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<1>
Accession Number
2005798826
Title
ACURATE neo: How Is This TAVR Valve Doing to Fit into an Increasingly
Crowded Field?.
Source
Current Cardiology Reports. 22 (10) (no pagination), 2020. Article Number:
107. Date of Publication: 01 Oct 2020.
Author
Okuno T.; Lanz J.; Pilgrim T.
Institution
(Okuno, Lanz, Pilgrim) Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern CH-3010, Switzerland
Publisher
Springer
Abstract
Purpose of Review: Critical appraisal of the available evidence on the
self-expanding ACURATE neo transcatheter heart valve (THV) for the
treatment of aortic valve disease. Recent Findings: In an
investigator-initiated, multicenter, randomized non-inferiority trial with
broad inclusion criteria, ACURATE neo failed to meet non-inferiority
compared with SAPIEN 3 with regard to a primary composite safety and
efficacy endpoint at 30 days. The difference was driven by higher rates of
moderate or severe paravalvular regurgitation and higher rates of acute
kidney injury. In turn, registry data suggest that the safety and efficacy
profile of the ACURATE neo is comparable to that of other commercially
available devices. Randomized evidence indicated favorable hemodynamic
results with large effective orifice areas and low residual gradients.
 Summary: The self-expanding ACURATE neo THV is associated with higher
rates of residual aortic regurgitation compared to the balloon-expandable
SAPIEN 3 THV. The supra-annular design with low residual gradients may be
advantageous in patients with small anatomy and mild degree of
calcification. Copyright © 2020, The Author(s).

<2>
Accession Number
360262298
Title
Do deficits in cardiac care influence high mortality rates in
schizophrenia? A systematic review and pooled analysis.
Source
Journal of psychopharmacology (Oxford, England). 24 (4 Suppl) (pp 69-80),
2010. Date of Publication: Nov 2010.
Author
Mitchell A.J.; Lord O.
Institution
(Mitchell) Department of Liaison Psychiatry, Leicester General Hospital,
Leicester, United Kingdom
Abstract
We have previously documented inequalities in the quality of medical care
provided to those with mental ill health but the implications for
mortality are unclear. We aimed to test whether disparities in medical
treatment of cardiovascular conditions, specifically receipt of medical
procedures and receipt of prescribed medication, are linked with elevated
rates of mortality in people with schizophrenia and severe mental illness.
We undertook a systematic review of studies that examined medical
procedures and a pooled analysis of prescribed medication in those with
and without comorbid mental illness, focusing on those which recruited
individuals with schizophrenia and measured mortality as an outcome. From
17 studies of treatment adequacy in cardiovascular conditions, eight
examined cardiac procedures and nine examined adequacy of prescribed
cardiac medication. Six of eight studies examining the adequacy of cardiac
procedures found lower than average provision of medical care and two
studies found no difference. Meta-analytic pooling of nine medication
studies showed lower than average rates of prescribing evident for the
following individual classes of medication; angiotensin converting enzyme
inhibitors (n = 6, aOR = 0.779, 95% CI = 0.638-0.950, p = 0.0137),
beta-blockers (n = 9, aOR = 0.844, 95% CI = 0.690-1.03, p = 0.1036) and
statins (n = 5, aOR = 0.604, 95% CI = 0.408-0.89, p = 0.0117). No
inequality was evident for aspirin (n = 7, aOR = 0.986, 95% CI =
0.7955-1.02, p = 0.382). Interestingly higher than expected prescribing
was found for older non-statin cholesterol-lowering agents (n = 4, aOR =
1.55, 95% CI = 1.04-2.32, p = 0.0312). A search for outcomes in this
sample revealed ten studies linking poor quality of care and possible
effects on mortality in specialist settings. In half of the studies there
was significantly higher mortality in those with mental ill health
compared with controls but there was inadequate data to confirm a
causative link. Nevertheless, indirect evidence supports the observation
that deficits in quality of care are contributing to higher than expected
mortality in those with severe mental illness (SMI) and schizophrenia. The
quality of medical treatment provided to those with cardiac conditions and
comorbid schizophrenia is often suboptimal and may be linked with
avoidable excess mortality. Every effort should be made to deliver
high-quality medical care to people with severe mental illness.

<3>
Accession Number
2007425928
Title
Sex Differences in All-Cause Mortality in the Decade Following Complex
Coronary Revascularization.
Source
Journal of the American College of Cardiology. 76 (8) (pp 889-899), 2020.
Date of Publication: 25 August 2020.
Author
Hara H.; Takahashi K.; van Klaveren D.; Wang R.; Garg S.; Ono M.;
Kawashima H.; Gao C.; Mack M.; Holmes D.R.; Morice M.-C.; Head S.J.;
Kappetein A.P.; Thuijs D.J.F.M.; Onuma Y.; Noack T.; Mohr F.W.; Davierwala
P.M.; Serruys P.W.
Institution
(Hara, Takahashi, Ono, Kawashima) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Hara, Wang, Ono, Kawashima, Gao, Onuma, Serruys) Department of
Cardiology, National University of Ireland, Galway, Galway, Ireland
(van Klaveren) Department of Public Health, Center for Medical Decision
Making, Erasmus MC, Rotterdam, Netherlands
(van Klaveren) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, MA, United States
(Wang, Gao) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Mack) Department of Cardiothoracic Surgery, Baylor Scott and White
Healthcare, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, Hopital prive Jacques Cartier,
Generale de Sante Massy, France
(Head, Kappetein, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Noack, Mohr, Davierwala) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier USA
Abstract
Background: The poorer prognosis of coronary artery disease in females
compared with males is related mainly to differences in baseline
characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) trial, the effect of
treatment with percutaneous coronary intervention (PCI) versus coronary
artery bypass grafting surgery (CABG) on mortality at 5 years differed
significantly between females and males; however, the optimal
revascularization beyond 5 years according to sex has not been evaluated.
 Objective(s): The aim of this study was to investigate the impact of
sex on mortality and sex-treatment interaction at 10 years.
 Method(s): The SYNTAXES (SYNTAX Extended Survival) study evaluated
vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or
left main coronary artery disease randomized to treatment with PCI or CABG
in the SYNTAX trial. All-cause death at 10 years was separately evaluated
in female and male patients with complex coronary artery disease.
 Result(s): Of 1,800 patients, 402 (22.3%) were female and 1,398
(77.7%) were males. Females had a higher 10-year mortality rate compared
with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not
an independent predictor of mortality (adjusted hazard ratio: 1.02; 95%
confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be
lower after CABG than after PCI, with a similar treatment effect for
female and male patients (adjusted hazard ratio for females: 0.90 [95%
confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76
[95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952).
 Conclusion(s): Female sex was not an independent predictor of
mortality at 10 years in patients with complex coronary artery disease.
The interaction between sex and treatment with PCI or CABG that was
observed at 5 years was no longer present at 10 years. (Synergy Between
PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES],
NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery
Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX],
NCT00114972) Copyright © 2020 American College of Cardiology
Foundation

<4>
Accession Number
2007431074
Title
The Rationale, Indications, Safety, and Use of Statins in the Pediatric
Population.
Source
Canadian Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Khoury M.; McCrindle B.W.
Institution
(Khoury) Division of Pediatric Cardiology, Department of Pediatrics,
University of Alberta, Edmonton, AB, Canada
(McCrindle) Labatt Family Heart Center, Department of Pediatrics, The
Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Together with heart-healthy lifestyle habits, statins serve as the
cornerstone of primary and secondary prevention of atherosclerotic
cardiovascular disease in adults. Several conditions, most notably
familial hypercholesterolemia (FH), cause early dyslipidemia and vascular
disease, contributing to the development and progression of
atherosclerosis from childhood and increased cardiovascular risk. In
recent decades, studies increasingly have evaluated the safety and
efficacy of statins in such high-risk youth. The strongest evidence for
pediatric statin use is for the heterozygous FH population, whereby statin
use has been shown to lower low-density lipoprotein cholesterol
effectively, slow the progression of atherosclerosis and vascular
dysfunction, and significantly reduce cardiovascular risk in early
adulthood. Numerous meta-analyses and Cochrane reviews have demonstrated
that attributed adverse effects, including liver toxicity, myositis, and
rhabdomyolysis, occur no more frequently in youth receiving statins than
placebos, with no impact on growth or development. However, further
studies evaluating the long-term safety of pediatric statin use are
required. In the current review, we summarize the pediatric experience of
statin use to date, focusing on its utility for FH, Kawasaki disease,
post-heart transplantation, and other at-risk populations. Current
guidelines and indications for use are summarized, and the short- and
medium-term safety experience is reviewed. Finally, a clinical approach to
the indications, initiation, and monitoring of statins in youth is
provided. Copyright © 2020 Canadian Cardiovascular Society

<5>
Accession Number
2007302672
Title
Fully automated postoperative ventilation in cardiac surgery patients: a
randomised clinical trial.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
De Bie A.J.R.; Neto A.S.; van Meenen D.M.; Bouwman A.R.; Roos A.N.;
Lameijer J.R.; Korsten E.H.M.; Schultz M.J.; Bindels A.J.G.H.
Institution
(De Bie, Bouwman, Roos, Korsten, Bindels) Department of Intensive Care
Unit, Catharina Hospital Eindhoven, Eindhoven, Netherlands
(De Bie, Korsten) Department of Electrical Engineering, Eindhoven
University of Technology, Eindhoven, Netherlands
(Neto, van Meenen, Schultz) Department of Intensive Care and Laboratory of
Experimental Intensive Care and Anesthesiology, Amsterdam University
Medical Centers, Amsterdam, Netherlands
(Neto) Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Lameijer) Department of Radiology, Catharina Hospital Eindhoven,
Eindhoven, Netherlands
(Schultz) Mahidol Oxford Tropical Medicine Research Unit, Faculty of
Tropical Medicine, Mahidol University, Bangkok, Thailand
(Schultz) Nuffield Department of Medicine, University of Oxford, Oxford,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Ensuring that lung-protective ventilation is achieved at scale
is challenging in perioperative practice. Fully automated ventilation may
be more effective in delivering lung-protective ventilation. Here, we
compared automated lung-protective ventilation with conventional
ventilation after elective cardiac surgery in haemodynamically stable
patients. Method(s): In this single-centre investigator-led study,
patients were randomly assigned at the end of cardiac surgery to receive
either automated (adaptive support ventilation) or conventional
ventilation. The primary endpoint was the proportion of postoperative
ventilation time characterised by exposure to predefined optimal,
acceptable, and critical (injurious) ventilatory parameters in the first
three postoperative hours. Secondary outcomes included severe hypoxaemia
(SpO<inf>2</inf> <85%) and resumption of spontaneous breathing. Data are
presented as mean (95% confidence intervals [CIs]). Result(s): We
randomised 220 patients (30.4% females; age: 62-76 yr). Subjects
randomised to automated ventilation (n=109) spent a 29.7% (95% CI:
22.1-37.4) higher mean proportion of postoperative ventilation time
receiving optimal postoperative ventilation after surgery (P<0.001)
compared with subjects receiving conventional postoperative ventilation
(n=111). Automated ventilation also reduced the proportion of
postoperative ventilation time that subjects were exposed to injurious
ventilatory settings by 2.5% (95% CI: 1-4; P=0.003). Severe hypoxaemia was
less likely in subjects randomised to automated ventilation (risk ratio:
0.26 [0.22-0.31]; P<0.01). Subjects resumed spontaneous breathing more
rapidly when randomised to automated ventilation (hazard ratio: 1.38
[1.05-1.83]; P=0.03). Conclusion(s): Fully automated ventilation in
haemodynamically stable patients after cardiac surgery optimised
lung-protective ventilation during postoperative ventilation, with fewer
episodes of severe hypoxaemia and an accelerated resumption of spontaneous
breathing. Clinical trial registration: NCT03180203. Copyright ©
2020 British Journal of Anaesthesia

<6>
Accession Number
632562352
Title
Safety of Enalapril in Infants: Data from the Pediatric Heart Network
Infant with Single Ventricle Trial.
Source
The Journal of pediatrics. (no pagination), 2020. Date of Publication: 05
Aug 2020.
Author
Mathur K.; Hsu D.T.; Lamour J.M.; Aydin S.I.
Institution
(Mathur, Hsu, Lamour) Division of Pediatric Cardiology, Children's
Hospital at Montefiore/Albert Einstein College of Medicine
(Aydin) Division of Pediatric Cardiology, Children's Hospital at
Montefiore/Albert Einstein College of Medicine; Division of Pediatric
Critical Care, Children's Hospital at Montefiore/Albert Einstein College
of Medicine
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess the safety profile of angiotensin converting enzyme
(ACE) inhibitor therapy in infants with single ventricle (ISV). STUDY
DESIGN: The Pediatric Heart Network (PHN) conducted a double-blind trial
involving infants with single ventricle physiology randomized to receive
enalapril or placebo and followed to 14 months of age. Data including
demographics, drug administration, hemodynamic monitoring, laboratory
measurements, adverse events, and survival were extracted from the public
use data set and compared between the placebo and enalapril-treated
groups. RESULT(S): The ISV trial randomized 230 patients, with 115
patients in each group. Initial enalapril dose was 0.10 mg/kg/day and
median maximal dose was 0.38 mg/kg/day. There was no significant
difference in change in blood pressure at study drug initiation or when
resuming study drug after Glenn surgery. The incidence of hyperkalemia and
neutropenia did not differ between groups. Renal dysfunction occurred in
3% of the enalapril group and none of the placebo patients, which was not
statistically significant. There was a high frequency of serious adverse
events in both groups. There was no difference in the frequency of heart
transplant or death between groups. CONCLUSION(S): Enalapril did not
have sustained hemodynamic effects at initiation or up-titration of drug.
Creatinine and potassium were not different between groups, although renal
dysfunction occurred more often in the enalapril patients. Although
efficacy of enalapril in neonates and single ventricles has not been
demonstrated, the safety profile of ACE inhibitors appears to be low risk
in infants and children with significant heart disease. Copyright
© 2020. Published by Elsevier Inc.

<7>
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Accession Number
632562103
Title
The effect of nebivolol on erectile function in the cases with coronary
artery bypass surgery: A protocol for a systematic review and
meta-analysis of randomized controlled trials.
Source
Medicine. 99 (32) (pp e21588), 2020. Date of Publication: 07 Aug 2020.
Author
Yang Y.; Yong S.; Li F.; Dong L.; Chang D.
Institution
(Yang, Yong, Li, Chang) Hospital of Chengdu University of Traditional
Chinese Medicine
(Dong) Department of Andrology, Reproductive and Women-Children Hospital,
Chengdu University of Traditional Chinese Medicine, Sichuan Province,
Chengdu, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Erectile dysfunction is a common disease. It affects the
quality of life of both husband and wife and its prevalence is higher in
patients with overt cardiovascular disease or cardiovascular risk factors.
In recent years, multiple studies confirm that nebivolol exerts protective
effects on erectile function against the disruptive effects of
cardiopulmonary bypass in patients undergoing coronary artery bypass
grafting, but its quality and efficacy have not been systematically
evaluated. Therefore, it is necessary to carry out a systematic review and
meta-analysis to fully evaluate the efficacy and safety of nebivolol on
erectile function in the cases with coronary artery bypass grafting.
METHODS AND ANALYSIS: Chinese and English literature of nebivolol on
erectile function in the cases with coronary artery bypass surgery
published before August 31, 2020 will be comprehensive searched in PubMed,
Cochrane Library, EMBASE, WANFANG, China National Knowledge
Infrastructure, VIP Chinese Science and Technology Journal Database,
Chinese biomedical document service system, and Clinicaltrials.gov. Only
randomized controlled trials that meet the eligibility criteria will be
included. Two researchers will independently complete literature
screening, data extraction and assess the risk of bias, and the third
investigator will handle disagreements. Our main evaluation includes 2
outcome indicators including the international index of erectile function
5 score and adverse events. RevMan 5.3 and Stata 14.0 will be used to
conduct this systematic review. The preferred reporting items for
systematic reviews and meta-analysis protocols (PRISMA-P) statement is
followed in this protocol and the PRISMA statement will be followed in the
completed systematic review. CONCLUSION AND DISSEMINATION: The efficacy
and safety of nebivolol on erectile function in the cases with coronary
artery bypass grafting will be evaluated. We will publish the results of
this systematic review in peer-reviewed journals to provide new evidence
to clinicians. ETHICS AND DISSEMINATION: Ethical approval is not required
as the review is a secondary study based on published literature. The
results will be published in a public issue journal to provide
evidence-based medical evidence for urologists and andrologists to make
better clinical decisions. REGISTRATION INFORMATION: INPLASY202060110.

<8>
Accession Number
632561447
Title
Intraoperative cell salvage for obstetrics: a prospective randomized
controlled clinical trial.
Source
BMC pregnancy and childbirth. 20 (1) (pp 452), 2020. Date of Publication:
07 Aug 2020.
Author
Liu Y.; Li X.; Che X.; Zhao G.; Xu M.
Institution
(Liu, Li, Che, Zhao) Department of Anaesthesiology, Beijing Obstetrics and
Gynecology Hospital, Capital Medical University, Beijing 100026, China
(Xu) Department of Anaesthesiology, Beijing Obstetrics and Gynecology
Hospital, Capital Medical University, Beijing 100026, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The latest basic studies and clinical evidence have confirmed
the safety and efficacy of intraoperative autologous blood cell
transfusion in cardiac surgery and orthopaedics. However, in caesarean
section, there are still concerns about the contamination of amniotic
fluid and foetal components, and consequently the application of
intraoperative autologous blood cell transfusion is not universal.
Therefore, this study aimed to evaluate the clinical value of
intraoperative autologous blood cell transfusion in obstetric surgery.
 METHOD(S): A prospective, randomized, controlled, feasibility study
was performed in women undergoing caesarean section. One hundred sixteen
participants were randomly assigned at a 1:1 ratio into either the
intraoperative cell salvage group or the control group. Allogeneic blood
cells were transfused into patients with haemoglobin concentrations<80
g/dL in both the intraoperative cell salvage group and the control group.
 RESULT(S): No significant differences were found between the two
groups in age, weight, maternal parity, history of previous caesarean
section, gestational weeks of delivery, etc. However, compared with the
control group, patients in the intraoperative cell salvage group had a
significantly lower amount of allogeneic blood cell transfusion, lower
incidence of postoperative incision infection, delayed wound healing,
perioperative allergy, adverse cardiovascular events, hypoproteinaemia and
shorter hospital stay. CONCLUSION(S): The results of this study
suggest that the use of autologous blood cell transfusion is safe and
effective for patients with obstetric haemorrhage. TRIAL REGISTRATION: All
procedures performed in studies involving human participants were in
accordance with the ethical standards of the Institutional and/or National
Research Committee of Beijing Obstetrics and Gynecology Hospital, Capital
Medical University (2016-XJS-003-01) as well as the 1964 Helsinki
Declaration and its later amendments or other comparable ethical
standards. The clinical trials were registered (ChiCTR-ICC-15,007,096) on
September 28, 2015.

<9>
Accession Number
632558423
Title
Effect of low-dose exogenous surfactant on infants with acute respiratory
distress syndrome after cardiac surgery: a retrospective analysis.
Source
BMC pulmonary medicine. 20 (1) (pp 210), 2020. Date of Publication: 06 Aug
2020.
Author
Zhang R.; Wang X.; Li S.; Yan J.
Institution
(Zhang) Department of Pediatric Intensive Care Unit, National Center for
Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Wang) Department of Pediatric Intensive Care Unit, National Center for
Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Li, Yan) Department of Surgery, Pediatric Cardiac Center, National Center
for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute respiratory distress syndrome (ARDS) in infants
undergoing cardiac surgery is associated with significant mortality and
prolonged ventilation; surfactant administration may be a useful therapy.
The purpose of this study is to evaluate the effect of low-dose exogenous
surfactant therapy on infants suffering ARDS after cardiac surgery.
 METHOD(S): We conducted a case-control study of infants diagnosed
with moderate-to-severe ARDS (PaO2/FiO2 <150) after cardiac surgery. A
case was defined as a patient that received surfactant and standard
therapy, while a control was defined as a patient that underwent standard
therapy. The primary endpoint was the improvement in oxygenation index
(OI) after 24-h of surfactant treatment; and secondary endpoints were the
ventilator time and PICU time. RESULT(S): Twenty-two infants treated
with surfactant were matched with 22 controls. Early low-dose (20mg/kg)
surfactant treatment was associated with improved outcomes. After
surfactant administration for 24-h, the surfactant group was much better
compared with the control group at the 24-h in OI (difference in average
change from baseline, -6.7 [95% CI, -9.3 to -4.1]) (P <0.01) and
ventilation index (VI, mean difference, -11.9 [95% CI, -18.1 to -5.7]) (P
<0.01). Ventilation time and PICU time were significantly shorter in the
surfactant group compared with the control group (133.6h+/-27.2 vs
218.4h+/-28.7, P <0.01; 10.7d+/-5.1 vs 17.5d+/-6.8, P <0.01). Infants in
the surfactant group under 3months benefit more from OI and VI than the
infants over 3months in a preliminary exploratory analysis.
 CONCLUSION(S): In infants with moderate-to-severe ARDS after cardiac
surgery, early low-dose exogenous surfactant treatment could prominently
improve oxygenation and reduce mechanical ventilation time and PICU time.
Infants younger than 3months may get more benefit of oxygenation than the
older ones. Randomized controlled trials are needed to explore the effect
of surfactant to ARDS of cardiac surgical infants.

<10>
Accession Number
632557863
Title
Use of thromboelastography to monitor effects of the hemocoagulase on the
blood coagulation in patients after thoracic surgery.
Source
Annals of palliative medicine. 9 (4) (pp 2090-2095), 2020. Date of
Publication: 01 Jul 2020.
Author
Lin C.; Zhang J.; Yang X.; Cheng J.; Sun L.; Jiang M.
Institution
(Lin, Zhang, Yang, Cheng, Sun, Jiang) Department of Blood Transfusion,
First Affiliated Hospital of Soochow University, Suzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Over the past few years, snake venom thrombin-like
preparations which possess the advantages of low toxicity, fast onset, and
long-lasting efficacy have been commonly used as hemostatic drugs in
clinical surgery. However, recently, cases of hypofibrinogenemia and
bleeding after using the hemocoagulase have been reported and cannot be
ignored. Our study used thromboelastography (TEG) to monitor the
hemocoagulase effects of blood coagulation status in patients after
thoracic surgery. METHOD(S): Patients suffering thoracic surgery in
the First Affiliated Hospital of Soochow University between June 2018 and
June 2019 were selected and grouped based on the results of postoperative
TEG. The patients with low coagulation index (CI) detected by the TEG were
set as the low CI group, and randomly selected patients with normal CI
were set as the control group and matched in gender, age, and disease type
with patients in the low CI group. The general condition, disease type,
preoperative blood coagulation routine, type of hemocoagulase used,
postoperative blood coagulation status, and blood transfusion status of
the two groups were separately analyzed. RESULT(S): The preoperative
fibrinogen (FIB) content in the low CI group was significantly lower than
that in the control group (P<0.01). Of the 43 patients, 41 had no bleeding
according to indicators like increased drainage. Two had a bleeding
tendency, and were thus clinically discontinued from hemocoagulase and
supplemented with FIB, fresh frozen plasma, and cryoprecipitate; their
drainage volume was significantly reduced, and reexamination of TEG showed
normal coagulation status. CONCLUSION(S): For patients with
preoperative low FIB or a lower limit of normal value, hemocoagulase
should be used with caution; after using this type of thrombin, applying
TEG for the timely monitoring of a patient's coagulation status is
optimally recommended.

<11>
Accession Number
612328834
Title
Effects of sacubitril/valsartan in the PARADIGM-HF trial (Prospective
Comparison of ARNI with ACEI to Determine Impact on Global Mortality and
Morbidity in Heart Failure) according to background therapy.
Source
Circulation: Heart Failure. 9 (9) (no pagination), 2016. Article Number:
003212. Date of Publication: 01 Sep 2016.
Author
Okumura N.; Jhund P.S.; Gong J.; Lefkowitz M.P.; Rizkala A.R.; Rouleau
J.L.; Shi V.C.; Swedberg K.; Zile M.R.; Solomon S.D.; Packer M.; Mcmurray
J.J.V.
Institution
(Okumura, Jhund, Mcmurray) BHF Cardiovascular Research Centre, University
of Glasgow, 126 University Pl, Glasgow G12 8TA, United Kingdom
(Gong, Lefkowitz, Rizkala, Shi) Novartis Pharmaceutical Corporation, East
Hanover, NJ, United States
(Rouleau) Institut de Cardiologie de Montreal, Universitede Montreal,
Montreal, QC, Canada
(Swedberg) Department of Molecular and Clinical Medicine, University of
Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Zile) Medical University of South Carolina, RHJ Department of Veterans
Administration Medical Center, Charleston, SC, United States
(Solomon) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(Packer) Baylor Heart and Vascular Institute, Baylor University Medical
Center, Dallas, TX, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In the PARADIGM-HF trial (Prospective Comparison of ARNI with
ACEI to Determine Impact on Global Mortality and Morbidity in Heart
Failure), the angiotensin receptor neprilysin inhibitor
sacubitril/valsartan was more effective than the angiotensin-converting
enzyme inhibitor enalapril in patients with heart failure and reduced
ejection fraction. We examined whether this benefit was consistent
irrespective of background therapy. Methods and Results - We examined the
effect of study treatment in the following subgroups: diuretics (yes/no),
digitalis glycoside (yes/no), mineralocorticoid receptor antagonist
(yes/no), and defibrillating device (implanted defibrillating device,
yes/no). We also examined the effect of study drug according to
beta-blocker dose (>=50% and <50% of target dose) and according to whether
patients had undergone previous coronary revascularization. We analyzed
the primary composite end point of cardiovascular death or heart failure
hospitalization, as well as cardiovascular death. Most randomized patients
(n=8399) were treated with a diuretic (80%) and beta-blocker (93%); 47% of
those taking a beta-blocker were treated with >=50% of the recommended
dose. In addition, 4671 (56%) were treated with a mineralocorticoid
receptor antagonist, 2539 (30%) with digoxin, and 1243 (15%) had a
defibrillating device; 2640 (31%) had undergone coronary
revascularization. Overall, the sacubitril/valsartan versus enalapril
hazard ratio for the primary composite end point was 0.80 (95% confidence
interval, 0.73-0.87; P<0.001) and for cardiovascular death was 0.80
(0.71-0.89; P<0.001). The effect of sacubitril/valsartan was consistent
across all subgroups examined. The hazard ratio for primary end point
ranged from 0.74 to 0.85 and for cardiovascular death ranged from 0.75 to
0.89, with no treatment-by-subgroup interaction. Conclusions - The benefit
of sacubitril/valsartan, over an angiotensin-converting enzyme inhibitor,
was consistent regardless of background therapy and irrespective of
previous coronary revascularization or beta-blocker dose. Copyright
© 2016 American Heart Association, Inc.

<12>
Accession Number
608761473
Title
Novel Approaches in Primary Cardiovascular Disease Prevention: The HOPE-3
Trial Rationale, Design, and Participants' Baseline Characteristics.
Source
Canadian Journal of Cardiology. 32 (3) (pp 311-318), 2016. Date of
Publication: 01 Mar 2016.
Author
Lonn E.; Bosch J.; Pogue J.; Avezum A.; Chazova I.; Dans A.; Diaz R.;
Fodor G.J.; Held C.; Jansky P.; Keltai M.; Keltai K.; Kunti K.; Kim J.-H.;
Leiter L.; Lewis B.; Liu L.; Lopez-Jaramillo P.; Pais P.; Parkhomenko A.;
Peters R.J.G.; Piegas L.S.; Reid C.M.; Sliwa K.; Toff W.D.; Varigos J.;
Xavier D.; Yusoff K.; Zhu J.; Dagenais G.; Yusuf S.
Institution
(Lonn, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Lonn, Bosch, Pogue, Yusuf) Population Health Research Institute, Hamilton
Health Sciences and McMaster University, Hamilton, ON, Canada
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Chazova) Russian Cardiology Research Complex, Moscow, Russian Federation
(Dans) College of Medicine of the University of the Philippines, Manula,
Philippines
(Diaz) Fundacion ECLA, Rosario, Argentina
(Fodor) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Held) Department of Medical Sciences, Uppsala University, Uppsala, Sweden
(Jansky) University Hospital Motol, Prague, Czechia
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Kunti) Diabetes Research Centre, University of Leicester, Leicester,
United Kingdom
(Kim) St. Paul's Hospital, The Catholic University of Korea, Seoul, South
Korea
(Leiter) Li Ka Shing Knowledge Institute and Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto,
Toronto, ON, Canada
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
(Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
(Lopez-Jaramillo) Fundacion Oftalmolgica de Santander (FOSCAL) and
Instituto Masira, Medical School, Universidad de Santander, Bucaramanga,
Colombia
(Pais, Xavier) Division of Clinical Research and Training, St. John's
Research Institute, Bangalore, India
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Peters) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Piegas) Hospital do Coracao, Sao Paulo, Brazil
(Reid, Varigos) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Sliwa) Hatter Institute for Cardiovascular Research in Africa, Department
of Medicine, University of Cape Town and Soweto Cardiovascular Research
Group, Johannesburg, South Africa
(Toff) Department of Cardiovascular Sciences, University of Leicester and
Leicester NIHR Biomedical Research Unit in Cardiovascular Disease,
Glenfield Hospital, Leicester, United Kingdom
(Yusoff) Universiti Teknologi MARA, Selangor, Malaysia
(Zhu) Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, China
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, QC, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cholesterol and blood pressure (BP) can be effectively and
safely lowered with statin drugs and BP-lowering drugs, reducing major
cardiovascular (CV) events by 20%-30% within 5 years in high-risk
individuals. However, there are limited data in lower-risk populations.
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating
whether cholesterol lowering with a statin drug, BP lowering with low
doses of 2 antihypertensive agents, and their combination safely reduce
major CV events in individuals at intermediate risk who have had no
previous vascular events and have average cholesterol and BP levels.
 Method(s): A total of 12,705 women 65 years or older and men 55 years
or older with at least 1 CV risk factor, no known CV disease, and without
any clear indication or contraindication to the study drugs were
randomized to rosuvastatin 10 mg/d or placebo and to
candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 x 2 factorial
design) and will be followed for a mean of 5.8 years. The coprimary study
outcomes are the composite of CV death, nonfatal myocardial infarction
(MI), and nonfatal stroke and the composite of CV death, nonfatal MI,
nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial
revascularization. Result(s): Participants were recruited from 21
countries in North America, South America, Europe, Asia, and Australia.
Mean age at randomization was 66 years and 46% were women.
 Conclusion(s): The HOPE-3 trial will provide new information on
cholesterol and BP lowering in intermediate-risk populations with average
cholesterol and BP levels and is expected to inform approaches to primary
prevention worldwide (HOPE-3 ClinicalTrials.gov
NCT00468923). Copyright © 2016 Canadian Cardiovascular Society.

<13>
Accession Number
2006069897
Title
Systematic Review of Atrial Vascular Access for Dialysis Catheter.
Source
Kidney International Reports. 5 (7) (pp 1000-1006), 2020. Date of
Publication: July 2020.
Author
Philipponnet C.; Aniort J.; Pereira B.; Azarnouch K.; Hadj-Abdelkader M.;
Chabrot P.; Heng A.-E.; Souweine B.
Institution
(Philipponnet, Aniort, Hadj-Abdelkader, Heng) Nephrology, Dialysis and
Transplantation Department, CHU Clermont Ferrand, Clermont Ferrand, France
(Pereira) Department of Clinical Research and Innovation (DRCI), CHU
Clermont-Ferrand, Clermont-Ferrand, France
(Azarnouch) Heart Surgery Department, CHU Clermont Ferrand, Clermont
Ferrand, France
(Chabrot) Department of Vascular Radiology, CHU Clermont Ferrand, Clermont
Ferrand, France
(Souweine) Medical Intensive Care Unit, UMR CNRS 6023, CHU
Clermont-Ferrand, Clermont-Ferrand, France
Publisher
Elsevier Inc
Abstract
Introduction: The last decade has seen a steady increase worldwide in the
prevalence of end-stage renal disease (ESRD). Hemodialysis is the major
modality of renal replacement therapy (RRT) in 70% to 90% of patients, who
require well-functioning vascular access for this procedure. The
recommended access for hemodialysis is an arteriovenous fistula or a
vascular graft. However, recourse to central venous catheters remains
essential for patients whose chronic renal disease is diagnosed at the end
stage or in whom an arteriovenous fistula cannot be created or maintained.
Tunneled dialysis catheter (TDC) exposure can induce venous stenosis and
occlusions and can result in superior vena cava syndrome and/or vascular
access loss. Exhaustion of conventional vascular accesses is 1 of the
greatest challenges that nephrologists and patients have to face. Several
unconventional salvage-therapy routes for TDC placement in patients with
exhausted upper body venous access have been reported in the literature.
 Method(s): We report 2 new cases of intra-atrial TDC placement for
patients with exhausted vascular access and perform a meta-analysis of
cases from the literature. Result(s): A total of 51 patients were
included. The TDC was inserted by a cardiovascular surgeon in all cases.
At the end of follow-up, 75% patients were alive. The median survival time
was 25 months. Survival time of hemodialysis patients with intra-atrial
TDC was lower than that observed with conventional TDC.
 Conclusion(s): This unconventional technique is safe and functional
for hemodialysis patients with exhausted venous access. Atrial vascular
access for TDC placement is salvage therapy and is therefore potentially
lifesaving. Copyright © 2020 International Society of Nephrology

<14>
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

<15>
Accession Number
2005565430
Title
Valve-Sparing Root Replacement Versus Composite Valve Grafting in Aortic
Root Dilation: A Meta-Analysis.
Source
Annals of Thoracic Surgery. 110 (1) (pp 296-306), 2020. Date of
Publication: July 2020.
Author
Elbatarny M.; Tam D.Y.; Edelman J.J.; Rocha R.V.; Chu M.W.A.; Peterson
M.D.; El-Hamamsy I.; Appoo J.J.; Friedrich J.O.; Boodhwani M.; Yanagawa
B.; Ouzounian M.
Institution
(Elbatarny, Tam, Edelman, Rocha, Ouzounian) Division of Cardiac Surgery,
Department of Surgery, Toronto General Hospital and University of Toronto,
Toronto, ON, Canada
(Elbatarny) Queen's University School of Medicine, Kingston, Ontario,
Canada
(Chu) Division of Cardiac Surgery, Department of Surgery, London Health
Sciences Center and University of Western Ontario, London, ON, Canada
(Peterson, Yanagawa) Division of Cardiac Surgery, Department of Surgery,
St. Michael's Hospital and University of Toronto, Toronto, ON, Canada
(El-Hamamsy) Division of Cardiac Surgery, Department of Surgery, Montreal
Heart Institute and Universite de Montreal, Montreal, QC, Canada
(Appoo) Division of Cardiac Surgery, Department of Surgery, Foothills
Medical Centre, University of Calgary, Calgary, AB, Canada
(Friedrich) Department of Critical Care Medicine, St. Michael's Hospital
and University of Toronto, Toronto, ON, Canada
(Boodhwani) Division of Cardiac Surgery, Department of Surgery, Ottawa
Heart Institute and University of Ottawa, Ottawa, ON, Canada
Publisher
Elsevier USA
Abstract
Background: Aortic valve-sparing operations theoretically have fewer
stroke and bleeding complications but may increase late reoperation risk
versus composite valve grafts. Method(s): We meta-analyzed all
studies comparing aortic valve-sparing (reimplantation and remodelling)
and composite valve-grafting (bioprosthetic and mechanical) procedures.
Early outcomes were all-cause mortality, reoperation for bleeding,
myocardial infarction, and thromboembolism/stroke. Long-term outcomes
included all-cause mortality, reintervention, bleeding, and
thromboembolism/stroke. Studies exclusively investigating dissection or
pediatric populations were excluded. Result(s): A total of 3794
patients who underwent composite valve grafting and 2424 who underwent
aortic valve-sparing procedures were included from 9 adjusted and 17
unadjusted observational studies. Mean follow-up was 5.8 +/- 3.0 years.
Aortic valve sparing was not associated with any difference in early
mortality, bleeding, myocardial infarction, or thromboembolic
complications. Late mortality was significantly lower after valve sparing
(incident risk ratio, 0.68; 95% confidence interval [CI], 0.54-0.87; P
<.01). Late thromboembolism/stroke (incident rate ratio, 0.36; 95% CI,
0.22-0.60; P <.01) and bleeding (incident rate ratio, 0.21; 95% CI,
0.11-0.42; P <.01) risks were lower after valve sparing. Procedure type
did not affect late reintervention. Conclusion(s): Aortic valve
sparing appears to be safe and associated with reduced late mortality,
thromboembolism/stroke, and bleeding compared with composite valve
grafting. Late durability is equivalent. Aortic valve sparing should be
considered in patients with favorable aortic valve
morphology. Copyright © 2020 The Society of Thoracic Surgeons

<16>
Accession Number
2005083723
Title
The impact of frailty on the economic evaluation of geriatric surgery:
hospital costs and opportunity costs based on meta-analysis.
Source
Journal of Medical Economics. 23 (8) (pp 819-830), 2020. Date of
Publication: 02 Aug 2020.
Author
Fuertes-Guiro F.; Viteri Velasco E.
Institution
(Fuertes-Guiro) Faculty of Medicine and Health Sciences, Universitat
Internacional de Catalunya, Barcelona, Spain
(Viteri Velasco) Quiron Salud University Hospital, Universitat
Internacional de Catalunya, Barcelona, Spain
Publisher
Taylor and Francis Ltd
Abstract
Objectives: We used a systematic review and meta-analysis to analyze the
difference in costs between surgery for frail and non-frail elderly
patients. The opportunity cost of frailty in geriatric surgery is
estimated using the results. Methodology: Two literature reviews were
carried out between 2000 and 2019: (1) studies comparing total hospital
costs of frail and non-frail surgical patients; (2) studies evaluating the
length of hospital stay and cost for surgical geriatric patients. We
performed a meta-analysis of the items selected in the first review. We
subsequently calculated the opportunity cost of frail patients, based on
the design of a cost/time variable. Result(s): Twelve articles in the
first review were selected (272,717 non-frail and 16,461 frail). Fourteen
articles were selected from the second review. Frail patients had higher
hospital costs than non-frail patients (22,282.541 and 16,388.844, p
<.001) and a longer hospital stay (10.16 days and 8.4 (p <.001)). The
estimated opportunity cost in frail patients is 1,019.56 (cost/time unit
factor of 579.30 /day). Conclusion(s): Frail surgical geriatric
patients generate a higher total hospital cost, and an opportunity cost
arising from not operating in the best possible state of health.
Preoperatively treating the frailty of elderly patients will improve the
use of health resources. Copyright © 2020 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<17>
Accession Number
2005045412
Title
Percutaneous mitral valve repair for secondary mitral valve regurgitation:
A systematic review and meta-analysis.
Source
European Journal of Internal Medicine. 78 (pp 107-112), 2020. Date of
Publication: August 2020.
Author
Kumar A.; Al-khafaji J.; Shariff M.; Vaz I.P.; Adalja D.; Doshi R.
Institution
(Kumar, Shariff) Department of Critical Care, St John's Medical college
hospital, Bengaluru, Karnataka, India
(Al-khafaji, Doshi) Department of Internal Medicine, University of Nevada
Reno School of Medicine, Reno, NV, United States
(Vaz) Department of internal medicine, Jackson Memorial
Hospital/University of Miami, Florida, United States
(Adalja) GMERS Gotri Medical College, Gotri Medical Education and Research
Center, Vadodara, Gujarat, India
Publisher
Elsevier B.V.
Abstract
Background: The first two randomized control trials (RCTs) studying the
role of MitraClip in patients with secondary mitral regurgitation (MR) had
antagonizing results. We, therefore, performed an updated meta-analysis of
RCTs and propensity score-matched observational studies investigating the
role of MitraClips in patients with secondary MR. A novel method of Kaplan
Meier Curve reconstruction from derived individual patient data will be
used to compare the survival probability of control groups in COAPT and
MITRA HF trail, and hence, access inter-study heterogeneity.
 Method(s): Medline and Cochrane databases was used for systematic
search. We used the Mantel-Haenszel method with a random-effect model to
calculate risk ratio (RR) with 95% confidence interval (CI) and inverse
variance method with a random-effect model to calculate the mean
difference (MD) with 95% confidence interval (CI). We used a fixed-effect
approach for meta-regression. Result(s): MitraClip reduced the risk
of all-cause mortality [RR: 0.72, CI: 0.55-0.95, P value = 0.02, I2 = 55%,
chi2P-value = 0.08] and readmission [RR: 0.62, CI: 0.42-0.92, P
value = 0.02, I2 = 90%, chi2P-value<0.01] at two
years follow-up. There was no effect of MitraClip on change in
cardiovascular mortality and 6 m walking distance at 12 months follow-up.
Meta-regression indicated left ventricular end diastolic volume and age
among the factors affecting outcomes. Reconstructed Kaplan Meier curves
confirmed considerable heterogeneity among patients randomized in MITRA HF
and COAPT trial. Conclusion(s): The present meta-analysis confirms
the beneficial role of percutaneous mitral valve repair in patients with
secondary MR. However, all the results were associated with considerable
heterogeneity. Copyright © 2020 European Federation of Internal
Medicine

<18>
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.

<19>
Accession Number
2007334311
Title
Surgical Closure of Atrial Septal Defects in Young Children-A Review of
Anesthesia Care in Sternotomy and Thoracotomy Approaches.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Karuppiah N.; Pehora C.; Haller C.; Taylor K.
Institution
(Karuppiah, Pehora, Taylor) Department of Anesthesia and Pain Medicine,
The Hospital for Sick Children, University of Toronto, Toronto, Canada
(Haller) Division of Cardiovascular Surgery, The Labatt Family Heart
Centre, The Hospital for Sick Children, Toronto, Canada
(Taylor) University of Toronto, Toronto, Canada
Publisher
W.B. Saunders
Abstract
Objectives: To review and compare the anesthetic management of atrial
septal defect (ASD) closures via mini lateral thoracotomy and sternotomy
approaches. Design(s): Retrospective analysis. Setting(s):
Single- center pediatric quaternary care hospital. Participant(s):
Patients aged <8 years of age undergoing ASD closure.
 Intervention(s): None. Measurements and Main Results: Outcome
measures included anesthetic technique, total amount and type of
analgesics, pain scores, procedure duration, complications, blood
transfusion requirements, and duration of stay. Each group had 15
patients. All patients in the sternotomy group received 0.25% bupivacaine
subcutaneous infiltration. Eleven of the 15 thoracotomy patients received
a fascial plane block, including serratus anterior and erector spinae
blocks, and 3 received subcutaneous infiltration. There was no difference
in opioid consumption intraoperatively or in the first 24 hours after
surgery (0.28 +/- 0.24 mg/kg morphine equivalents in thoracotomy group and
0.21 +/- 0.12 mg/kg in sternotomy group). Duration of procedure and
cardiopulmonary bypass duration were longer in the thoracotomy group.
There was no difference in cross-clamp duration between groups. There was
no difference in intensive care unit or hospital stay. Conclusion(s):
The authors reviewed perioperative pain management strategies used in
surgical ASD closures. Different fascial plane blocks were used. This
study has paved way to design a randomized control trial to compare
various regional techniques for cardiac surgeries and identified
opportunities for improved pain assessment scoring in children after
cardiac surgery. Copyright © 2020 Elsevier Inc.

<20>
Accession Number
2007321127
Title
A systematic review of radiological and histological findings of septic
myocardial calcifications.
Source
Journal of Forensic and Legal Medicine. 74 (no pagination), 2020. Article
Number: 102026. Date of Publication: August 2020.
Author
Cappelletti S.; Piacentino D.; Ciallella C.
Institution
(Cappelletti, Ciallella) Department of Anatomical, Histological, Forensic
Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
(Cappelletti) State Police Health Service Department, Ministry of
Interior, Rome, Italy
(Piacentino) Department of Psychiatry, Central Hospital, Sanitary Agency
of South Tyrol, Bolzano-Bozen, Italy
Publisher
Churchill Livingstone
Abstract
Myocardial calcification is a life-threatening condition that is a
recognised complication of ischaemic heart disease, cardiac surgery,
rheumatic fever, myocarditis and sepsis. Only sparse data, reporting the
clinical symptoms, the anatomo-pathological findings, the imaging findings
have been published and no exhaustive analysis of all these factors exists
in literature. To date, there have been 26 published cases in the medical
literature in which myocardial calcifications is the consequence of a
septic status. In this review, we will describe the main imaging and
histological findings, with particular attention to the known and
hypothesized mechanisms of myocardial calcifications. The results of this
study may help clinicians and forensic pathologists to identify possible
unrecognized cases and inspire the development of an international
registry by which to coordinate further research. Copyright ©
2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine

<21>
Accession Number
2006829157
Title
HEARTBiT: A Transcriptomic Signature for Excluding Acute Cellular
Rejection in Adult Heart Allograft Patients.
Source
Canadian Journal of Cardiology. 36 (8) (pp 1217-1227), 2020. Date of
Publication: August 2020.
Author
Shannon C.P.; Hollander Z.; Dai D.L.Y.; Chen V.; Assadian S.; Lam K.K.;
McManus J.E.; Zarzycki M.; Kim Y.; Kim J.-Y.V.; Balshaw R.; Gidlof O.;
Ohman J.; Smith J.G.; Toma M.; Ignaszewski A.; Davies R.A.; Delgado D.;
Haddad H.; Isaac D.; Kim D.; Mui A.; Rajda M.; West L.; White M.; Zieroth
S.; Tebbutt S.J.; Keown P.A.; McMaster W.R.; Ng R.T.; McManus B.M.
Institution
(Shannon, Hollander, Dai, Chen, Assadian, Lam, McManus, Zarzycki, Kim,
Balshaw, Tebbutt, Ng, McManus) Prevention of Organ Failure (PROOF) Centre
of Excellence, Vancouver, BC, Canada
(Lam, McManus) Department of Pathology, University of British Columbia,
Vancouver, BC, Canada
(Zarzycki, Kim, Kim, Tebbutt, Keown, McMaster, Ng) Department of Medicine,
University of British Columbia, Vancouver, BC, Canada
(Kim, McMaster) Department of Medical Genetics, University of British
Columbia, Vancouver, BC, Canada
(Ng) Department of Computer Science, University of British Columbia,
Vancouver, BC, Canada
(Balshaw) Department of Statistics, University of British Columbia,
Vancouver, BC, Canada
(Gidlof, Ohman, Smith) Department of Cardiology, Skane University
Hospital, Lund University, Lund, Sweden
(Toma, Ignaszewski) Department of Cardiology, University of British
Columbia, Vancouver, BC, Canada
(Davies) Department of Medicine, University of Ottawa, Ottawa, ON, Canada
(Delgado) University Health Network/Mount Sinai Hospital, Toronto, ON,
Canada
(Haddad) Department of Medicine, University of Saskatchewan, Saskatoon,
SK, Canada
(Isaac, Kim) Department of Medicine, University of Alberta, Calgary,
Aberta, Canada
(Mui) Department of Surgery, University of British Columbia, Vancouver,
BC, Canada
(Rajda) Department of Medicine, Dalhousie University, Halifax, NS, Canada
(West) Department of Pediatrics, University of Alberta, Edmonton, AB,
Canada
(White) Institut de Cardiologie de Montreal, Montreal, Quebec, Canada
(Zieroth) Department of Medicine, University of Manitoba, Winnipeg, MB,
Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Nine mRNA transcripts associated with acute cellular rejection
(ACR) in previous microarray studies were ported to the clinically
amenable NanoString nCounter platform. Here we report the diagnostic
performance of the resulting blood test to exclude ACR in heart allograft
recipients: HEARTBiT. Method(s): Blood samples for transcriptomic
profiling were collected during routine post-transplantation monitoring in
8 Canadian transplant centres participating in the Biomarkers in
Transplantation initiative, a large (n = 1622) prospective observational
study conducted between 2009 and 2014. All adult cardiac transplant
patients were invited to participate (median age = 56 [17 to 71]). The
reference standard for rejection status was histopathology grading of
tissue from endomyocardial biopsy (EMB). All locally graded ISHLT >= 2R
rejection samples were selected for analysis (n = 36). ISHLT 1R (n = 38)
and 0R (n = 86) samples were randomly selected to create a cohort
approximately matched for site, age, sex, and days post-transplantation,
with a focus on early time points (median days post-transplant = 42 [7 to
506]). Result(s): ISHLT >= 2R rejection was confirmed by EMB in 18
and excluded in 92 samples in the test set. HEARTBiT achieved 47%
specificity (95% confidence interval [CI], 36%-57%) given >= 90%
sensitivity, with a corresponding area under the receiver operating
characteristic curve of 0.69 (95% CI, 0.56-0.81). Conclusion(s):
HEARTBiT's diagnostic performance compares favourably to the only
currently approved minimally invasive diagnostic test to rule out ACR,
AlloMap (CareDx, Brisbane, CA) and may be used to inform care decisions in
the first 2 months post-transplantation, when AlloMap is not approved, and
most ACR episodes occur. Copyright © 2019 Canadian Cardiovascular
Society

<22>
Accession Number
2005802674
Title
Early mobilization reduces delirium after coronary artery bypass graft
surgery.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Shirvani F.; Naji S.A.; Davari E.; Sedighi M.
Institution
(Shirvani, Naji, Davari) Department of Nursing and Midwifery, Islamic Azad
University, Isfahan, Isfahan, Iran, Islamic Republic of
(Sedighi) Department of Neuroscience, Faculty of Advanced Technologies in
Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Postoperative delirium is common in patients undergoing
coronary artery bypass grafting, characterized by cognitive decline. This
study aimed to evaluate the effect of early planned mobilization on
delirium after coronary artery bypass grafting. Method(s): This
double-blind randomized clinical trial enrolled 92 consecutive patients
who underwent coronary artery bypass grafting from September to December
2018. The patients were divided into two groups of 46: a mobilization
protocol was applied in the intervention group in the first 2 days after
surgery; the control group received routine nursing care only. Demographic
data, medical records, and Neecham confusion scores were analyzed.
 Result(s): Patients in the control group used cigarettes (31.1% vs.
11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p =
0.002) more frequently, had longer intubation times (11.91 +/- 3.87 vs.
10.23 +/- 2.71 h, p = 0.020), and fewer blood components infused (15.6%
vs. 33.3%, p = 0.05). More patients in the intervention group had normal
function on the 2nd postoperative day compared to the control group (25
vs. 2, respectively, p = 0.001). The intervention group had significantly
higher Neecham scores on postoperative day 2 (22.49 +/- 2.03 vs. 26.82 +/-
2.10, p = 0.001). Multivariable analysis showed significant associations
between Neecham score and age (p = 0.022), ejection fraction (p = 0.015),
myocardial infarction (p = 0.016), systolic pressure (p = 0.009), and
diastolic pressure (p = 0.008). Conclusion(s): Early planned
mobilization was effective in reducing postoperative delirium in patients
undergoing coronary artery bypass grafting. Copyright © The
Author(s) 2020.

<23>
Accession Number
2005789243
Title
TAVR-related echocardiographic assessment-status quo, challenges and
perspectives.
Source
Acta Cardiologica. 75 (4) (pp 275-285), 2020. Date of Publication: 03 Jul
2020.
Author
Veulemans V.; Afzal S.; Papadopoulos G.; Maier O.; Kelm M.; Zeus T.;
Hellhammer K.
Institution
(Veulemans, Afzal, Papadopoulos, Maier, Kelm, Zeus, Hellhammer) Division
of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine,
University Hospital Duesseldorf, Dusseldorf, Germany
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Transcatheter aortic valve replacement (TAVR) is an emerging and a
well-established procedure for high-risk and inoperable patients
worldwide. Recent studies revealed furthermore that TAVR is equal or even
superior to surgical valve replacement in intermediate risk patients.
Therefore, a successful procedure is not only dependent on precise
preprocedural patient selection but also on careful intraprocedural
multimodal imaging guidance and adequate postprocedural follow-up. Up to
date, 2D/3D transthoracic and/or transoesophageal echocardiography is an
easy and goal-oriented tool for periprocedural TAVR-assessment regarding
annulus measurements, cardiac function and concomitant valve diseases.
Further procedural success is directly related to prevention of severe
early and late complications. Thus, a careful intra- and postprocedural
echocardiographic guidance is crucial to evaluate prosthetic function,
position and its haemodynamic implication and changes in the integrity of
the left ventricle during intra- and postprocedural management. We
explored the role of echocardiography for pre-, intra- and postprocedural
TAVR-assessment, illustrated by cases and possible algorithms, in a
comprehensive literature review. Furthermore, we describe the role of
fusion imaging, that is, real-time fusion of transoesophageal
echocardiography and fluoroscopy (EchoNavigator Release System
I and II) during TAVR. Copyright © 2019 Belgian Society of
Cardiology.

<24>
Accession Number
2005781340
Title
Normoxic management of cardiopulmonary bypass reduces myocardial oxidative
stress in adult patients undergoing coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Topcu A.C.; Bolukcu A.; Ozeren K.; Kavasoglu T.; Kayacioglu I.
Institution
(Topcu, Bolukcu, Ozeren, Kayacioglu) Department of Cardiovascular Surgery,
Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research
Hospital, Istanbul, Turkey
(Kavasoglu) Department of Anesthesiology and Reanimation, Dr. Siyami Ersek
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: We aimed to investigate whether normoxic cardiopulmonary
bypass would limit myocardial oxidative stress in adults undergoing
coronary artery bypass grafting. Method(s): Patients scheduled to
undergo elective isolated on-pump coronary artery bypass grafting were
randomized to normoxia and hyperoxia groups. The normoxia group received
35% oxygen during anesthetic induction, 35% during hypothermic bypass, and
45% during rewarming. The hyperoxia group received 70%, 50%, and 70%
oxygen, respectively. Coronary sinus blood samples were taken prior to
initiation of cardiopulmonary bypass and after reperfusion for myocardial
total oxidant and antioxidant status measurements. The primary endpoint
was myocardial total oxidant status. Secondary endpoints were myocardial
total antioxidant status and length of intensive care unit and hospital
stay. Result(s): Forty-eight patients were included. Twenty-two
received normoxic management. Mean +/- standard deviation of age was 58
+/- 9.07 years. Groups were balanced in terms of demographics, risk
factors, and operative data. Myocardial total oxidant status was
significantly lower in the normoxia group following reperfusion (p =
0.03). There was no statistically significant difference regarding
myocardial total antioxidant status and length of intensive care unit and
hospital stay (p = 0.08, p = 0.82, and p = 0.54, respectively).
 Conclusion(s): Normoxic cardiopulmonary bypass is associated with
reduced myocardial oxidative stress compared to hyperoxic cardiopulmonary
bypass in adult coronary artery bypass patients. Copyright © The
Author(s) 2020.

<25>
Accession Number
630596807
Title
Peritoneal dialysis for the prevention of fluid overload in infants after
cardiac surgery - A systematic review and meta-analysis.
Source
Saudi journal of kidney diseases and transplantation : an official
publication of the Saudi Center for Organ Transplantation, Saudi Arabia.
30 (6) (pp 1222-1235), 2019. Date of Publication: 01 Nov 2019.
Author
Bhatt G.C.; Das R.R.; Chaudhary B.; Satapathy A.K.; Malik S.
Institution
(Bhatt, Malik) Department of Pediatrics, All India Institute of Medical
Sciences, Bhopal, Madhya Pradesh, India
(Das, Satapathy) Department of Pediatrics, All India Institute of Medical
Sciences, Bhubaneswar, Odisha, India
(Chaudhary) Department of Pediatrics, All India Institute of Medical
Sciences, Jodhpur, Rajasthan, India
Publisher
NLM (Medline)
Abstract
The objective is to compare peritoneal dialysis with standard care therapy
for the prevention of fluid overload in infants after cardiac surgery. We
searched published literature through the major database up to December
2017. Randomized controlled trials (RCTs), quasi-randomized trials, and
observational studies were included in the study. The primary outcome
measures were as follows: all-cause mortality and duration of
hospitalization. Of the 392-citation retrieved, full text of 7 was finally
assessed for eligibility. Of these, a total of five studies (RCTs = 3, and
observational studies = 2) were included. There was no significant
difference between the prophylactic PD and the standard therapy group for
any of the primary outcomes. The present systematic review shows that
prophylactic PD is not beneficial compared to standard care in infants
postcardiac surgery for congenital heart disease. The GRADE evidence
generated was of "very low quality."

<26>
Accession Number
2004823909
Title
Effectiveness of pre-operative respiratory muscle training versus
conventional treatment for improving post operative pulmonary health after
coronary artery bypass grafting.
Source
Pakistan Journal of Medical Sciences. 36 (6) (pp 1-4), 2020. Date of
Publication: September - October 2020.
Author
Sahar W.; Ajaz N.; Haider Z.; Jalal A.
Institution
(Sahar) Department of Physiotherapy, Faisalabad Institute of Cardiology,
Faisalabad, Pakistan
(Ajaz) KKT-Orthopedic and Spine Center, Faisalabad, Pakistan
(Haider) Punjab Institute of Cardiology, Lahore, Pakistan
(Haider) Department of Cardiac Surgery, Punjab Institute of Cardiology,
Jail Road, Lahore, Pakistan
(Jalal) Office of the Executive Director, Faisalabad Institute of
Cardiology, Faisalabad, Pakistan
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To evaluate the Effectiveness of Pre-operative Respiratory
Muscle Training versus Conventional Treatment for Improving post-operative
pulmonary health after Coronary Artery Bypass Graft Surgery (CABG).
 Method(s): A Prospective Randomized clinical trial was performed on
sixty patients who underwent elective 6-minutes' walk test (6MWT) as
baseline. The subjects were then divided into two groups. The Group-I was
subjected to respiratory muscle training whereas the Group-2 received the
routine preoperative care. The (post-operatively). Duration of
post-operative mechanical ventilation, oxygen therapy and hospital stay
were also noted as outcome measures of this study. Result(s): The
pre-operative and post-operative readings showed that the patients in the
interventional group performed better than the control group in their 6MWT
with P-value of less than 0.05. Similarly the interventional group had
shorter duration of mechanical ventilation, dependence on oxygen therapy
and postoperative hospital stay as compared with the control group showing
P-values below 0.05. Conclusion(s): The results showed that
respiratory muscle training results in improved postoperative functional
capacity and reduces of hospital stay. Copyright © 2020,
Professional Medical Publications. All rights reserved.

<27>
Accession Number
632545111
Title
Comparison of outcome of transcatheter aortic valve implantation in
patients with advanced age: A systematic review and meta-analysis.
Source
Medicine. 99 (31) (pp e21443), 2020. Date of Publication: 31 Jul 2020.
Author
Zhu S.; Li H.; Zhang G.; Liu S.; Li Z.
Institution
(Zhu, Li, Zhang, Liu) First Clinical Medical College, Lanzhou University
(Li) Department of Hematology, First Hospital of Lanzhou University,
Lanzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective
treatment to aortic stenosis in patients with advanced age. However, age
is recognized as one of the most important risk factors. The aim of our
study is to compare the outcome of TAVI between octogenarian patients and
young patients. METHOD(S): Randomized controlled trials, cohort
studies and propensity score matching studies will be included in our
systematic review and meta-analysis to evaluate clinical outcome in
octogenarian patients who undergo TAVI. PubMed, EMBASE, MEDLINE, Cochrane
Library and Web of Science will be searched using a comprehensive
strategy. The related conference proceedings and reference lists of the
included studies will also be checked to identify additional studies.
Retrieved records, extract information and assess the risk of bias will be
screened by two reviewers independently. STATA software will be used to
conduct data synthesis. There is no requirement of ethical approval and
informed consent. RESULT(S): This study will eventually be published
in a peer reviewed journal in the form of a scientific paper.
 CONCLUSION(S): This study will provide a comprehensive review of the
available evidence for the treatment of aortic stenosis in octogenarian
patients underwent TAVI. We hope it will provide a relatively
comprehensive reference for clinical practice and future relevant clinical
trials. PROSPERO REGISTRATION NUMBER: CRD42020155189. STUDY PROTOCOL
REGISTRY: The protocol has been registered in PROSPERO, which is an
International Prospective Register of Systematic Reviews. The registration
number is CRD42020155189. ETHICS AND DISSEMINATION: Ethics approval and
patient consent are not required as this study is a systematic review and
meta-analysis.

<28>
Accession Number
632543104
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: July-September 2020.
Author
Pruthi G.; Singh N.G.; Nagaraja P.S.; Balaji R.M.; Manjunatha N.;
Choudhary P.K.; Raja M.
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, Sports Authority of Karnataka,
Bengaluru, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
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. Copyright © 2020
Annals of Cardiac Anaesthesia Published by Wolters Kluwer - Medknow.

<29>
Accession Number
632543093
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: July-September 2020.
Author
Yuhe K.; Huey Chew S.; Ang A.; Ge Ng R.R.; Boonkiangwong N.; Liu W.; Hao
Toh A.H.; Caleb M.G.; Man Ho R.C.; Ti L.K.
Institution
(Yuhe, Huey Chew, Ge Ng) Department of Anesthesiology, Singapore General
Hospital, 20 College Road, Academia, Level 5, Singapore
(Huey Chew) Department of Cardiovascular and Metabolic Disorders,
Duke-National University of Singapore Graduate Medical School, 8 College
Road, Singapore
(Ang, Liu, Man Ho, Ti) Yong Loo Lin School of Medicine, National
University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11,
Singapore
(Ge Ng, Boonkiangwong, Caleb) Department of Cardiac, Thoracic and Vascular
Surgery, National University Hospital Singapore, Singapore
(Liu, Ti) Department of Anesthesia, National University Health System, 5
Lower Kent Ridge Road, Singapore
(Hao Toh, Man Ho) Department of Psychological Medicine, National
University Health System, 5 Lower Kent Ridge Road, Singapore, Singapore
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
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. Copyright © 2020
Annals of Cardiac Anaesthesia Published by Wolters Kluwer - Medknow.

<30>
Accession Number
632543065
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: July-September 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
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
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. Copyright © 2020 Annals of Cardiac Anaesthesia 
Published by Wolters Kluwer - Medknow.

<31>
Accession Number
2005794332
Title
Continuous paravertebral block by intraoperative direct access versus
systemic analgesia for postthoracotomy pain relief.
Source
Cardiothoracic Surgeon. 28 (1) (no pagination), 2020. Article Number: 17.
Date of Publication: 01 Dec 2020.
Author
Deebis A.; Elattar H.; Saber O.; Elfakharany K.; Elnahal N.
Institution
(Deebis, Saber, Elfakharany, Elnahal) Cardiothoracic Surgery Department,
Faculty of Medicine, Zagazig University, Zagazig, Sharkia Governorate,
Egypt
(Elattar) Anesthesia and Intensive Care Department, Zagazig University,
Zagazig, Egypt
Publisher
Springer
Abstract
Background: Systemic analgesia with paracetamol and nonsteroidal
anti-inflammatory drugs plus opioids as a rescue medication had reported
to be better than that depend mainly on opioids for postoperative pain
relief. Thoracic paravertebral block reported to provide a comparable
postthoracotomy pain relief to epidural analgesia, with fewer side effects
due to its unilateral effect. Thoracic paravertebral catheter can be
inserted intraoperatively under direct vision during thoracic surgery
(Sabanathan's technique). This prospective randomized study was designed
to evaluate the safety and efficacy of this technique with continuous
infusion of lidocaine compared to systemic analgesia for postthoracotomy
pain relief. Result(s): Sixty-three patients were randomized to
receive a continuous infusion of lidocaine in the paravertebral catheter
for 3 postoperative days (thoracic paravertebral group, n = 32) or
systemic analgesia (systemic analgesia group, n = 31). All patients
underwent standard posterolateral thoracotomy. There were no significant
differences between both groups in age, sex, side, type, and duration of
operation. Pain scores measured on visual analogue scale and morphine
consumption were significantly lower in thoracic paravertebral group in
all postoperative days. Spirometric pulmonary functions were not reaching
the preoperative values in the third postoperative day in both groups, but
restorations of pulmonary functions were superior in paravertebral group.
No complications could be attributed to the paravertebral catheter. Side
effects, mainly nausea and vomiting followed by urinary retention, were
significantly more in systemic analgesia group (P = 0.03). Also, pulmonary
complications were more in systemic analgesia group but not reaching
statistical significance (P = 0.14). Conclusion(s): Continuous
paravertebral block by direct access to the paravertebral space using a
catheter inserted by the surgeon is a simple technique, with low risk of
complications, provides effective pain relief with fewer side effects, and
reduces the early loss of postoperative pulmonary functions when compared
to systemic analgesia. Copyright © 2020, The Author(s).

<32>
Accession Number
2007341634
Title
Radial artery harvesting in coronary artery bypass grafting
surgery-Endoscopic or open method? A meta-analysis.
Source
PLoS ONE. 15 (7 July) (no pagination), 2020. Article Number: e0236499.
Date of Publication: July 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
Public Library of Science (E-mail: plos@plos.org)
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. Copyright © 2020 Huang et al.

<33>
Accession Number
2007403619
Title
Mechanical or biological heart valve for dialysis-dependent patients? A
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Chi K.-Y.; Chiang M.-H.; Kang Y.-N.; Li S.-J.; Chan Y.-T.; Chen Y.-C.;
Wang S.-T.
Institution
(Chi) Department of Education, Center for Evidence-Based Medicine, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
(Chiang) School of Medicine, College of Medicine, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Kang) Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Kang) Institute of Health Policy & Management, College of Public Health,
National Taiwan University, Taipei, Taiwan (Republic of China)
(Li) Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Li) Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Li) Division of Cardiovascular Surgery, Department of Surgery, Wan Fang
Hospital, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chan) Department of General Medicine, Shuang Ho Hospital, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Chen, Wang) Department of Family Medicine, Taipei Medical University
Hospital, Taipei, Taiwan (Republic of China)
(Chen, Wang) Department of Family Medicine, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen) School of Nutrition and Health Sciences, College of Nutrition,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen) Graduate Institute of Metabolism and Obesity Sciences, Taipei
Medical University, Taipei, Taiwan (Republic of China)
(Wang) Health Management Center, Taipei Medical University Hospital,
Taipei, Taiwan (Republic of China)
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The optimal selection of prosthetic heart valve for
dialysis-dependent patients remains controversial. We investigated the
comparative effectiveness and safety of mechanical prosthesis (MP) and
bioprosthesis (BP) for these patients. Method(s): After the
systematic review, we included studies that involved patients on dialysis
undergoing aortic valve replacement or mitral valve replacement (MVR) and
reported comparative outcomes of MP and BP. Meta-analysis was performed
using random-effects model. We conducted a subgroup analysis based on the
valve position and postoperative international normalized ratio (INR),
which was extracted from either tables or methods of each study. A
meta-regression was used to examine the effects of study-level covariates.
 Result(s): We included 24 retrospective studies without
randomized-controlled trials, involving 10,164 participants (MP = 6934, BP
= 3230). Patients undergoing aortic valve replacement with MP exhibited a
better long-term survival effectiveness (hazard ratio, 0.64; 95%
confidence interval [CI], 0.47-0.86). Conversely, studies including MVR
demonstrated little difference in survival (hazard ratio, 0.90; 95% CI,
0.73-1.12). A meta-regression revealed that age had little effect on
long-term survival difference between MP and BP (beta = -0.0135, P =
.433). MP had a significantly greater bleeding risk than did BP when INR
was above 2.5 (incidence rate ratio, 10.58; 95% CI, 2.02-55.41). However,
when INR was below 2.5, bleeding events were comparable (incidence rate
ratio, 1.73; 95% CI, 0.78-3.82). The structural valve deterioration rate
was significantly lower in MP (risk ratio, 0.24; 95% CI, 0.14-0.44).
 Conclusion(s): MP is a reasonable choice for dialysis-dependent
patients without additional thromboembolic risk requiring aortic valve
replacement, for its better long-term survival, durability, and
noninferior bleeding risk compared with BP. Conversely, BP might be an
appropriate selection for patients with MVR, given its similar survival
rate and lower bleeding risk. Although our meta-regression demonstrates
little influence of age on long-term survival difference between MP and
BP, further studies stratifying patients based on age cut-off are
mandatory. Copyright © 2020 The American Association for Thoracic
Surgery

<34>
Accession Number
2005781545
Title
Sarcopenia in Patients Undergoing Transcatheter Aortic Valve Implantation
(TAVI): A Systematic Review of the Literature.
Source
Journal of Nutrition, Health and Aging. (no pagination), 2020. Date of
Publication: 2020.
Author
Bertschi D.; Kiss C.M.; Schoenenberger A.W.; Stuck A.E.; Kressig R.W.
Institution
(Bertschi, Kiss, Kressig) University Department of Geriatric Medicine
FELIX PLATTER, Burgfelderstrasse 101, Basel 4055, Switzerland
(Bertschi, Schoenenberger, Stuck) Department of Geriatrics, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
Serdi-Editions
Abstract
Background: In older patients, sarcopenia is a prevalent disease
associated with negative outcomes. Sarcopenia has been investigated in
patients undergoing transcatheter aortic valve implantation (TAVI), but
the criteria for diagnosis of the disease are heterogeneous. This
systematic review of the current literature aims to evaluate the
prevalence of sarcopenia in patients undergoing TAVI and to analyse the
impact of sarcopenia on clinical outcomes. Method(s): A comprehensive
search of the literature has been performed in electronic databases from
the date of initiation until March 2020. Using a pre-defined search
strategy, we identified studies assessing skeletal muscle mass, muscle
quality and muscle function as measures for sarcopenia in patients
undergoing TAVI. We evaluated how sarcopenia affects the outcomes
mortality at >=1 year, prolonged length of hospital stay, and functional
decline. Result(s): We identified 18 observational studies, enrolling
a total number of 9'513 patients. For assessment of skeletal muscle mass,
all included studies used data from computed tomography. Cutoff points for
definition of low muscle mass were heterogeneous, and prevalence of
sarcopenia varied between 21.0% and 70.2%. In uni- or multivariate
regression analysis of different studies, low muscle mass was found to be
a significant predictor of mortality, prolonged length of hospital stay,
and functional decline. No interventional study was identified measuring
the effect of nutritional or physiotherapy interventions on sarcopenia in
TAVI patients. Conclusion(s): Sarcopenia is highly prevalent among
patients undergoing TAVI, and negatively affects important outcomes. Early
diagnosis of this condition might allow a timely start of nutritional and
physiotherapy interventions to prevent negative outcomes in TAVI
patients. Copyright © 2020, Serdi and Springer-Verlag
International SAS, part of Springer Nature.

<35>
Accession Number
2005846121
Title
Pharmacologic Prophylaxis of Contrast-Induced Nephropathy.
Source
Interventional Cardiology Clinics. 9 (3) (pp 369-383), 2020. Date of
Publication: July 2020.
Author
Toso A.; Leoncini M.; Maioli M.; Bellandi F.
Institution
(Toso, Leoncini, Maioli, Bellandi) Division of Cardiology, Santo Stefano
Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Different pharmacologic agents have been tested in the effort to prevent
contrast-induced acute kidney injury (AKI) in the last two decades. To
date, however, no individual drug has received unanimous approval for this
aim. Since 2014 statins have been included as preventive treatment in the
European guidelines for revascularization procedures in cardiac patients.
The present update presents the latest findings in this field focusing on
the changing paradigms in the definition and consequently the approach to
nephroprotection that considers clinical prognosis as the major issue. We
note the current shift from attention to contrast-induced AKI to
contrast-associated AKI. Copyright © 2020 Elsevier Inc.

<36>
Accession Number
2005520785
Title
On-pump beating-heart coronary artery bypass grafting in high-risk
patients: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 35 (8) (pp 1958-1978), 2020. Date of
Publication: 01 Aug 2020.
Author
Dominici C.; Salsano A.; Nenna A.; Spadaccio C.; Mariscalco G.; Santini
F.; Chello M.
Institution
(Dominici, Nenna, Chello) Department of Cardiovascular Surgery, Universita
Campus Bio-Medico di Roma, Rome, Italy
(Salsano, Santini) Department of Cardiac Surgery, University of Genoa,
Genoa, Italy
(Spadaccio) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Mariscalco) Department of Cardiac Surgery, Glenfield Hospital, University
Hospitals of Leicester, Leicester, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Operative technique for surgical myocardial revascularization
in high-risk patients remains an argument of debate. On-pump coronary
artery bypass graft (CABG) with cardioplegic arrest and off-pump CABG have
intrinsic limitations. The hybrid approach of on-pump beating-heart CABG
(OPBHC) has been proposed over the years with conflicting results. This
systematic review and meta-analysis intends to summarize the contemporary
literature. Method(s): A literature search was conducted through
major electronic databases. The systematic review provided a total of 279
articles, of those 17 studies were included in the present study.
 Result(s): Compared with on-pump CABG, OPBHC patients showed a
preoperative higher risk profile but had reduced early mortality (risk
ratio [RR], 0.59, 95% CI, 0.36-0.97) and reduced postoperative stroke (RR,
0.60, 95% CI, 0.39-0.91). Also, interesting trends towards reduced
postoperative intra-aortic balloon pump use (RR, 0.56, 95% CI, 0.31-1.01)
and myocardial infarction (RR, 0.48, 95% CI, 0.22-1.07) were observed.
Baseline characteristics and postoperative complications were similar
between OPBHC and off-pump CABG, but limited data are available. The risk
of incomplete revascularization in OPBHC is lower than off-pump CABG (RR,
0.53, 95% CI, 0.33-0.87) but higher than conventional on-pump CABG (RR,
1.71, 95% CI, 1.23-2.39). Conclusion(s): OPBHC is an effective
technique to perform surgical revascularization in high-risk patients as
preventing haemodynamic deterioration and guaranteeing adequate end-organ
perfusion. OPBHC represents an alternative technique to on-pump and
off-pump CABG, in those cases in which complications deriving from
cardioplegic arrest or manipulation of the heart are more likely. For
these reasons, OPBHC might be useful in patients with recent myocardial
infarction or with left ventricular dysfunction. Copyright © 2020
Wiley Periodicals LLC

<37>
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.

<38>
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.

<39>
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).

<40>
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).

<41>
Accession Number
2007257915
Title
Effects of exercise-based cardiac rehabilitation in patients with acute
coronary syndrome: A meta-analysis.
Source
Medical Science Monitor. 25 (pp 5015-5027), 2019. Date of Publication: 07
Jul 2019.
Author
Ji H.; Fang L.; Yuan L.; Zhang Q.
Institution
(Ji) Department of Cardiology, Changzhou Hospital Affiliated to Nanjing
University of Chinese Medicine, Changzhou, Jiangsu, China
(Fang, Yuan, Zhang) Department of Cardiology, Changzhou Traditional
Chinese Medicine Hospital, Changzhou, Jiangsu, China
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: Acute coronary syndrome (ACS) has become an important cause of
death from cardiovascular disease. Cardiac rehabilitation (CR) plays an
essential role in ACS patients after treatment. Therefore, in order to
detect the impact of CR on mortality and major adverse cardiac events in
patients with ACS, we conducted this meta-analysis. Material/Methods: We
searched PubMed, Web of science, and EMBASE databases to obtain published
research results from 2010 to August 2018 to determine the relevant
research. Random-effects model or fixed-effects model were used to
calculate relative risk (RR) and 95% confidence interval (CI).
 Result(s): Overall, a total of 25 studies with 55 035 participants
were summarized in our meta-analysis. The results indicated that the
hazard ratio (HR) of mortality significantly lower in the CR group than in
the non-CR group (HR=-0.47; 95% CI=(-0.56 to -0.39; P<0.05). Fourteen
studies on mortality rate showed exercise was associated with reduced
cardiac death rates (RR=0.40; 95% CI=0.30 to 0.53; P<0.05). We found the
risk of major adverse cardiac events (MACE) was lower in the
rehabilitation group (RR=0.49; 95% CI=0.44 to 0.55; P<0.05). In 11
articles on CR including 8098 participants, the benefit in the CR group
was greater than in the control group concerning revascularization
(RR=0.69, 95% CI: 0.53 to 0.88; P=0.003). The recurrence rate of MI was
reported in 13 studies, and the risk was lower in the CR group (RR=0.63,
95% CI: 0.57-0.70; P<0.05). Conclusion(s): Our meta-analysis results
suggest that CR is clearly associated with reductions in cardiac
mortality, recurrence of MI, repeated PCI, CABG, and
restenosis. Copyright © Med Sci Monit.

<42>
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. 9 (15) (pp e015410), 2020. Date
of Publication: 04 Aug 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.

<43>
Accession Number
2007351366
Title
Assessment Of Lateral Costal Artery With Ct-angiography: Importance For
Patients Undergoing Coronary Artery Bypass Grafting.
Source
Journal of Cardiovascular Computed Tomography. Conference: 15th Annual
Scientific Meeting of the Society of Cardiovascular Computed Tomography.
14 (3 Supplement) (pp S47), 2020. Date of Publication: July - August 2020.
Author
McInnis M.; Rani Karur G.; Houbois C.
Institution
(McInnis, Rani Karur, Houbois) Toronto General Hospital, Toronto, ON,
Canada
Publisher
Elsevier Inc.
Abstract
Introduction: Coronary artery bypass grafting (CABG) is an established
treatment for coronary artery disease, frequently using the internal
mammary artery (IMA). In some patients, the IMA gives rise to a dominant
side branch named the lateral costal artery (LCA).The LCA is reported to
cause symptomatic angina following CABG if not ligated, via a steal
phenomenon. Computed tomography angiography (CTA) is commonly used to
evaluate the coronary arteries and, to date, no study has analysed the LCA
with CT. The aim of this study is to determine the prevalence and length
of LCA based in a cohort of patient who underwent CTA. Method(s):
This retrospective study included adult patients undergoing CTA from
01/2016-08/2018. One radiologist reviewed all studies for the presence or
absence of an LCA. Two blinded, independent readers (R1/R2) then reviewed
all studies with an LCA to determine sidedness and vessel length [measured
in intercostal spaces (ICS)]. We assessed for scan indication, aortic
size, contrast quality and coronary calcification. Result(s): A total
of 389 studies were analysed and LCA was present in 42 studies (11%)
(60.3+/-16.7y, 30 male). Frequent indications for CTA were follow-up (38%)
and new symptoms (40%). Mean aortic diameters were normal
(35.1mm+/-5.7/29.9mm+/-4.3/29.5mm+/-12.5). A unilateral LCA was present in
23/42 (55%) and bilateral LCA in 19/42 (45%) patients. Median vessel
length was two ICS (IQR 0;3), maximum length was five ICS. There was no
significant difference in vessel distribution for sex (OR0.6, CI95%
0.28-1.15; p=0.11). Inter-observer agreement was excellent (kappa 0.94,
CI95% 0.82-1.0; ICC 0.96, CI95% 0.93-0.98). Conclusion(s): LCA is an
IMA side branch of potential clinical significance identifiable by CTA.
Knowledge of the LCA anatomy may help in further clarifying its
controversial role in angina after CABG. [Formula presented] Copyright
© 2020

<44>
Accession Number
2007384325
Title
Adult cardiac surgical cost variation around the world: Protocol for a
systematic review.
Source
International Journal of Surgery Protocols. 23 (pp 11-14), 2020. Date of
Publication: 2020.
Author
Vervoort D.; Guetter C.R.; Trager L.; Shah P.; Diaz-Castrillon C.E.;
Etchill E.W.; Salenger R.
Institution
(Vervoort, Guetter) Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, United States
(Trager) University of Minnesota Medical School, Minneapolis, MN, United
States
(Shah) Baroda Medical College, Vadodara, Gujarat, India
(Diaz-Castrillon) University of Pittsburgh, Pittsburgh, PA, United States
(Etchill) Department of Surgery, Johns Hopkins Hospital, Baltimore, MD,
United States
(Salenger) Division of Cardiac Surgery, Department of Surgery, University
of Maryland School of Medicine, Baltimore, MD, United States
Publisher
Elsevier Ltd
Abstract
Introduction: Globally, over one million cardiac operations occur each
year, whereas cardiac surgery is expensive and largely inaccessible
without insurance or philanthropic support. Substantial cost variation has
been reported within cardiac surgery in the United States and among
non-cardiac surgical procedures globally, but little is known on the
global procedural cost variation for common adult cardiac surgical
procedures. Objectives and significance: This review seeks to assess
variation in procedural costs of coronary artery bypass grafting (CABG),
mitral valve repair, mitral valve replacement, aortic valve repair, aortic
valve replacement, and combined CABG-mitral or CABG-aortic valve
procedures between and within countries. Results may give insights in the
scope and drivers of cost variation around the world, posing cost
reduction lessons. Results may further inform the potential of economies
of scale in reducing procedural costs, benefiting patients, hospitals,
governments, and insurers. Methods and analysis: A systematic review will
be performed using the EconLit, Embase, PubMed/MEDLINE, Web of Science,
and WHO Global Index Medicus databases to identify articles published
between January 1, 2000 and June 1, 2020. Studies describing procedural
costs for CABG, mitral valve repair, mitral valve replacement, aortic
valve repair, aortic valve replacement, and combined CABG-mitral or
CABG-aortic valve procedures will be identified. Articles describing other
types of cardiac surgery, concomitant aortic surgery, only describing
costs related to non-surgical care, or with incomplete cost data will be
excluded from the analysis. No exclusion will be based solely on article
type or language. Identified costs will be converted to 2019 USD to
account for local currency unit inflation and exchange fluctuations.
Ethics and dissemination: This study protocol has been prospectively
registered on the International Platform of Registered Systematic Review
and Meta-analysis Protocols. This review requires no institutional review
board approval. Results of this study will be summarized and disseminated
in a peer-review journal. Copyright © 2020 The Author(s)

<45>
Accession Number
2005711044
Title
Starch or Saline After Cardiac Surgery: A Double-Blinded Randomized
Controlled Trial.
Source
Canadian Journal of Kidney Health and Disease. 7 (no pagination), 2020.
Date of Publication: 2020.
Author
Nagpal A.D.; Cowan A.; Li L.; Nusca G.; Guo L.; Novick R.J.; Harle C.C.;
House A.A.; Fox S.; Jones P.M.
Institution
(Nagpal, Li, Nusca, Guo, Novick, Fox) Department of Surgery, Division of
Cardiac Surgery, Western University, London Health Sciences Centre,
London, ON, Canada
(Nagpal, Novick) Critical Care Western, Western University, London, ON,
Canada
(Cowan, House) Department of Medicine, Division of Nephrology, Western
University, London, ON, Canada
(Harle, Jones) Department of Anesthesia & Perioperative Medicine, Western
University, London, ON, Canada
(Jones) Department of Epidemiology & Biostatistics, Western University,
London, ON, Canada
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Despite decades of investigation, the balance of clinical
risks and benefits of fluid supplementation with starch remain unresolved.
Patient-centered outcomes have not been well explored in a "real-world"
trial in cardiac surgery. Objective(s): We sought to compare a
starch-based fluid strategy with a saline-based fluid strategy in the
cardiac surgery patient. Design(s): A pragmatic blinded randomized
controlled trial comparing starch-based with saline-based fluid strategy.
 Setting(s): A large tertiary academic center in London Ontario
between September 2009 and February 2011. Participant(s): Patients
undergoing planned, isolated coronary revascularization. Measurements:
Serum creatinine and patient weight were measured daily postoperatively.
 Method(s): Patients were randomized to receive 6% hydroxyethyl starch
(Voluven) or saline for perioperative fluid requirements. Fluid
administration was not protocolized. Co-primary outcomes were incidence of
acute kidney injury (AKI) and maximum postoperative weight gain. Secondary
outcomes included bleeding, transfusion, inotropic and ventilator support,
and fluid utilization. Result(s): The study was prematurely
terminated due to resource limitations. A total of 69 patients (19%
female, mean age = 65) were randomized. Using RIFLE criteria for AKI,
"risk" occurred in 12 patients in each group (risk ratio [RR] = 1.0; 95%
confidence interval [CI] = 0.5-1.9; P = 1.00), whereas "injury" occurred
in 7 of 35 (20%) and 3 of 34 (9%) of patients in the starch and saline
groups, respectively (RR = 2.3; 95% CI = 0.6-8.1; P =.31). Maximum weight
gain, bleeding and blood product usage, and overall fluid requirement were
similar between groups. Limitation(s): The study had to be
prematurely terminated due to resource limitations which led to a small
sample size which was not sufficiently powered to detect a difference in
the primary outcomes. Conclusion(s): This pragmatic double-blinded
randomized controlled trial revealed a number of interesting
hypothesis-generating trends and confirmed the feasibility of undertaking
a logistically complex trial in a pragmatic fashion. Copyright ©
The Author(s) 2020.

<46>
Accession Number
2005711035
Title
Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in
Open Heart Surgery Patients: END-AF Low Dose Trial.
Source
Journal of International Medical Research. 48 (7) (no pagination), 2020.
Date of Publication: 2020.
Author
Tabbalat R.A.; Alhaddad I.; Hammoudeh A.; Khader Y.S.; Khalaf H.A.;
Obaidat M.; Barakat J.
Institution
(Tabbalat, Khalaf, Obaidat) Abdali Clemenceau Hospital, Amman, Jordan
(Alhaddad) Jordan Hospital, Amman, Jordan
(Hammoudeh) Istishari Hospital, Amman, Jordan
(Khader) Jordan University of Science and Technology, Irbid, Jordan
(Barakat) Al Khalidi Hospital and Medical Center, Amman, Jordan
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Studies using 1 mg of colchicine to prevent postoperative
atrial fibrillation (POAF) reported conflicting results. Moreover,
colchicine was associated with significant gastrointestinal (GI) side
effects. This study examined whether low-dose colchicine effectively
prevents POAF and whether low-dose therapy is associated with lower rates
of colchicine-induced GI side effects. Method(s): In this
prospective, randomized, double-blind, placebo-controlled study,
consecutive adult patients admitted for elective cardiac surgeries
randomly received a 1-mg dose of colchicine (n = 81) or placebo (n = 71)
orally 12 to 24 hours before surgery followed by a daily dose of 0.5 mg
until hospital discharge. The primary efficacy endpoint was the
development of at least one episode of POAF of >=5 minutes. The primary
safety endpoint was the development of adverse events, especially
diarrhea. Result(s): The in-hospital mortality rate was 3.9%. POAF
occurred in 13 patients (16.1%) in the colchicine group and 13 patients
(18.3%) in the placebo group (odds ratio 0.85 [95% Confidence Interval =
0.37-1.99]). Diarrhea occurred in two patients in each group and
necessitated treatment discontinuation in one patient in each group.
 Conclusion(s): Low-dose colchicine did not prevent POAF in patients
undergoing cardiac surgery. These results should be interpreted cautiously
because of the small sample size and early study termination.
ClinicalTrials.gov Unique Identifier number: NCT03015831 Copyright
© The Author(s) 2020.

<47>
Accession Number
2004841102
Title
State-of-the-art pediatric coronary artery bypass surgery: A literature
review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 539-548), 2020.
Date of Publication: 2020.
Author
Komarov R.; Ismailbaev A.; Chragyan V.; Kadyraliev B.; Sa M.P.B.O.;
Ruhparwar A.; Weymann A.; Zhigalov K.
Institution
(Komarov, Ismailbaev) Department of Cardiovascular Surgery, I.M. Sechenov
University Hospital, First Moscow State Medical University, Moscow,
Russian Federation
(Chragyan, Kadyraliev) Department of Cardiovascular Surgery, S.G. Sukhanov
Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical
University, Perm, Russian Federation
(Sa) Department of Cardiovascular Surgery, Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, PE, Brazil
(Ruhparwar, Weymann, Zhigalov) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To examine the results of various myocardial revascularization
techniques in pediatric patients to better understand the strategies for
surgical treatment of coronary artery pathologies. Method(s): We
analyzed 61 publications dedicated to the indications, methods, and
results of coronary bypass surgery in children. Due to the small size of
this cohort, case reports are also included in our review. Result(s):
The main indications for coronary bypass grafting in children are Kawasaki
disease, myocardial revascularization as a necessary procedure during the
congenital cardiac surgery, to manage intraoperative iatrogenic damage to
coronary arteries, and homozygous familial hypercholesterolemia. The use
of internal thoracic arteries as conduits for coronary bypass grafting in
children with Kawasaki disease showed significantly better results in
long-term functionality compared to autovenous conduits (87% and 44%,
respectively, P<0.001). Acute and late coronary events after arterial
switch operation for the transposition of the great arteries, anomalous
origin of the left coronary artery from the pulmonary artery, and left
main coronary artery atresia are the main congenital heart diseases where
surgical correction involves interventions on the coronary arteries.
 Conclusion(s): The internal thoracic artery is a reliable and durable
conduit that demonstrates proven growth potential in
children. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<48>
Accession Number
2007377541
Title
Meta-analysis of Incidence, Predictors and Consequences of Clinical and
Subclinical Bioprosthetic Leaflet Thrombosis After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Sannino A.; Hahn R.T.; Leipsic J.; Mack M.J.; Grayburn P.A.
Institution
(Sannino, Grayburn) The Heart Hospital, Clinical Research Department,
Baylor Scott & White Research Institute, Plano, TX, United States
(Hahn) New York Presbyterian Hospital, New York-Presbyterian/Columbia
University Medical Center, New York, NY, United States
(Leipsic) Department of Radiology, St. Paul's Hospital, University of
British Columbia, Vancouver, Canada, Canada
(Mack, Grayburn) The Heart Hospital Baylor Plano, Plano, TX, United States
(Sannino) Department of Advance Biomedical Sciences, University Federico
II, Naples, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Leaflet thrombosis (LT) has been claimed as a potential cause of
hemodynamic dysfunction or bioprosthetic valve degeneration of
transcatheter heart valves. Sparse and contrasting evidence exists,
however, regarding LT occurrence, prevention and treatment. MEDLINE, ISI
Web of Science and SCOPUS databases were searched for studies published up
to January 2020. Only studies reporting data on incidence and outcomes
associated to the presence/absence of clinical or subclinical LT, detected
or confirmed with a multidetector computed tomography exam were included.
The study was designed according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) requirements. Two reviewers
independently screened articles for fulfillment of inclusion criteria.
Data were pooled using a random-effect model. The primary end point was
the incidence of LT. Secondary outcomes included: stroke and transient
ischemic attacks and mean transvalvular gradients at different time-points
in patients with and without LT. Of the initial 200 studies, 22 were
finally included with a total of 11,567 patients. LT overall incidence was
8% (95% Confidence Interval [CI]: 5% to 13%, I2 = 96.4%). LT
incidence in patients receiving only antiplatelets was 13% (95% CI: 7% to
23%, p <0.0001); patients discharged on oral anticoagulants had a reported
incidence of 4% (95% CI: 2% to 8%, p <0.0001). Patients with LT, either
clinical or subclinical, were not at increased risk of stroke (OR 1.06,
95% CI: 0.75 to 1.50, p = 0.730, I2 = 0.0%) or transient
ischemic attacks (Odds Ratio 1.01, 95% CI: 0.40 to 2.57, p = 0.989,
I2 = 0.0%). LT was associated with higher mean transvalvular
gradients compared with patients without LT at 30 days post-transcatheter
implantation, but not at discharge or at 1 year. LT is a relatively common
event that, even when clinically manifest, is not associated with an
increased risk of cerebrovascular events. Although patients on
anticoagulants appear to be at lower risk of LT, the available evidence
does not allow formulation of recommendations for prophylactical
anticoagulation nor routine computed tomography after transcatheter aortic
valve replacement. Copyright © 2020 Elsevier Inc.

<49>
Accession Number
2007377488
Title
Transcatheter mitral valve-in-ring implantation in the flexible adjustable
attune annuloplasty ring.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Oestreich B.; Mbai M.; Sievert K.; Schnelle N.; Carpenter L.; Sievert H.;
Soule M.; Kelly R.F.; Sharma A.; Bertog S.
Institution
(Oestreich, Mbai, Soule, Kelly, Sharma, Bertog) University of Minnesota,
Minneapolis, MN, United States
(Mbai, Soule, Kelly, Sharma, Bertog) Minneapolis Veterans Affairs Medical
Center, Minneapolis, MN, United States
(Sievert, Schnelle, Sievert, Bertog) CardioVascular Center Frankfurt,
Frankfurt, Germany
(Carpenter) Abbott, Chicago, IL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter mitral valve-in-ring implantation (TMViR) poses unique
challenges when compared to valve-in-valve implantation due to the large
variation in the different annuloplasty rings used. Annuloplasty rings are
often classified according to whether they are complete or incomplete,
rigid, semi-rigid, or flexible, and whether their three-dimensional
geometry is saddle-shaped or flat. A limited number of annuloplasty rings
are available which are adjustable allowing the surgeon to increase or
decrease the size of the ring once it has been sutured in place. To our
knowledge there has been no description of TMViR in such adjustable
complete rings and recommendations on THV sizing and implantation are not
available on the Valve-in-Valve application. Here we report a case of
TMViR in an adjustable annuloplasty ring (Attune ring, Abbott, Chicago,
IL, USA) and review the literature on TMViR. Copyright © 2020
Elsevier Inc.

<50>
Accession Number
2007156612
Title
Efficacy of tolvaptan for fluid management after cardiovascular surgery: A
systematic review and meta-analysis of randomized control trials.
Source
Experimental and Therapeutic Medicine. 20 (3) (pp 2585-2592), 2020. Date
of Publication: September 2020.
Author
Jiang W.; Li X.; Meng Z.; Chen H.; Li J.; Wang J.; Zhao X.
Institution
(Chen, Jiang, Li, Li, Wang, Zhao) Department of Cardiology, Third Xiangya
Hospital of Central South University, 138 Tongzipo Road, Changsha, Hunan
410013, China
(Meng, Chen) Department of Cardiology, First Affiliated Hospital of
Kunming Medical University, Kunming, Yunnan 660034, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
The purpose of this study was to systematically search the literature and
analyze evidence from randomized controlled trials (RCTs) comparing
tolvaptan with conventional diuretics for postoperative fluid management
in cardiac surgery patients. An electronic search of PubMed, Scopus,
BioMed Central, CENTRAL (Cochrane Central Register of Controlled Trials)
and Google scholar databases was carried out up to 1st December 2019. Four
RCTs were included. Tolvaptan was co-administered with conventional
diuretics in all the studies. The mean postoperative urine output was
significantly greater in patients receiving tolvaptan as compared to
controls (MD=0.39; 95% CI: 0.17 to 0.61; P=0.006, I2=48%). Body
weight of patients on tolvaptan returned to pre-operative levels
significantly earlier (MD=-1.57; 95% CI: -2.48 to -0.66; P=0.007,
I2=50%). There was statistical significant difference in the
highest postoperative serum sodium levels (MD=2.34; 95% CI: -1.65 to 3.03;
p < 0.00001, I2=0%), lowest serum sodium levels (MD=2.05; 95%
CI: 1.41 to 2.68; p<0.00001, I2=0%) and mean serum sodium
levels (MD=1.69; 95% CI: 0.98 to 2.40; p<0.00001, I2=0%)
between the tolvaptan and control groups. Lowest serum potassium was
significantly higher with tolvaptan as compared to the control group
(MD=0.10; 95% CI: 0.01 to 0.18; P=0.03, I2=19%). There was no
significant difference in the length of ICU stay or incidence of
arrhythmias between the two groups. The quality of the included studies
was not high. Within the limitations of our study, our results indicate
that co-administration of tolvaptan with low dose of conventional
diuretics significantly increases urine output while maintaining
electrolyte balance in postoperative cardiac surgery patients. Faster
return of body weight to pre-operative levels is evident with tolvaptan.
Further high-quality RCTs are required to confirm this
evidence. Copyright © 2020 Spandidos Publications. All rights
reserved.

<51>
Accession Number
2006790386
Title
Persistent pain in intensive care survivors: a systematic review.
Source
British Journal of Anaesthesia. 125 (2) (pp 149-158), 2020. Date of
Publication: August 2020.
Author
Makinen O.J.; Backlund M.E.; Liisanantti J.; Peltomaa M.; Karlsson S.;
Kalliomaki M.-L.
Institution
(Makinen) Faculty of Medicine and Life Sciences, Tampere University,
Tampere, Finland
(Backlund) Department of Intensive Care, Helsinki University Hospital,
Helsinki, Finland
(Liisanantti) Oulu University Hospital, Oulu, Finland
(Peltomaa, Karlsson) Department of Intensive Care, Tampere University
Hospital, Tampere, Finland
(Kalliomaki) Department of Anaesthesiology, Tampere University Hospital,
Tampere, Finland
Publisher
Elsevier Ltd
Abstract
Background: According to earlier studies where the main aim has been
quality of life, there is growing evidence of increased levels of
persistent pain in survivors of critical illness. The cause of admission
and several factors during intensive care may have associated risk factors
for pain persistence. This systematic review aims to determine the
incidence or prevalence of persistent pain after critical illness and to
identify risk factors for it. Method(s): Six databases were searched,
and eventually nine studies were included in the final systematic process.
The validity of observational and cross-sectional studies was analysed
using the National Institute of Health 'Quality Assessment Tool for
Observational Cohort and Cross-Sectional Studies'. Result(s): The
incidence of persistent pain after intensive care varied from 28% to 77%.
Risk factors for persistent pain were acute pain at discharge from ICU,
higher thoracic trauma score, surgery, pre-existing pain, organ failure,
longer length of ventilator or hospital stay, and sepsis. No difference in
incidence between medical and surgical patients was found.
 Conclusion(s): New systematic, observational studies are warranted to
identify persistent pain-related factors in intensive care to improve pain
management protocols and thereby diminish the risk of persistent pain
after ICU stay. Copyright © 2020 British Journal of Anaesthesia

<52>
Accession Number
2005898701
Title
Endovascular Contact Aspiration versus Stent Retriever for
Revascularization in Patients with Acute Ischemic Stroke and Large Vessel
Occlusion: A Cost-Minimization Analysis.
Source
World Neurosurgery. 139 (pp e23-e31), 2020. Date of Publication: July
2020.
Author
Malhotra A.; Boltyenkov A.; Wu X.; Matouk C.C.; Forman H.P.; Gandhi D.;
Sanelli P.
Institution
(Malhotra, Wu, Matouk, Forman) Department of Radiology and Biomedical
Imaging, Yale School of Medicine, New Haven, CT, United States
(Matouk) Department of Neurosurgery, Yale School of Medicine, New Haven,
CT, United States
(Forman) Department of Economics, Yale School of Medicine, New Haven, CT,
United States
(Forman) Department of Management, Yale School of Medicine, New Haven, CT,
United States
(Forman) Department of Public Health, Yale School of Medicine, New Haven,
CT, United States
(Boltyenkov) Health Economics Modelling, Siemens Healthineers, Manhasset,
NY, United States
(Gandhi) Radiology, Neurology and Neurosurgery, University of Maryland
School of Medicine, Baltimore, MD, United States
(Sanelli) Department of Radiology, The Imaging Clinical Effectiveness and
Outcomes Research, Northwell Health, Manhasset, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Two main techniques for endovascular treatment of patients
with acute ischemic stroke are direct aspiration and stent retriever
thrombectomy. We hypothesized that the direct aspiration approach would be
less costly than the stent retriever approach. Method(s): We
constructed a decision tree based on the 2 approaches for endovascular
treatment. Branch point probabilities were obtained from the best
available, recently published literature. Costs were based on the list
prices of medical devices from vendors. From this, we obtained a base-case
analysis and conducted sensitivity analysis. Result(s): Our base-case
analysis revealed that the incremental cost per patient for endovascular
treatment was $5937 for direct aspiration-first pass technique and $9914
for stent retriever first pass technique. The cost difference per patient
treated was $3977. To drive the stent retriever first pass therapy to be
the less costly option, the cost of stent retriever first pass technique
has to go down more than 50%. Stent retriever first pass carries lower
cost when the success rate of first-line aspiration is lower than 14.6%,
which is highly improbable. Two-way sensitivity analysis revealed
scenarios in which stent retriever first pass approach would be less
costly than the direct aspiration-first pass approach; however, conditions
required for these scenarios are rarely encountered in clinical practice.
 Conclusion(s): Costs of endovascular treatment using a direct
aspiration-first pass approach are less than with a stent retriever first
pass approach. Copyright © 2020 Elsevier Inc.

<53>
Accession Number
2005098681
Title
Heparin Dose and Point-of-Care Measurements of Hemostasis in Cardiac
Surgery-Results of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (9) (pp 2362-2368),
2020. Date of Publication: September 2020.
Author
Lax M.; Pesonen E.; Hiippala S.; Schramko A.; Lassila R.; Raivio P.
Institution
(Lax, Pesonen, Hiippala, Schramko) Division of Anesthesiology, Department
of Anesthesiology, Intensive Care and Pain Medicine, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Lassila) Coagulation Disorders Unit, Laboratory Services, Department of
Hematology and Comprehensive Cancer Center, Helsinki University Hospital,
Helsinki, Finland
(Raivio) Department of Cardiac Surgery, Heart, and Lung Center, University
of Helsinki and Helsinki University Hospital, Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objective: High heparin doses during cardiopulmonary bypass (CPB) have
been suggested to reduce thrombin activation and consumption coagulopathy
and consequently bleeding complications. The authors investigated the
effect of a high heparin dose during CPB on point-of-care measurements of
coagulation. The authors hypothesized that during CPB a high heparin dose
compared with a lower heparin dose would reduce thrombin generation and
platelet activation and tested whether this would be reflected in the
results of rotational thromboelastometry (TEM) and platelet aggregation,
measured with multiple electrode aggregometry (MEA). Design(s):
Prospective, randomized, controlled, open single-center study.
 Setting(s): University teaching hospital. Participant(s):
Sixty-three consecutive patients undergoing elective coronary artery
bypass grafting with CPB were enrolled. Intervention(s): Patients
were randomly assigned to receive either a high (600 IU/kg, n = 32) or a
low (300 IU/kg, n = 31) initial dose of heparin. Target levels of
activated clotting time during CPB were >600 seconds in the high heparin
dose group and >400 seconds in the low heparin dose group.
 Measurements and Main Results: Blood samples were collected (1)
preoperatively after induction of anesthesia, (2) 10 minutes after aortic
declamping, (3) 30 minutes after protamine administration, and (4) 3 hours
after protamine administration. TEM and MEA were then measured. There was
no difference in blood loss up to 18 hours postoperatively (median 735 mL
for high dose v 610 mL for low dose; p < 0.056) or transfusions between
the groups. Total median heparin dose (54,300 IU v 27,000 IU; p = 0.001)
and median antifactor Xa levels during CPB (9.38 U/mL v 5.04 U/mL; p =
0.001) were greater in the high than in the low heparin dose group.
However, neither TEM nor MEA results differed significantly between the
groups. Conclusion(s): Compared with a lower dose of heparin during
CPB, a high dose of heparin had little effect on the point-of-care
measurements of hemostasis, TEM, and MEA. Based on the similarity of
platelet and coagulation activity assessments, the higher heparin dose
does not appear to offer benefit during CPB. Copyright © 2020
Elsevier Inc.

<54>
Accession Number
2005091991
Title
Anastomotic techniques for oesophagectomy for malignancy: systematic
review and network meta-analysis.
Source
BJS Open. 4 (4) (pp 563-576), 2020. Date of Publication: 01 Aug 2020.
Author
Kamarajah S.K.; Bundred J.R.; Singh P.; Pasquali S.; Griffiths E.A.
Institution
(Kamarajah) Department of Hepatobiliary, Pancreatic and Transplant
Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation
Trust, Newcastle upon Tyne, United Kingdom
(Kamarajah) Institute of Cellular Medicine, University of Newcastle,
Newcastle upon Tyne, United Kingdom
(Bundred) College of Medical and Dental Sciences, Birmingham, United
Kingdom
(Griffiths) Institute of Cancer and Genomic Sciences, College of Medical
and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
(Bundred, Singh, Griffiths) Department of Upper Gastrointestinal Surgery,
University Hospitals Birmingham NHS Foundation Trust, Birmingham, United
Kingdom
(Singh) Regional Oesophago-Gastric Unit, Royal Surrey NHS Foundation
Trust, Guildford, United Kingdom
(Pasquali) Department of Surgery, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Current evidence on the benefits of different anastomotic
techniques (hand-sewn (HS), circular stapled (CS), triangulating stapled
(TS) or linear stapled/semimechanical (LSSM) techniques) after
oesophagectomy is conflicting. The aim of this study was to evaluate the
evidence for the techniques for oesophagogastric anastomosis and their
impact on perioperative outcomes. Method(s): This was a systematic
review and network meta-analysis. PubMed, EMBASE and Cochrane Library
databases were searched systematically for randomized and non-randomized
studies reporting techniques for the oesophagogastric anastomosis. Network
meta-analysis of postoperative anastomotic leaks and strictures was
performed. Result(s): Of 4192 articles screened, 15 randomized and 22
non-randomized studies comprising 8618 patients were included. LSSM (odds
ratio (OR) 0.50, 95 per cent c.i. 0.33 to 0.74; P = 0.001) and CS (OR
0.68, 0.48 to 0.95; P = 0.027) anastomoses were associated with lower
anastomotic leak rates than HS anastomoses. LSSM anastomoses were
associated with lower stricture rates than HS anastomoses (OR 0.32, 0.19
to 0.54; P < 0.001). Conclusion(s): LSSM anastomoses after
oesophagectomy are superior with regard to anastomotic leak and stricture
rates. Copyright © 2020 The Authors. BJS Open published by John
Wiley & Sons Ltd on behalf of British Journal of Surgery Society

<55>
Accession Number
2004751247
Title
A review on cardiorenal syndrome.
Source
Journal of the Indian Medical Association. 118 (4) (pp 9-13), 2020. Date
of Publication: April 2020.
Author
Arulrhaj S.; Princy John P.
Institution
(Arulrhaj, Princy John) Sundaram Arulrhaj Hospitals, Tuticorin, India
Publisher
Indian Medical Association
Abstract
Cardio-renal syndrome is a blanket term which is used to denote clinical
conditions where there is coexistence of cardiac & renal deteriorations.
Considering the multitude of articles written about this topic, still the
underlying pathophysiological mechanisms continue to be puzzled and
implications for management continue to be debated. A classification for
CRS has been proposed in 2008 which is being used in clinical practice.
There is also need for cardio-renal interdisciplinary team for early
identification of decompensated cardio-renal syndrome and their
appropriate management. Here we review the epidemiology, classification of
CRS, the pathological mechanisms proposed & then focus on management
strategies. In this review article, we try to summarize the results from
MEDLINE, PubMed, Cochrane Library, Google and Google Scholar search (last
article updated till 2019) on the current understanding Cardio-renal
syndrome. Copyright © 2020, Indian Medical Association. All
rights reserved.

<56>
Accession Number
2004604073
Title
Efficacy of home versus centre-based cardiac rehabilitatioin improving
functional capacity and left ventricular ejection fraction in coronary
artery bypass graft (Cabg) patients.
Source
Indian Journal of Public Health Research and Development. 11 (5) (pp
165-171), 2020. Date of Publication: May 2020.
Author
Mujeeb K.F.M.; Kazi A.
Institution
(Mujeeb, Kazi) Department of Cardiovascular and Respiratory Physiotherapy,
Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences
(Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra 442001,
India
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India)
Abstract
Background: Coronary Artery Bypass Grafting (CABG) surgery is the most
commonly performed surgery for the coronary artery disease patients.
Cardiac Rehabilitation (CR) is an essential, useful and safe part of the
care for patients with coronary artery disease and who underwent CABG
surgery. Regular physical activity can improve functional capacity in
patients after CABG. Objective(s): To determine the efficacy of home
and centre-based cardiac rehabilitation in improving functional capacity
and left ventricular ejection fraction (LVEF) in patients underwent CABG
surgery. Material(s) and Method(s): Total twenty four (n=24) CABG
surgery participants were selected. They were divided into 2 groups by
utilizing convenient (purposive) sampling method. Group 'A' i.e.
centre-based (n=12, mean age: 53.83+/-7.61) and Group 'B' i.e. home-based
(n=12, mean age: 55.91+/-5.79). Both the groups received an eight (8)
weeks of CR program. Group-A participants attended a supervised structured
exercise training program for 3 days per week in hospital set-up. Group-B
participants were given an individualized tailored program of aerobic
exercises to do at home. All the participants were screened and evaluated
for baseline measurements and all the values were recorded at the day of
discharge from hospital. After 8 weeks of CR program participants were
re-assessed for LVEF and functional capacity. Result(s): Statistical
analysis was done by using SPSS 22.0. After an eight week of CR program,
significant improvements were observed in 6-MW distance, LVEF and Rate of
Perceived Exertion (RPE) (p=0.0001). Conclusion(s): The home-based
and centre-based cardiac rehabilitation programs were equally effective in
improving functional capacity and left ventricular ejection fraction in
CABG patients. Copyright © 2020, Indian Journal of Public Health
Research and Development. All rights reserved.

<57>
Accession Number
2003570830
Title
Low-Risk Transcatheter Versus Surgical Aortic Valve Replacement - An
Updated Meta-Analysis of Randomized Controlled Trials.
Source
Cardiovascular Revascularization Medicine. 21 (4) (pp 441-452), 2020. Date
of Publication: April 2020.
Author
Anantha-Narayanan M.; Kandasamy V.V.; Reddy Y.N.; Megaly M.; Baskaran J.;
Pershad A.; Suri R.M.; Garcia S.
Institution
(Anantha-Narayanan) University of Minnesota Medical Center, United States
(Kandasamy) University of Louisville Medical Center, United States
(Reddy) Mayo Clinic, United States
(Megaly, Garcia) Minneapolis Heart Institute, United States
(Baskaran) CHI Health Creighton University Medical Center, United States
(Pershad) University of Arizona, Banner, United States
(Suri) Cleveland Clinic, Abu Dhabi, United Arab Emirates
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: To perform a meta-analysis including all available randomized
controlled trials (RCTs) to date comparing transcatheter aortic valve
replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients
with severe aortic stenosis (AS) and low surgical risk.
 Background(s): Current guidelines recommend SAVR for patients with
severe symptomatic AS and low surgical risk. A few RCTs have evaluated
TAVR in low surgical risk patients but equipoise exists related to TAVR
valve durability, paravalvular leak (PVL) and role of TAVR in younger, low
surgical risk patients. Method(s): Five databases were analyzed from
January-2000 to March-2019 for RCTs comparing SAVR to TAVR in low-risk
severe AS patients. Result(s): Four RCTs on low-risk TAVR patients
with 2887 patients were included. Mean follow-up was ~24.1 +/- 24 months.
Early mortality was lower with TAVR compared to SAVR (RR: 0.44, 95% CI:
0.20-0.95, P = 0.038) whereas long-term mortality was similar (RR: 0.67,
95% CI: 0.39-1.14, P = 0.141). Both early and long-term stroke rates were
similar. TAVR was associated with lower risk of atrial fibrillation, major
bleeding, acute kidney injury (AKI) and rehospitalization, but higher
rates of permanent pacemaker implantation (PPM) and moderate or severe
PVL. There was no difference in major vascular complications, myocardial
infarction, endocarditis, aortic valve gradients and valve area at
follow-up. Conclusion(s): In low-risk patients with severe AS, TAVR
has a lower early mortality compared to SAVR with no difference in
long-term mortality. Although complication rates varied between TAVR and
SAVR, our study findings suggest that transfemoral-TAVR is an appropriate
treatment option for severe symptomatic AS in patients with low surgical
risk. Copyright © 2019 Elsevier Inc.

<58>
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).

<59>
Accession Number
2007327871
Title
Impact of advanced clinical fellowship training on future research
productivity and career advancement in adult cardiac surgery.
Source
Surgery (United States). (no pagination), 2020. Date of Publication: 2020.
Author
Wang H.; Bajaj S.S.; Williams K.M.; Pickering J.M.; Heiler J.C.;
Manjunatha K.; O'Donnell C.T.; Sanchez M.; Boyd J.H.
Institution
(Wang, Bajaj, Williams, Pickering, Heiler, Manjunatha, O'Donnell, Sanchez,
Boyd) Department of Cardiothoracic Surgery, Stanford University, Stanford,
CA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Advanced clinical fellowships are important for training
surgeons with a niche expertise. Whether this additional training impacts
future academic achievement, however, remains unknown. Here, we
investigated the impact of advanced fellowship training on research
productivity and career advancement among active, academic cardiac
surgeons. We hypothesized that advanced fellowships do not significantly
boost future academic achievement. Method(s): Using online sources
(eg, department webpages, CTSNet, Scopus, Grantome), we studied adult
cardiac surgeons who are current faculty at accredited United States
cardiothoracic surgery training programs, and who have practiced only at
United States academic centers since 1986 (n = 227). Publicly available
data regarding career advancement, research productivity, and grant
funding were collected. Data are expressed as counts or medians.
 Result(s): In our study, 78 (34.4%) surgeons completed an advanced
clinical fellowship, and 149 (65.6%) did not. Surgeons who pursued an
advanced fellowship spent more time focused on surgical training (P
<.0001), and those who did not were more likely to have completed a
dedicated research fellowship (P =.0482). Both groups exhibited similar
cumulative total publications (P =.6862), H-index (P =.6232), frequency of
National Institutes of Health grant funding (P =.8708), and time to
achieve full professor rank (P =.7099). After stratification by current
academic rank, or by whether surgeons pursued a dedicated research
fellowship, completion of an advanced clinical fellowship was not
associated with increased research productivity or accelerated career
advancement. Conclusion(s): Academic adult cardiac surgeons who
pursue advanced clinical fellowships exhibit similar research productivity
and similar career advancement as those who do not pursue additional
clinical training. Copyright © 2020 Elsevier Inc.

<60>
Accession Number
2007305878
Title
Rationale and design of a prospective, randomized, controlled, multicenter
study to evaluate the safety and efficacy of transcatheter heart valve
replacement in female patients with severe symptomatic aortic stenosis
requiring aortic valve intervention (Randomized researcH in womEn all
comers wIth Aortic stenosis [RHEIA] trial).
Source
American Heart Journal. 228 (pp 27-35), 2020. Date of Publication: October
2020.
Author
Eltchaninoff H.; Bonaros N.; Prendergast B.; Nietlispach F.; Vasa-Nicotera
M.; Chieffo A.; Pibarot P.; Bramlage P.; Sykorova L.; Kurucova J.; Bax
J.J.; Windecker S.; Dumonteil N.; Tchetche D.
Institution
(Eltchaninoff) Department of Cardiology, Rouen University Hospital, FHU
REMOD-VHF, Rouen, France
(Bonaros) Department of Cardiac Surgery, Medical University of Innsbruck,
Innsbruck, Austria
(Prendergast) St. Thomas' Hospital, London, United Kingdom
(Nietlispach) CardioVascularCenter, Hirslanden Klinik Im Park, Zurich,
Switzerland
(Vasa-Nicotera) University Heart Center Frankfurt, Frankfurt, Germany
(Chieffo) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Pibarot) Department of Cardiology, Quebec Heart & Lung Institute, Laval
University, Quebec City, QC, Canada
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Cloppenburg, Germany
(Sykorova, Kurucova) Edwards Lifesciences, Prague, Czechia
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Dumonteil, Tchetche) Groupe Cardiovasculaire Interventionnel, clinique
Pasteur Toulouse, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Limited data suggest that transcatheter (TAVR) as compared
with surgical aortic valve replacement (SAVR) may be more effective in
female than male patients. To date, most evidence is derived from subgroup
analyses of large trials, and a dedicated randomized trial evaluating
whether there is a difference in outcomes between these interventions in
women is warranted. The RHEIA trial will compare the safety and efficacy
of TAVR with SAVR in women with severe symptomatic aortic stenosis
requiring aortic valve intervention, irrespective of surgical risk.
Methods/Design: The RHEIA trial is a prospective, randomized, controlled
study that will enroll up to 440 patients across 35 sites in Europe. Women
with severe symptomatic aortic stenosis, with any but prohibitive surgical
risk status, will be randomized 1:1 to undergo aortic valve intervention
with either transfemoral TAVR with the SAPIEN 3 or SAPIEN 3 Ultra device
or SAVR and followed up for 1 year. The objective is to determine whether
TAVR is non-inferior to SAVR in this patient population and, if this is
fulfilled whether TAVR is actually superior to SAVR. The primary
safety/efficacy endpoint is a composite of all-cause mortality, all
stroke, and re-hospitalization (for valve or procedure-related symptoms or
worsening congestive heart failure) at 1 year post-procedure. Other
outcomes (assessed at 30 days and/or 1 year) include all-cause mortality;
bleeding, vascular, cardiac, cerebrovascular and renal complications;
aortic valve prosthesis and left ventricular function; cognitive function,
health status, and quality of life. Discussion(s): The RHEIA study
has been designed to evaluate the safety and efficacy of TAVR compared
with SAVR specifically in women with severe symptomatic aortic stenosis,
irrespective of the level of surgical risk. The results will be the first
to provide specific randomized evidence to guide treatment selection in
female patients with severe symptomatic aortic stenosis. Trial
registration: clinicaltrials.gov: NCT04160130 Copyright © 2020
Elsevier Inc.

<61>
Accession Number
2007303760
Title
Smartphone-based application to improve medication adherence in patients
after surgical coronary revascularization.
Source
American Heart Journal. 228 (pp 17-26), 2020. Date of Publication: October
2020.
Author
Yu C.; Liu C.; Du J.; Liu H.; Zhang H.; Zhao Y.; Yang L.; Li X.; Li J.;
Wang J.; Wang H.; Liu Z.; Rao C.; Zheng Z.
Institution
(Yu, Liu, Du, Liu, Zhang, Zhao, Li, Li, Rao, Zheng) National Clinical
Research Center of Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Liu, Zhang, Yang, Li, Rao, Zheng) Department of Cardiovascular Surgery,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
(Wang) Department of Thoracic and Cardiovascular Surgery, The First
Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang,
China
(Wang) General Hospital of Shenyang Military Region, Shenyang, Liaoning,
China
(Liu) Department of Cardiovascular Surgery, TEDA International
Cardiovascular Hospital, Peking Union Medical College and Chinese Academy
of Medical Science, Tianjin, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Secondary preventive therapies play a key role in the
prevention of adverse events after coronary artery bypass grafting (CABG).
However, adherence to secondary preventive drugs after CABG is often poor.
With the increasing penetration of smartphones, health-related smartphone
applications might provide an opportunity to improve medication adherence.
We aimed to evaluate the effectiveness and feasibility of using a
smartphone-based application to improve medication adherence in patients
after CABG. Method(s): The Measurement and Improvement Studies of
Surgical coronary revascularizatION: medication adherence (MISSION-2)
study is a multicenter randomized controlled trial that planned to enroll
over 1000 patients who underwent isolated CABG at one of four large
teaching hospitals in China; all enrolled participants had access to a
smartphone and were able to operate at least three smartphone
applications. The investigators randomly assigned the participants to one
of two groups: (1) the intervention group with an advanced smartphone
application for 6 months which was designed specifically for this trial
and did not exist before. Participants could receive medication reminders
and cardiac health education by the smartphone application or (2) the
control group with usual care. The primary outcome was CABG secondary
preventive medication adherence as measured by the translated Chinese
version of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 6
months after randomization. The secondary outcomes were mortality, major
adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular
rehospitalization, self-reported secondary preventive medication use after
6 months of follow-up, blood pressure (BP), body mass index (BMI), and
self-reported smoking status. All analyses were conducted using the
intention-to-treat principle. Result(s): A total of 1000 patients
(mean age, 57.28 [SD, 9.09] years; 85.5% male) with coronary heart disease
after CABG were enrolled between September 2015 and September 2016 and
were randomly assigned to the intervention (n = 501) or control group (n =
499). At 6 months, the proportion of low-adherence participants,
categorized by MMAS-8 scores, was 11.8% in the intervention group and
11.7% in the control group (RR = 1.005, 95% CI 0.682 to 1.480, P = 1.000).
Similar results were found in sensitivity analyses that considered
participants who withdrew from the study, or were lost to follow-up as
nonadherent. There were no significant differences in the secondary
clinical outcome measures, and there were no significant differences in
the primary outcome across the subgroups tested. In the intervention
group, the proportion of participants who used and operated the
application during the first month after CABG was 88.1%; however, the use
rate decreased sharply from 42.5% in the second month to 9.2% by the end
of the study (6 months). Conclusion(s): A smartphone-based
application supporting secondary prevention among patients after CABG did
not lead to a greater adherence to secondary preventive medications. The
limited room for improvement in medication adherence and the low
participants' engagement with the smartphone applications might account
for these non-significant outcomes. Copyright © 2020 Elsevier
Inc.

<62>
Accession Number
2002063597
Title
Clinical Outcomes of Sentinel Cerebral Protection System Use During
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 21 (6) (pp 717-722), 2020. Date
of Publication: June 2020.
Author
Ndunda P.M.; Vindhyal M.R.; Muutu T.M.; Fanari Z.
Institution
(Ndunda, Vindhyal, Muutu, Fanari) Internal Medicine, University of Kansas
School of Medicine - Wichita, 1010 N Kansas Street, Wichita, KS 67214,
United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine - Wichita, 551 N. Hillside, Suite 520, Wichita, KS
67214, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To compare the clinical outcomes following transcatheter aortic
valve replacement (TAVR) with and without the use of the Sentinel Cerebral
Protection System (Sentinel CPS). Background(s): Stroke occurs in
2-5% of patients at 30 days after TAVR and increases mortality >3 fold.
The Sentinel CPS is the only FDA (Food and Drug Administration) approved
cerebral embolic protection device. Method(s): The Cochrane Library,
PubMed and Web of Science were searched for relevant studies for inclusion
in the meta-analysis. Two authors independently screened and included
studies comparing the clinical outcomes after TAVR with and without the
Sentinel CPS. Risk of bias was assessed using the Cochrane tools (RoB2.0
and ROBINS-I). Result(s): Four studies comparing 606 patients
undergoing TAVR with Sentinel CPS to 724 without any embolic protection
device were included. Sentinel CPS use was associated with lower rates of
30-day mortality [0.8% vs 2.7%; RR 0.34 (95% CI 0.12, 0.92) I2
= 0%], 30-day symptomatic stroke [3.5% vs 6.1%; RR 0.51 (95% CI 0.29,
0.90) I2 = 0] and major or life-threatening bleeding [3.3% vs
6.6%; RR 0.50 (0.26, 0.98) I2 = 16%]. There was no significant
difference between the two arms in the incidence of acute kidney injury
[0.8% vs 1%; RR 0.85 (95% CI 0.22, 3.24) I2 = 0%] and major
vascular complications [5.1% vs 6%; RR 0.74 (0.33, 1.67) I2 =
45%]. Conclusion(s): The results suggest that Sentinel CPS use in
TAVR is associated with a lower risk of stroke, mortality and major or
life-threatening bleeding at 30 days. Copyright © 2019 Elsevier
Inc.

<63>
Accession Number
2007031167
Title
Meta-Analysis Comparing Multiple Arterial Grafts Versus Single Arterial
Graft for Coronary-Artery Bypass Grafting.
Source
American Journal of Cardiology. 130 (pp 46-55), 2020. Date of Publication:
1 September 2020.
Author
Changal K.; Masroor S.; Elzanaty A.; Patel M.; Mir T.; Khan S.; Nazir S.;
Soni R.; Oostra C.; Khuder S.; Eltahawy E.
Institution
(Changal, Nazir, Soni, Oostra) Cardiovascular Medicine, University of
Toledo Health Sciences, OH, United States
(Masroor) Cardiothoracic Surgery, University of Toledo Health Sciences,
OH, United States
(Elzanaty, Patel) Department of Medicine, University of Toledo Health
Sciences, OH, United States
(Mir) Department of Medicine, Wayne State University Detroit, MI, United
States
(Khan) Department of Medicine, St. Vincent's Hospital, Toledo, OH, United
States
(Khuder) University of Toledo Health Sciences, OH, United States
(Eltahawy) Cardiovascular Medicine, University of Toledo Health Sciences,
OH, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Observational studies and randomized controlled trials (RCTs) have shown
conflicting outcomes for multiple arterial graft (MAG) coronary artery
bypass graft surgery compared with single arterial grafts (SAGs). The
predominant evidence supporting the use of MAGs is observational. The aim
of this meta-analysis of RCTs is to compare outcomes following MAG and
SAG. We searched multiple databases for RCTs comparing MAG versus SAG. The
clinical outcomes studied were all-cause mortality, cardiac mortality,
myocardial infarction (MI), revascularization, stroke, sternal wound
complications, and major bleeding. We used hazard ratio (HR), relative
risk (RR), and corresponding 95% confidence interval (CI) for measuring
outcomes. Ten RCTs (6392 patients) were included. The average follow-up in
the studies was 4.2 years. The average age of the patients in the studies
ranged from 56.3 years to 74.6. No significant difference was seen between
MAG and SAG groups for all-cause mortality (11.8% vs 12.7%, HR 0.94, 95%
CI 0.81 to 1.09, p 0.36), cardiac mortality (4.1% vs 4.5%, HR 0.96 95% CI
0.74 to 1.26, p 0.77), MI (3.5% vs 5.1%, HR 0.87 95% CI 0.67 to 1.12, p
0.28), and major bleeding (3.3% vs 4.9%, RR 0.85 95% CI 0.64 to 1.13, p
0.26). Repeat revascularization in MAG showed a lower RR than SAG when one
of the confounding studies was excluded (RR 0.63, 95% CI 0.4 to 0.99, p
0.04). The incidence of stroke was lower in MAG than SAG (2.9% vs 3.9%, RR
0.74 95% CI 0.56 to 0.98, p 0.03). MAG had higher incidence of sternal
wound complications than SAG (2.9% vs 1.7%, RR 1.75 95% CI 1.19 to 2.55, p
0.004). In conclusion, MAG does not have a survival advantage compared
with SAG but is better in revascularization and risk of stroke. This
benefit may be set off by a higher incidence of sternal wound
complications in MAG. Copyright © 2020 Elsevier Inc.

<64>
Accession Number
2005883997
Title
Postcardiac Surgery Acute Stroke Therapies: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (9) (pp 2349-2354),
2020. Date of Publication: September 2020.
Author
Kashani H.H.; Mosienko L.; Grocott B.B.; Glezerson B.A.; Grocott H.P.
Institution
(Kashani, Mosienko, Grocott, Grocott) Department of Anesthesiology,
Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB,
Canada
(Glezerson) Department of Anesthesiology and Pain Medicine, University of
Ottawa, Ottawa, ON, Canada
Publisher
W.B. Saunders
Abstract
Objective: To identify interventions for the treatment of acute ischemic
stroke after cardiac surgery and to report the efficacy of these
treatments. Design(s): Systematic review and narrative synthesis
Participants: Patients with ischemic stroke after cardiac surgery.
 Intervention(s): Treatment efficacy of intra-arterial thrombolysis
(IAT) and/or endovascular mechanical thrombectomy (EMT). Methods and Main
Results: The MEDLINE (Ovid), Embase (Ovid), Scopus (Elsevier), and
Cochrane Central Register of Controlled Trials (Wiley) databases were
searched from January 1, 1990, until September 20, 2018. After reviewing
5,231 records, 8 case reports/series and 2 retrospective studies were
included (n = 33). Three of these reports (n = 19) published between 2001
and 2003 described IAT, and 6 studies (n = 14) published between 2015 and
2019 reported the use of EMT. In the 19 patients who received IAT, 3 (16%)
had good, 8 (42%) had moderate, and 8 (42%) had poor neurologic outcomes.
In the 14 patients who received EMT, 7 (50%) had good, 5 (36%) had
moderate, and 2 (14%) had poor neurologic outcomes. Conclusion(s):
Endovascular thrombectomy, with or without IAT, is being used increasingly
with success in patients presenting with postcardiac surgery stroke.
However, the number of patients reported is too small to confidently
understand its overall effect on neurologic outcomes in this
setting. Copyright © 2020 Elsevier Inc.

<65>
Accession Number
2005755017
Title
Effect of Desmopressin on Platelet Dysfunction During Antiplatelet
Therapy: A Systematic Review.
Source
Neurocritical Care. (no pagination), 2020. Date of Publication: 2020.
Author
Andersen L.K.; Hvas A.-M.; Hvas C.L.
Institution
(Andersen, Hvas) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
(Hvas) Department of Anaesthesiology and Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
Publisher
Springer
Abstract
Background and Objective: An increasing number of patients receive
antiplatelet therapy. Patients exposed to surgery while receiving platelet
inhibitors hold an increased bleeding risk. Especially in neurosurgery and
neurocritical care patients, bleeding and hematoma expansion are feared
complications as even minor bleedings may be hazardous. The objective of
this systematic review was to investigate the effect of desmopressin
(1-deamino-8-d-arginine vasopressin, DDAVP) on platelet function during
antiplatelet therapy in patients undergoing non-cardiac surgery, patients
who experience spontaneous or traumatic hemorrhage, healthy individuals
and in animals. Method(s): Studies were identified through a
systematic literature search in PubMed and EMBASE on August 19, 2019, with
an update on May 2, 2020, and from reference lists of the included
studies. Data on clinical and biochemical effect of DDAVP were extracted
from included studies for a qualitative data synthesis. Result(s): In
total, 22 studies were included: 18 human studies and four animal studies.
Overall, DDAVP improved bleeding time and increased platelet aggregation
in patients undergoing non-cardiac surgery, patients suffering
intracerebral or subarachnoid hemorrhage while receiving antiplatelet
therapy as well as in healthy individuals and animals exposed to
antiplatelet therapy. Observational data indicate that DDAVP may mitigate
hematoma expansion in patients with intracerebral hemorrhage or traumatic
brain injury. Conclusion(s): The present data hold biochemical
evidence that DDAVP improves platelet function during antiplatelet therapy
in humans and animals. The need for randomized trials is evident in order
to evaluate the potential clinical effect of DDAVP in management of
patients with spontaneous or traumatic hemorrhage, or undergoing
neurosurgery, while receiving antiplatelet therapy. Copyright ©
2020, Springer Science+Business Media, LLC, part of Springer Nature and
Neurocritical Care Society.

<66>
Accession Number
2005422128
Title
A prospective multicenter study of direct comparison of feasibility and
safety of pulmonary vein isolation using the minimally interrupted
apixaban between second-generation cryoballoon and radiofrequency ablation
of paroxysmal atrial fibrillation: J-HIT apixaban.
Source
Journal of Arrhythmia. 36 (4) (pp 617-623), 2020. Date of Publication: 01
Aug 2020.
Author
Yagishita A.; Goya M.; Iesaka Y.; Nitta J.; Takahashi A.; Nagata Y.;
Hachiya H.; Inaba O.; Inamura Y.; Tanaka Y.; Watanabe K.; Tao S.; Shirai
Y.; Yamamoto T.; Shiohira S.; Akiyoshi K.; Sekigawa M.; Maeda S.; Sasaki
T.; Takahashi Y.; Kawabata M.; Hirao K.
Institution
(Yagishita, Goya, Tao, Shirai, Yamamoto, Shiohira, Akiyoshi, Sekigawa,
Sasaki, Kawabata, Hirao) Department of Cardiovascular Medicine/Heart
Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
(Iesaka, Hachiya) Cardiovascular Center, Tsuchiura Kyodo Hospital,
Tsuchiura, Japan
(Nitta, Inaba, Inamura) Department of Cardiology, Saitama Red Cross
Hospital, Saitama, Japan
(Takahashi, Tanaka) Cardiovascular Center, Yokosuka Kyosai Hospital,
Yokosuka, Japan
(Nagata, Watanabe) Division of Cardiology, Musashino Red Cross Hospital,
Tokyo, Japan
(Maeda, Takahashi) Department of Advanced Arrhythmia Research, Tokyo
Medical and Dental University, Tokyo, Japan
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Background: The feasibility and safety of pulmonary vein isolation (PVI)
using cryoballoon (CB) for paroxysmal atrial fibrillation (PAF) with
minimally interrupted apixaban has not fully explored. Method(s): In
this multicenter, randomized prospective study, we enrolled patients with
PAF undergoing CB or radiofrequency (RF) ablation with interrupted
(holding 1 dose) apixaban. The primary composite end point consisted of
bleeding events, including pericardial effusion and major bleeding
requiring blood transfusion, or thromboembolic events at 4 weeks after
ablation; secondary end points included early recurrence of AF and
procedural duration. Result(s): A total of 250 patients underwent PVI
(125 assigned to the RF ablation and 125 assigned to the CB ablation). The
primary end point occurred in 1 patient in the CB ablation group (0.8%;
90% confidence interval [CI], 0.04 to 3.70) and 3 patients in the RF group
(2.4%, P =.622; risk ratio, 0333; 90% CI, 0.05 to 2.20). All events were
pericardial effusion, all of whom recovered after pericardiocentesis.
Early recurrence of AF occurred in 4 patients (3.2%) in the RF group and
in 6 patients (4.8%) in the CB group (P =.749). The procedural duration
was shorter in the CB group than that in the RF group (136.5 +/- 39.9 vs
179.5 +/- 44.8 min, P <.001). Conclusion(s): CB ablation with
minimally interrupted apixaban was feasible and safe in patients with PAF
undergoing PVI, which was equivalent to RF ablation. Copyright ©
2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons
Australia, Ltd on behalf of Japanese Heart Rhythm Society

<67>
Accession Number
2005044536
Title
The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio
in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 29 (7) (pp 1015-1024), 2020. Date of
Publication: July 2020.
Author
Liu Z.; Nguyen Khuong J.; Borg Caruana C.; Jackson S.M.; Campbell R.;
Ramson D.M.; Penny-Dimri J.C.; Kluger M.; Segal R.; Perry L.A.
Institution
(Liu, Nguyen Khuong, Borg Caruana, Jackson, Kluger, Segal, Perry)
Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Vic,
Australia
(Liu, Nguyen Khuong, Jackson) Melbourne Medical School, University of
Melbourne, Melbourne, Vic, Australia
(Campbell) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Ramson, Penny-Dimri) Department of Surgery, Monash University, Melbourne,
Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: The neutrophil-lymphocyte ratio (NLR) is an emerging
inflammatory perioperative biomarker which has been studied to predict the
incidence of postoperative atrial fibrillation (POAF) after cardiac
surgery. This systematic review and meta-analysis aimed to evaluate the
prognostic accuracy of elevated perioperative NLR in predicting POAF after
cardiac surgery. Method(s): Multiple databases were searched from
inception to May 2019 for prognostic studies on perioperative NLR and POAF
following cardiac surgery. Maximally adjusted odds ratios (OR) with
associated confidence intervals were obtained from each included study and
pooled using random effects inverse variance modelling for preoperative
NLR measurements, while standardised mean differences were pooled for
postoperative NLR values. The significance of inter- and intra-study
heterogeneity was explored using meta-regression. Result(s): 1,799
unique studies satisfied selection criteria, from which 12 studies
incorporating 9,262 participants were included. Elevated preoperative NLR
significantly predicted POAF, with a pooled OR of 1.42 (95% CI 1.16-1.72).
Multiple predefined covariates contributed to inter-study heterogeneity;
however, only prevalence of hypertension (p=0.0055), history of congestive
cardiac failure (p=0.0282) and average ejection fraction (p=0.0359) were
significant effect modifiers. Elevated postoperative NLR was not a
significant predictor of POAF (standardised mean difference 1.60 [95% CI
-0.56-3.77] between POAF+ and POAF- groups). Conclusion(s): Elevated
preoperative NLR is a promising prognostic biomarker for POAF, but
residual sources of heterogeneity remain. Larger scale validation studies
are required to justify the integration of preoperative NLR testing into
routine clinical practice. Copyright © 2019 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<68>
Accession Number
2005044340
Title
Meta-Analysis of Hospital-Volume Relationship in Transcatheter Aortic
Valve Implantation.
Source
Heart Lung and Circulation. 29 (7) (pp e147-e156), 2020. Date of
Publication: July 2020.
Author
Ando T.; Villablanca P.A.; Takagi H.; Briasoulis A.
Institution
(Ando) Department of Medicine, Division of Cardiology, Wayne State
University/Detroit Medical Center, Detroit, MI, United States
(Villablanca) Department of Medicine, Division of Cardiology, Henry Ford
Hospital, Detroit, MI, United States
(Takagi) Department of Surgery, Division of Cardiovascular Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Briasoulis) Department of Medicine, Division of Cardiology, University of
Iowa Hospitals and Clinics, Iowa City, IA, United States
Publisher
Elsevier Ltd
Abstract
Background: Whether a volume-outcome relationship, that is, higher volume
centres have better outcomes compared with lower volume hospitals, exists
in transcatheter aortic valve implantation (TAVI) has not yet been
systematically explored. Method(s): We performed a systematic review
and meta-analysis to evaluate whether highest or intermediate annual TAVI
volume hospitals has better short-term (in-hospital or 30-days) mortality
compared with the lowest volume hospitals. Odds ratio (OR) and 95%
confidence interval (CI) was calculated with the Mantel-Haenszel method.
 Result(s): We identified 10 publications from nine different
countries including TAVI performed between 2005-2017. Included patients
were mainly high-risk cohorts. We included five and six studies to assess
volume-outcome relationship in the highest and intermediate volume
hospitals compared with the lowest volume hospitals, respectively. Our
results showed that in both the highest (OR 0.66, 95%CI 0.53-0.83,
p=0.0003, I2=78%) and intermediate (OR 0.85, 95%CI 0.79-0.92,
p<0.0001, I2=0%) volume hospitals, there was a statistically
significant volume-outcome relationship for short-term mortality compared
with the lowest volume hospitals. Conclusion(s): Our review suggests
a significant volume-outcome relationship post-TAVI in both the highest
and intermediate volume hospitals compared with the lowest volume
hospitals mainly in high surgical risk patients. The high heterogeneity in
this relationship between the highest and the lowest volume hospitals
warrant cautious interpretation. Whether this relationship remains
significant in low-risk cohort requires further study. Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<69>
Accession Number
2003545194
Title
A Meta-Analysis Comparing Aspirin Alone Versus Dual Antiplatelet Therapy
for the Prevention of Venous Graft Failure Following Coronary Artery
Bypass Surgery.
Source
Cardiovascular Revascularization Medicine. 21 (6) (pp 792-796), 2020. Date
of Publication: June 2020.
Author
Hesterberg K.; Rawal A.; Khan S.; Rashid A.; Jones D.; Siddiqui T.; Khader
T.A.; Nayyar M.; Shah R.
Institution
(Hesterberg, Rawal, Jones, Khader, Nayyar, Shah) Department of Medicine,
University of Tennessee, Memphis, TN, United States
(Khan) Department of Medicine, Aga Khan University, Pakistan
(Rashid) Jackson Clinic, University of Tennessee, Jackson, TN, United
States
(Siddiqui) Department of Medicine, Texas Tech University Health Sciences
Center El Paso, TX, United States
(Shah) Department of Cardiology, Gulf Coast Regional Medical Center,
Panama City, FL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Aspirin (ASA) monotherapy is the current standard of care
after coronary artery bypass grafting (CABG) to prevent saphenous vein
graft (SVG) failure. Several small, randomized clinical trials (RCTs) have
suggested that dual antiplatelet therapy (DAPT) may be more effective at
preventing SVG failure than ASA alone; however, it is unclear whether some
P2Y12 inhibitors are more effective than others for the prevention of SVG
failure. Method(s): Scientific databases and websites were searched
to find RCTs. Both traditional pairwise meta-analysis using random-effect
model and network meta-analysis using mixed-treatment comparison models
were performed to compare the efficacy of various anti-platelet strategies
for the prevention of SVG failure. Result(s): Nine RCTs, which
included a total of 1677 patients, were analyzed. Compared to ASA alone,
DAPT decreased the risk of graft failure by 37% (RR: 0.63, 95% CI:
0.47-0.86; p = 0.003). In the moderator analysis, the decreased risk of
graft failure with DAPT was not significantly different in the ASA +
clopidogrel group than in the ASA + ticagrelor group (P-interaction =
0.17). The results of the network meta-analysis were consistent with those
from pairwise analyses. The risk of major bleeding was not statistically
significantly different between DAPT and ASA alone (RR: 1.35, 95% CI:
0.62-2.94; p = 0.45). Conclusion(s): In post-CABG patients, DAPT
seems to be more effective at preventing graft failure than ASA alone.
This strategy does not seem to significantly increase major bleeding risk.
Clopidogrel- and ticagrelor-based DAPT seem to be equally effective for
this indication. Copyright © 2019 Elsevier Inc.

<70>
Accession Number
632520742
Title
Utilization and outcomes of implantable left atrial appendage occlusion
device: Analysis of the national inpatient sample database.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S161), 2020.
Date of Publication: May 2020.
Author
Fratti J.D.C.; Rios L.H.P.; Gomez J.; Nazari J.
Institution
(Fratti, Gomez) John H Stroger Jr Hospital of Cook County, United States
(Rios) Evanston Hospital, Northshore University Healthsystems, United
States
(Nazari) NorthShore University Health Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Left atrial appendage occlusion (LAAO) devices are an
increasingly popular alternative to anti-coagulation in patients with
atrial fibrillation and elevated risk of stroke. However, data regarding
utilization, cost, and outcomes of implantable LAAO devices in the United
States are limited. We aim to report this data. Method(s): The
National Inpatient Sample/Health Care Utilization Project database was
queried from the years 2010 to 2014. The procedure and related
complications were calculated using the International Classification of
disease-Ninth edition. Continuous variables presented as mean +/-SD, and
categorical as a percent. Result(s): A total of 552 (Weighted for
national estimated=2733) procedures were analyzed. The mean age was
71.09+/-9.98 years, 60.4% were male, predominantly white (84.7%), followed
by Hispanic (6.5%) and Black (4.3%). Most procedures were elective (79%),
and performed in large- (69.7%), medium- (18.5%) and small-size hospitals
(11.8%). The majority (78.4%) were done in urban teaching hospitals,
(20.6%) in urban non-teaching hospital and (1%) in rural hospitals. The
mortality rate during admission was 1.9%, with an average length of stay
of 5.97+/-7.54 days, and a hospitalization cost of 128,261.06+/-142,249
American dollars. Costs were covered predominantly by Medicare (76%),
followed by private insurance (17.1%), Medicaid (2.4%), and self-paid
(1.9%). Following the procedure, 3.9% (107) of patients required
pericardiocentesis, 0.5% (15) pericardial window. Post procedure stroke
was 0.9% (26), device complications 0.4% (10), acute respiratory failure
4.2% (114), iatrogenic cardiac complications 5.4% (149), and
post-operative bleeding and hematoma 3.1% (85). Conclusion(s): The
Implantable LAAO device in the US was associated with low in-hospital
mortality and admissible complications. This analysis showed a similar
safety profile to the one described in FDA's manufacturer and user
facility device experience database, as well as large randomized trial
data.

<71>
Accession Number
632520729
Title
Long term outcomes of percutaneous coronary intervention versus coronary
artery bypass grafting in unprotected left main coronary artery disease :
A meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S191-S192),
2020. Date of Publication: May 2020.
Author
Jhand A.; Gajanan G.; Van Briggle B.; Dhawan R.; Siddique A.; Chatzizisis
Y.
Institution
(Jhand, Gajanan, Van Briggle, Dhawan, Siddique, Chatzizisis) University of
Nebraska Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Percutaneous coronary intervention (PCI) is an alternative to
coronary artery bypass grafting (CABG) in patients with unprotected left
main coronary artery disease (ULMCAD) and a favorable anatomy. We
performed a meta-analysis of randomized controlled trials (RCT) to
evaluate the outcomes of PCI versus CABG in ULMCAD. Method(s):
Pubmed, EMBASE and google scholar were systematically searched for RCT's
comparing the long term outcomes following PCI with drug eluting stents
(DES) and CABG in ULMCAD patients undergoing revascularization. Outcomes
of interest included all-cause mortality, cardiovascular mortality,
myocardial infarction (MI), stroke and repeat revascularization. Risk
Ratios (RR) and corresponding 95% confidence intervals (CI) were
calculated using a random-effect model. Result(s): 5 RCT's met our
inclusion criteria with a total of 4595 patients (PCI: 2297 and CABG:
2298). Mean SYNTAX score was comparable in the two groups (22.8 vs 22.6, p
= 0.92). At a mean follow-up of 5.2 +/- 3.2 years, no statistically
significant difference was observed in the incidence of all-cause
mortality, cardiovascular mortality, MI and stroke (figure1). However,
incidence of repeat revascularization was higher in the PCI group (RR:
1.71, 95% CI: 1.44-2.04, p<0.00001). Conclusion(s): Our analysis
shows that PCI with DES is associated with similar long term outcomes
except for repeat revascularization when compared to CABG in ULMCAD.

<72>
Accession Number
632520722
Title
Short- and long-term outcomes in patients with new-onset persistent left
bundle branch block after transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S153-S154),
2020. Date of Publication: May 2020.
Author
Megaly M.S.; Abraham B.; Abdelsalam M.; Saad M.; Omer M.A.; Elbadawi A.;
Mentias A.; Narayanan M.A.; Gafoor S.A.; Brilakis E.S.; Goessl M.;
Cavalcante J.L.; Garcia S.; Kapadia S.R.; Pershad A.; Sorajja P.; Sengupta
J.
Institution
(Megaly, Omer, Goessl, Sengupta) Abbott Northwestern Hospital, Minneapolis
Heart Institute, United States
(Abraham) Ascension St. John Hospital, United States
(Abdelsalam) Temple University, Conemaugh Memorial Medical Center, United
States
(Saad) Brown University Program, United States
(Elbadawi) University of Texas, Medical Branch at Galveston, United States
(Mentias) Cleveland Clinic, United States
(Narayanan) University of Minnesota, United States
(Gafoor) Swedish Medical Center, United States
(Brilakis, Cavalcante, Sorajja) Minneapolis Heart Institute, United States
(Garcia) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, United States
(Kapadia) Cleveland Clinic, United States
(Pershad) Banner University Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: The impact of new-onset persistent left bundle branch block
(LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause
mortality has been controversial. Method(s): We conducted a
systematic review and meta-analysis of eleven studies (7,398 patients)
comparing the short- and long- outcomes in patients who had new-onset LBBB
after TAVR vs. those who did not. Result(s): During a mean follow-up
of 20.5+/-14 months, patients who had new-onset persistent LBBB after TAVR
had a higher incidence of all-cause mortality (29.7% vs. 23.6%, OR 1.28
(1.04-1.58), p=0.02), rehospitalization for heart failure (HF) (19.5% vs.
17.3%, OR 1.4 (1.13-1.73), p=0.002), and permanent pacemaker implantation
(PPMi) (19.7% vs. 7.1%, OR 2.4 (1.64-3.52), p<0.001) compared with those
who did not. Five studies (4,180 patients) reported adjusted hazard ratios
(HR) for all-cause mortality; new LBBB remained associated with a higher
risk of mortality (Adjusted HR 1.43 (1.08-1.9), p<0.01,
I2=81%). Conclusion(s): Post-TAVR persistent LBBB is
associated with higher allcause mortality and HF. While efforts to
identify patients that need post-procedural PPMi are warranted, more
studies are required to evaluate the best follow-up and treatment
strategies to improve longterm outcomes in these patients. (Figure
Presented) .

<73>
Accession Number
632520699
Title
New trends in comparing trans-catheter Aortic Valve Replacement (AVR) with
surgical AVR in lower risk patients: A comprehensive met-analysis and
literature review.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S150-S151),
2020. Date of Publication: May 2020.
Author
Khan M.; Mir T.; Singh H.; Idris O.M.; Khan G.; Ullah W.; Rashid M.; Shah
J.; Changal K.H.; Ali S.
Institution
(Khan, Singh, Idris, Shah, Changal, Ali) Mercy Health St. Vincent's
Medical Center, United States
(Mir) DMC/Wayne State University, United States
(Khan) University of Missouri Kansas City Program, United States
(Ullah) Abington Jefferson Health, United States
(Rashid) Advent Health, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcutaneous aortic valve replacement (AVR) is a novel
percutaneous procedure for severe aortic stenosis and has been recently
approved by FDA in lower risk patients. We performed the first ever
met-analysis and literature review of clinical trials comparing both short
and long term outcomes in lower risk patients undergoing TAVR vs surgical
AVR (Having Society of thoracic surgeons score [STSS] <4% or equivalent).
 Method(s): Using predefined selection criteria as above, 68 articles
were identified. 6 eligible articles were selected after extensive review.
Primary effect outcomes were 30-day and 1 year all-cause mortality using
Risk Ratio (RR) with significant p-value<0.05. Result(s): A total of
4,670 subjects were included. Risk of 30-day all cause mortality was 40.1%
less in TAVR group, RR 0.60 (95% Confidence Interval [CI] 0.38-0.93
p:0.02) with no significant heterogeneity. 3 studies, Thyregod et al.,
Partner 3 trial and Evolut low risk trial also reported 1-year risk. This
was also statistically significant with a 38.8% decrease in the TAVR
group, RR 0.62 (95% CI 0.46-0.84 p:0.002). All studies reported 30-Day
risk of secondary outcomes. The risk of stroke was 37% less in TAVR group,
although this was not statistically significant, RR 0.73 (95% CI 0.48-1.1,
p:0.22). The risk of acute kidney injury stage 2 (AKI) and above was 54%
less in post-TAVR patients, RR 0.43 (95% CI 0.35-0.54 p <0.001) with no
heterogeneity. For vascular complications, RR was high in TAVR group, 1.83
(95% CI: 1.22-2.755, p:0.003) with significant heterogeneity. The risks
for Permanent Pacemaker (PPM) were also higher in the TAVR group, RR 2.88
(95% CI: 2.33-3.56, p<0.001) and significant heterogeneity was observed.
After removing Thyregod et al. and Partner-3 trial from the analysis,
heterogeneity was removed, but the relative risk was still high, RR 3.21
(95% CI 2.54 - 4.068 p< 0.001). Conclusion(s): TAVR is superior both
in short term and long-term mortality, a result that is statistically
significant and not demonstrated before. TAVR patients were also less
likely to have post-operative bleeding and AKI. However, the rates of PPM
and vascular complications are higher in TAVR patients and caution must be
exercised while extending indications to young patients.

<74>
Accession Number
632520696
Title
All-cause mortality after percutaneous coronary intervention versus
coronary artery bypass grafting for unprotected left main coronary artery
at 5-years: Meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S187-S188),
2020. Date of Publication: May 2020.
Author
Khan M.R.; Manan M.; Ahmad W.; Khalid M.; Kayani W.; Hamzeh I.; Virani
S.S.; Jneid H.; Alam M.
Institution
(Khan) McLaren Flint-Michigan State University, United States
(Manan) King Edward Medical University, Pakistan
(Ahmad) Nishtar Medical College, Pakistan
(Khalid, Kayani, Hamzeh, Virani, Alam) Baylor College of Medicine, United
States
(Jneid) Baylor College of Medicine, Michael E. DeBakey Veterans Affair
Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Long-term outcomes after unprotected left main (ULM)
revascularization with drug eluting stents (DES) compared to coronary
artery bypass grafting (CABG) continue to be defined as longer term follow
up from randomized controlled trials (RCTs) is reported. However, these
RCTs report smaller number of patients individually. We attempt to explore
these longer-term outcomes from RCTs in aggregate to better define
clinical outcomes. Method(s): An aggregate data meta-analysis of RCTs
comparing CABG with PCI for ULM was performed using random effects model.
Only RCTs reporting a long-term (5-year) follow-up were included in our
analysis. A literature search identified 5 studies and 4498 patients. The
primary outcome of interest was allcause mortality, secondary outcomes
included myocardial infarction (MI), stroke, repeat revascularization and
a composite outcome of major adverse cardiac and cerebrovascular events
(MACCE). Data were reported as odds ratio (OR) and 95% confidence
intervals. Result(s): Baseline demographic and clinical
characteristics were comparable. At 5-years, there was no difference
between CABG and PCI in terms of all-cause mortality (PCI: 10%, CABG:
10.9%, OR 0.98 [0.74-1.29]), stroke (OR 1.19 [0.66-2.14]) and MACCE (OR
0.82 [0.60-1.11]). However, CABG, compared to PCI was associated with a
significantly lower incidence of repeat revascularization (OR 0.54
[0.44-0.67]) and myocardial infarction (OR 0.69 [0.54-0.88]) (figure 1).
 Conclusion(s): PCI is a reasonable alternative to CABG for ULM
disease in select patient populations, but there is a need for even
longer-term follow-up.

<75>
Accession Number
632520676
Title
Outcome of transcatheter aortic valve implantation in tricuspid aortic
stenosis vs bicuspid aortic stenosis: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S147-S148),
2020. Date of Publication: May 2020.
Author
Hafeez H.; Farooqi M.S.; Akhtar K.H.; Farooqui A.A.; Iqbal A.G.; Huda
S.A.; Illahi Y.; Saqib N.; Pir M.S.; Mian R.; Haseeb A.; Ahmad M.M.;
Rajagopalan S.
Institution
(Hafeez, Mian) Wright Center for Graduate Medical Education Scranton, PA,
United States
(Farooqi, Farooqui, Illahi) King Edward Medical University, Pakistan
(Akhtar, Iqbal) University of Oklahoma, Health Sciences Center, United
States
(Huda) Suny Upstate Medical University, United States
(Saqib, Pir, Haseeb, Rajagopalan) Wright Center for Graduate Medical
Education, United States
(Ahmad) Aurora Health Care, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a
therapeutic modality for severe aortic stenosis. However, bicuspid aortic
stenosis (BAS) has been excluded in most randomized clinical trials. Here
we re-examine current evidence of clinical outcomes of TAVI in BAS versus
Tricuspid aortic stenosis (TAS) patients. Method(s): Extensive search
was performed on PubMed and Google scholar using keywords TAVI, TAS and
BAS, yielding 261 studies. 19 studies comparing outcome of TAVI in TAS and
BAS were identified. A total of 12,125 patients across different centers
were included. Study-level analysis was done with Review manager 5.3. I2 >
30% was considered an indicator of statistical heterogeneity. A Mantel-
Haenszel Random effects model was used to calculate pooled odds ratio (OR)
for endpoints. The results are reported as OR, 95% confidence interval
(CI) and P <0.05. Result(s): In 12,125 patients undergoing TAVI, TAS
had significant increase in paravalvular leak (OR: 1.48; 95% CI:
1.14-1.91; p = 0.003), stroke (OR: 1.59; 95% CI: 1.10-2.29; p = 0.01),
conversion to surgery (OR: 2.30; 95% CI: 1.29-4.1; p = 0.005) and
pacemaker implantation (OR: 1.67; 95% CI: 1.06-2.63; p = 0.03 ) (Panel A,
B, C, D). 30-day mortality (OR: 1.39; 95% CI: 0.97-1.99; p = 0.07), long
term mortality (OR: -0.01; 95% CI: -0.04-0.01; p = 0.34) (Panel E, F) and
myocardial Infarction (OR: 1.68; 95% CI: 0.76-3.73; p = 0.20) showed no
difference. Conclusion(s): TAVI can be offered to BAS patient as
outcomes are similar and in some cases better than TAS. (Table Presented)
.

<76>
Accession Number
632520643
Title
Use of embolic protection device in transcatheter aortic valve replacement
and its effect on all-cause mortality: A meta-analysis with trial
sequential analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S143-S144),
2020. Date of Publication: May 2020.
Author
Doshi R.; Adalja D.; Kumar A.; Shariff M.; Shah J.; Majmundar M.; Patel
P.; Gullapalli N.; Meraj P.M.
Institution
(Doshi, Gullapalli) University of Nevada, School of Medicine, United
States
(Adalja) Gotri Medical Education and Research Center, India
(Kumar, Shariff) St John's Medical College Hospital, India
(Shah) Mercy Health St. Vincent's Medical Center, United States
(Majmundar) Metropolitan Medical Center, United States
(Patel) Nassau University Medical Center, United States
(Meraj) Hofstra North Shore-LIJ School of Medicine, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: The role embolic protection device (EPD) in preventing stroke
during transcatheter aortic valve replacement (TAVR) procedures is well
established. The present meta-analysis with trial sequential analysis
focused on the effect of EPD on all-cause mortality. All results from
randomized control trials (RCTs) and propensity score-matched (PSM)
studies were pooled in the present metaanalysis. Method(s): A
comprehensive systematic search of the PubMed and EMBASE database was
performed to identify relevant articles. We used Mantel-Haenszel method
with random effect model to calculate odds ratio (OR) with 95% confidence
interval (CI). Trial sequential analysis (TSA) was performed to look for
the possibility of a type II error in the pooled estimates.
 Result(s): Four RCTs and 1 PSM study were included in the final
analysis. Use of EPD with TAVR resulted in statistically significant
reduction in the incidence of all-cause mortality [OR: 0.34, 95%CI:
0.14-0.82, P-value < 0.05, I2=0%, Chi-square P-value=0.92] [Figure 1,
PANEL A]. Funnel plot did not indicate publication bias [Figure 1, PANEL
B]. TSA indicated the possibility of type 2 error, and need for further
randomization to reach an information size of 1485 for conclusive evidence
[Figure 1, PANEL C]. Conclusion(s): EPD with TAVR reduced the
incidence of all-cause mortality significantly as compared to TAVR alone.
However as reported by TSA, further studies are required for conclusive
evidence. (Figure Presented) .

<77>
Accession Number
632520639
Title
Safety and predictors of next-day discharge after transcatheter aortic
valve replacement: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S220), 2020.
Date of Publication: May 2020.
Author
Sheikh M.A.A.; Deo S.V.; Riaz H.; Kalra A.; Altarabsheh S.E.; Raza S.; Deo
V.; Elgudin Y.; Pelletier M.; Markowitz A.H.
Institution
(Sheikh) University of Michigan Medical Center, United States
(Deo) Louis Stokes Cleveland Veterans Affairs Medical Center, United
States
(Riaz, Kalra) Cleveland Clinic, United States
(Altarabsheh) Queen Alia Heart Institute, Jordan
(Raza) Precision Analytics, United States
(Deo, Pelletier, Markowitz) Case Western Reserve University, United States
(Elgudin) Louis Stokes Cleveland Veterans, Affairs Medical Center, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter valve replacement (TAVR) is now approved for
patients with severe aortic stenosis (AS) across all risk profiles.
Next-day discharge (NDD) is an attractive strategy in a selected cohort of
patients; however, supporting evidence is limited. Hence, we conducted a
systematic review to present results in NDD patients after TAVR.
 Method(s): We conducted a systematic search (till August 2019) to
identify peer-reviewed original studies reporting clinical outcome of NDD
after TAVR. We analyzed events rates for mortality, stroke, acute kidney
injury and readmissions using a random effects model. We also evaluated
predictors promoting NDD. Result(s): We included 6 studies (2906 TAVR
patients, 17 centers world-wide) in our meta-analysis. Five studies were
retrospective analyses of a single center experience; 1 was an
industry-funded prospective cohort study. We observed wide variation in
NDD (22%-45.71%; p < 0.001). The majority received balloon-expandable
valves, only 5.21% patients were implanted with self-expanding valves.
Overall, 30-day mortality was 1% (0.5%-1.995). Mortality was not
influenced by study volume (p = 0.15). Pacemaker rates were 2.2%
(0.5%-8.52%) with wide variation between studies (0.6%-15.54%). Early
readmission rate was 6.63% (4.7%-9.21%); this varied significantly between
studies (range 3.85%-13.64%; p = 0.06). Acute kidney injury and stroke
rates were 1% and 0.8% respectively. When compared with routine discharge,
NDD did not impact mortality [OR 1.4 (0.66-2.93)] or readmission [OR 0.66
(0.36-1.2)]. Male sex, normal sinus rhythm and normal kidney function
promoted likelihood of NDD. Conclusion(s): Data evaluating NDD after
TAVR are limited. In selected patients, this strategy appears to be safe
with low risk for readmissions. Preliminary data suggest that these
patients have outcomes comparable to the acceptable standards.

<78>
Accession Number
632520604
Title
Comparison of balloon expandable vs self-expandable valve for
trans-catheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S216-S217),
2020. Date of Publication: May 2020.
Author
Raheja H.; Goel S.; Pasam R.; Ahuja K.R.R.; Sinha A.; Malik B.A.; Shani
J.; Frankel R.; Kapadia S.R.
Institution
(Raheja, Pasam, Sinha) Maimonides Medical Center, Brooklyn, United States
(Goel) Mount Sinai Medical Center, United States
(Ahuja) Cleveland Clinic, United States
(Malik, Kapadia) Cardiology Associates of Brooklyn, P.c., United States
(Shani) Maimonides Medical Center, United States
(Frankel) Cardiology Associates of Brooklyn, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: TAVR has become an effective and safe treatment option for
patients with severe aortic stenosis. Most of the currently available
prostheses employ either balloon-expandable or selfexpandable designs.
However, there is a paucity of data comparing these two widely used
prosthesis type. The aim of this study is to compare the clinical and
safety outcomes of Self Expandable Valves (SEV) vs Balloon Expandable
Valves (BEV). Method(s): We conducted an electronic database search
including PubMed, Web of Science, Google scholar and Cochrane Database of
all published data for studies comparing SEV vs BEV in patients undergoing
trans-femoral TAVR. Only the commonly used Medtronic SEV [CoreValve and
Evolut R] and Edwards Sapien BEV [Sapien, Sapien XT and Sapien 3] were
included for the final analysis. Event rates were compared using a forest
plot of odds ratio (OR) using a randomeffects model assuming inter-study
heterogeneity Results: A total of 16 studies (n=8671; SEV= 3749, BEV=
4922) were included in the final analysis. Pooled analysis revealed that
SEV compared to BEV had higher device failure rates (OR = 2.73, 95% CI =
1.20-6.17, P = 0.02), higher 30 day all-cause mortality (OR = 1.76, 95% CI
= 1.39-2.24, P < 0.00001), higher rates pacemaker implants (OR = 2.70, 95%
CI = 1.86-3.91, P < 0.00001), greater post procedural any grade
para-valvular leak (OR = 2.23, 95% CI = 1.67-2.98, P < 0.00001), greater
moderate to severe para-valvular leak (OR= 4.17, CI= 1.68-10.35, P= 0.002)
and greater moderate to severe post procedural trans-valvular aortic
regurgitation (OR = 1.89, 95% CI = 1.41- 2.54, P < 0.0001). There was no
difference between SEV and BEV in regard to 30-day cardiac mortality (OR =
1.25, 95% CI = 0.50-3.12, P = 0.63), major vascular events (OR = 0.89, 95%
CI = 0.61- 1.28, P = 0.53), major or life-threatening bleeding (OR = 1.05,
95% CI = 0.76-1.46, P = 0.75), 30-day myocardial infarction (OR = 0.95,
95% CI = 0.11- 8.47, P = 0.96) and 30-day stroke (OR = 0.96, 95% CI =
0.38-2.44, P = 0.94) Conclusion(s): SEV compared to BEV in patients
undergoing transfemoral TAVR has higher device failure rate, higher 30-day
all-cause mortality, higher incidence of new pacemaker implants, greater
paravalvular leak and trans-valvular aortic regurgitation post procedure.

<79>
Accession Number
632520592
Title
Hemodynamic performance of self-expanding vs balloon-expandable valves in
patients with bmi above 35 undergoing transcatheter aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S215-S216),
2020. Date of Publication: May 2020.
Author
Puleo C.W.; Price J.; Echavarria N.G.; Ramee S.R.; Lavie C.J.; Parrino P.;
Soto J.D.T.
Institution
(Puleo, Price, Ramee, Lavie, Parrino) Ochsner Cardiology, United States
(Echavarria) Univ ICESI/Fundacion Clinica Valle del Lili, Colombia
(Soto) Ochsner Heart and Vascular Institute, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been shown
in select populations to be a reasonable alternative to surgical aortic
valve replacement (SAVR). Although multiple retrospective studies suggest
superior improvement in hemodynamics following placement of self-expanding
valves (SEV) compared to balloonexpandable valves (BEV), there is limited
data regarding hemodynamics of these valves in obese population cohorts.
Given the high rates of patient-prosthesis mismatch (PPM) following both
SAVR and TAVR in obese patients, it is essential to identify the
postoperative risks and hemodynamics of these valves in this growing
population. Method(s): A retrospective chart review was performed on
117 patients with body max index (BMI) >35 kg/m2 who underwent
TAVR between 2017 and 2019 in a tertiary referral medical center.
Demographic and echocardiographic data was collected at baseline as well
as at 1 month and 1 year following TAVR. Patients with prior AVR were
excluded. Result(s): The mean age of participants was 72.6 years
(47-93). Mean STS score was 4.4%. All patients underwent TAVR with either
SEV (49%) or BEV (51%). Each valve type was associated with 1 in-hospital
death and 1 VARC-2 major vascular complication. Percutaneous closure
device failure and covered stent was required in 4 SEV cases (6.9%) and 3
BEV cases (5.1%). Post-operative pacemaker placement was required
following implantation of 12 SEVs (20.7%) and 11 BEVs (18.6%). At 1 month
following SEV implantation, mean indexed effective orifice area (iEOA) was
1.33 cm2/m2 (95% CI [1.19, 1.48]) and mean mean gradient (MG)
was 10.4 mmHg (95% CI [9.0, 11.9]). At 1 month following BEV implantation,
mean iEOA was 1.02 cm2/m2 (95% CI [0.85, 1.20]) and mean MG was
16.7 mmHg (95% CI [13.81, 19.66]). Moderate or worse paravalvular leak at
follow up was noted in 3 SEV cases (5.2%) and 3 BEV cases (5.1%). Mean
improvement in NYHA category was 0.94 for subjects who received an SEV and
0.89 for those who received a BEV. Conclusion(s): TAVR is a feasible
therapeutic option in patients with BMI > 35, with a similar complication
rate for SEV and BEV, though SEV appear to have superior hemodynamics at 1
month. Randomized trials are required to confirm this observation.

<80>
Accession Number
632520586
Title
Patient-prosthesis mismatch after transcatheter aortic valve replacement
in patients with BMI above 35: Size does matter.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S215), 2020.
Date of Publication: May 2020.
Author
Echavarria N.G.; Puleo C.W.; Price J.; Ramee S.R.; Parrino P.; Soto J.D.T.
Institution
(Echavarria) Univ ICESI/Fundacion Clinica Valle del Lili, Colombia
(Puleo, Price, Ramee, Parrino) Ochsner Cardiology, United States
(Soto) Ochsner Heart and Vascular Institute, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Obesity presents multiple challenges to transcatheter aortic
valve replacement (TAVR) and there is limited data available regarding the
prevalence of patient-prosthesis mismatch (PPM) in this population. With
the worsening prevalence of obesity, and reported PPM rates of 53 to 60%
in obese patients who undergo surgical aortic valve replacement (SAVR), it
is essential to identify the risk of PPM in this patient population when
undergoing TAVR. Method(s): A retrospective chart review was
performed on 117 patients with body max index (BMI) >35 kg/m2
who underwent TAVR between 2017 and 2019 in a tertiary referral medical
center. Demographic and echocardiographic data was collected at baseline,
1 month and 1 year following TAVR. Subjects with prior AVR were excluded.
 Result(s): All patients underwent TAVR with either balloon-expandable
valve (BEV) or self-expanding valve (SEV), with 50% of included
participants in each arm. Indexed effective orifice area (iEOA) with 95%
CI for all participants are plotted against mean gradient in figure 1. The
rates of overall PPM (iEOA<0.85cm2/m2) and severe PPM
(iEOA<0.65cm2/m2) were 37.5% and 9.4%, respectively, 30 days
following TAVR. When stratified based on valve type, BEV had a PPM rate of
56% (severe PPM 13%) and SEV had a PPM rate of 19% (severe PPM 6%).
 Conclusion(s): TAVR is a feasible therapeutic option in patients with
BMI > 35. There appears to be a lower incidence of PPM in TAVR compared to
SAVR based on previously reported PPM rates in similar SAVR cohorts. SEV
appear to have superior hemodynamic performance compared to BEV.
Randomized trials are required to confirm this observation.

<81>
Accession Number
632520571
Title
A meta-analysis of the impact of minimalist versus conventional standard
approach on ICU and hospital length of stay for transcatheter aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S138-S139),
2020. Date of Publication: May 2020.
Author
Apala D.R.; Jhand A.; Ginugu R.R.; Ramadan B.K.; Taylor J.
Institution
(Apala, Ramadan, Taylor) Creighton University, United States
(Jhand) University of Nebraska Medical Center, United States
(Ginugu) Mamata Medical College, India
Publisher
John Wiley and Sons Inc.
Abstract
Background: Minimalist approach (MA) has been increasingly used for TAVR
with studies showing good outcomes as compared to conventional approach
(CA). A minimalist approach includes * Local anesthesia +/- conscious
sedation * Done in Catheterization lab * Percutaneous access * No
intraoperative TEE * Immediate removal of temporary pacer wires post
procedure * Peripheral IV line * No urinary catheter As opposed to
Conventional approach requiring general anesthesia, operating room,
intraoperative TEE, pacer wires for 1-2 days, central iv line and urinary
catheter. We conducted this meta-analysis to evaluate for procedure
duration, efficacy, ICU and hospital length of stay comparing two
approaches. Method(s): PubMed, Cochrane and Web of Science databases
were systematically searched for studies comparing two approaches. The
analysis was performed using DerSimonian and Laird random effect model. OR
and 95% CI were calculated. Result(s): Six studies met out inclusion
criteria with a total of 1,737 patients (634 in MA and 1103 in CA groups).
There was no statistically significant difference in preoperative risk
assessment between two groups as compared by STS score. Device success
rate was comparable between two groups. When compared to CA, MA not only
had significantly lower procedure time, fluoroscopy time, contrast volume
(see fig. below) but also had significantly shorter ICU length of stay and
Hospital length of stay. Conclusion(s): Our analysis shows that
Minimalist approach for TAVR had significantly lesser ICU and Hospital
length of stays with shorter procedure duration and similar efficacy
profile as compared to conventional approach (Table Presented) .

<82>
Accession Number
632520559
Title
A meta-analysis on minimalist versus conventional standard approach
comparing mortality and outcomes of transcatheter aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S137-S138),
2020. Date of Publication: May 2020.
Author
Apala D.R.; Jhand A.; Ginugu R.R.; Ramadan B.K.; Taylor J.
Institution
(Apala, Ramadan, Taylor) Creighton University, United States
(Jhand) University of Nebraska Medical Center, United States
(Ginugu) India
Publisher
John Wiley and Sons Inc.
Abstract
Background: Minimalist approach (MA) has been increasingly used for TAVR
with studies showing comparable outcomes to conventional approach (CA). A
minimalist approach includes * Local anesthesia +/- conscious sedation *
Done in Catheterization lab * Percutaneous access * No intraoperative TEE
* Immediate removal of temporary pacer wires post procedure * Peripheral
IV line * No urinary catheter Methods: PubMed, Cochrane and Web of Science
databases were systematically searched for studies comparing two
approaches. Outcomes of interest were success rate, mortality and
complication rates. The analysis was performed using DerSimonian and Laird
random effect model. OR and 95% CI were calculated. Result(s): Six
studies met out inclusion criteria with a total of 1,737 patients (634 in
MA and 1103 in CA groups). There was no statistically significant
difference in preoperative risk assessment between two groups as compared
by STS. Device success rate was comparable between two groups. Minimalist
approach had no difference in In-hospital & 30day mortality, 30day
readmission rate, major vascular complications, paravalvular leak, new
pacemaker requirement or stroke incidence when compared to convention
approach. The incidence of major bleeding and AKI were significantly lower
in minimalist group. (See fig. below) Conclusion(s): Our analysis
shows that Minimalist approach for TAVR had better outcomes in terms of
major bleeding, AKI and similar outcomes in other variables compared to
conventional approach and can be safely used in routine practice. (Table
Presented) .

<83>
Accession Number
632520524
Title
Impact of chronic lung disease on the outcomes of transcatheter
mitral-valve repair in functional mitral regurgitation: The COAPT trial.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S76-S77),
2020. Date of Publication: May 2020.
Author
Saxon J.T.; Cohen D.J.; Chhatriwalla A.K.; Arnold S.V.; Kotinkaduwa L.N.;
Kar S.; Lim D.S.; Abraham W.T.; Lindenfeld J.; Mack M.J.; Stone G.W.
Institution
(Saxon, Cohen) Mid America Heart Institute, United States
(Chhatriwalla, Arnold) Saint Luke's Mid America Heart Institute, United
States
(Kotinkaduwa, Stone) Cardiovascular Research Foundation, United States
(Kar) Los Robles Hospital, United States
(Lim) University of Virginia Health System, United States
(Abraham) Ohio State University, Department of Cardiovascular Medicine,
United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, United States
(Mack) Baylor Scott and White Health, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Chronic obstructive pulmonary disease (COPD) often co-exists
with severe functional mitral regurgitation (FMR) in heart failure (HF).
Whether HF pts with COPD derive less benefit from transcatheter mitral
valve repair (TMVr) is unknown. Method(s): The COAPT trial randomized
614 pts with HF and 3-4+ FMR to TMVr with MitraClip + guideline-directed
medical therapy (GDMT) or GDMT alone. We used Cox proportional regression
models or ANCOVA models to assess the association between COPD and 2-year
clinical and quality of life (QOL) outcomes. Of note, pts with severe COPD
requiring home oxygen or chronic oral steroid use were excluded from
COAPT. Result(s): COPD was present in 143 (23.3%) pts. Pts with COPD
had worse baseline health status compared with pts without COPD
(KCCQ-Overall Summary [OS] score 46.1 vs 54.3, p<0.001). COPD was
associated with reduced benefit of TMVr with respect to 2-year mortality
(HR 1.13 (95%CI 0.67-1.93) with COPD vs 0.49 (95%CI 0.35-0.69) without
COPD, Pint=0.01) but not HF hospitalization (HR 0.61 (95%CI 0.37-1.01)
with COPD vs 0.48 (95%CI 0.36-0.64) without COPD, Pint=0.38). The QOL
benefit of TMVr was similar among pts with vs without COPD (Pint=0.76)
(Table). Conclusion(s): In COAPT, baseline COPD was associated with a
reduced survival benefit of TMVr, but baseline COPD did not impact the
benefit of TMVr on either HF hospitalizations or disease-specific health
status. These data suggest that pts with persistent 3-4+ FMR and COPD
should be considered for TMVr if HF-related symptoms persist despite
maximally-tolerated GDMT. (Table Presented) .

<84>
Accession Number
632520510
Title
A comparison of the efficacy of percutaneous mitral valve repair in
patients with and without atrial fibrillation: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S75), 2020.
Date of Publication: May 2020.
Author
Olarte N.; Rivera M.; Becerra V.; Fernandes M.; Alfonso C.E.; Cohen M.G.;
De Marchena E.
Institution
(Olarte) University of Miami, Jackson Memorial Hospital, United States
(Rivera) Washington University, United States
(Becerra) University of Miami, Miller School of Medicine, Jackson Memorial
Hospital, United States
(Fernandes) Emory University, United States
(Alfonso) University of Miami Hospital, United States
(Cohen) University of Miami, Miller School of Medicine, United States
(De Marchena) University of Miami, International Medicine Institute,
United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Atrial fibrillation (AF) often accompanies mitral
regurgitation and has been associated with poor outcomes after surgical
mitral valve repair. Outcomes after percutaneous mitral valve repair
(PMVR) in patients with AF have not been well-defined. Method(s):
PubMed, EMBASE, Scopus, Web of Science and Cochrane Library were searched
for randomized controlled trials and cohort studies reporting outcomes
after PMVR in patients with and without AF. Result(s): Six studies
were included for analysis, pooling 7,562 patients total. Patients with AF
had worse 30-day and 1-year all-cause mortality (OR: 1.43, 95% CI: 1.04 -
1.98; and OR: 1.33, 95% CI: 1.15 - 1.54). At 1 year, patients with AF were
less likely to have symptom improvement to New York Heart Association
Class I or II (OR: 0.72, 95% CI: 0.57 - 0.93) and more likely to be
hospitalized for heart failure (OR: 1.21, 95% CI: 1.02 - 1.42). There was
no difference in procedural success, defined as residual mitral
regurgitation grade 2 or lower, after PMVR (OR: 1.00, 95% CI: 0.84 -
1.19), and no difference of stroke at 30 days or 1 year (OR: 0.91, 95% CI:
0.30 - 2.75; and OR: 1.05, 95% CI: 0.64 - 1.71). Conclusion(s):
Similar to patients who undergo mitral valve surgery, patients with AF who
undergo PMVR have worse outcomes than those without AF despite initial
procedural success. Further studies are needed to investigate this
association.

<85>
Accession Number
632520500
Title
Impact of gender on outcomes of transcatheter mitral valve repair with
MitraClip: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S74-S75),
2020. Date of Publication: May 2020.
Author
Mustafa U.; Gill P.; Mina G.S.N.; Bailey S.R.
Institution
(Mustafa, Gill, Mina) Louisiana State University, Health Sciences Center,
United States
(Bailey) LSU Health Sciences Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Gender disparities in outcomes after mitral valve surgery are
well known. There are only studies reporting the influence of gender on
outcomes following mitral valve repair using MitraClip (MC) device. In
this meta-analysis, we describe outcomes by gender after edge-to-edge
mitral valve repair with MC. Method(s): Studies reporting the gender
specific outcomes in patients treated with MC were reviewed from January
2010 to November 2019. Outcomes evaluated include All-cause mortality, New
York Heart Association (NYHA) class, readmission for heart failure or
mitral regurgitation (MR) severity at the longest follow up. Pooled odds
ratio (OR) and 95% confidence interval (CI) were calculated using random
effects models. Result(s): Eleven studies with 16,469 patients (9931
males and 6538 females) were included. There was no difference in
all-cause mortality (OR: 1.05, 95% CI: 0.91-1.21, p=0.50), MR severity
(OR: 0.74, 95% CI: 0.39-1.39, p=0.35) or readmission for heart failure
(OR: 0.87, 95% CI: 0.53-1.43, p=0.58). However, NYHA class III/IV was more
frequent in female patients as compared to male patients at the end of
follow up (OR: 0.64, 95% CI: 0.52-0.79, p<0.0001). Conclusion(s): Our
meta-analysis suggests that female patients have worse NHYA functional
class after MC without any difference in allcause mortality, readmissions
for heart failure or MR severity when compared to male patients. (Figure
Presented) .

<86>
Accession Number
632520482
Title
Transradial vs. transfemoral secondary access for transfemoral
transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S169-S170),
2020. Date of Publication: May 2020.
Author
Jhand A.; Apala D.R.; Dhawan R.; Katta N.; Goldsweig A.M.
Institution
(Jhand, Dhawan, Goldsweig) University of Nebraska Medical Center, United
States
(Apala) Creighton University, United States
(Katta) University of Nebraska Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transradial access (TRA) is increasingly used as an
alternative to transfemoral access (TFA) for secondary access in
transfemoral transcatheter aortic valve replacement (TF-TAVR). We
performed a meta-analysis to compare outcomes between TRA and TFA.
 Method(s): PubMed, EMBASE, Scopus and CINAHL were systematically
searched for studies comparing TRA and TFA as secondary access sites for
TF-TAVR. Data collected included procedural characteristics, contrast
volume, fluoroscopy time and radiation dose. Inhospital outcomes included
all-cause mortality, stroke, vascular complications and major bleeding.
Risk ratio (RR), standardized mean difference (SMD) and corresponding 95%
confidence interval (CI) was calculated using a random effect model.
 Result(s): Five observational studies comprising 1183 patients (TRA:
572, TFA: 611) met inclusion criteria. Secondary access was utilized for
aortography during valve deployment and management of primary access site
complications. There were no significant differences in contrast volume
used, fluoroscopy time or radiation dose (Figure 1). The incidence of
death and vascular complications was similar in both groups. However, the
incidence of stroke (RR: 0.29, 95% CI: 0.12-0.72, p=0.008) and major
bleeding (RR: 0.48, 95% CI: 0.31-0.75, p=0.001) were lower in TRA.
 Conclusion(s): Our meta analysis favors TRA over TFA as a safer
secondary access approach for TF-TAVR.

<87>
Accession Number
632520478
Title
Prognosis of claims-vs. Trial-based ischemic and bleeding events occurring
beyond 1 year after coronary stenting: Findings from the EXTEND-DAPT
study.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S204), 2020.
Date of Publication: May 2020.
Author
Butala N.
Institution
(Butala) MGH, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: The use of administrative claims to ascertain outcomes in
cardiovascular clinical trials offers opportunity to improve data
collection and reduce trial costs. However, it is unknown whether events
identified with claims have similar prognosis compared to trialadjudicated
events. Method(s): We matched 1,336 patients >=65 years old who
received percutaneous coronary intervention (PCI) in the Dual Antiplatelet
Therapy (DAPT) Study with the National Cardiovascular Data Registry
CathPCI Registry linked to Medicare claims. We compared death at 21 months
post-randomization among patients with ischemic (myocardial infarction or
stroke) events and bleeding events identified with both trial adjudication
and claims, with trial adjudication only, and with claims only using Cox
proportional hazards models. Result(s): A total of 50 patients had
ischemic events identified with both trial adjudication and claims, 22 had
trial-adjudicated ischemic events only, 14 had ischemic events in claims
only, and 1250 had no ischemic events, with annualized mortality rates of
13.6%, 6.1%, 10.1%, and 1.26%, respectively. The hazard ratios for
mortality following an ischemic event were 22.5 (95% Confidence Interval
(CI): 10.3-49.0) when identified with trial adjudication and claims, 10.5
(95% CI: 2.45-44.7) when identified with trial adjudication only, and 22.6
(95% CI: 4.91-95.0) when identified with claims only. A total of 51
patients had bleeding events identified with both trial adjudication and
claims, 12 had trial-adjudicated bleeding events only, 59 had bleeding
events in claims only, and 1214 had no bleeding events, with annualized
mortality rates of 15.6%, 11.4%, 8.1%, and 0.95%, respectively. The hazard
ratios for mortality following a bleeding event were 21.5 (95% CI:
14.7-67.8) when identified with trial adjudication and claims, 40.6 (95%
CI: 9.19-179.2) when identified with trial adjudication only, and 21.8
(95% CI: 8.8-53.4) when identified with claims only. Conclusion(s):
In addition to trial-adjudicated events, ischemic and bleeding events
ascertained using claims were prognostically significant for death. Claims
may help identify additional clinically meaningful outcomes in future
cardiovascular clinical trials.

<88>
Accession Number
632520474
Title
The association between pre-existing atrial fibrillation and the long-term
outcomes among patients who underwent transcatheter mitral valve repair: A
systemic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S70-S71),
2020. Date of Publication: May 2020.
Author
Limpruttidham N.; Riangwiwat T.; Mekritthikrai R.; Prasitlumkum N.
Institution
(Limpruttidham, Mekritthikrai, Prasitlumkum) University of Hawaii,
Internal Medicine Residency Program, United States
(Riangwiwat) Geisinger Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter mitral valve repair (TMVR) is a novel
intervention to treat patients with symptomatic degenerative severe mitral
valve regurgitation (MR) with a high or prohibitive surgical risk. Atrial
fibrillation (AF) is an abnormal cardiac rhythm that is prevalent among
patients with severe MR. Recent studies suggest that pre-existing AF is
associated with an increase in all-cause mortality in patients undergoing
TMVR, although the relationship is inconclusive. Thus, we conducted a
systematic review of the literature and a meta-analysis to investigate
this association. Method(s): We comprehensively searched the
databases of PUBMED, MEDLINE, and EMBASE from the inception to December
2019. Included studies were published studies that reported an association
between pre-existing AF and long-term outcomes among patients who
underwent TMVR. Data from each study were systematically combined with a
random-effects, generic inverse variance method to calculate pooled risk
ratios and their 95% confidence intervals. Sensitivity analysis, funnel
plots, and Egger's tests were assessed for the validity of the results.
 Result(s): Ten observational studies were included in this
meta-analysis involving 12,808 patients undergoing TMVR. Pre-existing AF
was associated with a pooled 38.5% increase in all-cause mortality rate
(pooled risk ratio 1.385, 95% confidence interval 1.243 to 1.543, p-value
< 0.001). In addition, pre-existing AF was associated with increased
cardiovascular mortality (pooled risk ratio 1.700, p-value 0.059), heart
failure hospitalization (pooled risk ratio 1.168, p-value 0.040), and a
composite outcome between heart failure hospitalization and mortality
(pooled risk ratio 1.623, p-value 0.054). Sensitivity analysis showed no
significant deviation from the 95% confidence interval of the pooled risk
ratios. There was no significant evidence of publication bias from the
funnel plots and Egger's tests. Conclusion(s): Among patients
undergoing TMVR, pre-existing AF is associated with poor outcomes,
including higher all-cause mortality, cardiovascular mortality, and heart
failure hospitalization. Further study is necessary to identify
interventions that improve outcomes in these high-risk patients.

<89>
Accession Number
632520457
Title
Comparison of coronary artery bypass grafting with percutaneous coronary
intervention in patients with left ventricular systolic dysfunction.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S200-S201),
2020. Date of Publication: May 2020.
Author
Khan M.R.; Kayani W.; Pelton J.T.; Ansari A.; Paniagua D.; Khalid M.;
Denktas A.E.; Changezi H.U.; Munir A.; Alam M.; Jneid H.
Institution
(Khan) McLaren Flint-Michigan State University, United States
(Kayani, Pelton, Ansari, Khalid, Alam) Baylor College of Medicine, United
States
(Paniagua) Texas Heart Institute/Baylor, United States
(Denktas, Jneid) Baylor College of Medicine, Michael E. DeBakey Veterans
Affair Medical Center, United States
(Changezi) Regional Cardiology Associates, PLC, United States
(Munir) Hurley Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: There is a paucity of data on the optimal strategy of
revascularization for patients with coronary artery disease (CAD) and left
ventricular dysfunction (LVD) (ejection fraction (EF) <=50%).
 Method(s): We performed an aggregate data meta-analysis of clinical
outcomes (all-cause mortality, stroke, myocardial infarction (MI),
revascularization and a composite outcome of death, MI, stroke and
revascularization (MACCE)) and included studies on data comparing coronary
artery bypass (CABG) with percutaneous coronary intervention (PCI) for CAD
in LVD. An extensive literature search identified 20 studies (3
randomized, 17 observational) and 17,889 patients. Effect size was
estimated using a random-effects model. Result(s): Baseline
characteristics were comparable. At 30-days followup, CABG had comparable
all-cause mortality with PCI but a significantly higher odds of stroke
(odds ratio (OR) 4.73 [1.66-13.48]). At a weighted mean follow-up of
5-years, CABG had lower risk of all-cause mortality compared to PCI (CABG:
19.7%, PCI: 25.8% (OR 0.78 [0.69-0.89]), a trend which was consistent in
patients with EF <=35% (OR 0.59 [0.44-0.79]). PCI and CABG had comparable
rates of stroke at long-term follow-up while CABG had a decreased risk of
repeat revascularization (OR 0.26 [0.16-0.42]). (Figure 1. Forest plot of
allcause mortality at long-term follow-up)Conclusions: Compared to PCI,
CABG was associated with lower risk of long-term mortality and
revascularization but increased risk of upfront stroke in patients with
LVD. However, the data included comprised of predominantly observational
studies, highlighting the paucity and need for randomized trials.

<90>
Accession Number
632520445
Title
Quality of life between percutaneous coronary intervention and coronary
artery bypass graft: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S103-S104),
2020. Date of Publication: May 2020.
Author
Haseeb A.; Saqib N.; Bilal M.; Hafeez H.; Mian R.; Pir M.S.; Ahmad M.M.;
Rajagopalan S.; Boruah P.
Institution
(Haseeb, Saqib, Pir, Rajagopalan) Wright Center for Graduate Medical
Education, United States
(Bilal) Dow University of Health Sciences, Pakistan
(Hafeez, Mian, Boruah) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Ahmad) Aurora Health Care, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Quality of life (QoL) is an important tool for decisionmaking
and operational planning with regards to patient outcomes. Our group has
previously reported a cumulative QoL benefit of CABG over PCI at 1 year.
However with the advent of newer generation stents, an updated analysis
was performed. Method(s): A meta-analysis was conducted to compare
the QoL at 1-year between patients undergoing PCI and CABG using the
Seattle Angina Questionnaire (SAQ). An extensive search on PubMed,
Cochrane, EMBASE, and MedLine was done. Initial search with PCI and CABG
yielded 3,149 studies; adding "quality" narrowed to 298. Seven studies
with a total of 12,634 patients (7,034 PCI and 5,591 CABG) were
identified. A study-level analysis was done using Review Manager 5.3. A
Mantel-Haenszel Random-effects model was used to calculate the pooled mean
for homogeneous endpoints. The results are reported as mean with 95%
confidence intervals (CIs) and p-value <0.05 was considered significant.
 Result(s): QoL at 1-year using the SAQ was not statistically
different for CABG when compared with PCI with average intervention effect
[OR= -2.69; 95% CI=-5.36-0.26] and p-value 0.07 as shown in the forest
plot (Figure) with improved trend likely secondary to newer generation
stents. Conclusion(s): QoL evaluation at 1-year has no significant
difference between PCI and CABG contrary to the results published by our
group in previous meta-analysis. This is likely contributed by the newer
data showing better outcomes with the use of newer generation stents.
(Table Presented) .

<91>
Accession Number
632520433
Title
Machine learning-based in-hospital mortality prediction for transcatheter
mitral valve repair in The United States.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S68), 2020.
Date of Publication: May 2020.
Author
Suarez D.F.H.; Kim G.; Villablanca P.; Wiley J.M.; Roche-Lima A.
Institution
(Suarez, Roche-Lima) University of Puerto Rico, School of Medicine, United
States
(Kim) Yale New Haven Hospital, United States
(Villablanca) Henry Ford Health System, United States
(Wiley) Montefiore Medical Center, Albert Einstein College of Medicine,
United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter mitral valve repair (TMVr) utilization has
increased significantly in the United States over the last years. Yet, a
risk prediction tool for adverse events has not been developed. We aimed
to generate a machine learning-based algorithm to predict inhospital
mortality after TMVr. Method(s): Patients who underwent TMVr between
2012 and 2015 were identified using the national inpatient sample (NIS)
database. The study population was randomly divided into a training set
(n=636) and a testing set (n=213). Prediction models for in-hospital
mortality were obtained using five supervised machine learning
classifiers. Result(s): A total of 849 TMVr were analyzed in our
study. The overall in-hospital mortality was 3.1%. A naive Bayes (NB)
model had the best discrimination for fifteen variables with an Area Under
the Curve of 0.83 (95% CI, 0.80-0.87) compared to 0.77 for logistic
regression (95% CI, 0.58-0.95), 0.73 for artificial neural network (95%
CI, 0.55-0.91) and 0.67 for both random forest and support vector machine
(95% CI, 0.47-0.87). However, both random forest and logistic regression
models obtained for ten variables were as good as the best NB model with
an AUC=0.82 (95% CI, 0.79-0.86, p=0.34). History of coronary artery
disease, renal failure and smoking were the three most significant
predictors of in-hospital mortality. Conclusion(s): We developed a
robust machine learning-derived model to predict in-hospital mortality in
patients undergoing TMVr. While the best model was obtained by NB,
conventional logistic regression generated an alternative model with a
comparable performance.

<92>
Accession Number
632520428
Title
Multiple arterial grafts versus single arterial graft for multi-vessel
coronary artery bypass graft surgery; A systematic review and
meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S197-S198),
2020. Date of Publication: May 2020.
Author
Changal K.H.; Mir T.; Elzanaty A.M.; Patel M.; Nazir S.; Syed M.; Masroor
S.; Eltahawy E.A.
Institution
(Changal, Elzanaty, Patel, Nazir, Masroor) University of Toledo, United
States
(Mir) DMC/Wayne State University, United States
(Syed, Eltahawy) University of Toledo Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Observational studies have shown long term mortality benefit
with multiple arterial graft (MAG) coronary artery bypass graft surgery
(CABG) compared to single arterial grafts (SAGs) in multi-vessel coronary
artery disease. However, randomized controlled trials (RCTs) have not
shown a survival advantage of MAGs compared to SAG. A recent meta-analysis
of observational studies concluded that unmeasured confounders, rather
than biological superiority, may explain the survival advantage of MAGs in
observational series. The aim of our study is to perform a meta-analysis
of the RCTs to compare outcomes following MAGs and SAGs. Method(s):
We searched PUBMED, MEDLINE, EMBASE, and Clinicaltrials.gov for RCTs
comparing MAG versus SAG CABG. The clinical outcomes were studied at
maximum follow up and included all-cause mortality, cardiac mortality,
myocardial infarction (MI), revascularization, sternal wound
complications, and major bleeding. We used odds ratio (OR) and
corresponding 95% confidence interval (CI) for measuring outcomes.
 Result(s): A total of 10 RCTs (6392 patients) were included. The
average follow-up in the studies was 4.2 years (range 1-10 years). Average
age of patients was 67.2 years. Women formed 25% of the study population.
No statistically significant difference was seen between MAG and SAG
groups for all-cause mortality (11.8% vs. 12.7%, OR 0.93, 95% CI
0.67-1.16, P 0.37), cardiac mortality (1.8% vs. 2.8%, OR 0.61 95% CI
0.34-1.09, P 0.09), MI (3.4% vs. 4.9%, OR 0.84 95% CI 0.65-1.09, P 0.14),
repeat revascularization (7.3% vs. 9%, OR 0.63 95% CI 0.38-1.02, P 0.06),
and major bleeding (3.4% vs. 4.8%, OR 0.77 95% CI 0.46-1.29, P 0.20). MAG
group showed a higher incidence of sternal wound complication compared to
SAG (3% vs. 1.7%, OR 1.71 95% CI 1.15-2.55, P 0.008). Conclusion(s):
MAGs and SAGs for CABG have similar all-cause mortality, cardiac
mortality, revascularization rates, MI and bleeding complications. Sternal
wound complications are more in MAG group. Although, prior non-randomized
data has suggested MAGs to be better than SAGs and resulted in MAG being a
class Iia recommendation in the Society of Thoracic Surgeons guidelines
for CABG. Our meta-analysis of data from RCTs challenges this.

<93>
Accession Number
632520425
Title
Comparative effectiveness of coronary revascularization strategies on
mortality for acute coronary syndrome in older adults.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S196-S197),
2020. Date of Publication: May 2020.
Author
Shah A.I.; Dontsi M.; Rana J.S.; Solomon M.D.; Krishnaswami A.
Institution
(Shah, Rana, Solomon, Krishnaswami) Kaiser Permanente, United States
(Dontsi) Kaiser Permanente Department of Reasearch, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Contemporaneous data is needed on the comparative
effectiveness of coronary artery bypass grafting (CABG) and multi-vessel
percutaneous coronary intervention (PCI) in older patients presenting with
acute coronary syndrome (ACS). Method(s): Observational cohort study
of patients >= 65 years admitted for ACS and referred for coronary
angiogram between 2010-2018 in a large integrated healthcare delivery
system in Northern California. Patients with significant Left Main disease
and/or multi-vessel coronary disease undergoing CABG or PCI were included.
Patients with a prior CABG history or cardiac arrest within 24 hours were
excluded. Baseline demographics, comorbidities (Elixhauser index) and
angiographic details were obtained using validated algorithms from health
plan databases. Primary outcome was all-cause mortality. Multivariable Cox
models were used to estimate adjusted hazard ratios (HR) for the primary
exposure. Result(s): In 4,336 patients (32% female), CABG patients
(n=1,849) were younger (73.4+/-5.9 vs 75.6+/-7.3, p<.001) with a higher
comorbidity burden (Elixhauser Index 7.0+/-3.3 vs 6.5+/-3.6, p= <.001)
than PCI (n=2,487) patients. Over a mean follow-up time of 3.8 years (+/-
2.4 years), the risk-adjusted HR for mortality was 0.60 (95% CI 0.5-0. 7,
p<0.0001) for patients who underwent CABG. Conclusion(s): In this
observational study of older ACS patients with Left Main or multi vessel
coronary disease, CABG was associated with reduced mortality when compared
to contemporary PCI. Randomized trials are needed in this older population
to determine the optimum revascularization strategy.

<94>
Accession Number
632520415
Title
Transcatheter vs. surgical aortic valve replacement in renal transplant
patients : A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S164-S165),
2020. Date of Publication: May 2020.
Author
Mir T.; Darmoch F.; Al-khadra Y.; Pacha H.M.; Sattar Y.; Ullah W.; Ajmal
R.; Vacek T.P.; Gardi D.O.; Ali O.E.; Hakim Z.; Alraies M.C.
Institution
(Mir) DMC/Wayne State University, United States
(Darmoch) Beth Israel Deaconess Medical center, Harvard School of
Medicine, United States
(Al-khadra) Cleveland Clinic Foundation, United States
(Pacha) University of Texas Health Science Center, McGovern Medical
School, Memorial Hermann Heart and Vascular Institute, United States
(Sattar) Icahn School of Medicine at Mount Sinai Elmhurst, United States
(Ullah) Abington Jefferson Health, United States
(Ajmal, Vacek) Wayne State University, Detroit Medical Center Harper
Hospital, United States
(Gardi, Ali, Hakim, Alraies) Detroit Medical Center Heart Hospital, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcutaneous aortic valve replacement (TAVR) is approved in
high risk surgical patients. Its use in kidney transplant patients is
still debated. We are comparing TAVR vs surgical aortic valve replacement
(SAVR) mortality outcome, in severe aortic valve stenosis patients with
kidney transplant Methods: Data search was done by two independent persons
from PubMed, google scholar, Cochrane with key words "TAVR", "SAVR",
"outcome" and "kidney transplant". Only three trials were available with
direct comparison of TAVR vs SAVR in kidney transplant patients. We
compared mortality outcome in kidney transplant patients who had TAVR vs
SAVR. Result(s): Total of 369 studies, TAVR-109 and SAVR-260. Both
30-day mortality and 1-year mortality was studied in both groups in all 3
studies. TAVR was associated with lower mortality as compared with SAVR at
30-days and hospital discharge time (OR [odds ratio] of 0.72; CI 95%
[Confidence interval] of 0.27-1.91). However, TAVR mortality was higher as
compared to SAVR at 1-year (OR-1.62; CI 95% is 1.06-2.50) Fig. 1.3.
 Conclusion(s): although TAVR is associated with lower mortality at 30
days, SAVR had lower mortality at 1 year in patients with renal
transplant.

<95>
Accession Number
632520402
Title
Five years outcomes of left main unprotected percutaneous coronary
intervention versus coronary artery bypass surgery; a meta-analysis of
randomized trials.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S194-S195),
2020. Date of Publication: May 2020.
Author
Khan M.U.; Khan M.Z.; Lone A.N.; Valavoor S.; Khan S.U.
Institution
(Khan, Khan, Lone, Valavoor, Khan) West Virginia University, School of
Medicine, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Randomized trials for left main coronary artery disease
lesions have shown encouraging results for patients undergoing PCI. There
is paucity of data for long term outcomes. Our study aims to investigate
long-term efficacy of PCI vs CABG Methods: Four randomized controlled
trials reporting long term outcomes of unprotected left main coronary
artery disease undergoing revascularization comparing PCI with CABG were
included. Outcomes were pooled using random effects model. The primary
summary measure was risk ratio (RR) with 95 % confidence interval (CI)
Results: Four trials included a total 4394 patients with left main
coronary artery disease were randomly assigned to PCI or CABG arm. As
compared to PCI, patients treated with CABG had reduced risk of MACE
(RR:1.25; 95%CI 1.12-1.40, p=0.0001), MI(RR:1.56; 95%CI 1.002-2.43,
p=0.05), and revascularization(RR:1.70; 95%CI 1.44-1.99, p<0.0001) at 5
years. There was no significant difference in all-cause mortality
(RR:1.07; 95%CI 0.83-1.38, p=0.6), cardiovascular mortality(RR:1.04; 95%CI
0.74-1.46, p=0.8) and risk of stroke(RR:0.89; 95%CI 0.41-1.91, p=0.7).
 Conclusion(s): PCI was non inferior to CABG at 5 years for all-cause
mortality, cardiovascular mortality and stroke. Long term outcomes at 5
years for MI, MACE and revascularization were significantly better in CABG
patients.

<96>
Accession Number
632520395
Title
An updated meta-analysis comparing transcatheter aortic valve replacement
with surgical aortic valve replacement for severe aortic stenosis
encompassing all patient risk (Low, Intermediate, High-Prohibitive)
groups.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions Virtual
Conference, SCAI 2020. United States. 95 (Supplement 2) (pp S225-S227),
2020. Date of Publication: May 2020.
Author
Vij A.; Kassab K.; Ravi V.; Siddamsetti S.; Kodumuri V.K.
Institution
(Vij, Ravi) Rush University Hospital, United States
(Kassab, Siddamsetti) John H. Stroger Jr. Hospital of cook County, United
States
(Kodumuri) John Stroger Hospital of Cook County, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has shown
promising results in treatment of aortic stenosis from prohibitive to now
low risk patient population. We performed a metaanalysis encompassing all
available data to assess efficacy and safety of TAVR vs. SAVR.
 Method(s): We performed a systematic literature search for studies
that compared TAVR vs. SAVR in all-comer patients, irrespective of risk
profile. Only randomized controlled trials (RCT's) were included. Outcomes
of all-cause mortality, cardiovascular mortality, hospitalization, rate of
new onset of atrial fibrillation (AF), need for permanent pacemaker (PPM)
placement, stroke, renal failure, vascular complications and major
bleeding were analyzed. Separate subgroups analysis was done in low and
intermediate-high risk group. Mantel-Haenszel random-effects model was
used to estimate risk ratio (RR) and 95% confidence intervals (CI).
 Result(s): Eight RCT's were included with a total of 7906 patients.
Mean age was 79.4 years and mean STS score was 4.8 (TAVR) and 4.9 (SAVR).
There was no statistically significant difference in outcome of all-cause
mortality; {RR =1.05, [95% (CI), 0.95 to 1.15]; p =0.29} or in
cardiovascular mortality, hospitalization or stroke. There was a
statistically higher risk of need for PPM and vascular complication in the
TAVR arm. However, compared to TAVR, SAVR had higher risk of new onset AF,
major bleeding and renal failure. Conclusion(s): TAVR is a reasonable
alternative to SAVR. There is no difference in all-cause mortality when
analyzed for all-comers irrespective of STS score. TAVR efficacy and
safety appears to be superior to SAVR in low risk patients.

<97>
Accession Number
2004841104
Title
The evolution of mitral valve surgery: The future in the hand of robots.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 555-564), 2020.
Date of Publication: 2020.
Author
Harky A.; Kwok H.T.; Fan K.S.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool, United Kingdom
(Kwok) Leicester Medical School, Leicester, United Kingdom
(Fan) St. George's, University of London, London, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To examine the current literature behind the evolution of
mitral valve surgery techniques and their impact on patient outcomes.
 Method(s): An electronic literature search among major databases was
performed (PubMed, Embase, Scopus, Cochrane, and Google scholar). All the
relevant articles were screened and identified to be included in this
narrative review. The main outcomes were postoperative morbidity, length
of in-hospital stay, and long-term mortality. Result(s): Minimally
invasive and robot-assisted approach to mitral valve repair and
replacements has shown great potential in improving surgical outcomes when
compared against traditional midline sternotomy. Selected patients can
benefit from percutaneous mitral valve surgery; however, more evidence is
required to ascertain its long-term outcomes. Conclusion(s): Current
evidence suggests that robotic and minimal invasive mitral valve surgeries
are increasing in practice with satisfactory perioperative and mortality
rates. However, long-term data is yet to be published to support current
practice. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<98>
Accession Number
2007368720
Title
Long-Term Survival Following Transcatheter Mitral Valve Repair: Pooled
Analysis of Prospective Trials with the Carillon Device.
Source
Cardiovascular Revascularization Medicine. 21 (6) (pp 712-716), 2020. Date
of Publication: June 2020.
Author
Lipiecki J.; Kaye D.M.; Witte K.K.; Haude M.; Kapadia S.; Sievert H.;
Goldberg S.L.; Levy W.C.; Siminiak T.
Institution
(Lipiecki) Centre de Cardiologie Interventionnelle, Elsan, pole Sante
Republique, Clermont-Ferrand, France
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, Australia
(Witte) Leeds Institute for Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Haude) Medical Clinic I Stadtische Kliniken Neuss Lukaskrankenhaus,
Neuss, Germany
(Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Sievert) CardioVascular Center Sankt Katharinen, Frankfurt, Germany
(Sievert) Anglia Ruskin University, Chelmsford, United Kingdom
(Goldberg) Tyler Heart Institute at Community Hospital of the Monterey
Peninsula, Monterey, CA, United States
(Goldberg) Cardiac Dimensions, Kirkland, WA, United States
(Levy) Advanced Heart Failure, Division of Cardiology, University of
Washington Heart Institute, Seattle, WA, United States
(Siminiak) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose: To report long-term survival and to identify potential
determinants of survival among patients receiving treatment for functional
mitral regurgitation (FMR) with the Carillon device. Method(s): This
was a post hoc analysis in which we pooled prospectively collected data
from three studies of the Carillon device with available long-term vital
status data. Patient eligibility in these trials specified symptomatic
congestive heart failure despite guideline-directed medical therapy, grade
2 to 4 FMR, left ventricular enlargement, and reduced ejection fraction.
Echocardiographic parameters were available through the 12-month visit and
vital status was available through 5 years. The association of patient
characteristics and changes in echocardiographic parameters at 6 and 12
months with long-term survival was analyzed using Cox proportional hazards
regression. Result(s): A total of 74 patients (mean age 67 years, 72%
male, 59% MR grade 3 or 4) were treated with the Carillon device. Over 1
year of follow-up, the New York Heart Association (NYHA) class decreased
in 64% of patients, distance on the 6-minute walk test increased, and
echocardiographic measures indicated significant decreases in MR grade and
favorable left ventricular remodeling. The Kaplan-Meier survival rate was
83.6% at 1 year, 73.1% at 2 years, 67.9% at 3 years, and 56.2% at 4 and 5
years of follow-up. Primary determinants of long-term survival were a
decrease in NYHA class, an increase in 6-minute walk test distance, and a
decrease in regurgitant volume during the first year of follow-up.
 Conclusion(s): Among patients with congestive heart failure and grade
2 to 4 FMR who were symptomatic despite guideline-directed medical
therapy, transcatheter mitral valve repair with the Carillon device
resulted in a favorable 5-year survival rate. The survival benefit was
greatest among patients with improvement in clinical and hemodynamic
parameters during the first year of follow-up. Copyright © 2020

<99>
Accession Number
2004841103
Title
Three-dimensional printing: Is it useful for cardiac surgery?.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 549-554), 2020.
Date of Publication: 2020.
Author
de Oliveira M.A.B.; Dos Santos C.A.; Brandi A.C.; Botelho P.H.H.; Braile
D.M.
Institution
(de Oliveira) Department of Cardiac Surgery, Hospital Santo Antonio and
Femina Cuiaba, Sinop, Mato Grosso, Brazil
(de Oliveira) Department of Cardiovascular Surgery, Universidade Federal
do Mato Grosso, Sinop, Mato Grosso, Brazil
(Dos Santos, Brandi, Botelho, Braile) Hospital de Base, Sao Jose do Rio
Preto, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Introduction: The medical use of three-dimensional (3-D) images has been a
topic in the literature since 1988, but 95% of papers on 3-D printing were
published in the last six years. The increase in publications is the
result of advances in 3-D printing methods, as well as of the increasing
availability of these machines in different hospitals. This paper sought
to review the literature on 3-D printing and to discuss thoughtful ideas
regarding benefits and challenges to its incorporation into cardiothoracic
surgeons' routines. Method(s): A comprehensive and systematic search
of the literature was performed in PubMed and included material published
as of March 2020. Result(s): Using this search strategy, 9,253
publications on 3-D printing and 497 on "heart" 3-D printing were
retrieved. Conclusion(s): 3-D printed models are already helping
surgeons to plan their surgeries, helping patients and their families to
understand complex anatomy, helping fellows and residents to practice
surgery, even for rare cases, and helping nurses and other health care
staff to better understand some conditions, such as heart
diseases. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<100>
Accession Number
2004841038
Title
Nursing guidelines on cardiac surgery and parents' anxiety: Randomized
clinical trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 437-444), 2020.
Date of Publication: 2020.
Author
Xavier I.B.M.; Biscarra V.B.; Piccoli A.B.; Rodrigues C.G.; Hirakata V.N.;
de Moraes M.A.P.; Pellanda L.C.
Institution
(Xavier, Biscarra, Piccoli, de Moraes, Pellanda) Instituto de
Cardiologia/Fundacao, Universitaria de Cardiologia - IC/FUC, Porto Alegre,
RS, Brazil
(Rodrigues, Pellanda) Universidade Federal de Ciencias da Saude de Porto
Alegre, Porto Alegre, RS, Brazil
(Hirakata) Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: The preparation of parents of children who should undergo
cardiac surgery requires special treatment such as the explanations about
the event. This study aims to compare the effects of standardized nursing
guidelines with routine institutional orientation on the anxiety of
parents of children undergoing cardiac surgery. Method(s): Randomized
clinical trial. The sample consisted of parents of children who underwent
cardiac surgery from December 2010 to April 2011. Twenty-two parents were
randomized to the intervention group (IG) and received the standard
nursing guidelines and 22 participated in the control group (CG) and
received the routine guidelines from the institution. Anxiety was assessed
by the State-Trait Anxiety Inventory (STAI) applied in the preoperative
period, between 12 and 20 hours before surgery and before receiving
standard or institutional guidelines and 48 hours after surgery. The
analysis of variance (ANOVA) for repeated measures was performed to
evaluate the differences between the variations in STAI scores between the
groups during the studied period. The level of significance was 0.05.
 Result(s): There were no significant differences in baseline anxiety
scores between groups with regard to trait anxiety as well as state
anxiety: STAI-trait (CG 42.6+/-4.9 vs. IG 41.4+/-6.0, P=0.48); STAI-state
(CG 42.3+/-5.7 vs. IG 45.6+/-8.3, P=0.18). Likewise, the variation in
score after 48 hours was similar between groups (STAI-trait P=0.77;
STAI-state P=0.61). Conclusion(s): There were no significant
differences in the parents' anxiety levels when comparing the two types of
guidelines: the standard nursing and the institutional
orientation. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<101>
Accession Number
2004841037
Title
Which is the optimal frozen elephant trunk? A systematic review and
meta-analysis of outcomes in 2161 patients undergoing thoracic aortic
aneurysm surgery using e-vita open plus hybrid stent graft versus
thoraflexTM hybrid prosthesis.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 427-436), 2020.
Date of Publication: 2020.
Author
Harky A.; Fok M.; Bashir M.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Fok) Department of Vascular Surgery, Royal Liverpool Hospital, Liverpool,
United Kingdom
(Bashir) Vascular Surgery Department, Royal Blackburn Teaching Hospital,
Haslingden Rd, Blackburn, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To systematically review the rate of morbidity and mortality
associated with the use of E-vita hybrid stent graft and ThoraflexTM in
patients undergoing complex aortic surgery. Method(s): A
comprehensive search was undertaken among the four major databases to
identify published data about E-vita or ThoraflexTM in patients undergoing
repair of thoracic aortic aneurysms. Result(s): In total, 28 papers
were included in the study, encompassing a total of 2,161 patients (1,919
E-vita and 242 ThoraflexTM). Patients undergoing surgery with E-vita or
ThoraflexTM were of similar age and sex. The number of patients undergoing
non-elective repair with ThoraflexTM was higher than with E-vita (35.2%
vs. 28.7%, respectively). Cardiopulmonary bypass time was associated with
increasing mortality in E-vita patients, however a meta-analysis of
proportions showed higher 30-day mortality, permanent neurological
deficit, and one-year mortality for ThoraflexTM patients. Direct
statistical comparisons between E-vita and ThoraflexTM was not possible
due to heterogeneity of studies. Conclusion(s): Although there are
limited studies available, the available data suggests that mortality and
morbidity are lower for the E-vita device in thoracic aortic aneurysm
surgery than for ThoraflexTM. Long-term data of comparative studies do not
yet exist to assess viability of these procedures. Copyright ©
2020, Sociedade Brasileira de Cirurgia Cardiovascular. All rights
reserved.

<102>
[Use Link to view the full text]
Accession Number
632514566
Title
Continuous Lactate Measurement Devices and Implications for Critical Care:
A Literature Review.
Source
Critical Care Nursing Quarterly. 43 (3) (pp 269-273), 2020. Date of
Publication: 01 Jul 2020.
Author
Chavez J.; Glaser S.; Krom Z.
Institution
(Chavez, Krom) Critical Care Services, Cedars-Sinai Medical Center, 8700
Beverly Blvd, Los Angeles, CA 90048, United States
(Glaser) SSG Nurse Anesthesia Incorporated, Los Angeles, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this article is to review the literature on lactate
measurements in critical care and the current devices used to measure
noninvasively and invasively. Lactate measurements are currently being
used as a way to measure the severity of sepsis. Intravascular and
subcutaneous devices are some of the ways that these measurements can be
continuously gathered as well as point-of-care blood tests. New devices
that are being currently used with athletes can measure lactate
noninvasively. As the advance of technology continues to move at a fast
speed, an evaluation of literature is needed to assess the continued
support of lactate and the ability to move to noninvasive devices in
critical care. A literature search was conducted in February 2020, using
PubMed, CINAHL, MEDLINE, and Cochrane databases. There remains support for
the use of lactate and continuous lactate monitoring; however, currently,
noninvasive devices are not available for the critical care environment.
There are invasive techniques that are being used to measure lactate
continuously in critical care and are beneficial for the cardiac surgery
population. The review of the literature on continuous lactate
measurements produced evidence that supports prediction of morbidity and
mortality. There are no current noninvasive lactate measurement devices
that can be used in critical care, but they are being currently used in
the athletic community. Invasive continuous lactate measurement devices
are currently being used and beneficial. Copyright © 2020
Lippincott Williams and Wilkins. All rights reserved.

<103>
Accession Number
632514286
Title
Effect of dexmedetomidine on attenuation of hemodynamic response to
intubation, skin incision, and sternotomy in coronary artery bypass graft
patients: A double-blind randomized control trial.
Source
Journal of Anaesthesiology Clinical Pharmacology. 36 (2) (pp 255-260),
2020. Date of Publication: April-June 2020.
Author
Kamal M.; Agarwal D.; Singariya G.; Kumari K.; Paliwal B.; Ujwal S.
Institution
(Kamal, Agarwal, Kumari, Paliwal) Department of Anaesthesiology and
Critical Care, All India Institute of Medical Sciences, Jodhpur,
Rajasthan, India
(Singariya, Ujwal) Department of Anaesthesiology and Critical Care, Dr S N
Medical College, 123, Vaishali Avenue, Jhanwar Road, Jodhpur, Rajasthan
342008, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background and Aims: Coronary artery bypass grafting (CABG) surgery
involves various noxious stimuli resulting in stress response, which in
turn increases the risk of perioperative myocardial ischemia. The present
study was conducted to evaluate the effect of dexmedetomidine on the
attenuation of hemodynamic response to intubation, skin incision, and
sternotomy in CABG surgery. Material(s) and Method(s): Sixty patients
were randomized into two groups of 30 each. Group D patients received
dexmedetomidine 1 micro g/kg as loading dose over 10 min, followed by
continuous infusion of 0.5 micro g/kg/h. In group P, normal saline was
infused as loading and maintenance dose at similar rate. Hemodynamic
parameters, total induction dose of thiopentone, and adverse effects were
recorded. Statistical analysis was performed using SPSS version 20.0.
Chi-square test and ANNOVA test were used and P < 0.05 was considered
significant. Result(s): The percentage increase in heart rate was
significantly lesser in group D than group P after intubation (7.04% v/s
15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s
11.65%). Similarly increase in systolic, diastolic, and mean blood
pressure were significantly lesser in group D than group P after
intubation, skin incision, and sternotomy. There was a significant
reduction of mean total of thiopentone in group D in comparison to group
P. (1.16 mg/kg v/s 2.44 mg/kg) (P< 0.001). Conclusion(s):
Dexmedetomidine resulted in significant attenuation of hemodynamic
response to intubation, skin incision, and sternotomy in CABG surgery
without significant adverse effects. It also significantly reduced the
dose of thiopentone required for induction. Copyright © 2020
Journal of Anaesthesiology Clinical Pharmacology Published by
Wolters Kluwer-Medknow.

<104>
Accession Number
2007364014
Title
Premedication with a Combination of Ketamine and Midazolam in Pediatric
Cardiac Surgical Patients: A Comparison of Nasal versus Oral Route.
Source
Journal International Medical Sciences Academy. 31 (2) (pp 100-106), 2018.
Date of Publication: June 2018.
Author
Singh A.K.; Bedi P.S.; Singh A.
Institution
(Singh, Bedi) Department of Anaesthesiology and Critical Care, Base
Hospital Delhi Cantt, New Delhi, India
(Singh) Department of Community Medicine, Base Hospital Delhi Cantt, Acms,
New Delhi, India
(Bedi) Department of Anaesthesiology and Critical Care, Base Hospital
Delhi Cantt, New Delhi 110010, India
Publisher
International Medical Sciences Academy
Abstract
Background Premedication remains the most debating thought in
anaesthesiologist's mind, while preparing paediatric patients for
anaesthesia. Paediatric patients whether cyanotic or acynaotic planned for
cardiac surgical procedures poses most challenging task, as maintaining
haemodynamic stability remains of paramount importance. Even subtle
variation in vitals as compare to normal paediatric patients, may result
in haemodynamic compromise and devastating consequences. Method Around 100
pediatric cases undergoing cardiac surgery with diagnosis of cyanotic or
acynotic heart disease were randomized into oral vs nasal group using
computer randomization. In this study children included, were of age 3
months to 5 years, weight more than 5 kgs, suffering from congenital heart
disease (cyanotic or acyanotic). Patients with known h/o allergy to
Ketamine and Midazolam and known ear nose throat disease were excluded.
After informed written consent from parents and approval of Hospital
ethical committee, premedicament a combination of Midazolam (100 ug/kg)
and Ketamine (5 mg/Kg) were administered, nasally or orally as per group
assigned. The collected data was analyzed by using epi-info statistical
software and Mann-Whitney or Wilcoxon Two-Sample Test (Kruskal-Wallis test
for two groups) was applied for analysis. Result Analysis of collected
data was done to compare the results in term of clinical effects, of
combination of Ketamine and Midazolam in oral versus nasal route in
Premedication. There is no significant variation of pulse rate,
respiratory rate and oxygen saturation from baseline data in both nasal as
well as oral group after 30 minutes. There was significant difference for
separation timing between routes of administration of drugs. Nasal was
faster than oral as within 30 minutes of drug administration around 74.50%
in nasal group got separated, whereas in oral group it was only 42.85%,
where as regarding acceptance, it was better in oral route that is 85.71%
in comparison to nasal group in which it was only 43.13%. The collected
data was analyzed by using epi-info statistical software and Mann-Whitney
or Wilcoxon Two-Sample Test (Kruskal-Wallis test for two groups) was
applied for analysis. Conclusion Combination of Ketamine (5mg/kg) and
Midazolam 0.1 mg/kg is better than individual drugs alone as described by
earlier studies. They counter each other's side effects hence this
combination has good desired clinical outcome with least side effects.
Although acceptability is better in oral route but nasal route offers
distinct advantage over oral route as premedication, in term of
reliability and rapid onset. Reason behind this is nasal mucosa is rich in
venous plexus which facilitates rapid and more reliable absorption. It
also helps in more bioavailability due to its hepatic bypass
metabolism. Copyright © 2018 International Medical Sciences
Academy. All rights reserved.

<105>
Accession Number
2007364013
Title
A Comparative Study between Isoflurane and Propofol in Fast Track Cardiac
Anaesthesia for Patients Undergoing Coronary Artery Bypass Grafting.
Source
Journal International Medical Sciences Academy. 31 (2) (pp 95-99), 2018.
Date of Publication: June 2018.
Author
Bedi P.S.; Singh A.K.; Nambiar B.C.; Singh A.; Kumar P.
Institution
(Bedi, Singh, Nambiar, Kumar) Department of Anaesthesiology and Critical
Care, Base Hospital Delhi Cantt, New Delhi, India
(Singh) Department of Community Medicine, Base Hospital Delhi Cantt, ACMS,
New Delhi, India
(Singh) Department of Anaesthesiology and Critical Care, Base Hospital
Delhi Cantt, New Delhi 110010, India
Publisher
International Medical Sciences Academy
Abstract
Introduction Fast tracking is an early tracheal extubation of patients
after cardiac surgery i.e within 4 hours. It helps in early recovery and
discharge from ICU. In this study Propofol and Isoflurane were compared as
a maintenance agent for patients undergoing coronary artery bypass
grafting (CABG). Method Around 100 patients posted for elective CABG
surgery were included in the study after approval from the hospital
ethical committee. A randomized controlled, prospective study was
conducted. In one group Isolflurane and in the other group Propofol was
used for maintenance of anaesthesia and rest of the technique was similar
in both the groups. Data was analyzed using epi-info 6 statistical
software. Statistical tests used were Mann-Whitney or Wilcoxon Two-Sample
Test (Kruskal-Wallis test for two groups). Result On analysis no
significant variation in haemodynamics was observed from baseline data.
Statistically significant differences were observed in Isoflurane vs
Propofol group regarding tidal volume (413.5 +/- 90.4 ml vs 460.4 +/- 83.7
ml (P< 0.01), Eye Opening (82.9 +/- 11.6 min vs 10.9 +/- 1.5 (P < 0.01),
Response to Verbal Commands (112.9 +/- 17.5 min vs 16.5 +/- 2.3 (P< 0.01),
extubation time (140.6 +/- 18.9 min vs 21.3 +/- 3.2 (P < 0.01) after
reversal and hence fast tracking was better in Propofol group as compare
to Isoflurane. Conclusion Fast track anaesthesia using potent and short
acting narcotics combined with short acting anaesthetics facilitates early
extubation as compared to conventional anaesthetic
techniques. Copyright © 2018 International Medical Sciences
Academy. All rights reserved.

<106>
Accession Number
2007138006
Title
Supra annular sizing for TAVR in bicuspid aortic valve stenosis: A
meta-analysis.
Source
Indian Heart Journal. (no pagination), 2020. Date of Publication: 2020.
Author
Kumar A.; Doshi R.; Shariff M.; Adalja D.; Vallabhajosyula S.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
(Adalja) Department of Medicine, Gotri Medical Education and Research
Center, Vadodara, Gujrat, India
(Vallabhajosyula) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier B.V.

<107>
Accession Number
2005788323
Title
Cholesterol lowering with EVOLocumab to prevent cardiac allograft
Vasculopathy in De-novo heart transplant recipients: Design of the
randomized controlled EVOLVD trial.
Source
Clinical Transplantation. (no pagination), 2020. Date of Publication:
2020.
Author
Broch K.; Gude E.; Karason K.; Dellgren G.; Radegran G.; Gjesdal G.;
Gustafsson F.; Eiskjaer H.; Lommi J.; Pentikainen M.; Lemstrom K.B.;
Andreassen A.K.; Gullestad L.
Institution
(Broch, Gude, Andreassen, Gullestad) Department of Cardiology, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Karason, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Radegran, Gjesdal) The Clinic for Heart Failure and Valvular Disease,
Skane University Hospital, Lund, Sweden
(Radegran) Lund University, Lund, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Lommi, Pentikainen, Lemstrom) Helsinki University Hospital Heart and Lung
Center, Helsinki, Finland
(Lemstrom) University of Helsinki, Helsinki, Finland
(Gullestad) KG Jebsen Center for Cardiac Research, University of Oslo,
Norway and Center for Heart Failure Research, Oslo University Hospital,
Norway
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac allograft vasculopathy (CAV) is characterized by
diffuse thickening of the arterial intima. Statins reduce the incidence of
CAV, but despite the use of statins, CAV remains one of the leading causes
of long-term death after heart transplant. Inhibitors of proprotein
convertase subtilisin-kexin type 9 (PCSK9) substantially reduce
cholesterol levels but have not been tested in heart transplant
recipients. Method(s): The Cholesterol lowering with EVOLocumab to
prevent cardiac allograft Vasculopathy in De-novo heart transplant
recipients (EVOLVD) trial (ClinicalTrials.gov Identifier: NCT03734211) is
a randomized, double-blind trial designed to test the effect of the PCSK9
inhibitor evolocumab on coronary intima thickness in heart transplant
recipients. Adults who have received a cardiac transplant within the past
4-8 weeks are eligible. Exclusion criteria include an estimated glomerular
filtration rate < 20 mL/min/1.73 m2, renal replacement therapy,
or contraindications to coronary angiography with intravascular
ultrasound. 130 patients will be randomized (1:1) to 12-month treatment
with evolocumab or matching placebo. The primary endpoint is the coronary
artery intima thickness as measured by intravascular ultrasound.
 Conclusion(s): The EVOLVD trial is a randomized clinical trial
designed to show whether treatment with the PCSK9 inhibitor evolocumab can
ameliorate CAV over the first year after heart transplant. Copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<108>
Accession Number
632528602
Title
Intracoronary ALLogeneic heart STem cells to Achieve myocardial
Regeneration (ALLSTAR): a randomized, placebo-controlled, double-blinded
trial.
Source
European heart journal. (no pagination), 2020. Date of Publication: 04 Aug
2020.
Author
Makkar R.R.; Kereiakes D.J.; Aguirre F.; Kowalchuk G.; Chakravarty T.;
Malliaras K.; Francis G.S.; Povsic T.J.; Schatz R.; Traverse J.H.; Pogoda
J.M.; Smith R.R.; Marban L.; Ascheim D.D.; Ostovaneh M.R.; Lima J.A.C.;
DeMaria A.; Marban E.; Henry T.D.
Institution
(Makkar, Chakravarty, Marban, Henry) Smidt Heart Institute, Cedars-Sinai
Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
(Kereiakes) The Christ Hospital, Cincinnati, 2139 Auburn Ave, Cincinnati,
OH 45219, USA
(Aguirre) Prairie/St. Johns Hospital, 800 E Carpenter St, Springfield,
United States
(Kowalchuk) Sanger Heart & Vascular, 1001 Blythe Blvd Ste 300, Charlotte,
United States
(Malliaras) University of Athens, 17 Agiou Thoma street, Athens 11527,
Greece
(Francis) University of Minnesota Heart Care, Minneapolis, 6405 France Ave
S, Edina, MN 55435, USA
(Povsic) Duke University Hospital, 2301 Erwin Rd, Durham, United States
(Schatz) Scripps Green Hospital, 10666 N Torrey Pines Rd ,La Jolla, CA
92037, United States
(Traverse) Minneapolis Heart Institute Foundation, 920 E 28th St Ste 100,
Minneapolis, United States
(Pogoda, Smith, Marban, Ascheim) Capricor Therapeutics, Los Angeles, 8840
Wilshire Blvd Ste 2, Beverly Hills, CA 90211, USA
(Ostovaneh, Lima) Johns Hopkins University, 3400 N Charles St, Baltimore
MD 21218, United States
(DeMaria) University of California San Diego Medical Center, 200 W. Arbor
Drive, San Diego, CA 92103, USA
Publisher
NLM (Medline)
Abstract
AIMS: Cardiosphere-derived cells (CDCs) are cardiac progenitor cells that
exhibit disease-modifying bioactivity in various models of cardiomyopathy
and in previous clinical studies of acute myocardial infarction (MI),
dilated cardiomyopathy, and Duchenne muscular dystrophy. The aim of the
study was to assess the safety and efficacy of intracoronary
administration of allogeneic CDCs in the multicentre, randomized,
double-blinded, placebo-controlled, intracoronary ALLogeneic heart STem
cells to Achieve myocardial Regeneration (ALLSTAR) trial. METHODS AND
RESULTS: We enrolled patients 4weeks to 12months after MI, with left
ventricular ejection fraction (LVEF) <=45% and LV scar size >=15% of LV
mass by magnetic resonance imaging (MRI). A pre-specified interim analysis
was performed when 6-month MRI data were available. The trial was
subsequently stopped due to the low probability of detecting a significant
treatment effect of CDCs based on the primary endpoint. Patients were
randomly allocated in a 2:1 ratio to receive CDCs or placebo in the
infarct-related artery by stop-flow technique. The primary safety endpoint
was the occurrence, during 1-month post-intracoronary infusion, of acute
myocarditis attributable to allogeneic CDCs, ventricular tachycardia- or
ventricular fibrillation-related death, sudden unexpected death, or a
major adverse cardiac event (death or hospitalization for heart failure or
non-fatal MI or need for left ventricular assist device or heart
transplant). The primary efficacy endpoint was the relative percentage
change in infarct size at 12months post-infusion as assessed by
contrast-enhanced cardiac MRI. We randomly allocated 142 eligible patients
of whom 134 were treated (90 to the CDC group and 44 to the placebo
group). The mean baseline LVEF was 40% and the mean scar size was 22% of
LV mass. No primary safety endpoint events occurred. There was no
difference in the percentage change from baseline in scar size (P=0.51)
between CDCs and placebo groups at 6months. Compared with placebo, there
were significant reductions in LV end-diastolic volume (P=0.02), LV
end-systolic volume (P=0.02), and N-terminal pro b-type natriuretic
peptide (NT-proBNP) (P=0.02) at 6months in CDC-treated patients.
 CONCLUSION(S): Intracoronary infusion of allogeneic CDCs in patients
with post-MI LV dysfunction was safe but did not reduce scar size relative
to placebo at 6months. Nevertheless, the reductions in LV volumes and
NT-proBNP reveal disease-modifying bioactivity of CDCs. TRIAL
REGISTRATION: Clinicaltrials.gov identifier: NCT01458405. Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. © The Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<109>
Accession Number
632527380
Title
The 'wait for symptoms' strategy in asymptomatic severe aortic stenosis.
Source
Heart (British Cardiac Society). (no pagination), 2020. Date of
Publication: 03 Aug 2020.
Author
San Roman J.A.; Vilacosta I.; Antunes M.J.; Iung B.; Lopez J.; Schafers
H.-J.
Institution
(San Roman) Cardiology, Hospital Clinico Universitario de Valladolid
Servicio de Cardiologia, Valladolid, Spain
(Vilacosta) Cardiology, Hospital Clinico Universitario San Carlos, Madrid,
Spain
(Antunes) Cardiothoracic Surgery, Centro Hospitalar de Coimbra, Coimbra,
Portugal
(Iung) Cardiology, Hopital Bichat-Claude-Bernard, Paris, France
(Lopez) Cardiology, Hospital Clinico Universitario de Valladolid Servicio
de Cardiologia, Valladolid, Spain
(Schafers) Universitat des Saarlandes, Saarbrucken, Germany
Publisher
NLM (Medline)
Abstract
Calcific aortic stenosis is a prevalent and worrisome healthcare problem.
The therapeutic approach in asymptomatic aortic stenosis is not well
established. We argue that the natural history of this disease is based on
old incomplete studies with many limitations. Likewise, studies suggesting
that replacement, either surgical or percutaneous, improves prognosis in
asymptomatic patients with severe aortic stenosis have important drawbacks
and do not support this strategy as the treatment of choice. Despite the
lack of evidence, some groups recommend early valve replacement in
patients with severe asymptomatic aortic stenosis. There are five ongoing
randomised trials which will shed light on this topic. Our conclusion is
that unless a randomised study changes the evidence, valve replacement
cannot be recommended in asymptomatic patients with severe aortic
stenosis. Copyright © Author(s) (or their employer(s)) 2020. No
commercial re-use. See rights and permissions. Published by BMJ.

<110>
Accession Number
632526951
Title
Cardiovascular CT and MRI in 2019: Review of Key Articles.
Source
Radiology. (pp 200605), 2020. Date of Publication: 04 Aug 2020.
Author
Dodd J.D.; Leipsic J.
Institution
(Dodd, Leipsic) From the Department of Radiology, St. Vincent's University
Hospital, Elm Park, Dublin D4, Ireland (J.D.D.); School of Medicine,
University College Dublin, Dublin, Ireland (J.D.D); and Department of
Radiology, University of British Columbia, St. Paul's Hospital, Vancouver,
Canada (J.L.)
Publisher
NLM (Medline)
Abstract
Cardiac imaging is becoming commonplace throughout radiology practices and
is increasingly important in large-cohort prospective cardiovascular
trials and in statements and guidelines. In this review, the authors
summarize some of the most important imaging findings relevant to clinical
practice in the past year. Key coronary CT angiography studies have
included rigorous meta-analysis of its diagnostic accuracy, prognostic
implications of adverse coronary plaque features, and sex differences. The
value of CT for catheter-delivered valve implantation (eg, transcatheter
aortic and mitral valve replacements) was further elucidated in
large-cohort outcome trials. Hypertrophic cardiomyopathy registries have
revealed distinct clinical and MRI phenotypes, highlighting different
underlying causes, while others clarified the prognostic usefulness of MRI
in hypertrophic cardiomyopathy and Fabry disease. Artificial intelligence
and/or machine learning was applied to many aspects of cardiovascular
imaging, while evidence of the benefits of both adenosine stress perfusion
cardiac MRI and coronary CT angiography-derived fractional flow reserve
from real-world trials has increased. Studies on vaping and vascular
endothelial function and the whole-body MRI depiction of metabolic
syndrome consequences were also noteworthy. Although this review focuses
on Radiology articles, key articles from high-impact clinical journals are
also included. Although not possible to detail all articles because of
space limitations, the authors attempted to highlight those with the most
pragmatic and scientific value. Copyright © RSNA, 2020.

<111>
Accession Number
2005471520
Title
Supplemental Cardioplegia During Donor Heart Implantation: A Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 110 (2) (pp 545-552), 2020. Date of
Publication: August 2020.
Author
Ribeiro R.V.P.; Friedrich J.O.; Ouzounian M.; Yau T.; Lee J.; Yanagawa B.
Institution
(Ribeiro, Ouzounian, Yau) Division of Cardiovascular Surgery, Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network,
Toronto, ON, Canada
(Ribeiro, Yau) Institute of Medical Science, University of Toronto,
Toronto, ON, Canada
(Friedrich) Critical Care and Medicine Departments and Li Ka Shing
Knowledge Institute, St. Michael's Hospital, Department of Medicine and
Interdepartmental Division of Critical Care, University of Toronto,
Toronto, ON, Canada
(Lee, Yanagawa) Division of Cardiovascular Surgery, St. Michael's
Hospital, Toronto, ON, Canada
Publisher
Elsevier USA
Abstract
Background: The optimal donor heart preservation and management strategy
during heart transplantation remains controversial. We report the results
of a systematic review and meta-analysis of the effect of supplemental
cardioplegia administration during donor heart implant for
transplantation. Method(s): We searched MEDLINE and Embase databases
until February 2019 for studies comparing patients who received
transplants with the donor heart given supplemental cardioplegia or not.
Data were extracted by 2 independent investigators. The main outcomes were
early morbidity and mortality. Result(s): Included were 7
retrospective observational studies (4 comparing to historical controls)
and 3 randomized controlled trials enrolling 1125 patients. Supplemental
cardioplegia included crystalloid and blood cardioplegia given continuous
retrograde or as terminal "hot shots." Supplemental cardioplegia was
associated with improved early mortality (risk ratio [RR], 0.55; 95%
confidence interval [CI], 0.35-0.87; P <.01), greater rates of spontaneous
return of sinus rhythm (RR, 2.62; 95% CI, 1.50-4.56; P <.01), shorter
intensive care stay (mean difference, -3.4 days; 95% CI, -5.1 to -1.6; P
<.01), and lower incidence of ischemic changes seen on endomyocardial
biopsy specimens (RR, 0.49; 95% CI, 0.35-0.69; P <.01) compared with
controls. Midterm mortality was not different between groups (incident
rate ratio, 0.80; 95% CI, 0.51-1.26; P =.34). Conclusion(s):
Administration of supplemental cardioplegia may be associated with a
reduction in organ ischemic injury and shorter intensive care stay as well
as improvement in early survival after transplantation. This strategy may
be a simple and cost-effective adjunct to improve outcomes of heart
transplantation, especially in an era of increasing use of marginal donor
organs. Further investigation will be needed to confirm the findings of
this hypothesis-generating study. Copyright © 2020 The Society of
Thoracic Surgeons

<112>
Accession Number
2005280210
Title
Infective endocarditis in patients who have undergone transcatheter aortic
valve implantation: a review.
Source
Clinical Microbiology and Infection. 26 (8) (pp 999-1007), 2020. Date of
Publication: August 2020.
Author
Ostergaard L.; Lauridsen T.K.; Iversen K.; Bundgaard H.; Sondergaard L.;
Ihlemann N.; Moser C.; Fosbol E.
Institution
(Ostergaard, Bundgaard, Sondergaard, Ihlemann, Fosbol) The Heart Centre,
Rigshospitalet, Copenhagen, Denmark
(Lauridsen) Department of Cardiology, Glostrup Hospital, Rigshospitalet,
Copenhagen, Denmark
(Iversen) Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen,
Denmark
(Moser) Department of Clinical Microbiology, Rigshospitalet, Copenhagen,
Denmark
Publisher
Elsevier B.V.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been
approved for the treatment of severe aortic stenosis since 2008 and recent
trials have shown that TAVI is at least non-inferior to surgical aortic
valve replacement (SAVR) with regards to short-term efficacy and safety in
patients across all surgical risk profiles. Prosthetic valve endocarditis
of the transcatheter heart valve is a feared complication; data on the
risk of infective endocarditis (IE) subsequent to TAVI are now gradually
emerging. Objective(s): We set forth to conduct a review of the
incidence, diagnosis, microbial aetiologies, prevention, outcome and
management of TAVI-IE. Sources: From the MEDLINE database we included a
total of 12 observational studies and five studies of long-term results
from randomized controlled trials. Content: The incidence of TAVI-IE was
reported to be between 0.7% and 3.0% per person-year. The most common
microbes were reported to be enterococci, Staphylococcus aureus,
streptococci and coagulase-negative staphylococci. International
guidelines on prevention strategies of IE recommend good sanitary
conditions including cutaneous care, good oral hygiene and good care of
dialysis catheters. Antibiotic prophylaxis is recommended by guidelines
prior to dental procedures in patients with TAVI; however, evidence is
sparse. The majority of the patients included in this review with TAVI-IE
had an indication for surgical intervention due to IE (50.0% or more);
however, only a small subset of the patients underwent surgery (16.4% or
less). The in-hospital mortality was around 25%, i.e. of the same order of
magnitude as in prosthetic valve IE in general, but varied substantially
between studies (from 11% to 64%). Implications: The US Food and Drug
Administration's approval of TAVI in patients at low surgical risk may
change the characteristics of patients with TAVI, which may influence the
incidence, management, and outcome of patients with TAVI-IE. Copyright
© 2020 European Society of Clinical Microbiology and Infectious
Diseases

<113>
Accession Number
2005268415
Title
Prognostic impact of the presence of on-duty cardiologist on patients with
acute myocardial infarction admitted during off-hours.
Source
Journal of Cardiology. 76 (2) (pp 184-190), 2020. Date of Publication:
August 2020.
Author
Marume K.; Nagatomo K.; Yamamoto N.; Kaichi R.; Mori T.; Komaki S.; Ishii
M.; Kusaka H.; Toida R.; Kurogi K.; Nagamine Y.; Takashio S.; Arima Y.;
Sakamoto K.; Yamamoto E.; Kaikita K.; Tsujita K.
Institution
(Marume, Nagatomo, Yamamoto, Kaichi, Mori, Komaki, Ishii, Kusaka, Toida,
Kurogi) Department of Cardiovascular Medicine, Miyazaki Prefecture Nobeoka
Hospital, Miyazaki, Japan
(Nagamine) Department of Emergency Center, Miyazaki Prefecture Nobeoka
Hospital, Miyazaki, Japan
(Takashio, Arima, Sakamoto, Yamamoto, Kaikita, Tsujita) Department of
Cardiovascular Medicine, Graduate School of Medicine, Kumamoto University,
Kumamoto, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Owing to reduced staffing, patients hospitalized for acute
myocardial infarction (AMI) during off-hours (nights, weekends, and
holidays) have poorer outcomes than those admitted during regular hours.
Whether the presence of an on-duty cardiologist in a hospital during
off-hours is related to better outcomes for patients with AMI remains
unclear. The Miyazaki Prefectural Nobeoka Hospital had a unique medical
care system in that cardiologists were on call for half of the week and on
duty for the other half during off-hours, thus providing an opportunity to
assess the relationship between the presence of an on-duty cardiologist
and patient outcomes. We examined clinical outcomes of patients admitted
for AMI during off-hours according to the presence of an on-duty
cardiologist. Method(s): We recruited 225 consecutive patients with
AMI hospitalized during off-hours, who underwent stent implantation at
Miyazaki Prefecture Nobeoka Hospital from 2013 to 2017. The endpoints were
in-hospital death or long-term major adverse cardiac events (MACE)
including cardiovascular death, non-fatal MI, non-fatal stroke, stent
thrombosis, ischemia-driven target-lesion revascularization, admission
owing to unstable angina, or admission owing to heart failure.
 Result(s): Based on the presence of an on-call cardiologist at
admission, we divided patients into the cardiologist on-call group (n =
112) or cardiologist on-duty group (n = 113). The presence of an on-duty
cardiologist did not affect door-to-reperfusion time (p = 0.776), level of
peak creatine kinase (p = 0.971), or in-hospital death (p = 0.776). The
Kaplan-Meier curve analysis showed similar prognosis for the cardiologist
on-duty and cardiologist on-call groups (p = 0.843), and multivariable Cox
regression analysis showed that the presence of an on-duty cardiologist
was not associated with MACE. Conclusion(s): The presence of an
on-duty cardiologist is not a prognostic factor for patients hospitalized
for AMI during off-hours in our medical system. Further prospective
multicenter studies should confirm our results. Copyright © 2020
Japanese College of Cardiology

<114>
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

<115>
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.

<116>
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).

<117>
Accession Number
2006765745
Title
Prognostic Utility of Left Ventricular Global Longitudinal Strain in
Surgery for Primary Mitral Regurgitation: A Systematic Review.
Source
JACC: Cardiovascular Imaging. 13 (8) (pp 1838-1840), 2020. Date of
Publication: August 2020.
Author
Kaur S.; Jain V.; Sadana D.; Gillinov A.M.; Desai M.Y.; Griffin B.P.; Xu
B.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<118>
Accession Number
2005841156
Title
Use of smart technology for the early diagnosis of complications after
cardiac surgery: The BOX 2.0 study protocol.
Source
Journal of Medical Internet Research. 22 (4) (no pagination), 2020.
Article Number: e16326. Date of Publication: April 2020.
Author
Biersteker T.E.; Boogers M.J.; de Lind van Wijngaarden R.A.F.; Groenwold
R.H.H.; Trines S.A.; van Alem A.P.; Kirchhof C.J.H.J.; van Hof N.; Klautz
R.J.M.; Schalij M.J.; Treskes R.W.
Institution
(Biersteker, Boogers, Trines, van Hof, Schalij, Treskes) Department of
Cardiology, Leiden University Medical Center, Leiden, Netherlands
(de Lind van Wijngaarden, Klautz) Department of Cardiothoracic Surgery,
Leiden University Medical Center, Leiden, Netherlands
(Groenwold) Department of Clinical Epidemiology, Leiden University Medical
Center, Leiden, Netherlands
(van Alem) Department of Cardiology, Haaglanden Medisch Centrum, Den Haag,
Netherlands
(Kirchhof) Department of Cardiology, Alrijne Ziekenhuis, Leiderdorp,
Netherlands
Publisher
Journal of Medical Internet Research
Abstract
Background: Atrial fibrillation (AF), sternal wound infection, and cardiac
decompensation are complications that can occur after cardiac surgery.
Early detection of these complications is clinically relevant, as early
treatment is associated with better clinical outcomes. Remote monitoring
with the use of a smartphone (mobile health [mHealth]) might improve the
early detection of complications after cardiac surgery. Objective(s):
The primary aim of this study is to compare the detection rate of AF
diagnosed with an mHealth solution to the detection rate of AF diagnosed
with standard care. Secondary objectives include detection of sternal
wound infection and cardiac decompensation, as well as assessment of
quality of life, patient satisfaction, and cost-effectiveness.
 Method(s): The Box 2.0 is a study with a prospective intervention
group and a historical control group for comparison. Patients undergoing
cardiac surgery at Leiden University Medical Center are eligible for
enrollment. In this study, 365 historical patients will be used as
controls and 365 other participants will be asked to receive either The
Box 2.0 intervention consisting of seven home measurement devices along
with a video consultation 2 weeks after discharge or standard cardiac care
for 3 months. Patient information will be analyzed according to the
intention-to-treat principle. The Box 2.0 devices include a blood pressure
monitor, thermometer, weight scale, step count watch, single-lead
electrocardiogram (ECG) device, 12-lead ECG device, and pulse oximeter.
 Result(s): The study started in November 2018. The primary outcome of
this study is the detection rate of AF in both groups. Quality of life is
measured with the five-level EuroQol five-dimension (EQ-5D-5L)
questionnaire. Cost-effectiveness is calculated from a society perspective
using prices from Dutch costing guidelines and quality of life data from
the study. In the historical cohort, 93.9% (336/358) completed the
EQ-5D-5L and patient satisfaction questionnaires 3 months after cardiac
surgery. Conclusion(s): The rationale and design of a study to
investigate mHealth devices in postoperative cardiac surgery patients are
presented. The first results are expected in September 2020. Copyright
© Tom E Biersteker, Mark J Boogers, Robert AF de Lind van
Wijngaarden, Rolf HH Groenwold, Serge A Trines, Anouk P van Alem, Charles
JHJ Kirchhof, Nicolette van Hof, Robert JM Klautz, Martin J Schalij,
Roderick W Treskes.

<119>
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)

<120>
Accession Number
2005737728
Title
Clinical burden associated with postsurgical complications in major
cardiac surgeries in Asia-Oceania countries: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Dhippayom T.; Dilokthornsakul P.; Laophokhin V.; Kitikannakorn N.;
Chaiyakunapruk N.
Institution
(Dhippayom) Faculty of Pharmaceutical Sciences, Naresuan University,
Phitsanulok, Thailand
(Dilokthornsakul) Department of Pharmacy Practice, Center of
Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical
Sciences, Naresuan University, Phitsanulok, Thailand
(Laophokhin, Kitikannakorn) Department of Pharmaceutical Care, Centor for
Community of Drug System Research and Development (CDR), Faculty of
Pharmacy, Chiang Mai University, Chiang Mai, Thailand
(Chaiyakunapruk) Department of Pharmacotherapy, College of Pharmacy,
University of Utah, Salt Lake City, UT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Evidence on the burden of postsurgical complications is mainly
from studies in western countries, and little is highlighted in the
Asia-Oceania region. This study aimed to identify and compare the burden
of postsurgical complications in major cardiac surgeries in Asia-Oceania
countries. Method(s): A systematic search was performed in PubMed,
Embase, and CENTRAL between January 2000 and July 2018. Inclusion criteria
were: (a) observational studies or randomized control trials; (b) studied
in coronary artery bypass graft (CABG) and/or heart valve procedures; (c)
measured postsurgical clinical outcomes; and (d) conducted in Asia-Oceania
countries. Pooled effects were calculated using a random-effects model.
 Result(s): Of the 6032 articles screened, 472 studies with a total of
614 161 patients met the inclusion criteria. The pooled incidences (95%
confidence interval) of hospital mortality and 30-day mortality were
similar at 2.38% (2.16%-2.59%) and 2.33% (2.16%-2.50%), respectively.
Length of stay (LOS) was 14.07 days (13.44-14.71 days). The incidence for
atrial fibrillation (AF) and stroke/cerebrovascular accident (CVA) was
17.49% (15.99%-18.99%) and 1.64% (1.51%-1.78%), respectively. Below
outcomes tended to be better in studies on CABG compared to heart valve
procedures, including the incidence of hospital mortality
(1.97%[1.75%-2.18%] vs 3.97% [3.29%-4.65%]), AF (16.47% [14.85%-18.10%] vs
21.98% [17.41%-26.54%]), stoke/CVA (1.51% [1n 37%-1.65%] vs 2.55%
[2.07%-3.04%]), and mean LOS (days) (13.08 [12.51-13.65] vs 19.58
[16.72-22.45]). Similarly, all postsurgical complications tended to be
higher in studies involving high-risk patients vs non-high-risk patients.
 Conclusion(s): There are opportunities to improve clinical outcomes
of patients with high surgical risks and those undertaking heart valve
procedures, as they tend to have poorer survival and higher risk in
developing postsurgical complications. Copyright © 2020 Wiley
Periodicals LLC

<121>
Accession Number
2005737713
Title
Local prolonged release of antibiotic for prevention of sternal wound
infections postcardiac surgery-A novel technology.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Kachel E.; Moshkovitz Y.; Sternik L.; Sahar G.; Grosman-Rimon L.;
Belotserkovsky O.; Reichart M.; Stark Y.; Emanuel N.
Institution
(Kachel, Grosman-Rimon) Department of Cardiac Surgery, Poriya Medical
Center, Tiberias, Israel
(Kachel, Sternik) Department of Cardiac Surgery, Sheba Medical Centre, Tel
Hashomer, Israel
(Moshkovitz) Department of Cardiothoracic Surgery, Assuta Medical Center,
Tel Aviv, Israel
(Sahar) Department of Cardiothoracic Surgery, Soroka Medical Center, Beer
Sheva, Israel
(Belotserkovsky, Reichart, Stark, Emanuel) PolyPid Ltd, Petach-Tikva,
Israel
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Sternal wound infection (SWI) is a devastating postcardiac
surgical complication. D-PLEX<inf>100</inf> (D-PLEX) is a localized
prolonged release compound applied as a prophylactic at the completion of
surgery to prevent SWI. The D-PLEX technology platform is built as a
matrix of alternating layers of polymers and lipids, entrapping an
antibiotic (doxycycline). The objective of this study was to assess the
safety profile and pharmacokinetics of D-PLEX in reducing SWI rates
postcardiac surgery. Method(s): Eighty-one patients were enrolled in
a prospective single-blind randomized controlled multicenter study. Sixty
patients were treated with both D-PLEX and standard of care (SOC) and 21
with SOC alone. Both groups were followed 6 months for safety endpoints.
SWI was assessed at 90 days. Result(s): No SWI-related serious
adverse events (SAEs) occurred in either group. The mean plasma
C<inf>max</inf> in patients treated with D-PLEX was about 10 times lower
than the value detected following the oral administration of doxycycline
hyclate with an equivalent overall dose, and followed by a very low plasma
concentration over the next 30 days. There were no sternal infections in
the D-PLEX group (0/60) while there was one patient with a sternal
infection in the control group (1/21, 4.8%). Conclusion(s): D-PLEX
was found to be safe for use in cardiac surgery patients. By providing
localized prophylactic prolonged release of broad-spectrum antibiotics,
D-PLEX has the potential to prevent SWI postcardiac surgery and long-term
postoperative hospitalization, reducing high-treatment costs, morbidity,
and mortality. Copyright © 2020 Wiley Periodicals LLC

<122>
Accession Number
2005737701
Title
Anticoagulation following mitral valve repair.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Watt T.M.F.; Murray S.L.; Brescia A.A.; Burn D.A.; Wisniewski A.; Khan
S.P.; Romano M.A.; Bolling S.F.; The M.
Institution
(Watt, Murray, Brescia, Romano, Bolling) Department of Cardiac Surgery,
University of Michigan, Ann Arbor, MI, United States
(Burn) Department of Mathematics, Quinnipiac University, Hamden, CT,
United States
(Wisniewski) University of Toledo College of Medicine, Toledo, OH, United
States
(Khan) Department of Internal Medicine, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim: Anticoagulation after mitral valve repair is
controversial and guidelines are not well-established. This study
evaluated the association between postoperative warfarin use and
complications after mitral valve repair, including bleeding and
thromboembolic incidents, readmission, and mortality. Method(s): This
retrospective study investigated 1097 patients who underwent elective
mitral valve repair between April 2003 and March 2017, and was naive to
atrial fibrillation or prior cardiac surgery. This cohort had no other
indication for or against anticoagulation. About 775 patients were placed
on warfarin with international normalized ratio goal 2.5 and 322 patients
were not anticoagulated. The association between anticoagulation and
complications was assessed with univariate comparisons between groups and
multiple logistic regression. Result(s): Postoperative warfarin use
was associated with a reduced composite of bleeding and thromboembolic
complications (pulmonary embolism, TIA, stroke, pericardial effusion or
cardiac tamponade, gastrointestinal bleeding, and reoperation for
bleeding) with an odds ratio of 0.29 (95% confidence interval, 0.13-0.64,
P =.003). There was no difference in 30-day or 6-month mortality or
readmission rate between groups. Long-term survival estimates were
superior in the warfarin group (10-year: 92% vs 85%; log-rank P <.001).
 Conclusion(s): Our analysis showed that postoperative warfarin use
was associated with an overall reduced composite of bleeding and
thromboembolic incidents and superior long-term survival. These findings
suggest that anticoagulation with warfarin following mitral valve repair
may be a safe and effective means for avoiding postoperative complications
and that a large prospective randomized clinical trial is
warranted. Copyright © 2020 Wiley Periodicals LLC

<123>
Accession Number
631300804
Title
Sex-Related Differences in Early- and Long-Term Mortality After
Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review
and Meta-Analysis.
Source
The Journal of invasive cardiology. 32 (8) (pp 295-301), 2020. Date of
Publication: 01 Aug 2020.
Author
Parikh P.B.; Wang T.-Y.; Sharma N.; Kort S.; Skopicki H.A.; Gruberg L.;
Jeremias A.; Pyo R.; Chikwe J.; Butler J.
Institution
(Parikh) Department of Medicine, Stony Brook University Medical Center,
Health Sciences Center T16-080, Stony Brook
Publisher
NLM (Medline)
Abstract
BACKGROUND: Observational data suggest that early- and long-term outcomes
of transcatheter aortic valve replacement (TAVR) and surgical aortic valve
replacement (SAVR) differ significantly between men and women, but have
demonstrated conflicting results. This study sought to examine early- and
long-term mortality with TAVR and SAVR in women versus men.
 METHOD(S): Electronic search was performed until February 2018 for
studies reporting sex-specific mortality following TAVR or isolated SAVR.
Data were pooled using random-effects models. Outcomes included rates of
early mortality (in hospital or 30 days) and long term (1 year or longer).
 RESULT(S): With 35 studies, a total of 80,928 patients were included
in our systematic review and meta-analysis, including 40,861 men and
40,067 women. Pooled analyses suggested considerable sex-related
differences in longterm mortality following TAVR and SAVR. Following SAVR,
women had higher long-term mortality (odds ratio [OR], 1.35; 95%
confidence interval [CI], 1.16-1.56; P<.001) and a trend toward higher
early mortality (OR, 1.69; 95% CI, 0.97-2.97; P=.07) compared to men.
Following TAVR, women had lower long-term mortality (OR, 0.78; 95% CI,
0.71-0.86; P<.001) and no difference in early mortality (OR, 1.09; 95% CI,
0.96-1.23; P=.17) compared to men. CONCLUSION(S): In this systematic
review and meta-analysis, women had higher long-term mortality and a trend
toward higher early mortality compared to men following SAVR. Following
TAVR, women had lower long-term mortality and no difference in early
mortality compared with men.

<124>
Accession Number
630509518
Title
Clinical impact of conduction disturbances in transcatheter aortic valve
replacement recipients: a systematic review and meta-analysis.
Source
European heart journal. 41 (29) (pp 2771-2781), 2020. Date of Publication:
01 Aug 2020.
Author
Faroux L.; Chen S.; Muntane-Carol G.; Regueiro A.; Philippon F.;
Sondergaard L.; Jorgensen T.H.; Lopez-Aguilera J.; Kodali S.; Leon M.;
Nazif T.; Rodes-Cabau J.
Institution
(Faroux, Muntane-Carol, Philippon, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, 2725 chemin Ste-Foy ,Quebec City, QC G1V4G5,
Canada
(Chen, Kodali, Leon, Nazif) Columbia University Medical Center, New
York-Presbyterian Hospital, 177 Fort Washington Avenue, NY, NY 10032,
United States
(Regueiro) Institut Clinic Cardiovascular, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Carrer de
Villaroel, 170, Barcelona 08036, Spain
(Sondergaard, Jorgensen) Rigshospitalet, University of Copenhagen,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Lopez-Aguilera) Hospital Reina Sofia of Cordoba, Avenida Menendez Pidal,
Cordoba 14004, Spain
Publisher
NLM (Medline)
Abstract
AIMS: The clinical impact of new-onset persistent left bundle branch block
(NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter
aortic valve replacement (TAVR) recipients remains controversial. We aimed
to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on
1-year all-cause death, cardiac death, and heart failure hospitalization
and (ii) NOP-LBBB on the need for PPI at 1-year follow-up. METHODS AND
RESULTS: We performed a systematic search from PubMed and EMBASE databases
for studies reporting raw data on 1-year clinical impact of NOP-LBBB or
periprocedural PPI post-TAVR. Data from 30 studies, including 7792
patients (12 studies) and 42 927 patients (21 studies) for the evaluation
of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively.
NOP-LBBB was associated with an increased risk of all-cause death [risk
ratio (RR) 1.32, 95% confidence interval (CI) 1.17-1.49; P<0.001], cardiac
death (RR 1.46, 95% CI 1.20-1.78; P<0.001), heart failure hospitalization
(RR 1.35, 95% CI 1.05-1.72; P=0.02), and PPI (RR 1.89, 95% CI 1.58-2.27;
P<0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated
with a higher risk of all-cause death (RR 1.17, 95% CI 1.11-1.25; P<0.001)
and heart failure hospitalization (RR 1.18, 95% CI 1.03-1.36; P=0.02).
Permanent pacemaker implantation was not associated with an increased risk
of cardiac death (RR 0.84, 95% CI 0.67-1.05; P=0.13). CONCLUSION(S):
NOP-LBBB and PPI after TAVR are associated with an increased risk of
all-cause death and heart failure hospitalization at 1-year follow-up.
Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI
within the year following the procedure. Further studies are urgently
warranted to enhance preventive measures and optimize the management of
conduction disturbances post-TAVR. Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. © The
Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<125>
Accession Number
2007302182
Title
Autograft remodeling after the Ross procedure by cardiovascular magnetic
resonance imaging: Aortic stenosis versus insufficiency.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Lenoir M.; Emmott A.; Bouhout I.; Poirier N.; Tousch M.; El-Hamamsy I.;
Mongeon F.-P.
Institution
(Lenoir, Emmott, Bouhout, Poirier, Tousch, El-Hamamsy) Department of
Surgery, Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(El-Hamamsy) Division of Cardiac Surgery, Sacre-Coeur Hospital, Universite
de Montreal, Montreal, QC, Canada
(Poirier) Division of Cardiac Surgery, Sainte-Justine University Hospital
Center, Universite de Montreal, Montreal, QC, Canada
(Mongeon) Divison of Noninvasive Cardiology, Department of Specialized
Medicine, Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Studies suggest that patients undergoing the Ross procedure
for aortic insufficiency are at greater risk of autograft dilatation than
those with aortic stenosis. By using a tailored Ross technique to mitigate
autograft dilatation in patients with aortic insufficiency, we aimed to
compare the biomechanical and morphologic remodeling of the autograft at 1
year between patients with aortic insufficiency and patients with aortic
stenosis. Method(s): A total of 210 patients underwent a Ross
procedure (2011-2016). Of those, 86 patients (mean age 43 +/- 13 years;
32% were female) completed preoperative and postoperative cardiovascular
magnetic resonance imaging. A total of 71 studies were suitable for
analysis: 41 patients with aortic stenosis and 30 patients with aortic
insufficiency. Nine healthy adults were used as controls. Autograft root
dimensions, individual sinus volumes, and distensibility were measured
using cardiovascular magnetic resonance. Result(s): At 1 year, there
was no difference in autograft root dimensions between patients with
aortic stenosis (mean annulus 25.1 +/- 3.1 mm and sinus diameters 35 +/-
4.1 mm) and patients with aortic insufficiency (26.6 +/- 3 mm and 37.1 +/-
3.5 mm; P =.12 and.06, respectively). Relative sinus of Valsalva volumes
were symmetrical in the aortic stenosis (right 34.8% +/- 4%, left 33.7%
+/- 3.5%, noncoronary 31.4% +/- 3.2%) and aortic insufficiency groups
(34.8% +/- 3.9%, 33.8% +/- 2.8%, 31.3% +/- 3.7%, P =.85,.92, and.82), and
similar to those of healthy adults. Aortic root distensibility was reduced
in both groups compared with healthy adults (P =.003), but was similar
between aortic stenosis (3.12 +/- 1.58 x 10-3 mm
Hg-1) and aortic insufficiency (3.04 +/- 1.15 x 10-3
mm Hg-1; P =.9). Conclusion(s): Using a tailored
technique, there were no differences in the morphologic or biomechanical
remodeling of the autograft root 1 year after the Ross procedure between
patients with aortic stenosis and patients with aortic insufficiency.
However, autograft roots are stiffer than native aortic
roots. Copyright © 2020 The American Association for Thoracic
Surgery

<126>
Accession Number
2007294820
Title
Extended antiplatelet therapy with clopidogrel alone versus clopidogrel
plus aspirin after completion of 9- to 12-month dual antiplatelet therapy
for acute coronary syndrome patients with both high bleeding and ischemic
risk. Rationale and design of the OPT-BIRISK double-blinded,
placebo-controlled randomized trial.
Source
American Heart Journal. 228 (pp 1-7), 2020. Date of Publication: October
2020.
Author
Li Y.; Jing Q.; Wang B.; Wang X.; Li J.; Qiao S.; Chen S.; Angiolillo
D.J.; Han Y.
Institution
(Li, Jing, Wang, Wang, Li, Han) Department of Cardiology, General Hospital
of Northern Theater Command, Shenyang, China
(Qiao) Fu Wai Hospital of Chinese Academy of Medical Science, Beijing,
China
(Chen) Nanjing First Hospital of Nanjing Medical University, Nanjing,
China
(Angiolillo) University of Florida College of Medicine-Jacksonville,
Jacksonville, FL, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor
is the cornerstone for prevention ischemic events in patients with acute
coronary syndromes (ACS) and undergoing percutaneous coronary
intervention. However, the optimal antiplatelet strategy for ACS patients
with both high bleeding and high ischemic risks is unclear. Study design:
The OPT-BIRISK trial is a multicenter, double-blinded, placebo-controlled
randomized study designed to test the superiority of extended antiplatelet
therapy with clopidogrel monotherapy compared with aspirin and clopidogrel
for reduction of bleeding events in ACS patients with both high bleeding
and high ischemic risks ("bi-risk"). A total of 7,700 patients who
completed 9- to 12-month dual antiplatelet therapy after new-generation
drug-eluting stent implantation for the treatment of ACS will be
randomized to receive clopidogrel monotherapy or aspirin plus clopidogrel
for 9 months followed by aspirin monotherapy for 3 months. The primary end
point is Bleeding Academic Research Consortium type 2, 3, or 5 bleedings
at 9 months after randomization. The key secondary end point is major
adverse cardiac and cerebral events at 9 months after randomization,
defined as a composite of all-cause death, myocardial infarction, stroke,
or coronary artery revascularization. Conclusion(s): OPT-BIRISK is
the first large-scale randomized trial aimed to explore the optimal
antiplatelet strategy for bi-risk ACS patients after percutaneous coronary
intervention in current clinical practice. The results will add evidence
regarding de-escalation antiplatelet therapy for patients at special
risk. Copyright © 2020 Elsevier Inc.

<127>
Accession Number
632508010
Title
Ubiquinol supplementation in elderly patients undergoing aortic valve
replacement: biochemical and clinical aspects.
Source
Aging. 12 (no pagination), 2020. Date of Publication: 31 Jul 2020.
Author
Orlando P.; Sabbatinelli J.; Silvestri S.; Marcheggiani F.; Cirilli I.;
Dludla P.V.; Molardi A.; Nicolini F.; Tiano L.
Institution
(Orlando, Silvestri, Marcheggiani, Cirilli, Dludla, Tiano) Department of
Life and Environmental Sciences, Universita Politecnica delle Marche, Via
Brecce Bianche, Ancona 60100, Italy
(Sabbatinelli) Department of Clinical and Molecular Sciences, DISCLIMO,
Universita Politecnica delle Marche, Ancona 60100, Italy
(Dludla) Biomedical Research and Innovation Platform, South African
Medical Research Council, Tygerberg 7505, South Africa
(Molardi, Nicolini) Cardiac Surgery Department, Parma University Hospital,
Parma 43126, Italy
Publisher
NLM (Medline)
Abstract
Epidemiological data show a rise in the mean age of patients affected by
heart disease undergoing cardiac surgery. Senescent myocardium reduces the
tolerance to ischemic stress and there are indications about
age-associated deficit in post-operative cardiac performance. Coenzyme Q10
(CoQ10), and more specifically its reduced form ubiquinol (QH), improve
several conditions related to bioenergetic deficit or increased exposure
to oxidative stress. This trial (Eudra-CT 2009-015826-13) evaluated the
clinical and biochemical effects of ubiquinol in 50 elderly patients
affected by severe aortic stenosis undergoing aortic valve replacement and
randomized to either placebo or 400 mg/day ubiquinol from 7 days before to
5 days after surgery. Plasma and cardiac tissue CoQ10 levels and oxidative
status, circulating troponin I, CK-MB (primary endpoints), IL-6 and S100B
were assessed. Moreover, main cardiac adverse effects, NYHA class,
contractility and myocardial hypertrophy (secondary endpoints) were
evaluated during a 6-month follow-up visit. Ubiquinol treatment
counteracted the post-operative plasma CoQ10 decline (p<0.0001) and
oxidation (p=0.038) and curbed the post-operative increase in troponin I
(QH, 1.90 [1.47-2.48] ng/dL; placebo, 4.03 [2.45-6.63] ng/dL; p=0.007)
related to cardiac surgery. Moreover, ubiquinol prevented the adverse
outcomes that might have been associated with defective left ventricular
ejection fraction recovery in elderly patients.

<128>
Accession Number
632506325
Title
The diagnostic accuracy of procalcitonin in infectious patients after
cardiac surgery: a systematic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2020. Date of Publication: 27 Jul 2020.
Author
Li Q.; Zheng S.; Zhou P.Y.; Xiao Z.; Wang R.; Li J.
Institution
(Li, Zheng, Zhou, Xiao, Wang) Department of the Cardiovascular Surgery
(Li, Zheng) Qianqin Li and Shaoyi Zheng are contribute equally to this
work
(Li) School of Nursing, Southern Medical University, Guangzhou, China
Publisher
NLM (Medline)
Abstract
: Cardiac surgery with cardiopulmonary bypass (CPB) induces an acute
inflammatory response that may lead to a systemic inflammatory response
syndrome. The interest in procalcitonin (PCT) in the diagnosis of
bacterial infection in patients after cardiac surgery remains less
defined. The aim of this meta-analysis is to prospectively examine the
discriminatory power of PCT as markers of infection in hospitalized
patients with after cardiac surgery. The bivariate generalized nonlinear
mixed-effect model and the hierarchical summary receiver operating
characteristic model were used to estimate the pooled sensitivity,
specificity and summary receiver operating characteristic curve. The
pooled sensitivity and specificity were 0.81 (95% CI 0.75-0.87) and 0.78
(95% CI 0.73-0.83), respectively. The pooled positive likelihood ratio,
and negative likelihood ratio of PCT were 3.74 (95% CI 2.98-4.69) and 0.24
(95% CI 0.17-0.32), respectively. The pooled area under the summary
receiver operating characteristic curve of PCT using the HSROC method was
0.87 (95% CI 0.84- 0.90). This study indicated that PCT is a promising
marker for the diagnosis of sepsis for those patients who undergo cardiac
surgery.

<129>
Accession Number
632505718
Title
Nurse-Implemented Goal-Directed Strategy to Improve Pain and Sedation
Management in a Pediatric Cardiac ICU.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. (no pagination), 2020. Date of Publication: 28 Jul 2020.
Author
Lincoln P.A.; Whelan K.; Hartwell L.P.; Gauvreau K.; Dodsen B.L.; LaRovere
J.M.; Thiagarajan R.R.; Hickey P.A.; Curley M.A.Q.
Institution
(Lincoln, Whelan, Hickey) Department of Cardiovascular and Critical Care
Nursing Services, Boston Children's Hospital, MA, Boston
(Hartwell, Gauvreau, LaRovere, Thiagarajan) Department of Cardiology,
Boston Children's Hospital, MA, Boston
(Dodsen) Information Services Department, Boston Children's Hospital, MA,
Boston
(LaRovere, Thiagarajan, Hickey) Department of Pediatrics, Harvard School
of Medicine, MA, Boston
(Hickey) Department of Cardiovascular Services, Boston Children's
Hospital, MA, Boston
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To assess the impact of a nurse-implemented goal-directed
sedation strategy on patient care and nursing practice in a pediatric
cardiac ICU. DESIGN: Quality improvement project with a pre-post interval
measurement plan. SETTING: Thirty-one bed pediatric cardiac ICU in a
freestanding tertiary care children's hospital. PATIENTS: Postoperative
pediatric cardiac surgery patients. INTERVENTIONS: The implementation of
cardiac-Randomized Evaluation of Sedation Titration for Respiratory
Failure (RESTORE), a nurse-implemented goal directed strategy to improve
pain and sedation management in a pediatric cardiac ICU which included
daily team discussion of the patient's trajectory of illness (acute,
titration, or weaning phase), prescription of a sedation target score
based on the patient's trajectory of illness, arousal assessments, and
opioid and/or sedative titration. Withdrawal Assessment Scores were used
to assess and manage iatrogenic withdrawal symptoms. MEASUREMENTS AND MAIN
RESULTS: Data related to opioid and sedation use, pain and sedation
scores, and the occurrence and management of iatrogenic withdrawal
symptoms were reviewed on 1,243 patients during four separate time
periods: one pre-implementation and three discontinuous
post-implementation time intervals. Patient age and complexity were
consistent across the data collection periods. Post-implementation opioids
and benzodiazepines use was reduced about 50% without a concomitant
increase in the use of other sedative classes. Few post-intervention
patients were discharged from the pediatric cardiac ICU or to home on
methadone (pediatric cardiac ICU: pre 19% to post 3%; hospital: pre 12% to
post 1.3%). Documentation of pain, sedation, and withdrawal scores became
more consistent and nurses reported satisfaction with their patient's
comfort management. CONCLUSION(S): The implementation of a
nurse-driven goal-directed plan such as cardiac-RESTORE to manage
pediatric cardiac ICU patient pain and sedation is possible, sustainable,
and associated with reduced sedative and methadone use.

<130>
Accession Number
632503566
Title
A Risk Score Adults with Congenital Heart Disease undergoing Heart
Transplantation.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 29 Jul 2020.
Author
Seese L.; Morell V.; Viegas M.; Keebler M.; Hickey G.; Wang Y.; Kilic A.
Institution
(Seese, Wang, Kilic) Division of Cardiac Surgery at the University of
Pittsburgh Medical Center, PA USA, Pittsburgh, United States
(Morell, Viegas) Division of Congenital Heart Surgery at the Children's
Hospital of Pittsburgh, PA USA, Pittsburgh, United States
(Keebler, Hickey) Division of Cardiology, University of Pittsburgh Medical
Center, PA USA, Pittsburgh, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: This study derived and validated a risk score for one-year
mortality in adults with congenital heart disease (ACHD) undergoing OHT.
 METHOD(S): The UNOS registry identified ACHD (>=18 years) patients
who underwent OHT between 1987 and 2018. The primary outcome was 1-year
mortality. Associated covariates (univariate p<0.2) were entered into a
multivariable logistic regression model. Variable inclusion in the model
was assessed by improvement in the McFadden pseudo-R2, likelihood ratio
test, and c index. A risk score was created using the absolute magnitude
of the odds ratios from the derivation cohort, and its ability to predict
1-year mortality was tested in the validation cohort. RESULT(S):
1,388 recipients were randomly divided into derivation (66.7%, n=950) and
validation (33.3%, n=438) cohorts. A 13-point risk score incorporating
four pre-transplant variables (age, dialysis dependence, serum bilirubin
level and mechanical ventilation) was created. The predicted 1-year
mortality ranged from 14.6% (0 points) to 49.9% (13-points), p<0.0001. In
weighted regression analysis, there was a strong correlation between
predicted 1-year mortality and observed 1-year mortality in the validation
cohort (r=0.85, p<0.0001). Logistic regression also demonstrated a
significant association (OR 1.18, 95% CI 1.1, 1.3, p=0.004). The Brier
score of the composite score in the validation cohort was 0.14.
Kaplan-Meier analysis demonstrated that risk scores of four points or
higher portended worse survival at 1-year post-transplant (p<0.0001).
 CONCLUSION(S): This 13-point risk score for ACHD is predictive of
mortality within 1-year following OHT and has potential utilization in
improving recipient selection for OHT in adult patients with
CHD. Copyright © 2020. Published by Elsevier Inc.

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