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<1>
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.

<2>
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
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.

<3>
Accession Number
633027987
Title
The risk of cardiovascular disease in women after miscarriage, stillbirth,
and therapeutic abortion: A protocol for a systematic review and
meta-analysis.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 234. Date
of Publication: 07 Oct 2020.
Author
Muehlschlegel C.; Kyriacou H.; Al-Mohammad A.; Foster-Davies L.A.;
Simmons-Jones F.; Oliver-Williams C.
Institution
(Muehlschlegel, Kyriacou, Al-Mohammad, Foster-Davies) School of Clinical
Medicine, University of Cambridge, Cambridge, United Kingdom
(Simmons-Jones) Essex County Council, County Hall, Chelmsford, Essex CM1
1QH, United Kingdom
(Oliver-Williams) Homerton College, University of Cambridge, Cambridge,
United Kingdom
(Oliver-Williams) Cardiovascular Epidemiology Unit, Department of Public
Health and Primary Care, University of Cambridge, Cambridge, United
Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death in
women, responsible for approximately a third of all female deaths.
Pregnancy complications are known to be associated with a greater risk of
incident CVD in mothers. However, the relationships between pregnancy loss
due to miscarriage, stillbirth, or therapeutic abortion, and future
maternal cardiovascular health are under-researched. This study seeks to
provide an up-to-date systematic review and meta-analysis of the
relationship between these three forms of pregnancy loss and the
subsequent development of CVD. Method(s): This systematic review will
follow the Preferred Reporting Items for Systematic Review and
Meta-Analysis checklist (PRISMA) and the Meta-analyses Of Observational
Studies in Epidemiology (MOOSE) Checklist. A systematic search will be
undertaken using publications identified in MEDLINE (PubMed), Scopus, Web
of Knowledge, the CINAHL Nursing Database, and the Cochrane Library. The
eligibility of each publication will be determined by predefined selection
criteria. The quality of the included studies will be rated using the
Newcastle-Ottawa Scale. Pooled measures of association will be computed
using random-effects model meta-analyses. Between-study heterogeneity will
be assessed using the I 2 statistic and the Cochrane chi 2 statistic.
Small study effects will be evaluated for meta-analyses with sufficient
studies through the use of funnel plots and Egger's test.
 Discussion(s): The results of this systematic review will discuss the
long-term risks of multiple types of cardiovascular disease in women who
have experienced miscarriage, stillbirth, and/or therapeutic abortion. It
will contribute to the growing field of cardio-obstetrics as the first to
consider the full breadth of literature regarding the association between
all forms of pregnancy loss and future maternal cardiovascular disease.
Systematic review registration: PROSPERO registration number
[CRD42020167587] Copyright © 2020 The Author(s).

<4>
Accession Number
2005262350
Title
Patients' preferences after recurrent coronary narrowing: Discrete choice
experiments.
Source
Arquivos Brasileiros de Cardiologia. 115 (4) (pp 613-619), 2020. Date of
Publication: October 2020.
Author
Magliano C.A.D.S.; Monteiro A.L.; Rebelo A.R.O.; Santos G.F.; Pereira
C.C.A.; Krucien N.; Saraiva R.M.
Institution
(Magliano, Rebelo, Santos) Instituto Nacional de Cardiologia, Rio de
Janeiro, RJ, Brazil
(Monteiro) University of Illinois at Chicago, Chicago, IL, United States
(Pereira) Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de
Janeiro, RJ, Brazil
(Krucien) University of Aberdeen, Aberdeen, United Kingdom
(Saraiva) Instituto Nacional de Infectologia Evandro Chagas, Fundacao
Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Selecting the optimal treatment strategy for coronary
revascularization is challenging. A crucial endpoint to be considered when
making this choice is the necessity to repeat revascularization since it
is much more frequent after percutaneous coronary intervention (PCI) than
after coronary artery bypass grafting (CABG). Objective(s): This
study intends to provide insights on patients' preferences for
revascularization, strategies in the perspective of patients who had to
repeat revascularization. Method(s): We selected a sample of patients
who had undergone PCI and were hospitalized to repeat coronary
revascularization and elicited their preferences for a new PCI or CABG.
Perioperative death, long-term death, myocardial infarction, and repeat
revascularization were used to design scenarios describing hypothetical
treatments that were labeled as PCI or CABG. PCI was always presented as
the option with lower perioperative death risk and a higher necessity to
repeat procedure. A conditional logit model was used to analyze patients'
choices using R software. A p value < 0.05 was considered statistically
significant. Result(s): A total of 144 patients participated, most of
them (73.7%) preferred CABG over PCI (p < 0.001). The regression
coefficients were statistically significant for PCI label, PCI long-term
death, CABG perioperative death, CABG long-term death and repeat CABG. The
PCI label was the most important parameter (p < 0.05). Conclusion(s):
Most patients who face the necessity to repeat coronary revascularization
reject a new PCI, considering realistic levels of risks and benefits.
Incorporating patients' preferences into benefit-risk calculation and
treatment recommendations could enhance patient-centered
care. Copyright © 2020, Arquivos Brasileiros de Cardiologia. All
rights reserved.

<5>
Accession Number
2005213519
Title
The outcomes of using fixed-dose nomogram-guided unfractionated heparin
therapy in elderly patients in comparison with younger patients.
Source
Turk Geriatri Dergisi. 23 (3) (pp 308-316), 2020. Date of Publication:
2020.
Author
Acibuca A.; Muderrisoglu I.H.
Institution
(Acibuca) Baskent University School of Medicine, Dr Turgut Noyan
Application and Research Center, Cardiology, Adana, Turkey
(Muderrisoglu) Baskent University School of Medicine, Cardiology, Ankara,
Turkey
Publisher
Geriatrics Society
Abstract
Introduction: In elderly patients, the dosing of unfractionated heparin is
difficult because of changing metabolism, which affects the determination
of a therapeutic level. The aim of this study was to evaluate the effects
of unfractionated heparin therapy in an older population and to determine
whether there was any difference from a younger population in terms of the
activated partial thromboplastin time results and complication rates when
using a standard nomogram. Material(s) and Method(s): A total of 120
patients aged <80 years (Group 1) and 120 patients aged >=80 years (Group
2), all of whom had been given unfractionated heparin therapy for selected
indications in the coronary care unit, were randomly selected and
retrospectively enrolled in the study. Infusion time up to a maximum of 48
hours was included, and activated partial thromboplastin time results in
that period were categorised as subtherapeutic, therapeutic, or
supratherapeutic. The rates of the patients' subtherapeutic, therapeutic,
and supratherapeutic results were compared between groups. Result(s):
The peak activated partial thromboplastin time level was higher in
patients aged >=80 years (58.85 [51.28] vs 76.50 [57.45], p<0.001). The
supratherapeutic activated partial thromboplastin time percentage (0
[0.25] vs 0.20 [0.43], p<0.001) and numbers of first activated partial
thromboplastin time in the supratherapeutic range (10% vs 24.2%, p=0.004)
were significantly higher in the older group. Conclusion(s):
Over-anticoagulation may be a problem in the elderly population when using
standard nomograms. It was concluded that improvements should be made for
a nomogram specific to an older population. Copyright © 2020,
Geriatrics Society. All rights reserved.

<6>
Accession Number
2005082514
Title
Infective endocarditis by proteus species: A systematic review.
Source
GERMS. 10 (3) (pp 229-239), 2020. Date of Publication: 2020.
Author
Ioannou P.; Vougiouklakis G.
Institution
(Ioannou, Vougiouklakis) Department of Internal Medicine & Infectious
Diseases, University Hospital of Heraklion, Stavrakia and Voutes
crossroad, Heraklion, Crete PC 71110, Greece
Publisher
European Academy of HIV/AIDS and Infectious Diseases
Abstract
Proteus spp. are members of the Enterobacteriaceae family and are
Gram-negative, rod-shaped bacteria known to mainly cause urinary tract
infections (UTIs) in humans. However, even though scarce evidence exists
suggesting their potential to cause infective endocarditis (IE), a study
summarizing the existing evidence is lacking. The purpose of this study
was to systemically review all published cases of IE by Proteus species in
the literature. A systematic review of PubMed, Scopus and Cochrane Library
(through 5th May 2020) for studies providing epidemiological,
clinical and microbiological data as well as data on treatment and
outcomes of IE by Proteus species was performed. A total of 16 studies,
containing data of 16 patients, were included. A prosthetic valve was
present in 25%, while the most common causative pathogen was P. mirabilis.
Aortic valve was the most common infected site in 33.3%, followed by
mitral valve in 26.7%. Diagnosis was set with transesophageal
echocardiography in 37.5%, and transthoracic echocardiography in 25%,
while the diagnosis was set at autopsy in 25%. Fever and sepsis were
present in 100% and 84.6%, respectively. Aminoglycosides and
cephalosporins were the most common antimicrobials used for treatment.
Clinical cure was noted in 62.5%, while overall mortality was 43.8%. This
systematic review describes IE by Proteu species in detail and provides
information on epidemiology, clinical presentation, treatment and
outcomes. Copyright © GERMS 2020.

<7>
Accession Number
2005015256
Title
Review article outcomes at 5 years in patients with severe aortic
stenosis: Reviewing current information using the restricted mean survival
time.
Source
American Journal of Cardiovascular Disease. 10 (3) (pp 136-141), 2020.
Date of Publication: 2020.
Author
Messori A.; Bartoli L.; Trippoli S.
Institution
(Messori, Bartoli, Trippoli) HTA Unit, Toscana Region Health Service,
Toscana Region, Florence, Italy
Publisher
E-Century Publishing Corporation
Abstract
The information about outcomes at 5 years in patients receiving
transcatheter aortic valve replacement (TAVR) has grown. We interpreted
the information on this topic using the restricted mean survival time
(RMST). The purpose of our study was to summarise the current evidence
using an original outcome measure with potential methodological
advantages. Four cohorts of patients, previously published in the
literature, met our criterion of 5 years of follow-up after the implant;
another cohort was identified from a group of controls subjected to
surgical replacement of the valve. The estimated values of RMST at 5 years
for the 5 patient cohorts were the following (N = number of patients, all
time values in years): a) real-world high surgical risk cohort: N = 114,
RMST = 3.80; b) real-world cohort treated with Corevalve: N = 309, RMST =
3.79; c) a real-world cohort treated with Sapien: N = 180, RMST = 3.61; d)
TAVR arm of a randomized trial in intermediate risk patients: N = 1,011;
RMST = 3.73; e) surgical replacement arm of the same trial: N = 1,021,
RMST = 3.72. The main result of our analysis based on the RMST is
represented by the extreme homogeneity of the outcomes (RMSTs ranging from
3.61 to 3.80 years per patient) that remained virtually constant
irrespective of the baseline risk of the patients (intermediate or high
risk) and re-gardless of whether the intervention was transcatheter or by
surgical replacement. Last but not least, our analysis showed the good
methodological performance of the RMST in this disease
condition. Copyright © 2020, E-Century Publishing Corporation.
All rights reserved.

<8>
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.
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.

<9>
Accession Number
2008566461
Title
The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain
After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Xu Z.; Dai S.-H.; Jiang J.-L.; He L.-L.; Zheng J.-Q.; Yu H.
Institution
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) Department of Anesthesiology, West
China Hospital, Sichuan University, Chengdu, China
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) The Research Units of West China
(2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Sternal incisions can generate persistent and intense
post-sternotomy pain. Propofol has been shown to improve postoperative
analgesia, but the preventive effect on persistent pain after cardiac
surgery is unknown. The hypothesis of the present study was that
intraoperative propofol-based anesthesia compared with volatile anesthesia
could reduce the risk of chronic pain after cardiac surgery.
 Design(s): A single-center, two-arm, patient-and-evaluator-blinded,
randomized controlled trial. Setting(s): A single major urban
teaching and university hospital. Patient(s): Five-hundred adult
patients undergoing cardiac surgery via sternotomy randomly were assigned.
With six withdrawals from the study and five from surgery, 244 in the
total intravenous anesthesia group and 245 in the volatile group were
included in the modified intention-to-treat analysis.
 Intervention(s): Patients randomly were assigned to receive either
propofol-based total intravenous anesthesia or volatile anesthesia during
surgery. Measurements and Main Results: The primary outcomes were the
incidence of pain at three, six, and 12 months after surgery defined as
pain score >0 on the numeric rating scale. The secondary outcomes included
acute pain, opioid use during the first 72 hours after surgery, and
quality of life. The use of propofol did not significantly affect chronic
pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence
interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%,
difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v
20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with
volatile anesthetics. Furthermore, there were no differences in acute pain
score; morphine-equivalent consumption during the first 72 hours; and
quality of life at three, six, and 12 months after surgery.
 Conclusion(s): Intraoperative administration of propofol did not
reduce persistent pain after cardiac surgery compared with volatile
anesthetics. Copyright © 2020 Elsevier Inc.

<10>
Accession Number
2005445034
Title
The effect of different posture on normal saline injection in optic nerve
sheath diameter in thoracic epidural anesthesia.
Source
Pain Physician. 23 (6) (pp 573-579), 2020. Date of Publication: 2020.
Author
Park J.; Hong J.; Kim J.; Yi S.
Institution
(Park, Hong, Kim, Yi) Keimyung University DongSan Hospital, Keimyung
University School of Medicine, Daegu, South Korea
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Thoracolumbar or caudal epidural anesthesia affects
intracranial pressure (ICP) in both animals and humans. Epidural injection
increases ICP at least transiently. Measurement of the optic nerve sheath
diameter (ONSD) using ultrasonography is one of the noninvasive methods
for ICP assessment. Objective(s): The purpose of this study was to
investigate the effect of the different posture during epidural saline
injection to the ONSD under awake conditions. Study Design:
Prospective, randomized trial. Setting(s): An interventional pain
management practice in South Korea. Method(s): This study included 44
patients receiving thoracic epidural catheterization for pain management
after upper abdominal or thoracic surgery. Following successful epidural
space confirmation, patients were randomized to receive epidural saline
while supine (A group) or in sitting position (B group), respectively.
Transorbital sonography was performed for the measurement of the ONSD, and
the ONSD was measured at 3 mm posterior to the optic nerve head.
 Result(s): Both A and B groups showed significant increases of ONSD
according to time. Mean ONSD values measured at T10, T20, and T40
significantly increased from the baseline value (T0) (*P < 0.05
vs. T0,+P < 0.001 vs. T0,++P < 0.005 vs. T0). The
mean ONSD values measured at any of the time points and degrees of changes
(T10-T0, T20-T0, and T40-T0) between groups A and B did not show any
significant changes. Limitation(s): Epidural pressure and ONSD
measurement can make this study more reliable. Further study showing
changes of epidural pressure with ONSD measurement is required.
 Conclusion(s): Thoracic epidural injection of 10 mL of normal saline
resulted in a significant increase of ONSD compared with the baseline.
However, the different posture did not affect the increase of
ONSD. Copyright © 2020, American Society of Interventional Pain
Physicians. All rights reserved.

<11>
Accession Number
633047628
Title
Management of Anticoagulation in Pregnant Women with Mechanical Heart
Valves.
Source
Obstetrical and Gynecological Survey. 75 (3) (pp 190-198), 2020. Date of
Publication: 01 Mar 2020.
Author
Daughety M.M.; Zilberman-Rudenko J.; Shatzel J.J.; McCarty O.J.T.;
Raghunathan V.; Deloughery T.G.
Institution
(Daughety) Hematology and Medical Oncology, Duke University Medical
Center, Durham, NC, United States
(Zilberman-Rudenko) Oregon Health and Science University, Portland, OR,
United States
(Shatzel) Department of Biomedical Engineering, Division of Hematology and
Medical Oncology, Department of Hematology and Oncology, Oregon Health and
Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239,
United States
(McCarty) Department of Biomedical Engineering, Portland, OR, United
States
(Raghunathan) Division of Hematology and Medical Oncology, Portland, OR,
United States
(Deloughery) Department of Medicine, Oregon Health and Science University,
Portland, OR, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Importance Mechanical heart valves (MHVs) pose significant thrombogenic
risks to pregnant women and their fetuses, yet the choice of
anticoagulation in this clinical setting remains unclear. Various
therapeutic strategies carry distinct risk profiles that must be
considered when making the decision about optimal anticoagulation.
Objective We sought to review existing data and offer recommendations for
the anticoagulation of pregnant women with MHVs, as well as management of
anticoagulation in the peripartum period. Evidence Acquisition We
performed a literature review of studies examining outcomes in pregnant
women receiving systemic anticoagulation for mechanical valves, and also
reviewed data on the safety profiles of various anticoagulant strategies
in the setting of pregnancy. Results Warfarin has been shown to increase
rates of embryopathy and fetal demise, although it has traditionally been
the favored anticoagulant in this setting. Low-molecular-weight heparin,
when dosed appropriately with close therapeutic monitoring, has been shown
to be safe for both mother and fetus. Conclusions and Relevance We favor
the use of low-molecular-weight heparin with appropriate dosing and
monitoring for the anticoagulation of pregnant women with MHVs. Data
suggest that this approach minimizes the thrombotic risk associated with
the valve while also providing safe and effective anticoagulation that can
be easily managed in the peripartum period. Target Audience Obstetricians
and gynecologists, family physicians. Learning Objectives After completing
this activity, the learner should be better able to: describe the clinical
considerations in choosing an anticoagulation strategy for a pregnant
patient with an MHV; evaluate the existing data about the safety profile
of various anticoagulation strategies and the potential benefits and risks
of each approach to the mother and fetus; and discuss one recommended
approach to management of mechanical valves in the pregnant patient and
assess the clinical nuances associated with each individual patient's
decision. Copyright © 2020 Wolters Kluwer Health, Inc. All
rights reserved.

<12>
Accession Number
632870881
Title
A Single Prophylactic Dose of Ondansetron Given at Cessation of
Postoperative Propofol Sedation Decreases Postoperative Nausea and
Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial.
Source
Anesthesia and analgesia. 131 (4) (pp 1164-1172), 2020. Date of
Publication: 01 Oct 2020.
Author
Wang E.H.Z.; Sunderland S.; Edwards N.Y.; Chima N.S.; Yarnold C.H.;
Schwarz S.K.W.; Coley M.A.
Institution
(Wang) From the Pharmacy Department, St Paul's Hospital, Providence Health
Care, Vancouver, BC, Canada
(Wang) Faculty of Pharmaceutical Sciences
(Sunderland, Chima, Yarnold, Schwarz, Coley) Department of Anesthesiology,
Pharmacology & Therapeutics, University of British Columbia, Vancouver,
BC, Canada
(Edwards, Yarnold, Schwarz, Coley) Department of Anesthesia, St Paul's
Hospital, Providence Health Care, Vancouver, BC, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common
occurrence after cardiac surgery. However, in contrast to other surgical
populations, routine PONV prophylaxis is not a standard of care in cardiac
surgery. We hypothesized that routine administration of a single
prophylactic dose of ondansetron (4 mg) at the time of stopping
postoperative propofol sedation before extubation in the cardiac surgery
intensive care unit would decrease the incidence of PONV. METHOD(S):
With institutional human ethics board approval and written informed
consent, we conducted a randomized controlled trial in patients >=19 years
of age with no history of PONV undergoing elective or urgent cardiac
surgery procedures requiring cardiopulmonary bypass. The primary outcome
was the incidence of PONV in the first 24 hours postextubation, compared
by the chi test. Secondary outcomes included the incidence and times to
first dose of rescue antiemetic treatment administration, the incidence of
headaches, and the incidence of ventricular arrhythmias. RESULT(S):
PONV within the first 24 hours postextubation occurred in 33 of 77
patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in
the placebo group (relative risk, 0.70 [95% confidence interval {CI},
0.51-0.95]; absolute risk difference, -18% [95% CI, -33 to -2]; number
needed to treat, 5.5 [95% CI, 3.0-58.4]; chi test, P = .022). Kaplan-Meier
"survival" analysis of the times to first rescue antiemetic treatment
administration over 24 hours indicated that patients in the ondansetron
group fared better than those in the placebo group (log-rank [Mantel-Cox]
test; P = .028). Overall, 32 of 77 patients (42%) in the ondansetron group
received rescue antiemetic treatment over the first 24 hours
postextubation versus 47 of 82 patients (57%) in the placebo group
(relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference, -16%
[95% CI, -31 to 1]); P = .047. There were no significant differences
between the groups in the incidence of postoperative headache (ondansetron
group, 5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%];
Fisher exact test; P = .740) or ventricular arrhythmias (ondansetron
group, 2 of 77 patients [3%] versus placebo group, 4 of 82 patients [5%];
P = .68). CONCLUSION(S): These findings support the routine
administration of ondansetron prophylaxis at the time of discontinuation
of postoperative propofol sedation before extubation in patients following
cardiac surgery. Further research is warranted to optimize PONV
prophylaxis in cardiac surgery patients.

<13>
Accession Number
630857357
Title
Inhaled milrinone in cardiac surgical patients: a pilot randomized
controlled trial of jet vs. mesh nebulization.
Source
Scientific reports. 10 (1) (pp 2069), 2020. Date of Publication: 07 Feb
2020.
Author
Nguyen A.Q.-N.; Denault A.Y.; Theoret Y.; Perrault L.P.; Varin F.
Institution
(Nguyen, Varin) Faculty of Pharmacy, Universite de Montreal, Montreal,
Canada
(Denault) Department of Anesthesiology and Critical Care Division,
Montreal Heart Institute, Universite de Montreal, Montreal, Canada
(Theoret) Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, Canada
(Perrault) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Canada
Publisher
NLM (Medline)
Abstract
Inhaled milrinone administered before cardiopulmonary bypass (CPB) reduces
the severity of pulmonary hypertension during cardiac surgery. However,
milrinone pharmacokinetics has not been determined for this route of
administration. The objective of this study was to investigate inhaled
milrinone dosing in vitro and early plasma concentrations in vivo after
jet and mesh nebulization. Twelve pulmonary hypertensive patients
scheduled for cardiac surgery were randomized to receive milrinone (5mg)
by inhalation before CPB using a jet or mesh nebulizer. In vitro
experiments were conducted to determine the inhaled dose delivered with
either jet or mesh nebulization. In vivo experiments involved hemodynamic
monitoring and blood samples drawn from patients for the first 15min after
the end of inhalation to determine early plasma concentrations. After mesh
nebulization, the mean in vitro inhaled dose was almost 3-fold higher
compared to jet nebulization (46.4% vs 16.6% for mesh and jet,
respectively; mean difference, 29.8%; 95% CI, 14.1 to 45.5; P=0.006).
Consistent with this, the early plasma concentrations in vivo were also
2-3 fold higher after mesh nebulization (P=0.002-0.005). After inhalation
(jet or mesh nebulization), milrinone early plasma concentrations remained
within the therapeutic range. No systemic hypotension was reported in our
patients.

<14>
Accession Number
630483301
Title
Levosimendan and systemic vascular resistance in cardiac surgery patients:
a systematic review and meta-analysis.
Source
Scientific reports. 9 (1) (pp 20343), 2019. Date of Publication: 30 Dec
2019.
Author
Terbeck S.; Heinisch P.P.; Lenz A.; Friess J.-O.; Guensch D.; Carrel T.;
Eberle B.; Erdoes G.
Institution
(Terbeck, Friess, Guensch, Eberle, Erdoes) Department of Anesthesiology
and Pain Medicine, Inselspital, Bern University Hospital, University of
Bern, Bern, Switzerland
(Heinisch, Carrel) Department of Cardiovascular Surgery, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Lenz) Clinical Trials Unit, University of Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
Levosimendan is a potent non-adrenergic inodilator agent. The net effect
of hemodynamic changes may result in a hyperdynamic state with low
systemic vascular resistance. We conducted a systematic review and
meta-analysis assessing hemodynamics in cardiac surgery patients treated
with levosimendan. English-language literature was searched systematically
from 2006 until October 2018, including randomized controlled trials and
case-matched or retrospective studies providing at least two sequentially
measured hemodynamic variables in adult patients who underwent cardiac
surgery with cardiopulmonary bypass and were treated with levosimendan in
comparison to alternative drugs or devices. Cardiac index significantly
increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardized
mean difference (95% CI); p=0.003] from baseline to postoperative day
(POD) 1, and by 0.75 (0.25 to 1.25; p=0.003) from baseline to POD 7, when
corrected for the standardized mean difference at baseline by a
multivariate mixed effects meta-analysis model. With this correction for
baseline differences, other hemodynamic variables including systemic
vascular resistance did not significantly differ until POD 1 [-0.17 (-0.64
to 0.30), p=0.48] and POD 7 [-0.13 (-0.61 to 0.34), p=0.58] between the
levosimendan and the comparator group. Levosimendan increases cardiac
index in patients undergoing cardiac surgery. Although levosimendan has
inodilator properties, this meta-analysis finds no clinical evidence that
levosimendan produces vasopressor-resistant vasoplegic syndrome.

<15>
Accession Number
633405681
Title
Efficacy and safety of regenerated cellulose topical gauze haemostats in
managing secondary haemostasis: a randomised control trial.
Source
Journal of wound care. 29 (11) (pp 670-677), 2020. Date of Publication: 02
Nov 2020.
Author
Develle R.; Schaerf R.; Najibi S.; Conrad J.; Abate G.
Institution
(Develle, Abate) United Health Products, NV, Henderson, United States
(Schaerf, Najibi, Conrad) Department of Surgery, Providence St. Joseph
Medical Center, Burbank, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the efficacy and safety of HemoStyp (United Health
Products, US), a neutralised oxidised regenerated cellulose (NORC) and
Surgicel (Johnson & Johnson, US), an oxidised regenerated cellulose (ORC),
in the management of bleeding of surgical wounds during abdominal,
thoracic and vascular surgeries. METHOD(S): This study was a
prospective, non-inferiority, multicentre, randomised, open-label trial.
Surgical procedures were performed according to expected standard of care
and in compliance with all relevant laws and institutional guidelines.
Patients who developed Lewis Bleeding Scale grade 1 and grade 2 bleeds not
controlled through conventional techniques were randomised to either the
NORC or ORC treatment arms. Bleeding was measured every 30 seconds after
treatment, ending at five minutes after haemostasis was achieved or at 10
minutes if haemostasis was not achieved. RESULT(S): A total of 236
patients were included in the study. There was a total of seven adverse
events in the study, none of which had causality related to either the
NORC or ORC. For all surgical procedures, haemostasis was achieved more
quickly with the NORC than the ORC (p<0.0001). In addition, haemostasis
for all patients was achieved in under two minutes for the NORC compared
with 81% of patients in the ORC groups. For Lewis Bleeding Scale grade 1
bleeds, the median time to control bleeding was 24 seconds in the NORC
group and 51 seconds for the ORC group. For grade 2 bleeds, time to
control bleeding was 76 seconds and 116 seconds, respectively.
 CONCLUSION(S): For patients in this study, haemostasis was achieved
more quickly in the NORC treatment group compared with the ORC group, in
patients with Lewis grade 1 or 2 bleeds caused by surgical wounds
generated during abdominal, thoracic and vascular surgeries.

<16>
Accession Number
633404697
Title
The experiences of adult heart, lung, and heart-lung transplantation
recipients: A systematic review of qualitative research evidence.
Source
PloS one. 15 (11) (pp e0241570), 2020. Date of Publication: 2020.
Author
Stubber C.; Kirkman M.
Institution
(Stubber, Kirkman) Global and Women's Health, Public Health and Preventive
Medicine, Monash University, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
AIM: To review evidence about the experience of being the recipient of a
donated heart, lungs, or heart and lungs. DESIGN: A systematic review
(registered with PROSPERO: CRD42017067218), in accordance with PRISMA
guidelines. DATA SOURCES: Seven databases and Google Scholar were searched
in May 2017 and July 2019 for papers reporting English-language research
that had used qualitative methods to investigate experiences of adult
recipients. REVIEW METHODS: Quality was assessed and results were analysed
thematically. RESULT(S): 24 papers (reporting 20 studies) were
eligible and included. Their results were organised into three
chronological periods: pre-transplant (encompassing the themes of 'dynamic
psychosocial impact', 'resources and support'), transplant ('The Call',
'intensive care unit'), and post-transplant ('dynamic psychosocial
impact', 'management', 'rejection'). Sub-themes were also identified. It
was evident that contemplating and accepting listing for transplantation
entailed or amplified realisation of the precipitating illness's
existential threat. The period surrounding transplantation surgery was
marked by profound, often surreal, experiences. Thereafter, although life
usually improved, it incorporated unforeseen challenges. The
transplantation clinic remained important to the recipient. The meaning of
the clinic and its staff could be both reassuring (providing care and
support) and threatening (representing onerous medical requirements and
potential organ rejection). CONCLUSION(S): This review has
implications for the psychosocial care of transplant recipients and
indicates the need for further research to gain insight into the
experience of receiving a donated heart and/or lung. IMPACT: Medical
consequences of heart and lung transplantation are well documented; this
is the first systematic review of research using qualitative methods to
investigate the experience of heart, lung, and heart-and-lung
transplantation. The psychosocial impact of transplantation was found to
be dynamic and complex, with notable features evident before, during, and
after transplantation. Clinic staff remained significant to recipients. It
is clear that recipients need continuing psychosocial as well as medical
support.

<17>
Accession Number
2008595723
Title
Antitussive effect of a magnesium infusion during anesthetic emergence in
patients with double-lumen endotracheal tube: A randomized controlled
trial.
Source
Journal of Thoracic Disease. 12 (10) (pp 5691-5699), 2020. Date of
Publication: October 2020.
Author
Hur M.; Kim J.Y.; Kim D.H.; Yoo J.Y.; Shin H.-B.; Park B.; Kim M.; Park
E.; Park S.Y.
Institution
(Hur, Kim, Kim, Yoo, Kim, Park, Park) Department of Anesthesiology and
Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
(Shin, Park) Office of Biostatistics, Medical Research Collaboration
Center, Ajou Research Institute for Innovative Medicine, Ajou University
School of Medicine, Suwon, South Korea
Publisher
AME Publishing Company
Abstract
Background: A double-lumen endotracheal tube (DLT) inserted into the
bronchus can stimulate the respiratory tracts, causing coughing. Opioids
have been introduced to prevent emergence cough. However, the
administration of a significant opioid dose at the end of surgery may
result in undesirable events. Magnesium, common intracellular ion,
suppress bronchial smooth muscle contraction and have antitussive effect.
We investigated the antitussive effects of a magnesium infusion during
anesthetic emergence in patients who underwent thoracic surgery requiring
one-lung ventilation (OLV) anesthesia with a DLT. Method(s):
One-hundred forty patients undergoing OLV anesthesia with a DLT were
enrolled in this prospective, randomized double-blinded trial. In
combination with a low dose of remifentanil, patients were randomly
allocated to receive either magnesium sulphate (infusion of 15 mg/kg/hour
after a single bolus of 30 mg/kg) or normal saline during the operation
and emergence. Primary outcomes were the severity and incidence of cough
during emergence. Result(s): The severity of cough was assessed by
the cough severity grading score: 0, no cough; 1, single cough; 2, cough
persistence <5 seconds; 3, cough persistence >=5 seconds. There was a
significant difference in the severity score of cough between the groups
[median (IQR): 2 (0 to 3) in control group vs. 0 (0 to 1) in magnesium
group, P=0.003]. However, there was no significant difference in the
overall incidence of cough between both groups [42 (64.6%) in control
group vs. 31 (47.7%) in magnesium group, P=0.077]. Conclusion(s):
Magnesium attenuated the severity of cough during emergence after OLV
anesthesia using a DLT without adverse events. Copyright © 2020
AME Publishing Company. All rights reserved.

<18>
Accession Number
2008595715
Title
Obstructive sleep apnea-induced multi-organ dysfunction after elective
coronary artery bypass surgery in coronary heart disease patients.
Source
Journal of Thoracic Disease. 12 (10) (pp 5603-5616), 2020. Date of
Publication: October 2020.
Author
Wang J.; Wang X.; Yu W.; Zhang K.; Wei Y.
Institution
(Wang, Yu, Zhang) Department of Cardiac Surgery, Beijing An Zhen Hospital,
Capital Medical University, Beijing, China
(Wang) Center for Cardiac Intensive Care, Beijing An Zhen Hospital,
Capital Medical University, Beijing, China
(Wang) Department of General Surgery, Chinese PLA general hospital,
Beijing, China
(Wei) Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(Wei) Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen
Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District,
Beijing 100029, China
Publisher
AME Publishing Company
Abstract
Background: The aim of this study was to explore the underlying impact of
obstructive sleep apnea (OSA) on postoperative parameters of multi-organ
function among coronary heart disease (CHD) patients following elective
coronary artery bypass grafting (CABG). Method(s): Electronic
literature databases were searched manually and automatically for relevant
English articles. All of the included articles focused on a comparison of
the incidence of postoperative parameters of multi-organ function in CHD
patients undergoing elective CABG with and without OSA. Studies were
excluded if they met any one of the following criteria: (I) duplicate
publication; (II) ongoing or unpublished studies; (III) only published as
abstracts or conference proceedings; and (IV) less than 30 patients in the
patient cohort. Result(s): A total of 13 articles met our inclusion
criteria. The current study demonstrated OSA significantly increased the
incidence of major adverse cardiac and cerebrovascular events (MACCEs) in
CHD patients undergoing elective CABG compared with the controls [odds
risk (OR), 1.97; 95% CI, 1.50 to 2.59, P<0.0001]. In addition, OSA was
associated with an increased risk of new revascularization in CHD patients
undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, P<0.0001).
Moreover, reintubation and tracheostomy in the OSA group was increased
243% (OR, 3.43; 95% CI, 1.35 to 8.71; P=0.009) and 372% (OR, 4.72; 95% CI,
1.23 to 18.13; P=0.024), respectively, compared with the control group.
Besides, we also confirmed OSA significantly increased the acute kidney
injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P<0.0001).
 Conclusion(s): OSA may contribute to postoperative multi-organ
dysfunction among CHD patients undergoing elective CABG by increasing the
incidence of MACCEs, especially new revascularization, as well as
respiratory, and renal complications. Copyright © 2020 AME
Publishing Company. All rights reserved.

<19>
Accession Number
2008594026
Title
A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia
(TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Beverstock J.; Park T.; Alston R.P.; Song C.C.A.; Claxton A.; Sharkey T.;
Hutton S.; Fathers J.; Cawley W.
Institution
(Beverstock, Park, Alston, Song, Claxton, Sharkey, Hutton, Fathers,
Cawley) College of Medicine and Veterinary Medicine, University of
Edinburgh, Edinburgh, United Kingdom
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: The primary objective of this study was to compare one-year
mortality in patients undergoing cardiac surgery with volatile anesthesia
or total intravenous anesthesia (TIVA). Secondary objectives were to
compare in-hospital and 30-day mortality, postoperative levels of creatine
kinase (CK-MB) and cardiac troponin, and durations of tracheal intubation,
intensive care unit (ICU) and hospital stays. Design(s): Systematic
review and meta-analysis of randomized controlled trials (RCTs).
 Setting(s): International, multi-institution centers.
 Participant(s): Adults patients undergoing heart surgery.
 Intervention(s): Volatile anesthesia and TIVA. Measurements and
Main Results: Meta-analysis found no statistically significant difference
between patients receiving TIVA and volatile anesthesia in one-year
mortality (n = 6440, OR = 1.22, 95% CI 0.97 to 1.54, p = 0.09, Z = 1.67,
I2 = 0%), troponin (n = 3127, SMD = 0.26, 95% CI -0.01 to 0.52,
p = 0.05, Z = 1.92, I2 = 90%) and CK-MB concentration 24h
postoperatively (n = 1214, SMD = 0.10, 95% CI -0.17 to 0.36, unadjusted p
= 0.48, Z = 0.71, I2 = 79%), or time to tracheal extubation (n
= 1059, SMD = 0.10, 95% CI -0.28 to 0.49, p = 0.60, Z = 0.53, I2 = 88%).
The durations of ICU stay (n = 2003, SMD = 0.29, 95% CI 0.01 to 0.57, p =
0.04, Z = 2.05, I2 = 88%) and hospital stay (n = 1214, SMD =
0.42, 95% CI 0.10 to 0.75, p = 0.01, Z = 2.53, I2 = 91%) were
shorter in the volatile anesthetic compared to TIVA group.
 Conclusion(s): No significant differences in mortality (in-hospital,
30-day, 1-year), troponin and CK-MB concentrations 24 h postoperatively,
or time to tracheal extubation were found between patients who had
volatile anesthesia or TIVA. Compared to TIVA, volatile anesthesia was
associated with shorter durations of hospital and ICU stays. Copyright
© 2020 Elsevier Inc.

<20>
Accession Number
633415290
Title
Hybrid Convergent Procedure for the Treatment of Persistent and Long
Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical
Trial.
Source
Circulation. Arrhythmia and electrophysiology. (no pagination), 2020. Date
of Publication: 13 Nov 2020.
Author
DeLurgio D.B.; Crossen K.J.; Gill J.; Blauth C.; Oza S.R.; Magnano A.R.;
Mostovych M.A.; Halkos M.E.; Tschopp D.R.; Kerendi F.; Taigen T.L.; Shults
C.C.; Shah M.H.; Rajendra A.B.; Osorio J.; Silver J.S.; Hook B.G.;
Gilligan D.M.; Calkins H.
Institution
(DeLurgio, Halkos) Emory University - St. Joseph's Hospital, Atlanta,
United States
(Crossen) Cardiology Associates Research, LLC, MS, Tupelo, United States
(Gill, Blauth) Guy's & St. Thomas Hospital, London, United Kingdom
(Oza, Magnano, Mostovych) St. Vincent's HealthCare, FL, Jacksonville,
United States
(Tschopp, Kerendi) Austin Heart PLLC, TX, Austin, United States
(Taigen) Summa Health System, Akron, OH
(Shults, Shah) Medstar Washington Hospital Center, DC, WA
(Rajendra, Osorio) Grandview Medical Center, Birmingham, AL
(Silver, Hook) Lahey Clinic, MA, Burlington, United States
(Gilligan) Virginia Cardiovascular Specialists, VA, Richmond
(Calkins) Johns Hopkins Medicine, MD, Baltimore, United States
Publisher
NLM (Medline)
Abstract
Background - The limited effectiveness of endocardial catheter ablation
(CA) for persistent and long-standing persistent atrial fibrillation
(Ps/LSP-AF) treatment led to the development of a minimally-invasive
epicardial/endocardial ablation approach (Hybrid Convergent) to achieve a
more comprehensive lesion set with durable transmural lesions. The
multi-center randomized controlled CONVERGE trial (NCT01984346) evaluated
the safety of Hybrid Convergent and compared its effectiveness to CA for
Ps/LSP-AF treatment. Methods - One-hundred fifty-three patients were
randomized 2:1 to Hybrid Convergent vs. CA. Primary effectiveness was
freedom from AF/AFL/AT absent new/increased dosage of previously
failed/intolerant class I/III anti-arrhythmic drugs (AADs) through
12-months. Primary safety was major adverse events through 30 days.
CONVERGE permitted left atrium size up to 6cm and imposed no limits on AF
duration, making it the only ablation trial to substantially include
LSP-AF i.e. 42% patients with LSP-AF. Results - Of 149 evaluable patients
at 12 months, primary effectiveness was achieved in 67.7% (67/99) patients
with Hybrid Convergent and 50.0% (25/50) with CA (p=0.036) on/off
previously failed AADs and in 53.5% (53/99) versus 32.0% (16/50)
(p=0.0128) respectively off AADs. At 18-months using 7-day Holter, 74.0%
(53/72) Hybrid Convergent and 55% (23/42) CA patients experienced >=90% AF
burden reduction. A total of 2.9% (3/102) patients had primary safety
events within 7 days, and 4.9% (5/102) between 8-30 days post-procedure.
No deaths, cardiac perforations or atrioesophageal fistulas occurred. All
but one primary safety event resolved. Conclusions - The Hybrid Convergent
procedure has superior effectiveness compared to the CA for the treatment
of Ps/LSP-AF.

<21>
Accession Number
633415196
Title
Mini or full sternotomy for aortic valve repair? A systematic review of
the literature.
Source
The Journal of cardiovascular surgery. (no pagination), 2020. Date of
Publication: 13 Nov 2020.
Author
Murana G.; Pacini D.
Institution
(Murana) Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S.
Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna,
Italy
(Pacini) Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S.
Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna,
Italy
Publisher
NLM (Medline)
Abstract
Minimally invasive aortic valve replacement is becoming a standard
treatment. The possibility of extending this approach to more demanding
aortic root pathologies is being debated with limited evidence. Attaining
comfort in a complex aortic repair is a "dogma" that should always be
achieved. Perhaps, the patient's condition, the aortic anatomy and the
expertise creates the fundamental principles that achieve stable results
over time. In this review article, we sought to analyze and report the
experience and results of a currently available series on aortic valve
repair (with or without associated aortic root procedures) using mini
sternotomy. Early- and long-term data will be reported and discussed in
terms of survival and aortic valve function.

<22>
Accession Number
633411917
Title
Percutaneous coronary intervention with drug eluting stents versus
coronary artery bypass graft surgery in patients with advanced chronic
kidney disease: A systematic review and meta-analysis.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2020.
Date of Publication: 09 Nov 2020.
Author
Doulamis I.P.; Tzani A.; Tzoumas A.; Iliopoulos D.C.; Kampaktsis P.N.;
Briasoulis A.
Institution
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, MA, Boston
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, MA, Boston
(Tzoumas) Medical School, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Iliopoulos) Department of Cardiothoracic Surgery, Hygeia Medical Center,
Athens, Greece
(Kampaktsis) Division of Cardiology, New York University Langone Medical
Center, NY, NY
(Briasoulis) University of Iowa Hospitals and Clinics, IA, Iowa City,
United States
Publisher
NLM (Medline)
Abstract
Tomicron perform a systematic review and meta-analysis of the available
literature comparing safety and efficacy outcomes between percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) and coronary
artery bypass grafting (CABG) in patients with chronic kidney disease
(CKD). Eligible studies included patients with eGFR<60 mL/min/1.73 m2 that
underwent revascularization. Subgroup analyses according to DES generation
and dialysis status were performed. A total of 7157 and 8156 patients were
included in the CABG and PCI arms respectively across 16 studies eligible
studies. Weighted mean age was 68.6 and 63.8 years for the CABG and PCI
arms respectively. Mean follow-up time was 3.2 and 2.9 years respectively.
Compared to CABG, PCI was associated with increased risk for all-cause
mortality (HR: 1.28, 95% CI: 1.13, 1.46; P<.01), cardiac mortality (HR:
1.59, 95% CI: 1.13, 2.23; P=.01), myocardial infarction (MI) (HR: 1.89,
95% CI: 1.43, 2.49; P<.01) and repeat revascularization (HR: 2.97, 95% CI:
2.20, 3.97; P<.01). Risk for stroke was lower (HR: 0.64, 95% CI: 0.50,
0,81; P<.01) in the PCI group. These results were unchanged when 1st or
2nd DES were used. A subgroup analysis showed no difference in all-cause
mortality for DES PCI vs. CABG in dialysis patients (HR: 1.11, 95% CI:
0.71, 1.73; P=.65). In patients with CKD, PCI is associated with higher
risk of mortality, MI and repeat revascularization compared with CABG and
regardless of DES generation. Risk of stroke is higher with CABG. Type of
revascularization had no impact on survival of dialysis
patients. Copyright © 2020. Published by Elsevier Inc.

<23>
Accession Number
633409371
Title
A Pilot Trial of Platelets Stored Cold versus at Room Temperature for
Complex Cardiothoracic Surgery.
Source
Anesthesiology. (pp 1173-1183), 2020. Date of Publication: 2020.
Author
Strandenes G.; Sivertsen J.; Bjerkvig C.K.; Fosse T.K.; Cap A.P.; Del
Junco D.J.; Kristoffersen E.K.; Haaverstad R.; Kvalheim V.; Braathen H.;
Lunde T.H.F.; Hervig T.; Hufthammer K.O.; Spinella P.C.; Apelseth T.O.
Institution
(Strandenes, Sivertsen, Kristoffersen, Braathen, Lunde, Hervig, Apelseth)
Department of Immunology and Transfusion Medicine, United States
(Bjerkvig, Fosse) Department of Anesthesia and Intensive Care, United
States
(Haaverstad, Kvalheim) Department of Heart Disease, United States
(Apelseth) Department of Clinical Biochemistry and Pharmacology, United
States
(Hufthammer) Centre for Clinical Research, Haukeland University Hospital,
Bergen, Norway
(Strandenes) Department of War Surgery and Emergency Medicine, Norwegian
Armed Forces Medical Services, Oslo, Norway
(Bjerkvig, Fosse, Kristoffersen, Haaverstad, Kvalheim, Hervig) Institute
of Clinical Science, University of Bergen, Bergen, Norway
(Bjerkvig, Fosse) Norwegian Naval Special Operations Command, Bergen,
Norway
(Cap) U.S. Army Institute of Surgical Research, United States
(Del Junco) Joint Trauma System, Department of Defense Center of
Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, San
Antonio, Texas, United States
(Spinella) Division of Pediatric Critical Care, Department of Pediatrics,
Washington University in. St Louis, St. Louis, Missouri, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: This pilot trial focused on feasibility and safety to provide
preliminary data to evaluate the hemostatic potential of cold-stored
platelets (2degree to 6degreeC) compared with standard room
temperature-stored platelets (20degree to 24degreeC) in adult patients
undergoing complex cardiothoracic surgery. This study aimed to assess
feasibility and to provide information for future pivotal trials.
 Method(s): A single center two-stage exploratory pilot study was
performed on adult patients undergoing elective or semiurgent complex
cardiothoracic surgery. In stage I, a two-armed randomized trial,
platelets stored up to 7 days in the cold were compared with those stored
at room temperature. In the subsequent single-arm stage II, cold storage
time was extended to 8 to 14 days. The primary outcome was clinical effect
measured by chest drain output. Secondary outcomes were platelet function
measured by multiple electrode impedance aggregometry, total blood usage,
immediate and long-term (28 days) adverse events, length of stay in
intensive care, and mortality. Result(s): In stage I, the median
chest drain output was 720 ml (quartiles 485 to 1,170, n = 25) in patients
transfused with room temperature-stored platelets and 645 ml (quartiles
460 to 800, n = 25) in patients transfused with cold-stored platelets. No
significant difference was observed. The difference in medians between the
room temperature- and cold-stored up to 7 days arm was 75 ml (95% CI,
-220, 425). In stage II, the median chest drain output was 690 ml (500 to
1,880, n = 15). The difference in medians between the room temperature arm
and the nonconcurrent cold-stored 8 to 14 days arm was 30 ml (95% CI,
-1,040, 355). Platelet aggregation in vitro increased after transfusion in
both the room temperature- and cold-stored platelet study arms. Total
blood usage, number of adverse events, length of stay in intensive care,
and mortality were comparable among patients receiving cold-stored and
room temperature-stored platelets. Conclusion(s): This pilot trial
supports the feasibility of platelets stored cold for up to 14 days and
provides critical guidance for future pivotal trials in high-risk
cardiothoracic bleeding patients. Copyright © 2020 Georg Thieme
Verlag. All rights reserved.

<24>
Accession Number
633409343
Title
Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse
Cardiovascular Events in Patients at High Cardiovascular Risk: The
STRENGTH Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. (no pagination), 2020.
Date of Publication: 2020.
Author
Nicholls S.J.; Lincoff A.M.; Garcia M.; Bash D.; Ballantyne C.M.; Barter
P.J.; Davidson M.H.; Kastelein J.J.P.; Koenig W.; McGuire D.K.;
Mozaffarian D.; Ridker P.M.; Ray K.K.; Katona B.G.; Himmelmann A.; Loss
L.E.; Rensfeldt M.; Lundstrom T.; Agrawal R.; Menon V.; Wolski K.; Nissen
S.E.
Institution
(Nicholls) Monash Cardiovascular Research Centre, Victorian Heart
Institute, Monash University, Melbourne, Australia
(Lincoff, Garcia, Bash, Menon, Wolski, Nissen) Cleveland Clinic
Coordinating Center for Clinical Research, Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, OH, United States
(Ballantyne) Baylor College of Medicine, Houston, TX, United States
(Barter) University of New South Wales, Sydney, Australia
(Davidson) University of Chicago, Chicago, IL, United States
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Dzhk (German Centre for Cardiovascular Research), Partner Site Munich
Heart Alliance, Munich, Germany
(McGuire) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, United States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Ridker) Center for Cardiovascular Disease Prevention, Harvard Medical
School, Boston, MA, United States
(Ray) Imperial College of London, London, United Kingdom
(Katona, Loss) AstraZeneca BioPharmaceuticals RandD, Late-stage
Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD, United
States
(Himmelmann, Rensfeldt, Lundstrom, Agrawal) AstraZeneca BioPharmaceuticals
RandD, Late-stage Development, Cardiovascular, Renal and Metabolic,
Gothenburg, Sweden
Publisher
American Medical Association
Abstract
Importance: It remains uncertain whether the omega-3 fatty acids
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduce
cardiovascular risk. Objective(s): To determine the effects on
cardiovascular outcomes of a carboxylic acid formulation of EPA and DHA
(omega-3 CA) with documented favorable effects on lipid and inflammatory
markers in patients with atherogenic dyslipidemia and high cardiovascular
risk. Design, Setting, and Participant(s): A double-blind,
randomized, multicenter trial (enrollment October 30, 2014, to June 14,
2017; study termination January 8, 2020; last patient visit May 14, 2020)
comparing omega-3 CA with corn oil in statin-Treated participants with
high cardiovascular risk, hypertriglyceridemia, and low levels of
high-density lipoprotein cholesterol (HDL-C). A total of 13078 patients
were randomized at 675 academic and community hospitals in 22 countries in
North America, Europe, South America, Asia, Australia, New Zealand, and
South Africa. Intervention(s): Participants were randomized to
receive 4 g/d of omega-3 CA (n = 6539) or corn oil, which was intended to
serve as an inert comparator (n = 6539), in addition to usual background
therapies, including statins. Main Outcomes and Measures: The primary
efficacy measure was a composite of cardiovascular death, nonfatal
myocardial infarction, nonfatal stroke, coronary revascularization, or
unstable angina requiring hospitalization. Result(s): When 1384
patients had experienced a primary end point event (of a planned 1600
events), the trial was prematurely halted based on an interim analysis
that indicated a low probability of clinical benefit of omega-3 CA vs the
corn oil comparator. Among the 13078 treated patients (mean [SD] age, 62.5
[9.0] years; 35% women; 70% with diabetes; median low-density lipoprotein
[LDL] cholesterol level, 75.0 mg/dL; median triglycerides level, 240
mg/dL; median HDL-C level, 36 mg/dL; and median high-sensitivity
C-reactive protein level, 2.1 mg/L), 12633 (96.6%) completed the trial
with ascertainment of primary end point status. The primary end point
occurred in 785 patients (12.0%) treated with omega-3 CA vs 795 (12.2%)
treated with corn oil (hazard ratio, 0.99 [95% CI, 0.90-1.09]; P =.84). A
greater rate of gastrointestinal adverse events was observed in the
omega-3 CA group (24.7%) compared with corn oil-Treated patients (14.7%).
 Conclusions and Relevance: Among statin-Treated patients at high
cardiovascular risk, the addition of omega-3 CA, compared with corn oil,
to usual background therapies resulted in no significant difference in a
composite outcome of major adverse cardiovascular events. These findings
do not support use of this omega-3 fatty acid formulation to reduce major
adverse cardiovascular events in high-risk patients. Trial Registration:
ClinicalTrials.gov Identifier: NCT02104817. Copyright © 2020
American Medical Association. All rights reserved.

<25>
Accession Number
633408107
Title
Implantable cardioverter-defibrillators in cardiac transplant recipients:
A systematic review from the Electrophysiology Collaborative Consortium
for Meta-analysis-ELECTRAM investigators.
Source
Pacing and clinical electrophysiology : PACE. (no pagination), 2020. Date
of Publication: 12 Nov 2020.
Author
Garg J.; Shah K.; Turagam M.K.; Tzou W.; Gopinathannair R.; Natale A.;
Lakkireddy D.
Institution
(Garg) Division of Cardiology, Cardiac Arrhythmia Service, Medical College
of Wisconsin, Milwaukee, WI, United States
(Shah) Department of Cardiovascular Medicine, Beaumont Hospital, Oakland
University William Beaumont School of Medicine, Royal Oak, MI
(Turagam) Cardiac Arrhythmia Service, Helmsley Electrophysiology Center,
Icahn School of Medicine at Mount Sinai, NY
(Tzou) Division of Cardiology, Section of Cardiac Electrophysiology,
University of Colorado School of Medicine, Aurora, CO, United States
(Gopinathannair, Lakkireddy) Division of Electrophysiology, Kansas City
Heart Rhythm Institute and Research Foundation, Kansas City, KS, United
States
(Natale) Division of Electrophysiology, Texas Cardiac Arrhythmia Institute
at St. David's Medical Center, Austin, TX, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Implantable cardioverter-defibrillator (ICD) in patients
with heart failure with reduced ejection fraction reduces mortality
secondary to malignant arrhythmias. Whether cardiac transplant patients
considered high risk for sudden death (SD) derive similar benefits remains
controversial. METHOD(S): Systematic search, without language
restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and
ClinicalTrials.gov was performed from inception to June 4, 2020, for
studies that had reported outcomes in patients who had ICD implanted after
cardiac transplant. The outcomes studied were as follows: (a) SD and (b)
appropriate and inappropriate ICD therapies. RESULT(S): Seven studies
(from 1983 through 2018) with a total of 338 cardiac transplant patients
who received ICD met study inclusion criteria. The mean age was 48.37 +/-
14.85 years, and 70.4% were men. The pooled incidence of SD was 16.3% (95%
CI 6.2-29.0%; I2 = 66%). Appropriate and inappropriate ICD therapies were
observed in 12.1% (95% CI 5.3-20.4; I2 = 0%) and 3.5% (95% CI 0.11-9.58%;
I2 = 0%), respectively during the follow-up period (27.48 +/- 24.27
months). The most common cause for SD was heart failure (15.6%), followed
by electromechanical disassociation, malignant ventricular arrhythmias
(4.7% each, respectively), and cardiac allograft vasculopathy (CAV)
(3.1%). Furthermore, approximately 60% (10/17) of patients with
appropriate ICD shocks had CAV. CONCLUSION(S): Despite, low incidence
of arrhythmic mortality, there remains an increased burden of ventricular
arrhythmias, as evident by a 12% appropriate ICD shock rates, suggesting
ICD might be a practical decision in selected cardiac transplant patients
deemed high risk of SD (i.e., patients with advanced CAV and left
ventricular systolic dysfunction). Copyright © 2020 Wiley
Periodicals LLC.

<26>
Accession Number
633405527
Title
Transcatheter Mitral Valve Repair in Patients With and Without Cardiac
Resynchronization Therapy: The COAPT Trial.
Source
Circulation. Heart failure. (pp CIRCHEARTFAILURE120007293), 2020. Date of
Publication: 12 Nov 2020.
Author
Kosmidou I.; Lindenfeld J.; Abraham W.T.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.K.; Kipperman R.M.; Boudoulas K.D.; Redfors B.; Shahim B.;
Zhang Z.; Mack M.J.; Stone G.W.
Institution
(Kosmidou, Redfors, Shahim, Zhang, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, B.R., B.S., NY
(Kosmidou, Redfors) NewYork-Presbyterian Hospital/Columbia University
Irving Medical Center (I.K.
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, United
States
(Abraham, Boudoulas) Division of Cardiovascular Medicine, Ohio State
University
(Kar) Los Robles Regional Medical Center, Thousand Oaks
(Kar) Bakersfield Heart Hospital
(Lim) Division of Cardiology, University of Virginia
(Mishell) Kaiser Permanente-San Francisco Hospital
(Whisenant) Intermountain Heart Center, Salt Lake City, United States
(Kipperman) Gagnon Cardiovascular Institute, Morristown Medical Center
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, United States
(Mack) Baylor Scott and White Health, Plano, United States
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, NY
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the COAPT trial (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients With Functional
Mitral Regurgitation), treatment of heart failure (HF) patients with
moderate-severe or severe secondary mitral regurgitation with
transcatheter mitral valve repair (TMVr) using the MitraClip plus
guideline-directed medical therapy (GDMT) reduced 2-year rates of HF
hospitalization and all-cause mortality compared with GDMT alone. Whether
the benefits of the MitraClip extend to patients with previously implanted
cardiac resynchronization therapy (CRT) is unknown. We sought to examine
the effect of prior CRT in patients enrolled in COAPT. METHOD(S):
Patients (N=614) with moderate-severe or severe secondary mitral
regurgitation who remained symptomatic despite maximally tolerated doses
of GDMT were randomized 1:1 to the MitraClip (TMVr arm) versus GDMT only
(control arm). Outcomes were assessed according to prior CRT use.
 RESULT(S): Among 614 patients, 224 (36.5%) had prior CRT (115 and 109
randomized to TMVr and control, respectively) and 390 (63.5%) had no CRT
(187 and 203 randomized to TMVr and control, respectively). Patients with
CRT had similar 2-year rates of the composite of death or HF
hospitalization compared with those without CRT (57.6% versus 55%,
P=0.32). Death or HF hospitalization at 2 years was lower with TMVr versus
control treatment in patients with prior CRT (48.6% versus 67.2%, hazard
ratio, 0.60 [95% CI, 0.42-0.86]) and without CRT (42.5% versus 66.9%,
hazard ratio, 0.52 [95% CI, 0.39-0.69]; adjusted Pinteraction=0.23). The
effects of TMVr with the MitraClip on reducing the 2-year rates of
all-cause death (adjusted Pinteraction=0.14) and HF hospitalization
(adjusted Pinteraction=0.82) were also consistent in patients with and
without CRT as were improvements in quality-of-life and exercise capacity.
 CONCLUSION(S): In the COAPT trial, TMVr with the MitraClip improved
the 2-year prognosis of patients with HF and moderate-severe or severe
secondary mitral regurgitation who remained symptomatic despite maximally
tolerated GDMT, regardless of prior CRT implantation. REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier: NCT01626079.

<27>
Accession Number
2008442791
Title
Antiplatelet therapy and coronary artery bypass grafting: A systematic
review and network meta-Analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (3) (pp 354-363),
2020. Date of Publication: 01 Sep 2020.
Author
Gupta S.; Belley-Cote E.P.; Panchal P.; Pandey A.; Basha A.; Pallo L.;
Rochwerg B.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, Hamilton,
ON, Canada
(Gupta, Rochwerg, Whitlock) Department of Health Research Methods,
Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Mehta, Schwalm, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Panchal, Pandey, Basha) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Pallo) Faculty of Sciences, McMaster University, Hamilton, ON, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: Acetylsalicylic acid (ASA) monotherapy is the standard of care
after coronary artery bypass grafting (CABG), but the benefits of more
intense antiplatelet therapy, specifically dual antiplatelet therapy
(DAPT), require further exploration in CABG patients. We performed a
network meta-Analysis to compare the effects of various antiplatelet
regimens on saphenous vein graft patency, mortality, major adverse
cardiovascular events and bleeding among CABG patients. METHOD(S): We
searched Cochrane Central Register of Controlled Trials, Medical
Literature Analysis and Retrieval Systems Online, Excerpta Medica
Database, Cumulative Index to Nursing and Allied Health Literature,
American College of Physicians Journal Club and conference proceedings for
randomized controlled trials. Screening, data extraction, risk of bias
assessment and Grading of Recommendations Assessment, Development and
Evaluation were performed in duplicate. We conducted a random effect
Bayesian network meta-Analysis including both direct and indirect
comparisons. RESULT(S): We included 43 randomized controlled trials
studying 15 511 patients. DAPT with low-dose ASA and ticagrelor [odds
ratio (OR) 2.53, 95% credible interval (CrI) 1.35-4.72; I2 = 55; low
certainty] or clopidogrel (OR 1.56, 95% CrI 1.02-2.39; I2 = 55; very low
certainty) improved saphenous vein graft patency when compared to low-dose
ASA monotherapy. DAPT with low-dose ASA and ticagrelor was associated with
lower mortality (OR 0.52, 95% CrI 0.30-0.87; I2 = 14; high certainty) and
lower major adverse cardiovascular events (OR 0.63, 95% CrI 0.44-0.91; I2
= 0; high certainty) when compared to low-dose ASA monotherapy. Based on
moderate certainty evidence, DAPT was associated with an increase in major
bleeding. CONCLUSION(S): Our results suggest that DAPT improves
saphenous vein graft patency, mortality and major adverse cardiovascular
event. As such, surgeons and physicians should consider re-initiating DAPT
for acute coronary syndrome patients after their CABG, at the expense of
an increased risk for major bleeding. Clinical trial registration:
International Prospective Register of Systematic Reviews ID Number
CRD42019127695. Copyright © 2020 Oxford University Press. All
rights reserved.

<28>
Accession Number
2008415237
Title
Mortality after drug-eluting stents vs. coronary artery bypass grafting
for left main coronary artery disease: A meta-analysis of randomized
controlled trials.
Source
European Heart Journal. 41 (34) (pp 3228-3235), 2020. Date of Publication:
07 Sep 2020.
Author
Ahmad Y.; Howard J.P.; Arnold A.D.; Cook C.M.; Prasad M.; Ali Z.A.; Parikh
M.A.; Kosmidou I.; Francis D.P.; Moses J.W.; Leon M.B.; Kirtane A.J.;
Stone G.W.; Karmpaliotis D.
Institution
(Ahmad, Prasad, Ali, Parikh, Kosmidou, Moses, Leon, Kirtane, Karmpaliotis)
Center for Interventional Vascular Therapy, Columbia University Medical
Center, NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New
York, NY 10032, United States
(Ahmad, Howard, Arnold, Cook, Francis) National Heart and Lung Institute,
Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
(Ali, Kosmidou, Moses, Leon, Kirtane, Stone) Cardiovascular Research
Foundation, 1700 Broadway, New York, NY 10019, United States
(Stone) Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai,
1190 Fifth Avenue, New York, NY 10029, United States
Publisher
Oxford University Press
Abstract
Aims The optimal method of revascularization for patients with left main
coronary artery disease (LMCAD) is controversial. Coronary artery bypass
graft surgery (CABG) has traditionally been considered the gold standard
therapy, and recent randomized trials comparing CABG with percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) have reported
conflicting outcomes. We, therefore, performed a systematic review and
updated meta-analysis comparing CABG to PCI with DES for the treatment of
LMCAD. Methods We systematically identified all randomized trials
comparing PCI with DES vs. CABG in patients with LMCAD. The and results
primary efficacy endpoint was all-cause mortality. Secondary endpoints
included cardiac death, myocardial infarction (MI), stroke, and unplanned
revascularization. All analyses were by intention-to-treat. There were
five eligible trials in which 4612 patients were randomized. The weighted
mean follow-up duration was 67.1 months. There were no significant
differences between PCI and CABG for the risk of all-cause mortality
[relative risk (RR) 1.03, 95% confidence interval (CI) 0.81-1.32; P =
0.779] or cardiac death (RR 1.03, 95% CI 0.79-1.34; P = 0.817). There were
also no significant differences in the risk of stroke (RR 0.74, 95% CI
0.35-1.50; P = 0.400) or MI (RR 1.22, 95% CI 0.96-1.56; P = 0.110).
Percutaneous coronary intervention was associated with an increased risk
of unplanned revascularization (RR 1.73, 95% CI 1.49-2.02; P < 0.001).
Conclusion The totality of randomized clinical trial evidence demonstrated
similar long-term mortality after PCI with DES compared with CABG in
patients with LMCAD. Nor were there significant differences in cardiac
death, stroke, or MI between PCI and CABG. Unplanned revascularization
procedures were less common after CABG compared with PCI. These findings
may inform clinical decision-making between cardiologists, surgeons, and
patients with LMCAD. Copyright © The Author(s) 2020. Published by
Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/4.0/),
which permits unrestricted reuse, distribution, and reproduction in any
medium, provided the original work is properly cited.

<29>
Accession Number
2007983186
Title
Prospective partially randomized comparison of clopidogrel loading versus
maintenance dosing to prevent periprocedural myocardial infarction after
stenting for stable angina pectoris.
Source
International Journal of Clinical Pharmacology and Therapeutics. 58 (10)
(pp 523-530), 2020. Date of Publication: October 2020.
Author
Park J.H.; Kim J.S.; Ahn C.-M.; Hong S.J.; Ahn K.J.; Choi J.W.; Joo H.J.;
Yu C.W.; Lim D.-S.
Institution
(Park, Hong, Joo, Yu, Lim) Department of Cardiology, Cardiovascular
Center, Korea University Anam Hospital, Seoul, South Korea
(Kim) Division of Cardiology, Department of Internal Medicine, Sejong
General Hospital, Bucheon, South Korea
(Ahn) Devision of Cardiology, Severance Cardiovascular Hospital, Yonsei
University Health System, Seoul, South Korea
(Ahn) Department of Cardiology, Hanil General Hospital, Seoul, South Korea
(Choi) Department of Cardiology, Eulji Hospital, Seoul, South Korea
Publisher
Dustri-Verlag Dr. Karl Feistle
Abstract
What is known and objective: Pre-treatment of clopidogrel 600 mg is better
than 300 mg loading for reducing periprocedural myocardial infarction
(PMI). We aimed to evaluate pre-treatment methods for preventing PMI among
patients undergoing conventional coronary angiography (CAG) for stable
angina pectoris. Material(s) and Method(s): The study analyzed 402
patients who underwent percutaneous coronary intervention (PCI) during
2010 - 2011 at three Korean hospitals. Clopidogrel-naive patients received
routine maintenance therapy (75 mg/day for >= 5 days) and were randomly
assigned to a 300-mg reload (RL) or only the maintenance dose (MD).
Patients who received a loading dose (LD; 600 mg at 2 - 24 hours before
the procedure) were entered into a non-randomized group. Result(s):
After excluding patients who showed an abnormal creatinine kinase
myocardial band (CK-MB) level, the study included 233 patients in the LD
group, 85 patients in the RL group and 84 patients in the MD group. The LD
group had a significantly higher rate of PMI (LD: 21, RL: 3, MD: 0 cases;
p = 0.007) and a significant increase in the mean CK-MB levels after 8
hours (p = 0.016) and 24 h (p = 0.01). However, there was no difference in
PMI between the RL and MD groups. Furthermore, no significant differences
between the three groups were observed in the P2Y12 reaction unit (PRU)
values (p = 0.57). Albeit not significantly, the LD group had a higher
rate of moderate-to-severe GUSTO bleeding within 7 days. What is new and
conclusion: Clopidogrel maintenance is better than 600-mg loading for
preventing PMI, and the RL protocol did not further prevent
PMI. Copyright © 2020 Dustri-Verlag Dr. K. Feistle.

<30>
Accession Number
2007302672
Title
Fully automated postoperative ventilation in cardiac surgery patients: a
randomised clinical trial.
Source
British Journal of Anaesthesia. 125 (5) (pp 739-749), 2020. Date of
Publication: November 2020.
Author
De Bie A.J.R.; Neto A.S.; van Meenen D.M.; Bouwman A.R.; Roos A.N.;
Lameijer J.R.; Korsten E.H.M.; Schultz M.J.; Bindels A.J.G.H.
Institution
(De Bie, Bouwman, Roos, Korsten, Bindels) Department of Intensive Care
Unit, Catharina Hospital Eindhoven, Eindhoven, Netherlands
(De Bie, Korsten) Department of Electrical Engineering, Eindhoven
University of Technology, Eindhoven, Netherlands
(Neto, van Meenen, Schultz) Department of Intensive Care and Laboratory of
Experimental Intensive Care and Anesthesiology, Amsterdam University
Medical Centers, Amsterdam, Netherlands
(Neto) Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Lameijer) Department of Radiology, Catharina Hospital Eindhoven,
Eindhoven, Netherlands
(Schultz) Mahidol Oxford Tropical Medicine Research Unit, Faculty of
Tropical Medicine, Mahidol University, Bangkok, Thailand
(Schultz) Nuffield Department of Medicine, University of Oxford, Oxford,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Ensuring that lung-protective ventilation is achieved at scale
is challenging in perioperative practice. Fully automated ventilation may
be more effective in delivering lung-protective ventilation. Here, we
compared automated lung-protective ventilation with conventional
ventilation after elective cardiac surgery in haemodynamically stable
patients. Method(s): In this single-centre investigator-led study,
patients were randomly assigned at the end of cardiac surgery to receive
either automated (adaptive support ventilation) or conventional
ventilation. The primary endpoint was the proportion of postoperative
ventilation time characterised by exposure to predefined optimal,
acceptable, and critical (injurious) ventilatory parameters in the first
three postoperative hours. Secondary outcomes included severe hypoxaemia
(SpO<inf>2</inf> <85%) and resumption of spontaneous breathing. Data are
presented as mean (95% confidence intervals [CIs]). Result(s): We
randomised 220 patients (30.4% females; age: 62-76 yr). Subjects
randomised to automated ventilation (n=109) spent a 29.7% (95% CI:
22.1-37.4) higher mean proportion of postoperative ventilation time
receiving optimal postoperative ventilation after surgery (P<0.001)
compared with subjects receiving conventional postoperative ventilation
(n=111). Automated ventilation also reduced the proportion of
postoperative ventilation time that subjects were exposed to injurious
ventilatory settings by 2.5% (95% CI: 1-4; P=0.003). Severe hypoxaemia was
less likely in subjects randomised to automated ventilation (risk ratio:
0.26 [0.22-0.31]; P<0.01). Subjects resumed spontaneous breathing more
rapidly when randomised to automated ventilation (hazard ratio: 1.38
[1.05-1.83]; P=0.03). Conclusion(s): Fully automated ventilation in
haemodynamically stable patients after cardiac surgery optimised
lung-protective ventilation during postoperative ventilation, with fewer
episodes of severe hypoxaemia and an accelerated resumption of spontaneous
breathing. Clinical trial registration: NCT03180203. Copyright ©
2020 British Journal of Anaesthesia

<31>
Accession Number
2003400329
Title
Effects of Balanced Ultrafiltration During Extracorporeal Circulation for
Children with Congenital Heart Disease on Postoperative Serum Inflammatory
Response.
Source
Fetal and Pediatric Pathology. 39 (5) (pp 401-408), 2020. Date of
Publication: 02 Sep 2020.
Author
Chen F.; You Y.; Ding P.; Wu K.; Mo X.
Institution
(Chen, Ding, Wu, Mo) Department of Cardiovascular Surgery, Children's
Hospital of Nanjing Medical University, Nanjing, China
(You) Outpatient Department, Nanjing Tongren Hospital, School of Medicine,
Southeast University, Nanjing, China
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: We studied inflammatory marker changes with ultrafiltration
extracorporeal techniques and compared these levels to those occurring
during conventional techniques. Method(s): Seventy-four children
undergoing extracorporeal circulation during congenital heart surgery were
divided into two groups-conventional (control) and balanced
ultrafiltrations (study). Serum interleukin-6 (IL-6), tumor necrosis
factor-alpha (TNF-alpha), and soluble intercellular adhesion molecule-1
(sICAM-1), static lung compliance (Cstat), alveolar-arterial oxygen
partial pressure difference (A-aDO2), and oxygenation index (OI) were
measured. Result(s): Thirty minutes after extracorporeal circulation
(T1), IL-6 and TNF-alpha levels significantly increased (p <.05), which
plummeted 3 h after surgery (T2). The levels in the study group were lower
(p <.05). sICAM-1 levels at T1 and T2 significantly exceeded those at T0,
and study group had lower levels (p <.05). At T1, Cstat and OI dropped (p
<.05), which increased at T2 (p <.05), and study group had less decreases
(p <.05). A-aDO2 at T1 surpassed that before intervention (p <.05), and
study group had less increase (p <.05). Conclusion(s): Balanced
ultrafiltration exerts protective effects on children with congenital
heart disease undergoing extracorporeal circulation. Copyright ©
2019 Taylor & Francis Group, LLC.

<32>
Accession Number
2006842701
Title
Long-Term Graft Patency After Off-Pump and On-Pump Coronary Artery Bypass:
A CORONARY Trial Cohort.
Source
Annals of Thoracic Surgery. 110 (6) (pp 2055-2061), 2020. Date of
Publication: December 2020.
Author
Yang L.; Lin S.; Zhang H.; Gu D.; Chen S.; Shi Y.; Zheng Z.
Institution
(Yang, Lin, Zhang, Gu, Chen, Shi, Zheng) National Clinical Research Center
of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Publisher
Elsevier Inc.
Abstract
Background: Randomized controlled trials have compared the early and
midterm prognosis of on-pump coronary artery bypass grafting (CABG) and
off-pump CABG. However the results are controversial, and there is limited
information on graft patency and long-term outcomes. Method(s):
Between May 2007 and October 2011, 349 patients were randomized to
off-pump or on-pump CABG as part of the CORONARY trial at Fuwai Hospital.
The primary outcome was coronary bypass graft patency, which was assessed
at a mean of 6.7 +/- 1.7 years after surgery by multidetector computed
tomography. A secondary endpoint was a composite outcome of death,
nonfatal myocardial infarction, repeat coronary revascularization, or
stroke; mean follow-up was 6.5 +/- 1.7 years. Graft patency was compared
between the off-pump and on-pump CABG treatment arms in 206 patients with
follow-up computed tomography. Result(s): During the follow-up period
107 patients were in the off-pump CABG group and 99 in the on-pump group.
These patients underwent a total of 723 grafts, and the overall rate of
graft patency did not differ significantly between the off-pump and
on-pump groups (87.4% vs 88.9%, P = .527). The patency rate of the
posterior descending branch was lower than average. Higher incidences of
mortality, nonfatal myocardial infarction, and repeat revascularization
were found in the off-pump patients; however it did not reach
significance. Conclusion(s): There were no statistical differences in
graft patency rates in off-pump versus on-pump CABG patients during
long-term follow-up. The on-pump CABG group appeared to have a better
long-term prognosis even with no statistical differences for the limited
study population. Copyright © 2020 The Society of Thoracic
Surgeons

<33>
Accession Number
633395132
Title
COVID-19 and congenital heart disease: An insight of pathophysiology and
associated risks.
Source
Cardiology in the Young. (no pagination), 2020. Date of Publication: 2020.
Author
Haiduc A.A.; Ogunjimi M.; Shammus R.; Mahmood S.; Kutty R.; Lotto A.;
Guerrero R.; Harky A.; Dhannapuneni R.
Institution
(Haiduc, Shammus, Mahmood) Medical School, St George's, University of
London, Cranmer Terrace, United Kingdom
(Ogunjimi) Medical School, Imperial College London, Kensington, United
Kingdom
(Kutty, Lotto, Guerrero, Harky, Dhannapuneni) Department of Cardiac
Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Science,
University of Liverpool, Liverpool, United Kingdom
(Lotto, Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool, Liverpool, United Kingdom
(Lotto) Faculty of Health, Liverpool John Moores University, Liverpool,
United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Cambridge University Press
Abstract
Objective: We aimed to examine the literature to determine if both
paediatric and adult patients diagnosed with congenital heart disease
(CHD) are at a higher risk of poor outcomes if they have the coronavirus
disease 2019 (COVID-19), compared to those without CHD. Method(s): A
systematic review was executed using the Preferred Reporting Items for
Systematic Reviews and Meta-analysis (PRISMA) guidelines. To identify
articles related to COVID-19 and CHD, an extensive literature search was
performed on EMBASE, Medline, Scopus, and Global Health databases using
keywords and MeSH terms. Result(s): A total of 12 articles met the
inclusion criteria and were included for analysis in this systematic
review. Two themes were identified for data extraction: evidence
supporting higher risks in CHD patients and evidence against higher risks
in CHD patients. After combining the data, there were 99 patients with
CHDs out of which 12 required admissions to ICU. Conclusion(s): This
systematic review suggests that CHD may increase the risk of poor outcomes
for those with COVID-19, but also highlights the necessity for more
research with larger sample sizes in order to make a more justified
conclusion, as the majority of papers that were analysed were case series
and case reports. Future research should aim to quantify the risks if
possible whilst accounting for various confounding factors such as age and
treatment history. Copyright © The Author(s), 2020. Published by
Cambridge University Press.

<34>
Accession Number
633396169
Title
Thymic amyloidoma mimicking sclerosing thymoma in a triple vessel disease
patient: An incidental finding.
Source
Indian Journal of Pathology and Microbiology. 63 (4) (pp 608-610), 2020.
Article Number: 432. Date of Publication: October-December 2020.
Author
Dhingra H.; Singh A.; Baliyan A.; Bansal V.
Institution
(Dhingra, Singh) Department of Pathology, Adesh Institute of Medical
Sciences and Research, Bathinda, Punjab, India
(Baliyan) Focus Imaging and Research Centre Pvt Ltd, Laboratory Medicine
Division, New Delhi, India
(Bansal) Department of Pathology, Government Medical College and Hospital,
Sector 32-A, Chandigarh, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
A 65 year old man who underwent coronary artery bypass graft (CABG) for
triple vessel disease was found to have enlarged thymus. Biopsy of the
thymic mass revealed localised amyloid deposits demonstrating strong apple
green birefringence on polarised microscopy. Localized thymic amyloidosis
is an extremely rare finding with present case as the seventh in the world
and the first in India. Review of literature of thymic amyloidoma and its
close differential sclerosing thymoma is hereby described. Copyright
© 2020 Wolters Kluwer Medknow Publications. All rights reserved.

<35>
Accession Number
2008590912
Title
Management of Prosthesis-patient Mismatch after Aortic Valve Replacement.
Source
E Journal of Cardiovascular Medicine. 7 (2) (pp 60-65), 2020. Date of
Publication: June 2020.
Author
Demirsoy E.; Demir I.; Ugur M.
Institution
(Demirsoy) Sisli Kolan International Hospital, Clinic of Cardiovascular
Surgery, Istanbul, Turkey
(Demir) Istanbul University Istanbul Faculty of Medicine, Department of
Cardiovascular Surgery, Istanbul, Turkey
(Ugur) Sancaktepe Martyr, Ilhan Varank Training and Research Hospital,
Clinic of Cardiovascular Surgery, Istanbul, Turkey
Publisher
Galenos Publishing House
Abstract
Valve prostheses have played an important role in the past four decades in
the management of patients with valvular heart disease. Many of the
devices have been used for valve replacement and they have introduced new
clinical problems. One of these problems is prosthesis-patient mismatch
(PPM) which is associated with increased mid- and long-term mortality
after surgical aortic valve replacement (AVR) and transcatheter aortic
valve implantation. The aim of this study was to systematically review the
literature on the importance, prevention and feasibility of PPM in AVR and
percutaneous-AVR. The articles about PPM published between 2003-2018 were
analyzed. The results of surgical and transcatheter methods were discussed
together to prevent PPM. © Copyright 2019 by Heart and Health
Foundation of Turkey (TUSAV)

<36>
Accession Number
2008461055
Title
Meta-Analysis of Cerebral Embolic Protection During Transcatheter Aortic
Valve Replacement.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Nazir S.; Zafrullah F.; Virk H.U.H.; Sandhu C.S.; Ameen M.; Ahuja K.R.
Institution
(Nazir, Zafrullah) Division of Cardiology, University of Toledo Medical
Center, Toledo, OH, United States
(Virk) Division of Cardiology, Case Western Reserve University/University
Hospitals Cleveland Medical Center, Cleveland, OH, United States
(Sandhu, Ameen, Ahuja) Division of Cardiology, Reading Hospital-Tower
Health System, West Reading, United States
Publisher
Elsevier Inc.

<37>
Accession Number
2007969801
Title
Preprocedural circulating galectin-3 and the risk of mortality after
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Bioscience Reports. 40 (9) (no pagination), 2020. Article Number:
BSR20202306. Date of Publication: September 2020.
Author
Zhang H.-L.; Song G.-Y.; Zhao J.; Wang Y.-B.; Wang M.-Y.; Xu Y.-L.; Wang
B.-C.; Niu G.-N.; Liu Z.-H.; Wu Y.-J.
Institution
(Zhang, Song, Zhao, Wang, Wang, Xu, Wang, Niu, Liu, Wu) Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng
District, Beijing 100037, China
Publisher
Portland Press Ltd
Abstract
Background: Galectin-3 may predict mortality for patients with aortic
stenosis (AS) after transcatheter aortic valve replacement (TAVR).
However, the results were inconsistent. We aimed to evaluate the
association between baseline galectin and mortality after TAVR in a
meta-analysis. Method(s): Related follow-up studies were obtained by
systematic search of PubMed, Cochrane's Library, and Embase databases.
Both the fixed- and the random-effect models were used for the
meta-analysis. Subgroup analyses were performed to evaluate the influences
of study characteristics on the outcome. Result(s): Five prospective
cohort studies with 854 patients were included, with a follow-up period
between 1 and 1.9 years. Patients with higher baseline circulating
galectin-3 had an increased risk of all-cause mortality after TAVR
(random-effects model: Risk ratio [RR]: 1.63, 95% confidence interval
[CI]: 1.19-2.23, P=0.002; fixed-effects model: RR: 1.62, 95% CI:
1.19-2.20, P=0.002; I2 = 4%). Adjustment of estimated glomerular
filtration rate (RR: 1.73, P=0.02) or B-type natriuretic peptide (BNP) or
N-terminal pro-BNP (RR: 1.83, P=0.02) did not significantly affect the
result. A trend of stronger association between higher baseline
circulating galectin-3 and increased risk of all-cause mortality after
TAVR was observed in studies with an enzyme-linked fluorescent assay
(ELFA) (RR: 3.04, P=0.003) compared with those with an enzyme-linked
immunosorbent assay (ELISA) (RR: 1.42, P=0.04; P for subgroup difference
=0.06). Conclusion(s): Higher circulating galectin-3 before the
procedure may predict all-cause mortality of AS patients after
TAVR. Copyright ©2020 The Author(s).

<38>
Accession Number
2007962140
Title
Telehealth home monitoring and postcardiac surgery for congenital heart
disease.
Source
Pediatrics. 146 (3) (no pagination), 2020. Article Number: e20200531. Date
of Publication: September 2020.
Author
Cooper B.M.; Marino B.S.; Fleck D.A.; Lisanti A.J.; Golfenshtein N.;
Ravishankar C.; Costello J.M.; Huang L.; Hanlon A.L.; Curley M.A.Q.
Institution
(Ravishankar) Division of Cardiology, Department of Pediatrics, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Curley) Department of Anesthesia and Critical Medicine, Perelman School
of Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Cooper, Fleck, Huang) School of Nursing, University of Pennsylvania,
Philadelphia, PA, United States
(Cooper, Lisanti, Ravishankar, Curley) Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Marino, Costello) Ann and Robert H. Lurie Children's Hospital of Chicago,
Chicago, IL, United States
(Golfenshtein) Department of Nursing, University of Haifa, Haifa, Israel
(Hanlon, Curley) Department of Statistics, College of Science, Virginia
Polytechnic Institute and State University, Blacksburg, VA, United States
(Marino, Curley) Division of Cardiology and Critical Care Medicine,
Feinberg School of Medicine, Northwestern University, Chicago, IL, United
States
Publisher
American Academy of Pediatrics
Abstract
OBJECTIVES: To test the effect of a 4-month telehealth home monitoring
program (REACH), layered on usual care, on postdischarge outcomes in
parents of infants recovering from cardiac surgery and their infants.
 METHOD(S): Randomized trial of infants discharged from the hospital
after cardiac surgery for congenital heart disease. Consecutive infants
with complex congenital heart disease undergoing cardiac surgery within 21
days of life were enrolled at 3 university-affiliated pediatric cardiac
centers. RESULT(S): From 2012 to 2016, 219 parent-infant dyads were
enrolled; 109 were randomly assigned to the intervention group and 110 to
the control group. At 4 months postdischarge, parenting stress was not
significantly different between groups (total Parenting Stress Index in
the intervention group was 220 and in the control group was 215; P =.61).
The percentages of parents who met posttraumatic stress disorder (PTSD)
criteria and parent quality of life inventory scores were also not
significantly different between the 2 groups (PTSD in the intervention
group was 18% and was 18% in the control group; P =.56; the mean Ulm
Quality of Life Inventory for Parents in the intervention group was 71
andwas 70 in the control group; P =.88). Infant growth in both groups was
suboptimal (the mean weight-for-age z scores were 21.1 in the intervention
group and 21.2 in the control group; P =.56), and more infants in the
intervention group were readmitted to the hospital (66% in the
intervention group versus 57% in the control group; P,.001).
 CONCLUSION(S): When added to usual care, the REACH intervention was
not associated with an improvement in parent or infant outcomes. Four
months after neonatal heart surgery, ~20% of parents demonstrate PTSD
symptoms. Suboptimal infant growth and hospital readmissions were
common. Copyright © 2020 by the American Academy of Pediatrics

<39>
Accession Number
2007950068
Title
Meta-Analysis of Complete versus Culprit-Only Revascularization in
Patients with ST-Segment Elevation Myocardial Infarction and Multivessel
Coronary Disease.
Source
American Journal of Cardiology. 135 (pp 40-49), 2020. Date of Publication:
15 Nov 2020.
Author
Levett J.Y.; Windle S.B.; Filion K.B.; Cabaussel J.; Eisenberg M.J.
Institution
(Levett, Windle, Filion, Cabaussel, Eisenberg) Center of Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill
University, Montreal, QC, Canada
(Levett, Filion, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Filion) Department of Medicine, McGill University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital/McGill
University, Montreal, QC, Canada
Publisher
Elsevier Inc.
Abstract
Approximately half of patients with ST-segment elevation myocardial
infarction (STEMI) present with noninfarct related multivessel coronary
artery disease (CAD) during primary percutaneous coronary intervention
(PCI). However, questions remain concerning whether patients with STEMI
and multivessel CAD should routinely undergo complete revascularization.
Our objective was to compare the risks of major cardiovascular outcomes
and procedural complications in patients with STEMI and multivessel CAD
randomized to complete revascularization versus culprit-only PCI. We
conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) comparing complete revascularization to culprit-only PCI.
RCTs were identified via a systematic search of MEDLINE, Embase, and
Cochrane CENTRAL. Count data were pooled using DerSimonian and Laird
random-effects models with inverse variance weighting to obtain relative
risks (RRs) and 95% confidence intervals (CIs). A total of 9 RCTs (n =
6,751) were included, with mean/median follow-up times ranging from 6 to
36 months. Compared with culprit-only PCI, complete revascularization was
associated with a substantial reduction in major adverse cardiovascular
events (13.1% vs 22.1%; RR: 0.54; 95%CI: 0.43 to 0.66), repeat myocardial
infarction (4.9% vs 6.8%; RR: 0.64; 95%CI: 0.48 to 0.84), and repeat
revascularization (3.7% vs 12.3%; RR: 0.33; 95%CI: 0.25 to 0.44). Complete
revascularization may have beneficial effects on all-cause and
cardiovascular mortality, but 95%CIs were wide. Findings for stroke, major
bleeding, and contrast-induced acute kidney injury were inconclusive. In
conclusion, complete coronary artery revascularization appears to confer
benefit over culprit-only PCI in patients with STEMI and multivessel CAD,
and should be considered a first-line strategy in these
patients. Copyright © 2020 The Author(s)

<40>
Accession Number
2004443501
Title
Long-term follow-up with a smartphone application improves exercise
capacity post cardiac rehabilitation: A randomized controlled trial.
Source
European Journal of Preventive Cardiology. 27 (16) (pp 1782-1792), 2020.
Date of Publication: 01 Nov 2020.
Author
Lunde P.; Bye A.; Bergland A.; Grimsmo J.; Jarstad E.; Nilsson B.B.
Institution
(Lunde, Bergland, Nilsson) Department of Physiotherapy, Faculty of Health
Sciences, OsloMet - Oslo Metropolitan University, Norway
(Bye) Department of Nursing and Health Promotion, Faculty of Health
Sciences, OsloMet - Oslo Metropolitan University, Norway
(Bye) Regional Advisory Unit for Palliative Care, Department of Oncology,
Oslo University Hospital, Norway
(Grimsmo) Norwegian Heart and Lung Patient Organization, LHL-Hospital
Gardermoen, Norway
(Jarstad) Norwegian Sport Medicine Clinic (NIMI), Department of Cardiology
and Exercise Physiology, Norway
(Nilsson) Section for Physiotherapy, Division of Medicine, Oslo University
Hospital, Norway
Publisher
SAGE Publications Inc.
Abstract
Background: Mobile health interventions, especially smartphone
applications (apps), have been proposed as promising interventions for
supporting adherence to healthy behaviour in patients post cardiac
rehabilitation (CR). The overall aim of the study was to examine the
effect of individualized follow-up with an app for one year on peak oxygen
uptake (VO<inf>2peak</inf>) in patients completing CR. Design(s): The
study was designed as a single-blinded multicentre randomized controlled
trial. Method(s): The intervention group (IG) received individualized
follow-up enabled with an app for one year, while the control group (CG)
received usual care. The primary outcome was difference in
VO<inf>2peak</inf>. Secondary outcomes included exercise performance (time
to exhaustion, peak incline (%) and peak velocity (km/h)), bodyweight,
resting blood pressure, lipid profile, triglycerides, exercise habits,
health-related quality of life, health status and self-perceived goal
achievement. Result(s): In total, 113 patients completing CR (73.4%
with coronary artery disease, 16.8% after valve surgery and 9.8% with
other heart diseases) were randomly allocated to the IG or CG. Intention
to treat analyses showed a statistically significant difference in
VO<inf>2peak</inf> between the groups at follow-up of 2.2 ml/kg/min, 95%
confidence interval 0.9-3.5 (p < 0.001). Statistically significant
differences were also observed in exercise performance, exercise habits
and in self-perceived goal achievement. Conclusion(s): Individualized
follow-up for one year with an app significantly improved
VO<inf>2peak</inf>, exercise performance and exercise habits, as well as
self-perceived goal achievement, compared with a CG in patients post-CR.
There were no statistically significant differences between the groups at
follow-up in the other outcome measures evaluated. Copyright ©
The European Society of Cardiology 2020.

<41>
Accession Number
2003886866
Title
Non-linear is not superior to linear aerobic training periodization in
coronary heart disease patients.
Source
European Journal of Preventive Cardiology. 27 (16) (pp 1691-1698), 2020.
Date of Publication: 01 Nov 2020.
Author
Boidin M.; Trachsel L.-D.; Nigam A.; Juneau M.; Tremblay J.; Gayda M.
Institution
(Boidin, Trachsel, Nigam, Juneau, Gayda) Cardiovascular Prevention and
Rehabilitation (EPIC) Center, Montreal Heart Institute and Universite de
Montreal, Canada
(Boidin, Trachsel, Nigam, Juneau, Gayda) Research Center, Montreal Heart
Institute and Universite de Montreal, Canada
(Boidin, Tremblay) School of Kinesiology and Exercise Science, Faculty of
Medicine, Universite de Montreal, Canada
(Trachsel, Nigam, Juneau, Gayda) Faculty of Medicine, Department of
Medicine, Universite de Montreal, Canada
Publisher
SAGE Publications Inc.
Abstract
Background: We aimed to compare: (1) two different periodized aerobic
training protocols (linear (LP) versus non-linear (NLP)) on the
cardiopulmonary exercise response in patients with coronary heart disease;
(2) the proportion of responders between both training protocols.
 Design(s): A randomized controlled trial. Method(s): A total of
39 coronary heart disease patients completed either LP (n = 20, 65 +/- 10
years) or NLP (n = 19, 66 +/- 5 years). All patients completed a
cardiopulmonary exercise testing with gas exchange measurements. Patients
underwent a 12-week supervised exercise program including an isoenergetic
aerobic periodized training and a similar resistance training program, 3
times/week. Weekly energy expenditure was constantly increased in the LP
group for the aerobic training, while it was deeply increased and
intercepted with a recovery week each fourth week in the NLP group. Peak
oxygen uptake (peak VO<inf>2</inf>), oxygen uptake efficiency slope,
ventilatory efficiency slope (VE/VCO<inf>2</inf> slope), VO<inf>2</inf> at
the first (VT<inf>1</inf>) and second (VT<inf>2</inf>) ventilatory
thresholds, and oxygen pulse (O<inf>2</inf> pulse) were measured.
Responders were determined according the median value of the DELTApeak
VO<inf>2</inf> (mL.min-1.kg-1). Result(s): We
found similar improvement for peak VO<inf>2</inf> (LP: +8.1%, NLP: +5.3%,
interaction: p = 0.37; time: p < 0.001) and for oxygen uptake efficiency
slope, VT<inf>1</inf>, VT<inf>2</inf> and O<inf>2</inf> pulse in both
groups (interaction: p > 0.05; time: p < 0.05) with a greater effect size
in the LP group. The proportion of non-, low and high responders was
similar between groups (p = 0.29). Conclusion(s): In contrast to the
athletes, more variation (NLP) does not seem necessary for greater
cardiopulmonary adaptations in coronary heart disease
patients. Copyright © The European Society of Cardiology 2019.

<42>
Accession Number
2008031552
Title
CSF enhancement on post-contrast fluid-attenuated inversion recovery
images; a systematic review.
Source
NeuroImage: Clinical. 28 (no pagination), 2020. Article Number: 102456.
Date of Publication: January 2020.
Author
Freeze W.M.; van der Thiel M.; de Bresser J.; Klijn C.J.M.; van Etten
E.S.; Jansen J.F.A.; van der Weerd L.; Jacobs H.I.L.; Backes W.H.; van
Veluw S.J.
Institution
(Freeze, de Bresser, van der Weerd, van Veluw) Department of Radiology,
Leiden University Medical Center, Leiden, Netherlands
(Freeze, van der Thiel, Jacobs) Department of Neuropsychology and
Psychiatry, Alzheimer Center Limburg, School for Mental Health and
Neuroscience, Maastricht University, Maastricht, Netherlands
(van der Thiel, Jansen, Backes) Department of Radiology and Nuclear
Medicine, School for Mental Health and Neuroscience, Maastricht University
Medical Center, Maastricht, Netherlands
(Klijn) Department of Neurology, Donders Institute for Brain, Cognition
and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
(van Etten) Department of Neurology, Leiden University Medical Center,
Leiden, Netherlands
(Jansen) Department of Electrical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
(van der Weerd) Department of Human Genetics, Leiden University Medical
Center, Leiden, Netherlands
(Jacobs) Gordon Center for Medical Imaging, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Backes) Cardiovascular Research Institute Maastricht, Maastricht
University Medical Center, Maastricht, Netherlands
(van Veluw) Department of Neurology, J. Philip Kistler Stroke Research
Center, Massachusetts General Hospital and Harvard Medical School, Boston,
MA, United States
Publisher
Elsevier Inc.
Abstract
Cerebrospinal fluid (CSF) enhancement on T2-weighted post-contrast
fluid-attenuated inversion recovery (pcT2wFLAIR) images is a relatively
unknown neuroradiological marker for gadolinium-based contrast agent
extravasation due to blood-brain barrier (BBB) disruption. We
systematically reviewed human studies reporting on CSF enhancement on
pcT2wFLAIR images to provide a comprehensive overview of prevalence of
this new biomarker in healthy and diseased populations as well as its
etiology and optimal detection methodology. We extracted information on
the prevalence of CSF enhancement, its vascular risk factor and
neuroimaging correlates, and methodological attributes of each study.
Forty-four eligible studies were identified. By pooling data, we found
that the prevalence of CSF enhancement was 82% (95% confidence interval
(CI) 80-89) in meningitis (4 studies, 65 patients), 73% (95%CI 62-81) in
cases with (post-) acute intracerebral hemorrhage (2 studies, 77 cases),
64% (95% CI 54-73) in cases who underwent surgery for aneurysm treatment
(2 studies, 99 patients), 40% (95% CI 30-51) in cases who underwent
surgery for carotid artery disease treatment (3 studies, 76 patients), 27%
(95% CI 25-30) in cases with acute ischemic stroke (9 studies, 1148
patients), 21% (95% CI 17-23) in multiple sclerosis (6 studies, 897
patients), and 13% (95% CI 7-21) in adult controls (4 studies, 112 cases).
Presence of CSF enhancement was associated with higher age in eleven
studies, with lobar cerebral microbleeds in one study, and with cerebral
atrophy in four studies. PcT2wFLAIR imaging represents a promising method
that can provide novel perspectives on BBB leakage into CSF compartments,
with the potential to reveal important new insights into the
pathophysiological mechanisms of varying neurological
diseases. Copyright © 2020 The Authors

<43>
Accession Number
2008500329
Title
Critical Review and Meta-Analysis of Postoperative Sedation after Adult
Cardiac Surgery: Dexmedetomidine Versus Propofol.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Abowali H.A.; Paganini M.; Enten G.; Elbadawi A.; Camporesi E.M.
Institution
(Abowali, Paganini, Enten, Camporesi) Team Health Research Institute,
Tampa General Hospital, Tampa, FL, United States
(Elbadawi) University of Texas Medical Branch, Galveston, TX, United
States
Publisher
W.B. Saunders
Abstract
Objective: To evaluate reports from the published literature of all
randomized clinical trials (RCT) comparing postoperative sedation with
dexmedetomidine versus propofol in adult patients, after open cardiac
surgery. Design(s): A computerized search on Medline, EMBASE, Web of
Science, and Agency for Healthcare Research and Quality databases was
completed through June 2020. Meta-analysis of all published RCT comparing
dexmedetomidine versus propofol utilization in the postoperative phase,
using the standard Preferred Reporting Items for Systematic Reviews and
Meta-Analyses checklist. Setting(s): Assemblage and critical
discussion of 11 RCTs comparing postoperative sedation from standard
published reports from 2003 to 2019. Participant(s): The study
comprised 1,184 patients and analyzed critical discussion of time-based
parameters (time to extubation, intensive care unit length of stay, and
hospital length of stay) and nontime-dependent factors (delirium,
bradycardia, and hypotension). Measurements and Main Results: Time to
extubation was significantly reduced in the dexmedetomidine group
(standardized mean difference [SMD] = -0.70, 95% confidence interval [CI]
-0.98 to -0.42, p < 0.001); however, no difference in mechanical
ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.).
Dexmedetomidine significantly reduced the intensive care unit length of
stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not
translate into a reduced hospital length of stay (SMD = -1.13, 95% CI
-2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium
was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06,
N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p =
0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were
reported with propofol. Conclusion(s): Despite the ICU time
advantages afforded by dexmedetomidine over propofol, the former did not
seem to contribute to an overall reduction in hospital length of stay or
improvement in postoperative outcomes of heart valve surgery and CABG
patients. Copyright © 2020

<44>
Accession Number
2007174720
Title
Impact of atrial fibrillation on the outcomes of transcatheter mitral
valve repair using MitraClip: a systematic review and meta-analysis.
Source
Heart Failure Reviews. (no pagination), 2020. Date of Publication: 2020.
Author
Shah S.; Raj V.; Abdelghany M.; Mena-Hurtado C.; Riaz S.; Patel S.; Wiener
H.; Chaudhuri D.
Institution
(Shah, Raj, Chaudhuri) Department of Medicine, Division of Cardiology,
State University of New York Upstate Medical University, 750 E Adams
Street, Syracuse, NY 13210, United States
(Abdelghany) Pioneer Valley Cardiology, University of Massachusetts/
Baystate Medical Center, Mercy Medical Center, Springfield, MA, United
States
(Mena-Hurtado) Department of Medicine, Division of Cardiology, Yale
University School of Medicine, New Haven, CT, United States
(Riaz) Department of Medicine, State University of New York Upstate
Medical University, Syracuse, NY, United States
(Patel) Department of Pulmonary, Allergy and Critical care, University of
Alabama at Birmingham, Birmingham, AL, United States
(Wiener) Department of Epidemiology, University of Alabama at Birmingham
School of Public Health, Birmingham, AL, United States
Publisher
Springer
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral
regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In
this systematic review, we aimed to investigate the outcomes of TMVR using
MitraClip in AF patients. We performed a systematic search using PubMed,
SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for
studies that reported outcomes following MitraClip, in patients with AF
versus without AF. Seven studies with a total of 7678 patients met the
inclusion criteria. The risk of 1-year all-cause mortality following TMVR
was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p <= 0.001).
Similarly, the risk of heart failure hospitalization was higher in
patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of
bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p <=
0.001). The risk of procedural failure, in-hospital mortality,
cardiovascular mortality, and stroke was not significantly different
between the two groups. The higher risk of all-cause mortality, HF
hospitalization, and risk of bleeding in AF patients undergoing MitraClip
warrants attention. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<45>
Accession Number
632942075
Title
High Transaminases following Cardiac Surgery: A Narrative Review.
Source
Journal of Cardiac Critical Care. 4 (2) (pp 111-115), 2020. Article
Number: JCCC2046. Date of Publication: 01 Dec 2020.
Author
Omar A.S.; Taha A.; Al-Khulaifi A.
Institution
(Omar, Al-Khulaifi) Department of Cardiothoracic Surgery, Cardiac
Anesthesia and ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
(Omar) Department of Critical Care Medicine, Beni Suef University, Beni
Suef, Egypt
(Omar) Department of Clinical Medicine, Weill Cornell Medical College,
Qatar
(Taha) Department of Critical Care Medicine, King Khaled Specialized
Hospital, Dammam, Saudi Arabia
(Taha) Department of Cardiothoracic Surgery, Cardiac Anesthesia and Icu
Section, Heart Hospital, Hamad Medical Corporation, Doha PO 3050, Qatar
Publisher
Thieme India
Abstract
Elevation of liver enzymes after cardiac surgery is encountered
infrequently. Acute heart failure during and after surgery may be the
culprit responsible for liver dysfunction. However, it may create clinical
confusion whether acute liver dysfunction could induce some sort of
cardiac dysfunction through mechanisms similar to those encountered in
chronic liver disease. We searched through the Medline, Cochrane, and
Embase databases up to January 2018. We included review articles,
meta-analyses, and original trials on the elevation of liver enzymes after
cardiac surgery, and combined the following MESH terms: Intensive care,
cardiac surgery, high liver enzymes, ischemia, left ventricular
dysfunction, and critical illness. Case reports were excluded. Language
restrictions were not applied. References were examined for other
potentially useful articles. We did not find any articles that supported
the cardiac decompensation phenomenon after acute liver injury. In
contrast, low-hepatic flow, hypoxemia, or pump-induced inflammation could
induce hepatic dysfunction in acute settings after cardiac surgery. In
conclusion, a rise in the transaminases following cardiac surgery would
favor an ischemic etiology for the condition. Copyright © 2020
Thieme India. All rights reserved.

<46>
Accession Number
632690573
Title
Percutaneous Coronary Intervention Compared with Coronary Artery Bypass
Graft Surgery for Patients With 3-vessel Disease: A Preferred Reporting
Items for Systematic Reviews and Meta-Analyses-compliant Systematic Review
and Meta-analysis.
Source
Journal of cardiovascular pharmacology. 76 (5) (pp 527-532), 2020. Date of
Publication: 01 Nov 2020.
Author
Zhao H.; Zhang D.
Institution
(Zhao) Affiliated Hospital of Shandong University of Traditional Chinese
Medicine, Shandong, China
(Zhang) Department of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Previous investigations showed inconsistent results for
comparison in clinical outcomes between patients with 3-vessel disease
(3VD) treated with percutaneous coronary intervention (PCI) and coronary
artery bypass graft (CABG) surgery. A systematic review and meta-analysis
is essential to compare the clinical outcomes of PCI with CABG surgery for
patients with 3VD. METHOD(S): We systematically searched on PubMed
and Web of Science for articles which compared PCI with CABG for patients
with 3VD and published from January 1989 to January 2020. We computed the
hazard ratios (HRs) and 95% confidence intervals (CIs) for individual
clinical outcomes. RESULT(S): This study indicated that the PCI group
was associated with a 1.51-fold higher risk of all-cause mortality
compared with the CABG group in patients with 3VD (HR 1.51, 95% CI
1.38-1.65). In addition, the PCI group showed a 3.08-fold and 2.94-fold
higher risk compared with the CABG group in risks of myocardial infarction
(MI) and target-vessel revascularization (TVR), respectively (MI: HR 3.08,
95% CI 2.61-3.63; TVR: HR 2.94, 95% CI 1.94-4.46). CONCLUSION(S): In
conclusion, in patients with 3VD, PCI was consistently associated with
higher rates of all-cause mortality, MI, and TVR, compared with CABG.

<47>
Accession Number
631801704
Title
The effects of preoperative education of cardiac patients on haemodynamic
parameters, comfort, anxiety and patient-ventilator synchrony: A
randomised, controlled trial.
Source
Intensive & critical care nursing. 58 (pp 102799), 2020. Date of
Publication: 01 Jun 2020.
Author
Pazar B.; Iyigun E.
Institution
(Pazar) Department of Health, General Staff, Ankara, Turkey
(Iyigun) University of Health Sciences Turkey, Gulhane Faculty of Nursing,
Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients on mechanical ventilation are likely to suffer
stress, which may lead to problems of patient-ventilator synchrony,
anxiety, haemodynamic instability and decrease in comfort levels.
 OBJECTIVE(S): The aim of this study is to evaluate the effects of
preoperative education regarding haemodynamic parameters, patient comfort
and anxiety, and patient-ventilator synchrony provided to patients before
they undergo cardiac surgery. METHOD(S): The study is a randomised,
controlled clinical study, it was conducted at the cardiovascular surgery
clinic of a teaching hospital in Turkey. The study was conducted on 200
patients who underwent cardiac surgery and received mechanical
ventilation. Using the block randomisation method, the patients were
grouped into intervention and control groups, with 100 patients in each
group. The patients in the intervention group received preoperative
education on mechanical ventilation and the usage of the communication
panel that patients under mechanical ventilation use to communicate with
health personnel, the control group received no education. Data was
collected while the patients were on mechanical ventilation support in the
intensive care unit on their second postoperative day. RESULT(S): The
difference between the patient-ventilator synchrony levels of the patients
to the mechanical ventilation treatment in the intervention and control
groups was found statistically significant (p<0.05). The differences
between the haemodynamic measurements of the patients in both groups,
which were measured after the patients woke up and before extubation, were
also statistically significant (p<0.05). Median scores obtained by the
patients in the intervention group on the Perianaesthesia Comfort
Questionnaire and the Tension-Anxiety subscale of the Profile of Mood
Scale were 5.7 and 2.0, respectively. The median scores obtained by the
patients in the control group on the same scales were 4.1 and 24.0,
respectively. CONCLUSION(S): Compared to the participants in the
control group, the participants in the intervention group who received
education had higher patient-ventilator synchrony, comfort and
haemodynamic stability levels, as well as lower anxiety levels when they
were under mechanical ventilation, showing that results were better in the
intervention group than the control group. Copyright © 2020.
Published by Elsevier Ltd.

<48>
Accession Number
2008579726
Title
Use of protamine sulfate during transfemoral transcatheter aortic valve
implantation - A preliminary assessment of administration rate and impact
on complications.
Source
Postepy w Kardiologii Interwencyjnej. 16 (3) (pp 306-314), 2020. Date of
Publication: 2020.
Author
Zbronski K.; Grodecki K.; Gozdowska R.; Jedrzejczyk S.; Ostrowska E.;
Wysinska J.; Rymuza B.; Scislo P.; Wilimski R.; Kochman J.; Filipiak K.J.;
Opolski G.; Huczek Z.
Institution
(Zbronski, Grodecki, Gozdowska, Jedrzejczyk, Ostrowska, Wysinska, Rymuza,
Scislo, Kochman, Filipiak, Opolski, Huczek) First Department of
Cardiology, Medical University of Warsaw, Warsaw, Poland
(Wilimski) Department of Cardiac Surgery, Medical University of Warsaw,
Warsaw, Poland
Publisher
Termedia Publishing House Ltd.
Abstract
Introduction: Bleeding complications after transcatheter aortic valve
implantation (TAVI) are an important issue and negatively affect survival.
The rate and impact of protamine sulfate (PS) administration on bleeding
complications after TAVI remain unclear. Aim(s): To assess the impact
of PS on bleeding complications after TAVI. Material(s) and
Method(s): Between March 2010 and November 2016 two hundred fifty-eight
patients qualified for TAVI in one academic center were screened.
Baseline, procedural and follow-up data up to 30 days were collected and
analyzed. The primary endpoint (PE) was major bleeding according to the
Valve Academic Research Consortium up to 48 h after the procedure.
 Result(s): Overall, 186 patients (96 females, mean age: 80 years) met
the inclusion criteria. Thirty-nine (21%) subjects received PS. PE
occurred in 24.7% of the study population. There were no significant
differences in terms of the PE rate between the groups (25.6% in the PS
group and 24.7% in the remaining cohort, p = 0.9, odds ratio (OR) = 1.05,
confidence interval (CI): 0.47-2.4, p = 0.9). Multivariate analysis
identified female gender (OR = 2.2, CI: 1.08-4.4, p = 0.03) as an
independent predictor of PE occurrence. Similarly, female gender (OR = 2,
CI: 1.06-3.84, p = 0.03) as well as general anesthesia (GA, OR = 2.23, CI:
1.13-4.63, p = 0.02) and dose of unfractionated heparin per kilogram
(UFH/kg, OR = 1.02, CI: 1-1.03 per 1 IU increment, p = 0.02) predicted the
occurrence of a composite of major and minor bleeding. Conclusion(s):
In this analysis, PS administration did not decrease the PE rate. Female
gender predicted PE occurrence. Randomized, placebo-controlled trials are
required to accurately assess the impact of PS. Copyright © 2020
Termedia Publishing House Ltd.. All rights reserved.

<49>
Accession Number
632029991
Title
Exercise Electrocardiography and Computed Tomography Coronary Angiography
for Patients with Suspected Stable Angina Pectoris: A Post Hoc Analysis of
the Randomized SCOT-HEART Trial.
Source
JAMA Cardiology. 5 (8) (pp 920-928), 2020. Date of Publication: August
2020.
Author
Singh T.; Bing R.; Dweck M.R.; Van Beek E.J.R.; Mills N.L.; Williams M.C.;
Villines T.C.; Newby D.E.; Adamson P.D.
Institution
(Singh, Bing, Dweck, Van Beek, Mills, Williams, Newby, Adamson) British
Heart Foundation Centre for Cardiovascular Science, University of
Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
(Villines) Division of Cardiovascular Medicine, University of Virginia,
Charlottesville, United States
(Adamson) Christchurch Heart Institute, University of Otago, Christchurch,
New Zealand
Publisher
American Medical Association
Abstract
Importance: Recent European guidance supports a diminished role for
exercise electrocardiography (ECG) in the assessment of suspected stable
angina. Objective(s): To evaluate the utility of exercise ECG in
contemporary practice and assess the value of combined functional and
anatomical testing. Design, Setting, and Participant(s): This is a
post hoc analysis of the Scottish Computed Tomography of the Heart
(SCOT-HEART) open-label randomized clinical trial, conducted in 12
cardiology chest pain clinics across Scotland for patients with suspected
angina secondary to coronary heart disease. Between November 18, 2010, and
September 24, 2014, 4146 patients aged 18 to 75 years with stable angina
underwent clinical evaluation and 1417 of 1651 (86%) underwent exercise
ECG prior to randomization. Statistical analysis was conducted from
October 10 to November 5, 2019. Intervention(s): Patients were
randomized in a 1:1 ratio to receive standard care plus coronary computed
tomography (CT) angiography or to receive standard care alone. The present
analysis was limited to the 3283 patients who underwent exercise ECG alone
or in combination with coronary CT angiography. Main Outcomes and
Measures: The primary clinical end point was death from coronary heart
disease or nonfatal myocardial infarction at 5 years. Result(s):
Among the 3283 patients (1889 men; median age, 57.0 years [interquartile
range, 50.0-64.0 years]), exercise ECG had a sensitivity of 39% and a
specificity of 91% for detecting any obstructive coronary artery disease
in those who underwent subsequent invasive angiography. Abnormal results
of exercise ECG were associated with a 14.47-fold (95% CI, 10.00-20.41; P
<.001) increase in coronary revascularization at 1 year and a 2.57-fold
(95% CI, 1.38-4.63; P <.001) increase in mortality from coronary heart
disease death at 5 years or in cases of nonfatal myocardial infarction at
5 years. Compared with exercise ECG alone, results of coronary CT
angiography had a stronger association with 5-year coronary heart disease
death or nonfatal myocardial infarction (hazard ratio, 10.63; 95% CI,
2.32-48.70; P =.002). The greatest numerical difference in outcome with CT
angiography compared with exercise ECG alone was observed for those with
inconclusive results of exercise ECG (5 of 285 [2%] vs 13 of 283 [5%]),
although this was not statistically significant (log-rank P =.05).
 Conclusions and Relevance: This study suggests that abnormal results
of exercise ECG are associated with coronary revascularization and the
future risk of adverse coronary events. However, coronary CT angiography
more accurately detects coronary artery disease and is more strongly
associated with future risk compared with exercise ECG. Trial
Registration: ClinicalTrials.gov Identifier: NCT01149590. Copyright
© 2020 American Medical Association. All rights reserved.

<50>
Accession Number
631868059
Title
Complete vs Culprit-Lesion-Only Revascularization for ST-Segment Elevation
Myocardial Infarction: A Systematic Review and Meta-analysis.
Source
JAMA Cardiology. 5 (8) (pp 881-888), 2020. Date of Publication: August
2020.
Author
Bainey K.R.; Engstrom T.; Smits P.C.; Gershlick A.H.; James S.K.; Storey
R.F.; Wood D.A.; Mehran R.; Cairns J.A.; Mehta S.R.
Institution
(Bainey) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
(Engstrom) Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Smits) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Gershlick) Department of Cardiovascular Sciences, University of Leicester
and NIHR, National Institute of Heath Research, Leicester Cardiovascular
Biomedical Research Unit, University Hospitals of Leicester NHS (National
Health Service) Trust, Glenfield Hospital, Leicester, United Kingdom
(James) Department of Medical Sciences, Uppsala University, Uppsala,
Sweden
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Wood) Centre for Cardiovascular Innovation, University of British
Columbia, Vancouver, BC, Canada
(Mehran) Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai
School of Medicine, New York, NY, United States
(Cairns) Division of Cardiology, University of British Columbia,
Vancouver, BC, Canada
(Mehta) Population Health Research Institute, Hamilton Health Sciences,
McMaster University, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
Publisher
American Medical Association
Abstract
Importance: Recently, the Complete vs Culprit-Only Revascularization to
Treat Multivessel Disease After Early PCI (percutaneous coronary
intervention) for STEMI (ST-segment elevation myocardial infarction [MI])
(COMPLETE) trial showed that angiography-guided PCI of the nonculprit
lesion with the goal of complete revascularization reduced cardiovascular
(CV) death or new MI compared with PCI of the culprit lesion only in
STEMI. Whether complete revascularization also reduces CV mortality is
uncertain. Moreover, whether the association of complete revascularization
with hard clinical outcomes is consistent when fractional flow reserve
(FFR)-A nd angiography-guided strategies are used is unknown.
 Objective(s): To determine through a systematic review and
meta-analysis (1) whether complete revascularization is associated with
decreased CV mortality and (2) whether heterogeneity in the association
occurs when FFR-A nd angiography-guided PCI strategies for nonculprit
lesions are performed. Data Sources: A systematic search of MEDLINE,
Embase, ISI Web of Science, and CENTRAL (Cochrane Central Register of
Controlled Trials) from database inception to September 30, 2019, was
performed. Conference proceedings were also reviewed from January 1, 2002,
to September 30, 2019. Study Selection: English-language randomized
clinical trials comparing complete revascularization vs
culprit-lesion-only PCI in patients with STEMI and multivessel disease
were included. Data Extraction and Synthesis: The combined odds ratio (OR)
was calculated with the random-effects model using the Mantel-Haenszel
method (sensitivity with fixed-effects model). Heterogeneity was measured
using the I2statistic. Publication bias was evaluated using the
inverted funnel plot approach. Data were analyzed from October 2019 to
January 2020. Main Outcomes and Measures: Cardiovascular death and
the composite of CV death or new MI. Result(s): Ten randomized
clinical trials involving 7030 unique patients were included. The weighted
mean follow-up time was 29.5 months. Complete revascularization was
associated with reduced CV death compared with culprit-lesion-only PCI (80
of 3191 [2.5%] vs 106 of 3406 [3.1%]; OR, 0.69 [95% CI, 0.48-0.99]; P
=.05; fixed-effects model OR, 0.74 [95% CI, 0.55-0.99]; P =.04). All-cause
mortality occurred in 153 of 3426 patients (4.5%) in the complete
revascularization group vs 177 of 3604 (4.9%) in the culprit-lesion-only
group (OR, 0.84 [95% CI, 0.67-1.05]; P =.13; I2= 0%). Complete
revascularization was associated with a reduced composite of CV death or
new MI (192 of 2616 [7.3%] vs 266 of 2586 [10.3%]; OR, 0.69 [95% CI,
0.55-0.87]; P =.001; fixed-effects model OR, 0.69 [95% CI, 0.57-0.84]; P
<.001), with no heterogeneity in this outcome when complete
revascularization was performed using an FFR-guided strategy (OR, 0.78
[95% CI, 0.43-1.44]) or an angiography-guided strategy (OR, 0.61 [95% CI,
0.38-0.97]; P =.52 for interaction). Conclusions and Relevance: In
patients with STEMI and multivessel disease, complete revascularization
was associated with a reduction in CV mortality compared with
culprit-lesion-only PCI. There was no differential association with
treatment between FFR-A nd angiography-guided strategies on major CV
outcomes.. Copyright © 2020 American Medical Association. All
rights reserved.

<51>
Accession Number
631867997
Title
Efficacy of Evolocumab on Cardiovascular Outcomes in Patients with Recent
Myocardial Infarction: A Prespecified Secondary Analysis from the FOURIER
Trial.
Source
JAMA Cardiology. 5 (8) (pp 952-957), 2020. Date of Publication: August
2020.
Author
Gencer B.; MacH F.; Murphy S.A.; De Ferrari G.M.; Huber K.; Lewis B.S.;
Ferreira J.; Kurtz C.E.; Wang H.; Honarpour N.; Keech A.C.; Sever P.S.;
Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Gencer, Murphy, Sabatine, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, 60 Fenwood Rd, Hale Building, Boston, MA 02115, United States
(Gencer, MacH) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(De Ferrari) Division of Cardiology Citta della Salute e della Scienza,
Department of Medical Sciences, University of Torino, Turin, Italy
(Huber) Department of Medicine, Cardiology and Intensive Care Medicine and
Sigmund, Freud University, Medical School, Vienna, Austria
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ferreira) Hospital de Santa Cruz, Lisbon, Portugal
(Kurtz, Wang, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Publisher
American Medical Association
Abstract
Importance: The 2018 American Heart Association/American College of
Cardiology Multisociety Guideline on the Management of Blood Cholesterol
identified patients with recent (past 12 months) myocardial infarction
(MI) as very high risk, in whom a PCSK9 inhibitor is reasonable to add to
maximally tolerated statin combined with ezetimibe if their low-density
lipoprotein cholesterol level is 70 mg/dL or greater or non-high-density
lipoprotein cholesterol level is 100 mg/dL or greater. Objective(s):
To examine the clinical efficacy of evolocumab in patients with recent MI.
 Design, Setting, and Participant(s): This was a prespecified
secondary analysis of the Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, in which
27 564 patients with atherosclerotic cardiovascular disease treated with a
statin were randomized to evolocumab vs placebo. Patients with prior MI
with a known date (n = 22320) were stratified as having a recent MI
(within 12 months of randomization) or a remote MI (more than 12 months
prior to randomization). Per protocol, patients with MI within 4 weeks
prior to randomization were excluded from the FOURIER trial. Data were
collected from February 2013 to November 2016, and data were analyzed from
May 2019 to February 2020. Main Outcomes and Measures: The primary
composite end point was cardiovascular death, MI, stroke, hospitalization
for unstable angina, or coronary revascularization. The key secondary
composite end point was cardiovascular death, MI, or stroke.
 Result(s): Of 22320 included patients, 17516 (78.5%) were male, and
the mean (SD) age was 62.2 (9.0) years. Compared with 16609 patients with
a remote MI, 5711 patients with a recent MI were younger and more likely
to be treated with high-intensity statin (77.3% [4415] vs 69.3% [11506]).
In the placebo arm, the 3-year Kaplan-Meier rate for the primary end point
was 17.2% in patients with recent MI compared with 14.4% in those with
remote MI (adjusted HR, 1.45; 95% CI, 1.29-1.64; P <.001). Similarly, the
3-year Kaplan-Meier rates for the key secondary end point was also higher
in those with recent MI (10.9% vs 9.5%; adjusted HR, 1.45; 95% CI,
1.24-1.69; P <.001). In patients with a recent MI, evolocumab reduced the
risk of the primary and key secondary end points by 19% (hazard ratio
[HR], 0.81; 95% CI, 0.70-0.93) and 25% (HR, 0.75; 95% CI, 0.62-0.91),
respectively. In patients with a remote MI, evolocumab reduced the risk of
the primary and key secondary end points by 8% (HR, 0.92; 95% CI,
0.84-1.01; P for interaction =.13) and 15% (HR, 0.85; 95% CI, 0.76-0.96; P
for interaction =.24), respectively. Given the higher event rates in
patients with a recent MI, the absolute risk reductions over 3 years with
evolocumab were 3.7% in those with recent MI vs 1.1% in those with remote
MI for the primary end point and 3.2% vs 1.3%, respectively, for the key
secondary end point. Conclusions and Relevance: Patients with a
recent MI were at higher risk of cardiovascular events and tended to
experience greater absolute risk reductions with evolocumab than those
with remote MIs. These findings support the concept in US and European
guidelines to aggressively lower low-density lipoprotein cholesterol
levels in very high-risk patients, such as those with a recent MI. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633. Copyright
© 2020 American Medical Association. All rights reserved.

<52>
Accession Number
2008005147
Title
The effects of Vitamin D3 in pediatric patients undergoing congenital
heart surgery.
Source
Journal of Cellular and Molecular Anesthesia. 5 (2) (pp 66-73), 2020. Date
of Publication: April 2020.
Author
Jelveh-Moghaddam H.; Fani K.; Hekmat M.; Azari A.A.
Institution
(Jelveh-Moghaddam, Fani, Azari) Anesthesiology Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hekmat) Department of Cardiovascular Surgery, Shahid Modarres Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center
Abstract
Background: To investigate the effects of vitamin D3 on the surgical
outcome of pediatric patients undergoing cardiac surgery for congenital
heart conditions. Material(s) and Method(s): Ninety pediatric cardiac
surgery patients referred for preoperative evaluation were enrolled.
Patients with insufficient vitamin D3 levels received intramuscular
vitamin D3 (300,000 IU) three days before the surgery and those with final
vitamin D3 level of >=30 ng/dl were included and divided in 3 groups
(Group A: Abnormal Vit D levels, no Vit D treatment; Group B: Abnormal Vit
D levels, Vit D treatment up to normal serum Vit D levels before surgery;
Group C: normal baseline Vit D levels, no supplemental Vit D treatment).
Interleukin 1, 6, 10, tumor necrosis factor alpha, vital signs, and
arterial blood gas parameters were measured before the surgery and at 6
and 24 hours after cardiopulmonary bypass. Data on total hospital stay,
reoperation rates, and inotropes scores were retrieved. Additionally,
postoperative measures including hemodynamic factors, blood pressure,
heart rate, cardiac output, electrocardiography changes, chest-tube
drainage and ventilation-related factors (i.e. respiratory rate, arterial
blood gas, respiratory resistance, intubation time, ) were recorded.
 Result(s): We observed a significant increase in post cardiopulmonary
bypass levels of IL-10 and IL-6 in all groups (p<0.002) regardless of
vitamin D treatment status; however, no significant difference was seen in
levels of IL-1 and TNF-alpha. Groups B had more patients with critical
levels of VIS scores compared to groups A and C (p<0.002). Furthermore, no
differences in hemodynamic and metabolic parameters were observed.
 Conclusion(s): No significant difference in the rates of
postoperative parameters in patients with normal and those with deficient
levels of vitamin D3 was observed. Copyright © 2020 Journal of
Cellular and Molecular Anesthesia.

<53>
Accession Number
2003674213
Title
Del Nido cardioplegia in isolated adult coronary artery bypass surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 160 (6) (pp 1479-1485.e5),
2020. Date of Publication: December 2020.
Author
Timek T.A.; Beute T.; Robinson J.A.; Zalizadeh D.; Mater R.; Parker J.L.;
Lypka M.; Willekes C.L.
Institution
(Timek, Willekes) Division of Cardiothoracic Surgery, Spectrum Health,
Grand Rapids, Mich, United States
(Timek, Beute, Robinson, Zalizadeh, Mater, Willekes) Michigan State
University College of Human Medicine, Grand Rapids, Mich, United States
(Parker, Lypka) Office of Research, Spectrum Health, Grand Rapids, Mich,
United States
Publisher
Mosby Inc.
Abstract
Background: Del Nido cardioplegia (DC) offers prolonged single-dose
myocardial protection in pediatric cardiac surgery. We set out to evaluate
the efficacy of DC in adult patients undergoing isolated coronary artery
bypass grafting (CABG). Method(s): From January 2012 to October 2017,
851 consecutive isolated CABG surgeries were performed by 2 study surgeons
at our center with blood cardioplegia (BC, n = 350), used from January
2012 to April 2014, and DC (n = 501), used from May 2014 to October 2017.
Propensity matching was used to yield 325 well-matched pairs. Clinical
data were extracted from our local Society of Thoracic Surgeons database
and mortality data from the Michigan State Social Security Death Index.
 Result(s): Single-dose administration was used in 83% (417/501) of
patients receiving DC. In propensity-matched groups, postoperative median
troponin T levels (0.28 [0.16-0.59] ng/mL vs 0.46 [0.27-0.81] ng/mL; P <
.01) were lower for patients receiving DC, and no difference in ejection
fraction on postoperative echocardiography was observed (54 +/- 12% and 53
+/- 13% for BC and DC, respectively; P = .36). Perioperative outcomes were
similar except for greater rate of atrial fibrillation (33% vs 23%; P =
.01) in the DC group. Subgroup analyses revealed equivalent myocardial
protection and clinical outcomes in patients with age >=75 years, left
ventricular ejection fraction <=35%, left main disease, or Society of
Thoracic Surgeons score >=2.5%. Four-year survival did not differ between
patients undergoing BC or DC. Conclusion(s): The current study
revealed noninferior myocardial protection and clinical outcomes with DC
versus BC in both routine and greater-risk patients undergoing isolated
CABG. DC demonstrated the feasibility of single-dose administration for
isolated CABG surgery. Larger randomized studies are needed to further
explore the safety and efficacy of DC in adult cardiac surgery with longer
crossclamp times. Copyright © 2019 The American Association for
Thoracic Surgery

<54>
Accession Number
633381083
Title
Cancer risk in heart or lung transplant recipients: A meta-analysis.
Source
Transplantation. Conference: 26th Annual Congress of the International
Liver Transplantation Society, ILTS 2020. Turkey. 104 (SUPPL 3) (pp
S582-S583), 2020. Date of Publication: September 2020.
Author
Ge F.; Wang R.; Huo Z.; Wen Y.; Liang H.; Jiang Y.; Su Z.; Liang W.; He J.
Institution
(Ge) 1st Clinical School, Guangzhou Medical University, Guangzhou, China
(Wang, Huo, Wen, Jiang, Su) Nanshan School, Guangzhou Medical University,
Guangzhou, China
(Liang) Department of Thoracic Oncology, 1st Affiliated Hospital of
Guangzhou Medical University, Guangzhou, China
(Liang, He) Department of Thoracic Surgery, 1st Affiliated Hospital,
Guangzhou Medical University, Guangzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients underwent heart or lung transplantation are
considered to be associated with an increased risk of developing cancers.
However, the specific cancer risk at different sites among heart or lung
transplantation recipients remain unclear. Tumor mutational burden (TMB)
is a biomarker, which is a measure of immunogenicity of certain cancer.
 Method(s): PubMed, Web of Science, EMBASE, Medline, Cochrane Library
were searched. Random-effects meta-analyses were performed to calculate
standardized incidence ratios (SIRs) for heart or lung transplant
recipients versus the general population, stratified by types of
transplantation. Weighted linear regression (WLR) was performed to analyze
the associations between tumors' standardized incidence ratios (SIRs) and
corresponding tumor mutational burden (TMB). Result(s): Based on data
from 117,045 transplant recipients (51,173 heart transplant recipients and
65,872 lung transplant recipients) with a total follow- up of 578,014.8
person-years (heart transplantation: 259,913.2 personyears; lung
transplantation: 318,101.6 person-years), we identified that heart or lung
transplant recipients display a different risk in different cancers. Heart
transplant recipients were found to display a higher risk in all cancers
[SIR: 3.13; 95% Confidence Interval (CI): 2.38-4.13; P<0.001], squamous
cell carcinoma, lip cancer, non-melanoma skin cancer, non-Hodgkin's
lymphoma, basal cell cancer, kidney cancer, compared with the general
population. Lung transplant recipients were found to display a higher risk
in all cancers [SIR: 4.28; 95% CI: 2.98-6.60; P < 0.001], non-Hodgkin's
lymphoma, lip cancer, skin cancer, non-melanoma skin cancer, squamous cell
carcinoma, lung cancer, head and neck cancer, colorectal cancer, liver
cancer, cervical cancer and a lower risk in breast cancer, compared with
the general population (Table 1). The correlation coefficient of 0.54 [P =
0.047] and 0.79 [P < 0.001] in heart and lung transplant recipients,
respectively, suggested that 27% and 63% of the differences in the
standardized incidence ratios across cancer types may be explained by the
tumor mutational burden (Figure 1).

<55>
Accession Number
633381046
Title
Effect of donor simvastatin treatment on gene expression profiles in human
cardiac allografts during ischemia-reperfusion injury.
Source
Transplantation. Conference: 26th Annual Congress of the International
Liver Transplantation Society, ILTS 2020. Turkey. 104 (SUPPL 3) (pp S168),
2020. Date of Publication: September 2020.
Author
Krebs R.; Holmstrom E.; Dhaygude K.; Kankainen M.; Syrjala S.; Lukac J.;
Mattila P.; Nykanen A.; Lemstrom K.
Institution
(Krebs, Holmstrom, Dhaygude, Syrjala, Lukac, Nykanen, Lemstrom)
Transplantation Laboratory, University of Helsinki, Helsinki, Finland
(Kankainen, Mattila) Institute for Molecular Medicine Finland, University
of Helsinki, Helsinki, Finland
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: Statin therapy initiated early after heart transplantation has
beneficial effects on the development of cardiac allograft vasculopathy.
Recently, we showed in a randomized clinical trial that simvastatin
treatment of braindead donors conditions the heart transplant to endure
ischemia-reperfusion injury and to reduce the need for rejection-related
treatments early after transplantation (Nykanen et al, 2019). In this
study, we analyzed myocardial gene expression profiles of cardiac
allografts after donor simvastatin treatment. Method(s): In a
prospective, randomized, controlled double-blinded trial, 42 of 84 heart
transplant donors received 80 mg of simvastatin via nasogastric tube,
whereas the other 42 donors received no treatment. Transmural Tru- Cut
biopsies were taken from the apex of the donor heart's left ventricle
immediately before reperfusion and 1 hour after reperfusion. The
transcriptome of the biopsies was analyzed with RNA sequencing.
 Result(s): The preliminary analysis of RNA sequencing data from
myocardial biopsies of 20 + 20 patients revealed altogether 137
significantly differentially expressed genes in all pairwise comparisons.
Gene ontology analysis showed these genes to be related to biological
functions such as response to toxic substance, leukocyte migration,
immunity (neutrophil-mediated), response to lipopolysaccharide, and
response to oxidative stress. Enrichment pathway analysis indicated
alterations in Th17, TGF-b, and muscle repair signaling pathways. At time
of abstract submission, data of the remaining samples is about to enter
the sequencing data analysis pipeline. Conclusion(s): We have shown
in previous studies that donor simvastatin treatment has protective
effects against IRI in heart transplant recipients. In this study, we were
able to detect significantly differentially expressed genes related to
effects of simvastatin treatment. In order to single out genes that show
beneficial effects of simvastatin treatment, further analysis will be
conducted by exploring gene expression changes in specific biological
functional categories, such as interleukin signaling and neutrophil
degranulation. The complete analysis will be presented at the TTS 2020
congress.

<56>
Accession Number
633380991
Title
Improving patients' experience and medication adherence after heart
transplant using a multilevel ehealth intervention: The mheart clinical
trial.
Source
Transplantation. Conference: 26th Annual Congress of the International
Liver Transplantation Society, ILTS 2020. Turkey. 104 (SUPPL 3) (pp
S578-S579), 2020. Date of Publication: September 2020.
Author
Gomis-Pastor M.; Mirabet S.; Roig E.; Brossa V.; Lopez L.; Ros S.; Mas N.;
Mangues M.A.
Institution
(Gomis-Pastor, Mirabet, Roig, Brossa, Lopez, Ros) Heart Failure and Heart
Transplant Unit, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
(Gomis-Pastor, Mas, Mangues) Pharmacy Department, Hospital de la Santa
Creu i Santa Pau, Barcelona, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Non-adherence is a main issue after heart transplantation.
The main objective of this study is to evaluate if a mHealth-based
strategy is better than the conventional approach to improve adherence in
adults heart transplanted recipients and to asses patients experience of
therapeutic regimens. Method(s): This is a single-center randomized
controlled trial (RCT). Adult HTx recipients who were >1.5 years
post-transplant were randomly assigned 1:1 to the control group or
intervention group. Control group patients received usual care and the
intervention group received a mHealth based care strategy using the mHeart
software (mobile application). Result(s): A total of 134 HTx
recipients were randomized [intervention N=71; control N=63]. An attrition
rate of 4% was observed. The mean follow-up was 1.6 (SD 0.6) years. Mean
age was 55 (SD14) years; 30% were women. Adherence rate improvement from
the baseline was >65% according to the SMAQ questionnaire, significantly
higher in the intervention group (85 % vs 46% 65% OR=6.7 (2.9;15.8),
P-value=.000]. Patients' experience of therapeutic regimens (including the
degree of inconvenience related to taking medication [P-value=.002],
patient's knowledge of their regimen intakes [P-value=.019], drugs names
[P-value=.006], drugs doses [P-value=.030] and drugs indications
remembered [P-value=.003]) significantly improved in the intervention
versus the control group. In addition, patient's awareness of the
consequences of nonadherence significantly improved in both groups
[P-value<.01]. The in-clinic appointment needs and the intensity of the
follow-up were significantly reduced in the intervention group (65%)
versus the control group (35%) [OR=3.4 (1.7;6.9), P-value=.001].
 Conclusion(s): In our study, a mHealth based strategy significantly
improved adherence in heart transplant recipients. A significantly
reduction on the number of patients needing to travel to the clinic for
follow-up appointments with the clinical pharmacist was documented. The
mHealth approach will be a feasible way to continue providing long-term
advanced individually-tailored interventions by health providers to HTx
recipients in the at-home setting.

<57>
Accession Number
633377632
Title
Ultrasound-guided out-of-plane versus in-plane for radial arterial line
cannulation.
Source
Oman Medical Journal. Conference: Oman Medical Specialty Board Research
Forum 2019/2020. Oman. 35 (1) (pp 48), 2020. Date of Publication: 2020.
Author
Al Sheheimi R.; Maddali M.
Institution
(Al Sheheimi) R5,Anesthesia Residency Training Program, Oman Medical
Specialty Board, Muscat, Oman
(Maddali) National Heart Center, Royal Hospital, Muscat, Oman
Publisher
Oman Medical Specialty Board
Abstract
Objectives: Currently, short-axis out-of-plane and long-axis in-plane
ultrasound techniques are used to guide radial artery cannulation. This
study aimed to compare the success rate and the safety of the two
techniques. Method(s): This prospective observational study was
conducted in Cardiac Centre, Royal Hospital a tertiary health centre.
Eighty-four adult patients age 18-65 years old who underwent cardiac
surgery were enrolled in the study. A pilot study was used to determine
the sample size. The patients were randomly divided into two groups: the
out-of-plane and the in-plane ultrasound guidance approaches with 42
patients in each group. The primary endpoint to compare the groups was the
rate of cannula insertion successes on the first attempt. The secondary
endpoints were recorded and compared such as the number of skin puncture,
the number of cannula redirection, cannulation time, and vascular
complications including hematoma. Continuous demographic variables were
compared using independent t-test and time of cannulations were compared
using Mann-Whitney Utest due to the abnormal distribution. Categorical
clinical outcomes were compared using chi-square test. Ethical approval
was obtained from the Royal Hospital [MESRC#79/2015]. Result(s): All
patients completed the study and have been analyzed. The cannula insertion
success rate on the first attempt was significantly higher in the in-plane
group compared to the out-of-plane group (p = 0.007). The number of
cannula redirection and the number of skin puncture were significantly
higher in out-of-plane approach with p = 0.004 and p = 0.016,
respectively. However, cannulation time and the number of hematoma were
not significantly different between the two group (p = 0.792 and p =
0.241, respectively). Conclusion(s): We think that the in-plane USG
approach is cost effective and may be safer for arterial line cannulation.
The future studies may be conducted on difficult subgroup of patients like
obese or hemodynamically unstable patients.

<58>
Accession Number
633377598
Title
Assessment of stress response attenuation with caudal morphine using a
surrogate marker during pediatric cardiac surgery.
Source
Oman Medical Journal. Conference: Oman Medical Specialty Board Research
Forum 2019/2020. Oman. 35 (1) (pp 41), 2020. Date of Publication: 2020.
Author
Al Shamsi F.; Maddali M.M.
Institution
(Al Shamsi) R5,Anesthesia Residency Training Program, Oman Medical
Specialty Board, Muscat, Oman
(Maddali) National Heart Center, Royal Hospital, Muscat, Oman
Publisher
Oman Medical Specialty Board
Abstract
Objectives: The primary aim of this study was to compare the increase in
chromogranin A levels from baseline levels following on pump pediatric
cardiac surgery between patients that received bolus caudal morphine and
patients who had surgery under a conventional intravenous narcotic based
anesthetic protocol. The secondary objectives were to compare hemodynamic
responses to skin incision and magnitude of rise in blood sugar values
between the groups. Method(s): This was a prospective observational
study conducted on pediatric cardiac surgery patients at National Heart
Center, a tertiary care cardiac surgery center in Oman from September 2017
to September 2018. Sixty patients undergoing elective open heart surgery
after administration of general anesthesia were randomized. Group 1
(control group, n = 30) received an intravenous narcotic-based anesthesia
for analgesia and group 2 (study group, n = 30) received a bolus of
preservative free morphine (50 mugm/kg in 1 mL/kg normal saline) deposited
in the caudal space as the primary analgesic technique. Demographic data
including age, weight, duration of cardiopulmonary bypass, and duration of
mechanical ventilation were collected. Comparison of difference in median
values of chromogranin A levels between baseline and following completion
of surgery was done. Result(s): The demographic data, Aristotle
scores (both basic and composite), duration of cardiopulmonary bypass, and
duration of postoperative mechanical ventilation were comparable between
the groups. Caudal morphine group had significantly reduced rise in
systolic pressure compared to the control group (p = 0.006). Increase in
blood sugar reflected by the difference in the baseline and highest blood
sugar levels that were detected were similar in both groups. The
difference in the median value of the chromogranin A levels were
comparable in both groups. Conclusion(s): The rise in chromogranin A
levels in response to surgical stress was found to be similar in pediatric
cardiac surgical patients that received caudal morphine as compared to an
intravenous narcotic based anesthesia technique. Caudal morphine
attenuated stress response was comparable to narcotic based anesthesia
techniques. This study suggests an objective method of assessing the
stress attenuation in pediatric cardiac surgical patients by using a
surrogate marker.

<59>
Accession Number
2008499346
Title
Effect of dexmedetomidine on hemodynamic changes and inflammatory
responses in patients undergoing off-pump coronary-artery bypass grafting.
Source
Experimental and Therapeutic Medicine. 20 (6) (no pagination), 2020.
Article Number: e9380. Date of Publication: December 2020.
Author
ZHAI W.; YANG L.; SUN P.; LI Y.; HAN J.; WANG G.
Institution
(ZHAI, LI) Tianjin Medical University, Tianjin 300070, China
(ZHAI, SUN, HAN) Department of Anesthesiology, Tianjin Chest Hospital,
Tianjin 300222, China
(YANG) Departments of Cardiovascular Surgery, General Hospital of Tianjin
Medical University, Tianjin 300052, China
(WANG) Departments of Anesthesiology, General Hospital of Tianjin Medical
University, Tianjin 300052, China
Publisher
Spandidos Publications
Abstract
The aim of the present study was to determine the effect of
dexmedetomidine on hemodynamic changes and inflammatory responses in
patients undergoing off-pump coronary artery bypass grafting (OPCABG). A
total of 300 patients about to receive OPCABG were randomized evenly into
the control group (n=116) and study group (n=123). Intravenous
dexmedetomidine pump infusion was administered to patients in the study
group at a rate of 0.4 mug.kg-1.h-1. The control group received
physiological saline at the same infusion speed. Changes in hemodynamic
parameters and inflammatory indices were compared between the two groups.
Hemodynamic parameters, such as the heart rate and mean arterial pressure,
were lower in patients from the study group, compared with that in the
control group (both P<0.05). The levels of pro-inflammatory factors, such
as interleukin (IL)-6, tumor necrosis factor-alpha and C-reactive protein,
were also reduced in the study group (P<0.05). The observed levels of
IL-10 were lower in the control group compared with that in the study
group, although a statistically significant difference was not achieved.
Thus, the administration of dexmedetomidine in patients undergoing OPCABG
stabilized hemodynamics and reduced inflammation. Copyright ©
2020 Spandidos Publications. All rights reserved.

<60>
Accession Number
2008575544
Title
Meta-analysis Evaluating the Utility of Colchicine in Secondary Prevention
of Coronary Artery Disease.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Xia M.; Yang X.; Qian C.
Institution
(Xia, Qian) Department of Cardiology, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan Province, China
(Yang) Department of Medical Records, The Central Hospital of Enshi
Autonomous Prefecture, Enshi, Hubei Province, China
Publisher
Elsevier Inc.
Abstract
Colchicine has shown potential therapeutic benefits in cardiovascular
conditions owing to its broad anti-inflammatory properties. Here, we
performed a meta-analysis to determine the efficacy and safety of
colchicine in patients with coronary artery disease (CAD). A systematical
search in electronic databases of PubMed, The Cochrane Library, and Scopus
were carried out to identify eligible studies. Only randomized controlled
trials evaluating the cardiovascular effects of colchicine in CAD patients
were included. Study-level data of cardiovascular outcomes or adverse
events were pooled using random-effect models. We finally included 5
randomized controlled trials with follow-up duration >=6 months,
comprising a total of 11,790 patients with CAD. Compared with placebo or
no treatment, colchicine administration was associated with a
significantly lower incidence of major adverse cardiovascular events
(relative risk [RR] 0.65, 95% confidence interval [CI] 0.52 to 0.82). Such
a benefit was not modified by the clinical phenotype of CAD (p for
interaction = 0.34). Colchicine treatment also decreased the risk of
myocardial infarction (RR 0.73, 95% CI 0.55 to 0.98), coronary
revascularization (RR 0.61, 95% CI 0.42 to 0.89) and stroke (RR 0.47, 95%
CI 0.28 to 0.81) in CAD patients, but with no impact on cardiovascular
mortality. In addition, the rates of common adverse events were generally
similar between colchicine and control groups, including noncardiovascular
deaths (RR 1.50, 95% CI 0.93 to 2.40) and gastrointestinal symptoms (RR
1.05, 95% CI 0.91 to 1.22). In conclusion, the results of our
meta-analysis demonstrated that colchicine treatment may reduce the risk
of future cardiovascular events in CAD patients. Copyright © 2020
Elsevier Inc.

<61>
Accession Number
2008574731
Title
Meta-analysis Comparing Early Outcomes Following Transcatheter Aortic
Valve Implantation With the Evolut Versus Sapien 3 Valves.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Alperi A.; Faroux L.; Muntane-Carol G.; Rodes-Cabau J.
Institution
(Alperi, Faroux, Muntane-Carol, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, QC, Canada
Publisher
Elsevier Inc.
Abstract
We aimed to compare the early (in-hospital/30-day) outcomes (major
periprocedural complications, device success/valve performance, and
mortality) following transcatheter aortic valve implantation with the
Sapien 3 versus Evolut transcatheter valve systems. This was a systematic
review from PubMed and EMBASE databases for studies reporting raw data or
estimates. The outcomes analyzed were (1) in-hospital/30-day major
periprocedural complications, (2) device success and valve performance,
and (3) mortality. The outcomes were defined according to VARC-2 criteria.
A total of 24,628 transcatheter aortic valve implantation patients from 9
studies (1 randomized, 8 observational [5 case- or propensity-matched
analyses]) were included: 12,411 and 12,217 patients had Sapien 3 and
Evolut valve implantation, respectively. There were no differences between
devices regarding in-hospital/30-day stroke (risk ratio [RR] 0.95, 95%
confidence interval [CI] 0.34 to 2.66), major vascular complications (RR
1.03, 95% CI 0.63 to 1.68), acute kidney injury (RR 1.17, 95% CI 0.78 to
1.77), device success (RR 1.00, 95% CI 0.97 to 1.04) and moderate-severe
residual aortic regurgitation (RR 0.49, 95% CI 0.20 to 1.17). Sapien 3
recipients exhibited lower risk of permanent pacemaker implantation (RR
0.66, 95% CI 0.55 to 0.80), a higher risk of life-threatening bleeding (RR
1.82, 95% CI 1.18 to 2.80), and higher residual transvalvular gradients
(mean difference 3.95 mmHg, 95% CI 3.37 to 4.56). A lower risk of
in-hospital/30-day mortality was observed for Sapien 3 (RR 0.79, 95% CI
0.69 to 0.90). In conclusion, the similarities in device success rate and
major periprocedural complications (except for a higher and lower risk of
permanent pacemaker implantation and life-threatening bleeding,
respectively, with the Evolut system) support the lack of a valve type
effect accounting for the increased mortality risk observed with the
Evolut valve. Copyright © 2020 Elsevier Inc.

<62>
Accession Number
2008574687
Title
Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies
Evaluating Point-of-Care Tests of Coagulopathy in Cardiac Surgery.
Source
Transfusion Medicine Reviews. (no pagination), 2020. Date of Publication:
2020.
Author
Wozniak M.J.; Abbasciano R.; Monaghan A.; Lai F.Y.; Corazzari C.; Tutino
C.; Kumar T.; Whiting P.; Murphy G.J.
Institution
(Wozniak, Abbasciano, Monaghan, Lai, Corazzari, Kumar, Murphy) Department
of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre
in Cardiovascular Medicine, University of Leicester, Clinical Sciences
Wing, Glenfield General Hospital, Leicester, United Kingdom
(Corazzari, Tutino) Cardiac Surgery Unit, Insubria University, Varese,
Italy
(Whiting) Centre for Research Synthesis and Decision Analysis (CReSyDA),
Bristol Medical School, University of Bristol, Bristol, United Kingdom
Publisher
W.B. Saunders
Abstract
Treatment guidelines recommend the routine use of point-of-care diagnostic
tests for coagulopathy in the management of cardiac surgery patients at
risk of severe bleeding despite uncertainty as to their diagnostic
accuracy. We performed a systematic review and meta-analysis of studies
that evaluated the diagnostic accuracy of viscoelastometry, platelet
function tests, and modified thromboelastography (TEG) tests, for
coagulopathy in cardiac surgery patients. The reference standard included
resternotomy for bleeding, transfusion of non-red cell components, or
massive transfusion. We searched MEDLINE, EMBASE, CINAHL, and Clinical
Trials.gov, from inception to June 2019. Study quality was assessed using
QUADAS-2. Bivariate models were used to estimate summary sensitivity and
specificity with (95% confidence intervals). All 29 studies (7440
participants) included in the data synthesis evaluated the tests as
predictors of bleeding. No study evaluated their role in the management of
bleeding. None was at low risk of bias. Four were judged as low concern
regarding applicability. Pooled estimates of diagnostic accuracy were;
Viscoelastic tests, 12 studies, sensitivity 0.61 (0.44, 0.76), specificity
0.83 (0.70, 0.91) with significant heterogeneity. Platelet function tests,
12 studies, sensitivity 0.63 (0.53, 0.72), specificity 0.75 (0.64, 0.84)
with significant heterogeneity. TEG modification tests, 3 studies,
sensitivity 0.80 (0.67, 0.89), specificity 0.76 (0.69, 0.82) with no
evidence of heterogeneity. Studies reporting the highest values for
sensitivity and specificity had important methodological limitations. In
conclusion, we did not demonstrate predictive accuracy for commonly used
point-of-care devices for coagulopathic bleeding in cardiac surgery.
However, the certainty of the evidence was low. Copyright © 2020

<63>
Accession Number
633377302
Title
Association of Circulating Monocyte Chemoattractant Protein-1 Levels with
Cardiovascular Mortality: A Meta-analysis of Population-Based Studies.
Source
JAMA Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Georgakis M.K.; De Lemos J.A.; Ayers C.; Wang B.; Bjorkbacka H.; Pana
T.A.; Thorand B.; Sun C.; Fani L.; Malik R.; Dupuis J.; Engstrom G.;
Orho-Melander M.; Melander O.; Boekholdt S.M.; Zierer A.; Elhadad M.A.;
Koenig W.; Herder C.; Hoogeveen R.C.; Kavousi M.; Ballantyne C.M.; Peters
A.; Myint P.K.; Nilsson J.; Benjamin E.J.; Dichgans M.
Institution
(Georgakis, Malik, Dichgans) Institute for Stroke and Dementia Research,
University Hospital, Ludwig-Maximilians-University, Munich, Germany
(Georgakis) Graduate School for Systemic Neurosciences,
Ludwig-Maximilians-University, Munich, Germany
(De Lemos, Ayers) Division of Cardiology, University of Texas Southwestern
Medical Center, Dallas, United States
(Wang, Dupuis) Department of Biostatistics, Boston University School of
Public Health, Boston, MA, United States
(Bjorkbacka, Engstrom, Orho-Melander, Melander, Nilsson) Department of
Clinical Sciences Malmo, Lund University, Malmo, Sweden
(Pana, Myint) Institute of Applied Health Sciences, School of Medicine,
University of Aberdeen, Aberdeen, United Kingdom
(Thorand, Elhadad) Research Unit of Molecular Epidemiology, Helmholtz
Zentrum Munchen, German Research Center for Environmental Health,
Neuherberg, Germany
(Thorand, Herder, Peters) German Center for Diabetes Research,
Munchen-Neuherberg, Germany
(Sun, Hoogeveen, Ballantyne) Department of Medicine, Baylor College of
Medicine, Houston, TX, United States
(Fani, Kavousi) Department of Epidemiology, Erasmus Mc University Medical
Center, Rotterdam, Netherlands
(Boekholdt) Amsterdam Umc, University of Amsterdam, Department of
Cardiology, Amsterdam, Netherlands
(Zierer, Elhadad, Peters) Institute of Epidemiology, Helmholtz Zentrum
Munchen, German Research Center for Environmental Health, Neuherberg,
Germany
(Elhadad, Koenig, Peters) German Research Center for Cardiovascular
Disease, Partner Site of Munich Heart Alliance, Munich, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Ulm, Germany
(Herder) Institute for Clinical Diabetology, German Diabetes Center,
Leibniz Center for Diabetes Research at Heinrich Heine University
Dusseldorf, Dusseldorf, Germany
(Herder) Department of Endocrinology and Diabetology, Medical Faculty,
Heinrich Heine University Dusseldorf, Dusseldorf, Germany
(Peters) Institute of Medical Information Sciences, Biometry and
Epidemiology, Ludwig-Maximilians-University, Munich, Germany
(Benjamin) Section of Cardiovascular Medicine and Preventive Medicine,
Department of Medicine, Boston University School of Medicine, Boston, MA,
United States
(Benjamin) Department of Epidemiology, Boston University School of Public
Health, Boston, MA, United States
(Benjamin) Framingham Heart Study, National Heart, Blood Institute and
Boston University, Framingham, MA, United States
(Dichgans) Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
(Dichgans) German Centre for Neurodegenerative Diseases, Munich, Germany
Publisher
American Medical Association
Abstract
Importance: Human genetics and studies in experimental models support a
key role of monocyte-chemoattractant protein-1 (MCP-1) in atherosclerosis.
Yet, the associations of circulating MCP-1 levels with risk of coronary
heart disease and cardiovascular death in the general population remain
largely unexplored. Objective(s): To explore whether circulating
levels of MCP-1 are associated with risk of incident coronary heart
disease, myocardial infarction, and cardiovascular mortality in the
general population. Data Sources and Selection: Population-based cohort
studies, identified through a systematic review, that have examined
associations of circulating MCP-1 levels with cardiovascular end points.
Data Extraction and Synthesis: Using a prespecified harmonized analysis
plan, study-specific summary data were obtained from Cox regression models
after excluding individuals with overt cardiovascular disease at baseline.
Derived hazard ratios (HRs) were synthesized using random-effects
meta-analyses. Main Outcomes and Measures: Incident coronary heart
disease (myocardial infarction, coronary revascularization, and unstable
angina), nonfatal myocardial infarction, and cardiovascular death (from
cardiac or cerebrovascular causes). Result(s): The meta-analysis
included 7 cohort studies involving 21401 individuals (mean [SD] age, 53.7
[10.2] years; 10012 men [46.8%]). Mean (SD) follow-up was 15.3 (4.5) years
(326392 person-years at risk). In models adjusting for age, sex, and
race/ethnicity, higher MCP-1 levels at baseline were associated with
increased risk of coronary heart disease (HR per 1-SD increment in MCP-1
levels: 1.06 [95% CI, 1.01-1.11]; P =.01), nonfatal myocardial infarction
(HR, 1.07 [95% CI, 1.01-1.13]; P =.02), and cardiovascular death (HR, 1.12
[95% CI, 1.05-1.20]; P <.001). In analyses comparing MCP-1 quartiles,
these associations followed dose-response patterns. After additionally
adjusting for vascular risk factors, the risk estimates were attenuated,
but the associations of MCP-1 levels with cardiovascular death remained
statistically significant, as did the association of MCP-1 levels in the
upper quartile with coronary heart disease. There was no significant
heterogeneity; the results did not change in sensitivity analyses
excluding events occurring in the first 5 years after MCP-1 measurement,
and the risk estimates were stable after additional adjustments for
circulating levels of interleukin-6 and high-sensitivity C-reactive
protein. Conclusions and Relevance: Higher circulating MCP-1 levels
are associated with higher long-term cardiovascular mortality in
community-dwelling individuals free of overt cardiovascular disease. These
findings provide further support for a key role of MCP-1-signaling in
cardiovascular disease.. Copyright © 2020 BMJ Publishing Group.
All rights reserved.

<64>
Accession Number
613003182
Title
The efficacy of pre-emptive dexmedetomidine versus amiodarone in
preventing postoperative junctional ectopic tachycardia in pediatric
cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 614-620), 2016. Date of
Publication: October-December 2016.
Author
El-Shmaa N.S.; El Amrousy D.; El Feky W.
Institution
(El-Shmaa) Department of Anesthesia and Surgical ICU, Faculty of Medicine,
Tanta University, Tanta, Egypt
(El Amrousy) Department of Pediatrics, Tanta University Hospital, Tanta,
Egypt
(El Feky) Department of Cardiothoracic Surgery, Tanta University Hospital,
Tanta, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Objective: The objective of this study was to assess the effectiveness of
pre-emptive dexmedetomidine versus amiodarone in preventing junctional
ectopic tachycardia (JET) in pediatric cardiac surgery. Design(s):
This is a prospective, controlled study. Setting(s): This study was
carried out at a single university hospital. Subjects and Methods: Ninety
patients of both sexes, American Society of Anesthesiologists Physical
Status II and III, age range from 2 to 18 years, and scheduled for
elective cardiac surgery for congenital and acquired heart diseases were
selected as the study participants. Intervention(s): Patients were
randomized into three groups (30 each). Group I received dexmedetomidine 1
mcg/kg diluted in 100 ml of normal saline intravenously (IV) over a period
of 20 min, and the infusion was completed 10 min before the induction
followed by a 0.5 mcg/kg/h infusion for 72 h postoperative, Group II
received amiodarone 5 mg/kg diluted in 100 ml of normal saline IV over a
period of 20 min, and the infusion was completed 10 min before the
induction followed by a 10-15 mcg/kg/h infusion for 72 h postoperative,
and Group III received 100 ml of normal saline IV. Primary outcome was the
incidence of postoperative JET. Secondary outcomes included
vasoactive-inotropic score, ventilation time (VT), pediatric cardiac care
unit stay, hospital length of stay, and perioperative mortality.
 Measurements and Main Results: The incidence of JET was significantly
reduced in Group I and Group II (P = 0.004) compared to Group III. Heart
rate while coming off from cardiopulmonary bypass (CPB) was significantly
low in Group I compared to Group II and Group III (P = 0.000). Mean VT,
mean duration of Intensive Care Unit stay, and length of hospital stay
(day) were significantly short (P = 0.000) in Group I and Group II
compared to Group III (P = 0.000). Conclusion(s): Perioperative use
of dexmedetomidine and amiodarone is associated with significantly
decreased incidence of JET as compared to placebo without significant side
effects.

<65>
Accession Number
2008470817
Title
Comparison of outcomes following transfemoral versus trans-subclavian
approach for transcatheter aortic valve Implantation: A meta-analysis.
Source
IJC Heart and Vasculature. 31 (no pagination), 2020. Article Number:
100668. Date of Publication: December 2020.
Author
Al-Balah A.; Naqvi D.; Houbby N.; Chien L.; Sen S.; Athanasiou T.; Yousuf
Salmasi M.
Institution
(Al-Balah, Naqvi, Houbby, Chien) Faculty of Medicine, Imperial College
London, United Kingdom
(Sen) Department of Surgery, Imperial College London, United Kingdom
(Athanasiou, Yousuf Salmasi) Department of Cardiology, Imperial College
Healthcare Trust, London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: The subclavian artery is an alternative access route for
transcatheter aortic valve implantation (TAVI), with a potential advantage
in patients unsuitable for traditional access routes such as the femoral
artery. This study aimed to determine the safety and efficacy of the
trans-subclavian (TSc) compared to the trans-femoral (TF) approach.
 Method(s): A systematic review was conducted on two online databases:
Embase and Medline. The initial search returned 508 titles. Nine
observational studies were included: n = 2938 patients (2382 TF and 556
TSc). Result(s): Both TSc and TF groups were comparable for: 30-day
mortality (Odds ratio, OR 0.75, 95% CI 0.49 - 1.16, p = 0.195);
in-hospital stroke (OR 1.05, 95% CI 0.60-1.85, p = 0.859); myocardial
infarction (OR 1.97, 95% CI 0.74-5.23, p = 0.176); paravalvular leaks (OR
1.20, 95% CI 0.76-1.90, p = 0.439); rates of postoperative permanent
pacemaker implantation (OR 1.49, 95% CI 0.92-2.41, p = 0.105); in-hospital
bleeding and meta-analysis demonstrated no significant difference between
access points (OR 3.44, 95% CI 0.35-34.22, p = 0.292). Procedural time was
found to be longer in the TSc group (SMD 1.02; 95% CI 0.815-1.219, p <
0.001). Major vascular complications were significantly higher in the TF
group (OR 0.55, 95% CI 0.32-0.94, p = 0.029). Meta regression found no
influence of the covariates on the outcomes. Conclusion(s):
Subclavian access is both a safe and feasible alternative access route for
TAVI with lower risks of major vascular complications. This study supports
the use of subclavian access as a viable alternative in patient groups
where transfemoral TAVI is contraindicated. Copyright © 2020 The
Author(s)

<66>
Accession Number
2007735015
Title
Prognostic value of resting myocardial contrast echocardiography: A
meta-analysis.
Source
Echo Research and Practice. 7 (3) (pp 19-38), 2020. Date of Publication:
2020.
Author
Qian L.; Xie F.; Xu D.; Porter T.R.
Institution
(Qian, Xu) Department of Geriatrics, First Affiliated Hospital, Nanjing
Medical University, Nanjing, China
(Xie, Porter) Department of Internal Medicine, Section of Cardiology,
University of Nebraska Medical Center, Omaha, NE, United States
Publisher
BioScientifica Ltd.
Abstract
Background: Resting myocardial perfusion (MP) and wall motion (WM) imaging
during real-time myocardial contrast echocardiography (MCE) improves the
detection of coronary artery disease (CAD). However, its prognostic role
in different clinical settings (emergency department and outpatient
setting) remains unclear. Method(s): A systematic search in PubMed
and Embase databases, and the Cochrane library, was conducted to evaluate
the role of resting MP and WM in predicting major adverse cardiac events
(MACE), including death, nonfatal myocardial infarction (NFMI) and urgent
revascularization in patients presenting to either outpatient clinics or
emergency departments with suspected symptomatic CAD. Summary receiver
operating characteristic (SROC) curves, sensitivity and specificity plots
were applied to assess diagnostic performance using RevMan 5.3.
 Result(s): Seven studies met criteria, including 3668 patients (six
with follow up ranging from 2 days to 2.6 years). The Relative Risk (RR)
for predicting MACE in patients with both abnormal resting MP and WM was
6.1 (95% CI, 5.1-7.2) and 14.3 (95% CI, 10.3-19.8) for death/NFMI, when
compared to normal resting MP and WM patients. Having both abnormal
resting MP and WM was also more predictive of MACE (RR, 1.7; 95% CI
1.5-1.9) and death/NFMI (RR, 2.2; 95% CI, 1.8-2.7) when compared to
abnormal WM with normal resting MP. Conclusion(s): In this
meta-analysis of both ED and outpatient clinic presentations for suspected
CAD, having both a resting regional MP and WM abnormality identifies the
highest risk patient for adverse events. Copyright © 2020 The
authors

<67>
Accession Number
2007560748
Title
Impact of cognitive behavioral therapy on depression symptoms after
transcatheter aortic valve replacement: A randomized controlled trial.
Source
International Journal of Cardiology. 321 (pp 61-68), 2020. Date of
Publication: 15 Dec 2020.
Author
Edwards K.S.; Chow E.K.H.; Dao C.; Hossepian D.; Johnson A.G.; Desai M.;
Shah S.; Lee A.; Yeung A.C.; Fischbein M.; Fearon W.F.
Institution
(Edwards, Dao, Shah, Yeung, Fearon) Department of Medicine, Stanford
University, United States
(Chow, Desai) Quantitative Sciences Unit, Stanford University, United
States
(Hossepian, Johnson) PGSP-Stanford Psy.D. Consortium, Palo Alto
University, United States
(Lee, Fischbein) Department of Cardiothoracic Surgery, Stanford
University, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Depression is a significant concern after cardiac surgery and
has not been studied in patients undergoing transcatheter aortic valve
replacement (TAVR). We sought to examine the prevalence of pre-procedure
depression and anxiety symptoms and explore whether brief bedside
cognitive behavioral therapy (CBT) could prevent post-TAVR psychological
distress. Method(s): We prospectively recruited consecutive TAVR
patients and randomized them to receive brief CBT or treatment as usual
(TAU) during their hospitalization. Multi-level regression techniques were
used to evaluate changes by treatment arm in depression, anxiety, and
quality of life from baseline to 1 month post-TAVR adjusted for sex, race,
DM, CHF, MMSE, and STS score. Result(s): One hundred and forty six
participants were randomized. The mean age was 82 years, and 43% were
female. Self-reported depression and anxiety scores meeting cutoffs for
clinical level distress were 24.6% and 23.2% respectively. Both TAU and
CBT groups had comparable improvements in depressive symptoms at 1-month
(31% reduction for TAU and 35% reduction for CBT, p =.83). Similarly, both
TAU and CBT groups had comparable improvements in anxiety symptoms at
1-month (8% reduction for TAU and 11% reduction for CBT, p =.1). Quality
of life scores also improved and were not significantly different between
the two groups. Conclusion(s): Pre-procedure depression and anxiety
may be common among patients undergoing TAVR. However, TAVR patients show
spontaneous improvement in depression and anxiety scores at 1-month follow
up, regardless of brief CBT. Further research is needed to determine
whether more tailored CBT interventions may improve psychological and
medical outcomes. Copyright © 2020 Elsevier B.V.

<68>
Accession Number
2005122865
Title
Alcohol septal ablation versus septal myectomy treatment of obstructive
hypertrophic cardiomyopathy: A systematic review and meta-analysis.
Source
Journal of Clinical Medicine. 9 (10) (pp 1-12), 2020. Article Number:
3062. Date of Publication: October 2020.
Author
Bytyci I.; Nistri S.; Morner S.; Henein M.Y.
Institution
(Bytyci, Morner, Henein) Institute of Public Health and Clinical Medicine,
Umea University, Umea 90187, Sweden
(Bytyci) Universi College, Bardhosh, Prishtina, Kosovo 10000
(Bytyci) Clinic of Cardiology, University Clinical Centre of Kosovo,
Prishtina, Kosovo 10000
(Nistri) Cardiology Service, CMSR-Veneto Medica, Altavilla Vicentina
204-36077, Italy
(Henein) Molecular and Clinic Research Institute, St George University,
Brunel University, London SW17 0QT, United Kingdom
(Henein) Institute of Fluid Dynamics, Brunel University, London UB8 3PH,
United Kingdom
Publisher
MDPI AG
Abstract
Surgical myectomy (SM) and alcohol septal ablation (ASA) are two invasive
therapies for symptomatic patients with hypertrophic obstructive
cardiomyopathy (HOCM), despite medical therapy. This meta-analysis aims to
compare the efficacy of the two procedures. We searched all electronic
databases until February 2020 for clinical trials and cohorts comparing
clinical outcomes of ASA and SM treatment of patients with HOCM. The
primary endpoint was all-cause mortality, cardiovascular (CV) mortality,
sudden cardiac death (SCD), re-intervention, and complications. Secondary
endpoints included relief of clinical symptoms and drop of left
ventricular outflow tract (LVOT) gradient. Twenty studies (4547 patients;
2 CTs and 18 cohorts) comparing ASA vs. SM with a mean follow-up of 47 +/-
28.7 months were included. Long term (8.72 vs. 7.84%, p = 0.42) and short
term (1.12 vs. 1.27%, p = 0.93) all-cause mortality, CV mortality (2.48
vs. 3.66%, p = 0.26), SCD (1.78 vs. 0.76%, p = 0.20) and stroke (0.36 vs.
1.01%, p = 0.64) were not different between procedures. ASA was associated
with lower peri-procedural complications (5.57 vs. 10.5%, p = 0.04) but
higher rate of re-interventions (10.1 vs. 0.27%; p < 0.001) and pacemaker
dependency (12.4 vs. 4.31%, p = 0.0004) compared to SM. ASA resulted in
less reduction in LVOT gradient (-47.8 vs. -58.4 mmHg, p = 0.01) and less
improvement of clinical symptoms compared to SM (New York Heart
Association (NYHA) class III/IV, 82.4 vs. 94.5%, p <; 0.001, angina 53.2
vs. 84.2%, p = 0.02). Thus, ASA and SM treatment of HOCM carry a similar
risk of mortality. Peri-procedural complications are less in alcohol
ablation but re-intervention and pacemaker implantations are more common.
These results might impact the procedure choice in individual patients,
for the best clinical outcome. Copyright © 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<69>
Accession Number
2005013527
Title
Impact of recent heart failure hospitalization on clinical outcomes in
patients with severe aortic stenosis undergoing transcatheter aortic valve
replacement: an analysis from the PARTNER 2 trial and registries.
Source
European Journal of Heart Failure. 22 (10) (pp 1866-1874), 2020. Date of
Publication: 01 Oct 2020.
Author
Chen S.; Redfors B.; Crowley A.; Ben-Yehuda O.; Summers M.; Hahn R.T.;
Jaber W.A.; Pibarot P.; Alu M.C.; Chau K.H.; Kapadia S.; Nazif T.; Vahl
T.P.; Thourani V.; Kodali S.; Leon M.
Institution
(Chen, Redfors, Crowley, Ben-Yehuda, Hahn, Alu, Leon) Cardiovascular
Research Foundation, New York, NY, United States
(Chen, Redfors, Hahn, Alu, Chau, Nazif, Vahl, Kodali, Leon) Columbia
University Medical Center/New York-Presbyterian Hospital, New York, NY,
United States
(Summers, Jaber, Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Pibarot) Universite Laval, Quebec, Canada
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Heart failure (HF) hospitalization prior to transcatheter aortic
valve replacement (TAVR) is associated with increased post-procedural
mortality. We sought to assess the association between recent (<=6 months)
HF hospitalization and long-term adverse outcomes in patients with
symptomatic, severe aortic stenosis, undergoing TAVR in the PARTNER 2
trial and registries. Methods and Results: Intermediate to high or
even prohibitive risk patients who underwent TAVR in the PARTNER 2 trial
and registries were included in the analysis. Clinical outcomes at 30 days
and 2 years were compared between patients according to whether they were
recently hospitalized for HF, using Kaplan-Meier event rates and
study-stratified multivariable Cox proportional hazards regression models.
A sensitivity analysis was conducted using propensity score matching. Of
3988 patients (99.8%) with available information on recent HF
hospitalization, 1622 patients (40.7%) were hospitalized for HF symptoms
during the 6 months prior to TAVR. After multivariable adjustments, recent
HF hospitalization was associated with increased all-cause mortality at 30
days [adjusted hazard ratio (HR) 1.63, 95% confidence interval (CI)
1.07-2.48, P = 0.02] and 2 years (adjusted HR 1.30, 95% CI 1.13-1.49, P =
0.0003), which was driven by increased cardiovascular mortality. Infective
endocarditis rate at 2 years was also higher in patients with recent HF
hospitalization (adjusted HR 2.35, 95% CI 1.38-4.01, P = 0.002). These
results remained consistent when propensity score matching was used.
 Conclusion(s): In a large cohort of patients with severe symptomatic
aortic stenosis from the PARTNER 2 trial and registries, all-cause and
cardiovascular mortality as well as infective endocarditis rates at 2
years were higher in patients with recent HF
hospitalization. Copyright © 2020 European Society of Cardiology

<70>
Accession Number
632967836
Title
MRI for measuring therapy efficiency after revascularisation in ST-segment
elevation myocardial infarction: A systematic review and meta-regression
analysis.
Source
BMJ Open. 10 (9) (no pagination), 2020. Article Number: 034359. Date of
Publication: 28 Sep 2020.
Author
Kendziora B.; Stier H.; Schlattmann P.; Dewey M.
Institution
(Kendziora, Stier, Dewey) Institute of Radiology,
Charite-Universitatsmedizin Berlin, Humboldt-Universitat and Freie
Universitat, Berlin, Germany
(Schlattmann) Institute of Medical Statistics, Computer Sciences and
Documentation, Universitatsklinikum Jena, Friedrich-Schiller-Universitat,
Jena, Germany
Publisher
BMJ Publishing Group
Abstract
Objective To summarise existing data on the relation between the time from
symptom onset until revascularisation (time to reperfusion) and the
myocardial salvage index (MSI) calculated as proportion of non-necrotic
myocardium inside oedematous myocardium on T2-weighted and T1-weighted
late gadolinium enhancement MRI after ST-segment elevation myocardial
infarction (STEMI). Methods Studies including patients with revascularised
STEMI and stating both the time to reperfusion and the MSI measured by
T2-weighted and T1-weighted late gadolinium enhancement MRI were searched
in MEDLINE, EMBASE and ISI Web of Science until 16 May 2020. A mixed
effects model was used to evaluate the relation between the time to
reperfusion and the MSI. The gender distribution and mean age in included
patient groups, the timing of MRI, used MRI sequences and image
interpretation methodology were included in the mixed effects model to
explore between-study heterogeneity. Results We included 38 studies with
5106 patients. The pooled MSI was 42.6% (95% CI: 38.1 to 47.1). The pooled
time to reperfusion was 3.8 hours (95% CI: 3.5 to 4.0). Every hour of
delay in reperfusion was associated with an absolute decrease of 13.1%
(95% CI: 11.5 to 14.6; p<0.001) in the MSI. Between-study heterogeneity
was considerable (sigma 2 =167.8). Differences in the gender distribution,
timing of MRI and image interpretation among studies explained 45.2% of
the between-study heterogeneity. Conclusions The MSI on T2-weighted and
T1-weighted late gadolinium enhancement MRI correlates inversely with the
time to reperfusion, which indicates that cardioprotection achieved by
minimising the time to reperfusion leads to a higher MSI. The analysis
revealed considerable heterogeneity between studies. The heterogeneity
could partly be explained by differences in the gender distribution,
timing and interpretation of MRI suggesting that the MRI-assessed MSI is
not only influenced by cardioprotective therapy but also by patient
characteristics and MRI parameters. Copyright © 2020 American
Institute of Physics Inc.. All rights reserved.

<71>
Accession Number
632731502
Title
Systematic review and meta-analysis of outcomes of anatomic repair in
congenitally corrected transposition of great arteries.
Source
World Journal of Cardiology. 12 (8) (pp 427-436), 2020. Date of
Publication: August 2020.
Author
Chatterjee A.; Miller N.J.; Cribbs M.G.; Mukherjee A.; Law M.A.
Institution
(Chatterjee, Miller, Cribbs) Division of Cardiovascular Diseases,
University of Alabama at Birmingham, Birmingham, AL 35294, United States
(Cribbs, Law) Department of Pediatric Cardiology, University of Alabama at
Birmingham, Birmingham, AL 35294, United States
(Mukherjee) Department of Epidemiology, University of Alabama at
Birmingham School of Public health, Birmingham, AL 35233, United States
(Chatterjee) Division of Cardiovascular Disease, University of Alabama at
Birmingham, 510 20th St S FOT 920, Birmingham, AL 35294, United States
Publisher
Baishideng Publishing Group Co
Abstract
BACKGROUND Treatment of congenitally corrected transposition of great
arteries (cc-TGA) with anatomic repair strategy has been considered
superior due to restoration of the morphologic left ventricle in the
systemic circulation. However, data on long term outcomes are limited to
single center reports and include small sample sizes. AIM To perform a
systematic review and meta-analysis for observational studies reporting
outcomes on anatomic repair for cc-TGA. METHODS MEDLINE and Scopus
databases were queried using predefined criteria for reports published
till December 31, 2017. Studies reporting anatomic repair of minimum 5
cc-TGA patients with at least a 2 year follow up were included.
Meta-analysis was performed using Comprehensive meta-analysis v3.0
software. RESULTS Eight hundred and ninety-five patients underwent
anatomic repair with a pooled follow-up of 5457.2 patient-years (PY).
Pooled estimate for operative mortality was 8.3% [95% confidence interval
(CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical
circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed
post-operative atrioventricular block requiring a pacemaker. Patients
surviving initial surgery had a transplant free survival of 92.5% (CI:
89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY;
CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New
York Heart Association (NYHA) functional class I or II after 100 PY follow
up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8).
CONCLUSION Operative mortality with anatomic repair strategy for cc-TGA is
high. Despite that, transplant free survival after anatomic repair for
cc-TGA patients is highly favorable. Majority of patients maintain NYHA
I/II functional class. However, monitoring for burden of re-interventions
specific for operation type is very essential. Copyright © 2020
Baishideng Publishing Group Co. All rights reserved.

<72>
Accession Number
633364533
Title
Robot-assisted coronary artery bypass surgery: a systematic review and
meta-analysis of comparative studies.
Source
Canadian journal of surgery. Journal canadien de chirurgie. 63 (6) (pp
E491-E508), 2020. Date of Publication: 01 Nov 2020.
Author
Hammal F.; Nagase F.; Menon D.; Ali I.; Nagendran J.; Stafinski T.
Institution
(Hammal, Nagase, Menon, Ali, Nagendran, Stafinski) From the Health
Technology & Policy Unit, School of Public Health, University of Alberta,
Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac
Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of
Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB
(Ali); and the Division of Cardiac Surgery, Department of Surgery,
Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB
(Nagendran)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Robot-assisted coronary bypass (RCAB) surgery has been
proposed as an alternative to conventional coronary artery bypass grafting
(C-CABG) for managing coronary heart disease, but the evidence on its
performance compared to other existing treatments is unclear. The aim of
this study was to assess, through a systematic review of comparative
studies, the safety and clinical effectiveness of RCAB compared to C-CABG
and other minimally invasive approaches for the treatment of coronary
heart disease. METHOD(S): We conducted a systematic review of primary
studies in the English-language literature comparing RCAB to existing
treatment options (C-CABG, minimally invasive direct coronary artery
bypass [MIDCAB] and port-access coronary artery bypass [PA-CAB]) following
Cochrane Collaboration guidelines. Meta-analyses were performed where
appropriate. RESULT(S): We reviewed 13 studies: 11 primary studies of
RCAB (v. C-CABG in 7, v. MIDCAB in 3 and v. PA-CAB in 1) and 2 multicentre
database studies (RCAB v. non-RCAB). The overall quality of the evidence
was low. Most studies showed no significant benefit of RCAB over other
treatments in a majority of outcome variables. Meta-analyses showed that
RCAB had lower rates of pneumonia or wound infection than C-CABG, and
shorter intensive care unit length of stay than C-CABG or MIDCAB.
Individual studies showed that RCAB had some better outcomes than C-CABG
(ventilation time, transfusion, postoperative pain, hospital length of
stay) or MIDCAB (transfusion, postoperative pain, time to return to normal
activities, physical functioning and hospital length of stay). The review
of the database studies showed that RCAB was statistically superior to
non-RCAB approaches in postoperative pain, renal failure, transfusion,
reoperation for bleeding, stroke and hospital length of stay; however, the
difference between the 2 groups in several of these outcomes was small.
 CONCLUSION(S): Although the findings from this review of comparative
studies of RCAB appear promising and suggest that RCAB may offer some
benefits to patients, in the absence of randomized controlled trials,
these results should be interpreted cautiously.

<73>
Accession Number
2008476891
Title
Clinical outcomes of the self-expandable Evolut R valve versus the
balloon-expandable SAPIEN 3 valve in transcatheter aortic valve
implantation; a meta-analysis and systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Al-abcha A.; Saleh Y.; Charles L.; Prasad R.; Baloch Z.Q.; Hasan M.A.;
Abela G.S.
Institution
(Al-abcha, Charles, Prasad) Department of Internal Medicine, Michigan
State University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist Hospital, Houston, TX,
United States
(Baloch, Abela) Department of Internal Medicine, Division of Cardiology,
Michigan State University, East Lansing, MI, United States
(Hasan) Department of Cardiology, Ochsner Clinic, New Orleans, LA, United
States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is now indicated
in patients with symptomatic aortic stenosis and low, moderate, and high
surgical risk. There are multiple types of valves available in TAVR.
SAPIEN 3, and Evolut R are two of the most commonly used valves.
 Method(s): We conducted a systematic review and meta-analysis of all
studies that compared SAPIEN 3 vs Evolut R in patients undergoing TAVR.
The primary endpoint of this meta-analysis was 30-day mortality. Secondary
outcomes included major of life-threatening bleeding, risk of stroke, need
of permanent pacemaker implantation, and risk of moderate to severe
paravalvular regurgitation (PVR). Result(s): We included a total of 9
studies. One study was a randomized clinical trial, five were prospective
observational studies and three were retrospective. 30-day mortality rate
was similar between SAPIEN 3 and Evolut R (odds ratio (OR) 1.19; 95%
confidence interval (CI) 0.72 to 1.93; p = 0.47). The risk of major or
life-threatening bleeding (OR of 0.83, 95% CI 0.50 to 1.39; p = 0.48), and
the risk of stroke (OR of 0.82, 95% CI 0.38 to 1.78; p = 0.62) were also
similar between the two types of valves. Compared to SAPIEN 3, Evolut R
was associated with statistically significant risk of permanent pacemaker
implantation (OR of 1.40, 95% CI 1.15 to 1.70; p = 0.0007), and moderate
to severe PVR (OR of 2.56, 95% CI 1.14 to 5.74; p = 0.02).
 Conclusion(s): At 30 day follow up, both Evolut R and SAPIEN 3 shared
similar risks of 30-day mortality, major or life-threatening bleeding, and
stroke; however greater odds of pacemaker placement implantation and
moderate to severe PVR were associated with Evolut R. Copyright ©
2020 Elsevier Inc.

<74>
Accession Number
2007174470
Title
Safety and Effectiveness of Del Nido Cardioplegia in Comparison to
Blood-Based St. Thomas Cardioplegia in Congenital Heart Surgeries: A
Prospective Randomized Controlled Study.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (6) (pp
720-726), 2020. Date of Publication: November 2020.
Author
Haranal M.; Chin H.C.; Sivalingam S.; Raja N.; Mohammad Shaffie M.S.;
Namasiwayam T.K.; Fadleen M.; Fakhri N.
Institution
(Haranal, Chin, Sivalingam) Department of Pediatric Cardiac Surgery,
National Heart Institute, Kuala Lumpur, Malaysia
(Raja, Mohammad Shaffie, Namasiwayam) Department of Cardiac Anesthesia,
National Heart Institute, Kuala Lumpur, Malaysia
(Fadleen) Department of Perfusion Sciences, National Heart Institute,
Kuala Lumpur, Malaysia
(Fakhri) Department of Clinical Research, National Heart Institute, Kuala
Lumpur, Malaysia
Publisher
SAGE Publications Inc. ( United States)
Abstract
Background: To compare the safety and effectiveness of del Nido
cardioplegia with blood-based St Thomas Hospital (BSTH) cardioplegia in
myocardial protection in congenital heart surgery. Method(s): It is a
prospective, open-labeled, randomized controlled study conducted at
National Heart Institute, Kuala Lumpur from July 2018 to July 2019. All
patients with simple and complex congenital heart diseases (CHD) with good
left ventricular function (left ventricular ejection fraction [LVEF] >50%)
were included while those with LVEF <50% were excluded. A total of 100
patients were randomized into two groups of 50 each receiving either del
Nido or BSTH cardioplegia. Primary end points were the spontaneous return
of activity following aortic cross-clamp release and ventricular function
between two groups. Secondary end point was myocardial injury as assessed
by troponin T levels. Result(s): Cardiopulmonary bypass and aortic
cross-clamp time, return of spontaneous cardiac activity following the
aortic cross-clamp release, the duration of mechanical ventilation, and
intensive care unit stay were comparable between two groups. Statistically
significant difference was seen in the amount and number of cardioplegia
doses delivered (P <.001). The hemodilution was significantly less in the
del Nido complex CHD group compared to BSTH cardioplegia (P =.001) but no
difference in blood usage (P =.36). The myocardial injury was lesser
(lower troponin T release) with del Nido compared to BSTH cardioplegia (P
=.6). Conclusion(s): Our study showed that both del Nido and BSTH
cardioplegia are comparable in terms of myocardial protection. However,
single, less frequent, and lesser volume of del Nido cardioplegia makes it
more suitable for complex repair. Copyright © The Author(s) 2020.

<75>
Accession Number
2007166946
Title
Aortic valve replacement plus revascularization: The battle of surgical
versus transcatheter approach still rages.
Source
Catheterization and Cardiovascular Interventions. 96 (5) (pp 1126-1127),
2020. Date of Publication: 01 Nov 2020.
Author
Tarantini G.; Fraccaro C.
Institution
(Tarantini, Fraccaro) Department of Cardiac, Thoracic, Vascular Science
and Public Health, University of Padova, Padova, Italy
Publisher
John Wiley and Sons Inc (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany)
Abstract
The current guidelines for primary aortic valve disease suggest, with
different class of recommendation, concomitant coronary artery
revascularization in all candidates to aortic valve replacement with
angiographic evidence of significant coronary artery diameter stenosis
(>=70%, >=50% for left main stenosis) both for surgical or transcatheter
approach. Initial (non-patient-level) pooled data analyses suggest that a
percutaneous transcatheter approach confers similar outcomes compared to a
surgical approach in patients with severe AS and CAD. Further scientific
evidences from RCTs are warranted to clarify the prognostic impact of CAD
on TAVR candidates and to identify the most appropriate revascularization
strategy. Copyright © 2020 Wiley Periodicals LLC.

<76>
Accession Number
633332716
Title
Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): Study protocol
for a multicentre randomised, blind, placebo-controlled trial.
Source
BMJ Open. 10 (11) (no pagination), 2020. Article Number: e040914. Date of
Publication: 03 Nov 2020.
Author
Ishii K.; Yokoyama Y.; Yonekawa Y.; Ebata T.
Institution
(Ishii, Yokoyama, Yonekawa, Ebata) Surgical Oncology, Nagoya University
Graduate School of Medicine, Nagoya, Japan
Publisher
BMJ Publishing Group
Abstract
Introduction Pancreaticoduodenectomy (PD) is a major gastroenterological
surgery that results in a substantial amount of blood loss. Several
studies have demonstrated that major blood loss during PD is associated
with both short-term and long-term poor outcomes. Administration of
perioperative tranexamic acid (TXA) has been reported to reduce
intraoperative blood loss in various surgeries, including cardiovascular
surgery and orthopaedic surgery. Nevertheless, the effect of perioperative
TXA use in patients undergoing PD has not been investigated. This study
aims to investigate the effect of TXA on blood loss during PD. Methods and
analysis A multicentre (six hospitals), randomised, blind
(patient-blinded, surgeon-blinded, anaesthesiologist-blinded,
monitor-blinded), placebo-controlled trial of TXA during PD was started in
September 2019. Patients undergoing PD for biliary, duodenal or pancreatic
diseases are randomly assigned to the TXA or placebo group. The
stratification factors are the institutions and preoperative clinical
diagnosis. Before skin incision, the participants in TXA group are
administrated 1 g TXA as a loading infusion followed by a maintenance
infusion of 125 mg/hour TXA until the end of surgery or 8 hours from the
incision. Participants in the placebo group are administrated the same
volume of saline that is indistinguishable from the TXA. The primary
outcome is blood loss during PD. The secondary outcomes are intraoperative
and postoperative (up to day 2) blood transfusions, operation time,
anaesthesia time, postoperative laboratory variables, length of hospital
stay, in-hospital and 90-day mortality and postoperative complications
occurring within 28 days of surgery or requiring readmission. To date, 115
patients of a planned 220 have been enrolled in the study. Ethics and
dissemination This protocol was approved by the Nagoya University Clinical
Research Review Board and is registered with Japan Registry of Clinical
Trials on 15 August 2019. The results of this trial will be disseminated
through peer-reviewed journals. Trial registration number
jRCTs041190062. Copyright © 2020 American Institute of Physics
Inc.. All rights reserved.

<77>
Accession Number
2005425430
Title
Transcatheter aortic valve implantation in patients with severe aortic
valve stenosis at low surgical risk: A health technology assessment.
Source
Ontario Health Technology Assessment Series. 20 (14) (pp 1-148), 2020.
Date of Publication: 2020.
Publisher
Health Quality Ontario
Abstract
Background Surgical aortic valve replacement (SAVR) is the conventional
treatment for patients with severe aortic valve stenosis at low surgical
risk. Transcatheter aortic valve implantation (TAVI) is a less invasive
procedure. We conducted a health technology assessment (HTA) of TAVI for
patients with severe aortic valve stenosis at low surgical risk, which
included an evaluation of effectiveness, safety, cost-effectiveness, the
budget impact of publicly funding TAVI, and patient preferences and
values. Methods We used the 2016 Health Quality Ontario HTA on
TAVI2 as a source of eligible studies and performed a
systematic literature search for studies published since the 2016 review.
Eligible primary studies identified both through the 2016 HTA and through
our complementary literature search were used in a de novo analysis. We
assessed the risk of bias of each included study using the Cochrane
risk-of-bias tool and the quality of the body of evidence according to the
Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
Working Group criteria. An applicable, previously conducted
cost-effectiveness analysis was available, so we did not conduct a primary
economic evaluation. We analyzed the budget impact of publicly funding
TAVI in people at low surgical risk in Ontario. We also performed a
literature survey of the quantitative evidence of preferences and values
of patients for TAVI. The Canadian Agency for Drugs and Technologies in
Health (CADTH) conducted a review to evaluate the qualitative literature
on patient and provider preferences and values for TAVI. To contextualize
the potential value of TAVI, we spoke with people with severe aortic valve
stenosis. Results We identified two randomized controlled trials that
compared TAVI (transfemoral route) and SAVR in patients with severe aortic
valve stenosis at low surgical risk. Both studies have an ongoing
follow-up of 10 years, but 1-year and limited 2-year follow-up results are
currently available. At 30 days, compared with SAVR, TAVI had a slightly
lower risk of mortality (risk difference -0.8%, 95% confidence interval
[CI] -1.5% to -0.1%, GRADE: Moderate) and disabling stroke (risk
difference -0.8%, 95% CI -1.8% to -0.2%, GRADE: Moderate), and resulted in
more patients with symptom improvement (risk difference 11.8%, 95% CI 8.2%
to 15.5%, GRADE: High) and in a greater improvement in quality of life
(GRADE: High). At 1 year, TAVI and SAVR were similar with regard to
mortality (GRADE: Low), although TAVI may result in a slightly lower risk
of disabling stroke (GRADE: Moderate). Both TAVI and SAVR resulted in a
similar improvement in symptoms and quality of life at 1 year (GRADE:
Moderate). Compared with SAVR, TAVI had a higher risk of some
complications and a lower risk of others. Device-related costs for TAVI
(about $25,000) are higher than for SAVR (about $6,000). A published
cost-effectiveness analysis conducted from an Ontario Ministry of Health
perspective showed TAVI to be more expensive and, on average, slightly
more effective (i.e., it was associated with more quality-adjusted
life-years [QALYs]) than SAVR. Compared with SAVR, the incremental
cost-effectiveness ratios (ICERs) were $27,196 per QALY and $59,641 per
QALY for balloon-expandable and self-expanding TAVI, respectively.
Balloon-expandable TAVI was less costly (by $2,330 on average) and
slightly more effective (by 0.02 QALY on average) than self-expanding
TAVI. Among the three interventions, balloon-expandable TAVI had the
highest probability of being cost-effective. It was the preferred option
in 53% and 59% of model iterations, at willingness-to-pay values of
$50,000 and $100,000 per QALY, respectively. Self-expanding TAVI was
preferred in less than 10% of iterations. The budget impact of publicly
funding TAVI in Ontario is estimated to be an additional $5 to $8 million
each year for the next 5 years. The budget impact could be significantly
reduced with reductions in the device price. We did not find any
quantitative or qualitative evidence on patient preferences and values
specific to the low-risk surgical group. Among a mixed or generally
high-risk and population, people typically preferred the less invasive
nature and the faster recovery time of TAVI compared with SAVR, and people
were satisfied with the TAVI procedure. Patients with severe aortic valve
stenosis at low surgical risk and their caregivers perceived that TAVI
minimized pain and recovery time. Most patients who had TAVI returned to
their usual activities more quickly than they would have if they had had
SAVR. Our direct patient and caregiver consultations indicated a
preference for TAVI over SAVR. Conclusions Both TAVI (transfemoral route)
and SAVR resulted in improved patient symptoms and quality of life during
the 1 year of follow-up. The TAVI procedure is less invasive and resulted
in greater symptom improvement and quality of life than SAVR 30 days after
surgery. The TAVI procedure also resulted in a small improvement in
mortality and disabling stroke at 30 days. At 1 year, TAVI and SAVR were
similar with regard to mortality, although TAVI may result in a slightly
lower risk of disabling stroke. According to the study authors, longer
follow-up is needed to better understand how long TAVI valves last and to
draw definitive conclusions on the long-term outcomes of TAVI compared
with SAVR beyond 1 year. The TAVI procedure might be cost-effective for
patients at low surgical risk; however, there is some uncertainty in this
result. We estimated that the additional cost to provide public funding
for TAVI in people with severe aortic valve stenosis at low surgical risk
would range from about $5 million to $8 million over the next 5 years.
Among a mixed or generally high-risk population, people typically
preferred the less invasive nature and the faster recovery time of TAVI
compared with SAVR. Copyright © Queen's Printer for Ontario,
2020.

<78>
Accession Number
2008509973
Title
Early use of hemoadsorption in patients after out-of hospital cardiac
arrest - A matched pair analysis.
Source
PLoS ONE. 15 (11 November) (no pagination), 2020. Article Number:
e0241709. Date of Publication: November 2020.
Author
Akin M.; Garcheva V.; Sieweke J.-T.; Flierl U.; Daum H.C.; Bauersachs J.;
Schafer A.
Institution
(Akin, Garcheva, Sieweke, Flierl, Daum, Bauersachs, Schafer) Department of
Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School,
Hannover, Germany
Publisher
Public Library of Science
Abstract
Background Pro- and anti-inflammatory mediators are released during and
after cardiac arrest, which may be unfavourable. Small case-series and
observational studies suggested that unselective hemoadsorption may reduce
inadequately high cytokine levels during sepsis or cardiac surgery. We
aimed to assess the effect of cytokine adsorbtion on mortality in patients
following out-of-hospital cardiac arrest by comparing a patient cohort
with hemoadsorption after resuscitation for out-of-hospital cardiac arrest
to a control cohort without adsorption within the HAnnover COling REgistry
(HACORE). Methods We adopted an early routine use of hemoadsorption in
patients after out-of-hospital cardiac arrest with increased vasopressor
need and performed a 1:2 match according to age, gender, time to return of
spontaneous circulation, initial left-ventricular ejection fraction,
extracorporeal membrane-oxygenation or left-ventricular unloading by
Impella, need for renal replacement therapy, admission lactate, pH,
glomerular filtration rate to patients without an adsorber from HACORE.
The primary endpoint was 30-day mortality. Results Twenty-four patients
receiving hemoadsorption were matched to 48 patients without
hemoadsorption (mean age 62+/-13 years, 83% male). While there was no
significant difference in baseline parameters, 30-day mortality was higher
in patients treated with hemoadsorption than in the matched control group
(83% vs 65%, Log rank p = 0.011). Conclusions Routine use of
hemoadsorption did not reduce, but seems to be associated with higher
30-day mortality in patients after OHCA. Prior to routine adoption in
daily practice, hemoadsorption should be evaluated in properly sized
randomized controlled trials. Copyright: © 2020 Akin 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.

<79>
Accession Number
2008509903
Title
Systematic review of pre-clinical therapies for post-operative atrial
fibrillation.
Source
PLoS ONE. 15 (11 November) (no pagination), 2020. Article Number:
e0241643. Date of Publication: November 2020.
Author
Seo C.; Michie C.; Hibbert B.; Davis D.R.
Institution
(Seo, Michie, Hibbert, Davis) Department of Medicine, Division of
Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
Publisher
Public Library of Science
Abstract
Background Post-operative atrial fibrillation (POAF) is a frequent
cardiothoracic surgery complication that increases hospital stay,
mortality and costs. Despite decades of research, there has been no
systematic overview and meta-analysis of preclinical therapies for POAF in
animal models. Methods We performed a systematic search of MEDLINE and
EMBASE from their inception through September 2020 to determine the effect
of preclinical POAF therapies on primary efficacy outcomes using a
prospectively registered protocol (CRD42019155649). Bias was assessed
using the SYRCLE tool and CAMARADES checklist. Results Within the 26
studies that fulfilled our inclusion criteria, we identified 4 prevention
strategies including biological (n = 5), dietary (n = 2), substrate
modification (n = 2), and pharmacological (n = 17) interventions targeting
atrial substrate, cellular electrophysiology or inflammation. Only one
study altered more than 1 pathophysiological mechanism. 73% comprised
multiple doses of systemic therapies. Large animal models were used in 81%
of the studies. Preclinical therapies altogether attenuated atrial
fibrosis (SMD -2.09; 95% confidence interval [CI] -2.95 to -1.22; p <
0.00001; I2 = 47%), AF inducibility (RR 0.40; 95% CI 0.21 to
0.79; p = 0.008; I2 = 39%), and AF duration (SMD -2.19; 95% CI
-3.05 to -1.32; p < 0.00001; I2 = 50%). However, all the
criteria needed to evaluate the risk of bias was unclear for many outcomes
and only few interventions were independently validated by more than 1
research group. Conclusion Treatments with therapies targeting atrial
substrate, cellular electrophysiology or inflammation reduced POAF in
preclinical animal models compared to controls. Improving the quality of
outcome reporting, independently validating promising approaches and
targeting complimentary drivers of POAF are promising means to improve the
clinical translation of novel therapies for this highly prevalent and
clinically meaningful disease. Copyright © 2020 Seo 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.

<80>
Accession Number
2008509865
Title
Factors influencing the bias between blood gas analysis versus central
laboratory hemoglobin testing. A secondary analysis of a randomized
controlled trial.
Source
PLoS ONE. 15 (10 October) (no pagination), 2020. Article Number: e0240721.
Date of Publication: October 2020.
Author
Tanner L.; Lindau S.; Velten M.; Schlesinger T.; Wittmann M.; Kranke P.;
Berg K.; Piekarski F.; Fullenbach C.; Choorapoikayil S.; Hasenclever D.;
Zacharowski K.; Meybohm P.
Institution
(Tanner, Lindau, Berg, Piekarski, Fullenbach, Choorapoikayil, Hasenclever,
Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Goethe University Frankfurt,
Frankfurt am Main, Germany
(Velten, Wittmann) Department of Anesthesiology and Operative Intensive
Care Medicine, University Hospital Bonn, Rheinische
Friedrich-Wilhelms-University Bonn, Bonn, Germany
(Schlesinger, Kranke, Meybohm) Department of Anesthesiology, University
Hospital Wuerzburg, Wuerzburg, Germany
(Zacharowski) Institute for Medical Informatics, Statistics and
Epidemiology (IMISE), Medical Faculty of the University Leipzig, Leipzig,
Germany
Publisher
Public Library of Science
Abstract
Background Anemia is the most important complication during major surgery
and transfusion of red blood cells is the mainstay to compensate for life
threating blood loss. Therefore, accurate measurement of hemoglobin (Hb)
concentration should be provided in real-time. Blood Gas Analysis (BGA)
provides rapid point-of-care assessment using smaller sampling tubes
compared to central laboratory (CL) services. Objective This study aimed
to investigate the accuracy of BGA hemoglobin testing as compared to CL
services. Methods Data of the ongoing LIBERAL-Trial (Liberal transfusion
strategy to prevent mortality and anemia-associated ischemic events in
elderly non-cardiac surgical patients, LIBERAL) was used to assess the
bias for Hb level measured by BGA devices (ABL800 Flex
analyzer, GEM series and RapidPoint 500)
and CL as the reference method. For that, we analyzed pairs of Hb level
measured by CL and BGA within two hours. Furthermore, the impact of
various confounding factors including age, gender, BMI, smoker status,
transfusion of RBC, intraoperative hemodilution, and co-medication was
elucidated. In order to ensure adequate statistical analysis, only data of
participating centers providing more than 200 Hb pairs were used. Results
In total, three centers including 963 patients with 1,814 pairs of Hb
measurements were analyzed. Mean bias was comparable between ABL800 Flex
analyzer and GEM series: - 0.38 +/- 0.15 g/dl
whereas RapidPoint 500 showed a smaller bias (-0.09 g/dl) but
greater median absolute deviation (+/- 0.45 g/dl). In order to avoid
interference with different standard deviations caused by the different
analytic devices, we focused on two centers using the same BGA technique
(309 patients and 1,570 Hb pairs). A Bland-Altman analysis and LOWESS
curve showed that bias decreased with smaller Hb values in absolute
numbers but increased relatively. The smoker status showed the greatest
reduction in bias (0.1 g/dl, p<0.001) whereas BMI (0.07 g/dl, p = 0.0178),
RBC transfusion (0.06 g/dl, p<0.001), statins (0.04 g/dl, p<0.05) and beta
blocker (0.03 g/dl, p = 0.02) showed a slight effect on bias.
Intraoperative substitution of volume and other co-medications did not
influence the bias significantly. Conclusion Many interventions like
substitution of fluids, coagulating factors or RBC units rely on the
accuracy of laboratory measurement devices. Although BGA Hb testing showed
a consistently stable difference to CL, our data confirm that BGA devices
are associated with different bias. Therefore, we suggest that hospitals
assess their individual bias before implementing BGA as valid and stable
supplement to CL. However, based on the finding that bias decreased with
smaller Hb values, which in turn are used for transfusion decision, we
expect no unnecessary or delayed RBC transfusion, and no major impact on
the LIBERAL trial performance. Copyright © 2020 Tanner 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.

<81>
Accession Number
633365468
Title
Antiplatelet therapy and coronary artery bypass grafting: Protocol for a
systematic review and network meta-analysis.
Source
Medicine (United States). 98 (34) (no pagination), 2019. Article Number:
e16880. Date of Publication: 2019.
Author
Gupta S.; Belley-Cote E.P.; Rochwerg B.; Bozzo A.; Panchal P.; Pandey A.;
Mbuagbaw L.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Bozzo, Whitlock) Department of Surgery
(Gupta, Rochwerg, Bozzo, Whitlock) Department of Health Research Methods,
Evidence and Impact
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine
(Panchal, Pandey) Faculty of Health Sciences, McMaster University, Canada
(Belley-Cote, Mbuagbaw, Mehta, Schwalm, Whitlock) Population Health
Research Institute, David Braley Cardiac, Vascular and Stroke Research
Institute, 237 Barton St. E, Hamilton, ON L8L 2X2, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction:Saphenous vein graft (SVG) is the most common conduit used
for coronary artery bypass grafting (CABG) surgery. Unfortunately, SVG are
associated with poor long-term patency rates; a significant predictor of
re-operation rates and survival. As such, medical therapy to prevent SVG
narrowing or occlusion is of paramount importance. Aspirin (ASA)
monotherapy is the standard of care after CABG, to improve long-term major
adverse cardiovascular events (MACE) and graft patency. Benefits of dual
antiplatelet therapy (DAPT) have not been well established in all CABG
patients. We present a protocol for a network meta-analysis (NMA)
comparing the effects of various antiplatelet therapy regimens on SVG
patency, mortality, and bleeding among adult patients following CABG.
 Method(s):We will search CENTRAL, MEDLINE, EMBASE, CINAHL ACPJC, and
grey literature sources (AHA, ACC, ESC, and CCC conference proceedings,
ISRCTN Register, and WHO ICTRP) for randomized controlled trials (RCTs)
which fit our criteria. RCTs that evaluate different antiplatelet regimens
at least 3-months after CABG and have any of SVG patency, mortality, MACE,
and major bleeding as outcomes will be selected. We will perform title and
abstract screening, full-text screening, and data extraction independently
and in duplicate. Two independent reviewers will also assess risk of bias
(ROB) for each study, as well as evaluate quality of evidence using the
GRADE framework. We will use R to perform the NMA and use low-dose ASA as
reference within our network. We will report results as odds ratios with
confidence intervals for direct comparisons, and credible intervals for
indirect or mixed comparisons. We will use the surface under the
cumulative ranking curve (SUCRA) to estimate the ranking of interventions.
 Discussion(s):Given the limited direct comparison of various
antiplatelet regimens, a network approach is ideal to clarify the optimum
antiplatelet therapy after CABG. We hope that our NMA will be the largest
quantitative synthesis evaluating antiplatelet regimens among patients
requiring CABG. It should inform clinicians and guideline developers in
selecting the most effective and safest antiplatelet regimen.Systematic
Review registration: International Prospective Register for Systematic
Reviews (PROSPERO) - CRD42019127695. Copyright © 2019 the
Author(s).

<82>
Accession Number
633365729
Title
To transfuse or not transfuse: An intensive appraisal of red blood cell
transfusions in the ICU.
Source
Current Opinion in Hematology. 25 (6) (pp 468-472), 2018. Date of
Publication: 2018.
Author
Hayes M.M.; Uhl L.
Institution
(Hayes) Harvard Medical School, Beth Israel Deaconess Medical Center
Internal Medicine Residency, Carl J. Shapiro Institute for Education and
Research, Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical Intensive Care Unit, East Campus, ES 200, 330 Brookline Avenue,
Boston, MA 02215, United States
(Uhl) Harvard Medical School, Laboratory and Transfusion Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of reviewThis review is a critical appraisal of the current data
comparing restrictive vs. liberal transfusion strategies for patients who
are critically ill in ICUs. We focus on four subsets of critically ill
patients: pediatric patients, patients with gastrointestinal bleeds,
septic patients and patients undergoing cardiac surgery.Recent
findingsAlmost a decade after the TRICC trial, a randomized trial showing
the safety of a restrictive transfusion threshold in critically ill
patients, four large randomized controlled trials have shown that a
restrictive transfusion strategy is safe in pediatric critically ill
patients, patients with acute upper gastrointestinal bleeds, patients with
septic shock and patients undergoing cardiac surgery. A large multicenter
randomized trial is underway to determine the safety of a restrictive
strategy in myocardial infarction.SummaryA restrictive transfusion
threshold is recommended in nearly all critically ill patients. This is at
least noninferior to more liberal transfusion practice; in addition, a
restrictive threshold has shown improved outcomes in some patients and
decreased chances of adverse events in patients. Judicious use of red
cells improves patient outcome and protects the blood supply, a limited
resource. More data are needed to determine appropriate transfusion
threshold recommendations for patients with traumatic brain injury and
acute coronary syndrome. Copyright © 2018 Lippincott Williams and
Wilkins. All rights reserved.

<83>
Accession Number
633374433
Title
Risk Factors for Delirium and Cognitive Decline Following Coronary Artery
Bypass Grafting Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. (pp e017275), 2020. Date of
Publication: 07 Nov 2020.
Author
Greaves D.; Psaltis P.J.; Davis D.H.J.; Ross T.J.; Ghezzi E.S.; Lampit A.;
Smith A.E.; Keage H.A.D.
Institution
(Greaves, Ross, Ghezzi, Smith, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, Justice and Society Academic Unit University of
South Australia Adelaide Australia
(Psaltis) Vascular Research Centre Lifelong Health Theme South Australian
Health and Medical Research Institute Adelaide Australia
(Psaltis) Adelaide Medical School University of Adelaide Adelaide
Australia
(Psaltis) Department of Cardiology Royal Adelaide Hospital Central
Adelaide Local Health Network Adelaide Australia
(Davis) Medical Reasearch Council Unit for Lifelong Health and Ageing Unit
at UCL London United Kingdom
(Lampit) Academic Unit for Psychiatry of Old Age Department of Psychiatry
University of Melbourne Melbourne Australia
(Lampit) Department of Neurology Charite-Universitatsmedizin Berlin Berlin
Germany
(Smith) Alliance for Research in Exercise, Nutrition and Activity Allied
Health and Human Performance Academic Unit University of South Australia
Adelaide Australia
Publisher
NLM (Medline)
Abstract
Background Coronary artery bypass grafting (CABG) is known to improve
heart function and quality of life, while rates of surgery-related
mortality are low. However, delirium and cognitive decline are common
complications. We sought to identify preoperative, intraoperative, and
postoperative risk or protective factors associated with delirium and
cognitive decline (across time) in patients undergoing CABG. Methods and
Results We conducted a systematic search of Medline, PsycINFO, EMBASE, and
Cochrane (March 26, 2019) for peer-reviewed, English publications
reporting post-CABG delirium or cognitive decline data, for at least one
risk factor. Random-effects meta-analyses estimated pooled odds ratio for
categorical data and mean difference or standardized mean difference for
continuous data. Ninety-seven studies, comprising data from 60 479
patients who underwent CABG, were included. Moderate to large and
statistically significant risk factors for delirium were as follows: (1)
preoperative cognitive impairment, depression, stroke history, and higher
European System for Cardiac Operative Risk Evaluation (EuroSCORE) score,
(2) intraoperative increase in intubation time, and (3) postoperative
presence of arrythmia and increased days in the intensive care unit;
higher preoperative cognitive performance was protective for delirium.
Moderate to large and statistically significant risk factors for acute
cognitive decline were as follows: (1) preoperative depression and older
age, (2) intraoperative increase in intubation time, and (3) postoperative
presence of delirium and increased days in the intensive care unit.
Presence of depression preoperatively was a moderate risk factor for
midterm (1-6 months) post-CABG cognitive decline. Conclusions This
meta-analysis identified several key risk factors for delirium and
cognitive decline following CABG, most of which are nonmodifiable. Future
research should target preoperative risk factors, such as depression or
cognitive impairment, which are potentially modifiable. Registration URL:
https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020149276.

<84>
Accession Number
633374165
Title
Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese
Patients: a Systematic Review and Meta-Analysis.
Source
Cardiology in review. (no pagination), 2020. Date of Publication: 06 Nov
2020.
Author
Lee Y.; Anvari S.; Sam Soon M.; Tian C.; Wong J.A.; Hong D.; Anvari M.;
Doumouras A.G.
Institution
(Lee, Sam Soon, Tian, Hong, Anvari, Doumouras) Division of General
Surgery, McMaster University, Hamilton, Ontario, Canada
(Anvari) Department of Medicine, McMaster University, Hamilton, Ontario,
Canada
(Wong) Population Health Research Institute, McMaster University,
Hamilton, Ontario, Canada
Publisher
NLM (Medline)
Abstract
Class 2 obesity or greater (body mass index [BMI] >35kg/m) is a relative
contraindication for heart transplant due to its associated perioperative
risks and mortality. Whether bariatric surgery can act as a potential
bridging procedure to heart transplantation is unknown. The aim of this
systematic review and meta-analysis is to investigate the role of
bariatric surgery on improving transplant candidacy in patients with
end-stage heart failure (ESHF). MEDLINE, EMBASE, CENTRAL, and PubMed
databases were searched up to September 2019 for studies that performed
bariatric surgery on patients with severe obesity and ESHF. Outcomes of
interest included incidence of patients listed for heart transplantation
after bariatric surgery, proportion of patients that successfully received
transplant, the change in BMI after bariatric surgery, and 30-day
complications. Pooled estimates were calculated using a random effects
meta-analysis of proportions. Eleven studies with 98 patients were
included. Mean preoperative BMI was 44.9 (2.1) kg/m and BMI after surgery
was 33.2 (2.3) kg/m with an absolute BMI reduction of 26.1%. After
bariatric surgery, 71% (95% confidence interval [CI], 55%-86%) of patients
with ESHF were listed for transplantation. The mean time from bariatric
surgery to receiving a heart transplant was 14.9 (4.0) months. Of the
listed patients, 57% (95% CI, 39-74%) successfully received heart
transplant. The rate of 30-day mortality after bariatric surgery was 0%,
and the 30-day major and minor complications after bariatric surgery was
28% (95% CI, 10%-49%). Bariatric surgery can facilitate sustained weight
loss in obese patients with ESHF, improving heart transplant candidacy and
the incidence of transplantation.

<85>
Accession Number
633372353
Title
Rationale and design of a randomized clinical trial comparing safety and
efficacy of Myval transcatheter heart valve versus contemporary
transcatheter heart valves in patients with severe symptomatic aortic
valve stenosis: the LANDMARK trial.
Source
American heart journal. (no pagination), 2020. Date of Publication: 05 Nov
2020.
Author
Kawashima H.; Soliman O.; Wang R.; Ono M.; Hara H.; Gao C.; Zeller E.;
Thakkar A.; Tamburino C.; Bedogni F.; Neumann F.-J.; Thiele H.;
Abdel-Wahab M.; Morice M.-C.; Webster M.; Rosseel L.; Mylotte D.; Onuma
Y.; Wijns W.; Baumbach A.; Serruys P.W.
Institution
(Kawashima, Ono, Hara) Department of Cardiology, National University of
Ireland, Galway (NUIG), Galway, Ireland; Amsterdam UMC, University of
Amsterdam, Amsterdam, the Netherlands
(Soliman, Zeller, Rosseel, Mylotte, Onuma, Wijns) Department of
Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
(Wang, Gao) Department of Cardiology, National University of Ireland,
Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud
University Medical Center, Nijmegen, the Netherlands
(Thakkar) Meril Life Sciences Pvt. Ltd., India
(Tamburino) Ferrarotto Hospital, Policlinico Hospital and University of
Catania, Catania, Italy
(Bedogni) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Neumann) Department of Cardiology & Angiology II, University Heart Center
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Thiele, Abdel-Wahab) Heart Center Leipzig at University of Leipzig and
Leipzig Heart Institute, Leipzig, Germany
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud,
Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy, France
(Webster) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Baumbach) William Harvey Research Institute, Queen Mary University of
London, Barts Heart Centre, London, United Kingdom
(Serruys) Department of Cardiology, National University of Ireland, Galway
(NUIG), Galway, Ireland; NHLI, Imperial College London, London, United
Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: The recent approval of transcatheter aortic valve replacement
(TAVR) in patients with low operative risk has paved the way for the
introduction of novel and potentially improved technologies. The safety
and efficacy of these novel technologies should be investigated in
randomized control trials against the contemporary TAVR devices. The
objective of the LANDMARK trial is to compare the balloon-expandable Myval
transcatheter heart valve (THV) series with contemporary THV (SAPIEN THV
and Evolut THV series) series in patients with severe symptomatic native
aortic stenosis. METHODS/DESIGN: The LANDMARK trial
(ClinicalTrials.govNCT04275726, EudraCT number 2020-000137-40) is a
prospective, randomized, multinational, multicenter, open-label,
non-inferiority trial of approximately 768 patients treated with TAVR via
the transfemoral approach. Patients will be allocated in a 1:1
randomization to Myval THV series (n=384) or to contemporary THV (n=384)
(either of SAPIEN THV or Evolut THV series). The primary combined safety
and efficacy endpoint is a composite of all-cause mortality, all stroke
(disabling and non-disabling), bleeding (life-threatening or disabling),
acute kidney injury (stage 2 or 3), major vascular complications,
prosthetic valve regurgitation (moderate or severe), and conduction system
disturbances (requiring new permanent pacemaker implantation), according
to the Valve Academic Research Consortium-2 criteria at 30-day follow-up.
All patients will have follow-up up to 10 years following TAVR. SUMMARY:
The LANDMARK trial is the first randomized head-to-head trial comparing
Myval THV series to commercially available THVs in patients indicated for
TAVR. We review prior data on head-to-head comparisons of TAVR devices and
describe the rationale and design of the LANDMARK trial. Copyright
© 2020. Published by Elsevier Inc.

<86>
Accession Number
633371190
Title
Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as
Alternative Strategy for Nonparticipation in Clinic-Based Cardiac
Rehabilitation among Elderly Patients in Europe: A Randomized Clinical
Trial.
Source
JAMA Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Snoek J.A.; Prescott E.I.; Van Der Velde A.E.; Eijsvogels T.M.H.;
Mikkelsen N.; Prins L.F.; Bruins W.; Meindersma E.; Gonzalez-Juanatey
J.R.; Pena-Gil C.; Gonzalez-Salvado V.; Moatemri F.; Iliou M.-C.; Marcin
T.; Eser P.; Wilhelm M.; Van't Hof A.W.J.; De Kluiver E.P.
Institution
(Snoek, Van Der Velde, De Kluiver) Isala Heart Center, Dokter Van Heesweg
2, Zwolle 8025 AB, Netherlands
(Snoek) Sports Medicine Department Isala, Zwolle, Netherlands
(Prescott, Mikkelsen) Department of Cardiology, Bispebjerg Frederiksberg
University Hospital, Copenhagen, Denmark
(Eijsvogels) Radboud Institute for Health Sciences, Department of
Physiology, Radboud University Medical Center, Nijmegen, Netherlands
(Prins) Diagram, Zwolle, Netherlands
(Meindersma) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Gonzalez-Juanatey, Pena-Gil, Gonzalez-Salvado) Department of Cardiology,
Hospital Clinico Universitario de Santiago, Instituto de Investigacion
Sanitaria, CIBER CV, Madrid, Spain
(Moatemri, Iliou) Department of Cardiac Rehabilitation, Assistance
Publique Hopitaux de Paris, Paris, France
(Marcin, Eser, Wilhelm) Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Van't Hof) Department of Cardiology, Maastricht University Medical
Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Van't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
Publisher
American Medical Association
Abstract
Importance: Although nonparticipation in cardiac rehabilitation is known
to increase cardiovascular mortality and hospital readmissions, more than
half of patients with coronary artery disease in Europe are not
participating in cardiac rehabilitation. Objective(s): To assess
whether a 6-month guided mobile cardiac rehabilitation (MCR) program is an
effective therapy for elderly patients who decline participation in
cardiac rehabilitation. Design, Setting, and Participant(s): Patients
were enrolled in this parallel multicenter randomized clinical trial from
November 11, 2015, to January 3, 2018, and follow-up was completed on
January 17, 2019, in a secondary care system with 6 cardiac institutions
across 5 European countries. Researchers assessing primary outcome were
masked for group assignment. A total of 4236 patients were identified with
a recent diagnosis of acute coronary syndrome, coronary revascularization,
or surgical or percutaneous treatment for valvular disease, or documented
coronary artery disease, of whom 996 declined to start cardiac
rehabilitation. Subsequently, 179 patients who met the inclusion and
exclusion criteria consented to participate in the European Study on
Effectiveness and Sustainability of Current Cardiac Rehabilitation
Programmes in the Elderly trial. Data were analyzed from January 21 to
October 11, 2019. Intervention(s): Six months of home-based cardiac
rehabilitation with telemonitoring and coaching based on motivational
interviewing was used to stimulate patients to reach exercise goals.
Control patients did not receive any form of cardiac rehabilitation
throughout the study period. Main Outcomes and Measures: The primary
outcome parameter was peak oxygen uptake (Vo2peak) after 6 months.
 Result(s): Among 179 patients randomized (145 male [81%]; median age,
72 [range, 65-87] years), 159 (89%) were eligible for primary end point
analysis. Follow-up at 1 year was completed for 151 patients (84%). Peak
oxygen uptake improved in the MCR group (n = 89) at 6 and 12 months (1.6
[95% CI, 0.9-2.4] mL/kg-1/min-1 and 1.2 [95% CI, 0.4-2.0] mL/kg-1/min-1,
respectively), whereas there was no improvement in the control group (n =
90) (+0.2 [95% CI, -0.4 to 0.8] mL/kg-1/min-1 and +0.1 [95% CI, -0.5 to
0.7] mL/kg-1/min-1, respectively). Changes in Vo2peak were greater in the
MCR vs control groups at 6 months (+1.2 [95% CI, 0.2 to 2.1]
mL/kg-1/min-1) and 12 months (+0.9 [95% CI, 0.05 to 1.8] mL/kg-1/min-1).
The incidence of adverse events was low and did not differ between the MCR
and control groups. Conclusions and Relevance: These results suggest
that a 6-month home-based MCR program for patients 65 years or older with
coronary artery disease or a valvular intervention was safe and beneficial
in improving Vo2peak when compared with no cardiac rehabilitation. Trial
Registration: trialregister.nl Identifier: NL5168. Copyright ©
2020 Snoek JA et al. JAMA Cardiology.

<87>
Accession Number
633366619
Title
Comparison of the Effect of Breast Milk and Sodium Bicarbonate Solution
for Oral Care in Infants with Tracheal Intubation After Cardiothoracic
Surgery.
Source
Breastfeeding medicine : the official journal of the Academy of
Breastfeeding Medicine. (no pagination), 2020. Date of Publication: 06 Nov
2020.
Author
Yu X.-R.; Huang S.-T.; Xu N.; Dai W.-S.; Wang Z.-C.; Cao H.; Chen Q.
Institution
(Yu, Huang, Xu, Dai, Wang, Cao, Chen) Department of Cardiac Surgery,
Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian
Medical University, Fuzhou, China
(Yu, Huang, Xu, Dai, 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
Background: This study aimed to explore the effect of breast milk and
sodium bicarbonate solution used in oral care of infants with tracheal
intubation after cardiothoracic surgery. Method(s): A randomized
clinical controlled trial was conducted in a provincial hospital in China.
Fifty infantile patients were randomly divided into two groups: the
patients in the study group (n=25) used breast milk for oral care and the
patients in the control group (n=25) used sodium bicarbonate solution for
oral care. The relevant clinical data were recorded, including the
mechanical ventilation duration, length of intensive care unit (ICU) stay,
length of hospital stay, and complications. Result(s): The length of
ICU stay, length of hospital stay, and duration of mechanical ventilation
were shorter in the study group, but the difference was not statistically
significant (p>0.05). However, the incidence of thrush and
ventilator-associated pulmonary infection in the study group was
significantly lower than that in the control group (p<0.05).
 Conclusion(s): The use of breast milk for oral care has a positive
effect on the prevention of thrush and ventilator-associated pulmonary
infection in infants with tracheal intubation after cardiothoracic
surgery.

<88>
Accession Number
633376225
Title
Predictive value of early cardiac magnetic resonance imaging functional
and geometric indexes for adverse left ventricular remodelling in patients
with anterior ST-segment elevation myocardial infarction: A report from
the CIRCUS study.
Source
Archives of cardiovascular diseases. (no pagination), 2020. Date of
Publication: 04 Nov 2020.
Author
Pezel T.; Besseyre des Horts T.; Schaaf M.; Croisille P.; Biere L.;
Garcia-Dorado D.; Jossan C.; Roubille F.; Cung T.-T.; Prunier F.; Meyer
E.; Amaz C.; Derumeaux G.; de Poli F.; Hovasse T.; Gilard M.; Bergerot C.;
Thibault H.; Ovize M.; Mewton N.
Institution
(Pezel) Inserm, UMRS 942, Department of Cardiology, Lariboisiere Hospital,
Paris University, AP-HP, 75010 Paris, France; Division of Cardiology,
Johns-Hopkins University, 21287-0409 Baltimore, MD, USA
(Besseyre des Horts, Schaaf, Jossan, Amaz, Bergerot, Thibault, Ovize,
Mewton) Inserm 1407, Clinical Investigation Centre and Heart Failure
Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon,
universite Claude-Bernard Lyon 1, Bron 69677, France
(Croisille) Radiology Department, University Hospital of Saint-Etienne,
France
(Biere, Prunier) Cardiology Division, University Hospital of Angers,
Angers 49100, France
(Garcia-Dorado) Hospital Universitari Vall d'Hebron & Research Institute,
Universitat Autonoma de Barcelona, Barcelona 08035, Spain
(Roubille, Cung) UMR5203, Cardiology Division, University Hospital of
Montpellier, University of Montpellier 1 and 2, Montpellier 34295, France
(Meyer) Rangeuil Hospital, University Hospital of Toulouse, Paul-Sabatier
University, Toulouse 31400, France
(Derumeaux) DHU-ATVB, Henri-Mondor Hospital, Paris-Est Creteil University,
AP-HP, 94010 Creteil, France
(de Poli) Cardiology Division, Haguenau Hospital, Haguenau 67500, France
(Hovasse) Cardiology Division, Massy 91300, France
(Gilard) Department of Cardiology, Brest University Hospital, Brest 29200,
France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postinfarction adverse left ventricular (LV) remodelling is
strongly associated with heart failure events. Conicity index, sphericity
index and LV global functional index (LVGFI) are new LV remodelling
indexes assessed by cardiac magnetic resonance (CMR). AIM: To assess the
predictive value of the new indexes for 1-year adverse LV remodelling in
patients with anterior ST-segment elevated myocardial infarction (STEMI).
 METHOD(S): CMR studies were performed in 129 patients with anterior
STEMI (58+/-12 years; 78% men) from the randomized CIRCUS trial (CMR
substudy) treated with primary percutaneous coronary intervention and
followed for the occurrence of major adverse cardiovascular events (MACE)
(death or hospitalization for heart failure). Conicity index, sphericity
index, LVGFI, infarct size and microvascular obstruction (MVO) were
assessed by CMR performed 5+/-4 days after coronary reperfusion. Adverse
LV remodelling was defined as an increase in LV end-diastolic volume of
>=15% by transthoracic echocardiography at 1 year. RESULT(S): Adverse
LV remodelling occurred in 27% of patients at 1 year. Infarct size and MVO
were significantly predictive of adverse LV remodelling: odds ratio [OR]
1.03, 95% confidence interval [CI] 1.01-1.05 (P<0.001) and OR 1.12, 95% CI
1.05-1.22 (P<0.001), respectively. Among the newly tested indexes, only
LVGFI was significantly predictive of adverse LV remodelling (OR 1.10, 95%
CI 1.03-1.16; P=0.001). In multivariable analysis, infarct size remained
an independent predictor of adverse LV remodelling at 1 year (OR 1.05, 95%
CI 1.02-1.08; P<0.001). LVGFI and infarct size were associated with
occurrence of MACE: OR 1.21, 95% CI 1.08-1.37 (P<0.001) and OR 1.02, 95%
CI 1.00-1.04 (P=0.018), respectively. Conicity and sphericity indexes were
not associated with MACE. CONCLUSION(S): LVGFI was associated with
adverse LV remodelling and MACE 1 year after anterior STEMI. Copyright
© 2020. Published by Elsevier Masson SAS.

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