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<1>
Accession Number
2005609049
Title
Catheter ablation of atrial tachycardias after mitral valve surgery: A
systematic review and meta-analysis.
Source
Journal of Cardiovascular Electrophysiology. 31 (10) (pp 2632-2641), 2020.
Date of Publication: 01 Oct 2020.
Author
Marazzato J.; Cappabianca G.; Angeli F.; Crippa M.; Golino M.; Ferrarese
S.; Beghi C.; De Ponti R.
Institution
(Marazzato, Cappabianca, Angeli, Crippa, Golino, Ferrarese, Beghi, De
Ponti) Department of Medicine and Surgery, Ospedale di Circolo, University
of Insubria, Varese, Italy
(Angeli) Department of Medicine and Cardiopulmonary Rehabilitation,
Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Introduction: Data regarding catheter ablation (CA) of atrial tachycardias
(ATs) occurring after mitral valve surgery (MVS) are scarce. The aim of
this study was to assess the safety and efficacy of CA of ATs in this
surgical population through a systematic review of the literature and
meta-analysis. Method(s): A systematic search on PubMed/MEDLINE,
EMBASE, and Web of Science was performed considering patients undergoing
CA for ATs occurring after MVS. Periprocedural thromboembolic and
hemorrhagic complications were assessed. The acute success and maintenance
of sinus rhythm (SR) at a mid (<24 months) and long-term follow-up (FU)
after CA were investigated along with the burden of arrhythmic recurrence
at FU. Result(s): Fourteen studies for a total of 227 patients were
considered. Three-dimensional (3D) mapping systems were used in all
studies. Only two major bleedings were recorded with a pooled estimate of
periprocedural major complications of 0%. The acute success after CA was
95% with a clear improvement over time. Although maintenance of SR was 71%
at a midterm FU, long-term efficacy was as low as 47% due to an increased
burden of atrial fibrillation (AF) recurrence despite multiple
procedures/patient. Conclusion(s): In this meta-analysis, CA of
postsurgical ATs after MVS proved safe and effective but with still a
significant burden of AF recurrence at more than 24 months of FU due to a
progressive atrial substrate deterioration. The improvement of procedural
success over time might suggest a learning curve in optimizing the use of
3D mapping systems. Copyright © 2020 Wiley Periodicals LLC

<2>
Accession Number
2007712976
Title
Admissions Rate and Timing of Revascularization in the United States in
Patients With Non-ST-Elevation Myocardial Infarction.
Source
American Journal of Cardiology. 134 (pp 24-31), 2020. Date of Publication:
01 Nov 2020.
Author
Case B.C.; Yerasi C.; Wang Y.; Forrestal B.J.; Hahm J.; Dolman S.;
Weintraub W.S.; Waksman R.
Institution
(Case, Yerasi, Wang, Forrestal, Dolman, Weintraub, Waksman) Section of
Interventional Cardiology, MedStar Washington Hospital Center, Washington,
DC, United States
(Hahm) Georgetown University School of Medicine, Washington, DC, United
States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Clinical trials have shown improved outcomes with an early invasive
approach for non-ST-elevation myocardial infarction (NSTEMI). However,
real-world data on clinical characteristics and outcomes based on time to
revascularization are lacking. We aimed to analyze NSTEMI rates,
revascularization timing, and mortality using the 2016 Nationwide
Readmissions Database. We identify patients who underwent diagnostic
angiography and subsequently received either percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG). Finally,
revascularization timing and mortality rates (in-hospital and 30-day) were
extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations
in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic
angiography, with 34.1% (255,199) revascularized. Of revascularized
patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG.
Patients with more comorbidities tended to have more delayed
revascularization. PCI was most commonly performed on the day of admission
(32.9%; 65,155). This differs from CABG, which was most commonly performed
on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate
increased after day 1 for PCI patients and after day 4 for CABG patients,
whereas 30-day in-hospital mortality for both populations increased as
revascularization was delayed. Our study shows that patients undergoing
early revascularization differ from those undergoing later
revascularization. Mortality is generally high with delayed
revascularization, as these are sicker patients. Randomized clinical
trials are needed to evaluate whether very early revascularization (<90
minutes) is associated with improved long-term outcomes in high-risk
patients. Copyright © 2020 Elsevier Inc.

<3>
Accession Number
2007302672
Title
Fully automated postoperative ventilation in cardiac surgery patients: a
randomised clinical trial.
Source
British Journal of Anaesthesia. 125 (5) (pp 739-749), 2020. Date of
Publication: November 2020.
Author
De Bie A.J.R.; Neto A.S.; van Meenen D.M.; Bouwman A.R.; Roos A.N.;
Lameijer J.R.; Korsten E.H.M.; Schultz M.J.; Bindels A.J.G.H.
Institution
(De Bie, Bouwman, Roos, Korsten, Bindels) Department of Intensive Care
Unit, Catharina Hospital Eindhoven, Eindhoven, Netherlands
(De Bie, Korsten) Department of Electrical Engineering, Eindhoven
University of Technology, Eindhoven, Netherlands
(Neto, van Meenen, Schultz) Department of Intensive Care and Laboratory of
Experimental Intensive Care and Anesthesiology, Amsterdam University
Medical Centers, Amsterdam, Netherlands
(Neto) Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Lameijer) Department of Radiology, Catharina Hospital Eindhoven,
Eindhoven, Netherlands
(Schultz) Mahidol Oxford Tropical Medicine Research Unit, Faculty of
Tropical Medicine, Mahidol University, Bangkok, Thailand
(Schultz) Nuffield Department of Medicine, University of Oxford, Oxford,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Ensuring that lung-protective ventilation is achieved at scale
is challenging in perioperative practice. Fully automated ventilation may
be more effective in delivering lung-protective ventilation. Here, we
compared automated lung-protective ventilation with conventional
ventilation after elective cardiac surgery in haemodynamically stable
patients. Method(s): In this single-centre investigator-led study,
patients were randomly assigned at the end of cardiac surgery to receive
either automated (adaptive support ventilation) or conventional
ventilation. The primary endpoint was the proportion of postoperative
ventilation time characterised by exposure to predefined optimal,
acceptable, and critical (injurious) ventilatory parameters in the first
three postoperative hours. Secondary outcomes included severe hypoxaemia
(SpO<inf>2</inf> <85%) and resumption of spontaneous breathing. Data are
presented as mean (95% confidence intervals [CIs]). Result(s): We
randomised 220 patients (30.4% females; age: 62-76 yr). Subjects
randomised to automated ventilation (n=109) spent a 29.7% (95% CI:
22.1-37.4) higher mean proportion of postoperative ventilation time
receiving optimal postoperative ventilation after surgery (P<0.001)
compared with subjects receiving conventional postoperative ventilation
(n=111). Automated ventilation also reduced the proportion of
postoperative ventilation time that subjects were exposed to injurious
ventilatory settings by 2.5% (95% CI: 1-4; P=0.003). Severe hypoxaemia was
less likely in subjects randomised to automated ventilation (risk ratio:
0.26 [0.22-0.31]; P<0.01). Subjects resumed spontaneous breathing more
rapidly when randomised to automated ventilation (hazard ratio: 1.38
[1.05-1.83]; P=0.03). Conclusion(s): Fully automated ventilation in
haemodynamically stable patients after cardiac surgery optimised
lung-protective ventilation during postoperative ventilation, with fewer
episodes of severe hypoxaemia and an accelerated resumption of spontaneous
breathing. Clinical trial registration: NCT03180203. Copyright ©
2020 British Journal of Anaesthesia

<4>
Accession Number
2006834454
Title
Symptom-orientated oral hygiene for children after heart transplantation:
Effectiveness of a standardized prophylactic program.
Source
Pediatric Transplantation. (no pagination), 2020. Date of Publication:
2020.
Author
Schulz-Weidner N.; Bulski J.C.; Siahi-Benlarbi R.; Bauer J.; Logeswaran
T.; Jux C.; Wetzel W.-E.; Kramer N.
Institution
(Schulz-Weidner, Bulski, Siahi-Benlarbi, Wetzel, Kramer) Department of
Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig
University, Giessen, Germany
(Bauer, Logeswaran, Jux) Pediatric Heart Centre, Justus Liebig University,
Giessen, Germany
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Children with CHD, especially heart-transplanted patients, are predisposed
to have caries lesions, gingivitis and other oral findings like gingival
hyperplasia. The aim of the study was the implementation of a specific
oral hygiene program in these patients and its effect on the improvement
of oral health, especially gingival overgrowth. For this, we used a newly
developed systematic GHI to evaluate and describe this gingival
alteration. Thirty-three children, aged 6 to 15 years with cardiac
transplants (9 girls, 24 boys), were examined and introduced into a
specific oral hygiene program. Each child showed evidence of gingival
hyperplasia. They were randomly divided into three groups with the
following oral care measurements: Group ZZ tooth brushing, Group ZZS tooth
brushing and mouth rinsing, Group ZZSS tooth brushing, mouth rinsing and
the use of an additional single and sulcus toothbrush. A significant
decline of all oral health parameters could be proven in all groups.
Gingival hyperplasia (GHI) improved as well as plaque accumulation (QHI).
The children who used in addition to toothbrushing rinsing solutions
and/or additional miniature toothbrushes showed better parameters of the
gingival hygiene indexes from the baseline examination until the end of
the study. The results show that any infant with cardiac transplant has to
be introduced into an individualized oral hygiene program underlining the
need of comprehensive dental care in cooperation with pediatric
cardiology. Copyright © 2020 John Wiley Periodicals LLC

<5>
Accession Number
2006821220
Title
Acute aortic dissection during pregnancy: Trials and tribulations.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Rimmer L.; Heyward-Chaplin J.; South M.; Gouda M.; Bashir M.
Institution
(Rimmer, Heyward-Chaplin, South, Bashir) Vascular Surgery Department,
Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United
Kingdom
(Gouda) Department of Vascular and Endovascular Surgery, Mataria Teaching
Hospital, Cairo, Egypt
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: Type A acute aortic dissection (TAAD) during pregnancy is a
life-threatening event for both the mother and the unborn baby. Pregnancy
has been recognized as an independent risk factor for TAAD, postulated to
be due to physiological changes that cause hyperdynamic circulation. This
review seeks to outline the current controversies around this unique
group. Method(s): A comprehensive literature search was carried out
across large databases to assimilate relevant papers regarding acute
aortic dissection in pregnant women. Result(s): The presentation can
be atypical in many cases and further concern from clinicians of fetal
radiation exposure can result in missed or delayed diagnoses.
Investigation via the quickest form of imaging, whether computed
tomography, magnetic resonance imaging, or transesophageal
echocardiography, should be carried out promptly due to the high risk of
mortality. Surgical management of TAAD in pregnancy revolves primarily
around the decision to deliver the fetus concomitantly or to perform the
aortic repair with the fetus in utero. Conclusion(s): Management of
this group includes rapid and dynamic assessment without delay. From
conception to postpartum, there are multiple stages in which to manage
these women. Challenges in carrying out management in the form of
operative techniques and cardiopulmonary bypass place the fetus at risk
and must be approached with caution, particularly as there is little
evidence-base for many of these decisions. Further research into reducing
maternal and fetal mortality is necessary. Copyright © 2020 Wiley
Periodicals LLC

<6>
Accession Number
2004547235
Title
Upper gastrointestinal mucosal injury associated with ticagrelor plus
aspirin, ticagrelor alone, or aspirin alone at 1-year after coronary
artery bypass grafting.
Source
Journal of Gastroenterology and Hepatology (Australia). 35 (10) (pp
1720-1730), 2020. Date of Publication: 01 Oct 2020.
Author
Tang C.; Zhu Y.; Yang X.; Xu B.; Ye C.; Yang Y.; Zhong J.; Zhao Q.; Yu L.
Institution
(Tang, Xu, Zhong, Yu) Department of Gastroenterology, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Zhu, Ye, Yang, Zhao) Department of Cardiovascular Surgery, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Yang) Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
Publisher
Blackwell Publishing (E-mail: info@asia.blackwellpublishing.com)
Abstract
Background and Aim: The presence and severity of upper gastrointestinal
mucosal lesions have not been evaluated using esophagogastroduodenoscopy
(EGD) in patients receiving ticagrelor plus aspirin or alone after
myocardial revascularization. We assessed upper gastrointestinal mucosal
injury and the use of proton pump inhibitors (PPIs) in patients receiving
1 year of antiplatelet therapy after coronary artery bypass grafting
(CABG). Method(s): In this single-center prospective substudy of a
randomized trial, 231 patients completing 1-year antiplatelet therapy
(ticagrelor 90 mg twice daily plus aspirin 100 mg once daily, ticagrelor
90 mg twice daily, or aspirin 100 mg once daily, in 81, 80, and 70
patients, respectively) after CABG underwent 13C urea breath
testing and EGD. Gastroduodenal lesions were assessed by modified Lanza
score, and reflux esophagitis was evaluated according to Los Angeles
classification. Additionally, at least one ulcer >= 5 mm was separately
analyzed. Result(s): Among 231 patients, EGD showed 28 (12.1%) with
ulcers >= 5 mm, which were detected in 13.6% (11/81) of ticagrelor plus
aspirin recipients, 8.8% (7/80) of ticagrelor recipients, and 14.3%
(10/70) of aspirin recipients, and 24 (10.4%) had reflux esophagitis.
Eighty-eight (38.1%) patients had a positive 13C urea breath
testing after 1 year of treatment, and one patient received eradication
therapy during follow up. Nineteen (8.2%) patients received a PPI for >= 6
months. Conclusion(s): Severe upper gastrointestinal mucosal lesions
were more frequently observed in patients treated with ticagrelor plus
aspirin and aspirin monotherapy than in patients treated with ticagrelor
monotherapy for 1 year post-CABG. Prophylactic use of PPIs might be
inadequate. Copyright © 2020 Journal of Gastroenterology and
Hepatology Foundation and John Wiley & Sons Australia, Ltd

<7>
Accession Number
633050279
Title
Mitral Valve Bioprosthesis Is Safer Than Mechanical Mitral Prosthesis in
Young Women.
Source
The heart surgery forum. 23 (5) (pp E677-E684), 2020. Date of Publication:
23 Sep 2020.
Author
Singab H.; Sami G.
Institution
(Singab) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
(Sami) Nasser Institute for Research and Treatment, Cardiothoracic Surgery
Cairo, Egypt
Publisher
NLM (Medline)
Abstract
BACKGROUND: The ultimate goal of mitral valve surgery in young women is to
extend life expectancy and improve quality of life. Mitral valve
replacement (MVR) prosthesis in middle-aged women is a difficult choice
between the lifelong anticoagulation by mechanical prosthesis versus the
limited long-term durability of bioprosthesis. The current trend towards
reducing women's age for selecting bioprosthesis over mechanical
prosthesis leads to a dilemma for younger women decision making. The aim
of this study was to compare the safety and freedom from complications in
pregnancy and survival rate after mitral valve bioprosthesis versus
mechanical prosthesis in young women for whom mitral valve repair is not
feasible, or unsuitable. METHOD(S): This single-center non randomized
prospective study included all female patients undergoing MVR at our
center from January 2010 to February 2020. RESULT(S): In total, 355
young women patients underwent MVR at our center, of whom 174 received a
bioprosthesis and 181 received a mechanical prosthesis. The use of
anticoagulation among young women with mechanical prosthesis was
associated with a remarkable risk of postoperative bleeding, abortion, and
increased frequency of pregnancy-related complications (P < .0001). In
contrast, there was a considerable survival benefit for those who received
bioprosthesis (P = .0001). CONCLUSION(S): Our data confirm that the
use of mitral bioprosthesis in young women who desire to become pregnant
is safe, reduces complications, and increases survival.

<8>
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Accession Number
2008026893
Title
SPONTANEOUS LEFT ANTERIOR DESCENDING ARTERY DISSECTION IN PREGNANCY.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A152), 2020. Date of Publication: October 2020.
Author
Martinez-Tapia A.; Folterman C.; Axelband J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21,
2020 INTRODUCTION: Pregnancy-associated spontaneous coronary artery
dissection (P-SCAD) is a rare cause of a myocardial infarction (MI) that
occurs when there is an intimal tear in a coronary vessel. Initial
presentation includes chest pain (CP), diaphoresis, and sudden death. Most
commonly occurs in young healthy women in the postpartum period. We
describe a case of a previously healthy 36-year old pregnant female who
presented with spontaneous coronary artery dissection (SCAD) and anterior
MI prior to delivery. CASE PRESENTATION: A 36-year old female with
sarcoidosis, at 36 weeks gestation on low dose aspirin, presented to
emergency department (ED) with CP. She had a prior 7.5 pack year smoking
history with no current alcohol, drug use or family history of MIs. While
in ED, she suffered a seizure-like activity and was found to be
hypertensive. A magnesium drip was started for presumed eclampsia.
Subsequently, she had an episode of ventricular fibrillation with a period
of apnea that required chest compressions and defibrillation. CT chest
ruled out a pulmonary embolus and aortic dissection. CT head showed no
acute intracranial abnormality. Labs revealed a lactic acid of 7.4 and
troponin of 4.03. EKG had significant ST segment elevation in leads V2-V5
and a heparin drip was started. Patient was taken for emergent cardiac
catheterization which identified a SCAD of the long segment of Left
Anterior Descending (LAD) artery without evidence of plaques. A reduced
ejection fracture (EF) of 44% was appreciated on echocardiogram. Due the
extent and location of the dissection with possible maternal and fetal
demise, patient was scheduled for a C-section. Delivery was uncomplicated
for both mother and baby. The mother was managed medically with aspirin,
clopidogrel, amiodarone and discharged with a life vest. Follow up echo
two months later revealed improvement of EF to 65%. Patient is without
recurrence of arrhythmia or CP. DISCUSSION: P-SCAD most commonly presents
within the first month postpartum and less frequently, during pregnancy.
P-SCAD seems to be associated with multiparous state, infertility
treatment, and pre-eclampsia, none which were present in our patient. The
mechanism is unidentified but likely related to increased hemodynamic
stresses or hormonal effects weakening coronary arteries. The most common
vessel involved is the LAD. There are no guidelines in medical management,
but conservative therapy is typically pursued to aggressive interventions
such as PCI and CABG surgery. P-SCAD presentation is more acute and
dynamic than in non-pregnancy related SCAD. Fetal and maternal mortality
from P-SCAD during pregnancy is high with large risk of recurrence.
 CONCLUSION(S): P-SCAD is the most common cause of MI during pregnancy
in a woman without pre-existing coronary disease. Although rare, there
should be a high index of suspicion when a young pregnant patient presents
with CP due to increased mortality. Reference #1: Havakuk, O., Goland S,
Mehra, A., Elkayam, U. Pregnancy and the Risk of Spontaneous Coronary
Artery Dissection. Cardiovascular Interventions. 2017;10.
doi.org/10.1161/circinteventions.117.004941. Reference #2: Tweet, M.,
Hayes, S., Codsi, E., Gulati, R., Rose, C., Best, P. Spontaneous Coronary
Artery Dissection Associated With Pregnancy. Journal of the American
College of Cardiology Volume 70, Issue 4, July 2017 DOI:
10.1016/j.jacc.2017.05.055 Reference #3: Sheikh, A., & O'Sullivan, M.
Pregnancy-related Spontaneous Coronary Artery Dissection: Two Case Reports
and a Comprehensive Review of Literature. Heart Views. 2012 Apr-Jun;
13(2): 53-65. doi: 10.4103/1995-705X.99229 DISCLOSURES: No relevant
relationships by Jennifer Axelband, source=Web Response No relevant
relationships by Christopher Folterman, source=Web Response No relevant
relationships by Ana Martinez-Tapia, source=Web Response Copyright
© 2020 American College of Chest Physicians

<9>
Accession Number
2008026784
Title
A RARE CASE OF LEMIERRE'S SYNDROME CAUSING SEPTIC EMBOLI AND EMPYEMA
REQUIRING BILATERAL THORACOTOMY.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A499-A500), 2020. Date of Publication: October 2020.
Author
Kazim K.; Juneja P.; Baig M.; Gulati U.; Kanoff J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020
INTRODUCTION: Lemierre's Syndrome, a jugular vein thrombophlebitis most
commonly caused by anaerobic bacteria, often presents with septic emboli
and is usually responsive to intravenous antibiotics. We present a rare
case of Lemierre's syndrome due to Fusobacterium necrophorum that resulted
in septic emboli and secondary bilateral empyemas refractory to
appropriate antibiotics requiring thoracotomy with decortication. CASE
PRESENTATION: A 20-year-old male with no significant past medical history
or drug use was admitted with two weeks of fevers, pharyngitis, pleurisy
and hemoptysis. He was found to be in septic shock with a lactic acid of
7.5, had a CT angiography (CTA) chest that showed multiple peripheral
nodular opacifications suspicious for septic emboli, and was treated with
broad spectrum antibiotics. Antibiotics were adjusted to IV
Piperacillin-Tazobactam after initial gram stain showed gram negative
anaerobes. COVID-19, HIV, ANA, ANCA, and MRSA swab were negative. 2D echo
was also unremarkable. Blood cultures finalized to Fusobacterium
necrophorum. Despite lack of oropharyngeal and neck physical exam
findings, CT neck with contrast was obtained due to clinical suspicion of
Lemierre's syndrome and revealed thrombosis of the left internal jugular
and anterior external jugular vein, as well as a soft tissue abscess which
was drained by interventional radiology. Despite seven days of appropriate
antibiotics and negative repeat blood cultures, the patient continued to
have persistent fever and leukocytosis. Repeat CTA chest showed septic
emboli, now larger and cavitary, with new moderate-sized bilateral
loculated pleural effusions. After cardiothoracic surgery evaluation, he
underwent bilateral thoracotomy with decortication. He ultimately improved
and was discharged on oral amoxicillin and anticoagulation. DISCUSSION:
Lemierre's syndrome has a known association with thrombophlebitis and
septic emboli caused by Fusobacterium necrophorum. While a few cases have
reported the development of empyema, the majority of cases of this
syndrome with septicemia respond adequately to IV antibiotics. Our patient
had multiple septic emboli and developed empyemas that were refractory to
appropriate antibiotics and ultimately required bilateral thoracotomy.
Reported mortality rates still average approximately 17%, therefore, early
surgical intervention should be considered as a part of routine management
in complicated Lemierre's syndrome in order to improve clinical outcomes,
as noted in our case. CONCLUSION(S): This rare case demonstrates that
Lemierre's syndrome should be suspected as a differential for septic
emboli despite lack of oropharyngeal or neck physical exam findings.
Earlier consideration for repeat imaging and surgical intervention can
lead to favorable outcomes and decreases morbidity associated with
complications. Reference #1: De Smet, Ken et al. "Lemierre's syndrome: a
case study with a short review of literature." Acta clinica Belgica vol.
74,3 (2019): 206-210. doi:10.1080/17843286.2018.1474614 Reference #2:
Gupta, Shalini, and Shehzad S Merchant. "Lemierre's Syndrome: Rare, but
Life Threatening-A Case Report with Streptococcus intermedius." Case
reports in medicine vol. 2012 (2012): 624065. doi:10.1155/2012/624065
Reference #3: Habib, Saad et al. "Septic emboli of the lung due to
Fusobacterium necrophorum, a case of Lemierre's syndrome." Respiratory
medicine case reports vol. 28 100867. 2 Jun. 2019,
doi:10.1016/j.rmcr.2019.100867 DISCLOSURES: No relevant relationships by
Maarij Baig, source=Web Response No relevant relationships by Uday Gulati,
source=Web Response No relevant relationships by Prateek Juneja,
source=Web Response No relevant relationships by Jack Kanoff, source=Web
Response No relevant relationships by Kumail Kazim, source=Web
Response Copyright © 2020 American College of Chest Physicians

<10>
Accession Number
2008025567
Title
CORONARY ARTERY ECTASIA: A RARE FORM OF CORONARY ARTERY DISEASE AND
CORONARY ANOMALY.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A182), 2020. Date of Publication: October 2020.
Author
Maknojia A.; Lee J.; Ghatak A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21,
2020 INTRODUCTION: Coronary artery ectasia (CAE) is a rare incidental
coronary anomaly and is found in approximately 5% of patients who undergo
coronary angiography. CAE is not a benign condition nor is it within the
normal variation of healthy coronary arteries. CAE is considered as a
high-risk group for coronary events which include myocardial infarction,
heart failure, arrhythmias and sudden cardiac death. We present a patient
who presented with Non-ST elevation myocardial infarction (NSTEMI) due to
severe CAE and underwent ventricular fibrillation (VF) post coronary
artery bypass graft (CABG). CASE PRESENTATION: A 54-year-old Caucasian
male with medical history significant for tobacco abuse and hypertension
presented with NSTEMI. Percutaneous coronary angiography (PCI) revealed
70% diffuse disease with ectasia of the left circumflex artery (LCx), 95%
stenosis in the proximal segment of obtuse marginal, 80% narrowing of left
anterior descending (LAD), aneurysmal dilation of diagonal followed by 70%
disease and significantly ectatic (10mm) right coronary artery (RCA) with
90% stenosis in the mid segment. Due to the risk of artery rupture
associated with a PCI and the large vessel size precluding stent
adherence, cardiothoracic surgery was consulted to perform CABG of 5
vessels. His hospital course was complicated postoperatively by 2 episodes
of cardiac arrest caused by VF. He remained on pressor support but
eventually recovered and discharged home. DISCUSSION: Coronary artery
ectasia (CAE) is the aneurysmal dilatation of coronary artery. It is
defined as a dilatation with a diameter of 1.5 times the adjacent normal
coronary artery. CAE likely represents an exaggerated form of expansive
vascular remodeling in response to atherosclerotic plaque growth. The RCA
is the most common sites for CAE followed by the LAD and the LCX.
Appropriate treatment of CAE is murky due to the rarity of the disease.
CAE can be treated medically with anti-platelet and statin therapy unless
a patient has coexisting obstructive lesions and signs and symptoms. If
so, PCI is recommended. If not suitable for a PCI, CABG is the next choice
which can include surgical excision or ligation of CAE if needed which
confers additional risk in patient with CAE undergoing surgery.
Post-surgery risk of developing cardiac events like VF occur more
frequently in patients with CAE suggesting the need for more careful
management. In regards to our patient, he was young with good left
ventricular function before CABG which increased his probability of
survival despite two cardiac arrest. Moreover, young age <60 years, male,
obesity, smoking, hyperlipidemia and hypertension are all risk factors for
CAE with a good predictive value for future events. CONCLUSION(S):
CAE is a rare form of coronary artery disease. A close monitoring should
be done for patient undergoing any interventions as it increases the risk
of coronary events. Reference #1: Lee AY, Huang CL, Shyu MY Ventricular
fibrillation during coronary angiography in a patient with left dominant
coronary artery ectasia (2012) Experimental and clinical cardiology 17
(2): 79-80 Reference #2: Devabhaktuni S, Mercedes A, Diep J, Ahsan C.
Coronary Artery Ectasia-A Review of Current Literature (2016) Current
cardiology reviews. 12 (4): 318-323 Reference #3: Qin Y, Qin TC, Qin MC,
Qin YG, Qin. Risk Factors for Coronary Artery Ectasia and the Relationship
Between Hyperlipidemia and Coronary Artery Ectasia. (2019) Coronary artery
disease. DISCLOSURES: No relevant relationships by Abhijit Ghatak,
source=Web Response No relevant relationships by Jin Lee, source=Web
Response No relevant relationships by Arish Maknojia, source=Web
Response Copyright © 2020 American College of Chest Physicians

<11>
Accession Number
2008025291
Title
THE EFFICACY AND SAFETY OF USING PHENYLEPHRINE TO OPTIMIZE CEREBRAL
PERFUSION IN DELAYED NEURO-INTERVENTION OF ACUTE ISCHEMIC STROKE.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A977), 2020. Date of Publication: October 2020.
Author
Tavares M.; Foster K.; Gandhi N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020
INTRODUCTION: Permissive hypertension (HTN) in the management of acute
ischemic stroke (AIS) is not novel but a more recent approach considers
the use of vasopressors to optimize cerebral perfusion pressure in the
normotensive patient. CASE PRESENTATION: A 67-year-old female, active
smoker with no medical history, presented with difficulty speaking for 6
hours. Exam revealed expressive aphasia with no other neurologic deficits.
CT angiogram head showed abrupt cut-off of the distal M1 segment extending
to the middle cerebral artery (MCA) bifurcation and proximal M2 vessels
consistent with thromboembolism. Labs including cardiac enzymes were
unremarkable. Cerebral angiogram showed high-grade sub occlusive stenosis
of cervical left internal cerebral artery (ICA) and left MCA. She was
admitted to the intensive care unit and placed on aspirin and clopidogrel.
A systolic blood pressure (SBP) goal of 160-180mmHg was achieved using
normal saline and phenylephrine (PE) infusions. 72 hours later she
underwent successful percutaneous transluminal carotid artery angioplasty
and stenting of the left ICA stenosis with subsequent complete resolution
of her symptoms. PE was discontinued with new goal of SBP 100-120mmHg.
Three days later she had acute onset chest pain. ST depressions in
anterolateral leads on electrocardiogram and elevated cardiac enzymes
prompted coronary angiography, which showed triple vessel disease
requiring coronary artery bypass grafting. DISCUSSION: A U-shaped
relationship exists regarding morbidity and mortality in SBP control in
AIS. Elevated SBP increases risk of brain edema and hemorrhagic conversion
while low pressures cause decreased central perfusion pressure leading to
decreased collateral circulation to ischemic areas. In a 2001 pilot study
using PE in patients with AIS, beyond the window of systemic thrombolysis,
54% of patients had improved NIH stroke scale (NIHSS) after achieving
target SBP (160 mmHg or increase by 20% of admission SBP without exceeding
200 mmHg); no systemic or neurologic complications were reported.(1) A
randomized trial (RT) utilizing PE to target an elevated SBP showed a
short-term improvement in the NIHSS, cognitive score, and volume of
hypoperfused tissue, when compared to the control group, in individuals
with subacute and AIS.(2) In a multicenter RT of patients with
noncardioembolic AIS, ineligible for revascularization therapy, PE was
used to increase SBP up to 200 mmHg. 88.2% of patients in the intervention
group exhibited improvements in NIHSS scores of >=2 points; safety
outcomes did not significantly differ between groups.(3) Our patient had
complete resolution of neurologic symptoms after PE use and
neuro-intervention, which preceded a cardiac event. CONCLUSION(S):
While evidence exists to support the efficacy and safety of PE for SBP
augmentation in the setting of AIS, larger studies with emphasis on safety
are needed, as currently no guidelines exist. Reference #1: Rordorf G.,
Koroshetz W.J., Ezzeddine M.A., Segal A.Z., Buonanno F.S. A pilot study of
drug-induced hypertension for treatment of acute stroke. Neurology. 2001
May 8;56(9):1210-3. doi:10.1212/wnl.56.9.1210 Reference #2: Hillis A.E.,
Ulatowski J.A., Barker P.B., et al. A pilot randomized trial of induced
blood pressure elevation: effects on function and focal perfusion in acute
and sub acute stroke. Cerebrovasc Dis. 2003;16(3):236-246. doi:
10.1159/000071122 Reference #3: Bang O.Y., Chung J.W., Kim S.K., et al.
Therapeutic-induced hypertension in patients with noncardioembolic acute
stroke. Neurology. 2019 Nov 19;93(21):e1955-e1963. Epub 2019 Oct 23. doi:
10.1212/WNL.0000000000008520. DISCLOSURES: No relevant relationships by
Kyle Foster, source=Web Response No relevant relationships by Nisha
Gandhi, source=Web Response No relevant relationships by Matthew Tavares,
source=Web Response Copyright © 2020 American College of Chest
Physicians

<12>
Accession Number
2008024814
Title
HEPARIN-INDUCED THROMBOCYTOPENIA IN A PATIENT WITH ANTI-PHOSPHOLIPID
SYNDROME AFTER AORTIC VALVE REPLACEMENT.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A780), 2020. Date of Publication: October 2020.
Author
Patel P.; Budd A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Critical Care SESSION TYPE: Med
Student/Res Case Report PRESENTED ON: October 18-21, 2020 INTRODUCTION:
Heparin-induced thrombocytopenia (HIT) is a feared complication of heparin
exposure due to antibodies against platelet factor 4 (PF4) and heparin.
The reported incidence of HIT ranges from 0.1 to 5% in patients exposed to
heparin (1). Nearly all patients undergoing cardiac surgery are exposed to
heparin and up to 50% of patients who undergo cardiopulmonary bypass
develop antibodies to PF4. Though this does not necessarily correlate to a
higher incidence, 1-2% of cardiac patients develop HIT. In these patients,
alternative agents for anticoagulation are required, presenting unique
challenges in monitoring. CASE PRESENTATION: A 44-year-old female with
severe aortic insufficiency and moderate aortic stenosis was scheduled for
aortic valve replacement (AVR). Her history was notable for
anti-phospholipid syndrome (APLS) with an extensive history of thromboses
including hepatic, renal, pulmonary and placental thrombosis, maintained
on chronic warfarin. The patient had a remote history of HIT; however,
pre-operatively she had a negative PF4 antibody and serotonin release
assay (SRA), and bridging was done with enoxaparin. She underwent
successful AVR with heparin use intra-operatively. Post-operatively, her
platelet counts down-trended from 166,000/muL to 78,000/muL. Given her
remote history of HIT, repeat antibody and SRA were sent and argatroban
was used for post-op anticoagulation. As the patient's baseline activated
partial thromboplastin time (aPTT) was prolonged, argatroban was titrated
using thrombin time (TT). Argatroban was started at 0.2 mcg/kg/min. TT was
assessed every 6 hours after initiation with titration by 0.1mcg/kg/min
until a therapeutic goal of 30-50 seconds was achieved. DISCUSSION: In
healthy patients, aPTT is recommended for monitoring the effect of
argatroban. However, in the case of APLS, antibodies interfere with
coagulation tests that are phospholipid dependent, resulting in a
prolonged baseline aPTT. Though there is no established range for the use
of TT for monitoring argatroban, a recent study of agatroban in critically
ill patients found TT to correlate with plasma drug concentrations (2).
Low levels of argatroban were found to correlate with TT that are 30-50
seconds and intermediate plasma levels of argatroban correlate with TT
that are approximately 50-100 seconds. Other options include fixed dose
argatroban without monitoring of laboratory parameters or using
non-phospholipid dependent measures such as thromboelastometry (3).
 CONCLUSION(S): As is demonstrated in this case, suspected HIT
following cardiac surgery can be difficult to manage; this is further
compounded in patients with APLS with baseline altered coagulation
parameters. When a direct thrombin inhibitor is used, TT monitoring can be
considered in patients that cannot be monitored using aPTT. Reference #1:
Pishko AM, Cuker A. Heparin-Induced Thrombocytopenia in Cardiac Surgery
Patients. Semin Thromb Hemost. 2017; 43(7):691-698. Reference #2:
Beiderlinden M, Werner P, Bahlmann A, et al. Monitoring of argatroban and
lepirudin anticoagulation in critically ill patients by conventional
laboratory parameters and rotational thromboelastometry - a prospectively
controlled randomized double-blind clinical trial. BMC Anesthesiol. 2018;
18(1):18. Reference #3: Pendleton, R., Wheeler, M. M., & Rodgers, G. M.
Argatroban Dosing of Patients with Heparin-Induced Thrombocytopenia and an
Elevated aPTT Due to Antiphospholipid Antibody Syndrome. Annals of
Pharmacotherapy. 2006; 40(5): 972-976. DISCLOSURES: No relevant
relationships by Ashley Budd, source=Web Response No relevant
relationships by Prachi Patel, source=Web Response Copyright ©
2020 American College of Chest Physicians

<13>
Accession Number
633072977
Title
Efficacy of oral citrulline supplementation to decrease the risk of
pulmonary hypertension after congenital heart disease surgery.
Source
Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina). 77 (3)
(no pagination), 2020. Date of Publication: 16 Jun 2020.
Author
Silvera Ruiz S.; Grosso C.L.; Tablada M.; Cabrera M.; Dodelson de Kremer
R.; Juaneda E.; Larovere L.E.
Institution
(Silvera Ruiz) Centro de Estudio de las Metabolopatias Congenitas
(CEMECO), Hospital de Ninos de la Santisima Trinidad, Facultad de Ciencias
Medicas. Universidad Nacional de Cordoba, Cordoba, Argentina
(Grosso) Universidad Nacional de Cordoba. Facultad de Ciencias Medicas.
Ministerio de Salud de la Provincia de Cordoba. Hospital de Ninos de la
Santisima Trinidad. Centro de Estudio de las Metabolopatias Congenitas
(CEMECO). Cordoba, Argentina. 3 Universidad Nacional de Cordoba. Facultad
de Ciencias Medicas. Catedra de Clinica Pediatrica. Cordoba, Argentina
(Tablada) Universidad Nacional de Cordoba. Facultad de Ciencias
Agropecuarias. Catedra de Estadistica y Biometria. Cordoba, Argentina
(Cabrera, Juaneda) Ministerio de Salud de la Provincia de Cordoba.
Hospital de Ninos de la Santisima Trinidad. Servicio de Cardiologia.
Cordoba, Argentina
(Dodelson de Kremer) Universidad Nacional de Cordoba. Facultad de Ciencias
Medicas. Ministerio de Salud de la Provincia de Cordoba. Hospital de Ninos
de la Santisima Trinidad. Centro de Estudio de las Metabolopatias
Congenitas (CEMECO). Cordoba, Argentina. 3 Universidad Nacional de
Cordoba. Facultad de Ciencias Medicas. Catedra de Clinica Pediatrica.
Cordoba, Argentina
(Larovere) Universidad Nacional de Cordoba. Facultad de Ciencias Medicas.
Ministerio de Salud de la Provincia de Cordoba. Hospital de Ninos de la
Santisima Trinidad. Centro de Estudio de las Metabolopatias Congenitas
(CEMECO). Cordoba, Argentina. 2 Consejo Nacional de Investigacion
Cientifica y Tecnica (CONICET), Ministerio de Ciencia, Tecnologia e
Innovacion. Argentina. 3 Universidad Nacional de Cordoba. Facultad de
Ciencias Medicas. Catedra de Clinica Pediatrica. Cordoba, Argentina
Publisher
NLM (Medline)
Abstract
Pulmonary hypertension (PH) is a major cause of morbi-mortality among
patients with congenital heart disease (CHD) and also a potentially severe
complication after surgical repair. Oral citrulline, a precursor to NO
synthesis, is safe and efficacious for decreasing the risk of
postoperative PH. Objective(s): The aim of the present study was to
investigate in pediatric patients the changes of plasma citrulline,
arginine, homocysteine and nitric oxide (NO) metabolites and pulmonary
artery pressures (PAP) pre-post cardiac surgery in order to describe our
population status with regard to the risk of pulmonary hypertension and
look for potential biomarkers for early detection and treatment. Main
results/Discussion: 16 Argentine pediatric patients with CHD undergoing
cardiopulmonary bypass were randomized in two groups: (A) with and (B)
without perioperative citrulline supplementation. We found that plasma
citrulline median levels before surgery were lower in both groups respect
to referential values, probably due to the poor nutritional status of our
patients; only group A surpassed post-surgery the minimum recommended
level to avoid PH. Furthermore, none of the patients in group A showed
mean PAP higher than 20 mmHg, whereas in group B, 67% of the measurements
were >= than the reference level. Conclusion(s): We reaffirm that
citrulline supplementation it is effective in reducing postoperative
pulmonary hypertension and biomarkers could evidence patient status as a
translational medicine application.

<14>
Accession Number
2008030892
Title
Cardiovascular CT and MRI in 2019: Review of key articles.
Source
Radiology. 297 (1) (pp 17-30), 2020. Date of Publication: October 2020.
Author
Dodd J.D.; Leipsic J.
Institution
(Dodd) Department of Radiology, St. Vincent's University Hospital, Elm
Park, Dublin D4, Ireland
(Dodd) School of Medicine, University College Dublin, Dublin, Ireland
(Leipsic) Department of Radiology, University of British Columbia, St.
Paul's Hospital, Vancouver, Canada
Publisher
Radiological Society of North America Inc. (E-mail: radiology@rsna.org)
Abstract
Cardiac imaging is becoming commonplace throughout radiology practices and
is increasingly important in large-cohort prospective cardiovascular
trials and in statements and guidelines. In this review, the authors
summarize some of the most important imaging findings relevant to clinical
practice in the past year. Key coronary CT angiography studies have
included rigorous meta-analysis of its diagnostic accuracy, prognostic
implications of adverse coronary plaque features, and sex differences. The
value of CT for catheter-delivered valve implantation (eg, transcatheter
aortic and mitral valve replacements) was further elucidated in
large-cohort outcome trials. Hypertrophic cardiomyopathy registries have
revealed distinct clinical and MRI phenotypes, highlighting different
underlying causes, while others clarified the prognostic usefulness of MRI
in hypertrophic cardiomyopathy and Fabry disease. Artificial intelligence
and/or machine learning was applied to many aspects of cardiovascular
imaging, while evidence of the benefits of both adenosine stress perfusion
cardiac MRI and coronary CT angiography-derived fractional flow reserve
from real-world trials has increased. Studies on vaping and vascular
endothelial function and the whole-body MRI depiction of metabolic
syndrome consequences were also noteworthy. Although this review focuses
on Radiology articles, key articles from high-impact clinical journals are
also included. Although not possible to detail all articles because of
space limitations, the authors attempted to highlight those with the most
pragmatic and scientific value. Copyright © RSNA, 2020.

<15>
Accession Number
2008030887
Title
Efficacy and safety of paravertebral block versus intercostal nerve block
in thoracic surgery and breast surgery: A systematic review and
meta-analysis.
Source
PLoS ONE. 15 (10 October) (no pagination), 2020. Article Number: e0237363.
Date of Publication: October 2020.
Author
Huan S.; Deng Y.; Wang J.; Ji Y.; Yin G.
Institution
(Huan, Ji) Nanjing University of Chinese Medicine, Nanjing, Jangsu, China
(Deng, Wang, Yin) Department of Anesthesiology, Second Hospital of
Nanjing, Nanjing, Jangsu, China
(Ji) Department of Critical Medicine, Second Hospital of Nanjing, Nanjing,
Jangsu, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective To evaluate the analgesic efficacy and safety of paravertebral
block (PVB) versus intercostal nerve block (INB) in thoracic surgery and
breast surgery. Methods The PubMed, Web of Science, Embase and the
Cochrane Library were searched up to February 2020 for all available
randomized controlled trials (RCTs) that evaluated the analgesic efficacy
and safety of PVB compared with INB after thoracic surgery and breast
surgery. For binary variables, odds ratio (OR) and 95% confidence interval
(CI) was used. For continuous variables, weighted mean difference (WMD)
and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0
were used for performing the meta-analysis. Results A total of 9 trials
including 440 patients (PVB block:222 patients; INB: 218 patients) met the
inclusion criteria. In the primary outcome, there was no significant
differences between the two groups with respect to postoperative visual
analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P =
0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h
(Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD
= -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was
significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0.
33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h
(Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary
outcome, the analysis also showed no significant difference between the
groups according to the rates of postoperative nausea and vomit (OR = 0.
63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative
additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27).
There was significant difference in postoperative consumption of morphine
(Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). Conclusion
Compared with INB, PVB can provide better analgesia efficacy and cause
lower consumption of morphine after thoracic surgery and breast
surgery. Copyright: © 2020 Huan et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<16>
Accession Number
2008022128
Title
Effectiveness of polypill for prevention of cardiovascular disease
(polypars): Protocol of a randomized controlled trial.
Source
Archives of Iranian Medicine. 23 (8) (pp 548-556), 2020. Date of
Publication: August 2020.
Author
Malekzadeh F.; Gandomkar A.; Malekzadeh Z.; Poustchi H.; Moghadami M.;
Fattahi M.R.; Moini M.; Anushiravani A.; Mortazavi R.; Boogar S.S.;
Mohammadkarimi V.; Abtahi F.; Merat S.; Sepanlou S.G.; Malekzadeh R.
Institution
(Malekzadeh, Malekzadeh, Poustchi, Anushiravani, Merat, Sepanlou,
Malekzadeh) Digestive Disease Research Center, Digestive Disease Research
Institute, Shariati Hospital, Tehran University of Medical Sciences, North
Kargar Ave, Tehran 14117-13135, Iran, Islamic Republic of
(Malekzadeh, Gandomkar, Moghadami, Anushiravani, Malekzadeh)
Non-Communicable Disease Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Malekzadeh) Non-Communicable Diseases Research Center, Endocrinology and
Metabolism Population Sciences Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Poustchi, Malekzadeh) Digestive Oncology Research Center, Digestive
Disease Research Institute, Shariati Hospital, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Fattahi, Moini) Gastroenterohepatology Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Mortazavi, Boogar, Mohammadkarimi) Department of Internal Medicine,
School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Abtahi) Department of Cardiology, Cardiovascular Research Center School
of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Merat, Malekzadeh) Liver and Pancreatobiliary Diseases Research Center,
Digestive Disease Research Institute, Shariati Hospital, Tehran University
of Medical Sciences, Teheran, Iran, Islamic Republic of
Publisher
Academy of Medical Sciences of I.R. Iran
Abstract
Background: Cardiovascular diseases (CVDs) are the leading cause of death
in Iran. A fixed-dose combination therapy (polypill) was proposed as a
cost-effective strategy for CVD prevention, especially in lower-resource
settings. We conducted the PolyPars trial to assess the effectiveness and
safety of polypill for prevention of CVD. Method(s): The PolyPars
trial is a pragmatic cluster randomized controlled trial nested within the
Pars Cohort Study. Participants were randomized to an intervention arm and
a control arm. Participants in the control arm received minimal
non-pharmacological care, while those in the intervention arm received
polypill in addition to minimal care. The polypill comprises
hydrochlorothiazide 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, and either
enalapril 5 mg or valsartan 40 mg. The primary outcome of the study is
defined as the first occurrence of acute coronary syndrome (non-fatal
myocardial infarction and unstable angina), fatal myocardial infarction,
sudden cardiac death, new-onset heart failure, coronary artery
revascularization procedures, transient ischemic attack, cerebrovascular
accidents (fatal or non-fatal), and hospitalization due to any of the
mentioned conditions. The secondary outcomes of the study include adverse
events, compliance, non-cardiovascular mortality, changes in blood
pressure, fasting blood sugar, and lipids after five years of follow-up.
 Result(s): From December 2014 to December 2015, 4415 participants (91
clusters) were recruited. Of those, 2200 were in the polypill arm and 2215
in the minimal care arm. The study is ongoing. This trial was registered
with ClinicalTrials.gov number NCT03459560. Conclusion(s): Polypill
may be effective for primary prevention of CVDs in developing countries.
 Copyright © 2020 The Author(s).

<17>
Accession Number
2006945507
Title
Cancer risk in heart or lung transplant recipients: A comprehensive
analysis of 21 prospective cohorts.
Source
Cancer Medicine. (no pagination), 2020. Date of Publication: 2020.
Author
Ge F.; Li C.; Xu X.; Huo Z.; Wang R.; Wen Y.; Peng H.; Wu X.; Liang H.;
Peng G.; Li R.; Huang D.; Chen Y.; Xiong S.; Zhong R.; Cheng B.; Li J.; He
J.; Liang W.
Institution
(Ge, Li, Huo, Wang, Wen, Peng, Wu, Liang, Peng, Li, Huang, Chen, Xiong,
Zhong, Cheng, Li, He, Liang) Department of Thoracic Surgery and Oncology,
China State Key Laboratory of Respiratory Disease & National Clinical
Research Center for Respiratory Disease, the First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, China
(Ge) First Clinical School, Guangzhou Medical University, Guangzhou, China
(Xu, Peng, Li, Huang, Chen) Department of Transplantation, the First
Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
(Huo, Wang, Wen, Peng, Wu) Nanshan School, Guangzhou Medical University,
Guangzhou, China
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
We performed a meta-analysis to determine cancer risks at multiple sites
and their associations with tumor mutation burden (TMB), an index for
immunogenicity, in heart or lung transplant recipients. A comprehensive
search of PubMed, Web of Science, EMBASE, and Medline was conducted.
Random effects models were used to calculate standardized incidence ratios
(SIRs) versus the general population and to determine the risks of
different cancers. Weighted linear regression (WLR) was used to analyze
the associations between the SIRs and TMBs. (PROSPERO CRD42020159599).
Data from 21 studies including 116,438 transplant recipients (51,173 heart
transplant recipients and 65,265 lung transplant recipients) with a total
follow-up of 601,330.7 person-years were analyzed. Compared with the
general population, heart transplant recipients displayed a 3.13-fold
higher cancer risk [SIR: 3.13; 95% confidence interval (CI): 2.38-4.13; p
< 0.001]; lung transplant recipients displayed a 4.28-fold higher cancer
risk [SIR: 4.28; 95% CI: 3.18-5.77; p < 0.001]. The correlation
coefficients were 0.54 (p = 0.049) and 0.79 (p < 0.001) in heart and lung
transplant recipients, respectively, indicating that 29% and 63% of the
differences in the SIRs for cancer types might be explained by the TMBs.
Our study demonstrated that both heart and lung transplant recipients
displayed a higher risk of certain site-specific cancers. These findings
can provide individualized guidance for clinicians for detection of cancer
among heart or lung transplantation recipients. In addition, we provided
evidence that increased risks of post-transplant cancers can be attributed
to immunosuppression. Copyright © 2020 The Authors. Cancer
Medicine published by John Wiley & Sons Ltd.

<18>
Accession Number
633074481
Title
Mortality in low-risk patients with aortic stenosis undergoing
transcatheter or surgical aortic valve replacement: a reconstructed
individual patient data meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 30 Sep 2020.
Author
Celik M.; Milojevic M.M.; Durko A.P.; Oei F.B.S.; Bogers A.J.J.C.; Mahtab
E.A.F.
Institution
(Celik, Milojevic, Durko, Oei, Bogers, Mahtab) Department of
Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Although the standard of care for patients with severe aortic
stenosis at low-surgical risk has included surgical aortic valve
replacement (SAVR) since the mid-1960s, many clinical studies have
investigated whether transcatheter aortic valve implantation (TAVI) can be
a better approach in these patients. As no individual study has been
performed to detect the difference in mortality between these 2 treatment
strategies, we did a reconstructive individual patient data analysis to
study the long-term difference in all-cause mortality. METHOD(S):
Randomized clinical trials and propensity score-matched studies that
included low-risk adult patients with severe aortic stenosis undergoing
either SAVR or TAVI and with reports on the mortality rates during the
follow-up period were considered. The primary outcome was all-cause
mortality of up to 5years. RESULT(S): In the reconstructed individual
patient data analysis, there was no statistically significant difference
in all-cause mortality between TAVI and SAVR at 5years of follow-up [30.7%
vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.96-1.48;
P=0.104]. However, landmark analyses in patients surviving up to 1year of
follow-up showed significantly higher all-cause mortality at 5years of
follow-up (27.5% vs 17.3%, HR 1.77, 95% CI 1.29-2.43; P<0.001) in patients
undergoing TAVI compared to patients undergoing SAVR, respectively.
 CONCLUSION(S): This reconstructed individual patient data analysis in
low-risk patients with severe aortic stenosis demonstrates that the 5-year
all-cause mortality rates are higher after TAVI than after SAVR, driven by
markedly higher mortality rates between 1 and 5years of follow-up in the
TAVI group. The present results call for caution in expanding the TAVI
procedure as the treatment of choice for the majority of all low-risk
patients until long-term data from contemporary randomized clinical trials
are available. Copyright © The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
632798769
Title
Comparison of peres' formula and radiological landmark formula for optimal
depth of insertion of right internal jugular venous catheters.
Source
Indian Journal of Critical Care Medicine. 24 (7) (pp 527-530), 2020. Date
of Publication: 2020.
Author
Manudeep A.R.; Manjula B.P.; Dinesh Kumar U.S.
Institution
(Manudeep, Manjula) Department of Anesthesia, JSS Academy of Higher
Education and Research, Mysore, Karnataka, India
(Dinesh Kumar) Deparatment of Cardiothoracic and Vascular Anaesthesia, JSS
Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka,
India
Publisher
Jaypee Brothers Medical Publishers (P) Ltd
Abstract
Background: Central venous catheterization is a vital procedure for volume
resuscitation, infusion of drugs, and for central venous pressure
monitoring in the perioperative period and intensive care unit (ICU). It
is associated with position-related complications like arrhythmia's,
thrombosis, tamponade, etc. Several methods are used to calculate the
catheter insertion depth so as to prevent these position-related
complications. Objective(s): To compare Peres' formula and
radiological landmark formula for central venous catheter insertion depth
through right internal jugular vein (IJV) by the anterior approach.
 Material(s) and Method(s): A total of 102 patients posted for
elective cardiac surgery were selected and divided into two equal
groups-Peres' group (group P) and radiological landmark group (group R).
Central venous catheterization of right IJV was done under ultrasound
(USG) guidance. In group P, central venous catheter insertion depth was
calculated as height (cm)/10. In group R, central venous catheter
insertion depth was calculated by adding the distances from the puncture
point to the right sternoclavicular joint and on chest X-ray the distance
from the right sternoclavicular joint to carina. After insertion, the
catheter tip position was confirmed using transesophageal echocardiography
(TEE) in both the groups. Result(s): About 49% of the catheters in
group P and 74.5% in group R were positioned optimally as confirmed by
TEE, which was statistically significant. No complications were observed
in both the groups. Conclusion(s): Radiological landmark formula is
superior to Peres' formula for measuring optimal depth of insertion of
right internal jugular venous catheter. Copyright © The Author(s)
2020.

<20>
Accession Number
2005040884
Title
Efficacy of pectoral nerve block type ii versus thoracic paravertebral
block for analgesia in breast cancer surgery.
Source
Klinicka Onkologie. 33 (4) (pp 296-301), 2020. Date of Publication: 2020.
Author
Martsiniv V.V.; Loskutov O.A.; Strokan A.M.; Pylypenko M.M.; Bondar M.V.
Institution
(Martsiniv, Loskutov, Strokan, Pylypenko, Bondar) Department of
Anaesthesia and Intensive Care, P. L. Shupyk National Medical Academy of
Postgraduate Education, Kyiv, Ukraine
(Martsiniv, Strokan) Department of Anaesthesia and Intensive Care,
Feofaniya Clinical Hospital of State Management of Affairs, Kyiv, Ukraine
Publisher
Czech Medical Association J.E. Purkyne (E-mail: cls@cls.cz)
Abstract
Background: Ultrasound-guided pectoral nerve block type II is a recently
proposed technique for postoperative analgesia after breast cancer
surgery. The thoracic paravertebral block is wi-dely used for this purpose
by decades. The presented study compares the efficacy of these two
techniques for postoperative analgesia. Material(s) and Method(s):
Sixty adult women were undergoing unilateral radical mastectomy or
quadrantectomy with axillary dissection. The patients were randomized to
receive either pectoral nerve block with 30 ml ropivacaine 0.375% (Pecs
group) or thoracic paravertebral block with 20 ml ropivacaine 0.5% (TPVB
group). The evaluated variables included pain intensity by the numerical
rating scale at 0, 2, 4, 6, 12, 18 and the 24 hours, 24-hour postoperative
opioid (promedol) and nonopioid (ketoprofen) consumption and the time to
first rescue analgesia. Result(s): There were no statistically
significant differences between both groups in the pain intensity after
surgery. Ten (33%) patients from Pecs group and nine (30%) patients from
TPVB group did not require any analgesia within the first 24 hours (P =
0.793). The mean postoperative ketoprofen consumption was lower in Pecs
group: 63.3 (+/- 66.87) mg vs. 90.0 (+/- 84.49) mg (P = 0.283). The number
of patients who required promedol was 6 (20%) vs. 8 (27%) in Pecs and TPVB
groups, respectively (P = 0.542). The time to first analgesic request was
longer in Pecs group, 550 (400.0-600.0) min vs. 510 (360.0-600.0) min (P =
0.506) in TPVB group. Conclusion(s): In breast cancer surgery, the
pectoral nerve block type II with ropivacaine 0.375% can provide
postoperative analgesia that is comparable to the single-level thoracic
paravertebral block. Copyright © 2020, Czech Medical Association
J.E. Purkyne. All rights reserved.

<21>
Accession Number
2005634061
Title
New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 29 (10) (pp 1542-1553), 2020. Date of
Publication: October 2020.
Author
Indja B.; Woldendorp K.; Vallely M.P.; Grieve S.M.
Institution
(Indja, Grieve) Sydney Translational Imaging Laboratory, Heart Research
Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW,
Australia
(Indja, Woldendorp, Grieve) Faculty of Medicine and Health, The University
of Sydney, Sydney, NSW, Australia
(Vallely) Division of Cardiac Surgery, The Ohio State University,
Columbus, OH, United States
(Grieve) Department of Radiology, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: New-onset atrial fibrillation (NOAF) is a well-recognised,
although variably reported complication following surgical aortic valve
replacement (SAVR). Rates of NOAF following transcatheter aortic valve
implantation (TAVI) seem to be notably less than SAVR, even though this
population is typically older and of higher risk. The aim of this study
was to determine the prevalence of NOAF in both these populations and
associated postoperative outcomes. Method(s): We conducted a
systematic review and meta-analysis of studies reporting rates of NOAF
post SAVR or TAVI, along with early postoperative outcomes. Twenty-five
(25) studies with a total of 13,010 patients were included in the final
analysis. Result(s): The prevalence of NOAF post SAVR was 0.4 (95% CI
0.36-0.44) and post TAVI 0.15 (95% CI 0.11-0.18). NOAF was associated with
an increased risk of postoperative cerebrovascular accident (CVA) for SAVR
and TAVI (RR 1.44 95% CI 1.01-2.06 and RR 2.24 95% CI 1.46-3.45
respectively). NOAF was associated with increased mortality in the TAVI
group (RR 3.02 95% CI 1.55-5.9) but not the SAVR group (RR 1.00, 95% CI
0.54-1.84). Hospital length of stay was increased for both TAVI and SAVR
patients with NOAF (MD 2.54 days, 95% CI 2.0-3.00) and (MD 1.64 days, 95%
CI 0.04-3.24 respectively). Conclusion(s): The prevalence of NOAF is
significantly less following TAVI, as compared to SAVR. While NOAF is
associated with increased risk of postoperative stroke for both groups,
for TAVI alone NOAF confers increased risk of early
mortality. Copyright © 2020 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<22>
Accession Number
2005534459
Title
Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in
Low-Risk Patients.
Source
Heart Lung and Circulation. 29 (10) (pp 1527-1533), 2020. Date of
Publication: October 2020.
Author
Koshy A.N.; Murphy A.; Farouque O.; Horrigan M.; Yudi M.B.
Institution
(Koshy, Murphy, Farouque, Horrigan, Yudi) Department of Cardiology, Austin
Health, Melbourne, Vic, Australia
(Koshy, Murphy, Farouque, Horrigan, Yudi) The University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
revolutionised the treatment of severe aortic stenosis (AS), though its
safety and efficacy in low-risk patients remains to be established.
 Method(s): A systematic review of PubMed, Medline and EMBASE
identified four randomised controlled trials (RCTs) in patients at low
surgical risk comparing TAVR to surgical aortic valve replacement (SAVR).
A meta-analysis was performed with a primary outcome of a composite of
all-cause mortality and stroke at longest available follow-up.
 Result(s): A total of four RCTs with 2,836 patients was included in
the final analysis. 1,363 patients were randomised to SAVR and 1,473 to
TAVR. The composite of all-cause mortality and stroke was significantly
lower in patients undergoing TAVR compared with SAVR (OR 0.59, 95%CI
0.37-0.95, p=0.03) with low heterogeneity (I2=31%). The
difference in the primary composite outcome was driven by a difference in
mortality (OR 0.66, 95%CI 0.44-0.98, p=0.04; I2=0%) without
significant differences in stroke (OR 0.75 95%CI 0.45-1.26, p=0.28;
I2=37%). Weighted absolute risk difference (ARD) of the primary
composite outcome also favoured TAVR (ARD -2.0% 95%CI -3.3 to -0.7%,
p=0.002) with a number needed to treat (NNT) of 50 to prevent one death or
stroke. Patients undergoing TAVR had a significantly higher risk of
permanent pacemaker implantation (OR 3.9, 95%CI 1.8-8.4, p<0.001,
I2=84%) and moderate or severe paravalvular leak (OR 5.0, 95%CI
1.6-15.7, p=0.01; I2=19%). Conclusion(s): In patients with severe AS
at low surgical risk, the rate of the composite of death and stroke was
significantly lower with TAVR than with SAVR. Longer term follow-up with a
focus on the impact of permanent pacemaker (PPM) implantation,
paravalvular leak (PVL) and structural valve deterioration is essential
before the use of TAVR can be generalised to the broader population of
patients with AS. Copyright © 2020 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<23>
Accession Number
2008026836
Title
PNEUMOTHORAX ON E-FAST? NOT SO FAST.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A100), 2020. Date of Publication: October 2020.
Author
Agapian J.; Schurman A.; Edwards S.; Woods J.; Albini P.; Ludi D.; Coimbra
R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21,
2020 INTRODUCTION: Extended Focussed Assessment with Sonography for Trauma
(eFAST) has increasingly become the standard of care to identify
hemo/pneumothorax, with a much greater sensitivity than a supine CXR (87%
vs. 46%). Pneumothorax is recognized as a result of no "lung sliding",
which occurs because the visceral and parietal pleural linings have
separated. Symptomatic pneumothoraces are treated with tube thoracotomy.
CASE PRESENTATION: 65 year old male presented to the trauma center after
blunt chest trauma and hypotension. CXR did not show any obvious
pathology, but eFAST failed to show any lung slide on the left chest. A
left sided tube thoracotomy was performed after 1500mL of frank blood was
initially evacuated; the entire lung was noted to be densely adherent to
the chest wall; hemorrhage control was obtained by performing a pulmonary
tractotomy/lobectomy of the involved lung segment, and the patient was
then transferred to the SICU for ongoing resuscitation. DISCUSSION: eFAST
is a rapid and reliable tool to diagnose pneumothorax, by identifying the
lack of lung sliding. On the other hand, there may be other reasons why
the lung may not slide. In this case, the lack of lung sliding was due to
unknown history of chemical pleurodesis. Although rarely seen in the
trauma population, pleurodesis or any other pleural disease, can also
prevent the lung from sliding on eFAST. CONCLUSION(S): The lack of
lung sliding on an eFAST is usually pathognomonic of a pneumothorax,
especially in the context of trauma. Even though eFAST is more sensitive
than a plain CXR for pneumothorax, it may not be as specific. In turn, we
should consider a broader differential such as history of pleurodesis or
other intrathoracic adhesion when lack of lung slide on eFAST is observed.
Reference #1: Ali Ebrahimi, et. al. Diagnostic Accuracy of Chest
Ultrasonography Versus Chest Radiography for Identification of
Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos 2014; 13(4).
Reference #2: J. Corcoran, et. al.Thoracic Ultrasound as an Early
Predictor of Pleurodesis Success in Malignant Pleural Effusion. Chest
2018; 154(5). Reference #3: John Agapian, et.al. Use of Ultrasound to
Verify Intrathoracic Placement of Chest Tube. Chest 2014; 146(4).
DISCLOSURES: No relevant relationships by John Agapian, source=Web
Response No relevant relationships by Paul Albini, source=Web Response no
disclosure on file for Raul Coimbra; No relevant relationships by Sara
Edwards, source=Web Response no disclosure on file for Daniel Ludi; No
relevant relationships by Alexander Schurman, source=Web Response No
relevant relationships by John Woods, source=Web Response Copyright
© 2020 American College of Chest Physicians

<24>
Accession Number
2008025990
Title
DUAL RUPTURE OF THE NATIVE MITRAL AND AORTIC VALVE IN AN IMMUNOCOMPETENT
PATIENT WITH SUBACUTE INFECTIOUS ENDOCARDITIS CAUSED BY STREPTOCOCCUS
VIRIDIAN.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A224), 2020. Date of Publication: October 2020.
Author
Patel K.; Murari U.; Trivedi K.; Lakkasani S.; Guragai N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters
SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21,
2020 INTRODUCTION: Infectious endocarditis (IE) is a condition with high
morbidity and mortality, complications further worsen the prognosis. If
the diagnosis is delayed or appropriate therapeutic measures postponed,
mortality is even higher. We present a unique case of sub-acute IE, that
progressed rapidly to a surgical emergency. CASE PRESENTATION: 62-year old
African American male with no known medical history presented with
progressive fatigue, lethargy and 20 pounds of unintentional weight loss
in one month. He denied chest pain, palpitations, shortness of breath. He
denied intravenous drugs use but stated he had a recent dental cleaning
procedure. Vital signs showed temperature of 102.2 F. Physical exam was
positive for an apical holosystolic on cardiac auscultation. The Hb was 8
g/dL, with elevated WBC. The metabolic panel, cardiac troponin and initial
chest x ray were within normal limits. During a TTE with bubble study
patient developed acute onset dyspnea and diaphoresis. He desaturated to
78% on room air with new onset diffuse crepitations found on lung exam.
Patient was immediately intubated. TEE objectified presence of severe
aortic and mitral regurgitation with frail leaflets and vegetations.
Emergent left heart catheterization showed no coronary artery disease.
Patient was taken to the operative room immediately and was found to have
rupture of anterior mitral leaflet with a large vegetation and a severely
damaged left aortic leaflet with multiple vegetations on both the valvular
surfaces. The native aortic and mitral valves were replaced with
bio-prosthetic valves. Blood and valve tissue cultures grew viridians
streptococcus. Appropriate antibiotics were administered and the patient
was discharged in a stable condition. DISCUSSION: Streptococcus viridans,
a part of the normal flora of the mouth, are responsible for 40-60% of the
endocarditis cases occurring on the normal valves. Although it is rare to
see infective endocarditis after dental cleaning, it is possible as
evidenced in our case. Heart valve perforations are dreadful and can
quickly be fatal apart from urgent surgery. Their frequency remains poorly
specified, their diagnosis is made by TTE and TEE. Despite major
improvements in diagnosis and treatment, the mortality of IE still remains
high at 14% of in-hospital and at 20% to 30% with complications. In
addition to effective antibiotic therapy, surgery is most often required
as soon as possible to rule out life-threatening action. Our patient is an
example that shows the importance of timely interventions to decrease
mortality from acute complications of IE. CONCLUSION(S): The
prognosis of infectious endocarditis is worsened by the addition of
complications such as valvular or parietal perforation. The therapeutic
attitude most often calls for surgery in combination with well-conducted
antibiotic therapy, such as in cases of valve perforation or other
complications for which medical treatment is insufficient. Reference #1:
Karabinos I, Papadopoulos A, Toutouzas P. Severe mitral regurgitation due
to perforation of the mitral anterior leaflet. Eur J Echocardiogr.
2007;9:103-104. Reference #2: Feringa HH, Shaw LJ, Poldermans D, et al.
Mitral valve repair and replacement in endocarditis: a systematic review
of literature. Ann Thorac Surg. 2007;83(2):564-570. Reference #3: Bachrif
M, Laachach H, Benahmed I, et al. Infectious mitroaortic endocarditis
complicated by valve perforation, mycotic aneurysm and splenorenal
infarction. Pan Afr Med J. 2019;32:157. Published 2019 Apr 8.
doi:10.11604/pamj.2019.32.157.13009 DISCLOSURES: no disclosure on file for
Nirmal Guragai; No relevant relationships by Saraswathi Lakkasani,
source=Web Response No relevant relationships by Ujjwala Murari,
source=Web Response No relevant relationships by Kinjal Patel, source=Web
Response No relevant relationships by Krunal Trivedi, source=Web
Response Copyright © 2020 American College of Chest Physicians

<25>
Accession Number
2008025480
Title
AN UNBEARABLE TOOTHACHE: DESCENDING NECROTIZING MEDIASTINITIS FROM A
DENTAL ABSCESS.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A878), 2020. Date of Publication: October 2020.
Author
Bradsher A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020
INTRODUCTION: This case demonstrates a dangerous complication of dental
abscess. CASE PRESENTATION: A thirty-two-year-old man without any medical
history was admitted to a general medicine service for a dental abscess
which required tooth extraction and washout. He was discharged on oral
clindamycin but returned that evening after development of chest pain. He
was hemodynamically stable but refused to lay flat due to pain and
dyspnea. He was started on IV vancomycin, ceftriaxone, and clindamycin.
Overnight he developed significant respiratory distress requiring
intubation and transfer to the MICU. He had pneumonia and severe ARDS
requiring paralytics and proning. He was persistently febrile despite
broadening antimicrobials. Cardiothoracic surgery urgently operated after
a CT demonstrated large, partially loculated, mediastinal, pericardial,
and pleural effusions. He received drainage of an oropharyngeal abscess as
well as a drainage tube of the anterior mediastinum and bilateral tube
thoracostomies. OR cultures grew Strep anginosus, Prevotella sp., and
Staph epidermidis. Further washout with VATS was never feasible due to
inability to ventilate on one lung.Ten days into his hospitalization he
developed hyperkalemia and oliguric renal failure which required CRRT.
After twenty-two days of being intubated, tracheostomy was performed, and
he tolerated gradual ventilator weaning. He was transitioned to
intermittent hemodialysis and was transferred to the medical floor to
begin rehabilitation and trach collar trials. After nine weeks of
hospitalization he was discharged to inpatient rehabilitation and was able
to be decannulated from his tracheostomy tube. His renal function
recovered. He was discharged from rehabilitation after eight days. In
follow-up, he has remained well other than CKD stage 3. DISCUSSION:
Descending necrotizing mediastinitis is a progressive polymicrobial
complication seen in roughly 20% of cases of acute mediastinitis. The most
common pathogens are aerobic gram positive and anaerobic microbes followed
by gram negative bacilli. The diagnostic modality of choice is CT over
clinical suspicion or simple radiography. Two main varieties are
described: type I which occurs above the tracheal bifurcation and type II
which occurs below the tracheal bifurcation. The mortality rate in type I
is roughly 10% compared to 31.5% in type II. Type I is typically able to
be managed via transcervical drainage while type II generally requires
urgent thoracotomy with transcervical debridement. CONCLUSION(S):
This case of a young, otherwise healthy patient with type II descending
necrotizing mediastinitis demonstrates the need for correct and timely
diagnosis, urgent cervical debridement, and broad-spectrum antibiotics.
Even with appropriate therapy this was a near fatal case with significant
morbidity. Quick and decisive action is critical if mediastinitis is
suspected as is highlighted in this patient. Reference #1: Prado-Calleros
HM, Jimenez-Fuentes E, Jimenez-Escobar I. Descending necrotizing
mediastinitis: Systematic review on its treatment in the last 6 years, 75
years after its description. Head Neck. 2016;38 Suppl 1:E2275-E2283.
doi:10.1002/hed.24183 Reference #2: Ogle OE. Odontogenic Infections. Dent
Clin North Am. 2017;61(2):235-252. doi:10.1016/j.cden.2016.11.004
DISCLOSURES: No relevant relationships by Andrew Bradsher, source=Web
Response Copyright © 2020 American College of Chest Physicians

<26>
Accession Number
2008025310
Title
RAPIDLY PROGRESSING PURULENT PERICARDITIS CAUSED BY NEISSERIA MENINGITIDES
INFECTION.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A475), 2020. Date of Publication: October 2020.
Author
Langnas E.; Mustafa S.; Vira A.; Bilolikar A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION
TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020
INTRODUCTION: Purulent pericarditis is an uncommon clinical manifestation
of infection due to Neisseria meningitides [1]. Early differentiation of
purulent pericarditis from viral pericarditis is critical due to
life-threatening complications such as cardiac tamponade. We present a
case of a patient with rapidly progressing purulent pericarditis
associated with meningococcal bacteremia. CASE PRESENTATION: A 56-year-old
male with a history of HIV on HAART (CD4 count of 952 cells/muL) presented
to the emergency department with pleuritic chest pain and low-grade
fevers. He denied headache, neck stiffness, or sick contacts. He was
tachycardic, afebrile, and normotensive upon arrival. On cardiac
auscultation heart sounds were normal with no audible murmur or
pericardial rub and jugular veins were not distended. Initial lab workup
was significant for a white blood cell count of 20.8 bil/L and lactic acid
of 2.3 mmol/L. Electrocardiogram revealed diffuse ST elevations and
transthoracic echocardiogram demonstrated a small pericardial effusion. A
presumptive diagnosis of acute viral pericarditis was made and the patient
was started on colchicine. Quickly, within 12 hours, he developed
worsening chest pain, tachycardia, and hypotension. CT of the chest with
contrast was negative for pulmonary embolism but revealed a large
circumferential pericardial effusion confirmed by echocardiography, which
also showed evidence of early tamponade physiology. The patient was taken
for an emergent pericardiocentesis with drainage of 370 cc of purulent
fluid, which was negative by culture, with rapid improvement of
hemodynamics. Blood cultures obtained on admission grew beta lactamase
negative Neisseria meningitides group C. He was discharged home in stable
condition with a two-week course of IV ceftriaxone and a three-month
course of colchicine. Follow-up echocardiogram six weeks after discharge
demonstrated near resolution of the pericardial effusion with no evidence
of constriction. DISCUSSION: Since the introduction of antibiotics,
purulent bacterial pericarditis accounts for less than one percent of
cases of pericarditis in developed countries [2]. While Neisseria
meningitides classically manifests as meningitis and bacteremia, it is
important to be aware of this potential complication [1]. Prognosis
depends on prompt detection, antibiotic initiation, and drainage due to
complications such as life-threatening cardiac tamponade or constrictive
pericarditis [3]. This is clearly demonstrated by the rapidly enlarging
pericardial effusion with development of tamponade physiology in our
patient. CONCLUSION(S): This case underscores the importance of
recognizing a rare presentation of meningococcal infection as purulent
pericarditis and the need for early treatment due to its rapid
progression. Reference #1: Rosenstein NE, Perkins BA, Stephens DS, Popovic
T, Hughes JM. Meningococcal disease. N Engl J Med. 2001;344(18):1378-1388.
Reference #2: Imazio M, Gaita F, LeWinter M. Evaluation and treatment of
pericarditis: a systematic review. JAMA. 2015;314(14):1498-1506. Reference
#3: Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the
diagnosis and management of pericardial diseases: the task force for the
diagnosis and management of pericardial diseases of the European Society
of Cardiology (ESC). European Heart Journal. 2015;36(42):2921-2964
DISCLOSURES: No relevant relationships by Abhay Bilolikar, source=Web
Response No relevant relationships by Emily Langnas, source=Web Response
No relevant relationships by Syed Mustafa, source=Web Response No relevant
relationships by Amit Vira, source=Web Response Copyright © 2020
American College of Chest Physicians

<27>
Accession Number
633068438
Title
The use of dual therapy vs triple therapy in patients with atrial
fibrillation and acute coronary syndrome: A network meta-analysis of
randomized clinical trials.
Source
Neurology. Conference: 72nd Annual Meeting of the American Academy of
Neurology, AAN 2020. Canada. 94 (15 Supplement) (no pagination), 2020.
Date of Publication: 2020.
Author
Desai A.; Escamilla-Ocanas C.; Asgarisabet P.; Damani R.
Institution
(Desai, Escamilla-Ocanas, Damani) Baylor College of Medicine
(Asgarisabet) University of Texas
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: We conducted a network meta-analysis to identify the
anti-thrombotic regimen associated with the lowest rate of bleeding and
thromboembolic events in atrial fibrillation (AF) after coronary stenting.
 Background(s): About 15% of patients with AF require percutaneous
coronary interventions (PCIs) with stent placement to treat obstructive
coronary artery disease (CAD). Dual anti-platelet therapy (DAPT) with
acetylsalicylic acid (aspirin) and P2Y12 antagonist is recommended after
PCI. Patients requiring DAPT also require treatment with oral
anticoagulants for AF. Design/Methods: We searched PubMed, Embase, and
Cochrane databases to identify randomized controlled trials (RCTs) that
investigated use of DAPT and non-vitamin K antagonist oral anticoagulants
(NOACs) (triple therapy) against single anti-platelet and NOACs (dual
therapy) in setting of acute coronary syndrome and AF. Random-effect
models were used to pool data. We used I statistic to measure
heterogeneity between trials Results: We found 4 RCTs (ENTRUST, AUGUSTUS,
PIONEER, REDUAL) using different NOACs. AUGUSTUS trial was excluded since
data was not available to be analyzed. Three trials were included for
final analysis. Overall, 6355 patients (median age 70 years, 27.6% female,
mean CHADS2VASC Score 3.5) were included. Network metanalysis showed that
dual therapy group had a lower risk of major bleeding [HR 0.627 (95%
CI:0.49-0.79; p=0.005)] and intracranial hemorrhage [HR 0.34 (95%
CI:0.18-0.65; p=0.009)] as compared to triple therapy group. There was no
significantly increased risk of ischemic stroke [HR 1.12 (95%
CI:0.87-1.43; p=0.262)] or myocardial infarction [HR 1.13 (95% CI
0.79-1.61; p=0.378). However, risk of stent thrombosis was mildly
increased for dual therapy group [HR 1.38 (95% CI:1.00-1.9; p=0.049)].
 Conclusion(s): The use of dual therapy (single antiplatelet and NOAC)
is associated with a lower risk of major bleeding and intracranial
hemorrhage, with no significant difference in ischemic events (stroke and
myocardial infarction), when compared to triple therapy. However, the risk
of stent thrombosis was higher for the dual therapy group.

<28>
Accession Number
633068167
Title
Amyloid beta-related angiitis in the immunosuppressed: A case report.
Source
Neurology. Conference: 72nd Annual Meeting of the American Academy of
Neurology, AAN 2020. Canada. 94 (15 Supplement) (no pagination), 2020.
Date of Publication: 2020.
Author
Nelson T.; Leung B.; Bannykh S.; Patel J.; Shah K.; Dumitrascu O.
Institution
(Nelson) Neurology
(Bannykh) Pathology
(Patel, Shah) Department of Cardiology, Cedars-Sinai Medical Center
(Dumitrascu) Cedars-Sinai Medical Center
(Leung) Cedars Sinai Neurology
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Amyloid-beta-related angiitis (ABRA) is an immune-mediated
central nervous system vasculitis characterized by an inflammatory
response to amyloid-beta (Abeta) deposition within the walls of the
leptomeningeal and cortical arteries. Immunosuppression is the mainstay of
treatment. We present a case of ABRA in a patient on immunosuppressive
therapy after orthotopic heart transplantation (OHT) for cardiac
sarcoidosis. A 57-year-old man eight months post-OHT developed headaches
and dyscognitive seizures during hospitalization for disseminated
non-tuberculous mycobacterial infection. Brain MRI revealed bi-hemispheric
T2 FLAIR hyperintensities in the cortical and subcortical white matter,
predominantly in the right temporo-parietal region, originally ascribed to
infectious etiology. Supratentorial and infratentorial microhemorrhages
were seen and thought to be sequelae of OHT. Subsequently, he exhibited
gait ataxia and confusion. Repeat brain MRI showed more extensive
confluent white matter hyperintensities. Right parietal leptomeningeal and
cortex biopsy revealed amyloid angiopathy, with perivascular and
intramural histiocyte and lymphocyte collections. Mass spectroscopy
confirmed Abeta type IV deposition. Notably, the patient was on
immunosuppression with daily 5 mg oral prednisone and tacrolimus prior to
biopsy. After pulse-dose intravenous methylprednisolone followed by
high-dose oral prednisone, he demonstrated significant clinical and
radiographic improvement. No relapse was noted despite relatively rapid
tapering of the prednisone therapy, as mandated by his systemic infection.
 Background(s): N/A Design/Methods: N/A Results: N/A
 Conclusion(s): Despite no standard treatment protocol for ABRA, case
series have reinforced the benefit of prolonged courses of glucocorticoids
as single-agent or combination therapy with cyclophosphamide,
azathioprine, mycophenolate, or methotrexate. Hence management of ABRA in
patients with disseminated infections or OHT is challenging. Our case is
unique as review of existing literature has not revealed any similar cases
of patients on chronic immunosuppression at the time of ABRA diagnosis,
which one would expect to protect against this disorder. Additionally,
ABRA in association with cardiopulmonary sarcoidosis was not previously
reported, however, a common immunopathogenic mechanism is proposed.

<29>
Accession Number
633067664
Title
The growing challenge of post-TAVR strokes.
Source
Neurology. Conference: 72nd Annual Meeting of the American Academy of
Neurology, AAN 2020. Canada. 94 (15 Supplement) (no pagination), 2020.
Date of Publication: 2020.
Author
Han K.; Mehndiratta P.; Phipps M.; Chaturvedi S.
Institution
(Han) Department of Neurology, University of Maryland, School of Medicine
(Mehndiratta, Phipps) University of Maryland, School of Medicine
(Chaturvedi) University of Maryland
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To assess the current treatments for post-TAVR strokes.
 Background(s): Transcatheter aortic valve replacement (TAVR) is an
increasingly used approach for aortic valve replacement; in 2017, there
were 47,779 TAVRs, and 41,490 surgical aortic valve replacements in the
US. Given recent evidence that TAVR may be a safer approach even in
lowrisk patients, the incidence of post-TAVR strokes is expected to grow.
With an expected rate of 1.2% strokes at one year post-TAVR, we expect the
number of TAVR-related stroke to be 573 or higher. We present a patient
with a calcified cerebral embolus (CCE) after a TAVR procedure. There are
no practice parameters or guidelines for optimal treatment for acute CCEs,
but we review the literature to inform management of these rare strokes.
Design/Methods: Literature review was performed via comprehensive search
on PubMed, reviewing articles from 2000 to 2019. Keywords used included
'calcified,' 'embolic,' and 'stroke.' The full text of each relevant
article was reviewed. Result(s): Literature review and inclusion of
our case yielded 25 patients with intervention and mRS at 90 days. Six
patients received t-PA only, with an average mRS of 4.75. Thirteen
patients had IA only, with an average mRS of 4.1. Six patients had t-PA
and IA, with an average mRS of 2. While management of the patient in the
above case deferred t-PA given unlikelihood of this to dissolve a CCE,
there is some thought that activation of fibrinolysis can help soften any
thrombus forming around the calcification and increase mechanical
retrievability. Conclusion(s): There is limited literature on
thrombolysis and/or interventional therapy for post-TAVR calcific emboli.
Further study is needed to develop optimal treatment strategies for
cerebral calcified emboli, especially given an expected increase in the
number of TAVR procedures.

<30>
Accession Number
2006920981
Title
Contemporary Workup and Management of Asymptomatic Patients with Severe
Aortic Stenosis.
Source
Current Treatment Options in Cardiovascular Medicine. 22 (11) (no
pagination), 2020. Article Number: 47. Date of Publication: 01 Nov 2020.
Author
Tiwana J.K.; Otto C.M.
Institution
(Tiwana, Otto) Division of Cardiology, Department of Medicine, University
of Washington School of Medicine, Box 356422, 1959 NE Pacific St, HSB
AA522, Seattle, WA 98195, United States
Publisher
Springer
Abstract
Purpose of review: Appropriate management of asymptomatic patients with
severe aortic stenosis (AS) is increasingly debated given recent
improvements in options for aortic valve replacement (AVR). The goal of
this review is to provide an updated approach to evaluation and management
of patients with asymptomatic severe AS and to discuss the rationale for
early AVR. Recent findings: Registry data, retrospective studies, and one
small randomized controlled clinical trial suggest a mortality benefit to
AVR before symptom onset, although larger randomized trials are needed
given potential biases of observational data. Other promising approaches
to risk stratification of asymptomatic adults with severe AS include
cardiac biomarkers (such as serum B-type natriuretic peptide levels), left
ventricular global longitudinal strain, and myocardial fibrosis detected
on cardiac magnetic resonance imaging. Summary: Routine close
clinical follow-up, periodic imaging, patient education, and shared
decision-making are essential in caring for asymptomatic patients with
severe AS but there is not yet enough evidence to support early AVR in
most patients. Ongoing clinical trials and evaluation of biomarkers will
illuminate whether intervention before symptom onset will improve the
length or quality of life in adults with severe AS. Copyright ©
2020, Springer Science+Business Media, LLC, part of Springer Nature.

<31>
Accession Number
2006925551
Title
Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke
(TEDRAS): a prospective, blind, randomized and controlled clinical trial.
Source
European Journal of Neurology. (no pagination), 2020. Date of Publication:
2020.
Author
Hamzic S.; Braun T.; Butz M.; Khilan H.; Weber S.; Yeniguen M.; Gerriets
T.; Schramm P.; Juenemann M.
Institution
(Hamzic, Braun, Butz, Khilan, Yeniguen, Gerriets, Juenemann) Department of
Neurology, University Hospital Giessen and Marburg GmbH,
Justus-Liebig-University, Giessen, Germany
(Hamzic, Braun, Butz, Yeniguen, Gerriets, Schramm, Juenemann) Heart and
Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad
Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
(Khilan, Weber, Gerriets) Department of Neurology/Stroke Unit,
Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
(Schramm) Department of Anaesthesiology, University Medical Centre of the
Johannes Gutenberg-University, Mainz, Germany
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Background and purpose: Dysphagia is common in acute stroke and leads to
worse overall outcome. Transesophageal echocardiography (TEE) is used in
the diagnostic evaluation of stroke with regard to its etiology and is a
known cause of postoperative dysphagia in cardiac surgery. The prevalence
of dysphagia in acute stroke patients undergoing TEE remains unknown. The
aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute
Stroke (TEDRAS) study was to assess the influence of TEE on swallowing
among patients who have experienced acute stroke. Method(s): The
TEDRAS study was a prospective, blind, randomized, controlled trial that
included two groups of patients with acute stroke. Simple unrestricted
randomization was performed, and examiners were blinded to each other's
results. Swallowing was tested using flexible endoscopic evaluation of
swallowing (FEES) at three different time points in the intervention group
(24 h before, immediately after and 24 h after TEE) and in the control
group (FEES on three consecutive days and TEE earliest after the third
FEES). Validated scales were used to assess dysphagia severity for all
time points as primary outcome measures. Result(s): A total of 34
patients were randomized: 19 to the intervention group and 15 to the
control group. The key findings of the repeated-measures between-group
comparisons were significant increases in the intervention group for the
following dysphagia measures: (1) secretion severity score (immediately
after TEE: P < 0.001; 24 h after TEE: P < 0.001) and (2)
Penetration-Aspiration Scale score for saliva (immediately after TEE: P <
0.001; 24 h after TEE: P = 0.007), for small (immediately after TEE: P =
0.009) and large liquid boli (immediately after TEE: P = 0.009; 24 h after
TEE: P = 0.025). Conclusion(s): The results indicate a negative
influence of TEE on swallowing in acute stroke patients for at least 24
hours. Copyright © 2020 The Authors. European Journal of
Neurology published by John Wiley & Sons Ltd on behalf of European Academy
of Neurology

<32>
Accession Number
632980412
Title
Effect of ticagrelor with or without aspirin on vein graft outcome 1 year
after on-pump and off-pump coronary artery bypass grafting.
Source
Journal of Thoracic Disease. 12 (9) (pp 4915-4923), 2020. Date of
Publication: 01 Sep 2020.
Author
Zhu Y.; Xue Q.; Zhang M.; Hu J.; Liu H.; Wang R.; Wang X.; Han L.; Zhao Q.
Institution
(Zhu, Zhao) Department of Cardiovascular Surgery, Ruijin Hospital
Shanghai, Jiao Tong University School of Medicine, Shanghai, China
(Xue, Han) Department of Cardiovascular Surgery, Changhai Hospital of
Shanghai, Shanghai, China
(Zhang) Department of Cancer Control and Prevention, Shanghai Municipal
Center for Disease Control and Prevention, Shanghai, China
(Hu) Department of Cardiovascular Surgery, Fuwai Central China
Cardiovascular Hospital, Zhengzhou, China
(Liu) Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Wang) Department of Cardiovascular Surgery, Nanjing First Hospital,
Nanjing, China
(Wang) Department of Cardiovascular Surgery, Jiangsu Province Hospital,
Nanjing, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: In the present post hoc analysis of the DACAB trial, we
evaluated the effects of ticagrelor with or without aspirin on 1-year vein
graft outcomes after coronary artery bypass grafting (CABG) with and
without cardiopulmonary bypass (CPB) (on-pump and off-pump).
 Method(s): The DACAB trial was a multicenter, randomized, open-label,
parallel control study enrolling 500 patients with 1,460 vein grafts
undergoing CABG. For current post-hoc study, all patients in the DACAB
study were included in the analysis to compare the effects of different
antiplatelet regimens under on/off pump. Patients were randomly assigned
to 1 of 3 antiplatelet treatment regimens (ticagrelor plus aspirin, T + A;
ticagrelor alone, T; or aspirin alone, A) within 24 hours after CABG, and
were stratified into on-pump and off-pump subgroups. The primary outcome
was 1-year vein graft patency rate. Result(s): Totally 121 patients
underwent on-pump CABG (39 with 121 vein grafts in T + A, 36 with 101 vein
grafts in T, and 46 with 137 vein grafts in A) and 379 patients underwent
off-pump CABG (129 with 336 vein grafts in T + A, 130 with 387 vein grafts
in T, and 120 with 348 vein grafts in A). Compared with A, T + A showed a
higher 1-year vein graft patency rate in both on-pump (adjusted OR for
non-patency =0.62, 95% CI: 0.16-2.45) and off-pump (adjusted OR for
non-patency =0.35, 95% CI: 0.20-0.62) subgroups, P interaction =0.647;
whereas T did not in either on-pump (adjusted OR for non-patency = 0.92,
95% CI: 0.31-2.76) or off-pump (adjusted OR for non-patency =0.58, 95% CI:
0.34-1.00) subgroups, P interaction =0.430. Conclusion(s): In the
DACAB trial, for patients underwent either on-pump or off-pump CABG,
ticagrelor plus aspirin showed consistent benefit for achieving 1-year
vein graft patency, with particular benefit being seen in the
off-pump. Copyright © Journal of Thoracic Disease. All rights
reserved.

<33>
Accession Number
632980316
Title
Pregnancy outcome in women with mechanical prosthetic heart valvesat their
first trimester of pregnancy treated with unfractionated heparin (UFH) or
enoxaparin: A randomized clinical trial.
Source
Journal of Cardiovascular and Thoracic Research. 12 (3) (pp 209-213),
2020. Date of Publication: 2020.
Author
Movahedi M.; Motamedi M.; Sajjadieh A.; Bahrami P.; Saeedi M.
Institution
(Movahedi, Motamedi) Department of Obstetrics and Gynecology, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Sajjadieh, Bahrami) Department of Internal Medicine, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Saeedi) Department of Cardiac Surgery, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Saeedi) Department of General Medicine, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences (E-mail: bioimpacts@gmail.com)
Abstract
Introduction: Pregnancy increases the risks of thromboembolism for the
mother and fetus in patients with mechanical heart valves. The results of
some studies have indicated that low molecular weight heparin (LMWH), in
comparison with unfractionated heparin (UFH), leads to a lower incidence
rate of thrombocytopenia and a decrease in bleeding. Method(s): The
present randomized clinical trial involved 31 pregnant women with
mechanical heart valves at their first trimester (0-14 weeks) of
pregnancy. To perform the study, the patients were divided into two
groups, i.e. group A (LMWH group-16 patients) and group B (UFH group-15
patients). The birth weight, mode of delivery, and gestational age at
birth as well as the maternal and fetal complications were compared
between the two groups. Result(s): The mean age of mothers in the UFH
and LMWH groups was 32.67+/-9.11 and 31.50+/-5.81 years, respectively (P
value > 0.05). Although the rate of maternal and fetal complications was
higher in the UFH group as compared with the LMWH group, the observed
difference was not significant (P value > 0.05). Conclusion(s): LMWH
can be regarded as a safer therapy for both the mother and fetus due to
its lower number of refill prescriptions and fewer changes in the blood
level. Copyright © 2020 The Author (s).

<34>
Accession Number
632882398
Title
Clinical impact of conduction disturbances in transcatheter aortic valve
replacement recipients: A systematic review and meta-analysis.
Source
European Heart Journal. 41 (29) (pp 2771-2781), 2020. Date of Publication:
01 Aug 2020.
Author
Faroux L.; Chen S.; Muntane-Carol G.; Regueiro A.; Philippon F.;
Sondergaard L.; Jorgensen T.H.; Lopez-Aguilera J.; Kodali S.; Leon M.;
Nazif T.; Rodes-Cabau J.
Institution
(Faroux, Muntane-Carol, Philippon, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, QC G1V4G5,
Canada
(Chen, Kodali, Leon, Nazif) Columbia University Medical Center, New
York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY
10032, United States
(Regueiro) Institut Clinic Cardiovascular, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Carrer de
Villaroel, 170, Barcelona 08036, Spain
(Sondergaard, Jorgensen) Rigshospitalet, University of Copenhagen,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Lopez-Aguilera) Hospital Reina Sofia of Cordoba, Avenida Menendez Pidal,
Cordoba 14004, Spain
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
Aims The clinical impact of new-onset persistent left bundle branch block
(NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter
aortic valve replacement (TAVR) recipients remains controversial. We aimed
to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on
1-year all-cause death, cardiac death, and heart failure hospitalization
and (ii) NOP-LBBB on the need for PPI at 1-year follow-up. Methods We
performed a systematic search from PubMed and EMBASE databases for studies
reporting raw data on 1-year and results clinical impact of NOP-LBBB or
periprocedural PPI post-TAVR. Data from 30 studies, including 7792
patients (12 studies) and 42 927 patients (21 studies) for the evaluation
of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively.
NOP-LBBB was associated with an increased risk of all-cause death [risk
ratio (RR) 1.32, 95% confidence interval (CI) 1.17-1.49; P < 0.001],
cardiac death (RR 1.46, 95% CI 1.20-1.78; P < 0.001), heart failure
hospitalization (RR 1.35, 95% CI 1.05-1.72; P = 0.02), and PPI (RR 1.89,
95% CI 1.58-2.27; P < 0.001) at 1-year follow-up. Periprocedural PPI after
TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI
1.11-1.25; P < 0.001) and heart failure hospitalization (RR 1.18, 95% CI
1.03-1.36; P = 0.02). Permanent pacemaker implantation was not associated
with an increased risk of cardiac death (RR 0.84, 95% CI 0.67-1.05; P =
0.13). Conclusion NOP-LBBB and PPI after TAVR are associated with an
increased risk of all-cause death and heart failure hospitalization at
1-year follow-up. Periprocedural NOP-LBBB also increased the risk of
cardiac death and PPI within the year following the procedure. Further
studies are urgently warranted to enhance preventive measures and optimize
the management of conduction disturbances post-TAVR. Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. © The Author(s) 2020.

<35>
Accession Number
632800806
Title
Multicentre, randomized comparison of two-stent and provisional stenting
techniques in patients with complex coronary bifurcation lesions: The
DEFINITION II trial.
Source
European Heart Journal. 41 (27) (pp 2523-2536), 2020. Date of Publication:
14 Jul 2020.
Author
Zhang J.-J.; Ye F.; Xu K.; Kan J.; Tao L.; Santoso T.; Munawar M.;
Tresukosol D.; Li L.; Sheiban I.; Li F.; Tian N.-L.; Rodriguez A.E.;
Paiboon C.; Lavarra F.; Lu S.; Vichairuangthum K.; Zeng H.; Chen L.; Zhang
R.; Ding S.; Gao F.; Jin Z.; Hong L.; Ma L.; Wen S.; Wu X.; Yang S.; Yin
W.-H.; Zhang J.; Wang Y.; Zheng Y.; Zhou L.; Zhu Y.; Xu T.; Wang X.; Qu
H.; Tian Y.; Lin S.; Liu L.; Lu Q.; Li Q.; Li B.; Jiang Q.; Han L.; Gan
G.; Yu M.; Pan D.; Shang Z.; Zhao Y.; Liu Z.; Yuan Y.; Chen C.; Stone
G.W.; Han Y.; Chen S.-L.
Institution
(Zhang, Ye, Kan, Chen) Division of Cardiology, Nanjing First Hospital,
Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
(Xu, Han) Division of Cardiology, General Hospital of Northern Theater
Command, Shenyang, China
(Tao) Division of Cardiology, Xijing Hospital, 4th Military Medical
University, Xi'an, China
(Santoso) Division of Cardiology, Medistra Hospital, University of
Indonesia, Medical School, Jakarta, Indonesia
(Munawar) Division of Cardiology, Binawaluya Cardiac Center, Jakarta,
Indonesia
(Tresukosol) Division of Cardiology, Medicine Siriraj Hospital, Bangkok,
Thailand
(Li) Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou,
China
(Sheiban) Division of Cardiology, Pederzoli Hospital-Peschiera del Garda,
Verona, Italy
(Li) Division of Cardiology, Oriental General Hospital, Huainan, China
(Tian) Division of Cardiology, Nanjing Heart Center, Nanjing, China
(Rodriguez) Division of Cardiology, Otamendi Hospital, Buenos Aires,
Argentina
(Paiboon) Division of Cardiology, Bangkok General Hospital, Bangkok,
Thailand
(Lavarra) Division of Cardiology, Jilin Cardiovascular Hospital,
Changchun, China
(Lu) Division of Cardiology, Taicang 1st People's Hospital, Taicang, China
(Vichairuangthum) Division of Cardiology, Bangplee Hospital, Bangkok,
Thailand
(Zeng) Division of Cardiology, Wuhan Tongji Hospital, United Medical
University, Wuhan, China
(Chen) Division of Cardiology, Fujian Medical University Union Hospital,
Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center,
Fuzhou, China
(Zhang) Division of Cardiology, Shanghai Ruijin Hospital, Shanghai
Communication University, Shanghai, China
(Ding) Division of Cardiology, Xinhua Hospital, Huainan, China
(Gao) Division of Cardiology, Gansu Provincial People's Hospital, Lanzhou,
China
(Jin) Division of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Hong) Division of Cardiology, Jiangxi Provincial People's Hospital,
Nanchang, China
(Ma) Division of Cardiology, Anhui Provincial Hospital, Hefei, China
(Wen) Division of Cardiology, Tianjin 4th Central Hospital, Tianjin, China
(Wu) Division of Cardiology, Wuxi 3rd People's Hospital, Wuxi, China
(Yang) Division of Cardiology, Yixing People's Hospital, Yixing, China
(Yin) Division of Cardiology, Cheng-Hsin General Hospital, Taipei, Taiwan
(Republic of China)
(Zhang) Division of Cardiology, Cangzhou Central Hospital, Cangzhou, China
(Wang) Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen
University, Xiamen, China
(Zheng) Division of Cardiology, Jintan Traditional Chinese Medicine
Hospital, Jintan, China
(Zhou) Division of Cardiology, Liyang Hospital of Traditional Chinese
Medicine, Liyang, China
(Zhou) Division of Cardiology, Chuzhou People's Hospital, Chuzhou, China
(Zhu) Division of Cardiology, Huaian 2nd People's Hospital, Huaian, China
(Xu) Division of Cardiology, Xinyang Central Hospital, Xinyang, China
(Wang) Division of Cardiology, Lianyungang Traditional Chinese Medicine
Hospital, Lianyungang, China
(Qu) Division of Cardiology, XuanCheng Central Hospital, Xuancheng, China
(Tian) Division of Cardiology, Xuyi People's Hospital, Xuyi, China
(Lin) Division of Cardiology, Jintan People's Hospital, Jintan, China
(Liu) Division of Cardiology, Huainan People's Hospital, Huainan, China
(Lu) Division of Cardiology, 2nd People's Hospital, Shandong University,
Jinan, China
(Li) Division of Cardiology, Changzhou Traditional Chinese Medicine
Hospital, China
(Li) Division of Cardiology, Affiliated Hospital of Guangdong Medical
University, Zhanjiang, China
(Jiang) Division of Cardiology, Anqing 1st People's Hospital, Anqing,
China
(Han) Division of Cardiology, Changshu People's Hospital, Changshu, China
(Gan) Division of Cardiology, 17th Metallurgical Hospital, Maanshan, China
(Yu) Division of Cardiology, Qingdao Campus of Fuwai Hospital, Qingdao,
China
(Pan) Division of Cardiology, Xuzhou 2nd People's Hospital, Xuzhou, China
(Shang) Division of Cardiology, Wuxi Huishan District People's Hospital,
Wuxi, China
(Zhao) Division of Cardiology, Nanjing 81 Hospital, Nanjing, China
(Liu) Division of Cardiology, Hongze People's Hospital, Huai'an, China
(Yuan) Trinity College, University of Toronto, Toronto, Canada
(Chen) Mailman School of Public Health, Columbia University, New York, NY,
United States
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Ican School
of Medicine at Mount Sinai, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Chen) College of Pharmacy, Nanjing Medical University, Nanjing, China
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
Aim The present study aimed to assess the benefits of two-stent techniques
for patients with DEFINITION criteria-defined complex coronary bifurcation
lesions. Methods In total, 653 patients with complex bifurcation lesions
at 49 international centres were randomly assigned to under- and results
go the systematic two-stent technique (two-stent group) or provisional
stenting (provisional group). The primary endpoint was the composite of
target lesion failure (TLF) at the 1-year follow-up, including cardiac
death, target vessel myocardial infarction (TVMI), and clinically driven
target lesion revascularization (TLR). The safety endpoint was definite or
probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37
(11.4%) and 20 (6.1%) patients in the provisional and two-stent groups,
respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95%
confidence interval (CI) 0.30-0.90; P = 0.019], largely driven by
increased TVMI (7.1%, HR 0.43, 95% CI 0.20-0.90; P = 0.025) and clinically
driven TLR (5.5%, HR 0.43, 95% CI 0.19-1.00; P = 0.049) in the provisional
group. At the 1 year after indexed procedures, the incidence of cardiac
death was 2.5% in the provisional group, non-significant to 2.1% in the
two-stent group (HR 0.86, 95% CI 0.31-2.37; P = 0.772). Conclusion For
DEFINITION criteria-defined complex coronary bifurcation lesions, the
systematic two-stent approach was associated with a significant
improvement in clinical outcomes compared with the provisional stenting
approach. Further study is urgently warranted to identify the mechanisms
contributing to the increased rate of TVMI after provisional
stenting. Copyright © The Author(s) 2020. For permissions, please
email: journals.permissions@oup.com.

<36>
Accession Number
2005737713
Title
Local prolonged release of antibiotic for prevention of sternal wound
infections postcardiac surgery-A novel technology.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2695-2703), 2020. Date of
Publication: 01 Oct 2020.
Author
Kachel E.; Moshkovitz Y.; Sternik L.; Sahar G.; Grosman-Rimon L.;
Belotserkovsky O.; Reichart M.; Stark Y.; Emanuel N.
Institution
(Kachel, Grosman-Rimon) Department of Cardiac Surgery, Poriya Medical
Center, Tiberias, Israel
(Kachel, Sternik) Department of Cardiac Surgery, Sheba Medical Centre, Tel
Hashomer, Israel
(Moshkovitz) Department of Cardiothoracic Surgery, Assuta Medical Center,
Tel Aviv, Israel
(Sahar) Department of Cardiothoracic Surgery, Soroka Medical Center, Beer
Sheva, Israel
(Belotserkovsky, Reichart, Stark, Emanuel) PolyPid Ltd, Petach-Tikva,
Israel
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Introduction: Sternal wound infection (SWI) is a devastating postcardiac
surgical complication. D-PLEX<inf>100</inf> (D-PLEX) is a localized
prolonged release compound applied as a prophylactic at the completion of
surgery to prevent SWI. The D-PLEX technology platform is built as a
matrix of alternating layers of polymers and lipids, entrapping an
antibiotic (doxycycline). The objective of this study was to assess the
safety profile and pharmacokinetics of D-PLEX in reducing SWI rates
postcardiac surgery. Method(s): Eighty-one patients were enrolled in
a prospective single-blind randomized controlled multicenter study. Sixty
patients were treated with both D-PLEX and standard of care (SOC) and 21
with SOC alone. Both groups were followed 6 months for safety endpoints.
SWI was assessed at 90 days. Result(s): No SWI-related serious
adverse events (SAEs) occurred in either group. The mean plasma
C<inf>max</inf> in patients treated with D-PLEX was about 10 times lower
than the value detected following the oral administration of doxycycline
hyclate with an equivalent overall dose, and followed by a very low plasma
concentration over the next 30 days. There were no sternal infections in
the D-PLEX group (0/60) while there was one patient with a sternal
infection in the control group (1/21, 4.8%). Conclusion(s): D-PLEX
was found to be safe for use in cardiac surgery patients. By providing
localized prophylactic prolonged release of broad-spectrum antibiotics,
D-PLEX has the potential to prevent SWI postcardiac surgery and long-term
postoperative hospitalization, reducing high-treatment costs, morbidity,
and mortality. Copyright © 2020 Wiley Periodicals LLC

<37>
Accession Number
2005470461
Title
Percutaneous coronary intervention in the very elderly with NSTE-ACS: the
randomized 80+ study.
Source
Scandinavian Cardiovascular Journal. 54 (5) (pp 315-321), 2020. Date of
Publication: 02 Sep 2020.
Author
Hirlekar G.; Libungan B.; Karlsson T.; Back M.; Herlitz J.; Albertsson P.
Institution
(Hirlekar, Back, Albertsson) Department of Molecular and Clinical
Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg
University, Gothenburg, Sweden
(Hirlekar, Albertsson) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Libungan) Department of Cardiology, University Hospital of Iceland,
Reykjavik, Iceland
(Karlsson) Biostatistics, School of Public Health and Community Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Back) Department of Occupational Therapy and Physiotherapy, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Herlitz) Centre for Pre-hospital Research, Faculty of Caring Science,
Work Life and Social Welfare, University of Boras, Boras, Sweden
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Objective: The treatment strategy in the very elderly with NSTE-ACS is
debated, as they are often under-represented in clinical trials. The aim
of this multicenter randomized controlled trial was to compare invasive
and conservative strategies in the very elderly with NSTE-ACS.
 Method(s): We randomly assigned patients >= 80 years of age with
NSTE-ACS to an invasive strategy with coronary angiography and optimal
medical treatment or a conservative strategy with only optimal medical
treatment. The primary outcome was the combined endpoint of major adverse
cardiac and cerebrovascular events (MACCE). Sample size was powered for a
50% reduction of event rate in MACCE with an invasive strategy. We used
intention-to-treat analysis. Result(s): Altogether, 186 patients were
included between 2009 and 2017. The study was terminated prematurely due
to slow enrollment. At 12-month follow-up, the primary outcome occurred in
31 (33.3%) of the invasive treatment group and 34 (36.6%) of the
conservative treatment group, with a hazard ratio (HR) of 0.90 (95% CI
0.55-1.46; p = 0.66) for the invasive group relative to the conservative
group. The corresponding HR value for urgent revascularization was 0.29
(95% CI 0.10-0.85; p = 0.02), 0.56 (95% CI 0.27-1.18; p = 0.13) for
myocardial infarction, 0.70 (95% CI 0.31-1.58; p = 0.40) for all-cause
mortality, 1.35 (95% CI 0.23-7.98; p = 0.74) for stroke, and 1.62 (95% CI
0.67-3.90; p = 0.28) for recurrent hospitalization for cardiac reasons.
 Conclusion(s): In the very elderly with NSTE-ACS, we did not find any
significant difference in MACCE between invasive and conservative
treatment groups at 12-month follow-up, possibly due to small sample size.
ClinicalTrials.gov: NCT02126202. Copyright © 2020 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<38>
Accession Number
2005155531
Title
Investigating association between intraoperative hypotension and
postoperative neurocognitive disorders in non-cardiac surgery: A
comprehensive review.
Source
Journal of Clinical Medicine. 9 (10) (pp 1-24), 2020. Article Number:
3183. Date of Publication: October 2020.
Author
Krzych L.J.; Pluta M.P.; Putowski Z.; Czok M.
Institution
(Krzych) Department of Anaesthesiology and Intensive Care, Faculty of
Medical Sciences in Katowice, Medical University of Silesia, Katowice
40752, Poland
(Pluta, Putowski, Czok) Students' Scientific Society, Department of
Anaesthesiology and Intensive Care, Faculty of Medical Sciences in
Katowice, Medical University of Silesia, Katowice 40752, Poland
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Postoperative delirium (POD) and postoperative cognitive decline (deficit)
(POCD) are related to a higher risk of postoperative complications and
long-term disability. Pathophysiology of POD and POCD is complex, elusive
and multifactorial. Intraoperative hypotension (IOH) constitutes a
frequent and vital health hazard in the perioperative period.
Unfortunately, there are no international recommendations in terms of
diagnostics and treatment of neurocognitive complications which may arise
from hypotension-related hypoperfusion. Therefore, we performed a
comprehensive review of the literature evaluating the association between
IOH and POD/POCD in the non-cardiac setting. We have concluded that
available data are quite inconsistent and there is a paucity of
high-quality evidence convincing that IOH is a risk factor for POD/POCD
development. Considerable heterogeneity between studies is the major
limitation to set up reliable recommendations regarding intraoperative
blood pressure management to protect the brain against hypotension-related
hypoperfusion. Further well-designed and effectively-performed research is
needed to elucidate true impact of intraoperative blood pressure
variations on postoperative cognitive functioning. Copyright ©
2020 by the authors. Licensee MDPI, Basel, Switzerland.

<39>
Accession Number
633059985
Title
Glucocorticosteroid usage and major organ damage in patients with systemic
lupus erythematosus-meta-analyses of observational studies published
between 1979 and 2018.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2019. United States. 71 (Supplement 10) (pp
4542-4544), 2019. Date of Publication: October 2019.
Author
Mak A.; Cheung M.W.L.; Leong W.Y.J.; Dharmadhikari B.; Kow N.Y.; Petri M.;
Manzi S.; Clarke A.; Aranow C.; Arnaud L.; Askanase A.; Bae S.-C.;
Bernatsky S.; Bruce I.; Buyon J.; Chatham W.W.; Costedoat-Chalumeau N.;
Dooley M.A.; Fortin P.; Ginzler E.M.; Gladman D.; Gordon C.; Hanly J.G.;
Inanc M.; Isenberg D.A.; Jacobsen S.; James J.; Jonsen A.; Kalunian K.C.;
Kamen D.; Lim S.S.; Morand E.; Peschken C.; Pons-Estel B.A.; Rahman A.;
Ramsey-Goldman R.; Romero-Diaz J.; Ruiz-Irastorza G.; Sanchez-Guerrero J.;
Steinsson K.; Svenungsson E.; Urowitz M.; Van Vollenhoven R.; Vinet E.;
Voskuyl A.; Wallace D.J.; Alarcon G.
Institution
(Mak, Cheung) National University of Singapore, Singapore, Singapore
(Leong) Changi General Hospital, Singapore, Singapore
(Dharmadhikari, Kow) National University of Singapore, Singapore
(Petri) Johns Hopkins University, School of Medicine, Baltimore, MD,
United States
(Manzi) Allegheny Health Network, Pittsburg, PA, United States
(Clarke) University of Calgary, Calgary, AB, Canada
(Aranow) Feinstein Institute for Medical Research, Manhasset, NY, United
States
(Arnaud) Service de Rhumatologie, Centre National de Reference des
Maladies Autoimmunes Systemiques Rares RESO, Hopitaux Universitaires de
Strasbourg, Strasbourg, France
(Askanase) Columbia University Medical Center, New York, NY, United States
(Bae) Hanyang University Hospital for Rheumatic Diseases, Seoul, South
Korea
(Bernatsky) Research Institute of the McGill University Health Centre,
Montreal, QC, Canada
(Bruce) University of Manchester, Manchester, United Kingdom
(Buyon) NYU School of Medicine, New York, United States
(Chatham) University of Alabama Medical Center, Birmingham, AL, United
States
(Costedoat-Chalumeau) Cochin University Hospital, Paris, France
(Dooley) UnC Kidney Centre, Chapel Hill, NC, United States
(Fortin) Division de Rhumatologie, Departement de Medecine, CHU de Que
bec-Universite Laval, Quebec, QC, Canada
(Ginzler) State University of New York Downstate Medical Center, Brooklyn,
NY, United States
(Gladman, Sanchez-Guerrero) Toronto Western Hospital, Toronto, ON, Canada
(Gordon) University of Birmingham, Birmingham, United Kingdom
(Hanly) Dalhousie University, Halifax, NS, Canada
(Inanc) Istanbul University, Istanbul Faculty of Medicine, Department of
Internal Medicine, Istanbul, Turkey
(Isenberg) Centre for Rheumatology, London, United Kingdom
(Jacobsen) Copenhagen Lupus and Vasculitis Clinic, Copenhagen, Denmark
(James) Oklahoma Medical Research Foundation, University of Oklahoma
Health Sciences Center, Oklahoma City, OK, United States
(Jonsen) Lund University, Lund, Sweden
(Kalunian) UC San Diego School of Medicine, LaJolla, CA, United States
(Kamen) Division of Rheumatology and Immunology, Department of Medicine,
Medical University of South Carolina, Charleston, SC, United States
(Lim) Emory University, Atlanta, GA, United States
(Morand) Monash University, Melbourne, VIC, Australia
(Peschken) University of Manitoba, Winnipeg, Canada
(Pons-Estel) Centro Regional de Enfermedades Autoinmunes y Reumaticas
CREAR, Grupo Orono, Rosario, Rosario, Argentina
(Rahman) University College London, London, United Kingdom
(Ramsey-Goldman) Northwestern University, Chicago, IL, United States
(Romero-Diaz) Instituto Nacional de Ciencias Medicas y Nutricion Salvador,
Zubiran Vasco de Quiroga, Mexico City, Mexico
(Ruiz-Irastorza) Autoimmune Diseases Unit, Hospital Universitario Cruces,
Barakaldo, Spain
(Steinsson) Landspitali, University Hospital, Reykjavik, Iceland
(Svenungsson) Division of Rheumatology, Department of Medicine Solna,
Karolinska Institutet, Stockholm, Sweden
(Urowitz) University Health Network, University of Toronto, Toronto, ON,
Canada
(Van Vollenhoven) Amsterdam Rheumatology and Immunology Center ARC,
Amsterdam, Netherlands
(Vinet) McGill University Health Centre, Montreal, QC, Canada
(Voskuyl) Amsterdam Rheumatology and Immunology Center, Amsterdam,
Netherlands
(Wallace) Cedars-Sinai Medical Centre, Beverly Hills, CA, United States
(Alarcon) University of Alabama at Birmingham, Birmingham, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose : The impact of glucocorticoid (GC) use on major organ
damage in SLE patients has not been formally studied by amalgamating the
relevant data published in the literature over the past 40 years. We aimed
to study the association between GC use and the occurrence of major organ
damage in SLE patients by performing meta-analyses of observational
studies published between 1970 and December 2018. Methods : Literature
search on PubMed (from 1966 to December 2018) for prevalence and
longitudinal studies which reported GC exposure (proportion of GC users in
the cohort [%GC use] and/or GC use in defined doses) and the occurrence
(prevalence/incidence) of major organ damage in SLE patients using the
keywords cataract, cerebrovascular (CVA), stroke, cardiovascular (CVS),
angina, myocardial infarction (MI), coronary artery bypass, osteoporosis,
avascular necrosis (AVN) and osteonecrosis in respective combinations with
lupus was conducted. Studies with sample size < 50 and observation
duration < 12 months were excluded. The logit of the proportion of
patients with disease damage was modelled as a random effect in the
meta-analysis, which was employed to study the association between the
proportion of patients with organ damage and variables of GC use (mean
daily [mg/day] and cumulative [gm] prednisone [PDN] doses and %GC use). A
2-stage estimation of the random-effects logistic regression models was
used with restricted maximum likelihood estimation. Univariate
associations between organ damage and moderators were examined for
statistical significance, and variables related to GC use were adjusted
for SLE disease duration in multivariate models if their univariate P
values were < 0.2. Results : Out of 8,882 publications screened, 212
articles involving 205,619 SLE patients were eligible for the metaanalyses
(Figure 1), of which 97 were prevalence and 115 were longitudinal studies.
Univariate analyses of prevalence studies revealed that mean daily PDN
dose (odds ratio [OR]=1.10, p=0.007) and lower proportion of female in the
cohort (OR=0.002, p=0.002) were associated with the prevalence of overall
CVS events. Mean daily PDN dose (OR=1.52, p< 0.001) and %GC use
(OR=2,255.2, p< 0.001) were associated with the prevalence of AVN. A
significant association between cumulative PDN dose and prevalence of CVA
was found after multivariate adjustment for SLE disease duration (OR=1.07,
p=0.017). In longitudinal studies, a significant association was
identified between cumulative PDN dose and incidence of cataracts after
adjustment for SLE disease duration (OR=1.04, p=0.013). While the
incidence of MI in SLE patients has dropped over the past 40 years
(OR=0.94, p=0.002), it was associated with % GC use after adjustment for
SLE disease duration (OR=8.18, p=0.012). Interestingly, significant
univariate associations were found between antimalarial use and lower
prevalence of MI (OR=0.05, p=0.002) and lower incidence of CVA (OR=0.20,
p=0.032). Conclusion : Independent of SLE disease duration, cumulative PDN
dose was associated with higher prevalence of CVA and incidence of
cataracts, and higher incidence of MI was associated with overall GC use.

<40>
Accession Number
633059842
Title
Design of a phase 2, multicenter, randomized, double-blind,
placebo-controlled trial of 2 different dose regimens of iFX-1, a C5a
Inhibitor, as an Add-On Therapy for Granulomatosis with Polyangiitis or
Microscopic Polyangiitis.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2019. United States. 71 (Supplement 10) (pp
3002-3003), 2019. Date of Publication: October 2019.
Author
Merkel P.; Hellmich B.; Jayne D.; Ruckinger S.; Tamas Z.; Thielert C.;
Zenker O.
Institution
(Merkel) University of Pennsylvania, Philadelphia, PA, United States
(Hellmich) Department of Internal Medicine,Rheumatology and Immunology,
Vasculitis-Center Tubingen-Kirchheim, Medius Klinik Kirchheim, University
of Tubingen, Kirchheim-Teck, Kirchheim, Germany
(Jayne) Vasculitis and Lupus Clinic, Addenbrooke's Hospital, University of
Cambridge, Cambridge, United Kingdom
(Ruckinger) Metronomia Clinical Research GmbH, Munich, Germany
(Tamas, Thielert) InflaRx GmbH, Planegg, Germany
(Zenker) InflaRx GmbH, Jena, Germany
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose : Granulomatosis with polyangiitis (GPA) and
microscopic polyangiitis (MPA) are lifethreatening rare autoimmune
diseases to anti-neutrophil cytoplasmic antibody (ANCA)-associated
vasculitis (AAV). Standard of care (SOC) treatment includes
glucocorticoids (GCs) in combination with cyclophosphamide (CYC) or
rituximab (RTX). SOC is still associated with incomplete treatment
response, disease relapses, and long-term side effects. Complement
component 5a (C5a) is known to prime and activate neutrophils, which is a
major contributor to the pathogenesis of AAV. IFX-1, a monoclonal
antibody, specifically binds to C5a inhibiting C5a-induced biological
effects. Observations in previous clinical studies of sepsis, hidradenitis
suppurativa, and cardiac surgery indicate that IFX-1 is safe and
well-tolerated. These data suggest that IFX-1 might be a safe, tolerable,
and efficacious agent for the treatment of AAV. Methods : We describe the
design of an ongoing clinical trial evaluating the safety of two different
doses of IFX-1 or placebo as add-on therapy to SOC in subjects with
moderate to severe GPA or MPA. Results : This randomized,
placebo-controlled, multicenter trial is evaluating the safety of two
different doses of IFX-1 in combination with SOC, including a standard
tapering schedule for GCs (ClinicalTrials.gov NCT03712345). The trial will
be performed in about 40 sites in the USA and Canada and will include a
total of 36 subjects, 12 per arm. A pharmacokinetic (PK) substudy is
planned to enroll 15 subjects. Participation could last for up to 26
weeks, including a 16-week treatment and an 8-week follow-up period. Major
eligibility criteria are a diagnosis of new or relapsing GPA or MPA that
requires treatment with CYC or RTX plus GCs, positive test for ANCA, and
<= 1 major item or <= 3 minor items or <= 2 renal items on the Birmingham
Vasculitis Assessment Score version 3 (BVASv3). Intravenous IFX-1 or
placebo will be given on days 1, 4, 8, 15 and then every other week until
Week 16. Primary outcome is the number and percentage of subjects who
experience at least one treatment-emergent adverse event (TEAE) per
treatment group. Key secondary endpoints are IFX-1-related serious AEs and
TEAEs, AEs of special interest, proportion of subjects achieving clinical
response (reduction in BVAS of <=50% at Week 16 and no worsening in any
body system), proportion of subjects with clinical remission (BVAS = 0) at
Week 16, and PK and pharmacodynamic (PD) parameters. The safety of
subjects will be monitored continuously by an unblinded Independent Data
Monitoring Committee. Study enrollment in this trial began in October
2018. Conclusion : This prospective Phase 2 trial of subjects with AAV is
intended to demonstrate the safety, tolerability, and efficacy of IFX-1, a
C5a blocking therapy, in two different dose regimens in comparison with
placebo.

<41>
Accession Number
633059318
Title
Risk of incident myocardial infarction among disabled patients with
rheumatoid arthritis who were beneficiaries of the social security
disability insurance.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2019. United States. 71 (Supplement 10) (pp
4115-4117), 2019. Date of Publication: October 2019.
Author
Navarro-Millan I.; Rajan M.; Lui G.; Kern L.; Pinheiro L.; Sattui S.E.;
Mandl L.; Xie F.; Curtis J.; Safford M.
Institution
(Navarro-Millan, Rajan, Lui, Kern, Pinheiro, Safford) Weill Cornell
Medicine, New York, United States
(Sattui) Hospital for Special Surgery, New York, United States
(Mandl) Hospital for Special Surgery/Weill Cornell Medicine, New York, NY,
United States
(Xie, Curtis) University of Alabama at Birmingham, Birmingham, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose : Patients with RA have high risk for myocardial
infarction (MI). A meta-analysis showed that the age and sex adjusted
pooled relative risk of MI among patients with RA was 1.69, 95% confidence
interval (CI) 1.50 -1.90. There is limited understanding about the
prevalence and incidence of MI events among individuals younger than 65
years of age disabled (defined as beneficiaries of the social security
disability insurance (SSDI)) with RA. Figure 1. ROC for various risk
scores in predicting subclinical atherosclerosis Among patients with RA <
65 years of age who receive SSDI benefits in 2011, to 1) determine the
prevalence of cardiovascular disease (CVD) and CVD risk factors; and 2)
among those free of CVD at baseline, to compare the risk of incident MI
among those with and without CVD risk factors at baseline, to compare the
risk of incident MI among those with and without CVD risk factors at
baseline. Methods : We analyzed claims data of the SSDI beneficiaries aged
18-64 years of age with RA, defined as >=2 ICD-9 CM codes (714.xx) from a
rheumatologist > 7 and < 365 days apart, OR 1 ICD-9-CM code from a
rheumatologist AND a DMARD in 2011 in a period > 7 and < 365 days.
Prevalent CVD was defined by ICD-9-CM code from heart failure, stroke, or
CVD procedures (coronary artery bypass grafting, percutaneous coronary
intervention, or carotid endartherectomy) in 2011. We used the chronic
conditions data warehouse to identify CVD risk factors (ICD-9-CM codes for
diabetes, hyperlipidemia, hypertension, obesity) in 2011. We followed
subjects without prevalent CVD in 2011, through 2014 to determine incident
MI, defined as the first hospitalization for MI (discharge diagnosis
ICD-9-CM codes 410.xx). Age adjusted incidence rates were estimated using
Poisson models. Age-and sex-adjusted Cox proportional hazard model was
used to compare the risk for incident MI between patients with and without
CVD factors at baseline. Results : There were 48,905 patients in the study
sample; 78.9% were female, 72.2% were <=60 years of age, and 69% had at
least one CVD risk factor, with hypertension being the most prevalent
(52.7%) (Table 1). The prevalence of CVD was 9.3% (N = 4,528). Among the
44,377 without CVD at baseline, 28,538 (64%) had baseline CVD risk
factors; 433 MI events occurred among those with CVD risk factors and 143
among those without over 35.9 median months of follow-up (Table 2). The
age-adjusted incident rate of MI was 5.02 (95% CI 4.52 -5.58) per 1000
person-years for those with CVD risk factors and 3.42 (95% CI 2.90 -4.03)
per 1000 person-years for those without CVD risk factors. The age-and
sex-adjusted hazard ratio (HR) for incident MI for those with CVD risk
factors compared to those without was 1.47 (95% CI 1.22-1.78). Conclusion
: The prevalence of CVD and CVD risk factors was high in this population
of disabled individuals younger than 65 years of age with RA. The incident
rate for MI was high in the subgroup of patients without CVD risk factors
considering that 80% of those patients were 60 year of age or younger
(3.42 per 1000 person-year). As expected, patients with CVD risk factors
were 47% more likely to experience an MI compare to patients without CVD
risk factors.

<42>
Accession Number
2008005451
Title
Myocardial function, heart failure and arrhythmia in marfan syndrome: a
systematic literature review.
Source
Diagnostics. 10 (10) (no pagination), 2020. Article Number: 751. Date of
Publication: October 2020.
Author
Demolder A.; von Kodolitsch Y.; Muino-Mosquera L.; Backer J.D.
Institution
(Demolder, Muino-Mosquera, Backer) Centre for Medical Genetics, Ghent
University Hospital, Ghent 9000, Belgium
(von Kodolitsch) Department of Cardiology, University Heart Center,
Hamburg 20251, Germany
(Muino-Mosquera) Department of Paediatrics, Division of Paediatric
Cardiology, Ghent University Hospital, Ghent 9000, Belgium
(Backer) Department of Cardiology, Ghent University Hospital, Ghent 9000,
Belgium
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Marfan syndrome (MFS) is a heritable systemic connective tissue disease
with important cardiovascular involvement, including aortic root
dilatation and mitral valve prolapse. Life expectancy in patients with MFS
is mainly determined by cardiovascular complications, among which aortic
dissection or rupture are most dreaded. In recent years, heart failure and
ventricular arrhythmia have drawn attention as extra-aortic cardiovascular
manifestations and as additional reported causes of death. Imaging studies
have provided data supporting a primary myocardial impairment in the
absence of valvular disease or cardiovascular surgery, while studies using
ambulatory ECG have demonstrated an increased susceptibility to
ventricular arrhythmia. In this paper, current literature was reviewed in
order to provide insights in characteristics, pathophysiology and
evolution of myocardial function, heart failure and ventricular arrhythmia
in MFS. Copyright © 2020 by the authors.

<43>
Accession Number
2002634958
Title
Effects of Alirocumab on Cardiovascular Events After Coronary Bypass
Surgery.
Source
Journal of the American College of Cardiology. 74 (9) (pp 1177-1186),
2019. Date of Publication: 3 September 2019.
Author
Goodman S.G.; Aylward P.E.; Szarek M.; Chumburidze V.; Bhatt D.L.; Bittner
V.A.; Diaz R.; Edelberg J.M.; Hanotin C.; Harrington R.A.; Jukema J.W.;
Kedev S.; Letierce A.; Moryusef A.; Pordy R.; Ramos Lopez G.A.; Roe M.T.;
Viigimaa M.; White H.D.; Zeiher A.M.; Steg P.G.; Schwartz G.G.
Institution
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada and St. Michael's Hospital, University of Toronto,
Toronto, Ontario, Canada
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, South Australia, Australia
(Szarek) State University of New York, Downstate School of Public Health,
Brooklyn, NY, United States
(Chumburidze) Chapidze Emergency Cardiology Center, Tbilisi, Georgia
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Diaz) Estudios Cardiologicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Edelberg, Moryusef) Sanofi, Bridgewater, NJ, United States
(Hanotin, Letierce) Sanofi, Chilly-Mazarin, France
(Harrington) Stanford Center for Clinical Research, Department of
Medicine, Stanford University, Stanford, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Kedev) University Clinic of Cardiology, Skopje, North Macedonia
(Pordy) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
(Ramos Lopez) Medical Office, Guadalajara, Jalisco, Mexico
(Roe) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Roe) Division of Cardiology, Department of Medicine, Duke University
School of Medicine, Durham, NC, United States
(Viigimaa) SA Pohja-Eesti Regionaalhaigla, Tallinn, Estonia
(White) Green Lane Cardiovascular Services Auckland City Hospital,
Auckland, New Zealand
(Zeiher) Department of Medicine III, Goethe University, Frankfurt am Main,
Germany
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Patients with acute coronary syndrome (ACS) and history of
coronary artery bypass grafting (CABG) are at high risk for recurrent
cardiovascular events and death. Objective(s): This study sought to
determine the clinical benefit of adding alirocumab to statins in ACS
patients with prior CABG in a pre-specified analysis of ODYSSEY OUTCOMES
(Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome
During Treatment With Alirocumab). Method(s): Patients (n = 18,924) 1
to 12 months post-ACS with elevated atherogenic lipoprotein levels despite
high-intensity statin therapy were randomized to alirocumab or placebo
subcutaneously every 2 weeks. Median follow-up was 2.8 years. The primary
composite endpoint of major adverse cardiovascular events (MACE) comprised
coronary heart disease death, nonfatal myocardial infarction, ischemic
stroke, or unstable angina requiring hospitalization. All-cause death was
a secondary endpoint. Patients were categorized by CABG status: no CABG (n
= 16,896); index CABG after qualifying ACS, but before randomization (n =
1,025); or CABG before the qualifying ACS (n = 1,003). Result(s): In
each CABG category, hazard ratios (95% confidence intervals) for MACE (no
CABG 0.86 [0.78 to 0.95], index CABG 0.85 [0.54 to 1.35], prior CABG 0.77
[0.61 to 0.98]) and death (0.88 [0.75 to 1.03], 0.85 [0.46 to 1.59], 0.67
[0.44 to 1.01], respectively) were consistent with the overall trial
results (0.85 [0.78 to 0.93] and 0.85 [0.73 to 0.98], respectively).
Absolute risk reductions (95% confidence intervals) differed across CABG
categories for MACE (no CABG 1.3% [0.5% to 2.2%], index CABG 0.9% [-2.3%
to 4.0%], prior CABG 6.4% [0.9% to 12.0%]) and for death (0.4% [-0.1% to
1.0%], 0.5% [-1.9% to 2.9%], and 3.6% [0.0% to 7.2%]). Conclusion(s):
Among patients with recent ACS and elevated atherogenic lipoproteins
despite intensive statin therapy, alirocumab was associated with large
absolute reductions in MACE and death in those with CABG preceding the ACS
event. (ODYSSEY OUTCOMES: Evaluation of Cardiovascular Outcomes After an
Acute Coronary Syndrome During Treatment With Alirocumab;
NCT01663402) Copyright © 2019 American College of Cardiology
Foundation

<44>
Accession Number
2005987890
Title
Asymmetric dimethylarginine predicts perioperative cardiovascular
complications in patients undergoing medium-to-high risk non-cardiac
surgery.
Source
Journal of International Medical Research. 48 (8) (no pagination), 2020.
Date of Publication: 2020.
Author
Appel D.; Boger R.; Windolph J.; Heinze G.; Goetz A.E.; Hannemann J.
Institution
(Appel, Heinze, Goetz) University Medical Center Hamburg-Eppendorf,
Department of Anesthesiology, Hamburg, DE, Germany
(Boger, Windolph, Hannemann) University Medical Center Hamburg-Eppendorf,
Institute of Clinical Pharmacology and Toxicology, Hamburg, DE, Germany
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objectives: Perioperative cardiovascular events remain an important factor
that affects surgery outcome. We assessed if asymmetric dimethylarginine
(ADMA), an endogenous inhibitor of nitric oxide synthesis, predicts
perioperative risk, and if pre-operative supplementation with
L-arginine/L-citrulline improves the plasma L-arginine/ADMA ratio.
 Method(s): In this prospective study, planned thoracic and/or
abdominal surgery patients were randomized to receive
L-arginine/L-citrulline (5 g/day) or placebo 1 to 5 days before surgery.
We measured perioperative plasma ADMA and L-arginine levels. The primary
outcome was a 30-day combined cardiovascular endpoint. Result(s):
Among 269 patients, 23 (8.6%) experienced a major adverse cardiovascular
event. ADMA and C-reactive protein were significantly associated with the
incidence of cardiovascular complications in the multivariable-adjusted
analysis. The L-arginine plasma concentration was significantly higher on
the day of surgery with L-arginine/L-citrulline supplementation compared
with placebo. In patients with high pre-operative ADMA, there was a
non-significant trend towards reduced incidence of the primary endpoint
with L-arginine/L-citrulline supplementation (six vs. nine events).
 Conclusion(s): ADMA is a predictor of major adverse cardiovascular
complications in the perioperative period for patients who are undergoing
major abdominal and/or thoracic surgery. Supplementation with
L-arginine/L-citrulline increased the L-arginine plasma concentration,
enhanced the L-arginine/ADMA ratio, and induced a trend towards fewer
perioperative events. Copyright © The Author(s) 2020.

<45>
Accession Number
2005049202
Title
Physical exercise combined with cpap in subjects who underwent surgical
myocardial revascularization: A randomized clinical trial.
Source
Respiratory Care. 65 (2) (pp 150-157), 2020. Date of Publication: 01 Feb
2020.
Author
Windmoller P.; Bodnar E.T.; Casagrande J.; Dallazen F.; Schneider J.;
Berwanger S.A.; Borghi-Silva A.; Winkelmann E.R.
Institution
(Windmoller, Bodnar, Casagrande, Dallazen, Winkelmann) Undergraduate
Program in Physical Therapy at the Regional University of Northwestern Rio
Grande do Sul (UNIJUI), Ijui, Brazil
(Dallazen, Schneider, Berwanger) Cardiovascular Surgery Unit of the Heart
Institute of Ijui Charity Hospital, Ijui, Brazil
(Borghi-Silva) Graduate Program in Physical Therapy of the Federal
University of Sao Carlos (UFSCar), Sao Paulo, SP, Brazil
(Windmoller, Winkelmann) Graduate Program in Comprehensive Health Care
(UNICRUZ/UNIJUI), Ijui, Brazil
Publisher
American Association for Respiratory Care (E-mail: info@aarc.org)
Abstract
BACKGROUND: Aerobic exercise and CPAP benefit patients in the
postoperative period of cardiac surgery. To our knowledge, the association
of aerobic exercise on an exercise bicycle with CPAP has not yet been
demonstrated. Therefore, we aimed to evaluate the effectiveness of
physical exercise on a cycle ergometer combined with CPAP in the
postoperative period after coronary artery bypass graft surgery.
 METHOD(S): This was a randomized clinical trial, with recruitment
from May 2017 to December 2017 (registered in the Brazilian Clinical
Trials Registry: RBR69CDYF). The step group (n = 16 subjects) started
rehabilitation in the immediate postoperative period with breathing
exercises and passive mobilization in the sitting position, progressing to
active exercises, ambulation, and stair training. For the intervention
group (n = 15 subjects), dynamic exercises on a cycle ergometer combined
with CPAP were added to the step program from the second to the fourth
postoperative day in a single daily session. RESULT(S): Functional
capacity decreased in both groups, but this reduction was not significant
in the intervention group (P = .11). The length of stay in ICU was lower
in the intervention group (P = .050). In both groups there was a decrease
in maximum inspiratory and expiratory pressure, as well as in the 1-min
sit-to-stand test on the fourth postoperative day compared to the
preoperative period. CONCLUSION(S): Physical exercise combined with
CPAP promoted the maintenance of functional capacity and reduced the
length of stay in the ICU. Copyright © 2020 Daedalus
Enterprises].

<46>
Accession Number
2005048728
Title
High-flow nasal cannula therapy with early extubation for subjects
undergoing off-pump coronary artery bypass graft surgery.
Source
Respiratory Care. 65 (2) (pp 183-190), 2020. Date of Publication: 01 Feb
2020.
Author
Tatsuishi W.; Sato T.; Kataoka G.; Sato A.; Asano R.; Nakano K.
Institution
(Tatsuishi, Kataoka, Sato, Asano, Nakano) Department of Cardiovascular
Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo,
Japan
(Sato) Department of Clinical Engineering, Tokyo Women's Medical
University, Medical Center East, Tokyo, Japan
Publisher
American Association for Respiratory Care (E-mail: info@aarc.org)
Abstract
BACKGROUND: The effects of high-flow nasal cannula (HFNC) therapy on
postoperative atelec-tasis and duration of oxygen therapy after off-pump
coronary artery bypass graft are unknown. The purpose of this study was to
compare the effects of HFNC therapy for subjects who underwent off-pump
coronary artery bypass graft with the effects of standard oxygen therapy
in terms of oxygen requirement and atelectasis. METHOD(S): This
prospective single-blinded randomized, controlled trial included 148
subjects who underwent off-pump coronary artery bypass graft between 2010
and 2015 with HFNC (n = 72) or without HFNC (standard O<inf>2</inf>, n =
76). The primary end point was the percentage difference in loss of lung
volume between subjects with or without HFNC therapy. Secondary end points
included the total amount of oxygen administered and duration of oxygen
therapy with and without HFNC therapy. RESULT(S): There were
significant between-group differences in the percentage loss of lung
volume (P < .001), total amount of oxygen administered (P < .001),
duration of oxygen therapy (P < .001), and the need for postoperative
diuretic therapy (P = .037). The amount (rho = 0.569, P < .001) and
duration (rho = 0.678, P < .001) of oxygen administered were correlated
with atelectasis volume. CONCLUSION(S): Using HFNC therapy after
off-pump coronary artery bypass graft shortened the duration of oxygen
therapy and reduced the percentage loss of lung volume and total amount of
oxygen administered when compared with standard oxygen
therapy. Copyright © 2020 Daedalus Enterprises.

<47>
Accession Number
2004976744
Title
The lipid hypothesis: From resins to proprotein convertase
subtilisin/kexin type-9 inhibitors.
Source
Frontiers in Cardiovascular Drug Discovery. 5 (pp 48-81), 2020. Date of
Publication: 2020.
Author
Ramachandran S.; Bhartia M.; Konig C.S.
Institution
(Ramachandran) Department of Clinical Biochemistry, University Hospitals
Birmingham NHS Foundation Trust, West Midlands, United Kingdom
(Ramachandran) Department of Clinical Biochemistry, University Hospitals
of North Midlands, Faculty of Health Sciences, Staffordshire University,
Institute of Science and Technology, Keele University, Staffordshire,
United Kingdom
(Ramachandran, Konig) College of Engineering, Design & Physical Sciences,
Brunel University London, United Kingdom
(Bhartia) Apollo Hospitals, International Hospitals, Guwahati, Assam,
India
(Bhartia) Dr Bhartia's Diabetes and Thyroid clinic, Guwahati, Assam, India
Publisher
Bentham Science Publishers
Abstract
The validity of the lipid hypothesis has been debated recently in both,
the media and the medical press. In this chapter we review the relevant
evidence to evaluate whether it is still applicable in cardiovascular
prevention. After a brief description of developments leading to the lipid
hypothesis we consider prospective epidemiological studies, paying
particular attention to the Framingham Heart Study as it was conceived at
a time when lipid lowering therapy was unavailable. We also present the
predictive factors of the other commonly used cardiovascular risk scoring
models. All the algorithms show cholesterol (total or low density
lipoprotein - cholesterol) and high density lipoproteins to predict
cardiovascular disease. Our own data from the Whickham Study where
subjects were recruited in the pre-statin era also show total cholesterol
to be significantly associated with coronary heart disease. We then
discuss intervention randomised controlled studies using agents that lower
low density lipoprotein - cholesterol (resins, statins, ezetimibe and
Proprotein convertase subtilisin/kexin type 9 inhibitors) paying
particular attention to studies not demonstrating reduction in
cardiovascular outcomes. Apart from patients with heart failure and
possibly on dialysis the lipid hypothesis appears to be true. This is
reinforced by a meta-analysis carried out by the Cholesterol Treatment
Trialists' Collaboration. We do not feel that outcomes from cohort studies
consisting of patients subject to multiple guideline driven treatments can
be used as good quality evidence against the lipid hypothesis. We do
acknowledge that more research is required regarding heterogeneity and
describe a non-invasive way in which atherogenesis of the individual may
be measured. We would like future randomised controlled trials to
incorporate study of disease mechanism(s) within the study
design. Copyright © 2019 Bentham Science Publishers.

<48>
Accession Number
632644453
Title
Transcatheter versus surgical aortic valve replacement in renal transplant
patients: A meta-analysis.
Source
Cardiology Research. 11 (5) (pp 280-285), 2020. Date of Publication: 2020.
Author
Mir T.; Darmoch F.; Ullah W.; Sattar Y.; Hakim Z.; Pacha H.M.; Fouad L.;
Gardi D.; Glazier J.J.; Zehr K.; Alraies M.C.
Institution
(Mir) Wayne State University/Detroit Medical Center, Detroit, MI, United
States
(Darmoch) Internal Medicine, Beth Israel Deaconess Medical Center/Harvard
School of Medicine, Boston, MA, United States
(Ullah) Internal Medicine, Abington Jefferson Health, 1200 Old York Road,
Abington, PA 19044, United States
(Sattar) Internal Medicine, Icahn School of Medicine, Mount Sinai Elmhurst
Hospital, New York, NY, United States
(Hakim, Gardi, Glazier, Zehr, Alraies) Cardiovascular Medicine, Detroit
Medical Center, Wayne State University, Detroit, MI, United States
(Pacha) University of Texas Health Science Center, McGovern Medical
School, Memorial Hermann Heart and Vascular Institute, Houston, TX, United
States
(Fouad) Detroit Medical Center, Heart Hospital, Detroit, MI, United States
Publisher
Elmer Press (E-mail: richard.liu@elmerpress.com)
Abstract
Background: The outcome of transcutaneous aortic valve replacement (TAVR)
in patients with kidney transplant is unknown, as majority of these
patients were excluded from the major TAVR clinical trials. We sought to
compare patients with severe aortic stenosis who underwent TAVR versus
surgical aortic valve replacement (SAVR) with a history of kidney
transplant. Method(s): PubMed, Google Scholar and Cochrane databases
were searched to identify relevant articles. The incidence of all-cause
mortality and acute kidney injury (AKI) was calculated using relative risk
on a random effect model. Result(s): A total of 1,538 patients (TAVR
328, SAVR 1,210) were included in the study. TAVR was associated with
lower mortality as compared with SAVR at 30 days from the index procedure
(odds ratio (OR) 0.48, 95% confidence interval (CI): 0.25-0.93; P = 0.03).
Oneyear mortality was studied in three studies and showed comparable
mortality in patients undergoing TAVR and SAVR (OR: 0.76, 95% CI:
0.10-5.51; P = 0.78). Compared to SAVR, TAVR carries an identical risk of
AKI (OR: 0.44, 95% CI: 0.10-1.90; P = 0.27). A sensitivity analysis
performed by exclusion of Voudris et al study showed a non-significant
difference in the mortality incidence of two groups at 30 days (OR: 0.72,
95% CI: 0.27-1.91; P = 0.51). Conclusion(s): In patients with a
history of kidney transplant, TAVR was associated with a comparable risk
of mortality and AKI compared to SAVR. Copyright © 2020 Elmer
Press.

<49>
Accession Number
2007377458
Title
Meta-Analysis Comparing the Safety and Efficacy of Prasugrel and
Ticagrelor in Acute Coronary Syndrome.
Source
American Journal of Cardiology. 132 (pp 22-28), 2020. Date of Publication:
1 October 2020.
Author
Ullah W.; Ali Z.; Sadiq U.; Rafiq A.; Khan S.; Mamas M.A.; Sabouret P.;
Fischman D.L.
Institution
(Ullah, Ali, Sadiq) Abington Jefferson Health, Abington, PA, United States
(Rafiq) Ascension Via Christi St. Francis, Wichita, KS, United States
(Khan) Khyber Medical College, Peshawar, Pakistan
(Mamas) Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
(Sabouret) College National des Cardiologues Francais, Paris, France
(Mamas, Fischman) Thomas Jefferson University, Philadelphia, PA, United
States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Prasugrel and ticagrelor are preferred over clopidogrel for patients with
acute coronary syndrome who underwent percutaneous coronary intervention.
We sought to determine the relative merits of 1 agent over the other.
Multiple databases were queried to identify relevant randomized control
trials (RCTs) and observational cohort studies. Random-effects model was
used to calculate an unadjusted odds ratio (OR) for major adverse
cardiovascular and cerbrovascular events (MACCE) and its components. A
total of 27 (7 RCTs, 20 observational cohort studies) studies comprising
118,266 (prasugrel 62,716, ticagrelor 51,196) patients were included. At
30 days, prasugrel was associated with a significantly lower odds of MACCE
(OR 0.75, 95% confidence interval [CI] 0.67 to 0.85, p <=0.0001) and
mortality (OR 0.65, 95% CI 0.59 to 0.71, p <=0.0001). At 1 year, the
overall odds of mortality favored prasugrel (OR 0.79, 95% CI 0.68 to 0.92,
p = 0.002), but no significant interdrug difference was seen in terms of
MACCE (OR 0.89, 95% CI 0.76 to 1.05, p = 0.16). There was no significant
difference in the odds of overall myocardial infarction,
revascularization, stent thrombosis, stroke, and major bleeding events
between the 2 groups on both 30-day and 1-year follow-up. A subgroup
analysis of RCTs data showed no significant difference between prasugrel
and ticagrelor in terms of any end point at all time points. In
conclusion, prasugrel might have lower odds of MACCE and mortality at 30
days. However, there was no difference in the safety and efficacy end
points of 2 drugs at 1 year. The observed transient prasugrel-related
mortality benefits were subject to the bias of nonrandomized
assignment. Copyright © 2020 Elsevier Inc.

<50>
Accession Number
2007030669
Title
Comparing erector spinae plane block with serratus anterior plane block
for minimally invasive thoracic surgery: a randomised clinical trial.
Source
British Journal of Anaesthesia. 125 (5) (pp 802-810), 2020. Date of
Publication: November 2020.
Author
Finnerty D.T.; McMahon A.; McNamara J.R.; Hartigan S.D.; Griffin M.; Buggy
D.J.
Institution
(Finnerty, McMahon, McNamara, Hartigan, Griffin, Buggy) Division of
Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland
(Finnerty, Buggy) School of Medicine, University College Dublin, Dublin,
Ireland
(Finnerty, Buggy) EU COST Action 15204 Euro-Periscope, Brussels, Belgium
(Buggy) Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Ltd
Abstract
Background: Minimally invasive thoracic surgery causes significant
postoperative pain. Erector spinae plane (ESP) block and serratus anterior
plane (SAP) block promise effective thoracic analgesia compared with
systemically administered opioids, but have never been compared in terms
of terms of quality of recovery and overall morbidity after minimally
invasive thoracic surgery. Method(s): Sixty adult patients undergoing
minimally invasive thoracic surgery were randomly assigned to receive
either single-shot ESP or SAP block before surgery using levobupivacaine
0.25%, 30 ml. The primary outcome was quality of patient recovery at 24 h,
using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes
included area under the curve (AUC) of pain verbal rating scale (VRS) over
time, time to first opioid analgesia, postoperative 24 h opioid
consumption, in-hospital comprehensive complication index (CCI) score and
hospital stay. Result(s): The QoR-15 score was higher among ESP
patients compared with those in the SAP group, mean (standard deviation):
114 (16) vs 102 (22) (P=0.02). Time (min) to first i.v. opioid analgesia
in recovery was 32.6 (20.6) in ESP vs 12.7 (9.5) in SAP (P=0.003). AUC at
rest was 92 (31) mm h-1 vs 112 (35) in ESP and SAP (P=0.03),
respectively, whereas AUC on deep inspiration was 107 mm h-1
(32) vs 129 (32) in ESP and SAP (P=0.01), respectively. VRS pain on
movement in ESP and SAP at 24 h was, median (25-75% range): 4 (2-4) vs 5
(3-6) (P=0.04), respectively. Opioid consumption at 24 h postoperatively
was 29 (31) vs 39 (34) (P=0.37). Median (25-75%) CCI in ESP and SAP was 1
(0-2) vs 4 (0-26) (P=0.03), whereas hospital stay was 3 (2-6) vs 6 (3-9)
days (P=0.17), respectively. Conclusion(s): Compared with SAP, ESP
provides superior quality of recovery at 24 h, lower morbidity, and better
analgesia after minimally invasive thoracic surgery. Clinical trial
registration: NCT 03862612. Copyright © 2020 British Journal of
Anaesthesia

<51>
Accession Number
2006808738
Title
Topical versus low-dose systemic tranexamic acid in pediatric cardiac
surgery: A randomized clinical study.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Hatami F.; Valizadeh N.; Salehi F.; Hosseinzadeh Maleki M.
Institution
(Hatami, Valizadeh, Salehi) Department of Cardiology, Cardiovascular
Diseases Research Center, Birjand University of Medical Sciences, Birjand,
Iran, Islamic Republic of
(Hosseinzadeh Maleki) Department of Cardiac Surgery, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Objectives: The current study aimed to compare the benefits of topical and
low-dose systemic tranexamic acid administration in pediatric cardiac
surgery. Method(s): A total of 117 children undergoing cardiac
surgery for congenital heart disease were assigned into three groups.
Patients in the systemic group received 20 mg/kg-1 tranexamic
acid through the cardiopulmonary bypass followed by another dose of 20
mg/kg-1 after cardiopulmonary bypass separation. Patients in
the topical group were administered with 50 mg/kg-1 tranexamic
acid poured into the pericardium, while the control group received no
antifibrinolytics. The outcome measures of bleeding and blood products
transfusion were recorded over the first 48 h postoperatively.
 Result(s): Chest tube drainage was significantly lower in both
topical and systemic groups than the control group, but it did not differ
between the case groups. Blood products requirement did not show a
difference between groups. Neurological or thromboembolic events did not
variate among the groups, and no deaths occurred in this study.
 Conclusion(s): Topical or systemic tranexamic acid administration
reduced postoperative blood loss effectively without adding an extra
risk. Copyright © 2020 Wiley Periodicals LLC

<52>
Accession Number
2005558074
Title
Parental mobile health adherence to symptom home monitoring for infants
with congenital heart disease during the single ventricle interstage
period: A concept analysis.
Source
Journal for Specialists in Pediatric Nursing. 25 (4) (no pagination),
2020. Article Number: e12303. Date of Publication: 01 Oct 2020.
Author
Erickson L.A.; Emerson A.; Russell C.L.
Institution
(Erickson) Ward Family Heart Center, Children's Mercy Hospital, Kansas
City, MO, United States
(Emerson, Russell) School of Nursing, University of Missouri-Kansas City,
Kansas City, MO, United States
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Purpose: Single ventricle heart disease is fraught with risk for infant
mortality and morbidity. During the interstage period, or the time between
palliative cardiac surgeries, mobile health (mHealth) technology improves
the ability of registered nurse coordinators to monitor infant symptoms
through parental monitoring and reporting. The concept of parental mHealth
adherence to symptom home monitoring of infants with single ventricle
congenital heart disease has not been defined, despite increasing use of
mHealth technology. Method(s): Rodger's concept analysis method was
used to derive a unified definition of parental mHealth adherence to
symptom home monitoring of infants with congenital heart disease during
the single ventricle interstage period. A literature review included a
search of databases for studies that addressed interstage home mHealth
monitoring. Thematic analysis was applied to selected articles to derive a
unified definition based on attributes, antecedents, consequences, related
terms, and an illustrative case example. Sixteen publications were
selected. Attributes, antecedents, and consequences of the concept were
derived from the literature leading to a definition of parental mHealth
adherence for infants with congenital heart disease during the single
ventricle interstage period. The definition is the degree of adherence to
which parents' transfer mHealth data for their infant meet healthcare
providers' recommendations for symptom home monitoring. Consequences were
improved infant symptom home monitoring through parental mHealth adherence
measured by initiation, implementation, and discontinuation.
 Conclusion(s): The unified definition of the concept will provide a
firmer ground for research in mHealth and interstage pediatric care and a
guide for clinicians in developing new mHealth interventions for symptom
home monitoring. Practice Implications: This concept analysis hypothesizes
that infants with a single ventricle during the interstage period, whose
parents are mHealth symptom home monitoring adherent, will have timelier
symptom identification with resultant superior outcomes compared with
infants with a single ventricle during the interstage period whose parents
are not mHealth adherent. Copyright © 2020 Wiley Periodicals LLC

<53>
Accession Number
2008005146
Title
Potential effect of coenzyme q10 (ubiquinone) on serum ngal biomarker and
kidney function following coronary artery bypass grafting surgery.
Source
Journal of Cellular and Molecular Anesthesia. 5 (2) (pp 59-66), 2020. Date
of Publication: April 2020.
Author
Dastan F.; Ahmadi Z.H.; Pourshaban P.; Serati A.; Eskandari R.; Afzal G.;
Jahangirifard A.
Institution
(Dastan, Eskandari, Jahangirifard) Chronic Respiratory Diseases Research
Center, National Research Institute of Tuberculosis and Lung Diseases
(NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Dastan, Pourshaban, Afzal) Department of Clinical Pharmacy, School of
Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ahmadi) Lung Transplantation Research Center, National Research Institute
of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Serati) National Research Institute of Tuberculosis and Lung Diseases
(NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center (E-mail: contact@icdr.ac.ir)
Abstract
Background: Acute kidney injury (AKI) is a common complication after
coronary artery bypass grafting (CABG) surgery, and is associated with
major adverse outcomes. Effect of preoperative administration of coenzyme
Q10 was evaluated in order to realize that whether it could prevent the
occurrence of AKI following elective CABG surgery. Material(s) and
Method(s): Two hundred and fifty patients who were candidate for elective
CABG surgery between September 2017 and August 2018 were randomly assigned
to intervention group (receiving coenzyme Q10, 300 mg BID for 2 days
before surgery) and control group. Serum NGAL (neutrophil
gelatinase-associated lipocalin) was measured at baseline, 6 and 24 hours
after surgery. Serum creatinine (sCr) and urine output (UO) were also
measured at baseline and after surgery. Result(s): Fifty patients
completed the study. The total incidence of acute kidney injury was 32%.
There were no significant differences in the incidence of AKI (p=0.07)
between the two groups. Serum NGAL was shown no significant difference at
6 (p=0.13) and 24 (p=0.22) hours after surgery compared to the baseline
level between the two groups, whereas, the significant difference in the
hospitalization duration was shown between them (p=0.02).
 Conclusion(s): CoQ10 supplementation did not significantly decrease
the incidence of AKI in patients undergoing elective CABG. Copyright
© 2020 Journal of Cellular and Molecular Anesthesia.

<54>
Accession Number
2008001495
Title
Exercise and lung cancer surgery: A systematic review of
randomized-controlled trials.
Source
Critical Reviews in Oncology/Hematology. 156 (no pagination), 2020.
Article Number: 103086. Date of Publication: December 2020.
Author
Himbert C.; Klossner N.; Coletta A.M.; Barnes C.A.; Wiskemann J.; LaStayo
P.C.; Varghese Jr. T.K.; Ulrich C.M.
Institution
(Himbert, Klossner, Coletta, Ulrich) Huntsman Cancer Institute, Population
Sciences, Salt Lake City, UT, United States
(Himbert, Ulrich) Department of Population Health Sciences, University of
Utah, Salt Lake City, UT, United States
(Coletta, LaStayo) Department of Health, Kinesiology and Recreation,
University of Utah, Salt Lake City, UT, United States
(Barnes, LaStayo) Department of Physical Therapy and Athletic Training,
University of Utah, Salt Lake City, UT, United States
(Barnes, Varghese Jr.) Department of Surgery, University of Utah, Salt
Lake City, UT, United States
(Barnes, Varghese Jr.) Division of Cardiothoracic Surgery, University of
Utah, Salt Lake City, UT, United States
(Wiskemann) Division of Medical Oncology, National Center for Tumor
Diseases (NCT) and Heidelberg University Clinic, Heidelberg, Germany
Publisher
Elsevier Ireland Ltd
Abstract
Lung cancer patients undergoing surgery are often left physically
deconditioned and/or with functional deficits. Exercise interventions may
improve pulmonary and physical function before and after lung resection.
We conducted a systematic review of randomized-controlled trials (RCTs)
testing the impact of pre-, post-, and combined pre-and-post surgery
exercise interventions on physical and pulmonary function in lung cancer
patients. Exercise pre-surgery seems to substantially improve physical and
pulmonary function, which are factors associated with improved ability to
undergo surgery while reducing post-surgery complications. Evidence is
inconsistent for post-surgery interventions, reporting no or moderate
effects. Results from pre-and-post surgery interventions are limited to
one study. In conclusion, pre- and post-surgery exercise interventions,
individually, have shown beneficial effects for lung cancer patients
undergoing surgery. The impact of interventions combining both pre- and
post-surgery exercise programs remains unknown. More evidence is needed on
the ideal exercise setting, and timing across the lung cancer care
continuum. Copyright © 2020 Elsevier B.V.

<55>
Accession Number
2007665453
Title
Different classes of videoscopes and direct laryngoscopes for double-lumen
tube intubation in thoracic surgery: A systematic review and network
meta-analysis.
Source
PLoS ONE. 15 (8 August) (no pagination), 2020. Article Number: e0238060.
Date of Publication: August 2020.
Author
Kim Y.S.; Song J.; Lim B.G.; Lee I.O.; Won Y.J.
Institution
(Kim, Song, Lim, Lee, Won) Department of Anesthesiology and Pain Medicine,
Korea University Guro Hospital, Seoul, South Korea
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Double-lumen tube is commonly used in thoracic surgeries that
need one-lung ventilation, but its big size and stiff structure make it
harder to perform intubation than a conventional tracheal intubation tube.
 Objective(s): To investigate the effectiveness and safety of
videoscopes for double-lumen tube insertion. The primary outcome was the
success rate of first attempt intubation. Secondary outcomes were
intubation time, malposition, oral mucosal damage, sore throat, and
external manipulation. Design(s): Systematic review and network
meta-analysis Data sources: Databases (Pubmed, Embase, Cochrane, Kmbase,
Web of science, Scopus) up to June 23, 2020 were searched. Eligibility:
Randomized controlled trials comparing different videoscopes for
double-lumen tube intubation were included in this study. Method(s):
We classified and lumped the videoscope devices into the following groups:
standard (non-channeled) videolaryngoscope, channeled videolaryngoscope,
videostylet, and direct laryngoscope. After assessing the quality of
evidence, we statistically analyzed and chose the best device based on the
surface under the cumulative ranking curve (SUCRA) by using STATA software
(version 16). Result(s): We included 23 studies (2012 patients).
Based on the success rate of the first attempt, a rankogram suggested that
the standard videolaryngoscope (76.4 of SUCRA) was the best choice,
followed by videostylet (65.5), channeled videolaryngoscope (36.1), and
direct laryngoscope (22.1), respectively. However, with regard to reducing
the intubation time, the best choice was videostylet, followed by a direct
laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope,
respectively. Direct laryngoscope showed the lowest incidence of
malposition but required external manipulation the most. Channeled
videolaryngoscope showed the highest incidence of oral mucosal damage, but
showed the lower incidence of sore throat than standard videolaryngoscope
or direct laryngoscope. Conclusion(s): Most videoscopes improved the
success rate of double-lumen tube intubation; however, they were
time-consuming (except videostylet) and had a higher malposition rate than
the direct laryngoscope. Copyright: © 2020 Kim et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<56>
Accession Number
2007704343
Title
Impact of prosthesis-patient mismatch on early and late outcomes after
mitral valve replacement: a meta-analysis.
Source
Journal of Geriatric Cardiology. 17 (8) (pp 455-475), 2020. Date of
Publication: 2020.
Author
Tan M.-W.; Bai Y.-F.; Liu X.-H.; Xu Z.-Y.; An Z.; Ma Y.; Zhao L.-B.; Li
B.-L.
Institution
(Tan, Bai, Liu, Xu, An, Ma, Zhao, Li) Department of Cardiothoracic
Surgery, Changhai Hospital, Naval Military Medical University, Second
Military Medical University), Shanghai, China
Publisher
Science Press (E-mail: zhgdzh@vip.sina.com)
Abstract
Background Prognostic significance of prosthesis-patient mismatch (PPM)
after mitral valve replacement (MVR) remains uncertain because of the
limited studies reporting inconsistent or even contrary results. This
meta-analysis pooled results of all available studies comparing early and
late prognoses between patients with significant mitral PPM and those
without. Methods Studies were identified by searching Pubmed, Excerpta
Medica Database, Cochrane Central Register of Controlled Trials, and
ClinicalTrials.gov. Impact of PPM on postoperative hemodynamic results,
thirty-day mortality, overall mortality, mortality of thirty-day
survivors, and primary morbidity after MVR was evaluated via
meta-analysis. Robustness of pooled estimates, source of heterogeneity,
and publication bias were assessed via sensitivity analyses,
meta-regression as well as subgroup analysis stratified according to
methodological or clinical heterogeneity, or sequential omission method,
and funnel plot or Begg's and Egger's tests, respectively. Results
Nineteen cohort studies involving 9302 individuals (PPM group: n = 5109,
Control group: n = 4193) were included for meta-analysis. Total PPM and
severe PPM prevalence were 3.8%-85.9% and 1%-27%, with a mean value of
54.9% and 14.1%, respectively. As compared with control group, mitral PPM
group demonstrated a poorer postoperative hemodynamic status of higher
mean and peak residual transprosthetic pressure gradients (TPG), higher
postoperative systolic pulmonary artery pressure (SPAP) and less
reduction, higher postoperative pulmonary hypertension (PH) prevalence and
less PH regression, smaller net atrioventricular compliance, less NYHA
class decrease, higher postoperative functional tricuspid regurgitation
prevalence and less regression. The PPM group also revealed a higher
thirty-day mortality, long-term overall mortality, mortality of thirty-day
survivors, and postoperative congestive heart failure prevalence, which
were positively correlated with the severity of PPM if it was classified
into tri-level subgroups. Left ventricular end-diastolic diameter,
postoperative atrial fibrillation (AF) prevalence, and the AF regression
were analogous between groups. Most pooled estimates were robust according
to sensitivity analyses. Male patients and bioprosthesis implantation
proportion were prominent source of between-study heterogeneity on
thirty-day mortality. Publication bias was not significant in tests for
all the outcomes, except for SPAP and TPG. Conclusions Mitral PPM would
result in poorer postoperative hemodynamics and worse early and late
prognosis. Severe PPM must be avoided since deleterious impact of mitral
PPM was severity dependent. Copyright ©2020 JGC All rights
reserved;

<57>
[Use Link to view the full text]
Accession Number
2008004489
Title
Evaluation of Automated Delivery of Propofol Using a Closed-Loop
Anesthesia Delivery System in Patients Undergoing Thoracic Surgery: A
Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Sethi N.; Dutta A.; Puri G.D.; Panday B.C.; Sood J.; Gupta M.; Choudhary
P.K.; Sharma S.
Institution
(Sethi, Dutta, Panday, Sood, Gupta, Choudhary, Sharma) Department of
Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital,
New Delhi, India
(Puri) Department of Anaesthesia and Intensive Care, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objective: Automated propofol total intravenous anesthesia (TIVA)
administered by a closed-loop anesthesia delivery system (CLADS) exhibits
greater efficiency than conventional manual methods, but its use in major
thoracic surgery is limited. Design(s): Prospective, single-blind,
randomized controlled study. Setting(s): Single-center tertiary care
hospital. Participant(s): Patients undergoing thoracic surgery.
 Intervention(s): Patients were randomly allocated to receive
CLADS-driven (CLADS group) or manually controlled (manual group) propofol
TIVA. Measurements and Main Results: Anesthesia depth consistency
(primary objective) and anesthesia delivery performance, propofol usage,
work ergonomics, intraoperative hemodynamics, and recovery profile
(secondary objectives) were analyzed. No differences were found for
anesthesia depth consistency (percentage of time the bispectral index was
within +/- 10 of target) (CLADS group: 82.5% [78.5%-87.2%] v manual group:
86.5% [74.2%-92.5%]; p = 0.581) and delivery performance, including median
performance error (CLADS group: 3 [-4 to 6] v manual group: 1 [-2.5 to
6]); median absolute performance error (CLADS group: 10 [10-12] v manual
group:10 [8-12]); wobble (CLADS group: 10 [8-12] v manual group: 9
[6-10.5]); and global score (CLADS group: 24.2 [21.2-29.3] v manual group:
22.1 [17.3-32.3]) (p > 0.05). However, propofol requirements were
significantly lower in the CLADS group for induction (CLADS group: 1.27
+/- 0.21] mg/kg v manual group: 1.78 +/- 0.51 mg/kg; p = 0.014) and
maintenance (CLADS group: 4.02 +/- 0.99 mg/kg/h v manual group: 5.11 +/-
1.40 mg/kg/h; p = 0.025) of TIVA. Ergonomically, CLADS-driven TIVA was
found to be significantly superior to manual control (infusion adjustment
frequency/h) (manual infusion: 9.6 [7.8-14.9] v CLADS delivery [none]).
 Conclusion(s): In thoracic surgery patients, CLADS-automated propofol
TIVA confers significant ergonomic advantage along with lower propofol
usage. Copyright © 2020 Elsevier Inc.

<58>
Accession Number
2008003932
Title
Do economic evaluations of TAVI deal with learning effects, innovation,
and context dependency? A review.
Source
Health Policy and Technology. (no pagination), 2020. Date of Publication:
2020.
Author
Enzing J.J.; Vijgen S.; Knies S.; Boer B.; Brouwer W.B.F.
Institution
(Enzing, Knies, Boer, Brouwer) Erasmus School of Health Policy &
Management, Erasmus University Rotterdam, Rotterdam, Netherlands
(Enzing, Vijgen, Knies) Zorginstituut Nederland, Diemen, Netherlands
Publisher
Elsevier B.V. ( Netherlands)
Abstract
Introduction: Most collectively funded healthcare systems set limits to
their benefit package. Doing so requires judgements which may involve
economic evaluations. Performing such evaluations brings methodological
challenges, which may be more pronounced in non-pharmaceutical
interventions. For example, for medical devices, the validity of
assessment results may be limited by learning effects, incremental
innovation of the devices and the context-dependency of their outcomes.
 Objective(s): To review the extent to which "learning effects",
"incremental innovation" (related to outcomes) and "context-dependency"
are included and/or discussed in peer reviewed economic evaluations on
medical devices using Transcatheter Aortic Valve Implementation (TAVI) as
an example. Method(s): A systematic review was performed including
full economic evaluations of TAVI for operable patients with aortic
stenosis identified using the Pubmed database. Study characteristics,
study results and text fragments concerning the aforementioned aspects
were extracted. The quality of the studies was assessed using a quality
checklist (CHEC-extended). Result(s): Within 207 screened records, 15
studies were identified. Two studies referred to all three aspects, four
studies referred to none. "Learning effects" were discussed in five
studies, one of which described a method to cope with this challenge.
"Incremental innovation" was described in seven studies. Limitations in
generalizability of results related to context of care provision were
discussed in seven studies. Conclusion(s): The challenges related to
economic evaluations of TAVI and their influence on the validity of
reported results, are typically only partly discussed and rarely dealt
within peer reviewed studies. It is important for better informed policy
decisions that this improves. Copyright © 2020 Fellowship of
Postgraduate Medicine

<59>
Accession Number
2007982244
Title
Randomized Controlled Trial of Working Memory Intervention in Congenital
Heart Disease.
Source
Journal of Pediatrics. (no pagination), 2020. Date of Publication: 2020.
Author
Calderon J.; Wypij D.; Rofeberg V.; Stopp C.; Roseman A.; Albers D.;
Newburger J.W.; Bellinger D.C.
Institution
(Calderon, Bellinger) Department of Psychiatry, Boston Children's
Hospital, Boston, MA, United States
(Calderon, Bellinger) Department of Psychiatry, Harvard Medical School,
Boston, MA, United States
(Wypij, Rofeberg, Stopp, Roseman, Albers, Newburger) Department of
Cardiology, Boston Children's Hospital, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Wypij, Newburger) Department of Pediatrics, Harvard Medical School,
Boston, MA, United States
(Bellinger) Department of Neurology, Boston Children's Hospital, Boston,
MA, United States
(Bellinger) Department of Neurology, Harvard Medical School, Boston, MA,
United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Objectives: To evaluate the efficacy of Cogmed Working Memory Training
compared with the standard of care to improve executive function and
social outcomes in adolescents with congenital heart disease (CHD) who
underwent open-heart surgery in infancy and to identify factors associated
with changes in outcomes following the intervention. Study design: In a
single-center, randomized controlled trial, adolescents (13-16 years) with
CHD were randomly assigned to either Cogmed (home-based 45-minutes
sessions for 5-8 weeks) or to a control group. The primary outcome was
working memory. Secondary outcomes included inhibitory control and
cognitive flexibility as well as parent-reported executive function,
symptoms of attention deficit hyperactivity disorder, and social outcomes.
All measures were assessed at baseline, post-treatment (1-3 weeks
post-training) and at 3-month follow-up. Data were analyzed using an
intention-to-treat approach. Result(s): Sixty adolescents with CHD
participated (28 assigned to Cogmed). No improvement at the post-treatment
or 3-month follow-up assessments was found for the primary outcome measure
of working memory. Compared with the control group, participants assigned
to the intervention demonstrated benefits in inhibitory control and
attention at the 3-month follow-up (P = .02) and in parent-reported
cognitive regulatory skills at post-treatment and 3-month follow-up (P =
.02 and P = .04, respectively). Preterm birth, biventricular CHD, and
history of attention deficit hyperactivity disorder diagnosis were
associated with improved response to the intervention. Conclusion(s):
Cogmed intervention produced improvements in the self-regulatory control
abilities of adolescents with CHD. The training did not enhance other
areas of executive function or behavioral outcomes. Further studies are
needed to evaluate the longer-term potential benefits to other domains.
Trial registration: Clinicaltrials.gov: NCT02759263. Copyright ©
2020 Elsevier Inc.

<60>
Accession Number
2007963088
Title
Meta-Analysis of Aspirin Monotherapy Versus Dual Antiplatelet Therapy
After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Osman M.; Syed M.; Balla S.; Kheiri B.; Golwala H.; Zahr F.
Institution
(Osman, Syed, Balla) Division of Cardiology, West Virginia University
School of Medicine, Morgantown, WV, United States
(Kheiri, Golwala, Zahr) Knight Cardiovascular Institute, Oregon Health and
Science University, Portland, OR, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<61>
Accession Number
633049699
Title
Abstracts from Pharmacology 2019.
Source
British Journal of Clinical Pharmacology. Conference: Pharmacology 2019.
United Kingdom. 86 (6) (no pagination), 2020. Date of Publication: June
2020.
Author
Anonymous
Publisher
Blackwell Publishing Ltd
Abstract
The proceedings contain 71 papers. The topics discussed include: the
pharmacokinetics and relative bioavailability of mepolizumab 100 mg liquid
formulation administered subcutaneously to healthy participants: a
randomized trial; activity and pulmonary function collected via a
noninvasive platform differentiate healthy and asthmatic children;
SAMe-TT2R2 score and prediction of anticoagulation control with warfarin
in Arab patients with a mechanical heart valve prosthesis; assessment of
blood pressure control and target organ damage in a treated hypertensive
population-is clinic BP measurement enough?; comparison of pharmacotherapy
competence of good and poor prescribers in primary care; lipocalin-2
variants as effective biomarkers to stratify patients with heart failure
and/or chronic kidney disease; and occult hepatic steatosis - how can we
distinguish true treatment emerging liver signals from undetected
unrelated liver abnormalities?.

<62>
Accession Number
2007639951
Title
Cardiac protection with phosphocreatine: a meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA 2016
Abstracts. Switzerland. 30 (Supplement 1) (pp S16), 2016. Date of
Publication: May 2016.
Author
Fominskiy E.; Lomivorotov V.; Nepomniashchikh V.; Likhvantsev V.; Ma J.;
Lembo R.; Baiardo Redaelli M.; Abubakirov M.; Perovsky P.; Zangrillo A.;
Landoni G.
Institution
(Fominskiy, Lomivorotov, Nepomniashchikh, Abubakirov, Perovsky)
Academician EN Meshalkin Novosibirsk State Budget Research Institute Of
Circulation Pathology, Novosibirsk, Russian Federation
(Likhvantsev) Moscow Regional Clinical and Research Institute, Moscow,
Russian Federation
(Ma) Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R.,
China
(Lembo, Baiardo Redaelli, Zangrillo, Landoni) IRCCS San Raffaele
Scientific Institute, Milan, Italy
Publisher
W.B. Saunders
Abstract
Introduction: Phosphocreatine (PCr) plays an important role in the energy
metabolism of the heart and a decrease in its intracellular concentration
results in alteration of myocardium energetics and work. Method(s):
We conducted a meta-analysis of all randomised and matched trials that
compared PCr with placebo or standard treatment in patients with coronary
artery disease or chronic heart failure or in those undergoing cardiac
surgery. We systematically searched PubMed/Medline, Embase, Cochrane
Central Register of Controlled Trials, and Google Scholar up to November
1st, 2015, for pertinent trials. The primary outcome was the longest
follow-up all-cause mortality. Secondary outcomes included inotropes use,
ejection fraction (EF), peak creatinine kinase-myocardial band (CK-MB)
release, and the incidence of major arrhythmias, as well as spontaneous
recovery of the heart performance in the subgroup of patients undergoing
cardiac surgery with cardiopulmonary bypass. We pooled odds ratio (OR) and
mean difference (MD) using fixed- and random effects models. We tested for
heterogeneity using the Q statistic and quantified it with the I2
statistic. Meta-analysis was performed using Review Manager 5.3.5.
 Result(s): We identified 41 controlled trials, 31 of them randomised.
Patients receiving PCr had lower all-cause mortality when compared to the
control group (61/1731 [3.5%] vs. 177/1667 [10.6%]; OR 0.71, 95% CI
0.51-0.99; P=0.04; I2=0%; with 3,400 patients and 22 trials
included). Phosphocreatine administration was associated with higher LVEF
(MD 3.82, 95% CI 1.18-6.46; P=0.005; I2=98%), lower peak CK-MB
release (MD -6.08, 95% CI -8.01, -4.15; P<0.001; I2=97%), lower
rate of major arrhythmias (OR 0.42; 95% CI 0.27-0.66; P<0.001; I2=0%),
lower incidence of inotropic support (OR 0.39, 95% CI 0.25-0.61; P<0.001;
I2=56%) and a higher level of spontaneous recovery of the heart
performance after cardiopulmonary bypass (OR 3.49, 95% CI 2.28-5.35;
P<0.001; I2=49%) when compared with the control group.
 Discussion(s): In a mixed population of patients with coronary artery
disease, chronic heart failure or in those undergoing cardiac surgery PCr
administration was associated with improved cardiac outcomes and with a
reduction in all-cause mortality at the longest follow up available. Due
to the pharmacological plausibility of this effect and to the concordance
of the beneficial effects of PCr on several secondary but important
outcomes and survival, there is urgent need of a large multicentre
randomised trial to confirm these findings. Copyright © 2016

<63>
Accession Number
2007639740
Title
Efficacy and safety of fibrinogen concentrate in surgical patients: a
meta-analysis of randomised controlled trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA 2016
Abstracts. Switzerland. 30 (Supplement 1) (pp S8-S9), 2016. Date of
Publication: May 2016.
Author
Fominskiy E.; Lomivorotov V.; Nepomniashchikh V.; Monaco F.; Vitiello C.;
Votta C.D.; Camarda V.; Landoni G.
Institution
(Fominskiy, Lomivorotov, Nepomniashchikh) Academician EN Meshalkin
Novosibirsk State Budget Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Monaco, Vitiello, Votta, Camarda, Landoni) IRCCS San Raffaele Scientific
Institute, Milan, Italy
Publisher
W.B. Saunders
Abstract
Introduction: The evidence in support of fibrinogen concentrate (FC) use
for treatment of bleeding remains weak. The aim of this meta-analysis was
to investigate the efficacy and safety of FC in surgical patients by
including data from randomised controlled studies (RCTs). Method(s):
We searched PubMed/Medline, Embase, Cochrane Central Register of
Controlled Trials, Transfusion Evidence Library, Google Scholar, and the
proceedings from major international anaesthesiological meetings up to
November 1st, 2015 for RCTs that compared FC with placebo or other
comparators in surgical patients. The primary outcome was all-cause
mortality. We derived pooled risk ratios (RRs) and mean differences (MDs)
with either fixed effect or random effects models. Result(s): We
included 13 RCTs comprising 965 patients, of whom the majority underwent
cardiac surgery. All-cause mortality was lower in the fibrinogen group
(3/355 [0.8%] vs. 12/356 [3.4%]; RR 0.25; 95% CI 0.07-0.87; P=0.03;
I2=0%). The use of FC was associated with reduced bleeding (MD -125 mL;
95% CI -211, -39; P=0.004; I2=60%), a lower proportion of patients
receiving red blood cell transfusions (RR 0.76; 95% CI 0.63-0.93; P=0.007;
I2=47%), and a lower number of red blood cell units transfused versus
comparator (MD -0.87; 95% CI -1.33, -0.41; P=0.0002; I2=55%). There was no
difference in the rate of thrombotic events and myocardial infarction.
 Discussion(s): In surgical patients FC is associated with reduced
bleeding, lower transfusion requirements, and might reduce mortality with
no increase in the adverse events such as thrombotic events and myocardial
infarction. Copyright © 2016

<64>
Accession Number
2005082514
Title
Infective endocarditis by proteus species: A systematic review.
Source
GERMS. 10 (3) (pp 229-239), 2020. Date of Publication: 2020.
Author
Ioannou P.; Vougiouklakis G.
Institution
(Ioannou, Vougiouklakis) Department of Internal Medicine & Infectious
Diseases, University Hospital of Heraklion, Stavrakia and Voutes
crossroad, Heraklion, Crete PC 71110, Greece
Publisher
European Academy of HIV/AIDS and Infectious Diseases (E-mail:
office@germs.ro)
Abstract
Proteus spp. are members of the Enterobacteriaceae family and are
Gram-negative, rod-shaped bacteria known to mainly cause urinary tract
infections (UTIs) in humans. However, even though scarce evidence exists
suggesting their potential to cause infective endocarditis (IE), a study
summarizing the existing evidence is lacking. The purpose of this study
was to systemically review all published cases of IE by Proteus species in
the literature. A systematic review of PubMed, Scopus and Cochrane Library
(through 5th May 2020) for studies providing epidemiological,
clinical and microbiological data as well as data on treatment and
outcomes of IE by Proteus species was performed. A total of 16 studies,
containing data of 16 patients, were included. A prosthetic valve was
present in 25%, while the most common causative pathogen was P. mirabilis.
Aortic valve was the most common infected site in 33.3%, followed by
mitral valve in 26.7%. Diagnosis was set with transesophageal
echocardiography in 37.5%, and transthoracic echocardiography in 25%,
while the diagnosis was set at autopsy in 25%. Fever and sepsis were
present in 100% and 84.6%, respectively. Aminoglycosides and
cephalosporins were the most common antimicrobials used for treatment.
Clinical cure was noted in 62.5%, while overall mortality was 43.8%. This
systematic review describes IE by Proteu species in detail and provides
information on epidemiology, clinical presentation, treatment and
outcomes. Copyright © GERMS 2020.

<65>
Accession Number
2005074857
Title
Transthyretin cardiac amyloidosis and aortic stenosis: Connection and
therapeutic implications.
Source
Current Cardiology Reviews. 16 (3) (pp 221-230), 2020. Date of
Publication: 2020.
Author
Penalver J.; Ambrosino M.; Jeon H.D.; Agrawal A.; Kanjanahat-Takij N.;
Pitteloud M.; Stempel J.; Amanullah A.
Institution
(Penalver, Ambrosino, Jeon, Agrawal, Kanjanahat-Takij, Pitteloud, Stempel)
Department of Medicine, Einstein Medical Center, Philadelphia, PA 19141,
United States
(Amanullah) Department of Medicine, Cardiovascular Disease, Einstein
Medical Center, PA 19141, United States
Publisher
Bentham Science Publishers
Abstract
Background: There is a growing interest in the observed significant
incidence of transthyretin cardiac amyloidosis in elderly patients with
aortic stenosis. Approximately, 16% of patients with severe aortic
stenosis undergoing aortic valve replacement have transthyretin cardiac
amyloidosis. Outcomes after aortic valve replacement appear to be worst in
patients with concomi-tant transthyretin cardiac amyloidosis.
 Method(s): Publications in PubMed, Cochrane Library, and Embase
databases were systematically searched from January 2012 to September 2018
using the keywords transthyretin, amyloidosis, and aortic stenosis. All
studies published in English that reported the prevalence, association and
outcomes of transthyretin cardiac amyloidosis in patients with aortic
stenosis undergoing were in-cluded. Results/Conclusion: The relationship
between aortic stenosis and transthyretin cardiac amyloidosis is not well
understood. A few studies have proven successful surgical management when
both conditions coexist. This systematic review suggests that
transthyretin cardiac amyloidosis is common in elderly patients with
aortic stenosis and tend to have high mortality rates after AVR. The
significant incidence of the two diseases occurring simultaneously
warrants further investigation to improve management strategies in the
future. Copyright © 2020 Bentham Science Publishers.

<66>
Accession Number
632764897
Title
A Randomized Trial to Compare Serratus Anterior Plane Block and Erector
Spinae Plane Block for Pain Management following Thoracoscopic Surgery.
Source
Pain Medicine (United States). 21 (6) (pp 1248-1254), 2020. Date of
Publication: 01 Jun 2020.
Author
Ekinci M.; Ciftci B.; Golboyu B.E.; Demiraran Y.; Bayrak Y.; Tulgar S.
Institution
(Ekinci, Ciftci, Demiraran) Department of Anesthesiology and Reanimation,
Istanbul Medipol University, Mega Medipol University Hospital, Istanbul
34040, Turkey
(Golboyu) Department of Anesthesiology and Reanimation, Manisa State
Hospital, Manisa, Turkey
(Bayrak) Department of Thoracic Surgery, Istanbul Medipol University, Mega
Medipol University Hospital, Istanbul, Turkey
(Tulgar) Department of Anesthesiology, Faculty of Medicine, Maltepe
University, Istanbul, Turkey
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
Objective: Comparison of ultrasound (US)-guided erector spinae plane block
(ESPB) and serratus anterior plane block (SAPB) in video-Assisted thoracic
surgery (VATS) patients. The primary outcome was to compare perioperative
and postoperative (48 hours) opioid consumption. Method(s): A total
of 60 patients were randomized into two groups (N = 30): An ESPB group and
an SAPB group. All the patients received intravenous patient-controlled
postoperative analgesia and ibuprofen 400 mg intravenously every eight
hours. Visual analog scale (VAS) scores, opioid consumption, and adverse
events were recorded. Result(s): Intraoperative and postoperative
opioid consumption at 0-8, 8-16, and 16-24 hours and rescue analgesic use
were significantly lower in the ESPB group (P < 0.05). Static/dynamic VAS
scores were significantly lower in the ESPB group (P < 0.05). There was no
significant difference between static VAS scores at the fourth hour. There
were no differences between adverse effects. Block procedure time and
one-Time puncture success were similar between groups (P > 0.05 each).
 Conclusion(s): US-guided ESPB may provide better pain control than
SAPB after VATS. Question: Even though there are studies about analgesia
management after VATS, clinicians want to perform the technique that is
both less invasive and more effective. Finding(s): This randomized
trial showed that US-guided ESPB provides effective analgesia compared
with SAPB. Meaning: Performing single-injection ESPB reduces VAS scores
and opioid consumption compared with SAPB. Copyright © 2020
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.

<67>
Accession Number
633047628
Title
Management of Anticoagulation in Pregnant Women with Mechanical Heart
Valves.
Source
Obstetrical and Gynecological Survey. 75 (3) (pp 190-198), 2020. Date of
Publication: 01 Mar 2020.
Author
Daughety M.M.; Zilberman-Rudenko J.; Shatzel J.J.; McCarty O.J.T.;
Raghunathan V.; Deloughery T.G.
Institution
(Daughety) Hematology and Medical Oncology, Duke University Medical
Center, Durham, NC, United States
(Zilberman-Rudenko) Oregon Health and Science University, Portland, OR,
United States
(Shatzel) Department of Biomedical Engineering, Division of Hematology and
Medical Oncology, Department of Hematology and Oncology, Oregon Health and
Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239,
United States
(McCarty) Department of Biomedical Engineering, Portland, OR, United
States
(Raghunathan) Division of Hematology and Medical Oncology, Portland, OR,
United States
(Deloughery) Department of Medicine, Oregon Health and Science University,
Portland, OR, United States
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Importance Mechanical heart valves (MHVs) pose significant thrombogenic
risks to pregnant women and their fetuses, yet the choice of
anticoagulation in this clinical setting remains unclear. Various
therapeutic strategies carry distinct risk profiles that must be
considered when making the decision about optimal anticoagulation.
Objective We sought to review existing data and offer recommendations for
the anticoagulation of pregnant women with MHVs, as well as management of
anticoagulation in the peripartum period. Evidence Acquisition We
performed a literature review of studies examining outcomes in pregnant
women receiving systemic anticoagulation for mechanical valves, and also
reviewed data on the safety profiles of various anticoagulant strategies
in the setting of pregnancy. Results Warfarin has been shown to increase
rates of embryopathy and fetal demise, although it has traditionally been
the favored anticoagulant in this setting. Low-molecular-weight heparin,
when dosed appropriately with close therapeutic monitoring, has been shown
to be safe for both mother and fetus. Conclusions and Relevance We favor
the use of low-molecular-weight heparin with appropriate dosing and
monitoring for the anticoagulation of pregnant women with MHVs. Data
suggest that this approach minimizes the thrombotic risk associated with
the valve while also providing safe and effective anticoagulation that can
be easily managed in the peripartum period. Target Audience Obstetricians
and gynecologists, family physicians. Learning Objectives After completing
this activity, the learner should be better able to: describe the clinical
considerations in choosing an anticoagulation strategy for a pregnant
patient with an MHV; evaluate the existing data about the safety profile
of various anticoagulation strategies and the potential benefits and risks
of each approach to the mother and fetus; and discuss one recommended
approach to management of mechanical valves in the pregnant patient and
assess the clinical nuances associated with each individual patient's
decision. Copyright © 2020 Wolters Kluwer Health, Inc. All
rights reserved.

<68>
Accession Number
633050525
Title
Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Heart Association. (pp e017460), 2020. Date of
Publication: 29 Sep 2020.
Author
Faroux L.; Junquera L.; Mohammadi S.; Del Val D.; Muntane-Carol G.; Alperi
A.; Kalavrouziotis D.; Dumont E.; Paradis J.-M.; Delarochelliere R.;
Rodes-Cabau J.
Institution
(Faroux, Junquera, Mohammadi, Del Val, Muntane-Carol, Alperi,
Kalavrouziotis, Dumont, Paradis, Delarochelliere, Rodes-Cabau) Quebec
Heart and Lung InstituteLaval University Quebec City Quebec Canada
Publisher
NLM (Medline)
Abstract
Background Some concerns remain regarding the safety of transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement. We
aimed to compare the risk of 30-day complications and death in
transcarotid/transsubclavian versus transfemoral transcatheter aortic
valve replacement recipients. Methods and Results Data from 20 studies,
including 79 426 patients (16 studies) and 3992 patients (4 studies) for
the evaluation of the unadjusted and adjusted impact of the arterial
approach were sourced, respectively. The use of a
transcarotid/transsubclavian approach was associated with an increased
risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI,
1.90-2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI,
1.05-2.22). The pooled results deriving from unadjusted data showed an
increased risk of 30-day death (RR, 1.46; 95% CI, 1.22-1.74) and bleeding
(RR, 1.53; 95% CI, 1.18-1.97) in patients receiving transcatheter aortic
valve replacement through a transcarotid/transsubclavian access (compared
with the transfemoral group), but the associations between the arterial
access and death (OR, 1.22; 95% CI, 0.89-1.69), bleeding (OR, 1.05; 95%
CI, 0.68-1.61) were no longer significant when using adjusted data. No
significant effect of the arterial access on vascular complication was
observed in unadjusted (RR, 0.84; 95% CI, 0.66-1.06) and adjusted (OR,
0.79; 95% CI, 0.53-1.17) analyses. Conclusions Transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement were
associated with an increased risk of stroke compared with the transfemoral
approach. However, these nonfemoral arterial alternative accesses were not
associated with an increased risk of 30-day death, bleeding, or vascular
complication when taking into account the confounding factors.

<69>
Accession Number
633048120
Title
Wound Infection after CABG Using Internal Mammary Artery Grafts: A
Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2020. Date of
Publication: 2020.
Author
Oswald I.; Boening A.; Pons-Kuehnemann J.; Grieshaber P.
Institution
(Oswald, Boening, Grieshaber) Department of Adult and Pediatric
Cardiovascular Surgery, Justus Liebig University Giessen, Giessen, Germany
(Pons-Kuehnemann) Institute of Medical Informatics, Department of Medical
Statistics, Justus Liebig University Giessen, Giessen, Germany
(Oswald) Department of Adult and Pediatric Cardiovascular Surgery, Justus
Liebig University Giessen, Rudolf-Buchheim-Strabetae 7, Giessen 35392,
Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Internal mammary arteries show better long-term patency rates
than venous grafts. The use of both mammary arteries is associated with a
higher risk of sternal wound infections. This meta-analysis was designed
to assess the incidence of a wound healing disorder after bilateral
compared with single mammary artery bypass grafting. Compared with
existing meta-analysis this paper includes more current literature and one
randomized controlled trial. Methods A literature search was performed
using PubMed and the Cochrane Library. The quality of the articles was
assessed by the Newcastle Ottawa Scale. The odds ratio was used as a
measure of the chance of developing a wound healing disorder after
bilateral internal mammary artery (BIMA) surgery. Meta-analyses were
performed for different subgroups. Results Twenty studies met the quality
criteria, including one randomized controlled trial. The use of both
mammary arteries significantly increased the risk of superficial (odds
ratio [OR] 1.72) and deep (OR 1.75) wound healing disorder in the total
population (OR 1.80) as well as in the diabetic subgroup (OR 1.38) and
with both preparation techniques. The increased risk with BIMA grafting
was present independently of the preparation technique (pedicled: OR 1.89,
skeletonized: OR 1.37). Conclusion Bilateral internal mammary artery
grafting, especially in high-risk and diabetic patients, is associated
with an increased risk of wound healing impairment. Skeletonized
preparation does not eliminate the elevated wound healing disorder risk
after BIMA use. Copyright © 2020 Georg Thieme Verlag. All rights
reserved.

<70>
Accession Number
2006907476
Title
Comparing anticoagulation therapy alone versus anticoagulation plus single
antiplatelet drug therapy after transcatheter aortic valve implantation in
patients with an indication for anticoagulation: a systematic review and
meta-analysis.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2020. Date of
Publication: 2020.
Author
Zhu Y.; Meng S.; Chen M.; Jia R.; Nan J.; Li H.; Zhu H.; Li L.; Jin Z.
Institution
(Zhu, Chen, Li, Zhu, Jin) Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing 100029, China
(Meng, Jia, Nan, Li, Jin) Department of Cardiology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
Publisher
Springer
Abstract
Purpose: This meta-analysis compared the efficacy and safety of oral
anticoagulation (OAC) therapy alone versus OAC plus single antiplatelet
therapy (SAPT) in patients with an indication for chronic OAC (mostly due
to atrial fibrillation) after transcatheter aortic valve implantation
(TAVI). Method(s): A systematic literature search was performed in
the PubMed, Embase, and Cochrane Library databases to identify relevant
studies. Data was extracted from the eligible studies and outcomes
expressed as relative risks (RRs) with 95% confidence intervals (CIs).
 Result(s): Five studies comprising 1344 patients with an indication
for chronic OAC and undergoing TAVI were included. Of the 1344 patients,
480 patients received OAC therapy alone and 864 patients received OAC plus
SAPT. There were no significant differences between OAC alone versus OAC
plus SAPT in all-cause mortality (RR = 1.05, 95% CI 0.84-1.30, p = 0.69)
and ischemic stroke (RR = 0.95, 95% CI 0.95-1.61, p = 0.86). However, OAC
alone was associated with significantly lower risks of all bleeding events
(RR = 0.62, 95% CI 0.49-0.69, p < 0.0001) and major and/ life-threatening
bleeding events (RR = 0.57, 95% CI 0.42-0.76, p = 0.0002) compared to OAC
plus SAPT. Conclusion(s): In patients with an indication for chronic
anticoagulation, post-TAVI antithrombotic therapy with OAC alone compared
to OAC plus SAPT may be not significantly different in reducing all-cause
mortality and ischemic stroke, but has an important benefit in a
significantly lower risk of all bleeding and major and/life-threatening
bleeding events. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<71>
Accession Number
2006897670
Title
Preoperative extracorporeal membrane oxygenation for postinfarction
ventricular septal defect: Case series of three patients with a literature
review.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Artemiou P.; Gasparovic I.; Bezak B.; Hudec V.; Glonek I.; Hulman M.
Institution
(Artemiou, Gasparovic, Bezak, Hudec, Glonek, Hulman) Department of Cardiac
Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular
Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
The mortality rate after the development of postinfarction ventricular
septal defect (VSD) remains high, despite progress in pharmacologic
therapy, invasive cardiology, and surgical techniques. We present three
cases of preoperative venoarterial extracorporeal membrane oxygenation as
a bridge to reparative surgical repair in patients with cardiogenic shock
who would otherwise require emergent cardiac surgery with an associated
risk. Two patients were discharged, whereas the third patient died due to
pulmonary artery rupture after a right ventricular assist device
implantation, despite the fact that he had a successful bridge to
reparative surgery and VSD repair. Finally, a review of the current
literature concerning the use of preoperative venoarterial extracorporeal
membrane oxygenation as a bridge to reparative surgery is
provided. Copyright © 2020 Wiley Periodicals LLC

<72>
Accession Number
2006893205
Title
Off-pump versus on-pump redo coronary artery bypass grafting: a systematic
review and meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Zhang P.; Wang L.; Zhai K.; Huang J.; Wang W.; Ma Q.; Liu D.; Gao B.; Li
Y.
Institution
(Zhang, Wang, Zhai, Huang, Wang, Ma, Liu, Gao, Li) Department of Cardiac
Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou,
China
(Zhang, Zhai, Huang, Li) Laboratory of Extracorporeal Life Support,
Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Redo coronary artery bypass grafting (redo CABG) is associated
with increased mortality and morbidity. The aim of this study was to
systematically evaluate the evidence comparing the outcomes of off-pump
with on-pump redo CABG. Method(s): Studies were systematically
searched and identified using PubMed, EMBASE, the Cochrane Library, and
the International Clinical Trials Registry Platform (ICTRP) by two
researchers independently. The primary outcome was 30-day mortality, and
the secondary outcomes were in-hospital mortality, post-operative
complications, completeness of revascularization, blood transfusion rate,
duration of mechanical ventilation, intensive care unit and hospital
stays. Result(s): The 21 studies including 4,889 patients were
enrolled in our meta-analysis. Compared with on-pump, the off-pump
technique was associated with significantly reduced 30-day mortality (odds
ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001).
Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI =
0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial
fibrillation, myocardial infarction, acute kidney injury, low cardiac
output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p <
0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI =
0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR =
0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration
of mechanical ventilation, intensive care unit and hospital stays (mean
difference [MD] = -8.21 h, 95% CI = -11.74 to -4.68, p < 0.00001; MD =
-0.77 d, 95% CI = -0.81 to -0.73, p < 0.00001; MD = -2.24 d, 95% CI =
-3.17 to -1.32, p < 0.00001) could be observed when comparing the outcomes
of off-pump with on-pump redo CABG. There was nonsignificant difference
between off-pump and on-pump redo CABG in completeness of
revascularization. Conclusion(s): In patients undergoing redo CABG
surgery, the off-pump technique was associated with decreased mortality,
less post-operative complications when compared to on-pump. Copyright
© The Author(s) 2020.

<73>
Accession Number
2006893055
Title
Ultrasound versus thoracoscopic-guided paravertebral block during
thoracotomy.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Hegazy M.A.; Awad G.; Abdellatif A.; Saleh M.E.; Sanad M.
Institution
(Hegazy) Department of Anesthesia and Intensive Care, Faculty of Medicine,
Mansoura University, Egypt
(Awad, Abdellatif, Saleh, Sanad) Department of Cardiothoracic Surgery,
Faculty of Medicine, Mansoura University, Egypt
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: Paravertebral block can be performed with the aid of surgical
landmarks, ultrasound, or a thoracoscope. This study was designed to
compare ultrasound-guided paravertebral block with the thoracoscopic
technique. Method(s): This prospective randomized comparative study
included 40 adults scheduled for elective thoracic surgery. Study
participants were randomized to an ultrasound group or a thoracoscope
group. A catheter for paravertebral block was inserted prior to
thoracotomy with real-time ultrasound visualization in the ultrasound
group, and under thoracoscopic guidance in the thoracoscope group. Total
analgesic consumption, visual analogue pain score, technical difficulties,
and complications were compared between the 2 groups. Result(s):
Total analgesic consumption in the first 24 hours was less in the
ultrasound group than in the thoracoscope group (rescue intravenous
fentanyl 121.25 +/- 64.01 microg in the ultrasound group vs. 178.75 +/-
91.36 microg in the thoracoscope group; p = 0.027). Total paravertebral
bupivacaine consumption was 376.00 +/- 33.779 mg in the ultrasound group
and 471.50 +/- 64.341 mg in the thoracoscope group (p < 0.001). Technical
difficulties and complications in terms of time consumed during the
maneuver, more than one needle pass, and pleural puncture were
significantly lower in the ultrasound group than in the thoracoscope
group. Conclusion(s): Ultrasound-guided paravertebral catheter
insertion is more effective, technically easier, and safer than the
thoracoscope-assisted technique. Copyright © The Author(s) 2020.

<74>
Accession Number
2006892966
Title
Diagnostic accuracy of viscoelastic point-of-care identification of
hypofibrinogenaemia in cardiac surgical patients: A systematic review.
Source
Anaesthesia and Intensive Care. (no pagination), 2020. Date of
Publication: 2020.
Author
Gibbs N.M.; Weightman W.M.
Institution
(Gibbs, Weightman) Department of Anaesthesia, Sir Charles Gairdner
Hospital, Nedlands, Australia
(Gibbs) The University of Western Australia, Nedlands, Australia
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Hypofibrinogenaemia during cardiac surgery may increase blood loss and
bleeding complications. Viscoelastic point-of-care tests provide more
rapid diagnosis than laboratory measurement, allowing earlier treatment.
However, their diagnostic test accuracy for hypofibrinogenaemia has never
been reviewed systematically. We aimed to systematically review their
diagnostic test accuracy for the identification of hypofibrinogenaemia
during cardiac surgery. Two reviewers assessed relevant articles from
seven electronic databases, extracted data from eligible articles and
assessed quality. The primary outcomes were sensitivity, specificity and
positive and negative predictive values. A total of 576 articles were
screened and 81 full texts were assessed, most of which were clinical
agreement or outcome studies. Only 10 diagnostic test accuracy studies
were identified and only nine were eligible (ROTEMdelta 7; TEG5000 1;
TEG6S 1, n = 1820 patients) (ROTEM, TEM International GmbH, Munich,
Germany; TEG, Haemonetics, Braintree, MA, USA). None had a low risk of
bias. Four ROTEM studies with a fibrinogen threshold less than 1.5-1.6 g/l
and FIBTEM threshold A10 less than 7.5-8 mm had point estimates for
sensitivity of 0.61-0.88; specificity 0.54-0.94; positive predictive value
0.42-0.70; and negative predictive value 0.74-0.98 (i.e. false positive
rate 30%-58%; false negative rate 2%-26%). Two ROTEM studies with higher
thresholds for both fibrinogen (<2 g/l) and FIBTEM A10 (<9.5 mm) had
similar false positive rates (25%-46%), as did the two TEG studies
(15%-48%). This review demonstrates that there have been few diagnostic
test accuracy studies of viscoelastic point-of-care identification of
hypofibrinogenaemia in cardiac surgical patients. The studies performed so
far report false positive rates of up to 58%, but low false negative
rates. Further diagnostic test accuracy studies of viscoelastic
point-of-care identification of hypofibrinogenaemia are required to guide
their better use during cardiac surgery. Copyright © The
Author(s) 2020.

<75>
Accession Number
2006892770
Title
The effect of advanced recovery room care on postoperative outcomes in
moderate-risk surgical patients: a multicentre feasibility study.
Source
Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Ludbrook G.; Lloyd C.; Story D.; Maddern G.; Riedel B.; Richardson I.;
Scott D.; Louise J.; Edwards S.
Institution
(Ludbrook, Lloyd, Maddern) Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, Australia
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Riedel, Richardson) Department of Anaesthetics, Peri-operative and Pain
Medicine, the Peter MacCallum Cancer Centre, University of Melbourne,
Melbourne, Australia
(Scott) School of Medicine, Western Sydney University, Sydney, Australia
(Louise, Edwards) Adelaide Health Technology Assessment, University of
Adelaide, Adelaide, Australia
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Postoperative complications are common and may be under-recognised. It has
been suggested that enhanced postoperative care in the recovery room may
reduce in-hospital complications in moderate- and high-risk surgical
patients. We investigated the feasibility of providing advanced recovery
room care for 12-18 h postoperatively in the post-anaesthesia care unit.
The primary hypothesis was that a clinical trial of advanced recovery room
care was feasible. The secondary hypothesis was that this model may have a
sustained impact on postoperative in-hospital and post-discharge events.
This was a multicentre, prospective, feasibility before-and-after trial of
moderate-risk patients (predicted 30-day mortality of 1-4%) undergoing
non-cardiac surgery and who were scheduled for postoperative ward care.
Patients were managed using defined assessment checklists and goals of
care in an advanced recovery room care setting in the immediate
postoperative period. This utilised existing post-anaesthesia care unit
infrastructure and staffing, but extended care until the morning of the
first postoperative day. The advanced recovery room care trial was deemed
feasible, as defined by the recruitment and per protocol management of >
120 patients. However, in a specialised cancer centre, recruitment was
slow due to low rates of eligibility according to narrow inclusion
criteria. At a rural site, advanced recovery room care could not be
commenced due to logistical issues in establishing a new model of care. A
definitive randomised controlled trial of advanced recovery room care
appears feasible and, based on the indicative data on outcomes, we believe
this is warranted. Copyright © 2020 Association of Anaesthetists

<76>
Accession Number
2006888072
Title
Impact of lipid levels and high-intensity statins on vein graft patency
after CABG: Midterm results of the ACTIVE trial.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Division of Cardiac Surgery, Boca Raton Regional
Hospital, Florida Atlantic University, Boca Raton, FL, United States
(Ruel) Division of Cardiac Surgery, The University of Ottawa Heart
Institute, Ottawa, ON, Canada
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: High-dose atorvastatin did not improve 1-year vein graft
patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft
Events trial. However, it remains unknown whether high-intensity statins
may impact graft disease in the years that follow. Method(s): In the
trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80
mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the
choice of statin was left to the patient's physician. In this study of
participants who agreed to follow-up (N = 76), low-density lipoprotein
(LDL) levels were measured and graft patency was assessed 3 years after
surgery. Result(s): The rate of vein graft disease 3 years after
surgery was not significantly reduced with atorvastatin 80 mg during the
first postoperative year or the use of open-label high-intensity statin
thereafter (p = NS). However, a trend was observed between higher LDL
levels during the first postoperative year and a greater incidence of vein
graft disease at 3 years (p =.12). Among patients who had LDL levels more
than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease
at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl
(p =.15). Higher mean LDL levels during the first postoperative year were
associated with a higher rate of vein disease 3 years after surgery both
at the graft level (p =.03) and at the patient level (p =.03) in
multivariate analysis. Conclusion(s): Higher LDL levels during the
first postoperative year were associated with significantly greater vein
graft disease 3 years after CABG. Copyright © 2020 Wiley
Periodicals LLC

<77>
Accession Number
2006876233
Title
Effects of different mean arterial pressure targets on plasma volume, ANP
and glycocalyx-A randomized trial.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2020. Date of
Publication: 2020.
Author
Damen T.; Saadati S.; Forssell-Aronsson E.; Hesse C.; Bentzer P.; Ricksten
S.-E.; Nygren A.
Institution
(Damen, Ricksten, Nygren) Department of Anaesthesiology and Intensive Care
Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Damen, Ricksten, Nygren) Section of Cardiothoracic Anaesthesia and
Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
(Saadati, Forssell-Aronsson) Department of Radiation Physics, Institute of
Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Forssell-Aronsson) Department of Medical Physics and Biomedical
Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
(Hesse) Department of Laboratory Medicine, Institute of Biomedicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Bentzer) Department of Anaesthesia and Intensive Care, Helsingborg
Hospital, Helsingborg and Lund University, Helsingborg, Sweden
(Bentzer) Department of Clinical Sciences, Anaesthesiology, Lund
University, Lund, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Arterial haematocrit (Hct) has been shown to decrease after
anaesthesia induction, most probably because of an increased plasma volume
(PV). The primary objective was to quantify change in PV if mean arterial
pressure (MAP) was kept at baseline level or allowed to decrease to 60 mm
Hg. Our secondary objective was to evaluate underlying mechanisms of this
response. Method(s): Twenty-four coronary artery bypass patients were
randomized to a higher (90 mm Hg, intervention group) or lower (60 mm Hg,
control group) MAP by titration of norepinephrine. During the experimental
procedure, no fluids were administered. Baseline PV was measured by
125I-albumin and the change in PV was calculated from the
change in Hct. Changes in MAP, plasma 125I-albumin, colloid
osmotic pressure, albumin, Mid Regional-pro Atrial Natriuretic Peptide
(MR-proANP) and endothelial glycocalyx components were measured from
baseline to 50 minutes after anaesthesia induction. Result(s): The
MAP during the trial was 93 +/- 9 mm Hg in the intervention group and 62
+/- 5 mm Hg in the control group. PV increased with up to 420 +/- 180 mL
in the control group and 45 +/- 130 mL in the intervention group (P
<.001). Albumin and colloid osmotic pressure decreased significantly more
in the control group. MR-proANP increased in the control group but no
shedding of the glycocalyx layer was detected in either of the groups.
 Conclusion(s): Allowing mean arterial pressure to fall to 60 mm Hg
during anaesthesia induction, increases the plasma volume due to
reabsorption of interstitial water, with no ANP-induced degradation of the
endothelial glycocalyx. Copyright © 2020 The Authors. Acta
Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on
behalf of Acta Anaesthesiologica Scandinavica Foundation

<78>
Accession Number
2006875919
Title
Systematic review of the evaluation and management of coronary
pseudoaneurysm after stent implantation.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Hassan A.; Uretsky B.F.; Vargas Estrada A.M.; Hassan R.; Al-Hawwas M.;
Agarwal S.K.
Institution
(Hassan, Uretsky, Al-Hawwas, Agarwal) Department of Internal Medicine,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
(Uretsky, Al-Hawwas, Agarwal) Department of Internal Medicine, Central
Arkansas Veterans Health System, Little Rock, AR, United States
(Vargas Estrada) Department of Internal Medicine, Mercy Hospital, Fort
Smith, AR, United States
(Hassan) Department of Internal Medicine, Advocate Illinois Masonic
Medical Center, Chicago, IL, United States
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Pseudoaneurysm (PSA) formation is a rare but well-known complication of
coronary stenting. It develops after a procedural perforation disrupts the
integrity of the vessel wall but is contained by a single wall layer,
usually pericardium, extravascular thrombosis and later fibrosis. Medical
literature of PSA consists primarily of case reports. A systematic review
of pseudoaneurysm after coronary stenting was performed to summarize its
presentation, diagnostic imaging modalities, natural history, and
management approaches. Clinical presentations range from asymptomatic to
hemodynamic collapse, size from small to "giant," and treatment approaches
from surgical or percutaneous exclusion to "watchful waiting" and imaging
surveillance. Based on current information, a management algorithm is
provided recommending urgent to emergent exclusion for symptomatic PSA,
elective exclusion for large and giant PSA, and "watchful waiting" and
periodic imaging surveillance for small to moderate sized
PSA. Copyright © 2020 Wiley Periodicals LLC

<79>
Accession Number
362924095
Title
N-3 polyunsaturated fatty acids reduces post-operative atrial fibrillation
incidence in patients undergoing "on-pump" coronary artery bypass graft
surgery.
Source
Monaldi Archives for Chest Disease - Cardiac Series. 76 (2) (pp 93-98),
2011. Date of Publication: June 2011.
Author
Sorice M.; Tritto F.P.; Sordelli C.; Gregorio R.; Piazza L.
Institution
(Sorice, Tritto, Gregorio, Piazza) Department of Cardiac Surgery, S. Anna
e S. Sebastiano Hospital, Caserta, Italy
(Sorice, Tritto, Gregorio, Piazza) Via F. Palasciano, 81100 (CE), Italy
(Sordelli) Department of Cardiothoracic Sciences, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Sordelli) Via L. Bianchi, 80131 (NA), Italy
Publisher
Fondazione Salvatore Maugeri (Via Ferrata 8, Pavia 27100, Italy)
Abstract
Background: The aim of this study was to evaluate the efficacy of
preoperative and postoperative therapy with n-3 polyunsaturated fatty
acids in reducing the incidence of atrial fibrillation after coronary
artery bypass graft surgery. Method(s): 201 patients undergoing
coronary artery bypass graft surgery were randomized to 1) a control group
(105 patients), or 2) n-3 polyunsaturated fatty acids 2 g/day group (96
patients) for at least 5 days before surgery and until hospital discharge.
Groups were further subdivided in four subgroups according to the
operative technique: "off-pump"or "on-pump". The primary end point was to
evaluate the reduced incidence of postoperative in-hospital atrial
fibrillation in the (N-3 PUFA) group. Secondary end points were the impact
of the surgical technique on the incidence of postoperative arrhythmia and
the impact of n-3 polyunsaturated fatty acids therapy on post-operative
hospital length of stay. Result(s): The overall incidence of
post-operative atrial fibrillation was 17.4% (35/201). The arrhythmia
occurred in 11.4% (11/96) of the patients in therapy with n-3
polyunsaturated fatty acids and in 22.8% (24/105) in the control groups.
In particular, the statistical analysis of subgroups showed a significant
reduction of postoperative atrial fibrillation only in the group including
patients treated with n-3 polyunsaturated fatty acids undergoing "on-pump"
coronary artery bypass graft surgery. The length of hospital stay did not
differ among all groups. Conclusion(s): N-3 polyunsaturated fatty
acids administration significantly reduces the incidence of post-operative
atrial fibrillation in patients undergoing "on-pump" coronary artery
bypass graft surgery. N-3 polyunsaturated fatty acids therapy is not
associated with a shorter hospital stay.

<80>
Accession Number
632376315
Title
Effects of inhaled nitric oxide on haemodynamics and gas exchange in
children after having undergone cardiac surgery utilising cardiopulmonary
bypass.
Source
Cardiology in the Young. 30 (8) (pp 1151-1156), 2020. Date of Publication:
2020.
Author
Villarreal E.G.; Aiello S.; Evey L.W.; Flores S.; Loomba R.S.
Institution
(Villarreal, Evey, Flores) Texas Children's Hospital, Baylor School of
Medicine, Houston, TX, United States
(Villarreal) Tecnologico de Monterrey, Escuela de Medicina y Ciencias de
la Salud, Monterrey, Nuevo Leon, Mexico
(Aiello, Loomba) Chicago Medical School, Rosalind Franklin University of
Medicine and Science, North Chicago, IL, United States
(Loomba) Advocate Children's Hospital, Oak Lawn, IL, United States
Publisher
Cambridge University Press (E-mail: journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction: For CHD patients undergoing corrective surgery utilising
cardiopulmonary bypass, post-operative inhaled nitric oxide has been
administered to alleviate pulmonary hypertension. We performed a
systematic review and meta-analyses to determine the effect of inhaled
nitric oxide on haemodynamics, gas exchange, and hospitalisation
characteristics in children immediately after cardiopulmonary
bypass.Materials and methods: A systematic review of the literature was
performed to identify full-text manuscripts in English. PubMed, EMBASE,
and the Cochrane databases were queried. Once manuscripts were identified
for inclusion, a list of all the endpoints in each manuscript was created.
Endpoints with data present from two or more studies were then kept for
pooled analyses. All endpoints included were continuous variables and so
mean and standard deviation were utilised as the effect data for
comparison. Result(s): A total of eight studies were deemed
appropriate for inclusion. There were significant differences with
decreases in mean pulmonary artery pressure of -6.82 mmHg, left atrial
pressure of -1.16 mmHg, arteriovenous oxygen difference of -1.63, arterial
carbon dioxide concentration of -2.41 mmHg, mechanical ventilation
duration of -8.56 hours, and length of cardiac ICU stay duration of -0.91
days. All significant variables achieved p < 0.001. Conclusion(s):
Inhaled nitric oxide in children immediately after cardiopulmonary bypass
decreases mean pulmonary artery pressure significantly and decreases the
arterial carbon dioxide concentration significantly without significantly
altering other haemodynamic parameters. This results in a statistically
shorter duration of mechanical ventilation and cardiac ICU length of stay
without altering overall hospital length of stay. Copyright ©
2020 Cambridge University Press. All rights reserved.

<81>
Accession Number
633022640
Title
Prothrombin complex concentrate versus fresh frozen plasma in adults
undergoing heart surgery (PROPHESY) - A pragmatic pilot randomized
controlled trial.
Source
British Journal of Haematology. Conference: 60th Annual Scientific Meeting
of the British Society for Haematology. United Kingdom. 189 (Supplement 1)
(pp 152-153), 2020. Date of Publication: April 2020.
Author
Green L.; Roberts N.; Cooper J.; Chang I.; Gill R.; Klein A.; Agarwal S.;
Rossi A.; Sepehripour A.; Stanworth S.; Johnston A.; Monk V.; O'Brien B.
Institution
(Green) Blizard Institute, Barts and the London School of Medicine, Queen
Mary University of London
(Green) NHS Blood and Transplant
(Roberts, Rossi, Sepehripour, O'Brien) Barts Health NHS Trust
(Cooper, Chang, Johnston, Monk) William Harvey Research Institute, Barts
and the Royal London School of Medicine, Queen Mary University of London,
London, United Kingdom
(Gill) Southampton General Hospital, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
(Klein) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United
Kingdom
(Agarwal) Manchester Royal Infirmary, Manchester University NHS Foundation
Trust, Manchester, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust, Oxford,
United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH,
United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Fresh Frozen Plasma (FFP) is the standard treatment for
clotting factor replacement in bleeding patients undergoing cardiac
surgery in the UK. However, prothrombin complex concentrate (PCC) is being
used off-license in this setting due to higher concentration of clotting
factor levels, smaller volume, and more rapid administration as compared
to FFP. Method(s): PROPHESY is a pragmatic single-centre, pilot
randomized, controlled trial (RCT) that assessed the feasibility of a
large trial to compare FFP with PCC in cardiac surgery. The trial was
registered on the EudraCT database (2018-003041-41) and Clinicaltrials.gov
(NCT03715348). Primary outcome was to evaluate the proportion of subjects
who are consented and receive the intervention. Secondary objectives were
to assess the delivery of different components of the trial, protocol
violation/compliance and ability to collect outcome data up to 90 days
after surgery. Inclusion criteria: Adult patients (>=18 years, not on
vitamin-K antagonists) undergoing cardiac surgery who develop active
bleeding that requires FFP transfusion within 24 hours of surgery, were
randomized by the transfusion laboratory to FFP (15 ml/kg) or PCC (500 IU
if < 60 kg, 1000 IU if 61-90 kg, 1500 IU if > 90 kg) using block
randomization. If bleeding continued after administration of the first
study dose, standard care was administered (no subsequent PCC dose was
given). Followup was 90 days after surgery. Result(s): From January
2019 to November 2019, 180 patients were screened, of which 134 were
consented, 54 (40% recruitment rate) received an intervention (25 FFP and
29 PCC) and 50 were appropriately randomised (25 on each arm). Of those
that were randomised, the median age was 66 years (SD 12), 64% were male
and 76% (PCC arm) and 80% (FFP) had elective surgery. There were 18 trial
protocol deviations relating to randomisation (n = 10), intervention (n =
3), documentation (n = 2) and research blood samples collection (n = 3).
In randomised patients 113 adverse events (55 PCC vs. 58 FFP) and 19
serious adverse events (6 in 5 patients for PCC vs. 13 in 8 patients for
FFP) were reported. There was no increase in thromboembolic event relating
to PCC. Mean days alive and out of hospital within 90 days was 71.8 (SE =
1.8) for PCC and 73.8 (SE = 1.7) for FFP. No randomised patients were
withdrawn from the study, 5 were lost to follow-up and 4 died (2 FFP and 2
PCC). Follow-up data up to 90 days were collected in 89% of randomised
patients. Conclusion(s): There have been no RCTs to date that have
compared the efficacy/safety of FFP versus PCC in cardiac surgery patients
who are bleeding and this pilot study demonstrates that it is feasible to
perform a large trial in the future.

<82>
Accession Number
2007942124
Title
Comparative study of rotational atherectomy and endarterectomy in the
treatment of atheromatous lesions of the common femoral artery in presence
of a high hemorrhagic risk.
Source
Annals of Vascular Surgery. Conference: Selected papers from the Editorial
Board. United Kingdom. 68 (pp 128), 2020. Date of Publication: October
2020.
Author
Kashi-Dakhil M.; Bagan P.; Karrillon G.; Dakhil B.; Zaimy R.; Fourati M.;
Petitjean M.; Couffinhal J.C.
Publisher
Elsevier Inc.
Abstract
Objectives: Endarterectomy with or without patch angioplasty is regarded
as the treatment of reference of the stenoses of the common femoral artery
(CFA). However, the use of active stents in the treatment of acute
coronary syndromes (ACS) increases and requires the continuation of a
double antiplatelet aggregation (APA) during a minimum of three months.
Endovascular techniques as an alternative to conventional surgery might be
less invasive to treat these severe lesions of the CFA. We analyzed the
results of atherectomy in these patients at high hemorrhagic risk compared
to endarterectomy to treat CFA lesions in patients admitted for a critical
lower limb ischemia. Material(s) and Method(s): Patients hospitalized
between June 2017 and June 2018 for severe ischemia of the lower
extremities (Rutherford>IV) in relation with de novo CFA lesions and who
had recently undergone a percutaneous coronary revascularization were
included. The patients treated in center 1 had rotational atherectomy
(JetStream, Boston Scientific, USA) and angioplasty with an active
balloon. Patients managed in center 2 were treated by endarterectomy and
angioplasty with a xenoprosthetic patch (XenoSure Biologic Surgical Patch,
LeMaitre). The primary outcome was the morbidity related to the procedure
and the secondary outcomes were the durations of intervention and
hospitalization. Result(s): 14 patients were included, eight in the
conventional surgery group (C) and six in the atherectomy group (A), with
mean ages of 67 and 68 years, respectively. In each group, the patients
had similar risk factors. The rate of morbidity related to the procedure
was higher in group C (37%, hematomas, n=2; abscess, n = 1) compared to
group A (14%, one CFA false aneurysm), p=0.58. Average operative duration
was longer in group A (163min vs. 98min, p=0.0004) and the duration of
hospitalization was significantly shorter (1.2 vs. 5.2 days, p=0.007). All
the treated vessels were patent on echo-Doppler control at 18 months.
 Conclusion(s): The endovascular treatment of the CFA by atherectomy
appears to be more appropriate in patients at high-risk of local
complications (double APA, morbid obesity) presenting a severe ischemia. A
randomized study could confirm this observation. Copyright © 2020

<83>
Accession Number
2001036345
Title
Do We Still Need Wall Suction for Chest Drainage?.
Source
Heart Lung and Circulation. Conference: XXIV World Congress of Psychiatric
Genetics (WCPG). Israel. 27 (Supplement 3) (pp S502), 2018. Date of
Publication: 2018.
Author
Barozzi L.; Biagio L.S.; Meneguzzi M.; Courvoisier D.; Cregan I.; Walpoth
B.; Faggian G.
Institution
(Barozzi, Biagio, Meneguzzi, Courvoisier, Cregan, Walpoth, Faggian)
University of Verona, Verona, Italy
Publisher
Elsevier Ltd
Abstract
Purpose: Postoperative chest drainage systems are mostly based on water
seal and wall suction. A new, self-contained, electronic, continuous
pump-driven drainage system (nonstop suction from the operating room to
chest-tube removal) is compared with a traditional wall-suction system in
cardiac surgery. This new system is tested in a prospective, randomised
study. Methodology: In total, 120 adult elective cardiac patients
undergoing coronary artery bypass grafting and/or valve surgery were
randomised to the study group (n = 60 Thopaz + self-contained drainage
system; Medela AG, Switzerland) or control group (n = 60 wall suction
drainage system; Argyle Aqua-Seal [Covidien, Minneapolis, MN]). Unstable
angina, emergency procedures, and off-pump surgery were exclusion
criteria. Both groups had the same chest tubes sizes and similar
preoperative demographic criteria: age 67.8 vs 67.0 years, Euroscore 2.3
vs 2.2, and body surface area 1.92 vs 1.91 m2, respectively,
for the study and control groups. Comorbidity prevalence and length of
preoperative anticoagulation withdrawal interval were also similar.
 Result(s): Given homogenous intraoperative variables, total
chest-tube drainage was comparable among groups (566 vs 640 mL
[nonsignificant]), but the study group showed more efficient fluid
collection during the early postoperative phase and during transport to
the intensive care unit (p =.006 and p =.01) due to continuous suction.
Blood and cell-saver transfusions were similar in both groups.
Postoperative haemoglobin values showed no significant difference between
the two groups at the end of surgery, on day 1, and at discharge. The
study group also experienced quicker drain removal (29.8 vs 38.4 hours).
No patient had drain-related complications (pericardial effusion,
tamponade, pneumothorax). Conclusion(s): The new system showed more
efficient early drainage of the chest cavity and was as safe as
conventional systems. Quicker drain removal might impact on intensive care
unit stay and reduce costs. Additional advantages are portable size and
autonomous battery operation (i.e. allowing earlier patient mobility),
noiseless function, digital indications, and alarms. Copyright ©
2018

<84>
Accession Number
2007989674
Title
Erector spinae plane block: A narrative review with systematic analysis of
the evidence pertaining to clinical indications and alternative truncal
blocks.
Source
Journal of Clinical Anesthesia. 68 (no pagination), 2021. Article Number:
110063. Date of Publication: February 2021.
Author
Saadawi M.; Layera S.; Aliste J.; Bravo D.; Leurcharusmee P.; Tran D.Q.
Institution
(Saadawi, Tran) St. Mary's Hospital, Department of Anesthesiology, McGill
University, 3830 Ave Lacombe, Montreal, QC H3T-1M5, Canada
(Layera, Aliste, Bravo) Hospital Clinico Universidad de Chile, Department
of Anesthesiology and Perioperative Medicine, University of Chile, Office
B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago
8380456, Chile
(Leurcharusmee) Maharaj Nakorn Chiang Mai Hospital, Department of
Anaesthesiology, Chiang Mai University, 110 Intawarorot Street, Chiang Mai
50200, Thailand
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Study objective: This narrative review discusses the anatomy, mechanism of
action, techniques, pharmacology, indications, complications and
substitutes for erector spinae plane (ESP) blocks. Intervention(s):
The Medline, Embase and Google Scholar databases (inception-last week of
April 2020) were searched. For indications and alternative blocks, a
systematic analysis of the available evidence was carried out. In order to
highlight the best evidence available, only randomized trials with
prospective registration, blinded assessment and sample size justification
were retained for analysis. Main Result(s): The collective body of
anatomical studies suggests that ESP block may work through a combination
of different mechanisms (e.g., local anesthetic spread to the thoracic
paravertebral space, epidural space, and dorsal ramus). Compared to
control, the available evidence suggests that ESP block results in
decreased postoperative pain and opioid requirement for a wide array of
thoracic and abdominal surgical interventions. Erector spinae plane blocks
and thoracic paravertebral blocks seem to provide comparable benefits for
thoracoscopic and breast cancer surgery when performed with a similar
number of injections. Currently, ESP blocks should be favored over
intercostal blocks since, at best, the latter provide similar analgesia to
ESP blocks despite requiring multiple-level injections.
 Conclusion(s): In recent years, ESP blocks have become the topic of
considerable clinical interest. Future trials are required to investigate
their optimal technique, dose of local anesthetic and perineural
adjuvants. Moreover, additional investigation should compare ESP blocks
with robust multimodal analgesic regimens as well as truncal blocks such
as thoracic epidural block, midpoint transverse process to pleura block,
PECS block, quadratus lumborum block, and transversus abdominis plane
block. Copyright © 2020 Elsevier Inc.

<85>
Accession Number
2007865847
Title
A randomized trial of surgery alone versus surgery plus compression in the
treatment of venous leg ulcers in patients with primary venous
insufficiency.
Source
Vojnosanitetski Pregled. 77 (8) (pp 811-815), 2020. Date of Publication:
2020.
Author
Milic D.; Zivic S.; Golubovic M.; Bogdanovic D.; Lazarevic M.; Lazarevic
K.
Institution
(Milic, Zivic, Lazarevic) Clinical Center Nis, Clinic for Cardiovascular
and Transplant Surgery
(Golubovic, Bogdanovic) Center for Anesthesiology, Nis, Serbia
(Lazarevic) State University of Novi Pazar, Department of Biomedical
Sciences, Novi Pazar, Serbia
(Milic) University of Nis, Faculty of Medicine, Nis, Serbia
Publisher
Inst. Sci. inf., Univ. Defence in Belgrade (E-mail: vmaini1@eunet.yu)
Abstract
Background/Aim.Venous leg ulcers (VLU) are a significant health problem
worldwide. It is well known that VLU are difficult to treat and that they
have high tendency for recurrence. Compression therapy is the preferred
treatment modality but there is growing evidence that correction of
underlying venous disorder in early stages of the disease in addition to
compression treatment may improve ulcer healing and reduce recurrence
rate. Methods. An open, prospective, randomized, single-center study, with
a 6-months follow-up was performed to determine the efficacy of two
different treatment modalities (surgery alone versus surgery plus
compression) in the treatment of VLU in patients with primary venous
insufficiency. Patients with secondary venous insufficiency and/or
thrombosis were excluded from the study. Overall, 71 patients were
randomized (37 men, 34 women; mean age 60 years) into two groups: the
group A - 34 patients who underwent surgical intervention (stripping) and
postoperatively were treated with simple wound dressing only, and the
group B - 37 patients who underwent surgical intervention (stripping) and
wore a heelless open-toed elastic class III compression device knitted in
tubular form -Tubulcus (Laboratoires Innothera, Arcueil,
France). All patients in group B were instructed to wear compression
device continuously during the day and night. The study was performed at
the Clinic for Cardiovascular and Transplant Surgery, Clinical Centre Nis
(Serbia) with primary endpoint of the study being complete ulcer healing
at 180 days. Results. The healing rate was 29.41% (10/34) in the group A,
and 56.76% (21/37) in the group B (p < 0.01). Mean healing time in the
group A was 141 +/- 15 days, and in the group B it was 98 +/- 12 days
(Log-rank life table analysis: p < 0.001). Conclusion. This study suggests
that for VLU in patients with primary venous insufficiency, surgery plus
compression therapy provides higher healing rate and faster healing time
compared to surgery only. Copyright © 2020 Inst. Sci. inf., Univ.
Defence in Belgrade. All rights reserved.

<86>
Accession Number
2007982893
Title
Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic
Review and Meta-analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Eikelboom R.; Sanjanwala R.; Le M.-L.; Yamashita M.H.; Arora R.C.
Institution
(Eikelboom, Yamashita, Arora) Max Rady College of Medicine, University of
Manitoba, Winnipeg, Canada
(Sanjanwala, Yamashita, Arora) Cardiac Sciences Program, St. Boniface
Hospital, Winnipeg, MB, Canada
(Le) Libraries, University of Manitoba, Winnipeg, MB, Canada
(Yamashita, Arora) Institute of Cardiovascular Sciences, St. Boniface
Hospital Research Centre, Winnipeg, MB, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Postoperative atrial fibrillation (POAF) after cardiac surgery
is associated with longer hospital stay and increased in-hospital death
and stroke, but its long-term implications remain incompletely understood.
A systematic literature review was undertaken to investigate the impact of
POAF on long-term death and stroke in adult patients who undergo cardiac
operations. Method(s): Electronic databases (Cochrane, Embase, Ovid
MEDLINE, and PubMed) were queried from inception to October 2018. Included
studies compared long-term outcomes after cardiac operations in patients
with and without POAF. Adjusted and unadjusted meta-analyses examined
death, stroke, and major adverse cardiac and cerebrovascular events. Risk
of bias was evaluated with the Newcastle-Ottawa Scale. Result(s): The
inclusion criteria were met by 32 studies describing 155,575 patients who
had undergone cardiac operations. POAF occurred in 36,988 patients
(23.7%). Meta-analysis of 10 studies (44,367 patients) demonstrated
increased 1-year death in patients with POAF (odds ratio, 2.60; 95%
confidence interval, 2-3.38; P <.01). Aggregate adjusted hazard of death
(16 studies, n = 84,295) was also increased in patients with POAF (hazard
ratio, 1.25; 95% confidence interval, 1.2-1.3; P <.01).
 Conclusion(s): This systematic review and meta-analysis identified an
association between POAF and long-term death after cardiac surgery. More
comprehensive POAF prevention and management, including more stringent
follow-up for POAF recurrence after hospital discharge, may be indicated.
The included studies used inconsistent definitions of POAF and variable
exclusion criteria; however, estimates of heterogeneity are low.
Differences in preoperative comorbidities, such as age, ejection fraction,
and obesity, may not be fully accounted for in adjusted analyses. Future
work is required to delineate mechanisms linking POAF and death in this
population. Copyright © 2020

<87>
Accession Number
2007982671
Title
Restrictive or liberal transfusion for cardiac surgery: Spanish results of
a randomized multicenter international parallel open-label clinical trial.
Source
Medicina Intensiva. (no pagination), 2020. Date of Publication: 2020.
Author
Galan J.; Mateo E.; Carmona P.; Gajate L.; Mazer C.D.; Martinez-Zapata
M.J.
Institution
(Galan) Department of Anesthesia, Hospital de la Santa Creu I Sant Pau,
Barcelona, Spain
(Mateo) Department of Anesthesia, Consorcio Hospital General de Valencia,
Valencia, Spain
(Carmona) Department of Anesthesia, Hospital Universitario y Politecnico
La Fe de Valencia, Valencia, Spain
(Gajate) Department of Anesthesia, Hospital Ramon y Cajal, Madrid, Spain
(Mazer) Department of Anesthesia and LKSKI of Saint Michael's Hospital,
University of Toronto, Toronto, Canada
(Martinez-Zapata) Iberoamerican Cochrane-Centre-Clinical Epidemiology and
Health Service.IIB Sant Pau. CIBERESP, Barcelona, Spain
Publisher
Ediciones Doyma, S.L.

<88>
Accession Number
2007982523
Title
Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated
Meta-Analysis and Meta-Regression of Interventional Trials.
Source
Mayo Clinic Proceedings. (no pagination), 2020. Date of Publication: 2020.
Author
Bernasconi A.A.; Wiest M.M.; Lavie C.J.; Milani R.V.; Laukkanen J.A.
Institution
(Bernasconi) Global Organization for EPA and DHA Omega-3s (GOED), Salt
Lake City, UT, United States
(Wiest) Department of Statistical Science, University of Idaho, Moscow,
ID, United States
(Lavie, Milani) Department of Cardiovascular Diseases, John Ochsner Heart
and Vascular Institute, Ochsner Clinical School, The University of
Queensland School of Medicine, New Orleans, LA, United States
(Laukkanen) Institute of Public Health and Clinical Nutrition, University
of Eastern Finland, Kuopio, Finland, Faculty of Sport and Health Sciences,
University of Jyvaskyla, Jyvaskyla, Finland, Department of Medicine,
Central Finland Health Care District, Jyvaskyla, Finland
Publisher
Elsevier Ltd
Abstract
Objectives: To quantify the effect of eicosapentaenoic (EPA) and
docosahexaenoic (DHA) acids on cardiovascular disease (CVD) prevention and
the effect of dosage. Method(s): This study is designed as a random
effects meta-analysis and meta-regression of randomized control trials
with EPA/DHA supplementation. This is an update and expanded analysis of a
previously published meta-analysis which covers all randomized control
trials with EPA/DHA interventions and cardiovascular outcomes published
before August 2019. The outcomes included are myocardial infarction (MI),
coronary heart disease (CHD) events, CVD events (a composite of MI,
angina, stroke, heart failure, peripheral arterial disease, sudden death,
and non-scheduled cardiovascular surgical interventions), CHD mortality
and fatal MI. The strength of evidence was assessed using the Grading of
Recommendations Assessment, Development, and Evaluation framework.
 Result(s): A total of 40 studies with a combined 135,267 participants
were included. Supplementation was associated with reduced risk of MI
(relative risk [RR], 0.87; 95% CI, 0.80 to 0.96), high certainty number
needed to treat (NNT) of 272; CHD events (RR, 0.90; 95% CI, 0.84 to 0.97),
high certainty NNT of 192; fatal MI (RR, 0.65; 95% CI, 0.46 to 0.91]),
moderate certainty NNT = 128; and CHD mortality (RR, 0.91; 95% CI, 0.85 to
0.98), low certainty NNT = 431, but not CVD events (RR, 0.95; 95% CI, 0.90
to 1.00). The effect is dose dependent for CVD events and MI.
 Conclusion(s): Cardiovascular disease remains the leading cause of
death worldwide. Supplementation with EPA and DHA is an effective
lifestyle strategy for CVD prevention, and the protective effect probably
increases with dosage. Copyright © 2020 Mayo Foundation for
Medical Education and Research

<89>
Accession Number
2007982278
Title
IL-8 and CRP moderate the effects of preoperative psychological
interventions on postoperative long-term outcomes 6 months after CABG
surgery - The randomized controlled PSY-HEART trial.
Source
Brain, Behavior, and Immunity. (no pagination), 2020. Date of Publication:
2020.
Author
Salzmann S.; Euteneuer F.; Laferton J.A.C.; Shedden-Mora M.C.; Schedlowski
M.; Moosdorf R.; Rief W.
Institution
(Salzmann, Euteneuer, Laferton, Rief) Department of Clinical Psychology
and Psychotherapy, Philipps University of Marburg, Marburg, Germany
(Euteneuer) Clinical Psychology and Psychotherapy, Medical School Berlin,
Berlin, Germany
(Laferton) Department of Clinical Psychology and Psychotherapy,
Psychologische Hochschule Berlin, Berlin, Germany
(Shedden-Mora) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Schedlowski) Institute of Medical Psychology and Behavioral
Immunobiology, University Clinic Essen, Essen, Germany
(Schedlowski) Department of Clinical Neuroscience, Osher Center for
Integrative Medicine, Karolinska Institute, Stockholm 17177, Sweden
(Moosdorf) Department for Cardiovascular Surgery, Heart Center, Philipps
University of Marburg, Marburg, Germany
Publisher
Academic Press Inc. (E-mail: apjcs@harcourtbrace.com)
Abstract
Introduction: Inflammation has been related to several somatic and
psychological disorders and may moderate effects of psychological
interventions. In the PSY-HEART trial patients benefitted from
preoperative psychological interventions before undergoing coronary artery
bypass graft surgery (CABG) and, if necessary, concomitant valvular
surgery, compared to standard medical care. In this study we examined
whether patients' baseline inflammatory status moderated the intervention
effects. Material(s) and Method(s): In a prospective three-arm
randomized clinical trial with 6-months follow-up, 124 patients scheduled
for CABG surgery alone or concomitant with valvular surgery were
randomized to (i) standard medical care only (SMC) or two preoperative
psychological interventions: (ii) CBT-based optimizing expectations
(EXPECT) and an (iii) an active control group focusing on emotional
support (SUPPORT). Available baseline CRP- (n = 79), IL-6- (n = 78), IL-8-
(n = 78) and TNF-alpha-(n = 80) parameters were considered as potential
moderators (CRP as a categorical and continuous moderator). Linear mixed
model analyses were calculated to test whether baseline inflammatory
levels moderated intervention effects on disability, mental and physical
quality of life at 6 months after surgery. Result(s): IL-8 moderated
intervention effects on patients' disability and categorical CRP moderated
intervention effects on mental quality of life. Follow-up tests indicated
that EXPECT (and in part SUPPORT) led to lower postoperative disability
and higher mental quality of life compared to SMC in patients with low
baseline inflammatory markers. EXPECT indicated higher mental quality of
life compared to SUPPORT in the high CRP subgroup. Patients in the SMC
group had higher mental quality of life in the high CRP subgroup compared
to the low CRP subgroup. Conclusion(s): Especially for patients with
a lower inflammatory baseline status preoperative psychological
interventions might be helpful to optimize long-term CABG surgery
outcomes. Copyright © 2020 Elsevier Inc.

<90>
[Use Link to view the full text]
Accession Number
2007811781
Title
Effect of Rhythmic breathing on the Severity of Pain and Anxiety in
Patients after Coronary Artery Bypass Graft: a clinical trial study.
Source
Pakistan Journal of Medical and Health Sciences. 14 (2) (pp 1260-1265),
2020. Date of Publication: June 2020.
Author
Nasirnejad S.; Molavynejad S.; Jahani S.; Maraghi E.
Institution
(Nasirnejad, Molavynejad, Jahani) Nursing Care Research Center for Chronic
Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Maraghi) Assistant Professor of Biostatistics, Department of Statistics
and Epidemiology, School of Public Health, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Lahore Medical And Dental College (E-mail: nayyar_salam@yahoo.com)
Abstract
Aim: To determine the effects of rhythmic breathingon pain and anxiety in
patients after CABG. Design(s): Randomized clinical trial.
 Method(s): 102 patients undergoing CABG conveniently recruited from
ICU of Naft Grand Hospital's Department of Cardiac Surgery, Ahvaz, Iran.
Patients were randomly assigned to an intervention and a control group.
Then first day and on the second and third days after surgery the patients
were asked to exercise rhythmic breathing three times a day for 20 minutes
at 5-minute intervals. Data were collected using Numeric Rating scale and
Spielberger State-Trait Anxiety Inventory. The SPSS software (v. 16) was
used to analyze the data through the Chi-square, independent-sample t,
Wilcoxon, Mann-Whitney U, ANOVA and ANCOVA Results: The severity of pain
was significantly different in the intervention and control groups on the
first (p=0.036), second (P<0.001) and third (p=0.027) days. There was a
statistically significant difference between the two groups in terms of
anxiety levels before and after the intervention (p=0.001).
 Conclusion(s): Rhythmic breathing is recommended as a simple,
low-cost and non-invasive method that is accepted by the patients for
reducing the pain and anxiety after CABG. Copyright © 2020 Lahore
Medical And Dental College. All rights reserved.

<91>
Accession Number
2005112379
Title
Quality of life changes in acute coronary syndromes patients: A systematic
review and meta-analysis.
Source
International Journal of Environmental Research and Public Health. 17 (18)
(pp 1-28), 2020. Article Number: 6889. Date of Publication: 02 Sep 2020.
Author
Kaambwa B.; Gesesew H.A.; Horsfall M.; Chew D.
Institution
(Kaambwa, Gesesew, Horsfall, Chew) College of Medicine and Public Health,
Flinders University, Adelaide 5042, Australia
(Gesesew) Epidemiology, College of Health Sciences, Mekelle University,
Mekelle 231, Ethiopia
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
There is little up-to-date evidence about changes in quality of life
following treatment for acute coronary syndrome (ACS) patients. The main
aim of this review was to assess the changes in QoL in ACS patients after
treatment. We undertook a systematic review and meta-analysis of
quantitative studies. The search included studies that described the
change of QoL of ACS patients after receiving treatment options such as
percutaneous coronary intervention (PCI), coronary artery bypass grafting
(CABG) and medical therapy (MT). We synthesized findings using content
analysis and pooled the estimates using meta-analysis. We used the PRISMA
guidelines to select and appraise the studies and report the findings.
Twenty-nine (29) articles were included in the review. We found a
significant improvement of QoL in ACS patients after receiving treatment.
Particularly, the meta-analytic association found that the mean QoL of
patients diagnosed with ACS was higher after receiving treatment compared
to baseline (overall pooled mean difference = 31.88; 95% CI = 31.64-52.11,
I2 = 98) with patients on PCI having slightly lower QoL gains
(pooled mean difference = 30.22; 95% CI = 29.9-30.53, I2 = 0%)
compared to those on CABG (pooled mean difference = 34.01; 95% CI =
33.66-34.37, I2 = 0%). The review confirmed that QoL of ACS
patients improved after receiving treatment therapies although varied by
the treatment options and patients' preferences. This suggests the need to
perform further study on the QoL, patient preferences and physicians'
decision to prescription of treatment options. Copyright © 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<92>
Accession Number
2005082603
Title
Effect of sequential compression device on hemodynamic changes after
spinal anesthesia for caesarean section: A randomized controlled trial.
Source
Anesthesiology and Pain Medicine. 10 (5) (pp 1-6), 2020. Article Number:
e104705. Date of Publication: 2020.
Author
Javaherforooshzadeh F.; Pipelzadeh M.R.; Akhondzadeh R.; Adarvishi S.;
Alghozat M.
Institution
(Javaherforooshzadeh, Pipelzadeh, Akhondzadeh, Adarvishi) Ahvaz
Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Alghozat) Menopause Andropause Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute (E-mail: library@kowsarpub.com)
Abstract
Background: The benefit of sequential compression device (SCD) for the
prevention of hypotension after spinal anesthesia in cesarean sections has
not been determined. Objective(s): In this study, an attempt was made
to determine whether SCD can prevent hemodynamic changes following spinal
anesthesia for cesarean sections. Method(s): In a prospective
clinical trial, 76 parturient women undergoing elective cesarean sections
under spinal anesthesia were randomly divided into SCD or control groups.
The maternal hemodynamic changes within 75 min after spinal anesthesia,
nausea, vomiting, and neonatal Apgar score at 1 and 5 min were compared
between the groups. Result(s): There were no significant differences
between the groups in the patients' characteristics, maximum sensory
block, skin incision to delivery time, spinal anesthesia to delivery time
(min), and the total duration of surgery. Concerning heart rate changes,
RM ANOVA showed a significant difference in the effect of time, groups,
and the interaction of the two factors (P < 0.0001, P < 0.0001, and P <
0.0001, respectively). Tukey post hoc test showed that 3 min after spinal
anesthesia, diastolic blood pressure was significantly higher in the SCD
group than in the control group (P < 0.05). The SCD group had meaningfully
lower rates of nausea (P = 0.005) and vomiting (P = 0.001) than the
control group. The SCD group also demonstrated a significantly lower mean
ephedrine dosage per patient (4.1 mg against 17.1 mg, P = 0.001). However,
no significant difference was observed between the groups in terms of
neonatal Apgar scores at 1 and 5 minutes. Conclusion(s): This study
showed that SCD could reduce extensive changes in diastolic blood pressure
as an important hemodynamic parameter and the incidence of nausea and
vomiting. Thus, SCD can be used in spinal anesthesia care practices for
elective cesarean sections. Copyright © 2020, Author(s).

<93>
Accession Number
2006904582
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention in unprotected left main coronary artery disease: A
systematic review.
Source
Reviews in Cardiovascular Medicine. 21 (1) (pp 65-73), 2020. Date of
Publication: 30 Mar 2020.
Author
MacOvei L.; Magopet R.; Tanasa A.; Raileanu C.; Prisacariu C.; Presura
M.R.; Balasanian M.O.
Institution
(MacOvei, Magopet, Tanasa, Raileanu, Prisacariu, Balasanian) Institute of
Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, Iasi 700503,
Romania
(MacOvei, Tanasa, Prisacariu, Balasanian) University of Medicine and
Pharmacy Grigore T. Popa, Iasi 700115, Romania
(Presura) Cardiology Clinic of Piatra Neamt General Hospital, Neamt
610136, Romania
Publisher
IMR Press Limited (E-mail: tech@imrpress.org)
Abstract
This is an open access article under the CC BY-NC 4.0 license
(https://creativecommons.org/licenses/by-nc/4.0/). Critical lesion of the
unprotected left main coronary disease carries a tremendous mortality
burden, often associated with a diabetes status or multivessel disease,
with coronary artery bypass grafting being the standard treatment for over
40 years. Percutaneous coronary intervention with drug eluting stents
should be taken into consideration and could be a better option for
patients with low SYNTAX score as validated by the recently published
studies. This review summarizes the major randomized clinical trials and
meta-analyses concerning the debate regarding percutaneous coronary
intervention with drug eluting stents versus coronary artery bypass
grafting for unprotected left main coronary disease, along with the latest
European and American revascularization guidelines and tries to shed light
on this matter. The most results advocate that there is no convincing
difference in survival rate for both therapies, especially in patients
with isolated left main disease but with fewer major ischemic events for
coronary artery bypass grafting when compared with percutaneous coronary
intervention in multivessel coronary artery disease, at the rate of a
higher stroke incidence. The gaps in evidence are also highlighted,
especially the lack of randomized clinical trials with new generation drug
eluting stents versus coronary artery bypass grafting or those regarding
the best revascularization strategy for an acute coronary syndrome when
unprotected left main coronary disease is involved. Copyright ©
2020 IMR Press Limited. All rights reserved.

<94>
Accession Number
2005164124
Title
Effects of l-carnitine on serum lactate and cardiac complications in
patients with heart failure undergoing coronary artery bypass grafting: A
randomized clinical trial.
Source
Iranian Heart Journal. 21 (4) (pp 14-24), 2020. Date of Publication:
Autumn 2020.
Author
Jahangirifard A.; Farzanegan B.; Fani K.; Kermanshahi T.Z.; Faritus Z.;
Shojaeifard M.; Rad N.S.
Institution
(Jahangirifard) Department of Anesthesiology, Masih Daneshvari Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Farzanegan, Fani) Department of Anesthesiology, Modarres Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Kermanshahi) Department of Anesthesiology, Shohadaye Tajrish Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Faritus) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shojaeifard, Rad) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: The effects of L-carnitine on serum lactate and its metabolism
remain uncertain, particularly in candidates for revascularization with a
high likelihood of a postoperative rise in lactate levels. The present
study aimed to assess the effects of L-carnitine on lactate levels after
coronary artery bypass graft surgery (CABG) in patients with grade I heart
failure. Method(s): in this randomized clinical trial, 64 consecutive
patients suffering from mild heart failure (grade I) who were candidated
for coronary revascularization were randomly divided into 2 groups (32
patients in each group) receiving L-carnitine (3 g orally 2 hours before
surgery) or a placebo for the same duration before surgery. Postoperative
adverse events, as well as the trend of the change in the levels of serum
lactate, creatinine, and hemoglobin, within 24 hours after surgery were
assessed. Result(s): No difference was revealed between the 2 groups
in terms of serum lactate levels before surgery (1.51 +/- 0.79 in the
intervention group vs 1.35 +/- 0.43 in the control group; P = 0.33),
during intra-aortic balloon pumping (2.27 +/- 1.28 in the intervention
group vs 2.70 +/- 1.42 in the control group; P = 0.20), and also after
separating the pump (2.96 +/- 1.61 in the intervention group vs 2.56 +/-
0.87 in the control group; P = 0.22). No difference was also observed
concerning postoperative complications, including atrial fibrillation (P =
0.42), delirium (P = 0.99), agitation (P = 0.88), intra-aortic balloon
pump insertion (P = 0.99), atelectasis (P = 0.98), and respiratory
distress (P = 0.99). Conclusion(s): Administrating L-carnitine had no
protective effects on the rise in postoperative serum lactate levels
following CABG in our patients with low-grade heart failure. Copyright
© 2020, Iranian Heart Association. All rights reserved.

<95>
Accession Number
2005158925
Title
Severe aortic stenosis and attrwt amyloidosis - beware in the aging: A
case report and review of the literature.
Source
Clinical Interventions in Aging. 15 (pp 1863-1872), 2020. Date of
Publication: 2020.
Author
Adam R.; Munteanu A.; Mititelu R.; Onciul S.; Deleanu D.; Iliescu V.A.;
Popescu B.A.; Jurcut R.
Institution
(Adam, Deleanu, Popescu, Jurcut) Department of Cardiology, "Prof. Dr. C.
C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest,
Romania
(Adam, Onciul, Iliescu, Popescu, Jurcut) "Carol Davila" University of
Medicine and Pharmacy, Bucharest, Romania
(Munteanu) Department of Cardiology, Emergency University Central Military
Hospital, Bucharest, Romania
(Mititelu) Department of Nuclear Medicine, Emergency University Central
Military Hospital, Bucharest, Romania
(Onciul) Department of Cardiology, Clinical Emergency Hospital, Bucharest,
Romania
(Iliescu) Department of Cardiovascular Surgery, "Prof. Dr. C.C. Iliescu"
Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
Publisher
Dove Medical Press Ltd (E-mail: angela@dovepress.com)
Abstract
Degenerative aortic valve (AV) disease is the most frequent valvular heart
disease slowly progressing to severe aortic stenosis (AS) which usually
requires aortic valve replacement. Another frequent condition, especially
among elderly people, is cardiac amy-loidosis (CA), particularly the
wild-type transthyretin cardiac amyloidosis (ATTRwt). Since both of these
diseases are considered a marker of ageing, there is a significant
proportion of elderly patients who associate both severe AS and CA. Recent
studies reported a high prevalence of both severe AS and CA (AS-CA) in
elderly patients referred for TAVR of 13-16%, carrying a worse prognosis.
The present case illustrates the diagnostic algorithm and the management
of ATTRwt CA in an elderly patient with severe paradoxical low-flow
low-gradient AS, accompanied by a review of the current literature about
the red flags which help identifying CA in patients with severe AS, as
well as the prognosis and management of these disease
association. Copyright © 2020 Adam et al.

<96>
Accession Number
2007739488
Title
Effects of teriparatide and bisphosphonate on spinal fusion procedure: A
systematic review and network meta-analysis.
Source
PLoS ONE. 15 (9 September) (no pagination), 2020. Article Number:
e0237566. Date of Publication: September 2020.
Author
Cheng S.-H.; Kuo Y.-J.; Chen C.; Kang Y.-N.
Institution
(Cheng, Kuo) Department of Orthopedics, Wan Fang Hospital, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Cheng) Department of Orthopedics, Cheng Hsin General Hospital, Taipei,
Taiwan (Republic of China)
(Kuo) Department of Orthopedic Surgery, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen) Department of Public Health, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen, Kang) Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Chen) Division of Plastic Surgery, Department of Surgery, Wan Fang
Hospital, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen, Kang) Evidence-Based Medicine Center, Wan Fang Hospital, Taipei
Medical University, Taipei, Taiwan (Republic of China)
(Kang) Research Center of Big Data and Meta-Analysis, Wan Fang Hospital,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Kang) Institute of Health Policy & Management, College of Public Health,
National Taiwan University, Taipei, Taiwan (Republic of China)
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Giving patients anti-osteoporotic agents peri-operatively is a
well-accepted strategy to increase fusion rate and prevent complications.
The purpose of this study was to investigate effectiveness of teriparatide
and bisphosphonate on fusion surgery of thoracic and lumbar spine. Methods
We searched EMBASE and PubMed for randomized clinical trials (RCTs) and
prospective comparative studies using teriparatide or bisphosphonate in
peri-operative spinal fusion surgery. Our synthesized data of fusion rate,
Oswestry disability index (ODI), and adverse event in contrast-based
network meta-analysis. Pooled results were presented in risk ratio (RR) or
mean difference (MD) with 95% confidence interval (CI). Results Our search
hit eight RCTs and three prospective studies with 676 patients receiving
spinal surgery. Pooled result showed that teriparatide+Denosumab leads to
significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to
6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not
observe significant finding among placebo, teriparatide, and
bisphosphonate in the two network models. Conclusion This is the first
network meta-analysis providing an overview of the use of teriparatide and
bisphosphonate for spinal fusion surgery. Teriparatide treatments are
worth to be consider for spinal fusion surgery. Copyright © 2020
Cheng et al. This is an open access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<97>
Accession Number
2007794510
Title
Impact of Proportionality of Secondary Mitral Regurgitation on Outcome
After Transcatheter Mitral Valve Repair.
Source
JACC: Cardiovascular Imaging. (no pagination), 2020. Date of Publication:
2020.
Author
Karam N.; Lubos E.; Kalbacher D.; Braun D.; Deseive S.; Neuss M.; Butter
C.; Praz F.; Kassar M.; Petrescu A.; Pfister R.; Iliadis C.; Unterhuber
M.; Lurz P.; Thiele H.; Baldus S.; Stephan von Bardeleben R.; Blankenberg
S.; Massberg S.; Windecker S.; Hausleiter J.; Stolz L.; Orban M.; Nabauer
M.; Puscas T.; Tence N.; Latremouille C.; Westermann D.; Schofer N.;
Ludwig S.; Bannehr M.; Kucken T.; Edlinger C.; Hahnel V.; Brugger N.;
Pilgrim T.; Winkel M.G.; von Bardeleben S.; Korber M.; Mauri V.; Wosten
M.; Stephan Baldus C.M.; Noack T.; Borger M.; Blazek S.; Desch S.
Institution
(Orban, Braun, Deseive, Massberg, Hausleiter) Medizinische Klinik und
Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany
(Orban, Massberg, Hausleiter) Munich Heart Alliance, Partner Site German
Center for Cardiovascular Disease, Munich, Germany
(Karam) Department of Cardiology, European Hospital Georges Pompidou and
Paris Cardiovascular Research Center, INSERM U970, Paris, France
(Lubos, Kalbacher, Blankenberg) UKE Hamburg, Klinik und Poliklinik fur
Allgemeine und Interventionelle Kardiologie, Hamburg, Germany
(Neuss, Butter) Herzzentrum Brandenburg, Medizinische Hochschule
Brandenburg Theodor Fontane, Bernau, Germany
(Praz, Kassar, Windecker) Universitatsklinik fur Kardiologie, Inselspital,
Bern, Switzerland
(Petrescu, Stephan von Bardeleben) Zentrum fur Kardiologie, Johannes
Gutenberg-Universitat, Mainz, Germany
(Pfister, Iliadis, Baldus) Department III of Internal Medicine, Heart
Center, University of Cologne, Cologne, Germany
(Unterhuber, Lurz, Thiele) Department of Cardiology, Heart Center Leipzig
at University of Leipzig, Leipzig, Germany
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The purpose of this paper was to evaluate the impact of
proportionality of secondary mitral regurgitation (SMR) in a large
real-world registry of transcatheter edge-to-edge mitral valve repair
(TMVr) Background: Differences in the outcomes of recent randomized trials
of TMVr for SMR may be explained by the proportionality of SMR severity to
left ventricular (LV) volume. Method(s): The ratio of pre-procedural
effective regurgitant orifice area (EROA) to LV end-diastolic volume
(LVEDV) was retrospectively assessed in patients undergoing TMVr for
severe SMR between 2008 and 2019 from the EuroSMR registry. A recently
proposed SMR proportionality scheme was adapted to stratify patients
according to EROA/LVEDV ratio in 3 groups: MR-dominant (MD),
MR-LV-co-dominant (MLCD), and LV-dominant (LD). All-cause mortality was
assessed as a primary outcome, secondary heart failure (HF) outcomes
included hospitalization for HF (HHF), New York Heart Association (NYHA)
functional class, N-terminal pro-B-type natriuretic peptide (NT-proBNP),
6-min-walk distance, quality of life and MR grade. Result(s): A total
of 1,016 patients with an EROA/LVEDV ratio were followed for 22 months
after TMVr. MR was reduced to grade <=2+ in 92%, 96%, and 94% of patients
(for MD, MLCD, and LD, respectively; p = 0.18). After adjustment for
covariates including age, sex, diabetes, kidney function, body surface
area, LV ejection fraction, and procedural MR reduction (grade <=2+),
adjusted rates of 2-year mortality in MD patients did not differ from
those for MLCD patients (17% vs. 18%, respectively), whereas it was higher
in LD patients (23%; p = 0.02 for comparison vs. MD+MLCD). The adjusted
first HHF rate differed between groups (44% in MD, 56% in MLCD, 29% in LD;
p = 0.01) as did the adjusted time for first death or HHF rate (66% in MD,
82% in MLCD, 68% in LD; p = 0.02). Improvement of NYHA functional class
was seen in all groups (p < 0.001). Values for 6-min-walk distances,
quality of life and NT-proBNP improved in most patients.
 Conclusion(s): MD and MLCD patients had a comparable, adjusted 2-year
mortality rate after TMVr which was slightly better than that of LD
patients. Patients treated with TMVr had symptomatic improvement
regardless of EROA/LVEDV ratio. Copyright © 2020 American College
of Cardiology Foundation

<98>
Accession Number
632736772
Title
Efficiency of thyroid function test in the prediction of atrial
fibrillation following open heart surgery.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (7) (pp
740-744), 2020. Date of Publication: July 2020.
Author
Ozturk S.; Kayacioglu I.; Sensoz Y.; Ozdemir K.; Ozturk I.
Institution
(Ozturk, Kayacioglu, Sensoz, Ozdemir) Department of Cardiovascular
Surgery, Siyami Ersek Chest and Cardiovascular Surgery Education and
Research Hospital, Istanbul, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Objective: To analyse the efficiency of thyroid function tests (thyroid
stimulating hormone, thyroxine and tri-iodothyronine) on prediction of
postoperative atrial fibrillation. Study Design: Meta-analysis. Place
of Study: Siyami Ersek Chest and Cardiovascular Surgery Education and
Research Hospital, Istanbul, Turkey. Methodology: Literature review was
carried out in PubMed, Science Direct and Ovid Database. No date
limitations was applied. Trials, which evaluated the preoperative levels
of thyroid stimulating hormone, thyroxine and tri-iodothyronine in cardiac
surgery patients, were included. Only the articles in English language
were reviewed. We evaluated the results with fix or random effect models
according to the presence of heterogeneity (I2 >25%). Result(s): Five
hundred and forty-seven articles were obtained after screening of
databases. After checking over the titles and abstracts, five trials were
included which covered 380 patients and complied with inclusion criteria.
According to results of analysis, there was no significant relationship
between postoperative atrial fibrillation and thyroid stimulating hormone
(SMD: 0.38, 95%CI -0.46-1.23, p=0.375), and also thyroxine (SMD: 0.006,
95% CI -0.29-0.30, p=0.966). However, tri-iodothyronine (SMD: -1.06, 95%
CI -2.08- -0.03, p=0.04) was correlated with development of atrial
fibrillation. Heterogeneity was observed in three parameters
(I2; for TSH: 92.45%, for T3: 93.08% and for T4: 31.78%).
 Conclusion(s): Preoperative levels of tri-iodothyronine was an
effective parameter for predicting postoperative atrial fibrillation after
cardiac surgery, but there was a need of larger trials for eliminating
heterogeneity for all of the parameters of thyroid function
tests. Copyright © 2020 PeerJ Inc.. All rights reserved.

<99>
Accession Number
632556758
Title
Intraoperative cell salvage for obstetrics: A prospective randomized
controlled clinical trial.
Source
BMC Pregnancy and Childbirth. 20 (1) (no pagination), 2020. Article
Number: 452. Date of Publication: 07 Aug 2020.
Author
Liu Y.; Li X.; Che X.; Zhao G.; Xu M.
Institution
(Liu, Li, Che, Zhao, Xu) Department of Anaesthesiology, Beijing Obstetrics
and Gynecology Hospital, Capital Medical University, Beijing 100026, China
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: The latest basic studies and clinical evidence have confirmed
the safety and efficacy of intraoperative autologous blood cell
transfusion in cardiac surgery and orthopaedics. However, in caesarean
section, there are still concerns about the contamination of amniotic
fluid and foetal components, and consequently the application of
intraoperative autologous blood cell transfusion is not universal.
Therefore, this study aimed to evaluate the clinical value of
intraoperative autologous blood cell transfusion in obstetric surgery.
 Method(s): A prospective, randomized, controlled, feasibility study
was performed in women undergoing caesarean section. One hundred sixteen
participants were randomly assigned at a 1:1 ratio into either the
intraoperative cell salvage group or the control group. Allogeneic blood
cells were transfused into patients with haemoglobin concentrations < 80
g/dL in both the intraoperative cell salvage group and the control group.
 Result(s): No significant differences were found between the two
groups in age, weight, maternal parity, history of previous caesarean
section, gestational weeks of delivery, etc. However, compared with the
control group, patients in the intraoperative cell salvage group had a
significantly lower amount of allogeneic blood cell transfusion, lower
incidence of postoperative incision infection, delayed wound healing,
perioperative allergy, adverse cardiovascular events, hypoproteinaemia and
shorter hospital stay. Conclusion(s): The results of this study
suggest that the use of autologous blood cell transfusion is safe and
effective for patients with obstetric haemorrhage. Trial registration: All
procedures performed in studies involving human participants were in
accordance with the ethical standards of the Institutional and/or National
Research Committee of Beijing Obstetrics and Gynecology Hospital, Capital
Medical University (2016-XJS-003-01) as well as the 1964 Helsinki
Declaration and its later amendments or other comparable ethical
standards. The clinical trials were registered (ChiCTR-ICC-15,007,096) on
September 28, 2015. Copyright © 2020 The Author(s).

<100>
Accession Number
632905361
Title
Clinical situations for which 3D printing is considered an appropriate
representation or extension of data contained in a medical imaging
examination: Adult cardiac conditions.
Source
3D Printing in Medicine. 6 (1) (no pagination), 2020. Article Number: 24.
Date of Publication: 23 Sep 2020.
Author
Ali A.; Ballard D.H.; Althobaity W.; Christensen A.; Geritano M.; Ho M.;
Liacouras P.; Matsumoto J.; Morris J.; Ryan J.; Shorti R.; Wake N.;
Rybicki F.J.; Sheikh A.
Institution
(Ali, Rybicki) Department of Radiology, University of Cincinnati Medical
Center, Cincinnati, OH, United States
(Ballard) Mallinckrodt Institute of Radiology, Washington University
School of Medicine, Saint Louis, MO, United States
(Althobaity) King Faisal Specialist Hospital and Research Centre, Riyadh,
Saudi Arabia
(Christensen, Sheikh) Department of Radiology, Ottawa Hospital Research
Institute, University of Ottawa, Ottawa, ON, Canada
(Geritano) Boston Children's Hospital, Boston, MA, United States
(Ho) Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
(Liacouras) 3D Medical Applications Center, Walter Reed National Military
Medical Center, Washington, DC, United States
(Matsumoto, Morris) Department of Radiology, Mayo Clinic, Rochester, MN,
United States
(Ryan) Rady Children's Hospital, San Diego, CA, United States
(Shorti) Intermountain Healthcare, South Jordan, UT, United States
(Wake) Department of Radiology, Montefiore Medical Center, Bronx, NY,
United States
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Medical 3D printing as a component of care for adults with
cardiovascular diseases has expanded dramatically. A writing group
composed of the Radiological Society of North America (RSNA) Special
Interest Group on 3D Printing (SIG) provides appropriateness criteria for
adult cardiac 3D printing indications. Method(s): A structured
literature search was conducted to identify all relevant articles using 3D
printing technology associated with a number of adult cardiac indications,
physiologic, and pathologic processes. Each study was vetted by the
authors and graded according to published guidelines. Result(s):
Evidence-based appropriateness guidelines are provided for the following
areas in adult cardiac care; cardiac fundamentals, perioperative and
intraoperative care, coronary disease and ischemic heart disease,
complications of myocardial infarction, valve disease, cardiac
arrhythmias, cardiac neoplasm, cardiac transplant and mechanical
circulatory support, heart failure, preventative cardiology, cardiac and
pericardial disease and cardiac trauma. Conclusion(s): Adoption of
common clinical standards regarding appropriate use, information and
material management, and quality control are needed to ensure the greatest
possible clinical benefit from 3D printing. This consensus guideline
document, created by the members of the RSNA 3D printing Special Interest
Group, will provide a reference for clinical standards of 3D printing for
adult cardiac indications. Copyright © 2020 The Author(s).

<101>
Accession Number
632869011
Title
Revisiting the guidelines and choice the ideal substitute for aortic valve
endocarditis.
Source
Annals of Translational Medicine. 8 (15) (no pagination), 2020. Article
Number: 952. Date of Publication: 01 Aug 2020.
Author
Nappi F.; Singh S.S.A.; Spadaccio C.; Acar C.
Institution
(Nappi) Department of Cardiac Surgery, North Cardiological Center, 36 Rue
des Moulins Gemeaux, Saint-Denis 93200, France
(Singh, Spadaccio) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Singh, Spadaccio) University of Glasgow Institute of Cardiovascular and
Medical Sciences, Glasgow, United Kingdom
(Acar) Department of Cardiovascular Surgery, Heart Institute, La Pitie
Salpetriere Hospital, Paris, France
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Aortic valve replacement is the most commonly performed cardiac surgical
operation worldwide for infective endocarditis (IE). Long-term durability
and avoidance of infection relapse are the treatment goals. However, no
detailed guidelines on prosthesis selection and surgical strategy are
available. Management should be guided by a comprehensive evaluation of
infection extension and its microbiological characteristics, the clinical
profile of the patient and the risk of infection recurrence. We conducted
a literature search of the PubMed database, EMBASE and Cochrane Library
(through November 2019) for studies reporting to the use of biological
substitutes in aortic valve endocarditis (AVE). Studies comparing
long-term outcomes in the use of allogenic and autologous with
conventional prostheses were investigated. Conventional mechanical or
stented xenografts are the preferred choice for localized aortic
infection. In cases of complex IE with the involvement of the root or the
aorto-mitral continuity, the use of homografts are recommended, according
to surgeon's and center experience. Homograft use needs to be balanced
against the risk of structural degeneration. Prosthetic bioroot or
prosthetic valved conduit with a mechanical or bioprosthetic valve are
acceptable alternatives. The choice of aortic valves substitute and
surgical strategy in IE is multifaceted. Principles guiding the selection
of prosthesis and surgical approach rely on the long-term durability and
the avoidance of infection relapse. A decisional algorithm considering the
extension of the infection and its microbiological characteristics, the
clinical profile of the patient and the risk of infection recurrence is
provided. A multidisciplinary effort is required to achieve consistent
outcomes. Copyright © 2020 AME Publishing Company. All rights
reserved.

<102>
Accession Number
632868877
Title
Outcomes with percutaneous mitral repair vs. Optimal medical treatment for
functional mitral regurgitation: Systematic review.
Source
Annals of Translational Medicine. 8 (15) (no pagination), 2020. Article
Number: 962. Date of Publication: 01 Aug 2020.
Author
Cubero-Gallego H.; Hernandez-Vaquero D.; Avanzas P.; Almendarez M.; Adeba
A.; Lorca R.; Rozado J.; Escalera A.; Silva J.; Moris C.; Pascual I.
Institution
(Cubero-Gallego, Hernandez-Vaquero, Avanzas, Almendarez, Adeba, Lorca,
Rozado, Escalera, Silva, Moris, Pascual) Hospital Universitario Central de
Asturias, Heart Area, Oviedo, Spain
(Cubero-Gallego, Hernandez-Vaquero, Avanzas, Almendarez, Adeba, Lorca,
Rozado, Silva, Moris, Pascual) Instituto de Investigacion Sanitaria Del
Principado de Asturias, Oviedo, Spain
(Hernandez-Vaquero, Pascual) Functional Biology Department
(Avanzas, Moris) Departamento de Medicina, Universidad of Oviedo, Oviedo,
Spain
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Functional mitral regurgitation (MR) could be defined as a ventricular
disease where mitral valve is structurally normal, left chambers are
enlarged and mitral annulus is dilated with lack of coaptation of
leaflets. Transcatheter mitral valve repair technique has broadened the
therapeutic range in the treatment of severe MR. The aim of this study was
to review outcomes of MitraClip vs. medical treatment for functional MR.
We also planned to review the concept of functional MR, assessment of the
degree, prognosis and therapy options. This study followed the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. The Medline through PubMed database was used to search. The
present review included manuscripts published between January 2009 and
September 2019. Two authors independently screened titles and abstracts of
all publications, and performed the selection of studies and data
extraction. In the case of disagreements, consensus meetings reached the
final decision. Inclusion criteria were: (I) randomized controlled trials
and (II) works must compare MitraClip versus optimal medical treatment.
Transcatheter mitral valve repair along optimal medical treatment has been
compared with optimal medical therapy in two different randomized trials.
In the COAPT trial, the MitraClip group showed a significant reduction in
mortality and heart failure (HF) hospitalizations. In the MITRA-FR trial,
no significant differences were observed between both groups. We reviewed
important aspects of functional MR and performed a comprehensive review of
both trials comparing them and focusing on their
differences. Copyright © 2020 AME Publishing Company. All rights
reserved.

<103>
Accession Number
632998659
Title
Non-vitamin K antagonist oral anticoagulants (NOACs) after transcatheter
aortic valve replacement (TAVR): a network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2020 (10) (no pagination), 2020.
Article Number: CD013745. Date of Publication: 01 Oct 2020.
Author
Al Said S.; Kaier K.; Nury E.; Alsaid D.; Meder B.; Gibson C.M.; Bax J.;
Meerpohl J.J.; Katus H.
Institution
(Al Said, Meder, Katus) Department for Internal Medicine III Cardiology
Angiology and Pneumology, University Hospital Heidelberg, Heidelberg,
Germany
(Kaier) Institute for Medical Biometry and Statistics, Faculty of Medicine
and Medical Center, University of Freiburg, Freiburg, Germany
(Nury, Alsaid) Institute for Evidence in Medicine, Medical Center -
University of Freiburg, Faculty of Medicine, University of Freiburg,
Freiburg, Germany
(Al Said, Meder, Katus) DZHK (German Centre for Cardiovascular Research),
partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg,
Germany
(Gibson) Cardiology Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Meerpohl) Institute for Evidence in Medicine, Medical Center - University
of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To evaluate the efficacy and safety of NOACs
after TAVR in patients with and without an indication for anticoagulation.
An NMA will be conducted to assess the comparative effectiveness of
multiple interventions and to rank interventions after TAVR. Copyright
© 2020 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<104>
Accession Number
632831604
Title
Do perioperative protocols of enhanced recovery after cardiac surgery
improve postoperative outcome?.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (5) (pp 706-710),
2020. Date of Publication: 2020.
Author
Kamal Y.A.; Hassanein A.
Institution
(Kamal) Department of Cardiothoracic Surgery, Minia University, El-Minya,
Egypt
(Hassanein) Department of Anaesthesia and Intensive Care, Minia
University, El-Minya, Egypt
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether the application of an enhanced recovery
protocol or pathway improves patient outcomes after cardiac surgery. A
total of 3091 papers were found using the reported search. Finally, 12
papers represented the best available evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. Six studies referred to enhanced recovery protocol as fast
track (FT) and another 6 studies referred to it as enhanced recovery after
surgery (ERAS). Significant differences from conventional care were
reported for time to extubation or intubation time in 4 studies (3 FT, 1
ERAS), duration of intensive care unit stay in 6 studies (4 FT, 2 ERAS),
length of hospital stay (LOS) in 8 studies (5 FT, 3 ERAS), cost in 5
studies (4 FT, 1 ERAS), pain scores in 2 studies (2 ERAS) and opioid use
in 3 studies (3 ERAS). We conclude that FT or ERAS improve postoperative
outcomes including length of stay and pain control, without increasing
morbidity, mortality or readmission. However, there is a need for
prospective studies and standardized protocols. Copyright © The
Author(s) 2020.

<105>
Accession Number
632830806
Title
The role of fractional flow reserve in coronary artery bypass graft
surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (5) (pp 671-678),
2020. Date of Publication: 2020.
Author
Jayakumar S.; Bilkhu R.; Ayis S.; Nowell J.; Bogle R.; Jahangiri M.
Institution
(Jayakumar, Bilkhu, Nowell, Jahangiri) Department of Cardiothoracic
Surgery, St George's Hospital, London, United Kingdom
(Ayis) Department of Biostatistics, King's College London, London, United
Kingdom
(Bogle) Department of Cardiology, Clinical Academic Group, St George's
Hospital, London, United Kingdom
(Jahangiri) Department of Cardiothoracic Surgery, St George's Hospital,
Blackshaw Road, London SW17 0QT, United Kingdom
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
OBJECTIVES: Fractional flow reserve (FFR) measures the drop in perfusion
pressure across a stenosis, therefore representing its physiological
effect on myocardial blood flow. Its use is widespread in percutaneous
coronary interventions, though its role in coronary artery bypass graft
(CABG) surgery remains uncertain. This systematic review and meta-analysis
aims to evaluate current evidence on outcomes following FFR-guided CABG
compared to angiography-guided CABG. METHOD(S): A literature search
was conducted following PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) guidelines to identify all relevant articles.
Patient demographics and characteristics were extracted. The following
outcomes were analysed: repeat revascularization, myocardial infarction
(MI) and all-cause mortality. Pooled relative risks were analysed and
their 95% confidence intervals (CIs) were estimated using random-effects
models; P-value <0.05 was considered statistically significant.
Heterogeneity was assessed with Cochran's Q score and quantified by
I2 index. RESULT(S): Nine studies with 1146 patients (FFR:
574, angiography: 572) were included. There was no difference in MI or
repeat revascularization between the 2 groups (relative risk 0.76, 95% CI
0.41-1.43; P = 0.40, and relative risk 1.28, 95% CI 0.75-2.19; P = 0.36,
respectively). There was a significant reduction in all-cause mortality in
the FFR-guided CABG group compared to angiography-guided CABG, which was
not specifically cardiac related (relative risk 0.58, 95% CI 0.38-0.90; P
= 0.02). CONCLUSION(S): There was no reduction in repeat
revascularization or postoperative MI with FFR. In this fairly small
cohort, FFR-guided CABG provided a reduction in mortality, but this was
not reported to be due to cardiac causes. There may be a role for FFR in
CABG, but large-scale randomized trials are required to establish its
value. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<106>
Accession Number
632820527
Title
Intravenous iron therapy for patients with preoperative iron deficiency or
anaemia undergoing cardiac surgery reduces blood transfusions: A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (2) (pp 141-151),
2020. Date of Publication: 01 Aug 2020.
Author
Gupta S.; Panchal P.; Gilotra K.; Wilfred A.M.; Hou W.; Siegal D.;
Whitlock R.P.; Belley-Cote E.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, Hamilton,
ON, Canada
(Gupta, Whitlock) Department of Health Research Methods, Evidence and
Impact, McMaster University, Hamilton, ON, Canada
(Panchal, Gilotra, Wilfred, Hou) Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Siegal, Belley-Cote) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Siegal, Whitlock, Belley-Cote) Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) David Braley Cardiac, Vascular and Stroke Research
Institute, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
OBJECTIVES: The benefits of preoperative intravenous (IV) iron treatment
in cardiac surgery patients with preoperative anaemia or iron deficiency
have not been well-established. We performed a systematic review and
meta-analysis to determine the effects of treating preoperative anaemia or
iron deficiency with IV iron in adult cardiac surgery patients.
 METHOD(S): We searched Cochrane Central Register of Controlled
Trials, Medical Literature Analysis and Retrieval Systems Online and
Excerpta Medica Database for randomized controlled trials (RCTs) and
observational studies comparing IV iron to oral iron or no iron. We
performed title and abstract, full-text screening, data extraction and
risk of bias assessment independently and in duplicate. We pooled data
using a random effects model and evaluated the overall quality of
evidence. RESULT(S): We identified 4 RCTs and 7 observational
studies. Pooled data from observational studies suggested a benefit of IV
iron compared to no iron on mortality [relative risk 0.39, 95% confidence
interval (CI) 0.23-0.65; P < 0.001, very low quality], units transfused
per patient (mean difference -1.22, 95% CI -1.85 to -0.60; P < 0.001, very
low quality), renal injury (relative risk 0.50, 95% CI 0.36-0.69; P <
0.001, very low quality) and hospital length of stay (mean difference
-4.24 days, 95% CI -6.86 to -1.63; P = 0.001, very low quality). Pooled
data from RCTs demonstrated a reduction in the number of patients
transfused with IV iron compared to oral or no iron (relative risk 0.81,
95% CI 0.70-0.94; P = 0.005, moderate quality). The pooled estimates of
effect from RCTs for mortality, hospital length of stay, units transfused
per patient and renal injury were consistent in direction with
observational studies. CONCLUSION(S): This meta-analysis suggests
that IV iron improves postoperative morbidity in adult cardiac surgery
patients with preoperative anaemia or iron deficiency. A large, rigorous,
placebo-controlled, double-blinded, multicentre trial is needed to clarify
the role of IV iron in this patient population. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<107>
Accession Number
632820497
Title
In patients undergoing dialysis who require a valve replacement is a
bioprosthetic valve superior to a mechanical prosthesis in terms of
long-term survival and morbidity?.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (2) (pp 174-178),
2020. Date of Publication: 01 Aug 2020.
Author
Fong L.S.; Ang Z.H.; Wolfenden H.; Akhunji Z.
Institution
(Ang, Wolfenden, Akhunji) Department of Cardiothoracic Surgery, Prince of
Wales Hospital, Randwick, NSW, Australia
(Ang) Prince of Wales Clinical School, University of New South Wales,
Randwick, NSW, Australia
(Fong) Department of Cardiothoracic Surgery, Prince of Wales Hospital,
Darcy Street, Randwick, NSW 2145, Australia
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In [dialysis patients
undergoing a valve replacement] is [a bioprosthetic valve superior to a
mechanical prosthesis] for [long-term survival and morbidity]'. Altogether
more than 501 papers were found using the reported search, of which five
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
There was limited high-quality evidence with all studies being
retrospective. One meta-analysis and four cohort studies provided the
evidence that there was no significant difference in long-term survival
based on prosthesis type. However, the majority of studies demonstrated a
significantly higher rate of valve-related complications including
bleeding and thromboembolism, and readmission to hospital in the
mechanical valve prosthesis group, likely related to the requirement for
long-term anticoagulation. We conclude that overall long-term survival in
dialysis-dependent patients is poor. While prosthesis type does not play a
significant contributing role to long-term survival, bioprosthetic valves
were associated with significantly fewer valve-related complications.
Based on the available evidence, a bioprosthetic valve may be more
suitable in this high-risk group of patients as it may avoid the
complications associated with long-term anticoagulation without any
reduction in long-term survival. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<108>
Accession Number
633036464
Title
Native Aortic Root Thrombosis after Norwood Palliation for Hypoplastic
Left Heart Syndrome.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 25 Sep 2020.
Author
Rajab T.K.; Mitchell M.B.
Institution
(Rajab) Section of Pediatric Cardiothoracic Surgery, Medical University of
South Carolina, SC, Charleston, United States
(Mitchell) Section of Congenital Cardiac Surgery, University of Colorado,
CO, Aurora, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Norwood palliation for Hypoplastic Left Heart Syndrome
typically results in retrograde perfusion of the native aortic root. This
may predispose to native aortic root thrombosis (NART). METHOD(S):
Patients who underwent Stage 1 Norwood palliation at Children' Hospital
Colorado between 2003 and 2019 were retrospectively reviewed for NART.
Additional cases were identified by a systematic literature review.
Patient factors, operative details, presentation, diagnostic modalities,
treatments, and outcomes were analyzed. RESULT(S): Three cases were
identified among 241 patients who had undergone Stage 1 Norwood palliation
at Children's Hospital Colorado (mean follow-up 48 months). A 4th case
identified at Children's Hospital Colorado had undergone stage 1
palliation elsewhere. Twelve additional cases were identified from the
systematic literature review. Cases presented with new arrythmias (38%,
n=6/16), evidence of ischemia (31%, n=5/16), incidentally (19%, n=3/16),
inability to wean from post-operative support (6%, n=1/16) and cardiac
arrest (6%, n=1/16). The diagnosis was made by TTE (50%, n=8/16), TEE
(19%, n=3/16), cardiac catheterization (25%, n=4/16), and cardiac CT (6%,
n=1/16). Importantly, 44% (n=7/16) of cases were missed by TTE and
subsequently diagnosed by other modalities. Treatment strategies were
surgical thrombectomy (38%, n=6/16), anticoagulation alone (38%, n=6/16),
direct catheter thrombolysis (19%, n=3/16), and systemic thrombolysis (6%,
n=1/16). The rate of mortality or transplant listing was 44% (n=7/16).
 CONCLUSION(S): NART is an underappreciated complication of Norwood
palliation with high mortality. There should be a high index of suspicion
for NART in patients after Norwood palliation with an unexplained
complicated clinical course. Importantly, NART is frequently missed by
TTE. Copyright © 2020. Published by Elsevier Inc.

<109>
Accession Number
621655408
Title
Effects of hypertonic saline vs normal saline on lactate clearance after
cardiovascular surgery.
Source
Archivos de Cardiologia de Mexico. 88 (2) (pp 100-106), 2018. Date of
Publication: April-June 2018.
Author
Atehortua-Lopez L.H.; Mendoza-Franco R.; Escobar-Serna J.F.; Urrego L.A.;
Alzate F.; Jaimes F.
Institution
(Atehortua-Lopez, Alzate) Hospital Universitario San Vicente Fundacion,
Medellin, Colombia
(Atehortua-Lopez, Mendoza-Franco, Escobar-Serna, Urrego) Universidad de
Antioquia, Medellin, Colombia
(Jaimes) Universidad de Antioquia, Research Unit Hospital Pablo Tobon
Uribe, Medellin, Colombia
Publisher
Instituto Nacional de Cardiologia Ignazio Chavez (E-mail:
archivos@cardiologia.org.mx)
Abstract
Background: The postoperative care of patients subjected to cardiac
surgery frequently require a complete recovery with intravenous fluids,
but crystalloid solutions like normal saline may increase the interstitial
oedema, and it is also well known that fluid overload increases mortality.
 Objective(s): To compare the effect of 7.5% hypertonic saline (HS)
with 0.9% normal saline (NS) on lactate clearance, as well as the
haemodynamic response of patients during the first day after
cardiovascular bypass surgery. Method(s): The study included patients
18 years of age and older with coronary artery disease and/or heart valve
disease, and who underwent bypass surgery and/or cardiac valve replacement
and were randomly assigned to receive 4 mL/kg of HS or NS intravenously
for 30 min once they were admitted to the ICU. Lactate, arterial blood
gases, heart rate, central venous pressure, and pulmonary wedge pressure
were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The
analyses were carried out with an intention-to-treat principle.
 Result(s): Out of a total of 494 patients evaluated, 102 were
included and assigned to the HS groups (51 patients) or NS (51 patients).
The mean age of the participants was 59 +/- 14 years, and 59.8% were male.
No statistically significant differences were observed between two groups
in the lactate clearance, or in any of the secondary outcomes.
 Conclusion(s): Our study failed to show a better lactate clearance in
the group on hypertonic saline, and with no evidence of a higher incidence
of adverse effects in that group. Copyright © 2017 Instituto
Nacional de Cardiologia Ignacio Chavez.

<110>
Accession Number
620401046
Title
Systematic detection of polyvascular disease combined with aggressive
secondary prevention in patients presenting with severe coronary artery
disease: The randomized AMERICA Study.
Source
International Journal of Cardiology. 254 (pp 36-42), 2018. Date of
Publication: 01 Mar 2018.
Author
Collet J.-P.; Cayla G.; Ennezat P.-V.; Leclercq F.; Cuisset T.; Elhadad
S.; Henry P.; Belle L.; Cohen A.; Silvain J.; Barthelemy O.; Beygui F.;
Diallo A.; Vicaut E.; Montalescot G.
Institution
(Collet, Silvain, Barthelemy, Montalescot) Sorbonne Universite Paris 6,
ACTION Study Group, Institut de Cardiologie Hopital Pitie-Salpetriere
(APHP), INSERM UMRS, Paris 1166, France
(Cayla) ACTION Study Group, Cardiologie, CHU Caremeau, Universite de
Montpellier, Nimes, France
(Ennezat) Cardiologie, Pole Thorax et Vaisseaux, CHU La Tronche, Grenoble,
France
(Leclercq) Cardiologie, Hopital Arnaud de Villeneuve-CHU Montpellier,
France
(Cuisset) Department of Cardiology, CHU Timone and Aix-Marseille Univ,
INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis,
Faculty of Medicine, Marseille F-13385, France
(Elhadad) Cardiologie, CH de Lagny-Marne la Vallee, Jossigny, France
(Henry) Cardiologie, CHU Lariboisiere (APHP), Paris, France
(Belle) Cardiologie, Centre Hospitalier d'Annecy, France
(Cohen) Cardiologie, CHU Saint-Antoine (APHP), Paris, France
(Beygui) Cardiologie, Hopital de la Cote de Nacre, Caen, France
(Diallo, Vicaut) ACTION Study Group, Unite de Recherche Clinique-Hopital
Lariboisiere (APHP), France and Universite Denis Diderot, Paris, France
Publisher
Elsevier Ireland Ltd
Abstract
Background: The prevalence and associated-risk of asymptomatic multisite
artery disease (MSAD) in high risk coronary patients are unknown. Whether
systematic identification and aggressive management of asymptomatic MSAD
is clinically relevant in high risk coronary patients has not been
evaluated. Method(s): We randomly assigned 521 high risk coronary
patients defined by the presence of three-vessel coronary disease (n =
304) or recent acute coronary syndrome beyond the age of 75 years (n =
215) to either a strategy of systematic detection of asymptomatic MSAD
combined with an aggressive secondary prevention (n = 263) or to a more
conventional strategy based on treatment of coronary artery disease only
with standard of care (n = 258). The primary end point was the time to
first occurrence of death, any organ failure or ischemic event leading to
re-hospitalization through two years of follow-up. Result(s): The
pro-active strategy identified asymptomatic MSAD in 21.7% of patients with
few revascularizations (3.6%); the pro-active pharmacological secondary
prevention was obtained in > 85% of patients and life-style changes in <
60% of patients. At 2-year follow-up, the primary end point occurred in
44.9% of patients in the pro-active group and 43.0% of patients in the
conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34].
The rate of major bleeding did not differ significantly between groups
(4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). Conclusion(s): In
high risk coronary patients, there is no apparent benefit of a systematic
detection of asymptomatic extra-coronary atherothrombotic disease and
intensified treatment over a 2-year follow-up period. (Funded by the
Academic Allies in Cardiovascular Trials Initiatives and Organized
Networks and Institut de l'Atherothrombose; AMERICA ClinicalTrials.gov
number, NCT00445835). Copyright © 2017 Elsevier Ireland Ltd

<111>
Accession Number
618891751
Title
Effect of high-dose oral multivitamins and minerals in participants not
treated with statins in the randomized Trial to Assess Chelation Therapy
(TACT).
Source
American Heart Journal. 195 (pp 70-77), 2018. Date of Publication: January
2018.
Author
Issa O.M.; Roberts R.; Mark D.B.; Boineau R.; Goertz C.; Rosenberg Y.;
Lewis E.F.; Guarneri E.; Drisko J.; Magaziner A.; Lee K.L.; Lamas G.A.
Institution
(Issa, Lamas) Columbia University Division of Cardiology at Mount Sinai
Medical Center, Miami Beach, FL, United States
(Roberts, Mark, Lee) Duke University Clinical Research Institute, Durham,
NC, United States
(Boineau) National Center of Complementary and Integrative Health (NCCIH),
Bethesda, MD, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Rosenberg) National Heart, Blood and Lung Institute (NHLBI), Bethesda,
MD, United States
(Lewis) Brigham and Women's Hospital, Boston, MA, United States
(Guarneri) Pacific Pearl La Jolla, La Jolla, CA, United States
(Drisko) University of Kansas Medical Center, Kansas City, KS, United
States
(Magaziner) Magaziner Center for Wellness, Cherry Hill, NJ, United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Importance In a prespecified subgroup analysis of participants not on
statin therapy at baseline in the TACT, a high-dose complex oral
multivitamins and multimineral regimen was found to have a large
unexpected benefit compared with placebo. The regimen tested was
substantially different from any vitamin regimen tested in prior clinical
trials. Objective To explore these results, we performed detailed
additional analyses of participants not on statins at enrollment in TACT.
Design TACT was a factorial trial testing chelation treatments and a
28-component high-dose oral multivitamins and multiminerals regimen versus
placebo in post-myocardial infarction (MI) patients 50 years or older.
Participants There were 460 (27%) of 1,708 TACT participants not taking
statins at baseline, 224 (49%) were in the active vitamin group and 236
(51%) were in the placebo group. Setting Patients were enrolled at 134
sites around the United States and Canada. Intervention Daily high-dose
oral multivitamins and multiminerals (6 tablets, active or placebo). Main
outcome The primary end point of TACT was time to the first occurrence of
any component of the composite end point: all-cause mortality, MI, stroke,
coronary revascularization, or hospitalization for angina. Results The
primary end point occurred in 137 nonstatin participants (30%), of which
51 (23%) of 224 were in the active group and 86 (36%) of 236 were taking
placebo (hazard ratio, 0.62; 95% confidence interval, 0.44-0.87; P =.006).
Results in the key TACT secondary end point, a combination of
cardiovascular mortality, stroke, or recurrent MI, was consistent in
favoring the active vitamin group (hazard ratio, 0.46; 95% confidence
interval, 0.28-0.75; P =.002). Multiple end point analyses were consistent
with these results. Conclusion and relevance High-dose oral multivitamin
and multimineral supplementation seem to decrease combined cardiac events
in a stable, post-MI population not taking statin therapy at baseline.
These unexpected findings are being retested in the ongoing
TACT2. Copyright © 2017 The Authors

<112>
Accession Number
619051523
Title
Association between QRS duration on prehospital ECG and mortality in
patients with suspected STEMI.
Source
International Journal of Cardiology. 249 (pp 55-60), 2017. Date of
Publication: 15 Dec 2017.
Author
Hansen R.; Frydland M.; Moller-Helgestad O.K.; Lindholm M.G.; Jensen L.O.;
Holmvang L.; Ravn H.B.; Kjaergaard J.; Hassager C.; Moller J.E.
Institution
(Hansen, Moller-Helgestad, Jensen, Holmvang, Moller) Department of
Cardiology, Odense University Hospital, Sdr Boulevard 29, Odense C
DK-5000, Denmark
(Frydland, Lindholm, Ravn, Kjaergaard, Hassager) The Heart Center,
Copenhagen University Hospital Rigshospitalet, Blegdamsvej, Copenhagen
DK-2100, Denmark
Publisher
Elsevier Ireland Ltd
Abstract
Background QRS duration has previously shown association with mortality in
patients with acute myocardial infarction treated with thrombolytics, less
is known in patients with suspected ST segment elevation myocardial
infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus,
the objective was to investigate the prognostic effect of QRS duration on
prehospital ECG and presence of classic left and right bundle branch block
(LBBB/RBBB) for all-cause mortality in patients with suspected STEMI.
Method In total 2105 consecutive patients (mean age 64 +/- 13 years, 72%
men) with suspected STEMI were prospectively included. QRS duration was
registered from automated QRS measurement on prehospital ECG and patients
were divided according to quartiles of QRS duration (< 89 ms, 89-98 ms,
99-111 ms and > 111 ms). Primary endpoint was all-cause 30-day mortality.
Predictors of all-cause mortality were assessed using Cox proportional
hazards analysis. Results Among all patients median QRS duration was 98 ms
(IQR 88-112 ms). RBBB-morphology was seen in 126 patients (6.0%) and LBBB
in 88 patients (4.2%), 80% were treated with percutaneous coronary
intervention and the final diagnosis was STEMI in 1777 patients (84%).
Thirty-day mortality was 7.6% in patients with suspected STEMI. In
multivariable analysis, QRS duration > 111 ms (hazard ratio (HR) 3.08; 95%
confidence interval (CI): 1.71-5.57, p = 0.0002), LBBB - morphology (HR
3.0; 95% CI: 1.38-6.53, p = 0.006) and RBBB (HR 3.68; 95% CI: 1.95-6.95, p
< 0.0001) were associated with 30 day all-cause mortality. Conclusion In
patients with suspected STEMI, QRS prolongation, LBBB, and RBBB on
prehospital ECG are associated with increased risk of death. Copyright
© 2017 Elsevier B.V.

<113>
Accession Number
616876010
Title
The effect of economic downturn on the volume of surgical procedures: A
systematic review.
Source
International Journal of Surgery. 44 (pp 56-63), 2017. Date of
Publication: August 2017.
Author
Fujihara N.; Lark M.E.; Fujihara Y.; Chung K.C.
Institution
(Fujihara, Fujihara) International Research Fellow, Plastic Surgery
Section, University of Michigan, Ann Arbor, MI, United States
(Fujihara, Fujihara) Department of Hand Surgery, Nagoya University,
Nagoya, Japan
(Lark) Research Associate, University of Michigan Medical School, Ann
Arbor, MI, United States
(Chung) Professor of Surgery, Department of Surgery, Section of Plastic
Surgery, Assistant Dean for Faculty Affairs, University of Michigan
Medical School, Ann Arbor, MI, United States
Publisher
Elsevier Ltd
Abstract
Background Economic downturn can have a wide range of effects on medicine
at both individual and national levels. We aim to describe these effects
in relation to surgical volume to guide future planning for physician
specialization, patient expectations in the face of economic crises, or
estimating healthcare expenditure. We hypothesized that because of high
out-of-pocket costs, cosmetic procedure volumes would be most affected by
economic decline. Methods A systematic review was conducted using MEDLINE,
Embase, and ABI/INFORMS. The main search terms were "economic recession"
and "surgical procedures, operative". Studies were included if surgical
volumes were measured and economic indicators were used as predictors of
economic conditions. Results Twelve studies were included, and the most
common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and
cardiac surgeries (n = 2). The majority of studies found that in periods
of economic downturn, surgical volume decreased. Among the eight studies
using Pearson's correlation analysis, there were no significant
differences between cosmetic procedures and other elective procedures,
indicating that cosmetic procedures may display trends similar to those of
non-cosmetic elective procedures in periods of economic downturn.
Conclusions Surgical volume generally decreased when economic indicators
declined, observed for both elective and non-elective surgery fields.
However, a few specific procedure volumes such as vasectomy and caesarean
section for male babies increased during the economic downturn. Knowledge
of these trends can be useful for future surgical planning and
distribution of healthcare resources. Copyright © 2017 IJS
Publishing Group Ltd

<114>
Accession Number
616633961
Title
Transcathether aortic valve implantation with the new repositionable
self-expandable Evolut R versus CoreValve system: A case-matched
comparison.
Source
International Journal of Cardiology. 243 (pp 126-131), 2017. Date of
Publication: 15 Sep 2017.
Author
Giannini C.; De Carlo M.; Tamburino C.; Ettori F.; Latib A.M.; Bedogni F.;
Bruschi G.; Presbitero P.; Poli A.; Fabbiocchi F.; Violini R.; Trani C.;
Giudice P.; Barbanti M.; Adamo M.; Colombo P.; Benincasa S.; Agnifili M.;
Petronio A.S.
Institution
(Giannini, De Carlo, Petronio) Azienda Ospedaliero-Universitaria Pisana,
Pisa, Italy
(Tamburino, Barbanti) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Ettori, Adamo) Ospedali Civili, Brescia, Italy
(Latib, Benincasa) Scientific Institute S. Raffaele, Milan, Italy
(Bedogni, Agnifili) Policlinico San Donato, San Donato, Italy
(Bruschi, Colombo) "De Gasperis" Cardio Center ASST Niguarda Metropolitan
Hospital, Milan, Italy
(Presbitero) Clinical Institute Humanitas, Rozzano, Milan, Italy
(Poli) Ospedale Civile, Legnano, Italy
(Fabbiocchi) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Violini) San Camillo Forlanini Hospital, Rome, Italy
(Trani) Institute of Cardiology, Catholic University of Sacred Heart,
Rome, Italy
(Giudice) Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite promising results following transcatheter aortic valve
implantation (TAVI), several relevant challenges still remain. To overcome
these issues, new generation devices have been developed. The purpose of
the present study was to determine whether TAVI with the new
self-expanding repositionable Evolut R offers potential benefits compared
to the preceding CoreValve, using propensity matching. Methods Between
June 2007 and November 2015, 2148 consecutive patients undergoing TAVI
either CoreValve (n = 1846) or Evolut R (n = 302) were prospectively
included in the Italian TAVI ClinicalService project. For the purpose of
our analysis 211 patients treated with the Evolut R were matched to 211
patients treated with the CoreValve. An independent core laboratory
reviewed all angiographic procedural data and an independent clinical
events committee adjudicated all events. Results Patients treated with
Evolut R experienced higher 1-year overall survival (log rank test p =
0.045) and a significantly lower incidence of major vascular access
complications, bleeding events and acute kidney injury compared to
patients treated with the CoreValve. Recapture manoeuvres to optimize
valve deployment were performed 44 times, allowing a less implantation
depth for the Evolut R. As a consequence, the rate of more than mild
paravalvular leak and new permanent pacemaker was lower in patients
receiving the Evolut R. Conclusion In this matched comparison of high
surgical risk patients undergoing TAVI, the use of Evolut R was associated
with a significant survival benefit at 1 year compared with the CoreValve.
This was driven by lower incidence of periprocedural complications and
higher rates of correct anatomic positioning. Copyright © 2017
Elsevier B.V.

<115>
Accession Number
615615840
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with drug-eluting stents for left main coronary artery
disease: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. 241 (pp 142-148), 2017. Date of
Publication: 15 Aug 2017.
Author
Putzu A.; Gallo M.; Martino E.A.; Ferrari E.; Pedrazzini G.; Moccetti T.;
Cassina T.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
(Martino) Department of Anesthesia and Intensive Care, San Gerardo
Hospital, Via Pergolesi 33, Monza, Italy
(Pedrazzini, Moccetti) Department of Cardiology, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite several clinical studies, efficacy of coronary artery
bypass grafting (CABG) surgery versus percutaneous coronary intervention
(PCI) in patients with left main (LM) disease remains controversial. The
objective of this meta-analysis of randomized trials was to evaluate the
clinical outcome of CABG versus PCI with drug-eluting stents in LM
coronary disease. Methods We systematically searched online databases up
to March 2017 for randomized trials comparing CABG to PCI with
drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence
intervals (CIs). Results We included data from 5 randomized trials and
4595 patients. At 30 days, CABG was associated with higher stroke (OR 2.54
[95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45
[95% CI, 1.00-2.10]), with no other significant differences compared to
PCI. At 1 year, CABG reduced repeat revascularization (OR 0.56 [95% CI,
0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5
years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67])
and non-periprocedural myocardial infarction (OR 0.45 [95% CI,
0.29-0.70]), without significant differences on other outcomes.
Conclusions From the present updated meta-analysis of available studies on
LM coronary disease treatment, there were no differences in mortality,
myocardial infarction, and stroke rate at 3-5 years follow-up after CABG
or PCI, but CABG decreased the rate of repeat revascularization and
non-periprocedural infarction. However, at short-term follow-up, CABG
showed higher rate of stroke and periprocedural myocardial infarction, but
these effects attenuated over time. These findings merit further
investigation at longer follow-up. Copyright © 2017 Elsevier B.V.

<116>
Accession Number
614006705
Title
Deferred versus conventional stent implantation in patients with acute
ST-segment elevation myocardial infarction: An updated meta-analysis of 10
studies.
Source
International Journal of Cardiology. 230 (pp 509-517), 2017. Date of
Publication: 01 Mar 2017.
Author
Lee J.M.; Rhee T.-M.; Chang H.; Ahn C.; Park T.K.; Yang J.H.; Song Y.B.;
Choi S.-H.; Gwon H.-C.; Hahn J.-Y.
Institution
(Lee, Chang, Park, Yang, Song, Choi, Gwon, Hahn) Department of Internal
Medicine and Cardiovascular Center, Heart Vascular Stroke Institute,
Samsung Medical Center, Sungkyunkwan University School of Medicine, United
States
(Rhee) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background We sought to evaluate safety and efficacy of the deferred
stenting versus immediate stent implantation of infarct-related arteries
in patients with acute ST-segment elevation myocardial infarction (STEMI)
undergoing primary percutaneous coronary intervention (PCI). Methods A
meta-analysis using random-effects models were conducted. The primary
outcome, major adverse cardiac events (MACE), was a composite of all-cause
mortality, myocardial infarction (MI), any unplanned target vessel
revascularization (TVR), and hospitalization due to cardiac cause.
Periprocedural composite events were composed of acute re-occlusion,
no-reflow/slow flow, or distal embolization. Results Seven non-randomized
registries and three randomized trials comparing outcomes of deferred
versus immediate stenting in infarct-related arteries of 2281 STEMI
patients were selected. Risk of MACE between deferred or immediate
stenting did not differ significantly (rates, 12.8% vs 15.0%; pooled RR =
0.68, 95% CI: 0.43-1.06; p = 0.087; I2 = 26.8%). Deferred
stenting was associated with significantly reduced risk of periprocedural
composite events (rates, 5.3% vs 10.2%; pooled RR = 0.36, 95% CI:
0.18-0.69; p = 0.002; I2 = 68.0%) and flow abnormality in
infarct-related arteries (rates, 3.8% vs 8.4%; pooled RR = 0.29, 95% CI:
0.14-0.61; p = 0.001; I2 = 58.1%). However, clinical outcomes
including all-cause mortality, MI, or any unplanned TVR, were unaffected.
Meta-regression indicated a significant relationship between prolonged
total ischemic and reduced risk of MACE after deferred stenting (OR =
0.994, 95% CI: 0.990-0.998; p = 0.027; I2 residual 0.0%,
adjusted R2 = 100.0%). Conclusions Although deferred stenting
carried significantly lower risk of periprocedural composite events and
abnormal flow in patients undergoing primary PCI for STEMI, such benefits
had no impact on MACE, which did not differ significantly by timing of
stent placement. Copyright © 2016 Elsevier Ireland Ltd

<117>
Accession Number
613930457
Title
Risk factors and prognosis of postpericardiotomy syndrome in patients
undergoing valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 878-885.e1),
2017. Date of Publication: 01 Apr 2017.
Author
Bunge J.J.; Doevendans P.A.; Suyker W.J.; Bredee J.J.; Buhre W.F.;
Dieleman J.M.; van Dijk D.; van Herwerden L.A.; Kalkman C.J.; van
Klarenbosch J.; Moons K.G.; Nathoe H.M.; Numan S.C.; Ottens T.H.; Roes
K.C.; Sauer A.-M.C.; Slooter A.J.; van Osch D.; Jacob K.A.; Nierich A.P.;
Ennema J.J.; Rosseel P.M.; van der Meer N.J.; van der Maaten J.M.; Cernak
V.; Hofland J.; van Thiel R.J.; Diephuis J.C.; Schepp R.M.; Haenen J.; de
Lange F.; Boer C.; de Jong J.R.; Tijssen J.G.
Institution
(van Osch, Doevendans, Nathoe) Department of Cardiology, University
Medical Center Utrecht, Utrecht, Netherlands
(Dieleman, van Dijk) Department of Anesthesiology and Intensive Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Suyker) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bunge) Department of Intensive Care, Erasmus Medical Center, Rotterdam,
Netherlands
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Objective The study aim was to investigate the long-term prognosis and
risk factors of postpericardiotomy syndrome (PPS). Methods We performed a
single-center cohort study in 822 patients undergoing nonemergent valve
surgery. Risk factors of PPS were evaluated using multivariable logistic
regression analysis. We also compared the incidence of reoperation for
tamponade at 1 year between patients with and without PPS. Main secondary
outcomes were hospital stay and mortality. Results Of the 822 patients,
119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per
point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was
associated with a lower risk of PPS, whereas preoperative treatment for
pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20)
was associated with a higher risk of PPS. The incidence of reoperation for
tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49;
95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2%
versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13
days (interquartile range, 9-18 days) versus 11 days (interquartile range,
8-15 days) (P = .001), respectively. Conclusions Despite longer hospital
stays and more short-term reoperations for tamponade, patients with PPS
had an excellent 1-year prognosis. Copyright © 2016 The American
Association for Thoracic Surgery

<118>
Accession Number
618216921
Title
Effects of person-centred care after an event of acute coronary syndrome:
Two-year follow-up of a randomised controlled trial.
Source
International Journal of Cardiology. 249 (pp 42-47), 2017. Date of
Publication: 15 Dec 2017.
Author
Fors A.; Swedberg K.; Ulin K.; Wolf A.; Ekman I.
Institution
(Fors, Ulin, Wolf, Ekman) Institute of Health and Care Sciences,
Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden, Box 457,
Gothenburg 405 30, Sweden
(Fors, Swedberg, Ulin, Wolf, Ekman) Centre for Person-Centred Care (GPCC),
University of Gothenburg, Gothenburg, Sweden
(Fors) Narhalsan Research and Development Primary Health Care, Region
Vastra Gotaland, Sweden
(Swedberg) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Aim To assess the long-term effect of person-centred care (PCC) in
patients with acute coronary syndrome (ACS). Method Patients with ACS were
randomly assigned to treatment as usual (control group) or an added PCC
intervention for six months. The primary endpoint was a composite score of
changes in general self-efficacy >= five units, return to work or to a
prior activity level and re-hospitalisation or death. Results The
composite score improved in the PCC intervention group (n = 94) at a
two-year follow-up compared with the control group (n = 105) (18.1%, n =
17 vs. 10.5%, n = 11; P = 0.127). In the per-protocol analysis (n = 183)
the improvement was significant in favour of the PCC intervention (n = 78)
compared with usual care (n = 105) (21.8%, n = 17 vs. 10.5%, n = 11; P =
0.039). This effect was driven by the finding that more patients in the
PCC group improved their general self-efficacy score >= 5 units (32.2%, n
= 19 vs. 17.3%, n = 14; P = 0.046). The composite score improvement was
significantly higher in the PCC intervention group without post-secondary
education (n = 33) in comparison with corresponding patients in the
control group (n = 50) (30.3%, n = 10 vs. 10.0%, n = 5; P = 0.024).
Conclusion Implementation of PCC results in sustained improvements in
health outcome in patients with ACS. PCC can be incorporated into
conventional cardiac prevention programmes to improve equity in uptake and
patient health outcomes. Trial registration Swedish registry,
Researchweb.org, ID NR 65791. Copyright © 2017 The Authors

<119>
Accession Number
614025709
Title
Efficacy and safety of sedation with dexmedetomidine in critical care
patients: A meta-analysis of randomized controlled trials.
Source
Anaesthesia Critical Care and Pain Medicine. 35 (1) (pp 7-15), 2016. Date
of Publication: 01 Feb 2016.
Author
Constantin J.-M.; Momon A.; Mantz J.; Payen J.-F.; De Jonghe B.; Perbet
S.; Cayot S.; Chanques G.; Perreira B.
Institution
(Constantin, Momon, Perbet, Cayot) Perioperative Department, University
Hospital of Clermont-Ferrand, Clermont-Ferrand 63000, France
(Perreira) Biostatistics Unit, Department of Clinical Research and
Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand
63000, France
(Mantz) Department of Anaesthesiology and Critical Care Medicine, Hopital
Europeen Georges-Pompidou, Universite Paris-Descartes Sorbonne Paris Cite,
Paris 75908, France
(Payen) Department of Anaesthesia and Critical Care, Michallon Hospital,
boulevard de la Chantourne, Grenoble 38000, France
(Payen) Joseph-Fourier University, Grenoble Institute of Neurosciences,
chemin Fortune-Ferrini, Grenoble 38042, France
(De Jonghe) Reanimation Medico-Chirurgicale, Centre Hospitalier de
Poissy-St-Germain, Poissy 78300, France
(Chanques) Intensive Care and Anaesthesiology Department, University of
Montpellier Saint-Eloi Hospital, Montpellier 34000, France
Publisher
Elsevier Masson s.r.l.
Abstract
Introduction Dexmedetomidine may help physicians target a low level of
sedation. Unfortunately, the impact of dexmedetomidine on major endpoints
remains unclear in intensive care unit (ICU). Material and methods To
evaluate the association between dexmedetomidine use with efficacy and
safety outcomes, two reviewers independently identified randomized
controlled trials comparing dexmedetomidine with other sedative agents in
non-post-cardiac surgery critically ill patients in the PubMed and
Cochrane databases. Random effects models were considered if heterogeneity
was detected using the DerSimonian and Laird estimation method.
Statistical heterogeneity between results was assessed by examining forest
plots, confidence intervals (CI) and by using the I2 statistic.
The risk of bias was assessed using the risk of bias tool. Results This
meta-analysis included 1994 patients from 16 randomized controlled trials.
Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was
associated with a reduction in ICU length of stays (WMD = -0.304; 95% CI
[-0.477, -0.132]; P = 0.001), mechanical ventilation duration (WMD =
-0.313, 95% CI [-0.523, -0.104]; P = 0.003) and delirium incidence (RR =
0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also
associated with an increase in the incidence of bradycardia (RR = 1.947,
95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI
[1.013, 1.576]; P = 0.038). Conclusions and relevance In this first
meta-analysis including only randomized controlled trials related to ICU
patients, dexmedetomidine was associated with a 48 h reduction in ICU
length of stay, mechanical ventilation duration and delirium occurrence
despite a significant heterogeneity among studies. Dexmedetomidine was
also associated with an increase in bradycardia and
hypotension. Copyright © 2015 Societe francaise d'anesthesie et
de reanimation (Sfar)

<120>
Accession Number
611013027
Title
Is vitamin E supplementation effective in reducing mortality related to
cardiovascular events in people with type 2 diabetes mellitus? A
systematic review.
Source
IJC Metabolic and Endocrine. 12 (pp 42-45), 2016. Date of Publication: 01
Sep 2016.
Author
Patel N.; Amin P.; Shenoy A.
Institution
(Patel) Department of Cardiology, New York Harbor VA Healthcare System,
Brooklyn, NY, United States
(Amin) Department of Medicine, St. Francis Hospital, Roslyn, NY, United
States
(Patel, Shenoy) Department of Medicine, SUNY Downstate Medical Center,
Brooklyn, NY, United States
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To determine the effect of vitamin E in reducing cardiovascular
mortality in diabetic patients. Data source: Review of several English
language primary studies published from 2004 to 2015. Outcome measured:
The primary outcomes measure by all studies included 30-day mortality due
to congestive heart failure, myocardial infarction, stroke, and HDL
function as it relates to cardiovascular outcomes. The secondary outcomes
included hospitalization for CHF and coronary revascularization.
 Result(s): Five Randomized, double-blind, placebo-controlled trials
and 11 studies were used for this review. The study published by
Jaxa-Chamiec et al. showed that vitamin E is beneficial along with vitamin
C but is not effective when used alone. The study facilitated by Marchioli
et al., showed that vitamin E supplementation is associated with a
statistically non-significant (p = 0.18) increased risk of developing CHF.
Finally, a study by Milman et al. showed that vitamin E supplementation is
beneficial compared with a placebo group. This was a recurring theme and
common finding among the studies explored within the context of this
review. Conclusion(s): Although, two studies showed no benefit from
vitamin E supplementation, the remaining studies demonstrated that vitamin
E supplementation provided cardiovascular benefits in a specific diabetic
subpopulation. The study population that derived a favorable outcome from
vitamin E supplementation consisted of diabetic patients with the Hp 2-2
genotype. Hence, further studies should be conducted in diabetic
populations with the Hp 2-2 genotype for identifying the definitive
effects of vitamin E. Copyright © 2016 Published by Elsevier
Ireland Ltd.

<121>
Accession Number
608761473
Title
Novel Approaches in Primary Cardiovascular Disease Prevention: The HOPE-3
Trial Rationale, Design, and Participants' Baseline Characteristics.
Source
Canadian Journal of Cardiology. 32 (3) (pp 311-318), 2016. Date of
Publication: 01 Mar 2016.
Author
Lonn E.; Bosch J.; Pogue J.; Avezum A.; Chazova I.; Dans A.; Diaz R.;
Fodor G.J.; Held C.; Jansky P.; Keltai M.; Keltai K.; Kunti K.; Kim J.-H.;
Leiter L.; Lewis B.; Liu L.; Lopez-Jaramillo P.; Pais P.; Parkhomenko A.;
Peters R.J.G.; Piegas L.S.; Reid C.M.; Sliwa K.; Toff W.D.; Varigos J.;
Xavier D.; Yusoff K.; Zhu J.; Dagenais G.; Yusuf S.
Institution
(Lonn, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Lonn, Bosch, Pogue, Yusuf) Population Health Research Institute, Hamilton
Health Sciences and McMaster University, Hamilton, ON, Canada
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Chazova) Russian Cardiology Research Complex, Moscow, Russian Federation
(Dans) College of Medicine of the University of the Philippines, Manula,
Philippines
(Diaz) Fundacion ECLA, Rosario, Argentina
(Fodor) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Held) Department of Medical Sciences, Uppsala University, Uppsala, Sweden
(Jansky) University Hospital Motol, Prague, Czechia
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Kunti) Diabetes Research Centre, University of Leicester, Leicester,
United Kingdom
(Kim) St. Paul's Hospital, The Catholic University of Korea, Seoul, South
Korea
(Leiter) Li Ka Shing Knowledge Institute and Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto,
Toronto, ON, Canada
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
(Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
(Lopez-Jaramillo) Fundacion Oftalmolgica de Santander (FOSCAL) and
Instituto Masira, Medical School, Universidad de Santander, Bucaramanga,
Colombia
(Pais, Xavier) Division of Clinical Research and Training, St. John's
Research Institute, Bangalore, India
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Peters) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Piegas) Hospital do Coracao, Sao Paulo, Brazil
(Reid, Varigos) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Sliwa) Hatter Institute for Cardiovascular Research in Africa, Department
of Medicine, University of Cape Town and Soweto Cardiovascular Research
Group, Johannesburg, South Africa
(Toff) Department of Cardiovascular Sciences, University of Leicester and
Leicester NIHR Biomedical Research Unit in Cardiovascular Disease,
Glenfield Hospital, Leicester, United Kingdom
(Yusoff) Universiti Teknologi MARA, Selangor, Malaysia
(Zhu) Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, China
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, QC, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Cholesterol and blood pressure (BP) can be effectively and
safely lowered with statin drugs and BP-lowering drugs, reducing major
cardiovascular (CV) events by 20%-30% within 5 years in high-risk
individuals. However, there are limited data in lower-risk populations.
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating
whether cholesterol lowering with a statin drug, BP lowering with low
doses of 2 antihypertensive agents, and their combination safely reduce
major CV events in individuals at intermediate risk who have had no
previous vascular events and have average cholesterol and BP levels.
 Method(s): A total of 12,705 women 65 years or older and men 55 years
or older with at least 1 CV risk factor, no known CV disease, and without
any clear indication or contraindication to the study drugs were
randomized to rosuvastatin 10 mg/d or placebo and to
candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 x 2 factorial
design) and will be followed for a mean of 5.8 years. The coprimary study
outcomes are the composite of CV death, nonfatal myocardial infarction
(MI), and nonfatal stroke and the composite of CV death, nonfatal MI,
nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial
revascularization. Result(s): Participants were recruited from 21
countries in North America, South America, Europe, Asia, and Australia.
Mean age at randomization was 66 years and 46% were women.
 Conclusion(s): The HOPE-3 trial will provide new information on
cholesterol and BP lowering in intermediate-risk populations with average
cholesterol and BP levels and is expected to inform approaches to primary
prevention worldwide (HOPE-3 ClinicalTrials.gov
NCT00468923). Copyright © 2016 Canadian Cardiovascular Society.

<122>
Accession Number
604327098
Title
Systematic review of percutaneous coronary intervention and transcatheter
aortic valve implantation for concomitant aortic stenosis and coronary
artery disease.
Source
International Journal of Cardiology. 187 (1) (pp 453-455), 2015. Date of
Publication: 01 Aug 2015.
Author
Virk S.A.; Tian D.H.; Liou K.; Pathan F.; Villanueva C.; Akhunji Z.; Cao
C.
Institution
(Virk, Tian, Cao) Systematic Review Unit, Collaborative Research (CORE)
Group, Macquarie University, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
(Villanueva) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
(Akhunji, Cao) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Villanueva, Cao) University of New South Wales, Sydney, Australia
Publisher
Elsevier Ireland Ltd

<123>
Accession Number
604327035
Title
Fractional flow-guided management in patients with acute coronary
syndromes: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 187 (1) (pp 334-337), 2015. Date of
Publication: 01 Aug 2015.
Author
Briasoulis A.; Palla M.; Mostafa A.; Afonso L.; Grines C.
Institution
(Briasoulis, Palla, Mostafa, Afonso, Grines) Wayne State University,
Detroit Medical Center, Department of Cardiology, Detroit, IL 48226,
United States
Publisher
Elsevier Ireland Ltd

<124>
Accession Number
607050466
Title
Ventilator associated pneumonia and tracheostomy.
Source
Trends in Anaesthesia and Critical Care. 5 (6) (pp 184-187), 2015. Date of
Publication: December 2015.
Author
Cirillo F.; Hinkelbein J.; Romano G.M.; Piazza O.; Servillo G.; De
Robertis E.
Institution
(Cirillo, Romano, Servillo, De Robertis) Department of Neurosciences,
Reproductive and Odontostomatological Sciences, University of Naples
Federico II, Via S. Pansini, 5, Napoli 80131, Italy
(Cirillo, Hinkelbein) Department for Anaesthesiology and Intensive Care
Medicine, University Hospital Cologne, Kerpener Str. 62, Cologne 50937,
Germany
(Piazza) Department of Medicine and Surgery, Universita di Salerno,
Baronissi, SA, Italy
Publisher
Churchill Livingstone (E-mail: e-mail: cservice@harcourtbrace.com)
Abstract
This literature review focuses on the association between the incidence of
ventilator-associated pneumonia (VAP) and the time of tracheostomy in
different critical settings and analyses literature published during the
last five years. VAP is still a major problem in many mechanically
ventilated patients, and tracheostomy, bypassing the mouth and allowing
better oral hygiene, seems to show a benefit in terms of reduction of
incidence of VAP. Recent evidences suggest that tracheostomy, the earlier
it is performed, gives a benefit in this sense. Anyway, timing of
tracheostomy is strictly depending on the type of critical
environment. Copyright © 2015 Elsevier Ltd.

<125>
Accession Number
602988031
Title
Meta-analysis of clinical outcomes of patients who underwent percutaneous
coronary interventions for chronic total occlusions.
Source
American Journal of Cardiology. 115 (10) (pp 1367-1375), 2015. Date of
Publication: 15 May 2015.
Author
Christakopoulos G.E.; Christopoulos G.; Carlino M.; Jeroudi O.M.; Roesle
M.; Rangan B.V.; Abdullah S.; Grodin J.; Kumbhani D.J.; Vo M.; Luna M.;
Alaswad K.; Karmpaliotis D.; Rinfret S.; Garcia S.; Banerjee S.; Brilakis
E.S.
Institution
(Christakopoulos, Christopoulos, Jeroudi, Roesle, Rangan, Abdullah,
Grodin, Kumbhani, Luna, Banerjee, Brilakis) Department of Cardiovascular
Diseases, VA North Texas Healthcare System, UT Southwestern Medical
Center, Dallas, TX, United States
(Carlino) Department of Cardiovascular Diseases, San Raffaele Scientific
Institute, Milan, Italy
(Vo) Department of Cardiovascular Diseases, University of Manitoba, MT,
Canada
(Alaswad) Department of Cardiovascular Diseases, Henry Ford Hospital,
Detroit, MI, United States
(Karmpaliotis) Department of Cardiovascular Diseases, Columbia University,
New York, NY, United States
(Rinfret) Department of Cardiovascular Diseases, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Laval University, Quebec City,
QC, Canada
(Garcia) Department of Cardiovascular Diseases, Minneapolis VA Healthcare
System, University of Minnesota, Minneapolis, MN, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Successful percutaneous coronary intervention (PCI) for chronic total
occlusions (CTOs) has been associated with clinical benefit. There are no
randomized controlled trials on long-term clinical outcomes after CTO PCI,
limiting the available evidence to observational cohort studies. We sought
to perform a weighted meta-analysis of the long-term outcomes of
successful versus failed CTO PCI. A total of 25 studies, published from
1990 to 2014, with 28,486 patients (29,315 CTO PCI procedures) were
included. We analyzed data on mortality, subsequent coronary artery bypass
grafting (CABG), myocardial infarction, major adverse cardiac events,
angina pectoris, stroke, and target vessel revascularization using
random-effects models. Procedural success was 71% (range 51% to 87%).
During a weighted mean follow-up of 3.11 years, compared with
unsuccessful, successful CTO PCI was associated with lower mortality (odds
ratio [OR] 0.52, 95% confidence interval [CI] 0.43 to 0.63), less residual
angina (OR 0.38, 95% CI 0.24 to 0.60), lower risk for stroke (OR 0.72, 95%
CI 0.60 to 0.88), less need for subsequent coronary artery bypass grafting
(OR 0.18, 95% CI 0.14 to 0.22), and lower risk for major adverse cardiac
events (0.59, 95% CI 0.44 to 0.79). There was no difference in the
incidence of target vessel revascularization (OR 0.66, 95% CI 0.36 to
1.23) or myocardial infarction (OR 0.73, 95% CI 0.52 to 1.03). Outcomes
were similar in patients who underwent balloon angioplasty only or
stenting with bare metal or drug-eluting stents. Compared with failed
procedures, successful CTO PCIs are associated with a lower risk of death,
stroke, and coronary artery bypass grafting and less recurrent angina
pectoris. Copyright © 2015 Elsevier Inc. All rights reserved.

<126>
Accession Number
602976763
Title
Usefulness of colchicine to reduce perioperative myocardial damage in
patients who underwent on-pump coronary artery bypass grafting.
Source
American Journal of Cardiology. 115 (10) (pp 1376-1381), 2015. Date of
Publication: 15 May 2015.
Author
Giannopoulos G.; Angelidis C.; Kouritas V.K.; Dedeilias P.; Filippatos G.;
Cleman M.W.; Panagopoulou V.; Siasos G.; Tousoulis D.; Lekakis J.;
Deftereos S.
Institution
(Giannopoulos, Angelidis, Deftereos) Department of Cardiology, Athens
General Hospital G. Gennimatas, Athens, Greece
(Giannopoulos, Cleman, Deftereos) Section of Cardiovascular Medicine, Yale
University School of Medicine, New Haven, CT, United States
(Kouritas, Dedeilias) Department of Cardiac Surgery, Evangelismos General
Hospital, Athens, Greece
(Filippatos, Lekakis) Second Department of Cardiology, University of
Athens Medical School, Attikon Hospital, Athens, Greece
(Panagopoulou, Siasos, Tousoulis) First Department of Cardiology,
University of Athens Medical School, Hippokration Hospital, Athens, Greece
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
The objective of the present study was to test whether a perioperative
course of colchicine, in patients who underwent standard coronary artery
bypass grafting, would result in reduced postoperative increase of
myocardial injury biomarker levels. Patients were prospectively randomized
to colchicine or placebo starting 48 hours before scheduled coronary
artery bypass grafting and for 8 days thereafter (0.5 mg twice daily). The
primary outcome parameter was maximal high-sensitivity troponin T (hsTnT)
concentration within 48 hours after surgery. Secondary outcome measures
were maximal creatine kinase-myocardial brain fraction (CK-MB) levels and
area under the curve (AUC) of hsTnT and CK-MB concentrations; 59 patients
were included. Maximal hsTnT was 616 pg/ml (396 to 986) in the colchicine
group versus 1,613 pg/ml (732 to 2,587) in controls (p = 0.002). Maximal
CK-MB was 44.6 ng/ml (36.6 to 68.8) and 93.0 ng/ml (48.0 to 182.3),
respectively (p = 0.002). The median AUC for hsTnT was 40,755 pg h/ml
(20,868 to 79,176) in controls versus 20,363 pg h/ml (13,891 to 31,661) in
the colchicine group (p = 0.002). AUCs for CK-MB were 2,552 ng h/ml (1,564
to 4,791) in controls and 1,586 ng h/ml (1,159 to 2,073) in the colchicine
group (p = 0.003). The main complaints associated with colchicine were, as
expected, gastrointestinal, with 5 patients (16.7%) in the colchicine
group reporting diarrhea versus 1 control (3.4%) (p = 0.195). In
conclusion, a short perioperative course of colchicine was effective in
attenuating postoperative increases of hsTnT and CK-MB compared with
placebo. This finding, which needs confirmation in a larger clinical trial
powered to assess clinical endpoints, suggests a potential role for this
agent in reducing cardiac surgery-related myocardial damage. Copyright
© 2015 Elsevier Inc. All rights reserved.

<127>
Accession Number
602942373
Title
Usefulness of the left anterior descending artery wrapping around the left
ventricular apex to predict adverse clinical outcomes in patients with
anterior wall ST-segment elevation myocardial infarction (an INFUSE-AMI
substudy).
Source
American Journal of Cardiology. 115 (10) (pp 1389-1395), 2015. Date of
Publication: 15 May 2015.
Author
Kobayashi N.; Maehara A.; Mintz G.S.; Wolff S.D.; Genereux P.; Xu K.;
Mehran R.; Gibson C.M.; Brener S.J.; Stone G.W.
Institution
(Kobayashi, Maehara, Wolff, Genereux, Stone) Division of Cardiology, New
York Presbyterian Hospital, Columbia University Medical Center, New York,
NY, United States
(Kobayashi, Maehara, Mintz, Wolff, Genereux, Xu, Mehran, Brener, Stone)
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY,
United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Gibson) Department of Medicine, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Brener) Department of Medicine, New York Methodist Hospital, Brooklyn,
NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
The relation between left anterior descending coronary artery (LAD)
anatomic features and clinical outcomes in patients with anterior
ST-segment elevation myocardial infarction has not been fully
investigated. The Intracoronary Abciximab and Aspiration Thrombectomy in
Patients With Large Anterior Myocardial Infarction (INFUSE-AMI) trial
randomized 452 patients with anterior ST-segment elevation myocardial
infarctions who underwent mechanical revascularization to intralesional
abciximab versus no abciximab and to manual thrombus aspiration versus no
aspiration. The primary end point was infarct size (percentage left
ventricular mass) on contrast magnetic resonance imaging at 30 days.
"Wraparound LAD" was defined as an LAD reaching the apex and supplying the
apical inferior aspect of the heart. Among complete data available in 338
patients, 258 (76.3%) had wraparound LADs. Global infarct size (17.4% vs
16.1%, p = 0.64) and the left ventricular ejection fraction (49.7% vs
48.7%, p = 0.98) by contrast magnetic resonance imaging at 30 days were
comparable between patients with and those without wraparound LADs.
Regional apical anterior infarct size was comparable (59.5% vs 55.8%, p =
0.559) between the groups; however, apical septal (61.3% vs 48.9%, p =
0.005), apical inferior (19.0% vs 3.7%, p <0.0001), and apical lateral
(12.2% vs 4.8%, p = 0.0584) infarct sizes were larger in patients with
wraparound LADs compared with those with nonwraparound LADs. The incidence
of new-onset severe heart failure at 1 year was significantly higher in
patients with compared with those without wraparound LADs (6.3% vs 0%, p =
0.02). In conclusion, in patients with anterior ST-segment elevation
myocardial infarctions, as compared with the LAD not supplying the
inferior aspect of the heart, a wraparound LAD was associated with a
larger left ventricular apex infarct size, resulting in worse adverse
events at 1 year. Copyright © 2015 Elsevier Inc. All rights
reserved.

<128>
Accession Number
602690679
Title
Transcatheter Reduction of Paravalvular Leaks: ASystematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. 31 (3) (pp 260-269), 2015. Date of
Publication: 01 Mar 2015.
Author
Millan X.; Skaf S.; Joseph L.; Ruiz C.; Garcia E.; Smolka G.; Noble S.;
Cruz-Gonzalez I.; Arzamendi D.; Serra A.; Kliger C.; Sia Y.T.; Asgar A.;
Ibrahim R.; Jolicoeur E.M.
Institution
(Millan, Skaf, Asgar, Ibrahim, Jolicoeur) Department of Medicine, Montreal
Heart Institute, Universite de Montreal, Montreal, QC, Canada
(Joseph) Division of Clinical Epidemiology, McGill University Health
Centre, Montreal, QC, Canada
(Ruiz, Kliger) Division of Structural and Congenital Heart Disease, Lenox
Hill Heart and Vascular Institute-North Shore LIJ Health System, New York,
NY, United States
(Garcia) Division of Interventional Cardiology, Hospital Universitario
Clinico San Carlos, Madrid, Spain
(Smolka) Division of Cardiology, Medical University of Silesia, Katowice,
Poland
(Noble) Department of Medical Specialties, Cardiology Division, Universite
de Geneve, Geneva, Switzerland
(Cruz-Gonzalez) Division of Interventional Cardiology, Hospital
Universitario de Salamanca, Salamanca, Spain
(Arzamendi, Serra) Division of Interventional Cardiology, Hospital de la
Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
(Sia) Centre Hospitalier Universitaire de Montreal, Universite de
Montreal, Montreal, QC, Canada
Publisher
Pulsus Group Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Significant paravalvular leak (PVL) after surgical valve
replacement can result in intractable congestive heart failure and
hemolytic anemia. Because repeat surgery is performed in only few
patients, transcatheter reduction of PVL is emerging as an alternative
option, but its safety and efficacy remain uncertain. In this study we
sought to assess whether a successful transcatheter PVL reduction is
associated with an improvement in clinical outcomes. Method(s): We
identified 12 clinical studies that compared successful and failed
transcatheter PVL reductions in a total of 362 patients. A Bayesian
hierarchical meta-analysis was performed using cardiac mortality as a
primary end point. The combined occurrence of improvement in New York
Heart Association functional class or hemolytic anemia and the need for
repeat surgery, were used as secondary end points. Result(s): A
successful transcatheter PVL reduction was associated with a lower cardiac
mortality rate (odds ratio [OR], 0.08; 95% credible interval [CrI],
0.01-0.90) and with a superior improvement in functional class or
hemolytic anemia, compared with a failed intervention (OR, 9.95; 95% CrI,
2.10-66.73). Fewer repeat surgeries were also observed after successful
procedures (OR, 0.08; 95% CrI, 0.01-0.40). Conclusion(s): A
successful transcatheter PVL reduction is associated with reduced
all-cause mortality and improved functional class in patients deemed
unsuitable for surgical correction. Copyright © 2015 Canadian
Cardiovascular Society.

<129>
Accession Number
600743256
Title
Culprit-vessel versus complete revascularization during primary
angioplasty in ST-elevation myocardial infarction: An updated
meta-analysis.
Source
International Journal of Cardiology. 178 (pp 171-174), 2015. Date of
Publication: 15 Jan 2015.
Author
Briasoulis A.; Afonso L.; Palla M.; Sharma S.; Panaich S.; Papageorgiou
N.; Tousoulis D.
Institution
(Briasoulis, Afonso, Palla, Sharma, Panaich) Wayne State
University/DetroitMedical Center, Department of Cardiology, Detroit, IL
48226, United States
(Papageorgiou, Tousoulis) University of Athens Medical School, 1st
Department of Cardiology, Greece
Publisher
Elsevier Ireland Ltd

<130>
Accession Number
601020272
Title
Impact of thrombus burden on outcomes after standard versus mesh-covered
stents in acute myocardial infarction (from the MGuard for Acute ST
Elevation Reperfusion Trial).
Source
American Journal of Cardiology. 115 (2) (pp 161-166), 2015. Date of
Publication: 15 Jan 2015.
Author
Costa R.A.; Abizaid A.; Lotan C.; Dudek D.; Silber S.; Dizon J.M.; Maehara
A.; Dressler O.; Brener S.J.; Stone G.W.
Institution
(Costa, Abizaid) Department of Invasive Cardiology, Institute Dante
Pazzanese of Cardiology, Sao Paulo, Brazil
(Costa, Abizaid) Cardiovascular Research Center, Sao Paulo, Brazil
(Lotan) Hadassah Medical Center, Jerusalem, Israel
(Dudek) Department of Interventional Cardiology, Jagiellonian University
Medical College, Krakow, Poland
(Silber) Heart Center at the Isar, Munich, Germany
(Dizon, Maehara, Dressler, Brener, Stone) Cardiovascular Research
Foundation, New York, NY, United States
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, New York, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Large thrombus burden negatively affects the results of percutaneous
coronary intervention (PCI) for acute ST-segment elevation myocardial
infarction (STEMI). We investigated the impact of thrombus burden in
patients with STEMI undergoing primary PCI with the mesh-covered MGuard
stent (InspireMD Ltd., Tel Aviv, Israel) versus a control bare-metal or
drug-eluting stent. In 433 patients with STEMI randomized to the MGuard
stent versus a control stent, angiographically visible thrombus was
identified in 383 patients (88.5%), with median thrombus area 30.15
mm2 (22.70, 41.93). Lesions with large thrombus (area > median)
were treated with more frequent use of manual aspiration (80.8% vs 65.8%,
p = 0.0009) and longer (22.1 +/- 5.9 vs 19.4 +/- 5.4 mm, p <0.0001) and
larger (3.46 +/- 0.40 vs 3.29 +/- 0.36 mm, p <0.0001) stents. PCI of
lesions with large thrombus burden had more thrombotic complications
(30.6% vs 15.9%, p = 0.0007) and reduced angiographic success (80.3% vs
91.1%, p = 0.003). In large thrombus lesions, the MGuard stent was more
effective than control stents in achieving Thrombolysis In Myocardial
Infarction-3 flow (87.9% vs 74.5%, p = 0.02) and tended to result in less
slow flow or no reflow (8.8% vs 17.6%, p = 0.07). ST-segment resolution
was improved with the MGuard, and clinical outcomes were favorable in both
stent groups, regardless of thrombus burden. In conclusion, reperfusion
success is reduced after primary PCI in lesions with large thrombus
burden, an outcome that may be modified by the MGuard stent. Copyright
© 2015 Elsevier Inc.

<131>
Accession Number
373272258
Title
Body mass index and acute and long-term outcomes after acute myocardial
infarction (from the Harmonizing Outcomes with Revascularization and
Stents in Acute Myocardial Infarction Trial).
Source
American Journal of Cardiology. 114 (1) (pp 9-16), 2014. Date of
Publication: 01 Jul 2014.
Author
Herrmann J.; Gersh B.J.; Goldfinger J.Z.; Witzenbichler B.; Guagliumi G.;
Dudek D.; Kornowski R.; Brener S.J.; Parise H.; Fahy M.; McAndrew T.C.;
Stone G.W.; Mehran R.
Institution
(Herrmann, Gersh) Division of Cardiovascular Diseases, Department of
Medicine, Mayo Clinic, Rochester, MN, United States
(Goldfinger, Mehran) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Witzenbichler) Amper Kliniken AG, Dachau, Germany
(Guagliumi) Interventional Cardiology Unit, Ospedale Papa Giovanni XXIII,
Bergamo, Italy
(Dudek) Institute of Cardiology, Jagiellonian University, Krakow, Poland
(Kornowski) Division of Cardiology, Rabin Medical Center, Petach-Tikva,
Israel
(Brener) Institute for Cardiology and Cardiac Surgery, New York Methodist
Hospital, Brooklyn, NY, United States
(Brener, Parise, Fahy, McAndrew, Stone, Mehran) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Stone) Division of Cardiology, Columbia University Medical Center, New
York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
The clinical outcome of acute cardiovascular events may be more favorable
in patients with a high body mass index (BMI), although obesity increases
the risk for cardiovascular diseases. The authors sought to define the
association between BMI and acute and long-term outcome of patients
presenting within 12 hours of ST-segment myocardial infarction (STEMI) in
a large multinational cohort. A total of 3,579 patients enrolled in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial were stratified according to BMI quartiles: <24.5, 24.5
to <27.1, 27.1 to 30.1, and >30.1 kg/m2 (quartiles 1, 2, 3, and
4, respectively). Death, myocardial reinfarction, ischemia-driven target
vessel revascularization, stroke, and noncoronary artery bypass
grafting-related major bleeding events were centrally adjudicated for the
acute, 30 days, and yearly follow-up. Patients with a BMI in the highest
quartile were younger than patients in the lower BMI quartiles and more
frequently had hypertension, hyperlipidemia, and diabetes mellitus.
Complete occlusions and noncalcified lesions were more common in patients
with a high BMI. In-hospital mortality decreased with increasing BMI due
to lower cardiac mortality (2.9%, 2.3%, 1.2%, and 1.0% for quartiles 1, 2,
3, and 4, respectively, p <0.05). Out-of-hospital 3-year mortality was
also lower in higher-weight patients due to lower noncardiac mortality
(4.2%, 2.6%, 2.3%, and 1.7% for quartiles 1 to 4, respectively, p = 0.01).
After adjustment for covariates, BMI was no longer predictive of acute or
long-term mortality after STEMI. In conclusion, as BMI increases, patients
have a more extensive adjusted cardiovascular risk profile and disease
burden and premature STEMI onset but similar adjusted acute and long-term
outcomes. © 2014 Elsevier Inc. All rights reserved.

<132>
Accession Number
600226858
Title
Postprocedural anticoagulation for specific therapeutic indications after
revascularization for ST-segment elevation myocardial infarction (from the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction Trial).
Source
American Journal of Cardiology. 114 (9) (pp 1322-1328), 2014. Date of
Publication: 01 Nov 2014.
Author
Madhavan M.V.; Genereux P.; Kirtane A.J.; Xu K.; Witzenbichler B.; Mehran
R.; Stone G.W.
Institution
(Madhavan, Genereux, Kirtane, Stone) Department of Medicine, Columbia
University Medical Center, New York-Presbyterian Hospital, New York, NY,
United States
(Genereux, Kirtane, Xu, Mehran, Stone) Cardiovascular Research Foundation,
New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Witzenbichler) Helios Amper-Klinikum, Dachau, Germany
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Postprocedural anticoagulation (AC) after primary percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
may be administered for a number of specific therapeutic indications (e.g.
atrial fibrillation or left ventricular thrombus). However, the safety and
effectiveness of such post-PCI AC for specific indications are not well
defined. Thus, we sought to study outcomes after postprocedural AC for
specific indications in patients undergoing primary PCI for STEMI in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial. Patients who underwent primary PCI for STEMI in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial were grouped according to whether they received specific
indication AC. Adverse outcomes were assessed using propensity-adjusted
multivariate analyses. After excluding patients who received post-PCI AC
solely for routine prophylaxis, 410 patients (16.6%) received
postprocedural AC for specific indications and 2,063 patients (83.4%)
received no post-PCI AC. After propensity adjustment, use of
postprocedural AC for specific indications was associated with higher
rates of cardiac mortality, reinfarction, stent thrombosis, and major
bleeding at 30 days compared with patients who received no AC post-PCI. In
conclusion, in this large prospective study, use of postprocedural AC for
specific indications after primary PCI for STEMI was independently
associated with early rates of adverse ischemic and hemorrhagic outcomes.
Post-PCI AC for specific indications was also associated with worse
outcomes from 30 days to 3 years. Further studies are warranted to
determine the optimal use of postprocedural AC after primary PCI in
STEMI. Copyright © 2014 Elsevier Inc. All rights reserved.

<133>
Accession Number
601067629
Title
Appropriate Revascularization in Stable Angina: Lessons From the BARI 2D
Trial.
Source
Canadian Journal of Cardiology. 30 (12) (pp 1595-1601), 2014. Date of
Publication: 01 Dec 2014.
Author
Krone R.J.; Althouse A.D.; Tamis-Holland J.; Venkitachalam L.; Campos A.;
Forker A.; Jacobs A.K.; Ocampo S.; Steiner G.; Fuentes F.; Pena Sing I.R.;
Brooks M.M.
Institution
(Althouse, Brooks) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Tamis-Holland) Mount Sinai Saint Luke's Hospital, New York, NA, United
States
(Venkitachalam) Department of Biomedical and Health Informatics,
University of Missouri-Kansas City, Kansas City, MO, United States
(Campos, Ocampo) Department of Cardiology, Hospital de Especialidades,
Centro Medico La Raza, IMSS, MEX City, Mexico
(Forker) Mid America Heart Institute, University of Missouri-Kansas City,
Kansas City, MO, United States
(Jacobs) Boston University and Boston Medical Center, Boston, MA, United
States
(Steiner) The University of Toronto, Toronto, ON, Canada
(Fuentes) Division of Cardiology, The University of Texas Health Science
Center at Houston, Houston, TX, United States
(Pena Sing) Heart and Vascular Catheterization Laboratories, Nanticoke
Memorial Hospital, Seaford, DE, United States
(Pena Sing) New York University, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: The 2012 Guidelines for Diagnosis and Management of Patients
with Stable Ischemic Heart Disease recommend intensive antianginal and
risk factor treatment (optimal medical management [OMT]) before
considering revascularization to relieve symptoms. The Bypass Angioplasty
Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized
patients with ischemic heart disease and anatomy suitable to
revascularization to (1) initial OMT with revascularization if needed or
(2) initial revascularization plus OMT and found no difference in major
cardiovascular events. Ultimately, however, 37.9% of the OMT group was
revascularized during the 5-year follow-up period. Method(s): Data
from the 1192 patients randomized to OMT were analyzed to identify
subgroups in which the incidence of revascularization was so high that
direct revascularization without a trial period could be justified.
Multivariate logistic analysis, Cox regression models of baseline data,
and a landmark analysis of participants who did not undergo
revascularization at 6 months were constructed. Result(s): The models
that used only data available at the time of study entry had limited
predictive value for revascularization by 6 months or by 5 years; however,
the model incorporating severity of angina during the first 6 months could
better predict revascularization (C statistic= 0.789). Conclusion(s):
With the possible exception of patients with severe angina and proximal
left anterior descending artery disease, this analysis supports the
recommendation of the 2012 guidelines for a trial of OMT before
revascularization. Patients could not be identified at the time of
catheterization, but a short period of close follow-up during OMT
identified the nearly 40% of patients who underwent
revascularization. Copyright © 2014 Canadian Cardiovascular
Society.

<134>
Accession Number
52996033
Title
Association between transforming growth factor beta-1 +869T/C polymorphism
and acute rejection of solid organ allograft: A meta-analysis and
systematic review.
Source
Transplant Immunology. 30 (2-3) (pp 76-83), 2014. Date of Publication:
March 2014.
Author
Ge Y.-Z.; Yu P.; Jia R.-P.; Wu R.; Ding A.-X.; Li L.-P.; Zhao Y.; Feng
Y.-M.; Gui Z.-L.; Liao S.
Institution
(Ge, Yu, Jia, Wu, Zhao, Feng, Gui, Liao) Department of Urology and Center
of Renal Transplantation, Nanjing First Hospital, Nanjing Medical
University, 68 Changle Road, Nanjing 210006, China
(Ding) Department of General Surgery, Nanjing First Hospital, Nanjing
Medical University, 68 Changle Road, Nanjing 210006, China
(Li) Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing
Medical University, 68 Changle Road, Nanjing 210006, China
Publisher
Elsevier B.V. (Netherlands)
Abstract
Background: Transforming growth factor beta-1(TGFB1) is involved in the
acute rejection (AR) episodes of solid organ transplant recipients.
However, results from published studies on the association between
donor/recipient TGFB1 + 869 T/C polymorphism and AR risk are conflicting
and inconclusive. Method(s): PUBMED, EMBASE, CNKI and Wanfang
Database were searched to identify eligible studies investigating the
association between donor/recipient TGFB1 +. 869. T/C polymorphism and AR
risk. Statistical analysis was performed by using STATA 10.0.
 Result(s): A total of 29 studies were included. Overall, the donor
TGFB1 + 869 T/C polymorphism was significantly associated with AR risk in
heterozygote comparison (CT vs. TT: OR = 1.67, 95%CI, 1.17-2.39; P
heterogeneity = 0.285) and dominant model (CC vs. TC/TT: OR = 1.47, 95%CI,
1.05-2.06; P heterogeneity = 0.445). In addition, subgroup analysis
revealed that CT variant (CT vs. TT: OR = 1.97, 95%CI, 1.20-3.25; P
heterogeneity = 0.777) and CC/CT genotype (CC/CT vs. TT: OR = 1.72, 95%CI,
1.07, 2.78; P heterogeneity = 0.619) within donors contributed to higher
risk of AR in recipients administrated with CsA or FK506, compared with
those applied only CsA. On the other hand, no significant association
between recipient TGFB1 + 869 T/C polymorphism and AR was detected in all
genetic models. Conclusion(s): This meta-analysis and systematic
review suggested that donor TGFB1 + 869 T/C polymorphism was significantly
associated with AR of solid organ transplant recipients, and especially
among patients in CsA/FK 506 group compared with those in CsA group.
© 2014 Elsevier B.V.

<135>
Accession Number
52911580
Title
Meta-analysis comparing carvedilol versus metoprolol for the prevention of
postoperative atrial fibrillation following coronary artery bypass
grafting.
Source
American Journal of Cardiology. 113 (3) (pp 565-569), 2014. Date of
Publication: 01 Feb 2014.
Author
Dinicolantonio J.J.; Beavers C.J.; Menezes A.R.; Lavie C.J.; O'Keefe J.H.;
Meier P.; Vorobcsuk A.; Aradi D.; Komocsi A.; Chatterjee S.; D'Ascenzo F.;
Gasparini M.; Brugts J.; Biondi-Zoccai G.
Institution
(Dinicolantonio) Department of Preventive Cardiology, Saint Luke's
Hospital, University of Missouri-Kansas City, Kansas City, MO, United
States
(Beavers) Department of Pharmacy, Centennial Medical Center, Nashville,
TN, United States
(Menezes, Lavie) Department of Cardiovascular Diseases, Ochsner Clinical
School, University of Queensland School of Medicine, New Orleans, LA,
United States
(Lavie) Department of Preventive Medicine, Pennington Biomedical Research
Center, Baton Rouge, LA, United States
(O'Keefe) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Meier) Heart Hospital, University College London Hospitals UCLH, London,
United Kingdom
(Vorobcsuk, Aradi, Komocsi) Department of Interventional Cardiology, Heart
Centre, University of Pecs, Hungary
(Chatterjee) Cardiovascular Diseases, St. Luke's - Roosevelt Hospital
Center, Division of Cardiology, New York, NY, United States
(D'Ascenzo) Division of Cardiology, Department of Internal Medicine, Citta
della Salute e della Scienza, San Giovanni battista, Turin, Italy
(Gasparini) Department of Mathematical Sciences, Politecnico di Torino,
Rotterdam, Netherlands
(Brugts) Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam,
Netherlands
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Aradi) Department of Cardiology, Heart Center, Balatonfured, Hungary
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
A systematic review and meta-analysis was performed to evaluate the
effects of carvedilol versus metoprolol on the incidence of postoperative
atrial fibrillation in patients undergoing coronary artery bypass grafting
in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and
Excepta Medica (EMBASE) were searched up to March 2013 for suitable
randomized controlled trials. Data were pooled using random-effects model
for pairwise analyses. A total of 4 trials with 601 patients were included
in this analysis. Pairwise analyses showed that compared with metoprolol,
carvedilol significantly reduced the incidence of postoperative atrial
fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In
conclusion, compared with metoprolol, carvedilol significantly reduces the
incidence of postoperative atrial fibrillation in patients undergoing
coronary artery bypass grafting. © 2014 Elsevier Inc. All rights
reserved.

<136>
Accession Number
600241753
Title
A comparison among infusion of lidocaine and dexmedetomidine alone and in
combination in subjects undergoing coronary artery bypass graft: A
randomized trial.
Source
Contemporary Clinical Trials. 39 (2) (pp 303-309), 2014. Date of
Publication: November 01, 2014.
Author
Kim H.-J.; Kim W.H.; Kim G.; Kim E.; Park M.-H.; Shin B.S.; Sim W.S.; Kim
C.S.; Lee Y.T.; Cho H.S.
Institution
(Kim, Kim) Department of Anesthesiology and Pain Medicine, Samsung
Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon,
South Korea
(Kim, Kim, Kim, Park, Shin, Sim, Kim, Cho) Department of Anesthesiology
and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School
of Medicine, Seoul, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Previous studies have reported the cardioprotective effect of
dexmedetomidine and lidocaine. We compared the effect of lidocaine and
dexmedetomidine infusion during off-pump coronary artery bypass graft
(OPCAB). Method(s): 153 patients undergoing OPCAB were enrolled. The
lidocaine group (n. =. 36, Group LIDO) received an infusion of lidocaine
2. mg/kg/h after bolus 1.5. mg/kg; the dexmedetomidine group (n. =. 40,
Group DEX) received dexmedetomidine 0.3-0.7. mug/kg/h; the combined group
(n. =. 39, Group Combined) received infusion of both drugs; and the
control group (n. =. 38) received nothing. We measured serum creatinine
kinase-myocardial band (CK-MB) and cardiac troponin I (cTnI) concentration
before and immediately after the surgery, postoperative day (POD)#1 and
#2. The complication rate and clinical outcomes were compared.
 Result(s): The concentration of cTnI was significantly lower in the
Group LIDO and Group Combined than the control group on POD#2. The
concentration of CK-MB was significantly lower in the Group LIDO and Group
Combined compared to the control group on POD#1 and #2 [CK-MB on POD#1:
7.67 (5.78-11.92) vs. 7.18 (5.01-11.72) vs. 13.19 (6.85-23.87) in the
Group LIDO, combined and control, respectively, Group LIDO vs. control: p.
=. 0.003, Group Combined vs. control: p. =. 0.015]. The AUC of CK-MB was
significantly lower in the Group LIDO and Group Combined than the control
group. However, clinical variables including complication rate, ICU stay
and one-year mortality were not different. Conclusion(s): Lidocaine
infused at 2. mg/kg/h, but not dexmedetomidine infused at 0.3-0.7.
mug/kg/h reduced postoperative myocardial injury marker levels compared
with the control group. However, no other clinical benefits were
observed. Copyright © 2014 Elsevier Inc.

<137>
Accession Number
52829688
Title
Use of IVUS guided coronary stenting with drug eluting stent: A systematic
review and meta-analysis of randomized controlled clinical trials and high
quality observational studies.
Source
International Journal of Cardiology. 170 (1) (pp 54-63), 2013. Date of
Publication: 05 Dec 2013.
Author
Klersy C.; Ferlini M.; Raisaro A.; Scotti V.; Balduini A.; Curti M.;
Bramucci E.; De Silvestri A.
Institution
(Klersy, De Silvestri) Service of Biometry and Statistics, IRCCS
Fondazione Policlinico San Matteo, 27100 Pavia, Italy
(Ferlini, Raisaro, Bramucci) Department of Cardiology, IRCCS Fondazione
Policlinico San Matteo, Pavia, Italy
(Scotti, Balduini, Curti) Center for Scientific Documentation, IRCCS
Fondazione Policlinico San Matteo, Pavia, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives Long term safety of DES, particularly regarding
thrombosis is of concern. The hypothesized underlying mechanisms (stent
underexpansion, malapposition) could be prevented by IVUS guidance. Aim of
this meta-analysis of randomized controlled clinical trials (RCT) and high
quality observational cohort studies (HQ-OBS) is to quantify the potential
clinical benefit of intravascular ultrasound (IVUS) guidance in
drug-eluting stents (DES) implantation. Methods We performed an extensive
literature search for full-text articles published in 2003-2013. The
primary outcome was the rate of major adverse cardiac events (MACE) in RCT
and HQ-OBS; secondary outcomes were death, myocardial infarction (MI),
revascularization, thrombosis and post-procedural minimum lumen diameter
(MLD). Fixed/random effect relative risks (RRs) or standardized mean
difference (SMD) and 95% confidence interval (95% CI) were computed for
the meta-analysis. Results Thirty-four articles were retrieved from 268
found; of these 3 were RCT and 9 were HQ-OBS; 18,707 patients were
enrolled, 1037 in RCT and 17,670 in OBS. Median follow-up was 20 months.
IVUS guidance was associated with a significantly lower rate of MACE (RR =
0.80, 95% CI 0.71-0.89, p < 0.001), death (RR = 0.60, 95% CI 0.48-0.74, p
< 0.001), MI (RR = 0.59, 95% CI 0.44-0.80, p = 0.001) and thrombosis (RR =
0.50, 95% CI 0.32-0.80, p = 0.007) and larger MLD (SMD = 0.15, 95% CI 0.03
to 0.27, p = 0.014), but not of revascularization (RR = 0.95, 95% CI
0.82-1.09, p = 0.75). Conclusions In this meta-analysis, IVUS guidance in
DES implantation appears to reduce MACE, mortality and MI, possibly by
reducing thrombosis rather than restenosis rate. Patients at high risk for
thrombosis might be identified as the best candidate for IVUS guidance.
© 2013 Elsevier Ireland Ltd.

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