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<1>
Accession Number
2005726961
Title
Volatile Anesthesia Versus Total Intravenous Anesthesia During
Cardiopulmonary Bypass: A Narrative Review on the Technical Challenges and
Considerations.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Yeoh C.J.; Hwang N.C.
Institution
(Yeoh, Hwang) Department of Anaesthesiology, Singapore General Hospital,
Singapore
(Yeoh, Hwang) Department of Cardiothoracic Anaesthesia, National Heart
Centre, Singapore
Publisher
W.B. Saunders
Abstract
The Mortality in Cardiac Surgery Randomized Controlled Trial of Volatile
Anesthetics (MYRIAD) demonstrated that cardiac surgery with either
volatile anesthesia or intravenous anesthesia techniques can be comparable
with respect to morbidity and mortality. Maintaining anesthesia during
cardiopulmonary bypass (CPB) with either approach requires appreciation of
the nuances that are unique to each. This narrative review addresses these
technical challenges and other considerations. Copyright © 2020
Elsevier Inc.

<2>
Accession Number
631863550
Title
Is aortic valve replacement with a minimally invasive extracorporeal
circuit a contemporary option for octogenarians?.
Source
Interactive cardiovascular and thoracic surgery. 31 (1) (pp 56-62), 2020.
Date of Publication: 01 Jul 2020.
Author
El-Essawi A.; Follis M.; Brouwer R.; Breitenbach I.; Groeger S.; Anssar
M.; Harringer W.
Institution
(El-Essawi, Follis, Brouwer, Breitenbach, Groeger, Anssar, Harringer)
Department of Thoracic and Cardiovascular Surgery, Braunschweig, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Minimally invasive extracorporeal circuits have been
introduced to cardiac surgery in an attempt to reduce the negative effects
of cardiopulmonary bypass on patient outcome. On the other hand,
transcatheter aortic valve replacement (TAVR) provides an excellent option
to replace the aortic valve without the need for cardiopulmonary bypass.
Several studies have compared TAVR to surgical aortic valve replacement
(SAVR) but none have utilized a minimally invasive extracorporeal circuit.
 METHOD(S): We retrospectively analysed the results of both procedures
among octogenarians operated in our department from 2003 to 2016. Excluded
were patients with an active endocarditis, a history of previous cardiac
surgery, as well as those who had a minimally invasive surgical approach.
This yielded 81 and 142 octogenarians in the SAVR and TAVR groups,
respectively. To compensate for a lack of randomization, we performed a
propensity score analysis, which yielded 68 patient pairs for the final
analysis. RESULT(S): The 30-day postoperative mortality was lower in
the SAVR group (1.5% vs 5.9%) but not statistically significant (P = 0.4).
In contrast, the incidence of postoperative atrial fibrillation was lower
in the TAVR group (13% vs 29%) but also non-significant (P = 0.2).
Finally, the incidence of paravalvular leakage was in favour of the SAVR
group (2.9% vs 52%; P = 0.001) while the transfusion requirement was
significantly lower in the TAVR group (29% vs 72%; P<0.001).
 CONCLUSION(S): SAVR utilizing a minimally invasive extracorporeal
circuit improves the quality of patient care and can offer an alternative
to TAVR in octogenarians. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
631793999
Title
Right Ventricular Systolic Assessment by Transesophageal Versus
Transthoracic Echocardiography: Displacement, Velocity, and Myocardial
Deformation.
Source
Journal of cardiothoracic and vascular anesthesia. 34 (8) (pp 2152-2161),
2020. Date of Publication: 01 Aug 2020.
Author
Mauermann E.; Vandenheuvel M.; Francois K.; Bouchez S.; Wouters P.
Institution
(Mauermann) Department of Anesthesiology and Perioperative Medicine, Ghent
University Hospital, Ghent, Belgium; Department of Anesthesiology,
University Hospital Basel, Basel, Switzerland
(Vandenheuvel, Bouchez, Wouters) Department of Anesthesiology and
Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
(Francois) Department of Cardiac Surgery, Ghent University Hospital,
Ghent, Belgium
Publisher
NLM (Medline)
Abstract
OBJECTIVE: First, to compare tricuspid annular displacement and velocity
in transthoracic and transesophageal echocardiography (TTE, TEE) using
conventional angle-dependent technologies. Second, to evaluate both
alternative TEE views as well as an alternative technology (speckle
tracking) for overcoming proposed differences in TTE and TEE. DESIGN:
Prospective, comparative, cross-over study with a randomized order of
image acquisition. SETTING: University hospital. PARTICIPANTS: Adults
undergoing cardiac surgery. INTERVENTIONS: Postinduction standardized
image acquisition and analysis in TTE and TEE by 2 echocardiographers.
MEASUREMENTS AND MAIN RESULTS: The authors measured tricuspid annular
plane systolic excursion (TAPSE) by M-mode and velocity by tissue Doppler
(S') in the apical 4-chamber TTE view and midesophageal 4-chamber TEE view
(AP4C, ME4C). They then examined (1) the same measurements in alternative
TEE views with proposed better ultrasound angulation; and (2) speckle
tracking-based endpoints (TAPSE by speckle tracking, strain, and strain
rate). Data were available in 24 of 25 patients. Conventional TAPSE by
M-mode and velocity by tissue Doppler (TDI) were underestimated in the
ME4C compared with the AP4C reference (mean +/- standard deviation: TAPSE:
13.1 +/- 3.8 mm v 17.3 +/- 4.0 mm; S': 6.7 +/- 2.1 cm/s v 9.1 +/- 2.2
cm/s; both p < 0.001). Neither a modified deep transgastric view (TAPSE
14.5 +/- 4.7 mm, p=0.017; S' 6.8 +/- 1.8 cm/s, p < 0.001) nor a
transgastric right ventricular inflow view (TAPSE 12.3 +/- 4.0 mm,
p=0.001; S' 6.0 +/- 1.3 cm/s, p < 0.001) was similar to the AP4C. Speckle
tracking TAPSE was unbiased but with high variability (mean bias=-0.3 mm,
95% limits of agreement=-9.1 to 8.4); strain and strain rate were higher
in TEE than for TTE (-17.7 +/- 3.6 v -12.6 +/- 2.1, p < 0.001; -1.0 +/-
0.2/s v -0.7 +/- 0.1/s, p < 0.001). CONCLUSION(S): Right ventricular
displacement, velocity, and myocardial deformation measured by TEE versus
TTE are different. Neither alternative transesophageal echocardiography
views nor speckle tracking-based deformation is promising; TAPSE by
speckle tracking is unbiased but imprecise. Copyright © 2020
Elsevier Inc. All rights reserved.

<4>
Accession Number
631780850
Title
Selected 2019 Highlights in Congenital Cardiac Anesthesia.
Source
Journal of cardiothoracic and vascular anesthesia. 34 (8) (pp 2022-2027),
2020. Date of Publication: 01 Aug 2020.
Author
Ross F.J.; Vu E.L.; Fang Z.A.; Resheidat A.; Mossad E.B.; Mittnacht A.J.C.
Institution
(Ross) Department of Anesthesiology, Seattle Children's Hospital,
University of Washington, Seattle, WA
(Vu) Department of Anesthesiology, Lurie Children's Hospital, Northwestern
University Feinberg School of Medicine, Chicago, Mexico
(Fang) Department of Anesthesia and Pain Medicine, Hospital for Sick
Children Toronto, ON, Canada
(Resheidat, Mossad) Division of Pediatric Cardiovascular Anesthesia,
Baylor College of Medicine, Texas Children's Hospital, TX, Houston
(Mittnacht) Department of Anesthesiology, Westchester Medical Center, New
York Medical College, Valhalla, NY
Publisher
NLM (Medline)
Abstract
This article is a review of the highlights of pertinent literature
published in 2019, which is of interest to the pediatric cardiac
anesthesiologist. After a search of the United States National Library of
Medicine PubMed database, several topics emerged in which significant
contributions were made in 2019. The authors of this manuscript considered
the following topics noteworthy and were included in this review: advances
in pediatric heart transplantation, blood management in pediatric cardiac
surgery, the impact of nutrition on outcomes in congenital heart surgery,
and the use of vasopressin in patients after Fontan
palliation. Copyright © 2020 Elsevier Inc. All rights reserved.

<5>
Accession Number
632189521
Title
Evaluating the cardiovascular safety of sclerostin inhibition using
evidence from meta-analysis of clinical trials and human genetics.
Source
Science translational medicine. 12 (549) (no pagination), 2020. Date of
Publication: 24 Jun 2020.
Author
Bovijn J.; Krebs K.; Chen C.-Y.; Boxall R.; Censin J.C.; Ferreira T.;
Pulit S.L.; Glastonbury C.A.; Laber S.; Millwood I.Y.; Lin K.; Li L.; Chen
Z.; Milani L.; Smith G.D.; Walters R.G.; Magi R.; Neale B.M.; Lindgren
C.M.; Holmes M.V.
Institution
(Bovijn) Big Data Institute at the Li Ka Shing Centre for Health
Information and Discovery, University of Oxford, Oxford OX3 7FZ, United
Kingdom
(Bovijn, Censin, Laber, Lindgren) Wellcome Centre for Human Genetics,
University of Oxford, Oxford OX3 7BN, United Kingdom
(Krebs, Milani, Magi) Estonian Genome Center, Institute of Genomics,
University of Tartu, Tartu 51010, Estonia
(Chen, Neale) Analytic and Translational Genetics Unit, Massachusetts
General Hospital, Boston MA 02114, United States
(Chen) Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts
General Hospital, Boston MA 02114, United States
(Chen, Neale) Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge MA 02142, United States
(Boxall, Millwood, Lin, Chen, Walters, Holmes) Clinical Trial Service Unit
and Epidemiological Studies Unit (CTSU), Nuffield Department of Population
Health, University of Oxford, Oxford OX3 7LF, United Kingdom
(Boxall, Millwood, Walters, Holmes) Medical Research Council Population
Health Research Unit (MRC PHRU), Nuffield Department of Population Health,
University of Oxford, Oxford OX3 7LF, United Kingdom
(Censin, Ferreira, Pulit, Glastonbury, Laber) Big Data Institute at the Li
Ka Shing Centre for Health Information and Discovery, University of
Oxford, Oxford OX3 7FZ, United Kingdom
(Pulit, Lindgren) Program in Medical and Population Genetics, Broad
Institute, Cambridge MA 02142, United States
(Pulit) Department of Genetics, University Medical Center Utrecht, CX
Utrecht 3584, Netherlands
(Li) Department of Epidemiology and Biostatistics, Peking University
Health Science Centre, Peking University, Beijing 100191, China
(Smith) Medical Research Council Integrative Epidemiology Unit, University
of Bristol, Bristol BS8 2BN, United Kingdom
(Smith) Population Health Sciences, Bristol Medical School, University of
Bristol, Barley House, Oakfield Grove, Bristol BS8 2BN, United Kingdom
(Lindgren, Holmes) Big Data Institute at the Li Ka Shing Centre for Health
Information and Discovery, University of Oxford, Oxford OX3 7FZ, United
Kingdom
(Lindgren, Holmes) National Institute for Health Research Oxford
Biomedical Research Centre, Oxford University Hospitals NHS Foundation
Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
Publisher
NLM (Medline)
Abstract
Inhibition of sclerostin is a therapeutic approach to lowering fracture
risk in patients with osteoporosis. However, data from phase 3 randomized
controlled trials (RCTs) of romosozumab, a first-in-class monoclonal
antibody that inhibits sclerostin, suggest an imbalance of serious
cardiovascular events, and regulatory agencies have issued marketing
authorizations with warnings of cardiovascular disease. Here, we
meta-analyze published and unpublished cardiovascular outcome trial data
of romosozumab and investigate whether genetic variants that mimic
therapeutic inhibition of sclerostin are associated with higher risk of
cardiovascular disease. Meta-analysis of up to three RCTs indicated a
probable higher risk of cardiovascular events with romosozumab. Scaled to
the equivalent dose of romosozumab (210 milligrams per month; 0.09 grams
per square centimeter of higher bone mineral density), the SOST genetic
variants were associated with lower risk of fracture and osteoporosis
(commensurate with the therapeutic effect of romosozumab) and with a
higher risk of myocardial infarction and/or coronary revascularization and
major adverse cardiovascular events. The same variants were also
associated with increased risk of type 2 diabetes mellitus and higher
systolic blood pressure and central adiposity. Together, our findings
indicate that inhibition of sclerostin may elevate cardiovascular risk,
warranting a rigorous evaluation of the cardiovascular safety of
romosozumab and other sclerostin inhibitors. Copyright © 2020 The
Authors, some rights reserved; exclusive licensee American Association for
the Advancement of Science. No claim to original U.S. Government Works.

<6>
Accession Number
632190922
Title
Association between surgical risk and 30-day stroke after transcatheter
versus surgical aortic valve replacement: a systematic review and
meta-analysis.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2020.
Date of Publication: 25 Jun 2020.
Author
Matsuda Y.; Nai Fovino L.; Giacoppo D.; Scotti A.; Massussi M.; Ueshima
D.; Sasano T.; Fabris T.; Tarantini G.
Institution
(Matsuda, Nai Fovino, Giacoppo, Scotti, Massussi, Ueshima, Fabris,
Tarantini) Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padua Medical School, Padua, Italy
(Matsuda, Sasano) Department of Cardiovascular Medicine, Graduate School
of General Medical and Dental Science, Tokyo Medical and Dental
University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Stroke is a feared complication of transcatheter aortic valve
replacement (TAVR) and surgical aortic valve replacement (SAVR).
 OBJECTIVE(S): With this meta-analysis we aimed to evaluate the
incidence of 30-day stroke with TAVR and SAVR focusing on its possible
correlation with surgical risk. METHOD(S): Major electronic databases
were searched for studies published between January 2002 and October 2019
reporting the rates of 30-day stroke after TAVR and SAVR. Data were pooled
using fixed- and random-effects models. The primary outcome of the study
was stroke rate within 30-day from TAVR or SAVR. Results were stratified
according to surgical risk score (high, intermediate and low).
 RESULT(S): A total of 23 studies were identified (TAVR: 14,589
patients; SAVR: 11,681 patients). Regardless of the model used, in the
overall population TAVR was associated with a significant reduction in the
risk of stroke compared with SAVR (fixed effect: OR 0.78, 95% CI
0.66-0.92, p =.003; random-effects: OR 0.80, 95% CI 0.64-1.00, p =.045).
Rates of 30-day stroke after TAVR and SAVR were not significantly
different in the high- (OR 1.01, 95% CI 0.44-1.98, p =.105) and
intermediate-risk groups (OR 0.92, 95% CI 0.63-1.36, p =.319), while
low-risk patients had a lower rate of 30-day stroke after TAVR than SAVR
(OR 0.65, 95% CI 0.50-0.83, p <.001). Meta-regression showed a significant
association between surgical risk score and 30-day stroke rate (p =.007).
 CONCLUSION(S): TAVR is associated with a lower risk of 30-day stroke
compared with SAVR, mainly as a result of the significant advantage
observed in patients at low surgical risk. Copyright © 2020 Wiley
Periodicals LLC.

<7>
Accession Number
632188330
Title
Comparison of preincisional and postincisional parasternal intercostal
block on postoperative pain in cardiac surgery.
Source
Journal of cardiac surgery. (no pagination), 2020. Date of Publication: 24
Jun 2020.
Author
Padala S.R.A.N.; Badhe A.S.; Parida S.; Jha A.K.
Institution
(Padala, Badhe, Parida, Jha) Department of Anaesthesiology and Critical
Care, Jawaharlal Institute of Postgraduate Medical Education and Research,
Puducherry, India
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimum cardiac surgical pain management has known to
maintain hemodynamic stability and, reduces respiratory and cardiovascular
complications. Postoperative parasternal intercostal block has shown to
reduce postoperative analgesic consumption after cardiac surgery.
Therefore, this study sought to investigate the effectiveness of the
preoperative ultrasound guided parasternal block in reducing postoperative
pain after cardiac surgery. METHOD(S): This was a randomized,
prospective, interventional, single blind study comprised of 90 adult
patients scheduled for cardiac surgery involving sternotomy.
Preoperatively and postoperatively, 0.25% bupivacaine administered in 4mL
aliquots into the anterior (2nd-6th) intercostal spaces on each side about
2cm lateral to the sternal edge with a total volume of 40mL under
ultrasound guidance and direct vision, respectively. Postoperative pain
was rated according to visual analogue scale. Secondary outcomes included
intraoperative and postoperative fentanyl consumptions, dosages of rescue
medications, and time to extubation. MAIN RESULTS: There was no
significant differences in visual analogue score visual analogue score at
all time points till 24hours postoperatively. Intraoperative fentanyl
requirements (microgram/kg) before cardiopulmonary bypass was
significantly lower in pre-incisional group than the post-incisional group
(0.16+/-0.43 vs 0.68+/-0.72; P=.0001). Furthermore, there were no
significant difference in total fentanyl requirement (7.20+/-2.66 vs
8.37+/-3.13; P=.06) and tramadol requirement (0.02+/-0.15 vs 0.07+/-0.26;
P=.28) within first 24 hours. However, time to extubation was
significantly higher in the preoperative group (P=.02).
 CONCLUSION(S): Preoperative and postoperative parasternal intercostal
block provide comparable pain relief during the postoperative
period. Copyright © 2020 Wiley Periodicals LLC.

<8>
Accession Number
632152260
Title
Effect of Intraoperative Dexamethasone on Major Complications and
Mortality among Infants Undergoing Cardiac Surgery: The DECISION
Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 323 (24) (pp
2485-2492), 2020. Date of Publication: 23 Jun 2020.
Author
Lomivorotov V.; Kornilov I.; Boboshko V.; Shmyrev V.; Bondarenko I.;
Soynov I.; Voytov A.; Polyanskih S.; Strunin O.; Bogachev-Prokophiev A.;
Landoni G.; Nigro Neto C.; Oliveira Nicolau G.; Saurith Izquierdo L.;
Nogueira Nascimento V.; Wen Z.; Renjie H.; Haibo Z.; Bazylev V.; Evdokimov
M.; Sulejmanov S.; Chernogrivov A.; Ponomarev D.
Institution
(Lomivorotov, Kornilov, Boboshko, Shmyrev, Bondarenko, Soynov, Voytov,
Polyanskih, Strunin, Bogachev-Prokophiev, Ponomarev) E. N. Meshalkin
National Medical Research Center, 15 Rechkunovskaya St, Novosibirsk
630055, Russian Federation
(Lomivorotov) Novosibirsk State University, Novosibirsk, Russian
Federation
(Landoni) IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Nigro Neto, Oliveira Nicolau, Saurith Izquierdo, Nogueira Nascimento)
Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Wen, Renjie, Haibo) Shanghai Jiaotong University School of Medicine,
Shanghai Children's Medical Center, Shanghai Shi, China
(Bazylev, Evdokimov, Sulejmanov, Chernogrivov) Federal Centre of
Cardiovascular Surgery, Penza, Russian Federation
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Corticosteroids are widely used in pediatric cardiac surgery
to blunt systemic inflammatory response and to reduce complications;
nevertheless, their clinical efficacy is uncertain. Objective(s): To
determine whether intraoperative administration of dexamethasone is more
effective than placebo for reducing major complications and mortality
during pediatric cardiac surgery. Design, Setting, and
Participant(s): The Intraoperative Dexamethasone in Pediatric Cardiac
Surgery was an investigator-initiated, double-blind, multicenter
randomized trial that involved 4 centers in China, Brazil, and Russia. A
total of 394 infants younger than 12 months, undergoing cardiac surgery
with cardiopulmonary bypass were enrolled from December 2015 to October
2018, with follow-up completed in November 2018. Intervention(s): The
dexamethasone group (n = 194) received 1 mg/kg of dexamethasone; the
control group (n = 200) received an equivolume of 0.9% sodium chloride
intravenously after anesthesia induction. Main Outcomes and Measures:
The primary end point was a composite of death, nonfatal myocardial
infarction, need for extracorporeal membrane oxygenation, need for
cardiopulmonary resuscitation, acute kidney injury, prolonged mechanical
ventilation, or neurological complications within 30 days after surgery.
There were 17 secondary end points, including the individual components of
the primary end point, and duration of mechanical ventilation, inotropic
index, intensive care unit stay, readmission to intensive care unit, and
length of hospitalization. Result(s): All of the 394 patients
randomized (median age, 6 months; 47.2% boys) completed the trial. The
primary end point occurred in 74 patients (38.1%) in the dexamethasone
group vs 91 patients (45.5%) in the control group (absolute risk
reduction, 7.4%; 95% CI, -0.8% to 15.3%; hazard ratio, 0.82; 95% CI, 0.60
to 1.10; P =.20). Of the 17 prespecified secondary end points, none showed
a statistically significant difference between groups. Infections occurred
in 4 patients (2.0%) in the dexamethasone group vs 3 patients (1.5%) in
the control group. Conclusions and Relevance: Among infants younger
than 12 months undergoing cardiac surgery with cardiopulmonary bypass,
intraoperative administration of dexamethasone, compared with placebo, did
not significantly reduce major complications and mortality at 30 days.
However, the study may have been underpowered to detect a clinically
important difference. Trial Registration: ClinicalTrials.gov Identifier:
NCT02615262. Copyright © 2020 American Medical Association. All
rights reserved.

<9>
Accession Number
2006809651
Title
Baroreflex Activation Therapy in Patients With Heart Failure With Reduced
Ejection Fraction.
Source
Journal of the American College of Cardiology. 76 (1) (pp 1-13), 2020.
Date of Publication: 7 July 2020.
Author
Zile M.R.; Lindenfeld J.; Weaver F.A.; Zannad F.; Galle E.; Rogers T.;
Abraham W.T.
Institution
(Zile) Medical University of South Carolina, Charleston, SC, United States
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, SC, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
United States
(Zannad) Inserm Centre d'Investigation, CHU de Nancy, Institute Lorrain du
Coeur et des Vaisseaux, Universite de Lorraine, Nancy, France
(Galle) CVRx, Inc., Minneapolis, MN, United States
(Rogers) NAMSA, Inc., Minneapolis, Minneapolis, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
Publisher
Elsevier USA
Abstract
Background: This study demonstrated the safety and effectiveness of
baroreflex activation therapy (BAT) in patients with heart failure with
reduced ejection fraction (HFrEF). Objective(s): The BeAT-HF
(Baroreflex Activation Therapy for Heart Failure) trial was a multicenter,
prospective, randomized, controlled trial; subjects were randomized 1:1 to
receive either BAT plus optimal medical management (BAT group) or optimal
medical management alone (control group). Method(s): Four patient
cohorts were created from 408 randomized patients with HFrEF using the
following enrollment criteria: current New York Heart Association (NYHA)
functional class III or functional class II (patients who had a recent
history of NYHA functional class III); ejection fraction <=35%; stable
medical management for >=4 weeks; and no Class I indication for cardiac
resynchronization therapy. Effectiveness endpoints were the change from
baseline to 6 months in 6-min hall walk distance (6MHW), Minnesota Living
with HF Questionnaire quality-of-life (QOL) score, and N-terminal
pro-B-type natriuretic peptide (NT-proBNP) levels. The safety endpoint
included the major adverse neurological or cardiovascular system or
procedure-related event rate (MANCE). Result(s): Results from,
timeline and rationale for, cohorts A, B, and C are presented in detail in
the text. Cohort D, which represented the intended use population that
reflected the U.S. Food and Drug Administration-approved instructions for
use (enrollment criteria plus NT-proBNP <1,600 pg/ml), consisted of 245
patients followed-up for 6 months (120 in the BAT group and 125 in the
control group). BAT was safe and significantly improved QOL, 6MHW, and
NT-proBNP. In the BAT group versus the control group, QOL score decreased
(DELTA = -14.1; 95% confidence interval [CI]: -19 to -9; p < 0.001), 6MHW
distance increased (DELTA = 60 m; 95% CI: 40 to 80 m; p < 0.001),
NT-proBNP decreased (DELTA = -25%; 95% CI: -38% to -9%; p = 0.004), and
the MANCE free rate was 97% (95% CI: 93% to 100%; p < 0.001).
 Conclusion(s): BAT was safe and significantly improved QOL, exercise
capacity, and NT-proBNP. (Baroreflex Activation Therapy for Heart Failure
[BeAT-HF]; NCT02627196) Copyright © 2020 The Authors

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

<11>
Accession Number
2004439490
Title
Additional postdilatation using noncompliant balloons after
everolimus-eluting stent implantation: Results of the PRESS trial.
Source
Clinical Cardiology. 43 (6) (pp 606-613), 2020. Date of Publication: 01
Jun 2020.
Author
Park G.-M.; Lee J.-H.; Choi S.W.; Jeong J.-O.; Shin E.-S.; Bae J.-W.; Yoon
H.-J.; Jung K.T.; Baek J.Y.; Choi W.G.; Choi R.K.; Her S.-H.; Suh J.; Lee
J.B.; Lee S.-W.; Chae I.-H.; Choi S.-Y.; Seong I.-W.
Institution
(Park, Shin) Department of Cardiology, Ulsan University Hospital,
University of Ulsan College of Medicine, Ulsan, South Korea
(Lee, Choi, Jeong, Seong) Department of Cardiology, Chungnam National
University Hospital, Chungnam National University School of Medicine,
Daejeon, South Korea
(Bae) Department of Internal Medicine, Chungbuk National University
College of Medicine, Cheongju, South Korea
(Yoon) Department of Cardiology, Keimyung University Dongsan Medical
Center, Daegu, South Korea
(Jung) Department of Cardiology, Eulji University Hospital, Daejeon, South
Korea
(Baek) Department of Cardiology, Cheongju St. Mary's Hospital, Cheongju,
South Korea
(Choi) Department of Internal Medicine, School of Medicine, Konkuk
University, Chungju, South Korea
(Choi) Department of Cardiology, Mediplex Sejong Hospital, Bucheon, South
Korea
(Her) Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic
University of Korea, Seoul, South Korea
(Lee) Department of Cardiology, Daegu Catholic University Medical Center,
Daegu, South Korea
(Suh) Department of Cardiology, Soonchunhyang University Bucheon Hospital,
Bucheon, South Korea
(Lee) Department of Cardiology, Anyang Sam Hospital, Anyang, South Korea
(Lee) Department of Cardiology, Soonchunhyang University Cheonan Hospital,
Cheonan, South Korea
(Chae) Department of Cardiology, Seoul National University Bundang
Hospital, Bundang, South Korea
(Choi) Department of Cardiology, Ajou University Hospital, Suwon, South
Korea
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: There are limited data on the clinical value of routine
postdilatation using noncompliant balloons after contemporary drug-eluting
stent implantation. Hypothesis: Additional postdilatation using
noncompliant balloons after everolimus-eluting stent implantation could
provide better clinical outcomes. Method(s): We randomly assigned
1774 patients with coronary artery disease to undergo additional
high-pressure postdilatation using noncompliant balloons and
moderate-pressure dilatation using stent balloons after everolimus-eluting
stent implantation. The primary endpoint was a composite of death,
myocardial infarction (MI), stent thrombosis, and target vessel
revascularization (TVR) 2 years after randomization. Result(s): The
study was discontinued early owing to slow enrollment. In total, 810
patients (406 patients in the high pressure group and 404 in the moderate
pressure group) were finally enrolled. At 2 years, the primary endpoint
occurred in 3.6% of patients in the high pressure group and in 4.4% of
those in the moderate pressure group (P =.537). In addition, no
significant differences were observed between the two groups in the
occurrence of an individual end point of death (0.8% in the high pressure
group vs 1.5% in the moderate group, P =.304), MI (0.2% vs 0.5%, P =.554),
stent thrombosis (0% vs 0.2%, P =.316), or TVR (2.8% vs 2.6%, P =.880).
 Conclusion(s): The strategy of routine postdilatation using
noncompliant balloons after everolimus-eluting stent implantation did not
provide incremental clinical benefits. Copyright © 2020 The
Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

<12>
Accession Number
2006855888
Title
Overcoming underpowering: Trial simulations and a global rank end point to
optimize clinical trials in children with heart disease.
Source
American Heart Journal. 226 (pp 188-197), 2020. Date of Publication:
August 2020.
Author
Hill K.D.; Baldwin H.S.; Bichel D.P.; Ellis A.M.; Graham E.M.; Hornik
C.P.; Jacobs J.P.; Jaquiss R.D.B.; Jacobs M.L.; Kannankeril P.J.; Li J.S.;
Torok R.; Turek J.W.; O'Brien S.M.
Institution
(Hill, Hornik, Li, Torok, Turek) Duke Pediatric and Congenital Heart
Center, Durham, NC, United States
(Hill, Ellis, Hornik, Li, O'Brien) Duke Clinical Research Institute,
Durham, NC, United States
(Baldwin, Bichel, Kannankeril) Vanderbilt University Medical Center,
Nashville, TN, United States
(Graham) Medical University of South Carolina, Charleston, SC, United
States
(Jacobs, Jacobs) Johns Hopkins University School of Medicine, Baltimore,
MD, United States
(Jaquiss) University of Texas Southwestern, Dallas, TX, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Randomized controlled trials (RCTs) in children with heart
disease are challenging and therefore infrequently performed. We sought to
improve feasibility of perioperative RCTs for this patient cohort using
data from a large, multicenter clinical registry. We evaluated potential
enrollment and end point frequencies for various inclusion cohorts and
developed a novel global rank trial end point. We then performed trial
simulations to evaluate power gains with the global rank end point and
with use of planned covariate adjustment as an analytic strategy.
 Method(s): Data from the Society of Thoracic Surgery-Congenital Heart
Surgery Database (STS-CHSD, 2011-2016) were used to support development of
a consensus-based global rank end point and for trial simulations. For
Monte Carlo trial simulations (n = 50,000/outcome), we varied the odds of
outcomes for treatment versus placebo and evaluated power based on the
proportion of trial data sets with a significant outcome (P < .05).
 Result(s): The STS-CHSD study cohort included 35,967 infant index
cardiopulmonary bypass operations from 103 STS-CHSD centers, including
11,411 (32%) neonatal cases and 12,243 (34%) high-complexity (Society of
Thoracic Surgeons-European Association for Cardio-Thoracic Surgery
mortality category >=4) cases. In trial simulations, study power was 21%
for a mortality-only end point, 47% for a morbidity and mortality
composite, and 78% for the global rank end point. With covariate
adjustment, power increased to 94%. Planned covariate adjustment was
preferable to restricting to higher-risk cohorts despite higher event
rates in these cohorts. Conclusion(s): Trial simulations can inform
trial design. Our findings, including the newly developed global rank end
point, may be informative for future perioperative trials in children with
heart disease. Copyright © 2020 Elsevier Inc.

<13>
Accession Number
631728437
Title
A comparison of different antibiotic regimens for the treatment of
infective endocarditis.
Source
Cochrane Database of Systematic Reviews. 2020 (5) (no pagination), 2020.
Article Number: CD009880. Date of Publication: 14 May 2020.
Author
Marti-Carvajal A.J.; Dayer M.; Conterno L.O.; Gonzalez Garay A.G.;
Marti-Amarista C.E.
Institution
(Marti-Carvajal) Facultad de Ciencias de la Salud Eugenio Espejo,
Universidad UTE (Cochrane Ecuador), Quito, Ecuador
(Dayer) Department of Cardiology, Taunton and Somerset NHS Trust, Taunton,
United Kingdom
(Conterno) Medical School, Department of Internal Medicine, Infectious
Diseases Division, State University of Campinas (UNICAMP), Campinas,
Brazil
(Gonzalez Garay) Methodology Research Unit, Instituto Nacional de
Pediatria, Mexico City, Mexico
(Marti-Amarista) Department of Family Medicine, Northwell Health Southside
Hospital, Bay Shore, NY, United States
(Marti-Carvajal) School of Medicine, Universidad Francisco de Vitoria
(Cochrane Madrid), Madrid, Spain
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Infective endocarditis is a microbial infection of the
endocardial surface of the heart. Antibiotics are the cornerstone of
treatment, but due to the differences in presentation, populations
affected, and the wide variety of micro-organisms that can be responsible,
their use is not standardised. This is an update of a review previously
published in 2016. Objective(s): To assess the existing evidence
about the clinical benefits and harms of different antibiotics regimens
used to treat people with infective endocarditis. Search Method(s):
We searched the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference
Proceedings Citation Index - Science on 6 January 2020. We also searched
three trials registers and handsearched the reference lists of included
papers. We applied no language restrictions. Selection Criteria: We
included randomised controlled trials (RCTs) assessing the effects of
antibiotic regimens for treating definitive infective endocarditis
diagnosed according to modified Duke's criteria. We considered all-cause
mortality, cure rates, and adverse events as the primary outcomes. We
excluded people with possible infective endocarditis and pregnant women.
 Data Collection and Analysis: Two review authors independently
performed study selection, 'Risk of bias' assessment, and data extraction
in duplicate. We constructed 'Summary of findings' tables and used GRADE
methodology to assess the quality of the evidence. We described the
included studies narratively. Main Result(s): Six small RCTs
involving 1143 allocated/632 analysed participants met the inclusion
criteria of this first update. The included trials had a high risk of
bias. Three trials were sponsored by drug companies. Due to heterogeneity
in outcome definitions and different antibiotics used data could not be
pooled. The included trials compared miscellaneous antibiotic schedules
having uncertain effects for all of the prespecified outcomes in this
review. Evidence was either low or very low quality due to high risk of
bias and very low number of events and small sample size. The results for
all-cause mortality were as follows: one trial compared quinolone
(levofloxacin) plus standard treatment (antistaphylococcal penicillin
(cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin),
and rifampicin) versus standard treatment alone and reported 8/31 (26%)
with levofloxacin plus standard treatment versus 9/39 (23%) with standard
treatment alone; risk ratio (RR) 1.12, 95% confidence interval (CI) 0.49
to 2.56. One trial compared fosfomycin plus imipenem 3/4 (75%) versus
vancomycin 0/4 (0%) (RR 7.00, 95% CI 0.47 to 103.27), and one trial
compared partial oral treatment 7/201 (3.5%) versus conventional
intravenous treatment 13/199 (6.53%) (RR 0.53, 95% CI 0.22 to 1.31). The
results for rates of cure with or without surgery were as follows: one
trial compared daptomycin versus low-dose gentamicin plus an
antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or
vancomycin and reported 9/28 (32.1%) with daptomycin versus 9/25 (36%)
with low-dose gentamicin plus antistaphylococcal penicillin or vancomycin;
RR 0.89, 95% CI 0.42 to 1.89. One trial compared glycopeptide (vancomycin
or teicoplanin) plus gentamicin with cloxacillin plus gentamicin (13/23
(56%) versus 11/11 (100%); RR 0.59, 95% CI 0.40 to 0.85). One trial
compared ceftriaxone plus gentamicin versus ceftriaxone alone (15/34 (44%)
versus 21/33 (64%); RR 0.69, 95% CI 0.44 to 1.10), and one trial compared
fosfomycin plus imipenem versus vancomycin (1/4 (25%) versus 2/4 (50%); RR
0.50, 95% CI 0.07 to 3.55). The included trials reported adverse events,
the need for cardiac surgical interventions, and rates of uncontrolled
infection, congestive heart failure, relapse of endocarditis, and septic
emboli, and found no conclusive differences between groups (very
low-quality evidence). No trials assessed quality of life. Authors'
conclusions: This first update confirms the findings of the original
version of the review. Limited and low to very low-quality evidence
suggests that the comparative effects of different antibiotic regimens in
terms of cure rates or other relevant clinical outcomes are uncertain. The
conclusions of this updated Cochrane Review were based on few RCTs with a
high risk of bias. Accordingly, current evidence does not support or
reject any regimen of antibiotic therapy for the treatment of infective
endocarditis. Copyright © 2020 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<14>
Accession Number
2006880038
Title
Transfusion Use and Hemoglobin Levels by Blood Conservation Method After
Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
McNair E.D.; McKay W.P.; Mondal P.K.; Bryce R.D.T.
Institution
(McNair) Department of Pathology and Laboratory Medicine, College of
Medicine, University of Saskatchewan, Saskatoon, Canada
(McKay) Department of Anesthesiology, Perioperative Medicine, and Pain
Management, College of Medicine, University of Saskatchewan, Saskatoon,
Canada
(Mondal, Bryce) Department of Community Health and Epidemiology, CRSU,
College of Medicine, University of Saskatchewan, Saskatoon, Canada
Publisher
Elsevier USA
Abstract
Background: Guidelines recommend modified ultrafiltration (MUF) and cell
washing for blood conservation after cardiopulmonary bypass (CPB),
although information on outcomes is lacking. This research compared online
MUF (ultrafiltration of the patient's entire circulating volume) with
off-line MUF (ultrafiltration of the residual CPB volume) and
centrifugation (cell washing of the residual CPB volume). Method(s):
This prospective cohort study enrolled 99 consecutive patients, grouped by
method (group I, online MUF, n = 35; group II, off-line MUF, n = 30; group
III, centrifugation, n = 34). Primary outcome was transfusion by 18 hours.
Secondary outcomes were 18-hour hemoglobin levels, fluid balance (weight
change), and biomarker levels indicating coagulation and organ function.
 Result(s): By 18 hours, 22.9%, 6.7%, and 14.7% of group I, II, and
III patients, respectively, had undergone transfusion (P =.19). Percentage
weight gain differed by group (group I, 5.7%; group II, 1.3%; group III,
4.5%; P <.0001). Baseline to 18-hour hemoglobin change also differed by
group, with the group I increase significantly exceeding that of group II
(P =.002) but not differing from group III (P =.36). After adjustment for
European System for Cardiac Operative Risk Evaluation II (EuroSCORE),
weight gain, and transfusion, only the group II to III difference remained
significant (P =.002). Conclusion(s): Online MUF does not appear to
offer a reduction in blood transfusion over other methods. Although
patients undergoing online MUF had greater improvement in baseline to
18-hour hemoglobin compared with patients undergoing off-line MUF, this
benefit appeared attributable to fluid shifting. Off-line MUF was
associated with the least frequent transfusions. Although online MUF does
not appear to reduce blood transfusion, larger prospective randomized
controlled studies are required for confirmation. Copyright ©
2020

<15>
Accession Number
2006780491
Title
A Prospective Study Investigating Blood Patch Pleurodesis for
Postoperative Air Leaks After Pulmonary Resection.
Source
Journal of Surgical Research. 255 (pp 240-246), 2020. Date of Publication:
November 2020.
Author
Ploenes T.; Kyritsis I.; Mardanzai K.; Muhmann D.; Langehegermann L.;
Slama A.; Hegedus B.; Aigner C.
Institution
(Ploenes, Kyritsis, Mardanzai, Muhmann, Langehegermann, Slama, Hegedus,
Aigner) Department of Thoracic Surgery and Thoracic Endoscopy,
Ruhrlandklinik, West German Lung Center, University Hospital Essen,
University Duisburg-Essen, Essen, Germany
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Prolonged air leaks (PALs) after lung resection are one of the
most common complications in thoracic surgery. Several options are
available to treat PALs. The autologous blood patch pleurodesis is
commonly used but has not been thoroughly investigated. Material(s)
and Method(s): We conducted a prospective randomized study including all
consecutive patients with PALs after pulmonary resections. Patients were
randomized to either having received pleurodesis by injecting 100 mL
autologous blood at d 5 and 6 (Group A) or being placed under observation
(Group B). Patients from either group undergoing revisions were further
investigated by a post hoc analysis and formed Group C. Result(s): A
total of 24 patients were included: 10 patients were randomized to group A
and 14 to group B. Six patients (3 from each group) underwent surgical
revision and were included in Group C. Groups A and B did not differ in
baseline characteristics. The median time to drainage removal was 9 d
(range: 5-23 d) in Group A; 9 d (range: 2-20 d) in Group B; and 6 d in
Group C (range: 3-10 d), (A/B versus C, P < 0.04; A versus B was not
significant). Conclusion(s): There is no evidence indicating a
benefit for blood patch pleurodeses in patients undergoing lung resections
and presenting with postoperative PALs for more than 5 d. An early
operative closure of postoperative air leakage seems to be more
effective. Copyright © 2020 Elsevier Inc.

<16>
Accession Number
2006803151
Title
Pulmonary vein stenosis mimicking interstitial lung disease.
Source
Pulmonology. (no pagination), 2020. Date of Publication: 2020.
Author
Carrico F.; Gurioli C.; Piciucchi S.; Dubini A.; Tomassetti S.; Poletti V.
Institution
(Carrico) Pulmonology Department, Sousa Martins Hospital, Guarda, Portugal
(Gurioli, Tomassetti, Poletti) Department of Diseases of the Thorax, G.B.
Morgagni - L. Pierantoni Hospital, Forli, Italy
(Piciucchi) Radiology Department, G.B. Morgagni - L. Pierantoni Hospital,
Forli, Italy
(Dubini) Pathology Department, G.B. Morgagni - L. Pierantoni Hospital,
Forli, Italy
(Poletti) Department of Respiratory Diseases & Allergy, Aarhus University
Hospital, Aarhus, Denmark
Publisher
Elsevier Espana S.L.U
Abstract
Pulmonary vein stenosis (PVS) is a rare condition, often difficult to
diagnose and associated with poor prognosis at advanced stages. Lung
parenchymal abnormalities are indirect evidence of PVS and can manifest as
multifocal opacities, nodular lesions, unilateral effusions, and
interstitial septal thickening. These can lead to erroneous diagnoses of
airway disease, pneumonia, malignancy or interstitial lung disease. This
review summarizes the current literature about the approach, evaluation
and management of these patients. Our case report demonstrates that PVS is
an under-recognized complication of cardiovascular surgery and should be
considered in all patients presenting with respiratory symptoms after a
cardiac procedure. Copyright © 2020 Sociedade Portuguesa de
Pneumologia

<17>
Accession Number
631785822
Title
The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain
Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.
Source
Journal of Alzheimer's disease : JAD. 75 (4) (pp 1319-1328), 2020. Date of
Publication: 2020.
Author
VanDusen K.W.; Eleswarpu S.; Moretti E.W.; Devinney M.J.; Crabtree D.M.;
Laskowitz D.T.; Woldorff M.G.; Roberts K.C.; Whittle J.; Browndyke J.N.;
Cooter M.; Rockhold F.W.; Anakwenze O.; Bolognesi M.P.; Easley M.E.;
Ferrandino M.N.; Jiranek W.A.; Berger M.
Institution
(VanDusen, Eleswarpu, Moretti, Devinney, Whittle, Cooter, Berger)
Department of Anesthesiology, Duke University, Durham, United States
(Crabtree) Duke Office of Clinical Research, Duke University, Durham,
United States
(Laskowitz) Department of Neurology, Duke University, Durham, United
States
(Woldorff, Browndyke) Department of Psychiatry and Behavioral Sciences,
Duke University Medical Center, Durham, United States
(Woldorff) Department of Psychology and Neuroscience, Duke University,
Durham, United States
(Roberts, Berger) Center for Cognitive Neuroscience, Duke University
Medical Center, Durham, United States
(Rockhold) Duke Clinical Research Institute, Durham, United States
(Anakwenze, Bolognesi, Easley) Department of Orthopaedic Surgery, Duke
University, Durham, United States
(Ferrandino, Jiranek) Department of Surgery, Duke University, Durham,
United States
(Berger) Center for the Study of Aging and Human Development, Duke
University Medical Center, Durham, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative neurocognitive disorders (PND) are common
complications in older adults associated with increased 1-year mortality
and long-term cognitive decline. One risk factor for worsened long-term
postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic
risk factor APOE4. APOE4 is thought to elevate AD risk partly by
increasing neuroinflammation, which is also a theorized mechanism for PND.
Yet, it is unclear whether modulating apoE4 protein signaling in older
surgical patients would reduce PND risk or severity. OBJECTIVE(S):
MARBLE is a randomized, blinded, placebo-controlled phase II sequential
dose escalation trial designed to evaluate perioperative administration of
an apoE mimetic peptide drug, CN-105, in older adults (age>=60 years). The
primary aim is evaluating the safety of CN-105 administration, as measured
by adverse event rates in CN-105 versus placebo-treated patients.
Secondary aims include assessing perioperative CN-105 administration
feasibility and its efficacy for reducing postoperative neuroinflammation
and PND severity. METHOD(S): 201 patients undergoing non-cardiac,
non-neurological surgery will be randomized to control or CN-105 treatment
groups and receive placebo or drug before and every six hours after
surgery, for up to three days after surgery. Chart reviews, pre- and
postoperative cognitive testing, delirium screening, and blood and CSF
analyses will be performed to examine effects of CN-105 on perioperative
adverse event rates, cognition, and neuroinflammation. Trial results will
be disseminated by presentations at conferences and peer-reviewed
publications. CONCLUSION(S): MARBLE is a transdisciplinary study
designed to measure CN-105 safety and efficacy for preventing PND in older
adults and to provide insight into the pathogenesis of these geriatric
syndromes.

<18>
Accession Number
632080755
Title
Randomised, non-inferiority, controlled procedural outcomes TrIal
comParing reverse T and Protrusion versus double-kissing and crush
stenting: Protocol of the TIP TAP i randomised trial.
Source
BMJ Open. 10 (6) (no pagination), 2020. Article Number: e034264. Date of
Publication: 16 Jun 2020.
Author
Rakhimov K.; Buono A.; Anadol R.; Ullrich H.; Knorr M.; Ahoopai M.; Munzel
T.; Gori T.
Institution
(Rakhimov, Buono, Anadol, Ullrich, Knorr, Ahoopai, Munzel, Gori)
Kardiologie i, Universitatsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
(Anadol, Munzel, Gori) DZHK, Standort Rhein-Mainz, Universitatsmedizin
Mainz, Mainz, Rheinland-Pfalz, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction To assess the impact of 'reverse T and Protrusion' (TAP)
technique on the outcome after stenting of true bifurcation lesions of the
left main (LM) or proximal epicardial vessels as compared with double
kissing (DK)-crush technique. Methods and analysis 50 consecutive patients
with true coronary bifurcation lesion (Medina 1,1,1 or 0,1,1) of the LM or
the proximal main vessels, requiring a two-stent technique as first-line
strategy at University Medical Center Mainz, are randomised in a 1:1 ratio
to reverse TAP or DK-crush stenting. As recommended by best clinical
practice, final angiographic result is evaluated and optical coherence
tomographic (OCT) intracoronary imaging is performed to assess and
optimise the final result. The primary end point is defined as the
percentage of stent expansion in the side branch. Secondary end points
consist of angiographic and procedural success (assessed until patient's
discharge), procedural parameters (procedural time, fluoroscopy time, use
of devices, X-ray dose) and OCT parameters expressing expansion of the
stents. Safety parameters include all adverse events up to 6 months after
discharge. A clinical, angiographic and intracoronary imaging control at 6
months is planned. Ethics and dissemination The protocol complies with
good clinical practice and the ethical principles described in the
Declaration of Helsinki and is approved by the local ethics committee. The
results of the trial will be published as original article(s) in medical
journals and/or as presentation at congresses. Trial registration number
ClinicalTrials.gov Registry (NCT03714750) Copyright © Author(s)
(or their employer(s)) 2020. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<19>
Accession Number
632150809
Title
Preoperative computed tomography scans reduce the risk of stroke in
minimally invasive mitral valve surgery: A meta-analysis.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 56th Annual Meeting of the Eastern Cardiothoracic
Surgical Society, ECTSS. United States. 14 (1 Supplement) (pp 25S), 2019.
Date of Publication: September 2019.
Author
Khan F.M.; Leonard J.R.; Henry M.; Rahouma M.; Guy T.S.; Girardi L.N.;
Gaudino M.
Institution
(Khan, Leonard, Henry, Rahouma, Guy, Girardi, Gaudino) Weill Cornell
Medicine, New York-Presbyterian Hospital, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: Minimally invasive mitral valve surgery (MIMVS) is performed
with increasing frequency. Recent evidence suggests that patients
undergoing MIMVS have an increased risk of perioperative stroke, mainly
due to retrograde aortic embolization during femoral cardio-pulmonary
bypass. Systematic pre-operative computed tomography (CT) screening allows
visualization of the aorta and femoro-iliac vessels and individualization
of the surgical approach to the anatomic and pathologic characteristics of
the single patient. In this meta-analysis, we aim to determine if
systematic pre-operative CT screening decreases the incidence of
perioperative stroke and other complications following MIMVS.
 Method(s): A comprehensive online review was performed in PubMed from
inception to May 2018. Eligible studies reported MIMVS with retrograde
arterial perfusion. Studies were separated into 2 subgroups: systematic
pre-operative CT screening (CT group) and no CT screening (Non-CT). Pooled
event rates (PER) for operative mortality, perioperative stroke,
perioperative myocardial infarction, and new -onset renal failure
requiring dialysis were estimated and inter-group comparisons were
performed. Result(s): Fifty-seven studies (13,602 patients) were
analyzed (19 CT group and 38 Non-CT). The PER for perioperative stroke was
1.98% (CT group: 1.46% vs. Non-CT 2.21%, P = 0.03). The PER for new
dialysis was 1.87%, signifcantly lower in the CT group (0.83% vs. 2.33%, P
= 0.02) (Table SA15-1). The PER for operative mortality was 1.36% with a
trend towards better outcomes in the CT group (0.80% vs. 1.60%, P =
0.052). Conclusion(s): Systematic pre-operative CT screening is
associated with signifcantly lower risk of perioperative stroke, need for
dialysis, and a trend toward lower operative mortality after MIMVS.

<20>
Accession Number
632150657
Title
Surgical management of pulmonary artery aneurysms.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 56th Annual Meeting of the Eastern Cardiothoracic
Surgical Society, ECTSS. United States. 14 (1 Supplement) (pp 53S-54S),
2019. Date of Publication: September 2019.
Author
Sinha R.; Aribindi V.; Cunningham M.J.; Starnes V.; Baker C.
Institution
(Sinha) University of Texas Health Science Center, Houston, TX, United
States
(Aribindi) Baylor College of Medicine, Houston, TX, United States
(Cunningham, Starnes, Baker) University of Southern California, Los
Angeles, CA, United States
Publisher
SAGE Publications Ltd
Abstract
Objectives: Pulmonary artery aneurysms (PAAs) in adult patients are rare
clinical entities with multiple potential etiologies and paucity of data
regarding management. We present a surgical case series, treatment
approaches, and a comprehensive literature review of this uncommon
diagnosis. Method(s): A single-institution retrospective chart review
from 2007 to 2016 was performed looking for any surgical pulmonary artery
interventions. Preoperative workups, operative reports, and the hospital
courses were reviewed as well as a literature search via PubMed using the
keywords "pulmonary artery aneurysm." Results: A total of 6 patients (3
males, mean age of 52 years, mean follow-up 3.3 years with no PA
reintervention) with the diagnosis of PAAs were identifed (Table P38-1).
The mean main PA diameter was 5.1 cm (Fig. P38-1). Five out of 6 patients
had associated pulmonary valve (PV) pathology: 2 with stenosis, 2 with
regurgitation following repair of congenital pulmonary stenosis, and 1
with dysplastic P V. The remaining patient had pulmonary hypertension. A
pulmonary homograft was used in 4 out of 6 patients and hemashield graft
material in 1 patient. In that patient, a pericardial patch was used for
relief of right ventricular outfow tract obstruction without PV
intervention. An isolated PV replacement was performed in 1 patient, who
required reintervention with a tran-scatheter PV replacement 10 years
after the initial procedure. Conclusion(s): PAAs are infrequently
diagnosed but have the potential for complications. Treatment guidelines
are unclear and management strategies range from observation to prompt
intervention. Surgical options include replacement with a biologic or
synthetic material as well as reduction arterioplasty.

<21>
Accession Number
632150486
Title
Prospective nonrandomized comparative early and long-term results of
mitral valve surgery between right minithoracotomy and full sternotomy
approach.
Source
Innovations Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 4th Annual Scientific Meeting of the Japanese
Association for Minimally Invasive Cardiac Surgery, MICS. Japan. 14 (3
Supplement) (pp 15S), 2019. Date of Publication: December 2019.
Author
Chaiyaroj S.; Javakijkarnjanakul V.; Ruaengsri C.; Rattananont O.;
Lertsitthichai P.
Institution
(Chaiyaroj, Javakijkarnjanakul, Ruaengsri, Rattananont, Lertsitthichai)
Department of surgery, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand
Publisher
SAGE Publications Ltd
Abstract
Objectives: To report early and late clinical results comparing right mini
thoracotomy (RMT) versus full sternotomy (FS) mitral valve surgery (MVS).
 Method(s): Five hundred seventy-four consecutive patients who
underwent MVS were prospectively non randomized reviewed during January
2002 to October 2018. There were 333 in the FS group and 241 in the RMT
group. Baseline characteristics were compared. Early and late clinical
outcomes of 30-day mortality, reoperation for bleeding, stroke, prolonged
ventilation, renal failure, permanent pacemaker, and echocardiographic
hemodynamic performance were assessed and compared between the 2 groups.
 Result(s): Similar results were found between the RMT and FS MVS
groups including age 58.4 +/- 13.8, 58.8 +/- 13.6, P = 0.7, new atrial
fibrillation 5 (2%), 7 (2%), P = 0.9, and re operation for bleeding 2
(0.8%), 1 (0.3%), P = 0.9. There were less degenerative valve pathology
(79%, 50%, P < 0.001), aortic cross clamp time (107 +/- 37.3, 110 +/-
32.9, P = 0.4), cardiopulmonary bypass time (157.6 +/- 51.2, 170 +/- 51.6,
P = 0.005), and less bleeding and blood transfusion requirement in the RMT
group. Early clinical results of 30 days mortality, stroke, renal failure,
new pacemaker, and hemodynamic performance at 1 month, 3 to 6 month, and 1
year were comparable in both groups. Mean follow-up (year) was 4.9 + 2.5
(RMT), and 9 + 4.4 (FS). Survival probability and freedom from MACCE in
RMT and FS groups were 99.5%, 97.2% and 99.5%, 90.98%, P < 0.001,
respectively. Conclusion(s): RMT approach for MVS is associated with
cosmetic satisfaction, less bleeding, blood transfusion requirement,
similar effective hemodynamic performance, and comparable early and late
clinical results to FS approach.

<22>
Accession Number
617220467
Title
66th Annual Scientific Session of the American College of Cardiology and
i2 Summit: Innovation in Intervention, ACC.17.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(no pagination), 2017. Date of Publication: 21 Mar 2017.
Author
Anonymous
Publisher
Elsevier USA
Abstract
The proceedings contain 1541 papers. The topics discussed include:
outcomes of the different flow/gradient patterns of aortic stenosis after
aortic valve replacement: insights from partner 2A trial; association of
coronary epicardial endothelial dysfunction with low endothelial shear
stress in patients with mild coronary atherosclerosis who presented with
chest pain; prosthetic surgical tissue valve enlargement using a
high-pressure balloon (fracturing the ring) to facilitate transcatheter
valve-in-valve implantation; predictors of true ST-segment elevation
myocardial infarction in cocaine positive patients; initial results and
long-term follow-up of percutaneous mitral valvuloplasty in patients with
pulmonary hypertension; prognostic value of baseline n-terminal prohormone
type natriuretic peptide measurement in chronic lung disease patients with
severe aortic stenosis undergoing transcatheter aortic valve replacement;
trends in incidence and mortality associated with acute kidney injury in
patients undergoing PCI for acute coronary syndrome; intensity of statin
therapy and outcomes after transcatheter aortic valve replacement; five
year outcomes of fractional flow reserve guided versus intravascular
ultrasound guided percutaneous coronary intervention in intermediate
coronary artery disease; assessment of the safety of performing coronary
angioplasty without interrupting oral anticoagulants; left atrial
appendage occlusion in patients with atrial fibrillation and previous
major gastrointestinal bleeding: insight from the amplatzer cardiac plug
multicenter registry; QRS duration alterations after left ventricular
assist device implantation in patients with advanced heart disease; and
morphologic patterns of in-stent chronic total occlusions: an
intravascular ultrasound study.

<23>
Accession Number
632165842
Title
Effects of Massage on Post-Operative Pain in Infants with Complex
Congenital Heart Disease.
Source
Nursing research. (no pagination), 2020. Date of Publication: 19 Jun 2020.
Author
Harrison T.M.; Brown R.; Duffey T.; Frey C.; Bailey J.; Nist M.D.; Renner
L.; Fitch J.
Institution
(Harrison) The Ohio State University College of Nursing, Columbus, Ohio
University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
Nationwide Children's Hospital, Columbus, Ohio Nationwide Children's
Hospital, Columbus, Ohio COPC Ohio Center for Pediatrics, Dublin, Ohio The
Ohio State University College of Nursing, Columbus, Ohio Nationwide
Children's Hospital, Columbus, Ohio Nationwide Children's Hospital,
Columbus, Ohio
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain management is an essential component of care for
pediatric patients following surgery. Massage reduces self-reported
post-operative pain in adults with heart disease but has received little
attention in post-operative pediatric patients with congenital heart
disease (CCHD). OBJECTIVE(S): To evaluate the effectiveness of
massage compared to a rest period on post-operative pain scores and
physiologic responses in infants with CCHD. METHOD(S): We used a
two-group randomized clinical trial design with a sample of 60 infants
with CCHD between 1 day and 12 months of age following their first
cardiothoracic surgery. Both groups received standard post-operative care.
Group 1 received a daily 30-minute restriction of non-essential caregiving
(Quiet Time), and Group 2 received a daily 30-minute massage.
Interventions continued for seven consecutive days. Pain was measured 6
times daily using the Face, Legs, Activity, Cry, Consolability Pain
Assessment Tool (FLACC). Average daily doses of analgesics were recorded.
Heart rates (HR), respiratory rates (RR), and oxygen saturations (SpO2)
were recorded continuously. Daily averages and pre- and post- intervention
FLACC scores and physiologic responses were analyzed using descriptive
statistics, GLMM repeated measures, latent growth models, and/or
regression discontinuity analysis. Fentanyl-equivalent narcotic values
were used as a time-varying covariate. RESULT(S): Adjusted pain
scores were lower for the massage group on all days except day 7. Overall
there were no group effects on level of pain or differential rate of
change in pain. However, the massage group had lower daily pain scores
with small to medium effect size differences, largest at days 4, 5 and 6,
and lower average daily HR and RR. There was little difference between
groups in SpO2. Infants demonstrated immediate effects of massage, with HR
and RR decreasing and oxygen saturations increasing. DISCUSSION: This
study provides beginning evidence that post-operative massage may reduce
pain and improve physiologic parameters in infants with congenital heart
disease. This non-pharmacological adjunct to pain management may provide a
particular benefit for this population by reducing demand on the
cardiorespiratory system.

<24>
Accession Number
632165638
Title
Network Meta-analysis of Surgical Aortic Valve Replacement and Different
Transcatheter Heart Valve Systems for Symptomatic Severe Aortic Stenosis.
Source
The Canadian journal of cardiology. (no pagination), 2020. Date of
Publication: 28 Feb 2020.
Author
Ueyama H.; Kuno T.; Ando T.; Hayashida K.; Takagi H.
Institution
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, NY, United States
(Ando) Center for Interventional Vascular Therapy, Division of Cardiology,
New York-Presbyterian Hospital/Columbia University Medical Center, NY,
United States
(Hayashida) Division of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although different transcatheter heart valve (THV) systems
have been introduced to overcome transcatheter aortic valve replacement
(TAVR)-specific complications, head-to-head comparisons of these THV
systems are scarce. The aim of this study was to compare different THV
systems and surgical aortic valve replacement (SAVR) by conducting a
network meta-analysis. METHOD(S): PubMed and EMBASE were searched
through November 2019 for studies comparing safety and efficacy of
balloon-expandable valve (BEV), self-expanding valve (SEV), mechanically
expandable valve (MEV), and SAVR for symptomatic severe aortic stenosis.
End points in the short term at 30 days or discharge and the long term up
to 2 years were assessed. RESULT(S): We identified 11 randomized
controlled trials with a total of 10,300 patients eligible for inclusion
in our study. There were no significant differences in all-cause death
among different THV systems and SAVR in both short and long terms.
Disabling stroke was significantly lower with MEV vs BEV and SAVR (hazard
ratios [HRs] 0.31 [95% confidence interval [CI] 0.12-0.77] and 0.33 [95%
CI 0.14-0.76], respectively) in the long term. MEV was associated with an
increased risk of new permanent pacemaker implantation compared with BEV,
SEV, and SAVR (HRs 3.82 [95% CI 1.83-7.97], 1.85 [95% CI 1.02-3.36], and
5.23 [95% CI 2.61-10.47], respectively) in the long term.
 CONCLUSION(S): In patients with symptomatic severe aortic stenosis
undergoing intervention, there were no significant differences in
all-cause death among different THV systems and SAVR. MEV had low
frequency of disabling stroke compared with BEV and SAVR, but an increased
frequency of permanent pacemaker implantation compared with other
interventions. Copyright © 2020 Canadian Cardiovascular Society.
Published by Elsevier Inc. All rights reserved.

<25>
Accession Number
2005219447
Title
Efficacy of statin treatment based on cardiovascular outcomes in elderly
patients: a standard meta-analysis and Bayesian network analysis.
Source
Journal of International Medical Research. 48 (6) (no pagination), 2020.
Date of Publication: 2020.
Author
Zhai C.; Hou K.; Li R.; Hu Y.; Zhang J.; Zhang Y.; Wang L.; Zhang R.; Cong
H.
Institution
(Zhai, Hou, Cong) School of Medicine, Nankai University, Tianjin, China
(Zhai, Hou, Hu, Zhang, Zhang, Wang, Zhang, Cong) Department of Cardiology,
Tianjin Chest Hospital, Tianjin, China
(Li) Department of Internal Medicine, Tianjin GongAn Hospital, Tianjin,
China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Statins have been shown to be beneficial for the prevention of
cardiovascular events. In elderly individuals, the efficacy of statins
remains controversial and the comparative effect of statins has not been
assessed. Method(s): MEDLINE, Embase, and the Cochrane Central
database were searched for randomized controlled trials that assessed
statins in older patients. Result(s): Seventeen trials were analyzed.
When used for secondary prevention, statins were associated with reduced
risk of cardiovascular events, all-cause mortality, cardiovascular
mortality, revascularization, and stroke. When used for primary
prevention, statins reduced the risk of myocardial infarction and
revascularization, but did not significantly affect other outcomes. A
modest difference between pharmaceutical statin products was found, and
high-quality evidence indicated that intensive atorvastatin had the
greatest benefits for secondary prevention. Conclusion(s): In
secondary prevention, evidence strongly suggests that statins are
associated with a reduction in the risk of all-cause mortality,
cardiovascular events, cardiovascular mortality, and revascularization.
However, differences in the effects of various statins do not appear to
have significant effects on therapy in secondary prevention for the
elderly. Copyright © The Author(s) 2020.

<26>
Accession Number
2004450501
Title
Impact of machine-learning CT-derived fractional flow reserve for the
diagnosis and management of coronary artery disease in the randomized
CRESCENT trials.
Source
European Radiology. 30 (7) (pp 3692-3701), 2020. Date of Publication: 01
Jul 2020.
Author
Nous F.M.A.; Budde R.P.J.; Lubbers M.M.; Yamasaki Y.; Kardys I.; Bruning
T.A.; Akkerhuis J.M.; Kofflard M.J.M.; Kietselaer B.; Galema T.W.; Nieman
K.
Institution
(Nous, Budde, Lubbers, Kardys, Galema, Nieman) Department of Radiology &
Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein
40, Rotterdam 3015 GD, Netherlands
(Nous, Budde, Lubbers, Nieman) Department of Cardiology, Erasmus
University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD,
Netherlands
(Yamasaki) Department of Clinical Radiology, Graduate School of Medical
Sciences, Kyushu University, 3-1-1 Maidashi, Higashi Ward, Fukuoka
812-8582, Japan
(Bruning) Department of Cardiology, Maasstad Ziekenhuis, Maasstadweg 21,
Rotterdam 3079 DZ, Netherlands
(Akkerhuis) Department of Cardiology, Sint Franciscus Gasthuis, Kleiweg
500, Rotterdam 3045 PM, Netherlands
(Kofflard) Department of Cardiology, Albert Schweitzer Ziekenhuis, Albert
Schweitzerplaats 25, Dordrecht 3318 AT, Netherlands
(Kietselaer) Department of Cardiology, Zuyderland Medical Center, H.
Dunantstraat 5, Heerlen 6419 PC, Netherlands
(Nieman) Stanford University School of Medicine, Cardiovascular Institute,
300 Pasteur Drive, Room H2157, Stanford, CA 94305, United States
Publisher
Springer
Abstract
Objective: To determine the potential impact of on-site CT-derived
fractional flow reserve (CT-FFR) on the diagnostic efficiency and
effectiveness of coronary CT angiography (CCTA) in patients with
obstructive coronary artery disease (CAD) on CCTA. Method(s): This
observational cohort study included patients with suspected CAD who had
been randomized to cardiac CT in the CRESCENT I and II trials. On-site
CT-FFR was blindly performed in all patients with at least one >= 50%
stenosis on CCTA and no exclusion criteria for CT-FFR. We retrospectively
assessed the effect of adding CT-FFR to the CT protocol in patients with a
stenosis >= 50% on CCTA in terms of diagnostic effectiveness, i.e., the
number of additional tests required to determine the final diagnosis,
reclassification of the initial management strategy, and invasive coronary
angiography (ICA) efficiency, i.e., ICA rate without >= 50% CAD.
 Result(s): Fifty-three patients out of the 372 patients (14%) had at
least one >= 50% stenosis on CCTA of whom 42/53 patients (79%) had no
exclusion criteria for CT-FFR. CT-FFR showed a hemodynamically significant
stenosis (<= 0.80) in 27/53 patients (51%). The availability of CT-FFR
would have reduced the number of patients requiring additional testing by
57%-points compared with CCTA alone (37/53 vs. 7/53, p < 0.001). The
initial management strategy would have changed for 30 patients (57%, p <
0.001). Reserving ICA for patients with a CT-FFR <= 0.80 would have
reduced the number of ICA following CCTA by 13%-points (p = 0.016).
 Conclusion(s): Implementation of on-site CT-FFR may change management
and improve diagnostic efficiency and effectiveness in patients with
obstructive CAD on CCTA. Key Points: * The availability of on-site CT-FFR
in the diagnostic evaluation of patients with obstructive CAD on CCTA
would have significantly reduced the number of patients requiring
additional testing compared with CCTA alone. * The implementation of
on-site CT-FFR would have changed the initial management strategy
significantly in the patients with obstructive CAD on CCTA. * Restricting
ICA to patients with a positive CT-FFR would have significantly reduced
the ICA rate in patients with obstructive CAD on CCTA. Copyright
© 2020, European Society of Radiology.

<27>
Accession Number
2004045332
Title
Impact of renal function on clinical outcomes after PCI in ACS and stable
CAD patients treated with ticagrelor: a prespecified analysis of the
GLOBAL LEADERS randomized clinical trial.
Source
Clinical Research in Cardiology. 109 (7) (pp 930-943), 2020. Date of
Publication: 01 Jul 2020.
Author
Tomaniak M.; Chichareon P.; Klimczak-Tomaniak D.; Takahashi K.; Kogame N.;
Modolo R.; Wang R.; Ono M.; Hara H.; Gao C.; Kawashima H.;
Rademaker-Havinga T.; Garg S.; Curzen N.; Haude M.; Kochman J.; Gori T.;
Montalescot G.; Angiolillo D.J.; Capodanno D.; Storey R.F.; Hamm C.;
Vranckx P.; Valgimigli M.; Windecker S.; Onuma Y.; Serruys P.W.; Anderson
R.
Institution
(Tomaniak) Department of Cardiology, Erasmus University Medical Centre,
Erasmus University, Rotterdam, Netherlands
(Tomaniak, Kochman) First Department of Cardiology, Medical University of
Warsaw, Warsaw, Poland
(Chichareon, Takahashi, Kogame, Modolo, Ono, Hara, Kawashima) Department
of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Klimczak-Tomaniak) Department of Immunology, Transplantation and Internal
Medicine, Department of Cardiology, Hypertension and Internal Medicine,
Medical University of Warsaw, Warsaw, Poland
(Modolo) Department of Internal Medicine, Cardiology Division, University
of Campinas (UNICAMP), Campinas, Brazil
(Wang, Gao) Department of Cardiology, Xijing Hospital, Xi'an, China
(Rademaker-Havinga) Cardialysis Core Laboratories and Clinical Trial
Management, Rotterdam, Netherlands
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Curzen) University Hospital Southampton NHSF, Southampton, United Kingdom
(Haude) Department of Cardiology, Stadtische Kliniken Neuss, Neuss,
Germany
(Gori) Deutsches Zentrum fur Herz und Kreislauf Forschung, Standort
Rhein-Main, University Medical Center Mainz, Mainz, Germany
(Montalescot) Cardiology Department, ACTION Study Group, Nimes University
Hospital, Montpellier University, Nimes, France
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Capodanno) Division of Cardiology, A.O.U. "Policlinico-Vittorio
Emanuele", University of Catania, Catania, Italy
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Cardiology and Cardiothoracic Surgery
Directorate, Sheffield Teaching Hospitals NHS Foundation Trust,
Cardiovascular Research Unit, Centre for Biomedical Research, Northern
General Hospital, Sheffield, United Kingdom
(Hamm) University of Giessen, Giessen, Germany
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, Inselspital, University of Bern, Bern, Switzerland
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Anderson) University Hospital of Wales, Cardiff, United Kingdom
(Onuma, Serruys) Department of Cardiology, National University of Ireland,
Galway (NUIG), University Road, Galway H91 TK33, Ireland
(Wang, Gao) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
Publisher
Springer
Abstract
Background: Impaired renal function (IRF) is associated with increased
risks of both ischemic and bleeding events. Ticagrelor has been shown to
provide greater absolute reduction in ischemic risk following acute
coronary syndrome (ACS) in those with versus without IRF. Method(s):
A pre-specified sub-analysis of the randomized GLOBAL LEADERS trial (n =
15,991) comparing the experimental strategy of 23-month ticagrelor
monotherapy (after 1-month ticagrelor and aspirin dual anti-platelet
therapy [DAPT]) with 12-month DAPT followed by 12-month aspirin after
percutaneous coronary intervention (PCI) in ACS and stable coronary artery
disease (CAD) patients stratified according to IRF (glomerular filtration
rate < 60 ml/min/1.73 m2). Result(s): At 2 years, patients
with IRF (n = 2171) had a higher rate of the primary endpoint (all-cause
mortality or centrally adjudicated, new Q-wave myocardial infarction
[MI](hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.35-1.98,
p<inf>adj</inf> = 0.001), all-cause death, site-reported MI, all
revascularization and BARC 3 or 5 type bleeding, compared with patients
without IRF. Among patients with IRF, there were similar rates of the
primary endpoint (HR 0.82, 95% CI 0.61-1.11, p = 0.192, p<inf>int</inf> =
0.680) and BARC 3 or 5 type bleeding (HR 1.10, 95% CI 0.71-1.71, p =
0.656, p<inf>int</inf> = 0.506) in the experimental versus the reference
group. No significant interactions were seen between IRF and treatment
effect for any of the secondary outcome variables. Among ACS patients with
IRF, there were no between-group differences in the rates of the primary
endpoint or BARC 3 or 5 type bleeding; however, the rates of the
patient-oriented composite endpoint (POCE) of all-cause death, any stroke,
MI, or revascularization (p<inf>int</inf> = 0.028) and net adverse
clinical events (POCE and BARC 3 or 5 type bleeding) (p<inf>int</inf> =
0.045), were lower in the experimental versus the reference group. No
treatment effects were found in stable CAD patients categorized according
to presence of IRF. Conclusion(s): IRF negatively impacted long-term
prognosis after PCI. There were no differential treatment effects found
with regard to all-cause death or new Q-wave MI after PCI in patients with
IRF treated with ticagrelor monotherapy. Clinical trial registration: The
trial has been registered with ClinicalTrials.gov, number NCT01813435.
Graphic abstract: [Figure not available: see fulltext.]. Copyright
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

<28>
Accession Number
2006732683
Title
Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in
High-Risk Patients With Atrial Fibrillation.
Source
Journal of the American College of Cardiology. 75 (25) (pp 3122-3135),
2020. Date of Publication: 30 June 2020.
Author
Osmancik P.; Herman D.; Neuzil P.; Hala P.; Taborsky M.; Kala P.; Poloczek
M.; Stasek J.; Haman L.; Branny M.; Chovancik J.; Cervinka P.; Holy J.;
Kovarnik T.; Zemanek D.; Havranek S.; Vancura V.; Opatrny J.; Peichl P.;
Tousek P.; Lekesova V.; Jarkovsky J.; Novackova M.; Benesova K.; Widimsky
P.; Reddy V.Y.
Institution
(Osmancik, Herman, Tousek, Widimsky) Cardiocenter, Third Faculty of
Medicine, Charles University Prague and University Hospital Kralovske
Vinohrady, Prague, Czechia
(Neuzil, Hala, Lekesova, Reddy) Cardiocenter, Department of Cardiology, Na
Homolce Hospital, Prague, Czechia
(Taborsky) Cardiocenter, Department of Cardiology, University Hospital
Olomouc, Olomouc, Czechia
(Kala, Poloczek) Clinic of Cardiology, Masaryk University and University
Hospital Brno, Brno, Czechia
(Stasek, Haman) First Department of Internal Medicine, Faculty of
Medicine, University Hospital Hradec Kralove, Charles University Prague,
Prague, Czechia
(Branny, Chovancik) Department of Cardiology, Cardiocenter, Hospital
Podlesi a.s., Trinec, Czechia
(Cervinka, Holy) Department of Cardiology, Krajska zdravotni a.s., Masaryk
Hospital and J.E.Purkyne University, Usti nad Labem, Czechia
(Kovarnik, Zemanek, Havranek) Cardiocenter, Second Internal
Clinic-Cardiology and Angiology, Charles University, General Faculty
Hospital, Prague, Czechia
(Vancura, Opatrny) Department of Cardiology, University Hospital and
Faculty of Medicine Pilsen, Pilsen, Czechia
(Peichl) Cardiocenter, Institute of Clinical and Experimental Medicine,
Prague, Czechia
(Jarkovsky, Novackova, Benesova) Masaryk University, Institute of
Biostatistics and Analyses, Brno, Czechia
(Reddy) Helmsley Electrophysiology Center, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Percutaneous left atrial appendage closure (LAAC) is
noninferior to vitamin K antagonists (VKAs) for preventing atrial
fibrillation (AF)-related stroke. However, direct oral anticoagulants
(DOACs) have an improved safety profile over VKAs, and their effect on
cardiovascular and neurological outcomes relative to LAAC is unknown.
 Objective(s): This study sought to compare DOACs with LAAC in
high-risk patients with AF. Method(s): Left Atrial Appendage Closure
vs. Novel Anticoagulation Agents in Atrial Fibrillation (PRAGUE-17) was a
multicenter, randomized, noninferiority trial comparing LAAC with DOACs.
Patients were eligible to be enrolled if they had nonvalvular AF; were
indicated for oral anticoagulation (OAC); and had a history of bleeding
requiring intervention or hospitalization, a history of a cardioembolic
event while taking an OAC, and/or a CHA<inf>2</inf>DS<inf>2</inf>-VASc of
>=3 and HAS-BLED of >2. Patients were randomized to receive LAAC or DOAC.
The primary composite outcome was stroke, transient ischemic attack,
systemic embolism, cardiovascular death, major or nonmajor clinically
relevant bleeding, or procedure-/device-related complications. The primary
analysis was by modified intention to treat. Result(s): A high-risk
patient cohort (CHA<inf>2</inf>DS<inf>2</inf>-VASc: 4.7 +/- 1.5) was
randomized to receive LAAC (n = 201) or DOAC (n = 201). LAAC was
successful in 181 of 201 (90.0%) patients. In the DOAC group, apixaban was
most frequently used (192 of 201; 95.5%). At a median 19.9 months of
follow-up, the annual rates of the primary outcome were 10.99% with LAAC
and 13.42% with DOAC (subdistribution hazard ratio [sHR]: 0.84; 95%
confidence interval [CI]: 0.53 to 1.31; p = 0.44; p = 0.004 for
noninferiority). There were no differences between groups for the
components of the composite endpoint: all-stroke/TIA (sHR: 1.00; 95% CI:
0.40 to 2.51), clinically significant bleeding (sHR: 0.81; 95% CI: 0.44 to
1.52), and cardiovascular death (sHR: 0.75; 95% CI: 0.34 to 1.62). Major
LAAC-related complications occurred in 9 (4.5%) patients.
 Conclusion(s): Among patients at high risk for stroke and increased
risk of bleeding, LAAC was noninferior to DOAC in preventing major
AF-related cardiovascular, neurological, and bleeding events. (Left Atrial
Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation
[PRAGUE-17]; NCT02426944) Copyright © 2020 American College of
Cardiology Foundation

<29>
Accession Number
2006145398
Title
Subclinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic
Valves: PARTNER 3 Cardiac Computed Tomography Substudy.
Source
Journal of the American College of Cardiology. 75 (24) (pp 3003-3015),
2020. Date of Publication: 23 June 2020.
Author
Makkar R.R.; Blanke P.; Leipsic J.; Thourani V.; Chakravarty T.; Brown D.;
Trento A.; Guyton R.; Babaliaros V.; Williams M.; Jilaihawi H.; Kodali S.;
George I.; Lu M.; McCabe J.M.; Friedman J.; Smalling R.; Wong S.C.;
Yazdani S.; Bhatt D.L.; Bax J.; Kapadia S.; Herrmann H.C.; Mack M.; Leon
M.B.
Institution
(Makkar, Chakravarty, Trento, Friedman) Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Blanke, Leipsic) St. Paul's Hospital, University of British Columbia,
Vancouver, British Columbia, Canada
(Thourani) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Brown, Mack) Baylor Scott and White Healthcare, Plano, TX, United States
(Guyton, Babaliaros) Emory University, Atlanta, Georgia, Georgia
(Williams, Jilaihawi) New York University Langone Medical Center, New
York, NY, United States
(Kodali, George, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Lu) Department of Biostatistics, Edwards Lifesciences, Irvine, CA, United
States
(McCabe) University of Washington, Seattle, WA, United States
(Smalling) The University of Texas Health Science Center at Houston,
Houston, TX, United States
(Wong) Cornell University New York, New York, NY, United States
(Yazdani) Inova Heart and Vascular Institute (Fairfax Inova), Falls
Church, VA, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, MA, United States
(Bax) Leiden University Medical Centre, Leiden, Netherlands
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
Publisher
Elsevier USA
Abstract
Background: Subclinical leaflet thrombosis, characterized by
hypoattenuated leaflet thickening (HALT) and reduced leaflet motion
observed on 4-dimensional computed tomography (CT), may represent a form
of bioprosthetic valve dysfunction. Objective(s): The U.S. Food and
Drug Administration mandated CT studies to understand the natural history
of this finding, differences between transcatheter and surgical valves,
and its association with valve hemodynamics and clinical outcomes.
 Method(s): The PARTNER 3 (The Safety and Effectiveness of the SAPIEN
3 Transcatheter Heart Valve in Low-Risk Patients With Aortic Stenosis) CT
substudy randomized 435 patients with low-surgical-risk aortic stenosis to
undergo transcatheter aortic valve replacement (n = 221) or surgery (n =
214). Serial 4-dimensional CTs were performed at 30 days and 1 year and
were analyzed independently by a core laboratory. Result(s): The
incidence of HALT increased from 10% at 30 days to 24% at 1 year.
Spontaneous resolution of 30-day HALT occurred in 54% of patients at 1
year, whereas new HALT appeared in 21% of patients at 1 year. HALT was
more frequent in transcatheter versus surgical valves at 30 days (13% vs.
5%; p = 0.03), but not at 1 year (28% vs. 20%; p = 0.19). The presence of
HALT did not significantly affect aortic valve mean gradients at 30 days
or 1 year. Patients with HALT at both 30 days and 1 year, compared with
those with no HALT at 30 days and 1 year, had significantly increased
aortic valve gradients at 1 year (17.8 +/- 2.2 mm Hg vs. 12.7. +/- 0.3 mm
Hg; p = 0.04). Conclusion(s): Subclinical leaflet thrombosis was more
frequent in transcatheter compared with surgical valves at 30 days, but
not at 1 year. The impact of HALT on thromboembolic complications and
structural valve degeneration needs further assessment. Copyright
© 2020 The Authors

<30>
Accession Number
631759595
Title
An Exploratory Analysis of Proprotein Convertase Subtilisin/Kexin Type 9
Inhibition and Aortic Stenosis in the FOURIER Trial.
Source
JAMA Cardiology. 5 (6) (pp 709-713), 2020. Date of Publication: June 2020.
Author
Bergmark B.A.; O'Donoghue M.L.; Murphy S.A.; Kuder J.F.; Ezhov M.V.; Ceska
R.; Gouni-Berthold I.; Jensen H.K.; Tokgozoglu S.L.; MacH F.; Huber K.;
Gaciong Z.; Lewis B.S.; Schiele F.; Jukema J.W.; Pedersen T.R.; Giugliano
R.P.; Sabatine M.S.
Institution
(Bergmark, O'Donoghue, Murphy, Kuder, Giugliano, Sabatine) TIMI Study
Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, 60 Fenwood Rd, Ste 7022, Boston, MA 02115, United States
(Ezhov) National Medical Research Center of Cardiology, Moscow, Russian
Federation
(Ceska) Third Internal Medicine Clinic, Center for Preventive Cardiology,
University General Hospital, First Medical Faculty, Charles University,
Prague, Czechia
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Cologne, Germany
(Jensen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Jensen) Department of Clinical Medicine, Health, Aarhus University,
Aarhus, Denmark
(Tokgozoglu) Department of Cardiology, Hacettepe University, Ankara,
Turkey
(MacH) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(Huber) Cardiology and Intensive Care Medicine, Wilhelminenhospital, Third
Department of Medicine, Sigmund Freud University, Medical Faculty, Vienna,
Austria
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Disease, Medical University of Warsaw, Warsaw, Poland
(Lewis) Ruth and Bruce Rappaport School of Medicine, Lady Davis Carmel
Medical Center, Technion-IIT, Haifa, Israel
(Schiele) University Hospital Center Besancon, Besancon, France
(Jukema) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Jukema) Netherlands Heart Institute, Utrecht, Netherlands
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Despite recent advances in treatment of severe aortic valve
stenosis (AS), AS remains a life-threatening condition with no proven
disease-modifying therapy. Low-density lipoprotein cholesterol (LDL-C) and
lipoprotein(a) (Lp[a]) have been implicated in the pathobiology of AS. The
proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab reduces
circulating LDL-C concentrations by 50% to 60% and Lp(a) by 20% to 30%.
 Objective(s): To determine whether evolocumab reduces the risk of AS
events in patients with atherosclerotic cardiovascular disease.
 Intervention(s): Patients were randomized 1:1 to evolocumab or
placebo. Design, Setting, and Participant(s): Exploratory analysis of
the FOURIER trial, which enrolled 27564 patients with stable
atherosclerotic cardiovascular disease who were taking statin therapy at
1242 sites in 49 countries from February 2013 to November 2016. Patients
were randomized to evolocumab or placebo and followed up for a median
(interquartile range) of 2.2 (1.8-2.5) years. This post hoc analysis was
performed from September 2019 to February 2020. Main Outcomes and
Measures: Site-reported adverse events of new or worsening AS or aortic
valve replacement (termed AS events). The adjusted risk of AS events was
calculated with a multivariable model including concentrations of Lp(a)
and LDL-C corrected for Lp(a) content, plus age, sex, diabetes,
hypertension, current smoking, and estimated glomerular filtration rate.
Evolocumab efficacy was tested using a Cox proportional hazards model.
 Result(s): Aortic stenosis events occurred in 63 patients (48 men
[76%]; mean [SD] age, 69 [9] years) over a median of 2.2 years. Elevated
Lp(a) concentration was associated with higher rates of AS events
(adjusted hazard ratio [aHR], 1.55 [95% CI, 1.17-2.05] per SD; P =.002),
including aortic valve replacement (aHR, 2.22 [95% CI, 1.38-3.58] per SD;
P =.001), after multivariable adjustment. The corrected LDL-C
concentration was not significantly associated with AS events (aHR, 1.23
[95% CI, 0.93-1.61] per SD; P =.14). The overall HR for AS events with
evolocumab was 0.66 (95% CI, 0.40-1.09), with no apparent association in
the first year (HR, 1.09 [95% CI, 0.48-2.47]) but an HR of 0.48 (95% CI,
0.25-0.93) after the first year of treatment. Conclusions and
Relevance: In this exploratory analysis of the FOURIER trial, higher Lp(a)
levels, but not Lp(a)-corrected LDL-C levels, were associated with a
higher risk of subsequent AS events, including aortic valve replacement.
Long-term therapy with evolocumab may reduce AS events, and this raises
the possibility that specific pharmacologic lipid-lowering therapy could
offer a means to prevent or slow the progression of AS. These exploratory
findings merit further investigation with a dedicated randomized clinical
trial. Trial Registration: ClinicalTrials.gov Identifier:
NCT01764633. Copyright © 2020 American Medical Association. All
rights reserved.

<31>
Accession Number
631336317
Title
Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids with
Aortic Stenosis.
Source
JAMA Cardiology. 5 (6) (pp 694-702), 2020. Date of Publication: June 2020.
Author
Chen H.Y.; Cairns B.J.; Small A.M.; Burr H.A.; Ambikkumar A.; Martinsson
A.; Theriault S.; Munter H.M.; Steffen B.; Zhang R.; Levinson R.T.;
Shaffer C.M.; Rong J.; Sonestedt E.; Dufresne L.; Ljungberg J.; Naslund
U.; Johansson B.; Ranatunga D.K.; Whitmer R.A.; Budoff M.J.; Nguyen A.;
Vasan R.S.; Larson M.G.; Harris W.S.; Damrauer S.M.; Stark K.D.; Boekholdt
S.M.; Wareham N.J.; Pibarot P.; Arsenault B.J.; Mathieu P.; Gudnason V.;
O'Donnell C.J.; Rotter J.I.; Tsai M.Y.; Post W.S.; Clarke R.; Soderberg
S.; Bosse Y.; Wells Q.S.; Smith J.G.; Rader D.J.; Lathrop M.; Engert J.C.;
Thanassoulis G.
Institution
(Chen, Burr, Engert, Thanassoulis) Division of Experimental Medicine,
McGill University, Montreal, QC, Canada
(Chen, Burr, Ambikkumar, Zhang, Dufresne, Nguyen, Engert, Thanassoulis)
Preventive and Genomic Cardiology, McGill University Health Centre,
Research Institute, 1001 Decarie Blvd, Room D05.5120, Montreal, QC H4A
3J1, Canada
(Cairns, Clarke) MRC (Medical Research Council), Population Health
Research Unit, Nuffield Department of Population Health, University of
Oxford, Oxford, United Kingdom
(Cairns, Clarke) Clinical Trial Service Unit, Nuffield Department of
Population Health, University of Oxford, Oxford, United Kingdom
(Cairns, Clarke) Epidemiological Studies Unit, Nuffield Department of
Population Health, University of Oxford, Oxford, United Kingdom
(Small) Department of Medicine, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, United States
(Martinsson) Department of Cardiology, Clinical Sciences, Lund University,
Lund, Sweden
(Martinsson, Smith) Department of Cardiology, Skane University Hospital,
Lund, Sweden
(Theriault, Pibarot, Arsenault, Mathieu, Bosse) Quebec Heart and Lung
Institute, Laval University, Quebec City, QC, Canada
(Munter, Lathrop) McGill University, Genome Quebec Innovation Centre,
Montreal, QC, Canada
(Steffen, Tsai) Department of Laboratory Medicine and Pathology,
University of Minnesota, Minneapolis, MN, United States
(Levinson, Shaffer, Wells) Vanderbilt Translational and Clinical
Cardiovascular Research Center, Vanderbilt University Medical Center,
Nashville, TN, United States
(Rong, Vasan, Larson, O'Donnell) National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Rong, Vasan, Larson, O'Donnell) Boston University's Framingham Heart
Study, Boston, MA, United States
(Sonestedt) Nutritional Epidemiology, Department of Clinical Sciences
Malmo, Lund University, Malmo, Sweden
(Ljungberg, Naslund, Johansson, Soderberg) Department of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Ranatunga) Division of Research, Kaiser Permanente of Northern
California, Oakland, United States
(Whitmer) Department of Public Health Sciences, University of California,
Davis, United States
(Budoff, Rotter) Los Angeles Biomedical Research Institute, Torrance, CA,
United States
(Budoff, Rotter) Departments of Pediatrics and Medicine, Harbor-UCLA
(University of California Los Angeles), Medical Center, Torrance, United
States
(Harris) Department of Medicine, Sanford School of Medicine, University of
South Dakota, Sioux Falls, SD, United States
(Harris) OmegaQuant Analytics LLC, Sioux Falls, SD, United States
(Damrauer) Department of Surgery, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, United States
(Stark) Department of Kinesiology, University of Waterloo, Waterloo, ON,
Canada
(Boekholdt) Department of Cardiology, Amsterdam University Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Wareham) MRC Epidemiology Unit, University of Cambridge, Cambridge,
United Kingdom
(Gudnason) Faculty of Medicine, University of Iceland, Reykjavik, Iceland
(Post) Division of Cardiology, Department of Medicine, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
(Smith) Wallenberg Center for Molecular Medicine, Lund University, Lund,
Sweden
(Smith) Lund University Diabetes Center, Lund University, Lund, Sweden
(Rader) Department of Genetics, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, United States
(Lathrop, Engert) Department of Human Genetics, McGill University,
Montreal, QC, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Aortic stenosis (AS) has no approved medical treatment.
Identifying etiological pathways for AS could identify pharmacological
targets. Objective(s): To identify novel genetic loci and pathways
associated with AS. Design, Setting, and Participant(s): This
genome-wide association study used a case-control design to evaluate 44703
participants (3469 cases of AS) of self-reported European ancestry from
the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort
(from January 1, 1996, to December 31, 2015). Replication was performed in
7 other cohorts totaling 256926 participants (5926 cases of AS), with
additional analyses performed in 6942 participants from the Cohorts for
Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium.
Follow-up biomarker analyses with aortic valve calcium (AVC) were also
performed. Data were analyzed from May 1, 2017, to December 5, 2019.
Exposures: Genetic variants (615643 variants) and polyunsaturated fatty
acids (omega-6 and omega-3) measured in blood samples. Main Outcomes
and Measures: Aortic stenosis and aortic valve replacement defined by
electronic health records, surgical records, or echocardiography and the
presence of AVC measured by computed tomography. Result(s): The mean
(SD) age of the 44703 GERA participants was 69.7 (8.4) years, and 22019
(49.3%) were men. The rs174547 variant at the FADS1/2 locus was associated
with AS (odds ratio [OR] per C allele, 0.88; 95% CI, 0.83-0.93; P = 3.0 x
10-6), with genome-wide significance after meta-analysis with 7
replication cohorts totaling 312118 individuals (9395 cases of AS) (OR,
0.91; 95% CI, 0.88-0.94; P = 2.5 x 10-8). A consistent
association with AVC was also observed (OR, 0.91; 95% CI, 0.83-0.99; P
=.03). A higher ratio of arachidonic acid to linoleic acid was associated
with AVC (OR per SD of the natural logarithm, 1.19; 95% CI, 1.09-1.30; P =
6.6 x 10-5). In mendelian randomization, increased FADS1 liver
expression and arachidonic acid were associated with AS (OR per unit of
normalized expression, 1.31 [95% CI, 1.17-1.48; P = 7.4 x
10-6]; OR per 5-percentage point increase in arachidonic acid
for AVC, 1.23 [95% CI, 1.01-1.49; P =.04]; OR per 5-percentage point
increase in arachidonic acid for AS, 1.08 [95% CI, 1.04-1.13; P = 4.1 x
10-4]). Conclusions and Relevance: Variation at the
FADS1/2 locus was associated with AS and AVC. Findings from biomarker
measurements and mendelian randomization appear to link omega-6 fatty acid
biosynthesis to AS, which may represent a therapeutic
target. Copyright © 2020 American Medical Association. All rights
reserved.

<32>
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. 22 (6) (pp 1070-1079), 2020. Date of
Publication: 01 Jun 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

<33>
Accession Number
2004443186
Title
Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A
Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 41 (5) (pp 853-861), 2020. Date of Publication: 01
Jun 2020.
Author
Mylonas K.S.; Ziogas I.A.; Evangeliou A.; Hemmati P.; Schizas D.; Sfyridis
P.G.; Economopoulos K.P.; Bakoyiannis C.; Kapelouzou A.; Tzifa A.;
Avgerinos D.V.
Institution
(Mylonas, Sfyridis) Department of Pediatric Cardiac Surgery, Mitera
Children's Hospital, HYGEIA Group, Athens, Greece
(Mylonas, Schizas) First Department of Surgery, Laiko General Hospital,
National and Kapodistrian University of Athens, Athens 11527, Greece
(Ziogas) Department of Surgery, Vanderbilt Medical Center, Nashville, TN,
United States
(Ziogas, Evangeliou, Economopoulos) Surgery Working Group, Society of
Junior Doctors, Athens, Greece
(Hemmati) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Economopoulos) Department of Surgery, Duke University Medical Center,
Durham, NC, United States
(Bakoyiannis) Division of Vascular Surgery, Laikon General Hospital,
National and Kapodistrian University of Athens, Athens, Greece
(Kapelouzou) Clinical, Experimental Surgery & Translational Research,
Biomedical Research Foundation Academy of Athens, Athens, Greece
(Tzifa) Department of Pediatric Cardiology and Adult Congenital Heart
Disease, Mitera Children's Hospital, HYGEIA Group, Athens, Greece
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Hospital, Weill Cornell Medicine, New York City, NY, United States
Publisher
Springer
Abstract
Device closure is the first-line treatment for most atrial septal defects
(ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and
effective for ASD closure with comparable mortality/morbidity and superior
cosmetic results compared to conventional median sternotomy. Our goal was
to compare percutaneous versus MICS of ASDs. A systematic review was
performed using PubMed and the Cochrane Library (end-of-search date on May
22, 2019). Meta-analyses were conducted using fixed and random effects
models. In the present systematic review, we analyzed six studies
including 1577 patients with ASDs who underwent either MICS (n = 642) or
device closure (n = 935). Treatment efficacy was significantly higher in
the MICS (99.8%; 95% CI 98.9-99.9) compared to the device closure group
(97.3%; 95% CI 95.6-98.2), (OR 0.1; 95% CI 0.02-0.6). Surgical patients
experienced significantly more complications (16.2%; 95% CI 13.0-19.9)
compared to those that were treated with a percutaneous approach (7.1%;
95% CI 5.0-9.8), (OR 2.0; 95% CI 1.2-3.2). Surgery was associated with
significantly longer length of hospital stay (5.6 +/- 1.7 days) compared
to device closure (1.3 +/- 1.4 days), (OR 4.8; 95% CI 1.1-20.5). Residual
shunts were more common with the transcatheter (3.9%; 95% CI 2.7-5.5)
compared to the surgical approach (0.95%; 95% CI 0.3-2.4), (OR 0.1; 95% CI
0.06-0.5). There was no difference between the two techniques in terms of
major bleeding, hematoma formation, transfusion requirements, cardiac
tamponade, new-onset atrial fibrillation, permanent pacemaker placement,
and reoperation rates. MICS for ASD is a safe procedure and compares
favorably to transcatheter closure. Despite longer hospitalization
requirements, the MICS approach is feasible irrespective of ASD anatomy
and may lead to a more effective and durable repair. Copyright ©
2020, Springer Science+Business Media, LLC, part of Springer Nature.

<34>
Accession Number
632143905
Title
A meta-analysis of preoperative bronchoscopic marking for pulmonary
nodules.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 58 (1) (pp 40-50), 2020.
Date of Publication: 01 Jul 2020.
Author
Yanagiya M.; Kawahara T.; Ueda K.; Yoshida D.; Yamaguchi H.; Sato M.
Institution
(Yanagiya, Yamaguchi, Sato) Department of Thoracic Surgery, University of
Tokyo Graduate School of Medicine, Tokyo, Japan
(Kawahara) Biostatistics Division, Clinical Research Support Center,
University of Tokyo Hospital, Tokyo, Japan
(Ueda) Management Division, Clinical Research Support Center, University
of Tokyo Hospital, Tokyo, Japan
(Yoshida) Department of Surgery, Asahi General Hospital, Asahi, Japan
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Recent studies have suggested the usefulness of preoperative
bronchoscopic marking techniques for the localization of pulmonary nodules
in thoracic surgery. This systematic review and meta-analysis aimed to
evaluate the efficacy and safety of preoperative bronchoscopic marking.
 METHOD(S): The PubMed and Cochrane Library databases were searched
for clinical studies evaluating preoperative bronchoscopic marking for
pulmonary resection. Non-comparative and random effects model-based
meta-analyses were conducted to calculate the pooled success and
complication rates of bronchoscopic marking. RESULT(S): Twenty-five
eligible studies were included. Among these, 15 studies conducted dye
marking under electromagnetic navigation bronchoscopy, 4 used
virtual-assisted lung mapping and 7 used other marking methods. The
overall pooled successful marking rate, successful resection rate and
complete resection rate were 0.97 [95% confidence interval (CI)
0.95-0.99], 0.98 (95% CI 0.96-1.00) and 1.00 (95% CI 1.00-1.00),
respectively. The overall pooled rates of pleural injury and pulmonary
haemorrhage were 0.02 (95% CI 0.01-0.05) and 0.00 (95% CI 0.00-0.00),
respectively. CONCLUSION(S): This meta-analysis demonstrated that
bronchoscopic marking is very safe and effective. Bronchoscopic marking
should be considered, especially if there are concerns about the safety of
other localization methods. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<35>
Accession Number
2006779719
Title
Percutaneous Balloon Pericardiotomy (PBP) Revisited: A Case Report and
Review of Literature.
Source
Case Reports in Cardiology. 2020 (no pagination), 2020. Article Number:
8121763. Date of Publication: 2020.
Author
Aqel R.; Elqadi M.; Hammouri A.; Alqadi M.S.
Institution
(Aqel) National Center for Diabetes, Endocrinology and Genetics Center,
Amman, Jordan
(Elqadi, Hammouri) Al-Quds University, Faculty of Medicine, Jerusalem,
Palestine
(Alqadi) Al-Ahli Hospital, Hebron, Palestine
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. A Percutaneous Balloon Pericardiotomy (PBP) procedure is a
reemerging nonsurgical technique that helps in preventing the
reaccumulation of pericardial effusion. It is done percutaneously without
general anaesthesia. It has been proved to be effective in alleviating and
preventing recurrent pericardial effusion. Case Presentation. We reported
a 52-year-old male with stage IV adenocarcinoma causing recurrent
pericardial effusion. The patient experienced a worsening shortness of
breath. A surgical pericardial window was denied by the surgery team
secondary to severe respiratory distress; subsequently, the patient
underwent Percutaneous Balloon Pericardiotomy. Conclusion. Percutaneous
Balloon Pericardiotomy is efficacious and safe when done by well-trained
physicians. We think it should be considered as a preferred treatment
modality in most sicker patients with recurrent pericardial
effusion. Copyright © 2020 Raed Aqel et al.

<36>
Accession Number
2005392380
Title
The PASCAL Device-Early Experience with a Leaflet Approximation Device:
What Are the Benefits/Limitations Compared with the MitraClip?.
Source
Current Cardiology Reports. 22 (8) (no pagination), 2020. Article Number:
74. Date of Publication: 01 Aug 2020.
Author
Corpataux N.; Winkel M.G.; Kassar M.; Brugger N.; Windecker S.; Praz F.
Institution
(Corpataux, Winkel, Kassar, Brugger, Windecker, Praz) Department of
Cardiology, Bern University Hospital, University of Bern, Bern 3010,
Switzerland
Publisher
Springer
Abstract
Purpose of Review: This review article describes the technical features of
the novel Edwards PASCAL transcatheter valve repair system as well as the
evidence accumulated so far. Recent Findings: Transcatheter mitral and
tricuspid valve leaflet approximation enable treatment of patients with
mitral and tricuspid regurgitation who are not eligible for surgery. The
PASCAL device offers an alternative that may allow to overcome some of the
limitations of previous systems and open the path for an approach adapted
to individual patient's anatomy. Early data show similar safety and
efficacy compared with the Abbott MitraClip system. Summary: The
PASCAL system is a valuable addition to the armamentarium of transcatheter
mitral and tricuspid valve repair devices. Randomized head-to-head
comparisons and long-term data are needed to confirm the promising results
observed so far. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<37>
Accession Number
2006842729
Title
Machine-learning-based in-hospital mortality prediction for transcatheter
mitral valve repair in the United States.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Hernandez-Suarez D.F.; Ranka S.; Kim Y.; Latib A.; Wiley J.;
Lopez-Candales A.; Pinto D.S.; Gonzalez M.C.; Ramakrishna H.; Sanina C.;
Nieves-Rodriguez B.G.; Rodriguez-Maldonado J.; Feliu Maldonado R.;
Rodriguez-Ruiz I.J.; da Luz Sant'Ana I.; Wiley K.A.; Cox-Alomar P.;
Villablanca P.A.; Roche-Lima A.
Institution
(Hernandez-Suarez) Division of Cardiovascular Medicine, Department of
Medicine, University of Puerto Rico School of Medicine, San Juan, PR,
United States
(Ranka) Division of Cardiovascular Medicine, Department of Medicine,
University of Kansas School of Medicine, Kansas City, KS, United States
(Kim) Division of Cardiovascular Medicine, Department of Medicine, Yale
University School of Medicine, New Haven, CT, United States
(Latib, Wiley, Gonzalez, Sanina) Division of Cardiology, Department of
Medicine, Montefiore Medical Center/Albert Einstein College of Medicine,
New York, NY, United States
(Lopez-Candales) Division of Cardiology, Department of Medicine,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
(Pinto) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic, Rochester, MN, United States
(Nieves-Rodriguez, Rodriguez-Maldonado, Feliu Maldonado, Rodriguez-Ruiz,
da Luz Sant'Ana, Roche-Lima) Center for Collaborative Research in Health
Disparities, University of Puerto Rico School of Medicine, San Juan, PR,
United States
(Wiley) College of Agriculture and Life Sciences, Cornell University,
Ithaca, NY, United States
(Cox-Alomar) Division of Cardiology, Department of Medicine, Louisiana
State University, New Orleans, LA, United States
(Villablanca) Division of Cardiovascular Medicine, Department of Medicine,
Henry Ford Hospital, Detroit, MI, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter mitral valve repair utilization has increased
significantly in the United States over the last years. Yet, a
risk-prediction tool for adverse events has not been developed. We aimed
to generate a machine-learning-based algorithm to predict in-hospital
mortality after TMVR. Method(s): Patients who underwent TMVR from
2012 through 2015 were identified using the National Inpatient Sample
database. The study population was randomly divided into a training set (n
= 636) and a testing set (n = 213). Prediction models for in-hospital
mortality were obtained using five supervised machine-learning
classifiers. Result(s): A total of 849 TMVRs were analyzed in our
study. The overall in-hospital mortality was 3.1%. A naive Bayes (NB)
model had the best discrimination for fifteen variables, with an area
under the receiver-operating curve (AUC) of 0.83 (95% CI, 0.80-0.87),
compared to 0.77 for logistic regression (95% CI, 0.58-0.95), 0.73 for an
artificial neural network (95% CI, 0.55-0.91), and 0.67 for both a random
forest and a support-vector machine (95% CI, 0.47-0.87). History of
coronary artery disease, of chronic kidney disease, and smoking were the
three most significant predictors of in-hospital mortality.
 Conclusion(s): We developed a robust machine-learning-derived model
to predict in-hospital mortality in patients undergoing TMVR. This model
is promising for decision-making and deserves further clinical
validation. Copyright © 2020 Elsevier Inc.

<38>
Accession Number
2006842701
Title
Long-Term Graft Patency After Off-Pump and On-Pump Coronary Artery Bypass:
A CORONARY Trial Cohort.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Yang L.; Lin S.; Zhang H.; Gu D.; Chen S.; Shi Y.; Zheng Z.
Institution
(Yang, Lin, Zhang, Gu, Chen, Shi, Zheng) National Clinical Research Center
of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Publisher
Elsevier USA
Abstract
Background: Randomized controlled trials have compared the early and
midterm prognosis of on-pump coronary artery bypass grafting (CABG) and
off-pump CABG. However the results are controversial, and there is limited
information on graft patency and long-term outcomes. Method(s):
Between May 2007 and October 2011, 349 patients were randomized to
off-pump or on-pump CABG as part of the CORONARY trial at Fuwai Hospital.
The primary outcome was coronary bypass graft patency, which was assessed
at a mean of 6.7 +/- 1.7 years after surgery by multidetector computed
tomography. A secondary endpoint was a composite outcome of death,
nonfatal myocardial infarction, repeat coronary revascularization, or
stroke; mean follow-up was 6.5 +/- 1.7 years. Graft patency was compared
between the off-pump and on-pump CABG treatment arms in 206 patients with
follow-up computed tomography. Result(s): During the follow-up period
107 patients were in the off-pump CABG group and 99 in the on-pump group.
These patients underwent a total of 723 grafts, and the overall rate of
graft patency did not differ significantly between the off-pump and
on-pump groups (87.4% vs 88.9%, P = .527). The patency rate of the
posterior descending branch was lower than average. Higher incidences of
mortality, nonfatal myocardial infarction, and repeat revascularization
were found in the off-pump patients; however it did not reach
significance. Conclusion(s): There were no statistical differences in
graft patency rates in off-pump versus on-pump CABG patients during
long-term follow-up. The on-pump CABG group appeared to have a better
long-term prognosis even with no statistical differences for the limited
study population. Copyright © 2020

<39>
Accession Number
2006842568
Title
Impact of renin-angiotensin system inhibitors on outcomes after surgical
or transcatheter aortic valve replacement. A meta-analysis.
Source
Revista Espanola de Cardiologia. (no pagination), 2020. Date of
Publication: 2020.
Author
Amat-Santos I.J.; Santos-Martinez S.; Julca F.; Catala P.;
Rodriguez-Gabella T.; Redondo-Dieguez A.; Hinojosa W.; Veras C.; Campo A.;
Serrador Frutos A.; Carrasco-Moraleja M.; San Roman J.A.
Institution
(Amat-Santos, Santos-Martinez, Julca, Catala, Rodriguez-Gabella,
Redondo-Dieguez, Hinojosa, Veras, Campo, Serrador Frutos, San Roman)
Departamento de Cardiologia, Hospital Clinico Universitario de Valladolid,
CIBERCV, Valladolid, Spain
(Amat-Santos, Carrasco-Moraleja, San Roman) Departamento de Cardiologia,
Hospital Clinico Universitario de Valladolid, Valladolid, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: To determine whether renin-angiotensin system
inhibitor (RASi) prescription is associated with better outcomes after
transcatheter aortic valve implantation (TAVI) and surgical aortic valve
replacement (SAVR). Method(s): All comparative studies of RASi vs no
RASi prescription in patients undergoing TAVI/SAVR were gathered from
PubMed, Web of Science, and Google Scholar through August, 2019. We
extracted hazard ratios (HRs) with their confidence intervals (CIs) for
mortality from each study and combined study-specific estimates using
inverse variance-weighted averages of logarithmic HRs in the random
effects model. Result(s): We identified 6 eligible studies with a
total of 21 390 patients (TAVI: 17 846; SAVR: 3544) and included them in
the present meta-analysis. The 6 studies were observational comparative
studies (including 3 propensity score matched and 3 cohort studies) of
RASi vs no RASi prescription. The analysis demonstrated that RASi
prescription was associated with significantly lower mortality in the
whole group of patients undergoing aortic valve intervention (HR, 0.64;
95%CI, 0.47-0.88; P < .001). However, subgroup analysis suggested
differences according to the selected therapy, with TAVI showing better
mortality rates in the RASi group (HR, 0.67; 95%CI, 0.49-0.93) but not in
the SAVR group (HR, 0.61; 95%CI, 0.29-1.30). No funnel plot asymmetry was
identified, suggesting minimum publication bias. Sensitivity analyses
sequentially eliminating dissimilar studies did not substantially alter
the primary result favoring RASI prescription. Conclusion(s): These
findings suggest a mortality benefit of RASi in patients with AS treated
with aortic valve replacement that might be particularly relevant
following TAVI. Future randomized studies are warranted to confirm this
relevant finding.
Introduccion y objetivos: Determinar si la prescripcion de inhibidores del
sistema renina-angiotensina (iSRA) se asocia a mejores resultados tras
implante percutaneo de valvula aortica (TAVI) o recambio valvular aortico
quirurgico (RVAQ). Metodos: Se seleccionaron de PubMed, Web of Science, y
Google Scholar hasta agosto de 2019 estudios comparativos de iSRA vs
no-iSRA en pacientes sometidos a TAVI/RVAQ. Se extrajeron las hazard
ratios (HR) con sus intervalos de confianza para mortalidad de cada
estudio y estimadores especificos en el modelo de efectos aleatorios.
Resultados: Se incluyeron 6 estudios con un total de 21.390 pacientes
(TAVI: 17.846, RVAQ: 3.544). Los 6 fueron estudios comparativos (3
analisis de propension y 3 de cohortes) comparando iSRA vs no-iSRA. Se
demostro que la prescripcion de iSRA se asocia con una mortalidad
significativamente menor en pacientes sometidos a intervencion valvular
aortica (HR = 0,64; IC95%, 0,47-0,88; p < 0,001). Sin embargo, el analisis
por subgrupos sugirio diferencias en funcion de la terapia seleccionada,
con menor mortalidad en los sometidos a TAVI tratados con iSRA (HR = 0,67;
IC95%, 0,49-0,93) pero no en los tratados con RVAQ (HR = 0,61; IC95%,
0,29-1,30). No se identifico asimetria en el analisis funnel plot,
sugiriendo bajo riesgo de sesgo de publicacion. El analisis de
sensibilidad eliminando sucesivamente diferentes estudios no altero de
forma substancial el resultado. Conclusiones: Estos resultados sugieren
reduccion de la mortalidad con la prescripcion de iSRA en pacientes con
estenosis aortica sometidos a recambio valvular aortico, en particular
tras TAVI. Futuros estudios aleatorizados deberan confirmar o refutar este
relevante hallazgo. Copyright © 2020

<40>
Accession Number
2006803806
Title
Short- and Long-term Outcomes in Dialysis Patients Undergoing
Transcatheter Aortic Valve Implantation: A Systematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Kuno T.; Takagi H.; Ando T.; Ueyama H.; Fujisaki T.; Kodaira M.; Numasawa
Y.; Briasoulis A.; Hayashida K.
Institution
(Kuno, Ueyama) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Ando) Center for Interventional Vascular Therapy, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Fujisaki) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai St Luke's and West, New York, NY, United States
(Kodaira, Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga
Hospital, Ashikaga, Japan
(Briasoulis) Division of Cardiovascular Medicine, Section of Heart Failure
and Transplantation, University of Iowa, Iowa City, IA, United States
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
main treatment for symptomatic severe aortic stenosis, but patients on
dialysis have been excluded from major randomized controlled trials. Our
aim was to compare mortality and procedure-related complications after
TAVI in patients with end-stage renal disease (ESRD) on dialysis vs those
without. Method(s): EMBASE and MEDLINE were searched through November
2019 to investigate the comparative outcomes between patients with ESRD on
dialysis and those without who underwent TAVI. The main outcomes were
short-term (30-day/in-hospital) mortality and procedural complications,
and long-term (>6 months) all-cause mortality. Result(s): Our search
identified 10 observational studies enrolling 128,094 (5399 on dialysis)
patients who underwent TAVI. Dialysis patients had a significantly higher
rate of short-term and long-term mortality than nondialysis patients (odds
ratio [95% confidential interval]: 2.18 [1.64-2.89], P < 0.001,
I2 = 60%; 1.91 [1.46-2.50], P < 0.001, I2 = 80%,
respectively). In addition, dialysis patients had significantly higher
rates of short-term life-threatening and/or major bleeding, permanent
pacemaker implantation, and device failure compared with nondialysis
patients (odds ratio [95% confidential interval]: 1.90 [1.24-2.90], P <
0.001, I2 = 67%; 1.33 [1.15-1.53], P < 0.001, I2 =
0%; 2.08 [1.05-4.10], P = 0.03, respectively), but did not have
significantly higher rates of vascular complications and stroke.
 Conclusion(s): Dialysis patients had significantly higher rates of
short- and long-term mortality, short-term life-threatening and/or major
bleeding, permanent pacemaker implantation, and device failure compared
with nondialysis patients. Careful selection of patients who would benefit
from TAVI among patients with ESRD requiring dialysis is necessary to
prevent high rates of postprocedural complications. Copyright ©
2020 Canadian Cardiovascular Society

<41>
Accession Number
632159515
Title
Effect of Preloading With High Dose of Rosuvastatin on Serum Levels of
Inflammatory Markers After Percutaneous Coronary Intervention.
Source
The Journal of invasive cardiology. (no pagination), 2020. Date of
Publication: 22 Jun 2020.
Author
Slhessarenko J.R.; Hirata M.; Sousa A.; Bastos G.M.; Higa E.M.S.; Mouro
M.G.; Sobrera G.C.; Slhessarenko R.D.; Viana R.; Abizaid A.; Costa J.R.
Institution
(Slhessarenko) Av. Dr. Dante Pazzanese, Sao Paulo 04012-180, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to assess the effects of a high loading dose of
rosuvastatin (40 mg) on acute inflammatory response after coronary
stenting. METHOD(S): Patients with stable coronary disease without
statin use (>=7 days) and undergoing elective percutaneous coronary
intervention (PCI) in a native coronary artery were randomized to receive
a loading dose of rosuvastatin (n = 64) or not (n = 61). Blood samples
were obtained before statin intake (time point A), 3 hours after
medication (time point B), and 3 hours after PCI (time point C). The
primary goal was the comparison in the variation of the serum inflammatory
markers and their gene expression at the different time points between the
two groups. RESULT(S): Baseline clinical, angiographic, and
procedural characteristics did not significantly differ between the
groups, except for the more frequent use of postdilation in the control
group (73.4% vs 90.2%; P=.02). Patients pretreated with statin showed a
reduction in the serum levels of interleukin (IL)-1beta (DELTA = -0.491
pg/mL; Pinteraction<.001), IL-6 (DELTA = -0.209 pg/mL; Pinteraction<.001),
and plasminogen activator inhibitor 1 (DELTA = -1.573 pg/mL;
Pinteraction<.001) as well as in their genetic expression, which was not
observed in the control group. Regarding high-sensitivity c-reactive
protein, there was no significant variation in its value from time point A
to C in patients pretreated with statin (P=.58) while it significantly
increased in the control group (P=.04). CONCLUSION(S): Among patients
with stable coronary artery disease undergoing PCI with stents,
pretreatment with high dose of rosuvastatin resulted in significant
reduction in the serum levels of important inflammatory markers and their
genetic expression.

<42>
Accession Number
2006131257
Title
Surgical site infection and costs in low- And middle-income countries: A
systematic review of the economic burden.
Source
PLoS ONE. 15 (6) (no pagination), 2020. Article Number: e0232960. Date of
Publication: 01 Jun 2020.
Author
Monahan M.; Jowett S.; Pinkney T.; Brocklehurst P.; Morton D.G.; Abdali
Z.; Roberts T.E.
Institution
(Monahan, Brocklehurst, Morton, Roberts) NIHR Global Health and Global
Surgery Unit, Institute of Translational Medicine, University of
Birmingham, Birmingham, United Kingdom
(Monahan, Jowett, Abdali, Roberts) Health Economics Unit, Institute of
Applied Health, College of Medical and Dental Sciences, University of
Birmingham, Birmingham, United Kingdom
(Pinkney, Brocklehurst, Morton) Birmingham Surgical Trials Consortium,
Institute of Applied Health, College of Medical and Dental Sciences,
University of Birmingham, Birmingham, United Kingdom
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Surgical site infection (SSI) is a worldwide problem which has
morbidity, mortality and financial consequences. The incidence rate of SSI
is high in Low- and Middle-Income countries (LMICs) compared to high
income countries, and the costly surgical complication can raise the
potential risk of financial catastrophe. Objective The aim of the study is
to critically appraise studies on the cost of SSI in a range of LMIC
studies and compare these estimates with a reference standard of high
income European studies who have explored similar SSI costs. Methods A
systematic review was undertaken using searches of two electronic
databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up
to February 2019. Study characteristics, comparator group, methods and
results were extracted by using a standard template. Results Studies from
15 LMIC and 16 European countries were identified and reviewed in full.
The additional cost of SSI range (presented in 2017 international dollars)
was similar in the LMIC ($174-$29,610) and European countries
($21-$34,000). Huge study design heterogeneity was encountered across the
two settings. Discussion SSIs were revealed to have a significant cost
burden in both LMICs and High Income Countries in Europe. The magnitude of
the costs depends on the SSI definition used, severity of SSI, patient
population, choice of comparator, hospital setting, and cost items
included. Differences in study design affected the comparability across
studies. There is need for multicentre studies with standardized data
collection methods to capture relevant costs and consequences of the
infection across income settings. Copyright © 2020 Monahan et al.
This is an open access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source
are credited.

<43>
Accession Number
2006790386
Title
Persistent pain in intensive care survivors: a systematic review.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Makinen O.J.; Backlund M.E.; Liisanantti J.; Peltomaa M.; Karlsson S.;
Kalliomaki M.-L.
Institution
(Makinen) Faculty of Medicine and Life Sciences, Tampere University,
Tampere, Finland
(Backlund) Department of Intensive Care, Helsinki University Hospital,
Helsinki, Finland
(Liisanantti) Oulu University Hospital, Oulu, Finland
(Peltomaa, Karlsson) Department of Intensive Care, Tampere University
Hospital, Tampere, Finland
(Kalliomaki) Department of Anaesthesiology, Tampere University Hospital,
Tampere, Finland
Publisher
Elsevier Ltd
Abstract
Background: According to earlier studies where the main aim has been
quality of life, there is growing evidence of increased levels of
persistent pain in survivors of critical illness. The cause of admission
and several factors during intensive care may have associated risk factors
for pain persistence. This systematic review aims to determine the
incidence or prevalence of persistent pain after critical illness and to
identify risk factors for it. Method(s): Six databases were searched,
and eventually nine studies were included in the final systematic process.
The validity of observational and cross-sectional studies was analysed
using the National Institute of Health 'Quality Assessment Tool for
Observational Cohort and Cross-Sectional Studies'. Result(s): The
incidence of persistent pain after intensive care varied from 28% to 77%.
Risk factors for persistent pain were acute pain at discharge from ICU,
higher thoracic trauma score, surgery, pre-existing pain, organ failure,
longer length of ventilator or hospital stay, and sepsis. No difference in
incidence between medical and surgical patients was found.
 Conclusion(s): New systematic, observational studies are warranted to
identify persistent pain-related factors in intensive care to improve pain
management protocols and thereby diminish the risk of persistent pain
after ICU stay. Copyright © 2020 British Journal of Anaesthesia

<44>
Accession Number
2005726644
Title
Outcomes After Left Main Coronary Artery Revascularization by Percutaneous
Coronary Intervention or Coronary Artery Bypass Grafting According to
Smoking Status.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Shahim B.; Redfors B.; Chen S.; Morice M.-C.; Gersh B.J.; Puskas J.D.;
Kandzari D.E.; Merkely B.; Horkay F.; Crowley A.; Serruys P.W.; Kappetein
A.P.; Sabik J.F.; Ben-Yehuda O.; Stone G.W.
Institution
(Shahim, Redfors, Chen, Crowley, Ben-Yehuda, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors, Chen, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Morice) Hopital prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Merkely, Horkay) Heart and Vascular Center, Semmelweis University,
Budapest, Hungary
(Serruys) Department of Cardiology, NUIG, National University of Ireland,
Galway, Ireland
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Thorax Center, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cigarette smoking is a well-known risk factor for coronary artery disease
(CAD). However, the impact of smoking on outcomes after coronary
revascularization, especially in patients with left main CAD (LMCAD) is
less well understood. The EXCEL trial randomized 1,905 patients with LMCAD
and visually assessed low or intermediate anatomical complexity (SYNTAX
score <=32) to PCI with everolimus-eluting stents or CABG. Patients were
categorized according to smoking status (current, former, or never), and
their outcomes at 5 years were compared by logistic regression with
follow-up time included as a log-transformed offset variable. The primary
endpoint was a composite of death, myocardial infarction, or stroke. Among
1893 patients with known smoking status at baseline, 416 (22%) were
current smokers and 774 (41%) were former smokers. The crude rates of the
primary endpoint were 19.5% for never smokers, 20.5% for former smokers (p
= 0.61 vs never smokers), and 23.1% for smokers (p = 0.15 vs never
smokers). Compared with never smokers, the adjusted risk of the primary
endpoint was higher for current smokers (adjOR 1.82, 95% confidence
interval [CI] 1.126 to 2.63; p = 0.001), but not for former smokers (adjOR
1.00, 95% CI 0.75 to 1.33, p = 0.10). The relative efficacy of PCI versus
CABG for the 5-year primary endpoint was similar irrespective of smoking
status (P<inf>interaction</inf> = 0.22). In conclusion, current smokers in
the EXCEL trial had a higher adjusted 5-year risk of the primary composite
endpoint of death, myocardial infarction, or stroke than never smokers,
whereas former smokers were not at increased risk. Active smoking was a
risk factor after LMCAD revascularization irrespective of
revascularization method. Copyright © 2020 Elsevier Inc.

<45>
Accession Number
2005272144
Title
Cardiogenic shock in autoimmune rheumatologic diseases: an insight on
etiologies, management, and treatment outcomes.
Source
Heart Failure Reviews. (no pagination), 2020. Date of Publication: 2020.
Author
Battisha A.; Sawalha K.; Altibi A.M.; Madoukh B.; Al-Akchar M.; Patel B.
Institution
(Battisha, Sawalha) University of Massachusetts Medical School - Baystate,
Springfield, MA, United States
(Altibi) Harvard T.H. Chan School of Public Health, Harvard University,
Boston, MA, United States
(Altibi) Henry Ford Health System (HFHS), Jackson, MI, United States
(Madoukh) Overland Park Regional Medical Center - HCA Midwest Health,
Kansas City, MO, United States
(Al-Akchar) Southern Illinois University School of Medicine, Springfield,
IL, United States
(Patel) Heart and Vascular Institute, West Virginian University, 1 Medical
Center Dr., Morgantown, WV 26505, United States
Publisher
Springer
Abstract
Autoimmune rheumatological disorders are known to have an increased risk
for cardiovascular diseases including coronary artery disease (CAD),
myocarditis, pericarditis, valvulopathy, and in consequence cardiogenic
shock. Data on cardiogenic shock in rheumatological diseases are scarce;
however, several reports have highlighted this specific entity. We sought
to review the available literature and highlight major outcomes and the
management approaches in each disease. Systematic literature search,
including PubMed, Ovid/Medline, Cochrane Library, and Web of Science, was
conducted between January 2000 and December 2009. We reviewed all cases
reporting cardiogenic shock with rheumatologic conditions, including
systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Takayasu's
arteritis (TA), granulomatosis with polyangiitis (GPA), giant cell
arteritis (GCA), and antiphospholipid syndrome (APS). We selected 45
papers reporting a total of 48 cases. Mean age was 39 +/- 7.3 years and
68.8% were females. Most common rheumatologic conditions associated with
cardiogenic shock were SLE (31%), GPA (23%), TA (14.6%), APA (10.4%), and
RA (8.3%). Cardiogenic shock was found to be caused by eosinophilic
myocarditis in 58% of cases, CAD in 19% of cases, and valvulopathy in 6%
of cases. Most patient required high-dose steroids and second
immunosuppressant therapy. Mechanical circulatory supported was required
in 23 cases, IABP in 16 cases, and ECMO in 12 cases. Complete recovery
occurred in 37 patients while 9 patients died and 2 required heart
transplant. Responsible for two-thirds of cases, eosinophilic myocarditis
should be suspected in young cardiogenic shock patients with underlying
rheumatologic conditions. Lupus and GPA are the two most common
conditions. Copyright © 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<46>
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. 179 (7) (pp 1079-1087), 2020. Date of
Publication: 01 Jul 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.

<47>
Accession Number
632143319
Title
Disorders of the Aorta and Aortic Valve in Connective Tissue Diseases.
Source
Current cardiology reports. 22 (8) (pp 70), 2020. Date of Publication: 19
Jun 2020.
Author
Grygiel-Gorniak B.; Oduah M.-T.; Olagunju A.; Klokner M.
Institution
(Grygiel-Gorniak) Department of Rheumatology and Internal Diseases, Poznan
University of Medical Sciences, Poznan, Poland
(Oduah, Olagunju, Klokner) Department of Rheumatology and Internal
Diseases, Poznan University of Medical Sciences, Poznan, Poland
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The incidence of aortic valve disease in inherited
connective tissue disorders is well documented; however, recent studies
have only begun to unravel the pathology behind this association. In this
review, we aim to describe the etiology, clinical manifestations,
management, and prognosis of aortic and aortic valvular disorders that
co-exist in a variety of connective tissue diseases. An extensive
literature review was performed in PubMed. Articles from 2008 to 2018 were
included for review. Predetermined search terms used in PubMed include
"aortic manifestation of connective tissue diseases" and "aortic valve
disorders in rheumatologic disease." RECENT FINDINGS: Manifestations of
aortic valve disease in the context of connective tissue disorders include
valvular stenosis, regurgitation, and/or thoracic aortic aneurysms. Both
inherited and inflammatory connective tissue disorders contribute to
aortic valve damage with increased susceptibility associated with specific
gene variants. Anti-inflammatory and immunosuppressive therapies have
demonstrated beneficial results in Marfan's syndrome, Behcet disease,
rheumatoid arthritis, ankylosing spondylitis, and systemic sclerosis,
often leading to remission. Yet, such therapy is less effective in other
disorders compared to alternative treatments such as surgical
intervention. Additionally, regular echocardiographic studies should be
recommended to those suffering from these disorders, especially those at
higher risk for cardiovascular involvement. Given the rates of relapse
with immunosuppressants, even following aortic valve replacement, further
studies are needed to determine if certain dosing and/or combinations of
immunosuppressants could be given to those diagnosed with connective
tissue diseases to prevent progression of aortic valve involvement.

<48>
Accession Number
631869019
Title
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural
mesothelioma.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 58 (1) (pp 1-24), 2020.
Date of Publication: 01 Jul 2020.
Author
Opitz I.; Scherpereel A.; Berghmans T.; Psallidas I.; Glatzer M.; Rigau
D.; Astoul P.; Bolukbas S.; Boyd J.; Coolen J.; De Bondt C.; De Ruysscher
D.; Durieux V.; Faivre-Finn C.; Fennell D.A.; Galateau-Salle F.; Greillier
L.; Hoda M.A.; Klepetko W.; Lacourt A.; McElnay P.; Maskell N.A.; Mutti
L.; Pairon J.-C.; Van Schil P.; van Meerbeeck J.P.; Waller D.; Weder W.;
Putora P.M.; Cardillo G.
Institution
(Opitz, Weder) Department of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Scherpereel) Department of Pulmonary and Thoracic Oncology, French
National Network of Clinical Expert Centers for Malignant Pleural
Mesothelioma Management (Mesoclin), Lille, France
(Scherpereel) Department of Pulmonary and Thoracic Oncology, University
Lille, INSERM U1189, OncoThAI, CHU Lille, Lille, France
(Berghmans) Thoracic Oncology Clinic, Institut Jules Bordet, Brussels,
Belgium
(Psallidas) Oxford Centre for Respiratory Medicine, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Glatzer, Putora) Department of Radiation Oncology, Kantonsspital St.
Gallen, St. Gallen, Switzerland
(Rigau) Iberoamerican Cochrane Center, Barcelona, Spain
(Astoul) Department of Thoracic Oncology, Pleural Diseases and
Interventional Pulmonology, Aix-Marseille University, Hopital Nord,
Marseille, France
(Bolukbas) Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen,
Germany
(Boyd) European Lung Foundation, Sheffield, United Kingdom
(Coolen) Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
(De Bondt, van Meerbeeck) Department of Pulmonology and Thoracic Oncology,
Antwerp University and Antwerp University Hospital, Antwerp, Belgium
(De Ruysscher) Department of Radiation Oncology (Maastro Clinic),
Maastricht University Medical Center+, GROW Research Institute,
Maastricht, Netherlands
(Durieux) Bibliotheque des Sciences de la Sante, Universite Libre de
Bruxelles (ULB), Brussels, Belgium
(Faivre-Finn) Christie NHS Foundation Trust, University of Manchester,
Manchester, United Kingdom
(Fennell) Leicester Cancer Research Centre, University of Leicester and
University of Leicester Hospitals NHS Trust, Leicester, United Kingdom
(Galateau-Salle) Department of Biopathology, National Reference Center for
Pleural Malignant Mesothelioma and Rare Peritoneal Tumors MESOPATH, Centre
Leon Berard, Lyon, France
(Greillier) Department of Multidisciplinary Oncology and Therapeutic
Innovations, Aix Marseille University, Assistance Publique Hopitaux de
Marseille, Inserm UMR1068, CNRS UMR7258, Marseille, France
(Hoda, Klepetko) Department of Thoracic Surgery, Medical University of
Vienna, Vienna, Austria
(Lacourt) University Bordeaux, INSERM, Bordeaux Population Health Research
Center, Bordeaux, France
(McElnay) Newcastle University, Newcastle upon Tyne, United Kingdom
(Maskell) Academic Respiratory Unit, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Mutti) Teaching Hospital Vercelli/Gruppo Italiano, Vercelli, Italy
(Pairon) Universite Paris-Est Creteil, Service de Pathologies
professionnelles et de l'Environnement, CHI Creteil, Creteil INSERM U955,
France
(Van Schil) Department of Thoracic and Vascular Surgery, Antwerp
University and Antwerp University Hospital, Antwerp, Belgium
(Waller) Barts Thorax Centre, St Bartholomew's Hospital, London, United
Kingdom
(Putora) Department of Radiation Oncology, University of Bern, Bern,
Switzerland
(Cardillo) Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
Publisher
NLM (Medline)
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic
Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery
(EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force
brought together experts to update previous 2009 ERS/ESTS guidelines on
management of malignant pleural mesothelioma (MPM), a rare cancer with
globally poor outcome, after a systematic review of the 2009-2018
literature. The evidence was appraised using the Grading of
Recommendations, Assessment, Development and Evaluation approach. The
evidence syntheses were discussed and recommendations formulated by this
multidisciplinary group of experts. Diagnosis: pleural biopsies remain the
gold standard to confirm the diagnosis, usually obtained by thoracoscopy
but occasionally via image-guided percutaneous needle biopsy in cases of
pleural symphysis or poor performance status. Pathology: standard staining
procedures are insufficient in ~10% of cases, justifying the use of
specific markers, including BAP-1 and CDKN2A (p16) for the separation of
atypical mesothelial proliferation from MPM. Staging: in the absence of a
uniform, robust and validated staging system, we advise using the most
recent 2016 8th TNM (tumour, node, metastasis) classification, with an
algorithm for pretherapeutic assessment. Monitoring: patient's performance
status, histological subtype and tumour volume are the main prognostic
factors of clinical importance in routine MPM management. Other potential
parameters should be recorded at baseline and reported in clinical trials.
Treatment: (chemo)therapy has limited efficacy in MPM patients and only
selected patients are candidates for radical surgery. New promising
targeted therapies, immunotherapies and strategies have been reviewed.
Because of limited data on the best combination treatment, we emphasize
that patients who are considered candidates for a multimodal approach,
including radical surgery, should be treated as part of clinical trials in
MPM-dedicated centres. Copyright © The article has been
co-published with permission in the European Journal of Cardio-Thoracic
Surgery and the European Respiratory Journal. All rights reserved in
respect of European Journal of Cardio-Thoracic Surgery, © European
Association for Cardio-Thoracic Surgery 2020 and European Respiratory
Journal, © European Respiratory Society 2020. The articles are
identical except for minor stylist

<49>
Accession Number
632132497
Title
Impact of minimal invasive extracorporeal circulation on atrial
fibrillation after coronary artery bypass surgery.
Source
Artificial organs. (no pagination), 2020. Date of Publication: 18 Jun
2020.
Author
Ellam S.; Hartikainen J.; Korvenoja P.; Pitkanen O.; Tyrvainen E.; Valtola
A.; Halonen J.
Institution
(Ellam, Pitkanen, Tyrvainen) Department of Anesthesiology and Operative
Services, Kuopio University Hospital, Kuopio, Finland
(Hartikainen, Valtola, Halonen) Heart Center, Kuopio University Hospital,
School of Medicine, University of Eastern Finland, Kuopio, Finland
(Korvenoja) South Karelia Central Hospital, Lappeenranta, Finland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Postoperative atrial fibrillation (POAF) is the most common
arrhythmia after cardiac surgery with an incidence between 15-50 % and
pathophysiology not fully known. By choosing the method of extracorporeal
circulation with focus on the reduction of systemic inflammatory response,
one can potentially decrease the risk of POAF. In this prospective,
randomized trial, we compared minimal invasive extracorporeal circulation
(MiECC) with conventional extracorporeal circulation (CECC) in the
prevention of POAF after coronary artery bypass surgery (CABG).
 METHOD(S): A total of 240 patients who were scheduled for their first
on-pump CABG, were randomized to MiECC or CECC. The primary outcome
measure was the incidence of first POAF during the first 84 hours after
surgery. RESULT(S): POAF occurred in 42/120 (35.0 %) MiECC patients
and 43/120 (35.8%) CECC patients with non-significant difference between
the groups (OR 1.043, 95% CI 0.591-1.843, p=0.884). The first
postoperative creatine kinase-MB mass (CK-MBm) value was lower in the
MiECC group, 13.95 [10.5-16.7] (median [IQR]) than in the CECC group,
15.30 [11.4-18.9] (p=0.036) whereas the use of perioperative dobutamine
was higher in the MiECC group, 18/120 (15.0%), than in the CECC group
8/120 (6.7%) (p=0.038). The incidence of a stroke, perioperative
myocardial infarction and resternotomy caused by bleeding did not differ
in the MiECC and CECC groups. Age (OR 1.08, 95% CI 1.04-1.13, p=0.000) and
peak postoperative CK-MBm (OR 1.57, 95% CI 1.06-2.37, p=0.026) were
independent predictors of POAF. CONCLUSION(S): MiECC compared to CECC
was not effective in reducing the incidence of POAF in patients undergoing
CABG. Copyright This article is protected by copyright. All rights
reserved.

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