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<1>
Accession Number
2007648761
Title
Outcomes of individualized goal-directed therapy based on cerebral oxygen
balance in high-risk patients undergoing cardiac surgery: A randomized
controlled trial.
Source
Journal of Clinical Anesthesia. 67 (no pagination), 2020. Article Number:
110032. Date of Publication: December 2020.
Author
Cheng X.-Q.; Zhang J.-Y.; Wu H.; Zuo Y.-M.; Tang L.-L.; Zhao Q.; Gu E.-W.
Institution
(Cheng, Wu, Zuo, Tang, Zhao, Gu) Department of Anesthesiology, First
Affiliated Hospital of Anhui Medical University, Hefei 230022, China
(Zhang) Department of Pharmacology, Anhui Medical University, Hefei
230032, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To investigate whether optimizing individualized
goal-directed therapy (GDT) based on cerebral oxygen balance in high-risk
surgical patients would reduce postoperative morbidity. Design(s):
This was a prospective, randomized, controlled study. Setting(s): The
study was performed in the First Affiliated Hospital of Anhui Medical
University, Hefei, China, from April 2017 to July 2018. Patient(s):
146 high-risk adult patients undergoing valve replacements or coronary
artery bypass surgery with cardiopulmonary bypass (CPB) were enrolled.
 Intervention(s): Patients were randomized to an individualized GDT
group or usual care group. Individualized GDT was targeted to achieve the
following goals: A less than 20% decline in the regional cerebral oxygen
saturation (rScO<inf>2</inf>) level from baseline; a less than 20% decline
in the mean arterial pressure (MAP) from baseline, as well as a bispectral
index (BIS) of 45-60 before and after CPB and 40-45 during CPB.
Measurements: The primary outcome was a composite endpoint of 30-day
mortality and major postoperative complications. Main Result(s): 128
completed the trial and were included in the modified intention-to-treat
analysis. Early morbidity was similar between the GDT (25 [39%] of 65
patients) and usual care groups (33 [53%] of 63 patients) (relative risk
0.73, 95% CI 0.50-1.08; P = 0.15). Secondary analysis showed that 75 (59%)
of 128 patients achieved individual targets (irrespective of intervention)
and sustained less morbidity (relative risk 3.41, 95% CI 2.19-5.31; P <
0.001). Conclusion(s): In high-risk patients undergoing cardiac
surgery, individualized GDT therapy did not yield better outcomes,
however, the achievement of preoperative individual targets may be
associated with less morbidity. Trial registration: Clinicaltrials.gov
identifier: NCT03103633. Registered on 1 April 2017. Copyright ©
2020 Elsevier Inc.

<2>
Accession Number
630600451
Title
Efficacy of paravertebral block techniques in thoracic surgery: Systematic
literature review.
Source
Colombian Journal of Anesthesiology. 48 (1) (pp 20-29), 2020. Date of
Publication: 01 Jan 2020.
Author
Cadavid-Puentes A.M.; Casas-Arroyave F.D.; Palacio-Montoya L.M.;
Valencia-Gallon E.
Institution
(Cadavid-Puentes, Casas-Arroyave) Anesthesiology and Reanimation Division,
Universidad de Antioquia, Hospital Universitario San Vicente Fundacion,
Calle 64 No. 51D-154, Medellin, Colombia
(Palacio-Montoya, Valencia-Gallon) IPS Universitaria, Universidad de
Antioquia, Medellin, Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: revcolanest@scare.org.co)
Abstract
Introduction:Postoperative pain in thoracic surgery in adults is usually
severe, and to control it there are many analgesic methods that include
paravertebral blockade (PVB). Until now, there is no clarity on which is
the most effective technique to perform this blockade.
 Objective(s):To describe the different PVB techniques and its
analgesic effect in thoracic surgery. Method(s):A systematic review
of the literature was performed. We included studies that analyzed
patients in open chest surgery and used PVB as analgesic technique. The
Cochrane and Grading of Recommendation Assessment, Development and
Evaluation strategies were used to analyze biases and evidence. The
results are presented graphically by means of a visual analog scale (VAS)
pain and opioid consumption equivalent to morphine for each technique
found. We summarize the results with a qualitative approach without
meta-analysis. Result(s):A total of 38 articles were analyzed (2188
patients). 13 using PVB guided by surface anatomy (SA-PVB), 7
Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and
the remaining using PVB performed under direct visualization by the
surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and
US-PVB, and greater than 5 in studies with S-PVB; however, opioid
consumption in the postoperative period was similar between the techniques
described. Conclusion(s):PVB can be performed through 4 techniques.
Techniques of US-PVB or SA-PVB have shown better consistency to manage
postoperative acute pain in thoracic surgery. Copyright © 2019
Sociedad Colombiana de Anestesiologia y Reanimacion (S.C.A.R.E.).
Published by Wolters Kluwer.

<3>
Accession Number
628886804
Title
Perioperative use of levosimendan in patients undergoing cardiac surgery:
Systematic review and meta-analysis.
Source
Colombian Journal of Anesthesiology. 47 (3) (pp 142-153), 2019. Date of
Publication: 01 Jul 2019.
Author
Oliveros H.; Garcia H.; Rubio C.; Navarrete J.
Institution
(Oliveros) Universidad de la Sabana, Campus Puente del Comun, Chia,
Cundinamarca, Colombia
(Garcia, Rubio, Navarrete) Hospital Militar Central, Bogota, Colombia
(Garcia, Rubio, Navarrete) Universidad Militar Nueva Granada, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: revcolanest@scare.org.co)
Abstract
Introduction: Patients undergoing cardiac surgery frequently develop low
cardiac output syndrome (LCOS). Multiple interventions including
levosimendan have been used in the prevention and treatment of LCOS.
Preliminary studies reported lower mortality respect to placebo or other
inotropes, however, recently, 3 clinical trials found no benefit against
this outcome. Objective(s): Our objective was to evaluate the
evidence of levosimendan on mortality and secondary outcomes in patients
undergoing cardiac surgery, and to determine the sources of heterogeneity.
 Method(s): We conducted a systematic review and meta-analysis of the
clinical trials that evaluated the efficacy of levosimendan in patients
undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality
and other outcomes such as kidney injury with dialysis requirement and
LCOS, using fixed and random effects models. The risk of bias was assessed
and the sources of heterogeneity were explored. Result(s): Of 47
studies identified, 14 studies were selected (n=2752). Regarding the
mortality outcome and use of levosimendan, only a decrease was found in
the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While
high-quality studies, there was no protective effect (OR 0.99, 95% CI
0.70-1.40) with an I2 = 0%. The quality of the studies and
ejection fraction were the main sources of heterogeneity.
 Conclusion(s): In high-quality studies, the use of levosimendan in
patients undergoing cardiovascular surgery has no effect on 30-day
mortality. There was a protective effect on postoperative renal failure
with dialysis. Copyright © 2019 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.).

<4>
Accession Number
2007341634
Title
Radial artery harvesting in coronary artery bypass grafting
surgery-Endoscopic or open method? A meta-analysis.
Source
PLoS ONE. 15 (7 July) (no pagination), 2020. Article Number: e0236499.
Date of Publication: July 2020.
Author
Huang T.-Y.; Huang T.-S.; Cheng Y.-T.; Wang Y.-C.; Chen T.-P.; Yin S.-Y.;
Yeh C.-H.
Institution
(Huang, Wang, Chen, Yin, Yeh) Department of Thoracic and Cardiovascular
Surgery, Chang Gung Memorial Hospital at Keelung, Chiayi, Taiwan (Republic
of China)
(Huang) Department of Biomedical Engineering, National Taiwan University,
Taipei, Taiwan (Republic of China)
(Huang) Department of General Surgery, Keelung Chang Gung Memorial
Hospital, Taoyuan City, Taiwan (Republic of China)
(Huang, Yeh) Community Medicine Research Center, Keelung Chang Gung
Memorial Hospital, Taoyuan City, Taiwan (Republic of China)
(Huang, Yeh) Department of Chinese Medicine, College of Medicine, Chang
Gung University, Taoyuan City, Taiwan (Republic of China)
(Cheng, Yeh) Department of Thoracic and Cardiovascular Surgery, Chang Gung
Memorial Hospital at Linkou, Taoyuan City, Taiwan (Republic of China)
(Yeh) College of Medicine, Chang Gung University, Taoyuan City, Taiwan
(Republic of China)
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
We analyzed the clinical outcomes of open radial artery harvesting (OAH)
and endoscopic radial artery harvesting (EAH) undergoing coronary artery
bypass grafting (CABG). We designed this meta-analysis conducted using
Pubmed, Medline, the Cochrane Library, and EMBASE. Articles with
comparisons of OAH and EAH undergoing CABG were included. Primary outcomes
included the wound infection rate, the wound complication rate,
neurological complications of the forearm, in-hospital mortality,
long-term survival, and the patency rate. The results of our study
included six randomized controlled trials (RCTs), two non-randomized
controlled trials (NRCTs) with matching, and 10 NRCTs. In total, 2919
patients were included in 18 studies, while 1187 (40.7%) and 1732 (59.3%)
patients received EAH and OAH, respectively. EAH was associated with a
lower incidence of wound infection (RR = 0.29, 95% confidence interval
(CI) = 0.14 to 0.60, p = 0.03), and neurological complications over the
harvesting site (RR = 0.41, 95% CI = 0.27 to 0.62, p < 0.0001). There was
no significant difference in 30-day mortality, long-term survival (over
one year), and the graft patency rate. According to our analysis,
endoscopic radial artery harvesting can improve the outcome of the
harvesting site, without affecting the mortality, long-term survival, and
graft patency. Copyright © 2020 Huang et al.

<5>
Accession Number
2007651494
Title
The effect of tranexamic acid on the values of activated clotting time in
patients undergoing cardiac surgery: A PRISMA-compliant systematic review
and meta-analysis.
Source
Journal of Clinical Anesthesia. 67 (no pagination), 2020. Article Number:
110020. Date of Publication: December 2020.
Author
Yao Y.-T.; He L.-X.; Tan J.-C.
Institution
(Yao, He) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Peking Union Medical College and Chinese
Academy of Medical Sciences, Beijing 100037, China
(Tan) Department of Anesthesiology, Shunde Hospital of South Medical
University, Foshan 528300, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: Activated clotting time (ACT) is a non-specific test to
evaluate the adequacy of systemic heparinization whose value could be
influenced by many factors. Tranexamic acid (TXA) is a widely used
antifibrinolytic agent worldwide and whether TXA influences ACT value in
cardiac surgical patients remains unknown. Current study was performed to
address this question. Design(s): Systematic review and
meta-analysis. PUBMED, Cochrane Library, EMBASE, OVID and Chinese
BioMedical Literature & Retrieval System were searched using search terms
"tranexamic acid", "activated clotting time", "cardiac surgery",
"randomized controlled trial" till May 7th, 2020, to identify all relevant
randomized controlled trials (RCTs). Setting(s): Operating room.
 Patient(s): Cardiac surgical patients. Intervention(s): TXA or
placebo. Measurements: Primary outcomes of interest included
peri-operative ACT values. Secondary outcomes of interest include heparin
dosage, protamine dosage, postoperative bleeding and blood transfusion.
 Main Result(s): Search yielded 13 studies including 1168 patients,
and 619 patients were allocated into Group TXA and 549 into Group Control
(placebo). Meta-analysis suggested that, ACT values after heparinization
[(WMD = -1.45; 95%CI: -12.52 to 15.43; P = 0.84)] and after protamine
[(WMD = -1.18; 95%CI: -2.81 to 0.46; P = 0.16)] were comparable between
Group TXA and Group Control, and that TXA did not influence heparin dose
in adult patients [(WMD = 0.38; 95%CI: 0.30 to 0.46; P<0.00001) with no
heterogeneity (I2 = 4%, P = 0.35)] and protamine dose for
heparin reversal [(WMD = 5.23; 95%CI: -0.33 to 10.80; P = 0.07) with no
heterogeneity (I2 = 0, P = 0.58)]. Meta-analysis also
demonstrated that, TXA administration significantly reduced post-operative
bleeding volume [(WMD = -126.33; 95%CI: -177.46 to -75.19; P < 0.0001),
post-operative red blood cell (RBC) transfusion volume [(WMD = -71.86; 95%
CI: -88.22 to -55.50; P < 0.00001), fresh frozen plasma (FFP) transfusion
volume [(WMD = -13.83; 95% CI: -23.67 to -4.00; P = 0.006) and platelet
concentrate (PC) transfusion volume [(WMD = -0.20; 95% CI: -0.29 to -0.10;
P < 0.0001). Conclusion(s): This meta-analysis suggested that, TXA
administration did not influence ACT value, heparin and protamine doses,
but significantly reduced post-operative blood loss and transfusion
requirement in cardiac surgical patients. Copyright © 2020
Elsevier Inc.

<6>
Accession Number
2007377541
Title
Meta-analysis of Incidence, Predictors and Consequences of Clinical and
Subclinical Bioprosthetic Leaflet Thrombosis After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. 132 (pp 106-113), 2020. Date of
Publication: 1 October 2020.
Author
Sannino A.; Hahn R.T.; Leipsic J.; Mack M.J.; Grayburn P.A.
Institution
(Sannino, Grayburn) The Heart Hospital, Clinical Research Department,
Baylor Scott & White Research Institute, Plano, TX, United States
(Hahn) New York Presbyterian Hospital, New York-Presbyterian/Columbia
University Medical Center, New York, NY, United States
(Leipsic) Department of Radiology, St. Paul's Hospital, University of
British Columbia, Vancouver, Canada, Canada
(Mack, Grayburn) The Heart Hospital Baylor Plano, Plano, TX, United States
(Sannino) Department of Advance Biomedical Sciences, University Federico
II, Naples, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Leaflet thrombosis (LT) has been claimed as a potential cause of
hemodynamic dysfunction or bioprosthetic valve degeneration of
transcatheter heart valves. Sparse and contrasting evidence exists,
however, regarding LT occurrence, prevention and treatment. MEDLINE, ISI
Web of Science and SCOPUS databases were searched for studies published up
to January 2020. Only studies reporting data on incidence and outcomes
associated to the presence/absence of clinical or subclinical LT, detected
or confirmed with a multidetector computed tomography exam were included.
The study was designed according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) requirements. Two reviewers
independently screened articles for fulfillment of inclusion criteria.
Data were pooled using a random-effect model. The primary end point was
the incidence of LT. Secondary outcomes included: stroke and transient
ischemic attacks and mean transvalvular gradients at different time-points
in patients with and without LT. Of the initial 200 studies, 22 were
finally included with a total of 11,567 patients. LT overall incidence was
8% (95% Confidence Interval [CI]: 5% to 13%, I2 = 96.4%). LT
incidence in patients receiving only antiplatelets was 13% (95% CI: 7% to
23%, p <0.0001); patients discharged on oral anticoagulants had a reported
incidence of 4% (95% CI: 2% to 8%, p <0.0001). Patients with LT, either
clinical or subclinical, were not at increased risk of stroke (OR 1.06,
95% CI: 0.75 to 1.50, p = 0.730, I2 = 0.0%) or transient
ischemic attacks (Odds Ratio 1.01, 95% CI: 0.40 to 2.57, p = 0.989,
I2 = 0.0%). LT was associated with higher mean transvalvular
gradients compared with patients without LT at 30 days post-transcatheter
implantation, but not at discharge or at 1 year. LT is a relatively common
event that, even when clinically manifest, is not associated with an
increased risk of cerebrovascular events. Although patients on
anticoagulants appear to be at lower risk of LT, the available evidence
does not allow formulation of recommendations for prophylactical
anticoagulation nor routine computed tomography after transcatheter aortic
valve replacement. Copyright © 2020 Elsevier Inc.

<7>
Accession Number
2006074466
Title
Effect of Dexmedetomidine on Delirium in Elderly Surgical Patients: A
Meta-analysis of Randomized Controlled Trials.
Source
Annals of Pharmacotherapy. (no pagination), 2020. Date of Publication:
2020.
Author
Lin C.; Tu H.; Jie Z.; Zhou X.; Li C.
Institution
(Lin, Tu, Zhou, Li) Huazhong University of Science and Technology Union
Shenzhen Hospital, Shenzhen, Guangdong, China
(Jie) Guangdong Medical University, Zhanjiang, Guangdong, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: The purpose of this meta-analysis is to assess the effect of
dexmedetomidine on delirium in elderly surgical patients. Data
Sources: The Cochrane Library, Web of Science, PubMed, EMBASE, and Google
Scholar were searched (January 1, 2000, to February 4, 2020) for
randomized controlled trials (RCTs). Study Selection and Data Extraction:
RCTs without language restrictions were included if delirium incidence was
assessed in elderly surgical patients receiving dexmedetomidine.
Intervention and basic information were extracted. Data Synthesis: 21
studies were included. Dexmedetomidine reduced delirium occurrence (risk
ratio [RR] = 0.55; 95% CI = 0.45 to 0.67) in elderly surgical patients
with sufficient evidence from trial sequential analysis. Dexmedetomidine
did not prevent delirium incidence for cardiac surgery (RR = 0.71; 95% CI
= 0.44 to 1.15) with insufficient evidence. Dexmedetomidine decreased
mortality incidence (RR = 0.47; 95% CI = 0.25 to 0.89), shortened the
length of intensive care unit (ICU; standard mean difference [SMD] =
-0.46) and hospital stays (SMD = -0.41), and increased bradycardia
incidence (RR = 1.60). Relevance to Patient Care and Clinical Practice:
This review revealed that dexmedetomidine could reduce delirium incidence
for elderly noncardiac surgical patients, and the effect of
dexmedetomidine on delirium for elderly cardiac surgical patients needs
further studies to guide clinicians. Conclusion(s): Dexmedetomidine
reduced delirium incidence in elderly surgical patients. The efficacy of
dexmedetomidine on delirium for elderly cardiac surgical patients warrants
further studies. Furthermore, dexmedetomidine was associated with an
increased bradycardia incidence, shorter length of ICU/hospital stays, and
a lower incidence of mortality. Copyright © The Author(s) 2020.

<8>
[Use Link to view the full text]
Accession Number
627169283
Title
Effect of Digital Storytelling on Anxiety in Patients Who Are Candidates
for Open-Heart Surgery.
Source
The Journal of cardiovascular nursing. 34 (3) (pp 231-235), 2019. Date of
Publication: 01 May 2019.
Author
Moghimian M.; Akbari M.; Moghaddasi J.; Niknajad R.
Institution
(Moghimian) Nursing & Midwifery Sciences Development Research Center and
Department of Nursing, Najafabad Branch, PhD Member of Young Researcher
Club and Department of Nursing, Khoorasgan Branch, Islamic Azad
University, Department of Medical Surgical Nursing, Shahrekord University
of Medical Sciences, MSc Instructor, Nursing and Midwifery Student
Research Committee and Department of Operative Room, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Open-heart surgery in persons with cardiovascular disease is
associated with high levels of anxiety. OBJECTIVE(S): The goal of
this study was to determine the effect of digital storytelling on anxiety
in patients who were candidates for open-heart surgery. METHOD(S): In
this quasi-experimental study, 80 patients were randomly allocated into 2
groups. The intervention group received routine training and digital
storytelling. In each group, anxiety was measured by the State-Trait
Anxiety Inventory anxiety scale before surgery and 5 days after surgery.
The collected data were analyzed using SPSS software V18. RESULT(S):
There was no significant difference in the anxiety of both groups during
the 2 days before the surgery (P = .40). After the surgery, the mean of
anxiety scores in the intervention group was lower than that of the
control group (P < .001). CONCLUSION(S): Digital storytelling is an
effective method to reduce anxiety in patients who are candidates for
open-heart surgery.

<9>
Accession Number
626540941
Title
Ischemia and perioperative infarction.
Source
Colombian Journal of Anesthesiology. 46 (Supplement 2) (pp 39-45), 2018.
Date of Publication: 01 Mar 2018.
Author
Navarro-Vargas J.R.; Borrero L.M.G.
Institution
(Navarro-Vargas) School of Medicine, Universidad Nacional de Colombia,
Bogota, Colombia
(Navarro-Vargas) Hospital Universitario de Colombia, Universidad Nacional
de Colombia, Bogota, Colombia
(Borrero) Sindicato Antioqueno de Anestesiologia (Anestesiar), Medellin,
Colombia
(Navarro-Vargas) National Resuscitation Committee, Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.), Carrera 15a No. 120-74, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: revcolanest@scare.org.co)
Abstract
Introduction: Perioperative medicine has provided anesthetists with a
proactive role in the prevention of perioperative complications, in
particular cardiovascular events such as myocardial injury after
non-cardiac surgery. Objective(s): Using cardiovascular risk
concepts, pre-operative assessment for non-cardiac surgery, optimization
of the hemodynamic status, determination of differences between elective
and urgent patients, monitoring, close follow-up after surgery, and
measurements of ultrasensitive troponin in the first 48 hours
postoperatively, anesthetists are now able to identify and address early
clinical manifestations of perioperative ischemia and myocardial
infarction (MI) in patients at risk. Material(s) and Method(s):
Narrative review: Queries in various databases on perioperative ischemia
and non-fatal infarction in Pubmed, Science Direct, and Ovid.
 Result(s): The analysis of cardiac troponin levels is of the utmost
importance in the prognosis of perioperative MI. Diagnosis can be made
earlier, and it has been shown that the majority of these perioperative
events have their onset within the first 48 hours of the postoperative
period, when the physiological stress is highest in patients taken to
non-cardiac surgery. Copyright © 2018 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.). Published by Wolters Kluwer.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

<10>
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Accession Number
632781272
Title
Cytokine Removal in Critically Ill Patients Requiring Surgical Therapy for
Infective Endocarditis (RECReATE): An Investigator-initiated Prospective
Randomized Controlled Clinical Trial Comparing Two Established Clinical
Protocols.
Source
Medicine. 99 (15) (pp e19580), 2020. Date of Publication: 01 Apr 2020.
Author
Gisler F.; Spinetti T.; Erdoes G.; Luedi M.M.; Pfortmueller C.A.; Messmer
A.S.; Jenni H.; Englberger L.; Schefold J.C.
Institution
(Gisler, Jenni, Englberger) Department of Cardiovascular Surgery
(Spinetti, Pfortmueller, Messmer, Schefold) Department of Intensive Care
Medicine
(Erdoes, Luedi) Department of Anaesthesiology and Pain Medicine,
Inselspital, Bern University Hospital, University of Bern, Switzerland
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Infective endocarditis (IE) and other severe infections
induce significant changes in the immune response in a considerable number
of affected patients. Numerous IE patients develop a persistent functional
immunological phenotype that can best be characterized by a profound
anti-inflammation and/ or functional "anergy." This is pronounced in
patients with unresolved infectious foci and was previously referred to as
"injury-associated immunosuppression" (IAI). IAI can be assessed by
measurement of the monocytic human leukocyte antigen-DR (mHLA-DR)
expression, a global functional marker of immune competence. Persistence
of IAI is associated with prolonged intensive care unit length of stay,
increased secondary infection rates, and death. Immunomodulation to
reverse IAI was shown beneficial in early immunostimulatory (randomized
controlled) clinical trials. METHOD(S): Prospective 1:1 randomized
controlled clinical study to compare the course of mHLA-DR in patients
scheduled for cardiac surgery for IE. Patients will receive either best
standard of care plus cytokine adsorption during surgery while on
cardiopulmonary bypass (protocol A) versus best standard of care alone,
that is, surgery without cytokine adsorption (protocol B). A total of 54
patients will be recruited and randomized. The primary endpoint is a
change in quantitative expression of mHLA-DR (antibodies per cell on CD14+
monocytes/ macrophages, assessed using a quantitative standardized assay)
from baseline (preoperation [pre-OP], visit 1) to day 1 post-OP (visit 4).
DISCUSSION: This randomized controlled clinical trial (RECReATE) will
compare 2 clinical treatment protocols and will investigate whether
cytokine adsorption restores monocytic immune competence (reflected by
increased mHLA-DR expression) in patients with IE undergoing cardiac
surgery. TRIAL REGISTRATION: This protocol was registered in
ClinicalTrials.gov, under number NCT03892174, first listed on March 27,
2019.

<11>
Accession Number
2007724478
Title
High-Sensitivity Cardiac Troponin-Optimizing the Diagnosis of Acute
Myocardial Infarction/Injury in Women (CODE-MI): Rationale and design for
a multicenter, stepped-wedge, cluster-randomized trial.
Source
American Heart Journal. 229 (pp 18-28), 2020. Date of Publication:
November 2020.
Author
Zhao Y.; Izadnegahdar M.; Lee M.K.; Kavsak P.A.; Singer J.; Scheuermeyer
F.; Udell J.A.; Robinson S.; Norris C.M.; Lyon A.W.; Pilote L.; Cox J.;
Hassan A.; Rychtera A.; Johnson D.; Mills N.L.; Christenson J.; Humphries
K.H.
Institution
(Zhao, Lee, Humphries) BC Centre for Improved Cardiovascular Health
(ICVHealth) at Centre for Health Evaluation and Outcome Sciences (CHEOS),
Vancouver, BC, Canada
(Izadnegahdar, Robinson, Humphries) Division of Cardiology, University of
British Columbia, Vancouver, BC, Canada
(Kavsak) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Singer) School of Population and Public Health, University of British
Columbia, Vancouver, BC, Canada
(Singer, Scheuermeyer, Christenson) Centre for Health Evaluation and
Outcome Sciences (CHEOS), Vancouver, BC, Canada
(Scheuermeyer, Christenson) Department of Emergency Medicine, Vancouver,
BC, Canada
(Scheuermeyer, Christenson) St. Paul's Hospital, Vancouver, BC, Canada
(Udell) Division of Cardiovascular, Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Udell) Women's College Hospital, Toronto, ON, Canada
(Robinson) Royal Jubilee Hospital, Victoria, BC, Canada
(Norris) Faculty of Nursing and Division of Cardiovascular Surgery,
University of Alberta, Edmonton, AB, Canada
(Norris) Cardiovascular Health and Stroke Strategic Clinical Network,
Alberta Health Services, Edmonton, AB, Canada
(Lyon) Department of Pathology and Laboratory Medicine, Saskatchewan
Health Authority, Saskatoon, SK, Canada
(Pilote) Divisions of General Internal Medicine and Clinical Epidemiology,
Department of Medicine, Research Institute of the McGill University Health
Centre and McGill University, Montreal, Quebec, Canada
(Cox) Division of Cardiology, Department of Medicine, Dalhousie
University, Halifax, NS, Canada
(Hassan) Division of Cardiovascular Surgery, New Brunswick Heart Centre,
Dalhousie University, Saint John, NB, Canada
(Rychtera) Patient Partners, Vancouver, BC, Canada
(Johnson) Patient Partners, Vernon, BC, Canada
(Mills) British Heart Foundation Centre for Cardiovascular Science and
Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Despite evidence that high-sensitivity cardiac troponin (hs-cTn) levels in
women are lower than in men, a single threshold based on the 99th
percentile upper reference limit of the overall reference population is
commonly used to diagnose myocardial infarction in clinical practice. This
trial aims to determine whether the use of a lower female-specific hs-cTn
threshold would improve the diagnosis, treatment, and outcomes of women
presenting to the emergency department with symptoms suggestive of
myocardial ischemia. Methods/Design: CODE-MI (hs-cTn-Optimizing the
Diagnosis of Acute Myocardial Infarction/Injury in Women) is a
multicenter, stepped-wedge, cluster-randomized trial of 30 secondary and
tertiary care hospitals across 8 Canadian provinces, with the unit of
randomization being the hospital. All adults (>=20 years of age)
presenting to the emergency department with symptoms suggestive of
myocardial ischemia and at least 1 hs-cTn test are eligible for inclusion.
Over five, 5-month intervals, hospitals will be randomized to implement
lower female hs-cTn thresholds according to the assay being used at each
site. Men will continue to be assessed using the overall thresholds
throughout. Women with a peak hs-cTn value between the female-specific and
the overall thresholds will form our primary cohort. The primary outcome,
a 1-year composite of all-cause mortality or readmission for nonfatal
myocardial infarction, incident heart failure, or emergent/urgent coronary
revascularization, will be compared before and after the implementation of
female thresholds using mixed-effects logistic regression models. The
cohort and outcomes will be obtained from routinely collected
administrative data. The trial is designed to detect a 20% relative risk
difference in the primary outcome, or a 2.2% absolute difference, with 82%
power. Conclusion(s): This pragmatic trial will assess whether
adopting lower female hs-cTn thresholds leads to appropriate assessment of
women with symptoms suggestive of myocardial infarction, thereby improving
treatment and outcomes. Copyright © 2020 Elsevier Inc.

<12>
Accession Number
2007713605
Title
Machine learning improves mortality risk prediction after cardiac surgery:
Systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Benedetto U.; Dimagli A.; Sinha S.; Cocomello L.; Gibbison B.; Caputo M.;
Gaunt T.; Lyon M.; Holmes C.; Angelini G.D.
Institution
(Benedetto, Dimagli, Sinha, Cocomello, Gibbison, Caputo, Angelini)
Department of Translational Health Sciences, Bristol Heart Institute,
University of Bristol, London, United Kingdom
(Gaunt, Lyon) Population Health Sciences, University of Bristol, London,
United Kingdom
(Holmes) Department of Statistics, University of Oxford, Oxford, United
Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Interest in the usefulness of machine learning (ML) methods
for outcomes prediction has continued to increase in recent years.
However, the advantage of advanced ML model over traditional logistic
regression (LR) remains controversial. We performed a systematic review
and meta-analysis of studies comparing the discrimination accuracy between
ML models versus LR in predicting operative mortality following cardiac
surgery. Method(s): The present systematic review followed the
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
statement. Discrimination ability was assessed using the C-statistic.
Pooled C-statistics and its 95% credibility interval for ML models and LR
were obtained were obtained using a Bayesian framework. Pooled estimates
for ML models and LR were compared to inform on difference between the 2
approaches. Result(s): We identified 459 published citations of which
15 studies met inclusion criteria and were used for the quantitative and
qualitative analysis. When the best ML model from individual study was
used, meta-analytic estimates showed that ML were associated with a
significantly higher C-statistic (ML, 0.88; 95% credibility interval,
0.83-0.93 vs LR, 0.81; 95% credibility interval, 0.77-0.85; P = .03). When
individual ML algorithms were instead selected, we found a nonsignificant
trend toward better prediction with each of ML algorithms. We found no
evidence of publication bias (P = .70). Conclusion(s): The present
findings suggest that when compared with LR, ML models provide better
discrimination in mortality prediction after cardiac surgery. However, the
magnitude and clinical influence of such an improvement remains
uncertain. Copyright © 2020 The American Association for Thoracic
Surgery

<13>
Accession Number
2006111693
Title
Outcomes in minimally invasive double valve surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Brown L.J.; Mellor S.L.; Niranjan G.; Harky A.
Institution
(Brown, Mellor) Birmingham Medical School, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, United Kingdom
(Niranjan, Harky) Department of Cardiothoracic Surgery, Liverpool Heart
and Chest, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To review current literature evidence on outcomes of minimally
invasive double valve surgeries (MIS). Method(s): A comprehensive
electronic literature search was done from inception to 20th June 2020
identifying articles that discussed outcomes of minimally invasive
approach in double valve surgeries either as a solo cohort or as
comparative to conventional sternotomies. No limit was placed on time and
place of publication and the evidence has been summarized in narrative
manner within the manuscript. Result(s): Majority of current
literature reported similar perioperative and clinical outcomes between
MIS and conventional median sternotomy; except that MIS has better
cosmetic effects and pain control. Nevertheless, minimal invasive
techniques are associated with longer cardiopulmonary bypass and aortic
cross-clamp times which may have impact on the reported outcomes and
overall morbidity and mortality rates. Conclusion(s): Minimally
invasive double valve surgery continues to develop, but scarcity in the
literature suggests uptake is slow, possibly due to the learning curve
associated with MIS. Many outcomes appear to be comparable to conventional
sternotomy. There is need for larger, multi-center, and randomized trial
to fully evaluate and establish the early, mid- and long-term morbidity
and mortality rates associated with both techniques. Copyright ©
2020 Wiley Periodicals LLC

<14>
Accession Number
2006096658
Title
Nitric oxide added to the sweep gas of the oxygenator during
cardiopulmonary bypass in infants: A pilot randomized controlled trial.
Source
Artificial Organs. (no pagination), 2020. Date of Publication: 2020.
Author
Niebler R.A.; Chiang-Ching H.; Daley K.; Janecke R.; Jobe S.M.; Mitchell
M.E.; Varner C.; Woods K.; Scott J.P.
Institution
(Niebler, Jobe, Woods) Departments of Pediatrics, Medical College of
Wisconsin, Milwaukee, WI, United States
(Niebler, Daley, Mitchell, Varner, Scott) Herma Heart Institute,
Children's Wisconsin, Milwaukee, WI, United States
(Chiang-Ching) School of Public Health, University of Wisconsin,
Milwaukee, WI, United States
(Janecke, Jobe) Versiti Blood Research Institute, Milwaukee, WI, United
States
(Mitchell) Departments of Cardiothoracic Surgery, Medical College of
Wisconsin, Milwaukee, WI, United States
(Scott) Departments of Anesthesia, Medical College of Wisconsin,
Milwaukee, WI, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Our objective was to assess the effect of nitric oxide added to the sweep
gas of the oxygenator during cardiopulmonary bypass (CPB) in infants on
platelet count, platelet function, clinical outcomes, and safety. A
randomized, double-blinded, placebo-controlled clinical trial in infants
less than a year of age undergoing cardiac surgery requiring CPB was
undertaken. Nitric oxide at a dose of 20 ppm was added to the sweep gas in
the treatment group. Blood was collected at baseline and prior to
separation from CPB to measure platelet count and function as determined
by responsiveness to specific agonists. Clinical outcomes were observed
through hospital discharge. Methemoglobin levels were measured
preoperatively, at the conclusion of CPB, and upon admission to the ICU.
Forty patients consented and were randomized in the trial. Eighteen
patients were randomized to the treatment group and 22 were included in
the placebo group. The groups were similar in terms of age, weight,
gender, and surgical complexity. No significant differences were found in
measures of platelet count, platelet response to agonist, or clinical
outcomes. Patients in the treatment group had higher methemoglobin levels
after receiving nitric oxide, but no levels approached toxicity (maximum
2.4%). Nitric oxide added to the sweep gas of the oxygenator during CPB in
infants did not have an appreciable effect on the preservation of platelet
count, platelet responsiveness to agonist, or clinical outcomes.
Methemoglobin levels were increased after receiving nitric oxide but were
far below a toxic level of 15%. Copyright © 2020 International
Center for Artificial Organ and Transplantation (ICAOT) and Wiley
Periodicals LLC.

<15>
Accession Number
632782065
Title
A systematic evaluation on reporting quality of modern studies on
pulmonary heart valve implantation in large animals.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 04 Sep 2020.
Author
Uiterwijk M.; Vis A.; de Brouwer I.; van Urk D.; Kluin J.
Institution
(Uiterwijk, Vis, de Brouwer, van Urk, Kluin) Department of Cardiothoracic
Surgery, Amsterdam University Medical Center, University of Amsterdam,
Heart Center, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Before new heart valves can be implanted safely in humans,
animal experiments have to be performed. These animal experiments have to
be clearly designed, analysed and reported to assess the accuracy and
importance of the findings. We aimed to provide an overview of the
reporting and methodological quality of preclinical heart valve research.
 METHOD(S): We conducted a systematic literature search on biological
and mechanical pulmonary valve implantations in large animals. We used the
Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines to
score the quality of reporting in each article. We compared the scores
before and after the introduction of the ARRIVE guidelines (2010).
 RESULT(S): We screened 348 articles, of which 31 articles were
included. The included articles reported a mean of 54.7% adequately scored
ARRIVE items (95% confidence interval 52.2-57.3%). We did not identify a
difference in reporting quality (54.7% vs 54.8%) between articles
published before and after 2010. We found an unclear (lack of description)
risk of selection bias, performance bias and detection bias.
 CONCLUSION(S): The reporting quality of studies that implanted
bioprosthetic or mechanical valves in the pulmonary position in the large
animal model is not on the desired level. The introduction of the ARRIVE
guidelines in 2010 did not improve the reporting quality in this field of
research. Hereby, we want to emphasize the importance of clearly
describing the methods and transparently reporting the results in animal
experiments. This is of great importance for the safe translation of new
heart valves to the clinic. CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO
(CRD42019147895). Copyright © The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<16>
Accession Number
632778088
Title
When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A
Review.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 31 Aug 2020.
Author
Sabe A.A.; Percy E.; Kaneko T.; Plichta R.P.; Hughes G.C.
Institution
(Sabe, Percy, Kaneko) Division of Cardiac Surgery, Brigham and Women's
Hospital, Harvard Medical School, MA, Boston
(Plichta, Hughes) Division of Cardiovascular and Thoracic Surgery, Duke
University Medical Center, Durham
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute type A aortic dissection (ATAAD) is a surgical emergency
with an operative mortality of up to 30%, a rate which has not changed
meaningfully in over two decades. A growing body of research has
highlighted several comorbidities and presenting factors in which delay or
permanent deferral of surgery may be considered; however, modern
comprehensive summative reviews are lacking. The urgency and timing of
this review are underscored by significant challenges in resource
utilization posed by the COVID-19 pandemic. This review provides an update
on the current understanding of risk assessment, surgical candidacy, and
operative timing in patients with ATAAD. METHOD(S): A literature
search was conducted through PubMed and Embase databases to identify
relevant studies relating to risk assessment in ATAAD. Articles were
selected via group consensus based on quality and relevance.
 RESULT(S): Several patient factors have been identified which
increase risk in ATAAD repair. In particular, frailty, advanced age, prior
cardiac surgery, and use of novel anticoagulant medications have been
studied. The understanding of malperfusion syndromes has also expanded
significantly, including recommendations for surgical delay. Finally,
approaches to triage have been significantly influenced by resource
limitations related to the ongoing COVID-19 pandemic. While medical
management remains a reasonable option in carefully selected patients at
prohibitive risk for open surgery, endovascular therapies for treatment of
ATAAD are rapidly evolving. CONCLUSION(S): Early surgical repair
remains the preferred treatment for most patients with ATAAD, however,
improvements in risk stratification should guide appropriate delay or
permanent deferral of surgery in select individuals. Copyright ©
2020. Published by Elsevier Inc.

<17>
Accession Number
632775219
Title
Advancement of a standardised enteral feeding protocol in functional
single ventricle patients following stage i palliation using
cerebro-somatic near-infrared spectroscopy.
Source
Cardiology in the Young. (no pagination), 2020. Date of Publication: 2020.
Author
Raymond T.T.; Valle S.; Garza J.; Yeramaneni S.; Wurtz E.; Sample B.;
Kozak N.; Stigall W.; Gatlin S.; Burton G.
Institution
(Raymond, Wurtz, Sample, Kozak, Burton) Department of Pediatrics, Cardiac
Intensive Care, Medical City Children's Hospital, 7777 Forest Lane,
Dallas, TX 75230, United States
(Valle, Yeramaneni) HCA Research Institute, Medical City Children's
Hospital, Dallas, TX, United States
(Garza) Children's Health, Division of Cardiology, Dallas, TX, United
States
(Stigall) Pediatric Critical Care, Cook Children's Hospital, Fort Worth,
TX, United States
(Gatlin) Department of Pediatrics, Division of Cardiology, Arkansas
Children's Hospital, Little Rock, AR, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction:Infants with single ventricle following stage I palliation
are at risk for poor nutrition and growth failure. We hypothesise a
standardised enteral feeding protocol for these infants that will result
in a more rapid attainment of nutritional goals without an increased
incidence of gastrointestinal co-morbidities.Materials and
methods:Single-centre cardiac ICU, prospective case series with historical
comparisons. Feeding cohort consisted of consecutive patients with a
single ventricle admitted to cardiac ICU over 18 months following stage I
palliation (n = 33). Data were compared with a control cohort and admitted
to the cardiac ICU over 18 months before feeding protocol implementation
(n = 30). Feeding protocol patients were randomised: (1) protocol with
cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n
= 17) or (2) protocol without cerebro-somatic near-infrared spectroscopy
feeding advancement criteria (n = 16). Result(s):Median time to
achieve goal enteral volume was significantly higher in the control
compared to feeding cohort. There were no significant differences in
enteral feeds being held for feeding intolerance or necrotising
enterocolitis between cohorts. Feeding cohort had significant improvements
in discharge nutritional status (weight, difference admit to discharge
weight, weight-for-age z score, volume, and caloric enteral nutrition) and
late mortality compared to the control cohort. No infants in the feeding
group with cerebro-somatic near-infrared spectroscopy developed
necrotising enterocolitis versus 4/16 (25%) in the feeding cohort without
cerebro-somatic near-infrared spectroscopy (p = 0.04).
 Conclusion(s):A feeding protocol is a safe and effective means of
initiating and advancing enteral nutrition in infants following stage I
palliation and resulted in improved nutrition delivery, weight gain, and
nourishment status at discharge without increased incidence of
gastrointestinal co-morbidities. Copyright © The Author(s),
2020. Published by Cambridge University Press.

<18>
Accession Number
2007630369
Title
Effects of peripheral and different inspiratory muscle training methods in
coronary artery disease patients with metabolic syndrome: A
randomized-controlled trial.
Source
Respiratory Medicine. 172 (no pagination), 2020. Article Number: 106119.
Date of Publication: October 2020.
Author
Muammer K.; Mutluay F.; Demir R.; Ozkan A.A.
Institution
(Muammer, Demir, Ozkan) Department of Cardiology, Cardiology Institute,
Istanbul University, Istanbul, Turkey
(Mutluay) Department of Physiotherapy and Rehabilitation, Faculty of
Health Sciences, Medipol University, Istanbul, Turkey
Publisher
W.B. Saunders Ltd
Abstract
Background Objective: To investigate the effects of peripheral muscle
training (PMT) and different inspiratory muscle training (IMT) methods on
respiratory functions, exercise capacity, and biochemistry parameters in
coronary artery disease patients with metabolic syndrome. Method(s):
This prospective, single-blind, randomized-controlled study included 60
patients of stable coronary artery disease with metabolic syndrome (New
York Heart Association [NYHA] Class I-II, left ventricular ejection
fraction >40%). Patients were randomly divided into three groups:
neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT
group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group
(PMT group, n = 20). Treatment continued for six weeks for all groups. The
NMES was applied to rectus abdominis, IMT was applied with 30% of maximal
inspiratory pressures, and PMT was applied at home. Spirometry, maximal
inspiratory and expiratory pressure, dyspnea scores, exercise stress test,
and biochemistry parameters were measured before and after training.
 Result(s): There were significant improvements in spirometric tests,
respiratory muscle strength, dyspnea scores, exercise capacity, fasting
blood glucose, and antistreptolysin O after treatment in all groups (p <
0.05). Significant improvements in C-reactive protein and erythrocyte
sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p <
0.05). Among the groups, there was a significant difference in maximal
inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p =
0.037) in favor of NMES + PMT group (p < 0.05). Conclusion(s): Our
study results showed significant improvements in respiratory functions,
exercise capacity, and biochemistry markers in all groups. Different IMT
methods can be used in cardiopulmonary rehabilitation to improve exercise
intolerance in coronary artery disease patients with metabolic syndrome.
Clinical Trial registration number: NCT03523026. Copyright © 2020

<19>
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.
 Objective(s): To evaluate the effectiveness and safety of Zephyr EBV
in heterogeneous emphysema with little to no collateral ventilation in the
treated lobe. 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. 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. 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. Copyright © 2018 by the American
Thoracic Society.

<20>
Accession Number
2005603837
Title
Efficacy and safety of riociguat in combination therapy for patients with
pulmonary arterial hypertension (PATENT studies).
Source
Pulmonary Circulation. 10 (3) (no pagination), 2020. Date of Publication:
2020.
Author
Ghofrani H.-A.; Grunig E.; Jansa P.; Langleben D.; Rosenkranz S.; Preston
I.R.; Rahaghi F.; Sood N.; Busse D.; Meier C.; Humbert M.
Institution
(Ghofrani) University of Giessen and Marburg Lung Center, Member of German
Center for Lung Research, Giessen, Germany
(Ghofrani) Department of Medicine, Imperial College London, London, United
Kingdom
(Grunig) Center for Pulmonary Hypertension, Thoraxklinic, University
Hospital Heidelberg, Member of the German Center for Lung Research (DZL,
Heidelberg, Germany
(Jansa) First Faculty of Medicine and General Teaching Hospital, Charles
University, Prague, Czechia
(Langleben) Center for Pulmonary Vascular Disease and Lady Davis
Institute, Jewish General Hospital, McGill University, Montreal, QC,
Canada
(Rosenkranz) Klinik III fur Innere Medizin, Herzzentrum der Universitat zu
Koln, Koln, Germany
(Preston) Critical Care and Sleep Division, Tufts Medical Center, Tufts
University School of Medicine, Boston, MA, United States
(Rahaghi) Department of Pulmonary and Critical Care Medicine, Cleveland
Clinic Florida, Weston, FL, United States
(Sood) The Lung Center, The Ohio State University, Columbus, OH, United
States
(Busse) Chrestos Concept GmbH Co. KG, Essen, Germany
(Meier) Bayer AG, Berlin, Germany
(Humbert) Assistance Publique-Hopitaux de Paris, Service de Pneumologie,
Hopital Bicetre, Universite Paris-Sud, Laboratoire d'Excellence en
Recherche sur le Medicament et Innovation Therapeutique, Institut National
de la Sante et de la Recherche Medicale Unite 999, Le Kremlin-Bicetre,
France
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Many patients with pulmonary arterial hypertension do not achieve
treatment goals with monotherapy, and therefore combination therapy is
becoming the standard of care. The soluble guanylate cyclase stimulator
riociguat is licensed for the treatment of pulmonary arterial
hypertension; here we present findings from patients who were receiving
combined riociguat plus endothelin receptor antagonists or non-intravenous
prostanoids in the randomized, placebo-controlled PATENT-1 study and its
open-label extension (PATENT-2). Moreover, we include new data from
patients receiving early sequential combination therapy (three to six
months of endothelin receptor antagonist treatment) or long-term
background endothelin receptor antagonist therapy (>6 months). Patients
were randomized to riociguat 2.5 mg-maximum (N = 131 pretreated patients)
and placebo (N = 60 pretreated patients). Riociguat improved 6-min walking
distance (PATENT-1 primary endpoint), functional capacity, and
hemodynamics after 12 weeks in pretreated patients. The placebo-corrected
changes in 6-min walking distance were +24 m in endothelin receptor
antagonist-pretreated patients and +106 m in the small group of
prostanoid-pretreated patients. In the early sequential combination and
long-term background endothelin receptor antagonist groups, the
placebo-corrected changes in 6-min walking distance were +65 m (95% CI: 17
to 113 m) and +13 m (95% CI: -8 to 33 m), respectively. In conclusion,
these data suggest that early sequential combination of an endothelin
receptor antagonist plus riociguat is a feasible treatment option. Both
early sequential therapy and long-term background endothelin receptor
antagonist plus riociguat were well tolerated in the PATENT
studies. Copyright © The Author(s) 2020.

<21>
Accession Number
2004881528
Title
Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a
meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. 68 (8) (pp 746-753), 2020.
Date of Publication: 01 Aug 2020.
Author
Wei Y.; Xu Z.-Q.D.; Li H.
Institution
(Wei) Capital Medical University, Beijing, China
(Wei, Li) Department of Thoracic Surgery, Beijing Chao-Yang Hospital,
Capital Medical University, Beijing, China
(Xu) Department of Neurobiology, School of Basic Medical Science, Capital
Medical University, Beijing, China
Publisher
Springer
Abstract
Objective: Palmar hyperhidrosis affects 0.6-10% of the general population,
having an important impact in patients' quality of life. The definitive
treatment for palmar hyperhidrosis is thoracic sympathectomy. The purpose
of this study is to evaluate the quality of life after thoracic
sympathectomy for palmar hyperhidrosis. Method(s): The interest
studies were searched in six comprehensive databases. The quality of the
studies was assessed using the risk of bias tool recommended by the
Cochrane system evaluation manual. Meta-analysis was performed with RevMan
version 5.3. The outcome of interest was quality of life. The subgroup
analysis and sensitive analysis were performed. Result(s): Nine
trials, including 895 patients, with accessible data comparing
preoperative quality of life score with postoperative quality-of-life
score were used for data analysis. Compared with preoperative
quality-of-life score, application of thoracic sympathectomy improved the
postoperative quality of life of palmar hyperhidrosis patients (MD =
57.81, 95% CI 53.33-62.30). Subgroup analysis of the different thoracic
sympathectomy segment showed that there was no significant difference in
the results obtained when operated with single segment or multiple
segments (single segment: MD = 61.16, 95% CI [56.10, 66.22], multiple
segments: MD = 52.14, 95% CI [48.39, 55.88]). Conclusion(s): The
meta-analysis provided evidence of the improved quality of life after
thoracic sympathectomy for palmar hyperhidrosis. Copyright ©
2020, The Japanese Association for Thoracic Surgery.

<22>
Accession Number
2007551380
Title
Dexmedetomidine improves early postoperative neurocognitive disorder in
elderly male patients undergoing thoracoscopic lobectomy.
Source
Experimental and Therapeutic Medicine. 20 (4) (pp 3867-3876), 2020. Date
of Publication: October 2020.
Author
Shi H.; Du X.; Wu F.; Hu Y.; Xv Z.; Mi W.
Institution
(Shi, Xv, Mi) Anesthesia and Operation Center, Chinese PLA General
Hospital, Beijing 100853, China
(Shi, Du, Wu, Hu) Department of Anesthesiology, Affiliated Hospital of
Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Perioperative neurocognitive disorder (PND) is a common complication
following thoracic surgery that frequently occurs in patients >=65 years.
PND includes postoperative cognitive dysfunction (POCD) and postoperative
delirium (POD). To investigate whether intravenous dexmedetomidine (DEX)
is able to improve neurocognitive function in elderly male patients
following thoracoscopic lobectomy, a randomized, double-blinded,
placebo-controlled trial was performed at the Affiliated Hospital of Inner
Mongolia Medical University (Hohhot, China). Patients aged >=65 years were
enrolled and were subjected to thoracic surgery under general anesthesia.
A computer-generated randomization sequence was used to randomly assign
patients (at a 1:1 ratio) to receive either intravenous DEX (0.5
micro g/kg per h, from induction until chest closure) or placebo
(intravenous normal saline).TheprimaryendpointwastheresultoftheMini-Mental
State Examination (MMSE). The secondary endpoints were the results of the
Montreal Cognitive Assessment (MoCA) and those obtained with the Confusion
Assessment Method (CAM), as well as the incidence of POCD and POD during
the first 7 postoperative days. Other observational indexes included sleep
quality at night, self-anxiety scale prior to the operation and 7 days
following the operation and the visual analogue scale (VAS) score at rest
and during movement on the first and third day following the operation.
Furthermore, at 6 h following surgery, the MMSE score in the DEX group was
significantly higher than that in the saline group. At 6 h and on the
first day postoperatively, the MoCA score in the DEX group was
significantly higher than that in the saline group. The incidence of POCD
and POD in the DEX group was 13.2 and 7.5%, respectively, while that in
the saline group was 35.8 and 11.3%, respectively. There was a significant
difference in the incidence of POCD between the two groups (P<0.01). In
the DEX group, mean sleep quality was increased, whereas the mean VAS was
decreased compared with the corresponding values in the saline group. In
conclusion, elderly male patients who underwent thoracoscopic lobectomy
under continuous infusion of DEX (0.5 micro g/kg/h) exhibited a
reduced incidence of POCD during the first 7 postoperative days as
compared with the placebo group. Furthermore, DEX improved the subjective
sleep quality in the first postoperative night, reduced anxiety and
alleviated postoperative pain. In addition, it increased the incidence of
bradycardia. The present study was registered in the Chinese Clinical
Trial Registry (www.chictr.org.cn; registration no.
ChiCTR-IPR-17010958). Copyright © This work is licensed under a
Creative Commons Attribution 4.0 International (CC BY 4.0) License

<23>
Accession Number
2006052740
Title
Clinical outcomes after transcatheter aortic valve replacement in South
America: A centre-level systematic review and meta-analysis of
observational data.
Source
Journal of Evaluation in Clinical Practice. (no pagination), 2020. Date of
Publication: 2020.
Author
Boissonnet C.P.; Giorgi M.A.; Carosella L.; Brescacin C.; Pissinis J.;
Guetta J.N.
Institution
(Boissonnet, Giorgi, Guetta) Health Economics and Technology Assessment
Unit, Instituto Universitario CEMIC, Centro de Educacion Medica e
Investigaciones Clinicas "Norberto Quirno" (CEMIC), Buenos Aires,
Argentina
(Boissonnet, Giorgi, Guetta) Cardiology Section, Department of Internal
Medicine, Centro de Educacion Medica e Investigaciones Clinicas "Norberto
Quirno" (CEMIC), Buenos Aires, Argentina
(Giorgi) Department of Pharmacology, Instituto Universitario CEMIC, Buenos
Aires, Argentina
(Carosella, Brescacin, Pissinis) Department of Internal Medicine, Centro
de Educacion Medica e Investigaciones Clinicas "Norberto Quirno" (CEMIC),
Buenos Aires, Argentina
Publisher
Blackwell Publishing Ltd
Abstract
Objectives: To estimate in-hospital and 30-day outcomes after
transcatheter aortic valve replacement (TAVR) in South America through a
systematic review and meta-analysis of observational data. Method(s):
We comprehensively searched for papers published in peer-reviewed medical
journals and for abstracts presented in medical conferences of the region
from 1 September 2008, through 29 June 2020, using predefined criteria. We
included single-centre studies on TAVR populations with >=10 patients from
South America reporting any in-hospital or 30-day clinical outcome.
 Result(s): Fifty-five cohorts from seven countries, pooling 3001
patients, were included in a random-effects meta-analysis. Self-expandable
prostheses were the most frequently implanted. Pooled estimate of
procedure success by VARC2 criteria was 90.0% (95%CI 81.8%-94.7%;
I2 75.0%). The pooled estimate rates of the outcomes were as
follow: post-procedure moderate or severe aortic regurgitation, 9.7%
(95%CI 6.0%-15.4%; I2 65.4%), in-hospital cardiac tamponade,
4.0% (95%CI 2.5%-6.6%; I2 0%), in-hospital stroke, 4.1% (95%CI
2.9%-5.7%; I2 0%), in-hospital major vascular complication,
7.8% (95%CI 5.2%-11.5%; I2 22.3%), in-hospital permanent
pacemaker implantation, 19.4% (95%CI 15.9%-23.4%; I2 53.8%),
in-hospital mortality, 8.0% (95%CI 6.7%-9.6%; I2 0%), and
30-day mortality, 9.7% (95%CI 7.9%-11.8%; I2 26.4%).
 Conclusion(s): As compared with published international registries,
the overall results of TAVR in South America seemed underrated.
Significant heterogeneity was observed in procedural success, pacemaker
requirement, and post-procedure moderate or severe aortic regurgitation.
This study provides a real-life framework for the analysis of the
performance of this technology in the region, intended to be a starting
point for quality improvement. Copyright © 2020 John Wiley & Sons
Ltd

<24>
Accession Number
2005875739
Title
Telemedicine in cardiovascular surgery during COVID-19 pandemic: A
systematic review and our experience.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Ajibade A.; Younas H.; Pullan M.; Harky A.
Institution
(Ajibade) Birmingham Medical School, University of Birmingham, Birmingham,
United Kingdom
(Younas) St George's Medical School, University of London, London, United
Kingdom
(Pullan, Harky) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Sciences,
University of Liverpool, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The SAR-COV-2 pandemic has had an unprecedented effect on the
UK's healthcare systems. To reduce spread of the virus, elective
treatments and surgeries have been postponed or canceled. There has been a
rise in the use of telemedicine (TM) as an alternative way to carry
outpatient consultations. This systematic review aims to evaluate the
extent to which TM may be able to support cardiac and vascular surgery
patients in the COVID-19 era. Method(s): We looked into how TM can
support the management of patients via triaging, preoperative, and
postoperative care. Evaluations targeted the clinical effectiveness of
common TM methods and the feasibility of applying those methods in the UK
during this pandemic. Result(s): Several studies have published their
evidence on the benefit of TM and its benefit during COVID-19, the data
related to cardiovascular surgery and how this will impact future practice
of this speciality is emerging and yet larger studies with appropriate
timing of outcomes to be published. Conclusion(s): Overall, the use
of virtual consultations and remote monitoring is feasible and best placed
to support these patients via triaging and postoperative monitoring.
However, TM can be limited by the need of sophisticated technological
requirement and patients' educational and know-how computer literacy
level. Copyright © 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<25>
[Use Link to view the full text]
Accession Number
632444552
Title
Use of administrative claims to assess outcomes and treatment effect in
randomized clinical trials for transcatheter aortic valve replacement:
Findings from the EXTEND study.
Source
Circulation. 142 (3) (pp 203-213), 2020. Date of Publication: 21 Jul 2020.
Author
Strom J.B.; Faridi K.F.; Butala N.M.; Zhao Y.; Tamez H.; Valsdottir L.R.;
Brennan J.M.; Shen C.; Popma J.J.; Kazi D.S.; Yeh R.W.
Institution
(Strom, Zhao, Tamez, Valsdottir, Shen, Kazi, Yeh) Richard A. and Susan F.
Smith Center for Outcomes Research in Cardiology, Boston, MA, United
States
(Strom, Faridi, Zhao, Tamez, Valsdottir, Shen, Popma, Kazi, Yeh) Division
of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston,
MA, United States
(Strom, Butala, Zhao, Tamez, Valsdottir, Shen, Popma, Kazi, Yeh) Harvard
Medical School, Boston, MA, United States
(Butala) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(Faridi) Section of Cardiovascular Medicine, Yale School of Medicine,
United States
(Brennan) Duke Clinical Research Institute, Durham, NC, United States
(Popma, Yeh) Baim Institute for Clinical Research, Boston, MA, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Whether passively collected data can substitute for
adjudicated outcomes to reproduce the magnitude and direction of treatment
effect observed in cardiovascular clinical trials is not well known.
 Method(s): We linked adults >=65 years of age in the HiR (US
CoreValve Pivotal High Risk) and SURTAVI trials (Surgical or Transcatheter
Aortic Valve Replacement in Intermediate-Risk Patients) to 100% Medicare
inpatient claims, January 1, 2011, to December 31, 2016. Primary (eg,
death and stroke) and secondary trial end points were compared across
treatment arms (eg, transcatheter aortic valve replacement [TAVR] versus
surgical aortic valve replacement [SAVR]) using trial-adjudicated outcomes
versus outcomes derived from claims at 1 year (HiR) or 2 years (SURTAVI).
 Result(s): Among 600 linked HiR participants (linkage rate, 80.0%),
the rate of the trial's primary end point of all-cause mortality occurred
in 13.7% of patients receiving TAVR and 16.4% of patients receiving SAVR
at 1 year by using both trial data (hazard ratio, 0.84 [95% CI,
0.65-1.09]; P=0.33) and claims data (hazard ratio, 0.86 [95% CI,
0.66-1.11]; P=0.34; interaction P value=0.80). Noninferiority of TAVR
relative to SAVR was seen by using both trial- and claims-based outcomes
(P<inf>noninferiority</inf><0.001 for both). Among 1005 linked SURTAVI
trial participants (linkage rate, 60.5%), the trial's primary end point
was 12.9% for TAVR and 13.1% for SAVR using trial data (hazard ratio, 1.08
[95% CI, 0.79-1.48]; P=0.90), and 11.3% for TAVR and 12.5% for SAVR
patients using claims data (hazard ratio, 1.02 [95% CI, 0.73-1.41];
P=0.58; interaction P value=0.89). TAVR was noninferior to SAVR when
compared using both trial and claims
(P<inf>non</inf><inf>inferiority</inf><0.001 for both). Rates of
procedural secondary outcomes (eg, aortic valve reintervention, pacemaker
rates) were more closely concordant between trial and claims data than
nonprocedural outcomes (eg, stroke, bleeding, cardiogenic shock).
 Conclusion(s): In the HiR and SURTAVI trials, ascertainment of trial
primary end points using claims reproduced both the magnitude and
direction of treatment effect in comparison with adjudicated event data,
but nonfatal and nonprocedural secondary outcomes were not as well
reproduced. Use of claims to substitute for adjudicated outcomes in
traditional trial treatment comparisons may be valid and feasible for
all-cause mortality and certain procedural outcomes but may be less
suitable for other end points. Copyright © 2020 Lippincott
Williams and Wilkins. All rights reserved.

<26>
[Use Link to view the full text]
Accession Number
632765023
Title
Fontan-associated liver disease: Screening, management, and transplant
considerations.
Source
Circulation. 142 (6) (pp 591-604), 2020. Date of Publication: 11 Aug 2020.
Author
Emamaullee J.; Zaidi A.N.; Schiano T.; Kahn J.; Valentino P.L.; Hofer
R.E.; Taner T.; Wald J.W.; Olthoff K.M.; Bucuvalas J.; Fischer R.
Institution
(Emamaullee) Liver Transplant Center, Children's Hospital-Los Angeles, CA,
United States
(Emamaullee) Department of Surgery, Keck School of Medicine, University of
Southern California, Los Angeles., United States
(Kahn) Division of Gastrointestinal and Liver Diseases, Keck School of
Medicine, University of Southern California, Los Angeles, United States
(Zaidi) Mount Sinai Cardiovascular Institute, Recanati/Miller
Transplantation Institute, Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Zaidi) Children's Heart Center, Recanati/Miller Transplantation
Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Schiano) Divisions of Hepatology, Recanati/Miller Transplantation
Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Bucuvalas) Pediatric Hepatology, Recanati/Miller Transplantation
Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Valentino) Section of Gastroenterology and Hepatology, Department of
Pediatrics, Yale University School of Medicine, New Haven, CT, United
States
(Hofer) Departments of Anesthesiology and Perioperative Medicine, Mayo
Clinic, Rochester, MN, United States
(Taner) Departments of Surgery, Mayo Clinic, Rochester, MN, United States
(Taner) Departments of Immunology, Mayo Clinic, Rochester, MN, United
States
(Wald) Division of Cardiology, Department of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
(Olthoff) Department of Surgery, University of Pennsylvania, Philadelphia,
PA, United States
(Fischer) Department of Gastroenterology, Liver Care Center, Children's
Mercy Kansas City, MO, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Surgical innovation and multidisciplinary management have allowed children
born with univentricular physiology congenital heart disease to survive
into adulthood. An estimated global population of 70 000 patients have
undergone the Fontan procedure and are alive today, most of whom are <25
years of age. Several unexpected consequences of the Fontan circulation
include Fontan-associated liver disease. Surveillance biopsies have
demonstrated that virtually 100% of these patients develop clinically
silent fibrosis by adolescence. As they mature, there are increasing
reports of combined heart-liver transplantation resulting from advanced
liver disease, including bridging fibrosis, cirrhosis, and hepatocellular
carcinoma, in this population. In the absence of a transplantation option,
these young patients face a poor quality of life and overall survival.
Acknowledging that there are no consensus guidelines for diagnosing and
monitoring Fontan-associated liver disease or when to consider heart
transplantation versus combined heart-liver transplantation in these
patients, a multidisciplinary working group reviewed the literature
surrounding Fontan-associated liver disease, with a specific focus on
considerations for transplantation. Copyright © 2020 Lippincott
Williams and Wilkins. All rights reserved.

<27>
[Use Link to view the full text]
Accession Number
632765005
Title
Association of factor v leiden with subsequent atherothrombotic events: A
GENIUS-CHD study of individual participant data.
Source
Circulation. 142 (6) (pp 546-555), 2020. Date of Publication: 11 Aug 2020.
Author
Mahmoodi B.K.; Tragante V.; Kleber M.E.; Holmes M.V.; Schmidt A.F.;
McCubrey R.O.; Howe L.J.; Direk K.; Allayee H.; Baranova E.V.; Braund
P.S.; Delgado G.E.; Eriksson N.; Gijsberts C.M.; Gong Y.; Hartiala J.;
Heydarpour M.; Pasterkamp G.; Kotti S.; Kuukasjarvi P.; Lenzini P.A.;
Levin D.; Lyytikainen L.-P.; Muehlschlegel J.D.; Nelson C.P.; Nikus K.;
Pilbrow A.P.; Wilson Tang W.H.; Van Der Laan S.W.; Van Setten J.;
Vilmundarson R.O.; Deanfield J.; Deloukas P.; Dudbridge F.; James S.;
Mordi I.R.; Teren A.; Bergmeijer T.O.; Body S.C.; Bots M.; Burkhardt R.;
Cooper-Dehoff R.M.; Cresci S.; Danchin N.; Doughty R.N.; Grobbee D.E.;
Hagstrom E.; Hazen S.L.; Held C.; Hoefer I.E.; Hovingh G.K.; Johnson J.A.;
Kaczor M.P.; Kahonen M.; Klungel O.H.; Laurikka J.O.; Lehtimaki T.;
Maitland-Van Der Zee A.H.; McPherson R.; Palmer C.N.; Kraaijeveld A.O.;
Pepine C.J.; Sanak M.; Sattar N.; Scholz M.; Simon T.; Spertus J.A.;
Stewart A.F.R.; Szczeklik W.; Thiery J.; Visseren F.L.J.; Waltenberger J.;
Richards A.M.; Lang C.C.; Cameron V.A.; Akerblom A.; Pare G.; Marz W.;
Samani N.J.; Hingorani A.D.; Ten Berg J.M.; Wallentin L.; Asselbergs F.W.;
Patel R.S.
Institution
(Mahmoodi, Bergmeijer, Ten Berg) St. Antonius Hospital, Department of
Cardiology Nieuwegein, Netherlands
(Mahmoodi) Division of Hemostasis and Thrombosis, Department of
Hematology, UMC Groningen, University of Groningen, Netherlands
(Tragante, Schmidt, Van Setten, Kraaijeveld, Asselbergs) Department of
Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University,
Netherlands
(Baranova, Klungel, Maitland-Van Der Zee) Division of Pharmacoepidemiology
and Clinical Pharmacology, UMC Utrecht, Utrecht University, Netherlands
(Pasterkamp) Department of Clinical Chemistry, UMC Utrecht, Utrecht
University, Netherlands
(Van Der Laan) Central Diagnostics Laboratory, Division Laboratories,
Pharmacy, and Biomedical Genetics, UMC Utrecht, Utrecht University,
Netherlands
(Bots, Grobbee) Julius Center for Health Sciences and Primary Care, UMC
Utrecht, Utrecht University, Netherlands
(Hoefer) Department of Clinical Chemistry and Hematology, UMC Utrecht,
Utrecht University, Netherlands
(Visseren) Department of Vascular Medicine, UMC Utrecht, Utrecht
University, Netherlands
(Gijsberts) Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht
University, Netherlands
(Kleber, Delgado, Marz) Vth Department of Medicine, Medical Faculty
Mannheim, Heidelberg University, Germany
(Holmes) Clinical Trial Service Unit and Epidemiological Studies Unit,
Nuffield Department of Population Health, Medical Research Council
Population Health Research Unit, University of Oxford, United Kingdom
(Holmes) National Institute for Health Research Oxford Biomedical Research
Centre, Oxford University Hospital, United Kingdom
(Howe, Direk, Deanfield, Hingorani, Patel) Institute of Cardiovascular
Science, UCL BHF Research Accelerator, Faculty of Population Health
Science, University College London, United Kingdom
(McCubrey) Intermountain Heart Institute, Intermountain Medical Center,
Salt Lake City, UT, United States
(Allayee, Hartiala) Departments of Preventive Medicine and Biochemistry
and Molecular Medicine, Keck School of Medicine of University of Southern
California, Los Angeles, United States
(Hartiala) Institute for Genetic Medicine, Keck School of Medicine of
University of Southern California, Los Angeles, United States
(Braund, Nelson, Samani) Department of Cardiovascular Sciences, University
of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital,
United Kingdom
(Braund) NIHR Leicester Biomedical Research Centre, Glenfield Hospital,
United Kingdom
(Eriksson, James, Held, Akerblom, Wallentin) Uppsala Clinical Research
Center, Sweden
(Gong, Cooper-Dehoff, Johnson) Department of Pharmacotherapy and
Translational Research, Center for Pharmacogenomics, University of
Florida, Gainesville, United States
(Pepine) College of Medicine, Division of Cardiovascular Medicine,
University of Florida, Gainesville, United States
(Heydarpour, Muehlschlegel) Department of Anesthesiology, Perioperative
and Pain Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Heydarpour) Harvard Medical School, Harvard University, Boston, MA,
United States
(Kotti) Assistance Publique-Hopitaux de Paris (APHP), Department of
Clinical Pharmacology, Platform of Clinical Research of East Paris
(URCEST-CRCEST-CRB HUEP-UPMC), France
(Kuukasjarvi, Laurikka) Departments of Cardio-Thoracic Surgery, Finnish
Cardiovascular Research Center - Tampere, Faculty of Medicine and Health
Techonology, Tampere University, Finland
(Lyytikainen, Lehtimaki) Clinical Chemistry, Finnish Cardiovascular
Research Center - Tampere, Faculty of Medicine and Health Techonology,
Tampere University, Finland
(Nikus) Cardiology, Finnish Cardiovascular Research Center - Tampere,
Faculty of Medicine and Health Techonology, Tampere University, Finland
(Kahonen) Clinical Physiology, Finnish Cardiovascular Research Center -
Tampere, Faculty of Medicine and Health Techonology, Tampere University,
Finland
(Kahonen) Department of Clinical Physiology, Tampere University Hospital,
Finland
(Lenzini, Cresci) Department of Genetics, Statistical Genomics Division,
Washington University School of Medicine, Saint Louis, MO, United States
(Lenzini) Department of Medicine, Cardiovascular Division, Washington
University School of Medicine, Saint Louis, MO, United States
(Levin, Mordi, Lang) Division of Molecular and Clinical Medicine, School
of Medicine, University of Dundee, United Kingdom
(Levin) Department of Clinical Chemistry, Fimlab Laboratories, Tampere,
Finland
(Mordi) Department of Cardiology, Heart Center, Tampere University
Hospital, Finland
(Lang) Department of Cardio-Thoracic Surgery, Heart Center, Tampere
University Hospital, Finland
(Pilbrow, Richards, Cameron) Christchurch Heart Institute, University of
Otago Christchurch, New Zealand
(Wilson Tang, Hazen) Department of Cardiovascular and Metabolic Sciences,
Lerner Research Institute, Cleveland Clinic, OH, United States
(Wilson Tang) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, OH, United States
(Wilson Tang) Center for Microbiome and Human Health, Cleveland Clinic,
OH, United States
(Vilmundarson, Stewart) Ruddy Canadian Cardiovascular Genetics Centre,
University of Ottawa Heart Institute, ON, Canada
(McPherson) Departments of Medicine and Biochemistry, Microbiology, and
Immunology, University of Ottawa, ON, Canada
(Deloukas) William Harvey Research Institute, Barts and the London Medical
School, Centre for Genomic Health, Queen Mary University of London, United
Kingdom
(Dudbridge) Department of Health Sciences, University of Leicester, United
Kingdom
(Hagstrom) Department of Medical Sciences, Cardiology, Uppsala University,
Sweden
(Dudbridge, Hagstrom) Department of Cardiology, Uppsala University,
Uppsala Clinical Research Center, Sweden
(Teren) Heart Center Leipzig, Germany
(Burkhardt, Scholz, Thiery) LIFE Research Center for Civilization
Diseases, University of Leipzig, Germany
(Burkhardt) Institute for Medical Informatics, Statistics, and
Epidemiology, University of Leipzig, Germany
(Body) Department of Anesthesiology, Boston University School of Medicine,
MA, United States
(Body) Institute of Clinical Chemistry, Laboratory Medicine, University
Hospital Regensburg, Germany
(Danchin) Assistance Publique-Hopitaux de Paris (APHP), Department of
Cardiology, Hopital Europeen Georges Pompidou, FACT (French Alliance for
Cardiovascular Trials), Universite Paris Descartes, France
(Doughty) Heart Health Research Group, University of Auckland, New Zealand
(Hovingh) Department of Vascular Medicine, Academic Medical Center,
University of Amsterdam, Netherlands
(Hovingh) Department of Respiratory Medicine, Academic Medical Center,
University of Amsterdam, Netherlands
(Kaczor, Sanak, Szczeklik) Department of Internal Medicine, Jagiellonian
University Medical College, Krakow, Poland
(Palmer) Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics,
Division of Molecular and Clinical Medicine, Ninewells Hospital and
Medical School, Dundee, United Kingdom
(Sattar) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
(Simon) Assistance Publique-Hopitaux de Paris (APHP), Department of
Clinical Pharmacology, Platform of Clinical Research of East Paris
(URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular
Trials), Sorbonne Universite, Paris-06, France
(Simon) Paris-Sorbonne University, UPMC-Site St Antoine, France
(Spertus) University of Missouri-Kansas City, Kansas City, MO, United
States
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Spertus) Institute of Laboratory Medicine, Clinical Chemistry and
Molecular Diagnostics, University Hospital, Leipzig, Germany
(Waltenberger) Department of Cardiovascular Medicine, University of
Munster, Germany
(Waltenberger) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Pare) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Pare) Population Health Research Institute, Hamilton, ON, Canada
(Marz) Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
(Marz) Clinical Institute of Medical and Chemical Laboratory Diagnostics,
Medical University of Graz, Austria
(Asselbergs) Health Data Research UK, Institute of Health Informatics,
University College London, United Kingdom
(Patel) Bart's Heart Centre, St Bartholomew's Hospital, London, United
Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Studies examining the role of factor V Leiden among patients
at higher risk of atherothrombotic events, such as those with established
coronary heart disease (CHD), are lacking. Given that coagulation is
involved in the thrombus formation stage on atherosclerotic plaque
rupture, we hypothesized that factor V Leiden may be a stronger risk
factor for atherothrombotic events in patients with established CHD.
 Method(s): We performed an individual-level meta-analysis including
25 prospective studies (18 cohorts, 3 case-cohorts, 4 randomized trials)
from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease)
consortium involving patients with established CHD at baseline.
Participating studies genotyped factor V Leiden status and shared risk
estimates for the outcomes of interest using a centrally developed
statistical code with harmonized definitions across studies. Cox
proportional hazards regression models were used to obtain age- and
sex-adjusted estimates. The obtained estimates were pooled using
fixed-effect meta-analysis. The primary outcome was composite of
myocardial infarction and CHD death. Secondary outcomes included any
stroke, ischemic stroke, coronary revascularization, cardiovascular
mortality, and all-cause mortality. Result(s): The studies included
69 681 individuals of whom 3190 (4.6%) were either heterozygous or
homozygous (n=47) carriers of factor V Leiden. Median follow-up per study
ranged from 1.0 to 10.6 years. A total of 20 studies with 61 147
participants and 6849 events contributed to analyses of the primary
outcome. Factor V Leiden was not associated with the combined outcome of
myocardial infarction and CHD death (hazard ratio, 1.03 [95% CI,
0.92-1.16]; I2=28%; P-heterogeneity=0.12). Subgroup analysis
according to baseline characteristics or strata of traditional
cardiovascular risk factors did not show relevant differences. Similarly,
risk estimates for the secondary outcomes including stroke, coronary
revascularization, cardiovascular mortality, and all-cause mortality were
also close to identity. Conclusion(s): Factor V Leiden was not
associated with increased risk of subsequent atherothrombotic events and
mortality in high-risk participants with established and treated CHD.
Routine assessment of factor V Leiden status is unlikely to improve
atherothrombotic events risk stratification in this
population. Copyright © 2020 Lippincott Williams and Wilkins. All
rights reserved.

<28>
Accession Number
632381658
Title
Cardiac Surgery 2019 Reviewed.
Source
Thoracic and Cardiovascular Surgeon. 68 (5) (pp 362-375), 2020. Date of
Publication: 01 Aug 2020.
Author
Doenst T.; Bargenda S.; Kirov H.; Moschovas A.; Tkebuchava S.; Safarov R.;
Velichkov I.; Diab M.
Institution
(Doenst, Bargenda, Kirov, Moschovas, Tkebuchava, Safarov, Velichkov, Diab)
Department of Cardiothoracic Surgery, Friedrich-Schiller University of
Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
For the year 2019, almost 25,000 published references can be found in
PubMed when entering the search term cardiac surgery. We used the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
approach for article selection and reviewed the main fields of adult
cardiac surgery (i.e., coronary, valve, aortic, and heart failure
surgery). The past decade has experienced an enormous development of
interventional techniques that compete more and more with classic surgery.
This contest was broadly visible in 2019. It peaked over the
interpretation of the EXCEL trial data, where percutaneous coronary
intervention and coronary artery bypass grafting (CABG) for left main
disease were compared. A novel pathomechanism for CABG was proposed,
potentially answering open questions in the field. In aortic valve
surgery, two low-risk trials comparing transcatheter aortic valve
implantation (TAVI) to classic aortic valve replacement (surgical aortic
valve replacement) received attention for showing equal or superior
short-term outcomes for TAVI. Longer follow-up information from recent
trials became available presenting results emphasizing the need for joint
decision making. While publications addressing surgery on the aorta and
the mitral and tricuspid valves were less abundant, there was substantial
activity regarding left ventricular assist device support and heart
transplantation. This article attempts to summarize the most pertinent
publications. It does not expect to be complete and cannot be free of
individual interpretation. We aimed to provide a condensed summary of
2019s publications with a stimulus for in-depth reading and a basis
supporting patient information. Copyright © 2020 Georg Thieme
Verlag. All rights reserved.

<29>
Accession Number
2007726724
Title
Near Infrared Spectroscopy in Anemia Detection and Management: A
Systematic Review.
Source
Transfusion Medicine Reviews. (no pagination), 2020. Date of Publication:
2020.
Author
Crispin P.; Forwood K.
Institution
(Crispin) John Curtin School of Medical Research, Australian National
University, Acton, ACT, Australia
(Crispin) Haematology Department, Canberra Hospital, Garran, ACT,
Australia
(Forwood) Haematology Department, Dunedin Hospital, Dunedin, New Zealand
Publisher
W.B. Saunders
Abstract
Red cell transfusions are intended to improve oxygen delivery to tissues.
Although studies comparing hemoglobin concentration triggers for
transfusion have been done, the hemoglobin threshold for clinical benefit
remains uncertain. Direct measurement of tissue oxygenation with
non-invasive near infrared spectroscopy has been proposed as a more
physiological transfusion trigger, but its clinical role remains unclear.
This systematic review examined the role of near infrared spectroscopy for
detection of anemia and guiding transfusion decisions. Abstracts were
identified up until May 2019 through searches of PubMed, EMBASE and The
Web of Science. There were 69 studies meeting the inclusion criteria, most
(n = 65) of which were observational studies. Tissue oxygen saturation had
been measured in a wide range of clinical settings, with neonatal
intensive care (n = 26) and trauma (n = 7) being most common. Correlations
with hemoglobin concentration and tissue oxygenation were noted and there
were correlations between changes in red cell mass and changes in tissue
oxygenation through blood loss or transfusion. The value of tissue
oxygenation for predicting transfusion was determined in only four
studies, all using muscle oxygen saturation in the adult trauma setting.
The overall sensitivity was low at 34% (27%-42%) and while it had better
specificity at 78% (74%-82%), differing and retrospective approaches
create a high level of uncertainty with respect to these conclusions.
There were four prospective randomized studies involving 540 patients, in
cardiac and neurological surgery and in neonates that compared near
infrared spectroscopy to guide transfusion decisions with standard
practice. These showed a reduction in the number of red cells transfused
per patient (OR: 0.44 [0.09-0.79]), but not the number of patients who
received transfusion (OR: 0.71 [0.46-1.10]), and no change in clinical
outcomes. Measuring tissue oxygen saturation has potential to help guide
transfusion; however, there is a lack of data upon which to recommend
widespread implementation into clinical practice. Standardization of
measurements is required and greater research into levels at which tissue
oxygenation may lead to adverse clinical outcomes would help in the design
of future clinical trials. Copyright © 2020 Elsevier Inc.

<30>
Accession Number
2007712976
Title
Admissions Rate and Timing of Revascularization in the United States in
Patients With Non-ST-Elevation Myocardial Infarction.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Case B.C.; Yerasi C.; Wang Y.; Forrestal B.J.; Hahm J.; Dolman S.;
Weintraub W.S.; Waksman R.
Institution
(Case, Yerasi, Wang, Forrestal, Dolman, Weintraub, Waksman) Section of
Interventional Cardiology, MedStar Washington Hospital Center, Washington,
DC, United States
(Hahm) Georgetown University School of Medicine, Washington, DC, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Clinical trials have shown improved outcomes with an early invasive
approach for non-ST-elevation myocardial infarction (NSTEMI). However,
real-world data on clinical characteristics and outcomes based on time to
revascularization are lacking. We aimed to analyze NSTEMI rates,
revascularization timing, and mortality using the 2016 Nationwide
Readmissions Database. We identify patients who underwent diagnostic
angiography and subsequently received either percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG). Finally,
revascularization timing and mortality rates (in-hospital and 30-day) were
extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations
in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic
angiography, with 34.1% (255,199) revascularized. Of revascularized
patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG.
Patients with more comorbidities tended to have more delayed
revascularization. PCI was most commonly performed on the day of admission
(32.9%; 65,155). This differs from CABG, which was most commonly performed
on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate
increased after day 1 for PCI patients and after day 4 for CABG patients,
whereas 30-day in-hospital mortality for both populations increased as
revascularization was delayed. Our study shows that patients undergoing
early revascularization differ from those undergoing later
revascularization. Mortality is generally high with delayed
revascularization, as these are sicker patients. Randomized clinical
trials are needed to evaluate whether very early revascularization (<90
minutes) is associated with improved long-term outcomes in high-risk
patients. Copyright © 2020 Elsevier Inc.

<31>
Accession Number
2007712970
Title
Effects of stem cells on non-ischemic cardiomyopathy: a systematic review
and meta-analysis of randomized controlled trials.
Source
Cytotherapy. (no pagination), 2020. Date of Publication: 2020.
Author
Xia L.; Zeng L.; Pan J.; Ding Y.
Institution
(Xia, Pan, Ding) Department of Clinical Medicine, School of Medicine,
Zhejiang University City College, Hangzhou, China
(Zeng) Department of Pharmacology, School of Medicine, Zhejiang University
City College, Hangzhou, China
Publisher
Elsevier B.V.
Abstract
Background aims: To assess the impacts of stem cell therapy on clinical
outcomes in patients with non-ischemic cardiomyopathy (NICM). The effect
of stem cell therapy on prognosis is unclear and controversial.
 Method(s): The authors performed a systematic review and
meta-analysis of the effects of autologous stem cell transplantation in
patients with NICM on a composite outcome of all-cause mortality and heart
transplantation, left ventricular ejection fraction (LVEF), left
ventricular end-diastolic diameter (LVEDD), New York Heart Association
(NYHA) classification, 6-minute walk test (6-MWT) distance and serum brain
natriuretic peptide (BNP) level, considering studies published before
March 19, 2020. Result(s): Twelve trials with 623 subjects met
inclusion criteria. Compared with the control group, stem cell therapy
improved LVEF (weighted mean difference [WMD], 4.08%, 95% confidence
interval [CI], 1.93-6.23, P = 0.0002) and 6-MWT distance (WMD, 101.49 m,
95% CI, 45.62-157.35, P = 0.0004) and reduced BNP level (-294.94 pg/mL,
95% CI, -383.97 to -205.90, P < 0.00001) and NYHA classification (-0.70,
95% CI, -0.98 to -0.43, P < 0.00001). However, LVEDD showed no significant
difference between the two groups (WMD, -0.09 cm, 95% CI, -0.23 to 0.06, P
= 0.25). In 10 studies (535 subjects) employing the intracoronary route
for cell delivery, mortality and heart transplantation were decreased
(risk ratio [RR], 0.73, 95% CI, 0.52-1.00, P = 0.05). Furthermore, in four
studies (248 subjects) with peripheral CD34+ cells, either all-cause
mortality (RR, 0.44, 95% CI, 0.23-0.86, P = 0.02) or mortality and heart
transplantation (RR, 0.45, 95% CI, 0.27-0.77, P = 0.003) improved in the
treatment group compared with the control. The trial sequential analysis
suggested the information size of LVEF, 6-WMT and BNP has been adequate
for evidencing the benefits of stem cells on NICM. However, to determine
the potential survival benefit, more clinical data are required to make
the statistical significance in meta-analysis more conclusive.
 Conclusion(s): This meta-analysis demonstrates that stem cell therapy
may improve survival, exercise capacity and cardiac ejection fraction in
NICM, which suggests that stem cells are a promising option for NICM
treatment. Copyright © 2020 International Society for Cell and
Gene Therapy

<32>
Accession Number
632771378
Title
Does Quicker Mean Better? Comparison of Rapid Deployment Versus
Conventional Aortic Valve Replacement.
Source
International heart journal. (no pagination), 2020. Date of Publication:
02 Sep 2020.
Author
Lu Y.; Wang J.; Chen Z.; Wei J.; Li F.; Cai Z.
Institution
(Lu, Wang, Cai) Department of Cardiology, Second Affiliated Hospital,
Zhejiang University School of Medicine
(Chen) Department of Clinical Epidemiology and Biostatistics, Second
Affiliated Hospital, Zhejiang University School of Medicine
(Wei) Children's Hospital, Zhejiang University School of Medicine
(Li) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology
Publisher
NLM (Medline)
Abstract
The aim of this meta-analysis was to compare the clinical outcomes in
patients who underwent rapid deployment aortic valve replacement (RDAVR)
and conventional bio prosthetic aortic valve replacement (CAVR).We
performed a literature search by August 2018. The primary outcomes were
hospital and 1-year mortality, and the secondary endpoints included the
aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) time, and
postoperative and valve-related complications.Two randomized controlled
trials and 13 propensity score-matched studies were included. There was no
difference between RDAVR and CAVR in hospital mortality (2.5% versus 2.1%;
risk ratio (RR) 1.16 [95% confidence interval (CI) 0.80-1.68]) or 1-year
mortality (2.9% versus 4.1%; RR 0.69 [95% CI 0.34-1.34]). RDAVR
significantly reduced the ACC time ( (mean difference (MD) -24.33 [95% CI
-28.35 to -20.32]) and CPB time (MD -21.51 [95% CI -22.83 to -20.20]). The
pooled analysis showed that RDAVR doubled the occurrence of permanent
pacemaker implantation (8.6% versus 4.3%; RR 2.05 [95% CI 1.62-2.60]).
Meanwhile, the blood transfusion amount (MD -1.54 [95% CI -2.22 to -0.86])
and postoperative atrial fibrillation (POAF) occurrence (RR 0.83 [95% CI
0.69-0.99]) was reduced. The difference of paravalvular leakage frequency
between RDAVR and CAVR was marginal (RR 1.77 [95% CI 1.00-3.17]; P =
0.05). Furthermore, RDAVR was related to larger valves (MD 0.70 cm [95% CI
0.33-1.07]) and lower mean pressure gradients (MD -1.93 mmHg [95% CI -3.58
to -0.28]).The hospital and 1-year survival rates between RDAVR and CAVR
are comparable. RDAVR reduces POAF occurrence and blood transfusion but is
associated with a higher occurrence of pacemaker implantation.

<33>
Accession Number
2007622411
Title
Rationale and design of the MULTISTARS AMI Trial: A randomized comparison
of immediate versus staged complete revascularization in patients with
ST-segment elevation myocardial infarction and multivessel disease.
Source
American Heart Journal. 228 (pp 98-108), 2020. Date of Publication:
October 2020.
Author
Stahli B.E.; Varbella F.; Schwarz B.; Nordbeck P.; Felix S.B.; Lang I.M.;
Toma A.; Moccetti M.; Valina C.; Vercellino M.; Rigopoulos A.G.; Rohla M.;
Schindler M.; Wischnewsky M.; Linke A.; Schulze P.C.; Richardt G.;
Laugwitz K.-L.; Weidinger F.; Rottbauer W.; Achenbach S.; Huber K.;
Neumann F.-J.; Kastrati A.; Ford I.; Ruschitzka F.; Maier W.
Institution
(Stahli, Schindler, Ruschitzka, Maier) Department of Cardiology,
University Heart Center, University Hospital Zurich, Zurich, Switzerland
(Varbella) Infermi Hospital, Rivoli, Turin, Italy
(Schwarz, Richardt) Heart Center, Segeberger Kliniken GmbH, Academic
Teaching Hospital for the Universities of Kiel, Lubeck and Hamburg, Bad
Segeberg, Germany
(Nordbeck) Department of Internal Medicine I, University Hospital
Wurzburg, Wurzburg, Germany
(Felix) Department of Internal Medicine B, University Medicine Greifswald,
Greifswald, and DZHK (German Centre for Cardiovascular Research), Partner
Site Greifswald, Germany
(Lang, Toma) Department of Internal Medicine II, Cardiology, Medical
University of Vienna, Vienna, Austria
(Moccetti) Fondazione Cardiocentro Ticino, Lugano, Switzerland
(Valina, Neumann) Division of Cardiology and Angiology II, University
Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
(Vercellino) Department of Internal Medicine, Santi Antonio e Biagio e
Cesare Arrigo Hospital, Alessandria, Italy
(Rigopoulos) Mid-German Heart Center, Department of Internal Medicine III
(KIM-III), Division of Cardiology, Angiology and Intensive Medical Care,
University Hospital Halle, Martin-Luther-University Halle, Halle, Germany
(Rohla, Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital and Sigmund Freud University, Medical
School, Vienna, Austria
(Wischnewsky) FB Mathematics and Computer Science, University of Bremen,
Bremen, Germany
(Linke) Technische Universitat Dresden, Department of Internal Medicine
and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
(Schulze) Department of Internal Medicine I, Division of Cardiology,
Pneumology, Angiology and Intensive Medical Care, University Hospital
Jena, Friedrich-Schiller-University Jena, Jena, Germany
(Laugwitz) Clinic and Policlinic Internal Medicine I (Cardiology and
Angiology), Klinikum rechts der Isar, Technische Universitat Munchen,
Munich, Germany
(Weidinger) 2nd Medical Department with Cardiology and
Intensive Care Medicine, Rudolfstiftung Hospital, Vienna, Austria
(Rottbauer) Internal Medicine II, Ulm University Medical Center, Ulm,
Germany
(Achenbach) Department of Cardiology, Friedrich-Alexander-University
Erlangen-Nurnberg, Erlangen, Germany
(Kastrati) Deutsches Herzzentrum Munchen, Technische Universitat, Munich,
and DZHK (German Centre for Cardiovascular Research), partner site Munich
Heart Alliance, Germany
(Ford) Robertson Centre for Biostatistics, University of Glasgow, Glasgow,
United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
About half of patients with acute ST-segment elevation myocardial
infarction (STEMI) present with multivessel coronary artery disease (MVD).
Recent evidence supports complete revascularization in these patients.
However, optimal timing of non-culprit lesion revascularization in STEMI
patients is unknown because dedicated randomized trials on this topic are
lacking. Study design: The MULTISTARS AMI trial is a prospective,
international, multicenter, randomized, two-arm, open-label study planning
to enroll at least 840 patients. It is designed to investigate whether
immediate complete revascularization is non-inferior to staged (within
19-45 days) complete revascularization in patients in stable hemodynamic
conditions presenting with STEMI and MVD and undergoing primary
percutaneous coronary intervention (PCI). After successful primary PCI of
the culprit artery, patients are randomized in a 1:1 ratio to immediate or
staged complete revascularization. The primary endpoint is a composite of
all-cause death, non-fatal myocardial infarction, ischemia-driven
revascularization, hospitalization for heart failure, and stroke at 1
year. Conclusion(s): The MULTISTARS AMI trial tests the hypothesis
that immediate complete revascularization is non-inferior to staged
complete revascularization in stable patients with STEMI and
MVD. Copyright © 2020 The Authors

<34>
Accession Number
2007622004
Title
Comparison of optical coherence tomography-guided versus intravascular
ultrasound-guided percutaneous coronary intervention: Rationale and design
of a randomized, controlled OCTIVUS trial.
Source
American Heart Journal. 228 (pp 72-80), 2020. Date of Publication: October
2020.
Author
Kang D.-Y.; Ahn J.-M.; Park H.; Lee P.H.; Kang S.-J.; Lee S.-W.; Kim
Y.-H.; Park S.-W.; Kim S.-W.; Hur S.-H.; Cho Y.-K.; Lee C.H.; Hong S.J.;
Hong Y.J.; Yoon Y.W.; Kim S.-J.; Bae J.-H.; Oh J.-H.; Park D.-W.; Park
S.-J.
Institution
(Kang, Ahn, Park, Lee, Kang, Lee, Kim, Park, Park, Park) Division of
Cardiology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
(Kim) Division of Cardiology, Chung-Ang University Hospital, Chung-Ang
University College of Medicine, Seoul, South Korea
(Hur, Cho, Lee) Division of Cardiology, Keimyung University Dongsan
Hospital, Daegu, South Korea
(Hong) Department of Cardiology, Cardiovascular Center, Korea University
Anam Hospital, Seoul, South Korea
(Hong) Department of Cardiology, Chonnam National University Hospital,
Gwangju, South Korea
(Yoon) Division of Cardiology, Heart Center, Gangnam Severance Hospital,
Yonsei University College of Medicine, Seoul, South Korea
(Kim) Department of Cardiology, Kyunghee University College of Medicine,
Seoul, South Korea
(Bae) Department of Cardiology, Konyang University Hospital, Daejeon,
South Korea
(Oh) Department of Cardiology, Pusan National University Hospital, Busan,
South Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The clinical value of intracoronary imaging for percutaneous
coronary intervention (PCI) guidance is well acknowledged. Intravascular
ultrasound (IVUS) and optical coherence tomography (OCT) are the most
commonly used intravascular imaging to guide and optimize PCI in
day-to-day practice. However, the comparative effectiveness of IVUS-guided
versus OCT-guided PCI with respect to clinical end points remains unknown.
Methods and design: The OCTIVUS study is a prospective, multicenter,
open-label, parallel-arm, randomized trial comparing the effectiveness of
2 imaging-guided strategies in patients with stable angina or acute
coronary syndromes undergoing PCI in Korea. A total of 2,000 patients are
randomly assigned in a 1:1 ratio to either an OCT-guided PCI strategy or
an IVUS-guided PCI strategy. The trial uses a pragmatic comparative
effectiveness design with inclusion criteria designed to capture a broad
range of real-world patients with diverse clinical and anatomical
features. PCI optimization criteria are predefined using a common
algorithm for online OCT or IVUS. The primary end point, which was tested
for both noninferiority (margin, 3.1 percentage points for the risk
difference) and superiority, is target-vessel failure (cardiac death,
target-vessel myocardial infarction, or ischemia-driven target-vessel
revascularization) at 1 year. Result(s): Up to the end of July 2020,
approximately 1,200 "real-world" PCI patients have been randomly enrolled
over 2 years. Enrollment is expected to be completed around the midterm of
2021, and primary results will be available by late 2022 or early 2023.
 Conclusion(s): This large-scale, multicenter, pragmatic-design
clinical trial will provide valuable clinical evidence on the relative
efficacy and safety of OCT-guided versus IVUS-guided PCI strategies in a
broad population of patients undergoing PCI in the daily clinical
practice. Copyright © 2020 Elsevier Inc.

<35>
Accession Number
2007031167
Title
Meta-Analysis Comparing Multiple Arterial Grafts Versus Single Arterial
Graft for Coronary-Artery Bypass Grafting.
Source
American Journal of Cardiology. 130 (pp 46-55), 2020. Date of Publication:
1 September 2020.
Author
Changal K.; Masroor S.; Elzanaty A.; Patel M.; Mir T.; Khan S.; Nazir S.;
Soni R.; Oostra C.; Khuder S.; Eltahawy E.
Institution
(Changal, Nazir, Soni, Oostra) Cardiovascular Medicine, University of
Toledo Health Sciences, OH, United States
(Masroor) Cardiothoracic Surgery, University of Toledo Health Sciences,
OH, United States
(Elzanaty, Patel) Department of Medicine, University of Toledo Health
Sciences, OH, United States
(Mir) Department of Medicine, Wayne State University Detroit, MI, United
States
(Khan) Department of Medicine, St. Vincent's Hospital, Toledo, OH, United
States
(Khuder) University of Toledo Health Sciences, OH, United States
(Eltahawy) Cardiovascular Medicine, University of Toledo Health Sciences,
OH, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Observational studies and randomized controlled trials (RCTs) have shown
conflicting outcomes for multiple arterial graft (MAG) coronary artery
bypass graft surgery compared with single arterial grafts (SAGs). The
predominant evidence supporting the use of MAGs is observational. The aim
of this meta-analysis of RCTs is to compare outcomes following MAG and
SAG. We searched multiple databases for RCTs comparing MAG versus SAG. The
clinical outcomes studied were all-cause mortality, cardiac mortality,
myocardial infarction (MI), revascularization, stroke, sternal wound
complications, and major bleeding. We used hazard ratio (HR), relative
risk (RR), and corresponding 95% confidence interval (CI) for measuring
outcomes. Ten RCTs (6392 patients) were included. The average follow-up in
the studies was 4.2 years. The average age of the patients in the studies
ranged from 56.3 years to 74.6. No significant difference was seen between
MAG and SAG groups for all-cause mortality (11.8% vs 12.7%, HR 0.94, 95%
CI 0.81 to 1.09, p 0.36), cardiac mortality (4.1% vs 4.5%, HR 0.96 95% CI
0.74 to 1.26, p 0.77), MI (3.5% vs 5.1%, HR 0.87 95% CI 0.67 to 1.12, p
0.28), and major bleeding (3.3% vs 4.9%, RR 0.85 95% CI 0.64 to 1.13, p
0.26). Repeat revascularization in MAG showed a lower RR than SAG when one
of the confounding studies was excluded (RR 0.63, 95% CI 0.4 to 0.99, p
0.04). The incidence of stroke was lower in MAG than SAG (2.9% vs 3.9%, RR
0.74 95% CI 0.56 to 0.98, p 0.03). MAG had higher incidence of sternal
wound complications than SAG (2.9% vs 1.7%, RR 1.75 95% CI 1.19 to 2.55, p
0.004). In conclusion, MAG does not have a survival advantage compared
with SAG but is better in revascularization and risk of stroke. This
benefit may be set off by a higher incidence of sternal wound
complications in MAG. Copyright © 2020 Elsevier Inc.

<36>
Accession Number
2005044536
Title
The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio
in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 29 (7) (pp 1015-1024), 2020. Date of
Publication: July 2020.
Author
Liu Z.; Nguyen Khuong J.; Borg Caruana C.; Jackson S.M.; Campbell R.;
Ramson D.M.; Penny-Dimri J.C.; Kluger M.; Segal R.; Perry L.A.
Institution
(Liu, Nguyen Khuong, Borg Caruana, Jackson, Kluger, Segal, Perry)
Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Vic,
Australia
(Liu, Nguyen Khuong, Jackson) Melbourne Medical School, University of
Melbourne, Melbourne, Vic, Australia
(Campbell) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Ramson, Penny-Dimri) Department of Surgery, Monash University, Melbourne,
Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: The neutrophil-lymphocyte ratio (NLR) is an emerging
inflammatory perioperative biomarker which has been studied to predict the
incidence of postoperative atrial fibrillation (POAF) after cardiac
surgery. This systematic review and meta-analysis aimed to evaluate the
prognostic accuracy of elevated perioperative NLR in predicting POAF after
cardiac surgery. Method(s): Multiple databases were searched from
inception to May 2019 for prognostic studies on perioperative NLR and POAF
following cardiac surgery. Maximally adjusted odds ratios (OR) with
associated confidence intervals were obtained from each included study and
pooled using random effects inverse variance modelling for preoperative
NLR measurements, while standardised mean differences were pooled for
postoperative NLR values. The significance of inter- and intra-study
heterogeneity was explored using meta-regression. Result(s): 1,799
unique studies satisfied selection criteria, from which 12 studies
incorporating 9,262 participants were included. Elevated preoperative NLR
significantly predicted POAF, with a pooled OR of 1.42 (95% CI 1.16-1.72).
Multiple predefined covariates contributed to inter-study heterogeneity;
however, only prevalence of hypertension (p=0.0055), history of congestive
cardiac failure (p=0.0282) and average ejection fraction (p=0.0359) were
significant effect modifiers. Elevated postoperative NLR was not a
significant predictor of POAF (standardised mean difference 1.60 [95% CI
-0.56-3.77] between POAF+ and POAF- groups). Conclusion(s): Elevated
preoperative NLR is a promising prognostic biomarker for POAF, but
residual sources of heterogeneity remain. Larger scale validation studies
are required to justify the integration of preoperative NLR testing into
routine clinical practice. Copyright © 2019 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<37>
Accession Number
2004947247
Title
Coronary atherosclerosis and myocardial ischemia.
Source
Revista de la Federacion Argentina de Cardiologia. 49 (2) (pp 43-44),
2020. Date of Publication: April-June 2020.
Author
Marzilli M.
Institution
(Marzilli) University of Pisa, Pisa, Italy
Publisher
Federacion Argentina de Cardiologia (E-mail: edifac@fac.org.ar)

<38>
Accession Number
2004922579
Title
Empagliflozin attenuates neointimal hyperplasia after drug-eluting-stent
implantation in patients with type 2 diabetes.
Source
Heart and Vessels. 35 (10) (pp 1378-1389), 2020. Date of Publication: 01
Oct 2020.
Author
Hashikata T.; Ikutomi M.; Jimba T.; Shindo A.; Kakuda N.; Katsushika S.;
Yokoyama M.; Kishi M.; Sato T.; Matsushita M.; Ohnishi S.; Yamasaki M.
Institution
(Hashikata, Ikutomi, Jimba, Shindo, Kishi, Sato, Matsushita, Ohnishi,
Yamasaki) Department of Cardiology, NTT Medical Center Tokyo, 5-9-22
Higashigotanda, Shinagawa, Tokyo 141-0022, Japan
(Kakuda, Katsushika) Department of Cardiovascular Medicine, Graduate
School of Medicine, The University of Tokyo, Tokyo, Japan
(Yokoyama) Division of Cardiology, Department of Internal Medicine, The
Jikei University School of Medicine, Tokyo, Japan
Publisher
Springer
Abstract
The effects of empagliflozin, a sodium-glucose co-transporter 2 inhibitor,
on neointimal response after drug-eluting-stent (DES) implantation remains
unknown. Insufficiently controlled diabetes patients with coronary artery
disease planned for DES stenting were consecutively enrolled. The patients
were assigned to receive empagliflozin in addition to standard therapy or
intensive therapy using other glucose-lowering drugs (oGLD). The primary
endpoint was thickness of neointimal hyperplasia (NIH) 12 months after
stenting assessed by optical coherence tomography (OCT). A total of 28
patients were analyzed (n = 15 in the empagliflozin group, n = 13 in the
oGLD group). The levels of glucose profile were not significantly
different between both groups at follow-up [HbA1c; 7.2 +/- 0.8 vs 7.3 +/-
0.9%, p = 0.46]. In OCT analysis, neointima was significantly less in the
empagliflozin group than the oGLD group [mean NIH thickness: 137 +/- 32 vs
168 +/- 39 mum, p = 0.02]. Changes of systolic and diastolic blood
pressure (BP), changes of body mass index, and changes of hematocrit after
additional treatment were significantly associated with NIH attenuation,
whereas no correlation was observed in changes in blood glucose
parameters. Multivariate logistic regression analysis revealed that
changes in systolic BP was the strongest predictor for NIH attenuation,
followed by changes in diastolic BP. In patients with type 2 diabetes,
standard plus empagliflozin attenuated neointimal progression as compared
with intensive standard therapy after DES implantation. Our data possibly
support a beneficial effect of empagliflozin in type 2 diabetes required
for coronary revascularization therapy. Copyright © 2020,
Springer Japan KK, part of Springer Nature.

<39>
Accession Number
2006048893
Title
Infective endocarditis by Acinetobacter species: a systematic review.
Source
Journal of Chemotherapy. (no pagination), 2020. Date of Publication: 2020.
Author
Ioannou P.; Mavrikaki V.; Kofteridis D.P.
Institution
(Ioannou, Mavrikaki, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete,
Greece
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
A. baumannii-A. calcoaceticus complex infections are increasingly
frequent, especially in intensive care units. Such infections are
associated with a mortality that can be as high as 62%. On the other hand,
infective endocarditis (IE) is an uncommon disease with notable morbidity
and mortality. Even though IE is rarely caused by Acinetobacter species,
these infections can be particularly problematic due to increasing
antimicrobial resistance. The purpose of this study was to systemically
review all published cases of IE by Acinetobacter species in the
literature. A systematic review of PubMed, Scopus and Cochrane library
(through 25 April 2020) for studies providing epidemiological, clinical,
microbiological as well as treatment data and outcomes of IE by
Acinetobacter species was performed. A total of 35 studies, containing
data of 37 patients, were included. A prosthetic valve was present in
40.5%, while the most common causative pathogen was A. baumannii-A.
calcoaceticus complex, followed by A. lwoffii. Aortic valve was the
commonest infected site, followed by mitral valve. Diagnosis was set with
transthoracic echocardiography in 48.6%, while the diagnosis was set at
autopsy in 20%. Fever and sepsis were the commonest clinical
presentations, followed by heart failure and embolic phenomena.
Aminoglycosides, cephalosporins and carbapenems were the commonest
antimicrobials used. Clinical cure was noted in 70.3%, while overall
mortality was 32.4%. Development of heart failure was independently
associated with mortality by IE. This systematic review thoroughly
describes IE by Acinetobacter and provides information on epidemiology,
clinical presentation, treatment and outcomes. Copyright © 2020
Edizioni Scientifi che per l'Informazione su Farmaci e Terapia.

<40>
Accession Number
2005181241
Title
Hypertonic saline for fluid resuscitation in ICU patients post-cardiac
surgery (HERACLES): a double-blind randomized controlled clinical trial.
Source
Intensive Care Medicine. 46 (9) (pp 1683-1695), 2020. Date of Publication:
01 Sep 2020.
Author
Pfortmueller C.A.; Kindler M.; Schenk N.; Messmer A.S.; Hess B.; Jakob L.;
Wenger S.; Waskowski J.; Zuercher P.; Stoehr F.; Jakob S.M.; Englberger
L.; Schefold J.C.
Institution
(Pfortmueller, Kindler, Schenk, Messmer, Hess, Jakob, Wenger, Waskowski,
Zuercher, Stoehr, Jakob, Schefold) Department of Intensive Care Medicine,
Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse
18, Bern 3010, Switzerland
(Englberger) Department of Cardiovascular Surgery, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
Publisher
Springer
Abstract
Purpose: Recent evidence questions a liberal approach to fluid
resuscitation in intensive care unit (ICU) patients. Here, we assess
whether use of hypertonic saline applied as single infusion at ICU
admission after cardiac surgery can reduce cumulative perioperative fluid
volume. Method(s): Prospective randomized double-blind single-center
clinical trial investigates effects of a single infusion of hypertonic
saline (HS) versus normal saline (comparator). Primary endpoint was the
cumulative amount of fluid administered in patients in the hypertonic
saline versus the 0.9% saline groups (during ICU stay). Upon ICU
admission, patients received a single infusion of 5 ml/kg body weight of
7.3% NaCl (or 0.9% NaCl) over 60 min. Patients undergoing cardiac surgery
for elective valvular and/or coronary heart disease were included.
Patients with advanced organ dysfunction, infection, and/or patients on
chronic steroid medication were excluded. Result(s): A total of 101
patients were randomized to receive the study intervention (HS n = 53, NS
n = 48). Cumulative fluid intake on the ICU (primary endpoint) did not
differ between the HS and the NS groups [median 3193 ml (IQR 2052-4333 ml)
vs. 3345 ml (IQR 2332-5043 ml)]. Postoperative urinary output until ICU
discharge was increased in HS-treated patients [median 2250 ml (IQR
1640-2690 ml) vs. 1545 ml (IQR 1087-1976 ml)], and ICU fluid balance was
lower in the HS group when compared to the NS group [296 ml (IQR - 441 to
1412 ml) vs. 1137 ml (IQR 322-2660 ml)]. Conclusion(s): In a
monocentric prospective double-blind randomized clinical trial, we
observed that hypertonic saline did not reduce the total fluid volume
administered on the ICU in critically ill cardiac surgery patients.
Hypertonic saline infusion was associated with timely increase in urinary
output. Variations in electrolyte and acid-base homeostasis were
transient, but substantial in all patients. Copyright © 2020,
Springer-Verlag GmbH Germany, part of Springer Nature.

<41>
Accession Number
2004572825
Title
Fractional Flow Reserve Derived from Computed Tomography Coronary
Angiography in the Assessment and Management of Stable Chest Pain:
Rationale and Design of the FORECAST Trial.
Source
Cardiovascular Revascularization Medicine. 21 (7) (pp 890-896), 2020. Date
of Publication: July 2020.
Author
Mahmoudi M.; Nicholas Z.; Nuttall J.; Bresser M.; Maishman T.; Berry C.;
Hlatky M.A.; Douglas P.; Rajani R.; Fox K.; Curzen N.
Institution
(Mahmoudi, Curzen) Faculty of Medicine, University of Southampton, United
Kingdom
(Nicholas, Curzen) Coronary Research Group, University Hospital
Southampton, Southampton, United Kingdom
(Nuttall, Bresser, Maishman) Clinical Trials Unit, University of
Southampton, Southampton, United Kingdom
(Berry) British Heart Foundation Glasgow Cardiovascular Research Centre,
University of Glasgow, United Kingdom
(Hlatky) Stanford University School of Medicine, Stanford, CA, United
States
(Douglas) Duke University School of Medicine, Durham, NC, United States
(Rajani) Guy's & St Thomas' NHS Trust, London, United Kingdom
(Fox) Imperial College, London, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Fractional flow reserve measurement based on computed
tomography (FFR<inf>CT</inf>) is a novel, well validated, non-invasive
method for determining the presence and extent of coronary artery disease
(CAD) combined with a physiological assessment of vessel-specific ischemia
in patients with chest pain. Previous studies indicate that
FFR<inf>CT</inf> reduces the uptake of invasive angiography that shows no
significant CAD, without compromising patient safety. The clinical
effectiveness and economic impact of using FFR<inf>CT</inf> instead of
other tests in the initial evaluation of patients with stable chest pain
has not been tested in a randomized trial. Method(s): The FORECAST
trial will randomise 1400 patients with stable chest pain to receive
either FFR<inf>CT</inf> or routine clinical assessment as directed by the
National Institute for Health and Care Excellence (NICE) CG95 guideline
for Chest Pain of Recent Onset. The primary endpoint will be resource
utilisation over the subsequent nine months, including non-invasive
cardiac investigations, invasive coronary angiography, coronary
revascularization, hospitalization for cardiac events, and the use of
cardiac medications. Key pre-specified secondary endpoints will be major
adverse cardiac events, angina severity, quality of life, patient
satisfaction, time to definitive management plan, time to completion of
initial evaluation, number of hospital attendances, and working days lost
in patients who are in employment. Conclusion(s): The FORECAST
randomized trial will assess the clinical and economic outcomes of using
FFR<inf>CT</inf> as the primary test to evaluate patients presenting with
stable chest pain. Copyright © 2019 Elsevier Inc.

<42>
Accession Number
2004368705
Title
Efficacy and Safety of Transcarotid Transcatheter Aortic Valve
Replacement: A Systematic Review.
Source
Cardiovascular Revascularization Medicine. 21 (7) (pp 917-926), 2020. Date
of Publication: July 2020.
Author
Bob-Manuel T.; Almusawi H.; Rezan T.; Khaira H.; Akingbola A.; Nasir A.;
Soto J.T.; Jenkins J.; Ibebuogu U.N.
Institution
(Bob-Manuel, Rezan, Khaira, Akingbola, Nasir, Soto, Jenkins) John Ochsner
Heart and Vascular Center, New Orleans, LA, United States
(Almusawi) Department of Hospital Medicine, Leonard J Charbert Medical
Center, Houma, LA, United States
(Ibebuogu) Division of Cardiology, University of Tennessee Health Science
Center, Memphis, TN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: In patients who are not suitable for traditional access routes
for transcatheter aortic valve replacement (TAVR) due to severe peripheral
vascular disease (PVD) or prohibitive surgical risk, carotid artery (CA)
access is an emerging route for TAVR. This study represents the most up to
date on outcomes of carotid access TAVR. Method(s): A systematic
review was conducted as per the Preferred Reporting Instructions for
Systematic Reviews and Meta-analysis (PRISMA). We performed a thorough
electronic search through Pubmed, SCOPUS and Embase databases. Statistical
analyses were performed using SPSS version 24 (IBM Corporation, Armonk,
New York, USA). Result(s): A total of 15 non-randomized studies were
included in this systematic review comprising of patients that received
TAVR via 4 vascular access sites, transcarotid (TC) (N = 1035),
transfemoral (TF) (N = 1116), transapical (TAP) (N = 307), transaortic
(TAO) (N = 176) and transaxillary (TAX) (N = 90). In the Transcarotid
cases, device success was achieved in 95.6% of patients (n = 748). The
30-day and 1-yr mortality was 4.2% and 10.5% respectively. 15.3% of
patients required new pacemaker implantation. In-hospital stroke or TIA
occurred in 4% of cases. 30-day stroke or TIA occurred in 5% of cases.
There were no hemorrhagic strokes. 30-day Mortality was significantly
higher in the Transaortic group (12.1%) compared to the Transcarotid group
(2.6%) [RR = 2.93 95% CI = 1.15-7.58; p = 0.027]. There were no
differences in outcomes between the Transcarotid group and the Transapical
or Transaxillary groups. Conclusion(s): The most contemporary data on
Carotid access TAVR shows impressive device success, low rates of stroke
and pacemaker implantation and an acceptable 30-day and 1-year mortality.
30-day mortality was significantly lower in TC compared to TAO
patients. Copyright © 2019 Elsevier Inc.

<43>
Accession Number
2004247942
Title
Extracorporeal membrane oxygenation without therapeutic anticoagulation in
adults: A systematic review of the current literature.
Source
International Journal of Artificial Organs. 43 (9) (pp 570-578), 2020.
Date of Publication: 01 Sep 2020.
Author
Fina D.; Matteucci M.; Jiritano F.; Meani P.; Lo Coco V.; Kowalewski M.;
Maessen J.; Guazzi M.; Ballotta A.; Ranucci M.; Lorusso R.
Institution
(Fina, Ballotta, Ranucci) Department of Cardiovascular Anesthesia and ICU,
IRCCS Policlinico San Donato, Milan, Italy
(Fina, Matteucci, Jiritano, Meani, Lo Coco, Kowalewski, Maessen, Lorusso)
Department of Cardiothoracic Surgery, Maastricht University Medical
Centre, Maastricht, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Jiritano) Department of Cardiac Surgery, Magna Graecia University of
Catanzaro, Catanzaro, Italy
(Kowalewski) Thoracic Research Centre, Nicolaus Copernicus University,
Collegium Medicum in Bydgoszcz, Innovative Medical Forum, Bydgoszcz,
Poland
(Guazzi) IRCCS Policlinico San Donato, University of Milan, Milan, Italy
(Lorusso) Cardiovascular Research Institute, Maastricht University,
Maastricht, Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Extracorporeal membrane oxygenation is essential for the treatment of
refractory cardiopulmonary failure. Its use may be complicated by worse
haemorrhagic complications exacerbated by extracorporeal membrane
oxygenation-related therapeutic anticoagulation. Progressive technological
advancements have made extracorporeal membrane oxygenation components less
thrombogenic, potentially allowing its application with temporary
avoidance of systemic anticoagulants. A systematic review of all the
available experiences, reporting the use of extracorporeal membrane
oxygenation without systemic anticoagulation in the published literature
was performed. Only patient series were included, irrespective of the
clinical indication. The survival, extracorporeal membrane oxygenation
system-related dysfunction and complications rates, as well as in-hospital
outcome, were analysed. Six studies were selected for the analysis.
Veno-arterial extracorporeal membrane oxygenation was used in 84% of
patients, while veno-venous extracorporeal membrane oxygenation was
applied in the remaining cases. Anticoagulation was avoided because of the
high risk of bleeding after cardiac surgery (64%), active major bleeding
(23%) or presence of severe traumatic injury (9%). Duration of support
ranged from 0.3 to 1128 h. Heparin was antagonized by protamine in all the
post-cardiotomy cases. Successfully extracorporeal membrane oxygenation
weaning was achieved in 74% of the treated cases, with a hospital
discharge of 58% of patients. Rates of extracorporeal membrane oxygenation
malfunctioning due to clot formation and blood transfusion requirement
varied remarkably in the published series. Extracorporeal membrane
oxygenation without systemic anticoagulation appears feasible in selected
circumstances. Further investigations are warranted to elucidate actual
aspects regarding extracorporeal membrane oxygenation system performance,
related adverse events and benefits associated with this
management. Copyright © The Author(s) 2020.

<44>
Accession Number
2003873591
Title
Left Ventricular Size Predicts Clinical Benefit After Percutaneous Mitral
Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and
Meta-Regression Analysis.
Source
Cardiovascular Revascularization Medicine. 21 (7) (pp 857-864), 2020. Date
of Publication: July 2020.
Author
Zimarino M.; Ricci F.; Capodanno D.; De Innocentiis C.; Verrengia E.;
Swaans M.J.; Lombardi C.; Brouwer J.; Gallina S.; Grasso C.; De Caterina
R.; Tamburino C.
Institution
(Zimarino, De Innocentiis, Verrengia, Gallina) Institute of Cardiology "G.
d'Annunzio" University, Chieti, Italy
(Ricci) Institute for Advanced Biomedical Technologies, Department of
Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University,
Chieti, Italy
(Ricci) Department of Clinical Sciences, Lund University, Clinical
Research Center, Skane University Hospital, Malmo 205-02, Sweden
(Capodanno, Grasso, Tamburino) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Swaans, Brouwer) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Lombardi) Cardiology, Department of Medical and Surgical Specialties,
University of Brescia, Italy
(De Caterina) Institute of Cardiology, University of Pisa, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The benefit of percutaneous mitral valve repair (PMVR) in
patients with secondary MR is still debated. We aimed to compare the
outcome of PMVR with optimal medical therapy (OMT) versus OMT alone in
patients with secondary mitral regurgitation (MR) and to assess the role
of potential effect modifiers. Method(s): We performed a systematic
review and meta-analysis of 2 randomized clinical trials (RCT) and 7
non-randomized observational studies (nROS). Hazard ratios (HR) and 95%
confidence intervals (CI) were pooled through inverse variance
random-effects model to compute the summary effect size for all-cause
death, cardiovascular death and cardiac-related hospitalization. Subgroup
and meta-regression analysis were also performed. Result(s): An
overall population of 3118 individuals (67% men; mean age, 73 years) was
included: 1775 PMVR+OMT and 1343 OMT patients, with mean follow-up of 24
+/- 15 months. PMVR+OMT was associated with a lower risk of all-cause
death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95%
CI: 0.34-0.89) and cardiac-related hospitalization (HR:0.77; 95% CI:
0.64-0.92). Meta-regression analysis showed that larger left ventricular
end-diastolic volume index (LVEDVI) portends higher risk of all-cause
death, cardiovascular death and cardiac-related hospitalization after PMVR
(p < 0.001 for all). Conclusion(s): This study-level meta-analysis
shows that PMVR+OMT is associated with reduced all-cause death,
cardiovascular death and cardiac-related hospitalization when compared
with OMT alone in secondary MR. LVEDVI is a predictive marker of efficacy,
as patients with smaller LVEDVI have been shown to derive the largest
benefit from PMVR. Copyright © 2019 Elsevier Inc.

<45>
Accession Number
632665179
Title
Telehealth Home Monitoring and Postcardiac Surgery for Congenital Heart
Disease.
Source
Pediatrics. 146 (3) (no pagination), 2020. Date of Publication: 01 Sep
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.
 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. 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).
 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. Copyright © 2020 by the American Academy of Pediatrics.

<46>
Accession Number
631782024
Title
Postoperative Mortality of Indigenous Populations Compared with
Nonindigenous Populations: A Systematic Review.
Source
JAMA Surgery. 155 (7) (pp 636-656), 2020. Date of Publication: July 2020.
Author
McLeod M.; Signal V.; Gurney J.; Sarfati D.
Institution
(McLeod, Signal, Gurney, Sarfati) Department of Public Health, University
of Otago Wellington, Wellington, New Zealand
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: A range of factors have been identified as possible
contributors to racial/ethnic differences in postoperative mortality that
are also likely to hold true for indigenous populations. Yet despite its
severity as an outcome, death in the period following a surgical procedure
is underresearched for indigenous populations. Objective(s): To
describe postoperative mortality experiences for minority indigenous
populations compared with numerically dominant nonindigenous populations
and examine the factors that drive any differences observed. Evidence
Review: This review was conducted according to PRIMSA guidelines and
registered on PROSPERO. Articles were identified through searches of the
Embase, Ovid MEDLINE, Scopus, and Cumulative Index to Nursing and Allied
Health Literature databases, with manual review of references and gray
literature searches conducted. Eligible articles included those that
reported associations between ethnicity/indigeneity and mortality up to 90
days following surgery and published in English between January 1, 1990,
and March 26, 2019. Data on the study design, setting, participants
(including indigeneity), and results were extracted. A modified
Newcastle-Ottawa Quality Assessment Scale was used to determine study
quality. Finding(s): A total of 442 abstracts were screened, 92
articles were reviewed in full text, and 21 articles (from 20 studies) and
7 reports underwent data extraction. All included studies were cohort
studies (3 prospective and the remainder retrospective) investigating a
wide range of surgical procedures in the US, Australia, or New Zealand.
Seven studies were from single facilities, while the remainder used data
from national databases. Sample sizes ranged, with indigenous sample sizes
ranging from 20 to 3052 patients and a number of studies reporting less
than 10 indigenous deaths. The postoperative mortality experience for
minority indigenous populations compared with the nonindigenous
populations was mixed. There was evidence from several studies that
indigenous populations may be more likely to die following cardiac
procedures. However, the available evidence has overall poor study
quality, with methods to identify the indigenous populations being a major
limitation of most of the studies. Conclusions and Relevance:
Postoperative mortality experiences for indigenous populations should not
be interpreted in isolation from the broader context of inequities across
the health care pathway and must take into account the quality of data
used for indigenous identification.. Copyright © 2020 American
Medical Association. All rights reserved.

<47>
Accession Number
632758238
Title
Feasibility and efficacy of lung ultrasound to investigate pulmonary
complications in patients who developed postoperative Hypoxaemia-a
prospective study.
Source
BMC anesthesiology. 20 (1) (pp 220), 2020. Date of Publication: 01 Sep
2020.
Author
Xie C.; Sun K.; You Y.; Ming Y.; Yu X.; Yu L.; Huang J.; Yan M.
Institution
(Xie, Sun, You, Ming, Yu, Yu, Yan) Department of Anesthesiology and Pain
Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang
University, Jiefang Road 88th, Hangzhou 310016, China
(Huang) Department of Anesthesiology & Perioperative Medicine, University
of Louisville, KY, Louisville 40202, United States
(Yan) Department of Anesthesiology and Pain Medicine, Second Affiliated
Hospital, Zhejiang University School of Medicine, NO, 88 Jiefang Road,
Hangzhou 310009, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative pulmonary complications (PPCs) and hypoxaemia
are associated with morbidity and mortality. We aimed to evaluate the
feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in
patients suffering from hypoxaemia after general anaesthesia and compare
the results to those of thoracic computed tomography (CT). METHOD(S):
Adult patients who received general anaesthesia and suffered from
hypoxaemia in the postanaesthesia care unit (PACU) were analysed.
Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry
(SPO2) less than 92% for more than 30s under ambient air conditions. LUS
was performed by two trained anaesthesiologists once hypoxaemia occurred.
After LUS examination, each patient was transported to the radiology
department for thoracic CT scan within 1h before returning to the ward.
 RESULT(S): From January 2019 to May 2019, 113 patients (61 men)
undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic
surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients,
15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients,
8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis,
while LUS revealed atelectasis in 311 of the CT-confirmed zones.
Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were
detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan,
and LUS detected 131 of these zones. LUS was reliable in diagnosing
atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy
97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic
accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0%
and diagnostic accuracy 95.1%). CONCLUSION(S): Lung ultrasound is
feasible, efficient and accurate in diagnosing different aetiologies of
postoperative hypoxia in healthy-weight patients in the PACU. TRIAL
REGISTRATION: Current Controlled Trials NCT03802175 , 2018/12/05,
www.ClinicalTrials.gov.

<48>
Accession Number
632756336
Title
Effects of teriparatide and bisphosphonate on spinal fusion procedure: A
systematic review and network meta-analysis.
Source
PloS one. 15 (9) (pp e0237566), 2020. Date of Publication: 2020.
Author
Cheng S.-H.; Kuo Y.-J.; Chen C.; Kang Y.-N.
Institution
(Cheng, Kuo) Department of Orthopedics, Wan Fang Hospital, Taipei Medical
University, Republic of China (Taiwan), Taipei, Taiwan (Republic of China)
(Cheng) Department of Orthopedics, Cheng Hsin General Hospital, Republic
of China (Taiwan), Taipei, Taiwan (Republic of China)
(Kuo) Department of Orthopedic Surgery, School of Medicine, College of
Medicine, Taipei Medical University, Republic of China (Taiwan), Taipei,
Taiwan (Republic of China)
(Chen) Department of Public Health, School of Medicine, College of
Medicine, Taipei Medical University, Republic of China (Taiwan), Taipei,
Taiwan (Republic of China)
(Chen, Kang) Cochrane Taiwan, Taipei Medical University, Republic of China
(Taiwan), Taipei, Taiwan (Republic of China)
(Chen) Division of Plastic Surgery, Department of Surgery, Wan Fang
Hospital, Taipei Medical University, Republic of China (Taiwan), Taipei,
Taiwan (Republic of China)
(Chen, Kang) Evidence-Based Medicine Center, Wan Fang Hospital, Taipei
Medical University, Republic of China (Taiwan), Taipei, Taiwan (Republic
of China)
(Kang) Research Center of Big Data and Meta-Analysis, Wan Fang Hospital,
Taipei Medical University, Republic of China (Taiwan), Taipei, Taiwan
(Republic of China)
(Kang) Institute of Health Policy & Management, College of Public Health,
National Taiwan University, Republic of China (Taiwan), Taipei, Taiwan
(Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Giving patients anti-osteoporotic agents peri-operatively is a
well-accepted strategy to increase fusion rate and prevent complications.
The purpose of this study was to investigate effectiveness of teriparatide
and bisphosphonate on fusion surgery of thoracic and lumbar spine.
 METHOD(S): We searched EMBASE and PubMed for randomized clinical
trials (RCTs) and prospective comparative studies using teriparatide or
bisphosphonate in peri-operative spinal fusion surgery. Our synthesized
data of fusion rate, Oswestry disability index (ODI), and adverse event in
contrast-based network meta-analysis. Pooled results were presented in
risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI).
 RESULT(S): Our search hit eight RCTs and three prospective studies
with 676 patients receiving spinal surgery. Pooled result showed that
teriparatide+Denosumab leads to significantly higher fusion rate than
placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95%
CI: 1.13 to 5.96). We did not observe significant finding among placebo,
teriparatide, and bisphosphonate in the two network models.
 CONCLUSION(S): This is the first network meta-analysis providing an
overview of the use of teriparatide and bisphosphonate for spinal fusion
surgery. Teriparatide treatments are worth to be consider for spinal
fusion surgery.

<49>
Accession Number
632755117
Title
Long-term outcomes of patients with stable coronary disease and chronic
kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or
Surgery Study II Trial.
Source
Nephrology, dialysis, transplantation : official publication of the
European Dialysis and Transplant Association - European Renal Association.
35 (8) (pp 1369-1376), 2020. Date of Publication: 01 Aug 2020.
Author
Lima E.G.; Charytan D.M.; Hueb W.; de Azevedo D.F.C.; Garzillo C.L.;
Favarato D.; Linhares Filho J.P.P.; Martins E.B.; Batista D.V.; Rezende
P.C.; Hueb A.C.; Ramires J.A.F.; Kalil Filho R.
Institution
(Lima, Hueb, de Azevedo, Garzillo, Favarato, Linhares Filho, Martins,
Batista, Rezende, Hueb, Ramires, Kalil Filho) Department of Clinical
Cardiology, Heart Institute (InCor), University of Sao Paulo, Sao Paulo,
Brazil
(Charytan) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, MA, Boston, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Chronic kidney disease (CKD) is associated with a worse
prognosis in patients with stable coronary artery disease (CAD); however,
there is limited randomized data on long-term outcomes of CAD therapies in
these patients. We evaluated long-term outcomes of CKD patients with CAD
who underwent randomized therapy with medical treatment (MT) alone,
percutaneous coronary intervention (PCI) or coronary artery bypass graft
surgery (CABG). METHOD(S): Baseline estimated glomerular filtration
rate (eGFR) was obtained in 611 patients randomized to one of three
therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II
trial. Patients were categorized in preserved renal function and mild or
moderate CKD groups depending on their eGFR (>=90, 89-60 and
59-30mL/min/1.73m2, respectively). The primary clinical endpoint, a
composite of overall death and myocardial infarction, and its individual
components were analyzed using proportional hazards regression (Clinical
Trial registration information: http://www.controlled-trials.com.
Registration number: ISRCTN66068876). RESULT(S): Of 611 patients, 112
(18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%)
moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and
44.7% (P=0.02) for preserved eGFR, mild CKD and moderate CKD,
respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for
preserved eGFR, mild CKD and moderate CKD, respectively (P=0.001). For
preserved eGFR, there was no significant difference in outcomes between
therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1%
for CABG and 41.1% for MT (P=0.006) [adjusted hazard ratio (HR) = 0.26,
95% confidence interval (CI) 0.07-0.88; P=0.03 for PCI versus MT; and
adjusted HR = 0.48; 95% CI 0.31-0.76; P=0.002 for CABG versus MT]. We also
observed higher mortality rates in the MT group (28.6%) compared with PCI
(24.1%) and CABG (19.0%) groups (P=0.015) among mild CKD subjects
(adjusted HR = 0.44, 95% CI 0.25-0.76; P=0.003 for CABG versus MT;
adjusted HR = 0.56, 95% CI 0.07-4.28; P=0.58 for PCI versus MT). Results
were similar with moderate CKD group but did not achieve significance.
 CONCLUSION(S): Coronary interventional therapy, both PCI and CABG, is
associated with lower rates of events compared with MT in mild CKD
patients >10years of follow-up. More study is needed to confirm these
benefits in moderate CKD. Copyright © The Author(s) 2018.
Published by Oxford University Press on behalf of ERA-EDTA. All rights
reserved.

<50>
Accession Number
2006079472
Title
Effects of intraoperative dexmedetomidine on the incidence of acute kidney
injury in pediatric cardiac surgery patients: A randomized controlled
trial.
Source
Paediatric Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Kim E.-H.; Lee J.-H.; Kim H.-S.; Jang Y.-E.; Ji S.-H.; Kim W.-H.; Kwak
J.G.; Kim J.-T.
Institution
(Kim, Lee, Kim, Jang, Ji, Kim) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Seoul, South Korea
(Kim, Kwak) Department of Cardiothoracic Surgery, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
Publisher
Blackwell Publishing Ltd
Abstract
Background: Perioperative dexmedetomidine use has been reported to reduce
the incidence of postoperative acute kidney injury after adult cardiac
surgery. However, large-scale randomized controlled trials evaluating the
effect of dexmedetomidine use on acute kidney injury in pediatric patients
are lacking. Aim(s): We investigated whether intraoperative
dexmedetomidine could reduce the incidence of acute kidney injury in
pediatric cardiac surgery patients. Method(s): In total, 141
pediatric patients were randomly assigned to dexmedetomidine or control
groups. After anesthetic induction, patients in the dexmedetomidine group
were administered 1 micro g/kg of dexmedetomidine over 10 minutes and
an additional 0.5 micro g/kg/h of dexmedetomidine during surgery.
Additionally, 1 micro g/kg of dexmedetomidine was infused immediately
after cardiopulmonary bypass was initiated. The incidence of acute kidney
injury was defined following Kidney Disease Improving Global Outcomes
guidelines. Result(s): The final analysis included 139 patients. The
incidence of acute kidney injury did not differ between dexmedetomidine
and control groups (16.9% vs 23.5%; odds ratio 0.661; 95% CI 0.285 to
1.525; P =.33). Similarly, neither the incidence of abnormal postoperative
estimated glomerular filtration rate values (P =.96) nor the incidence of
arrhythmia, mechanical ventilation duration, length of stay in the
intensive care unit, and hospitalization differed between the two groups.
 Conclusion(s): Intraoperative dexmedetomidine did not reduce acute
kidney injury incidence in pediatric cardiac surgery
patients. Copyright © 2020 John Wiley & Sons Ltd

<51>
Accession Number
2006074334
Title
Carotid access for transcatheter aortic valve replacement: A
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Sharma S.P.; Chaudhary R.; Ghuneim A.; Harder W.; David S.; Choksi N.;
Kondur S.; Kambhatla S.; Kondur A.
Institution
(Sharma, Ghuneim, Harder, Choksi, Kondur, Kambhatla, Kondur) Department of
Cardiology, Garden City Hospital, Garden City, MI, United States
(Chaudhary) Division of Hospital Internal Medicine, Mayo Clinic,
Rochester, MN, United States
(David) Division of Cardiology, Ascension Providence Hospital, Southfield,
MI, United States
(Kambhatla) Division of Internal Medicine, Garden City Hospital, Garden
City, MI, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We sought to evaluate the feasibility and safety of carotid
access transcatheter aortic valve replacement (TAVR) by performing a
meta-analysis of published cases. Background(s): Several case series
and regional data have provided initial basis for carotid access TAVR in
patients with prohibitive femoral approach. We performed this
meta-analysis to provide further evidence of feasibility and safety of
carotid TAVR. Method(s): We searched PubMed, EMBASE, CINAHL, and
Cochrane CENTRAL for any study on carotid access TAVR involving 5 patients
since inception till March 1, 2020. Random-effects model was used to
compute overall effects. The outcomes analyzed were all-cause mortality,
Transient ischemic attack (TIA)/stroke, need for permanent pacemaker (PPM)
implantation, pericardial tamponade, access site complications, major
bleeding, and length of stay. Result(s): There was a total of 17
retrospective studies (n = 2082) with a median follow-up of 1 month. Mean
age of the patient was 80 years. Mean Euroscore and STS scores were 15 +/-
6.2 and 7.9 +/- 3.3, respectively. The procedural success rate was 99%.
The rate of all-cause mortality was 6.7% (range 4.6-9.7%, p <.001,
I2 = 67%). Incidence of TIA/stroke was 3.9% (range 3.1-4.8%, p
<.001, I2 = 0%) and PPM implantation was 16.7% (range
12.5-21.9%, p <.001, I2 = 56%). Rate of pericardial tamponade,
vascular complication, and major bleeding were 1.7, 2.5, and 7%,
respectively. Average length of hospital stay was 7.7 days.
 Conclusion(s): Our results show that transcarotid approach is a
feasible option in patients with prohibitive femoral access for
TAVR. Copyright © 2020 Wiley Periodicals LLC.

<52>
Accession Number
632756280
Title
Meta-Analysis of Complete Versus Culprit-Only Revascularization in
Patients with ST-Segment Elevation Myocardial Infarction and Multivessel
Coronary Disease.
Source
The American journal of cardiology. (no pagination), 2020. Date of
Publication: 29 Aug 2020.
Author
Levett J.Y.; Windle S.B.; Filion K.B.; Cabaussel J.; Eisenberg M.J.
Institution
(Levett) Center of Clinical Epidemiology, Lady Davis Institute, Jewish
General Hospital/McGill University, Montreal, QC, Canada; Faculty of
Medicine, McGill University, Montreal, QC, Canada
(Windle, Cabaussel) Center of Clinical Epidemiology, Lady Davis Institute,
Jewish General Hospital/McGill University, QC, Montreal, Canada
(Filion) Center of Clinical Epidemiology, Lady Davis Institute, Jewish
General Hospital/McGill University, Montreal, QC, Canada; Faculty of
Medicine, McGill University, Montreal, QC, Canada; Department of
Epidemiology, Biostatistics and Occupational Health, McGill University,
Montreal, QC, Canada; Department of Medicine, McGill University, Montreal,
Quebec, Canada
(Eisenberg) Center of Clinical Epidemiology, Lady Davis Institute, Jewish
General Hospital/McGill University, Montreal, QC, Canada; Faculty of
Medicine, McGill University, Montreal, QC, Canada; Department of
Epidemiology, Biostatistics and Occupational Health, McGill University,
Montreal, QC, Canada; Division of Cardiology, Jewish General
Hospital/McGill University, Montreal, QC, Canada
Publisher
NLM (Medline)
Abstract
Approximately half of patients with ST-segment elevation myocardial
infarction (STEMI) present with non-infarct related multivessel coronary
artery disease (CAD) during primary percutaneous coronary intervention
(PCI). However, questions remain concerning whether patients with STEMI
and multivessel CAD should routinely undergo complete revascularization.
Our objective was to compare the risks of major cardiovascular outcomes
and procedural complications in patients with STEMI and multivessel CAD
randomized to complete revascularization versus culprit-only PCI. We
conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) comparing complete revascularization to culprit-only PCI.
RCTs were identified via a systematic search of MEDLINE, Embase, and
Cochrane CENTRAL. Count data were pooled using DerSimonian and Laird
random-effects models with inverse variance weighting to obtain relative
risks (RRs) and 95% confidence intervals (CIs). A total of 9 RCTs
(n=6,751) were included, with mean/median follow-up times ranging from six
to 36 months. Compared with culprit-only PCI, complete revascularization
was associated with a substantial reduction in major adverse
cardiovascular events (13.1% vs. 22.1%; RR: 0.54; 95% CI: 0.43-0.66),
repeat myocardial infarction (4.9% vs. 6.8%; RR: 0.64; 95% CI: 0.48-0.84),
and repeat revascularization (3.7% vs. 12.3%; RR: 0.33; 95% CI:
0.25-0.44). Complete revascularization may have beneficial effects on
all-cause and cardiovascular mortality, but 95% CIs were wide. Findings
for stroke, major bleeding, and contrast-induced acute kidney injury were
inconclusive. In conclusion, complete coronary artery revascularization
appears to confer benefit over culprit-only PCI in patients with STEMI and
multivessel CAD, and should be considered a first-line strategy in these
patients. Copyright © 2020. Published by Elsevier Inc.

<53>
Accession Number
632755640
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. Article
Number: rapm-2020-101496. Date of Publication: 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,
Hanoi, Vietnam
(Ho, Nguyen) Department of Cardiac Surgery, Vinmec Central Park
International Hospital, Ho Chi Minh City, Vietnam
(Phan Van, Dinh Nguyen Thien) Department of Pharmacology, Forensic
Medicine Center, Ho Chi Minh City, Vietnam
(Bringuier) Department of Biostatistics, Hopital Lapeyronie, Montpellier,
France
(Capdevila) Anesthesiology and Critical Care Department, Neurosciences
Institute, Inserm U1051, Hopital Lapeyronie, Montpellier, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
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 48 hours and improves
analgesia in children who undergo cardiac surgery. 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 30 mug/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 48 hours after surgery.
Adverse events were noted. Result(s): The total dose of morphine in
48 hours was significantly decreased in patients receiving a bilateral
ESPB with ropivacaine (120+/-320 mug/kg) compared with patients with
saline infusion (512+/-560 mug/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 24 hours postoperatively (p=0.05 and 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). 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 48
hours and demonstrates better postoperative analgesia compared with a
control group. Trial registration number NCT03593642. Copyright ©
American Society of Regional Anesthesia & Pain Medicine 2020. No
commercial re-use. See rights and permissions. Published by BMJ.

<54>
Accession Number
632753988
Title
Cardiac Surgery 2019 Reviewed.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2020. Date of
Publication: 2020.
Author
Doenst T.; Bargenda S.; Kirov H.; Moschovas A.; Tkebuchava S.; Safarov R.;
Velichkov I.; Diab M.
Institution
(Doenst, Bargenda, Kirov, Moschovas, Tkebuchava, Safarov, Velichkov, Diab)
Department of Cardiothoracic Surgery, Friedrich-Schiller University of
Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
For the year 2019, almost 25,000 published references can be found in
PubMed when entering the search term cardiac surgery. We used the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
approach for article selection and reviewed the main fields of adult
cardiac surgery (i.e., coronary, valve, aortic, and heart failure
surgery). The past decade has experienced an enormous development of
interventional techniques that compete more and more with classic surgery.
This contest was broadly visible in 2019. It peaked over the
interpretation of the EXCEL trial data, where percutaneous coronary
intervention and coronary artery bypass grafting (CABG) for left main
disease were compared. A novel pathomechanism for CABG was proposed,
potentially answering open questions in the field. In aortic valve
surgery, two low-risk trials comparing transcatheter aortic valve
implantation (TAVI) to classic aortic valve replacement (surgical aortic
valve replacement) received attention for showing equal or superior
short-term outcomes for TAVI. Longer follow-up information from recent
trials became available presenting results emphasizing the need for joint
decision making. While publications addressing surgery on the aorta and
the mitral and tricuspid valves were less abundant, there was substantial
activity regarding left ventricular assist device support and heart
transplantation. This article attempts to summarize the most pertinent
publications. It does not expect to be complete and cannot be free of
individual interpretation. We aimed to provide a condensed summary of
2019s publications with a stimulus for in-depth reading and a basis
supporting patient information. Copyright © 2020 Georg Thieme
Verlag. All rights reserved.

<55>
Accession Number
632753757
Title
Vasopressor Therapy in the Intensive Care Unit.
Source
Seminars in Respiratory and Critical Care Medicine. (no pagination), 2020.
Date of Publication: 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
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
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. Copyright © 2020 American Medical
Association. All rights reserved.

<56>
[Use Link to view the full text]
Accession Number
354314062
Title
Validation of VKORCI and CYP2C9 genotypes on interindividual warfarin
maintenance dose: A prospective study in Chinese patients.
Source
Pharmacogenetics and Genomics. 19 (3) (pp 226-234), 2009. Date of
Publication: March 2009.
Author
Huang S.-W.; Chen H.-S.; Wang X.-Q.; Huang L.; Xu D.-L.; Hu X.-J.; Huang
Z.-H.; He Y.; Chen K.-M.; Xiang D.-K.; Zou X.-M.; Li Q.; Ma L.-Q.; Wang
H.-F.; Chen B.-L.; Li L.; Jia Y.-K.; Xu X.-M.
Institution
(Huang, Li, Li, Xu) Department of Medical Genetics, School of Basic
Medical Sciences, Southern Medical University, China
(Chen, Huang, He, Chen) Department of Cardiac Surgery, Gaozhou People's
Hospital, Gaozhou, China
(Xu, Ma) Department of Cardiology, Nanfang Hospital, Guangzhou, Guangdong,
China
(Hu, Li) Department of Laboratory, Nanfang Hospital, Guangzhou, Guangdong,
China
(Zou, Wang) Department of Cardiac Surgery, Nanfang Hospital, Guangzhou,
Guangdong, China
(Wang, Jia) 'ChangChun Teachers' College, Changchun, Jilin, China
(Huang, Huang) Department of Laboratory, Guizhou Provincial People's
Hospital, Guiyang, Guizhou, China
(Xiang) Department of Cardiac Surgery, Guizhou Provincial People's
Hospital, Guiyang, Guizhou, China
(Chen) Department of Cardiology, Guizhou Provincial People's Hospital,
Guiyang, Guizhou, China
(Xu) Department of Medical Genetics, School of Basic Medical Sciences,
Southern Medical University, Guangzhou 510515, Guangdong, China
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives To develop a warfarin-dosing algorithm that could be combined
with pharmacogenomic and demographic factors, and to evaluate its
effectiveness in a randomized prospective controlled clinical trial.
Methods A pharmacogenetics-based dosing model was derived using
retrospective data from 266 Chinese patients and multiple linear
regression analysis. To prospectively validate this model, 156 patients
with an operation of heart valve replacement were enrolled and randomly
assigned to the group of pharmacogenetics-guided or traditional dosing for
warfarin therapy. All patients were followed up for 50 days after
initiation of warfarin therapy. The log-rank test was compared with the
time-to-event (Kaplan-Meier) curves. Cox proportional hazards-regression
model was used to assess the hazard ratio of the time to reach stable
dose. Results The linear regression model derived from the pharmacogenomic
model correlated with 54.1 % of warfarin dosing variance. The final
multiple linear regression model included age, body surface area, VKORC1,
and CYP2C9 genotype. The study showed that the hazard ratio for the time
to reach stable dose was 1.932 for the traditional dosing group versus the
model-based group and a close and highly significant relationship was
observed to exist between the predicted and the actual warfarin dose
(R2 = 0.454). Conclusion A pharmacogenetics-based dosing
algorithm has been developed for improvement in the time to reach the
stable dosing of warfarin. This model may be useful in helping the
clinicians to prescribe warfarin with greater safety and efficiency.
© 2009 Wolters Kluwer Health Lippincott Williams & Wilkins.

<57>
Accession Number
632343690
Title
Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics
during one-lung ventilation: a randomized clinical controlled trial.
Source
PeerJ. 2020 (6) (no pagination), 2020. Article Number: e9247. Date of
Publication: 2020.
Author
Xu B.; Gao H.; Li D.; Hu C.; Yang J.
Institution
(Xu, Yang) Department of Anesthesiology, First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu, China
(Xu, Gao, Li, Hu) Department of Anesthesiology, Affiliated Wuxi People's
Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
Publisher
PeerJ Inc. (E-mail: pete@peerj.com)
Abstract
Background. Dexmedetomidine (Dex), a selective a<inf>2</inf>-adrenergic
receptor agonist, has been previously reported to attenuate intrapulmonary
shunt during one-lung ventilation (OLV) and to alleviate
bronchoconstriction. However, the therapeutic effects of nebulized Dex on
pulmonary shunt and lung mechanics during OLV have not been evaluated.
Here we determine whether nebulized dexmedetomidine improved pulmonary
shunt and lung mechanics in patients undergoing elective thoracic surgery
in a prospective randomized controlled clinical trial. Methods. One
hundred and twenty-eight patients undergoing elective thoracoscopic
surgery were included in this study and randomly divided into four groups:
0.9% saline (Placebo group), 0.5 micro g/kg (Dex<inf>0.5</inf> group),
1 micro g/kg (Dex<inf>1</inf> group) and 2 micro g/kg
(Dex<inf>2</inf> group) dexmedetomidine. After bronchial intubation,
patients received different nebulized doses of dexmedetomidine (0.5
micro g/kg, 1 micro g/kg and 2 micro g/kg) or 0.9% saline
placebo during two-lung ventilation(TLV). OLV was initiated 15 min after
bronchial intubation. Anesthesia was maintained with intravenous infusion
of cisatracurium and propofol. Bispectral Index values were maintained
within 40-50 by adjusting the infusion of propofol in all groups. Arterial
blood gas samples and central venous blood gas samples were taken as
follows: 15 min after bronchial intubation during two-lung ventilation
(TLV<inf>15</inf>), after 30 and 60 min of OLV (OLV<inf>30</inf> and
OLV<inf>60</inf>, respectively) and 15 min after reinstitution of TLV
(ReTLV). Dynamic compliance was also calculated at TLV<inf>15</inf>,
OLV<inf>30</inf>, OLV<inf>60</inf> and ReTLV. Results. Dex decreased the
requirement of propofol in a dose-dependent manner(P = 0.000). Heart rate
(HR) and mean arterial pressure (MAP) displayed no significant difference
among groups (P = 0.397 and 0.863). Compared with the placebo group, Dex
administered between 0.5 and 2 micro g/kg increased partial pressure
of oxygen (P<inf>a</inf>O<inf>2</inf>) significantly at OLV<inf>30</inf>
and OLV<inf>60</inf> (P = 0.000); however, Dex administered between 1 and
2 micro g/kg decreased pulmonary shunt fraction
(Q<inf>s</inf>/Q<inf>t</inf>) at OLV<inf>30</inf> and OLV<inf>60</inf>(P =
0.000). Compared with the placebo group, there were significant increases
with dynamic compliance (Cdyn) after OLV in Dex<inf>0.5</inf>,
Dex<inf>1</inf> and Dex<inf>2</inf> group(P = 0.000). Conclusions.
Nebulized dexmedetomidine improved oxygenation not only by decreasing
pulmonary shunt but also by improving lung compliance during OLV, which
may be effective in managing OLV. Copyright 2020 Xu et al.

<58>
Accession Number
632067339
Title
Long-term ticagrelor for secondary prevention in patients with prior
myocardial infarction and no history of coronary stenting: Insights from
PEGASUS-TIMI 54.
Source
European Heart Journal. 41 (17) (pp 1625-1632), 2020. Date of Publication:
01 May 2020.
Author
Furtado R.H.M.; Nicolau J.C.; Magnani G.; Im K.; Bhatt D.L.; Storey R.F.;
Steg P.G.; Spinar J.; Budaj A.; Kontny F.; Corbalan R.; Kiss R.G.; Abola
M.T.; Johanson P.; Jensen E.C.; Braunwald E.; Sabatine M.S.; Bonaca M.P.
Institution
(Furtado, Im, Bhatt, Braunwald, Sabatine, Bonaca) TIMI Study Group,
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical
School, Boston, United States
(Furtado, Nicolau) Instituto Do Coracao (InCor), Hospital das Clinicas,
Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Eneas de Carvalho
Aguiar 44, Sao Paulo 05403, Brazil
(Magnani) University Hospital of Parma, Via Gramsci, 14, Parma PR 43126,
Italy
(Storey) University of Sheffield, Western Bank, Sheffield S102TN, United
Kingdom
(Steg) Assistance Publique-Hopitaux de Paris, 3 Avenue Victoria, Paris
75004, France
(Spinar) University Hospital Brno, 20 Jihlavska, Brno, Czechia
(Budaj) Centre of Postgraduate Medical Education, Grochowski Hospital,
Grenadierow 51/59, Warsaw 04-073, Poland
(Kontny) Department of Cardiology, Stavanger University Hospital, Gerd
Ragna Bloch Thorsens gate 8, Stavanger, Norway
(Kontny) Drammen Heart Center, Dronninggata 28, Drammen 3004, Norway
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Lira 40, Santiago, Chile
(Kiss) Department of Cardiology, Military Hospital, Robert Karoly krt.,
Budapest 1134, Hungary
(Abola) College of Medicine, University of the Philippines, Philippine
Heart Center, Quezon City, Metro Manila, Philippines
(Johanson, Jensen) AstraZeneca, Molndal 43153, Sweden
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
13199 E Montview Blvd Suite 200, Aurora, CO, United States
Publisher
Oxford University Press
Abstract
Aims: PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet
therapy (DAPT) with aspirin and ticagrelor reduced the risk of major
adverse cardiovascular events (MACE), with an acceptable increase in
bleeding, in patients with prior myocardial infarction (MI). While much of
the discussion around prolonged DAPT has been focused on stented patients,
patients with prior MI without prior coronary stenting comprise a
clinically important subgroup. Methods and Results: This was a
pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162
patients with prior MI (1-3 years) and additional high-risk features to
ticagrelor 60 mg, 90 mg, or placebo twice daily in addition to aspirin. A
total of 4199 patients had no history of coronary stenting at baseline.
The primary efficacy outcome (MACE) was the composite of cardiovascular
death, MI, or stroke. Patients without history of coronary stenting had
higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR)
1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. The
relative risk reduction in MACE with ticagrelor (pooled doses) was similar
in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting
(HR 0.85, 95% CI 0.75-0.96; P for interaction = 0.76). Conclusion(s):
Long-term ticagrelor reduces thrombotic events in patients with prior MI
regardless of whether they had prior coronary stenting. These data
highlight the benefits of DAPT in prevention of spontaneous
atherothrombotic events and indicate that long-term ticagrelor may be
considered in high-risk patients with prior MI even if they have not been
treated with stenting. ClinicalTrials.gov Identifier:
NCT01225562. Copyright © 2019 Published on behalf of the European
Society of Cardiology. All rights reserved. © 2019 The Author(s).

<59>
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. Copyright
© 2020 Waqas Ullah et al.

<60>
Accession Number
2005711035
Title
Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in
Open Heart Surgery Patients: END-AF Low Dose Trial.
Source
Journal of International Medical Research. 48 (7) (no pagination), 2020.
Date of Publication: 2020.
Author
Tabbalat R.A.; Alhaddad I.; Hammoudeh A.; Khader Y.S.; Khalaf H.A.;
Obaidat M.; Barakat J.
Institution
(Tabbalat, Khalaf, Obaidat) Abdali Clemenceau Hospital, Amman, Jordan
(Alhaddad) Jordan Hospital, Amman, Jordan
(Hammoudeh) Istishari Hospital, Amman, Jordan
(Khader) Jordan University of Science and Technology, Irbid, Jordan
(Barakat) Al Khalidi Hospital and Medical Center, Amman, Jordan
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Studies using 1 mg of colchicine to prevent postoperative
atrial fibrillation (POAF) reported conflicting results. Moreover,
colchicine was associated with significant gastrointestinal (GI) side
effects. This study examined whether low-dose colchicine effectively
prevents POAF and whether low-dose therapy is associated with lower rates
of colchicine-induced GI side effects. Method(s): In this
prospective, randomized, double-blind, placebo-controlled study,
consecutive adult patients admitted for elective cardiac surgeries
randomly received a 1-mg dose of colchicine (n = 81) or placebo (n = 71)
orally 12 to 24 hours before surgery followed by a daily dose of 0.5 mg
until hospital discharge. The primary efficacy endpoint was the
development of at least one episode of POAF of >=5 minutes. The primary
safety endpoint was the development of adverse events, especially
diarrhea. Result(s): The in-hospital mortality rate was 3.9%. POAF
occurred in 13 patients (16.1%) in the colchicine group and 13 patients
(18.3%) in the placebo group (odds ratio 0.85 [95% Confidence Interval =
0.37-1.99]). Diarrhea occurred in two patients in each group and
necessitated treatment discontinuation in one patient in each group.
 Conclusion(s): Low-dose colchicine did not prevent POAF in patients
undergoing cardiac surgery. These results should be interpreted cautiously
because of the small sample size and early study termination.
ClinicalTrials.gov Unique Identifier number: NCT03015831 Copyright
© The Author(s) 2020.

<61>
Accession Number
2004997555
Title
Effects of remote ischemic pre-conditioning to prevent contrast-induced
nephropathy after intravenous contrast medium injection: A randomized
controlled trial.
Source
Korean Journal of Radiology. 21 (11) (pp 1230-1238), 2020. Date of
Publication: Nov 2020.
Author
Belabbas D.; Koch C.; Chaudru S.; Lederlin M.; Laviolle B.; Pabic E.L.;
Boulmier D.; Heautot J.-F.; Mahe G.
Institution
(Belabbas, Chaudru, Lederlin, Laviolle, Pabic, Boulmier, Heautot, Mahe)
Vascular Medicine Unit, Department of Radiology, University Hospital
Pontchaillou, Rennes, France
(Koch) Department of Radiodology, Toulouse University Hospital, Toulouse,
France
Publisher
Korean Radiological Society (E-mail: office@radiology.or.kr)
Abstract
Objective: We aimed to assess the effects of remote ischemic
pre-conditioning (RIPC) on the incidence of contrast-induced nephropathy
(CIN) after an intravenous (IV) or intra-arterial injection of contrast
medium (CM) in patient and control groups. Material(s) and Method(s):
This prospective, randomized, single-blinded, controlled trial included 26
patients who were hospitalized for the evaluation of the feasibility of
transcatheter aortic valve implantation and underwent investigations
including contrast-enhanced computed tomography (CT), with Mehran risk
scores greater than or equal to six. All the patients underwent four
cycles of five minute-blood pressure cuff inflation followed by five
minutes of total deflation. In the RIPC group (n = 13), the cuff was
inflated to 50 mm Hg above the patient's systolic blood pressure (SBP); in
the control group (n = 13), it was inflated to 10 mm Hg below the
patient's SBP. The primary endpoint was the occurrence of CIN.
Additionally, variation in the serum levels of cystatin C was assessed.
 Result(s): One case of CIN was observed in the control group, whereas
no cases were detected in the RIPC group (p = 0.48, analysis of 25
patients). Mean creatinine values at the baseline, 24 hours after
injection of CM, and 48 hours after injection of CM were 88 +/- 32
micro mol/L, 91 +/- 28 micro mol/L and 82 +/- 29 micro mol/L,
respectively (p = 0.73) in the RIPC group, whereas in the control group,
they were 100 +/- 36 micro mol/L, 110 +/- 36 micro mol/L, and 105
+/- 34 micro mol/L, respectively (p = 0.78). Cystatin C values (median
[Q1, Q3]) at the baseline, 24 hours after injection of CM, and 48 hours
after injection of CM were 1.10 [1.08, 1.18] mg/L, 1.17 [0.97, 1.35] mg/L,
and 1.12 [0.99, 1.24] mg/L, respectively (p = 0.88) in the RIPC group,
whereas they were 1.11 [0.97, 1.28] mg/L, 1.13 [1.08, 1.25] mg/L, and 1.16
[1.03, 1.31] mg/L, respectively (p = 0.93), in the control group.
 Conclusion(s): The risk of CIN after an IV injection of CM is very
low in patients with Mehran risk score greater than or equal to six and
even in the patients who are unable to receive preventive hyperhydration.
Hence, the Mehran risk score may not be an appropriate method for the
estimation of the risk of CIN after IV CM injection. Copyright ©
2020 The Korean Society of Radiology.

<62>
Accession Number
2004989352
Title
The role of acupuncture in cardiac anesthesia: A meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 13 (8) (pp
5673-5689), 2020. Date of Publication: 2020.
Author
Wang H.; Xie X.; Zhao G.; Yang S.; Li J.
Institution
(Wang, Xie, Zhao, Li) Department of Anesthesiology, Guangdong Provincial
Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China
(Yang) Health Management Department of Traditional Chinese Medicine,
Guangzhou 11th People's Hospital, Guangzhou, Guangdong 510000, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To explore the role of acupuncture in cardiac anesthesia.
 Method(s): We searched MeSH terms including "acupuncture", "electric
acupuncture", "anesthesia", "heart surgery", "open chest surgery" in
PubMed, CNKI, Wanfang Data, China Journal Net, Vipnet, Longyuan Journal
Net and Springer Database. Randomized clinical trials regarding comparison
between acupuncture-assisted anesthesia (AAA) and general anesthesia (GA)
from January 1979 to January 2020 were obtained. The data quality of the
enrolled studies was evaluated following Cochrane handbook with Review
Manager 5.1.0 as the analysis tool. Result(s): Nine randomized,
controlled studies were included. AAA was superior to GA in the following
outcomes: elevated SpO<inf>2</inf> (Z = 17.13, P < 0.00001), longer length
of stay in resuscitation room (Z = 80.81, P < 0.0001), higher mean
arterial pressure (Z = 18.26, P <0.0001) and Prince-Henry scores (Z =
40.23, P < 0.0001), reduced consumption of inhalation anesthetics (Z =
94.34, P <0.0001) and intravenous anesthesia (Z = 130.86, P < 0.0001),
lower postoperative VAS score (Z = 39.15, P < 0.0001), incidence of low
blood pressure (Z = 3.31, P = 0.0009), postoperative nausea and vomiting
(Z = 4.49, P <0.0001), chills (Z = 3.31, P = 0.0009) and dysphoria (Z =
3.44, P = 0.006), and shortened extubation time in patients undergoing
thoracotomy (Z = 66.87, P < 0.0001). Conclusion(s): Meta-analysis
shows that AAA has beneficial clinical effects in open heart surgery. It
can improve respiratory and circulatory functions, reduce the consumption
of anesthetic drugs, extubation time, recovery time, pain intensity and
adverse reactions in the early stage of anes-thesia, which is suitable for
thoracotomy. Copyright © 2020, E-Century Publishing Corporation.
All rights reserved.

<63>
Accession Number
632728134
Title
Different classes of videoscopes and direct laryngoscopes for double-lumen
tube intubation in thoracic surgery: A systematic review and network
meta-analysis.
Source
PloS one. 15 (8) (pp e0238060), 2020. Date of Publication: 2020.
Author
Kim Y.S.; Song J.; Lim B.G.; Lee I.O.; Won Y.J.
Institution
(Kim, Song, Lim, Lee, Won) Department of Anesthesiology and Pain Medicine,
Korea University Guro Hospital, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Double-lumen tube is commonly used in thoracic surgeries that
need one-lung ventilation, but its big size and stiff structure make it
harder to perform intubation than a conventional tracheal intubation tube.
 OBJECTIVE(S): To investigate the effectiveness and safety of
videoscopes for double-lumen tube insertion. The primary outcome was the
success rate of first attempt intubation. Secondary outcomes were
intubation time, malposition, oral mucosal damage, sore throat, and
external manipulation. DESIGN: Systematic review and network
meta-analysis. DATA SOURCES: Databases (Pubmed, Embase, Cochrane, Kmbase,
Web of science, Scopus) up to June 23, 2020 were searched. ELIGIBILITY:
Randomized controlled trials comparing different videoscopes for
double-lumen tube intubation were included in this study. METHOD(S):
We classified and lumped the videoscope devices into the following groups:
standard (non-channeled) videolaryngoscope, channeled videolaryngoscope,
videostylet, and direct laryngoscope. After assessing the quality of
evidence, we statistically analyzed and chose the best device based on the
surface under the cumulative ranking curve (SUCRA) by using STATA software
(version 16). RESULT(S): We included 23 studies (2012 patients).
Based on the success rate of the first attempt, a rankogram suggested that
the standard videolaryngoscope (76.4 of SUCRA) was the best choice,
followed by videostylet (65.5), channeled videolaryngoscope (36.1), and
direct laryngoscope (22.1), respectively. However, with regard to reducing
the intubation time, the best choice was videostylet, followed by a direct
laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope,
respectively. Direct laryngoscope showed the lowest incidence of
malposition but required external manipulation the most. Channeled
videolaryngoscope showed the highest incidence of oral mucosal damage, but
showed the lower incidence of sore throat than standard videolaryngoscope
or direct laryngoscope. CONCLUSION(S): Most videoscopes improved the
success rate of double-lumen tube intubation; however, they were
time-consuming (except videostylet) and had a higher malposition rate than
the direct laryngoscope.

<64>
Accession Number
632727030
Title
Effects of Massage on Postoperative Pain in Infants With Complex
Congenital Heart Disease.
Source
Nursing research. 69 (5S Suppl 1) (pp S36-S46), 2020. Date of Publication:
01 Sep 2020.
Author
Harrison T.M.; Brown R.; Duffey T.; Frey C.; Bailey J.; Nist M.D.; Renner
L.; Fitch J.
Institution
(Harrison) Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The
Ohio State University College of Nursing, Columbus. Roger Brown, PhD, is
Professor, University of Wisconsin-Madison School of Nursing. Travis
Duffey, LMT, is Licensed Massage Therapist, Nationwide Children's
Hospital, Columbus, Ohio. Corrie Frey, LMT, CIMI, CPMT, is Licensed
Massage Therapist, Nationwide Children's Hospital, Columbus, Ohio. Jacob
Bailey, BSN, RN, is Staff Nurse, COPC Ohio Center for Pediatrics, Dublin.
Marliese Dion Nist, PhD, RNC, is Postdoctoral Fellow, The Ohio State
University College of Nursing, Columbus, Ohio. Lauren Renner, MSN, RN,
CPNP, is APRN Clinical Leader, Nationwide Children's Hospital, Columbus,
Ohio. Jill Fitch, MD, is Pediatric Intensivist, Nationwide Children's
Hospital, Columbus, OH
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain management is an essential component of care for
pediatric patients following surgery. Massage reduces self-reported
postoperative pain in adults with heart disease but has received little
attention in postoperative pediatric patients with complex congenital
heart disease (CCHD). OBJECTIVE(S): The aim of the study was to
evaluate the effectiveness of massage compared to a rest period on
postoperative pain scores and physiological responses in infants with
CCHD. METHOD(S): We used a two-group randomized clinical trial design
with a sample of 60 infants with CCHD between 1 day and 12 months of age
following their first cardiothoracic surgery. Both groups received
standard postoperative care. Group 1 received a daily 30-minute
restriction of nonessential caregiving (quiet time), and Group 2 received
a daily 30-minute massage. Interventions continued for seven consecutive
days. Pain was measured six times daily using the Face, Legs, Activity,
Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of
analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and
oxygen saturations (SpO2) were recorded continuously. Daily averages, pre-
and postintervention FLACC scores, and physiological responses were
analyzed using descriptive statistics, generalized linear mixed models
repeated measures, latent growth models, and/or regression discontinuity
analysis. Fentanyl-equivalent narcotic values were used as a time-varying
covariate. RESULT(S): Adjusted pain scores were lower for the massage
group on all days except Day 7. Overall, there were no group effects on
level of pain or differential rate of change in pain. However, the massage
group had lower daily pain scores with small to medium effect size
differences, largest at Days 4, 5, and 6, and lower average daily HR and
RR. There was little difference between groups in SpO2. Infants
demonstrated immediate effects of massage, with HR and RR decreasing and
oxygen saturations increasing. DISCUSSION: This study provides beginning
evidence that postoperative massage may reduce pain and improve
physiological parameters in infants with congenital heart disease. This
nonpharmacological adjunct to pain management may provide a particular
benefit for this population by reducing demand on the cardiorespiratory
system.

<65>
Accession Number
632722144
Title
Clinical Implications of Physical Function and Resilience in Patients
Undergoing Transcatheter Aortic Valve Replacement.
Source
Journal of the American Heart Association. 9 (17) (pp e017075), 2020. Date
of Publication: 01 Sep 2020.
Author
Goel K.; O'Leary J.M.; Barker C.M.; Levack M.; Rajagopal V.; Makkar R.R.;
Bajwa T.; Kleiman N.; Linke A.; Kereiakes D.J.; Waksman R.; Allocco D.J.;
Rizik D.G.; Reardon M.J.; Lindman B.R.
Institution
(Goel, O'Leary, Barker, Levack, Lindman) Structural Heart and Valve Center
Vanderbilt University Medical Center Nashville TN
(Goel, O'Leary, Barker, Lindman) Cardiovascular Medicine Division
Vanderbilt University Medical Center Nashville TN
(Levack) Cardiac Surgery Department Vanderbilt University Medical Center
Nashville TN
(Rajagopal) Marcus Heart Valve Center Piedmont Heart Institute Atlanta GA
(Makkar) Cedars - Sinai Heart Institute Los Angeles CA
(Bajwa) Aurora Cardiovascular Services Aurora Sinai/Aurora St. Luke's
Medical Centers Milwaukee WI
(Kleiman, Reardon) Department of Cardiovascular Surgery Houston Methodist
DeBakey Heart and Vascular Center Houston TX
(Linke) Department of Internal Medicine and Cardiology Heart Center
Dresden Technical University of Dresden Germany
(Kereiakes) The Christ Hospital Heart and Vascular Center Lindner Research
Center Cincinnati OH
(Waksman) Section of Interventional Cardiology MedStar Washington Hospital
Center Washington DC
(Allocco) Clinical Sciences Boston Scientific Corp Marlborough MA
(Rizik) HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale
AZ
Publisher
NLM (Medline)
Abstract
Background Gait speed is a reliable measure of physical function and
frailty in patients with aortic stenosis undergoing transcatheter aortic
valve replacement (TAVR). Slow gait speed pre-TAVR predicts worse clinical
outcomes post-TAVR. The consequences of improved versus worsened physical
function post-TAVR are unknown. Methods and Results The REPRISE III
(Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through
Implantation of Lotus Valve System-Randomized Clinical Evaluation) trial
randomized high/extreme risk patients to receive a mechanically-expanded
or self-expanding transcatheter heart valve. Of 874 patients who underwent
TAVR, 576 with complete data at baseline and 1 year were included in this
analysis. Slow gait speed in the 5-m walk test was defined as <0.83 m/s. A
clinically meaningful improvement (>=0.1 m/s) in gait speed 1 year after
TAVR occurred in 39% of patients, 35% exhibited no change, and 26%
declined (>=0.1 m/s). Among groups defined by baseline/1-year post-TAVR
gait speeds, 1- to 2-year mortality or hospitalization rates were as
follows: 6.6% (normal/normal), 8.0% (slow/normal), 20.9% (normal/slow),
and 21.5% (slow/slow). After adjustment, slow gait speed at 1 year
(regardless of baseline speed) was associated with a 3.5-fold increase in
death/hospitalization between 1 and 2 years compared with those with
normal baseline/1-year gait speed. Patients whose slow gait speed
normalized at 1 year had no increased risk. One-year, but not baseline,
gait speed was associated with death or hospitalization between 1 and 2
years (adjusted hazard ratio, 0.83 per 0.1 m/s faster gait; 95% CI,
0.74-0.93, P=0.001). Conclusions Marked heterogeneity exists in the
trajectory of physical function after TAVR and this, more than baseline
function, has clinical consequences. Identifying and optimizing factors
associated with physical resilience after TAVR may improve outcomes.
Registration URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02202434.

<66>
[Use Link to view the full text]
Accession Number
2007636779
Title
Misplacement of transjugular intrahepatic portosystemic shunts: A surgical
challenge for liver transplantation?.
Source
Surgery (United States). (no pagination), 2020. Date of Publication: 2020.
Author
Addeo P.; Schaaf C.; Faitot F.; Terrone A.; Julliard O.; Besch C.; Serfaty
L.; Bachellier P.
Institution
(Addeo, Schaaf, Faitot, Terrone, Julliard, Bachellier)
Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pole des
Pathologies Digestives, Hepatiques et de la Transplantation, Hopital de
Hautepierre-Hopitaux Universitaires de Strasbourg, Universite de
Strasbourg, France
(Besch, Serfaty) Hepatology Department, Pole des Pathologies Digestives,
Hepatiques et de la Transplantation, Hopital de Hautepierre-Hopitaux
Universitaires de Strasbourg, Universite de Strasbourg, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The impact of transjugular intrahepatic portosystemic shunt
misplacement on outcomes of liver transplantation remains controversial.
We systematically reviewed the literature on the outcomes of liver
transplantation with transjugular intrahepatic portosystemic shunt
misplacement. Method(s): This systematic review was conducted
according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. The Cochrane library, PubMed, and Embase were
searched (January 1990-April 2020) for studies reporting patients
undergoing liver transplantation with transjugular intrahepatic
portosystemic shunt misplacement. Result(s): Thirty-six studies
reporting 181 patients who underwent liver transplantation with
transjugular intrahepatic portosystemic shunt misplacement were
identified. Transjugular intrahepatic portosystemic shunt was misplaced
with a variable degree of extension toward the inferior vena cava/right
heart in 63 patients (34%), the spleno/portal/superior mesenteric venous
confluence in 105 patients (58%), and both in 15 patients (8%).
Transjugular intrahepatic portosystemic shunt thrombosis was also present
in 21 cases (12%). The median interval between transjugular intrahepatic
portosystemic shunt placement and liver transplantation ranged from 1 day
to 6 years. Complete transjugular intrahepatic portosystemic shunt removal
was successfully performed in all but 12 (7%) patients in whom part of the
transjugular intrahepatic portosystemic shunt was left in situ. Cardiac
surgery under cardiopulmonary bypass was necessary to remove transjugular
intrahepatic portosystemic shunt from the right heart in 4 patients (2%),
and a venous graft interposition was necessary for a portal anastomosis in
5 patients (3%). Postoperative mortality (90 days) was 1.1% (2 patients),
and portal vein thrombosis developed postoperatively in 4 patients (2%).
 Conclusion(s): Misplaced transjugular intrahepatic portosystemic
shunt removal is possible in most cases during liver transplantation with
extremely low mortality and good postoperative outcomes. Preoperative
surgical strategy and intraoperative tailored surgical technique reduces
the potential consequences of transjugular intrahepatic portosystemic
shunt misplacement. Copyright © 2020 Elsevier Inc.

<67>
Accession Number
2007621416
Title
Postoperative Pain Management and the Incidence of Ipsilateral Shoulder
Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A
Prospective Audit.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Hodge A.; Rapchuk I.L.; Gurunathan U.
Institution
(Hodge) Department of Anaesthesia and Perioperative Medicine, Royal
Brisbane and Women's Hospital, Brisbane, Queensland, Australia
(Hodge, Rapchuk) University of Queensland
(Rapchuk, Gurunathan) Department of Anaesthesia and Perfusion Services,
The Prince Charles Hospital, Brisbane, Queensland, Australia
Publisher
W.B. Saunders
Abstract
Objectives: Ipsilateral shoulder pain (ISP) is a common but variably
occurring (42%-85%) complication after thoracic surgery. Multiple
potential treatments, including upper limb blocks, intrapleural local
anaesthetic infiltration, and systemic opioids, have undergone trials,
with limited efficacy. Phrenic nerve infiltration is a potential
intervention that may prevent ISP. The aim of this study was to assess the
incidence and severity of ISP after thoracic surgery at the authors'
institution, where phrenic nerve infiltration is commonly used.
 Design(s): Observational cohort study. Setting(s): A single-
center study in a tertiary referral center in Brisbane, Australia.
 Participant(s): This study comprised all adult patients undergoing
thoracic surgery at a tertiary- care referral center from May to July
2018. Measurements and Main Results: Surgical procedures were divided
into open thoracotomy, video-assisted thoracic surgery (VATS) and
VATS-guided mini-thoracotomy. The primary outcome was a comparison of
incidence of ISP among the 3 types of surgical procedures. Data were
analyzed using Stata (StataCorp), with significance testing by
Kruskal-Wallis equality of populations rank test. A p value of < 0.05 was
deemed significant. Sixty thoracic surgeries were performed during the
audit period. Nineteen patients had thoracotomies performed for lobectomy
or pneumonectomy, all of whom received phrenic nerve infiltration. The
incidence of moderate-to-severe ipsilateral shoulder pain among the
thoracoctomy cohort was 15.8% (3/19). Of the 36 VATS procedures audited, 7
patients (19.4%) received infiltration of their phrenic nerve, none of
whom reported postoperative ISP. Of the remaining twenty-nine patients who
did not receive phrenic nerve infiltration, there were 4 cases of
moderate-to-severe ipsilateral shoulder pain (11.1%). Four of the 5
patients (80%) who underwent VATS-guided mini-thoracotomies received
phrenic nerve infiltration intraoperatively. Three patients reported
moderate-to-severe ISP and of these 3 patients, 2 patients had phrenic
nerve infiltration, and 1 patient did not receive infiltration. Overall,
there were no statistically significant differences in rest or dynamic
pain scores across the surgical groups at any time point. Mann-Whitney
test revealed that the participants with ISP were significantly older than
those without ISP (p = 0.006). However, there were no significant
differences in sex or body mass index between those with and without ISP.
 Conclusion(s): The authors observed a lower (15.8%) incidence of
moderate-to-severe ISP among their thoracotomy patients than reported in
prior literature. Injection of local anesthetic into the phrenic nerve fat
pad at the level of the diaphragm appeared to be an effective and safe
surgical intervention that may eliminate a significant cause of ISP. None
of the VATS patients who received phrenic nerve infiltration experienced
ISP. Postoperative pain in VATS is expected to be reduced by avoiding the
use of a rib spreader, severing of the intercostal nerves, and division of
muscle tissue, which may account for the lower observed rates of ISP in
the VATS cohort who did not receive phrenic nerve infiltration. Further
randomized controlled trials are warranted to establish if patients
undergoing various VATS procedures benefit from this
intervention. Copyright © 2020 Elsevier Inc.

<68>
Accession Number
2007621164
Title
Peak Serum Chloride and Hyperchloremia in Patients Undergoing Cardiac
Surgery Is Not Explained by Chloride-Rich Intravenous Fluid Alone: A
Post-Hoc Analysis of the LICRA Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
McIlroy D.R.; Murphy D.; Shotwell M.S.; Bhatia D.
Institution
(McIlroy, Murphy, Bhatia) Alfred Hospital, Monash University, Melbourne,
Victoria, Australia
(McIlroy, Shotwell) Vanderbilt University Medical Center, Nashville, TN,
United States
Publisher
W.B. Saunders
Abstract
Objectives: With the exception of 0.9% saline, little is known about
factors that may contribute to increased serum chloride concentration
(S<inf>Cl</inf>-) in patients undergoing cardiac surgery. For
the present study, the authors sought to characterize the association
between administered chloride load from intravenous fluid and other
perioperative variables, with peak perioperative
S<inf>Cl</inf>-. Design(s): Secondary analysis of data
from a previously published controlled clinical trial in which patients
were assigned to a chloride-rich or chloride-limited perioperative fluid
strategy (NCT02020538). Setting(s): Academic medical center.
 Participant(s): The study comprised 1,056 adult patients with normal
preoperative S<inf>Cl</inf>- undergoing cardiac surgery.
 Intervention(s): None Measurements and Main Results: Peak
perioperative S<inf>Cl</inf>- and hyperchloremia, defined as
peak S<inf>Cl</inf>- >110 mmol/L, were selected as co-primary
endpoints. Regression modeling identified factors independently associated
with these endpoints. Mean (standard deviation) peak perioperative
S<inf>Cl</inf>- was 114 (5) mmol/L, and hyperchloremia occurred
in 824 (78.0%) of the cohort. In addition to administered volume of 0.9%
saline, multivariate linear and logistic regression modeling consistently
associated preoperative S<inf>Cl</inf>- (regression coefficient
0.5; 95% confidence interval [CI] 0.4-0.6 mmol/L; odds ratio 1.60; 95% CI
1.41-1.82 per 1 mmol/L increase) and cardiopulmonary bypass duration
(regression coefficient 0.1; 95% CI 0.1-0.2 mmol/L; odds ratio 1.12; 95%
CI 1.06-1.19 per 10 minutes) with both co-primary outcomes. Multivariate
modeling only explained approximately 50% of variability in peak
S<inf>Cl</inf>-. Conclusion(s): The present study's data
identified an association for both 0.9% saline administration and other
nonfluid variables with peak perioperative S<inf>Cl</inf>- and
hyperchloremia. Stand-alone strategies to limit administration of
chloride-rich intravenous fluid may have limited ability to prevent
hyperchloremia in this setting. Copyright © 2020 Elsevier Inc.

<69>
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. 5 (9) (pp 1486-1494), 2020. Date of
Publication: September 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.
 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. 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. 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. Copyright © 2020 International Society of
Nephrology

<70>
Accession Number
2007431074
Title
The Rationale, Indications, Safety, and Use of Statins in the Pediatric
Population.
Source
Canadian Journal of Cardiology. 36 (9) (pp 1372-1383), 2020. Date of
Publication: September 2020.
Author
Khoury M.; McCrindle B.W.
Institution
(Khoury) Division of Pediatric Cardiology, Department of Pediatrics,
University of Alberta, Edmonton, AB, Canada
(McCrindle) Labatt Family Heart Center, Department of Pediatrics, The
Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Together with heart-healthy lifestyle habits, statins serve as the
cornerstone of primary and secondary prevention of atherosclerotic
cardiovascular disease in adults. Several conditions, most notably
familial hypercholesterolemia (FH), cause early dyslipidemia and vascular
disease, contributing to the development and progression of
atherosclerosis from childhood and increased cardiovascular risk. In
recent decades, studies increasingly have evaluated the safety and
efficacy of statins in such high-risk youth. The strongest evidence for
pediatric statin use is for the heterozygous FH population, whereby statin
use has been shown to lower low-density lipoprotein cholesterol
effectively, slow the progression of atherosclerosis and vascular
dysfunction, and significantly reduce cardiovascular risk in early
adulthood. Numerous meta-analyses and Cochrane reviews have demonstrated
that attributed adverse effects, including liver toxicity, myositis, and
rhabdomyolysis, occur no more frequently in youth receiving statins than
placebos, with no impact on growth or development. However, further
studies evaluating the long-term safety of pediatric statin use are
required. In the current review, we summarize the pediatric experience of
statin use to date, focusing on its utility for FH, Kawasaki disease,
post-heart transplantation, and other at-risk populations. Current
guidelines and indications for use are summarized, and the short- and
medium-term safety experience is reviewed. Finally, a clinical approach to
the indications, initiation, and monitoring of statins in youth is
provided. Copyright © 2020 Canadian Cardiovascular Society

<71>
Accession Number
2007138006
Title
Supra annular sizing for TAVR in bicuspid aortic valve stenosis: A
meta-analysis.
Source
Indian Heart Journal. 72 (4) (pp 309-311), 2020. Date of Publication: July
- August 2020.
Author
Kumar A.; Doshi R.; Shariff M.; Adalja D.; Vallabhajosyula S.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
(Adalja) Department of Medicine, Gotri Medical Education and Research
Center, Vadodara, Gujrat, India
(Vallabhajosyula) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier B.V.

<72>
Accession Number
2006765650
Title
Incidence, predictors and outcomes of valve-in-valve TAVI: A systematic
review and meta-analysis.
Source
International Journal of Cardiology. 316 (pp 64-69), 2020. Date of
Publication: 1 October 2020.
Author
Giordana F.; Bruno F.; Conrotto F.; Saglietto A.; D'Ascenzo F.; Grosso
Marra W.; Dvir D.; Webb J.; D'Onofrio A.; Camboni D.; Grubitzsch H.;
Duncan A.; Kaneko T.; Toggweiler S.; Latib A.; Nerla R.; Salizzoni S.; La
Torre M.; Trompeo A.; D'Amico M.; Rinaldi M.; De Ferrari G.
Institution
(Giordana, Bruno, Conrotto, Saglietto, D'Ascenzo, Grosso Marra, D'Amico,
De Ferrari) Division of Cardiology, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital and University of
Turin, Italy
(Salizzoni, La Torre, Trompeo, Rinaldi) Division of Cardiosurgery,
Cardiovascular and Thoracic Department, Citta della Salute e della Scienza
Hospital and University of Turin, Italy
(Dvir) University of Washington, Seattle, WA, United States
(Webb) Centre for Heart Valve Innovation, St Paul's Hospital, University
of British Columbia, Vancouver, BC, Canada
(D'Onofrio) Division of Cardiology, Monaldi Hospital, Naples, Italy
(Camboni) Department of Cardio-Thoracic Surgery, University Medical Center
Regensburg, Germany
(Grubitzsch) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
(Duncan) Royal Brompton Hospital, London, United Kingdom
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Switzerland
(Latib) Interventional Cardiology Unit, San Raffaele Scientific Institute,
Milan, Italy
(Nerla) Cardiovascular Department, Humanities Gavazzeni, Bergamo, Italy
(Latib) Department of Cardiology, Montefiore Medical Centre, New York,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Surgical aortic valve replacement has been the treatment of choice
for patients with aortic valve disease before the arrival of transcatheter
aortic valve replacement (TAVI), although limited by degeneration of the
bioprosthesis. "Redo" intervention itself is burdened by high risk of
complications and valve-in-valve (ViV) TAVI could be a valid strategy of
redo for patients with comorbidities. Methods and Results: Two
independent reviewers screened all studies investigating patients
undergoing ViV TAVI. Mortality at 30 days and at 1 year was the primary
end point. Of 286 studies identified, 26 articles were included in this
review with a total of 1448 patients. Median age was 78.8 years, 57.7%
male. Median STS score and Logistic EuroSCORE were 9.4% and 31.3%
respectively. Stenosis (45%) was the leading cause of prosthesis failure.
Transfemoral approach was preferred (76%), with a prevalence of balloon
expandable valves (73.3%). Mean follow up was 376 days. Overall and
cardiovascular mortality at 30 days was 6.5% and 5.5% respectively, while
at 1 year it was 14.5% and 8.9% respectively. At meta-regression analysis
study year (p <.001), Logistic EuroSCORE (p <.01) and valve diameter <= 21
mm (p <.05) at 30 days, and stenosis as reason for failure (p =.05) at 1
year were identified as possible predictors of survival.
 Conclusion(s): ViV TAVI offers a valid strategy to treat high risk
patients with a failure of bioprosthesis with satisfying results in terms
of short and mid-term mortality. Future studies are needed to find
predictors of long term survival and outcomes in lower risk
patients. Copyright © 2020 Elsevier B.V.

<73>
Accession Number
2006049780
Title
Mechanical Support in Early Cardiogenic Shock: What Is the Role of
Intra-aortic Balloon Counterpulsation?.
Source
Current Heart Failure Reports. (no pagination), 2020. Date of Publication:
2020.
Author
Kimman J.R.; Van Mieghem N.M.; Endeman H.; Brugts J.J.; Constantinescu
A.A.; Manintveld O.C.; Dubois E.A.; den Uil C.A.
Institution
(Kimman, Van Mieghem, Brugts, Constantinescu, Manintveld, Dubois, den Uil)
Department of Cardiology, Thorax Center, Erasmus University Medical
Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, Netherlands
(Endeman, Dubois, den Uil) Department of Intensive Care Medicine, Erasmus
University Medical Center, Rotterdam, Netherlands
Publisher
Springer
Abstract
Purpose of Review: We aim to summarize recent insights and provide an
up-to-date overview on the role of intra-aortic balloon pump (IABP)
counterpulsation in cardiogenic shock (CS). Recent Findings: In the
largest randomized controlled trial (RCT) of patients with CS after acute
myocardial infarction (AMICS), IABP did not lower mortality. However,
recent data suggest a role for IABP in patients who have persistent
ischemia after revascularization. Moreover, in the growing population of
CS not caused by acute coronary syndrome (ACS), multiple retrospective
studies and one small RCT report on significant hemodynamic improvement
following (early) initiation of IABP support, which allowed bridging of
most patients to recovery or definitive therapies like heart transplant or
a left ventricular assist device (LVAD). Summary: Routine use of IABP
in patients with AMICS is not recommended, but many patients with CS
either from ischemic or non-ischemic cause may benefit from IABP at least
for hemodynamic improvement in the short term. There is a need for a
larger RCT regarding the role of IABP in selected patients with ACS, as
well as in patients with non-ACS CS. Copyright © 2020, The
Author(s).

<74>
Accession Number
2005644577
Title
A pilot randomized-controlled trial evaluating the erector spinae plane
block in thoracic and breast surgery.
Source
Canadian Journal of Anesthesia. 67 (10) (pp 1371-1380), 2020. Date of
Publication: 01 Oct 2020.
Author
Uda Y.; Byrne K.; Brahmbhatt A.; Gotmaker R.; Lim D.; Konishi Y.; Eves
T.K.; Paxton E.; Barrington M.J.
Institution
(Uda, Brahmbhatt, Gotmaker, Konishi, Paxton, Barrington) Department of
Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Victoria
Parade, Fitzroy, PO Box 2900, Melbourne, VIC 3065, Australia
(Byrne) Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
(Brahmbhatt, Barrington) Department of Medicine and Radiology, Faculty of
Medicine, Dentistry and Health Sciences, University of Melbourne,
Melbourne, VIC, Australia
(Lim) Department of Pharmacy, St. Vincent's Hospital, Melbourne, VIC,
Australia
(Konishi) Department of Anesthesia, School of Medicine, Teikyo University,
Tokyo, Japan
(Eves) Department of Anatomy and Neuroscience, Faculty of Medicine,
Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC,
Australia
Publisher
Springer
Abstract
Purpose: This pilot study evaluated the feasibility of investigating the
effect of the erector spinae plane (ESP) block on the patient-centred
outcomes of quality of recovery-15 (QoR-15), and brief pain inventory
(BPI) in thoracic and breast surgery patients. Method(s): In this
randomized-controlled pilot trial, 82 patients undergoing video-assisted
thoracoscopic surgery (n = 77) and mastectomy (n = 5) received either
continuous ESP block with ropivacaine (ropivacaine group) or the same
procedure with 0.9% saline (saline group). All patients received surgical
intercostal block (thoracic surgery) or local anesthetic infiltration
(breast surgery). Feasibility as the primary outcome was evaluated on
recruitment (three patients per week), catheter retention (above 90% at 24
hr), and patient attrition (less than 10%). Secondary outcomes comprised
of QoR-15, BPI, and opioid consumption. Result(s): Recruitment rate
was 1.8 patients per week. Catheters were retained in 77 patients (94%) at
24 hr. At three months, five patients were lost to follow-up (6%). At 24
hr compared with baseline, the ropivacaine group had a smaller decline in
QoR-15 score (median difference, 14; 95% confidence interval [CI], 2 to
26; P = 0.02) and a smaller increase in BPI global score (median
difference, 14; 95% CI, 0 to 24; P = 0.048). There was no difference in
opioid consumption (P = 0.08). Conclusion(s): In this pilot study,
the target recruitment rate was not met, but catheter retention and
patient attrition rates were both satisfactory. A definitive trial with
QoR-15 as the primary outcome would require 300 study participants. Trial
registration: Australian New Zealand Clinical Trials Registry
(ID12618000701224); registered 30 April 2018. Copyright © 2020,
Canadian Anesthesiologists' Society.

<75>
Accession Number
2005235872
Title
Revascularization in cardiogenic shock.
Source
Herz. 45 (6) (pp 537-541), 2020. Date of Publication: 01 Sep 2020.
Author
Freund A.; Desch S.; Thiele H.
Institution
(Freund, Desch, Thiele) Department of Internal Medicine/Cardiology, Heart
Center Leipzig at University of Leipzig, Strumpellstr. 39, Leipzig 04289,
Germany
(Freund, Desch) German Center for Cardiovascular Research (DZHK), Berlin,
Germany
Publisher
Springer Medizin (E-mail: kundenservice@springermedizin.de)
Abstract
Approximately 10% of patients with acute myocardial infarction develop
cardiogenic shock. Randomized studies have shown a significant improvement
in survival with early revascularization, which now represents the most
important cornerstone in the treatment of infarct-related cardiogenic
shock. In the vast majority of cases, this is achieved by percutaneous
coronary intervention (PCI). In cases of complex coronary anatomy or
mechanical complications, the Heart Team should be consulted promptly. The
randomized CULPRIT-SHOCK study showed a survival advantage for patients
with multivessel coronary artery disease and a percutaneous
revascularization strategy who were treated by culprit-lesion-only PCI
compared with immediate multivessel PCI. There are currently few data on
anticoagulation and antiplatelet therapy in cardiogenic shock as well as
on active mechanical circulatory support in this setting. Copyright
© 2020, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<76>
Accession Number
2004841104
Title
The evolution of mitral valve surgery: The future in the hand of robots.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 555-564), 2020.
Date of Publication: 2020.
Author
Harky A.; Kwok H.T.; Fan K.S.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool, United Kingdom
(Kwok) Leicester Medical School, Leicester, United Kingdom
(Fan) St. George's, University of London, London, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To examine the current literature behind the evolution of
mitral valve surgery techniques and their impact on patient outcomes.
 Method(s): An electronic literature search among major databases was
performed (PubMed, Embase, Scopus, Cochrane, and Google scholar). All the
relevant articles were screened and identified to be included in this
narrative review. The main outcomes were postoperative morbidity, length
of in-hospital stay, and long-term mortality. Result(s): Minimally
invasive and robot-assisted approach to mitral valve repair and
replacements has shown great potential in improving surgical outcomes when
compared against traditional midline sternotomy. Selected patients can
benefit from percutaneous mitral valve surgery; however, more evidence is
required to ascertain its long-term outcomes. Conclusion(s): Current
evidence suggests that robotic and minimal invasive mitral valve surgeries
are increasing in practice with satisfactory perioperative and mortality
rates. However, long-term data is yet to be published to support current
practice. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<77>
Accession Number
2004841103
Title
Three-dimensional printing: Is it useful for cardiac surgery?.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 549-554), 2020.
Date of Publication: 2020.
Author
de Oliveira M.A.B.; Dos Santos C.A.; Brandi A.C.; Botelho P.H.H.; Braile
D.M.
Institution
(de Oliveira) Department of Cardiac Surgery, Hospital Santo Antonio and
Femina Cuiaba, Sinop, Mato Grosso, Brazil
(de Oliveira) Department of Cardiovascular Surgery, Universidade Federal
do Mato Grosso, Sinop, Mato Grosso, Brazil
(Dos Santos, Brandi, Botelho, Braile) Hospital de Base, Sao Jose do Rio
Preto, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Introduction: The medical use of three-dimensional (3-D) images has been a
topic in the literature since 1988, but 95% of papers on 3-D printing were
published in the last six years. The increase in publications is the
result of advances in 3-D printing methods, as well as of the increasing
availability of these machines in different hospitals. This paper sought
to review the literature on 3-D printing and to discuss thoughtful ideas
regarding benefits and challenges to its incorporation into cardiothoracic
surgeons' routines. Method(s): A comprehensive and systematic search
of the literature was performed in PubMed and included material published
as of March 2020. Result(s): Using this search strategy, 9,253
publications on 3-D printing and 497 on "heart" 3-D printing were
retrieved. Conclusion(s): 3-D printed models are already helping
surgeons to plan their surgeries, helping patients and their families to
understand complex anatomy, helping fellows and residents to practice
surgery, even for rare cases, and helping nurses and other health care
staff to better understand some conditions, such as heart
diseases. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<78>
Accession Number
2004841102
Title
State-of-the-art pediatric coronary artery bypass surgery: A literature
review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 539-548), 2020.
Date of Publication: 2020.
Author
Komarov R.; Ismailbaev A.; Chragyan V.; Kadyraliev B.; Sa M.P.B.O.;
Ruhparwar A.; Weymann A.; Zhigalov K.
Institution
(Komarov, Ismailbaev) Department of Cardiovascular Surgery, I.M. Sechenov
University Hospital, First Moscow State Medical University, Moscow,
Russian Federation
(Chragyan, Kadyraliev) Department of Cardiovascular Surgery, S.G. Sukhanov
Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical
University, Perm, Russian Federation
(Sa) Department of Cardiovascular Surgery, Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, PE, Brazil
(Ruhparwar, Weymann, Zhigalov) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To examine the results of various myocardial revascularization
techniques in pediatric patients to better understand the strategies for
surgical treatment of coronary artery pathologies. Method(s): We
analyzed 61 publications dedicated to the indications, methods, and
results of coronary bypass surgery in children. Due to the small size of
this cohort, case reports are also included in our review. Result(s):
The main indications for coronary bypass grafting in children are Kawasaki
disease, myocardial revascularization as a necessary procedure during the
congenital cardiac surgery, to manage intraoperative iatrogenic damage to
coronary arteries, and homozygous familial hypercholesterolemia. The use
of internal thoracic arteries as conduits for coronary bypass grafting in
children with Kawasaki disease showed significantly better results in
long-term functionality compared to autovenous conduits (87% and 44%,
respectively, P<0.001). Acute and late coronary events after arterial
switch operation for the transposition of the great arteries, anomalous
origin of the left coronary artery from the pulmonary artery, and left
main coronary artery atresia are the main congenital heart diseases where
surgical correction involves interventions on the coronary arteries.
 Conclusion(s): The internal thoracic artery is a reliable and durable
conduit that demonstrates proven growth potential in
children. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<79>
Accession Number
2004841038
Title
Nursing guidelines on cardiac surgery and parents' anxiety: Randomized
clinical trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 437-444), 2020.
Date of Publication: 2020.
Author
Xavier I.B.M.; Biscarra V.B.; Piccoli A.B.; Rodrigues C.G.; Hirakata V.N.;
de Moraes M.A.P.; Pellanda L.C.
Institution
(Xavier, Biscarra, Piccoli, de Moraes, Pellanda) Instituto de
Cardiologia/Fundacao, Universitaria de Cardiologia - IC/FUC, Porto Alegre,
RS, Brazil
(Rodrigues, Pellanda) Universidade Federal de Ciencias da Saude de Porto
Alegre, Porto Alegre, RS, Brazil
(Hirakata) Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: The preparation of parents of children who should undergo
cardiac surgery requires special treatment such as the explanations about
the event. This study aims to compare the effects of standardized nursing
guidelines with routine institutional orientation on the anxiety of
parents of children undergoing cardiac surgery. Method(s): Randomized
clinical trial. The sample consisted of parents of children who underwent
cardiac surgery from December 2010 to April 2011. Twenty-two parents were
randomized to the intervention group (IG) and received the standard
nursing guidelines and 22 participated in the control group (CG) and
received the routine guidelines from the institution. Anxiety was assessed
by the State-Trait Anxiety Inventory (STAI) applied in the preoperative
period, between 12 and 20 hours before surgery and before receiving
standard or institutional guidelines and 48 hours after surgery. The
analysis of variance (ANOVA) for repeated measures was performed to
evaluate the differences between the variations in STAI scores between the
groups during the studied period. The level of significance was 0.05.
 Result(s): There were no significant differences in baseline anxiety
scores between groups with regard to trait anxiety as well as state
anxiety: STAI-trait (CG 42.6+/-4.9 vs. IG 41.4+/-6.0, P=0.48); STAI-state
(CG 42.3+/-5.7 vs. IG 45.6+/-8.3, P=0.18). Likewise, the variation in
score after 48 hours was similar between groups (STAI-trait P=0.77;
STAI-state P=0.61). Conclusion(s): There were no significant
differences in the parents' anxiety levels when comparing the two types of
guidelines: the standard nursing and the institutional
orientation. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<80>
Accession Number
2004841037
Title
Which is the optimal frozen elephant trunk? A systematic review and
meta-analysis of outcomes in 2161 patients undergoing thoracic aortic
aneurysm surgery using e-vita open plus hybrid stent graft versus
thoraflexTM hybrid prosthesis.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 427-436), 2020.
Date of Publication: 2020.
Author
Harky A.; Fok M.; Bashir M.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Fok) Department of Vascular Surgery, Royal Liverpool Hospital, Liverpool,
United Kingdom
(Bashir) Vascular Surgery Department, Royal Blackburn Teaching Hospital,
Haslingden Rd, Blackburn, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To systematically review the rate of morbidity and mortality
associated with the use of E-vita hybrid stent graft and ThoraflexTM in
patients undergoing complex aortic surgery. Method(s): A
comprehensive search was undertaken among the four major databases to
identify published data about E-vita or ThoraflexTM in patients undergoing
repair of thoracic aortic aneurysms. Result(s): In total, 28 papers
were included in the study, encompassing a total of 2,161 patients (1,919
E-vita and 242 ThoraflexTM). Patients undergoing surgery with E-vita or
ThoraflexTM were of similar age and sex. The number of patients undergoing
non-elective repair with ThoraflexTM was higher than with E-vita (35.2%
vs. 28.7%, respectively). Cardiopulmonary bypass time was associated with
increasing mortality in E-vita patients, however a meta-analysis of
proportions showed higher 30-day mortality, permanent neurological
deficit, and one-year mortality for ThoraflexTM patients. Direct
statistical comparisons between E-vita and ThoraflexTM was not possible
due to heterogeneity of studies. Conclusion(s): Although there are
limited studies available, the available data suggests that mortality and
morbidity are lower for the E-vita device in thoracic aortic aneurysm
surgery than for ThoraflexTM. Long-term data of comparative studies do not
yet exist to assess viability of these procedures. Copyright ©
2020, Sociedade Brasileira de Cirurgia Cardiovascular. All rights
reserved.

<81>
Accession Number
632683350
Title
Outcome of Flow-Gradient Patterns of Aortic Stenosis after Aortic Valve
Replacement: An Analysis of the PARTNER 2 Trial and Registry.
Source
Circulation: Cardiovascular Interventions. 13 (7) (no pagination), 2020.
Article Number: e008792. Date of Publication: 01 Jul 2020.
Author
Salaun E.; Clavel M.-A.; Hahn R.T.; Jaber W.A.; Asch F.M.; Rodriguez L.;
Weissman N.J.; Gertz Z.M.; Herrmann H.C.; Dahou A.; Annabi M.-S.; Toubal
O.; Bernier M.; Beaudoin J.; Leipsic J.; Blanke P.; Ridard C.; Ong G.;
Rodes-Cabau J.; Webb J.G.; Zhang Y.; Alu M.C.; Douglas P.S.; Makkar R.;
Miller D.C.; Lindman B.R.; Thourani V.H.; Leon M.B.; Pibarot P.
Institution
(Salaun, Clavel, Dahou, Annabi, Toubal, Bernier, Beaudoin, Ridard, Ong,
Rodes-Cabau, Pibarot) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec/Quebec Heart and Lung Institute, Laval University,
2725 Chemin Sainte-Foy No. A2075, Quebec, Quebec G1V-4G5, Canada
(Hahn, Zhang, Alu, Leon) Columbia University Medical Center/New
York-Presbyterian Hospital, United States
(Hahn, Zhang, Alu, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Jaber, Rodriguez) Heart and Vascular Institute, Cleveland Clinic, OH,
United States
(Asch, Weissman, Thourani) MedStar Health Research Institute at Washington
Hospital Center, DC, United States
(Gertz) Division of Cardiology, Virginia Commonwealth University,
Richmond, United States
(Herrmann) University of Pennsylvania Medical Center, Philadelphia, United
States
(Leipsic, Blanke, Webb) St Paul's Hospital, Vancouver, BC, Canada
(Ong) Division of Cardiology, St Michael's Hospital, Toronto, ON, Canada
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, NC, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Miller) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University School of Medicine, CA, United States
(Lindman) Vanderbilt University Medical Center, Nashville, TN, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Although aortic valve replacement is associated with a major
benefit in high-gradient (HG) severe aortic stenosis (AS), the results in
low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe
AS may be subdivided in classical low-flow (left ventricular ejection
fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular
ejection fraction >=50% but stroke volume index <35 mL/m2) and
LG; and normal-flow (left ventricular ejection fraction >=50% and stroke
volume index >=35 mL/m2) and LG. The primary objective is to
determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter
Valves) and registry the outcomes after aortic valve replacement of the 4
flow-gradient groups. Method(s): A total of 3511 patients from the
PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry
(n=1601) were included. The flow-gradient pattern was determined at
baseline transthoracic echocardiography and classified as follows: (1) HG;
(2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The
primary end point for this analysis was the composite of (1) death; (2)
rehospitalization for heart failure symptoms and valve prosthesis
complication; or (3) stroke. Result(s): The distribution was HG, 2229
patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG,
247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year
rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8%
(P=0.002) and normal-flow-LG: 32.1% (P=0.05) but was not statistically
different from paradoxical low-flow-LG: 33.6% (P=0.18). There was no
significant difference in the 2-year rates of clinical events between
transcatheter aortic valve replacement versus surgical aortic valve
replacement in the whole cohort and within each flow-gradient group.
 Conclusion(s): The LG AS pattern was highly prevalent (36.5%) in the
PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS
and was associated with higher rates of death, rehospitalization, or
stroke at 2 years compared with the HG group. Clinical outcomes were as
good in the LG AS groups with preserved left ventricular ejection fraction
compared with the HG group. Copyright © 2020 Lippincott Williams
and Wilkins. All rights reserved.

<82>
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. 9 (17) (pp e016964), 2020. Date
of Publication: 01 Sep 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.

<83>
Accession Number
632570404
Title
Antiplatelet therapy and coronary artery bypass grafting: a systematic
review and network meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 31 (3) (pp 354-363),
2020. Date of Publication: 01 Sep 2020.
Author
Gupta S.; Belley-Cote E.P.; Panchal P.; Pandey A.; Basha A.; Pallo L.;
Rochwerg B.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, ON,
Hamilton, Canada
(Gupta, Rochwerg, Whitlock) Department of Health Research Methods,
McMaster University, ON, Hamilton, Canada
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine, McMaster
University, ON, Hamilton, Canada
(Belley-Cote, Mehta, Schwalm, Whitlock) Population Health Research
Institute, ON, Hamilton, Canada
(Panchal, Pandey, Basha) Faculty of Health Sciences, McMaster University,
ON, Hamilton, Canada
(Pallo) Faculty of Sciences, McMaster University, ON, Hamilton, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Acetylsalicylic acid (ASA) monotherapy is the standard of care
after coronary artery bypass grafting (CABG), but the benefits of more
intense antiplatelet therapy, specifically dual antiplatelet therapy
(DAPT), require further exploration in CABG patients. We performed a
network meta-analysis to compare the effects of various antiplatelet
regimens on saphenous vein graft patency, mortality, major adverse
cardiovascular events and bleeding among CABG patients. METHOD(S): We
searched Cochrane Central Register of Controlled Trials, Medical
Literature Analysis and Retrieval Systems Online, Excerpta Medica
Database, Cumulative Index to Nursing and Allied Health Literature,
American College of Physicians Journal Club and conference proceedings for
randomized controlled trials. Screening, data extraction, risk of bias
assessment and Grading of Recommendations Assessment, Development and
Evaluation were performed in duplicate. We conducted a random effect
Bayesian network meta-analysis including both direct and indirect
comparisons. RESULT(S): We included 43 randomized controlled trials
studying 15 511 patients. DAPT with low-dose ASA and ticagrelor [odds
ratio (OR) 2.53, 95% credible interval (CrI) 1.35-4.72; I2 = 55; low
certainty] or clopidogrel (OR 1.56, 95% CrI 1.02-2.39; I2 = 55; very low
certainty) improved saphenous vein graft patency when compared to low-dose
ASA monotherapy. DAPT with low-dose ASA and ticagrelor was associated with
lower mortality (OR 0.52, 95% CrI 0.30-0.87; I2 = 14; high certainty) and
lower major adverse cardiovascular events (OR 0.63, 95% CrI 0.44-0.91; I2
= 0; high certainty) when compared to low-dose ASA monotherapy. Based on
moderate certainty evidence, DAPT was associated with an increase in major
bleeding. CONCLUSION(S): Our results suggest that DAPT improves
saphenous vein graft patency, mortality and major adverse cardiovascular
event. As such, surgeons and physicians should consider re-initiating DAPT
for acute coronary syndrome patients after their CABG, at the expense of
an increased risk for major bleeding. CLINICAL TRIAL REGISTRATION:
International Prospective Register of Systematic Reviews ID Number
CRD42019127695. Copyright © The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<84>
Accession Number
632508010
Title
Ubiquinol supplementation in elderly patients undergoing aortic valve
replacement: biochemical and clinical aspects.
Source
Aging. 12 (15) (pp 15514-15531), 2020. Date of Publication: 31 Jul 2020.
Author
Orlando P.; Sabbatinelli J.; Silvestri S.; Marcheggiani F.; Cirilli I.;
Dludla P.V.; Molardi A.; Nicolini F.; Tiano L.
Institution
(Orlando, Silvestri, Marcheggiani, Cirilli, Dludla, Tiano) Department of
Life and Environmental Sciences, Universita Politecnica delle Marche, Via
Brecce Bianche, Ancona 60100, Italy
(Sabbatinelli) Department of Clinical and Molecular Sciences, DISCLIMO,
Universita Politecnica delle Marche, Ancona 60100, Italy
(Dludla) Biomedical Research and Innovation Platform, South African
Medical Research Council, Tygerberg 7505, South Africa
(Molardi, Nicolini) Cardiac Surgery Department, Parma University Hospital,
Parma 43126, Italy
Publisher
NLM (Medline)
Abstract
Epidemiological data show a rise in the mean age of patients affected by
heart disease undergoing cardiac surgery. Senescent myocardium reduces the
tolerance to ischemic stress and there are indications about
age-associated deficit in post-operative cardiac performance. Coenzyme Q10
(CoQ10), and more specifically its reduced form ubiquinol (QH), improve
several conditions related to bioenergetic deficit or increased exposure
to oxidative stress. This trial (Eudra-CT 2009-015826-13) evaluated the
clinical and biochemical effects of ubiquinol in 50 elderly patients
affected by severe aortic stenosis undergoing aortic valve replacement and
randomized to either placebo or 400 mg/day ubiquinol from 7 days before to
5 days after surgery. Plasma and cardiac tissue CoQ10 levels and oxidative
status, circulating troponin I, CK-MB (primary endpoints), IL-6 and S100B
were assessed. Moreover, main cardiac adverse effects, NYHA class,
contractility and myocardial hypertrophy (secondary endpoints) were
evaluated during a 6-month follow-up visit. Ubiquinol treatment
counteracted the post-operative plasma CoQ10 decline (p<0.0001) and
oxidation (p=0.038) and curbed the post-operative increase in troponin I
(QH, 1.90 [1.47-2.48] ng/dL; placebo, 4.03 [2.45-6.63] ng/dL; p=0.007)
related to cardiac surgery. Moreover, ubiquinol prevented the adverse
outcomes that might have been associated with defective left ventricular
ejection fraction recovery in elderly patients.

<85>
Accession Number
632159515
Title
Effect of Preloading With High Dose of Rosuvastatin on Serum Levels of
Inflammatory Markers After Percutaneous Coronary Intervention.
Source
The Journal of invasive cardiology. 32 (9) (pp 335-341), 2020. Date of
Publication: 01 Sep 2020.
Author
Slhessarenko J.R.; Hirata M.; Sousa A.; Bastos G.M.; Higa E.M.S.; Mouro
M.G.; Sobrera G.C.; Slhessarenko R.D.; Viana R.; Abizaid A.; Costa J.R.
Institution
(Slhessarenko) Av. Dr. Dante Pazzanese, Sao Paulo 04012-180, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to assess the effects of a high loading dose of
rosuvastatin (40 mg) on acute inflammatory response after coronary
stenting. METHOD(S): Patients with stable coronary disease without
statin use (>=7 days) and undergoing elective percutaneous coronary
intervention (PCI) in a native coronary artery were randomized to receive
a loading dose of rosuvastatin (n = 64) or not (n = 61). Blood samples
were obtained before statin intake (time point A), 3 hours after
medication (time point B), and 3 hours after PCI (time point C). The
primary goal was the comparison in the variation of the serum inflammatory
markers and their gene expression at the different time points between the
two groups. RESULT(S): Baseline clinical, angiographic, and
procedural characteristics did not significantly differ between the
groups, except for the more frequent use of postdilation in the control
group (73.4% vs 90.2%; P=.02). Patients pretreated with statin showed a
reduction in the serum levels of interleukin (IL)-1beta (DELTA = -0.491
pg/mL; Pinteraction<.001), IL-6 (DELTA = -0.209 pg/mL; Pinteraction<.001),
and plasminogen activator inhibitor 1 (DELTA = -1.573 pg/mL;
Pinteraction<.001) as well as in their genetic expression, which was not
observed in the control group. Regarding high-sensitivity c-reactive
protein, there was no significant variation in its value from time point A
to C in patients pretreated with statin (P=.58) while it significantly
increased in the control group (P=.04). CONCLUSION(S): Among patients
with stable coronary artery disease undergoing PCI with stents,
pretreatment with high dose of rosuvastatin resulted in significant
reduction in the serum levels of important inflammatory markers and their
genetic expression.

<86>
Accession Number
632105542
Title
Prehabilitation in patients awaiting elective coronary artery bypass graft
surgery - effects on functional capacity and quality of life: a randomized
controlled trial.
Source
Clinical rehabilitation. 34 (10) (pp 1256-1267), 2020. Date of
Publication: 01 Oct 2020.
Author
Steinmetz C.; Bjarnason-Wehrens B.; Baumgarten H.; Walther T.; Mengden T.;
Walther C.
Institution
(Steinmetz) Institute of Sport Science, Department of Training Science and
Kinesiology, University of Gottingen, Gottingen, Germany
(Bjarnason-Wehrens) Institute of Cardiology and Sports Medicine, German
Sport University Cologne, Cologne, Germany
(Baumgarten) Kerckhoff Heart Center, Department of Cardiothoracic Surgery,
Bad Nauheim, Germany
(Walther) Department of Cardiothoracic Surgery, University of Frankfurt,
Frankfurt am Main, Germany
(Mengden) Kerckhoff Heart Center, Department of Rehabilitation, Bad
Nauheim, Germany
(Walther) Department of Cardiology, University of Frankfurt, Frankfurt am
Main, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the impact of an exercise-based prehabilitation
(EBPrehab) program on pre- and postoperative exercise capacity, functional
capacity (FC) and quality of life (QoL) in patients awaiting elective
coronary artery bypass graft surgery (CABG). DESIGN: A two-group
randomized controlled trail. SETTING: Ambulatory prehabilitation.
SUBJECTS: Overall 230 preoperative elective CABG-surgery patients were
randomly assigned to an intervention (IG, n=88; n=27 withdrew after
randomization) or control group (CG, n=115). INTERVENTION: IG: two-week
EBPrehab including supervised aerobic exercise. CG: usual care. MAIN
MEASURES: At baseline (T1), one day before surgery (T2), at the beginning
(T3) and at the end of cardiac rehabilitation (T4) the following
measurements were performed: cardiopulmonary exercise test, six-minute
walk test (6MWT), Timed-Up-and-Go Test (TUG) and QoL (MacNew
questionnaire). RESULT(S): A total of 171 patients (IG, n=81; CG,
n=90) completed the study. During EBPrehab no complications occurred.
Preoperatively FC (6MWTIG: 443.0+/-80.1m to 493.5+/-75.5m, P=0.003; TUGIG:
6.9+/-2.0s to 6.1+/-1.8s, P=0.018) and QoL (IG: 5.1+/-0.9 to 5.4+/-0.9,
P<0.001) improved significantly more in IG compared to CG. Similar effects
were observed postoperatively in FC (6MWDIG: DELTA-64.7m, pT1-T3=0.013;
DELTA+47.2m, pT1-T4<0.001; TUGIG: DELTA+1.4s, pT1-T3=0.003).
 CONCLUSION(S): A short-term EBPrehab is effective to improve
perioperative FC and preoperative QoL in patients with stable coronary
artery disease awaiting CABG-surgery.ID: NCT04111744
(www.ClinicalTrials.gov; Preoperative Exercise Training for Patients
Undergoing Coronary Artery Bypass Graft Surgery- A Prospective Randomized
Trial).

<87>
Accession Number
632098208
Title
Postoperative Psychological Disorders Among Heart Transplant Recipients: A
Meta-Analysis and Meta-Regression.
Source
Psychosomatic medicine. 82 (7) (pp 689-698), 2020. Date of Publication: 01
Sep 2020.
Author
Loh A.Z.H.; Tan J.S.Y.; Tam J.K.C.; Zhang M.W.; Ho C.S.H.; Ho R.C.
Institution
(Loh) From the Departments of Psychological Medicine (Loh, Ho) and Surgery
(Tam), Yong Loo Lin School of Medicine (Tan), National University of
Singapore; Department of Cardiac, Thoracic and Vascular Surgery (Tam),
National University Heart Centre; Institute of Mental Health, National
Health Group (Zhang); Department of Psychological Medicine (Ho), National
University Health System; and Biomedical Institute for Global Health
Research and Technology (Ho), National University of Singapore, Singapore,
Singapore
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This meta-analysis evaluates the pooled prevalence of
depression, anxiety, adjustment disorder, and posttraumatic stress
disorder (PTSD) among heart transplant recipients globally and determines
underlying moderators. METHOD(S): The authors searched PubMed,
Embase, PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL databases
from inception to March 1, 2019, and 1321 records and 42 full-text
articles were selected and reviewed according to Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines. We calculated the
pooled prevalence proportion of depression, anxiety, adjustment disorder,
and PTSD using random-effects models. Meta-regression was performed to
identify important moderators that contribute to heterogeneity.
 RESULT(S): Twenty studies met the inclusion criteria and comprised
2169 patients. The pooled prevalence of depression was 21.6% (95%
confidence interval [CI] = 16.8%-27.3%), anxiety 11.1% (95% CI =
3.8%-28.5%), adjustment disorder 11.0% (95% CI = 3.1%-32.1%), and PTSD
13.5% (95% CI = 8%-21.8%). There was significant heterogeneity.
Meta-regression was conducted to account for the heterogeneity of the
prevalence proportion. Predisposing factors, for example, New York Heart
Association classes II and III/IV, steroid treatment, and acute rejection
of transplant (<3 months), were associated with high prevalence of
depression. Protective factors, for example, age and higher ejection
fraction after transplant of patients, were associated with low prevalence
of depression. Female sex, single status, and number of months since
transplant were associated with high prevalence of anxiety. Single status
was associated with high prevalence of both adjustment disorder and
transplant-related PTSD. CONCLUSION(S): The prevalence of psychiatric
conditions, particularly depression, is high in heart transplant
recipients. The identified protective and risk factors may guide
psychological interventions in heart transplant recipients.

<88>
Accession Number
2007684982
Title
Ultrasound-Guided Out-of-Plane Versus In-Plane Radial Artery Cannulation
in Adult Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Arora N.R.; Maddali M.M.; Al-Sheheimi R.A.R.; Al-Mughairi H.;
Panchatcharam S.M.
Institution
(Arora, Maddali) Department of Cardiac Anesthesia, National Heart Center,
Royal Hospital, Muscat, Oman
(Al-Sheheimi, Al-Mughairi) Oman Medical Specialty Board, Muscat, Oman
(Panchatcharam) Department of Studies and Research, Oman Medical Specialty
Board, Muscat, Oman
Publisher
W.B. Saunders
Abstract
Objectives: The primary objective was to compare the rate of first-pass
radial arterial cannulation using out-of-plane ultrasound guidance with
in-plane imaging. The secondary endpoints were a comparison of the number
of times the cannula was redirected, the number of attempts, the number of
skin punctures, the incidence of hematoma, the time to completion of the
cannulation procedure, and the number of failed attempts between the 2
ultrasound imaging techniques. Design(s): A prospective, randomized,
observational study. Setting(s): A tertiary cardiac care center.
 Participant(s): Adult patients undergoing elective cardiac surgery.
 Intervention(s): Radial artery cannulation with ultrasound guidance.
 Measurements and Main Results: Eighty-four adult patients scheduled
for elective cardiac surgery were randomly assigned to the out-of-plane
ultrasound group (group I, n = 42) or the in-plane ultrasound group (group
II, n = 42) for left radial artery cannulation. A linear ultrasound probe
was used to identify the radial artery. In each approach, the number of
times first-pass success was achieved, the number of times the cannula was
redirected, the number of skin punctures, the incidence of hematomas, and
the number of failed attempts were recorded. The first-pass success rate
was greater in the in-plane ultrasound group and was statistically
significant (p = 0.007). In the out-of-plane ultrasound group, a larger
number of patients needed redirection of the cannula (p = 0.002). The
number of patients in whom the skin needed to be punctured more than once
was greater in the out-of-plane ultrasound group compared with the
in-plane ultrasound group (p = 0.002). The incidence of hematoma formation
and time to completion of the technique were similar in both groups (p =
0.241 and p = 0.792, respectively). Conclusion(s): In-plane
ultrasound guidance appeared to be superior for achieving a higher
first-pass success rate more often with minimal redirections and skin
punctures compared with out-of-plane ultrasound guidance. Copyright
© 2020 Elsevier Inc.

<89>
Accession Number
2007675853
Title
An evidence-based review of neuromodulation for the treatment and
management of refractory angina.
Source
Best Practice and Research: Clinical Anaesthesiology. (no pagination),
2020. Date of Publication: 2020.
Author
Urits I.; Patel A.; Leider J.; Anya A.; Franscioni H.; Jung J.W.; Kassem
H.; Kaye A.D.; Viswanath O.
Institution
(Urits) Beth Israel Deaconess Medical Center, Department of Anesthesia,
Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA,
United States
(Patel, Leider, Anya, Franscioni, Jung) Georgetown University School of
Medicine, Washington, DC, United States
(Kassem) Mount Sinai Medical Center, Department of Anesthesiology, Miami
Beach, FL, United States
(Kaye, Viswanath) Louisiana State University Health Shreveport, Department
of Anesthesiology, Shreveport, LA, United States
(Viswanath) Valley Pain Consultants - Envision Physician Services,
Phoenix, AZ, United States
(Viswanath) Creighton University School of Medicine, Department of
Anesthesiology, Omaha, NE, United States
(Viswanath) University of Arizona College of Medicine-Phoenix, Department
of Anesthesiology, Phoenix, AZ, United States
Publisher
Bailliere Tindall Ltd
Abstract
Angina pectoris is defined as substernal chest pain that is typically
exacerbated by exertion, stress, or other exposures. There are various
methods of treatment for angina. Lifestyle modification and
pharmacological management are considered as conservative treatments. If
these medications do not result in the resolution of pain, more invasive
approaches are an option, like coronary revascularization. Refractory
angina (RA) is differentiated from acute or chronic angina based on the
persistence of symptoms despite conventional therapies. Overall, the
prevalence of RA is estimated to be 5%-15% in patients with coronary
artery disease, which can account for up to 1,500,000 current cases and
100,000 new cases in the United States per year. Spinal cord stimulation
treatment is a viable option for patients who are suffering from RA pain
and are either not candidates for revascularization surgery or are
currently not being well managed on more traditional treatments. Many
studies show a positive result. Copyright © 2020

<90>
Accession Number
2007669621
Title
PCV22 An Investigation of Health Technology Assessments (HTAS) on
Transcatheter Aortic Valve Implantation (TAVI) over Time: As Evidence
Evolves How Does HTA Respond?.
Source
Value in Health Regional Issues. Conference: ISPOR Asia Pacific 2020. 22
(Supplement) (pp S30), 2020. Date of Publication: September 2020.
Author
Osborne C.; Strachan L.
Institution
(Osborne) University of Technology, Sydney (UTS), Ultimo, NSW, Australia
(Strachan) Medtronic, Macquarie Park, NSW, Australia
Publisher
Elsevier Inc.
Abstract
Objectives: TAVI is an extensively studied minimally invasive treatment
for severe Aortic Stenosis (AS). Numerous HTAs have been performed on TAVI
since the mid-2000's with varying level of focus and rigor. The objective
of this study is to investigate the evolution and trends in published
International HTA's on TAVI. Method(s): A systematic search (Sept
2019) of HTA organisation websites (62 sites) was augmented by a search of
PubMed and the CRD York HTA database using targeted search terms for TAVI.
The main characteristics of published HTAs was extracted. Result(s):
Since 2008, twenty published HTA's on TAVI use in AS from 14 geographies
including one core HTA regional report (EUnetHTA) were retrieved for
review. The purpose and objectives, methods utilised, evidence included
and final conclusions and recommendations of the HTAs varied between
countries and over time. Several HTAs were acknowledged to be rapid
assessments, although the definition and application of this method was
inconsistent. While differences existed, in most countries, early HTAs
focussed on severe/inoperable AS patients, then more recently,
moderate/low risk populations were evaluated, which follows closely the
generation of the RCT evidence for TAVI. However, there were differences
in how this evidence was synthesised and the use or type of economic
evaluation utilised. Despite this, the cost-effectiveness of TAVI in most
healthcare settings improved over time as clinical evidence accumulated.
Use of real-world data was permitted by some HTA bodies in order to
justify actual resource use, local patient demographics and other areas of
uncertainty. Interestingly, the acceptability and quality of this type of
evidence was often disputed. Conclusion(s): International HTA reports
for TAVI use in AS differ substantially, driven largely by the unique
objectives of each health system. The impact of these differences on
patient access and ultimately health outcomes needs to be
examined. Copyright © 2020

<91>
Accession Number
2007669371
Title
PCV2 Volatile Anesthetics Versus TOTAL Intravenous Anesthesia in Patients
Undergoing Coronary Artery Bypass Grafting: An Updated Meta-Analysis and
Trial Sequential Analysis of Randomized Controlled Trials.
Source
Value in Health Regional Issues. Conference: ISPOR Asia Pacific 2020. 22
(Supplement) (pp S26), 2020. Date of Publication: September 2020.
Author
Jiao X.F.; Ni X.F.; Li H.; Zhang L.L.
Institution
(Jiao, Ni, Zhang) West China Second University Hospital, Sichuan
University, Chengdu, China
(Li) West China Second Hospital, Sichuan University, chengdu 51, China
Publisher
Elsevier Inc.
Abstract
Objectives: 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. Method(s): 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.
 Result(s): 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.
 Conclusion(s): 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. Copyright
© 2020

<92>
Accession Number
632604613
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) (no pagination), 2020. Article
Number: 283. 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
(Rolid, Broch, Gullestad, Nytroen) 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
BioMed Central (E-mail: info@biomedcentral.com)
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. 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 25 min. HRQoL was assessed by the
Short Form-36 version 2 (SF-36v2) and the Hospital Anxiety and Depression
Scale, mean 11 weeks 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. 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. 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. Copyright © 2020 The Author(s).

<93>
Accession Number
632733691
Title
A meta-analysis of preoperative bronchoscopic marking for pulmonary
nodules.
Source
European Journal of Cardio-thoracic Surgery. 58 (1) (pp 40-50), 2020. Date
of Publication: 01 Jul 2020.
Author
Yanagiya M.; Kawahara T.; Ueda K.; Yoshida D.; Yamaguchi H.; Sato M.
Institution
(Yanagiya, Yamaguchi, Sato) Department of Thoracic Surgery, University of
Tokyo, Graduate School of Medicine, Tokyo, Japan
(Kawahara) Biostatistics Division, Clinical Research Support Center,
University of Tokyo Hospital, Tokyo, Japan
(Ueda) Management Division, Clinical Research Support Center, University
of Tokyo Hospital, Tokyo, Japan
(Yoshida) Department of Surgery, Asahi General Hospital, Asahi, Japan
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Recent studies have suggested the usefulness of preoperative
bronchoscopic marking techniques for the localization of pulmonary nodules
in thoracic surgery. This systematic review and meta-analysis aimed to
evaluate the efficacy and safety of preoperative bronchoscopic marking.
 METHOD(S): The PubMed and Cochrane Library databases were searched
for clinical studies evaluating preoperative bronchoscopic marking for
pulmonary resection. Non-comparative and random effects model-based
meta-analyses were conducted to calculate the pooled success and
complication rates of bronchoscopic marking. RESULT(S): Twenty-five
eligible studies were included. Among these, 15 studies conducted dye
marking under electromagnetic navigation bronchoscopy, 4 used
virtual-assisted lung mapping and 7 used other marking methods. The
overall pooled successful marking rate, successful resection rate and
complete resection rate were 0.97 [95% confidence interval (CI)
0.95-0.99], 0.98 (95% CI 0.96-1.00) and 1.00 (95% CI 1.00-1.00),
respectively. The overall pooled rates of pleural injury and pulmonary
haemorrhage were 0.02 (95% CI 0.01-0.05) and 0.00 (95% CI 0.00-0.00),
respectively. CONCLUSION(S): This meta-analysis demonstrated that
bronchoscopic marking is very safe and effective. Bronchoscopic marking
should be considered, especially if there are concerns about the safety of
other localization methods. Copyright © 2020 The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<94>
Accession Number
632733658
Title
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural
mesothelioma.
Source
European Journal of Cardio-thoracic Surgery. 58 (1) (pp 1-24), 2020. Date
of Publication: 01 Jul 2020.
Author
Opitz I.; Scherpereel A.; Berghmans T.; Psallidas I.; Glatzer M.; Rigau
D.; Astoul P.; Bolukbas S.; Boyd J.; Coolen J.; De Bondt C.; De Ruysscher
D.; Durieux V.; Faivre-Finn C.; Fennell D.A.; Galateau-Salle F.; Greillier
L.; Hoda M.A.; Klepetko W.; Lacourt A.; McElnay P.; Maskell N.A.; Mutti
L.; Pairon J.-C.; Van Schil P.; Van Meerbeeck J.P.; Waller D.; Weder W.;
Putora P.M.; Cardillo G.
Institution
(Opitz, Weder) Department of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Scherpereel) Department of Pulmonary and Thoracic Oncology, Fr. Natl.
Netwk. of Clinical Expert Centers for Malignant Pleural Mesothelioma
Management (Mesoclin), Lille, France
(Scherpereel) Department of Pulmonary and Thoracic Oncology, University
Lille, Chu Lille, Inserm U1189, OncoThAI, Lille, France
(Berghmans) Thoracic Oncology Clinic, Institut Jules Bordet, Brussels,
Belgium
(Psallidas) Oxford Centre for Respiratory Medicine, Oxford University
Hospitals Nhs Foundation Trust, Oxford, United Kingdom
(Glatzer, Putora) Department of Radiation Oncology, Kantonsspital St.
Gallen, St. Gallen, Switzerland
(Rigau) Iberoamerican Cochrane Center, Barcelona, Spain
(Astoul) Department of Thoracic Oncology Pleural Diseases and
Interventional Pulmonology, Hopital Nord, Aix-Marseille University,
Marseille, France
(Bolukbas) Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen,
Germany
(Boyd) European Lung Foundation, Sheffield, United Kingdom
(Coolen) Department of Imaging and Pathology, Ku Leuven, Leuven, Belgium
(De Bondt, Van Meerbeeck) Department of Pulmonology and Thoracic Oncology,
Antwerp University, Antwerp University Hospital, Antwerp, Belgium
(De Ruysscher) Department of Radiation Oncology (Maastro Clinic),
Maastricht University Medical Center+, Grow Research Institute,
Maastricht, Netherlands
(Durieux) Bibliotheque des Sciences de la Sante, Universite Libre de
Bruxelles (ULB), Brussels, Belgium
(Faivre-Finn) Christie Nhs Foundation Trust, University of Manchester,
Manchester, United Kingdom
(Fennell) Leicester Cancer Research Centre, University of Leicester,
University of Leicester Hospitals Nhs Trust, Leicester, United Kingdom
(Galateau-Salle) Department of Biopathology, National Reference Center for
Pleural Malignant Mesothelioma and Rare Peritoneal Tumors Mesopath, Centre
Leon Berard, Lyon, France
(Greillier) Department of Multidisciplinary Oncology and Therapeutic
Innovations, Aix Marseille University, Assistance Publique Hopitaux de
Marseille, Inserm UMR1068, Cnrs UMR7258, Marseille, France
(Hoda, Klepetko) Department of Thoracic Surgery, Medical University of
Vienna, Vienna, Austria
(Lacourt) University Bordeaux, Inserm, Bordeaux Population Health Research
Center, Team Epicene, Umr 1219, Bordeaux, France
(McElnay) Newcastle University, Newcastle upon Tyne, United Kingdom
(Maskell) Academic Respiratory Unit, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Mutti) Teaching Hospital Vercelli, Gruppo Italiano, Vercelli, Italy
(Pairon) Inserm U955, GEIC2O, Universite Paris-Est Creteil, Service de
Pathologies Professionnelles et de l'Environnement, Institut Sante-Travail
Paris-Est, Creteil CHI Creteil, France
(Van Schil) Department of Thoracic and Vascular Surgery, Antwerp
University, Antwerp University Hospital, Antwerp, Belgium
(Waller) Barts Thorax Centre, St Bartholomew's Hospital, London, United
Kingdom
(Putora) Department of Radiation Oncology, University of Bern, Bern,
Switzerland
(Cardillo) Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic
Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery
(EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force
brought together experts to update previous 2009 ERS/ESTS guidelines on
management of malignant pleural mesothelioma (MPM), a rare cancer with
globally poor outcome, after a systematic review of the 2009-2018
literature. The evidence was appraised using the Grading of
Recommendations, Assessment, Development and Evaluation approach. The
evidence syntheses were discussed and recommendations formulated by this
multidisciplinary group of experts. Diagnosis: pleural biopsies remain the
gold standard to confirm the diagnosis, usually obtained by thoracoscopy
but occasionally via image-guided percutaneous needle biopsy in cases of
pleural symphysis or poor performance status. Pathology: standard staining
procedures are insufficient in ~10% of cases, justifying the use of
specific markers, including BAP-1 and CDKN2A (p16) for the separation of
atypical mesothelial proliferation from MPM. Staging: in the absence of a
uniform, robust and validated staging system, we advise using the most
recent 2016 8th TNM (tumour, node, metastasis) classification, with an
algorithm for pretherapeutic assessment. Monitoring: patient's performance
status, histological subtype and tumour volume are the main prognostic
factors of clinical importance in routine MPM management. Other potential
parameters should be recorded at baseline and reported in clinical trials.
Treatment: (chemo)therapy has limited efficacy in MPM patients and only
selected patients are candidates for radical surgery. New promising
targeted therapies, immunotherapies and strategies have been reviewed.
Because of limited data on the best combination treatment, we emphasize
that patients who are considered candidates for a multimodal approach,
including radical surgery, should be treated as part of clinical trials in
MPM-dedicated centres. Copyright © 2020 The article has been
co-published with permission in the European Journal of Cardio-Thoracic
Surgery and the European Respiratory Journal. All rights reserved in
respect of European Journal of Cardio-Thoracic Surgery,

<95>
Accession Number
632604530
Title
A meta-analysis of the incidence rate of postoperative acute kidney injury
in patients with congenital heart disease.
Source
BMC Nephrology. 21 (1) (no pagination), 2020. Article Number: 350. 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, Wang) Department of Cardiovascular Surgery, Qingdao
Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao,
Shandong 266000, China
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
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. 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 I 2 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. 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 < 1 month than in those
aged 1 month to 18 years, < 18 years, and >= 18 years (P < 0.05).
 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. Copyright © 2020
The Author(s).

<96>
Accession Number
2005015256
Title
Review article outcomes at 5 years in patients with severe aortic
stenosis: Reviewing current information using the restricted mean survival
time.
Source
American Journal of Cardiovascular Disease. 10 (3) (pp 136-141), 2020.
Date of Publication: 2020.
Author
Messori A.; Bartoli L.; Trippoli S.
Institution
(Messori, Bartoli, Trippoli) HTA Unit, Toscana Region Health Service,
Toscana Region, Florence, Italy
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The information about outcomes at 5 years in patients receiving
transcatheter aortic valve replacement (TAVR) has grown. We interpreted
the information on this topic using the restricted mean survival time
(RMST). The purpose of our study was to summarise the current evidence
using an original outcome measure with potential methodological
advantages. Four cohorts of patients, previously published in the
literature, met our criterion of 5 years of follow-up after the implant;
another cohort was identified from a group of controls subjected to
surgical replacement of the valve. The estimated values of RMST at 5 years
for the 5 patient cohorts were the following (N = number of patients, all
time values in years): a) real-world high surgical risk cohort: N = 114,
RMST = 3.80; b) real-world cohort treated with Corevalve: N = 309, RMST =
3.79; c) a real-world cohort treated with Sapien: N = 180, RMST = 3.61; d)
TAVR arm of a randomized trial in intermediate risk patients: N = 1,011;
RMST = 3.73; e) surgical replacement arm of the same trial: N = 1,021,
RMST = 3.72. The main result of our analysis based on the RMST is
represented by the extreme homogeneity of the outcomes (RMSTs ranging from
3.61 to 3.80 years per patient) that remained virtually constant
irrespective of the baseline risk of the patients (intermediate or high
risk) and re-gardless of whether the intervention was transcatheter or by
surgical replacement. Last but not least, our analysis showed the good
methodological performance of the RMST in this disease
condition. Copyright © 2020, E-Century Publishing Corporation.
All rights reserved.

<97>
Accession Number
632741584
Title
3D printing in adult cardiovascular surgery and interventions: A
systematic review.
Source
Journal of Thoracic Disease. 12 (6) (pp 3227-3237), 2020. Date of
Publication: 01 Jun 2020.
Author
Wang C.; Zhang L.; Qin T.; Xi Z.; Sun L.; Wu H.; Li D.
Institution
(Wang, Zhang, Qin, Xi, Sun, Wu, Li) Department of Cardiovascular Surgery,
Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002,
China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
3D printing in adult cardiac and vascular surgery has been evaluated over
the last 10 years, and all of the available literature reports benefits
from the use of 3D models. In the present study, we analyzed the current
applications of 3D printing for adult cardiovascular disease treated with
surgical or catheter-based interventions, including the clinical medical
simulation of physiological or pathology conducted with 3D printing in
this field. A search of PubMed and MEDLINE databases were supplemented by
searching through bibliographies of key articles. Thereafter, data on
demographic, clinical scenarios and application, imaging modality,
purposes of using with 3D printing, outcomes and follow-up were extracted.
A total of 43 articles were deemed eligible and included. 296 patients
(mean age: 65.4+/-14.2 years; male, 58.2%) received 3D printing for
cardiac and vascular surgery or conditions [percutaneous left atrial
appendage occlusion (LAAO), TAVR, mitral valve disease, aortic valve
replacement, coronary artery abnormality, HOCM, aortic aneurysm and aortic
dissection, Kommerell's diverticulum, primary cardiac tumor and
ventricular aneurysm]. Eight papers reported the utility of 3D printing in
the medical simulator and training fields. Most studies were conducted
starting in 2014. Twenty-six was case report. The major scenario used with
3D printing technology was LAAO (50.3%) and followed by TAVR (17.6%). CT
and echocardiography were two main imaging techniques that were used to
generate 3D-printed heart models. All studies showed that 3D-printed
models were helpful for preoperative planning, orientation, and medical
teaching. The important finding is that 3D printing provides a unique
patient-specific method to assess complex anatomy and is helpful for
intraoperative orientation, decision-making, creating functional models,
and teaching adult cardiac and vascular surgery, including catheter-based
heart surgery. Copyright © Journal of Thoracic Disease. All
rights reserved.

<98>
Accession Number
632738141
Title
Post-cardiac surgery chylopericardium.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (6) (pp
627-632), 2020. Date of Publication: 01 Jun 2020.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Post-cardiac surgery chylopericardium is a rare complication. This
systematic review included 87 articles with 119 patients of post-cardiac
surgery chylopericardium. Chylopericardium developed after operations for
congenital heart defect more than those for acquired heart disease, and
more patients in whom post-cardiac surgery chylopericardium developed were
with complex than with simple congenital heart defects. Cardiac tamponade
occurred in 35 (29.4%) patients. The onset time of chylopericardium was
18.2 days earlier in patients operated for acquired than in those for
congenital heart defects. Post-cardiac surgery chylopericardium were
curable to conservative treatment in most patients. The recurrence of
post-cardiac surgery chylopericardium was on day 13.2 +/-18.2 after the
initial treatment. The overall early and late mortality rates were 1.7%
(2/119) and 1.7% (2/117), respectively. Most patients with post-cardiac
surgery chylopericardium were diagnosed by laboratory analysis of chylous
fluid. Patients with mild chylopericardium usually show good response to
conservative treatment. Whereas, patients with massive chylopericardium
and rapid accumulation, incurable to conservative treatment and recurrent
to either conservative or surgical treatment, warrant further surgical
treatment. Copyright © 2020 College of Physicians and Surgeons
Pakistan. All rights reserved.

<99>
Accession Number
2006052978
Title
Clopidogrel drug interactions: a review of the evidence and clinical
implications.
Source
Expert Opinion on Drug Metabolism and Toxicology. (no pagination), 2020.
Date of Publication: 2020.
Author
Lee C.H.; Franchi F.; Angiolillo D.J.
Institution
(Lee, Franchi, Angiolillo) Division of Cardiology, University of Florida
College of Medicine-Jacksonville, Jacksonville, FL, United States
(Lee) Division of Cardiology, Department of Internal Medicine, Veterans
Health Service Medical Center, Seoul, South Korea
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Patients with cardiovascular disease are commonly affected
by a number of comorbidities leading to a high prevalence of polypharmacy.
Polypharmacy increases the probability of drug-drug interactions (DDIs).
Amongst these, DDIs involving clopidogrel, the most commonly utilized
platelet P2Y<inf>12</inf> inhibitor, is a topic of potential clinical
concern. Areas covered: This article reviews DDIs between clopidogrel and
drugs which are widely used in clinical practice. In particular, drugs
shown to interfere with the pharmacodynamic and pharmacokinetic effects of
clopidogrel and the clinical implications of these findings are reviewed.
These drugs include inhibitors of gastric acid secretion, statins, calcium
channel blockers, antidiabetic agents, and antimicrobial agents. For the
references, we searched PubMed, EMBASE, or the Cochrane Library. Expert
opinion: Clopidogrel-drug interactions are common. Most of these DDIs are
limited to laboratory findings showing an impact on clopidogrel-induced
antiplatelet effects. While variability in clopidogrel-induced
antiplatelet effects is known to affect clinical outcomes, with high
platelet reactivity being associated with thrombotic complications among
patients undergoing coronary stenting, most studies assessing the clinical
implications of clopidogrel-drug interactions have not shown to
significantly affect outcomes. However, awareness of these DDIs remains
important for optimizing the selection of concomitant
therapies. Copyright © 2020 Informa UK Limited, trading as Taylor
& Francis Group.

<100>
Accession Number
632749674
Title
Safety and effectiveness of strategies to reduce radiation exposure to
proceduralists performing cardiac catheterization procedures: a systematic
review.
Source
JBI evidence synthesis. (no pagination), 2020. Date of Publication: 29 Aug
2020.
Author
Fernandez R.; Ellwood L.; Barrett D.; Weaver J.
Institution
(Fernandez, Ellwood) Centre for Evidence Based Initiatives in Health Care:
A JBI Centre of Excellence
(Fernandez, Ellwood) Centre for Research in Nursing and Health, St George
Hospital, Sydney, Australia
(Fernandez) School of Nursing, University of Wollongong, Sydney, Australia
(Barrett) Interventional Cardiology, St Andrews Private Hospital, Ipswich,
Australia
(Weaver) Cardiology Department, Royal Prince Alfred Hospital, Sydney,
Australia
(Weaver) School of Medicine, University of New South Wales, Sydney,
Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this systematic review was to synthesize the
best available evidence on the effect of various radiation protection
strategies on radiation dose received by proceduralists performing cardiac
catheterization procedures involving fluoroscopy. INTRODUCTION: Cardiac
catheterization procedures under fluoroscopy are the gold standard
diagnostic and treatment method for patients with coronary artery disease.
The growing demand of procedures means that proceduralists are being
exposed to increasing amounts of radiation, resulting in an increased risk
of deterministic and stochastic effects. Standard protective strategies
and equipment such as lead garments reduce radiation exposure; however,
the evidence surrounding additional equipment is contradictory. INCLUSION
CRITERIA: Randomized controlled trials that compared the use of an
additional radiation protection strategy with conventional radiation
protection methods were considered for inclusion. The primary outcome of
interest was the radiation dose received by the proceduralist during
cardiac catheterization procedures. METHOD(S): A three-step search
was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library
(CENTRAL). Trials published in the English language with adult
participants were included. Trials published from database inception until
July 2019 were eligible for inclusion. The methodological quality of the
included trials studies was assessed using the JBI critical appraisal
checklist for randomized controlled trials. Quantitative data were
extracted from the included papers using the JBI data extraction tool.
Results that could not be pooled in meta-analysis were reported in a
narrative form. RESULT(S): Fifteen randomized controlled trials were
included in the review. Six radiation protection strategies were assessed:
leaded and unleaded pelvic or arm drapes, transradial protection board,
remotely controlled mechanical contrast injector, extension tubing for
contrast injection, real-time radiation monitor, and a reduction in frame
rate to 7.5 frames per second. Pooled data from two trials demonstrated a
statistically significant decrease in the mean radiation dose (P <
0.00001) received by proceduralists performing transfemoral cardiac
catheterization on patients who received a leaded pelvic drape compared to
standard protection. One trial that compared the use of unleaded pelvic
drapes placed on patients compared to standard protection reported a
statistically significant decrease (P = 0.004) in the mean radiation dose
received by proceduralists.Compared to standard protection, two trials
that used unleaded arm drapes for patients, one trial that used a remotely
controlled mechanical contrast injector, and one trial that used a
transradial protection board demonstrated a statistically significant
reduction in the radiation dose received by proceduralists.Similarly,
using a frame rate of 7.5 versus 15 frames per second and monitoring
radiation dose in real-time radiation significantly lowered the radiation
dose received by the proceduralist. One trial demonstrated no
statistically significant difference in proceduralist radiation dose among
those who used the extension tubing compared to standard protection. (P =
1) CONCLUSION(S):: This review provides evidence to support the use
of leaded pelvic drapes for patients as an additional radiation protection
strategy for proceduralists performing transradial or transfemoral cardiac
catheterization. Further studies on the effectiveness of using a lower
fluoroscopy frame rate, real-time radiation monitor, and transradial
protection board are needed.

<101>
Accession Number
632744221
Title
Systematic reviews and meta-analyses in cardiac surgery: rules of the road
- 2.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 27 Aug 2020.
Author
Gaudino M.; Fremes S.; Bagiella E.; Bangalore S.; Demetres M.; D'Ascenzo
F.; Biondi-Zoccai G.; Di Franco A.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
NY, NY, United States
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook
Health Sciences Centre, University of Toronto, Toronto, ON, Canada
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, NY, NY, United States
(Bangalore) New York University Grossman School of Medicine, NY, NY,
United States
(Demetres) Weill Cornell Medicine, Samuel J. Wood Library & C.V. Starr
Biomedical Information Center, NY, NY, United States
(D'Ascenzo) Division of Cardiology, "Citta della scienza e della Salute",
University of Turin, Turin, Italy
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy; Mediterranea
Cardiocentro, Naples, Italy
(Di Franco) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
NY, NY, United States
Publisher
NLM (Medline)
Abstract
In the era of evidence-based medicine, systematic reviews and
meta-analyses are considered at the top of evidence hierarchy. Despite the
almost exponential increase in the number of published meta-analyses over
the course of the last decades, only a small minority of them is of high
quality, with major flaws involving every aspect of the meta-analytic
process. The strength of a meta-analysis is closely linked to the quality
of the included studies. Once preliminary phases are completed, it is
vital that selected papers undergo a thorough quality assessment, using
the most appropriate tools among those available. Analytical approaches
must be tailored to the nature of the extracted data and the specific
purpose of the meta-analysis. Appraisal of heterogeneity is a key step to
inform subgroup or meta-regression analyses. The solidity of the results
of the main analysis (especially in meta-analyses of observational studies
or studies with high heterogeneity) should be tested by means of pertinent
sensitivity analyses. Finally, the investigators should be aware of the
possibility of publication bias and make efforts to assess it using
qualitative and quantitative methods. The aim of the second part of this
expert review is to provide guidance on how to appropriately perform trial
level meta-analyses, with particular focus on the quality assessment of
the included studies, the choice of the appropriate statistical approach,
the methods to deal with heterogeneity (including subgroup,
meta-regression and sensitivity analyses), and the appraisal of
publication bias. Copyright © 2020. Published by Elsevier Inc.

<102>
Accession Number
632742506
Title
Colchicine in Patients with Chronic Coronary Disease.
Source
The New England journal of medicine. (no pagination), 2020. Date of
Publication: 31 Aug 2020.
Author
Nidorf S.M.; Fiolet A.T.L.; Mosterd A.; Eikelboom J.W.; Schut A.; Opstal
T.S.J.; The S.H.K.; Xu X.-F.; Ireland M.A.; Lenderink T.; Latchem D.;
Hoogslag P.; Jerzewski A.; Nierop P.; Whelan A.; Hendriks R.; Swart H.;
Schaap J.; Kuijper A.F.M.; van Hessen M.W.J.; Saklani P.; Tan I.; Thompson
A.G.; Morton A.; Judkins C.; Bax W.A.; Dirksen M.; Alings M.M.W.; Hankey
G.J.; Budgeon C.A.; Tijssen J.G.P.; Cornel J.H.; Thompson P.L.
Institution
(Nidorf, Fiolet, Mosterd, Eikelboom, Schut, Opstal, The, Xu, Ireland,
Lenderink, Latchem, Hoogslag, Jerzewski, Nierop, Whelan, Hendriks, Swart,
Schaap, Kuijper, van Hessen, Saklani, Tan, Thompson, Morton, Judkins, Bax,
Dirksen, Alings, Hankey, Budgeon, Tijssen, Cornel, Thompson) From
GenesisCare Western Australia (S.M.N., X.-F.X., M.A.I., D.L., A.W., R.H.,
P.S., I.T., A.G.T., A. Morton, P.L.T.), the Heart and Vascular Research
Institute (S.M.N., P.L.T.) and the Department of Neurology (G.J.H.), Sir
Charles Gairdner Hospital, and the Faculty of Health and Medical Sciences
(G.J.H., P.L.T.) and the School of Population and Global Health (C.A.B.),
University of Western Australia, Perth, the Department of Cardiology,
Fiona Stanley Hospital, Murdoch, WA (C.J.), and the Harry Perkins
Institute of Medical Research, Nedlands, WA (P.L.T.) - all in Australia;
the Dutch Network for Cardiovascular Research (A.T.L.F., A. Mosterd, A.S.,
S.H.K.T., T.L., P.H., A.J., P.N., H.S., J.S., A.F.M.K., M.W.J.H., M.D.,
M.M.W.A., J.H.C.), the Netherlands Heart Institute (A.T.L.F.), and the
Department of Cardiology (A.T.L.F.) and the Julius Center for Health
Sciences and Primary Care (A. Mosterd, M.M.W.A.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Evidence from a recent trial has shown that the
antiinflammatory effects of colchicine reduce the risk of cardiovascular
events in patients with recent myocardial infarction, but evidence of such
a risk reduction in patients with chronic coronary disease is limited.
 METHOD(S): In a randomized, controlled, double-blind trial, we
assigned patients with chronic coronary disease to receive 0.5 mg of
colchicine once daily or matching placebo. The primary end point was a
composite of cardiovascular death, spontaneous (nonprocedural) myocardial
infarction, ischemic stroke, or ischemia-driven coronary
revascularization. The key secondary end point was a composite of
cardiovascular death, spontaneous myocardial infarction, or ischemic
stroke. RESULT(S): A total of 5522 patients underwent randomization;
2762 were assigned to the colchicine group and 2760 to the placebo group.
The median duration of follow-up was 28.6 months. A primary end-point
event occurred in 187 patients (6.8%) in the colchicine group and in 264
patients (9.6%) in the placebo group (incidence, 2.5 vs. 3.6 events per
100 person-years; hazard ratio, 0.69; 95% confidence interval [CI], 0.57
to 0.83; P<0.001). A key secondary end-point event occurred in 115
patients (4.2%) in the colchicine group and in 157 patients (5.7%) in the
placebo group (incidence, 1.5 vs. 2.1 events per 100 person-years; hazard
ratio, 0.72; 95% CI, 0.57 to 0.92; P=0.007). The incidence rates of
spontaneous myocardial infarction or ischemia-driven coronary
revascularization (composite end point), cardiovascular death or
spontaneous myocardial infarction (composite end point), ischemia-driven
coronary revascularization, and spontaneous myocardial infarction were
also significantly lower with colchicine than with placebo. The incidence
of death from noncardiovascular causes was higher in the colchicine group
than in the placebo group (incidence, 0.7 vs. 0.5 events per 100
person-years; hazard ratio, 1.51; 95% CI, 0.99 to 2.31).
 CONCLUSION(S): In a randomized trial involving patients with chronic
coronary disease, the risk of cardiovascular events was significantly
lower among those who received 0.5 mg of colchicine once daily than among
those who received placebo. (Funded by the National Health Medical
Research Council of Australia and others; LoDoCo2 Australian New Zealand
Clinical Trials Registry number, ACTRN12614000093684.). Copyright
© 2020 Massachusetts Medical Society.

<103>
Accession Number
632740136
Title
Impact of Proportionality of Secondary Mitral Regurgitation on Outcome
After Transcatheter Mitral Valve Repair.
Source
JACC. Cardiovascular imaging. (no pagination), 2020. Date of Publication:
24 Aug 2020.
Author
Orban M.; Karam N.; Lubos E.; Kalbacher D.; Braun D.; Deseive S.; Neuss
M.; Butter C.; Praz F.; Kassar M.; Petrescu A.; Pfister R.; Iliadis C.;
Unterhuber M.; Lurz P.; Thiele H.; Baldus S.; Stephan von Bardeleben R.;
Blankenberg S.; Massberg S.; Windecker S.; Hausleiter J.
Institution
(Orban, Massberg, Hausleiter) Medizinische Klinik und Poliklinik I,
Klinikum der Universitat Munchen, Munich, Germany; Munich Heart Alliance,
Partner Site German Center for Cardiovascular Disease, Munich, Germany
(Karam) Department of Cardiology, European Hospital Georges Pompidou and
Paris Cardiovascular Research Center, INSERM U970, Paris, France
(Lubos, Kalbacher, Blankenberg) UKE Hamburg, Klinik und Poliklinik fur
Allgemeine und Interventionelle Kardiologie, Hamburg, Germany
(Braun, Deseive) Medizinische Klinik und Poliklinik I, Klinikum der
Universitat Munchen, Munich, Germany
(Neuss, Butter) Herzzentrum Brandenburg, Medizinische Hochschule
Brandenburg Theodor Fontane, Bernau, Germany
(Praz, Kassar, Windecker) Universitatsklinik fur Kardiologie, Inselspital
Bern, Switzerland
(Petrescu, Stephan von Bardeleben) Zentrum fur Kardiologie, Johannes
Gutenberg-Universitat, Mainz, Germany
(Pfister, Iliadis, Baldus) Department III of Internal Medicine, Heart
Center, University of Cologne, Cologne, Germany
(Unterhuber, Lurz, Thiele) Department of Cardiology, Heart Center Leipzig
at University of Leipzig, Leipzig, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The purpose of this paper was to evaluate the impact of
proportionality of secondary mitral regurgitation (SMR) in a large
real-world registry of transcatheter edge-to-edge mitral valve repair
(TMVr) BACKGROUND: Differences in the outcomes of recent randomized trials
of TMVr for SMR may be explained by the proportionality of SMR severity to
left ventricular (LV) volume. METHOD(S): The ratio of pre-procedural
effective regurgitant orifice area (EROA) to LV end-diastolic volume
(LVEDV) was retrospectively assessed in patients undergoing TMVr for
severe SMR between 2008 and 2019 from the EuroSMR registry. A recently
proposed SMR proportionality scheme was adapted to stratify patients
according to EROA/LVEDV ratio in 3 groups: MR-dominant (MD),
MR-LV-co-dominant (MLCD), and LV-dominant (LD). All-cause mortality was
assessed as a primary outcome, secondary heart failure (HF) outcomes
included hospitalization for HF (HHF), New York Heart Association (NYHA)
functional class, N-terminal pro-B-type natriuretic peptide (NT-proBNP),
6-min-walk distance, quality of life and MR grade. RESULT(S): A total
of 1,016 patients with an EROA/LVEDV ratio were followed for 22 months
after TMVr. MR was reduced to grade <=2+ in 92%, 96%, and 94% of patients
(for MD, MLCD, and LD, respectively; p = 0.18). After adjustment for
covariates including age, sex, diabetes, kidney function, body surface
area, LV ejection fraction, and procedural MR reduction (grade <=2+),
adjusted rates of 2-year mortality in MD patients did not differ from
those for MLCD patients (17% vs. 18%, respectively), whereas it was higher
in LD patients (23%; p = 0.02 for comparison vs. MD+MLCD). The adjusted
first HHF rate differed between groups (44% in MD, 56% in MLCD, 29% in LD;
p = 0.01) as did the adjusted time for first death or HHF rate (66% in MD,
82% in MLCD, 68% in LD; p = 0.02). Improvement of NYHA functional class
was seen in all groups (p < 0.001). Values for 6-min-walk distances,
quality of life and NT-proBNP improved in most patients.
 CONCLUSION(S): MD and MLCD patients had a comparable, adjusted 2-year
mortality rate after TMVr which was slightly better than that of LD
patients. Patients treated with TMVr had symptomatic improvement
regardless of EROA/LVEDV ratio. Copyright © 2020 American College
of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<104>
Accession Number
2004512782
Title
Vasoplegia During Cardiopulmonary Bypass: Current Literature and Rescue
Therapy Options.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (10) (pp 2766-2775),
2020. Date of Publication: October 2020.
Author
Ortoleva J.; Shapeton A.; Vanneman M.; Dalia A.A.
Institution
(Ortoleva) Department of Anesthesiology and Perioperative Medicine, Tufts
Medical Center, Boston, MA, United States
(Shapeton) Department of Anesthesia, Critical Care and Pain Medicine,
Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston,
MA, United States
(Vanneman, Dalia) Department of Anesthesiology, Pain Medicine, and
Critical Care Medicine, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
Vasoplegia syndrome in the cardiac surgical intensive care unit and
postoperative period has been an area of interest to clinicians because of
its prevalence and effects on morbidity and mortality. However, there is a
paucity of evidence regarding the treatment of vasoplegia syndrome during
cardiopulmonary bypass (on-CPB VS). This review aims to detail the
incidence, outcomes, and possible treatment options for patients who
develop vasoplegia during bypass. The pharmacologic rescue agents
discussed are used in cases in which vasoplegia during CPB is refractory
to standard catecholamine agents, such as norepinephrine, epinephrine, and
phenylephrine. Methods to improve vasoplegia during CPB can be both
pharmacologic and nonpharmacologic. In particular, optimization of CPB
parameters plays an important nonpharmacologic role in vasoplegia during
CPB. Pharmacologic agents that have been demonstrated as being effective
in vasoplegia include vasopressin, terlipressin, methylene blue,
hydroxocobalamin, angiotensin II (Giapreza), vitamin C, flurbiprofen
(Ropion), and hydrocortisone. Although these agents have not been
specifically evaluated for vasoplegia during CPB, they have shown signs of
effectiveness for vasoplegia postoperatively to varying degrees.
Understanding the evidence for, dosing, and side effects of these agents
is crucial for cardiac anesthesiologists when treating vasoplegia during
CPB bypass. Copyright © 2019 Elsevier Inc.

<105>
Accession Number
2001432997
Title
Right ventricular involvement in hypertrophic cardiomyopathy: Patterns and
implications.
Source
Hellenic Journal of Cardiology. 61 (1) (pp 3-8), 2020. Date of
Publication: January - February 2020.
Author
Keramida K.; Lazaros G.; Nihoyannopoulos P.
Institution
(Keramida, Lazaros, Nihoyannopoulos) Unit of Inherited Cardiovascular
Diseases/Heart Center of the Young and Athletes, First Department of
Cardiology, Hippokration General Hospital, National and Kapodistrian
University of Athens, Greece
(Nihoyannopoulos) National Heart and Lung Institute Imperial College
London, London, United Kingdom
Publisher
Hellenic Cardiological Society
Abstract
Although hypertrophic cardiomyopathy (HCM) is the most common inherited
cardiomyopathy worldwide, the criteria for its definition and most of the
literature concern the left ventricle, thus confirming the theory that the
right ventricle is the neglected one. Right ventricular (RV) involvement
includes structural and functional changes with significant impact on
clinical presentation and prognosis. The pattern of RV hypertrophy can be
variable with possible dynamic obstruction. Histological findings suggest
similar pathogenetic changes in both ventricles supporting the common
myopathic process with sarcomeric mutations. Systolic dysfunction of the
RV is subtle, and the classical echocardiographic indices are usually
within normal limits, while global longitudinal strain is significantly
impaired. Diastolic dysfunction of the RV is also evident in patients with
HCM possibly due to fibrosis of the RV free wall and/or the obstruction of
the RV filling with significant prognostic implications. RV involvement in
HCM is associated with increased incidence of supraventricular and
ventricular arrhythmias, severe dyspnea, pulmonary thromboembolism,
progressive heart failure, and increased risk of sudden cardiac death.
Therefore, the RV should be routinely included in the detailed assessment
of patients with HCM. Copyright © 2018 Hellenic Society of
Cardiology

<106>
Accession Number
2007551039
Title
Variations of perioperative cardiac surgery blood glucose and glycemic
variability in diabetes and non-diabetes.
Source
Journal of the Medical Association of Thailand. 103 (8) (pp 777-784),
2020. Date of Publication: August 2020.
Author
Sindhvananda W.; Surit M.
Institution
(Sindhvananda) Department of Anesthesiology, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
(Surit) Department of Anesthesiology, Faculty of Medicine, Naresuan
University, Phitsanulok, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Background: Not only perioperative high blood glucose but also glycemic
variability (GV) is significantly associated with mortality in cardiac
surgery. Perioperative hyperglycemia in diabetes (DM) patients is
well-known, however, there is less information in non-diabetes (non-DM)
patients. Objective(s): The present study objectives were to show the
variations of perioperative blood glucose, to compare the characteristics,
frequency, and severity of hyperglycemia, and to compare GV between non-DM
and DM undergoing cardiac surgery. Material(s) and Method(s): A
prospective observational study was conducted between January 2016 and
July 2018. Cardiac-surgery patients, age 20 to 80 years, undergoing
cardiopulmonary bypass (CPB) were recruited. The differentiation between
the DM and the non-DM was based on standard diagnosis. Perioperative blood
glucose was measured every 30 minutes by POCT-glucose and controlled by
insulin based on the institutional protocol. GV measures were standard
deviation (SD), coefficient of variance (CV), and mean absolute glucose
(MAG). Characteristics of blood glucose changes were demonstrated, which
were related to events or surgical procedure. Comparison of blood glucose,
GV, and events of hyperglycemia were carried out using Student t-test or
chi-square test as appropriate. Result(s): Perioperative
hyperglycemia were 60% in DM and 30% in non-DM. Hyperglycemia started at
the beginning of the operation in DM and in late CPB in non-DM. Inotropes
or vasopressors was associated with sharp shooting increases of blood
glucose. Hyperglycemia with more severity was commonly found during the
early postoperative period in both DM and non-DM. The GV of DM was higher
than in non-DM. The average MAG were 31.98 and 28.05 mg/dl/hour in DM and
non-DM, which was the only measure that could significantly differentiate
DM and non-DM. Conclusion(s): Perioperative hyperglycemia in cardiac
surgery occurred in both non-DM and DM despite the treatment by insulin
infusion. Inotropes or vasopressors infusion was significantly related to
a sudden hyperglycemia. MAG might be a better monitor of GV than SD and CV
during cardiac surgery. Copyright © JOURNAL OF THE MEDICAL
ASSOCIATION OF THAILAND.

<107>
Accession Number
2006954829
Title
Prognostic value of cardiac cycle efficiency in children undergoing
cardiac surgery: a prospective observational study.
Source
British Journal of Anaesthesia. 125 (3) (pp 321-329), 2020. Date of
Publication: September 2020.
Author
Han D.; Pan S.; Li H.; Meng L.; Luo Y.; Ou-Yang C.
Institution
(Han, Pan, Luo, Ou-Yang) Anaesthesia Department, Affiliated Children's
Hospital, Capital Institute of Paediatrics, Beijing, China
(Li) Clinical Medicine, North China University of Science and Technology,
Hebei, China
(Meng) Department of Evidence based Medicine, Capital Institute of
Paediatrics, Beijing, China
(Ou-Yang) Anaesthesia Center, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Publisher
Elsevier Ltd
Abstract
Background: Cardiac cycle efficiency (CCE) derived from a
pressure-recording analytical method is a unique parameter to assess
haemodynamic performance from an energetic view. This study investigated
changes of CCE according to an anatomical diagnosis group, and its
association with early postoperative outcomes in children undergoing
cardiac surgery. Method(s): Ninety children were included with a
ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or
total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with
other haemodynamic parameters, was recorded from anaesthesia induction
until 48 h post-surgery. Predictive CCE (CCE<inf>p</inf>) was defined as
the average of CCE at post-modified ultrafiltration and CCE at the end of
surgery. The relationship between CCE and early outcomes was assessed by
the comparison between the high-CCE<inf>p</inf> group (CCE<inf>p</inf>
>=75th centile) and the low-CCE<inf>p</inf> group (CCE<inf>p</inf> <=25th
centile). Result(s): There was a significant time x diagnostic group
interaction effect in the trend of CCE. Compared with the
high-CCE<inf>p</inf> group (n=23), the low-CCE<inf>p</inf> group (n=22)
required more inotropics post-surgery, had higher lactate concentrations
at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay,
and higher frequency of peritoneal fluid. Conclusion(s):
Perioperative changes of CCE vary according to anatomical diagnosis in
children undergoing cardiac surgery. Children with TOF have an
unfavourable trend of CCE compared with children with VSD or TAPVC. A
decline in CCE is associated with adverse early postoperative outcomes.
Clinical trial registration: ChiCTR1800014996. Copyright © 2020
British Journal of Anaesthesia

<108>
Accession Number
2006003911
Title
Aortic Valve Intervention During Aortic Root Surgery in Children: A
Systematic Review.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (5) (pp
611-618), 2020. Date of Publication: 01 Sep 2020.
Author
Rodriguez M.; Malvea A.; McNally D.; Bijelic V.; Guo M.; Momoli F.;
Boodhwani M.
Institution
(Rodriguez) Division of Cardiovascular Surgery, Children's Hospital of
Eastern Ontario, Ottawa, ON, Canada
(Rodriguez, Malvea, Guo, Momoli, Boodhwani) University of Ottawa, Ottawa,
ON, Canada
(McNally) Pediatric Intensive Care Unit, Children's Hospital of Eastern
Ontario, Ottawa, ON, Canada
(Bijelic) Clinical Research Unit, Children's Hospital of Eastern Ontario,
Ottawa, ON, Canada
(Guo, Boodhwani) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Pediatric aortic root dilatation is a life-threatening
condition that lacks guidelines for surgical management. We aimed to
analyze the data on aortic valve interventions during root surgery to
guide decision-making. Method(s): A search was performed of MEDLINE,
Embase, CENTRAL, ClinicalTrials.gov, and WHO ICTRP. Citations were
screened in duplicate and independently to identify randomized controlled
trials, cohorts, and case series involving populations aged 0 to 18 years,
who received valve-sparing and valve-replacing aortic root surgeries
between 1999 and 2019. Outcomes considered included mortality
(perioperative, one year, five year), reintervention rates.
 Result(s): After duplicate removal, 689 citations were screened
through abstract and full text review, identifying five eligible studies.
All five were observational studies evaluating valve-sparing procedures.
There were 81 patients with a mean study age range of 9.9 to 13.9 years.
Both reimplantation (74%) and remodeling (26%) subtypes were done. Range
of mean duration of follow-up was 1.2 to 4.4 years. There was no mortality
reported until the one-year follow-up period. The long-term mortality rate
was calculated as 0.02 per patient-year (95% CI: 0.01-0.05). The long-term
reintervention rate was 0.08 per patient-year (95% CI: 0.05-0.13).
 Conclusion(s): There is limited experience on aortic valve
intervention during aortic root surgery in children. Single-arm studies on
valve-sparing surgeries show excellent survival up to one year. Mortality
and reintervention rates increase in the longer term. The small sample
size and lack of controlled studies do not allow for direct comparisons
between procedure types. Copyright © The Author(s) 2020.

<109>
Accession Number
2006003902
Title
Monocusp Valves Do Not Improve Early Operative Mortality in Tetralogy of
Fallot: A Meta-Analysis.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (5) (pp
619-624), 2020. Date of Publication: 01 Sep 2020.
Author
Awori M.N.; Awori J.A.; Mehta N.P.; Makori O.
Institution
(Awori, Mehta, Makori) Department of Surgery, School of Medicine,
University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
(Awori) Department of Pediatrics, Seattle Children's Hospital, Seattle,
WA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Monocusp valves are thought to reduce early operative mortality and
morbidity associated with pediatric tetralogy of Fallot repair. As there
are no published randomized clinical trials comparing outcomes with and
without a monocusp valve, we performed a meta-analysis of observational
studies in accordance with established protocols. After systematically
searching PubMed, the Cochrane Library, and Google Scholar, 12 studies
were included. The operative mortality was compared in 695 patients, and
we found no difference between patients with and patients without a
monocusp valve. Monocusp valves may not improve operative mortality of
tetralogy of Fallot repair in pediatric patients. Copyright © The
Author(s) 2020.

<110>
Accession Number
2005484465
Title
Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and
recommendations from the women's SSC of the ISTH.
Source
Journal of Thrombosis and Haemostasis. 18 (8) (pp 1813-1838), 2020. Date
of Publication: 01 Aug 2020.
Author
Amgalan A.; Allen T.; Othman M.; Ahmadzia H.K.
Institution
(Amgalan) Georgetown University School of Medicine, Washington, DC, United
States
(Allen) Department of Anesthesiology, Duke University Hospital, Durham,
NC, United States
(Othman) Department of Biomedical and Molecular Sciences, School of
Medicine, Queen's University, Kingston, ON, Canada
(Othman) School of Baccalaureate Nursing, St. Lawrence College, Kingston,
ON, Canada
(Ahmadzia) Department of Obstetrics and Gynecology, Division of Maternal
Fetal Medicine, The George Washington University School of Medicine and
Health Sciences, Washington, DC, United States
Publisher
Blackwell Publishing Ltd
Abstract
Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are
point-of-care viscoelastic devices that use whole blood samples to assess
coagulation and fibrinolysis. These devices have been studied extensively
in cardiac surgery, but there is limited robust evidence supporting its
use in obstetrics. The hesitancy toward its routine use in obstetrics may
be due to the current lack of randomized controlled trials and large
observational studies. The study aims to systematically review studies
that investigated TEG/ROTEM use in pregnancy or peripartum, and to provide
recommendations for future studies to fill current research gaps. We
performed a systematic review of studies on viscoelastic testing in
obstetrics. Included studies were original research, used TEG or ROTEM
during pregnancy or peripartum, and published in English. Ninety-three
studies, spanning 31 years from 1989 to 2020 and with a total of 32,817
participants, were included. Sixty-two (66.7%) of the studies used TEG and
31 (33.3%) used ROTEM. To date, there are a total of two randomized
controlled trials on TEG/ROTEM use in obstetrics. ROTEM may be used to
guide transfusion therapy for postpartum hemorrhage. TEG and ROTEM can
detect the hypercoagulable changes associated with pregnancy. Variability
between study protocols and results suggests the need for future large
prospective high-quality studies with standardized protocols to
investigate the utility of TEG/ROTEM in assessing risk for thrombosis and
hemorrhage as well as in guiding prophylaxis and treatment in obstetric
patients. This review identifies the gaps and provides concrete
recommendations for future studies to fill those gaps. Copyright
© 2020 International Society on Thrombosis and Haemostasis

<111>
Accession Number
625728239
Title
The Effect of High-Flow Nasal Oxygen Therapy on Postoperative Pulmonary
Complications and Hospital Length of Stay in Postoperative Patients: A
Systematic Review and Meta-Analysis.
Source
Journal of Intensive Care Medicine. 35 (10) (pp 1129-1140), 2020. Date of
Publication: 01 Oct 2020.
Author
Lu Z.; Chang W.; Meng S.; Xue M.; Xie J.; Xu J.; Qiu H.; Yang Y.; Guo F.
Institution
(Lu, Chang, Meng, Xue, Xie, Xu, Qiu, Yang, Guo) Department of Critical
Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,
Nanjing, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To evaluate the effect of high-flow nasal cannula oxygen (HFNO)
therapy on hospital length of stay (LOS) and postoperative pulmonary
complications (PPCs) in adult postoperative patients. Data Sources:
PubMed, Embase, the Cochrane Library, Web of Science of Studies, China
National Knowledge Index, and Wan Fang databases were searched until July
2018. Study Selection: Randomized controlled trials (RCTs) comparing HFNO
with conventional oxygen therapy or noninvasive mechanical ventilation in
adult postoperative patients were included. The primary outcomes were
hospital LOS and PPCs; short-term mortality (defined as intensive care
unit, hospital, or 28-day mortality) and intubation rate were the
secondary outcomes. Data Extraction: Demographic variables, high-flow
oxygen therapy application, effects, and side effects were retrieved. Data
were analyzed by the methods recommended by the Cochrane Collaboration.
The strength of evidence was assessed by the Grading of Recommendations
Assessment, Development and Evaluation. Random errors were evaluated with
trial sequential analysis. Data Synthesis: Fourteen studies (2568
patients) met the inclusion criteria and were included. Compared to the
control group, the pooled effect showed that HFNO was significantly
associated with a shorter hospital stay (mean difference: -0.81; 95%
confidence interval [CI]: -1.34 to -0.29, P =.002), but not mortality
(risk ratio [RR]: 1.0, 95% CI: 0.63 to 1.59, P = 1.0). Weak evidence of a
reduction in reintubation rate (RR: 0.76, 95% CI: 0.57-1.01, P =.06) and
PPC rate (RR: 0.89, 95% CI: 0.75-1.06, P =.18) with HFNO versus control
group was recorded. Conclusion(s): The available RCTs suggest that,
among the adult postoperative patients, HFNO therapy compared to the
control group significantly reduces hospital LOS. Copyright © The
Author(s) 2018.

<112>
Accession Number
2007593692
Title
Pectointercostal Fascial Block (PIFB) as a Novel Technique for
Postoperative Pain Management in Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Kumar A.K.; Chauhan S.; Bhoi D.; Kaushal B.
Institution
(Kumar, Chauhan, Kaushal) Department of Cardiac Anesthesiology, CN Center,
All India Institute of Medical Sciences, New Delhi, India
(Bhoi) Department of Anesthesiology, Pain Medicine and Critical Care, All
India Institute of Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To determine the efficacy of pectointercostal fascial block in
relieving postoperative pain in patients undergoing cardiac surgery.
 Design(s): Single-blinded, prospective, randomized controlled trial.
 Setting(s): Single-center tertiary care teaching hospital.
 Participant(s): A total 40 participants undergoing cardiac surgery
aged 18 to 80 years. Intervention(s): Subjects were categorized into
2 groups of 20 each. In group 2 participants (interventional group),
bilateral pectointercostal fascial block was given using ropivacaine
injection 0.25% after completion of surgery, before shifting to the
intensive care unit. Measurements and Main Results: Postoperative
pain was measured after extubation at 0, 3, 6, and 12 hours, using a
numeric rating scale. Pain in group 2 was significantly less and lasted
for a longer duration than in group 1. Fentanyl requirement was
significantly higher in group 1 (1.06 +/- 0.12 micro /kg) than in
group 2 (0.82 +/- 0.19 micro /kg). Conclusion(s):
Pectointercostal fascial block is an easy and efficient technique to
reduce postoperative pain after cardiac surgery. Copyright © 2020
Elsevier Inc.

<113>
Accession Number
2005640635
Title
New-onset atrial fibrillation and outcomes following isolated coronary
artery bypass surgery: A systematic review and meta-analysis.
Source
Clinical Cardiology. 43 (9) (pp 928-934), 2020. Date of Publication: 01
Sep 2020.
Author
Kerwin M.; Saado J.; Pan J.; Ailawadi G.; Mazimba S.; Salerno M.; Mehta N.
Institution
(Kerwin, Saado, Pan) Division of Internal Medicine, University of
Virginia, Charlottesville, VA, United States
(Ailawadi) Division of Cardiovascular Surgery, University of Virginia,
Charlottesville, VA, United States
(Mazimba, Salerno, Mehta) Division of Cardiovascular Medicine, University
of Virginia, Charlottesville, VA, United States
(Mehta) Division of Cardiovascular Medicine, William Beaumont Oakland
University, Royal Oak, MI, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Prior meta-analyses have shown that new-onset atrial fibrillation (NOAF)
occurs in up to 40% of patients following cardiac surgery and is
associated with substantial major adverse cardiovascular events. The
stroke and mortality implications of NOAF in isolated CABG without
concomitant valve surgery is not known. We thought that NOAF would be
associated with increased risk of stroke and mortality, even in patients
undergoing isolated CABG. A blinded review of studies from MEDLINE,
CENTRAL, and Web of Science was done by two independent investigators.
Stroke, 30-day/hospital mortality, long-term cardiovascular mortality, and
long-term (>1 year) all-cause mortality were analyzed. We used Review
Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461
studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF
incidence ranged from 15% to 36%. NOAF was associated with increased risk
of stroke (unadjusted OR 2.15 [1.82, 2.53] [P <.00001]; adjusted OR 1.88
[1.02, 3.46] [P =.04]). NOAF was associated with increased 30-day/hospital
mortality (OR 2.35 [1.67, 3.32] [P <.00001]) and long-term cardiovascular
mortality (OR 2.04 [1.35, 3.09] [P =.0007]) NOAF was associated with
increased long-term all-cause mortality (unadjusted OR 1.79 [1.63, 1.96]
[P <.00001]; adjusted OR 1.58 [1.24, 2.00] [P =.0002]). We found that the
incidence of NOAF following isolated CABG is high and is associated with
increased stroke rate and mortality. Early recognition and management of
NOAF could improve outcomes. Copyright © 2020 The Authors.
Clinical Cardiology published by Wiley Periodicals LLC.

<114>
Accession Number
632726353
Title
A randomised comparison of the efficacy of a Coopdech bronchial blocker
and a double-lumen endotracheal tube for minimally invasive esophagectomy.
Source
Translational Cancer Research. 9 (8) (pp 4686-4692), 2020. Date of
Publication: 01 Aug 2020.
Author
Zhang T.-H.; Liu X.-Q.; Cao L.-H.; Fu J.-H.; Lin W.-Q.
Institution
(Zhang, Cao, Lin) Department of Anaesthesia, Sun Yat-Sen University,
Cancer Center, State Key Laboratory of Oncology in South China and
Collaborative Innovation Center for Cancer Medicine, Guangdong Esophageal
Cancer Institute, Guangzhou, China
(Liu) Department of Anesthesia, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen
University, Guangzhou, China
(Fu) Department of Thoracic Surgery, Sun Yat-Sen University, Cancer
Center, State Key Laboratory of Oncology in South China and Collaborative
Innovation Center for Cancer Medicine, Guangdong Esophageal Cancer
Institute, Guangzhou, China
(Lin) Department of Blood Transfusion, Sun Yat-Sen University, Cancer
Center, State Key Laboratory of Oncology in South China and Collaborative
Innovation Center for Cancer Medicine, Guangdong Esophageal Cancer
Institute, Guangzhou, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Both a bronchial blocker (BB) and a double-lumen endotracheal
tube (DLT) can achieve lung collapse and one-lung ventilation (OLV) during
thoracic surgery. The purpose of this study was to compare these two
airway devices in terms of efficacy in video-assisted thoraco-laparoscopic
esophagectomy for cancer. Method(s): A total of 55 patients underwent
combined thoracoscopic and laparoscopic esophagectomy for cancer were
enrolled and divided into a Coopdech bronchial blocker group (CBB group,
n=27) or a DLT group (DLT group, n=28). The primary outcome was the lung
collapse scores at 1, 5, 10 minutes after the opening of the pleural and
assessed using a verbal analogue scale via a real-time video view.
Secondary outcomes including time for tube localization, incidence of tube
displacement, postoperative sore throats, and surgeons' satisfaction with
surgical manipulations were collected. Result(s): The patients in the
CBB group achieved better lung collapse scores at 5 minutes (7.4+/-1.3 vs.
6.4+/-0.9 minutes, P<0.01) and 10 minutes (8.9+/-0.8 vs. 7.1+/-0.9
minutes, P<0.01) after opening the pleura, and they had lower incidence of
postoperative sore throats [5 (18%) vs. 16 (57%), P<0.01] when compared
with patients in DLT group. However, the time for tube localization were
significantly longer in CBB group than in DLT group (210+/-120 vs.
125+/-60 s, P<0.05). There were no significant difference in tube
displacement, hypoxemia (SpO2 <90%) during OLV, and in surgeons'
satisfaction with surgical manipulations. Conclusion(s): CBB
technique can be a potential alternative to the conventional DLT strategy
for lung collapse and OLV during esophagectomy. Copyright ©
Translational Cancer Research. All rights reserved.

<115>
Accession Number
632690125
Title
Effect of Prophylactic Levosimendan on All-Cause Mortality in Pediatric
Patients Undergoing Cardiac Surgery-An Updated Systematic Review and
Meta-Analysis.
Source
Frontiers in Pediatrics. 8 (no pagination), 2020. Article Number: 456.
Date of Publication: 14 Aug 2020.
Author
Wang H.; Luo Q.; Li Y.; Zhang L.; Wu X.; Yan F.
Institution
(Wang, Luo, Li, Wu, Yan) Department of Anesthesiology, Fuwai Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Zhang) Department of Anesthesiology, Chongqing Traditional Chinese
Medicine Hospital, Chongqing, China
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: Levosimendan, a calcium sensitizer, enhances the myocardial
function by generating more energy-efficient myocardial contractility than
that achieved through adrenergic stimulation with catecholamines. We
conducted this meta-analysis to primarily investigate the effects of
levosimendan on all-cause mortality in pediatric patients undergoing
cardiac surgery under cardiopulmonary bypass. Method(s): The
databases of Pubmed, Embase, and Cochrane Library were searched till 21st
March 2020. The eligible criteria were participants with age<18 year and
undergoing cardiac surgery for congenital heart disease (CHD), and studies
of comparison between levosimendan and placebo or other inotropes. Stata
version 12.0 was used to perform statistical analyses. Result(s): Six
randomized controlled trials (RCTs) and 1 case-control trial (CCT)
including 436 patients were included. The results showed that levosimendan
did not significantly decrease all-cause mortality compared with control
drugs (and placebo) in children undergoing cardiac surgery (P = 0.403).
Perioperative prophylactic levosimendan administration strikingly
decreased the low cardiac output syndrome (LCOS) incidence (P = 0.016) but
did not significantly reduce acute kidney injury (AKI) incidence (P =
0.251) and shorten mechanical ventilation and ICU stay time compared with
other inotropes and placebo by analyzing the included literatures
[mechanical ventilation (or intubation) time: P = 0.188; ICU stay time: P
= 0.620]. Conclusion(s): Compared with other inotropes and placebo,
perioperative prophylactic administration of levosimendan did not decrease
the rates of mortality and AKI and shorten the time of mechanical
ventilation (or intubation) and ICU stay but demonstrated a significant
reduction in LCOS incidence after corrective surgery in pediatric patients
for CHD. Due to limited number of included studies, the current data were
insufficient to make the conclusions. © Copyright © 2020
Wang, Luo, Li, Zhang, Wu and Yan.

<116>
Accession Number
2007651468
Title
In-hospital clinical outcomes of transcatheter aortic valve replacement in
patients with concomitant carotid artery stenosis: Insights from the
national inpatient sample.
Source
IJC Heart and Vasculature. 31 (no pagination), 2020. Article Number:
100621. Date of Publication: December 2020.
Author
Chakraborty S.; Faisaluddin M.; Ashish K.; Amgai B.; Bandyopadhyay D.;
Patel N.; Hajra A.; Aggarwal G.; Ghosh R.K.; Kalra A.
Institution
(Chakraborty) Miami Valley Hospital, Dayton, OH, United States
(Faisaluddin) Deccan College of Medical Sciences, Hyderabad, India
(Ashish) Crozer-Chester Medical Center, Philadelphia, United States
(Amgai, Patel) Interfaith Medical Center, Brooklyn, NY, United States
(Bandyopadhyay) Icahn School of Medicine at Mount Sinai/Mount Sinai St
Luke's and West, Manhattan, NY, United States
(Hajra) Jacobi Medical Center/Albert Einstein College of Medicine, Bronx,
NY, United States
(Aggarwal) Jersey City Medical Center, Jersey City, NJ, United States
(Ghosh) Medstar Union Memorial, Baltimore, MD, United States
(Kalra) Cleveland Clinic Foundation, Akron General, Akron, OH, United
States
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Carotid artery stenosis (CAS) is a common occurrence in
elderly patients undergoing transcatheter aortic valve replacement (TAVR).
We conducted a retrospective study to identify the impact of CAS on
in-hospital outcomes following TAVR. Method(s): We queried the
National Inpatient Sample (NIS) for 2016-2017 and identified patients who
underwent TAVR with concomitant CAS using the ICD-10 codes. The primary
endpoint of our study was in-hospital mortality and acute ischemic stroke.
 Result(s): We identified 80,740 TAVR-related hospitalizations. Of
these, 6.9% (N = 5555) patients had concomitant CAS. The mean age for CAS
patients was 80 +/- 7.4 years. Females were represented equally in both
groups. Traditional comorbidities like dyslipidemia [78.3% (N = 4350) vs.
68.2% (N = 51261); P < 0.001] and peripheral arterial disease [27.4% (N =
1525) vs. 12.7% (N = 9526); P < 0.001] were more frequently observed among
CAS patients. Patients with CAS had higher rates of previous stroke [17.5%
(N = 970) vs. 11.8% (N = 8902); P < 0.001] and CABG 23.8% (N = 1320) vs.
18.6% (N = 14022); P < 0.001]. Other cardiovascular risk factors were
similar between the two groups. Moreover, no differences in in-hospital
outcomes including mortality [odds ratio (OR): 1.35, CI: 0.48-3.83; P =
0.57] were observed in the propensity matched cohort. Conclusion(s):
Our study did not find any major differences in outcomes in the CAS group
following TAVR; however, a more detailed randomized controlled study with
long-term follow-up of these patients is needed. Copyright © 2020
The Authors

<117>
Accession Number
632732833
Title
The effectiveness of aromatherapy on preoperative anxiety in adults: A
systematic review and meta-analysis of randomized controlled trials.
Source
International journal of nursing studies. 111 (pp 103747), 2020. Date of
Publication: 12 Aug 2020.
Author
Guo P.; Li P.; Zhang X.; Liu N.; Wang J.; Yang S.; Yu L.; Zhang W.
Institution
(Guo, Zhang, Liu, Wang, Yang, Yu, Zhang) School of Nursing, Jilin
University, No. 965 Xinjiang, Street, Changchun, Jilin Province 130021,
China
(Li) Second Hospital of Jilin University, Changchun, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Preoperative anxiety is very common in adults awaiting all
types of surgical procedures, which can interfere with the start and
completion of surgery and increase the risk of postoperative
complications. In this context, many researchers and clinical
practitioners have attempted to use aromatherapy to help adults reduce
preoperative anxiety. OBJECTIVE(S): To investigate systematically the
efficacy of aromatherapy on preoperative anxiety in adults. DESIGN: A
systematic review and meta-analysis of randomized controlled trials was
undertaken. DATA SOURCES: PubMed, Embase, Cochrane Library, Web of
Science, PsycINFO and CINAHL were comprehensively searched from their
inception to June 2020. REVIEW METHODS: Studies on the use of aromatherapy
for treating preoperative anxiety in adults were included. Two reviewers
assessed the risk of bias of the included studies independently using the
Cochrane Collaboration 'Risk of Bias' tool. Overall meta-analysis and five
subgroup analyses regarding the type of control, the type of aroma
preparations, delivery mode, session length and surgery type were
performed using RevMan 5.3. The Higgins' I2 (%) statistic was used to
measure heterogeneity. A funnel plot and Egger's test were used to
evaluate publication bias. RESULT(S): Twenty studies comprising 1717
participants were included. The meta-analysis indicated that aromatherapy
could significantly ameliorate preoperative anxiety (standard mean
difference=-0.57, 95% confidence interval [-0.75, -0.39], p<0.00001) for
adults awaiting surgical procedures, compared to placebo control,
conventional care and no intervention. The subgroup analysis based on the
surgery type showed that aromatherapy had a great improvement on
preoperative anxiety for patients awaiting cardiac surgery and relatively
low-risk surgery. Lavender oil, citrus species preparations and rose oil
were the three most commonly used aroma preparations that could
significantly improve preoperative anxiety. Most delivery modes of
aromatherapy, including inhalation, massage, and oral administration, were
effective. Moreover, short length (<=20 min per session) aromatherapy
showed a better effect on preoperative anxiety (mean difference=-5.84, 95%
confidence interval [-8.09, -3.59], p<0.00001) than aromatherapy lasting
more than 20-minutes per session (mean difference=-2.15, 95% confidence
interval [-3.81, -0.49], p = 0.01). CONCLUSION(S): Aromatherapy is an
effective intervention for reducing preoperative anxiety in adults.
Short-length aromatherapy inhalation seems to be more worthy of being
recommended in clinical settings. More well-designed randomized controlled
trials containing a wider range of surgical types and participants from
more countries are needed to verify our findings before we can make strong
recommendations. Copyright © 2020. Published by Elsevier Ltd.

<118>
Accession Number
632731091
Title
Time-to-treatment initiation of colchicine and cardiovascular outcomes
after myocardial infarction in the Colchicine Cardiovascular Outcomes
Trial (COLCOT).
Source
European heart journal. (no pagination), 2020. Date of Publication: 29 Aug
2020.
Author
Bouabdallaoui N.; Tardif J.-C.; Waters D.D.; Pinto F.J.; Maggioni A.P.;
Diaz R.; Berry C.; Koenig W.; Lopez-Sendon J.; Gamra H.; Kiwan G.S.;
Blondeau L.; Orfanos A.; Ibrahim R.; Gregoire J.C.; Dube M.-P.; Samuel M.;
Morel O.; Lim P.; Bertrand O.F.; Kouz S.; Guertin M.-C.; L'Allier P.L.;
Roubille F.
Institution
(Bouabdallaoui, Tardif, Ibrahim, Gregoire, Dube, Samuel, L'Allier)
Montreal Heart Institute, Canada and Universite de Montreal, 5000 Belanger
Street, Montreal, QC H1T 1C8, Canada
(Waters) San Francisco General Hospital, CA
(Pinto) Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de
Medicina da Universidade de Lisboa, Lisboa, Portugal
(Maggioni) ANMCO Research Center, Firenze, Italy
(Diaz) Estudios Clinicos Latinoamerica, Rosario, Argentina
(Berry) University of Glasgow and NHS Glasgow Clinical Research Facility,
Glasgow, United Kingdom
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), partner site
Munich Heart Alliance, Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Germany
(Lopez-Sendon) IdiPaz, UAM, Spain
(Gamra) Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Kiwan) Bellevue Medical Center, Beirut, Lebanon
(Blondeau, Orfanos, Guertin) Montreal Health Innovations Coordinating
Center (MHICC), Montreal, Canada
(Morel) Division of Cardiovascular Medicine, Nouvel Hopital Civil,
Strasbourg University Hospital, Strasbourg, France
(Morel) INSERM (French National Institute of Health and Medical Research),
UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
(Lim) Department of Cardiology, AP-HP, Hopital Universitaire Henri-Mondor
and INSERM U955, Universite Paris-Est Creteil, Creteil, France
(Bertrand) Institut de Cardiologie et Pneumologie de Quebec, Quebec City,
Canada
(Kouz) Centre Hospitalier Regional de Lanaudiere, Joliette, Canada
(Roubille) Universite de Montpellier, INSERM, CNRS, CHU de Montpellier,
France
Publisher
NLM (Medline)
Abstract
AIMS: The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated
the benefits of targeting inflammation after myocardial infarction (MI).
We aimed to determine whether time-to-treatment initiation (TTI)
influences the beneficial impact of colchicine. METHODS AND RESULTS: In
COLCOT, patients were randomly assigned to receive colchicine or placebo
within 30days post-MI. Time-to-treatment initiation was defined as the
length of time between the index MI and the initiation of study
medication. The primary efficacy endpoint was a composite of
cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent
hospitalization for angina requiring coronary revascularization. The
relationship between endpoints and various TTI (<3, 4-7 and >8days) was
examined using multivariable Cox regression models. Amongst the 4661
patients included in this analysis, there were 1193, 720, and 2748
patients, respectively, in the three TTI strata. After a median follow-up
of 22.7months, there was a significant reduction in the incidence of the
primary endpoint for patients in whom colchicine was initiated < Day 3
compared with placebo [hazard ratios (HR)=0.52, 95% confidence intervals
(CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated
between Days 4 and 7 (HR=0.96, 95% CI 0.53-1.75) or > Day 8 (HR=0.82, 95%
CI 0.61-1.11). The beneficial effects of early initiation of colchicine
were also demonstrated for urgent hospitalization for angina requiring
revascularization (HR=0.35), all coronary revascularization (HR=0.63), and
the composite of cardiovascular death, resuscitated cardiac arrest, MI, or
stroke (HR=0.55, all P<0.05). CONCLUSION(S): Patients benefit from
early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION:
COLCOT ClinicalTrials.gov number, NCT02551094. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<119>
Accession Number
632728590
Title
The Art and Science of Mentorship in Cardiothoracic Surgery: A Systematic
Review of the Literature.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 25 Aug 2020.
Author
Odell D.D.; Edwards M.; Fuller S.; Loor G.; Antonoff M.B.
Publisher
NLM (Medline)
Abstract
BACKGROUND: As academic cardiothoracic surgeons focus on producing a new
generation of successful surgeon leaders, mentorship has emerged as one of
the most important variables influencing professional and personal success
and satisfaction. We explore the literature to determine the benefits,
qualities and features of the mentor relationship. METHOD(S): A
comprehensive review was performed in February for 2020 of Ovid MEDLINE,
Cochrane Central Register of Controlled Trials, and the SCOPUS Database
using 'mentor' as a primary search term. The titles and abstracts of these
publications were then reviewed by 2 of the authors to identify relevant
sources addressing topics related to mentorship in cardiothoracic surgery
and identify 4 specific areas of focus (1) the value of mentorship, (2)
the skills needed to be an effective mentor, (3) effective approaches for
identifying and receiving mentorship, and (4) the unique considerations
associated with mentorship for traditionally underrepresented populations
in surgery. RESULT(S): Of 16,469 articles reviewed, 167 relevant
manuscripts were identified and 62 were included. CONCLUSION(S):
There is undeniable value in mentorship when navigating a career in
cardiothoracic surgery. By sharing the most significant features and
skills of both ideal mentors and mentees, we hope to provide a framework
to improve the quality of mentorship from both sides. Copyright ©
2020. Published by Elsevier Inc.

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