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<1>
Accession Number
2005875740
Title
Microplegia in cardiac surgery: Systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2737-2746), 2020. Date of
Publication: 01 Oct 2020.
Author
Owen C.M.; Asopa S.; Smart N.A.; King N.
Institution
(Owen, King) School of Biomedical Sciences, Faculty of Health, University
of Plymouth, Plymouth, United Kingdom
(Asopa) South West Cardiothoracic Centre, University Hospitals Plymouth,
Plymouth, United Kingdom
(Smart) Exercise Physiology, School of Science and Technology, University
of New England, Armidale, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Consensus on the optimum choice of cardioplegia remains
elusive. One possibility that has been suggested to have beneficial
properties is microplegia, a cardioplegia of reduced crystalloid volume.
The aim of this meta-analysis is to comprehensively investigate
microplegia against a range of clinical outcomes. Method(s): To
identify potential studies, systematic searches were carried out in four
databases (eg, Pubmed, EMBASE). The search strategy included the key
concepts of "microplegia" OR "mini-cardioplegia" OR "miniplegia" AND
"cardiac surgery." This was followed by a meta-analysis investigating:
mortality, crystalloid volume; cardiopulmonary bypass time; cross-clamp
time; intra-aortic balloon pump use; spontaneous heartbeat recovery;
inotropic support; low cardiac output syndrome; myocardial infarction;
acute renal failure; atrial fibrillation, reoperation for bleeding;
creatine kinase myocardial band (CK-MB); intensive care unit (ICU) time
and hospital stay. Result(s): Eleven studies comprising 5798
participants were analyzed. Microplegia used a lower volume of
crystalloids and led to a higher spontaneous return of heartbeat, odds
ratio (OR) 4.271 (95% confidence intervals [CIs]: 1.935, 9.423;
I2 = 76.57%; P <.001) and a lower requirement for inotropic
support, OR: 0.665 (95% CI: 0.47, 0.941; I2 = 3.53%; P =.021).
Microplegia was also associated with a lower CK-MB release, mean
difference (MD) -6.448 ng/mL (95% CI: -9.386, -3.511; I2 = 0%;
P <.001) and a shorter ICU stay, MD: -0.411 days (95% CI: -0.812, -0.009;
I2 = 17.65%; P =.045). All other comparisons were
nonsignificant. Conclusion(s): Microplegia has similar effects to
other types of cardioplegia and is beneficial with regard to spontaneous
return of heartbeat, inotropic support, ICU stay, and CK-MB
release. Copyright © 2020 The Authors. Journal of Cardiac Surgery
published by Wiley Periodicals LLC

<2>
Accession Number
2005609370
Title
Mitral valve surgery combined with on-pump versus off-pump myocardial
revascularization: A prospective randomized analysis with midterm
follow-up.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2649-2656), 2020. Date of
Publication: 01 Oct 2020.
Author
Zavolozhin A.; Shonbin A.; Bystrov D.; Enginoev S.
Institution
(Zavolozhin, Shonbin) Department of Surgery, Arkhangelsk State Medical
University, Arkhangelsk, Russian Federation
(Zavolozhin, Enginoev) Department of Cardiac Surgery, FSBI Federal Centre
for Cardiovascular Surgery of the Ministry of Health of the Russian
Federation, Astrakhan, Russian Federation
(Shonbin, Bystrov) Department of Cardiac Surgery, City Hospital No 1,
Arkhangelsk, Russian Federation
(Enginoev) Department of Cardiac Surgery, Astrakhan State Medical
University, Astrakhan, Russian Federation
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The aim of the study was to compare results off-pump coronary
artery bypass (OPCAB) combined mitral valve reconstruction (MVR) with
standard on-pump approach. Method(s): From January 2014 to December
2017, a total of 53 patients received a combined myocardial
revascularization and MVR for multivessel coronary artery disease (CAD)
complicated by severe ischemic mitral regurgitation (IMR). All the
subjects were divided into two groups: group I: 27 patients, received
OPCAB + MVR, and group II (control group): 26 patients with on-pump
myocardial revascularization (ONCAB) + MVR. Result(s): The aortic
cross-clamp (ACC) and cardio-pulmonary bypass (CPB) times were longer in
group II, 47.0 (44.0; 55.0) vs 94.5 (89.75; 105.5) minutes, P <.05 and
70.0 (63.0; 77.0) vs 138.5 (127.0; 157.5) minutes, P <.05, respectively.
Evaluation of major clinical events showed that the implementation of the
off-pump stage of myocardial revascularization in patients with severe IMR
did not lead to significant changes in the mortality and postoperative
complications. Furthermore, its use did not affect the volume of blood
loss and need for blood transfusion, the duration of mechanical
ventilation, the need for inotropic therapy, as well as the duration of
the patient's resuscitation and the total duration of hospitalization,
with the one exception: the troponin-T level increase in the OPCAB + MVR
group was less than in the ONCAB + MVR group. Conclusion(s): OPCAB
combined MVR in patients with CAD and severe IMR can be performed with
shorter CPB and ACC times, and lower troponin-T level after surgery,
without reducing the risk of surgical complications. Copyright ©
2020 Wiley Periodicals LLC

<3>
Accession Number
632930532
Title
Transcatheter versus surgical aortic valve replacement in patients with
cardiac surgery: Meta-analysis and systematic review of the literature.
Source
Journal of Cardiovascular Development and Disease. 7 (3) (no pagination),
2020. Article Number: 36. Date of Publication: September 2020.
Author
Latif A.; Lateef N.; Ahsan M.J.; Kapoor V.; Usman R.M.; Cooper S.;
Andukuri V.; Mirza M.; Ashfaq M.Z.; Khouzam R.
Institution
(Latif, Lateef, Ahsan, Kapoor, Cooper, Andukuri, Mirza, Ashfaq) Department
of Internal Medicine, Creighton University, Omaha, NE 68124, United States
(Usman) Department of Internal Medicine, University of Tennessee, Memphis,
TN 38152, United States
(Khouzam) Department of Cardiology, University of Tennessee, Memphis, TN
38152, United States
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
The number of patients with severe aortic stenosis (AS) and a history of
prior cardiac surgery has increased. Prior cardiac surgery increases the
risk of adverse outcomes in patients undergoing aortic valve replacement.
To evaluate the impact of prior cardiac surgery on clinical endpoints in
patients undergoing transcatheter aortic valve replacement (TAVR) versus
surgical aortic valve replacement (SAVR), we performed a literature search
using PubMed, Embase, Google Scholar, and Scopus databases. The clinical
endpoints included in our study were 30-day mortality, 1-2-year mortality,
acute kidney injury (AKI), bleeding, stroke, procedural time, and duration
of hospital stay. Seven studies, which included a total of 8221 patients,
were selected. Our study found that TAVR was associated with a lower
incidence of stroke and bleeding complications. There was no significant
difference in terms of AKI, 30-day all-cause mortality, and 1-2-year
all-cause mortality between the two groups. The average procedure time and
duration of hospital stay were 170 min less (p <= 0.01) and 3.6 days
shorter (p < 0.01) in patients with TAVR, respectively. In patients with
prior coronary artery bypass graft and severe AS, both TAVR and SAVR are
reasonable options. However, TAVR may be associated with a lower incidence
of complications like stroke and perioperative bleeding, in addition to a
shorter length of stay. Copyright © 2020 by the authors.

<4>
[Use Link to view the full text]
Accession Number
632444552
Title
Use of administrative claims to assess outcomes and treatment effect in
randomized clinical trials for transcatheter aortic valve replacement:
Findings from the EXTEND study.
Source
Circulation. 142 (3) (pp 203-213), 2020. Date of Publication: 21 Jul 2020.
Author
Strom J.B.; Faridi K.F.; Butala N.M.; Zhao Y.; Tamez H.; Valsdottir L.R.;
Brennan J.M.; Shen C.; Popma J.J.; Kazi D.S.; Yeh R.W.
Institution
(Strom, Zhao, Tamez, Valsdottir, Shen, Kazi, Yeh) Richard A. and Susan F.
Smith Center for Outcomes Research in Cardiology, Boston, MA, United
States
(Strom, Faridi, Zhao, Tamez, Valsdottir, Shen, Popma, Kazi, Yeh) Division
of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston,
MA, United States
(Strom, Butala, Zhao, Tamez, Valsdottir, Shen, Popma, Kazi, Yeh) Harvard
Medical School, Boston, MA, United States
(Butala) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(Faridi) Section of Cardiovascular Medicine, Yale School of Medicine,
United States
(Brennan) Duke Clinical Research Institute, Durham, NC, United States
(Popma, Yeh) Baim Institute for Clinical Research, Boston, MA, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Background: Whether passively collected data can substitute for
adjudicated outcomes to reproduce the magnitude and direction of treatment
effect observed in cardiovascular clinical trials is not well known.
 Method(s): We linked adults >=65 years of age in the HiR (US
CoreValve Pivotal High Risk) and SURTAVI trials (Surgical or Transcatheter
Aortic Valve Replacement in Intermediate-Risk Patients) to 100% Medicare
inpatient claims, January 1, 2011, to December 31, 2016. Primary (eg,
death and stroke) and secondary trial end points were compared across
treatment arms (eg, transcatheter aortic valve replacement [TAVR] versus
surgical aortic valve replacement [SAVR]) using trial-adjudicated outcomes
versus outcomes derived from claims at 1 year (HiR) or 2 years (SURTAVI).
 Result(s): Among 600 linked HiR participants (linkage rate, 80.0%),
the rate of the trial's primary end point of all-cause mortality occurred
in 13.7% of patients receiving TAVR and 16.4% of patients receiving SAVR
at 1 year by using both trial data (hazard ratio, 0.84 [95% CI,
0.65-1.09]; P=0.33) and claims data (hazard ratio, 0.86 [95% CI,
0.66-1.11]; P=0.34; interaction P value=0.80). Noninferiority of TAVR
relative to SAVR was seen by using both trial- and claims-based outcomes
(P<inf>noninferiority</inf><0.001 for both). Among 1005 linked SURTAVI
trial participants (linkage rate, 60.5%), the trial's primary end point
was 12.9% for TAVR and 13.1% for SAVR using trial data (hazard ratio, 1.08
[95% CI, 0.79-1.48]; P=0.90), and 11.3% for TAVR and 12.5% for SAVR
patients using claims data (hazard ratio, 1.02 [95% CI, 0.73-1.41];
P=0.58; interaction P value=0.89). TAVR was noninferior to SAVR when
compared using both trial and claims (P<inf>non</inf>
<inf>inferiority</inf><0.001 for both). Rates of procedural secondary
outcomes (eg, aortic valve reintervention, pacemaker rates) were more
closely concordant between trial and claims data than nonprocedural
outcomes (eg, stroke, bleeding, cardiogenic shock). Conclusion(s): In
the HiR and SURTAVI trials, ascertainment of trial primary end points
using claims reproduced both the magnitude and direction of treatment
effect in comparison with adjudicated event data, but nonfatal and
nonprocedural secondary outcomes were not as well reproduced. Use of
claims to substitute for adjudicated outcomes in traditional trial
treatment comparisons may be valid and feasible for all-cause mortality
and certain procedural outcomes but may be less suitable for other end
points. Copyright © 2020 Lippincott Williams and Wilkins. All
rights reserved.

<5>
Accession Number
2006146083
Title
Cardiac Surgery in Trisomy 13 and 18: A Guide to Clinical Decision-Making.
Source
Pediatric Cardiology. 41 (7) (pp 1319-1333), 2020. Date of Publication: 01
Oct 2020.
Author
Carvajal H.G.; Callahan C.P.; Miller J.R.; Rensink B.L.; Eghtesady P.
Institution
(Carvajal, Miller, Rensink, Eghtesady) Section of Pediatric Cardiothoracic
Surgery, Department of Surgery, Washington University School of Medicine
in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, United States
(Callahan) Department of Surgery, Barnes-Jewish Hospital, Washington
University School of Medicine in St. Louis, Saint Louis, MO, United States
Publisher
Springer
Abstract
There has been substantial controversy regarding treatment of congenital
heart defects in infants with trisomies 13 and 18. Most reports have
focused on surgical outcomes versus expectant treatment, and rarely there
has been an effort to consolidate existing evidence into a more coherent
way to help clinicians with decision-making and counseling families. An
extensive review of the existing literature on cardiac surgery in patients
with these trisomies was conducted from 2004 to 2020. The effects of
preoperative and perioperative factors on in-hospital and long-term
mortality were analyzed, as well as possible predictors for postoperative
chronic care needs such as tracheostomy and gastrostomy. Patients with
minimal or no preoperative pulmonary hypertension and mechanical
ventilation undergoing corrective surgery at a weight greater than 2.5 kg
suffer from lower postoperative mortality. Infants with lower-complexity
cardiac defects are likely to benefit the most from surgery, although
their expected mortality is higher than that of infants without trisomy.
Omphalocele confers an increased mortality risk regardless of cardiac
surgery. Gastrointestinal comorbidities increased the risk of gastrostomy
tube placement, while those with prolonged mechanical ventilation and
respiratory comorbidities are more likely to require tracheostomy. Cardiac
surgery is feasible in children with trisomies 13 and 18 and can provide
improved long-term results. However, this is a clinically complex
population, and both physicians and caretakers should be aware of the
long-term challenges these patients face following surgery when discussing
treatment options. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<6>
Accession Number
2005883806
Title
The Effect of Caregiver-Mediated Mobility Interventions in Hospitalized
Patients on Patient, Caregiver, and Health System Outcomes: A Systematic
Review.
Source
Archives of Rehabilitation Research and Clinical Translation. 2 (3) (no
pagination), 2020. Article Number: 100053. Date of Publication: September
2020.
Author
Yasmeen I.; Krewulak K.D.; Grant C.; Stelfox H.T.; Fiest K.M.
Institution
(Yasmeen, Krewulak, Grant, Stelfox, Fiest) Department of Critical Care
Medicine, Alberta Health Services and Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
(Grant) Department of Clinical Neurosciences, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
(Stelfox, Fiest) Department of Community Health Sciences and O'Brien
Institute for Public Health, University of Calgary, Calgary, AB, Canada
(Fiest) Department of Psychiatry and Hotchkiss Brain Institute, Cumming
School of Medicine, University of Calgary, Calgary, AB, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objective: To synthesize the evidence examining caregiver-mediated
mobility interventions in a hospital setting and whether they improve
patient, caregiver, or health system outcomes. Data Sources: We
searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from
inception to September 7, 2018. Study Selection: Two reviewers
independently selected original research in inpatient settings that
reported on an intervention delivered by a caregiver (eg, family, friend,
paid worker) and directed to the patient's mobility. Mobility
interventions were categorized based on the level of caregiver engagement
using a 3-category framework: inform (provision of education on patient's
condition and management), activate (prompting caregivers to take action
in patient care), and collaborate (encouraging interaction with providers
or other caregivers). Data Extraction: One reviewer extracted data,
and another checked the data. Quality was assessed using the Cochrane
Collaboration's risk of bias tool and Grading of Recommendations,
Assessment, Development and Evaluation approach. Data Synthesis:
Forty studies met the inclusion criteria; most were randomized controlled
trials (n=16/40, 40.0%) and investigated older adults (n=18/40, 45.0%)
with stroke (n=20/40, 50.0%). Inform (n=2) and activate (n=4)
interventions and combined inform-activate (n=5/6, 83.3%) and
inform-activate-collaborate (n=6/10, 60.0%) interventions were reported to
improve patient mobility. Inform-activate and inform-collaborate
interventions were reported to improve caregiver outcomes (eg, burden)
(n=13/19, 68.4%). Studies that engaged caregivers in all 3 strategies
(inform-activate-collaborate) were reported to improve health system
outcomes (eg, hospital readmission) (n=4/6, 66.7%). Most studies were of
unclear (n=22/40, 55.0%) or low risk of bias (n=11/40, 27.5%) for most
domains. Conclusion(s): Engaging caregivers in mobility of
hospitalized patients may improve patient mobility as well as caregiver
and health system outcomes. Copyright © 2020 The Authors

<7>
Accession Number
632877046
Title
Effects of dexmedetomidine on cerebral oxygen saturation and postoperative
cognitive function in elderly patients undergoing minimally invasive
coronary artery bypass surgery.
Source
Clinical Hemorheology and Microcirculation. 74 (4) (pp 383-389), 2020.
Date of Publication: 2020.
Author
Gao Y.; Zhu X.; Huang L.; Teng J.; Li F.
Institution
(Gao, Teng, Li) Department of Anesthesiology, First Affiliated Hospital of
Hebei North University, No. 12 Changqing Road, Qiaoxi District,
Zhangjiakou, Hebei 075000, China
(Zhu) Department of Imaging Center, First Affiliated Hospital of Hebei
North University, Zhangjiakou, Hebei, China
(Huang) Department of Anesthesiology, Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
Publisher
IOS Press BV (E-mail: sales@iospress.com)
Abstract
OBJECTIVE: This study aimed to investigate the effects of dexmedetomidine
on cerebral oxygen saturation [Sct(O2)] and postoperative cognitive
function in elderly patients undergoing minimally invasive coronary artery
bypass graft surgery. METHOD(S): Sixty elderly patients who received
minimally invasive coronary artery bypass graft surgery were randomly
equally divided into dexmedetomidine group (group D) and control group
(group N). The patients in group D were pumped with 1 mug/kg
dexmedetomidine for 15min before incision, followed by continuous pumping
at 0.3-0.5 mug/(kg.h) till the end of the operation. The patients in group
N received same dose of normal saline during the operation. Sct(O2) was
monitored at pre-induction (T0), post-induction (T1), 30min (T2) after
single-lung ventilation, and after surgery (T3). Mini-mental state
examination (MMSE) was used to assess the cognitive function at 1 day
before, 72 hour and 7 days after surgery. RESULT(S): Sct(O2) level in
group D was significantly higher than that in group N at T2 (P<0.05).
Sct(O2) level was statistically lower at T2 than that at T0, T1 and T3 in
the same group N (P<0.05). At 72h and 7d after operation, the incidence of
cognitive dysfunction in group D was markedly lower than that in group N
(P<0.05), the MMSE score in group D was markedly higher than those in
group N, but was significantly lower than that before surgery (P<0.05).
 CONCLUSION(S): Dexmedetomidine can alleviate the decrease of Sct(O2)
during single-lung ventilation, improve postoperative cognitive function,
and reduce the incidence of POCD in elderly patients with minimally
invasive coronary artery bypass surgery. Copyright © 2020 - IOS
Press and the authors. All rights reserved.

<8>
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.

<9>
[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.

<10>
Accession Number
2005688417
Title
Publication of cardiac surgery research papers in top cardiovascular
journals.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2734-2736), 2020. Date of
Publication: 01 Oct 2020.
Author
Gaudino M.; Morsi M.; Hameed I.; Naik A.; Robinson N.B.; Benedetto U.;
Ruel M.
Institution
(Gaudino, Morsi, Hameed, Naik, Robinson) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim: To evaluate the publication rate of articles related
to cardiac surgery in the four main cardiovascular journals over the last
5 years. Method(s): A bibliometric review of all full-length articles
published between January 2014 and March 2020 in the top four
cardiovascular journals (Circulation, European Heart Journal (EHJ),
Journal of the American College of Cardiology (JACC), and JAMA Cardiology)
was conducted. For each eligible article in the four journals, the journal
of publication, study design, area of interest, country of origin, and
type of intervention tested (for cardiac surgery and interventional
cardiology studies) were extracted. The affiliations of all editorial
board members were identified from journal websites or from online
searches and recorded as from cardiac surgery, cardiology, or another
discipline. Correlations between variables were evaluated. Result(s):
A total of 4835 articles were reviewed. Cardiac surgery studies amounted
to 6.2% (104) of total research publications in JACC, 4.4% (74) in
Circulation, 3.6% (13) in JAMA Cardiology, and 2.0% (22) in EHJ (P <.001).
The percentage of cardiac surgery publications was significantly less than
interventional cardiology publications (P <.001). Conclusion(s):
Cardiac surgery studies represent only a small minority of the articles
published in the top cardiovascular journals over the last 5 years, with
significant differences between individual journals. Cardiac surgery
studies were more often observational and this may constitute one
important reason for their under-representation. Copyright © 2020
Wiley Periodicals LLC

<11>
Accession Number
633147519
Title
The effect of early oral stimulation with breast milk on the feeding
behavior of infants after congenital cardiac surgery.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 309), 2020. Date of
Publication: 09 Oct 2020.
Author
Yu X.-R.; Huang S.-T.; Xu N.; Wang L.-W.; Wang Z.-C.; Cao H.; Chen Q.
Institution
(Yu, Huang, Xu, Wang, Wang, Cao, Chen) Department of Cardiac Surgery,
Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian
Medical University, Fuzhou, China
(Yu, Huang, Xu, Wang, Wang, Cao, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
(Wang, Chen) Department of Cardiovascular Surgery, Union Hospital, Fujian
Medical University, Fuzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate the effect of early oral stimulation with breast
milk on the feeding behavior of infants after congenital cardiac surgery.
 METHOD(S): Infants with congenital heart disease were randomly
divided into the breast milk oral stimulation group (n =23), physiological
saline oral stimulation group (n =23) and control group (n =23). Debra
Beckman's oral exercise program was used with breast milk and
physiological saline in the breast milk oral stimulation group and the
physiological saline oral stimulation group, respectively. The time oral
feeding and total oral nutrition were started, the length of intensive
care unit (ICU) stay and hospital stay, weight and the complications at
discharge were recorded for each group and statistically analyzed.
 RESULT(S): The time oral feeding and total oral nutrition were
started and the length of ICU stay and hospital stay were significantly
less in the breast milk oral stimulation group and physiological saline
oral stimulation group than in the control group (P <0.05). There were no
significant differences in other indicators between the breast milk oral
stimulation group and the physiological saline oral stimulation group,
except for the time total oral nutrition began (P <0.05). However, there
were no significant differences in weight or complications at discharge
among the three groups (P>0.05). CONCLUSION(S): Early oral
stimulation exercises with breast milk can help infant patients quickly
recover total oral nutrition and reduce the length of ICU and hospital
stay after cardiac surgery.

<12>
Accession Number
633061650
Title
Classification of aerosol-generating procedures: A rapid systematic
review.
Source
BMJ Open Respiratory Research. 7 (1) (no pagination), 2020. Article
Number: e000730. Date of Publication: 09 Oct 2020.
Author
Jackson T.; Deibert D.; Wyatt G.; Durand-Moreau Q.; Adisesh A.; Khunti K.;
Khunti S.; Smith S.; Chan X.H.S.; Ross L.; Roberts N.; Toomey E.;
Greenhalgh T.; Arora I.; Black S.M.; Drake J.; Syam N.; Temple R.; Straube
S.
Institution
(Jackson, Deibert, Wyatt, Durand-Moreau, Straube) Division of Preventive
Medicine, Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Adisesh) Division of Occupational Medicine, Department of Medicine,
University of Toronto, Toronto, ON, Canada
(Khunti) Diabetes Research Centre, University of Leicester, Leicester,
United Kingdom
(Khunti) School of Medicine and Dentistry, Barts and the London School of
Medicine and Dentistry, London, United Kingdom
(Smith) Canadian Standards Biological Aerosols Group, Canadian Standards
Association, Toronto, ON, Canada
(Chan) Centre for Tropical Medicine and Global Health, Nuffield Department
of Medicine, University of Oxford, Oxford, Oxfordshire, United Kingdom
(Ross) Division of Infectious Diseases, Children's Hospital of Los
Angeles, Los Angeles, CA, United States
(Roberts) Bodleian Health Care Libraries, University of Oxford, Oxford,
Oxfordshire, United Kingdom
(Toomey) School of Allied Health, University of Limerick, Limerick,
Ireland
(Greenhalgh) Nuffield Department of Primary Care Health Sciences,
University of Oxford, Oxford, Oxfordshire, United Kingdom
(Arora, Black, Drake, Syam, Temple) Medical Sciences Division, University
of Oxford, Oxford, Oxfordshire, United Kingdom
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
In the context of covid-19, aerosol generating procedures have been
highlighted as requiring a higher grade of personal protective equipment.
We investigated how official guidance documents and academic publications
have classified procedures in terms of whether or not they are
aerosol-generating. We performed a rapid systematic review using preferred
reporting items for systematic reviews and meta-Analyses standards.
Guidelines, policy documents and academic papers published in english or
french offering guidance on aerosol-generating procedures were eligible.
We systematically searched two medical databases (medline, cochrane
central) and one public search engine (google) in march and april 2020.
Data on how each procedure was classified by each source were extracted.
We determined the level of agreement across different guidelines for each
procedure group, in terms of its classification as aerosol generating,
possibly aerosol-generating, or nonaerosol-generating. 128 documents met
our inclusion criteria; they contained 1248 mentions of procedures that we
categorised into 39 procedure groups. Procedures classified as
aerosol-generating or possibly aerosol-generating by >=90% of documents
included autopsy, surgery/postmortem procedures with high-speed devices,
intubation and extubation procedures, bronchoscopy, sputum induction,
manual ventilation, airway suctioning, cardiopulmonary resuscitation,
tracheostomy and tracheostomy procedures, non-invasive ventilation,
high-flow oxygen therapy, breaking closed ventilation systems, nebulised
or aerosol therapy, and high frequency oscillatory ventilation.
Disagreements existed between sources on some procedure groups, including
oral and dental procedures, upper gastrointestinal endoscopy, thoracic
surgery and procedures, and nasopharyngeal and oropharyngeal swabbing.
There is sufficient evidence of agreement across different international
guidelines to classify certain procedure groups as aerosol generating.
However, some clinically relevant procedures received surprisingly little
mention in our source documents. To reduce dissent on the remainder, we
recommend that (a) clinicians define procedures more clearly and
specifically, breaking them down into their constituent components where
possible; (b) researchers undertake further studies of aerosolisation
during these procedures; and (c) guideline-making and policy-making bodies
address a wider range of procedures. Copyright ©

<13>
Accession Number
632911494
Title
Appropriate therapy for patients with stable ischemic heart disease: a
review of literature and the implication of the International Study of
Comparative Effectiveness with Medical and Invasive Approaches trial.
Source
Current opinion in cardiology. 35 (6) (pp 658-663), 2020. Date of
Publication: 01 Nov 2020.
Author
Guo M.H.; Nantsios A.; Ruel M.
Institution
(Guo) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The aim of this review is to review the current
literature on the management of stable ischemic heart disease in light of
findings from the International Study of Comparative Effectiveness with
Medical and Invasive Approaches (ISCHEMIA) trial. RECENT FINDINGS:
Compared with optimal medical therapy, coronary artery bypass grafting
(CABG) has been shown to improve survival and incidence of myocardial
infarction in patients with stable ischemic heart disease whereas
percutaneous coronary intervention (PCI) has not. The ISCHEMIA trial
compared an initial conservative management strategy with optimal medical
therapy with an initial invasive strategy with coronary angiogram followed
by revascularization and found no difference in survival and myocardial
infarction between the two groups. However, the trial was conducted under
the assumption that patients would be referred to the most efficacious
revascularization therapy; it was apparent that CABG was underutilized in
many appropriate patients in the ISCHEMIA trial. The study highlighted the
importance of optimizing medical therapy in stable ischemic heart disease
(SIHD) patients but does not answer whether revascularization or
conservative management is better for patients with SIHD. SUMMARY: Optimal
medical therapy is an important element and should be included in the
Heart Team discussion, and also applied after revascularization from PCI
or CABG. Cardiac surgeons need to continue to advocate for the appropriate
use of CABG based on the current available evidence.

<14>
Accession Number
2005150148
Title
Effect of early mobilization on physical function in patients after
cardiac surgery: A systematic review and meta-analysis.
Source
International Journal of Environmental Research and Public Health. 17 (19)
(pp 1-11), 2020. Article Number: 7091. Date of Publication: 01 Oct 2020.
Author
Kanejima Y.; Shimogai T.; Kitamura M.; Ishihara K.; Izawa K.P.
Institution
(Kanejima, Shimogai, Kitamura, Ishihara, Izawa) Department of Public
Health, Graduate School of Health Sciences, Kobe University, Kobe
654-0142, Japan
(Kanejima, Shimogai, Kitamura, Ishihara, Izawa) Cardiovascular Stroke
Renal Project (CRP), Kobe 654-0142, Japan
(Kanejima, Shimogai) Department of Rehabilitation, Kobe City Medical
Center General Hospital, Kobe 650-0047, Japan
(Kitamura) Department of Physical Therapy, Kokura Rehabilitation College,
2-10 Kuzuharahigashi 2-chome, Kokuraminami-ku, Kitakyushu 800-0206, Japan
(Ishihara) Department of Rehabilitation, Sakakibara Heart Institute of
Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
The objective effects of early mobilization on physical function in
patients after cardiac surgery remain unknown. The purpose of the present
study was to clarify the effects of early mobilization on physical
function in patients after cardiac surgery through meta-analysis. Four
electronic databases were searched on 2 August 2019. We used search
keywords related to "early mobilization", "cardiac surgery", and
"randomized controlled trials". All randomized controlled trials
conducting early mobilization after cardiac surgery were included. We
defined early mobilization as the application of physical activity within
the first five postoperative days. Citations and data extraction were
independently screened in duplicate by two authors. The meta-analysis was
conducted using random-effects modeling with EZR software. The primary
outcome was the distance walked during the six-minute walking test at
hospital discharge. Six randomized controlled trials comprising 391
patients were included following screening of 591 studies. All studies
included coronary artery bypass grafting as the cardiac surgery conducted.
Early mobilization started on postoperative days 1-2 and was conducting
twice daily. Early mobilization showed a trend of being combined with
respiratory exercise or psychoeducation. The meta-analysis showed that the
distance walked during the 6-min walking test improved by 54 m (95%
confidence interval, 31.1-76.9; I2 = 52%) at hospital
discharge. The present study suggested that early mobilization after
cardiac surgery may improve physical function at discharge. Copyright
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

<15>
Accession Number
2008357218
Title
Methylene blue reduces incidence of early postoperative cognitive
disorders in elderly patients undergoing major non-cardiac surgery: An
open-label randomized controlled clinical trial.
Source
Journal of Clinical Anesthesia. 68 (no pagination), 2021. Article Number:
110108. Date of Publication: February 2021.
Author
Deng Y.; Wang R.; Li S.; Zhu X.; Wang T.; Wu J.; Zhang J.
Institution
(Deng, Zhang) Department of Anesthesiology, Shanghai Cancer Center, Fudan
University, Shanghai 200032, China
(Wang, Li, Wang) Department of Anesthesiology, Huashan Hospital, Fudan
University, Shanghai 200040, China
(Zhu) Department of Psychiatry, Huashan Hospital, Fudan University,
Shanghai 200040, China
(Wu) Department of Neurology, Huashan Hospital, Fudan University, Shanghai
200040, China
(Zhang) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai 200032, China
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Study objective: The purpose of the present study was to investigate
whether methylene blue (MB) could reduce the incidences of postoperative
delirium (POD) and early postoperative cognitive dysfunction (POCD) in
elderly patients undergoing major non-cardiac surgery. Design(s):
Prospective, randomized, open-label clinical trial. Setting(s):
University-affiliated hospital. Patient(s): Two hundred and
forty-eight elderly patients scheduled for non-cardiac surgery.
 Intervention(s): Elderly patients undergoing non-cardiac major
surgery were randomly assigned to MB group (n = 124), who receiving
intravenous infusion of 2 mg/kg MB within 60 min immediately after
anesthetic induction, or control group (n = 124), who receiving equal
volume saline in the same way. Measurements: All patients were evaluated
with delirium and neuropsychological batteries before and after surgery,
as well as perioperative adverse events. Two plasma biomarkers superoxide
dismutase (SOD) and homocysteine (HCY) were measured pre- and
post-operatively. Main Result(s): There were total 39
cases(15.7%)experienced POD. The incidence of POD in MB group was
significantly less than that in control group (7.3% vs. 24.2%, OR = 0.24,
95%CI: 0.11-0.53, p < 0.001). The incidence of early POCD at postoperative
7th day in MB group was also less than that in control group (16.1% vs.
40.2%, OR = 0.30, 95% CI: 0.16-0.57, p < 0.001). The adverse events were
comparable in both groups. In addition, there was no significant
correlation between POD/POCD and levels of SOD or HCY. Conclusion(s):
We conclude that intraoperative intravenous 2 mg/kg MB could significantly
reduce the incidences of POD and early POCD in elderly surgical patients,
while not remarkably increase incidence of perioperative adverse events,
suggesting MB may be clinically effective and safe for prevention of early
postoperative neurocognitive disorders. Copyright © 2020 Elsevier
Inc.

<16>
Accession Number
2008345969
Title
Electromagnetic versus blind guidance of a postpyloric feeding tube in
critically ill children.
Source
Pediatrics. 146 (4) (no pagination), 2020. Article Number: e20193773. Date
of Publication: 01 Dec 2020.
Author
Jha P.; Rupp L.; Bonilla L.; Gelfond J.; Shah J.N.; Meyer A.D.
Institution
(Jha) Division of Critical Care, Department of Pediatrics, Children's
Hospital of Nevada, University Medical Center, Las Vegas, NV, United
States
(Jha) Department of Pediatrics, University of Nevada Las Vegas School of
Medicine, Las Vegas, NV, United States
(Rupp, Bonilla, Shah, Meyer) Pediatric Services, University Health System,
San Antonio, TX, United States
(Shah) Division of Pediatric Gastroenterology, University of Texas Health
San Antonio, San Antonio, TX, United States
(Meyer) Division of Pediatric Critical Care, Department of Pediatrics,
University of Texas Health San Antonio, San Antonio, TX, United States
(Gelfond) Department of Epidemiology and Biostatistics, University of
Texas Health San Antonio, San Antonio, TX, United States
Publisher
American Academy of Pediatrics (E-mail: csc@aap.org)
Abstract
BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a
time-consuming procedure associated with multiple attempts and radiation
exposure. Our objective with this study is to compare the time, attempts,
and radiation exposure using the electromagnetic versus blind method to
place a postpyloric feeding tube in critically ill children. Our
hypothesis is that using electromagnetic guidance decreases the procedure
time, number of x-rays, and number of attempts, compared to the blind
method. METHOD(S): Eleven pediatric nurses participated in a
randomized controlled intention-to-treat study at an academic pediatric
medical, surgical, and congenital cardiac ICU. University of Texas Health
Epidemiology and Biostatistics generated a randomization sequence with
sealed envelopes. A standard (2-sided) F-test of association between the
electromagnetic and blind method yielded 40 subjects with 86% power. Data
were analyzed with Fisher's exact test for categorical variables and the
Wilcoxon rank test for continuous variables, with data documented as
median (interquartile range [IQR]). RESULT(S): We randomly assigned
52 patients to either the electromagnetic (n = 28) or blind method (n =
24). The number of attempts and radiographs was at a median of 2 (IQR:
1-2.25) using the blind method, compared to the electromagnetic method at
a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with
the electromagnetic method, compared to only 66.7% with the blind
technique (P = .008). The total time required was 2.5 minutes (IQR:
2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR:
9.25-27.0) for the blind method (P = .001). CONCLUSION(S):
Electromagnetic guidance is a superior, faster, and overall safer method
to place a postpyloric feeding tube in critically ill
children. Copyright © 2020 by the American Academy of Pediatrics.

<17>
Accession Number
2008361236
Title
Dextran- Versus Crystalloid-Based Prime in Cardiac Surgery: A Prospective
Randomized Pilot Study.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1541-1547), 2020. Date of
Publication: November 2020.
Author
Barbu M.; Kolsrud O.; Ricksten S.-E.; Dellgren G.; Zetterberg H.; Blennow
K.; Bjork K.; Thoren A.; Hansson C.; Jeppsson A.
Institution
(Barbu) Department of Cardiology, Blekinge Hospital, Karlskrona, Sweden
(Barbu, Dellgren, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Kolsrud, Dellgren, Bjork, Hansson, Jeppsson) Department of Cardiothoracic
Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
(Ricksten, Thoren) Department of Cardiothoracic Anaesthesia and Intensive
Care, Sahlgrenska University Hospital, Gothenburg, Sweden
(Ricksten) Department of Anesthesiology and Intensive Care, Institute of
Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
(Zetterberg, Blennow) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Zetterberg, Blennow) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, Sahlgrenska Academy, University
of Gothenburg, Molndal, Sweden
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: The optimum priming fluid for the cardiopulmonary bypass (CPB)
circuit is still debated. We compared a new hyperoncotic priming solution
containing dextran 40, which has an electrolyte composition that mimics
extracellular fluid, with a standard crystalloid-based prime.
 Method(s): Eighty cardiac surgery patients were included in this
double-blind, randomized, single-center study. Patients were randomized to
either a dextran-based prime or a crystalloid prime containing Ringer's
acetate and mannitol. The primary end point was colloid oncotic pressure
in serum during CPB. Secondary end points included fluid balance, bleeding
and transfusion requirements, pulmonary function, hemolysis, systemic
inflammation, and markers of renal, hepatic, myocardial, and brain injury.
Blood samples were collected before, during, and after CPB.
 Result(s): Colloid oncotic pressure was higher in the dextran group
than in the crystalloid prime group during CPB (18.8 +/- 2.9 versus 16.4
+/- 2.9 mm Hg; P <.001) and 10 minutes after CPB (19.2 +/- 2.7 versus 16.8
+/- 2.9 mm Hg; P <.001). Patients in the dextran group required less
intravenous fluid during CPB (1090 +/- 499 versus 1437 +/- 543 mL; P
=.004) and net fluid balance was less positive 12 hours after surgery
(1431 +/- 741 versus 1901 +/- 922 mL; P =.014). Plasma-free hemoglobin was
significantly lower in the dextran group 2 hours after CPB (0.18 +/- 0.11
versus 0.41 +/- 0.33; P =.001). There were no significant differences in
bleeding, transfusion requirements, organ function, systemic inflammation,
or brain and myocardial injury markers between groups at any time point.
 Conclusion(s): Our results suggest that a hyperoncotic dextran-based
priming solution preserves intraoperative colloid oncotic pressure
compared with crystalloid prime. Larger studies with clinically valid end
points are necessary to evaluate hyperoncotic prime solutions
further. Copyright © 2020 The Society of Thoracic Surgeons

<18>
Accession Number
2005197566
Title
The prospects of secondary moderate mitral regurgitation after aortic
valve replacement -meta-analysis.
Source
International Journal of Environmental Research and Public Health. 17 (19)
(pp 1-14), 2020. Article Number: 7335. Date of Publication: 01 Oct 2020.
Author
Bilbija I.; Matkovic M.; Cubrilo M.; Aleksic N.; Lazovic J.M.; Cumic J.;
Tutus V.; Jovanovic M.; Putnik S.
Institution
(Bilbija, Matkovic, Cubrilo, Aleksic, Putnik) Department for Cardiac
Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
(Bilbija, Matkovic, Aleksic, Putnik) Department of Surgery with
Anesthesiology, Faculty of Medicine, University of Belgrade, Belgrade
11000, Serbia
(Lazovic) Department for Biostatistics, Faculty of Medicine, University of
Belgrade, Belgrade 11000, Serbia
(Cumic, Tutus) Department for Anesthesiology and Intensive Care, Clinical
Center of Serbia, Belgrade 11000, Serbia
(Jovanovic) Institute for Cardiovascular Diseases Dedinje, Belgrade 11000,
Serbia
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Aortic valve replacement for aortic stenosis represents one of the most
frequent surgical procedures on heart valves. These patients often have
concomitant mitral regurgitation. To reveal whether the moderate mitral
regurgitation will improve after aortic valve replacement alone, we
performed a systematic review and meta-analysis. We identified 27 studies
with 4452 patients that underwent aortic valve replacement for aortic
stenosis and had co-existent mitral regurgitation. Primary end point was
the impact of aortic valve replacement on the concomitant mitral
regurgitation. Secondary end points were the analysis of the left
ventricle reverse remodeling and long-term survival. Our results showed
that there was significant improvement in mitral regurgitation
postoperatively (RR, 1.65; 95% CI 1.36-2.00; p < 0.00001) with the average
decrease of 0.46 (WMD; 95% CI 0.35-0.57; p < 0.00001). The effect is more
pronounced in the elderly population. Perioperative mortality was higher
(p < 0.0001) and long-term survival significantly worse (p < 0.00001) in
patients that had moderate/severe mitral regurgitation preoperatively. We
conclude that after aortic valve replacement alone there are fair chances
but for only slight improvement in concomitant mitral regurgitation. The
secondary moderate mitral regurgitation should be addressed at the time of
aortic valve replacement. A more conservative approach should be followed
for elderly and high-risk patients. Copyright © 2020, MDPI AG.
All rights reserved.

<19>
Accession Number
633144843
Title
An economic model to assess the value of triclosan-coated sutures in
reducing the risk of surgical-site infection in coronary artery bypass
graft in India.
Source
Journal of Indian College of Cardiology. 10 (2) (pp 79-84), 2020. Date of
Publication: April-June 2020.
Author
Mahajan N.; Pillai R.; Chopra H.; Grover A.; Kohli A.
Institution
(Mahajan, Pillai) Medical Affairs, Clinical Operations and Device Safety,
Johnson and Johnson Pvt. Ltd, Mumbai, Maharashtra, India
(Chopra, Grover, Kohli) Medical Affairs, Clinical Operations and Device
Safety, Johnson and Johnson Pvt. Ltd, Mumbai, Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: The incidence of surgical site infections (SSIs) is higher in
India compared to the rest of the world. In patients undergoing coronary
artery bypass graft (CABG), the risk is even higher. SSI following CABG is
associated with an additional length of stay (LOS) resulting in additional
costs, thus causing a significant economic burden on patients and society.
We aimed to determine the additional costs and LOS due to SSIs after CABG
and to evaluate the efficacy of triclosan-coated sutures (TCS) in reducing
the SSI rate. Methodology: A systematic literature search of available
evidence for both epidemiologic and economic data related to the incidence
of SSI (from 1998 to 2018) and efficacy of TCS (from 2000 to 2018)
respectively, were gathered. We compared 100 surgeries from private and
public hospitals for CABG and calculated cost-effectiveness of TCS in
comparison to conventional nonantimicrobial-coated sutures (NCS) using a
decision-tree cost model. Result(s): Three studies were analyzed out
of 109 citations for the analysis of SSI incidence and for the efficacy of
TCS versus NCS, five studies were included. We performed a one-way
sensitivity analysis to calculate the impact of efficacy (%) and SSI
incidences (%) and cost of NCS and TCS on cost savings depicted by Tornado
charts. Sensitivity analysis on the comparison of TCS with NCS, a base
cost saving of CABG for a private hospital was INR 14,476 and public
hospital INR 4145. Conclusion(s): The use of TCS reduced SSI
incidence and cost savings for CABG surgeries in both public and private
sectors in India. Copyright © 2020 Journal of Indian College of
Cardiology Published by Wolters Kluwer - Medknow.

<20>
Accession Number
2008362965
Title
Aortic valve sparing surgery. Results to 9 years.
Source
Cirugia Cardiovascular. (no pagination), 2020. Date of Publication: 2020.
Author
Alvarez-Cabo R.; Vigil-Escalera C.; Escalera A.E.; Meana B.; Martin M.; de
la Hera J.M.; Salmeron C.; Diaz R.; Hernandez-Vaquero D.; Meca J.; Mencia
P.; Zabala M.; Callejo F.; Llosa J.C.; Morales C.; Silva J.
Institution
(Alvarez-Cabo, Vigil-Escalera, Escalera, Meana, Salmeron, Diaz,
Hernandez-Vaquero, Meca, Mencia, Zabala, Callejo, Llosa, Morales, Silva)
Servicio de Cirugia Cardiaca, Area del Corazon, Hospital Universitario
Central de Asturias (HUCA), Oviedo, Asturias, Spain
(Martin, de la Hera) Servicio de Cardiologia, Area del Corazon, Hospital
Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: Clinical practice guidelines recommend, in
young patients and experienced centers, aortic valve sparing surgery for
the treatment of aortic regurgitation as an alternative to aortic valve
replacement. It is a complex surgery, but demanded more frequently. We
must consider it as a therapeutic option and explain its results.
 Method(s): Prospective, non randomized, analysis of 138 patients
operated on with aortic valve sparing surgery (2011-2019). Result(s):
They presented: mean-age 58.1+/-14.2 years, 33 (23.9%) women, 9 (6.5%)
emerging; EUROSCORE-II: 3.35+/-2.9, EUROSCORE-LOGISTIC: 9.29+/-7. Valve
morphology was: 83 (60.1%)-tricuspid, 44 (31.9%)-bicuspid, 11
(8%)-unicuspid. Procedures performed: (valve-reimplantation [DAVID] +
aortic-plasty): 78 (56.5%); (aortic-remodeling [YACOUB] + aortic-plasty):
22 (15.9%); aortic-plasty+supracoronary-tube: 15 (10.9%); aortic-plasty:
23 (16.7%). The 69.36% of aortic leafleats required multiple techniques:
(63.5%) central-plication, (10.3%) decalcification and (20.9%)
pericardium-plasty. There was reoperation for bleeding 4 (2.9%). Eight
(5.8%) patients died in the immediate postoperative period (3.9% of
electives). Preoperative aortic regurgitation was: I-II(18.1%), III(17.4%)
and IV(64.5%). Intra-operative regurgitation grade II persisted in 16
(11.6%) patients, converting to aortic prostheses. The mean follow-up was
44.2+/-28.6 (median 42.5) months. At 9 years they are free of aortic
regurgitation >= III: 83.5% (whole-series); 84.6% (aortic-root-treatment
[DAVID+YACOUB]) vs. 81.9% (no-aortic-root-treatment) (p=0.4); 88.8%
(DAVID), 63.2% (YACOUB), 85.7% (aortic-plasty+supracoronary-tube) and
78.3% (aortic-plasty) (p=0.22); 63.5% (pericardium-plasty) vs. 97.7%
(without pericardium-plasty) (p<0.0001). And they are free of
re-operation: 88.4% (whole-series); 89.7% (aortic-root-treatment
[DAVID+YACOUB]) vs. 85.8% (no-aortic-root-treatment) (p=0.27); 89.5%
(DAVID), 93.3% (YACOUB), 92.8% (aortic-plasty+supracoronary-tube) and
78.3% (aortic-plasty) (p=0.24); 71.5% (pericardium-plasty) vs.
100%(without pericardium-plasty) (p<0.0001). At follow-up there were
endocarditis in 2 (1.75%) patients, there were no thromboembolic events.
 Conclusion(s): The durability of aortic valve sparing surgery is
good, without significant differences between different types of
techniques; the use of heterologous pericardium is the main cause of
reduced durability. Copyright © 2020 Sociedad Espanola de Cirugia
Cardiovascular y Endovascular

<21>
Accession Number
2008362882
Title
Remote ischemic preconditioning in isolated valve intervention. A pooled
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Moscarelli M.; Angelini G.D.; Emanueli C.; Suleiman S.; Pepe M.;
Contegiacomo G.; Punjabi P.P.
Institution
(Moscarelli, Emanueli, Punjabi) Imperial College London, National Heart
Lung Institute, United Kingdom
(Angelini, Suleiman) Clinical Sciences, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
(Contegiacomo) Dept of Cardiovascular surgery, GVM Care&Research, Bari,
Italy
(Pepe) Cardiology Unit, Department of Emergency and Organ Transplantation,
University of Bari Aldo Moro, Bari, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Recent studies have shown no benefits from remote ischemic
preconditioning (RIPC) in patients undergoing coronary artery bypass
surgery. One possible explanation is that given previous exposure to
angina and ischemia/reperfusion injury these patients, may be already
'naturally preconditioned'. The role of RIPC in a context of isolated
valve intervention, both surgical and particularly transcatheter is less
clear and remains under investigated, with few high-quality studies.
 Method(s): A systematic literature review identified 8 candidate
studies that met the meta-analysis criteria. We analyzed outcomes of 610
subjects (312 RIPC and 298 SHAM) with random effects modeling. Each study
was assessed for heterogeneity. The primary outcome was the extent of
periprocedural myocardial injury, as reflected by the area under the curve
for serum troponin concentration. Secondary endpoints included relevant
intra- and post-operative outcomes; sensitivity and high-quality subgroup
analysis was also carried out. Result(s): Six and two studies
reported the effect of RIPC in surgical and transcatheter valve
intervention. There was a significant difference between-group in terms of
periprocedural Troponin release (standardized mean difference (SMD: 0.74
[95% CI: 0.52; 0.95], p = 0.02) with no heterogeneity (chi2
2.40, I2 0%, p = 0.88). RIPC was not associated with any
improvement in post-operative outcomes. No serious adverse RIPC related
events were reported. Conclusion(s): RIPC seems to elicit overall
periprocedural cardioprotection in patients undergoing valvular
intervention, yet with no benefit on early clinical
outcomes. Copyright © 2020 Elsevier B.V.

<22>
Accession Number
633152726
Title
Overall and Cause-Specific Mortality in Randomized Clinical Trials
Comparing Percutaneous Interventions With Coronary Bypass Surgery: A
Meta-analysis.
Source
JAMA internal medicine. (no pagination), 2020. Date of Publication: 12 Oct
2020.
Author
Gaudino M.; Hameed I.; Farkouh M.E.; Rahouma M.; Naik A.; Robinson N.B.;
Ruan Y.; Demetres M.; Biondi-Zoccai G.; Angiolillo D.J.; Bagiella E.;
Charlson M.E.; Benedetto U.; Ruel M.; Taggart D.P.; Girardi L.N.; Bhatt
D.L.; Fremes S.E.
Institution
(Gaudino, Hameed, Rahouma, Naik, Robinson, Ruan, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, NY
(Hameed) Section of Cardiothoracic Surgery, Yale School of Medicine, New
Haven, CT, United States
(Farkouh) Peter Munk Cardiac Centre, University of Toronto, Toronto, ON,
Canada
(Demetres) Weill Cornell Medicine, Samuel J. Wood Library and C. V. Starr
Biomedical Information Center, NY
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) NapoliItaly
(Angiolillo) Division of Cardiology, Department of Medicine, University of
Florida College of Medicine-Jacksonville, Jacksonville, United States
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, NY
(Charlson) Division of General Internal Medicine, Weill Cornell Medical
College, NY
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, Oxford, United Kingdom
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
Importance: Mortality is a common outcome in trials comparing percutaneous
coronary intervention (PCI) with coronary artery bypass grafting (CABG).
Controversy exists regarding whether all-cause mortality or cardiac
mortality is preferred as a study end point, because noncardiac mortality
should be unrelated to the treatment. Objective(s): To evaluate the
difference in all-cause and cause-specific mortality in randomized
clinical trials (RCTs) comparing PCI with CABG for the treatment of
patients with coronary artery disease. Data Sources: MEDLINE (1946 to
the present), Embase (1974 to the present), and the Cochrane Library (1992
to the present) databases were searched on November 24, 2019. Reference
lists of included articles were also searched, and additional studies were
included if appropriate. Study Selection: Articles were considered for
inclusion if they were in English, were RCTs comparing PCI with
drug-eluting or bare-metal stents and CABG for the treatment of coronary
artery disease, and reported mortality and/or cause-specific mortality.
Trials of PCI involving angioplasty without stenting were excluded. For
each included trial, the publication with the longest follow-up duration
for each outcome was selected. Data Extraction and Synthesis: For data
extraction, all studies were reviewed by 2 independent investigators, and
disagreements were resolved by a third investigator in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
guideline. Data were pooled using fixed- and random-effects models.
 Main Outcomes and Measures: The primary outcomes were all-cause and
cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were
performed for PCI trials using drug-eluting vs bare-metal stents and for
trials involving patients with left main disease. Result(s):
Twenty-three unique trials were included involving 13620 unique patients
(6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study
populations; mean age range, 60.0-71.0 years). The weighted mean (SD)
follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with
a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29)
and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but
also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41).
 Conclusions and Relevance: Percutaneous coronary intervention was
associated with higher all-cause, cardiac, and noncardiac mortality
compared with CABG at 5 years. The significantly higher noncardiac
mortality associated with PCI suggests that even noncardiac deaths after
PCI may be procedure related and supports the use of all-cause mortality
as the end point for myocardial revascularization trials.

<23>
Accession Number
633151479
Title
Impact of renin-angiotensin system blocker after aortic valve
replacement-a systematic review and meta-analysis.
Source
Annals of palliative medicine. (no pagination), 2020. Date of Publication:
21 Sep 2020.
Author
Zeng L.; Li J.; Yang J.; Liao Y.; Chen M.
Institution
(Zeng, Yang) West China Hospital, Sichuan University, Chengdu, China
(Li, Chen) Department of Cardiology, West China Hospital, Chengdu, China
(Liao) Department of Cardiology, West China Hospital, Chengdu, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Data reporting the impact of renin-angiotensin system
inhibitor (RASi) after aortic valve replacement (AVR) is controversy.
 METHOD(S): The PubMed database was systematically searched for
studies reporting the mortality and hazard ratios (HRs) of RASi following
surgical and transcatheter AVR (SAVR, TAVR). Random-effects model was used
when the I2 statistic was more than 50% and its P value was less than
0.05, otherwise, the fixed-effects model was conducted. RESULT(S):
Nine articles incorporating 33,063 patients were eligible. Patients having
the description of RASi were associated with lower all-cause mortality at
30 days (OR, 0.80, 95% CI, 0.69 to 0.94), 1 year (OR, 0.75, 95% CI, 0.69
to 0.81) and beyond 1 year (OR, 0.52, 95% CI, 0.38 to 0.73) after AVR.
Consistently, patients with RASi had lower risk for all-cause mortality
(HR, 0.87, 95% CI, 0.84 to 0.91) beyond 1 year following AVR albeit
adjusting confounders. Interestingly, beneficial effect of RASi was still
observed in patients with preserved ejection fraction following TAVR (HR,
0.90, 95% CI, 0.87 to 0.94). In addition, patients taking RASi had lower
cardiovascular mortality than those patients without RASi after TAVR (30
days, OR, 0.63, 95% CI, 0.44 to 0.90; 1 year, OR, 0.60, 95% CI, 0.50 to
0.73; beyond 1 year, OR, 0.63, 95% CI, 0.54 to 0.74). CONCLUSION(S):
Patients with RASi exhibited better short- and long-term survival
following AVR compared to those patients without RASi, which warranted
further studies to support such findings.

<24>
Accession Number
633149928
Title
Redevelopment and validation of the SYNTAX score II to individualise
decision making between percutaneous and surgical revascularisation in
patients with complex coronary artery disease: secondary analysis of the
multicentre randomised controlled SYNTAXES trial with external cohort
validation.
Source
Lancet (London, England). (no pagination), 2020. Date of Publication: 08
Oct 2020.
Author
Takahashi K.; Serruys P.W.; Fuster V.; Farkouh M.E.; Spertus J.A.; Cohen
D.J.; Park S.-J.; Park D.-W.; Ahn J.-M.; Kappetein A.P.; Head S.J.; Thuijs
D.J.; Onuma Y.; Kent D.M.; Steyerberg E.W.; van Klaveren D.
Institution
(Takahashi) Department of Cardiology, Amsterdam Universities Medical
Centers, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Serruys, Onuma) Department of Cardiology, National University of Ireland,
Galway, Ireland
(Fuster) Zena and Michael Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, USA; Centro Nacional De
Investigaciones Cardiovasculares Carlos III, Madrid, Spain
(Farkouh) Peter Munk Cardiac Centre and The Heart and Stroke Richard Lewar
Centre, University of Toronto, ON, Toronto, Canada
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, MO, USA;
University of Missouri-Kansas City, Kansas City, MO, USA
(Cohen) University of Missouri-Kansas City, Kansas City, MO, USA
(Park, Park, Ahn) Department of Cardiology, Asan Medical Center, Seoul,
South Korea
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Kent) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, MA, Tufts
Medical Center, Boston, United States
(Steyerberg) Department of Biomedical Data Sciences, Leiden, Netherlands;
University Medical Centre, Leiden, Netherlands
(van Klaveren) Department of Public Health, Erasmus University Medical
Centre, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomised controlled trials are considered the gold standard
for testing the efficacy of novel therapeutic interventions, and typically
report the average treatment effect as a summary result. As the result of
treatment can vary between patients, basing treatment decisions for
individual patients on the overall average treatment effect could be
suboptimal. We aimed to develop an individualised decision making tool to
select an optimal revascularisation strategy in patients with complex
coronary artery disease. METHOD(S): The SYNTAX Extended Survival
(SYNTAXES) study is an investigator-driven extension follow-up of a
multicentre, randomised controlled trial done in 85 hospitals across 18
North American and European countries between March, 2005, and April,
2007. Patients with de-novo three-vessel and left main coronary artery
disease were randomly assigned (1:1) to either the percutaneous coronary
intervention (PCI) group or coronary artery bypass grafting (CABG) group.
The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox
regression to develop a clinical prognostic index for predicting death
over a 10-year period, which was combined, in a second stage, with
assigned treatment (PCI or CABG) and two prespecified effect-modifiers,
which were selected on the basis of previous evidence: disease type
(three-vessel disease or left main coronary artery disease) and anatomical
SYNTAX score. We used similar techniques to develop a model to predict the
5-year risk of major adverse cardiovascular events (defined as a composite
of all-cause death, non-fatal stroke, or non-fatal myocardial infarction)
in patients receiving PCI or CABG. We then assessed the ability of these
models to predict the risk of death or a major adverse cardiovascular
event, and their differences (ie, the estimated benefit of CABG versus PCI
by calculating the absolute risk difference between the two strategies) by
cross-validation with the SYNTAX trial (n=1800 participants) and external
validation in the pooled population (n=3380 participants) of the FREEDOM,
BEST, and PRECOMBAT trials. The concordance (C)-index was used to measure
discriminative ability, and calibration plots were used to assess the
degree of agreement between predictions and observations. FINDINGS: At
cross-validation, the newly developed SYNTAX score II, termed SYNTAX score
II 2020, showed a helpful discriminative ability in both treatment groups
for predicting 10-year all-cause deaths (C-index=0.73 [95% CI 0.69-0.76]
for PCI and 0.73 [0.69-0.76] for CABG) and 5-year major adverse
cardiovascular events (C-index=0.65 [0.61-0.69] for PCI and C-index=0.71
[0.67-0.75] for CABG). At external validation, the SYNTAX score II 2020
showed helpful discrimination (C-index=0.67 [0.63-0.70] for PCI and
C-index=0.62 [0.58-0.66] for CABG) and good calibration for predicting
5-year major adverse cardiovascular events. The estimated treatment
benefit of CABG over PCI varied substantially among patients in the trial
population, and the benefit predictions were well calibrated.
INTERPRETATION: The SYNTAX score II 2020 for predicting 10-year deaths and
5-year major adverse cardiovascular events can help to identify
individuals who will benefit from either CABG or PCI, thereby supporting
heart teams, patients, and their families to select optimal
revascularisation strategies. FUNDING: The German Heart Research
Foundation and the Patient-Centered Outcomes Research
Institute. Copyright © 2020 Elsevier Ltd. All rights reserved.

<25>
Accession Number
633148945
Title
Influenza Vaccination Blunts the Inflammatory Response in Patients
Undergoing Cardiopulmonary Bypass.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 07 Oct 2020.
Author
Atoui R.; F F.E.; Saroka K.; Mireau J.; McElhaney J.E.; Hare G.
Institution
(Atoui) Division of Cardiac Surgery, Health Sciences North, Northern
Ontario School of Medicine, Sudbury, ON, Canada
(F) Department of Anesthesia, Hamilton Health Sciences, McMaster
University, Hamilton, Ontario, Canada; Department of Anesthesia, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Saroka) Laurentian University, Sudbury, ON, Canada
(Mireau) Department of Anesthesia, Health Sciences North, Northern Ontario
School of Medicine, Sudbury, ON, Canada
(McElhaney) Health Sciences North Research Institute, Sudbury, ON, Canada
(Hare) Department of Anesthesia, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) with cardiopulmonary
bypass (CPB) induces an inflammatory reaction that is associated with
postoperative complications. Influenza vaccination has been shown to
decrease cardiovascular morbidity in patients with cardiovascular disease,
possibly via its anti-inflammatory properties. We hypothesize that
influenza vaccination would attenuate the inflammatory reaction after CPB.
 METHOD(S): Thirty patients undergoing CABG were blindly randomized to
receive the influenza vaccine (group I, N=15) or a placebo (group II,
N=15) preoperatively. Serum samples of pro-inflammatory mediators
(interleukin-6, interleukin-8, tumor necrosis factor, C-reactive protein)
as well as the anti-inflammatory interleukin-10 were collected at
different time points perioperatively. Assessment of myocardial
dysfunction was investigated by measuring hemodynamic, echocardiographic
data and troponin levels. Other clinical outcomes were collected
prospectively. RESULT(S): Pro-inflammatory cytokine levels were
significantly reduced in the treatment group [interleukin-6 (157.4 pg/dL
vs 256 pg/dL,p=0.043), interleukin-8(65.03 pg/dL vs 118.56 pg/dl,p=0.025)
and tumor necrosis factor(12.05 pg/dl vs 20.8 pg/dl,p=0.003)]. These
differences were observed at the end of CPB and persisted for 2 days
postoperatively. Interestingly, the level of the anti-inflammatory marker
interleukin-10 was significantly higher in group I (83.3 pg/dl vs 15.15
pg/dl, p=0.008). Evidence of improved myocardial protection was observed
in group I as reflected by troponin measurements postoperatively (6020.2
pg/dl vs 12098.01 pg/dl,p=0.052). CONCLUSION(S): Influenza
vaccination attenuates the inflammatory response to CPB as reflected by a
reduction in the level of troponin and pro-inflammatory mediators and an
increase in the anti-inflammatory cytokine interleukin-10. Copyright
© 2020. Published by Elsevier Inc.

<26>
Accession Number
633146647
Title
Risk of postoperative neurological exacerbation in patients with infective
endocarditis and intracranial haemorrhage.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 09 Oct 2020.
Author
Diab M.; Musleh R.; Lehmann T.; Sponholz C.; Pletz M.W.; Franz M.; Schulze
P.C.; Witte O.W.; Kirchhof K.; Doenst T.; Gunther A.
Institution
(Diab, Musleh, Doenst) Department of Cardiothoracic Surgery, Jena
University Hospital, Jena, Germany
(Musleh, Witte, Gunther) Department of Neurology, Jena University
Hospital, Jena, Germany
(Lehmann) Institute of Medical Statistics, Computer and Data Sciences,
Jena University Hospital, Jena, Germany
(Sponholz) Department of Anesthesiology and Intensive Care Medicine, Jena
University Hospital, Jena, Germany
(Pletz) Institute for Infectious Diseases and Infection Control, Jena
University Hospital, Jena, Germany
(Franz, Schulze) Division of Cardiology, Department of Internal Medicine
I, Jena University Hospital, Jena, Germany
(Kirchhof) Division of Neuroradiology, Department of Radiology, Jena
University Hospital, Jena, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Cardiac surgery in patients with infective endocarditis (IE)
and preoperative intracranial haemorrhage (pre-ICH) is a highly debatable
issue, and guidelines are still not well defined. The goal of this study
was to investigate the effect of cardiac surgery and its timing on the
clinical outcomes of patients with IE and pre-ICH. METHOD(S): We did
a single-centre retrospective analysis of data from patients with
preoperative brain imaging who had surgery for left-sided IE between
January 2007 and May 2018. RESULT(S): Among the 363 patients included
in the study, 34 had pre-ICH. Hospital mortality was similar between the
patients with and without pre-ICH (29% vs 27%, respectively; P=0.84).
Unadjusted, postoperative neurological deterioration appeared higher in
patients with pre-ICH (24% vs 17%; P=0.35). In multivariable analysis,
pre-ICH did not qualify as an independent predictor for either
postoperative neurological deterioration [odds ratio 1.10, 95% confidence
interval (CI) 0.44-2.73; P=0.84] or hospital mortality (odds ratio 1.02,
95% CI 0.43-2.40; P=0.96). Postoperative partial thromboplastin time was
significantly elevated in 4 patients with relevant post-ICH compared with
those patients without relevant post-ICH (65.5 vs 37.6, respectively;
P=0.004). CONCLUSION(S): Pre-ICH was not an independent predictor for
postoperative neurological deterioration or hospital mortality in patients
with IE. Postoperative coagulation management seems to be crucial in
patients with IE with ICH. Although this is to date the largest
monocentric study addressing surgical decision and timing, the number of
patients with pre-ICH was low. Therefore, these conclusions should be
regarded with caution; randomized clinical trials are
needed. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<27>
Accession Number
633144289
Title
Long-Term Results of the RAPCO Trials.
Source
Circulation. (pp 1330-1338), 2020. Date of Publication: 2020.
Author
Buxton B.F.; Hayward P.A.; Raman J.; Moten S.C.; Rosalion A.; Gordon I.;
Seevanayagam S.; Matalanis G.; Benedetto U.; Gaudino M.; Hare D.L.
Institution
(Buxton, Raman, Moten, Seevanayagam, Matalanis) Department of Cardiac
Surgery, Austin Hospital, Melbourne, Australia
(Buxton, Hayward, Raman, Rosalion, Seevanayagam, Matalanis, Hare) Faculty
of Medicine, Dentistry and Health Sciences, University of Melbourne,
Australia
(Gordon) Statistical Consulting Centre, University of Melbourne, Australia
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Hare) Department of Cardiology, Austin Health, Melbourne, Australia
(Hare) Level 5 Hsb, Austin Hospital, Studley Road, Heidelberg, VIC 3084,
Australia
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Background: An internal thoracic artery graft to the left anterior
descending artery is standard in coronary bypass surgery, but controversy
exists on the best second conduit. The RAPCO trials (Radial Artery Patency
and Clinical Outcomes) were designed to compare the long-term patency of
the radial artery (RA) with that of the right internal thoracic artery
(RITA) and the saphenous vein (SV). Method(s): In RAPCO-RITA (the
RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or
<60 years of age if they had diabetes mellitus) were randomized to receive
RA or free RITA graft on the second most important coronary target. In
RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients >=70
years of age (or >=60 years of age if they had diabetes mellitus) were
randomized to receive RA or SV graft. The primary outcome was 10-year
graft failure. Long-term mortality was a nonpowered coprimary end point.
The main analysis was by intention to treat. Result(s): In the RA
versus RITA comparison, the estimated 10-year patency was 89% for RA
versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI,
0.23-0.88]). Ten-year patient survival estimate was 90.9% in the RA arm
versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI,
0.30-0.95]). In the RA versus SV comparison, the estimated 10-year patency
was 85% for the RA versus 71% for the SV (hazard ratio for graft failure,
0.40 [95% CI, 0.15-1.00]), and 10-year patient survival estimate was 72.6%
for the RA group versus 65.2% for the SV group (hazard ratio for
mortality, 0.76 [95% CI, 0.47-1.22]). Conclusion(s): The 10-year
patency rate of the RA is significantly higher than that of the free RITA
and better than that of the SV. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT00475488. Copyright © 2020 Lippincott Williams and Wilkins.
All rights reserved.

<28>
Accession Number
633144280
Title
Randomized, Controlled Trial Comparing Mitral Valve Repair with Leaflet
Resection Versus Leaflet Preservation on Functional Mitral Stenosis: The
CAMRA CardioLink-2 Study.
Source
Circulation. (pp 1342-1350), 2020. Date of Publication: 2020.
Author
Chan V.; Mazer C.D.; Ali F.M.; Quan A.; Ruel M.; De Varennes B.E.; Gregory
A.J.; Bouchard D.; Whitlock R.P.; Chu M.W.A.; Dokollari A.; Mesana T.;
Bhatt D.L.; Latter D.A.; Zuo F.; Tsang W.; Teoh H.; Juni P.; Leong-Poi H.;
Verma S.
Institution
(Chan, Ruel, Mesana) Division of Cardiac Surgery, University of Ottawa
Heart Institute, H3405-40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
(Chan) School of Epidemiology, Public Health and Preventive Medicine,
University of Ottawa, ON, Canada
(Ruel) Department of Cellular and Molecular Medicine, University of
Ottawa, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada
(Ali, Tsang, Leong-Poi) Division of Cardiology, Li Ka Shing Knowledge
Institute of St. Michael's Hospital, Toronto, ON, Canada
(Quan, Dokollari, Latter, Teoh, Verma) Division of Cardiac Surgery, Li Ka
Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto,
ON M5B 1W8, Canada
(Zuo, Juni) Applied Health Research Centre, Li Ka Shing Knowledge
Institute of St. Michael's Hospital, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Li Ka Shing Knowledge
Institute of St. Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, ON, Canada
(Mazer) Department of Physiology, University of Toronto, ON, Canada
(Latter, Verma) Department of Surgery, University of Toronto, ON, Canada
(Tsang, Juni, Leong-Poi) Department of Medicine, University of Toronto,
ON, Canada
(Juni) Institute of Health Policy, Management, and Evaluation, University
of Toronto, ON, Canada
(Verma) Department of Pharmacology and Toxicology, University of Toronto,
ON, Canada
(De Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University Health Center, Montreal, QC, Canada
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
Cumming School of Medicine, University of Calgary, AB, Canada
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
Libin Cardiovascular Institute of Alberta, Calgary, Canada
(Bouchard) Department of Cardiac Surgery, Montreal Heart Institute and
Universite de Montreal, QC, Canada
(Whitlock) Division of Cardiac Surgery, McMaster University, Hamilton, ON,
Canada
(Whitlock) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
(Whitlock) Population Health Research Institute, Hamilton, ON, Canada
(Chu) Division of Cardiac Surgery, London Health Sciences Center,
University of Western Ontario, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Background: Equipoise exists between the use of leaflet resection and
preservation for surgical repair of mitral regurgitation caused by
prolapse. We therefore performed a randomized, controlled trial comparing
these 2 techniques, particularly in regard to functional mitral stenosis.
 Method(s): One hundred four patients with degenerative mitral
regurgitation surgically amenable to either leaflet resection or
preservation were randomized at 7 specialized cardiac surgical centers.
Exclusion criteria included anterior leaflet or commissural prolapse, as
well as a mixed cause for mitral valve disease. Using previous data, we
determined that a sample size of 88 subjects would provide 90% power to
detect a 5-mm Hg difference in mean mitral valve gradient at peak
exercise, assuming an SD of 6.7 mm with a 2-sided test with alpha=5% and
10% patient attrition. The primary end point was the mean mitral gradient
at peak exercise 12 months after repair. Result(s): Patient age,
proportion who were female, and Society of Thoracic Surgeons risk score
were 63.9+/-10.4 years, 19%, and 1.4+/-2.8% for those who were assigned to
leaflet resection (n=54), and 66.3+/-10.8 years, 16%, and 1.9+/-2.6% for
those who underwent leaflet preservation (n=50). There were no
perioperative deaths or conversions to replacement. At 12 months, moderate
mitral regurgitation was observed in 3 subjects in the leaflet resection
group and 2 in the leaflet preservation group. The mean transmitral
gradient at 12 months during peak exercise was 9.1+/-5.2 mm Hg after
leaflet resection and 8.3+/-3.3 mm Hg after leaflet preservation (P=0.43).
The participants had similar resting peak (8.3+/-4.4 mm Hg versus
8.4+/-2.6 mm Hg; P=0.96) and mean resting (3.2+/-1.9 mm Hg versus
3.1+/-1.1 mm Hg; P=0.67) mitral gradients after leaflet resection and
leaflet preservation, respectively. The 6-minute walking distance was
451+/-147 m for those in the leaflet resection versus 481+/-95 m for the
leaflet preservation group (P=0.27). Conclusion(s): In this
adequately powered randomized trial, repair of mitral prolapse with either
leaflet resection or leaflet preservation was associated with similar
transmitral gradients at peak exercise at 12 months postoperatively. These
data do not support the hypothesis that a strategy of leaflet resection
(versus preservation) is associated with a risk of functional mitral
stenosis. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier NCT02552771. Copyright © 2020 Lippincott Williams and
Wilkins. All rights reserved.

<29>
Accession Number
2007952627
Title
Ticagrelor or Prasugrel in Patients With Acute Coronary Syndromes and
Diabetes Mellitus.
Source
JACC: Cardiovascular Interventions. 13 (19) (pp 2238-2247), 2020. Date of
Publication: 12 October 2020.
Author
Ndrepepa G.; Kastrati A.; Menichelli M.; Neumann F.-J.; Wohrle J.;
Bernlochner I.; Richardt G.; Witzenbichler B.; Sibbing D.; Gewalt S.;
Angiolillo D.J.; Hamm C.W.; Hapfelmeier A.; Trenk D.; Laugwitz K.-L.;
Schunkert H.; Schupke S.; Mayer K.
Institution
(Ndrepepa, Kastrati, Gewalt, Schunkert, Schupke, Mayer) Department of
Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
(Ndrepepa, Kastrati, Gewalt, Schunkert, Schupke, Mayer) Technische
Universitat Munchen, Munich, Germany
(Kastrati, Bernlochner, Sibbing, Laugwitz, Schunkert, Schupke) German
Center for Cardiovascular Research, Partner Site Munich Heart Alliance,
Munich, Germany
(Menichelli) Department of Cardiology, Ospedale Fabrizio Spaziani,
Frosinone, Italy
(Neumann, Trenk) Department of Cardiology and Angiology II, University
Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
(Wohrle) Department of Cardiology, Medical Campus Lake Constance,
Friedrichshafen, Germany
(Bernlochner, Laugwitz) Medizinische Klinik und Poliklinik Innere Medizin
I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar,
Munich, Germany
(Richardt) Heart Center Bad Segeberg, Bad Segeberg, Germany
(Witzenbichler) Departments of Cardiology and Pneumology, Helios
Amper-Klinikum Dachau, Dachau, Germany
(Sibbing) Department of Cardiology, Klinik der Universitat Munchen,
Ludwig-Maximilians-University, Munich, Germany
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Hamm) Heart Center, Campus Kerckhoff of Justus-Liebig-University,
Giessen, Germany
(Hamm) German Center for Cardiovascular Research, Partner Site Rhine-Main,
Frankfurt, Germany
(Hapfelmeier) Technical University of Munich, School of Medicine,
Institute of General Practice and Health Services Research, Munich,
Germany
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The aim of this study was to assess the efficacy and safety of
ticagrelor versus prasugrel in patients with diabetes mellitus (DM)
presenting with acute coronary syndromes (ACS) in whom invasive therapy
was planned. Background(s): The efficacy and safety of ticagrelor
versus prasugrel in patients with ACS with DM undergoing invasive
treatment remain unknown. Method(s): This pre-specified analysis of
the ISAR-REACT (Intracoronary Stenting and Antithrombotic Regimen: Rapid
Early Action for Coronary Treatment) 5 trial included 892 patients with
ACS with DM and 3,124 patients with ACS without DM randomized to prasugrel
or ticagrelor. The primary endpoint was a composite of death, myocardial
infarction, or stroke; the safety endpoint was Bleeding Academic Research
Consortium types 3 to 5 bleeding (both assessed 12 months after
randomization). Result(s): The primary endpoint occurred in 51
patients (11.2%) in the ticagrelor group and 55 patients (13.0%) in the
prasugrel group in the DM cohort (hazard ratio: 0.84; 95% confidence
interval: 0.58 to 1.24; p = 0.383) and in 132 patients (8.6%) in the
ticagrelor group and 81 patients (5.2%) in the prasugrel group in the
non-DM cohort (hazard ratio: 1.70; 95% confidence interval: 1.29 to 2.24;
p < 0.001). There was a significant treatment arm-by-diabetic status
interaction (p<inf>int</inf> = 0.0035). Bleeding Academic Research
Consortium types 3 to 5 bleeding occurred in 27 patients (6.9%) in the
ticagrelor group and 19 patients (5.5%) in the prasugrel group (p = 0.425)
in the DM cohort and in 68 patients (5.2%) in the ticagrelor group and 60
patients (4.6%) in the prasugrel group in the non-DM cohort (p = 0.500).
 Conclusion(s): DM seems to affect the efficacy of ticagrelor and
prasugrel in patients with ACS. In patients with DM, the efficacy of
ticagrelor was comparable with that of prasugrel. (Prospective, Randomized
Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary
Syndrome [ISAR-REACT 5]; NCT01944800) Copyright © 2020

<30>
Accession Number
372670714
Title
Echocardiographic evaluation of the effects of a single bolus of
erythropoietin on reducing ischemia-reperfusion injuries during coronary
artery bypass graft surgery; a randomized, double-blind, placebo-control
study.
Source
Iranian Journal of Medical Sciences. 39 (2) (pp 94-101), 2014. Date of
Publication: 2014.
Author
Ziabakhsh-Tabary S.; Jalalian R.; Mokhtari-Esbuie F.; Habibi M.R.
Institution
(Ziabakhsh-Tabary) Department of Cardiac Surgery, Fatemeh Zahra Hospital,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Jalalian) Department of Cardiovascular, Fatemeh Zahra Hospital,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Mokhtari-Esbuie) Fatemeh Zahra Hospital, Mazandaran University of Medical
Science, Sari, Iran, Islamic Republic of
(Habibi) Department of Anesthesiology, Fatemeh Zahra Hospital, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
Publisher
Shriaz University of Medical Sciences (E-mail: info@gmj.ir)
Abstract
Background: Erythropoietin (EPO) is known as a regulating hormone for the
production of red blood cells, called erythropoiesis. Some studies have
shown that EPO exerts some non-hematopoietic protective effects on
ischemia-reperfusion injuries in myocytes. Using echocardiography, we
evaluated the effect of EPO infusion on reducing ischemia-reperfusion
injuries and improvement of the cardiac function shortly after coronary
artery bypass graft surgery (CABG). Method(s): Forty-three patients
were recruited in this study and randomly divided into two groups: the EPO
group, receiving standard medication and CABG surgery plus EPO (700 IU/
kg), and the control group, receiving standard medication and CABG surgery
plus normal saline (10 cc) as placebo. The cardiac function was assessed
through echocardiography before as well as at 4 and 30 days after CABG.
 Result(s): Echocardiography indicated that the ejection fraction had
no differences between the EPO and control groups at 4 days (47.05+/-6.29
vs. 45.90+/-4.97; P=0.334) and 30 days after surgery (47.27+/-28 vs.
46.62+/-5.7; P=0.69). There were no differences between the EPO and
control groups in the wall motion score index at 4 (P=0.83) and 30 days
after surgery (P=0.902). In the EPO group, there was a reduction in left
ventricular end-systolic and end-diastolic diameters (LVESD and LVEDD,
respectively), as compared to the control group. Conclusion(s): Our
results indicated that perioperative exogenous EPO infusion could not
improve the ventricular function and wall motion index in the immediate
post-CABG weeks. Nevertheless, a reduction in LVEDD and LVESD at 4 days
and 30 days after CABG in the EPO group, by comparison with the control
group, suggested that EPO correlated with a reduction in the remodeling of
myocytes and reperfusion injuries early after CABG.

<31>
Accession Number
628857637
Title
Efficacy of lipid-lowering therapy beyond statins to prevent
cardiovascular events: a meta-analysis.
Source
European Journal of Preventive Cardiology. 27 (15) (pp 1675-1678), 2020.
Date of Publication: 01 Oct 2020.
Author
Dykun I.; Mincu R.; Hendricks S.; Balcer B.; Totzeck M.; Rassaf T.;
Mahabadi A.A.
Institution
(Dykun, Mincu, Hendricks, Balcer, Totzeck, Rassaf, Mahabadi) The
Department of Cardiology and Vascular Medicine, University of
Duisburg-Essen, Germany
Publisher
SAGE Publications Inc. (United States. E-mail: claims@sagepub.com)

<32>
Accession Number
2005677011
Title
Prednisone and azathioprine in patients with inflammatory cardiomyopathy:
systematic review and meta-analysis.
Source
ESC Heart Failure. 7 (5) (pp 2278-2296), 2020. Date of Publication: 01 Oct
2020.
Author
Timmermans P.; Barradas-Pires A.; Ali O.; Henkens M.; Heymans S.; Negishi
K.
Institution
(Timmermans) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Timmermans) University Hospital Gasthuisberg, Leuven, Belgium
(Barradas-Pires) Royal Brompton and Harefield NHS Foundation Trust,
London, United Kingdom
(Ali) Detroit Medical Center, Department of Cardiology, Wayne State
University School of Medicine, United States
(Henkens, Heymans) Department of Cardiology, CARIM School for
Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences,
Maastricht University, Maastricht, Netherlands
(Heymans) Department of Cardiovascular Sciences, Centre for Molecular and
Vascular Biology, Catholic University of Leuven, Leuven, Belgium
(Negishi) Menzies Institute for Medical Research, University of Tasmania,
Hobart, Australia
(Negishi) Nepean Clinical School, The University of Sydney, Kingswood,
Sydney, Australia
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims Chronic non-viral myocarditis, also called inflammatory
cardiomyopathy, can be treated with immune suppression on tops of optimal
medical therapy (OMT) for heart failure, using a combination of
prednisolone and azathioprine (IPA). However, there has been inconsistency
in the effects of immunosuppression treatment. This meta-analysis is the
first to evaluate all available data of the effect of this treatment on
left ventricular ejection fraction (LVEF) and the combined clinical
endpoint of cardiovascular mortality and/or heart transplantation-free
survival. Methods and results All trials with using IPA vs. OMT in this
syndrome were searched using OVID Medline and ClinicalTrials. gov,
following the PRISMA guidelines. Missing data were retrieved after
contacting the corresponding authors. All data was reviewed and analysed
using and standard meta-analysis methods. A random effect model was used
to pool the effect sizes. A total of four trials (three randomised
controlled trials and one propensity-matched retrospective registry)
including 369 patients were identified. IPA on top of OMT did not improve
LVEF [mean difference 9.9% (95% confidence interval -1.8, 21.7)] with
significant heterogeneity. When we limited our pooled estimate to the
published studies only, significant LVEF improvement by IPA was observed
[14% (1.4, 26.6)]. No cardiovascular mortality benefit was observed with
the intervention [risk ratio 0.34 (0.08, 1.51)]. Conclusions At the
moment, there is insufficient evidence supporting functional and
prognostic benefits of IPA added to OMT in virus negative inflammatory
positive cardiomyopathy. Further adequate-powered well-designed
prospective RCTs should be warranted to explore the potential effects of
adding immunosuppressive therapy to OMT. Copyright © 2020 The
Heart Failure Association of the European Society of Cardiology / John
Wiley & Sons Ltd

<33>
Accession Number
632738141
Title
Post-cardiac surgery chylopericardium.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (6) (pp
627-632), 2020. Date of Publication: 01 Jun 2020.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Post-cardiac surgery chylopericardium is a rare complication. This
systematic review included 87 articles with 119 patients of post-cardiac
surgery chylopericardium. Chylopericardium developed after operations for
congenital heart defect more than those for acquired heart disease, and
more patients in whom post-cardiac surgery chylopericardium developed were
with complex than with simple congenital heart defects. Cardiac tamponade
occurred in 35 (29.4%) patients. The onset time of chylopericardium was
18.2 days earlier in patients operated for acquired than in those for
congenital heart defects. Post-cardiac surgery chylopericardium were
curable to conservative treatment in most patients. The recurrence of
post-cardiac surgery chylopericardium was on day 13.2 +/-18.2 after the
initial treatment. The overall early and late mortality rates were 1.7%
(2/119) and 1.7% (2/117), respectively. Most patients with post-cardiac
surgery chylopericardium were diagnosed by laboratory analysis of chylous
fluid. Patients with mild chylopericardium usually show good response to
conservative treatment. Whereas, patients with massive chylopericardium
and rapid accumulation, incurable to conservative treatment and recurrent
to either conservative or surgical treatment, warrant further surgical
treatment. Copyright © 2020 College of Physicians and Surgeons
Pakistan. All rights reserved.

<34>
Accession Number
632604530
Title
A meta-analysis of the incidence rate of postoperative acute kidney injury
in patients with congenital heart disease.
Source
BMC Nephrology. 21 (1) (no pagination), 2020. Article Number: 350. Date of
Publication: 17 Aug 2020.
Author
Li D.; Niu Z.; Huang Q.; Sheng W.; Wang T.
Institution
(Li) Department of Environmental Health, Qingdao Centers for Disease
Control and Prevention, Qingdao, Shandong 266033, China
(Niu, Huang, Sheng, Wang) Department of Cardiovascular Surgery, Qingdao
Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao,
Shandong 266000, China
Publisher
BioMed Central Ltd (United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is a common complication of cardiac
surgery. However, the incidence rate of AKI in patients with congenital
heart disease (CHD) greatly varies between reports owing to the different
definitions used for AKI. Therefore, this study was designed as a
meta-analysis aimed at summarizing the incidence rate of AKI in patients
with congenital heart disease (CHD) on the basis of different AKI
criteria. Method(s): Studies published till April 24, 2020, on the
incidence rate of AKI in patients with CHD, were retrieved from electronic
databases and printed literature. To pool data from the included studies,
the effect size, a combined statistics, was chosen and presented with the
incidence rate and 95% confidence interval (CI). Heterogeneity was
evaluated using I 2 statistics and Cochran Q test. The incidence rates
obtained from the subgroup analysis according to study location, type of
surgery, type of cohort, age, and AKI criteria) were also evaluated to
determine the correlation of AKI with these factors. Publication bias was
estimated using the Egger test. Result(s): Thirty studies, comprising
9925 patients with AKI who had CHD, were included. Overall, the pooled
incidence rate of AKI in the patients with CHD was 38.4% (95% CI,
32.0-44.7%). However, the incidence rate was not significantly affected by
gender, study location, type of surgery, type of cohort, and AKI criteria.
Moreover, age was significantly associated with the incidence of AKI, and
the incidence rate was higher in the patients aged < 1 month than in those
aged 1 month to 18 years, < 18 years, and >= 18 years (P < 0.05).
 Conclusion(s): In this study, the estimated incidence rate of AKI in
patients with CHD was 38.4% and may be influenced by age. These findings
highlight the importance of further investigation of the specific causes
of and effective preventive measures for AKI. Copyright © 2020
The Author(s).

<35>
Accession Number
632593541
Title
A new mechanism of the protamine-dependent hypotension after
cardiopulmonary bypass and the role of calcium.
Source
Cellular and Molecular Biology. 65 (6) (pp 28-32), 2019. Date of
Publication: 2019.
Author
Aydin S.
Institution
(Aydin) Cardiovascular Surgery Department, Elazig Research and Education
Hospital, Health Science University, Elazig 23119, Turkey
(Aydin) Department of Medical Biochemistry and Clinical Biochemistry,
(Firat Hormones Research Group), Firat University Hospital, Elazig 23119,
Turkey
Publisher
Cellular and Molecular Biology Association
Abstract
Heparin and protamine are two indispensable agents of cardiopulmonary
bypass surgery with effects on the cardiovascular and hematological
system. Heparin is used as an anticoagulant in open heart surgery; whereas
protamine is used to neutralize heparin effects when surgery is
terminated. Protamine is given in order to neutralize heparin effects
after cardiopulmonary bypass surgery and it causes hypotension in
patients. However, the mechanism of this side effect is not clearly known.
Current mechanism is that hypotension occurs after the administration of
protamine due to the conformational change in the calcium channels or
anaphylactoid thromboxane release or serum ionized calcium levels. The
present study was to explain how protamine causes hypotension in
evidence-based medicine indexed in PubMed and Web of Science. In addition
to above mechanisms, possibly the infused protamine binds heparin and
causes the coagulation cascade to activate heparin-AT complex on thrombin
beside activating FXIa, FXa and FIXa and causing the re-use of
Ca2+. The re-use of Ca2+ at the coagulation cascade
initiates an anion gap and it is assumed that hypotension develops because
of the Ca2+ deficiency. Ca2+ ions are trapped in the
thrombus by the resumption of thrombus formation. Ca2+ ions
trapped in the thrombus cannot be used, so that Ca2+ ion
deficit will develop in circulation and hypotension occurs due to the
insufficiency of Ca2+ ions. The administration of
Ca2+ ions together with the protamine might help to eliminate
the side effect of the protamine (hypotension) while neutralizing heparin
after open heart surgery in light of the information provided in the
literature. Copyright © 2019 by the C.M.B. Association. All
rights reserved.

<36>
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.

<37>
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.

<38>
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. (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

<39>
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

<40>
Accession Number
2003642921
Title
"The heart supporters": systematic review for ventricle assist devices in
congenital heart surgery.
Source
Heart Failure Reviews. 25 (6) (pp 1027-1035), 2020. Date of Publication:
01 Nov 2020.
Author
Comentale G.; Giordano R.; Pilato E.; D'Amore A.; Romano R.; Simeone S.;
Browning R.; Palma G.; Iannelli G.
Institution
(Comentale, Giordano, Pilato, D'Amore, Simeone, Palma, Iannelli) Division
of Cardiac Surgery, University of Napoli "Federico II", Sergio Pansini
ndegree5, Napoli 80131, Italy
(Romano) Division of Pediatrics, University of Napoli "Federico II",
Sergio Pansini ndegree5, Napoli 80131, Italy
(Browning) Division of Cardiovascular Perfusion, The Royal Brompton,
London, United Kingdom
Publisher
Springer
Abstract
Ventricular assist device (VAD) implantation is a widely used procedure in
children with cardiac failure refractory to medical therapy as a long-term
bridge to recovery or transplant. This strategy has proved to be of an
enormous advantage in the cure of these children. The aim of this review
is to evaluate the current strategies used for clinical monitoring of
paediatric patients with a VAD, focusing on the management of several
aspects such as anticoagulant and antiplatelet therapy, haemorrhagic and
thrombotic complications, as well as the effects that VADs have on the
exposure, effectiveness and the safety of drugs. The sources used for this
research are MEDLINE, PubMed and Cochrane Library. The use of key words
such as "paediatric ventricular assist device", "clinical management",
"anticoagulant therapy" and "infections" retrieved 146 papers. With the
application of the inclusion criteria, 42 articles have been selected, but
following further analysis, only 21 were eligible. The post-implant
process is still complicated due to the lack of guidelines regarding
clinical management and for the frequent occurrence of adverse events
including bleeding, infection and thromboembolic episodes. From these
findings, we can highlight the importance of establishing a suitable
antithrombotic therapy, as well as ensuring that the prevention and
treatment of infection are paramount during the management of these
patients. The clinical management of VAD paediatric children is complex
and challenging. At the moment, there are no guidelines regarding
strategies to adopt, but from the analysed surveys, it has been possible
to highlight a relative coherence between adopted therapies in different
centres worldwide. Copyright © 2019, Springer Science+Business
Media, LLC, part of Springer Nature.

<41>
Accession Number
633133634
Title
Video-assisted thoracoscopic or conventional thoracic surgery in infants
and children: Current evidence.
Source
European Journal of Pediatric Surgery. (no pagination), 2020. Date of
Publication: 2020.
Author
Kiblawi R.; Zoeller C.; Zanini A.; Ure B.M.; Dingemann J.; Kuebler J.F.;
Schukfeh N.
Institution
(Kiblawi, Zoeller, Ure, Dingemann, Kuebler, Schukfeh) Department of
Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strase 1,
Hannover, Niedersachsen 30625, Germany
(Zanini) Department of Pediatric Surgery, University of Witwatersrand,
Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Introduction The pros and cons of video-assisted thoracoscopic versus
conventional thoracic surgery in infants and children are still under
debate. We assessed reported advantages and disadvantages of
video-assisted thoracoscopy in pediatric surgical procedures, as well as
the evidence level of the available data. Materials and Methods A
systematic literature search was performed to identify manuscripts
comparing video-assisted thoracoscopic and the respective conventional
thoracic approach in classic operative indications of pediatric surgery.
Outcome parameters were analyzed and graded for level of evidence
(according to the Oxford Centre of Evidence-Based Medicine). Results A
total of 48 comparative studies reporting on 12,709 patients, 11
meta-analyses, and one pilot randomized controlled trial including 20
patients were identified. More than 15 different types of advantages for
video-assisted thoracoscopic surgery were described, mostly with a level
of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery
was associated with shorter hospital stay, shorter postoperative
ventilation, and shorter time to chest drain removal. Mortality rate and
severe complications did not differ between thoracoscopic and conventional
thoracic pediatric surgery, except for congenital diaphragmatic hernia
repair with a lower mortality and higher recurrence rate after
thoracoscopic repair. The most frequently reported disadvantage for
video-assisted thoracoscopic surgery was longer operative time. Conclusion
The available data point toward improved recovery in pediatric
video-assisted thoracoscopic surgery despite longer operative times.
Further randomized controlled trials are needed to justify the widespread
use of video assisted thoracoscopy in pediatric surgery. Copyright
© Georg Thieme Verlag KG.

<42>
Accession Number
633040579
Title
Bilateral Remote Ischaemic Conditioning in Children (BRICC) trial:
Protocol for a two-centre, double-blind, randomised controlled trial in
young children undergoing cardiac surgery.
Source
BMJ Open. 10 (10) (no pagination), 2020. Article Number: 042176. Date of
Publication: 07 Oct 2020.
Author
Drury N.E.; Bi R.; Woolley R.L.; Stickley J.; Morris K.P.; Montgomerie J.;
Van Doorn C.; Dunn W.B.; Madhani M.; Ives N.J.; Kirchhof P.; Jones T.J.
Institution
(Drury, Bi, Stickley, Jones) Paediatric Cardiac Surgery, Birmingham
Children's Hospital, Birmingham, West Midlands, United Kingdom
(Drury, Madhani, Kirchhof, Jones) Institute of Cardiovascular Sciences,
University of Birmingham, Birmingham, West Midlands, United Kingdom
(Bi, Morris) Paediatric Intensive Care, Birmingham Children's Hospital,
Birmingham, West Midlands, United Kingdom
(Woolley, Ives) Birmingham Clinical Trials Unit, University of Birmingham,
Birmingham, West Midlands, United Kingdom
(Woolley, Morris, Ives) Institute of Applied Health Research, University
of Birmingham, Birmingham, West Midlands, United Kingdom
(Montgomerie) Paediatric Cardiac Anaesthesia, Birmingham Children's
Hospital, Birmingham, West Midlands, United Kingdom
(Van Doorn) Congenital Cardiac Surgery, Leeds Teaching Hospitals NHS
Trust, Leeds, West Yorkshire, United Kingdom
(Dunn) School of Biosciences, University of Birmingham, Birmingham, West
Midlands, United Kingdom
(Dunn) Phenome Centre Birmingham, University of Birmingham, Birmingham,
West Midlands, United Kingdom
(Kirchhof) Cardiology, University Heart and Vascular Center, UKE, Hamburg,
Germany
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Introduction Myocardial protection against ischaemic-reperfusion injury is
a key determinant of heart function and outcome following cardiac surgery
in children. However, with current strategies, myocardial injury occurs
routinely following aortic cross-clamping, as demonstrated by the
ubiquitous rise in circulating troponin. Remote ischaemic preconditioning,
the application of brief, non-lethal cycles of ischaemia and reperfusion
to a distant organ or tissue, is a simple, low-risk and readily available
technique which may improve myocardial protection. The Bilateral Remote
Ischaemic Conditioning in Children (BRICC) trial will assess whether
remote ischaemic preconditioning, applied to both lower limbs immediately
prior to surgery, reduces myocardial injury in cyanotic and acyanotic
young children. Methods and analysis The BRICC trial is a two-centre,
double-blind, randomised controlled trial recruiting up to 120 young
children (age 3 months to 3 years) undergoing primary repair of tetralogy
of Fallot or surgical closure of an isolated ventricular septal defect.
Participants will be randomised in a 1:1 ratio to either bilateral remote
ischaemic preconditioning (3x5 min cycles) or sham immediately prior to
surgery, with follow-up until discharge from hospital or 30 days,
whichever is sooner. The primary outcome is reduction in area under the
time-concentration curve for high-sensitivity (hs) troponin-T release in
the first 24 hours after aortic cross-clamp release. Secondary outcome
measures include peak hs-troponin-T, vasoactive inotrope score, arterial
lactate and central venous oxygen saturations in the first 12 hours, and
lengths of stay in the paediatric intensive care unit and the hospital.
Ethics and dissemination The trial was approved by the West
Midlands-Solihull National Health Service Research Ethics Committee
(16/WM/0309) on 5 August 2016. Findings will be disseminated to the
academic community through peer-reviewed publications and presentation at
national and international meetings. Parents will be informed of the
results through a newsletter in conjunction with a local charity. Trial
registration number ISRCTN12923441. Copyright © 2020 BMJ
Publishing Group. All rights reserved.

<43>
Accession Number
633027989
Title
Outcomes after corrective surgery for congenital dextro-transposition of
the arteries using the arterial switch technique: A scoping systematic
review.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 231. Date
of Publication: 07 Oct 2020.
Author
Morfaw F.; Leenus A.; Mbuagbaw L.; Anderson L.N.; Dillenburg R.; Thabane
L.
Institution
(Morfaw, Leenus, Mbuagbaw, Anderson, Thabane) Department of Health
Research Methods Evidence and Impact, McMaster University, Hamilton, ON,
Canada
(Morfaw) Department of Obstetrics and Gynecology, Faculty of Medicines and
Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
(Morfaw) Faculty of Health Sciences, University of Bamenda, Bamenda,
Cameroon
(Mbuagbaw, Thabane) Biostatistics Unit/FSORC, St Joseph
Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing,
Hamilton, ON L8N 4A6, Canada
(Mbuagbaw) Centre for Development of Best Practices in Health, Yaounde
Central Hospital, Yaounde, Cameroon
(Dillenburg, Thabane) Departments of Pediatrics and Anesthesia, McMaster
University, Hamilton, ON, Canada
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Dextro-transposition of the great arteries (d-TGA) is the most
frequent cyanotic congenital heart pathology in neonates. Surgical
correction of this condition is possible using the arterial switch
operation (ASO) which was first performed by Jatene in 1975.
 Objective(s): The aim of this study was to summarise the evidence on
short-(less than 1 year), medium-(1-20 years), and long-term (more than 20
years) outcomes of children with d-TGA treated with the ASO. The primary
outcome was survival. Secondary outcomes were freedom from cardiac
reoperations, occurrence of aortic insufficiency, pulmonary stenosis,
coronary artery anomalies, neuropsychological development problems and
quality of life. Method(s): We searched MEDLINE, EMBASE, CINAHL,
LILACS, and reference lists of included articles for studies reporting
outcomes after ASO for d-TGA. Screening, data extraction and risk of bias
assessment were done independently by two reviewers. We pooled data using
a random-effects meta-analysis of proportions and, where not possible,
outcomes were synthesized narratively. We used the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) system to
assess the certainty of the evidence for each outcome. Main
Result(s): Following ASO for TGA, short-term survival was 92.0% (95% CI
91.0-93.0%; I 2 = 85.8%, 151 studies, 30,186 participants; moderate
certainty evidence). Medium-term survival was 90.0% (95% CI 89.0-91.0%; I
2 = 84.3%, 133 studies; 23,686 participants, moderate certainty evidence),
while long-term survival was 87.0% (95% CI 80.0-92.0 %; I 2 = 84.5%, 4
studies, 933 participants, very low certainty evidence). Evaluation of the
different secondary outcomes also showed satisfactory results in the
short, medium and long term. Subgroup analysis suggests slightly higher
survival following ASO for TGA in the second surgical era (1998 to 2018)
than in the first surgical era (1975 to 1997) in the short and medium term
[93.0% (95% CI 92.0-94.0) vs 90.0% (95% CI 89.0-92.0) and 93.0% (95% CI
91.0-94.0) vs 88.0% (87.0-90.0%) respectively] but not in the long term
[81.0% (95% CI 76.0-86.0%) vs 89.0% (80.0-95.0%)]. Conclusion(s):
Pooled data from many sources suggests that the ASO for d-TGA leads to
high rates of survival in the short, medium, and long term. Copyright
© 2020 The Author(s).

<44>
Accession Number
633139633
Title
Prosthetic valve endocarditis by Trichosporon mucoides: A case report and
review of literature.
Source
Medicine. 99 (41) (pp e22584), 2020. Date of Publication: 09 Oct 2020.
Author
Oh T.H.; Shin S.U.; Kim S.S.; Kim S.E.; Kim U.J.; Kang S.-J.; Jang H.-C.;
Jung S.I.; Shin J.-H.; Park K.-H.
Institution
(Oh, Shin, Kim, Kim, Kim, Kang, Jang, Jung, Park) Department of Infectious
Diseases, Chonnam National University Hospital
(Kim, Kang, Jang, Jung, Park) Department of Infectious Diseases
(Shin) Department of Laboratory Medicine, Chonnam National University
Medical School, Gwangju, South Korea
Publisher
NLM (Medline)
Abstract
NATIONALE: Trichosporon species are widely distributed in nature and are
emerging opportunistic human pathogens. Trichosporon infections are
associated with superficial cutaneous involvement in immunocompetent
individuals to severe systemic disease in immunocompromised patients.
Until now, there is no report in infective endocarditis by Trichosporon
mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A
66-year-old man presented with a fever that had occurred for a period of 6
months. He had undergone aortic valve replacement 10 years prior.
Transthoracic echocardiography showed vegetations on the prosthetic aortic
valve and native mitral valve. T mucoides was detected in the cultures of
blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA
and internal transcribed spacer were performed. INTERVENTIONS: Infections
were successfully controlled with valve replacement and voriconazole plus
liposomal amphotericin B therapy. OUTCOME(S): There has been no sign
of recurrence for 18-months after treatment completion. LESSONS: This is
the first reported case of infective endocarditis due to T mucoides.
Clinicians should consider Trichosporon species as causative agents of
endocarditis in patients who have undergone cardiac surgery.

<45>
Accession Number
633136255
Title
Mitral valve re-repair vs replacement following failed initial repair: a
systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 304), 2020. Date of
Publication: 07 Oct 2020.
Author
Veerappan M.; Cheekoty P.; Sazzad F.; Kofidis T.
Institution
(Veerappan, Cheekoty, Sazzad, Kofidis) Department of Cardiac, Thoracic and
Vascular Surgery, National University Heart Centre, National University
Health System-NUHS, 1E Kent Ridge Road ,9th Floor ,Tower Block 119228,
Singapore
(Veerappan) School of Medicine, University of Dundee, Dundee, United
Kingdom
(Cheekoty) School of Medicine, Newcastle University, Newcastle, United
Kingdom
(Sazzad, Kofidis) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal treatment strategy following a failed mitral valve
repair remains unclear. This study aims to compare and analyse available
studies which report the clinical outcomes post mitral valve re-repair
(MVr) or replacement (MVR) after a prior mitral valve repair.
 METHOD(S): Based on PRISMA guidelines, a literature search was
performed utilising PubMed, Cochrane and Scopus databases to identify
retrospective cohort studies that reported outcomes of MVr and MVR after a
prior mitral valve repair. Data regarding operative mortality, clinical
outcomes and complications were extracted, synthesized and meta-analysed
where appropriate. RESULT(S): Eight studies with a total cohort of
1632 patients were used. After analysis, no significant differences in the
short term and long-term operative mortality, incidence of stroke,
congestive heart failure, Grade 1 and Grade 2 mitral regurgitation,
requirement of 3rd mitral valve operation and reoperation due bleeding
were found between the two groups. However, a slightly higher incidence of
postoperative atrial fibrillation (OR: 0.11, CI: 0.02 to 0.17, I2 =0%, p
=0.02) was observed in the MVR group, as compared to the MVr group.
 CONCLUSION(S): MVr appears to be a viable alternative to MVR for
mitral valve reoperation, given that they are associated with similar
post-operative outcomes.

<46>
Accession Number
2005213502
Title
Effect of age on clinical outcomes following on-/off-pump coronary artery
bypass: Meta- analysis and meta-regression.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 797-814), 2020.
Date of Publication: 2020.
Author
Mauldon H.; Dieberg G.; Smart N.; King N.
Institution
(Mauldon, King) University of Plymouth, Ringgold Standard Institution,
Plymouth, United Kingdom
(Dieberg, Smart) University of New England, Ringgold Standard Institution,
Armidale, Australia
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: There is currently much debate about which patients would
benefit more after on- or off-pump coronary artery bypass grafting (CABG).
The aim of this meta-analysis and meta-regression is to investigate the
effect of age on short-term clinical outcomes after these approaches.
 Method(s): To identify potential studies, systematic searches were
carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of
Science, and the Cochrane Central Register of Controlled Trials (CENTRAL).
The search strategy included the key concepts of "cardiopulmonary bypass"
AND "coronary artery bypass grafting" AND "off pump" OR "on pump". This
was followed by a meta-analysis and meta-regression investigating the
effect of age on the incidences of stroke, myocardial infarction (MI), and
mortality. Result(s): Thirty-seven studies including 15,324
participants were analysed. Overall, there was a significant odds
reduction for patients receiving off-pump CABG suffering a stroke (odds
ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048);
however, when patients were subdivided according to different age bands,
this difference disappeared. There were also no significant differences in
the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR
0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no
significant relationship between age and stroke (P=0.652), age and
mortality (P=548), and age and MI (P=0.464). Conclusion(s): Patients
undergoing CABG are becoming older and may suffer from multiple
comorbidities increasing their risk profile. However, with respect to
short-term clinical outcomes, the patient's age does not help in
determining whether off- or on-pump is superior. Copyright ©
2020, Sociedade Brasileira de Cirurgia Cardiovascular. All rights
reserved.

<47>
Accession Number
633130272
Title
Substitution of propofol for dexmedetomidine in the anaesthetic regimen
does not ameliorate the post-operative cognitive decline in elderly
patients.
Source
Indian Journal of Anaesthesia. 64 (10) (pp 880-886), 2020. Date of
Publication: October 2020.
Author
Chawdhary A.A.; Kulkarni A.; Nozari A.
Institution
(Chawdhary) Department of Anaesthesiology and Critical Care, Dr. Baba
Saheb Ambedkar Hospital and Medical College, Rohini, Delhi, India
(Kulkarni) Department of Anaesthesiology, Rajiv Gandhi Cancer Institute
and Research Centre, Rohini, Delhi, India
(Nozari) Department of Anaesthesiology, Boston University School of
Medicine, Boston, MA, United States
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Post-operative cognitive dysfunction (POCD) is a
poorly understood complication particularly observed in elderly patients,
with long-term poor outcome. The randomised study was to compare the
incidence of POCD in elderly with bispectral index (BIS)-guided
intra-operative use of either dexmedetomidine or propofol with
sevoflurane. Method(s): Eighty-seven patients, planned for
non-cardiac surgery under general anaesthesia, were included between June
2017 and March 2018. After exclusion of 7 patients, remaining 80 patients
were randomised into dexmedetomidine group and propofol group with 40
patients each. In both the groups, BIS-guided anaesthesia was provided.
Cognitive function was assessed by an anaesthesiologist using a battery of
neuropsychological tests at baseline pre-operatively, third and seventh
day after surgery. The data were entered into a Microsoft Excel
spreadsheet and analysis was performed using Statistical Package for
Social Sciences (SPSS) version 21. Result(s): Propofol group had a
non-significant lower incidence of POCD on third day and dexmedetomidine
group showed decreased incidence of POCD on seventh day, accompanied by
lower anaesthetic requirement (inhalational as well as intravenous)
concomitant with delayed emergence with an acceptable BIS value.
 Conclusion(s): Dexmedetomidine appeared to be anaesthetic sparing as
compared to propofol. BIS monitoring for titrating depth of anaesthesia
and hence the anaesthetic exposure is an invaluable tool as compared to
routine care anaesthesia for reducing POCD. The patients in both groups
did not develop significant POCD until the seventh post-operative
day. Copyright © 2020 Indian Journal of Anaesthesia 
Published by Wolters Kluwer - Medknow

<48>
Accession Number
2006989271
Title
Comparison of anterior, posterior, and anterior combined with posterior
surgical treatment of thoracic and lumbar spinal tuberculosis: a
systematic review.
Source
Journal of International Medical Research. 48 (2) (no pagination), 2019.
Date of Publication: 2019.
Author
Bian Z.; Gui Y.; Feng F.; Shen H.; Lao L.
Institution
(Bian, Gui, Feng, Shen, Lao) Department of Spine Surgery, Renji Hospital,
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: This study was performed to compare different surgical
approaches in the treatment of spinal tuberculosis. Method(s): We
conducted a literature search to identify and analyze papers published
from January 1966 to April 2018 relevant to comparison of the anterior,
posterior, and anterior combined with posterior approaches in the
treatment of spinal tuberculosis of the thoracic and lumbar regions.
 Result(s): Twenty-five studies involving 2295 patients were
identified in this systematic review. The operative time was significantly
longer in the anterior combined with posterior approach than in the other
two approaches. Blood loss was significantly greater in the anterior
combined with posterior approach (1125.0 +/- 275.5 mL) than in the
posterior approach (710.4 +/- 192.4 mL). The difference in correction of
the kyphosis angle among the three procedures was not significant. The
overall surgical and transthoracic complications were significantly lower
in the posterior approach. The clinical outcome of all patients improved,
but there was no significant difference among the three procedures.
 Conclusion(s): Blood loss, overall surgical and transthoracic
complications, and the operative time are different among the three
approaches. Therefore, different factors must be carefully assessed in
deciding among the three procedures. Copyright © The Author(s)
2019.

<49>
Accession Number
2008340287
Title
Effect of Retrograde Autologous Blood Priming of Cardiopulmonary Bypass on
Hemodynamic Parameters and Pulmonary Mechanics in Pediatric Cardiac
Surgery: A Randomized Clinical Study.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Singab H.; Gamal M.A.; Refaey R.; Al-Taher W.
Institution
(Singab, Gamal, Refaey) Cardiothoracic Surgery Department, Ain Shams
University Faculty of Medicine, Ain Shams University Hospitals, Cairo,
Egypt
(Al-Taher) Anesthesia and Intensive Care Department, Ain Shams University
Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
The present study aimed to assess the impact of retrograde autologous
priming (RAP) on hemodynamics and pulmonary mechanics in children
subjected to cardiothoracic surgery. This prospective randomized study
analyzed the clinical records of 124 children with risk adjustment in
congenital heart surgery-1 left to right lesions subjected to cardiac
surgery. They comprised 64 patients in RAP group and 60 patients in the
conventional priming group. The preoperative, intraoperative and
postoperative data of the studied patients were reported. The outcome
measures included hematocrit (Hct) value, blood gases, lung mechanics
parameters, transfusion needs, ICU stay, postoperative complications and
mortality. Preoperatively, there were no significant differences between
the studied groups regarding the demographic data, underlying lesions,
laboratory data, blood gases and pulmonary mechanics parameters.
Intraoperatively, RAP group patients had significantly lower amount of
blood loss, less frequent need to packed red blood cells (RBC)s
transfusion and better Hct values when compared with the control group.
Postoperatively, RAP group patients had significantly higher Hct% at ICU
arrival, significantly better pulmonary mechanics parameters and
significantly shorter duration on mechanical ventilation. RAP in children
older than 12 months subjected to cardiac surgery for risk adjustment in
congenital heart surgery-1 left to right lesions is associated with less
transfusion needs and better pulmonary mechanics. Copyright ©
2020 Elsevier Inc.

<50>
Accession Number
2008334639
Title
Effect of preparative rehabilitation on recovery after cardiac surgery: A
systematic review.
Source
Annals of Physical and Rehabilitation Medicine. (no pagination), 2020.
Date of Publication: 2020.
Author
Yau D.K.W.; Underwood M.J.; Joynt G.M.; Lee A.
Institution
(Yau, Joynt, Lee) Department of Anaesthesia and Intensive Care, The
Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma
Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong
Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery, The
Chinese University of Hong Kong, 7/F Main Clinical Block and Trauma
Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong
Kong
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Physical prehabilitation (preparative rehabilitation) programs
may have beneficial effects on enhancing physical strength and functional
status before surgery, but their effects on postoperative recovery are
unclear. Objective(s): This systematic review investigated the
effectiveness of physical prehabilitation programs before cardiac surgery
on postoperative recovery and other perioperative outcomes.
 Method(s): We searched for reports of randomised controlled trials of
any prehabilitation programs that included physical activity or an
exercise training component in adults undergoing elective cardiac surgery,
published in any language, from six bibliographic databases (last search
on June 20, 2019). We assessed trials for risk of bias, overall certainty
of evidence and quality of intervention reporting using the Cochrane Risk
of Bias Assessment Tool, GRADE system and the Template for Intervention
Description and Replication checklist and guide, respectively.
 Result(s): All 7 studies (726 participants) were at high risk of bias
because of lack of blinding. The quality of prehabilitation reporting was
moderate because program adherence was rarely assessed. The timing of
prehabilitation ranged from 5 days to 16 weeks before surgery and from
face-to-face exercise prescription to telephone counselling and
monitoring. We found uncertain effects of prehabilitation on postoperative
clinical outcomes (among the many outcomes assessed): perioperative
mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to
5.95; I2 = 0%; low-certainty evidence) and postoperative atrial
fibrillation (relative risk 0.75, 95% CI 0.38 to 1.46; I2 =
50%; very low-certainty evidence). However, prehabilitation may improve
postoperative functional capacity and slightly shorten the hospital stay
(mean difference -0.66 days, 95% CI -1.29 to -0.03; I2 = 45%;
low-certainty evidence). Conclusion(s): Despite the high
heterogeneity among physical prehabilitation trials and the uncertainty
regarding robust clinical outcomes, physical prehabilitation before
cardiac surgery seems to enhance selected postoperative functional
performance measures and slightly reduce the hospital length of stay after
cardiac surgery. Copyright © 2020 Elsevier Masson SAS

<51>
Accession Number
2007008517
Title
The effect of levosimendan on postoperative bleeding and blood transfusion
in cardiac surgical patients: a PRISMA-compliant systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Yao Y.-T.; He L.-X.; Zhao Y.-Y.
Institution
(Yao, He, Zhao) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Levosimendan (LEVO), is an inotropic agent which has been
shown to be associated with better myocardial performance, and higher
survival rate in cardiac surgical patients. However, preliminary clinical
evidence suggested that LEVO increased the risk of post-operative bleeding
in patients undergoing valve surgery. Currently, there has been no
randomized controlled trials (RCTs) designed specifically on this issue.
Therefore, we performed present systemic review and meta-analysis.
 Method(s): Electronic databases were searched to identify all RCTs
comparing LEVO with Control (placebo, blank, dobutamine, milrinone, etc).
Primary outcomes include post-operative blood loss and re-operation for
bleeding. Secondary outcomes included post-operative transfusion of red
blood cells (RBC), fresh frozen plasma (FFP) and platelet concentrates
(PC). For continuous variables, treatment effects were calculated as
weighted mean difference (WMD) and 95% confidential interval (CI). For
dichotomous data, treatment effects were calculated as odds ratio (OR) and
95% CI. Result(s): Search yielded 15 studies including 1,528
patients. Meta-analysis suggested that, LEVO administration was not
associated with increased risk of reoperation for bleeding
post-operatively (OR = 1.01; 95%CI: 0.57 to 1.79; p = 0.97) and more blood
loss volume (WMD = 28.25; 95%CI: -19.21 to 75.72; p = 0.24). Meta-analysis
also demonstrated that, LEVO administration did not increase
post-operative transfusion requirement for RBC (rate: OR = 0.97; 95%CI:
0.72 to 1.30; p = 0.83 and volume: WMD = 0.34; 95%CI: -0.55 to 1.22; p =
0.46), FFP (volume: WMD = 0.00; 95%CI: -0.10 to 0.10; p = 1.00) and PC
(rate: OR = 1.01; 95%CI: 0.41 to 2.50; p = 0.98 and volume: WMD = 0.00;
95%CI: -0.05 to 0.04; p = 0.95). Conclusion(s): This meta-analysis
suggested that, peri-operative administration of LEVO was not associated
with increased risks of post-operative bleeding and blood transfusion
requirement in cardiac surgical patients. Copyright © The
Author(s) 2020.

<52>
Accession Number
633140363
Title
Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation
in Saphenous Vein Grafts: Randomized Controlled Trial.
Source
Journal of the American Heart Association. (pp e017434), 2020. Date of
Publication: 09 Oct 2020.
Author
Fahrni G.; Farah A.; Engstrom T.; Galatius S.; Eberli F.; Rickenbacher P.;
Conen D.; Mueller C.; Pfister O.; Twerenbold R.; Coslovsky M.; Cattaneo
M.; Kaiser C.; Mangner N.; Schuler G.; Pfisterer M.; Mobius-Winkler S.;
Jeger R.V.
Institution
(Fahrni, Rickenbacher, Conen, Mueller, Pfister, Twerenbold, Coslovsky,
Cattaneo, Kaiser, Pfisterer, Jeger) University Hospital Basel Switzerland
(Farah) Klinikum Westfalen Dortmund Germany
(Farah) Central Clinic Bad Berka Germany
(Engstrom) Rigshospitalet Copenhagen Denmark
(Galatius) Bispebjerg University Hospital Copenhagen Denmark
(Galatius) Gentofte Hospital Hellerup Denmark
(Eberli) Triemli Hospital Zurich Switzerland
(Conen) Population Health Research Institute McMaster University Hamilton
Canada
(Mangner) Herzzentrum Dresden Technische Universitat Dresden Dresden
Germany
(Mangner, Schuler, Mobius-Winkler) Heart Center University of Leipzig
Germany
(Mobius-Winkler) University of Jena Germany
Publisher
NLM (Medline)
Abstract
Background Efficacy data on drug-eluting stents (DES) versus bare-metal
stents (BMS) in saphenous vein grafts are controversial. We aimed to
compare DES with BMS among patients undergoing saphenous vein grafts
intervention regarding long-term outcome. Methods and Results In this
multinational trial, patients were randomized to paclitaxel-eluting or
BMS. The primary end point was major adverse cardiac events (cardiac
death, nonfatal myocardial infarction, and target-vessel revascularization
at 1 year. Secondary end points included major adverse cardiac events and
its individual components at 5-year follow-up. One hundred seventy-three
patients were included in the trial (89 DES versus 84 BMS). One-year major
adverse cardiac event rates were lower in DES compared with BMS (2.2%
versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03-0.64, P=0.01), which was
mainly driven by a reduction of subsequent myocardial infarctions and need
for target-vessel revascularization. Five-year major adverse cardiac event
rates remained lower in the DES compared with the BMS arm (35.5% versus
56.1%, hazard ratio, 0.40; 95% CI, 0.23-0.68, P<0.001). A
landmark-analysis from 1 to 5 years revealed a persistent benefit of DES
over BMS (hazard ratio, 0.33; 95% CI, 0.13-0.74, P=0.007) in terms of
target-vessel revascularization. More patients in the BMS group underwent
multiple target-vessel revascularization procedures throughout the study
period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8],
P=0.013). Enrollment was stopped before the target sample size of 240
patients was reached. Conclusions In this randomized controlled trial with
prospective long-term follow-up of up to 5 years, DES showed a better
efficacy than BMS with sustained benefits over time. DES may be the
preferred strategy in this patient population. Registration URL:
https://www.clinicaltrials.gov; Unique identifier: NCT00595647.

<53>
Accession Number
633139704
Title
Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid
Aortic Valve Stenosis.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 07 Oct 2020.
Author
Forrest J.K.; Ramlawi B.; Deeb G.M.; Zahr F.; Song H.K.; Kleiman N.S.;
Chetcuti S.J.; Michelena H.I.; Mangi A.A.; Skiles J.A.; Huang J.; Popma
J.J.; Reardon M.J.
Institution
(Forrest, Mangi) Departments of Internal Medicine (Cardiology) and Surgery
(Cardiac Surgery), Yale University School of Medicine, New Haven, CT,
United States
(Ramlawi, Skiles) Department of Cardiothoracic Surgery and Cardiology,
Valley Health System, Winchester, VA
(Deeb, Chetcuti) Departments of Cardiac Surgery and Interventional
Cardiology, University of Michigan Hospitals, Ann Arbor, United States
(Zahr, Song) Departments of Interventional Cardiology and Cardiothoracic
Surgery, Oregon Health and Science University, Portland, Jamaica
(Kleiman, Reardon) Departments of Interventional Cardiology and
Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular
Institute, Houston, TX
(Michelena) Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester,
MN
(Huang) Department of Statistics, Medtronic, Minneapolis, MN, United
States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA
Publisher
NLM (Medline)
Abstract
Importance: The outcomes of transcatheter aortic valve replacement (TAVR)
in low-risk patients with bicuspid aortic valve stenosis have not been
studied in a large scale, multicentered, prospective fashion.
 Objective(s): To evaluate the procedural safety, efficacy, and 30-day
outcomes of TAVR in patients with bicuspid aortic stenosis at low surgical
risk. Design, Setting, and Participant(s): The Low Risk Bicuspid
Study is a prospective, single-arm trial study with inclusion/exclusion
criteria developed from the Evolut Low Risk Randomized Trial. Follow-up is
planned for 10 years. Patients underwent TAVR at 25 centers in the United
States who were also participating in the Evolut Low Risk Randomized Trial
from December 2018 to October 2019. Eligible patients had severe bicuspid
aortic valve stenosis and met American Heart Association/American College
of Cardiology guideline indications for aortic valve replacement.
 Intervention(s): Patients underwent attempted implant of an Evolut or
Evolut PRO transcatheter aortic valve, with valve size based on annular
measurements. Main Outcomes and Measures: The prespecified primary
end point was the incidence of all-cause mortality or disabling stroke at
30 days. The prespecified primary efficacy end point was device success
defined as the absence of procedural mortality, the correct position of 1
bioprosthetic heart valve in the proper anatomical location, and the
absence of more than mild aortic regurgitation postprocedure.
 Result(s): A total of 150 patients underwent an attempted implant.
Baseline characteristics include mean age of 70.3 (5.5) years, 48.0%
female (n=72), and a mean Society of Thoracic Surgeons score of 1.4
(0.6%). Most patients (136; 90.7%) had Sievers type I valve morphology.
The incidence of all-cause mortality or disabling stroke was 1.3% (95% CI,
0.3%-5.3%) at 30 days. The device success rate was 95.3% (95% CI,
90.5%-98.1%). At 30 days, the mean (SD) AV gradient was 7.6 (3.7) mm Hg
and effective orifice area was 2.3 (0.7) cm2. A new permanent pacemaker
was implanted in 22 patients (15.1%). No patients had greater than mild
paravalvular leak. Conclusions and Relevance: Transcatheter aortic
valve replacement in low-surgical risk patients with bicuspid aortic valve
stenosis achieved favorable 30-day results, with low rates of death and
stroke and high device success rate. Trial Registration:
ClinicalTrials.gov Identifier: NCT03635424.

<54>
Accession Number
633135798
Title
Current state of noninvasive, continuous monitoring modalities in
pediatric anesthesiology.
Source
Current opinion in anaesthesiology. (no pagination), 2020. Date of
Publication: 06 Oct 2020.
Author
van Wijk J.J.; Weber F.; Stolker R.J.; Staals L.M.
Institution
(van Wijk, Weber, Staals) Department of Anesthesiology, Erasmus MC Sophia
Children's Hospital
(Stolker) Department of Anesthesiology, Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The last decades, anesthesia has become safer, partly
due to developments in monitoring. Advanced monitoring of children under
anesthesia is challenging, due to lack of evidence, validity and size
constraints. Most measured parameters are proxies for end organ function,
in which an anesthesiologist is actually interested. Ideally, monitoring
should be continuous, noninvasive and accurate. This present review
summarizes the current literature on noninvasive monitoring in noncardiac
pediatric anesthesia. RECENT FINDINGS: For cardiac output (CO) monitoring,
bolus thermodilution is still considered the gold standard. New
noninvasive techniques based on bioimpedance and pulse contour analysis
are promising, but require more refining in accuracy of CO values in
children. Near-infrared spectroscopy is most commonly used in cardiac
surgery despite there being no consensus on safety margins. Its place in
noncardiac anesthesia has yet to be determined. Transcutaneous
measurements of blood gases are used mainly in the neonatal intensive care
unit, and is finding its way to the pediatric operation theatre.
Especially CO2 measurements are accurate and useful. SUMMARY: New
techniques are available to assess a child's hemodynamic and respiratory
status while under anesthesia. These new monitors can be used as
complementary tools together with standard monitoring in children, to
further improve perioperative safety.

<55>
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.

<56>
Accession Number
613799386
Title
Impact of incomplete percutaneous revascularization in patients with
multivessel coronary artery disease: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 5 (12) (no pagination), 2016.
Article Number: e004598. Date of Publication: 01 Dec 2016.
Author
Nagaraja V.; Ooi S.-Y.; Nolan J.; Large A.; De Belder M.; Ludman P.; Bagur
R.; Curzen N.; Matsukage T.; Yoshimachi F.; Kwok C.S.; Berry C.; Mamas
M.A.
Institution
(Nagaraja, Ooi) Department of Cardiology, Prince of Wales Hospital,
Sydney, NSW, Australia
(Nolan, Large, Kwok, Mamas) Royal Stoke University Hospital, University
Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nolan, Kwok, Mamas) Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine, University of Keele, Stoke-on-Trent,
United Kingdom
(De Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(Bagur) Division of Cardiology, Department of Medicine and Department of
Epidemiology and Biostatistics, London Health Sciences Centre, Western
University, London, ON, Canada
(Curzen) University Hospital Southampton and Faculty of Medicine,
University of Southampton, United Kingdom
(Matsukage, Yoshimachi) Division of Cardiology, Tokai University School of
Medicine, Isehara, Japan
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background-Up to half of patients undergoing percutaneous coronary
intervention have multivessel coronary artery disease (MVD) with
conflicting data regarding optimal revascularization strategy in such
patients. This paper assesses the evidence for complete revascularization
(CR) versus incomplete revascularization in patients undergoing
percutaneous coronary intervention, and its prognostic impact using
meta-analysis. Methods and Results-A search of PubMed, EMBASE, MEDLINE,
Current Contents Connect, Google Scholar, Cochrane library, Science
Direct, and Web of Science was conducted to identify the association of CR
in patients with multivessel coronary artery disease undergoing
percutaneous coronary intervention with major adverse cardiac events and
mortality. Random-effects metaanalysis was used to estimate the odds of
adverse outcomes. Meta-regression analysis was conducted to assess the
relationship with continuous variables and outcomes. Thirty-eight
publications that included 156 240 patients were identified. Odds of death
(OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI
0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50- 0.81), and major
adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly
lower in the patients who underwent CR. These outcomes were unchanged on
subgroup analysis regardless of the definition of CR. Similar findings
were recorded when CR was studied in the chronic total occlusion (CTO)
subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed
a negative relationship between the OR for mortality and the percentage of
CR. Conclusion-CR is associated with reduced risk of mortality and major
adverse cardiac events, irrespective of whether an anatomical or a
score-based definition of incomplete revascularization is used, and this
magnitude of risk relates to degree of CR. These results have important
implications for the interventional management of patients with
multivessel coronary artery disease. Copyright © 2016 The
Authors.

<57>
Accession Number
613430248
Title
Isolated human pulmonary artery structure and function pre -and
post-cardiopulmonary bypass surgery.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002822. Date of Publication: 01 Feb 2016.
Author
Dora K.A.; Stanley C.P.; Jaaly E.A.; Fiorentino F.; Ascione R.; Reeves
B.C.; Angelini G.D.
Institution
(Dora, Stanley) Department of Pharmacology, University of Oxford, United
Kingdom
(Jaaly, Fiorentino, Angelini) Department of Cardiothoracic Surgery,
Hammersmith Hospital, Imperial College London, London, United Kingdom
(Ascione, Reeves, Angelini) Bristol Heart Institute, Bristol Royal
Infirmary, University of Bristol, United Kingdom
(Stanley) The Victor Chang Cardiac Research Institute, Sydney, Australia
Publisher
John Wiley and Sons Inc
Abstract
Background-Pulmonary dysfunction is a known complication after cardiac
surgery using cardiopulmonary bypass, ranging from subclinical functional
changes to prolonged postoperative ventilation, acute lung injury, and
acute respiratory distress syndrome. Whether human pulmonary arterial
function is compromised is unknown. The aim of the present study was to
compare the structure and function of isolated and cannulated human
pulmonary arteries obtained from lung biopsies after the chest was opened
(pre-cardiopulmonary bypass) to those obtained at the end of
cardiopulmonary bypass (post-cardiopulmonary bypass) from patients
undergoing coronary artery bypass graft surgery. Methods and
Results-Pre-and post-cardiopulmonary bypass lung biopsies were received
from 12 patients undergoing elective surgery. Intralobular small arteries
were dissected, cannulated, pressurized, and imaged using confocal
microscopy. Functionally, the thromboxane mimetic U46619 produced
concentration-dependent vasoconstriction in 100% and 75% of pre-and
post-cardiopulmonary bypass arteries, respectively. The
endothelium-dependent agonist bradykinin stimulated vasodilation in 45%
and 33% of arteries pre-and post-cardiopulmonary bypass, respectively.
Structurally, in most arteries smooth muscle cells aligned
circumferentially; live cell viability revealed that although 100% of
smooth muscle and 90% of endothelial cells from pre -cardiopulmonary
bypass biopsies had intact membranes and were considered viable, only 60%
and 58%, respectively, were viable from post-cardiopulmonary bypass
biopsies. Conclusions-We successfully investigated isolated pulmonary
artery structure and function in fresh lung biopsies from patients
undergoing heart surgery. Pulmonary artery contractile tone and
endothelium-dependent dilation were significantly reduced in
post-cardiopulmonary bypass biopsies. The decreased functional responses
were associated with reduced cell viability. Clinical Trial
Registration--URL: http://www.isrctn.com/ISRCTN34428459. Copyright
© 2016 The Authors.

<58>
Accession Number
2006909314
Title
Revascularisation in older adult patients with non-ST-segment elevation
acute coronary syndrome: effect and impact on 6-month mortality.
Source
European Heart Journal: Acute Cardiovascular Care. 9 (4) (pp 358-366),
2020. Date of Publication: 01 Jun 2020.
Author
Bardaji A.; Barrabes J.A.; Ribera A.; Bueno H.; Fernandez-Ortiz A.;
Marrugat J.; Oristrell G.; Ferreira-Gonzalez I.
Institution
(Bardaji) Servicio de Cardiologia, Hospital Universitari de Tarragona Joan
XXIII, Tarragona, Spain
(Barrabes, Ribera, Oristrell, Ferreira-Gonzalez) Servicio de Cardiologia,
Hospital Universitari Vall d'Hebron, Barcelona, Spain
(Bueno) Servicio de Cardiologia, Hospital Universitario, 12 de Octubre,
Madrid, Spain
(Fernandez-Ortiz) Servicio de Cardiologia, Hospital Clinico San Carlos,
Madrid, Spain
(Marrugat) Grupo de Epidemiologia y Genetica Cardiovascular, Instituto
Hospital del Mar de Investigaciones Medicas, Barcelona, Spain
Publisher
SAGE Publications Inc. (United States. E-mail: claims@sagepub.com)
Abstract
Although revascularisation in non-ST-segment elevation acute coronary
syndrome (NSTEACS) is associated with better outcomes, its impact in older
adult patients is unclear. This is a retrospective analyses of three
national NSTEACS registries conducted during the past decade in Spain.
Patients aged 75 years and older were included: DESCARTES (DES; year 2002;
n=534), MASCARA (MAS; 2005; n=1736) and DIOCLES (DIO; 2012; n=593). The
adjusted association between revascularisation and total (inhospital and
6-month) mortality was estimated by two-stage meta-analysis (pooled effect
across the three registries with inverse-variability weights) and
one-stage meta-analysis (multilevel model with random effects across
studies). The impact of revascularisation was assessed comparing the
observed and the expected mortality based on a logistic regression model
in the pooled database. Although revascularisation was associated with a
lower risk of mortality in meta-analyses (two-stage: odds ratio 0.44, 95%
confidence interval 0.29-0.67; one-stage: odds ratio 0.54, 95% confidence
interval 0.36-0.81) and the revascularisation rate increased steadily from
2002 (DES 14.2%) to 2012 (DIO 43.7%), its impact was not patent across
registries, probably because this increase was concentrated in low and
medium-risk GRACE strata (tertile 1, 2 and 3: MAS 59%, 20% and 6%; DIO
64%, 39% and 19%, respectively). In conclusion, a consistent increase of
revascularisation in NSTEACS in older adults was not followed by a
decrease in mortality at 6 months, probably because the impact of this
strategy is limited to the higher risk population, the stratum with the
lowest revascularisation rate in real life. Copyright © The
European Society of Cardiology 2019.

<59>
Accession Number
2005644577
Title
A pilot randomized-controlled trial evaluating the erector spinae plane
block in thoracic and breast surgery.
Source
Canadian Journal of Anesthesia. 67 (10) (pp 1371-1380), 2020. Date of
Publication: 01 Oct 2020.
Author
Uda Y.; Byrne K.; Brahmbhatt A.; Gotmaker R.; Lim D.; Konishi Y.; Eves
T.K.; Paxton E.; Barrington M.J.
Institution
(Uda, Brahmbhatt, Gotmaker, Konishi, Paxton, Barrington) Department of
Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Victoria
Parade, Fitzroy, PO Box 2900, Melbourne, VIC 3065, Australia
(Byrne) Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
(Brahmbhatt, Barrington) Department of Medicine and Radiology, Faculty of
Medicine, Dentistry and Health Sciences, University of Melbourne,
Melbourne, VIC, Australia
(Lim) Department of Pharmacy, St. Vincent's Hospital, Melbourne, VIC,
Australia
(Konishi) Department of Anesthesia, School of Medicine, Teikyo University,
Tokyo, Japan
(Eves) Department of Anatomy and Neuroscience, Faculty of Medicine,
Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC,
Australia
Publisher
Springer
Abstract
Purpose: This pilot study evaluated the feasibility of investigating the
effect of the erector spinae plane (ESP) block on the patient-centred
outcomes of quality of recovery-15 (QoR-15), and brief pain inventory
(BPI) in thoracic and breast surgery patients. Method(s): In this
randomized-controlled pilot trial, 82 patients undergoing video-assisted
thoracoscopic surgery (n = 77) and mastectomy (n = 5) received either
continuous ESP block with ropivacaine (ropivacaine group) or the same
procedure with 0.9% saline (saline group). All patients received surgical
intercostal block (thoracic surgery) or local anesthetic infiltration
(breast surgery). Feasibility as the primary outcome was evaluated on
recruitment (three patients per week), catheter retention (above 90% at 24
hr), and patient attrition (less than 10%). Secondary outcomes comprised
of QoR-15, BPI, and opioid consumption. Result(s): Recruitment rate
was 1.8 patients per week. Catheters were retained in 77 patients (94%) at
24 hr. At three months, five patients were lost to follow-up (6%). At 24
hr compared with baseline, the ropivacaine group had a smaller decline in
QoR-15 score (median difference, 14; 95% confidence interval [CI], 2 to
26; P = 0.02) and a smaller increase in BPI global score (median
difference, 14; 95% CI, 0 to 24; P = 0.048). There was no difference in
opioid consumption (P = 0.08). Conclusion(s): In this pilot study,
the target recruitment rate was not met, but catheter retention and
patient attrition rates were both satisfactory. A definitive trial with
QoR-15 as the primary outcome would require 300 study participants. Trial
registration: Australian New Zealand Clinical Trials Registry
(ID12618000701224); registered 30 April 2018. Copyright © 2020,
Canadian Anesthesiologists' Society.

<60>
Accession Number
2007560582
Title
Multiple versus single arterial grafting in coronary artery bypass
grafting: A meta-analysis of randomized controlled trials and propensity
score studies.
Source
International Journal of Cardiology. 320 (pp 55-63), 2020. Date of
Publication: 01 Dec 2020.
Author
Saraiva F.A.; Leite-Moreira J.P.; Barros A.S.; Lourenco A.P.; Benedetto
U.; Leite-Moreira A.F.
Institution
(Saraiva, Leite-Moreira, Barros, Lourenco, Leite-Moreira) Cardiovascular
Research and Development Center, Department of Surgery and Physiology,
Faculty of Medicine of the University of Porto, Porto, Portugal
(Lourenco) Department of Anaesthesiology, Centro Hospitalar Universitario
Sao Joao, Porto, Portugal
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Leite-Moreira) Department of Cardiothoracic Surgery, Centro Hospitalar
Universitario Sao Joao, Porto, Portugal
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: We conducted a meta-analysis of randomized controlled trials
(RCTs) and propensity score (PS) studies comparing survival and major
adverse cardiac and cerebrovascular events (MACCEs) of patients who
underwent coronary artery bypass grafting (CABG) with multiple (MAG)
versus single arterial grafting (SAG). Method(s): MEDLINE, Web of
Science and Cochrane Library were used to find relevant literature
(1960-2018). Survival at a follow-up >=1 year, MACCEs and early outcomes
were evaluated. Time-to-event outcomes were collected through hazard ratio
(HR) along with their variance, and the other endpoints using frequencies
from matched sample or adjusted odds ratios. Random effect models were
used to compute combined statistical measures and 95% confidence intervals
(CI) through generic inverse variance method (time-to-event) or
Mantel-Haenszel method (binary events). Result(s): Twenty-nine PS
cohorts and 8 RCTs comprising 122,832 patients (52,178 MAG and 70,654 SAG)
were included in this meta-analysis. MAG was associated with lower early
mortality (OR: 0.82, 95%CI: 0.71-0.95, p = .007), long-term mortality (HR:
0.76, 95%CI: 0.73-0.78, p < .001) and MACCEs (HR: 0.85, 95%CI: 0.79-0.91,
p < .001). Increased risk of sternal wound complications (SWC) was only
observed when the bilateral internal mammary artery configuration was used
for MAG (OR MAG BIMA: 1.96, 95%CI: 1.37-2.81, p < .001).
 Conclusion(s): Although the BIMA configuration increases the risk of
SWC, MAG improves both early and long-term survival as well as MACCEs in
CABG. Copyright © 2020

<61>
Accession Number
2006908190
Title
A Rare Case of Partial Aortic Mechanical Valve Thrombosis With Intact
Mitral Mechanical Valve Presenting With ST-Elevation Myocardial Infarction
Patients.
Source
Journal of Investigative Medicine High Impact Case Reports. 8 (no
pagination), 2020. Date of Publication: 2020.
Author
Khalid M.O.; Malyshev Y.; Hashmi A.T.; Siddiqui S.; Patel N.; Shani J.;
Ayzenberg S.
Institution
(Khalid, Malyshev, Hashmi, Siddiqui, Shani, Ayzenberg) Maimonides Medical
Center, Brooklyn, NY, United States
(Patel) Interfaith Medical Center, Brooklyn, NY, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
The incidence of mechanical valve thrombosis (MVT) is around 0.4 per 100
patient-years. Mitral valve thrombosis has a higher incidence than aortic
valve thrombosis with a nearly 5-fold increase. Various factors contribute
to MVT. The most common cause of valve thrombosis is poor
adherence/disruption of anticoagulation therapy. Low cardiac output is
known to increase the risk of prosthetic valve thrombosis. Other factors
such as diabetes, hypertension, and other patient comorbidities might also
play a role. Decreased flow promotes hypercoagulability. Lower pressure in
the left atrium (and higher velocities in the left ventricle) can
partially contribute to the higher incidence of mitral MVT versus aortic
MVT. The presenting symptoms usually depend on the severity of the valve
thrombosis; nonobstructive valve thrombosis patients have progressive
dyspnea, signs of heart failure, and systemic embolization with strokes
being the most common complication. In this article, we present a case of
a middle-aged woman with a history of mitral and aortic mechanical
prosthesis who presented with an ST-segment elevation myocardial
infarction and pulmonary edema due to mechanical aortic valve prosthesis
thrombosis. She had an isolated mechanical aortic valve prosthesis
thrombosis with intact mitral valve, which, to the best of our knowledge,
has not yet been described. We performed a literature review by searching
PubMed and Embase using the keywords "mechanical valve," "thrombosis,"
"aortic," and "mitral," our search did not show similar
cases. Copyright © 2020 American Federation for Medical Research.

<62>
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.

<63>
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. (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

<64>
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. 9 (19) (pp e017460), 2020. Date
of Publication: 20 Oct 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.

<65>
Accession Number
630877981
Title
Identifying critically important cardiovascular outcomes for trials in
hemodialysis: an international survey with patients, caregivers and health
professionals.
Source
Nephrology, dialysis, transplantation : official publication of the
European Dialysis and Transplant Association - European Renal Association.
35 (10) (pp 1761-1769), 2020. Date of Publication: 01 Oct 2020.
Author
O'Lone E.; Howell M.; Viecelli A.K.; Craig J.C.; Tong A.; Sautenet B.;
Herrington W.G.; Herzog C.A.; Jafar T.H.; Jardine M.; Krane V.; Levin A.;
Malyszko J.; Rocco M.V.; Strippoli G.; Tonelli M.; Wang A.Y.-M.; Wanner
C.; Zannad F.; Winkelmayer W.C.; Wheeler D.C.
Institution
(O'Lone, Howell, Tong, Strippoli) Sydney School of Public Health,
University of Sydney, NSW, Sydney, Australia
(O'Lone, Howell, Tong, Strippoli) Centre for Kidney Research, Children's
Hospital at Westmead, NSW, Sydney, Australia
(Viecelli) Department of Nephrology, Princess Alexandra Hospital,
Brisbane, Australia
(Viecelli) Australasian Kidney Trials Network, University of Queensland,
Brisbane, Australia
(Craig) College of Medicine and Health, Flinders University, SA, Adelaide,
Australia
(Sautenet) Department of Nephrology and Clinical Immunology, Tours
University, Tours, France
(Sautenet) Department of Nephrology-Hypertension, Dialysis, Renal
Transplantation, Tours Hospital, Tours, France
(Sautenet) ToursFrance
(Herrington) Nuffield Department of Population Health, University of
Oxford, Medical Research Council Population Health Research Unit, Clinical
Trial Service Unit and Epidemiological Studies Unit, Oxford, United
Kingdom
(Herzog) Department of Medicine, Division of Cardiology, Hennepin County
Medical Center, University of Minnesota, MN, Minneapolis, United States
(Jafar) Program in Health Services and Systems Research, Duke-NUS Graduate
Medical School, Singapore
(Jafar) Department of Renal Medicine, Singapore General Hospital,
Singapore
(Jafar) Department of Medicine, Section of Nephrology, Aga Khan
University, Karachi, Pakistan
(Jardine) George Institute for Global Health, NSW, Sydney, Australia
(Jardine) Concord Repatriation General Hospital, NSW, Sydney, Australia
(Krane, Wanner) Department of Medicine I, Division of Nephrology,
University Hospital, Wurzburg, Germany
(Levin) Division of Nephrology, University of British Columbia, Vancouver,
Canada
(Malyszko) Department of Nephrology, Dialysis and Internal Medicine Warsaw
Medical University, Warsaw, Poland
(Rocco) Wake Forest School of Medicine, Section on Nephrology,
Winston-Salem, United States
(Strippoli) Department of Emergency and Organ Transplantation, University
of Bari, Bari, Italy
(Strippoli) Medical Scientific Office, Diaverum Sweden AB, Lund, Sweden
(Strippoli) Diaverum Academy, Bari, Italy
(Tonelli) Department of Medicine, Division of Nephrology, University of
Calgary, AB, Calgary, Canada
(Wang) Department of Medicine, Queen Mary Hospital, University of Hong
Kong, Hong Kong, China
(Zannad) Universite de Lorraine, Inserm CIC 1433 and INI-CRCT, CHU, Nancy,
France
(Winkelmayer) Selzman Institute for Kidney Health, Section of Nephrology,
Baylor College of Medicine, TX, Houston, United States
(Wheeler) Department of Renal Medicine, University College London, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiovascular disease (CVD) is a major contributor to
morbidity and mortality in people on hemodialysis (HD). Cardiovascular
outcomes are reported infrequently and inconsistently across trials in HD.
This study aimed to identify the priorities of patients/caregivers and
health professionals (HPs) for CVD outcomes to be incorporated into a core
outcome set reported in all HD trials. METHOD(S): In an international
online survey, participants rated the absolute importance of 10
cardiovascular outcomes (derived from a systematic review) on a 9-point
Likert scale, with 7-9 being critically important. The relative importance
was determined using a best-worst scale. Likert means, medians and
proportions and best-worst preference scores were calculated for each
outcome. Comments were thematically analyzed. RESULT(S): Participants
included 127 (19%) patients/caregivers and 549 (81%) HPs from 53
countries, of whom 530 (78%) completed the survey in English and 146 (22%)
in Chinese. All but one cardiovascular outcome ('valve replacement') was
rated as critically important (Likert 7-9) by all participants; 'sudden
cardiac death', 'heart attack', 'stroke' and 'heart failure' were all
rated at the top by patients/caregivers (median Likert score 9).
Patients/caregivers ranked the same four outcomes as the most important
outcomes with mean preference scores of 6.2 (95% confidence interval
4.8-7.5), 5.9 (4.6-7.2), 5.3 (4.0-6.6) and 4.9 (3.6-6.3), respectively.
The same four outcomes were ranked most highly by HPs. We identified five
themes underpinning the prioritization of outcomes: 'clinical equipoise
and potential for intervention', 'specific or attributable to HD',
'severity or impact on the quality of life', 'strengthen knowledge and
education', and 'inextricably linked burden and risk'. CONCLUSION(S):
Patients and HPs believe that all cardiovascular outcomes are of critical
importance but consistently identify sudden cardiac death, myocardial
infarction, stroke and heart failure as the most important outcomes to be
measured in all HD trials. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of ERA-EDTA. All rights
reserved.

<66>
Accession Number
633106231
Title
Meta-analysis of clinical outcomes comparing use of transesophageal
echocardiography versus no transesophageal echocardiogram during
transcatheter aortic valve replacement.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2020
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2020. United States. 13 (SUPPL 1) (no pagination),
2020. Date of Publication: May 2020.
Author
Okereke I.M.; Fatima U.; Khan M.U.; Khalid M.; Opoku-Asare I.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transesophageal echocardiography (TEE) is routinely used for
intraoperative guidance for TAVR procedures. TAVR is also done with
minimal imaging or no TEE guidance (minimal imaging approach). The
clinical benefits of intraprocedure TEE during TAVR compared to minimal
imaging approach has not been well established. Aim(s): To perform a
meta-analysis of available trials comparing effectiveness of
intraprocedural TEE versus minimal imaging approach during TAVR procedure.
Hypothesis: TAVR with intraprocedural TEE is associated with better
clinical outcomes compared with minimalist imaging approach.
 Method(s): 8 retrospective observational studies were identified via
a comprehensive literature search that incorporated Embase, MEDLINE, and
CENTRAL. Each selected study reported on the comparison between TAVR
performed with TEE guidance or with no TEE (minimalist strategy) during
the procedure. Studies were screened for risk of bias using a quality
assessment tool. Outcomes studied included all-cause mortality,
cardiovascular mortality, paravalvular leak as defined by the original
trial, readmission within 30 days, stroke, myocardial infarction (MI) ,
and acute kidney injury (AKI). For each outcome, estimates were pooled and
reported as a risk ratio with 95% confidence interval (CI).
 Result(s): A total of 2057 patients were divided into TEE (n=1115)
vs. non-TEE (n=942) cohorts. No significant difference was seen between
TEE vs non-TEE groups in reducing cardiovascular mortality (RR=2.06
[95%CI: 0.91- 4.67], p=0.08 ), all cause mortality (RR= 0.63 [95% CI:
0.21- 1.90], p=0.41), readmission within 30 days (RR=0.49 [95% CI:
0.06-4.41], p=0.53), stroke (RR=0.97 [95% CI: 0.27- 3.47], p=0.96), MI
(RR=0.92 [95%CI: 0.26- 3.29], p=0.90), and AKI (RR=1.24 [95% CI:
0.16-9.35], p=0.83). A significant increase in paravalvular leak was
observed within the non-TEE group (RR=1.19 [95% CI: 1.01-1.39], p=0.04) in
comparison to the TEE group. Conclusion(s): TEE guidance during TAVR
is associated with reduced paravalvular leak when compared with minimal
imaging approach. No other clinical difference was observed between the
two approaches. Further studies are needed to validate these findings.

<67>
Accession Number
633105913
Title
Meta-analysis comparing the results of transcatheter aortic valve
replacement in severe aortic stenosis in patients with and without prior
chest radiation therapy.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2020
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2020. United States. 13 (SUPPL 1) (no pagination),
2020. Date of Publication: May 2020.
Author
Zafar M.R.; Miller T.W.; Alkhawlani T.; Alkhafaji N.; Shahbaz A.; Mustafa
S.F.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Cancer survivors with symptomatic severe aortic stenosis and a
history of chest radiation therapy represent a complex and challenging
cohort for management. Here we present a meta-analysis and systematic
review of the literature regarding the outcomes of transcatheter aortic
valve replacement (TAVR) in patients with prior chest radiation therapy
(XRT group) versus patients without prior chest radiation therapy (non-XRT
group). Following a comprehensive database search filtering through 129
relevant studies 4 most robust studies were included for in-depth
analysis. Methods and Results: Articles were screened from Scopus,
PubMed, and Cochrane Library databases (updated through December 31,
2019). Rev Man 5.3 was used for data analysis. We included four
observational studies (Dijos M et al: 2015, Bouleti C et al: 2016, Agrawal
N et al: 2019, Gajanana D et al: 2019). The primary outcomes measured are
30-day mortality, cardiovascular mortality, major bleeding event,
post-procedural pacemaker implantation, and strokes / transient ischemic
attacks.The pooled random effect analysis demonstrated no statistically
significant difference in two groups undergoing TAVR in 30-day mortality,
cardiovascular mortality, postprocedure major bleed event, and permanent
pacemaker implantation with an odds ratio of 1.44 [95% CI: 0.57, 3.67];
1.42 [95% CI: 0.50, 4.04]; 1.29 [95% CI: 0.71, 2.34] and 1.31 [95% CI:
0.61, 2.81] respectively.Statistically significant higher risk of
stoke/transient ischemic attacks in non-XRT group as compare to XRT group
undergoing transcatheter aortic valve replacement with an odds ratio of
2.34 [95% CI: 1.18, 4.62]. Conclusion(s): XRT group undergoing TAVR
have few post-procedural complications, with rates similar to those of
non-XRT group undergoing TAVR. Although, our study showed statistically
significant higher risk of stroke/ transient ischemic attach in non-XRT
group as compare to XRT group. Larger, multicenter studies are needed to
assess long-term outcomes of TAVR patients with prior chest radiation.

<68>
Accession Number
633105878
Title
Implementation of appropriate use criteria for cardiology tests and
procedures: A systematic review and meta-analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2020
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2020. United States. 13 (SUPPL 1) (no pagination),
2020. Date of Publication: May 2020.
Author
Winchester D.E.; Merritt J.; Waheed N.; Norton H.; Manja V.; Shah N.R.;
Helfrich C.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The American College of Cardiology appropriate use criteria
(AUC) provide clinicians with evidence-informed recommendations for
cardiac care. Adopting AUC into clinical workflows may present challenges,
and there may be specific implementation strategies that are effective in
promoting effective use of AUC. We sought to assess the effect of
implementing AUC in clinical practice. Method(s): We conducted a
meta-analysis of studies found through a systematic search of the MEDLINE,
Web of Science, Cochrane, or CINAHL databases. Peer-reviewed manuscripts
published after 2005 that reported on the implementation of AUC for a
cardiovascular test or procedure were included. The analysis protocol was
submitted a priori to the PROSPERO international prospective register of
systematic reviews. We used a structured data extraction spreadsheet for
elements such as study design, implementation strategy, and primary
outcome. Result(s): We included 18 studies, the majority used
pre/post cohort designs; few (n=3) were randomized trials. Most studies
used multiple strategies (n=12, 66.7%). Education was the most common
individual intervention strategy (n=13, 72.2%), followed by audit &
feedback (n=8, 44.4%) and computerized physician order entry (CPOE) (n=6,
33.3%). No studies reported on formal use of stakeholder engagement or
'nudges'. In meta-analysis, AUC implementation was associated with a
reduction in inappropriate/rarely appropriate care (odds ratio 0.62, 95 %
confidence interval 0.49- 0.78). Funnel plot suggests the possibility of
publication bias. Conclusion(s): We found most published efforts to
implement AUC succeeded at reducing inappropriate/rarely appropriate care.
Studies rarely explored how or why the implementation strategy was
effective. Because interventions were infrequently tested in isolation, it
is difficult to make observations about their effectiveness as stand-alone
strategies.

<69>
Accession Number
633105829
Title
Non-st-elevation myocardial infarction: Admissions, rate, and timing of
revascularization in the United States.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2020
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2020. United States. 13 (SUPPL 1) (no pagination),
2020. Date of Publication: May 2020.
Author
Case B.C.; Yerasi C.; Wang Y.; Forrestal B.J.; Hahm J.; Dolman S.;
Weintraub W.S.; Waksman R.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: This study aimed to evaluate non-ST-elevation myocardial
infarction (NSTEMI) rates, revascularization timing, and mortality rates
using the Nationwide Readmissions Database (NRD). Background(s):
Clinical trials have shown improved outcomes with reduced mortality with
an early invasive approach for NSTEMI. However, real-world data are
lacking. Method(s): The study cohort was obtained from the 2016 NRD
dataset. We used the International Classification of Diseases, Tenth
Revision, to 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.
 Result(s): Our analysis included 748,463 NSTEMI admissions in 2016.
Of these admissions, 50.1% (374,988) underwent diagnostic angiography with
38.9% (253,492) revascularized: 77.6% (197,945) PCI and 22.4% (57,254)
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 (Figure 1). Conclusion(s):
Our study shows that mortality generally increased as revascularization
was delayed, while sicker patients tended to have longer delays until
revascularization. However, confounding variables prevent definite causal
attribution. Randomized clinical trials are needed to evaluate whether
very early revascularization (<90 minutes) is associated with improved
long-term outcomes in high-risk patients.

<70>
Accession Number
633105461
Title
Use of administrative claims to ascertain outcomes in randomized clinical
trials for transcatheter aortic valve replacement: findings from the
extending trialbased evaluations of medical therapies using novel sources
of data (extend) study.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2020
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2020. United States. 13 (SUPPL 1) (no pagination),
2020. Date of Publication: May 2020.
Author
Strom J.B.; Zhao Y.; Faridi K.F.; Butala N.; Tamez H.; Valsdottir L.;
Brennan J.M.; Shen C.; Popma J.J.; Kazi D.S.; Yeh R.W.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Administrative claims may be a low cost alternative to
traditional clinical trial event adjudication, but whether claims data can
validly substitute for adjudicated outcomes to reproduce trial-derived
treatment effects is uncertain. Method(s): We linked adults aged >=65
in the US CoreValve Pivotal High Risk (HiR) and Surgical or Transcatheter
Aortic Valve Replacement in Intermediate-Risk Patients (SURTAVI) Trials to
100% Medicare inpatient claims (2003-2016). Primary (i.e. death and
stroke) and secondary trial endpoints (i.e. bleeding, acute kidney injury,
cardiogenic shock, pacemaker implantation, aortic valve reintervention,
myocardial infarction, and major adverse cerebrovascular and
cardiovascular events [MACCE]) were compared across treatment arms (i.e.
TAVR vs. SAVR) using outcomes derived from claims at 1 year (HiR) or 2
years (SURTAVI), and compared with trial-adjudicated outcomes.
 Result(s): Among 600 linked HiR participants (linkage rate 80.0%),
the rate of the trial's primary endpoint of all-cause mortality at 1-year
was 13.7% for TAVR and 16.4% for SAVR using both trial data (HR 0.84, 95%
CI 0.65-1.09; p = 0.33) and claims data (HR 0.86, 95% CI 0.66-1.11; p =
0.34; interaction p-value = 0.80) (Figure). Among 1004 linked SURTAVI
trial participants (linkage rate 60.5%), the trial's primary endpoint of
combined death and stroke at 2-years was 12.9% for TAVR and 13.1% for SAVR
using trial data (HR 1.08, 95% CI 0.79-1.48, p = 0.90), and 11.3% for TAVR
and 12.5% for SAVR patients using claims data (HR 1.02, 95% CI 0.73-1.41,
p = 0.58; interaction pvalue = 0.89) (Figure). Procedural secondary
outcomes (e.g., aortic valve reintervention, pacemaker implantation) were
more concordant between trials and claims than non-procedural outcomes
(e.g. bleeding, cardiogenic shock, stroke). Acute kidney injury,
myocardial infarction, and MACCE outcomes were also concordant between
data types. Conclusion(s): In both HiR and SURTAVI trials,
ascertainment of trial primary endpoints using claims reproduced both the
magnitude and direction of treatment effect observed in adjudicated event
data. Non-fatal secondary outcomes displayed variable concordance. Use of
claims to substitute for adjudicated outcomes in traditional trial
treatment comparisons may be a valid alternative for some endpoints.

<71>
Accession Number
633105309
Title
Gender differences and outcome after isolated coronary artery bypass
grafting: A systematic review and meta-analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2020
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2020. United States. 13 (SUPPL 1) (no pagination),
2020. Date of Publication: May 2020.
Author
Deo S.V.; Chang C.; Neudecker M.; Raza S.; Altarabsheh S.; Cmolik B.L.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Coronary artery bypass grafting (CABG) is among the most
common surgical procedures performed in developed nations. In spite of
this, studies have reported gender differences in clinical outcome exist
in outcome after CABG. As data is limited to observational studies, we
performed a systematic review to compare CABG outcome between women and
men. Method(s): We queried databases (1 January 2000 - 20 January
2020) to identify original studies comparing CABG outcome between genders.
Our aims were (1) to study differences in risk factors (2) to compare
early mortality, stroke, wound infection, acute kidney injury rates and
long-term survival. We pooled risk ratios (RR) with inverse variance
weighting and a random effects model for early end-points. Long-term
survival was compared using incident risk ratios (IRR). All results are
presented with their 95% confidence interval. Result(s): We
identified 24 observational studies (1,647,035 women and 3,642,057 men)
from 13 countries for inclusion. At time of CABG, women were older (66 vs
64 years; p < 0.01) and had a higher incidence of diabetes mellitus (32%
vs 24%; p < 0.01), congestive heart failure (12% vs 8%; p < 0.01) and
emergent surgery (13% vs 9%). More men had left ventricular dysfunction
(12% vs 10%; p < 0.01) and prior myocardial infarction (40% vs 37%). Women
received fewer grafts (mean difference -0.22; p < 0.01) and arterial
conduits (OR 0.51, CI 0.41 - 0.63; p < 0.01). Early mortality (4% vs 2.5%,
OR 1.5, CI 1.4 - 1.7) and stroke rates (OR 1.9, CI 1.3 - 1.7) were higher
in women. Sternal wound infection (4.7% vs 2%) was also higher in women
(OR 1.8, CI 1.1 - 1.8, p = 0.001). Acute kidney injury (OR 1.1, p = 0.09)
and long-term survival (IRR 0.9, CI 0.8 - 1.2, p = 0.9) are comparable.
 Conclusion(s): Our meta-analysis demonstrates that women and men have
significant differences in presentation and outcome after CABG. While
women have worse post-operative outcomes, longterm survival is comparable.

<72>
Accession Number
633116879
Title
Impact of atrial fibrillation on outcomes of patients treated by
transcatheter mitral valve repair: A systematic review and meta-analysis.
Source
Medicine. 99 (40) (pp e22195), 2020. Date of Publication: 02 Oct 2020.
Author
Sun F.; Liu H.; Zhang Q.; Lu F.; Zhan H.; Zhou J.
Institution
(Sun, Lu, Zhan, Zhou) Department of Cardiovascular Surgery
(Liu) Department of Emergency
(Zhang) Department of Endovascular Surgery, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Conflicting data have been reported related to the impact of
atrial fibrillation (AF) on outcomes after transcatheter mitral valve
repair with MitraClip (MC) implantation. In this study, we assessed the
prognosis of MC-treated patients according to the presence of pre-existing
AF. METHOD(S): Randomized and observational studies reporting
outcomes of pre-existing AF or sinus rhythm in patients undergoing MC
treatment were identified with an electronic search. Outcomes of interest
were short-and long-term mortality, stroke, bleeding, rehospitalization,
myocardial infarction (MI), cardiogenic shock, acute procedure success,
the hospital stay, and the number of Clips implanted. RESULT(S):
Eight studies (8466 individuals) were eligible. Compared to sinus rhythm,
long-term mortality, the risk of bleeding, rehospitalization, and longer
hospital stay were significantly higher in AF groups, whereas similar
correlations were found in the analysis of other outcomes.
 CONCLUSION(S): AF may be related with worse outcomes in patients
undergoing MC implantation, including long-term mortality, major bleeding,
and rehospitalization. AF should be taken into account when referring a
patient for MC treatment.

<73>
Accession Number
633116220
Title
Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet
Resection Versus Leaflet Preservation on Functional Mitral Stenosis: The
CAMRA CardioLink-2 Study.
Source
Circulation. 142 (14) (pp 1342-1350), 2020. Date of Publication: 06 Oct
2020.
Author
Chan V.; Mazer C.D.; Ali F.M.; Quan A.; Ruel M.; de Varennes B.E.; Gregory
A.J.; Bouchard D.; Whitlock R.P.; Chu M.W.A.; Dokollari A.; Mesana T.;
Bhatt D.L.; Latter D.A.; Zuo F.; Tsang W.; Teoh H.; Juni P.; Leong-Poi H.;
Verma S.
Institution
(Chan, Ruel, Mesana) Division of Cardiac Surgery, University of Ottawa
Heart Institute, ON
(Chan) School of Epidemiology, Public Health and Preventive Medicine
(V.C.), University of Ottawa, ON, Canada
(Mazer) Department of Anesthesia (C.D.M.), Li Ka Shing Knowledge Institute
of St. Michael's Hospital, ON, Toronto, Canada
(Mazer) Department of Anesthesiology and Pain Medicine (C.D.M.),
University of Toronto, ON, Canada
(Mazer) Department of Physiology (C.D.M.), University of Toronto, ON,
Canada
(Ali, Tsang, Leong-Poi) Division of Cardiology (F.M.A., Li Ka Shing
Knowledge Institute of St. Michael's Hospital, ON, Toronto, Canada
(Quan, Dokollari, Latter, Teoh, Verma) Division of Cardiac Surgery (A.Q.,
A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada
(Ruel) Department of Cellular and Molecular Medicine (M.R.), University of
Ottawa, ON, Canada
(de Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University Health Center, QC, Montreal
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
Cumming School of Medicine, University of Calgary, AB
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
Libin Cardiovascular Institute of Alberta, Calgary, Canada
(Bouchard) Department of Cardiac Surgery, Montreal Heart Institute and
Universite de Montreal, QC
(Whitlock) Division of Cardiac Surgery (R.P.W.), McMaster University, ON,
Hamilton, Canada
(Whitlock) Department of Health Research Methods, McMaster University, ON,
Hamilton, Canada
(Whitlock) Population Health Research Institute, ON, Hamilton, Bermuda
(Chu) Division of Cardiac Surgery, London Health Sciences Center,
University of Western Ontario
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston
(Latter, Verma) Department of Surgery (D.A.L., University of Toronto, ON,
Canada
(Zuo, Juni) Applied Health Research Centre (F.Z., Li Ka Shing Knowledge
Institute of St. Michael's Hospital, ON, Toronto, Canada
(Tsang, Juni, Leong-Poi) Department of Medicine (W.T., University of
Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism (H.T.), Li Ka Shing
Knowledge Institute of St. Michael's Hospital, ON, Toronto, Canada
(Juni) Institute of Health Policy, Management, Evaluation (P.J.),
University of Toronto, ON, Canada
(Verma) Department of Pharmacology and Toxicology (S.V.), University of
Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Equipoise exists between the use of leaflet resection and
preservation for surgical repair of mitral regurgitation caused by
prolapse. We therefore performed a randomized, controlled trial comparing
these 2 techniques, particularly in regard to functional mitral stenosis.
 METHOD(S): One hundred four patients with degenerative mitral
regurgitation surgically amenable to either leaflet resection or
preservation were randomized at 7 specialized cardiac surgical centers.
Exclusion criteria included anterior leaflet or commissural prolapse, as
well as a mixed cause for mitral valve disease. Using previous data, we
determined that a sample size of 88 subjects would provide 90% power to
detect a 5-mmHg difference in mean mitral valve gradient at peak exercise,
assuming an SD of 6.7 mm with a 2-sided test with alpha=5% and 10% patient
attrition. The primary end point was the mean mitral gradient at peak
exercise 12 months after repair. RESULT(S): Patient age, proportion
who were female, and Society of Thoracic Surgeons risk score were
63.9+/-10.4 years, 19%, and 1.4+/-2.8% for those who were assigned to
leaflet resection (n=54), and 66.3+/-10.8 years, 16%, and 1.9+/-2.6% for
those who underwent leaflet preservation (n=50). There were no
perioperative deaths or conversions to replacement. At 12 months, moderate
mitral regurgitation was observed in 3 subjects in the leaflet resection
group and 2 in the leaflet preservation group. The mean transmitral
gradient at 12 months during peak exercise was 9.1+/-5.2 mmHg after
leaflet resection and 8.3+/-3.3 mmHg after leaflet preservation (P=0.43).
The participants had similar resting peak (8.3+/-4.4 mmHg versus 8.4+/-2.6
mmHg; P=0.96) and mean resting (3.2+/-1.9 mmHg versus 3.1+/-1.1 mmHg;
P=0.67) mitral gradients after leaflet resection and leaflet preservation,
respectively. The 6-minute walking distance was 451+/-147 m for those in
the leaflet resection versus 481+/-95 m for the leaflet preservation group
(P=0.27). CONCLUSION(S): In this adequately powered randomized trial,
repair of mitral prolapse with either leaflet resection or leaflet
preservation was associated with similar transmitral gradients at peak
exercise at 12 months postoperatively. These data do not support the
hypothesis that a strategy of leaflet resection (versus preservation) is
associated with a risk of functional mitral stenosis. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier NCT02552771.

<74>
Accession Number
633116151
Title
Long-Term Results of the RAPCO Trials.
Source
Circulation. 142 (14) (pp 1330-1338), 2020. Date of Publication: 06 Oct
2020.
Author
Buxton B.F.; Hayward P.A.; Raman J.; Moten S.C.; Rosalion A.; Gordon I.;
Seevanayagam S.; Matalanis G.; Benedetto U.; Gaudino M.; Hare D.L.
Institution
(Buxton, Raman, Moten, Seevanayagam, Matalanis) Department of Cardiac
Surgery, Austin Hospital, J.R., S.C.M., S.S., Melbourne
(Buxton, Hayward, Raman, Rosalion, Seevanayagam, Matalanis, Hare) Faculty
of Medicine, Dentistry and Health Sciences (B.F.B., J.R., S.S., G.M.,
University of Melbourne, Australia
(Gordon) Statistical Consulting Centre (I.G.), University of Melbourne,
Australia
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
(U.B.)
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY
(Hare) Department of Cardiology, Austin Health, Melbourne
Publisher
NLM (Medline)
Abstract
BACKGROUND: An internal thoracic artery graft to the left anterior
descending artery is standard in coronary bypass surgery, but controversy
exists on the best second conduit. The RAPCO trials (Radial Artery Patency
and Clinical Outcomes) were designed to compare the long-term patency of
the radial artery (RA) with that of the right internal thoracic artery
(RITA) and the saphenous vein (SV). METHOD(S): In RAPCO-RITA (the
RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or
<60 years of age if they had diabetes mellitus) were randomized to receive
RA or free RITA graft on the second most important coronary target. In
RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients >=70
years of age (or >=60 years of age if they had diabetes mellitus) were
randomized to receive RA or SV graft. The primary outcome was 10-year
graft failure. Long-term mortality was a nonpowered coprimary end point.
The main analysis was by intention to treat. RESULT(S): In the RA
versus RITA comparison, the estimated 10-year patency was 89% for RA
versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI,
0.23-0.88]). Ten-year patient survival estimate was 90.9% in the RA arm
versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI,
0.30-0.95]). In the RA versus SV comparison, the estimated 10-year patency
was 85% for the RA versus 71% for the SV (hazard ratio for graft failure,
0.40 [95% CI, 0.15-1.00]), and 10-year patient survival estimate was 72.6%
for the RA group versus 65.2% for the SV group (hazard ratio for
mortality, 0.76 [95% CI, 0.47-1.22]). CONCLUSION(S): The 10-year
patency rate of the RA is significantly higher than that of the free RITA
and better than that of the SV. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT00475488.

<75>
Accession Number
2006970404
Title
Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic
review and meta-analysis of the impact of GDHT on post-operative pulmonary
complications.
Source
Perioperative Medicine. 9 (1) (no pagination), 2020. Article Number: 30.
Date of Publication: 01 Dec 2020.
Author
Dushianthan A.; Knight M.; Russell P.; Grocott M.P.W.
Institution
(Dushianthan, Knight, Russell, Grocott) General Intensive Care Unit,
University Hospital Southampton NHS Foundation Trust, Southampton SO16
6YD, United Kingdom
(Dushianthan, Grocott) Anaesthesia Perioperative and Critical Care
Research Group, Southampton NIHR Biomedical Research Centre, University
Hospital Southampton/University of Southampton, Southampton, United
Kingdom
(Dushianthan, Grocott) Clinical and Experimental Sciences, Faculty of
Medicine, University of Southampton, Southampton, United Kingdom
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative goal-directed haemodynamic therapy (GDHT),
defined as the administration of fluids with or without inotropes or
vasoactive agents against explicit measured goals to augment blood flow,
has been evaluated in many randomised controlled trials (RCTs) over the
past four decades. Reported post-operative pulmonary complications
commonly include chest infection or pneumonia, atelectasis, acute
respiratory distress syndrome or acute lung injury, aspiration
pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the
substantial clinical literature in this area, it remains unclear whether
their incidence is reduced by GDHT. This systematic review aims to
determine the effect of GDHT on the respiratory outcomes listed above, in
surgical patients. Method(s): We searched the Cochrane Central
Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical
trial registries up until January 2020. We included all RCTs reporting
pulmonary outcomes. The primary outcome was post-operative pulmonary
complications and secondary outcomes were specific pulmonary complications
and intra-operative fluid input. Data synthesis was performed on Review
Manager and heterogeneity was assessed using I2 statistics.
 Result(s): We identified 66 studies with 9548 participants reporting
pulmonary complications. GDHT resulted in a significant reduction in total
pulmonary complications (OR 0.74, 95% CI 0.59 to 0.92). The incidence of
pulmonary infections, reported in 45 studies with 6969 participants, was
significantly lower in the GDHT group (OR 0.72, CI 0.60 to 0.86).
Pulmonary oedema was recorded in 23 studies with 3205 participants and was
less common in the GDHT group (OR 0.47, CI 0.30 to 0.73). There were no
differences in the incidences of pulmonary embolism or acute respiratory
distress syndrome. Sub-group analyses demonstrated: (i) benefit from GDHT
in general/abdominal/mixed and cardiothoracic surgery but not in
orthopaedic or vascular surgery; and (ii) benefit from fluids with
inotropes and/or vasopressors in combination but not from fluids alone.
Overall, the GDHT group received more colloid (+280 ml) and less
crystalloid (-375 ml) solutions than the control group. Due to clinical
and statistical heterogeneity, we downgraded this evidence to moderate.
 Conclusion(s): This systematic review and meta-analysis suggests that
the use of GDHT using fluids with inotropes and/or vasopressors, but not
fluids alone, reduces the development of post-operative pulmonary
infections and pulmonary oedema in general, abdominal and cardiothoracic
surgical patients. This evidence was graded as moderate. PROSPERO registry
reference: CRD42020170361. Copyright © 2020, The Author(s).

<76>
Accession Number
2005213500
Title
Transcaval access to the abdominal aorta: Indications of interest to
surgeons and a comprehensive literature review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 781-788), 2020.
Date of Publication: 2020.
Author
Lozano Sanchez F.S.; Gonzalez I.C.; Calvo R.S.; Sanchez Fernandez P.L.
Institution
(Lozano Sanchez, Calvo) Department of Angiology and Vascular Surgery,
Hospital Universitario de Salamanca, Salamanca, Spain
(Gonzalez, Sanchez Fernandez) Department of Cardiology, Hospital
Universitario de Salamanca, Salamanca, Spain
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
We performed a review of the literature (until August 01, 2019) on the
occasion of the first transcaval approach for transcatheter aortic valve
implantation in our hospital. This review focuses mainly on the
indications of this alternative access route to the aorta. It may be
useful for vascular surgeons in selected cases, such as the treatment of
endoleaks after endovascular aneurysm repair and thoracic endovascular
aneurysm repair. We describe historical aspects of transcaval access to
the aorta, experimental studies, available case series and outcomes.
Finally, we summarize the most significant technical aspects of this
little-known access. Copyright © 2020, Sociedade Brasileira de
Cirurgia Cardiovascular. All rights reserved.

<77>
Accession Number
2005213499
Title
The current management of cardiac tumours: A comprehensive literature
review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 770-780), 2020.
Date of Publication: 2020.
Author
Joshi M.; Kuma S.; Noshirwani A.; Harky A.
Institution
(Joshi, Noshirwani) Countess of Chester Hospital, Chester, United Kingdom
(Kuma) Aintree University Hospital, Liverpool, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To understand the current evidence and guidelines behind the
appropriate management of cardiac tumours. Method(s): A comprehensive
electronic literature search has been performed in major databases
-PubMed, Embase, Scopus, Ovid, and Google Scholar. All articles that
discussed all different forms of cardiac tumours, their clinical
presentation, diagnosis, and management methods have been critically
appraised in this narrative review. Result(s): All relevant studies
have been summarized in appropriate sections within our review. Cardiac
tumours are rare but can be catastrophic and life-threatening if not
identified and managed on timely manner. Utilization of all the available
imaging methods can be of equivocal importance, relevant to each cardiac
tumour. Surgical excision is the ultimate treatment method, however
histopathological results can guide the adjunct treatment.
 Conclusion(s): Early detection of cardiac tumours has significant
effect on planning the method of intervention. Technological advancements
and increased availability of imaging modalities have enabled earlier and
more accurate detection of these tumours. Novel medical therapies,
recommendations for screening, and operative techniques have all
contributed to overall improving knowledge of these tumours and ultimately
patient outcomes. Copyright © 2020, Sociedade Brasileira de
Cirurgia Cardiovascular. All rights reserved.

<78>
Accession Number
2005213483
Title
Comparison between the effects of bretschneiders htk solution and cold
blood cardioplegia on systemic endothelial functions in patients who
undergo coronary artery bypass surgery: A prospective randomized and
controlled trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 634-643), 2020.
Date of Publication: 2020.
Author
Mercan I.; Dereli Y.; Topcu C.; Tanyeli O.; Isik M.; Gormus N.; Ozturk
E.Y.
Institution
(Mercan) Department of Cardiovascular Surgery, Konya Training and Research
Hospital, Konya, Turkey
(Dereli, Tanyeli, Isik, Gormus) Department of Cardiovascular Surgery,
Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
(Topcu) Department of Biochemistry, Necmettin Erbakan University, Meram
Faculty of Medicine, Konya, Turkey
(Ozturk) Department of Public Health, Necmettin Erbakan University, Meram
Faculty of Medicine, Konya, Turkey
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To investigate the effects of Bretschneiders
histidine-tryptophan-ketoglutarate (HTK) solution and cold blood
cardioplegia on systemic endothelial functions. Method(s): A total of
50 patients who underwent isolated coronary artery bypass surgery between
March 2018 and May 2018 were randomly divided into two groups -group 1
(Bretschneiders HTK solution, n=25) and group 2 (cold blood cardioplegia,
n=25). Data related to the indicators of endothelial dysfunction were
recorded. Flow-mediated dilation was measured together with the assessment
of the values of endothelin-1, von Willebrand factor, and asymmetric
dimethylarginine to identify endothelial dysfunction. Then, the two groups
were compared regarding these values. Result(s): The most significant
result of our study was that the endothelin-1 level was significantly
higher in group 2 than in group 1 (P<0.001). The value of flow-mediated
dilation was found to increase to a lesser degree on the postoperative
days compared to the value at the day of admission in group 1 (P=0.002 and
P=0.030, respectively). Conclusion(s): Cardiopulmonary bypass leads
to endothelial dysfunction. Our results revealed that Bretschneiders HTK
solution causes less severe endothelial injury than cold blood
cardioplegia. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<79>
Accession Number
2008328279
Title
Late-onset native valve endocarditis caused by Corynebacterium
kroppenstedtii.
Source
International Journal of Infectious Diseases. 101 (pp 1-3), 2020. Date of
Publication: December 2020.
Author
Roth S.; Ehrlich T.; Schafers H.-J.; Becker S.L.
Institution
(Roth, Becker) Institute of Medical Microbiology and Hygiene, Saarland
University, Homburg, Germany
(Ehrlich, Schafers) Department of Thoracic and Cardiovascular Surgery,
Saarland University, Homburg, Germany
Publisher
Elsevier B.V. ( Netherlands)
Abstract
Corynebacterium kroppenstedtii is an emerging cause of granulomatous
mastitis and recurrent breast abscesses in women, but data on its clinical
relevance in nongynecological disease conditions are limited. Here, we
report the first case of a late-onset endocarditis of a native aortic
valve in a 73-year-old male patient who presented with symptomatic aortic
insufficiency. Echocardiography and cardiac computed tomography revealed
the perforation of the noncoronary cusp and a large perivalvular abscess
cavity. Hence, the surgical replacement of the aortic valve and aortic
root were performed. Intraoperatively obtained tissue specimens grew C.
kroppenstedtii and the patient made a full recovery after a 6-week course
of antibiotic treatment. We briefly review the literature pertaining to
antimicrobial susceptibility patterns of C. kroppenstedtii and available
treatment recommendations. Our report calls for further studies to assess
the role of this bacterium as a causative agent of infections other than
granulomatous mastitis. Copyright © 2020 The Author(s)

<80>
Accession Number
633124546
Title
NGS of microRNAs involved in cardioprotection induced by sevoflurane
compared to propofol in myocardial revascularization surgery: The
ACDHUVV-16 Clinical Trial.
Source
Current medicinal chemistry. (no pagination), 2020. Date of Publication:
01 Oct 2020.
Author
Orriach J.L.G.; Belmonte J.J.E.; Aliaga M.R.; Fernandez A.R.; Capitan
M.J.R.; Munoz G.Q.; Ponferrada A.R.; Torres J.A.; Santiago-Fernandez C.;
Gonzalez E.M.; Navarro M.R.; Bautista R.; Maldonado J.G.; Garrido-Sanchez
L.; Manas J.C.
Institution
(Orriach, Aliaga, Capitan, Ponferrada, Navarro, Manas) Department of
Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Malaga,
Spain
(Belmonte, Fernandez, Munoz) Instituto de Investigacion Biomedica de
Malaga (IBIMA), Malaga, Spain
(Torres, Santiago-Fernandez) Unidad de Gestion Clinica de Endocrinologia y
Nutricion, Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Gonzalez) Department of Anesthesia, Hospital Universitario, Spain
(Bautista, Maldonado) Genomic and Ultrasecuenciation. Supercomputacion y
Bioinno-vacion Center, Malaga University, Malaga, Spain
(Garrido-Sanchez) CIBER Fisiopatologia de la Obesidad y
Nutricion-CIBEROBN, Instituto de Salud, Carlos III, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND: Numerous studies have demonstrated that halogenated agents
elicit myocardial conditioning effects when adminis-tered perioperatively
in cardiac surgery. Recent evidence has been published of the benefits of
maintaining exposure to halogenated agents during the early postoperative
period. The enzymatic mechanisms by which this beneficial effect is
exerted were explained recently. OBJECTIVE(S): Our study was
performed to investigate whether this phenomenon is mediated by either the
activation or suppression of miR-NAs targeted by halogenated anesthetics.
 METHOD(S): A double-blind, two-stage trial was conducted. The results
of the first stage of the trial are presented in this paper. The sample
was composed of patients undergoing off-pump myocardial revascularization
surgery. Patients were randomized to receive either sevoflu-rane [S] or
propofol [P] during the intraoperative and early postoperative period
(during the first six hours after the intervention). Hemody-namics (heart
rate, blood pressure, central venous pressure, cardiac index, systolic
volume index, LVEF) and myocardial enzymes (troponin I) were monitored at
six hour intervals during the first 48 hours. In the first stage of the
trial, blood was drawn for gene sequencing from eight patients (four per
group) at baseline and at 24 h. In the second stage of the study, a qPCR
analysis was performed of the miRNAs identified as significant by gene
sequencing. Levels of cardioprotective enzymes (serine/threonine protein
kinase (Akt), tumor necrosis fac-tor alpha (TNFalpha), extracellular
regulated protein kinase (ERK 1/2), and caspase 3) were measured to assess
their role in myocardial condi-tioning pathways. The purpose was to
identify the miRNAs that play a major role in myocardial conditioning
induced by halogenated agents. Concentrations of cardioprotective enzymes
were higher in patients who received sevoflurane, as compared to patients
who were administered propofol. RESULT(S): NGS differences were
observed between baseline and 24-h values in the two study groups. In
group P, miRNA 197-3p was over-expressed, whereas miRNAs 4443 and 1294,
708-3p were underexpressed. In group S, miRNAs 615-3p, 4466, 29, 937-3p,
636, 197-3P, 184, 4685, 296-3p, 147b, 3199, 6815, 1294 and 3176 were
underexpressed; whereas 708-3p was overexpressed. qPCR showed significant
variations in miRNAs 197-3p, 4443, 708-3p and 1294 in the P group, and in
miRNAs 937-3p, 636, 197-3p, 296-3p and 708-3p in the S group.
 CONCLUSION(S): In the P Group, changes in the expression of some
miRNAs were associated with lower concentrations of the enzymes in-volved
in myocardial pre- and postconditioning. In contrast, in Group S,
variations in miRNAs were associated with the activation of medi-ators of
anesthetic-induced pre- and post-conditioning, a reduction in cell
apoptosis, and a decrease in caspase and TnBF alpha concentra-tions.
Changes in these miRNAs were associated with a better prognosis in
patients with ischemic heart disease. The main limitation of this study
will be overcome in the second stage of the trial, where the specific role
of each miRNA will be determined. Copyright© Bentham Science
Publishers; For any queries, please email at epub@benthamscience.net.

<81>
Accession Number
633123223
Title
Longitudinal course of depressive, anxiety and post-traumatic stress
disorder symptoms after heart surgery: a meta-analysis of 94 studies.
Source
Psychosomatic medicine. (no pagination), 2020. Date of Publication: 05 Oct
2020.
Author
Rosson S.; Monaco F.; Miola A.; Cascino G.; Stubbs B.; Correll C.U.; Firth
J.; Ermis C.; Perrotti A.; Marciello F.; Carvalho A.F.; Brunoni A.R.;
Fusar-Poli P.; Fornaro M.; Gentile G.; Granziol U.; Pigato G.; Favaro A.;
Solmi M.
Institution
(Rosson, Miola, Favaro, Solmi) Neurosciences Department, University of
Padua, Padua, Italy
(Monaco) Department of Mental Health, Residential Eating Disorder Unit
'Mariconda', ASL Salerno, Salerno, Italy
(Cascino, Marciello) Department of Medicine, Surgery and Dentistry 'Scuola
Medica Salernitana', Section of Neurosciences, University of Salerno,
Salerno, Italy
(Stubbs) Physiotherapy Department, South London and Maudsley National
Health Services Foundation Trust, London, United Kingdom
(Stubbs) Department of Psychological Medicine, Institute of Psychiatry,
Psychology, Neuroscience, King's College London, London, United Kingdom
(Correll) Zucker Hillside Hospital, Department of Psychiatry, Northwell
Health, NY, United States
(Correll) Zucker School of Medicine at Hofstra/Northwell, Department of
Psychiatry and Molecular Medicine, Hempstead, NY, USA
(Correll) The Feinstein Institute for Medical Research, Center for
Psychiatric Neuroscience, Manhasset, NY, USA
(Correll) Charite Universitatsmedizin Berlin, Department of Child and
Adolescent Psychiatry, Berlin, Germany
(Firth) Division of Psychology and Mental Health, Faculty of Biology,
Medicine and Health, University of Manchester, Manchester, United Kingdom
(Firth) NICM Health Research Institute, School of Science and Health,
University of Western Sydney, Sydney, Australia
(Firth) Centre for Youth Mental Health, University of Melbourne,
Melbourne, Australia
(Ermis) Department of Child and Adolescent Psychiatry, Dokuz Eylul
University
(Perrotti) Cardio-Thoracic Surgery Department, University Hospital Jean
Minjoz, Boulevard Fleming, Besancon 25000, France
(Perrotti) EA 3920, University of Franche-Comte, 25000, Besancon, France
(Carvalho) Centre for Addiction and Mental Health (CAMH), ON, Toronto,
Canada
(Carvalho) Department of Psychiatry, University of Toronto, ON, Toronto,
Canada
(Brunoni) Department of Psychiatry and Psychotherapy, University Hospital,
LMU Munich, Munich, Germany
(Brunoni) Service of Interdisciplinary Neuromodulation, Department of
Psychiatry, Laboratory of Neurosciences (LIM-27) and National Institute of
Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry,
University of Sao Paulo, Sao Paulo, Brazil
(Brunoni) Departamento de Clinica Medica, Faculdade de Medicina da USP,
Hospital Universitario, Sao Paulo, Brazil
(Fusar-Poli, Solmi) Early Psychosis: Interventions and Clinical-detection
(EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry,
Psychology& Neuroscience, King's College London, London, United Kingdom
(Fusar-Poli) OASIS service, South London and Maudsley NHS Foundation
Trust, London, United Kingdom
(Fusar-Poli) Department of Brain and Behavioral Sciences, University of
Pavia, Pavia, Italy
(Fusar-Poli) National Institute for Health Research, Maudsley Biomedical
Research Centre, South London and Maudsley NHS Foundation Trust, London,
United Kingdom
(Fornaro) Neuroscience, Reproductive Science and Odontostolmatology,
Section of Psychiatry, University School of Medicine Federico II, Naples,
Italy
(Gentile, Favaro, Solmi) Neuroscience Centre, University of Padua, Padua,
Italy
(Granziol) Department of General Psychology, University of Padua, Padua,
Italy
(Pigato) Padua University Hospital, Psychiatry Unit, Padua, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To analyze the longitudinal course of depression, anxiety and
post-traumatic stress disorder (PTSD) symptoms in cardiac patients
following heart surgery (HS). METHOD(S): We conducted a systematic
review and random-effects meta-analysis of cohort studies on patients
undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and
at least 30 days after. Subgroup and meta-regression analyses,
investigation of publication bias, and quality assessment were undertaken.
 RESULT(S): We included 94 studies relating to 15,561 patients. HS
included coronary artery bypass graft surgery, valve replacement,
implantable cardioverter defibrillator placement, left ventricular assist
device placement, heart transplantation, and other types of HS. Across
studies, symptoms of depression (g=0.32; 95%CI=0.25,0.39; p<0.001) and
anxiety improved after HS (g=0.52; 95%CI=0.43,0.62; p<0.001), while PTSD
symptoms worsened (g=-0.42; 95%CI=-0.80,-0.04; p=0.032). The reduction of
depression and anxiety levels was more pronounced for patients with
underlying coronary artery disease and heart failure, and persisted over
one year after HS, whereas the increase in PTSD symptoms returned to
baseline after 6 months. Depression improvement was inversely associated
with older age, diabetes, hypertension and dyslipidemia, and positively
with baseline heart failure. No additional clinical or demographic
variables were associated with the course of anxiety symptoms. Quality of
included studies was low overall. Publication bias was non-significant.
 CONCLUSION(S): Depressive and anxiety symptoms improve over one-year
after HS, while PTSD symptoms might worsen. Older patients, those with
metabolic comorbidities, valve disease or ventricular arrhythmias are at
higher risk for continued depressive and anxiety symptoms and should be
monitored closely.

<82>
Accession Number
2004805145
Title
Patients who do not complete cardiac rehabilitation have an increased risk
of cardiovascular events during long-term follow-up.
Source
Netherlands Heart Journal. 28 (9) (pp 460-466), 2020. Date of Publication:
01 Sep 2020.
Author
Sunamura M.; ter Hoeve N.; van den Berg-Emons R.J.G.; Boersma E.;
Geleijnse M.L.; van Domburg R.T.
Institution
(Sunamura, ter Hoeve) Capri Cardiac Rehabilitation, Rotterdam, Netherlands
(ter Hoeve, van den Berg-Emons) Department of Rehabilitation Medicine,
Erasmus University Medical Center, Rotterdam, Netherlands
(Boersma, Geleijnse, van Domburg) Department of Cardiology, Thorax center,
Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: Cardiac rehabilitation (CR) has favourable effects on
cardiovascular mortality and morbidity. Therefore, it might reasonable to
expect that incomplete CR participation will result in suboptimal patient
outcomes. Method(s): We studied the 914 post-acute coronary syndrome
patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE)
trial. They all started a 'standard' CR programme, with physical exercises
(group sessions) twice a week for 12 weeks. Incomplete CR was defined as
participation in <75% of the scheduled exercise sessions. Patients were
followed-up for 2.7 years, and the incidence of cardiac events was
recorded. Major adverse cardiac events (MACE) included all-cause
mortality, non-fatal myocardial infarction and coronary revascularisation.
 Result(s): A total of 142 (16%) patients had incomplete CR. They had
a higher incidence of MACE than their counterparts who completed CR (11.3%
versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval
[CI] 1.47-5.26). Furthermore, the incidence of any cardiac event,
including MACE and coronary revascularisation, was higher (20.4% versus
11.0%, aHR 1.54; 95% CI 0.98-2.44). Patients with incomplete CR were more
often persistent smokers than those who completed CR (31.7% versus 11.5%),
but clinical characteristics were similar otherwise. Conclusion(s):
Post-ACS patients who did not complete a 'standard' 12-week CR programme
had a higher incidence of adverse cardiac events during long-term
follow-up than those who completed the programme. Since CR is proven
beneficial, further research is needed to understand the reasons why
patients terminate prematurely. Copyright © 2020, The Author(s).

<83>
Accession Number
2004769897
Title
Predictive Value for Outcome and Evolution of Geriatric Parameters after
Transcatheter Aortic Valve Implantation.
Source
Journal of Nutrition, Health and Aging. 24 (6) (pp 598-605), 2020. Date of
Publication: 01 Jun 2020.
Author
Roca F.; Durand E.; Eltchaninoff H.; Chassagne P.
Institution
(Roca, Chassagne) Department of Geriatric medicine, Rouen University
Hospital, Rouen F 76000, France
(Durand, Eltchaninoff) Department of Cardiology, Rouen University
Hospital, FHU REMOD-VHF, Rouen F 76000, France
(Roca) Service de Medecine Geriatrique, CHU de Rouen, Rouen Cedex 76031,
France
Publisher
Serdi-Editions
Abstract
Objectives: To identify parameters of comprehensive geriatric assessment
(CGA) CGA including ABCDEF score, a multidomain frailty assessment,
associated with poor outcome after TAVI and to assess the evolution of CGA
parameters at 6-months follow-up. Design(s): One-year monocentric
prospective cohort study. Setting(s): Departments of geriatric
medicine and cardiology in Rouen University Hospital, Normandy, France.
 Participant(s): All patients over 70, selected for TAVI by a
multidisciplinary "heart team". Measurements: 8-areas CGA was performed
before TAVI and at 6-months follow-up. Poor outcome was defined as
decrease in 1 BADL or unplanned readmission at 6 months or death within
the first year after TAVI. Geriatric characteristics associated with poor
outcome were assessed by logistic regression with surgical scores as
bivariable. Geriatric characteristics were compared between baseline and
6-months follow-up. Result(s): 114 patients (mean age 85.8+/-5.3
years) were included. Mean EuroSCORE was 19.1+/-10.6%. Poor outcome
occurred in 57(50.0%) patients. Loss of one BADL (OR: 1.66,
95CI[1.11-2.48]), decrease in IADL (OR: 1.41, 95CI[1.14-1.74]), in
plasmatic albumin (OR: 1.10, 95CI[1.01-1.20]), in MMSe (OR: 1.13,
95CI[1.02-1.26]), low walking speed (OR: 1.53, 95CI[1.01-2.33]) and ABCDEF
score >=2 (OR: 1.63, 95CI[1.09-2.42]) were independently associated with
poor outcome. In survivors with complete follow-up (n=80), most geriatric
parameters were maintained 6 months after TAVI, but IADL decreased
(5.6+/-1.9 to 4.9+/-2.2, p<0.001). MMSe increased in patients with
previous cognitive impairments whereas it decreased in those without
(p<0.001). Conclusion(s): CGA parameters are independently associated
with poor outcome after TAVI. These parameters, but IADL, are maintained
at 6 months and course of the MMSe depends on previous cognitive
status. Copyright © 2020, Serdi and Springer-Verlag International
SAS, part of Springer Nature.

<84>
Accession Number
2004253870
Title
The prognostic value of late gadolinium enhancement in myocarditis and
clinically suspected myocarditis: systematic review and meta-analysis.
Source
European Radiology. 30 (5) (pp 2616-2626), 2020. Date of Publication: 01
May 2020.
Author
Yang F.; Wang J.; Li W.; Xu Y.; Wan K.; Zeng R.; Chen Y.
Institution
(Yang, Wang, Li, Xu, Zeng, Chen) Department of Cardiology, West China
Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan
610041, China
(Wan) Department of Geriatrics, West China Hospital, Sichuan University,
Chengdu, Sichuan Province 610041, China
(Chen) Center of Rare diseases, West China Hospital, Sichuan University,
Chengdu, Sichuan Province 610041, China
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Objective: To evaluate the prognostic value of late gadolinium enhancement
(LGE) in myocarditis and clinically suspected myocarditis. Method(s):
The study was registered in PROSPERO (CRD42019144976). A systematic search
of PubMed, Ovid Medline, Embase, Web of Science and the Cochrane Central
Register of Controlled Trials was completed. Major adverse cardiac event
(MACE) was defined as the combination of all-cause mortality or
cardiovascular death, resuscitated cardiac arrest, heart transplantation,
appropriate implantable cardioverter-defibrillator shock,
rehospitalisation following a cardiac event and recurrent acute
myocarditis. Combined outcome was defined as the combination of all
adverse events. Pooled odds ratios (ORs) and 95% confidence intervals
(CIs) were calculated to evaluate the prognostic value of LGE.
 Result(s): Eight articles including 1319 patients (mean age, 38.8 +/-
12.9 years) were included in the meta-analysis. The study showed that
positive LGE was strongly associated with an increased risk of combined
outcome (pooled OR, 5.85; 95% CI, 2.88 to 11.86; p < 0.001) and of MACE
(pooled OR, 4.57; 95% CI, 2.18 to 9.59; p < 0.001). Additionally, in a
subgroup analysis with mean ejection fraction (EF) point of 50%, the
pooled ORs for the combined outcome were 6.46 for left ventricular EF
(LVEF) > 50% and 7.90 for LVEF <= 50%, and the pooled ORs for MACE were
9.03 and 3.45, respectively. After 3 years of follow-up, the worse
outcomes occurred mainly in patients with positive LGE.
 Conclusion(s): Positive LGE is a powerful prognosticator of adverse
outcome in myocarditis and clinically suspected myocarditis, irrespective
of LVEF. Key Points: * Forty-four percent to 100% of myocarditis patients
have positive late gadolinium enhancement. * Positive LGE was a powerful
prognosticator of adverse outcome in myocarditis and clinically suspected
myocarditis, irrespective of LVEF. * LGE-CMR is important tool for risk
stratification in myocarditis and clinically suspected
myocarditis. Copyright © 2020, European Society of Radiology.

<85>
Accession Number
2004242524
Title
Effect of single-dose crystalloid cardioplegic agent compared to bloody
cardioplegic agent in cardiac surgery in children with tetralogy of
fallot.
Source
ARYA Atherosclerosis. 16 (1) (pp 24-32), 2020. Date of Publication: 2020.
Author
Bigdelian H.; Hosseini A.
Institution
(Bigdelian) Department of Cardiac Surgery, School of Medicine, Cardiac
Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Hosseini) Department of Cardiac Surgery, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (E-mail: crc@mui.ac.ir)
Abstract
BACKGROUND: Cardioplegia is one of the main post-operative cardiac
protective factors widely used in recent decades in the form of
crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose
of this study was to compare the effect of a crystalloid cardioplegic
agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in
pediatric cardiac surgery among children with Tetralogy of Fallot (TOF).
 METHOD(S): This study was performed on 60 children with TOF, who were
candidates for heart repair surgery. The participants were randomly
divided into two groups of crystalloid cardioplegic agent and bloody
cardioplegic agent. Operative outcomes such as required time for onset of
heart arrest, duration of returning to normal heart rhythm, and
cardiopulmonary bypass (CPB) time, and operative complications were
compared between the two groups. RESULT(S): The duration of returning
to normal heart rhythm (50.43 +/- 10.93 seconds vs. 43.03 +/- 16.35
seconds; P = 0.044) and duration of inotropy (80.40 +/- 27.14 hours vs.
63.20 +/- 26.91 hours; P = 0.017) were significantly higher in the DN
group compared to the St. Thomas group. However, there were no significant
differences between the two groups in terms of heart arrest time,
cross-clamp time, CPB time, supplementary lasix time, duration of
intubation, and intensive care unit (ICU) and hospital length of stay
(LOS) (P > 0.050). CONCLUSION(S): The use of St. Thomas cardioplegic
solution was more effective in reducing the duration of returning to
normal heart rhythm and inotropy compared with DN cardioplegic agent, and
a single dose of these two cardioplegic agents can keep the mean cardiac
arrest duration within the range of 50-70 minutes. It seems that the use
of St. Thomas cardioplegic solution can be suggested in pediatric heart
surgery. Copyright © 2020, Isfahan University of Medical
Sciences(IUMS). All rights reserved.

<86>
Accession Number
2002073987
Title
Coronary Embolism: A Systematic Review.
Source
Cardiovascular Revascularization Medicine. 21 (3) (pp 367-374), 2020. Date
of Publication: March 2020.
Author
Lacey M.J.; Raza S.; Rehman H.; Puri R.; Bhatt D.L.; Kalra A.
Institution
(Lacey) Department of Medicine, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Raza) Harrington Heart & Vascular Institute, University Hospitals
Cleveland Medical Center, Case Western Reserve University School of
Medicine, Cleveland, United States
(Rehman) Methodist DeBakey Heart & Vascular Center, Houston Methodist
Hospital, Houston, TX, United States
(Puri, Kalra) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Coronary embolism is a rare and potentially fatal phenomenon
that occurs primarily in patients with valvular heart disease and atrial
fibrillation. There is a lack of consensus regarding the diagnosis,
treatment, and management of coronary embolism, leaving management at the
discretion of the treating physician. Through this review, we aim to
establish a better understanding of coronary embolism, and to identify
treatment options - invasive and non-invasive - that may be used to manage
coronary embolism. Methods and Results: Our systematic review
included 147 documented cases of coronary embolism from case reports and
case series. The average age of our population was 54.2 +/- 17.6 years.
The most common causes of coronary embolism included infective
endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart
valve thrombosis (16.3%). Initial presentation was indistinguishable from
an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the
diagnosis required a high level of suspicion and evaluation with
angiography. Treatment strategies included, but were not limited to,
thrombectomy, thrombolysis, balloon angioplasty and stent placement.
Myocardial dysfunction on echocardiography was observed in over 80% of
patients following coronary embolism. "Good outcomes" were reported in
68.7% of case reports and case series, with a mortality rate of 12.9%.
 Conclusion(s): Coronary embolism is an under-recognized etiology of
myocardial infarction with the potential for significant morbidity and
mortality. To improve outcomes, physicians should strive for early
diagnosis and intervention based on the underlying etiology. Thrombectomy
may be considered with the goal of rapid restoration of coronary
flow. Copyright © 2019 Elsevier Inc.

<87>
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).

<88>
Accession Number
2005618475
Title
The importance of heart rate in isoprenaline-induced takotsubo-like
cardiac dysfunction in rats.
Source
ESC Heart Failure. 7 (5) (pp 2690-2699), 2020. Date of Publication: 01 Oct
2020.
Author
Ali A.; Redfors B.; Lundgren J.; Alkhoury J.; Oras J.; Gan L.-M.; Omerovic
E.
Institution
(Ali, Redfors, Lundgren, Alkhoury, Omerovic) Department of Molecular and
Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University
of Gothenburg, Gothenburg, Sweden
(Redfors, Gan, Omerovic) Department of Cardiology, Institute of Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Oras) Department of Anesthesiology and Intensive Care Medicine, Institute
of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Gan) Early Clinical Development, Cardiovascular Renal and Metabolic
Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Gothenburg, Sweden
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims: Takotsubo syndrome (TS) is an acute cardiac syndrome characterized
by regional myocardial akinesia that cannot be attributed to a culprit
lesion in coronary arteries. Cardiac overstimulation by catecholamines in
the setting of stress is implicated in the pathogenesis of TS. While
catecholamine-induced alterations in cardiac contractility have been
studied as part of the causal pathway in TS, the importance of
catecholamine-mediated tachycardia has not been studied. Our aim was to
explore whether the reduction in heart rate, either by pharmacological
suppression of the sinoatrial node with ivabradine or by surgical
induction of third-degree atrioventricular block, prevents
isoprenaline-induced TS-like akinesia in an experimental animal model.
 Methods and Results: We used 142 female Sprague-Dawley rats in two
separate protocols. The TS-like phenotype was induced by an
intraperitoneal bolus dose of isoprenaline (ISO) 50 mg/kg. In the first
protocol, we randomized 54 rats to ivabradine 10 min before ISO (IVAB1),
ivabradine 10 min after ISO (IVAB2), or saline 10 min before ISO
(CONTROL). In the second protocol, we randomized 88 rats to surgically
induced complete heart block (CHB) or sham operation (CTRL) 10 min before
the administration of ISO. All drugs were administered intraperitoneally.
We recorded heart rate and blood pressure invasively in the right carotid
artery. Cardiac morphology and function were evaluated by high-resolution
echocardiography (VisualSonics 770 VEVO, Toronto, Ontario, Canada) 90 min
after ISO injection. IVAB1 and IVAB2 rats had significantly lower heart
rate and less pronounced TS-like cardiac dysfunction than CONTROL. CHB
rats had a lower (54%) heart rate, and no animal developed left
ventricular akinesia. In the first protocol, the CONTROL group had a
median degree of akinesia of 10.2 [inter-quartile range (IQR) 0.0-18.6].
The IVAB1 group showed a median of akinesia of 0% (IQR 0.0-0.0, P ' 0.001
vs. CONTROL). In the IVAB2 group, 5% had TS-like dysfunction (P = 0.001).
Ejection fraction was higher in both the IVAB1 (92%, IQR 89-95) and IVAB2
groups (93%, IQR 87-96) than in the CONTROL group (78%, IQR 63-87, P '
0.05). In the second protocol, the median degree of akinesia in the CTRL
group was 21.9% (IQR 8.9-24.6). In the CHB group, no rat developed
akinesia (median 0%; IQR 0.0-0.0, P ' 0.001 vs. CONTROL). Ejection
fraction was higher in the CHB group (90%, IQR 87-92) than in the CTRL
group (51%, IQR 87-92, P ' 0.05). Conclusion(s): Isoprenaline-induced
TS-like cardiac dysfunction can be prevented by lowering heart rate.
Tachycardia may be an important part of the causal pathway in
TS. Copyright © 2020 The Authors. ESC Heart Failure published by
John Wiley & Sons Ltd on behalf of the European Society of Cardiology

<89>
Accession Number
2005253149
Title
Thromboelastometry and a hemostasis management system are most beneficial
for guiding hemostatic therapy in cardiac surgery patients with a
EuroSCORE II of >=1.83%: a randomized controlled two-step trial.
Source
Journal of Anesthesia. 34 (5) (pp 666-674), 2020. Date of Publication: 01
Oct 2020.
Author
Kodaka M.; Ichikawa J.; Ando K.; Komori M.
Institution
(Kodaka, Ichikawa, Ando, Komori) Department of Anesthesiology and
Intensive Care, Tokyo Women's Medical University Medical Center East,
Arakawa-ku, Tokyo 116-8567, Japan
Publisher
Springer Japan (E-mail: orders@springer.jp)
Abstract
Purpose: We evaluated the efficacy of hemostatic therapy based on
point-of-care (POC) testing in patients undergoing cardiac surgery.
 Method(s): This was a single-institution, prospective, randomized,
double-blinded study. In step 1, 90 patients scheduled for elective
cardiac surgery underwent complete blood count and fibrinogen measurements
at baseline, after cardiopulmonary bypass (CPB) initiation (CPB start),
just after CPB end, and in the intensive care unit (ICU). In step 2, 72
patients scheduled for elective cardiac surgery underwent conventional
laboratory coagulation tests (control group) or POC coagulation tests (POC
group). Transfusions were prepared using the fibrinogen and platelet
values at mainly "CPB start" for the control group, and using the ROTEM
values at mainly "CPB end" for the POC group. Consequently, the step 2
patients were divided into high- and low-risk subgroups based on the
EuroSCORE II by logistic regression analysis; transfusion data and
bleeding volumes were compared between the control and POC groups within
the high- and low-risk subgroups. Result(s): In step 1, all blood
components were significantly decreased at CPB start compared with
baseline, and platelet and fibrinogen levels remained almost constant from
CPB start to end. In step 2, the transfusion rates and perioperative
bleeding volumes did not significantly differ between the control and POC
groups. Subgroup analysis suggested that only the high-risk subgroup
significantly differed regarding perioperative red blood cell transfusion
and total bleeding volume in the ICU. Conclusion(s): POC testing is
beneficial for cardiac surgery patients with a EuroSCORE II of
>=1.83%. Copyright © 2020, Japanese Society of Anesthesiologists.

<90>
Accession Number
2005165531
Title
Emergence delirium is associated with increased postoperative delirium in
elderly: a prospective observational study.
Source
Journal of Anesthesia. 34 (5) (pp 675-687), 2020. Date of Publication: 01
Oct 2020.
Author
Zhang Y.; He S.-T.; Nie B.; Li X.-Y.; Wang D.-X.
Institution
(Zhang, He, Wang) Departments of Anesthesiology and Critical Care
Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing
100034, China
(Nie) Departments of Anesthesiology, Fujian Provincial Cancer Hospital,
Fuzhou, Fujian, China
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Wang) Department of Outcomes Research Consortium, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Springer Japan (E-mail: orders@springer.jp)
Abstract
Background: The clinical significance of emergence delirium remains
unclear. The purpose of this study was to investigate the association
between emergence delirium and postoperative delirium in elderly after
general anesthesia and surgery. Method(s): This prospective
observational study was done in a tertiary hospital in Beijing, China.
Elderly patients (65-90 years) who underwent major noncardiac surgery
under general anesthesia and admitted to the postanesthesia care unit
(PACU) after surgery were enrolled. Emergence delirium was assessed with
the Confusion Assessment Method for the Intensive Care Unit during PACU
stay. Postoperative delirium was assessed with the Confusion Assessment
Method during the first 5 postoperative days. The association between
emergence delirium and postoperative delirium was analyzed with a
multivariable logistic regression model. Result(s): A total of 942
patients were enrolled and 915 completed the study. Emergence delirium
developed in 37.0% (339/915) of patients during PACU stay; and
postoperative delirium developed in 11.4% (104/915) of patients within the
first 5 postoperative days. After adjusted confounding factors, the
occurrence of emergence delirium is independently associated with an
increased risk of postoperative delirium (OR 1.717, 95% CI 1.078-2.735, P
= 0.023). Patients with emergence delirium stayed longer in PACU and
hospital after surgery, and developed more non-delirium complications
within 30 days. Conclusion(s): Emergence delirium in elderly admitted
to the PACU after general anesthesia and major surgery is independently
associated with an increased risk of postoperative delirium. Patients with
emergence delirium had worse perioperative outcomes. Chinese Clinical
Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734 Copyright ©
2020, The Author(s).

<91>
Accession Number
2004223380
Title
Medium-Term Bioresorbable Scaffold Outcomes Utilising Data From an
Australian Clinical Quality Registry.
Source
Heart Lung and Circulation. 29 (10) (pp 1440-1448), 2020. Date of
Publication: October 2020.
Author
Dawson L.P.; Dinh D.; Montalto S.; Duffy S.J.; Dick R.; Gutman J.; Brennan
A.; Carruthers H.; Doyle J.; Stub D.; Whitbourn R.; Cox N.; Cooke J.;
Gooley R.; Hiew C.; Reid C.; Lefkovits J.
Institution
(Dawson, Montalto, Lefkovits) Department of Cardiology, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Dinh, Duffy, Brennan, Carruthers, Doyle, Stub, Reid, Lefkovits)
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Vic, Australia
(Duffy, Stub) Department of Cardiovascular Medicine, The Alfred Hospital,
Melbourne, Vic, Australia
(Dick) Department of Cardiology, Epworth Hospital, Melbourne, Vic,
Australia
(Gutman, Whitbourn) Department of Cardiology, St Vincent's Private
Hospital, Melbourne, Vic, Australia
(Whitbourn) Department of Cardiology, St Vincent's Hospital, Melbourne,
Vic, Australia
(Cox) Department of Cardiology, Western Health, Melbourne, Vic, Australia
(Cooke) Department of Cardiology, Eastern Health, Melbourne, Vic,
Australia
(Gooley) Department of Cardiology, Monash Health, Melbourne, Vic,
Australia
(Hiew) Department of Cardiology, University Hospital, Geelong, Vic,
Australia
Publisher
Elsevier Ltd
Abstract
Background: Bioresorbable scaffolds (BRS) are a novel technology in
coronary intervention. However, recent trials demonstrate higher rates of
device failure compared to contemporary drug-eluting stents. This study
sought to utilise a clinical quality registry to assess the medium-term
safety of the Abbott Absorb BRS (Abbott Vascular, Santa Clara, CA, USA),
in an Australian context. Method(s): A prospective, observational
study of 192 BRS percutaneous coronary interventions (PCI) compared to
31,773 non-BRS PCIs entered in the Victorian Cardiac Outcomes Registry
from 2013 to 2017. The main outcome measure was patient-oriented composite
endpoint (POCE) events comprising all-cause mortality, any myocardial
infarction (MI), and any revascularisation. Result(s): Bioresorbable
scaffolds patients (mean age 61.6+/-10.5 years, 79% male) were younger,
had less comorbidity, less prior PCI, fewer ST elevation myocardial
infarction (STEMI) presentations, lower rates of multi-lesion disease and
more adjuvant devices compared to non-BRS PCI (all p<0.01). All-cause
mortality was 2.1%, myocardial infarction (MI) 2.1%, scaffold thrombosis
3.1% and any revascularisation 14.1% (mean follow-up 27.4+/-8.9 months).
POCE events occurred in 11.5% at 1 year and 16.9% at 2 years, comparable
to pooled-trial data. Multivariate predictors of POCE were >1 scaffold
used (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.9-11.4, p<0.01)
and scaffold diameter <=2.5 mm (OR 3.3, 95% CI 1.4-7.6, p=0.02). Over 95%
guideline adherence was achieved in six of eight patient selection
criteria and four of six device deployment criteria. Conclusion(s):
In an Australian setting, BRS were used in non-complex patients. Most
guidelines for use were adhered to and outcomes were comparable to pooled
trial data. Clinical quality registries are effective in assessing novel
treatments and technologies when potential safety concerns
develop. Copyright © 2019 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<92>
Accession Number
2005430186
Title
Perioperative outcomes of robot-assisted vs video-assisted and traditional
open thoracic surgery for lung cancer: A systematic review and network
meta-analysis.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
16 (5) (pp 1-14), 2020. Date of Publication: 01 Oct 2020.
Author
Hu J.; Chen Y.; Dai J.; Zhu X.; Gonzalez-Rivas D.; Jiang G.; Li H.; Zhang
P.
Institution
(Hu, Chen, Dai, Zhu, Gonzalez-Rivas, Jiang, Zhang) Department of Thoracic
Surgery, Shanghai Pulmonary Hospital, Tongji University School of
Medicine, Shanghai, China
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, Coruna, Spain
(Li) Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Background: The superiority of robot-assisted thoracic surgery (RATS) over
video-assisted thoracic surgery (VATS) and thoracotomy remains
controversial for lung cancer. Method(s): A network meta-analysis
(NMA) and pairwise meta-analysis (PMA) were performed to evaluate the
perioperative outcomes using five databases. Result(s): Thirty-two
studies involving 6593 patients were included for analysis. The NMA showed
that RATS had similar operative time, conversion rate to thoracotomy,
number of lymph node, postoperative morbidity, and length of hospital stay
with VATS, except for lower 30-day mortality. Compared with thoracotomy,
longer operative time and shorter hospital stay were observed in RATS, but
no significant difference was observed in number of lymph node,
postoperative morbidity, and 30-day mortality in both NMA and PMA. In
lobectomy/segmentectomy subgroup, all outcomes, except for operative time
of RATS vs VATS and number of lymph node, were similar with overall
analyses. Conclusion(s): RATS had comparable perioperative outcomes
with VATS and open surgery. Copyright © 2020 John Wiley & Sons
Ltd

<93>
Accession Number
2005154469
Title
Synchronous versus staged carotid artery stenting and coronary artery
bypass graft for patients with concomitant severe coronary and carotid
artery stenosis: A systematic review and meta-analysis.
Source
Vascular. 28 (6) (pp 808-815), 2020. Date of Publication: 01 Dec 2020.
Author
Tzoumas A.; Giannopoulos S.; Charisis N.; Texakalidis P.; Kokkinidis D.G.;
Zisis S.N.; Machinis T.; Koullias G.J.
Institution
(Tzoumas) Fourth Department of Surgery, Medical School, Aristotle
University, Thessaloniki, Greece
(Giannopoulos) Division of Cardiology, Rocky Mountain Regional VA Medical
Center, Aurora, CO, United States
(Charisis) Department of Surgery, Stonybrook University, Stonybrook, NY,
United States
(Texakalidis) Department of Neurosurgery, Emory University, Atlanta, GA,
United States
(Kokkinidis) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine New York, NY, United States
(Zisis) Fourth Department of Surgery, National and Kapodistrian University
of Athens, Attikon University Hospital, Athens, Greece
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Coronary artery disease requiring coronary artery bypass graft
(CABG) frequently coexists with critical carotid stenosis. The most
optimized strategy for treating concomitant carotid and coronary artery
disease remains debatable. Objective(s): The aim of this
meta-analysis was to compare synchronous CAS and CABG versus staged CAS
and CABG for patients with concomitant coronary artery disease and carotid
artery stenosis in terms of peri-operative (30-day) and long-term clinical
outcomes. Method(s): This study was performed according to the PRISMA
guidelines. Eligible studies were identified through a search of PubMed,
Scopus and Cochrane database until December 2019. A meta-analysis was
conducted with the use of a random effects model. The I-square statistic
was used to assess heterogeneity. Result(s): Four studies comprising
357 patients were included in this meta-analysis. Patients who were
treated with the synchronous approach had a statistically significant
higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00-13.69;
I2 = 0%) compared tomicron the staged group. Peri-operative
mortality (OR: 4.50; 95% CI: 0.88-23.01; I2 = 0%), myocardial
infarction (MI) (OR: 1.54; 95% CI: 0.18- 13.09; I2 = 0%),
postoperative bleeding (OR: 0.27;95% CI: 0.02-3.12; I2 = 0%),
transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04- 9.20;
I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI:
0.03-4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27;
95% CI: 0.02-3.12; I2 = 0.0%) were similar between the two
groups. Synchronous CAS-CABG and staged CAS followed by CABG were
associated with similar rates of late mortality (OR: 3.75; 95% CI:
0.50-27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01-12.03;
I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84-15.20;
I2 = 0.0%) after a mean follow-up of 47 months.
 Conclusion(s): The simultaneous approach was associated with an
increased risk of 30-day stroke compared to staged CAS and CABG. However,
no statistically significant difference was found in long-term results of
mortality, MI and stroke between the two approaches. Future studies are
warranted to validate our results. Copyright © The Author(s)
2020.

<94>
Accession Number
2004594703
Title
The effect of aromatherapy with rose and lavender on anxiety, surgical
site pain, and extubation time after open-heart surgery: A double-center
randomized controlled trial.
Source
Phytotherapy Research. 34 (10) (pp 2675-2684), 2020. Date of Publication:
01 Oct 2020.
Author
Babatabar Darzi H.; Vahedian-Azimi A.; Ghasemi S.; Ebadi A.; Sathyapalan
T.; Sahebkar A.
Institution
(Babatabar Darzi, Vahedian-Azimi, Ghasemi) Trauma Research Center, Nursing
Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ebadi) Behavioral Sciences Research Center, Life Style Institute, Nursing
Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Sathyapalan) Department of Academic Diabetes, Endocrinology and
Metabolism, Hull York Medical School, University of Hull, Hull, United
Kingdom
(Sahebkar) Halal Research Center of IRI, FDA, Tehran, Iran, Islamic
Republic of
(Sahebkar) Neurogenic Inflammation Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Biotechnology Research Center, Pharmaceutical Technology
Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
To determine the effect of aromatherapy with rose and lavender on the
patient outcomes after open-heart surgery (OHS). In the clinical trial,
patients were randomized to four groups. One group received routine care,
the placebo group received a cotton swab soaked in water and the other two
groups received either a cotton swab containing three drops of rose or
lavender essence (0.2 ml). A total of 160 patients were randomized into
four groups. Intergroup anxiety was not significantly different; however,
the reciprocal time-group effect was significant among the four groups.
The extubation time was significant among the four groups which related to
rose essence group compared with the control group (p <.001) and placebo
group (p =.029). The surgical site pain was significant in the rose
essence and lavender groups compared to the control group. Aromatherapy
can reduce extubation time, surgical site pain severity, and anxiety in
patients undergoing OHS. Copyright © 2020 John Wiley & Sons, Ltd.

<95>
Accession Number
2004443747
Title
Effectiveness of comprehensive cardiac rehabilitation in coronary artery
disease patients treated according to contemporary evidence based
medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II).
Source
European Journal of Preventive Cardiology. 27 (16) (pp 1756-1774), 2020.
Date of Publication: 01 Nov 2020.
Author
Salzwedel A.; Jensen K.; Rauch B.; Doherty P.; Metzendorf M.-I.; Hackbusch
M.; Voller H.; Schmid J.-P.; Davos C.H.
Institution
(Salzwedel, Voller) Department of Rehabilitation Research, University of
Potsdam, Germany
(Jensen, Hackbusch) Institute of Medical Biometry and Informatics (IMBI),
University of Heidelberg, Germany
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Germany
(Doherty) Department of Health Sciences, University of York, United
Kingdom
(Metzendorf) Cochrane Metabolic and Endocrine Disorders Group, Heinrich
Heine University Dusseldorf, Germany
(Schmid) Department of Cardiology, Clinic Barmelweid, Switzerland
(Davos) Cardiovascular Research Laboratory, Academy of Athens, Greece
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: Despite numerous studies and meta-analyses the prognostic
effect of cardiac rehabilitation is still under debate. This update of the
Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and
practice focused approach including only cardiac rehabilitation
interventions based on published standards and core components to evaluate
cardiac rehabilitation delivery and effectiveness in improving patient
prognosis. Design(s): A systematic review and meta-analysis.
 Method(s): Randomised controlled trials and retrospective and
prospective controlled cohort studies evaluating patients after acute
coronary syndrome, coronary artery bypass grafting or mixed populations
with coronary artery disease published until September 2018 were included.
 Result(s): Based on CROS inclusion criteria out of 7096 abstracts six
additional studies including 8671 patients were identified (two randomised
controlled trials, two retrospective controlled cohort studies, two
prospective controlled cohort studies). In total, 31 studies including
228,337 patients were available for this meta-analysis (three randomised
controlled trials, nine prospective controlled cohort studies, 19
retrospective controlled cohort studies; 50,653 patients after acute
coronary syndrome 14,583, after coronary artery bypass grafting 163,101,
mixed coronary artery disease populations; follow-up periods ranging from
9 months to 14 years). Heterogeneity in design, cardiac rehabilitation
delivery, biometrical assessment and potential confounders was
considerable. Controlled cohort studies showed a significantly reduced
total mortality (primary endpoint) after cardiac rehabilitation
participation in patients after acute coronary syndrome (prospective
controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval
(CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI
0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI
0.08-0.48), but the single randomised controlled trial fulfilling the CROS
inclusion criteria showed neutral results. Cardiac rehabilitation
participation was also associated with reduced total mortality in patients
after coronary artery bypass grafting (retrospective controlled cohort
studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial
without fatal events), and in mixed coronary artery disease populations
(retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two
out of 10 controlled cohort studies with neutral results).
 Conclusion(s): CROS II confirms the effectiveness of cardiac
rehabilitation participation after acute coronary syndrome and after
coronary artery bypass grafting in actual clinical practice by reducing
total mortality under the conditions of current evidence-based coronary
artery disease treatment. The data of CROS II, however, underscore the
urgent need to define internationally accepted minimal standards for
cardiac rehabilitation delivery as well as for scientific
evaluation. Copyright © The European Society of Cardiology 2020.

<96>
[Use Link to view the full text]
Accession Number
2004292338
Title
Peripheral versus central extracorporeal membrane oxygenation for
postcardiotomy shock: Multicenter registry, systematic review, and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 160 (5) (pp
1207-1216.e44), 2020. Date of Publication: November 2020.
Author
Mariscalco G.; Salsano A.; Fiore A.; Dalen M.; Ruggieri V.G.; Saeed D.;
Jonsson K.; Gatti G.; Zipfel S.; Dell'Aquila A.M.; Perrotti A.; Loforte
A.; Livi U.; Pol M.; Spadaccio C.; Pettinari M.; Ragnarsson S.; Alkhamees
K.; El-Dean Z.; Bounader K.; Biancari F.; Dashey S.; Yusuff H.; Porter R.;
Sampson C.; Harvey C.; Settembre N.; Fux T.; Amr G.; Lichtenberg A.;
Jeppsson A.; Gabrielli M.; Reichart D.; Welp H.; Chocron S.; Fiorentino
M.; Lechiancole A.; Netuka I.; De Keyzer D.; Strauven M.; Palve K.
Institution
(Mariscalco, El-Dean) Department of Cardiac Surgery, Glenfield Hospital,
University Hospitals of Leicester, Leicester, United Kingdom
(Salsano) Division of Cardiac Surgery, Department of Integrated Surgical
and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Robert Debre
University Hospital, Reims, France
(Saeed) Cardiovascular Surgery, University Hospital of Dusseldorf,
Dusseldorf, Germany
(Jonsson) Department of Cardiac Surgery, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Zipfel) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila) Department of Cardiothoracic Surgery, Munster University
Hospital, Munster, Germany
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Loforte) Department of Cardiothoracic, Transplantation and Vascular
Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
(Livi) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
(Pol) Institute of Clinical and Experimental Medicine, Prague, Czechia
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Pettinari) Department of Cardiovascular Surgery, Ziekenhuis
Oost-Limburgl, Genk, Belgium
(Ragnarsson) Department of Cardiothoracic Surgery, University of Lund,
Lund, Sweden
(Alkhamees) Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
(Bounader) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Biancari) Heart Center, Turku University Hospital and University of
Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background: We hypothesized that cannulation strategy in venoarterial
extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in
the perioperative survival of patients affected by postcardiotomy shock.
 Method(s): Between January 2010 and March 2018, 781 adult patients
receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers
were retrieved from the Postcardiotomy Veno-arterial Extracorporeal
Membrane Oxygenation study registry. A parallel systematic review and
meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through
December 2018 was also accomplished. Result(s): Central and
peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536
(68.6%) patients, respectively. Main indications for the institution
VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart
failure following cardiopulmonary bypass weaning (48%). The doubly robust
analysis after inverse probability treatment weighting by propensity score
demonstrated that central VA-ECMO was associated with greater hospital
mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18),
reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence
interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds
ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review
provided a total of 2491 individuals with postcardiotomy shock treated
with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall
patient population was 66.6% (95% confidence interval, 64.7-68.4%), and
pooled unadjusted risk ratio analysis confirmed that patients undergoing
peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients
undergoing central cannulation (risk ratio, 0.92; 95% confidence interval,
0.87-0.98). Adjustments for important confounders did not alter our
results. Conclusion(s): In patients with postcardiotomy shock treated
with VA-ECMO, central cannulation was associated with greater in-hospital
mortality than peripheral cannulation. Copyright © 2019 The
American Association for Thoracic Surgery

<97>
Accession Number
2003273825
Title
Single- versus multidose cardioplegia in adult cardiac surgery patients: A
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 160 (5) (pp
1195-1202.e12), 2020. Date of Publication: November 2020.
Author
Gambardella I.; Gaudino M.F.L.; Antoniou G.A.; Rahouma M.; Worku B.;
Tranbaugh R.F.; Nappi F.; Girardi L.N.
Institution
(Gambardella, Gaudino, Rahouma, Worku, Tranbaugh, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian
Medical Center, New York, NY, United States
(Gambardella, Antoniou, Worku, Tranbaugh) Department of Cardiothoracic
Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist
Hospital, Brooklyn, NY, United States
(Antoniou) Department of Vascular & Endovascular Surgery, The Royal Oldham
Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
(Antoniou) Division of Cardiovascular Sciences, School of Medical
Sciences, University of Manchester, Manchester, United Kingdom
(Nappi) Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis,
Paris, France
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Objective: To compare outcomes of single (intervention group: del Nido
[DN], and histamine-tryptophan-ketoglutarate) versus multidose (control
group) cardioplegia in the adult cardiac surgery patients. Method(s):
Medical search engines were interrogated to identify relevant randomized
controlled trials and propensity-score matched cohorts. Meta-analysis was
conducted for primary (in-hospital/30-day mortality) and secondary
(ischemic and cardiopulmonary bypass [CPB] times, reperfusion
fibrillation, peak of cardiac enzymes, myocardial infarction) endpoints.
Subgroup analyses were conducted for study design and type of
intervention, and meta-regression for primary outcome included type of
surgery and left ventricular ejection fraction as moderators.
 Result(s): Ten randomized controlled trials and 13 propensity-score
matched cohorts were included, reporting on 5516 patients. Estimates are
expressed as (parameter value [OR, odds ratio; MD, mean difference; SMD,
standardized mean difference]/unit of measure [95% confidence interval], P
value). DN reduced ischemic time (MD, -7.18 minutes [-12.52 to -1.84], P
<.01), CPB time (MD, -10.44 minutes [-18.99 to -1.88], P.01), reperfusion
fibrillation (OR, 0.16 [0.05-0.54], P <.01), and cardiac enzymes (SMD
-0.17 [-0.29, 0.05], P <.01) compared with multidose cardioplegia. None of
these beneficial effects were reproduced by
histamine-tryptophan-ketoglutarate, which instead increased CPB time (MD,
2.04 minutes [0.73-3.37], P <.01) and reperfusion fibrillation (OR, 1.80
[1.20-2.70], P <.01). There was no difference in mortality and myocardial
infarction between single and multidose, independently of type of surgery
or left ventricular ejection fraction. Conclusion(s): DN decreases
operative times, reperfusion fibrillation, and surge of cardiac enzymes
compared with multidose cardioplegia. Copyright © 2019 The
American Association for Thoracic Surgery

<98>
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.

<99>
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.

<100>
Accession Number
2007891817
Title
Implications of Alternative Definitions of Peri-Procedural Myocardial
Infarction After Coronary Revascularization.
Source
Journal of the American College of Cardiology. 76 (14) (pp 1609-1621),
2020. Date of Publication: 6 October 2020.
Author
Gregson J.; Stone G.W.; Ben-Yehuda O.; Redfors B.; Kandzari D.E.; Morice
M.-C.; Leon M.B.; Kosmidou I.; Lembo N.J.; Brown W.M.; Karmpaliotis D.;
Banning A.P.; Pomar J.; Sabate M.; Simonton C.A.; Dressler O.; Kappetein
A.P.; Sabik J.F.; Serruys P.W.; Pocock S.J.
Institution
(Gregson, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone, Ben-Yehuda, Redfors, Leon, Kosmidou, Lembo, Karmpaliotis,
Dressler) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Ben-Yehuda, Redfors, Leon, Kosmidou, Lembo, Karmpaliotis)
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center,
New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Kandzari, Brown) Piedmont Heart Institute, Atlanta, Georgia, United
States
(Morice) Ramsay Generale deSante, Hopital Prive Jacques Cartier, Massy,
France
(Banning) Oxford University Hospitals, Oxford, United Kingdom
(Pomar, Sabate) Hospital Clinic, Barcelona, Spain
(Simonton) PCICHUCK LLC, Charlotte, NC, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) National University of Ireland, Galway (NUIG), Galway, Ireland
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Varying definitions of procedural myocardial infarction (PMI)
are in widespread use. Objective(s): This study sought to determine
the rates and clinical relevance of PMI using different definitions in
patients with left main coronary artery disease randomized to percutaneous
coronary intervention (PCI) versus coronary artery bypass grafting (CABG)
surgery in the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial.
 Method(s): The pre-specified protocol definition of PMI
(PMI<inf>Prot</inf>) required a large elevation of creatine kinase-MB
(CK-MB), with identical threshold for both procedures. The Third Universal
Definition of MI (types 4a and 5) (PMI<inf>UD</inf>) required lesser
biomarker elevations but with supporting evidence of myocardial ischemia,
different after PCI and CABG. For the PMI<inf>UD</inf>, troponins were
used preferentially (available in 49.5% of patients), CK-MB otherwise. The
multivariable relationship between each PMI type and 5-year mortality was
determined. Result(s): PMI<inf>Prot</inf> occurred in 34 of 935
(3.6%) patients after PCI and 56 of 923 (6.1%) patients after CABG
(difference -2.4%; 95% confidence interval [CI]: -4.4% to -0.5%; p =
0.015). The corresponding rates of PMI<inf>UD</inf> were 37 (4.0%) and 20
(2.2%), respectively (difference 1.8%; 95% CI: 0.2% to 3.4%; p = 0.025).
Both PMI<inf>Prot</inf> and PMI<inf>UD</inf> were associated with 5-year
cardiovascular mortality (adjusted hazard ratio [HR]: 2.18 [95% CI: 1.13
to 4.23] and 2.87 [95% CI: 1.44 to 5.73], respectively).
PMI<inf>Prot</inf> was associated with a consistent hazard of
cardiovascular mortality after both PCI and CABG (p<inf>interaction</inf>
= 0.86). Conversely, PMI<inf>UD</inf> was strongly associated with
cardiovascular mortality after CABG (adjusted HR: 11.94; 95% CI: 4.84 to
29.47) but not after PCI (adjusted HR: 1.14; 95% CI: 0.35 to 3.67)
(p<inf>interaction</inf> = 0.004). Results were similar for all-cause
mortality and with varying PMI<inf>UD</inf> biomarker definitions. Only
large biomarker elevations (CK-MB >=10x upper reference limit and troponin
>=70x upper reference limit) were associated with mortality.
 Conclusion(s): The rates of PMI after PCI and CABG vary greatly with
different definitions. In the EXCEL trial, the pre-specified
PMI<inf>Prot</inf> was associated with similar hazard after PCI and CABG,
whereas PMI<inf>UD</inf> was strongly associated with mortality after CABG
but not after PCI. (EXCEL Clinical Trial [EXCEL];
NCT01205776) Copyright © 2020 American College of Cardiology
Foundation

<101>
Accession Number
2007891814
Title
Inhibition of Interleukin-1beta and Reduction in Atherothrombotic
Cardiovascular Events in the CANTOS Trial.
Source
Journal of the American College of Cardiology. 76 (14) (pp 1660-1670),
2020. Date of Publication: 6 October 2020.
Author
Everett B.M.; MacFadyen J.G.; Thuren T.; Libby P.; Glynn R.J.; Ridker P.M.
Institution
(Everett, MacFadyen, Glynn, Ridker) Division of Preventive Medicine,
Department of Medicine, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, United States
(Everett, Libby, Ridker) Division of Cardiovascular Medicine, Department
of Medicine, Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
(Thuren) Novartis Pharmaceutical Corporation, East Hanover, New Jersey,
and Basel, Switzerland
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Inflammation reduction with the interleukin (IL)-1beta
inhibitor canakinumab significantly reduces the first major adverse
cardiovascular event in patients with prior myocardial infarction (MI) and
residual inflammatory risk (high-sensitivity C-reactive protein >= 2
mg/l). However, the effect of canakinumab on the total number of
cardiovascular events, including recurrent events collected after a first
event, is unknown. Objective(s): This study sought to determine
whether randomly allocated canakinumab would reduce the total burden of
serious cardiovascular events. Method(s): We randomized 10,061
patients to placebo or canakinumab 50 mg, 150 mg, or 300 mg once every 3
months and compared the rates of the composite of all serious
cardiovascular events (MI, stroke, coronary revascularization, and
cardiovascular death) in active versus placebo groups. We used negative
binomial regression to account for correlations among repeated events in
the same person and to estimate rate ratios and 95% confidence intervals.
 Result(s): During a median of 3.7 years of follow-up, 3,417 total
serious cardiovascular events occurred in 2,003 individuals among the
10,061 unique patients randomized. Canakinumab reduced the rates of total
serious cardiovascular events, with rates per 100 person-years in the
placebo, 50 mg, 150 mg, and 300 mg canakinumab groups of 10.4, 8.4, 8.3,
and 8.2, respectively. The corresponding rate ratios (95% confidence
intervals) compared with placebo were 0.80 (0.69 to 0.93) for 50 mg, 0.79
(0.68 to 0.92) for 150 mg, and 0.78 (0.67 to 0.91) for 300 mg.
 Conclusion(s): Anti-inflammatory therapy with canakinumab
significantly reduced the total number of cardiovascular events in
patients with prior MI and evidence of residual inflammatory risk.
(Cardiovascular Risk Reduction Study [Reduction in Recurrent Major CV
Disease Events] (CANTOS); NCT01327846 Copyright © 2020 American
College of Cardiology Foundation

<102>
Accession Number
2007444112
Title
Resection following concurrent chemotherapy and high-dose radiation for
stage IIIA non-small cell lung cancer.
Source
Journal of Thoracic and Cardiovascular Surgery. 160 (5) (pp 1331-1345.e1),
2020. Date of Publication: November 2020.
Author
Donington J.S.; Paulus R.; Edelman M.J.; Krasna M.J.; Le Q.-T.;
Suntharalingam M.; Loo B.W.; Hu C.; Bradley J.D.
Institution
(Donington, Paulus) Department of Department of Surgery, University of
Chicago Medicine and Biologic Sciences, Chicago, Ill, United States
(Hu) NRG Oncology Statistics and Data Management Center, Philadelphia, Pa,
United States
(Edelman) Division of Medical Oncology, Department of Medicine, University
of Maryland Medical Center, Baltimore, Md, United States
(Krasna) Department of Surgery, Jersey Shore University Medical Center,
Neptune City, NJ, United States
(Le, Loo) Department of Radiation Oncology, Stanford Cancer Institute,
Stanford, Calif, United States
(Suntharalingam) Department of Radiation Oncology, University of Maryland
School of Medicine, Baltimore, Md, United States
(Hu) Division of Biostatistics and Bioinformatics, Sidney Kimmel
Comprehensive Cancer Center, Johns Hopkins University School of Medicine,
Baltimore, Md, United States
(Bradley) Department of Radiation Oncology, Winship Cancer Institute,
Emory University, Atlanta, Ga, United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Objective: Concern exists regarding surgery after thoracic radiation. We
aimed to assess early results of anatomic resection following induction
therapy with platinum-based chemotherapy and full-dose thoracic radiation
for resectable N2+ stage IIIA non-small cell lung cancer. Method(s):
Two prospective trials were recently conducted by NRG Oncology in patients
with resectable N2+ stage IIIA non-small cell lung cancer with the primary
end point of mediastinal node sterilization following concurrent full-dose
chemoradiotherapy (Radiation Therapy Oncology Group trials 0229 and 0839).
All surgeons demonstrated postinduction resection expertise. Induction
consisted of weekly carboplatin (area under the curve, 2.0) and paclitaxel
(50 mg/m2) and concurrent thoracic radiation 60 Gy (0839)/61.2
Gy (0229) in 30 fractions. Patients in study 0839 were randomized 2:1 to
weekly panitumumab + chemoradiotherapy or chemoradiotherapy alone during
induction. Primary results were similar in all treatment arms and reported
previously. Short-term surgical outcomes are reported here.
 Result(s): One hundred twenty-six patients enrolled; 93 (74%) had
anatomic resection, 77 underwent lobectomy, and 16 underwent extended
resection. Microscopically margin-negative resections occurred in 85
(91%). Fourteen (15%) resections were attempted minimally invasively,
including 2 converted without event. Grade 3 or 4 surgical adverse events
were reported in 26 (28%), 30-day mortality in 4 (4%) and 90-day mortality
in 5 (5%). Patients undergoing extended resection experienced similar
rates of grade 3 or 4 adverse events (odds ratio, 0.95; 95% confidence
interval, 0.42-3.8) but higher 30-day (1.3% vs 18.8%) (odds ratio, 17.54;
95% confidence interval, 1.75-181.8) and 90-day mortality (2.6% vs 18.8%)
(odds ratio, 8.65; 95% confidence interval, 1.3-56.9). Conclusion(s):
Lobectomy was performed safely following full-dose concurrent
chemoradiotherapy in these multi-institutional prospective trials;
however, increased mortality was noted with extended
resections. Copyright © 2020 The American Association for
Thoracic Surgery

<103>
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.

<104>
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.

<105>
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 (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. 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

<106>
Accession Number
2006858932
Title
The venous thromboembolism prophylaxis in patients receiving thoracic
surgery: A systematic review.
Source
Asia-Pacific Journal of Clinical Oncology. (no pagination), 2020. Date of
Publication: 2020.
Author
Wang Q.; Ding J.; Yang R.
Institution
(Wang, Ding, Yang) Department of Thoracic Surgery, The Affiliated Brain
Hospital of Nanjing Medical University (South Branch, Nanjing Chest
Hospital), Nanjing, China
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
Objectives: Venous thromboembolism (VTE) is a significant and preventable
cause of mortality and morbidity in thoracic surgery. It usually deep
venous thromboembolism (DVT) and pulmonary thromboembolism (PE). We
conducted this article to perform a systematic review on prophylaxis of
perioperative VTE in patients undergoing thoracic surgery especially lung
surgery and esophageal surgery and to identify potential areas for future
research. Method(s): The systematic review we conducted included
studies of patients undergoing thoracic surgery especially lung surgery
and esophageal surgery. Result(s): The study identified 2621
references. Finally, 22 trials with a total of 9072 patients were
included. Only six studies declared that they continued a follow-up after
the discharge of the patients. (range: 1-3 months); three studies reported
on major bleeding events as an outcome measure, and the incidence varied
from 0.8% to 1.6%. Total 346 VTEs occurred, and the overall mean risk of
VTE was estimated at 3.8% (range: 0.77-27%). Conclusion(s): The
evidence for using thromboprophylaxis in thoracic surgery is limited and
controversial, predominantly based on clinical consensus. Future research
is needed to focus on identifying risk of VTE and providing sufficient
evidence with high quality to support clinical strategies concerning the
prophylaxis for VTE. Copyright © 2020 John Wiley & Sons
Australia, Ltd

<107>
Accession Number
2006857515
Title
Comparison of transhiatal esophagectomy using a mediastinoscope with
transhiatal esophagectomy by the classic method.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Rezaei R.; Masuom S.H.F.; Soroush N.; Zehi V.
Institution
(Rezaei, Masuom, Soroush) Endoscopic and Minimally Invasive Surgery
Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of
(Zehi) General Surgery, Torbat-e- Heydariyeh University of Medical
Sciences, Torbat-e-Heydariyeh, Iran, Islamic Republic of
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: This study aimed to evaluate the results of transhiatal
esophagectomy using a mediastinoscope in comparison with conventional
transhiatal esophagectomy. Method(s): Sixty-two esophageal cancer
patients who were referred to our thoracic surgery clinic between April
2015 and March 2017, and met the inclusion criteria, were randomly divided
into two groups of 31 each. In the first group, patients were operated on
by conventional transhiatal esophagectomy. In the second group, only
release of the thoracic esophagus through a neck incision (mediastinal
esophagolysis) was performed using a mediastinoscope. The other surgical
procedures were similar to those in the first group. Result(s): The
mean age of the patients was almost the same in both groups (57.7 years in
the first group versus 56.7 years in the second group). There was no
significant difference in sex ratio. The mean volume of blood loss during
the operation, mean operative time, and intensive care unit stay as well
as cardiopulmonary complications and early postoperative complications
were lower in the group that had esophagectomy using a mediastinoscope,
and the number of resected mediastinal lymph nodes was greater.
 Conclusion(s): Based on the results of this study, it can be expected
that use of a video mediastinoscope for esophagolysis of the thoracic
esophagus in a transhiatal esophagectomy procedure is safe and it will
reduce the morbidity and mortality in these patients. Copyright ©
The Author(s) 2020.

<108>
Accession Number
2007957209
Title
Is preoperative balloon aortic valvuloplasty of interest for severe aortic
stenosis in hip fracture surgery?.
Source
Injury. (no pagination), 2020. Date of Publication: 2020.
Author
Ferre F.; Viarnes M.; Martin C.; Bosch L.; Bouisset F.; Lhermusier T.;
Reina N.; Lairez O.; Minville V.
Institution
(Ferre, Viarnes, Martin, Bosch, Minville) Centre Hospitalier Universitaire
de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
(Bouisset, Lhermusier, Lairez) Cardiologie, Pole cardiovasculaire et
metabolique, CHU Rangueil, Toulouse, France
(Reina) Departement de chirurgie Orthopedique et Traumatologique, Hopital
Pierre-Paul Riquet, CHU Purpan, Toulouse, France
Publisher
Elsevier Ltd
Abstract
Purpose: In elderly patients, the discovery and management of a severe
aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent
and controversial issue. The objective of this study was to evaluate
preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip
fracture surgery. Method(s): We conducted an observational,
monocentric, retrospective study from 2011 to 2018. Survival (30-day,
90-day and 180-day mortality) and the occurrence of perioperative
complications were analyzed and compared between control (i.e. no BAV
prior to surgery) and preoperative BAV groups in patients with hip
fracture surgery and a formal transthoracic echocardiographic diagnosis of
severe AS (aortic valve area < 1 cm2). Patients' allocation to the
intervention and control groups was after a discussion between
cardiologist, anesthesiologist and the surgeon. Result(s): Among the
8506 patients who underwent hip fracture surgery, 29 patients in the
control group and 30 patients in the BAV group were finally included.
Kaplan-Meier survival analysis demonstrated a significant decrease in
mortality in the BAV group (p=0.014) despite an increase in median time to
operation of about 48 hours (p<0.0001). Multivariate analysis (stepwise
logistic regression) showed that postoperative delirium (OR [95%CI]: 17.5
[1.8-168]; p=0.013) and postoperative acute congestive heart failure (OR
[95%CI]: 59.4 [5.0-711.1]; p=0.0013) were predictive factors of 30-day
mortality with an area under ROC curve of 0.90 (95%CI: 0.80-0.97;
p<0.0001). Conclusion(s): preoperative BAV for severe AS could reduce
the mortality of hip fracture patients despite an increase in time to
operation. This improved survival could be linked to the decrease in
cardiologic and neurologic adverse events. A larger prospective randomized
study is necessary before generalizing our results. Copyright ©
2020

<109>
Accession Number
633079094
Title
Electromagnetic Versus Blind Guidance of a Postpyloric Feeding Tube in
Critically Ill Children.
Source
Pediatrics. 146 (4) (no pagination), 2020. Date of Publication: 01 Oct
2020.
Author
Jha P.; Rupp L.; Bonilla L.; Gelfond J.; Shah J.N.; Meyer A.D.
Institution
(Jha) Division of Critical Care, Department of Pediatrics, Children's
Hospital of Nevada at University Medical Center, Las Vegas, Nevada;
(Jha) Department of Pediatrics, University of Nevada Las Vegas School of
Medicine, Las Vegas, NV, Mexico
(Rupp, Bonilla, Shah, Meyer) Pediatric Services, University Health System,
San Antonio, Texas; and
(Gelfond) Department of Epidemiology and Biostatistics, University of
Texas Health San Antonio, San Antonio, TX, Mexico
(Shah) Divisions of Pediatric Gastroenterology and
(Meyer) Pediatric Critical Care, Department of Pediatrics and
Publisher
NLM (Medline)
Abstract
BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a
time-consuming procedure associated with multiple attempts and radiation
exposure. Our objective with this study is to compare the time, attempts,
and radiation exposure using the electromagnetic versus blind method to
place a postpyloric feeding tube in critically ill children. Our
hypothesis is that using electromagnetic guidance decreases the procedure
time, number of x-rays, and number of attempts, compared to the blind
method. METHOD(S): Eleven pediatric nurses participated in a
randomized controlled intention-to-treat study at an academic pediatric
medical, surgical, and congenital cardiac ICU. University of Texas Health
Epidemiology and Biostatistics generated a randomization sequence with
sealed envelopes. A standard (2-sided) F-test of association between the
electromagnetic and blind method yielded 40 subjects with 86% power. Data
were analyzed with Fisher's exact test for categorical variables and the
Wilcoxon rank test for continuous variables, with data documented as
median (interquartile range [IQR]). RESULT(S): We randomly assigned
52 patients to either the electromagnetic (n = 28) or blind method (n =
24). The number of attempts and radiographs was at a median of 2 (IQR:
1-2.25) using the blind method, compared to the electromagnetic method at
a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with
the electromagnetic method, compared to only 66.7% with the blind
technique (P = .008). The total time required was 2.5 minutes (IQR:
2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR:
9.25-27.0) for the blind method (P = .001). CONCLUSION(S):
Electromagnetic guidance is a superior, faster, and overall safer method
to place a postpyloric feeding tube in critically ill
children. Copyright © 2020 by the American Academy of Pediatrics.

<110>
Accession Number
632995772
Title
Effects of electroencephalography and regional cerebral oxygen saturation
monitoring on perioperative neurocognitive disorders: A systematic review
and meta-analysis.
Source
BMC Anesthesiology. 20 (1) (no pagination), 2020. Article Number: 254.
Date of Publication: 30 Sep 2020.
Author
Ding L.; Chen D.X.; Li Q.
Institution
(Ding, Chen, Li) National Clinical Research Center for Geriatrics,
Department of Anesthesiology, West China Hospital, Sichuan University,
Research Units of West China (2018RU012), Chinese Academy of Medical
Sciences, Chengdu 610041, China
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative neurocognitive disorders (PND) is a common
postoperative complication including postoperative delirium (POD),
postoperative cognitive decline (POCD) or delayed neurocognitive recovery.
It is still controversial whether the use of intraoperative cerebral
function monitoring can decrease the incidence of PND. The purpose of this
study was to evaluate the effects of different cerebral function
monitoring (electroencephalography (EEG) and regional cerebral oxygen
saturation (rSO2) monitoring) on PND based on the data from randomized
controlled trials (RCTs). Method(s): The electronic databases of Ovid
MEDLINE, PubMed, EMBASE, Cochrane Library database were systematically
searched using the indicated keywords from their inception to April 2020.
The odds ratio (OR) or mean difference (MD) with 95% confidence interval
(CI) were employed to analyze the data. Heterogeneity across analyzed
studies was assessed with chi-square test and I2 test. Result(s):
Twenty two RCTs with 6356 patients were included in the final analysis.
Data from 12 studies including 4976 patients were analyzed to assess the
association between the EEG-guided anesthesia and PND. The results showed
that EEG-guided anesthesia could reduce the incidence of POD in patients
undergoing non-cardiac surgery (OR: 0.73; 95% CI: 0.57-0.95; P = 0.02),
but had no effect on patients undergoing cardiac surgery (OR: 0.44; 95%
CI: 0.05-3.54; P = 0.44). The use of intraoperative EEG monitoring reduced
the incidence of POCD up to 3 months after the surgery (OR: 0.69; 95% CI:
0.49-0.96; P = 0.03), but the incidence of early POCD remained unaffected
(OR: 0.61; 95% CI: 0.35-1.07; P = 0.09). The remaining 10 studies compared
the effect of rSO2 monitoring to routine care in a total of 1380
participants on the incidence of PND. The results indicated that
intraoperative monitoring of rSO2 could reduce the incidence of POCD (OR
0.53, 95% CI 0.39-0.73; P < 0.0001), whereas no significant difference was
found regarding the incidence of POD (OR: 0.74; 95% CI: 0.48-1.14; P =
0.17). Conclusion(s): The findings in the present study indicated
that intraoperative use of EEG or/and rSO2 monitor could decrease the risk
of PND. Trial registration: PROSPREO registration number: CRD42019130512.
 Copyright © 2020 The Author(s).

<111>
Accession Number
632870258
Title
Early intervention or watchful waiting for asymptomatic severe aortic
valve stenosis: a systematic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 21 (11) (pp
897-904), 2020. Date of Publication: 01 Nov 2020.
Author
Ullah W.; Gowda S.N.; Khan M.S.; Sattar Y.; Al-Khadra Y.; Rashid M.;
Mohamed M.O.; Alkhouli M.; Kapadia S.; Bagur R.; Mamas M.A.; Fischman
D.L.; Alraies M.C.
Institution
(Ullah) Abington Jefferson Health, Abington, United States
(Gowda) University of South Dakota, Sioux Falls
(Khan) Mercy Saint Vincent Medical Center, MI
(Sattar) Icahn school of medicine at Mount Sinai Elmhurst Hospital, NY
(Al-Khadra, Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Rashid, Mohamed, Mamas) Keele Cardiovascular Research Group, Centre for
Prognosis Research, Institute of Primary Care and Health Sciences, Keele
University, Academic Department of Cardiology, Royal Stoke Hospital,
United Kingdom
(Alkhouli) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, Rochester, MN, United States
(Bagur) London Health Sciences Centre, London, ON, Canada
(Mamas, Fischman) Department of Cardiology, Thomas Jefferson Hospital,
Philadelphia, PA, United States
(Alraies) Detroit Medical Center, DMC Heart Hospital, Detroit, MI, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The management of patients with severe but asymptomatic aortic
stenosis is challenging. Evidence on early aortic valve replacement (AVR)
versus symptom-driven intervention in these patients is unknown.
 METHOD(S): Electronic databases were searched, articles comparing
early-AVR with conservative management for severe aortic stenosis were
identified. Pooled adjusted odds ratio (OR) was computed using a
random-effect model to determine all-cause and cardiovascular mortality.
 RESULT(S): A total of eight studies consisting of 2201 patients were
identified. Early-AVR was associated with lower all-cause mortality [OR
0.24, 95% confidence interval (CI) 0.13-0.45, P <= 0.00001] and
cardiovascular mortality (OR 0.21, 95% CI 0.06-0.70, P = 0.01) compared
with conservative management. The number needed to treat to prevent 1
all-cause and cardiovascular mortality was 4 and 9, respectively. The odds
of all-cause mortality in a selected patient population undergoing
surgical AVR (SAVR) (OR 0.16, 95% CI 0.09-0.29, P <= 0.00001) and SAVR or
transcatheter AVR (TAVR) (OR 0.53, 95% CI 0.35-0.81, P = 0.003) were
significantly lower compared with patients who are managed conservatively.
A subgroup sensitivity analysis based on severe aortic stenosis (OR 0.24,
95% CI 0.11-0.52, P = 0.0004) versus very severe aortic stenosis (OR 0.20,
95% CI 0.08-0.51, P = 0.0008) also mirrored the findings of overall
results. CONCLUSION(S): Patients with asymptomatic aortic valve
stenosis have lower odds of all-cause and cardiovascular mortality when
managed with early-AVR compared with conservative management. However,
because of significant heterogeneity in the classification of asymptomatic
patients, large scale studies are required.

<112>
Accession Number
631736906
Title
Short-term outcomes of on- vs off-pump coronary artery bypass grafting in
patients with left ventricular dysfunction: a systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 84), 2020. Date of
Publication: 11 May 2020.
Author
Guan Z.; Guan X.; Gu K.; Lin X.; Lin J.; Zhou W.; Xu M.; Wan F.; Zhang Z.;
Song C.
Institution
(Guan, Gu, Lin, Zhou, Zhang) Department of Cardiology surgery, Peking
University Third Hospital, 49 North Garden Rd., Beijing 100191, China
(Guan) Peking University, Beijing 100871, China
(Lin) Beijing University of Technology, Beijing 100124, China
(Xu) Department of Cardiology, Peking University Third Hospital, NHC Key
Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,
Beijing 100191, China
(Wan) Shanghai East Hospital, Tongji University, 150 Jimo Rd., Shanghai
100124, China
(Song) Department of Orthopedics, Peking University Third Hospital, 49
North Garden Rd., Beijing 100191, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Does the manipulation of the off-pump CABG (OPCAB) in patient
with depressed left ventricular function is better than on-pump CABG
(ONCAB) approach in in-hospital mortality and morbidities? Here we
undertook a meta-analysis of the best evidence available on the comparison
of primary and second clinical outcomes of the off-pump and on-pump CABG.
DESIGN: Systematic literature reviewer and meta-analysis. DATA SOURCES:
PubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled
Trials were searched the studies which comparing the use of the off-pump
CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January
1990.1 to January 2018. ELIGIBILITY CRITERIA: All observation studies and
randomized controlled trials comparing on-pump and off-pump as main
technique for multi-vessel coronary artery disease (defined as severe
stenosis (>70%) in at least 2 major diseased coronary arteries) with left
ventricular dysfunction(defined as ejection fraction (EF) 40% or less)
were included. DATA EXTRACTION AND SYNTHESIS: Authors will screen and
select the studies extract the following data, first author, year of
publication, trial characters, study design, inclusion and exclusion
criteria, graft type, clinical outcome, assess the risk of bias and
heterogeneity. Study-specific estimates will pool through the modification
of the Newcastle-Ottawa scale for the quality of study and while
leave-one-out analysis will be used to detect the impact of individual
studies on the robustness of outcomes. RESULT(S): Among the 987
screened articles, a total of 16 studies (32,354 patients) were included.
A significant relationship between patient risk profile and benefits from
OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84;
95% confidence interval [CI], 0.73-0.97; P=0.02), stroke (OR, 0.69; 95%
CI, 0.55-0.86; P=0.00), myocardial infarction (MI) (OR, 0.71; 95% CI,
0.53-0.96; P=0.02), renal failure (OR, 0.71; 95% CI, 0.55-0.93; P=0.01),
pulmonary complication (OR, 0.68; 95% CI, 0.52-0.90; P=0.01), infection
(OR, 0.67; 95% CI, 0.49-0.91; P=0.00),postoperative transfusion (OR, 0.25;
95% CI, 0.08-0.84; P=0.02) and reoperation for bleeding (OR, 0.56; 95% CI,
0.41-0.75; P=0.00). There was no significant difference in atrial
fibrillation (AF) (OR, 0.96;95%; CI, 0.78-1.41; P=0.56) and neurological
dysfunction (OR, 0.88; 95% CI, 0.49-1.57; P=0.65). CONCLUSION(S):
Compared with the on-pump CABG with LVD, using the off-pump CABG is a
better choice for patients with lower mortality, stroke, MI, RF, pulmonary
complication, infection, postoperative transfusion and reoperation for
bleeding. Further randomized studies are warranted to corroborate these
observational data.

<113>
Accession Number
631735645
Title
Comparing the effects of ketorolac and Paracetamol on postoperative pain
relief after coronary artery bypass graft surgery. A randomized clinical
trial.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 80), 2020. Date of
Publication: 11 May 2020.
Author
Javaherforooshzadeh F.; Abdalbeygi H.; Janatmakan F.; Gholizadeh B.
Institution
(Javaherforooshzadeh) Department of Cardiac Anesthesia, Ahvaz
Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Abdalbeygi, Janatmakan) Department of Anesthesia, Ahvaz Anesthesiology
and Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Gholizadeh) Atherosclerosis Research Center, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Pain management after coronary artery bypass graft (CABG)
surgery remains challenging. OBJECTIVE(S): This study aimed to
compare the effects of Ketorolac and Paracetamol on postoperative CABG
pain relief. METHOD(S): This double-blind randomized clinical trial
study was conducted in Ahvaz, Iran, from September 2018-December 2019. Two
consecutive groups of 60 patients undergoing elective on-pump coronary
artery bypass graft surgery. INTERVENTION: The patients were divided into
0.5mg/kg of ketorolac mg/dl and 10mg/kg of Paracetamol after surgery for
pain management. Primary outcomes were: visual analog pain scale (VAS) at
the time point immediately after extubation (baseline) and at 6, 12, 24
and 48h and the total dose of morphine consumption. Secondary outcomes
included the hemodynamic variables, weaning time, chest tube derange,
in-hospital mortality and myocardial infarction. STATISTICAL ANALYSIS: The
data were analyzed using SPSS version 22(SPSS, Chicago, IL). The
Mann-Whitney U-test was used to compare demographic data, VAS scores,
vital signs, and side effects. Repeated measurements were tested within
groups using Friedman's ANOVA and the Wilcoxon rank-sum test. Values were
expressed as means +/- standard deviations. Statistical significance was
defined as a p-value <0.05. RESULT(S): Compared with baseline scores,
there were significant declines in VAS scores in both groups throughout
the time sequence (P< 0.05). The statistical VAS score was slightly higher
in the Paracetamol group at most time points, except for the time of 6h.
However, at 24 and 48h, the VAS score in group Paracetamol was
significantly higher than in group Ketorolac. There were no significant
differences between groups about hemodynamic variables.
 CONCLUSION(S): The efficacy of ketorolac is comparable to that of
Paracetamol in postoperative CABG pain relief. TRIAL REGISTRY:
IRCT20150216021098N5. Registered at 2019-09-12.

<114>
Accession Number
631654345
Title
Pain relief following sternotomy in conventional cardiac surgery: A review
of non neuraxial regional nerve blocks.
Source
Annals of Cardiac Anaesthesia. 23 (2) (pp 200-208), 2020. Date of
Publication: April-June 2020.
Author
Kar P.; Ramachandran G.
Institution
(Kar, Ramachandran) Department of Anesthesia and Intensive Care, Nizams
Institute of Medical Sciences, Hyderabad, Telangana, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Acute post-operative pain following sternotomy in cardiac surgery should
be adequately managed so as to avoid adverse hemodynamic consequences and
pulmonary complications. In the era of fast tracking, adequate and
efficient technique of post-operative analgesia enables early extubation,
mobilization and discharge from intensive care unit. Due to increasing
expertise in ultrasound guided blocks there is a recent surge in trial of
bilateral nerve blocks for pain relief following sternotomy. The aim of
this article was to review non-neuraxial regional blocks for analgesia
following sternotomy in cardiac surgery. Due to the paucity of similar
studies and heterogeneity, the assessment of bias, systematic review or
pooled analysis/meta-analysis was not feasible. A total of 17 articles
were found to be directly related to the performance of non-neuraxial
regional nerve blocks across all study designs. Due to scarcity of
literature, comments cannot be made on the superiority of these blocks
over each other. However, most of the reviewed techniques were found to be
equally efficacious or better than conventional and established
techniques. Copyright © 2020 Annals of Cardiac Anaesthesia 
Published by Wolters Kluwer-Medknow.

<115>
Accession Number
630762691
Title
Effects of cycle ergometer use in early mobilization following cardiac
surgery: a randomized controlled trial.
Source
Clinical rehabilitation. 34 (4) (pp 450-459), 2020. Date of Publication:
01 Apr 2020.
Author
Gama Lordello G.G.; Goncalves Gama G.G.; Lago Rosier G.; Viana P.A.D.C.;
Correia L.C.; Fonteles Ritt L.E.
Institution
(Gama Lordello, Goncalves Gama, Viana, Correia, Fonteles Ritt) Bahiana
School of Medicine and Public Health, Salvador, Brazil
(Gama Lordello, Lago Rosier, Viana) Hospital Santa Izabel, Santa Casa da
Bahia, Salvador, Brazil
(Goncalves Gama) Edgard Santos Teaching Hospital, Federal University of
Bahia, Salvador, Brazil
(Correia) Hospital Alianca, Salvador, Brazil
(Fonteles Ritt) Hospital Cardio Pulmonar, Salvador, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the effect of early use of a cycle ergometer,
compared to a standard care protocol, in postoperatory in-hospital
mobility following cardiac surgery. DESIGN: A randomized controlled trial.
SETTING: Tertiary hospital in Salvador, Bahia, Brazil. SUBJECTS: Patients
submitted to elective cardiac surgery (valvular or coronary bypass surgery
by sternotomy). INTERVENTION: Patients were randomly allocated in two
groups: (1) cycle ergometer training group (10-minute session) and (2)
control group submitted standard physiotherapy protocol (10-minute
session). Training was provided twice a day, immediately following
extubation and until patient was discharged from the intensive care. MAIN
MEASURES: The primary outcome was the difference in the total number of
steps recorded on the pedometer over three days. Secondary outcomes were
mobility in different subgroups and the reasons that prevented individuals
from walking during early cardiac rehabilitation. RESULT(S): A total
of 228 participants completed the study. No significant difference was
found in the total number of steps between the groups after intervention:
2183 (range: 1729-2772) in the intervention group versus 2006 (1517-2657)
in the control group (P=0.167). However, self-reports indicated better
motivation in the intervention group (P=0.044). No adverse events occurred
during the study. CONCLUSION(S): As a strategy for early mobilization
following cardiac surgery, the use of a cycle ergometer failed to increase
independent physical activity compared to a standard care protocol.
Nevertheless, it was safe and could be an alternative to make
rehabilitation more attractive and motivational for this patient
population.

<116>
Accession Number
2008025733
Title
MIGHTY MITIS.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A278), 2020. Date of Publication: October 2020.
Author
Chandna S.; Sankaramangalam K.; Shah M.
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: Transcatheter Aortic Valve Replacement (TAVR) is the
mainstay treatment of severe aortic stenosis especially in the elderly
with multiple comorbidities and is emerging as an alternative to surgical
aortic valve replacement (SAVR). (1) The rate of infective endocarditis
(IE) following TAVR has been reported to be around 1.5%.(2) Herein, we
describe a case where the patient developed prosthetic valve endocarditis
(PVE) 2 months after undergoing TAVR. CASE PRESENTATION: A 73-year-old
male presented to the emergency with cough, chills, and bilateral lower
extremity swelling for a week. His medical history was significant for
hypertension, hyperlipidemia, type 2 diabetes mellitus, bradycardia status
post dual lead pacemaker (2013), and severe aortic stenosis status post
TAVR (26mm SAPIEN 3 valve via right femoral artery- TAVR was done 2 months
prior to this presentation). The patient underwent a dental procedure 3
weeks after the TAVR and did not receive any antibiotic prophylaxis prior
to the dental procedure. Duke Criteria indicated 'Possible infective
endocarditis (IE)'. Transthoracic echocardiogram (TTE) did not show any
vegetation. Blood cultures yielded Streptococcus mitis/ oralis.
Transesophageal echocardiogram (TEE) showed 0.6 X 0.2cm vegetation on the
left coronary cusp of the prosthetic aortic valve and mild paravalvular
aortic insufficiency. The pacemaker was vegetation-free. He was started on
intravenous (IV) ceftriaxone, responded well to it, and was discharged
with a 6weeks course of IV ceftriaxone and he was referred to
cardiothoracic surgery for further evaluation. DISCUSSION: IE is an
uncommon complication after TAVR. PVE associated with TAVR is difficult to
diagnose and has a dismal prognosis so TAVR- IE deserves prompt diagnosis
and treatment. PVE presents with fever, new or changing heart murmur, new
or worsening heart failure, or new or progressive cardiac conduction
abnormalities. The most frequently encountered pathogens in early PVE
(within two months of TAVR) are S. aureus and coagulase-negative
staphylococci followed by gram-negative bacilli and fungi. The most
frequently encountered pathogens in intermediate PVE (2 to 12 months after
TAVR) and late PVE (more than 12 months after TAVR) are streptococci and
S. aureus followed by coagulase-negative staphylococci and enterococci.
The main sources of PVE are dental interventions and respiratory, skin,
urological, and gastrointestinal infections.(2) Studies have shown that
men are found to be affected by IE more often than women. (3)
 CONCLUSION(S): As per the American Heart Association (AHA) and the
European Society for Cardiology (ESC) guidelines, PVE should be treated
with a bactericidal agent for at least six weeks. Guidelines recommend
early surgery in complicated cases including those with heart failure,
perivalvular complications, and high risk of embolism. Emphasis should
also be given on any pre-procedure prophylaxis. Reference #1: Smith CR,
Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG,
PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve
replacement in high-risk patients. N Engl J Med. 2011;364:2187-98.
Reference #2: Amat-Santos IJ, Ribeiro HB, Urena M, Allende R, Houde C,
Bedard E, Perron J, Delarochelliere R, Paradis JM, Dumont E, Doyle D,
Mohammadi S, Cote M, San Roman JA, Rodes-Cabau J. Prosthetic valve
endocarditis after transcatheter valve replacement: A systematic review.
JACC Cardiovasc Interv. 2015;8:334-346. Reference #3: Olsen NT, Backer O
De, Thyregod HGH, Vejlstrup N, Bundgaard H, Sondergaard L. Structural
Heart Disease Prosthetic Valve Endocarditis After Transcatheter Aortic
Valve Implantation. 2015;1-9. DISCLOSURES: No relevant relationships by
Sanya Chandna, source=Web Response No relevant relationships by Kesavan
Sankaramangalam, source=Web Response No relevant relationships by Monarch
Shah, source=Web Response Copyright © 2020 American College of
Chest Physicians

<117>
Accession Number
2008025705
Title
CARDIAC PAPILLARY FIBROELASTOMA ORIGINATING FROM THE COUMADIN RIDGE.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A171-A172), 2020. Date of Publication: October 2020.
Author
Mehmood Lak H.; Kerndt C.; Unai S.; Tanaka-esposito C.; Shah G.; Ahmed T.;
Maroo 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: Cardiac papillary fibroelastomas (CPF) are rare, benign
primary cardiac tumors that typically arise from cardiac valves.
Identification of this tumor is generally established with TTE and TEE.
The coumadin ridge of the left atrium, a tissue fold between the left
upper pulmonary vein and the left atrial appendage, is an uncommon
location for a papillary fibroelastoma. However, awareness of this
potential location is important, as papillary fibroelastomas have embolic
potential and are a risk factor for embolic stroke. CASE PRESENTATION: A
70-year-old female with hypothyroidism, hyperlipidemia, and a family
history of an undefined connective tissue disorder presented with a left
occipital and right cerebellar cerebrovascular accident (CVA). The CVA was
thought to be cardioembolic in origin, and she underwent TEE. She was
found to have a small patent foramen ovale, but no intracardiac thrombi.
An implantable loop recorder was implanted due to a history of paroxsysms
of tachycardia that were often precipitated by lying down. Monitoring
revealed frequent episodes of paroxysmal atrial fibrillation. The patient
was anticoagulated with apixaban, and she opted to undergo a pulmonary
vein isolation to achieve rhythm control. Intracardiac echocardiogram at
the start of the pulmonary vein isolation revealed a small mobile
echodensity attached to the coumadin ridge. TEE confirmed the presence of
a 1.0 cm x 0.6 cm frondular, highly mobile echodensity attached to the
coumadin ridge.It was not readily apparent on standard TEE views, but was
located by sweeping posteriorly through the left atrium at the junction
between the left upper pulmonary vein and the left atrial appendage. The
pulmonary vein isolation was abandoned, and the patient was referred to a
cardiothoracic surgeon. The patient underwent excision of the left atrial
mass, successful left and right MAZE procedure, left atrial appendage
ligation with Gilinov clip 35 mm, and PFO closure. Histopathology of the
left atrial mass revealed a papillary fibroelastoma. DISCUSSION: Cardiac
papillary fibroelastoma represents the second most common primary cardiac
tumor. Studies suggest that CPF encompass 4.4-8.0% of primary cardiac
tumors. The gross pathologic appearance that assimilates to a sea-anemone,
given its centralized core with an extensive number of radiating fronds.
Over 80.0% of documented CPF cases demonstrate attachment to a cardiac
valve, with non-valvular lesions accounting for only 20.0%. Upon review of
literature, only 6 previous cases have reported CPF originating from the
coumadin ridge. CONCLUSION(S): CPF are benign tumors that stem from
the valvular endocardium. Although the majority of CPF arise directly from
cardiac valves, they can also arise from non-valvular structures,
including the coumadin ridge. Awareness of this rare potential location of
CPF is important when performing TEE for assessment of cardioembolic
lesions. Reference #1: Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC,
Sacchi TJ. Cardiac papillary fibroelastoma: a comprehensive analysis of
725 cases. American Heart Journal. 2003;146(3):404-10. Reference #2: Sun
JP, Asher CR, Yang XS, Cheng GG, Scalia GM, Massed AG, et al. Clinical and
Echocardiographic Characteristics of Papillary Fibroelastomas.
Circulation. 2001May;103(22):2687-93. DISCLOSURES: no disclosure on file
for Taha Ahmed; No relevant relationships by Connor Kerndt, source=Web
Response No relevant relationships by HASSAN MEHMOOD LAK, source=Web
Response No relevant relationships by Anjli Maroo, source=Web Response No
relevant relationships by Gautam Shah, source=Web Response No relevant
relationships by Christine Tanaka-esposito, source=Web Response No
relevant relationships by Shinya Unai, source=Web Response Copyright
© 2020 American College of Chest Physicians

<118>
Accession Number
2007975180
Title
THE SAFETY AND EFFICACY OF HIGHER COMPARED TO LOWER INTRAOPERATIVE BLOOD
PRESSURE IN ADULT PATIENTS UNDERGOING CARDIAC SURGERY: A SYSTEMATIC REVIEW
AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S107-S108), 2020. Date of
Publication: October 2020.
Author
McEwen C.; Young J.; Qiu Y.; Amir T.; Whitlock R.; Mazer D.; Jacobsohn E.;
Belley-Cote E.; Spence J.
Institution
(McEwen, Young, Qiu, Amir, Whitlock, Mazer, Jacobsohn, Belley-Cote,
Spence) HamiltonONCanada
Publisher
Elsevier Inc.
Abstract
Background: The 2019 EACTS/EACTA/EBCP guidelines for the management of
cardiopulmonary bypass (CPB) in adult cardiac surgery recommend
maintaining mean arterial pressure (MAP) within a range of 50-80 mmHg. We
performed a systematic review and meta-analysis of randomized controlled
trials (RCTs) to determine the impact of high vs. low blood pressure
targets during CPB on morbidity and mortality in adult patients undergoing
cardiac surgery. Methods and Results: We searched MEDLINE, EMBASE,
Web of Science, the Cumulative Index to Nursing and Allied Health
Literature (CINAHL), and the Cochrane Central Register of Controlled
Trials (CENTRAL) from 1975 until March 28, 2020, for RCTs comparing high
vs. low intraoperative blood pressure targets during CPB in adult patients
undergoing any cardiac surgical procedure. Reference lists from existing
studies, grey literature, and conference proceedings were screened for
relevance. Two reviewers independently performed duplicate title and
abstract screening, full-text screening, data extraction, and risk of bias
assessment using the Cochrane Collaboration's risk of bias tool. We
assessed the quality of evidence for each outcome using the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) approach.
Six RCTs (n=940) comparing high (MAP 72.5 +/- 9.8) with low (MAP 53.8 +/-
9.0) were included. There was no significant difference in perioperative
delirium (RR 0.46, 95% CI [0.03, 8.62], p=0.61, very low quality
evidence), postoperative cognitive decline (RR 1.22, 95% CI [0.72, 2.06],
p=0.46, low quality evidence), perioperative stroke (RR 0.95, 95% CI
[0.19, 4.89], p=0.95, very low quality evidence), acute kidney injury (RR
1.09, 95% CI [0.76, 1.56], p=0.65, low quality evidence), or 30-day
mortality (RR 1.63, 95% CI [0.61, 4.36], p=0.33, low quality evidence)
when high (compared to low) blood pressure targets were used. Intensive
care unit length-of-stay was shorter (MD -0.07, 95% CI [-0.11, -0.03],
p=0.001, moderate quality evidence), but more patients received blood
transfusion (RR 1.40, 95% CI [1.08,1.82], p=0.01, high quality evidence)
with high intraoperative blood pressure targets. Conclusion(s): The
available evidence suggests that higher blood pressure targets during CPB
may decrease ICU length-of-stay while increasing the risk of receiving a
transfusion. Blood pressure targets' impact on major morbidity and
mortality remains unclear. Further research examining the relationship
between intraoperative blood pressure targets and patient-important
outcomes should be a priority. [Formula presented] Copyright ©
2020

<119>
Accession Number
2005207204
Title
Comparison of the effectiveness of allopurinol and methylprednisolone in
reducing reperfusion injury in coronary artery bypass surgery.
Source
Journal of Drug and Alcohol Research. 9 (pp 1-6), 2020. Article Number:
2360102. Date of Publication: 2020.
Author
Kurniawan H.; Perdana A.; Alatas A.; Nasution A.H.
Institution
(Kurniawan) Fellow of cardiac anesthesia, University of Indonesia,
Indonesia
(Perdana, Alatas) Cardiovascular Anesthesiologist, University of
Indonesia, Indonesia
(Nasution) Cardiovascular Anesthesiologist, University of Sumatera Utara,
Indonesia
Publisher
Ashdin Publishing (E-mail: info@ashdin.com)
Abstract
Background: Reperfusion injury due to the release of ROS when using CPB
and the return of oxygen-rich blood flow to ischemic myocardium after the
release of aortic clamps, can cause myocardial dysfunction. Allopurinol as
an inhibitor of xanthine oxidase and methylprednisolone is used to reduce
the effects of inflammation and reperfusion injury. Method(s): A
double-blind randomized clinical trial study was conducted on 42 patients
undergoing coronary artery bypass surgery using CPB between October 2019
and March 2020, which was allocated to the allopurinol group or the
methylprednisolone group. Examination of biomarkers of reperfusion injury
is carried out by examination of a blood sample of MDA which is performed
shortly after the installation of a central venous catheter and 5 minutes
after the aortic clamp are removed. MDA examination is done by the ELISA
method. Assessment of VIS was carried out in the first 24 hours of
postsurgical treatment. While the assessment of the incidence of
postoperative arial fibrilation was performed during the first 48 hours
after surgery. Result(s): MDA post reperfusion levels increased
significantly in the administration of methylprednisolone (p=0.041) and
increased not significantly in the administration of allopurinol
(p=0.251). The postoperative VIS value in the administration of
allopurinol was significantly lower than in the administration of
methylprednisolone (median 6 vs. 22, p = 0.009). The incidence of POAF in
the two groups showed no differences were statistically significant (p =
0.231). Conclusion(s): Allopurinol is more effective than
methylprednisolone and can be used in efforts to reduce reperfusion injury
in coronary artery bypass surgery. Copyright © 2020 Heru
Kurniawan, et al.

<120>
Accession Number
633108827
Title
The effect of tranexamic acid in reducing postoperative hemorrhage in
patients undergoing coronary artery bypass graft.
Source
Saudi Journal of Anaesthesia. 14 (4) (pp 431-435), 2020. Date of
Publication: October-December 2020.
Author
Rostami A.; Hoseini A.; Kamali A.
Institution
(Rostami) Department of Cardiology, Student Research Committee, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Hoseini) Department of and Medical Intern, Student Research Committee,
Arak University of Medical Sciences, Arak, Iran, Islamic Republic of
(Kamali) Department of Anesthesiology and Critical Care, Student Research
Committee, Arak University of Medical Sciences, Arak, Iran, Islamic
Republic of
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: Nowadays, cardiovascular diseases such as coronary heart
disease are one of the most important causes of human mortality worldwide.
Coronary artery bypass graft (CABG) surgery is a standard therapy approach
for those suffering from coronary artery disease. Tranexamic acid (TXA),
an antifibrinolytic drug, which, in turn, inhibits fibrinolysis, leading
to the prevention of bleeding, thus, the present study aimed to evaluate
the effect of topical TXA on bleeding reduction after coronary artery
CABG. Material(s) and Method(s): In this study 62 patients were
randomly divided into two groups of TXA and control. After surgery and
removal from the cardiopulmonary pump, TXA (2 g) was injected locally into
the mediastinum by the surgeon. In the second group (control) the same
amount of normal saline (100 cc) was given. Data were analyzed by SPSS 19
software via the t-test and Fisher's test. Result(s): A significant
difference was found between the 2 groups in terms of postoperative
hemorrhage, packed cell volume, platelet transfusion, duration of surgery,
and received FFP (P = 0.0001; P = 0.01; P = 0.0001; P = 0.0001; P =
0.0001), where were found to be lower in the TXA group than in the placebo
group. There was no significant difference in age, sex, return to the
operating room, and discharge. Conclusion(s): The use of topical TXA
in GABC significantly reduced postoperative hemorrhage, packed cell
volume, platelet> transfusion, and FFP after surgery. Besides, it had no
significant effect on the return to the operating room and
mortality. Copyright © 2020 Wolters Kluwer Medknow Publications.
All rights reserved.

<121>
Accession Number
2006981181
Title
Improving health-related quality of life and adherence to health-promoting
behaviors among coronary artery bypass graft patients: a non-randomized
controlled trial study.
Source
Quality of Life Research. (no pagination), 2020. Date of Publication:
2020.
Author
Zafari Nobari S.; Vasli P.; Hosseini M.; Nasiri M.
Institution
(Zafari Nobari, Vasli, Hosseini) Department of Nursing, School of Nursing
and Midwifery, Shahid Beheshti University of Medical Sciences, Vali Asr
Ave., Niayesh Cross Road, Tehran, Iran, Islamic Republic of
(Nasiri) Department of Basic Sciences, School of Nursing and Midwifery,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Purpose: This study aimed to determine the impact of a healthy lifestyle
empowerment program on health-related quality of life and adherence to
health-promoting behaviors in coronary artery bypass graft patients.
 Method(s): This non-randomized controlled trial was conducted in 2019
on 97 coronary artery bypass graft patients in Iran. Participants were
selected by culturally pragmatic and non-randomized method and assigned to
healthy lifestyle empowerment program group (HLEPG) (n = 49) and
conventional education group (CEG) (n = 48). Data were collected by the
12-item short-form health survey (SF-12) and health-promoting lifestyle
profile II (HPLP2), which were administered at baseline and three-month
follow-up. The healthy lifestyle empowerment program and conventional
education as two interventions were performed for HLEPG and CEG,
respectively. Data analysis was performed using the paired t-test,
independent t-test, analysis of covariance and linear mixed method at the
0.05 significance level. Result(s): In the follow-up, both groups
showed a significant increase in the mean score of health-related quality
of life (p <= 0.001) but this increase was visibly greater in the HLEPG
(from 23.47 +/- 7.48 to 35.60 +/- 5.95) than in the CEG (from 22.93 +/-
5.93 to 27.6 +/- 4.90). The healthy lifestyle empowerment program also
significantly increased the mean score of adherence to health-promoting
behaviors in the HLEPG (p <= 0.001), whereas no such change was observed
in the CEG. The results of the linear mixed model showed that the
follow-up scores health-related quality of life and adherence to
health-promoting behaviors of the HLEPG were 27.26 and 7.56 units
significantly greater than the CEG after HLEP, respectively (p < 0.001).
 Conclusion(s): Considering the results of this study, health care
providers are recommended to devise and implement healthy lifestyle
empowerment programs to improve the health-related quality of life of
coronary artery bypass surgery patients. Clinical trial registration:
Registered at Iranian Registry of Clinical Trials
(IRCT20171213037860N1). Copyright © 2020, Springer Nature
Switzerland AG.

<122>
Accession Number
633113456
Title
Impact of Different Annuloplasty Methods for Tricuspid regurgitation; a
Network Meta-Analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 01 Oct 2020.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although moderate-severe tricuspid valve regurgitation (TR) is
an independent risk factor for progressive heart failure and increased
mortality, the best method for tricuspid repair remains controversial. As
such, we conducted a network meta-analysis to compare early and late
outcomes for suture, flexible band, and rigid ring as tricuspid
annuloplasty (TAP) in patients with TR. METHOD(S): MEDLINE and EMBASE
were searched through February 15th, 2020 to identify randomized
controlled trials and observational trials that investigated early and
late outcomes after TAP for TR. The outcomes of interest were
perioperative mortality, all-cause mortality and TR recurrence with more
than 1-year follow-up. TR recurrence was defined as at least moderate (TR
grade 2) on serial echocardiogram. RESULT(S): Tow randomized
controlled trials and 15 observational trials were identified, including
6,138 patients who underwent TAP. Median follow-up period was 1-7.4 year.
There were no significant differences of perioperative and all-cause
mortality among three TAP methods. Rigid ring TAP was associated with a
significant reduction in TR recurrence compared to suture TAP (Hazard
ratio, 0.42; 95% Confidence Interval, 0.23-0.78; p =0.0053). There were no
significant differences in TR recurrence were observed between flexible
band and suture TAP or flexible band and rigid ring TAP.
 CONCLUSION(S): Our network meta-analysis demonstrated significant
reduction in TR recurrence for rigid ring TAP compared to Suture TAP,
although no significant differences were observed between suture and
flexible band TAP, and flexible band and rigid ring TAP. There was no
significant mortality difference among suture, flexible band, and rigid
ring TAP. Copyright © 2020. Published by Elsevier Inc.

<123>
Accession Number
2008026754
Title
RIB OSTEOCHONDROMA PRESENTING AS HEMOTHORAX.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A101), 2020. Date of Publication: October 2020.
Author
Sharma 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: Osteochondroma's are benign tumors most commonly found
on the long bones of the leg, pelvis or shoulder blade. Usually benign,
much of the management is set around observation and symptom control. The
next step would be surgical excision of the tumor along with pathological
analysis and close monitoring for malignant transformation or recurrence.
This case further supports possible complications of osteochondromas. CASE
PRESENTATION: A 21 yo M with no significant past medical history presented
with right sided posterior back pain along the 6th-9th rib. Pain was
sharp, worsened with inspiration and movement and radiated to the right
shoulder. An XR Chest showed moderate right pleural effusion along with a
mass projecting over the right anterior 6th and 7th intercostal space. A
CT Chest showed and exophytic sclerotic/well corticated bony lesion
arising from the inferomedial aspect of the anterior right sixth rib
measuring 3.1 x 3.8 x 3.3 cm. It was invading he intercostal space between
the sixth and seventh rib along with the diaphragm at the anterolateral
sulcus. Additionally, a right-sided pleural effusion was better visualized
showing material in the inferior aspect consistent with blood products. An
US-Guided thoracentesis drained 1L of cloudy/bloody fluid. No malignant
cells identified and no growth on culture. CT Surgery was consulted and
patient underwent excision of the chest wall tumor including partial
resection of the 6th rib. The 7th rib did not show any involvement. The
chest cavity was also entered where a large loculated hemothorax was seen.
This was evacuated along with decorticating of the right lower lobe due to
thickened pleura and old blood products. The exophytic mass and rib were
sent to pathology for gross and histologic examination. The histologic
features showed a cartilaginous cap, trabecular bone, normal hematopoiesis
characteristic for osteochondroma. DISCUSSION: Upon literature review it
seems there are several case reports reported in the literature showing
complications caused by osteochondromas of the thoracic cage. Much of the
literature review showed hemothorax as the most common complication as
well as diaphragmatic and intrapericardial penetration. This case report
seeks to further report another case of a osteochondroma arising from the
rib presenting as a hemothorax along with diaphragmatic involvement.
Additionally, similar case reports reviewed in literature shows his
presentation may be a common complication of osteochondromas arising from
the rib. CONCLUSION(S): Osteochondromas, although mostly benign may
present with complications should they arise from sites other than the
long bones of the body where they are most commonly found. One of the most
common complications seen in literature is hemothorax if arising from the
thoracic cavity. Clinicians should be aware of this presentation of a
pleural effusion and mass arising from the rib. Reference #1: Kitsoulis P,
Galani V, Stefanaki K, et al. Osteochondromas: review of the clinical,
radiological and pathological features. In Vivo. 2008
Sep-Oct;22(5):633-46PDF) Reference #2: Keith G. Buchan, Vipin Zamvar,
Kayapanda M. Mandana, E. Nihal, P. Kulatilake, Juxtacardiac costal
osteochondroma presenting as recurrent haemothorax, European Journal of
Cardio-Thoracic Surgery, Volume 20, Issue 1, July 2001, Pages 208-210,
https://doi.org/10.1016/S1010-7940(01)00721-7 Reference #3: Harrison, N.
K., Wilkinson, J., O'Donohue, J., Hansell, D., Sheppard, M. N., Goldstraw,
P. G., Davison, A. G., & Newman Taylor, A. J. (1994). Osteochondroma of
the rib: an unusual cause of haemothorax. Thorax, 49(6), 618-619.
https://doi.org/10.1136/thx.49.6.618 DISCLOSURES: No relevant
relationships by Rajeev Sharma, source=Web Response Copyright ©
2020 American College of Chest Physicians

<124>
Accession Number
2008026472
Title
STREPTOCOCCUS AGALACTIAE ENDOCARDITIS: AN UNUSUAL COMPLICATION OF GOOD'S
SYNDROME.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A1219), 2020. Date of Publication: October 2020.
Author
Jafri F.; Arif S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum
Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October
18-21, 2020 INTRODUCTION: Good's Syndrome is a rare disorder characterized
by thymoma associated with hypogammaglobulinemia resulting in combined B
and T cell immunodeficiency in adults. We present a case of Good's
syndrome manifesting as infective endocarditis. CASE PRESENTATION: A
66-year-old female without significant medical history presented with a
14-day history of fevers, malaise, myalgias, anorexia, night sweats, and
weight loss. She denied chest pain, cough, and dyspnea, syncope or
orthopnea. On arrival, vitals were stable. She appeared cachectic without
any other significant physical exam findings. Initial blood work was
unremarkable. Further testing revealed low immunoglobulin levels IgA <5,
IgM <5 and IgG <37. Blood cultures remained negative. Chest CT showed an
anterior mediastinal mass and small bilateral pleural effusions.
Transesophageal echocardiogram showed aortic valve vegetation (1.5x0.5
cm2) with moderate aortic regurgitation. She was empirically started on
broad-spectrum antibiotics. She underwent aortic valve replacement and
mediastinal mass removal with pathology confirmed as thymoma on biopsy.
Valve tissue PCR was positive for Streptococcus Agalactiae. Flow cytometry
of CD45+ lymphoid gate showed normal T cells with an absent B cell
population. She was given a dose of intravenous immunoglobulins (IVIG)
resulting in the normalization of IgG levels. She was discharged with
close clinic follow-up for IVIG infusions. Her repeat IgG levels after 6
months remained in a normal range. DISCUSSION: Hypogammaglobinemia seen in
Good's syndrome leads to increased susceptibility to opportunistic
infections with predominance for encapsulated bacteria, viruses and fungi.
Diagnosis is often challenging as the initial presentation can vary. As
noted in our case, It should be suspected after an incidental finding of
thoracic mass is seen on imaging in an appropriate clinical context. It
can also present with symptoms due to local compressive effects of thymoma
including cough, chest pain, hoarseness of voice, Horner syndrome,
Superior vena cava syndrome, and dysphagia. When Good Syndrome is
suspected, further investigation with measurement of T-cell subsets,
B-cell and immunoglobulin levels is warranted. Treatment requires surgical
resection of thymoma and immunoglobulin replacement in addition to the
treatment of opportunistic infections. It is associated with worse
outcomes as compared to X-linked agammaglobulinemia and combined variable
immunodeficiency. It is reported that survival at 5-years following
diagnosis is around 70%. CONCLUSION(S): Good's syndrome should be
considered in adults with thymoma with unexplained hypogammaglobulinemia.
Its diagnosis is often challenging due to variable symptomatology and lack
of awareness of this condition. However, due to high mortality and
morbidity associated with it, early recognition and timely intervention
are essential to improve prognosis. Reference #1: Kelleher P, Misbah SA.
Review: What is Good's syndrome? Immunological abnormalities in patients
with thymoma. J Clin Pathol Jan. 2003;56(1):12-16. Reference #2: Kelesidis
T, Yang O. Review: Good's syndrome remains a mystery after 55 years: A
systematic review of the scientific evidence. Clinical Immunology Jun.
2010;135(3):347-363 Reference #3: Ohuchi M, Inoune S, Igarashi T, et al.
Good Syndrome Coexisting With Leukopenia. Ann Thorac Surg.
2007;84:2095-2097 DISCLOSURES: No relevant relationships by Shahrukh Arif,
source=Web Response No relevant relationships by Firas Jafri, source=Web
Response Copyright © 2020 American College of Chest Physicians

<125>
Accession Number
2008026329
Title
INTRAPARENCHYMAL PLACEMENT: A COMPLICATION OF CHEST TUBE INSERTION.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A2523), 2020. Date of Publication: October 2020.
Author
Patel N.; Patel T.; Steenson S.; Krvavac A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE:
Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020
INTRODUCTION: Tube thoracostomy (TT) is a procedure that is performed in
emergent and non-emergent settings by a variety of physicians. TT is
oftentimes a lifesaving intervention, but significant risks still exist.
The incidence of chest tube misplacement is reported to be 3%, with an
overall procedural complication rate of 15-20% [1]. We present the case of
a young male who underwent TT, complicated by tube malposition. CASE
PRESENTATION: A 36-year-old Caucasian male with no medical history
presented with a three-day history of right-sided chest pain and shortness
of breath. He denied a family history of hypercoagulable disorders, or
recent travel. Vital signs on arrival: temperature of 37.8 degreeC, heart
rate of 84 beats per minute, respiratory rate of 18 breaths per minute,
blood pressure of 113/80 mmHg, and an oxygen saturation of 93% on room
air. Physical exam revealed a tall, thin, distressed male with absent
breath sounds over the right chest. Routine laboratory analysis was
unremarkable. A chest radiograph (CXR) was consistent with a large
right-sided pneumothorax (PTX) causing lung collapse [Figure 1A]. He
underwent emergent right-sided TT by a trainee via surgical technique.
Follow-up CXR revealed adequate tube positioning and resolution of the PTX
[Figure 1B]. Once admitted, a computed tomography (CT) scan of his chest
was obtained because of noticeable output of blood clots from the chest
tube and increasing chest pain reported by the patient. The chest CT
revealed the chest tube traversing a transpulmonary, intraparenchymal
route through the anterior segment of the right upper lobe [Figure 2A-B].
Pulmonary and cardiothoracic surgery consultations were obtained. The
chest tube was subsequently removed at bedside and the patient was
monitored with serial CXR to ensure sustained expansion of the right lung.
DISCUSSION: Intraparenchymal chest tube placement has been identified as
one of the most common and dangerous complications of TT. Risk factors for
intraparenchymal chest tube placement include: presence of pleural
adhesions, using a trocar method of insertion, and operator inexperience.
In a study of 61 TT performed by trainees, 35% resulted in identifiable
procedural complications, 53% of which were the result of tube malposition
[2]. Management of tube malposition largely revolves around the use of
imaging to assess proper tube position. Traditionally, CXR was used due to
its availability and cost-effectiveness. However, when compared to chest
CT, CXR was shown to be less accurate in the assessment of tube position
[3]. Complications of chest tube malposition include lung laceration,
hemothorax, and development of bronchopleural fistulas.
 CONCLUSION(S): Early signs of chest tube malposition such as
inadequate drainage is often overlooked. Therefore, it is prudent that
clinicians tasked with insertion or management of chest tubes be cognizant
of the complications of chest tube malposition. Reference #1: Hernandez
MC, El Khatib M, Prokop L, Zielinski MD, Aho JM. Complications in tube
thoracostomy: Systematic review and meta-analysis. The journal of trauma
and acute care surgery. 2018;85(2):410. Reference #2: Ball CG, Lord J,
Laupland KB, Gmora S, Mulloy RH, Ng AK, et al. Chest tube complications:
how well are we training our residents? Canadian Journal of Surgery.
2007;50(6):450. Reference #3: Lim K-E, Tai S-C, Chan C-Y, Hsu Y-Y, Hsu
W-C, Lin B-C, et al. Diagnosis of malpositioned chest tubes after
emergency tube thoracostomy: is computed tomography more accurate than
chest radiograph? Clinical imaging. 2005;29(6):401-5. DISCLOSURES: No
relevant relationships by Armin Krvavac, source=Web Response No relevant
relationships by Naleen Patel, source=Web Response No relevant
relationships by Tarang Patel, source=Web Response No relevant
relationships by Sarah Steenson, source=Web Response Copyright ©
2020 American College of Chest Physicians

<126>
Accession Number
2008026122
Title
CARDIAC TEMPONADE AS INITIAL PRESENTATION OF ADENOCARCINOMA OF LUNG.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A1425), 2020. Date of Publication: October 2020.
Author
Khan A.; Khan S.; Zafar R.; Caniglia M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case
Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary
cardiac tumors are extremely uncommon and mostly cardiac tumors are
associated with metastases from secondary tumors. Here we describe a case
of a patient with primary lung cancer presenting with cardiac tamponade on
initial presentation. CASE PRESENTATION: 70 years old male active smoker
who presented to the emergency room for the complain of shortness of
breath (SOB).He had Chest x-ray done which showed possible lower lobe
infiltrates and was given antibiotics and sent home. He again presented to
hospital four days later for worsening SOB. A CTA chest was done to rule
out pulmonary embolism (PE) which was negative for PE but showed large
pericardial effusion and left upper lobe small nodule. Patient had urgent
ECHO done which showed very large effusion with tamponade physiology and
also showed masses on free wall of left and right ventricles concerning
for metastases. Cardiothoracic surgery was consulted and patient underwent
pericardial window procedure. He also underwent CT guided biopsy of lung
nodule which was consistent with moderately differentiate adenocarcinoma.
His pericardial fluid cytology was also consistent with Metastatic
adenocarcinoma. Post operatively patient did well and oncology service was
consulted for cancer management. DISCUSSION: Metastatic tumors to heart
are rare, although the lung cancer is the most common malignant tumor,
review of literature showed only few cases of cardiac metastases
associated with lung cancer. Various studies have shown the incidence of
cardiac metastases ranging between 2.3% to 18.3% 1. Lung Cancer, melanoma
and mediastinal primary tumors are the most common cancers associated with
cardiac metastases. Bussani and etal reported adenocarcinoma as the most
common lung cancer metastasizes to the heart in 26% of cases, followed by
squamous cell carcinoma in 23.4% cases. One study showed Epicardium (88%)
and pericardium (5-11%) are the most common site of cardiac metastasis and
endocardium (< 3%) is the least involve site. 2 Metastases to heart occurs
by direct extension, via blood stream, lymphatics and intracavitary
diffusion through either the inferior vena cava or the pulmonary veins.
Coronary arteries evaluation is recommended as they get compressed by
metastatic tumor.3 Chemotherapy, radiotherapy, and surgery are the
treatment options but usually prognosis is poor. CONCLUSION(S):
Cardiac metastases are rare and high index of suspicion is required as
variety of complications may occur due to metastasis including cardiac
tamponade needing urgent pericardiocentesis. In patients with cardiac
metastases a thorough evaluation should be performed to find secondary
cancers. Reference #1: Bussani R, De-Giorgio F, Abbate A. Cardiac
metastases. J Clin Pathol 60: 27-34, 2007. Reference #2: Abe S, Watanabe
N, Ogura S. Myocardial metastasis from primary lung cancer: myocardial
infarction-like ECG change and pathologic findings. Jpn J Med 30: 213-218,
1991. Reference #3: Butany J, Nair V, Naseemuddin A. Cardiac tumours:
diagnosis and management. Lancet Oncol 6: 219-228, 2005. DISCLOSURES: No
relevant relationships by Michael Caniglia, source=Web Response No
relevant relationships by Adnan Khan, source=Web Response No relevant
relationships by Sana Khan, source=Web Response No relevant relationships
by Ramsha Zafar, source=Web Response Copyright © 2020 American
College of Chest Physicians

<127>
Accession Number
2008025841
Title
STROKE AND CONGESTIVE HEART FAILURE IN A PATIENT WITH CONGENITAL
DEXTROCARDIA AND SINGLE VENTRICLE AFTER FONTAN PROCEDURE.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A292), 2020. Date of Publication: October 2020.
Author
Abdelmalek J.; Elmassry M.; El Nawaa S.E.N.; Sethi P.; Test V.
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: Fontan's procedure is the definitive palliative surgery
for patients with single ventricle, creating permanent cavopulmonary
circulation. CASE PRESENTATION: This is a 19-year-old male who was
diagnosed with situs solitus with isolated dextrocardia, TGA, single
ventricle with pulmonary and tricuspid atresia at birth. The patient had a
series of cardiac corrective surgeries ending with permanent fenestrated
Fontan's total cavopulmonary connection. Post-operatively, he developed
thromboembolic stroke, and was found to have an extensive thrombus within
the left pulmonary artery with extension to Fontan's baffle. He was
treated with Warfarin with improvement of his neurological deficit.
Cardiac MRI later showed moderate atrioventricular valve regurgitation
(AVVR) and his ejection fraction (EF) was 33%. Patient is currently
managed with Warfarin as well as congestive heart failure (CHF)
guideline-directed medical therapy. DISCUSSION: Patients treated
surgically with palliative Fontan's procedure are prone to thromboembolic
events [1,2] due to coagulation abnormalities associated with hepatic
congestion and increased right-to-left shunting. They need to be
chronically anticoagulated [3]. Heart failure usually also ensues due to
sudden drop in preload filling of the chronically volume-overloaded
ventricle leading to significantly reduced cardiac output.
 CONCLUSION(S): Understanding the new cardiac hemodynamic physiology
after corrective surgeries and their complications, is pivotal for timely
diagnosis and treatment of adult congenital heart disease patients.
Reference #1: Odegard KC, McGowan FX Jr, Zurakowski D, et al. Procoagulant
and anticoagulant factor abnormalities following the Fontan procedure:
increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc
Surg. 2003;125(6):1260-1267. doi:10.1016/s0022-5223(02)73605-2 Reference
#2: Wilson DG, Wisheart JD, Stuart AG. Systemic thromboembolism leading to
myocardial infarction and stroke after fenestrated total cavopulmonary
connection. Br Heart J. 1995;73(5):483-485. doi:10.1136/hrt.73.5.483
Reference #3: Alsaied T, Alsidawi S, Allen CC, Faircloth J, Palumbo JS,
Veldtman GR. Strategies for thromboprophylaxis in Fontan circulation: a
meta-analysis. Heart. 2015;101(21):1731-1737.
doi:10.1136/heartjnl-2015-307930 DISCLOSURES: No relevant relationships by
John Abdelmalek, source=Web Response No relevant relationships by Saif El
Naser El Nawaa, source=Web Response No relevant relationships by Mohamed
Elmassry, source=Web Response No relevant relationships by pooja sethi,
source=Web Response No relevant relationships by Victor Test, source=Web
Response Copyright © 2020 American College of Chest Physicians

<128>
Accession Number
2008025731
Title
EMPYEMA NECESSITANS: A LESSON ON SOURCE CONTROL.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A424), 2020. Date of Publication: October 2020.
Author
Alexander K.; Adhikari P.
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: Empyema necessitans is an uncommon complication of an
empyema. It results from spread of pleural space infection into soft
tissues of the thoracic wall, forming an abscess. CASE PRESENTATION: 39
y/o woman presented with dyspnea and fever. CT chest showed a complex
right sided empyema with parapneumonic pleural effusion. Right tube
thoracostomy was performed. She had subsequent decline requiring
vasopressor support and intubation with mechanical ventilation. She was
started on broad spectrum antibiotics. Pleural fluid culture grew
streptococcus constellatus and peptostreptococcus micros. Her antibiotics
were de-escalated to Ertapenem after reviewing sensitivities. She was
extubated in 3 days, chest tube was removed, and she was transferred out
of ICU. On the floor, she required oxygen by nasal cannula, had
intermittent fevers, and her WBC remained elevated, despite appropriate
antibiotics. She developed tenderness, warmth, erythema, and induration,
along her right lateral chest wall. CT chest showed development of
loculated pleural fluid collection laterally in the right chest, as well
as complex fluid collection in the posterior right lateral chest wall.
Right thoracotomy with partial pulmonary decortication and drainage of
chest wall abscess was performed. Her febrile episodes stopped, she was
weaned off oxygen and her WBC normalized. DISCUSSION: Empyema necessitans
occurs due to suppurative spread from the pleural space into adjacent soft
tissues. In the case of our patient, this led to development of right
sided chest wall abscess. Despite treatment with appropriate antibiotics
and tube thoracostomy, our patient did not exhibit significant clinical
improvement until the focus of her infection was adequately addressed. In
cases of treatment failure, the position, and catheter lumen of the
thoracostomy tube should be evaluated. Additionally, imaging can determine
if the pleural fluid collection is complex, for example loculated, or if
there has been development of a complication, such as empyema necessitans
or bronchopleural fistula. In the case of a complicated empyema,
additional chest tube placement, and/or use of intrapleural fibrinolytics
are viable treatment options. If these measures fail, escalation to
video-assisted thoracic surgery (VATS) is an option. In our literature
review, one meta-analysis highlighted the comparison of VATS vs tube
thoracostomy, revealing no statistically significant difference in
mortality or procedural complications, however, the mean length of
hospital stay was reduced for those treated with VATS. CONCLUSION(S):
Complicated empyema can be managed with tube thoracostomy, with escalation
to VATS if necessary. It can result in a rare complication of empyema
necessitans, in which case, development of thoracic wall abscess must be
addressed. This particular case highlights the importance of source
control in achieving resolution of the underlying infection. Reference #1:
Garvia, Veronica. and Manju Paul. "Empyema." StatPearls, StatPearls
Publishing, 2020. Reference #2: Redden, Mark D et al. "Surgical versus
non-surgical management for pleural empyema." The Cochrane database of
systematic reviews vol. 3,3 CD010651. 17 Mar. 2017,
doi:10.1002/14651858.CD010651.pub2 Reference #3: Lagunes, Leonel et al.
"Current understanding in source control management in septic shock
patients: a review." Annals of translational medicine vol. 4,17 (2016):
330. doi:10.21037/atm.2016.09.02 DISCLOSURES: No relevant relationships by
Prakash Adhikari, source=Web Response No relevant relationships by Krystal
Alexander, source=Web Response Copyright © 2020 American College
of Chest Physicians

<129>
Accession Number
2008025443
Title
A CASE OF CARDIAC TAMPONADE ASSOCIATED WITH CENTRAL LINE PLACEMENT.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A1915-A1916), 2020. Date of Publication: October 2020.
Author
Ayzenbart V.; Franco-Palacios D.; Kollipara V.; Epps M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE:
Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020
INTRODUCTION: Each year over five million central venous catheters are
inserted. With the subclavian approach, catheter malposition (9.3%) and
hemo-or pneumothorax (1.3%) were the most common mechanical complications
based on a meta-analysis of over 4000 central lines. Here, we describe a
rare case of subclavian central line-associated cardiac tamponade with a
favorable outcome. CASE PRESENTATION: A 41-year-old woman with a history
of sickle cell-beta thalassemia presented with acute diffuse myalgia. Her
vital signs were only notable for hypertension (175/102 mmHg). On
admission, her hemoglobin was 6.5 g/dL and peripheral access was unable to
be obtained to administer a blood transfusion. Immediately after an
unsuccessful right subclavian vein central line placement, patient
developed acute chest pain and dyspnea. She then became hypotensive
despite fluid resuscitation and required intubation and vasopressor
initiation. Compared to her admission chest X-ray, her X-ray after the
attempt showed a widening of the vascular pedicle, vanishing of the azygos
vein, and a mild cardiac enlargement. In the ICU she was in refractory
shock requiring norepinephrine, vasopressin, phenylephrine and epinephrine
drips. Bedside echocardiogram showed a large pericardial effusion with
right atrial and ventricular diastolic collapse. Emergent
pericardiocentesis drained 400 mL of sanguineous fluid followed by
improved hemodynamics with rapid weaning off all vasopressors. Computed
tomography of the chest revealed extensive bilateral middle and basilar
lung consolidations but no vasculature abnormalities. Patient's
respiratory status improved, she was extubated, and she recovered well.
DISCUSSION: Our patient's symptoms and chest X-ray findings after the
attempt are suggestive of blood extravasation due to traumatic right
subclavian puncture and tamponade development due to catheter tip entering
into the pericardial space. Tamponade physiology occurs when pericardial
fluid or blood compresses all cardiac chambers decreasing venous return,
decreasing diastolic chamber compliance, lowering cardiac output, and
causing cardiogenic shock. Out of a few reports of cardiac tamponade post
central line placement, only one patient did not suffer death or severe
anoxic brain insult. In most cases, mortality was due to cardiac or
superior vena cava perforation. Our case highlights a further need for
simulation-based training with ultrasonography in applying practice
guidelines for central venous access provided by the American Society of
Anesthesiologist Task Force during and after residency to decrease the
rate of complications. CONCLUSION(S): Cardiac tamponade is a rare
complication of central line placement and should be suspected in patients
with respiratory distress, chest pain, or refractory shock. More
simulation-based training is necessary to improve central line placement
competency. Reference #1: McGee D, Gould M. Preventing complications of
central venous catheterization. N Engl J Med. 2003; 348:1123-1133.
Reference #2: Barsuk J, McGaghie W, Cohen E, et al. Use of
simulation-based mastery learning to improve the quality of central venous
catheter placement in a medical intensive care unit. J Hosp Med. 2009;
4(7):397-403. Reference #3: Apfelbaum J, Rupp S, Tung A, et al. Practice
guidelines for central venous access 2020: an update report by the
American Society of Anesthesiologists Task Force on central venous access.
Anesthesiology. 2020; 132:8-43. DISCLOSURES: No relevant relationships by
Vira Ayzenbart, source=Web Response No relevant relationships by Michael
Epps, source=Web Response No relevant relationships by Domingo
Franco-Palacios, source=Web Response No relevant relationships by
Venkateswara Kollipara, source=Web Response Copyright © 2020
American College of Chest Physicians

<130>
Accession Number
2008025245
Title
ACUTE PERICARDIAL EFFUSION IN A MIDDLE AGED MAN WITH COVID-19.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A2547-A2548), 2020. Date of Publication: October 2020.
Author
Rajevac H.; Khan Z.; Djurdjevic N.; Bachan M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med
Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION:
COVID-19 is caused by SARSCoV-2 virus which affects many organs, but
mostly the respiratory system. We report a case of COVID-19 disease
associated with acute moderate pericardial effusion. CASE PRESENTATION: 53
year old man with history of OSA, DM type 2, HTN, obesity and HLD had
fever, chills and cough for which he was treated with Azithromicin for 5
days as an outpatient. However, on day 6 he presented to the hospital with
diarrhea, fever, chills and a productive cough. He denied chest pain,
palpitations, PND, orthopnea, previous cardiac issues. In the ED, his
vitals were: T 102 F, HR 87/min, BP 181/94 mmHg, O2 Sat 96% on RA. On
chest auscultation he had scattered bi-basilar rhonchi, and muffled heart
sounds, no JVD. Laboratory: WBC 3.4 K/cmm, Hgb 12.1 g/dl, Plt 166 K/cmm,
Na 131, K 5.5, Cr 2.3, BUN:33, pro BNP 187; troponin negative. COVID PCR
assay (+), EKG: low voltage QRS, no ischemic changes. Chest CT scan showed
moderate size pericardial effusion, small scattered low attenuation patchy
areas throughout both lungs. He was started on
Azithromycin/Hydroxychloroquine and given a dose of Tocilizumab. Previous
transthoracic ECHO 5 years ago was normal. On hospital day 3 he developed
worsening of hypoxic respiratory failure and was intubated. He
subsequently developed severe ARDS.Repeated EKG with low voltage QRS, no
cardiac ischemia, troponin level peaked up to 0.13, and trended down to
0.04, CPK 586 U/L. The patient developed worsening renal failure, remained
intermittently hypotensive requiring vasopressors, and hypoxemic to 70s
despite maximal ventilator settings. On day 8 he became bradycardic,
developed PEA and passed away. DISCUSSION: COVID-19 is caused by SARS COV
2 RNA beta coronavirus. Fever, cough, dyspnea are most common symptoms.
Troponemia has been described as a cardiac manifestation of COVID-19 [1].
Most common radiological findings are ground glass opacities (88.0%),
bilateral involvement (87.5%), and multilobarity (78.8%)[2]. Pericardial
effusion can be acute or chronic. Most common causes are viruses,
bacteria, rheumatological diseases, malignancy, trauma and idiopathic.
Changes like pericardial effusion are very rarely described in COVID
infected patients, mentioned with disease progression[2,3]. Our case had a
moderately sized pericardial effusion on initial presentation before he
developed worsening of hypoxic respiratory failure. Upon review of the old
EKGs and CXR patient did not have any signs of pericardial effusion.
Radiological finding of pericardial effusion may also be a poor prognostic
sign of COVID-19, which may be explained by escalation of the severe
systemic inflammatory response. Limitations of this case are no ECHO or
pericardiocentesis were done due Infection control recommendations for
COVID -19 at the time. CONCLUSION(S): Pericardial effusion can be
associated with COVID-19 infection, and may be an indicator of more severe
disease. Reference #1: Cardiac Involvement in a Patient With Coronavirus
Disease 2019 (COVID-19).Inciardi RM1, Lupi L1, Zaccone G1, Italia L1,
Raffo M1, Tomasoni D1, Cani DS1, Cerini M1, Farina D2, Gavazzi E2, Maroldi
R2, Adamo M1, Ammirati E3, Sinagra G4, Lombardi CM1, Metra M1. Reference
#2: Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging
Findings in 919 Patients.Salehi S1, Abedi A1, Balakrishnan S1,
Gholamrezanezhad A1 Reference #3: Imaging and clinical features of
patients with 2019 novel coronavirus SARS-CoV-2Xi Xu,#1 Chengcheng Yu,#2
Jing Qu,2 Lieguang Zhang,2 Songfeng Jiang,2 Deyang Huang,2 Bihua Chen,2
Zhiping Zhang,2 Wanhua Guan,2 Zhoukun Ling,2 Rui Jiang,2 Tianli Hu,2 Yan
Ding,2 Lin Lin,2 Qingxin Gan,2 Liangping Luo,corresponding author1
Xiaoping Tang,corresponding author2 and Jinxin Liucorresponding author2
DISCLOSURES: No relevant relationships by Moses Bachan, source=Web
Response No relevant relationships by Nikola Djurdjevic, source=Web
Response No relevant relationships by Zinobia Khan, source=Web Response No
relevant relationships by Hana Rajevac, source=Web Response Copyright
© 2020 American College of Chest Physicians

<131>
Accession Number
2008024790
Title
WHAT IS IN HIS RIGHT VENTRICLE? AN UNUSUAL AND LIFE-THREATENING
PRESENTATION OF VTE.
Source
Chest. Conference: CHEST 2020 Annual Meeting. 158 (4 Supplement) (pp
A2078-A2079), 2020. Date of Publication: October 2020.
Author
Raymond-Forde S.; Elwing J.; Mcloughlin R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Fellows Pulmonary Vascular Disease Posters SESSION TYPE:
Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION:
Acute pulmonary embolism (PE) with right heart thrombi is a rare and
high-risk presentation of venous thromboembolism, with an estimated
incidence of 4 -18% (1) and mortality of 27.1% with treatment, 90.9-100%
without treatment. There is no expert consensus regarding optimal
management, with treatment decisions individualized by the managing
clinician and available expertise at the treating facility. CASE
PRESENTATION: A 78-year old man with non-obstructive coronary artery
disease presented to a rural hospital with exertional chest pain
associated with shortness of breath, dizziness, and diaphoresis. Blood
pressure was 85/57mmHg, with a repeat of 106/70mmHg, pulse 116,
respiratory rate 19, oxygen saturation 92% on room air. Physical
examination revealed tachycardia, clear lung fields, and mild bilateral
lower extremity edema without calf tenderness. Electrocardiogram showed
sinus tachycardia with ST depression in lateral leads, T wave inversion
with Q waves in inferior leads. Troponin I was elevated at 0.05 ng/ml, BNP
1112 pg/ml. Chest radiography was normal. Subsequent troponin was
0.07ng/ml. Echocardiography showed a dilated right ventricle with severe
systolic dysfunction with a serpentine, mobile density extending from the
right atria to the right ventricular apex and into the pulmonic valve,
measuring 108mm x15mm (Fig 1). There was severe pulmonary hypertension
with pulmonary artery pressure estimated at 80mmHg. CT pulmonary
angiography showed a saddle pulmonary embolism and heavy clot burden in
both main pulmonary arteries and multiple lobar branches (Fig 2). He
received thrombolysis followed by unfractionated heparin infusion.
Treatment was complicated by mild epistaxis. Echocardiography after 72
hours showed dissolution of the right heart thrombus, and systolic
pressure significantly improved at 38mmHg. He was discharged on hospital
day three on rivaroxaban. DISCUSSION: Pulmonary embolism complicated by
right heart thrombi is a rare clinical entity. Thrombolytic therapy is
indicated for high-risk PE, defined by persistent hypotension, and select
cases of intermediate-risk PE, defined by hemodynamic stability with right
ventricular dysfunction and elevated troponin levels. Thrombolysis,
compared to anticoagulation with heparin, leads to a more rapid resolution
of pulmonary obstruction and a reduction in pulmonary artery pressure
(2,3). Small case series and case reports have reported similar success
with thrombolysis and surgical embolectomy for PE with right heart
thrombi. Surgical embolectomy is proposed by the pulmonary embolism
response team in its 2019 recommendations for pulmonary embolism with
right heart thrombi and high clot burden. CONCLUSION(S): Pulmonary
embolism with right heart thrombi is a severe manifestation of venous
thromboembolic disease requiring prompt and definitive therapy. Systemic
thrombolytic therapy may be an acceptable option if bleeding risk is low.
Reference #1: 1. Free-floating thrombi in the right heart: diagnosis,
management, and prognosis in 38 consecutive cases. L, Bera J et al.
Circulation: June 1, 1999; 99(21):2779-83. Reference #2: 2. 2019 ESC
Guidelines for the diagnosis and management of acute pulmonary embolism
developed in collaboration with the European Respiratory Society (ERS):
The Task Force for the diagnosis and management of acute pulmonary
embolism of the European Society of Cardiology (ESC) Reference #3: 3.
Comparative efficacy of different modalities for treatment of right heart
thrombi in transit: a pooled analysis. Athappan G, Sengodan P, Chacko P,
Gandhi S Vasc Med. 2015 Apr; 20(2):131-8. DISCLOSURES: Chair of a
Committee relationship with PHA Please note: PHA Medically Led Sessions,
PHA Preceptorship Added 05/22/2020 by Jean Elwing, source=Web Response
Removed 05/22/2020 by Jean Elwing, source=Web Response Educator
relationship with PH CME Programs - PHA, Simply Speaking, Impact PH Please
note: Intermittent, Ongoing Added 05/22/2020 by Jean Elwing, source=Web
Response, value=Honoraria Principal Investigator relationship with
Actelion, Arena, Reata, United Therapeutics Please note: Ongoing -
University is Paid Directly Added 05/22/2020 by Jean Elwing, source=Web
Response, value=Grant/Research Support Advisory Committee Member
relationship with United Therapeutics Please note: $5001 - $20000 Added
06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee
Principal Investigator relationship with Lung LLC, Liquidia, Phase Bio,
Complexa, Gossamer Bio Please note: Ongoing - University is Paid Directly
Added 05/22/2020 by Jean Elwing, source=Web Response, value=Grant/Research
Support Member of a Committee relationship with PHA Please note: PHA
Education Committee Added 05/22/2020 by Jean Elwing, source=Web Response
Removed 05/22/2020 by Jean Elwing, source=Web Response Advisory Committee
Member relationship with Liquidia, Acceleron Please note: $1001 - $5000
Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee
Advisory Committee Member relationship with Acceleron Please note: $5001 -
$20000 Added 06/05/2020 by Jean Elwing, source=Web Response,
value=Consulting fee Removed 06/05/2020 by Jean Elwing, source=Web
Response No relevant relationships by ROBERT MCLOUGHLIN, source=Web
Response No relevant relationships by Sharon Raymond-Forde, source=Web
Response Copyright © 2020 American College of Chest Physicians

<132>
Accession Number
2007975240
Title
A SYSTEMATIC REVIEW AND META-ANALYSIS OF 45 RANDOMIZED STUDIES USING
PROTOCOL-DRIVEN ASSESSMENT OF SAPHENOUS VEIN GRAFT PATENCY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S93), 2020. Date of Publication:
October 2020.
Author
Ribeiro R.; Lee J.; Friedrich J.; Ouzounian M.; Verma S.; Yanagawa B.
Institution
(Ribeiro, Lee, Friedrich, Ouzounian, Verma, Yanagawa) TorontoONCanada
Publisher
Elsevier Inc.
Abstract
Background: The saphenous vein (SV) is still the most commonly used
conduit for coronary artery bypass grafting (CABG). Data on graft patency
varies widely between studies. Here, we performed a systematic review and
meta-analysis only of studies using protocol-driven angiogram and CT
angiogram (CTA) to determine SV graft patency and identify risk factors
for graft occlusion. Methods and Results: We searched MEDLINE and
EMBASE databases to May 2019 for randomized clinical trials published
after 2000 which assessed SV graft patency following CABG with
protocol-driven angiography or CTA. Data was extracted by two independent
investigators. Primary outcome was SV graft patency. We identified 45
randomized clinical trials reporting on 8497 patients. SV graft patency
was 93% (92-95%), 85% (82-89%), and 86% (80-92%) at 6 months, at 18
months, and beyond 3 years. Diabetes (risk ratio [RR] 1.13, 95% CI:
1.01-1.26, p=0.03), off-pump CABG (RR 1.30, 95% CI: 1.08-1.56, p=0.005),
target vessel size < 1.5mm (RR 1.36, 95% CI: 1.14-1.61, p<0.001), and
endoscopic vein harvest (RR 1.25, 95% CI: 1.07-1.46, p=0.005) were
associated with increased risk for graft occlusion. Target vessel
territory, severity of native vessel stenosis, and antiplatelet therapy
were not associated with graft occlusion in our study. Conclusion(s):
This is the largest meta-analysis of SV graft patency focusing on
protocol-drive angiograms and CTA. We report 80-92% mid-term patency in
the modern CABG era. These rates are similar to those reported for second
arterial grafts and are better than SV patency rates reported in studies
reporting clinically-driven post-CABG angiography. Copyright ©
2020

<133>
Accession Number
2007975237
Title
DEVELOPMENT AND EVALUATION OF A PREOPERATIVE PREPARATION PROGRAM FOR
PARENTS OF CHILDREN UNDERGOING FONTAN SURGERY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S26), 2020. Date of Publication:
October 2020.
Author
Rehman J.; Rempel G.; Williams E.; Meakins L.; Bauman M.; Massicotte P.;
Davis R.; Dahl J.; Mackie A.
Institution
(Rehman, Rempel, Williams, Meakins, Bauman, Massicotte, Davis, Dahl,
Mackie) EdmontonABCanada
Publisher
Elsevier Inc.
Abstract
Background: The Fontan operation is performed at 2-4 years of age and is
the final surgical intervention needed in children with a univentricular
heart. Prior work by our team identified that parent's perspectives of
major challenges post Fontan include a) psychological distress, b)
prolonged pleural drainage resulting in lengthy hospitalizations, and c)
the need for postoperative anticoagulation. The aim of this study was to
develop and evaluate a video-based online teaching program for parents to
address these challenges. Methods and Results: We conducted a
single-center mixed-methods cluster randomized controlled trial of an
educational intervention vs. control. The educational intervention
consisted of three brief (~5 minute) professionally-developed whiteboard
videos, available to parents online from the time of enrolment in the
preadmission clinic to 1 month postoperatively. Each video addressed one
of the unique post- Fontan challenges described above. Content of videos
was created by a parent with lived experience and team members. The
primary outcome was the parent's State Trait Anxiety Inventory
(STAI)-State score 1-week post-surgery. Secondary endpoints were a) parent
STAI-State score 1-month postoperatively, b) the child's Post Hospital
Behaviour Questionnaire (PHBQ) score 1 week and 1 month postoperatively (a
measure of resilience, i.e. the capacity to cope with stress), and c)
parent feedback on the videos, including semi-structured interviews. We
enrolled 26 children (13 females) and one parent per child, 16 into the
intervention group. Mean STAI-State score 1 week postoperatively was 52.8
+/- 6.5 vs. 55.5 +/- 3.9 in the intervention and control groups
respectively (p=0.25). One month postoperatively, mean STAI-State score
was 50.9 +/- 6.7 vs. 53.9 +/- 3.9 respectively (p=0.25). PHBQ scores were
in the maladaptive range but did not differ between study groups.
Pre-operatively, 71-86% of parents agreed or strongly agreed that the
videos were helpful; 89-100% of parents agreed or strongly agreed that the
videos were helpful by 1-month postoperatively. Intervention group parents
who were interviewed generally agreed that the videos would be of more
benefit if they offered "more detail" and were provided earlier in the
pre-operative preparation process. Participants recognized the main value
of the videos as being a method for standardizing information provided to
parents. Conclusion(s): An online video-based intervention program
did not impact STAI-State scores or PHBQ scores. However, the majority of
parents agreed that the videos were helpful, particularly when their child
was 1-month post-surgery. Qualitative findings will inform future
educational video development for parents of children undergoing cardiac
surgery. Women and Children's Health Research Institute
(WCHRI) Copyright © 2020

<134>
Accession Number
2007975215
Title
CLINICAL EFFECTIVENESS OF CONTINUOUS-FLOW LVAD THERAPY IN NON-ISCHEMIC
VERSUS ISCHEMIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S61-S62), 2020. Date of Publication:
October 2020.
Author
Yin C.; Wavell C.; Sokolowski A.; Klingel M.; Nagpal D.
Institution
(Yin, Wavell, Sokolowski, Klingel, Nagpal) LondonONCanada
Publisher
Elsevier Inc.
Abstract
Background: Left ventricular assist devices (LVADs) are being increasingly
used to manage patients with symptomatic end-stage heart failure (ESHF)
refractory to medical and resynchronization therapies. Although clinicians
may be less inclined to consider long-term LVAD therapy in ESHF as a
result of non-ischemic cardiomyopathy (NICM) due to potentially greater
right ventricular (RV) involvement than ischemic cardiomyopathy (ICM), it
is currently unknown whether HF etiology has a clinically meaningful
effect on outcomes following LVAD implantation. In this systematic review,
we set out to determine whether ischemic versus non-ischemic etiology has
any impact on patient-relevant outcomes. Methods and Results:
MEDLINE, EMBASE, PubMed and Cochrane Library were searched for studies
that examined survival and transplant rates following LVAD implantation in
NICM or ICM patients. Two investigators independently screened citations
identified from our search with discrepancies settled by discussion. Two
reviewers independently extracted the data from included studies.
Disagreements were resolved by review by a third reviewer. Quality of
included studies was assessed using the Newcastle-Ottawa Quality
Assessment Scale for Cohort Studies. From a total of 2,843 citations
identified, seven studies met all inclusion criteria. Studies were
generally of good quality, however reporting of patient demographics,
outcomes and complications was heterogenous. We found no significant
difference in 30-day (OR = 1.82 [0.67-4.97]) or 1-year survival (OR = 1.00
[0.47-2.12]), or in transplant rates post-device implantation (OR = 0.47
[0.16-1.39]) between NICM and ICM groups. Patients were found to have
similar outcomes up to one year on LVAD therapy. The majority of studies
that met inclusion criteria did not report patient survival beyond the
1-year mark. Conclusion(s): Heart transplantation continues to be the
gold standard treatment for patients with medically-refractory ESHF.
Unfortunately, the availability of donor organs continues to be limited.
Fortunately, durable LVAD support has emerged as a viable strategy for
bridging ESHF patients to transplant and as destination therapy. The
results of our systematic review suggest that early outcomes of LVAD
therapy do not appear to be impacted by heart failure etiology up to one
year post-device implantation. Our findings suggest that there are no
differences in short- or medium-term outcomes following LVAD therapy in
patients with ICM vs NICM. However, further investigation will be required
to delineate the long-term outcomes of LVAD therapy in ICM and NICM beyond
the 1-year mark. [Formula presented] [Formula presented] Copyright
© 2020

<135>
Accession Number
2007975214
Title
METFORMIN CONTINUATION VERSUS INTERRUPTION FOLLOWING CORONARY ANGIOGRAPHY:
CONTEMPORARY RISK OF LACTIC ACIDOSIS. A PILOT SINGLE-CENTER RANDOMIZED
CONTROL TRIAL.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S112-S113), 2020. Date of
Publication: October 2020.
Author
Shavadia J.; Minhas R.; Orvold J.; Basran R.; Wells C.; Devilliers J.;
Pearce C.; Eckstein J.; Pausjenssen E.; Haddad H.; Mangipudi R.; Rana M.
Institution
(Shavadia, Minhas, Orvold, Basran, Wells, Devilliers, Pearce, Eckstein,
Pausjenssen, Haddad, Mangipudi, Rana) SaskatoonSKCanada
Publisher
Elsevier Inc.
Abstract
Background: Metformin-associated lactic acidosis occurs very infrequently;
however, with the significantly greater comorbidity burden and acuity of
patients with diabetes undergoing coronary angiography/angioplasty (CA),
the inherent risk of metformin-associated lactic acidosis may be
significantly increased. Additionally, significant variations in
contemporary practice pattern around peri-CA metformin use still continue
to exist. Methods and Results: This is a pilot, single-center,
open-labelled, randomized comparison of metformin continuation or 48-hour
interruption following CA (Saskatoon, Clinical Trials.gov 03980990). All
patients had metformin continued to the time of the angiogram. Patients
presenting with cardiogenic shock, cardiac arrest, history of chronic
liver disease, severe chronic kidney disease (eGFR<30 or on dialysis) or
requiring coronary artery bypass graft surgery following CA were
ineligible for inclusion. Planned enrollment of 500 patients had been
anticipated for the calendar year (June 2019-June 2020), and stratified at
randomization by in/out-patient status. The primary outcome included
lactic acidosis (lactate >=5mmol/L +/- bicarbonate <18mmol/l) at 48-72
hours after CA. Key secondary outcomes included: absolute lactate levels,
acute kidney injury (AKI, >=25% or 27mumol/L rise at 48-72 hours) and
all-cause mortality at 1-week. Continuous variables are expressed as
medians (25th, 75th percentile) and categorical variables as frequency
(%). At study interruption (March 12/20, COVID-19) 312 patients had been
randomized, of whom 52% presented with an acute coronary syndrome (n=
161/312; STEMI 11%). Baseline characteristics were balanced across the two
groups, including the proportion treated with PCI (Table 1). Follow up
lactate levels were available in: continued arm 71% (n=112/157), interrupt
arm 67% (n=104/155). No patients in either arm had serum lactate
>=5mmol/L, however, metformin continuation compared with a 48-hour
interruption had significantly higher median lactate levels (1.70 [1.15,
2.2] vs. 1.40 [1.2, 1.8], p=0.02); no between-group differences were
evident for serum bicarbonate (26.0 [24, 28] mmol/L vs. 25.0 [24, 27]
mmol/l, p=0.15). No differences were evident in the rates of AKI (7.7% vs.
8.3% p= 1.0). No patients died in either treatment arm at 1-week (vital
status available for all 312 patients). Conclusion(s):
 Conclusion(s): In this interim analysis of contemporary treated
patients with diabetes, all of whom had metformin continued up to CA,
metformin continuation compared with a 48-hour interruption was not
associated with clinically relevant lactic acidosis. Continued metformin
use however appears to associate with higher 48-72-hour lactate levels,
without differences in AKI or all-cause mortality at 1-week. Trial
completion is anticipated with COVID-19 pandemic resolution. [Formula
presented] Royal University Hospital Foundation Copyright © 2020

<136>
Accession Number
2007975150
Title
THE LONG-TERM PROGNOSTIC IMPACT OF NEW-ONSET POSTOPERATIVE ATRIAL
FIBRILLATION IN OLDER PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT
SURGERY: A POPULATION-BASED ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S53-S54), 2020. Date of Publication:
October 2020.
Author
Raslan I.; Rashid M.; Austin P.; Lee J.; Atzema C.; Farkouh M.; Lee D.; Ha
A.
Institution
(Raslan, Rashid, Austin, Lee, Atzema, Farkouh, Lee, Ha) TorontoONCanada
Publisher
Elsevier Inc.
Abstract
Background: Post-operative atrial fibrillation (POAF) after coronary
artery bypass graft (CABG) surgery had been associated with death and
adverse cardiovascular (CV) outcomes. However, prior studies were limited
by non-surgical comparator groups, might not have fully excluded those
with prior AF, and consequently could have overestimated the risks
associated with POAF. From a population-based registry, we examined
whether new-onset POAF after CABG was associated with adverse outcomes in
older patients over long-term follow-up. Methods and Results: Using a
provincial registry linked to administrative databases for outcomes, we
conducted a retrospective cohort study of consecutive patients (>65 years)
who underwent isolated CABG in Ontario, Canada between Oct/08-Mar/18.
Index surgeries were identified from the CorHealth Cardiac Registry.
Patients prescribed with oral anticoagulation within 90 days before
surgery were excluded. Diagnoses and outcomes were ascertained from the
CIHI-DAD using the International Classification of Diseases (ICD-10)
coding system. The exposure was a diagnosis of AF identified from a
validated coding algorithm within 90 days post-CABG discharge. The primary
outcome was a composite of death, myocardial infarction (MI), stroke, or
non-central nervous system thromboembolism (TE). Multivariable Cox
proportional regression models were used to examine the association
between POAF and the primary outcome. Cause-specific multivariable
competing risk models were performed to analyze the association between
POAF and: (i)CV death or (ii)MI/stroke/TE. The start of follow-up began on
day#90 (time=0) after discharge from CABG surgery. End of follow-up was
death or Mar/31/19, whichever came first. The cohort consisted of 23,774
patients (median age: 72 years (IQR=68-76) and 22% women) of whom 6,693
(28.9%) patients had POAF within 90 days of discharge after CABG. The
total follow-up was 118,368 person-years and the primary outcome
(death/MI/stroke/TE) occurred in 1,474 (6.4%) patients. After
multivariable adjustment, POAF was associated with an increased rate of
death/MI/stroke/TE (HR 1.17, 95% CI 1.05-1.31). Older age, COPD, history
of MI, diabetes, HF, PVD, and CKD were also associated with worse outcomes
(figure). POAF was associated with greater rate of all-cause mortality (HR
1.25, 95% CI 1.08-1.44) and CV death (HR 1.48, 95% CI 1.09-2.00) but was
not associated with increased rate of MI/stroke/TE (HR 1.11, 95% CI
0.95-1.29). Conclusion(s): Among patients who underwent isolated
CABG, new-onset POAF was associated with mortality but not ischemic CV
outcomes over long-term follow-up. Risk stratification to identify
patients at highest risk of ischemic CV outcomes may help inform the
design of future randomized trials examining the impact of oral
anticoagulation in the POAF+CABG population. [Formula presented] Canadian
Cardiovascular Society Atrial Fibrillation (AF) Award Copyright ©
2020

<137>
Accession Number
2007975129
Title
IMPACT OF APPROPRIATE ECHOCARDIOGRAPHY USE ON UTILIZATION OF CARDIAC
SERVICES AND OUTCOMES IN PATIENTS WITH HEART FAILURE OR CORONARY ARTERY
DISEASE: A RETROSPECTIVE COHORT STUDY OF THE ECHO WISELY RANDOMIZED
CONTROLLED TRIAL.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S86), 2020. Date of Publication:
October 2020.
Author
Mir H.; Chu C.; Bouck Z.; Sivaswamy A.; Austin P.; Dudzinski D.; Nesbitt
G.; Edwards J.; Yared K.; Wong B.; Hansen M.; Weinerman A.;
Thavendiranathan P.; Johri A.; Rakowski H.; Picard M.; Weiner R.; Bhatia
R.
Institution
(Mir, Chu, Bouck, Sivaswamy, Austin, Dudzinski, Nesbitt, Edwards, Yared,
Wong, Hansen, Weinerman, Thavendiranathan, Johri, Rakowski, Picard,
Weiner, Bhatia) TorontoONCanada
Publisher
Elsevier Inc.
Abstract
Background: Interventions aimed at reducing low-value care and testing may
be effective in changing physician practice. While important, such
interventions may also lead to unintended consequences. These include
under- or over-utilization of ancillary testing or adverse clinical
outcomes. Our objective was to determine the impact of an intervention
aimed at reducing the proportion of rarely appropriate transthoracic
echocardiography (TTE) on utilization of ancillary services and clinical
outcomes for patients with a previous diagnosis of coronary artery disease
(CAD) and/or congestive heart failure (HF). Methods and Results: A
retrospective cohort of outpatients with CAD and HF was obtained using
administrative databases to identify patients with at least one visit to
an Ontario-based Cardiologist in a randomized controlled trial (the
EchoWISELY Study) between April 30, 2015 and April 30, 2016. Cardiologists
were randomized to either receive audit-and-feedback on the appropriate
use criteria for TTE or to perform usual practice. The primary outcomes
were related to healthcare utilization and included rates of diagnostic
and therapeutic testing within 30 days and 1 year of the index visit, and
physician visit within 1 year of index visit. The secondary outcomes were
adverse clinical events such as hospitalization and death within 1 year of
index visit. The CAD and HF cohort each consisted of 70 physicians, of
which 37 were in the control group and 33 were in the intervention group.
A total of 4,877 CAD patients and 2,311 HF patients were included in the
analysis. There was no difference between control and intervention groups
in the utilization of diagnostic and therapeutic procedures such as
cardiac catheterization (20.0% vs 16.7%; P-value 0.41), number of
physician visits within 1-year (18.4% vs 18.7%; P-value 0.83), all-cause
hospitalization (34.3% vs 31.3%; P-value 0.44) or death (4.1% vs 4.8%;
P-value 0.94) in the CAD group. Similarly, there was no difference between
control and intervention groups in the utilization of diagnostic and
therapeutic procedures such as cardiac catheterization (20.0% vs 19.4%;
P-value 0.38), number of physician visits within 1-year (29.4% vs 29.3%;
P-value 0.84), all-cause hospitalization (60.0% vs 53.6%; P-value 0.35) or
death (18.2% vs 14.8%; P-value 0.72) in the HF group. Conclusion(s):
This study provided reassurance that despite implementation of an
intervention within a larger randomized controlled trial that successfully
reduced rarely appropriate TTE, there was no difference in the utilization
of ancillary testing or clinical outcomes such as patient visits,
hospitalization, or death among patients with CAD or HF. [Formula
presented] [Formula presented] Canadian Institutes of Health Research
(CIHR), Heart and Stroke Foundation of Canada Copyright © 2020

<138>
Accession Number
2007975109
Title
POLYGENIC CONTRIBUTION TO LOW-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS AND
CARDIOVASCULAR RISK IN MONOGENIC FAMILIAL HYPERCHOLESTEROLEMIA.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S93), 2020. Date of Publication:
October 2020.
Author
Brunham L.; Trinder M.; Paquette M.; Baass A.
Institution
(Brunham, Trinder, Paquette, Baass) OttawaONCanada
Publisher
Elsevier Inc.
Abstract
Background: Familial hypercholesterolemia (FH) is the most common
autosomal dominant genetic disorder, and causes elevated levels of
low-density lipoprotein cholesterol (LDL-C) and increased risk of
atherosclerotic cardiovascular disease (ASCVD). Even among patients with
monogenic FH, there is substantial interindividual variability in LDL-C
levels and risk of ASCVD. We assessed the influence of an LDL-C polygenic
score on levels of LDL-C and risk of ASCVD for individuals with monogenic
FH. Methods and Results: We constructed a weighted LDL-C polygenic
score, composed of 28 single-nucleotide variants, for individuals with
monogenic FH from the British Columbia FH (n=275), Nutrition, Metabolism
and Atherosclerosis Clinic (n=552), and UK Biobank cohorts (n=289). We
assessed the association between LDL-C levels and ASCVD risk with LDL-C
polygenic score using linear regression and Cox-proportional hazard
models, respectively. ASCVD was defined as myocardial infarction, coronary
or carotid revascularization, transient ischemic attack, or stroke. The
results from individual cohorts were combined in fixed-effect
meta-analyses. Levels of LDL-C were significantly associated with LDL-C
polygenic score in the Nutrition, Metabolism and Atherosclerosis Clinic
cohort (beta=0.763, SE=0.225), UK Biobank cohort (beta=0.545, SE=0.228),
and in the meta-analysis (beta [95% CI] = 0.597 [0.297-0.896]).
Additionally, an elevated LDL-C polygenic score (>=80th percentile) was
associated with a trend towards increased ASCVD risk in all 3 cohorts
individually. This association was statistically significant in the
meta-analysis (hazard ratio [95% CI] = 1.52 [1.03-2.24], p=0.036).
 Conclusion(s): Polygenic contributions to LDL-C can help explain the
heterogeneity in clinical presentation and ASCVD risk of individuals with
monogenic FH, and may help to refine risk prediction in FH. Canadian
Institutes of Health Research - Canada Research Chairs Program, Michael
Smith Foundation, Vanier Canada Graduate Scholarship Copyright ©
2020

<139>
Accession Number
2007975097
Title
EFFICACY AND SAFETY OF LOW INTENSITY VITAMIN K ANTAGONISTS IN WESTERN AND
EAST-ASIAN POPULATIONS OF LEFT-SIDED MECHANICAL HEART VALVE PATIENTS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S96), 2020. Date of Publication:
October 2020.
Author
Pandey A.; Xu K.; Zhang L.; Gupta S.; Eikelboom J.; Belley-Cote E.;
Whitlock R.
Institution
(Pandey, Xu, Zhang, Gupta, Eikelboom, Belley-Cote, Whitlock)
HamiltonONCanada
Publisher
Elsevier Inc.
Abstract
Background: The optimal INR target with vitamin K antagonist (VKA) therapy
in patients with mechanical heart valves is unclear. Although higher INR
targets are often used in Western countries, data from randomized
controlled trials (RCTs) have suggested that lower INR targets may offer
reduced bleeding rates without a significant difference in thromboembolic
rates. Lower INR targets are frequently used in East-Asia. The objective
of this systematic review and meta-analysis was to evaluate the effects of
lower versus higher INR targets in Western and East-Asian populations on
rates of thromboembolism and bleeding in left-sided mechanical heart valve
patients. Methods and Results: We searched Western databases
including Cochrane CENTRAL, Medline, and Embase as well as Chinese
databases including SinoMed, CNKI, and Wanfang Data for RCTs and
observational studies evaluating effects of lower versus higher INR
targets in patients with left-sided contemporary mechanical heart valves.
We pooled risk ratios (RRs) using a random-effects model separately for
Western and East-Asian data, and tested for interaction. We identified
eight RCTs (n=5,616) including two (n=120) from East Asia, as well as 19
observational studies (n=9,059), including 16 (n=5,574) from East Asia.
The median INR target of the low INR groups was <= 2.0 in 16 of 18
East-Asian studies and 5 of 9 Western studies. In the RCTs, lower compared
with higher INR targets were associated with similar rates of
thromboembolism (2.4% vs. 2.3%; RR: 1.15, 95% CI: 0.82, 1.61, I2=0%) and
lower rates of bleeding (22.3% vs. 41.2%, RR: 0.47, 95% CI: 0.27, 0.81,
I2=89%), with no statistical evidence of heterogeneity by region (Western
vs. East Asian). In observational studies, lower INR targets, compared
with higher INR targets, were also associated with similar rates of
thromboembolism (3.2% vs. 5.8%; RR: 0.77, 95% CI: 0.52, 1.14, I2=31%) and
lower rates of bleeding (5.1% vs. 11.7%, RR: 0.30, 95% CI: 0.24, 0.38,
I2=15%). There was significant heterogeneity in thromboembolism by region
(p-for-interaction=0.02). Lack of reporting on major bleeding and
mortality in East-Asian studies precluded analysis of these outcomes.
 Conclusion(s): In patients with left-sided contemporary mechanical
heart valves, lower INR targets, compared with higher INR targets, are
associated with similar rates of thromboembolism and lower rates of
bleeding. Copyright © 2020

<140>
Accession Number
2007975095
Title
ADENOSINE DIPHOSPHATE RECEPTOR INHIBITOR MONOTHERAPY WITH TICAGRELOR OR
CLOPIDOGREL FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC
REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S31-S32), 2020. Date of Publication:
October 2020.
Author
Haghbayan H.; Durocher D.; Coomes E.; Lavi S.
Institution
(Haghbayan, Durocher, Coomes, Lavi) LondonONCanada
Publisher
Elsevier Inc.
Abstract
Background: In patients undergoing percutaneous coronary intervention
(PCI) with implantation of coronary stents, the risk of stent thrombosis
is mitigated with antiplatelet therapy. While current clinical practice is
to treat patients with dual antiplatelet therapy (DAPT), combining aspirin
with an adenosine diphosphate receptor inhibitor (ADPri), prolonged
therapy is associated with heightened bleeding risk. Limiting DAPT to a
shorter period after PCI, followed by ADPri monotherapy, may be an
attractive strategy for optimizing the balance between thrombotic and
bleeding risks. While several randomized controlled trials (RCTs) have
been published examining this strategy, the optimal duration of
abbreviated DAPT run-in and the ideal choice of ADPri remain uncertain.
 Methods and Results: We undertook a systematic review and
meta-analysis of RCTs assessing abbreviated DAPT followed by ADPri
monotherapy post coronary stenting. Primary outcomes were defined as
clinically important bleeding, major adverse cardiovascular events (MACE),
and all-cause mortality. We searched MEDLINE and EMBASE from their
inceptions to November 2019 with study selection and data extraction
performed in duplicate. We pooled data at one year using random effects
models; relative risks (RRs) with 95% confidence intervals (95%CIs) were
generated using the inverse variance method. Pre-specified sub-group
analyses were undertaken according to duration of DAPT and primary ADPri
employed. Four trials (n=29084) were eligible for inclusion. Mean age was
65 years and 51.5% of patients were recruited in the context of acute
coronary syndrome. Following meta-analysis, the occurrence of clinically
significant bleeding events was significantly lower in patients receiving
ADPri monotherapy (4 studies; n=29084; RR=0.60; 95%CI, 0.43-0.83; I2=73%;
Figure-A), with no significant difference in the rates of all-cause
mortality (4 studies; n=29084; RR=0.87; 95%CI, 0.71-1.06; I2=0%; Figure-B)
or MACE (4 studies; n=29084; RR=0.90; 95%CI, 0.79-1.03; I2=1%; Figure-C).
In subgroup analysis, trends toward lower rates of both all-cause
mortality (2 studies; n=23082 participants; RR=0.81; 95%CI, 0.65-1.01;
I2=0%; Figure-B) and MACE (2 studies; n=23082 participants; RR=0.90;
95%CI, 0.79-1.03; I2=25%; Figure-C) were seen in the studies employing
ticagrelor as opposed to clopidogrel; however, neither analysis reached
statistical significance (p-values=0.06 and 0.19, respectively). There was
no differential treatment effect based on the duration of abbreviated DAPT
prior to ADPri monotherapy in sub-group analysis. Conclusion(s):
Following PCI in patients with coronary disease, an abbreviated course of
DAPT followed by ADPri monotherapy significantly reduces rates of bleeding
with no difference in rates of MACE or all-cause mortality. [Formula
presented] Copyright © 2020

<141>
Accession Number
2007975094
Title
SIGNIFICANT CARDIOVASCULAR BENEFITS OF ICOSAPENT ETHYL FROM REDUCE-IT.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S114-S115), 2020. Date of
Publication: October 2020.
Author
Bhatt D.; Steg P.; Miller M.; Brinton E.; Jacobson T.; Ketchum S.; Juliano
R.; Jiao L.; Doyle R.; Granowitz C.; Tardif J.; Verma S.; Ballantyne C.
Institution
(Bhatt, Steg, Miller, Brinton, Jacobson, Ketchum, Juliano, Jiao, Doyle,
Granowitz, Tardif, Verma, Ballantyne) BostonMAUnited States
Publisher
Elsevier Inc.
Abstract
Background: Statin-treated patients with established cardiovascular
disease or diabetes remain at high risk for ischemic events. We explored
if icosapent ethyl (IPE), a stable, prescription high-dose
eicosapentaenoic acid (EPA) ethyl ester, reduces major cardiovascular
events in such patients, and if serum EPA correlated with risk reductions
 Methods and Results: REDUCE-IT, a global, placebo-controlled trial,
randomized statin-treated patients with controlled LDL-cholesterol,
elevated triglycerides, and established cardiovascular disease (71%) or
diabetes plus risk factors (29%) to IPE 4 g/day or placebo; 4.9-year
median follow-up. The primary (cardiovascular death, nonfatal myocardial
infarction [MI], nonfatal stroke, coronary revascularization, or unstable
angina) and key secondary (cardiovascular death, nonfatal MI, or nonfatal
stroke) endpoints were analyzed by time to first and total (first and
subsequent) events. IPE reduced the primary (22.0% versus 17.2%, HR 0.75
95%; CI, 0.68-0.83; P= 0.000000016; NNT=21) and key secondary (14.8%
versus 11.2%, HR 0.74; 95% CI, 0.65-0.83; P= 0.0000006; NNT=28) (Figure).
Total primary (89 versus 61 per 1000 patient years, RR 0.70, 95% CI
0.62-0.78, P=0.00000000036) and key secondary (44 versus 23 per 1000
patient years, RR 0.72, 95% CI 0.63-0.82, P=0.0000007) endpoint events
were (Figure). On-treatment EPA strongly correlated with risk reductions
(primary, key secondary, cardiovascular death, MI, stroke, coronary
revascularization, unstable angina, sudden cardiac death, cardiac arrest,
new heart failure, all-cause mortality). Serious adverse event rates
statistically greater with IPE were low, including a small but significant
increase in atrial fibrillation/flutter (AF/F), and a non-statistically
significant increase in serious bleeding. On-study AF/F was more likely as
recurrent (i.e., in patients with a AF/F history; absolute risk difference
[ARD]=6.23%; p=0.003) than as new onset AF/F (ARD=0.56%; p=0.08).
Important for benefit-risk considerations, compared to patients without
these events, patients with these events experienced similar primary and
key secondary endpoint reductions, including patients with a history of
atrial fibrillation/flutter (interaction p-values=0.37 and 0.55,
respectively), on-study atrial fibrillation/flutter (interaction
p-values=0.37 and 0.40), or bleeding events (interaction p-values=0.95 and
0.99). Conclusion(s): In statin-treated patients with controlled
LDL-cholesterol, elevated triglycerides, and cardiovascular disease or
diabetes, IPE 4 g/day significantly and substantially reduced the risk of
first and subsequent ischemic events. On-treatment EPA strongly correlated
with event reductions, providing mechanistic underpinnings for the sizable
risk reductions. Serious adverse events that occurred at higher rates with
IPE, were low overall, and patients experienced similar substantial
cardiovascular benefit. As a first-in-class therapy approved in the United
States and Canada, IPE is an important option for cardiovascular risk
reduction in at-risk patients. [Formula presented] Amarin Pharma
Inc. Copyright © 2020

<142>
Accession Number
2007975073
Title
EFFECT OF BARIATRIC SURGERY ON NATRIURETIC PEPTIDE LEVELS: A SYSTEMATIC
REVIEW AND META ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S64-S65), 2020. Date of Publication:
October 2020.
Author
Anvari S.; Lee Y.; Lam M.; Wong J.; Hong D.; Doumouras A.
Institution
(Anvari, Lee, Lam, Wong, Hong, Doumouras) HamiltonONCanada
Publisher
Elsevier Inc.
Abstract
Background: Natriuretic peptides have established roles as biomarkers for
monitoring heart failure, as well as predictors of cardiovascular
mortality. Paradoxically, patients with obesity have been shown to have
lower circulating natriuretic peptide levels despite increased rates of
hypertension and cardiovascular disease. Bariatric surgery has been shown
to lead to sustained weight loss. However, the effect of bariatric surgery
and associated weight loss on BNP and NT-proBNP levels is unclear. The
purpose of this study was to conduct a systematic review and meta-analysis
of the literature to determine the effect of bariatric surgery on BNP and
NT-proBNP levels. Methods and Results: MEDLINE, EMBASE, and Cochrane
Central Register of Controlled Trials (CENTRAL) were searched to February
2020. Primary outcomes included change in NT-proBNP or BNP levels
following bariatric surgery, as well as change in weight and body mass
index (BMI). Secondary outcomes included change in blood pressure,
echocardiographic findings, and symptoms of heart failure, if reported.
MINORS tool was used to assess quality of evidence. Twelve studies with a
total of 622 patients were included. The majority of patients underwent
Roux-en-Y gastric bypass (RYGB) (70.5%),. Mean absolute reduction in BMI
was 23%. NT-proBNP levels increased significantly from baseline at both 6
months (mean difference (MD) 53.67 pg/mL; 95% CI, 28.72-78.61; P = <0.001,
I2 = 99%; 8 studies) and 12 months (MD 51.16 pg/mL; 95% CI, 20.46-81.86; P
= 0.001, I2 = 99%; 8 studies) post-bariatric surgery. BNP levels also
increased significantly at 6 months (MD 17.57 pg/mL; 95% CI, 7.62-27.51; P
<0.001, I2 = 95%; 4 studies). Systolic and diastolic blood pressure
decreased significantly 12 months following bariatric surgery. Studies
that measured echocardiographic findings saw improvement in LV mass and
E/A ratio, but no significant change in ejection fraction.
 Conclusion(s): Bariatric surgery is associated with an increase in
natriuretic peptide levels, which may be an important mediator associated
with the improvement in cardiac function observed after the
procedure. Copyright © 2020

<143>
Accession Number
2007975061
Title
STORY OF A SMALL SCAR: ANALYSING THE EVIDENCE FOR MINIMALLY INVASIVE
MITRAL VALVE SURGERY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2020. 36 (10 Supplement) (pp S106), 2020. Date of Publication:
October 2020.
Author
Eqbal A.; Gupta S.; Basha A.; Qiu Y.; Wu N.; Rega F.; Chu F.; Belley-Cote
E.; Whitlock R.
Institution
(Eqbal, Gupta, Basha, Qiu, Wu, Rega, Chu, Belley-Cote, Whitlock)
HamiltonONCanada
Publisher
Elsevier Inc.
Abstract
Background: Minimally invasive mitral valve surgery (MMVS) is increasingly
used. While proponents argue reduced transfusion rates and shorter
hospital stays, whether this approach leads to better long-term outcomes
remains unclear. We conducted a systematic review and meta-analysis
comparing MMVS to conventional sternotomy for mitral valve surgery.
 Methods and Results: We searched Cochrane CENTRAL, MEDLINE, EMBASE,,
and the ISRCTN Register for randomized controlled trials (RCTs) and
observational studies comparing MMVS techniques (thoracotomy, port access,
partial sternotomy, or robotic) to conventional sternotomy for mitral
valve surgery. We performed title and abstract, full-text screening, and
data extraction independently and in duplicate. We pooled data using
random effect models. Eight RCTs and 111 observational studies (total
n=38,106) met eligibility criteria. Data presented below compare all MMVS
approaches to conventional sternotomy. Patients who underwent MMVS spent
significantly fewer days in hospital (RCTs: MD-2.23, 95%CI[-3.67, -0.80],
p=0.002, I2=94%; observational studies: MD-2.33, 95%CI[-2.64, -2.02],
p<0.001, I2=98%). In observational studies, MMVS was associated with a
lower risk of surgical site complications (RR0.65, 95%CI[0.48, 0.88],
p<0.01, I2=0%). RCT data supported this trend but was not significant
(RR0.38, 95%CI[0.14, 1.03], p=0.06, I2=0%). The risk of re-exploration for
bleeding did not differ between groups (RCT: RR0.65, 95%CI[0.21, 1.98],
p=0.44, I2=0%; observational studies: RR0.98, 95%CI[0.82, 1.16], p=0.78,
I2=0%). Observational studies also suggested that MMVS is associated with
reduced transfusion requirements with both fewer units transfused per
patient (MD-1.23, 95%CI[-1.56, -0.90], p<0.001, I2=95%) and fewer patients
transfused (RR0.65, 95%CI[0.58, 0.73], p<0.001, I2=84%). However, this was
not confirmed by RCTs (units transfused per patient: MD-1.62, 95%CI[-4.09,
0.85], p=0.20, I2=99%; number of patients transfused: RR0.93, 95%CI[0.61,
1.44], p=0.76, I2=0%). Adverse events, including all-cause mortality
(3.4%) and thromboembolic events (1.8%), were rare. Nonetheless,
observational studies suggested lower mortality with MMVS (RR0.59,
95%CI[0.52, 0.68], p<0.001, I2=0%), but this was not corroborated by RCT
data (RR0.99, 95%CI[0.43, 2.26], p=0.97, I2=0%). The risk of significant
post-operative mitral regurgitation (>=2+ or requiring re-intervention)
did not differ between the two groups at latest follow-up (RCT: RR0.76,
95%CI[0.17, 3.40], p=0.72, I2=0%, mean follow-up 2.11+/-1.53 years;
observational studies: RR1.18, 95%CI[0.75, 1.85], p=0.47, I2=34%, mean
follow-up 3.77+/-0.45 years). Conclusion(s): Based on the current
evidence, MMVS is associated with shorter length of hospital stay with no
significant difference in short-term morbidity and mortality. However,
there remains a paucity of data on the long-term outcomes of MMVS when
compared to conventional sternotomy. Copyright © 2020

<144>
Accession Number
2007968678
Title
Intravenous Iron or Red Blood Cell Supplementation and Risk of Serious
Infection in Left Ventricular Assist Device Patients.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2020. 26 (10 Supplement) (pp S137), 2020.
Date of Publication: October 2020.
Author
Siddiqi H.K.; Vieira J.; Pfeffer M.; Coakley L.; Stewart G.C.; Mallidi
H.R.; Givertz M.M.; Mehra M.R.
Institution
(Siddiqi, Vieira, Coakley, Stewart, Mallidi, Givertz, Mehra) Brigham and
Women's Hospital, Boston, MA, United States
(Pfeffer) Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Patients with durable left ventricular assist devices
(LVADs) are at high risk for serious infection and associated mortality.
Furthermore, these patients also have a high prevalence of iron deficiency
due to ongoing hemolysis, increased propensity for gastrointestinal
bleeding, and dysregulated iron metabolism that accompanies mechanical
circulatory support and heart failure. Intravenous (IV) iron-related
supplementation [IVIRS, including IV iron infusion or red blood cell
transfusion (RBC)] has been hypothesized to increase risk of infection.
Hypothesis: IVIRS (IV iron infusion or RBC transfusion) is associated with
an increased risk of serious infection in LVAD patients. Method(s):
This is a single center, retrospective, observational cohort study of 211
consecutive adult patients [median age 57.2 years
(25th-75th percentile: 48.7-65.7 years), 19% female]
who were discharged and followed after de-novo LVAD implantation between
May 2008 and December 2019. Patients were followed until either end of the
study period, or occurrence of death, heart transplantation, or LVAD
removal/replacement, whichever came first. All administration of IVIRS and
diagnosis of serious infection after discharge from index hospitalization
was abstracted from the electronic medical record. Serious infection was
defined as the first incident infection requiring hospitalization, divided
into LVAD-associated infections (pump/cannula, pocket or driveline
infection) and non-LVAD infections. Multivariate logistic regression was
used to examine the association between IVIRS and serious infections.
 Result(s): Over a median follow-up of 15.2 months
(25th-75th percentile: 6.9-29.4 months), 69 (33%)
LVAD patients received IVIRS, of whom 47 (68%) received IV iron and 44
(64%) received RBC transfusion. During follow-up, 87 (41%) patients
suffered a serious infection, of which 48 (55%) were LVAD-associated
infections and 39 (45%) were non-LVAD infections. After adjustment for
age, sex, diabetes, chronic kidney disease, prior cardiac surgery,
destination therapy and pre-IVIRS serious infection, LVAD patients who
received IVIRS had 2.85 times higher odds of any first serious infection
compared to those who did not receive IVIRS during the study period (95%
CI 1.49-5.46, p=0.002). Patients who received IVIRS had a significant 3.03
times greater odds of non-LVAD infection (95% CI 1.37-6.70, p=0.006) and a
non-significant 1.54 times greater odds of LVAD infection (95% CI
0.75-3.18, p=0.24), compared to LVAD patients who did not receive IVIRS.
 Conclusion(s): IVIRS use is associated with a higher risk of serious
infection in LVAD patients, primarily due to serious non-LVAD infections.
These findings merit further study in larger cohorts and randomized trials
to determine best practices surrounding IVIRS in LVAD
patients. Copyright © 2020

<145>
Accession Number
2007968677
Title
Should We Continue Wasting Hearts? Outcomes of Heart Transplantation From
Hepatitis C Donors: A Systematic Literature Review.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2020. 26 (10 Supplement) (pp S37), 2020.
Date of Publication: October 2020.
Author
Villegas-Galaviz J.; Guglin M.
Institution
(Villegas-Galaviz, Guglin) Indiana University School of Medicine,
Indinapolis, IN, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: The number of patients dying awaiting heart transplantation
(HT) can be reduced through HT from Hepatitis C nucleic acid test positive
donors (HCV+D) to negative recipients (HCV-R). This strategy remains
underused. Objective(s): Analyze the outcomes of HT from HCV+D to
HCV-R, of several transplant centers in the era of direct-acting antiviral
therapy (DAA). Method(s): We searched for literature published from
January 2015 to April 2020 with "Hepatitis C Virus" & "Heart
Transplantation" as keywords. Result(s): We identified 195 HT from
HCV+D to HCV-R, done in 12 centers, reported as part of clinical studies,
case reports, or case series. There were no deaths reported due to HCV
infection in recipients of HCV+D and their survivals at 1, 6, and 12
months were 96.2, 93.2, and 89.3 percent, respectively (table 1).
Sustained virologic response at 12 weeks (SVR-12) was achieved in all
cases where the data were available. HCV was transmitted via HT to 97.6%
of the reported subjects, and all with viremia received DAA. DAA was
started after identifying viremia (delayed strategy) in 10 centers, and in
2 of them preemptively (immediately after HT). DAA duration was intended
for 12 weeks in the delayed regimen, and 4 in the preemptive, with no
difference in SVR-12. Within the preemptive regimen, no changes or
extension of DAA were reported, while 5 subjects in the delayed regimen
required either changes or extensions (to 24 weeks) of the initial DAA.
 Conclusion(s): HCV is highly contagious via HT. Current DAA provides
an excellent cure rate, with all cases reported to date achieving SVR-12.
For those under a preemptive regimen, no changes or extension in DAA were
required. Recipients of hearts from HCV+D had an excellent survival, and
no deaths related to HCV were reported. Copyright © 2020

<146>
Accession Number
2007968555
Title
The Prognosis and Predictors of Recovered Ejection Fraction Heart Failure:
A Systematic Review and Meta-analysis.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2020. 26 (10 Supplement) (pp S124-S125),
2020. Date of Publication: October 2020.
Author
Altaie S.; Elkolaly S.S.; Khalife W.
Institution
(Altaie, Khalife) UTMB, galveston, TX, United States
(Elkolaly) Menoufia University, Shebin Elkom, Menoufia, Egypt
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: HFrecEF is a new entity included among the other types of
heart failure. It represents the improvement of LVEF above the upper limit
of HFrEF which usually ranges from 40 to 55%. Hypothesis: We aimed to
assess the predictors, measures of mortality and hospitalization of
HFrecEF to compare it with HFrEF and HFpEF. Method(s): We conducted a
systematic search in eight databases; PubMed, Scopus, Web of Science,
Google Scholar, New York Academy of Medicine (NYAM), System for
Information on Grey Literature in Europe (SIGLE), Global Health Library
(GHL) and Virtual Health Library (VHL). Our primary endpoint was assessing
the prognosis of HFrecEF in comparison with HFrEF and HFpEF. The secondary
endpoint was assessing the predictors of LVEF recovery. Result(s):
Three-hundred eighty-two records were retrieved from the searched
databases. After screening for eligibility criteria, 18 articles were
chosen for qualitative synthesis and 15 articles were chosen for
quantitative synthesis. All the prognostic measures including all-cause
mortality, cardiovascular mortality, all-cause hospitalization,
cardiovascular hospitalization and HF hospitalization were significantly
lower in HFrecEF than HFrEF (RR= 0.58; 95% CI= 0.45-0.7, RR= 0.41; 95% CI=
0.29-0.58, RR= 0.75; 95% CI= 0.61-0.94, RR= 0.75; 95% CI= 0.73-0.78, RR,
0.56; 95% CI= 0.4-0.78 respectively) (Figures 1, 2, 3). The difference
between HFrecEF and HFpEF patients regarding all-cause mortality was
insignificant (Figure 1). Female gender, younger age, less severity of HF
condition and lower rates of previous indications of CABG surgeries and
defibrillator placements were associated with higher rates of LVEF
recovery. Conclusion(s): HFrecEF has a significantly different
prognosis from HFrEF, which supports the hypothesis considering it a
separate entity of heart failure types. Copyright © 2020

<147>
Accession Number
2007968544
Title
Outcomes After Bariatric Surgery In Patients With Ventricular Assist
Devices: Systematic Review And Individual Participant Data Meta-analysis.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2020. 26 (10 Supplement) (pp S53), 2020.
Date of Publication: October 2020.
Author
daSilva-deAbreu A.; Alhafez B.A.; Curbelo-Pena Y.; Lavie C.J.; Ventura
H.O.; Loro-Ferrer J.F.; Mandras S.A.
Institution
(daSilva-deAbreu, Lavie, Ventura, Mandras) Ochsner Clinic Foundation, New
Orleans, LA, United States
(daSilva-deAbreu) The UQ Ochsner Clinical School, Faculty of Medicine, The
University of Queensland, New Orleans, LA, United States
(daSilva-deAbreu, Loro-Ferrer) Universidad de Las Palmas de Gran Canaria,
Las Palmas de Gran Canaria, Spain
(Alhafez) The Ohio State University, Columbus, OH, United States
(Curbelo-Pena) Consorci Sanitari de l'Alt Penedes i Garraf, Barcelona,
Spain
(Lavie, Ventura, Mandras) The UQ Ochsner Clinical School, Faculty of
Medicine, The University of Queensland., New Orleans, LA, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Body mass index (BMI) >= 35 kg/m2 is a major
contraindication for heart transplantation (HT). Consequently, many
patients who would otherwise be good HT candidates require ventricular
assist devices (VADs) as destination therapy. Furthermore, some HT
candidates who initially had a BMI < 35 kg/m2 but gained weight
during VAD support may lose their candidacy. All evidence for a potential
role of bariatric surgery (BS) in obese VAD patients comes from small
cohorts and case reports which makes its interpretation challenging.
 Method(s): A systematic search was performed in ClinicalTrials.gov,
Cochrane, Embase and PubMed. Other sources screened included Google
Scholar, meeting proceedings, journal sites, and references cited in
included studies. Selected subjects were obese, adult patients with VADs
who underwent BS and had follow-up BMI data. Result(s): Twelve
references with 29 patients (age 41.9 [+/- 12.2] years, 63.6% male) were
included. The baseline BMI was 45.2 (+/- 6.7) kg/m2. Most
patients (82.8%) underwent sleeve gastrectomy while 17.2% received
Roux-en-Y gastric bypass. Median follow-up was 24 (12-30) months. Eleven
(39.3%) patients had postoperative adverse events after BS. Among the 23
patients with documented listing status (listed vs. not listed for HT)
after BS, 78.3% lost enough weight and were listed for HT. Thirteen
patients underwent HT 14.4 (+/- 7) months after BS, and three patients had
myocardial recovery with VAD explantation after weight loss. Twenty-two of
28 (78.6%) patients achieved the composite outcome of BMI < 35
kg/m2/OHT/listing for OHT/myocardial recovery at 11 (3-17)
months. Figure 1 shows a Kaplan-Meier curve for the composite outcome.
There were no deaths during the HT-free 1-year follow-up.
 Conclusion(s): In VAD patients who are not HT candidates due to
obesity, BS may allow for enough weight loss to improve their candidacy
for HT or even achieve myocardial recovery. Although there were no deaths
reported during HT-free 1-year follow-up, there was a high rate of adverse
events during the postoperative period. However, the rate of these events
may decrease as programs become more experienced with BS in VAD
patients. Copyright © 2020

<148>
Accession Number
2007968493
Title
Effects of Bromocriptine in Peripartum Cardiomyopathy: A Systematic Review
and Meta-analysis.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2020. 26 (10 Supplement) (pp S24), 2020.
Date of Publication: October 2020.
Author
Kittipibul V.; Mahabir S.; Croix G.R.S.; Ibrahim M.; Hernandez G.A.;
Chaparro S.
Institution
(Kittipibul, Mahabir) University of Miami Miller School of Medicine,
Miami, FL, United States
(Croix) Division of Cardiology, Columbia University at Mount Sinai Medical
Center of Florida, Miami beach, FL, United States
(Ibrahim) Division of Cardiovascular Medicine, Boston Medical
Center/Boston University, Boston, MA, United States
(Hernandez) Division of Cardiovascular Diseases, University of Mississippi
Medical Center, Jackson, MS, United States
(Chaparro) Advanced Heart Failure Program, Baptist Health South Florida,
Miami, FL, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially
life-threatening form of heart failure affecting women toward the end
trimester of pregnancy, during delivery, or early postpartum period.
Bromocriptine, a dopamine D2 agonist, has been used as an adjunctive
treatment for PPCM with controversial benefits. Method(s): : A
comprehensive literature search was conducted through April 2020 using
MEDLINE, EMBASE and Scopus. We included studies comparing outcomes of PPCM
with or without bromocriptine use. Pooled risk ratio (RR) with 95%
confidence intervals (CI) and I2 statistic were calculated
using the random-effects model. Complete recovery was defined by
improvement of left ventricular ejection fraction (LVEF) to more than 50%.
Poor outcomes were defined by a composite of death, need for heart
transplant or left ventricular assist device, persistent New York Heart
Association (NYHA) functional class III/V or LVEF <= 35% at 6-month
follow-up. Result(s): We included 8 studies (2 randomized-controlled,
6 observational) involving 593 PPCM patients: 263 (44%) received
bromocriptine. Baseline LVEF was not significantly different between 2
groups: 29.5% in bromocriptine group and 31.8% in control group. LVEF
increased in both groups but LVEF at follow-up was significantly higher in
the bromocriptine group: 53.3% vs. 41.8% with mean difference of 11.9%
(95%CI 5.5-18.4, p<0.001). Bromocriptine use was associated with
significantly higher survival (91.6% vs. 83.9%, RR 1.11 p=0.02, 95%CI
1.01-1.20, I2=0%). Subgroup analysis of 2 randomized-controlled
trials showed a non-significant trend toward higher survival with
bromocriptine treatment (84.5% vs. 69.0%, RR 1.22 P=0.06, 95%CI 0.99-1.49,
I2=0%). There was no significant association between
bromocriptine use and complete recovery (46.9% vs. 46.8%, RR 0.94 p=0.74,
95%CI 0.67-1.33, I2=0%) and composite poor outcomes (13.7% vs.
33.3%, RR 0.60 p=0.54, 95%CI 0.12-3.03, I2=90%).
 Conclusion(s): Our meta-analysis suggests that addition of
bromocriptine to standard HF treatment in PPCM population was associated
with significantly higher LVEF improvement and higher survival. No
association with complete recovery (LVEF >50%) or lower composite adverse
clinical outcomes (death, need for heart transplant or left ventricular
assist device, persistent NYHA functional class III/V or LVEF <= 35%) was
seen. The findings, although encouraging, should be studied in larger
randomized-controlled studies. Copyright © 2020

<149>
Accession Number
2007968366
Title
Intravenous Sodium Ferric Gluconate Complex And Iron Dextran Are Safe For
Administration During Hospitalization For Heart Failure With Reduced
Ejection Fraction.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2020. 26 (10 Supplement) (pp S48), 2020.
Date of Publication: October 2020.
Author
Lavelle R.I.; Unkovic P.R.; Hasan A.K.; Kissling K.T.
Institution
(Lavelle, Unkovic, Hasan, Kissling) The Ohio State University Wexner
Medical Center, Columbus, OH, United States
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Iron deficiency (ID) with or without anemia is common in
patients who have heart failure with reduced ejection fraction (HFrEF).
Several trials have demonstrated improvement in symptoms and exercise
tolerance in response to IV iron in patients with chronic HFrEF. To date,
no large randomized trials evaluating the impact of IV iron on mortality
and hospitalization in acutely decompensated HFrEF patients have been
published. In addition, the interchangeability of IV iron preparations in
this population is unknown. Currently, our institution has only sodium
ferric gluconate complex (SFGC) and iron dextran on inpatient formulary.
Hypothesis: Administration of IV SFGC or iron dextran during
hospitalization for acute decompensated HFrEF reduces mortality and
cardiovascular (CV) hospitalization with a low rate of adverse events.
 Method(s): Single-center, retrospective cohort study of adult
patients with a primary discharge diagnosis of heart failure, a reduced EF
(<40%), and ID admitted between January 2016-October 2019. The
intervention group, consisting of patients who received IV SFGC or iron
dextran during admission, was compared to a control group who did not
receive IV iron. Patients with prior LVADs, heart transplants, or apparent
alternate indications for IV iron were excluded, including those who
received blood transfusions, erythropoietin-stimulating agents or
hemodialysis. All patients who received IV iron (including those excluded
from efficacy analysis for other reasons) comprised the safety population.
The primary outcome was incidence of CV hospitalization or all-cause
mortality within 90 days of discharge. Secondary outcomes included
incidence of adverse events (AEs). Result(s): Of the 141 patients
included in the efficacy analysis, 33 were in the intervention group and
108 were in the control group. Groups were generally well-matched.
Hemoglobin, ferritin, and iron saturation were significantly lower in the
intervention group at baseline. The primary outcome occurred in 45.5% of
intervention group patients and 62% of controls (p=0.091). Among the
safety population (N=82), 45 patients received IV SFGC, 37 iron dextran,
and one both agents. One AE (nausea) was reported. Conclusion(s):
Administration of IV SFGC or iron dextran was associated with a
non-significant reduction in 90-day CV hospitalization or mortality. The
low incidence of reported AEs supports safety of these IV iron
formulations in the study population. Results from large randomized trials
regarding morbidity and mortality are eagerly anticipated. Copyright
© 2020

<150>
Accession Number
2008020913
Title
The patency of graft and anastomoses in sequential and individual coronary
artery bypass grafting: A meta-analysis.
Source
Anatolian Journal of Cardiology. 24 (4) (pp 235-243), 2020. Date of
Publication: October 2020.
Author
Li Y.; Liu B.; Li C.; Yu Y.; Liu X.; Li L.; Li Z.; Duan C.; Luo S.; Hou W.
Institution
(Li, Liu, Yu, Liu, Li, Li, Duan, Hou) Departments of Cardiovascular
Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
(Li) Departments of Operating Room, Affiliated Hospital of Weifang Medical
University, Weifang, China
(Luo) Departments of Public Health Management, Affiliated Hospital of
Weifang Medical University, Weifang, China
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: To compare the patency of graft and anastomoses in sequential
and individual coronary artery bypass grafting (CABG). Method(s): Our
study used the Cochrane Library database, Excerpta Medica database, Web of
Science, and PubMed. Studies comparing the outcomes of graft or
anastomosis patency were assessed independently by two reviewers to
identify the literature of satisfaction. We used Review Manager and STATA
software for statistical analysis. Result(s): Fifteen cohort studies
were analyzed, including 10681 patients, 12957 grafts, and 4341
anastomoses, under sequential and individual CABG. Compared with the
sequential group, the individual one is statistically significant in the
graft patency [risk ratio (RR)=1.07, 95% confidence interval (CI )
1.01-1.13; p=0.02] and anastomosis patency (RR=1.06, 95% CI 1.01-1.12;
p=0.005). Conclusion(s): Our study suggested that the patency of the
individual group, in terms of graft and anastomosis patency, is better
than that of the sequential one. Copyright © 2020 by Turkish
Society of Cardiology.

<151>
Accession Number
2008001844
Title
Structural Deterioration of Transcatheter Versus Surgical Aortic Valve
Bioprostheses in the PARTNER-2 Trial.
Source
Journal of the American College of Cardiology. 76 (16) (pp 1830-1843),
2020. Date of Publication: 20 Oct 2020.
Author
Pibarot P.; Ternacle J.; Jaber W.A.; Salaun E.; Dahou A.; Asch F.M.;
Weissman N.J.; Rodriguez L.; Xu K.; Annabi M.-S.; Guzzetti E.; Beaudoin
J.; Bernier M.; Leipsic J.; Blanke P.; Clavel M.-A.; Rogers E.; Alu M.C.;
Douglas P.S.; Makkar R.; Miller D.C.; Kapadia S.R.; Mack M.J.; Webb J.G.;
Kodali S.K.; Smith C.R.; Herrmann H.C.; Thourani V.H.; Leon M.B.; Hahn
R.T.
Institution
(Pibarot, Ternacle, Salaun, Annabi, Guzzetti, Beaudoin, Bernier, Clavel)
Institut Universitaire de Cardiologie et de Pneumologie de Quebec/Quebec
Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
(Jaber, Rodriguez, Kapadia) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
(Dahou, Alu, Kodali, Smith, Leon, Hahn) Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
(Dahou, Alu, Kodali, Smith, Leon, Hahn) Cardiovascular Research
Foundation, New York, NY, United States
(Asch, Weissman) MedStar Health Research Institute at Washington Hospital
Center, Washington, DC, United States
(Xu, Rogers) Edwards Lifesciences, Irvine, CA, United States
(Leipsic, Blanke, Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, NC, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Miller) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Mack) Baylor Scott & White Healthcare, Plano, TX, United States
(Herrmann) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, Georgia, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: It is unknown whether transcatheter valves will have similar
durability as surgical bioprosthetic valves. Definitions of structural
valve deterioration (SVD), based on valve related reintervention or death,
underestimate the incidence of SVD. Objective(s): This study sought
to determine and compare the 5-year incidence of SVD, using new
standardized definitions based on echocardiographic follow-up of valve
function, in intermediate-risk patients with severe aortic stenosis given
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR) in the PARTNER (Placement of Aortic Transcatheter
Valves) 2A trial and registry. Method(s): In the PARTNER 2A trial,
patients were randomly assigned to receive either TAVR with the SAPIEN XT
or SAVR, whereas in the SAPIEN 3 registry, patients were assigned to TAVR
with the SAPIEN 3. The primary endpoint was the incidence of SVD, that is,
the composite of SVD-related hemodynamic valve deterioration during
echocardiographic follow-up and/or SVD-related bioprosthetic valve failure
(BVF) at 5 years. Result(s): Compared with SAVR, the SAPIEN-XT TAVR
cohort had a significantly higher 5-year exposure adjusted incidence rates
(per 100 patient-years) of SVD (1.61 +/- 0.24% vs. 0.63 +/- 0.16%),
SVD-related BVF (0.58 +/- 0.14% vs. 0.12 +/- 0.07%), and all-cause
(structural or nonstructural) BVF (0.81 +/- 0.16% vs. 0.27 +/- 0.10%) (p
<= 0.01 for all). The 5-year rates of SVD (0.68 +/- 0.18% vs. 0.60 +/-
0.17%; p = 0.71), SVD-related BVF (0.29 +/- 0.12% vs. 0.14 +/- 0.08%; p =
0.25), and all-cause BVF (0.60 +/- 0.15% vs. 0.32 +/- 0.11%; p = 0.32) in
SAPIEN 3 TAVR were not significantly different to a propensity score
matched SAVR cohort. The 5-year rates of SVD and SVD-related BVF were
significantly lower in SAPIEN 3 versus SAPIEN XT TAVR matched cohorts.
 Conclusion(s): Compared with SAVR, the second-generation SAPIEN XT
balloon-expandable valve has a higher 5-year rate of SVD, whereas the
third-generation SAPIEN 3 has a rate of SVD that was not different from
SAVR. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves -
PII A [PARTNERII A]; NCT01314313; The PARTNER II Trial: Placement of
AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate
[PARTNERII S3i]; NCT03222128) Copyright © 2020 American College
of Cardiology Foundation

<152>
Accession Number
2008037684
Title
Atrial Fibrillation and Transcatheter Repair of Functional Mitral
Regurgitation: Evidence From a Meta-Regression.
Source
JACC: Cardiovascular Interventions. 13 (20) (pp 2374-2384), 2020. Date of
Publication: 26 Oct 2020.
Author
Kaur S.; Sadana D.; Patel J.; Gad M.; Sankaramangalam K.; Krishnaswamy A.;
Miyasaka R.; Harb S.C.; Kapadia S.R.
Institution
(Kaur, Patel, Gad) Department of Internal Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Sadana) Department of Pulmonary and Critical Care, Cleveland Clinic,
Cleveland, OH, United States
(Sankaramangalam) Department of Internal Medicine, Saint Peter's
University Hospital/Rutgers Robert Wood Johnson Medical School, New
Brunswick, NJ, United States
(Krishnaswamy, Kapadia) Department of Interventional Cardiology, Cleveland
Clinic, Cleveland, OH, United States
(Miyasaka, Harb) Department of Cardiovascular Imaging, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The aim of this study was to assess the impact of atrial
fibrillation (AF) on mortality and efficacy in patients with functional
mitral regurgitation (FMR) undergoing MitraClip implantation.
 Background(s): AF is a common arrhythmia in patients with severe FMR
undergoing transcatheter mitral valve repair with the MitraClip device.
Although AF has been consistently shown to be associated with poor
outcomes after mitral valve surgery, the impact of AF on outcomes of
MitraClip placement in patients with FMR has not been well studied.
 Method(s): Prospective, retrospective registries, observational
studies, and randomized controlled trials on MitraClip reporting AF and
FMR as one of the variables from inception until January 2019 were
included. Result(s): Of the initial 1,694 studies, 15 studies met the
inclusion criteria. From a total of 5,184 patients, 2,105 patients were
identified to have FMR and AF. All-cause 30-day mortality in patients with
FMR was 3.7% (95% confidence interval: 2.87 to 4.66) and 1-year mortality
was 17.9% (95% confidence interval: 16.01 to 19.71). The meta-regression
analysis studying the impact of AF among patients with FMR treated with
the MitraClip demonstrated no difference in mortality at 30 days but
demonstrated significantly increased mortality at 1 year (95% confidence
interval: 0.0006 to 0.0027) (p = 0.004). AF did not influence procedural
success. Conclusion(s): This meta-regression identifies AF as an
independent negative predictor of long-term mortality after MitraClip
implantation in patients with FMR. The mechanism of worse outcomes in
patients with AF requires further study. Copyright © 2020
American College of Cardiology Foundation

<153>
Accession Number
2008037683
Title
Baseline Functional Capacity and Transcatheter Mitral Valve Repair in
Heart Failure With Secondary Mitral Regurgitation.
Source
JACC: Cardiovascular Interventions. 13 (20) (pp 2331-2341), 2020. Date of
Publication: 26 Oct 2020.
Author
Malik U.I.; Ambrosy A.P.; Ku I.A.; Mishell J.M.; Kar S.; Lim D.S.;
Whisenant B.K.; Cohen D.J.; Arnold S.V.; Kotinkaduwa L.N.; Lindenfeld J.;
Abraham W.T.; Mack M.J.; Stone G.W.
Institution
(Malik, Ambrosy, Ku, Mishell) Department of Cardiology, The Permanente
Medical Group, San Francisco, CA, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Whisenant) Intermountain Medical Center Heart Institute, Salt Lake City,
UT, United States
(Cohen, Arnold) University of Missouri-Kansas City School of Medicine,
Kansas City, MO, United States
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Stone) The 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
Objectives: The aim of this study was to determine the prognostic utility
of baseline functional status and its impact on the outcomes of
transcatheter mitral valve repair (TMVr) in patients with heart failure
(HF) with secondary mitral regurgitation (SMR). Background(s): The
COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous
Therapy for Heart Failure Patients With Functional Mitral Regurgitation)
trial demonstrated that TMVr with the MitraClip in patients with HF with
moderate to severe or severe SMR improved health-related quality of life.
The clinical utility of a baseline assessment of functional status for
evaluating prognosis and identifying candidates likely to derive a robust
benefit from TMVr has not been previously studied in patients with HF with
SMR. Method(s): The COAPT study was a multicenter, randomized,
controlled, parallel-group, open-label trial of TMVr with the MitraClip
plus guideline-directed medical therapy (GDMT) versus GDMT alone in
patients with HF, left ventricular ejection fraction 20% to 50%, and
moderate to severe or severe SMR. Baseline functional status was assessed
by 6-min walk distance (6MWD). Result(s): Patients with 6MWD less
than the median (240 m) were older, were more likely to be female, and had
more comorbidities. After multivariate modeling, age (p = 0.005), baseline
hemoglobin (p = 0.007), and New York Heart Association functional class
III/IV symptoms (p < 0.0001) were independent clinical predictors of 6MWD.
Patients with 6MWD <240 m versus >=240 m had a higher unadjusted and
adjusted rate of the 2-year composite of all-cause death or HF
hospitalization (64.4% vs. 48.6%; adjusted hazard ratio: 1.53; 95%
confidence interval: 1.19 to 1.98; p = 0.001). However, there was no
interaction between baseline 6MWD and the relative effectiveness of TMVr
plus GDMT versus GDMT alone with respect to the composite endpoint (p =
0.633). Conclusion(s): Baseline assessment of functional capacity by
6MWD was a powerful discriminator of prognosis in patients with HF with
SMR. TMVr with the MitraClip provided substantial improvements in clinical
outcomes for this population irrespective of baseline functional
capacity. Copyright © 2020 American College of Cardiology
Foundation

<154>
Accession Number
2008037680
Title
NYHA Functional Classification and Outcomes After Transcatheter Mitral
Valve Repair in Heart Failure: The COAPT Trial.
Source
JACC: Cardiovascular Interventions. 13 (20) (pp 2317-2328), 2020. Date of
Publication: 26 Oct 2020.
Author
Giustino G.; Lindenfeld J.; Abraham W.T.; Kar S.; Lim D.S.; Grayburn P.A.;
Kapadia S.R.; Cohen D.J.; Kotinkaduwa L.N.; Weissman N.J.; Mack M.J.;
Stone G.W.
Institution
(Giustino, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University
College of Medicine, Columbus, OH, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Cohen) University of Missouri-Kansas City School of Medicine, Kansas
City, MO, United States
(Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Weissman) Georgetown University, Washington, DC, United States
(Mack) Baylor Scott and White Heart Hospital Plano, Plano, TX, United
States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate the outcomes of
MitraClip implantation versus guideline-directed medical therapy (GDMT) in
patients with secondary mitral regurgitation (SMR) according to baseline
functional status as assessed by the widely used New York Heart
Association (NYHA) functional classification. Background(s): Patients
with heart failure (HF) and impaired functional status at baseline have
poor prognosis. Whether the effects of transcatheter repair of secondary
SMR in patients with HF are influenced by baseline functional status is
unknown. Method(s): In the COAPT (Cardiovascular Outcomes Assessment
of the MitraClip Percutaneous Therapy for Heart Failure Patients with
Functional Mitral Regurgitation) trial, patients with HF with moderate to
severe or severe SMR who remained symptomatic despite maximally tolerated
GDMT were randomized to MitraClip implantation versus GDMT alone. Outcomes
were evaluated according to baseline functional status as assessed using
the NYHA functional classification. The primary endpoint of interest was
the rate of death or HF-related hospitalization (HFH) at 2 years in
time-to-first-event analyses. Result(s): Among 613 randomized
patients, 240 were in NYHA functional class II (39.2%), 322 were in NYHA
functional class III (52.5%), and 51 were in ambulatory NYHA functional
class IV (8.3%). Rates of death or HFH were progressively higher with
increasing NYHA functional class. Compared with GDMT alone, MitraClip
implantation resulted in lower 2-year rates of death or HFH consistently
in patients in NYHA functional class II (39.7% vs. 63.7%; hazard ratio
[HR]: 0.54; 95% confidence interval [CI]: 0.37 to 0.77), NYHA functional
class III (46.6% vs. 65.5%; HR: 0.60; 95% CI: 0.45 to 0.82), and NYHA
functional class IV (66.7% vs. 85.2%; HR: 0.55; 95% CI: 0.28 to 1.10;
p<inf>interaction</inf> = 0.86). Greater improvements in quality of life
at 2 years were observed in patients treated with the MitraClip compared
with GDMT irrespective of baseline functional status. Conclusion(s):
The NYHA functional classification provides prognostic utility in patients
with HF and moderate to severe or severe SMR. In the COAPT trial, the
benefits of MitraClip implantation were consistent in patients with better
or worse functional status as assessed by NYHA functional class.
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT
Trial] [COAPT]; NCT01626079) Copyright © 2020

<155>
Accession Number
2005207320
Title
The effect of preoperative carbohydrate loading on clinical and
biochemical outcomes after cardiac surgery: A systematic review and
meta-analysis of randomized trials.
Source
Nutrients. 12 (10) (pp 1-21), 2020. Article Number: 3105. Date of
Publication: October 2020.
Author
Kotfis K.; Jamiol-Milc D.; Skonieczna-zydecka K.; Folwarski M.; Stachowska
E.
Institution
(Kotfis) Department of Anesthesiology, Intensive Therapy and Acute
Intoxications, Pomeranian Medical University, Szczecin 70-111, Poland
(Jamiol-Milc, Skonieczna-zydecka, Stachowska) Department of Human
Nutrition and Metabolomics, Pomeranian Medical University in Szczecin,
Szczecin 71-460, Poland
(Folwarski) Department of Clinical Nutrition and Dietetics, Medical
University of Gdansk, Gdansk 80-210, Poland
(Folwarski) Home Enteral and Parenteral Nutrition Unit, General Surgery,
Nicolaus Copernicus Hospital, Gdansk 80-210, Poland
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Background and aim: Preoperative fasting leads to metabolic stress and
causes insulin resistance in patients undergoing cardiac surgery. The aim
of this study was to assess the effect of preoperative oral carbohydrate
loading (OCH) on outcome in patients undergoing planned cardiac surgery by
systematically reviewing the literature and synthesizing evidence from
randomized controlled trials (RCTs). Method(s): Systematic search of
PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was
performed to identify relevant RCTs from databased inception until
05/03/2020. We included studies that compared outcome measures between OCH
with control (placebo or standard starvation). We conducted a
random-effect meta-analysis of clinical and biochemical parameters.
 Result(s): Nine studies (N = 9) were included with a total of 507
patients. OCH significantly decreased aortic clamping duration (n = 151,
standardized mean difference (SMD) = -0.28, 95% confidence interval (CI) =
-0.521 to -0.038, p = 0.023 and differences in means (DM) = -6.388, 95%CI
= -11.246 to -1.529, p = 0.010). Patients from treatment groups had
shorter intensive care unit (ICU) stay (n = 202, SMD = -0.542, 95%CI =
-0.789 to -0.295, p < 0.001 and DM = -25.925, 95%CI = -44.568 to -7.283, p
= 0.006) and required fewer units of insulin postoperatively (n = 85, SMD
= -0.349, 95%CI = -0.653 to -0.044, p = 0.025 and DM = -4.523, 95%CI =
-8.417 to -0.630, p = 0.023). The necessity to use inotropic drugs was
significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI =
0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a
significant effect. Conclusion(s): Preoperative OCH in patients
undergoing cardiac surgery demonstrated a 20% reduction in the use of
inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease
in aortic clamping duration and a 35% decrease of postoperative insulin
requirement. Copyright © 2020 by the authors. Licensee MDPI,
Basel, Switzerland.

<156>
Accession Number
2006953192
Title
Perspectives of Surgeons from Atlanta, USA.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Mohamed Ahmed E.; Chen E.P.
Institution
(Mohamed Ahmed, Chen) Division of Cardiothoracic Surgery, Department of
Surgery, Emory School of Medicine, Atlanta, GA, United States
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: The COVID-19 pandemic in late 2019 quickly stretched health
care system across the globe. Mortalities, shortages in health care system
capacity, and lack of experience in similar circumstances required
innovation in the way health care is delivered. Health care systems
changed operating schedules, staff work pattern, and how patients are
cared for. The effects of these changes reached patients, staff and
training in different ways. Method(s): We searched the Pubmed and
EMBASE for articles related to COVID-19. We also searched local emails and
information provided to staff during the pandemic. Result(s): The
COVID-19 pandemic affected organizations, patients, and staff. The
organizations and staff had to adapt to the times to provide a safe and
appropriate service to our patients. Conclusion(s): The pandemic
challenged and changed the way we work as health care providers, and how
we train the future surgeons. Changes in the system were
effective. Copyright © 2020 Wiley Periodicals LLC

<157>
[Use Link to view the full text]
Accession Number
633088275
Title
A single-dose of stellate ganglion block for the prevention of
postoperative dysrhythmias in patients undergoing thoracoscopic surgery
for cancer: A randomised controlled double-blind trial.
Source
European Journal of Anaesthesiology. 37 (4) (pp 323-331), 2020. Date of
Publication: 01 Apr 2020.
Author
Wu C.-N.; Wu X.-H.; Yu D.-N.; Ma W.-H.; Shen C.-H.; Cao Y.
Institution
(Wu, Wu, Ma) Department of Anaesthesiology, First Affiliated Hospital of
Guangzhou University of Chinese Medicine, Guangzhou, China
(Wu) Department of Anesthesiology, Peking University Shenzhen Hospital,
Shenzhen, China
(Yu) Department of Anesthesiology, Guangdong Provincial People's Hospital,
Guangzhou, China
(Shen) Department of Thoracic Surgery, First Affiliated Hospital of
Guangzhou University of Chinese Medicine, Guangzhou, China
(Cao) Department of Cardiovascular Pharmacology, School of Pharmacological
Science, Southern Medical University, Guangzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUNDNew-onset arrhythmias and sleep disturbances are frequently
observed during the postoperative period in patients undergoing thoracic
surgery.OBJECTIVEWe evaluated the effectiveness of a single-dose stellate
ganglion block (SGB) to prevent the occurrence of arrhythmias in patients
undergoing thoracic surgery for cancer.DESIGNRandomised controlled
double-blind study.SETTINGSingle university hospital.PATIENTSNinety
patients with lung cancer or oesophagal cancer scheduled for elective
video-assisted thoracoscopic surgery were randomly randomised into one of
two equal groups (the SGB group and control group, n = 40
each).INTERVENTIONSPatients received a single dose of 5 ml of 0.5%
ropivacaine during ultrasound-guided SGB before induction of general
anaesthesia in the SGB group.MAIN OUTCOME MEASURESHolter ECG was
continuously monitored during the first 48 postoperative hours, and sleep
state was monitored during the first two postoperative nights.RESULTSThe
incidences of postoperative supraventricular tachycardias were lower in
the SGB group compared with the control group during the first 48
postoperative hours; 11.6 (5/43) vs. 31.8% (14/44), respectively, P =
0.023 (odds ratio 0.28, 95% confidence interval 0.09 to 0.87). The SGB
also prolonged the total sleep time and increased the sleep efficiency
during the first two postoperative nights. The duration of stage N2 sleep
was longer in the SGB group compared with the control group [28
(interquartile range, 14 to 58) to 94 (interquartile range, 69 to 113)
min, P = 0.016] on the first postoperative night. There were no
differences in the duration of stage N1 and N3 sleep (P = 0.180, 0.086,
respectively) on the first postoperative night, and the duration of stage
N1, N2 and N3 sleep (P = 0.194, 0.057, 0.405, respectively) on the second
postoperative night between the groups.CONCLUSIONA pre-operative SGB
effectively prevented the occurrence of postoperative supraventricular
tachycardias and improves the objective sleep quality in patients
undergoing thoracic surgery for cancer.TRIAL REGISTRATION
NUMBERChiCTR-1900023064. Copyright © 2020 Lippincott Williams and
Wilkins. All rights reserved.

<158>
Accession Number
632980906
Title
Impact of physician's sex/gender on processes of care, and clinical
outcomes in cardiac operative care: A systematic review.
Source
BMJ Open. 10 (9) (no pagination), 2020. Article Number: e037139. Date of
Publication: 29 Sep 2020.
Author
Etherington N.; Deng M.; Boet S.; Johnston A.; Mansour F.; Said H.; Zheng
K.; Sun L.Y.
Institution
(Etherington, Boet, Sun) Clinical Epidemiology Program, Ottawa Hospital
Research Institute, Ottawa, Ontario, Canada
(Etherington, Deng, Boet, Mansour, Said) Department of Anaesthesiology and
Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
(Johnston, Sun) School of Epidemiology and Public Health, Faculty of
Medicine, University of Ottawa, Ottawa, Ontario, Canada
(Zheng, Sun) Division of Cardiac Anesthesiology, Department of
Anesthesiology and Pain Medicine, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Sun) Cardiovascular Research Program, Institute for Clinical Evaluative
Sciences, Ottawa, Ontario, Canada
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Objectives This systematic review aimed to assess the role of physician's
sex and gender in relation to processes of care and/or clinical outcomes
within the context of cardiac operative care. Design A systematic review.
Data sources Searches were conducted in PsycINFO, Embase and Medline from
inception to 6 September 2018. The reference lists of relevant systematic
reviews and included studies were also searched. Eligibility criteria for
selecting studies Quantitative studies of any design were included if they
were published in English or French, involved patients of any age
undergoing a cardiac surgical procedure and specifically assessed
differences in processes of care or clinical patient outcomes by
physician's sex or gender. Studies were screened in duplicate by two pairs
of independent reviewers. Outcome measures Processes of care, patient
morbidity and patient mortality. Results The search yielded 2095
publications after duplicate removal, of which two were ultimately
included. These studies involved various types of surgery, including
cardiac. One study found that patients treated by female surgeons compared
with male surgeons had a lower 30-day mortality. The other study, however,
found no differences in patient outcomes by surgeon's sex. There were no
studies that investigated anaesthesiologist's sex/gender. There were also
no studies investing physician's sex or gender exclusively in the cardiac
operating room. Conclusions The limited data surrounding the impact of
physician's sex/gender on the outcomes of cardiac surgery inhibits drawing
a robust conclusion at this time. Results highlight the need for primary
research to determine how these factors may influence cardiac operative
practice, in order to optimise provider's performance and improve outcomes
in this high-risk patient group. Copyright © 2020 Author(s) (or
their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<159>
Accession Number
632660765
Title
Postoperative outcomes of kidney transplant recipients undergoing
non-transplant-related elective surgery: A systematic review and
meta-analysis.
Source
BMC Nephrology. 21 (1) (no pagination), 2020. Article Number: 365. Date of
Publication: 25 Aug 2020.
Author
Palamuthusingam D.; Kunarajah K.; Pascoe E.M.; Johnson D.W.; Hawley C.M.;
Fahim M.
Institution
(Palamuthusingam) Metro South Integrated Nephrology and Transplant
Services, Logan Hospital, Armstrong Road and Loganlea Road, Meadowbrook,
QLD 4131, Australia
(Palamuthusingam, Johnson, Hawley, Fahim) Faculty of Medicine, University
of Queensland, St Lucia, QLD 4072, Australia
(Palamuthusingam) School of Medicine, Griffith University, Mount Gravatt,
QLD, Australia
(Kunarajah) Department of Medicine, Sunshine Coast University Hospital,
Doherty St, Birtinya, QLD 4575, Australia
(Pascoe) Centre for Health Services Research, University of Queensland, St
Lucia, QLD 4072, Australia
(Johnson, Hawley, Fahim) Metro South Integrated Nephrology and Transplant
Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba,
QLD 4074, Australia
(Johnson) Translational Research Institute, Brisbane, Australia
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Reliable estimates of the absolute and relative risks of
postoperative complications in kidney transplant recipients undergoing
elective surgery are needed to inform clinical practice. This systematic
review and meta-analysis aimed to estimate the odds of both fatal and
non-fatal postoperative outcomes in kidney transplant recipients following
elective surgery compared to non-transplanted patients. Method(s):
Systematic searches were performed through Embase and MEDLINE databases to
identify relevant studies from inception to January 2020. Risk of bias was
assessed by the Newcastle Ottawa Scale and quality of evidence was
summarised in accordance with GRADE methodology (grading of
recommendations, assessment, development and evaluation). Random effects
meta-analysis was performed to derive summary risk estimates of outcomes.
Meta-regression and sensitivity analyses were performed to explore
heterogeneity. Result(s): Fourteen studies involving 14,427 kidney
transplant patients were eligible for inclusion. Kidney transplant
recipients had increased odds of postoperative mortality; cardiac surgery
(OR 2.2, 95%CI 1.9-2.5), general surgery (OR 2.2, 95% CI 1.3-4.0) compared
to non-transplanted patients. The magnitude of the mortality odds was
increased in the presence of diabetes mellitus. Acute kidney injury was
the most frequently reported non-fatal complication whereby kidney
transplant recipients had increased odds compared to their
non-transplanted counterparts. The odds for acute kidney injury was
highest following orthopaedic surgery (OR 15.3, 95% CI 3.9-59.4). However,
there was no difference in the odds of stroke and pneumonia.
 Conclusion(s): Kidney transplant recipients are at increased odds for
postoperative mortality and acute kidney injury following elective
surgery. This review also highlights the urgent need for further studies
to better inform perioperative risk assessment to assist in planning
perioperative care. Copyright © 2020 The Author(s).

<160>
Accession Number
633093586
Title
Postoperative pain therapy with hydromorphone; comparison of
patient-controlled analgesia with target-controlled infusion and standard
patient-controlled analgesia: A randomised controlled trial.
Source
European journal of anaesthesiology. (no pagination), 2020. Date of
Publication: 01 Oct 2020.
Author
Wehrfritz A.; Ihmsen H.; Fuchte T.; Kim M.; Kremer S.; Weiss A.; Schuttler
J.; Jeleazcov C.
Institution
(Wehrfritz) From the Department of Anaesthesiology, University Hospital
Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Germany
(AW, HI, TF, Erlangen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The challenge of managing acute postoperative pain is the well
tolerated and effective administration of analgesics with a minimum of
side effects. The standard therapeutic approach is patient-controlled
analgesia (PCA) with systemic opioids. To overcome problems of oscillating
opioid concentrations, we studied patient-controlled analgesia by
target-controlled infusion (TCI-PCA) as an alternative. OBJECTIVE(S):
To compare efficacy, safety and side effects of standard PCA with TCI-PCA
for postoperative pain therapy with hydromorphone. DESIGN: Single-blinded,
randomised trial. SETTING: University Hospital, Germany from December 2013
to April 2015. PARTICIPANTS: Fifty adults undergoing cardiac surgery.
INTERVENTIONS: Postoperative pain therapy on the ICU was managed with
intravenous (i.v.) hydromorphone and patients randomised to TCI-PCA with
target plasma concentrations between 0.8 and 10 ng ml, or PCA with bolus
doses of 0.2 mg. Pain was regularly assessed using the 11-point numerical
rating scale (NRS). Blood pressure, heart rate, oxygen saturation and
cardiac output were continuously monitored, and adverse events were
registered throughout the study. MAIN OUTCOME MEASURES: NRS pain ratings,
hydromorphone doses, haemodynamic effects and side effects.
 RESULT(S): NRS pain ratings, total doses of hydromorphone and
haemodynamic data did not differ significantly between TCI-PCA and PCA.
The number of bolus doses during PCA was significantly higher than the
number of target increases during TCI-PCA (P = 0.006). The number of
negative requests was also significantly higher during PCA than during
TCI-PCA (P = 0.02). The respiratory rate on the first postoperative
morning was 25 +/- 6 min during TCI-PCA, compared with 19 +/- 4 min during
PCA (P = 0.022). Nausea occurred in 30% after TCI-PCA and 24% after PCA (P
= 0.46). CONCLUSION(S): TCI-PCA was effective and well tolerated in
acute postoperative pain management after cardiac surgery. Further studies
are needed to evaluate this approach in clinical practice. TRIAL
REGISTRATION: EudraCT Number: 2013-002875-16, and ClinicalTrials.gov
Identifier: NCT02035709.

<161>
Accession Number
633089585
Title
A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff
Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A
Prospective Randomized Controlled Study.
Source
Anesthesia and analgesia. (no pagination), 2020. Date of Publication: 23
Sep 2020.
Author
Yamada Y.; Tanabe K.; Nagase K.; Ishihara T.; Iida H.
Institution
(Yamada, Tanabe, Nagase, Iida) From the Department of Anesthesiology and
Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
(Ishihara) Gifu University Hospital Innovative and Clinical Research
Promotion Center, Gifu University, Gifu, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Double-lumen endobronchial tubes (DLTs) are used for one-lung
ventilation (OLV) during thoracic surgery. Overinflation into the
bronchial cuff causes damage to the tracheobronchial mucosa, whereas
underinflation leads to an incomplete collapse of the nonventilated lung
or incomplete ventilation of the ventilated lung. However, how to
determine the appropriate bronchial cuff volume and pressure during OLV is
unclear. The objective of this study is to compare the required bronchial
cuff volume for lung separation obtained by 2 different cuff inflation
methods under closed- and open-chest conditions. METHOD(S): A total
of 64 patients scheduled to undergo elective thoracic surgery requiring
OLV were recruited. Left DLTs were used for both right- and left-sided
surgery. The patients were randomly assigned to 1 of 2 inflation-type
groups to estimate the bronchial cuff volume. In the capnogram
waveform-guided bronchial cuff inflation group (capno group, n = 27), the
bronchial cuff was inflated until a capnometer sampling gas containing CO2
from the nonventilated lung displayed a flat line. The corresponding
bronchial cuff volume and pressure were then recorded. In the
pressure-guided bronchial cuff inflation group (pressure group, n = 29),
the bronchial cuff was inflated by a cuff inflator to a pressure of 20 cm
H2O. Lung separation was confirmed when a flat line of a capnometer was
observed after gas sampling from the nonventilated lung. RESULT(S):
Under closed-chest conditions, the bronchial cuff sealing volume for the
capno group was significantly lower than that for the pressure group (mean
[standard deviation {SD}], 1.00 [0.65] mL vs 1.44 [0.59] mL, mean
difference, - 0.44; 97.5% confidence interval [CI], -0.78 to - 0.11; P =
.010). Under open-chest conditions, the bronchial cuff sealing volume for
the capno group was also significantly lower than that for the pressure
group (mean [SD], 0.65 [0.66] mL vs 1.22 [0.45] mL, mean difference,
-0.58; 97.5% CI, -0.88 to -0.27; P < .001). CONCLUSION(S): The lowest
cuff volume providing an air-tight bronchial seal was obtained by the
capnogram waveform-guided bronchial cuff inflation method. Since the cuff
volume required to achieve an air-tight seal decreases after opening the
chest, readjustment of the bronchial cuff volume to prevent bronchial cuff
damage to the tracheobronchial mucosa after opening the chest may be
advisable.

<162>
Accession Number
633088898
Title
The Use of Central Venous to Arterial Carbon Dioxide Tension Gap for
Outcome Prediction in Critically Ill Patients: A Systematic Review and
Meta-Analysis.
Source
Critical care medicine. (no pagination), 2020. Date of Publication: 30 Sep
2020.
Author
Al Duhailib Z.; Hegazy A.F.; Lalli R.; Fiorini K.; Priestap F.;
Iansavichene A.; Slessarev M.
Institution
(Al Duhailib, Hegazy, Fiorini, Priestap, Slessarev) Division of Critical
Care, Department of Medicine, Western University, London Health Sciences
Centre, ON, London, Canada
(Al Duhailib) Department of Health Research Methods, Evidence, McMaster
University, ON, and Impact, Hamilton, Canada
(Al Duhailib) Department of Critical Care Medicine, King Faisal Specialist
Hospital and Research Centre, Riyadh, Saudi Arabia
(Hegazy) Department of Anesthesia and Perioperative Medicine, Western
University, London Health Sciences Centre, ON, London, Canada
(Lalli) Department of Pediatrics, Western University, London Health
Sciences Centre, ON, London, Canada
(Iansavichene) Health Science Library, London Health Sciences Centre,
Victoria Campus, ON, London, Canada
(Slessarev) Department of Medical Biophysics, Western University, ON,
London, Canada
(Slessarev) Brain and Mind Institute, Western University, ON, London,
Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: In this systematic review and meta-analysis, we assessed
whether a high CO2 gap predicts mortality in adult critically ill patients
with circulatory shock. DATA SOURCES: A systematic search of MEDLINE and
EMBASE electronic databases from inception to October 2019. STUDY
SELECTION: Studies from adult (age >= 18 yr) ICU patients with shock
reporting CO2 gap and outcomes of interest. Case reports and conference
abstracts were excluded. DATA EXTRACTION: Data extraction and study
quality assessment were performed independently in duplicate. DATA
SYNTHESIS: We used the Newcastle-Ottawa Scale to assess methodological
study quality. Effect sizes were pooled using a random-effects model. The
primary outcome was mortality (28 d and hospital). Secondary outcomes were
ICU length of stay, hospital length of stay, duration of mechanical
ventilation, use of renal replacement therapy, use of vasopressors and
inotropes, and association with cardiac index, lactate, and central venous
oxygen saturation. CONCLUSION(S): We included 21 studies (n = 2,155
patients) from medical (n = 925), cardiovascular (n = 685), surgical (n =
483), and mixed (n = 62) ICUs. A high CO2 gap was associated with
increased mortality (odds ratio, 2.22; 95% CI, 1.30-3.82; p = 0.004) in
patients with shock, but only those from medical and surgical ICUs. A high
CO2 gap was associated with higher lactate levels (mean difference 0.44
mmol/L; 95% CI, 0.20-0.68 mmol/L; p = 0.0004), lower cardiac index (mean
difference, -0.76 L/min/m; 95% CI, -1.04 to -0.49 L/min/m; p = 0.00001),
and central venous oxygen saturation (mean difference, -5.07; 95% CI,
-7.78 to -2.37; p = 0.0002). A high CO2 gap was not associated with longer
ICU or hospital length of stays, requirement for renal replacement
therapy, longer duration of mechanical ventilation, or higher vasopressors
and inotropes use. Future studies should evaluate whether resuscitation
aimed at closing the CO2 gap improves mortality in shock.

<163>
Accession Number
633085905
Title
Right Ventricular Outflow Tract Reconstruction with Medtronic Freestyle
Valve in the Ross Procedure: A Systematic Review with Meta-Analysis.
Source
Artificial organs. (no pagination), 2020. Date of Publication: 01 Oct
2020.
Author
Van den Eynde J.; Sa M.P.B.O.; Callahan C.P.; Dimagli A.; Vervoort D.;
Kampaktsis P.N.; Zhigalov K.; Ruhparwar A.; Weymann A.
Institution
(Van den Eynde) Department of Cardiovascular Diseases, Unit of Cardiac
Surgery, University Hospitals Leuven, Leuven, Belgium
(Sa) Division of Cardiovascular Surgery of Pronto, Socorro Cardiologico de
Pernambuco, PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
(Callahan) Hospital for Sick Children, University of Toronto, Toronto, ON,
Canada
(Dimagli) School of Clinical Sciences, Bristol Heart Institute, University
of Bristol, United Kingdom
(Vervoort) Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, United States
(Kampaktsis) Department of Medicine, New York University Langone Medical
Center, NY, United States
(Zhigalov, Ruhparwar, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cryopreserved pulmonary homografts (PH) are the current gold
standard for right ventricular outflow tract (RVOT) reconstruction in the
Ross procedure. Unfortunately, their use is limited by a relatively scarce
availability and high cost. Porcine stentless xenografts (SX) such as the
Medtronic Freestyle SX are increasingly being used, although it is unclear
whether the hemodynamic performance and the long-term durability are
satisfactory. METHOD(S): The present systematic review followed the
Preferred Reporting Items for Systematic reviews and Meta-Analysis
(PRISMA) statement. The pooled treatment effects were calculated using a
weighted DerSimonian-Laird random effects model. We also evaluated the
effect of time after RVOT reconstruction on valve gradients using
meta-regression. RESULT(S): Six studies with a total of 156 patients
met the inclusion criteria. The pooled estimates for the pooled follow-up
of 37 months were: 1.3% operative mortality; 94.8% overall survival; 7.5%
structural valve deterioration; 5.2% reintervention; 73.3% asymptomatic;
and 1.5% moderate or severe pulmonary insufficiency. Peak valve gradients
were significantly correlated with time after RVOT, increasing during
follow-up. Three studies compared PH with SX; one concluded that the SX is
an acceptable alternative for RVOT reconstruction, whereas two concluded
that this valvular substitute had inferior performance.
 CONCLUSION(S): The Freestyle SX can be considered as an alternative
to PH, although it might be associated with more reinterventions, higher
peak valve pressure gradients, and pulmonary valve
dysfunction. Copyright This article is protected by copyright. All
rights reserved.

<164>
Accession Number
633075975
Title
Efficacy of a WeChat based intervention to adherence to secondary
prevention in patients undergoing coronary artery bypass graft in China: A
randomized controlled trial.
Source
Journal of telemedicine and telecare. (pp 1357633X20960639), 2020. Date of
Publication: 30 Sep 2020.
Author
Wang J.; Zeng Z.; Dong R.; Sheng J.; Lai Y.; Yu J.; Zuo H.
Institution
(Wang, Zeng, Zuo) Beijing Anzhen Hospital, Capital Medical University,
Beijing Institute of Heart Lung and Blood Vessel Disease, China
(Dong, Sheng, Lai, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: We assessed whether the social media-based (WeChat)
intervention integrated with follow-up care could improve adherence to
drugs, lifestyle changes and clinical risk markers in patients undergoing
coronary artery bypass graft (CABG) in China. METHOD(S): We
randomized patients at hospital discharge following CABG to intervention
group or control care in China. The intervention is a structured programme
of cardiac health education, medication reminders and cardiologist-based
follow-up service using WeChat platform. The control group maintains a
routine practice pattern. The primary outcome is adherence to
cardioprotective medications measured for 12 months after discharge. We
also evaluated the lifestyle modifications and clinical risk markers at 12
months. RESULT(S): A total of 164 participants completed the trial
for analysis. The intervention group had significantly greater adherence
to statins use 98.6% vs. 75.0% (p<0.01), beta-blockers 93.4% vs. 69.3%
(p<0.01) and aspirin 98.8% vs. 87.8% (p<0.001). The intervention group had
significantly greater adherence to regular physical activity (64.2% vs.
48.2%; p<0.039). Furthermore, intervention versus standard group at 12
months had significantly lower mean systolic blood pressure and
low-density lipoprotein cholesterol (p<0.05). DISCUSSION: A WeChat-based
intervention strategy in post-CABG patients improved adherence to
medications, including statin, aspirin and beta-blockers, and regular
physical activity and resulted in an improvement in systolic blood
pressure and low-density lipoprotein cholesterol level.

<165>
Accession Number
2007958536
Title
Perioperative intravenous S-ketamine for acute postoperative pain in
adults: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 68 (no pagination), 2021. Article Number:
110071. Date of Publication: February 2021.
Author
Wang X.; Lin C.; Lan L.; Liu J.
Institution
(Wang, Lin, Lan, Liu) Department of Anesthesiology, the First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Study objective: To evaluate the effectiveness and safety of S-ketamine
for pain relief and analgesic consumption in surgical patients.
 Design(s): Systematic review and meta-analysis of randomized
controlled trials (RCTs). Setting(s): Perioperative setting.
 Patient(s): A total of 905 adult patients undergoing surgery using
general anesthesia: 504 patients in the S-ketamine group and 401 patients
in the placebo group. Intervention(s): Intravenous S-ketamine as an
adjuvant to general anesthesia compared with placebo. Measurements: The
primary outcomes were resting and movement pain scores (VAS/NRS 0-10) and
morphine consumption within 4, 12, 24 and 48 h after surgery. The
secondary outcomes included postoperative complications such as nausea,
vomiting, and psychotomimetic adverse events. We used the guidelines of
the Recommendation Assessment, Development, and Evaluation (GRADE) system
to evaluate the level of certainty for the main results. Main
Result(s): A total of 12 studies were included. The types of surgery
included abdominal surgery, thoracotomy, gynecologic surgery, arthroscopic
anterior cruciate ligament repair, cardiac surgery, laparoscopic
cholecystectomy, lumbar spinal fusion surgery, radical prostatectomy, and
hemorrhoidectomy. There were significant improvements in resting pain
scores at 4, 12 and 24 h with S-ketamine versus placebo [4 h: standardized
mean difference (SMD) -1.11; 95% confidence interval (CI): -1.53, -0.68, p
< 0.00001; GRADE = moderate; 12 h: SMD -0.88; 95%CI: -1.42, -0.34, p =
0.001; GRADE = moderate; 24 h: SMD -0.39; 95%CI: -0.73, -0.06, p = 0.02;
GRADE = moderate]. The incidence of pain scores at 48 h showed no
statistical difference between the two groups (SMD -0.27; 95%CI: -1.12,
0.58, p = 0.53, GRADE = moderate). The movement pain scores were not
significantly different between the two groups at each time point (4 h:
SMD -0.34; 95%CI: -0.73, 0.05, p = 0.09, GRADE = moderate; 12 h: SMD
-0.42; 95%CI: -1.46, 0.63, p = 0.44, GRADE = low; 24 h: SMD -0.58; 95%CI:
-1.25, 0.09, p = 0.09, GRADE = moderate; 48 h: SMD -0.49; 95%CI: -1.11,
0.14, p = 0.13, GRADE = low). At 4 and 12 h after surgery, the consumption
of morphine was significantly reduced in the S-ketamine group (4 h: SMD
-0.98; 95%CI: -1.37, -0.06, p < 0.00001, GRADE = moderate; 12 h: SMD
-1.36; 95%CI: -2.26, -0.46, p = 0.003, GRADE = low). There were no
significant differences in morphine use at 24 and 48 h between the two
groups (24 h: SMD -0.70; 95%CI: -1.42, 0.02, p = 0.06, GRADE = low; 48 h:
SMD -0.79; 95%CI: -2.26, 1.03, p = 0.39, GRADE = low). The risk for nausea
[relative risk (RR) = 1.04; 95%CI: 0.83, 1.30, p = 0.73], vomiting (RR =
1.07; 95%CI: 0.84, 1.38, p = 0.57), and psychotomimetic adverse events (RR
= 1.57; 95%CI: 0.82, 2.99, p = 0.17) showed no significant increase in the
S-ketamine group. Conclusion(s): Intravenous S-ketamine as an adjunct
to general anesthesia is effective for assisting analgesia and decreases
the intensity of pain and opioid requirements in a short period of time
after surgery, but it may increase the psychotomimetic adverse event rate.
Overall, the level of certainty is moderate to low. Copyright ©
2020 Elsevier Inc.

<166>
Accession Number
632959737
Title
Perioperative gabapentin in pediatric thoracic surgery
patients-randomized, placebo-controlled, phase 4 trial.
Source
Pain Medicine (United States). 21 (8) (pp 1562-1571), 2020. Date of
Publication: 2020.
Author
Tomaszek L.; Fenikowski D.; Maciejewski P.; Komotajtys H.; Gawron D.
Institution
(Tomaszek, Fenikowski, Maciejewski, Komotajtys, Gawron) Department of
Thoracic Surgery, Institute of Tuberculosis and Lung Diseases, Rabka-Zdroj
Branch, Rabka-Zdroj, Poland
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
Objective. To determine whether the use of perioperative gabapentin
reduces postoperative pain and anxiety, decreases ropivacaine consumption
and side effects, and improves patient satisfaction. Design. Randomized,
placebo-controlled, phase 4 trial. Blinding. Participants, care providers,
investigators, data analysts. Setting. Department of Thoracic Surgery of
the Institute of Tuberculosis and Lung Disease, Rabka Zdroj Branch,
Poland. Subjects. Forty patients undergoing the Ravitch procedure.
Methods. Patients aged nine to 17 years were randomized into a gabapentin
(preoperative 15 mg/kg, treatment) or placebo group. Postoperative
analgesia included gabapentin (7.5 mg/kg) or placebo two times per day for
three days, epidural ropivacaine fentanyl, paracetamol, nonsteroidal
anti-inflammatory drugs, and metamizol as a "rescue drug." Pain, anxiety,
analgesic consumption, side effects, and patient satisfaction were
recorded. Results. There was no statistically significant difference in
median pain scores (numerical rating scale < 1/10) or incidence of adverse
side effects between the gabapentin group (N 1/4 20) and the placebo group
(N 1/4 20). Postoperative anxiety scores were significantly lower than
before surgery in the gabapentin group (6 [4-8] vs 7 [6-8.5], P < 0.01)
and remained unchanged in the placebo group (6 [5-6.5] vs 6 [5-7], P 1/4
0.07). Gabapentin-treated patients received a lower number of doses of
ondansetron when compared with the placebo group (6 [5-6] vs 7 [6-9], P
1/4 0.02). A significant negative association was found between patient
satisfaction and postoperative state anxiety in the gabapentin group (R
1/4 -0.51, P 1/4 0.02). Conclusions. Perioperative administration of
gabapentin resulted in a decrease of postoperative anxiety in pediatric
patients undergoing the Ravitch procedure. Copyright © 2019
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com

<167>
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.

<168>
Accession Number
632571258
Title
Efficacy and safety of bempedoic acid for prevention of cardiovascular
events and diabetes: A systematic review and meta-analysis.
Source
Cardiovascular Diabetology. 19 (1) (no pagination), 2020. Article Number:
128. Date of Publication: 12 Aug 2020.
Author
Wang X.; Zhang Y.; Tan H.; Wang P.; Zha X.; Chong W.; Zhou L.; Fang F.
Institution
(Wang, Zhang, Tan, Zhou, Fang) West China Hospital, Sichuan University,
No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
(Zhang, Wang, Zha) Affiliated Hospital of Chengdu University, Chengdu
University, Chengdu, Sichuan, China
(Chong) Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
BioMed Central Ltd (United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Bempedoic acid is an oral, once-daily, first-in-class drug
being developed for the treatment of hyperlipidemia. However, evidence of
bempedoic acid use for the prevention of cardiovascular events and
diabetes is lacking. Thus, we aim to evaluate the benefit and safety of
bempedoic acid use for the prevention of cardiovascular events and
diabetes. Method(s): We searched Medline, Embase, and the Cochrane
Central Register of Controlled Trials with no language restriction from
inception until March 3, 2020. Pairs of reviewers independently identified
randomized controlled trials comparing the use of bempedoic acid with
placebo or no treatment for primary prevention of cardiovascular events in
statin-intolerant patients with hypercholesterolemia. The primary outcomes
were major adverse cardiac events, and percent change in LDL-C.
 Result(s): We identified 11 trials including a total of 4391
participants. Bempedoic acid use was associated with a reduction in
composite cardiovascular outcome (RR 0.75, 95% CI 0.56-0.99; I2 = 0%).
Bempedoic acid reduced LDL-C levels (MD - 22.91, 95% CI - 27.35 to -
18.47; I2 = 99%), and similarly reduced CRP levels (MD -24.70, 95% CI -
32.10 to - 17.30; I2 = 53%). Bempedoic acid was associated with a
reduction in rates of new-onset or worsening diabetes (RR 0.65, 95% CI
0.44-0.96; I2 = 23%). Conclusion(s): Bempedoic acid in patients with
hypercholesterolemia was associated with a lower risk of cardiovascular
events and diabetes. Copyright © 2020 The Author(s).

<169>
Accession Number
632531986
Title
Phlebosclerosis in lower extremities veins - A systematic review.
Source
Vasa - European Journal of Vascular Medicine. 49 (5) (pp 349-358), 2020.
Date of Publication: August 2020.
Author
Tepelenis K.; Papathanakos G.; Barbouti A.; Paraskevas G.; Kitsouli A.;
Alexandra Kefala M.; Tepelenis N.; Kanavaros P.; Kitsoulis P.
Institution
(Tepelenis) Department of Surgery, General Hospital of Filiates, Bebi
Petrou 10, Thesprotia, Greece
(Papathanakos) Intensive Care Unit, University Hospital of Ioannina,
Ioannina, Greece
(Barbouti, Kitsouli, Kanavaros, Kitsoulis) Anatomy - Histology -
Embryology, University of Ioannina, Ioannina, Greece
(Paraskevas) Orthopaedics, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Alexandra Kefala) Pediatrician, Ioannina, Greece
(Tepelenis) Department of Pathology, Agia Sofia Children's Hospital,
Athens, Greece
(Kitsoulis) Orthopaedics, University of Ioannina, Ioannina, Greece
Publisher
Hogrefe Verlag GmbH & Co. KG (E-mail: verlag@hogrefe.de)
Abstract
Phlebosclerosis is a venous wall degenerative disease which has gained
little popularity in the literature due to its uncertain clinical
significance. The objective of this review is to evaluate the
epidemiology, etiology and clinical significance of phlebosclerosis in
lower extremities veins, particularly the effect of preexisting
phlebosclerosis of the great saphenous vein on vein graft patency. Medline
was searched from inception until November 1, 2019. Reference lists of
included studies were scanned. Only articles published after 1949 were
included. Two reviewers independently screened titles/abstracts and
fulltext papers for any study design in relation to phlebosclerosis in
lower extremities veins and abstracted data. A total of 16 Cohort studies
and one case-control study (3708 participants, mean age 61.8 years, 59.3 %
men, and 40.7 % women) were included after screening 317 titles and
abstracts, and 80 full-text articles. The incidence of phlebosclerosis
ranged from 1.5-9.7 % depending on the radiological features. On the
contrary, the incidence of the phlebosclerotic great saphenous vein prior
to its use as a vein graft was 26.9-91 % on histological examination. The
small saphenous vein was the most common location of phlebosclerosis
followed by the great saphenous vein. There is a link between
phlebosclerosis and age, venous insufficiency and haemodialysis. As for
the vein graft patency seven studies demonstrated a correlation between
preexisting phlebosclerosis and vein graft stenosis, whereas three studies
failed to prove any association. In conclusion, the radiological incidence
of phlebosclerosis depended on the ultrasound findings. Its presence in
the great saphenous vein prior to its use as a vein graft is established
on histological examination. The small saphenous vein is mainly affected.
Risk factors included age, haemodialysis, and venous insufficiency.
Preexisting wall thickness of the great saphenous vein graft seemed to
affect negatively its patency in bypass surgery. Copyright © 2020
Hogrefe.

<170>
Accession Number
2005737728
Title
Clinical burden associated with postsurgical complications in major
cardiac surgeries in Asia-Oceania countries: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. 35 (10) (pp 2618-2626), 2020. Date of
Publication: 01 Oct 2020.
Author
Dhippayom T.; Dilokthornsakul P.; Laophokhin V.; Kitikannakorn N.;
Chaiyakunapruk N.
Institution
(Dhippayom) Faculty of Pharmaceutical Sciences, Naresuan University,
Phitsanulok, Thailand
(Dilokthornsakul) Department of Pharmacy Practice, Center of
Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical
Sciences, Naresuan University, Phitsanulok, Thailand
(Laophokhin, Kitikannakorn) Department of Pharmaceutical Care, Centor for
Community of Drug System Research and Development (CDR), Faculty of
Pharmacy, Chiang Mai University, Chiang Mai, Thailand
(Chaiyakunapruk) Department of Pharmacotherapy, College of Pharmacy,
University of Utah, Salt Lake City, UT, United States
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Background: Evidence on the burden of postsurgical complications is mainly
from studies in western countries, and little is highlighted in the
Asia-Oceania region. This study aimed to identify and compare the burden
of postsurgical complications in major cardiac surgeries in Asia-Oceania
countries. Method(s): A systematic search was performed in PubMed,
Embase, and CENTRAL between January 2000 and July 2018. Inclusion criteria
were: (a) observational studies or randomized control trials; (b) studied
in coronary artery bypass graft (CABG) and/or heart valve procedures; (c)
measured postsurgical clinical outcomes; and (d) conducted in Asia-Oceania
countries. Pooled effects were calculated using a random-effects model.
 Result(s): Of the 6032 articles screened, 472 studies with a total of
614 161 patients met the inclusion criteria. The pooled incidences (95%
confidence interval) of hospital mortality and 30-day mortality were
similar at 2.38% (2.16%-2.59%) and 2.33% (2.16%-2.50%), respectively.
Length of stay (LOS) was 14.07 days (13.44-14.71 days). The incidence for
atrial fibrillation (AF) and stroke/cerebrovascular accident (CVA) was
17.49% (15.99%-18.99%) and 1.64% (1.51%-1.78%), respectively. Below
outcomes tended to be better in studies on CABG compared to heart valve
procedures, including the incidence of hospital mortality
(1.97%[1.75%-2.18%] vs 3.97% [3.29%-4.65%]), AF (16.47% [14.85%-18.10%] vs
21.98% [17.41%-26.54%]), stoke/CVA (1.51% [1n 37%-1.65%] vs 2.55%
[2.07%-3.04%]), and mean LOS (days) (13.08 [12.51-13.65] vs 19.58
[16.72-22.45]). Similarly, all postsurgical complications tended to be
higher in studies involving high-risk patients vs non-high-risk patients.
 Conclusion(s): There are opportunities to improve clinical outcomes
of patients with high surgical risks and those undertaking heart valve
procedures, as they tend to have poorer survival and higher risk in
developing postsurgical complications. Copyright © 2020 Wiley
Periodicals LLC

<171>
Accession Number
2005640635
Title
New-onset atrial fibrillation and outcomes following isolated coronary
artery bypass surgery: A systematic review and meta-analysis.
Source
Clinical Cardiology. 43 (9) (pp 928-934), 2020. Date of Publication: 01
Sep 2020.
Author
Kerwin M.; Saado J.; Pan J.; Ailawadi G.; Mazimba S.; Salerno M.; Mehta N.
Institution
(Kerwin, Saado, Pan) Division of Internal Medicine, University of
Virginia, Charlottesville, VA, United States
(Ailawadi) Division of Cardiovascular Surgery, University of Virginia,
Charlottesville, VA, United States
(Mazimba, Salerno, Mehta) Division of Cardiovascular Medicine, University
of Virginia, Charlottesville, VA, United States
(Mehta) Division of Cardiovascular Medicine, William Beaumont Oakland
University, Royal Oak, MI, United States
Publisher
John Wiley and Sons Inc (E-mail: info@wiley.com)
Abstract
Prior meta-analyses have shown that new-onset atrial fibrillation (NOAF)
occurs in up to 40% of patients following cardiac surgery and is
associated with substantial major adverse cardiovascular events. The
stroke and mortality implications of NOAF in isolated CABG without
concomitant valve surgery is not known. We thought that NOAF would be
associated with increased risk of stroke and mortality, even in patients
undergoing isolated CABG. A blinded review of studies from MEDLINE,
CENTRAL, and Web of Science was done by two independent investigators.
Stroke, 30-day/hospital mortality, long-term cardiovascular mortality, and
long-term (>1 year) all-cause mortality were analyzed. We used Review
Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461
studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF
incidence ranged from 15% to 36%. NOAF was associated with increased risk
of stroke (unadjusted OR 2.15 [1.82, 2.53] [P <.00001]; adjusted OR 1.88
[1.02, 3.46] [P =.04]). NOAF was associated with increased 30-day/hospital
mortality (OR 2.35 [1.67, 3.32] [P <.00001]) and long-term cardiovascular
mortality (OR 2.04 [1.35, 3.09] [P =.0007]) NOAF was associated with
increased long-term all-cause mortality (unadjusted OR 1.79 [1.63, 1.96]
[P <.00001]; adjusted OR 1.58 [1.24, 2.00] [P =.0002]). We found that the
incidence of NOAF following isolated CABG is high and is associated with
increased stroke rate and mortality. Early recognition and management of
NOAF could improve outcomes. Copyright © 2020 The Authors.
Clinical Cardiology published by Wiley Periodicals LLC.

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