevention practices is a
necessity. With this relatively new technology, evidence-based data to
guide best practices remains limited and is an important area of future
research. Copyright © 2020, This is a U.S. Government work and
not under copyright protection in the US; foreign copyright protection may
apply.

<54>
Accession Number
631881073
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) (no pagination), 2020. Article
Number: 218. 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, Haidian District, 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
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
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. Copyright © 2020 The Author(s).

<55>
Accession Number
2005145452
Title
Transcatheter aortic valve replacement in patients with a history of
cancer: Periprocedural and long-term outcomes.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Murphy A.C.; Koshy A.N.; Cameron W.; Horrigan M.; Kearney L.; Yeo B.;
Farouque O.; Yudi M.B.
Institution
(Murphy, Koshy, Cameron, Horrigan, Kearney, Farouque, Yudi) Department of
Cardiology, Austin Health, Melbourne, VIC, Australia
(Murphy, Koshy, Kearney, Farouque, Yudi) Department of Medicine, The
University of Melbourne, Melbourne, VIC, Australia
(Yeo) Department of Oncology, The Olivia Newton-John Cancer and Wellness
Centre, Melbourne, VIC, Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: A history of cancer is incorporated into the surgical risk
assessment of patients undergoing surgical aortic valve replacement
through the Society for Thoracic Surgeons score. However, the prognostic
significance of cancer in patients treated with transcatheter aortic valve
replacement (TAVR) is unclear. As the cancer survivorship population
increases, it is imperative to establish the efficacy and safety of TAVR
in patients with severe symptomatic aortic stenosis (AS) and a history of
malignancy. Objective(s): The primary goal of this study was to
assess the periprocedural outcomes and long-term mortality in patients
with a history of cancer undergoing TAVR. Method(s): A systematic
review of PubMed, MEDLINE, and EMBASE was conducted to identify studies
reporting outcomes in patients with a history of malignancy undergoing
TAVR. A meta-analysis was performed using a random-effects model with a
primary outcome of all-cause mortality and cardiac mortality at the
longest follow-up. On secondary analyses, procedural safety was assessed.
 Result(s): A total of 13 observational studies with 10,916 patients
were identified in the systematic review. Seven studies including 6,323
patients were included in the quantitative analysis. Short-term mortality
(relative risk [RR] 0.61, 95%CI 0.36-1.01; p =.06) and long-term all-cause
mortality (RR 1.24, 95%CI 0.95-1.63; p =.11) were not significantly
different when comparing patients with and without a history of cancer. No
significant difference in the rate of periprocedural complications
including stroke, bleeding, acute kidney injury, and pacemaker
implantation was noted. Conclusion(s): In patients with severe AS
undergoing TAVR, a history of cancer was not associated with adverse short
or long-term survival. Based on these findings, TAVR should be considered
in all patients with severe symptomatic AS, irrespective of their history
of malignancy. Copyright © 2020 Wiley Periodicals LLC.

<56>
Accession Number
2005109621
Title
Children's heart and COVID-19: Up-to-date evidence in the form of a
systematic review.
Source
European Journal of Pediatrics. (no pagination), 2020. Date of
Publication: 2020.
Author
Sanna G.; Serrau G.; Bassareo P.P.; Neroni P.; Fanos V.; Marcialis M.A.
Institution
(Sanna, Serrau, Neroni, Fanos, Marcialis) Neonatal Intensive Care Unit,
University of Cagliari, Cagliari, Italy
(Bassareo) Mater Misericordiae University Hospital and Our Lady's
Children's Hospital Crumlin, University College of Dublin, Dublin, Ireland
(Bassareo) Mater Misericordiae University Hospital, University College of
Dublin, Eccles St, Inns Quay, Dublin D07 R2WY, Ireland
Publisher
Springer
Abstract
The new coronavirus disease outbreak in 2019 (COVID-19) represents a
dramatic challenge for healthcare systems worldwide. As to viral tropism,
lungs are not the only COVID-19 target but also the heart may be involved
in a not negligible percentage of the infected patients.
Myocarditis-related cardiac dysfunction and potentially life-threatening
arrhythmias are the main aftermaths. A few studies showed that myocardial
injury in adult patients is often linked with a fatal outcome. Conversely,
scientific evidence in children is sparse, although several reports were
published with the description of a cardiac involvement in COVID-19
paediatric patients. In these young subjects, a background of surgically
treated congenital heart disease seems to be a predisposing factor.
 Conclusion(s): This systematic review is aimed at summarizing all
COVID-19 cases with a cardiac involvement published in paediatric age and
trying to explain the underlying mechanisms responsible for
COVID-19-related myocardial damage.What is Known:* Coronaviruses proved to
be able to jump from animals to humans.* The outbreak of COVID-19 started
from China (Dec 2019) and became pandemic.What is New:* Even in childhood,
COVID-19 is not without the risk of cardiac involvement.* Myocarditis,
heart failure, and arrhythmias are among the possible
manifestations. Copyright © 2020, Springer-Verlag GmbH Germany,
part of Springer Nature.

<57>
Accession Number
631971109
Title
Long-term effects of high-intensity training vs. moderate intensity
training in heart transplant recipients: A 3-year follow-up study of the
randomized controlled HITTS study.
Source
American journal of transplantation : official journal of the American
Society of Transplantation and the American Society of Transplant
Surgeons. (no pagination), 2020. Date of Publication: 02 Jun 2020.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Bjorkelund E.; Authen
A.R.; Grov I.; Broch K.; Gullestad L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Gude, Bjorkelund, Authen, Grov, Broch,
Gullestad, Nytroen) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Rolid, Andreassen, Yardley, Gullestad, Nytroen) Institute of Clinical
Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(Rolid, Yardley) Norwegian Health Association, Oslo, Norway
(Rolid, Broch, Gullestad, Nytroen) KG Jebsen Center for Cardiac Research,
University of Oslo, Norway and the Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
Publisher
NLM (Medline)
Abstract
The randomized controlled High-Intensity Interval Training in De Novo
Heart Transplant Recipients in Scandinavia (HITTS) study compared 9 months
of high-intensity interval training (HIT) with moderate intensity
continuous training in de novo heart transplant recipients. In our 3-year
follow-up study, we aimed to determine whether the effect of early
initiation of HIT on peak oxygen consumption (VO2peak ) persisted for 2
years post-intervention. The study's primary endpoint was the change in
VO2peak (mL/kg/min). The secondary endpoints were muscle strength, body
composition, heart rate response, health-related quality of life, daily
physical activity, biomarkers and heart function. Of 78 patients who
completed the 1-year HITTS trial, 65 entered our study and 62 completed
the study tests. VO2peak increased from baseline to 1 year and levelled
off thereafter. During the intervention period, the increase in VO2peak
was larger in the HIT arm; however, 2 years later, there was no
significant between-group difference in VO2peak . However, the mean change
in the anaerobic threshold and extensor muscle endurance remained
significantly higher in the HIT group. Early initiation of HIT after heart
transplantation appears to have some sustainable long-term effects.
Clinical trial registration number: NCT01796379. Copyright This
article is protected by copyright. All rights reserved.

<58>
Accession Number
631966561
Title
Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical
Trials of Left Main Coronary Artery Revascularization.
Source
JAMA Internal Medicine. (no pagination), 2020. Date of Publication: 2020.
Author
Brophy J.M.
Institution
(Brophy) McGill University Health Center, Montreal, QC, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Patients with left main coronary artery disease have improved
outcomes with coronary revascularization compared with medical therapy,
but the choice of optimal revascularization technique is unresolved.
 Objective(s): To use bayesian methods to analyze the risk differences
for patients with left main coronary artery disease randomized to
treatment with coronary artery bypass surgery (CABG) compared with those
randomized to percutaneous coronary intervention (PCI) in recent
randomized clinical trials (RCTs). Design, Setting, and
Participant(s): A systematic review using the PubMed database with the
query string "(left main disease) and (PCI or CABG) and (5-year follow-up)
and (clinical trial)" identified all RCTs from January 1996 to January
2020 comparing CABG to PCI for treatment of patients with left main
coronary artery disease and with 5-year follow-up data. With the use of
bayesian methods, the largest and most publicized RCT (EXCEL; Evaluation
of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left
Main Revascularization; 2019) was reanalyzed (1) as an isolated entity
using noninformative priors and (2) in the context of previous knowledge
using informative priors derived from similar trials. Published aggregate
data were used with assignments from each trial following the original
intention-to-treat principle. Combining EXCEL data with varying levels of
prior information using Bayes theorem provided final (posterior)
probability distributions for primary and secondary outcomes. Main
Outcomes and Measures: A composite end point of death, nonfatal myocardial
infarction, and stroke was the primary EXCEL outcome and was accordingly
the primary outcome for this reanalysis. Secondary analyses were performed
for isolated all-cause mortality and for the composite outcome along with
repeated revascularization procedures. Result(s): When EXCEL data
were analyzed using the originally stated noninferiority design, the
5-year primary outcome difference reported (2.8%; 95% CI, -0.9% to 6.5%)
exceeded the predefined 4.2% noninferiority margin; thus, the null
hypothesis of PCI inferiority could not be rejected. By contrast, the
present bayesian analysis of the EXCEL primary outcome estimated 95%
probability that the 5-year primary outcome difference was increased with
PCI compared with CABG and 87% probability that this difference was
greater than 1 extra event per 100 patients treated. Bayesian analyses
also suggested 99% probability that EXCEL total mortality was increased
with PCI and 94% probability that this absolute difference exceeded 1
extra deaths per 100 treated. A systematic review identified 3 other RCTs
that studied the same question. The incorporation of this prior knowledge
reduced the estimated probability of any excess mortality with PCI to 85%.
For the secondary composite end point, which also included repeated
revascularizations, there were estimated probabilities of 98% for at least
4 extra events and of 90% for at least 5 extra events per 100 patients
treated with PCI. Conclusions and Relevance: Bayesian analysis
assisted in RCT data interpretation and specifically suggested, whether
based on EXCEL results alone or on the totality of available evidence,
that PCI was associated with inferior long-term results for all events,
including mortality, compared with CABG for patients with left main
coronary artery disease.. Copyright © 2020 American Medical
Association. All rights reserved.

<59>
Accession Number
631949896
Title
Characteristics of Contemporary Randomized Clinical Trials and Their
Association with the Trial Funding Source in Invasive Cardiovascular
Interventions.
Source
JAMA Internal Medicine. (no pagination), 2020. Date of Publication: 2020.
Author
Gaudino M.; Hameed I.; Rahouma M.; Khan F.M.; Tam D.Y.; Biondi-Zoccai G.;
Demetres M.; Charlson M.E.; Ruel M.; Crea F.; Falk V.; Girardi L.N.;
Fremes S.; Chikwe J.
Institution
(Gaudino, Hameed, Rahouma, Khan, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Biondi-Zoccai) IRCCS Neuromed, Pozzilli, Italy
(Demetres) Samuel J. Wood Library and C. V. Starr Biomedical Information
Centre, Weill Cornell Medicine, New York, NY, United States
(Charlson) Division of General Internal Medicine, Weill Cornell Medical
College, New York, NY, United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Crea) Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
(Crea) Department of Cardiovascular and Thoracic Sciences, Universita
Cattolica de Sacro Cuore, Roma, Italy
(Falk) Department of Cardiovascular Surgery, Charite, Berlin, Germany
(Falk) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Falk) German Center for Cardiovascular Research, Berlin, Germany
(Falk) Department of Health Science and Technology, Swiss Federal
Institute of Technology, Zurich, Switzerland
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Changes in evidence-based practice and guideline
recommendations depend on high-quality randomized clinical trials (RCTs).
Commercial device and pharmaceutical manufacturers are frequently involved
in the funding, design, conduct, and reporting of trials, the implications
of which have not been recently analyzed. Objective(s): To evaluate
the design, outcomes, and reporting of contemporary randomized clinical
trials of invasive cardiovascular interventions and their association with
the funding source. Design, Setting, and Participant(s): This
cross-sectional study analyzed published RCTs between January 1, 2008, to
May 31, 2019. The trials included those involving coronary, vascular and
structural interventional cardiology, and vascular and cardiac surgical
procedures. Main Outcomes and Measures: We assessed (1) trial
characteristics, (2) finding of a statistically significant difference in
the primary end point favoring the experimental intervention, (3)
reporting of implied treatment advantage in trials without significant
differences in primary end point, (4) existence of major discrepancies
between registered and published primary outcomes, (5) number of patients
whose outcomes would need to switch from a nonevent to an event to convert
a significant difference in primary end point to nonsignificant, and (6)
association with funding source. Result(s): Of the 216 RCTs analyzed,
115 (53.2%) reported having commercial sponsorship. Most trials had 80%
power to detect an estimated treatment effect of 30%, and 128 trials
(59.3%) used composite primary end points. The median (interquartile range
[IQR]) sample size was 502 (204-1702) patients, and the median (IQR)
follow-up duration was 12 (1.0-14.4) months. Overall, 123 trials (57.0%)
reported a statistically significant difference in the primary outcome
favoring the experimental intervention; reporting strategies that implied
an advantage were identified in 55 (65.5%) of 84 trials that reported
nonsignificant differences. Commercial sponsorship was associated with a
statistically significantly greater likelihood of favorable outcomes
reporting (exponent of regression coefficient beta, 2.80; 95% CI,
1.09-7.18; P =.03) and with the reporting of findings that are
inconsistent with the trial results. Discrepancies between the registered
and published primary outcomes were found in 82 trials (38.0%), without
differences in trial sponsorship. A median (IQR) number of 5 (2.8-12.5)
patients experiencing a different outcome would have change statistically
significant results to nonsignificant. Commercial sponsorship was
associated with a greater number of patients (exponent of regression
coefficient beta, 1.29; 95% CI, 1.00-1.66; P =.04). Conclusions and
Relevance: These results suggest that contemporary RCTs of invasive
cardiovascular interventions are relatively small and fragile, have short
follow-up, and have limited power to detect large treatment effects.
Commercial support appeared to be associated with differences in trial
design, results, and reporting.. Copyright © 2020 Cambridge
University Press. All rights reserved.

<60>
Accession Number
2005524071
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
for myocardial infarction complicated by cardiogenic shock.
Source
American Heart Journal. (no pagination), 2020. Date of Publication: 2020.
Author
Smilowitz N.R.; Alviar C.L.; Katz S.D.; Hochman J.S.
Institution
(Smilowitz, Alviar, Katz, Hochman) Leon H. Charney Division of Cardiology,
Department of Medicine, New York University School of Medicine, New York,
NY, United States
(Smilowitz) Division of Cardiology, Department of Medicine, New York, NY,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Myocardial infarction (MI) complicated by cardiogenic shock
(CS) is associated with high mortality. Early coronary revascularization
improves survival, but the optimal mode of revascularization remains
uncertain. We sought to characterize practice patterns and outcomes of
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in patients with MI complicated by CS. Method(s):
Patients hospitalized for MI with CS between 2002 and 2014 were identified
from the United States National Inpatient Sample. Trends in management
were evaluated over time. Propensity score matching was performed to
identify cohorts with similar baseline characteristics and MI
presentations who underwent PCI and CABG. The primary outcome was
in-hospital all-cause mortality. Result(s): A total of 386,811
hospitalizations for MI with CS were identified; 67% were STEMI. Overall,
62.4% of patients underwent revascularization, with PCI in 44.9%, CABG in
14.1%, and a hybrid approach in 3.4%. Coronary revascularization for MI
and CS increased over time, from 51.5% in 2002 to 67.4% in 2014 (P for
trend < .001). Patients who underwent CABG were more likely to have
diabetes mellitus (35.5% vs. 29.2%, P < .001) and less likely to present
with STEMI (48.7% vs. 80.9%, P < .001) than those who underwent PCI. CABG
(without PCI) was associated with lower mortality than PCI (without CABG)
overall (18.9% vs. 29.0%, P < .001) and in a propensity-matched subgroup
of 19,882 patients (19.0% vs. 27.0%, P < .001). Conclusion(s): CABG
was associated with lower in-hospital mortality than PCI among patients
with MI complicated by CS. Due to the likelihood of residual confounding,
a randomized trial of PCI versus CABG in patients with MI, CS, and
multi-vessel coronary disease is warranted. Copyright © 2020

<61>
Accession Number
2005516606
Title
Enhanced Recovery After Surgery: A Narrative Review of its Application in
Cardiac Surgery.
Source
Annals of Thoracic Surgery. 109 (6) (pp 1937-1944), 2020. Date of
Publication: June 2020.
Author
Baxter R.; Squiers J.; Conner W.; Kent M.; Fann J.; Lobdell K.; DiMaio
J.M.
Institution
(Baxter, Squiers) Department of Surgery, Baylor University Medical Center,
Dallas, TX, United States
(Conner) Cardiothoracic and Vascular Surgeons, PA, Austin, TX, United
States
(Kent) Division of Thoracic Surgery, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Fann) Department of Cardiothoracic Surgery, Stanford University Medical
Center, Stanford, CA, United States
(Lobdell) Sanger Heart and Vascular Institute, Atrium Health, Charlotte,
NC, United States
(DiMaio) Department of Surgery, Baylor Scott and White, The Heart
Hospital, Plano, TX, United States
Publisher
Elsevier USA
Abstract
Background: Enhanced Recovery After Surgery (ERAS) is a perioperative
patient management strategy that is being adopted rapidly across surgical
specialties worldwide. Components of ERAS work collaboratively throughout
the perioperative course to achieve significant benefits for both the
patient and the entire health care system. The use of ERAS in cardiac
surgery (ERAS-C) could lead to similar improvements, but currently, use of
ERAS-C programs is lacking and not well defined. Method(s): A
literature search was performed of the Medline database to capture
relevant studies discussing ERAS-C. Key concepts were extracted from these
articles and grouped according to appropriate perioperative stages.
Supporting literature was also included, briefly discussing the historical
progression of cardiac surgery to enhanced recovery pathways, potential
limitations to these pathways in cardiac surgery, and the first studies
evaluating the use of an ERAS program with cardiac surgery patients.
 Result(s): Initial results of ERAS-C studies have shown similar
benefits to those of other surgical fields, including decreased hospital
and intensive care unit lengths of stay (1-4 days and 4-20 hours,
respectively), improved perioperative pain control (25%-60% decreased
opioid usage), and improvements in early postoperative mobility and oral
diets. Results especially beneficial to cardiac surgery have also been
reported, such as an 8% to 14% decreased incidence of postoperative atrial
fibrillation. Conclusion(s): This review presents pertinent current
research related to the implementation of ERAS programs in the field of
cardiac surgery and provides a call to action for further investigation
and adaption of ERAS in cardiac surgery. Copyright © 2020 The
Society of Thoracic Surgeons

<62>
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

<63>
Accession Number
2004630460
Title
Extending inferences from a randomized trial to a new target population.
Source
Statistics in Medicine. 39 (14) (pp 1999-2014), 2020. Date of Publication:
30 Jun 2020.
Author
Dahabreh I.J.; Robertson S.E.; Steingrimsson J.A.; Stuart E.A.; Hernan
M.A.
Institution
(Dahabreh, Robertson) Center for Evidence Synthesis in Health, Brown
University, Providence, RI, United States
(Dahabreh, Robertson) Department of Health Services, Policy & Practice,
Brown University, Providence, RI, United States
(Dahabreh) Department of Epidemiology, Brown University, Providence, RI,
United States
(Dahabreh, Hernan) Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA, United States
(Steingrimsson) Department of Biostatistics, School of Public Health,
Brown University, Providence, RI, United States
(Stuart) Departments of Mental Health, Biostatistics, and Health Policy
and Management, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, United States
(Hernan) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Hernan) Harvard-MIT Division of Health Sciences and Technology, Boston,
MA, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
When treatment effect modifiers influence the decision to participate in a
randomized trial, the average treatment effect in the population
represented by the randomized individuals will differ from the effect in
other populations. In this tutorial, we consider methods for extending
causal inferences about time-fixed treatments from a trial to a new target
population of nonparticipants, using data from a completed randomized
trial and baseline covariate data from a sample from the target
population. We examine methods based on modeling the expectation of the
outcome, the probability of participation, or both (doubly robust). We
compare the methods in a simulation study and show how they can be
implemented in software. We apply the methods to a randomized trial nested
within a cohort of trial-eligible patients to compare coronary artery
surgery plus medical therapy versus medical therapy alone for patients
with chronic coronary artery disease. We conclude by discussing issues
that arise when using the methods in applied analyses. Copyright
© 2020 John Wiley & Sons, Ltd.

<64>
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.

<65>
[Use Link to view the full text]
Accession Number
631945823
Title
The serratus anterior plane block for analgesia after thoracic surgery: A
meta-analysis of randomized controlled trails.
Source
Medicine. 99 (21) (pp e20286), 2020. Date of Publication: 22 May 2020.
Author
Liu X.; Song T.; Xu H.-Y.; Chen X.; Yin P.; Zhang J.
Institution
(Liu, Song, Xu) Department of Anesthesiology, First Hospital of Jilin
University, Changchun, Jilin, China
(Chen) Department of Anesthesiology, China-Japan Friendship Hospital,
Beijing, China
(Yin) Department of Anesthesiology, Second Hospital of Shanxi Medical
University, Taiyuan, China
(Zhang) Department of Ophthalmology, First Hospital of Jilin University,
Changchun, Jilin, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The serratus anterior plane (SAP) block is a newer method that
can be used in patients undergoing thoracic surgeries. The postoperative
analgesia efficacy of SAP blocks for thoracic surgery remains
controversial. We conduct a meta-analysis to evaluate the analgesia of SAP
blocks after thoracic surgery. METHOD(S): We searched PubMed, Embase,
EBSCO, the Cochrane Library, Web of Science, and CNKI for randomized
controlled trials (RCTs) regarding the postoperative pain control of a SAP
block on thoracic surgery. All of the dates were screened and evaluated by
two researchers and meta-analysis was performed using RevMan5.3 software.
 RESULT(S): A total of 8 RCTs involving 542 patients were included.
The meta-analysis showed statistically significant differences between the
two groups with respect to postoperative pain scores at 2 h (standardized
mean difference [Std.MD] = -1.26; 95% confidence interval [CI] = -1.66 to
-0.86; P < .0001); 6 h (SMD = -0.50; 95%CI = -0.88 to -0.11; P = .01); 12
h (SMD = -0.63; 95%CI = -1.10 to -0.16; P = .009); 24 h (SMD = -0.99;
95%CI = -1.44 to -0.51; P < .0001); postoperative opioid consumption at 24
h (SMD = -0.83; 95%CI = -1.10 to -0.56; P < .00001); and postoperative
nausea and vomiting (PONV) rates (RR = 0.39; 95% CI = 0.21-0.73; P =
.003). CONCLUSION(S): The SAP block can play an important role in the
management of pain after thoracic surgery by reducing both pain scores and
24-h postoperative opioids consumption. In addition, there is fewer
incidence of PONV in the SAP block group.

<66>
Accession Number
631940079
Title
Extracorporeal Membrane Oxygenation for Early Graft Dysfunction Following
Heart Transplantation: 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
S418-S419), 2020. Date of Publication: 01 Apr 2020.
Author
Aleksova N.; Billia F.; Foroutan F.; Buchan T.A.; Bielecki J.;
Vishram-Nielsen J.K.; Alvarez J.; Kinsella A.; Clark K.; Zhu A.; Lau K.;
McGuinty C.; Francis T.; Stanimirovic A.; Malik A.; Posada J.G.D.; Fan E.;
Rac V.; Rao V.; Ross H.J.; Alba A.C.
Institution
(Aleksova, Billia, Foroutan, Buchan, Vishram-Nielsen, Alvarez, Kinsella,
Clark, Zhu, Lau, McGuinty, Malik, Posada, Rao, Ross, Alba) Peter Munk
Cardiac Centre, Toronto General Hospital-University Health Network, ON,
Toronto, Canada
(Bielecki, Francis, Stanimirovic, Rac) Ted Rogers Centre of Health
Research - Peter Munk Cardiac Centre, University of Toronto, ON, Toronto,
Canada
(Fan) Toronto General Hospital-University Health Network, ON, Toronto,
Canada
Publisher
NLM (Medline)
Abstract
PURPOSE: Early graft dysfunction (EGD) is a major cause of morbidity and
mortality following heart transplantation (HT). The rate of severe EGD
requiring inotropes and/or mechanical circulatory support such as
veno-arterial extracorporeal membrane oxygenation (VA ECMO) ranges from
8-20%. Our objective was to systematically review studies that reported on
mortality in adult HT recipients who developed severe EGD requiring VA
ECMO and conduct a meta-analysis. METHOD(S): A systematic search of
the literature was conducted until June 1, 2019. Eligible studies included
full texts and abstracts published after 2009, >=10 adults post-HT who
developed EGD requiring VA ECMO and reported on mortality. The primary
outcome of short-term mortality was defined as death at 30 days and/or
hospital discharge and was analysed using a random effects model. A
meta-regression analysis to explore heterogeneity based on a priori
defined factors was performed. The quality of the evidence was assessed
using the GRADE framework. RESULT(S): Of 17 305 publications
screened, 22 observational studies identified 242 deaths in 670 patients
from 1987-2018 (Figure). 21 studies (95%) were retrospective and most
(86%) were conducted at a single centre. The quality of the evidence was
rated as moderate. 14 studies (64%) included patients requiring VA ECMO
within 24h post-HT; the rest included an extended early post-HT period (up
to 7 days). The median age of patients was 49 yrs (IQR 36-62), 18% (IQR
13-29) were female, 47% (IQR 39-77) had a prior sternotomy, and ischemic
time was 198 (IQR 191-224) min. Pooled short-term mortality was 36.8% (95%
CI 28.7-43.3, I2 =70%). In the meta-regression, short-term mortality was
higher in studies with a higher proportion of females. CONCLUSION(S):
The use of VA ECMO for EGD post-HT is associated with significant clinical
benefit with acceptable short-term survival. Future studies are needed to
identify factors that may further improve outcomes for patients who
experience EGD. Copyright © 2020. Published by Elsevier Inc.

<67>
Accession Number
631940004
Title
Infection-Related Morbidity with Continuous-Flow Left Ventricular Assist
Systems: A Comprehensive Analysis of the Randomized MOMENTUM 3 Trial.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S45), 2020. Date of Publication: 01 Apr 2020.
Author
Patel C.B.; Bailey S.H.; Blue L.; Cagliostro B.; Entwistle J.W.; John R.;
Thohan V.; Su X.; Somo S.I.; Sood P.; Mehra M.R.
Institution
(Patel, Blue) Duke University Medical Center, Durham
(Bailey) Allegheny General Hospital, Pittsburg, United States
(Cagliostro) New York-Presbyterian/Columbia University Medical Center, NY,
NY
(Entwistle) Thomas Jefferson University Hospital, Philadelphia, United
States
(John) University of Minnesota Medical Center, MN, Minneapolis, United
States
(Thohan) Mission Health System, Asheville, United States
(Su, Somo, Sood) Abbott Park, Abbott, United States
(Mehra) Brigham and Women's Hospital, MA, Boston
Publisher
NLM (Medline)
Abstract
PURPOSE: The MOMENTUM 3 trial established superiority of a fully
magnetically-levitated HeartMate 3 (HM3) centrifugal pump over the axial
flow HeartMate II (HMII) pump on hemocompatibility-related outcomes.
Infection-related outcomes were no different between the two devices. We
sought to understand the types of infection, temporal trends, clinical
correlates and risk markers over 2-years of support. METHOD(S):
MOMENTUM 3 randomized 1020 patients to either the HM 3 (515) or HM II
(505) groups. Morbidity and mortality related outcomes were analyzed
between patients with or without major infection complications. Cox
regression analyses were utilized to identify characteristics associated
with major infectious complications. RESULT(S): The cumulative number
of infections was 1213 (634 HM3 and 579 HMII), and major infection
occurred in 58% HM3 and 56% HMII patients (p=0.57). Localized infections
unrelated to pump components were most common (n=681/1213; 56%), followed
by driveline infection (n=329/1213; 27%), sepsis (n=194/1213; 16%), and
other events (n=9/1213; 0.7%). Bacterial pathogens were implicated in
806/1213 events (66%) and significant predictors of infection included
gender (men vs. women; HR:0.73, p=0.003), BUN (HR:1.12, p=0.01),
preimplant history of cardiac surgery (HR:1.28, p=0.01), and BMI>=30
(HR:1.43, p<0.0001). Most deaths in those with infection ultimately
occurred due to non-infectious causes (Figure). CONCLUSION(S):
Infection is the commonest adverse effect in patients implanted with
contemporary continuous-flow pumps with most such events presenting as
events unrelated to the pump components. Whether mechanical circulatory
devices confer an immunosuppressive effect leading to propensity for
infection warrants closer scrutiny to understand and ameliorate this
morbidity. (Funded by Abbott; MOMENTUM 3 NCT02224755). Copyright
© 2020. Published by Elsevier Inc.

<68>
Accession Number
631939758
Title
Mortality in Patients with Cardiogenic Shock Supported with Veno-Arterial
Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Evaluating the Impact of Etiology.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. S. 39 (4) (pp
S186), 2020. Date of Publication: 01 Apr 2020.
Author
Alba A.C.; Foroutan F.; Buchan T.A.; Alvarez J.; Kinsella A.; Clark K.;
Lau K.; Zhu A.; McGuinty C.; Aleksova N.; Vishram-Nielsen J.; Malik A.;
Francis T.; Stanimirovic A.; Bielecki J.; Fan E.; Rao V.; Ross H.J.; Rac
V.; Billia F.
Institution
(Alba, Foroutan, Buchan, Alvarez, Kinsella, Clark, Lau, Zhu, McGuinty,
Aleksova, Vishram-Nielsen, Malik, Fan, Rao, Ross, Rac, Billia) Peter Munk
Cardiac Centre - Toronto General Hospital, ON, Toronto, Canada
(Francis, Stanimirovic, Bielecki) Institute of Health Policy, Management
and Evaluation - University of Toronto, ON, Toronto, Canada
Publisher
NLM (Medline)
Abstract
PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is
associated with improved outcomes in patients with cardiogenic shock (CS).
However, studies evaluating its benefit have reported contradictory
results. One of the main factors impacting outcomes is likely related to
etiology of CS. This meta-analysis aimed to evaluate mortality after
VA-ECMO across multiple etiologies of CS. METHOD(S): In June 2019, we
systematically searched for studies in electronic databases and references
of previous meta-analyses. We selected observational studies with >=10
adults patients reporting on short-term mortality (30 days or discharge)
after the initiation of VA-ECMO by CS etiology published after 2009. We
meta-analyzed mortality using random effect models and performed
meta-regression to evaluate the impact of CS etiology and other study
characteristics. We evaluated the quality of the evidence using the GRADE
tool. RESULT(S): We included 342 studies (29,515 patients) with CS
due to myocarditis (11 studies, 846 patients), acute myocardial infarction
- AMI (66 studies, 3,849 patients), decompensated heart failure-HF (30
studies, 3,251 patients), post-heart transplant (23 studies, 703
patients), post-cardiotomy (93 studies, 12,076 patients), and post-cardiac
arrest-CA (119 studies, 8,790 patients). Studies on myocarditis included
younger populations (median age 47 years, 25th - 75th percentile 43-53),
and higher proportion of female patients (48%). Studies on AMI and
post-cardiotomy reported older population age (61 years, 56-65). Pooled
mortality was significantly different by CS etiology: in post-heart
transplant 36% (95%CI 29%-43%), myocarditis 41% (34%-47%), HF 51%
(44%-58%), post-cardiotomy 58% (55%-62%), post-AMI 60% (56%-64%),
post-in-hospital CA 63% (56%-69%), and post-out-of-hospital CA 76%
(69%-82%). Differences in age, sex and recruitment time across studies did
not explain the differences in mortality in patients with different CS
etiology. The quality of the evidence was deemed moderate.
 CONCLUSION(S): The benefit of VA-ECMO differs significantly depending
on CS etiology. Further studies evaluating other factors impacting
mortality in each patient population may further refine patient selection
and management to improve short-term outcomes. Copyright © 2020.
Published by Elsevier Inc.

<69>
Accession Number
2006057947
Title
The Quality of Peer-Reviewed Publications on Surgery for Early Stage Lung
Cancer Within the Veterans Health Administration.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Welp A.M.; Abbott S.E.; Samson P.; Cameron R.B.; Cornwell L.D.; Harpole
D.; Moghanaki D.
Institution
(Welp) Virginia Commonwealth University School of Medicine, Richmond, VA,
United States
(Abbott) Hunter Holmes McGuire VA Medical Center, Richmond, VA, United
States
(Samson) Department of Radiation Oncology, Washington University in St.
Louis/Barnes-Jewish Hospital, St. Louis, MO, United States
(Cameron) Division of Cardiothoracic Surgery, Department of Surgery,
University of California Los Angeles, Los Angeles, CA, United States
(Cameron) Department of Cardiothoracic Surgery, West Los Angeles VA
Medical Center, Los Angeles, CA, United States
(Cornwell) Division of Cardiothoracic Surgery, Department of Surgery,
Baylor College of Medicine, Houston, TX, United States
(Cornwell) Operative Care Line, Michael E. DeBakey VA Medical Center,
Houston, TX, United States
(Harpole) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Harpole) Department of Cardiothoracic Surgery, Durham VA Medical Center,
Durham, NC, United States
(Moghanaki) Department of Radiation Oncology, Emory University School of
Medicine, Atlanta, Georgia, Georgia
(Moghanaki) Department of Radiation Oncology, Atlanta VA Health Care
System, Decatur, Georgia, Georgia
Publisher
W.B. Saunders
Abstract
The peer-reviewed literature is often referenced to generalize outcomes
for lung cancer surgeries performed within the Veterans Health
Administration (VHA) and include assessments following resection of early
stage non-small-cell lung cancer (NSCLC). We sought to determine the
reliability of these reports that are publicly available. A systematic
review was undertaken to identify PubMed indexed articles that report
postoperative outcomes following surgical resections for stage I NSCLC
within the VHA. Only studies that reported American Joint Committee on
Cancer staging were included. Eleven studies spanning 49 years (1966-2015)
met the inclusion criteria. Two reported findings from national VHA
databases while 9 reported outcomes from single institutions. Reporting of
outcomes and prognostic factors varied widely between studies and were
frequently omitted. This made it difficult to evaluate prognostic factors
that may be associated with a wide range of 30- and 90-day perioperative
mortality (0-3.8% and 0-6.4%), 3- and 5-year cause-specific survival
(72-92% and 32-84%), and 3- and 5- year overall survival (47-85.7% and
24-74%). The quality of peer-reviewed literature that reports outcomes
following thoracic surgery for stage I NSCLC in the VHA is inconsistent
and precludes accurate assessments for generalizations about the quality
of care in this healthcare system. Efforts to develop a dedicated outcome
tracking and registry system can provide more meaningful evidence to
identify areas for improvement for this often-curable
malignancy. Copyright © 2020

<70>
Accession Number
631946250
Title
Will urinary biomarkers provide a breakthrough in diagnosing cardiac
surgery-associated AKI? - A systematic review.
Source
Biomarkers : biochemical indicators of exposure, response, and
susceptibility to chemicals. (pp 1-40), 2020. Date of Publication: 01 Jun
2020.
Author
Hussain M.L.; Hamid P.F.; Chakane N.
Institution
(Hussain, Hamid, Chakane) Medical Researcher at California Institute of
Behavioural Neurosciences and Psychology, CA, United States
Publisher
NLM (Medline)
Abstract
Introduction: Acute kidney injury following cardiac surgery is a dreaded
complication contributing to early mortality. Diagnosing AKI using serum
creatinine usually results in a delay. To combat this, certain kidney
damage specific biomarkers were investigated to identify if they can serve
as early predictors of cardiac surgery-associated AKI (CSA-AKI). This
study systematically reviews three such biomarkers; NGAL, tissue inhibitor
of matrix metalloproteinase-2 (TIMP-2) and insulin-like growth factor
binding protein-7 (IGFBP7) to identify if they can serve as early
predictors of CSA-AKI. Method(s): Systematic search was carried out
on literature reporting the diagnostic ability of the three biomarkers
from databases in accordance with PRISMA guidelines. Result(s): We
found 43 articles reporting urinary-NGAL levels (n=34 in adults, n=9 in
children) and 10 studies reporting TIMP-2 and IGFBP7 levels among adults.
Interestingly, NGAL showed high diagnostic value in predicting AKI in
children (seven among nine studies with AUROC >0.8). The cell cycle arrest
biomarkers, namely TIMP-2 and IGFBP7, showed high diagnostic value in
predicting AKI in adults (five among ten studies with AUROC >0.8).
 Conclusion(s): In predicting CSA-AKI; the diagnostic value of NGAL is
high in the pediatric population while the diagnostic value of TIMP-2 and
IGFBP7 is high in adults.

<71>
Accession Number
631945488
Title
Current perspective on fibrinogen concentrate in critical bleeding.
Source
Expert review of clinical pharmacology. (no pagination), 2020. Date of
Publication: 01 Jun 2020.
Author
Leal-Noval S.R.; Fernandez Pacheco J.; Casado Mendez M.; Cuenca-Apolo D.;
Munoz-Gomez M.
Institution
(Leal-Noval) Neuro Critical Care department. University Hospital "Virgen
del Rocio" and Institute of Biomedicine "IBIS", Avda Manuel Siurot s/n,
Seville 41013, Spain
(Fernandez Pacheco) Pharmacy and Statistics and Design, University
Hospital "Virgen del Rocio" and Institute of Biomedicine "IBIS", Avda
Manuel Siurot s/n, Seville 41013, Spain
(Casado Mendez, Cuenca-Apolo) Critical Care department. University
Hospital "Virgen del Rocio" and Institute of Biomedicine "IBIS", Avda
Manuel Siurot s/n, Seville 41013, Spain
(Munoz-Gomez) Department of Surgical Specialties, Biochemistry and
Immunology, University of Malaga, Campus Teatinos s/n, Malaga 29071, Spain
Publisher
NLM (Medline)
Abstract
INTRODUCTION: . Massive hemorrhage continues to be a treatable cause of
death. Its management varies from prefixed ratio-driven administration of
blood components to goal-directed therapy based on point-of-care testing
and administration of coagulation factor concentrates. AREAS COVERED: . We
review the current role of fibrinogen concentrate (FC) for the management
of massive hemorrhage, either administered without coagulation testing in
life-threatening hemorrhage, or within an algorithm based on viscoelastic
hemostatic assays and plasma fibrinogen level. We identified relevant
guidelines, meta-analyses, randomized controlled trials, and observational
studies that included indications, dosage, and adverse effects of FC,
especially thromboembolic events. EXPERT OPINION: . Moderate- to
high-grade evidence supports the use of FC for the treatment of severe
hemorrhage in trauma and cardiac surgery; a lower grade of evidence is
available for its use in postpartum hemorrhage and end-stage liver
disease. Pre-emptive FC administration in non-bleeding patients is not
recommended. FC should be administered early, and in a goal-directed
manner, guided by early amplitude of clot firmness parameters (A5- or
A10-FIBTEM) or hypofibrinogenemia. Further investigation is required into
the early use of FC, as well as its potential advantages over
cryoprecipitate, and whether or not its administration at high doses leads
to a greater risk of adverse events.

<72>
Accession Number
631945477
Title
Subclinical leaflet thrombosis after transcatheter aortic valve
replacement: a meaningless finding? A systematic review and meta-analysis.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2020. Date of Publication: 01 Jun 2020.
Author
Casula M.; Fortuni F.; Ferlini M.; Mauri S.; Rebuffi C.; Rossini R.;
Ferrario M.; Visconti L.O.
Institution
(Casula, Fortuni, Visconti) Coronary Care Unit, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Casula, Fortuni) Department of Molecular Medicine, University of Pavia,
Pavia, Italy
(Ferlini, Mauri, Ferrario, Visconti) Division of Cardiology - Fondazione
IRCCS Policlinico San Matteo, Pavia, Italy
(Rebuffi) Scientific documentation center - Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
(Rossini) Cardiologia, Ospedale Santa Croce e Carle, Cuneo, Italy
Publisher
NLM (Medline)

EPICORE Embase Updates

Saturday, June 13, 2020

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

No comments:

Post a Comment

Followers

Blog Archive

About Me