EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 75

Results Generated From:
Embase <1980 to 2020 Week 38>
Embase (updates since 2020-09-11)

<1>
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. <br/>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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<2>
Accession Number
2007425952
Title
Cardiac Implantable Electronic Devices Following Heart Transplantation.
Source
JACC: Clinical Electrophysiology. 6 (8) (pp 1028-1042), 2020. Date of
Publication: August 2020.
Author
DeFilippis E.M.; Rubin G.; Farr M.A.; Biviano A.; Wan E.Y.; Takeda K.;
Garan H.; Topkara V.K.; Yarmohammadi H.
Institution
(DeFilippis, Rubin, Farr, Biviano, Wan, Garan, Topkara, Yarmohammadi)
Division of Cardiology, Department of Medicine, Columbia University Irving
Medical Center, New York, NY, United States
(Takeda) Division of Cardiothoracic Surgery, Department of Surgery,
Columbia University Irving Medical Center, New York, NY, United States
Publisher
Elsevier Inc
Abstract
Permanent pacemaker (PPM) implantation is required in a subset of patients
(~10%) for sinus node dysfunction or atrioventricular block both early and
late after heart transplantation. The incidence of PPM implantation has
decreased to <5% with the advent of bicaval anastamosis transplantation
surgery. Pacing dependence upon follow-up has been variably reported. An
even smaller percentage of transplantation recipients (1.5% to 3.4%)
undergo implantable cardioverter-defibrillator (ICD) placement. Rigorous
data are lacking for the use of ICDs in the transplantation population and
is largely derived from cohort studies and case series. Sudden cardiac
death occurs in approximately 10% of transplantation recipients, but
multiple nonarrhythmic factors are believed to be responsible, including
acute rejection, late graft failure with electromechanical dissociation,
and ischemia due to cardiac allograft vasculopathy. This review provides a
comprehensive analysis of the existing data regarding the role for PPMs
and ICDs in this population, including leadless PPMs and subcutaneous
ICDs, special considerations, and future directions.<br/>Copyright &#xa9;
2020 American College of Cardiology Foundation

<3>
Accession Number
2006765748
Title
The value of extensive catheter linear ablation on persistent atrial
fibrillation (the CLEAR-AF Study).
Source
International Journal of Cardiology. 316 (pp 125-129), 2020. Date of
Publication: 1 October 2020.
Author
Yao Y.; Hu F.; Du Z.; He J.; Shi H.; Zhang J.; Cai H.; Jia Y.; Tang M.;
Niu G.; Chen G.; Ding L.; Zheng L.; Liang E.; Wu L.
Institution
(Yao, Hu, Du, Jia, Tang, Niu, Chen, Ding, Zheng, Liang, Wu) Cardiac
Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(He) Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
(Shi) Department of Cardiology, Beijing Hospital, Beijing, China
(Zhang) Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
(Cai) Department of Cardiology, General Hospital, Tianjin Medical
University, Tianjin, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: The ablation therapy for persistent atrial fibrillation
(PerAF) is still a challenge due to the high recurrence rate. This study
was aimed to investigate the value of extensive linear ablation with
contact force sensing techniques for PerAF. <br/>Method(s): A total of 214
patients with PerAF were enrolled in five centers. The patients were
randomly assigned to Group I (PVI + LA roof line+ LA anterior wall line)
and Group II (PVI + LA roof line), mitral valve isthmus lines were added
in both groups if the atrial fibrillation (AF) could not be terminated
after all approaches above. <br/>Result(s): Acute success rate of AF
termination during the ablation procedure in Group I was significantly
higher than Group II (P = 0.028). Two-years follow-up showed no
significant difference in the sinus rhythm maintenance rate between the
two groups (63.4% in group I vs. 57.2% in group II, P = 0.218). More
patients in Group I recurred as organized atrial tachycardia (AT) and can
be precisely mapped during repeat ablation procedures (15 vs. 2, P =
0.001). The Kaplan-Meier estimates of AF/AT-free survival after repeat
ablation procedures were 76.2% in Group I and 47.1% in Group II (P =
0.039). <br/>Conclusion(s): Extensive linear ablation with contact force
monitoring did not improve the long-term outcomes for PerAF patients.
Repeat ablation procedure showed a possible higher chance of sinus rhythm
restoration during follow-up.<br/>Copyright &#xa9; 2020

<4>
Accession Number
2005520629
Title
Empirical use of causal inference methods to evaluate survival differences
in a real-world registry vs those found in randomized clinical trials.
Source
Statistics in Medicine. 39 (22) (pp 3003-3021), 2020. Date of Publication:
30 Sep 2020.
Author
Lee H.-J.; Wong J.B.; Jia B.; Qi X.; DeLong E.R.
Institution
(Lee, Jia, Qi, DeLong) Department of Biostatistics and Bioinformatics,
Duke University, Durham, NC, United States
(Wong) Tufts Medical Center, Division of Clinical Decision Making,
Department of Medicine, Tufts University School of Medicine, Boston, MA,
United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
With heighted interest in causal inference based on real-world evidence,
this empirical study sought to understand differences between the results
of observational analyses and long-term randomized clinical trials. We
hypothesized that patients deemed "eligible" for clinical trials would
follow a different survival trajectory from those deemed "ineligible" and
that this factor could partially explain results. In a large observational
registry dataset, we estimated separate survival trajectories for
hypothetically trial-eligible vs ineligible patients under both coronary
artery bypass surgery (CABG) and percutaneous coronary intervention (PCI).
We also explored whether results would depend on the causal inference
method (inverse probability of treatment weighting vs optimal full
propensity matching) or the approach to combine propensity scores from
multiple imputations (the "across" vs "within" approaches). We found that,
in this registry population of PCI/CABG multivessel patients, 32.5% would
have been eligible for contemporaneous RCTs, suggesting that RCTs enroll
selected populations. Additionally, we found treatment selection bias with
different distributions of propensity scores between PCI and CABG
patients. The different methodological approaches did not result in
different conclusions. Overall, trial-eligible patients appeared to
demonstrate at least marginally better survival than ineligible patients.
Treatment comparisons by eligibility depended on disease severity. Among
trial-eligible three-vessel diseased and trial-ineligible two-vessel
diseased patients, CABG appeared to have at least a slight advantage with
no treatment difference otherwise. In conclusion, our analyses suggest
that RCTs enroll highly selected populations, and our findings are
generally consistent with RCTs but less pronounced than major registry
findings.<br/>Copyright &#xa9; 2020 John Wiley & Sons, Ltd.

<5>
Accession Number
2004762466
Title
Vitamin c for cardiac protection during percutaneous coronary
intervention: A systematic review of randomized controlled trials.
Source
Nutrients. 12 (8) (pp 1-21), 2020. Article Number: 2199. Date of
Publication: August 2020.
Author
Khan S.A.; Bhattacharjee S.; Ghani M.O.A.; Walden R.; Chen Q.M.
Institution
(Khan, Bhattacharjee, Chen) Department of Pharmacy Practice and Science,
College of Pharmacy, University of Arizona, 1295 N. Martin Ave, Tucson, AZ
85721, United States
(Ghani) Department of Cardiac Surgery, Vanderbilt University, Nashville,
TN 37203, United States
(Walden) Annette and Irwin Eskind Family Biomedical Library, Jean &
Alexander Heard Libraries, Vanderbilt University, Nashville, TN 37203,
United States
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Percutaneous coronary intervention (PCI) is the preferred treatment for
acute coronary syndrome (ACS) secondary to atherosclerotic coronary artery
disease. This nonsurgical procedure is also used for selective patients
with stable angina. Although the procedure is essential for restoring
blood flow, reperfusion can increase oxidative stress as a side effect. We
address whether intravenous infusion of vitamin C (VC) prior to PCI
provides a benefit for cardioprotection. A total of eight randomized
controlled trials (RCT) reported in the literature were selected from 371
publications through systematic literature searches in six electronic
databases. The data of VC effect on cardiac injury biomarkers and cardiac
function were extracted from these trials adding up to a total of 1185
patients. VC administration reduced cardiac injury as measured by troponin
and CK-MB elevations, along with increased antioxidant reservoir, reduced
reactive oxygen species (ROS) and decreased inflammatory markers.
Improvement of the left ventricular ejection fraction (LVEF) and
telediastolic left ventricular volume (TLVV) showed a trend but
inconclusive association with VC. Intravenous infusion of VC before PCI
may serve as an effective method for cardioprotection against reperfusion
injury.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI, Basel,
Switzerland.

<6>
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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<7>
Accession Number
2006135383
Title
Effects of anesthetics on microvascular reactivity measured by vascular
occlusion tests during off-pump coronary artery bypass surgery: a
randomized controlled trial.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2020. Date
of Publication: 2020.
Author
Cho Y.J.; Yoo S.J.; Nam K.; Bae J.Y.; Lee S.H.; Jeon Y.
Institution
(Cho, Yoo, Nam, Bae, Lee, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
Publisher
Springer (E-mail: editorial@springerplus.com)
Abstract
Abstract: Microvascular function may be modulated by various anesthetics.
Desflurane and propofol anesthesia have different effects on microvascular
function. However, there are few reports on the effects of sevoflurane and
desflurane on microvascular function during cardiac surgery. We compared
the effects of sevoflurane and desflurane on microvascular reactivity, as
measured by the vascular occlusion tests (VOTs) during off-pump coronary
artery bypass (OPCAB) surgery. Patients undergoing OPCAB were eligible for
study inclusion. Patients were excluded if they were unsuitable for
treatment with volatile agents or the VOT, had renal failure or
uncontrolled diabetes, or were pregnant. The enrolled patients were
randomized to receive sevoflurane or desflurane during surgery. Tissue
oxygen saturation (StO<inf>2</inf>) dynamics during the VOT were measured
at baseline (pre-anesthesia), pre-anastomosis, post-anastomosis of vessel
grafts, and at the end of surgery. Macrohemodynamic variables, arterial
blood gas parameters, and in-hospital adverse events were also evaluated.
A total of 64 patients (32 in each group) were analyzed. StO<inf>2</inf>
dynamics did not differ between the groups. Compared to baseline,
StO<inf>2</inf> and the rate of recovery following vascular occlusion
decreased at the end of surgery in both groups (adjusted p-value, <
0.001), and no group difference was observed. Macrohemodynamic variables,
blood gas analysis results, and the rate of postoperative in-hospital
adverse events were similar between the groups. Microvascular reactivity,
as measured by the VOT during OPCAB, showed no difference between the
sevoflurane and desflurane groups. Also, there were no group differences
in macrohemodynamics or the rate of postoperative adverse events. Trial
registration: Clinicaltrials.gov, identifier NCT03209193; registered on
July 3, 2017.<br/>Copyright &#xa9; 2020, Springer Nature B.V.

<8>
Accession Number
2006126609
Title
A 3 year post-intervention follow-up on mortality in advanced heart
failure (EVITA vitamin D supplementation trial).
Source
ESC Heart Failure. (no pagination), 2020. Date of Publication: 2020.
Author
Zittermann A.; Ernst J.B.; Prokop S.; Fuchs U.; Berthold H.K.;
Gouni-Berthold I.; Gummert J.F.; Pilz S.
Institution
(Zittermann, Ernst, Prokop, Fuchs, Gummert) Clinic for Thoracic and
Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University
Bochum, Georgstrase 11, Bad Oeynhausen D-32545, Germany
(Berthold) Department of Internal Medicine and Geriatrics, Bethel Clinic
(EvKB), Bielefeld, Germany
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes and Preventive
Medicine (PEDP), University of Cologne, Cologne, Germany
(Pilz) Division of Endocrinology and Diabetology, Department of Internal
Medicine, Medical University of Graz, Graz, Austria
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims: Vitamin D supplementation is widely used in the clinical setting,
but its effects on mortality and cardiovascular outcomes in patients with
heart failure are unclear. This paper reports outcome data that were
collected during follow-up of 3 years after closure of the EVITA trial (a
3 year randomized, placebo-controlled, intervention study with 4000 IU
vitamin D daily in patients with advanced heart failure), to capture
potential latency effects of vitamin D supplementation on clinical
outcomes. <br/>Methods and Results: The prespecified primary endpoint was
overall mortality. Secondary endpoints included hospitalization,
mechanical circulatory support implantation, high urgent listing for heart
transplantation, and heart transplantation. For group comparisons, we used
Cox regression models with a time-dependent categorical covariate. The
calculated net difference in circulating 25-hydroxyvitamin D between the
vitamin D and placebo groups dropped from 60.9 nmol/L at the end of the
active study period to 3.2 nmol/L at the end of the post-intervention
period. During the entire 6 year period, 73 patients (36.5%) died in the
placebo group and 76 (38.8%) in the vitamin D group. Out of these 149
patients, 36 and 39 died during the first 3 years, and 37 and 37 during
the second 3 years, respectively. The hazard ratio (HR) for mortality in
the vitamin D versus the placebo group was 1.06 [95% confidence interval
(CI): 0.68-1.66] for the first 3 years and 1.07 (95% CI: 0.68-1.70) for
the 3 year post-intervention follow-up. Compared with the placebo group,
the HRs for hospitalization and for mechanical circulatory support implant
were significantly higher in the vitamin D group during vitamin D
supplementation (HR = 1.31, 95% CI: 1.01-1.68 and HR = 2.01, 95% CI:
1.08-3.76, respectively) but not after vitamin D discontinuation (HR =
1.10, 95% CI: 0.62-1.94 and HR = 0.99, 95% CI: 0.38-2.56, respectively).
There was no significant time-dependent effect on the risk of high urgent
listing for heart transplantation and heart transplantation.
<br/>Conclusion(s): No beneficial latency effects of vitamin D
supplementation on overall mortality could be demonstrated. Instead, the
disappearance of unfavourable findings in the vitamin D group (higher HRs
for hospitalization and for mechanical circulatory support implant) after
vitamin D discontinuation supports the assumption of adverse vitamin D
effects on the cardiovascular system at doses of 4000 IU
daily.<br/>Copyright &#xa9; 2020 The Authors. ESC Heart Failure published
by John Wiley & Sons Ltd on behalf of the European Society of Cardiology

<9>
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). <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9;
2020 Wiley Periodicals LLC

<10>
Accession Number
2004270367
Title
The role of serratus anterior plane and pectoral nerves blocks in cardiac
surgery, thoracic surgery and trauma: a qualitative systematic review.
Source
Anaesthesia. 75 (10) (pp 1372-1385), 2020. Date of Publication: 01 Oct
2020.
Author
Jack J.M.; McLellan E.; Versyck B.; Englesakis M.F.; Chin K.J.
Institution
(Jack, Chin) Department of Anaesthesia, Toronto Western Hospital,
University of Toronto, Toronto, ON, Canada
(McLellan) Department of Anaesthesia and Peri-operative Medicine, Royal
Brisbane and Women's Hospital, Brisbane, QLD, Australia
(Versyck) Department of Anaesthesia and Pain Medicine, AZ Turnhout,
Turnhout, Belgium
(Englesakis) Library and Information Services, University Health Network,
Toronto, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Serratus anterior plane and pectoral nerves blocks are recently described
alternatives to established regional anaesthesia techniques in cardiac
surgery, thoracic surgery and trauma. We performed a systematic review to
establish the current state of evidence for the analgesic role of these
fascial plane blocks in these clinical settings. We identified relevant
studies by searching multiple databases and trial registries from
inception to June 2019. Study heterogeneity prevented meta-analysis and
studies were instead qualitatively summarised and stratified by type of
surgery and comparator. We identified 51 studies: nine randomised control
trials; 13 cohort studies; 19 case series; and 10 case reports. The
majority of randomised controlled trials studied the serratus anterior
plane block in thoracotomy or video-assisted thoracoscopic surgery, with
only two investigating pectoral nerves blocks. The evidence in thoracic
trauma comprised only case series and reports. Results indicate that
single-injection serratus anterior plane and the pectoral nerves blocks
reduce pain scores and opioid consumption compared with systemic analgesia
alone in cardiothoracic surgery, cardiac-related interventional procedures
and chest trauma for approximately 6-12 h. The duration of action appears
longer than intercostal nerve blocks but may be shorter than thoracic
paravertebral blockade. Block duration may be prolonged by a continuous
catheter technique with potentially similar results to thoracic epidural
analgesia. There were no reported complications and the risk of
haemodynamic instability appears to be low. The current evidence, though
limited, supports the efficacy and safety of serratus anterior plane and
the pectoral nerves blocks as analgesic options in cardiothoracic
surgery.<br/>Copyright &#xa9; 2020 Association of Anaesthetists

<11>
Accession Number
632839337
Title
Effect of Intramyocardial Grafting Collagen Scaffold With Mesenchymal
Stromal Cells in Patients With Chronic Ischemic Heart Disease: A
Randomized Clinical Trial.
Source
JAMA network open. 3 (9) (pp e2016236), 2020. Date of Publication: 01 Sep
2020.
Author
He X.; Wang Q.; Zhao Y.; Zhang H.; Wang B.; Pan J.; Li J.; Yu H.; Wang L.;
Dai J.; Wang D.
Institution
(He, Wang, Zhang, Pan, Wang) Department of Thoracic and Cardiovascular
Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical
School, Nanjing, China
(Zhao, Dai) Key Laboratory of Molecular Developmental Biology, Institute
of Genetics and Developmental Biology, Chinese Academy of Sciences,
Beijing, China
(Wang, Wang) Center for Clinical Stem Cell Research, Affiliated Drum Tower
Hospital of Nanjing University Medical School, Nanjing, China
(Li) Department of Cardiology, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Nanjing, China
(Yu) Department of Radiology, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Nanjing, China
Publisher
NLM (Medline)
Abstract
Importance: Cell therapy may be helpful for cardiac disease but has been
fraught with poor cell retention and survival after transplantation.
<br/>Objective(s): To determine whether cell-laden hydrogel treatment is
safe and feasible for patients with chronic ischemic heart disease (CIHD).
<br/>Design, Setting, and Participant(s): This randomized, double-blind
clinical trial was conducted between March 1, 2016, and August 31, 2019,
at a single hospital in Nanjing, China. Among 115 eligible patients with
CIHD, 50 patients with left ventricular ejection fraction of 45% or less
were selected to receive elective coronary artery bypass grafting (CABG)
and additionally randomized to cell-plus-collagen treatment (collagen/cell
group), cell treatment alone (cell group), or a control group. Sixty-five
patients were excluded because of severe comorbidities or unwillingness to
participate. Forty-four participants (88%) completed the study. The last
patient completed 12 months of follow-up in August 2019. Analyses were
prespecified and included all patients with available data.
<br/>Intervention(s): During CABG, patients in the collagen/cell group
were treated with human umbilical cord-derived mesenchymal stromal cell
(hUC-MSC)-laden collagen hydrogel intramyocardial injection, and the cell
group was treated with hUC-MSCs alone. Patients in the control group
underwent CABG alone. <br/>Main Outcomes and Measures: The primary outcome
was safety of the cell-laden collagen hydrogel assessed by the incidence
of serious adverse events. The secondary end point was the efficacy of
treatment, according to cardiovascular magnetic resonance imaging-based
left ventricular ejection fraction and infarct size. <br/>Result(s): Fifty
patients (mean [SD] age, 62.6 [8.3] years; 38 men [76%]) were enrolled, of
whom 18 were randomized to the collagen/cell group, 17 to the cell group,
and 15 to the control group. Patient characteristics did not differ among
groups at baseline. For the primary end point, no significant differences
in serious adverse events, myocardial damage markers, and renal or liver
function were observed among all groups after treatment; the collagen/cell
and cell groups each had 1 case of hospitalization because of heart
failure, and no serious adverse events were seen in the control group. At
12 months after treatment, the mean infarct size percentage change was
-3.1% (95% CI, -6.20% to -0.02%; P=.05) in the collagen/cell group, 5.19%
(-1.85% to 12.22%, P=.35) in the cell group, and 8.59% (-3.06% to 20.25%,
P=.21) in the control group. <br/>Conclusions and Relevance: This study
provides, to our knowledge, the first clinical evidence that the use of
collagen hydrogel is safe and feasible for cell delivery. These findings
provide a basis for larger clinical studies. Trial Registration:
ClinicalTrials.gov Identifier: NCT02635464.

<12>
Accession Number
632813872
Title
Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients
With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial
FIM-BGC-2014-01.
Source
Frontiers in Pharmacology. 11 (no pagination), 2020. Article Number: 1331.
Date of Publication: 26 Aug 2020.
Author
Guerrero-Orriach J.L.; Malo-Manso A.; Ramirez-Aliaga M.; Florez Vela A.I.;
Galan-Ortega M.; Moreno-Cortes I.; Gonzalez-Almendros I.;
Ramirez-Fernandez A.; Ariza-Villanueva D.; Escalona-Belmonte J.J.;
Quesada-Munoz G.; Sepulveda-Haro E.; Romero-Molina S.; Bellido-Estevez I.;
Gomez-Luque A.; Rubio-Navarro M.; Alcaide-Torres J.; Santiago-Fernandez
C.; Garrido-Sanchez L.; Cruz-Manas J.
Institution
(Guerrero-Orriach, Malo-Manso, Ramirez-Aliaga, Galan-Ortega,
Gonzalez-Almendros, Ramirez-Fernandez, Escalona-Belmonte, Quesada-Munoz,
Bellido-Estevez, Gomez-Luque, Alcaide-Torres, Santiago-Fernandez,
Garrido-Sanchez) Institute of Biomedical Research in Malaga [IBIMA],
Malaga, Spain
(Guerrero-Orriach, Malo-Manso, Ramirez-Aliaga, Florez Vela, Galan-Ortega,
Moreno-Cortes, Ramirez-Fernandez, Ariza-Villanueva, Escalona-Belmonte,
Quesada-Munoz, Sepulveda-Haro, Romero-Molina, Gomez-Luque, Rubio-Navarro,
Cruz-Manas) Department of Anaesthesiology, Virgen de la Victoria
University Hospital, Malaga, Spain
(Guerrero-Orriach, Bellido-Estevez, Gomez-Luque) Department of
Pharmacology and Pediatrics, School of Medicine, University of Malaga,
Malaga, Spain
(Alcaide-Torres, Santiago-Fernandez, Garrido-Sanchez) Unidad de Gestion
Clinica de Endocrinologia y Nutricion, Virgen de la Victoria University
Hospital, Malaga, Spain
(Santiago-Fernandez, Garrido-Sanchez) CIBER Fisiopatologia de la Obesidad
y Nutricion-CIBEROBN, Instituto de Salud Carlos III, Malaga, Spain
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: Low-cardiac output syndrome (LCOS) after cardiac surgery
secondary to systemic hypoperfusion is associated with a higher incidence
of renal and neurological damage. A range of effective therapies are
available for LCOS. The beneficial systemic effects of levosimendan
persist even after cardiac output is restored, which suggests an
independent cardioprotective effect. <br/>Method(s): A double-blind
clinical trial was conducted in patients with a confirmed diagnosis of
LCOS randomized into two treatment groups (levosimendan vs. dobutamine).
Monitoring of hemodynamic (cardiac index, systolic volume index, heart
rate, mean arterial pressure, central venous pressure, central venous
saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP,
troponin I); and renal parameters was performed using acute kidney injury
scale (AKI scale) and renal and brain ultrasound measurements [vascular
resistance index (VRI)] at diagnosis and during the first 48 h.
<br/>Result(s): Significant differences were observed between groups in
terms of cardiac index, systolic volume index, NT-proBNP, and kidney
injury stage at diagnosis. In the levosimendan group, there were
significant variations in AKI stage after 24 and 48 h. No significant
differences were observed in the other parameters studied.
<br/>Conclusion(s): Levosimendan showed a beneficial effect on renal
function in LCOS patients after cardiac surgery that was independent from
cardiac output and vascular tone. This effect is probably achieved by
pharmacological postconditioning. Clinical Trial Registration: EUDRA CT,
identifier 2014-001461-27.
https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-
27.<br/>&#xa9; Copyright &#xa9; 2020 Guerrero-Orriach, Malo-Manso,
Ramirez-Aliaga, Florez Vela, Galan-Ortega, Moreno-Cortes,
Gonzalez-Almendros, Ramirez-Fernandez, Ariza-Villanueva,
Escalona-Belmonte, Quesada-Munoz, Sepulveda-Haro, Romero-Molina,
Bellido-Estevez, Gomez-Luque, Rubio-Navarro, Alcaide-Torres,
Santiago-Fernandez, Garrido-Sanchez and Cruz-Manas.

<13>
Accession Number
632839252
Title
Short-term outcome of the intuity rapid deployment prosthesis: a
systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 10 Sep 2020.
Author
Klop I.D.G.; Kougioumtzoglou A.M.; Kloppenburg G.T.L.; van Putte B.P.;
Sprangers M.A.G.; Klein P.; Nieuwkerk P.T.
Institution
(Klop, Kloppenburg, van Putte, Klein) Department of Cardiothoracic
Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Kougioumtzoglou, van Putte) Department of Cardiothoracic Surgery,
Amsterdam University Medical Centers, Academic Medical Center, Amsterdam,
Netherlands
(Sprangers, Nieuwkerk) Department of Psychology, Amsterdam University
Medical Centers, Academic Medical Center, University of Amsterdam,
Amsterdam Public Health Research Institute, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Limited access aortic valve replacement is an alternative
approach for the treatment of calcified aortic valve disease. To
facilitate limited access aortic valve replacement, rapid deployment valve
prostheses have been developed aiming to reduce surgical impact. This
systematic review gives an overview of current literature regarding the
INTUITY or INTUITY Elite rapid deployment biological valve prosthesis.
<br/>METHOD(S): Cochrane, Embase and MEDLINE were searched to identify
relevant studies. All studies reporting on patients who underwent isolated
or combined surgical aortic valve replacement with the INTUITY or INTUITY
Elite valve prosthesis were considered eligible. Primary end points were
technical success rate, 30-day mortality, cerebrovascular accident,
paravalvular leak and permanent pacemaker implantation. Secondary end
points included procedural data such as aortic cross-clamping time,
cardiopulmonary bypass time and procedural approach. <br/>RESULT(S): A
total of 16 articles fulfilled the inclusion and exclusion criteria and
comprised 4.184 patients. Thirty-day mortality was 2.7% (1.9-3.7%),
cerebrovascular accident 2.6% (1.4-4.7%), permanent pacemaker implantation
7.9% (6.6-9.5%) and severe postoperative paravalvular leak requiring a
reintervention 3.3% (1.7-6.1%). Technical success rate varied between
93.9% and 100%. Conventional median sternotomy was most commonly
performed, ranging from 21.7% to 89.6%. Upper hemi-sternotomy was
performed more often than anterior right thoracotomy, ranging from 10.4%
to 63.3% and 2.2% to 26.1%. The mean transvalvular pressure gradient
ranged between 9.0 and 10.3mmHg at 1 year postoperatively.
<br/>CONCLUSION(S): This review demonstrates that the technical success
rate of the INTUITY or INTUITY Elite rapid deployment valve system is
high, also in limited access aortic valve replacement. Mortality and
cerebrovascular accident rates are low, but the need for postoperative
permanent pacemaker implantation and reintervention rate for paravalvular
leakage is increased.<br/>Copyright &#xa9; The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<14>
Accession Number
632850312
Title
Trans-esophageal echocardiography during endovascular procedures for
thoracic aorta diseases: sensitivity and specificity analysis.
Source
The Journal of cardiovascular surgery. (no pagination), 2020. Date of
Publication: 10 Sep 2020.
Author
Nana P.N.; Brotis A.G.; Tsolaki V.; Spanos K.; Mpatzalexis K.; Zakynthinos
E.; Giannoukas A.D.; Kouvelos G.N.
Institution
(Nana) Vascular Surgery Department, Larissa University Hospital, Faculty
of Medicine, School of Health Sciences, University of Thessaly, Greece
(Brotis) Department of Neurosurgery, Larissa University Hospital, Faculty
of Medicine, School of Health Sciences, University of Thessaly, Greece
(Tsolaki, Zakynthinos) Intensive Care Unit, Larissa University Hospital,
Faculty of Medicine, School of Health Sciences, University of Thessaly,
Greece
(Spanos, Mpatzalexis, Giannoukas, Kouvelos) Vascular Surgery Department,
Larissa University Hospital, Faculty of Medicine, School of Health
Sciences, University of Thessaly, Greece
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The widespread use of endovascular repair in thoracic aorta
(TEVAR) pathologies has ameliorated post-operative outcomes. This
meta-analysis was designed to investigate the intra-operative use of
transesophageal echocardiography (TEE) compared to angiography in patients
undergoing TEVAR. EVIDENCE ACQUISITION: The meta-analysis was conducted
using the Preferred Reporting Items for Systematic Reviews and
Meta-Analysis statement (PRISMA) guidelines. A data search of the English
literature was conducted, using PubMed, EMBASE and CENTRAL databases,
until November 30, 2019. The Grading of Recommendations, Assessment,
Development and Evaluation (GRADE) approach was used to evaluate the
quality of evidence and the summary of findings for each of the included
outcomes. EVIDENCE SYNTHESIS: The final analysis included 7 articles (183
patients). All patients underwent TEVAR using intra-operative TEE and
angiography. The sensitivity and specificity rates of entry points were
0.624 (95% CI 0.145-0.97) and 0.377 (95% CI 0.029-0.856), respectively.
Regarding the detection of adequate guidewire advancement, the sensitivity
was 0.778 (95% CI 0.288-939) and specifity 0.346 (95% CI 0.019-0.844). TEE
could detect endograft incomplete deployment within acceptable rates of
sensitivity and specifity, estimated at 0.616 (95% CI 0.141-0.971) and
0.365 (95% CI 0.028-0.845), respectively. The intra-operative detection of
endoleaks presented a sensitivity estimated at 0.875 (0.51-0.998) and
specificity at 0.698 (95% CI 0.284-0.904). <br/>CONCLUSION(S): Despite the
limitations of this analysis, TEE may be evaluated in the current
endovascular era, as a useful tool, providing adequate information, on
graft deployment and early endoleaks.

<15>
Accession Number
632848870
Title
Meta-Analysis Comparing Angiography-Guided versus FFR-Guided Coronary
Artery Bypass Grafting.
Source
The American journal of cardiology. (no pagination), 2020. Date of
Publication: 08 Sep 2020.
Author
Changal K.; Patel M.; Salman F.; Nazir S.; Gupta R.
Institution
(Changal, Nazir, Gupta) Department of Cardiovascular Medicine, University
of Toledo, OH, United States
(Patel) Department of Medicine, University of Toledo, OH, United States
(Salman) Department of Medicine, Mercy Health St. Vincent Medical Center,
OH, Toledo, United States
Publisher
NLM (Medline)

<16>
Accession Number
358711431
Title
The protective effect of influenza vaccination on the clinical course of
coronary disease in patients with acute coronary syndromes treated by
primary PCI - A report from FLUCAD study.
Source
Postepy w Kardiologii Interwencyjnej. 6 (1) (pp 6-11), 2010. Date of
Publication: 2010.
Author
Ciszewski A.; Bilinska Z.T.; Kepka C.; Kruk M.; Ksiezycka-Majczynska E.;
Ruzyllo W.
Institution
(Ciszewski, Bilinska, Kepka, Kruk, Ksiezycka-Majczynska, Ruzyllo) Instytut
Kardiologii, ul. Alpejska 42, 04-628 Warszawa, Poland
Publisher
Termedia Publishing House Ltd.
Abstract
Background and aim: We compared the protective effect of influenza
vaccination on the clinical course of coronary artery disease (CAD) in
patients (pts) with acute coronary syndrome (ACS) treated by primary
angioplasty (PCI), and in stable angina pts. <br/>Method(s): Prospective,
randomized 1 : 1, double-blind, placebo controlled study. We included 658
optimally treated CAD pts; 477 men, mean age 59.9 +/- 10.3 years. Median
follow-up was 298 (interquartile range 263-317) days. <br/>Result(s):
There were 157 pts (83 - active vaccine, 74 - placebo) vaccinated after
primary PCI in ACS, and 501 pts (242 - vaccine, 259 - placebo) with stable
angina. In stable angina pts there were no significant differences in
estimated 12-month cumulative event rates between vaccinated and placebo
groups for the: primary endpoint (cardiovascular death), secondary
endpoints: major adverse cardiac event (MACE) - (cardiovascular death or
myocardial infarction or coronary revascularization) and coronary ischemic
event (composite of MACE or hospitalization for angina). In ACS group, in
vaccinated pts we observed: (1) a significant reduction in the rate of
coronary ischemic event with HR 0.37 (95% CI 0.14-0.99, p = 0.047); (2) a
statistical trend for reduction of MACE with HR 0.36 (95% CI 0.09-1.39; p
= 0.139); (3) no effect on cardiovascular mortality. <br/>Conclusion(s):
The protective effect of influenza vaccination on CAD clinical course was
observed in pts with ACS but not in those with stable angina. Influenza
vaccination may be safely performed immediately after ACS and primary PCI.

<17>
[Use Link to view the full text]
Accession Number
632567565
Title
Late atrial arrhythmias after lung transplantation: A meta-analysis.
Source
Journal of Cardiovascular Medicine. 21 (8) (pp 577-582), 2020. Date of
Publication: 01 Aug 2020.
Author
Saglietto A.; Matta M.; Gaita F.; De Ferrari G.M.; Anselmino M.
Institution
(Saglietto, De Ferrari, Anselmino) Division of Cardiology, Department of
Medical Sciences, 'Citta della Salute e della Scienza di Torino' Hospital,
University of Turin, Dogliotti 14, Turin 10126, Italy
(Matta) Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
(Gaita) Cardiovascular Department, Clinica Pinna Pintor, Policlinico di
Monza, Turin, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BackgroundAtrial arrhythmias are common following noncardiac thoracic
surgery. In particular, early postoperative atrial arrhythmias after lung
transplantation are very frequent, especially atrial fibrillation (AFib).
Late atrial arrhythmia occurrence following lung transplantation, instead,
has been less commonly reported.MethodsThe aim of the present systematic
review and meta-analysis is to analyse the incidence rate of late atrial
arrhythmia and AFib in lung transplantation patients, with a special focus
on double lung transplant (DLT), also to assess potential predictors of
AFib occurrence. After bibliographic search (PUBMED/Medline and Embase
databases), a random-effect model meta-analysis was performed: seven
studies were finally included, including 2068 lung transplantation
patients.ResultsThe pooled incidence rate of late atrial arrhythmia was
4.3%/year [95% confidence interval (CI) 2.8-6.1%/year, I²=
69%], whereas late AFib incidence rate was 1.5%/year (95% CI
0.7-2.6%/year, I²= 87%). In patients undergoing DLT, the pooled
incidence rate of late atrial arrhythmia was 4.1%/year (95% CI
2.5-6.0%/year, I²= 67%), while the AFib incidence rate was
0.9%/year (95% CI 0.1-2.4%/year, I²= 92%). A longer follow-up
duration significantly related to the reduced incidence rate of AFib (P =
0.02). History of AFib (hazard ratio 11.2, 95% CI 5.9-21.3) and early
postoperative AFib (hazard ratio 10.3, 95% CI 5.9-18.0) emerged, instead,
as relevant predictors of AFib occurrence.ConclusionLate atrial arrhythmia
occurrence is not infrequent in lung transplantation patients; however,
late Afib incidence was rare and showed a time-dependent decrease,
particularly in DLT patients, suggesting that a transmural pulmonary veins
isolation, the mainstay of transcatheter ablation, is effective in
decreasing the likelihood of experiencing AFib.<br/>Copyright &#xa9; 2020
Lippincott Williams and Wilkins. All rights reserved.

<18>
Accession Number
2005950418
Title
Possible differential benefits of edetate disodium in post-myocardial
infarction patients with diabetes treated with different hypoglycemic
strategies in the Trial to Assess Chelation Therapy (TACT).
Source
Journal of Diabetes and its Complications. 34 (8) (no pagination), 2020.
Article Number: 107616. Date of Publication: August 2020.
Author
Escolar E.; Ujueta F.; Kim H.; Mark D.B.; Boineau R.; Nahin R.L.; Goertz
C.; Lee K.L.; Anstrom K.J.; Lamas G.A.
Institution
(Escolar, Ujueta, Lamas) Columbia University Division of Cardiology at
Mount Sinai Medical Center, Miami, FL, United States
(Kim, Mark, Lee, Anstrom) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Kim, Mark, Lee, Anstrom) Duke University, Durham, NC, United States
(Boineau, Nahin) National Heart, Lung, and Blood Institute, Bethesda, MD,
United States
(Goertz) Duke Department of Orthopaedic Surgery, Duke University, Durham,
NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The NIH-funded Trial to Assess Chelation Therapy (TACT)
randomized 1708 stable patients age >=50 who were >=6 months post
myocardial infarction to 40 infusions of an edetate disodium-based regimen
or placebo. In 633 patients with diabetes, edetate disodium significantly
reduced the primary composite endpoint of mortality, recurrent myocardial
infarction, stroke, coronary revascularization, or hospitalization for
angina (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.44-0.79, p
< 0.001). The principal secondary endpoint of a composite of
cardiovascular death, myocardial infarction, or stroke was also reduced
(HR 0.60, 95% CI 0.39-0.91, p = 0.017). It is unknown if the treatment
effect differs by diabetes therapy. <br/>Method(s): We grouped the subset
of 633 patients with diabetes according to glucose-lowering therapy at
time of randomization. The log-rank test was used to compare active
therapy versus placebo. All treatment comparisons were performed using
2-sided significance tests at the significance level of 0.05 and were as
randomized. Relative risks were expressed as HR with associated 95% CI,
calculated using the Cox proportional hazards model. <br/>Result(s): There
were 162 (25.7%) patients treated with insulin; 301 (47.5%) with oral
hypoglycemics only; and 170 (26.8%) receiving no pharmacologic treatment
for diabetes. Patients on insulin reached the primary endpoint more
frequently than patients on no pharmacologic treatment [61 (38%) vs 49
(29%) (HR 1.56, 95% CI 1.07-2.27, p = 0.022)] or oral hypoglycemics [61
(38%) vs 87 (29%) (HR 1.46, 1.05-2.03, p = 0.024)]. The primary endpoint
occurred less frequently with edetate disodium based therapy versus
placebo in patients on insulin [19 (26%) vs 42 (48%) (HR 0.42, 95% CI
0.25-0.74, log-rank p = 0.002)], marginally in patients on oral
hypoglycemics [38 (25%) vs 49 (34%) (HR 0.66, 95% CI 0.43-1.01, log-rank p
= 0.041)], and no significant difference in patients not treated with a
pharmacologic therapy [23 (25%) vs 26 (34%) (HR 0.69, 95% CI 0.39-1.20,
log-rank p = 0.225)]. The interaction between randomized intravenous
treatment and type of diabetes therapy was not statistically significant
(p = 0.203). <br/>Conclusion(s): Edetate disodium treatment in stable,
post-myocardial infarction patients with diabetes suggests that patients
on insulin therapy at baseline may accrue the greatest benefit. Clinical
Trial Registration: clinicaltrials.gov identifier:
http://clinicaltrials.gov/ct2/show/NCT00044213?term=TACT&rank=7 identifier
Trial to Assess Chelation Therapy (TACT), NCT00044213.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<19>
Accession Number
2005250313
Title
Balloon Angioplasty of Infrapopliteal Arteries: A Systematic Review and
Proposed Algorithm for Optimal Endovascular Therapy.
Source
Journal of Endovascular Therapy. 27 (4) (pp 547-564), 2020. Date of
Publication: 01 Aug 2020.
Author
Giannopoulos S.; Varcoe R.L.; Lichtenberg M.; Rundback J.; Brodmann M.;
Zeller T.; Schneider P.A.; Armstrong E.J.
Institution
(Giannopoulos, Armstrong) Division of Cardiology, Rocky Mountain Regional
VA Medical Center, University of Colorado, Denver, CO, United States
(Varcoe) Department of Surgery, Prince of Wales Hospital, Faculty of
Medicine, University of New South Wales, , The Vascular Institute, Prince
of Wales Hospital, Sydney, NSW, Australia
(Lichtenberg) Angiology Department, Vascular Centre Clinic Arnsberg,
Germany
(Rundback) Advanced Interventional Vascular Services LLP, Teaneck, NJ,
United States
(Brodmann) Division of Angiology, Department of Internal Medicine, Medical
University of Graz, Austria
(Zeller) Department of Angiology, Universitats-Herzzentrum Bad Krozingen,
Germany
(Schneider) Division of Vascular and Endovascular Surgery, University of
California at San Francisco, CA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Endovascular revascularization has been increasingly utilized to treat
patients with chronic limb-threatening ischemia (CLTI), particularly
atherosclerotic disease in the infrapopliteal arteries. Lesions of the
infrapopliteal arteries are the result of 2 different etiologies: medial
calcification and intimal atheromatous plaque. Although several devices
are available for endovascular treatment of infrapopliteal lesions,
balloon angioplasty still comprises the mainstay of therapy due to a lack
of purpose-built devices. The mechanism of balloon angioplasty consists of
adventitial stretching, medial necrosis, and dissection or plaque
fracture. In many cases, the diffuse nature of infrapopliteal disease and
plaque complexity may lead to dissection, recoil, and early restenosis.
Optimal balloon angioplasty requires careful attention to assessment of
vessel calcification, appropriate vessel sizing, and the use of long
balloons with prolonged inflation times, as outlined in a treatment
algorithm based on this systematic review. Further development of specific
devices for this arterial segment are warranted, including devices for
preventing recoil (eg, dedicated atherectomy devices), treating
dissections (eg, tacks, stents), and preventing neointimal hyperplasia
(eg, novel drug delivery techniques and drug-eluting stents). Further
understanding of infrapopliteal disease, along with the development of new
technologies, will help optimize the durability of endovascular
interventions and ultimately improve the limb-related outcomes of patients
with CLTI.<br/>Copyright &#xa9; The Author(s) 2020.

<20>
Accession Number
2005175948
Title
Safety and Efficacy of Drug-Coated Balloon Angioplasty for the Treatment
of Chronic Limb-Threatening Ischemia: A Systematic Review and
Meta-Analysis.
Source
Journal of Endovascular Therapy. 27 (4) (pp 647-657), 2020. Date of
Publication: 01 Aug 2020.
Author
Giannopoulos S.; Ghanian S.; Parikh S.A.; Secemsky E.A.; Schneider P.A.;
Armstrong E.J.
Institution
(Giannopoulos, Ghanian, Armstrong) Division of Cardiology, Rocky Mountain
Regional VA Medical Center, University of Colorado, Denver, CO, United
States
(Parikh) Center for Interventional Vascular Therapy, Columbia University
Irving Medical Center, New York, NY, United States
(Secemsky) Division of Cardiology, Beth Israel Medical Center, Boston, MA,
United States
(Schneider) Division of Vascular and Endovascular Surgery, University of
California at San Francisco, CA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: To investigate the safety and efficacy of drug-coated balloons
(DCB) for the treatment of femoropopliteal or infrapopliteal lesions in
patients with chronic limb-threatening ischemia (CLTI). <br/>Material(s)
and Method(s): A systematic literature search was conducted in PubMed,
Scopus, and Cochrane Central up to January 2020 to identify randomized
trials and observational studies presenting data on the effectiveness and
safety of DCBs in the treatment of femoropopliteal or infrapopliteal
lesions. A meta-analysis utilizing random effects modeling was conducted
to investigate primary patency and all-cause mortality at 12 months; the
results are reported as the odds ratios (ORs) and 95% confidence intervals
(CIs). Secondary outcomes were procedural success, bailout stenting,
target lesion revascularization (TLR), reocclusion, major amputation,
wound healing, and major adverse limb events. <br/>Result(s): Twenty-six
studies, 12 retrospective and 14 prospective, comprising 2108 CLTI
patients treated with DCBs for femoropopliteal (n=1315) or infrapopliteal
(n=793) lesions were analyzed. The average lesion lengths were 121+/-44
and 135+/-53 mm, respectively. The overall 12-month all-cause mortality
and major amputation rates were 9% (95% CI 6% to 13%) and 5% (95% CI 2% to
8%), respectively. Primary patency rates were 82% (95% CI 76% to 87%) and
64% (95% CI 58% to 70%), respectively. A sensitivity analysis of the
infrapopliteal lesions demonstrated no difference between DCB and balloon
angioplasty in terms of primary patency, TLR, major amputation, or
mortality over 12 months. However, patients with infrapopliteal lesions
undergoing DCB angioplasty did have a significantly lower risk for
reocclusion (10% vs 25%; OR 0.38, 95% CI 0.21 to 0.70, p=0.002).
<br/>Conclusion(s): DCB angioplasty of femoropopliteal and infrapopliteal
lesions in patients with CLTI results in acceptable 12-month patency
rates, although comparative data have not shown a patency benefit for
infrapopliteal lesions. The 12-month mortality rate of DCB vs balloon
angioplasty was not significantly different, but studies with longer-term
outcomes are necessary to determine any association between DCB use and
mortality in patients with CLTI.<br/>Copyright &#xa9; The Author(s) 2020.

<21>
Accession Number
2003512939
Title
Combined Aerobic and Resistance Training for Peak Oxygen Uptake, Muscle
Strength, and Hypertrophy After Coronary Artery Disease: a Systematic
Review and Meta-Analysis.
Source
Journal of Cardiovascular Translational Research. 13 (4) (pp 601-611),
2020. Date of Publication: 01 Aug 2020.
Author
Lee J.; Lee R.; Stone A.J.
Institution
(Lee, Stone) Department of Kinesiology and Health Education, College of
Education, University of Texas at Austin, Austin, TX, United States
(Lee) Department of Human Movement Science, Incheon National University,
Incheon, South Korea
Publisher
Springer
Abstract
Maximal aerobic capacity measured as peak oxygen consumption
(VO<inf>2peak</inf>), muscle strength, and muscle hypertrophy are the
potent predictors of survival after coronary artery disease (CAD). The
purpose of this study was to review the effects of combined aerobic
training (AT) and resistance training (RT) on the three outcomes in CAD
patients. Five electronic databases were searched. Combined AT and RT
trials in 21 studies had a significantly greater favorable effect on all
three outcomes compared with control groups (CON). In subgroup analyses
for VO<inf>2peak</inf>, longer session duration and shorter post-CAD
period were associated with larger effect size (ES). For muscle strength,
higher training volume, longer post-CAD period, and younger age were
associated with larger ES. In hypertrophy, longer training duration was
associated with larger ES. Moderate intensity, 2-3 days per week, 50 min
(AT), three sets of 10-12 repetitions, and seven exercises (RT) for 14
weeks are recommended.<br/>Copyright &#xa9; 2019, Springer
Science+Business Media, LLC, part of Springer Nature.

<22>
Accession Number
2002302540
Title
Systematic Review and Meta-Analysis of Genetic Risk of Developing Chronic
Postsurgical Pain.
Source
Journal of Pain. 21 (1-2) (pp 2-24), 2020. Date of Publication: January -
February 2020.
Author
Chidambaran V.; Gang Y.; Pilipenko V.; Ashton M.; Ding L.
Institution
(Chidambaran, Ashton) Department of Anesthesiology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Chidambaran) Department of Pediatrics, University of Cincinnati,
Cincinnati, OH, United States
(Gang, Ding) Division of Biostatistics, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Gang) Department of Mathematical Sciences, University of Cincinnati,
Cincinnati, OH, United States
(Pilipenko) Division of Human Genetics, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
Publisher
Churchill Livingstone Inc.
Abstract
Chronic postsurgical pain (CPSP) is a significant detriment to
postsurgical recovery and a risk factor for prolonged opioid use. Emerging
evidence suggests the estimated heritability for chronic pain is 45% and
that genetic factors partially explain individual susceptibility to CPSP.
The aim of this study was to systematically review, assess quality, and
summarize the studies in humans that have investigated genetic factors
associated with CPSP. We also conducted a meta-analysis to derive a single
effect size for evaluable genetic associations with CPSP. Our
comprehensive literature search included review of 21 full-text articles
evaluating variants of 69 genes for association with CPSP. We found
significant gene variant associations reported for variants/haplotypes of
26 genes involved in neurotransmission, pain signaling, immune responses
and neuroactive ligand-receptor interaction, with CPSP. Six variants of 5
genes (COMT: rs4680 and rs6269, OPRM1: rs1799971, GCH1: rs3783641, KCNS1:
rs734784 and TNFA: rs1800629), were evaluated by more than one study and
were included in the meta-analysis. At rs734784 (A>G) of KCNS1, presence
of G allele marginally increased risk of CPSP (Additive genetic model;
Odds ratio: 1.511; 95% CI 1-2.284; P value:.050), while the other variants
did not withstand meta-analyses criteria. Our findings demonstrate the
role of genetic factors with different functions in CPSP, and also
emphasize that single genetic factors have small effect sizes in
explaining complex conditions like CPSP. Heterogeneity in surgical
cohorts, population structure, and outcome definitions, as well as small
number of available studies evaluating same variants, limit the
meta-analysis. There is a need for large-scale, homogenous, replication
studies to validate candidate genes, and understand the underlying
biological networks underpinning CPSP. <br/>Perspective(s): Our systematic
review comprehensively describes 21 studies evaluating genetic association
with CPSP, and limitations thereof. A meta-analysis of 6 variants (5
genes) found marginally increased risk for CPSP associated with rs734784
A>G of the potassium voltage-gated channel gene (KCNS1). Understanding
genetic predisposition for CPSP will enable prediction and personalized
management.<br/>Copyright &#xa9; 2019 United States Association for the
Study of Pain, Inc.

<23>
Accession Number
2006119769
Title
Surgical repair of anomalous aortic origin of coronary artery in adults.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Karangelis D.; S. Mylonas K.; Loggos S.; Adreanides E.; Tzifa A.;
Mitropoulos F.
Institution
(Karangelis, Loggos, Mitropoulos) Department of Cardiac Surgery, Mitera
Hospital, Athens, Greece
(S. Mylonas, Tzifa) Department of Congenital Cardiology, Mitera Hospital,
Athens, Greece
(Adreanides) Department of Cardiology, Medical Institution Military
Shareholder Fund, Athens, Greece
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Anomalous aortic origin of a coronary artery is a congenital abnormality
of the origin or course of a coronary artery that arises from the aorta.
The surgical treatment of this anomaly is highly variable and
controversial and is achieved by implementing elaborate techniques of
anatomic repair or by simple coronary artery bypass grafting. This review
was conducted in accordance with the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers
determined whether studies met the inclusion criteria. Eligible papers
were published in English, clinical studies describing surgical repair of
anomalous aortic origin of a coronary artery including coronary artery
bypass in adults, and enrolled '5 patients. In the absence of multicentre
trials, 7 single-center retrospective series were included, which
demonstrated comparable short- and midterm outcomes of anatomic repair and
coronary artery bypass in adults with anomalous aortic origin of a
coronary artery. Coronary unroofing was the preferred technique when the
anomalous artery has an intramural component, but there is a risk of
aortic insufficiency. Anatomic repair is technically demanding and should
be carried out in experienced centers. Coronary artery bypass with
internal thoracic artery or vein grafts is technically straightforward
with low operative risk and comparable midterm outcomes, however,
long-term outcomes are unknown. Coronary artery bypass grafting is the
technique of choice for older patients, in those with concomitant coronary
artery disease, as a bailout procedure for failed anatomic repair, or in
centers without experience in anatomic repair for anomalous aortic origin
of a coronary artery.<br/>Copyright &#xa9; The Author(s) 2020.

<24>
Accession Number
628732836
Title
Acupressure on Anxiety and Sleep Quality After Cardiac Surgery: A
Randomized Controlled Trial.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 34 (6) (pp 1222-1231), 2019. Date of
Publication: 01 Dec 2019.
Author
Aygin D.; Sen S.
Publisher
NLM (Medline)
Abstract
PURPOSE: To determine the effect of acupressure on anxiety and sleep
quality after cardiac surgery. DESIGN: A randomized pre-post test control
group design. <br/>METHOD(S): Patients after cardiac surgery were divided
into two groups: the intervention group (n = 50), who received acupressure
on four different acupoints plus standard care, and the control group (n =
50), who received only standard care. Patients were admitted to the
surgical clinic from the intensive care unit after 3 or 4 days of surgery.
The levels of anxiety and sleep quality were evaluated during three
postoperative days starting from their first day in the surgical clinic.
FINDINGS: Among the patients in the intervention group, the usage of
acupressure decreased the level of anxiety and increased the sleep quality
significantly compared with the control group (P < .05).
<br/>CONCLUSION(S): Our findings showed that acupressure decreased the
level of anxiety and improved the sleep quality in the surgical clinic
after cardiac surgery.<br/>Copyright &#xa9; 2019 American Society of
PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

<25>
[Use Link to view the full text]
Accession Number
632825140
Title
Risk factors for hospital readmission in adult patients with heart failure
with reduced ejection fraction: a systematic review.
Source
JBI evidence synthesis. 18 (8) (pp 1641-1700), 2020. Date of Publication:
01 Aug 2020.
Author
Schjodt I.; Liljeroos M.; Larsen P.; Johnsen S.P.; Stromberg A.; Logstrup
B.B.
Institution
(Schjodt) 1Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark 2Department of Health, Medicine and Caring Sciences, Linkoping
University, Linkoping, Sweden 3Centre for Clinical Research Sormland,
Uppsala University, Eskilstuna, Sweden 4Health Sciences Research Center,
University College Lillebaelt, Odense, Denmark 5Danish Center for Clinical
Health Services Research, Department of Clinical Medicine, Aalborg
University, Aalborg, Denmark 6Department of Cardiology, Linkoping
University Hospital, Linkoping, Sweden 7Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this review was to identify and synthesize
evidence on risk factors associated with hospital readmission within the
first year after heart failure hospitalization among patients with heart
failure with reduced left ventricular ejection fraction. INTRODUCTION:
Heart failure is associated with a high risk of hospital readmission.
Readmissions are associated with higher mortality and health care costs.
It is a high health care priority to identify vulnerable patients with
heart failure who may potentially benefit from targeted personalized care
interventions aiming to reduce readmissions. INCLUSION CRITERIA: This
review considered studies including adult patients who had heart failure
with a reduced left ventricular ejection fraction <= 40% who were
discharged after a heart failure hospitalization. The authors included
studies with experimental and observational designs evaluating risk
factors for i) all-cause hospital readmission, ii) heart failure hospital
readmission, and iii) composite outcomes within seven, 15, 30, 60, 90,
180, and 365 days after hospital discharge. Composite outcomes included
end points where all-cause readmission and/or heart failure readmission
were part of a defined end point (i.e. all-cause readmission or mortality;
heart failure readmission or mortality; cardiovascular readmission;
cardiovascular readmission or mortality; and readmission, mortality, or
cardiac transplant). Studies reporting all-cause readmission and/or heart
failure readmission as a primary outcome, secondary outcome, or part of a
composite outcome were included. <br/>METHOD(S): PubMed, Embase, CINAHL,
Cochrane CENTRAL, PsycINFO, OpenGrey, MedNar, DART-Europe, ProQuest
Dissertations and Theses, and the Grey Literature Report in Public Health
were searched to find both published and unpublished studies in English,
Swedish, Norwegian, or Danish from 2000 to June 2018. Study selection,
critical appraisal, data extraction, and data synthesis followed the JBI
approach for systematic reviews. Statistical pooling was not possible due
to clinical and methodological heterogeneity of the studies included and
the lack of risk factors reported more than once. A narrative summary of
the findings was performed. <br/>RESULT(S): Fifty-two studies, including
one randomized controlled trial and 51 cohort studies with a total of
128,186 participants, were included. Risk factors for readmission were
reported for 30-day outcome in 16 studies, 60-day in three studies, 90-day
in 15 studies, 180-day in 12 studies, and 365-day outcome in 15 studies.
Based on multivariable analyses from 43 cohort studies and results from
one randomized controlled trial, the authors identified several factors
associated with higher risk of all-cause readmission, heart failure
readmission, and composite outcomes (e.g. readmission or death) within 30,
60, 90, 180, and 365 days after discharge for a heart failure
hospitalization. <br/>CONCLUSION(S): This review provides a comprehensive
overview of factors associated with a clinical outcome after a heart
failure hospitalization in patients with heart failure with left
ventricular ejection fraction <= 40%. Owing to the heterogeneity of
variables investigated and the lack of comparability of findings, the
clinical impact of the identified risk factors remains uncertain. This
review highlights research gaps and the need for a standardized way to
define and measure all-cause readmission, heart failure readmission, and
composite end points in clinical research to improve study quality and
enable comparison of findings between studies.

<26>
Accession Number
2007801771
Title
Comparison of novel oral anticoagulants versus warfarin for post-operative
atrial fibrillation after coronary artery bypass grafting.
Source
Annals of Medicine and Surgery. 58 (pp 130-133), 2020. Date of
Publication: October 2020.
Author
Manuel L.; Fong L.S.; Ang Z.H.; Grant P.
Institution
(Manuel, Fong, Ang, Grant) Department of Cardiothoracic Surgery, Prince of
Wales Hospital, Sydney, Australia
Publisher
Elsevier Ltd
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does the use of Novel
Oral Anticoagulants (NOACs) result in more complications than Warfarin for
treatment of post-operative atrial fibrillation (AF) following coronary
artery bypass grafting (CABG)?' Altogether more than 93 papers were found
using the reported search with 4 studies representing the best evidence to
answer the clinical question, including 1 randomised trial and 3
retrospective case-control studies. The authors, journal, date and country
of publication, patient group studied, study type, relevant outcomes and
results of these papers were tabulated. Timing for initiation of
anticoagulation was similar across the studies, with both demonstrating
longer hospital stays and greater time to reach therapeutic
anticoagulation in the warfarin cohort. Three studies reported similar
safety between the two groups. One study revealed significantly more
invasive interventions for pleural or pericardial effusions in the NOAC
group, whilst in contrast another study demonstrated a higher rate of
major bleeding in the warfarin cohort. Cost-analysis revealed that NOACs
were overall more cost-effective compared to warfarin despite the higher
cost for the medication itself. In conclusion, the use of NOACs after CABG
for post-operative AF can be used as an alternative to warfarin, however,
one should remain vigilant for possible pericardial or pleural effusions
which may require reintervention. Further dedicated research and larger
appropriately powered randomised control trials are needed to confirm the
safety of NOACs in post-cardiac surgery patients.<br/>Copyright &#xa9;
2020 The Authors

<27>
Accession Number
632824993
Title
Publication Performance in German Academic Heart Surgery.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2020. Date of
Publication: 08 Sep 2020.
Author
Debus E.S.; Dolg M.; Reichenspurner H.; Grundmann R.T.
Institution
(Debus, Dolg, Grundmann) Universitatsklinikum Hamburg-Eppendorf, Hamburg,
Germany
(Reichenspurner) Cardiovascular Surgery, Universitatsklinikum
Hamburg-Eppendorf, Hamburg, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: This study was designed to evaluate the publication
performance of management teams consisting of chief and senior physicians
in German university cardiac surgery units over a 10-year period and to
facilitate benchmarking. <br/>METHOD(S): The cutoff date for
consideration of staffing from the unit Web site and publications was July
1, 2017. The literature search was based on an evaluation of the PubMed
database. The 5-year impact factor (IF) from 2016 was assigned to each
journal. <br/>RESULT(S): Two thousand five hundred thirty-five
publications (average IF 3.02) were registered, published in 323 journals.
Of a total of 341 management team members, 235 (68.9%) published as first
or last author over the 10-year period. The number of publications from
the units divided into quintiles varied considerably with the first six
units contributing 39.0% of all publications and the last nine units 9.4%.
With a cumulative IF total of 3265, the publications of the first six
units accounted for 42.7% of the cumulative IF, the last unit quintile
amounted to 621 (8.1%) of the cumulative IF. When considering publications
per managing member, the first quintile averaged 11.9 publications (29.6
IF) per managing member, the last quintile 3.3 publications (8.0 IF) per
member. <br/>CONCLUSION(S): The six units of the first quintile published
on average 3.6 times more per managing member than the nine units in the
last quintile and the average cumulative IF per member in the first
quintile was almost five times higher. Further investigation must show
whether this considerable difference in publication activity between the
university units is also observed in other operative fields.<br/>Copyright
Thieme. All rights reserved.

<28>
Accession Number
2004693095
Title
Preoperative Pulse Pressure and Adverse Postoperative Outcomes: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (3) (pp 624-631),
2020. Date of Publication: March 2020.
Author
Zeng J.; Zheng G.; Li Y.; Yang Y.
Institution
(Zeng, Zheng, Li) Department of Anesthesiology, The First Affiliated
Hospital of Jinan University, Guangzhou, China
(Zeng) Department of Anesthesiology, Liuzhou People's Hospital, Liuzhou,
China
(Yang) Out-patient Department, Liuzhou People's Hospital, Liuzhou, China
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the association between preoperative pulse pressure
(PP) and the incidences of renal, neurologic, cardiac, and mortality
outcomes after surgery. <br/>Design(s): Systematic review and
meta-analysis of cohort studies. <br/>Setting(s): Hospitals.
<br/>Participant(s): Patients who underwent cardiac or noncardiac
surgeries. <br/>Intervention(s): The preoperative PP was measured.
Measurement and Main Results: Relevant cohort studies were obtained by
systematic search of PubMed and Embase databases. A randomized effect
model was used to pool the results. The multivariate adjusted risk ratio
(RR) and its 95% confidence intervals (CI) were calculated to reflect the
association between preoperative PP and adverse postoperative outcomes.
Twelve cohort studies that included 40,143 patients who had undergone
cardiac, vascular, or noncardiac surgery were included in the
meta-analysis. The results showed that above a threshold of 40 mmHg, an
increase in preoperative PP of 10 mmHg was independently associated with
increased risk for renal events (adjusted RR: 1.13, 95% CI 1.08-1.19, p <
0.001; I² = 0%), neurologic events (adjusted RR: 1.75, 95% CI
1.01-3.02, p = 0.04; I² = 70%), cardiac events (adjusted RR:
1.19, 95% CI 1.03-1.37, p = 0.01; I² = 0%), major
cardiovascular adverse events (adjusted RR: 1.62, 95% CI 1.10-2.41, p =
0.02; I² = 0%), and overall mortality (adjusted RR: 1.13, 95%
CI 1.07-1.20, p < 0.001; I² = 0%) after surgery.
<br/>Conclusion(s): Patients with higher-than-normal preoperative PP are
at increased risk for adverse postoperative outcomes.<br/>Copyright &#xa9;
2019

<29>
Accession Number
602083510
Title
Specific antidotes in development for reversal of novel anticoagulants: A
review.
Source
Recent Patents on Cardiovascular Drug Discovery. 9 (1) (pp 2-10), 2014.
Date of Publication: 01 Dec 2014.
Author
Gomez-Outes A.; Suarez-Gea M.L.; Lecumberri R.; Terleira-Fernandez A.I.;
Vargas-Castrillon E.
Institution
(Gomez-Outes, Suarez-Gea) Division of Pharmacology and Clinical
Evaluation, Medicines for Human Use, Spanish Agency for Medicines and
Medical Devices (AEMPS), Madrid, Spain
(Lecumberri) Department of Hematology, University Clinic of Navarra,
Pamplona, Spain
(Terleira-Fernandez, Vargas-Castrillon) Department of Clinical
Pharmacology, Hospital Clinico, Madrid, Spain
(Terleira-Fernandez, Vargas-Castrillon) Department of Pharmacology,
Universidad Complutense, Madrid, Spain
Publisher
Bentham Science Publishers (P.O. Box 294, Bussum 1400 AG, Netherlands)
Abstract
In the last decade, several direct oral anticoagulants (DOAC; dabigatran,
rivaroxaban, apixaban, edoxaban) have been marketed for prophylaxis and/or
treatment of thromboembolism without having specific antidotes available
for their reversal. Current management of bleeding associated to DOAC
includes the removal of all antithrombotic medications and supportive
care. Non-specific procoagulant agents (prothrombin complex concentrates
and activated factor VIIa) have been used in case of serious bleeding.
Currently, some specific antidotes for the DOAC are under development.
Idarucizumab (BI 655075; Boehringer Ingelheim) is a fragment of an
antibody (Fab), which is a specific antidote to the oral direct thrombin
inhibitor dabigatran. Andexanet alfa (r-Antidote, PRT064445; Portola
Pharmaceuticals) is a truncated form of enzymatically inactive factor Xa,
which binds and reverses the anticoagulant action of the factor Xa
inhibitors (e.g.: rivaroxaban, apixaban and edoxaban). Aripazine (PER-977,
ciraparantag; Perosphere Inc.) is a synthetic small molecule (~500 Da)
that reverses oral dabigatran, apixaban, rivaroxaban, as well as
subcutaneous fondaparinux and LMWH in vivo. These antidotes could provide
an alternative for management of life-threatening bleeding events
occurring with the above-mentioned anticoagulants. In addition, the
specific antidote anivamersen (RB007; Regado Biosciences Inc.) is an RNA
aptamer in clinical development to reverse the anticoagulant effect of the
parenteral factor IXa inhibitor pegnivacogin, which is also in
development. This anticoagulant-antidote pair may provide an alternative
in situations in which a fast onset and offset of anticoagulation is
needed, like in patients undergoing cardiac surgery with extracorporeal
circulation, as an alternative to the heparin/protamine pair. This patent
review includes a description of the pharmacological characteristics of
the novel specific antidotes, the available results from completed
non-clinical and clinical studies and the description of ongoing clinical
trials with the new compounds.<br/>Copyright &#xa9; 2014 Bentham Science
Publishers.

<30>
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. <br/>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). <br/>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. <br/>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.<br/>Copyright &#xa9; 2019 Elsevier Inc.

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

<32>
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. <br/>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). <br/>Setting(s): Operating room.
<br/>Patient(s): Cardiac surgical patients. <br/>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.
<br/>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). <br/>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.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<33>
[Use Link to view the full text]
Accession Number
632798998
Title
Cardiovascular morbidity in a randomized trial comparing GnRH agonist and
GnRH antagonist among patients with advanced prostate cancer and
preexisting cardiovascular disease.
Source
Journal of Urology. 202 (6) (pp 1199-1207), 2019. Date of Publication:
2019.
Author
Margel D.; Peer A.; Ber Y.; Shavit-Grievink L.; Tabachnik T.; Sela S.;
Witberg G.; Baniel J.; Kedar D.; Duivenvoorden W.C.M.; Rosenbaum E.;
Pinthus J.H.
Institution
(Margel, Ber, Shavit-Grievink, Tabachnik, Sela, Baniel, Kedar) Division of
Urology, Rabin Medical Center, Petach Tikva, Israel
(Shavit-Grievink, Rosenbaum) Davidoff Cancer Centre, Rabin Medical Center,
Petach Tikva, Israel
(Witberg) Department of Cardiology, Rabin Medical Center, Petach Tikva,
Israel
(Margel, Baniel, Kedar) Sackler Faculty of Medicine, Tel Aviv University,
Tel Aviv, Israel
(Peer) Department of Oncology, Rappaport Faculty of Medicine,
Technion-Israel Institute of Technology, Haifa, Israel
(Duivenvoorden, Pinthus) Division of Urology, Department of Surgery,
McMaster University, Hamilton, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose:Androgen deprivation therapy may increase the risk of
cardiovascular disease. Limited data suggest that GnRH
(gonadotropin-releasing hormone) antagonist may be associated with a lower
risk of cardiovascular disease than GnRH agonist.Materials and Methods:We
performed a phase II, randomized, open label study in men with prostate
cancer and preexisting cardiovascular disease who were randomized to
receive GnRH agonists or antagonists for 1 year. The primary outcome was
endothelial function measured by the EndoPAT 2000 device (Itamar Medical,
Caesarea, Israel). The predefined secondary outcome was a new
cardiovascular event. Patients were followed for the development of
cardiovascular disease, defined as death, myocardial infarction, a
cerebrovascular event, percutaneous angioplasty with coronary stent
insertion or hospitalizations due to cardiac events. <br/>Result(s):A
total of 80 patients were enrolled in study, including 41 and 39 who
received GnRH antagonist and agonist, respectively. Patients in each arm
had similar baseline characteristics. We did not detect a difference in
the primary end point (endothelial function) between the groups (mean +/-
SD reactive hyperemia index 2.07 +/- 0.15 vs 1.92 +/- 0.11, p=0.42).
However, during the trial period a new cardiovascular event (the secondary
end point) developed in 15 patients. Of cases new major cardiovascular and
cerebrovascular events developed in 9, including death in 2, myocardial
infarction in 1, a cerebrovascular event in 2 and percutaneous angioplasty
with coronary stent insertion in 4. Of the patients 20% randomized to GnRH
agonist experienced a major cardiovascular and cerebrovascular event
compared to 3% of those on GnRH antagonist (p=0.013). The absolute risk
reduction in major cardiovascular and cerebrovascular events at 12 months
using GnRH antagonist was 18.1% (95% CI 4.6-31.2, p=0.032).
<br/>Conclusion(s):To our knowledge this is the first prospective study to
test cardiovascular outcomes among patients with prostate cancer who
received androgen deprivation therapy. No differences in the primary end
point were noted between the study arms. However, the secondary end point
revealed that patients treated with GnRH agonist experienced significantly
more major cardiovascular and cerebrovascular events than those treated
with GnRH antagonist. These phase II results suggest that in patients with
prostate cancer who have preexisting cardiovascular disease selecting the
androgen deprivation therapy modality may differentially affect cardiac
outcomes.<br/>Copyright &#xa9; 2019 by American Urological Association
Education and Research, Inc.

<34>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2020 The American Association for Thoracic
Surgery

<35>
Accession Number
2007784408
Title
Modulation of Cardiovascular Risk by Monogenic and Polygenic Determinants
of Low-Density Lipoprotein Cholesterol^: Winner.
Source
Journal of Clinical Lipidology. Conference: National Lipid Association
2020 Scientific Sessions. United States. 14 (4) (pp 555-556), 2020. Date
of Publication: July - August 2020.
Author
Trinder M.; Paquette M.; Cermakova L.; Ban M.; Hegele R.; Mancini G.B.J.;
Francis G.; Baass A.; Brunham L.
Publisher
Elsevier Ltd
Abstract
Lead Author's Financial Disclosure: M.T. is supported by a Vanier Canada
Graduate Scholarship. Study Funding: This project was by a Sector
Improvement Program project from Genome BC. M.T. is supported by a Vanier
Canada Graduate Scholarship. L.R.B. is supported by a Michael Smith
Foundation for Health Research Scholar Award and is a Canada Research
Chair in Preci. Background/Synopsis: Familial hypercholesterolemia (FH) is
the most common autosomal dominant genetic disorder and is caused by
pathogenic mutations in the LDLR, APOB, or PCSK9 genes. FH leads to
lifelong elevations in low-density lipoprotein cholesterol (LDL-C) and
increases the risk of atherosclerotic cardiovascular disease (ASCVD).
However, many individuals with suspected FH have a polygenic, rather than
a monogenic etiology for their condition. It is unclear if the genetic
cause of hypercholesterolemia alters the risk of ASCVD. Objective/Purpose:
Our objectives were to: 1) compare the cardiovascular risk of monogenic
and polygenic hypercholesterolemia among patients with similar LDL-C
levels, and 2) assess the influence of an LDL-C polygenic score on risk of
ASCVD among individuals with monogenic FH. <br/>Method(s): We used
genotyping array and exome sequencing data to identify individuals with FH
or polygenic hypercholesterolemia in 48,741 individuals from the UK
Biobank (weighted LDL-C polygenic score >95th percentile using 223-single
nucleotide variants). We examined the influence of genotype on risk of
coronary/carotid revascularization, myocardial infarction, stoke, and
all-cause mortality among the study population, and among individuals with
FH (n=277), polygenic hypercholesterolemia (n=2,379), or undetermined
etiology of hypercholesterolemia (n=2,232) that were matched for LDL-C
levels measured at study enrollment. Additionally, we used a fixed-effect
meta-analysis to assess the influence of LDL-C polygenic scores on LDL-C
levels and ASCVD risk for individuals with monogenic FH, using data from
the British Columbia FH registry (n=275); Nutrition, Metabolism and
Atherosclerosis Clinic registry (n=552); and UK Biobank (n=277).
<br/>Result(s): Firstly, we identified 277 individuals from the UK Biobank
with suspected genetic FH (1 in 176). Individuals with FH were
significantly more likely to experience an ASCVD event at an age of
55-years-old or younger relative to those without FH (6.14% versus 2.04%:
p<0.001). Among individuals with comparable levels of LDL-C, both FH
(hazard ratio [95% confidence interval]: 1.93 [1.32-2.82]; p<0.001) and
polygenic hypercholesterolemia (hazard ratio [95% confidence interval]:
1.26 [1.03-1.55]; p=0.02) significantly increased the risk of ASCVD
relative to individuals with hypercholesterolemia that did not have an
identified genetic cause. Secondly, in the meta-analysis, an elevated
LDL-C polygenic score was associated with significantly increased risk of
ASCVD (hazard ratio [95% confidence interval] = 1.55 [1.15-2.08],
p=0.004). <br/>Conclusion(s): Our data establish that monogenic FH is
associated with a greater risk of ASCVD than polygenic
hypercholesterolemia. Furthermore, among individuals with monogenic FH,
polygenic contributions to LDL-C may help explain some of the
heterogeneity in ASCVD risk. [Formula presented]<br/>Copyright &#xa9; 2020

<36>
[Use Link to view the full text]
Accession Number
632824063
Title
Effect of intrathecal morphine plus patient-controlled analgesia with
morphine versus patient-controlled analgesia with morphine alone on total
morphine dose 24 hours post-surgery: a systematic review.
Source
JBI evidence synthesis. 18 (8) (pp 1611-1640), 2020. Date of Publication:
01 Aug 2020.
Author
Pitre L.; Garbee D.; Tipton J.; Schiavo J.; Pitt A.
Institution
(Pitre) School of Nursing, United States 2The Louisiana Centre for
Promotion of Optimal Health Outcomes: A JBI Centre of Excellence 3School
of Dentistry, Louisiana State University Health Sciences Center, New
Orleans, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this review was to evaluate the effects of
preoperative intrathecal morphine (ITM) in addition to patient-controlled
analgesia with morphine (PCAM) versus PCAM without preoperative ITM on
total morphine dose in the first 24 hours postoperatively in adult
patients undergoing abdominal or thoracic surgery. INTRODUCTION:
Postoperative pain is a significant problem for patients undergoing major
abdominal and thoracic surgery. Intrathecal morphine can reduce
postoperative pain and reduce intravenous (IV) morphine requirements
during the first 24 hours after surgery; however, the amount of IV
morphine dose reduction achieved has not been well established. This
knowledge could help anesthesia providers determine if ITM is an
appropriate analgesic option for patients. INCLUSION CRITERIA: This review
included studies with participants 18 years of age or older receiving
general anesthesia for abdominal or thoracic surgery. Studies were
included that used the intervention of preoperative ITM in addition to
PCAM versus PCAM without preoperative ITM. Total morphine dose in
milligrams during the first 24 hours after surgery was the outcome of
interest. <br/>METHOD(S): A search of PubMed and CINAHL was conducted for
studies published between January 1984 and October 2018 using the key
terms intrathecal, morphine, postoperative, pain, patient-controlled
analgesia and general anesthesia. Index terms and keywords from identified
articles were used to search CINAHL, Cochrane Central Register of
Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE,
ProQuest Dissertations and Theses/Nursing and Allied Health Databases, and
Scopus. The reference lists of articles that underwent critical appraisal
were searched for additional studies. Methodological quality was assessed
using the JBI Critical Appraisal Checklist for Randomized Controlled
Trials. Two independent reviewers assessed each selected article. Study
results were pooled in statistical meta-analysis using the JBI System for
the Unified Management, Assessment and Review of Information, and two
studies were described in narrative form. Differences in IV morphine dose
between the ITM plus PCAM and PCAM alone groups were calculated to produce
the weighted mean difference (WMD) utilizing a 95% confidence interval
(CI). Heterogeneity was assessed using chi and I values. Subgroup analysis
was conducted on two studies that included IV non-opioid analgesia in
addition to ITM and PCAM for postoperative analgesia. <br/>RESULT(S):
Seven RCTs with a total sample size of 352 patients were included in this
review. Five studies that evaluated postoperative total morphine dose in
milligrams with and without preoperative ITM were included for statistical
meta-analysis, with 277 participants from four countries. Total morphine
dose was significantly reduced in patients who received ITM (WMD = -24.44
mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without ITM. Subgroup
analysis of two studies involving 112 participants using IV acetaminophen
in addition to ITM and PCAM indicated no additional benefit after ITM was
already administered (WMD = -25.93, 95% CI -32.05 to -19.80 mg). Two
studies with 75 participants were described narratively because total
morphine dose was reported as median rather than mean values.
<br/>CONCLUSION(S): In this review, ITM provided a significant decrease in
overall total morphine dose during the first 24 hours after surgery in
abdominal surgery patients. The addition of IV non-opioids to the
postoperative analgesia protocol showed no additional reduction in
postoperative IV morphine dose between groups. SYSTEMATIC REVIEW
REGISTRATION NUMBER: PROSPERO CRD42018100613.

<37>
Accession Number
2007806824
Title
Oxygen Management During Cardiopulmonary Bypass: A Single-Center, 8-Year
Retrospective Cohort Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Grocott B.B.; Kashani H.H.; Maakamedi H.; Dutta V.; Hiebert B.; Rakar M.;
Grocott H.P.
Institution
(Grocott, Kashani, Maakamedi, Dutta, Grocott) Department of
Anesthesiology, Perioperative and Pain Medicine, University of Manitoba,
Winnipeg, MB, Canada
(Hiebert, Rakar) Cardiac Sciences Program, Winnipeg Regional Health
Authority, Winnipeg, MB, Canada
Publisher
W.B. Saunders
Abstract
Objective: To characterize the institutional oxygen management practices
during cardiopulmonary bypass (CPB) in patients undergoing cardiac
surgery, including any potential changes during an 8-year study period.
<br/>Design(s): A retrospective cohort study. <br/>Setting(s): A tertiary
care cardiac surgical program. <br/>Participant(s): Patients who underwent
cardiac surgery involving CPB, with or without hypothermic circulatory
arrest (HCA), between January 1, 2010, and December 31, 2017.
<br/>Measurements and Main Results: In addition to baseline patient
characteristics, the authors recorded the partial pressures of arterial
oxygen (PaO<inf>2</inf>), fraction of inspired oxygen, and mixed venous
oxygen saturation during CPB of 696 randomly selected patients during an
8-year study period. The overall mean PaO<inf>2</inf> was 255 +/- 48 mmHg,
without any significant change during the 8-year study period (p = 0.30).
The mean PaO<inf>2</inf> of HCA patients was significantly higher than in
patients without HCA (327 +/- 93 mmHg v 252 +/- 45 mmHg, respectively; p <
0.001). <br/>Conclusion(s): The current approach to oxygen management
during CPB at the authors' institution is within the range of hyperoxemic
levels, and these practices have not changed over time. The impact of
these practices on patients' outcomes is not fully understood, and
additional studies are needed to establish firm evidence to guide optimal
oxygen management practice during CPB.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<38>
Accession Number
2007794437
Title
Neutrophil Gelatinase-Associated Lipocalin Measured on Clinical Laboratory
Platforms for the Prediction of Acute Kidney Injury and the Associated
Need for Dialysis Therapy: A Systematic Review and Meta-analysis.
Source
American Journal of Kidney Diseases. (no pagination), 2020. Date of
Publication: 2020.
Author
Albert C.; Zapf A.; Haase M.; Rover C.; Pickering J.W.; Albert A.; Bellomo
R.; Breidthardt T.; Camou F.; Chen Z.; Chocron S.; Cruz D.; de Geus
H.R.H.; Devarajan P.; Di Somma S.; Doi K.; Endre Z.H.; Garcia-Alvarez M.;
Hjortrup P.B.; Hur M.; Karaolanis G.; Kavalci C.; Kim H.; Lentini P.;
Liebetrau C.; Lipcsey M.; Martensson J.; Muller C.; Nanas S.; Nickolas
T.L.; Pipili C.; Ronco C.; Rosa-Diez G.J.; Ralib A.; Soto K.;
Braun-Dullaeus R.C.; Heinz J.; Haase-Fielitz A.
Institution
(Albert, Braun-Dullaeus) University Clinic for Cardiology and Angiology,
Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
(Zapf) Department of Medical Biometry and Epidemiology, University Medical
Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
(Haase) Faculty of Medicine, Otto-von-Guericke University, Magdeburg,
Germany
(Albert, Haase, Albert) Diaverum Renal Services Germany, Potsdam, Germany
(Rover, Heinz) Department of Medical Statistics, University Medical Center
Gottingen, Gottingen, Germany
(Pickering) Department of Medicine, University of Otago Christchurch;
Emergency Department, Christchurch Hospital, Christchurch, New Zealand
(Albert) Department for Nephrology and Endocrinology, Klinikum Ernst von
Bergmann, Potsdam, Germany
(Bellomo) Department of Intensive Care, The Austin Hospital, Melbourne,
Australia
(Bellomo) Centre for Integrated Critical Care, The University of
Melbourne, Melbourne, Australia
(Breidthardt, Muller) Department of Internal Medicine, University Hospital
Basel, Basel, Switzerland
(Breidthardt, Muller) Department of Nephrology, University Hospital Basel,
Basel, Switzerland
(Breidthardt, Muller) Department of Cardiology, University Hospital Basel,
Basel, Switzerland
(Camou) Service de reanimation medicale, hopital Saint-Andre, CHU de
Bordeaux, France
(Chen) Department of Critical Care Medicine, Nanfang Hospital, Southern
Medical University, Guangdong, China
(Chocron) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Cruz) Division of Nephrology-Hypertension, University of California, San
Diego, CA, United States
(de Geus) Department of Intensive Care, Erasmus University Medical Center,
Rotterdam, Netherlands
(Devarajan) Division of Nephrology and Hypertension, Cincinnati Children's
Hospital, University of Cincinnati, Cincinnati, OH
(Di Somma) Emergency Medicine, Department of Medical-Surgery Sciences and
Translational Medicine, Sapienza' University of Rome S. Andrea Hospital,
Rome, Italy
(Doi) Department of Emergency and Critical Care Medicine, The University
of Tokyo, Tokyo, Japan
(Endre) Department of Nephrology, Prince of Wales Hospital and Clinical
School, University of New South Wales, Sydney, Australia
(Garcia-Alvarez) Department of Anesthesiology, Hospital de la Santa Creu i
Sant Pau, Barcelona, Spain
(Hjortrup) Department of Intensive Care, Copenhagen University Hospital,
Copenhagen, Denmark
(Hur, Kim) Department of Laboratory Medicine, Konkuk University School of
Medicine, Seoul, South Korea
(Karaolanis) Vascular Unit, First Department of Surgery, "Laiko" General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens, Greece
(Kavalci) Emergency Department, Baskent University Faculty of Medicine,
Ankara, Turkey
(Lentini) Department of Nephrology and Dialysis, San Bassiano Hospital,
Bassano del Grappa, Italy
(Liebetrau) Department of Cardiology, Kerckhoff Clinic, Bad Nauheim,
Germany
(Lipcsey) CIRRUS, Hedenstierna laboratory, Anaesthesiology and Intensive
care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
(Martensson) Section of Anaesthesia and Intensive Care Medicine,
Department of Physiology and Pharmacology, Karolinska Institutet,
Stockholm, Sweden
(Nanas, Pipili) First Critical Care Department, 'Evangelismos' General
Hospital, National and Kapodistrian University of Athens, Athens, Greece
(Nickolas) Columbia University Vagelos College of Physicians and Surgeons,
New York, NY, United States
(Ronco) Department of Nephrology, Dialysis & Transplantation, University
of Padova, Vicenza, Italy
(Ronco) International Renal Research Institute, San Bortolo Hospital,
Vicenza, Italy
(Rosa-Diez) Department of Nephrology, Dialysis and Transplantation,
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
(Ralib) Department of Anaesthesiology and Intensive Care, International
Islamic University Malaysia, Pahang, Malaysia
(Soto) Department of Nephrology, Hospital Fernando Fonseca, Lisbon,
Portugal
(Soto) CEAUL, Centro de Estatistica e Aplicacoes da Universidade de
Lisboa, Lisbon, Portugal
(Haase-Fielitz) Department of Cardiology, Immanuel Diakonie Bernau, Heart
Center Brandenburg, Brandenburg Medical School Theodor Fontane, Faculty of
Health Sciences, University of Potsdam, Potsdam, Germany
Publisher
W.B. Saunders
Abstract
Rationale & Objective: The usefulness of measures of neutrophil
gelatinase-associated lipocalin (NGAL) in urine or plasma obtained on
clinical laboratory platforms for predicting acute kidney injury (AKI) and
AKI requiring dialysis (AKI-D) has not been fully evaluated. We sought to
quantitatively summarize published data to evaluate the value of urinary
and plasma NGAL for kidney risk prediction. <br/>Study Design:
Literature-based meta-analysis and individual-study-data meta-analysis of
diagnostic studies following PRISMA-IPD guidelines. Setting & Study
Populations: Studies of adults investigating AKI, severe AKI, and AKI-D in
the setting of cardiac surgery, intensive care, or emergency department
care using either urinary or plasma NGAL measured on clinical laboratory
platforms. Selection Criteria for Studies: PubMed, Web of Science,
Cochrane Library, Scopus, and congress abstracts ever published through
February 2020 reporting diagnostic test studies of NGAL measured on
clinical laboratory platforms to predict AKI. <br/>Data Extraction:
Individual-study-data meta-analysis was accomplished by giving authors
data specifications tailored to their studies and requesting standardized
patient-level data analysis. Analytical Approach: Individual-study-data
meta-analysis used a bivariate time-to-event model for interval-censored
data from which discriminative ability (AUC) was characterized. NGAL
cutoff concentrations at 95% sensitivity, 95% specificity, and optimal
sensitivity and specificity were also estimated. Models incorporated as
confounders the clinical setting and use versus nonuse of urine output as
a criterion for AKI. A literature-based meta-analysis was also performed
for all published studies including those for which the authors were
unable to provide individual-study data analyses. <br/>Result(s): We
included 52 observational studies involving 13,040 patients. We analyzed
30 data sets for the individual-study-data meta-analysis. For AKI, severe
AKI, and AKI-D, numbers of events were 837, 304, and 103 for analyses of
urinary NGAL, respectively; these values were 705, 271, and 178 for
analyses of plasma NGAL. Discriminative performance was similar in both
meta-analyses. Individual-study-data meta-analysis AUCs for urinary NGAL
were 0.75 (95% CI, 0.73-0.76) and 0.80 (95% CI, 0.79-0.81) for severe AKI
and AKI-D, respectively; for plasma NGAL, the corresponding AUCs were 0.80
(95% CI, 0.79-0.81) and 0.86 (95% CI, 0.84-0.86). Cutoff concentrations at
95% specificity for urinary NGAL were >580 ng/mL with 27% sensitivity for
severe AKI and >589 ng/mL with 24% sensitivity for AKI-D. Corresponding
cutoffs for plasma NGAL were >364 ng/mL with 44% sensitivity and >546
ng/mL with 26% sensitivity, respectively. <br/>Limitation(s): Practice
variability in initiation of dialysis. Imperfect harmonization of data
across studies. <br/>Conclusion(s): Urinary and plasma NGAL concentrations
may identify patients at high risk for AKI in clinical research and
practice. The cutoff concentrations reported in this study require
prospective evaluation.<br/>Copyright &#xa9; 2020 National Kidney
Foundation, Inc.

<39>
Accession Number
631756594
Title
Cardiovascular magnetic resonance native T<inf>2</inf> and T<inf>2</inf>
^* quantitative values for cardiomyopathies and heart
transplantations: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Magnetic Resonance. 22 (1) (no pagination),
2020. Article Number: 34. Date of Publication: 11 May 2020.
Author
Snel G.J.H.; Van Den Boomen M.; Hernandez L.M.; Nguyen C.T.; Sosnovik
D.E.; Velthuis B.K.; Slart R.H.J.A.; Borra R.J.H.; Prakken N.H.J.
Institution
(Snel, Van Den Boomen, Hernandez, Borra, Prakken) Department of Radiology,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, Groningen 9713 GZ, Netherlands
(Van Den Boomen, Nguyen, Sosnovik) Department of Radiology, Athinoula A.
Martinos Center for Biomedical Imaging, Massachusetts General Hospital,
Harvard Medical School, 149 13th Street, Charlestown, MA 02129, United
States
(Nguyen, Sosnovik) Cardiovascular Research Center, Massachusetts General
Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129,
United States
(Sosnovik) Division of Health Sciences and Technology, Harvard-MIT, 7
Massachusetts Avenue, Cambridge, MA 02139, United States
(Velthuis) Department of Radiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht 3584 CX, Netherlands
(Slart, Borra) Department of Nuclear Medicine and Molecular Imaging,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, Groningen 9713 GZ, Netherlands
(Slart) Department of Biomedical Photonic Imaging, University of Twente,
Dienstweg 1, Enschede 7522 ND, Netherlands
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Background: The clinical application of cardiovascular magnetic resonance
(CMR) T<inf>2</inf> and T<inf>2</inf> ^* mapping is currently
limited as ranges for healthy and cardiac diseases are poorly defined. In
this meta-analysis we aimed to determine the weighted mean of
T<inf>2</inf> and T<inf>2</inf> ^* mapping values in patients
with myocardial infarction (MI), heart transplantation, non-ischemic
cardiomyopathies (NICM) and hypertension, and the standardized mean
difference (SMD) of each population with healthy controls. Additionally,
the variation of mapping outcomes between studies was investigated.
<br/>Method(s): The PRISMA guidelines were followed after literature
searches on PubMed and Embase. Studies reporting CMR T<inf>2</inf> or
T<inf>2</inf> ^* values measured in patients were included. The
SMD was calculated using a random effects model and a meta-regression
analysis was performed for populations with sufficient published data.
<br/>Result(s): One hundred fifty-four studies, including 13,804 patient
and 4392 control measurements, were included. T<inf>2</inf> values were
higher in patients with MI, heart transplantation, sarcoidosis, systemic
lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM),
dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87,
1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with
controls. T<inf>2</inf> values in iron overload patients (SMD =-0.54, P =
0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both
not differ from controls. T<inf>2</inf> ^* values were lower in
patients with MI and iron overload (SMD of-1.99 and-2.39, respectively, P
< 0.01) compared with controls. T<inf>2</inf> ^* values in HCM
patients (SMD =-0.61, P = 0.22), DCM patients (SMD =-0.54, P = 0.06) and
hypertension patients (SMD =-1.46, P = 0.10) did not differ from controls.
Multiple CMR acquisition and patient demographic factors were assessed as
significant covariates, thereby influencing the mapping outcomes and
causing variation between studies. <br/>Conclusion(s): The clinical
utility of T<inf>2</inf> and T<inf>2</inf> ^* mapping to
distinguish affected myocardium in patients with cardiomyopathies or heart
transplantation from healthy myocardium seemed to be confirmed based on
this meta-analysis. Nevertheless, variation of mapping values between
studies complicates comparison with external values and therefore require
local healthy reference values to clinically interpret quantitative
values. Furthermore, disease differentiation seems limited, since changes
in T<inf>2</inf> and T<inf>2</inf> ^* values of most
cardiomyopathies are similar.<br/>Copyright &#xa9; 2020 The Author(s).

<40>
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. <br/>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. <br/>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]. <br/>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.<br/>&#xa9; Copyright &#xa9; 2020
Wang, Luo, Li, Zhang, Wu and Yan.

<41>
[Use Link to view the full text]
Accession Number
632514566
Title
Continuous Lactate Measurement Devices and Implications for Critical Care:
A Literature Review.
Source
Critical Care Nursing Quarterly. 43 (3) (pp 269-273), 2020. Date of
Publication: 01 Jul 2020.
Author
Chavez J.; Glaser S.; Krom Z.
Institution
(Chavez, Krom) Critical Care Services, Cedars-Sinai Medical Center, 8700
Beverly Blvd, Los Angeles, CA 90048, United States
(Glaser) SSG Nurse Anesthesia Incorporated, Los Angeles, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this article is to review the literature on lactate
measurements in critical care and the current devices used to measure
noninvasively and invasively. Lactate measurements are currently being
used as a way to measure the severity of sepsis. Intravascular and
subcutaneous devices are some of the ways that these measurements can be
continuously gathered as well as point-of-care blood tests. New devices
that are being currently used with athletes can measure lactate
noninvasively. As the advance of technology continues to move at a fast
speed, an evaluation of literature is needed to assess the continued
support of lactate and the ability to move to noninvasive devices in
critical care. A literature search was conducted in February 2020, using
PubMed, CINAHL, MEDLINE, and Cochrane databases. There remains support for
the use of lactate and continuous lactate monitoring; however, currently,
noninvasive devices are not available for the critical care environment.
There are invasive techniques that are being used to measure lactate
continuously in critical care and are beneficial for the cardiac surgery
population. The review of the literature on continuous lactate
measurements produced evidence that supports prediction of morbidity and
mortality. There are no current noninvasive lactate measurement devices
that can be used in critical care, but they are being currently used in
the athletic community. Invasive continuous lactate measurement devices
are currently being used and beneficial.<br/>Copyright &#xa9; 2020
Lippincott Williams and Wilkins. All rights reserved.

<42>
Accession Number
632502377
Title
Nasal decolonization of staphylococcus aureus and the risk of surgical
site infection after surgery: A meta-Analysis.
Source
Annals of Clinical Microbiology and Antimicrobials. 19 (1) (no
pagination), 2020. Article Number: 33. Date of Publication: 30 Jul 2020.
Author
Tang J.; Hui J.; Ma J.; Mingquan C.
Institution
(Tang, Mingquan) Department of Infectious Diseases and Hepatology, Huashan
Hospital, Fudan University, Shanghai 200040, China
(Hui) Department of Infectious Diseases, First Affiliated Hospital of
Zhejiang University, Hangzhou 310003, China
(Ma) Department of Endocrinology and Metabolism, Gansu Provincial
Hospital, Lanzhou 730000, China
(Mingquan) Department of Emergency, Huashan Hospital, Fudan University,
Shanghai 200040, China
Publisher
BioMed Central (E-mail: info@biomedcentral.com)
Abstract
Aim: To assess the effects of nasal decontamination on preventing surgical
site infections (SSIs) in people who are Staphylococcus aureus carriers
undergoing different types of surgeries and diverse measures of
decolonization. <br/>Method(s): Relevant randomized controlled trials
(RCTs) were identified through systematic searches of the PubMed, Embase,
Web of science, and the Cochrane Library databases. The risk ratios (RRs)
and 95% confidence intervals (CIs) were calculated and the effects model
was chosen according to the heterogeneity. Subgroup analyses were
performed according to different types of surgeries and measures of
decolonization that Staphylococcus aureus carriers were applied.
<br/>Result(s): Twenty RCTs published between 1996 and 2019 involving
10,526 patients were included. Pooled results showed that the overall SSIs
and pulmonary surgery SSIs presented with a statistical difference in
measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both
p < 0.01). However, the associations between nasal decolonization and
increased risks of SSIs in orthopedics surgery or cardiovascular surgery
remained insignificant in studies. As for the diverse measures of nasal
decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used
different types of antimicrobial drugs, and 5% use others. The SSIs rate
were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259-0.864), while
no significant difference was shown in the use of mupirocin (RR = 0.871,
95% CI 0.544-1.394). <br/>Conclusion(s): It seems that nasal
decolonization of Staphylococcus aureus may be associated with a reduction
of SSIs in these patients, especially in patients who have been
administered by pulmonary surgeries or treated with
chlorhexidine.<br/>Copyright &#xa9; 2020 The Author(s).

<43>
Accession Number
2004805145
Title
Patients who do not complete cardiac rehabilitation have an increased risk
of cardiovascular events during long-term follow-up.
Source
Netherlands Heart Journal. 28 (9) (pp 460-466), 2020. Date of Publication:
01 Sep 2020.
Author
Sunamura M.; ter Hoeve N.; van den Berg-Emons R.J.G.; Boersma E.;
Geleijnse M.L.; van Domburg R.T.
Institution
(Sunamura, ter Hoeve) Capri Cardiac Rehabilitation, Rotterdam, Netherlands
(ter Hoeve, van den Berg-Emons) Department of Rehabilitation Medicine,
Erasmus University Medical Center, Rotterdam, Netherlands
(Boersma, Geleijnse, van Domburg) Department of Cardiology, Thorax center,
Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: Cardiac rehabilitation (CR) has favourable effects on
cardiovascular mortality and morbidity. Therefore, it might reasonable to
expect that incomplete CR participation will result in suboptimal patient
outcomes. <br/>Method(s): We studied the 914 post-acute coronary syndrome
patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE)
trial. They all started a 'standard' CR programme, with physical exercises
(group sessions) twice a week for 12 weeks. Incomplete CR was defined as
participation in <75% of the scheduled exercise sessions. Patients were
followed-up for 2.7 years, and the incidence of cardiac events was
recorded. Major adverse cardiac events (MACE) included all-cause
mortality, non-fatal myocardial infarction and coronary revascularisation.
<br/>Result(s): A total of 142 (16%) patients had incomplete CR. They had
a higher incidence of MACE than their counterparts who completed CR (11.3%
versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval
[CI] 1.47-5.26). Furthermore, the incidence of any cardiac event,
including MACE and coronary revascularisation, was higher (20.4% versus
11.0%, aHR 1.54; 95% CI 0.98-2.44). Patients with incomplete CR were more
often persistent smokers than those who completed CR (31.7% versus 11.5%),
but clinical characteristics were similar otherwise. <br/>Conclusion(s):
Post-ACS patients who did not complete a 'standard' 12-week CR programme
had a higher incidence of adverse cardiac events during long-term
follow-up than those who completed the programme. Since CR is proven
beneficial, further research is needed to understand the reasons why
patients terminate prematurely.<br/>Copyright &#xa9; 2020, The Author(s).

<44>
[Use Link to view the full text]
Accession Number
632434613
Title
Effects of Different Doses of Remote Ischemic Preconditioning on Kidney
Damage among Patients Undergoing Cardiac Surgery: A Single-Center
Mechanistic Randomized Controlled Trial.
Source
Critical Care Medicine. 48 (8) (pp E690-E697), 2020. Date of Publication:
01 Aug 2020.
Author
Meersch M.; Kullmar M.; Pavenstadt H.; Rossaint J.; Kellum J.A.; Martens
S.; Klausmeyer P.; Schmidt E.A.; Kerschke L.; Zarbock A.
Institution
(Meersch, Kullmar, Rossaint, Klausmeyer, Schmidt, Zarbock) Department of
Anaesthesiology, Intensive Care Medicine and Pain Medicine, University
Hospital Munster, Munster, Germany
(Pavenstadt) Department of Medicine, Division D, Nephrology, University
Hospital Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Martens) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Kerschke) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: We have previously shown that remote ischemic preconditioning
reduces acute kidney injury (acute kidney injury) in high-risk patients
undergoing cardiopulmonary bypass and that the protective effect is
confined to patients who exhibit an increased urinary tissue inhibitor of
metalloproteinases-2 and insulin-like growth factor-binding protein 7 in
response to remote ischemic preconditioning. The purpose of this study was
to determine the optimal intensity of remote ischemic preconditioning to
induce required [tissue inhibitor of metalloproteinases-2]*[insulin-like
growth factor-binding protein 7] changes and further explore mechanisms of
remote ischemic preconditioning. <br/>Design(s): Observational and
randomized controlled, double-blind clinical trial. <br/>Setting(s):
University Hospital of Muenster, Germany. <br/>Patient(s): High-risk
patients undergoing cardiac surgery as defined by the Cleveland Clinic
Foundation Score. <br/>Intervention(s): In the interventional part,
patients were randomized to receive either one of four different remote
ischemic preconditioning doses (3 x 5 min, 3 x 7 min, 3 x 10 min remote
ischemic preconditioning, or 3 x 5 min remote ischemic preconditioning + 2
x 10 min remote ischemic preconditioning in nonresponders) or sham-remote
ischemic preconditioning (control). <br/>Measurements and Main Results:
The primary endpoint of the interventional part was change in urinary
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] between pre- A nd postintervention. To examine
secondary objectives including acute kidney injury incidence, we included
an observational cohort. A total of 180 patients were included in the
trial (n = 80 observational and n = 100 randomized controlled part [20
patients/group]). The mean age was 69.3 years (10.5 yr), 119 were men
(66.1%). Absolute changes in [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7] were
significantly higher in all remote ischemic preconditioning groups when
compared with controls (p < 0.01). Although we did not observe a
dose-response relationship on absolute changes in [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7]
across the four different remote ischemic preconditioning groups, in the
15 patients failing to respond to the lowest dose, nine (60%) responded to
a subsequent treatment at a higher intensity. Compared with controls,
fewer patients receiving remote ischemic preconditioning developed acute
kidney injury within 72 hours after surgery as defined by both Kidney
Disease: Improving Global Outcomes criteria (30/80 [37.5%] vs 61/100
[61.0%]; p = 0.003). <br/>Conclusion(s): All doses of remote ischemic
preconditioning significantly increased [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7] and
significantly decreased acute kidney injury compared with controls.
High-dose remote ischemic preconditioning could stimulate [tissue
inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding
protein 7] increases in patients refractory to low-dose remote ischemic
preconditioning.<br/>Copyright &#xa9; 2020 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<45>
Accession Number
2007682982
Title
The effects of taurine supplementation on obesity, blood pressure and
lipid profile: A meta-analysis of randomized controlled trials.
Source
European Journal of Pharmacology. 885 (no pagination), 2020. Article
Number: 173533. Date of Publication: 15 October 2020.
Author
Guan L.; Miao P.
Institution
(Guan) Gastroenterology Department, The First Hospital of China Medical
University, No.155 North Nanjing Street Heping District, Shenyang,
Liaoning 110001, China
(Miao) General Surgery Department, The First Hospital of China Medical
University, No.155 North Nanjing Street Heping District, Shenyang,
Liaoning 110001, China
Publisher
Elsevier B.V.
Abstract
Taurine plays a pivotal role in regulating glucose and lipid metabolism,
blood pressure homeostasis, and obesity largely due to its cytoprotective,
antioxidant, and anti-inflammatory actions. Despite promising data from
animal studies in this scenario, the efficacy of taurine supplementation
in human studies has been inconsistent. The main objective of this
meta-analysis was to appraise the effects of taurine supplementation on
liver markers and, secondarily, to explore anthropometric measures as
well. Pubmed, SCOPUS, Web of Science, and Google Scholar were searched
from inception to April 2020. There were 12 eligible peer-reviewed studies
meeting the inclusion criteria. Most studies were conducted in patients
with liver or metabolic dysregulation (diabetes, hepatitis, fatty liver,
obesity, cystic fibrosis, chronic alcoholism, and cardiac surgery). The
taurine dosage varied from 0.5 to 6 g/d for 15 days to 6 months. Pooled
effect sizes suggested a significant effect of taurine administration on
systolic blood pressure (weighted mean difference (WMD): -4.67 mm Hg;
95%CI, -9.10 to -0.25), diastolic blood pressure (WMD: -2.90 mm Hg; 95%CI,
-4.29 to -1.52), total cholesterol (WMD: -10.87 mg/dl; 95%CI, -16.96 to
-4.79), and triglycerides (WMD: -13.05 mg/dl; 95%CI, -25.88 to -0.22);
however, it had no effect on fasting blood glucose (WMD: 0.06 mg/dl),
HDL-C (WMD: 0.90 mg/dl), LDL-C (WMD: -6.17 mg/dl), as well as on body mass
index (WMD: -0.46 kg/m²) and body weight (WMD: -0.47 kg) as the
anthropometric measures. These findings indicate that, in patients with
liver dysregulation, taurine supplementation can lower blood pressure and
improve the lipid profile by reducing total cholesterol and triglyceride
levels.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<46>
Accession Number
2006915539
Title
Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic
Review and Meta-analysis.
Source
European Journal of Vascular and Endovascular Surgery. 60 (3) (pp
469-478), 2020. Date of Publication: September 2020.
Author
Daud A.; Kaur B.; McClure G.R.; Belley-Cote E.P.; Harlock J.; Crowther M.;
Whitlock R.P.
Institution
(Daud) Faculty of Medicine, University of Toronto, Toronto, Canada
(Kaur, McClure, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(McClure, Harlock) Division of Vascular Surgery, Department of Surgery,
McMaster University, Hamilton, ON, Canada
(Belley-Cote, Crowther) Department of Medicine, McMaster University and St
Joseph's Hospital, Hamilton, ON, Canada
(Belley-Cote, Whitlock) Population Health Research Institute, Hamilton,
ON, Canada
(Whitlock) Division of Cardiac Surgery, McMaster University, Hamilton, ON,
Canada
Publisher
W.B. Saunders Ltd
Abstract
Objective: In vascular and cardiac surgery, the ability to maintain
haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin
based sealants were introduced as a means to prevent or halt bleeding
during surgery. Whether fibrin and thrombin sealants affect surgical
outcomes is poorly established. A systematic review and meta-analysis was
performed to examine the impact of fibrin or thrombin sealants on patient
outcomes in vascular and cardiac surgery. Data sources: Cochrane CENTRAL,
Embase, and MEDLINE, as well as trial registries, conference abstracts,
and reference lists of included articles were searched from inception to
December 2019. Review methods: Studies comparing the use of fibrin or
thrombin sealant with either an active (other haemostatic methods) or
standard surgical haemostatic control in vascular and cardiac surgery were
searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk
Of Bias In Non-randomised Studies - of Interventions) were used to assess
the risk of bias of the included randomised and non-randomised studies;
quality of evidence was assessed by the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) framework. Two reviewers
screened studies, assessed risk of bias, and extracted data independently
and in duplicate. Data from included trials were pooled using a random
effects model. <br/>Result(s): Twenty-one studies (n = 7 622 patients)
were included: 13 randomised controlled trials (RCTs), five retrospective,
and three prospective cohort studies. Meta-analysis of the RCTs showed a
statistically significant decrease in the volume of blood lost (mean
difference 120.7 mL, in favour of sealant use [95% confidence interval
{CI} -150.6 - -90.7; p < .001], moderate quality). Time to haemostasis was
also shown to be reduced in patients receiving sealant (mean difference
-2.5 minutes [95% CI -4.0 - -1.1; p < .001], low quality). Post-operative
blood transfusions, re-operation due to bleeding, and 30 day mortality
were not significantly different for either RCTs or observational data.
<br/>Conclusion(s): The use of fibrin and thrombin sealants confers a
statistically significant but clinically small reduction in blood loss and
time to haemostasis; it does not reduce blood transfusion. These Results
may support selective rather than routine use of fibrin and thrombin
sealants in vascular and cardiac surgery.<br/>Copyright &#xa9; 2020
European Society for Vascular Surgery

<47>
Accession Number
2005252851
Title
Device-related epistaxis risk: continuous-flow left ventricular assist
device-supported patients.
Source
European Archives of Oto-Rhino-Laryngology. 277 (10) (pp 2767-2773), 2020.
Date of Publication: 01 Oct 2020.
Author
Koycu A.; Vural O.; Bahcecitapar M.; Jafarov S.; Beyazpinar G.; Beyazpinar
D.S.
Institution
(Koycu, Vural, Jafarov, Beyazpinar) Department of Otolaryngology, Head and
Neck Surgery, Faculty of Medicine, Baskent University, Ankara 06490,
Turkey
(Bahcecitapar) Department of Statistics, Faculty of Science, Hacettepe
University, Ankara 06800, Turkey
(Beyazpinar) Department of Cardiovascular Surgery, Faculty of Medicine,
Baskent University, Ankara 06490, Turkey
Publisher
Springer
Abstract
Background: The aim of this study was to analyze the effect of
device-dependent factors on epistaxis episodes comparing patients
supported with a continuous-flow left ventricular assist device (CF-LVAD)
to patients under the same antithrombotic therapy. <br/>Method(s):
Patients who underwent CF-LVAD between 2012 and 2018 were reviewed
retrospectively from the institutionally adopted electronic database.
Patients who underwent mitral valve replacement (MVR) surgery receiving
the same anticoagulant and antiaggregant therapy were included as a
control group. Demographics, epistaxis episodes, and nonepistaxis bleeding
between the two groups were compared. <br/>Result(s): A total of 179
patients met the inclusion criteria (61 patients CF-LVAD group, 118
patients MVR group). The median (range) follow-up periods for the study
(CF-LVAD) and control (MVR) groups were 370 (2819) and 545.70 (2356) days,
respectively. There was a significant difference for frequency of bleeding
episodes per month between CF-LVAD and MVR groups (p = 0.003 < 0.05). The
most common site of bleeding was the anterior septum in both groups (90.9%
for the CF-MVR group and 100% for the MVR group). While 14 patients (23%)
had nonepistaxis bleeding in the CF-LVAD group, only two patients (1.7%)
had nonepistaxis bleeding in the MVR group. There were significant
differences in nonepistaxis bleeding rates between the CF-LVAD and MVR
groups (chi²=19.79, p < 0.001). <br/>Conclusion(s): Both
epistaxis and nonepistaxis bleeding rates were higher in the CF-LVAD group
than in the MVR group. This suggests that the use of CF-LVAD support could
directly increase the risk of hemorrhagic complications. <br/>Level of
Evidence: 2A (Etiology/Harm)<br/>Copyright &#xa9; 2020, Springer-Verlag
GmbH Germany, part of Springer Nature.

<48>
Accession Number
2005018017
Title
"BAX602" in Preventing Surgical Adhesion after Extracorporeal Ventricular
Assist Device Implantation for Refractory Congestive Heart Failure: Study
Protocol for a Multicenter Randomized Clinical Trial.
Source
Cardiovascular Drugs and Therapy. 34 (5) (pp 651-657), 2020. Date of
Publication: 01 Oct 2020.
Author
Fukushima S.; Asakura K.; Hamasaki T.; Onda K.; Watanabe T.; Shiose A.;
Ono M.; Fukushima N.; Yamamoto H.; Fujita T.
Institution
(Fukushima, Fujita) Department of Cardiac Surgery, National Cerebral and
Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka 564-8565, Japan
(Asakura, Onda, Yamamoto) Department of Data Science, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Hamasaki) The Biostatistics Center and Department of Biostatistics and
Bioinformatics, George Washington University, Washington, DC, United
States
(Watanabe, Fukushima) Department of Transplant Medicine, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Shiose) Department of Cardiovascular Surgery, Kyushu University Hospital,
Fukuoka, Japan
(Ono) Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan
Publisher
Springer
Abstract
Background: The high surgical risk in redo cardiac surgery is largely
attributed to adhesions around the epicardium and the great vessels.
BAX602 is an adhesion prevention reagent composed of two synthetic
polyethylene glycols. Spraying BAX602 over the epicardium and the great
vessels reportedly contributes to adhesion prevention after pediatric
cardiac surgery. The present study aims to evaluate the safety and
effectiveness of BAX602 spray in patients undergoing extracorporeal
ventricular assist device implantation surgery to treat refractory
congestive heart failure. Methods and Design: This investigator-initiated,
multicenter, pivotal, two-arm, open-label, randomized trial will include a
total of 30 patients. The primary outcome measure is the severity of
adhesions, which will be evaluated during re-sternotomy surgery performed
2-12 weeks after the primary extracorporeal ventricular assist device
implantation surgery. The adhesion severity will be evaluated at five
predefined sites using a four-grade adhesion evaluation score (0 = no
adhesion; 1 = filmy and avascular adhesion; 2 = dense/vascular adhesion; 3
= cohesive adhesion). This measure will be summarized in two ways to
evaluate the effect of BAX602: (1) the total score of the severity of
adhesions at all five sites (ranging from 0 to 15), and (2) the total
number of sites with dense/vascular or cohesive adhesions (ranging from 0
to 5). Ethics and Dissemination: The study findings will be disseminated
at regional, national, and international conferences and through
peer-reviewed scientific journals. Trial Registration: The trial was
registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000038998)
on 6 January 2020.<br/>Copyright &#xa9; 2020, The Author(s).

<49>
Accession Number
2007747317
Title
49. A systematic review of spine surgery complications in the ambulatory
surgical center setting.
Source
Spine Journal. Conference: 35th Annual Meeting of the North American Spine
Society. 20 (9 Supplement) (pp S23-S24), 2020. Date of Publication:
September 2020.
Author
Hrynewycz N.; Brundage T.; Jenkins N.; Parrish J.; Singh K.
Institution
(Hrynewycz) ChicagoILUnited States
(Brundage) Midwest Orthopedics at Rush, Chicago, IL, United States
(Jenkins, Parrish, Singh) Rush University Medical Center, Chicago, IL,
United States
Publisher
Elsevier Inc.
Abstract
BACKGROUND CONTEXT: In recent years, a combination of improved anesthesia,
surgical techniques, and technological advances have facilitated a rise in
the use of ambulatory surgery centers (ASC). Despite the lower costs
associated with ASCs, improved efficiency, and increased patient
satisfaction, there is inconsistent reporting of complication rates.
PURPOSE: This study aims to review current literature in order to
determine the outcomes and complication rates in relation to spine surgery
in ambulatory surgical centers. STUDY DESIGN/SETTING: Retrospective.
PATIENT SAMPLE: One hundred and fifty articles on spine surgery
complications in ambulatory surgical centers. OUTCOME MEASURES:
Postoperative complications (cardiac, GI, MSK, operative, pain,
neurologic, pulmonary, urologic, vascular, and wounds). <br/>METHOD(S):
This systematic review was completed utilizing the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies
were identified through Embase and Pubmed databases using the search
string ((("ambulatory surgery center") AND "spine surgery") AND
"complications"). Articles were excluded if they did not report outpatient
surgery in an ASC, if they did not define complications in a language
other than English, nonhuman studies, or if the articles were classified
as reviews, book chapters, single case reports, or small case series (<=10
patients). Comparative studies were only included if they provided the
number of both ambulatory and nonambulatory patients. The primary outcome
was the frequency of complications with respect to the following
categories: cardiac, gastrointestinal, MSK/spine/operative, pain,
persistent neurologic, pulmonary, transient neurologic, urologic,
vascular, and wound. <br/>RESULT(S): Our query identified 150 articles.
After filtering relevance by title, abstract, and full text, 22 articles
were included. After accounting for two studies that were conducted on the
same study sample, a total of 11,245 patients were analyzed in this study.
The most recent study reported results from May 2019. While five studies
did not list their surgical technique, reported techniques by each study
included open (6), MIS (2), endoscopic (4), microsurgery (1), and combined
techniques (4). The following rates of complications were determined:
cardiac 2/2168 (0.09%), gastrointestinal 2/1320 (0.15%),
MSK/spine/operative 10/8210 (0.12%), pain 10/4634 (0.22%), persistent
neurologic 5/3318 (0.15%), pulmonary 1/1839 (0.05%), transient neurologic
11/3821 (0.29%), urologic 2/250 (0.80%), vascular 6/5277 (0.11%), and
wound 7/5733 (0.12%). <br/>CONCLUSION(S): After literature review, this is
the first study to comprehensively analyze the current state of literature
reporting on the complication profile of all ASC spine surgery procedures.
The most common complications were urologic (0.8%) and the most infrequent
were pulmonary (0.05%). Case reports varied significantly with regard to
the type and rate of complications reported. Although the patient
population undergoing ASC spine surgery is likely to be screened more
rigorously than the inpatient spine surgery population, this study
provides complication profiles to assist surgeons in counseling patients
on the most realistic expectations. FDA DEVICE/DRUG STATUS: This abstract
does not discuss or include any applicable devices or drugs.<br/>Copyright
&#xa9; 2020

<50>
Accession Number
632815378
Title
Effectiveness of Polypill for Prevention of Cardiovascular Disease
(PolyPars): Protocol of a Randomized Controlled Trial.
Source
Archives of Iranian medicine. 23 (8) (pp 548-556), 2020. Date of
Publication: 01 Aug 2020.
Author
Malekzadeh F.; Gandomkar A.; Malekzadeh Z.; Poustchi H.; Moghadami M.;
Fattahi M.R.; Moini M.; Anushiravani A.; Mortazavi R.; Sadeghi Boogar S.;
Mohammadkarimi V.; Abtahi F.; Merat S.; Sepanlou S.G.; Malekzadeh R.
Institution
(Malekzadeh, Malekzadeh, Poustchi, Anushiravani, Merat, Sepanlou,
Malekzadeh) Digestive Disease Research Center, Digestive Disease Research
Institute, Shariati Hospital, Tehran University of Medical Sciences, Iran,
Islamic Republic of
(Malekzadeh, Gandomkar, Moghadami, Anushiravani, Malekzadeh)
Non-Communicable Disease Research Center, Shiraz University of medical
Sciences, Shiraz, Iran, Islamic Republic of
(Malekzadeh) Non-Communicable Diseases Research Center, Endocrinology and
Metabolism Population Sciences Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Poustchi, Malekzadeh) Digestive Oncology Research Center, Digestive
Disease Research Institute, Shariati Hospital, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Fattahi, Moini) Gastroenterohepatology Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Mortazavi, Sadeghi Boogar, Mohammadkarimi) Department of Internal
Medicine, School of Medicine, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Abtahi) Department of Cardiology, Cardiovascular Research Center School
of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Merat, Malekzadeh) Liver and Pancreatobiliary Diseases Research Center,
Digestive Disease Research Institute, Shariati Hospital, Tehran University
of Medical Sciences, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death
in Iran. A fixed-dose combination therapy (polypill) was proposed as a
cost-effective strategy for CVD prevention, especially in lower-resource
settings. We conducted the PolyPars trial to assess the effectiveness and
safety of polypill for prevention of CVD. <br/>METHOD(S): The PolyPars
trial is a pragmatic cluster randomized controlled trial nested within the
Pars Cohort Study. Participants were randomized to an intervention arm and
a control arm. Participants in the control arm received minimal
non-pharmacological care, while those in the intervention arm received
polypill in addition to minimal care. The polypill comprises
hydrochlorothiazide 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, and either
enalapril 5 mg or valsartan 40 mg. The primary outcome of the study is
defined as the first occurrence of acute coronary syndrome (non-fatal
myocardial infarction and unstable angina), fatal myocardial infarction,
sudden cardiac death, new-onset heart failure, coronary artery
revascularization procedures, transient ischemic attack, cerebrovascular
accidents (fatal or non-fatal), and hospitalization due to any of the
mentioned conditions. The secondary outcomes of the study include adverse
events, compliance, non-cardiovascular mortality, changes in blood
pressure, fasting blood sugar, and lipids after five years of follow-up.
<br/>RESULT(S): From December 2014 to December 2015, 4415 participants (91
clusters) were recruited. Of those, 2200 were in the polypill arm and 2215
in the minimal care arm. The study is ongoing. This trial was registered
with ClinicalTrials.gov number NCT03459560. <br/>CONCLUSION(S): Polypill
may be effective for primary prevention of CVDs in developing
countries.<br/>Copyright &#xa9; 2020 The Author(s). This is an open-access
article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0), which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.

<51>
Accession Number
632699931
Title
Cardiac papillary fibroelastoma originating from the coumadin ridge and
review of literature.
Source
BMJ Case Reports. 13 (8) (no pagination), 2020. Article Number: e235361.
Date of Publication: 26 Aug 2020.
Author
Lak H.M.; Kerndt C.C.; Unai S.; Maroo A.
Institution
(Lak) Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Kerndt) Internal Medicine, Spectrum Health, Grand Rapids, MI, United
States
(Unai) Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland,
OH, United States
(Maroo) Cardiovascular Medicine, Fairview Hospital, Cleveland, OH, United
States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Papillary fibroelastomas represent the second most common benign cardiac
tumour, secondary only to cardiac myxoma. A majority of patients are
asymptomatic on presentation. The most common clinical manifestations
include stroke, transient ischaemic attack, myocardial infarction and
angina. Echocardiography remains the primary imaging modality for
identification of these tumours. The majority of papillary fibroelastomas
arise from the valves. Simple surgical excision is the mainstay of
treatment, carrying an excellent prognosis. We present an unusual case of
cardiac papillary fibroelastoma originating from the coumadin ridge (CR)
in a 70-year-old woman. The patient exhibited increasing paroxysms of her
atrial fibrillation and was pursuing a MAZE procedure. Preoperatively, a
transesophageal echocardiogram revealed a 0.7x1 cm intracardiac mass that
had echocardiographic appearance of a fibroelastoma. Surgical resection
and MAZE procedures were performed. The gross specimen and histopathology
findings were consistent with papillary fibroelastoma. This case reports
the seventh documented case of fibroelastoma originating from the
CR.<br/>Copyright &#xa9;

<52>
Accession Number
2007794871
Title
The Shaggy Aorta Syndrome: An Updated Review.
Source
Annals of Vascular Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Serra R.; Bracale U.M.; Jiritano F.; Ielapi N.; Licastro N.; Provenzano
M.; Andreucci M.; Pingitore A.; de Franciscis S.; Mastroroberto P.;
Serraino G.F.
Institution
(Serra, Ielapi, de Franciscis) Interuniversity Center of Phlebolymphology
(CIFL). International Research and Educational Program in Clinical and
Experimental Biotechnology" at the Department of Medical and Surgical
Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
(Serra, Licastro, de Franciscis) Department of Medical and Surgical
Sciences, University of Catanzaro, Catanzaro, Italy
(Bracale, Licastro) Department of Public Health, University of Naples
"Federico II", Naples, Italy
(Jiritano, Mastroroberto, Serraino) Department of Experimental and
Clinical Medicine, University of Catanzaro, Catanzaro, Italy
(Ielapi) Sapienza" University of Rome, Department of Public Health and
Infectious Disease, Roma, Italy
(Provenzano, Andreucci) Department of Health Sciences, University of
Catanzaro, Catanzaro, Italy
(Pingitore) Department of Radiology, Pugliese-Ciaccio Hospital of
Catanzaro, Catanzaro, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Shaggy aorta (SA) depicts the severe aortic surface
degeneration, extremely friable, and likely to cause spontaneous
peripheral and visceral embolization or during catheterization, aortic
manipulation, surgery, or minimally invasive procedures. This study aims
to provide the most accurate and up-to-date information on this disease.
<br/>Method(s): Potentially eligible studies to be included were
identified by searching the following databases: CENTRAL Library,
ClinicalTrials.gov, MEDLINE, and CINAHL, using a combination of subject
headings and text words to identify relevant studies: (Shaggy aorta) OR
(aortic embolization) OR (aortic embolism) OR (aortic thrombus) OR (aortic
plaque). From a total of 29,111 abstracts, and after applying inclusion
and exclusion criteria, we considered 60 studies for inclusion in this
review. <br/>Result(s): Appropriate measurement and assessment of the
aortic wall are pivotal in the modern era, in particular when percutaneous
procedures are performed, as SA has been identified as an independent risk
factor for spinal cord injury, mesenteric embolization, and cerebral
infarction after endovascular aortic repair. Furthermore, SA increases the
rate of cerebral complications during transcatheter aortic valve
implantation. <br/>Conclusion(s): In conclusion, prompt diagnosis of SA
syndrome and appropriate guidelines on the management of these conditions
may help physicians to better assess the patient risk and to minimize the
dreadful-related complications.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<53>
Accession Number
632817679
Title
Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke: A
prospective, blind, randomized and controlled clinical trial
(T.E.D.R.A.S.).
Source
European journal of neurology. (no pagination), 2020. Date of Publication:
08 Sep 2020.
Author
Hamzic S.; Braun T.; Butz M.; Khilan H.; Weber S.; Yeniguen M.; Gerriets
T.; Schramm P.; Juenemann M.
Institution
(Hamzic, Braun, Butz, Khilan, Gerriets) Department of Neurology,
University Hospital Giessen and Marburg GmbH, Justus-Liebig-University,
Giessen, Germany
(Hamzic, Braun, Butz, Yeniguen, Schramm, Juenemann) Heart and Brain
Research Group, Kerckhoff Clinic GmbH, Heart-, Lung-, Vascular- and
Rheumatic Centre Bad Nauheim, Germany
(Khilan, Weber, Gerriets) Gesundheitszentrum Wetterau, Department of
Neurology / Stroke Unit, Friedberg, Hesse, Germany
(Yeniguen, Gerriets, Schramm, Juenemann) Department of Anaesthesiology,
University Medical Centre of the Johannes Gutenberg-University, Mainz,
Germany
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Dysphagia is common in acute stroke and deteriorates the
overall outcome. Transesophageal echocardiography (TEE) builds the
diagnostic workup of stroke etiology and is known as cause of
postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in
acute stroke patients undergoing TEE remains unknown. The aim of
T.E.D.R.A.S. was to assess the influence of TEE on swallowing among acute
stroke patients. <br/>METHOD(S): T.E.D.R.A.S. as a prospective, blind,
randomized, controlled trial included patients with acute stroke in two
groups. Simple unrestricted randomization was performed, and examiners
were blinded for each other's results. Swallowing was tested using
Flexible Endoscopic Evaluation of Swallowing (FEES) at three different
intervals in the intervention group (IG) (24 hours before, immediately
after and 24 hours after TEE) and within the control group (CG) (FEES on
three consecutive days and TEE earliest after the last FEES). Validated
scores assessed dysphagia severity for all time points as primary outcome
measures. <br/>RESULT(S): 34 patients were randomized in the IG (n=19) and
the CG (n=15). Key findings using repeated measures between group
comparisons shows significant increases in the IG among the following
dysphagia measures: 1.) Secretion severity score (immediately after TEE: p
<0.001, 24h after TEE: p<0.001). 2.) Penetration-aspiration-scale for
saliva (immediately after TEE: p <0.001; 24h after TEE: p= 0.007), for
small (immediately after TEE: p=0.009) and for large liquid boli
(immediately after TEE: p=0.009, 24h after TEE: p=0.025).
<br/>CONCLUSION(S): The results indicate a negative influence of TEE on
swallowing in acute stroke patients for at least for hours.<br/>Copyright
This article is protected by copyright. All rights reserved.

<54>
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.
<br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2020 The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<55>
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.<br/>Copyright &#xa9; The Author(s) 2020.

<56>
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.
<br/>Method(s): We performed a systematic search of PubMed, EMBASE, and
the Cochrane Library up to December 2019 for studies that assessed signs
of decongestion in patients with WRF during ADHF admission. The primary
outcome was all-cause mortality and heart transplantation. <br/>Result(s):
Thirteen studies were selected with a pooled population of 8138 patients.
During the follow-up period of 60-450 days, 19.2% of patients died.
Unstratified, patients with WRF versus no WRF had a higher risk for
mortality (odds ratio [OR], 1.71 [95% confidence interval {CI},
1.45-2.01]; P < 0.0001). However, patients who achieved decongestion had a
similar prognosis (OR, 1.15 [95% CI, 0.89-1.49]; P = 0.30). Moreover,
patients with WRF who achieved decongestion had a better prognosis
compared with those without WRF or decongestion (OR, 0.63 [95% CI,
0.46-0.86]; P = 0.004). This tendency persisted for the sensitivity
analyses. <br/>Conclusion(s): Decongestion is a powerful effect modifier
that attenuates harmful associations of WRF with mortality. Future studies
should not assess WRF as an endpoint without concomitant assessment of
achieved volume status.<br/>Copyright &#xa9; 2020 International Society of
Nephrology

<57>
Accession Number
2006829203
Title
Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging
Improves Prediction of the Failing Heart.
Source
Canadian Journal of Cardiology. 36 (9) (pp 1525-1533), 2020. Date of
Publication: September 2020.
Author
Woudstra O.I.; van Dissel A.C.; van der Bom T.; de Bruin-Bon R.H.A.C.M.;
van Melle J.P.; van Dijk A.P.J.; Vliegen H.W.; Mulder B.J.M.; Tanck
M.W.T.; Meijboom F.J.; Bouma B.J.
Institution
(Woudstra, van Dissel, van der Bom, de Bruin-Bon, Mulder, Bouma) Heart
Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC,
University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The
Netherlands, Netherlands
(Woudstra, Meijboom) Department of Cardiology, University Medical Center
Utrecht, Utrecht, The Netherlands, Netherlands
(van Dissel, Mulder) Netherlands Heart Institute, Utrecht, The
Netherlands, Netherlands
(van Melle) Department of Cardiology, University Medical Center Groningen,
Groningen, The Netherlands, Netherlands
(van Dijk) Department of Cardiology, Radboud University Medical Center,
Nijmegen, The Netherlands, Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands, Netherlands
(Tanck) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Predicting heart failure events in patients with a systemic
right ventricle (sRV) due to transposition of the great arteries (TGA) is
important for timely intensification of follow-up. This study assessed the
value of strain compared with currently used parameters as predictor for
heart failure-free survival in patients with sRV. <br/>Method(s): In
participants of a multicentre trial, speckle-tracking echocardiography
(STE) was performed to assess global longitudinal strain (GLS), mechanical
dispersion (MD), and postsystolic shortening (PSS). Cox regression was
used to determine the association of STE parameters with the combined end
point of progression of heart failure and death, compared with
cardiovascular magnetic resonance (CMR) and computed tomography (CT)
derived parameters. <br/>Result(s): Echocardiograms of 60 patients were
analyzed (mean age 34 +/- 11 years, 65% male, 35% congenitally corrected
TGA). Mean GLS was -13.5 +/- 2.9%, median MD was 49 (interquartile range
[IQR] 30-76) ms, and 14 patients (23%) had PSS. During a median 8 (IQR
7-9) years, 15 patients (25%) met the end point. GLS, MD, and PSS were all
associated with heart failure-free survival in univariable analysis. After
correction for age, only GLS (optimal cutoff > -10.5%) and CMR/CT-derived
sRV ejection fraction (optimal cutoff < 30%) remained associated with
heart failure-free survival: hazard ratio (HR) 8.27, 95% confidence
interval (CI) 2.50-27.41 (P < 0.001), and HR 4.34, 95% CI 1.48-12.74 (P =
0.007), respectively). Combining GLS and ejection fraction improved
prediction, with patients with both GLS > -10.5% and sRV ejection fraction
< 30% at highest risk (HR 19.69, 95% CI 4.90-79.13; P < 0.001).
<br/>Conclusion(s): The predictive value of GLS was similar to that of
CMR/CT-derived ejection fraction. The combination of GLS and ejection
fraction identified patients at highest risk of heart failure and death.
Easily available STE parameters can be used to guide follow-up intensity
and can be integrated into future risk prediction scores.<br/>Copyright
&#xa9; 2020 Canadian Cardiovascular Society

<58>
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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<59>
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.
<br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2020 International Society for Cell and
Gene Therapy

<60>
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. <br/>Design(s): A prospective, randomized,
observational study. <br/>Setting(s): A tertiary cardiac care center.
<br/>Participant(s): Adult patients undergoing elective cardiac surgery.
<br/>Intervention(s): Radial artery cannulation with ultrasound guidance.
<br/>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). <br/>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.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<61>
Accession Number
632561674
Title
The effects of foot reflexology on agitation and extubation time in male
patients following coronary artery bypass surgery: A randomized controlled
clinical trial.
Source
Complementary therapies in clinical practice. 40 (pp 101201), 2020. Date
of Publication: 01 Aug 2020.
Author
Allahbakhhsian A.; Gholizadeh L.; Allahbakhshian M.; Sarbakhsh P.;
Abbaszadeh Y.
Institution
(Allahbakhhsian, Abbaszadeh) Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Gholizadeh) Faculty of Health, University of Technology Sydney, Sydney,
Australia
(Allahbakhshian) Faculty of Nursing and Midwifery, Shahid Beheshti
University of Medical Sciences. Tehran, Iran, Islamic Republic of
(Sarbakhsh) Faculty of Public Health, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND AND PURPOSE: This study examined the effects of foot
reflexology on agitation and extubation time of male patients following
coronary artery bypass graft surgery. MATERIALS AND METHODS: In this
randomized three-arm controlled clinical trial, participants (n = 120)
were randomly assigned to the intervention, placebo, or control groups.
The intervention group received foot reflexology massage for 15 min.
Agitation was assessed using the Richmond Agitation- Sedation Scale before
the intervention (Time 1) and immediately (Time 2) and 10 min after the
intervention (Time 3). Extubation time was measured as the time from
gaining full consciousness to endotracheal extubation. <br/>RESULT(S):
Agitation reduced in all groups from Time 1 to Time 3 (p < 0.05); however,
the intervention group showed a significantly higher reduction at Time 2
(p < 0.001) and Time 3 (p < 0.001). Also, extubation time was
significantly shorter in the intervention group (p < 0.01).
<br/>CONCLUSION(S): Foot reflexology may be introduced as a nursing
intervention to facilitate the weaning process in the cardiac
ICUs.<br/>Copyright &#xa9; 2020 Elsevier Ltd. All rights reserved.

<62>
Accession Number
632221496
Title
Self-expanding intra-annular versus commercially available transcatheter
heart valves in high and extreme risk patients with severe aortic stenosis
(PORTICO IDE): a randomised, controlled, non-inferiority trial.
Source
Lancet (London, England). 396 (10252) (pp 669-683), 2020. Date of
Publication: 05 Sep 2020.
Author
Makkar R.R.; Cheng W.; Waksman R.; Satler L.F.; Chakravarty T.; Groh M.;
Abernethy W.; Russo M.J.; Heimansohn D.; Hermiller J.; Worthley S.; Chehab
B.; Cunningham M.; Matthews R.; Ramana R.K.; Yong G.; Ruiz C.E.; Chen C.;
Asch F.M.; Nakamura M.; Jilaihawi H.; Sharma R.; Yoon S.-H.; Pichard A.D.;
Kapadia S.; Reardon M.J.; Bhatt D.L.; Fontana G.P.
Institution
(Makkar, Cheng, Chakravarty, Nakamura, Yoon) Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
(Waksman, Satler) DC, Washington Hospital Center, WA, United States
(Groh, Abernethy) Mission Health and Hospitals, Asheville, United States
(Russo) Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ,
USA; Newark Beth Israel Medical Center, Newark, NY, USA
(Heimansohn, Hermiller) St Vincent Heart Center, IN, Indianapolis, United
States
(Worthley) Royal Adelaide Hospital, Adelaide, SA, Australia; Genesis Care,
Sydney, NSW, Australia
(Chehab) Cardiovascular Research Institute of Kansas, Ascension Via
Christi Hospital, Wichita, United States
(Cunningham, Matthews) University of Southern California, Los Angeles, CA,
USA
(Ramana) Advocate Christ Medical Center, Oak Lawn, IL, USA; Heart Care
Centers of Illinois, Palos Park, IL, USA
(Yong) Fiona Stanley Hospital, Murdoch, WA, Australia
(Ruiz) Hackensack University Medical Center, Hackensack, United States
(Chen) Newark Beth Israel Medical Center, Newark, NY, USA
(Asch) MedStar Health Research Institute, DC, WA, United States
(Jilaihawi) NYU Langone Health, NY, NY, United States
(Sharma) Stanford University Medical Center, Stanford, CA, USA
(Pichard) Abbott Park, Abbott, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, USA
(Reardon) Houston Methodist Hospital, TX, Houston, United States
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, MA, Boston,
United States
(Fontana) Cardiovascular Institute, Los Robles Regional Medical Center,
Thousand Oaks, CA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomised trial data assessing the safety and efficacy of the
self-expanding intra-annular Portico transcatheter aortic valve system
(Abbott Structural Heart, St Paul, MN, USA) compared with any commercially
available valves are needed to compare performance among designs.
<br/>METHOD(S): In this prospective, multicentre, non-inferiority,
randomised controlled trial (the Portico Re-sheathable Transcatheter
Aortic Valve System US Investigational Device Exemption trial [PORTICO
IDE]), high and extreme risk patients with severe symptomatic aortic
stenosis were recruited from 52 medical centres experienced in performing
transcatheter aortic valve replacement in the USA and Australia. Patients
were eligible if they were aged 21 years or older, in New York Heart
Association functional class II or higher, and had severe native aortic
stenosis. Eligible patients were randomly assigned (1:1) using permuted
block randomisation (block sizes of 2 and 4) and stratified by clinical
investigational site, surgical risk cohort, and vascular access method, to
transcatheter aortic valve replacement with the first generation Portico
valve and delivery system or a commercially available valve (either an
intra-annular balloon-expandable Edwards-SAPIEN, SAPIEN XT, or SAPIEN 3
valve [Edwards LifeSciences, Irvine, CA, USA]; or a supra-annular
self-expanding CoreValve, Evolut-R, or Evolut-PRO valve [Medtronic,
Minneapolis, MN, USA]). Investigational site staff, implanting physician,
and study participant were unmasked to treatment assignment. Core
laboratories and clinical event assessors were masked to treatment
allocation. The primary safety endpoint was a composite of all-cause
mortality, disabling stroke, life-threatening bleeding requiring
transfusion, acute kidney injury requiring dialysis, or major vascular
complication at 30 days. The primary efficacy endpoint was all-cause
mortality or disabling stroke at 1 year. Clinical outcomes and valve
performance were assessed up to 2 years after the procedure. Primary
analyses were by intention to treat and the Kaplan-Meier method to
estimate event rates. The non-inferiority margin was 8.5% for primary
safety and 8.0% for primary efficacy endpoints. This study is registered
with ClinicalTrials.gov, NCT02000115, and is ongoing. FINDINGS: Between
May 30 and Sept 12, 2014, and between Aug 21, 2015, and Oct 10, 2017, with
recruitment paused for 11 months by the funder, we recruited 1034
patients, of whom 750 were eligible and randomly assigned to the Portico
valve group (n=381) or commercially available valve group (n=369). Mean
age was 83 years (SD 7) and 395 (52.7%) patients were female. For the
primary safety endpoint at 30 days, the event rate was higher in the
Portico valve group than in the commercial valve group (52 [13.8%] vs 35
[9.6%]; absolute difference 4.2, 95% CI -0.4 to 8.8 [upper confidence
bound {UCB} 8.1%]; pnon-inferiority=0.034, psuperiority=0.071). At 1 year,
the rates of the primary efficacy endpoint were similar between the groups
(55 [14.8%] in the Portico group vs 48 [13.4%] in the commercial valve
group; difference 1.5%, 95% CI -3.6 to 6.5 [UCB 5.7%];
pnon-inferiority=0.0058, psuperiority=0.50). At 2 years, rates of death
(80 [22.3%] vs 70 [20.2%]; p=0.40) or disabling stroke (10 [3.1%] vs 16
[5.0%]; p=0.23) were similar between groups. INTERPRETATION: The Portico
valve was associated with similar rates of death or disabling stroke at 2
years compared with commercial valves, but was associated with higher
rates of the primary composite safety endpoint including death at 30 days.
The first-generation Portico valve and delivery system did not offer
advantages over other commercially available valves.Abbott.<br/>Copyright
&#xa9; 2020 Elsevier Ltd. All rights reserved.

<63>
Accession Number
632047029
Title
Epidemiology of infective endocarditis in transcatheter aortic valve
replacement: systemic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 21 (10) (pp
790-801), 2020. Date of Publication: 01 Oct 2020.
Author
Prasitlumkum N.; Vutthikraivit W.; Thangjui S.; Leesutipornchai T.;
Kewcharoen J.; Riangwiwat T.; Dworkin J.
Institution
(Prasitlumkum, Kewcharoen, Dworkin) Department of Internal Medicine,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Vutthikraivit) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Thangjui, Leesutipornchai) Department of Internal Medicine, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand
(Riangwiwat) Cardiology Department, Geisinger Medical Center, Danville,
PA, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Infective endocarditis following transcatheter aortic valve
replacement (TAVR) is an emerging problem, with a high rate of morbidity
and mortality. However, little is known about the burden of disease, and
data on infective endocarditis incidence are scarce. This study aimed to
evaluate the incidence of infective endocarditis in TAVR by performing a
systematic review and meta-analysis of the literature. <br/>METHOD(S): We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to October 2019. Included studies were prospective or
retrospective cohort studies that reported the event rate of infective
endocarditis in patients who underwent TAVR. Data from each study were
combined using the random-effects method to calculate pooled incidence
with 95% confidence intervals (CIs). <br/>RESULT(S): A total of 30 studies
consisting of 73 780 patients undergoing TAVR were included in this
meta-analysis. Overall, the pooled estimated incidence of infective
endocarditis following TAVR was 7 in 1000 patients (95% CI: 0.5-1%). For
early infective endocarditis, the pooled estimated incidence was 8 per
1000 patients (95% CI: 0.5-1.1%). For late infective endocarditis, the
pooled estimated incidence was 2 in 1000 patients (95% CI: 0.1-0.4%).
Significantly, the overall pooled infective endocarditis mortality rate
was 39% (95% CI: 28.7-49.4%). <br/>CONCLUSION(S): The current study
demonstrates the incidence of overall, early, and late infective
endocarditis following TAVR, ranging from 2 to 8 per 1000 patients.
Although it remains a rare event, infective endocarditis following TAVR is
associated with high mortality.

<64>
Accession Number
631759650
Title
Effect of Evolocumab on Type and Size of Subsequent Myocardial Infarction:
A Prespecified Analysis of the FOURIER Randomized Clinical Trial.
Source
JAMA Cardiology. 5 (7) (pp 787-793), 2020. Date of Publication: July 2020.
Author
Wiviott S.D.; Giugliano R.P.; Morrow D.A.; De Ferrari G.M.; Lewis B.S.;
Huber K.; Kuder J.F.; Murphy S.A.; Forni D.M.; Kurtz C.E.; Honarpour N.;
Keech A.C.; Sever P.S.; Pedersen T.R.; Sabatine M.S.
Institution
(Wiviott, Giugliano, Morrow, Murphy, Forni, Sabatine) Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA, United States
(Giugliano, Kuder, Murphy, Sabatine) Thrombolysis in Myocardial Infarction
(TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(De Ferrari) Department of Medical Sciences, University of Torino,
Cardiology Aou Citta della Salute e della Scienza, Torino, Italy
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Huber) Wilhelminen Hospital, Vienna, Austria
(Kurtz, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Center, University of Sydney, Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
Niversity of Oslo, Oslo, Norway
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The PCSK9 inhibitor evolocumab reduced major vascular events
in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in
Subjects With Elevated Risk (FOURIER) trial, yet the types and sizes of
myocardial outcomes in FOURIER have not been previously explored.
<br/>Objective(s): To assess the types and sizes of myocardial infarction
(MI) and the effect of evolocumab on MI by subtype. <br/>Design, Setting,
and Participant(s): A prespecified analysis of a multicenter double-blind
randomized clinical trial. Patients were randomized to evolocumab or
placebo and followed up for a median of 2.2 years. The study included
27564 patients with stable atherosclerotic disease receiving statin
therapy. Clinical end points were evaluated by the Thrombolysis in
Myocardial Infarction clinical events committee. Rates presented are
3-year Kaplan-Meier estimates. Data were collected from 2013 to 2016 and
analyzed from June 2017 to December 2019. <br/>Main Outcomes and Measures:
Myocardial infarction was defined based on the third universal MI
definition, and further classified according to MI type (universal MI
subclass, ST-segment elevation myocardial infarction [STEMI] vs non-STEMI)
and by MI size (determined by peak troponin level). <br/>Result(s): A
total of 27564 patients were randomized, with a mean (SD) age of 62.5
(9.0) years, and 20795 (75%) were male. Of these, 1107 patients
experienced a total of 1288 MIs. Most MIs (68%) were atherothrombotic
(type 1), with 15% from myocardial oxygen supply-demand mismatch (type 2)
and 15% percutaneous coronary intervention-related (type 4). Sudden death
(type 3) and coronary artery bypass grafting-related (type 5) accounted
for a total of 21 MIs (<2%). Evolocumab significantly reduced the risk of
first MI by 27% (4.4% vs 6.3%; hazard ratio [HR], 0.73; 95% CI, 0.65-0.82;
P <.001), type 1 by 32% (2.9% vs 4.5%; HR, 0.68; 95% CI, 0.59-0.79; P
<.001), and type 4 by 35% (0.8% vs 1.1%; HR, 0.65; 95% CI, 0.48-0.87; P
=.004), with no effect on type 2 (0.9% vs 0.8%; HR, 1.09; 95% CI,
0.82-1.45; P =.56). Most MIs (688 [59.8%]) had troponin levels greater
than or equal to 10 times the upper limit of normal. The benefit was
highly significant and consistent regardless of the size of MI with a 34%
reduction in MIs with troponin level greater than or equal to 10 times the
upper limit of normal (2.6% vs 3.7%; HR, 0.66; 95% CI, 0.56-0.77; P <.001)
and a 36% reduction in the risk of STEMI (1.0% vs 1.5%; HR, 0.64; 95% CI,
0.49-0.84; P <.001). <br/>Conclusions and Relevance: Low-density
lipoprotein cholesterol lowering with evolocumab was highly effective in
reducing the risk of MI. This reduction with evolocumab included benefit
across multiple subtypes of MI related to plaque rupture, smaller and
larger MIs, and both STEMI and non-STEMI. These data are consistent with
the known benefit of low-density lipoprotein cholesterol lowering and
underscore the reduction in clinically meaningful events. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633.<br/>Copyright
&#xa9; 2020 American Medical Association. All rights reserved.

<65>
Accession Number
631417788
Title
A case of combined aortic bioprosthetic valve degeneration and
patient-prosthesis mismatch during pregnancy: decision-making and
implications after pregnancy.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 21 (10) (pp
820-824), 2020. Date of Publication: 01 Oct 2020.
Author
Sciatti E.; Orabona R.; Prefumo F.; Vizzardi E.; Valcamonico A.; Repossini
A.; Sartori E.; Metra M.; Chiari E.
Institution
(Sciatti, Vizzardi, Metra, Chiari) Cardiology Unit
(Orabona, Prefumo, Valcamonico, Sartori) Department of Obstetrics and
Gynecology
(Repossini) Cardiac Surgery Unit, ASST Spedali Civili and University of
Brescia, Brescia, Italy
Publisher
NLM (Medline)

<66>
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. <br/>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. <br/>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. <br/>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.
<br/>Conclusion(s): Our results show that transcarotid approach is a
feasible option in patients with prohibitive femoral access for
TAVR.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC.

<67>
Accession Number
632795406
Title
The effect of aromatherapy with peppermint essential oil on nausea and
vomiting after cardiac surgery: A randomized clinical trial.
Source
Complementary therapies in clinical practice. 40 (pp 101199), 2020. Date
of Publication: 01 Aug 2020.
Author
Afazel M.R.; Azizi-Fini I.; Maghami M.
Institution
(Maghami, Afazel) Trauma Nursing Research Center, Faculty of Nursing and
Midwifery, Kashan University of Medical Sciences, Iran, Islamic Republic
of
(Azizi-Fini) Trauma Nursing Research Center, Faculty of Nursing and
Midwifery, Kashan University of Medical Sciences, Iran, Islamic Republic
of
(Maghami) Department of Biostatistics and Epidemiology, School of Health,
Isfahan university of Medical sciences, Isfahan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
Background Postoperative nausea and vomiting are common in patients who
underwent cardiac surgery. This study aimed to examine the effect of
peppermint essential oil inhalation on the postoperative nausea and
vomiting after cardiac surgery. Methods In this clinical trial study, 60
cardiac surgery patients were divided into control and intervention
groups. The intervention group underwent nebulizer aromatherapy with
peppermint essential oil before the endotracheal tube was removed after
surgery. Patients' nausea and vomiting were then assessed through a
checklist. The independent-samples t-test, chi-square, and Generalized
estimating equation were used for data analysis. Results Totally 85.7% of
the patients undergone coronary artery bypass graft surgery. The two
groups did not significantly differ in terms of their baseline demographic
and clinical variables (P > 0.05). Significant differences were found
between the intervention and control groups in terms of the frequency of
nausea (0.63 +/- 0.81 vs. 1.46 +/- 1.21), its duration (3.78 +/- 5.09 vs.
7.97 +/- 5.55 min), and severity (2.43 +/- 2.84 vs. 4.61 +/- 2.85), and in
the frequency of vomiting episodes (0.17 +/-.46 vs. 0.73 +/-.60) in the
first four hours after extubation (P < 0.05). <br/>Conclusion(s):
Peppermint essential oil inhalation has beneficial effects on reducing
nausea and vomiting after open-heart surgery. Using peppermint essential
oil inhalation for managing postoperative nausea and vomiting is
recommended.<br/>Copyright &#xa9; 2020 Elsevier Ltd. All rights reserved.

<68>
Accession Number
632795227
Title
Interleukin-6 in Patients with Cardiac Myxoma.
Source
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 30
(8) (pp 849-852), 2020. Date of Publication: 01 Aug 2020.
Author
Yuan S.-M.; Lin H.-Z.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Fujian Province, Putian,
China
(Lin) Department of Clinical Laboratory, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Fujian Province, Putian,
China
Publisher
NLM (Medline)
Abstract
The relationships between interleukin (IL)-6 and cardiac myxoma remain to
be clarified. This article systematically reviewed the IL-6 properties in
cardiac myxoma patients based on retrieval of pertinent literature
published between 1998 and 2018. Significant differences were found in
circulating IL-6 values between preoperation and 1 and 6 months after
operation. Preoperative circulating IL-6 correlated significantly with
tumour volume (r=0.8552, p=0.003), while there were no significant
correlations with maximal tumour dimension (r=0.2443, p=0.190). No
correlation was found between circulating IL-6 at 1 and 6 months after
tumour resection with either tumour volume or with maximal tumour
dimension. The positive rate of immunostaining of IL-6 in cardiac myxoma
tissues was 93.3%. Overproduction of IL-6 is responsible for the
inflammatory presentations, constitutional symptoms, and recurrence and
distal embolisation of cardiac myxoma. Cardiac myxoma could be a cellular
source of IL-6 release. Cardiac myxoma resection is an absolute choice of
eliminating IL-6 production in these patients. Key Words: Cardiac surgical
procedures, Cytokines; Inflammation, Interleukin-6, Neoplasms.

<69>
Accession Number
632793382
Title
Effects of foot massage and patient education in patients undergoing
coronary artery bypass graft surgery: A randomized controlled trial.
Source
Complementary therapies in clinical practice. 40 (pp 101215), 2020. Date
of Publication: 01 Aug 2020.
Author
Chandrababu R.; Nayak B.S.; Pai V.B.; N R.; George L.S.; Devi E.S.; George
A.
Institution
(Chandrababu, George) Manipal College of Nursing, Manipal Academy of
Higher Education, Manipal, Karnataka 576104, India
(Nayak) Manipal College of Nursing, Manipal Academy of Higher Education,
Manipal, Karnataka 576104, India
(Pai) Royal Papworth Hospital, NHS Foundation Trust, Cambridge Biomedical
Campus, Cambridge, United Kingdom
(N) Department of Data Science, Prasanna School of Public Health, Manipal
Academy of Higher Education, Manipal, Karnataka 576104, India
(George) Manipal College of Nursing, Manipal Academy of Higher Education,
Manipal, Karnataka 576104, India
(Devi) Manipal College of Nursing, Manipal Academy of Higher Education,
Manipal, Karnataka 576104, India
Publisher
NLM (Medline)
Abstract
BACKGROUND: Anxiety, pain, and fatigue are common postoperative problems
that disturb the recovery and quality of life in patients undergoing
coronary artery bypass graft (CABG) surgery. These postoperative problems
are associated with prolonged recovery and decreased quality of life. This
study was aimed at evaluating the combined effects of foot massage and
patient education on anxiety, fatigue, pain, self-efficacy, and quality of
life in patients undergoing CABG surgery. MATERIAL AND METHODS: In this
randomized controlled trial (RCT), 130 participants were randomly
allocated to experimental (n = 65) and control (n = 65) groups. The
experimental group received a combination of foot massage and patient
education as interventions and the control group received usual care of
the hospital. <br/>RESULT(S): The experimental group had a significant
decrease in anxiety (p = 0.001), fatigue (p = 0.001), pain (p = 0.001),
and increased self-efficacy (p = 0.001) and quality of life (p = 0.001).
<br/>CONCLUSION(S): The combined form of foot massage and patient
education is effective in decreasing anxiety, fatigue, pain, and
increasing self-efficacy and the quality of life. These interventions will
support the recovery of patients and reduce their suffering.<br/>Copyright
&#xa9; 2020 Elsevier Ltd. All rights reserved.

<70>
Accession Number
2006119034
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients with Left Ventricular Systolic Dysfunction.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2020. Date of
Publication: 2020.
Author
Khan M.R.; Kayani W.T.; Pelton J.; Ansari A.; Paniagua D.; Khalid U.;
Denktas A.; Changezi H.U.; Munir A.; Jimenez E.; Alam M.; Jneid H.
Institution
(Khan, Changezi, Munir) Division of Cardiology, McLaren-Flint/Michigan
State University, Flint, MI, United States
(Kayani, Pelton, Ansari, Paniagua, Khalid, Denktas, Alam, Jneid) Section
of Cardiology, Department of Internal Medicine, Baylor College of
Medicine, Houston, TX 77030, United States
(Khalid, Jimenez, Jneid) Division of Cardiology, Michael E. DeBakey
Veterans Affairs Medical Center, Houston, TX 77030, United States
(Jimenez) Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans
Affairs Medical Center, Houston, TX, United States
Publisher
Springer
Abstract
Purpose: There is a paucity of comparative data examining the optimal
revascularization strategy in patients with left ventricular systolic
dysfunction (LVD). <br/>Method(s): We performed an aggregate data
meta-analysis of clinical outcomes comparing percutaneous coronary
intervention (PCI) versus coronary artery bypass (CABG) in patients with
LVD (left ventricle ejection fraction (LVEF) of <= 40%), using the random
effects model. Effects size is reported as odds ratio (OR) and a 95%
confidence interval. Outcomes included all-cause mortality, myocardial
infarction, stroke, repeat revascularization, and a composite of major
adverse cardiac and cerebrovascular events (MACCE) at 30-day, 3-year, and
long-term (6.3 +/- 0.9 years) follow-ups. Seventeen studies (16
observational, 1 randomized) and 18,599 patients (CABG 9651; PCI 8948)
were included. <br/>Result(s): PCI and CABG had comparable all-cause
mortality at 30 days (OR 0.78, 95% CI 0.49-1.23) and 3 years (OR 1.05, 95%
CI 0.91-1.21); however, PCI was associated with increased long-term
morality after a mean follow-up of 6.3 +/- 0.9 years (31.6% vs. 24.3%, OR
1.41, 95% CI 1.21-1.64). A similar mortality trend was observed in the
subgroup of patients with EF <= 35%. PCI had a higher rate of repeat
revascularization at 3-year and long-term follow-ups. The long-term rates
of stroke and MI were comparable. PCI, on the other hand, had lower rates
of stroke at 30-day and 3-year follow-ups. <br/>Conclusion(s): CABG was
associated with lower rates of long-term mortality and revascularization
but higher rate of upfront stroke in patients with LVD. However, the data
included consisted predominantly of observational studies, highlighting
the paucity and need for randomized trials.<br/>Copyright &#xa9; 2020,
Springer Science+Business Media, LLC, part of Springer Nature.

<71>
Accession Number
2006109685
Title
Outcomes with MANTA Device for Large-Bore Access Closure after
Transcatheter Aortic Valve Replacement: A Meta-Analysis.
Source
Structural Heart. (no pagination), 2020. Date of Publication: 2020.
Author
Megaly M.; Buda K.G.; Brilakis E.S.; Pershad A.; Louka B.; Saad M.;
Abdelaziz H.K.; Anantha Narayanan M.; Syed M.; Mentias A.; Omer M.;
Alexander J.; Titus J.; Garcia S.
Institution
(Megaly, Brilakis, Omer, Alexander, Titus, Garcia) Minneapolis Heart
Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Buda) Division of Cardiology, Hennepin Healthcare, Minneapolis,
MN, United States
(Pershad) Division of Cardiology, Banner University Medical
Center/University of Arizona, Phoenix, AZ, United States
(Louka) Division of Cardiology, Willis Knighton Medical Center,
Shreveport, LA, United States
(Saad, Abdelaziz) Division of Cardiology, Ain Shams University, Cairo,
Egypt
(Saad) Division of Cardiology, The Warren Alpert School of Medicine at
Brown University, Providence, RI, United States
(Abdelaziz) Lancashire Cardiac Center, Blackpool Victoria Hospital,
Blackpool, United Kingdom
(Anantha Narayanan) Division of Vascular Medicine, Yale-New Haven
Hospital, New Haven, CT, United States
(Syed) Division of Cardiology, University of Toledo, Toledo, OH, United
States
(Mentias) Division of Cardiology, Cleveland Clinic Foundation, Cleveland,
OH, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Data comparing MANTA to other vascular closure devices (VCDs)
after TAVR is limited. <br/>Method(s): We performed a meta-analysis of all
published studies reporting the outcomes of MANTA vs. other VCDs in TAVR
patients. Outcomes included major and minor vascular complications, major
and minor bleeding, VCD failure, blood transfusion, additional surgical or
endovascular treatment, flow-limiting dissection, hematomas,
pseudoaneurysm, change in hemoglobin, and length of stay (LOS).
Definitions used were according to the "Valve Academic Research
Consortium-2 consensus document" (VARC-2). <br/>Result(s): We included
five observational studies with a total of 1,410 patients (MANTA n = 601,
other VCDs = 809). Three studies compared MANTA to the Proglide device
(Abbot Vascular, CA, USA), and two studies compared MANTA to the Prostar
XL device (Abbott Vascular, IL, USA). The prevalence of moderate to severe
calcification was higher in the MANTA group (31% vs. 21%, p = 0.01)
compared with other VCDs group. During the index hospitalization, there
was no difference in all major or minor complications between MANTA and
other VCDs. In a sensitivity analysis, comparing MANTA to Proglide, the
risk of major and minor vascular complications, major and minor bleeding,
and VCD failure was similar for both devices. <br/>Conclusion(s): In the
TAVR population, although more used in calcified vessels, the safety
profile and efficacy of the new collagen-based VCD, MANTA, is similar to
currently available suture based VCD's Proglide and Prostar
XL.<br/>Copyright &#xa9; 2020 Cardiovascular Research Foundation.

<72>
Accession Number
632796853
Title
Preprocedural circulating galectin-3 and the risk of mortality after
transcatheter aortic valve replacement: a systematic review and meta
analysis.
Source
Bioscience reports. (no pagination), 2020. Date of Publication: 07 Sep
2020.
Author
Zhang H.-L.; Song G.-Y.; Zhao J.; Wang Y.-B.; Wang M.-Y.; Xu Y.-L.; Wang
B.-C.; Niu G.-N.; Liu Z.-H.; Wu Y.-J.
Institution
(Zhang, Song, Zhao, Wang, Wang, Xu, Wang, Niu, Liu, Wu) Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Galectin-3 may predict mortality for patients with aortic
stenosis (AS) after transcatheter aortic valve replacement (TAVR).
However, the results were inconsistent. We aimed to evaluate the
association between baseline galectin and mortality after TAVR in a
meta-analysis. <br/>METHOD(S): Related follow-up studies were obtained by
systematic search of PubMed, Cochrane's Library, and Embase databases.
Both the fixed and the random-effect models were used for the
meta-analysis. Subgroup analyses were performed to evaluate the influences
of study characteristics on the outcome. <br/>RESULT(S): Five prospective
cohort studies with 854 patients were included, with a follow-up period
between 1-1.9 years. Patients with higher baseline circulating galectin-3
had an increased risk of all-cause mortality after TAVR (random-effect
model: risk ratio [RR]: 1.63, 95% confidence interval [CI]: 1.19 to 2.23,
P = 0.002; fixed effect model: RR: 1.62, 95% CI: 1.19 to 2.20, P = 0.002;
I2 = 4%). Adjustment of estimated glomerular filtration rate (RR: 1.73, P
= 0.02) or B type natriuretic peptide or N-terminal pro B type natriuretic
peptide (RR: 1.83, P = 0.02) did not significantly affect the result. A
trend of stronger association between higher baseline circulating
galectin-3 and increased risk of all-cause mortality after TAVR was
observed in studies with an enzyme-linked fluorescent assay (RR: 3.04, P =
0.003) compared to those with an enzyme linked immunosorbent assay (RR:
1.42, P = 0.04; P for subgroup difference = 0.06). <br/>CONCLUSION(S):
Higher circulating galectin-3 before the procedure may predict all-cause
mortality of AS patients after TAVR.<br/>Copyright 2020 The Author(s).

<73>
Accession Number
632795623
Title
Catheter-based treatment of the dissected ascending aorta: a systematic
review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 07 Sep 2020.
Author
Wang C.; von Segesser L.K.; Maisano F.; Ferrari E.
Institution
(Wang) Department of Cardiovascular Surgery. Jinling Hospital, Nanjing
University, School Medicine, Nanjing, China
(von Segesser) Department of Surgery and Anesthesiology, Cardiovascular
Research Unit, University Hospital of Lausanne, Lausanne, Switzerland
(Maisano, Ferrari) Department of Cardiovascular Surgery, University
Hospital of Zurich, Zurich, Switzerland
(Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino Foundation,
Lugano, Switzerland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Type A aortic dissection requires immediate surgical repair.
Despite improvements in surgery and anaesthesia, there is still a
considerable risk when high-risk patients are concerned. Less invasive
endovascular treatments are under evaluation. We investigated the current
status of catheter-based treatment for type A aortic dissection with the
entry tear located in the ascending aorta. <br/>METHOD(S): A PubMed search
was supplemented by searching through bibliographies and key articles.
Demographics, risk score, stent graft detail, access route, mortality,
cause of death, complications, reinterventions and follow-up data were
extracted and analysed. <br/>RESULT(S): Thirty-one articles (7
retrospective reports; 24 case reports/series) were included in the study.
In total, 104 patients (mean age 71+/-14years) received endovascular
treatment for acute (63) or chronic (41) type A dissection. A history of a
major cardiac or aortic operation was present in 29 patients. The mean
EuroSCORE II was 30+/-20 in 4 reports. A total of 114 stent grafts were
implanted: 'off-the-shelf', 65/114; custom made, 12/114; and modified,
7/114. Hospital complications included intraprocedural conversion to open
surgery (2/104), stroke (2/104), coronary stenting (2/104), early endoleak
(9/104) and repeat aortic endovascular treatment for endoleak (5/104).
Hospital mortality was 10% (intraoperative death 2/104). Mean duration of
follow-up time was 21+/-21months (range 1-81months); follow-up data were
available for 86 patients: 10 patients died of non-aortic-related causes;
reintervention for aortic disease (endovascular repair or open surgery)
was performed in 8 patients. <br/>CONCLUSION(S): Catheter-based ascending
aorta repair for type A aortic dissection with the entry tear in the
ascending aorta can be considered in carefully selected high-risk
patients. Further analysis and specifically designed devices are
required.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<74>
Accession Number
632788296
Title
Rationale and Design of the Randomized Controlled Trial of New Oral
Anticoagulants vs. Warfarin for post Cardiac Surgery Atrial Fibrillation:
The NEW-AF Trial.
Source
Annals of surgery. (no pagination), 2020. Date of Publication: 01 Sep
2020.
Author
Osho A.A.; Moonsamy P.; Ethridge B.R.; Leya G.A.; D'Alessandro D.A.;
Jassar A.S.; Villavicencio M.A.; Melnitchouk S.I.; Tolis G.; Langer N.B.;
Funamoto M.; Li S.S.; Colon K.M.; Mohan N.; Locascio J.J.; Lubitz S.A.;
Akeju O.; Sundt T.M.
Institution
(Osho, Moonsamy, Leya, D'Alessandro, Jassar, Villavicencio, Melnitchouk,
Tolis, Langer, Funamoto, Li, Mohan, Sundt) Division of Cardiac Surgery,
Massachusetts General Hospital, MA, Boston
(Ethridge, Colon, Akeju) Department of Anesthesia, Massachusetts General
Hospital, MA, Boston
(Locascio) Harvard Catalyst Biostatistical Group, Harvard Medical School,
MA, Boston
(Lubitz) Division of Cardiology, Massachusetts General Hospital, MA,
Boston
Publisher
NLM (Medline)
Abstract
: New onset atrial fibrillation commonly occurs following cardiac surgery
and is associated with increased rates of stroke and mortality. In
non-surgical patients with atrial fibrillation, novel oral anticoagulants
(NOACs) have been shown to confer equivalent benefits for stroke
prevention with less bleeding risk and less tedious monitoring
requirements compared with Warfarin. However, NOACs have yet to be adopted
widely in cardiac surgery patients. The NEW-AF study has been designed as
a pragmatic, prospective, randomized controlled trial that will compare
financial, convenience and safety outcomes for patients with new onset
atrial fibrillation after cardiac surgery who are treated with NOACs
versus Warfarin. Study results may contribute to optimizing the options
for stroke prophylaxis in cardiac surgery patients and catalyze more
widespread application of NOAC therapy in this patient population. The
trial is registered with clinicaltrials.gov under registration number
NCT03702582Rationale and Design of the Randomized Controlled Trial of New
Oral Anticoagulants vs. Warfarin for post Cardiac Surgery Atrial
Fibrillation: The NEW-AF Trial.

<75>
Accession Number
632787431
Title
Improvement of ejection fraction and mortality in ischaemic heart failure.
Source
Heart. (no pagination), 2020. Date of Publication: 2020.
Author
Perry A.S.; Mann D.L.; Brown D.L.
Institution
(Perry) University of Washington, School of Medicine, Seattle, WA, United
States
(Mann, Brown) Cardiovascular Division, Washington University in St. Louis,
St. Louis, MO 63110, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The frequency and predictors of improvement in left ventricular
ejection fraction (LVEF) in ischaemic cardiomyopathy and its association
with mortality is poorly understood. We sought to assess the predictors of
LVEF improvement >=10% and its effect on mortality. <br/>Method(s): We
compared characteristics of patients enrolled in The Surgical Treatment
for Ischaemic Heart Failure (STICH) trial with and without improvement of
LVEF >=10% at 24 months. A logistic regression model was constructed to
determine the independent predictors of LVEF improvement. A Cox
proportional hazards model was created to assess the independent
association of improvement in LVEF >=10% with mortality. <br/>Result(s):
Of the 1212 patients enrolled in STICH, 618 underwent echocardiographic
assessment of LVEF at baseline and 24 months. Of the patients randomised
to medical therapy plus coronary artery bypass graft surgery (CABG), 58
(19%) had an improvement in LVEF >10% compared with 51 (16%) patients
assigned to medical therapy alone (p=0.30). Independent predictors of LVEF
improvement >10% included prior myocardial infarction (OR 0.44, 95% CI:
0.28 to 0.71, p=0.001) and lower baseline LVEF (OR 0.94, 95% CI: 0.91 to
0.97, p<0.001). Improvement in LVEF >10% (HR 0.61, 95% CI: 0.44 to 0.84,
p=0.004) and randomisation to CABG (HR 0.72, 95% CI: 0.57 to 0.90,
p=0.004) were independently associated with a reduced hazard of mortality.
<br/>Conclusion(s): Improvement of LVEF >=10% at 24 months was uncommon in
patients with ischaemic cardiomyopathy, did not differ between patients
assigned to CABG and medical therapy or medical therapy alone and was
independently associated with reduced mortality. Trial registration
number: NCT00023595. <br/>Copyright &#xa9; 2020 Author(s) (or their
employer(s)). No commercial re-use. See rights and permissions. Published
by BMJ.