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<1>
Accession Number
2007425952
Title
Cardiac Implantable Electronic Devices Following Heart Transplantation.
Source
JACC: Clinical Electrophysiology. 6 (8) (pp 1028-1042), 2020. Date of
Publication: August 2020.
Author
DeFilippis E.M.; Rubin G.; Farr M.A.; Biviano A.; Wan E.Y.; Takeda K.;
Garan H.; Topkara V.K.; Yarmohammadi H.
Institution
(DeFilippis, Rubin, Farr, Biviano, Wan, Garan, Topkara, Yarmohammadi)
Division of Cardiology, Department of Medicine, Columbia University Irving
Medical Center, New York, NY, United States
(Takeda) Division of Cardiothoracic Surgery, Department of Surgery,
Columbia University Irving Medical Center, New York, NY, United States
Publisher
Elsevier Inc
Abstract
Permanent pacemaker (PPM) implantation is required in a subset of patients
(~10%) for sinus node dysfunction or atrioventricular block both early and
late after heart transplantation. The incidence of PPM implantation has
decreased to <5% with the advent of bicaval anastamosis transplantation
surgery. Pacing dependence upon follow-up has been variably reported. An
even smaller percentage of transplantation recipients (1.5% to 3.4%)
undergo implantable cardioverter-defibrillator (ICD) placement. Rigorous
data are lacking for the use of ICDs in the transplantation population and
is largely derived from cohort studies and case series. Sudden cardiac
death occurs in approximately 10% of transplantation recipients, but
multiple nonarrhythmic factors are believed to be responsible, including
acute rejection, late graft failure with electromechanical dissociation,
and ischemia due to cardiac allograft vasculopathy. This review provides a
comprehensive analysis of the existing data regarding the role for PPMs
and ICDs in this population, including leadless PPMs and subcutaneous
ICDs, special considerations, and future directions.<br/>Copyright &#xa9;
2020 American College of Cardiology Foundation

<2>
Accession Number
624788881
Title
A multicenter randomized controlled trial of Zephyr Endobronchial Valve
treatment in heterogeneous emphysema (LIBERATE).
Source
American Journal of Respiratory and Critical Care Medicine. 198 (9) (pp
1151-1164), 2018. Date of Publication: 01 Nov 2018.
Author
Criner G.J.; Sue R.; Wright S.; Dransfield M.; Rivas-Perez H.; Wiese T.;
Sciurba F.C.; Shah P.L.; Wahidi M.M.; De Oliveira H.G.; Morrissey B.; Hays
S.; Majid A.; Pastis N.; Kopas L.; Vollenweider M.; Machuzak M.; Hsia
D.W.; Sung A.; Jarad N.; Kornaszewska M.; Hazelrigg S.; Krishna G.;
Armstrong B.; Shargill N.S.; Slebos D.-J.; Cordova F.; Desai P.; Marchetti
N.; Kim V.; Shenoy K.; Travaline J.; Thomas J.; Criner L.-Y.H.; Thornburg
A.; Thomas T.; Bhatt S.; Wells J.M.; Seabron-Harris N.; Gauhar U.;
Despirito C.; Field J.B.; Chandra D.; Leader J.; Semaan R.; Ledezma C.;
Kemp S.; Garner J.; Aboelhassan A.; Srikanthan K.; Tenda E.; Abraham A.;
Sim C.; Mahmood K.; Shofer S.; Coles K.; Oliveira G.A.; Machado B.;
Benedetto I.; Svartman F.; Neto A.D.M.; Schreiner L.; Vieira T.; Yoneda
K.; Tham T.; Tompkins D.; Cardoso P.F.G.; Athanazio R.; Nominando F.;
Rached S.; Cassimiro L.; Seeley E.; Shrestha P.; Dincheva G.R.; Alape-Moya
D.; Parikh M.; Paton A.; Agnew A.; Strange C.; Beiko T.; Woodford D.;
Blanton M.; Connolly T.; Santacruz J.F.; Shah B.; Herrera L.; Khan R.;
Sernulka K.; Michael McFadden P.; Barbers R.; Hernandez M.; Almeida F.;
Cicenia J.; Gildea T.; Mehta A.; Sethi S.; Meli Y.; Casaburi R.; Stringer
W.; Diaz L.; Ramsey M.; Van Wert R.; Morris K.; Batchelor T.; Sequeiros
I.; Tucker K.; Kornaszweska M.; Fallouh H.; Sabit R.; Naase H.; George J.;
Salimian A.; Dyer H.; Adams K.; Bade K.; Benn B.S.; Canfield M.; Villalan
S.V.; Stewart T.; ten Hacken N.H.T.; Klooster K.; Hartman J.; Augustijn S.
Institution
(Criner) Department of Thoracic Medicine and Surgery, Lewis Katz School of
Medicine, Temple University, Philadelphia, PA, United States
(Sue, Wright, Thornburg, Thomas) St. Joseph's Hospital and Medical Center,
Phoenix, AZ, United States
(Dransfield, Bhatt, Wells, Seabron-Harris) University of Alabama,
Birmingham UAB Lung Health Center, Birmingham, AZ, United States
(Rivas-Perez, Wiese) Department of Medicine, University of Louisville,
Louisville, KY, United States
(Sciurba) Division of Pulmonary, Allergy and Critical Care Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Shah, Kemp, Garner, Aboelhassan, Srikanthan, Tenda, Abraham, Sim) Royal
Brompton Hospital and Imperial College, London, United Kingdom
(Wahidi) Duke University Medical Center, Duke University, Durham, NC,
United States
(De Oliveira) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(Morrissey) Division of Pulmonary, Critical Care and Sleep Medicine,
University of California, Davis, Sacramento, CA, United States
(Cardoso) Instituto do Coracao, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Hays, Seeley, Shrestha, Dincheva) University of California, San
Francisco, San Francisco, CA, United States
(Majid) Interventional Pulmonology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Pastis, Strange, Beiko, Woodford, Blanton) Medical University of South
Carolina, Charleston, SC, United States
(Kopas) Pulmonary Critical Care and Sleep Medicine Consultants, Houston
Methodist, Houston, TX, United States
(Vollenweider) Orlando Health Pulmonary and Sleep Medicine Group, Orlando
Regional Medical Center, Orlando, FL, United States
(Michael McFadden) Keck School of Medicine, University of Southern
California, Los Angeles, CA, United States
(Machuzak) Center for Major Airway Diseases, Cleveland Clinic, Cleveland
Clinic Foundation, Respiratory Institute, Cleveland, OH, United States
(Hsia, Casaburi, Stringer, Diaz) Los Angeles Biomedical Research
Institute, Harbor-University of California Los Angeles, Torrance, CA,
United States
(Sung, Ramsey, Van Wert, Morris) Stanford Hospital and Clinics, Stanford,
CA, United States
(Jarad, Batchelor, Sequeiros, Tucker) University Hospital Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Kornaszewska) Department of Cardiothoracic Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Hazelrigg) Division of Cardiothoracic Surgery, Department of Surgery,
Southern Illinois University School of Medicine, Springfield, IL, United
States
(Krishna, Benn, Canfield, Villalan, Stewart) Palo Alto Medical Foundation,
El Camino Hospital, Mountain View, CA, United States
(Armstrong) QST Consultations Ltd., Allendale, MI, United States
(Shargill) Pulmonx Corporation, Redwood City, CA, United States
(Slebos) Department of Pulmonary Diseases, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
(Criner, Cordova, Desai, Marchetti, Kim, Shenoy, Travaline, Thomas,
Criner) Lewis Katz School of Medicine, Temple University, Philadelphia,
PA, United States
(Rivas-Perez, Wiese, Gauhar, Despirito) University of Louisville,
Louisville, KY, United States
(Sciurba, Field, Chandra, Leader, Semaan, Ledezma) University of
Pittsburgh, Pittsburgh, PA, United States
(Wahidi, Mahmood, Shofer, Coles) Duke University Medical Center, Durham,
NC, United States
(De Oliveira, Oliveira, Machado, Benedetto, Svartman, Neto, Schreiner,
Vieira) Hospital das Clinicas de Porto Alegre, Porto Alegre, Brazil
(Morrissey, Yoneda, Tham, Tompkins) University of California, Davis,
Sacramento, CA, United States
(Cardoso, Athanazio, Nominando, Rached, Cassimiro) Instituto do Coracao,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, Brazil
(Majid, Alape-Moya, Parikh, Paton, Agnew) Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Kopas, Connolly, Santacruz, Shah) Houston Methodist Hospital-Texas
Medical Center, Houston, TX, United States
(Vollenweider, Herrera, Khan, Sernulka) Orlando Regional Medical Center,
Orlando, FL, United States
(Michael McFadden, Barbers, Hernandez) University of Southern California,
Los Angeles, CA, United States
(Machuzak, Almeida, Cicenia, Gildea, Mehta, Sethi, Meli) Cleveland Clinic
Foundation, Cleveland, OH, United States
(Kornaszweska, Fallouh, Sabit, Naase, George, Salimian, Dyer) University
Hospital of Wales, Cardiff, United Kingdom
(Hazelrigg, Adams, Bade) Southern Illinois University School of Medicine,
Springfield, IL, United States
(Slebos, ten Hacken, Klooster, Hartman, Augustijn) University Medical
Center Groningen, Groningen, Netherlands
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: This is the first multicenter randomized controlled trial to
evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV)
in patients with little to no collateral ventilation out to 12 months.
<br/>Objective(s): To evaluate the effectiveness and safety of Zephyr EBV
in heterogeneous emphysema with little to no collateral ventilation in the
treated lobe. <br/>Method(s): Subjects were enrolled with a 2:1
randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at
12 months was the DELTAEBV-SoC of subjects with a post-bronchodilator FEV1
improvement from baseline of greater than or equal to 15%. Secondary
endpoints included absolute changes in post-bronchodilator
FEV<inf>1</inf>, 6-minute-walk distance, and St. George's Respiratory
Questionnaire scores. <br/>Measurements and Main Results: A total of 190
subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and
16.8% SoC subjects had a DFEV1 greater than or equal to 15% (P < 0.001).
DEBV-SoC at 12 months was statistically and clinically significant: for
FEV<inf>1</inf>, 0.106 L (P < 0.001); 6-minute-walk distance, +39.31 m (P
= 0.002); and St. George's Respiratory Questionnaire, -7.05 points (P =
0.004). Significant DELTAEBV-SoC were also observed in hyperinflation
(residual volume, 2522 ml; P < 0.001), modified Medical Research Council
Dyspnea Scale (20.8 points; P < 0.001), and the BODE (body mass index,
airflow obstruction, dyspnea, and exercise capacity) index (-1.2 points).
Pneumothorax was the most common serious adverse event in the treatment
period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths
occurred in the EBV group during this phase, and one each in the EBV and
SoC groups between 46 days and 12 months. <br/>Conclusion(s): Zephyr EBV
provides clinically meaningful benefits in lung function, exercise
tolerance, dyspnea, and quality of life out to at least 12 months, with an
acceptable safety profile in patients with little or no collateral
ventilation in the target lobe.<br/>Copyright &#xa9; 2018 by the American
Thoracic Society.

<3>
Accession Number
2005844265
Title
Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery: A
Systematic Review.
Source
Annals of Thoracic Surgery. 110 (3) (pp 1063-1071), 2020. Date of
Publication: September 2020.
Author
Guenther T.M.; Sherazee E.A.; Wisneski A.D.; Gustafson J.D.; Wozniak C.J.;
Raff G.W.
Institution
(Guenther, Sherazee, Raff) Department of Surgery, University of California
Davis, Sacramento, CA, United States
(Guenther, Sherazee, Gustafson, Wozniak) Department of Cardiothoracic
Surgery, David Grant Medical Center, Travis Air Force Base, CA, United
States
(Wisneski) Department of Cardiothoracic Surgery, University of California
San Francisco, San Francisco, CA, United States
(Gustafson, Wozniak) Norman M. Rich Department of Surgery, Uniformed
Services University of the Health Sciences, Bethesda, MD, United States
Publisher
Elsevier USA
Abstract
Background: Anomalous origin of the right coronary artery from the
pulmonary artery (ARCAPA) is a rare congenital cardiac lesion that has
been diagnosed in both children and adults with symptoms ranging from an
asymptomatic murmur to sudden cardiac death. The aim of this review was to
characterize published cases of ARCAPA to better understand this rare
congenital coronary anomaly. <br/>Method(s): A systematic review was
performed using PubMed, Embase, and Google Scholar for cases of ARCAPA.
Keywords searched included: "anomalous origin of the right coronary artery
from the pulmonary artery" and "ARCAPA." Results: A total of 223 cases of
ARCAPA were identified in 193 case reports. There was a slight male
predominance (54.5%) and the median age at presentation was 14.0 years.
Thirty-eight percent of patients were asymptomatic and most commonly
identified during evaluation of a murmur. Angina and dyspnea were the most
common presenting symptoms (22.4% and 17.0%, respectively). In symptomatic
patients, a bimodal distribution of age at presentation was observed with
a peak near birth and another between ages 40 and 60 years. The condition
was most commonly diagnosed with coronary angiography (40.4%). Most cases
were repaired surgically (72.6%) and reimplantation of the right coronary
artery onto the aorta was the most common method of repair (62.3%).
<br/>Conclusion(s): ARCAPA represents a rare coronary anomaly with great
variability in clinical presentation. An understanding of the
pathophysiology associated with the lesion is critical when determining
treatment strategies.<br/>Copyright &#xa9; 2020 The Society of Thoracic
Surgeons

<4>
Accession Number
2005680839
Title
Surgical Pulmonary Embolectomy Outcomes for Acute Pulmonary Embolism.
Source
Annals of Thoracic Surgery. 110 (3) (pp 1072-1080), 2020. Date of
Publication: September 2020.
Author
Choi J.H.; O'Malley T.J.; Maynes E.J.; Weber M.P.; D'Antonio N.D.; Mellado
M.; West F.M.; Galanis T.; Gonsalves C.F.; Marhefka G.D.; Awsare B.K.;
Merli G.J.; Tchantchaleishvili V.
Institution
(Choi, O'Malley, Maynes, Weber, D'Antonio, Tchantchaleishvili) Division of
Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United
States
(Mellado) Faculty of Medicine, University of Chile, Santiago, Chile
(West, Awsare) Division of Critical Care, Pulmonary/Allergy, and
Immunology, Thomas Jefferson University, Philadelphia, PA, United States
(Galanis, Merli) Department of Surgery, Thomas Jefferson Vascular Center,
Thomas Jefferson University, Philadelphia, PA, United States
(Gonsalves) Division of Vascular and Interventional Radiology, Thomas
Jefferson University Philadelphia, PA, United States
(Marhefka) Division of Cardiology, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
Elsevier USA
Abstract
Background: Acute pulmonary embolism (PE) is associated with significant
mortality. Surgical embolectomy is a viable treatment option; however, it
remains controversial as a result of variable outcomes. This review
investigates patient outcomes after surgical embolectomy for acute PE.
<br/>Method(s): An electronic search was performed to identify articles
reporting surgical embolectomy for treatment of PE. 32 studies were
included comprising 936 patients. Demographic, perioperative, and outcome
data were extracted and pooled for systematic review. <br/>Result(s): Mean
patient age was 56.3 years (95% confidence interval [CI], 52.5, 60.1), and
50% were male (95% CI, 46, 55); 82% had right ventricular dysfunction (95%
CI, 62, 93), 80% (95% CI, 67, 89) had unstable hemodynamics, and 9% (95%
CI, 5, 16) experienced cardiac arrest. Massive PE and submassive PE were
present in 83% (95% CI, 43, 97)] and 13% (95% CI, 2, 56) of patients,
respectively. Before embolectomy, 33% of patients (95% CI, 14, 60)
underwent systemic thrombolysis, and 14% (95% CI, 8, 24) underwent
catheter embolectomy. Preoperatively, 47% of patients were ventilated (95%
CI, 26; 70), and 36% had percutaneous cardiopulmonary support (95% CI, 11,
71). Mean operative time and mean cardiopulmonary bypass time were 170
minutes (95% CI, 101, 239) and 56 minutes (95% CI, 42, 70), respectively.
Intraoperative mortality was 4% (95% CI, 2, 8). Mean hospital and
intensive care unit stay were 10 days (95% CI, 6, 14) and 2 days (95% CI,
1, 3), respectively. Mean postoperative systolic pulmonary artery pressure
(sPAP) was significantly decreased from the preoperative period (sPAP
57.8, mm Hg; 95% CI, 53, 62.7) to the postoperative period (sPAP, 31.3 mm
Hg; 24.9, 37.8); P <.01). In-hospital mortality was 16% (95% CI, 12, 21).
Overall survival at 5 years was 73% (95% CI, 64, 81). <br/>Conclusion(s):
Surgical embolectomy is an acceptable treatment option with favorable
outcomes.<br/>Copyright &#xa9; 2020 The Society of Thoracic Surgeons

<5>
Accession Number
2003512762
Title
Thoracoscopic repair of esophageal atresia.
Source
Surgery Today. 50 (9) (pp 966-973), 2020. Date of Publication: 01 Sep
2020.
Author
Okuyama H.; Saka R.; Takama Y.; Nomura M.; Ueno T.; Tazuke Y.
Institution
(Okuyama, Saka, Takama, Nomura, Ueno, Tazuke) Department of Pediatric
Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka,
Suita, Osaka 565-0871, Japan
Publisher
Springer (Singapore)
Abstract
Thoracoscopic repair (TR) of esophageal atresia (EA) has been performed
with increasing frequency over the last two decades, with the expectation
of improved outcomes by avoiding thoracotomy. To understand the current
practice and outcomes of TR of EA, we reviewed the relevant literature,
including 15 case series, 7 comparative studies, and 3 meta-analysis
comparing TR with conventional open repair (COR). Most of the studies had
a retrospective design and small numbers of patients. Although the
evidence level is low because of the lack of prospective studies, this
review found that TR is as safe as COR, with comparative outcomes.
Moreover, there were several advantages of TR over COR, such as less blood
loss and a shorter hospital stay. The long-term outcomes of TR remain
unclear because of limited data. Moreover, there is a significant learning
curve over the first 10-20 TRs performed. We conclude that TR of EA, when
conducted by experienced surgeons, is a safe and minimally invasive
alternative to COR and may yield better results than COR in appropriately
selected patients.<br/>Copyright &#xa9; 2019, Springer Nature Singapore
Pte Ltd.

<6>
Accession Number
2003337950
Title
Detecting delayed intracranial hemorrhage with repeat head imaging in
trauma patients on antithrombotics with no hemorrhage on the initial
image: A retrospective chart review and meta-analysis.
Source
American Journal of Surgery. 220 (1) (pp 55-61), 2020. Date of
Publication: July 2020.
Author
Huang G.S.; Dunham C.M.; Chance E.A.; Hileman B.M.
Institution
(Huang, Dunham) Trauma/ Critical Care/ General Surgery, St Elizabeth
Youngstown Hospital, 1044 Belmont Ave, Youngstown, OH 44501, United States
(Chance, Hileman) Trauma/ Neuroscience Research, St Elizabeth Youngstown
Hospital, 1044 Belmont Ave, Youngstown, OH 44501, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: There is debate regarding routine repeat head computed
tomography (CT) in blunt trauma patients on a pre-injury antithrombotic
when the initial CT is negative for intracranial hemorrhage (ICH). Data
sources: Retrospective chart review and systematic literature review with
meta-analysis. <br/>Conclusion(s): In the chart review, 32.1% did not have
a repeat head CT and 67.9% did. The delayed ICH incidence between those
with and without a repeat head CT was similar (1.7% vs 0, p =.3101). The
current study was combined with the identified 24 studies. Delayed ICH
with or without routine repeat CT was similar between antiplatelet and
anticoagulant categories (1.4% vs. 1.3%, p =.5322). Delayed ICH was lower
for patients without routine repeat CT compared to those with routine
repeat CT (0.8% vs 1.7%, p =.0008). For this patient population, repeat
scans should be discretionary. Routine repeat CT may identify a larger
proportion of minor delayed ICH.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<7>
Accession Number
2007425928
Title
Sex Differences in All-Cause Mortality in the Decade Following Complex
Coronary Revascularization.
Source
Journal of the American College of Cardiology. 76 (8) (pp 889-899), 2020.
Date of Publication: 25 August 2020.
Author
Hara H.; Takahashi K.; van Klaveren D.; Wang R.; Garg S.; Ono M.;
Kawashima H.; Gao C.; Mack M.; Holmes D.R.; Morice M.-C.; Head S.J.;
Kappetein A.P.; Thuijs D.J.F.M.; Onuma Y.; Noack T.; Mohr F.W.; Davierwala
P.M.; Serruys P.W.
Institution
(Hara, Takahashi, Ono, Kawashima) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Hara, Wang, Ono, Kawashima, Gao, Onuma, Serruys) Department of
Cardiology, National University of Ireland, Galway, Galway, Ireland
(van Klaveren) Department of Public Health, Center for Medical Decision
Making, Erasmus MC, Rotterdam, Netherlands
(van Klaveren) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, MA, United States
(Wang, Gao) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Mack) Department of Cardiothoracic Surgery, Baylor Scott and White
Healthcare, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, Hopital prive Jacques Cartier,
Generale de Sante Massy, France
(Head, Kappetein, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Noack, Mohr, Davierwala) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier USA
Abstract
Background: The poorer prognosis of coronary artery disease in females
compared with males is related mainly to differences in baseline
characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) trial, the effect of
treatment with percutaneous coronary intervention (PCI) versus coronary
artery bypass grafting surgery (CABG) on mortality at 5 years differed
significantly between females and males; however, the optimal
revascularization beyond 5 years according to sex has not been evaluated.
<br/>Objective(s): The aim of this study was to investigate the impact of
sex on mortality and sex-treatment interaction at 10 years.
<br/>Method(s): The SYNTAXES (SYNTAX Extended Survival) study evaluated
vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or
left main coronary artery disease randomized to treatment with PCI or CABG
in the SYNTAX trial. All-cause death at 10 years was separately evaluated
in female and male patients with complex coronary artery disease.
<br/>Result(s): Of 1,800 patients, 402 (22.3%) were female and 1,398
(77.7%) were males. Females had a higher 10-year mortality rate compared
with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not
an independent predictor of mortality (adjusted hazard ratio: 1.02; 95%
confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be
lower after CABG than after PCI, with a similar treatment effect for
female and male patients (adjusted hazard ratio for females: 0.90 [95%
confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76
[95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952).
<br/>Conclusion(s): Female sex was not an independent predictor of
mortality at 10 years in patients with complex coronary artery disease.
The interaction between sex and treatment with PCI or CABG that was
observed at 5 years was no longer present at 10 years. (Synergy Between
PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES],
NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery
Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX],
NCT00114972)<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<8>
Accession Number
2005960674
Title
The long-term effects of prolonged intensive care stay postcardiac
surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Mackie-Savage U.F.; Lathlean J.
Institution
(Mackie-Savage, Lathlean) School of Health Sciences, Faculty of
Environmental and Life Sciences, University of Southampton, Southampton,
United Kingdom
(Mackie-Savage) Specialist Surgery Division, University College London
Hospital, University College London Hospitals NHS Trust, London, United
Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Short-term outcomes for those with a prolonged length of stay
(LOS) in intensive care (ITU) following cardiac surgery are poor, with
higher rates of in-hospital mortality and morbidity. Consequently,
discharge from hospital has been considered the key measure of success.
However, there has been a shift towards long-term outcomes, functional
recovery and quality of life (QoL) as measures of surgical quality. The
aim of this review is to compare and critique the findings of multiple
studies to determine the long-term effects of prolonged ITU stay
postcardiac surgery. <br/>Method(s): A computerized literature search of
CINAHL, EMBASE and Google Scholar databases, based on keywords "long-term
effects," "prolonged ITU stay," "cardiac surgery," with rigorous CASP
critique was undertaken. <br/>Result(s): The search yielded 12 papers
meeting the inclusion criteria, with eight retrospective and four
prospective studies. Eight of these 12 papers identified inferior
long-term survival or higher mortality rates for those who had prolonged
LOS in ITU in comparison to "normal" LOS or a control. The greatest burden
of mortality was 6 months to 1 year postdischarge. Three papers found that
quality of life was adversely affected or worse for those who had
experienced prolonged LOS in ITU. <br/>Conclusion(s): Further research is
required to provide better quality evidence into QoL, following prolonged
stay in ICU postcardiac surgery. The evidence reviewed suggests that the
risk of mortality in this demographic of patients is higher, especially
within the first year and, therefore, more frequent medical surveillance
of these patients is recommended.<br/>Copyright &#xa9; 2020 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals LLC

<9>
Accession Number
632667580
Title
Vasopressor Therapy in the Intensive Care Unit.
Source
Seminars in respiratory and critical care medicine. (no pagination), 2020.
Date of Publication: 20 Aug 2020.
Author
Russell J.A.; Gordon A.C.; Williams M.D.; Boyd J.H.; Walley K.R.; Kissoon
N.
Institution
(Russell, Boyd, Walley) Department of Medicine, Centre for Heart Lung
Innovation, St. Paul's Hospital, University of British Columbia,
Vancouver, BC, Canada
(Russell, Boyd, Walley) Division of Critical Care Medicine, St. Paul's
Hospital, University of British Columbia, Vancouver, BC, Canada
(Gordon) Department of Surgery and Cancer, Division of Anaesthetics, Pain
Medicine and Intensive Care, Imperial College London, London, United
Kingdom
(Gordon) Department of Surgery and Cancer, Intensive Care Unit, Imperial
College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
(Williams) Department of Medicine, Indiana University Health Methodist
Hospital, Indiana University School of Medicine, Indianapolis, IN, United
States
(Kissoon) Department of Pediatrics, British Columbia Children's Hospital,
University of British Columbia, Vancouver, BC, Canada
Publisher
NLM (Medline)
Abstract
After fluid administration for vasodilatory shock, vasopressors are
commonly infused. Causes of vasodilatory shock include septic shock,
post-cardiovascular surgery, post-acute myocardial infarction,
postsurgery, other causes of an intense systemic inflammatory response,
and drug -associated anaphylaxis. Therapeutic vasopressors are hormones
that activate receptors-adrenergic: alpha1, alpha2, beta1, beta2;
angiotensin II: AG1, AG2; vasopressin: AVPR1a, AVPR1B, AVPR2; dopamine:
DA1, DA2. Vasopressor choice and dose vary widely because of patient and
physician practice heterogeneity. Vasopressor adverse effects are
excessive vasoconstriction causing organ ischemia/infarction,
hyperglycemia, hyperlactatemia, tachycardia, and tachyarrhythmias. To
date, no randomized controlled trial (RCT) of vasopressors has shown a
decreased 28-day mortality rate. There is a need for evidence regarding
alternative vasopressors as first-line vasopressors. We emphasize that
vasopressors should be administered simultaneously with fluid replacement
to prevent and decrease duration of hypotension in shock with
vasodilation. Norepinephrine is the first-choice vasopressor in septic and
vasodilatory shock. Interventions that decrease norepinephrine dose
(vasopressin, angiotensin II) have not decreased 28-day mortality
significantly. In patients not responsive to norepinephrine, vasopressin
or epinephrine may be added. Angiotensin II may be useful for rapid
resuscitation of profoundly hypotensive patients. Inotropic agent(s)
(e.g., dobutamine) may be needed if vasopressors decrease ventricular
contractility. Dopamine has fallen to almost no-use recommendation because
of adverse effects; angiotensin II is available clinically; there are
potent vasopressors with scant literature (e.g., methylene blue); and the
novel V1a agonist selepressin missed on its pivotal RCT primary outcome.
In pediatric septic shock, vasopressors, epinephrine, and norepinephrine
are recommended equally because there is no clear evidence that supports
the use of one vasoactive agent. Dopamine is recommended when epinephrine
or norepinephrine is not available. New strategies include perhaps
patients will be started on several vasopressors with complementary
mechanisms of action, patients may be selected for particular vasopressors
according to predictive biomarkers, and novel vasopressors may emerge with
fewer adverse effects.<br/>Copyright Thieme. All rights reserved.

<10>
Accession Number
632665592
Title
Bilateral ultrasound-guided thoracic erector spinae plane blocks using a
programmed intermittent bolus improve opioid-sparing postoperative
analgesia in pediatric patients after open cardiac surgery: a randomized,
double-blind, placebo-controlled trial.
Source
Regional anesthesia and pain medicine. (no pagination), 2020. Date of
Publication: 19 Aug 2020.
Author
Macaire P.; Ho N.; Nguyen V.; Phan Van H.; Dinh Nguyen Thien K.; Bringuier
S.; Capdevila X.
Institution
(Macaire) Anesthesia and Pain Department, Vinmec International Hospital,
Viet Nam, Hanoi, Vietnam
(Ho, Nguyen) Department of Cardiac Surgery, Viet Nam, Vinmec Central Park
International Hospital, Ho Chi Minh City
(Phan Van, Dinh Nguyen Thien) Department of Pharmacology, Forensic
Medicine Center, Viet Nam, Ho Chi Minh City
(Bringuier) Department of Biostatistics, Hopital Lapeyronie, Montpellier,
France
(Capdevila) Anesthesiology and Critical Care Department and Neurosciences
Institute, Inserm U1051, Hopital Lapeyronie, Montpellier, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative pain after pediatric cardiac surgery is usually
treated with intravenous opioids. Recently, the focus has been on
postoperative regional analgesia with the introduction of
ultrasound-guided erector spinae plane blocks (ESPBs). We hypothesized
that bilateral ESPB with a programmed intermittent bolus (PIB) regimen
decreases postoperative morphine consumption at 48hours and improves
analgesia in children who undergo cardiac surgery. <br/>METHOD(S): This
randomized, double-blind, placebo-controlled study comprised 50 children
who underwent cardiac surgery through midline sternotomy. The patients
were allocated randomly into two groups: ultrasound-guided bilateral ESPB
at the level of T3-T4 transverse process then PIB with saline infusion
(group 1, n=23) or PIB with 0.2% ropivacaine (group 2, n=27). Intravenous
morphine at 30micro&#32;g/kg/hour was used as rescue analgesia.
Postoperative pain was assessed using the COMFORT-B score for extubation,
drain removal, and mobilization, and the FLACC (Face, Legs, Activity, Cry,
Consolability) scale at 0, 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48hours
after surgery. Adverse events were noted. <br/>RESULT(S): The total dose
of morphine in 48hours was significantly decreased in patients receiving a
bilateral ESPB with ropivacaine (120+/-320micro&#32;g/kg) compared with
patients with saline infusion (512+/-560micro&#32;g/kg; p=0.03). Fourteen
per cent of patients required rescue analgesia with morphine in group 2
compared with 41% in group 1 (p=0.05). The patients in group 2
demonstrated significantly reduced COMFORT-B scores at extubation, drain
removal, and mobilization compared with those in group 1 and had reduced
FLACC scale levels at 20 and 24hours postoperatively (p=0.05and p=0.001,
respectively). No differences were reported for extubation and drain
removal times or for length of hospital stay. In addition, vomiting
episodes were decreased in group 2 (p=0.01). <br/>CONCLUSION(S): In
pediatric cardiac surgery, the results of this study confirm our
hypothesis that bilateral ESPB analgesia with ropivacaine decreases the
postoperative morphine consumption at 48hours and demonstrates better
postoperative analgesia compared with a control group.Trial registration
number NCT03593642.<br/>Copyright &#xa9; American Society of Regional
Anesthesia & Pain Medicine 2020. No commercial re-use. See rights and
permissions. Published by BMJ.

<11>
Accession Number
632665532
Title
General versus Local Anesthesia with Conscious Sedation in Transcatheter
Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial.
Source
Circulation. (no pagination), 2020. Date of Publication: 21 Aug 2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Lurz P.;
Eitel I.; Marquetand C.; Nef H.; Doerr O.; Vigelius-Rauch U.; Lauten A.;
Landmesser U.; Treskatsch S.; Abdel-Wahab M.; Sandri M.; Holzhey D.;
Borger M.; Ender J.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.; Fach
A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.; Funkat
A.-K.; Desch S.; Berggreen A.E.; Heringlake M.; de Waha-Thiele S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri,
Holzhey, Borger, Ender) Heart Center Leipzig at University of Leipzig,
Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, de Waha-Thiele) University Clinic
Schleswig-Holstein and University Heart Center Lubeck, Lubeck, Germany;
German Center for Cardiovascular Research (DZHK), Germany
(Nef, Doerr, Vigelius-Rauch) Giesen, Germany
(Lauten, Landmesser) German Center for Cardiovascular Research (DZHK),
Germany; Universitatsklinikum Charite, Campus Benjamin Franklin, Berlin,
Germany
(Treskatsch) Universitatsklinikum Charite, Campus Benjamin Franklin,
Berlin, Germany
(Ince, Oner) Universitatsklinikum Rostock, Rostock, Germany
(Hambrecht, Fach, Augenstein) Klinikum Links der Weser, Bremen, Germany
(Frey) German Center for Cardiovascular Research (DZHK), Germany;
University Clinic SchleswigHolstein, Kiel, Germany
(Konig) Institut fur Medizinische Biometrie und Statistik, University of
Lubeck, Lubeck, Germany; German Center for Cardiovascular Research (DZHK),
Germany
(Vonthein) Institut fur Medizinische Biometrie und Statistik, University
of Lubeck, Lubeck, Germany
(Ruckert, Funkat) Leipzig Heart Institute, Leipzig, Germany
(Desch, Desch) Heart Center Leipzig at University of Leipzig, Leipzig,
Germany; Leipzig Heart Institute, Leipzig, Germany; German Center for
Cardiovascular Research (DZHK), Germany
(Berggreen, Heringlake) University Clinic Schleswig-Holstein and
University Heart Center Lubeck, Lubeck, Germany
Publisher
NLM (Medline)
Abstract
Background: In clinical practice, local anesthesia with conscious sedation
(CS) is performed in roughly 50% of patients undergoing transcatheter
aortic valve replacement (TAVR). However, no randomized data assessing the
safety and efficacy of CS versus general anesthesia (GA) are available.
<br/>Method(s): SOLVE-TAVI is a multicenter, open-label, 2x2 factorial,
randomized trial of 447 patients with aortic stenosis undergoing
transfemoral TAVR comparing CS versus GA. The primary efficacy endpoint
was powered for equivalence (equivalence margin 10% with significance
level 0.05) and consisted of the composite of all-cause mortality, stroke,
myocardial infarction, infection requiring antibiotic treatment, and acute
kidney injury at 30 days. <br/>Result(s): The primary composite endpoint
occurred in 27.2% of CS and 26.4% of GA patients (rate difference 0.8
[90%CI -6.2 to 7.8]; Pequivalence=0.015). Event rates for the individual
components were as follows: all-cause mortality 3.2% versus 2.3% (rate
difference 1.0 [90%CI - 2.9 to 4.8]; Pequivalence<0.001), stroke 2.4%
versus 2.8% (rate difference -0.4 [90%CI -3.8 to 3.8];
Pequivalence<0.001), myocardial infarction 0.5% versus 0.0% (rate
difference 0.5 [90%CI -3.0 to 3.9]; Pequivalence<0.001), infection
requiring antibiotics 21.1% versus 22.0% (rate difference -0.9 [90%CI -7.5
to 5.7]; Pequivalence=0.011), acute kidney injury 9.0% versus 9.2% (rate
difference - 0.2 [90%CI -5.2 to 4.8]; Pequivalence=0.0005). There was a
lower need for inotropes or vasopressors with CS (62.8%) versus GA (97.3%)
(rate difference -34.4 [90%CI -41.0 to -27.8]). <br/>Conclusion(s): Among
patients with aortic stenosis undergoing transfemoral TAVR, use of CS
compared with GA resulted in similar outcomes for the primary efficacy
endpoint. These findings suggest that CS can be safely applied for TAVR.
Clinical Trial Registration: URL: https://clinicaltrials.gov Unique
Identifier: NCT02737150.

<12>
Accession Number
632665179
Title
Telehealth Home Monitoring and Postcardiac Surgery for Congenital Heart
Disease.
Source
Pediatrics. (no pagination), 2020. Date of Publication: 19 Aug 2020.
Author
Medoff Cooper B.; Marino B.S.; Fleck D.A.; Lisanti A.J.; Golfenshtein N.;
Ravishankar C.; Costello J.M.; Huang L.; Hanlon A.L.; Curley M.A.Q.
Institution
(Medoff Cooper) School of Nursing, University of Pennsylvania,
Philadelphia, Pennsylvania; medoff@upenn.edu
(Medoff Cooper, Lisanti, Ravishankar, Curley) Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Marino, Costello) Ann & Robert H. Lurie Children's Hospital of Chicago,
Chicago, IL, Mexico
(Marino, Curley) Division of Cardiology and Critical Care Medicine,
Feinberg School of Medicine, Northwestern University, Chicago, IL, Mexico
(Fleck, Huang) School of Nursing, University of Pennsylvania,
Philadelphia, PA, United States
(Golfenshtein) Department of Nursing, University of Haifa, Haifa, Israel
(Ravishankar) Division of Cardiology, Department of Pediatrics and
(Hanlon, Curley) Department of Statistics, College of Science, Virginia
Polytechnic Institute and State University, Blacksburg, Virginia; and
(Curley) Department of Anesthesia and Critical Medicine, Perelman School
of Medicine, University of Pennsylvania, Philadelphia, PA, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To test the effect of a 4-month telehealth home monitoring
program (REACH), layered on usual care, on postdischarge outcomes in
parents of infants recovering from cardiac surgery and their infants.
<br/>METHOD(S): Randomized trial of infants discharged from the hospital
after cardiac surgery for congenital heart disease. Consecutive infants
with complex congenital heart disease undergoing cardiac surgery within 21
days of life were enrolled at 3 university-affiliated pediatric cardiac
centers. <br/>RESULT(S): From 2012 to 2016, 219 parent-infant dyads were
enrolled; 109 were randomly assigned to the intervention group and 110 to
the control group. At 4 months postdischarge, parenting stress was not
significantly different between groups (total Parenting Stress Index in
the intervention group was 220 and in the control group was 215; P = .61).
The percentages of parents who met posttraumatic stress disorder (PTSD)
criteria and parent quality of life inventory scores were also not
significantly different between the 2 groups (PTSD in the intervention
group was 18% and was 18% in the control group; P =.56; the mean Ulm
Quality of Life Inventory for Parents in the intervention group was 71
andwas 70 in the control group; P = .88). Infant growth in both groups was
suboptimal (the mean weight-for-age z scores were -1.1 in the intervention
group and -1.2 in the control group; P = .56), and more infants in the
intervention group were readmitted to the hospital (66% in the
intervention group versus 57% in the control group; P < .001).
<br/>CONCLUSION(S): When added to usual care, the REACH intervention was
not associated with an improvement in parent or infant outcomes. Four
months after neonatal heart surgery, ~20% of parents demonstrate PTSD
symptoms. Suboptimal infant growth and hospital readmissions were
common.<br/>Copyright &#xa9; 2020 by the American Academy of Pediatrics.

<13>
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

<14>
Accession Number
632519963
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) (no pagination), 2020. Article Number: e038936. 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, PR, United States
(Melin) Department of Pharmacy Practice, University of Puerto Rico School
of Pharmacy, Medical Sciences Campus, San Juan, PR, United States
(Marin-Maldonado) RCMI Program, Academic Affairs Deanship, University of
Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
(Gonzalez-Sepulveda, Rivas-Tumanyan) Research Design and Biostatistics
Core, Puerto Rico Clinical and Translational Research Consortium (PRCTRC),
Medical Sciences Campus, San Juan, PR, 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, PR, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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; 2020 BMJ Publishing Group.
All rights reserved.

<15>
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

<16>
Accession Number
2005928771
Title
Exploring mechanisms of action in clinical trials of complex surgical
interventions using mediation analysis.
Source
Clinical Trials. (no pagination), 2020. Date of Publication: 2020.
Author
Sharples L.; Papachristofi O.; Rex S.; Landau S.
Institution
(Sharples, Papachristofi, Rex) Department of Medical Statistics, London
School of Hygiene and Tropical Medicine, London, United Kingdom
(Papachristofi) Novartis Pharma AG, Basel, Switzerland
(Rex) University of Sheffield, Sheffield, United Kingdom
(Landau) King's College London, London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Surgical interventions allow for tailoring of treatment to
individual patients and implementation may vary with surgeon and
healthcare provider. In addition, in clinical trials assessing two
competing surgical interventions, the treatments may be accompanied by
co-interventions. <br/>Aim(s): This study explores the use of causal
mediation analysis to (1) delineate the treatment effect that results
directly from the surgical intervention under study and the indirect
effect acting through a co-intervention and (2) to evaluate the benefit of
the surgical intervention if either everybody in the trial population
received the co-intervention or nobody received it. <br/>Method(s): Within
a counterfactual framework, relevant direct and indirect effects of a
surgical intervention are estimated and adjusted for confounding via
parametric regression models, for the situation where both mediator and
outcome are binary, with baseline stratification factors included as fixed
effects and surgeons as random intercepts. The causal difference in
probability of a successful outcome (estimand of interest) is calculated
using Monte Carlo simulation with bootstrapping for confidence intervals.
Packages for estimation within standard statistical software are reviewed
briefly. A step by step application of methods is illustrated using the
Amaze randomised trial of ablation as an adjunct to cardiac surgery in
patients with irregular heart rhythm, with a co-intervention (removal of
the left atrial appendage) administered to a subset of participants at the
surgeon's discretion. The primary outcome was return to normal heart
rhythm at one year post surgery. <br/>Result(s): In Amaze, 17% (95%
confidence interval: 6%, 28%) more patients in the active arm had a
successful outcome, but there was a large difference between active and
control arms in the proportion of patients who received the
co-intervention (55% and 30%, respectively). Causal mediation analysis
suggested that around 1% of the treatment effect was attributable to the
co-intervention (16% natural direct effect). The controlled direct effect
ranged from 18% (6%, 30%) if the co-intervention were mandated, to 14%
(2%, 25%) if it were prohibited. Including age as a moderator of the
mediation effects showed that the natural direct effect of ablation
appeared to decrease with age. <br/>Conclusion(s): Causal mediation
analysis is a useful quantitative tool to explore mediating effects of
co-interventions in surgical trials. In Amaze, investigators could be
reassured that the effect of the active treatment, not explainable by
differential use of the co-intervention, was significant across
analyses.<br/>Copyright &#xa9; The Author(s) 2020.

<17>
Accession Number
2005897508
Title
Effect of intracameral epinephrine on heart rate, post-operative ocular
hypertension, and long-term outcome following canine phacoemulsification.
Source
Veterinary Ophthalmology. (no pagination), 2020. Date of Publication:
2020.
Author
Osinchuk S.C.; Salpeter E.M.; Lavallee G.; Leis M.L.; Sandmeyer L.S.
Institution
(Osinchuk, Salpeter, Lavallee, Leis, Sandmeyer) Department of Small Animal
Clinical Science, Western College of Veterinary Medicine, University of
Saskatchewan, Saskatoon, SK, Canada
(Leis) Department of Veterinary Clinical Sciences, College of Veterinary
Medicine, University of Minnesota, Minneapolis, MN, United States
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: To determine the effect of intrsacameral epinephrine on heart
rate, blood pressure, post-operative ocular hypertension, and
complications following canine phacoemulsification. Procedures: A
prospective, double-blinded, controlled trial was carried out using 30
client-owned dogs undergoing phacoemulsification. Eyes were randomly
assigned to a treatment group receiving intracameral (IC) epinephrine (n =
31) or balanced salt solution (n = 25) at the beginning of surgery. Heart
rate, post-operative intraocular pressures, and outcomes were compared
between treatment groups. <br/>Result(s): No adverse reactions to IC
epinephrine or saline were observed. Post-operative ocular hypertension
developed at the 2 and/or 4 hours pressure reading in 35% and 46% in the
epinephrine and saline groups, respectively (P =.5072). There were 9.7%
and 23.1% eyes that developed complications in the IC epinephrine and
saline groups, respectively (P =.2373). <br/>Conclusion(s): Intracameral
epinephrine is safe to use, and non-significant decreases in
post-operative ocular hypertension and long-term complications were
observed.<br/>Copyright &#xa9; 2020 American College of Veterinary
Ophthalmologists

<18>
Accession Number
2007457680
Title
Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery
Disease? A Systematic Review and Meta-Analysis.
Source
Journal of Interventional Cardiology. 2020 (no pagination), 2020. Article
Number: 4081642. 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, PA, United States
(Sattar) Icahn School of Medicine, New York, NY, United States
(Ullah) Kabir Medical College, Peshawar, Pakistan
(Susheela) Loyola Medical Center, Hines, IL, United States
(Mukhtar) Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
(Alraies) Detroit Medical Center, Detroit, MI, United States
(Mamas) Keele Cardiovascular Research Group, Keele University, Royal Stoke
Hospital, Keele, United Kingdom
(Mamas, Fischman) Thomas Jefferson University, Philadelphia, PA, United
States
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
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. Methods. 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). Results. 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). Conclusion. 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.

<19>
Accession Number
632502377
Title
Nasal decolonization of staphylococcus aureus and the risk of surgical
site infection after surgery: A meta-Analysis.
Source
Annals of Clinical Microbiology and Antimicrobials. 19 (1) (no
pagination), 2020. Article Number: 33. Date of Publication: 30 Jul 2020.
Author
Tang J.; Hui J.; Ma J.; Mingquan C.
Institution
(Tang, Mingquan) Department of Infectious Diseases and Hepatology, Huashan
Hospital, Fudan University, Shanghai 200040, China
(Hui) Department of Infectious Diseases, First Affiliated Hospital of
Zhejiang University, Hangzhou 310003, China
(Ma) Department of Endocrinology and Metabolism, Gansu Provincial
Hospital, Lanzhou 730000, China
(Mingquan) Department of Emergency, Huashan Hospital, Fudan University,
Shanghai 200040, China
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Aim: To assess the effects of nasal decontamination on preventing surgical
site infections (SSIs) in people who are Staphylococcus aureus carriers
undergoing different types of surgeries and diverse measures of
decolonization. <br/>Method(s): Relevant randomized controlled trials
(RCTs) were identified through systematic searches of the PubMed, Embase,
Web of science, and the Cochrane Library databases. The risk ratios (RRs)
and 95% confidence intervals (CIs) were calculated and the effects model
was chosen according to the heterogeneity. Subgroup analyses were
performed according to different types of surgeries and measures of
decolonization that Staphylococcus aureus carriers were applied.
<br/>Result(s): Twenty RCTs published between 1996 and 2019 involving
10,526 patients were included. Pooled results showed that the overall SSIs
and pulmonary surgery SSIs presented with a statistical difference in
measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both
p < 0.01). However, the associations between nasal decolonization and
increased risks of SSIs in orthopedics surgery or cardiovascular surgery
remained insignificant in studies. As for the diverse measures of nasal
decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used
different types of antimicrobial drugs, and 5% use others. The SSIs rate
were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259-0.864), while
no significant difference was shown in the use of mupirocin (RR = 0.871,
95% CI 0.544-1.394). <br/>Conclusion(s): It seems that nasal
decolonization of Staphylococcus aureus may be associated with a reduction
of SSIs in these patients, especially in patients who have been
administered by pulmonary surgeries or treated with chlorhexidine.
<br/>Copyright &#xa9; 2020 The Author(s).

<20>
Accession Number
632381656
Title
Levosimendan Reduces Mortality and Low Cardiac Output Syndrome in Cardiac
Surgery.
Source
Thoracic and Cardiovascular Surgeon. 68 (5) (pp 400-408), 2020. Date of
Publication: 01 Aug 2020.
Author
Weber C.; Esser M.; Eghbalzadeh K.; Sabashnikov A.; Djordjevic I.; Maier
J.; Merkle J.; Choi Y.-H.; Madershahian N.; Liakopoulos O.; Deppe A.C.;
Wahlers T.C.W.
Institution
(Weber, Esser, Eghbalzadeh, Sabashnikov, Djordjevic, Maier, Merkle, Choi,
Madershahian, Liakopoulos, Deppe, Wahlers) Department of Cardiothoracic
Surgery, University of Cologne, Kerpener Street 62, Cologne 50937, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background There has been conflicting evidence concerning the effect of
levosimendan on clinical outcomes in patients undergoing cardiac surgery.
Therefore, we performed a systematic review and conducted this
meta-analysis to provide evidence for/against the administration of
levosimendan in cardiac surgery patients. Methods We performed a
meta-analysis from literature search in PubMed, EMBASE, and Cochrane
Library. Only randomized controlled trials comparing the administration of
levosimendan in cardiac surgery patients with a control group (other
inotrope, standard therapy/placebo, or an intra-aortic balloon pump) were
included. In addition, at least one clinical outcome had to be mentioned:
Mortality, myocardial infarction, low cardiac output syndrome (LCOS),
acute kidney injury, renal replacement therapy, atrial fibrillation,
prolonged inotropic support, length of intensive care unit, and hospital
stay. The pooled treatment effects (odds ratio [OR], 95% confidence
intervals [CI]) were assessed using a fixed or random effects model.
Results The literature search retrieved 27 randomized, controlled trials
involving a total of 3,198 patients. Levosimendan led to a significant
reduction in mortality (OR: 0.67; 95% CI: 0.49-0.91; p = 0.0087).
Furthermore, the incidence of LCOS (OR: 0.56, 95% CI: 0.42-0.75; p <
0.0001), acute kidney injury (OR: 0.63; 95% CI: 0.46-0.86; p = 0.0039),
and renal replacement therapy (OR: 0.70; 95% CI: 0.50-0.98; p = 0.0332)
was significantly decreased in the levosimendan group. Conclusion Our
meta-analysis suggests beneficial effects for the prophylactic use of
levosimendan in patients with severely impaired left ventricular function
undergoing cardiac surgery. The administration of levosimendan was
associated with a reduced mortality, less LCOS, and restored adequate
organ perfusion reflected in less acute kidney injury.<br/>Copyright
&#xa9; 2020 Georg Thieme Verlag. All rights reserved.

<21>
Accession Number
632381648
Title
Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain
Control Post-Cardiac Surgery: A Randomized Controlled Trial.
Source
Thoracic and Cardiovascular Surgeon. 68 (5) (pp 409-415), 2020. Date of
Publication: 01 Aug 2020.
Author
El Shora H.A.; El Beleehy A.A.; Abdelwahab A.A.; Ali G.A.; Omran T.E.;
Hassan E.A.; Arafat A.A.
Institution
(El Shora, El Beleehy) Anesthesia and Surgical ICU Department, Faculty of
Medicine-Tanta University, Tanta, Gharbeya, Egypt
(Abdelwahab, Omran, Hassan, Arafat) Department of Cardiothoracic Surgery,
Faculty of Medicine-Tanta University, Al-Giesh Street, Tanta, Gharbeya
31529, Egypt
(Ali) Department of Cardiothoracic Surgery, Faculty of Medicine-Zagazig
University, Zagazig, Sharkia, Egypt
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Adequate pain control after cardiac surgery is essential.
Paravertebral block is a simple technique and avoids the potential
complications of epidural catheters. The objective of this study is to
compare the effect of ultrasound-guided bilateral thoracic paravertebral
block with thoracic epidural block on pain control after cardiac surgery.
Materials and Methods Between March 2016 and 2017, 145 patients who had
cardiac surgery through median sternotomy were randomized by stratified
blocked randomization into two groups. Group I (n = 70 patients) had
bilateral ultrasound-guided thoracic paravertebral block and Group II (n =
75 patients) had thoracic epidural analgesia. The primary end point was
the postoperative visual analogue scale (VAS). The duration of mechanical
ventilation, intensive care unit (ICU), and hospital stay were the
secondary end points. The study design is a randomized parallel
superiority clinical trial. Results Both groups had similar preoperative
and operative characteristics. No significant difference in VAS measured
immediately after endotracheal extubation then after 12, 24, and 48 hours
between groups (p = 0.45). Pain score significantly declined with the
repeated measures (p < 0.001) and the decline was not related to the
treatment group. Postoperative pain was significantly related to diabetes
mellitus (p = 0.039). Six patients in group I (8.5%) required an
additional dose of morphine versus three patients (4%) in group II (p =
0.30). Patients in group I had significantly shorter ICU stay (p = 0.005)
and lower incidence of urinary retention (p = 0.04) and vomiting (p =
0.018). No difference was found in operative complications between groups.
Conclusion This randomized parallel controlled trial demonstrates that
ultrasound-guided paravertebral block is safe and effective method for
relieving post-cardiac surgery sternotomy pain compared with thoracic
epidural analgesia but not superior to it.<br/>Copyright &#xa9; 2020 Georg
Thieme Verlag. All rights reserved.

<22>
Accession Number
2007560869
Title
Diagnosis and management of silent coronary ischemia in patients
undergoing carotid endarterectomy.
Source
Journal of Vascular Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Krievins D.; Zellans E.; Latkovskis G.; Jegere S.; Kumsars I.; Kaufmanis
K.; Erglis A.; Zarins C.K.
Institution
(Krievins, Zellans, Latkovskis, Jegere, Kumsars, Erglis) Department of
Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga,
Latvia
(Krievins, Zellans, Latkovskis, Jegere, Kumsars, Kaufmanis, Erglis)
Faculty of Medicine, University of Latvia, Riga, Latvia
(Zarins) HeartFlow, Inc, Redwood City, Calif, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Coronary artery disease is the primary cause of death in
patients with carotid artery disease and silent ischemia is a marker for
adverse coronary events. A new noninvasive cardiac diagnostic test,
coronary computed tomography-derived fractional flow reserve
(FFR<inf>CT</inf>) can reliably identify ischemia-producing coronary
stenosis in patients with coronary artery disease and help to select
patients for coronary revascularization. The purpose of this study is to
determine the prevalence of silent coronary ischemia in patients
undergoing carotid endarterectomy (CEA) and to evaluate the usefulness of
FFR<inf>CT</inf> in selecting patients for coronary revascularization to
decrease cardiac events and improve survival. <br/>Method(s): Patients
with no cardiac history or symptoms admitted for elective CEA were
enrolled in a prospective, open-label, institutional review board-approved
study and underwent preoperative coronary computed tomography angiography
(CTA) and FFR<inf>CT</inf> with results available to physicians for
patient management. Lesion-specific coronary ischemia was defined as
FFR<inf>CT</inf> of 0.80 or less distal to a focal coronary stenosis with
an FFR<inf>CT</inf> of 0.75 or less, indicating severe ischemia. Primary
end point was incidence of major adverse cardiovascular events (MACE;
defined as cardiovascular death, myocardial infarction, or stroke) at 30
days and 1 year. <br/>Result(s): Coronary CTA and FFR<inf>CT</inf> was
performed in 90 CEA patients (age 67 +/- 8 years; male 66%).
Lesion-specific coronary ischemia was found in 51 patients (57%) with a
mean FFR<inf>CT</inf> of 0.71 +/- 0.14. Severe coronary ischemia was
present in 39 patients (43%), 26 patients had multivessel ischemia, and 5
had left main disease. CEA was performed as scheduled in all patients with
no postoperative deaths or myocardial infarctions. There were no MACE
events at 30 days. After recovery from surgery, 36 patients with
significant lesion-specific ischemia underwent coronary angiography with
coronary revascularization (percutaneous coronary intervention or coronary
artery bypass grafting) in 30 patients (33%). Survival at 1 year was 100%
and freedom from MACE was 98%. <br/>Conclusion(s): Patients undergoing CEA
have a high prevalence of unsuspected (silent) coronary ischemia, which
may place them at risk for coronary events. Preoperative diagnosis of
silent ischemia using CTA and FFR<inf>CT</inf> can identify high-risk
patients and help to guide patient management. Selective postoperative
coronary revascularization of patients with significant ischemia may
decrease the risk of cardiac events and improve survival, but longer
follow-up is needed and prospective, controlled trials are
indicated.<br/>Copyright &#xa9; 2020 The Authors

<23>
Accession Number
2007560748
Title
Impact of cognitive behavioral therapy on depression symptoms after
transcatheter aortic valve replacement: A randomized controlled trial.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Edwards K.S.; Chow E.K.H.; Dao C.; Hossepian D.; Johnson A.G.; Desai M.;
Shah S.; Lee A.; Yeung A.C.; Fischbein M.; Fearon W.F.
Institution
(Edwards, Dao, Shah, Yeung, Fearon) Department of Medicine, Stanford
University, United States
(Chow, Desai) Quantitative Sciences Unit, Stanford University, United
States
(Hossepian, Johnson) PGSP-Stanford Psy.D. Consortium, Palo Alto
University, United States
(Lee, Fischbein) Department of Cardiothoracic Surgery, Stanford
University, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Depression is a significant concern after cardiac surgery and
has not been studied in patients undergoing transcatheter aortic valve
replacement (TAVR). We sought to examine the prevalence of pre-procedure
depression and anxiety symptoms and explore whether brief bedside
cognitive behavioral therapy (CBT) could prevent post-TAVR psychological
distress. <br/>Method(s): We prospectively recruited consecutive TAVR
patients and randomized them to receive brief CBT or treatment as usual
(TAU) during their hospitalization. Multi-level regression techniques were
used to evaluate changes by treatment arm in depression, anxiety, and
quality of life from baseline to 1 month post-TAVR adjusted for sex, race,
DM, CHF, MMSE, and STS score. <br/>Result(s): One hundred and forty six
participants were randomized. The mean age was 82 years, and 43% were
female. Self-reported depression and anxiety scores meeting cutoffs for
clinical level distress were 24.6% and 23.2% respectively. Both TAU and
CBT groups had comparable improvements in depressive symptoms at 1-month
(31% reduction for TAU and 35% reduction for CBT, p =.83). Similarly, both
TAU and CBT groups had comparable improvements in anxiety symptoms at
1-month (8% reduction for TAU and 11% reduction for CBT, p =.1). Quality
of life scores also improved and were not significantly different between
the two groups. <br/>Conclusion(s): Pre-procedure depression and anxiety
may be common among patients undergoing TAVR. However, TAVR patients show
spontaneous improvement in depression and anxiety scores at 1-month follow
up, regardless of brief CBT. Further research is needed to determine
whether more tailored CBT interventions may improve psychological and
medical outcomes.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<24>
Accession Number
2005955195
Title
Closed-incision negative-pressure wound management in surgery-literature
review and recommendations.
Source
European Surgery - Acta Chirurgica Austriaca. (no pagination), 2020. Date
of Publication: 2020.
Author
Smolle M.A.; Nischwitz S.P.; Hutan M.; Trunk P.; Lumenta D.; Bernhardt
G.A.
Institution
(Smolle, Bernhardt) Department of Orthopaedics and Trauma, Medical
University of Graz, Auenbruggerplatz 5, Graz 8036, Austria
(Nischwitz, Lumenta) Division of Plastic, Aesthetic and Reconstructive
Surgery, Medical University of Graz, Graz, Austria
(Hutan) Department of Surgery, Landesklinikum Hainburg, Hainburg/Donau,
Austria
(Trunk) Department of Cardiovascular Surgery, Ljubljana University Medical
Centre, Ljubljana, Slovenia
(Nischwitz) COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM
RESEARCH Forschungsgesellschaft mbH, Graz, Austria
Publisher
Springer Medizin
Abstract
Background: Wound healing deficits and subsequent surgical site infections
are potential complications after surgical procedures, resulting in
increased morbidity and treatment costs. Closed-incision negative-pressure
wound therapy (ciNPWT) systems seem to reduce postoperative wound
complications by sealing the wound and reducing tensile forces.
<br/>Material(s) and Method(s): We conducted a collaborative English
literature review in the PubMed database including publications from 2009
to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and
trauma, general surgery, plastic surgery, cardiac surgery and vascular
surgery). With literature reviews, case reports and expert opinions
excluded, the remaining 59 studies were critically summarized and
evaluated with regard to their level of evidence. <br/>Result(s): Of nine
studies analysed in orthopaedics and trauma, positive results of ciNPWT
were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10
(100%) of studies analysed in plastic, vascular and general surgery,
respectively, a positive effect of ciNPWT was observed. On the contrary,
only 4 of 12 studies from cardiac surgery discovered positive effects of
ciNPWT (33.3%). <br/>Conclusion(s): ciNPWT is a promising treatment
modality to improve postoperative wound healing, notably when facing
increased tensile forces. To optimise ciNPWT benefits, indications for its
use should be based on patient- and procedure-related risk
factors.<br/>Copyright &#xa9; 2020, The Author(s).

<25>
Accession Number
632657083
Title
Robustness of the Comparative Observational Evidence Supporting Class I
and II Cardiac Surgery Procedures.
Source
Journal of the American Heart Association. (pp e016964), 2020. Date of
Publication: 20 Aug 2020.
Author
Gaudino M.; Hameed I.; Robinson N.B.; Naik A.; Weidenmann V.; Ruan Y.; Tam
D.; Girardi L.N.; Fremes S.
Institution
(Gaudino, Hameed, Robinson, Naik, Weidenmann, Ruan, Girardi) Department of
Cardiothoracic Surgery Weill Cornell Medicine New York NY
(Tam, Fremes) Schulich Heart Centre Sunnybrook Health Science University
of Toronto Toronto Ontario Canada
Publisher
NLM (Medline)
Abstract
Background Current cardiac surgery guidelines give Class I and II
recommendations to valve-sparing root replacement over the Bentall
procedure, mitral valve (MV) repair over replacement, and multiple
arterial grafting with bilateral internal thoracic artery based on
observational evidence. We evaluated the robustness of the observational
studies supporting these recommendations using the E value, an index of
unmeasured confounding. Methods and Results Observational studies cited in
the guidelines and in the 3 largest meta-analyses comparing the procedures
were evaluated for statistically significant effect measures. Two E values
were calculated: 1 for the effect-size estimate and 1 for the lower limit
of the 95% CI. Thirty-one observational studies were identified, and E
values were computed for 75 effect estimates. The observed effect
estimates for improved clinical outcomes with valve-sparing root
replacement versus the Bentall procedure, MV repair versus replacement,
and grafting with bilateral internal thoracic artery versus single
internal thoracic artery could be explained by an unmeasured confounder
that was associated with both the treatment and outcome by a risk ratio of
more than 16.77, 4.32, and 3.14, respectively. For MV repair versus
replacement and grafting with bilateral internal thoracic artery versus
single internal thoracic artery, the average E values were lower than the
effect sizes of the other measured confounders in 33.3% and 60.9% of the
studies, respectively. For valve-sparing root replacement versus the
Bentall procedure, no study reported effect sizes for associations of
other covariates with outcomes. Conclusions The E values for observational
evidence supporting the use of valve-sparing root replacement, MV repair,
and grafting with bilateral internal thoracic artery over the Bentall
procedure, MV replacement, and grafting with single internal thoracic
artery are relatively low. This suggests that small-to-moderate unmeasured
confounding could explain most of the observed associations for these
procedures.

<26>
Accession Number
632651146
Title
Critical Coarctation of the Aorta in Selective Fetal Growth Restriction
and the Role of Coronary Stent Implantation.
Source
Fetal Diagnosis and Therapy. (no pagination), 2020. Date of Publication:
2020.
Author
Gijtenbeek M.; Haak M.C.; Ten Harkel A.D.J.; Bokenkamp R.; Eyskens B.;
Ortibus E.; Meyns B.; Gewillig M.; Lewi L.
Institution
(Gijtenbeek, Haak) Division of Fetal Medicine, Department of Obstetrics,
Leiden University Medical Center, Leiden, Netherlands
(Ten Harkel, Bokenkamp) Department of Pediatric Cardiology, Leiden
University Medical Center, Leiden, Netherlands
(Meyns) Department of Cardiac Surgery, University Hospitals Leuven,
Leuven, Belgium
(Eyskens, Gewillig) Department of Pediatrics, Pediatric Cardiology,
University Hospitals Leuven, Leuven, Belgium
(Eyskens, Ortibus, Gewillig, Lewi) Department of Development and
Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven,
Leuven, Belgium
(Ortibus) Department of Pediatrics., Pediatric Neurology, University
Hospitals Leuven, Leuven, Belgium
(Meyns) Department of Cardiovascular Sciences, Biomedical Sciences, KU
Leuven, Leuven, Belgium
(Lewi) Department of Obstetrics Andamp; Gynecology, University Hospitals
Leuven, Herestraat 49, Leuven BE-3000, Belgium
Publisher
S. Karger AG
Abstract
Introduction: Monochorionic twins are at increased risk of congenital
heart defects (CHDs). Up to 26% have a birth weight <1,500 g, a CHD
requiring neonatal surgery, therefore, poses particular challenges.
<br/>Objective(s): The aim of the study was to describe pregnancy
characteristics, perinatal management, and outcome of monochorionic twins
diagnosed with critical coarctation of the aorta (CoA). <br/>Method(s): We
included monochorionic twins diagnosed with critical CoA (2010-2019) at 2
tertiary referral centers, and we systematically reviewed the literature
regarding CoA in monochorionic twins. <br/>Result(s): Seven neonates were
included. All were the smaller twin of pregnancies complicated by
selective fetal growth restriction. The median gestational age at birth
was 32 weeks (28-34). Birth weight of affected twins ranged as 670-1,800
g. One neonate underwent coarctectomy at the age of 1 month (2,330 g). Six
underwent stent implantation, performed between day 8 and 40, followed by
definitive coarctectomy between 4 and 9 months in 4. All 7 developed
normally, except for 1 child with neurodevelopmental delay. Three co-twins
had pulmonary stenosis, of whom 1 required balloon valvuloplasty. The
literature review revealed 10 cases of CoA, all in the smaller twin. Six
cases detected in the first weeks after birth were treated with
prostaglandins alone, by repeated transcatheter angioplasty or by surgical
repair, with good outcome in 2 out of 6. <br/>Conclusion(s): CoA
specifically affects the smaller twin of growth discordant monochorionic
twin pairs. Stent implantation is a feasible bridging therapy to surgery
in these low birth weight neonates.<br/>Copyright &#xa9; 2020 S. Karger
AG. All rights reserved.

<27>
Accession Number
2004983460
Title
Dose-response analysis between hemoglobin A1c and risk of atrial
fibrillation in patients with and without known diabetes.
Source
PLoS ONE. 15 (2) (no pagination), 2020. Article Number: e0227262. Date of
Publication: 01 Feb 2020.
Author
Zhao H.; Liu M.; Chen Z.; Mei K.; Yu P.; Xie L.
Institution
(Zhao) Department of Anesthesiology, Third Hospital of Nanchang, Nanchang,
Jiangxi, China
(Liu) Department of Cardiology, Seventh People's Hospital, Zhengzhou,
Henan, China
(Chen) Fuzhou University of International Studies and Trade, Fuzhou,
Fujian, China
(Mei) Department of Anesthesiology, Shangrao People's Hospital, Shangrao,
Jiangxi, China
(Yu) Department of Endocrinology, Second Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
(Xie) Department of Respiratory and Critical Care Medicine, Second
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The relationship between serum hemoglobin A1c (HbA1c) and
atrial fibrillation (AF) or postoperative AF (POAF) in coronary artery
bypass (CABG) patients is still under debate. It is also unclear whether
there is a dose-response relationship between circulating HbA1c and the
risk of AF or POAF. Methods and results The Cochrane Library, PubMed, and
EMBASE databases were searched. A robust-error meta-regression method was
used to summarize the shape of the dose-response relationship. The RR and
95%CI were using a random-effects model. In total, 14 studies were
included, totaling 17,914 AF cases among 352,325 participants. The summary
RR per 1% increase in HbA1c was 1.16 (95% CI: 1.07-1.27). In the subgroup
analysis, the summary RR was 1.13 (95% CI: 1.08-1.19) or 1.12 (95% CI:
1.05-1.20) for patients with diabetes or without known diabetes,
respectively. The nonlinear analysis showed a nonlinear
(P<inf>nonlinear</inf> = 0.04) relationship between HbA1c and AF, with a
significantly increased risk of AF if HbA1c was over 6.3%. However, HbA1c
(per 1% increase) was not associated with POAF in patients with diabetes
(RR: 1.13, P = 0.34) or without known diabetes (RR: 0.91, P = 0.37) among
patients undergoing CABG. Conclusion Our results suggest that higher HbA1c
was associated with an increased risk of AF, both in diabetes and in
without diabetes or with unknown diabetes. However, no association was
found between HbA1c and POAF in patients undergoing CABG. Further
prospective studies with larger population sizes are needed to explore the
association between serum HbA1c level and the risk of POAF.<br/>Copyright
&#xa9; 2020 Zhao et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<28>
Accession Number
2004670444
Title
Infective endocarditis post-transcatheter aortic valve implantation
(TAVI), microbiological profile and clinical outcomes: A systematic
review.
Source
PLoS ONE. 15 (1) (no pagination), 2020. Article Number: e0225077. Date of
Publication: 01 Jan 2020.
Author
Khan A.; Aslam A.; Satti K.N.; Ashiq S.
Institution
(Khan, Aslam, Ashiq) Sharif Medical and Dental College, Lahore, Pakistan
(Satti) Senior Registrar Rawalpindi Institute of Cardiology, Rawalpindi,
Pakistan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The data on infective endocarditis after transcatheter aortic
valve implantation (TAVI) is scarce and limited to case reports and case
series in the literature. It is the need of the hour to analyze the
available data on post-TAVI infective endocarditis from the available
literature. The objectives of this systematic review were to evaluate the
incidence of infective endocarditis after transcatheter aortic valve
implantation, its microbiological profile and clinical outcomes. It will
help us to improve the antibiotic prophylaxis strategies and treatment
options for infective endocarditis in the context of TAVI. Methods EMBASE,
Medline and the CENTRAL trials registry of the Cochrane Collaboration were
searched for articles on infective endocarditis in post-TAVI patients till
October 2018. Eleven articles were included in the systematic review. The
outcomes assessed werethe incidence of infective endocarditis, its
microbiological profile andclinical outcomes including major adverse
cardiac event (MACE), net adverse clinical event (NACE), surgical
intervention and valve-in-valve procedure. Results The incidence of
infective endocarditis varied from 0%-14.3% in the included studies, the
mean was3.25%. The average duration of follow-up was 474 days (1.3 years).
Enterococci were the most common causative organism isolated from 25.9% of
cases followed by Staphylococcus aureus (16.1%) and coagulase-negative
Staphylococcus species (14.7%). The mean in-hospital mortality and
mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative
incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and
11.3%,respectively. Only a single study by Martinez-Selles et al. reported
arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7%
post-TAVI infective endocarditis patients according to 2 studies. The
surgical intervention and valve-in-valve procedure were reported in 11.4%
and 6.4% cases, respectively. Conclusion The incidence of post-TAVI
infective endocarditis is low being 3.25% but it is associated with high
mortality and complications. The most common complication is heart failure
with a cumulative incidence of 37.1%. Enterococciare the most common
causative organism isolated from 25.9% of cases followed by Staphylococcus
aureus in 16.1% of cases. Appropriate measures should be taken to prevent
infective endocarditis in post-TAVI patients including adequate
antibiotics prophylaxis directed specifically against these
organisms.<br/>Copyright &#xa9; 2020 Khan et al.

<29>
Accession Number
2003581529
Title
Volatile anesthetics versus total intravenous anesthesia in patients
undergoing coronary artery bypass grafting: An updated metaanalysis and
trial sequential analysis of randomized controlled trials.
Source
PLoS ONE. 14 (10) (no pagination), 2019. Article Number: e0224562. Date of
Publication: 01 Oct 2019.
Author
Jiao X.-F.; Lin X.-M.; Ni X.-F.; Li H.-L.; Zhang C.; Yang C.-S.; Song
H.-X.; Yi Q.-S.; Zhang L.-L.
Institution
(Jiao, Ni, Li, Zhang, Yang, Song, Yi, Zhang) Department of Pharmacy, West
China Second University Hospital, Sichuan University, Sichuan, China
(Jiao, Ni, Li, Zhang, Yang, Song, Yi, Zhang) Evidence-Based Pharmacy
Center, West China Second University Hospital, Sichuan University,
Sichuan, China
(Jiao, Lin, Ni, Li, Zhang, Yang, Song, Yi, Zhang) Key Laboratory of Birth
Defects and Related Diseases of Women and Children, Sichuan University,
Ministry of Education, Sichuan, China
(Jiao, Ni, Yi) West China School of Medicine, Sichuan University, Sichuan,
China
(Lin) Department of Anesthesiology, West China Second University Hospital,
Sichuan University, Sichuan, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The benefits of volatile anesthetics in coronary artery bypass
grafting (CABG) patients remain controversial. We aimed to conduct an
updated meta-analysis to assess whether the use of volatile anesthetics
during CABG could reduce mortality and other outcomes. Methods We searched
eight databases from inception to June 2019 and included randomized
controlled trials (RCTs) comparing the effects of volatile anesthetics
versus total intravenous anesthesia (TIVA) in CABG patients. The primary
outcomes were operative mortality and one-year mortality. The secondary
outcomes included the length of stay in the intensive care unit (ICU) and
hospital and postoperative safety outcomes (myocardial infarction, heart
failure, arrhythmia, stroke, delirium, postoperative cognitive impairment,
acute kidney injury, and the use of intra-aortic balloon pump (IABP) or
other mechanical circulatory support). Trial sequential analysis (TSA) was
performed to control for random errors. Results A total of 89 RCTs
comprising 14,387 patients were included. There were no significant
differences between the volatile anesthetics and TIVA groups in operative
mortality (relative risk (RR) = 0.92, 95% confidence interval (CI):
0.68-1.24, p = 0.59, I2 = 0%), one-year mortality (RR = 0.64, 95% CI:
0.32-1.26, p = 0.19, I2 = 51%), or any of the postoperative safety
outcomes. The lengths of stay in the ICU and hospital were shorter in the
volatile anesthetics group than in the TIVA group. TSA revealed that the
results for operative mortality, one-year mortality, length of stay in the
ICU, heart failure, stroke, and the use of IABP were inconclusive.
Conclusions Conventional meta-analysis suggests that the use of volatile
anesthetics during CABG is not associated with reduced risk of mortality
or other postoperative safety outcomes when compared with TIVA. TSA shows
that the current evidence is insufficient and inconclusive. Thus, future
large RCTs are required to clarify this issue.<br/>Copyright &#xa9; 2019
Jiao et al. This is an open access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<30>
Accession Number
2003581491
Title
The use of prophylactic intra-aortic balloon pump in high-risk patients
undergoing coronary artery bypass grafting.
Source
PLoS ONE. 14 (10) (no pagination), 2019. Article Number: e0224273. Date of
Publication: 01 Oct 2019.
Author
Nakamura K.; Hamasaki A.; Uchida T.; Kobayashi K.; Sho R.; Kim C.; Uchino
H.; Shimanuki T.; Sadahiro M.
Institution
(Nakamura, Kobayashi, Kim, Uchino, Shimanuki) Division of Cardiovascular
Surgery, Nihonkai General Hospital, Sakata, Japan
(Hamasaki, Uchida, Sadahiro) Second Department of Surgery, Yamagata
University, Faculty of Medicine, Yamagata, Japan
(Sho) Department of Public Health, Yamagata University, Faculty of
Medicine, Yamagata, Japan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective Intra-aortic balloon pump (IABP) is one of the most commonly
used mechanical circulatory assist devices for high-risk patients
undergoing cardiac surgery. In an effort to validate previously reported
clinical outcomes, we describe the preoperative characteristics and
outcomes of patients who underwent prophylactic IABP in high-risk patients
undergoing coronary artery bypass grafting (CABG). Design A prospective
observational study Methods From 2005 to 2017, 471 patients underwent
either isolated or combined CABG at our institution. Of those, 393
patients underwent isolated CABG and were included for the analysis.
Eighty-five patients (22%) were considered high-risk and underwent
prophylactic IABP, with subsequent review of surgical morbidity and
mortality rates. Results The 30-day postoperative mortality (prophylactic
IABP group vs non prophylactic IABP group: 0% vs 1.6%, p = 0.589) and
major adverse cardiac or cerebrovascular events (5.9% vs 3.3%, p = 0.333)
were not significantly different between the two groups. Prolonged
mechanical ventilation (>72 hours) (12.5% vs 4.2%, p = 0.014) occurred
more frequently in the prophylactic IABP group. Conclusions No
IABP-related complications were noted, emphasizing that the use of
prophylactic IABP in high-risk patients undergoing CABG is an acceptable
option.<br/>Copyright &#xa9; 2019 Nakamura et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<31>
Accession Number
2002958743
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in patients at low and intermediate risk: A risk specific
meta-analysis of randomized controlled trials.
Source
PLoS ONE. 14 (9) (no pagination), 2019. Article Number: e0221922. Date of
Publication: 01 Sep 2019.
Author
Fang F.; Tang J.; Zhao Y.; He J.; Xu P.; Faramand A.
Institution
(Fang, Zhao, He) West China Hospital, Sichuan University, Chengdu,
Sichuan, China
(Tang) Chinese University of Hong Kong, Shenzhen, Guangdong, China
(Xu) Sichuan University Library, Chengdu, Sichuan, China
(Faramand) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Transcatheter aortic valve implantation (TAVI) is an option for
treatment for patients with severe aortic stenosis who are at high risk
for death with surgical aortic valve replacement (SAVR). It is unknown
whether TAVI can be safely introduced to intermediate-and low-risk
patients. Objective To compare the efficacy and safety of TAVI and SAVR in
patients with intermediate-and low-surgical risk. Data sources Medline,
Embase, and the Cochrane Central Register of Controlled Trials were
searched from inception to April 15, 2019. Study selection We included
randomized controlled trials comparing TAVI with SAVR in patients with
intermediate-and low-surgical risk. Data extraction Meta-analyses were
conducted using random-effects models to calculate risk ratios (RR) with
corresponding 95% confidence interval (CI). Two independent reviewers
completed citation screening, data abstraction, and risk assessment.
Primary outcome was a composite of all-cause mortality or disabling stroke
at 12 months. Data Synthesis A total of 5 trials randomizing 6390 patients
were included. In patients with low risk, TAVI was associated with a
significant reduction in the composite of all-cause mortality or disabling
stroke compared with SAVR (RR, 0.56; 95%CI, 0.40-0.79; I² =
0%). This benefit was not replicated in patients with intermediate risk
(RR, 0.96; 95% CI, 0.80-1.15; I² = 0%). Similar results were
seen separately in all-cause mortality and disabling stroke when TAVI was
compared with SAVR. Conclusion For patients with severe aortic stenosis
who were at low risk for death from surgery, TAVI achieved superior
clinical outcomes compared to SAVR; however, these benefits were not seen
in those with intermediate risk. This information may inform discussions
about deciding between SAVR and TAVI for patients with low to intermediate
risk separately.<br/>Copyright &#xa9; 2019 Fang et al.

<32>
Accession Number
2002842475
Title
Costs of clinical events in type 2 diabetes mellitus patients in the
Netherlands: A systematic review.
Source
PLoS ONE. 14 (9) (no pagination), 2019. Article Number: e0221856. Date of
Publication: 01 Sep 2019.
Author
Van Schoonhoven A.V.; Gout-Zwart J.J.; De Vries M.J.S.; Van Asselt A.D.I.;
Dvortsin E.; Vemer P.; Van Boven J.F.M.; Postma M.J.
Institution
(Van Schoonhoven, De Vries, Vemer, Postma) Unit of PharmacoTherapy,
Epidemiology and Economics (PTE2), Department of Pharmacy, University of
Groningen, Groningen, Netherlands
(Gout-Zwart, Dvortsin) Asc Academics, Groningen, Netherlands
(Gout-Zwart) Department of Nephrology, University of Groningen, University
Medical Centre Groningen (UMCG), Groningen, Netherlands
(Van Asselt, Vemer) Department of Epidemiology, University Medical Centre
Groningen, Groningen, Netherlands
(Van Asselt, Postma) Department of Health Sciences, University of
Groningen, University Medical Centre Groningen (UMCG), Groningen,
Netherlands
(Van Boven) Department of General Practice and Elderly Care, University of
Groningen, University Medical Center Groningen (UMCG), Groningen,
Netherlands
(Van Boven) Department of Clinical Pharmacy and Pharmacology, University
of Groningen, University Medical Centre Groningen (UMCG), Groningen,
Netherlands
(Postma) Department of Economics, Econometrics and Finance, University of
Groningen, Faculty of Economics and Business, Groningen, Netherlands
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Type 2 diabetes mellitus (T2DM) is an established risk factor
for cardiovascular and nephropathic events. In the Netherlands, prevalence
of T2DM is expected to be as high as 8% by 2025. This will result in
significant clinical and economic impact, highlighting the need for
well-informed reimbursement decisions for new treatments. However,
availability and consistent use of costing methodologies is limited.
Objective We aimed to systematically review recent costing data for
T2DM-related cardiovascular and nephropathic events in the Netherlands.
Methods A systematic literature review in PubMed and Embase was conducted
to identify available Dutch cost data for T2DM-related events, published
in the last decade. Information extracted included costs, source, study
population, and costing perspective. Finally, papers were evaluated using
the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).
Results Out of initially 570 papers, 36 agreed with the inclusion
criteria. From these studies, 150 cost estimates for T2DM-related clinical
events were identified. In total, 29 cost estimates were reported for
myocardial infarction (range: 196-27,038), 61 for stroke (495-54,678),
fifteen for heart failure (325-16,561), 24 for renal failure
(2,438-91,503), and seventeen for revascularisation (3,000-37,071). Only
four estimates for transient ischaemic attack were available, ranging from
587 to 2,470. Adherence to CHEERS was generally high. Conclusions The most
expensive clinical events were related to renal failure, while TIA was the
least expensive event. Generally, there was substantial variation in
reported cost estimates for T2DM-related events. Costing of clinical
events should be improved and preferably standardised, as accurate and
consistent results in economic models are desired.<br/>Copyright &#xa9;
2019 van Schoonhoven et al. This is an open access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<33>
Accession Number
2002662559
Title
Heart rate recovery and morbidity after noncardiac surgery: Planned
secondary analysis of two prospective, multi-centre, blinded observational
studies.
Source
PLoS ONE. 14 (8) (no pagination), 2019. Article Number: e0221277. Date of
Publication: 01 Aug 2019.
Author
Ackland G.L.; Abbott T.E.F.; Minto G.; Clark M.; Owen T.; Prabhu P.; May
S.M.; Reynolds J.A.; Cuthbertson B.H.; Wijesundera D.; Pearse R.M.
Institution
(Ackland, Abbott, May, Reynolds, Pearse) William Harvey Research
Institute, Queen Mary University of London, London, United Kingdom
(Minto) Department of Anaesthesia, Derriford Hospital, Plymouth Hospitals
NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth
University, Plymouth, United Kingdom
(Clark) Department of Anaesthesia, Royal Bournemouth Hospital,
Bournemouth, United Kingdom
(Owen) Department of Anaesthesia, Royal Preston Hospital, Lancashire
Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
(Prabhu) Department of Anaesthesia, Royal Surrey County Hospital,
Guildford, United Kingdom
(Cuthbertson, Wijesundera) Department of Critical Care Medicine,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Cuthbertson, Wijesundera) Department of Anesthesia, University of
Toronto, Toronto, ON, Canada
(Wijesundera) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, ON, Canada
(Wijesundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, Toronto, ON, Canada
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Impaired cardiac vagal function, quantified preoperatively as
slower heart rate recovery (HRR) after exercise, is independently
associated with perioperative myocardial injury. Parasympathetic (vagal)
dysfunction may also promote (extra-cardiac) multi-organ dysfunction,
although perioperative data are lacking. Assuming that cardiac vagal
activity, and therefore heart rate recovery response, is a marker of
brainstem parasympathetic dysfunction, we hypothesized that impaired HRR
would be associated with a higher incidence of morbidity after noncardiac
surgery. Methods In two prospective, blinded, observational cohort
studies, we established the definition of impaired vagal function in terms
of the HRR threshold that is associated with perioperative myocardial
injury (HRR 12 beats min^-1 (bpm), 60 seconds after cessation of
cardiopulmonary exercise testing. The primary outcome of this secondary
analysis was all-cause morbidity three and five days after surgery,
defined using the Post-Operative Morbidity Survey. Secondary outcomes of
this analysis were type of morbidity and time to become morbidity-free.
Logistic regression and Cox regression tested for the association between
HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR;
(95% confidence intervals). Results 882/1941 (45.4%) patients had
HRR12bpm. All-cause morbidity within 5 days of surgery was more common in
585/822 (71.2%) patients with HRR12bpm, compared to 718/1119 (64.2%)
patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR12bpm was
associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p
= 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91
(1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)),
neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38
(1.14-1.68); p = 0.001) within 5 days of surgery. Conclusions Multi-organ
dysfunction is more common in surgical patients with cardiac vagal
dysfunction, defined as HRR 12 bpm after preoperative cardiopulmonary
exercise testing.<br/>Copyright &#xa9; 2019 Ackland et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<34>
Accession Number
2002560975
Title
Comparison of early and delayed invasive strategies in short-medium term
among patients with non-ST segment elevation acute coronary syndrome: A
systematic review and meta-analysis.
Source
PLoS ONE. 14 (8) (no pagination), 2019. Article Number: e0220847. Date of
Publication: 01 Aug 2019.
Author
Zhang M.-B.; Guo C.; Li M.; Lv Y.-H.; Fan Y.-D.; Wang Z.-L.
Institution
(Zhang, Guo, Li, Lv, Wang) First Medical Clinical College of Lanzhou
University, Lanzhou, China
(Fan) Department of Cardiology, Emergency General Hospital, Beijing, China
(Wang) Department of Cardiology, First Hospital of Lanzhou University,
Lanzhou, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background and objectives An invasive approach is recommended as the
treatment of patients with non-ST elevated acute coronary syndromes
(NSTE-ACS). However, it remains unclear that the optimal time of
angiography and intervention for patients with NSTE-ACS at present. This
study was designed to compare the effect of early and delayed invasive
strategies on short-medium term prognosis in patients with those. Methods
Pubmed, Cochrane Library and Embase were searched up to Dec-30-2018.
Randomized clinical trials comparing an early versus a delayed invasive
strategy in patients with NSTEACS were included. The primary endpoint
(all-cause death and recurrent myocardial infarction) and secondary
endpoint (major bleeding and recurrent revascularization), as well as
composite endpoint were assessed by random or fixed effected meta-analysis
with software RevMan 5.3 version after short-medium term follow up. Result
A total of six randomized clinical trials involving 4,277 early or delayed
invasive strategies patients with NSTE-ACS were included in the
meta-analysis. Time to coronary angiography varied from 0.5 to 24 h in the
early invasive strategy and from 18.6 to 72 h in the delayed invasive
strategy. There was a statistical difference in the primary endpoint of
all-cause death among patients with NSTE-ACS between early and delayed
invasive strategies (4.6% vs 6%; OR:0.76; 95% CI:0.58 to 1.00; P = 0.05;
I2 = 0%), but not for recurrent myocardial infarction (6.0% vs 6.3%; OR:
0.94; 95% CI: 0.55 to 1.61; P = 0.82; I2 = 60%). The major bleeding in
patients with NSTE-ACS was similar between both invasive strategies (2.7%
vs 3.1%; OR:0.88; 95% CI:0.59 to 1.31; P = 0.54; I2 = 0%). However, the
composite endpoint in the early invasive strategy patients with NSTE-ACS
was significantly lower than that of the delayed invasive strategy (10.9%
vs 13.9%; OR:0.76; 95% CI:0.63 to 0.92; P = 0.006; I2 = 0%), and the
recurrent revascularization between both strategies was just the opposite
(8.7% vs 5.9%; OR:1.5; 95%CI:1.15 to 1.97; P = 0.003; I2 = 0%). Conclusion
The systematic review and meta-analysis demonstrated that the early
invasive strategy had a beneficial trend on all-cause death and
significantly reduced the composite endpoint in patients with NSTE-ACS,
but increased the rate of revascularization. These data could provide a
solution for patients with those.<br/>Copyright &#xa9; 2019 Zhang et al.

<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
632587632
Title
Comparison of minimally invasive surgery for non-flail chest rib
fractures: A prospective cohort study.
Source
Journal of Thoracic Disease. 12 (7) (pp 3706-3714), 2020. Date of
Publication: 01 Jul 2020.
Author
Li Y.; Gao E.; Yang Y.; Gao Z.; He W.; Zhao Y.; Wu W.; Zhao T.; Guo X.
Institution
(Li, Gao, Yang, Gao, He, Zhao, Wu, Zhao, Guo) Department of Thoracic
Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital,
Shanghai, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: To evaluate therapeutic efficacy of minimally invasive and
small incision surgery [minimally invasive surgery (MIS)] in patients with
non-flail chest rib fractures through a prospective cohort study.
<br/>Method(s): This study included 98 patients with non-flail chest rib
fractures (>=3 displaced fractures) and 66 patients undergoing MIS served
as the experimental group and 32 patients receiving conservative treatment
served as the matched control group. Pain index and indicators of
pulmonary function [vital capacity (VC); forced expiratory volume in one
second (FEV1); peak expiratory flow (PEF)] for the two groups were
assessed and compared at the time of admission and before discharge. In
addition, duration of pain, time required for the patient to regain the
ability to perform daily self-care, mental labor, and moderate-to-severe
physical labor, and duration of chest discomfort were measured during
long-term follow-up and compared between the two groups. <br/>Result(s):
There were also no significant differences (P>0.05) in pain index (8 vs.
8) or indicators of pulmonary function (VC: 31.0% vs. 26.5%; FEV1: 29.9%
vs. 26.7%; PEF: 15.2% vs. 12.0%) were found between the MIS and
conservative treatment groups at the time of admission; while pain index
(3 vs. 6), VC (42.1% vs. 35.3%), and FEV1 (44.2% vs. 35.9%) were
significantly different between the two groups (P<0.05) but not in PEF
(21.2% vs. 19.6%) before discharge. Long-term follow-up showed that
duration of pain, time required for the patient to regain the ability to
engage in daily self-care, mental labor, and moderate-to-severe physical
labor, and duration of chest discomfort in the MIS group were
significantly more improved than in the conservative treatment group
(P<0.05). <br/>Conclusion(s): MIS was a simple and safe treatment that
significantly relieved chest pain and rapidly restored pulmonary function
and improved the long-term quality of life of patients with non-flail
chest rib fractures of >=3 ribs with displacement.<br/>Copyright &#xa9;
Journal of Thoracic Disease. All rights reserved.

<37>
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

<38>
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.

<39>
Accession Number
625742819
Title
The Accuracy of Urinary TIMP-2 and IGFBP7 for the Diagnosis of Cardiac
Surgery-Associated Acute Kidney Injury: A Systematic Review and
Meta-Analysis.
Source
Journal of Intensive Care Medicine. 35 (10) (pp 1013-1025), 2020. Date of
Publication: 01 Oct 2020.
Author
Tai Q.; Yi H.; Wei X.; Xie W.; Zeng O.; Zheng D.; Sun J.; Wang G.; Wang
S.; Liu G.
Institution
(Tai, Xie, Zheng, Sun, Wang, Wang, Liu) Intensive Care Unit, The First
Affiliated Hospital, Sun Yat-sen University, Guangdong Province, China
(Yi, Wei) Surgical Intensive Care Unit, The Third Affiliated Hospital of
Sun Yat-sen University, Guangdong Province, China
(Zeng) Department of Cardiology Intensive Care Unit, First People's
Hospital of Chenzhou, Hunan Province, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Tissue inhibitor of metalloproteinase 2 (TIMP-2) and
insulin-like growth factor binding protein 7 (IGFBP7) are recent promising
markers for identification of cardiac surgery-associated acute kidney
injury (CSA-AKI). The aim of this study was systematically and
quantitatively to evaluate the accuracy of urinary TIMP-2 and IGFBP7 for
the diagnosis of CSA-AKI. <br/>Method(s): Three databases including
PubMed, ISI web of knowledge, and Embase were systematically searched from
inception to March 2018. Two investigators conducted the processes of
literature search study selection, data extraction, and quality evaluation
independently. Meta-DiSc and STATA were used for all statistical analyses.
<br/>Result(s): A total of 8 studies comprising 552 patients were included
in this meta-analysis. Pooled sensitivity and specificity with
corresponding 95% confidence intervals (CIs) were 0.79 (95% CI, 0.71-0.86,
I² = 74.2%) and 0.76 (95% CI, 0.72-0.80, I² =
80.8%), respectively. Pooled positive likelihood ratio (LR), negative LR,
and diagnostic odds ratio were 3.49 (95% CI, 2.44-5.00, I² =
61.5%), 0.31(95% CI, 0.19-0.51, I² = 51.8%), and 14.89 (95% CI,
7.31-30.32, I² = 27.9%), respectively. The area under curve
estimated by summary receiver operating characteristic was 0.868 (standard
error [SE] 0.032) with a Q* value of 0.799 (SE 0.032). Sensitivity
analysis demonstrated that one study notably affected the stability of
pooled results. One of the subgroups investigated-AKI threshold-could
account for partial heterogeneity. <br/>Conclusion(s): Urinary TIMP-2 and
IGFBP7 is a helpful biomarker for early diagnosis of CSA-AKI. And, the
potential of this biomarker with a broader spectrum of clinical settings
may be the focus of future studies.<br/>Copyright &#xa9; The Author(s)
2018.

<40>
Accession Number
2003779007
Title
Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After
Coronary Artery Bypass Graft Surgery.
Source
Heart Lung and Circulation. 29 (8) (pp 1180-1186), 2020. Date of
Publication: August 2020.
Author
Manapunsopee S.; Thanakiatpinyo T.; Wongkornrat W.; Chuaychoo B.;
Thirapatarapong W.
Institution
(Manapunsopee, Thanakiatpinyo, Thirapatarapong) Department of
Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Wongkornrat) Cardiothoracic Division, Department of Surgery, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Chuaychoo) Division of Respiratory Diseases and Tuberculosis, Department
of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Elsevier Ltd
Abstract
Background: Although the use of incentive spirometry with a deep breathing
exercise (DBE) is widely used in clinical practice in patients who have
undergone coronary artery bypass graft (CABG) surgery, the effect of this
combination therapy has not been conclusively elucidated. The aim of this
study was to investigate the effect of postoperative combined incentive
spirometry and DBE versus DBE alone on inspiratory muscle strength
following CABG. <br/>Method(s): This randomised clinical trial was
conducted in patients scheduled to undergo CABG surgery at Siriraj
Hospital, Bangkok Thailand. The study group received incentive spirometry
and DBE, and the control group received DBE only. Maximal inspiratory
pressure (MIP) before surgery and at day 4 after surgery was assessed by a
respiratory pressure meter. Secondary outcomes, including postoperative
pulmonary complication and duration of postoperative hospitalisation, were
obtained from the medical records. <br/>Result(s): Ninety (90) patients
were included, with 47 and 43 patients assigned to the study and control
groups, respectively. In both groups, there was a significant reduction in
MIP from preoperative baseline to postoperative day 4; however, the MIP in
the incentive spirometry group had a significantly smaller reduction in
MIP compared with the control group (33.0+/-23.2% vs 47.2+/-20.1%,
respectively; p=0.006, 95% confidence interval, 3.9-23.3). There was no
difference between groups regarding secondary outcomes.
<br/>Conclusion(s): Patients in the study group had significantly better
recovery of inspiratory muscle strength on day 4 post-CABG than patients
in the control group. There was no significant difference between groups
for either postoperative pulmonary complications or length of hospital
stay.<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)

<41>
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

<42>
Accession Number
2005903583
Title
Syndrome of progressive deforming non-inflammatory arthritis of childhood:
two patients of camptodactyly-arthropathy-coxa vara-pericarditis syndrome.
Source
Rheumatology International. (no pagination), 2020. Date of Publication:
2020.
Author
Johnson N.; Chaudhary H.; Kumrah R.; Pilania R.K.; Sharma Y.; Sharma A.;
Kaur A.; Mukherjee S.; Kakkar N.; Vignesh P.
Institution
(Johnson, Chaudhary, Kumrah, Pilania, Kaur, Mukherjee, Vignesh) Allergy
Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre,
Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh 160012, India
(Kakkar) Department of Histopathology, Postgraduate Institute of Medical
Education and Research, Chandigarh 160012, India
(Sharma, Sharma) Dr. Rajendra Prasad Government Medical College, Kangra,
Himachal Pradesh 176001, India
Publisher
Springer
Abstract
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare
familial arthropathy of childhood, commonly misdiagnosed as juvenile
idiopathic arthritis. It is characterized by non-inflammatory arthropathy,
coxa vara deformity, and sterile pericarditis. We describe two children
with CACP syndrome who were referred to the rheumatology clinic for the
suspicion of inflammatory arthritis. A literature search was carried out
using PubMed/ Medline and Embase databases. English language reports of
mutation-proven cases of CACP syndrome reported until 31 March 2020 were
retrieved and analysed. Both the children had a delay in diagnosis (age at
diagnosis- 12 and 13 years, respectively) and had received
immunomodulatory therapy for suspected inflammatory arthritis. Presence of
symmetrical arthropathy of large joints, camptodactyly, and normal
inflammatory parameters are clues that indicated CACP syndrome. One child
with a novel variant in PRG4 also had associated mitral valve prolapse and
regurgitation. Both had severe constrictive pericarditis requiring
pericardiectomy. On literature review, a total of 98 mutation-proven cases
of CACP syndrome have been reported till date. Arthropathy in CACP
syndrome mainly involves knees, wrists, ankles, and hips. Pericarditis is
usually mild, however, can present rarely with severe symptoms requiring
surgical intervention. CACP syndrome can closely mimic inflammatory
arthritis and early clinical recognition is important to avoid
misdiagnosis. Molecular confirmation is essential for early diagnosis and
future genetic counselling for affected families.<br/>Copyright &#xa9;
2020, Springer-Verlag GmbH Germany, part of Springer Nature.

<43>
Accession Number
2005887822
Title
Reverse remodeling after percutaneous transluminal septal myocardial
ablation in severe but asymptomatic LVOT obstruction (RASTA) study:
Rationale and design of transcatheter septal reduction in asymptomatic
patients with severe hypertrophic obstructive cardiomyopathy.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Arslan F.; Akdim F.; ten Berg J.M.
Institution
(Arslan, Akdim, ten Berg) Department of Cardiology, St. Antonius Hospital
Nieuwegein, Nieuwegein, Netherlands
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of this study is to evaluate the impact of
percutaneous transluminal septal myocardial ablation (PTSMA) on remodeling
in asymptomatic patients with hypertrophic obstructive cardiomyopathy
(HOCM) and severe left ventricular outflow tract (LVOT) obstruction.
<br/>Background(s): Symptoms justify invasive treatment in HOCM patients
with LVOT obstruction. Adverse structural and functional changes
(remodeling) in the heart occur preceding heart failure and sudden cardiac
death. Early invasive treatment in asymptomatic patients may reverse
adverse remodeling to the same extent as in symptomatic patients.
<br/>Method(s): Reverse remodeling after PTSMA in severe but asymptomatic
LVOT obstruction (RASTA) study is a prospective single-blind randomized
trial (ClinicalTrials.gov number: NCT04230551). Ten asymptomatic HOCM
patients with an exertional LVOT gradient >=50 mmHg (or >30 mmHg in rest)
are randomized 1:1 to PTSMA versus conservative therapy, in the absence of
mitral valve disease or other indications for cardiac surgery. Five
symptomatic (reference group) will undergo PTSMA according to the current
guidelines. <br/>Result(s): Remodeling is assessed using extensive cardiac
imaging with transthoracic echocardiography and late gadolinium
enhancement cardiac magnetic resonance at baseline and during follow-up at
1, 12, and 24 months. Extracellular volume fraction, global, and regional
strain analysis, geometry, pressure gradients and changes in
four-dimensional velocity mapping are primary parameters to study
(reversal of) adverse remodeling. <br/>Conclusion(s): The RASTA study
gives insight in cardiac remodeling that may occur in asymptomatic
patients after PTSMA. It will provide arguments whether to pursue (or not)
a larger trial with clinical endpoints in asymptomatic HOCM patients with
severe LVOT obstruction.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<44>
Accession Number
2002368801
Title
Pre-operative stress testing in the evaluation of patients undergoing
non-cardiac surgery: A systematic review and meta-analysis.
Source
PLoS ONE. 14 (7) (no pagination), 2019. Article Number: e0219145. Date of
Publication: 01 Jul 2019.
Author
Kalesan B.; Nicewarner H.; Intwala S.; Leung C.; Balady G.J.
Institution
(Kalesan) Department of Medicine and Community Health Sciences, Boston
University, School of Medicine and Public Health, Boston, MA, United
States
(Nicewarner, Intwala, Leung, Balady) Department of Medicine, Boston
Medical Center, Boston University Medical Campus, Boston, MA, United
States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Pre-operative stress testing is widely used to evaluate
patients for non-cardiac surgeries. However, its value in predicting
peri-operative mortality is uncertain. The objective of this study is to
assess the type and quality of available evidence in a comprehensive and
statistically rigorous evaluation regarding the effectiveness of
pre-operative stress testing in reducing 30-day post -operative mortality
following non -cardiac surgery. Methods The databases of MEDLINE, EMBASE,
and CENTRAL databases (from inception to January 27, 2016) were searched
for all studies in English. We included studies with pre-operative stress
testing prior to 10 different non-cardiac surgery among adults and
excluded studies with sample size<15. The data on study characteristics,
methodology and outcomes were extracted independently by two observers and
checked by two other observers. The primary outcome was 30-day mortality.
We performed random effects meta-analysis to estimate relative risk (RR)
and 95% confidence intervals (95% CI) in two-group comparison and pooled
the rates for stress test alone. Heterogeneity was assessed using I2 and
methodological quality of studies using Newcastle-Ottawa Quality
Assessment Scale. The predefined protocol was registered in PROSPERO
#CRD42016049212. Results From 1807 abstracts, 79 studies were eligible
(297,534 patients): 40 had information on 30- day mortality, of which 6
studies compared stress test versus no stress test. The risk of 30- day
mortality was not significant in the comparison of stress testing versus
none (RR: 0.79, 95% CI = 0.35-1.80) along with weak evidence for
heterogeneity. For the studies that evaluated stress testing without a
comparison group, the pooled rates are 1.98% (95% CI = 1.25- 2.85) with a
high heterogeneity. There was evidence of potential publication bias and
small study effects. Conclusions Despite substantial interest and research
over the past 40 years to predict 30-day mortality risk among patients
undergoing non-cardiac surgery, the current body of evidence is
insufficient to derive a definitive conclusion as to whether stress
testing leads to reduced perioperative mortality.<br/>Copyright &#xa9;
2019 Kalesan et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<45>
Accession Number
632648158
Title
Efficiency of Thyroid Function Test in the Prediction of Atrial
Fibrillation Following Open Heart Surgery.
Source
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 30
(7) (pp 740-744), 2020. Date of Publication: 01 Jul 2020.
Author
Ozturk S.; Kayacioglu I.; Sensoz Y.; Ozdemir K.; Ozturk I.
Institution
(Ozturk, Kayacioglu, Sensoz, Ozdemir) Department of Cardiovascular
Surgery, Siyami Ersek Chest and Cardiovascular Surgery Education and
Research Hospital, Istanbul, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To analyse the efficiency of thyroid function tests (thyroid
stimulating hormone, thyroxine and tri-iodothyronine) on prediction of
postoperative atrial fibrillation. STUDY DESIGN: Meta-analysis. Place of
Study: Siyami Ersek Chest and Cardiovascular Surgery Education and
Research Hospital, Istanbul, Turkey. METHODOLOGY: Literature review was
carried out in PubMed, Science Direct and Ovid Database. No date
limitations was applied. Trials, which evaluated the preoperative levels
of thyroid stimulating hormone, thyroxine and tri-iodothyronine in cardiac
surgery patients, were included. Only the articles in English language
were reviewed. We evaluated the results with fix or random effect models
according to the presence of heterogeneity (I2 >25%). <br/>RESULT(S): Five
hundred and forty-seven articles were obtained after screening of
databases. After checking over the titles and abstracts, five trials were
included which covered 380 patients and complied with inclusion criteria.
According to results of analysis, there was no significant relationship
between postoperative atrial fibrillation and thyroid stimulating hormone
(SMD: 0.38, 95%CI -0.46-1.23, p=0.375), and also thyroxine (SMD: 0.006,
95% CI -0.29-0.30, p=0.966). However, tri-iodothyronine (SMD: -1.06, 95%
CI -2.08- -0.03, p=0.04) was correlated with development of atrial
fibrillation. Heterogeneity was observed in three parameters (I2; for TSH:
92.45%, for T3: 93.08% and for T4: 31.78%). <br/>CONCLUSION(S):
Preoperative levels of tri-iodothyronine was an effective parameter for
predicting postoperative atrial fibrillation after cardiac surgery, but
there was a need of larger trials for eliminating heterogeneity for all of
the parameters of thyroid function tests. Key Words: Cardiac surgery,
Atrial fibrillation, Thyroid stimulating hormone, Thyroxine,
Tri-iodothyronine.

<46>
Accession Number
632642182
Title
A meta-analysis of the incidence rate of postoperative acute kidney injury
in patients with congenital heart disease.
Source
BMC nephrology. 21 (1) (pp 350), 2020. Date of Publication: 17 Aug 2020.
Author
Li D.; Niu Z.; Huang Q.; Sheng W.; Wang T.
Institution
(Li) Department of Environmental Health, Qingdao Centers for Disease
Control and Prevention, Qingdao, Shandong 266033, China
(Niu, Huang, Sheng) Department of Cardiovascular Surgery, Qingdao
Municipal Hospital, No. 5 Donghai Middle Road, Qingdao, Shandong 266000,
China
(Wang) Department of Cardiovascular Surgery, Qingdao Municipal Hospital,
No. 5 Donghai Middle Road, Qingdao, Shandong 266000, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute kidney injury (AKI) is a common complication of cardiac
surgery. However, the incidence rate of AKI in patients with congenital
heart disease (CHD) greatly varies between reports owing to the different
definitions used for AKI. Therefore, this study was designed as a
meta-analysis aimed at summarizing the incidence rate of AKI in patients
with congenital heart disease (CHD) on the basis of different AKI
criteria. <br/>METHOD(S): Studies published till April 24, 2020, on the
incidence rate of AKI in patients with CHD, were retrieved from electronic
databases and printed literature. To pool data from the included studies,
the effect size, a combined statistics, was chosen and presented with the
incidence rate and 95% confidence interval (CI). Heterogeneity was
evaluated using I2 statistics and Cochran Q test. The incidence rates
obtained from the subgroup analysis according to study location, type of
surgery, type of cohort, age, and AKI criteria) were also evaluated to
determine the correlation of AKI with these factors. Publication bias was
estimated using the Egger test. <br/>RESULT(S): Thirty studies, comprising
9925 patients with AKI who had CHD, were included. Overall, the pooled
incidence rate of AKI in the patients with CHD was 38.4% (95% CI,
32.0-44.7%). However, the incidence rate was not significantly affected by
gender, study location, type of surgery, type of cohort, and AKI criteria.
Moreover, age was significantly associated with the incidence of AKI, and
the incidence rate was higher in the patients aged <1month than in those
aged 1month to 18years, <18years, and>=18years (P<0.05).
<br/>CONCLUSION(S): In this study, the estimated incidence rate of AKI in
patients with CHD was 38.4% and may be influenced by age. These findings
highlight the importance of further investigation of the specific causes
of and effective preventive measures for AKI.

<47>
Accession Number
632642151
Title
High-intensity interval training and health-related quality of life in de
novo heart transplant recipients - results from a randomized controlled
trial.
Source
Health and quality of life outcomes. 18 (1) (pp 283), 2020. Date of
Publication: 17 Aug 2020.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Bjorkelund E.; Authen
A.R.; Grov I.; Pettersen K.I.; Dall C.H.; Karason K.; Broch K.; Gullestad
L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Gude, Bjorkelund, Authen, Grov, Pettersen,
Broch, Gullestad, Nytroen) Department of Cardiology, Oslo University
Hospital Rikshospitalet, Rikshospitalet ,PO Box 4950 Nydalen, Oslo N-0424,
Norway
(Rolid, Andreassen, Yardley, Gullestad, Nytroen) Institute of Clinical
Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(Rolid, Yardley) Norwegian Health Association, Oslo, Norway
(Rolid, Broch, Gullestad, Nytroen) KG Jebsen Center for Cardiac Research,
University of Oslo, Norway and Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
(Dall) Department of Cardiology, Bispebjerg University Hospital,
Copenhagen, Denmark
(Karason) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: Studies on the effect of high-intensity interval training
(HIT) compared with moderate intensity continuous training (MICT) on
health-related quality of life (HRQoL) after heart transplantation (HTx)
is scarce. No available studies among de novo HTx recipients exists. This
study aimed to investigate the effect of HIT vs. MICT on HRQoL in de novo
recipients. <br/>METHOD(S): The HITTS study randomized eighty-one de novo
HTx recipients to receive either HIT or MICT (1:1). The HIT intervention
were performed with 2-4 interval bouts with an intensity of 85-95% of
maximal effort. The MICT group exercised at an intensity of 60-80% of
their maximal effort with a duration of 25min. HRQoL was assessed by the
Short Form-36 version 2 (SF-36v2) and the Hospital Anxiety and Depression
Scale, mean 11weeks after surgery and after a nine months' intervention.
The participants recorded their subjective effect of the interventions on
their general health and well-being on a numeric visual analogue scale.
Clinical examinations and physical tests were performed. Differences
between groups were investigated with independent Student t-tests and with
Mann-Whitney U tests where appropriate. Within-group differences were
analyzed with Paired-Sample t-tests and Wilcoxon Signed Rank tests.
Correlations between SF-36 scores and VO2peak were examined with Pearson's
correlations. <br/>RESULT(S): Seventy-eight participants completed the
intervention. Both exercise modes were associated with improved exercise
capacity on the physical function scores of HRQoL. Mental health scores
remained unchanged. No differences in the change in HRQoL between the
groups occurred except for Role Emotional subscale with a larger increase
in the HIT arm. Better self-reported physical function was associated with
higher VO2peak and muscle strength. <br/>CONCLUSION(S): HIT and MICT
resulted in similar mean changes in HRQoL the first year after HTx. Both
groups experienced significant improvements in the physical SF-36v2. TRIAL
REGISTRATION: ClinicalTrials.gov number: NCT01796379 Registered 18
February 2013.

<48>
Accession Number
2005930449
Title
Staged Percutaneous Coronary Intervention with Rotational Atherectomy or
Bypass Surgery in Chronic Hemodialysis and Severely Calcified Left Main
True Bifurcation Lesion: A Case Report and Literature Review.
Source
Clinical Medicine Insights: Cardiology. 14 (no pagination), 2020. Date of
Publication: 2020.
Author
Dan K.; Shinoda A.; Garcia-Garcia H.M.
Institution
(Dan, Shinoda) Ichinomiya Nishi Hospital, Aichi, Japan
(Dan, Garcia-Garcia) MedStar Washington Hospital Center, Washington, DC,
United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Previous observational studies and meta-analyses reported that the optimal
strategy of coronary revascularization (percutaneous coronary intervention
[PCI] and bypass surgery) for anatomically complex coronary artery lesions
in the chronic hemodialysis setting is still controversial because the
long-term outcomes were superior with coronary artery bypass grafting,
especially with regard to repeat revascularization; however, short-term
mortality with PCI was significantly lower because it is less invasive.
Moreover, no guidelines show a strategy for this setting. We report the
case of a patient with chronic dialysis and calcified left main true
bifurcation lesion who underwent staged PCI with rotational atherectomy
and minimally invasive direct coronary artery bypass for in-stent
restenosis who died of non-occlusive mesenteric ischemia.<br/>Copyright
&#xa9; The Author(s) 2020.

<49>
Accession Number
2005929860
Title
Is endoscopic radial artery harvesting open for business?.
Source
Journal of Cardiac Surgery. 35 (9) (pp 2155-2157), 2020. Date of
Publication: 01 Sep 2020.
Author
Robinson N.B.; Tatoulis J.; Gaudino M.
Institution
(Robinson, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Tatoulis) Royal Melbourne Hospital, University of Melbourne, Melbourne,
VIC, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
With the resurgence of the radial artery in coronary artery bypass
grafting, the debate on the optimal harvesting technique continues. Here,
we comment on a randomized series in which the authors conclude that
endoscopic harvesting techniques offer the benefit of improved cosmetic
outcomes and decreased neurological complications with comparable
graft-related outcomes when compared with open harvesting. We conclude
that although this study is well designed and conducted, there are several
areas of concern including surgical technique and statistical
power.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<50>
Accession Number
2004947404
Title
Early valve replacement for severe aortic valve disease: Effect on
mortality and clinical ramifications.
Source
Journal of Clinical Medicine. 9 (9) (pp 1-22), 2020. Article Number: 2694.
Date of Publication: September 2020.
Author
Koerber J.P.; Bennetts J.S.; Psaltis P.J.
Institution
(Koerber) Department of Anaesthesia, Flinders Medical Centre, Adelaide, SA
5042, Australia
(Bennetts) Department of Cardiac and Thoracic Surgery, Flinders Medical
Centre, Adelaide, SA 5042, Australia
(Bennetts) College of Medicine and Public Health, Flinders University,
Adelaide, SA 5042, Australia
(Psaltis) Adelaide Medical School, Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, SA 5000, Australia
(Psaltis) Vascular Research Centre, Lifelong Health Theme, South
Australian Health and Medical Research Institute, Adelaide, SA 5000,
Australia
(Psaltis) Department of Cardiology, Central Adelaide Local Health Network,
Adelaide, SA 5000, Australia
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Timing of aortic valve intervention for chronic aortic regurgitation (AR)
and/or aortic stenosis (AS) potentially affects long-term survival. The
2014 American Heart Association/American College of Cardiology (AHA/ACC)
guidelines provide recommendations for the timing of intervention.
Subsequent to the guidelines' release, several studies have been published
that suggest a survival benefit from earlier timing of surgery for severe
AR and/or AS. The aim of this review was to determine whether patients who
have chronic aortic regurgitation (AR) and/or aortic stenosis (AS) have a
survival benefit from earlier timing of aortic valve surgery. Medical
databases were systematically searched from January 2015 to April 2020 for
randomized controlled trials (RCTs) and observational studies that
examined the timing of aortic valve replacement surgery for chronic AR
and/or AS. For chronic AR, four observational studies and no RCTs were
identified. For chronic AS, five observational studies, one RCT and one
meta-analysis were identified. One observational study examining mixed
aortic valve disease (MAVD) was identified. All of these studies, for AR,
AS, and MAVD, found long-term survival benefit from timing of aortic valve
surgery earlier than the current guidelines. Larger prospective RCTs are
required to evaluate the benefit of earlier surgical
intervention.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI,
Basel, Switzerland.

<51>
Accession Number
632609660
Title
Inotropes for the prevention of low cardiac output syndrome and mortality
for paediatric patients undergoing surgery for congenital heart disease: a
network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2020 (8) (no pagination), 2020.
Article Number: CD013707. Date of Publication: 19 Aug 2020.
Author
Burkhardt B.E.U.; Hummel J.; Rucker G.; Stiller B.
Institution
(Burkhardt) Department of Cardiology, Kinderspital Zurich, Zurich,
Switzerland
(Hummel, Stiller) Department of Congenital Heart Defects and Pediatric
Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
(Rucker) Institute of Medical Biometry and Statistics, Faculty of Medicine
and Medical Center - University of Freiburg, Freiburg, Germany
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To compare in a network meta-analysis the
efficacy and safety of different prophylactic medications either against
no treatment, or placebo, or against each other (as mono- or combination
prophylaxis) for the prevention of low cardiac output syndrome and
mortality for paediatric patients undergoing surgery for congenital heart
disease. To generate a clinically useful ranking of prophylactic
medications (mono- and combination prophylaxis) according to efficacy and
safety.<br/>Copyright &#xa9; 2020 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<52>
Accession Number
632557008
Title
Hospital costs and prognosis in end-stage renal disease patients receiving
coronary artery bypass grafting.
Source
BMC Nephrology. 21 (1) (no pagination), 2020. Article Number: 333. 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, Chiali,
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
BioMed Central (E-mail: info@biomedcentral.com)
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 +/- 10.04 years. Of these patients, 29.2% were
aged >=70 years, and 66.7% were male. ESRD patients had marginally higher
intensive care unit (ICU) stays (11.06 vs 7.24 days) 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. <br/>Copyright &#xa9; 2020 The Author(s).

<53>
Accession Number
2007513033
Title
Metastatic pulmonary calcifications postcardiac transplant in a
15-year-old patient: A case report and review of literature.
Source
Radiology Case Reports. 15 (10) (pp 1978-1982), 2020. Date of Publication:
October 2020.
Author
AlNuaimi D.; ElKaissi M.; Wahla A.; Shafiq I.; Abdulghaffar S.
Institution
(AlNuaimi, ElKaissi, Wahla, Shafiq) Cleveland Clinic Abu Dhabi, AlMaryah
Island, Abu Dhabi, United Arab Emirates
(Abdulghaffar) Rashid Hospital, Dubai Health Authority, Dubai, United Arab
Emirates
Publisher
Elsevier Inc
Abstract
Metastatic pulmonary calcification is a metabolic lung disease that occurs
due to a prolonged hypercalcemic state where calcium salts precipitate
into numerous foci or nodules of fluffy calcifications in the lung apices,
usually bilaterally. Calcifications can also occur in other organs such as
in the stomach and the kidneys. It is often underdiagnosed and is usually
associated with end stage renal failure and resultant secondary
hyperparathyroidism. Nevertheless, it is rarely reported in the
postcardiac surgery status and cardiac transplant patients. We present a
case of a 15-year-old male patient with a recent history of cardiac
transplant due to a complex congenital heart disease where findings of
extensive metastatic pulmonary calcifications were seen a routine
follow-up chest radiograph. Clinical manifestations of metastatic
pulmonary calcifications can range from having no symptoms or mild dyspnea
on exertion to fulminant respiratory failure. Therefore, early recognition
of imaging features and initiation of proper management is crucial to the
patient's outcome.<br/>Copyright &#xa9; 2020

<54>
Accession Number
2004921793
Title
Pcsk9 inhibitors, the most significant advance in lipilowering therapy
since statins? A literature review.
Source
Osteopathic Family Physician. 11 (4) (pp 24-30), 2019. Date of
Publication: July-August 2019.
Author
Wilson A.
Institution
(Wilson) Department of Medicine, San Antonio Uniformed Services Health
Education Consortium, Joint Base San Antonio, Fort Sam Houston, TX, United
States
Publisher
American College of Osteopathic Family Physicians (E-mail:
belindab@acofp.org)
Abstract
OBJECTIVE: The purpose of this study was to evaluate efficacy, safety and
cost of PCSK9 inhibitors. <br/>METHOD(S): PubMed was used to search for
literature regarding PCSK9 inhibitors up to May 1, 2018. Clinical trials,
systematic reviews, meta-analyses and prescribing information were
utilized for this review. Inclusion criteria was Phase II, III randomized
control trials (RCT) and review articles comparing treatment of
hypercholesterolemia in adults with and without PCSK9 inhibitors. All
studies were completed from 2012-2017 and were conducted primarily in
America. <br/>RESULT(S): Evolocumab and alirocumab are the only FDA
approved PCSK9 inhibitors and have been shown to reduce baseline LDL-C by
50-60% in multiple clinical trials. Although there is no proven all-cause
or cardiovascular mortality benefit associated with these drugs, there is
a significant reduction in myocardial infarction (MI), stroke and coronary
revascularization in treatment groups. DISCUSSION: Low-density lipoprotein
cholesterol (LDL-C) is a well characterized risk factor for cardiovascular
disease (CVD). While hypercholesterolemia is often well controlled with
statins, there remains a need for additional lipid lowering therapy in
select patients. PCSK9 inhibitors represent a novel approach to lowering
LDL-C in patients with familial hypercholesterolemia and clinical
atherosclerotic cardiovascular disease (ASCVD) alone or in combination
with other cholesterol lowering medications. PCSK9 inhibitors are well
tolerated, with the most common side effects being local injection site
reactions and flu-like symptoms. High cost remains the most significant
obstacle for widespread use. PCSK9 inhibitors have a valuable role in the
lipid lowering treatment algorithm with their full therapeutic potential
yet to be realized.<br/>Copyright &#xa9; American College of Osteopathic
Family Physicians. All rights reserved.

<55>
Accession Number
2007560582
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: 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, Lourenco, Leite-Moreira) Cardiovascular
Research and Development Center, Department of Surgery and Physiology,
Faculty of Medicine of the University of Porto, Porto, Portugal
(Lourenco) 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) Department of Cardiothoracic Surgery, Centro Hospitalar
Universitario Sao Joao, Porto, Portugal
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: We conducted a meta-analysis of randomized controlled trials
(RCTs) and propensity score (PS) studies comparing survival and major
adverse cardiac and cerebrovascular events (MACCEs) of patients who
underwent coronary artery bypass grafting (CABG) with multiple (MAG)
versus single arterial grafting (SAG). <br/>Method(s): MEDLINE, Web of
Science and Cochrane Library were used to find relevant literature
(1960-2018). Survival at a follow-up >=1 year, MACCEs and early outcomes
were evaluated. Time-to-event outcomes were collected through hazard ratio
(HR) along with their variance, and the other endpoints using frequencies
from matched sample or adjusted odds ratios. Random effect models were
used to compute combined statistical measures and 95% confidence intervals
(CI) through generic inverse variance method (time-to-event) or
Mantel-Haenszel method (binary events). <br/>Result(s): Twenty-nine PS
cohorts and 8 RCTs comprising 122,832 patients (52,178 MAG and 70,654 SAG)
were included in this meta-analysis. MAG was associated with lower early
mortality (OR: 0.82, 95%CI: 0.71-0.95, p = .007), long-term mortality (HR:
0.76, 95%CI: 0.73-0.78, p < .001) and MACCEs (HR: 0.85, 95%CI: 0.79-0.91,
p < .001). Increased risk of sternal wound complications (SWC) was only
observed when the bilateral internal mammary artery configuration was used
for MAG (OR MAG BIMA: 1.96, 95%CI: 1.37-2.81, p < .001).
<br/>Conclusion(s): Although the BIMA configuration increases the risk of
SWC, MAG improves both early and long-term survival as well as MACCEs in
CABG.<br/>Copyright &#xa9; 2020

<56>
Accession Number
632648910
Title
Risk factors for hospital readmission in adult patients with heart failure
with reduced ejection fraction: a systematic review.
Source
JBI evidence synthesis. (no pagination), 2020. Date of Publication: 06 Jul
2020.
Author
Schjodt I.; Liljeroos M.; Larsen P.; Johnsen S.P.; Stromberg A.; Logstrup
B.B.
Institution
(Schjodt) 1Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark 2Department of Health, Medicine and Caring Sciences, Linkoping
University, Linkoping, Sweden 3Centre for Clinical Research Sormland,
Uppsala University, Eskilstuna, Sweden 4Health Sciences Research Center,
University College Lillebaelt, Odense, Denmark 5Danish Center for Clinical
Health Services Research, Department of Clinical Medicine, Aalborg
University, Aalborg, Denmark 6Department of Cardiology, Linkoping
University Hospital, Linkoping, Sweden 7Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this review was to identify and synthesize
evidence on risk factors associated with hospital readmission within the
first year after heart failure (HF) hospitalization among patients with HF
with reduced left ventricular ejection fraction (LVEF). INTRODUCTION:
Heart failure is associated with a high risk of hospital readmission.
Readmissions are associated with higher mortality and health care costs.
It is a high health care priority to identify vulnerable patients with HF
who may potentially benefit from targeted personalized care interventions
aiming to reduce readmissions. INCLUSION CRITERIA: This review considered
studies including adult patients who had HF with a reduced LVEF <= 40% who
were discharged after a HF hospitalization. We included studies with
experimental and observational designs evaluating risk factors for i)
all-cause hospital readmission, ii) HF hospital readmission, and iii)
composite outcomes within 7, 15, 30, 60, 90, 180, and 365 days after
hospital discharge. Composite outcomes included end points where all-cause
readmission and/or HF readmission were part of a defined end point (i.e.
all-cause readmission or mortality; HF readmission or mortality;
cardiovascular readmission; cardiovascular readmission or mortality; and
readmission, mortality, or cardiac transplant. Studies reporting all-cause
readmission and/or HF readmission as a primary outcome, secondary outcome,
or part of a composite outcome were included. <br/>METHOD(S): PubMed,
Embase, CINAHL, Cochrane CENTRAL, PsycINFO, OpenGrey, MedNar, DART-Europe,
ProQuest Dissertations and Theses, and the Grey Literature Report in
Public Health were searched to find both published and unpublished studies
in English, Swedish, Norwegian, or Danish from 2000 to June 2018. Study
selection, critical appraisal, data extraction, and data synthesis
followed the JBI approach for systematic reviews. Statistical pooling was
not possible due to clinical and methodological heterogeneity of the
studies included and the lack of risk factors reported more than once. A
narrative summary of the findings was consequently performed.
<br/>RESULT(S): Fifty-two studies, including one randomized controlled
trial and 51 cohort studies with a total of 128,186 participants, were
included. Risk factors for readmission were reported for 30-day outcome in
16 studies, 60-day in three studies, 90-day in 15 studies, 180-day in 12
studies, and 365-day outcome in 15 studies. Based on multivariable
analyses from 43 cohort studies and results from one randomized controlled
trial, we identified several factors associated with higher risk of
all-cause readmission, HF readmission, and composite outcomes (e.g.
readmission or death within 30, 60, 90, 180, and 365 days after discharge
for a HF hospitalization). <br/>CONCLUSION(S): This review provides a
comprehensive overview of factors associated with a clinical outcome after
a HF hospitalization in patients with HF with LVEF <= 40%. Owing to the
heterogeneity of variables investigated and the lack of comparability of
findings, the clinical impact of the identified risk factors remains
uncertain. This review highlights research gaps and the need for a
standardized way to define and measure all-cause readmission, HF
readmission, and composite end points in clinical research to improve
study quality and enable comparison of findings between studies.

<57>
Accession Number
632648573
Title
Effect of intrathecal morphine plus patient-controlled analgesia with
morphine versus patient-controlled analgesia with morphine alone on total
morphine dosage 24 hours after surgery: a systematic review.
Source
JBI evidence synthesis. (no pagination), 2020. Date of Publication: 28 May
2020.
Author
Pitre L.; Garbee D.; Tipton J.; Schiavo J.; Pitt A.
Institution
(Pitre) School of Nursing, United States 2School of Dentistry, Louisiana
State University Health Sciences Center, United States 3The Louisiana
Center for Promotion of Optimal Health Outcomes: a JBI Center of
Excellence, New Orleans, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this review was to evaluate the effects of
preoperative intrathecal morphine (ITM) in addition to patient-controlled
analgesia with morphine (PCAM) versus PCAM without preoperative ITM on
total morphine dosage in the first 24 hours postoperatively in adult
patients undergoing abdominal or thoracic surgery. INTRODUCTION:
Postoperative pain is a significant problem for patients undergoing major
abdominal and thoracic surgery. Intrathecal morphine can reduce
postoperative pain and reduce intravenous (IV) morphine requirements
during the first 24 hours after surgery; however, the amount of IV
morphine dose reduction achieved has not been well established. This
knowledge could help anesthesia providers determine if ITM is an
appropriate analgesic option for patients. INCLUSION CRITERIA: This review
included studies with participants 18 years of age or older receiving
general anesthesia (GA) for abdominal or thoracic surgery. Studies were
included that used the intervention of preoperative ITM in addition to
PCAM) versus PCAM without preoperative ITM. Total morphine dosage in
milligrams during the first 24 hours after surgery was the outcome of
interest. <br/>METHOD(S): A search of PubMed and CINAHL was conducted for
studies published between January 1984 and October 2018 using the key
terms intrathecal, morphine, postoperative, pain, patient-controlled
analgesia and general anesthesia. Index terms and keywords from identified
articles were used to search CINAHL, Cochrane Central Register of
Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE,
ProQuest Dissertations and Thesis/Nursing and Allied Health Databases and
Scopus. The reference lists of articles that underwent critical appraisal
were searched for additional studies. Methodological quality was assessed
using the JBI Critical Appraisal Checklist for Randomized Control Trials.
Two independent reviewers assessed each selected article. Study results
were pooled in statistical meta-analysis using the JBI System for the
Unified Management, Assessment and Review of Information, and two studies
were described in narrative form. Differences in IV morphine dosage
between the ITM plus PCAM and PCAM alone groups were calculated to produce
the weighted mean difference (WMD) utilizing a 95% confidence interval.
Heterogeneity was assessed using Chi-square and I values. Subgroup
analysis was conducted on two studies that included IV non-opioid
analgesia in addition to ITM and PCAM for postoperative analgesia.
<br/>RESULT(S): Seven RCTs with a total sample size of 352 were included
in this review. Five studies that evaluated postoperative total morphine
dosage in milligrams with and without preoperative ITM were included for
statistical meta-analysis, with 277 participants from four countries.
Total morphine dosage was significantly reduced in patients who received
ITM (WMD = -24.44 mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without
ITM. Subgroup analysis of two studies, involving 112 participants using IV
acetaminophen in addition to ITM and PCAM, indicated no additional benefit
after ITM was already administered (WMD = -25.93, 95% CI -32.05 to -19.80
mg). Two studies with 75 participants were described narratively because
total morphine dosage was reported as median rather than mean values.
<br/>CONCLUSION(S): In this review, ITM provided a significant decrease in
overall total morphine dosage during the first 24 hours after surgery in
abdominal surgery patients. The addition of IV non-opioids to the
postoperative analgesia protocol showed no additional reduction in
postoperative IV morphine dosage between groups.

<58>
Accession Number
365049465
Title
Prevention of immune-mediated transfusion-related acute lung injury; from
bloodbank to patient.
Source
Current Pharmaceutical Design. 18 (22) (pp 3241-3248), 2012. Date of
Publication: July 2012.
Author
Muller M.C.A.; Porcelijn L.; Vlaar A.P.J.
Institution
(Muller, Vlaar) Department of Intensive Care Medicine, Academic Medical
Center, Amsterdam, Netherlands
(Vlaar) Department of Internal Medicine, Academic Medical Center,
Amsterdam, Netherlands
(Muller, Vlaar) Laboratory of Experimental Intensive Care and
Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam,
Netherlands
(Porcelijn) Sanquin Diagnostic Services, Amsterdam, Netherlands
Publisher
Bentham Science Publishers
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of
transfusion related morbidity and mortality. Immunemediated TRALI is
caused by leucocyte and neutrophil antibodies in the transfused blood
products that react with white blood cell antigens of the recipient,
hereby inducing endothelial damage and lung injury. About two thirds of
TRALI cases are thought to be immunemediated. Both Human Leucocyte
Antibodies (HLA Class I and II) and Human Neutrophil Antibodies (HNA) are
involved in TRALI. Most antibodies result from allo-exposure of the blood
donor, with multiparous donors having the highest incidence of antibodies.
Detection of anti-leucocyte and anti-neutrophil antibodies is complex and
many uncertainties still exist regarding the interpretation of the test
results. In this review we discuss the evidence and effectiveness of
measurements to prevent immune-mediated TRALI from a bloodbank and bedside
perspective. From a bloodbank perspective various preventive measures have
been implicated. In some countries bloodbanks have successfully
implemented donor selection strategies, ranging from testing of
allo-exposed donors for leucocyte antibodies to the exclusion of all
females from donating high plasma volume products. Another strategy
involves dilution of antibodies present by pooling of plasma donations of
multiple donors. From a bedside view, the most important measure to
prevent TRALI is to limit patients' exposure to allogenic bloodproducts.
Furthermore recognition and awareness of the syndrome need to be
heightened among clinicians. &#xa9; 2012 Bentham Science Publishers.

<59>
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.

<60>
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.

<61>
[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.

<62>
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.

<63>
Accession Number
2006731266
Title
Efficacy of different doses of omega-3 fatty acids on cardiovascular
outcomes: Rationale and design of a network meta-analysis.
Source
Minerva Cardioangiologica. 68 (1) (pp 47-50), 2020. Date of Publication:
February 2020.
Author
Lombardi M.; Chiabrando J.G.; Vescovo G.M.; Bressi E.; Del Buono M.G.;
Carbone S.; Koenig R.; van Tassell B.W.; Dixon D.L.; Abbate A.; Biondi
Zoccai G.
Institution
(Lombardi, Bressi, Del Buono, Carbone, van Tassell, Abbate) VCU Pauley
Heart Center, Division of Cardiology, Department of Internal Medicine,
Virginia Commonwealth University, Richmond, VA, United States
(Lombardi, Del Buono) Department of Cardiovascular and Thoracic Sciences,
Sacred Heart Catholic University, Rome, Italy
(Chiabrando) Interventional Cardiology Service, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina
(Chiabrando) Health Science Statistics Applied Laboratory (LEACS),
Department of Pharmacology and Toxicology, University of Buenos Aires,
Buenos Aires, Argentina
(Vescovo) Department of Cardiac Thoracic, Vascular Sciences and Public
Health, University of Padua, Padua, Italy
(Carbone) Department of Kinesiology and Health Sciences, College of
Humanities and Sciences, Virginia Commonwealth University, Richmond, VA,
United States
(Koenig) Tompkins-McCaw Library for the Health Sciences, VCU Libraries
Virginia Commonwealth University, Richmond, VA, United States
(van Tassell, Dixon) Department of Pharmacotherapy and Outcomes Science,
Virginia Commonwealth University, Richmond, VA, United States
(Biondi Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Italy
(Biondi Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The impact of omega-3 fatty acids (O3FA) supplementation on
cardiovascular risk is still in debate, largely due to the heterogeneity
of population enrolled and variable dose and composition of the
formulations used in the previous studies. Yet, O3FA may favorably impact
on cardiovascular risk by reducing major cardiovascular events (including
cardiac death and ischemic events). EVIDENCE ACQUISITION: We aim to
perform a comprehensive review of the topic of O3FA for cardiovascular
prevention, stemming from a systematic review, to pairwise meta-analysis
and network meta-analysis, limiting our inclusion only to randomized
clinical trials comparing low dose (LD) (<1 g per day) O3FA and high dose
(HD) (>1 g per day) O3FA versus placebo. The efficacy outcomes of interest
are total death, cardiac death, sudden cardiac death, myocardial
infarction, stroke, coronary revascularization, unstable angina and major
vascular events. Safety outcomes of interest are bleeding,
gastrointestinal disturbances and atrial fibrillation events. EVIDENCE
SYNTHESIS: This meta-analysis is expected to include several important
studies on cardiovascular primary and secondary prevention and detail on
important cardiovascular outcomes. Furthermore, we intend to highlight
safety outcomes related to O3FA supplementation. <br/>CONCLUSION(S): The
present network meta-analysis results will aid physicians in the decision
to prescribe O3FA in patients with or at risk of cardiovascular events. In
particular, it will be able to solve controversies emerged from previous
randomized clinical trials and meta-analyses regarding the benefit of
different doses of O3FA supplementation in the cardiovascular
prevention.<br/>Copyright &#xa9; 2019 EDIZIONI MINERVA MEDICA

<64>
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.

<65>
Accession Number
2004835121
Title
A Prospective Randomized Blinded Trial of Remote Ischemic Preconditioning
in Children Undergoing Cardiac Surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (2) (pp 313-322),
2020. Date of Publication: Summer 2020.
Author
Verdesoto Rodriguez M.C.; Spenceley N.; Ilina M.; Danton M.H.D.
Institution
(Verdesoto Rodriguez) University of Glasgow, Glasgow, United Kingdom
(Spenceley, Ilina, Danton) Royal Children's Hospital, Glasgow, United
Kingdom
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) has been proposed as an
intervention to protect myocardium and attenuate end-organ dysfunction
associated with cardiopulmonary bypass. We investigated the effect of RIPC
in children undergoing cardiopulmonary bypass involving clinical outcome,
cardiac and end-organ function, inflammatory response, and myocardial gene
expression. A prospective, investigator-blinded, randomized, controlled
trial was performed. Patients were randomized into RIPC or Control; RIPC
consisted of three 5-minute cycles of limb ischemia-reperfusion taking
place 1 and 12 hours preoperatively. Clinical outcomes included cardiac
function, ICU surveillance, and renal function. In addition, inflammatory
markers and myocardial gene expression were evaluated. RIPC patients
required shorter ICU stay (days), RIPC: 1.8 (0.94-3.88) vs Control: 4.9
(1.63-7.20), P = 0.029. Echocardiography parameters demonstrated reduced
biventricular function following surgery showing no difference between
groups. A nonsignificant trend for reduced troponin was observed following
RIPC: AUC analysis, RIPC: 393.05 (98.85-1038.73) vs Control: 596.10
(225.38-954.24) P = 0.75. B-type natriuretic peptide and renal function
parameters were similar between groups. Postoperative TNF-alpha was
significantly reduced after RIPC, RIPC: 15.42 (7.81-114.86) vs Control:
108.98 (42.28-301.19) P = 0.02. Remaining inflammatory markers
demonstrated no significant difference between groups. HSP-60 showed lower
myocardial expression following RIPC, RIPC: 3.95 (2.69-6.28) vs Control:
6.83 (4.74-8.81), P = 0.05. Expression of other analyzed genes was not
influenced by RIPC. RIPC was associated with shorter ICU stay and reduced
TNF-alpha but did not influence other clinical outcomes, not confer
protection against cardiac injury or renal dysfunction. The association
between RIPC and ICU stay may be influenced by unaccounted latent
variables, including cardiac morphology.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<66>
Accession Number
629554197
Title
Perioperative Gabapentin in Pediatric Thoracic Surgery
Patients-Randomized, Placebo-Controlled, Phase 4 Trial.
Source
Pain medicine (Malden, Mass.). 21 (8) (pp 1562-1571), 2020. Date of
Publication: 01 Aug 2020.
Author
Tomaszek L.; Fenikowski D.; Maciejewski P.; Komotajtys H.; Gawron D.
Institution
(Tomaszek, Fenikowski, Maciejewski, Komotajtys, Gawron) Department of
Thoracic Surgery, Institute of Tuberculosis and Lung Diseases, Rabka-Zdroj
Branch, Poland
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine whether the use of perioperative gabapentin
reduces postoperative pain and anxiety, decreases ropivacaine consumption
and side effects, and improves patient satisfaction. DESIGN: Randomized,
placebo-controlled, phase 4 trial. BLINDING: Participants, care providers,
investigators, data analysts. SETTING: Department of Thoracic Surgery of
the Institute of Tuberculosis and Lung Disease, Rabka Zdroj Branch,
Poland. SUBJECTS: Forty patients undergoing the Ravitch procedure.
<br/>METHOD(S): Patients aged nine to 17years were randomized into a
gabapentin (preoperative 15mg/kg, treatment) or placebo group.
Postoperative analgesia included gabapentin (7.5mg/kg) or placebo two
times per day for three days, epidural ropivacaine + fentanyl,
paracetamol, nonsteroidal anti-inflammatory drugs, and metamizol as a
"rescue drug." Pain, anxiety, analgesic consumption, side effects, and
patient satisfaction were recorded. <br/>RESULT(S): There was no
statistically significant difference in median pain scores (numerical
rating scale < 1/10) or incidence of adverse side effects between the
gabapentin group (N=20) and the placebo group (N=20). Postoperative
anxiety scores were significantly lower than before surgery in the
gabapentin group (6 [4-8] vs 7 [6-8.5], P < 0.01) and remained unchanged
in the placebo group (6 [5-6.5] vs 6 [5-7], P = 0.07). Gabapentin-treated
patients received a lower number of doses of ondansetron when compared
with the placebo group (6 [5-6] vs 7 [6-9], P = 0.02). A significant
negative association was found between patient satisfaction and
postoperative state anxiety in the gabapentin group (R = -0.51, P = 0.02).
<br/>CONCLUSION(S): Perioperative administration of gabapentin resulted in
a decrease of postoperative anxiety in pediatric patients undergoing the
Ravitch procedure.<br/>Copyright &#xa9; 2019 American Academy of Pain
Medicine. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<67>
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. 9 (16) (pp e017347), 2020. Date
of Publication: 18 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.

<68>
Accession Number
632545111
Title
Comparison of outcome of transcatheter aortic valve implantation in
patients with advanced age: A systematic review and meta-analysis.
Source
Medicine. 99 (31) (pp e21443), 2020. Date of Publication: 31 Jul 2020.
Author
Zhu S.; Li H.; Zhang G.; Liu S.; Li Z.
Institution
(Zhu, Li, Zhang, Liu) First Clinical Medical College, Lanzhou University
(Li) Department of Hematology, First Hospital of Lanzhou University,
Lanzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective
treatment to aortic stenosis in patients with advanced age. However, age
is recognized as one of the most important risk factors. The aim of our
study is to compare the outcome of TAVI between octogenarian patients and
young patients. <br/>METHOD(S): Randomized controlled trials, cohort
studies and propensity score matching studies will be included in our
systematic review and meta-analysis to evaluate clinical outcome in
octogenarian patients who undergo TAVI. PubMed, EMBASE, MEDLINE, Cochrane
Library and Web of Science will be searched using a comprehensive
strategy. The related conference proceedings and reference lists of the
included studies will also be checked to identify additional studies.
Retrieved records, extract information and assess the risk of bias will be
screened by two reviewers independently. STATA software will be used to
conduct data synthesis. There is no requirement of ethical approval and
informed consent. <br/>RESULT(S): This study will eventually be published
in a peer reviewed journal in the form of a scientific paper.
<br/>CONCLUSION(S): This study will provide a comprehensive review of the
available evidence for the treatment of aortic stenosis in octogenarian
patients underwent TAVI. We hope it will provide a relatively
comprehensive reference for clinical practice and future relevant clinical
trials. PROSPERO REGISTRATION NUMBER: CRD42020155189. STUDY PROTOCOL
REGISTRY: The protocol has been registered in PROSPERO, which is an
International Prospective Register of Systematic Reviews. The registration
number is CRD42020155189. ETHICS AND DISSEMINATION: Ethics approval and
patient consent are not required as this study is a systematic review and
meta-analysis.

<69>
Accession Number
632237880
Title
Incidence and risk factors for new-onset atrial fibrillation following
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Intensive & critical care nursing. 60 (pp 102897), 2020. Date of
Publication: 01 Oct 2020.
Author
Higgs M.; Sim J.; Traynor V.
Institution
(Higgs) School of Nursing, Faculty of Science, Medicine and Health,
University of Wollongong, NSW, Wollongong, Australia
(Sim, Traynor) School of Nursing, Faculty of Science, Medicine and Health,
University of Wollongong, NSW, Wollongong, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To estimate the incidence of new-onset post-operative atrial
fibrillation after isolated coronary artery bypass surgery and summarise
the evidence on risk factors that predispose people to developing the
complication. STUDY DESIGN/METHODS: A systematic review was conducted to
identify studies from the CINAHL, MEDLINE and Cochrane databases. A title
and abstract review was conducted by one reviewer. Full text review and
quality assessment processes were conducted by two reviewers. Incidence
data was combined in meta-analysis using the 'metaprop' routine in Stata
and risk factor data were synthesised in narrative and table format.
<br/>RESULT(S): Ten studies, including 6173 participants, were included in
the review. The estimated pooled incidence of post-operative atrial
fibrillation was 25% (CI 0.19-0.30). In a secondary meta-analysis
including studies that only included first time bypass surgery recipients
the estimated pooled incidence was 26% (CI 0.14-0.41). Due to high levels
of heterogeneity these results should be interpreted with caution. Risk
factors with the strongest associations to post-operative atrial
fibrillation were chronic obstructive pulmonary disease, decreased partial
pressure of oxygen on air, congestive heart failure, right coronary artery
disease, male gender, prolonged cross clamp time and port-operative
inotropic exposure. <br/>CONCLUSION(S): Further prospective studies are
needed to strengthen the current evidence base.<br/>Copyright &#xa9; 2020
Elsevier Ltd. All rights reserved.

<70>
Accession Number
631716346
Title
Comparison of the Zurich Observation Pain Assessment with the Behavioural
Pain Scale and the Critical Care Pain Observation Tool in nonverbal
patients in the intensive care unit: A prospective observational study.
Source
Intensive & critical care nursing. 60 (pp 102874), 2020. Date of
Publication: 01 Oct 2020.
Author
Frohlich M.R.; Meyer G.; Spirig R.; Bachmann L.M.
Institution
(Frohlich) Kantonsspital Aarau (Switzerland), Department of Clinical
Nursing Science & Department of Perioperative Medicine; Martin Luther
University Halle-Wittenberg (Germany), Institute for Health and Nursing
Science. Electronic address: martin.froehlich@ksa.ch
(Meyer) Martin Luther University Halle-Wittenberg (Germany), Institute for
Health and Nursing Science
(Spirig) University of Basel (Switzerland), Institute for Nursing Science
(Bachmann) Zurich (Switzerland)Switzerland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine the concordance of Zurich Observation Pain
Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical
Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU
patients. DESIGN: Prospective observational study [BASEC-Nr.
PB_2016-02324]. SETTING: A total of 49 ICU patients from cardiovascular,
visceral and thoracic surgery and neurology and neurosurgery were
recruited. Data from 24 patients were analyzed. MAIN OUTCOME MEASUREMENTS:
Three independent observers assessed pain with the BPS, the CPOT or ZOPA
prior, during and after a potential painful nursing intervention. Tools
were randomized concerning the pain management after each pain assessment.
Frequency of nine additional pain indicating items from a previous
qualitative, explorative study was calculated. <br/>RESULT(S): ZOPA was
positive in 32 of 33 measuring cycles (97.0%; 95%CI: 84.2-99.9%), followed
by the CPOT (28/33 cycles, 84.8%; 95%CI: 68.1-94.9%) and the BPS (23/33
cycles, 67.0%; 95%CI: 51.3-84.4%). In 22/33 cycles all tools were
concordant (66.7%; 95%CI: 48.2-82.0%). Analgesics were provided in 29 out
of 33 cycles (87.9%; 95%CI: 71.8-96.6%). Additional pain indicating items
were inconsistently reported. <br/>CONCLUSION(S): ZOPA is concordant with
the BPS and the CPOT to indicate pain but detects pain earlier due to the
low threshold value. Inclusion of further items does not improve pain
assessment.<br/>Copyright &#xa9; 2020 Elsevier Ltd. All rights reserved.

<71>
Accession Number
2005688398
Title
Discontinuation of anticoagulants after successful surgical ablation of
atrial fibrillation.
Source
Journal of Cardiac Surgery. 35 (9) (pp 2216-2223), 2020. Date of
Publication: 01 Sep 2020.
Author
Lauritzen D.J.; Vodstrup H.J.; Christensen T.D.; Hald M.O.; Christensen
R.; Heiberg J.
Institution
(Lauritzen, Vodstrup, Christensen, Hald, Christensen, Heiberg) Department
of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus,
Denmark
(Lauritzen, Vodstrup, Christensen, Hald, Heiberg) Department of Clinical
Medicine, Aarhus University, Aarhus, Denmark
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The decision of whether to continue oral anticoagulation
therapy (OAT) after successful surgical ablation of atrial fibrillation is
challenging, and current guidelines provide no specific recommendations on
whether or not it is safe to terminate OAT. Therefore, the aim of this
study was to assess long-term outcomes in patients who either did or did
not, receive OAT after surgical ablation of atrial fibrillation.
<br/>Method(s): In a prospective follow-up study, patients were included
if surgical ablation of atrial fibrillation concomitantly with other
cardiac surgery was done, between 2004 and 2018 at Aarhus University
Hospital, Denmark. After 12 months, OAT was discontinued if: (a) sinus
rhythm was documented by electrocardiogram, (b) atrial fibrillation was
absent on 5-day Holter monitoring, (c) CHADS<inf>2</inf> score <=2, and
(d) no other indications for OAT were present. Follow-up was ended in
April 2019. <br/>Result(s): A total of 560 patients underwent surgical
ablation of which 436 patients reached the baseline at 12 months; 286
patients received OAT, and 150 had OAT discontinued. Survival analysis
revealed no differences between the two groups (P =.723). Mean survival
time in the group receiving OAT was 5.3 +/- 3.3 years, compared to 5.1 +/-
3.0 years in the group where OAT was discontinued (P =.784). There was no
difference in major adverse cardiac and cerebrovascular events between the
two groups (P =.846). <br/>Conclusion(s): Discontinuation of OAT is safe
in patients with a CHADS<inf>2</inf> score <=2 following successful
surgical ablation and left atrial appendage occlusion. This conclusion
needs to be confirmed in randomized trials.<br/>Copyright &#xa9; 2020
Wiley Periodicals LLC

<72>
Accession Number
2005619680
Title
A comparison of figure-of-8-suture versus manual compression for venous
access closure after cardiac procedures: An updated meta-analysis.
Source
PACE - Pacing and Clinical Electrophysiology. 43 (8) (pp 856-865), 2020.
Date of Publication: 01 Aug 2020.
Author
Mujer M.T.; Al-Abcha A.; Flores J.; Saleh Y.; Robinson P.
Institution
(Mujer, Al-Abcha, Saleh) Department of Medicine, Michigan State
University, East Lansing, MI, United States
(Flores) University of the Philippines College of Medicine, Manila,
Philippines
(Robinson) Pat and Jim Calhoun Cardiology Center, University of
Connecticut, Farmington, CT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Manual compression (MC) is the current standard to achieve
postprocedural hemostasis in patients who need venous vascular access
closure after cardiovascular procedures. Figure-of-8 (F8) suture for
venous access closure has been reported to be a safe and efficacious
alternative to MC. <br/>Method(s): A systematic search was done using
PubMed, Google Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without
language restriction up until April 15, 2020 for studies comparing F8
suture versus MC. Risk ratio (RR) and mean difference (MD) with 95%
confidence interval (CI) were calculated using a random effects model.
<br/>Result(s): Time to achieve hemostasis was significantly reduced in
the F8 arm [MD -21.04 min (95% CI: -35.66 to -6.42; P =.005)]. Access site
bleeding was significantly lower in the F8 group [RR 0.35 (95% CI: 0.18 to
0.66; P =.001)] along with a lower incidence of hematoma formation [RR
0.42 (95% CI: 0.26 to 0.67; P =.0003)]. There was no significant
difference in rates of fistula or pseudoaneurysm formation between the two
groups. Overall access site complications were lower in the F8 arm [RR
0.38 (95% CI: 0.26 to 0.55; P <.00001)] and the effect was more pronounced
for sheaths >=10 Fr [RR 0.33 (95% CI: 0.18 to 0.60; P =.0003)]. There was
lower postprocedural protamine use in the F8 group [RR 0.07 (95% CI: 0.01
to 0.36; P =.001)]. <br/>Conclusion(s): For large-bore venous access
closure, the F8 suture results in a shortened time to achieve hemostasis
along with a lower overall risk of access site complications and
postprocedural protamine use.<br/>Copyright &#xa9; 2020 Wiley Periodicals
LLC

<73>
Accession Number
2005609220
Title
Is carotid screening redundant for patients undergoing coronary artery
bypass grafting?.
Source
Journal of Cardiac Surgery. 35 (9) (pp 2297-2306), 2020. Date of
Publication: 01 Sep 2020.
Author
Volpi S.; Ali J.M.
Institution
(Volpi, Ali) Department of Cardiothoracic Surgery, Royal Papworth
Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Stroke is a devastating complication following coronary artery
bypass grafting, which thankfully occurs with low incidence. The role of
preoperative carotid ultrasound remains unclear. Whilst it is a cheap and
reliable way of diagnosing carotid stenosis (CS), it is unclear if and how
this knowledge should impact on subsequent patient management.
<br/>Method(s): A systematic review of the literature was performed using
the PRISMA guideline. A literature search was conducted on the MEDLINE
database from 1950 to May 2020 using the OVID interface. Fifteen papers
out of a total of 5931 were identified for inclusion. <br/>Result(s): The
evidence overall suggests that patients with severe CS are likely to have
an increased incidence of postoperative stroke-however, the prevalence of
severe CS is low, and even in this cohort of patients, the incidence is
not particularly high. <br/>Conclusion(s): In screened patients identified
to have severe CS, there appears to be a generally low appetite for
undertaking carotid intervention internationally either before or
concurrently with the coronary artery bypass grafting. Putting this all
together, the widespread screening of asymptomatic patients would appear
to not be justified.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<74>
Accession Number
2005572488
Title
Mitral valve repair with minimally invasive approaches vs sternotomy: A
meta-analysis of early and late results in randomized and matched
observational studies.
Source
Journal of Cardiac Surgery. 35 (9) (pp 2307-2323), 2020. Date of
Publication: 01 Sep 2020.
Author
Sa M.P.B.O.; Van den Eynde J.; Cavalcanti L.R.P.; Kadyraliev B.; Enginoev
S.; Zhigalov K.; Ruhparwar A.; Weymann A.; Dreyfus G.
Institution
(Sa, Cavalcanti) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco, PROCAPE, University of Pernambuco, Recife,
Pernambuco, Brazil
(Van den Eynde) Department of Cardiovascular Diseases, Unit of Cardiac
Surgery, University Hospitals Leuven, Leuven, Belgium
(Kadyraliev) Department of Cardiac Surgery, S.G. Sukhanov Federal Center
of Cardiovascular Surgery, E.A. Vagner Perm State Medical University,
Perm, Russian Federation
(Enginoev) Department of Cardiac Surgery, Federal Center for
Cardiovascular Surgery, Astrakhan, Russian Federation
(Enginoev) Department of Cardiovascular Surgery, Astrakhan State Medical
University, Astrakhan, Russian Federation
(Zhigalov, Ruhparwar, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
(Dreyfus) Department of Cardiac Surgery, Institut Montsouris, University
Pierre et Marie Curie, Paris, France
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: Minimally invasive cardiac surgery (MICS)
for mitral valve repair (MVRp) has been increasingly used. This study
aimed to evaluate the early and late results of MICS for MVRp vs
conventional sternotomy. <br/>Material(s) and Method(s): A systematic
review of randomized controlled trials or observational studies (with
matched populations) comparing MICS and conventional MVRp reporting any of
the following outcomes: mortality, MVRp failure, complications, blood
transfusion, readmission within 30 days after discharge, long-term
reoperation for mitral regurgitation, operative times, mechanical
ventilation time, intensive care unit (ICU) stay, or hospital stay. The
pooled treatment effects were calculated using a random-effects model.
<br/>Result(s): Ten studies involving 6792 patients (MICS: 3396 patients;
Conventional: 3296 patients) met the eligibility criteria. In the pooled
analysis, MICS significantly reduced the risk for blood transfusion (odds
ratio [OR], 0.654; 95% confidence interval [CI] 0.462-0.928; P =.017) and
readmission within 30 days after discharge (OR, 0.615; 95% 0.456-0.829; P
=.001). MICS was associated with a significantly longer cross-clamp time
(mean difference 14 minutes; 95% CI, 7.4-21 minutes; P <.001), CPB time
(24 minutes; 95% CI, 14-35 minutes; P <.001), and total operative time
(36; 95% CI, 15-56 minutes; P <.001), but a significantly shorter ICU stay
(-8.5; 95% CI -15; -1.8; P =.013) and hospital stay (-1.3, 95% CI -2.1;
-0.45; P =.003). This meta-analysis found no significant difference
regarding the risk of in-hospital and long-term mortality, nor
complications. <br/>Conclusion(s): Despite longer operative times, MICS
for MVRp reduces ICU and hospital stay, as well as readmission rates and
the need for transfusion.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<75>
Accession Number
2005541054
Title
Prospective randomized trial of endoscopic vs open radial artery harvest
for CABG: Clinical outcome, patient satisfaction, and midterm RA graft
patency.
Source
Journal of Cardiac Surgery. 35 (9) (pp 2147-2154), 2020. Date of
Publication: 01 Sep 2020.
Author
Tamim M.; Alexiou C.; Al-Hassan D.; Al-Faraidy K.
Institution
(Tamim, Alexiou) Department of Cardiac Surgery, King Fahd Military Medical
Complex, Dhahran, Saudi Arabia
(Al-Hassan) Department of Radiology, King Fahd Military Medical Complex,
Dhahran, Saudi Arabia
(Al-Faraidy) Department of Cardiology, King Fahd Military Medical Complex,
Dhahran, Saudi Arabia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim: Endoscopic radial artery (RA) harvest (ERAH) is an
alternative to open RA harvest (ORAH) technique. Our aim was to ascertain
clinical outcomes, patent satisfaction, and 1-year angiographic patency
rates after ERAH and ORAH. <br/>Patients and Methods: A total of 50
patients undergoing coronary artery bypass grafting were prospectively
randomized to two groups. In the ERAH group (25 patients) the RA was
harvested endoscopically and in the ORAH group (25 patients) openly.
<br/>Result(s): There were not differences between the groups in
preoperative characteristics. Length of skin incision was shorter in ERAH
(P <.001) but there were not differences in the length of RA, harvest
time, blood flow, and pulsatility index after ERAH and ORAH. Wound healing
was uniformly smooth in ERAH and there were two hematomas and one
infection in ORAH. Postoperatively, major neuralgias were present in five
patients in ORAH and none in ERAH and minor neuralgias in 11 and 3
patients (P =.02) respectively. Twenty-four patients in ERAH and four in
ORAH graded their experience as excellent (P <.001). One-year angiographic
RA patency was 90% without intergroup difference. Target vessel stenosis
less than 90% adversely affected RA patency (P <.0001).
<br/>Conclusion(s): In expert center, ERAH does not appear to have
negative impact on the time harvest, the length, and quality of RA
conduit, the wound healing, and the occurrence of hand and forearm
complications. In addition, provides excellent cosmetic result and patient
satisfaction. RA graft patency is gratifying when placed to a target
coronary artery vessel with stenosis greater than 90%.<br/>Copyright
&#xa9; 2020 Wiley Periodicals LLC

<76>
Accession Number
2005540955
Title
Surgical vs transfemoral aortic valve replacement in low-risk patients: An
updated meta-analysis of trial and registry data.
Source
Journal of Cardiac Surgery. 35 (9) (pp 2264-2274), 2020. Date of
Publication: 01 Sep 2020.
Author
Luthra S.; Leiva-Juarez M.M.; Ohri S.K.
Institution
(Luthra, Ohri) Wessex Cardiothoracic Centre, Southampton University
Hospitals NHS Trust, Southampton, United Kingdom
(Leiva-Juarez) Department of Surgery, Brookdale University Hospital and
Medical Center, Brooklyn, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Transfemoral aortic valve replacement (TAVR) has been studied
extensively in patients with improving safety and efficacy in high to
intermediate-risk patients with aortic stenosis. TAVR has been now
approved for patients with low surgical risk. <br/>Objective(s): The
purpose of this study is to integrate the evidence from randomized
controlled trials (RCT) and large registry data comparing TAVR to surgical
aortic valve repair (SAVR). <br/>Method(s): Seven studies (three RCTs, one
post hoc study of a RCT, and three registries) were included. Incidence
rate ratios (IRR) of outcomes of interest (overall mortality, 30-day
mortality, cardiovascular death, stroke, pacemaker implantation [PPMI],
myocardial infarction, moderate-severe paravalvular leak [PVL], and
re-intervention) were compared using a random-effects model.
<br/>Result(s): The pooled analysis included 24 819 patients (TAVR, 8227
and SAVR, 16 592). 2,952 (11.9%) patients were from RCTs and 21 867
(88.1%) were registry patients. Thirty-day mortality was lower in TAVR
(logIRR, -0.43; 95% CI. -0.61 to -0.25; P <.001), whereas the rate of
moderate-severe PVL (logIRR, 1.44; 95% CI, 0.58-2.3; P <.001) and PPMI
(logIRR, 1.13; 95% CI, 1.02-1.24; P <.001) were higher. There were no
significant differences in the rates of overall mortality, reintervention,
cardiovascular death, myocardial infarction, or stroke between SAVR and
TAVR. <br/>Conclusion(s): Early mortality is higher in SAVR while rates of
PVL and PPMI are substantially higher in TAVR. There is no significant
advantage with TAVR for overall survival, cardiovascular death, stroke,
MI, and re-intervention rates.<br/>Copyright &#xa9; 2020 Wiley Periodicals
LLC

<77>
Accession Number
2005268682
Title
Randomized Trial of 2 Endoscopic Radial Artery Harvesting
Devices-Immunofluorescence Assessment.
Source
Annals of Thoracic Surgery. 110 (3) (pp 897-902), 2020. Date of
Publication: September 2020.
Author
Van Linden A.; Hecker F.; Lehmann-Grube J.; Arsalan M.; Richter M.; Matzke
B.; Holubec T.; Walther T.
Institution
(Van Linden, Hecker, Arsalan, Holubec, Walther) Department of
Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt,
Frankfurt, Germany
(Lehmann-Grube) Medical School, Justus Liebig University Giessen, Giessen
(Richter) Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim,
Germany
(Matzke) Max-Planck-Institute for Heart and Lung Research, Bad Nauheim,
Germany
Publisher
Elsevier USA
Abstract
Background: Various devices are available for endoscopic radial artery
harvesting during coronary artery bypass grafting. Thermal spread and
graft damage, however, are common concerns. The aim of this study was to
compare the MiFusion TLS2 system (Endotrust, Nettetal Germany) with direct
heat technique and the LigaSure Maryland system (Medtronic, Dublin,
Ireland) using advanced bipolar technique in a prospective randomized
study. <br/>Method(s): One hundred consecutive patients undergoing
coronary artery bypass grafting with endoscopic radial artery harvesting
were prospectively included and randomized 1:1. The proximal (brachial)
ends of the grafts were analyzed using fluorescence microscopy with focus
on graft integrity. In addition, harvesting time, graft sealing, residual
bleeding, and incidence of neurological disorders were compared.
<br/>Result(s): Patient age was 67 +/- 8 years. Mean harvesting time was
26.5 +/- 9 minutes for the TLS2 and 23.2 +/- 8 minutes for the LigaSure (P
= .049). Overall graft integrity was good in both groups. A significantly
better graft integrity was observed in the LigaSure group (scale 0 to 3; 3
= best) with 2.5 +/- 0.6 for TLS2 and 2.8 +/- 0.4 for LigaSure (P = .031).
LigaSure provided significantly better graft sealing (scale 0 to 2; 0 =
best) with 0.6 +/- 0.7 vs 1.0 +/- 0.6 (TLS2) (P = .006) and less residual
bleeding (scale 1 to 5; 1 = best) with 1.4 +/- 0.6 vs 2.0 +/- 0.9 (TLS2)
(P < .001). Transient sensibility disorders were less frequently observed
with LigaSure (2% vs 16%, P = .015). <br/>Conclusion(s): Endoscopic radial
artery harvesting can be performed with excellent results and good graft
integrity using both devices. Compared with the MiFusion TLS2, the
LigaSure device led to faster procedural times and resulted in better
graft integrity. Along with providing a better seal, LigaSure was
associated with less sensibility disorders.<br/>Copyright &#xa9; 2020 The
Society of Thoracic Surgeons

<78>
Accession Number
2007132674
Title
Early surgery versus watchful waiting in patients with moderate aortic
stenosis and left ventricular systolic dysfunction.
Source
Korean Circulation Journal. 50 (9) (pp E99), 2020. Date of Publication:
September 2020.
Author
Moon I.; Kim M.; Choi J.-W.; Park J.-B.; Hwang H.-Y.; Kim H.-K.; Kim
Y.-J.; Kim K.-H.; Kim K.-B.; Sohn D.-W.; Lee S.-P.
Institution
(Moon) Division of Cardiology, Department of Internal Medicine,
Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
(Kim, Park, Kim, Kim, Sohn, Lee) Department of Internal Medicine, Seoul
National University Hospital, Seoul, South Korea
(Choi, Hwang, Kim, Kim) Department of Cardiovascular Thoracic Surgery,
Seoul National University Hospital, Seoul, South Korea
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: Severe aortic stenosis (AS) with left
ventricular systolic dysfunction (LVSD) is a class I indication for aortic
valve replacement (AVR) but this recommendation is not well established in
those at the stage of moderate AS. We investigate the clinical impact of
AVR among patients with moderate AS and LVSD. <br/>Method(s): From 2001 to
2017, we consecutively identified patients with moderate AS and LVSD,
defined as aortic valve area 1.0-1.5 cm² and left ventricular
ejection fraction <50%. The primary outcome was all-cause death. The
outcomes were compared between those who underwent early surgical AVR
(within 2 years of index echocardiography) at the stage of moderate AS
versus those who were followed medically without AVR at the outpatient
clinic. <br/>Result(s): Among 255 patients (70.1+/-11.3 years, male 62%),
37 patients received early AVR. The early AVR group was younger than the
medical observation group (63.1+/-7.9 vs. 71.3+/-11.4) with a lower
prevalence of hypertension and chronic kidney disease. During a median
1.8-year follow up, 121 patients (47.5%) died, and the early AVR group
showed a significantly lower all-cause death rate than the medical
observation group (5.03PY vs. 18.80PY, p<0.001). After multivariable
Cox-proportional hazard regression adjusting for age, sex, comorbidities,
and laboratory data, early AVR at the stage of moderate AS significantly
reduced the risk of death (hazard ratio, 0.43; 95% confidence interval
0.20-0.91; p=0.028). <br/>Conclusion(s): In patients with moderate AS and
LVSD, AVR reduces the risk of all-cause death. A prospective randomized
trial is warranted to confirm our findings.<br/>Copyright &#xa9; 2020. The
Korean Society of Cardiology This is an Open Access article distributed
under the terms of the Creative Commons Attribution Non-Commercial License
(https://creativecommons.org/licenses/by-nc/4.0) which permits
unrestricted noncommercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

<79>
Accession Number
2007541500
Title
Anticoagulation with or without antiplatelet therapy following
transcatheter aortic valve replacement for patients with atrial
fibrillation: A meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Yokoyama Y.; Briasoulis A.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Briasoulis) Division of Cardiology, Heart failure and Transplantation,
University of Iowa, IA, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Although current guidelines recommend oral anticoagulants
(OAC) with or without antiplatelet therapy (APT) following transcatheter
aortic valve replacement (TVAR) in patients with an indication for
long-term anticoagulation therapy, the optimal antithrombotic strategy
remains unknown in these population. Herein, we conducted a meta-analysis
comparing the outcome of OAC alone versus OAC with APT following TAVR in
patients with atrial fibrillation (AF). <br/>Method(s): MEDLINE and EMBASE
were searched through May 2020 to identify clinical trials that
investigated OAC alone versus OAC with APT following TAVR in patients with
AF. From each study, we extracted the hazard ratios (HRs) or risk ratios
of major or life threatening bleeding, stroke, all-cause mortality and
cardiovascular mortality. <br/>Result(s): 1 randomized controlled trial
and 3 observational studies were identified, which enrolled a total of
2032 patients with AF who underwent TAVR assigned to the OAC group (n =
722) or OAC with APT group (n = 1310). Pooled analyses demonstrated the
rate of major or life threatening bleeding was significantly lower in the
OAC group compared to the OAC with APT group (HR [95% Confidence Interval
[CI] = 0.54 [0.38-0.77], P = .0006]). However, the rate of stroke was
similar in both groups (HR [95% CI] = 1.22 [0.80-1.87], P = .36).
All-cause and cardiovascular mortalities were also similar in both groups.
<br/>Conclusion(s): We observed that OAC with APT following TAVR in
patients with AF increased the risk of bleeding compared to OAC alone
without decreasing the risk of stroke.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<80>
Accession Number
2007541471
Title
Surgical Strategy for Intravenous Cardiac Leiomyomatosis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Deng Y.; Dong S.; Song B.
Institution
(Deng, Dong, Song) Department of Cardiovascular Surgery, The First
Hospital of Lanzhou University, Gansu Province, China
Publisher
Elsevier Ltd
Abstract
Intravenous-cardiac leiomyomatosis (IVCL) is a rare, histologically benign
but biologically aggressive tumour. Accurate diagnosis and appropriate
treatment choices are important for prognosis. The best surgical approach
remains unclear owing to limited evidence. This study aimed to assess
surgical strategies for treating IVCL and to propose individualised
surgical strategies. We searched PubMed, Web of Science, and the Cochrane
Library to identify case reports and case series published in English over
the last 10 years. Two (2) reviewers independently screened the literature
according to the inclusion and exclusion criteria, and subsequently
extracted data. One hundred and ten (110) cases were included. According
to our analysis, IV cardiac leiomyomatosis is most common in the fifth
decade, and the mean age at detection is 45.71+/-7.67 years. Most patients
had undergone previous hysterectomy/myomectomy, or had a co-existing
uterine leiomyoma when admitted. The most common clinical presentations
were dyspnoea, palpitation, pelvic mass, and leg oedema. More patients
benefited more from one-stage surgery. Seventy-eight per cent (78%) of
cases experienced a surgical approach of thoracic and abdominal incisions.
Extractions of IVCL were varied. Eighty-seven (87) patients experienced
cardiopulmonary bypass and deep hypothermic circulatory arrest was
performed on 64.4% of them. Total hysterectomy and bilateral oophorectomy,
together with pelvic leiomyoma excision, were done in 76.0% of patients.
Overall, surgical strategies for IVCL are varied; the optimal strategy
required consideration of multiple factors. Complete resection is
recommended for both single- and two-stage operations. Once complete
resection is achieved, recurrence is rare.<br/>Copyright &#xa9; 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<81>
Accession Number
2007522911
Title
Pharmacological interventions for the prevention of renal injury in
surgical patients: a systematic literature review and meta-analysis.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Pathak S.; Olivieri G.; Mohamed W.; Abbasciano R.; Roman M.; Tomassini S.;
Lai F.; Wozniak M.; Murphy G.J.
Institution
(Pathak, Olivieri, Mohamed, Abbasciano, Roman, Tomassini, Lai, Wozniak,
Murphy) Department of Cardiovascular Sciences, National Institute for
Health Research Leicester Biomedical Research Unit in Cardiovascular
Medicine, University of Leicester, Leicester, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: The aim of this systematic review was to summarise the results
of randomised controlled trials (RCTs) that have evaluated pharmacological
interventions for renoprotection in people undergoing surgery.
<br/>Method(s): Searches were conducted to update a previous review using
the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to
August 23, 2019. RCTs evaluating the use of pharmacological interventions
for renal protection in the perioperative period were included. The
co-primary outcome measures were 30-day mortality and acute kidney injury
(AKI). Pooled effect estimates were expressed as risk ratios (RRs) (95%
confidence intervals). <br/>Result(s): We included 228 trials enrolling 56
047 patients. Twenty-three trials were considered to be at low risk of
bias across all domains. Atrial natriuretic peptides (14 trials; n=2207)
reduced 30-day mortality (RR: 0.63 [0.41, 0.97]) and AKI events (RR: 0.43
[0.33, 0.56]) without heterogeneity. These effects were consistent across
cardiac surgery and vascular surgery subgroups, and in sensitivity
analyses restricted to studies at low risk of bias. Inodilators (13
trials; n=2941) reduced mortality (RR: 0.71 [0.53, 0.94]) and AKI events
(RR: 0.65 [0.50, 0.85]) in the primary analysis and in cardiac surgery
cohorts. Vasopressors (4 trials; n=1047) reduced AKI (RR: 0.56 [0.36,
0.86]). Nitric oxide donors, alpha-2-agonists, and calcium channel
blockers reduced AKI in primary analyses, but not after exclusion of
studies at risk of bias. Overall, assessment of the certainty of the
effect estimates was low. <br/>Conclusion(s): There are multiple effective
pharmacological renoprotective interventions for people undergoing
surgery.<br/>Copyright &#xa9; 2020 The Authors

<82>
Accession Number
363112973
Title
Intrapleural t-PA plus DNase improved clinical outcomes in patients with
pleural infection.
Source
Annals of Internal Medicine. 155 (12) (pp JC6-9), 2011. Date of
Publication: 20111220.
Author
Mathur P.N.
Institution
(Mathur) Indiana University School of Medicine, Indianapolis, IN, United
States
Publisher
American College of Physicians

<83>
Accession Number
354578151
Title
How can we prevent and treat cardiogenic shock in patients who present to
non-tertiary hospitals with myocardial infarction? A systematic review.
Source
Medical Journal of Australia. 190 (8) (pp 440-445), 2009. Date of
Publication: 20 Apr 2009.
Author
O'Connor E.; Fraser J.F.
Institution
(O'Connor, Fraser) Critical Care Research Group, Prince Charles Hospital,
Brisbane, QLD, Australia
Publisher
Australasian Medical Publishing Co. Ltd
Abstract
Objective: To evaluate current evidence in support of therapies for
preventing and treating cardiogenic shock (CS) after acute myocardial
infarction that can be initiated in hospitals without invasive cardiac
facilities. Study design: Systematic review. Data sources: MEDLINE and
PubMed were searched from January 1985 to May 2008 using the MeSH terms
"myocardial infarction", "thrombolytic therapy", "shock, cardiogenic",
"angioplasty, transluminal, percutaneous coronary", "intra-aortic balloon
pumping" and "platelet aggregation inhibitors". Additional keyword and
reference list searches were performed. Articles in English relating to
adults were included. Study selection: Meta-analyses and comparative
studies were included if they reported mortality or prevention of CS as an
endpoint. In total, 35 articles were analysed (four meta-analyses, eight
randomised controlled trials and 23 cohort studies). Data extraction:
Studies were summarised by the first author and the level of evidence
graded. Each study was checked by the second author and consensus was
reached about inclusion and levels of evidence. Data synthesis: In the
management and prevention of CS, the following are supported by high-level
evidence: prehospital thrombolysis, transfer for emergency
revascularisation (patients aged < 75 years) and thrombolysis for older
patients (patients aged >= 75 years). In established CS, evidence
supporting inhospital thrombolysis and intra-aortic balloon pump use in
patients aged < 75 years and emergency revascularisation in older patients
is limited to subgroup analyses and observational studies.
<br/>Conclusion(s): In regional centres, prevention of CS is achieved with
early fibrinolysis, preferably before hospital arrival. Patients of all
ages should be considered for thrombolysis, early transfer for coronary
revascularisation, and intra-aortic balloon pump insertion unless
contraindicated. Glycoprotein inhibitors have no role in the management of
CS in non-tertiary hospitals.

<84>
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.

<85>
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.

<86>
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

<87>
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.

<88>
Accession Number
632613878
Title
Bariatric surgery in obese patients with ventricular assist devices.
Source
BMC research notes. 13 (1) (pp 382), 2020. Date of Publication: 14 Aug
2020.
Author
daSilva-deAbreu A.; Alhafez B.A.; Curbelo-Pena Y.; Lavie C.J.; Ventura
H.O.; Loro-Ferrer J.F.; Mandras S.A.
Institution
(daSilva-deAbreu, Lavie, Ventura, Mandras) John Ochsner Heart and Vascular
Institute, Ochsner Clinic Foundation, LA, New Orleans, United States
(daSilva-deAbreu, Lavie, Ventura, Mandras) University of Queensland
Ochsner Clinical School, Faculty of Medicine, University of Queensland,
LA, New Orleans, United States
(daSilva-deAbreu, Loro-Ferrer) Doctoral School, Universidad de Las Palmas
de Gran Canaria, Las Palmas, Spain
(Alhafez) Department of Internal Medicine, The Ohio State University,
Columbus, OH, USA
(Curbelo-Pena) Service of General Surgery, Consorci Sanitari de L'Alt
Penedes I Garraf, Barcelona, Spain
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Patients with end-stage heart failure (ESHF) treated with
ventricular assist devices (VADs) tend to gain weight, which may prevent
them from receiving heart transplantation (HT) if their body mass index
(BMI) reaches>=35 kg/m2. The objective was to synthesize all cases
available in the literature and describe the most important outcomes of
bariatric surgery (BS) in VAD patients, including BMI trends, reaching a
BMI<35 kg/m2, listing for HT, achieving HT, myocardial recovery, and
mortality. These data were obtained for an individual participant data
(IPD) meta-analysis and include available IPD for every case in the
scientific literature describing VAD patients undergoing BS during VAD
support with documented postoperative BMI (and time of measurement) during
follow-up. DATA DESCRIPTION: These data include baseline, periprocedural,
and long-term outcomes for the 29 patients meeting selection criteria. The
composite outcome includes reaching a BMI<35 kg/m2, listing for HT,
receiving HT, and myocardial recovery, indicating significant BMI loss
associated with major ESHF outcomes. As multiple centers are becoming more
experienced in this field, the present data can be merged with their
databases to form larger samples that will allow to perform further
statistical analysis to identify outcome predictors and improve clinical
protocols and outcomes.

<89>
Accession Number
632613643
Title
Certificate of need laws: a systematic review and cost-effectiveness
analysis.
Source
BMC health services research. 20 (1) (pp 748), 2020. Date of Publication:
14 Aug 2020.
Author
Conover C.J.; Bailey J.
Institution
(Conover) Duke University Center for Health Policy and Inequalities
Research, 310 Trent Drive, Durham 27710, United States
(Bailey) Department of Economics, Providence College, 1 Cunningham Sq,
Providence, RI, 02918, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Certificate of Need (CON) laws, currently in place in 35 US
states, require certain health care providers to obtain a certification of
their economic necessity from a state board before opening or undertaking
a major expansion. We conduct the first systematic review and
cost-effectiveness analysis of these laws. <br/>METHOD(S): We review 90
articles to summarize the evidence on how certificate of need laws affect
regulatory costs, health expenditures, health outcomes, and access to
care. We use the findings from the systematic review to conduct a
cost-effectiveness analysis of CON. <br/>RESULT(S): The literature
provides mixed results, on average finding that CON increases health
expenditures and overall elderly mortality while reducing heart surgery
mortality. Our cost-effectiveness analysis estimates that the costs of CON
laws somewhat exceed their benefits, although our estimates are quite
uncertain. <br/>CONCLUSION(S): The literature has not yet reached a
definitive conclusion on how CON laws affect health expenditures,
outcomes, or access to care. While more and higher quality research is
needed to reach confident conclusions, our cost-effectiveness analysis
based on the existing literature shows that the expected costs of CON
exceed its benefits.

<90>
Accession Number
2007488762
Title
Predictors of Clinical Response to Transcatheter Reduction of Secondary
Mitral Regurgitation: The COAPT Trial.
Source
Journal of the American College of Cardiology. 76 (9) (pp 1007-1014),
2020. Date of Publication: 1 September 2020.
Author
Grayburn P.A.; Sannino A.; Cohen D.J.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.K.; Rinaldi M.J.; Kapadia S.R.; Rajagopal V.; Crowley A.;
Kotinkaduwa L.N.; Lindenfeld J.; Abraham W.T.; Mack M.J.; Stone G.W.
Institution
(Grayburn, Sannino, Mack) Baylor Heart and Vascular Institute, Baylor
University Medical Center, Dallas, TX, United States
(Cohen) University of Missouri-Kansas City School of Medicine, Kansas
City, MO, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Whisenant) Intermountain Heart Center, Salt Lake City, UT, United States
(Rinaldi) Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC,
United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Rajagopal) Piedmont Hospital, Atlanta, Georgia, Georgia
(Crowley, Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular
Research Foundation, New York, NY, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, New York, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter mitral valve repair with the MitraClip results
in marked clinical improvement in some but not all patients with secondary
mitral regurgitation (MR) and heart failure (HF). <br/>Objective(s): This
study sought to evaluate the clinical predictors of a major response to
treatment in the COAPT trial. <br/>Method(s): Patients with HF and severe
MR who were symptomatic on maximally tolerated guideline-directed medical
therapy (GDMT) were randomly assigned to MitraClip plus GDMT or GDMT
alone. Super-responders were defined as those alive without HF
hospitalization and with >=20-point improvement in the Kansas City
Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score at 12 months.
Responders were defined as those alive without HF hospitalization and with
a 5 to <20-point KCCQ-OS improvement at 12 months. Nonresponders were
those who either died, were hospitalized for HF, or had <5-point
improvement in KCCQ-OS at 12 months. <br/>Result(s): Among 614 enrolled
patients, 41 (6.7%) had missing KCCQ-OS data and could not be classified.
At 12 months, there were 79 super-responders (27.2%), 55 responders
(19.0%), and 156 nonresponders (53.8%) in the MitraClip arm compared with
29 super-responders (10.2%), 46 responders (16.3%), and 208 nonresponders
(73.5%) in the GDMT-alone arm (overall p < 0.0001). Independent baseline
predictors of clinical responder status were lower serum creatinine and
KCCQ-OS scores and treatment assignment to MitraClip. MR grade and
estimated right ventricular systolic pressure at 30 days were improved to
a greater degree in super-responders and responders but not in
nonresponders. <br/>Conclusion(s): Baseline predictors of clinical
super-responders in patients with HF and severe secondary MR in the COAPT
trial were lower serum creatinine, KCCQ-OS score and MitraClip treatment.
Improved MR severity and reduced right ventricular systolic pressure at 30
days are associated with a long-term favorable clinical response after
transcatheter mitral valve repair. (Cardiovascular Outcomes Assessment of
the MitraClip Percutaneous Therapy for Heart Failure Patients With
Functional Mitral Regurgitation [COAPT]; NCT01626079)<br/>Copyright &#xa9;
2020 American College of Cardiology Foundation

<91>
Accession Number
632614992
Title
Are the Current Cardiac Rehabilitation Programs Optimized to Improve
Cardiorespiratory Fitness in Patients? A Meta-Analysis.
Source
Journal of aging and physical activity. (pp 1-16), 2020. Date of
Publication: 14 Aug 2020.
Author
Manresa-Rocamora A.; Sarabia J.M.; Sanchez-Meca J.; Oliveira J.;
Vera-Garcia F.J.; Moya-Ramon M.
Publisher
NLM (Medline)
Abstract
Previous meta-analyses have shown that high-intensity interval training
(HIIT) is more suitable than moderate continuous training (MCT) for
improving peak oxygen uptake (VO2peak) in patients with coronary artery
disease. However, none of these meta-analyses have tried to explain the
heterogeneity of the empirical studies in optimizing cardiac
rehabilitation programs. Therefore, our aims were (a) to estimate the
effect of MCT and HIIT on VO2peak, and (b) to find the potential moderator
variables. A search was conducted in PubMed, Scopus, and ScienceDirect.
Out of the 3,110 references retrieved, 29 studies fulfilled the selection
criteria to be included in our meta-analysis. The mean difference was used
as the effect size index. Our results showed significant enhancements in
VO2peak after cardiac rehabilitation based on MCT and HIIT (mean
difference = 3.23; 95% confidence interval [2.81, 3.65] ml.kg-1.min-1 and
mean difference = 4.61; 95% confidence interval [4.02, 5.19]
ml.kg-1.min-1, respectively), with greater increases after HIIT (p <
.001). Heterogeneity analyses reached statistical significance with
moderate heterogeneity for MCT (p < .001; I2 = 67.0%), whereas no
heterogeneity was found for the effect of HIIT (p = .220; I2 = 22.0%).
Subgroup analyses showed significant between-group heterogeneity of the
MCT-induced effect based on the training mode (p < .001; I2 = 90.4%), the
risk of a new event (p = .010; I2 = 77.4%), the type of cardiovascular
event (p = .009; I2 = 84.8%), the wait time to start cardiac
rehabilitation (p = .010; I2 = 76.6%), and participant allocation (p =
.002; I2 = 89.9%). Meta-regressions revealed that the percentages of
patients undergoing a revascularization procedure (B = -0.022; p = .041)
and cardiorespiratory fitness at baseline (B = -0.103; p = .025) were
inversely related to the MCT-induced effect on the VO2peak.

<92>
Accession Number
2007510341
Title
Systematic Review of the Association Between Worsening Renal Function and
Mortality in Patients With Acute Decompensated Heart Failure.
Source
Kidney International Reports. (no pagination), 2020. Date of Publication:
2020.
Author
Yamada T.; Ueyama H.; Chopra N.; Yamaji T.; Azushima K.; Kobayashi R.;
Kinguchi S.; Urate S.; Suzuki T.; Abe E.; Saigusa Y.; Wakui H.; Partridge
P.; Burger A.; Bravo C.A.; Rodriguez M.A.; Ivey-Miranda J.; Tamura K.;
Testani J.; Coca S.
Institution
(Yamada, Ueyama, Chopra, Burger) Department of Medicine, Mount Sinai Beth
Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Yamada, Yamaji, Azushima, Kobayashi, Kinguchi, Urate, Suzuki, Abe, Wakui,
Tamura) Department of Medical Science and Cardiorenal Medicine, Yokohama
City University Graduate School of Medicine, Yokohama, Japan
(Azushima) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore Medical School, Singapore
(Saigusa) Department of Biostatistics, Yokohama City University School of
Medicine, Yokohama, Japan
(Partridge) College of Arts and Sciences, University of Miami, Coral
Gables, FL, United States
(Bravo) Department of Medicine, Division of Cardiology, Columbia
University Medical Center, New York, NY, United States
(Rodriguez) Department of Medicine, Division of Cardiology, Albert
Einstein College of Medicine, Bronx, NY, United States
(Ivey-Miranda) Cardiology Hospital, XXI Century National Medical Center,
Mexican Social Security Institute, Mexico City, Mexico, Mexico
(Testani) Section of Cardiovascular Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Coca) Division of Nephrology, Department of Medicine, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc
Abstract
Introduction: Outcomes in acute decompensated heart failure (ADHF) have
remained poor. Worsening renal function (WRF) is common among patients
with ADHF. However, the impact of WRF on the prognosis is controversial.
We hypothesized that in patients with ADHF, the achievement of concomitant
decongestion would diminish the signal for harm associated with WRF.
<br/>Method(s): We performed a systematic search of PubMed, EMBASE, and
the Cochrane Library up to December 2019 for studies that assessed signs
of decongestion in patients with WRF during ADHF admission. The primary
outcome was all-cause mortality and heart transplantation. <br/>Result(s):
Thirteen studies were selected with a pooled population of 8138 patients.
During the follow-up period of 60-450 days, 19.2% of patients died.
Unstratified, patients with WRF versus no WRF had a higher risk for
mortality (odds ratio [OR], 1.71 [95% confidence interval {CI},
1.45-2.01]; P < 0.0001). However, patients who achieved decongestion had a
similar prognosis (OR, 1.15 [95% CI, 0.89-1.49]; P = 0.30). Moreover,
patients with WRF who achieved decongestion had a better prognosis
compared with those without WRF or decongestion (OR, 0.63 [95% CI,
0.46-0.86]; P = 0.004). This tendency persisted for the sensitivity
analyses. <br/>Conclusion(s): Decongestion is a powerful effect modifier
that attenuates harmful associations of WRF with mortality. Future studies
should not assess WRF as an endpoint without concomitant assessment of
achieved volume status.<br/>Copyright &#xa9; 2020 International Society of
Nephrology

<93>
Accession Number
632624103
Title
Impact of cognitive behavioral therapy on depression symptoms after
transcatheter aortic valve replacement: A randomized controlled trial.
Source
International journal of cardiology. (no pagination), 2020. Date of
Publication: 12 Aug 2020.
Author
Edwards K.S.; Chow E.K.H.; Dao C.; Hossepian D.; Johnson A.G.; Desai M.;
Shah S.; Lee A.; Yeung A.C.; Fischbein M.; Fearon W.F.
Institution
(Edwards, Dao, Shah, Yeung, Fearon) Department of Medicine, Stanford
University, United States
(Chow, Desai) Quantitative Sciences Unit, Stanford University, (United
States of America)
(Hossepian, Johnson) PGSP-Stanford Psy.D. Consortium, Palo Alto
University, United States
(Lee, Fischbein) Department of Cardiothoracic Surgery, Stanford
University, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Depression is a significant concern after cardiac surgery and
has not been studied in patients undergoing transcatheter aortic valve
replacement (TAVR). We sought to examine the prevalence of pre-procedure
depression and anxiety symptoms and explore whether brief bedside
cognitive behavioral therapy (CBT) could prevent post-TAVR psychological
distress. <br/>METHOD(S): We prospectively recruited consecutive TAVR
patients and randomized them to receive brief CBT or treatment as usual
(TAU) during their hospitalization. Multi-level regression techniques were
used to evaluate changes by treatment arm in depression, anxiety, and
quality of life from baseline to 1month post-TAVR adjusted for sex, race,
DM, CHF, MMSE, and STS score. <br/>RESULT(S): One hundred and forty six
participants were randomized. The mean age was 82years, and 43% were
female. Self-reported depression and anxiety scores meeting cutoffs for
clinical level distress were 24.6% and 23.2% respectively. Both TAU and
CBT groups had comparable improvements in depressive symptoms at 1-month
(31% reduction for TAU and 35% reduction for CBT, p=.83). Similarly, both
TAU and CBT groups had comparable improvements in anxiety symptoms at
1-month (8% reduction for TAU and 11% reduction for CBT, p=.1). Quality of
life scores also improved and were not significantly different between the
two groups. <br/>CONCLUSION(S): Pre-procedure depression and anxiety may
be common among patients undergoing TAVR. However, TAVR patients show
spontaneous improvement in depression and anxiety scores at 1-month follow
up, regardless of brief CBT. Further research is needed to determine
whether more tailored CBT interventions may improve psychological and
medical outcomes.<br/>Copyright &#xa9; 2020. Published by Elsevier B.V.