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<1>
Accession Number
610299916
Title
Comparison of early period results of blood use in open heart surgery.
Source
Journal of Research in Medical Sciences. 21 (2) (no pagination), 2016.
Date of Publication: 2016.
Author
Huseyin S.; Yuksel V.; Guclu O.; Turan F.N.; Canbaz S.; Ege T.; Sunar H.
Institution
(Huseyin, Yuksel, Guclu, Canbaz, Ege) Departments of Cardiovascular
Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey
(Turan) Departments of Biostatistics, Faculty of Medicine, Trakya
University, Edirne, Turkey
(Sunar) Kartal Kosuyolu Research Hospital, Istanbul, Turkey
Publisher
Isfahan University of Medical Sciences(IUMS)
Abstract
Background: Various adverse effects of homologous blood transfusion
detected particularly in open heart surgery, in which it is frequently
used, lead researchers to study on autologous blood use and to evaluate
the patient's blood better. Due to the complications of homologous blood
transfusion, development of techniques that utilize less transfusion has
become inevitable. We aimed to evaluate the effects of acute normovolemic
hemodilution (ANH) in patients undergoing open heart surgery.
<br/>Material(s) and Method(s): In this study, 120 patients who underwent
open heart surgery were included. Patients were grouped into three:
Autologous transfusion group (Group 1), homologous transfusion group
(Group 2), and those received autologous blood and homologous blood
products (Group 3). Patient data regarding preoperative characteristics,
biochemical parameters, drainage, extubation time, duration of stay at
intensive care, atrial fibrillation (AF) development, and hospital stay
were recorded. <br/>Result(s): A statistically significant difference (P <
0.005) was found in favor of autologous group (Group 1) with respect to
gender, body surface area, European System for Cardiac Operative Risk
Evaluation, smoking, hematocrit levels, platelet counts, urea, C-reactive
protein levels, protamine use, postoperative drainage, frequency of AF
development, intubation period, stay at intensive care and hospital stay,
and amount of used blood products. <br/>Conclusion(s): The use of
autologous blood rather than homologous transfusion is not only attenuates
side effects and complications of transfusion but also positively affects
postoperative recovery process. Therefore, ANH can be considered as an
easy, effective, and cheap technique during open heart
surgery.<br/>Copyright &#xa9; 2016 Journal of Research in Medical
Sciences.

<2>
Accession Number
2006777348
Title
Sex and Age Differences in Patients With Unstable Angina Pectoris: A
Single-Center Retrospective Study.
Source
American Journal of the Medical Sciences. 360 (3) (pp 268-278), 2020. Date
of Publication: September 2020.
Author
Xu M.; Li H.-W.; Chen H.; Guo C.-Y.
Institution
(Xu, Li, Chen, Guo) Department of Cardiology, Beijing Friendship Hospital,
Capital Medical University, Beijing, China
(Li) Department of Geriatrics, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
Publisher
Elsevier B.V.
Abstract
Background: Sex and age may affect the pathogenesis of coronary heart
disease, such as cardiovascular risk factors, treatment and prognosis, but
this information is not well known. <br/>Method(s): This was a
single-center retrospective cohort study. Patients with unstable angina
pectoris between January 2013 and June 2018 were included and stratified
into 4 age groups (<55, 55-64, 65-74 and >=75 years). The cardiovascular
risk factors profile, treatment and in-hospital prognosis differences by
sex and age were explored. <br/>Result(s): This study included 5,908
patients (2,198 women). The women were older than the men (mean age 67 vs.
62 years). Approximately 2 of 3 patients had >=3 cardiovascular risk
factors. Men were more likely to be smokers, and women had a higher level
of total cholesterol, low-density lipoprotein cholesterol and high-density
lipoprotein cholesterol. Hypertension, diabetes and chronic kidney disease
were more frequent in women >= 65 years old than in similarly aged men.
Men and women less than 65 years of age had more frequent family history
of coronary heart disease, higher body mass index, higher fasting plasma
glucose, and higher lipid levels, especially for patients <55 years of
age. More women tended to receive medical therapy than men (51.6% vs.
42.8%, P < 0.01). The overall incidence of in-hospital major adverse
cardiovascular events was higher in men than in women (4.1% vs. 2.6%, P <
0.05), whereas there was no sex difference in the in-hospital cardiac
mortality (0.2% vs. 0.2%, P > 0.05). <br/>Conclusion(s): Women had higher
cholesterol levels, and were less likely to undergo revascularization
therapy than similarly aged men, and elderly women had a higher prevalence
of hypertension, diabetes, and chronic kidney disease than elderly men.
In-hospital major adverse cardiovascular events were lower in women than
in men; however, there was no sex difference in the in-hospital cardiac
mortality.<br/>Copyright &#xa9; 2020

<3>
Accession Number
2006725744
Title
Relationships between mitral annular calcification and cardiovascular
events: A meta-analysis.
Source
Echocardiography. (no pagination), 2020. Date of Publication: 2020.
Author
Wang T.K.M.; Griffin B.P.; Xu B.; Rodriguez L.L.; Popovic Z.B.; Gillinov
M.A.; Pettersson G.B.; Desai M.Y.
Institution
(Wang, Griffin, Xu, Rodriguez, Popovic, Desai) Section of Cardiovascular
Imaging, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH,
United States
(Gillinov, Pettersson) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Mitral annular calcification (MAC) is prevalent in the aging
population, with recent renewed interest regarding its associations with
cardiovascular risk factors, outcomes, and influence on valvular heart
disease and interventions. This meta-analysis aimed to report the
relationships between MAC and cardiovascular mortality and morbidity
events. <br/>Method(s): Relevant studies were searched from PubMed,
Cochrane, and Embase databases until November 30, 2019. Associations
between MAC as a binary variable with death and cardiovascular events were
pooled using random-effects models. The main outcomes of interest were
all-cause and cardiovascular mortality, myocardial infarction, stroke,
heart failure, atrial fibrillation, and procedural outcomes.
<br/>Result(s): Among 799 article abstracts and 122 full-text articles
screened, 26 (16 prospective and 10 retrospective) studies totaling 35 070
subjects were analyzed. MAC was associated with higher all-cause death,
hazard ratio (95% confidence interval) 1.76 (1.43-2.22), and
cardiovascular mortality 1.85 (1.45-23.5). It also positively correlated
with myocardial infarction 1.48 (1.22-1.79), stroke 1.51 (1.22-2.05),
incidental heart failure 1.55 (1.30-1.84), atrial fibrillation 1.75
(1.43-2.15), and their composite, major adverse cardiovascular events
(MACE). Finally, conversion to mitral valve replacement at time of cardiac
surgery was more in patients with MAC than without MAC, with odds ratio
(95% confidence interval) 2.82 (1.28-6.18). <br/>Conclusion(s): Mitral
annular calcification was overall associated with higher rates of death,
and both individual and composite cardiovascular events. The presence of
increasingly encountered MAC has significant clinical implications for
cardiovascular risk assessment and valvular interventions.<br/>Copyright
&#xa9; 2020 Wiley Periodicals LLC

<4>
Accession Number
2006130111
Title
Intraoperative transesophageal echocardiography in cardiovascular surgery.
Consensus document from the Spanish Society of Anesthesia and Critical
Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular
Surgery (SECCE).
Source
Cirugia Cardiovascular. (no pagination), 2020. Date of Publication: 2020.
Author
Carmona Garcia P.; Garcia Fuster R.; Mateo E.; Badia Gamarra S.; Lopez
Cantero M.; Gutierrez Carretero E.; Maestre M.L.; Legname V.; Fita G.;
Vives M.; Koller Bernhard T.; Sanchez Perez E.; Miralles Bagan J.;
Italiano S.; Darias-Delbey B.; Barrio J.M.; Hortal J.; Saez de Ibarra
J.I.; Hernandez A.
Institution
(Carmona Garcia) Servicio de Anestesiologia y Reanimacion, Hospital
Universitario la Fe, Valencia, Espana. Miembro del grupo de trabajo en
Ecografia de la Seccion de Cuidados Criticos de la SEDAR. Coordinadora del
grupo de trabajo en Ecocardiografia, transesofagica intraoperatoria de la
SEDAR
(Garcia Fuster) Servicio de Cirugia Cardiaca, Consorcio Hospital General
Universitario de Valencia, Espana. Coordinador del grupo de trabajo en
Ecocardiografia, transesofagica intraoperatoria de la SECCE
(Mateo) Servicio de Anestesiologia y Reanimacion, Consorcio Hospital
General Universitario de Valencia, Valencia, Spain
(Badia Gamarra) Servicio de Cirugia Cardiaca, Hospital Universitario Trias
y Pujol, Badalona, Spain
(Lopez Cantero) Servicio de Anestesiologia y Reanimacion, Hospital
Universitario la Fe, Valencia, Spain
(Gutierrez Carretero) Servicio de Cirugia Cardiaca, Hospital,
Universitario Virgen del Rocio, Sevilla, Spain
(Maestre) Seccion Cardiotoracica, Servicio de Anestesiologia y
Reanimacion, Hospital Sant Pau, Barcelona, Spain
(Legname) Servicio de Cirugia Cardiaca, Centro Medico Teknon, Barcelona,
Spain
(Fita) Seccion Cardiotoracica, Servicio de Anestesiologia y Reanimacion.
Hospital Clinic, Barcelona, Spain
(Vives) DESA. Seccion Cardiotoracica, Servicio de Anestesiologia y
Reanimacion, Hospital Universitario Dr Josep Trueta de Girona, Espana.
Miembro del grupo de trabajo en Ecografia de la Seccion de Cuidados
Criticos de la SEDAR
(Koller Bernhard, Italiano) Seccion Cardiotoracica, Servicio de
Anestesiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Sanchez Perez) EDAIC. Seccion de Cirugia Cardiaca, Servicio de Anestesia
y Reanimacion, Hospital General Universitario Gregorio Maranon, Madrid,
Espana. Miembro del grupo de trabajo en Ecografia de la Seccion de
Cuidados Criticos de la SEDAR
(Miralles Bagan) Seccion Cardiotoracica, Servicio Anestesiologia y
Reanimacion, Hospital Sant Pau, Barcelona, Spain
(Darias-Delbey) Servicio Anestesiologia y Reanimacion, Proceso del
Paciente, Cardioquirurgico, Complejo Hospitalario Universitario de
Canarias, Santa Cruz de Tenerife, Spain
(Barrio) Seccion Anestesia y Reanimacion Cardiovascular, Servicio de
Anestesia y Reanimacion, Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Hortal) Servicio de Anestesiologia y Reanimacion, Hospital General.
Universitario Gregorio Maranon, Madrid, Spain
(Saez de Ibarra) Servicio de Cirugia Cardiaca, Hospital Universitario Son
Espases, Palma de Mallorca, Spain
(Hernandez) Departamento de Anestesia y Cuidados Intensivos, Grupo
Policlinica, Ibiza, Espana. Miembro del grupo de trabajo en Ecografia de
la Seccion de Cuidados Criticos, de la SEDAR Representante del subcomite
de Educacion de EACTA, EDAIC, Codirector grupo EchoSim
Publisher
Elsevier Doyma
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows
an evaluation of cardiac morphology and function in real time and it is a
quality standard in cardiovascular surgery. It has become a fundamental
tool for both monitoring and diagnosis in the intraoperative period that
allows decide the correct surgical planning and pharmacological
management. The goal of this document is to answer the questions of when
and how the perioperative TEE should be performed in cardiovascular
surgery, what are their applications in the intraoperative, who should
perform it and how the information should be transmitted. The authors made
a systematic review of international guidelines, review articles and
clinical trials to answer by consensus to these questions.<br/>Copyright
&#xa9; 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular

<5>
Accession Number
2005700310
Title
Safety and Haemodynamic Outcomes of Currently Available Suture-less Aortic
Valves in Patients With Aortic Stenosis: A Meta-Analysis.
Source
Heart Lung and Circulation. 29 (9) (pp 1301-1309), 2020. Date of
Publication: September 2020.
Author
Amer M.; Al Jawad M.A.; Omar A.; Metwaly H.
Institution
(Amer) Mahala Cardiac Center, El Gharbeya, Egypt
(Al Jawad, Omar, Metwaly) Department of Cardio-Thoracic Surgery, Faculty
of Medicine, Ain Shams University, Cairo, Egypt
Publisher
Elsevier Ltd
Abstract
Background: Suture-less aortic valves aim to achieve better outcomes and
to aid and facilitate the minimally invasive aortic valve replacement
procedure by tackling the issue of cross-clamp time, which is an
independent predictor of postoperative outcomes, especially in patients
with serious comorbidities. By reducing the number of sutures, the time
for suture placement is reduced. Our meta-analysis tried to assess the
safety and haemodynamic performance of the suture-less aortic valve
prostheses to ascertain their benefits as a viable alternative to current
established measures. <br/>Method(s): From their inceptions to February
2017, six electronic databases were searched. Relevant studies using
commercially accessible suture-free valves to replace the aortic valve
have been recognised. Based on the predefined endpoints, data were
collected and analysed. <br/>Result(s): For incorporation in qualitative
and quantitative analyses, 24 studies were recognised, with a total number
of 5,073 patients undergoing suture-less aortic valve replacement.
Mortality incidence at the 30-day and 12-month follow-ups were 2.5% and
2.7%, respectively, while the incidences of thromboembolic events (1.6%)
and paravalvular leak (0.5%) were acceptable. <br/>Conclusion(s): Current
available evidence indicates that sutureless aortic valve replacement is a
safe operation showing low mortality and complication rates, with
satisfactory haemodynamic performance.<br/>Copyright &#xa9; 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<6>
Accession Number
2007114271
Title
Cardiac resynchronization therapy for the failing systemic right
ventricle: A systematic review.
Source
International Journal of Cardiology. 318 (pp 74-81), 2020. Date of
Publication: 1 November 2020.
Author
Kharbanda R.K.; Moore J.P.; Taverne Y.J.H.J.; Bramer W.M.; Bogers
A.J.J.C.; de Groot N.M.S.
Institution
(Kharbanda, de Groot) Department of Cardiology, Erasmus MC, University
Medical Center, Rotterdam, Netherlands
(Kharbanda, Taverne, Bogers) Department of Cardiothoracic Surgery, Erasmus
MC, University Medical Center, Rotterdam, Netherlands
(Moore) Ahmanson/UCLA Adult Congenital Heart Disease Center, California,
Los Angeles, United States
(Taverne) Department of Anatomy, ERCATHAN, Erasmus MC, university Medical
Center, Rotterdam, Netherlands
(Bramer) Medical library Erasmus MC, University Medical Center, Rotterdam,
Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Patients with a systemic right ventricle (SRV) are at high risk for
development of heart failure early in life. An SRV is encountered in
patients with congenitally corrected transposition of the great arteries
(CCTGA) or dextro-transposition of the great arteries (DTGA) with previous
atrial switch repair (Mustard or Senning procedure). Progressive heart
failure is one of the leading cause of mortality in these patients.
Therefore, cardiac resynchronization therapy (CRT) has gained increasing
momentum for use in this challenging congenital heart disease (CHD)
population. However, current guidelines differ in recommendations for CRT
in patients with an SRV as evidence supporting CRT has thus far only been
described in case reports and retrospectively in relatively small study
populations. In fact, the European Society of Cardiology Guideline for the
management of grown-up congenital heart disease consider CRT to be
'experimental' in this population. This systematic review critically
summarizes current literature on CRT in SRV patients and provides future
perspectives for further research in this challenging and growing CHD
population.<br/>Copyright &#xa9; 2020 The Authors

<7>
Accession Number
2007891817
Title
Implications of Alternative Definitions of Peri-Procedural Myocardial
Infarction After Coronary Revascularization.
Source
Journal of the American College of Cardiology. 76 (14) (pp 1609-1621),
2020. Date of Publication: 6 October 2020.
Author
Gregson J.; Stone G.W.; Ben-Yehuda O.; Redfors B.; Kandzari D.E.; Morice
M.-C.; Leon M.B.; Kosmidou I.; Lembo N.J.; Brown W.M.; Karmpaliotis D.;
Banning A.P.; Pomar J.; Sabate M.; Simonton C.A.; Dressler O.; Kappetein
A.P.; Sabik J.F.; Serruys P.W.; Pocock S.J.
Institution
(Gregson, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone, Ben-Yehuda, Redfors, Leon, Kosmidou, Lembo, Karmpaliotis,
Dressler) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Ben-Yehuda, Redfors, Leon, Kosmidou, Lembo, Karmpaliotis)
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center,
New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Kandzari, Brown) Piedmont Heart Institute, Atlanta, Georgia, United
States
(Morice) Ramsay Generale deSante, Hopital Prive Jacques Cartier, Massy,
France
(Banning) Oxford University Hospitals, Oxford, United Kingdom
(Pomar, Sabate) Hospital Clinic, Barcelona, Spain
(Simonton) PCICHUCK LLC, Charlotte, NC, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) National University of Ireland, Galway (NUIG), Galway, Ireland
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Varying definitions of procedural myocardial infarction (PMI)
are in widespread use. <br/>Objective(s): This study sought to determine
the rates and clinical relevance of PMI using different definitions in
patients with left main coronary artery disease randomized to percutaneous
coronary intervention (PCI) versus coronary artery bypass grafting (CABG)
surgery in the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial.
<br/>Method(s): The pre-specified protocol definition of PMI
(PMI<inf>Prot</inf>) required a large elevation of creatine kinase-MB
(CK-MB), with identical threshold for both procedures. The Third Universal
Definition of MI (types 4a and 5) (PMI<inf>UD</inf>) required lesser
biomarker elevations but with supporting evidence of myocardial ischemia,
different after PCI and CABG. For the PMI<inf>UD</inf>, troponins were
used preferentially (available in 49.5% of patients), CK-MB otherwise. The
multivariable relationship between each PMI type and 5-year mortality was
determined. <br/>Result(s): PMI<inf>Prot</inf> occurred in 34 of 935
(3.6%) patients after PCI and 56 of 923 (6.1%) patients after CABG
(difference -2.4%; 95% confidence interval [CI]: -4.4% to -0.5%; p =
0.015). The corresponding rates of PMI<inf>UD</inf> were 37 (4.0%) and 20
(2.2%), respectively (difference 1.8%; 95% CI: 0.2% to 3.4%; p = 0.025).
Both PMI<inf>Prot</inf> and PMI<inf>UD</inf> were associated with 5-year
cardiovascular mortality (adjusted hazard ratio [HR]: 2.18 [95% CI: 1.13
to 4.23] and 2.87 [95% CI: 1.44 to 5.73], respectively).
PMI<inf>Prot</inf> was associated with a consistent hazard of
cardiovascular mortality after both PCI and CABG (p<inf>interaction</inf>
= 0.86). Conversely, PMI<inf>UD</inf> was strongly associated with
cardiovascular mortality after CABG (adjusted HR: 11.94; 95% CI: 4.84 to
29.47) but not after PCI (adjusted HR: 1.14; 95% CI: 0.35 to 3.67)
(p<inf>interaction</inf> = 0.004). Results were similar for all-cause
mortality and with varying PMI<inf>UD</inf> biomarker definitions. Only
large biomarker elevations (CK-MB >=10x upper reference limit and troponin
>=70x upper reference limit) were associated with mortality.
<br/>Conclusion(s): The rates of PMI after PCI and CABG vary greatly with
different definitions. In the EXCEL trial, the pre-specified
PMI<inf>Prot</inf> was associated with similar hazard after PCI and CABG,
whereas PMI<inf>UD</inf> was strongly associated with mortality after CABG
but not after PCI. (EXCEL Clinical Trial [EXCEL];
NCT01205776)<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<8>
Accession Number
2007891814
Title
Inhibition of Interleukin-1beta and Reduction in Atherothrombotic
Cardiovascular Events in the CANTOS Trial.
Source
Journal of the American College of Cardiology. 76 (14) (pp 1660-1670),
2020. Date of Publication: 6 October 2020.
Author
Everett B.M.; MacFadyen J.G.; Thuren T.; Libby P.; Glynn R.J.; Ridker P.M.
Institution
(Everett, MacFadyen, Glynn, Ridker) Division of Preventive Medicine,
Department of Medicine, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, United States
(Everett, Libby, Ridker) Division of Cardiovascular Medicine, Department
of Medicine, Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
(Thuren) Novartis Pharmaceutical Corporation, East Hanover, New Jersey,
and Basel, Switzerland
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Inflammation reduction with the interleukin (IL)-1beta
inhibitor canakinumab significantly reduces the first major adverse
cardiovascular event in patients with prior myocardial infarction (MI) and
residual inflammatory risk (high-sensitivity C-reactive protein >= 2
mg/l). However, the effect of canakinumab on the total number of
cardiovascular events, including recurrent events collected after a first
event, is unknown. <br/>Objective(s): This study sought to determine
whether randomly allocated canakinumab would reduce the total burden of
serious cardiovascular events. <br/>Method(s): We randomized 10,061
patients to placebo or canakinumab 50 mg, 150 mg, or 300 mg once every 3
months and compared the rates of the composite of all serious
cardiovascular events (MI, stroke, coronary revascularization, and
cardiovascular death) in active versus placebo groups. We used negative
binomial regression to account for correlations among repeated events in
the same person and to estimate rate ratios and 95% confidence intervals.
<br/>Result(s): During a median of 3.7 years of follow-up, 3,417 total
serious cardiovascular events occurred in 2,003 individuals among the
10,061 unique patients randomized. Canakinumab reduced the rates of total
serious cardiovascular events, with rates per 100 person-years in the
placebo, 50 mg, 150 mg, and 300 mg canakinumab groups of 10.4, 8.4, 8.3,
and 8.2, respectively. The corresponding rate ratios (95% confidence
intervals) compared with placebo were 0.80 (0.69 to 0.93) for 50 mg, 0.79
(0.68 to 0.92) for 150 mg, and 0.78 (0.67 to 0.91) for 300 mg.
<br/>Conclusion(s): Anti-inflammatory therapy with canakinumab
significantly reduced the total number of cardiovascular events in
patients with prior MI and evidence of residual inflammatory risk.
(Cardiovascular Risk Reduction Study [Reduction in Recurrent Major CV
Disease Events] (CANTOS); NCT01327846<br/>Copyright &#xa9; 2020 American
College of Cardiology Foundation

<9>
Accession Number
2007885047
Title
Intraoperative Remifentanil Infusion and Postoperative Pain Outcomes After
Cardiac Surgery-Results from Secondary Analysis of a Randomized,
Open-Label Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Subramaniam K.; Ibarra A.; Ruppert K.; Mallikarjun K.; Orebaugh S.
Institution
(Subramaniam, Ibarra, Orebaugh) Department of Anaesthesiology and
Perioperative Medicine, University of Pittsburgh Medical Center,
Pittsburgh, United States
(Ruppert) Department of Epidemiology, Clinical and Translational Science
Institute, University of Pittsburgh, Pittsburgh, United States
(Mallikarjun) St Louis School of Medicine, Washington University, St
Louis, MO, United States
Publisher
W.B. Saunders
Abstract
Design: Report of secondary pain outcomes from a prospective, randomized,
open-label clinical trial that compared remifentanil and fentanyl on
perioperative hyperglycemic response in cardiac surgery. <br/>Setting(s):
Single institution, tertiary university hospital. <br/>Participant(s): The
study comprised 116 adult elective cardiac surgical patients.
<br/>Intervention(s): Participants were randomly assigned to receive
either intermittent fentanyl boluses (F) or continuous remifentanil
infusion (R) intraoperatively. <br/>Measurements and Main Results:
Postoperative pain was evaluated with pain scores every 6 hours for 48
hours. Pain threshold to mechanical stimuli was measured around the
sternotomy incision at 48 and 96 hours. The development of chronic pain
was assessed using the numeric rating scale at 1, 3, 6, and 12 months
after discharge. The final analysis included 106 patients. Pain scores and
wound hyperalgesia were not significantly different postoperatively
between the groups. The incidence of chronic pain at 3 months was
comparable in both groups (61% in group F v 58% in group R; p = 0.79).
Pain of more-than-mild degree was seen in 13 (32%) patients in group F and
8 (19%) in group R (p = 0.25) at 3 months. Median pain scores were not
significantly different between the groups at 1, 3, 6, and 12 months after
discharge from the hospital. <br/>Conclusion(s): The present study's
findings suggested that intraoperative remifentanil infusion does not
significantly worsen pain outcomes in patients undergoing elective cardiac
surgery.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<10>
Accession Number
632908960
Title
Clinical performance of decellularized heart valves versus standard tissue
conduits: a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 260), 2020. Date of
Publication: 18 Sep 2020.
Author
Waqanivavalagi S.W.F.R.; Bhat S.; Ground M.B.; Milsom P.F.; Cornish J.
Institution
(Waqanivavalagi, Bhat, Ground, Cornish) Department of Medicine, Faculty of
Medical and Health Sciences, University of Auckland, Grafton, Auckland
1023, New Zealand
(Waqanivavalagi) Adult Emergency Department, Auckland City Hospital
,Auckland District Health Board, Grafton, Auckland 1023, New Zealand
(Bhat) Department of Surgery, Faculty of Medical and Health Sciences,
University of Auckland, Grafton, Auckland 1023, New Zealand
(Ground) Department of Medicine, Dunedin School of Medicine, University of
Otago, Dunedin 9054, New Zealand
(Milsom) Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital
,Auckland District Health Board, Grafton, Auckland 1023, New Zealand
Publisher
NLM (Medline)
Abstract
BACKGROUND: Valve replacement surgery is the definitive management
strategy for patients with severe valvular disease. However, valvular
conduits currently in clinical use are associated with significant
limitations. Tissue-engineered (decellularized) heart valves are
alternative prostheses that have demonstrated promising early results. The
purpose of this systematic review and meta-analysis is to perform robust
evaluation of the clinical performance of decellularized heart valves
implanted in either outflow tract position, in comparison with standard
tissue conduits. <br/>METHOD(S): Systematic searches were conducted in the
PubMed, Scopus, and Web of Science databases for articles in which
outcomes between decellularized heart valves surgically implanted within
either outflow tract position of human subjects and standard tissue
conduits were compared. Primary endpoints included postoperative mortality
and reoperation rates. Meta-analysis was performed using a random-effects
model via the Mantel-Haenszel method. <br/>RESULT(S): Seventeen articles
were identified, of which 16 were included in the meta-analysis. In total,
1418 patients underwent outflow tract reconstructions with decellularized
heart valves and 2725 patients received standard tissue conduits.
Decellularized heart valves were produced from human pulmonary valves and
implanted within the right ventricular outflow tract in all cases. Lower
postoperative mortality (4.7% vs. 6.1%; RR 0.94, 95% CI: 0.60-1.47;
P=0.77) and reoperation rates (4.8% vs. 7.4%; RR 0.55, 95% CI: 0.36-0.84;
P=0.0057) were observed in patients with decellularized heart valves,
although only reoperation rates were statistically significant. There was
no statistically significant heterogeneity between the analyzed articles
(I2 =31%, P=0.13 and I2 =33%, P =0.10 respectively). <br/>CONCLUSION(S):
Decellularized heart valves implanted within the right ventricular outflow
tract have demonstrated significantly lower reoperation rates when
compared to standard tissue conduits. However, in order to allow for more
accurate conclusions about the clinical performance of decellularized
heart valves to be made, there need to be more high-quality studies with
greater consistency in the reporting of clinical outcomes.

<11>
Accession Number
632907066
Title
Retrograde Autologous Priming in Cardiac Surgery: Results From a
Systematic Review and Meta-analysis.
Source
Anesthesia and analgesia. (no pagination), 2020. Date of Publication: 16
Sep 2020.
Author
Hensley N.B.; Gyi R.; Zorrilla-Vaca A.; Choi C.W.; Lawton J.S.; Brown
C.H.; Frank S.M.; Grant M.C.; Cho B.C.
Institution
(Hensley, Frank, Grant) From the Department of Anesthesiology/Critical
Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United
States
(Gyi, Brown, Cho) Department of Anesthesiology/Critical Care Medicine,
Johns Hopkins University, School of Medicine, Baltimore, MD, United States
(Zorrilla-Vaca) Universidad del Valle School of Medicine, Cali, Columbia
(Choi, Lawton) Division of Cardiac Surgery, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Retrograde autologous priming (RAP) before cardiopulmonary
bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a
systematic review of the literature to examine the impact of RAP on
perioperative allogeneic red cell transfusions in cardiac surgical
patients. <br/>METHOD(S): This study involved a systematic review and
meta-analysis of randomized controlled trials (RCTs) and observational
studies evaluating the use of RAP in cardiac surgery involving CPB. The
primary outcome was intraoperative allogeneic red cell transfusion.
Secondary outcomes included whole hospital allogeneic transfusions and
adverse events such as acute kidney injury (AKI) and stroke.
<br/>RESULT(S): A total of 11 RCTs (n = 1337 patients) were included,
comparing RAP patients (n = 674) to control (n = 663). In addition, 10
observational studies (n = 2327) were included, comparing RAP patients (n
= 1257) to control (n = 1070). Overall, RAP was associated with a
significantly reduced incidence of intraoperative red cell transfusion (n
= 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI],
0.22-0.55, P < .001) compared to controls. This effect was seen among RCTs
(n = 10 studies; OR = 0.19; 95% CI, 0.08-0.45, P < .001) and observational
studies (n = 8 studies; OR = 0.66; 95% CI, 0.50-0.87, P = .004) in
isolation. RAP was also associated with a significantly reduced incidence
of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI,
0.19-0.41, P < .001). Among the studies that reported AKI and stroke
outcomes, there was no statistically significant increased odds of AKI or
stroke in either RAP or control patients. <br/>CONCLUSION(S): Based on the
pooled results of the available literature, RAP is associated with a
significant reduction in intraoperative and whole hospital allogeneic red
cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical
patients and thus, lessen transfusions. Additional high-quality
prospective studies are necessary to determine the ideal priming volume
necessary to confer the greatest benefit without incurring organ injury.

<12>
Accession Number
2007511810
Title
Preoperative evaluation of patients and preparation for surgery.
Source
Chirurgia (Turin). 33 (4) (pp 210-215), 2020. Date of Publication: August
2020.
Author
Grebic D.; Rudec M.; Kustic D.; Naglic N.; Nikic M.; Mrsic A.; Mrsic E.
Institution
(Grebic) Department of General and Oncological Surgery, Clinical Hospital
Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
(Rudec) Department of Endocrinology, Clinical Hospital Center Rijeka,
School of Medicine, University of Rijeka, Rijeka, Croatia
(Kustic) Clinical Department of Nuclear Medicine, Clinical Hospital Center
Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
(Naglic, Nikic, Mrsic, Mrsic) Faculty of Medicine, University of Rijeka,
Rijeka, Croatia
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The preoperative evaluation and preparation is a
multidisciplinary, multistep process preceding surgery, consisting of the
preoperative risk assessment and the patient's medical status optimization
before surgery, with the purpose of reducing surgical morbidity and
mortality. EVIDENCE ACQUISITION: Preoperative evaluation includes taking a
medical history and performing routine diagnostic tests. In a
pre-anesthetic evaluation, the airway is assessed, commonly by the LEMON
approach, in order to predict potential problems that may be encountered
during intubation, as well as in order to estimate perioperative risk
using ASA classification. Although the patient's preoperative preparation
depends on the type of surgery, preoperative fasting is important in any
surgical procedure, due to anesthesia reasons. To reduce surgical
infections, antibiotic prophylaxis is used. EVIDENCE SYNTHESIS:
Preoperative evaluation is a dynamic process that implies a thoughtful
reconsideration of all gathered information, with the purposes of meeting
both patients' needs and the requirements of surgery and anesthesia. It is
an opportunity to evaluate the acute illness and to optimize chronic
disease, as well as to assess perioperative risk. Medical history and
physical examination remain the strongest predictors of the perioperative
risk. According to recent studies, preoperative routine tests in an
apparently healthy patient, are neither beneficial nor cost-effective.
<br/>CONCLUSION(S): Preoperative evaluation and preparation protocols are
used in order to reduce the morbidity and mortality of the patients
undergoing surgery. Following the guidelines for each step of the protocol
and providing evaluation and care for the patients based on their needs,
lead to desired surgical outcomes.<br/>Copyright &#xa9; 2019 EDIZIONI
MINERVA MEDICA.

<13>
Accession Number
2007327853
Title
Comorbidity-dependent changes in alpha and broadband electroencephalogram
power during general anaesthesia for cardiac surgery.
Source
British Journal of Anaesthesia. 125 (4) (pp 456-465), 2020. Date of
Publication: October 2020.
Author
Kaiser H.A.; Hirschi T.; Sleigh C.; Reineke D.; Hartwich V.; Stucki M.;
Rummel C.; Sleigh J.; Hight D.
Institution
(Kaiser, Hirschi, Hartwich, Stucki, Hight) Department of Anaesthesiology
and Pain Medicine, Inselspital, Bern University Hospital, University of
Bern, Switzerland
(Sleigh) Department of Mathematics, University of Auckland, Auckland, New
Zealand
(Reineke) Department of Cardiovascular Surgery, University Hospital Bern,
Inselspital, Bern, Switzerland
(Rummel) University of Bern, Support Center for Advanced Neuroimaging,
University Institute for Diagnostic and Interventional Neuroradiology,
Inselspital, Bern, Switzerland
(Sleigh) Department of Anaesthesia, Waikato Clinical School, University of
Auckland, Hamilton, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Age and comorbidities are reported to induce neurobiological
transformations in the brain. Whilst the influence of ageing on
anaesthesia-induced electroencephalogram (EEG) changes has been
investigated, the effect of comorbidities has not yet been explored. We
hypothesised that certain diseases significantly affect frontal EEG alpha
and broadband power in cardiac surgical patients. <br/>Method(s): We
analysed the frontal EEGs of 589 patients undergoing isoflurane general
anaesthesia from a prospective observational study. We used multi- and
uni-variable regression to analyse the relationships between comorbidities
and age as independent with peak and oscillatory alpha, and broadband
power as dependent variables. A score of comorbidities and minimum
alveolar concentration (MAC) was built to interrogate the combined effect
of age and score on alpha and broadband power. <br/>Result(s): At the
univariable level, many comorbidities were associated with lower EEG alpha
or broadband power. Multivariable regression indicated the independent
association of numerous comorbidities and MAC with peak alpha
(R²=0.19) and broadband power (R²=0.31). The
association with peak alpha power is markedly reduced when the underlying
broadband effect is subtracted (R²=0.09). Broadband measures
themselves are more strongly correlated with comorbidities and MAC
(R²=0.31) than age (R²=0.15). <br/>Conclusion(s):
Comorbidities and age are independently associated with decreasing frontal
EEG alpha and broadband power during general anaesthesia. For alpha power,
the association is highly dependent on the underlying broadband effect.
These findings might have significant clinical consequences for automated
computation for depth of anaesthesia in comorbid patients, because
misclassification might pose the risk of under- or over-dosing of
anaesthetics. Clinical trial registration: NCT02976584.<br/>Copyright
&#xa9; 2020 British Journal of Anaesthesia

<14>
Accession Number
2007164302
Title
Five-year outcomes comparing percutaneous coronary intervention with
drug-eluting stents versus coronary artery bypass grafting in patients
with left main coronary artery disease: A systematic review and
meta-analysis.
Source
Atherosclerosis. 308 (pp 50-56), 2020. Date of Publication: September
2020.
Author
Zhang J.; Jiang T.; Hou Y.; Chen F.; Yang K.; Sang W.; Wu H.; Ma Y.; Xu
F.; Chen Y.
Institution
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) Department of Emergency
Medicine, Qilu Hospital of Shandong University, Jinan, China
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) Shandong Provincial
Clinical Research Center for Emergency and Critical Care Medicine,
Institute of Emergency and Critical Care Medicine of Shandong University,
Qilu Hospital of Shandong University, Jinan, China
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) Key Laboratory of
Emergency and Critical Care Medicine of Shandong Province, Key Laboratory
of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province,
Shandong Provincial Engineering Laboratory for Emergency and Critical Care
Medicine, Qilu Hospital of Shandong University, Jinan, China
(Zhang, Jiang, Hou, Yang, Sang, Wu, Ma, Xu, Chen) The Key Laboratory of
Cardiovascular Remodeling and Function Research, Chinese Ministry of
Education, Chinese Ministry of Health and Chinese Academy of Medical
Sciences, The State and Shandong Province Joint Key Laboratory of
Translational Cardiovascular Medicine, Qilu Hospital of Shandong
University, Jinan, China
(Chen) Emergency Department, The Affiliated Hospital of Inner Mongolia
Medical University, Huhhot, China
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: In patients with left main coronary artery disease
(LMCAD), long-term outcomes after percutaneous coronary intervention (PCI)
with drug-eluting stents (DES) compared with coronary artery bypass
grafting (CABG) remain controversial. We conducted a meta-analysis to
compare the efficacy and safety of PCI with DES and CABG in LMCAD
patients. <br/>Method(s): We comprehensively searched in Web of Science,
EMBASE, PubMed, and Cochrane databases for eligible randomised controlled
trials (RCTs) comparing the 5-year clinical outcomes between PCI with DES
and CABG in LMCAD patients. Random-effect models were applied to analyse
risk ratios (RRs) and hazard ratios (HRs) across studies, and
I² to assess heterogeneity. <br/>Result(s): We screened 4 RCTs
including 4394 patients distributed randomly into PCI (n = 2197) and CABG
(n = 2197) groups. In comparison to CABG, PCI showed non-inferiority
concerning a composite of death, myocardial infarction, and stroke (HR
1.22, 95% confident interval [CI] 0.84-1.75), death (HR 1.06, 95% CI
0.81-1.40) and stroke (HR 0.80, 95% CI 0.42-1.53). Regarding major adverse
cardiac or cerebrovascular events (MACCE) rate, both strategies show
clinical equipoise in patients with a low-to-intermediate Synergy Between
PCI with TAXUS and Cardiac Surgery (SYNTAX) score (HR 1.20, 95% CI
0.85-1.70), while CABG had an advantage over PCI in those with a high
SYNTAX score (HR 1.64, 95% CI 1.20-2.24). <br/>Conclusion(s): CABG showed
advantage over PCI with DES for LMCAD patients in MACCE. PCI and CABG
showed equivalent 5-year clinical risk of a composite of all-cause
mortality, myocardial infarction, and stroke, but the former had higher
risk of repeat revascularization.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<15>
Accession Number
2005999532
Title
Lung protective ventilation in infants undergoing cardiopulmonary bypass
surgery for congenital heart disease: A prospective randomized controlled
trial.
Source
Paediatric Anaesthesia. 30 (7) (pp 814-822), 2020. Date of Publication: 01
Jul 2020.
Author
Sun Y.; Shen S.-E.; Deng X.-M.; Cai Y.; Du Y.
Institution
(Sun, Shen, Cai, Du) Department of Anesthesiology and Critical Care
Medicine, Xin Hua Hospital affiliated to Jiaotong University School of
Medicine, Shanghai, China
(Deng) Department of Anesthesiology and Intensive Care Medicine, Changhai
Hospital affiliated to The Second Military Medical University, Shanghai,
China
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Background: Lung protective ventilation (LPV) has been applied to surgical
adults with normal pulmonary function for optimizing mechanical
ventilation and reducing postoperative pulmonary complications. Few
studies have reported the use of LPV in infants undergoing cardiac surgery
with cardiopulmonary bypass (CPB). <br/>Aim(s): To explore safety and
effectiveness of LPV in infants undergoing CPB surgery for congenital
heart disease (CHD). <br/>Method(s): Included in this study were 77
infants who underwent CPB surgery for CHD from November 2017 to September
2018. They were randomized into the LPV group and conventional ventilation
(CV) group. In the LPV group, small-tidal-volume (6-8 ml/kg) ventilation,
lung recruitment by PEEP increment to the maximum level of 15 cm
H<inf>2</inf>O after CPB, and individualized optimal PEEP titration were
applied. In the CV group, traditional tidal volume (10-12 ml/kg with zero
PEEP) was applied. The primary outcome was the ratio of arterial partial
pressure of oxygen to inspiratory oxygen fraction
(PaO<inf>2</inf>/FiO<inf>2</inf>). The secondary outcomes were respiratory
dynamic parameters, hypoxemia, prognostic indexes, and postoperative
pulmonary complications. <br/>Result(s): PaO<inf>2</inf>/FiO<inf>2</inf>
in the LPV group (416.86, 95%CI: 381.60-452.12) was significantly higher
than that in the CV group (263.37, 95%CI: 227.65-299.09) after
intervention (P <.001). There was a significant difference in the trend of
change in dynamic compliance, alveolar-arterial oxygen difference,
arterial-end-expired carbon dioxide difference, driving pressure, and
respiratory index between the two groups at different time points from
weaning from CPB to 2 hours after operation. There was no significant
difference in PaO<inf>2</inf>/FiO<inf>2</inf>, alveolar-arterial oxygen
difference, respiratory index, and dynamic compliance 2 hours
postoperative and in the incidence of postoperative pulmonary
complications, prognostic indexes between the two groups.
<br/>Conclusion(s): LPV could be used safely in infants undergoing CPB in
that it can improve oxygenation, alveolar aeration, and dynamic
compliance, and reduce driving pressure, pulmonary shunting, and dead
space. Its effect on oxygenation, pulmonary gas exchange, and pulmonary
compliance was relatively short, and had less impact on postoperative
pulmonary complications and prognosis.<br/>Copyright &#xa9; 2020 John
Wiley & Sons Ltd

<16>
Accession Number
2006170945
Title
Left atrial appendage exclusion is effective in reducing postoperative
stroke after mitral valve replacement.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Jiang S.; Zhang H.; Wei S.; Zhang L.; Gong Z.; Li B.; Wang Y.
Institution
(Jiang, Zhang, Wei, Zhang, Gong, Li, Wang) Department of Cardiovascular
Surgery, Chinese PLA General Hospital, Beijing, China
(Zhang, Wei) Department of Cardiovascular Surgery, PLA Medical School,
Beijing, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: This study aimed to evaluate the role of surgical left atrial
appendage (LAA) exclusion in the prevention of stroke after mitral valve
replacement (MVR). <br/>Method(s): We retrospectively reviewed clinical
data of 860 patients who received MVR in our center from January 2008 to
January 2013. The patients were randomly assigned to two surgical groups,
namely LAA exclusion group (n = 521) and LAA nonexclusion group (n = 339)
according to whether concurrent surgical exclusion of the LAA was to be
undertaken or not before surgery in a blind fashion. MVR was performed by
two experienced surgeons. The LAA was explored during the operation and
mural thrombus removed in all cases. The LAA was left intact in
nonocclusion group whereas the neck of the LAA was closed with a two-layer
continued suture in exclusion group. The incidence of early postoperative
ischemic stroke between the two groups was compared. <br/>Result(s): The
patients' age was 53 +/- 12 years, with 48.1% male and 67.9% with
rheumatic disease. Mural thrombosis was seen in 18.8% of the patients and
atrial fibrillation (AF) coexisted in 62.4%. All operations were
successfully performed and no difference was noted in in-hospital
mortality, re-exploration for bleeding, and other major complications
between the two groups. The incidence of ischemic stroke in LAA exclusion
group was significantly lower than in nonexclusion group (0.6% vs. 2.7%, p
=.011). The subgroup multivariate analysis showed that LAA exclusion
significantly reduced the risk of postoperative stroke in patients with AF
(odds ratio [OR] = 0.070, 95% confidence interval [CI]: 0.006-0.705, p
=.025) but not in non-AF patients (OR = 1.902, 95% CI: 0.171-21.191, p
=.601). <br/>Conclusion(s): Concurrent LAA exclusion during MVR is a safe
and effective way to reduce postoperative ischemic stroke, particularly in
patients with AF.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<17>
Accession Number
2006170921
Title
Effects of antidiabetic medications on cardiovascular outcomes.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Leung M.S.T.; Lin S.G.; Uthayanan L.; Harky A.
Institution
(Leung, Lin, Uthayanan) Department of Surgery, Faculty of Medicine,
University of London, St George's Hospital Medical School, London, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Hyperglycemia is associated with an increased risk of adverse
cardiovascular outcomes, such as heart failure, coronary heart disease,
stroke, and in-hospital mortality. For those receiving cardiac surgery, up
to half develop hyperglycemia while 30% have a diagnosis of diabetes,
which is defined by chronic hyperglycemia. Due to a prothrombic state and
endovascular damage, patients with diabetes have a twofold increased risk
of cardiovascular events. <br/>Method(s): Electronic literature search was
done to identify articles that have discussed antidiabetic medications and
how it is impacting the glycemia status as well as cardiovascular
outcomes. No limits were placed on timing of the publication or type of
the article. Key words and MeSH terms were used to conduct the search and
the results are summarized in a narrative manner within each relevant
section. <br/>Result(s): Antidiabetic medications play a key role in
lowering blood glucose levels to reduce adverse cardiovascular outcomes.
However, it is a challenge to assess their cardiovascular safety due to
confounding factors, such as age, obesity, smoking, hyperlipidemia, and
high blood pressure. Further research in this field is required to
understand this correlation closely. <br/>Conclusion(s): Optimizing blood
glucose level during the perioperative period with correct medication and
dose have a significant role in reducing morbidities. Measures should be
taken to provide a safe blood glucose level for optimum
outcomes.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<18>
Accession Number
2006170892
Title
Coronary artery bypass grafting: Factors affecting outcomes.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Kusu-Orkar T.-E.; Kermali M.; Oguamanam N.; Bithas C.; Harky A.
Institution
(Kusu-Orkar) Department of Surgery, Queens Medical Center, Nottingham,
United Kingdom
(Kermali, Bithas) Faculty of Medicine, St. George's University of London,
London, United Kingdom
(Oguamanam) Department of Emergency Medicine, East Sussex Healthcare NHS
Trust, Seaford, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Liverpool Center 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
Introduction: Coronary artery bypass grafting forms the bulk of a cardiac
surgeon's workload. An extensive amount of research has been undertaken to
improve the outcomes of this procedure. This literature review aimed to
summarize key areas that influence coronary artery bypass grafting in
modern day practice. <br/>Method(s): A comprehensive electronic search was
done using PubMed, Ovid, SCOPUS, Embase and google scholar from inception
to July 2020. Articles were included if they discussed factors affecting
outcomes in coronary bypass grafting (CABG). Case reports, expert opinion,
and editorials were excluded. <br/>Result(s): There are many factors that
influence and predict outcomes following coronary artery bypass surgery.
Age, diabetes, and isolated systolic hypertension were preoperative
factors with strong correlation to mortality and morbidity rates post
CABG. In addition to these, the degree of renal failure and heart failure
correlated with poorer operative results. The use of the left internal
mammary artery has transformed outcomes and has proven advantage over
venous conduit use. Newer minimal invasive techniques have the potential
to further optimize outcomes. <br/>Conclusion(s): The numerous and complex
factors which impair outcomes following CABG need to be further researched
and addressed using larger trials and possible optimization of
multi-disciplinary team approach to further improve long term
outcomes.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<19>
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. 40 (9) (no pagination), 2020. Date of Publication: 30
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; Beilishi Road
167, Xicheng District, Beijing 100037, 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 and 1.9 years. Patients with higher baseline circulating
galectin-3 had an increased risk of all-cause mortality after TAVR
(random-effects model: risk ratio [RR]: 1.63, 95% confidence interval
[CI]: 1.19-2.23, P=0.002; fixed-effects model: RR: 1.62, 95% CI:
1.19-2.20, P=0.002; I2 = 4%). Adjustment of estimated glomerular
filtration rate (RR: 1.73, P=0.02) or B-type natriuretic peptide (BNP) or
N-terminal pro-BNP (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
(ELFA) (RR: 3.04, P=0.003) compared with those with an enzyme-linked
immunosorbent assay (ELISA) (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 &#xa9; 2020 The Author(s).

<20>
Accession Number
627910841
Title
Ropivacaine/Fentanyl vs. Bupivacaine/Fentanyl for Pain Control in Children
after Thoracic Surgery: A Randomized Study.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. 20 (4) (pp 390-397), 2019. Date of Publication: 01 Aug
2019.
Author
Tomaszek L.; Fenikowski D.; Komotajtys H.; Gawron D.
Institution
(Tomaszek) Division of Specialist Nursing, Department of Nursing, Faculty
of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow
University, Krakow, Poland; Pediatric Division, Department of Thoracic
Surgery, Institute for Tuberculosis and Lung Diseases, Rabka-Zdroj, Poland
(Fenikowski, Komotajtys, Gawron) Pediatric Division, Department of
Thoracic Surgery, Institute for Tuberculosis and Lung Diseases, Poland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although bupivacaine remains a standard local anesthetic for
postoperative epidural infusions in pediatric patients, it is increasingly
being replaced with ropivacaine by many anesthesiologists. Ropivacaine is
associated with less risk for cardiac and central nervous system toxicity.
AIMS: The purpose of this study was to compare analgesic efficacy and
adverse events of postoperative epidural analgesia with
ropivacaine/fentanyl versus bupivacaine/fentanyl in children after the
Ravitch procedure and thoracotomy. DESIGN: This was a prospective
randomized controlled study. SETTINGS: This study was conducted at the
Department of Thoracic Surgery of the Institute of Tuberculosis and Lung
Diseases in Rabka Zdroj, Poland. PARTICIPANTS/SUBJECTS: 94 patients
undergoing elective thoracic surgery. <br/>METHOD(S): Patients aged 7-17
years were randomly allocated into a ropivacaine 0.2% (RF, n = 45) or
bupivacaine 0.125% (BF, n = 45) group; 1 mL of each analgesic solution
contained 5 mug fentanyl. All patients received acetaminophen and
nonsteroidal anti-inflammatory drugs. Nurses assessed pain intensity and
incidence of adverse events over 72 hours after surgery and modified
analgesia if patient pain intensity was greater than 2 out of 10.
<br/>RESULT(S): There was no statistically significant difference in
median pain scores and incidence of adverse events between the RF group
and the BF group. The analgesia was excellent (median pain intensity
scores at rest, during deep breathing, and when coughing was less than 1
out of 10 in all patients). Adverse events included incidents of
desaturation (64/90), nausea (18/90), vomiting (31/90), pruritus (12/90),
urinary retention (2/90), paresthesia (11/90), anisocoria (2/90), and
Horner syndrome (2/90). <br/>CONCLUSION(S): Thoracic epidural analgesia
using an RF and BF solution resulted in similar pain relief and adverse
event profiles.<br/>Copyright &#xa9; 2019 American Society for Pain
Management Nursing. Published by Elsevier Inc. All rights reserved.

<21>
Accession Number
2006708365
Title
Preoperative left stellate ganglion block: Does it offer
arrhythmia-protection during off-pump CABG surgery? A randomized clinical
trial.
Source
Egyptian Journal of Anaesthesia. 36 (1) (pp 194-200), 2020. Date of
Publication: 01 Jan 2020.
Author
Abd Allah E.; Bakr M.A.; Abdallah Abdelrahman S.; Taha A.M.; Kamel E.Z.
Institution
(Abd Allah, Bakr, Abdallah Abdelrahman, Kamel) Departments of Anesthesia
and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
(Taha) Cardiothoracic Surgery, Faculty of Medicine, Assiut University,
Assiut, Egypt
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Cardiac arrhythmias are not uncommon during and after coronary
artery bypass graft cardiac surgeries. Preliminary studies showed the
preventive effects of stellate ganglion block upon cardiac arrhythmias;
however, this could be the 1^st study focusing upon
intraoperative arrhythmias during offpump coronary artery bypass graft
surgery as a main goal. <br/>Method(s): This is a randomized controlled
trial. The study involved forty adult patients undergoing elective offpump
coronary artery bypass graft surgery. Twenty patients received left SGB
with 10 ml of 2% lidocaine before induction of anesthesia (B group), and
twenty patients as a control group (A group). Intraoperative and 24-hours
postoperative electrocardiogram and hemodynamics were monitored, in
addition to the mean postoperative 24-hours inotropic score.
<br/>Result(s): There was a significantly higher incidence of
intraoperative arrhythmias in the control group in the form of
bradyarrhythmia (25%), supraventricular tachycardia (30%), atrial
fibrillation (5%), ventricular tachycardia (10%), and ventricular
fibrillation (5%) in comparison to the block group where atrial
fibrillation occurred only in 4 patients (20%) with the p value of 0.007.
Mean arterial blood pressure and heart rate showed significantly lower
values in the SGB group intraoperatively. Postoperative mean 24-hour
inotropic score and hemodynamics showed insignificant differences.
<br/>Conclusion(s): Preoperative left stellate ganglion block can decrease
incidence of arrhythmias during offpump coronary artery bypass graft
surgeries. The technique showed a safe profile upon hemodynamics during
the study period.<br/>Copyright &#xa9; 2020 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<22>
Accession Number
632857379
Title
The use of dexmedetomidine and intravenous acetaminophen for the
prevention of postoperative delirium in cardiac surgery patients over 60
years of age: A pilot study.
Source
F1000Research. 6 (no pagination), 2017. Article Number: 1842. Date of
Publication: 2017.
Author
Susheela A.T.; Packiasabapathy S.; Gasangwa D.-V.; Patxot M.; O'Neal J.;
Marcantonio E.; Subramaniam B.
Institution
(Susheela, Packiasabapathy, Gasangwa, Patxot, Subramaniam) Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA 02215-5400, United States
(O'Neal) Department of Anesthesiology, Vanderbilt University Medical
Center, 1215 21st Ave. S., Suite 5160 MCE NT, Nashville, TN 37232, United
States
(Marcantonio) Department of Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA 02215-5400, United States
Publisher
F1000 Research Ltd
Abstract
Background: Delirium is associated with many negative health outcomes.
Postoperative sedation and opioid administration may contribute to
delirium. We hypothesize that the use of dexmedetomidine and Intravenous
acetaminophen (IVA) may lead to reduced opioid consumption and decreased
incidence of postoperative delirium. This pilot study aims to assess
feasibility of using dexmedetomidine and IVA in cardiac surgical patients,
and estimate the effect size for incidence and duration of delirium.
<br/>Method(s): A total of 12 adult patients >60 years of age undergoing
cardiac surgery were recruited and randomized into 4 groups: Propofol only
(P), Propofol with IVA (P+A), Dexmedetomidine only (D), Dexmedetomidine
with IVA (D+A). Preoperative baseline cognition and postoperative delirium
was assessed daily until discharge. The feasibility was assessed by the
number of patients who completed the study. <br/>Result(s): All patients
completed the study successfully. The total incidence of delirium in the
study population was 42% (5/12): 67% (2/3) in the group P, and 67% (2/3)
in the group D, 33% (1/3) in D+A group and 0%(0/3) P+A group. The
incidence of delirium was 17% (1/6) in the group receiving IVA compared to
67% (4/6) that did not receive IVA. The mean range of duration of delirium
was 0-1 days. One patient expired after surgery, unrelated to the study
protocol. One patient in the D group experienced hypotension (systolic
blood pressure <90 mm of Hg.) <br/>Conclusion(s): The feasibility of
performing a project is ascertained by the study. Patients receiving IVA
had lower incidence of delirium compared to patients not receiving IVA
which suggests that IVA may have a role in reducing the incidence of
delirium. A prospective randomized, placebo-controlled trial will be the
next step in investigating the role of dexmedetomidine and IVA in reducing
the incidence of delirium.<br/>Copyright &#xa9; 2017 Susheela AT et al.

<23>
Accession Number
632892099
Title
Publication performance in German academic heart surgery.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2020. Date of
Publication: 2020.
Author
Debus E.S.; Dolg M.; Reichenspurner H.; Grundmann R.T.
Institution
(Debus, Dolg, Grundmann) Herz- und Gefaszentrum, Universitatsklinikum
Hamburg-Eppendorf, Hamburg, Germany
(Reichenspurner) Cardiovascular Surgery, Universitatsklinikum
Hamburg-Eppendorf, Hamburg, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
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. Methods 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. Results 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. Conclusions 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 &#xa9; 2020 BMJ
Publishing Group. All rights reserved.

<24>
Accession Number
624788881
Title
A multicenter randomized controlled trial of Zephyr Endobronchial Valve
treatment in heterogeneous emphysema (LIBERATE).
Source
American Journal of Respiratory and Critical Care Medicine. 198 (9) (pp
1151-1164), 2018. Date of Publication: 01 Nov 2018.
Author
Criner G.J.; Sue R.; Wright S.; Dransfield M.; Rivas-Perez H.; Wiese T.;
Sciurba F.C.; Shah P.L.; Wahidi M.M.; De Oliveira H.G.; Morrissey B.;
Cardoso P.F.G.; Hays S.; Majid A.; Pastis N.; Kopas L.; Vollenweider M.;
Michael McFadden P.; Machuzak M.; Hsia D.W.; Sung A.; Jarad N.;
Kornaszewska M.; Hazelrigg S.; Krishna G.; Armstrong B.; Shargill N.S.;
Slebos D.-J.
Institution
(Criner) Department of Thoracic Medicine and Surgery, Lewis Katz School of
Medicine, Temple University, Philadelphia, PA, United States
(Sue, Wright) St. Joseph's Hospital and Medical Center, Phoenix, AZ,
United States
(Dransfield) University of Alabama, Birmingham UAB Lung Health Center,
Birmingham, AZ, United States
(Rivas-Perez, Wiese) Department of Medicine, University of Louisville,
Louisville, KY, United States
(Sciurba) Division of Pulmonary, Allergy and Critical Care Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Shah) Royal Brompton Hospital and Imperial College, London, United
Kingdom
(Wahidi) Duke University Medical Center, Duke University, Durham, NC,
United States
(De Oliveira) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(Morrissey) Division of Pulmonary, Critical Care and Sleep Medicine,
University of California, Davis, Sacramento, CA, United States
(Cardoso) Instituto do Coracao, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Hays) University of California, San Francisco, San Francisco, CA, United
States
(Majid) Interventional Pulmonology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Pastis) Medical University of South Carolina, Charleston, SC, United
States
(Kopas) Pulmonary Critical Care and Sleep Medicine Consultants, Houston
Methodist, Houston, TX, United States
(Vollenweider) Orlando Health Pulmonary and Sleep Medicine Group, Orlando
Regional Medical Center, Orlando, FL, United States
(Michael McFadden) Keck School of Medicine, University of Southern
California, Los Angeles, CA, United States
(Machuzak) Center for Major Airway Diseases, Cleveland Clinic, Cleveland
Clinic Foundation, Respiratory Institute, Cleveland, OH, United States
(Hsia) Los Angeles Biomedical Research Institute, Harbor-University of
California Los Angeles, Torrance, CA, United States
(Sung) Stanford Hospital and Clinics, Stanford, CA, United States
(Jarad) University Hospital Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Kornaszewska) Department of Cardiothoracic Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Hazelrigg) Division of Cardiothoracic Surgery, Department of Surgery,
Southern Illinois University School of Medicine, Springfield, IL, United
States
(Krishna) Palo Alto Medical Foundation, El Camino Hospital, Mountain View,
CA, United States
(Armstrong) QST Consultations Ltd., Allendale, MI, United States
(Shargill) Pulmonx Corporation, Redwood City, CA, United States
(Slebos) Department of Pulmonary Diseases, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
American Thoracic Society (E-mail: membership@thoracic.org)
Abstract
Rationale: This is the first multicenter randomized controlled trial to
evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV)
in patients with little to no collateral ventilation out to 12 months.
<br/>Objective(s): To evaluate the effectiveness and safety of Zephyr EBV
in heterogeneous emphysema with little to no collateral ventilation in the
treated lobe. <br/>Method(s): Subjects were enrolled with a 2:1
randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at
12 months was the DELTAEBV-SoC of subjects with a post-bronchodilator FEV1
improvement from baseline of greater than or equal to 15%. Secondary
endpoints included absolute changes in post-bronchodilator
FEV<inf>1</inf>, 6-minute-walk distance, and St. George's Respiratory
Questionnaire scores. <br/>Measurements and Main Results: A total of 190
subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and
16.8% SoC subjects had a DFEV1 greater than or equal to 15% (P < 0.001).
DEBV-SoC at 12 months was statistically and clinically significant: for
FEV<inf>1</inf>, 0.106 L (P < 0.001); 6-minute-walk distance, +39.31 m (P
= 0.002); and St. George's Respiratory Questionnaire, -7.05 points (P =
0.004). Significant DELTAEBV-SoC were also observed in hyperinflation
(residual volume, 2522 ml; P < 0.001), modified Medical Research Council
Dyspnea Scale (20.8 points; P < 0.001), and the BODE (body mass index,
airflow obstruction, dyspnea, and exercise capacity) index (-1.2 points).
Pneumothorax was the most common serious adverse event in the treatment
period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths
occurred in the EBV group during this phase, and one each in the EBV and
SoC groups between 46 days and 12 months. <br/>Conclusion(s): Zephyr EBV
provides clinically meaningful benefits in lung function, exercise
tolerance, dyspnea, and quality of life out to at least 12 months, with an
acceptable safety profile in patients with little or no collateral
ventilation in the target lobe.<br/>Copyright &#xa9; 2018 by the American
Thoracic Society.

<25>
Accession Number
359568478
Title
Single dose dexamethasone for postoperative nausea and vomiting - A
matched case-control study of postoperative infection risk.
Source
Anaesthesia and Intensive Care. 38 (4) (pp 661-666), 2010. Date of
Publication: July 2010.
Author
Percival V.G.; Riddell J.; Corcoran T.B.
Institution
(Percival, Riddell, Corcoran) Department of Anaesthesia and Pain Medicine,
Royal Perth Hospital, North Block, Wellington Street, Perth, WA 6000,
Australia
(Corcoran) School of Medicine and Pharmacology, University of Western
Australia, Australia
(Corcoran) Royal Perth Hospital, Australia
Publisher
Australian Society of Anaesthetists
Abstract
Dexamethasone is an effective prophylaxis against postoperative nausea and
vomiting but is immunosuppressive and may predispose patients to an
increased postoperative infection risk. This matched case-control study
examined the association between the administration of a single
intraoperative anti-emetic dose of dexamethasone (4 to 8 mg) and
postoperative infection in patients undergoing non-emergency surgery in a
university trauma centre. Cases were defined as patients who developed
infection between one day and one month following an operative procedure
under general anaesthesia. Controls who did not develop infection were
matched for procedure, age and gender. Exclusion criteria included
immunosuppressive medications, chronic glucocorticoid therapy, cardiac
surgical and solid-organ transplantation procedures. Sixty-three cases and
172 controls were identified. Cases were more likely to have received
dexamethasone intraoperatively (25.4 vs 11%, P=0.006), and less likely to
have received perioperative antibiotic prophylaxis (60.3 vs 84.3%,
P=0.001). Stepwise, multivariate conditional logistic regression confirmed
these associations, with adjusted odds ratios of 3.03 (1.06 to 19.3,
P=0.035) and 0.12 (0.02 to 0.7, P=0.004) respectively for the associations
between dexamethasone and perioperative antibiotic prophylaxis, with
postoperative infection. We conclude that intraoperative administration of
dexamethasone for anti-emetic purposes may confer an increased risk of
postoperative infection.

<26>
Accession Number
2007522657
Title
Use of Erector Spinae Plane Block in Thoracic Surgery Leads to Rapid
Recovery From Anesthesia.
Source
Annals of Thoracic Surgery. 110 (4) (pp 1153-1159), 2020. Date of
Publication: October 2020.
Author
Chaudhary O.; Baribeau Y.; Urits I.; Sharkey A.; Rashid R.; Hess P.; Krumm
S.; Fatima H.; Zhang Q.; Gangadharan S.; Mahmood F.; Matyal R.
Institution
(Chaudhary, Baribeau, Urits, Sharkey, Rashid, Hess, Krumm, Zhang, Mahmood,
Matyal) Department of Anesthesia, Critical Care and Pain Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(Fatima) Department of Surgery, Division of Cardiac Surgery, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
(Gangadharan) Department of Surgery, Division of Thoracic Surgery, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Ultrasound guidance has resulted in a continuous evolution in
techniques for pain control for video-assisted thoracoscopic surgery
(VATS). The objective of this study was to compare erector spinae plane
block with intercostal block as multimodal analgesia to elucidate quality
of postoperative pain control and preservation of pulmonary function after
VATS. <br/>Method(s): A consecutive cohort of patients undergoing elective
VATS was enrolled in the study and divided into erector spinae plane block
and intercostal block groups. Spirometry and visual analog scale pain
score exams were performed to measure forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV<inf>1</inf>), FEV<inf>1</inf>/FVC
ratio, and forced expiratory flow in intervals of 25% to 75%. Chronic pain
was assessed by reviewing surgical follow-up notes. <br/>Result(s):
Seventy-eight patients were included. Comparing the erector spinae plane
block group with the intercostal block group found significant improvement
in visual analog scale pain score (3.2 vs 6.4, P < .001), postanesthesia
care unit length of stay (127.3 vs 189.5 minutes, P = .045), preservation
in lung volume parameters at 2 hours (FVC: 40.5% vs 51.4%, P < .001;
FEV<inf>1</inf>: 40.9% vs 53.8%, P < .001; and forced expiratory flow in
intervals of 25%-75%: 39.7% vs 53.7%, P = .019) and at 24 hours (FVC:
37.8% vs 50.5%, P < .001; FEV<inf>1</inf>: 34.3% vs 51.9%, P < .001;
forced expiratory flow in intervals of 25%-75%: 27.1% vs 56.3%, P < .001),
respectively. <br/>Conclusion(s): Erector spinae plane block improves
acute and chronic pain control and preserves lung function. Thus, it has
the potential for enhanced recovery from VATS as part of a multimodal
analgesia regimen.<br/>Copyright &#xa9; 2020 The Society of Thoracic
Surgeons

<27>
Accession Number
631966561
Title
Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical
Trials of Left Main Coronary Artery Revascularization.
Source
JAMA Internal Medicine. 180 (7) (pp 986-992), 2020. Date of Publication:
July 2020.
Author
Brophy J.M.
Institution
(Brophy) McGill University Health Center, 1001 Decarie Blvd, Montreal, QC
H4A 3J1, Canada
Publisher
American Medical Association (E-mail: shirley.martin@ama-assn.org)
Abstract
Importance: Patients with left main coronary artery disease have improved
outcomes with coronary revascularization compared with medical therapy,
but the choice of optimal revascularization technique is unresolved.
<br/>Objective(s): To use bayesian methods to analyze the risk differences
for patients with left main coronary artery disease randomized to
treatment with coronary artery bypass surgery (CABG) compared with those
randomized to percutaneous coronary intervention (PCI) in recent
randomized clinical trials (RCTs). <br/>Design, Setting, and
Participant(s): A systematic review using the PubMed database with the
query string "(left main disease) and (PCI or CABG) and (5-year follow-up)
and (clinical trial)" identified all RCTs from January 1996 to January
2020 comparing CABG to PCI for treatment of patients with left main
coronary artery disease and with 5-year follow-up data. With the use of
bayesian methods, the largest and most publicized RCT (EXCEL; Evaluation
of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left
Main Revascularization; 2019) was reanalyzed (1) as an isolated entity
using noninformative priors and (2) in the context of previous knowledge
using informative priors derived from similar trials. Published aggregate
data were used with assignments from each trial following the original
intention-to-treat principle. Combining EXCEL data with varying levels of
prior information using Bayes theorem provided final (posterior)
probability distributions for primary and secondary outcomes. <br/>Main
Outcomes and Measures: A composite end point of death, nonfatal myocardial
infarction, and stroke was the primary EXCEL outcome and was accordingly
the primary outcome for this reanalysis. Secondary analyses were performed
for isolated all-cause mortality and for the composite outcome along with
repeated revascularization procedures. <br/>Result(s): When EXCEL data
were analyzed using the originally stated noninferiority design, the
5-year primary outcome difference reported (2.8%; 95% CI, -0.9% to 6.5%)
exceeded the predefined 4.2% noninferiority margin; thus, the null
hypothesis of PCI inferiority could not be rejected. By contrast, the
present bayesian analysis of the EXCEL primary outcome estimated 95%
probability that the 5-year primary outcome difference was increased with
PCI compared with CABG and 87% probability that this difference was
greater than 1 extra event per 100 patients treated. Bayesian analyses
also suggested 99% probability that EXCEL total mortality was increased
with PCI and 94% probability that this absolute difference exceeded 1
extra deaths per 100 treated. A systematic review identified 3 other RCTs
that studied the same question. The incorporation of this prior knowledge
reduced the estimated probability of any excess mortality with PCI to 85%.
For the secondary composite end point, which also included repeated
revascularizations, there were estimated probabilities of 98% for at least
4 extra events and of 90% for at least 5 extra events per 100 patients
treated with PCI. <br/>Conclusions and Relevance: Bayesian analysis
assisted in RCT data interpretation and specifically suggested, whether
based on EXCEL results alone or on the totality of available evidence,
that PCI was associated with inferior long-term results for all events,
including mortality, compared with CABG for patients with left main
coronary artery disease.<br/>Copyright &#xa9; 2020 American Medical
Association. All rights reserved.

<28>
Accession Number
2006156290
Title
Subxiphoid versus intercostal video-assisted thoracic surgery for lung
resection: a meta-analysis.
Source
Minimally Invasive Therapy and Allied Technologies. (no pagination), 2020.
Date of Publication: 2020.
Author
Mei L.-X.; Wang Y.-Y.; Chen Y.; Dai L.; Chen M.-W.
Institution
(Mei, Wang, Chen, Dai, Chen) Department of Cardiothoracic Surgery, the
First Affiliated Hospital of GuangXi Medical University, Nanning, China
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Introduction: To systematically evaluate the safety and advantages of
subxiphoid approach video-assisted thoracic surgery (SA-VATS) compared
with intercostal approach video-assisted thoracic surgery (IA-VATS) for
lung resection, we conducted a meta-analysis of the current literature.
<br/>Material(s) and Method(s): The literature search was conducted in
PubMed, Web of Science, Cochrane Library, Embase, and China National
Knowledge Infrastructure. RevMan 5.3 software was used to perform this
meta-analysis. <br/>Result(s): Eleven studies involving 934 patients were
included. Compared with patients in the IA-VATS group, those in the
SA-VATS group had lower pain scores on the day of the operation and at 24
h, 48 h and 72 h after the operation (p <.001) and suffered from less
postoperative paraesthesia at the first, third and sixth months after the
operation (p <.001). Moreover, there was no statistically significant
difference between the two groups regarding postoperative complications,
intraoperative blood loss, length of hospital stay, drainage amount, or
chest tube duration. However, SA-VATS had a longer operative time (p
<.001). <br/>Conclusion(s): SA-VATS is a safe surgical technique and has
superior postoperative outcomes over IA-VATS for lung resection in terms
of acute postoperative pain and chronic postoperative
paraesthesia.<br/>Copyright &#xa9; 2020 Society of Medical Innovation and
Technology.

<29>
Accession Number
2006151338
Title
Percutaneous large-bore axillary access is a safe alternative to surgical
approach: A systematic review.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Southmayd G.; Hoque A.; Kaki A.; Tayal R.; Rab S.T.
Institution
(Southmayd, Hoque, Rab) Division of Cardiology, Emory University School of
Medicine, Atlanta, GA, United States
(Kaki) Division of Cardiology, Ascension St. John Hospital, Detroit, MI,
United States
(Tayal) Division of Cardiology, RWJ Barnabas Health, Newark Beth Israel
Medical Center, Newark, NJ, United States
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Objectives: To systematically review relevant literature regarding
cardiovascular outcomes of large-bore axillary arterial access via
percutaneous and surgical approaches. <br/>Background(s): In patients with
severe peripheral arterial disease (PAD) undergoing cardiac interventions,
large-bore femoral access may be prohibitive. The axillary artery provides
an alternative vascular access for transcatheter aortic valve replacement
(TAVR) or mechanical circulatory support. There have been limited
comparisons of percutaneous transaxillary (pTAX) approach with the more
traditional surgical transaxillary (sTAX) approach. <br/>Method(s): Pubmed
and Medline databases were queried through January 2019 for studies
describing pTAX or sTAX approaches with TAVR or Impella insertion. Primary
outcomes were access-related mortality, 30-day mortality, stroke, major
vascular complications, and major bleeding. <br/>Result(s): One hundred
and fifty five studies were reviewed, with additional unpublished data
from 1 institution. Twenty-two studies met the inclusion criteria. Patient
data was heterogeneous, with 69% TAVR and 31% Impella use in the pTAX
group, and 96% TAVR and 4% Impella use in the sTAX group. There was more
cardiogenic shock in the pTAX group. When compared to surgical approach,
the percutaneous approach had similar 30-day mortality for TAVR (5.6% vs
4.6%, OR non-significant) and Impella (43.4% vs 38.6%, OR
non-significant), similar stroke rates (4.3% vs 4.2%, OR non-significant),
similar major vascular complications (2.8% vs 2.3%, OR non-significant)
and less major bleeding (2.7% vs 17.9%, OR significant).
<br/>Conclusion(s): Data suggests large-bore pTAX access has similar
30-day mortality, stroke rates, and major vascular complications as sTAX
access, with less major bleeding. Additional studies are needed to
validate results.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<30>
Accession Number
2006151257
Title
Transcatheter vs surgical aortic valve replacement in low to intermediate
surgical risk aortic stenosis patients: A systematic review and
meta-analysis of randomized controlled trials.
Source
Clinical Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Zhang D.; Mao X.; Liu D.; Zhang J.; Luo G.; Luo L.
Institution
(Zhang, Mao, Liu, Zhang, Luo, Luo) Department of Cardiovascular Surgery,
The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is regarded as
the most superior alternative treatment approach for patients with aortic
stenosis (AS) who are associated with high surgical risk, whereas the
effectiveness of TAVR vs surgical aortic valve replacement (SAVR) in low
to intermediate surgical risk patients remained inconclusive. This study
aimed to determine the best treatment strategies for AS with low to
intermediate surgical risk based on published randomized controlled trials
(RCTs). Hypothesis and Methods: RCTs that compared TAVR vs SAVR in AS
patients with low to intermediate surgical risk were identified by PubMed,
EmBase, and the Cochrane library from inception till April 2019. The
pooled relative risks (RRs) with 95% confidence intervals (CIs) were
calculated for the data collected using random-effects models.
<br/>Result(s): Seven RCTs with a total of 6929 AS patients were enrolled.
We noted that TAVR significantly increased the risk of transient ischemic
attack (TIA) (RR: 1.43; 95%CI: 1.04-1.96; P =.029), and permanent
pacemaker implantation (RR: 3.00; 95%CI: 1.70-5.30; P <.001). However,
TAVR was associated with lower risk of post-procedural bleeding (RR: 0.57;
95%CI: 0.33-0.98; P =.042), new-onset or worsening of atrial fibrillation
(RR: 0.32; 95%CI: 0.23-0.45; P <.001), acute kidney injury (RR: 0.40;
95%CI: 0.25-0.63; P <.001), and cardiogenic shock (RR: 0.34; 95%CI:
0.19-0.59; P <.001). The risk of aortic-valve reintervention at 1- (RR:
2.63; 95%CI: 1.34-5.15; P =.005), and 2 years (RR: 3.19; 95%CI: 1.63-6.24;
P =.001) in low to intermediate surgical risk patients who received TAVR
was significantly increased than those who received SAVR.
<br/>Conclusion(s): These findings indicated that low to intermediate
surgical risk patients who received TAVR had low risk of complications,
whereas the risk of TIA, permanent pacemaker implantation, and
aortic-valve reintervention was increased.<br/>Copyright &#xa9; 2020 The
Authors. Clinical Cardiology published by Wiley Periodicals LLC.

<31>
Accession Number
630509429
Title
Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial
function, inflammatory parameters, and platelet function in patients with
acute coronary syndrome undergoing coronary artery stenting: a randomized,
blinded, parallel study.
Source
European heart journal. 41 (33) (pp 3144-3152), 2020. Date of Publication:
01 Sep 2020.
Author
Schnorbus B.; Daiber A.; Jurk K.; Warnke S.; Koenig J.; Lackner K.J.;
Munzel T.; Gori T.
Institution
(Schnorbus, Daiber, Munzel, Gori) Zentrum fur Kardiologie, Kardiologie I,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Schnorbus, Jurk) Center for Thrombosis and Hemostasis,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Daiber, Munzel, Gori) Deutsches Zentrum fur Herz-Kreislauferkrankungen
(DZHK), Standort Rhein-Main, Langenbeckstrase 1, Mainz 55131, Germany
(Warnke) Interdisciplinary Center for Clinical Trials (IZKS),
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Koenig) Institute of Medical Biostatistics, Epidemiology and Informatics,
University Medical Center, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Lackner) Institute of Clinical Chemistry and Laboratory Medicine,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
Publisher
NLM (Medline)
Abstract
AIMS: In a randomized, parallel, blinded study, we investigate the impact
of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial
function in patients undergoing stenting for an acute coronary syndrome.
METHODS AND RESULTS: The primary endpoint of the study was the change in
endothelium-dependent flow-mediated dilation (FMD) following stenting. A
total of 90 patients (age 62+/-9years, 81 males, 22 diabetics, 49 non-ST
elevation myocardial infarctions) were enrolled. There were no significant
differences among groups in any clinical parameter. Acutely before
stenting, all three drugs improved FMD without differences between groups
(P=0.73). Stenting blunted FMD in the clopidogrel and ticagrelor group
(both P<0.01), but not in the prasugrel group. During follow-up, prasugrel
was superior to clopidogrel [mean difference 2.13, 95% confidence interval
(CI) 0.68-3.58; P=0.0047] and ticagrelor (mean difference 1.57, 95% CI
0.31-2.83; P=0.0155), but this difference was limited to patients who
received the study therapy 2h before stenting. Ticagrelor was not
significantly superior to clopidogrel (mean difference 0.55, 95% CI -0.73
to 1.82; P=0.39). No significant differences were seen among groups for
low-flow-mediated dilation. Plasma interleukin (IL)-6 (P=0.02 and P=0.01,
respectively) and platelet aggregation reactivity in response to adenosine
diphosphate (P=0.002 and P=0.035) were lower in the prasugrel compared to
clopidogrel and ticagrelor group. <br/>CONCLUSION(S): As compared to
ticagrelor and clopidogrel, therapy with prasugrel in patients undergoing
stenting for an acute coronary syndrome is associated with improved
endothelial function, stronger platelet inhibition, and reduced IL-6
levels, all of which may have prognostic implications. This effect was
lost in patients who received the study medication immediately after
stenting. EUDRACT-NO: 2011-005305-73.<br/>Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<32>
Accession Number
627657119
Title
SUPERIOR SVG: no touch saphenous harvesting to improve patency following
coronary bypass grafting (a multi-Centre randomized control trial,
NCT01047449).
Source
Journal of cardiothoracic surgery. 14 (1) (pp 85), 2019. Date of
Publication: 02 May 2019.
Author
Deb S.; Singh S.K.; de Souza D.; Chu M.W.A.; Whitlock R.; Meyer S.R.;
Verma S.; Jeppsson A.; Al-Saleh A.; Brady K.; Rao-Melacini P.; Belley-Cote
E.P.; Tam D.Y.; Devereaux P.J.; Novick R.J.; Fremes S.E.
Institution
(Deb, Tam, Fremes) Sunnybrook Health Sciences Centre, Institute of Health
Policy, Management and Evaluation, University of Toronto, Room H405, 2075
Bayview Ave., Toronto, ON M4N 3M5, Canada
(Singh) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(de Souza) Department of Cardiothoracic and Vascular Surgery, Orebro
University, Orebro, Sweden
(Chu) Department of Surgery, Western University, London Health Sciences
Centre, London, Canada
(Whitlock, Brady, Rao-Melacini, Belley-Cote, Devereaux) Population Health
Research Institute, McMaster University and Hamilton Health Sciences,
Hamilton, Canada
(Meyer) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Verma) St. Michael's Hospital, Toronto, Canada
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Al-Saleh) McMaster University, Hamilton, Canada
(Novick) University of Calgary and Foothills Medical Centre, Calgary,
Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Single centre studies support No Touch (NT) saphenous vein
graft (SVG) harvesting technique. The primary objective of the SUPERIOR
SVG study was to determine whether NT versus conventional (CON) SVG
harvesting was associated with improved SVG patency 1year after coronary
artery bypass grafting surgery (CABG). <br/>METHOD(S): Adults undergoing
isolated CABG with at least 1 SVG were eligible. CT angiography was
performed 1-year post CABG. Leg adverse events were assessed with a
questionnaire. A systematic review was performed for published NT graft
patency studies and results aggregated including the SUPERIOR study
results. <br/>RESULT(S): Two hundred and-fifty patients were randomized
across 12-centres (NT 127 versus CON 123 patients). The primary outcome
(study SVG occlusion or cardiovascular (CV) death) was not significantly
different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%), p=0.15).
Similarly, the proportion of study SVGs with significant stenosis or total
occlusion was not significantly different between groups (NT: 8/102
(7.8%), CON: 16/107 (15.0%), p=0.11). Vein harvest site infection was more
common in the NT patients 1month postoperatively (23.3% vs 9.5%, p<0.01).
Including this study's results, in a meta-analysis, NT was associated with
a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence
Interval 0.29-0.82, p=0.007 in 3 randomized and 1 observational study at
1year postoperatively. <br/>CONCLUSION(S): The NT technique was not
associated with improved patency of SVGs at 1-year following CABG while
early vein harvest infection was increased. The aggregated data is
supportive of an important reduction of SVG occlusion at 1year with NT
harvesting. TRIAL REGISTRATION: NCT01047449 .

<33>
Accession Number
632886825
Title
Recommendations and Alerting for Delirium Alleviation in Real-Time
(RADAR): Protocol for a pilot randomized controlled trial.
Source
F1000Research. 8 (pp 1683), 2019. Date of Publication: 2019.
Author
Vlisides P.E.; Ragheb J.W.; Leis A.; Schoettinger A.; Hickey K.; McKinney
A.; Brooks J.; Zierau M.; Norcott A.; Yang S.; Avidan M.S.; Min L.
Institution
(Vlisides, Ragheb, Leis, McKinney, Brooks, Zierau, Yang) Department of
Anesthesiology, University of Michigan Medical School, MI, Ann Arbor
48170, United States
(Vlisides) Center for Consciousness Science, University of Michigan
Medical School, MI, Ann Arbor 48109, United States
(Schoettinger) Department of Social Work, Michigan Medicine, MI, Ann Arbor
48109, United States
(Hickey) University of Michigan School of Nursing, MI, Ann Arbor 48109,
United States
(Norcott, Min) Department of Internal Medicine, Division of Geriatric and
Palliative Medicine, University of Michigan Medical School, MI, Ann Arbor
48109, United States
(Norcott) Department of Internal Medicine, Division of Geriatric and
Palliative Medicine, Veterans Affairs Ann Arbor Healthcare System, MI, Ann
Arbor 48105, United States
(Avidan) Department of Anesthesiology, Washington University School of
Medicine, St. Louis, MO, 63110, USA
(Min) Geriatric Research Education and Clinical Care, MI, VA Ann Arbor
Healthcare System, Ann Arbor 48105, United States
Publisher
NLM (Medline)
Abstract
Background: Delirium is a common and serious complication of major surgery
for older adults. Postoperative social and behavioral support (e.g., early
mobilization, mealtime assistance) may reduce the incidence and impact of
delirium, and these efforts are possible with proactive patient-care
programs. This pilot trial tests the hypothesis that a multicomponent
decision support system, which sends automated alerts and recommendations
to patient-care programs and family members for high-risk patients, will
improve the postoperative environment for neurocognitive and clinical
recovery. <br/>Method(s): This will be a randomized, controlled, factorial
pilot trial at a large academic medical center. High-risk, non-cardiac
surgery patients (>=70 years old) will be recruited. Patients will be
allocated to a usual care group (n=15), Hospital Elder Life Program
(HELP)-based paging system (n=15), family-based paging system (n=15), or
combined HELP- and family-based system (n=15). The primary outcome will be
the presence of delirium, defined by positive long-form Confusion
Assessment Method screening. Secondary outcomes will include additional
HELP- and family-based performance metrics along with various
neurocognitive and clinical recovery measures. Exploratory outcomes
include the incidence of positive family-based delirium assessments
post-discharge, 36-item Short Form Survey, PROMIS Cognitive Function
Abilities Subset 4a, and 30-day readmission rates. Ethics and
dissemination: This trial has received approval by the University of
Michigan Medical Institutional Review Board (IRBMED). Dissemination plans
include presentation at scientific conferences, publication in medical
journals, and distribution via educational and news media. Registration:
ClinicalTrials.gov Identifier NCT04007523, registered on
7/3/2019.<br/>Copyright: &#xa9; 2019 Vlisides PE et al.

<34>
Accession Number
632857135
Title
Recommendations and Alerting for Delirium Alleviation in Real-Time
(RADAR): Protocol for a pilot randomized controlled trial.
Source
F1000Research. 8 (no pagination), 2020. Article Number: 1683. Date of
Publication: 2020.
Author
Vlisides P.E.; Ragheb J.W.; Leis A.; Schoettinger A.; Hickey K.; McKinney
A.; Brooks J.; Zierau M.; Norcott A.; Yang S.; Avidan M.S.; Min L.
Institution
(Vlisides, Ragheb, Leis, McKinney, Brooks, Zierau, Yang) Department of
Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
48170, United States
(Vlisides) Center for Consciousness Science, University of Michigan
Medical School, Ann Arbor, MI 48109, United States
(Schoettinger) Department of Social Work, Michigan Medicine, Ann Arbor, MI
48109, United States
(Hickey) University of Michigan School of Nursing, Ann Arbor, MI 48109,
United States
(Norcott, Min) Department of Internal Medicine, Division of Geriatric and
Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI
48109, United States
(Norcott) Department of Internal Medicine, Division of Geriatric and
Palliative Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann
Arbor, MI 48105, United States
(Avidan) Department of Anesthesiology, Washington University School of
Medicine, St. Louis, MO 63110, United States
(Min) Geriatric Research Education and Clinical Care, VA Ann Arbor
Healthcare System, Ann Arbor, MI 48105, United States
Publisher
F1000 Research Ltd
Abstract
Background: Delirium is a common and serious complication of major surgery
for older adults. Postoperative social and behavioral support (e.g., early
mobilization, mealtime assistance) may reduce the incidence and impact of
delirium, and these efforts are possible with proactive patient-care
programs. This pilot trial tests the hypothesis that a multicomponent
decision support system, which sends automated alerts and recommendations
to patient-care programs and family members for high-risk patients, will
improve the postoperative environment for neurocognitive and clinical
recovery. <br/>Method(s): This will be a randomized, controlled, factorial
pilot trial at a large academic medical center. High-risk, non-cardiac
surgery patients (>=70 years old) will be recruited. Patients will be
allocated to a usual care group (n=15), Hospital Elder Life Program
(HELP)-based paging system (n=15), family-based paging system (n=15), or
combined HELP- and family-based system (n=15). The primary outcome will be
the presence of delirium, defined by positive long-form Confusion
Assessment Method screening. Secondary outcomes will include additional
HELP- and family-based performance metrics along with various
neurocognitive and clinical recovery measures. Exploratory outcomes
include the incidence of positive family-based delirium assessments
post-discharge, 36-item Short Form Survey, PROMIS Cognitive Function
Abilities Subset 4a, and 30-day readmission rates. Ethics and
dissemination: This trial has received approval by the University of
Michigan Medical Institutional Review Board (IRBMED). Dissemination plans
include presentation at scientific conferences, publication in medical
journals, and distribution via educational and news media. Registration:
ClinicalTrials.gov Identifier NCT04007523, registered on
7/3/2019.<br/>Copyright &#xa9; 2020 Vlisides PE et al.

<35>
Accession Number
632810945
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) (no pagination), 2020. Article Number: e2016236.
Date of Publication: September 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, 321 Zhongshan Rd, Nanjing 210008, China
(Zhao, Dai) Key Laboratory of Molecular Developmental Biology, Institute
of Genetics and Developmental Biology, Chinese Academy of Sciences,
Beijing 100101, 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
American Medical Association (E-mail: shirley.martin@ama-assn.org)
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.<br/>Copyright &#xa9; 2020
American Medical Association. All rights reserved.

<36>
Accession Number
632876468
Title
The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain
Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.
Source
Journal of Alzheimer's Disease. 75 (4) (pp 1319-1328), 2020. Date of
Publication: 2020.
Author
Vandusen K.W.; Eleswarpu S.; Moretti E.W.; Devinney M.J.; Crabtree D.M.;
Laskowitz D.T.; Woldorff M.G.; Roberts K.C.; Whittle J.; Browndyke J.N.;
Cooter M.; Rockhold F.W.; Anakwenze O.; Bolognesi M.P.; Easley M.E.;
Ferrandino M.N.; Jiranek W.A.; Berger M.; Adams S.B.; Amundsen C.L.;
Avasarala P.; Barber M.D.; Berchuck A.; Blazer Iii D.G.; Brassard R.;
Brigman B.E.; Cai V.; Christensen S.K.; Cox M.W.; Davidson B.A.; Deorio
J.K.; Erdmann D.; Erickson M.M.; Funk B.L.; Gadsden J.; Gage M.J.;
Gingrich J.R.; Greenup R.A.; Ha C.; Habib A.; Abi Hachem R.; Hall A.E.;
Hartwig M.G.; Havrilesky L.J.; Heflin M.T.; Holland C.; Hollenbeck S.T.;
Hopkins T.J.; Inman B.A.; Jang D.W.; Kahmke R.R.; Karikari I.; Kawasaki
A.; Klapper J.A.; Klifto C.S.; Klinger R.; Knechtle S.J.;
Lagoo-Deenadayalan S.A.; Lee W.T.; Levinson H.; Lewis B.D.; Lidsky M.E.;
Lipkin M.E.; Mantyh C.R.; McDonald S.R.; Migaly J.; Miller T.E.; Mithani
S.K.; Mosca P.J.; Moul J.W.; Novick T.L.; Olson S.A.; Pappas T.N.; Park
J.J.; Peterson A.C.; Phillips B.T.; Polascik T.J.; Potash P.; Preminger
G.M.; Previs R.A.; Robertson C.N.; Scales Jr C.D.; Shah K.N.; Scheri R.P.;
Siddiqui N.Y.; Smani S.; Southerland K.W.; Stang M.T.; Syed A.; Szydlowska
A.; Thacker J.K.M.; Terrando N.; Toulgoat-Dubois Y.; Visco A.G.; Weidner
A.C.; Yanamadala M.; Zani Jr S.; Price C.
Institution
(Vandusen, Eleswarpu, Moretti, Devinney, Whittle, Cooter, Berger,
Avasarala, Brassard, Cai, Christensen, Funk, Gadsden, Ha, Habib, Hall,
Holland, Hopkins, Lewis, Miller, Park, Potash, Smani, Syed, Szydlowska,
Terrando, Toulgoat-Dubois, Price) Department of Anesthesiology, Duke
University, Durham, NC, United States
(Crabtree) Duke Office of Clinical Research, Duke University, Durham, NC,
United States
(Laskowitz) Department of Neurology, Duke University, Durham, NC, United
States
(Woldorff, Browndyke) Department of Psychiatry and Behavioral Sciences,
Duke University Medical Center, Durham, NC, United States
(Woldorff) Department of Psychology and Neuroscience, Duke University,
Durham, NC, United States
(Roberts, Berger) Center for Cognitive Neuroscience, Duke University
Medical Center, Durham, NC, United States
(Rockhold) Duke Clinical Research Institute, Durham, NC, United States
(Anakwenze, Bolognesi, Easley, Adams, Brigman, Deorio, Erickson, Gage,
Klifto, Olson) Department of Orthopaedic Surgery, Duke University, Durham,
NC, United States
(Ferrandino, Jiranek, Blazer Iii, Cox, Erdmann, Gingrich, Greenup, Abi
Hachem, Hartwig, Hollenbeck, Inman, Jang, Kahmke, Klapper, Knechtle,
Lagoo-Deenadayalan, Lee, Levinson, Lidsky, Lipkin, Mantyh, Migaly,
Mithani, Mosca, Moul, Novick, Pappas, Peterson, Phillips, Polascik,
Preminger, Robertson, Scales Jr, Shah, Scheri, Southerland, Stang,
Thacker, Zani Jr) Department of Surgery, Duke University, Durham, NC,
United States
(Berger, Amundsen, Barber, Berchuck, Davidson, Havrilesky, Heflin,
Kawasaki, Previs, Siddiqui, Visco) Center for the Study of Aging and Human
Development, Duke University Medical Center, Durham, NC, United States
(Weidner) Department of Obstetrics and Gynecology, Duke University,
Durham, NC, United States
(Abi Hachem, Jang, Karikari) Department of Neurosurgery, Duke University,
Durham, NC, United States
(Heflin, Klinger, McDonald, Yanamadala) Department of Medicine, Duke
University, Durham, NC, United States
(Levinson) Department of Dermatology, Duke University, Durham, NC, United
States
(Levinson) Department of Pathology, Duke University, Durham, NC, United
States
(Scales Jr) Department of Population Health Sciences, Duke University,
Durham, NC, United States
(Zani Jr) Department of Mechanical Engineering and Materials Science, Duke
University, Durham, NC, United States
Publisher
IOS Press BV (E-mail: sales@iospress.com)
Abstract
Background: Perioperative neurocognitive disorders (PND) are common
complications in older adults associated with increased 1-year mortality
and long-term cognitive decline. One risk factor for worsened long-term
postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic
risk factor APOE4. APOE4 is thought to elevate AD risk partly by
increasing neuroinflammation, which is also a theorized mechanism for PND.
Yet, it is unclear whether modulating apoE4 protein signaling in older
surgical patients would reduce PND risk or severity. <br/>Objective(s):
MARBLE is a randomized, blinded, placebo-controlled phase II sequential
dose escalation trial designed to evaluate perioperative administration of
an apoE mimetic peptide drug, CN-105, in older adults (age>=60 years). The
primary aim is evaluating the safety of CN-105 administration, as measured
by adverse event rates in CN-105 versus placebo-treated patients.
Secondary aims include assessing perioperative CN-105 administration
feasibility and its efficacy for reducing postoperative neuroinflammation
and PND severity. <br/>Method(s): 201 patients undergoing non-cardiac,
non-neurological surgery will be randomized to control or CN-105 treatment
groups and receive placebo or drug before and every six hours after
surgery, for up to three days after surgery. Chart reviews, pre-and
postoperative cognitive testing, delirium screening, and blood and CSF
analyses will be performed to examine effects of CN-105 on perioperative
adverse event rates, cognition, and neuroinflammation. Trial results will
be disseminated by presentations at conferences and peer-reviewed
publications. <br/>Conclusion(s): MARBLE is a transdisciplinary study
designed to measure CN-105 safety and efficacy for preventing PND in older
adults and to provide insight into the pathogenesis of these geriatric
syndromes. <br/>Copyright &#xa9; 2020-IOS Press and the authors. All
rights reserved.

<37>
Accession Number
2007884736
Title
Sugammadex for Fast-Track Surgery in Children Undergoing Cardiac Surgery:
A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Li L.; Jiang Y.; Zhang W.
Institution
(Li) Department of Anesthesiology, Wenzhou Central Hospital, Wenzhou,
China
(Jiang) Department of Anesthesiology, Shanghai Children's Hospital,
Shanghai Jiao Tong University, Shanghai, China
(Zhang) Department of Anesthesiology, Women and Children's Hospital of
Jiaxing University, Jiaxing, China
Publisher
W.B. Saunders
Abstract
Objective: The purpose of this study was to evaluate the safety and
efficacy of sugammadex for fast-track surgery in children undergoing
cardiac surgery. <br/>Design(s): This was a prospective, randomized,
controlled clinical study. <br/>Setting(s): University hospital.
<br/>Participant(s): The study comprised 60 children undergoing cardiac
surgery. <br/>Intervention(s): The children in group S received
sugammadex, 4 mg/kg, for reversal of neuromuscular block, and the children
in group N received neostigmine, 30 micro&#32;g/kg, and atropine, 15
micro&#32;g/kg. <br/>Measurements and Main Results: The recovery time to a
train-of-four of 0.9 and extubation time were significantly shorter in the
group S than in group N (3.4 +/- 1.2 min v 76.2 +/- 20.5 min and 31.0 +/-
6.4 min v 125.2 +/- 21.6 min, respectively; p < 0.01). The heart rate
after drug administration was higher in group S than in group N (102.7 +/-
9.4 beats/min v 96.9 +/- 8.5 beats/min; p = 0.03), whereas the mean
arterial pressure after drug administration was similar in both groups.
The length of hospital stay was shorter in group S (5.8 +/- 1.0 v 6.5 +/-
0.9 days; p = 0.03), and the hospitalization expenses were decreased in
group S compared with that of group N ($1,036 +/- $114 v $1,286 +/- $187;
p < 0.01). The incidence of postoperative atelectasis was less in group S
than in group N (0 v 20%; p = 0.024). <br/>Conclusion(s): Sugammadex can
shorten the extubation time and reduce the incidence of postoperative
atelectasis, with fewer adverse events, in children undergoing cardiac
surgery. It may be beneficial to use sugammadex for fast-track surgery in
children undergoing cardiac surgery.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<38>
Accession Number
2007883556
Title
Sublingual Sufentanil Tablet System Versus Continuous Morphine Infusion
for Postoperative Analgesia in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Van Tittelboom V.; Poelaert R.; Malbrain M.L.N.G.; La Meir M.; Staessens
K.; Poelaert J.
Institution
(Van Tittelboom, Poelaert) Department of Anesthesiology and Perioperative
Medicine, UZ Brussels, Jette, Belgium
(Malbrain) Department of Intensive Care, UZ Brussels, Faculty of Medicine
and Pharmacy, Jette, Belgium
(La Meir) Department of Cardiac Surgery, UZ Brussels, Faculty of Medicine
and Pharmacy, Jette, Belgium
(Staessens) Department of Perfusion, UZ Brussels, Jette, Belgium
(Poelaert) Department of Anesthesiology and Perioperative Medicine, UZ
Brussels, Faculty of Medicine and Pharmacy, Jette, Belgium
Publisher
W.B. Saunders
Abstract
Objective(s): To assess the effectiveness and side effects of a
patient-controlled sublingual sufentanil tablet system for postoperative
analgesia after cardiac surgery and to compare it to a nurse-controlled
continuous morphine infusion. <br/>Design(s): Prospective, open-label,
randomized controlled trial. <br/>Setting(s): Single university academic
center. <br/>Participant(s): Adult patients undergoing cardiac surgery,
which included a sternotomy. <br/>Intervention(s): Sublingual sufentanil
tablet system versus nurse-controlled continuous morphine infusion.
<br/>Measurements and Main Results: A total of 483 cardiac surgery
patients were screened for eligibility, of whom 64 patients completed the
study. No statistically significant differences were found for baseline
characteristics between both groups. All mean numeric rating scale (NRS)
pain scores from after extubation until intensive care unit discharge were
<=3 in both groups. The cumulative mean NRS pain score from 24 hours after
extubation (primary outcome) (t = hours after extubation) was
significantly different in favor of the morphine group: (t = 0-24) (0.8
[0.7] v 1.3 [0.8]; p = 0.006). Later cumulative mean pain scores were also
in favor of the morphine group: (t = 24-48) (0.2 [0.3] v 0.6 [0.5]; p =
0.001) and (t = 48-63) (0.0 [0.0] v 0.1 [0.2]; p = 0.013). The cumulative
opioid dose (in milligrams intravenous morphine equivalents) was
significantly higher in the morphine group compared with the sublingual
sufentanil group (241.94 [218.73] v 39.84 [21.96]; p = 0.0001). No
differences were found for the incidences of postoperative nausea and
vomiting, sedation, hypoventilation, bradycardia, or hypotension between
both groups (secondary outcomes). <br/>Conclusion(s): Despite resulting in
statistically significantly higher pain scores, a patient-controlled
sublingual sufentanil tablet system offers adequate analgesia after
cardiac surgery and reduces opioid consumption when compared with
continuous morphine infusion.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<39>
Accession Number
2007883469
Title
Combined Cardiothoracic Surgery and Liver Transplantation Versus Isolated
Liver Transplantation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Bui C.C.M.; Tanner C.; Nguyen-Buckley C.; Scovotti J.; Wray C.; Xia V.W.
Institution
(Bui, Tanner, Nguyen-Buckley, Scovotti, Wray, Xia) Department of
Anesthesiology and Perioperative Medicine, David Geffen School of Medicine
at UCLA, Los Angeles, CA, United States
Publisher
W.B. Saunders
Abstract
Objective: Combined cardiothoracic surgery and liver transplantation
(cCSLT) recently increasingly has been used. Despite that, liver
transplant immediately after cardiothoracic surgery has not been
well-characterized. The authors aimed to compare perioperative management
and postoperative outcomes between patients undergoing cCSLT and isolated
liver transplantation (iLT). <br/>Design(s): A retrospective study.
<br/>Setting(s): University tertiary medical center. <br/>Participant(s):
Twenty-five cCSLT patients and 1091 iLT patients at a single institution
from 2010 to 2017. <br/>Intervention(s): Twenty-five cCSLT patients were
compared with 100 randomly selected and 100 propensity-matched iLT
patients. <br/>Measurements and Main Results: All cCSLT patients underwent
comprehensive preoperative evaluation by a multidisciplinary team. Of 25
cardiothoracic surgeries, heart transplant (n = 9) was most common,
followed by coronary artery bypass grafting (n = 5) and lung transplant (n
= 3). Intraoperative management of cCSLT was provided by 2 separate teams,
one for cardiothoracic surgery and one for liver transplantation. Patients
undergoing cCSLT often required cardiopulmonary bypass, an intra-aortic
balloon pump, extracorporeal membrane oxygenation, or cardiac
pharmacologic therapies and, additionally, needed more interventions
including antifibrinolytic administration, venovenous bypass, massive
blood transfusion, and platelet transfusions compared with iLT patients.
Ninety-day survival rates were similar in the cCSLT (100%) and iLT groups
(random iLT 87% and matched iLT 93%, log-rank test p = 0.089).
<br/>Conclusion(s): Despite having end-stage liver disease and advanced
cardiothoracic disorders and experiencing a complex intraoperative course,
cCSLT patients had comparable 90-day survival to iLT patients.
Comprehensive planning before transplant, optimal patient/donor selection,
the multiple-team model, and meticulous intraoperative management are
critical to the success of cCSLT.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<40>
Accession Number
632887828
Title
Systematic review of perioperative mortality risk prediction models for
adults undergoing inpatient non-cardiac surgery.
Source
ANZ journal of surgery. (no pagination), 2020. Date of Publication: 15 Sep
2020.
Author
Reilly J.R.; Gabbe B.J.; Brown W.A.; Hodgson C.L.; Myles P.S.
Institution
(Reilly, Myles) Department of Anaesthesiology and Perioperative Medicine,
Alfred Health, Melbourne, VIC, Australia
(Reilly, Myles) Department of Anaesthesia and Perioperative Medicine,
Monash University, Melbourne, VIC, Australia
(Gabbe, Hodgson) School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Brown) Department of Surgery, Alfred Health, Melbourne, VIC, Australia
(Brown) Department of Surgery, Monash University, Melbourne, VIC,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Risk prediction tools can be used in the perioperative setting
to identify high-risk patients who may benefit from increased surveillance
and monitoring in the postoperative period, to aid shared decision-making,
and to benchmark risk-adjusted hospital performance. We evaluated
perioperative risk prediction tools relevant to an Australian context.
<br/>METHOD(S): A systematic review of perioperative mortality risk
prediction tools used for adults undergoing inpatient noncardiac surgery,
published between 2011 and 2019 (following an earlier systematic review).
We searched Medline via OVID using medical subject headings consistent
with the three main areas of risk, surgery and mortality/morbidity. A
similar search was conducted in Embase. Tools predicting morbidity but not
mortality were excluded, as were those predicting a composite outcome that
did not report predictive performance for mortality separately. Tools were
also excluded if they were specifically designed for use in cardiac or
other highly specialized surgery, emergency surgery, paediatrics or
elderly patients. <br/>RESULT(S): Literature search identified 2568
studies for screening, of which 19 studies identified 21 risk prediction
tools for inclusion. <br/>CONCLUSION(S): Four tools are candidates for
adapting in the Australian context, including the Surgical Mortality
Probability Model (SMPM), Preoperative Score to Predict Postoperative
Mortality (POSPOM), Surgical Outcome Risk Tool (SORT) and NZRISK. SORT has
similar predictive performance to POSPOM, using only six variables instead
of 17, contains all variables of the SMPM, and the original model
developed in the UK has already been successfully adapted in New Zealand
as NZRISK. Collecting the SORT and NZRISK variables in a national surgical
outcomes study in Australia would present an opportunity to simultaneously
investigate three of our four shortlisted models and to develop a locally
valid perioperative mortality risk prediction model with high predictive
performance.<br/>Copyright &#xa9; 2020 Royal Australasian College of
Surgeons.

<41>
Accession Number
632880212
Title
Utilization and procedural adverse outcomes associated with Watchman
device implantation.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. (no
pagination), 2020. Date of Publication: 14 Sep 2020.
Author
Khalil F.; Arora S.; Killu A.M.; Tripathi B.; DeSimone C.V.; Egbe A.;
Noseworthy P.A.; Kapa S.; Mulpuru S.; Gersh B.; Mohamad A.; Friedman P.;
Holmes D.; Deshmukh A.J.
Institution
(Khalil, Killu, DeSimone, Egbe, Noseworthy, Kapa, Mulpuru, Gersh, Mohamad,
Friedman, Holmes, Deshmukh) Department of Cardiovascular Medicine, Mayo
Clinic, 200 First Street SW, Rochester, United States
(Arora) Division of Cardiology, Case Western Reserve University,
Cleveland, OH, USA
(Tripathi) Department of Cardiology, University of Arizona, AZ, Phoenix,
United States
Publisher
NLM (Medline)
Abstract
AIMS : The Food and Drug Administration (FDA) approval of the Watchman
device [percutaneous left atrial appendage occlusion (LAAO)] has resulted
in the widespread use of this procedure in many centres across the USA. We
sought to estimate the nationwide utilization and frequency of adverse
outcomes associated with Watchman device implantation. The objective of
this study was to evaluate the Watchman device implantation
peri-procedural complications and comparison of the results with the
previous studies. METHODS AND RESULTS : The National Inpatient Sample
(NIS) was queried for all hospitalizations with a primary diagnosis of
atrial fibrillation or atrial flutter during the year 2016 with
percutaneous LAAO during the same admission (ICD-10 code-02L73DK). The
frequency of peri-procedural complications, including mortality,
procedure-related stroke, major bleeding requiring blood transfusion, and
pericardial effusion, was assessed. We compared the complication rates
with the published randomized controlled trials and the European Watchman
registry. An estimated 5175 LAAO procedures were performed in 2016. The
majority of procedures was performed in males (59.1%), age >=75years
(58.7%), and White (83.1%). The overall complication rate was 1.9%. The
in-hospital mortality was 0.29%. Pericardial effusion requiring
pericardiocentesis was the most frequent complication (0.68%). Bleeding
requiring transfusion was noted in 0.1% of device implants. The rates of
post-procedure stroke and systemic embolism were 0% and 0.29%,
respectively. CONCLUSION : Percutaneous LAAO with the Watchman device in
the USA is associated with low in-hospital complications and a similar
safety profile to a recently published EWOLUTION cohort. The complication
rates were lower than those reported in the major randomized clinical
trials (RCTs). We report the frequency of peri-procedural complications of
the LAAO using the Watchman device from the NIS database. We also compare
the frequency of peri-procedural complications with the previously
published RCTs and EWOLUTION cohort. Our findings are in concordance with
findings from EWOLUTION cohort and compare favourably with
RCTs.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<42>
Accession Number
632876954
Title
Daring discourse: should the ESP block be renamed RIP II block?.
Source
Regional anesthesia and pain medicine. (no pagination), 2020. Date of
Publication: 14 Sep 2020.
Author
Lonnqvist P.A.; Karmakar M.K.; Richardson J.; Moriggl B.
Institution
(Lonnqvist) Physiology and Pharmacology, Karolinska Institute, Stockholm,
Sweden
(Karmakar) Department of Anesthesia and Intensive Care, The Chinese
University of Hong Kong, Shatin, Hong Kong
(Richardson) Department of Anaesthetics and Pain Medicine, Bradford Royal
Infirmary, Bradford, United Kingdom
(Moriggl) Anatomy, Histology and Embryology, Medical University of
Innsbruck, Innsbruck, Austria
Publisher
NLM (Medline)
Abstract
During the time period 1984 to the turn of the millennium, interpleural
nerve blockade was touted as a very useful regional anesthetic nerve
blockade for most procedures or conditions that involved the trunk and was
widely practiced despite the lack of proper evidence-based support.
However, as an adequate evidence base developed, the interest for this
type of nerve block dwindled and very few centers currently use it-thereby
to us representing the rest in peace (RIP) I block. Unfortunately, we get
a deja-vu sensation when we observe the current fascination with the
erector spinae plane block (ESPB), which since 2019 has generated as many
as 98 PubMed items. This daring discourse point out the lack of a proper
evidence base of the ESPB compared with other established nerve blocking
techniques as well as the lack of a proven mechanism of action that
explains how this nerve block technique can be effective regarding
surgical procedures performed on the front of the trunk. Emerging
meta-analysis data also raise concern and give cause to healthy skepticism
regarding the use of ESPB for major thoracic or abdominal surgery. Against
this background, we foresee that ESPB (and variations on this theme) will
end up in a similar fashion as interpleural nerve blockade, thereby soon
to be renamed the RIP II block.<br/>Copyright &#xa9; American Society of
Regional Anesthesia & Pain Medicine 2020. No commercial re-use. See rights
and permissions. Published by BMJ.

<43>
Accession Number
632874189
Title
A Systematic Review of Guidelines for Dual Antiplatelet Therapy in
Coronary Artery Bypass Graft.
Source
European journal of clinical investigation. (pp e13405), 2020. Date of
Publication: 14 Sep 2020.
Author
Zhang Z.-Z.-P.; Zhang S.-Z.; Zhou H.-M.; Fan Y.-Q.; Liu M.-H.; Zhong
X.-B.; Yang D.-Y.; Guo Y.; Zhuang X.-D.; Liao X.-X.
Institution
(Zhang) Zhongshan School of Medicine, Sun Yat-sen University, Guangdong
Province, Guangzhou, China
(Zhang, Zhou, Fan, Liu, Zhong, Yang, Guo, Zhuang, Liao) Cardiology
Department, First Affiliated Hospital of Sun Yat-Sen University, Guangdong
Province, Guangzhou, China
(Zhang, Zhou, Fan, Liu, Zhong, Yang, Guo, Zhuang, Liao) NHC Key Laboratory
of Assisted Circulation, Sun Yat-Sen University, Guangdong Province,
Guangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In most situations, many patients undergoing Coronary Artery
Bypass Graft (CABG) are on Dual Anti-Platelet Therapy (DAPT), which is
also required after CABG. The adjustment of antiplatelet strategy remains
controversial. In this study, we systematically review current guidelines,
seeking consensus and controversies to facilitate clinical practice.
METHODS AND RESULTS: Guidelines are searched in PubMed, Embase, ECRI
Guideline Trust and websites of guidelines organizations and professional
society. Guidelines with recommendations of DAPT for patients undergo CABG
are included. Two reviewers appraised guidelines with the Appraisal of
Guideline for Research and Evaluation II (AGREE II). Relevant
recommendations are extracted and summarized. A total of 14 guidelines
meeting inclusion criteria are selected, with average AGREE II scores from
44% to 86%. Most guidelines score high in domains other than
"Applicability". Many guidelines are not detailed enough in reporting
considerations behind recommendations. Current guidelines are consistent
on the management of antiplatelet strategy before elective CABG and using
DAPT after surgery for preventing graft vessel occlusion. Evidence is
still lacking in urgent CABG and resumption of the previous DAPT after
surgery. <br/>CONCLUSION(S): Current guidelines on DAPT in CABG are
generally satisfying. Suspending P2Y12 inhibitors while aspirin continued
before elective CABG is recommended, as well as 12 months of DAPT
following CABG. More evidence is needed to guide antiplatelet therapy in
urgent CABG, and to prove the benefits of resuming previous
DAPT.<br/>Copyright This article is protected by copyright. All rights
reserved.

<44>
Accession Number
624063457
Title
Effects of the first phase of cardiac rehabilitation training on
self-efficacy among patients undergoing coronary artery bypass graft
surgery.
Source
Journal of Tehran University Heart Center. 13 (3) (pp 126-131), 2018. Date
of Publication: 15 Jul 2018.
Author
Borzou S.R.; Amiri S.; Salavati M.; Soltanian A.R.; Safarpoor G.
Institution
(Borzou) Chronic Diseases (Home Care) Research Center, Faculty of Nursing
and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran,
Islamic Republic of
(Amiri) Faculty of Nursing and Midwifery, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Salavati) Department of Nursing, Nursing & Midwifery Faculty, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Soltanian) Modeling of Noncommunicable Diseases Research Center, School
of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran,
Islamic Republic of
(Safarpoor) Department of Cardiac Surgery, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
Publisher
Tehran Heart Center (E-mail: abbasi.hesam@gmail.com)
Abstract
Background: Heart surgery is vital for patients with coronary artery
diseases that do not respond to drug treatments. We aimed to determine the
effects of the implementation of the first phase of a cardiac
rehabilitation program on self-efficacy in patients after coronary artery
bypass graft surgery (CABG). <br/>Method(s): This clinical trial study was
conducted on 60 post-CABG patients by convenience sampling method in 2016.
Those selected were randomly assigned to intervention (n=30) and control
group (n=30). Overall, 72 hours after CABG, the first phase of the cardiac
rehabilitation program both in theory and in practice (face-to-face and
group methods) was conducted. Data were collected using a self-efficacy
questionnaire completed by the patients in 3 stages: before the
intervention, at discharge, and at 1 month after discharge. Data was
analyzed by using analysis of covariance and repeated measures.
<br/>Result(s): The mean of age in the intervention and control groups was
61.60+/-11.72 and 57.97+/-13. 4 years, respectively. There were 16 (53.3%)
male patients in each group. The mean score of self-efficacy was not
significantly different between the 2 groups before the intervention
(P=0.076), whereas it had a meaningful statistical difference between the
2 groups at discharge and 1 month afterward (P<0.001). <br/>Conclusion(s):
The implementation of the first phase of the cardiac rehabilitation
program not only augmented self-efficacy in regard to independent daily
activities but also lessened the need for the second phase of the program
among our post-CABG patients.<br/>Copyright &#xa9; 2018, Tehran Heart
Center. All rights reserved.

<45>
Accession Number
2007837984
Title
Physiology-guided revascularization versus optimal medical therapy of
nonculprit lesions in elderly patients with myocardial infarction:
Rationale and design of the FIRE trial.
Source
American Heart Journal. 229 (pp 100-109), 2020. Date of Publication:
November 2020.
Author
Biscaglia S.; Guiducci V.; Santarelli A.; Amat Santos I.; Fernandez-Aviles
F.; Lanzilotti V.; Varbella F.; Fileti L.; Moreno R.; Giannini F.;
Colaiori I.; Menozzi M.; Redondo A.; Ruozzi M.; Gutierrez Ibanes E.; Diez
Gil J.L.; Maietti E.; Biondi Zoccai G.; Escaned J.; Tebaldi M.; Barbato
E.; Dudek D.; Colombo A.; Campo G.
Institution
(Biscaglia, Tebaldi, Campo) Cardiovascular Institute, Azienda Ospedaliero
Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, Italy
(Guiducci, Colaiori) Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S.
Maria Nuova Hospital, Viale Risorgimento 80, Reggio Emilia, Italy
(Santarelli, Menozzi) Cardiovascular Department, Infermi Hospital, Viale
Luigi Settembrini 2, Rimini, Italy
(Amat Santos, Redondo) CIBERCV, Cardiology Department, Hospital Clinico
Universitario, Valladolid, Spain
(Fernandez-Aviles, Gutierrez Ibanes) Servicio de Cardiologia, Hospital
General Universitario Gregorio Maranon, CIBERCV, Calle del Dr Esquerdo 46,
Madrid, Spain
(Fernandez-Aviles, Gutierrez Ibanes) Universidad Carlos III, Calle Madrid
126, Madrid, Spain
(Lanzilotti) U.O.C. Cardiologia, Ospedale Maggiore, Largo Nigrisoli 2,
Bologna, Italy
(Varbella) Department of Cardiology, Infermi Hospital, Rivoli, Italy
(Varbella) Department of Cardiology, San Luigi Gonzaga Hospital,
Orbassano, Turin, Italy
(Fileti) Cardiology Department, S. Maria delle Croci Hospital, Viale Randi
5, Ravenna, Italy
(Moreno) Instituto de Investigacion Hospital La Paz (IDIPAZ), University
Hospital La Paz, Madrid, Madrid, Spain
(Moreno) Centro de Investigacion Biomedica en Red en Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain
(Giannini, Dudek, Colombo, Campo) Maria Cecilia Hospital, GVM Care &
Research, Via Corriera 1, Cotignola, Italy
(Ruozzi) Cardiology Unit, Ospedale Civile di Baggiovara, Modena, Italy
(Diez Gil) Servicio de Cardiologia, H. Universitario y Politecnico La Fe,
Valencia, Spain
(Maietti) Department of Medical Science, University of Ferrara, Ferrara,
Italy
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Escaned) Hospital Clinico San Carlos IDISCC, Complutense University of
Madrid, Calle del Prof Martin Lagos s/n, Madrid, Spain
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Via Pansini, Naples, Italy
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
ul. Sw Anny 12, Krakow, Poland
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background: Myocardial infarction (MI) in elderly patients is associated
with unfavorable prognosis, and it is becoming an increasingly prevalent
condition. The prognosis of elderly patients is equally impaired in
ST-segment elevation (STE) or non-STE (NSTE), and it is markedly worsened
by the common presence of multivessel disease (MVD). Given the limited
evidence available for elderly patients, it has not yet been established
whether, as for younger patients, a complete revascularization strategy in
MI patients with MVD should be advocated. We present the design of a
dedicated study that will address this research gap. Methods and design:
The FIRE trial is a prospective, randomized, international, multicenter,
open-label study with blinded adjudicated evaluation of outcomes. Patients
aged 75 years and older, with MI (either STE or NSTE), MVD at coronary
artery angiography, and a clear culprit lesion will be randomized to
culprit-only treatment or to physiology-guided complete revascularization.
The primary end point will be the patient-oriented composite end point of
all-cause death, any MI, any stroke, and any revascularization at 1 year.
The key secondary end point will be the composite of cardiovascular death
and MI. Quality of life and physical performance will be evaluated as
well. All components of the primary and key secondary outcome will be
tested also at 3 and 5 years. The sample size for the study is 1,400
patients. Implications: The FIRE trial will provide evidence on whether a
specific revascularization strategy should be applied to elderly patients
presenting MI and MVD to improve their clinical outcomes.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<46>
[Use Link to view the full text]
Accession Number
2007388073
Title
Effect of Ezetimibe+Pitavastatin on Cardiovascular Outcomes in Patients
with ST-Segment Elevation Myocardial Infarction (from the HIJ-PROPER
Study).
Source
American Journal of Cardiology. 132 (pp 15-21), 2020. Date of Publication:
1 October 2020.
Author
Otsuki H.; Arashi H.; Yamaguchi J.; Kawada-Watanabe E.; Ogawa H.; Hagiwara
N.
Institution
(Otsuki, Arashi, Yamaguchi, Kawada-Watanabe, Ogawa, Hagiwara) Department
of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical
University, Tokyo, Japan
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Lipid-lowering therapy is necessary to reduce cardiovascular event rates
in patients with ST-segment elevation myocardial infarction (STEMI). This
study aimed to evaluate the effect of intensive lipid-lowering therapy,
which comprised pitavastatin and ezetimibe, on patients with STEMI. We
therefore undertook a post hoc subanalysis of the HIJ-PROPER study's data
that examined the clinical outcomes of the patients with dyslipidemia and
STEMI (n = 880) who received pitavastatin and ezetimibe therapy (intensive
lipid-lowering therapy group) or pitavastatin monotherapy (standard
lipid-lowering therapy group), and we evaluated their cardiovascular
events. The primary end point was a composite of all-cause death, nonfatal
myocardial infarction, nonfatal stroke, unstable angina, and
ischemia-driven revascularization. During the median 3.4-year follow-up
period, the cumulative rates of the primary end point were 31.9% and 39.7%
in the intensive lipid-lowering therapy and standard lipid-lowering
therapy groups, respectively (hazard ratio [HR], 0.77; 95% confidence
interval [CI], 0.62 to 0.97; p = 0.02). Compared with the standard
lipid-lowering therapy group, the intensive lipid-lowering therapy group
had significantly lower all-cause death (6.9% vs 3.2%; HR, 0.45; 95% CI,
0.23 to 1.84; p = 0.01) and nonfatal stroke (2.9% vs 1.6%; HR, 0.77; 95%
CI, 0.62 to 0.97; p = 0.02) rates. Patients with pitavastatin and
ezetimibe therapy, as compared with pitavastatin monotherapy, had a lower
cardiovascular event in STEMI patients. In conclusion, adding ezetimibe to
statin therapy may be beneficial for patients with dyslipidemia and
STEMI.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<47>
Accession Number
2007377541
Title
Meta-analysis of Incidence, Predictors and Consequences of Clinical and
Subclinical Bioprosthetic Leaflet Thrombosis After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. 132 (pp 106-113), 2020. Date of
Publication: 1 October 2020.
Author
Sannino A.; Hahn R.T.; Leipsic J.; Mack M.J.; Grayburn P.A.
Institution
(Sannino, Grayburn) The Heart Hospital, Clinical Research Department,
Baylor Scott & White Research Institute, Plano, TX, United States
(Hahn) New York Presbyterian Hospital, New York-Presbyterian/Columbia
University Medical Center, New York, NY, United States
(Leipsic) Department of Radiology, St. Paul's Hospital, University of
British Columbia, Vancouver, Canada, Canada
(Mack, Grayburn) The Heart Hospital Baylor Plano, Plano, TX, United States
(Sannino) Department of Advance Biomedical Sciences, University Federico
II, Naples, Italy
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Leaflet thrombosis (LT) has been claimed as a potential cause of
hemodynamic dysfunction or bioprosthetic valve degeneration of
transcatheter heart valves. Sparse and contrasting evidence exists,
however, regarding LT occurrence, prevention and treatment. MEDLINE, ISI
Web of Science and SCOPUS databases were searched for studies published up
to January 2020. Only studies reporting data on incidence and outcomes
associated to the presence/absence of clinical or subclinical LT, detected
or confirmed with a multidetector computed tomography exam were included.
The study was designed according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) requirements. Two reviewers
independently screened articles for fulfillment of inclusion criteria.
Data were pooled using a random-effect model. The primary end point was
the incidence of LT. Secondary outcomes included: stroke and transient
ischemic attacks and mean transvalvular gradients at different time-points
in patients with and without LT. Of the initial 200 studies, 22 were
finally included with a total of 11,567 patients. LT overall incidence was
8% (95% Confidence Interval [CI]: 5% to 13%, I² = 96.4%). LT
incidence in patients receiving only antiplatelets was 13% (95% CI: 7% to
23%, p <0.0001); patients discharged on oral anticoagulants had a reported
incidence of 4% (95% CI: 2% to 8%, p <0.0001). Patients with LT, either
clinical or subclinical, were not at increased risk of stroke (OR 1.06,
95% CI: 0.75 to 1.50, p = 0.730, I² = 0.0%) or transient
ischemic attacks (Odds Ratio 1.01, 95% CI: 0.40 to 2.57, p = 0.989,
I² = 0.0%). LT was associated with higher mean transvalvular
gradients compared with patients without LT at 30 days post-transcatheter
implantation, but not at discharge or at 1 year. LT is a relatively common
event that, even when clinically manifest, is not associated with an
increased risk of cerebrovascular events. Although patients on
anticoagulants appear to be at lower risk of LT, the available evidence
does not allow formulation of recommendations for prophylactical
anticoagulation nor routine computed tomography after transcatheter aortic
valve replacement.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<48>
Accession Number
2007334323
Title
Multiple Arterial Grafting: A Critical Analysis.
Source
American Journal of Cardiology. 132 (pp 178-179), 2020. Date of
Publication: 1 October 2020.
Author
Kurlansky P.; Gaudino M.
Institution
(Kurlansky) Department of Surgery, Center for Innovation and Outcomes
Research, Columbia University Medical Center, New York, NY, United States
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
525 E 68th St, New York, NY 10065, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<49>
Accession Number
2007177868
Title
Drug-Eluting Stents Versus Bypass Surgery for Left Main Disease: An
Updated Meta-Analysis of Randomized Controlled Trials With Long-Term
Follow-Up.
Source
American Journal of Cardiology. 132 (pp 168-172), 2020. Date of
Publication: 1 October 2020.
Author
Ahmad Y.; Howard J.P.; Arnold A.D.; Ali Z.A.; Francis D.; Moses J.W.; Leon
M.B.; Kirtane A.J.; Karmpaliotis D.; Stone G.W.
Institution
(Ahmad, Ali, Moses, Leon, Kirtane, Karmpaliotis) Columbia University
Medical Center/New York-Presbyterian Hospital, New York, NY, United States
(Ahmad, Howard, Arnold, Francis) National Heart and Lung Institute,
Imperial College London, London, United Kingdom
(Ali, Moses, Leon, Kirtane, Stone) The Cardiovascular Research Foundation,
New York, NY, United States
(Stone) Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai,
New York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<50>
Accession Number
2007164341
Title
A Meta-Analysis of Cardiovascular Outcomes in Patients With
Hypercholesterolemia Treated With Bempedoic Acid.
Source
American Journal of Cardiology. 132 (pp 166-168), 2020. Date of
Publication: 1 October 2020.
Author
Asbeutah A.A.A.; Asbeutah S.A.; Abu-Assi M.A.
Institution
(Asbeutah) Department of Internal Medicine, University of Tennessee Health
Sciences Center, Memphis, TN, United States
(Asbeutah) Faculty of Medicine, Health Sciences Center, Kuwait University,
Kuwait City, Kuwait
(Abu-Assi) Department of Science, College of Basic Education, Public
Authority for Applied Education and Training, Kuwait City, Kuwait
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<51>
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

<52>
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 (E-mail: info@royensoc.co.uk)
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

<53>
Accession Number
2003620964
Title
Prospective evaluation of drug eluting self-apposing stent for the
treatment of unprotected left main coronary artery disease: 1-year results
of the TRUNC study.
Source
Catheterization and Cardiovascular Interventions. 96 (2) (pp E142-E148),
2020. Date of Publication: 01 Aug 2020.
Author
Briguori C.; Tamburino C.; Jessurun G.A.J.; Meyer-Gessner M.; Reczuch K.;
Cortese B.; Maillard L.; Anthonio R.L.; La Manna A.; Morice M.-C.; Bouchez
D.; Balland A.; Huynh V.-P.; Baumbach A.
Institution
(Briguori) Mediterranea Cardiocentro, Naples, Italy
(Tamburino, La Manna) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Jessurun, Anthonio) Treant Zorggroep, Emmen, Netherlands
(Meyer-Gesner) Augusta Krankenhaus, Dusseldorf, Germany
(Reczuch) Medical University of Wroclaw, Wroclaw, Poland
(Reczuch) Military Hospital, Wroclaw, Poland
(Cortese) ASST Fatebenefratelli Sacco, Milano, Italy
(Maillard) GCS ES Axium Rambot, Aix en Provence, France
(Morice) CERC, Massy, France
(Bouchez, Balland, Huynh) STENTYS SA, Paris, France
(Baumbach) Barts Heart Centre, London, United Kingdom
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Objectives: To assess long-term safety and efficacy of the Xposition S
self-apposing stent in the treatment of unprotected left main coronary
artery (ULMCA) disease. <br/>Background(s): Percutaneous intervention with
stents has emerged as a valid alternative to surgical revascularization to
treat ULMCA disease. Conventional balloon-expandable stents face technical
challenges, particularly in large left main diameter requiring extensive
optimization and side branch access in distal bifurcation. Xposition S
allows for optimal apposition, bridging diameter differences, and allows
expansion to vessel diameters up to 6.0 mm. <br/>Method(s): Between June
2016 and July 2017, 205 patients were enrolled in this international,
prospective, multicenter registry. Patients with SYNTAX score >= 33 or
recent STEMI were excluded. IVUS during procedure was performed in a
prespecified subgroup of 50 patients. The primary clinical endpoint was 12
months Target lesion failure (TLF) and the primary efficacy endpoint was
angiographic success. <br/>Result(s): Distal left main bifurcation was
involved in 92.7%, treated with provisional approach in most cases
(79.4%). TLF rate at 12 months was 8.3%, which was defined as a composite
of cardiac death (2.0%), target-vessel MI (2.9%), and TLR (5.4%). Most
revascularizations occurred at SB ostium. IVUS analysis demonstrated
optimal stent apposition with only one reported malapposition and
promising poststenting minimal stent area measures. <br/>Conclusion(s):
The TRUNC study confirms that Xposition S self-apposing stent is a valid
and feasible option for the treatment of ULMCA disease. Such results were
reached without the systematic need of stent optimisation techniques,
focusing mainly on lesion treatment.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<54>
Accession Number
2003509560
Title
Antithrombotic strategies after transcatheter aortic valve implantation:
Insights from a network meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 96 (2) (pp E177-E186),
2020. Date of Publication: 01 Aug 2020.
Author
Kuno T.; Takagi H.; Sugiyama T.; Ando T.; Miyashita S.; Valentin N.;
Shimada Y.J.; Kodaira M.; Numasawa Y.; Kanei Y.; Hayashida K.; Bangalore
S.
Institution
(Kuno, Miyashita, Valentin) Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Sugiyama) Diabetes and Metabolism Information Center, Research Institute,
Center for Global Health and Medicine, Tokyo, Japan
(Sugiyama) Department of Health Services Research, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Sugiyama) Department of Public Health/Health Policy, Graduate School of
Medicine, The University of Tokyo, Tokyo, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Shimada) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, New York, NY, United States
(Kodaira, Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga
Hospital, Ashikaga, Japan
(Kanei) Department of Cardiology, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Bangalore) New York University School of Medicine, New York, NY, United
States
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Objectives: We aimed to investigate the efficacy and safety of different
antithrombotic strategies in patients undergoing transcatheter aortic
valve implantation (TAVI) using network meta-analyses. <br/>Background(s):
Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual
antiplatelet therapy (DAPT), +/- oral anticoagulant (OAC) was conducted to
determine the appropriate post TAVI antithrombotic regimen. However, there
was limited direct comparisons across the different therapeutic
strategies. <br/>Method(s): MEDLINE and EMBASE were searched through
December 2018 to investigate the efficacy and safety of different
antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in
patients undergoing TAVI. The main outcome were all-cause mortality, major
or life-threatening bleeding events, and stroke. <br/>Result(s): Our
search identified 3 randomized controlled trials and 10 nonrandomized
studies, a total of 20,548 patients who underwent TAVI. All OACs were
vitamin K antagonists. There was no significant difference on mortality
except that OAC + DAPT had significantly higher rates of mortality
compared with others (p <.05, I² = 0%). SAPT had significantly
lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard
ratio [HR]: 0.59 [0.46-0.77], p <.001, HR: 0.58 [0.34-0.99], p =.045, HR:
0.41 [0.18-0.93], p =.033, respectively, I² = 0%). There was no
significant difference on stroke among all antithrombotic strategies.
<br/>Conclusion(s): Patients who underwent TAVI had similar all-cause
mortality rates among different antithrombotic strategies except OAC+DAPT.
Patients on SAPT had significantly lower bleeding risk than those on DAPT,
OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred
regimen when there is no indication for DAPT or OAC. When DAPT or OAC is
indicated, DAPT + OAC should be avoided.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<55>
Accession Number
632571019
Title
Erythropoietin plus iron versus control treatment including placebo or
iron for preoperative anaemic adults undergoing non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2020 (8) (no pagination), 2020.
Article Number: CD012451. Date of Publication: 13 Aug 2020.
Author
Kaufner L.; von Heymann C.; Henkelmann A.; Pace N.L.; Weibel S.; Kranke
P.; Meerpohl J.J.; Gill R.
Institution
(Kaufner, Henkelmann) Department of Anaesthesiology and Intensive Care
Medicine, Charite - University Medicine Berlin, Berlin, Germany
(von Heymann) Department of Anaesthesiology, Intensive Care Medicine,
Emergency Care Medicine and Pain Therapy, Vivantes Klinikum im
Friedrichshain, Berlin, Germany
(Pace) Department of Anesthesiology, University of Utah, Salt Lake City,
UT, United States
(Weibel, Kranke) Department of Anaesthesia and Critical Care, University
of Wurzburg, Wurzburg, Germany
(Meerpohl) Institute for Evidence in Medicine, Medical Center - University
of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
(Gill) Department of Anaesthetics, Southampton University Hospital NHS
Trust, Southampton, United Kingdom
(Meerpohl) Cochrane Germany, Cochrane Germany Foundation, Freiburg,
Germany
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Background: Approximately 30% of adults undergoing non-cardiac surgery
suffer from preoperative anaemia. Preoperative anaemia is a risk factor
for mortality and adverse outcomes in different surgical specialties and
is frequently the reason for blood transfusion. The most common causes are
renal, chronic diseases, and iron deficiency. International guidelines
recommend that the cause of anaemia guide preoperative anaemia treatment.
Recombinant human erythropoietin (rHuEPO) with iron supplementation has
frequently been used to increase preoperative haemoglobin concentrations
in patients in order to avoid the need for perioperative allogeneic red
blood cell (RBC) transfusion. <br/>Objective(s): To evaluate the efficacy
of preoperative rHuEPO therapy (subcutaneous or parenteral) with iron
(enteral or parenteral) in reducing the need for allogeneic RBC
transfusions in preoperatively anaemic adults undergoing non-cardiac
surgery. <br/>Search Method(s): We searched CENTRAL, Ovid MEDLINE(R), Ovid
Embase, ISI Web of Science: SCI-EXPANDED and CPCI-S, and clinical trial
registries WHO ICTRP and ClinicalTrials.gov on 29 August 2019.
<br/>Selection Criteria: We included all randomized controlled trials
(RCTs) that compared preoperative rHuEPO + iron therapy to control
treatment (placebo, no treatment, or standard of care with or without
iron) for preoperatively anaemic adults undergoing non-cardiac surgery. We
used the World Health Organization (WHO) definition of anaemia:
haemoglobin concentration (g/dL) less than 13 g/dL for males, and 12 g/dL
for non-pregnant females (decision of inclusion based on mean haemoglobin
concentration). We defined two subgroups of rHuEPO dosage: 'low' for 150
to 300 international units (IU)/kg body weight, and 'high' for 500 to 600
IU/kg body weight. <br/>Data Collection and Analysis: Two review authors
collected data from the included studies. Our primary outcome was the need
for RBC transfusion (no autologous transfusion, fresh frozen plasma or
platelets), measured in transfused participants during surgery
(intraoperative) and up to five days after surgery. Secondary outcomes of
interest were: haemoglobin concentration (directly before surgery), number
of RBC units (where one unit contains 250 to 450 mL) transfused per
participant (intraoperative and up to five days after surgery), mortality
(within 30 days after surgery), length of hospital stay, and adverse
events (e.g. renal dysfunction, thromboembolism, hypertension, allergic
reaction, headache, fever, constipation). <br/>Main Result(s): Most of the
included trials were in orthopaedic, gastrointestinal, and gynaecological
surgery and included participants with mild and moderate preoperative
anaemia (haemoglobin from 10 to 12 g/dL). The duration of preoperative
rHuEPO treatment varied across the trials, ranging from once a week to
daily or a 5-to-10-day period, and in one trial preoperative rHuEPO was
given on the morning of surgery and for five days postoperatively. We
included 12 trials (participants = 1880) in the quantitative analysis of
the need for RBC transfusion following preoperative treatment with rHuEPO
+ iron to correct preoperative anaemia in non-cardiac surgery; two studies
were multiarmed trials with two different dose regimens. Preoperative
rHuEPO + iron given to anaemic adults reduced the need RBC transfusion
(risk ratio (RR) 0.55, 95% confidence interval (CI) 0.38 to 0.80;
participants = 1880; studies = 12; I² = 84%; moderate-quality
evidence due to inconsistency). This analysis suggests that on average,
the combined administration of rHuEPO + iron will mean 231 fewer
individuals will need transfusion for every 1000 individuals compared to
the control group. Preoperative high-dose rHuEPO + iron given to anaemic
adults increased the haemoglobin concentration (mean difference (MD) 1.87
g/dL, 95% CI 1.26 to 2.49; participants = 852; studies = 3; I²
= 89%; low-quality evidence due to inconsistency and risk of bias) but not
low-dose rHuEPO + iron (MD 0.11 g/dL, 95% CI -0.46 to 0.69; participants =
334; studies = 4; I² = 69%; low-quality evidence due to
inconsistency and risk of bias). There was probably little or no
difference in the number of RBC units when rHuEPO + iron was given
preoperatively (MD -0.09, 95% CI -0.23 to 0.05; participants = 1420;
studies = 6; I² = 2%; moderate-quality evidence due to
imprecision). There was probably little or no difference in the risk of
mortality within 30 days of surgery (RR 1.19, 95% CI 0.39 to 3.63;
participants = 230; studies = 2; I² = 0%; moderate-quality
evidence due to imprecision) or of adverse events including local rash,
fever, constipation, or transient hypertension (RR 0.93, 95% CI 0.68 to
1.28; participants = 1722; studies = 10; I² = 0%;
moderate-quality evidence due to imprecision). The administration of
rHuEPO + iron before non-cardiac surgery did not clearly reduce the length
of hospital stay of preoperative anaemic adults (MD -1.07, 95% CI -4.12 to
1.98; participants = 293; studies = 3; I² = 87%; low-quality
evidence due to inconsistency and imprecision). Authors' conclusions:
Moderate-quality evidence suggests that preoperative rHuEPO + iron therapy
for anaemic adults prior to non-cardiac surgery reduces the need for RBC
transfusion and, when given at higher doses, increases the haemoglobin
concentration preoperatively. The administration of rHuEPO + iron
treatment did not decrease the mean number of units of RBC transfused per
patient. There were no important differences in the risk of adverse events
or mortality within 30 days, nor in length of hospital stay. Further,
well-designed, adequately powered RCTs are required to estimate the impact
of this combined treatment more precisely.<br/>Copyright &#xa9; 2020 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<56>
Accession Number
628222474
Title
Coronary-subclavian steal syndrome, an easily overlooked entity in
interventional cardiology.
Source
Catheterization and Cardiovascular Interventions. 96 (3) (pp 614-619),
2020. Date of Publication: 01 Sep 2020.
Author
De Roeck F.; Tijskens M.; Segers V.F.M.
Institution
(De Roeck, Tijskens, Segers) Department of Cardiology, University Hospital
Antwerp, Edegem, Belgium
(Segers) Laboratory of Physiopharmacology, University of Antwerp, Wilrijk,
Belgium
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Coronary-subclavian steal syndrome (CSSS) is a severe complication of
coronary artery bypass graft (CABG) surgery with internal mammary artery
grafting. It is caused by functional graft failure due to a
hemodynamically significant proximal subclavian artery stenosis. In this
manuscript, we provide a comprehensive review of literature and we report
a series of five consecutive CSSS cases. This case series illustrates the
variable clinical presentation, thereby emphasizing the importance of
raised awareness concerning this pathology in CABG patients.<br/>Copyright
&#xa9; 2019 Wiley Periodicals, Inc.

<57>
Accession Number
2005897508
Title
Effect of intracameral epinephrine on heart rate, post-operative ocular
hypertension, and long-term outcome following canine phacoemulsification.
Source
Veterinary Ophthalmology. 23 (5) (pp 872-878), 2020. Date of Publication:
01 Sep 2020.
Author
Osinchuk S.C.; Salpeter E.M.; Lavallee G.; Leis M.L.; Sandmeyer L.S.
Institution
(Osinchuk, Salpeter, Lavallee, Leis, Sandmeyer) Department of Small Animal
Clinical Science, Western College of Veterinary Medicine, University of
Saskatchewan, Saskatoon, SK, Canada
(Leis) Department of Veterinary Clinical Sciences, College of Veterinary
Medicine, University of Minnesota, Minneapolis, MN, United States
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Purpose: To determine the effect of intrsacameral epinephrine on heart
rate, blood pressure, post-operative ocular hypertension, and
complications following canine phacoemulsification. Procedures: A
prospective, double-blinded, controlled trial was carried out using 30
client-owned dogs undergoing phacoemulsification. Eyes were randomly
assigned to a treatment group receiving intracameral (IC) epinephrine (n =
31) or balanced salt solution (n = 25) at the beginning of surgery. Heart
rate, post-operative intraocular pressures, and outcomes were compared
between treatment groups. <br/>Result(s): No adverse reactions to IC
epinephrine or saline were observed. Post-operative ocular hypertension
developed at the 2 and/or 4 hours pressure reading in 35% and 46% in the
epinephrine and saline groups, respectively (P =.5072). There were 9.7%
and 23.1% eyes that developed complications in the IC epinephrine and
saline groups, respectively (P =.2373). <br/>Conclusion(s): Intracameral
epinephrine is safe to use, and non-significant decreases in
post-operative ocular hypertension and long-term complications were
observed.<br/>Copyright &#xa9; 2020 American College of Veterinary
Ophthalmologists

<58>
Accession Number
2005769784
Title
Opportunities for patients to engage in postoperative recovery following
cardiac surgery: A systematic narrative review.
Source
Patient Education and Counseling. 103 (10) (pp 2095-2106), 2020. Date of
Publication: October 2020.
Author
McDonall J.; Heynsbergh N.; Oxley S.; Botti M.; Hutchinson A.
Institution
(McDonall, Heynsbergh, Botti, Hutchinson) Faculty of Health, School of
Nursing and Midwifery, Centre for Quality and Patient Safety Research,
Deakin University, Melbourne 3220, Australia
(Oxley, Botti, Hutchinson) Epworth HealthCare, Bridge Road, Melbourne
3121, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To compare patient booklets with clinical guidelines and care
pathways to assess: gaps in content and depth of information delivered,
opportunities for patients participation and to review the trajectory of
care to inform recovery. <br/>Method(s): A systematic review of the grey
literature was conducted using Google search engine and a variety of terms
related to cardiac surgery, patient outcomes and recovery pathways.
Patient books and care pathways were obtained from major hospitals in
Melbourne. Resources were included if they were published between January
2013-August 2018 and written in English. <br/>Result(s): A total of 31
resources were included in the review, (n = 14 patient booklets, n = 17
clinician guides). Twenty-one topics of recovery were identified. Patient
booklets provided information on more topics of recovery than clinician
guides (50 % and 24 % respectively). Clinician guides provided more depth
on information on topics of recovery than patient booklets (85 % and 73 %
respectively). The majority of patient booklets outlined patient
participation was in five topics of recovery. <br/>Conclusion(s): Gaps in
the type and depth of information exist between patient and clinician
guidelines. Clearer guidelines on how patients can participate in care are
needed. Practice implications: Nurses are key drivers in facilitating
patient participation in postoperative recovery.<br/>Copyright &#xa9; 2020
Elsevier B.V.

<59>
Accession Number
2004975778
Title
Pleural Effusions After Congenital Cardiac Surgery Requiring Readmission:
A Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 41 (6) (pp 1145-1152), 2020. Date of Publication: 01
Aug 2020.
Author
Hughes A.; Carter K.; Cyrus J.; Karam O.
Institution
(Hughes, Carter) Division of Pediatric Cardiology, Children's Hospital of
Richmond at VCU, Richmond, VA, United States
(Cyrus) Tompkins-McCaw Library for the Health Sciences, VCU Libraries,
Virginia Commonwealth University, Richmond, VA, United States
(Karam) Division of Pediatric Critical Care Medicine, Children's Hospital
of Richmond at VCU, Richmond, VA, United States
Publisher
Springer
Abstract
Patients with congenital heart disease (CHD) are surviving longer thanks
to improved surgical techniques and increasing knowledge of natural
history. Pleural effusions continue to be a complication that affect many
surgical patients and are associated with increased morbidity, many times
requiring readmission and additional invasive procedures. The risks for
development of pleural effusion after hospital discharge are ill-defined,
which leads to uncertainty related to strategies for prevention. Our
primary objective was to determine, in patients with CHD requiring
cardiopulmonary bypass, the prevalence of post-surgical pleural effusions
leading to readmission. The secondary objective was to identify risk
factors associated with post-surgical pleural effusions requiring
readmission. We identified 4417 citations; 10 full-text articles were
included in the final review. Of the included studies, eight focused on
single-ventricle palliation, one looked at Tetralogy of Fallot patients,
and another on pleural effusion in the setting of post-pericardiotomy
syndrome. Using a random-effect model, the overall prevalence of pleural
effusion requiring readmission was 10.2% (95% CI 4.6; 17.6). Heterogeneity
was high (I² = 91%). In a subpopulation of patients after
single-ventricle palliation, the prevalence was 13.0% (95% CI 6.0;21.0),
whereas it was 3.0% (95% CI 0.4;6.75) in patients mostly with
biventricular physiology. We were unable to accurately assess risk
factors. A better understanding of this complication with a focus on
single-ventricle physiology will allow for improved risk stratification,
family counseling, and earlier recognition of pleural effusion in this
patient population.<br/>Copyright &#xa9; 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<60>
Accession Number
2004465193
Title
Review of the discard and/or refusal rate of offered donor hearts to
pediatric waitlisted candidates.
Source
Pediatric Transplantation. 24 (3) (no pagination), 2020. Article Number:
e13674. Date of Publication: 01 May 2020.
Author
Schweiger M.; Everitt M.D.; Chen S.; Nandi D.; Castro J.; Gupta D.; Scheel
J.; Lal A.K.; Ablonczy L.; Kirk R.; Miera O.; Davies R.R.; Dipchand A.I.
Institution
(Schweiger) Division of Cardiac Surgery, Pediatric Heart Center,
University Children's Hospital Zurich, Zurich, Switzerland
(Everitt) Children's Hospital Colorado, Denver, CO, United States
(Chen) Stanford University, Palo Alto, CA, United States
(Nandi) Nationwide Children's Hospital, Columbus, OH, United States
(Castro) Fundacion Cardiovascular de Colombia, Bucaramanga City, Colombia
(Gupta) Congenital Heart Center, University of Florida, Gainesville, FL,
United States
(Scheel) Washington University School of Medicine, St Louis, MO, United
States
(Lal) University of Utah, Salt Lake City, UT, United States
(Ablonczy) Pediatric Cardiac Center, Hungarian Institute of Cardiology,
Budapest, Hungary
(Kirk) Division of Pediatric Cardiology, University of Texas Southwestern
Medical Center, Children's Medical Center, Dallas, TX, United States
(Miera) Department of Congenital Heart Disease/Pediatric Cardiology,
Deutsches Herzzentrum, Berlin, Germany
(Davies) Department of Cardiovascular and Thoracic Surgery, Children's
Medical Center, University of Texas Southwestern Medical Center, Dallas,
TX, United States
(Dipchand) Labatt Family Heart Centre, Hospital for Sick Children,
University of Toronto, Toronto, ON, Canada
Publisher
Pharmacotherapy Publications Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
We aimed to review current literature on the discard rate of donor hearts
offered to pediatric recipients and assess geographical differences.
Consequences and ways to reduce the discard rate are discussed. A systemic
review on published literature on pediatric transplantation published in
English since 2010 was undertaken. Additionally, a survey was sent to
international OPOs with the goal of incorporating responses from around
the world providing a more global picture. Based on the literature review
and survey, there is a remarkably wide range of discard and/or refusal for
pediatric hearts offered for transplant, ranging between 18% and 57% with
great geographic variation. The data suggest that that the overall refusal
rate may have decreased over the last decade. Reasons for organ discard
were difficult to identify from the available data. Although the refusal
rate of pediatric donor hearts seems to be lower compared to that reported
in adults, it is still as high as 57% with geographic
variation.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<61>
Accession Number
2004465105
Title
Review of interactions between high-risk pediatric heart transplant
recipients and marginal donors including utilization of risk score models.
Source
Pediatric Transplantation. 24 (3) (no pagination), 2020. Article Number:
e13665. Date of Publication: 01 May 2020.
Author
Gossett J.G.; Amdani S.; Khulbey S.; Punnoose A.R.; Rosenthal D.N.; Smith
J.; Smits J.; Dipchand A.I.; Kirk R.; Miera O.; Davies R.R.
Institution
(Gossett) University of California Benioff Children's Hospitals, San
Francisco, CA, United States
(Amdani) Cleveland Clinic Children's Hospital, Cleveland, OH, United
States
(Khulbey) Apollo Hospital, Hyderabad, India
(Punnoose) Children's Hospital of Wisconsin, Milwaukee, WI, United States
(Rosenthal) Stanford University, Palo Alto, CA, United States
(Smith) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Smits) Eurotransplant International Foundation, Leiden, Netherlands
(Dipchand) Labatt Family Heart Centre, Hospital for Sick Children,
University of Toronto, Toronto, ON, Canada
(Kirk) Division of Pediatric Cardiology, Children's Medical Center,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Miera) Department of Congenital Heart Disease/Pediatric Cardiology,
Deutsches Herzzentrum, Berlin, Germany
(Davies) Department of Cardiovascular and Thoracic Surgery, Children's
Medical Center, University of Texas Southwestern Medical Center, Dallas,
TX, United States
Publisher
Pharmacotherapy Publications Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Donor organ acceptance practices vary among pediatric heart
transplant professionals. We sought to understand what is known about the
interactions between the "high-risk" recipient and the "marginal donor,"
and how donor risk scores can impact this discussion. <br/>Method(s): A
systematic review of published literature on pediatric HTx was undertaken
with the assistance of a medical librarian. Two authors independently
assessed search results, and papers were reviewed for inclusion.
<br/>Result(s): We found that there are a large number of individual
factors, and clusters of factors, that have been used to label individual
recipients "high-risk" and individual donors "marginal." The terms
"high-risk recipient" and "marginal donor" have been used broadly in the
literature making it virtually impossible to make comparisons between
publications. In general, the data support that patients who could be
easily agreed to be "sicker recipients" are at more risk compared to those
who are clearly "healthier," albeit still "sick enough" to need
transplantation. Given this variability in the literature, we were unable
to define how being a "high-risk" recipient interplays with accepting a
"marginal donor." Existing risk scores are described, but none were felt
to adequately predict outcomes from factors available at the time of offer
acceptance. <br/>Conclusion(s): We could not determine what makes a donor
"marginal," a recipient "high-risk," or how these factors interplay within
the specific recipient-donor pair to determine outcomes. Until there are
better risk scores predicting outcomes at the time of organ acceptance,
programs should continue to evaluate each organ and recipient
individually.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<62>
Accession Number
2004453523
Title
Permanent pacemaker implantation in pediatric heart transplant recipients:
A systematic review and evidence quality assessment.
Source
Pediatric Transplantation. 24 (3) (no pagination), 2020. Article Number:
e13698. Date of Publication: 01 May 2020.
Author
Mylonas K.S.; Repanas T.; Athanasiadis D.I.; Voulgaridou A.; Sfyridis
P.G.; Bakoyiannis C.; Kapelouzou A.; Avgerinos D.V.; Tzifa A.; Kalangos A.
Institution
(Mylonas, Sfyridis, Kalangos) Department of Pediatric Cardiac Surgery,
Mitera Children's Hospital, HYGEIA Group, Athens, Greece
(Mylonas, Tzifa) Department of Pediatric Cardiology and Adult Congenital
Heart Disease, Mitera Children's Hospital, HYGEIA Group, Athens, Greece
(Repanas) Department of Cardiology, Augusta Hospital, Dusseldorf, Germany
(Athanasiadis) Department of Surgery, Indiana University School of
Medicine, Indianapolis, IN, United States
(Voulgaridou) Department of Pediatrics, Kavala General Hospital, Kavala,
Greece
(Bakoyiannis) Division of Vascular Surgery, Laikon General Hospital,
National and Kapodistrian University of Athens, Athens, Greece
(Kapelouzou) Clinical, Experimental Surgery & Translational Research,
Biomedical Research Foundation Academy of Athens, Athens, Greece
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Hospital, Weill Cornell Medicine, New York City, NY, United States
Publisher
Pharmacotherapy Publications Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Bradyarrhythmias are a common complication following pediatric OHT and may
require permanent pacemaker implantation (PPM). The purpose of this study
was to investigate the incidence, predictors, and outcomes of children
undergoing PPM implantation following OHT. A PRISMA-compliant systematic
literature review was performed using the PubMed database and the Cochrane
Library (end-of-search date: January 27, 2019). The Newcastle-Ottawa scale
and the Joanna Briggs Institute tool were used to assess the quality of
cohort studies and case reports, respectively. We analyzed data from a
total of 11 studies recruiting 7198 pediatric patients who underwent heart
transplant. PPM implantation was performed in 1.9% (n = 137/7,198; 95% CI:
1.6-2.2) of the patients. Most patients underwent dual-chamber pacing
(46%, 95% CI: 32.6-59.7). Male-to-female ratio was 1.3:1. Mean patient age
at the time of OHT was 10.1 +/- 6.3. Overall, biatrial anastomosis was
used in 62.2% (95% CI: 52.8-70.6) of the patients. The bicaval technique
was performed in the remaining 37.8% (95% CI: 29.4-47.1). Sinus node
dysfunction was the most frequent indication for PPM implantation (54.4%;
95% CI: 42.6-65.7) followed by AV block (45.6%; 95% CI: 34.3-57.3). The
median time interval between OHT and PPM implantation ranged from 17 days
to 12.5 years. All-cause mortality was 27.9% (95% CI: 18.6-39.6) during a
median follow-up of 5 years. PPM implantation is rarely required after
pediatric OHT. The most common indication for pacing is sinus node
dysfunction, and patients undergoing biatrial anastomosis may be more
likely to require PPM.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<63>
Accession Number
2004154997
Title
Behavioral economics-A framework for donor organ decision-making in
pediatric heart transplantation.
Source
Pediatric Transplantation. 24 (3) (no pagination), 2020. Article Number:
e13655. Date of Publication: 01 May 2020.
Author
Butler A.; Chapman G.; Johnson J.N.; Amodeo A.; Bohmer J.; Camino M.;
Davies R.R.; Dipchand A.I.; Godown J.; Miera O.; Perez-Blanco A.;
Rosenthal D.N.; Zangwill S.; Kirk R.
Institution
(Butler, Chapman) Carnegie Mellon University, Pittsburgh, PA, United
States
(Johnson) Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN,
United States
(Amodeo) Bambino Gesu Children's Hospital, Rome, Italy
(Bohmer) The Queen Silvia Children's Hospital, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Camino) Madrid Hospital Gregorio Maranon, Madrid, Spain
(Davies) Department of Cardiovascular and Thoracic Surgery, University of
Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX,
United States
(Dipchand) Labatt Family Heart Centre, Hospital for Sick Children,
University of Toronto, Toronto, ON, Canada
(Godown) Vanderbilt University Medical Center, Nashville, TN, United
States
(Miera) Department of Congenital Heart Disease/Pediatric Cardiology,
Deutsches Herzzentrum, Berlin, Germany
(Perez-Blanco) Spanish National Transplant Organization, Madrid, Spain
(Rosenthal) Stanford University, Palo Alto, CA, United States
(Zangwill) Phoenix Children's Hospital, Phoenix, AZ, United States
(Kirk) Division of Pediatric Cardiology, University of Texas Southwestern
Medical Center, Children's Medical Center, Dallas, TX, United States
Publisher
Pharmacotherapy Publications Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The high discard rate of pediatric donor hearts presents a major challenge
for children awaiting heart transplantation. Recent literature identifies
several factors that contribute to the disparities in pediatric donor
heart usage, including regulatory oversight, the absence of guidelines on
pediatric donor heart acceptance, and variation among transplant programs.
However, a likely additional contributor to this issue are the behavioral
factors influencing transplant team decisions in donor offer scenarios, a
topic that has not yet been studied in detail. Behavioral economics and
decision psychology provide an excellent foundation for investigating
decision-making in the pediatric transplant setting, offering key insights
into the behavior of transplant professionals. We conducted a systematic
review of published literature in pediatric heart transplant related to
behavioral economics and the psychology of decision-making. In this
review, we draw on paradigms from these two domains in order to examine
how existing aspects of the transplant environment, including regulatory
oversight, programmatic variation, and allocation systems, may precipitate
potential biases surrounding donor offer decisions. Recognizing how human
decision behavior influences donor acceptance is a first step toward
improving utilization of potentially viable pediatric donor
hearts.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<64>
Accession Number
2003817794
Title
Clinical outcomes after TAVR with heparin or bivalirudin as periprocedural
anticoagulation in patients with and without peripheral arterial disease:
Results from the BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 96 (3) (pp E377-E386),
2020. Date of Publication: 01 Sep 2020.
Author
Zilberszac R.; Chandiramani R.; Hengstenberg C.; Sartori S.; Cao D.;
Chandrasekhar J.; Schafer U.; Tchetche D.; Violini R.; Jeger R.; Van Belle
E.; Boekstegers P.; Hambrecht R.; Tron C.; Dumenteil N.; Linke A.; ten
Berg J.M.; Deliargyris E.N.; Anthopoulos P.; Mehran R.; Dangas G.
Institution
(Zilberszac, Hengstenberg) Department of Cardiology, Medical University of
Vienna, Vienna, Austria
(Chandiramani, Sartori, Cao, Chandrasekhar, Mehran, Dangas) The Zena and
Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Schafer) Department of Cardiology, University Heart Center, Hamburg,
Germany
(Schafer) Department of Cardiology, Asklepios Clinics St. Georg, Hamburg,
Germany
(Tchetche, Dumenteil) Department of General and Interventional Cardiology,
Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse,
France
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Rome,
Italy
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Van Belle) Department of Cardiology and INSERM UMR 1011, University
Hospital and CHRU Lille, Lille, France
(Boekstegers) Department of Cardiology, Helios Heart Center Siegburg,
Siegburg, Germany
(Hambrecht) Department of Cardiology, Klinikum Links der Weser, Bremen,
Germany
(Tron) Department of Cardiology, Rouen University Hospital, Rouen, France
(Linke) Department of Cardiology, Universitat Leipzig, Herzzentrum,
Leipzig, Germany
(ten Berg) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Deliargyris) PLx Pharma Inc., Sparta, NJ, United States
(Anthopoulos) Division of Cardiology, The Medicines Company, Zurich,
Switzerland
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Objectives: This study sought to investigate the clinical outcomes of
patients with and without peripheral artery disease (PAD) in the BRAVO-3
trial with respect to the effect of bivalirudin versus unfractionated
heparin (UFH). <br/>Background(s): PAD is found frequently in patients
undergoing transcatheter aortic valve replacement (TAVR) and is reported
to confer an increased risk of adverse events. It is unknown whether
patients with and without PAD may demonstrate a differential response to
bivalirudin versus UFH. <br/>Method(s): BRAVO-3 was a randomized
multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH
(31 centers, n = 802). Major adverse cardiovascular events (MACE) were a
composite of 30-day death, myocardial infarction, or cerebrovascular
accidents (CVA). Net adverse cardiovascular events (NACE) were a composite
of major bleeding or MACE. <br/>Result(s): The total cohort included 119
patients with PAD. Vascular complications occurred significantly more
frequently in patients with PAD both in-hospital (25.2 vs. 16.7%; OR 1.68)
and at 30 days (29.4 vs. 17.3%; OR 1.99). No significant differences were
observed regarding mortality, NACE, MACE, major bleeding or CVA with
bivalirudin versus UFH among patients with or without PAD. In patients
with PAD, bivalirudin was associated with an increased risk of minor
vascular complications at 30 days. <br/>Conclusion(s): Patients with PAD
undergoing transfemoral TAVR did not exhibit an increased risk of any
major adverse events, according to the procedural anticoagulant
randomization. However, patients treated with Bivalirudin had
significantly higher rates of minor vascular complications.<br/>Copyright
&#xa9; 2019 The Authors. Catheterization and Cardiovascular Interventions
published by Wiley Periodicals, Inc.

<65>
Accession Number
631955079
Title
Cardiac structural changes after transcatheter aortic valve replacement:
systematic review and meta-analysis of cardiovascular magnetic resonance
studies.
Source
Journal of cardiovascular magnetic resonance : official journal of the
Society for Cardiovascular Magnetic Resonance. 22 (1) (pp 41), 2020. Date
of Publication: 01 Jun 2020.
Author
Mehdipoor G.; Chen S.; Chatterjee S.; Torkian P.; Ben-Yehuda O.; Leon
M.B.; Stone G.W.; Prince M.R.
Institution
(Mehdipoor, Chen, Ben-Yehuda, Leon, Stone) Cardiovascular Research
Foundation, NY, NY, United States
(Chen, Ben-Yehuda, Leon) Department of Cardiology, Columbia University
College of Physicians and Surgeons, NY, NY, United States
(Chatterjee) Saint Francis Hospital of the University of Connecticut, CT,
Hartford, United States
(Torkian) Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, NY, NY, United States
(Prince) Department of Radiology, Weill Cornell Medical College& New York
Presbyterian Hospital, 416 East 55th Street, NY, NY 10022, United States
(Prince) Department of Radiology, Columbia University College of
Physicians and Surgeons, NY, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly
used to treat patients with severe aortic stenosis (AS). Cardiovascular
magnetic resonance imaging (CMR) provides reliable and reproducible
estimates for assessment of cardiac structure and function after TAVR. The
goal of this study was to conduct a systematic review and meta-analysis of
the literature to assess left ventricular (LV) volumes, mass and function
by CMR after TAVR. <br/>METHOD(S): Using Meta-analysis of Observational
Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase
for studies reporting CMR findings before and at least 1month after TAVR.
Main factors of interest were LV end-diastolic volume index (LVEDVi), LV
end-systolic volume index (LVESVi), LV mass index (LVMi), and left
ventricular ejection fraction (LVEF). Standardized mean differences (SMD)
were pooled by random effects meta-analytic techniques. <br/>RESULT(S): Of
453 screened publications, 10 studies (published between 2012 and 2018)
were included. A total of 305 patients completed pre- and post-TAVR
follow-up CMR (mean age range 78.6-85.0years, follow-up range 6-15months).
Random effects analysis showed TAVR resulted in reduced LVEDVi (SMD:
-0.25, 95% CI: -0.43 to -0.07, P=0.006), LVESVi (SMD: -0.24, 95% CI: -0.44
to -0.05, P=0.01), LVMi (SMD: -0.82, 95% CI: -1.0 to -0.63, P<0.001) and
increased LVEF (SMD: 22, 95% CI: 6 to 38%, P =0.006). Heterogeneity across
studies was low (I2: 0%, Pheterogeneity>0.05 for all). The median
reduction was 4ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5ml/m2 (IQR: 3.0 to
6.0) for LVESVi, and 15.1g/m2 (IQR: 11.8 to 18.3) for LVMi. The median
increase for LVEF was 3.4% (IQR 1.0 to 4.6%). <br/>CONCLUSION(S): CMR
demonstrates reverse LV remodeling occurrs within 6-15months after TAVR,
with reductions in LVEDVi, LVESVi and LVMi, and increased LVEF.

<66>
Accession Number
2007842845
Title
Qualitative Analysis of Surgical Studies Using Extracted Data from the
Manufacturer and User Facility Device Experience (MAUDE) Database.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2020 Annual Clinical Congress. 231 (4 Supplement 2)
(pp e267), 2020. Date of Publication: October 2020.
Author
Zaepfel C.; Ziapour B.; Iafrati M.D.; Salehi P.
Institution
(Zaepfel, Ziapour, Iafrati, Salehi) Tufts Medical Center, Cardiovascular
center, Division of vascular surgery, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Introduction: To evaluate the limitations of using the Manufacturer and
User Facility Device Experience (MAUDE) database in surgical studies, we
analyzed the quality of studies having ever used MAUDE in the field of
cardiovascular surgery. <br/>Method(s): We systematically searched the
Cochrane Library, PubMed, EMBASE, and Google Scholar for randomized and
nonrandomized studies. Two authors evaluated the quality of the retrieved
observational studies, according to the National Institute of Health
quality assessment tool for either case-series or cross-sectional studies.
<br/>Result(s): Fifty-eight from 172 identified studies were eligible for
final qualitative review. Thirty two were case series, 8 were abstracts of
case-series, and 13 were reviews or case discussion with an included
series from MAUDE. Also, five articles were cross-sectional studies. 26
(81.3%) of 32 formal case-series, as well as 4 (80%) of five
cross-sectional studies, were assessed as having poor quality.
<br/>Conclusion(s): The majority of studies using the MAUDE database are
of case series or cross-sectional design, and are mostly of poor quality,
partly because of MAUDE limitations. Investigators are encouraged to
extract as much details as possible from MAUDE entries and use available
quality assessment tools to improve the quality of these studies. Using
medical case report standards during the process of reporting and indexing
adverse events in MAUDE can improve the database quality. Also, indexing
event-free cases of all used devices can provide a denominator to
calculate the prevalence of each adverse event and may transform the
database into a useful and authoritative source for analytic
research.<br/>Copyright &#xa9; 2020

<67>
Accession Number
632871167
Title
A Comprehensive Update on Aspirin Management During Noncardiac Surgery.
Source
Anesthesia and analgesia. 131 (4) (pp 1111-1123), 2020. Date of
Publication: 01 Oct 2020.
Author
Gerstein N.S.; Albrechtsen C.L.; Mercado N.; Cigarroa J.E.; Schulman P.M.
Institution
(Gerstein) From the Department of Anesthesiology and Critical Care
Medicine, University of New Mexico School of Medicine, Albuquerque, NM,
United States
(Albrechtsen) L. Burrell College of Osteopathic Medicine, Las Cruces, NM,
Mexico
(Mercado) Division of Cardiology, Department of Internal Medicine,
University of New Mexico School of Medicine, Albuquerque, NM, United
States
(Cigarroa) Division of Cardiology, Knight Cardiovascular Institute
(Schulman) Department of Anesthesiology and Perioperative Medicine, Oregon
Health & Science University, Portland, Oregon
Publisher
NLM (Medline)
Abstract
Aspirin is considered critical lifelong therapy for patients with
established cardiovascular (CV) disease (including coronary artery,
cerebrovascular, and peripheral arterial diseases) and is consequently one
of the most widely used medications worldwide. However, the indications
for aspirin use continue to evolve and recent trials question its efficacy
for primary prevention. Although one third of patients undergoing
noncardiac surgery and at risk for a major adverse CV event receive
aspirin perioperatively, uncertainty still exists about how aspirin should
be optimally managed in this context, and significant practice variability
remains. Recent trials suggest that the risks of continuing aspirin during
the perioperative period outweigh the benefits in many cases, but data on
patients with high CV risk remain limited. We performed a comprehensive
PubMed and Medline literature search using the following keywords:
aspirin, aspirin withdrawal, perioperative, coronary artery disease,
cerebrovascular disease, peripheral artery disease, and CV disease; we
manually reviewed all relevant citations for inclusion. Patients taking
aspirin for the primary prevention of CV disease should likely discontinue
it during the perioperative period, especially when there is a high risk
of bleeding. Patients with established CV disease but without a coronary
stent should likely continue aspirin during the perioperative period
unless undergoing closed-space surgery. Patients with a history of
coronary stenting also likely need aspirin continuation throughout the
perioperative period for nonclosed space procedures. Perioperative
clinicians need to balance the risks of ceasing aspirin before surgery
against its continuation during the perioperative interval using a
patient-specific strategy. The guidance on decision-making with regard to
perioperative aspirin cessation or continuation using currently available
clinical data from studies in high-risk patients along with nonclinical
aspirin studies is conflicting and does not enable a simplified or unified
answer. However, pertinent guidelines on CV disease management provide a
basic framework for aspirin management, and large trial findings provide
some insight into the safety of perioperative aspirin cessation in some
contexts, although uncertainty on perioperative aspirin still exists. This
review provides an evidence-based update on perioperative aspirin
management in patients undergoing noncardiac surgery with a focus on
recommendations for perioperative clinicians on continuing versus holding
aspirin during this context.

<68>
Accession Number
632870881
Title
A Single Prophylactic Dose of Ondansetron Given at Cessation of
Postoperative Propofol Sedation Decreases Postoperative Nausea and
Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial.
Source
Anesthesia and analgesia. 131 (4) (pp 1164-1172), 2020. Date of
Publication: 01 Oct 2020.
Author
Wang E.H.Z.; Sunderland S.; Edwards N.Y.; Chima N.S.; Yarnold C.H.;
Schwarz S.K.W.; Coley M.A.
Institution
(Wang) From the Pharmacy Department, St Paul's Hospital, Providence Health
Care, Vancouver, BC, Canada
(Wang) Faculty of Pharmaceutical Sciences
(Sunderland, Chima, Yarnold, Schwarz, Coley) Department of Anesthesiology,
Pharmacology & Therapeutics, University of British Columbia, Vancouver,
BC, Canada
(Edwards, Yarnold, Schwarz, Coley) Department of Anesthesia, St Paul's
Hospital, Providence Health Care, Vancouver, BC, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common
occurrence after cardiac surgery. However, in contrast to other surgical
populations, routine PONV prophylaxis is not a standard of care in cardiac
surgery. We hypothesized that routine administration of a single
prophylactic dose of ondansetron (4 mg) at the time of stopping
postoperative propofol sedation before extubation in the cardiac surgery
intensive care unit would decrease the incidence of PONV. <br/>METHOD(S):
With institutional human ethics board approval and written informed
consent, we conducted a randomized controlled trial in patients >=19 years
of age with no history of PONV undergoing elective or urgent cardiac
surgery procedures requiring cardiopulmonary bypass. The primary outcome
was the incidence of PONV in the first 24 hours postextubation, compared
by the chi test. Secondary outcomes included the incidence and times to
first dose of rescue antiemetic treatment administration, the incidence of
headaches, and the incidence of ventricular arrhythmias. <br/>RESULT(S):
PONV within the first 24 hours postextubation occurred in 33 of 77
patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in
the placebo group (relative risk, 0.70 [95% confidence interval {CI},
0.51-0.95]; absolute risk difference, -18% [95% CI, -33 to -2]; number
needed to treat, 5.5 [95% CI, 3.0-58.4]; chi test, P = .022). Kaplan-Meier
"survival" analysis of the times to first rescue antiemetic treatment
administration over 24 hours indicated that patients in the ondansetron
group fared better than those in the placebo group (log-rank [Mantel-Cox]
test; P = .028). Overall, 32 of 77 patients (42%) in the ondansetron group
received rescue antiemetic treatment over the first 24 hours
postextubation versus 47 of 82 patients (57%) in the placebo group
(relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference, -16%
[95% CI, -31 to 1]); P = .047. There were no significant differences
between the groups in the incidence of postoperative headache (ondansetron
group, 5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%];
Fisher exact test; P = .740) or ventricular arrhythmias (ondansetron
group, 2 of 77 patients [3%] versus placebo group, 4 of 82 patients [5%];
P = .68). <br/>CONCLUSION(S): These findings support the routine
administration of ondansetron prophylaxis at the time of discontinuation
of postoperative propofol sedation before extubation in patients following
cardiac surgery. Further research is warranted to optimize PONV
prophylaxis in cardiac surgery patients.

<69>
Accession Number
632870677
Title
Meta-Analysis of Perioperative Stroke and Mortality in CABG Patients With
Carotid Stenosis.
Source
The neurologist. 25 (5) (pp 113-116), 2020. Date of Publication: 01 Sep
2020.
Author
Roy P.; Brahme I.; Reddy R.P.; Wechsler L.; Gleason T.; Thirumala P.D.
Institution
(Roy, Brahme, Reddy, Thirumala) Departments of Neurological Surgery
(Wechsler, Gleason) Cardiothoracic Surgery
(Thirumala) Neurology, University of Pittsburgh Medical Center,
Pittsburgh, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is a proven approach in
the treatment of coronary heart disease, but the surgery has several
complications, including stroke and death. Though it has been established
that perioperative stroke is associated with higher rates of long-term
mortality, the relationship between stroke and mortality in the
perioperative period has not yet been systematically examined.
<br/>METHOD(S): Online databases of peer-reviewed literature were searched
to retrieve articles concerning mortality and stroke after CABG in
patients with carotid stenosis. Six studies (n=3786) were included for
analysis. This study was conducted at a single University hospital system,
University of Pittsburgh Medical Center, on patients who underwent CABG.
The data obtained from peer-reviewed literature originated from several
sources, primarily single institution hospitals. <br/>RESULT(S):
Consistent with current literature, the incidence of stroke in CABG
patients with significant carotid stenosis was 2.1%. Data were further
analyzed to generate a summary odds ratio of stroke-related mortality
after CABG, which showed that patients who died within 30 days of CABG
were 7.3 times more likely to have had a perioperative stroke (95%
confidence interval, 4.1-13.2). The 30-day mortality rate among
perioperative stroke victims was 14.4% versus 2.3% for nonstroke patients.
<br/>CONCLUSION(S): Together, these data suggest an association between
stroke and mortality in the perioperative period in patients undergoing
CABG, demonstrating a need for improved monitoring, screening, and
treatment of stroke before, during, and shortly after surgery.

<70>
Accession Number
2006146083
Title
Cardiac Surgery in Trisomy 13 and 18: A Guide to Clinical Decision-Making.
Source
Pediatric Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Carvajal H.G.; Callahan C.P.; Miller J.R.; Rensink B.L.; Eghtesady P.
Institution
(Carvajal, Miller, Rensink, Eghtesady) Section of Pediatric Cardiothoracic
Surgery, Department of Surgery, Washington University School of Medicine
in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, United States
(Callahan) Department of Surgery, Barnes-Jewish Hospital, Washington
University School of Medicine in St. Louis, Saint Louis, MO, United States
Publisher
Springer
Abstract
There has been substantial controversy regarding treatment of congenital
heart defects in infants with trisomies 13 and 18. Most reports have
focused on surgical outcomes versus expectant treatment, and rarely there
has been an effort to consolidate existing evidence into a more coherent
way to help clinicians with decision-making and counseling families. An
extensive review of the existing literature on cardiac surgery in patients
with these trisomies was conducted from 2004 to 2020. The effects of
preoperative and perioperative factors on in-hospital and long-term
mortality were analyzed, as well as possible predictors for postoperative
chronic care needs such as tracheostomy and gastrostomy. Patients with
minimal or no preoperative pulmonary hypertension and mechanical
ventilation undergoing corrective surgery at a weight greater than 2.5 kg
suffer from lower postoperative mortality. Infants with lower-complexity
cardiac defects are likely to benefit the most from surgery, although
their expected mortality is higher than that of infants without trisomy.
Omphalocele confers an increased mortality risk regardless of cardiac
surgery. Gastrointestinal comorbidities increased the risk of gastrostomy
tube placement, while those with prolonged mechanical ventilation and
respiratory comorbidities are more likely to require tracheostomy. Cardiac
surgery is feasible in children with trisomies 13 and 18 and can provide
improved long-term results. However, this is a clinically complex
population, and both physicians and caretakers should be aware of the
long-term challenges these patients face following surgery when discussing
treatment options.<br/>Copyright &#xa9; 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<71>
Accession Number
632870258
Title
Early intervention or watchful waiting for asymptomatic severe aortic
valve stenosis: a systematic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2020. Date of Publication: 08 Sep 2020.
Author
Ullah W.; Gowda S.N.; Khan M.S.; Sattar Y.; Al-Khadra Y.; Rashid M.;
Mohamed M.O.; Alkhouli M.; Kapadia S.; Bagur R.; Mamas M.A.; Fischman
D.L.; Alraies M.C.
Institution
(Ullah) Abington Jefferson Health, Abington, United States
(Gowda) University of South Dakota, Sioux Falls
(Khan) Mercy Saint Vincent Medical Center, MI
(Sattar) Icahn school of medicine at Mount Sinai Elmhurst Hospital, NY
(Al-Khadra, Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Rashid, Mohamed, Mamas) Keele Cardiovascular Research Group, Centre for
Prognosis Research, Institute of Primary Care and Health Sciences, Keele
University, Academic Department of Cardiology, Royal Stoke Hospital,
United Kingdom
(Alkhouli) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, Rochester, MN, United States
(Bagur) London Health Sciences Centre, London, ON, Canada
(Mamas, Fischman) Department of Cardiology, Thomas Jefferson Hospital,
Philadelphia, PA, United States
(Alraies) Detroit Medical Center, DMC Heart Hospital, Detroit, MI, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The management of patients with severe but asymptomatic aortic
stenosis is challenging. Evidence on early aortic valve replacement (AVR)
versus symptom-driven intervention in these patients is unknown.
<br/>METHOD(S): Electronic databases were searched, articles comparing
early-AVR with conservative management for severe aortic stenosis were
identified. Pooled adjusted odds ratio (OR) was computed using a
random-effect model to determine all-cause and cardiovascular mortality.
<br/>RESULT(S): A total of eight studies consisting of 2201 patients were
identified. Early-AVR was associated with lower all-cause mortality [OR
0.24, 95% confidence interval (CI) 0.13-0.45, P <= 0.00001] and
cardiovascular mortality (OR 0.21, 95% CI 0.06-0.70, P = 0.01) compared
with conservative management. The number needed to treat to prevent 1
all-cause and cardiovascular mortality was 4 and 9, respectively. The odds
of all-cause mortality in a selected patient population undergoing
surgical AVR (SAVR) (OR 0.16, 95% CI 0.09-0.29, P <= 0.00001) and SAVR or
transcatheter AVR (TAVR) (OR 0.53, 95% CI 0.35-0.81, P = 0.003) were
significantly lower compared with patients who are managed conservatively.
A subgroup sensitivity analysis based on severe aortic stenosis (OR 0.24,
95% CI 0.11-0.52, P = 0.0004) versus very severe aortic stenosis (OR 0.20,
95% CI 0.08-0.51, P = 0.0008) also mirrored the findings of overall
results. <br/>CONCLUSION(S): Patients with asymptomatic aortic valve
stenosis have lower odds of all-cause and cardiovascular mortality when
managed with early-AVR compared with conservative management. However,
because of significant heterogeneity in the classification of asymptomatic
patients, large scale studies are required.

<72>
Accession Number
2004997555
Title
Effects of remote ischemic pre-conditioning to prevent contrast-induced
nephropathy after intravenous contrast medium injection: A randomized
controlled trial.
Source
Korean Journal of Radiology. 21 (11) (pp 1230-1238), 2020. Date of
Publication: Nov 2020.
Author
Belabbas D.; Koch C.; Chaudru S.; Lederlin M.; Laviolle B.; Pabic E.L.;
Boulmier D.; Heautot J.-F.; Mahe G.
Institution
(Belabbas, Chaudru, Lederlin, Laviolle, Pabic, Boulmier, Heautot, Mahe)
Vascular Medicine Unit, Department of Radiology, University Hospital
Pontchaillou, Rennes, France
(Koch) Department of Radiodology, Toulouse University Hospital, Toulouse,
France
Publisher
Korean Radiological Society (E-mail: office@radiology.or.kr)
Abstract
Objective: We aimed to assess the effects of remote ischemic
pre-conditioning (RIPC) on the incidence of contrast-induced nephropathy
(CIN) after an intravenous (IV) or intra-arterial injection of contrast
medium (CM) in patient and control groups. <br/>Material(s) and Method(s):
This prospective, randomized, single-blinded, controlled trial included 26
patients who were hospitalized for the evaluation of the feasibility of
transcatheter aortic valve implantation and underwent investigations
including contrast-enhanced computed tomography (CT), with Mehran risk
scores greater than or equal to six. All the patients underwent four
cycles of five minute-blood pressure cuff inflation followed by five
minutes of total deflation. In the RIPC group (n = 13), the cuff was
inflated to 50 mm Hg above the patient's systolic blood pressure (SBP); in
the control group (n = 13), it was inflated to 10 mm Hg below the
patient's SBP. The primary endpoint was the occurrence of CIN.
Additionally, variation in the serum levels of cystatin C was assessed.
<br/>Result(s): One case of CIN was observed in the control group, whereas
no cases were detected in the RIPC group (p = 0.48, analysis of 25
patients). Mean creatinine values at the baseline, 24 hours after
injection of CM, and 48 hours after injection of CM were 88 +/- 32
micro&#32;mol/L, 91 +/- 28 micro&#32;mol/L and 82 +/- 29 micro&#32;mol/L,
respectively (p = 0.73) in the RIPC group, whereas in the control group,
they were 100 +/- 36 micro&#32;mol/L, 110 +/- 36 micro&#32;mol/L, and 105
+/- 34 micro&#32;mol/L, respectively (p = 0.78). Cystatin C values (median
[Q1, Q3]) at the baseline, 24 hours after injection of CM, and 48 hours
after injection of CM were 1.10 [1.08, 1.18] mg/L, 1.17 [0.97, 1.35] mg/L,
and 1.12 [0.99, 1.24] mg/L, respectively (p = 0.88) in the RIPC group,
whereas they were 1.11 [0.97, 1.28] mg/L, 1.13 [1.08, 1.25] mg/L, and 1.16
[1.03, 1.31] mg/L, respectively (p = 0.93), in the control group.
<br/>Conclusion(s): The risk of CIN after an IV injection of CM is very
low in patients with Mehran risk score greater than or equal to six and
even in the patients who are unable to receive preventive hyperhydration.
Hence, the Mehran risk score may not be an appropriate method for the
estimation of the risk of CIN after IV CM injection.<br/>Copyright &#xa9;
2020 The Korean Society of Radiology.

<73>
Accession Number
632343690
Title
Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics
during one-lung ventilation: a randomized clinical controlled trial.
Source
PeerJ. 2020 (6) (no pagination), 2020. Article Number: e9247. Date of
Publication: 2020.
Author
Xu B.; Gao H.; Li D.; Hu C.; Yang J.
Institution
(Xu, Yang) Department of Anesthesiology, First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu, China
(Xu, Gao, Li, Hu) Department of Anesthesiology, Affiliated Wuxi People's
Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
Publisher
PeerJ Inc. (E-mail: pete@peerj.com)
Abstract
Background. Dexmedetomidine (Dex), a selective a<inf>2</inf>-adrenergic
receptor agonist, has been previously reported to attenuate intrapulmonary
shunt during one-lung ventilation (OLV) and to alleviate
bronchoconstriction. However, the therapeutic effects of nebulized Dex on
pulmonary shunt and lung mechanics during OLV have not been evaluated.
Here we determine whether nebulized dexmedetomidine improved pulmonary
shunt and lung mechanics in patients undergoing elective thoracic surgery
in a prospective randomized controlled clinical trial. Methods. One
hundred and twenty-eight patients undergoing elective thoracoscopic
surgery were included in this study and randomly divided into four groups:
0.9% saline (Placebo group), 0.5 micro&#32;g/kg (Dex<inf>0.5</inf> group),
1 micro&#32;g/kg (Dex<inf>1</inf> group) and 2 micro&#32;g/kg
(Dex<inf>2</inf> group) dexmedetomidine. After bronchial intubation,
patients received different nebulized doses of dexmedetomidine (0.5
micro&#32;g/kg, 1 micro&#32;g/kg and 2 micro&#32;g/kg) or 0.9% saline
placebo during two-lung ventilation(TLV). OLV was initiated 15 min after
bronchial intubation. Anesthesia was maintained with intravenous infusion
of cisatracurium and propofol. Bispectral Index values were maintained
within 40-50 by adjusting the infusion of propofol in all groups. Arterial
blood gas samples and central venous blood gas samples were taken as
follows: 15 min after bronchial intubation during two-lung ventilation
(TLV<inf>15</inf>), after 30 and 60 min of OLV (OLV<inf>30</inf> and
OLV<inf>60</inf>, respectively) and 15 min after reinstitution of TLV
(ReTLV). Dynamic compliance was also calculated at TLV<inf>15</inf>,
OLV<inf>30</inf>, OLV<inf>60</inf> and ReTLV. Results. Dex decreased the
requirement of propofol in a dose-dependent manner(P = 0.000). Heart rate
(HR) and mean arterial pressure (MAP) displayed no significant difference
among groups (P = 0.397 and 0.863). Compared with the placebo group, Dex
administered between 0.5 and 2 micro&#32;g/kg increased partial pressure
of oxygen (P<inf>a</inf>O<inf>2</inf>) significantly at OLV<inf>30</inf>
and OLV<inf>60</inf> (P = 0.000); however, Dex administered between 1 and
2 micro&#32;g/kg decreased pulmonary shunt fraction
(Q<inf>s</inf>/Q<inf>t</inf>) at OLV<inf>30</inf> and OLV<inf>60</inf>(P =
0.000). Compared with the placebo group, there were significant increases
with dynamic compliance (Cdyn) after OLV in Dex<inf>0.5</inf>,
Dex<inf>1</inf> and Dex<inf>2</inf> group(P = 0.000). Conclusions.
Nebulized dexmedetomidine improved oxygenation not only by decreasing
pulmonary shunt but also by improving lung compliance during OLV, which
may be effective in managing OLV.<br/>Copyright 2020 Xu et al.

<74>
Accession Number
368408847
Title
Comparison of Cardioprotective Effects of Volatile Anesthetics in Children
Undergoing Ventricular Septal Defect Closure.
Source
World Journal for Pediatric and Congenital Heart Surgery. 4 (1) (pp
24-29), 2013. Date of Publication: January 2013.
Author
Singh P.; Chauhan S.; Jain G.; Talwar S.; Makhija N.; Kiran U.
Institution
(Singh, Chauhan, Makhija, Kiran) Department of Cardiac Anaesthesia, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Jain) Department of Cardiac Anaesthesia, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India
(Talwar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Volatile anesthetic agents may precondition the myocardium and
protect against ischemia and infarction. Preconditioning by volatile
anesthetic agents is well documented in adults but is underinvestigated in
children. The present study compares the effect of preconditioning in
children by three volatile anesthetic agents alongwith several other
variables associated with cardioprotection. <br/>Method(s): Eighty
children scheduled for ventricular septal defect closure under
cardioplegic arrest were assigned to preconditioning for five minutes
after commencement of cardiopulmonary bypass (CPB) with one minimum
alveolar concentration (MAC)of oneof the following agents: isoflurane,
sevoflurane, desflurane, or placebo(oxygen-air mixture).The plasma
concentration of creatine kinaseMB(CK-MB) was determined after initiation
ofCPB, and again 6 and 24 hours after admission to the intensive care unit
(ICU) after surgery. Duration of inotropic support, mechanical
ventilation, and length of ICUstay in all the groups were also recorded.
<br/>Result(s): Preconditioning with isoflurane, sevoflurane, and
desflurane was associated with significantly decreased postoperative
release of CK-MB as compared to placebo group at 6 (group 1: 237.2+/-189,
group 2: 69.8+/-15.8, group 3: 64.7+/-37.8, and group 4: 70.4+/-26.7) and
24 hours (group 1: 192.4+/-158.2, group 2: 67.7+/-25.0, group 3:
85.7+/-66.8, and group 4: 50.4+/-31.6) after admission toICU. No
significant differenceswereobserved in theCK-MBlevels among the three
volatile anesthetic agents.Duration of inotropic support, mechanical
ventilation, and length of ICU stay were greater in placebo group as
compared to other groups without reaching statistical significance.
<br/>Conclusion(s): Volatile anesthetic appear to provide definite
cardioprotection to pediatricmyocardium. No conclusion can be drawn
regarding the best preconditioning agent among isoflurane, sevoflurane,
and desflurane. &#xa9; The Author(s) 2012.

<75>
Accession Number
368408895
Title
Controlling Oxygenation During Initiation of Cardiopulmonary Bypass: Can
It Improve Immediate Postoperative Outcomes in Cyanotic Children
Undergoing Cardiac Surgery? A Prospective Randomized Study.
Source
World Journal for Pediatric and Congenital Heart Surgery. 3 (3) (pp
310-316), 2012. Date of Publication: July 2012.
Author
Babu B.; Bhat S.; Prabuswamy H.P.; Kamalapurkar G.; Kumar H.V.J.; Libu
G.K.; Shilpa S.; Lokesh B.K.
Institution
(Babu) Department of Cardiothoracic Surgery, Apollo Hospitals, 154/11,
Bannerghatta Road, Bangalore 560076, India
(Babu, Bhat, Prabuswamy, Kamalapurkar, Kumar, Shilpa) Department of
Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bangalore, India
(Libu) Department of Community Medicine and Statistics, Karakonam Medical
College, Trivandrum, India
(Lokesh) Department of Perfusion, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bangalore, India
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: Cardiopulmonary bypass (CPB) initiated with high oxygen levels
may expose cyanotic children to reoxygenation injury. The ideal method of
initiation of bypass to prevent this phenomenon still remains largely
unproven. This study tested the hypothesis that controlling oxygenation
during initiation of CPB improves early postoperative outcomes.
<br/>Method(s): Thirty-one cyanotic children were randomized to two
treatment arms of the study. In group A (intervention), CPB was initiated
with fraction of inspired oxygen (Fio2) 0.21, and after one minute of full
bypass, Fio2 was increased at increments of 0.1 per minute to reach 0.6.
In group B (hyperoxemic), CPB was initiated using Fio2 > 0.6. Aortic cross
clamp time (minutes), CPB time (minutes), creatine phosphokinase-MB
(CPK-MB) levels (U/L), lactate levels (mmol/L), duration of ventilator
support (hours), inotropic support (hours), and intensive care unit (ICU)
stay (hours) as well as hospital mortality were measured. <br/>Result(s):
Levels of CPK-MB (group A mean = 59.6 U/L, 95% confidence interval [CI]:
45.9-73.3; group B mean = 82.6 U/L, 95% CI: 66.1-99.1, P = .016) and
ventilation time (group A median = 16.5 hours; interquartile range [IQR] =
11.25-23; group B median = 27.5 hours; IQR = 17-54, P = .045) were
significantly lower in the intervention group. Other parameters showed no
significant differences: CPB time (group A median = 71.5 minutes, IQR =
64-100; group B median = 95.5 minutes, IQR = 58-145, P = .71), cross clamp
time (group A mean = 59.2 minutes, 95% CI: 47.6-70.8; group B mean = 66.57
minutes, 95% CI: 47.6-88.5, P =.57), lactate levels (mmol/L; group A
median = 1.8, IQR = 1.48-2.59; group B median = 2.1, IQR = 1.29-2.62, P =
1), inotropic support (group A median = 47.5 hours, IQR = 36-73.75; group
B median = 59.5 hours, IQR = 41.75-92.5, P = .27), ICU stay (group A
median = 59.5 hours, IQR = 48.25-118.5; group B median = 85 hours, IQR =
47.75-137.50, P = .21), and mortality (group A n = 2, group B n = 2).
<br/>Conclusion(s): A controlled oxygenation protocol was associated with
significantly lower postoperative CPK-MB levels. Evaluation of other end
points including ventilation times requires a study with larger sample
size for validation. &#xa9; The Author(s) 2012.

<76>
Accession Number
368408871
Title
The Effects of Multiple Doses of Glucocorticoids on the Inflammatory
Response to Cardiopulmonary Bypass in Children.
Source
World Journal for Pediatric and Congenital Heart Surgery. 3 (4) (pp
439-445), 2012. Date of Publication: October 2012.
Author
Bronicki R.A.; Checchia P.A.; Stuart-Killion R.B.; Dixon D.J.; Backer C.L.
Institution
(Bronicki) Department of Pediatric Critical Care Medicine, Children's
Hospital of Orange County, Orange, CA, United States
(Checchia) Division of Critical Care Medicine, St Louis Children's
Hospital, Washington University, St Louis, MO, United States
(Stuart-Killion) Division of Pediatric Cardiology, Lucile Packard
Children's Hospital, Stanford University, Stanford, CA, United States
(Dixon) Division of Biostatistics, Washington University School of
Medicine, St Louis, MO, United States
(Backer) Division of Cardiovascular-Thoracic Surgery Ann and Robert H.
Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., mc 22, Chicago,
IL 60611-2605, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: We previously demonstrated that a dose of glucocorticoids
(GCs) administered prior to cardiopulmonary bypass (CPB) is effective at
suppressing the inflammatory response to CPB and leads to an improved
postoperative course. We evaluated whether an additional dose of GC
administered eight hours prior to CPB would lead to further clinical
benefit. <br/>Method(s): We conducted a prospective study in which
patients were randomized to receive placebo or GC eight hours prior to
CPB, in addition to a dose of GC administered following induction of
anesthesia. We measured serum inflammatory mediator levels and
postoperative clinical parameters. <br/>Result(s): Thirty-one patients
were included in the study. Eighteen patients received two doses of GC and
13 patients received a single does of GC. Complement C3a levels were
significantly lower at 24 hours following surgery in those patients who
received two doses of GC (3136 +/- 1650 vs 1779 +/- 1616 ng/mL, P = .04).
There was no significant difference in tumor necrosis factor (TNF)-alpha
or interleukin (IL)-6 levels at any time between groups. There was no
significant difference in core body temperature or renal function (based
on serum creatinine levels) between groups. There was no significant
difference between groups in duration of mechanical ventilation (2.4 +/-
1.5 vs 3.6 +/- 3.7 days, two vs one dose, respectively, P = .33) or length
of stay in the intensive care unit ([ICU]; 3.4 +/- 1.4 vs 4.9 +/- 3.6
days, 2 vs 1 dose, respectively, P = .15). <br/>Conclusion(s): While those
patients who received two doses of GC prior to surgery had significantly
less complement activation postoperatively, clinical outcomes did not
differ between groups. We conclude that the practice of administering an
additional dose of GC prior to CPB is not supported. However, a large
randomized study is needed to conclusively discount the potential benefit
of this strategy. &#xa9; The Author(s) 2012.

<77>
Accession Number
2007557297
Title
Perioperative oral eltrombopag versus intravenous immunoglobulin in
patients with immune thrombocytopenia: a non-inferiority, multicentre,
randomised trial.
Source
The Lancet Haematology. 7 (9) (pp e640-e648), 2020. Date of Publication:
September 2020.
Author
Arnold D.M.; Heddle N.M.; Cook R.J.; Hsia C.; Blostein M.; Jamula E.;
Sholzberg M.; Lin Y.; Kassis J.; Larratt L.; Tinmouth A.; Amini S.;
Schipperus M.; Lim W.; Vishnu P.; Warner M.; Carruthers J.; Li N.; Lane
S.; Kelton J.G.
Institution
(Arnold, Heddle, Kelton) Michael G DeGroote School of Medicine, McMaster
University, Hamilton, ON, Canada
(Arnold, Heddle, Jamula, Carruthers, Li, Lane, Kelton) McMaster Centre for
Transfusion Research, Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Arnold, Kelton) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Lim) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Arnold) Canadian Blood Services, Ancaster, ON, Canada
(Cook) Department of Statistics and Actuarial Science, University of
Waterloo, Waterloo, ON, Canada
(Hsia) Department of Medicine, Division of Hematology, University of
Western Ontario, London, ON, Canada
(Blostein) Department of Medicine, McGill University, Montreal, QC, Canada
(Sholzberg) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Lin) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
(Kassis) Faculty of Medicine, Universite de Montreal, Montreal, QC, Canada
(Larratt) Division of Hematology, University of Alberta, Edmonton, AB,
Canada
(Tinmouth) Department of Medicine, University of Ottawa, Ottawa, ON,
Canada
(Amini, Schipperus) Department of Hematology, HagaZiekenhuis, The Hague,
Netherlands
(Schipperus) Department of Hematology, University Medical Centre
Groningen, Groningen, Netherlands
(Vishnu) Division of Hematology, Mayo Clinic College of Medicine,
Jacksonville, FL, United States
(Warner) McGill University Health Centre, Montreal, QC, Canada
Publisher
Elsevier Ltd
Abstract
Background: Patients with immune thrombocytopenia are at risk of bleeding
during surgery, and intravenous immunoglobulin is commonly used to
increase the platelet count. We aimed to establish whether perioperative
eltrombopag was non-inferior to intravenous immunoglobulin.
<br/>Method(s): We did a randomised, open-label trial in eight academic
hospitals in Canada. Patients were aged at least 18 years, with primary or
secondary immune thrombocytopenia and platelet counts less than 100 x
10⁹ cells per L before major surgery or less than 50 x
10⁹ cells per L before minor surgery. Previous intravenous
immunoglobulin within 2 weeks or thrombopoietin receptor agonists within 4
weeks before randomisation were not permitted. Patients were randomly
assigned to receive oral daily eltrombopag 50 mg from 21 days
preoperatively to postoperative day 7 or intravenous immunoglobulin 1 g/kg
or 2 g/kg 7 days before surgery. Eltrombopag dose adjustments were allowed
weekly based on platelet counts. The randomisation sequence was generated
by a computerised random number generator, concealed and stratified by
centre and surgery type (major or minor). The central study statistician
was masked to treatment allocation. The primary outcome was achievement of
perioperative platelet count targets (90 x 10⁹ cells per L
before major surgery or 45 x 10⁹ cells per L before minor
surgery) without rescue treatment. We did intention-to-treat and
per-protocol analyses using an absolute non-inferiority margin of -10%.
This trial is registered with ClinicalTrials.gov, NCT01621204.
<br/>Finding(s): Between June 5, 2013, and March 7, 2019, 92 patients with
immune thrombocytopenia were screened, of whom 74 (80%) were randomly
assigned: 38 to eltrombopag and 36 to intravenous immunoglobulin. Median
follow-up was 50 days (IQR 49-55). By intention-to-treat analysis,
perioperative platelet targets were achieved for 30 (79%) of 38 patients
assigned to eltrombopag and 22 (61%) of 36 patients assigned to
intravenous immunoglobulin (absolute risk difference 17.8%, one-sided
lower limit of the 95% CI 0.4%; p<inf>non-inferiority</inf>=0.005). In the
per-protocol analysis, perioperative platelet targets were achieved for 29
(78%) of 37 patients in the eltrombopag group and 20 (63%) of 32 in the
intravenous immunoglobulin group (absolute risk difference 15.9%,
one-sided lower limit of the 95% CI -2.1%;
p<inf>non-inferiority</inf>=0.009). Two serious adverse events occurred in
the eltrombopag group: one treatment-related pulmonary embolism and one
vertigo. Five serious adverse events occurred in the intravenous
immunoglobulin group (atrial fibrillation, pancreatitis, vulvar pain,
chest tube malfunction and conversion to open splenectomy); all were
related to complications of surgery. No treatment-related deaths occurred.
<br/>Interpretation(s): Eltrombopag is an effective alternative to
intravenous immunoglobulin for perioperative treatment of immune
thrombocytopenia. However, treatment with eltrombopag might increase risk
of thrombosis. The decision to choose one treatment over the other will
depend on patient preference, resource limitations, cost, and individual
risk profiles. <br/>Funding(s): GlaxoSmithKline and
Novartis.<br/>Copyright &#xa9; 2020 Elsevier Ltd

<78>
Accession Number
2004707492
Title
Aortic valve stenosis and mitochondrial dysfunctions: Clinical and
molecular perspectives.
Source
International Journal of Molecular Sciences. 21 (14) (pp 1-24), 2020.
Article Number: 4899. Date of Publication: 02 Jul 2020.
Author
Pedriali G.; Morciano G.; Patergnani S.; Cimaglia P.; Morelli C.; Mikus
E.; Ferrari R.; Gasbarro V.; Giorgi C.; Wieckowski M.R.; Pinton P.
Institution
(Pedriali, Morciano, Patergnani, Ferrari, Pinton) Maria Cecilia Hospital,
GVM Care & Research, Cotignola, Ravenna 48033, Italy
(Morciano, Patergnani, Gasbarro, Giorgi, Pinton) Department of Medical
Sciences, Laboratory for Technologies of Advanced Therapies (LTTA),
University of Ferrara, Ferrara 44121, Italy
(Cimaglia, Mikus) Cardiovascular Department, Maria Cecilia Hospital, GVM
Care & Research, Cotignola, Ravenna 48033, Italy
(Morelli, Ferrari) Cardiology Unit, Azienda Ospedaliero Universitaria di
Ferrara, Ferrara 44121, Italy
(Wieckowski) Laboratory of Mitochondrial Biology and Metabolism, Nencki
Institute of Experimental Biology, Pasteur 3, Warsaw 02-093, Poland
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Calcific aortic stenosis is a disorder that impacts the physiology of
heart valves. Fibrocalcific events progress in conjunction with thickening
of the valve leaflets. Over the years, these events promote stenosis and
obstruction of blood flow. Known and common risk factors are congenital
defects, aging and metabolic syndromes linked to high plasma levels of
lipoproteins. Inflammation and oxidative stress are the main molecular
mediators of the evolution of aortic stenosis in patients and these
mediators regulate both the degradation and remodeling processes.
Mitochondrial dysfunction and dysregulation of autophagy also contribute
to the disease. A better understanding of these cellular impairments might
help to develop new ways to treat patients since, at the moment, there is
no effective medical treatment to diminish neither the advancement of
valve stenosis nor the left ventricular function impairments, and the
current approaches are surgical treatment or transcatheter aortic valve
replacement with prosthesis.<br/>Copyright &#xa9; 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<79>
Accession Number
2004604425
Title
Antithrombotic strategy for patients with acute coronary syndrome: A
perspective from east asia.
Source
Journal of Clinical Medicine. 9 (6) (pp 1-19), 2020. Article Number: 1963.
Date of Publication: June 2020.
Author
Numasawa Y.; Sawano M.; Fukuoka R.; Ejiri K.; Kuno T.; Shoji S.; Kohsaka
S.
Institution
(Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga Hospital,
Ashikaga 326-0843, Japan
(Sawano, Fukuoka, Shoji, Kohsaka) Department of Cardiology, Keio
University School of Medicine, Tokyo 160-8582, Japan
(Ejiri) Department of Cardiovascular Medicine, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
700-8558, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY 10003, United States
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com)
Abstract
Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention
has become the standard of care, particularly in patients with acute
coronary syndrome (ACS). Current clinical guidelines recommend novel P2Y12
inhibitors (e.g., prasugrel or ticagrelor) in addition to aspirin based on
the results of representative randomized controlled trials conducted
predominantly in Western countries. These agents were superior to
clopidogrel in reducing the composite ischemic events, with a trade-off of
the increased bleeding events. However, multiple differences exist between
East Asian and Western patients, especially with respect to their
physique, thrombogenicity, hemorrhagic diathesis, and on-treatment
platelet reactivity. Recent studies from East Asian countries (e.g., Japan
or South Korea) have consistently demonstrated that use of novel P2Y12
inhibitors is associated with a higher risk of bleeding events than use of
clopidogrel, despite borderline statistical difference in the incidence of
composite ischemic events. Additionally, multiple studies have shown that
the optimal duration of DAPT may be shorter in East Asian than Western
patients. This review summarizes clinical studies of antithrombotic
strategies in East Asian patients with ACS. Understanding these
differences in antithrombotic strategies including DAPT and their impacts
on clinical outcomes will aid in selection of the optimal tailored
antithrombotic therapy for patients with ACS.<br/>Copyright &#xa9; 2020 by
the authors. Licensee MDPI, Basel, Switzerland.

<80>
Accession Number
2003522319
Title
Interatrial septum dissection and atrial wall hematoma following
transseptal puncture: A systematic review of the literature.
Source
Catheterization and Cardiovascular Interventions. 96 (2) (pp 424-431),
2020. Date of Publication: 01 Aug 2020.
Author
Meier D.; Antiochos P.; Herrera-Siklody C.; Eeckhout E.; Delabays A.;
Tzimas G.; Fournier S.; Pascale P.; Muller O.; Monney P.
Institution
(Meier, Antiochos, Herrera-Siklody, Eeckhout, Delabays, Tzimas, Fournier,
Pascale, Muller, Monney) Division of Cardiology, University Hospital of
Lausanne (CHUV), Lausanne, Switzerland
(Fournier) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Italy
(Pascale, Muller, Monney) Faculty of Biology and Medicine, Lausanne
University, Lausanne, Switzerland
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Interatrial septum (IAS) dissection due to transseptal
puncture (TSP) is a rare, underreported complication of the procedure.
Data on the mechanism, diagnosis, and management of this complication are
lacking. <br/>Method(s): We conducted a systematic review of all reported
cases of IAS dissection with or without associated LA hematoma due to TSP,
by thoroughly searching MEDLINE and EMBASE through May 2019.
<br/>Result(s): After screening of n = 882 studies, eight studies with a
total of 19 patients addressed the complication of IAS dissection and/or
LA hematoma secondary to TSP. Median age was 63 years with a 1:1 male to
female ratio. Ablation of atrial fibrillation was the most frequently
reported procedure (84%). Diagnosis was established using fluoroscopy with
contrast injection (58%), TEE (32%) or intracardiac echocardiography (5%).
The mechanism identified involved puncture of the septum secundum portion
of the IAS, leading to transient needle passage into the extracardiac
space. In the majority of patients, the hematoma remained localized in the
IAS and management was conservative with progressive resolution of the
hematoma during follow-up (95%). Two patients (11%) required further
intervention by either pericardiocentesis or surgical drainage due to
hemodynamic instability. <br/>Conclusion(s): IAS dissection with or
without hematoma after TSP remains an underdiagnosed entity. The main
mechanism involves lesion to the septum secundum portion of the IAS,
resulting in needle passage into the extracardiac space and local
bleeding. Although conservative management may be sufficient in the
majority of cases, interventional cardiologists should be familiar with
this complication and its diagnosis.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<81>
Accession Number
2005181241
Title
Hypertonic saline for fluid resuscitation in ICU patients post-cardiac
surgery (HERACLES): a double-blind randomized controlled clinical trial.
Source
Intensive Care Medicine. 46 (9) (pp 1683-1695), 2020. Date of Publication:
01 Sep 2020.
Author
Pfortmueller C.A.; Kindler M.; Schenk N.; Messmer A.S.; Hess B.; Jakob L.;
Wenger S.; Waskowski J.; Zuercher P.; Stoehr F.; Jakob S.M.; Englberger
L.; Schefold J.C.
Institution
(Pfortmueller, Kindler, Schenk, Messmer, Hess, Jakob, Wenger, Waskowski,
Zuercher, Stoehr, Jakob, Schefold) Department of Intensive Care Medicine,
Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse
18, Bern 3010, Switzerland
(Englberger) Department of Cardiovascular Surgery, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
Publisher
Springer
Abstract
Purpose: Recent evidence questions a liberal approach to fluid
resuscitation in intensive care unit (ICU) patients. Here, we assess
whether use of hypertonic saline applied as single infusion at ICU
admission after cardiac surgery can reduce cumulative perioperative fluid
volume. <br/>Method(s): Prospective randomized double-blind single-center
clinical trial investigates effects of a single infusion of hypertonic
saline (HS) versus normal saline (comparator). Primary endpoint was the
cumulative amount of fluid administered in patients in the hypertonic
saline versus the 0.9% saline groups (during ICU stay). Upon ICU
admission, patients received a single infusion of 5 ml/kg body weight of
7.3% NaCl (or 0.9% NaCl) over 60 min. Patients undergoing cardiac surgery
for elective valvular and/or coronary heart disease were included.
Patients with advanced organ dysfunction, infection, and/or patients on
chronic steroid medication were excluded. <br/>Result(s): A total of 101
patients were randomized to receive the study intervention (HS n = 53, NS
n = 48). Cumulative fluid intake on the ICU (primary endpoint) did not
differ between the HS and the NS groups [median 3193 ml (IQR 2052-4333 ml)
vs. 3345 ml (IQR 2332-5043 ml)]. Postoperative urinary output until ICU
discharge was increased in HS-treated patients [median 2250 ml (IQR
1640-2690 ml) vs. 1545 ml (IQR 1087-1976 ml)], and ICU fluid balance was
lower in the HS group when compared to the NS group [296 ml (IQR - 441 to
1412 ml) vs. 1137 ml (IQR 322-2660 ml)]. <br/>Conclusion(s): In a
monocentric prospective double-blind randomized clinical trial, we
observed that hypertonic saline did not reduce the total fluid volume
administered on the ICU in critically ill cardiac surgery patients.
Hypertonic saline infusion was associated with timely increase in urinary
output. Variations in electrolyte and acid-base homeostasis were
transient, but substantial in all patients.<br/>Copyright &#xa9; 2020,
Springer-Verlag GmbH Germany, part of Springer Nature.

<82>
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.

<83>
Accession Number
632304998
Title
Lipoprotein-associated phospholipase A2 activity, genetics and calcific
aortic valve stenosis in humans.
Source
Heart. 106 (18) (pp 1407-1412), 2020. Date of Publication: 01 Sep 2020.
Author
Perrot N.; Theriault S.; Rigade S.; Chen H.Y.; Dina C.; Martinsson A.;
Boekholdt S.M.; Capoulade R.; Le Tourneau T.; Messika-Zeitoun D.; Engert
J.C.; Wareham N.J.; Clavel M.-A.; Pibarot P.; Smith J.G.; Schott J.J.;
Mathieu P.; Bosse Y.; Thanassoulis G.; Arsenault B.J.
Institution
(Perrot, Theriault, Clavel, Pibarot, Mathieu, Bosse, Arsenault) Centre de
Recherche de l'Institut, Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec city, QC, Canada
(Perrot, Clavel, Pibarot, Arsenault) Department of Medicine, Faculty of
Medicine, Universite Laval, Quebec city, QC, Canada
(Theriault) Department of Molecular Biology, Medical Biochemistry and
Pathology, Faculty of Medicine, Universite Laval, Quebec city, QC, Canada
(Rigade, Dina, Capoulade, Schott) L'Institut du Thorax, INSERM, CNRS, UNIV
Nantes, CHU Nantes, Nantes, France
(Chen, Engert, Thanassoulis) McGill University Health Center Research
Institute, Montreal, QC, Canada
(Martinsson, Smith) Department of Cardiology, Clinical Sciences, Lund
University, Lund, Sweden
(Martinsson) Department of Cardiology, Sahlgrenska Universitetssjukhuset,
Goteborg, Sweden
(Boekholdt) Department of Cardiology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
(Le Tourneau) Ultrasound and Cardiology Departments, University Hospital,
Institut du Thorax, Nantes, France
(Messika-Zeitoun) University of Ottawa Heart Institute, APHP, Bichat
Hospital, Ottawa, ON, Canada
(Wareham) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(Smith) Wallenberg Center for Molecular Medicine, Lund University Diabetes
Center, Lund University, Lund, Sweden
(Mathieu) Department of Surgery, Faculty of Medicine, Universite Laval,
Quebec city, QC, Canada
(Bosse) Department of Molecular Medicine, Faculty of Medicine, Universite
Laval, Quebec city, QC, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity has
been shown to predict calcific aortic valve stenosis (CAVS) outcomes. Our
objective was to test the association between plasma Lp-PLA2 activity and
genetically elevated Lp-PLA2 mass/activity with CAVS in humans. Methods
and results Lp-PLA2 activity was measured in 890 patients undergoing
cardiac surgery, including 476 patients undergoing aortic valve
replacement for CAVS and 414 control patients undergoing coronary artery
bypass grafting. After multivariable adjustment, Lp-PLA2 activity was
positively associated with the presence of CAVS (OR=1.21 (95% CI 1.04 to
1.41) per SD increment). We selected four single nucleotide polymorphisms
(SNPs) at the PLA2G7 locus associated with either Lp-PLA2 mass or activity
(rs7756935, rs1421368, rs1805017 and rs4498351). Genetic association
studies were performed in eight cohorts: Quebec-CAVS (1009 cases/1017
controls), UK Biobank (1350 cases/349 043 controls), European Prospective
Investigation into Cancer and Nutrition-Norfolk (504 cases/20 307
controls), Genetic Epidemiology Research on Aging (3469 cases/51 723
controls), Malmo Diet and Cancer Study (682 cases/5963 controls) and three
French cohorts (3123 cases/6532 controls), totalling 10 137 CAVS cases and
434 585 controls. A fixed-effect meta-analysis using the inverse-variance
weighted method revealed that none of the four SNPs was associated with
CAVS (OR=0.99 (95% CI 0.96 to 1.02, p=0.55) for rs7756935, 0.97 (95% CI
0.93 to 1.01, p=0.11) for rs1421368, 1.00 (95% CI 1.00 to 1.01, p=0.29)
for rs1805017, and 1.00 (95% CI 0.97 to 1.04, p=0.87) for rs4498351).
Conclusions Higher Lp-PLA2 activity is significantly associated with the
presence of CAVS and might represent a biomarker of CAVS in patients with
heart disease. Results of our genetic association study suggest that
Lp-PLA2 is however unlikely to represent a causal risk factor or
therapeutic target for CAVS. <br/>Copyright &#xa9;

<84>
[Use Link to view the full text]
Accession Number
2007051570
Title
Is ischemia a disease or syndrome, the cause of angina, and now even a
trial?.
Source
Heart and Metabolism. (81) (pp 36-39), 2020. Date of Publication: 2020.
Author
Boden W.E.
Institution
(Boden) VA New England Healthcare System, Boston University School of
Medicine, Harvard Medical School, Boston, MA, United States
Publisher
Les Laboratoires Seriver (50 Rue Carnot, F-92284, Suresnes Cedex, France)
Abstract
The clinical manifestations of myocardial ischemia are protean in nature
and include a variable combination of typical or atypical angina symptoms,
electrocardiographic changes, noninvasive findings of regional wall motion
abnormalities, and reversible scintigraphic perfusion defects-the changes
of which, importantly, may or may not be of epicardial coronary origin.
Thus, mounting evidence indicates that the presence or absence of
atherosclerotic coronary artery disease (CAD) should no longer be
considered a surrogate marker for myocardial ischemia, as suggested by the
high prevalence of minor or absent coronary obstruction among patients
with proven myocardial ischemia. Whereas the management of CAD has been
largely predicated on the plausible assumption that flow-limiting
obstructions of the epicardial coronary arteries are the proximate cause
of both angina and myocardial ischemia, there is scant evidence from many
randomized trials and several meta-analyses that treating epicardial
coronary obstructions in patients with stable CAD, particularly with
percutaneous coronary intervention (PCI), reduces mortality and morbidity,
as compared with optimal medical therapy (OMT). A crucial scientific
question for which evidence has been lacking is whether more severe and
extensive myocardial ischemia is the driver of adverse cardiovascular
outcomes and whether an invasive strategy with myocardial
revascularization would be superior to OMT alone in such patients. The
results of the recent ISCHEMIA trial (International Study of Comparative
Health Effectiveness with Medical and Invasive Approaches), however, have
failed to show-even in this higher-risk CAD subset-any incremental
clinical benefit of revascularization as compared with OMT alone on
cardiac event reduction.<br/>Copyright &#xa9; 2020 Les Laboratoires
Seriver. All rights reserved.

<85>
Accession Number
2006942348
Title
Blood transfusion and ischaemic outcomes according to anemia and bleeding
in patients with non-ST-segment elevation acute coronary syndromes:
Insights from the TAO randomized clinical trial.
Source
International Journal of Cardiology. 318 (pp 7-13), 2020. Date of
Publication: 1 November 2020.
Author
Deharo P.; Ducrocq G.; Bode C.; Cohen M.; Cuisset T.; Mehta S.R.; Pollack
C.V.; Wiviott S.D.; Rao S.V.; Jukema J.W.; Erglis A.; Moccetti T.; Elbez
Y.; Steg P.G.
Institution
(Deharo, Cuisset) Departement de Cardiologie, CHU Timone, Marseille
F-13385, France
(Deharo) Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France
(Deharo) Aix-Marseille Universite, Faculte de Medecine, Marseille F-13385,
France
(Ducrocq, Elbez, Steg) Hopital Bichat, Assistance Publique-Hopitaux de
Paris, Paris, France
(Bode) Heart Center Freiburg University, Cardiology and Angiology I,
Faculty of Medicine, Freiburg, Germany
(Cohen) Rutgers-New Jersey medical school, Newark, NJ, United States
(Mehta) McMaster University and the Population Health Research Institute,
Hamilton Health Sciences, Hamilton, ON, Canada
(Pollack) Department of Emergency Medicine, Thomas Jefferson University,
Philadelphia, PA, United States
(Wiviott) TIMI Study Group, Division of Cardiovascular Medicine, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Rao) Department of Cardiology, Duke Clinical Research Institute, Durham,
NC, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Erglis) University of Latvia, Pauls Stradins Clinical University Hospita,
Riga, Latvia
(Moccetti) Electrophysiology Unit, Department of Cardiology, Fondazione
Cardiocentro Ticino, via Tesserete 48, Lugano 6900, Switzerland
(Jukema) Netherlands Heart Institute, Utrecht, Netherlands
(Ducrocq, Elbez, Steg) French Alliance for Cardiovascular Trials,
Departement Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat,
Universite de Paris, Institut National de la Sante et de la Recherche
Medicale, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Cohen) Newark Beth Israel medical centre, New Jersey, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The benefits and risks of blood transfusion in patients with
acute myocardial infarction who are anemic or who experience bleeding are
debated. We sought to study the association between blood transfusion and
ischemic outcomes according to haemoglobin nadir and bleeding status in
patients with NST-elevation myocardial infarction (NSTEMI).
<br/>Method(s): The TAO trial randomized patients with NSTEMI and coronary
angiogram scheduled within 72h to heparin plus eptifibatide versus
otamixaban. After exclusion of patients who underwent coronary artery
bypass surgery, patients were categorized according to transfusion status
considering transfusion as a time-varying covariate. The primary ischemic
outcome was the composite of all-cause death or MI within 180 days of
randomization. Subgroup analyses were performed according to
pre-transfusion hemoglobin nadir and bleeding status. <br/>Result(s):
12,547 patients were enrolled. Among these, blood transfusion was used in
489 (3.9%) patients. Patients who received transfusion had a higher rate
of death or MI (29.9% vs. 8.1%, p<0.01). This excess risk persisted after
adjustment on GRACE score and nadir of hemoglobin (HR 3.36 95%CI 2.63-4.29
p<0.01). Subgroup analyses showed that blood transfusion was associated
with a higher risk in patients without overt bleeding (adjusted HR 6.25
vs. 2.85; p-interaction 0.001) as well as in those with hemoglobin nadir >
9.0 g/dl (HR 4.01; p-interaction<0.0001). <br/>Conclusion(s): In patients
with NSTEMI, blood transfusion was associated with an overall increased
risk of ischaemic events. However, this was mainly driven by patients
without overt bleeding and those hemoglobin nadir > 9.0g/dl. This suggests
possible harm of transfusion in those groups.<br/>Copyright &#xa9; 2020
Elsevier B.V.

<86>
Accession Number
2006140373
Title
The impact of minimal invasive extracorporeal circulation on postoperative
kidney function.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Media A.S.; Juhl-Olsen P.; Magnusson N.E.; Modrau I.S.
Institution
(Media, Modrau) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Juhl-Olsen) Department of Anaesthesiology and Intensive Care, Aarhus
University Hospital, Aarhus, Denmark
(Juhl-Olsen, Magnusson, Modrau) Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark
(Magnusson) Medical Research Laboratory, Aarhus University, Aarhus,
Denmark
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Acute kidney injury following cardiac surgery is a frequent
complication associated with increased mortality and morbidity. Minimal
invasive extracorporeal circulation is suggested to preserve postoperative
renal function. The aim of this study was to assess the impact of minimal
invasive versus conventional extracorporeal circulation on early
postoperative kidney function. <br/>Method(s): Randomized controlled trail
including 60 patients undergoing elective stand-alone coronary artery
bypass graft surgery and allocated in a 1:1 ratio to either minimal
invasive (n = 30) or conventional extracorporeal circulation (n = 30).
Postoperative kidney injury was assessed by elevation of plasma neutrophil
gelatinase-associated lipocalin (NGAL), a sensitive tubular injury
biomarker. In addition, we assessed changes in estimated glomerular
filtration rate (eGFR), and the incidence of acute kidney injury according
to the Acute Kidney Injury Network (AKIN) classification. <br/>Result(s):
We observed no differences between groups regarding increase of plasma
NGAL (p = 0.31) or decline of eGFR (p = 0.82). In both groups, 6/30
patients developed acute kidney injury according to the AKIN
classification, all regaining preoperative renal function within 30 days.
<br/>Conclusion(s): Our findings challenge the superiority of minimal
invasive compared to conventional extracorporeal circulation in terms of
preservation of renal function following low-risk coronary
surgery.<br/>Copyright &#xa9; The Author(s) 2020.

<87>
Accession Number
632741584
Title
3D printing in adult cardiovascular surgery and interventions: A
systematic review.
Source
Journal of Thoracic Disease. 12 (6) (pp 3227-3237), 2020. Date of
Publication: 01 Jun 2020.
Author
Wang C.; Zhang L.; Qin T.; Xi Z.; Sun L.; Wu H.; Li D.
Institution
(Wang, Zhang, Qin, Xi, Sun, Wu, Li) Department of Cardiovascular Surgery,
Jinling Hospital, Nanjing University, School Medicine, Nanjing 210002,
China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
3D printing in adult cardiac and vascular surgery has been evaluated over
the last 10 years, and all of the available literature reports benefits
from the use of 3D models. In the present study, we analyzed the current
applications of 3D printing for adult cardiovascular disease treated with
surgical or catheter-based interventions, including the clinical medical
simulation of physiological or pathology conducted with 3D printing in
this field. A search of PubMed and MEDLINE databases were supplemented by
searching through bibliographies of key articles. Thereafter, data on
demographic, clinical scenarios and application, imaging modality,
purposes of using with 3D printing, outcomes and follow-up were extracted.
A total of 43 articles were deemed eligible and included. 296 patients
(mean age: 65.4+/-14.2 years; male, 58.2%) received 3D printing for
cardiac and vascular surgery or conditions [percutaneous left atrial
appendage occlusion (LAAO), TAVR, mitral valve disease, aortic valve
replacement, coronary artery abnormality, HOCM, aortic aneurysm and aortic
dissection, Kommerell's diverticulum, primary cardiac tumor and
ventricular aneurysm]. Eight papers reported the utility of 3D printing in
the medical simulator and training fields. Most studies were conducted
starting in 2014. Twenty-six was case report. The major scenario used with
3D printing technology was LAAO (50.3%) and followed by TAVR (17.6%). CT
and echocardiography were two main imaging techniques that were used to
generate 3D-printed heart models. All studies showed that 3D-printed
models were helpful for preoperative planning, orientation, and medical
teaching. The important finding is that 3D printing provides a unique
patient-specific method to assess complex anatomy and is helpful for
intraoperative orientation, decision-making, creating functional models,
and teaching adult cardiac and vascular surgery, including catheter-based
heart surgery.<br/>Copyright &#xa9; Journal of Thoracic Disease. All
rights reserved.

<88>
Accession Number
632738141
Title
Post-cardiac surgery chylopericardium.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (6) (pp
627-632), 2020. Date of Publication: 01 Jun 2020.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Post-cardiac surgery chylopericardium is a rare complication. This
systematic review included 87 articles with 119 patients of post-cardiac
surgery chylopericardium. Chylopericardium developed after operations for
congenital heart defect more than those for acquired heart disease, and
more patients in whom post-cardiac surgery chylopericardium developed were
with complex than with simple congenital heart defects. Cardiac tamponade
occurred in 35 (29.4%) patients. The onset time of chylopericardium was
18.2 days earlier in patients operated for acquired than in those for
congenital heart defects. Post-cardiac surgery chylopericardium were
curable to conservative treatment in most patients. The recurrence of
post-cardiac surgery chylopericardium was on day 13.2 +/-18.2 after the
initial treatment. The overall early and late mortality rates were 1.7%
(2/119) and 1.7% (2/117), respectively. Most patients with post-cardiac
surgery chylopericardium were diagnosed by laboratory analysis of chylous
fluid. Patients with mild chylopericardium usually show good response to
conservative treatment. Whereas, patients with massive chylopericardium
and rapid accumulation, incurable to conservative treatment and recurrent
to either conservative or surgical treatment, warrant further surgical
treatment.<br/>Copyright &#xa9; 2020 College of Physicians and Surgeons
Pakistan. All rights reserved.

<89>
Accession Number
632726353
Title
A randomised comparison of the efficacy of a Coopdech bronchial blocker
and a double-lumen endotracheal tube for minimally invasive esophagectomy.
Source
Translational Cancer Research. 9 (8) (pp 4686-4692), 2020. Date of
Publication: 01 Aug 2020.
Author
Zhang T.-H.; Liu X.-Q.; Cao L.-H.; Fu J.-H.; Lin W.-Q.
Institution
(Zhang, Cao, Lin) Department of Anaesthesia, Sun Yat-Sen University,
Cancer Center, State Key Laboratory of Oncology in South China and
Collaborative Innovation Center for Cancer Medicine, Guangdong Esophageal
Cancer Institute, Guangzhou, China
(Liu) Department of Anesthesia, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen
University, Guangzhou, China
(Fu) Department of Thoracic Surgery, Sun Yat-Sen University, Cancer
Center, State Key Laboratory of Oncology in South China and Collaborative
Innovation Center for Cancer Medicine, Guangdong Esophageal Cancer
Institute, Guangzhou, China
(Lin) Department of Blood Transfusion, Sun Yat-Sen University, Cancer
Center, State Key Laboratory of Oncology in South China and Collaborative
Innovation Center for Cancer Medicine, Guangdong Esophageal Cancer
Institute, Guangzhou, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Both a bronchial blocker (BB) and a double-lumen endotracheal
tube (DLT) can achieve lung collapse and one-lung ventilation (OLV) during
thoracic surgery. The purpose of this study was to compare these two
airway devices in terms of efficacy in video-assisted thoraco-laparoscopic
esophagectomy for cancer. <br/>Method(s): A total of 55 patients underwent
combined thoracoscopic and laparoscopic esophagectomy for cancer were
enrolled and divided into a Coopdech bronchial blocker group (CBB group,
n=27) or a DLT group (DLT group, n=28). The primary outcome was the lung
collapse scores at 1, 5, 10 minutes after the opening of the pleural and
assessed using a verbal analogue scale via a real-time video view.
Secondary outcomes including time for tube localization, incidence of tube
displacement, postoperative sore throats, and surgeons' satisfaction with
surgical manipulations were collected. <br/>Result(s): The patients in the
CBB group achieved better lung collapse scores at 5 minutes (7.4+/-1.3 vs.
6.4+/-0.9 minutes, P<0.01) and 10 minutes (8.9+/-0.8 vs. 7.1+/-0.9
minutes, P<0.01) after opening the pleura, and they had lower incidence of
postoperative sore throats [5 (18%) vs. 16 (57%), P<0.01] when compared
with patients in DLT group. However, the time for tube localization were
significantly longer in CBB group than in DLT group (210+/-120 vs.
125+/-60 s, P<0.05). There were no significant difference in tube
displacement, hypoxemia (SpO2 <90%) during OLV, and in surgeons'
satisfaction with surgical manipulations. <br/>Conclusion(s): CBB
technique can be a potential alternative to the conventional DLT strategy
for lung collapse and OLV during esophagectomy.<br/>Copyright &#xa9;
Translational Cancer Research. All rights reserved.

<90>
Accession Number
632684490
Title
Endocarditis risk with bioprosthetic and mechanical valves: Systematic
review and meta-analysis.
Source
Heart. 106 (18) (pp 1413-1419), 2020. Date of Publication: 01 Sep 2020.
Author
Anantha-Narayanan M.; Reddy Y.N.V.; Sundaram V.; Murad M.H.; Erwin P.J.;
Baddour L.M.; Schaff H.V.; Nishimura R.A.
Institution
(Anantha-Narayanan) Section of Cardiovascular Diseases, Yale-New Haven
Hospital, New Haven, CT, United States
(Reddy, Erwin, Nishimura) Division of Cardiovascular Diseases, Mayo Clinic
College of Medicine, Rochester, MN, United States
(Sundaram) Harrington Heart and Vascular Institute, University Hospitals
Case Medical Center, Cleveland, OH, United States
(Sundaram) Division of Population Science, National Heart and Lung
Institute, London, United Kingdom
(Murad) Knowledge and Evaluation Research, Mayo Clinic, Rochester, MN,
United States
(Baddour) Division of Infectious Diseases, Mayo Clinic Department of
Health Sciences Research, Rochester, MN, United States
(Schaff) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Bioprosthetic valves are being used with increased frequency for
valve replacement, with controversy regarding risk:benefit ratio compared
with mechanical valves in younger patients. However, prior studies have
been too small to provide comparative estimates of less common but serious
adverse events such as infective endocarditis. We aimed to compare the
incidence of infective endocarditis between bioprosthetic valves and
mechanical valves. Methods We searched PubMed, Cochrane, EMBASE, Scopus
and Web of Science from inception to April 2018 for studies comparing
left-sided aortic and mitral bioprosthetic to mechanical valves for
randomised trials or observational studies with propensity matching. We
used random-effects model for our meta-analysis. Our primary outcome of
interest was the rate of infective endocarditis at follow-up. Results 13
comparison groups with 43 941 patients were included. Mean age was 59+/-7
years with a mean follow-up of 10.4+/-5.0 years. Patients with
bioprosthetic valves had a higher risk of infective endocarditis compared
with patients receiving mechanical valves (OR 1.59, 95% CI 1.35 to 1.88,
p<0.001) with an absolute risk reduction of 9 per 1000 (95% CI 6 to 14).
Heterogeneity within the included studies was low (I 2 =0%). Exclusion of
the study with maximum weight did not change the results of the analysis
(OR 1.57, 95% CI 1.14 to 2.17, p=0.006). A meta-regression of follow-up
time on incidence of infective endocarditis was not statistically
significant (p=0.788) indicating difference in follow-up times did not
alter the pooled risk of infective endocarditis. Conclusions Bioprosthetic
valves may be associated with a higher risk of infective endocarditis.
These data should help guide the discussion when deciding between
bioprosthetic and mechanical valves in individual patients. <br/>Copyright
&#xa9;

<91>
Accession Number
632857060
Title
Is the Use of BIMA in CABG Sub-Optimal? A Review of the Current Clinical
and Economic Evidence Including Innovative Approaches to the Management of
Mediastinitis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2020. Date of Publication: 14 Sep 2020.
Author
Bayer N.; Hart W.M.; Arulampalam T.; Hamilton C.; Schmoeckel M.
Institution
(Bayer, Schmoeckel) Asklepios Klinik St Georg, Hamburg, Germany
(Hart, Arulampalam, Hamilton) ManchesterUnited Kingdom
Publisher
NLM (Medline)
Abstract
Bilateral internal mammary artery (BIMA) in coronary artery bypass
grafting (CABG) has traditionally been limited. This review looks at the
recent outcome data on BIMA in CABG focusing on the management of risk
factors for mediastinitis, one of the potential barriers for more
extensive BIMA utilization. A combination of pre-, intra- and
postoperative strategies are essential to reduce mediastinitis. Limited
data indicate that the incidence of mediastinitis can be reduced using
closed incision negative-pressure wound therapy as a part of these
strategies with the possibility of offering patients best treatment
options by extending BIMA to those with a higher risk of mediastinitis.
Recent economic data imply that the technology may challenge the current
low uptake of BIMA by reducing the short-term cost differentials between
single internal mammary artery and BIMA. Given that most published
randomized controlled trials and meta-analyses of observational long-term
outcome data favor BIMA, if short-term complications of BIMA including
mediastinitis can be controlled adequately, there may be opportunities for
more extensive use of BIMA leading to improved long-term outcomes. An
ongoing study looking at BIMA in high-risk patients may provide evidence
to support the hypothesis that mediastinitis should not be a factor in
limiting the use of BIMA in CABG.

<92>
Accession Number
632856104
Title
Respiratory nursing care with Angong Niuhuang pill for patients with
chronic obstructive pulmonary disease following cardiac surgery.
Source
Japan journal of nursing science : JJNS. (no pagination), 2020. Date of
Publication: 13 Sep 2020.
Author
Lv L.; Zheng J.; Zhang Y.; Chen B.; Yan F.; Qin X.; Zheng C.; Wu Z.; Feng
K.
Institution
(Zheng) Department of Gynecology, First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
(Zhang, Chen, Qin, Zheng, Wu, Feng) Department of Cardiac Surgery, First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
(Yan) Division of Cardiovascular Medicine, First Affiliated Hospital, Sun
Yat-sen University, Guangzhou, China
Publisher
NLM (Medline)
Abstract
AIM: Angong Niuhuang pill (ANP) is a traditional Chinese medicine (TCM)
drug widely used for treating stroke. This study aimed to investigate the
effect of ANP on respiratory nursing outcomes in chronic obstructive
pulmonary disease (COPD) patients following cardiac surgery.
<br/>METHOD(S): A total of 80 COPD patients following cardiac surgery were
enrolled and randomized into the control group receiving routine
postoperative nursing and ANP group additionally receiving ANP treatment
for 3days (n = 40 for both group). The frequency of back percussion, time
of back percussion, amount of expectoration, arterial blood gas levels
were compared between groups. <br/>RESULT(S): Compared to the control
group, the ANP group had a significantly shorter daily mean time of back
percussion at day 3 (p = .036) and day 7 (p = .014). The daily mean amount
of expectoration was higher at day3 (p = .018) but lower at day 7 (p =
.043) in the ANP group than in the control group. In addition, the ANP
group had significantly higher hemoglobin saturation (SpO2 ) and partial
pressure of oxygen (PaO2 ) but lower partial pressure of carbon dioxide
(PaCO2 ) at both day 3 and day 7 than the control group (all p<.05).
Furthermore, the time of postoperative aerosol inhalations (p = .041),
pulmonary infection rate (p = .025) and postoperative hospital stay (p =
.036) were significantly reduced in the ANP group. The ANP group had
significantly lower TCM symptom scores at day 3 and day 7 after surgery.
<br/>CONCLUSION(S): These results suggested that ANP treatment can
effectively promote the postoperative recovery and respiratory nursing
outcomes in COPD patients following cardiac surgery.<br/>Copyright &#xa9;
2020 Japan Academy of Nursing Science.

<93>
Accession Number
632852588
Title
Diagnosis of Infective Endocarditis by Subtype Using
¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed
Tomography: A Contemporary Meta-Analysis.
Source
Circulation: Cardiovascular Imaging. (no pagination), 2020. Article
Number: e010600. Date of Publication: 2020.
Author
Wang T.K.M.; Sanchez-Nadales A.; Igbinomwanhia E.; Cremer P.; Griffin B.;
Xu B.
Institution
(Wang, Cremer, Griffin, Xu) Section of Cardiovascular Imaging, Robert and
Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold
Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic,
OH, United States
(Sanchez-Nadales, Igbinomwanhia) Department of Medicine, Advocate Illinois
Masonic Medical Center, Chicago, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Infective endocarditis (IE) remains a difficult to diagnose
condition associated with high mortality. 18F-fluorodeoxyglucose positron
emission tomography/computed tomography (18F-FDG PET/CT) has recently
emerged as another IE imaging modality, although diagnostic accuracy
varies across observational studies and types of IE. This meta-analysis
assessed the diagnostic performance of 18F-FDG PET/CT for IE and its
subtypes. Methods We searched Pubmed, Cochrane, and Embase from January
1980 to September 2019 for studies reporting both sensitivity and
specificity of 18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data
for all cases of IE and its subgroups of native valve IE, prosthetic valve
IE, and cardiac implantable electronic devices IE. Results We screened
2566 records from the search, assessed 52 full-text articles, and included
26 studies totaling 1358 patients (509 IE cases). Pooled sensitivity and
specificity (95% CI, inconsistency I-square statistic) were 0.74
(0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of
endocarditis. Corresponding parameters for native valve IE were
sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99,
34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and
specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable
electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity
0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were
higher for the 17 studies since 2015 than the 9 studies published before
2015. Conclusions 18F-FDG PET/CT had high specificity for all IE subtypes;
however, sensitivity was markedly lower for native valve IE than
prosthetic valve IE and cardiac implantable electronic devices IE. It is,
therefore, a useful adjunct modality for assessing endocarditis,
especially in the challenging scenarios of prosthetic valve IE and cardiac
implantable electronic devices IE, with improving performance over time,
related to advances in 18F-FDG PET/CT techniques. <br/>Copyright &#xa9;
2020 American Heart Association, Inc.