EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2007410270
Title
Revascularization Deferral of Nonculprit Stenoses on the Basis of
Fractional Flow Reserve: 1-Year Outcomes of 8,579 Patients.
Source
JACC: Cardiovascular Interventions. 13 (16) (pp 1894-1903), 2020. Date of
Publication: 24 August 2020.
Author
Cerrato E.; Mejia-Renteria H.; Dehbi H.-M.; Ahn J.-M.; Cook C.; Dupouy P.;
Baptista S.B.; Raposo L.; Van Belle E.; Gotberg M.; Davies J.E.; Park
S.-J.; Escaned J.
Institution
(Cerrato) Department of Interventional Cardiology, San Luigi Gonzaga
University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin,
Italy
(Cerrato, Mejia-Renteria, Escaned) Hospital Clinico San Carlos IDISSC and
Universidad Complutense de Madrid, Madrid, Spain
(Dehbi) Comprehensive Clinical Trials Unit at University College London,
London, United Kingdom
(Ahn, Cook, Park) Heart Institute, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Cook, Davies) Department of Cardiology, Imperial College London, London,
United Kingdom
(Dupouy) Hopital Prive d'Antony, Antony, France
(Baptista) Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
(Raposo) Cardiology Department, Hospital Santa Cruz, CHLO, Carnaxide,
Portugal
(Van Belle) Department of Cardiology, University Hospital, Lille, France
(Gotberg) Department of Cardiology, Clinical Sciences, Lund University,
Skane University Hospital, Lund, Sweden
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Intracoronary physiology is increasingly used in nonculprit
stenoses of patients with acute coronary syndromes (ACS). However,
evidence regarding the safety of fractional flow reserve-based deferral in
patients with ACS, compared with patients with stable angina pectoris
(SAP), is scarce. <br/>Objective(s): The aim of this study was to evaluate
the safety of revascularization deferral on the basis of fractional flow
reserve interrogation of nonculprit lesions in patients with ACS.
<br/>Method(s): A pooled analysis was performed of individual patient data
included in 5 large international published studies on physiology-guided
revascularization. The primary endpoint was major adverse cardiac events
(MACE) (a composite of death, nonfatal myocardial infarction, or unplanned
revascularization) at 1-year follow-up. Clinical outcomes of patients with
ACS and SAP were compared in both the deferred and the revascularized
groups. <br/>Result(s): A total of 8,579 patients were included in the
analysis, 6,461 with SAP and 2,118 with ACS and nonculprit stenoses. Using
fractional flow reserve, revascularization was deferred in 5,129 patients
(59.8%) and performed in 3,450 patients (40.2%). In the deferred ACS
group, a higher MACE rate was observed compared with the deferred SAP
group (4.46% vs. 2.83%; adjusted hazard ratio [HR]: 1.72; 95% confidence
interval [CI]: 1.17 to 2.53; p < 0.01). In particular, early unplanned
revascularization (3.34% and 2.04% in ACS and SAP; adjusted HR: 1.81; 95%
CI: 1.09 to 3.00; p = 0.02) contributed to this excess in MACE but the
difference between the ACS and SAP groups did not reach statistical
significance. On the contrary, no differences in outcomes linked to
clinical presentation were found in treated patients (MACE rate 6.51% vs.
6.20%; adjusted HR: 1.21; 95% CI: 0.88 to 1.26; p = 0.24).
<br/>Conclusion(s): Patients with ACS in whom revascularization of
nonculprit lesions was deferred on the basis of fractional flow reserve
have more MACE at 1 year compared with patients with SAP with deferred
revascularization. Unplanned revascularization mainly contributed to this
excess of MACE.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<2>
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. <br/>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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<3>
Accession Number
2005416313
Title
The use of extracorporeal membrane oxygenation postcardiotomy-A systematic
review.
Source
Journal of Cardiac Surgery. 35 (8) (pp 1941-1953), 2020. Date of
Publication: 01 Aug 2020.
Author
Harahwa T.; Chor C.Y.T.; Harky A.
Institution
(Harahwa, Chor) School of Medicine, St George's, University of London,
London, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The use of extracorporeal membrane oxygenation (ECMO) in
cardiac surgery has been established in cases of postcardiotomy
cardiogenic shock, which is refractory to conventional therapy with
inotropes and intra-aortic balloon pulsation support. We sought to examine
the literature in a systematic review manner on the outcomes of using ECMO
postcardiac surgery. <br/>Method(s): A comprehensive electronic literature
search was done to identify all the articles that have discussed the use
of ECMO postcardiac surgery. The keywords and medical subject headings
terms were used to identify the relevant articles. Studies have been
screened according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. <br/>Result(s): The identified studies have
been summarized in each relevant section of this study. Cardiogenic shock
postcardiac surgery can benefit from ECMO to varying degrees and the
survival for this; otherwise, fatal condition has been shown to be
improving through the use of ECMO. However, the decision and timing to
initiate ECMO therapy remains selective and is dependent on a range of
factors such as patient factor, clinician's judgment, meaning there is no
consistent and solid ground regarding the timing of ECMO initiation.
<br/>Conclusion(s): Current evidence suggests that the circulatory support
provided by ECMO improves survival rates for postcardiac surgery
cardiogenic shock patients who are refractory to inotropic management,
without such ECMO support patient mortality rates would be much
greater.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<4>
Accession Number
2004884435
Title
Effect of an educational intervention based on basnef model on treatment
adherence after coronary artery bypass surgery: A randomized clinical
trial.
Source
ARYA Atherosclerosis. 16 (3) (pp 1-10), 2020. Date of Publication: 2020.
Author
Torknejad A.; Babaei S.; Mirmohammadsadeghi M.
Institution
(Torknejad) Faculty of Nursing and Midwifery, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
(Babaei) Nursing and Midwifery Care Research Center, Faculty of Nursing
and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Mirmohammadsadeghi) Chamran Medical and Research Heart Center AND
Department of Cardiac Surgery, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Coronary artery bypass graft (CABG) surgery is the most
effective treatment for cardiovascular disease (CVD). Adherence to
treatment after CABG surgery is very important. One of the educational
models used in this regard is the BASNEF (Belief, Attitudes, Subjective
Norms, and Enabling Factors) model. The present study aimed to assess the
effect of an educational intervention based on BASNEF model on adherence
to treatment in patients after CABG surgery. <br/>METHOD(S): The present
study was a randomized clinical trial. In this study, 72 patients who had
undergone CABG surgery participated in the two intervention and control
groups. Patients in the intervention group took part in 4 40-minute
educational sessions based on BASNEF model after discharge. The patients
in both groups completed the Modanloo Adherence to Treatment Questionnaire
(MATQ) and a researcher-made BASNEF model questionnaire before the
intervention, after the educational intervention, and at the 3-month
follow-up. Data were analyzed using independent t-test, chi-square test,
Man-Whitney test, and repeated measures analysis of variance (ANOVA).
Mauchly's sphericity test was used for testing sphericity and the
Greenhouse-Geisser correction was used in the case of lack of sphericity.
All P-values of less than 0.05 were considered significant.
<br/>RESULT(S): The total score of the MATQ and its subscales had
significantly improved in the intervention group after the intervention
compared with the control group (P < 0.05). In addition, the mean scores
of the model constructs (knowledge, attitude, behavior intention,
subjective norms, and enabling factors) had significantly improved after
the intervention in the intervention group in comparison with the control
group (P < 0.05). <br/>CONCLUSION(S): The educational intervention based
on BASNEF model improved adherence to treatment in patients after CABG
surgery. Moreover, the model constructs improved in the intervention group
in comparison with the control group after the intervention.<br/>Copyright
&#xa9; 2020, Isfahan University of Medical Sciences(IUMS). All rights
reserved.

<5>
Accession Number
2004474535
Title
Reply to the article: Nicholas C. Dang, Abbas Ardehali, Brian A. Bruckner,
Patrick E. Parrino, Daniel L. Gillen, Rachel W. Hoffman, Russell Spotnitz,
Stephanie Cavoores, Ian J. Shorn, Roberto J. Manson, William D. Spotnitz.
Prospective, multicenter, randomized, controlled trial evaluating the
performance of a novel combination powder vs hemostatic matrix in
cardiothoracic operations. J Card Surg. 2019;1-7. DOI: 10.1111/jocs.14376.
Source
Journal of Cardiac Surgery. 35 (5) (pp 1157-1158), 2020. Date of
Publication: 01 May 2020.
Author
Spazierer D.; Moersdorf G.
Institution
(Spazierer) Surgical Sciences and Engineering, Baxter Medical Products
GmbH, Vienna, Austria
(Moersdorf) Advanced Surgery DACH, Baxter Deutschland GmbH,
Unterschleissheim, Germany
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)

<6>
Accession Number
632571019
Title
Erythropoietin plus iron versus control treatment including placebo or
iron for preoperative anaemic adults undergoing non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2020 (8) (no pagination), 2020.
Article Number: CD012451. Date of Publication: 13 Aug 2020.
Author
Kaufner L.; von Heymann C.; Henkelmann A.; Pace N.L.; Weibel S.; Kranke
P.; Meerpohl J.J.; Gill R.
Institution
(Kaufner, Henkelmann) Department of Anaesthesiology and Intensive Care
Medicine, Charite - University Medicine Berlin, Berlin, Germany
(von Heymann) Department of Anaesthesiology, Intensive Care Medicine,
Emergency Care Medicine and Pain Therapy, Vivantes Klinikum im
Friedrichshain, Berlin, Germany
(Pace) Department of Anesthesiology, University of Utah, Salt Lake City,
UT, United States
(Weibel, Kranke) Department of Anaesthesia and Critical Care, University
of Wurzburg, Wurzburg, Germany
(Meerpohl) Institute for Evidence in Medicine, Medical Center - University
of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
(Gill) Department of Anaesthetics, Southampton University Hospital NHS
Trust, Southampton, United Kingdom
(Meerpohl) Cochrane Germany, Cochrane Germany Foundation, Freiburg,
Germany
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Approximately 30% of adults undergoing non-cardiac surgery
suffer from preoperative anaemia. Preoperative anaemia is a risk factor
for mortality and adverse outcomes in different surgical specialties and
is frequently the reason for blood transfusion. The most common causes are
renal, chronic diseases, and iron deficiency. International guidelines
recommend that the cause of anaemia guide preoperative anaemia treatment.
Recombinant human erythropoietin (rHuEPO) with iron supplementation has
frequently been used to increase preoperative haemoglobin concentrations
in patients in order to avoid the need for perioperative allogeneic red
blood cell (RBC) transfusion. <br/>Objective(s): To evaluate the efficacy
of preoperative rHuEPO therapy (subcutaneous or parenteral) with iron
(enteral or parenteral) in reducing the need for allogeneic RBC
transfusions in preoperatively anaemic adults undergoing non-cardiac
surgery. <br/>Search Method(s): We searched CENTRAL, Ovid MEDLINE(R), Ovid
Embase, ISI Web of Science: SCI-EXPANDED and CPCI-S, and clinical trial
registries WHO ICTRP and ClinicalTrials.gov on 29 August 2019.
<br/>Selection Criteria: We included all randomized controlled trials
(RCTs) that compared preoperative rHuEPO + iron therapy to control
treatment (placebo, no treatment, or standard of care with or without
iron) for preoperatively anaemic adults undergoing non-cardiac surgery. We
used the World Health Organization (WHO) definition of anaemia:
haemoglobin concentration (g/dL) less than 13 g/dL for males, and 12 g/dL
for non-pregnant females (decision of inclusion based on mean haemoglobin
concentration). We defined two subgroups of rHuEPO dosage: 'low' for 150
to 300 international units (IU)/kg body weight, and 'high' for 500 to 600
IU/kg body weight. <br/>Data Collection and Analysis: Two review authors
collected data from the included studies. Our primary outcome was the need
for RBC transfusion (no autologous transfusion, fresh frozen plasma or
platelets), measured in transfused participants during surgery
(intraoperative) and up to five days after surgery. Secondary outcomes of
interest were: haemoglobin concentration (directly before surgery), number
of RBC units (where one unit contains 250 to 450 mL) transfused per
participant (intraoperative and up to five days after surgery), mortality
(within 30 days after surgery), length of hospital stay, and adverse
events (e.g. renal dysfunction, thromboembolism, hypertension, allergic
reaction, headache, fever, constipation). <br/>Main Result(s): Most of the
included trials were in orthopaedic, gastrointestinal, and gynaecological
surgery and included participants with mild and moderate preoperative
anaemia (haemoglobin from 10 to 12 g/dL). The duration of preoperative
rHuEPO treatment varied across the trials, ranging from once a week to
daily or a 5-to-10-day period, and in one trial preoperative rHuEPO was
given on the morning of surgery and for five days postoperatively. We
included 12 trials (participants = 1880) in the quantitative analysis of
the need for RBC transfusion following preoperative treatment with rHuEPO
+ iron to correct preoperative anaemia in non-cardiac surgery; two studies
were multiarmed trials with two different dose regimens. Preoperative
rHuEPO + iron given to anaemic adults reduced the need RBC transfusion
(risk ratio (RR) 0.55, 95% confidence interval (CI) 0.38 to 0.80;
participants = 1880; studies = 12; I² = 84%; moderate-quality
evidence due to inconsistency). This analysis suggests that on average,
the combined administration of rHuEPO + iron will mean 231 fewer
individuals will need transfusion for every 1000 individuals compared to
the control group. Preoperative high-dose rHuEPO + iron given to anaemic
adults increased the haemoglobin concentration (mean difference (MD) 1.87
g/dL, 95% CI 1.26 to 2.49; participants = 852; studies = 3; I²
= 89%; low-quality evidence due to inconsistency and risk of bias) but not
low-dose rHuEPO + iron (MD 0.11 g/dL, 95% CI -0.46 to 0.69; participants =
334; studies = 4; I² = 69%; low-quality evidence due to
inconsistency and risk of bias). There was probably little or no
difference in the number of RBC units when rHuEPO + iron was given
preoperatively (MD -0.09, 95% CI -0.23 to 0.05; participants = 1420;
studies = 6; I² = 2%; moderate-quality evidence due to
imprecision). There was probably little or no difference in the risk of
mortality within 30 days of surgery (RR 1.19, 95% CI 0.39 to 3.63;
participants = 230; studies = 2; I² = 0%; moderate-quality
evidence due to imprecision) or of adverse events including local rash,
fever, constipation, or transient hypertension (RR 0.93, 95% CI 0.68 to
1.28; participants = 1722; studies = 10; I² = 0%;
moderate-quality evidence due to imprecision). The administration of
rHuEPO + iron before non-cardiac surgery did not clearly reduce the length
of hospital stay of preoperative anaemic adults (MD -1.07, 95% CI -4.12 to
1.98; participants = 293; studies = 3; I² = 87%; low-quality
evidence due to inconsistency and imprecision). Authors' conclusions:
Moderate-quality evidence suggests that preoperative rHuEPO + iron therapy
for anaemic adults prior to non-cardiac surgery reduces the need for RBC
transfusion and, when given at higher doses, increases the haemoglobin
concentration preoperatively. The administration of rHuEPO + iron
treatment did not decrease the mean number of units of RBC transfused per
patient. There were no important differences in the risk of adverse events
or mortality within 30 days, nor in length of hospital stay. Further,
well-designed, adequately powered RCTs are required to estimate the impact
of this combined treatment more precisely.<br/>Copyright &#xa9; 2020 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<7>
Accession Number
2007450260
Title
Monotherapy With a P2Y<inf>12</inf> Inhibitor or Aspirin for Secondary
Prevention in Patients With Established Atherosclerosis: A Systematic
Review and Meta-Analysis.
Source
Journal of Vascular Surgery. Conference: 2020 New England Society for
Vascular Surgery (Virtual) Annual Meeting. 72 (3) (pp 1144), 2020. Date of
Publication: September 2020.
Author
Chiarito M.; Sanz-Sanchez J.; Cannata F.; Cao D.; Sturla M.; Cristina
Panico M.
Publisher
Mosby Inc.
Abstract
Study design: Systematic review and meta-analysis of randomized trials in
PubMed, Embase, BioMedCentral, Google Scholar, and Cochrane Central
Register of Controlled Trials performed on December 18, 2019; also
references from identified articles and abstracts presented at relevant
scientific meetings from 2017 to 2019. <br/>Key Findings: Nine randomized
trials with 42,108 patients allocated to P2Y<inf>12</inf> inhibitor or
aspirin (ASA) showed a borderline reduction in myocardial infarction (MI)
with P2Y<inf>12</inf> inhibitors but no significant difference in stroke
or vascular death. The risk of major bleeding did not differ between the
two groups. <br/>Conclusion(s): P2Y<inf>12</inf> inhibitor monotherapy is
associated with risk reduction in MI compared with ASA but is of debatable
clinical relevance in view of the high number needed to prevent MI.
Commentary: Commentary: P2Y<inf>12</inf> inhibitors are more profound
platelet inhibitors than ASA, meaning that they may be more likely to
prevent ischemic events and thromboembolism but also may be more likely to
cause bleeding. This is certainly true for dual antiplatelet therapy.
P2Y<inf>12</inf> inhibitors are more expensive than ASA. The most commonly
used agents are clopidogrel (Plavix) and ticagrelor (Brilinta); the latter
is the stronger antiplatelet agent. The take home message of this study is
that most of our patients should be on lifelong ASA (yes, there are
exceptions). Why do vascular surgeons need to be familiar with these
agents? I think most of us have enough experience with clopidogrel to
decide whether it is safe to perform arterial endovascular interventions
(no problem), carotid endarterectomy (most studies show no increased
bleeding), or open aortic surgery (I wouldn't) if a patient is taking this
drug. But what about ticagrelor? You need to decide if you would be
willing to perform arterial endovascular interventions if a patient is
taking this drug (probably ok), carotid endarterectomy (I would not), or
open aortic surgery (I think you'd be crazy). We are obligated to be
familiar with drugs such as ticagrelor. Cardiologists are prescribing them
more and more after coronary artery stenting.<br/>Copyright &#xa9; 2020

<8>
Accession Number
632611431
Title
Wound Infection after CABG Using Internal Mammary Artery Grafts: A
Meta-Analysis.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2020. Date of
Publication: 13 Aug 2020.
Author
Oswald I.; Boening A.; Pons-Kuehnemann J.; Grieshaber P.
Institution
(Oswald, Boening, Grieshaber) Department of Adult and Pediatric
Cardiovascular Surgery, Justus Liebig University Giessen, Giessen, Germany
(Pons-Kuehnemann) Institute of Medical Informatics, Department of medical
Statistics, Justus Liebig University Giessen, Giessen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Internal mammary arteries show better long-term patency rates
than venous grafts. The use of both mammary arteries is associated with a
higher risk of sternal wound infections. This meta-analysis was designed
to assess the incidence of a wound healing disorder after bilateral
compared with single mammary artery bypass grafting. Compared with
existing meta-analysis this paper includes more current literature and one
randomized controlled trial. <br/>METHOD(S): A literature search was
performed using PubMed and the Cochrane Library. The quality of the
articles was assessed by the Newcastle Ottawa Scale. The odds ratio was
used as a measure of the chance of developing a wound healing disorder
after bilateral internal mammary artery (BIMA) surgery. Meta-analyses were
performed for different subgroups. <br/>RESULT(S): Twenty studies met the
quality criteria, including one randomized controlled trial. The use of
both mammary arteries significantly increased the risk of superficial
(odds ratio [OR] 1.72) and deep (OR 1.75) wound healing disorder in the
total population (OR 1.80) as well as in the diabetic subgroup (OR 1.38)
and with both preparation techniques. The increased risk with BIMA
grafting was present independently of the preparation technique (pedicled:
OR 1.89, skeletonized: OR 1.37). <br/>CONCLUSION(S): Bilateral internal
mammary artery grafting, especially in high-risk and diabetic patients, is
associated with an increased risk of wound healing impairment.
Skeletonized preparation does not eliminate the elevated wound healing
disorder risk after BIMA use.<br/>Copyright Thieme. All rights reserved.

<9>
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. <br/>Design(s): Systematic review and narrative synthesis
Participants: Patients with ischemic stroke after cardiac surgery.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<10>
Accession Number
2005845373
Title
Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and
Improvement After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 127 (pp 105-112), 2020. Date of
Publication: 15 July 2020.
Author
Ghezzi E.S.; Ross T.J.; Davis D.; Psaltis P.J.; Loetscher T.; Keage H.A.D.
Institution
(Ghezzi, Ross, Loetscher, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, Justice and Society, University of South
Australia, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing Unit at UCL, London,
United Kingdom
(Psaltis) Vascular Research Centre, Lifelong Health Theme, South
Australian Health and Medical Research Institute, Adelaide, Australia
(Psaltis) Adelaide University Medical School, University of Adelaide,
Adelaide, Australia
(Psaltis) Department of Cardiology, Central Adelaide Local Health Network,
Adelaide, Australia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Changes to cognition, both decline and improvement, are commonly reported
after transcatheter aortic valve implantation (TAVI). However, previous
systematic reviews and meta-analyses have missed these subgroups by
assessing whole-group-averages for cognitive outcomes. We sought to pool
estimates to identify the prevalence of cognitive decline and improvement
after TAVI, as well as associated factors for these outcomes. A systematic
review identified 15 articles appropriate for meta-analysis. When robust
cognitive change definitions were employed, the pooled prevalence of
incident cognitive impairment up to 1-, 1 to 6-, and >=6-months post-TAVI
was 7%, 14%, and 12%, respectively. For cognitive improvement, the
prevalence from 1 to 6 months and >=6 months after TAVI was estimated to
be 19% and 11%, respectively. Two factors were associated with these
cognitive outcomes: (1) using a cerebral embolic protection device was
associated with decreased prevalence of cognitive decline up to 1-week
post-TAVI; (2) baseline cognitive impairment had a large association with
post-TAVI cognitive improvement. In conclusion, cognitive decline and
cognitive improvement are experienced by approximately 7% to 19% of
patients after TAVI, respectively. Those with the lowest cognitive
performance pre-TAVI appear to have the most to gain in terms of cognitive
improvement post-TAVI. Identifying further predictive factors for
cognitive decline and improvement post-TAVI will facilitate a
personalized-medicine approach for cognitive care and
prognosis.<br/>Copyright &#xa9; 2020 The Author(s)

<11>
Accession Number
2004104589
Title
The safety of pulse corticosteroid therapy- Systematic review and
meta-analysis.
Source
Seminars in Arthritis and Rheumatism. 50 (3) (pp 534-545), 2020. Date of
Publication: June 2020.
Author
Edel Y.; Avni T.; Shepshelovich D.; Reich S.; Rozen-Zvi B.; Elbaz M.;
Leibovici L.; Molad Y.; Gafter-Gvili A.
Institution
(Edel, Molad) Rheumatology unit Beilinson Hospital, Rabin Medical Center,
Petah Tikva, Israel
(Edel) Department of Medicine C, Beilinson Hospital, Rabin Medical Center,
Petah Tikva 49100, Israel
(Avni, Elbaz, Leibovici) Department of Medicine E, Beilinson Hospital,
Rabin Medical Center, Petah Tikva, Israel
(Shepshelovich, Reich, Gafter-Gvili) Department of Medicine A, Beilinson
Hospital, Rabin Medical Center, Petah Tikva, Israel
(Rozen-Zvi) Nephrology unit Beilinson Hospital, Rabin Medical Center,
Petah Tikva, Israel
(Edel, Avni, Shepshelovich, Rozen-Zvi, Elbaz, Leibovici, Molad,
Gafter-Gvili) Sackler Faculty of Medicine, Tel Aviv University, Israel
Publisher
W.B. Saunders
Abstract
Objective: To amass all available evidence from randomized controlled
trials regarding the safety of pulse corticosteroids therapy, in order to
establish its safety. <br/>Patients and Methods: All electronic databases
from 1/1966 up to 02/2019 were reviewed to find all randomized controlled
trials comparing pulse corticosteroids to oral corticosteroids or to
placebo/no treatment. Two reviewers independently extracted and recorded
data regarding type of corticosteroid treatment, dosages, length of
treatment and follow-up. Risk ratios (RR) with 95% (CI) for differences
between pulse corticosteroids and comparator were pooled using a fixed
effect meta-analysis. The primary outcome was occurrence of severe adverse
events (SAEs). Secondary outcomes included any adverse events (AEs), AEs
requiring discontinuation, AEs per system involved and all-cause
mortality. <br/>Result(s): A total of 64 trials were included: 18 trials
which compared pulse corticosteroids to oral corticosteroids and 46 trials
which compared pulse corticosteroids to placebo/no intervention. Pulse
corticosteroids was not associated with increased risk for SAEs for both
comparators: RR 0.77 (95% CI 0.52-1.14), and RR 0.99 (95% CI 0.93-1.06),
respectively. Sensitivity analysis based on adequate allocation
concealment and use of a valid AE grading did not alter the results.
Subgroup analysis revealed no increased risk of specific SAEs or AEs with
pulse corticosteroids compared to oral corticosteroids.
<br/>Conclusion(s): Pulse corticosteroids was not associated with an
increase risk of SAEs and should be regarded as safe.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<12>
Accession Number
2007088346
Title
Anesthetic management of neonates undergoing diagnostic and therapeutic
cardiac catheterization: a systematic literature review.
Source
Brazilian Journal of Anesthesiology. 70 (3) (pp 278-287), 2020. Date of
Publication: May - June 2020.
Author
Valencia-Arango L.M.; Fajardo-Escolar A.P.; Segura-Salguero J.C.;
Saenz-Quispe S.; Rincon-Restrepo C.; Posada A.; Ronderos V.; Perea-Bello
A.H.
Institution
(Valencia-Arango, Fajardo-Escolar, Segura-Salguero, Saenz-Quispe,
Rincon-Restrepo, Perea-Bello) Hospital Universitario San Ignacio.
Universidad Javeriana, Facultad de Medicina, Bogota, Colombia
(Posada, Ronderos) Universidad Javeriana. Facultad de Medicina, Bogota,
Colombia
Publisher
Elsevier Editora Ltda
Abstract
Background: Several interventional cardiology procedures are required in
neonates with congenital heart disease. Interventional cardiology
procedures have a higher risk of cardiac arrest compared to other
interventions. At present, there is great heterogeneity in the
perioperative management of congenital heart disease neonates undergoing
diagnostic cardiac catheterization or therapeutic cardiac catheterization.
Study objectives: Primary aim: Provide a systematic review of the most
effective and/or safe anesthetic and perioperative management in neonates
with congenital heart disease who undergo diagnostic cardiac
catheterization or therapeutic cardiac catheterization. Secondary aim:
Identify the medications, monitoring parameters and airway management used
in the same population. <br/>Design(s): Systematic literature review.
<br/>Setting(s): Catheterization laboratory. <br/>Method(s): Literature
was searched (December 2017) in electronic databases Medline, EMBASE,
ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane
Database of Systematic Reviews, Database of Abstracts of Reviews of
Effects and Health Technology Assessment Database. <br/>Main Result(s):
From 130 records identified, four studies met inclusion criteria and
quality assessment. None of the studies were relevant to the primary
objective. Regarding the secondary objectives, one study compared the
efficacy and adverse effects of racemic ketamine and its S(+) ketamine
enantiomer, one study reported the efficacy of subarachnoid anesthesia for
high-risk children undergoing diagnostic cardiac catheterization, one
study identified the factors associated to high severity adverse events
related to sedation, anesthesia and airway, and one study retrospectively
analyzed cardiac catheterization procedures in neonates weighing less than
2.5 kg. <br/>Conclusion(s): There are no evidence-based recommendations
available for congenital heart disease neonates undergoing cardiac
catheterization. More studies are required to evaluate the ideal
anesthetic and perioperative management in this population.<br/>Copyright
&#xa9; 2020 Sociedade Brasileira de Anestesiologia

<13>
Accession Number
2005851225
Title
A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure
in Children.
Source
World Journal for Pediatric and Congenital Heart Surgery. (no pagination),
2020. Date of Publication: 2020.
Author
Kennedy J.T.; DiLeonardo O.; Hurtado C.G.; Nelson J.S.
Institution
(Kennedy, Hurtado, Nelson) University of Central Florida College of
Medicine, Orlando, FL, United States
(Kennedy) Department of Surgery, University of Cincinnati College of
Medicine, Cincinnati, OH, United States
(DiLeonardo) Department of Medical Education, Nemours Children's Hospital,
Orlando, FL, United States
(DiLeonardo) Nemours Children's Hospital Medical Library, Orlando, FL,
United States
(Nelson) Department of Cardiovascular Services, Nemours Children's
Hospital, Orlando, FL, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Antibiotic prophylaxis following delayed sternal closure in pediatric
cardiac surgery is not standardized. We systematically reviewed relevant
literature published between 1990 and 2019 to aid future trial design.
Patient characteristics, antimicrobial prophylaxis regimens, and
postoperative incidence of infection were collected. Twenty-eight studies
described 36 different regimens in over 3,000 patients. There were 11
single-drug regimens and 25 multidrug regimens. Cefazolin-only was the
most common regimen (9/36, 25%). The overall incidence of surgical site
infection was 7.5% (217/2,910 patients) and bloodstream infection was 7.4%
(123/1,667 patients). In the 2010s, multidrug regimens were associated
with a significantly lower incidence of both surgical site infections
(4.6% vs. 20%, P <.001) and bloodstream infections (6.0% vs. 50%, P <.001)
compared to single-drug regimens.<br/>Copyright &#xa9; The Author(s) 2020.

<14>
Accession Number
2005840808
Title
Top 100 cited manuscripts in aortic valve replacement: A bibliometric
analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Oo S.; Fan K.H.; Khare Y.; Fan K.S.; Chan J.; Lam C.M.; Lai S.H.D.; Kwan
L.Y.A.
Institution
(Oo) Department of Cardiothoracic Surgery, University Hospitals Bristol
and Weston NHS Foundation Trust, Bristol, United Kingdom
(Fan, Khare) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Fan, Lai, Kwan) Department of Medical Education, University of London,
London, United Kingdom
(Chan) Department of Cardiothoracic Surgery, University Hospitals Coventry
and Warwickshire NHS Trust, Coventry, United Kingdom
(Lam) Department of General Surgery, Cardiff and Vale University Health
Board, Cardiff, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
This bibliometric analysis aims to identify publications and highlight the
key areas that have shaped modern clinical practices for aortic valve
replacement (AVR). In this paper, the top 100 most cited manuscripts for
AVR are analyzed. The Thomson Reuters Web of Science database was searched
using the terms "aortic valve replacement," "AVR," "sAVR," "tAVR," or
"TAVI." The results were ranked by citation number and the top 100
articles were further analyzed by evaluating the subject, author, journal,
year of publication, institution, and country of origin. Thirty-thousand
and eight hundred eligible papers were examined, with an accumulation of
81 851 citations in total and a mean citation of 819 per manuscript
(ranged: 344-4180). The New England Journal of Medicine had the most
manuscripts whereas Circulation had the most citations. The number of
citations has also significantly increased for articles published after
2000.The most cited manuscript highlighting the management of valvular
heart disease, was written by Baumgartner et al By providing the most
influential references, this work serves as a comprehensive guide to
topics of interest in the field of AVR.<br/>Copyright &#xa9; 2020 Wiley
Periodicals LLC

<15>
Accession Number
2005840624
Title
Effects of pulmonary perfusion during cardiopulmonary bypass on lung
functions after cardiac operation.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Karacalilar M.; Onan I.S.; Onan B.; Sen O.; Gonca S.; Solakoglu S.;
Yeniterzi M.
Institution
(Karacalilar, Onan, Onan, Sen, Yeniterzi) Department of Cardiovascular
Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery
Hospital, University of Health Sciences Turkey, Istanbul, Turkey
(Gonca) Department of Histology and Embryology, Faculty of Medicine,
Kocaeli University, Kocaeli, Turkey
(Solakoglu) Department of Histology and Embryology, Capa Faculty of
Medicine, Istanbul University, Istanbul, Turkey
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Pulmonary artery perfusion during cardiopulmonary bypass (CPB)
is a known but rarely used technique in adult cardiac surgery. In this
study, we aimed to investigate biochemical and histopathological effects
of pulmonary artery perfusion during CPB on lung functions.
<br/>Method(s): Between May 2014 and August 2014, all patients (n = 24)
who gave informed consent for participating this study with inclusion
criteria were included. Patients undergoing isolated coronary artery
bypass grafting were sequentially randomized to conventional CPB (control
group, n = 12) and conventional CPB with selective pulmonary artery
perfusion (study group, n = 12). Lung functions were monitored using PF
ratio, alveolar-arterial oxygen gradient, and lactate levels. A small
sample tissue from the left lung was excised for histopathologic
examination. Immunocytochemistry analysis was performed using anti-rabbit
polyclonal vascular endothelial growth factor (VEGF), rabbit polyclonal
inducible nitric oxide synthase (i-NOS), and BCL-2 antibodies.
<br/>Result(s): Postoperative course of the patients were uneventful
without any clinical outcome differences in terms of cardiopulmonary
complications, ventilation time and hospital stay. Pulmonary perfusion
group had significantly better oxygenation values after extubation and at
postoperative 24-hour. Electron microscopy examinations revealed better
preservation of the alveolar wall integrity with pulmonary perfusion. The
intensity of VEGF, i-NOS, and BCL-2 antibody expressions in bronchial
epithelial cells were more prominent in the pulmonary perfusion group.
<br/>Conclusion(s): Pulmonary artery perfusion during aortic
cross-clamping provides better oxygenation and preservation of the wall
alveolar integrity after coronary artery bypass grafting surgery. This
technique can be used as a protective strategy to minimize CPB-induced
lung injury in adult cardiac surgery.<br/>Copyright &#xa9; 2020 Wiley
Periodicals LLC

<16>
Accession Number
2005524071
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
for myocardial infarction complicated by cardiogenic shock.
Source
American Heart Journal. 226 (pp 255-263), 2020. Date of Publication:
August 2020.
Author
Smilowitz N.R.; Alviar C.L.; Katz S.D.; Hochman J.S.
Institution
(Smilowitz, Alviar, Katz, Hochman) Leon H. Charney Division of Cardiology,
Department of Medicine, New York University School of Medicine, New York,
NY, United States
(Smilowitz) Division of Cardiology, Department of Medicine, New York, NY,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Myocardial infarction (MI) complicated by cardiogenic shock
(CS) is associated with high mortality. Early coronary revascularization
improves survival, but the optimal mode of revascularization remains
uncertain. We sought to characterize practice patterns and outcomes of
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in patients with MI complicated by CS. <br/>Method(s):
Patients hospitalized for MI with CS between 2002 and 2014 were identified
from the United States National Inpatient Sample. Trends in management
were evaluated over time. Propensity score matching was performed to
identify cohorts with similar baseline characteristics and MI
presentations who underwent PCI and CABG. The primary outcome was
in-hospital all-cause mortality. <br/>Result(s): A total of 386,811
hospitalizations for MI with CS were identified; 67% were STEMI. Overall,
62.4% of patients underwent revascularization, with PCI in 44.9%, CABG in
14.1%, and a hybrid approach in 3.4%. Coronary revascularization for MI
and CS increased over time, from 51.5% in 2002 to 67.4% in 2014 (P for
trend < .001). Patients who underwent CABG were more likely to have
diabetes mellitus (35.5% vs. 29.2%, P < .001) and less likely to present
with STEMI (48.7% vs. 80.9%, P < .001) than those who underwent PCI. CABG
(without PCI) was associated with lower mortality than PCI (without CABG)
overall (18.9% vs. 29.0%, P < .001) and in a propensity-matched subgroup
of 19,882 patients (19.0% vs. 27.0%, P < .001). <br/>Conclusion(s): CABG
was associated with lower in-hospital mortality than PCI among patients
with MI complicated by CS. Due to the likelihood of residual confounding,
a randomized trial of PCI versus CABG in patients with MI, CS, and
multi-vessel coronary disease is warranted.<br/>Copyright &#xa9; 2020

<17>
Accession Number
2005273642
Title
Perioperative Bridging/Cessation of Antiplatelet Agents: 2020 Update.
Source
Current Anesthesiology Reports. 10 (3) (pp 273-281), 2020. Date of
Publication: 01 Sep 2020.
Author
Cha S.; Hensley N.B.
Institution
(Cha, Hensley) Department of Anesthesiology & Critical Care Medicine,
Johns Hopkins University School of Medicine, Baltimore, MD, United States
Publisher
Springer
Abstract
Purpose of Review: Perioperative management of patients receiving
antiplatelet therapy is common and must carefully balance the risk of
ischemia or thrombosis with bleeding. Here we describe pathways of
platelet aggregation unique to the perioperative period and mechanisms of
commonly encountered antiplatelet medications, and review current
literature evaluating strategies for antiplatelet management surrounding
elective noncardiac and cardiac surgery. Recent Findings: Antiplatelet
therapies demonstrate unique risk profiles for stent thrombosis and
bleeding that may be dependent on individual genetic polymorphisms. Use of
scoring systems or point-of-care platelet function assays may identify
patients especially vulnerable to alterations in perioperative
antiplatelet management, and guide timing of surgery. Prior guidelines,
which recommend a minimum 6-month delay in elective surgery for patients
receiving dual-antiplatelet therapy following percutaneous coronary
intervention (PCI), may be amended to 3 months in certain cases in which
newer generation antiplatelet therapies are administered. While use of
intravenous bridging agents may reduce platelet reactivity during cardiac
surgery, there is no single antiplatelet strategy which consistently
reduces rates of major bleeding or cardiovascular events. <br/>Summary:
There is insufficient evidence to support any specific perioperative
antiplatelet strategy. Cases should be individualized to balance the risks
of stent thrombosis and bleeding. Current recommendations may be modified
if the risk of delaying surgery outweighs the risk of stent thrombosis. It
is reasonable to guide management by utilizing scoring systems and
point-of-care platelet function assays.<br/>Copyright &#xa9; 2020,
Springer Science+Business Media, LLC, part of Springer Nature.

<18>
Accession Number
2004297581
Title
Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic
function in cardiac surgical patients: a randomised controlled trial.
Source
Anaesthesia. 75 (9) (pp 1180-1190), 2020. Date of Publication: 01 Sep
2020.
Author
Duncan A.E.; Jia Y.; Soltesz E.; Leung S.; Yilmaz H.O.; Mao G.; Timur
A.A.; Kottke-Marchant K.; Rogers H.J.; Ma C.; Ince I.; Karimi N.; Yagar
S.; Trombetta C.; Sessler D.I.
Institution
(Duncan) Departments of Cardiothoracic Anesthesiology and Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Jia, Leung, Yilmaz, Ince, Karimi, Yagar, Sessler) Department of Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Soltesz) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Mao, Ma) Departments of Quantitative Health Sciences and Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Timur, Rogers) Department of Laboratory Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Kottke-Marchant) Department of Pathology and Laboratory Administration,
Cleveland Clinic, Cleveland, OH, United States
(Trombetta) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Blackwell Publishing Ltd
Abstract
Whether third-generation hydroxyethyl starch solutions provoke kidney
injury or haemostatic abnormalities in patients having cardiac surgery
remains unclear. We tested the hypotheses that intra-operative
administration of a third-generation starch does not worsen postoperative
kidney function or haemostasis in cardiac surgical patients compared with
human albumin 5%. This triple-blind, non-inferiority, clinical trial
randomly allocated patients aged 40-85 who underwent elective aortic valve
replacement, with or without coronary artery bypass grafting, to plasma
volume replacement with 6% starch 130/0.4 vs. 5% human albumin. Our
primary outcome was postoperative urinary neutrophil gelatinase-associated
lipocalin concentrations, a sensitive and early marker of postoperative
kidney injury. Secondarily, we evaluated urinary interleukin-18; acute
kidney injury using creatinine RIFLE criteria, coagulation measures,
platelet count and function. Non-inferiority (delta 15%) was assessed with
correction for multiple comparisons. We enrolled 141 patients (69 starch,
72 albumin) as planned. Results of the primary analysis demonstrated that
postoperative urine neutrophil gelatinase-associated lipocalin (median
(IQR [range])) was slightly lower with hydroxyethyl starch (5 (1-68
[0-996]) ng.ml^-1) vs. albumin (5 (2-74 [0-1604])
ng.ml^-1), although not non-inferior [ratio of geometric means
(95%CI) 0.91 (0.57, 1.44); p = 0.15] due to higher than expected
variability. Urine interleukin-18 concentrations were reduced, but
interleukin-18 and kidney injury were again not non-inferior. Of 11
individual coagulation measures, platelet count and function, nine were
non-inferior to albumin. Two remaining measures, thromboelastographic R
value and arachidonic acid-induced platelet aggregation, were clinically
similar but with wide confidence intervals. Starch administration during
cardiac surgery produced similar observed effects on postoperative kidney
function, coagulation, platelet count and platelet function compared with
albumin, though greater than expected variability and wide confidence
intervals precluded the conclusion of non-inferiority. Long-term mortality
and kidney function appeared similar between starch and
albumin.<br/>Copyright &#xa9; 2020 The Authors. Anaesthesia published by
John Wiley & Sons Ltd on behalf of Association of Anaesthetists

<19>
Accession Number
2003522319
Title
Interatrial septum dissection and atrial wall hematoma following
transseptal puncture: A systematic review of the literature.
Source
Catheterization and Cardiovascular Interventions. 96 (2) (pp 424-431),
2020. Date of Publication: 01 Aug 2020.
Author
Meier D.; Antiochos P.; Herrera-Siklody C.; Eeckhout E.; Delabays A.;
Tzimas G.; Fournier S.; Pascale P.; Muller O.; Monney P.
Institution
(Meier, Antiochos, Herrera-Siklody, Eeckhout, Delabays, Tzimas, Fournier,
Pascale, Muller, Monney) Division of Cardiology, University Hospital of
Lausanne (CHUV), Lausanne, Switzerland
(Fournier) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Italy
(Pascale, Muller, Monney) Faculty of Biology and Medicine, Lausanne
University, Lausanne, Switzerland
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Interatrial septum (IAS) dissection due to transseptal
puncture (TSP) is a rare, underreported complication of the procedure.
Data on the mechanism, diagnosis, and management of this complication are
lacking. <br/>Method(s): We conducted a systematic review of all reported
cases of IAS dissection with or without associated LA hematoma due to TSP,
by thoroughly searching MEDLINE and EMBASE through May 2019.
<br/>Result(s): After screening of n = 882 studies, eight studies with a
total of 19 patients addressed the complication of IAS dissection and/or
LA hematoma secondary to TSP. Median age was 63 years with a 1:1 male to
female ratio. Ablation of atrial fibrillation was the most frequently
reported procedure (84%). Diagnosis was established using fluoroscopy with
contrast injection (58%), TEE (32%) or intracardiac echocardiography (5%).
The mechanism identified involved puncture of the septum secundum portion
of the IAS, leading to transient needle passage into the extracardiac
space. In the majority of patients, the hematoma remained localized in the
IAS and management was conservative with progressive resolution of the
hematoma during follow-up (95%). Two patients (11%) required further
intervention by either pericardiocentesis or surgical drainage due to
hemodynamic instability. <br/>Conclusion(s): IAS dissection with or
without hematoma after TSP remains an underdiagnosed entity. The main
mechanism involves lesion to the septum secundum portion of the IAS,
resulting in needle passage into the extracardiac space and local
bleeding. Although conservative management may be sufficient in the
majority of cases, interventional cardiologists should be familiar with
this complication and its diagnosis.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<20>
Accession Number
2003509560
Title
Antithrombotic strategies after transcatheter aortic valve implantation:
Insights from a network meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 96 (2) (pp E177-E186),
2020. Date of Publication: 01 Aug 2020.
Author
Kuno T.; Takagi H.; Sugiyama T.; Ando T.; Miyashita S.; Valentin N.;
Shimada Y.J.; Kodaira M.; Numasawa Y.; Kanei Y.; Hayashida K.; Bangalore
S.
Institution
(Kuno, Miyashita, Valentin) Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Sugiyama) Diabetes and Metabolism Information Center, Research Institute,
Center for Global Health and Medicine, Tokyo, Japan
(Sugiyama) Department of Health Services Research, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Sugiyama) Department of Public Health/Health Policy, Graduate School of
Medicine, The University of Tokyo, Tokyo, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Shimada) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, New York, NY, United States
(Kodaira, Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga
Hospital, Ashikaga, Japan
(Kanei) Department of Cardiology, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Bangalore) New York University School of Medicine, New York, NY, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to investigate the efficacy and safety of different
antithrombotic strategies in patients undergoing transcatheter aortic
valve implantation (TAVI) using network meta-analyses. <br/>Background(s):
Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual
antiplatelet therapy (DAPT), +/- oral anticoagulant (OAC) was conducted to
determine the appropriate post TAVI antithrombotic regimen. However, there
was limited direct comparisons across the different therapeutic
strategies. <br/>Method(s): MEDLINE and EMBASE were searched through
December 2018 to investigate the efficacy and safety of different
antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in
patients undergoing TAVI. The main outcome were all-cause mortality, major
or life-threatening bleeding events, and stroke. <br/>Result(s): Our
search identified 3 randomized controlled trials and 10 nonrandomized
studies, a total of 20,548 patients who underwent TAVI. All OACs were
vitamin K antagonists. There was no significant difference on mortality
except that OAC + DAPT had significantly higher rates of mortality
compared with others (p <.05, I² = 0%). SAPT had significantly
lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard
ratio [HR]: 0.59 [0.46-0.77], p <.001, HR: 0.58 [0.34-0.99], p =.045, HR:
0.41 [0.18-0.93], p =.033, respectively, I² = 0%). There was no
significant difference on stroke among all antithrombotic strategies.
<br/>Conclusion(s): Patients who underwent TAVI had similar all-cause
mortality rates among different antithrombotic strategies except OAC+DAPT.
Patients on SAPT had significantly lower bleeding risk than those on DAPT,
OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred
regimen when there is no indication for DAPT or OAC. When DAPT or OAC is
indicated, DAPT + OAC should be avoided.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<21>
Accession Number
2007465319
Title
Rectal diclofenac administration for prevention of post-endoscopic
retrograde cholangio-pancreatography (ERCP) acute pancreatitis. Randomized
prospective study.
Source
Clinica Terapeutica. 170 (5) (pp E332-E336), 2019. Date of Publication:
2019.
Author
Geraci G.; Palumbo V.D.; D'Orazio B.; Maffongelli A.; Fazzotta S.; Lo
Monte A.I.
Institution
(Geraci, Palumbo, D'Orazio, Maffongelli, Fazzotta, Lo Monte) University
Teaching Hospital "Paolo Giaccone" of Palermo, Section of General and
Thoracic Surgery, Palermo, Italy
Publisher
Societa Editrice Universo (E-mail: annali@seu-roma.it)
Abstract
Introduction. Post-Endoscopic Retrograde Cholangio-Pancreatography
pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic
operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs
(specifically, 100 mg of diclofenac) have shown promising prophylactic
activity in PEP. The aim of our prospective study is to report whether
prophylactic oral versus rectal suppository versus intramuscular
diclofenac versus placebo are able to reduce the incidence and the
severity of ERCP-induced pancreatitis. Materials and Methods. in this
randomized, double-blinded, prospective study, 100 patients (49 male, 51
female), similar with regard to indication for ERCP, were enrolled between
January 2016 and November 2017 to undergo ERCP in the Section of General
and Thoracic Surgery of University Hospital of Palermo. They were
randomized into five groups, respectively 20 patients with placebo by
mouth; 20 patients with 50 mg diclofenac sodium enteric-coated capsules by
mouth; 20 with 100 mg rectal suppository diclofenac, 20 with 75 mg/3 ml
intramuscular diclofenac sodium, 20 with 75 mg/3 ml intramuscular
diclofenac sodium and 20 with 75 mg/3 ml intravenous diclofenac. All drugs
were administered 30 to 90 minutes before ERCP. All clinical data were
collected one day before and 2, 12 and 24 hour after ERCP. Results. data
were prospectively collected and to demonstrate the preventive effect of
rectal diclofenac on PEP, a two-by-two table and chi-square test with
Yates correction were used: the incidence of PEP was significantly lower
(p < 0.001) in the rectal diclofenac group respect to other groups and, in
the same way, the incidence of post-ERCP pain was significantly lower in
the rectal diclofenac group than in the other groups (p = 0.001) and
patients discharge was consequently earlier (p < 0.01). Conclusions. 100
mg dose rectal diclofenac administered 30-60 minutes before ERCP can
effectively prevent PEP.<br/>Copyright &#xa9; Societa Editrice Universo
(SEU).

<22>
Accession Number
2007481454
Title
Point-of-Care Platelet Function Monitoring: Implications for Patients With
Platelet Inhibitors in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Bolliger D.; Lance M.D.; Siegemund M.
Institution
(Bolliger) Department for Anesthesia, Prehospital Emergency Medicine and
Pain Therapy, University Hospital Basel, Basel, Switzerland
(Lance) Department of Anesthesiology, Intensive Care Unit and
Perioperative Medicine, Weill-Cornell Medicine-Qatar, Hamad Medical
Corporation, Doha, Qatar
(Siegemund) Intensive Care Medicine, University Hospital Basel, Basel,
Switzerland
Publisher
W.B. Saunders
Abstract
Although most physicians are comfortable managing the limited
anticoagulant effect of aspirin, the recent administration of potent
P2Y<inf>12</inf> receptor inhibitors in patients undergoing cardiac
surgery remains a dilemma. Guidelines recommend discontinuation of potent
P2Y<inf>12</inf> inhibitors 5- to- 7 days before surgery to reduce the
risk of postoperative hemorrhage. Such a strategy might not be feasible
before urgent surgery, due to ongoing myocardial ischemia or in patients
at high risk for thromboembolic events. Recently, different point-of-care
devices to assess functional platelet quality have become available for
clinical use. The aim of this narrative review was to evaluate the
implications and potential benefits of platelet function monitoring in
guiding perioperative management and therapeutic options in patients
treated with antiplatelets, including aspirin or P2Y<inf>12</inf> receptor
inhibitors, undergoing cardiac surgery. No objective superiority of one
point-of-care device over another was found in a large meta-analysis.
Their accuracy and reliability are generally limited in the perioperative
period. In particular, preoperative platelet function testing has been
used to assess platelet contribution to bleeding after cardiac surgery.
However, predictive values for postoperative hemorrhage and transfusion
requirements are low, and there is a significant variability between and
within these tests. Further, platelet function monitoring has been used to
optimize the preoperative waiting period after cessation of dual
antiplatelet therapy before urgent cardiac surgery. Furthermore, studies
assessing their value in therapeutic decisions in bleeding patients after
cardiac surgery are scarce. A general and liberal use of perioperative
platelet function testing is not yet recommended.<br/>Copyright &#xa9;
2020 The Authors

<23>
Accession Number
2007466883
Title
Cardiac Rehabilitation Programs for Chronic Heart Disease: A Bayesian
Network Meta-analysis.
Source
Canadian Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Huang R.; Palmer S.C.; Cao Y.; Zhang H.; Sun Y.; Su W.; Liang L.; Wang S.;
Wang Y.; Xu Y.; Melgiri N.D.; Jiang L.; Strippoli G.F.M.; Li X.
Institution
(Huang, Li) Department of Gerontology, the Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Palmer) Department of Medicine, University of Otago - Christchurch,
Christchurch, New Zealand
(Cao, Jiang) Department of Cardiothoracic Surgery, the First People's
Hospital of Yunnan Province, Kunming, Yunnan Province, China
(Zhang, Su, Liang) Department of Cardiology, the First People's Hospital
of Yunnan Province, Kunming, Yunnan Province, China
(Sun) Institute of Ultrasound Imaging, the Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Wang, Wang) Department of Rehabilitation Medicine, the Second Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Xu) Statistical Laboratory, Chuang Xu Institute of Lifesciences,
Chongqing, China
(Melgiri) Impactys Foundation for Biomedical Research, San Diego, CA,
United States
(Strippoli) Department of Emergency and Organ Transplantation, University
of Bari, Bari, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cardiac rehabilitation is a medically supervised program after
coronary events that involves exercise and dietary modification. We
evaluated the comparative benefits and harms of cardiac rehabilitation
strategies via a network meta-analysis. <br/>Method(s): We followed a
pre-specified protocol (PROSPERO: CRD42018094998). We searched Embase,
MEDLINE, and Cochrane Central Register of Randomized Trials databases for
randomized controlled trials that evaluated cardiac rehabilitation vs a
second form of rehabilitation or standard/usual care in adults after
myocardial infarction, coronary artery bypass grafting, percutaneous
coronary intervention, or angiography. Risk of bias and evidence quality
was evaluated using the Cochrane tool and Grading of Recommendations
Assessment, Development and Evaluation (GRADE), respectively. Pairwise and
Bayesian network meta-analyses were performed for 11 clinical outcomes.
<br/>Result(s): We included 134 randomized controlled trials involving
62,322 participants. Compared with standard care, exercise-only cardiac
rehabilitation reduced the odds of cardiovascular mortality (odds ratio
[OR], 0.70; 95% credibility interval [CrI], 0.51-0.96; moderate-quality
evidence), major adverse cardiovascular events (OR, 0.57; 95% CrI,
0.40-0.78; low-quality evidence), nonfatal myocardial infarction (OR,
0.71; 95% CrI, 0.54-0.93; moderate-quality evidence), all-cause
hospitalization (OR, 0.74; 95% CrI, 0.54-0.98; moderate-quality evidence),
and cardiovascular hospitalization (OR, 0.69; 95% CrI, 0.51-0.88;
moderate-quality evidence). Exercise-only cardiac rehabilitation was
associated with lower cardiovascular hospitalization risk relative to
cardiac rehabilitation without exercise (OR, 0.68; 95% CrI, 0.48-0.97;
moderate-quality evidence). <br/>Conclusion(s): Cardiac rehabilitation
programs containing exercise might provide broader cardiovascular benefits
compared with those without exercise.<br/>Copyright &#xa9; 2020 Canadian
Cardiovascular Society

<24>
Accession Number
632600299
Title
Levosimendan in the treatment of patients with acute cardiac conditions:
an expert opinion of the Association of Intensive Cardiac Care of the
Polish Cardiac Society.
Source
Kardiologia polska. (no pagination), 2020. Date of Publication: 12 Aug
2020.
Author
Tycinska A.; Gierlotka M.; Bugajski J.; Deja M.; Depukat R.; Gruchala M.;
Grzesk G.; Kasprzak J.D.; Kubica J.; Kucewicz-Czech E.; Leszek P.; Plonka
J.; Sobkowicz B.; Straburzynska-Migaj E.; Wilk K.; Zawislak B.; Zymlinski
R.; Stepinska J.
Publisher
NLM (Medline)
Abstract
Levosimendan is a new inodilator which acts by three main mechanisms:
increase calcium sensitivity of cardiomyocytes, acts as a vasodilator due
to the opening of potassium channels, and possesses the cardioprotective
action. Levosimendan has found its indication mainly in the treatment of
acute, decompensated heart failure (indication IIb according to ESC
guidelines). However, the results of many clinical trials indicate the
validity of using repeated infusions of levosimendan in patients with
stable heart failure, as a bridge therapy to heart transplantation, also
in patients with accompanying right ventricle heart failure and pulmonary
hypertension. Due to the complex mechanism of action, including the
cardioprotective and anti-aggregating effect, the use of levosimandan may
be particularly beneficial in patients with acute coronary syndromes,
preventing the occurrence of acute heart failure. Several data indicate
that levosimendan administered prior to cardiac surgery may improve
outcomes in patients with severely impaired left ventricle function. The
multidirectional mechanism of action also affects other organs and
systems. The positive effect of levosimendan in the treatment of
cardio-renal and cardio-hepatic syndromes has been demonstrated.
Levosimendan has a safe and predictable profile of action, does not induce
tolerance, and shows no adverse effects affecting patients survival or
prognosis. However, with inconclusive results of the previous studies,
there is a need to conduct a properly designed, multicentre, randomized,
placebo-controlled study, including an adequately large group of
outpatients with chronic advanced systolic heart failure.

<25>
Accession Number
632598204
Title
Rheumatic Heart Disease anno 2020: Impacts of gender and migration on
epidemiology and management.
Source
European journal of clinical investigation. (pp e13374), 2020. Date of
Publication: 13 Aug 2020.
Author
Mutagaywa R.K.; Wind A.-M.; Kamuhabwa A.; Cramer M.J.; Chillo P.;
Chamuleau S.
Institution
(Mutagaywa, Chillo) School of Medicine, Muhimbili University of Health and
Allied Sciences, Tanzania
(Mutagaywa, Wind, Cramer, Chamuleau) Faculty of Medicine, Division of
Heart and Lung, department of Cardiology, University Medical Centre
Utrecht, Netherlands
(Kamuhabwa) School of Pharmacy, Muhimbili University of Health and Allied
Sciences, Tanzania
(Chamuleau) Faculty of Medicine, Division of Heart and Lung, department of
Cardiology, Amsterdam University Medical Centre, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: The epidemiology and management of diseases can be influenced
by social demographic factors. Gender and migration are among these
factors. <br/>METHOD(S): We aimed at reviewing the impacts of gender and
migration on Rheumatic heart disease (RHD) epidemiology and management by
a non-systematic literature review of published studies on RHD worldwide.
Our PubMed search terms included RHD pathophysiology, diagnosis,
complications, management or prevention, combined with words 'rheumatic
mitral stenosis (MS)', 'outcomes after percutaneous balloon mitral
valvuloplasty (PBMV)', 'gender or sex difference', and 'migration'. The
reporting of this study conforms to SANRA (the Scale for Assessment of
Narrative Review Articles) guidelines. <br/>RESULT(S): We retrieved eight
studies about the impact of sex on outcomes after PBMV. All of these
studies showed a female predominance for RHD. Two studies showed that
there is no impact, three studies showed female sex as a predictor of poor
outcomes, and the other three showed male sex a predictor of poor
outcomes. Although RHD is reported to be eradicated in the developed
countries, 2.1% of refugees recently screened for RHD in Italy were found
to have subclinical RHD. This prevalence is similar to those found in
India (2.0%), Cambodia (2.2%), and Mozambique (3%). <br/>CONCLUSION(S):
There are contradicting results for outcomes after PBMV between males and
females. It is not clear whether sex difference plays a role in
pathophysiology, diagnosis, management and prognosis of MS. Migration has
impacts on epidemiology and management of RHD. Further studies are
required in these two fields to explore their relationship to
RHD.<br/>Copyright This article is protected by copyright. All rights
reserved.

<26>
Accession Number
632594983
Title
Efficacy and Safety of PCSK9 Inhibition With Evolocumab in Reducing
Cardiovascular Events in Patients With Metabolic Syndrome Receiving Statin
Therapy: Secondary Analysis From the FOURIER Randomized Clinical Trial.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 12 Aug 2020.
Author
Deedwania P.; Murphy S.A.; Scheen A.; Badariene J.; Pineda A.L.; Honarpour
N.; Keech A.C.; Sever P.S.; Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Deedwania) University of California School of Medicine, San Francisco,
Fresno
(Murphy, Sabatine, Giugliano) TIMI Study Group, Division of Cardiovascular
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA
(Scheen) Department of Medicine, CHU Liege, Liege University, Liege,
Belgium
(Badariene) Clinic of Cardiac and Vascular Diseases, Institute of Clinical
Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
(Pineda, Honarpour) Amgen, Thousand Oaks, CA
(Keech) Sydney Medical School, NHMRC Clinical Trials Centre, University of
Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Norway
(Sabatine) Deputy Editor
Publisher
NLM (Medline)
Abstract
Importance: The PCSK9 inhibitor evolocumab reduced low-density lipoprotein
cholesterol and cardiovascular events in the FOURIER randomized clinical
trial. Patients with metabolic syndrome (MetS) are at increased
cardiovascular risk. <br/>Objective(s): To investigate outcomes with
evolocumab in patients with and without MetS. <br/>Design, Setting, and
Participant(s): The FOURIER trial randomized patients worldwide with
stable atherosclerotic cardiovascular disease receiving statin to
evolocumab vs placebo with follow-up for a median of 2.2 years. Data were
collected February 2013 to November 2016. For this prespecified analysis,
patients with the requisite data were stratified based on the National
Cholesterol Education Program Adult Treatment Panel III MetS criteria; in
secondary analyses, patients were further substratified by diabetes at
baseline. Analysis was intention to treat. Analysis began March 2018 and
ended April 2020. <br/>Intervention(s): Patients were randomized to
evolocumab or placebo. <br/>Main Outcomes and Measures: The primary end
point was cardiovascular death, myocardial infarction, stroke,
hospitalization for unstable angina, or coronary revascularization. The
key secondary end point was cardiovascular death, myocardial infarction,
or stroke. <br/>Result(s): Of 27342 patients (mean [SD] age, 63 [9] years;
20623 men [75.4%]) included in this analysis, 16361 (59.8%) with baseline
MetS were, when compared with patients without MetS, at higher risk of
cardiovascular events (adjusted hazard ratio [95% CI], 1.31 [1.18-1.46];
P<.001 for the primary and 1.38 [1.20-1.57]; P<.001 for the key secondary
end point). Evolocumab reduced low-density lipoprotein cholesterol
similarly in patients with MetS (median [interquartile range], 92 [79-109]
mg/dL vs 30 [19-48] mg/dL; P<.001) and without MetS (median [interquartile
range], 92 [81-108] mg/dL vs 29 [18-44] mg/dl; P<.001). For the primary
end point, the hazard ratios (95% CI) with evolocumab vs placebo were 0.83
(0.76-0.91) and 0.89 (0.79-1.01) in patients with and without MetS (P for
interaction=.39). For the key secondary end point, the corresponding
hazard ratios (95% CIs) were 0.76 (0.68-0.86) and 0.86 (0.74-1.01) (P for
interaction=.23), respectively. Evolocumab did not increase the risk of
new-onset diabetes or other major safety outcomes including worsening
glycemic control, compared with placebo in patients with MetS.
<br/>Conclusions and Relevance: Patients with atherosclerotic
cardiovascular disease and MetS have substantial residual risk of
cardiovascular events despite statin therapy. Evolocumab significantly
reduced low-density lipoprotein cholesterol and cardiovascular risk in
patients with MetS without increasing new-onset diabetes, worsening
glycemic control, or other major safety events. These data suggest the
addition of evolocumab to statin therapy in patients with atherosclerotic
cardiovascular disease and MetS is safe and efficacious to reduce residual
cardiovascular risk. Trial Registration: ClinicalTrials.gov Identifier:
NCT01764633.

<27>
Accession Number
2007380526
Title
Clinical Impact of Preexisting Right Bundle Branch Block after
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Journal of Interventional Cardiology. 2020 (no pagination), 2020. Article
Number: 1789516. Date of Publication: 2020.
Author
Saint Croix G.R.; Lacy S.C.; Hrachian H.; Beohar N.
Institution
(Saint Croix, Hrachian, Beohar) Columbia University Division of
Cardiology, Mount Sinai Medical Center, Miami Beach, FL, United States
(Lacy) Miller School of Medicine, University of Miami, Miami, FL, United
States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Introduction. Transcatheter aortic valve replacement (TAVR) is now the
treatment of choice for patients with severe aortic stenosis regardless of
their surgical risk. Right bundle branch block (RBBB) can be a predictor
for development of significant atrioventricular (AV) block after TAVR,
requiring permanent pacemaker implantation (PPI). However, data related to
the risk of PPI requirement with preexisting RBBB is scarce. Hence, this
systematic review and meta-analysis aims to assess clinical outcomes of
patients undergoing TAVR with RBBB on preexisting electrocardiogram.
Methods. We performed a systematic literature review to identify
randomized and nonrandomized clinical studies that reported any clinical
impact of patients undergoing TAVR with preexisting RBBB. A total of eight
databases including PubMed (Medline), Embase, Cochrane Library, ACP
Journal Club, Scopus, DARE, and Ovid containing articles from January 2000
to May 2020 were analyzed. Results. We identified and screened 224
potential eligible publications through the databases and found 14
relevant clinical trials for a total of 15,319 participants. There was an
increased 30-day pacemaker implantation rate of 38.1% in the RBBB group
compared to 11.4% in the no RBBB group with a risk ratio of 3.56 (RR 3.56
(95% CI 3.21-3.93, p<0.01)). There was an increased 30-day all-cause
mortality in the RBBB group of 9.5% compared with 6.3% in the no RBBB
group with an odds ratio of 1.60 (OR 1.60 (95% CI 1.14-2.25, p<0.01)).
Conclusion. This study indicates that patients with preexisting RBBB have
higher incidence of PPI and all-cause mortality after TAVR compared with
patients without RBBB. Further trials are needed to compare the clinical
outcomes based on TAVR valve types and assess the benefit of PPI in
patients with new-onset RBBB after TAVR.<br/>Copyright &#xa9; 2020 Garly
R. Saint Croix et al.

<28>
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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2020, The Author(s).

<29>
Accession Number
2005548199
Title
Selonsertib for patients with bridging fibrosis or compensated cirrhosis
due to NASH: Results from randomized phase III STELLAR trials.
Source
Journal of Hepatology. 73 (1) (pp 26-39), 2020. Date of Publication: July
2020.
Author
Harrison S.A.; Wong V.W.-S.; Okanoue T.; Bzowej N.; Vuppalanchi R.; Younes
Z.; Kohli A.; Sarin S.; Caldwell S.H.; Alkhouri N.; Shiffman M.L.; Camargo
M.; Li G.; Kersey K.; Jia C.; Zhu Y.; Djedjos C.S.; Subramanian G.M.;
Myers R.P.; Gunn N.; Sheikh A.; Anstee Q.M.; Romero-Gomez M.; Trauner M.;
Goodman Z.; Lawitz E.J.; Younossi Z.
Institution
(Harrison) Pinnacle Clinical Research, San Antonio, TX, United States
(Wong) Department of Medicine and Therapeutics, The Chinese University of
Hong Kong, Hong Kong, Hong Kong, Hong Kong
(Okanoue) Saiseikai Suita Hospital, Suita City, Osaka, Japan
(Bzowej) Oschner Medical Center, New Orleans, LA, United States
(Vuppalanchi) Indiana University School of Medicine, Indianapolis, IN,
United States
(Younes) Gastro One, Germantown, TN, United States
(Kohli) The Institute for Liver Health, Chandler, AZ, United States
(Sarin) Institute of Liver and Biliary Sciences, New Delhi, India
(Caldwell) University of Virginia, Charlottesville, VA, United States
(Alkhouri, Lawitz) Texas Liver Institute, University of Texas Health San
Antonio, TX, United States
(Shiffman) Liver Institute of Virginia, Bon Secours Mercy Health,
Richmond, VA, United States
(Camargo, Li, Kersey, Jia, Zhu, Djedjos, Subramanian, Myers) Gilead
Sciences, Inc., Foster City, CA, United States
(Gunn) Pinnacle Clinical Research, Austin, TX, United States
(Sheikh) GI Specialists of Georgia, Marietta, GA, United States
(Anstee) Institute of Cellular Medicine, Faculty of Medical Sciences,
Newcastle University, Newcastle upon Tyne, UK & Newcastle NIHR Biomedical
Research Center, Newcastle upon Tyne Hospitals NHS Foundation Trust,
Newcastle upon Tyne, United Kingdom
(Romero-Gomez) Hospital Universitario Virgen del Rocio, Sevilla, Spain
(Trauner) Division of Gastroenterology and Hepatology, Medical University
of Vienna, Austria
(Goodman, Younossi) Inova Fairfax Hospital, Falls Church, VA, United
States
Publisher
Elsevier B.V.
Abstract
Background & Aims: Apoptosis signal-regulating kinase 1 (ASK1) plays a key
role in hepatocyte injury, inflammation, and fibrosis in non-alcoholic
steatohepatitis (NASH). We evaluated the safety and antifibrotic effect of
selonsertib, a selective inhibitor of ASK1, in patients with advanced
fibrosis due to NASH. <br/>Method(s): We conducted 2 randomized,
double-blind, placebo-controlled, phase III trials of selonsertib in
patients with NASH and bridging fibrosis (F3, STELLAR-3) or compensated
cirrhosis (F4, STELLAR-4). Patients were randomized 2:2:1 to receive
selonsertib 18 mg, selonsertib 6 mg, or placebo once daily for 48 weeks.
Liver biopsies were performed at screening and week 48 and non-invasive
tests of fibrosis (NITs) were evaluated. The primary efficacy endpoint was
the proportion of patients with >=1-stage improvement in fibrosis without
worsening of NASH at week 48. Additional endpoints included changes in
NITs, progression to cirrhosis (in STELLAR-3), and liver-related clinical
events. <br/>Result(s): Neither trial met the primary efficacy endpoint.
In STELLAR-3, fibrosis improvement without worsening of NASH was observed
in 10% (31/322, p = 0.49 vs. placebo), 12% (39/321, p = 0.93 vs. placebo),
and 13% (21/159) of patients in the selonsertib 18 mg, selonsertib 6 mg,
and placebo groups, respectively. In STELLAR-4, the primary endpoint was
achieved in 14% (51/354; p = 0.56), 13% (45/351; p = 0.93), and 13%
(22/172) of patients, respectively. Although selonsertib led to
dose-dependent reductions in hepatic phospho-p38 expression indicative of
pharmacodynamic activity, it had no significant effect on liver
biochemistry, NITs, progression to cirrhosis, or adjudicated clinical
events. The rates and types of adverse events were similar among
selonsertib and placebo groups. <br/>Conclusion(s): Forty-eight weeks of
selonsertib monotherapy had no antifibrotic effect in patients with
bridging fibrosis or compensated cirrhosis due to NASH. Lay summary:
Patients with non-alcoholic steatohepatitis (NASH) can develop scarring of
the liver (fibrosis), including cirrhosis, which increases the risks of
liver failure and liver cancer. We tested whether 48 weeks of treatment
with selonsertib reduced fibrosis in patients with NASH and advanced liver
scarring. We did not find that selonsertib reduced fibrosis in these
patients. Trial registration details: Clinicaltrials.gov numbers
NCT03053050 and NCT03053063.<br/>Copyright &#xa9; 2020

<30>
Accession Number
2004792753
Title
In Vivo Protamine Titration Using Activated Coagulation Time to Neutralize
Heparin Anticoagulation in Cardiac Surgery: Proof of Concept.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (9) (pp 2369-2374),
2020. Date of Publication: September 2020.
Author
Rochon A.G.; Belisle S.; Couture P.; Fortier A.; Lebon J.-S.; Deschamps A.
Institution
(Rochon, Belisle, Couture, Lebon, Deschamps) Department of Anesthesia,
Montreal Heart Institute, Montreal, QC, Canada
(Fortier, Deschamps) Department of Montreal Health Innovations
Coordinating Center, Montreal Heart Institute, Universite de Montreal,
Montreal, QC, Canada
Publisher
W.B. Saunders
Abstract
Objective: In vivo protamine titration (IVPT) is based on the observation
of a plateau on the decay curve of the celite activated clotting times
(ACTs) during protamine infusion for heparin reversal. The aim of the
present study was to determine the optimal protamine/heparin ratio to
reverse anticoagulation using IVPT curves. <br/>Design(s): Prospective,
randomized study. <br/>Setting(s): Tertiary care university hospital.
<br/>Participant(s): The study comprised 138 patients undergoing elective
cardiac surgery requiring cardiopulmonary bypass. <br/>Intervention(s):
The control group was given a protamine infusion of 1.3 mg per 1 mg (100
U) of heparin over 21 minutes. ACT was measured every 3 minutes. In the
test group, the protamine dose was prepared using the same ratio as for
the control group, and ACT values were measured every 3 minutes until a
plateau was reached (2 consecutive ACT values <160 s), at which time the
protamine infusion was stopped. The protamine/heparin ratio, blood losses,
transfusions, and heparin concentrations were recorded. <br/>Result(s):
The protamine dose was lower in the test group (456.00 +/- 105.66 mg
[control group] v 295.25 +/- 100.60 mg [test group]; p < 0.0001). The mean
protamine/heparin ratios were 1.30 +/- 0.10 (control group) and 0.81 +/-
0.22 (test group) (p < 0.0001). Heparin concentrations were greater in the
test group 15 minutes (0.10 [0-0.2] U/mL v 0 [0-0.1] U/mL; p = < 0.0001)
and 3 hours (0 [0-0.1] U/mL v 0 [0-0] U/mL; p = 0.0002) after protamine
infusion. There was no difference in the blood losses and transfusion
requirements. <br/>Conclusion(s): IVPT is safe and efficient in this
low-risk population.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<31>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<32>
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). <br/>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. <br/>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). <br/>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%]. <br/>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.<br/>Copyright &#xa9; 2019 Elsevier
Inc.

<33>
[Use Link to view the full text]
Accession Number
632530903
Title
Effect of high-dose ulinastatin on the cardiopulmonary bypass-induced
inflammatory response in patients undergoing open-heart surgery.
Source
Chinese Medical Journal. 133 (12) (pp 1476-1478), 2020. Date of
Publication: 2020.
Author
Liu Y.; Wang Y.-L.; Zou S.-H.; Sun P.-F.; Zhao Q.
Institution
(Liu) Department of Drug Dispensing, Affiliated Hospital of Qingdao
University, Qingdao, Shandong 266500, China
(Wang, Zou, Sun, Zhao) Department of Clinical Pharmacy, Yuhuangding
Hospital of Qingdao University, Yantai, Shandong 264000, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<34>
Accession Number
2007257567
Title
Infective endocarditis after TAVI: A meta-analysis and systematic review
of epidemiology, risk factors and clinical consequences.
Source
Reviews in Cardiovascular Medicine. 21 (2) (pp 263-274), 2020. Date of
Publication: June 2020.
Author
Tinica G.; Tarus A.; Enache M.; Artene B.; Rotaru I.; Bacusca A.; Burlacu
A.
Institution
(Tinica, Tarus, Enache, Rotaru, Bacusca) Department of Cardiovascular
Surgery, Cardiovascular Diseases Institute, Iasi 700503, Romania
(Tinica, Tarus, Enache, Artene, Rotaru, Bacusca, Burlacu) Grigore T. Popa'
University of Medicine, Iasi 700115, Romania
(Artene, Burlacu) Department of Interventional Cardiology, Cardiovascular
Diseases Institute, Iasi 700503, Romania
Publisher
IMR Press Limited (E-mail: tech@imrpress.org)
Abstract
Infective endocarditis (IE) represents one of the most challenging
clinical entities, requiring a multidisciplinary approach. The increasing
number of surgical and transcatheter heart valves replacements performed
annually lead to a higher incidence of prosthetic valve endocarditis.
Transcatheter aortic valve implantation (TAVI) brought a new alternative
for the treatment of aortic stenosis and a new subgroup of IE with its
features. We aimed to compare the incidence of IE in TAVI and surgical
valve replacement (SAVR) to identify risk factors for TAVI-IE, evaluate
the possible impact on mortality, and clarify the best treatment
strategies. A digital scan in PubMed and SCOPUS databases was performed.
68 publications were selected to perform a meta-analysis and systematic
review on epidemiology, risk factors, and mortality predictors in TAVI-IE.
No significant difference in IE rate was noted between patients with TAVI
and those with SAVR for in-hospital, early, mid-term and late IE. Male
gender, intubation, new pacemaker implantation IE and CKD were correlated
with TAVI-IE. Surgical treatment was performed in 22.3% of cases. Overall
mortality for the pooled cohort was 38.3%. In a multivariate logistic
regression model, surgical treatment and self-expandable device were
linked to lower mortality in TAVI-IE. Even if the invasive procedure can
trigger bacteremia, exposing the TAVI valve to future infection, no
significant difference in IE rate was noted in our analysis between
patients with TAVI and those with SAVR for in-hospital, early, mid-term
and late IE. Surgical treatment of TAVI-IE can be a viable option in
patients with a prohibitive risk score.<br/>Copyright &#xa9; 2020 Tinica
et al. Published by IMR Press.

<35>
Accession Number
632587652
Title
Gender differences in aortic valve replacement: Is surgical aortic valve
replacement riskier and transcatheter aortic valve replacement safer in
women than in men?.
Source
Journal of Thoracic Disease. 12 (7) (pp 3737-3746), 2020. Date of
Publication: 01 Jul 2020.
Author
Caponcello M.G.; Banderas L.M.; Ferrero C.; Bramlage C.; Thoenes M.;
Bramlage P.
Institution
(Caponcello, Banderas, Ferrero, Thoenes, Bramlage) Departamento Farmacia y
Tecnologia Farmaceutica, Universidad de Sevilla, Sevilla, Spain
(Caponcello, Bramlage, Bramlage) Institute for Pharmacology and Preventive
Medicine, Cloppenburg, Germany
(Thoenes) Leman Research Institute, Switzerland
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Aortic stenosis (AS) is a progressive and degenerative disease that
necessitates valve replacement through either surgical aortic valve
replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
Various studies have shown that, unlike for TAVR, SAVR is associated with
an elevated risk for women as compared to men. The aim of this review is
to better understand the risks and their possible causes, associated with
the use of both TAVR and SAVR in female patients. Our systematic review
included studies published between 2012 and 2020, identified through
specific searches of PubMed. Compatibility of publications, determined by
the use of pre-defined inclusion/exclusion criteria, resulted in 15
articles being used in our review. Overall, more men than women undergo
SAVR, but our findings confirmed that SAVR is associated with worse
outcomes in women in the short-term. Reasons for a higher 30-day mortality
post-SAVR in women include an increased age, higher in-hospital mortality
and, possibly baseline comorbidities and anatomical differences. There was
no difference observed in 30-day mortality between men and women
undergoing TAVR. Female patients appear to have a better longer-term
survival post-TAVR than their male counterparts. Understanding the reasons
why women have worse outcomes post-SAVR is essential for ensuring
appropriate treatment selection for patients with AS, as well as for
achieving the best possible long-term and safety outcomes for these
patients.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<36>
Accession Number
2005875817
Title
The role of Cor-Knot in the future of cardiac surgery: A systematic
review.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Jenkin I.; Prachee I.; Sokal P.A.; Harky A.
Institution
(Jenkin, Prachee) Medical Sciences Division, University of Oxford, Oxford,
United Kingdom
(Sokal) Department of Medicine, School of Medicine, University of
Liverpool, Liverpool, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The Cor-Knot automated fastener has been used to eliminate the
need for manual knot-tying in cardiac valve surgery for over a decade. We
review the current literature pertaining to Cor-Knot and discuss its
benefits and shortcomings with respect to cardiac valve surgery.
<br/>Method(s): A comprehensive literature search was conducted to
identify articles discussing the use of automated fasteners and manually
tied knots in the setting of cardiac valve surgery. The search terms used
were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener",
"automated fastener", "aortic valve", "mitral valve", "minimally
invasive", and "titanium". These terms were used as keywords and, in
combination, as MeSH terms to maximize the output of literature searches.
Twenty-four relevant articles were identified and reviewed.
<br/>Result(s): Current literature provides evidence to support the role
of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing
total operation times as compared with manual knot-tying. However, studies
to date fail to provide evidence for the translation of these
intraoperative advantages into improved patient outcomes. Moreover,
Cor-Knot is associated with a significant financial burden.
<br/>Conclusion(s): A plethora of evidence exists to support the
intraoperative advantages provided by Cor-Knot. However, the literature is
yet to support its role in facilitating superior clinical outcomes as
compared with manual knot tying. Larger high-quality trials and studies
are required to provide evidence supporting the ongoing use of Cor-Knot in
valve surgery.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<37>
Accession Number
2005875804
Title
Key methodological choices determine the results of randomized trials in
cardiac surgery: Every trial is perfectly designed to get the results it
gets.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Gaudino M.; Zwischenberger B.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Zwischenberger) Department of Surgery, Duke University Medical Center,
Durham, NC, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)

<38>
Accession Number
2005875740
Title
Microplegia in cardiac surgery: Systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Owen C.M.; Asopa S.; Smart N.A.; King N.
Institution
(Owen, King) School of Biomedical Sciences, Faculty of Health, University
of Plymouth, Plymouth, United Kingdom
(Asopa) South West Cardiothoracic Centre, University Hospitals Plymouth,
Plymouth, United Kingdom
(Smart) Exercise Physiology, School of Science and Technology, University
of New England, Armidale, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Consensus on the optimum choice of cardioplegia remains
elusive. One possibility that has been suggested to have beneficial
properties is microplegia, a cardioplegia of reduced crystalloid volume.
The aim of this meta-analysis is to comprehensively investigate
microplegia against a range of clinical outcomes. <br/>Method(s): To
identify potential studies, systematic searches were carried out in four
databases (eg, Pubmed, EMBASE). The search strategy included the key
concepts of "microplegia" OR "mini-cardioplegia" OR "miniplegia" AND
"cardiac surgery." This was followed by a meta-analysis investigating:
mortality, crystalloid volume; cardiopulmonary bypass time; cross-clamp
time; intra-aortic balloon pump use; spontaneous heartbeat recovery;
inotropic support; low cardiac output syndrome; myocardial infarction;
acute renal failure; atrial fibrillation, reoperation for bleeding;
creatine kinase myocardial band (CK-MB); intensive care unit (ICU) time
and hospital stay. <br/>Result(s): Eleven studies comprising 5798
participants were analyzed. Microplegia used a lower volume of
crystalloids and led to a higher spontaneous return of heartbeat, odds
ratio (OR) 4.271 (95% confidence intervals [CIs]: 1.935, 9.423;
I² = 76.57%; P <.001) and a lower requirement for inotropic
support, OR: 0.665 (95% CI: 0.47, 0.941; I² = 3.53%; P =.021).
Microplegia was also associated with a lower CK-MB release, mean
difference (MD) -6.448 ng/mL (95% CI: -9.386, -3.511; I² = 0%;
P <.001) and a shorter ICU stay, MD: -0.411 days (95% CI: -0.812, -0.009;
I² = 17.65%; P =.045). All other comparisons were
nonsignificant. <br/>Conclusion(s): Microplegia has similar effects to
other types of cardioplegia and is beneficial with regard to spontaneous
return of heartbeat, inotropic support, ICU stay, and CK-MB
release.<br/>Copyright &#xa9; 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<39>
Accession Number
2005875739
Title
Telemedicine in cardiovascular surgery during COVID-19 pandemic: A
systematic review and our experience.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Ajibade A.; Younas H.; Pullan M.; Harky A.
Institution
(Ajibade) Birmingham Medical School, University of Birmingham, Birmingham,
United Kingdom
(Younas) St George's Medical School, University of London, London, United
Kingdom
(Pullan, Harky) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Sciences,
University of Liverpool, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The SAR-COV-2 pandemic has had an unprecedented effect on the
UK's healthcare systems. To reduce spread of the virus, elective
treatments and surgeries have been postponed or canceled. There has been a
rise in the use of telemedicine (TM) as an alternative way to carry
outpatient consultations. This systematic review aims to evaluate the
extent to which TM may be able to support cardiac and vascular surgery
patients in the COVID-19 era. <br/>Method(s): We looked into how TM can
support the management of patients via triaging, preoperative, and
postoperative care. Evaluations targeted the clinical effectiveness of
common TM methods and the feasibility of applying those methods in the UK
during this pandemic. <br/>Result(s): Several studies have published their
evidence on the benefit of TM and its benefit during COVID-19, the data
related to cardiovascular surgery and how this will impact future practice
of this speciality is emerging and yet larger studies with appropriate
timing of outcomes to be published. <br/>Conclusion(s): Overall, the use
of virtual consultations and remote monitoring is feasible and best placed
to support these patients via triaging and postoperative monitoring.
However, TM can be limited by the need of sophisticated technological
requirement and patients' educational and know-how computer literacy
level.<br/>Copyright &#xa9; 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<40>
Accession Number
2005851133
Title
Conventional versus minimally invasive extracorporeal circulation in
patients undergoing cardiac surgery: protocol for a randomised controlled
trial (COMICS).
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Despite low mortality, cardiac surgery patients may
experience serious life-threatening post-operative complications, often
due to extracorporeal circulation and reperfusion. Miniaturised
cardiopulmonary bypass (minimally invasive extracorporeal circulation) has
been developed aiming to reduce the risk of post-operative complications
arising with conventional extracorporeal circulation. <br/>Method(s): The
COMICS trial is a multi-centre, international, two-group parallel
randomised controlled trial testing whether type II, III or IV minimally
invasive extracorporeal circulation is effective and cost-effective
compared to conventional extracorporeal circulation in patients undergoing
elective or urgent coronary artery bypass grafting, aortic valve
replacement or coronary artery bypass grafting + aortic valve replacement.
Randomisation (1:1 ratio) is concealed and stratified by centre and
surgical procedure. The primary outcome is a composite of 12 serious
complications, objectively defined or adjudicated, 30 days after surgery.
Secondary outcomes (at 30 days) include other serious adverse events
(primary safety outcome), use of blood products, length of intensive care
and hospital stay and generic health status (also at 90 days). Status of
the trial: Two centres started recruiting on 08 May 2018; 10 are currently
recruiting and 603 patients have been randomised (11 May 2020). The
recruitment rate from 01 April 2019 to 31 March 2020 was 40-50
patients/month. About 80% have had coronary artery bypass grafting only.
Adherence to allocation is good. <br/>Conclusion(s): The trial is feasible
but criteria for progressing to a full trial were not met on time. The
Trial Steering and Data Monitoring Committees have recommended that the
trial should currently continue.<br/>Copyright &#xa9; The Author(s) 2020.

<41>
Accession Number
2005851101
Title
Preoperative C-reactive protein as a predictor of postoperative acute
kidney injury in patients undergoing coronary artery bypass grafting.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Mohamed W.; Asimakopoulos G.
Institution
(Mohamed) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Asimakopoulos) Department of Cardiac Surgery, Royal Brompton Hospital,
London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
C-reactive protein is a well-known marker of inflammation and may be
preoperatively elevated in the absence of infection in adult cardiac
surgery patients, indicating a baseline inflammatory process. We conducted
a literature search to assess the available evidence on whether there is
an association between preoperative C-reactive protein and acute kidney
injury after coronary artery bypass grafting. Included only were
observational studies which investigated this association. We excluded
abstracts, case reports, animal studies and articles in languages other
than English. Altogether, 199 papers were retrieved from the search
strategy reported, of which 6 studies were included in the final review.
The study types, publication details, patient groups and key results are
tabulated. A qualitative assessment of these papers was conducted. We
conclude that there is some evidence to support the association between
high preoperative C-reactive protein level and postoperative acute kidney
injury and complications after coronary artery bypass grafting. Owing to
variability in acute kidney injury definitions and C-reactive protein
levels for different cohorts in the observational studies reviewed, it is
unclear from current evidence what serum C-reactive protein cut-off level
is significantly associated with postoperative acute kidney injury.
Further evidence is needed to investigate whether raised preoperative
C-reactive protein in the absence of an infective cause could have a role
in risk prediction models for cardiac surgery-associated acute kidney
injury.<br/>Copyright &#xa9; The Author(s) 2020.

<42>
Accession Number
632589791
Title
Effects of intraoperative dexmedetomidine on the incidence of acute kidney
injuryin pediatric cardiac surgery patients: A randomized controlled
trial.
Source
Paediatric anaesthesia. (no pagination), 2020. Date of Publication: 11 Aug
2020.
Author
Kim E.-H.; Lee J.-H.; Kim H.-S.; Jang Y.-E.; Ji S.-H.; Kim W.-H.; Kwak
J.G.; Kim J.-T.
Institution
(Kim, Lee, Kim, Jang, Ji, Kim) Department of Anesthesiology and Pain
medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Jongno-GU, Seoul 03080, South Korea
(Kim, Kwak) Department of Cardiothoracic surgery, Seoul National
University Hospital, Seoul National University College of Medicine,
Jongno-GU, Seoul 03080, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative dexmedetomidineuse has been reported to reduce
the incidence of postoperative acute kidney injuryafter adult cardiac
surgery. However, large-scale randomized controlled trials evaluating the
effect of dexmedetomidine use on acute kidney injury in pediatric patients
are lacking. AIMS: We investigated whether intraoperativedexmedetomidine
could reduce the incidence of acute kidney injury in pediatric cardiac
surgery patients. <br/>METHOD(S): In total, 141 pediatric patients were
randomly assigned to dexmedetomidine or control groups. After anesthetic
induction, patients in the dexmedetomidine group were administered 1
micro&#32;g/kg of dexmedetomidine over 10 minutes, and an additional 0.5
micro&#32;g/kg/hof dexmedetomidine during surgery. Additionally, 1
micro&#32;g/kg of dexmedetomidine was infused immediately after
cardiopulmonary bypass was initiated. The incidence of acute kidney
injurywas defined following Kidney Disease Improving Global Outcomes
guidelines. <br/>RESULT(S): The final analysis included 139 patients. The
incidence of acute kidney injury did not differ between dexmedetomidine
and control groups (16.9% vs. 23.5%; odds ratio 0.661; 95% CI 0.285 to
1.525; p = 0.33). Similarly,neither the incidence of abnormal
postoperative estimated glomerular filtration ratevalues (P = 0.96)
differed between the two groups, northe incidence of arrhythmia,
mechanical ventilation duration, length of stay in the intensive care
unit,and hospitalization. <br/>CONCLUSION(S): Intraoperative
dexmedetomidine did not reduce acute kidney injuryincidence in pediatric
cardiac surgery patients.<br/>Copyright This article is protected by
copyright. All rights reserved.

<43>
Accession Number
632587339
Title
The wait for symptoms' strategy in asymptomatic severe aortic stenosis.
Source
Heart. (no pagination), 2020. Date of Publication: 2020.
Author
San Roman J.A.; Vilacosta I.; Antunes M.J.; Iung B.; Lopez J.; Schafers
H.-J.
Institution
(San Roman, Lopez) 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
(Schafers) Klinik fur Thorax- und Herz- Gefaschirurgie, Universitat des
Saarlandes, Saarbrucken, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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. <br/>Copyright &#xa9; Author(s) (or their employer(s)) 2020. No
commercial re-use. See rights and permissions. Published by BMJ.

<44>
Accession Number
629838786
Title
Double-chambered Left Ventricle: Clinical features comparison between
children and adults.
Source
Journal of the College of Physicians and Surgeons Pakistan. 29 (11) (pp
1087-1091), 2019. Date of Publication: 2019.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province
351100, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Double-chambered left ventricle is a rare congenital heart defect. The
clinical features, diagnosis, treatment and patient prognosis of this
lesion have not been sufficiently elaborated. The present systematic
review found that the accessory ventricular septum was often an abnormal
muscle band, and sometimes a membranous structure, a fibromuscular ridge,
or prominent trabeculations. Less than one-third of the patients are
associated with other congenital heart defects. Diagnosis of
double-chambered left ventricle can usually be made by transthoracic
echocardiography; however, it might be misdiagnosed as atrial or
ventricular septal defect. The accessory chamber was often smaller than
the main chamber, and often has wall thinning. The accessory chamber wall
dysfunction/hypokinesis was seen in half of the cases. One-third patients
had left ventricular outflow tract obstruction. The adult patients showed
abnormal electrocardiographic findings more than in pediatrics.
Nevertheless, no differences were found between adult and pediatric
patients in terms of left ventricular function and structure, treatment of
choice, and patient outcomes. Most patients are asymptomatic with no left
ventricular obstruction, and thus do not need surgical treatment. Surgical
resection of the accessory ventricular septum is warranted when the
patients become symptomatic as a result of left ventricular obstruction,
or associated with other congenital heart defects. The patients' outcomes
are promising. Differential diagnosis should be made from other types of
left ventricular outpouching, other congenital heart defects, and left
ventricular non-compaction.<br/>Copyright &#xa9; 2019 College of
Physicians and Surgeons Pakistan. All rights reserved.

<45>
Accession Number
2003464820
Title
Cardiovascular Outcomes with Transcatheter vs. Surgical Aortic Valve
Replacement in Low-Risk Patients: An Updated Meta-Analysis of Randomized
Controlled Trials.
Source
Cardiovascular Revascularization Medicine. 21 (4) (pp 453-460), 2020. Date
of Publication: April 2020.
Author
Kundu A.; Sardar P.; Malhotra R.; Qureshi W.T.; Kakouros N.
Institution
(Kundu, Malhotra, Qureshi, Kakouros) Division of Cardiovascular Medicine,
University of Massachusetts Medical School, Worcester, MA, United States
(Sardar) Division of Cardiology, Brown University, Rhode Island Hospital,
Providence, RI, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: TAVR is an established treatment option in high and
intermediate-risk patients with severe AS. There is less data regarding
the efficacy of TAVR in low-risk patients. This meta-analysis evaluated
efficacy and safety outcomes of transcatheter aortic valve replacement
(TAVR) in comparison to surgical aortic valve replacement (SAVR) in
low-risk patients with severe aortic stenosis (AS). <br/>Method(s):
Databases were searched for randomized controlled trials (RCTs) that
compared TAVR with SAVR for the treatment of low-risk patients with severe
AS. We calculated pooled odds ratios (ORs) and 95% confidence intervals
(CIs) using the random-effects model. <br/>Result(s): The final analysis
included 2953 patients from 5 studies. Compared to SAVR, TAVR was
associated with similar mid-term mortality [OR 0.67; 95% CI 0.37-1.21; p =
0.18], as well as similar short-term mortality [OR 0.51; 95% CI 0.24-1.11;
p = 0.09]. Randomization to TAVR was associated with a reduced risk of
developing acute kidney injury [OR 0.26; 95% CI 0.13-0.52; p < 0.001],
short-term major bleeding [OR 0.27; 95% CI 0.12-0.60; p < 0.001] and
new-onset atrial fibrillation [OR 0.17; 95% CI 0.14-0.21; p < 0.001].
However, TAVR was associated with a higher risk of requiring permanent
pacemaker implantation [OR 4.25; 95% CI 1.86-9.73; p < 0.001]. There was
no significant difference in the risk of myocardial infarction, stroke,
endocarditis or aortic valve re-intervention between the two groups.
<br/>Conclusion(s): Our meta-analysis showed that TAVR has similar
clinical efficacy to SAVR, with a more favorable safety profile, in
patients with severe AS who are at low-surgical risk.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<46>
Accession Number
2007295902
Title
Percutaneous complete revascularization strategies using sirolimus-eluting
biodegradable polymer-coated stents in patients presenting with acute
coronary syndrome and multivessel disease: Rationale and design of the
BIOVASC trial.
Source
American Heart Journal. 227 (pp 111-117), 2020. Date of Publication:
September 2020.
Author
den Dekker W.K.; Van Mieghem N.M.; Bennett J.; Sabate M.; Esposito G.; van
Bommel R.J.; Daemen J.; Vrolix M.; Cummins P.A.; Lenzen M.J.; Boersma E.;
Zijlstra F.; Diletti R.
Institution
(den Dekker, Van Mieghem, Daemen, Cummins, Lenzen, Boersma, Zijlstra,
Diletti) Department of Cardiology, Erasmus MC, University Medical Center
Rotterdam, Thoraxcenter, Rotterdam, Netherlands
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Sabate) Cardiovascular institute, Hospital Clinic University of
Barcelona, IDIBAPS, Barcelona, Spain
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Naples, Italy
(van Bommel) Department of Cardiology, Tergooi Blaricum, Blaricum,
Netherlands
(Vrolix) Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Complete revascularization in patients with an acute coronary
syndrome and multivessel disease is superior compared to culprit-only
treatment. However, it is unknown whether direct complete or staged
complete revascularization should be pursued. <br/>Method(s): The BIOVASC
study is an investigator-initiated, prospective, multicenter, randomized,
2-arm, international, open-label, noninferiority trial. We will randomize
1,525 patients 1:1 to immediate complete revascularization (experimental
arm) or culprit-only plus staged complete revascularization (control arm).
Patients will be enrolled in approximately 30 sites in Belgium, Italy, the
Netherlands, and Spain. The primary end point is a composite of all-cause
mortality, nonfatal myocardial infarction, any unplanned ischemia-driven
revascularization (excluding staged procedures in the control arm at the
predetermined time), and cerebrovascular events (MACCE) at 1 year post
index procedure. <br/>Conclusion(s): The BIOVASC study aims to further
refine the treatment algorithm for acute coronary syndrome patients with
multivessel disease in terms of optimal timing for complete
revascularization (Clinicaltrials.gov NCT03621501).<br/>Copyright &#xa9;
2020 The Authors

<47>
Accession Number
2007012665
Title
Selection and insertion of vascular access devices in pediatrics: A
systematic review.
Source
Pediatrics. 145 (pp S243-S268), 2020. Article Number: e20193474H. Date of
Publication: 01 Jun 2020.
Author
Paterson R.S.; Chopra V.; Brown E.; Kleidon T.M.; Cooke M.; Rickard C.M.;
Bernstein S.J.; Ullman A.J.
Institution
(Paterson, Brown, Kleidon, Cooke, Rickard, Ullman) Alliance for Vascular
Access Teaching and Research, Menzies Health Institute Queensland,
Griffith University, Nathan, QLD, Australia
(Cooke, Rickard, Ullman) School of Nursing and Midwifery, Griffith
University, Nathan, QLD, Australia
(Paterson, Brown) Child Health Research Centre, Faculty of Medicine,
University of Queensland, Brisbane, QLD, Australia
(Chopra, Bernstein) Patient Safety Enhancement Program, Center for
Clinical Management Research, Veterans Affair Ann Arbor Healthcare System,
Ann Arbor, MI, United States
(Chopra) Divisions of Hospital Medicine, Medical School, University of
Michigan, Ann Arbor, MI, United States
(Chopra, Bernstein) General Medicine, Department of Internal Medicine,
Medical School, University of Michigan, Ann Arbor, MI, United States
(Kleidon, Ullman) Queensland Children's Hospital, Brisbane, QLD, Australia
Publisher
American Academy of Pediatrics (141 Northwest Point Blvd, P.O. Box 927,
Elk Grove Village IL 60007-1098, United States)
Abstract
OBJECTIVE: To critically review the evidence for the selection and
insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data
were sourced from the US National Library of Medicine, Cumulative Index to
Nursing and Allied Health, the Cochrane Library databases, Embase, and
international clinical trial databases. STUDY SELECTION: Clinical practice
guidelines, systematic reviews, cohort designs, randomized control trials
(RCTs), quasi RCTs, before-after trials, or case-control studies that
reported on complications and/or risk as well as reliability of VADs in
patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were
independently reviewed to extract and summarize details on the number of
patients and catheters, population, age of participants, VAD type, study
method, indication, comparators, and the frequency of VAD failure or
complications. <br/>RESULT(S): VAD selection and insertion decision-making
in general hospitalized and some specialized patient populations were well
evidenced. The use of single-lumen devices and ultrasound-guided
techniques was also broadly supported. There was a lack of RCTs, and for
neonates, cardiac patients, patients with difficult venous access, midline
catheters, catheter-to-vein ratio, and near-infrared devices, the lack of
evidence necessitated broadening the review scope. LIMITATIONS:
Limitations include the lack of formal assessment of the quality of
evidence and the lack of RCTs and systematic reviews. Consequently,
clinical decision-making in certain pediatric populations is not guided by
strong, evidence-based recommendations. <br/>CONCLUSION(S): This is the
first synthesis of available evidence for the selection and insertion of
VADs in pediatric patients and is important for determining the
appropriateness of VADs in pediatric patients.<br/>Copyright &#xa9; 2020
by the American Academy of Pediatrics

<48>
Accession Number
2006171614
Title
Clinical Impact of Preprocedural Moderate or Severe Mitral Regurgitation
on Outcomes After Transcatheter Aortic Valve Replacement.
Source
Canadian Journal of Cardiology. 36 (7) (pp 1112-1120), 2020. Date of
Publication: July 2020.
Author
Miura M.; Yamaji K.; Shirai S.; Hayashi M.; Kawaguchi T.; Arai Y.;
Sakaguchi G.; Ando K.; Naganuma T.; Mizutani K.; Araki M.; Tada N.;
Yamanaka F.; Tabata M.; Ueno H.; Takagi K.; Higashimori A.; Watanabe Y.;
Yamamoto M.; Hayashida K.
Institution
(Miura, Yamaji, Shirai, Hayashi, Kawaguchi, Ando) Department of
Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
(Arai, Sakaguchi) Department of Cardiovascular Surgery, Kokura Memorial
Hospital, Kitakyushu, Japan
(Naganuma) Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
(Mizutani) Department of Cardiovascular Medicine, Osaka City University
Graduate School of Medicine, Osaka, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama-City Eastern
Hospital, Yokohama, Japan
(Tada) Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
(Yamanaka) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kamakura, Japan
(Tabata) Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa
Medical Center, Urayasu, Japan
(Ueno) Second Department of Internal Medicine, University of Toyama,
Toyama, Japan
(Takagi) Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
(Higashimori) Department of Cardiology, Kishiwada Tokushukai Hospital,
Kishiwada, Japan
(Watanabe) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
(Yamamoto) Department of Cardiology, Toyohashi Heart Center, Toyohashi,
Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The influence of improved mitral regurgitation (MR) on the
outcomes of transcatheter aortic valve replacement (TAVR) is unknown. Our
aim was to determine the impact of significant preprocedural MR and the
improvement of MR after TAVR. <br/>Method(s): A population of 1587
patients from the Optimized Catheter Valvular Intervention Transcatheter
Aortic Valve Implantation (OCEAN-TAVI) registry were evaluated.
Preprocedural MR was mild or less in 1443 patients (90.9%) and moderate or
severe in 144 patients (9.1%). <br/>Result(s): Moderate or severe MR was
associated with increased risk for all-cause mortality at 1 year (adjusted
hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.84; P = 0.005)
and 2 years (adjusted hazard ratio, 1.64; 95% CI, 1.15-2.34; P = 0.007).
At 6 months after TAVR, the MR grade improved in 77.4% of the patients
with moderate or severe baseline MR. Multivariate analysis showed that the
absence of previous myocardial infarction (odds ratio, 8.00; 95% CI,
1.74-36.8; P = 0.008) and beta-blocker use at baseline (odds ratio, 2.71;
95% CI, 1.09-6.70; P = 0.031) were independently associated with improved
MR at 6 months (vs unchanged, worsened MR, or death). Patients with
improved MR had a significantly lower rate of midterm readmission for
heart failure (11.6%) than those with unchanged or worsened MR (30.8%, P =
0.007). <br/>Conclusion(s): Moderate or severe MR was associated with
increased risk of all-cause mortality 2 years after TAVR. Moderate or
severe baseline MR was improved in most patients at 6 months after TAVR.
Patients with unchanged or worsened MR had an increased rate of
readmission for heart failure.<br/>Copyright &#xa9; 2019 Canadian
Cardiovascular Society

<49>
Accession Number
2005572145
Title
Coronary revascularization during treatment of severe aortic stenosis: A
meta-analysis of the complete percutaneous approach (PCI plus TAVR) versus
the complete surgical approach (CABG plus SAVR).
Source
Journal of Cardiac Surgery. 35 (8) (pp 2009-2016), 2020. Date of
Publication: 01 Aug 2020.
Author
Tarus A.; Tinica G.; Bacusca A.; Artene B.; Popa I.V.; Burlacu A.
Institution
(Tarus, Tinica, Bacusca) Department of Cardiovascular Surgery,
Cardiovascular Diseases Institute, Iasi, Romania
(Tinica, Popa, Burlacu) Grigore T. Popa University of Medicine and
Pharmacy, Iasi, Romania
(Artene, Burlacu) Department of Interventional Cardiology, Cardiovascular
Diseases Institute, Iasi, Romania
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The management of patients with coexisting severe aortic
stenosis (AS) and coronary artery disease (CAD) is still facing a great
deal of uncertainty when it comes to choosing between the entire surgical
versus the complete percutaneous approaches, after accurately balancing
risks versus outcomes. <br/>Aim(s): To evaluate clinical outcomes and
mortality of transcatheter aortic valve replacement (TAVR) plus
percutaneous coronary intervention (PCI) compared with surgical aortic
valve replacement (SAVR) plus coronary arteries bypass grafting (CABG)
procedures in patients with concomitant AS and CAD. <br/>Method(s):
Electronic databases of PubMed, EMBASE, and SCOPUS were searched for
relevant articles assessing outcome parameters of interest. The study
endpoints were the rate of overall myocardial infarction and stroke within
30 days and the rate of 30-day mortality and 2-year mortality between
patients with TAVR/PCI and those with SAVR/CABG. <br/>Result(s):
Random-effect meta-analysis did not reveal any significant difference
between 30-day safety outcomes: myocardial infarction (TAVR/PCI vs
SAVR/CABG: odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.20-1.33;
I² = 0%), stroke (TAVR/PCI vs SAVR/CABG: OR: 0.88; 95% CI:
0.45-1.73; I² = 0%). No significant difference in 30-day
mortality (OR: 0.72; 95% CI: 0.43-1.21; I² = 0%) and 2-year
mortality (OR: 1.50; 95% CI: 0.77-2.94; I² = 81%) rate was
noted between patients with TAVR/PCI and those with SAVR/CABG.
<br/>Conclusion(s): When comparing the total percutaneous and total
surgical treatment, no significant difference in short-term safety
outcomes or early and late mortality was observed. More evidence is needed
to guide the clinical decision.<br/>Copyright &#xa9; 2020 Wiley
Periodicals LLC

<50>
Accession Number
2005398108
Title
Role of yoga in the prevention and management of various cardiovascular
diseases and their risk factors: A comprehensive scientific evidence-based
review.
Source
Explore. 16 (4) (pp 257-263), 2020. Date of Publication: July - August
2020.
Author
Mooventhan A.; Nivethitha L.
Institution
(Mooventhan) Department of Research and Development, Government Yoga and
Naturopathy Medical College, Arumbakkam, Chennai, Tamil Nadu 600106, India
(Nivethitha) Department of Naturopathy, Government Yoga and Naturopathy
Medical College, Chennai, Tamil Nadu 600106, India
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiovascular diseases (CVDs) are a group of disorders of the heart and
blood vessels. CVDs are the leading cause of deaths worldwide. Though yoga
is gaining popularity as a therapy, especially in CVD patients, there is a
lack of a comprehensive review reporting its role in the management of
various CVDs and their risk factors. Thus, we performed a comprehensive
literature search in the PubMed/Medline electronic database. An aggregate
of 603 articles published from inception were screened and 85 articles
that are applicable were reported. This review suggests that yoga may play
a role as an adjuvant in the management of various CVDs and their risk
factors. However, many studies had a small sample size, different types
and durations of the yoga interventions, and did not provide the details
of mechanisms behind the improvements. Thus, further studies are warranted
to explore the mechanisms of the impacts of yoga.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<51>
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. <br/>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.
<br/>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).
<br/>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.<br/>Copyright &#xa9; 2020 The American Association for Thoracic
Surgery

<52>
Accession Number
629882593
Title
Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following
Cardiac Surgery: Pilot Study.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. 21 (4) (pp 314-322), 2020. Date of Publication: 01 Aug
2020.
Author
Alameri R.; Dean G.; Castner J.; Volpe E.; Elghoneimy Y.; Jungquist C.
Institution
(Alameri) Department of Fundamental Nursing, College Nursing, Imam
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
(Dean, Castner, Volpe, Jungquist) School of Nursing, State University of
New York, Buffalo, NY, United States
(Elghoneimy) College of Medicine, Imam Abdulrahman Bin Faisal University,
Dammam, Saudi Arabia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain is the most pervasive distressing symptom following
cardiac surgery. Forty percent of postoperative cardiac patients report
inadequate pain management. Undertreated acute pain results in increased
anxiety, delayed wound healing, and increased chance of persistent chronic
pain. Foot massage is a safe, visible complementary approach to manage
acute pain following surgery. AIM: The aim of this study is to evaluate
the efficacy of integrating foot massage therapy for managing postcardiac
pain. <br/>METHOD(S): A randomized placebo controlled single blinded trial
comparing foot massage to placebo was conducted at a large hospital in
Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in
experimental and 15 in placebo group) participated in the study.
Ten-minute foot massage was delivered to the experimental group by a nurse
researcher, twice during one day, within 30 minutes after receiving an
opioid pain medication. <br/>RESULT(S): The findings of this study
indicate that foot massage significantly (p < .05) decreases pain
intensity and anxiety in patients who have undergone cardiac surgery
compared with a placebo control group. <br/>CONCLUSION(S): Providing
non-pharmacologic interventions for pain is the responsibility of the
nursing staff. Foot massage is within the scope of nursing practice and is
a safe and effective manner of improving patient care. Foot massage in
conjunction with pharmacological interventions is effective in improving
pain and anxiety. Future studies should consider focusing on frequency,
dose, feasibility, acceptability, and participants'
satisfaction.<br/>Copyright &#xa9; 2019 American Society for Pain
Management Nursing. Published by Elsevier Inc. All rights reserved.

<53>
[Use Link to view the full text]
Accession Number
632331785
Title
Association of Factor V Leiden With Subsequent Atherothrombotic Events: A
GENIUS-CHD Study of Individual Participant Data.
Source
Circulation. 142 (6) (pp 546-555), 2020. Date of Publication: 11 Aug 2020.
Author
Mahmoodi B.K.; Tragante V.; Kleber M.E.; Holmes M.V.; Schmidt A.F.;
McCubrey R.O.; Howe L.J.; Direk K.; Allayee H.; Baranova E.V.; Braund
P.S.; Delgado G.E.; Eriksson N.; Gijsberts C.M.; Gong Y.; Hartiala J.;
Heydarpour M.; Pasterkamp G.; Kotti S.; Kuukasjarvi P.; Lenzini P.A.;
Levin D.; Lyytikainen L.-P.; Muehlschlegel J.D.; Nelson C.P.; Nikus K.;
Pilbrow A.P.; Wilson Tang W.H.; van der Laan S.W.; van Setten J.;
Vilmundarson R.O.; Deanfield J.; Deloukas P.; Dudbridge F.; James S.;
Mordi I.R.; Teren A.; Bergmeijer T.O.; Body S.C.; Bots M.; Burkhardt R.;
Cooper-DeHoff R.M.; Cresci S.; Danchin N.; Doughty R.N.; Grobbee D.E.;
Hagstrom E.; Hazen S.L.; Held C.; Hoefer I.E.; Hovingh G.K.; Johnson J.A.;
Kaczor M.P.; Kahonen M.; Klungel O.H.; Laurikka J.O.; Lehtimaki T.;
Maitland-van der Zee A.H.; McPherson R.; Palmer C.N.; Kraaijeveld A.O.;
Pepine C.J.; Sanak M.; Sattar N.; Scholz M.; Simon T.; Spertus J.A.;
Stewart A.F.R.; Szczeklik W.; Thiery J.; Visseren F.L.J.; Waltenberger J.;
Richards A.M.; Lang C.C.; Cameron V.A.; Akerblom A.; Pare G.; Marz W.;
Samani N.J.; Hingorani A.D.; Ten Berg J.M.; Wallentin L.; Asselbergs F.W.;
Patel R.S.
Institution
(Mahmoodi, Bergmeijer, Ten Berg) St. Antonius Hospital, Department of
Cardiology, Nieuwegein, Netherlands
(Mahmoodi) Division of Hemostasis and Thrombosis, Department of
Hematology, UMC Groningen, University of Groningen
(Tragante, Schmidt, van Setten, Kraaijeveld, Asselbergs) Department of
Cardiology, A.F.S., A.O.K., UMC Utrecht, Utrecht University, Netherlands
(Kleber, Delgado, Marz) Vth Department of Medicine, Medical Faculty
Mannheim, Heidelberg University, Germany (M.E.K.
(Holmes) Clinical Trial Service Unit and Epidemiological Studies Unit,
Nuffield Department of Population Health and Medical Research Council
Population Health Research Unit, University of Oxford, United Kingdom
(M.V.H.)
(Holmes) National Institute for Health Research Oxford Biomedical Research
Centre, Oxford University Hospital, United Kingdom (M.V.H.)
(Schmidt, Howe, Direk, Deanfield, Hingorani, Asselbergs, Patel) Institute
of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of
Population Health Science, University College London, United Kingdom
(A.F.S.
(McCubrey) Intermountain Heart Institute, Intermountain Medical Center,
Salt Lake City, United States
(Allayee, Hartiala) Departments of Preventive Medicine and Biochemistry
and Molecular Medicine (H.A., Keck School of Medicine of University of
Southern California, Los Angeles, Mexico
(Baranova, Klungel, Maitland-van der Zee) Division of Pharmacoepidemiology
and Clinical Pharmacology (E.V.B., UMC Utrecht, Utrecht University,
Netherlands
(Braund, Nelson, Samani) Department of Cardiovascular Sciences, University
of Leicester, BHF Cardiovascular Research Centre, United Kingdom (P.S.B.,
Glenfield Hospital
(Braund, Samani) NIHR Leicester Biomedical Research Centre, United Kingdom
(P.S.B., Glenfield Hospital
(Eriksson, James, Held, Akerblom, Wallentin) Uppsala Clinical Research
Center, C.H., A.A.
(Gijsberts, Nelson) Laboratory of Experimental Cardiology (C.M.G.), UMC
Utrecht, Utrecht University, Netherlands
(Gong, Cooper-DeHoff, Johnson) Department of Pharmacotherapy and
Translational Research and Center for Pharmacogenomics (Y.G., University
of Florida, Gainesville, United States
(Hartiala) Institute for Genetic Medicine (J.H.), Keck School of Medicine
of University of Southern California, Los Angeles, Mexico
(Heydarpour, Muehlschlegel) Department of Anesthesiology, Perioperative
and Pain Medicine, Brigham and Women's Hospital, Boston
(Heydarpour, Muehlschlegel) Harvard Medical School, Harvard University,
Boston
(Pasterkamp) Department of Clinical Chemistry (G.Pasterkamp), UMC Utrecht,
Utrecht University, Netherlands
(Kotti) Department of Clinical Pharmacology, Assistance Publique-Hopitaux
de Paris (APHP)Platform of Clinical Research of East Paris
(URCEST-CRCEST-CRB HUEP-UPMC)
(Kuukasjarvi, Laurikka) Departments of Cardio-Thoracic Surgery (P.K.,
Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and
Health Techonology, Tampere University, Finland
(Lenzini, Cresci) Department of Genetics, Statistical Genomics Division
(P.A.L., Washington University School of Medicine, MO, Saint Louis,
Seychelles
(Levin, Mordi, Lang) Division of Molecular and Clinical Medicine, School
of Medicine, University of Dundee, United Kingdom (D.L., I.R.M., United
Kingdom
(Lyytikainen, Lehtimaki) Clinical Chemistry (L.-P.L., Finnish
Cardiovascular Research Center - Tampere, Faculty of Medicine and Health
Techonology, Tampere University, Finland
(Lyytikainen, Lehtimaki) Department of Clinical Chemistry, Fimlab
Laboratories, Finland (L.-P.L., Tampere, Finland
(Nikus) Cardiology (K.N.), Finnish Cardiovascular Research Center -
Tampere, Faculty of Medicine and Health Techonology, Tampere University,
Finland
(Nikus) Department of Cardiology (K.N.), Heart Center, Tampere University
Hospital, Finland
(Pilbrow, Richards, Cameron) Christchurch Heart Institute, University of
Otago Christchurch, A.M.R.
(Wilson Tang, Hazen) Department of Cardiovascular and Metabolic Sciences,
Lerner Research institute (W.H.W.T., Cleveland Clinic, OH, Switzerland
(Wilson Tang) Department of Cardiovascular Medicine, Heart and Vascular
Institute (W.H.W.T.), Cleveland Clinic, OH, Switzerland
(van der Laan) Central Diagnostics Laboratory, Division Laboratories,
Pharmacy, Biomedical Genetics (S.W.v.d.L.), UMC Utrecht, Utrecht
University, Netherlands
(Vilmundarson, Stewart) Ruddy Canadian Cardiovascular Genetics Centre,
University of Ottawa Heart Institute, ON
(Deloukas) William Harvey Research Institute, Barts and the London Medical
School, the Centre for Genomic Health, Queen Mary University of London,
United Kingdom (P.D.)
(Dudbridge) Department of Health Sciences, University of Leicester, United
Kingdom (F.D.)
(James, Hagstrom, Held, Akerblom) Department of Medical Sciences,
Cardiology, Uppsala University, C.H., A.A.
(Teren) Heart Center Leipzig, Germany (A.T.)
(Teren, Burkhardt, Scholz, Thiery) LIFE Research Center for Civilization
Diseases (A.T., R.B., University of Leipzig, Germany
(Body) Department of Anesthesiology, Boston University School of Medicine
(Bots, Grobbee) Julius Center for Health Sciences and Primary Care (M.B.,
UMC Utrecht, Utrecht University, Netherlands
(Bots) Institute of Clinical Chemistry and Laboratory Medicine, University
Hospital Regensburg, Germany (R.B.)
(Cooper-DeHoff, Johnson, Pepine) College of Medicine, Division of
Cardiovascular Medicine (R.M.C.-D.H., University of Florida, Gainesville,
United States
(Cresci) Department of Medicine, Cardiovascular Division (S.C.),
Washington University School of Medicine, MO, Saint Louis, Seychelles
(Danchin) Assistance Publique-Hopitaux de Paris (APHP), Department of
Cardiology, Hopital Europeen Georges Pompidou; FACT (french Alliance for
cardiovascular trials); and Universite Paris Descartes, France (N.D.)
(Doughty) Heart Health Research Group, University of Auckland
(Hagstrom) Department of Cardiology, Uppsala University, Uppsala Clinical
Research Center
(Hazen) Center for Microbiome and Human Health (S.L.H.), Cleveland Clinic,
OH, Switzerland
(Hoefer) Department of Clinical Chemistry and Hematology (I.E.H.), UMC
Utrecht, Utrecht University, Netherlands
(Hovingh) Department of Vascular Medicine (G.K.H.), Academic Medical
Center, University of Amsterdam, Netherlands
(Kaczor, Sanak, Szczeklik) Department of Internal Medicine, Jagiellonian
University Medical College, Poland (M.P.K., Krakow
(Kahonen) Clinical Physiology (M.K.), Finnish Cardiovascular Research
Center - Tampere, Faculty of Medicine and Health Techonology, Tampere
University, Finland
(Kahonen) Department of Clinical Physiology, Tampere University Hospital,
Finland (M.K.)
(Laurikka) Department of Cardio-Thoracic Surgery (J.O.L.), Heart Center,
Tampere University Hospital, Finland
(Maitland-van der Zee) Department of Respiratory Medicine (A.H.M.-v.d.Z.),
Academic Medical Center, University of Amsterdam, Netherlands
(McPherson, Stewart) Departments of Medicine and Biochemistry,
Microbiology, Immunology, University of Ottawa, ON
(Palmer) Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics,
Division of Molecular and Clinical Medicine, Ninewells Hospital and
Medical School, United Kingdom (C.N.P.), Dundee
(Sattar) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom (N.S.)
(Scholz) Institute for Medical Informatics, Statistics, Epidemiology
(M.Scholz), University of Leipzig, Germany
(Simon) Assistance Publique-Hopitaux de Paris (APHP), Department of
Clinical Pharmacology, Platform of Clinical Research of East Paris
(URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular
trials); Sorbonne Universite, Paris-06, France (T.S.)
(Simon) Paris-Sorbonne University, UPMC-Site St Antoine
(Spertus) University of Missouri-Kansas City (J.A.S.)
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, United
States
(Thiery) Institute of Laboratory Medicine, Clinical Chemistry and
Molecular Diagnostics, University Hospital, Germany (J.T.), Leipzig,
Germany
(Visseren) Department of Vascular Medicine (F.L.J.V.), UMC Utrecht,
Utrecht University, Netherlands
(Waltenberger) Department of Cardiovascular Medicine, University of
Munster, Germany (J.W.)
(Richards) Cardiovascular Research Institute, National University of
Singapore (A.M.R.)
(Pare) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Ontario, Canada (G.Pare)
(Pare) Population Health Research Institute, Hamilton, Ontario, Canada
(G.Pare)
(Marz) Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
(W.M.)
(Marz) Clinical Institute of Medical and Chemical Laboratory Diagnostics,
Medical University of Graz
(Asselbergs) Health Data Research UK and Institute of Health Informatics,
University College London, United Kingdom (F.W.A.)
(Patel) Bart's Heart Centre, United Kingdom (R.S.P.), St Bartholomew's
Hospital, London
Publisher
NLM (Medline)
Abstract
BACKGROUND: Studies examining the role of factor V Leiden among patients
at higher risk of atherothrombotic events, such as those with established
coronary heart disease (CHD), are lacking. Given that coagulation is
involved in the thrombus formation stage on atherosclerotic plaque
rupture, we hypothesized that factor V Leiden may be a stronger risk
factor for atherothrombotic events in patients with established CHD.
<br/>METHOD(S): We performed an individual-level meta-analysis including
25 prospective studies (18 cohorts, 3 case-cohorts, 4 randomized trials)
from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease)
consortium involving patients with established CHD at baseline.
Participating studies genotyped factor V Leiden status and shared risk
estimates for the outcomes of interest using a centrally developed
statistical code with harmonized definitions across studies. Cox
proportional hazards regression models were used to obtain age- and
sex-adjusted estimates. The obtained estimates were pooled using
fixed-effect meta-analysis. The primary outcome was composite of
myocardial infarction and CHD death. Secondary outcomes included any
stroke, ischemic stroke, coronary revascularization, cardiovascular
mortality, and all-cause mortality. <br/>RESULT(S): The studies included
69681 individuals of whom 3190 (4.6%) were either heterozygous or
homozygous (n=47) carriers of factor V Leiden. Median follow-up per study
ranged from 1.0 to 10.6 years. A total of 20 studies with 61147
participants and 6849 events contributed to analyses of the primary
outcome. Factor V Leiden was not associated with the combined outcome of
myocardial infarction and CHD death (hazard ratio, 1.03 [95% CI,
0.92-1.16]; I2=28%; P-heterogeneity=0.12). Subgroup analysis according to
baseline characteristics or strata of traditional cardiovascular risk
factors did not show relevant differences. Similarly, risk estimates for
the secondary outcomes including stroke, coronary revascularization,
cardiovascular mortality, and all-cause mortality were also close to
identity. <br/>CONCLUSION(S): Factor V Leiden was not associated with
increased risk of subsequent atherothrombotic events and mortality in
high-risk participants with established and treated CHD. Routine
assessment of factor V Leiden status is unlikely to improve
atherothrombotic events risk stratification in this population.

<54>
[Use Link to view the full text]
Accession Number
631587225
Title
A multinational observational study exploring adherence with the kidney
disease: Improving global outcomes recommendations for prevention of acute
kidney injury after cardiac surgery.
Source
Anesthesia and Analgesia. 130 (4) (pp 910-916), 2020. Date of Publication:
April 2020.
Author
Kullmar M.; Weiss R.; Ostermann M.; Campos S.; Novellas N.G.; Thomson G.;
Haffner M.; Arndt C.; Wulf H.; Irqsusi M.; Monaco F.; Di Prima A.L.;
Garcia-Alvarez M.; Italiano S.; Correoso M.F.; Kunst G.; Nair S.; L'Acqua
C.; Hoste E.; Vandenberghe W.; Honore P.M.; Kellum J.A.; Forni L.;
Grieshaber P.; Wempe C.; Meersch M.; Zarbock A.
Institution
(Kullmar, Wempe, Meersch, Zarbock) Department of Anesthesiology, Intensive
Care Medicine and Pain Medicine, University Hospital Munster, Munster,
Germany
(Weis, Ostermann, Campos, Novellas, Thomson, Haffner) Department of
Critical Care, Guy's & St Thomas' NHS Foundation Hospital, London, United
Kingdom
(Arndt, Wulf) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Marburg, Marburg, Germany
(Irqsusi) Department of Cardiac Surgery, University Hospital Marburg,
Marburg, Germany
(Monaco, Di Prima) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Garcia-Alvarez, Italiano, Correoso) Department of Anesthesiology,
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Kunst, Nair) Department of Anaesthetics, King's College Hospital, Denmark
Hill, London, United Kingdom
(L'Acqua) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Hoste, Vandenberghe) Department of Intensive Care Medicine, University
Hospital Gent, Gent, Belgium
(Honore) Department of Intensive Care, CHU Brugmann University Hospital,
Brussel, Belgium
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pennsylvania, United States
(Forni) Department of Intensive Care Medicine, Royal Surrey County
Hospital, Guildford, United Kingdom
(Grieshaber) Department of Cardiac Surgery, University Hospital Giessen,
Giessen, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO)
guidelines recommend a bundle of different measures for patients at
increased risk of acute kidney injury (AKI). Prospective, single-center,
randomized controlled trials (RCTs) have shown that management in
accordance with the KDIGO recommendations was associated with a
significant reduction in the incidence of postoperative AKI in high-risk
patients. However, compliance with the KDIGO bundle in routine clinical
practice is unknown. <br/>METHOD(S): This observational prevalence study
was performed in conjunction with a prospective RCT investigating the role
of the KDIGO bundle in high-risk patients undergoing cardiac surgery. A
2-day observational prevalence study was performed in all participating
centers before the RCT to explore routine clinical practice. The
participating hospitals provided the following data: demographics and
surgical characteristics, AKI rates, and compliance rates with the
individual components of the bundle. <br/>RESULT(S): Ninety-five patients
were enrolled in 12 participating hospitals. The incidence of AKI within
72 hours after cardiac surgery was 24.2%. In 5.3% of all patients,
clinical management was fully compliant with all 6 components of the
bundle. Nephrotoxic drugs were discontinued in 52.6% of patients, volume
optimization was performed in 70.5%, 52.6% of the patients underwent
functional hemodynamic monitoring, close monitoring of serum creatinine
and urine output was undertaken in 24.2% of patients, hyperglycemia was
avoided in 41.1% of patients, and no patient received radiocontrast
agents. The patients received on average 3.4 (standard deviation [SD]
+/-1.1) of 6 supportive measures as recommended by the KDIGO guidelines.
There was no significant difference in the number of applied measures
between AKI and non-AKI patients (3.2 [SD +/-1.1] vs 3.5 [SD +/-1.1]; P =
.347). <br/>CONCLUSION(S): In patients after cardiac surgery, compliance
with the KDIGO recommendations was low in routine clinical
practice.<br/>Copyright &#xa9; 2020 International Anesthesia Research
Society.

<55>
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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<56>
[Use Link to view the full text]
Accession Number
632582335
Title
Fontan-Associated Liver Disease: Screening, Management, and Transplant
Considerations.
Source
Circulation. 142 (6) (pp 591-604), 2020. Date of Publication: 11 Aug 2020.
Author
Emamaullee J.; Zaidi A.N.; Schiano T.; Kahn J.; Valentino P.L.; Hofer
R.E.; Taner T.; Wald J.W.; Olthoff K.M.; Bucuvalas J.; Fischer R.
Institution
(Emamaullee) Liver Transplant Center
(Emamaullee) Department of Surgery (J.E.), Keck School of Medicine,
University of Southern California, Los Angeles, Mexico
(Zaidi) Mount Sinai Cardiovascular Institute (A.N.Z.), Recanati/Miller
Transplantation Institute, Icahn School of Medicine at Mount Sinai, NY, NY
(Zaidi) Children's Heart Center (A.N.Z.), Recanati/Miller Transplantation
Institute, Icahn School of Medicine at Mount Sinai, NY, NY
(Schiano) Divisions of Hepatology (T.S.), Recanati/Miller Transplantation
Institute, Icahn School of Medicine at Mount Sinai, NY, NY
(Kahn) Keck School of Medicine, University of Southern California,
Division of Gastrointestinal and Liver Diseases (J.K.), Los Angeles,
Mexico
(Valentino) Section of Gastroenterology and Hepatology, Department of
Pediatrics, Yale University School of Medicine, CT (P.L.V.), New Haven,
United States
(Hofer) Departments of Anesthesiology and Perioperative Medicine (R.E.H.),
Mayo Clinic, MN, Rochester
(Taner) Surgery (T.T.), Mayo Clinic, MN, Rochester
(Taner) Immunology (T.T.), Mayo Clinic, MN, Rochester
(Wald) Division of Cardiology, Department of Medicine (J.W.W.), University
of Pennsylvania, Philadelphia, United States
(Olthoff) Department of Surgery (K.M.O.), University of Pennsylvania,
Philadelphia, United States
(Bucuvalas) Pediatric Hepatology (J.B.), Recanati/Miller Transplantation
Institute, Icahn School of Medicine at Mount Sinai, NY, NY
(Fischer) Department of Gastroenterology, Liver Care Center, Children's
Mercy Kansas City
Publisher
NLM (Medline)
Abstract
Surgical innovation and multidisciplinary management have allowed children
born with univentricular physiology congenital heart disease to survive
into adulthood. An estimated global population of 70 000 patients have
undergone the Fontan procedure and are alive today, most of whom are <25
years of age. Several unexpected consequences of the Fontan circulation
include Fontan-associated liver disease. Surveillance biopsies have
demonstrated that virtually 100% of these patients develop clinically
silent fibrosis by adolescence. As they mature, there are increasing
reports of combined heart-liver transplantation resulting from advanced
liver disease, including bridging fibrosis, cirrhosis, and hepatocellular
carcinoma, in this population. In the absence of a transplantation option,
these young patients face a poor quality of life and overall survival.
Acknowledging that there are no consensus guidelines for diagnosing and
monitoring Fontan-associated liver disease or when to consider heart
transplantation versus combined heart-liver transplantation in these
patients, a multidisciplinary working group reviewed the literature
surrounding Fontan-associated liver disease, with a specific focus on
considerations for transplantation.

<57>
Accession Number
632582065
Title
Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery
Disease? A Systematic Review and Meta-Analysis.
Source
Journal of interventional cardiology. 2020 (pp 4081642), 2020. Date of
Publication: 2020.
Author
Ullah W.; Sattar Y.; Ullah I.; Susheela A.; Mukhtar M.; Alraies M.C.;
Mamas M.A.; Fischman D.L.
Institution
(Ullah) Abington Jefferson Health, Abington, United States
(Sattar) Icahn School of Medicine, NY, NY, United States
(Ullah) Kabir Medical College, Peshawar, Pakistan
(Susheela) Loyola Medical Center, Hines, United States
(Mukhtar) Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
(Alraies) Detroit Medical Center, MI, Detroit, United States
(Mamas) Keele Cardiovascular Research Group, Keele University, Royal Stoke
Hospital, Keele, United Kingdom
(Mamas, Fischman) Thomas Jefferson University, Philadelphia, United States
Publisher
NLM (Medline)
Abstract
Background: The safety and efficacy of percutaneous coronary intervention
(PCI) versus coronary artery bypass grafting (CABG) for stable left main
coronary artery disease (LMCAD) remains controversial. <br/>Method(s):
Digital databases were searched to compare the major adverse
cardiovascular and cerebrovascular events (MACCE) and its components. A
random effect model was used to compute an unadjusted odds ratio (OR).
<br/>Result(s): A total of 43 studies (37 observational and 6 RCTs)
consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were
identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76;
p=0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30-0.91; p=0.02)
was significantly lower in the PCI group. There was no significant
difference in the rate of myocardial infarction (MI) (p=0.17) and
revascularization (p=0.12). At 5 years, CABG was favored due to a
significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18-2.36; p=<0.04),
MI (OR, 1.67; 95% CI, 1.35-2.06; p=<0.00001), and revascularization (OR,
2.80; 95% CI, 2.18-3.60; p=<0.00001), respectively. PCI was associated
with a lower overall rate of a stroke, while the risk of all-cause
mortality was not significantly different between the two groups at 1-
(p=0.75), 5- (p=0.72), and 10-years (p=0.20). The Kaplan-Meier curve
reconstruction revealed substantial variations over time; the 5-year
incidence of MACCE was 38% with CABG, significantly lower than 45% with
PCI (p=<0.00001). <br/>Conclusion(s): PCI might offer early safety
advantages, while CABG provides greater durability in terms of lower
long-term risk of ischemic events. There appears to be an equivalent risk
for all-cause mortality.<br/>Copyright &#xa9; 2020 Waqas Ullah et al.

<58>
Accession Number
632581306
Title
Comparison of Heart Team vs Interventional Cardiologist Recommendations
for the Treatment of Patients With Multivessel Coronary Artery Disease.
Source
JAMA network open. 3 (8) (pp e2012749), 2020. Date of Publication: 03 Aug
2020.
Author
Tsang M.B.; Schwalm J.D.; Gandhi S.; Sibbald M.G.; Gafni A.; Mercuri M.;
Salehian O.; Lamy A.; Pericak D.; Jolly S.; Sheth T.; Ainsworth C.;
Velianou J.; Valettas N.; Mehta S.; Pinilla N.; Yanagawa B.; Zhang L.; Chu
V.; Parry D.; Whitlock R.; Dyub A.; Cybulsky I.; Semelhago L.; Ioannou K.;
Hameed A.; Wright D.; Mulji A.; Darvish-Kazem S.; Gupta N.; Alshatti A.;
Natarajan M.K.
Institution
(Tsang, Schwalm, Sibbald, Salehian, Lamy, Jolly, Sheth, Ainsworth,
Velianou, Valettas, Mehta, Pinilla, Ioannou, Hameed, Wright, Mulji,
Darvish-Kazem, Alshatti, Natarajan) Division of Cardiology, Department of
Medicine, McMaster University, Hamilton, Ontario, Canada
(Gandhi, Gupta) Division of Cardiology, Department of Medicine, University
of Toronto, Toronto, ON, Canada
(Gandhi) Trillium Health Partners, Mississauga, ON, Canada
(Gafni) Center for Health Economics and Policy Analysis, Department of
Health Research Methods, Evidence and Impact, McMaster University,
Hamilton, Ontario, Canada
(Mercuri, Pericak, Zhang, Chu, Parry, Whitlock, Dyub, Cybulsky, Semelhago)
Division of Cardiovascular Surgery, Department of Surgery, McMaster
University, Hamilton, Ontario, Canada
(Yanagawa) Division of Cardiovascular Surgery, St Michael's Hospital,
Toronto, ON, Canada
(Yanagawa) Division of Cardiac Surgery, Department of Surgery, University
of Toronto, Toronto, ON, Canada
(Parry) Dunedin Hospital, Otago, New Zealand
(Ioannou) Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada
(Darvish-Kazem) Brampton Civic Hospital, William Osler Health System,
Brampton, ON, Canada
Publisher
NLM (Medline)
Abstract
Importance: Although the heart team approach is recommended in
revascularization guidelines, the frequency with which heart team
decisions differ from those of the original treating interventional
cardiologist is unknown. <br/>Objective(s): To examine the difference in
decisions between the heart team and the original treating interventional
cardiologist for the treatment of patients with multivessel coronary
artery disease. <br/>Design, Setting, and Participant(s): In this
cross-sectional study, 245 consecutive patients with multivessel coronary
artery disease were recruited from 1 high-volume tertiary care referral
center (185 patients were enrolled through a screening process, and 60
patients were retrospectively enrolled from the center's database). A
total of 237 patients were included in the final virtual heart team
analysis. Treatment decisions (which comprised coronary artery bypass
grafting, percutaneous coronary intervention, and medication therapy) were
made by the original treating interventional cardiologists between March
15, 2012, and October 20, 2014. These decisions were then compared with
pooled-majority treatment decisions made by 8 blinded heart teams using
structured online case presentations between October 1, 2017, and October
15, 2018. The randomized members of the heart teams comprised experts from
3 domains, with each team containing 1 noninvasive cardiologist, 1
interventional cardiologist, and 1 cardiovascular surgeon. Cases in which
all 3 of the heart team members disagreed and cases in which procedural
discordance occurred (eg, 2 members chose coronary artery bypass grafting
and 1 member chose percutaneous coronary intervention) were discussed in a
face-to-face heart team review in October 2018 to obtain pooled-majority
decisions. Data were analyzed from May 6, 2019, to April 22, 2020.
<br/>Main Outcomes and Measures: The Cohen kappa coefficient between the
treatment recommendation from the heart team and the treatment
recommendation from the original treating interventional cardiologist.
<br/>Result(s): Among 234 of 237 patients (98.7%) in the analysis for whom
complete data were available, the mean (SD) age was 67.8 (10.9) years; 176
patients (75.2%) were male, and 191 patients (81.4%) had stenosis in 3
epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI,
24.5%-36.7%) in treatment decisions between the heart team and the
original treating interventional cardiologist occurred, with a Cohen kappa
of 0.478 (95% CI, 0.336-0.540; P=.006). The heart team decision was more
frequently unanimous when it was concordant with the decision of the
original treating interventional cardiologist (109 of 163 cases [66.9%])
compared with when it was discordant (28 of 71 cases [39.4%]; P<.001).
When the heart team agreed with the original treatment decision, there was
more agreement between the heart team interventional cardiologist and the
original treating interventional cardiologist (138 of 163 cases [84.7%])
compared with when the heart team disagreed with the original treatment
decision (14 of 71 cases [19.7%]); P<.001). Those with an original
treatment of coronary artery bypass grafting, percutaneous coronary
intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71
patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a
different treatment recommendation from the heart team than the original
treating interventional cardiologist; the difference across the 3 groups
was statistically significant (P=.002). <br/>Conclusions and Relevance:
The heart team's recommended treatment for patients with multivessel
coronary artery disease differed from that of the original treating
interventional cardiologist in up to 30% of cases. This subset of cases
was associated with a lower frequency of unanimous decisions within the
heart team and less concordance between the interventional cardiologists;
discordance was more frequent when percutaneous coronary intervention or
medication therapy were considered. Further research is needed to evaluate
whether heart team decisions are associated with improvements in outcomes
and, if so, how to identify patients for whom the heart team approach
would be beneficial.

<59>
Accession Number
2004892679
Title
Effect of intravenous injection of vitamin c on postoperative pulmonary
complications in patients undergoing cardiac surgery: A double-blind,
randomized trial.
Source
Drug Design, Development and Therapy. 14 (pp 3263-3270), 2020. Date of
Publication: 2020.
Author
Wang D.; Wang M.; Zhang H.; Zhu H.; Zhang N.; Liu J.
Institution
(Wang, Wang, Zhang, Zhu, Zhang) Jiangsu Province Key Laboratory of
Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
(Liu) Department of Anesthesiology, The Affiliated Hospital of Xuzhou
Medical University, Xuzhou, Jiangsu, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: In this study, the effect of intravenous vitamin C during surgery
on the incidence of postoperative pulmonary complications (PPCs) in
patients undergoing cardiopulmonary bypass and cardiac surgery was
observed, and its protective effect on the lungs was evaluated to provide
a reference for clinical medication. <br/>Patients and Methods: Patients
undergoing cardiac surgery under cardiopulmonary bypass (CPB) were
selected. The patients were divided into group A and group C by random
sequence. Patients in group A received intravenous vitamin C 1 g 10
minutes after induction of anesthesia, 10 minutes before cardiac
reanimation and at the moment of sternal closure. Patients in group C were
intravenously injected with the same volume of saline at the same time.
The primary outcome was the postoperative pulmonary complication severity
score. Other outcomes were the incidence of PPCs, awakening time,
extubation time, length of ICU stay, length of hospital stay, adverse
events, oxygenation index (PaO<inf>2</inf>/FiO<inf>2</inf>), alveolar
arterial oxygen partial pressure difference (A-aDO<inf>2</inf>), dynamic
lung compliance (Cd) and static lung compliance (Cs). <br/>Result(s):
Seventy patients completed the study. Compared to group C, the
postoperative pulmonary complication score [2(2-3) vs 2(1-2); P=0.009] and
the incidence of postoperative pulmonary complications (32.43% vs 12.12%;
P =0.043) were lower in group A. There were no significant differences in
awakening time, extubation time, length of ICU stay, length of hospital
stay, adverse events, PaO<inf>2</inf>/FiO<inf>2</inf>, A-aDO<inf>2</inf>,
Cs, and Cd between the two groups (P>0.05). <br/>Conclusion(s): In
summary, this small randomized trial including low-risk cardiac surgery
patients shows that intravenous vitamin C may safely be administered and
may be helpful to prevent PPCs after cardiac surgery.<br/>Copyright &#xa9;
2020 Wang et al.

<60>
Accession Number
2004892536
Title
A randomized controlled trial comparing analgesic efficacies of an
ultrasound-guided approach with and without a combined pressure
measurement technique for thoracic paravertebral blocks after open
thoracotomy.
Source
Therapeutics and Clinical Risk Management. 16 (pp 727-734), 2020. Date of
Publication: 2020.
Author
Choi E.K.; Kim J.-I.; Park S.-J.
Institution
(Choi, Kim, Park) Department of Anesthesiology and Pain Medicine, Yeungnam
University College of Medicine, Daegu, South Korea
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Ultrasound-guided thoracic paravertebral block (TPVB) is an
established means for providing postoperative analgesia in thoracic
surgery. However, there are conflicting results regarding the efficacy of
post-thoracotomy pain management of ultrasound-guided TPVB when compared
with that using traditional landmark approach. We therefore con-ducted a
comparative study to evaluate the analgesic efficacy of TPVB when pressure
measurement during needle advancement is combined with an
ultrasound-guided approach. <br/>Patients and Methods: The patients
scheduled for lobectomy through thoracotomy were randomly allocated to
receive either the ultrasound-guided approach only group (U group) or the
ultrasound-guided approach combined with pressure measurement group (UP
group) (n = 36 per group). Before thoracic muscle closure, 0.375%
ropivacaine (20 mL) was administered as a bolus, followed by a continuous
infusion of 0.2% ropivacaine (0.1 mL/kg/hr) in both groups. Postoperative
pain was assessed using the visual analogue scale (VAS) pain score while
resting and coughing. Local anesthetics and pethidine usage and sensory
block area were also evaluated. <br/>Result(s): The UP group showed
significantly lower VAS scores, local anesthetics and pethidine usage, and
a wider sensory block area than the U group. <br/>Conclusion(s): A
combined technique with ultrasound guidance and pressure measurement
provided a superior analgesic effect over that of an ultrasound-guided
approach alone for the management of post-thoracotomy pain.<br/>Copyright
&#xa9; 2020 Choi et al.

<61>
Accession Number
632572511
Title
Saphenous vein graft aneurysm - Unusual cause of hemoptysis: A case report
and review of literature.
Source
Journal of Postgraduate Medicine. 66 (3) (pp 165-168), 2020. Date of
Publication: July-September 2020.
Author
Khan B.; Khanolkar U.; Raj V.; Ashok K.
Institution
(Khan) Department of Pulmonology, Narayana Health City, Bengaluru, India
(Khanolkar) Department of Cardiology, Narayana Health City, Bengaluru,
India
(Raj, Ashok) Department of Radiology and Imaging Services, Narayana Health
City, Bengaluru, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Hemoptysis due to saphenous venous graft (SVG) aneurysm is an extremely
rare condition and published literature has described the role of
conservative management, surgical resection, and covered stent. Here, we
report a successful placement of a covered stent for SVG aneurysm in a
56-year-old male who presented with hemoptysis. He was a known diabetic
and had undergone a coronary artery bypass grafting 5 years ago. Computed
tomography (CT) chest and fiberoptic bronchoscopy performed in another
local hospital had revealed blood in the left lingula with spillover into
the left lung parenchyma. Hence, he had received empirical
anti-tuberculosis medication for 2 months without any improvement. He was
referred to our hospital for further management of hemoptysis.
Multidetector CT (MDCT) angiography of the chest covering coronaries
performed at our hospital revealed SVG aneurysm that was managed with
covered stent placement.<br/>Copyright &#xa9; 2020 Wolters Kluwer Medknow
Publications. All rights reserved.

<62>
Accession Number
632529803
Title
Perioperative Corticosteroid Therapy in Children Undergoing Cardiac
Surgery: A Systematic Review and Meta-Analysis.
Source
Frontiers in Pediatrics. 8 (no pagination), 2020. Article Number: 350.
Date of Publication: 24 Jul 2020.
Author
Li Y.; Luo Q.; Wu X.; Jia Y.; Yan F.
Institution
(Li, Luo, Wu, Jia, Yan) Department of Anesthesiology, National Center of
Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: The benefit-risk profile of perioperative corticosteroids in
pediatric patients undergoing cardiac surgery remains controversial.
<br/>Objective(s): To investigate the influence of perioperative
corticosteroids on the postoperative mortality and clinical outcomes in
pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
<br/>Method(s): We conducted a systematic search using MEDLINE, EMBASE,
and Cochrane Database through August 31, 2019. We included randomized
controlled trials comparing perioperative corticosteroids with other
clinical interventions, placebo, or no treatment in children between 0 and
18 years of age undergoing cardiac surgery. The primary outcome of
interest was all-cause in-hospital mortality. The secondary outcomes were
length of intensive care unit stay (LOIS), duration of mechanical
ventilation (DMV), postoperative insulin therapy, postoperative low
cardiac output syndrome (LCOS), postoperative infection, maximal
temperature (T<inf>max</inf>) in the first 24 h postoperatively, urine
output (UO) in the first 24 h postoperatively, serum lactate at
postoperative day (POD) 1, blood glucose at POD 1, vasoactive inotrope
score (VIS) at POD 1, and postoperative acute kidney injury (AKI). Study
quality was assessed using the Cochrane Risk of Bias Assessment Tool.
<br/>Result(s): Our analysis included 17 studies and 848 pediatric
patients. The data demonstrated that children receiving corticosteroids
showed no significant difference on the all-cause in-hospital mortality
with a fixed-effect model (RR = 0.59, 95% CI = 0.28-1.25, P = 0.55)
compared with controls. For the secondary outcomes, corticosteroids had a
statistically significant reduction on the VIS at POD1 (MD = -2.04, 95% CI
= -3.96 -0.12, P = 0.04), while it might be significantly associated with
an increased blood glucose at POD1 (MD = 1.38, 95% CI = 0.68-2.09, P =
0.0001) and a 2.69-fold higher risk of postoperative insulin therapy (RR =
2.69, 95% CI = 1.37-5.27, P = 0.004). No statistical significance was
shown in other secondary outcomes. <br/>Conclusion(s): Perioperative
corticosteroids might not significantly improve clinical outcomes
identified as mortality, LOIS, DMV, AKI, and LCOS other than VIS at POD1.
However, it might increase the blood glucose and episodes of insulin
therapy. Perioperative corticosteroids to attenuate the inflammatory
response are not supported by available evidence from our study. Further
results from ongoing randomized controlled trials with a larger sample
size are required.<br/>&#xa9; Copyright &#xa9; 2020 Li, Luo, Wu, Jia and
Yan.

<63>
Accession Number
632362301
Title
Study protocol for a randomised controlled trial evaluating the effects of
the orexin receptor antagonist suvorexant on sleep architecture and
delirium in the intensive care unit.
Source
BMJ Open. 10 (7) (no pagination), 2020. Article Number: e038474. Date of
Publication: 19 Jul 2020.
Author
Azimaraghi O.; Hammer M.; Santer P.; Platzbecker K.; Althoff F.C.;
Patrocinio M.; Grabitz S.D.; Wongtangman K.; Rumyantsev S.; Xu X.;
Schaefer M.S.; Fuller P.M.; Subramaniam B.; Eikermann M.
Institution
(Azimaraghi, Hammer, Santer, Platzbecker, Althoff, Patrocinio, Grabitz,
Xu, Schaefer, Subramaniam, Eikermann) Department of Anesthesia, Critical
Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts, United States
(Wongtangman) Department of Anesthesiology, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Rumyantsev) Pharmacy, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts, United States
(Fuller) Department of Neurology, Program in Neuroscience and Division of
Sleep Medicine, Beth Israel Deaconess Medical Center, Boston,
Massachusetts, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Insomnia frequently occurs in patients admitted to an
intensive care unit (ICU). Sleep-promoting agents may reduce rapid eye
movement sleep and have deliriogenic effects. Suvorexant (Belsomra) is an
orexin receptor antagonist with Food and Drug Administration (FDA)
approval for the treatment of adult insomnia, which improves sleep onset
and maintenance as well as subjective measures of quality of sleep. This
trial will evaluate the efficacy of postoperative oral suvorexant
treatment on night-time wakefulness after persistent sleep onset as well
as the incidence and duration of delirium among adult cardiac surgical
patients. Methods and analysis In this single-centre, randomised,
double-blind, placebo-controlled trial, we will enrol 120 patients, aged
60 years or older, undergoing elective cardiac surgery with planned
postoperative admission to the ICU. Participants will be randomised to
receive oral suvorexant (20 mg) or placebo one time a day starting the
night after extubation. The primary outcome will be wakefulness after
persistent sleep onset. The secondary outcome will be total sleep time.
Exploratory outcomes will include time to sleep onset, incidence of
postoperative in-hospital delirium, number of delirium-free days and
subjective sleep quality. Ethics and dissemination Ethics approval was
obtained through the Committee on Clinical Investigations' at Beth Israel
Deaconess Medical Center (protocol number 2019P000759). The findings will
be published in peer-reviewed journals. Trial registration number This
trial has been registered at clinicaltrials.gov on 17 September 2019
(NCT04092894).<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2020.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<64>
Accession Number
632579983
Title
Infective Endocarditis After Surgical and Transcatheter Aortic Valve
Replacement: A State of the Art Review.
Source
Journal of the American Heart Association. (pp e017347), 2020. Date of
Publication: 08 Aug 2020.
Author
Alexis S.L.; Malik A.H.; George I.; Hahn R.T.; Khalique O.K.; Seetharam
K.; Bhatt D.L.; Tang G.H.L.
Institution
(Alexis, Tang) Department of Cardiovascular Surgery Mount Sinai Medical
Center New York NY
(Malik) Department of Medicine Westchester Medical Center Valhalla NY
(George) Division of Cardiac Surgery Columbia University Medical Center
New York NY
(Hahn, Khalique) Division of Cardiology Columbia University Medical Center
New York NY
(Seetharam) Icahn School of Medicine at Mount Sinai New York NY
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center Harvard
Medical School Boston MA
Publisher
NLM (Medline)
Abstract
Prosthetic valve endocarditis (PVE) after surgical aortic valve
replacement and transcatheter aortic valve replacement (TAVR) carries
significant morbidity/mortality. Our review aims to compare incidence,
predisposing factors, microbiology, diagnosis, management, and outcomes of
PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed
and Embase to identify published studies from January 1, 2015 to March 13,
2020. Key words were indexed for original reports, clinical studies, and
reviews. Reports were evaluated by 2 authors against a priori
inclusion/exclusion criteria. Studies were included if they reported
incidence and outcomes related to surgical aortic valve replacement/TAVR
PVE and excluded if they were published pre-2015 or included a small
population. We followed the Cochrane methodology and Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines for all stages
of the design and implementation. Study quality was based on the
Newcastle-Ottawa Scale. Thirty-three studies with 311 to 41 025 patients
contained relevant information. The majority found no significant
difference in incidence of surgical aortic valve replacement/TAVR PVE
(reported as 0.3%-1.2% per patient-year versus 0.6%-3.4%), but there were
key differences in pathogenesis. TAVR has a specific set of infection
risks related to entry site, procedure, and device, including
nonstandardized protocols for infection control, valve crimping injury,
paravalvular leak, neo-leaflet stress, intact/calcified native leaflets,
and intracardiac hardware. With the expansion of TAVR to lower risk and
younger patients, a better understanding of pathogenesis, patient
presentation, and guideline-directed treatment is paramount. When
operative intervention is necessary, mortality remains high at 20% to 30%.
Unique TAVR infection risks present opportunities for PVE prevention,
therefore, further investigation is imperative.

<65>
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. <br/>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<br/>Copyright &#xa9; 2020
Elsevier Inc.

<66>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<67>
Accession Number
2005976215
Title
From meta-analysis to the individual patient with atrial fibrillation and
coronary artery disease: the complexity of antithrombotic treatment in
real-world clinical practice and the need for a tailored approach.
Source
European Journal of Internal Medicine. 77 (pp 27-29), 2020. Date of
Publication: July 2020.
Author
Boriani G.; Imberti J.F.; Vitolo M.
Institution
(Boriani, Imberti, Vitolo) Cardiology Division, Department of Biomedical,
Metabolic and Neural Sciences, University of Modena and Reggio Emilia,
Policlinico di Modena, Modena, Italy
Publisher
Elsevier B.V.

<68>
Accession Number
2005859673
Title
Restricted versus liberal intraoperative benzodiazepine use in cardiac
anaesthesia for reducing delirium (B-Free Pilot): a pilot, multicentre,
randomised, cluster crossover trial.
Source
British Journal of Anaesthesia. 125 (1) (pp 38-46), 2020. Date of
Publication: July 2020.
Author
Spence J.; Belley-Cote E.; Jacobsohn E.; Lee S.F.; Whitlock R.; Bangdiwala
S.; Syed S.; Sarkaria A.; MacIsaac S.; Lengyel A.; Long S.; Um K.;
McIntyre W.F.; Kavosh M.; Fast I.; Arora R.; Lamy A.; Connolly S.;
Devereaux P.J.
Institution
(Spence, Syed, Long) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock) Department of Critical Care, McMaster
University, Hamilton, ON, Canada
(Spence, Belley-Cote, Whitlock, Lamy, Devereaux) Department of Health
Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON,
Canada
(Spence, Belley-Cote, Lee, Whitlock, Bangdiwala, McIntyre, Lamy, Connolly,
Devereaux) Population Health Research Institute, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Connolly, Devereaux) Department of Medicine
(Cardiology), McMaster University, Hamilton, ON, Canada
(Jacobsohn, Kavosh, Fast) Department of Anesthesia and Perioperative
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Jacobsohn, Arora) Department of Critical Care, University of Manitoba,
Winnipeg, MB, Canada
(Whitlock, Lamy) Department of Surgery (Cardiac Surgery), McMaster
University, Hamilton, ON, Canada
(Sarkaria) Department of Family and Community Medicine, University of
Toronto, Toronto, ON, Canada
(MacIsaac) School of Medicine, Faculty of Medicine, Royal College of
Surgeons, Dublin, Ireland
(Lengyel) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Um) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Arora) Department of Surgery (Cardiac Surgery), University of Manitoba,
Winnipeg, MB, Canada
Publisher
Elsevier Ltd
Abstract
Background: Delirium is common after cardiac surgery and is associated
with adverse outcomes. Perioperative benzodiazepine use is associated with
delirium and is common during cardiac surgery, which may increase the risk
of postoperative delirium. We undertook a pilot study to inform the
feasibility of a large randomised cluster crossover trial examining
whether an institutional policy of restricted benzodiazepine
administration during cardiac surgery (compared with liberal
administration) would reduce delirium. <br/>Method(s): We conducted a
two-centre, pilot, randomised cluster crossover trial with four 4 week
crossover periods. Each centre was randomised to a policy of restricted or
liberal use, and then alternated between the two policies during the
remaining three periods. Our feasibility outcomes were adherence to each
policy (goal >=80%) and outcome assessment (one delirium assessment per
day in the ICU in >=90% of participants). We also evaluated the incidence
of intraoperative awareness in one site using serial Brice questionnaires.
<br/>Result(s): Of 800 patients undergoing cardiac surgery during the
trial period, 127/800 (15.9%) had delirium. Of these, 355/389 (91.3%)
received benzodiazepines during the liberal benzodiazepine periods and
363/411 (88.3%) did not receive benzodiazepines during the restricted
benzodiazepine periods. Amongst the 800 patients, 740 (92.5%) had >=1
postoperative delirium assessment per day in the ICU. Of 521 patients
screened for intraoperative awareness, one patient (0.2%), managed during
the restricted benzodiazepine period (but who received benzodiazepine),
experienced intraoperative awareness. <br/>Conclusion(s): This pilot study
demonstrates the feasibility of a large, multicentre, randomised, cluster
crossover trial examining whether an institutional policy of restricted vs
liberal benzodiazepine use during cardiac surgery will reduce
postoperative delirium. Clinical trial registration:
NCT03053869.<br/>Copyright &#xa9; 2020 British Journal of Anaesthesia

<69>
Accession Number
2004631423
Title
The effects of analgesic treatment and chest physiotherapy on the
complications of the patients with rib fractures that arise from blunt
chest trauma.
Source
Ulusal Travma ve Acil Cerrahi Dergisi. 26 (4) (pp 531-537), 2020. Date of
Publication: 2020.
Author
Alar T.; Gedik I.E.; Kara M.
Institution
(Alar) Department of Thoracic Surgery, Canakkale Onsekiz Mart University,
Faculty of Medicine, Canakkale, Turkey
(Gedik) Department of Thoracic Surgery, Erzurum Regional Education and
Research Hospital, Erzurum, Turkey
(Kara) Department of Thoracic Surgery, Istanbul University Istanbul
Faculty of Medicine, Istanbul, Turkey
Publisher
Turkish Association of Trauma and Emergency Surgery
Abstract
BACKGROUND: This prospective study aims to investigate the effect of chest
physiotherapy and analgesic therapy on the possible complications of
isolated rib fractures attributable to blunt thoracic trauma, such as
hemothorax and pneumothorax. <br/>METHOD(S): Patients who presented to
Canakkale Onsekiz Mart University School of Medicine Hospital's Emergency
Department and Thoracic Surgery outpatient clinics within the first 24
hours of the post-traumatic period and did not have additional
intrathoracic complications at presentation with blunt thoracic trauma and
who were diagnosed with isolated rib fractures were enrolled in this
prospective research study. The groups were designated as the patients who
would receive analgesic treatment only (Group A) and the patients who
would receive chest physiotherapy and analgesic treatment together (Group
B). Patients who had first and second rib fractures or three or more rib
fractures and who did not have additional organ injury were hospitalized
in the Thoracic Surgery clinics; patients who had other organ trauma were
hospitalized in related clinics. Patients were reassessed on their seventh
and 30^th post-traumatic days with physical examination and
radiologic studies. <br/>RESULT(S): The mean age of the 114 patients were
56.3+/-16.4 (22-87). There were 37 (32.5%) women and 77 (67.5%) men. Each
group included 57 patients. The most common form of trauma was the
same-level falls (31.6%). The mean number of rib fractures of all
participants was 2.6+/-0.7 (1-10); the median number was 1.5. Fifty-two
(45.6%) patients were hospitalized. The mean length of stay was 4.0+/-1.1
days. At the end of their treatment and follow-up periods, pleural
effusion was found in 28 patients (24.6%) out of 114 enrolled at the side
of trauma. Group B had a higher number of patients with pleural effusion
(43.9%) than group A (5.3%). We performed tube thoracostomy in four
patients, all of which were in group B (p<0.05). <br/>CONCLUSION(S): As a
result of this study, chest physiotherapy maneuvers have increased the
incidence of late hemothorax in patients with three or more isolated rib
fractures. Also, minimal hemothoraces (<300 ml) may spontaneously regress,
and no additional surgical treatment are required if the proper follow-up
procedures are performed. It is advisable to hospitalize the blunt
thoracic trauma patients who have three or more rib fractures and who are
planned to undergo chest physiotherapy and or are prone to de-velop
additional complications because of possible risks.<br/>Copyright &#xa9;
2020 Turkish Association of Trauma and Emergency Surgery.

<70>
Accession Number
2004555956
Title
Understanding and addressing variation in health care-associated
infections after durable ventricular assist device therapy: Protocol for a
mixed methods study.
Source
Journal of Medical Internet Research. 22 (1) (no pagination), 2020.
Article Number: e14701. Date of Publication: 2020.
Author
Chandanabhumma P.P.; Fetters M.D.; Pagani F.D.; Malani P.N.; Hollingsworth
J.M.; Funk R.J.; Aaronson K.D.; Zhang M.; Kormos R.L.; Chenoweth C.E.;
Shore S.; Watt T.M.F.; Cabrera L.; Likosky D.
Institution
(Chandanabhumma, Fetters) Mixed Methods Program, Department of Family
Medicine, University of Michigan, Ann Arbor, MI, United States
(Pagani, Watt, Cabrera, Likosky) Department of Cardiac Surgery, University
of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States
(Malani, Chenoweth) Division of Infectious Diseases, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, United States
(Hollingsworth) Department of Urology, University of Michigan, Ann Arbor,
MI, United States
(Funk) Department of Strategic Management and Entrepreneurship, Carlson
School of Management, University of Minnesota, Minneapolis, MN, United
States
(Aaronson, Shore) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, United States
(Zhang) Department of Biostatistics, School of Public Health, University
of Michigan, Ann Arbor, MI, United States
(Kormos) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
Publisher
Journal of Medical Internet Research
Abstract
Background: Durable ventricular assist device (VAD) therapy is reserved
for patients with advanced heart failure who have a poor estimated 1-year
survival. However, despite highly protocolized management processes,
patients are at a unique risk for developing a health care-associated
infection (HAI). Few studies have examined optimal strategies for HAI
prevention after durable VAD implantation, despite variability in rates
across centers and their impact on short- and long-term outcomes.
<br/>Objective(s): The objective of this study is to develop
recommendations for preventing the most significant HAIs after durable VAD
implantation. The study has 3 specific aims: (1) identify determinants of
center-level variability in HAI rates, (2) develop comprehensive
understanding of barriers and facilitators for achieving low center-level
HAI rates, and (3) develop and disseminate a best practices toolkit for
preventing HAIs that accommodates various center contexts. <br/>Method(s):
This is a sequential mixed methods study starting with a cross-sectional
assessment of current practices. To address aim 1, we will conduct (1) a
systematic review of HAI prevention studies and (2) in-depth quantitative
analyses using administrative claims, in-depth clinical data, and
organizational surveys of VAD centers. For aim 2, we will apply a mixed
methods patient tracer assessment framework to conduct semistructured
interviews, field observations, and document analysis informed by findings
from aim 1 at 5 high-performing (ie, low HAIs) and 5 low-performing (ie,
high HAI) centers, which will be examined using a mixed methods case
series analysis. For aim 3, we will build upon the findings from the
previous aims to develop and field test an HAI preventive toolkit, acquire
stakeholder input at an annual cardiac surgical conference, disseminate
the final version to VAD centers nationwide, and conduct follow-up surveys
to assess the toolkit's adoption. <br/>Result(s): The project was funded
by the Agency for Healthcare Research and Quality in 2018 and enrollment
for the overall project is ongoing. Data analysis is currently under way
and the first results are expected to be submitted for publication in
2019. <br/>Conclusion(s): This mixed methods study seeks to quantitatively
assess the determinants of HAIs across clinical centers and qualitatively
identify the context-specific facilitators and barriers for attaining low
HAI rates. The mixed data findings will be used to develop and disseminate
a stakeholder-acceptable toolkit of evidence-based HAI prevention
recommendations that will accommodate the specific contexts and needs of
VAD centers.<br/>Copyright &#xa9; 2020 Journal of Medical Internet
Research. All rights reserved.

<71>
Accession Number
2004538313
Title
Percutaneous Coronary Intervention Techniques for Bifurcation Disease:
Network Meta-analysis Reveals Superiority of Double-Kissing Crush.
Source
Canadian Journal of Cardiology. 36 (6) (pp 906-914), 2020. Date of
Publication: June 2020.
Author
Crimi G.; Mandurino-Mirizzi A.; Gritti V.; Scotti V.; Strozzi C.; de
Silvestri A.; Montalto C.; di Giacomo C.; d'Ascenzo F.; Repetto A.;
Ferlini M.; Marinoni B.; Ferrario M.; de Servi S.; Visconti L.O.; Klersy
C.
Institution
(Crimi, Mandurino-Mirizzi, Gritti, Montalto, di Giacomo, Repetto, Ferlini,
Marinoni, Ferrario, Visconti) Division of Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Mandurino-Mirizzi, Strozzi, Montalto, di Giacomo) University of Pavia,
Pavia, Italy
(Scotti) Centre for Scientific Documentation, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
(de Silvestri, Klersy) Service of Clinical Epidemiology and Biostatistic,
Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
(d'Ascenzo) Division of Cardiology, Citta Della Salute e Della Scienza,
Turin, Italy
(de Servi) Cardiovascular Department, IRCCS Multimedica, Milan, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Provisional T-stenting (PS) is generally recommended to treat
patients with coronary bifurcation disease (CBD) percutaneously, but PS
may not fit all complex bifurcation anatomies. Therefore, several types of
up-front 2-stent techniques have been described. We aimed to identify the
best percutaneous coronary intervention (PCI) technique to manage patients
with CBD. <br/>Method(s): We systematically reviewed randomized controlled
trials (RCTs) including patients undergoing CBD PCI which included several
types of PCI techniques-PS, double-kissing (DK) crush, T-stenting and
protrusion, culotte, dedicated bifurcation stents, crushing, and
T-stenting-and we compared device-oriented clinical events (DOCEs), a
composite of cardiac death, target-vessel myocardial infarction, stent
thrombosis, and target-lesion or target-vessel revascularization, in a
network meta-analysis. We included 26 RCTs, leading to a pooled population
of 10,339 patient-years and a total of 1229 DOCEs. <br/>Result(s): The
DK-crush technique was associated with the lowest DOCE rate, with a
relative risk of 0.62 (95% CI 0.42-0.92) compared with the PS technique.
DK-crush had the highest probability (model likelihood 90.2%, area under
the cumulative ranking curve 98.0%) of being the best technique among
those explored to reduce DOCEs in patients receiving CBD PCI.
<br/>Conclusion(s): When a 2-stent strategy is considered in a patient
with CBD, the DK-crush technique reduces DOCEs compared with other
bifurcation techniques based on all available RCTs.<br/>Copyright &#xa9;
2019 Canadian Cardiovascular Society

<72>
Accession Number
632357896
Title
Creatine kinase is associated with bleeding after myocardial infarction.
Source
Open Heart. 7 (2) (no pagination), 2020. Article Number: e001261. Date of
Publication: 16 Jul 2020.
Author
Brewster L.M.; Fernand J.
Institution
(Brewster) CK Science Foundation, Amsterdam, Netherlands
(Fernand) Clinic for Health and Individual Medicine, Utrecht, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background The ADP-scavenging enzyme creatine kinase (CK) is reported to
reduce ADP-dependent platelet activation. Therefore, we studied whether
highly elevated CK after ST-elevation myocardial infarction (STEMI) is
associated with bleeding. Methods Data of the Thrombolysis in Myocardial
Infarction Study Group phase II trial on the efficacy of angioplasty,
following intravenous recombinant tissue-type plasminogen activator
(rt-PA), are used to assess whether peak plasma CK (CKmax) is
independently associated with adjudicated fatal or non-fatal bleeding
(primary) and combined bleeding/all-cause mortality (secondary) in
multivariable binomial logistic regression analysis, adjusting for
baseline and treatment allocation covariates. Results The included
patients (n=3339, 82% men, 88% white, mean age 57 years, SE 0.2) had a
history of angina pectoris (55%), hypertension (38%) and/or diabetes
mellitus (13%). CKmax ranged from 16 to 55 890 IU/L (mean 2389 IU/L, SE
41), reached within 8 hours in 51% of the patients (93% within 24 hours).
Adjudicated fatal/non-fatal bleeding occurred in 30% of the patients
(respectively 26% in the low vs 34% in the high CK tertile), and
bleeding/all-cause mortality in 35% (29% in the low vs 40% in the high CK
tertile). In multivariable regression analysis, the adjusted OR for
fatal/non-fatal bleeding (vs not bleeding and survival) was 2.6 (95% CI
1.8 to 3.7)/log CKmax increase, and 3.1 (2.2 to 4.4) for
bleeding/all-cause mortality. Conclusion Highly elevated plasma CK after
myocardial infarction might be an independent predictor of bleeding and
haemorrhagic death. This biologically plausible association warrants
further prospective study of the potential role of extracellular CK in
ADP-dependent platelet activation and bleeding.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<73>
Accession Number
632342627
Title
Oral switch versus standard intravenous antibiotic therapy in left-sided
endocarditis due to susceptible staphylococci, streptococci or enterococci
(RODEO): A protocol for two open-label randomised controlled trials.
Source
BMJ Open. 10 (7) (no pagination), 2020. Article Number: e033540. Date of
Publication: 14 Jul 2020.
Author
Lemaignen A.; Bernard L.; Tattevin P.; Bru J.-P.; Duval X.; Hoen B.;
Brunet-Houdard S.; Mainardi J.-L.; Caille A.
Institution
(Lemaignen, Bernard) Service de Medecine Interne et Maladies Infectieuses,
Centre Hospitalier Regional, Universitaire de Tours, Tours, France
(Lemaignen) Universite de Tours, Faculte de Medecine, Pres Centre-Val de
Loire Universite, Tours, France
(Tattevin) Service de Maladies Infectieuses et de Reanimation Medicale,
Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
(Bru) Service d'Infectiologie et de Medecine Interne, Centre Hospitalier
Annecy-Genevois, Epagny Metz-Tessy, Rhone-Alpes, France
(Duval) Inserm Clinical Investigation Center 1425, Iame 1138, Universite
Paris Diderot, Sorbonne Paris-Cite, Paris, Ile-de-France, France
(Duval) Service de Maladies Infectieuses et Tropicales, Assistance
Publique-Hopitaux de Paris, Hopital Bichat, Paris, France
(Hoen) Service de Maladies Infectieuses et Tropicales, Chru de Nancy,
Vandoeuvre-les-Nancy, France
(Brunet-Houdard, Caille) Unite d'Evaluation Medico-Economique, EA7505
Education Ethique, Sante, Centre Hospitalier Regional Universitaire de
Tours, Universite de Tours, Tours, France
(Mainardi) Service de Microbiologie, Aphp, Hopital Europeen Georges
Pompidou, Paris, France
(Caille) Inserm CIC1415, Chru de Tours, Tours, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Left-sided infective endocarditis (IE) is a serious infection
with a heavy burden for patients and healthcare system. Oral switch after
initial intravenous antibiotic therapy may reduce costs and improve
patients' discomfort without increasing unfavourable outcomes. We describe
the methodology of two simultaneously conducted open-label randomised
trials aiming to assess non-inferiority of oral switch as compared with
entirely intravenous antibiotic therapy for the treatment of left-sided
IE. Methods and analysis Two simultaneous multicentre open-label
prospective randomised trials assessing non-inferiority of oral switch
during antibiotic treatment as compared with entirely intravenous therapy
in patients with left-sided IE are ongoing. One trial is dedicated to
left-sided IE caused by multisusceptible staphylococci (Relais Oral Dans
le traitement des Endocardites a staphylocoques ou streptOcoques
(RODEO)-1) and the other is dedicated to left-sided IE caused by
susceptible streptococci or enterococci (RODEO-2). It is planned to
randomise 324 patients in each trial after an initial course of at least
10 days of intravenous antibiotic therapy either to continue intravenous
antibiotic therapy or to switch to oral antibiotic therapy. The primary
outcome is treatment failure within 3 months after the end of antibiotic
treatment, a composite outcome defined by all-cause death and/or
symptomatic embolic events and/or unplanned valvular surgery and/or
microbiological relapse (with the primary pathogen). Secondary outcomes
include patient quality of life, echocardiographic outcome, costs and
efficiency associated with IE care. Statistical analysis will be performed
with a non-inferiority margin of 10% and a one-sided 2.5% type I error.
Ethics and dissemination Written informed consent will be obtained from
all participants. This study was approved by Tours Research ethics
committee (CPP TOURS-Region Centre-Ouest 1, 2015-R26, 23 February 2016).
Study findings will be published in peer-reviewed journals and
disseminated through presentation at relevant national and international
conferences. Trial registration number EudraCT Number: 2015-002371-16 and
NCT02701608; NCT02701595.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<74>
Accession Number
2005220797
Title
Impact of inferior caval valve implantation on severity of tricuspid
regurgitation and right heart function.
Source
Echocardiography. 37 (7) (pp 999-1007), 2020. Date of Publication: 01 Jul
2020.
Author
Mattig I.; Knebel F.; Hewing B.; Stangl V.; Stangl K.; Laule M.; Dreger H.
Institution
(Mattig, Knebel, Hewing, Stangl, Stangl, Laule, Dreger) Medizinische
Klinik mit Schwerpunkt Kardiologie und Angiologie, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Knebel, Hewing, Laule) Berlin Institute of Health (BIH), Berlin, Germany
(Knebel, Hewing, Stangl, Stangl, Dreger) DZHK (German Centre for
Cardiovascular Research), Berlin, Germany
(Hewing) Department of Cardiology III - Adult Congenital and Valvular
Heart Disease, University Hospital Muenster, Muenster, Germany
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aims: Severe tricuspid regurgitation (TR) is a common finding in heart
failure patients and associated with increased mortality. New
interventional therapeutic options are needed as many heart failure
patients are unfit for surgery. The TRICAVAL study compared valve
implantation into the inferior vena cava (CAVI) with optimal medical
therapy (OMT) in patients with severe TR. Here, we report details on the
impact of CAVI on TR severity as well as right heart function and
morphology. <br/>Methods and Results: We randomized 28 patients with
severe TR to CAVI (n = 14) with transfemoral implantation of an Edwards
Sapien XT valve into the inferior vena cava or OMT (n = 14). Inclusion and
exclusion criteria were based on anatomical and clinical parameters.
Echocardiographic measurements were performed at baseline, at the first
postoperative day and one, three, and twelve months after randomization.
As proof of concept of an effective sealing of the inferior vena cava, we
detected a significant decrease in systolic hepatic vein reflux volume
(11.0 [6.2-21.9] mL vs 3.5 [0.6-8.5] mL, P =.016) and hepatic vein
diameter (11.5 [10.0-14.8] mm vs 10.0 [9.3-11.8] mm, P =.034) at
thirty-day follow-up. However, CAVI had no significant impact on TR,
cardiac function, and morphology. <br/>Conclusion(s): Caval valve
implantation significantly reduced systolic reflux into the hepatic veins
but was not associated with an improvement in cardiac function,
morphology, or TR severity.<br/>Copyright &#xa9; 2020 The Authors.
Echocardiography published by Wiley Periodicals LLC

<75>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright
&#xa9; 2019 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<76>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2020
Annals of Cardiac Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<77>
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.
<br/>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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2020 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<78>
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.<br/>Copyright &#xa9;
2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine

<79>
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.
<br/>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.
<br/>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. <br/>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.

<80>
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.
<br/>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. <br/>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.
<br/>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.

<81>
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. <br/>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. <br/>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. <br/>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.

<82>
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.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<83>
Accession Number
2005499667
Title
Effects of thoracic nerve block on perioperative lung injury, immune
function, and recovery after thoracic surgery.
Source
Clinical and Translational Medicine. 10 (3) (no pagination), 2020. Article
Number: e38. Date of Publication: 01 Jul 2020.
Author
Zhang W.; Cong X.; Zhang L.; Sun M.; Li B.; Geng H.; Gu J.; Zhang J.
Institution
(Zhang, Cong, Zhang, Sun, Li, Geng, Zhang) Department of Anesthesiology
and Perioperative Medicine, Center for Clinical Single Cell Biomedicine,
Henan Provincial People's Hospital, People's Hospital of Zhengzhou
University, Zhengzhou, Henan, China
(Gu) Department of General Medicine, Henan Provincial People's Hospital,
People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: To investigate the effects of thoracic nerve block on
perioperative lung injury, immune function, and recovery after thoracic
surgery. <br/>Method(s): A total of 120 patients with lung cancer were
randomly allocated into three groups: general anesthesia group (GAL
group), thoracic paravertebral nerve block (TPVB) combined with general
anesthesia (TPL group), and TPVB (with paravertebral dexmedetomidine)
combined with general anesthesia group (TDL group); 120 patients with
esophageal cancer were randomly allocated into three groups: general
anesthesia group (GAE group), TPVB combined with general anesthesia group
(TPE group), and thoracic epidural block combined with general anesthesia
group (TEE group). Lung injury and immune function were evaluated.
Hemodynamic changes, early recovery in post-anesthesia care unit, pain,
6-min walking test (6MWT), drug consumption, and life quality were also
observed. The duration in the PACU of patients was retrospectively
analyzed. The effect of dexmedetomidine on lung injury was established in
vitro. <br/>Result(s): The lung injury, including injury scores,
apoptosis, and inflammation, were decreased in the TDL group compared with
the GAL group and TPL group. The ratio of CD4⁺/CD8⁺
cells at the end of surgery was higher in the TPE group than in the GAE
group. More stable hemodynamic was found in TPL group and TPE group. Acute
pain was alleviated and the 6MWT was enhanced by TPVB with or without
dexmedetomidine. Anesthetic consumption was decreased by thoracic nerve
block. <br/>Conclusion(s): Thoracic nerve block, especially TPVB with or
without paravertebral dexmedetomidine, can enhance recovery after thoracic
surgery. Protection against independent lung injury and cellular immune
dysfunction may be a potential mechanism.<br/>Copyright &#xa9; 2020 The
Authors. Clinical and Translational Medicine published by John Wiley &
Sons Australia, Ltd on behalf of Shanghai Institute of Clinical
Bioinformatics

<84>
Accession Number
632564077
Title
Implementing a pharmacogenetic-driven algorithm to guide dual antiplatelet
therapy (DAPT) in Caribbean Hispanics: protocol for a non-randomised
clinical trial.
Source
BMJ open. 10 (8) (pp e038936), 2020. Date of Publication: 06 Aug 2020.
Author
Hernandez-Suarez D.F.; Melin K.; Marin-Maldonado F.; Nunez H.J.; Gonzalez
A.F.; Gonzalez-Sepulveda L.; Rivas-Tumanyan S.; Naik H.; Ruano G.; Scott
S.A.; Duconge J.
Institution
(Hernandez-Suarez, Nunez, Gonzalez) Division of Cardiovascular Medicine,
University of Puerto Rico School of Medicine, Medical Sciences Campus, San
Juan, United States
(Melin) Department of Pharmacy Practice, University of Puerto Rico School
of Pharmacy, Medical Sciences Campus, San Juan, United States
(Marin-Maldonado) RCMI Program, Academic Affairs Deanship, University of
Puerto Rico, Medical Sciences Campus, San Juan, United States
(Gonzalez-Sepulveda, Rivas-Tumanyan) Research Design and Biostatistics
Core, Puerto Rico Clinical and Translational Research Consortium (PRCTRC),
Medical Sciences Campus, San Juan, United States
(Naik, Scott) Department of Genetics and Genomic Sciences, Icahn School of
Medicine at Mount Sinai, New York City, NY, United States
(Ruano) Hartford Hospital Institute of Living, Hartford, CT, United States
(Duconge) Department of Pharmaceutical Sciences, University of Puerto Rico
School of Pharmacy, Medical Sciences Campus, San Juan, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Minority populations in the USA are disproportionately
affected by cardiovascular conditions. Reduced responsiveness to
clopidogrel among carriers of CYP2C19 variants has been reported in
patients with either coronary artery disease (CAD) or acute coronary
syndrome (ACS) after the percutaneous coronary intervention (PCI).
Previous studies have evaluated CYP2C19 genotyping-guided antiplatelet
therapy in selected populations; however, this has yet to be tested among
Hispanics. Given the paucity of clinical research on CYP2C19 and
antiplatelet clinical outcomes in Hispanics, our study will test the
safety and efficacy of a genetic-driven treatment algorithm to guide dual
antiplatelet therapy (DAPT) in Caribbean Hispanics. METHODS AND ANALYSIS:
This is a multicentre, prospective, non-randomised clinical trial that
proposes an assessment of pharmacogenomic-guided DAPT in post-PCI
Caribbean Hispanic patients with ACS or CAD. We will recruit 250 patients
to be compared with a matched non-concurrent cohort of 250
clopidogrel-treated patients (standard-of-care). Major adverse
cardiovascular events (MACEs) such as all-cause death, myocardial
infarction (MI), stroke, coronary revascularisation, stent thrombosis and
bleedings over 6 months will be the study endpoints. Among the recruited,
high-risk patients will be escalated to ticagrelor and low-risk patients
will remain on clopidogrel. The primary objective is to determine whether
genetic-guided therapy is superior to standard of care. The secondary
objective will determine if clopidogrel treatment in low-risk patients is
not associated with a higher rate of MACEs compared with escalated
antiplatelet therapy in high-risk patients. Patients will be enrolled up
to the group's completion. ETHICS AND DISSEMINATION: Approval was obtained
from the Institutional Review Board of the University of Puerto Rico
Medical Sciences Campus (protocol # A4070417). The study will be carried
out in compliance with the Declaration of Helsinki and International
Conference on Harmonization Good Clinical Practice Guidelines. Findings
will be published in a peer-reviewed journal and controlled access to
experimental data will be available. TRIAL REGISTRATION NUMBER:
NCT03419325; Pre-results.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<85>
[Use Link to view the full text]
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.

<86>
Accession Number
632570482
Title
Hospital costs and prognosis in end-stage renal disease patients receiving
coronary artery bypass grafting.
Source
BMC nephrology. 21 (1) (pp 333), 2020. Date of Publication: 08 Aug 2020.
Author
Liao K.-M.; Kuo L.-T.; Lu H.-Y.
Institution
(Liao) Department of Internal Medicine, Chi Mei Medical Center, Taiwan
(Republic of China)
(Kuo) Division of Neurosurgery, Department of Surgery, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Lu) Department of Industrial Engineering and Management, National Yunlin
University of Science and Technology, Yunlin, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery disease is common in patients with end-stage
renal disease (ESRD). Patients with ESRD are a high-risk group for cardiac
surgery and have increased morbidity and mortality. Most studies comparing
ESRD patients receiving coronary artery bypass grafting (CABG) or
percutaneous coronary intervention have found that the long-term survival
is good in ESRD patients after CABG. The aim of our study was to compare
ESRD patients who underwent CABG with the general population who underwent
CABG, in terms of prognosis and hospital costs. <br/>METHOD(S): This study
analyzed data from the National Health Insurance Research Database in
Taiwan for patients who were diagnosed with ESRD and received CABG
(ICD-9-CM codes 585 or 586) between January 1, 2004, and December 31,
2009. The ESRD patients included in this study all received catastrophic
illness cards with the major illness listed as ESRD from the Ministry of
Health and Welfare in Taiwan. The control subjects were randomly selected
patients without ESRD after propensity score matching with ESRD patients
according to age, gender, and comorbidities at a 2:1 ratio from the same
dataset. <br/>RESULT(S): A total of 48 ESRD patients received CABG, and
their mean age was 62.04+/-10.04years. Of these patients, 29.2% were aged
>=70years, and 66.7% were male. ESRD patients had marginally higher
intensive care unit (ICU) stays (11.06 vs 7.24days) and significantly
higher ICU costs (28,750 vs 17,990 New Taiwan Dollars (NTD)) than non-ESRD
patients. Similarly, ESRD patients had significantly higher surgical costs
(565,200 vs. 421,890 NTD), a higher perioperative mortality proportion
(10.4% vs 2.1%) and a higher postoperative mortality proportion (33.3% vs
11.5%) than non-ESRD patients. <br/>CONCLUSION(S): After CABG, ESRD
patients had a higher risk of mortality than non-ESRD patients, and ICU
and surgery costs were also higher among the ESRD patients than among
patients without ESRD.

<87>
[Use Link to view the full text]
Accession Number
632567905
Title
Towards integrative neuromonitoring of the surgical newborn: A systematic
review.
Source
European Journal of Anaesthesiology. 37 (8) (pp 701-712), 2020. Date of
Publication: 01 Aug 2020.
Author
Costerus S.A.; Van Hoorn C.E.; Hendrikx D.; Kortenbout J.; Hunfeld M.;
Vlot J.; Naulaers G.; Tibboel D.; De Graaff J.C.
Institution
(Costerus, Hendrikx, Tibboel) Department of Pediatric Surgery and
Intensive Care, Sophia Children's Hospital, Erasmus MC, Dr Molewaterplein
60, Rotterdam 3000 CB, Netherlands
(Van Hoorn, De Graaff) Department of Anesthesiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Hunfeld) Department of Electrical Engineering, KU Leuven, Leuven, Belgium
(Kortenbout) Department of Biomedical Engineering, Erasmus University
Medical Center, Netherlands
(Vlot) Department of Pediatric Neurology, Erasmus University Medical
Center-Sophia Children's Hospital, Rotterdam, Netherlands
(Naulaers) Department of Neonatal Intensive Care Unit, University
Hospitals Leuven, Leuven, Belgium
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUNDThe altered neurodevelopment of children operated on during the
neonatal period might be due to peri-operative changes in the homeostasis
of brain perfusion. Monitoring of vital signs is a standard of care, but
it does not usually include monitoring of the brain.OBJECTIVESTo evaluate
methods of monitoring the brain that might be of value. We also wanted to
clarify if there are specific risk factors that result in peri-operative
changes and how this might be evaluated.DESIGNSystematic review.DATA
SOURCESA structured literature search was performed in MEDLINE in Ovid,
Embase, Cochrane CENTRAL, Web of Science and Google Scholar.ELIGIBILITY
CRITERIAStudies in neonates who received peri-operative neuromonitoring
were eligible for inclusion; studies on neurosurgical procedures or
cardiac surgery with cardiopulmonary bypass and/or deep hypothermia
cardiac arrest were excluded.RESULTSNineteen of the 24 included studies,
totalling 374 infants, reported the use of near-infrared spectroscopy.
Baseline values of cerebral oxygenation greatly varied (mean 53 to 91%)
and consequently, no coherent results were found. Two studies found a
correlation between cerebral oxygenation and mean arterial blood pressure.
Five studies, with in total 388 infants, used (amplitude-integrated)
electro-encephalography to study peri-operative brain activity. Overall,
the brain activity decreased during anaesthesia and epileptic activity was
more frequent in the peri-operative phase. The association between
intra-operative cerebral saturation or activity and neuro-imaging
abnormalities and/or neurodevelopmental outcome was investigated in six
studies, but no association was found.CONCLUSIONNeuromonitoring with the
techniques currently used will neither help our understanding of the
altered neonatal pathophysiology, nor enable early detection of deviation
from the norm. The modalities lack specificity and are not related to
clinical (long-term) outcome or prognosis. Accordingly, we were unable to
draw up a monitoring guideline.<br/>Copyright &#xa9; 2020 Lippincott
Williams and Wilkins. All rights reserved.

<88>
[Use Link to view the full text]
Accession Number
632567880
Title
Postoperative atrial fibrillation following emergency noncardiothoracic
surgery: A systematic review.
Source
European Journal of Anaesthesiology. 37 (8) (pp 671-679), 2020. Date of
Publication: 01 Aug 2020.
Author
Bjerrum E.; Wahlstroem K.L.; Gogenur I.; Burcharth J.; Ekeloef S.
Institution
(Bjerrum, Wahlstroem, Gogenur, Burcharth, Ekeloef) Center for Surgical
Science (CSS), Department of Surgery, Zealand University Hospital,
Lykkebaekvej 1, Koege 4600, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUNDPostoperative atrial fibrillation (POAF) occurs frequently
following cardiothoracic surgery and is associated with a higher mortality
and a longer hospital stay. The condition is less studied following
noncardiothoracic surgery as well as emergency surgery.OBJECTIVEThe aim of
this systematic review was to investigate the occurrence of atrial
fibrillation following emergency noncardiothoracic surgery and associated
risk factors and mortality.DESIGNWe conducted a systematic review
according to the Preferred Reporting Items for Systematic reviews and
Meta-Analyses guidelines. Observational studies and randomised controlled
trials were assessed for risk of bias using the Downs and Black checklist
and Cochrane Handbook for Systematic reviews of intervention.DATA SOURCESA
systematic literature search of PubMed, EMBASE and Scopus was carried out
in August 2019. No publication date- or source restrictions were
imposed.ELIGIBILITY CRITERIAObservational and randomised controlled trials
were included if data on POAF occurring after an emergency,
noncardiothoracic, surgical intervention on adult patients could be
extracted.RESULTSWe identified 15 studies eligible for inclusion covering
orthopaedic-, abdominal-, vascular-, neuro- and miscellaneous
noncardiothoracic surgery. The occurrence of POAF after emergency
noncardiothoracic surgery ranged from 1.5 to 12.2% depending on type of
surgery and intensity of cardiac monitoring. Studies that investigated
risk factors and associated mortality found emergency surgery and
increasing age to be associated with risk of POAF. Moreover, POAF was
generally associated with an increase in long-term and short-term
mortality.CONCLUSIONIn this study, atrial fibrillation occurred
frequently, especially following emergency orthopaedic, vascular and
neurosurgery. Emergency surgery and age were independent risk factors for
developing atrial fibrillation. POAF seems to be related to a higher risk
of postoperative complications and mortality, though further studies with
long-term follow-up are needed.TRIAL
REGISTRATIONCRD42019112090.<br/>Copyright &#xa9; 2020 Lippincott Williams
and Wilkins. All rights reserved.

<89>
[Use Link to view the full text]
Accession Number
632567565
Title
Late atrial arrhythmias after lung transplantation: A meta-analysis.
Source
Journal of Cardiovascular Medicine. 21 (8) (pp 577-582), 2020. Date of
Publication: 01 Aug 2020.
Author
Saglietto A.; Matta M.; Gaita F.; De Ferrari G.M.; Anselmino M.
Institution
(Saglietto, De Ferrari, Anselmino) Division of Cardiology, Department of
Medical Sciences, 'Citta della Salute e della Scienza di Torino' Hospital,
University of Turin, Dogliotti 14, Turin 10126, Italy
(Matta) Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
(Gaita) Cardiovascular Department, Clinica Pinna Pintor, Policlinico di
Monza, Turin, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BackgroundAtrial arrhythmias are common following noncardiac thoracic
surgery. In particular, early postoperative atrial arrhythmias after lung
transplantation are very frequent, especially atrial fibrillation (AFib).
Late atrial arrhythmia occurrence following lung transplantation, instead,
has been less commonly reported.MethodsThe aim of the present systematic
review and meta-analysis is to analyse the incidence rate of late atrial
arrhythmia and AFib in lung transplantation patients, with a special focus
on double lung transplant (DLT), also to assess potential predictors of
AFib occurrence. After bibliographic search (PUBMED/Medline and Embase
databases), a random-effect model meta-analysis was performed: seven
studies were finally included, including 2068 lung transplantation
patients.ResultsThe pooled incidence rate of late atrial arrhythmia was
4.3%/year [95% confidence interval (CI) 2.8-6.1%/year, I²=
69%], whereas late AFib incidence rate was 1.5%/year (95% CI
0.7-2.6%/year, I²= 87%). In patients undergoing DLT, the pooled
incidence rate of late atrial arrhythmia was 4.1%/year (95% CI
2.5-6.0%/year, I²= 67%), while the AFib incidence rate was
0.9%/year (95% CI 0.1-2.4%/year, I²= 92%). A longer follow-up
duration significantly related to the reduced incidence rate of AFib (P =
0.02). History of AFib (hazard ratio 11.2, 95% CI 5.9-21.3) and early
postoperative AFib (hazard ratio 10.3, 95% CI 5.9-18.0) emerged, instead,
as relevant predictors of AFib occurrence.ConclusionLate atrial arrhythmia
occurrence is not infrequent in lung transplantation patients; however,
late Afib incidence was rare and showed a time-dependent decrease,
particularly in DLT patients, suggesting that a transmural pulmonary veins
isolation, the mainstay of transcatheter ablation, is effective in
decreasing the likelihood of experiencing AFib.<br/>Copyright &#xa9; 2020
Lippincott Williams and Wilkins. All rights reserved.

<90>
Accession Number
632466012
Title
Early prediction of acute kidney injury in neonates with cardiac surgery.
Source
World Journal of Pediatric Surgery. 3 (2) (no pagination), 2020. Article
Number: e000107. Date of Publication: 25 Jun 2020.
Author
Shi S.; Fan J.; Shu Q.
Institution
(Shi, Fan) Cardiac Intensive Care Unit, Children's Hospital, Zhejiang
University, School of Medicine, Hangzhou, China
(Shu) Department of Thoracic and Cardiovascular Surgery, Children's
Hospital, Zhejiang University, School of Medicine, Hangzhou, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Acute kidney injury (AKI) occurs in 42-64 of the neonatal
patients experiencing cardiac surgery, contributing to postoperative
morbidity and mortality. Current diagnostic criteria, which are mainly
based on serum creatinine and hourly urine output, are not sufficiently
sensitive and precise to diagnose neonatal AKI promptly. The purpose of
this review is to screen the recent literature, to summarize the novel and
cost-effective biomarkers and approaches for neonatal AKI after cardiac
surgery (CS-AKI), and to provide a possible research direction for future
work. Data sources We searched PubMed for articles published before
November 2019 with pertinent terms. Sixty-seven articles were found and
screened. After excluding 48 records, 19 articles were enrolled for final
analysis. Results Nineteen articles were enrolled, and 18 possible urinary
biomarkers were identified and evaluated for their ability to diagnose
CS-AKI. Urinary neutrophil gelatinase-associated lipocalin (uNGAL), serum
cystatin C (sCys), urinary human kidney injury molecule-1 (uKIM-1),
urinary liver fatty acid-binding protein (uL-FABP) and interleukin-18
(uIL-18) were the most frequently described as the early predictors of
neonatal CS-AKI. Conclusions Neonates are vulnerable to CS-AKI. UNGAL,
sCys, uL-FABP, uKIM-1 and uIL-18 are potential biomarkers for early
prediction of neonatal CS-AKI. Renal regional oxygen saturation by
near-infrared spectroscopy is a non-invasive approach for early
identification of neonatal AKI. Further work should focus on exploring a
sensitive and specific combined diagnostic model that includes novel
biomarkers and other complementary methods.<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2020. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<91>
Accession Number
2007444229
Title
Percutaneous Coronary Intervention or Surgery for Unprotected Left Main
Disease: The Evaluation of XIENCE Versus Coronary Artery Bypass Surgery
for Effectiveness of Left Main Revascularization Trial at 5 Years.
Source
Interventional Cardiology Clinics. (no pagination), 2020. Date of
Publication: 2020.
Author
Azzalini L.; Stone G.W.
Institution
(Azzalini, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New
York, NY 10029, United States
(Stone) The Cardiovascular Research Foundation, New York, NY, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although coronary artery bypass graft (CABG) surgery traditionally has
been considered the gold standard for left main revascularization,
percutaneous coronary intervention has evolved in the past decades so that
it now represents a valid alternative to CABG in a large proportion of
cases. The landmark Evaluation of XIENCE versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is
the largest contemporary randomized comparison assessing the impact of
revascularization strategies for left main disease. This review discusses
the background, rationale, design, results, and implications of the EXCEL
trial.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<92>
Accession Number
2007444114
Title
Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain
Management in Cardiac Surgery: A Prospective, Randomized,
Placebo-Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Khera T.; Murugappan K.R.; Leibowitz A.; Bareli N.; Shankar P.; Gilleland
S.; Wilson K.; Oren-Grinberg A.; Novack V.; Venkatachalam S.; Rangasamy
V.; Subramaniam B.
Institution
(Khera, Murugappan, Leibowitz, Shankar, Gilleland, Wilson, Oren-Grinberg,
Novack, Venkatachalam, Rangasamy, Subramaniam) Center for Anesthesia and
Research Excellence, Department of Anesthesia Critical Care and Pain
Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
(Murugappan, Leibowitz, Oren-Grinberg, Subramaniam) Harvard Medical
School, Boston, MA, United States
(Bareli) Clinical Research Center, Soroka University Medical Center,
Beer-Sheva, Israel
Publisher
W.B. Saunders
Abstract
Objective: To explore the effect of pecto-intercostal fascial plane block
(PIFB) on postoperative opioid requirements, pain scores, lengths of
intensive care unit and hospital stays and incidence of postoperative
delirium in cardiac surgical patients. <br/>Design(s): Single- center,
prospective, randomized (1:1), quadruple- blinded, placebo-controlled
trial. <br/>Setting(s): Single center, tertiary- care center.
<br/>Participant(s): The study comprised 80 adult cardiac surgical
patients (age >18 y) requiring median sternotomy. <br/>Intervention(s):
Patients were randomly assigned to receive ultrasound-guided PIFB, with
either 0.25% bupivacaine or placebo, on postoperative days 0 and 1.
<br/>Measurements and Main Results: Of the 80 patients randomized, the
mean age was 65.78 +/- 8.73 in the bupivacaine group and 65.70 +/- 9.86 in
the placebo group (p = 0.573). Patients receiving PIFB with 0.25%
bupivacaine showed a statistically significant reduction in visual analog
scale scores (4.8 +/- 2.7 v 5.1 +/- 2.6; p < 0.001), but the 48-hour
cumulative opioid requirement computed as morphine milligram equivalents
was similar (40.8 +/- 22.4 mg v 49.1 +/- 26.9 mg; p = 0.14). There was no
difference in the incidence of postoperative delirium between the groups
evaluated using the 3-minute diagnostic Confusion Assessment Method (3/40
[7.5%] v 5/40 [12.5%] placebo; p = 0.45). <br/>Conclusion(s): Patients who
received PIFB with bupivacaine showed a decline in cumulative opioid
consumption postoperatively, but this difference between the groups was
not statistically significant. Low incidence of complications and
improvement in visual analog scale pain scores suggested that the PIFB can
be performed safely in this population and warrants additional studies
with a larger sample size.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<93>
Accession Number
2007444112
Title
Resection following concurrent chemotherapy and high-dose radiation for
stage IIIA non-small cell lung cancer.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Donington J.S.; Paulus R.; Edelman M.J.; Krasna M.J.; Le Q.-T.;
Suntharalingam M.; Loo B.W.; Hu C.; Bradley J.D.
Institution
(Donington, Paulus) Department of Department of Surgery, University of
Chicago Medicine and Biologic Sciences, Chicago, Ill, United States
(Hu) NRG Oncology Statistics and Data Management Center, Philadelphia, Pa,
United States
(Edelman) Division of Medical Oncology, Department of Medicine, University
of Maryland Medical Center, Baltimore, Md, United States
(Krasna) Department of Surgery, Jersey Shore University Medical Center,
Neptune City, NJ, United States
(Le, Loo) Department of Radiation Oncology, Stanford Cancer Institute,
Stanford, Calif, United States
(Suntharalingam) Department of Radiation Oncology, University of Maryland
School of Medicine, Baltimore, Md, United States
(Hu) Division of Biostatistics and Bioinformatics, Sidney Kimmel
Comprehensive Cancer Center, Johns Hopkins University School of Medicine,
Baltimore, Md, United States
(Bradley) Department of Radiation Oncology, Winship Cancer Institute,
Emory University, Atlanta, Ga, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Concern exists regarding surgery after thoracic radiation. We
aimed to assess early results of anatomic resection following induction
therapy with platinum-based chemotherapy and full-dose thoracic radiation
for resectable N2+ stage IIIA non-small cell lung cancer. <br/>Method(s):
Two prospective trials were recently conducted by NRG Oncology in patients
with resectable N2+ stage IIIA non-small cell lung cancer with the primary
end point of mediastinal node sterilization following concurrent full-dose
chemoradiotherapy (Radiation Therapy Oncology Group trials 0229 and 0839).
All surgeons demonstrated postinduction resection expertise. Induction
consisted of weekly carboplatin (area under the curve, 2.0) and paclitaxel
(50 mg/m²) and concurrent thoracic radiation 60 Gy (0839)/61.2
Gy (0229) in 30 fractions. Patients in study 0839 were randomized 2:1 to
weekly panitumumab + chemoradiotherapy or chemoradiotherapy alone during
induction. Primary results were similar in all treatment arms and reported
previously. Short-term surgical outcomes are reported here.
<br/>Result(s): One hundred twenty-six patients enrolled; 93 (74%) had
anatomic resection, 77 underwent lobectomy, and 16 underwent extended
resection. Microscopically margin-negative resections occurred in 85
(91%). Fourteen (15%) resections were attempted minimally invasively,
including 2 converted without event. Grade 3 or 4 surgical adverse events
were reported in 26 (28%), 30-day mortality in 4 (4%) and 90-day mortality
in 5 (5%). Patients undergoing extended resection experienced similar
rates of grade 3 or 4 adverse events (odds ratio, 0.95; 95% confidence
interval, 0.42-3.8) but higher 30-day (1.3% vs 18.8%) (odds ratio, 17.54;
95% confidence interval, 1.75-181.8) and 90-day mortality (2.6% vs 18.8%)
(odds ratio, 8.65; 95% confidence interval, 1.3-56.9). <br/>Conclusion(s):
Lobectomy was performed safely following full-dose concurrent
chemoradiotherapy in these multi-institutional prospective trials;
however, increased mortality was noted with extended
resections.<br/>Copyright &#xa9; 2020 The American Association for
Thoracic Surgery

<94>
Accession Number
2007443905
Title
The 2019 ERS/ESTS/EACTS/ESTRO Guidelines on the Management of Patients
With Malignant Pleural Mesothelioma.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Gelzinis T.A.
Institution
(Gelzinis) University of Pittsburgh, Pittsburgh, PA, United States
Publisher
W.B. Saunders
Abstract
Malignant pleural mesothelioma is a rare aggressive cancer, with insidious
growth, and is associated with poor outcomes that have not improved over
the years. A task force made up of members of the European Respiratory
Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European
Association for Cardio-Thoracic Surgery (EACTS)/European Society for
Radiotherapy and Oncology (ESTRO) societies, who are experts in the field
of malignant mesothelioma, reviewed the literature from 2009 to 2018 to
update the 2009 guidelines concerning epidemiology, diagnosis, staging,
and treatment, including surgical, radiotherapy, and medical management,
as well as palliative care to provide the best evidence-based
recommendations for this patient population.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<95>
Accession Number
632570859
Title
Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art
Review.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 06 Aug 2020.
Author
Vervoort D.; Swain J.D.; Pezzella A.T.; Kpodonu J.
Institution
(Vervoort) Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
United States
(Swain) Division of Cardiovascular Surgery, Department of Surgery,
Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
(Pezzella) International Children's Heart Fund, Boca Raton, FL, United
States
(Kpodonu) Division of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Six billion people in low- and middle-income countries (LMICs)
lack timely or ready access to safe and affordable cardiac surgical care
when needed, which remains a low priority on the global public health and
global surgery agenda. Here, we perform the first state-of-the-art review
of cardiac surgical care in LMICs to highlight the important milestones
and current progress, as well as challenges associated with the expansion
of sustainable global cardiac surgery for those in need. <br/>METHOD(S): A
literature review was performed searching the PubMed/MEDLINE and Google
Scholar databases using a combination of cardiac surgery, global health,
and LMIC keywords. The Institute for Health Metrics and Evaluation Global
Burden of Disease Results Tool was used to assess the global burden of
disease related to cardiovascular surgical diseases. <br/>RESULT(S):
High-income countries are estimated to have over hundred times as many
cardiac surgeons per million population compared to low-income countries.
There are over 4,000 cardiac centers worldwide, but less than one center
per ten million population in LMICs. Approximately 1.5 million cardiac
operations are performed globally, of which a disproportionally low number
in LMICs. Despite the high costs associated with cardiac operations,
recent data suggests the favorable cost-effectiveness thereof in LMICs.
Opportunities arise to sustainably integrate cardiac surgery in holistic
health systems strengthening interventions. <br/>CONCLUSION(S): Skepticism
underlying the need, feasibility, and cost-effectiveness of cardiac
surgery in LMICs prevail, but recent advances, successful case studies,
and existing data illustrate the potential of expanding cardiac care
globally.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<96>
Accession Number
632570404
Title
Antiplatelet therapy and coronary artery bypass grafting: a systematic
review and network meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 09 Aug 2020.
Author
Gupta S.; Belley-Cote E.P.; Panchal P.; Pandey A.; Basha A.; Pallo L.;
Rochwerg B.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, ON,
Hamilton, Canada
(Gupta, Rochwerg, Whitlock) Department of Health Research Methods,
McMaster University, ON, Hamilton, Canada
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine, McMaster
University, ON, Hamilton, Canada
(Belley-Cote, Mehta, Schwalm, Whitlock) Population Health Research
Institute, ON, Hamilton, Canada
(Panchal, Pandey, Basha) Faculty of Health Sciences, McMaster University,
ON, Hamilton, Canada
(Pallo) Faculty of Sciences, McMaster University, ON, Hamilton, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Acetylsalicylic acid (ASA) monotherapy is the standard of care
after coronary artery bypass grafting (CABG), but the benefits of more
intense antiplatelet therapy, specifically dual antiplatelet therapy
(DAPT), require further exploration in CABG patients. We performed a
network meta-analysis to compare the effects of various antiplatelet
regimens on saphenous vein graft patency, mortality, major adverse
cardiovascular events and bleeding among CABG patients. <br/>METHOD(S): We
searched Cochrane Central Register of Controlled Trials, Medical
Literature Analysis and Retrieval Systems Online, Excerpta Medica
Database, Cumulative Index to Nursing and Allied Health Literature,
American College of Physicians Journal Club and conference proceedings for
randomized controlled trials. Screening, data extraction, risk of bias
assessment and Grading of Recommendations Assessment, Development and
Evaluation were performed in duplicate. We conducted a random effect
Bayesian network meta-analysis including both direct and indirect
comparisons. <br/>RESULT(S): We included 43 randomized controlled trials
studying 15 511 patients. DAPT with low-dose ASA and ticagrelor [odds
ratio (OR) 2.53, 95% credible interval (CrI) 1.35-4.72; I2 = 55; low
certainty] or clopidogrel (OR 1.56, 95% CrI 1.02-2.39; I2 = 55; very low
certainty) improved saphenous vein graft patency when compared to low-dose
ASA monotherapy. DAPT with low-dose ASA and ticagrelor was associated with
lower mortality (OR 0.52, 95% CrI 0.30-0.87; I2 = 14; high certainty) and
lower major adverse cardiovascular events (OR 0.63, 95% CrI 0.44-0.91; I2
= 0; high certainty) when compared to low-dose ASA monotherapy. Based on
moderate certainty evidence, DAPT was associated with an increase in major
bleeding. <br/>CONCLUSION(S): Our results suggest that DAPT improves
saphenous vein graft patency, mortality and major adverse cardiovascular
event. As such, surgeons and physicians should consider re-initiating DAPT
for acute coronary syndrome patients after their CABG, at the expense of
an increased risk for major bleeding. CLINICAL TRIAL REGISTRATION:
International Prospective Register of Systematic Reviews ID Number
CRD42019127695.<br/>Copyright &#xa9; The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<97>
Accession Number
632570384
Title
Influence of Valve Type and Antiplatelet Regimen on Platelet Reactivity
After TAVI: Subanalysis of the REAC-TAVI Trial.
Source
The Journal of invasive cardiology. (no pagination), 2020. Date of
Publication: 10 Aug 2020.
Author
Trejo-Velasco B.; Cruz-Gonzalez I.; Tello-Montoliu A.; Baz-Alonso J.A.;
Salvadores P.J.; Moreno R.; Romaguera R.; Molina-Navarro E.; Paredes-Galan
E.; De-Miguel-Castro A.; Bastos-Fernandez G.; Ortiz-Saez A.;
Fernandez-Barbeira S.; Iniguez-Romo A.; Jimenez-Diaz V.A.
Institution
(Jimenez-Diaz) Cardiovascular Research Unit & Cardiology Department,
Hospital Alvaro Cunqueiro, University Hospital of Vigo, Estrada de Clara
Campoamor, 341, 36312, Vigo, Spain. sooner_79@hotmail.com or
victor.alfonso.jimenez.diaz@sergas.es
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Ticagrelor has proven more effective than clopidogrel at
attaining a maintained suppression of high platelet reactivity (HPR) in
aortic stenosis patients undergoing transcatheter aortic valve
implantation (TAVI). This study aims to assess the influence of implanted
valve type on the degree of platelet reactivity (PR) after TAVI.
<br/>METHOD(S): This study is a prespecified analysis of REAC-TAVI, a
prospective, multicenter study that included patients on dual-antiplatelet
therapy with aspirin and clopidogrel before TAVI. Patients with HPR (n =
48) were randomized to aspirin and clopidogrel or aspirin and ticagrelor
for 3 months, while those without HPR (n = 20) were continued on aspirin
and clopidogrel. PR was measured 6 hours, 24 hours, 5 days, 30 days, and
90 days after TAVI with VerifyNow assay. Bioprosthetic valves were
classified as balloon-expandable valve (BEV), self-expandable valve (SEV),
or other. <br/>RESULT(S): Sixty-eight patients comprising 32 BEVs, 28
SEVs, and 8 other valves were included. Devices were larger and
postdilation was more frequent in the SEV group. Follow-up PR was lower in
patients treated with ticagrelor vs those treated with clopidogrel at all
time points after TAVI, including patients without baseline HPR (P<.001).
PR after TAVI was similar in the three groups. Major cardiovascular
adverse events, stroke, and hemorrhagic complications were comparable
across the different bioprosthesis groups at 4-month follow-up.
<br/>CONCLUSION(S): The effect of valve type on PR after TAVI is similar
across the spectrum of most transcatheter valves. In our sample,
ticagrelor achieved a faster and more effective reduction in PR than
clopidogrel in patients with HPR undergoing TAVI, irrespective of valve
type.

<98>
Accession Number
632570336
Title
Multiple versus single arterial grafting in coronary artery bypass
grafting: A meta-analysis of randomized controlled trials and propensity
score studies.
Source
International journal of cardiology. (no pagination), 2020. Date of
Publication: 06 Aug 2020.
Author
Saraiva F.A.; Leite-Moreira J.P.; Barros A.S.; Lourenco A.P.; Benedetto
U.; Leite-Moreira A.F.
Institution
(Saraiva, Leite-Moreira, Barros) Cardiovascular Research and Development
Center, Department of Surgery and Physiology, Faculty of Medicine of the
University of Porto, Porto, Portugal
(Lourenco) Cardiovascular Research and Development Center, Department of
Surgery and Physiology, Faculty of Medicine of the University of Porto,
Porto, Portugal; Department of Anaesthesiology, Centro Hospitalar
Universitario Sao Joao, Porto, Portugal
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Leite-Moreira) Cardiovascular Research and Development Center, Department
of Surgery and Physiology, Faculty of Medicine of the University of Porto,
Porto, Portugal; Department of Cardiothoracic Surgery, Centro Hospitalar
Universitario Sao Joao, Porto, Portugal. Electronic address:
amoreira@med.up.pt
Publisher
NLM (Medline)

<99>
Accession Number
632569927
Title
Pregnancy after Heart Transplantation.
Source
Journal of cardiac failure. (no pagination), 2020. Date of Publication: 06
Aug 2020.
Author
DeFilippis E.M.; Kittleson M.M.
Institution
(DeFilippis) Division of Cardiology, Columbia University Irving Medical
Center
(Kittleson) Division of Cardiology, Cedars-Sinai Medical Center
Publisher
NLM (Medline)
Abstract
As post-transplant survival improves, many heart transplant (HT)
recipients are of, or are surviving to, childbearing age. Solid organ
transplant recipients who become pregnant should be managed by a
multidisciplinary cardio-obstetrics team including specialists in maternal
and fetal medicine, cardiology and transplant medicine, as well as
anesthesia, neonatology, psychology, genetics, and social services. With
careful patient selection, pregnancy after HT can been managed safely. The
purpose of this comprehensive review is to summarize the current evidence
and recommendations surrounding pre-conception counseling, medical
management and surveillance, maternal outcomes, breastfeeding, and
remaining gaps in knowledge.<br/>Copyright &#xa9; 2020 Elsevier Ltd. All
rights reserved.

<100>
Accession Number
632561674
Title
The effects of foot reflexology on agitation and extubation time in male
patients following coronary artery bypass surgery: A randomized controlled
clinical trial.
Source
Complementary therapies in clinical practice. 40 (pp 101201), 2020. Date
of Publication: 25 May 2020.
Author
Allahbakhhsian A.; Gholizadeh L.; Allahbakhshian M.; Sarbakhsh P.;
Abbaszadeh Y.
Institution
(Allahbakhhsian, Abbaszadeh) Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Gholizadeh) Faculty of Health, University of Technology Sydney, Sydney,
Australia
(Allahbakhshian) Faculty of Nursing and Midwifery, Shahid Beheshti
University of Medical Sciences. Tehran, Iran, Islamic Republic of
(Sarbakhsh) Faculty of Public Health, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND AND PURPOSE: This study examined the effects of foot
reflexology on agitation and extubation time of male patients following
coronary artery bypass graft surgery. MATERIALS AND METHODS: In this
randomized three-arm controlled clinical trial, participants (n = 120)
were randomly assigned to the intervention, placebo, or control groups.
The intervention group received foot reflexology massage for 15 min.
Agitation was assessed using the Richmond Agitation- Sedation Scale before
the intervention (Time 1) and immediately (Time 2) and 10 min after the
intervention (Time 3). Extubation time was measured as the time from
gaining full consciousness to endotracheal extubation. <br/>RESULT(S):
Agitation reduced in all groups from Time 1 to Time 3 (p < 0.05); however,
the intervention group showed a significantly higher reduction at Time 2
(p < 0.001) and Time 3 (p < 0.001). Also, extubation time was
significantly shorter in the intervention group (p < 0.01).
<br/>CONCLUSION(S): Foot reflexology may be introduced as a nursing
intervention to facilitate the weaning process in the cardiac
ICUs.<br/>Copyright &#xa9; 2020 Elsevier Ltd. All rights reserved.