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<1>
Accession Number
632351367
Title
Effect of oxygenation modalities among patients with postoperative
respiratory failure: A pairwise and network meta-analysis of randomized
controlled trials.
Source
Journal of Intensive Care. 8 (1) (no pagination), 2020. Article Number:
51. Date of Publication: 17 Jul 2020.
Author
Zayed Y.; Kheiri B.; Barbarawi M.; Rashdan L.; Gakhal I.; Ismail E.;
Kerbage J.; Rizk F.; Shafi S.; Bala A.; Sidahmed S.; Bachuwa G.; Seedahmed
E.
Institution
(Zayed, Barbarawi, Rashdan, Gakhal, Shafi, Bala, Sidahmed, Bachuwa)
Department of Internal Medicine, Hurley Medical Center, Michigan State
University, One Hurley Plaza, Flint, MI 48503, United States
(Kheiri) Knight Cardiovascular Institute, Oregon Health and Science
University, Portland, OR, United States
(Ismail) College of Human Medicine, Michigan State University, East
Lansing, MI, United States
(Kerbage) Department of Anesthesia, Lebanese University, Beirut, Lebanon
(Rizk) College of Osteopathic Medicine, Michigan State University, East
Lansing, MI, United States
(Seedahmed) Department of Pulmonary and Critical Care, Hurley Medical
Center, Michigan State University, Flint, MI, United States
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative respiratory failure is associated with increased
perioperative complications. Our aim is to compare outcomes between
non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and
standard oxygen in patients at high-risk for or with established
postoperative respiratory failure. Method(s): Electronic databases
including PubMed, Embase, and the Cochrane Library were reviewed from
inception to September 2019. We included only randomized controlled trials
(RCTs) that compared NIV, HFNC, and standard oxygen in patients at high
risk for or with established postoperative respiratory failure. We
performed a Bayesian network meta-analysis to calculate the odds ratio
(OR) and Bayesian 95% credible intervals (CrIs). Result(s): Nine RCTs
representing 1865 patients were included (the mean age was 61.6 +/- 10.2
and 64.4% were males). In comparison with standard oxygen, NIV was
associated with a significant reduction in intubation rate (OR 0.23; 95%
Cr.I. 0.10-0.46), mortality (OR 0.45; 95% Cr.I. 0.27-0.71), and intensive
care unit (ICU)-acquired infections (OR 0.43, 95% Cr.I. 0.25-0.70).
Compared to standard oxygen, HFNC was associated with a significant
reduction in intubation rate (OR 0.28, 95% Cr.I. 0.08-0.76) and
ICU-acquired infections (OR 0.41; 95% Cr.I. 0.20-0.80), but not mortality
(OR 0.58; 95% Cr.I. 0.26-1.22). There were no significant differences
between HFNC and NIV regarding different outcomes. In a subgroup analysis,
we observed a mortality benefit with NIV over standard oxygen in patients
undergoing cardiothoracic surgeries but not in abdominal surgeries.
Furthermore, in comparison with standard oxygen, NIV and HFNC were
associated with lower intubation rates following cardiothoracic surgeries
while only NIV reduced the intubation rates following abdominal surgeries.
 Conclusion(s): Among patients with post-operative respiratory
failure, HFNC and NIV were associated with significantly reduced rates of
intubation and ICU-acquired infections compared with standard oxygen.
Moreover, NIV was associated with reduced mortality in comparison with
standard oxygen. Copyright © 2020 The Author(s).

<2>
Accession Number
2005586369
Title
Impact of Different Doses of Omega-3 Fatty Acids on Cardiovascular
Outcomes: a Pairwise and Network Meta-analysis.
Source
Current Atherosclerosis Reports. 22 (9) (no pagination), 2020. Article
Number: 45. Date of Publication: 01 Sep 2020.
Author
Lombardi M.; Chiabrando J.G.; Vescovo G.M.; Bressi E.; Del Buono M.G.;
Carbone S.; Koenig R.A.; Van Tassell B.W.; Abbate A.; Biondi-Zoccai G.;
Dixon D.L.
Institution
(Lombardi, Bressi, Del Buono, Carbone, Van Tassell, Abbate, Dixon) VCU
Pauley Heart Center, Virginia Commonwealth University, Richmond, VA,
United States
(Lombardi, Del Buono) Department of Cardiovascular and Thoracic Sciences,
Catholic University of the Sacred Heart, Rome, Italy
(Chiabrando) Interventional Cardiology Service, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina
(Chiabrando) Health Science Statistics Applied Laboratory (LEACS),
Pharmacology and Toxicology Department, School of Medicine, University of
Buenos Aires, Buenos Aires, Argentina
(Vescovo) Department of Cardiac Thoracic, Vascular Sciences and Public
Health, University of Padua, Padua, Italy
(Bressi) Division of Cardiology, Policlinico Casilino, Rome, Italy
(Carbone) Department of Kinesiology & Health Sciences, College of
Humanities & Sciences, Virginia Commonwealth University, Richmond, VA,
United States
(Koenig) Tompkins-McCaw Library for the Health Sciences, VCU Libraries
Virginia Commonwealth University, Richmond, VA, United States
(Van Tassell, Dixon) Department of Pharmacotherapy & Outcomes Science,
Virginia Commonwealth University, Richmond, VA, United States
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
Publisher
Springer
Abstract
Purpose of Review: Omega-3 fatty acid (O3FA) supplementation has shown
conflicting evidence regarding its benefit in cardiovascular events. We
performed a pairwise and network meta-analysis to elucidate the benefit of
different doses of O3FA supplementation in cardiovascular prevention.
Recent Findings: Fourteen studies were identified providing data on
125,763 patients. A prespecified cut-off value of < 1 g per day was set
for low-dose (LD) O3FA and > 1 g per day for high-dose (HD) O3FA. The
efficacy outcomes of interest were total death, cardiac death, sudden
cardiac death, myocardial infarction, stroke, coronary revascularization,
unstable angina, and major vascular events. Safety outcomes of interest
were bleeding, gastrointestinal disturbances, and atrial fibrillation
events. HD treatment was associated with a lower risk of cardiac death
(IRR 0.79, 95% CI [0.65-0.96], p = 0.03 versus control), myocardial
infarction (0.71 [0.62-0.82], p < 0.0001 versus control and 0.79
[0.67-0.92], p = 0.003 versus LD), coronary revascularization (0.74
[0.66-0.83], p < 0.0001 versus control and 0.74 [0.66-0.84], p < 0.0001
versus LD), unstable angina (0.73 [0.62-0.86], p = 0.0001 versus control
and 0.74 [0.62-0.89], p = 0.002 versus LD), and major vascular events
(0.78 [0.71-0.85], p < 0.0001 versus control and 0.79 [0.72-0.88], p <
0.0001 versus LD). HD treatment was associated with increased risk for
bleeding events (1.49 [1.2-1.84], p = 0.0002 versus control and 1.63
[1.16-2.3], p = 0.005 versus LD) and increased atrial fibrillation events
compared to control (1.35 [1.1-1.66], p = 0.004). Summary: HD O3FA
treatment was associated with lower cardiovascular events compared to LD
and to control, but increased risk for bleeding and atrial fibrillation
events. Copyright © 2020, Springer Science+Business Media, LLC,
part of Springer Nature.

<3>
Accession Number
2004762539
Title
10 khz high-frequency spinal cord stimulation for chronic thoracic pain: A
multicenter case series and a guide for optimal anatomic lead placement.
Source
Pain Physician. 23 (4) (pp E369-E376), 2020. Date of Publication:
July-August 2020.
Author
Sayed D.; Foster J.; Nairizi A.; Sills S.; Miller A.
Institution
(Sayed, Foster) Department of Anesthesiology, University of Kansas Medical
Center, Kansas City, KS, United States
(Nairizi) Nevada Advanced Pain Specialists, Reno, NV, United States
(Sills) Touchstone Interventional Pain Center, Medford, OR, United States
(Miller) School of Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Surgical options for thoracic pain are limited and carry
significant risk and morbidity. Spinal cord stimulation has the potential
to be used for treatment of thoracic pain, as it has been useful for
treating multiple types of chronic pain. Conventional tonic stimulation is
limited in the treatment of thoracic pain, as it can produce paresthesia
that is difficult to localize. Conversely, high-frequency spinal cord
stimulation (HF-SCS) does not activate dorsal column Abeta fibers and does
not produce paresthesia, and thus may be more beneficial in treating
thoracic back pain not manageable with tonic stimulation.
 Objective(s): To evaluate (1) the efficacy of 10 kHz HF-SCS for
patients with chronic thoracic pain; and (2) appropriate paresthesia-free
lead placement and programming targets for 10 kHz HF-SCS for patients with
chronic thoracic pain. Study Design: Retrospective case series.
 Setting(s): Multisite academic medical center or pain clinic.
 Method(s): A retrospective chart review was performed on 19 patients
with thoracic back pain who underwent HF-SCS implantation. These patients
had lead placement and stimulation between the T1-T6 vertebral levels.
Outcome measures collected include location of device implant, stimulation
settings, and pain scores at baseline, end of trial, and 1, 6, and 12
months postimplant. Followup phone calls collected information on if the
patient reported functional improvement, improved sleep, or decreased pain
medication usage. A Wilcoxon signed-rank test compared differences in mean
pain scores across time points. Result(s): Significantly decreased
Visual Analog Scale scores were observed with 17/19 (89.5%) patients
demonstrating response to therapy (>50% reduction in pain scores). These
results were sustained relative to baseline at 1, 6, and 12 months
postimplant, depending on length of followup. Many patients also reported
functional improvement (17/19), improved sleep (14/19), and reduction in
use of pain medications after implantation (9/19). A total of 15/19
patients reported best relief when contacts over T1 or T2 vertebrae were
used for stimulation. Limitation(s): This study is limited by its
retrospective design. Additionally, including documentation from multiple
sites may be prone to selection and abstraction bias. Data were also not
available for all patients at all time points. Conclusion(s): HF-SCS
may be a viable option for significant, long-lasting pain relief for
thoracic back pain. There may also be evidence for anatomically based lead
placement and programming for thoracic back pain. Randomized, controlled
trials with extended follow-up are needed to further evaluate this
therapy. Copyright © 2020, American Society of Interventional
Pain Physicians. All rights reserved.

<4>
Accession Number
2007243965
Title
Outcomes of Open Versus Percutaneous Access for Patients Enrolled in the
GREAT Registry.
Source
Annals of Vascular Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Baxter R.D.; Hansen S.K.; Gable C.E.; DiMaio J.M.; Shutze W.P.; Gable D.R.
Institution
(Baxter) Department of Graduate Medical Education - General Surgery,
Baylor University Medical Center, Dallas, TX, United States
(Hansen) Department of Graduate Medical Education - Vascular Surgery,
Baylor University Medical Center, Dallas, TX, United States
(Gable) Texas A&M University, College Station, TX, United States
(DiMaio, Shutze, Gable) Division of Vascular Surgery, Baylor Scott and
White Heart Hospital, Texas Vascular Associates, Plano, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Arterial access and device delivery in endovascular aortic
repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have evolved
from open femoral or iliac artery exposure to selective percutaneous
arterial access. Although regional application of percutaneous access for
these 2 procedures varies widely, the use of this technique continues to
increase. Currently, differences in the use of percutaneous access between
EVAR and TEVAR have not been well explored. The Gore Global Registry for
Endovascular Aortic Treatment (GREAT) registry collected relevant data for
evaluation of these issues and the comparative results between open and
percutaneous approaches in regard to complication rates and length of stay
(LOS). Method(s): This study was performed via a retrospective review
of patients from the GREAT registry (Clinicaltrials.gov no. NCT01658787).
The primary variable of this study was access site complications including
postoperative hematoma, vessel dissection, and pseudoaneurysm. Patients
were categorized by abdominal (EVAR) and thoracic (TEVAR) aortic
procedures using percutaneous-only, cutdown-only, and combined vascular
access techniques for a total of 6 groups. Standard statistical
methodology was used to perform single-variable and multivariable analysis
of a variety of covariates including LOS, geographical location of
procedure, procedural success rate, and access sheath size.
 Result(s): Of 4,781 patients from the GREAT registry, 3,837 (80.3%)
underwent EVAR and 944 (19.7%) underwent TEVAR with percutaneous-only
access techniques being used in 2,017 (42.2%) and cutdown-only in 2,446
(51.2%). There was variable application of percutaneous access by
geographic region with Australia and New Zealand using this technique more
frequently and Brazil using percutaneous access the least. No significant
difference in the rate of access site complications was detected between
the 6 groups of patients in the study; however, significantly lower rates
of access site complications were associated with percutaneous-only
compared with both cutdown-only and combined techniques (P = 0.03). In
addition, associated with significantly higher rates of access site
complications was longer LOS (P < 0.01). Average LOS was 5.2 days and was
higher in the TEVAR group (10.1 days) than that in EVAR (4.0 days, P <
0.05). Increased sheath size does not appear to increase the risk of
access site complication. Conclusion(s): There was no significant
difference found in the complication rate between percutaneous and cutdown
access techniques. This analysis demonstrates that percutaneous-only
access is safe, has low complication rates, and has lower LOS compared
with open access or combined access techniques. Copyright © 2020
Elsevier Inc.

<5>
Accession Number
2007179300
Title
Meta-analysis Comparing Transradial Versus Transfemoral Secondary Access
in Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Jhand A.; Apala D.R.; Dhawan R.; Katta N.; Aronow H.D.; Daniels M.J.;
Porter T.R.; Altin E.; Goldsweig A.M.
Institution
(Jhand, Dhawan, Katta, Porter, Goldsweig) Division of Cardiovascular
Medicine, University of Nebraska Medical Center, Omaha, NE, United States
(Apala) Department of Internal Medicine, Creighton University School of
Medicine, Omaha, NE, United States
(Aronow) Warren Alpert Medical School, Brown University, Lifespan
Cardiovascular Institute, Providence, RI, United States
(Daniels) Manchester Heart Centre, Manchester Royal Infirmary, Manchester
University NHS Foundation Trust, Manchester, United Kingdom
(Altin) Division of Cardiovascular Medicine, Yale University School of
Medicine, New Haven, CT, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Up to a quarter of vascular complications during transcatheter aortic
valve implantation (TAVI) result from secondary access via the femoral
artery (FA). The radial artery (RA) is increasingly used as an alternative
to the FA for secondary access in TAVI. Limited data exist on the outcomes
of RA secondary access versus FA secondary access. We therefore conducted
a systematic review and meta-analysis comparing secondary access sites.
PubMed, EMBASE, Scopus, Cochrane library and CINAHL were searched
systematically for studies comparing RA and FA as secondary access sites
for TAVI. Primary outcomes of interest were vascular complications and
major bleeding. Secondary outcomes included all-cause mortality, stroke
and myocardial infarction (MI). Risk ratio (RR), standardized mean
difference and corresponding 95% confidence intervals (CI) were calculated
using a random effects model. Six observational studies comprising 6,373
patients (RA: 1,514, FA: 4,859) met inclusion criteria. Secondary access
was utilized for aortography during valve deployment and to manage primary
access site complications. Procedural characteristics were similar in both
groups. RA was associated with a lower risk of major bleeding (RR: 0.51,
95% CI: 0.40 to 0.64, p <0.00001). No statistically significant difference
was observed in the incidence of overall vascular complications, however,
the risk of major vascular complications was lower with RA (RR: 0.45, 95%
CI: 0.32 to 0.63, p <0.00001). The incidence of stroke and all-cause
mortality was lower in RA, whereas no difference was observed in the risk
of MI. In conclusion, our meta-analysis suggests that RA secondary access
is associated with better outcomes for TAVI than FA. Copyright ©
2020 Elsevier Inc.

<6>
Accession Number
2007164367
Title
Three-dimensional geometry of coronary arteries after arterial switch
operation for transposition of the great arteries and late coronary
events.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Batteux C.; Abakka S.; Gaudin R.; Vouhe P.; Raisky O.; Bonnet D.
Institution
(Batteux, Abakka, Gaudin, Vouhe, Raisky, Bonnet) Department of Congenital
and Pediatric Cardiology, Centre de Reference Malformations Cardiaques
Congenitales Complexes, Hopital Necker-Enfants Malades, Assistance
Publique-Hopitaux de Paris, Paris, France
(Vouhe, Raisky, Bonnet) Universite de Paris, Paris, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Using 3-dimensional (3D) modeling to predict late coronary
events after the arterial switch operation (ASO) for transposition of the
great arteries (TGA). Method(s): We reviewed 100 coronary computed
tomography scans performed after ASO randomly selected from
free-from-coronary-event patients and 21 coronary computed tomography
scans from patients who had a coronary event later than 3 years after ASO.
Using 3D modeling software, we defined and measured 6 geometric criteria
for each coronary artery: Clockwise position of coronary ostium, First
centimeter angle defined as the angle between of the coronary artery
ostium and the first centimeter of the vessel, Minimal 3D angle between
the coronary first centimeter and the aortic wall, ostium height defined
as the distance between the ostium and the aortic valve, distance between
the coronary ostium and the pulmonary artery, and distance between the
coronary first centimeter and the pulmonary artery. Result(s): None
of the right ostium geometric parameters were associated with coronary
events. Four out of 6 criteria of left coronary artery geometry were
associated to coronary events: Clockwise position of the left ostium
>67degree (P < .001), First centimeter angle >62degree (P < .01), minimal
3D angle <39degree (P = .003), distance between the coronary ostium and
the pulmonary artery <1 mm/mm (P = .03). The association of first
centimeter angle >62degree and minimal angle in 3D <39degree had a 88%
sensitivity and a 81% specificity to predict coronary events (receiver
operator characteristics curve, 0.847; 95% confidence interval,
0.745-0.949; P < .001). Conclusion(s): The acquired geometric
characteristics of the transferred left coronary artery are associated
with coronary events. Imaging coronary arteries after ASO might be useful
to select patients at higher risk of coronary events and to tailor
surveillance. Copyright © 2020 The American Association for
Thoracic Surgery

<7>
Accession Number
2005688417
Title
Publication of cardiac surgery research papers in top cardiovascular
journals.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Gaudino M.; Morsi M.; Hameed I.; Naik A.; Robinson N.B.; Benedetto U.;
Ruel M.
Institution
(Gaudino, Morsi, Hameed, Naik, Robinson) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim: To evaluate the publication rate of articles related
to cardiac surgery in the four main cardiovascular journals over the last
5 years. Method(s): A bibliometric review of all full-length articles
published between January 2014 and March 2020 in the top four
cardiovascular journals (Circulation, European Heart Journal (EHJ),
Journal of the American College of Cardiology (JACC), and JAMA Cardiology)
was conducted. For each eligible article in the four journals, the journal
of publication, study design, area of interest, country of origin, and
type of intervention tested (for cardiac surgery and interventional
cardiology studies) were extracted. The affiliations of all editorial
board members were identified from journal websites or from online
searches and recorded as from cardiac surgery, cardiology, or another
discipline. Correlations between variables were evaluated. Result(s):
A total of 4835 articles were reviewed. Cardiac surgery studies amounted
to 6.2% (104) of total research publications in JACC, 4.4% (74) in
Circulation, 3.6% (13) in JAMA Cardiology, and 2.0% (22) in EHJ (P <.001).
The percentage of cardiac surgery publications was significantly less than
interventional cardiology publications (P <.001). Conclusion(s):
Cardiac surgery studies represent only a small minority of the articles
published in the top cardiovascular journals over the last 5 years, with
significant differences between individual journals. Cardiac surgery
studies were more often observational and this may constitute one
important reason for their under-representation. Copyright © 2020
Wiley Periodicals LLC

<8>
Accession Number
2005688398
Title
Discontinuation of anticoagulants after successful surgical ablation of
atrial fibrillation.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Lauritzen D.J.; Vodstrup H.J.; Christensen T.D.; Hald M.O.; Christensen
R.; Heiberg J.
Institution
(Lauritzen, Vodstrup, Christensen, Hald, Christensen, Heiberg) Department
of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus,
Denmark
(Lauritzen, Vodstrup, Christensen, Hald, Heiberg) Department of Clinical
Medicine, Aarhus University, Aarhus, Denmark
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The decision of whether to continue oral anticoagulation
therapy (OAT) after successful surgical ablation of atrial fibrillation is
challenging, and current guidelines provide no specific recommendations on
whether or not it is safe to terminate OAT. Therefore, the aim of this
study was to assess long-term outcomes in patients who either did or did
not, receive OAT after surgical ablation of atrial fibrillation.
 Method(s): In a prospective follow-up study, patients were included
if surgical ablation of atrial fibrillation concomitantly with other
cardiac surgery was done, between 2004 and 2018 at Aarhus University
Hospital, Denmark. After 12 months, OAT was discontinued if: (a) sinus
rhythm was documented by electrocardiogram, (b) atrial fibrillation was
absent on 5-day Holter monitoring, (c) CHADS<inf>2</inf> score <=2, and
(d) no other indications for OAT were present. Follow-up was ended in
April 2019. Result(s): A total of 560 patients underwent surgical
ablation of which 436 patients reached the baseline at 12 months; 286
patients received OAT, and 150 had OAT discontinued. Survival analysis
revealed no differences between the two groups (P =.723). Mean survival
time in the group receiving OAT was 5.3 +/- 3.3 years, compared to 5.1 +/-
3.0 years in the group where OAT was discontinued (P =.784). There was no
difference in major adverse cardiac and cerebrovascular events between the
two groups (P =.846). Conclusion(s): Discontinuation of OAT is safe
in patients with a CHADS<inf>2</inf> score <=2 following successful
surgical ablation and left atrial appendage occlusion. This conclusion
needs to be confirmed in randomized trials. Copyright © 2020
Wiley Periodicals LLC

<9>
Accession Number
2005688347
Title
Sex-related differences in outcomes after coronary artery bypass surgery-A
patient-level pooled analysis of randomized controlled trials: rationale
and study protocol.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Gaudino M.; Alexander J.H.; Egorova N.; Kurlansky P.; Lamy A.; Bakaeen F.;
Hameed I.; Di Franco A.; Demetres M.; Robinson N.B.; Chikwe J.; Lawton
J.S.; Devereaux P.J.; Taggart D.P.; Flather M.; Reents W.; Boening A.;
Diegeler A.; Girardi L.N.; Fremes S.E.; Benedetto U.
Institution
(Gaudino, Hameed, Di Franco, Robinson, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Alexander) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Egorova) Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Kurlansky) Department of Surgery, Center for Innovation and Outcomes
Research, Columbia University Medical Center, New York, NY, United States
(Lamy, Devereaux) Department of Surgery, Population Health Research
Institute, McMaster University, Hamilton, ON, Canada
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Chikwe) Department of Cardiac Surgery in the Smidt Heart Institute at
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, Oxford, United Kingdom
(Flather) Research and Development Unit, Norfolk and Norwich University
Hospitals NHS Foundation Trust, Norwich, United Kingdom
(Reents, Diegeler) Department Cardiac Surgery, Cardiovascular Center Bad
Neustadt/Saale, Bad Neustadt, Saale, Germany
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Giesen, Germany
(Fremes) Department of Surgery, Schulich Heart Centre Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Canada
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: The impact of sex on the outcomes after coronary artery
bypass grafting (CABG) is controversial. The majority of CABG studies are
retrospectively collected clinical or registry data, women comprise only a
minority, and the reported findings represent the male predominated
cohort. This individual patient meta-analysis is aimed at evaluating
sex-related differences in outcomes after CABG using high quality data
from randomized controlled trials (RCTs). Methods and Analysis: A
systematic literature search will be performed to identify all CABG RCTs
(minimum follow-up: 5 years). Detailed specification for the minimum
deidentified patient records' data requirements will be provided to RCT
primary contact to request their deidentified data for pooling. The pooled
analysis will follow the prospective register of systematic reviews
(PROSPERO) and the preferred reporting items for systematic reviews and
meta-analyses for individual patient data systematic reviews (PRISMA-IPD)
recommendations and will compare sex-related outcomes after CABG. The main
hypothesis is that outcomes after CABG are worse in women than in men. We
will also test whether treatment effects for off-pump and the use of
multiple arterial grafts are present within each sex, and also, whether
there are differential treatment effects between sexes. The primary
endpoint will be a composite of all-cause mortality, myocardial
infarction, stroke, and repeat revascularization at long-term follow up.
Ethics and Dissemination: Ethics approval and participant consent for the
study will be obtained locally by each study team if needed. Data will be
disseminated and submitted to peer-reviewed scientific journals and
meetings irrespective of study outcome. Copyright © 2020 Wiley
Periodicals LLC

<10>
Accession Number
2005619680
Title
A comparison of figure-of-8-suture versus manual compression for venous
access closure after cardiac procedures: An updated meta-analysis.
Source
PACE - Pacing and Clinical Electrophysiology. (no pagination), 2020. Date
of Publication: 2020.
Author
Mujer M.T.; Al-Abcha A.; Flores J.; Saleh Y.; Robinson P.
Institution
(Mujer, Al-Abcha, Saleh) Department of Medicine, Michigan State
University, East Lansing, MI, United States
(Flores) University of the Philippines College of Medicine, Manila,
Philippines
(Robinson) Pat and Jim Calhoun Cardiology Center, University of
Connecticut, Farmington, CT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Manual compression (MC) is the current standard to achieve
postprocedural hemostasis in patients who need venous vascular access
closure after cardiovascular procedures. Figure-of-8 (F8) suture for
venous access closure has been reported to be a safe and efficacious
alternative to MC. Method(s): A systematic search was done using
PubMed, Google Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without
language restriction up until April 15, 2020 for studies comparing F8
suture versus MC. Risk ratio (RR) and mean difference (MD) with 95%
confidence interval (CI) were calculated using a random effects model.
 Result(s): Time to achieve hemostasis was significantly reduced in
the F8 arm [MD -21.04 min (95% CI: -35.66 to -6.42; P =.005)]. Access site
bleeding was significantly lower in the F8 group [RR 0.35 (95% CI: 0.18 to
0.66; P =.001)] along with a lower incidence of hematoma formation [RR
0.42 (95% CI: 0.26 to 0.67; P =.0003)]. There was no significant
difference in rates of fistula or pseudoaneurysm formation between the two
groups. Overall access site complications were lower in the F8 arm [RR
0.38 (95% CI: 0.26 to 0.55; P <.00001)] and the effect was more pronounced
for sheaths >=10 Fr [RR 0.33 (95% CI: 0.18 to 0.60; P =.0003)]. There was
lower postprocedural protamine use in the F8 group [RR 0.07 (95% CI: 0.01
to 0.36; P =.001)]. Conclusion(s): For large-bore venous access
closure, the F8 suture results in a shortened time to achieve hemostasis
along with a lower overall risk of access site complications and
postprocedural protamine use. Copyright © 2020 Wiley Periodicals
LLC

<11>
Accession Number
632451738
Title
Radial artery harvesting in coronary artery bypass grafting
surgery-Endoscopic or open method? A meta-analysis.
Source
PloS one. 15 (7) (pp e0236499), 2020. Date of Publication: 2020.
Author
Huang T.-Y.; Huang T.-S.; Cheng Y.-T.; Wang Y.-C.; Chen T.-P.; Yin S.-Y.;
Yeh C.-H.
Institution
(Huang, Wang, Chen, Yin, Yeh) Department of Thoracic and Cardiovascular
Surgery Chang Gung Memorial Hospital at Keelung, Chiayi, Taiwan (Republic
of China)
(Huang) Department of Biomedical Engineering, National Taiwan University,
Taipei, Taiwan (Republic of China)
(Huang) Department of General Surgery, Keelung Chang Gung Memorial
Hospital, Taoyuan City, Taiwan (Republic of China)
(Huang, Yeh) Community Medicine Research Center, Keelung Chang Gung
Memorial Hospital, Taoyuan City, Taiwan (Republic of China)
(Huang, Yeh) Department of Chinese Medicine, College of Medicine, Chang
Gung University, Taoyuan City, Taiwan (Republic of China)
(Cheng, Yeh) Department of Thoracic and Cardiovascular Surgery, Chang Gung
Memorial Hospital at Linkou, Taoyuan City, Taiwan (Republic of China)
(Yeh) College of Medicine, Chang Gung University, Taoyuan City, Taiwan
(Republic of China)
Publisher
NLM (Medline)
Abstract
We analyzed the clinical outcomes of open radial artery harvesting (OAH)
and endoscopic radial artery harvesting (EAH) undergoing coronary artery
bypass grafting (CABG). We designed this meta-analysis conducted using
Pubmed, Medline, the Cochrane Library, and EMBASE. Articles with
comparisons of OAH and EAH undergoing CABG were included. Primary outcomes
included the wound infection rate, the wound complication rate,
neurological complications of the forearm, in-hospital mortality,
long-term survival, and the patency rate. The results of our study
included six randomized controlled trials (RCTs), two non-randomized
controlled trials (NRCTs) with matching, and 10 NRCTs. In total, 2919
patients were included in 18 studies, while 1187 (40.7%) and 1732 (59.3%)
patients received EAH and OAH, respectively. EAH was associated with a
lower incidence of wound infection (RR = 0.29, 95% confidence interval
(CI) = 0.14 to 0.60, p = 0.03), and neurological complications over the
harvesting site (RR = 0.41, 95% CI = 0.27 to 0.62, p < 0.0001). There was
no significant difference in 30-day mortality, long-term survival (over
one year), and the graft patency rate. According to our analysis,
endoscopic radial artery harvesting can improve the outcome of the
harvesting site, without affecting the mortality, long-term survival, and
graft patency.

<12>
[Use Link to view the full text]
Accession Number
632444552
Title
Use of Administrative Claims to Assess Outcomes and Treatment Effect in
Randomized Clinical Trials for Transcatheter Aortic Valve Replacement:
Findings from the EXTEND Study.
Source
Circulation. (pp 203-213), 2020. Date of Publication: 2020.
Author
Strom J.B.; Faridi K.F.; Butala N.M.; Zhao Y.; Tamez H.; Valsdottir L.R.;
Brennan J.M.; Shen C.; Popma J.J.; Kazi D.S.; Yeh R.W.
Institution
(Strom, Zhao, Tamez, Valsdottir, Shen, Kazi, Yeh) Richard A. and Susan F.
Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess
Medical Center, 375 Longwood Avenue, Boston, MA 02215, United States
(Strom, Faridi, Zhao, Tamez, Valsdottir, Shen, Popma, Kazi, Yeh) Division
of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston,
MA, United States
(Strom, Butala, Zhao, Tamez, Valsdottir, Shen, Popma, Kazi, Yeh) Harvard
Medical School, Boston, MA, United States
(Butala) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(Faridi) Section of Cardiovascular Medicine, Yale School of Medicine
(Brennan) Duke Clinical Research Institute, Durham, NC, United States
(Popma, Yeh) Baim Institute for Clinical Research, Boston, MA, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Whether passively collected data can substitute for
adjudicated outcomes to reproduce the magnitude and direction of treatment
effect observed in cardiovascular clinical trials is not well known.
 Method(s): We linked adults >=65 years of age in the HiR (US
CoreValve Pivotal High Risk) and SURTAVI trials (Surgical or Transcatheter
Aortic Valve Replacement in Intermediate-Risk Patients) to 100% Medicare
inpatient claims, January 1, 2011, to December 31, 2016. Primary (eg,
death and stroke) and secondary trial end points were compared across
treatment arms (eg, transcatheter aortic valve replacement [TAVR] versus
surgical aortic valve replacement [SAVR]) using trial-adjudicated outcomes
versus outcomes derived from claims at 1 year (HiR) or 2 years (SURTAVI).
 Result(s): Among 600 linked HiR participants (linkage rate, 80.0%),
the rate of the trial's primary end point of all-cause mortality occurred
in 13.7% of patients receiving TAVR and 16.4% of patients receiving SAVR
at 1 year by using both trial data (hazard ratio, 0.84 [95% CI,
0.65-1.09]; P=0.33) and claims data (hazard ratio, 0.86 [95% CI,
0.66-1.11]; P=0.34; interaction P value=0.80). Noninferiority of TAVR
relative to SAVR was seen by using both trial- and claims-based outcomes
(Pnoninferiority0.001 for both). Among 1005 linked SURTAVI trial
participants (linkage rate, 60.5%), the trial's primary end point was
12.9% for TAVR and 13.1% for SAVR using trial data (hazard ratio, 1.08
[95% CI, 0.79-1.48]; P=0.90), and 11.3% for TAVR and 12.5% for SAVR
patients using claims data (hazard ratio, 1.02 [95% CI, 0.73-1.41];
P=0.58; interaction P value=0.89). TAVR was noninferior to SAVR when
compared using both trial and claims (Pnoninferiority<0.001 for both).
Rates of procedural secondary outcomes (eg, aortic valve reintervention,
pacemaker rates) were more closely concordant between trial and claims
data than nonprocedural outcomes (eg, stroke, bleeding, cardiogenic
shock). Conclusion(s): In the HiR and SURTAVI trials, ascertainment
of trial primary end points using claims reproduced both the magnitude and
direction of treatment effect in comparison with adjudicated event data,
but nonfatal and nonprocedural secondary outcomes were not as well
reproduced. Use of claims to substitute for adjudicated outcomes in
traditional trial treatment comparisons may be valid and feasible for
all-cause mortality and certain procedural outcomes but may be less
suitable for other end points. Copyright © 2020 Lippincott
Williams and Wilkins. All rights reserved.

<13>
Accession Number
2007092305
Title
Rationale and design of PROACT Xa: A randomized, multicenter, open-label,
clinical trial to evaluate the efficacy and safety of apixaban versus
warfarin in patients with a mechanical On-X Aortic Heart Valve.
Source
American Heart Journal. 227 (pp 91-99), 2020. Date of Publication:
September 2020.
Author
Jawitz O.K.; Wang T.Y.; Lopes R.D.; Chavez A.; Boyer B.; Kim H.; Anstrom
K.J.; Becker R.C.; Blackstone E.; Ruel M.; Thourani V.H.; Puskas J.D.;
Gerdisch M.W.; Johnston D.; Capps S.; Alexander J.H.; Svensson L.G.
Institution
(Jawitz, Wang, Lopes, Chavez, Kim, Anstrom, Alexander) Duke Clinical
Research Institute, Durham, NC, United States
(Jawitz) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Boyer, Capps) CryoLife, Inc., Kennesaw, GA, United States
(Becker) Division of Cardiovascular Health and Diseases, University of
Cincinnati Heart, Lung & Vascular Institute, Cincinnati, OH, United States
(Blackstone, Johnston, Svensson) Department of Thoracic and Cardiovascular
Surgery, Cleveland Clinic, Cleveland, OH, United States
(Ruel) Division of Cardiac Surgery, University of Ottawa, Ottawa, ON,
Canada
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai St. Luke's, New
York, NY, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan Hospital,
Indianapolis, IN, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Vitamin K antagonists are the only approved oral anticoagulants for
long-term prophylaxis against valve thrombosis and thromboembolism in
patients with a mechanical heart valve. Despite the proven efficacy and
safety of anticoagulation with the oral direct factor Xa inhibitor
apixaban compared with warfarin in high-risk populations including
subjects with atrial fibrillation or with venous thromboembolism, it
remains unknown whether patients with a mechanical heart valve can be
safely managed with apixaban. The On-X Aortic Heart Valve and On-X
Ascending Aortic Prosthesis with the Vascutek Gelweave Valsalva Graft may
have lower rates of valve thrombosis and thromboembolism than conventional
bileaflet and tilting disc valves due its unique pyrolytic carbon
composition and flared inlet design. Design(s): PROACT Xa is a
randomized, multicenter, open-label, active-controlled trial comparing
apixaban with warfarin in patients with an On-X Aortic Heart Valve or On-X
Ascending Aortic Prosthesis with the Vascutek Gelweave Valsalva Graft. The
study will randomize approximately 1,000 patients from approximately 60
sites in North America who underwent aortic valve replacement at least 3
months prior. Patients will be randomized 1:1 to receiving apixaban 5 mg
twice daily or warfarin with a target international normalized ratio of
2.0-3.0. The last randomized participant will be followed for at least 2
years. The primary efficacy outcome is the composite of valve thrombosis
and valve-related thromboembolism, and the primary safety outcome is major
bleeding. Assuming the primary outcome occurs in warfarin-anticoagulated
patients at a rate of 1.75%/patient-year, the study has more than 90%
power to assess noninferiority of apixaban treatment with an absolute
noninferiority margin of 1.75%/patient-year. A second co-primary analysis
is to compare the hazard rate for the apixaban arm to twice the objective
performance criterion for thromboembolism and valve thrombosis, that is,
3.4%/patient-year. PROACT Xa will determine whether patients with an On-X
Aortic Heart Valve can be anticoagulated with apixaban as an alternative
to warfarin. Copyright © 2020 The Authors

<14>
[Use Link to view the full text]
Accession Number
2007059718
Title
Multielectrode Mapping Versus Point-by-Point Mapping for Catheter Ablation
of Ventricular Tachycardia: A Systematic Review and Meta-Analysis.
Source
JACC: Clinical Electrophysiology. 6 (7) (pp 876-878), 2020. Date of
Publication: July 2020.
Author
De Silva K.; Virk S.; Nalliah C.J.; Campbell T.; Kumar S.
Publisher
Elsevier Inc

<15>
Accession Number
2007126824
Title
Effectiveness and safety of Suxiao Jiuxin pill in treating acute coronary
syndrome: a systematic review and Meta-analysis.
Source
Journal of Traditional Chinese Medicine. 40 (4) (pp 518-529), 2020. Date
of Publication: 15 Aug 2020.
Author
Liu C.; Duan L.; Huang M.; Li J.; Xiong X.; Chen G.; He H.; Zhang Z.; Wang
J.
Institution
(Liu, Duan, Huang, Li, Xiong, Chen, He, Zhang, Wang) Department of
Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical
Sciences, Beijing 100053, China
(Liu, Duan, Huang, Chen, He) Graduate School, Beijing University of
Chinese Medicine, Beijing 100029, China
Publisher
Journal of Traditional Chinese Medicine (18 Beixincang, Dongzhimen Nei,
Beijing 100700, China)
Abstract
OBJECTIVE: To evaluate the effectiveness and safety of Suxiao Jiuxin pill
(SX) in acute coronary syndrome (ACS) treatment. METHOD(S): An
extensive search of four English databases (Medline/PubMed, Cochrane
Library, Embase, and World Health Organization International Clinical
Trials Registration Platform) and four Chinese databases (Chinese National
Knowledge Infrastructure, Wanfang, China Science and Technology Journal,
and Chinese Biomedical Literature Service System) was performed.
Randomized, controlled trials (RCTs) involving SX combined with
conventional therapy versus conventional therapy were included. The
extracted data included populations, interventions, outcomes, and risk of
bias. The cardiovascular events served as the primary outcome. Review
Manager 5.3 software was used for data analysis. Relative risks (RRs) with
95% confidence intervals (CIs) were the effect measure. RESULT(S): A
total of eight RCTs with 979 patients were included. There were 559
patients with unstable angina (UA) in six RCTs and 420 patients with acute
myocardial infarction (AMI) in two RCTs. Our review showed that SX plus
conventional therapy might reduce the incidence of the total endpoint (RR:
0.34, 95% CI: 0.17, 0.68, P = 0.002), with no obvious adverse events (RR:
1.29, 95% CI: 0.60, 2.77, P = 0.52) compared with conventional therapy for
patients with UA. Additionally, SX plus conventional therapy also reduced
the incidence of the total endpoint (RR: 0.35, 95% CI: 0.18, 0.68, P =
0.002) compared with conventional therapy in patients with AMI. SX plus
conventional therapy also reduced the incidence of ventricular
fibrillation (RR: 0.23, 95% CI: 0.10, 0.57, P = 0.001) compared with
conventional therapy in patients with AMI. CONCLUSION(S): Our results
suggest that SX is beneficial for treating patients with UA or AMI.
However, our findings should be treated with caution because of the poor
methodological quality of the included trials. Therefore, more
multicenter, large-sample, high-quality RCTs are required to provide
high-quality evidence. Copyright © 2020 JTCM. All rights
reserved.

<16>
Accession Number
2004971212
Title
Cardiac troponin is associated with cardiac outcomes in men and women with
atrial fibrillation, insights from the ARISTOTLE trial.
Source
Journal of Internal Medicine. 288 (2) (pp 248-259), 2020. Date of
Publication: 01 Aug 2020.
Author
Rosjo H.; Hijazi Z.; Omland T.; Westerbergh J.; Lyngbakken M.N.; Alexander
J.H.; Gersh B.J.; Granger C.B.; Hylek E.M.; Lopes R.D.; Siegbahn A.;
Wallentin L.
Institution
(Rosjo, Hijazi, Wallentin) Department of Medical Sciences, Cardiology,
Uppsala University, Uppsala, Sweden
(Rosjo) Division of Research and Innovation, Akershus University Hospital,
Lorenskog, Norway
(Rosjo, Omland, Lyngbakken) Institute of Clinical Medicine, University of
Oslo, Oslo, Norway
(Rosjo, Hijazi, Westerbergh, Siegbahn, Wallentin) Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Omland, Lyngbakken) Department of Cardiology, Division of Medicine,
Akershus University Hospital, Lorenskog, Norway
(Alexander, Granger, Lopes) Duke Clinical Research Institute, Duke Health,
Durham, NC, United States
(Gersh) Mayo Clinic College of Medicine, Rochester, MN, United States
(Hylek) Boston University Medical Center, Boston, MA, United States
(Siegbahn) Department of Medical Sciences, Clinical Chemistry, Uppsala
University, Uppsala, Sweden
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac troponin T (cTnT) and I (cTnI) concentrations provide
strong prognostic information in anticoagulated patients with atrial
fibrillation (AF). Whether the associations between cardiac troponin
concentrations and mortality and morbidity differ by sex is not known.
 Objective(s): To assess whether men and women have different
concentrations and prognostic value of cTnT and cTnI measurements in
anticoagulated patients with AF. Method(s): cTnT and cTnI
concentrations were measured with high-sensitivity (hs) assays in EDTA
plasma samples obtained from the multicentre ARISTOTLE trial, which
randomized patients with AF and at least one risk factor for stroke or
systemic embolic event to warfarin or apixaban. Patients were stratified
according to sex and the associations between hs-troponin concentrations,
and all-cause death, cardiac death, myocardial infarction, stroke or
systemic embolic event and major bleeding were assessed in multivariable
regression models. Result(s): We found higher cardiac troponin
concentrations in men (n = 9649) compared to women (n = 5331), both for
hs-cTnT (median 11.8 [Q1-3 8.1-18.0] vs. 9.6 [6.7-14.3] ng L-1,
P < 0.001) and hs-cTnI (5.8 [3.4-10.8] vs. 4.9 [3.1-8.8] ng
L-1, P < 0.001). Adjusting for baseline demographics,
comorbidities and medications, men still had significantly higher
hs-troponin concentrations than women. C-reactive protein and N-terminal
pro-B-type natriuretic peptide concentrations were higher in female
patients. Both hs-cTnT and hs-cTnI concentrations were associated with all
clinical outcomes similarly in men and women (p-value for interaction
>0.05 for all end-points). Conclusion(s): Men have higher hs-troponin
concentrations than women in AF. Regardless of sex, hs-troponin
concentrations remain similarly associated with adverse clinical outcomes
in anticoagulated patients with AF. Copyright © 2020 The Authors.
Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf
of Association for Publication of The Journal of Internal Medicine

<17>
Accession Number
2004717212
Title
Long-term outcomes of patients with unprotected left main coronary artery
disease treated with percutaneous angioplasty versus bypass grafting: A
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Medicine. 9 (7) (pp 1-10), 2020. Article Number: 2231.
Date of Publication: July 2020.
Author
Bajraktari G.; Zhubi-bakija F.; Ndrepepa G.; Alfonso F.; Elezi S.; Rexhaj
Z.; Bytyci I.; Bajraktari A.; Poniku A.; Henein M.Y.
Institution
(Bajraktari, Bytyci, Bajraktari, Henein) Department of Public Health and
Clinical Medicine, Umea University, Umea 90737, Sweden
(Bajraktari, Zhubi-bakija, Rexhaj, Bytyci, Poniku) Clinic of Cardiology,
University Clinical Centre of Kosova, Pristina 10000, Serbia
(Bajraktari, Elezi, Poniku) Medical Faculty, University of Prishtina
"Hasan Prishtina", Pristina 10000, Serbia
(Ndrepepa) Deutsches Herzzentrum Munchen, Technische Universitat, Munich
80636, Germany
(Alfonso) Cardiac Department, La Princesa University Hospital, Institute
of Health Research, IIS-IP, CIBER-CV University Autonoma of Madrid, Madrid
28029, Spain
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Background and Aim: Treatment of patients with left main coronary artery
disease (LMCA) with percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) remains controversial. The aim of this
meta-analysis was to compare the long-term clinical outcomes of patients
with unprotected LMCA treated randomly by PCI or CABG. Method(s):
PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and
ClinicalTrials.gov database searches identified five randomized trials
(RCTs) including 4499 patients with unprotected LMCA comparing PCI (n =
2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five
years. Random effect risk ratios were used for efficacy and safety
outcomes. The study was registered in PROSPERO. The primary outcome was
major adverse cardiac events (MACE), defined as a composite of death from
any cause, myocardial infarction or stroke. Result(s): Compared to
CABG, patients assigned to PCI had a similar rate of MACE (risk ratio
(RR): 1.13; 95% CI: 0.94 to 1.36; p = 0.19), myocardial infarction (RR:
1.48; 95% CI: 0.97 to 2.25; p = 0.07) and stroke (RR: 0.87; 95% CI: 0.62
to 1.23; p = 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI:
0.89 to 1.28; p = 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95%
CI: 0.89 to 1.43; p = 0.31) were not different. However, the risk of any
repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15; p < 0.00001) was
higher in patients assigned to PCI. Conclusion(s): The findings of
this meta-analysis suggest that the long-term survival and MACE of
patients who underwent PCI for unprotected LMCA stenosis were comparable
to those receiving CABG, despite a higher rate of repeat
revascularization. Copyright © 2020 by the authors. Licensee
MDPI, Basel, Switzerland.

<18>
Accession Number
2006087520
Title
Graft patency after FFR-guided versus angiography-guided coronary artery
bypass grafting: The GRAFFITI trial.
Source
EuroIntervention. 15 (11) (pp E999-E1005), 2019. Date of Publication:
December 2019.
Author
Toth G.G.; de Bruyne B.; Kala P.; Ribichini F.; Casselman F.; Ramos R.;
Piroth Z.; Fournier S.; Piccoli A.; van Mieghem C.; Penicka M.; Mates M.;
Nemec P.; van Praet F.; Stockman B.; Degriek I.; Barbato E.
Institution
(Toth) University Heart Center Graz, Division of Cardiology, Department of
Medicine, Medical University Graz, Graz, Austria
(Toth, de Bruyne, Casselman, Fournier, van Mieghem, Penicka, van Praet,
Stockman, Degriek, Barbato) Cardiovascular Research Center Aalst, OLV
Clinic, Aalst, Belgium
(Kala) Department of Cardiology and Internal Medicine, University Hospital
Brno, Medical Faculty, Masaryk University, Brno, Czechia
(Ribichini, Piccoli) Division of Cardiology, Department of Medicine,
University of Verona, Verona, Italy
(Ramos) Hospital Santa Marta, Centro Hospitalar Lisboa Central, Lisbon,
Portugal
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
(Mates) Cardiovascular Center, Na Homolce Hospital, Prague, Czechia
(Nemec) Centre of Cardiovascular and Transplant Surgery, Brno, Czechia
(Barbato) Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
Publisher
Europa Group
Abstract
Aims: The aim of this study was to assess prospectively the clinical
benefits of fractional flow reserve (FFR) in guiding coronary artery
bypass grafting (CABG). Methods and Results: GRAFFITI is a
single-blinded, prospective, multicentre, randomised controlled trial of
FFR-guided versus angiography-guided CABG. We enrolled patients undergoing
coronary angiography, having a significantly diseased left anterior
descending artery or left main stem and at least one more major coronary
artery with intermediate stenosis, assessed by FFR. Surgical strategy was
defined based on angiography, blinded to FFR values prior to
randomisation. After randomisation, patients were operated on either
following the angiography-based strategy (angiography-guided group) or
according to FFR, i.e., with an FFR <=0.80 as cut-off for grafting
(FFR-guided group). The primary endpoint was graft patency at 12 months.
Between March 2012 and December 2016, 172 patients were randomised either
to the angiography-guided group (84 patients) or to the FFR-guided group
(88 patients). The patients had a median of three [3; 4] lesions; diameter
stenosis was 65% (50%; 80%), FFR was 0.72 (0.50; 0.82). Compared to the
angiography-guided group, the FFR-guided group received fewer anastomoses
(3 [3; 3] vs 2 [2; 3], respectively; p=0.004). One-year angiographic
follow-up showed no difference in overall graft patency (126 [80%] vs 113
[81%], respectively; p=0.885). One-year clinical follow-up, available in
98% of patients, showed no difference in the composite of death,
myocardial infarction, target vessel revascularisation and stroke.
 Conclusion(s): FFR guidance of CABG has no impact on one-year graft
patency, but it is associated with a simplified surgical
procedure. Copyright © Europa Digital & Publishing 2019. All
rights reserved.

<19>
Accession Number
2007103936
Title
Feasibility of Perioperative eHealth Interventions for Older Surgical
Patients: A Systematic Review.
Source
Journal of the American Medical Directors Association. (no pagination),
2020. Date of Publication: 2020.
Author
Jonker L.T.; Haveman M.E.; de Bock G.H.; van Leeuwen B.L.; Lahr M.M.H.
Institution
(Jonker, Haveman, van Leeuwen) Department of Surgery, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(Jonker, de Bock, Lahr) Department of Epidemiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: EHealth interventions are increasingly being applied in
perioperative care but have not been adequately studied for older surgical
patients who could potentially benefit from them. Therefore, we evaluated
the feasibility of perioperative eHealth interventions for this
population. Design(s): A systematic review of prospective
observational and interventional studies was conducted. Three electronic
databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and
July 2019. Study quality was assessed by Methodological Index for
Non-Randomized Studies (MINORS) with and without control group. Setting
and Participants: Studies of surgical patients with an average age >=65
years undergoing any perioperative eHealth intervention with active
patient participation (with the exception of telerehabilitation following
orthopedic surgery) were included. Measures: The main outcome measure was
feasibility, defined as a patient's perceptions of usability,
satisfaction, and/or acceptability of the intervention. Other outcomes
included compliance and study completion rate. Result(s): Screening
of 1569 titles and abstracts yielded 7 single-center prospective studies
with 223 patients (range n = 9-69 per study, average age 66-74 years)
undergoing oncological, cardiovascular, or orthopedic surgery. The median
MINORS scores were 13.5 of 16 for 6 studies without control group, and 14
of 24 for 1 study with a control group. Telemonitoring interventions were
rated as "easy to use" by 89% to 95% of participants in 3 studies.
Patients in 3 studies were satisfied with the eHealth intervention and
would recommend it to others. Acceptability (derived from consent rate)
ranged from 71% to 89%, compliance from 53% to 86%, and completion of
study follow-up from 54% to 95%. Conclusions and Implications: Results of
7 studies involving perioperative eHealth interventions suggest their
feasibility and encourage further development of technologies for older
surgical patients. Future feasibility studies require clear definitions of
appropriate feasibility outcome measures and a comprehensive description
of patient characteristics such as functional performance, level of
education, and socioeconomic status. Copyright © 2020 AMDA - The
Society for Post-Acute and Long-Term Care Medicine

<20>
Accession Number
632310979
Title
Intravenous iron therapy for patients with preoperative iron deficiency or
anaemia undergoing cardiac surgery reduces blood transfusions: a
systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 31 (2) (pp 141-151),
2020. Date of Publication: 01 Aug 2020.
Author
Gupta S.; Panchal P.; Gilotra K.; Wilfred A.M.; Hou W.; Siegal D.;
Whitlock R.P.; Belley-Cote E.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, ON,
Hamilton, Canada
(Gupta, Whitlock) Department of Health Research Methods, McMaster
University, ON, Hamilton, Canada
(Panchal, Gilotra, Wilfred, Hou) Faculty of Health Sciences, McMaster
University, ON, Hamilton, Canada
(Siegal, Belley-Cote) Department of Medicine, McMaster University, ON,
Hamilton, Canada
(Siegal, Whitlock, Belley-Cote) Population Health Research Institute, ON,
Hamilton, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The benefits of preoperative intravenous (IV) iron treatment
in cardiac surgery patients with preoperative anaemia or iron deficiency
have not been well-established. We performed a systematic review and
meta-analysis to determine the effects of treating preoperative anaemia or
iron deficiency with IV iron in adult cardiac surgery patients.
 METHOD(S): We searched Cochrane Central Register of Controlled
Trials, Medical Literature Analysis and Retrieval Systems Online and
Excerpta Medica Database for randomized controlled trials (RCTs) and
observational studies comparing IV iron to oral iron or no iron. We
performed title and abstract, full-text screening, data extraction and
risk of bias assessment independently and in duplicate. We pooled data
using a random effects model and evaluated the overall quality of
evidence. RESULT(S): We identified 4 RCTs and 7 observational
studies. Pooled data from observational studies suggested a benefit of IV
iron compared to no iron on mortality [relative risk 0.39, 95% confidence
interval (CI) 0.23-0.65; P<0.001, very low quality], units transfused per
patient (mean difference -1.22, 95% CI -1.85 to -0.60; P<0.001, very low
quality), renal injury (relative risk 0.50, 95% CI 0.36-0.69; P<0.001,
very low quality) and hospital length of stay (mean difference -4.24days,
95% CI -6.86 to -1.63; P=0.001, very low quality). Pooled data from RCTs
demonstrated a reduction in the number of patients transfused with IV iron
compared to oral or no iron (relative risk 0.81, 95% CI 0.70-0.94;
P=0.005, moderate quality). The pooled estimates of effect from RCTs for
mortality, hospital length of stay, units transfused per patient and renal
injury were consistent in direction with observational studies.
 CONCLUSION(S): This meta-analysis suggests that IV iron improves
postoperative morbidity in adult cardiac surgery patients with
preoperative anaemia or iron deficiency. A large, rigorous,
placebo-controlled, double-blinded, multicentre trial is needed to clarify
the role of IV iron in this patient population. CLINICAL TRIAL
REGISTRATION: International prospective register of systematic reviews ID
Number CRD42019122844. Copyright © The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<21>
Accession Number
632200259
Title
Clinical and conceptual approaches to interpreting the findings of
systematic review and meta-analysis of mortality after drug-eluting stents
vs. coronary artery bypass grafting for left main coronary artery disease.
Source
European heart journal. 41 (28) (pp 2710-2711), 2020. Date of Publication:
21 Jul 2020.
Author
Jayaraj R.; Kumaraswamy C.; Shaw P.
Institution
(Jayaraj) Northern Territory Medical Program (NTMP), College of Medicine
and Public Health, Flinders University, CDU Campus ,Ellengowan Drive,
Darwin, NT 0909, Australia
(Jayaraj, Shaw) Department of Artificial Intelligence, Nanjing University
of Information Science and Technology (NUIST), Jiangsu, China
(Kumaraswamy) School of Public Health, University of Adelaide, North
Terrace Campus, Adelaide SA 5005, Australia
Publisher
NLM (Medline)

<22>
Accession Number
2005845373
Title
Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and
Improvement After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 127 (pp 105-112), 2020. Date of
Publication: 15 July 2020.
Author
Ghezzi E.S.; Ross T.J.; Davis D.; Psaltis P.J.; Loetscher T.; Keage H.A.D.
Institution
(Ghezzi, Ross, Loetscher, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, Justice and Society, University of South
Australia, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing Unit at UCL, London,
United Kingdom
(Psaltis) Vascular Research Centre, Lifelong Health Theme, South
Australian Health and Medical Research Institute, Adelaide, Australia
(Psaltis) Adelaide University Medical School, University of Adelaide,
Adelaide, Australia
(Psaltis) Department of Cardiology, Central Adelaide Local Health Network,
Adelaide, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Changes to cognition, both decline and improvement, are commonly reported
after transcatheter aortic valve implantation (TAVI). However, previous
systematic reviews and meta-analyses have missed these subgroups by
assessing whole-group-averages for cognitive outcomes. We sought to pool
estimates to identify the prevalence of cognitive decline and improvement
after TAVI, as well as associated factors for these outcomes. A systematic
review identified 15 articles appropriate for meta-analysis. When robust
cognitive change definitions were employed, the pooled prevalence of
incident cognitive impairment up to 1-, 1 to 6-, and >=6-months post-TAVI
was 7%, 14%, and 12%, respectively. For cognitive improvement, the
prevalence from 1 to 6 months and >=6 months after TAVI was estimated to
be 19% and 11%, respectively. Two factors were associated with these
cognitive outcomes: (1) using a cerebral embolic protection device was
associated with decreased prevalence of cognitive decline up to 1-week
post-TAVI; (2) baseline cognitive impairment had a large association with
post-TAVI cognitive improvement. In conclusion, cognitive decline and
cognitive improvement are experienced by approximately 7% to 19% of
patients after TAVI, respectively. Those with the lowest cognitive
performance pre-TAVI appear to have the most to gain in terms of cognitive
improvement post-TAVI. Identifying further predictive factors for
cognitive decline and improvement post-TAVI will facilitate a
personalized-medicine approach for cognitive care and
prognosis. Copyright © 2020 The Author(s)

<23>
Accession Number
2005726977
Title
Impact of the time interval between diagnosis and symptoms on survival of
surgical patients with left-sided infective endocarditis: A propensity
score analysis.
Source
Medicina Clinica. 155 (2) (pp 63-67), 2020. Date of Publication: 24 July
2020.
Author
Urso S.; Tena M.A.; Gonzalez-Barbeito M.; Paredes F.; Quevedo V.; Portela
F.
Institution
(Urso, Tena, Gonzalez-Barbeito, Paredes, Portela) Cardiac Surgery
Department, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria,
Spain
(Quevedo) Cardiology Department, Hospital Universitario Dr. Negrin, Las
Palmas de Gran Canaria, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Objectives: We aimed to explore the impact of the time interval between
symptoms and diagnosis on post-operative infective endocarditis (IE)
survival. Method(s): From 2014 to 2019, data from 93 consecutive
patients undergoing cardiac surgery due to left-sided +/- right-sided IE
were prospectively recorded in our specific electronic database. Patients
were classified into 2 groups according to time interval between first
clinical symptoms and definitive endocarditis diagnosis: patients with
early diagnosis (<=8 days) and patients with late diagnosis (>8 days).
Follow-up was 100% complete, and follow-up mean time was 471 days.
 Result(s): Among the 93 patients undergoing cardiac surgery due to
definite left-sided IE, 48 (51.6%) had early-diagnosed IE whereas 45
(48.4%) presented with a late-diagnosed IE. Unadjusted and propensity
score adjusted mid-term survival Kaplan-Meier analysis showed
significantly worse survival of patients belonging to the early-diagnosis
group (p .019 and .049 respectively). Multivariable Cox regression
analysis identified only one predictor of mid-term mortality: EuroSCORE II
(Hazard ratio 1.03, 95% CI 1.01-1.05, p .0008). Conclusion(s): The
association in the Kaplan-Meier analysis between "early-diagnosis group"
and mortality suggests that this group of patients presents clinical
characteristics of severity that, on the one hand, speed up the diagnostic
process and on the other, converge in the determination of a higher
euroSCORE II value, which is the only independent predictor of mid-term
mortality according to our analysis. Copyright © 2020 Elsevier
Espana, S.L.U.

<24>
Accession Number
2005644577
Title
A pilot randomized-controlled trial evaluating the erector spinae plane
block in thoracic and breast surgery.
Source
Canadian Journal of Anesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Uda Y.; Byrne K.; Brahmbhatt A.; Gotmaker R.; Lim D.; Konishi Y.; Eves
T.K.; Paxton E.; Barrington M.J.
Institution
(Uda, Brahmbhatt, Gotmaker, Konishi, Paxton, Barrington) Department of
Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Victoria
Parade, Fitzroy, PO Box 2900, Melbourne, VIC 3065, Australia
(Byrne) Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
(Brahmbhatt, Barrington) Department of Medicine and Radiology, Faculty of
Medicine, Dentistry and Health Sciences, University of Melbourne,
Melbourne, VIC, Australia
(Lim) Department of Pharmacy, St. Vincent's Hospital, Melbourne, VIC,
Australia
(Konishi) Department of Anesthesia, School of Medicine, Teikyo University,
Tokyo, Japan
(Eves) Department of Anatomy and Neuroscience, Faculty of Medicine,
Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC,
Australia
Publisher
Springer
Abstract
Purpose: This pilot study evaluated the feasibility of investigating the
effect of the erector spinae plane (ESP) block on the patient-centred
outcomes of quality of recovery-15 (QoR-15), and brief pain inventory
(BPI) in thoracic and breast surgery patients. Method(s): In this
randomized-controlled pilot trial, 82 patients undergoing video-assisted
thoracoscopic surgery (n = 77) and mastectomy (n = 5) received either
continuous ESP block with ropivacaine (ropivacaine group) or the same
procedure with 0.9% saline (saline group). All patients received surgical
intercostal block (thoracic surgery) or local anesthetic infiltration
(breast surgery). Feasibility as the primary outcome was evaluated on
recruitment (three patients per week), catheter retention (above 90% at 24
hr), and patient attrition (less than 10%). Secondary outcomes comprised
of QoR-15, BPI, and opioid consumption. Result(s): Recruitment rate
was 1.8 patients per week. Catheters were retained in 77 patients (94%) at
24 hr. At three months, five patients were lost to follow-up (6%). At 24
hr compared with baseline, the ropivacaine group had a smaller decline in
QoR-15 score (median difference, 14; 95% confidence interval [CI], 2 to
26; P = 0.02) and a smaller increase in BPI global score (median
difference, 14; 95% CI, 0 to 24; P = 0.048). There was no difference in
opioid consumption (P = 0.08). Conclusion(s): In this pilot study,
the target recruitment rate was not met, but catheter retention and
patient attrition rates were both satisfactory. A definitive trial with
QoR-15 as the primary outcome would require 300 study participants. Trial
registration: Australian New Zealand Clinical Trials Registry
(ID12618000701224); registered 30 April 2018. Copyright © 2020,
Canadian Anesthesiologists' Society.

<25>
Accession Number
2005640635
Title
New-onset atrial fibrillation and outcomes following isolated coronary
artery bypass surgery: A systematic review and meta-analysis.
Source
Clinical Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Kerwin M.; Saado J.; Pan J.; Ailawadi G.; Mazimba S.; Salerno M.; Mehta N.
Institution
(Kerwin, Saado, Pan) Division of Internal Medicine, University of
Virginia, Charlottesville, VA, United States
(Ailawadi) Division of Cardiovascular Surgery, University of Virginia,
Charlottesville, VA, United States
(Mazimba, Salerno, Mehta) Division of Cardiovascular Medicine, University
of Virginia, Charlottesville, VA, United States
(Mehta) Division of Cardiovascular Medicine, William Beaumont Oakland
University, Royal Oak, MI, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Prior meta-analyses have shown that new-onset atrial fibrillation (NOAF)
occurs in up to 40% of patients following cardiac surgery and is
associated with substantial major adverse cardiovascular events. The
stroke and mortality implications of NOAF in isolated CABG without
concomitant valve surgery is not known. We thought that NOAF would be
associated with increased risk of stroke and mortality, even in patients
undergoing isolated CABG. A blinded review of studies from MEDLINE,
CENTRAL, and Web of Science was done by two independent investigators.
Stroke, 30-day/hospital mortality, long-term cardiovascular mortality, and
long-term (>1 year) all-cause mortality were analyzed. We used Review
Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461
studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF
incidence ranged from 15% to 36%. NOAF was associated with increased risk
of stroke (unadjusted OR 2.15 [1.82, 2.53] [P <.00001]; adjusted OR 1.88
[1.02, 3.46] [P =.04]). NOAF was associated with increased 30-day/hospital
mortality (OR 2.35 [1.67, 3.32] [P <.00001]) and long-term cardiovascular
mortality (OR 2.04 [1.35, 3.09] [P =.0007]) NOAF was associated with
increased long-term all-cause mortality (unadjusted OR 1.79 [1.63, 1.96]
[P <.00001]; adjusted OR 1.58 [1.24, 2.00] [P =.0002]). We found that the
incidence of NOAF following isolated CABG is high and is associated with
increased stroke rate and mortality. Early recognition and management of
NOAF could improve outcomes. Copyright © 2020 The Authors.
Clinical Cardiology published by Wiley Periodicals LLC.

<26>
Accession Number
2005408763
Title
Cardiac Imaging With 123I-meta-iodobenzylguanidine and
Analogous PET Tracers: Current Status and Future Perspectives.
Source
Seminars in Nuclear Medicine. 50 (4) (pp 331-348), 2020. Date of
Publication: July 2020.
Author
Wan N.; Travin M.I.
Institution
(Wan, Travin) Division of Nuclear Medicine, Department of Radiology, and
Division of Cardiology, Department of Medicine, Montefiore Medical Center
and The Albert Einstein College of Medicine, Bronx, NY, United States
Publisher
W.B. Saunders
Abstract
Autonomic innervation plays an important role in proper functioning of the
cardiovascular system. Altered cardiac sympathetic function is present in
a variety of diseases, and can be assessed with radionuclide imaging using
sympathetic neurotransmitter analogues. The most studied adrenergic
radiotracer is cardiac 123I-meta-iodobenzylguanidine
(123I-mIBG). Cardiac 123I-mIBG uptake can be
evaluated using both planar and tomographic imaging, thereby providing
insight into global and regional sympathetic innervation. Standardly
assessed imaging parameters are the heart-to-mediastinum ratio and washout
rate, customarily derived from planar images. Focal tracer deficits on
tomographic imaging also show prognostic utility, with some data
suggesting that the best approach to tomographic image interpretation may
differ from conventional methods. Cardiac 123I-mIBG image
findings strongly correlate with the severity and prognosis of many
cardiovascular diseases, especially heart failure and ventricular
arrhythmias. Cardiac 123I-mIBG imaging in heart failure is FDA
approved for prognostic purposes. With the robustly demonstrated ability
to predict occurrence of potentially fatal arrhythmias, cardiac
123I-mIBG imaging shows promise for better selecting patients
who will benefit from an implantable cardioverter defibrillator, but
clinical use has been hampered by lack of the randomized trial needed for
incorporation into societal guidelines. In patients with ischemic heart
disease, cardiac 123I-mIBG imaging aids in assessing the extent
of damage and in identifying arrhythmogenic regions. There have also been
studies using cardiac 123I-mIBG for other conditions, including
patients following heart transplantation, diabetic related cardiac
abnormalities and chemotherapy induced cardiotoxicity. Positron emission
tomographic adrenergic radiotracers, that improve image quality, have been
investigated, especially 11C-meta-hydroxyephedrine, and most
recently 18F-fluorbenguan. Cadmium-zinc-telluride cameras also
improve image quality. With better spatial resolution and quantification,
PET tracers and advanced camera technologies promise to expand the
clinical utility of cardiac sympathetic imaging. Copyright © 2020
Elsevier Inc.

<27>
Accession Number
2004835121
Title
A Prospective Randomized Blinded Trial of Remote Ischemic Preconditioning
in Children Undergoing Cardiac Surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (2) (pp 313-322),
2020. Date of Publication: Summer 2020.
Author
Verdesoto Rodriguez M.C.; Spenceley N.; Ilina M.; Danton M.H.D.
Institution
(Verdesoto Rodriguez) University of Glasgow, Glasgow, United Kingdom
(Spenceley, Ilina, Danton) Royal Children's Hospital, Glasgow, United
Kingdom
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) has been proposed as an
intervention to protect myocardium and attenuate end-organ dysfunction
associated with cardiopulmonary bypass. We investigated the effect of RIPC
in children undergoing cardiopulmonary bypass involving clinical outcome,
cardiac and end-organ function, inflammatory response, and myocardial gene
expression. A prospective, investigator-blinded, randomized, controlled
trial was performed. Patients were randomized into RIPC or Control; RIPC
consisted of three 5-minute cycles of limb ischemia-reperfusion taking
place 1 and 12 hours preoperatively. Clinical outcomes included cardiac
function, ICU surveillance, and renal function. In addition, inflammatory
markers and myocardial gene expression were evaluated. RIPC patients
required shorter ICU stay (days), RIPC: 1.8 (0.94-3.88) vs Control: 4.9
(1.63-7.20), P = 0.029. Echocardiography parameters demonstrated reduced
biventricular function following surgery showing no difference between
groups. A nonsignificant trend for reduced troponin was observed following
RIPC: AUC analysis, RIPC: 393.05 (98.85-1038.73) vs Control: 596.10
(225.38-954.24) P = 0.75. B-type natriuretic peptide and renal function
parameters were similar between groups. Postoperative TNF-alpha was
significantly reduced after RIPC, RIPC: 15.42 (7.81-114.86) vs Control:
108.98 (42.28-301.19) P = 0.02. Remaining inflammatory markers
demonstrated no significant difference between groups. HSP-60 showed lower
myocardial expression following RIPC, RIPC: 3.95 (2.69-6.28) vs Control:
6.83 (4.74-8.81), P = 0.05. Expression of other analyzed genes was not
influenced by RIPC. RIPC was associated with shorter ICU stay and reduced
TNF-alpha but did not influence other clinical outcomes, not confer
protection against cardiac injury or renal dysfunction. The association
between RIPC and ICU stay may be influenced by unaccounted latent
variables, including cardiac morphology. Copyright © 2019
Elsevier Inc.

<28>
Accession Number
2004046557
Title
The effects of Hegu point ice massage on post-sternotomy pain in patients
undergoing coronary artery bypass grafting: A single-blind, randomized,
clinical trial.
Source
Advances in Integrative Medicine. 7 (2) (pp 73-78), 2020. Date of
Publication: May 2020.
Author
Taherian T.; Shorofi S.A.; Zeydi A.E.; Charati J.Y.; Pouresmail Z.; Jafari
H.
Institution
(Taherian) School of Nursing and Midwifery, Student Research Committee,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Shorofi, Jafari) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Shorofi) Adjunct Research Fellow, Flinders University, Adelaide,
Australia
(Zeydi) School of Nursing and Midwifery, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Charati) School of Health Sciences, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Pouresmail) School of Nursing and Midwifery, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Elsevier Australia
Abstract
Background and purpose: Pain is considered as one of the most common
problems among patients undergoing open heart surgery. We aimed to
evaluate the effects of Hegu point ice massage on the level of pain
experienced after coronary artery bypass grafting Material(s) and
Method(s): This is a single-blind, randomized, clinical trial, conducted
on 80 patients who were recruited via convenience sampling method. The
sample was randomly divided into two groups. In the experimental group,
ice massage was performed at the Hegu point on the left hand by applying a
medium pressure for 10 min (2 min massage, 15 s rest) in postoperative day
1 and 2. In the control group, glass marbles were applied at the Hegu
point on the left hand with no pressure and massage for 10 min. Pain
intensity was measured in both groups before the intervention and at 30,
60, and 120 min following the intervention. Result(s): Following the
intervention on the postoperative day 1, the mean pain score for the
experimental and control groups was 2.97 +/- 1.40 and 3.64 +/- 1.56,
respectively. For the experimental and control groups on postoperative day
2, the mean pain score was 2.35 +/- 1.12 versus 3.03 +/- 1.40,
respectively. Following the intervention on postoperative day 1, the mean
pain score was 2.97 +/- 1.40 and 3.64 +/- 1.56 in the experimental and
control groups, respectively. The mean pain score for the experimental
group was 2.35 +/- 1.12 compared with 3.03 +/- 1.40 for the control group
after the intervention on the second postoperative day. Statistically
significant differences were revealed for the mean pain score between the
two groups after the intervention on the first (p = 0.04) and second (p =
0.02) postoperative days. Conclusion(s): Hegu point ice massage is an
effective method for relieving pain associated with coronary artery bypass
grafting in specific patients. Copyright © 2019 Elsevier Ltd

<29>
Accession Number
2003792693
Title
Aorto-cardiac fistula etiology, presentation, and management: A systematic
review.
Source
Heart and Lung. 49 (3) (pp 317-323), 2020. Date of Publication: May - June
2020.
Author
Foster T.J.; Amin A.H.; Busu T.; Patel K.; Farjo P.; Hallak A.A.; Ali N.;
Alkhouli M.
Institution
(Foster, Busu, Patel, Farjo, Alkhouli) Division of Cardiovascular Disease,
West Virginia University, 1 Medical Drive, Morgantown, WV 26505, United
States
(Amin) Section of Cardiology, Carilion Clinic, Carilion Clinic, Virginia
Tech-Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016,
United States
(Hallak) West Virginia University Health Science Center, 1 Medical Drive,
Morgantown, WV 26505, United States
(Ali) Department of Pediatrics, Carilion Clinic, Virginia Tech-Carilion
School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States
(Alkhouli) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, Rochester, MN, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Aorto-cardiac fistulae are a rare but increasingly reported
entity, and data are scarce. Method(s): The authors performed a
systematic review of ACFs to characterize the underlying etiology,
clinical presentation, and compare outcomes of treatment strategies.
 Result(s): 3,733 publications were identified in the search. Of
those, 292 studies including 300 patients were included. Etiology of ACFs
was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other
causes. Most patients (74%) presented with heart failure. Common locations
were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The
majority of patients (71%) were treated surgically, while 13% were treated
percutaneously, and 16% were treated conservatively. Patients who were
managed conservatively had a higher mortality than those treated with
invasive closure (53% vs. 12% vs. 3%, p = <0.00001). Conclusion(s):
This systematic review sheds light on this highly morbid condition. Once
recognized, fistula closure appears to be superior to conservative
management. Copyright © 2019 Elsevier Inc.

<30>
Accession Number
2003464820
Title
Cardiovascular Outcomes with Transcatheter vs. Surgical Aortic Valve
Replacement in Low-Risk Patients: An Updated Meta-Analysis of Randomized
Controlled Trials.
Source
Cardiovascular Revascularization Medicine. 21 (4) (pp 453-460), 2020. Date
of Publication: April 2020.
Author
Kundu A.; Sardar P.; Malhotra R.; Qureshi W.T.; Kakouros N.
Institution
(Kundu, Malhotra, Qureshi, Kakouros) Division of Cardiovascular Medicine,
University of Massachusetts Medical School, Worcester, MA, United States
(Sardar) Division of Cardiology, Brown University, Rhode Island Hospital,
Providence, RI, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: TAVR is an established treatment option in high and
intermediate-risk patients with severe AS. There is less data regarding
the efficacy of TAVR in low-risk patients. This meta-analysis evaluated
efficacy and safety outcomes of transcatheter aortic valve replacement
(TAVR) in comparison to surgical aortic valve replacement (SAVR) in
low-risk patients with severe aortic stenosis (AS). Method(s):
Databases were searched for randomized controlled trials (RCTs) that
compared TAVR with SAVR for the treatment of low-risk patients with severe
AS. We calculated pooled odds ratios (ORs) and 95% confidence intervals
(CIs) using the random-effects model. Result(s): The final analysis
included 2953 patients from 5 studies. Compared to SAVR, TAVR was
associated with similar mid-term mortality [OR 0.67; 95% CI 0.37-1.21; p =
0.18], as well as similar short-term mortality [OR 0.51; 95% CI 0.24-1.11;
p = 0.09]. Randomization to TAVR was associated with a reduced risk of
developing acute kidney injury [OR 0.26; 95% CI 0.13-0.52; p < 0.001],
short-term major bleeding [OR 0.27; 95% CI 0.12-0.60; p < 0.001] and
new-onset atrial fibrillation [OR 0.17; 95% CI 0.14-0.21; p < 0.001].
However, TAVR was associated with a higher risk of requiring permanent
pacemaker implantation [OR 4.25; 95% CI 1.86-9.73; p < 0.001]. There was
no significant difference in the risk of myocardial infarction, stroke,
endocarditis or aortic valve re-intervention between the two groups.
 Conclusion(s): Our meta-analysis showed that TAVR has similar
clinical efficacy to SAVR, with a more favorable safety profile, in
patients with severe AS who are at low-surgical risk. Copyright ©
2019 Elsevier Inc.

<31>
Accession Number
2002663111
Title
Transcatheter Aortic Valve Replacement in Low-Risk Patients: A
Meta-Analysis of Randomized Controlled Trials.
Source
Cardiovascular Revascularization Medicine. 21 (4) (pp 461-466), 2020. Date
of Publication: April 2020.
Author
Al-Abdouh A.; Upadhrasta S.; Fashanu O.; Elias H.; Zhao D.; Hasan R.K.;
Michos E.D.
Institution
(Al-Abdouh, Upadhrasta, Fashanu, Elias) Department of Medicine, Saint
Agnes Hospital, Baltimore, MD, United States
(Fashanu, Michos) The Ciccarone Center for the Prevention of
Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD,
United States
(Zhao, Michos) Department of Epidemiology, Johns Hopkins University,
Baltimore, MD, United States
(Hasan, Michos) Division of Cardiology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become the
standard treatment option for patients with symptomatic severe aortic
stenosis (AS) with high surgical risk and a reasonable option for
intermediate surgical risk as an alternative to surgical aortic valve
replacement (SAVR). The role of TAVR in lower risk patients is less
established but has been the focus of recent randomized controlled trials
(RCTs). We performed a meta-analysis of RCTs to assess TAVR outcomes among
low surgical risk patients. Methods and Results: Systematic search of
RCTs was done using PubMed, EMBASE, and Cochrane Library databases.
Statistical analysis was performed with RevMan v5.3 software using a
random effects model to report risk ratio (RR) with 95% confidence
interval (CI). A total of three RCTs including 2698 patients (1375 TAVR
and 1323 SAVR) were analyzed. Compared to SAVR, TAVR was not associated
with all-cause mortality [RR 0.86 (95% CI 0.61-1.19); P = 0.36;
I2 = 8%] or stroke [RR 0.82 (0.48-1.43); P = 0.49;
I2 = 42%]. However, TAVR was significantly associated with
lower risk of acute kidney injury [RR 0.27 (0.13-0.54); P = 0.0002;
I2 = 0%], new-onset atrial fibrillation [RR 0.26 (0.18-0.39); P
< 0.00001; I2 = 80%], and life-threatening or disabling
bleeding [RR 0.35 (0.22-0.55); P < 0.00001; I2 = 57%], but a
higher risk of moderate-severe paravalvular leak [RR 4.40 (1.22-15.86); P
= 0.02; I2 = 26%] and permanent pacemaker insertion [RR 2.73
(1.41-5.28); P = 0.003; I2 = 83%]. Conclusion(s): There is
no difference in all-cause mortality or stroke between TAVR and SAVR, but
TAVR is associated with lower risk of other perioperative complications
except for moderate-severe paravalvular leak and the need for permanent
pacemaker implantation. Copyright © 2019

<32>
Accession Number
632415577
Title
Association of Gender and Race With Allocation of Advanced Heart Failure
Therapies.
Source
JAMA network open. 3 (7) (pp e2011044), 2020. Date of Publication: 01 Jul
2020.
Author
Breathett K.; Yee E.; Pool N.; Hebdon M.; Crist J.D.; Yee R.H.; Knapp
S.M.; Solola S.; Luy L.; Herrera-Theut K.; Zabala L.; Stone J.; McEwen
M.M.; Calhoun E.; Sweitzer N.K.
Institution
(Breathett, Sweitzer) Sarver Heart Center, Division of Cardiology,
Department of Medicine, University of Arizona, Tucson, United States
(Yee, Yee) Sarver Heart Center, Clinical Research Office, University of
Arizona, Tucson, United States
(Pool, Crist, McEwen) College of Nursing, University of Arizona, Tucson,
United States
(Hebdon) College of Nursing, University of Utah, Salt Lake City, United
States
(Knapp) Statistics Consulting Lab, Bio5 Institute, University of Arizona,
Tucson, United States
(Solola) Department of Medicine, University of Arizona, Tucson, United
States
(Luy) University of Rochester, NY
(Herrera-Theut) University of Arizona Medical School, Tucson, United
States
(Zabala) Department of Medicine, University of California, Los Angeles,
Mexico
(Stone) Department of Psychology, University of Arizona, Tucson, United
States
(Calhoun) Center for Population Health Sciences, University of Arizona,
Tucson, United States
Publisher
NLM (Medline)
Abstract
Importance: Racial bias is associated with the allocation of advanced
heart failure therapies, heart transplants, and ventricular assist
devices. It is unknown whether gender and racial biases are associated
with the allocation of advanced therapies among women. Objective(s):
To determine whether the intersection of patient gender and race is
associated with the decision-making of clinicians during the allocation of
advanced heart failure therapies. Design, Setting, and
Participant(s): In this qualitative study, 46 US clinicians attending a
conference for an international heart transplant organization in April
2019 were interviewed on the allocation of advanced heart failure
therapies. Participants were randomized to examine clinical vignettes that
varied 1:1 by patient race (African American to white) and 20:3 by gender
(women to men) to purposefully target vignettes of women patients to
compare with a prior study of vignettes of men patients. Participants were
interviewed about their decision-making process using the think-aloud
technique and provided supplemental surveys. Interviews were analyzed
using grounded theory methodology, and surveys were analyzed with Wilcoxon
tests. Exposure: Randomization to clinical vignettes. Main Outcomes
and Measures: Thematic differences in allocation of advanced therapies by
patient race and gender. Result(s): Among 46 participants (24 [52%]
women, 20 [43%] racial minority), participants were randomized to the
vignette of a white woman (20 participants [43%]), an African American
woman (20 participants [43%]), a white man (3 participants [7%]), and an
African American man (3 participants [7%]). Allocation differences
centered on 5 themes. First, clinicians critiqued the appearance of the
women more harshly than the men as part of their overall impressions.
Second, the African American man was perceived as experiencing more severe
illness than individuals from other racial and gender groups. Third, there
was more concern regarding appropriateness of prior care of the African
American woman compared with the white woman. Fourth, there were greater
concerns about adequacy of social support for the women than for the men.
Children were perceived as liabilities for women, particularly the African
American woman. Family dynamics and finances were perceived to be greater
concerns for the African American woman than for individuals in the other
vignettes; spouses were deemed inadequate support for women. Last,
participants recommended ventricular assist devices over transplantation
for all racial and gender groups. Surveys revealed no statistically
significant differences in allocation recommendations for African American
and white women patients. Conclusions and Relevance: This national
study of health care professionals randomized to clinical vignettes that
varied only by gender and race found evidence of gender and race bias in
the decision-making process for offering advanced therapies for heart
failure, particularly for African American women patients, who were judged
more harshly by appearance and adequacy of social support. There was no
associated between patient gender and race and final recommendations for
allocation of advanced therapies. However, it is possible that bias may
contribute to delayed allocation and ultimately inequity in the allocation
of advanced therapies in a clinical setting.

<33>
Accession Number
632414973
Title
In patients undergoing dialysis who require a valve replacement is a
bioprosthetic valve superior to a mechanical prosthesis in terms of
long-term survival and morbidity?.
Source
Interactive cardiovascular and thoracic surgery. 31 (2) (pp 174-178),
2020. Date of Publication: 01 Aug 2020.
Author
Fong L.S.; Ang Z.H.; Wolfenden H.; Akhunji Z.
Institution
(Fong, Ang, Wolfenden, Akhunji) Department of Cardiothoracic Surgery,
Prince of Wales Hospital, NSW, Randwick, Australia
(Ang) Prince of Wales Clinical School, University of New South Wales, NSW,
Randwick, Australia
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In [dialysis patients
undergoing a valve replacement] is [a bioprosthetic valve superior to a
mechanical prosthesis] for [long-term survival and morbidity]'. Altogether
more than 501 papers were found using the reported search, of which five
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
There was limited high-quality evidence with all studies being
retrospective. One meta-analysis and four cohort studies provided the
evidence that there was no significant difference in long-term survival
based on prosthesis type. However, the majority of studies demonstrated a
significantly higher rate of valve-related complications including
bleeding and thromboembolism, and readmission to hospital in the
mechanical valve prosthesis group, likely related to the requirement for
long-term anticoagulation. We conclude that overall long-term survival in
dialysis-dependent patients is poor. While prosthesis type does not play a
significant contributing role to long-term survival, bioprosthetic valves
were associated with significantly fewer valve-related complications.
Based on the available evidence, a bioprosthetic valve may be more
suitable in this high-risk group of patients as it may avoid the
complications associated with long-term anticoagulation without any
reduction in long-term survival. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<34>
Accession Number
632408563
Title
Beta-blockers for congestive heart failure in children.
Source
Cochrane Database of Systematic Reviews. 2020 (7) (no pagination), 2020.
Article Number: CD007037. Date of Publication: 23 Jul 2020.
Author
Alabed S.; Sabouni A.; Al Dakhoul S.; Bdaiwi Y.
Institution
(Alabed) Academic Unit of Radiology, University of Sheffield, Sheffield,
United Kingdom
(Sabouni) KasrAlAiny School of Medicine, Cairo University, Cairo, Egypt
(Al Dakhoul) Department of Medicine, The Wirral University Teaching
Hospitals, Upton, Wirral, United Kingdom
(Bdaiwi) Faculty of Medicine, Damascus University, Damascus, Syrian Arab
Republic
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Beta-blockers are an essential part of standard therapy in
adult congestive heart failure and therefore, are expected to be
beneficial in children. However, congestive heart failure in children
differs from that in adults in terms of characteristics, aetiology, and
drug clearance. Therefore, paediatric needs must be specifically
investigated. This is an update of a Cochrane review previously published
in 2009. Objective(s): To assess the effect of
beta-adrenoceptor-blockers (beta-blockers) in children with congestive
heart failure. Search Method(s): We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE,
EMBASE, and LILACS up to November 2015. Bibliographies of identified
studies were checked. No language restrictions were applied.
 Selection Criteria: Randomised, controlled, clinical trials
investigating the effect of beta-blocker therapy on paediatric congestive
heart failure. Data Collection and Analysis: Two review authors
independently extracted and assessed data from the included trials.
 Main Result(s): We identified four new studies for the review update;
the review now includes seven studies with 420 participants. Four small
studies with 20 to 30 children each, and two larger studies of 80 children
each, showed an improvement of congestive heart failure with beta-blocker
therapy. A larger study with 161 participants showed no evidence of
benefit over placebo in a composite measure of heart failure outcomes. The
included studies showed no significant difference in mortality or heart
transplantation rates between the beta-blocker and control groups. No
significant adverse events were reported with beta-blockers, apart from
one episode of complete heart block. A meta-analysis of left ventricular
ejection fraction (LVEF) and fractional shortening (LVFS) data showed a
very small improvement with beta-blockers. However, there were vast
differences in the age, age range, and health of the participants
(aetiology and severity of heart failure; heterogeneity of diagnoses and
co-morbidities); there was a range of treatments across studies (choice of
beta-blocker, dosing, duration of treatment); and a lack of standardised
methods and outcome measures. Therefore, the primary outcomes could not be
pooled in meta-analyses. Authors' conclusions: There is not enough
evidence to support or discourage the use of beta-blockers in children
with congestive heart failure, or to propose a paediatric dosing scheme.
However, the sparse data available suggested that children with congestive
heart failure might benefit from beta-blocker treatment. Further
investigations in clearly defined populations with standardised
methodology are required to establish guidelines for therapy.
Pharmacokinetic investigations of beta-blockers in children are also
required to provide effective dosing in future trials. Copyright
© 2020 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<35>
Accession Number
2005898529
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: August 2020.
Author
Mauermann E.; Vandenheuvel M.; Francois K.; Bouchez S.; Wouters P.
Institution
(Mauermann, Vandenheuvel, Bouchez, Wouters) Department of Anesthesiology
and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
(Mauermann) Department of Anesthesiology, University Hospital Basel,
Basel, Switzerland
(Francois) Department of Cardiac Surgery, Ghent University Hospital,
Ghent, Belgium
Publisher
W.B. Saunders
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(s): Prospective, comparative, cross-over study with a
randomized order of image acquisition. Setting(s): University
hospital. Participant(s): Adults undergoing cardiac surgery.
 Intervention(s): 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.

<36>
Accession Number
632439574
Title
Infective endocarditis after TAVI: a meta-analysis and systematic review
of epidemiology, risk factors and clinical consequences.
Source
Reviews in cardiovascular medicine. 21 (2) (pp 263-274), 2020. Date of
Publication: 30 Jun 2020.
Author
Tinica G.; Tarus A.; Enache M.; Artene B.; Rotaru I.; Bacusca A.; Burlacu
A.
Institution
(Tinica, Tarus, Enache, Rotaru, Bacusca) Department of Cardiovascular
Surgery, Cardiovascular Diseases Institute, Iasi 700503, Romania
(Tinica, Tarus, Enache, Artene, Rotaru, Bacusca, Burlacu) 'Grigore T.
Popa' University of Medicine, Iasi 700115, Romania
(Artene, Burlacu) Department of Interventional Cardiology, Cardiovascular
Diseases Institute, Iasi 700503, Romania
Publisher
NLM (Medline)
Abstract
Infective endocarditis (IE) represents one of the most challenging
clinical entities, requiring a multidisciplinary approach. The increasing
number of surgical and transcatheter heart valves replacements performed
annually lead to a higher incidence of prosthetic valve endocarditis.
Transcatheter aortic valve implantation (TAVI) brought a new alternative
for the treatment of aortic stenosis and a new subgroup of IE with its
features. We aimed to compare the incidence of IE in TAVI and surgical
valve replacement (SAVR) to identify risk factors for TAVI-IE, evaluate
the possible impact on mortality, and clarify the best treatment
strategies. A digital scan in PubMed and SCOPUS databases was performed.
68 publications were selected to perform a meta-analysis and systematic
review on epidemiology, risk factors, and mortality predictors in TAVI-IE.
No significant difference in IE rate was noted between patients with TAVI
and those with SAVR for in-hospital, early, mid-term and late IE. Male
gender, intubation, new pacemaker implantation IE and CKD were correlated
with TAVI-IE. Surgical treatment was performed in 22.3% of cases. Overall
mortality for the pooled cohort was 38.3%. In a multivariate logistic
regression model, surgical treatment and self-expandable device were
linked to lower mortality in TAVI-IE. Even if the invasive procedure can
trigger bacteremia, exposing the TAVI valve to future infection, no
significant difference in IE rate was noted in our analysis between
patients with TAVI and those with SAVR for in-hospital, early, mid-term
and late IE. Surgical treatment of TAVI-IE can be a viable option in
patients with a prohibitive risk score. Copyright © 2020 Tinica
et al. Published by IMR press.

<37>
Accession Number
632438659
Title
Post-cardiac Surgery Chylopericardium.
Source
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 30
(6) (pp 627-632), 2020. Date of Publication: 01 Jun 2020.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Fujian Province, Putian,
China
Publisher
NLM (Medline)
Abstract
Post-cardiac surgery chylopericardium is a rare complication. This
systematic review included 87 articles with 119 patients of post-cardiac
surgery chylopericardium. Chylopericardium developed after operations for
congenital heart defect more than those for acquired heart disease, and
more patients in whom post-cardiac surgery chylopericardium developed were
with complex than with simple congenital heart defects. Cardiac tamponade
occurred in 35 (29.4%) patients. The onset time of chylopericardium was
18.2 days earlier in patients operated for acquired than in those for
congenital heart defects. Post-cardiac surgery chylopericardium were
curable to conservative treatment in most patients. The recurrence of
post-cardiac surgery chylopericardium was on day 13.2 +/-18.2 after the
initial treatment. The overall early and late mortality rates were 1.7%
(2/119) and 1.7% (2/117), respectively. Most patients with post-cardiac
surgery chylopericardium were diagnosed by laboratory analysis of chylous
fluid. Patients with mild chylopericardium usually show good response to
conservative treatment. Whereas, patients with massive chylopericardium
and rapid accumulation, incurable to conservative treatment and recurrent
to either conservative or surgical treatment, warrant further surgical
treatment. Key Words: Cardiac surgical procedures, Pericardial effusion,
Postoperative complications.

<38>
Accession Number
632408566
Title
Chelation therapy for atherosclerotic cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2020 (5) (no pagination), 2020.
Article Number: CD002785. Date of Publication: 03 Jun 2020.
Author
Villarruz-Sulit M.V.; Forster R.; Dans A.L.; Tan F.N.; Sulit D.V.
Institution
(Villarruz-Sulit) Asia-Pacific Center for Evidence-Based Healthcare,
Ermita, Manila, Philippines
(Forster) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
(Dans) Section of Adult Medicine, College of Medicine, University of the
Philippines, Ermita, Philippines
(Tan) Emergency Department, Montefiore Westchester Square Campus, New
York, United States
(Sulit) Department of Internal Medicine, Cardinal Santos Medical Center,
San Juan City, Metro Manila, Philippines
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Chelation therapy is promoted and practiced around the world
as a form of alternative medicine in the treatment of atherosclerotic
cardiovascular disease. It has been suggested as a safe, relatively
inexpensive, non-surgical method of restoring blood flow in
atherosclerotic vessels. However, there is currently limited high-quality,
adequately-powered research informing evidence-based medicine on the
topic, specifically regarding clinical outcomes. Due to this limited
evidence, the benefit of chelation therapy remains controversial at
present. This is an update of a review first published in 2002.
 Objective(s): To assess the effects of ethylene diamine tetra-acetic
acid (EDTA) chelation therapy versus placebo or no treatment on clinical
outcomes among people with atherosclerotic cardiovascular disease.
 Search Method(s): For this update, the Cochrane Vascular Information
Specialist searched the Cochrane Vascular Specialised Register, Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
databases, the World Health Organization International Clinical Trials
Registry Platform and ClinicalTrials.gov trials register to 6 August 2019.
We searched the bibliographies of the studies retrieved by the literature
searches for further trials. Selection Criteria: We included studies
if they were randomised controlled trials of EDTA chelation therapy versus
placebo or no treatment in participants with atherosclerotic
cardiovascular disease. The main outcome measures we considered include
all-cause or cause-specific mortality, non-fatal cardiovascular events,
direct or indirect measurement of disease severity, and subjective
measures of improvement or adverse events. Data Collection and
Analysis: Two review authors independently extracted data and assessed
trial quality using standard Cochrane procedures. A third author
considered any unresolved issues, and we discussed any discrepancies until
a consensus was reached. We contacted study authors for additional
information. Main Result(s): We included five studies with a total of
1993 randomised participants. Three studies enrolled participants with
peripheral vascular disease and two studies included participants with
coronary artery disease, one of which specifically recruited people who
had had a myocardial infarction. The number of participants in each study
varied widely (from 10 to 1708 participants), but all studies compared
EDTA chelation to a placebo. Risk of bias for the included studies was
generally moderate to low, but one study had high risk of bias because the
study investigators broke their randomisation code halfway through the
study and rolled the placebo participants over to active treatment.
Certainty of the evidence, as assessed by GRADE, was generally low to very
low, which was mostly due to a paucity of data in each outcome's
meta-analysis. This limited our ability to draw any strong conclusions. We
also had concerns about one study's risk of bias regarding blinding and
outcome assessment that may have biased the results. Two studies with
coronary artery disease participants reported no evidence of a difference
in all-cause mortality between chelation therapy and placebo (risk ratio
(RR) 0.97, 95% CI 0.73 to 1.28; 1792 participants; low-certainty). One
study with coronary artery disease participants reported no evidence of a
difference in coronary heart disease deaths between chelation therapy and
placebo (RR 1.02, 95% CI 0.70 to 1.48; 1708 participants; very
low-certainty). Two studies with coronary artery disease participants
reported no evidence of a difference in myocardial infarction (RR 0.81,
95% CI 0.57 to 1.14; 1792 participants; moderate-certainty), angina (RR
0.95, 95% CI 0.55 to 1.67; 1792 participants; very low-certainty), and
coronary revascularisation (RR 0.46, 95% CI 0.07 to 3.25; 1792
participants). Two studies (one with coronary artery disease participants
and one with peripheral vascular disease participants) reported no
evidence of a difference in stroke (RR 0.88, 95% CI 0.40 to 1.92; 1867
participants; low-certainty). Ankle-brachial pressure index (ABPI; also
known as ankle brachial index) was measured in three studies, all
including participants with peripheral vascular disease; two studies found
no evidence of a difference in the treatment groups after three months
after treatment (mean difference (MD) 0.02, 95% CI -0.03 to 0.06; 181
participants; low-certainty). A third study reported an improvement in
ABPI in the EDTA chelation group, but this study was at high risk of bias.
Meta-analysis of maximum and pain-free walking distances three months
after treatment included participants with peripheral vascular disease and
showed no evidence of a difference between the treatment groups (MD
-31.46, 95% CI -87.63 to 24.71; 165 participants; 2 studies;
low-certainty). Quality of life outcomes were reported by two studies that
included participants with coronary artery disease, but we were unable to
pool the data due to different methods of reporting and varied criteria.
However, there did not appear to be any major differences between the
treatment groups. None of the included studies reported on vascular
deaths. Overall, there was no evidence of major or minor adverse events
associated with EDTA chelation treatment. Authors' conclusions: There is
currently insufficient evidence to determine the effectiveness or
ineffectiveness of chelation therapy in improving clinical outcomes of
people with atherosclerotic cardiovascular disease. More high-quality,
randomised controlled trials are needed that assess the effects of
chelation therapy on longevity and quality of life among people with
atherosclerotic cardiovascular disease. Copyright © 2020 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<39>
[Use Link to view the full text]
Accession Number
632434613
Title
Effects of Different Doses of Remote Ischemic Preconditioning on Kidney
Damage among Patients Undergoing Cardiac Surgery: A Single-Center
Mechanistic Randomized Controlled Trial.
Source
Critical Care Medicine. (pp E690-E697), 2020. Date of Publication: 2020.
Author
Meersch M.; Kullmar M.; Pavenstadt H.; Rossaint J.; Kellum J.A.; Martens
S.; Klausmeyer P.; Schmidt E.A.; Kerschke L.; Zarbock A.
Institution
(Meersch, Kullmar, Rossaint, Klausmeyer, Schmidt, Zarbock) Department of
Anaesthesiology, Intensive Care Medicine and Pain Medicine, University
Hospital Munster, Munster, Germany
(Pavenstadt) Department of Medicine, Division D, Nephrology, University
Hospital Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Martens) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Kerschke) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: We have previously shown that remote ischemic preconditioning
reduces acute kidney injury (acute kidney injury) in high-risk patients
undergoing cardiopulmonary bypass and that the protective effect is
confined to patients who exhibit an increased urinary tissue inhibitor of
metalloproteinases-2 and insulin-like growth factor-binding protein 7 in
response to remote ischemic preconditioning. The purpose of this study was
to determine the optimal intensity of remote ischemic preconditioning to
induce required [tissue inhibitor of metalloproteinases-2]*[insulin-like
growth factor-binding protein 7] changes and further explore mechanisms of
remote ischemic preconditioning. Design(s): Observational and
randomized controlled, double-blind clinical trial. Setting(s):
University Hospital of Muenster, Germany. Patient(s): High-risk
patients undergoing cardiac surgery as defined by the Cleveland Clinic
Foundation Score. Intervention(s): In the interventional part,
patients were randomized to receive either one of four different remote
ischemic preconditioning doses (3 x 5 min, 3 x 7 min, 3 x 10 min remote
ischemic preconditioning, or 3 x 5 min remote ischemic preconditioning + 2
x 10 min remote ischemic preconditioning in nonresponders) or sham-remote
ischemic preconditioning (control). Measurements and Main Results:
The primary endpoint of the interventional part was change in urinary
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] between pre- and postintervention. To examine
secondary objectives including acute kidney injury incidence, we included
an observational cohort. A total of 180 patients were included in the
trial (n = 80 observational and n = 100 randomized controlled part [20
patients/group]). The mean age was 69.3 years (10.5 yr), 119 were men
(66.1%). Absolute changes in [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7] were
significantly higher in all remote ischemic preconditioning groups when
compared with controls (p < 0.01). Although we did not observe a
dose-response relationship on absolute changes in [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7]
across the four different remote ischemic preconditioning groups, in the
15 patients failing to respond to the lowest dose, nine (60%) responded to
a subsequent treatment at a higher intensity. Compared with controls,
fewer patients receiving remote ischemic preconditioning developed acute
kidney injury within 72 hours after surgery as defined by both Kidney
Disease: Improving Global Outcomes criteria (30/80 [37.5%] vs 61/100
[61.0%]; p = 0.003). Conclusion(s): All doses of remote ischemic
preconditioning significantly increased [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7] and
significantly decreased acute kidney injury compared with controls.
High-dose remote ischemic preconditioning could stimulate [tissue
inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding
protein 7] increases in patients refractory to low-dose remote ischemic
preconditioning. Copyright © 2020 Lippincott Williams and
Wilkins. All rights reserved.

<40>
Accession Number
2007084995
Title
Synthetic mRNA Encoding VEGF-A in Patients Undergoing Coronary Artery
Bypass Grafting: Design of a Phase 2a Clinical Trial.
Source
Molecular Therapy - Methods and Clinical Development. 18 (pp 464-472),
2020. Date of Publication: 11 September 2020.
Author
Anttila V.; Saraste A.; Knuuti J.; Jaakkola P.; Hedman M.; Svedlund S.;
Lagerstrom-Fermer M.; Kjaer M.; Jeppsson A.; Gan L.-M.
Institution
(Anttila, Saraste) Heart Center, Turku University Hospital and University
of Turku, Turku, Finland
(Saraste, Knuuti) Turku PET Center, Turku University Hospital and
University of Turku, Turku, Finland
(Jaakkola, Hedman) Heart Center, Kuopio University Hospital, Kuopio,
Finland
(Svedlund) Department of Clinical Physiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Svedlund, Jeppsson, Gan) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Lagerstrom-Fermer, Gan) Research and Early Development, Cardiovascular,
Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg,
Sweden
(Kjaer) Early Biometrics and Statistical Innovation, Data Science & AI,
BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gan) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
Cell Press (E-mail: subs@cell.com)
Abstract
Therapeutic angiogenesis may improve outcomes in patients with coronary
artery disease undergoing surgical revascularization. Angiogenic factors
may promote blood vessel growth and regenerate regions of ischemic but
viable myocardium. Previous clinical trials of vascular endothelial growth
factor A (VEGF-A) gene therapy with DNA or viral vectors demonstrated
safety but not efficacy. AZD8601 is VEGF-A<inf>165</inf> mRNA formulated
in biocompatible citrate-buffered saline and optimized for high-efficiency
VEGF-A expression with minimal innate immune response. EPICCURE is an
ongoing randomized, double-blind, placebo-controlled study of the safety
of AZD8601 in patients with moderately decreased left ventricular function
(ejection fraction 30%-50%) undergoing elective coronary artery bypass
surgery. AZD8601 3 mg, 30 mg, or placebo is administered as 30 epicardial
injections in a 10-min extension of cardioplegia. Injections are targeted
to ischemic but viable myocardial regions in each patient using
quantitative 15O-water positron emission tomography (PET)
imaging (stress myocardial blood flow < 2.3 mL/g/min; resting myocardial
blood flow > 0.6 mL/g/min). Improvement in regional and global myocardial
blood flow quantified with 15O-water PET is an exploratory
efficacy outcome, together with echocardiographic, clinical, functional,
and biomarker measures. EPICCURE combines high-efficiency delivery with
quantitative targeting and follow-up for robust assessment of the safety
and exploratory efficacy of VEGF-A mRNA angiogenesis (ClinicalTrials.gov:
NCT03370887).
In the EPICCURE study, patients undergoing coronary artery bypass grafting
receive epicardial injections of synthetic mRNA encoding vascular
endothelial growth factor A or placebo. Imaging of myocardial blood flow
with 15O-water PET is used to target injections to ischemic but
viable regions in each participant and to monitor potential
improvement. Copyright © 2020 The Authors

<41>
Accession Number
2006910091
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. Article
Number: eaay6570. 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, Censin, Ferreira, Pulit, Glastonbury, Laber, Lindgren, Holmes)
Big Data Institute, 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
(Pulit, Lindgren) Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA 02142, United States
(Pulit) Department of Genetics, University Medical Center Utrecht, Utrecht
3584 CX, 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) National Institute for Health Research Oxford
Biomedical Research Centre, Oxford University Hospitals NHS Foundation
Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
(Chen) Biogen, Cambridge, MA 02142, United States
(Pulit) Vertex Pharmaceuticals, Abingdon OX14 4RW, United Kingdom
(Glastonbury) BenevolentAI, London W1T 5HD, United Kingdom
Publisher
American Association for the Advancement of Science
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.

<42>
Accession Number
2005602733
Title
Re-Thinking the Role of Statistics in Informing Heart Team Decisions: A
Consensus Distribution Approach.
Source
Structural Heart. (pp 1-2), 2020. Date of Publication: 2020.
Author
McAndrew T.; Redfors B.
Institution
(McAndrew) Department of Biostatistics and Epidemiology, School of Public
Health and Health Sciences, University of Massachusetts Amherst, Amherst,
MA, United States
(McAndrew, Redfors) The Cardiovascular Research Foundation, New York, NY,
United States
(Redfors) Department of Cardiology, NewYork-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)

<43>
Accession Number
2005597314
Title
Risk of major adverse cardiovascular events of CYP2C19 loss-of-function
genotype guided prasugrel/ticagrelor vs clopidogrel therapy for acute
coronary syndrome patients undergoing percutaneous coronary intervention:
a meta-analysis.
Source
Platelets. (pp 1-10), 2020. Date of Publication: 2020.
Author
Biswas M.; Kali M.S.K.; Biswas T.K.; Ibrahim B.
Institution
(Biswas, Kali) Department of Pharmacy, University of Rajshahi, Rajshahi,
Bangladesh
(Biswas) Department of Medicine, Faridpur Medical College Hospital,
Faridpur, Bangladesh
(Ibrahim) School of Pharmaceutical Sciences, Universiti Sains Malaysia,
Penang, Malaysia
Publisher
Taylor and Francis Ltd
Abstract
The most effective antiplatelet treatments for acute coronary syndrome
(ACS) patients carrying CYP2C19 loss-of-function (LoF) alleles undergoing
percutaneous coronary intervention (PCI) is still debating and
conflicting. It was aimed to compare the efficacy and safety endpoints for
these patients treated with alternative P2Y12 receptor blockers (e.g.
prasugrel or ticagrelor) against clopidogrel. Literature was searched in
PubMed, Cochrane library, Synapse and 1000 Genomes databases following
PRISMA guidelines for identifying relevant studies. Aggregated risk was
estimated by RevMan software using either fixed/random-effects models
where P values<0.05 (two-sided) were considered statistically significant.
Nine studies comprising 16,132 ACS patients undergoing PCI were included
in this analysis in which 2,746 and 2,640 patients were in the CYP2C19 LoF
clopidogrel and alternatives treatment group, respectively. It was
demonstrated that patients treated with prasugrel or ticagrelor
significantly reduced the risk of MACEs (RR 0.58; 95% CI 0.45-0.76;
P<0.0001) as compared to patients with clopidogrel where both groups
carrying CYP2C19 LoF alleles. Subgroup analysis showed that prasugrel or
ticagrelor significantly reduced the risk of cardiovascular death (RR
0.44; 95% CI: 0.25-0.74; P=0.002) and MI (RR 0.60; 95% CI: 0.44-0.81;
P=0.0008) while other clinical outcomes were not found statistically
significant between these two groups; stroke (RR 0.77; 95% CI: 0.43-1.38;
P =0.39), stent thrombosis (RR 0.67; 95% CI: 0.38-1.18; P =0.17), unstable
angina (RR 0.55; 95% CI: 0.13-2.33; P =0.42), revascularisation (RR 0.79;
95% CI: 0.28-2.24; P=0.66). Bleeding events were not found significantly
different between these groups (RR 1.06; 95% CI: 0.88-1.28; P=0.55).
Considering efficacy and safety, alternative antiplatelets (e.g. prasugrel
or ticagrelor) may be regarded as better treatment option as compared to
clopidogrel for ACS patients undergoing PCI. Copyright © 2020,
© 2020 Taylor & Francis Group, LLC.

<44>
Accession Number
2006087523
Title
Ten-year outcomes from a randomised comparison of zotarolimus-eluting and
sirolimus-eluting stents: The SORT out III study.
Source
EuroIntervention. 15 (11) (pp E1022-E1024), 2019. Date of Publication:
December 2019.
Author
Pareek M.; Madsen M.; Warnakula Olesen K.K.; Jensen L.O.; Christiansen
E.H.; Kristensen S.D.; Lassen J.F.; Thuesen L.; Botker H.E.; Maeng M.
Institution
(Pareek, Warnakula Olesen, Christiansen, Kristensen, Botker, Maeng)
Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus,
Denmark
(Madsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Jensen, Lassen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Thuesen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Publisher
Europa Group

<45>
Accession Number
2005910008
Title
Assessing the safety and efficacy of TAVR compared to SAVR in
low-to-intermediate surgical risk patients with aortic valve stenosis: An
overview of reviews.
Source
International Journal of Cardiology. 314 (pp 43-53), 2020. Date of
Publication: 1 September 2020.
Author
Mc Morrow R.; Kriza C.; Urban P.; Amenta V.; Amaro J.A.B.; Panidis D.;
Chassaigne H.; Griesinger C.B.
Institution
(Mc Morrow, Kriza, Urban, Amenta, Amaro, Panidis, Chassaigne, Griesinger)
European Commission, Joint Research Centre (JRC), Ispra, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) was initially
introduced to treat patients with aortic valve stenosis (AS) at high-risk
for surgical aortic valve replacement (SAVR). Today, there is ample
evidence supporting TAVR in high-risk groups. However, in recent years
TAVR has been extended to low-to intermediate risk groups and relevant
clinical evidence is still emerging, leaving some uncertainties.
 Method(s): To obtain information on TAVR versus SAVR in low-to
intermediate risk groups, we conducted an overview of systematic reviews
following PRISMA guidelines and based on a systematic search of EMBASE,
MEDLINE, Cochrane and CRD databases. We focused on systematic reviews
assessing mortality and VARC 2 as clinical outcomes. Result(s): The
majority of the 11 systematic reviews included in our study reported no
differences in mortality between TAVR and SAVR at short and long-term
follow-up times. Two reviews that included the most recent RCTs on
low-risk patients reported a decreased mortality risk with TAVR at
one-year follow-up. Regarding the secondary endpoints of stroke and MI,
the majority of studies presented similar results for TAVR and SAVR. Acute
Kidney Injury, Bleeding Complications, Atrial Fibrillation were less
frequent with TAVR, with lower risk of Permanent Pacemaker Implantation
and Aortic Regurgitation with SAVR. Conclusion(s): Our overview
indicated that TAVR is a promising intervention for low-to-intermediate
surgical risk patients; however additional evidence from longer term
follow-up is needed to confirm these findings. This overview highlights
inconsistencies about reporting and presentation of data, most notably
limited clarity on effects of risk of bias on trial results. Copyright
© 2020 The Authors

<46>
Accession Number
2005859673
Title
Restricted versus liberal intraoperative benzodiazepine use in cardiac
anaesthesia for reducing delirium (B-Free Pilot): a pilot, multicentre,
randomised, cluster crossover trial.
Source
British Journal of Anaesthesia. 125 (1) (pp 38-46), 2020. Date of
Publication: July 2020.
Author
Spence J.; Belley-Cote E.; Jacobsohn E.; Lee S.F.; Whitlock R.; Bangdiwala
S.; Syed S.; Sarkaria A.; MacIsaac S.; Lengyel A.; Long S.; Um K.;
McIntyre W.F.; Kavosh M.; Fast I.; Arora R.; Lamy A.; Connolly S.;
Devereaux P.J.
Institution
(Spence, Syed, Long) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock) Department of Critical Care, McMaster
University, Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock, Lamy, Devereaux) Department of Health
Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON,
Canada
(Spence, Belley-Cote, Lee, Whitlock, Bangdiwala, McIntyre, Lamy, Connolly,
Devereaux) Population Health Research Institute, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Connolly, Devereaux) Department of Medicine
(Cardiology), McMaster University, Hamilton, ON, Canada
(Jacobsohn, Kavosh, Fast) Department of Anesthesia and Perioperative
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Jacobsohn, Arora) Department of Critical Care, University of Manitoba,
Winnipeg, MB, Canada
(Whitlock, Lamy) Department of Surgery (Cardiac Surgery), McMaster
University, Hamilton, ON, Canada
(Sarkaria) Department of Family and Community Medicine, University of
Toronto, Toronto, ON, Canada
(MacIsaac) School of Medicine, Faculty of Medicine, Royal College of
Surgeons, Dublin, Ireland
(Lengyel) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Um) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Arora) Department of Surgery (Cardiac Surgery), University of Manitoba,
Winnipeg, MB, Canada
Publisher
Elsevier Ltd
Abstract
Background: Delirium is common after cardiac surgery and is associated
with adverse outcomes. Perioperative benzodiazepine use is associated with
delirium and is common during cardiac surgery, which may increase the risk
of postoperative delirium. We undertook a pilot study to inform the
feasibility of a large randomised cluster crossover trial examining
whether an institutional policy of restricted benzodiazepine
administration during cardiac surgery (compared with liberal
administration) would reduce delirium. Method(s): We conducted a
two-centre, pilot, randomised cluster crossover trial with four 4 week
crossover periods. Each centre was randomised to a policy of restricted or
liberal use, and then alternated between the two policies during the
remaining three periods. Our feasibility outcomes were adherence to each
policy (goal >=80%) and outcome assessment (one delirium assessment per
day in the ICU in >=90% of participants). We also evaluated the incidence
of intraoperative awareness in one site using serial Brice questionnaires.
 Result(s): Of 800 patients undergoing cardiac surgery during the
trial period, 127/800 (15.9%) had delirium. Of these, 355/389 (91.3%)
received benzodiazepines during the liberal benzodiazepine periods and
363/411 (88.3%) did not receive benzodiazepines during the restricted
benzodiazepine periods. Amongst the 800 patients, 740 (92.5%) had >=1
postoperative delirium assessment per day in the ICU. Of 521 patients
screened for intraoperative awareness, one patient (0.2%), managed during
the restricted benzodiazepine period (but who received benzodiazepine),
experienced intraoperative awareness. Conclusion(s): This pilot study
demonstrates the feasibility of a large, multicentre, randomised, cluster
crossover trial examining whether an institutional policy of restricted vs
liberal benzodiazepine use during cardiac surgery will reduce
postoperative delirium. Clinical trial registration:
NCT03053869. Copyright © 2020 British Journal of Anaesthesia

<47>
Accession Number
2005760960
Title
Comparison of Different Anticoagulation Regimens Regarding Maternal and
Fetal Outcomes in Pregnant Patients With Mechanical Prosthetic Heart
Valves (from the Multicenter ANATOLIA-PREG Registry).
Source
American Journal of Cardiology. 127 (pp 113-119), 2020. Date of
Publication: 15 July 2020.
Author
Guner A.; Kalcik M.; Gursoy M.O.; Gunduz S.; Astarcioglu M.A.; Bayam E.;
Kalkan S.; Yesin M.; Karakoyun S.; Ozkan M.
Institution
(Guner, Gunduz, Bayam, Kalkan, Ozkan) Department of Cardiology, Kosuyolu
Kartal Heart Training and Research Hospital, Istanbul, Turkey
(Kalcik) Department of Cardiology, Faculty of Medicine, Hitit University,
Corum, Turkey
(Gursoy) Department of Cardiology, Izmir Katip Celebi University, Ataturk
Training and Research Hospital, Izmir, Turkey
(Astarcioglu) Department of Cardiology, Dumlupinar University, Kutahya
Evliya Celebi Education and Research Hospital, Dumlupinar, Turkey
(Yesin, Karakoyun) Department of Cardiology, Faculty of Medicine, Kars
Kafkas University, Kars, Turkey
(Ozkan) Faculty of Health Sciences, Ardahan University, Ardahan, Turkey
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Mechanical prosthetic heart valves (MPHVs) are highly thrombogenic, and a
pregnancy-induced procoagulant status increases the risk of MPHV
thrombosis. Despite numerous case reports, 2 major registries and
meta-analyses/systematic reviews, optimal anticoagulation therapy during
pregnancy remains controversial. The goal of this study was to evaluate
different anticoagulation regimens in pregnant patients with MPHVs. The
outcomes of anticoagulation regimens were assessed retrospectively in
pregnant women (110 women; 155 pregnancies) with MPHVs. The study
population was divided into 5 groups according to anticoagulation regimens
used; high-dose warfarin (>5 mg/d) throughout pregnancy (group 1),
low-dose warfarin (<=5 mg/d) throughout pregnancy (group 2), low molecular
weight heparin (LMWH) throughout pregnancy (group 3), first trimester
LMWH, 2nd and 3rd trimester warfarin (group 4), first 2 trimester LMWH,
and 3rd trimester warfarin (group 5). Of 155 pregnancies, 55 (35%)
resulted in fetal loss; whereas 41 (27%) cases with abortion (miscarriage
and therapeutic) and 14 (9%) stillbirths occurred. The comparison of the
groups showed that the whole abortion rates including therapeutic abortion
were significantly higher in Group 1, and lower in groups 3 and 5 (p
<0.001). However, miscarriage rates were similar between the groups. A
total of 53 pregnancies (34%) suffered from prosthetic valves thrombosis
(PVT) during pregnancy or in the postpartum period. Group 2 had
significantly lower rates of PVT than the other groups (p <0.001). In
conclusion, the current data suggests that there is no optimal therapy,
and that all managements have advantages and disadvantages. Low-dose
warfarin (<=5 mg/day) regimen with therapeutic international normalized
ratio levels may provide effective maternal protection throughout
pregnancy with acceptable fetal outcomes. Copyright © 2020
Elsevier Inc.

<48>
Accession Number
627286945
Title
Oropharyngeal dysphagia and laryngeal dysfunction after lung and heart
transplantation: A systematic review.
Source
Disability and rehabilitation. 42 (15) (pp 2083-2092), 2020. Date of
Publication: 01 Jul 2020.
Author
Black R.; McCabe P.; Glanville A.; Bogaardt H.; MacDonald P.; Madill C.
Institution
(Black, Glanville, MacDonald) St Vincents Hospital, Darlinghurst,
Australia
(Black, McCabe, Bogaardt, Madill) Speech Pathology, Faculty of Health
Sciences, University of Sydney, Australia
Publisher
NLM (Medline)
Abstract
Purpose: Oropharyngeal dysphagia and laryngeal dysfunction are known to
impact on health outcomes of patients with critical illness. The incidence
in patients after heart and/or lung transplantation is unknown. This paper
investigates the frequency, characteristics and risk factors for these
complications following such transplantation. Method(s): Eight
databases were systematically searched. Inclusion criteria were (a) adults
who underwent heart and/or lung transplantation as their primary surgery,
(b) new onset of oropharyngeal dysphagia and/or laryngeal dysfunction and
dysphonia identified in the acute hospital phase (c) original studies (d)
in English. Result(s): Two thousand six hundred and sixteen articles
were identified. Five met the inclusion criteria. Studies were few and
heterogeneous in design and sample size, therefore meta-analysis was not
performed. All included studies were of relatively low quality. However,
rates of oropharyngeal dysphagia up to 70.5% were reported, with 25% of
these patients presenting with vocal cord palsy. Conclusion(s):
Limited conclusions can be drawn from the available evidence regarding the
frequency, characteristics and risk factors for the development of
oropharyngeal dysphagia and/or laryngeal dysfunction after heart and/or
lung transplantation due to limited evidence and low quality of the
included studies. This highlights the need for high quality studies in
this population.Implications for rehabilitationOropharyngeal dysphagia and
dysphonia are known to impact on mortality and quality of lifeThere is a
paucity of literature describing these complications after lung and/or
heart transplantation, however the data available indicates high rates of
swallowing and voice disorders in this immunosuppressed populationEarly
identification and management of oropharyngeal dysphagia and dysphonia is
vital to aid rehabilitation and improve mortality and quality of life in
patients following lung and/or heart transplantation.

<49>
Accession Number
631417786
Title
Mortality in trials on transcatheter aortic valve implantation versus
surgical aortic valve replacement: a pooled meta-analysis of
Kaplan-Meier-derived individual patient data.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 58 (2) (pp 221-229),
2020. Date of Publication: 01 Aug 2020.
Author
Barili F.; Freemantle N.; Pilozzi Casado A.; Rinaldi M.; Folliguet T.;
Musumeci F.; Gerosa G.; Parolari A.
Institution
(Barili, Pilozzi Casado) Department of Cardiac Surgery, S. Croce Hospital,
Cuneo, Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This meta-analysis of Kaplan-Meier-estimated individual
patient data was designed to evaluate the effects of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on
the long-term all-cause mortality rate, to examine the potential
time-varying effect and to model their hazard ratios (HRs) over time.
Moreover, we sought to compare traditional meta-analytic tools and
estimated individual patient data meta-analyses. METHOD(S): Trials
comparing TAVI versus SAVR were identified through Medline, Embase,
Cochrane databases and specialist websites. The primary outcome was death
from any cause at follow-up. Enhanced secondary analyses of survival
curves were performed estimating individual patient time-to-event data
from published Kaplan-Meier curves. Treatments were compared with the
random effect Cox model in a landmark framework and fully parametric
models. RESULT(S): We identified 6 eligible trials that included 6367
participants, randomly assigned to undergo TAVI (3252) or SAVR (3115).
According to the landmark analysis, the incidence of death in the first
year after implantation was significantly lower in the TAVI group
[risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99;
P=0.04], whereas there was a reversal of the HR after 40months
(risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P=0.04) favouring SAVR
over TAVI. This time-varying trend of HRs was also confirmed by a fully
parametric time-to-event model. Traditional meta-analytic tools were shown
to be biased because they did not intercept heterogeneity and the
time-varying effect. CONCLUSION(S): The mortality rates in trials of
TAVI versus SAVR are affected by treatments with a time-varying effect.
TAVI is related to better survival in the first months after implantation
whereas, after 40months, it is a risk factor for all-cause
mortality. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<50>
Accession Number
631026746
Title
Intraoperative localization of cardiac conduction tissue regions using
real-time fibre-optic confocal microscopy: first in human trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 58 (2) (pp 261-268),
2020. Date of Publication: 01 Aug 2020.
Author
Kaza A.K.; Mondal A.; Piekarski B.; Sachse F.B.; Hitchcock R.
Institution
(Kaza, Mondal, Piekarski) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, MA, Boston, United States
(Sachse, Hitchcock) Department of Biomedical Engineering, University of
Utah, UT, Salt Lake City, United States
(Sachse) Nora Eccles Harrison Cardiovascular Research and Training
Institute, University of Utah, UT, Salt Lake City, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to evaluate the feasibility and
safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium
dye for the intraoperative location of conduction tissue regions during
paediatric heart surgery. METHOD(S): The pilot study included 6
patients undergoing elective surgery for the closure of isolated secundum
atrial septal defect aged 30days to 21years. FCM imaging was integrated
within the normal intraoperative protocol for atrial septal defect repair.
Fluorescein sodium dye was applied on the arrested heart. FCM images were
acquired at the atrioventricular node region, sinus node region and right
ventricle (RV). Total imaging time was limited to 3min. Any adverse events
related to the study were recorded and analysed. Subjects received
standard postoperative care. Trained reviewers (n=9) classified,
de-identified and randomized FCM images (n=60) recorded from the patients
as presenting striated, reticulated or indistinguishable microstructures.
The reliability of reviewer agreement was assessed using Fleiss' kappa.
 RESULT(S): The FCM imaging instruments were integrated effectively
into the cardiac surgery operating room. All adverse events found in the
study were deemed expected and not related to FCM imaging. Reticulated
myocardial microstructures were found during FCM imaging at
atrioventricular node and sinus node regions, while striated
microstructures were observed in RV. Reliability of agreement of reviewers
classifying the FCM images was high (Fleiss' kappa: 0.822).
 CONCLUSION(S): FCM using fluorescein sodium dye was found to be safe
for use during paediatric heart surgery. The study demonstrates the
potential for FCM to be effective in identifying conduction tissue regions
during congenital heart surgery. CLINICAL TRIAL REGISTRATION NUMBER:
NCT03189134. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<51>
Accession Number
631831092
Title
Corrigendum to 'Mortality in trials on transcatheter aortic valve
implantation versus surgical aortic valve replacement: a pooled
meta-analysis of Kaplan-Meier-derived individual patient data' Eur J
Cardiothorac Surg 2020;58:221-9.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 58 (2) (pp 409), 2020.
Date of Publication: 01 Aug 2020.
Author
Barili F.; Freemantle N.; Casado A.P.; Rinaldi M.; Folliguet T.; Musumeci
F.; Gerosa G.; Parolari A.
Institution
(Barili, Casado) Department of Cardiac Surgery, S. Croce Hospital, Cuneo,
Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta` della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
NLM (Medline)

<52>
[Use Link to view the full text]
Accession Number
631770503
Title
Towards integrative neuromonitoring of the surgical newborn: A systematic
review.
Source
European journal of anaesthesiology. 37 (8) (pp 701-712), 2020. Date of
Publication: 01 Aug 2020.
Author
Costerus S.A.; van Hoorn C.E.; Hendrikx D.; Kortenbout J.; Hunfeld M.;
Vlot J.; Naulaers G.; Tibboel D.; de Graaff J.C.
Institution
(Costerus) From the Department of Pediatric Surgery, Erasmus University
Medical Center-Sophia Children's Hospital (SAC, JV, DT), Department of
Anesthesiology, Erasmus University Medical Center, Rotterdam, The
Netherlands (CvH, JCdG), Department of Electrical Engineering, KU Leuven,
Leuven, Belgium (DH), Department of Biomedical Engineering, Erasmus
University Medical Center (JK), Department of Pediatric Neurology, Erasmus
University Medical Center-Sophia Children's Hospital, Rotterdam, The
Netherlands (MH) and Department of Neonatal Intensive Care Unit,
University Hospitals Leuven, Leuven, Belgium (GN)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The altered neurodevelopment of children operated on during
the neonatal period might be due to peri-operative changes in the
homeostasis of brain perfusion. Monitoring of vital signs is a standard of
care, but it does not usually include monitoring of the brain.
 OBJECTIVE(S): To evaluate methods of monitoring the brain that might
be of value. We also wanted to clarify if there are specific risk factors
that result in peri-operative changes and how this might be evaluated.
DESIGN: Systematic review. DATA SOURCES: A structured literature search
was performed in MEDLINE in Ovid, Embase, Cochrane CENTRAL, Web of Science
and Google Scholar. ELIGIBILITY CRITERIA: Studies in neonates who received
peri-operative neuromonitoring were eligible for inclusion; studies on
neurosurgical procedures or cardiac surgery with cardiopulmonary bypass
and/or deep hypothermia cardiac arrest were excluded. RESULT(S):
Nineteen of the 24 included studies, totalling 374 infants, reported the
use of near-infrared spectroscopy. Baseline values of cerebral oxygenation
greatly varied (mean 53 to 91%) and consequently, no coherent results were
found. Two studies found a correlation between cerebral oxygenation and
mean arterial blood pressure. Five studies, with in total 388 infants,
used (amplitude-integrated) electro-encephalography to study
peri-operative brain activity. Overall, the brain activity decreased
during anaesthesia and epileptic activity was more frequent in the
peri-operative phase. The association between intra-operative cerebral
saturation or activity and neuro-imaging abnormalities and/or
neurodevelopmental outcome was investigated in six studies, but no
association was found. CONCLUSION(S): Neuromonitoring with the
techniques currently used will neither help our understanding of the
altered neonatal pathophysiology, nor enable early detection of deviation
from the norm. The modalities lack specificity and are not related to
clinical (long-term) outcome or prognosis. Accordingly, we were unable to
draw up a monitoring guideline.

<53>
Accession Number
2005643928
Title
FFR-guided versus coronary angiogram-guided CABG: A review and
meta-analysis of prospective randomized controlled trials.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Timbadia D.; Ler A.; Sazzad F.; Alexiou C.; Kofidis T.
Institution
(Timbadia) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Timbadia, Ler, Sazzad, Kofidis) Department of Cardiac Thoracic and
Vascular Surgery, National University Heart Centre, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Sazzad, Kofidis) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Alexiou) Department of Cardiac Surgery, Interbalkan European Medical
Centre, Thessaloniki, Greece
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Fractional flow reserve (FFR) is a well-established method for
the evaluation of coronary artery stenosis before percutaneous coronary
intervention. However, whether FFR assessment should be routinely used
before coronary artery bypass graft surgery (CABG) remains unclear. A
meta-analysis of prospectively randomized controlled trials (PRCTs) was
carried out to compare the outcomes of FFR-guided CABG vs coronary
angiography (CAG)-guided CABG. Method(s): The meta-analysis adhered
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and
included reporting data on 269 patients with 6 and 12 month follow-up.
Primary endpoints were rates of overall death, MACCE, target vessel
revascularization, and spontaneous myocardial infarction (MI). Secondary
endpoints were overall graft patency and patency of arterial and venous
grafts. Result(s): There were no significant differences between the
FFR-guided and CAG-guided groups in the rates of overall death, MACCE,
target vessel revascularization, spontaneous MI and graft patency.
Meta-analysis of FARGO and GRAFFITI PRCTs showed that FFR-guided CABG and
CAG-guided CABG produced similar clinical outcomes with similar graft
patency rates up to a year postoperatively. Conclusion(s): Currently
available PRCTs showes no sufficient evidence to support the use FFR in
CABG. Copyright © 2020 Wiley Periodicals LLC

<54>
Accession Number
2005280146
Title
Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac
Surgery: Results From a Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (8) (pp 2072-2080),
2020. Date of Publication: August 2020.
Author
Thorlacius E.M.; Wahlander H.; Ojala T.; Ylanen K.; Keski-Nisula J.;
Synnergren M.; Romlin B.S.; Ricksten S.-E.; Castellheim A.
Institution
(Thorlacius, Romlin, Ricksten, Castellheim) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Wahlander) Department of Pediatric Cardiology, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Thorlacius, Wahlander, Romlin, Ricksten, Castellheim) Region Vastra
Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
(Ojala, Ylanen) Department of Pediatric Cardiology, Children's Hospital,
Helsinki University Hospital, Helsinki University, Helsinki, Finland
(Keski-Nisula) Department of Anesthesia and Intensive Care, Children's
Hospital, Helsinki University Hospital, Helsinki University, Helsinki,
Finland
(Synnergren) Department of Pediatric Thoracic Surgery, Sahlgrenska
University Hospital, Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: The present study aimed to determine the differential effects
of intraoperative administration of milrinone versus levosimendan on
myocardial function after pediatric cardiac surgery. Transthoracic
echocardiography was used for myocardial function evaluation using
biventricular longitudinal strain with 2-dimensional speckle tracking
echocardiography in addition to conventional echocardiographic variables.
 Design(s): A secondary analysis of a randomized, prospective,
double-blinded clinical drug trial. Setting(s): Two pediatric
tertiary university hospitals. Participant(s): Infants between 1 and
12 months old diagnosed with ventricular septal defect, complete
atrioventricular septal defect, or tetralogy of Fallot who were scheduled
for corrective surgery with cardiopulmonary bypass. Intervention(s):
The patients were randomly assigned to receive an infusion of milrinone or
levosimendan at the start of cardiopulmonary bypass and for 26 consecutive
hours. Measurements and Main Results: Biventricular longitudinal
strain and conventional echocardiographic variables were measured
preoperatively, on the first postoperative morning, and before hospital
discharge. The association between perioperative parameters and
postoperative myocardial function also was investigated. Images were
analyzed for left ventricular (n = 67) and right ventricular (n = 44)
function. The day after surgery, left ventricular longitudinal strain
deteriorated in both the milrinone and levosimendan groups (33% and 39%,
respectively). The difference was not significant. The corresponding
deterioration in right ventricular longitudinal strain was 42% and 50%
(nonsignificant difference). For both groups, biventricular longitudinal
strain approached preoperative values at hospital discharge. Preoperative
N-terminal pro-brain natriuretic peptide could predict the left
ventricular strain on postoperative day 1 (p = 0.014). Conclusion(s):
Levosimendan was comparable with milrinone for left and right ventricular
inotropic support in pediatric cardiac surgery. Copyright © 2020
Elsevier Inc.

<55>
Accession Number
2005220797
Title
Impact of inferior caval valve implantation on severity of tricuspid
regurgitation and right heart function.
Source
Echocardiography. 37 (7) (pp 999-1007), 2020. Date of Publication: 01 Jul
2020.
Author
Mattig I.; Knebel F.; Hewing B.; Stangl V.; Stangl K.; Laule M.; Dreger H.
Institution
(Mattig, Knebel, Hewing, Stangl, Stangl, Laule, Dreger) Medizinische
Klinik mit Schwerpunkt Kardiologie und Angiologie, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Knebel, Hewing, Laule) Berlin Institute of Health (BIH), Berlin, Germany
(Knebel, Hewing, Stangl, Stangl, Dreger) DZHK (German Centre for
Cardiovascular Research), Berlin, Germany
(Hewing) Department of Cardiology III - Adult Congenital and Valvular
Heart Disease, University Hospital Muenster, Muenster, Germany
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aims: Severe tricuspid regurgitation (TR) is a common finding in heart
failure patients and associated with increased mortality. New
interventional therapeutic options are needed as many heart failure
patients are unfit for surgery. The TRICAVAL study compared valve
implantation into the inferior vena cava (CAVI) with optimal medical
therapy (OMT) in patients with severe TR. Here, we report details on the
impact of CAVI on TR severity as well as right heart function and
morphology. Methods and Results: We randomized 28 patients with
severe TR to CAVI (n = 14) with transfemoral implantation of an Edwards
Sapien XT valve into the inferior vena cava or OMT (n = 14). Inclusion and
exclusion criteria were based on anatomical and clinical parameters.
Echocardiographic measurements were performed at baseline, at the first
postoperative day and one, three, and twelve months after randomization.
As proof of concept of an effective sealing of the inferior vena cava, we
detected a significant decrease in systolic hepatic vein reflux volume
(11.0 [6.2-21.9] mL vs 3.5 [0.6-8.5] mL, P =.016) and hepatic vein
diameter (11.5 [10.0-14.8] mm vs 10.0 [9.3-11.8] mm, P =.034) at
thirty-day follow-up. However, CAVI had no significant impact on TR,
cardiac function, and morphology. Conclusion(s): Caval valve
implantation significantly reduced systolic reflux into the hepatic veins
but was not associated with an improvement in cardiac function,
morphology, or TR severity. Copyright © 2020 The Authors.
Echocardiography published by Wiley Periodicals LLC

<56>
Accession Number
2005098927
Title
The Use of Bivalirudin in Pediatric Cardiac Surgery and in the
Interventional Cardiology Suite.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (8) (pp 2215-2223),
2020. Date of Publication: August 2020.
Author
Goswami D.; DiGiusto M.; Wadia R.; Barnes S.; Schwartz J.; Steppan D.;
Nelson-McMillan K.; Ringel R.; Steppan J.
Institution
(Goswami, DiGiusto, Wadia, Barnes, Schwartz, Steppan, Nelson-McMillan,
Steppan) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
(DiGiusto, Nelson-McMillan, Ringel) Department of Pediatrics, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
W.B. Saunders
Abstract
Anticoagulation is an essential component for patients undergoing
cardiopulmonary bypass or extracorporeal membrane oxygenation and for
those with ventricular assist devices. However, thrombosis and bleeding
are common complications. Heparin continues to be the agent of choice for
most patients, likely owing to practitioners' comfort and experience and
the ease with which the drug's effects can be reversed. However,
especially in pediatric cardiac surgery, there is increasing interest in
using bivalirudin as the primary anticoagulant. This drug circumvents
certain problems with heparin administration, such as heparin resistance
and heparin-induced thrombocytopenia, but it comes with additional
challenges. In this manuscript, the authors review the literature on the
emerging role of bivalirudin in pediatric cardiac surgery, including its
use with cardiopulmonary bypass surgery, extracorporeal membrane
oxygenation, ventricular assist devices, and interventional cardiology.
Moreover, they provide an overview of bivalirudin's pharmacodynamics and
monitoring methods. Copyright © 2020 Elsevier Inc.

<57>
Accession Number
2004841792
Title
A systematic review of chyle leaks and their management following axillary
surgery.
Source
European Journal of Surgical Oncology. 46 (6) (pp 931-942), 2020. Date of
Publication: June 2020.
Author
Farkas N.; Wong J.; Monib S.; Thomson S.
Institution
(Farkas, Wong, Monib, Thomson) West Hertfordshire Breast Care Unit, West
Hertfordshire Hospitals NHS Trust, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Introduction: Chyle leaks following surgery to the axilla are seldom
encountered with an incidence <0.7%. Management varies with no consensus
in the literature. Injury to branching tributaries of the thoracic duct
may require lengthy management at significant cost to patient and clinical
team. This paper aims to provide an up-to-date review to support clinical
management. Method(s): The term 'chyle' was combined with 'breast' or
'axilla.' EMBASE, Medline and PubMed database searches were conducted. All
papers published in English were included with no exclusion date limits.
 Result(s): 51 cases from 31 papers. All were female (mean age =
53.3yrs). 47/51 leaks were left-sided. 5/51 underwent sentinel node
biopsy, 19/51 level II axillary node clearance (ANC), 23/51 level III ANC,
5/51 not specified. 59% (30/51) of leaks were identified within 2
postoperative days (mean = 3.3days). 96% initially managed conservatively:
Drain = 38/51; low-fat diet = 34/51; compression bandaging = 20/51;
Aspiration = 6/51. 40/51 (78%) were successfully managed conservatively,
11 patients returned to theater for secondary management. 7/11 recorded
volumes >500mls/24 hrs before secondary surgery. Mean resolution time from
initial surgery was 17.3days (range = 4-64days). No statistically
significant difference (p = 0.72) in time to resolution between
conservatively and surgically managed patients. Conclusion(s): Chyle
leaks are rarely seen following axillary surgery. Aberrant thoracic duct
anatomy represents the likeliest aetiology. We advocate early recognition
and tailored individual management. Conservative management with
non-suction drainage, low-fat diet and axillary compression bandaging
appear effective where output <500ml/24 hrs. Secondary surgical management
should be considered in high chylous output (<500mls/24 hrs) patients
unresponsive to conservative measures. We propose a management algorithm
to aide clinicians. Copyright © 2020

<58>
Accession Number
2004814474
Title
Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist
Device-Case Series and Review of Literature.
Source
Obesity Surgery. 30 (9) (pp 3628-3633), 2020. Date of Publication: 01 Sep
2020.
Author
Van Aelst P.; Deleus E.; Van der Schueren B.; Meyns B.; Vandersmissen K.;
Lannoo M.
Institution
(Van Aelst, Deleus, Lannoo) Department of Abdominal Surgery, University
Hospitals Leuven, Leuven, Belgium
(Van der Schueren) Department of Endocrinology, University Hospitals
Leuven, Leuven, Belgium
(Meyns, Vandersmissen) Department of Clinical Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
Publisher
Springer
Abstract
For patients with advanced heart failure, left ventricular assist device
(LVAD) can serve as a bridge to heart transplantation. Patients with class
II obesity are eligible for implantation of LVAD but do not meet criteria
for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is
proposed as weight losing modality in order to reach the New York Heart
Association (NYHA) criteria for listing. In our center, three patients on
LVAD with need for weight-reducing therapy were treated with laparoscopic
sleeve gastrectomy. We reviewed our data retrospectively and compared it
with the literature. Successful weight loss was achieved in all patients,
without postoperative adverse events. Two out of three were listed on
transplant waiting list. Our results are similar to those described in
other series. Copyright © 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<59>
Accession Number
2004382434
Title
Ventricular arrhythmias following continuous-flow left ventricular assist
device implantation: A systematic review.
Source
Artificial Organs. 44 (8) (pp E313-E325), 2020. Date of Publication: 01
Aug 2020.
Author
Gordon J.S.; Maynes E.J.; Choi J.H.; Wood C.T.; Weber M.P.; Morris R.J.;
Massey H.T.; Tchantchaleishvili V.
Institution
(Gordon, Maynes, Choi, Wood, Weber, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Ventricular arrhythmias (VA) are not uncommon after continuous-flow left
ventricular assist device (CF-LVAD) implantation. In this systematic
review, we sought to identify the patterns of VA that occurred following
CF-LVAD implantation and evaluate their outcomes. An electronic search was
performed to identify all articles reporting the development of VA
following CF-LVAD implantation. VA was defined as any episode of
ventricular fibrillation (VF) or sustained (>30 seconds) ventricular
tachycardia (VT). Eleven studies were pooled for the analysis that
included 393 CF-LVAD patients with VA. The mean patient age was 57 years
[95%CI: 54; 61] and 82% [95%CI: 73; 88] were male. Overall, 37% [95%CI:
19; 60] of patients experienced a new onset VA after CF-LVAD implantation,
while 60% [95%CI: 51; 69] of patients had a prior history of VA. Overall,
88% of patients [95%CI: 78; 94] were supported on HeartMate II CF-LVAD, 6%
[95%CI: 3; 14] on HeartWare HVAD, and 6% [95%CI: 2; 13] on other CF-LVADs.
VA was symptomatic in 47% [95%CI: 28; 68] of patients and in 50% [95%CI:
37; 52], early VA (<30 days from CF-LVAD) was observed. The 30-day
mortality rate was 7% [95%CI: 5; 11]. Mean follow-up was 22.9 months
[95%CI: 4.8; 40.8], during which 27% [95%CI: 17; 39] of patients underwent
heart transplantation. In conclusion, approximately a third of patients
had new VA following CF-LVAD placement. VA in CF-LVAD patients is often
symptomatic, necessitates treatment, and carries a worse
prognosis. Copyright © 2020 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<60>
Accession Number
2003545210
Title
Transcatheter Versus Surgical Aortic Valve Replacement in
Low-Surgical-Risk Patients: A Meta-Analysis of Randomized-Controlled
Trials and Propensity-Matched Studies.
Source
Cardiovascular Revascularization Medicine. 21 (5) (pp 612-618), 2020. Date
of Publication: May 2020.
Author
Rawasia W.F.; Usman M.S.; Mujeeb F.A.; Zafar M.; Khan S.U.; Alkhouli M.
Institution
(Rawasia, Khan, Alkhouli) West Virginia University, Heart and Vascular
Institute, Morgantown, WV, United States
(Usman, Mujeeb, Zafar) Dow University of Health Sciences, Karachi,
Pakistan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: We performed a meta-analysis of randomized trials (RCT) and
propensity-matched (PSM) studies comparing transcatheter aortic valve
implantation (TAVI) with surgical aortic valve replacement (SAVR) in low
surgical risk patients. Method(s): Published studies including
low-risk patients who underwent TAVI (n = 9068) or SAVR (n = 17,388) were
included. Outcomes of interest were short-term (30-day) and mid-term
(1-year) mortality and major complications. Result(s): Short-term
mortality was lower with TAVI vs. SAVR (1.8% vs. 2.8%, RR = 0.67,
[0.56-0.80]). TAVI was associated with lower risk of atrial fibrillation
(7.4% vs. 36.5%, RR = 0.21, [0.14-0.31]), and kidney injury (5.3% vs. 9%,
RR = 0.45, [0.26-0.80]), but had higher incidence of vascular
complications (5.5% vs. 1.4%, RR = 4.88 [1.47-16.18]), and permanent
pacemaker implantation (14.9% vs. 3.4%, RR = 4.94 [3.03-8.08]). Stroke
rates were similar between both interventions (1.7% vs. 2.2%, RR = 0.80
[0.54-1.18]). Mid-term all-cause mortality was similar in the pooled
analysis for TAVI vs. SAVR (8.6% vs. 8.4%, RR = 0.90 [0.66-1.24]), but was
lower with TAVI in RCTs (2.1% vs. 3.5%, RR = 0.61 [0.39-0.95]).
Cardiovascular mortality was lower with TAVI (1.6% vs. 2.9%, RR = 0.55
[0.33-0.90]), but stroke (3% vs. 4.2%, RR = 0.69, [0.45-1.06]) and valve
re-interventions rates (0.8% vs. 0.6%, RR = 1.28 [0.52-3.17]) were similar
between both strategies. Conclusion(s): TAVI in low surgical risk
patients is associated with lower short-term morbidity and mortality
compared with SAVR. Copyright © 2019 Elsevier Inc.

<61>
Accession Number
2002753202
Title
Percutaneous Coronary Intervention for Left Main Coronary Disease in New
Zealand: National Linkage Study of Characteristics and In-Hospital
Outcomes (ANZACS-QI 38).
Source
Cardiovascular Revascularization Medicine. 21 (5) (pp 573-579), 2020. Date
of Publication: May 2020.
Author
Wang T.K.M.; Kerr A.; Kasargod C.; Chan D.; Cicovic S.; Dimalapang E.;
Webster M.; Somaratne J.
Institution
(Wang, Kasargod, Chan, Cicovic, Dimalapang, Webster, Somaratne) Green Lane
Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
(Wang, Kerr) Department of Cardiology, Middlemore Hospital, Auckland, New
Zealand
(Kerr) Department of Medicine, University of Auckland, Auckland, New
Zealand
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Approximately 5% of coronary angiographies detect LMS disease
>50%. Recent randomized trials showed PCI has comparable outcomes to
coronary artery bypass grafting (CABG) in low or intermediate risk
candidates. In clinical practice, PCI is frequently utilized in those with
prohibitive surgical risk. We reviewed contemporary national results of
percutaneous coronary intervention (PCI) for left main coronary disease
(LMS) disease in New Zealand. Method(s): All patients undergoing PCI
for LMS disease from 01/09/2014-24/09/2017 were extracted from the All New
Zealand Acute Coronary Syndrome-Quality Improvement registry with national
dataset linkage, analyzing characteristics and in-hospital outcomes.
 Result(s): The cohort included 469 patients, mean age 70.8 +/- 10.7
years, male 331 (71%), and the majority 339 (72%) were unprotected LMS.
Indications include ST-elevation myocardial infarction (STEMI) 83 (18%)
and NSTEMI or unstable angina 229 (49%). Compared with protected LMS,
unprotected LMS were more likely to present with an acute coronary
syndrome (73% versus 48%, P < 0.001), and to die in-hospital (9.4% versus
3.9%, P = 0.045). In those with unprotected LMS, in-hospital mortality
after acute STEMI PCI was higher than for other indications (21.1% versus
6.1%, P < 0.001). Independent predictors of in-hospital death and major
adverse cardiovascular events included STEMI, femoral access and worse
renal function. Conclusion(s): Our LMS PCI cohort had high mortality
rates, especially those presenting with STEMI and an unprotected LMS. This
reflects the contemporary real-world practice of LMS PCI being
predominantly performed in high risk patients which differs from
randomized trial populations, and this should be considered before
comparing with CABG outcomes. Copyright © 2019 Elsevier Inc.

<62>
[Use Link to view the full text]
Accession Number
632256751
Title
Postoperative atrial fibrillation following emergency noncardiothoracic
surgery: A systematic review.
Source
European journal of anaesthesiology. 37 (8) (pp 671-679), 2020. Date of
Publication: 01 Aug 2020.
Author
Bjerrum E.; Wahlstroem K.L.; Gogenur I.; Burcharth J.; Ekeloef S.
Institution
(Bjerrum) From the Center for Surgical Science (CSS), Department of
Surgery, Zealand University Hospital, Lykkebaekvej 1, IG, Slovenia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) occurs frequently
following cardiothoracic surgery and is associated with a higher mortality
and a longer hospital stay. The condition is less studied following
noncardiothoracic surgery as well as emergency surgery. OBJECTIVE(S):
The aim of this systematic review was to investigate the occurrence of
atrial fibrillation following emergency noncardiothoracic surgery and
associated risk factors and mortality. DESIGN: We conducted a systematic
review according to the Preferred Reporting Items for Systematic reviews
and Meta-Analyses guidelines. Observational studies and randomised
controlled trials were assessed for risk of bias using the Downs and Black
checklist and Cochrane Handbook for Systematic reviews of intervention.
DATA SOURCES: A systematic literature search of PubMed, EMBASE and Scopus
was carried out in August 2019. No publication date- or source
restrictions were imposed. ELIGIBILITY CRITERIA: Observational and
randomised controlled trials were included if data on POAF occurring after
an emergency, noncardiothoracic, surgical intervention on adult patients
could be extracted. RESULT(S): We identified 15 studies eligible for
inclusion covering orthopaedic-, abdominal-, vascular-, neuro- and
miscellaneous noncardiothoracic surgery. The occurrence of POAF after
emergency noncardiothoracic surgery ranged from 1.5 to 12.2% depending on
type of surgery and intensity of cardiac monitoring. Studies that
investigated risk factors and associated mortality found emergency surgery
and increasing age to be associated with risk of POAF. Moreover, POAF was
generally associated with an increase in long-term and short-term
mortality. CONCLUSION(S): In this study, atrial fibrillation occurred
frequently, especially following emergency orthopaedic, vascular and
neurosurgery. Emergency surgery and age were independent risk factors for
developing atrial fibrillation. POAF seems to be related to a higher risk
of postoperative complications and mortality, though further studies with
long-term follow-up are needed. TRIAL REGISTRATION: CRD42019112090.

<63>
Accession Number
632417926
Title
Evaluation of tranexamic acid utilization in a community academic trauma
center.
Source
Academic Emergency Medicine. Conference: Annual Meeting of the Society for
Academic Emergency Medicine, SAEM 2020. United States. 27 (Supplement 1)
(pp S130), 2020. Date of Publication: May 2020.
Author
Dominguez N.; Krizo J.; Martyna S.; Weltlin G.; Ebersbacher C.; Mallat A.;
Heaney A.
Institution
(Dominguez, Krizo, Martyna, Weltlin, Ebersbacher, Mallat, Heaney)
Cleveland Clinic Akron General
Publisher
Blackwell Publishing Inc.
Abstract
Background and Objectives: Hemorrhage is responsible for more than 60,000
deaths per year in the United States and an estimated 1.9 million deaths
per year worldwide. Use of pro-coagulant hemostatic agents such as
tranexamic acid (TXA) has increased in recent years, thanks in part to the
results of international randomized controlled trials studying it's
efficacy in various settings. Additionally, appropriate utilization and
administration is an essential, but often difficult task to complete. This
paper will examine the global utilization of TXA in a community academic
hospital to determine if TXA use is consistent with industry
recommendations across a myriad of specialties Methods: A descriptive,
single-center, retrospective cohort study was conducted to evaluate the
use of IV TXA in adult patients presenting to Cleveland Clinic Akron
General (CCAG). 716 adult patients were included between September 1, 2017
and October 31, 2018. Patients were divided into categories based on
indication for TXA use, including: Massive Bleeding, Orthopedic Surgery,
Post-Partum Hemorrhage, Trauma, and Cardiac Surgery. The primary outcome
of this study was to determine TXA utilization compliance with current
recommendations Results: Of the 716 patients who received TXA, the most
common uses were Orthopedic Surgery (n=322), Postpartum Hemorrhage after
Cesarean Section (n=32), Postpartum Hemorrhage with Vaginal Birth (n=24),
cardiac surgery (n=24). The remainder of cases included Trauma (n=12),
Local Fibrinolytic Bleeding (n=12), and Massive Bleeding (n=11). When
assessed for compliance with accepted industry standards for TXA, the
highest compliance was noted in the patients treated for post-partum
hemorrhage and trauma. Compliance was 81% (n=26) when associated with
Cesarean section, 88% (n=21) when associated with vaginal birth, and 58%
when associated with Trauma (n=12). Lowest compliance was noted in cardiac
surgery with a compliance rate of 4% (n=1). Despite being the most
frequent utilizer of TXA, compliance in orthopedic surgery was 33% (n=109)
 Conclusion(s): The majority of TXA use is during orthopedic
procedures, however with the lowest compliance rate. Obstetrics have the
highest compliance to current dosing recommendations. Analyzing current
uses, outcomes, and pitfalls may lead to standardized protocols that
reduce time to treat and outcomes.

<64>
[Use Link to view the full text]
Accession Number
632428581
Title
Effects of Different Doses of Remote Ischemic Preconditioning on Kidney
Damage Among Patients Undergoing Cardiac Surgery: A Single-Center
Mechanistic Randomized Controlled Trial.
Source
Critical care medicine. 48 (8) (pp e690-e697), 2020. Date of Publication:
01 Aug 2020.
Author
Meersch M.; Kullmar M.; Pavenstadt H.; Rossaint J.; Kellum J.A.; Martens
S.; Klausmeyer P.; Schmidt E.A.; Kerschke L.; Zarbock A.
Institution
(Meersch) Department of Anaesthesiology, Intensive Care Medicine and Pain
Medicine, Germany. 2Department of Medicine, Division D, Nephrology,
University Hospital Munster, Germany. 3Center for Critical Care
Nephrology, Department of Critical Care Medicine, University of
Pittsburgh, PA. 4Department of Cardiac Surgery, Germany. 5Institute of
Biostatistics and Clinical Research, University of Munster, Pittsburgh,
Munster, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We have previously shown that remote ischemic preconditioning
reduces acute kidney injury (acute kidney injury) in high-risk patients
undergoing cardiopulmonary bypass and that the protective effect is
confined to patients who exhibit an increased urinary tissue inhibitor of
metalloproteinases-2 and insulin-like growth factor-binding protein 7 in
response to remote ischemic preconditioning. The purpose of this study was
to determine the optimal intensity of remote ischemic preconditioning to
induce required [tissue inhibitor of metalloproteinases-2]*[insulin-like
growth factor-binding protein 7] changes and further explore mechanisms of
remote ischemic preconditioning. DESIGN: Observational and randomized
controlled, double-blind clinical trial. SETTING: University Hospital of
Muenster, Germany. PATIENTS: High-risk patients undergoing cardiac surgery
as defined by the Cleveland Clinic Foundation Score. INTERVENTIONS: In the
interventional part, patients were randomized to receive either one of
four different remote ischemic preconditioning doses (3x5min, 3x7min,
3x10min remote ischemic preconditioning, or 3x5min remote ischemic
preconditioning + 2x10min remote ischemic preconditioning in
nonresponders) or sham-remote ischemic preconditioning (control).
MEASUREMENTS AND MAIN RESULTS: The primary endpoint of the interventional
part was change in urinary [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7]
between pre- and postintervention. To examine secondary objectives
including acute kidney injury incidence, we included an observational
cohort. A total of 180 patients were included in the trial (n = 80
observational and n = 100 randomized controlled part [20 patients/group]).
The mean age was 69.3 years (10.5 yr), 119 were men (66.1%). Absolute
changes in [tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] were significantly higher in all remote ischemic
preconditioning groups when compared with controls (p < 0.01). Although we
did not observe a dose-response relationship on absolute changes in
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] across the four different remote ischemic
preconditioning groups, in the 15 patients failing to respond to the
lowest dose, nine (60%) responded to a subsequent treatment at a higher
intensity. Compared with controls, fewer patients receiving remote
ischemic preconditioning developed acute kidney injury within 72 hours
after surgery as defined by both Kidney Disease: Improving Global Outcomes
criteria (30/80 [37.5%] vs 61/100 [61.0%]; p = 0.003). CONCLUSION(S):
All doses of remote ischemic preconditioning significantly increased
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] and significantly decreased acute kidney injury
compared with controls. High-dose remote ischemic preconditioning could
stimulate [tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] increases in patients refractory to low-dose
remote ischemic preconditioning.

<65>
Accession Number
632416107
Title
Study protocol for a randomised controlled trial evaluating the effects of
the orexin receptor antagonist suvorexant on sleep architecture and
delirium in the intensive care unit.
Source
BMJ open. 10 (7) (pp e038474), 2020. Date of Publication: 19 Jul 2020.
Author
Azimaraghi O.; Hammer M.; Santer P.; Platzbecker K.; Althoff F.C.;
Patrocinio M.; Grabitz S.D.; Wongtangman K.; Rumyantsev S.; Xu X.;
Schaefer M.S.; Fuller P.M.; Subramaniam B.; Eikermann M.
Institution
(Azimaraghi, Hammer, Santer, Platzbecker, Althoff, Patrocinio, Grabitz,
Xu, Schaefer, Subramaniam) Department of Anesthesia, Critical Care and
Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, United States
(Wongtangman) Department of Anesthesiology, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Rumyantsev) Pharmacy, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, MA, United States
(Fuller) Department of Neurology, Program in Neuroscience and Division of
Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Eikermann) Department of Anesthesia, Critical Care and Pain Medicine,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Insomnia frequently occurs in patients admitted to an
intensive care unit (ICU). Sleep-promoting agents may reduce rapid eye
movement sleep and have deliriogenic effects. Suvorexant (Belsomra) is an
orexin receptor antagonist with Food and Drug Administration (FDA)
approval for the treatment of adult insomnia, which improves sleep onset
and maintenance as well as subjective measures of quality of sleep. This
trial will evaluate the efficacy of postoperative oral suvorexant
treatment on night-time wakefulness after persistent sleep onset as well
as the incidence and duration of delirium among adult cardiac surgical
patients. METHODS AND ANALYSIS: In this single-centre, randomised,
double-blind, placebo-controlled trial, we will enrol 120 patients, aged
60 years or older, undergoing elective cardiac surgery with planned
postoperative admission to the ICU. Participants will be randomised to
receive oral suvorexant (20mg) or placebo one time a day starting the
night after extubation. The primary outcome will be wakefulness after
persistent sleep onset. The secondary outcome will be total sleep time.
Exploratory outcomes will include time to sleep onset, incidence of
postoperative in-hospital delirium, number of delirium-free days and
subjective sleep quality. ETHICS AND DISSEMINATION: Ethics approval was
obtained through the 'Committee on Clinical Investigations' at Beth Israel
Deaconess Medical Center (protocol number 2019P000759). The findings will
be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: This
trial has been registered at clinicaltrials.gov on 17 September 2019
(NCT04092894). 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.

<66>
Accession Number
632334968
Title
Effects of Supervised Early Resistance Training versus standard care on
cognitive recovery following cardiac surgery via median sternotomy (the
SEcReT study): Protocol for a randomised controlled pilot study.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 649. Date of
Publication: 15 Jul 2020.
Author
Pengelly J.M.S.; Royse A.G.; Bryant A.L.; Williams G.P.; Tivendale L.J.;
Dettmann T.J.; Canty D.J.; Royse C.F.; El-Ansary D.A.
Institution
(Pengelly, El-Ansary) Department of Nursing and Allied Health, Swinburne
University of Technology, Hawthorn, Melbourne, VIC, Australia
(Royse, Canty, Royse, El-Ansary) Department of Surgery, University of
Melbourne, Melbourne, VIC, Australia
(Royse, Tivendale) Department of Cardiothoracic Surgery, Royal Melbourne
Hospital, Parkville, VIC, Australia
(Bryant, Williams) Department of Physiotherapy, University of Melbourne,
Parkville, VIC, Australia
(Dettmann) Kieser Australia, South Melbourne, VIC, Australia
(Canty) Department of Medicine, Monash University, Clayton, VIC, Australia
(Canty) Department of Anaesthesia and Perioperative Medicine, Monash
Health, Clayton, VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Parkville, VIC, Australia
(Royse) Australian Director, Outcomes Research Consortium Cleveland
Clinic, Cleveland, OH, United States
(El-Ansary) Clinical Research Institute, Westmead Private Hospital,
Westmead, Sydney, NSW, Australia
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Introduction: Mild cognitive impairment is considered a precursor to
dementia and significantly impacts upon quality of life. The prevalence of
mild cognitive impairment is higher in the post-surgical cardiac
population than in the general population, with older age and
comorbidities further increasing the risk of cognitive decline. Exercise
improves neurogenesis, synaptic plasticity and inflammatory and
neurotrophic factor pathways, which may help to augment the effects of
cognitive decline. However, the effects of resistance training on
cognitive, functional and overall patient-reported recovery have not been
investigated in the surgical cardiac population. This study aims to
determine the effect of early moderate-intensity resistance training,
compared to standard care, on cognitive recovery following cardiac surgery
via a median sternotomy. The safety, feasibility and effect on functional
recovery will also be examined. Method(s): This study will be a
prospective, pragmatic, pilot randomised controlled trial comparing a
standard care group (low-intensity aerobic exercise) and a
moderate-intensity resistance training group. Participants aged 18 years
and older with coronary artery and/or valve disease requiring surgical
intervention will be recruited pre-operatively and randomised 1:1 to
either the resistance training or standard care group post-operatively.
The primary outcome, cognitive function, will be assessed using the
Alzheimer's Disease Assessment Scale and cognitive subscale. Secondary
measures include safety, feasibility, muscular strength, physical
function, multiple-domain quality of recovery, dynamic balance and patient
satisfaction. Assessments will be conducted at baseline (pre-operatively)
and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months.
 Discussion(s): The results of this pilot study will be used to
determine the feasibility of a future large-scale randomised controlled
trial that promotes the integration of early resistance training into
existing aerobic-based cardiac rehabilitation programs in Australia. Trial
registration: Australian New Zealand Clinical Trials Registry (ANZCTR)
ACTRN12617001430325p. Registered on 9 October 2017. Universal Trial Number
(UTN): U1111-1203-2131. Copyright © 2020 The Author(s).

<67>
Accession Number
632334891
Title
Outcomes after transcatheter aortic valve replacement in cancer survivors
with prior chest radiation therapy: A systematic review and meta-analysis.
Source
Cardio-Oncology. 6 (1) (no pagination), 2020. Article Number: 8. Date of
Publication: 14 Jul 2020.
Author
Zafar M.R.; Mustafa S.F.; Miller T.W.; Alkhawlani T.; Sharma U.C.
Institution
(Zafar, Miller, Alkhawlani, Sharma) Department of Medicine, Division
Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875
Ellicott Street, Buffalo, NY 14203, United States
(Mustafa) Department of Internal Medicine, William Beaumont Hospital,
Royal Oak, MI, United States
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: Cancer survivors with prior chest radiation therapy (C-XRT)
frequently present with aortic stenosis (AS) as the first manifestation of
radiation-induced heart disease. They are considered high-risk for
surgical valve replacement. Transcatheter aortic valve replacement (TAVR)
is as an attractive option for this patient population but the outcomes
are not well established in major clinical trials. The authors performed a
systemic review and meta-analysis of clinical studies for the outcomes
after TAVR in cancer survivors with prior C-XRT. Method(s): Online
databases were searched from inception to April 2020 for studies
evaluating the outcomes of TAVR in patients with and without C-XRT. We
analyzed the pooled estimates (with their 95% confidence intervals) of the
odds ratio (OR) for the all-cause mortality at 30-day and 1-year
follow-ups, 4-point safety outcomes (stroke, major bleed, access-related
vascular complications and need for a pacemaker), a 2-point efficacy
outcome (mean aortic valve gradient and left ventricular ejection
fraction) and worsening of congestive heart failure (CHF). Four studies
were included following 2054 patients with and without prior C-XRT
exposure (164 patients and 1890 patients respectively). Result(s):
The C-XRT group had similar 30-day mortality compared to the control group
(OR 1.29, 95% CI 0.64 to 2.58, p = 0.48). The 1-year mortality was higher
in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p = 0.01). Apart from higher
congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03,
CI 1.36 to 3.04, p = 0.0006), TAVR resulted in similar safety and efficacy
outcomes in both groups. Conclusion(s): TAVR in the C-XRT group has
similar 30-day mortality, safety, and efficacy outcomes compared to the
control group; however, they have higher 1-year mortality and CHF
exacerbation. Including an oncologist to the cardiology team who considers
cancer stage in the decision-making process and applying additional
preoperative scores such as frailty indices may refine the risk assessment
for these patients. The quality of analyzed data is modest, warranting
randomized trials to assess the true benefits of TAVR in these patients.
 Copyright © 2020 The Author(s).

<68>
Accession Number
2005677011
Title
Prednisone and azathioprine in patients with inflammatory cardiomyopathy:
systematic review and meta-analysis.
Source
ESC Heart Failure. (no pagination), 2020. Date of Publication: 2020.
Author
Timmermans P.; Barradas-Pires A.; Ali O.; Henkens M.; Heymans S.; Negishi
K.
Institution
(Timmermans) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Timmermans) University Hospital Gasthuisberg, Leuven, Belgium
(Barradas-Pires) Royal Brompton and Harefield NHS Foundation Trust,
London, United Kingdom
(Ali) Detroit Medical Center, Department of Cardiology, Wayne State
University School of Medicine, United States
(Henkens, Heymans) Department of Cardiology, CARIM School for
Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences,
Maastricht University, Maastricht, Netherlands
(Heymans) Department of Cardiovascular Sciences, Centre for Molecular and
Vascular Biology, Catholic University of Leuven, Leuven, Belgium
(Negishi) Menzies Institute for Medical Research, University of Tasmania,
Hobart, Australia
(Negishi) Nepean Clinical School, The University of Sydney, Kingswood,
Sydney, Australia
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims Chronic non-viral myocarditis, also called inflammatory
cardiomyopathy, can be treated with immune suppression on tops of optimal
medical therapy (OMT) for heart failure, using a combination of
prednisolone and azathioprine (IPA). However, there has been inconsistency
in the effects of immunosuppression treatment. This meta-analysis is the
first to evaluate all available data of the effect of this treatment on
left ventricular ejection fraction (LVEF) and the combined clinical
endpoint of cardiovascular mortality and/or heart transplantation-free
survival. Methods and results All trials with using IPA vs. OMT in this
syndrome were searched using OVID Medline and ClinicalTrials. gov,
following the PRISMA guidelines. Missing data were retrieved after
contacting the corresponding authors. All data was reviewed and analysed
using and standard meta-analysis methods. A random effect model was used
to pool the effect sizes. A total of four trials (three randomised
controlled trials and one propensity-matched retrospective registry)
including 369 patients were identified. IPA on top of OMT did not improve
LVEF [mean difference 9.9% (95% confidence interval -1.8, 21.7)] with
significant heterogeneity. When we limited our pooled estimate to the
published studies only, significant LVEF improvement by IPA was observed
[14% (1.4, 26.6)]. No cardiovascular mortality benefit was observed with
the intervention [risk ratio 0.34 (0.08, 1.51)]. Conclusions At the
moment, there is insufficient evidence supporting functional and
prognostic benefits of IPA added to OMT in virus negative inflammatory
positive cardiomyopathy. Further adequate-powered well-designed
prospective RCTs should be warranted to explore the potential effects of
adding immunosuppressive therapy to OMT. Copyright © 2020 The
Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of
the European Society of Cardiology

<69>
Accession Number
632424138
Title
Combining Biomarkers and Imaging for Short-Term Assessment of
Cardiovascular Disease Risk in Apparently Healthy Adults.
Source
Journal of the American Heart Association. (pp e015410), 2020. Date of
Publication: 23 Jul 2020.
Author
Gore M.O.; Ayers C.R.; Khera A.; deFilippi C.R.; Wang T.J.; Seliger S.L.;
Nambi V.; Selvin E.; Berry J.D.; Hundley W.G.; Budoff M.; Greenland P.;
Drazner M.H.; Ballantyne C.M.; Levine B.D.; de Lemos J.A.
Institution
(Gore) Department of Medicine University of Colorado Anschutz Medical
Campus Aurora CO
(Gore) Department of Medicine Denver Health and Hospital Authority Denver
CO
(Gore) Community Health Department Colorado Prevention Center Aurora CO
(Ayers, Khera, Wang, Berry, Drazner, Levine, de Lemos) Department of
Medicine University of Texas Southwestern Medical Center Dallas TX
(deFilippi) Inova Heart and Vascular Institute Fall Church VA
(Seliger) Department of Medicine University of Maryland School of Medicine
Baltimore MD
(Nambi, Ballantyne) Department of Medicine Baylor College of Medicine
Houston TX
(Nambi, Ballantyne) Houston Methodist DeBakey Heart and Vascular Center
Houston TX
(Nambi) Department of Medicine Michael E. DeBakey Veterans Affairs
Hospital Houston TX
(Selvin) Department of Epidemiology Johns Hopkins Bloomberg School of
Public Health Baltimore MD
(Hundley) Departments of Medicine and Radiological Sciences Wake Forest
Health Sciences Winston-Salem NC
(Budoff) Los Angeles Biomedical Research Institute Los Angeles CA
(Greenland) Northwestern University Chicago IL, Department of Preventive
Medicine Feinberg School of Medicine
Publisher
NLM (Medline)
Abstract
Background Current strategies for cardiovascular disease (CVD) risk
assessment focus on 10-year or longer timeframes. Shorter-term CVD risk is
also clinically relevant, particularly for high-risk occupations, but is
under-investigated. Methods and Results We pooled data from participants
in the ARIC (Atherosclerosis Risk in Communities study), MESA
(Multi-Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study),
free from CVD at baseline (N=16 581). Measurements included N-terminal
pro-B-type natriuretic peptide (>100 pg/mL prospectively defined as
abnormal); high-sensitivity cardiac troponin T (abnormal >5 ng/L);
high-sensitivity C-reactive protein (abnormal >3 mg/L); left ventricular
hypertrophy by ECG (abnormal if present); carotid intima-media thickness,
and plaque (abnormal >75th percentile for age and sex or presence of
plaque); and coronary artery calcium (abnormal >10 Agatston U). Each
abnormal test result except left ventricular hypertrophy by ECG was
independently associated with increased 3-year risk of global CVD
(myocardial infarction, stroke, coronary revascularization, incident heart
failure, or atrial fibrillation), even after adjustment for traditional
CVD risk factors and the other test results. When a simple integer score
counting the number of abnormal tests was used, 3-year
multivariable-adjusted global CVD risk was increased among participants
with integer scores of 1, 2, 3, and 4, by =2-, 3-, 4.5- and 8-fold,
respectively, when compared with those with a score of 0. Qualitatively
similar results were obtained for atherosclerotic CVD (fatal or non-fatal
myocardial infarction or stroke). Conclusions A strategy incorporating
multiple biomarkers and atherosclerosis imaging improved assessment of
3-year global and atherosclerotic CVD risk compared with a standard
approach using traditional risk factors.

<70>
Accession Number
2002475354
Title
Comparison of dexmedetomidine versus propofol-based anaesthesia for
controlled hypotension in functional endoscopic sinus surgery.
Source
Southern African Journal of Anaesthesia and Analgesia. 25 (2) (pp 37-40),
2019. Date of Publication: 23 Apr 2019.
Author
Bharathwaj D.K.; Kamath S.S.
Institution
(Bharathwaj, Kamath) Department of Anaesthesiology, Kasturba Medical
College, Mangalore, India
(Bharathwaj, Kamath) Manipal Academy of Higher Education, Manipal,
Karnataka, India
Publisher
Medpharm Publications (PO Box 14804, Lyttelton, Gauteng 0157, South
Africa)
Abstract
Background: Increased intraoperative bleeding during functional endoscopic
sinus surgery (FESS) affects operative field visibility, which increases
both duration of surgery and frequency of complications. Controlled
hypotension is an anaesthetic technique in which there is deliberate
reduction of systemic blood pressure during anaesthesia. The aim of the
study was to compare the efficacy of dexmedetomidine against propofol
infusion when used for controlled hypotension during FESS. Method(s):
A randomised, prospective, and single-blinded study was carried out, which
included 80 patients of either sex of ASA grade I & II who underwent
elective FESS. Patients were randomly assigned to two groups: Group A
(dexmedetomidine), Group B (propofol). Intraoperative mean arterial
pressure (MAP), heart rate (HR), surgical grade of bleeding (based on the
Fromme- Boezzart scale), and amount of bleeding were recorded.
 Result(s): Groups were well matched for their demographic data. There
was a statistically significant difference (p < 0.05) between Group A and
Group B in heart rate, mean arterial pressure (MAP) and mean total blood
loss, with Group A being effectively in controlled on all three parameters
during FESS. However, there was no significant difference (p > 0.05) in
terms of surgical grade of bleeding between Group A and Group B.
 Conclusion(s): Both dexmedetomidine and propofol infusion are
efficacious to facilitate controlled hypotension and haemodynamic
stability intraoperatively. Copyright © 2019 The Author(s).

<71>
Accession Number
628249912
Title
Effects of programmed intermittent thoracic paravertebral bolus of
levobupivacaine on the spread of sensory block: A randomized, controlled,
double-blind study.
Source
Regional Anesthesia and Pain Medicine. 44 (3) (pp 326-332), 2019. Date of
Publication: 01 Mar 2019.
Author
Hida K.; Murata H.; Ichinomiya T.; Inoue H.; Sato S.; Hara T.
Institution
(Hida, Murata, Ichinomiya, Inoue, Hara) Department of Anesthesiology,
Nagasaki University, School of Medicine, Nagasaki 852-8501, Japan
(Sato) Clinical Research Center, Nagasaki University Hospital, Nagasaki,
Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives This randomized, controlled, double-blind trial
compared the effectiveness of levobupivacaine delivery of a programmed
intermittent paravertebral bolus with a continuous paravertebral infusion.
Methods Thirty-two consecutively enrolled patients who underwent
unilateral video-assisted thoracic surgery were randomized to receive
either a programmed intermittent paravertebral bolus of 10 mL of 0.2%
levobupivacaine every 2 hours (Bolus group, n=16) or a continuous
paravertebral infusion of 0.2% levobupivacaine at 5 mL/hour (Infusion
group, n=16) after the operation. Postoperatively, after injection of 20
mL of 0.25% levobupivacaine through the paravertebral catheter, a
mechanical infusion pump was set depending on the assigned group. The
primary efficacy outcome was the number of anesthetized dermatomes 24
hours after the initial bolus of levobupivacaine. The secondary efficacy
outcomes included the number of anesthetized dermatomes at other time
points, pain at rest and coughing, additional analgesic use and patient
acceptance of the analgesic technique. Arterial levobupivacaine
concentration was measured to ensure safety. P<0.05 was considered
statistically significant. Results The mean (95% CI) number of
anesthetized dermatomes 24 hours after the initial bolus of
levobupivacaine was significantly larger among subjects receiving
programmed intermittent bolus (n=16) compared with those receiving
continuous infusion (n=16; 6.8 (5.7-7.9) vs 3.1 (2.0-4.2); p<0.001). The
arterial levobupivacaine concentration did not reach a toxic level.
Conclusions The programmed intermittent paravertebral bolus of
levobupivacaine provided a wider dermatomal spread of sensory block than
continuous paravertebral infusion with an identical hourly dose of
levobupivacaine. Trial registration number UMIN000022532. Copyright
© 2019 American Society of Regional Anesthesia & Pain Medicine.

<72>
Accession Number
632295786
Title
Anxiety and clinical outcomes of patients with acute coronary syndrome: A
meta-analysis.
Source
BMJ Open. 10 (7) (no pagination), 2020. Article Number: e034135. Date of
Publication: 09 Jul 2020.
Author
Li J.; Ji F.; Song J.; Gao X.; Jiang D.; Chen G.; Chen S.; Lin X.; Zhuo C.
Institution
(Li, Jiang, Chen, Chen, Zhuo) Psychiatric Neuroimaging-Genetic and
Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin
Anding Hospital, Tianjin, China
(Ji, Zhuo) Department of Psychiatric-Neuro-Imaging-Genetics Laboratory,
School of Mental of Jining, Medical University, Jining, China
(Song) Department of Cardiology, Center for Cardiovascular Translational
Research, Beijing Key Laboratory of Early Prediction, Intervention of
Acute Myocardial Infarction, Peking University People's Hospital, Beijing,
China
(Gao) Health Management Institute, Medical Data Statistical Analysis
Center, Medical Big Data Analysis Center, Chinese PLA General Hospital,
Beijing, China
(Lin) Department of Psychiatric-Neuro-Imaging-Genetics Laboratory, Wenzhou
Seventh People's Hospital, Wenzhou, China
(Zhuo) Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin,
China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Anxiety has been suggested to be associated with poor outcomes
in patients with acute coronary syndrome (ACS). However, results of
previous follow-up studies were inconsistent. The aim of this
meta-analysis was to evaluate the association between anxiety and clinical
outcomes in patients with ACS, and to investigate the potential role of
depression underlying the above association. Design A meta-analysis of
prospective follow-up studies. Setting Hospitals. Participants Patients
with ACS. Interventions We included related prospective follow-up studies
up through 20 July 2019 that were identified by searching PubMed and
Embase databases. A random-effect model was used for the meta-analysis.
Anxiety was evaluated by validated instruments at baseline. Primary and
secondary outcome measures We determined the association between anxiety
and risks of mortality and adverse cardiovascular events (MACEs) in
patients with ACS. Results Our analysis included 17 studies involving 39
038 patients wqith ACS. Anxiety was independently associated with
increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to
1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p<0.001)
in patients with ACS. Subgroup analyses showed that depression may at
least partly confound the association between anxiety and poor outcomes in
patients with ACS. Adjustment of depression significantly attenuated the
association between anxiety and MACEs (adjusted RR 1.25, 95% CI 1.04 to
1.52, p=0.02). Moreover, anxiety was not significantly associated with
mortality risk after adjusting for depression (adjusted RR 0.88, 95% CI
0.66 to 1.17, p=0.37). Conclusions Anxiety is associated with increased
risk of mortality and MACEs in patients with ACS. However, at least part
of the association may be confounded by concurrent depressive symptoms in
these patients. 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.

<73>
Accession Number
632067315
Title
Comparison of newer generation self-expandable vs. balloon-expandable
valves in transcatheter aortic valve implantation: The randomized
SOLVE-TAVI trial.
Source
European Heart Journal. 41 (20) (pp 1890-1899), 2020. Date of Publication:
21 May 2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Eitel I.;
Marquetand C.; Nef H.; Doerr O.; Lauten A.; Landmesser U.; Abdel-Wahab M.;
Sandri M.; Holzhey D.; Borger M.; Ince H.; Oner A.; Meyer-Saraei R.;
Wienbergen H.; Fach A.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.;
Funkat A.-K.; De Waha-Thiele S.; Desch S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Abdel-Wahab, Sandri, Holzhey,
Borger, Desch) Heart Center Leipzig, University of Leipzig, Strumpellstr.
39, Leipzig 04289, Germany
(Thiele, Feistritzer, Stachel, Hartung, Abdel-Wahab, Sandri, Holzhey,
Borger, Ruckert, Funkat, Desch) Leipzig Heart Institute, Russenstrase 69a,
Leipzig D-04289, Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, De Waha-Thiele) University Clinic
Schleswig-Holstein, University Heart Center Lubeck, Ratzeburger Allee 160,
Lubeck D-23538, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Frey, Konig,
De Waha-Thiele, Desch) German Center for Cardiovascular Research (DZHK),
Ratzeburger Allee 160, Lubeck D-23538, Germany
(Nef, Doerr) Medizinische Klinik i, Abteilung fur Kardiologie,
Universitatsklinikum Marburg/Giesen, Klinikstr. 33, Giesen D-35392,
Germany
(Lauten, Landmesser) Universitatsklinikum Charite, Campus Benjamin
Franklin, Hindenburgdamm 30, Berlin D-12200, Germany
(Ince, Oner) Medizinische Klinik i im Zentrum fur Innere Medizin (ZIM),
Universitatsklinikum Rostock, Ernst-Heydemann-Str. 6, Rostock D-18057,
Germany
(Wienbergen, Fach) Klinikum Links der Weser, Herzzentrum Bremen,
Senator-Wessling-Str. 1, Bremen D-28277, Germany
(Frey) Department of Cardiology, University Clinic Schleswig-Holstein,
Campus Kiel, Schittenhelmstr. 12, Kiel D-24105, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
Universitat zu Lubeck, Universitatsklinikum Schleswig-Holstein, Campus
Lubeck, Ratzeburger Allee 160, Lubeck D-23562, Germany
Publisher
Oxford University Press
Abstract
Aims: Transcatheter aortic valve implantation (TAVI) has emerged as
established treatment option in patients with symptomatic aortic stenosis.
Technical developments in valve design have addressed previous limitations
such as suboptimal deployment, conduction disturbances, and paravalvular
leakage. However, there are only limited data available for the comparison
of newer generation self-expandable valve (SEV) and balloon-expandable
valve (BEV). Methods and Results: SOLVE-TAVI is a multicentre,
open-label, 2 x 2 factorial, randomized trial of 447 patients with aortic
stenosis undergoing transfemoral TAVI comparing SEV (Evolut R, Medtronic
Inc., Minneapolis, MN, USA) with BEV (Sapien 3, Edwards Lifesciences,
Irvine, CA, USA). The primary efficacy composite endpoint of all-cause
mortality, stroke, moderate/severe prosthetic valve regurgitation, and
permanent pacemaker implantation at 30 days was powered for equivalence
(equivalence margin 10% with significance level 0.05). The primary
composite endpoint occurred in 28.4% of SEV patients and 26.1% of BEV
patients meeting the prespecified criteria of equivalence [rate difference
-2.39 (90% confidence interval, CI -9.45 to 4.66); P<inf>equivalence</inf>
= 0.04]. Event rates for the individual components were as follows:
all-cause mortality 3.2% vs. 2.3% [rate difference -0.93 (90% CI -4.78 to
2.92); P<inf>equivalence</inf> < 0.001], stroke 0.5% vs. 4.7% [rate
difference 4.20 (90% CI 0.12 to 8.27); P<inf>equivalence</inf> = 0.003],
moderate/severe paravalvular leak 3.4% vs. 1.5% [rate difference -1.89
(90% CI -5.86 to 2.08); P<inf>equivalence</inf> = 0.0001], and permanent
pacemaker implantation 23.0% vs. 19.2% [rate difference -3.85 (90% CI
-10.41 to 2.72) in SEV vs. BEV patients; P<inf>equivalence</inf> = 0.06].
 Conclusion(s): In patients with aortic stenosis undergoing
transfemoral TAVI, newer generation SEV and BEV are equivalent for the
primary valve-related efficacy endpoint. These findings support the safe
application of these newer generation percutaneous valves in the majority
of patients with some specific preferences based on individual valve
anatomy. Copyright © 2020 Published on behalf of the European
Society of Cardiology. All rights reserved. © The Author(s) 2020.

<74>
Accession Number
2007070235
Title
Effects of erector spinae plane block on postoperative pain and
side-effects in adult patients underwent surgery: A systematic review and
meta-analysis of randomized controlled trials.
Source
International Journal of Surgery. 80 (pp 107-116), 2020. Date of
Publication: August 2020.
Author
Cai Q.; Liu G.-Q.; Huang L.-S.; Yang Z.-X.; Gao M.-L.; Jing R.; Liu Z.;
Pan L.-H.
Institution
(Cai, Jing, Liu, Pan) Department of Anesthesiology, Guangxi Medical
University Cancer Hospital, Nanning, Guangxi 530021, China
(Liu, Yang) School of Basic Medicine at Guangxi Medical University,
Nanning, Guangxi 530021, China
(Huang) Department of Hepatobiliary Surgery, Taihe Hospital, Hubei
University of Medicine, Shiyan, Hubei 442000, China
(Gao) Department of Anesthesiology, Taihe Hospital, Hubei University of
Medicine, Shiyan, Hubei 442000, China
Publisher
Elsevier Ltd
Abstract
Background: Recently, the effects of erector spinae plane block on
postoperative pain have become increasingly controversial. This
meta-analysis compared the effects of ESP block versus placebo on
postoperative analgesia and side effects to determine whether the new
technique is a reliable alternative for pain management. Method(s):
PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure
(CNKI), and Wanfang Database were searched for clinical studies
investigating the analgesic effect of ESP block versus placebo. The
primary outcomes included the visual analogue scale (VAS) at rest and
during movement, as well as the postoperative morphine consumption in 24
h, and the secondary outcome was the rate of postoperative nausea and
vomiting (PONV). The choice of using the fixed or random-effects model
depended on whether the heterogeneity tested by I2 statistic
was more than 50%. Seeking sources of heterogeneity and exploring the
effect of clinical details on the final result were performed by subgroup
analysis. Additionally, the test for stability of the pooled result was
realized by sensitivity analysis. Finally, we evaluated the quality of the
evidence for the outcomes. STATA 13.0 software was selected as the main
analysis software in the meta-analysis. Result(s): Eighteen
randomized controlled trials (RCTs) comprising 1041 patients were
reviewed. This meta-analysis showed that ESP block could significantly
reduce patients' pain scores at 1 h, 6 h, 12 h, and 24 h after surgery at
rest or during movement; 24-h postoperative morphine consumption; and the
incidence of PONV. Conclusion(s): ESP block as a novel technique
exhibited superior postoperative analgesic effects, reducing the
postoperative complications in spinal, thoracic, and abdominal surgeries
during the early postoperative period. However, as a new nerve block
technique, numerous large-sized RCTs are needed for further
research. Copyright © 2020 IJS Publishing Group Ltd

<75>
Accession Number
2007022014
Title
A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic
valve replacement in low-risk patients with severe aortic stenosis.
Source
Journal of Geriatric Cardiology. 17 (1) (pp 43-50), 2020. Date of
Publication: 2020.
Author
Malik A.H.; Zaid S.; Ahmad H.; Goldberg J.; Dutta T.; Undemir C.; Cohen
M.; Aronow W.S.; Lansman S.L.
Institution
(Malik) Department of Medicine, Westchester Medical Center, New York
Medical College, Valhalla, NY, United States
(Zaid, Ahmad, Dutta, Cohen, Aronow) Department of Cardiology, Westchester
Medical Center, New York Medical College, Valhalla, NY, United States
(Goldberg, Undemir, Lansman) Section of Cardiothoracic Surgery, Department
of Surgery, Westchester Medical Center, Valhalla, NY, United States
Publisher
Science Press (E-mail: wangjing@neigae.ac.cn)
Abstract
Background Transcatheter aortic valve replacement (TAVR) for the treatment
symptomatic severe aortic stenosis (AS) is indicated in patients with
intermediate or higher surgical risk. Latest trials showed TAVR, and
surgical aortic valve replacement (SAVR) perform similarly at 1-year for
the composite outcomes of mortality, stroke and rehospitalization. We
performed a comprehensive meta-analysis to compare individual outcomes at
1-year for TAVR compared to SAVR in low-risk patients. Methods PubMed,
Embase, and Cochrane central were searched for all the randomized
controlled trials (RCTs) that reported 1-year comparative outcomes of TAVR
and surgical aortic valve replacement (SAVR). Our conclusions are based
upon the random-effects model using DerSimonian-Laird estimator. Results
Data from 4 trials and 2887 randomized patients showed that TAVR had lower
rates of all-cause mortality, cardiovascular mortality, and atrial
fibrillation compared to SAVR at 1-year follow-up (P < 0.05 for all).
Also, TAVR was also associated with a significantly higher risk of
permanent pacemaker implantation and moderate-severe paravalvular leak (P
< 0.05). Conclusions The latest randomised trial data demonstrates that in
short-term, TAVR is safe and effective in reducing all-cause mortality or
stroke. Longer follow-up of RCTs is needed to determine the durability of
clinical benefits in TAVR over SAVR in low-risk patients. Copyright
© 2020 JGC All rights reserved

<76>
Accession Number
2006805991
Title
Mitral valve replacement using subvalvular apparatus: A systematic review
and meta-analysis.
Source
Heart Surgery Forum. 23 (3) (pp E385-E392), 2020. Date of Publication: May
2020.
Author
Hsieh W.C.; Aboud A.; Henry B.M.; Kan C.D.; Omara M.; Lindner J.
Institution
(Hsieh) First Faculty of Medicine, Charles University, Prague, Czechia
(Hsieh, Lindner) 2nd Department of Cardiovascular Surgery, First Faculty
of Medicine, Charles University, General University Hospital in Prague,
Prague, Czechia
(Aboud) Department of Cardiac and Thoracic Vascular Surgery, University of
Schleswig-Holstein, Lubeck Campus, Lubeck, Germany
(Henry) Division of Cardiology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States
(Kan) Division of Cardiovascular Surgery, Department of Surgery, National
Cheng Kung University Hospital, Tainan, Taiwan (Republic of China)
(Omara) Department of Thoracic and Cardiovascular Surgery, Research
Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: To assess clinical outcomes among participants undergoing
mitral valve replacement with preservation of subvalvular apparatus.
 Method(s): Electronic databases, including PubMed, Embase, Science
Direct, World of Science, Scopus, Biosis, SciElo and Cochrane library,
were probed using an extensive search strategy. Studies that reported at
least one clinical outcome, such as morbidity, mortality, early 30-day
mortality, myocardial failure, survival, late cerebrovascular events,
length of stay, or major operative complications (stroke, prolonged
ventilation, and reoperation for bleeding, renal failure, and sternal
infection) were considered for inclusion. Data was extracted and pooled
into a meta-analysis in RevMan (version 5.3) using a random-effects model.
 Result(s): A total of 21 studies with 5,106 participants (age range:
27.3-69.2 years) were included in this meta-analysis. Preservation of the
subvalvular apparatus during MVR significantly reduces the risk of
long-term mortality (OR: 0.46; 95% CI: 0.33-0.64), but not early mortality
(OR: 0.76; 95% CI: 0.12-4.93). No significant difference ejection fraction
was observed (SMD: 0.10; 95% CI: -0.44-0.64). Similarly, there was no
significant difference in the risk of stroke, renal failure, and pneumonia
between C-MVR and in the control group. Conclusion(s): MVR with the
preservation of subvalvular apparatus improves clinical outcomes, such as
long-term mortality, hospital length of stay, pneumonia, and bleeding.
There is no significant difference in the risk of stroke, renal failure,
or ICU length of stay. However, there is very limited data available with
respect to bleeding, sepsis, and nosocomial infections. Copyright
© 2020 Forum Multimedia Publishing, LLC.

<77>
Accession Number
2005566380
Title
Percutaneous pulmonary valve implantation in patients with right
ventricular outflow tract dysfunction: a systematic review and
meta-analysis.
Source
Therapeutic Advances in Chronic Disease. 10 (no pagination), 2019. Date of
Publication: 2019.
Author
Ran L.; Wang W.; Secchi F.; Xiang Y.; Shi W.; Huang W.
Institution
(Ran) The First Clinical College of Chongqing Medical University,
Chongqing, China
(Wang, Xiang, Shi) Department of Cardiology, First Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Secchi) Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy
(Huang) Department of Cardiology, The First Affiliated Hospital of
Chongqing Medical University, No. 1 Youyi Road, Yuzhong District,
Chongqing 400016, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Pulmonary valve replacement is required for patients with
right ventricular outflow tract (RVOT) dysfunction. Surgical and
percutaneous pulmonary valve replacement are the treatment options.
Percutaneous pulmonary valve implantation (PPVI) provides a less-invasive
therapy for patients. The aim of this study was to evaluate the
effectiveness and safety of PPVI and the optimal time for implantation.
 Method(s): We searched PubMed, EMBASE, Clinical Trial, and Google
Scholar databases covering the period until May 2018. The primary
effectiveness endpoint was the mean RVOT gradient; the secondary endpoints
were the pulmonary regurgitation fraction, left and right ventricular
end-diastolic and systolic volume indexes, and left ventricular ejection
fraction. The safety endpoints were the complication rates.
 Result(s): A total of 20 studies with 1246 participants enrolled were
conducted. The RVOT gradient decreased significantly [weighted mean
difference (WMD) = -19.63 mmHg; 95% confidence interval (CI): -21.15,
-18.11; p < 0.001]. The right ventricular end-diastolic volume index
(RVEDVi) was improved (WMD = -17.59 ml/m2; 95% CI: -20.93, -14.24; p <
0.001), but patients with a preoperative RVEDVi >140 ml/m2 did not reach
the normal size. Pulmonary regurgitation fraction (PRF) was notably
decreased (WMD = -26.27%, 95% CI: -34.29, -18.25; p < 0.001). The
procedure success rate was 99% (95% CI: 98-99), with a stent fracture rate
of 5% (95% CI: 4-6), the pooled infective endocarditis rate was 2% (95%
CI: 1-4), and the incidence of reintervention was 5% (95% CI: 4-6).
 Conclusion(s): In patients with RVOT dysfunction, PPVI can relieve
right ventricular remodeling, improving hemodynamic and clinical
outcomes. Copyright © The Author(s), 2019.

<78>
Accession Number
629992767
Title
Levosimendan Reduces Mortality and Low Cardiac Output Syndrome in Cardiac
Surgery.
Source
The Thoracic and cardiovascular surgeon. 68 (5) (pp 400-408), 2020. Date
of Publication: 01 Aug 2020.
Author
Weber C.; Esser M.; Eghbalzadeh K.; Sabashnikov A.; Djordjevic I.; Maier
J.; Merkle J.; Choi Y.-H.; Madershahian N.; Liakopoulos O.; Deppe A.C.;
Wahlers T.C.W.
Institution
(Weber, Esser, Eghbalzadeh, Sabashnikov, Djordjevic, Maier, Merkle, Choi,
Madershahian, Liakopoulos, Deppe, Wahlers) Department of Cardiothoracic
Surgery, University of Cologne, Cologne, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: There has been conflicting evidence concerning the effect of
levosimendan on clinical outcomes in patients undergoing cardiac surgery.
Therefore, we performed a systematic review and conducted this
meta-analysis to provide evidence for/against the administration of
levosimendan in cardiac surgery patients. METHOD(S): We performed a
meta-analysis from literature search in PubMed, EMBASE, and Cochrane
Library. Only randomized controlled trials comparing the administration of
levosimendan in cardiac surgery patients with a control group (other
inotrope, standard therapy/placebo, or an intra-aortic balloon pump) were
included. In addition, at least one clinical outcome had to be mentioned:
mortality, myocardial infarction, low cardiac output syndrome (LCOS),
acute kidney injury, renal replacement therapy, atrial fibrillation,
prolonged inotropic support, length of intensive care unit, and hospital
stay. The pooled treatment effects (odds ratio [OR], 95% confidence
intervals [CI]) were assessed using a fixed or random effects model.
 RESULT(S): The literature search retrieved 27 randomized, controlled
trials involving a total of 3,198 patients. Levosimendan led to a
significant reduction in mortality (OR: 0.67; 95% CI: 0.49-0.91;
p=0.0087). Furthermore, the incidence of LCOS (OR: 0.56, 95% CI:
0.42-0.75; p<0.0001), acute kidney injury (OR: 0.63; 95% CI: 0.46-0.86;
p=0.0039), and renal replacement therapy (OR: 0.70; 95% CI: 0.50-0.98;
p=0.0332) was significantly decreased in the levosimendan group.
 CONCLUSION(S): Our meta-analysis suggests beneficial effects for the
prophylactic use of levosimendan in patients with severely impaired left
ventricular function undergoing cardiac surgery. The administration of
levosimendan was associated with a reduced mortality, less LCOS, and
restored adequate organ perfusion reflected in less acute kidney
injury. Copyright Georg Thieme Verlag KG Stuttgart . New York.

<79>
Accession Number
2005978425
Title
Growth of cardiac infants with post-surgical chylothorax can be supported
using modified fat breast milk with proactive nutrient-enrichment and
advancement feeding protocols; an open-label trial.
Source
Clinical Nutrition ESPEN. (no pagination), 2020. Date of Publication:
2020.
Author
DiLauro S.; Russell J.; McCrindle B.W.; Tomlinson C.; Unger S.; O'Connor
D.L.
Institution
(DiLauro, McCrindle, Tomlinson, Unger, O'Connor) Department of Nutritional
Sciences, University of Toronto, Medical Sciences Building, 5th Floor,
Room 5253, 1 King's College Circle, Toronto M5S 1A8, Canada
(DiLauro, Russell, McCrindle) Labatt Family Heart Centre, The Hospital for
Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
(DiLauro, O'Connor) Translational Medicine Program, The Hospital for Sick
Children, 686 Bay Street, Toronto M5G 0A4, Canada
(Russell, McCrindle, Tomlinson) Department of Pediatrics, Faculty of
Medicine, University of Toronto, Toronto M5G 1X8, Canada
(Tomlinson, Unger) Department of Neonatology, The Hospital for Sick
Children, 555 University Avenue, Toronto M5G 1X8, Canada
(Unger, O'Connor) Rogers Hixon Ontario Human Milk Bank, Mount Sinai
Hospital, 600 University Ave, Toronto M5G 1X5, Canada
(Unger, O'Connor) Department of Pediatrics, Mount Sinai Hospital, 600
University Avenue, Toronto M5G 1X5, Canada
Publisher
Elsevier Ltd
Abstract
Background & aim: Previously we showed that modified fat breast milk
(MFBM) facilitated resolution of post-surgical chylothorax in cardiac
infants, but their weight-for-age and length-for-age z-scores declined
over the >=6-week treatment duration. Our aim was to evaluate the growth
of infants diagnosed with post-surgical chylothorax and fed according to
one of two proactive feeding protocols using MFBM or a high medium
triglyceride (MCT)-containing formula (standard of care). Method(s):
In this open-label trial, infants who were receiving >50% of their enteral
feeds as breast milk prior to chylothorax diagnosis were randomized to
receive their enteral feeds according to one of two proactive MFBM
protocols: Target Fortification (n = 8), where the protein concentration
of defatted breast milk was measured weekly and multi- and single-nutrient
modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial
Concentration (n = 8), where defatted breast milk was initially fortified
to an energy and nutrient level higher than that of unmodified breast milk
(80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of
infants (n = 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml
protein). The intervention lasted for a minimum of 6-weeks after chest
tube removal and continued after discharge. Weekly weight, length and head
circumference (HC) measurements were completed. Result(s): At
enrolment, there was no statistically significant differences in mean
(+/-SD) weight-for-age (-1.6 +/- 0.9, n = 24), length-for-age (-1.3 +/-
0.8), or HC-for-age (-0.9 +/- 1.0) z-scores among groups. Changes in mean
weight- (-0.3 +/- 0.9, n = 23), length- (0.1 +/- 0.6) and HC-for-age (0.2
+/- 0.6) z-scores did not differ among groups over the treatment period.
There was no difference in duration or volume of chest tube drainage
across groups. Conclusion(s): Use of proactive MFBM feeding protocols
both resolve chylothorax and support growth in infants following
cardiothoracic surgery. Trial registration: ClinicalTrials.gov
(NCT02577419). Copyright © 2020 The Authors

<80>
Accession Number
2005714677
Title
Long-Term Outcomes With Drug-Eluting Stents or Coronary Artery Bypass
Surgery for Unprotected Left Main Coronary Disease: A Meta-Analysis and
Trial Sequential Analysis of Randomized Trials.
Source
American Journal of Cardiology. 126 (pp 111-112), 2020. Date of
Publication: 1 July 2020.
Author
Elgendy I.Y.; Mahmoud A.N.; Gad M.; Elgendy A.Y.; Bhatt D.L.
Institution
(Elgendy) Division of Cardiology, Massachusetts General Hospital and
Harvard Medical School, Boston, MA, United States
(Mahmoud) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Gad) Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Elgendy) Division of Cardiovascular Medicine, University of Florida,
Gainesville, FL, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<81>
Accession Number
2005645066
Title
Long-term atrial arrhythmias incidence after heart transplantation.
Source
International Journal of Cardiology. 311 (pp 58-63), 2020. Date of
Publication: 15 July 2020.
Author
Anselmino M.; Matta M.; Saglietto A.; Gallo C.; Gaita F.; Marchetto G.;
Rinaldi M.; De Ferrari G.M.; Boffini M.
Institution
(Anselmino, Saglietto, Gallo, De Ferrari) Division of Cardiology,
Department of Medical Sciences, "Citta della Salute e della Scienza di
Torino" Hospital, University of Turin, Turin, Italy
(Matta) Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
(Gaita) Cardiovascular Department, Clinica Pinna Pintor, Policlinico di
Monza, Turin, Italy
(Marchetto, Rinaldi, Boffini) Division of Cardiac Surgery, Department of
Surgical Sciences, Citta della Salute e della Scienza, University of
Turin, Turin, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: Atrial arrhythmias after heart transplantation have rarely
been investigated. The aim of this study is to assess incidence, type and
predictors of atrial arrhythmias during a long-term follow-up in a large
population of heart-transplanted patients. Method(s): Consecutive
patients undergone to heart transplantation at our Centre from 1990 to
2017 were enrolled. All documented atrial arrhythmias were systematically
reviewed during a long-term follow-up after heart transplantation. Atrial
fibrillation (AF), atrial flutter and tachycardias were defined according
to current guidelines. Result(s): Overall, 364 patients were included
and followed for 120 +/- 70 months. During the follow-up period 108
(29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus
rhythm was present in 355 (97.5%) patients. Nine patients had persistent
atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%)
patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%)
patients, always atrial flutters. At univariate analysis several
echocardiographic (left ventricular end-diastolic diameter, TEI index,
mitral and tricuspid regurgitation grade) hemodynamic (systolic and
diastolic pulmonary pressure, capillary wedge pressure) and clinical
(dyslipidaemia, weight, pacemaker implantation) parameters related to
higher incidence of atrial arrhythmias. Conclusion(s): Persistent
atrial arrhythmias, and most of all AF, are rare among heart
transplantation carriers, despite substantial comorbidities resulting in
significant mortality. It can be speculated that the lesion set provided
by the surgical technique, a complete and transmural electrical isolation
of the posterior left atrium wall, represents an effective lesion set to
prevent persistent AF. Copyright © 2020

<82>
Accession Number
2004122677
Title
Tolvaptan can limit postoperative paroxysmal atrial fibrillation
occurrence after open-heart surgery.
Source
Surgery Today. 50 (8) (pp 841-848), 2020. Date of Publication: 01 Aug
2020.
Author
Nakamura Y.; Kishimoto Y.; Harada S.; Onohara T.; Otsuki Y.; Horie H.;
Nishimura M.
Institution
(Nakamura, Kishimoto, Harada, Onohara, Otsuki, Horie, Nishimura)
Department of Cardiovascular Surgery, Tottori University Faculty of
Medicine, Tottori University Hospital, 36-1 Nishi-cho, Yonago 683-8504,
Japan
Publisher
Springer ( Singapore)
Abstract
Purpose: Tolvaptan administration in the early postoperative period after
cardiac surgery rapidly treats fluid retention without affecting the renal
function. Tolvaptan also has the benefit of not stimulating the
renin-angiotensin and sympathetic nervous systems, which are risk factors
for postoperative paroxysmal atrial fibrillation. In this study, we
examined the hypothesis that tolvaptan administration reduces
postoperative paroxysmal atrial fibrillation and worsening of the renal
function incidence in patients who have undergone open-heart surgery.
 Method(s): From our previous randomized study, we selected 166
open-heart surgery patients, divided them into 2 groups [tolvaptan group,
83 patients; control (non-tolvaptan) group, 83 patients], and compared the
incidence of postoperative paroxysmal atrial fibrillation and worsening of
the renal function in the postoperative period between the groups.
 Result(s): The incidence of worsening of the renal function was
significantly lower in the tolvaptan group than in the control group (4.8%
vs. 15.7%; P = 0.04). The incidence of postoperative paroxysmal atrial
fibrillation within 14 days was also significantly lower in the tolvaptan
group than in the control group (26.5% vs. 42.2%; P = 0.011).
 Conclusion(s): Tolvaptan administration in the early postoperative
period after open-heart surgery may reduce the incidence of postoperative
paroxysmal atrial fibrillation and worsening of the renal
function. Copyright © 2020, Springer Nature Singapore Pte Ltd.

<83>
Accession Number
2003434883
Title
Perioperative Biomarkers Predicting Postoperative Atrial Fibrillation Risk
After Coronary Artery Bypass Grafting: A Narrative Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (7) (pp 1933-1941),
2020. Date of Publication: July 2020.
Author
Khan M.S.; Yamashita K.; Sharma V.; Ranjan R.; Selzman C.H.; Dosdall D.J.
Institution
(Khan, Yamashita, Ranjan, Selzman, Dosdall) Nora Eccles Harrison
Cardiovascular Research and Training Institute, University of Utah, Salt
Lake City, UT, United States
(Yamashita, Ranjan, Dosdall) Division of Cardiovascular Medicine,
University of Utah, Salt Lake City, UT, United States
(Sharma, Selzman, Dosdall) Division of Cardiothoracic Surgery, University
of Utah, Salt Lake City, UT, United States
(Ranjan, Dosdall) Department of Bioengineering, University of Utah, Salt
Lake City, UT, United States
Publisher
W.B. Saunders
Abstract
Postoperative atrial fibrillation (POAF) after cardiac surgery remains a
highly prevalent and costly condition that negatively impacts patient
quality of life and survival. Numerous retrospective studies,
meta-analysis, and review papers have been reported identifying POAF risk
based on patients' risk factors and clinical biomarkers. In this narrative
review, the authors report significant variations among selected pre- and
perioperative biomarkers used to predict POAF incidence in patients
without a history of atrial fibrillation (AF). POAF prediction based on
B-type natriuretic peptide, N-terminal pro B-type natriuretic peptide,
C-reactive protein, interleukin-6, creatinine, and plasminogen activator
inhibitor-1 differs significantly among different studies, thereby
limiting their clinical utility to predict POAF risk with high accuracy.
Conversely, soluble vascular endothelial cells adhesion molecule-1,
soluble CD40 ligand, Galectin-3, and aldosterone show promise for better
POAF prediction. However, the current datasets for these selected
biomarkers are not of sufficient size to validate the broad clinical
application specifically for patients with no prior history of
AF. Copyright © 2019 Elsevier Inc.

<84>
Accession Number
632400020
Title
The role of entropy monitoring in reducing propofol requirements during
open heart surgeries. A prospective randomized study.
Source
Annals of cardiac anaesthesia. 23 (3) (pp 272-276), 2020. Date of
Publication: 01 Jul 2020.
Author
Elgebaly A.S.; El Mourad M.B.; Fathy S.M.
Institution
(Elgebaly, El Mourad, Fathy) Department of Anesthesia and PSICUD, Faculty
of Medicine, Tanta University, Egypt
Publisher
NLM (Medline)
Abstract
Background: Hypotension, which is commonly associated with propofol
induction of general anesthesia in coronary artery bypass grafting (CABG)
surgery, may cause adverse consequences in patients with coronary artery
diseases undergoing this type of surgeries. The clinical absence of verbal
response and eyelash reflex was used as an endpoint for hypnosis. Spectral
entropy, as a novel monitoring method for the endpoint of hypnosis, affect
the dose of required anesthetic agents for induction as well as the
hemodynamic profile during general anesthesia in CABG surgery.
 Aim(s): We hypothesized that entropy monitoring might reduce the dose
of propofol required for induction of anesthesia during CABG surgery and
could maintain hemodynamic stability when compared with the conventional
clinical monitoring. Material(s) and Method(s): Sixty adult patients
of both sexes, aged 30-60 years, ASA II and III, and scheduled for CABG
surgery were enrolled in this prospective, controlled, randomized,
double-blind study. These patients were randomly divided into two equal
groups to receive intravenous propofol for induction of anesthesia guided
by either the patients' clinical response (Group I) or by entropy
monitoring (Group II). The total dose of propofol used for induction of
anesthesia was recorded. Hemodynamic parameters and entropy values were
also recorded. Result(s): Propofol consumption was significantly
reduced in Group II than Group I (P = 0.000*). Heart rate showed no
statistical significance between the two groups, whereas the mean arterial
pressure significantly decreased at induction in group I compared to Group
II (P = 0.000*). The entropy values were significantly lower in Group I
than Group II at induction (P = 0.036* for state entropy; 0.002* for
response entropy). However, during intubation, and after 1 and 5 min,
entropy indices displayed a significant increase in Group I than Group II.
 Conclusion(s): Entropy monitoring significantly reduced the dose of
propofol required for induction of anesthesia and maintained hemodynamic
stability compared to the conventional clinical monitoring during CABG
surgeries.

<85>
Accession Number
632399634
Title
Pharmacological preconditioning with intralipid in patients undergoing
off-pump coronary artery bypass surgery.
Source
Annals of cardiac anaesthesia. 23 (3) (pp 327-331), 2020. Date of
Publication: 01 Jul 2020.
Author
Pruthi G.; Singh N.G.; Nagaraja P.S.; Balaji R.M.; Manjunatha N.;
Choudhary P.K.; Raja M.K.
Institution
(Pruthi, Singh, Nagaraja, Balaji, Manjunatha, Raja) Department of Cardiac
Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Jayanagar, Karnataka, India
(Choudhary) Department of Sports Medicine, Bengaluru, Karnataka, India
Publisher
NLM (Medline)
Abstract
Aims and Objectives: The objective of the study was to determine the
preconditioning myocardial protective effects of intralipid (IL) in
off-pump coronary artery bypass (OPCAB) surgery by measuring highly
sensitive troponin T (hsTnT) and cardiac-specific creatine kinase (CK-MB)
as markers of myocardial injury. Material(s) and Method(s): : Thirty
patients, scheduled to undergo elective OPCAB surgery, were randomly
assigned to the IL group (n = 15) or control (C) group (n = 15); the IL
group received an infusion of 20% IL 2 ml/kg, 30 min prior to
revascularization and the control group received an equivalent volume of
normal saline. Serum levels of hsTnT and CK-MB were measured before
surgery and at 6 h, 24 h, 48 h, and 72 h postoperatively. Also,
intraoperative hemodynamic parameters, inotrope use, ventilatory hours,
ICU stay, postoperative left ventricular ejection fraction, postoperative
lipid profile, renal and hepatic function tests were measured.
 Result(s): The hsTnT values at the 24 h, 48 h, and 72 h in IL group
were significantly lower as compared with the control group. The decline
in plasma levels of CK-MB mirrored the hsTnT levels post revascularization
at 24 h and 48 h in the IL group compared with the control group; however,
at 72 h, level was comparable in both the groups. None of the treated
patients had abnormal lipid metabolism, deranged renal, and hepatic
function. Conclusion(s): The study revealed Intralipid as a safe
pharmacological preconditioning agent for OPCAB surgeries which can reduce
the postischemic myocardial injury indicated by the reduction in
postischemic cardiac enzymes hsTnT and CK-MB.

<86>
Accession Number
632399493
Title
Comparison of postoperative cognitive decline in patients undergoing
conventional vs miniaturized cardiopulmonary bypass: A randomized,
controlled trial.
Source
Annals of cardiac anaesthesia. 23 (3) (pp 309-314), 2020. Date of
Publication: 01 Jul 2020.
Author
Yuhe K.; Huey Chew S.T.; Ang A.S.; Ge Ng R.R.; Boonkiangwong N.; Liu W.;
Hao Toh A.H.; Caleb M.G.; Man Ho R.C.; Ti L.K.
Institution
(Yuhe) Department of Anesthesiology, Singapore General Hospital, 20
College Road ,Academia ,Level 5, Singapore
(Huey Chew) Department of Anesthesiology, Singapore General Hospital, 20
College Road, Academia, Level 5; Department of Cardiovascular and
Metabolic Disorders, Duke-National University of Singapore Graduate
Medical School, 8 College Road, Singapore
(Ang) Yong Loo Lin School of Medicine, National University of Singapore,
NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore
(Ge Ng, Caleb) Department of Anesthesiology, Singapore General Hospital,
20 College Road, Academia, Level 5; Department of Cardiac, Thoracic and
Vascular Surgery, National University Hospital Singapore, 5 Lower Kent
Ridge Road, Singapore
(Boonkiangwong) Department of Cardiac, Thoracic and Vascular Surgery,
National University Hospital Singapore, Singapore
(Liu, Ti) Yong Loo Lin School of Medicine, National University of
Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of
Anesthesia, National University Health System, 5 Lower Kent Ridge Road,
Singapore
(Hao Toh) Department of Psychological Medicine, National University Health
System, 5 Lower Kent Ridge Road, Singapore
(Man Ho) Yong Loo Lin School of Medicine, National University of
Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of
Psychological Medicine, National University Health System, 5 Lower Kent
Ridge Road, Singapore
Publisher
NLM (Medline)
Abstract
Background: Neurocognitive dysfunction is a common complication of
coronary artery bypass grafting (CABG) with incidence of 19-38%. The
miniaturized cardiopulmonary bypass (MCPB) system was developed to reduce
hemodilution and inflammation and provides better cerebral protection than
conventional cardiopulmonary bypass (CCPB). In a meta-analysis, MCPB was
associated with a 10-fold reduction in the incidence of strokes. However,
its effect on postoperative cognitive decline (POCD) is unknown. We
assessed if MCPB decreases POCD after CABG and compared the risk factors.
 Method(s): A total of 71 Asian patients presenting for elective CABG
at a tertiary center were enrolled. They were randomly assigned to MCPB (n
= 36) or CCPB group (n = 35) and followed up in a single-blinded,
prospective, randomized controlled trial. The primary outcome was POCD as
measured by the repeatable battery of neuropsychological status (RBANS).
Inflammatory markers (tumor necrosis factor-alpha and interleukin-6),
hematocrit levels, and neutron-specific enolase (NSE) levels were studied.
 Result(s): Overall, the incidence of POCD at 3 months was 50%, and
this was not significantly different between both groups (51.4 vs 50.0%, P
= 0.90). Having <6 years of formal education [risk ratio (RR) = 3.014, 95%
confidence interval (CI) = 1.054-8.618, P = 0.040] was significantly
associated with POCD in the CCPB group, while the lowest hematocrit during
cardiopulmonary bypass was independently associated with POCD in the MCPB
group (RR = 0.931, 95% CI = 0.868-0.998, P = 0.044). The postoperative
inflammatory markers and NSE levels were similar between the two groups.
 Conclusion(s): This study shows that the MCPB was not superior to
CCPB with cell salvage and biocompatible tubing with regard to the
neurocognitive outcomes measured by the RBANS.

<87>
Accession Number
632203308
Title
Cardiac Surgery 2019 Reviewed.
Source
The Thoracic and cardiovascular surgeon. 68 (5) (pp 362-375), 2020. Date
of Publication: 01 Aug 2020.
Author
Doenst T.; Bargenda S.; Kirov H.; Moschovas A.; Tkebuchava S.; Safarov R.;
Velichkov I.; Diab M.
Institution
(Doenst, Bargenda, Kirov, Moschovas, Tkebuchava, Safarov, Velichkov, Diab)
Department of Cardiothoracic Surgery, Friedrich-Schiller University of
Jena, Jena, Germany
Publisher
NLM (Medline)
Abstract
For the year 2019, almost 25,000 published references can be found in
PubMed when entering the search term "cardiac surgery." We used the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
approach for article selection and reviewed the main fields of adult
cardiac surgery (i.e., coronary, valve, aortic, and heart failure
surgery). The past decade has experienced an enormous development of
interventional techniques that compete more and more with classic surgery.
This contest was broadly visible in 2019. It peaked over the
interpretation of the EXCEL trial data, where percutaneous coronary
intervention and coronary artery bypass grafting (CABG) for left main
disease were compared. A novel pathomechanism for CABG was proposed,
potentially answering open questions in the field. In aortic valve
surgery, two low-risk trials comparing transcatheter aortic valve
implantation (TAVI) to classic aortic valve replacement (surgical aortic
valve replacement) received attention for showing equal or superior
short-term outcomes for TAVI. Longer follow-up information from recent
trials became available presenting results emphasizing the need for joint
decision making. While publications addressing surgery on the aorta and
the mitral and tricuspid valves were less abundant, there was substantial
activity regarding left ventricular assist device support and heart
transplantation. This article attempts to summarize the most pertinent
publications. It does not expect to be complete and cannot be free of
individual interpretation. We aimed to provide a condensed summary of
2019s publications with a stimulus for in-depth reading and a basis
supporting patient information. Copyright Georg Thieme Verlag KG
Stuttgart . New York.

<88>
Accession Number
2004699587
Title
External stents for vein grafts in coronary artery bypass grafting:
Targeting intimal hyperplasia.
Source
Surgical Technology International. 36 (pp 1-5), 2020. Date of Publication:
May 2020.
Author
Weltert L.P.; Irace F.G.; Wolf L.G.; Fusca S.; Garufi L.; D'aleo S.;
Scaffa R.; Chirichilli I.; Salica A.; Bellisario A.; Ricci A.; DE PAULIS
R.
Institution
(Weltert, Irace, Wolf, Fusca, D'aleo, Scaffa, Salica, Bellisario, Ricci,
DE PAULIS) HEART SURGERY UNIT, EUROPEAN HOSPITAL, ROME, Italy
(Weltert) DEPARTMENT OF STATISTICS, SAN CAMILLUS INTERNATIONAL UNIVERSITY
FOR HEALTH SCIENCES, ROME, Italy
(Garufi) CARDIAC SURGERY, DEPARTMENT OF CARDIAC, THORACIC AND VASCULAR
SCIENCES, UNIVERSITY OF PADUA, PADOVA, Italy
(Chirichilli) DEPARTMENT OF CARDIAC SURGERY AND HEART TRANSPLANTATION, SAN
CAMILLO FORLANINI HOSPITAL, ROME, Italy
Publisher
Universal Medical Press
Abstract
Progressive saphenous vein graft (SVG) failure remains a key limitation to
the long-term success of coronary artery bypass grafting (CABG). SVG
disease after the first year is dominated by intimal hyperpla-sia, which
predisposes the SVG to thrombosis and accelerated atherosclerosis. The
objective of this study was to review and summarize the latest
experimental and clinical data on the use of mechanical external stents
for vein grafts. Method(s): In January 2020, the PubMed database was
searched using the terms "external stent", "CABG", "saphenous vein graft"
and "intimal hyperplasia". The results were reviewed and only randomized
experimental and clinical studies that analyzed the effect of external
stenting on venous intimal hyperplasia were included in the analysis,
together with studies that investigated the clinical benefit of external
stenting. Result(s): Eight experimental and four clinical trials met
the search criteria. Controlled trials in different large animal models
concluded that external stenting significantly reduced intimal hyperplasia
3-6 months post implantation, and reduced both thrombosis rates and the
development of lumen irregularities. Data from randomized controlled
trials with a follow-up period of 1-4.5 years supported the pre-clinical
findings and demonstrated that external stents significantly reduced vein
graft disease. Conclusion(s): Strong evidence indicates that
supporting the vein with external stents is safe and leads to clear
advantages at both the anatomical and cellular levels. With the further
accumulation of consistent positive results, external stenting of SVG may
become the standard of care in future CABG. Copyright © 2020
Surgical Technology InternationalTM.

<89>
Accession Number
2005638997
Title
Safety and Benefit of Transesophageal Echocardiography in Liver Transplant
Surgery: A Position Paper From the Society for the Advancement of
Transplant Anesthesia (SATA).
Source
Liver Transplantation. 26 (8) (pp 1019-1029), 2020. Date of Publication:
01 Aug 2020.
Author
De Marchi L.; Wang C.J.; Skubas N.J.; Kothari R.; Zerillo J.; Subramaniam
K.; Efune G.E.; Braunfeld M.Y.C.; Mandel S.
Institution
(De Marchi) Department of Anesthesiology, MedStar-Georgetown University
Hospital, Washington, DC, United States
(Wang) US Anesthesia Partners - Washington, Seattle, WA, United States
(Wang) Swedish Heart and Vascular Institute, Seattle, WA, United States
(Skubas) Cardiothoracic Anesthesiology, Anesthesiology Institute Cleveland
Clinic, Cleveland, OH, United States
(Kothari) Department of Anesthesia and Perioperative Care, University of
California San Francisco, San Francisco, CA, United States
(Zerillo) Department of Anesthesiology, Perioperative and Pain Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Subramaniam) Department of Anesthesiology, University of Pittsburgh
School of Medicine, Pittsburgh, PA, United States
(Efune) Department of Anesthesiology and Pain Management, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Braunfeld) Department of Anesthesiology & Perioperative Medicine,
University of California Los Angeles, Los Angeles, CA, United States
(Mandel) Department of Anesthesia, University of Colorado, Aurora, CO,
United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
More anesthesiologists are routinely using transesophageal
echocardiography (TEE) during liver transplant surgery, but the effects on
patient outcome are unknown. Transplant anesthesiologists are therefore
uncertain if they should undergo additional training and adopt TEE. In
response to these clinical questions, the Society for the Advancement of
Transplant Anesthesia appointed experts in liver transplantation and who
are certified in TEE to evaluate all available published evidence on the
topic. The aim was to produce a summary with greater explanatory power
than individual reports to guide transplant anesthesiologists in their
decision to use TEE. An exhaustive search recovered 51 articles of
uncontrolled clinical observations. Topics chosen for this study were
effectiveness and safety because they were a major or minor topic in all
articles. The pattern of clinical use was a common topic and was included
to provide contextual information. Summarized observations showed
effectiveness as the ability to make a new and unexpected diagnosis and to
direct the choice of clinical management. These were reported in each
stage of liver transplant surgery. There were observations that TEE
facilitated rapid diagnosis of life-threatening conditions difficult to
identify with other types of monitoring commonly used in the operating
room. Real-time diagnosis by TEE images made anesthesiologists confident
in their choice of interventions, especially those with a high risk of
complications such as use of anticoagulants for intracardiac thrombosis.
The summarized observations in this systematic review suggest that TEE is
an effective form of monitoring with a safety profile similar to that in
cardiac surgery patients. Copyright © 2020 by the American
Association for the Study of Liver Diseases.

<90>
Accession Number
2007112517
Title
Effect of different types of exercise on sleep deprivation and functional
capacity in middle aged patients after coronary artery bypass grafting.
Source
Sleep Science. 13 (2) (pp 113-118), 2020. Date of Publication: 2020.
Author
Atef H.; Helmy Z.; Farghaly A.
Institution
(Atef, Helmy, Farghaly) Cairo University, Physical Therapy for Internal
Medicine, Cairo, Egypt
Publisher
Brazilian Association of Sleep and Latin American Federation of Sleep
Societies
Abstract
Introduction: There are still many gaps in research concerning the effect
of different physical training modalities on sleep quality in the
population underwent coronary artery bypass graft (CABG) surgeries.
 Objective(s): The purpose of this study was to compare the effect of
different exercise types on sleep quality and functional capacity after
CABG. Material(s) and Method(s): 80 Participants aged 45-65 years
were randomized to two groups: aerobic group (AG), and combined aerobic
and resistance group (ARG). Training lasted ten consecutive weeks with 30
uninterrupted sessions. The actigraph together with Pittsburg Sleep
Quality Index (PSQI) were used in sleep quality assessment. Six-minute
walk test (6MWT) was used in assessment of functional capacity. The
actigraph (Actiwatch Minimitter Company, Incorporated (INC) - Sunriver,
OR, USA) was placed on the non-dominant wrist and activities were
monitored continuously while being recorded at one-minute intervals. The
participants kept the device for a period of 96 hours, filled PSQI, and
did 6MWT before the first and last training sessions. Result(s):
There was significant decrease in the mean value of sleep latency,
fragmentation index, light sleep duration and sleep quality scores
(p<0.01); and significant increase in total sleep duration, deep sleep
duration, number of points on the actigraphy, sleep efficiency and
functional capacity in both (AG) and (ARG) (p<0.01), that difference was
more significant in the aerobic group (AG) (p<0.01). Conclusion(s):
Both modes of exercise (aerobic alone and combined aerobic and resistance
exercises) can improve sleep quality and functional capacity, but isolated
aerobic exercise can do that more significantly. Copyright © 2020
Brazilian Association of Sleep and Latin American Federation of Sleep
Societies. All rights reserved.

<91>
Accession Number
2007155751
Title
Analgesic efficacy of ultrasound guided bilateral transversus thoracis
muscle plane block in pediatric cardiac surgery: a randomized,
double-blind, controlled study.
Source
Journal of Clinical Anesthesia. 67 (no pagination), 2020. Article Number:
110002. Date of Publication: December 2020.
Author
Abdelbaser I.I.; Mageed N.A.
Institution
(Abdelbaser, Mageed) Department of Anesthesiology and Surgical Intensive
Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria St,
Mansoura 35516, Egypt
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: Adequate perioperative pain control in children
undergoing cardiac surgery is mandatory. Intravenous opioids and neuraxial
anesthetic techniques have been used but didn't gained any popularity. The
aim of the current study was to evaluate the analgesic efficacy of
transversus thoracis plane (TTP) block in pediatric cardiac surgery.
 Design(s): Superiority, randomized, double-blind, controlled study.
 Setting(s): Intraoperative and postoperative in intensive care unit
(ICU), Mansoura university children hospital, Egypt. Patient(s):
Eighty pediatric patients aged 2-12 years, undergoing cardiac surgery via
median sternotomy, were randomly allocated into 2 equal groups, the
control group and TTP block group. Intervention(s): Controlled group
received only fentanyl for perioperative analgesia, while TTP block was
performed in the intervention group (TTP group). Measurements: The primary
outcome measure was the total dose of fentanyl in the first postoperative
24 h after extubation, while the secondary outcome measures were
postoperative pain score, intraoperative fentanyl consumption, time to
extubation and ICU length of stay. Main Result(s): During the first
postoperative 24 h, total fentanyl consumption was significantly lower (P
< 0.05) in the TTP block group (9.892 +/- 3.397 mug/kg) than the control
group (18.500 +/- 3.401 mug/kg) and modified objective pain score was
significantly (P < 0.05) lower in TTP block group than the control group
all over the time. Total intraoperative fentanyl requirement was
significantly (P < 0.05) lower in TTP block group (8.27 +/- 1.170 mug/kg)
than the control group (13.72 +/- 1.186 mug/kg). Conclusion(s): The
use of TTP block decreased perioperative fentanyl consumption and reduced
postoperative pain intensity. Copyright © 2020 Elsevier Inc.

<92>
Accession Number
2006910736
Title
Effect of selenium added to the cardioplegic solution on cardiac
protection in coronary artery bypass grafting surgeries: A randomized,
double-blinded, clinical trial study.
Source
Iranian Red Crescent Medical Journal. 21 (10) (no pagination), 2019.
Article Number: 92737. Date of Publication: October 2019.
Author
Shafa M.; Azemati S.; Abasi M.; Hemati R.
Institution
(Shafa, Azemati, Abasi, Hemati) Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: library@kowsarpub.com)
Abstract
Background: Coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to
the development of myocardial damage and dysfunction. Selenium is the main
cofactor for many antioxidant enzymes. Selenium level is decreased during
heart surgeries affecting the cardiopulmonary pump, which in turn can
aggravate the organ and heart dysfunction and mortality.
 Objective(s): The aim of this study was to evaluate the cardiac
protective effects of adding selenium to cardioplegia solution in these
surgeries. Method(s): In this randomized, double-blind, clinical
trial study that was conducted in the department of cardiac surgery of
Shiraz University of Medical Sciences (SUMS) in Shiraz, Iran, 67 elected
CABG patients were allocated to the two control or selenium groups. In the
intervention group, 1000 micro g sodium selenite was added to
cardioplegia solution. The same amount of normal saline was added to the
cardioplegia solution in the control group. Arterial blood samples were
withdrawn before anesthesia induction (T1), immediately after the surgery
(T2), as well as, 6 and 24 hours after the surgery (T3 and T4
respectively), to determine the CK-MB and Troponin I levels.
 Result(s): According to our findings, the CK-MB and Troponin I
cardiac enzyme levels were significantly different, considering different
time points (P < 0.05). Despite lower enzyme levels in the selenium group,
the differences were not statistically significant between the two groups
(P > 0.05). There were also no significant differences between the two
groups regarding systolic and diastolic blood pressures.
 Conclusion(s): The administration of 1000 micro g sodium selenite
via cardioplegia solution had no significant cardioprotective effect
during coronary bypass surgery in CABG patients. Copyright ©
2019, Author(s). This is an open-access article distributed under the
terms of the Creative Commons Attribution-NonCommercial 4.0 International
License (http://creativecommons.org/licenses/by-nc/4.0/) which permits
copy and redistribute the material just in noncommercial usages, provided
the original work is properly cited

<93>
Accession Number
2007104433
Title
Effects of coronary artery bypass grafting surgery on olfactory and taste
functions.
Source
Heart Surgery Forum. 22 (5) (pp E416-E422), 2019. Date of Publication:
October 2019.
Author
Erdem K.; Ucaroglu E.R.; Sehitogullari A.; Yuksel A.; Tekce H.; Velioglu
Y.; Demirhan A.; Korkmaz U.T.K.; Borulu F.; Unal O.; Ulku A.; Calisir E.
Institution
(Erdem, Ucaroglu, Yuksel, Velioglu, Korkmaz, Unal, Ulku, Calisir)
Department of Cardiovascular Surgery, Faculty of Medicine, Bolu Abant
Izzet Baysal University, Bolu, Turkey
(Sehitogullari) Departmant of Thoracic Surgery, Faculty of Medicine,
Sakarya University, Sakarya, Turkey
(Tekce) Department of Nephrology, Faculty of Medicine, Bolu Abant Izzet
Baysal University, Bolu, Turkey
(Demirhan) Department of Anesthesiology and Reanimation, Faculty of
Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
(Borulu) Department of Cardiovascular Surgery, Faculty of Medicine,
Ataturk University, Erzurum, Turkey
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Olfactory and taste sensations have a high impact on the
quality of life. Impaired olfactory and taste functions may have a
negative effect on physical and mental well-being, personal hygiene, and
nutritional satisfaction, leading to the occurrence of depressive symptoms
and impaired quality of life. Therefore, the recovery period of patients
with disturbed olfactory and taste functions may be prolonged, and return
to active life may be delayed. We designed this study to determine whether
on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have
any effects on olfactory and taste functions and compare these functions
between the surgical groups. Method(s): A total of 60 patients, who
underwent elective isolated first-time CABG, were included in this study.
Patients were divided into two groups as Off-Pump and On-Pump CABG groups
with 30 patients in each group. In addition to patients' primary clinical
and laboratory data, olfactory and taste functions were evaluated pre- and
postoperatively in both groups separately, and then these functions were
compared between the groups. Olfactory functions were evaluated by the
Brief Smell Identification Test, while taste functions by the Burghart
Taste test. Result(s): Olfactory functions significantly were
disrupted in the postoperative period in patients undergoing on-pump CABG
(P value < .05), while these functions significantly were not affected in
patients undergoing off-pump CABG (P value > .05). During the preoperative
period, advanced age and smoking were detected to be independent
predictors of impaired olfactory function for the study population. During
the postoperative period, smoking, amount of postoperative bleeding and
serum low-density lipoprotein (LDL) level were found to be independent
predictors of impaired olfactory function for just the On-Pump CABG Group.
In both groups, no significant deterioration in taste functions occurred
during the postoperative period (P value > .05). Conclusion(s): Our
study demonstrated that olfactory function was impaired in patients, who
underwent on-pump CABG in the postoperative period, and significant
impairment in taste function was present in neither off-pump nor on-pump
CABG patients. However, the results of our study should be supported by
more comprehensive, prospective, randomized controlled trials with more
extensive patient series and by further tests. Copyright © 2019
Forum Multimedia Publishing, LLC

<94>
[Use Link to view the full text]
Accession Number
2007104425
Title
An open-label, single center, retrospective study to evaluate clinical
outcomes with surgical sealant in bentall procedures: A cohort study.
Source
Heart Surgery Forum. 22 (5) (pp E396-E400), 2019. Date of Publication:
September 2019.
Author
Gu J.; Lai H.; Li J.; Sun Y.; Liu C.; Wang Y.; Zhang Z.; Kang L.; Huang
B.; Wang C.
Institution
(Gu, Lai, Li, Sun, Liu, Wang, Zhang, Kang, Huang, Wang) Zhongshan
Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District,
Shanghai City 200032, China
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Cardiovascular surgery is associated with substantial risk for
postoperative bleeding with increased patient morbidity and mortality.
Numerous intraoperative techniques have been utilized to reduce this risk.
This study was to assess postoperative bleeding-related parameters
following Bentall procedures and to examine the impact of intraoperative
surgical sealant application. Method(s): The medical/surgical records
of 100 consecutive Bentall procedure cases were examined retrospectively
for perioperative surgical sealant use and postoperative bleeding-related
outcomes. Result(s): Of the 100 patient cases, three died during the
postoperative period, and 97 were evaluable. Surgical sealant was utilized
in 56 patient cases (57.8%). The utilization versus no utilization of
surgical sealant was associated with significant reductions in most
postoperative bleeding-related parameters, including less drainage (P =
.028), resternotomy for hemorrhage (P = .036), transfusion of red blood
cells (P = .022 at 48 hours; P = .027 total in-hospital), transfusion of
fresh frozen plasma (P = .04 at 48 hours; P = .004 total in-hospital), and
a higher percentage of cases not needing blood transfusion (P = .002). The
surgical sealant group had longer cardiopulmonary bypass circuit (P =
.016) and aortic cross-clamp time (P = .001), with no significant
between-group differences in intubation time (P = .636) or intensive care
unit duration (P = .294). When excluding urgent cases or Stanford type A
aortic dissections, intensive care unit duration significantly was shorter
in the surgical sealant group (P = .017). Surgical sealant use was not
associated with any adverse events. Conclusion(s): The application of
surgical sealant to the anastomosis suture line in Bentall procedures
reduces postoperative drainage, bleeding, and transfusion utilization.
Further studies are warranted to investigate these benefits in
prospective, randomized clinical trials. Copyright © 2019 Forum
Multimedia Publishing, LLC

<95>
Accession Number
2007104410
Title
Comparison by real-time hemodynamic and cardiac efficiency monitoring of
sufentanil-midazolam and sevoflurane for anesthesia induction in children
undergoing cardiac surgery: A prospective randomized study.
Source
Heart Surgery Forum. 22 (1) (pp E38-E44), 2019. Date of Publication:
February 2019.
Author
Han D.; Liu Y.-G.; Pan S.-D.; Luo Y.; Li J.; Ou-Yang C.
Institution
(Han, Pan, Ou-Yang) Departments of Anesthesia
(Luo) Cardiac Surgery
(Li) Clinical Physiology Laboratory, Capital Institute, Pediatrics
Affiliated Children's Hospital, Beijing, China
(Han, Liu, Ou-Yang) Anesthesia Center, Capital Medical University
Affiliated Beijing Anzhen Hospital, Beijing, China
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Intravenous sufentanil-midazolam and inhalational sevoflurane
are widely used for anesthetic induction in children undergoing cardiac
surgery. However, knowledge about their effects on hemodynamics and
cardiac efficiency remains limited due largely to the lack of direct
monitoring method. We used a minimally invasive technique, the pressure
recording analytical method (PRAM), to directly monitor hemodynamics and
cardiac efficiency, and compared the effects of the two anesthetic
regimens in children undergoing ventricular septal defect repair.
 Method(s): Forty-four children (2.3 +/- 0.9 years) were randomized
into two groups to receive either intravenous sufentanil (1 mug/kg) and
midazolam (0.2 mg/kg) (Group SM) or 2.0 MAC sevoflurane (Group S) to
complete induction after sedation was obtained with 2.0 MAC sevoflurane.
Systemic hemodynamic data recorded by PRAM included heart rate (HR),
systolic (SBP) and mean (MBP) blood pressure, stroke volume index (SVI),
cardiac index (CI), systemic vascular resistance index (SVRI), the maximal
slope of systolic upstroke (dp/dt<inf>max</inf>) and cardiac cycle
efficiency (CCE) after sedation obtained; 1, 2, and 5 minutes after
induction achieved; 1, 2, 5, and 10 minutes after intubation.
 Result(s): HR and SVRI showed a decrease in Group SM but an increase
in Group S (P<inf>time*group</inf> < 0.0001) in the study period. SVI and
CCE showed an increase in Group SM but a decrease in Group S
(P<inf>time*group</inf> < 0.0001). SBP, MBP, and CI were related to time
after polynomial transformation, showing an increase after intubation in
Group SM but a decrease in Group S (P<inf>time2*group</inf> < 0.0001).
 Conclusion(s): PRAM provides meaningful and direct monitoring of
hemodynamic parameters as well as cardiac efficiency during the dynamic
period of anesthetic induction in children undergoing cardiac surgery. As
compared to inhalational sevoflurane, intravenous sufentanil-midazolam
exerts more favorable effects on systemic hemodynamics and cardiac
efficiency during anesthetic induction in this group of
patients. Copyright © 2019 Forum Multimedia Publishing, LLC

<96>
Accession Number
2007164350
Title
Treatment options for ischemic mitral regurgitation: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Nappi F.; Antoniou G.A.; Nenna A.; Michler R.; Benedetto U.; Avtaar Singh
S.S.; Gambardella I.C.; Chello M.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Antoniou) Department of Vascular and Endovascular Surgery, The Royal
Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United
Kingdom
(Antoniou) Division of Cardiovascular Sciences, School of Medical
Sciences, University of Manchester, Manchester, United Kingdom
(Nenna, Chello) Department of Cardiovascular Surgery, University Campus
Bio-Medico of Rome, Rome, Italy
(Michler) Department of Surgery and Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
NY, United States
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Gambardella) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Treatment of ischemic mitral regurgitation (IMR) is in
evolution, as percutaneous procedures and complex surgical repair have
been recently investigated in randomized clinical trials and matched
studies. This study aims to review and compare the current treatment
options for IMR. Method(s): A comprehensive literature search was
conducted using electronic databases. The primary outcome was all-cause
long-term mortality. The secondary outcomes were perioperative mortality,
unplanned rehospitalization, reoperation, and composite end points as
defined in the original articles. Result(s): A total of 12 articles
met the inclusion criteria and were included in the final meta-analysis.
The MitraClip procedure did not confer a significant benefit in mortality
and repeated hospitalization compared with medical therapy alone. In
patients with moderate IMR, the adjunct of mitral procedure over coronary
artery bypass graft is not associated with clinical improvements. When
evaluating mitral valve (MV) replacement versus repair, hospital mortality
was greater among patients undergoing replacement (odds ratio [OR], 1.91;
P =.009), but both reoperation and readmission rates were lower (OR, 0.60,
P =.05; and OR, 0.45, P <.02, respectively). Comparing restrictive
annuloplasty alone with adjunctive subvalvular repair, subvalvular
procedures resulted in fewer readmissions (OR, 0.50; P =.06) and adverse
composite end points (P =.009). Conclusion(s): MitraClip procedure is
not associated with improved outcomes compared with medical therapy. MV
replacement is associated with increased early mortality but reduced
reoperation rate and readmission rate compared with MV repair using
annuloplasty in moderate-to-severe IMR. Despite no significant benefit in
isolated outcomes comparing annular and adjunct subvalvular procedures,
the adjunct of subvalvular procedures reduces the risk of major
postoperative adverse events. Copyright © 2020 The American
Association for Thoracic Surgery

<97>
Accession Number
2007164302
Title
Five-year outcomes comparing percutaneous coronary intervention with
drug-eluting stents versus coronary artery bypass grafting in patients
with left main coronary artery disease: A systematic review and
meta-analysis.
Source
Atherosclerosis. (no pagination), 2020. Date of Publication: 2020.
Author
Zhang J.; Jiang T.; Hou Y.; Chen F.; Yang K.; Sang W.; Wu H.; Ma Y.; Xu
F.; Chen Y.
Institution
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) Department of Emergency
Medicine, Qilu Hospital of Shandong University, Jinan, China
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) Shandong Provincial
Clinical Research Center for Emergency and Critical Care Medicine,
Institute of Emergency and Critical Care Medicine of Shandong University,
Qilu Hospital of Shandong University, Jinan, China
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) Key Laboratory of
Emergency and Critical Care Medicine of Shandong Province, Key Laboratory
of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province,
Shandong Provincial Engineering Laboratory for Emergency and Critical Care
Medicine, Qilu Hospital of Shandong University, Jinan, China
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) The Key Laboratory of
Cardiovascular Remodeling and Function Research, Chinese Ministry of
Education, Chinese Ministry of Health and Chinese Academy of Medical
Sciences, The State and Shandong Province Joint Key Laboratory of
Translational Cardiovascular Medicine, Qilu Hospital of Shandong
University, Jinan, China
(Chen) Emergency Department, The Affiliated Hospital of Inner Mongolia
Medical University, Huhhot, China
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: In patients with left main coronary artery disease
(LMCAD), long-term outcomes after percutaneous coronary intervention (PCI)
with drug-eluting stents (DES) compared with coronary artery bypass
grafting (CABG) remain controversial. We conducted a meta-analysis to
compare the efficacy and safety of PCI with DES and CABG in LMCAD
patients. Method(s): We comprehensively searched in Web of Science,
EMBASE, PubMed, and Cochrane databases for eligible randomised controlled
trials (RCTs) comparing the 5-year clinical outcomes between PCI with DES
and CABG in LMCAD patients. Random-effect models were applied to analyse
risk ratios (RRs) and hazard ratios (HRs) across studies, and
I2 to assess heterogeneity. Result(s): We screened 4 RCTs
including 4394 patients distributed randomly into PCI (n = 2197) and CABG
(n = 2197) groups. In comparison to CABG, PCI showed non-inferiority
concerning a composite of death, myocardial infarction, and stroke (HR
1.22, 95% confident interval [CI] 0.84-1.75), death (HR 1.06, 95% CI
0.81-1.40) and stroke (HR 0.80, 95% CI 0.42-1.53). Regarding major adverse
cardiac or cerebrovascular events (MACCE) rate, both strategies show
clinical equipoise in patients with a low-to-intermediate Synergy Between
PCI with TAXUS and Cardiac Surgery (SYNTAX) score (HR 1.20, 95% CI
0.85-1.70), while CABG had an advantage over PCI in those with a high
SYNTAX score (HR 1.64, 95% CI 1.20-2.24). Conclusion(s): CABG showed
advantage over PCI with DES for LMCAD patients in MACCE. PCI and CABG
showed equivalent 5-year clinical risk of a composite of all-cause
mortality, myocardial infarction, and stroke, but the former had higher
risk of repeat revascularization. Copyright © 2020 Elsevier B.V.

<98>
Accession Number
2007151997
Title
Performance and Safety of Transfemoral TAVI With SAPIEN XT in Australian
Patients With Severe Aortic Stenosis at Intermediate Surgical Risk:
SOLACE-AU Trial.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Yong G.; Walton T.; Ng M.; Gurvitch R.; Worthley S.; Whitbourn R.; Jepson
N.; Bhindi R.; Shang K.; Sinhal A.
Institution
(Yong) Fiona Stanley Hospital, Perth, WA, Australia
(Walton) Alfred Health, Melbourne, Vic, Australia
(Ng) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Gurvitch) Royal Melbourne Hospital, Melbourne, Vic, Australia
(Worthley) GenesisCare Cardiology, Sydney, NSW, Australia
(Whitbourn) St Vincent's Hospital Melbourne & Melbourne University,
Melbourne, Vic, Australia
(Jepson) Prince of Wales Public Hospital and Eastern Heart Clinic, Sydney,
NSW, Australia; University of NSW, Sydney, NSW, Australia
(Bhindi) North Shore Private Hospital, Sydney, NSW, Australia
(Shang) Edwards Lifesciences, Irvine, CA, United States
(Sinhal) Flinders Medical Centre, Flinders University, Adelaide, SA,
Australia
Publisher
Elsevier Ltd
Abstract
Background: To determine the safety and performance of the SAPIEN XT
transcatheter heart valve (THV) in Australian patients with severe aortic
stenosis (AS) and intermediate surgical risk. Method(s): Eligible
patients in this multi-centre, prospective, consecutively enrolled,
non-randomised, clinical trial, received transcatheter aortic valve
replacement via femoral artery access. Follow-up visits were at discharge,
30 days, and 6, 12, and 24 months. The primary endpoint was Valve Academic
Research Consortium-2 composite safety at 30 days: all-cause mortality,
all stroke, life-threatening bleeding, acute kidney injury-Stage 3,
coronary artery obstruction requiring intervention, major vascular
complication, and valve-related dysfunction requiring repeat procedure.
Other endpoints were device success (successful vascular access, delivery,
and deployment; correct position; intended performance mean aortic valve
gradient <20 mmHg, mild or less paravalvular aortic regurgitation [PAR];
and only one valve implanted) and New York Heart Association functional
class (NYHA). Kaplan-Meier (KM) estimates were calculated for the primary
endpoint. Result(s): At baseline, mean patient (N=199) age was 85.5
years, mean Society of Thoracic Surgeon score was 5.9, and 78.4% were in
NYHA class III/IV. The primary composite endpoint KM estimate was 12.1%.
Device success was 88.8%. SAPIEN XT was implanted in the proper location
in 98.5% (n=2: valve-in-valve procedures, n=1: no implant due to left main
coronary artery occlusion). No device malfunctions were reported. The post
procedure PAR was mild or less in 93.8% of patients. Mean aortic gradient
decreased from baseline (50.0 mmHg) to 2 years (10.3 mmHg). Most patients
(90.9%) were in NYHA class I/II at 30 days. New permanent pacemaker rate
was 8.1%. Stroke at 30 days was 3.5% (1.5% disabling). Conclusion(s):
SAPIEN XT was safe and improved heart failure symptoms and valve
haemodynamics in this cohort of Australian patients. Copyright ©
2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<99>
Accession Number
2005650331
Title
Evaluating the free radial forearm flap versus the pedicled pectoralis
major myocutaneous flap for oesophago-pharyngeal reconstruction: decision
making, outcome and literature review.
Source
European Journal of Plastic Surgery. (no pagination), 2020. Date of
Publication: 2020.
Author
Karonidis A.; Tsoutsos D.
Institution
(Karonidis, Tsoutsos) Department of Plastic Surgery, Microsurgery & Burns
Unit, General Hospital of Athens "G. Gennimatas", Mesogeion 154, Athens
11527, Greece
Publisher
Springer
Abstract
Background: The successful reconstruction of oesophago-hypopharyngeal
defects is a challenge and the choice of the best reconstructive option is
still controversial. The purposes of this study were to evaluate the use
of the free radial forearm flap (RFF) or the pedicled pectoralis major
(PM) flap for oesophago-hypopharyngeal reconstruction and to review the
literature, considering the free flap option as the state of the art. The
decision making, outcome and common complications were assessed.
 Method(s): From 2013 to 2018, 15 sequential patients with laryngeal
carcinoma, 61 years and BMI 24.6, were included in this retrospective
study. They underwent laryngectomy-pharyngo/esophagectomy and immediate or
secondary pharyngoesophageal reconstruction. Nine patients underwent
reconstruction with RFF (group A) and six with PM flap (group B). We
excluded patients with history of thoracic and breast surgery and
synchronous malignancy. We used the SPSS v.21 for statistical analysis.
 Result(s): The duration of surgery for RFF was longer (731 min versus
435 min). Postoperatively, all patients received radiotherapy, whereas
chemotherapy was administered in one patient. The RFF was the procedure of
choice for stages III-IV and larger defects and the PM for stage II (p =
0.002). Overall complication rates, fistula, stricture and swallowing
dysfunction were found higher in group B, but not significant
(p<inf>Compl</inf> = 0.315, p<inf>Fist</inf> = 1.000,
p<inf>Strict/Swall</inf> = 0.143). Furthermore, the secondary PM
reconstructions had non-statistically significant even higher fistula and
swallowing dysfunction rates (p = 0.400). Both groups reported equal good
results in terms of oral alimentation and speech. Conclusion(s): We
found that the RFF and PM flap could provide comparable outcomes in
oesophago-pharyngeal reconstruction. The RFF seems to be a superior
reconstructive option for advanced disease and larger defects and is
associated with better swallowing and fewer complications Level of
evidence: Level III, therapeutic study. Copyright © 2020,
Springer-Verlag GmbH Germany, part of Springer Nature.

<100>
Accession Number
632411630
Title
Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain
Control Post-Cardiac Surgery: A Randomized Controlled Trial.
Source
The Thoracic and cardiovascular surgeon. 68 (5) (pp 409-415), 2020. Date
of Publication: 01 Aug 2020.
Author
El Shora H.A.; El Beleehy A.A.; Abdelwahab A.A.; Ali G.A.; Omran T.E.;
Hassan E.A.; Arafat A.A.
Institution
(El Shora, El Beleehy) Anesthesia and Surgical ICU Department, Faculty of
Medicine-Tanta University, Egypt
(Abdelwahab, Omran, Hassan, Arafat) Department of Cardiothoracic Surgery,
Faculty of Medicine-Tanta University, Egypt
(Ali) Department of Cardiothoracic Surgery, Faculty of Medicine- Zagazig
University, Zagazig, Egypt
Publisher
NLM (Medline)
Abstract
BACKGROUND: Adequate pain control after cardiac surgery is essential.
Paravertebral block is a simple technique and avoids the potential
complications of epidural catheters. The objective of this study is to
compare the effect of ultrasound-guided bilateral thoracic paravertebral
block with thoracic epidural block on pain control after cardiac surgery.
MATERIALS AND METHODS: Between March 2016 and 2017, 145 patients who had
cardiac surgery through median sternotomy were randomized by stratified
blocked randomization into two groups. Group I (n=70 patients) had
bilateral ultrasound-guided thoracic paravertebral block and Group II
(n=75 patients) had thoracic epidural analgesia. The primary end point was
the postoperative visual analogue scale (VAS). The duration of mechanical
ventilation, intensive care unit (ICU), and hospital stay were the
secondary end points. The study design is a randomized parallel
superiority clinical trial. RESULT(S): Both groups had similar
preoperative and operative characteristics. No significant difference in
VAS measured immediately after endotracheal extubation then after 12, 24,
and 48 hours between groups (p=0.45). Pain score significantly declined
with the repeated measures (p<0.001) and the decline was not related to
the treatment group. Postoperative pain was significantly related to
diabetes mellitus (p=0.039). Six patients in group I (8.5%) required an
additional dose of morphine versus three patients (4%) in group II
(p=0.30). Patients in group I had significantly shorter ICU stay (p=0.005)
and lower incidence of urinary retention (p=0.04) and vomiting (p=0.018).
No difference was found in operative complications between groups.
 CONCLUSION(S): This randomized parallel controlled trial
demonstrates that ultrasound-guided paravertebral block is safe and
effective method for relieving post-cardiac surgery sternotomy pain
compared with thoracic epidural analgesia but not superior to
it. Copyright Georg Thieme Verlag KG Stuttgart . New York.

<101>
Accession Number
632410684
Title
Association of Radial Artery Graft vs Saphenous Vein Graft with Long-term
Cardiovascular Outcomes among Patients Undergoing Coronary Artery Bypass
Grafting: A Systematic Review and Meta-analysis.
Source
JAMA - Journal of the American Medical Association. 324 (2) (pp 179-187),
2020. Date of Publication: 14 Jul 2020.
Author
Gaudino M.; Benedetto U.; Fremes S.; Ballman K.; Biondi-Zoccai G.;
Sedrakyan A.; Nasso G.; Raman J.; Buxton B.; Hayward P.A.; Moat N.;
Collins P.; Webb C.; Peric M.; Petrovic I.; Yoo K.J.; Hameed I.; Di Franco
A.; Moscarelli M.; Speziale G.; Puskas J.D.; Girardi L.N.; Hare D.L.;
Taggart D.P.
Institution
(Gaudino, Hameed, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, United
States
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Fremes) Department of Surgery, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, Canada
(Ballman, Sedrakyan) Department of Healthcare Policy and Research, Weill
Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
(Nasso, Moscarelli, Speziale) Cardiothoracic and Vascular Department,
Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
(Raman) Austin Hospital, Melbourne, VIC, Australia
(Raman, Buxton, Hayward) Department of Surgery, University of Melbourne,
Melbourne, VIC, Australia
(Moat, Collins, Webb) NHLI, Imperial College London, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Peric, Petrovic) Dedinje Cardiovascular Institute, Belgrade University
School of Medicine, Belgrade, Serbia
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
(Puskas) Department of Cardiovascular Surgery, Mount Sinai St. Luke's, New
York, NY, United States
(Hare) Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Melbourne, VIC, Australia
(Hare) Department of Cardiology, Austin Health, Melbourne, VIC, Australia
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Observational studies have suggested that the use of radial
artery grafts for coronary artery bypass grafting may improve clinical
outcomes compared with the use of saphenous vein grafts, but this has not
been confirmed in randomized trials. Objective(s): To compare
clinical outcomes between patients receiving radial artery vs saphenous
vein grafts for coronary artery bypass grafting after long-term follow-up.
 Design, Setting, and Participant(s): Patient-level pooled analysis
comparing radial artery vs saphenous vein graft in adult patients
undergoing isolated coronary artery bypass grafting from 5 countries
(Australia, Italy, Serbia, South Korea, and the United Kingdom), with
enrollment from 1997 to 2009 and follow-up completed in 2019.
 Intervention(s): Patients were randomized to undergo either radial
artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery
bypass grafting. Main Outcomes and Measures: The primary outcome was
a composite of death, myocardial infarction, or repeat revascularization
and the secondary outcome was a composite of death or myocardial
infarction. Result(s): A total of 1036 patients were randomized (mean
age, 66.6 years in the radial artery group vs 67.1 years in the saphenous
vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in
the saphenous vein group); 942 (90.9%) of the originally randomized
patients completed 10 years of follow-up (510 in the radial artery group).
At a median (interquartile range) follow-up of 10 (10-11) years, the use
of the radial artery, compared with the saphenous vein, in coronary artery
bypass grafting was associated with a statistically significant reduction
in the incidence of the composite outcome of death, myocardial infarction,
or repeat revascularization (220 vs 237 total events; 41 vs 47 events per
1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P <.001) and
of the composite of death or myocardial infarction (188 vs 193 total
events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95%
CI, 0.63-0.94]; P =.01). Conclusions and Relevance: In this
individual participant data meta-analysis with a median follow-up of 10
years, among patients undergoing coronary artery bypass grafting, the use
of the radial artery compared with the saphenous vein was associated with
a lower risk of a composite of cardiovascular outcomes. Copyright
© 2020 American Medical Association. All rights reserved.

<102>
Accession Number
632408231
Title
Does the Presence of Significant Mitral Regurgitation prior to
Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact
Mortality? - Meta-Analysis and Systematic Review.
Source
Cardiology (Switzerland). 145 (7) (pp 428-438), 2020. Date of Publication:
01 Jul 2020.
Author
Sethi A.; Kodumuri V.; Prasad V.; Chaudhary A.; Coromilas J.; Kassotis J.
Institution
(Sethi, Chaudhary, Coromilas, Kassotis) Division of Cardiology, Rutgers
Robert Wood Johnson Medical School, New Brunswick, NJ, United States
(Kodumuri) John H. Stroger Hospital of Cook County, Chicago, IL, United
States
(Prasad) Division of Cardiology, Loma Linda University, Loma Linda, CA,
United States
Publisher
S. Karger AG
Abstract
Background: Mitral regurgitation (MR) is commonly encountered in patients
with severe aortic stenosis (AS). However, its independent impact on
mortality in patients undergoing transcatheter aortic valve implantation
(TAVI) has not been established. Method(s): We performed a systematic
search for studies reporting characteristics and outcome of patients with
and without significant MR and/or adjusted mortality associated with MR
post-TAVI. We conducted a meta-analysis of quantitative data.
 Result(s): Seventeen studies with 20,717 patients compared outcomes
and group characteristics. Twenty-one studies with 32,257 patients
reported adjusted odds of mortality associated with MR. Patients with MR
were older, had a higher Society of Thoracic Surgeons score, lower left
ventricular ejection fraction, a higher incidence of prior myocardial
infarction, atrial fibrillation, and a trend towards higher NYHA class
III/IV, but had similar mean gradient, gender, and chronic kidney disease.
The MR patients had a higher unadjusted short-term (RR = 1.46, 95% CI
1.30-1.65) and long-term mortality (RR = 1.40, 95% CI 1.18-1.65). However,
16 of 21 studies with 27,777 patients found no association between MR and
mortality after adjusting for baseline variables. In greater than half of
the patients (0.56, 95% CI 0.45-0.66) MR improved by at least one grade
following TAVI. Conclusion(s): The patients with MR undergoing TAVI
have a higher burden of risk factors which can independently impact
mortality. There is a lack of robust evidence supporting an increased
mortality in MR patients, after adjusting for other compounding variables.
MR tends to improve in the majority of patients post-TAVI. Copyright
© 2020

<103>
Accession Number
2004696181
Title
Cardiovascular protection variables based on exercise intensity in stable
coronary heart disease patients after coronary stenting: A comparative
study.
Source
Vascular Health and Risk Management. 16 (pp 257-270), 2020. Date of
Publication: 2020.
Author
Lalenoh I.; Oepangat E.; Purwowiyoto B.S.; Santoso A.; Romdoni R.;
Sarvasti D.
Institution
(Sarvasti) Department of Internal Medicine, Faculty of Medicine Widya,
Mandala Catholic University, Surabaya, Indonesia
(Lalenoh, Oepangat) Department of Cardiology, Siloam Hospital TB
Simatupang, Jakarta, Indonesia
(Purwowiyoto, Santoso) Department of Cardiology and Vascular Medicine,
Faculty of Medicine, University of Indonesia National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
(Romdoni) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Airlangga University, Dr. Soetomo District General Hospital,
Surabaya, Indonesia
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Our study aimed at determining and comparing the mechanism of
cardiovascular protection variables in moderate-intensity continuous
training (MICT) and high-intensity interval training (HIIT) in patients
with stable coronary heart disease (CHD) after coronary stenting.
Participants and Methods: This experimental study used the same subject
and cross-over design, involving eleven stable CHD patients after coronary
stenting. These were randomly divided into two groups; MICT for 29 minutes
at 50-60% heart rate reserve and HIIT with 4x4 minute intervals at 60-80%
heart rate reserve, each followed by three minutes of active recovery at
40-50% heart rate reserve. These were conducted three times a week for two
weeks. The participants' levels of adrenaline, noradrenaline, endothelial
nitric oxide synthase (eNOS), extracellular superoxide dismutase (EC-SOD)
activity assayed, and flow-mediated dilatation (FMD) were examined before
and after treatments were completed. Result(s): The HIIT
significantly increased the levels of noradrenaline and eNOS compared with
MICT (p<0.05). Also, HIIT was better in maintaining EC-SOD activity and
FMD compared with MICT (p<0.05). Through the noradrenalin pathway, HIIT
had a direct and significant effect on eNOS and FMD (p<0.05) but MICT,
through the noradrenaline pathways, had a direct and significant effect on
eNOS (p<0.05), and through the EC-SOD activity pathways had a direct and
significant effect on FMD (p<0.05). MICT reduced EC-SOD activity and also
decreased the FMD value. Conclusion(s): HIIT is superior to MICT in
increasing cardiovascular protection by increasing the concentrations of
noradrenalin and eNOS, maintaining EC-SOD activity, and FMD in stable CHD
patients after coronary stenting. Copyright © 2020 Sarvasti et
al.

<104>
Accession Number
2004696162
Title
Original article does intravenous tranexamic acid reduce bleeding during
mastoidectomy?.
Source
American Journal of Blood Research. 10 (3) (pp 46-51), 2020. Article
Number: AJBR0109975. Date of Publication: 2020.
Author
Ziaei S.; Joni S.S.; Shahriar R.; Shahzamani M.
Institution
(Ziaei) Dept. of Dral and Maxillofacial Medicine, Faculty of Dentistry,
Sharekord Branch, Shahrekord, Iran, Islamic Republic of
(Joni) Department of Radiology, Razi Hospital, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Shahriar) School of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Shahzamani) Department of Surgery, Chamran Heart Center and University
Hospital, School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Mastoidectomy is one of the important head and neck surgeries which is
mostly performed due to com-plications of otitis media. This procedure is
performed under microscopic surgery and as a result, a clean visual field
is required for surgeons. Bleeding is one of the important issues during
microscopic surgeries which reduces visualization. In this clinical trial,
we aimed to examine effects of tranexamic acid in reducing bleeding during
mas-toidectomy. Here we investigated 69 patients who were candidates of
mastoidectomy. Patients were randomized into two groups. In group 1,
patients received tranexamic acid (10 mg/kg) at the beginning of surgeries
along with other anesthetic drugs. In group 2, patients received normal
saline as placebo with the same volume. Data regard-ing to bleeding,
duration of surgeries, heart rate and blood pressure of patients were
collected and analyzed. We indicated that administration of tranexamic
acid is associated with significant reduced bleeding and also reduced
blood pressure during surgeries (P<0.001). Taken together, we suggest that
otolaryngologists should administer tranexamic acid during microscopic
surgeries in order to reduce bleeding and provide a better visual
field. Copyright © 2020, E-Century Publishing Corporation. All
rights reserved.

<105>
Accession Number
632351326
Title
Effectiveness of wound infusion of 0.2% ropivacaine by patient control
analgesia pump after minithoracotomy aortic valve replacement: A
randomized, double-blind, placebo-controlled trial.
Source
BMC Anesthesiology. 20 (1) (no pagination), 2020. Article Number: 172.
Date of Publication: 18 Jul 2020.
Author
Mijovski G.; Podbregar M.; Ksela J.; Jenko M.; Sostaric M.
Institution
(Mijovski, Podbregar, Jenko, Sostaric) Department of Anaesthesiology and
Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty
of Medicine, University of Ljubljana, Zaloska cesta 2, Ljubljana 1000,
Slovenia
(Ksela) Department of Cardiovascular Surgery, University Medical Centre
Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana,
Slovenia
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: Local anesthetic wound infusion has become an invaluable
technique in multimodal analgesia. The effectiveness of wound infusion of
0.2% ropivacaine delivered by patient controlled analgesia (PCA) pump has
not been evaluated in minimally invasive cardiac surgery. We tested the
hypothesis that 0.2% ropivacaine wound infusion by PCA pump reduces the
cumulative dose of opioid needed in the first 48 h after minithoracothomy
aortic valve replacement (AVR). Method(s): In this prospective,
randomized, double-blind, placebo-controlled study, 70 adult patients (31
female and 39 male) were analyzed. Patients were randomized to receive
0.2% ropivacaine or 0.9% saline wound infusion by PCA pump for 48 h
postoperatively. PCA pump was programmed at 5 ml h- 1 continuously and 5
ml of bolus with 60 min lockout. Pain levels were assessed and recorded
hourly by Numeric Rating Scale (NRS). If NRS score was higher than three
the patient was administered 3 mg of opioid piritramide repeated and
titrated as needed until pain relief was achieved. The primary outcome was
the cumulative dose of the opioid piritramide in the first 48 h after
surgery. Secondary outcomes were frequency of NRS scores higher than
three, patient's satisfaction with pain relief, hospital length of stay,
side effects related to the local anesthetic and complications related to
the wound catheter. Result(s): The cumulative dose of the opioid
piritramide in the first 48 h after minithoracotomy AVR was significantly
lower (p < 0.001) in the ropivacaine (R) group median 3 mg (IQR 6 mg) vs.
9 mg (IQR 9 mg). The number of episodes of pain where NRS score was
greater than three median 2 (IQR 2), vs 3 (IQR 3), (p = 0.002) in the
first 48 h after surgery were significantly lower in the ropivacaine
group, compared to control. Patient satisfaction with pain relief in our
study was high. There were no wound infections and no side-effects from
the local anesthetic. Conclusion(s): Wound infusion of local
anesthetic by PCA pump significantly reduced opioid dose needed and
improves pain control postoperatively. We have also shown that it is a
feasible method of analgesia and it should be considered in the multimodal
pain control strategy following minimally invasive cardiac surgery. Trial
registration: ClinicalTrials.gov NCT03079830, date of registration: March
15, 2017. Retrospecitvely registered. Copyright © 2020 The
Author(s).

<106>
Accession Number
632335055
Title
Biochemical response to cryothermal and radiofrequency exposure of the
human myocardium at surgical ablation of atrial fibrillation: A randomized
controlled trial.
Source
Translational Medicine Communications. 5 (1) (no pagination), 2020.
Article Number: 11. Date of Publication: 13 Jul 2020.
Author
Boano G.; Aneq M.A.; Spyrou G.; Enocsson H.; Charitakis E.; Vanky F.
Institution
(Boano, Vanky) Department of Health, Medicine and Caring Sciences,
Linkoping University, Department of Thoracic and Vascular Surgery in
Ostergotland, Linkoping, Sweden
(Aneq) Department of Health, Medicine and Caring Sciences, Linkoping
University, Department of Clinical Physiology in Linkoping, Linkoping,
Sweden
(Spyrou) Division of Clinical Chemistry, Department of Biomedical and
Clinical Sciences, Linkoping University, Linkoping, Sweden
(Enocsson) Department of Biomedical and Clinical Sciences, Linkoping
University, Division of Inflammation and Infection, Linkoping, Sweden
(Charitakis) Department of Cardiology in Linkoping, Department of Health,
Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: Surgical cryothermia and radiofrequency (RF) ablations for
atrial fibrillation (AF) seem to result in similar sinus rhythm
restoration, but the biochemical consequences of the two methods are
unclear. We aimed to compare the biochemical responses to the two ablative
methods in concomitant mitral valve surgery (MVS). Method(s): Sixty
mitral valve surgery patients with AF were prospectively included.
Forty-one patients planned for ablation were randomized to cryothermia (n
= 20) or radiofrequency (n = 21) ablation and 19 served as controls.
Markers for myocardial injury, inflammation, cell stress, apoptosis, and
heart failure were analyzed pre- and postoperatively at different time
points. Result(s): Troponin T and creatine kinase isoenzyme MB
(CK-MB) peak levels were significantly higher in the cryothermia group
compared with the RF group (12,805 [6140-15,700] vs. 2790 [1880-4180]
ng/L; P = 0.002 and 271 [217-357] vs. 79 [66-93] mug/L; P < 0.001,
respectively). Both groups had significantly higher levels than the
no-ablation group. There were no group differences in C-reactive protein
(CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there
were correlations between pre- and postoperative levels of both CRP (r s =
0.41, P = 0.001) and NT-proBNP (r s = 0.48, P < 0.001). Protease-activated
receptor 1 (PAR-1) and heat shock protein 27 (HSP27) were significantly
increased in the cryoablation group. Conclusion(s): Cryoablation
results in a larger myocardial injury and possibly more elevated apoptotic
activity and cell stress compared with the RF technique. The type of
ablation device did not have any significant influence on the
postoperative inflammatory response nor on the early postoperative levels
of NT-proBNP. Copyright © 2020 The Author(s).

<107>
Accession Number
632334924
Title
Effect of intraoperative dexmedetomidine infusion on delirium in adult
patients following cardiac valve surgery: A protocol of a randomized,
double-blinded, and placebo-controlled study.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 645. Date of
Publication: 14 Jul 2020.
Author
Wang H.-B.; Zhang L.; Zhang Z.; Yuan S.; Yan F.-X.; Luo Q.-P.
Institution
(Wang, Zhang, Yuan, Yan, Luo) Department of Anesthesiology, Fuwai
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, No. 167 North Lishi Road, Xicheng District, Beijing,
China
(Zhang) Department of Anesthesiology, Chongqing Traditional Chinese
Medicine Hospital, Chongqing, No. 6, 7 Branch Road, Panxi, Jiangbei
District, Chongqing, China
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is an acute status of brain dysfunction that commonly
occurs in patients who have undergone cardiac surgery, and increases
morbidity and mortality. It is associated with risk factors, such as older
age, use of narcotics, cardiopulmonary bypass, and hypothermia.
Dexmedetomidine infusion might exert a neuroprotective effect. However,
the effect of perioperative administration of dexmedetomidine on the
incidence of postoperative delirium (POD) in patients undergoing cardiac
or non-cardiac surgery is yet controversial. The present study aimed to
reveal the effect of intraoperative dexmedetomidine administration on the
incidence of delirium in adult patients following cardiac surgery.
 Method(s): This single-center, randomized, double-blinded, and
placebo-controlled trial consisted of 652 patients randomly divided into
two groups: dexmedetomidine and placebo. 0.6 mug/kg dexmedetomidine will
be infused 10 min after central vein catheterization, followed by a
continuous infusion at a speed of 0.4 mug/kg/h until the end of surgery in
the dexmedetomidine group, while normal saline will be administered at the
same rate in the placebo group. The primary outcome is the incidence of
POD during the first 7 days post-surgery. The secondary outcomes include
duration of mechanical ventilation after surgery, duration of stay in the
intensive care unit and the hospital after surgery, incidence of
hypotension during or after dexmedetomidine infusion, acute kidney injury
and sudden arrhythmia during the hospital stay postoperatively, and
all-cause mortality in 30 and 90 days after surgery, respectively.
 Discussion(s): This study was approved by the Ethics Committee of the
Chinese Academy of Medical Sciences Fuwai Hospital on 6 March 2019
(2019-1180). The results will be disseminated at academic conferences and
submitted to peer-reviewed publications. Either positive or negative
results will provide guidance for clinical practice. Trial registration:
The Chinese Clinical Trial Registry (http://www.chictr.org.cn)
ChiCTR1900022583. Registered on 17 April 2019. Copyright © 2020
The Author(s).

<108>
Accession Number
632414718
Title
Exercise after Heart Transplantation: Typical Alterations, Diagnostics and
Interventions.
Source
International journal of sports medicine. (no pagination), 2020. Date of
Publication: 20 Jul 2020.
Author
Schmidt T.; Bjarnason-Wehrens B.; Predel H.-G.; Reiss N.
Institution
(Schmidt, Reiss) Institute for Cardiovascular Research, Bad Rothenfelde,
Germany
(Schmidt, Bjarnason-Wehrens, Predel) Department of Preventive and
Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and
Sports Medicine, German Sport University Cologne, Cologne, Germany
Publisher
NLM (Medline)
Abstract
For the treatment of terminal heart failure, heart transplantation is
considered to be the gold standard, leading to significantly improved
quality of life and long-time survival. For heart transplant recipients,
the development and maintenance of good functional performance and
adequate exercise capacity is crucial for renewed participation and
integration in self-determined live. In this respect, typical
transplant-related alterations must be noted that play a significant role,
leading to restrictions both centrally and peripherally. Before patients
begin intensive and structured exercise training, a comprehensive
diagnosis of their exercise capacity should take place in order to
stratify the risks involved and to plan the training units accordingly.
Particularly endurance sports and resistance exercises are recommended to
counter the effects of the underlying disease and the immunosuppressive
medication. The performance level achieved can vary considerably depending
on their individual condition, from gentle activity through a
non-competitive-level to intensive competitive sports. This paper includes
an overview of the current literature on heart transplant recipients,
their specific characteristics, as well as typical cardiovascular and
musculoskeletal alterations. It also discusses suitable tools for
measuring exercise capacity, recommendations for exercise training,
required precautions and the performance level usually
achieved. Copyright © Georg Thieme Verlag KG Stuttgart . New
York.

<109>
Accession Number
632412812
Title
Post-operative atrial fibrillation after cardiac surgery: a systematic
review and meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 17 Jul 2020.
Author
Eikelboom R.; Sanjanwala R.; Le M.-L.; Yamashita M.H.; Arora R.C.
Institution
(Eikelboom) Max Rady College of Medicine, University of Manitoba,
Winnipeg, Canada
(Sanjanwala) Cardiac Sciences Program, St. Boniface Hospital, Winnipeg,
MB, Canada
(Le) Libraries, University of Manitoba, Winnipeg, MB, Canada
(Yamashita, Arora) Max Rady College of Medicine, University of Manitoba,
Winnipeg, Canada; Cardiac Sciences Program, St. Boniface Hospital,
Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St.
Boniface Hospital Research Centre, Winnipeg, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Post-operative atrial fibrillation (POAF) after cardiac
surgery is associated with longer hospital stay and increased in-hospital
stroke and mortality, but its longer-term implications remain incompletely
understood. A systematic literature review was undertaken to investigate
the impact of POAF on long-term mortality and stroke in adult cardiac
surgery patients. METHOD(S): Electronic databases (Cochrane, EMBASE,
Ovid Medline, PubMed) were queried from inception to October 2018.
Included studies compared long-term outcomes in cardiac surgery patients
with and without POAF. Adjusted and unadjusted meta-analyses examined
mortality, stroke, and major adverse cardiac and cerebrovascular events.
Risk of bias was evaluated with the Newcastle-Ottawa Scale.
 RESULT(S): Thirty-two studies describing 155,575 cardiac surgery
patients met inclusion criteria; 36,988 patients (23.7%) had POAF.
Meta-analysis of 10 studies (44,367 patients) demonstrated increased
one-year mortality in patients with POAF (odds ratio 2.60, 95% confidence
interval 2-3.38; p <0.01). Aggregate adjusted hazard of death (16 studies,
n=84,295) was also increased in patients with POAF (hazard ratio 1.25, 95%
confidence interval 1.2-1.3; p<0.01). CONCLUSION(S): This systematic
review and meta-analysis identified an association between POAF and
long-term mortality after cardiac surgery. More comprehensive POAF
prevention and management, including more stringent follow-up for POAF
recurrence after hospital discharge, may be indicated. While included
studies used inconsistent definitions of POAF and variable exclusion
criteria, estimates of heterogeneity are low. Differences in preoperative
comorbidities such as age, ejection fraction, and obesity may not be fully
accounted for in adjusted analyses. Future work is required to delineate
mechanisms linking POAF and mortality in this population. Copyright
© 2020. Published by Elsevier Inc.

<110>
Accession Number
632410246
Title
Coronary Subclavian Steal Syndrome: A Contemporary Review.
Source
Cardiology (Switzerland). (no pagination), 2020. Date of Publication:
2020.
Author
Lak H.M.; Shah R.; Verma B.R.; Roselli E.; Caputo F.; Xu B.
Institution
(Lak, Verma) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Shah, Xu) Department of Cardiovascular Medicine, Heart, Vascular and
Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Roselli) Department of Thoracic and Cardiovascular Surgery, Heart,
Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United
States
(Caputo) Department of Vascular Surgery, Heart, Vascular and Thoracic
Institute, Cleveland Clinic, Cleveland, OH, United States
(Xu) Section of Cardiovascular Imaging, Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Sydell and Arnold Miller Family
Heart, Vascular And, Thoracic Institute, 9500 Euclid Avenue, Cleveland, OH
44195, United States
Publisher
S. Karger AG
Abstract
Coronary subclavian steal syndrome (CSSS) is a rare cause of angina. It
occurs in patients with prior coronary artery bypass grafting and,
specifically, a left internal mammary artery (LIMA) to left anterior
descending artery (LAD) graft and co-existent significant subclavian
artery stenosis. In this context, there is retrograde blood flow through
the LIMA to LAD graft to supply the subclavian artery beyond the
significant stenosis. This potentially occurs at the cost of compromising
coronary artery perfusion dependent on the LIMA graft. In this review, we
present a case of a middle-aged female who suffered from CSSS and review
the literature for the contemporary diagnosis and management of this
condition. Copyright © 2020 S. Karger AG, Basel. All rights
reserved.

<111>
Accession Number
621382238
Title
Lancet-CAMS Health Summit, 2017.
Source
The Lancet. Conference: Chinese Academy of Medical Sciences Health Summit,
CAMS 2017. China. 390 (SPEC.ISS 1) (no pagination), 2017. Date of
Publication: 01 Dec 2017.
Author
Anonymous
Publisher
Lancet Publishing Group

<112>
Accession Number
620194240
Title
Updates on percutaneous valvuloplasty.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 23), 2017.
Date of Publication: December 2017.
Author
Ragg C.
Institution
(Ragg) Angioclinic Vein Centers, Berlin, Germany
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: If vein dilatation is the major component of
a valve insufficiency, long-term diameter reduction by external
compression may be a solution. Percutaneous valvuloplasty (PVP) using
cross-linked hyaluronan to achieve diameter reduction has been recently
introduced. Now, a first evaluation of an approved commercial product was
performed. Method(s): In this prospective controlled study, 22
patients with proximal GSV valve incompetence but preserved and mobile
valve structures according to 8 -16MHz ultrasound analysis were included
(8 f, 4m, 32 -54 yr/o): Vein diameter was 7.0 -12.0, mean 8.6mm). PVP was
performed by use of a cross-linked hyaluronan acid (Princess Volume,
Croma) and a safety cannula (Sterimedix). Result(s): Orthograde flow
was established in 20/22 cases (90.9%). Gel volumina varied from 4 -13 ml
(mean: 8.2 ml. There were no adverse reactions. At one year follow-up,
orthograde flow was present in 14/20 cases (70.0%). 5/6 cases (83,3%) with
recurring reflux successfully received supplementary hyaluronan injections
of 2 -6 ml. At one year follow-up, the assisted success rate was 95%.
 Conclusion(s): Percutaneous valvuloplasty is the first
minimal-invasive method to eliminate venous reflux while fully preserving
the target vein. It is effective and safe. Early detection of vein disease
is mandatory to fulfill eligibility. Maintenance injections will be
required in few year's intervals, like known from esthetic hyaluronan
applications.

<113>
Accession Number
620194239
Title
Is a Negative ELISA for Heparin-Induced Thrombocytopenia Really Negative?.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 61), 2017.
Date of Publication: December 2017.
Author
Lohr J.; Wright E.; Leuenberger K.; Jiang J.
Institution
(Lohr) Lohr Surgical Specialists LLC, Cincinnati, OH, United States
(Wright) University of Cincinnati, School of Medicine, Cincinnati, OH,
United States
(Leuenberger) US Oncology, Cincinnati, OH, United States
(Jiang) Mercy Health West, Cincinnati, OH, United States
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: To increase awareness that a negative
enzyme-linked immunosorbent assay (ELISA) test may represent a false
negative result. Serotonin assays are confirmatory but are no longer being
routinely done in order to contain costs. This practice needs to be
carefully considered especially when platelet counts remain low. We
describe a case of heparin induced thrombocytopenia in a patient with a
negative ELISA test. Method(s): Case report and retrospective review
of literature of heparin and heparin-induced thrombocytopenia (HIT)
antibodies and testing. Result(s): The patient is a 58 year old male
who underwent aortic prosthetic valve replacement and aortic
reconstruction. His hospital course was complicated by bowel perforation
and subtotal colectomy seven days post-op. All labs were consistent with
his hospital course at that time. Ten days later while the patient was on
a heparin drip, he developed a persistent decline in platelet count. At
this point, an ELISA test was negative. Further testing, four days later
included a serotonin release assay, which came back positive for HIT. He
was treated with Argatroban. Conclusion(s): In a patient population
where anticoagulation is imperative, when should we be suspicious of false
negatives? The multitude of tests for HIT has varying degrees of
sensitivity and specificity. Providers must be aware that false negatives
can and do occur with both platelet aggregation studies and ELISA antibody
tests. In a patient who is not recovering as expected, there must be
suspicion for HIT and the most definitive test, the serotonin release
assay, must be performed. In some circumstances, where there is a high
degree of suspicion for HIT, it may be beneficial to bypass initial ELISA
or platelet aggregation screening tests in favor of the serotonin release
assay which will have the best chance of catching patients who may
otherwise not be discovered. Treatment and testing should be tailored to
the clinical situation.

<114>
Accession Number
620194204
Title
Paradigm shifts in surgery and what we can expect for the future.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 50-51), 2017.
Date of Publication: December 2017.
Author
Kumar K.; Qualls E.; Thakur A.; Thakur V.
Institution
(Kumar) Affiliated with Medical Practice of Dr. Anjani Thakur, Turlock,
CA, United States
(Qualls) California State University, Stanislaus, Turlock, CA, United
States
(Thakur, Thakur) Valley Vein Health Center, Turlock, CA, United States
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: Innovations in health care have shifted
standards of surgical treatment throughout history. The purpose of this
systematic review is to reflect on the paradigm shift of endovenous
ablation in the treatment of venous insufficiency and the circumstances in
which it arose, as well as conduct a comparative historical analysis of
similar paradigm shifts for other surgical interventions. Through this
comparison, we can begin to predict trends for future paradigm shifts and
how they will improve the surgical management of disease. Method(s):
The PubMed database was used to identify scholarly articles that allowed a
historical overview of changes in surgery paradigms. This analysis
occurred between December of 2016 and February of 2017. The articles
identified ranged from the 1920's to present. The data was analyzed to
determine changes in case volume, treatment efficacy, doctor and patient
responses to the new treatment at the time of implementation, and economic
factors in healthcare diffusion that allowed the novel treatment to become
the new treatment paradigm. Result(s): Specifically, the paradigm
shift of endovenous ablation modeled that of previous shifts such as
peptic ulcer disease, pulmonary tuberculosis, coronary artery bypass
grafting versus coronary angioplasty, abdominoperineal resection versus
chemoradiation therapy, and open versus laparoscopic cholecystectomy.
These surgeries had previously utilized a more invasive and often less
effective treatment modality than the newly introduced paradigm.
Endovenous radiofrequency ablation and endovenous laser ablation, compared
to sclerotherapy and ligation, have become the first-line treatments of
chronic venous insufficiency due to the lesser degree of invasiveness.
Ligation alone demonstrated a 43-71% failure rate at 5 years and ligation
in conjunction with stripping had a 25-60% failure rate. This ranged from
5 to 34 years within the available literature.64-68 Niedzwiecki68
identified a host of research relating risk factors associated with vein
stripping and ligation -an aggregate 0.5% average incidence of pulmonary
embolism, an average 1% incidence of deep venous thrombosis (DVT), an 8%
incidence of infection, and an approximately 0.5% incidence of lymphedema.
69-76 Paresthesia occurred in nearly 1 in 4 patients treated by stripping
from the saphenofemoral junction, while an average of 1 in 10 patients
noted paresthesia limited to above the knee saphenous stripping66,77-80.
Endovenous laser ablation studies demonstrated high success rates
initially (ranging from 97-100%), as did early trials of laparoscopy in
treatment of acute cholecystectomy. Regarding peptic ulcer disease, we
found that the introduction of a surgical alternative, cimetidine and
proton pump inhibitors, decreased surgical management through partial
vagotomy in the U.S. by 50% between 1966 and 1978. This study also found a
significant decrease in peptic ulcer complications in the mid-eighties
that coincided with the discovery of H pylori as a causative agent for
peptic ulcer disease. 10 Rates of surgery declined from 8 to 3.3 per
100,000 individuals between 1988 and 2003 in men, and 5.5 to 2.7 in women.
Its rapid implementation was attributed to a nearly 20% savings in
treatment cost and reduced invasiveness. In pulmonary tuberculosis
management, several papers were found after the mid-1950's to address
surgical management of the disease as only secondary to administration of
isoniazid (and later) rifampicin, pyrazinamide and ethambutol.
Antimycobacterial therapy was significantly less invasive and led to a
much better quality of life outlook than earlier induced pneumothorax.
Bypass grafting was once a staple procedure in the treatment of stable
coronary artery disease, but between 2001 and 2011, the volume of CABG
operations in the U.S. decreased by nearly 46% -from 395,000 to 213,700.33
This trend was also demonstrated across the majority of OECD (Organization
for Economic Cooperation and Development) countries between 2000 and 2012.
Among European countries, Spain and France show angioplasty rates at
nearly 90%. A study conducted by the London School of Economics analyzing
healthcare diffusion found that nearly 30% of angioplasty procedures are a
direct substitutes for CABG, demonstrating a cost savings of nearly 60;
however, this shift occurred much more rapidly in wealthier nations. The
treatment of anal carcinoma saw a large shift after the publication of the
Nigro protocol of chemoradiative therapy. As of 2001, abdominoperineal
resection is performed in only 20% to 30% of rectal cancer patients across
OECD countries. Knab et al argued that there is little downside to an
attempt at laparoscopy in a patient without previous upper abdominal
surgery and that 100% of operations for acute cholecystitis should be
initiated laparoscopically. Studies also showed similar morbidity and
mortality between laparoscopic and open surgery and decreased length of
hospital stay -sometimes less than 24 hours -and decreased postoperative
pain. Several contributing factors to a successful shift were identified,
such as increased efficacy and shorter recovery period; however, some
procedures showed a shift even with resistance from physicians, like
laparoscopy initially, given significant benefits. Conclusion(s):
Today, the primary treatment of venous insufficiency no longer involves
stripping or ligation procedures, and demonstrated a safe and effective
modality that led to the wide availability of endovenous ablation therapy.
The most common characteristics of a successful paradigm shift were found
to be increased efficacy, minimal invasiveness, a short recovery period,
cost savings, decreased retreatment necessity, and safety. These criteria
may help us to predict which new technological advances will become future
first-line treatments, and even which treatments -such as tuberculosis
amid multidrug resistance -may regress to pre-paradigm protocols.

<115>
Accession Number
2007060841
Title
Dexmedetomidine for reduction of atrial fibrillation and delirium after
cardiac surgery (DECADE): a randomised placebo-controlled trial.
Source
The Lancet. 396 (10245) (pp 177-185), 2020. Date of Publication: 18 - 24
July 2020.
Author
Turan A.; Duncan A.; Leung S.; Karimi N.; Fang J.; Mao G.; Hargrave J.;
Gillinov M.; Trombetta C.; Ayad S.; Hassan M.; Feider A.; Howard-Quijano
K.; Ruetzler K.; Sessler D.I.; Bergese S.; De Oliveira G.; Honar H.; Niazi
A.; Elliott K.; Hamadnalla H.; Chodavarapu P.; Bajracharya G.; Fitzgerald
P.; Cuko E.; Akhtar Z.; Lokhande C.; Khan M.Z.; Khoshknabi D.; Riter Q.;
Hutcherson M.; Yagar S.; Glosse L.; Saha P.; Raza S.
Institution
(Turan, Fang, Mao, Ruetzler, Sessler) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
(Ayad, Hassan) Department of Regional Practice, Cleveland Clinic,
Cleveland, OH, United States
(Turan, Ayad, Ruetzler) Department of General Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Duncan, Hargrave, Trombetta) Department of Cardiovascular Anesthesiology,
Cleveland Clinic, Cleveland, OH, United States
(Mao) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Leung) Department of Radiology, Metrohealth Hospital, Cleveland, OH,
United States
(Karimi) Department of Anesthesiology, University of Rochester, Rochester,
NY, United States
(Feider) Department of Anesthesia, University of Iowa Hospitals and
Clinics, Iowa City, IA, United States
(Howard-Quijano) Department of Anesthesiology and Perioperative Medicine,
University of Pittsburgh School of Medicine and University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Atrial fibrillation and delirium are common consequences of
cardiac surgery. Dexmedetomidine has unique properties as sedative agent
and might reduce the risk of each complication. This study coprimarily
aimed to establish whether dexmedetomidine reduces the incidence of
new-onset atrial fibrillation and the incidence of delirium.
 Method(s): A randomised, placebo-controlled trial was done at six
academic hospitals in the USA. Patients who had had cardiac surgery with
cardiopulmonary bypass were enrolled. Patients were randomly assigned 1:1,
stratified by site, to dexmedetomidine or normal saline placebo.
Randomisation was computer generated with random permuted block size 2 and
4, and allocation was concealed by a web-based system. Patients,
caregivers, and evaluators were all masked to treatment. The study drug
was prepared by the pharmacy or an otherwise uninvolved research associate
so that investigators and clinicians were fully masked to allocation.
Participants were given either dexmedetomidine infusion or saline placebo
started before the surgical incision at a rate of 0.1 mug/kg per h then
increased to 0.2 mug/kg per h at the end of bypass, and postoperatively
increased to 0.4 mug/kg per h, which was maintained until 24 h. The
coprimary outcomes were atrial fibrillation and delirium occurring between
intensive care unit admission and the earlier of postoperative day 5 or
hospital discharge. All analyses were intention-to-treat. The trial is
registered with ClinicalTrials.gov, NCT02004613 and is closed.
 Finding(s): 798 patients of 3357 screened were enrolled from April
17, 2013, to Dec 6, 2018. The trial was stopped per protocol after the
last designated interim analysis. Among 798 patients randomly assigned,
794 were analysed, with 400 assigned to dexmedetomidine and 398 assigned
to placebo. The incidence of atrial fibrillation was 121 (30%) in 397
patients given dexmedetomidine and 134 (34%) in 395 patients given
placebo, a difference that was not significant: relative risk 0.90 (97.8%
CI 0.72, 1.15; p=0.34). The incidence of delirium was non-significantly
increased from 12% in patients given placebo to 17% in those given
dexmedetomidine: 1.48 (97.8% CI 0.99-2.23). Safety outcomes were
clinically important bradycardia (requiring treatment) and hypotension,
myocardial infarction, stroke, surgical site infection, pulmonary
embolism, deep venous thrombosis, and death. 21 (5%) of 394 patients given
dexmedetomidine and 8 (2%) of 396 patients given placebo, had a serious
adverse event as determined by clinicians. 1 (<1%) of 391 patients given
dexmedetomidine and 1 (<1%) of 387 patients given placebo died.
 Interpretation(s): Dexmedetomidine infusion, initiated at anaesthetic
induction and continued for 24 h, did not decrease postoperative atrial
arrhythmias or delirium in patients recovering from cardiac surgery.
Dexmedetomidine should not be infused to reduce atrial fibrillation or
delirium in patients having cardiac surgery. Funding(s): Hospira
Pharmaceuticals. Copyright © 2020 Elsevier Ltd

<116>
Accession Number
2007039676
Title
China Tongxinluo Study for myocardial protection in patients with Acute
Myocardial Infarction (CTS-AMI): Rationale and design of a randomized,
double-blind, placebo-controlled, multicenter clinical trial.
Source
American Heart Journal. 227 (pp 47-55), 2020. Date of Publication:
September 2020.
Author
Xu Y.; Li X.; Zhang H.; Wu Y.; Zhang J.; Li J.; Dou K.; Yan H.; You S.;
Liang Y.; Xu L.; Gao X.; Liu C.; Dong Q.; Zhang W.; Song G.; Zhang T.;
Jiang L.; Chen G.; Tang R.; Jin C.; Yang J.; Yao C.; Xian Y.; Peterson
E.D.; Gao R.; Yang Y.
Institution
(Xu, Li, Zhang, Wu, Zhang, Li, Dou, Yan, You, Yang, Liang, Xu, Gao, Liu,
Dong, Zhang, Song, Zhang, Jiang, Chen, Tang, Jin, Yang, Gao, Yang) Fuwai
Hospital, National Center of Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Yao) Peking University Clinical Research Institute, Peking University,
Beijing, China
(Xian, Peterson) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) remains a serious
life-threatening event. Despite coronary revascularization, patients might
still suffer from poor outcomes caused by myocardial no-reflow and
ischemic/reperfusion injury. Tongxinluo (TXL), a traditional Chinese
medicine, has been preliminarily demonstrated to reduce myocardial
no-reflow and ischemic/reperfusion injury. We further hypothesize that TXL
treatment is also effective in reducing clinical end points for the
patients with STEMI. Methods and Results: The CTS-AMI trial is a
prospective, randomized, double-blind, placebo-controlled, multicenter
clinical study in China. An estimated 3,796 eligible patients with STEMI
from about 120 centers are randomized 1:1 ratio to TXL or placebo groups.
All enrolled patients are orally administrated a loading dose of 8
capsules of TXL or placebo together with dual antiplatelet agents on
admission followed by 4 capsules 3 times a day until 12 months. The
primary end point is 30-day major adverse cardiovascular and
cerebrovascular events, a composite of cardiac death, myocardial
reinfarction, emergency coronary revascularization, and stroke. Secondary
end points include each component of the primary end point, 1-year major
adverse cardiovascular and cerebrovascular events, and other efficacy and
safety parameters. Conclusion(s): Results of CTS-AMI trial will
determine the clinical efficacy and safety of traditional Chinese medicine
TXL capsule in the treatment of STEMI patients in the reperfusion
era. Copyright © 2020 The Authors

<117>
Accession Number
628685968
Title
Short-term water-and land-based exercise training comparably improve
exercise capacity and vascular function in patients after a recent
coronary event: A pilot randomized controlled trial.
Source
Frontiers in Physiology. 10 (JUL) (no pagination), 2019. Article Number:
903. Date of Publication: 2019.
Author
Vasic D.; Novakovic M.; Mijovski M.B.; Zagar B.B.; Jug B.
Institution
(Vasic, Jug) Faculty of Medicine, University of Ljubljana, Ljubljana,
Slovenia
(Vasic) Terme Krka, Smarjeske Toplice, Slovenia
(Novakovic, Jug) Department of Vascular Diseases, University Medical
Center, Ljubljana, Slovenia
(Mijovski) Laboratory for Haemostasis and Atherothrombosis, Department of
Vascular Diseases, University Medical Center, Ljubljana, Slovenia
(Zagar) KRKA, D.d., Novo Mesto, Slovenia
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: We hypothesized that a 2-week twice daily aquatic endurance
plus calisthenics exercise training program: (i) increases aerobic
exercise capacity (peak oxygen uptake/V?O<inf>2</inf>peak), (ii) improves
endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces
circulating markers of low-grade inflammation and hemostasis, as compared
to land-based endurance plus calisthenics exercise training or no exercise
in patients undergoing short-term residential cardiac rehabilitation after
a recent coronary artery disease (CAD) event. Method(s): Patients
with a recent myocardial infarction or revascularization procedure were
randomized into two interventional groups and a control group. The
interventional groups underwent supervised aerobic endurance plus
calisthenics exercise training either in thermo-neutral water or on land
at moderate intensity (60-80% of the peak heart rate achieved during
symptom-limited graded exercise testing) for 30 min twice daily for 2
weeks (i.e., 24 sessions). The control group was deferred from supervised
exercise training for the 2-week duration of the intervention, but was
advised low-to-moderate intensity physical activity at home while waiting.
At baseline and after the intervention period, all participants underwent
estimation of aerobic exercise capacity, brachial artery flow-mediated
dilatation (FMD, measured ultrasonographically at rest and during reactive
hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac
dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8,
IL-10), cell adhesion (ICAM, P-selectin), and hemostasis
(fibrinogen, D-dimer). Result(s): A total of 89 patients (mean age
59.9 +/- 8.2 years, 77.5% males, V.O<inf>2</inf>peak at baseline 14.8 +/-
3.5 ml kg-1 min-1) completed the study. Both
exercise modalities were safe (no significant adverse events recorded) and
associated with a significant improvement in V.O<inf>2</inf>peak as
compared to controls: age and baseline V.O<inf>2</inf>peak-adjusted
end-of-study V.O<inf>2</inf>peak increased to 16.7 (95% CI
16.0-17.4) ml kg-1 min-1 with land-based
training (p < 0.001 for change from baseline) and to 18.6 (95% CI
17.9-19.3) ml kg-1 min-1 with water-based
training (p < 0.001 for change from baseline), but not in controls (14.9
ml kg -1 min-1; 95% CI
14.2-15.6; p = 0.775 for change from baseline). FMD also
increased in both intervention groups (from 5.5 to 8.8%, p < 0.001 with
land-based, and from 7.2 to 9.2%, p < 0.001 with water-based training,
respectively), as compared to controls (p for change 0.629). No
significant changes were detected in biomarkers of inflammation, cell
adhesion or hemostasis, whereas levels of NT-proBNP (marker of cardiac
dysfunction) decreased in the water-based training group (p = 0.07 vs.
controls). Conclusion(s): Endurance plus calisthenics exercise
training in thermo-neutral water is safe, and improves aerobic exercise
capacity and vascular function in patients undergoing short-term
residential cardiac rehabilitation after a recent CAD event. Copyright
© 2007 - 2019 Frontiers Media S.A. All Rights Reserved.

<118>
Accession Number
626519353
Title
The effect of hyperoxia on mortality in critically ill patients: A
systematic review and meta analysis.
Source
BMC Pulmonary Medicine. 19 (1) (no pagination), 2019. Article Number: 53.
Date of Publication: 26 Feb 2019.
Author
Ni Y.-N.; Wang Y.-M.; Liang B.-M.; Liang Z.-A.
Institution
(Ni, Liang, Liang) Department of Respiratory and Critical Care, West China
School of Medicine and West China Hospital, Sichuan University, No.37
Guoxue Alley, Chengdu 610041, China
(Wang) Department of Respiratory Medicine, Sichuan Second Hospital of
Traditional Chinese Medicine, Chengdu, Sichuan 610031, China
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: Studies investigating the role of hyperoxia in critically ill
patients have reported conflicting results. We did this analysis to reveal
the effect of hyperoxia in the patients admitted to the intensive care
unit (ICU). Method(s): Electronic databases were searched for all the
studies exploring the role of hyperoxia in adult patients admitted to ICU.
The primary outcome was mortality. Random-effect model was used for
quantitative synthesis of the adjusted odds ratio (aOR). Result(s):
We identified 24 trials in our final analysis. Statistical heterogeneity
was found between hyperoxia and normoxia groups in patients with
mechanical ventilation (I2 = 92%, P < 0.01), cardiac
arrest(I2 = 63%, P = 0.01), traumatic brain injury
(I2 = 85%, P < 0.01) and post cardiac surgery (I2 =
80%, P = 0.03). Compared with normoxia, hyperoxia was associated with
higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well
as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and
extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02).
 Conclusion(s): Hyperoxia would lead to higher mortality in critically
ill patients especially in the patients with cardiac arrest and
ELS. Copyright © 2019 The Author(s).

<119>
Accession Number
626182708
Title
Genome-wide association study of myocardial infarction, atrial
fibrillation, acute stroke, acute kidney injury and delirium after cardiac
surgery - A sub-analysis of the RIPHeart-Study.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 26. Date of Publication: 24 Jan 2019.
Author
Westphal S.; Stoppe C.; Gruenewald M.; Bein B.; Renner J.; Cremer J.;
Coburn M.; Schaelte G.; Boening A.; Niemann B.; Kletzin F.; Roesner J.;
Strouhal U.; Reyher C.; Laufenberg-Feldmann R.; Ferner M.; Brandes I.F.;
Bauer M.; Kortgen A.; Stehr S.N.; Wittmann M.; Baumgarten G.; Struck R.;
Meyer-Treschan T.; Kienbaum P.; Heringlake M.; Schoen J.; Sander M.;
Treskatsch S.; Smul T.; Wolwender E.; Schilling T.; Degenhardt F.; Franke
A.; Mucha S.; Tittmann L.; Kohlhaas M.; Fuernau G.; Brosteanu O.;
Hasenclever D.; Zacharowski K.; Meybohm P.; Stevanovic A.; Rossaint R.;
Felzen M.; Goetzenich A.; Moormann T.; Chalk K.; Knuefermann P.; Boehm O.;
Hoeft A.; Winterhalter M.; Iken S.; Weber C.; Wiedenbeck C.; Schwarzmann
G.; Pense K.; Fichtlscherer A.Z.S.; Goerlach G.; Wollbrueck M.; Boening
U.; Weigand M.; Strauchmann J.; August K.; Morsbach K.U.; Paxian M.;
Reinhard K.; Scholz J.; Broch O.; Francksen H.; Albrecht M.; Kuhr B.;
Heinze H.; Paarmann H.; Sievers H.-H.; Klotz S.; Hachenberg T.; Werner C.;
Mauff S.; Alms A.; Bergt S.; Roewer N.
Institution
(Westphal, Strouhal, Reyher, Kohlhaas, Zacharowski, Meybohm) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Frankfurt, Germany
(Stoppe, Coburn, Schaelte) Department of Anaesthesiology, Medical Faculty,
RWTH Aachen, University Aachen, Aachen, Germany
(Bein) Department of Anaesthesiology, Intensive Care Medicine, Emergency
Medicine and Pain Therapy, Asklepios Klinik St. Georg, Hamburg, Germany
(Gruenewald, Bein, Renner) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel,
Germany
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Boening, Niemann) Department of Cardiovascular Surgery, University of
Giessen, Giessen, Germany
(Sander) Department of Anaesthesiology and Intensive Care, University of
Giessen, Giessen, Germany
(Kletzin) Clinic of Anaesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Roesner) Department of Anaesthesiology and Intensive Care, Suedstadt
Hospital Rostock, Rostock, Germany
(Laufenberg-Feldmann, Ferner) Department of Anesthesiology, Medical Center
of Johannes Gutenberg-University, Mainz, Germany
(Brandes) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Goettingen, Goettingen, Germany
(Bauer) Department of Anaesthesiology and Intensive Care, Klinikum Region
Hannover, Hannover, Germany
(Kortgen) Department of Anaesthesiology and Intensive Care Medicine,
Center for Sepsis Control and Care, Jena University Hospital, Jena,
Germany
(Stehr) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Leipzig, Germany
(Wittmann, Struck) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Baumgarten) Department of Anaesthesiology and Intensive Care Medicine,
Johanniter Hospital Bonn, Bonn, Germany
(Meyer-Treschan, Kienbaum) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
(Heringlake) Department of Anaesthesiology and Intensive Care Medicine,
University Luebeck, Luebeck, Germany
(Schoen) Department of Anaesthesiology and Intensive Care Medicine,
Hospital Neuruppin, Neuruppin, Germany
(Treskatsch) Department of Anaesthesiology and Intensive Care Medicine,
Charite-Universitatsmedizin Berlin, Campus Charite Mitte, Berlin, Germany
(Smul, Wolwender, Schilling) Department of Anaesthesiology, University
Hospital Wuerzburg, Wuerzburg, Germany
(Degenhardt, Franke, Mucha, Tittmann) Institute of Clinical Molecular
Biology, Kiel University, University Hospital Schleswig-Holstein, Campus
Kiel, Kiel, Germany
(Fuernau) University Heart Center Luebeck, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Hospital
Schleswig-Holstein, Luebeck, Luebeck, Germany
(Brosteanu) Clinical Trial Centre, University Leipzig, Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Leipzig, Germany
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of our study was the identification of genetic
variants associated with postoperative complications after cardiac
surgery. Method(s): We conducted a prospective, double-blind,
multicenter, randomized trial (RIPHeart). We performed a genome-wide
association study (GWAS) in 1170 patients of both genders (871 males, 299
females) from the RIPHeart-Study cohort. Patients undergoing non-emergent
cardiac surgery were included. Primary endpoint comprises a binary
composite complication rate covering atrial fibrillation, delirium,
non-fatal myocardial infarction, acute renal failure and/or any new stroke
until hospital discharge with a maximum of fourteen days after surgery.
 Result(s): A total of 547,644 genotyped markers were available for
analysis. Following quality control and adjustment for clinical covariate,
one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 x
10-8) and 139 (adjusted for all other outcomes) SNPs showed
promising association with p < 1 x 10-5 from the GWAS.
 Conclusion(s): We identified several potential loci, in particular
PHLPP2, BBS9, RyR2, DUSP4 and HSPA8, associated with new-onset of atrial
fibrillation, delirium, myocardial infarction, acute kidney injury and
stroke after cardiac surgery. Copyright © 2019 The Author(s).

<120>
Accession Number
608041907
Title
Influence of isoflurane on the diastolic pressure-flow relationship and
critical occlusion pressure during arterial CABG surgery: A randomized
controlled trial.
Source
PeerJ. 2016 (1) (no pagination), 2016. Article Number: e1619. Date of
Publication: 2016.
Author
Hinz J.; Mansur A.; Hanekop G.G.; Weyland A.; Popov A.F.; Schmitto J.D.;
Grune F.F.; Bauer M.; Kazmaier S.
Institution
(Hinz, Mansur) Department of Anesthesiology, University Medical Center
Goettingen, Germany
(Hanekop, Kazmaier) Department of Anesthesiology, University Medical
Center Goettingen, Goettingen, Germany
(Weyland) Department of Anesthesiology and Intensive Care Medicine,
University of Oldenburg, Oldenburg, Germany
(Popov) Department of Cardiothoracic Surgery, Transplantation and
Mechanical Support, Royal Brompton and Harefield Hospital, London, United
Kingdom
(Schmitto) Department of Cardiothoracic, Transplant and Vascular Surgery,
Hannover Medical School, Hannover, Germany
(Grune) Department of Anesthesiology, Erasmus University/Rotterdam,
Rotterdam, Netherlands
(Bauer) Department of Anesthesiology, University Medical Center
Goettingen, Gottingen, Germany
Publisher
PeerJ Inc. (E-mail: pete@peerj.com)
Abstract
The effects of isoflurane on the determinants of blood flow during
Coronary Artery Bypass Graft (CABG) surgery are not completely understood.
This study characterized the influence of isoflurane on the diastolic
Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP)
during CABG surgery. Twenty patients undergoing CABG surgery were studied.
Patients were assigned to an isoflurane or control group. Hemodynamic and
flow measurements during CABG surgery were performed twice (15 minutes
after the discontinuation of extracorporeal circulation (T15) and again 15
minutes later (T30)). The zero flow pressure intercept (a measure of COP)
was extrapolated from a linear regression analysis of the instantaneous
diastolic P-F relationship. In the isoflurane group, the application of
isoflurane significantly increased the slope of the diastolic P-F
relationship by 215% indicating a mean reduction of Coronary Vascular
Resistance (CVR) by 46%. Simultaneously, the Mean Diastolic Aortic
Pressure (MDAP) decreased by 19% mainly due to a decrease in the systemic
vascular resistance index by 21%. The COP, cardiac index, heart rate, Left
Ventricular End-Diastolic Pressure (LVEDP) and Coronary Sinus Pressure
(CSP) did not change significantly. In the control group, the parameters
remained unchanged. In both groups, COP significantly exceeded the CSP and
LVEDP at both time points. We conclude that short-term application of
isoflurane at a sedative concentration markedly increases the slope of the
instantaneous diastolic P-F relationship during CABG surgery implying a
distinct decrease with CVR in patients undergoing CABG surgery. ©
Copyright 2016 Hinz et al.

<121>
Accession Number
600165797
Title
Use of ivabradine and atorvastatin in emergent orthopedic lower limb
surgery and computed tomography coronary plaque imaging and novel
biomarkers of cardiovascular stress and lipid metabolism for the study and
prevention of perioperative myocardial infarction: Study protocol for a
randomized controlled trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 352. Date of
Publication: 2014.
Author
Rudd N.; Subiakto I.; Asrar ul Haq M.; Mutha V.; van Gaal W.J.
Institution
(Rudd, Subiakto, Asrar ul Haq, Mutha, van Gaal) Department of Cardiology,
The Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia
(Rudd, Subiakto, Asrar ul Haq, Mutha, van Gaal) Department of Medicine,
University of Melbourne, Grattan St, Melbourne, VIC 2010, Australia
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: The incidence of perioperative myocardial infarction (PMI)
globally is known to be around 2 to 3% and can prolong hospitalization,
increased morbidity and mortality. Little is known about the
pathophysiology and risk factors for PMI. We investigate the presence of
elevated novel cardiac markers and preoperative coronary artery plaque
through contemporary laboratory techniques to determine the correlation
with PMI, as well as studying ivabradine and atorvastatin as protective
pharmacotherapies against PMI in the context of orthopedic surgery.
Methods/Design: We aim to enroll 200 patients aged above 60 years who
suffer from neck of femur fracture requiring surgery. Patients will be
randomized to four arms (no study drugs, atorvastatin only, ivabradine
only and ivabradine and atorvastatin). Our primary outcome is incidence of
PMI. All patients will receive an electrocardiogram, cardiac
echocardiography, measurement of novel cardiac biomarkers and computed
tomography (CT) coronary angiography. A telephone interview post discharge
will be conducted at 30 days, 60 days and 1 year. Discussion(s): We
postulate that ivabradine and atorvastatin will reduce the rate and
magnitude of PMI following surgery by reducing heart rate and attenuating
catecholamine-induced tachycardia postoperatively. Secondly, we postulate
that postoperative reduction in heart rate and catecholamine-induced
tachycardia with ivabradine will correlate with a reduction in
cardiovascular novel biomarkers which will reduce atrial stretch and
postoperative incidence of arrhythmia. We aim to demonstrate that
treatment with ivabradine and atorvastatin will cause a reduction in the
incidence and magnitude of PMI, the benefit of which is derived primarily
in patients with greater atherosclerotic burden as measured by higher CT
coronary calcium scores. Copyright © 2014 Rudd et al.; licensee
BioMed Central Ltd.

<122>
Accession Number
601266217
Title
Contrasting clinical evidence for market authorisation of cardio-vascular
devices in Europe and the USA: A systematic analysis of 10 devices based
on Austrian pre-reimbursement assessments.
Source
BMC Cardiovascular Disorders. 14 (1) (no pagination), 2014. Article
Number: 154. Date of Publication: November 04, 2014.
Author
Wild C.; Erdos J.; Zechmeister I.
Institution
(Wild, Erdos, Zechmeister) Ludwig Boltzmann Institute for Health
Technology Assessment (LBI-HTA), Garnisongasse 7/20, Vienna 1090, Austria
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: European medical device regulation is under scrutiny and will
be re-regulated with stricter rules concerning requirements for clinical
evidence for high-risk medical devices. It is the aim of this study to
analyse the differences between Europe and USA in dealing with risks and
benefits of new cardio-vascular devices. Method(s): Since no
information is available on clinical data used by the Notified Body for
CE-marking, data from Austrian pre-reimbursement assessments close to
European market approval were used as proxy and compared with clinical
data available at time of market approval by FDA in the USA.
 Result(s): 10 cardio-vascular interventions with 27 newly CE approved
medical devices were analysed. The time lag between market authorisation
in Europe and in the USA is 3 to 7 years. Only 7 CE-marked devices also
hold a FDA market approval, 7 further devices are in FDA approved ongoing
efficacy trials. For 4 of the CE-marked devices the FDA market application
or the approval-trial was either suspended due to efficacy or safety
concerns or the approval was denied. Evidence available at time of
CE-marking are most often case-series or small feasibility RCTs, while
large RCTs and only in rare cases prospective cohort studies are the basis
of FDA approvals. Additionally, the FDA often requires post-approval
studies for high-risk devices. Conclusion(s): Market authorisation
based on mature clinical data deriving from larger RCTs and longer
follow-ups do not only change the perspective on the risk-benefit ratio,
but also secures real patient benefit and safety and assures payers of
investing only in truly innovative devices. Copyright © 2014 Wild
et al.

<123>
Accession Number
52437276
Title
Cerebral ischemia initiates an immediate innate immune response in
neonates during cardiac surgery.
Source
Journal of Neuroinflammation. 10 (no pagination), 2013. Article Number:
796. Date of Publication: 07 Feb 2013.
Author
Algra S.O.; Groeneveld K.M.; Schadenberg A.W.L.; Haas F.; Evens F.C.M.;
Meerding J.; Koenderman L.; Jansen N.J.G.; Prakken B.J.
Institution
(Algra, Haas, Evens) Department of Pediatric Cardiothoracic Surgery,
Wilhelmina Children's Hospital, University Medical Center Utrecht,
Lundlaan 6, Utrecht, EA 3584, Netherlands
(Groeneveld, Koenderman) Department of Surgery, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht, CX 3584, Netherlands
(Algra, Schadenberg, Meerding, Prakken) Department of Pediatric
Immunology, Center for Cellular and Molecular Intervention, University
Medical Center Utrecht, Lundlaan 6, Utrecht, EA 3584, Netherlands
(Algra, Schadenberg, Jansen) Pediatric Intensive Care Unit, Wilhelmina
Children's Hospital, University Medical Center Utrecht, Lundlaan 6,
Utrecht, EA 3584, Netherlands
(Algra) Pediatric Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: A robust inflammatory response occurs in the hours and days
following cerebral ischemia. However, little is known about the immediate
innate immune response in the first minutes after an ischemic insult in
humans. We utilized the use of circulatory arrest during cardiac surgery
to assess this. Method(s): Twelve neonates diagnosed with an aortic
arch obstruction underwent cardiac surgery with cardiopulmonary bypass and
approximately 30 minutes of deep hypothermic circulatory arrest (DHCA,
representing cerebral ischemia). Blood samples were drawn from the vena
cava superior immediately after DHCA and at various other time points from
preoperatively to 24 hours after surgery. The innate immune response was
assessed by neutrophil and monocyte count and phenotype using FACS, and
concentrations of cytokines IL-1beta, IL-6, IL-8, IL-10, TNFalpha, sVCAM-1
and MCP-1 were assessed using multiplex immunoassay. Results were compared
to a simultaneously drawn sample from the arterial cannula. Twelve other
neonates were randomly allocated to undergo the same procedure but with
continuous antegrade cerebral perfusion (ACP). Result(s): Immediately
after cerebral ischemia (DHCA), neutrophil and monocyte counts were higher
in venous blood than arterial (P = 0.03 and P = 0.02 respectively). The
phenotypes of these cells showed an activated state (both P <0.01). Most
striking was the increase in the 'non-classical' monocyte subpopulations
(CD16intermediate; arterial 6.6% vs. venous 14%; CD16+ 13% vs.
22%, both P <0.01). Also, higher IL-6 and lower sVCAM-1 concentrations
were found in venous blood (both P = 0.03). In contrast, in the ACP group,
all inflammatory parameters remained stable. Conclusion(s): In
neonates, approximately 30 minutes of cerebral ischemia during deep
hypothermia elicits an immediate innate immune response, especially of the
monocyte compartment. This phenomenon may hold important clues for the
understanding of the inflammatory response to stroke and its potentially
detrimental consequences.Trial registration: ClinicalTrial.gov:
NCT01032876. © 2013 Algra et al; licensee BioMed Central Ltd.

<124>
Accession Number
362920891
Title
Simvastatin plus ezetimibe reduced major atherosclerotic events in
patients with chronic kidney disease.
Source
Annals of Internal Medicine. 155 (10) (pp JC5-2), 2011. Date of
Publication: 20111115.
Author
Baigent C.; Landray M.J.; Reith C.
Institution
(Baigent) Clinical Trial Service Unit, Epidemiological Studies Unit
(CTSU), Oxford, England, United Kingdom
Publisher
American College of Physicians

<125>
Accession Number
355596180
Title
Structured information during the ICU stay to reduce anxiety: Study
protocol of a multicenter randomized controlled trial.
Source
Trials. 10 (pp 84), 2009. Article Number: 84. Date of Publication: 14 Sep
2009.
Author
Fleischer S.; Berg A.; Neubert T.R.; Koller M.; Behrens J.; Becker R.;
Horbach A.; Radke J.; Rothmund M.; Kuss O.
Institution
(Fleischer, Berg, Behrens) Institute of Health and Nursing Science,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany
(Neubert, Becker) Department of Nursing Research, University Hospital
Giessen and Marburg, Marburg, Germany
(Koller) Center for Clinical Trials, University Hospital Regensburg,
Germany
(Horbach) Sana Herzchirurgische Klinik Stuttgart, Germany
(Horbach) Department 4: Health and Social Work, University of Applied
Sciences, Frankfurt/Main, Germany
(Radke) Department of Anesthesiology and Intensive Care Medicine,
University Hospital, Martin-Luther-University Halle-Wittenberg, Germany
(Rothmund) Institute for Theoretical Surgery/Department of Visceral,
Thoracic and Vascular Surgery, University Hospital Giessen and Marburg,
Location Marburg, Germany
(Kuss) Institute of Medical Epidemiology, Biostatistics, and Informatics,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: ICU stay is often associated with negative experiences for the
individual patient. Many patients are disabled and their communication is
restricted during the ICU stay. Specific information on procedures,
sensations and coping behavior are thought to reduce anxiety on the ICU.
Until now information programs to reduce anxiety were mainly delivered
preoperatively, completely neglecting informational needs of non-elective
ICU patients. Method(s): The trial is designed as a prospective
multicenter randomized controlled trial in the cities of Marburg, Halle
and Stuttgart. Elective and non-elective ICU patients will be included.
The trial includes an intervention and a control group on the ICU. The
control group receives a trivial conversation without any ICU-specific
information. The intervention group receives an information program with
specific procedural, sensory and coping information about their ICU stay.
Both conversations take place in the ICU and are planned to take about 10
minutes. Discussion(s): In contrast to former trials on information
programs on the ICU-stay our intervention will take place in the ICU
itself. This approach will ensure to compensate for memory effects due to
anesthesia or preoperative stress. Further the results will be applicable
to non-elective ICU-patients. Trial Registration: ClinicalTrials
NCT00764933. © 2009 Fleischer et al; licensee BioMed Central Ltd.

<126>
Accession Number
2007038473
Title
Individualized PEEP ventilation between tumor resection and dural suture
in craniotomy.
Source
Clinical Neurology and Neurosurgery. 196 (no pagination), 2020. Article
Number: 106027. Date of Publication: September 2020.
Author
Liu H.; Wu X.; Li J.; Liu Y.; Huang Y.; Zhang M.; Zhu J.; Chen P.; Xie H.;
Dong J.
Institution
(Liu, Wu, Li, Liu, Huang, Zhu, Chen, Xie) Department of Anesthesiology,
The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road,
Suzhou 215004, China
(Zhang) Department of Infection Control, The Second Affiliated Hospital of
Soochow University, 1055 Sanxiang Road, Suzhou 215004, China
(Dong) Department of Neurosurgery, The Second Affiliated Hospital of
Soochow University, 1055 Sanxiang Road, Suzhou 215004, China
Publisher
Elsevier B.V.
Abstract
Objective: Atelectasis, which affects oxygenation, is always occurred
after craniotomy under general anesthesia. The commonly used protective
ventilation strategy, which includes recruitment maneuver and higher level
of positive end-expiratory pressure (PEEP), can effectively reduce
atelectasis after heart and abdominal surgery, but increase intracranial
pressure and reduce cerebral perfusion in patients undergoing craniotomy.
We hypothesized individualized PEEP ventilation between tumor resection
and dural suture in craniotomy could effectively reduce postoperative
atelectasis, improve PaO<inf>2</inf>/FiO<inf>2</inf> ratio, and without
reducing the regional cerebral oxygen saturation (rScO<inf>2</inf>).
 Patients and Methods: 96 patients underwent tumor craniotomy in
supine position were randomized into the control group (C group) and
individualized PEEP group (P group). In the C group, the tidal volume (VT)
was set at 8 mL/kg of predicted body weight, but PEEP were not used. In
the P group, VT was set at 6 mL/kg of predicted body weight combined with
individualized PEEP between tumor resection and dural suture, while in
other periods of general anesthesia, VT was set at 8 mL/kg of predicted
body weight. PaO<inf>2</inf>/FiO<inf>2</inf> ratio, lung ultrasound score
(LUS) and rScO<inf>2</inf> were measured before induction, 1 h and 24 h
after extubation. Result(s): Individual PEEP in the P group was 7.0
(4.0-9.0). The PaO<inf>2</inf>/FiO<inf>2</inf> ratio and rScO<inf>2</inf>
in the P group were significantly higher than that of the C group (395 +/-
62 vs. 344 +/- 40, 67 +/- 5 vs. 61 +/- 4, respectively, p < 0.05) and the
LUS of the experimental group was significantly lower than that of the C
group [7.5 (5.3-8.3) vs. 10.0 (9.0-12.0), p < 0.05] 1 h after extubation.
 Conclusion(s): Mechanical ventilation with individualized PEEP
between tumor resection and dural suture in craniotomy can reduce
atelectasis, improve PaO<inf>2</inf>/FiO<inf>2</inf> ratio and
rScO<inf>2</inf> 1 h after extubation. Copyright © 2020 Elsevier
B.V.

<127>
Accession Number
2007029029
Title
Accelerated treatment of endocarditis-The POET II trial: Rationale and
design of a randomized controlled trial: Design and rationale of the POET
II trial.
Source
American Heart Journal. 227 (pp 40-46), 2020. Date of Publication:
September 2020.
Author
Ostergaard L.; Pries-Heje M.M.; Hasselbalch R.B.; Rasmussen M.; Akesson
P.; Horvath R.; Povlsen J.; Gill S.; Bruun N.E.; Mullertz K.; Tuxen C.D.;
Ihlemann N.; Helweg-Larsen J.; Moser C.; Fosbol E.L.; Bundgaard H.;
Iversen K.
Institution
(Ostergaard, Pries-Heje, Ihlemann, Fosbol, Bundgaard) The Heart Center,
Rigshospitalet, Copenhagen, Denmark
(Hasselbalch, Iversen) Department of Cardiology, Herlev-Gentofte Hospital,
Copenhagen, Denmark
(Rasmussen, Akesson) Department of Infectious Diseases, Skane University
Hospital, Lund, Sweden
(Horvath) Department of Infectious Diseases, The Prince Charles Hospital,
Brisbane, Australia
(Povlsen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Gill) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Bruun) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Mullertz) Department of Cardiology, Nordsjaellands Hospital, Hillerod,
Denmark
(Tuxen) Department of Cardiology, Bispebjerg-Frederiksberg Hospital,
Copenhagen, Denmark
(Helweg-Larsen) Department of Infectious Diseases, Rigshospitalet,
Copenhagen, Denmark
(Moser) Department of Clinical Microbiology, Rigshospitalet, Copenhagen,
Denmark
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The optimal antibiotic treatment length for infective
endocarditis (IE) is uncertain. International guidelines recommend
treatment duration of up to 6 weeks for patients with left-sided IE but
are primarily based on historical data and expert opinion. Efficacies of
modern therapies, fast recovery seen in many patients with IE, and
complications to long hospital stays challenge the rationale for fixed
treatment durations in all patients. Objective(s): The objective was
to conduct a noninferiority randomized controlled trial (acronym POET II)
investigating the safety of accelerated (shortened) antibiotic therapy as
compared to standard duration in patients with left-sided IE.
 Method(s): The POET II trial is a multicenter, multinational,
open-label, noninferiority randomized controlled trial. Patients with
definite left-sided IE due to Streptococcus spp, Staphylococcus aureus, or
Enterococcus faecalis will be eligible for enrolment. Each patient will be
randomized to accelerated antibiotic treatment or standard-length
treatment (1:1) following clinical stabilization as defined by clinical
parameters, laboratory values, and transesophageal echocardiography
findings. Accelerated treatment will be between 2 and 4 weeks, whereas
standard-length treatment will be between 4 and 6 weeks, depending on
microbiologic etiology, complications, need for valve surgery, and
prosthetic versus native valve endocarditis. The primary outcome is a
composite of all-cause mortality, unplanned cardiac surgery, relapse of
bacteremia, or embolization within 6 months of randomization.
 Conclusion(s): The POET II trial will investigate the safety of
accelerated antibiotic therapy for patients with left-sided IE caused by
Streptococcus spp, Staphylococcus aureus, or Enterococcus faecalis. The
results of the POET II trial will improve the evidence base of treatment
recommendations, and clinical practice may be altered. Copyright
© 2020 Elsevier Inc.

<128>
Accession Number
613799386
Title
Impact of incomplete percutaneous revascularization in patients with
multivessel coronary artery disease: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 5 (12) (no pagination), 2016.
Article Number: e004598. Date of Publication: 01 Dec 2016.
Author
Nagaraja V.; Ooi S.-Y.; Nolan J.; Large A.; De Belder M.; Ludman P.; Bagur
R.; Curzen N.; Matsukage T.; Yoshimachi F.; Kwok C.S.; Berry C.; Mamas
M.A.
Institution
(Nagaraja, Ooi) Department of Cardiology, Prince of Wales Hospital,
Sydney, NSW, Australia
(Nolan, Large, Kwok, Mamas) Royal Stoke University Hospital, University
Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nolan, Kwok, Mamas) Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine, University of Keele, Stoke-on-Trent,
United Kingdom
(De Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(Bagur) Division of Cardiology, Department of Medicine and Department of
Epidemiology and Biostatistics, London Health Sciences Centre, Western
University, London, ON, Canada
(Curzen) University Hospital Southampton and Faculty of Medicine,
University of Southampton, United Kingdom
(Matsukage, Yoshimachi) Division of Cardiology, Tokai University School of
Medicine, Isehara, Japan
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
Publisher
John Wiley and Sons Inc.
Abstract
Background-Up to half of patients undergoing percutaneous coronary
intervention have multivessel coronary artery disease (MVD) with
conflicting data regarding optimal revascularization strategy in such
patients. This paper assesses the evidence for complete revascularization
(CR) versus incomplete revascularization in patients undergoing
percutaneous coronary intervention, and its prognostic impact using
meta-analysis. Methods and Results-A search of PubMed, EMBASE, MEDLINE,
Current Contents Connect, Google Scholar, Cochrane library, Science
Direct, and Web of Science was conducted to identify the association of CR
in patients with multivessel coronary artery disease undergoing
percutaneous coronary intervention with major adverse cardiac events and
mortality. Random-effects metaanalysis was used to estimate the odds of
adverse outcomes. Meta-regression analysis was conducted to assess the
relationship with continuous variables and outcomes. Thirty-eight
publications that included 156 240 patients were identified. Odds of death
(OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI
0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50- 0.81), and major
adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly
lower in the patients who underwent CR. These outcomes were unchanged on
subgroup analysis regardless of the definition of CR. Similar findings
were recorded when CR was studied in the chronic total occlusion (CTO)
subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed
a negative relationship between the OR for mortality and the percentage of
CR. Conclusion-CR is associated with reduced risk of mortality and major
adverse cardiac events, irrespective of whether an anatomical or a
score-based definition of incomplete revascularization is used, and this
magnitude of risk relates to degree of CR. These results have important
implications for the interventional management of patients with
multivessel coronary artery disease. Copyright © 2016 The
Authors.

<129>
Accession Number
613430248
Title
Isolated human pulmonary artery structure and function pre -and
post-cardiopulmonary bypass surgery.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002822. Date of Publication: 01 Feb 2016.
Author
Dora K.A.; Stanley C.P.; Jaaly E.A.; Fiorentino F.; Ascione R.; Reeves
B.C.; Angelini G.D.
Institution
(Dora, Stanley) Department of Pharmacology, University of Oxford, United
Kingdom
(Jaaly, Fiorentino, Angelini) Department of Cardiothoracic Surgery,
Hammersmith Hospital, Imperial College London, London, United Kingdom
(Ascione, Reeves, Angelini) Bristol Heart Institute, Bristol Royal
Infirmary, University of Bristol, United Kingdom
(Stanley) The Victor Chang Cardiac Research Institute, Sydney, Australia
Publisher
John Wiley and Sons Inc.
Abstract
Background-Pulmonary dysfunction is a known complication after cardiac
surgery using cardiopulmonary bypass, ranging from subclinical functional
changes to prolonged postoperative ventilation, acute lung injury, and
acute respiratory distress syndrome. Whether human pulmonary arterial
function is compromised is unknown. The aim of the present study was to
compare the structure and function of isolated and cannulated human
pulmonary arteries obtained from lung biopsies after the chest was opened
(pre-cardiopulmonary bypass) to those obtained at the end of
cardiopulmonary bypass (post-cardiopulmonary bypass) from patients
undergoing coronary artery bypass graft surgery. Methods and
Results-Pre-and post-cardiopulmonary bypass lung biopsies were received
from 12 patients undergoing elective surgery. Intralobular small arteries
were dissected, cannulated, pressurized, and imaged using confocal
microscopy. Functionally, the thromboxane mimetic U46619 produced
concentration-dependent vasoconstriction in 100% and 75% of pre-and
post-cardiopulmonary bypass arteries, respectively. The
endothelium-dependent agonist bradykinin stimulated vasodilation in 45%
and 33% of arteries pre-and post-cardiopulmonary bypass, respectively.
Structurally, in most arteries smooth muscle cells aligned
circumferentially; live cell viability revealed that although 100% of
smooth muscle and 90% of endothelial cells from pre -cardiopulmonary
bypass biopsies had intact membranes and were considered viable, only 60%
and 58%, respectively, were viable from post-cardiopulmonary bypass
biopsies. Conclusions-We successfully investigated isolated pulmonary
artery structure and function in fresh lung biopsies from patients
undergoing heart surgery. Pulmonary artery contractile tone and
endothelium-dependent dilation were significantly reduced in
post-cardiopulmonary bypass biopsies. The decreased functional responses
were associated with reduced cell viability. Clinical Trial
Registration--URL: http://www.isrctn.com/ISRCTN34428459. Copyright
© 2016 The Authors.

<130>
Accession Number
610819058
Title
Impact of valve morphology on the prevalence of coronary artery disease: A
systematic review and meta-analysis.
Source
Journal of the American Heart Association. 5 (5) (no pagination), 2016.
Article Number: e003200. Date of Publication: 01 May 2016.
Author
Poggio P.; Cavallotti L.; Songia P.; Di Minno A.; Ambrosino P.; Mammana
L.; Parolari A.; Alamanni F.; Tremoli E.; Di Minno M.N.D.
Institution
(Poggio, Cavallotti, Songia, Di Minno, Mammana, Alamanni, Tremoli, Di
Minno) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Cavallotti, Mammana, Alamanni) Dipartimento di Medicina e Chirurgia,
University of Milan, Italy
(Songia, Tremoli) Department of Pharmacological and Biomolecular Sciences,
University of Milan, Italy
(Parolari) Department of Biomedical Sciences for Health, University of
Milan, Italy
(Ambrosino, Di Minno) Division of Cardiology, Department of Advanced
Biomedical Sciences, Federico II University, Naples, Italy
(Parolari) Unita Operativa di Cardiochirurgia e Ricerca Traslazionale, San
Donato IRCCS, San Donato Milanese, Italy
Publisher
John Wiley and Sons Inc.
Abstract
Background-Literature studies suggested a lower prevalence of coronary
artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid
aortic valve (TAV) patients. However, this finding has been challenged. We
performed a meta-analysis to assess whether aortic valve morphology has a
different association with CAD, concomitant coronary artery bypass
grafting (CABG), and postoperative mortality. Methods and Results-Detailed
search was conducted according to the PRISMA (Preferred Reporting Items
for Systematic reviews and Meta-Analyses) guideline to identify all
patients with BAV or TAV and presence of CAD, concomitant myocardial
surgical revascularization, and the postoperative mortality. Thirty-one
studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery
were included. BAV patients showed a lower prevalence of CAD (odds ratio
[OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35,
0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than
TAV. However, BAV subjects were significantly younger than TAV (mean
difference: -7.29; 95% CI: -11.17, -3.41) were more frequently males (OR,
1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension
(OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54,
0.93). Interestingly, a metaregression analysis showed that younger age
and lower prevalence of diabetes were associated with lower prevalence of
CAD (Z value: -3.03; P=0.002 and Z value: -3.10; P=0.002, respectively)
and CABG (Z value: -2.69; P=0.007 and Z value: -3.36; P=0.001,
respectively) documented in BAV patients. Conclusions-Analysis of raw data
suggested an association of aortic valve morphology with prevalence of
CAD, concomitant CABG, and postoperative mortality. Interestingly, the
differences in age and diabetes have a profound impact on prevalence of
CAD between BAV and TAV. In conclusion, our meta-analysis suggests that
the presence of CAD is independent of aortic valve
morphology. Copyright © 2016 The Authors.

<131>
Accession Number
610471206
Title
Cerebrovascular events after no-touch off-pump coronary artery bypass
grafting, conventional side-clamp off-pump coronary artery bypass, and
proximal anastomotic devices: A meta-analysis.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002802. Date of Publication: 01 Feb 2016.
Author
Pawliszak W.; Kowalewski M.; Raffa G.M.; Malvindi P.G.; Kowalkowska M.E.;
Szwed K.A.; Borkowska A.; Kowalewski J.; Anisimowicz L.
Institution
(Pawliszak, Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Division of Ergonomics and Physical Effort, Department of
Hygiene, Epidemiology and Ergonomics, Collegium Medicum UMK, Bydgoszcz,
Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) Wessex Cardiothoracic Centre, University Hospital Southampton
NHS Foundation Trust, Southampton, United Kingdom
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Department of Clinical Neuropsychology, Collegium
Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Nicolaus Copernicus University, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
Publisher
John Wiley and Sons Inc.
Abstract
Background--Off-pump coronary artery bypass (OPCAB) has been shown to
reduce the risk of neurologic complications as compared to coronary artery
bypass grafting performed with cardiopulmonary bypass. Side-clamping of
the aorta while constructing proximal anastomoses, however, still carries
substantial risk of cerebral embolization. We aimed to perform a
comprehensive meta-analysis of studies assessing 2 clampless techniques:
aortic "no-touch" and proximal anastomosis devices (PAD) for OPCAB.
Methods and Results--PubMed, CINAHL, CENTRAL, and Google Scholar databases
were screened for randomized controlled trials and observational studies
comparing "no-touch" and/or PAD with side-clamp OPCAB and reporting
short-term (=30 days) outcomes: cerebrovascular accident and all-cause
mortality. A total of 18 studies (3 randomized controlled trials)
enrolling 25 163 patients were included. Aortic "no-touch" was associated
with statistically lower risk of cerebrovascular accident as compared to
side-clamp OPCAB: risk ratio 95% CI: 0.41 (0.27-0.61); P<0.01; I2=0%.
Event rates were 0.36% and 1.28% for "no-touch" and sideclamp OPCAB,
respectively. No difference was seen between PAD and side-clamp OPCAB:
0.71 (0.33-1.55); P=0.39; I2=39%. A trend towards increased 30-day
all-cause mortality with PAD and no difference with "no-touch" were
observed when compared to side-clamp OPCAB. In a subset analysis,
"no-touch" consistently reduced the risk of cerebrovascular accident
regardless of patients' baseline risk characteristics. A benefit with PAD
was observed in low-risk patients. Conclusions--Aortic "no-touch"
technique was associated with nearly 60% lower risk of postoperative
cerebrovascular events as compared to conventional side-clamp OPCAB with
effect consistent across patients at different risk. Copyright ©
2016 The Authors.

<132>
Accession Number
632268440
Title
The effect of milrinone on mortality in adult patients who underwent CABG
surgery: a systematic review of randomized clinical trials with a
meta-analysis and trial sequential analysis.
Source
BMC Cardiovascular Disorders. 20 (1) (no pagination), 2020. Article
Number: 328. Date of Publication: 08 Jul 2020.
Author
Ren Y.-S.; Li L.-F.; Peng T.; Tan Y.-J.; Sun Y.; Cheng G.-L.; Zhang G.-M.;
Li J.
Institution
(Ren, Li, Peng, Tan, Sun, Cheng, Zhang, Li) Shandong New Time
Pharmaceutical Co., Ltd., Linyi, China
(Ren, Tan, Zhang, Li) National Engineering and Technology Research Center
of Chirality Pharmaceutica, Lunan Pharmaceutical Group Co, Ltd., Linyi,
China
(Ren, Li, Peng, Tan, Sun, Cheng, Zhang, Li) State Key Laboratory of
Generic Manufacture Technology of Chinese Traditional Medicine, Lunan
Pharmaceutical Group Co, Ltd., Linyi, China
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: As an inodilator, milrinone is commonly used for patients who
undergo coronary artery bypass graft (CABG) surgery because of its
effectiveness in decreasing the cardiac index and mitral regurgitation.
The aim of this study was to perform a systematic review and meta-analysis
of existing studies from the past 20 years to evaluate the impact of
milrinone on mortality in patients who undergo CABG surgery.
 Method(s): We performed a systematic literature search on the
application of milrinone in patients who underwent CABG surgery in studies
published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the
Cochrane Central Register. The included studies evaluated milrinone groups
compared to groups receiving either placebo or standard treatment and
further compared the systemic administration. Result(s): The network
meta-analysis included 723 patients from 16 randomized clinical trials.
Overall, there was no significant difference in mortality between the
milrinone group and the placebo/standard care group when patients
underwent CABG surgery. In addition, 9 trials (with 440 randomized
patients), 4 trials (with 212 randomized patients), and 10 trials (with
470 randomized patients) reported that the occurrence of myocardial
infarction (MI), myocardial ischemia, and arrhythmia was lower in the
milrinone group than in the placebo/standard care group. Between the
milrinone treatment and placebo/standard care groups, the occurrence of
myocardial infarction, myocardial ischemia, and arrhythmia was
significantly different. However, the occurrence of stroke and renal
failure, the duration of inotropic support (h), the need for an
intra-aortic balloon pump (IABP), and mechanical ventilation (h) between
these two groups showed no differences. Conclusion(s): Based on the
current results, compared with placebo, milrinone might be unable to
decrease mortality in adult CABG surgical patients but can significantly
ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia.
These results provide evidence for the further clinical application of
milrinone and of therapeutic strategies for CABG surgery. However, along
with milrinone application in clinical use, sufficient data from
randomized clinical trials need to be collected, and the potential
benefits and adverse effects should be analyzed and
reevaluated. Copyright © 2020 The Author(s).

<133>
Accession Number
2005562546
Title
How valvular calcification can affect the outcomes of transcatheter aortic
valve implantation.
Source
Expert Review of Medical Devices. (pp 1-12), 2020. Date of Publication:
2020.
Author
Milhorini Pio S.; Bax J.; Delgado V.
Institution
(Milhorini Pio, Bax, Delgado) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: In transcatheter aortic valve implantation (TAVI),
assessment of aortic valve calcification is not as standardized as aortic
annulus measurement. Aortic valve calcification is important for stable
anchoring of the prosthesis to the aortic annulus. However, excessive
aortic valve calcification is related to procedural complications. Areas
covered: This review covers the methods to assess aortic valve
calcification and the implications of aortic valve calcium burden for TAVI
outcomes. We performed a systematic review of the literature in Pubmed and
secondary sources. Furthermore, future perspectives on how to integrate
aortic valve calcification assessment in the management of patients with
aortic stenosis is discussed. Expert opinion: Thorough assessment of the
aortic valve and aortic root components including aortic valve
calcification is key in the planning of TAVI. Aortic valve calcification
load, location and extension are important contributors to paravalvular
regurgitation. Asymmetric calcification burden with greater calcification
of the left-coronary cusp related to higher need of permanent pacemaker
implantation. Patients with moderate and severe left ventricular outflow
tract/subannular calcification are more susceptible to aortic annular
rupture. Periprocedural dislodgement of calcium form cusps and commissures
is one of the main reasons of coronary artery ostial occlusion during
transcatheter aortic valve implantation. Abbreviations: Ao, aorta; LA,
left atrium; LAA, left atrial appendage; LV, left ventricle; LVOT, left
ventricular outflow tract; THV, transcatheter heart valve. Copyright
© 2020, © 2020 The Author(s). Published by Informa UK Limited,
trading as Taylor & Francis Group.

<134>
Accession Number
2004724537
Title
The safety and efficacy of ultrasound-guided serratus anterior plane block
(Sapb) combined with dexmedetomidine for patients undergoing
video-assisted thoracic surgery (vats): A randomized controlled trial.
Source
Journal of Pain Research. 13 (pp 1785-1795), 2020. Date of Publication:
2020.
Author
Li X.; Liu Y.; Zhao J.; Xiang Z.; Ren C.; Qiao K.
Institution
(Li, Xiang, Qiao) Department of Anesthesiology, The First People's
Hospital of Tianmen, Tianmen, Hubei, China
(Liu, Zhao, Ren) Department of Anesthesiology, Liaocheng People's
Hospital, Liaocheng, Shandong, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Although video-assisted thoracic surgery (VATS) can
significantly reduce postoperative pain, the incidence is as high as
30-50%. The purpose of this study was to explore the safety and efficacy
of ultrasound-guided serratus anterior plane block (SAPB) combined with
dexmedetomidine (Dex) for patients undergoing VATS. Method(s): Eighty
patients were randomized into two groups (20 mL 0.5% ropivacaine plus 0.5
micro g/kg or 1 micro g/kg Dex). Primary outcome was the visual
analog scale of pain while coughing (VASc) score at 24 h after surgery.
Secondary outcomes included hemodynamics, sufentanil consumption, number
of patients needing rescue analgesia, time to first rescue analgesic,
total dose of rescue analgesic, satisfaction scores of patients and
surgeons, time of chest tube removal, length of hospital stay, adverse
effects, the prevalence of chronic pain and quality of life.
 Result(s): Compared with D1 group, visual analog scale of pain at
rest (VASr) was significantly lower during the first 24 h after surgery,
while VASc was significantly lower during the first 48 h after surgery
(P<0.05). Mean arterial pressure was significantly decreased from T2 to
T8, and heart rate was significantly decreased from T2 to T7 in the D2
group (P<0.05). Consumption of sevoflurane, remifentanil, DEX and the
recovery time were significantly reduced in the D2 group (P <0.05).
Consumption of sufentanil 8-72 h after surgery was significantly lower in
the D2 group (P<0.05). Additionally, the number of patients who required
rescue analgesia, the time to the first dose of rescue analgesia, and the
total dose of rescue analgesia was significantly lower in the D2 group
(P<0.05). Conclusion(s): The results of this study show that 1
micro g/kg DEX is a beneficial adjuvant to ropivacaine for
single-injection SAPB in VATS patients while stable hemodynamics were
maintained. Copyright © 2020 Li et al.

<135>
Accession Number
2004716370
Title
The effect of vitamin C supplementation on cardiac enzymes after coronary
artery bypass graft: A double-blind randomized control trial.
Source
Current Nutrition and Food Science. 16 (5) (pp 833-838), 2020. Date of
Publication: 2020.
Author
Moludi J.; Alizadeh M.; Jafari-Vayghyan H.; Foroumandi E.; Maleki V.;
Ebrahimi B.; Sadeghpour A.; Alizadehasl A.; Tabaee A.S.
Institution
(Moludi, Foroumandi, Maleki) Student Research Committee, Faculty of
Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Moludi, Alizadeh) Nutrition Research Center, Faculty of Nutrition, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Jafari-Vayghyan) School of Health, Arak University of Medical Sciences,
Arak, Iran, Islamic Republic of
(Ebrahimi) Department of Food Science and Technology, Maragheh University
of Medical Science, Maragheh, Iran, Islamic Republic of
(Sadeghpour, Alizadehasl) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Tabaee) Rajaie Cardiovascular Medi cal and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
Background: Coronary artery bypass graft (CABG) is associated with
oxidative stress and tissue damage. Vitamin C, as an antioxidant agent,
has an important role in attenuating the oxidative stress damage and might
have cardio-protective effects after CABG. We aimed to evaluate the
probable roles of vitamin C supplementation in cardiac biomarkers after
CABG. Method(s): In this randomized control trial, 122 patients
undergoing CABG were randomly assigned to the intervention (n=54) and
control group (n=68) and received vitamin C (2 g intravenously) or
placebo, respectively. The surgical methods of the patients in the two
groups were identical. The primary efficacy endpoint of this trial is the
difference in the levels of CK-MB, Troponin and Total Antioxidant Capacity
(TAC) were measured at study entry and 24 hrs after surgery between the
two groups. Result(s): The two groups were not significantly
different in terms of basic variables. Within-group comparison showed
significant rises in the level of troponin (P < 0.001) and CK-MB (P <
0.001) over time. However, between-group comparison showed no significant
difference between the two groups in terms of CK-MB (P=0.826) and troponin
(P=0.821). As a whole, the correlation between cardiac enzymes and
surgical characteristic was not seen. Conclusion(s): The results
showed that pretreatment with vitamin C could not reduce cardiac marker
following CABG. After the intervention, TAC did not differ between and
within the intervention and the control groups. Pretreatment with vitamin
C as an antioxidant agent could not reduce ischemicreperfusion resulting
in CABG. Copyright © 2020 Bentham Science Publishers.

<136>
Accession Number
2004397409
Title
Passive Peritoneal Drainage Impact on Fluid Balance and Inflammatory
Mediators: A Randomized Pilot Study.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (2) (pp
150-158), 2020. Date of Publication: 01 Mar 2020.
Author
Pourmoghadam K.K.; Kubovec S.; DeCampli W.M.; Khallouq B.B.; Piggott K.;
Blanco C.; Fakioglu H.; Kube A.; Narasimhulu S.S.
Institution
(Pourmoghadam, DeCampli, Kube) Section of Pediatric Cardiovascular
Surgery, Arnold Palmer Hospital for Children, Orlando, FL, United States
(Pourmoghadam, Kubovec, DeCampli, Khallouq, Narasimhulu) University of
Central Florida College of Medicine, Orlando, FL, United States
(Piggott, Blanco, Fakioglu, Narasimhulu) Pediatric Cardiac Intensive Care,
Orlando, FL, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Infants after cardiopulmonary bypass are exposed to increasing
inflammatory mediator release and are at risk of developing fluid
overload. The aim of this pilot study was to evaluate the impact of
passive peritoneal drainage on achieving negative fluid balance and its
ability to dispose of inflammatory cytokines. Method(s): From
September 2014 to November 2016, infants undergoing STAT category 3, 4,
and 5 operations were randomized to receive or not receive intraoperative
prophylactic peritoneal drain. We analyzed time to negative fluid balance
and perioperative variables for each group. Pro- and anti-inflammatory
cytokines were measured from serum and peritoneal fluid in the passive
peritoneal drainage group and serum in the control group postoperatively.
 Result(s): Infants were randomized to prophylactic passive peritoneal
drain group (n = 13) and control (n = 12). The groups were not
significantly different in pre- and postoperative peak lactate levels,
postoperative length of stay, and mortality. Peritoneal drain patients
reached time to negative fluid balance at a median of 1.42 days
(interquartile range [IQR]: 1.00-2.91), whereas the control at 3.08 (IQR:
1.67-3.88; P =.043). Peritoneal drain patients had lower diuretic index at
72 hours, median of 2.86 (IQR: 1.21-4.94) versus 6.27 (IQR: 4.75-11.11; P
=.006). Consistently, tumor necrosis factor-alpha, interleukin (IL)-4,
IL-6, IL-8, IL-10, and interferon-gamma were present at higher levels in
peritoneal fluid than serum at 24 and 72 hours. However, serum cytokine
levels in peritoneal drain and control group, at 24 and 72 hours
postoperatively, did not differ significantly. Conclusion(s): The
prophylactic passive peritoneal drain patients reached negative fluid
balance earlier and used less diuretic in early postoperative period. The
serum cytokine levels did not differ significantly between groups at 24
and 72 hours postoperatively. However, there was no significant difference
in mortality and postoperative length of stay. Copyright © The
Author(s) 2020.

<137>
Accession Number
2007088346
Title
Anesthetic management of neonates undergoing diagnostic and therapeutic
cardiac catheterization: a systematic literature review.
Source
Brazilian Journal of Anesthesiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Valencia-Arango L.M.; Fajardo-Escolar A.P.; Segura-Salguero J.C.;
Saenz-Quispe S.; Rincon-Restrepo C.; Posada A.; Ronderos V.; Perea-Bello
A.H.
Institution
(Valencia-Arango, Fajardo-Escolar, Segura-Salguero, Saenz-Quispe,
Rincon-Restrepo, Perea-Bello) Hospital Universitario San Ignacio.
Universidad Javeriana, Facultad de Medicina, Bogota, Colombia
(Posada, Ronderos) Universidad Javeriana. Facultad de Medicina, Bogota,
Colombia
Publisher
Elsevier Editora Ltda
Abstract
Background: Several interventional cardiology procedures are required in
neonates with congenital heart disease. Interventional cardiology
procedures have a higher risk of cardiac arrest compared to other
interventions. At present, there is great heterogeneity in the
perioperative management of congenital heart disease neonates undergoing
diagnostic cardiac catheterization or therapeutic cardiac catheterization.
Study objectives: Primary aim: Provide a systematic review of the most
effective and/or safe anesthetic and perioperative management in neonates
with congenital heart disease who undergo diagnostic cardiac
catheterization or therapeutic cardiac catheterization. Secondary aim:
Identify the medications, monitoring parameters and airway management used
in the same population. Design(s): Systematic literature review.
 Setting(s): Catheterization laboratory. Method(s): Literature
was searched (December 2017) in electronic databases Medline, EMBASE,
ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane
Database of Systematic Reviews, Database of Abstracts of Reviews of
Effects and Health Technology Assessment Database. Main Result(s):
From 130 records identified, four studies met inclusion criteria and
quality assessment. None of the studies were relevant to the primary
objective. Regarding the secondary objectives, one study compared the
efficacy and adverse effects of racemic ketamine and its S(+) ketamine
enantiomer, one study reported the efficacy of subarachnoid anesthesia for
high-risk children undergoing diagnostic cardiac catheterization, one
study identified the factors associated to high severity adverse events
related to sedation, anesthesia and airway, and one study retrospectively
analyzed cardiac catheterization procedures in neonates weighing less than
2.5 kg. Conclusion(s): There are no evidence-based recommendations
available for congenital heart disease neonates undergoing cardiac
catheterization. More studies are required to evaluate the ideal
anesthetic and perioperative management in this population. Copyright
© 2020

<138>
Accession Number
631515080
Title
What Interventions Do Physical Therapists Provide for Patients With
Cardiorespiratory Conditions, Neurological Conditions, and Conditions
Requiring Acute Hospital Care? A Systematic Review.
Source
Physical therapy. 100 (7) (pp 1180-1205), 2020. Date of Publication: 19
Jul 2020.
Author
Zadro J.R.; Cheng S.; O'Keeffe M.; Maher C.G.
Institution
(Zadro) Sydney School of Public Health, Institute for Musculoskeletal
Health, Faculty of Medicine and Health, University of Sydney, Level 10 N,
King George V Building, Royal Prince Alfred Hospital, Missenden Road
,Camperdown, NSW 2050, Australia
(Cheng) Discipline of Physiotherapy, Faculty of Health Sciences,
University of Sydney, NSW, Australia
(O'Keeffe, Maher) Sydney School of Public Health, Institute for
Musculoskeletal Health, Faculty of Medicine and Health, University of
Sydney
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this systematic review was to determine what
percentages of physical therapists provide interventions that are of high
value, low value, or unknown value for cardiorespiratory conditions,
neurological conditions, or conditions requiring acute hospital care.
Whether an intervention was considered high or low value was determined by
reference to guidelines or systematic reviews. METHOD(S): Searches of
numerous databases were performed by combining terms synonymous with
"practice patterns" and "physical therapy" until April 2018. Studies that
investigated what interventions physical therapists provide for any
cardiorespiratory condition, neurological condition, or condition
requiring acute hospital care through surveys and audits of clinical notes
were included. Through the use of medians and interquartile ranges, the
percentages of physical therapists who provided interventions that were of
high value, low value, or unknown value were summarized. RESULT(S):
Twenty-six studies were included. The median percentages of physical
therapists who provided interventions of high, low, and unknown value for
chronic obstructive pulmonary disease ranged from 78% to 96%, 67% to 100%,
and 56% to 91%, respectively. These percentages ranged from 61% to 97%,
87% to 98%, and 83% to 98% for adults who were critically ill in intensive
care units; 70% to 93%, 38% to 50%, and 8% to 95% before or after
cardiac/thoracic surgery; 25% to 96%, 23% to 84%, and 96% for acute
stroke; and 11% (high value) and 13% (unknown value) for Parkinson
disease, respectively. CONCLUSION(S): This review found patterns of
physical therapist practice for cardiorespiratory conditions, neurological
conditions, and conditions requiring acute hospital care that were both
evidence based and not evidence based. A concern is that a substantial
percentage of physical therapists provided interventions that were of low
or unknown value despite the availability of high-value interventions.
IMPACT: This systematic review is the first, to our knowledge, to
summarize the percentage of physical therapist treatment choices that were
high versus low value for cardiorespiratory conditions, neurological
conditions, and conditions requiring acute hospital care. The findings
highlight areas of practice where low-value care could be replaced with
high-value care-such as in the management of patients who have chronic
obstructive pulmonary disease or who are in intensive care-and identify an
urgent need to develop and test strategies to ensure that patients with
these conditions receive the interventions most likely to improve their
outcomes. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of American Physical Therapy Association. All
rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<139>
Accession Number
617835079
Title
Efficacy of brief behavioral counselling by allied health professionals to
promote physical activity in people with peripheral arterial disease
(BIPP): study protocol for a multi-center randomized controlled trial.
Source
BMC public health. 16 (1) (pp 1148), 2016. Article Number: 1148. Date of
Publication: 09 Nov 2016.
Author
Burton N.W.; Ademi Z.; Best S.; Fiatarone Singh M.A.; Jenkins J.S.; Lawson
K.D.; Leicht A.S.; Mavros Y.; Noble Y.; Norman P.; Norman R.; Parmenter
B.J.; Pinchbeck J.; Reid C.M.; Rowbotham S.E.; Yip L.; Golledge J.
Institution
(Burton) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Ademi) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Ademi) Vascular Surgery The Royal Brisbane and Women's Hospital, Herston,
Sydney, QLD 4059, Australia
(Best, Pinchbeck, Yip, Golledge) Exercise, Health and Performance Faculty
Research Group, Faculty of Health Sciences, University of Sydney, Sydney,
NSW 2141, Australia
(Fiatarone Singh) Vascular Surgery The Royal Brisbane and Women's
Hospital, Herston, Sydney, QLD 4059, Australia
(Jenkins) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Lawson) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Lawson) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Leicht) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Mavros, Noble) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141,
Australia
(Norman) Exercise, Health and Performance Faculty Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Norman, Reid) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141,
Australia
(Parmenter) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141,
Australia
(Reid) Exercise, Health and Performance Faculty Research Group, Faculty of
Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
(Rowbotham) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141,
Australia
(Rowbotham) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141,
Australia
(Golledge) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141,
Australia
Abstract
BACKGROUND: Physical activity is recommended for people with peripheral
arterial disease (PAD), and can improve walking capacity and quality of
life; and reduce pain, requirement for surgery and cardiovascular events.
This trial will assess the efficacy of a brief behavioral counselling
intervention delivered by allied health professionals to improve physical
activity in people with PAD.
METHODS: This is a multi-center randomised controlled trial in four cities
across Australia. Participants (N=200) will be recruited from specialist
vascular clinics, general practitioners and research databases and
randomised to either the control or intervention group. Both groups will
receive usual medical care, a written PAD management information sheet
including advice to walk, and four individualised contacts from a
protocol-trained allied health professional over 3 months (weeks 1, 2, 6,
12). The control group will receive four 15-min telephone calls with
general discussion about PAD symptoms and health and wellbeing. The
intervention group will receive behavioral counselling via two 1-h
face-to-face sessions and two 15-min telephone calls. The counselling is
based on the 5A framework and will promote interval walking for 3x40
min/week. Assessments will be conducted at baseline, and 4, 12 and 24
months by staff blinded to participant allocation. Objectively assessed
outcomes include physical activity (primary), sedentary behavior, lower
limb body function, walking capacity, cardiorespiratory fitness,
event-based claudication index, vascular interventions, clinical events,
cardiovascular function, circulating markers, and anthropometric measures.
Self-reported outcomes include physical activity and sedentary behavior,
walking ability, pain severity, and health-related quality of life. Data
will be analysed using an intention-to-treat approach. An economic
evaluation will assess whether embedding the intervention into routine
care would likely be value for money. A cost-effectiveness analysis will
estimate change in cost per change in activity indicators due to the
intervention, and a cost-utility analysis will assess change in cost per
quality-adjusted life year. A full uncertainty analysis will be
undertaken, including a value of information analysis, to evaluate the
economic case for further research.
DISCUSSION: This trial will evaluate the efficacy and cost-effectiveness
of a brief behavioral counselling intervention for a common cardiovascular
disease with significant burden.
TRIAL REGISTRATION: ACTRN 12614000592640 Australian New Zealand Clinical
Trials Registry. Registration Date 4 June 2014.

<140>
Accession Number
632162291
Title
Consolidated quality improvements following benchmarking with
cardiothoracic surgery registries-a systematic review.
Source
European Journal of Cardio-thoracic Surgery. 57 (5) (pp 817-825), 2020.
Date of Publication: 01 May 2020.
Author
De By T.M.M.H.; Muslem R.; Caliskan K.; Bortolussi G.; Philipsen T.;
Friberg O.; Bogers A.J.J.C.; Pagano D.
Institution
(De By) European Association for Cardio-Thoracic Surgery, Windsor, United
Kingdom
(De By, Muslem, Bogers) Department of Cardiothoracic Surgery, Erasmus
Medical Center, Rotterdam, Netherlands
(Caliskan) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Bortolussi) Department of Cardiac Thoracic Vascular Sciences and Public
Health, Padua University Hospital, Padua, Italy
(Philipsen) Department of Cardiac Surgery, Universitair Ziekenhuis Gent,
Gent, Belgium
(Friberg) Department of Cardiothoracic and Vascular Surgery, Orebro
University Hospital, Orebro, Sweden
(Pagano) Department of Cardiothoracic Surgery, University of Birmingham,
University Hospital Birmingham, Birmingham, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The influence of registries in medicine is large. However, there has been
no systematic assessment conducted to quantify the impact of benchmarking
with registries focused on cardiothoracic surgery. Numerous publications
conclude that registry participation leads to improvement of outcomes for
patients. A large number of registries provide evidence sub-structured by
statistics that show decreases in morbidity and mortality in the
participants' clinical units. Many authors praise the benchmarking method
making use of databases of registries as having a positive effect on
outcome of care. However, studies proving the direct causal relation
between the use of cardiothoracic surgery-oriented registries and
improvement of clinical in-hospital outcomes are extremely scarce. We
aimed to analyse the causal relation between the use of cardiothoracic
surgery-oriented registries and improvement of clinical outcomes. In a
systematic literature review, publications demonstrating the use of
registry data to obtain consolidated quality improvements were selected.
After analysis of 2990 scientific publications, 6 studies filled the
inclusion criteria. The selected studies acknowledged that benchmarking of
data against registries was used for a focused and methodologically
organized improvement in cardiothoracic departments. In conjunction with
the impact of the applied methods on healthcare, their results demonstrate
quantifiable enhanced local outcomes over time. Copyright © 2019
The Author(s).

<141>
Accession Number
2006983370
Title
A case of granular cell tumor of the mediastinum treated by VATS and a
review of literature.
Source
Respiratory Case Reports. 9 (1) (pp 20-24), 2020. Date of Publication:
February 2020.
Author
Demiroz S.M.; Findik G.; Yilmaz G.; Demirag F.; Tari P.
Institution
(Demiroz, Findik, Yilmaz) Department of Thoracic Surgery, University of
Health Sciences, Ankara Ataturk Chest Diseases and Thoracic Surgery
Training and Research Hospital, Ankara, Turkey
(Demirag) Department of Pathology, University of Health Sciences, Ankara
Ataturk Chest Diseases and Thoracic Surgery Training and Research
Hospital, Ankara, Turkey
(Tari) Department of Nuclear Medicine, University of Health Sciences,
Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research
Hospital, Ankara, Turkey
Publisher
LookUs Scientific (E-mail: respircase@respircase.com)
Abstract
Granular cell tumors (GCT) of mediastinal origin are extremely rare. To
the best of our knowledge there have been a total of 21 cases reported
since the first case was reported by Harrer in 1972. Both benign and
malign forms of GCTs have been reported, and some criteria for malign
forms have been described. Preoperative diagnoses are challenging due to
the rareness of the condition. Histopathological studies should include
immunhistochemistry. Given the rareness of such tumors in the mediastinum,
the findings and the diagnostic yield of PET-CT are still unclear. Herein
we present the case of a 50-year-old woman suffering from back pain whose
diagnosis was based on a thorax computed tomography followed by PET-CT,
and who was treated with a video-assisted thoracic surgical excision, with
a final pathologic diagnosis of a "granular cell tumor" of the posterior
mediastinum. Copyright © 2020 LookUs Scientific. All rights
reserved.

<142>
Accession Number
632162318
Title
Comparative efficacy and safety of antithrombotic therapy for
transcatheter aortic valve replacement: A systematic review and network
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 57 (5) (pp 965-976), 2020.
Date of Publication: 01 May 2020.
Author
Zhu Y.; Zou Z.; Huang Y.; Zhang L.; Chen H.; Li Y.; Liu C.; Li X.; Xu D.;
Zeng Q.
Institution
(Zhu, Zou, Huang, Zhang, Chen, Li, Li, Xu, Zeng) First Clinical Medical
College, State Key Laboratory of Organ Failure Research, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Zhu, Huang, Xu, Zeng) Guangzhou Regenerative Medicine and Health
Guangdong Laboratory, Guangzhou, China
(Liu) Department of Cardiology, Guangzhou First People's Hospital, School
of Medicine, South China University of Technology, Guangzhou, China
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We sought to determine the optimal antithrombotic therapy
after transcatheter aortic valve replacement. METHOD(S): Related
scientific databases were searched until December 2018. We conducted a
pairwise and a network meta-analysis within a frequentist framework,
measuring 30-day bleeding, stroke and all-cause mortality. The surface
under the cumulative ranking (SUCRA) curve was estimated to rank the
therapies. The Grading of Recommendations Assessment, Development and
Evaluation (GRADE) approach was performed. The protocol was registered
with PROSPERO (CRD42018111163). RESULT(S): Eight studies comprising
2173 patients were analysed. The risk of 30-day bleeding was higher for
dual antiplatelet therapy (DAPT) than single antiplatelet therapy (SAPT)
[odds ratio (OR) 1.90 (1.10-3.28); P = 0.02], whereas there was no
difference in the risk of 30-day stroke [OR 1.27 (0.38-4.20); P = 0.69]
and mortality [OR 1.46 (0.67-3.22); P = 0.34] between DAPT and SAPT. In
the network meta-analysis, DAPT + oral anticoagulant (OAC) increased the
risk of 30-day bleeding compared with SAPT [OR 6.21 (1.74-22.17); P =
0.005], DAPT [OR 3.27 (1.04-10.32); P = 0.043], SAPT + OAC [OR 4.87
(2.51-9.45); P < 0.001] and OAC [OR 14.4 (1.3-154.7); P = 0.028].
Additionally, patients receiving DAPT + OAC had the highest risks for
30-day bleeding (SUCRA 1.0%). OAC seemed to be superior to SAPT and DAPT
in terms of 30-day bleeding (SUCRA OAC: 86.3%, SAPT: 72.3%, DAPT: 32.3%)
and stroke (SUCRA 54.2%, 47.4%, 40.5%), but not mortality (SUCRA 69.6%,
74.1%, 43.4%). CONCLUSION(S): There is a trend towards less bleeding
with the application of SAPT, but no mortality benefit with the
application of DAPT is shown. The comparison of SAPT, DAPT and OAC shows
that OAC may improve the balance between stroke and bleeding, which can
reduce the risk of mortality. In addition, the application of DAPT + OAC
was ranked the worst amongst all treatment modalities and should be
avoided due to an increased risk of bleeding. Clinical trial registration
number: PROSPERO (International Prospective Register of Systematic
Reviews, CRD42018111163). Copyright © 2019 The Author(s).

<143>
Accession Number
2004639825
Title
Vasopressors and inotropes in acute myocardial infarction related
cardiogenic shock: A systematic review and meta-analysis.
Source
Journal of Clinical Medicine. 9 (7) (pp 1-12), 2020. Article Number: 2051.
Date of Publication: July 2020.
Author
Karami M.; Hemradj V.V.; Ouweneel D.M.; Den Uil C.A.; Limpens J.;
Otterspoor L.C.; Vlaar A.P.; Lagrand W.K.; Henriques J.P.S.
Institution
(Karami, Ouweneel, Henriques) Heart Center, Department of Interventional
Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University
of Amsterdam, Amsterdam 1105 AZ, Netherlands
(Hemradj) Department of Cardiology, Isala, Zwolle 8025 AB, Netherlands
(Den Uil) Departments of Cardiology and Intensive Care Medicine, Erasmus
MC, University Medical Center, Rotterdam 3015 GD, Netherlands
(Limpens) Medical Library, Amsterdam UMC, University of Amsterdam,
Amsterdam 1105 AZ, Netherlands
(Otterspoor) Heart Center Catharina Hospital, Eindhoven 5623 EJ,
Netherlands
(Vlaar, Lagrand) Department of Intensive Care, Amsterdam UMC, University
of Amsterdam, Amsterdam 1105 AZ, Netherlands
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Vasopressors and inotropes are routinely used in acute myocardial
infarction (AMI) related cardiogenic shock (CS) to improve hemodynamics.
We aimed to investigate the effect of routinely used vasopressor and
inotropes on mortality in AMI related CS. A systematic search of MEDLINE,
EMBASE and CENTRAL was performed up to 20 February 2019. Randomized and
observational studies reporting mortality of AMI related CS patients were
included. At least one group should have received the vasopressor/inotrope
compared with a control group not exposed to the vasopressor/inotrope.
Exclusion criteria were case reports, correspondence and studies including
only post-cardiac surgery patients. In total, 19 studies (6 RCTs) were
included, comprising 2478 CS patients. The overall quality of evidence was
graded low. Treatment with adrenaline, noradrenaline, vasopressin,
milrinone, levosimendan, dobutamine or dopamine was not associated with a
difference in mortality between therapy and control group. We found a
trend toward better outcome with levosimendan, compared with control (RR
0.69, 95% CI 0.47-1.00). In conclusion, we found insufficient evidence
that routinely used vasopressors and inotropes are associated with reduced
mortality in patients with AMI related CS. Considering the limited
evidence, this study emphasizes the need for randomized trials with
appropriate endpoints and methodology. Copyright © 2020 by the
authors. Licensee MDPI, Basel, Switzerland.

<144>
Accession Number
2004605799
Title
Metabolic disorders With kidney transplant.
Source
Clinical Journal of the American Society of Nephrology. 15 (5) (pp
732-742), 2020. Date of Publication: May 2020.
Author
Cohen E.; Korah M.; Callender G.; Aguiar R.B.; Haakinson D.
Institution
(Cohen) Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT,
United States
(Korah) Yale University School of Medicine, New Haven, CT, United States
(Callender) Department of Surgery, Section of Endocrine Surgery, Yale
University, New Haven, CT, United States
(Aguiar) Department of Medicine, Section of Endocrinology, Yale
University, New Haven, CT, United States
(Haakinson) Department of Surgery, Section of Transplant, Yale University,
New Haven, CT, United States
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Metabolic disorders are highly prevalent in kidney transplant candidates
and recipients and can adversely affect post-transplant graft outcomes.
Management of diabetes, hyperparathyroidism, and obesity presents distinct
opportunities to optimize patients both before and after transplant as
Well as the ability to track objective data over time to assess a
patient's ability to partner effectively With the health care team and
adhere to complex treatment regimens. Optimization of these particular
disorders can most dramatically decrease the risk of surgical and
cardiovascular complications post-transplant. Approximately 60% of
nondiabetic patients experience hyperglycemia in the immediate
post-transplant phase. Multiple risk factors have been identified related
to development ofNew onset diabetes after transplant,andit is estimated
that upward of 7%-30% of patients Will develop New onset diabetes Within
the first year post-transplant. There are a number of medications studied
in the kidney transplant population for diabetes management, and recent
data and the risks and benefits of each regimen should be optimized.
Secondary hyperparathyroidism occurs in most patients With CKD and can
persist after kidney transplant in up to 66% of patients, despite an
initial decrease in parathyroid hormone levels. Parathyroidectomy and
medical management are the options for treatment of secondary
hyperparathyroidism, but there is no randomized, controlled trial
providing clear recommendations for optimal management, and
patient-specific factors should be considered. Obesity is the most common
metabolic disorder affecting the transplant population in both the pre-and
post-transplant phases of care. Not only does obesity have associations
and interactions With comorbid illnesses, such as diabetes, dyslipidemia,
and cardiovascular disease, all of Which increase morbidity and mortality
post-transplant, but it also is intimately inter-related With access to
transplantation for patients With kidney failure. We Review these
metabolic disorders and their management, including data in patients With
kidney transplants. Copyright © 2020 by the American Society of
Nephrology.

<145>
Accession Number
632378488
Title
Prevention of nosocomial infection using oral chlorhexidine among patients
undergoing cardiac surgery: A meta-analysis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2020. United
States. 201 (1) (no pagination), 2020. Date of Publication: 2020.
Author
Ogbac M.E.; Tamayo J.V.
Institution
(Ogbac) Section of Pulmonology, Perpetual Help Medical Center-Las Pinas,
Las Pinas, Philippines
(Tamayo) Perpetual Help Medical Center-Las Pinas, Las Pinas, Philippines
Publisher
American Thoracic Society
Abstract
Rationale:Infections namely pneumonia, urinary tract infection, and wound
infection can complicate post-operative outcomes of cardiac surgeries such
as percutaneous coronary intervention and coronary artery bypass grafts.
These preventable complications have caused significant delay in the
improvement and even death in certain patients undergoing these
procedures. Oral chlorhexidine has been proven to prevent nosocomial
infections particularly ventilatorassociated pneumonia (VAP). Certain
studies have also proved its effect on the prevention of infection among
nonintubated patients. In this meta-analysis, we studied the different
randomized controlled trials (RCT) comparing the effect of oral
chlorhexidine in the prevention of nosocomial infections among patients
undergoing cardiac surgeries. Method(s):Several published RCT about
the effect of oral chlorhexidine and occurrence of nosocomial infection
among patients undergoing cardiac surgeries were identified using PUBMED,
MEDLINE, COCHRANE, and EMBASE. The studies included were published from
1996 to 2019. The primary outcome was the incidence of nosocomial
infection. Subset analysis was also made comparing the different
nosocomial infections. Result(s): Based on this meta-analysis, it was
found that oral chlorhexidine has significantly reduced the number of
nosocomial infections after cardiac surgeries. Among these infections,
hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP),
urinary tract infection, and wound infection have lower incidence in
patients treated with oral chlorhexidine although only the HAP and VAP
were statistically significant. The incidence of positive culture growth
was also statistically in favor with oral chlorhexidine.
 Conclusion(s): Nosocomial infections are deleterious complications of
post cardiac procedures that can be easily prevented. With this study, it
has shown that the use of oral chlorhexidine as part of the routine
regimens during cardiac surgeries can significantly prevent if not lower
incidence of infection.

<146>
Accession Number
632378021
Title
Identifying clinical risk factors for long-term cardiovascular sequelae
after hospitalization for sepsis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2020. United
States. 201 (1) (no pagination), 2020. Date of Publication: 2020.
Author
Myers L.; Liu V.; Lu W.Y.; Thai K.K.; Kipnis P.; Martinez A.; Clancy H.;
Desai M.; Go A.S.; Walkey A.J.
Institution
(Myers) Pulmonary/Critical Care, Massachusetts General Hospital, Boston,
MA, United States
(Liu, Lu, Thai, Kipnis, Martinez, Clancy, Go) Kaiser Permanente Division
of Research, Oakland, CA, United States
(Desai) Stanford University, Palo Alto, CA, United States
(Walkey) Boston Univ, School of Med, Boston, MA, United States
Publisher
American Thoracic Society
Abstract
Rationale: A growing population of patients surviving sepsis now face
post-sepsis cardiovascular complications. However, the events during
sepsis hospitalization that are associated with increased cardiovascular
risk are poorly understood. Method(s): We identified Sepsis-3
survivors (2011-2017) in a Northern California integrated health system
with health plan membership in the year before/after hospitalization for
sepsis. We grouped outcomes as post-sepsis cardiovascular disease in the
year after discharge as atherosclerotic cardiovascular disease (ASCVD
including myocardial infarction stroke, coronary artery bypass graft
surgery), heart failure (HF) and atrial fibrillation (AF). We grouped
clinical risk factors in three time-based categories: baseline, pre-sepsis
or intra-sepsis. Baseline factors included demographics and
atherosclerotic cardiovascular disease risk factors. Pre-sepsis factors
included comorbidities, diagnostic studies and medication use before
hospitalization. Intrasepsis factors included lab values, treatments and
severity of illness metrics measured during hospitalization. Re-sampling
methods were used to develop a predictive model on 75% of randomly
selected subjects using the Least Absolute Shrinkage and Selection
Operator technique along with a logistic and Cox regression modeling.
Missing data were handled using multiple imputation. We stratified
patients in the training data by pre-existing cardiovascular disease and
evaluated model performance using cross-validated model area under the
curve (CV-AUC). Result(s): Our cohort included 86,222 unique sepsis
survivors. Mean age of 72+/-16 years with an equal male:female ratio Mean
length of stay was 4.8+/-2.8 days with 25.2% of patients requiring
intensive care. Post-sepsis 1- year cardiovascular outcomes occurred in
5.4% (ASCVD), 5.3% (HF), and 19.3% (AF) of patients. In training data,
model CV-AUCs for HF and AF outcomes were higher for patients without
prior histories of disease than among those with prior histories of
disease (Figure). In 1-year post-sepsis HF incidence, the CV-AUC was 0.81
among those without prior HF and 0.72 among those with prior HF.
Similarly, the CV-AUC for 1-year incident AF was 0.76 among those without
AF history and 0.68 among those with AF history. In 1-year incident HF and
AF, as opposed to ASCVD, the largest improvements in CV-AUCs were seen
with intra-sepsis clinical factors. Using Cox regression with or without
competing risk of death and several multiple imputation methods, results
were similar Conclusion(s): Clinical factors encountered during
sepsis improved prediction of 1-year post-sepsis cardiovascular sequelae,
particularly among patients without a pre-sepsis history of HF and AF. Our
results suggest that intra-sepsis events are mechanistically related to
post-sepsis cardiac events and may offer targets to reduce long-term
morbidity (Figure Presented).

<147>
Accession Number
632377148
Title
ATS 2020 Abstract.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2020. United
States. 201 (1) (no pagination), 2020. Date of Publication: 2020.
Author
Anonymous
Publisher
American Thoracic Society
Abstract
The proceedings contain 2059 papers. The topics discussed include: the
narrow-spectrum antibiotic treatment score: a novel quantitative tool for
assessing broad- and narrow-spectrum antibiotic use in severe
community-acquired pneumonia; prevention of nosocomial infection using
oral chlorhexidine among patients undergoing cardiac surgery: a
meta-analysis; trends in the clinical characteristics of pneumococcal
pneumonia in Japanese elderly adults between 2012 and 2017; predictors of
new onset atrial fibrillation in patients hospitalized with pneumonia; is
direct intensive care unit admission for patients with severe community
acquired pneumonia associated with lower 30-day mortality?; use of the
MRSA Nares test to prevent overutilization of antibiotics against MRSA for
patients with severe community acquired pneumonia; bacterial co-infection
in patients admitted to the ICU due to severe influenza is not related
with previous influenza vaccination; immunity to influenza a virus
infection during pregnancy; association of sputum microbial communities to
smoking in adulthood and respiratory syncytial virus lower respiratory
illness in early life: a longitudinal birth cohort study; and the
microbiome in nebulizers used with mouthpieces or facemasks by
hospitalized non-cystic fibrosis patients.

<148>
Accession Number
632376705
Title
Automated oxygen administration vs manual oxygen therapy after major
abdominal or thoracic surgery-international multicenter randomized
controlled study.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2020. United
States. 201 (1) (no pagination), 2020. Date of Publication: 2020.
Author
Lellouche F.; Jaber S.; Verzilli D.; Jacob C.; Huiban B.; Futier E.;
Kerforne T.; Pateau V.; Bouchard P.; Consigny M.; Nowak E.; L'Her E.
Institution
(Lellouche, Bouchard) IUCPQ, Quebec, QC, Canada
(Jaber, Verzilli) CHU Montpellier, Montpellier, France
(Jacob, Huiban, Pateau, Consigny, Nowak, L'Her) CHU La Cavale Blanche,
Brest, France
(Futier) CHU Clermont-Ferrand, Clermont-Ferrand, France
(Kerforne) CHU Poitiers, Poitier, France
Publisher
American Thoracic Society
Abstract
Background Hypoxemia and hyperoxia may occur after surgery with related
complications. Automated oxygen titration and weaning (FreeO<inf>2</inf>)
may improve oxygenation and outcome. Aims and objectives To evaluate the
impact of FreeO<inf>2</inf> vs conventional O2 after surgeries at risk of
desaturation. Methods This study is a prospective, multicenter, randomized
controlled, open trial. After thoracic or abdominal surgery, patients were
randomly assigned to the manual O2 administration or automated O2
administration (FreeO<inf>2</inf>). Primary outcome was the percentage of
time spent in the target zone of oxygen SpO<inf>2</inf> during a 3-hours
time frame (time in the recovery room) and a 3-days time frame. Secondary
outcomes were the nursing workload, the time spent with severe
desaturation (SpO<inf>2</inf><85%), with severe hyperoxemia
(SpO<inf>2</inf>>98%); the O2 consumption the duration of O2
administration during hospitalization, the frequency of use of ventilation
(invasive or noninvasive) the hospitalization length of stay and the
survival rate. Results 200 patients were enrolled and 198 randomized and
analyzed There was no significant difference in baseline characteristics.
Oxygenation data in the first 3 hours are presented in the Figure. During
the 3 days after the surgery, the % of time within the SpO<inf>2</inf>
target was increased with FreeO<inf>2</inf> (94.0% vs.62.1% 31.9 [26.3
;37.4], P<0.001). The time with hypoxemia was reduced with
FreeO<inf>2</inf> (31 vs 373 minutes, -95 [-452 ; -16], P<0.001) as well
as the time with hyperoxemia (148 vs. 800 minutes, -553 [-1155 ; -148],
P>0.001). Time with severe hypoxemia (2 vs 10 minutes) and severe
hyperoxemia (4 vs.174 minutes) were also significantly reduced with
FreeO<inf>2</inf>. After 3 days, 17 patients (18.3%) in the
FreeO<inf>2</inf> group vs 34 patients (33.3%) (0.43 [0.22 ; 0.85],
P<0.001) still required oxygen therapy Conclusion After major abdominal
and thoracic surgeries (i) Automated oxygen titration and weaning with
FreeO<inf>2</inf> significantly improves oxygenation parameters (ii)
Patients are maintained with FreeO<inf>2</inf> in the recommended
SpO<inf>2</inf> target > 90% of the time (iii) FreeO<inf>2</inf> decreases
both severe hypoxemia and severe hyperoxemia (iv) Reduces the number of
patients requiring oxygen therapy after 3 days. Trial registration:
clinicaltrials.gov identifier NCT02546830 (Figure Presented).

<149>
Accession Number
632118319
Title
Status of solid organ transplantation inturkey.
Source
Transplant International. Conference: 19th Congress of the European
Society for Organ Transplantation. Denmark. 32 (Supplement 2) (pp 413),
2019. Date of Publication: October 2019.
Author
Kahveci E.; Yildirim G.; Hos G.; Cimen S.
Institution
(Cimen) Diskapi Research and Training Hospital, Health Sciences University
(Kahveci) International Transplant Network
(Yildirim) Turkish Transplant Foundation
(Hos) Sisli Etfal Research and Training Hospital
(Cimen) Health Sciences University
Publisher
Blackwell Publishing Ltd
Abstract
Objective: The aim of this study was to review solid organ transplantation
in Turkey. This review displays the weaknesses as well as strengths of
national transplant politics. Emergence of the weaknesses can trigger
potential endeavors which will improve the overall solid organ transplant
activity and outcomes. Material(s) and Method(s): The current
(December 2018) solid organ transplant patient waitlists made by the organ
transplant division of Turkish Ministry of Health, list of solid organ
transplant centers and electronic databases including the 2002-2018 data
regarding live and cadaveric solid organ transplantation updated annually
by the same division were analyzed retrospectively. Result(s): Our
review showed that 26063 patients were in the waitlist for a solid organ
transplantation in Turkey as of December 2018. Most of these patients (n =
22462; 86.2%) were waitlisted for kidney transplant while 2153 (%0.8) and
1084 (%0.4) of the entire group were expecting a liver and heart
transplant, respectively. Only 2 patients were waitlisted for a small
bowel transplant which was the least demanded organ for transplantation in
Turkey. Analysis of the transplant centers (n = 82) revealed that most of
the solid organ transplant activities were performed by university
hospitals (n = 31; 38%). Hospitals governed by the Ministry of Health had
23 transplant centers in total (28%). University Hospitals owned by
foundations (n = 11) represented the smallest group (13%). Review of
transplant activities year by year demonstrated that numbers of both live
and cadaveric organ transplants increased yearly: 361 live kidney
transplants in 2002 vs 3008 in 2018; 189 cadaveric kidney transplants in
2002 vs 858 in 2018; 77 cadaveric and 82 live liver transplants in 2002 vs
1150 live and 438 cadaveric liver transplants in 2018 and 20 heart
transplants in 2002 vs 91 in 2018. Despite the fact that both live and
cadaveric organ transplant numbers increased by time, the increase in live
transplants were dramatic (8- fold increase in live kidney transplant.
(Figure Presented).

<150>
Accession Number
632118089
Title
Remote ischemic preconditioning in transplantation (RIPTRANS)-a
prospective randomized trial.
Source
Transplant International. Conference: 19th Congress of the European
Society for Organ Transplantation. Denmark. 32 (Supplement 2) (pp 381),
2019. Date of Publication: October 2019.
Author
Uutela A.; Lemstrom K.; Passov A.; Lempinen M.; Helantera I.; Makisalo H.;
Nordin A.; Isoniemi H.; Alberg F.; Syrjala S.; Raivio P.; Kiss J.; Nykanen
A.; Stark C.; Pesonen E.; Sallinen V.
Institution
(Uutela, Lemstrom, Passov, Lempinen, Helantera, Makisalo, Nordin,
Isoniemi, Alberg, Syrjala, Raivio, Kiss, Nykanen, Stark, Pesonen,
Sallinen) Helsinki University Hospital, University of Helsinki
Publisher
Blackwell Publishing Ltd
Abstract
Background: Remote ischemic preconditioning (RIPC) is a concept, where
temporarily induced ischemia produces protection against ischemia in a
remote organ. RIPC has extensively been studied in animal models and
clinically in heart surgery, but the benefits of RIPC in transplantation
are unclear. The primary aim of this study is to find out whether RIPC
performed in donation after brain deaddonors could decrease delayed graft
function (DGF) rate of kidney transplants. Methods/Materials: In this
prospective randomized controlled trial donors planned for kidney
procurement will be randomly allocated 1:1 to either RIPC or
sham-procedure. RIPC will consist of brief periods of lower extremity
ischemia made with a tourniquet, followed by releasing the blood flow.
After the diagnosis of brain death is made, a tourniquet is placed around
the donors thigh and inflated to 300 mmHg four times 5 min with 5 min
pauses in between. An equal intervention is done on the donors other thigh
just before transferring the donor to the operating theatre. In
sham-procedure arm, the tourniquet is placed similarly but it is not
inflated. Donors with hemodynamic instability or aged < 18 years will be
excluded. The primary outcome is delayed graft function (DGF) of kidney
transplants, which is defined as need for dialysis within the first week
after transplantation. Key secondary outcomes are measurements of graft
function and survival for kidney, liver, pancreas, heart and lung
allografts. Based on a power calculation, 500 kidney transplantations are
needed to show DGF decrease from current 25% to 15%. This trial is
registered in ClinicalTrials.gov (NCT03855722). Results : The trial will
start recruiting on March 11th, 2019. Safety interim analysis will be
performed after 16 donors have been randomized. Recruiting is estimated to
take 3-4 years. Conclusion(s): RIPTRANS trial will provide Level 1
evidence on RIPC in transplantation.

<151>
Accession Number
632117856
Title
Va ecmo support in a heart transplant center: bridge to transplant and
bridge to recovery from severe primary graft dysfunction.
Source
Transplant International. Conference: 19th Congress of the European
Society for Organ Transplantation. Denmark. 32 (Supplement 2) (pp 405),
2019. Date of Publication: October 2019.
Author
Steffen S.; Abaurre V.; Gaiotto F.; Honorato R.; Loureco D.; Gaspar S.;
Braga F.; Grinberg M.; Mangini S.; Seguro L.; Wosniak L.; Galas F.; Bacal
F.; Jatene F.
Institution
(Steffen, Abaurre, Gaiotto, Honorato, Loureco, Gaspar, Braga, Grinberg,
Mangini, Seguro, Wosniak, Galas, Bacal, Jatene) Heart Institute - Sao
Paulo
Publisher
Blackwell Publishing Ltd
Abstract
Background: Heart Transplant is the definitive treatment of end-stage
heart failure. VA ECMO can be used as a bridge to transplant with good
results, and also may be used as a bridge do recovery due to Primary Graft
Dysfunction (PGD). The purpose of this study is to present our
perioperative experience with ECMO in the context of Heart Transplant.
 Method(s): We analyzed retrospectively all adult patients submitted
to heart transplant between January 2017 and March 2019. A total of 105
patients were operated in this period. Medical records were collected from
our electronic database. We screened patients who required VA ECMO as a
bridge to transplant or as a bridge to recovery after heart transplant
with PGD. Result(s): 11 patients required perioperative VA-ECMO
support. Of those, 9 patients before transplant and 2 patients after
transplant. The mean age was 39.6 years within the preoperative group and
48 years within the postoperative group. The main indication for
transplant (45.4%) was dilated cardiomyopathy. The overall mortality
observed was 33% at the preoperative group and 50% at the postoperative
group. The group's characteristics are listed at table 1.
 Conclusion(s): VA ECMO is a safe, viable and not expensive support to
bridge patients to heart transplant who are worsening despite optimal
medical therapy. A 'hybrid' configuration (figure 1) offers good support,
with less limb and lung complications, usually observed with peripheral
femoral cannulation.VA ECMO can be used as a bridge to recovery in
patients with severe PGD, showing satisfactory results. (Table Presented).

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