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

<2>
Accession Number
2006024417
Title
Focus on a rare clinical entity: unicuspid aortic valve disease.
Source
Expert Review of Cardiovascular Therapy. 18 (9) (pp 625-633), 2020. Date
of Publication: 01 Sep 2020.
Author
Naito S.; Sequeira-Gross T.; Petersen J.; Holst T.; Reichenspurner H.;
Girdauskas E.
Institution
(Naito, Sequeira-Gross, Petersen, Holst, Reichenspurner, Girdauskas)
Department of Cardiovascular Surgery, University Heart and Vascular Center
Hamburg, Hamburg, Germany
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Introduction: While the understanding of the pathophysiology and clinical
implication of bicuspid aortic valves evolves rapidly, the natural history
of unicuspid aortic valves is still poorly understood. Hence, a
universally accepted diagnostic work-up process and therapy
recommendations for UAV still have to be established. Areas covered: This
article aims to give an overview on the most recent literature addressing
the pathophysiology, the diagnostic tools and appropriate surgical therapy
options of unicuspid aortic valve. Due to the rare prevalence, the
understanding of pathophysiology is still missing. Further, symptomatic
aortic valve disease are seen much earlier life stage in this cohorts.
Thus, it highlights the several surgical treatment options with pro and
contra especially for the young adult cohorts. Expert opinion: Large scale
prospective observational studies using standardized diagnostic criteria
are needed to reveal the clinical course. Further appropriate treatment
strategies of unicuspid aortic valve patients is demanded. Copyright
© 2020 Informa UK Limited, trading as Taylor & Francis Group.

<3>
Accession Number
2005221304
Title
Extrapolation of Survival Benefits in Patients with Transthyretin Amyloid
Cardiomyopathy Receiving Tafamidis: Analysis of the Tafamidis in
Transthyretin Cardiomyopathy Clinical Trial.
Source
Cardiology and Therapy. 9 (2) (pp 535-540), 2020. Date of Publication: 01
Dec 2020.
Author
Li B.; Alvir J.; Stewart M.
Institution
(Li, Alvir) Pfizer, New York, NY, United States
(Stewart) Pfizer, Groton, CT, United States
Publisher
Adis
Abstract
Introduction: In the Tafamidis in Transthyretin Cardiomyopathy Clinical
Trial (ATTR-ACT; ClinicalTrials.gov number NCT01994889), tafamidis reduced
the risk of all-cause mortality in patients with transthyretin amyloid
cardiomyopathy (ATTR-CM) by 30% versus placebo. Median overall survival
was not achieved in either treatment arm (57.1 and 70.5% of patients in
the placebo and tafamidis groups, respectively, survived at 30 months),
limiting assessment of the potential survival benefits of treatment.
 Method(s): A survival extrapolation analysis was conducted following
technical support guidelines from the National Institute for Health and
Care Excellence. Multiple models (i.e., exponential, Weibull, gamma,
log-logistic, log-normal, Gompertz, generalized gamma, and generalized F)
were applied to systematically fit different candidate curves to existing
patient-level data from the 30-month treatment period in ATTR-ACT. The
relative goodness-of-fit for each candidate curve was then tested by
Akaike's and Bayesian information criteria to select a single model that
was fitted to the placebo and pooled tafamidis treatment arms.
 Result(s): A gamma distribution was selected as best fitting model
and fitted to both treatment arms. The resulting estimated median overall
survival was 35.16 months for placebo and 52.64 months for tafamidis
(difference 17.48 months). Conclusion(s): This extrapolation of
survival data from ATTR-ACT further supports the efficacy of tafamidis in
patients with ATTR-CM. Owing to the limitations of this analysis, these
survival estimates should be interpreted with caution; however, they are
consistent with recently presented findings from a combined analysis of
data from ATTR-ACT and interim data from an ongoing long-term extension
study (median follow-up 36 months; ClinicalTrials.gov number NCT02791230).
Trial Registration: ClinicalTrials.gov: NCT01994889. Copyright ©
2020, The Author(s).

<4>
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Accession Number
631932845
Title
Remote Management of Pacemaker Patients with Biennial In-Clinic
Evaluation: Continuous Home Monitoring in the Japanese At-Home Study: A
Randomized Clinical Trial.
Source
Circulation: Arrhythmia and Electrophysiology. 13 (5) (no pagination),
2020. Date of Publication: 01 May 2020.
Author
Watanabe E.; Yamazaki F.; Goto T.; Asai T.; Yamamoto T.; Hirooka K.; Sato
T.; Kasai A.; Ueda M.; Yamakawa T.; Ueda Y.; Yamamoto K.; Tokunaga T.;
Sugai Y.; Tanaka K.; Hiramatsu S.; Arakawa T.; Schrader J.; Varma N.; Ando
K.
Institution
(Watanabe) Department of Cardiology, Fujita Health University, School of
Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192,
Japan
(Yamazaki) Department of Cardiovascular Surgery, Shizuoka City Shizuoka
Hospital, Japan
(Goto) Department of Cardiology, Nagoya City University Hospital (T.G.),
Aichi, Japan., Japan
(Asai) Department of Cardiology, Ichinomiya Municipal Hospital, Aichi,
Japan
(Yamamoto) Department of Cardiology, Handa City Hospital, Aichi, Japan
(Hirooka) Department of Cardiology, National Hospital Organization Osaka
National Hospital, Tokyo, Japan
(Sato) Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
(Kasai) Department of Cardiology, Japanese Red Cross Ise Hospital, Mie,
Japan
(Ueda) Department of Cardiology, Chiba University Hospital, Tokyo, Japan
(Yamakawa) Department of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Ueda) Department of Cardiology, Osaka Police Hospital, Japan
(Yamamoto) Department of Cardiology, Kochi Health Sciences Center, Japan
(Tokunaga) Department of Cardiology, JA Toride Medical Ctr, Ibaraki, Japan
(Sugai) Department of Cardiology, Hiraka General Hospital, Akita, Japan
(Tanaka) Department of Cardiology, Kasukabe Chuo General Hospital,
Saitama, Japan
(Hiramatsu) Department of Cardiology, Fukuyama Cardiovascular Hospital,
Hiroshima, Japan
(Arakawa) Department of Cardiology, Daido Hospital, Aichi, Japan
(Schrader) Biotronik, Berlin, Germany
(Varma) Cleveland Clinic, Heart and Vascular Institute, OH, United States
(Ando) Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Background: Current expert consensus recommends remote monitoring for
cardiac implantable electronic devices, with at least annual in-office
follow-up. We studied safety and resource consumption of exclusive remote
follow-up (RFU) in pacemaker patients for 2 years. Method(s): In
Japan, consecutive pacemaker patients committed to remote monitoring were
randomized to either RFU or conventional in-office follow-up (conventional
follow-up) at twice yearly intervals. RFU patients were only seen if
indicated by remote monitoring. All returned to hospital after 2 years.
The primary end point was a composite of death, stroke, or cardiovascular
events requiring surgery, and the primary hypothesis was noninferiority
with 5% margin. Result(s): Of 1274 randomized patients (50.4% female,
age 77+/-10 years), 558 (RFU) and 550 (Conventional follow-up) patients
reached either the primary end point or 24 months follow-up. The primary
end point occurred in 10.9% and 11.8%, respectively (P=0.0012 for
noninferiority). The median (interquartile range) number of in-office
follow-ups was 0.50 (0.50-0.63) in RFU and 2.01 (1.93-2.05) in
conventional follow-up per patient-year (P<0.001). Insurance claims for
follow-ups and directly related diagnostic procedures were 18 800 Yen (16
500-20 700 Yen) in RFU and 21 400 Yen (16 700-25 900 Yen) in conventional
follow-up (P<0.001). Only 1.4% of remote follow-ups triggered an
unscheduled in-office follow-up, and only 1.5% of scheduled in-office
follow-ups were considered actionable. Conclusion(s): Replacing
periodic in-office follow-ups with remote follow-ups for 2 years in
pacemaker patients committed to remote monitoring does not increase the
occurrence of major cardiovascular events and reduces resource
consumption. Registration: URL: Https://clinicaltrials.gov; Unique
identifier: NCT01523704. Copyright © 2020 Lippincott Williams and
Wilkins. All rights reserved.

<5>
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Accession Number
631578039
Title
Major adverse cardiovascular events associated with postoperative atrial
fibrillation after noncardiac surgery: A systematic review and
meta-analysis.
Source
Circulation: Arrhythmia and Electrophysiology. 13 (1) (no pagination),
2020. Article Number: e007437. Date of Publication: 01 Jan 2020.
Author
Alturki A.; Marafi M.; Proietti R.; Cardinale D.; Blackwell R.; Dorian P.;
Bessissow A.; Vieira L.; Greiss I.; Essebag V.; Healey J.S.; Huynh T.
Institution
(Alturki, Essebag, Huynh) Division of Cardiology, McGill University Health
Center, Montreal, QC, Canada
(Bessissow) Division of General Internal Medicine, McGill University
Health Center, Montreal, QC, Canada
(Marafi, Vieira) Department of Neurology and Neurosurgery, Montreal
Neurological Institute, QC, Canada
(Proietti) Department of Cardiac, Thoracic and Vascular Sciences,
University of Padua, Italy
(Cardinale) Cardioncology Unit, European Institute of Oncology, I.R.C.C.S,
Milan, Italy
(Blackwell) Department of Urology, Loyola University Health Center,
Chicago, IL, United States
(Dorian) Division of Cardiology, St Michael's Hospital, University of
Toronto, ON, Canada
(Greiss) Division of Cardiology, Univerity of Montreal Health Centre, QC,
Canada
(Healey) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a frequent
occurrence after noncardiac surgery. It remains unclear whether POAF is
associated with an increased risk of major adverse events. We aimed to
elucidate the risk of stroke, myocardial infarction, and death associated
with POAF following noncardiac surgery by a meta-analysis of randomized
controlled studies and observational studies. Method(s): We searched
electronic databases from inception up to August 1, 2019 for all studies
that reported stroke or myocardial infarction in adult patients who
developed POAF following noncardiac surgery. We used random-effects models
to summarize the studies. Result(s): The final analyses included 28
studies enrolling 2 612 816 patients. At 1-month (10 studies), POAF was
associated with an =3-fold increase in the risk of stroke (weighted mean
2.1% versus 0.7%; odds ratio [OR], 2.82 [95% CI, 2.15-3.70]; P<0.001).
POAF was associated with =4-fold increase in the long-term risk of stroke
with (weighted mean, 2.0% versus 0.6%; OR, 4.12 [95% CI, 3.32-5.11];
P<=0.001) in 8 studies with >=12-month follow-up. There was a significant
overall increase in the risk of stroke and myocardial infarction
associated with POAF (weighted mean, 2.5% versus 0.9%; OR, 3.44 [95% CI,
2.38-4.98]; P<0.001) and (weighted mean, 12.6% versus 2.7%; OR, 4.02 [95%
CI, 3.08-5.24]; P<0.001), respectively. Furthermore, POAF was associated
with a 3-fold increase in all-cause mortality at 30 days (weighted mean,
15.0% versus 5.4%; OR, 3.36 [95% CI, 2.13-5.31]; P<0.001).
 Conclusion(s): POAF was associated with markedly higher risk of
stroke, myocardial infarction, and all-cause mortality following
noncardiac surgery. Future studies are needed to evaluate the impact of
optimal cardiovascular pharmacotherapies to prevent POAF and to decrease
the risk of major adverse events in these high-risk
patients. Copyright © 2020 Lippincott Williams and Wilkins. All
rights reserved.

<6>
[Use Link to view the full text]
Accession Number
631577630
Title
Interventional studies performed in emergency medical communication
centres: Systematic review.
Source
European Journal of Emergency Medicine. 27 (1) (pp 21-26), 2020. Date of
Publication: 01 Feb 2020.
Author
Reuter P.-G.; Chauvin A.; Javaud N.; Adnet F.; Lapostolle F.; Yordanov Y.
Institution
(Reuter, Adnet, Lapostolle) Urgences-Samu 93, Hopital Avicenne, Assistance
Publique-Hopitaux de Paris, Universite Paris 13, Bobigny, France
(Reuter, Adnet, Lapostolle) Inserm U942, Biomarkers in Cardioneurovascular
Diseases, Universite Paris 7-Denis Diderot
(Chauvin) Emergency Departement, Hopital Lariboisiere, Assistance
Publique-Hopitaux de Paris, Faculte de Medecine, Universite Diderot
(Chauvin, Yordanov) INSERM U1153, Statistic and Epidemiologic Research
Center Sorbonne Paris Cite, METHODS Team, Hotel-Dieu Hospital
(Javaud) Centre de Reference sur les Angioedemes A Kinines (CReAk),
Universite Paris 7-Denis Dideros
(Yordanov) Sorbonne Universites, UPMC Paris Univ-06
(Yordanov) Service des Urgences, Hopital Saint Antoine, Assistance
Publique-Hopitaux de Paris, Paris, France
(Reuter) Samu 92, Hopital Raymond Poincare, Assistance Publique-Hopitaux
de Paris, Universite Versailles-Saint-Quentin-en-Yvelines, Garches, France
(Javaud) Service des Urgences-Hopital Louis Mourier, Assistance
Publique-Hopitaux de Paris, Universite Paris 7-Denis Diderot, Colombes,
France
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
We aimed to both quantitatively and qualitatively describe interventional
research performed in emergency medical communication centres. We
conducted a systematic review of articles published in MEDLINE, Cochrane
Central Register of Controlled Trials and Web of Science. Studies
evaluating therapeutic or organizational interventions directed by call
centres in the context of emergencies were included. Studies of call
centre management for general practice or nonhealthcare agencies were
excluded. We assessed general characteristics and methodological
information for each study. Quality was evaluated by the Cochrane Risk of
Bias tool or the Newcastle-Ottawa Scale. Among 3896 articles screened, we
retained 59; 41 studies were randomized controlled trials (69%) and 18
(31%) were before-after studies; 41 (69%) took place in a single centre.
For 33 (56%), 22 (37%) and 4 (7%) studies, the models used were simulation
training, patient-based or experimental, respectively. The main topic was
cardiac arrests (n = 45, 76%), with outcome measures of cardiopulmonary
resuscitation quality and dispatch assistance. Among randomized controlled
trials, risk of bias was unclear or high for selective reporting for 37
(90%) studies, low for blinding of outcomes for 34 (83%) and low for
incomplete outcomes for 31 (76%). Regarding before-after studies, quality
was high in 9 (50%) studies. Few interventional studies have been
performed in call centres. Studies mainly involved simulation and focussed
on cardiac arrest. The quality of studies needs improvement to allow for a
better recognition and understanding of emergency medical call
control. Copyright © 2020 Lippincott Williams and Wilkins. All
rights reserved.

<7>
Accession Number
2007928017
Title
Chinese Herbal Formula Xuefu Zhuyu for Stable Angina (CheruSA): Study
Protocol for a Multicenter Randomized Controlled Trial.
Source
Evidence-based Complementary and Alternative Medicine. 2020 (no
pagination), 2020. Article Number: 7612721. Date of Publication: 2020.
Author
Liao S.; Zhang Z.; Li G.; Zhou L.; Jiang J.; Zhang N.; Wang Y.; Du Y.; Wen
Z.
Institution
(Liao, Zhou) Second Clinical Medical College (Second Affiliated Hospital),
Guangzhou University of Chinese Medicine, Guangzhou 510405, China
(Zhang) Liaoning University of Traditional Chinese Medicine, Shenyang
110847, China
(Li, Zhou, Wen) Key Unit of Methodology in Clinical Research, Guangdong
Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
(Li) Mathematical Engineering Academy of Chinese Medicine, Guangzhou
University of Chinese Medicine, Guangzhou 510405, China
(Jiang, Zhang, Wang, Du) Cardiovascular Department, Affiliated Hospital of
Liaoning University of Traditional Chinese Medicine, Shenyang 110032,
China
(Wen) State Key Laboratory of Dampness Syndrome of Chinese Medicine,
Second Affiliated Hospital of Guangzhou University of Chinese Medicine,
Guangzhou 510120, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Introduction. Stable angina (SA) in coronary heart disease is a common
ischemic heart disease endangering the patient's quality of life and
longevity. Clinical trials have demonstrated that the Chinese herbal
formula Xuefu Zhuyu (XFZY) has benefits for SA patients. However, there
remains a lack of high-quality evidence to support clinical
decision-making. Therefore, we designed a randomized controlled trial
(RCT) to evaluate the efficacy and safety of XFZY for SA. Methods and
Analysis. This multicenter, double-blinded RCT will be conducted in China.
152 eligible participants will be randomly assigned to either an XFZY
group or a control group at a 1: 1 ratio. Participants in the XFZY group
will receive XFZY plus routine care, while those in the control group will
receive placebo plus routine care. The study period is 26 weeks, including
a 2-week run-in period, a 12-week treatment period, and a 12-week
follow-up. The primary outcome is the change in visual analogue scale
score for angina pain intensity from baseline to 12 weeks. The secondary
outcomes are the angina attack frequency and duration, the nitroglycerin
dosage consumed, the Canadian Cardiovascular Society grading of effort
angina, the Seattle Angina Questionnaire, the
EuroQol-5-Dimensions-5-Level, the incidence of major adverse cardiac
events, health cost evaluation, and overall assessment for study drugs.
Ethics and Dissemination. The study has been approved by the ethics
committee of Guangdong Provincial Hospital of Chinese Medicine (approval
no. BF2019-175-01). Results will be submitted for publication in
peer-reviewed journals and disseminated at scientific conferences. This
trial is registered with ChiCTR1900026899, registered on 26 October
2019. Copyright © 2020 Shaojun Liao et al.

<8>
Accession Number
2008354680
Title
Anticoagulation After Isolated Mitral Valve Repair: A Systematic Review
and Meta-Analysis of Clinical Outcomes.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Papadimas E.; Tan Y.K.; Choong A.M.T.L.; Kofidis T.; Teoh K.L.K.
Institution
(Papadimas, Choong, Kofidis, Teoh) Department of Cardiac Thoracic &
Vascular Surgery, National University Heart Centre, Singapore
(Tan, Kofidis) Yong Loo Lin School of Medicine, Singapore
(Choong, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Choong, Kofidis) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
Publisher
Elsevier Ltd
Abstract
Recommendations from international guidelines on optimal
thromboprophylaxis after mitral repair are controversial and based on
underpowered observational studies. This study aimed to evaluate the
prophylactic use of warfarin after isolated mitral valve repair (MVr). A
PubMed, EMBASE and Scopus search for studies in English on postoperative
thromboprophylaxis for isolated MVr published to February 2020 was
performed. The analysis excluded all studies with combined operations,
mitral valve replacement and preoperative or postoperative atrial
fibrillation. Clinical endpoints that were studied were thromboembolic
events, bleeding complications and mortality. Random effects meta-analyses
of the effect of postoperative warfarin use as compared with no warfarin
use across all clinical endpoints was conducted. Warfarin use did not
confer benefit in terms of thromboembolic prophylaxis after isolated MVr
in patients without atrial fibrillation (OR, 0.97; 95% CI, 0.72-1.31). At
the same time, it did not increase the risk of bleeding complications (OR,
1.10; 95% CI, 0.53-2.30) or affect overall survival during the follow-up
period of the included studies (OR, 1.06; 95% CI, 0.28-4.05). To conclude,
warfarin use is not necessary for patients after isolated MVr who remain
in sinus rhythm. Recommendations from international guidelines may need to
be revisited for this group of patients. Copyright © 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<9>
Accession Number
2007027586
Title
The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass
Vasoplegia.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2020. Date of
Publication: 2020.
Author
Papazisi O.; Palmen M.; Danser A.H.J.
Institution
(Papazisi, Palmen) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Danser) Department of Internal Medicine, Division of Pharmacology,
Erasmus Medical Center, Rotterdam, Netherlands
Publisher
Springer
Abstract
Purpose: Vasoplegia is a common complication after cardiac surgery and is
related to the use of cardiopulmonary bypass (CPB). Despite its
association with increased morbidity and mortality, no consensus exists in
terms of its treatment. In December 2017, angiotensin II (AII) was
approved by the Food and Drug Administration (FDA) for use in vasodilatory
shock; however, except for the ATHOS-3 trial, its use in vasoplegic
patients that underwent cardiac surgery on CPB has mainly been reported in
case reports. Thus, the aim of this review is to collect all the
clinically relevant data and describe the pharmacologic mechanism,
efficacy, and safety of this novel pharmacologic agent for the treatment
of refractory vasoplegia in this population. Method(s): Two
independent reviewers performed a systematic search in PubMed, Embase, Web
of Science, and Cochrane Library using relevant MeSH terms (Angiotensin
II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures).
 Result(s): The literature search yielded 820 unique articles. In
total, 9 studies were included. Of those, 2 were randomized clinical
trials (RCTs) and 6 were case reports and 1 was a retrospective cohort
study. Conclusion(s): AII appears to be a promising means of
treatment for patients with post-operative vasoplegia. It is demonstrated
to be effective in raising blood pressure, while no major adverse events
have been reported. It remains uncertain whether this agent will be
broadly available and whether it will be more advantageous in the clinical
management of vasoplegia compared to other available vasopressors. For
that reason, we should contain our eagerness and enthusiasm regarding its
use until supplementary knowledge becomes available. Copyright ©
2020, The Author(s).

<10>
Accession Number
2007027352
Title
Effect of Albumin Addition to Cardiopulmonary Bypass Prime on Outcomes in
Children Undergoing Open-Heart Surgery (EACPO Study)-A Randomized
Controlled Trial.
Source
World Journal for Pediatric and Congenital Heart Surgery. (no pagination),
2020. Date of Publication: 2020.
Author
Rauf A.; Joshi R.K.; Aggarwal N.; Agarwal M.; Kumar M.; Dinand V.; Joshi
R.
Institution
(Rauf, Joshi) Department of Pediatric Intensive Care, Sir Ganga Ram
Hospital, New Delhi, Delhi, India
(Joshi, Aggarwal, Agarwal, Kumar) Department of Pediatric Cardiac
Sciences, Sir Ganga Ram Hospital, New Delhi, Delhi, India
(Dinand) Department of Research, Sir Ganga Ram Hospital, New Delhi, Delhi,
India
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: There is a paucity of literature regarding the association of
high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB)
and outcomes, and no consensus exists regarding the composition of optimal
CPB priming solution. This study aimed to examine the impact of high
oncotic pressure priming by the addition of 20% human albumin on outcomes.
 Method(s): Double-blinded, randomized controlled study was done in
the pediatric cardiac intensive care unit of a tertiary care hospital.
Consecutive children with congenital heart diseases admitted for
open-heart surgery were randomized into two groups, where the study group
received an additional 20% albumin to conventional blood prime before CPB
initiation. Result(s): We enrolled 39 children in the high oncotic
prime (added albumin) group and 37 children in the conventional prime
group. In the first 24-hour postoperative period, children in the albumin
group had significantly lower occurrence of hypotension (28.2% vs 54%, P
=.02), requirement of fluid boluses (25.6% vs 54%, P =.006), and lactate
clearance time (6 vs 9 hours, P <.001). Albumin group also had
significantly higher platelet count (x103/microL) at 24 hours
(112 vs 91, P =.02). There was no significant difference in intra-CPB
hemodynamic parameters and incidence of acute kidney injury. In subgroup
analysis based on risk category, significantly decreased intensive care
unit stay (4 vs 5 days, P =.04) and hospital stay (5 vs 7 days, P =.002)
were found in the albumin group in low-risk category. Conclusion(s):
High oncotic pressure CPB prime using albumin addition might be beneficial
over conventional blood prime, and our study does provide a rationale for
further studies. Copyright © The Author(s) 2020.

<11>
Accession Number
2007027010
Title
Prosthesis-patient mismatch after mitral valve replacement: A pooled
meta-analysis of Kaplan-Meier-derived individual patient data.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Tomsic A.; Arabkhani B.; Schoones J.W.; Etnel J.R.G.; Marsan N.A.; Klautz
R.J.M.; Palmen M.
Institution
(Tomsic, Arabkhani, Klautz, Palmen) Department of Cardiothoracic Surgery,
Leiden University Medical Centre, Leiden, Netherlands
(Schoones) Walaeus Library, Leiden University Medical Centre, Leiden,
Netherlands
(Etnel) Department of Cardiothoracic Surgery, Erasmus University Medical
Centre, Rotterdam, Netherlands
(Marsan) Department of Cardiology, Leiden University Medical Centre,
Leiden, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The hemodynamic effect and early and late survival impact of
prosthesis-patient mismatch (PPM) after mitral valve replacement remains
insufficiently explored. Method(s): Pubmed, Embase, Web of Science,
and Cochrane Library databases were searched for English language original
publications. The search yielded 791 potentially relevant studies. The
final review and analysis included 19 studies compromising 11,675
patients. Result(s): Prosthetic effective orifice area was calculated
with the continuity equation method in 7 (37%), pressure half-time method
in 2 (10%), and partially or fully obtained from referenced values in 10
(53%) studies. Risk factors for PPM included gender (male), diabetes
mellitus, chronic renal disease, and the use of bioprostheses. When
pooling unadjusted data, PPM was associated with higher perioperative
(odds ratio [OR]: 1.66; 95% confidence interval [CI]: 1.32-2.10; p <.001)
and late mortality (hazard ratio [HR]: 1.46; 95% CI: 1.21-1.77; p <.001).
Moreover, PPM was associated with higher late mortality when Cox
proportional-hazards regression (HR: 1.97; 95% CI: 1.57-2.47; p <.001) and
propensity score (HR: 1.99; 95% CI: 1.34-2.95; p <.001) adjusted data were
pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84-1.22; p =.88) or
severe (HR: 1.19; 95% CI: 0.89-1.58; p =.24) PPM were not related to
higher late mortality when adjusted data were pooled individually. PPM was
associated with higher systolic pulmonary pressures (mean difference: 7.88
mmHg; 95% CI: 4.72-11.05; p <.001) and less pulmonary hypertension
regression (OR: 5.78; 95% CI: 3.33-10.05; p <.001) late after surgery.
 Conclusion(s): Mitral valve PPM is associated with higher
postoperative pulmonary artery pressure and might impair perioperative and
overall survival. The relation should be further assessed in properly
designed studies. Copyright © 2020 The Authors. Journal of
Cardiac Surgery published by Wiley Periodicals LLC

<12>
Accession Number
2006763491
Title
Comparison of postoperative outcomes following multidetector computed
tomography based vs transesophageal echocardiography based annulus sizing
for transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Echocardiography. 37 (10) (pp 1617-1626), 2020. Date of Publication: 01
Oct 2020.
Author
Tang G.; Lv Q.; He X.
Institution
(Tang, Lv, He) Department of Echocardiography, The Affiliated Hospital of
Qingdao University, Qingdao, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The purpose of this paper was to evaluate the difference in
postoperative outcomes following multidetector computed tomography (MDCT)
and transesophageal echocardiography (TEE)-based annulus sizing for
transcatheter aortic valve replacement (TAVR). Method(s): Electronic
search of PubMed, Biomed Central, Scopus, and Google Scholar databases was
conducted until August 15, 2019. We included all types of studies
comparing MDCT-based annulus sizing with TEE-based annulus sizing and
assessing paravalvular regurgitation (PVR). Data were summarized using the
Mantel-Haenszel odds ratio (OR) with 95% confidence intervals (CI).
 Result(s): A total of six studies were included. Pooled analysis of
431 participants in the MDCT group and 509 participants in the TEE group
demonstrated that MDCT-based annulus sizing is associated with a
significantly lower incidence of more than moderate PVR as compared to
2DTEE-based sizing (OR: 0.31, 95% CI: 0.18-0.54, P <.0001; I2 =
0%). There was no statistical difference in annulus rupture (OR: 0.57, 95%
CI: 0.12-2.66, P =.91; I2 = 0%), procedural mortality (OR:
0.97, 95% CI: 0.19-4.86, P =.97; I2 = 0%), and 30-day mortality
(OR: 0.63, 95% CI: 0.26-1.50, P =.29; I2 = 0%) with MDCT or
2DTEE-based annulus sizing. Compared with 3DTEE, the incidence of PVR in
the MDCT group was lower, but there was no statistical difference in
30-day mortality. Conclusion(s): Use of MDCT in comparison with 2DTEE
is associated with significantly lower incidence of more than moderate PVR
after TAVR. There seems to be no difference in annulus rupture and 30-day
mortality with either imaging modality. Copyright © 2020 The
Authors. Echocardiography published by Wiley Periodicals LLC

<13>
Accession Number
2005726644
Title
Outcomes After Left Main Coronary Artery Revascularization by Percutaneous
Coronary Intervention or Coronary Artery Bypass Grafting According to
Smoking Status.
Source
American Journal of Cardiology. 127 (pp 16-24), 2020. Date of Publication:
15 July 2020.
Author
Shahim B.; Redfors B.; Chen S.; Morice M.-C.; Gersh B.J.; Puskas J.D.;
Kandzari D.E.; Merkely B.; Horkay F.; Crowley A.; Serruys P.W.; Kappetein
A.P.; Sabik J.F.; Ben-Yehuda O.; Stone G.W.
Institution
(Shahim, Redfors, Chen, Crowley, Ben-Yehuda, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors, Chen, Ben-Yehuda) NewYork-Presbyterian Hospital/Columbia
University Medical Center, New York, NY, United States
(Morice) Hopital prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Merkely, Horkay) Heart and Vascular Center, Semmelweis University,
Budapest, Hungary
(Serruys) Department of Cardiology, NUIG, National University of Ireland,
Galway, Ireland
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Thorax Center, Erasmus MC, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Cigarette smoking is a well-known risk factor for coronary artery disease
(CAD). However, the impact of smoking on outcomes after coronary
revascularization, especially in patients with left main CAD (LMCAD) is
less well understood. The EXCEL trial randomized 1,905 patients with LMCAD
and visually assessed low or intermediate anatomical complexity (SYNTAX
score <=32) to PCI with everolimus-eluting stents or CABG. Patients were
categorized according to smoking status (current, former, or never), and
their outcomes at 5 years were compared by logistic regression with
follow-up time included as a log-transformed offset variable. The primary
endpoint was a composite of death, myocardial infarction, or stroke. Among
1893 patients with known smoking status at baseline, 416 (22%) were
current smokers and 774 (41%) were former smokers. The crude rates of the
primary endpoint were 19.5% for never smokers, 20.5% for former smokers (p
= 0.61 vs never smokers), and 23.1% for smokers (p = 0.15 vs never
smokers). Compared with never smokers, the adjusted risk of the primary
endpoint was higher for current smokers (adjOR 1.82, 95% confidence
interval [CI] 1.126 to 2.63; p = 0.001), but not for former smokers (adjOR
1.00, 95% CI 0.75 to 1.33, p = 0.10). The relative efficacy of PCI versus
CABG for the 5-year primary endpoint was similar irrespective of smoking
status (P<inf>interaction</inf> = 0.22). In conclusion, current smokers in
the EXCEL trial had a higher adjusted 5-year risk of the primary composite
endpoint of death, myocardial infarction, or stroke than never smokers,
whereas former smokers were not at increased risk. Active smoking was a
risk factor after LMCAD revascularization irrespective of
revascularization method. Copyright © 2020 Elsevier Inc.

<14>
Accession Number
2008398361
Title
Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity
Score Analysis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Ali U.S.; Lan N.S.R.; Gilfillan M.; Ho K.; Pavey W.; Dwivedi G.; Slimani
E.K.; Edelman J.; Merry C.; Larbalestier R.
Institution
(Ali, Gilfillan, Pavey, Slimani, Edelman, Merry, Larbalestier) Department
of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia
(Lan, Dwivedi) Department of Cardiology, Fiona Stanley Hospital, Perth,
WA, Australia
(Ho) Medical School, University of Western Australia, School of Veterinary
& Life Sciences, Murdoch University and Intensive Care Unit, Royal Perth
Hospital, Perth, WA, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: The role of intra-aortic balloon pumps (IABP) in high-risk
patients undergoing coronary artery bypass graft (CABG) surgery remains
controversial. We report the 5-year experience from a new Australian
centre. Method(s): We retrospectively analysed 690 patients
undergoing urgent isolated CABG surgery at a Western Australian tertiary
centre from February 2015 to May 2020. De-identified data was obtained
from the Australia & New Zealand Society of Cardiothoracic Surgeons
database. Patients were stratified according to preoperative IABP use. A
propensity score was created for the probability of IABP use and a
propensity adjusted analysis was performed using logistic regression. The
primary outcome was 30-day mortality. Secondary outcomes were
postoperative inhospital outcomes. Result(s): Preoperative IABP was
used in 78 patients (11.3%). After propensity score adjustment, in a
subgroup of patients with reduced ejection fraction or left main disease,
30-day mortality (7.0% vs 2.0%, OR 6.03, 95% CI 1.89-19.28, p=0.002) was
significantly higher in the IABP group. Red blood cell transfusions (19.7%
vs 12.6%, OR 1.86, 95% CI 1.02-3.35, p=0.039), prolonged inotrope use
(78.9% vs 50.9%, OR 6.11, 95% CI 2.77-13.48, p<0.001), prolonged invasive
ventilation (28.2% vs 3.4%, OR 20.2, 95% CI 8.24-49.74, p<0.001),
mesenteric ischaemia (2.8% vs 0%, OR 4.52, 95% CI 1.15-17.77, p=0.031) and
multisystem organ failure (1.3% vs 0.7%, OR 25.68, 95% CI 2.55-258.34,
p=0.006) were significantly higher in the IABP group. Conclusion(s):
In patients undergoing isolated CABG surgery, preoperative IABP use was
associated with increased 30-day mortality and adverse outcomes. Large
randomised controlled trials are required to confirm our
findings. Copyright © 2020

<15>
Accession Number
2008398244
Title
Cardiac Surgery and Small Island States: A Bridge Too Far?.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Vervoort D.; Vinck E.E.; Tiwari K.K.; Tapaua N.
Institution
(Vervoort) Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Johns Hopkins University, Baltimore,
MD, United States
(Vinck) Department of Surgery, El Bosque University, Bogota, Colombia
(Vinck) Dr. Horacio Oduber Hospitaal, Oranjestad, Aruba
(Tiwari) Department of Cardiothoracic Surgery, ADK Hospital, Male,
Maldives
(Tapaua) Department of Surgery, University of Papua New Guinea, Papua New
Guinea
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Small island developing states (SIDS) make up nearly 1% of the
world's population, with 65 million people across 58 countries. Small
island developing states have some of the highest rates of rheumatic heart
disease in addition to a substantial burden of congenital heart defects
and a growing burden of ischemic heart disease. Here, we present an
overview of cardiac surgical services in SIDS, with a focus on Papua New
Guinea, the Maldives, and Aruba. Method(s): We performed a literature
review using the PubMed/MEDLINE and Google Scholar databases to identify
articles describing cardiac surgery services in SIDS. Case studies of the
history and current state of cardiac surgery in Papua New Guinea, the
Maldives, and Aruba were developed and informed by local clinical
experience. Result(s): Nine SIDS have independent cardiac surgical
centers and 5 SIDS have local centers supported by visiting teams. Papua
New Guinea started cardiac surgery in 1993 and is served by a public
center, performing nearly 100 cardiac surgeries per year. The Maldives
introduced cardiac surgery services in 2018, with 1 local cardiac surgeon
supported by Nepalese cardiac surgeons, performing 33 cardiac surgeries in
15 months. In Aruba, no local cardiac center exists and over 150 patients
are sent abroad for cardiac surgery, representing 12% of total health
spending. Conclusion(s): Small island developing states have limited
availability of cardiac surgery but pressing clinical needs. Independent
cardiac centers exist with acceptable outcomes and lower costs than
foreign treatment, which suggests the need to strengthen regionalization
models to deliver cardiac surgical care in SIDS. Copyright © 2020

<16>
Accession Number
2008396493
Title
Revascularization versus medical therapy for the treatment of stable
coronary artery disease: A meta-analysis of contemporary randomized
controlled trials.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Laukkanen J.A.; Kunutsor S.K.
Institution
(Laukkanen) Institute of Clinical Medicine, Department of Medicine,
University of Eastern Finland, Kuopio, Finland
(Laukkanen) Central Finland Health Care District, Department of Medicine,
Jyvaskyla, Finland
(Laukkanen) Institute of Public Health and Clinical Nutrition, University
of Eastern Finland, Kuopio, Finland
(Kunutsor) National Institute for Health Research Bristol Biomedical
Research Centre, University Hospitals Bristol and Weston NHS Foundation
Trust and the University of Bristol, Bristol, United Kingdom
(Kunutsor) Translational Health Sciences, Bristol Medical School,
University of Bristol, Southmead Hospital, Learning & Research Building
(Level 1), Bristol, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: We conducted a systematic review and meta-analysis of
contemporary randomized controlled trials (RCTs) to compare clinical
outcomes among stable coronary artery disease (CAD) patients treated with
revascularization [percutaneous coronary intervention (PCI),
coronary-artery bypass grafting (CABG) or both] plus medical therapy (MT)
versus MT alone. Method(s): Prospective RCTs were sought from
MEDLINE, Embase, The Cochrane Library, and Web of Science up to April
2020. Data was extracted on study characteristics, methods, and outcomes.
Relative risks (RRs) with 95% confidence intervals (CIs) were pooled for
the composite of all-cause mortality, myocardial infarction (MI),
revascularizations, rehospitalizations, or stroke; its individual
components and other cardiovascular endpoints. Result(s): Twelve
unique RCTs comprising of 15,774 patients were included. There was no
significant difference in all-cause mortality risk (0.95, 95% CI:
0.86-1.06); however, revascularization plus MT reduced the risk of the
composite outcome of all-cause mortality, MI, revascularizations,
rehospitalizations, or stroke (0.69, 95% CI: 0.55-0.87); unplanned
revascularization (0.53, 95% CI: 0.40-0.71); and fatal MI (0.65, 95% CI:
0.49-0.84). Revascularization plus MT reduced the risk of stroke at 1 year
(0.44, 95% CI: 0.30-0.65) and unplanned revascularization and the
composite outcome of all-cause mortality, MI, revascularizations,
rehospitalizations, or stroke at 2-5 years. Conclusion(s):
Revascularization plus MT does not confer survival advantage beyond that
of MT among patients with stable CAD. However, revascularization plus MT
may reduce the overall risk of the combined outcome of mortality, MI,
revascularizations, rehospitalizations, or stroke, which could be driven
by a decrease in the risk of unplanned revascularizations or fatal
MI. Copyright © 2020 Elsevier B.V.

<17>
Accession Number
633215062
Title
Adjuvant chemotherapy after radical nephroureterectomy improves the
survival outcome of high-risk upper tract urothelial carcinoma patients
with cardiovascular comorbidity.
Source
Scientific reports. 10 (1) (pp 17674), 2020. Date of Publication: 19 Oct
2020.
Author
Luo Y.; Feng B.; Wei D.; Han Y.; Li M.; Zhao J.; Lin Y.; Hou Z.; Jiang Y.
Institution
(Luo, Feng, Wei, Han, Li, Zhao, Lin, Hou, Jiang) Department of Urology,
Beijing Anzhen Hospital, Capital Medical University, Anzhenli Street,
Chaoyang District, Beijing 100029, China
Publisher
NLM (Medline)
Abstract
This prospective randomized comparative trial study aimed to evaluate the
therapeutic outcomes of radical nephroureterectomy and adjuvant
chemotherapy (ACT) used in combination in high risk upper tract urothelial
carcinoma (UTUC) patients with cardiovascular comorbidity. Based on the
inclusion criteria of high-risk UTUC in EAU guidelines (updated in 2014),
all eligible patients treated in our hospital from January 2014 to March
2018 were included, and cases with late disease, renal dysfunction, severe
cardiopulmonary disease or other malignant tumors were excluded. The cases
were randomized into two groups based on treatment regimen. Multivariate
analyses were performed to analyze the influencing factors of survival
outcome in the enrolled patients. The Cox proportional-hazards model and
the Kaplan-Meier method were employed to assess progression free survival
(PFS), overall survival (OS) and cancer specific survival (CSS). In
addition, the potential adverse effects of chemotherapy were actively
monitored. A total of 176 high-risk UTUC individuals with cardiovascular
comorbidity were enrolled and evaluated in this study. Median follow-up
durations were 30 months (range 6-54) in the RNU (n=82) group and 36
months (range 6-54) in the RNU+ACT (n=94) group. Multivariable analysis
indicated that peri-operative cardiovascular events risk grade was
independent prognostic factor for OS. Tumor size was independent
prognostic factor for PFS and CSS. BMI and lymphovacular invasion were
significant predictors of PFS. Clinical stage, lymph node involvement, and
tumor grade were significant predictors of PFS, OS and CSS in these
patients. Especially, chemotherapy was helpful in improving PFS [P<0.001,
HR=6.327 (5.115-7.793)], OS [P=0.013, HR=2.336 (1.956-2.883)] and CSS
[P=0.008, HR=3.073 (2.533-3.738)]. Kaplan-Meier analysis demonstrated that
the oncologic outcomes of RNU treated high-risk UTUC patients were
improved much significantly by ACT, including PFS [P=0.0033, HR=3.78
(3.13-4.55)], OS [P=0.0397, HR=1.39 (1.01-1.75)] and CSS [P=0.0255,
HR=1.26 (1.07-1.45)]. Further analysis of the lymph node positive subgroup
showed that the median time of oncologic events was enhanced in RNU+ACT
treated individuals in comparison with the RNU group, including PFS (11.4
months vs. 31.9 months, P=0.0018), OS (26.8 months vs. 36.3 months,
P=0.0255) and CSS (28.2 months vs. 39.3 months, P=0.0197). In the T3/4
cohort, significantly increased median PFS (13.9 months vs. 36.3 months,
P=0.0217), OS (20.6 months vs. 32.2 months, P=0.0183) and CSS (21.9 months
vs. 38.4 months, P=0.0226) were obtained in the combination group.
Additionally, no severe adverse events (over grade 4) associated with
chemotherapy were detected in the RNU+ACT group. In conclusion, ACT after
radical surgery has statistically significant therapeutic effects on PFS,
OS and CSS in high-risk UTUC patients with cardiovascular comorbidity.

<18>
Accession Number
633168541
Title
The Association Between Obesity and Risk of Acute Kidney Injury After
Cardiac Surgery.
Source
Frontiers in Endocrinology. 11 (no pagination), 2020. Article Number:
534294. Date of Publication: 06 Oct 2020.
Author
Shi N.; Liu K.; Fan Y.; Yang L.; Zhang S.; Li X.; Wu H.; Li M.; Mao H.; Xu
X.; Ma S.-P.; Xiao P.; Jiang S.
Institution
(Shi, Fan, Yang, Zhang, Li, Jiang) Clinical Metabolomics Center, China
Pharmaceutical University, Nanjing, China
(Shi, Fan, Yang, Zhang, Li, Ma) State Key Laboratory of Natural Medicines,
China Pharmaceutical University, Nanjing, China
(Liu, Wu, Li, Mao, Xu) Department of Nephrology, Jiangsu Province
Hospital, Nanjing, China
(Xiao) Department of Cardiology, The Affiliated Sir Run Run Hospital of
Nanjing Medical University, Nanjing, China
(Jiang) Department of Infectious Diseases, Nanjing Hospital of Chinese
Medicine, Nanjing University of Chinese Medicine, Nanjing, China
Publisher
Frontiers Media S.A. (c/o Michael Kenyon, ch. de la Pecholettaz 6,
Epalinges 1066, Switzerland. E-mail: info@frontiersin.org)
Abstract
Objective: To determine the relationship between obesity and the risk of
AKI after cardiac surgery (CS-AKI) in a cohort study. Method(s): A
total of 1,601 patients undergoing cardiac surgery were collected and
their incidence of CS-AKI was recorded. They were divided into
underweight, normal weight, overweight, and obese groups. Logistic
regression was used to estimate the association between BMI (body mass
index) and CS-AKI risk. Then, a meta-analysis of published cohort studies
was conducted to confirm this result using PubMed and Embase databases.
 Result(s): A significant association was observed in this independent
cohort after adjusting age, gender, hypertension and New York Heart
Association classification (NYHA) class. Compared with normal BMI group
(18.5 <= BMI < 24.0), the individuals with aberrant BMI level had an
increased AKI risk (OR: 1.68, 95% CI: 1.01-2.78) for BMI < 18.5 group and
(OR: 1.43, 95% CI: 0.96-2.15) for BMI >= 28.0. Interestingly, the U-shape
curve showed the CS-AKI risk reduced with the increasing of BMI when BMI
<= 24.0. As BMI increases with BMI > 24.0, the risk of developing CS-AKI
increased significantly. In the confirmed meta-analysis, compared with
normal weight, overweight group with cardiac surgery had higher AKI risk
(OR: 1.28, 95% CI: 1.16-1.41, P<inf>heterogeneity</inf> = 0.49). The
similar association was found in obesity subgroup (OR: 1.79, 95% CI:
1.57-2.03, P<inf>heterogeneity</inf> = 0.42). Conclusion(s): In
conclusion, the results suggested that abnormal BMI was a risk factor for
CS-AKI independently. © Copyright © 2020 Shi, Liu, Fan,
Yang, Zhang, Li, Wu, Li, Mao, Xu, Ma, Xiao and Jiang.

<19>
Accession Number
633101036
Title
Ultrathin-strut biodegradable polymer versus durable polymer drug-eluting
stents: a meta-analysis.
Source
Open Heart. 7 (2) (no pagination), 2020. Article Number: e001394. Date of
Publication: 12 Oct 2020.
Author
Monjur M.R.; Said C.F.; Bamford P.; Parkinson M.; Szirt R.; Ford T.
Institution
(Monjur, Said, Bamford, Parkinson, Ford) Department of Cardiology, Central
Coast Local Health District, Gosford, NSW, Australia
(Monjur, Bamford, Ford) Faculty of Health and Medicine, University of
Newcastle, Callaghan, NSW, Australia
(Szirt) Department of Cardiology, St George Hospital, Sydney, NSW,
Australia
(Ford) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, United Kingdom
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Objectives Determine whether an ultrathin biodegradable polymer
sirolimus-eluting stent ('Orsiro' -BP-SES) has clinical benefits over
second-generation durable polymer drug-eluting stents (DP-DES). Methods We
conducted a prospective systematic review and meta-analysis of randomised
clinical trials comparing Orsiro BP-SES against DP-DES (PROSPERO
Registration: CRD42019147136). The primary outcome was target lesion
failure (TLF): composite of cardiac death, target vessel myocardial
infarction (TVMI) and clinically indicated target lesion revascularisation
(TLR)) evaluated at the longest available follow-up. Results Nine trials
randomised 11 302 patients to either Orsiro BP-SES or DP-DES. At mean
weighted follow-up of 2.8 years, the primary outcome (TLF) occurred in 501
of 6089 (8.2%) participants with BP-SES compared with 495 of 5213 (9.5%)
participants with DP-DES. This equates to an absolute risk reduction of
1.3% in TLF in favour of Orsiro BP-SES (OR 0.82; 95% CI 0.69 to 0.98;
p=0.03). This was driven by a reduction in TVMI (OR 0.80; 95% CI 0.65 to
0.98; p=0.03). There were no significant differences in other clinical
endpoints: cardiac death, TLR and stent thrombosis. Conclusion The Orsiro
BP-SES shows promising clinical outcomes in patients undergoing
percutaneous coronary intervention compared with contemporary
second-generation DES at a short to medium term follow-up. More research
is warranted to evaluate performance over a longer follow-up period and in
different clinical and lesion subsets. Copyright © Author(s) (or
their employer(s)) 2020.

<20>
Accession Number
2008381014
Title
High-Flow Nasal Cannula in the Immediate Postoperative Period: A
Systematic Review and Meta-analysis.
Source
Chest. 158 (5) (pp 1934-1946), 2020. Date of Publication: November 2020.
Author
Chaudhuri D.; Granton D.; Wang D.X.; Burns K.E.A.; Helviz Y.; Einav S.;
Trivedi V.; Mauri T.; Ricard J.-D.; Mancebo J.; Frat J.-P.; Jog S.;
Hernandez G.; Maggiore S.M.; Mbuagbaw L.; Hodgson C.L.; Jaber S.; Goligher
E.C.; Brochard L.; Rochwerg B.
Institution
(Chaudhuri, Granton, Rochwerg) Department of Medicine, McMaster
University, Hamilton
(Mbuagbaw, Rochwerg) Department of Health Research Methods, Evidence and
Impact, McMaster University, Hamilton
(Wang) Schulich School of Medicine, Western University, London
(Goligher, Brochard) Interdepartmental Division of Critical Care Medicine,
University of Toronto, Toronto, ON, Canada
(Brochard) Keenan Research Centre for Biomedical Science, Li Ka Shing
Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
(Burns, Trivedi, Jaber) Department of Anaesthesiology and Critical Care
Medicine B (DAR B), Saint-Eloi Teaching Hospital, PhyMed Exp, INSERM
U1046, University of Montpellier, Montpellier
(Ricard) Assistance Publique-Hopital de Paris, Service de Reanimation
Medico-chirurgicale, Hopital Louis Mourier, Colombes, France
(Ricard) Universite de Paris, INSERM, IAME, UMR 1137, Paris
(Frat) CHU de Poitiers, Medecine Intensive Reanimation, Poitiers, France
(Frat) INSERM, CIC-1402, equipe ALIVE, Poitiers, France
(Frat) Universite de Poitiers, Faculte de Medecine et de Pharmacie de
Poitiers, Poitiers, France
(Helviz, Einav) General Intensive Care Unit, Shaare Zedek Medical Center,
Jerusalem, Israel
(Einav) Faculty of Medicine, Hebrew University, Jerusalem, Israel
(Mauri) Dipartimento di fisopatologia medico-chirurgica e dei trapianti,
Universita degli Studi di Milano, Milan
(Mauri) Department of Anesthesia, Critical Care and Emergency, Fondazione
IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan
(Maggiore) Department of Medical, Oral and Biotechnological Sciences,
Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
(Maggiore) Department of Anesthesiology and Critical Care, SS. Annunziata
Hospital, Chieti, Italy
(Mancebo) Servei de Medicina Intensiva, Hospital Universitari Sant Pau,
Barcelona, Spain
(Jog) Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital
and Research Centre, Pune, India
(Hernandez) University Hospital Virgen de la Salud, Toledo, Spain
(Hodgson) Department of Epidemiology and Preventive Medicine, Australian
and New Zealand Intensive Care Research Centre, Monash University,
Melbourne, VIC, Australia
Publisher
Elsevier Inc.
Abstract
Background: Studies have demonstrated that high-flow nasal cannula (HFNC)
prevents intubation in acute hypoxic respiratory failure when compared
with conventional oxygen therapy (COT). However, the data examining
routine HFNC use in the immediate postoperative period are less clear.
Research Question: Is routine HFNC use superior to COT or noninvasive
ventilation (NIV) use in preventing intubation in patients
postoperatively? Study Design and Methods: We comprehensively searched
databases (PubMed, Embase, Web of Science) to identify randomized
controlled trials (RCTs) that compared the effect of HFNC use with that of
COT or NIV in the immediate postoperative period on reintubation,
escalation of respiratory support, hospital mortality, ICU and hospital
length of stay (LOS), postoperative hypoxemia, and treatment
complications. We assessed individual study risk of bias (RoB) by using
the revised Cochrane RoB 2 tool and rated certainty in outcomes by using
the Grading of Recommendations Assessment, Development and Evaluation
framework. Result(s): We included 11 RCTs enrolling 2,201 patients.
Ten compared HFNC with COT and one with NIV. Compared with COT use, HFNC
use in the postoperative period was associated with a lower reintubation
rate (relative risk [RR], 0.32; 95% CI, 0.12-0.88; absolute risk reduction
[ARR], 2.9%; moderate certainty) and decreased escalation of respiratory
support (RR, 0.54; 95% CI, 0.31-0.94; ARR, 5.8%; very low certainty). Post
hoc subgroup analysis suggested that this effect was driven by patients
who were obese and/or at high risk (subgroup differences, P = .06). We did
not find differences in any of the other stated outcomes between HFNC and
COT. HFNC was also no different from NIV in reintubation rate, respiratory
therapy failure, or ICU LOS. Interpretation(s): With evidence of
moderate certainty, prophylactic HFNC reduces reintubation and escalation
of respiratory support compared with COT in the immediate postoperative
period after cardiothoracic surgery. This effect is likely driven by
patients who are at high risk and/or obese. These findings support
postoperative prophylactic HFNC use in the patients who are at high risk
and/or obese undergoing cardiothoracic surgery. Copyright © 2020
American College of Chest Physicians

<21>
Accession Number
2008378029
Title
Global Longitudinal Strain Predicts Survival and Left Ventricular Function
After Mitral Valve Surgery: A Meta-analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Canessa M.; Thamman R.; Americo C.; Soca G.; Dayan V.
Institution
(Canessa, Americo, Soca, Dayan) National Institute of Cardiac Surgery,
Montevideo, Uruguay
(Thamman) School of Medicine, University of Pittsburgh, Pittsburgh, PA,
United States
(Dayan) Centro Cardiovascular Universitario, Montevideo, Uruguay
Publisher
W.B. Saunders
Abstract
The timing for surgical treatment in patients with primary organic severe
mitral valve regurgitation and preserved left ventricular ejection
fraction (LVEF) systolic is a challenge since it depends upon LV end
systolic dimension and LVEF which may be late markers of LV dysfunction.
Echocardiography is the most important tool in the diagnosis of
mechanisms, etiology, severity, and hemodynamic consequences of mitral
regurgitation. The global longitudinal strain (GLS), a new and sensitive
method for the detection of LV dysfunction, might be a useful method for
the evaluation of preclinical systolic dysfunction. Nevertheless, its role
for predicting postoperative outcomes is not well established. A
meta-analysis was performed to address the role of GLS in patients with
severe mitral regurgitation and preserved LVEF who underwent mitral
surgery. We included studies that compared outcomes according to
preoperative GLS in regard to survival and postoperative LV function. We
included 2358 patients enrolled in 8 studies. Patients with reduced GLS%
had worse long term survival after mitral valve surgery (hazard ratio =
1.13, 95% confidence interval [CI]: 1.02-1.26). Patients with
preoperatively reduced GLS% had lower LVEF after surgery (mean difference
[MD] = -5.06%, 95% CI: -8.97-1.16%) and additionally, patients who
presented postoperative LVEF dysfunction had worse preoperative GLS (MD =
4.33, 95% CI: 3.89-4.76). In patients with primary mitral regurgitation,
preoperative GLS is a predictor for long term survival and postoperative
LVEF. It is a useful parameter to be included when considering early
surgery in patients with severe mitral regurgitation and normal
LVEF. Copyright © 2020 Elsevier Inc.

<22>
Accession Number
2007063508
Title
Long-term follow-up of percutaneous coronary intervention versus coronary
artery bypass grafting in left main coronary artery disease: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Garg A.; Rout A.; Raheja H.; Hakeem H.; Sharma S.
Institution
(Garg, Sharma) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Rout) Division of Cardiology, Einstein Medical Center Philadelphia,
Philadelphia, PA, United States
(Raheja) Division of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Hakeem) Division of Cardiology, Newark Beth Israel Medical center,
Newark, NJ, United States
Publisher
John Wiley and Sons Inc (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail: info@wiley.com)
Abstract
Objectives: We conducted a systematic review and meta-analysis to evaluate
the long-term outcomes of PCI compared to CABG in patients with LMCAD.
 Background(s): Recent data from randomized controlled trials (RCTs)
has raised concerns regarding the long-term efficacy and safety of
percutaneous coronary intervention (PCI) compared with coronary artery
bypass grafting (CABG) in patients with left main coronary artery disease
(LMCAD). Method(s): We searched MEDLINE and EMBASE databases for
published RCTs comparing PCI using stenting with CABG in patients with
LMCAD. Preferred reporting items for systematic review and meta-analysis
guidelines were used for the present study. End-points of interest were
all-cause mortality, cardiovascular (CV) mortality, myocardial infarction
(MI), stroke, and repeat revascularization at longest available follow-up.
Relevant data were collected and pooled odds ratio (OR) with 95%
confidence intervals (CI) was calculated using random-effects model.
 Result(s): Five RCTs including a total of 4,499 patients were
included in the final analysis. Mean duration of follow-up was 96 months.
The risks of all-cause mortality [OR 1.09 (95% CI 0.88-1.34)] and
cardiovascular mortality [1.14 (0.88-1.47)] were comparable between PCI
and CABG. There were no statistically significant differences between PCI
and CABG for MI [1.52 (0.98-2.37)] and stroke [0.84 (0.48-1.45)].
Conversely, repeat revascularization was significantly higher with PCI as
compared with CABG [1.82 (1.49-2.22)]. Conclusion(s): At long-term
follow-up, PCI is associated with similar risks of mortality but a higher
risk of repeat revascularization compared with CABG in LMCAD. Long-term
risk of MI with PCI compared to CABG needs to be further explored in
future studies. Copyright © 2020 Wiley Periodicals LLC

<23>
[Use Link to view the full text]
Accession Number
633226554
Title
Neuromuscular electrical stimulation in early rehabilitation of patients
with postoperative complications after cardiovascular surgery: A
randomized controlled trial.
Source
Medicine. 99 (42) (pp e22769), 2020. Date of Publication: 16 Oct 2020.
Author
Sumin A.N.; Oleinik P.A.; Bezdenezhnykh A.V.; Ivanova A.V.
Publisher
NLM (Medline)
Abstract
BACKGROUND: To evaluate the effectiveness of neuromuscular electrical
stimulation (NMES) in early rehabilitation of patients with postoperative
complications after cardiovascular surgery. METHOD(S): 37 patients
(25 men and 12 women) aged 45 to 70 years with postoperative complications
after cardiovascular surgery were included in the study. Eighteen patients
underwent NMES daily since postoperative day 3 until discharge in addition
to standard rehabilitation program (NMES group), and 19 patients underwent
standard rehabilitation program only (non-NMES group). The primary outcome
was the knee extensors strength at discharge in NMES group and in control.
Secondary outcomes were the handgrip strength, knee flexor strength, and
cross-sectional area (CSA) of the quadriceps femoris in groups at
discharge. RESULT(S): Baseline characteristics were not different
between the groups. Knee extensors strength at discharge was significantly
higher in the NMES group (28.1 [23.8; 36.2] kg on the right and 27.45
[22.3; 33.1] kg on the left) than in the non-NMES group (22.3 [20.1; 27.1]
and 22.5 [20.1; 25.9] kg, respectively; P < .001). Handgrip strength, knee
flexor strength, quadriceps CSA, and 6 minute walk distance at discharge
in the groups had no significant difference. CONCLUSION(S): This
pilot study shows a beneficial effect of NMES on muscle strength in
patients with complications after cardiovascular surgery. The use of NMES
showed no effect on strength of non-stimulated muscle, quadriceps CSA, and
distance of 6-minute walk test at discharge.Further blind randomized
controlled trials should be performed with emphasis on the effectiveness
of NEMS in increasing muscle strength and structure in these patients.

<24>
Accession Number
633225626
Title
The Effect of Melatonin on the Serum Level of Interleukin 6 and
Interleukin 9 in Coronary Artery Bypass Grafting Surgery.
Source
Asian journal of anesthesiology. 58 (1) (pp 35-44), 2020. Date of
Publication: 01 Mar 2020.
Author
Jouybar R.; Setoodeh M.; Saravi Z.F.; Ahmadi S.; Karami A.; Khademi S.;
Izadpanah A.; Jannati M.; Shafa M.; Asadpour E.; Masih F.; Malekzadeh M.
Institution
(Jouybar, Karami) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Setoodeh, Izadpanah) Anesthesiology and Critical Care Research Center,
Shiraz University of Medical Science, Shiraz, Iran, Islamic Republic of
(Saravi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Ahmadi) Fasa University of Medical Science, Fasa, Iran, Islamic Republic
of
(Khademi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Jannati, Shafa) Assosiated Professor of Cardiovascular Surgery,
Cardiovascular Research Center, Shiraz University of Medical Science,
Shiraz, Iran, Islamic Republic of
(Asadpour) Assosiated Professor of Pharmacology, Anesthesiology and
Critical Care Research Center, Shiraz University of Medical Science,
Shiraz, Iran, Islamic Republic of
(Masih) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Malekzadeh) Shiraz Institute for Cancer Research, School of Medicine,
Shiraz University of Medical Science, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Cardiopulmonary bypass has been recognized as one of the main
causes of systemic inflammatory response syndrome, leading to
post-operative complications. The aim of this study was to investigate the
effect of melatonin on the serum levels of interleukin 6 (IL-6) and IL-9
in patients undergoing coronary artery bypass grafting surgery.
 METHOD(S): Forty-four patients undergoing elective coronary artery
bypass surgery were randomly allocated into two study groups of melatonin
(n = 23) and placebo (n = 21). Patients in the melatonin group received
two melatonin tablet, 5 mg daily for 3 days before surgery, 10 mg tablet
(two doses of 5 mg) 1 h before induction of anesthesia and finally, 10 mg
melatonin tablet in the intensive care unit, placebo group patients
received placebo at the same time periods. Serum levels of IL-9 and IL-6
were measured as baseline (T1), before induction of anesthesia (T2), 6 and
24 h after off pump (T3, T4). Data were analyzed using SPSS 23 software
(IBM Corp., Armonk, NY, USA). RESULT(S): The mean serum level of IL-6
was significantly lower in the melatonin group at T3 and T4 (p < 0.05).
Also, in both groups, serum levels of IL-6 in T3 showed a significant
increase compared to T1. Serum levels of IL-9 had no significant
difference between the two groups at T1, T2, T3, and T4.
 CONCLUSION(S): The results of this study showed that pre-operative
melatonin administration could modify inflammatory cytokines secretion
such as IL-6 while it has no significant effect on the serum levels of IL-
9. Neither of the changes was clinically significant.

<25>
Accession Number
633225125
Title
An invited commentary on: "Effect of acute normovolemic hemodilution on
coronary artery bypass grafting: a systematic review and meta-analysis of
22 randomized trials".
Source
International journal of surgery (London, England). (no pagination), 2020.
Date of Publication: 17 Oct 2020.
Author
Akay S.; Akay H.
Institution
(Akay) Emergency Medicine Clinic, University of Health Sciences, Izmir
Bozyaka Education and Research Hospital, Izmir, Turkey
(Akay) Emergency Medicine Clinic, University of Health Sciences, Izmir
Bozyaka Education and Research Hospital, Izmir, Turkey
Publisher
NLM (Medline)

<26>
Accession Number
633224809
Title
Polygenic Contribution to Low-Density Lipoprotein Cholesterol Levels and
Cardiovascular Risk in Monogenic Familial Hypercholesterolemia.
Source
Circulation. Genomic and precision medicine. 13 (5) (pp 515-523), 2020.
Date of Publication: 01 Oct 2020.
Author
Trinder M.; Paquette M.; Cermakova L.; Ban M.R.; Hegele R.A.; Baass A.;
Brunham L.R.
Institution
(Trinder, Brunham) Centre for Heart Lung Innovation (M.T., University of
British Columbia, Vancouver, Canada
(Trinder, Brunham) Experimental Medicine Program (M.T., University of
British Columbia, Vancouver, Canada
(Paquette, Baass) Nutrition, Metabolism and Atherosclerosis Clinic,
Institut de recherches cliniques de Montreal
(Cermakova, Brunham) Healthy Heart Program Prevention Clinic, St Paul's
Hospital, British Columbia (L.C., Vancouver, Canada
(Ban, Hegele) Departments of Medicine and Biochemistry, Schulich School of
Medicine and Dentistry and Robarts Research Institute, Western University,
London
(Baass) Departments of Medicine, McGill University, Montreal, QC, France
(Brunham) Departments of Medicine and Medical Genetics (L.R.B.),
University of British Columbia, Vancouver, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Familial hypercholesterolemia (FH) is a common autosomal
codominant genetic disorder, which causes elevated levels of low-density
lipoprotein cholesterol (LDL-C) and increased risk of premature
atherosclerotic cardiovascular disease (ASCVD). Even among individuals
with monogenic FH, there is substantial interindividual variability in
LDL-C levels and risk of ASCVD. We assessed the influence of an LDL-C
polygenic score on levels of LDL-C and risk of ASCVD for individuals with
monogenic FH. METHOD(S): We constructed a weighted LDL-C polygenic
score, composed of 28 single-nucleotide variants, for individuals with
monogenic FH from the British Columbia FH (n=262); Nutrition, Metabolism
and Atherosclerosis Clinic (n=552); and UK Biobank cohorts (n=306). We
assessed the association between LDL-C polygenic score with LDL-C levels
and ASCVD risk using linear regression and Cox-proportional hazard models,
respectively. ASCVD was defined as myocardial infarction, coronary or
carotid revascularization, transient ischemic attack, or stroke. The
results from individual cohorts were combined in fixed-effect
meta-analyses. RESULT(S): Levels of LDL-C were significantly
associated with LDL-C polygenic score in the Nutrition, Metabolism and
Atherosclerosis Clinic cohort, UK Biobank cohort, and in the meta-analysis
(beta [95% CI]=0.13 [0.072-0.19] per a 20% increase in LDL-C polygenic
score percentile, P<0.0001). Additionally, an elevated LDL-C polygenic
score (>=80th percentile) was associated with a trend towards increased
ASCVD risk in all 3 cohorts individually. This association was
statistically significant in the meta-analysis (hazard ratio [95% CI]=1.48
[1.02-2.14], P=0.04). CONCLUSION(S): Polygenic contributions to LDL-C
explain some of the heterogeneity in clinical presentation and ASCVD risk
for individuals with FH.

<27>
Accession Number
633220994
Title
Transcatheter Aortic Valve Replacement in Low-risk Patients with Bicuspid
Aortic Valve Stenosis.
Source
JAMA Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Forrest J.K.; Ramlawi B.; Deeb G.M.; Zahr F.; Song H.K.; Kleiman N.S.;
Chetcuti S.J.; Michelena H.I.; Mangi A.A.; Skiles J.A.; Huang J.; Popma
J.J.; Reardon M.J.
Institution
(Forrest, Mangi) Departments of Internal Medicine (Cardiology) and Surgery
(Cardiac Surgery), Yale University School of Medicine, 789 Howard Ave,
Dana 3 Cardiology Section, New Haven, CT 06519, United States
(Ramlawi, Skiles) Department of Cardiothoracic Surgery and Cardiology,
Valley Health System, Winchester, VA, United States
(Deeb, Chetcuti) Departments of Cardiac Surgery and Interventional
Cardiology, University of Michigan Hospitals, Ann Arbor, United States
(Zahr, Song) Departments of Interventional Cardiology and Cardiothoracic
Surgery, Oregon Health and Science University, Portland, United States
(Kleiman, Reardon) Departments of Interventional Cardiology and
Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular
Institute, Houston, TX, United States
(Michelena) Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester,
MN, United States
(Huang) Department of Statistics, Medtronic, Minneapolis, MN, United
States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
Publisher
American Medical Association (E-mail: shirley.martin@ama-assn.org)
Abstract
Importance: The outcomes of transcatheter aortic valve replacement (TAVR)
in low-risk patients with bicuspid aortic valve stenosis have not been
studied in a large scale, multicentered, prospective fashion.
 Objective(s): To evaluate the procedural safety, efficacy, and 30-day
outcomes of TAVR in patients with bicuspid aortic stenosis at low surgical
risk. Design, Setting, and Participant(s): The Low Risk Bicuspid
Study is a prospective, single-arm trial study with inclusion/exclusion
criteria developed from the Evolut Low Risk Randomized Trial. Follow-up is
planned for 10 years. Patients underwent TAVR at 25 centers in the United
States who were also participating in the Evolut Low Risk Randomized Trial
from December 2018 to October 2019. Eligible patients had severe bicuspid
aortic valve stenosis and met American Heart Association/American College
of Cardiology guideline indications for aortic valve replacement.
 Intervention(s): Patients underwent attempted implant of an Evolut or
Evolut PRO transcatheter aortic valve, with valve size based on annular
measurements. Main Outcomes and Measures: The prespecified primary
end point was the incidence of all-cause mortality or disabling stroke at
30 days. The prespecified primary efficacy end point was device success
defined as the absence of procedural mortality, the correct position of 1
bioprosthetic heart valve in the proper anatomical location, and the
absence of more than mild aortic regurgitation postprocedure.
 Result(s): A total of 150 patients underwent an attempted implant.
Baseline characteristics include mean age of 70.3 (5.5) years, 48.0%
female (n = 72), and a mean Society of Thoracic Surgeons score of 1.4
(0.6%). Most patients (136; 90.7%) had Sievers type I valve morphology.
The incidence of all-cause mortality or disabling stroke was 1.3% (95% CI,
0.3%-5.3%) at 30 days. The device success rate was 95.3% (95% CI,
90.5%-98.1%). At 30 days, the mean (SD) AV gradient was 7.6 (3.7) mm Hg
and effective orifice area was 2.3 (0.7) cm2. A new permanent
pacemaker was implanted in 22 patients (15.1%). No patients had greater
than mild paravalvular leak. Conclusions and Relevance: Transcatheter
aortic valve replacement in low-surgical risk patients with bicuspid
aortic valve stenosis achieved favorable 30-day results, with low rates of
death and stroke and high device success rate. Trial Registration:
ClinicalTrials.gov Identifier: NCT03635424. Copyright © 2020
American Medical Association. All rights reserved.

<28>
Accession Number
633218194
Title
Prehabilitation before elective coronary artery bypass grafting surgery: a
scoping review protocol.
Source
JBI evidence synthesis. (no pagination), 2020. Date of Publication: 16 Oct
2020.
Author
Olsen D.B.; Pedersen P.U.; Noergaard M.W.
Institution
(Olsen) Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Pedersen, Noergaard) Danish Centre of Systematic Reviews: A JBI Centre of
Excellence, Centre of Clinical Guidelines, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
(Noergaard) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this scoping review is to identify and map
existing preoperative interventions, referred to as prehabilitation, in
adult patients awaiting coronary bypass grafting (CABG) surgery at home.
This scoping review also seeks to examine the feasibility and patient
experiences in order to inform clinical practice and underpin a future
systematic review. INTRODUCTION: As patients age, comorbidities become
more common. Strategies to improve postoperative outcomes and to
accelerate recovery are required in patients undergoing CABG.
Prehabilitation refers to a proactive process of increasing functional
capacity before surgery to improve the patient's capacity to withstand
upcoming physiologic stress and thus avoid postoperative complications.
INCLUSION CRITERIA: This scoping review will consider any studies
including adult patients awaiting CABG surgery at home. Studies will
provide information on any prehabilitation intervention to optimize
preoperative physical and psychological health status. Studies conducted
in any setting will be included. METHOD(S): The methodology will
follow the JBI recommendations for scoping reviews. Any published or
unpublished source of information will be considered. Studies published in
English, German, Danish, Swedish, and Norwegian will be included, with no
geographical or cultural limitations. Retrieved papers will be screened by
two independent reviewers, and a standardized tool will be used to extract
data from each included source. The results will be presented as a map of
the data extracted in a tabular form together with a narrative summary to
provide a description of the existing evidence.

<29>
Accession Number
633217653
Title
Colchicine for Secondary Prevention of Cardiovascular Disease: A
Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Source
The Canadian journal of cardiology. (no pagination), 2020. Date of
Publication: 16 Oct 2020.
Author
Samuel M.; Tardif J.-C.; Bouabdallaoui N.; Khairy P.; Dube M.-P.; Blondeau
L.; Guertin M.-C.
Institution
(Samuel, Bouabdallaoui, Khairy, Dube) Montreal Heart Institute, Universite
de Montreal, Montreal, Canada
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal,
Canada;
(Blondeau, Guertin) Montreal Health Innovations Coordinating Center,
Montreal, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Reduction of inflammation with colchicine has emerged as a
therapeutic option for secondary cardiovascular prevention in patients
with coronary artery disease (CAD). Our objective was to consolidate
evidence from randomized controlled trials (RCTs) evaluating the efficacy
and safety of low-dose colchicine for secondary cardiovascular prevention
among patients with CAD on standard medical therapy. METHOD(S): RCTs
comparing the incidence of cardiovascular events between patients with
clinically manifest CAD randomized to colchicine versus placebo (or no
colchicine) were included. The primary composite efficacy endpoint
included cardiovascular mortality, myocardial infarction (MI), ischemic
stroke, and urgent coronary revascularization. The DerSimonian and Laird
random effects model was used to calculate pooled hazard ratios (HRs) and
95% confidence intervals (CIs). RESULT(S): Four RCTs, with a pooled
sample size of 11,594 patients, were included (colchicine n=5774;
placebo/no colchicine n=5820). Included RCTs studied populations with
stable CAD (N=2) and acute coronary syndrome (N=2). Compared to placebo or
no colchicine, colchicine was associated with a statistically significant
reduction in the incidence of the primary composite endpoint [pooled HR
0.68 (95% CI 0.54-0.81); I2=37.7%]. The reduction in cardiovascular events
among patients randomized to colchicine was driven by statistically
significant reductions in MIs, ischemic strokes, and urgent coronary
revascularizations (p<0.05 for all) and was relatively consistent among
subgroups. The incidence of safety outcomes did not differ between groups
(p>0.05). CONCLUSION(S): In secondary cardiovascular prevention, the
addition of low-dose colchicine to standard medical therapy reduces the
incidence of major cardiovascular events, except cardiovascular mortality,
when compared to standard medical therapy alone. Copyright ©
2020. Published by Elsevier Inc.

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

<31>
Accession Number
365182019
Title
Tacrolimus-induced nephrotoxicity and genetic variability: A review.
Source
Annals of Transplantation. 17 (2) (pp 111-121), 2012. Date of Publication:
2012.
Author
Gijsen V.M.G.J.; Madadi P.; Dube M.-P.; Hesselink D.A.; Koren G.; de Wildt
S.N.
Institution
(Gijsen, Madadi, Koren) Division of Clinical Pharmacology and Toxicology,
Hospital for Sick Children, Toronto, ON, Canada
(Gijsen, de Wildt) Department of Pediatric Surgery and Intensive Care,
Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
(Dube) Montreal Heart Institute Research Centre, Montreal, QC, Canada
(Dube) Department of Medicine, Universite de Montreal, Montreal, QC,
Canada
(Hesselink) Department of Internal Medicine, Division of Nephrology and
Renal Transplantation, Erasmus MC, Rotterdam, Netherlands
Publisher
Medical Science International (E-mail: iza.pranga@isl-science.com)
Abstract
Background: Calcineurin inhibition (CNI) is the mainstay of
immunosuppressant therapy for most solid organ transplant patients. High
tacrolimus levels are related with acute nephrotoxicity, but the
relationship with chronic toxicity is less clear. Variation in disposition
of tacrolimus is associated with genetic variation in CYP3A5. Hence, could
genetic variation in CYP3A5 or other genes involved in tacrolimus
disposition and effect be associated with a risk for tacrolimus-induced
nephrotoxicity? To perform a review of the literature and to identify if
genetic variation in CYP3A5 or other genes involved in tacrolimus
disposition or effect may be associated with tacrolimus-induced
nephrotoxicity and/or renal dysfunction in solid organ transplant
recipients. Material/Methods: Pubmed/Medline, Embase and Google were
searched from their inception till November 8th 2010 with the
search terms 'tacrolimus', 'genetics', and 'nephrotoxicity' or 'renal
dysfunction'. References of relevant articles were screened as well.
 Result(s): We identified 13 relevant papers. In kidney recipients,
associations between donor ABCB1, recipient CCR5 genotype and
tacrolimus-induced nephrotoxicity were found. CYP3A5 genotype studies in
kidney recipients yielded contradictory results. In liver recipients, a
possible association between recipient ACE, CYP3A5, ABCB1 and CYP2C8
genetic polymorphisms and tacrolimus-induced nephrotoxicity was suggested.
In heart recipients, TGF-beta genetic polymorphisms were associated with
tacrolimus-induced nephrotoxicity. The quality of the studies varied
considerably. Conclusion(s): Limited evidence suggests that variation
in genes involved in pharmacokinetics (ABCB1 and CYP3A5) and
pharmacodynamics (TGF-beta, CYP2C8, ACE, CCR5) of tacrolimus may impact a
transplant recipients' risk to develop tacrolimus-induced nephrotoxicity
across different transplant organ groups. © Ann Transplant, 2012.

<32>
Accession Number
633061650
Title
Classification of aerosol-generating procedures: A rapid systematic
review.
Source
BMJ Open Respiratory Research. 7 (1) (no pagination), 2020. Article
Number: e000730. Date of Publication: 09 Oct 2020.
Author
Jackson T.; Deibert D.; Wyatt G.; Durand-Moreau Q.; Adisesh A.; Khunti K.;
Khunti S.; Smith S.; Chan X.H.S.; Ross L.; Roberts N.; Toomey E.;
Greenhalgh T.; Arora I.; Black S.M.; Drake J.; Syam N.; Temple R.; Straube
S.
Institution
(Jackson, Deibert, Wyatt, Durand-Moreau, Straube) Division of Preventive
Medicine, Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Adisesh) Division of Occupational Medicine, Department of Medicine,
University of Toronto, Toronto, ON, Canada
(Khunti) Diabetes Research Centre, University of Leicester, Leicester,
United Kingdom
(Khunti) School of Medicine and Dentistry, Barts and the London School of
Medicine and Dentistry, London, United Kingdom
(Smith) Canadian Standards Biological Aerosols Group, Canadian Standards
Association, Toronto, ON, Canada
(Chan) Centre for Tropical Medicine and Global Health, Nuffield Department
of Medicine, University of Oxford, Oxford, Oxfordshire, United Kingdom
(Ross) Division of Infectious Diseases, Children's Hospital of Los
Angeles, Los Angeles, CA, United States
(Roberts) Bodleian Health Care Libraries, University of Oxford, Oxford,
Oxfordshire, United Kingdom
(Toomey) School of Allied Health, University of Limerick, Limerick,
Ireland
(Greenhalgh) Nuffield Department of Primary Care Health Sciences,
University of Oxford, Oxford, Oxfordshire, United Kingdom
(Arora, Black, Drake, Syam, Temple) Medical Sciences Division, University
of Oxford, Oxford, Oxfordshire, United Kingdom
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
In the context of covid-19, aerosol generating procedures have been
highlighted as requiring a higher grade of personal protective equipment.
We investigated how official guidance documents and academic publications
have classified procedures in terms of whether or not they are
aerosol-generating. We performed a rapid systematic review using preferred
reporting items for systematic reviews and meta-Analyses standards.
Guidelines, policy documents and academic papers published in english or
french offering guidance on aerosol-generating procedures were eligible.
We systematically searched two medical databases (medline, cochrane
central) and one public search engine (google) in march and april 2020.
Data on how each procedure was classified by each source were extracted.
We determined the level of agreement across different guidelines for each
procedure group, in terms of its classification as aerosol generating,
possibly aerosol-generating, or nonaerosol-generating. 128 documents met
our inclusion criteria; they contained 1248 mentions of procedures that we
categorised into 39 procedure groups. Procedures classified as
aerosol-generating or possibly aerosol-generating by >=90% of documents
included autopsy, surgery/postmortem procedures with high-speed devices,
intubation and extubation procedures, bronchoscopy, sputum induction,
manual ventilation, airway suctioning, cardiopulmonary resuscitation,
tracheostomy and tracheostomy procedures, non-invasive ventilation,
high-flow oxygen therapy, breaking closed ventilation systems, nebulised
or aerosol therapy, and high frequency oscillatory ventilation.
Disagreements existed between sources on some procedure groups, including
oral and dental procedures, upper gastrointestinal endoscopy, thoracic
surgery and procedures, and nasopharyngeal and oropharyngeal swabbing.
There is sufficient evidence of agreement across different international
guidelines to classify certain procedure groups as aerosol generating.
However, some clinically relevant procedures received surprisingly little
mention in our source documents. To reduce dissent on the remainder, we
recommend that (a) clinicians define procedures more clearly and
specifically, breaking them down into their constituent components where
possible; (b) researchers undertake further studies of aerosolisation
during these procedures; and (c) guideline-making and policy-making bodies
address a wider range of procedures. Copyright ©

<33>
[Use Link to view the full text]
Accession Number
632806002
Title
Anakinra in Recurrent Pericarditis: Current Evidence on Clinical Use,
Effectiveness, and Safety.
Source
Journal of Cardiovascular Pharmacology. 76 (1) (pp 42-49), 2020. Date of
Publication: 2020.
Author
Correia E.T.D.O.; Dos Santos Barbetta L.M.; De Almeida J.P.C.L.; Mesquita
E.T.
Institution
(Correia, Dos Santos Barbetta, De Almeida, Mesquita) Deparment of Clinical
Medicine, Universidade Federal Fluminense, 37 Miguel de Frias St, Niteroi,
Rio de Janeiro 24220-008, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Anakinra is a recombinant human interleukin 1 receptor antagonist that
competes and blocks the biologic effects of interleukin 1, reducing
systemic inflammatory responses. In the 2015 guidelines for the diagnosis
and management of pericardial diseases of the European Society of
Cardiology, anakinra was established as a third-line therapy option for
refractory recurrent pericarditis (RP). Recently, important studies that
investigates the effect and safety of anakinra in RP were published, such
as the AIRTRIP trial and the International Registry of Anakinra for
Pericarditis. This article presents the current evidence about the
effectiveness and safety of anakinra in RP and discusses its clinical
application and mechanisms. Copyright © 2020 Lippincott Williams
and Wilkins. All rights reserved.

<34>
Accession Number
630084623
Title
A Randomized Trial of Intravenous Thyroxine for Brain-Dead Organ Donors
With Impaired Cardiac Function.
Source
Progress in transplantation (Aliso Viejo, Calif.). 30 (1) (pp 48-55),
2020. Date of Publication: 01 Mar 2020.
Author
Dhar R.; Stahlschmidt E.; Marklin G.
Institution
(Dhar) Division of Neurocritical Care, Department of Neurology, Washington
University School of Medicine in St Louis, MO, United States
(Stahlschmidt, Marklin) Mid-America Transplant, St Louis, MO, USA
Publisher
NLM (Medline)
Abstract
RATIONALE: Brain death (BD) precipitates cardiac dysfunction impairing the
ability to transplant hearts from eligible organ donors. Retrospective
studies have suggested that thyroid hormone may enhance myocardial
recovery and increase hearts transplanted. We performed a randomized trial
evaluating whether intravenous thyroxine (T4) improves cardiac function in
BD donors with impaired ejection fraction (EF). METHOD(S): All
heart-eligible donors managed at a single-organ procurement organization
(OPO) underwent protocolized fluid resuscitation. Those weaned off
vasopressors underwent transthoracic echocardiography (TTE) within 12
hours of BD and, if EF was below 60%, were randomized to T4 infusion or no
T4 for 8 hours, after which TTE was repeated. RESULT(S): Of 77
heart-eligible donors, 36 were weaned off vasopressors. Ejection fraction
was depressed in 30, of whom 28 were randomized to T4 (n = 17) vs control
(n = 11). Baseline EF was comparable (45%, interquartile range [IQR]
42.5-47.5 vs 40%, 40-50, P = .32). Ejection fraction did not improve more
with T4 (10%, IQR 5-15 vs 5%, 0-12.5, P = .24), although there was a trend
to more hearts transplanted (59% vs 27%, P = .14). This difference
appeared to be accounted for by more donors with a history of drug use in
the T4 group, who exhibited greater improvements in EF (15% vs 0% without
drug use, P = .01) and more often had hearts transplanted (12 of 19 vs 1
of 9, P = .01). CONCLUSION(S): In this small randomized study of BD
donors with impaired cardiac function, T4 infusion did not result in
greater cardiac recovery. A larger randomized trial comparing T4 to
placebo appears warranted but would require collaboration across multiple
OPOs.

<35>
Accession Number
2004851609
Title
Preventive effect of low-dose landiolol on postoperative atrial
fibrillation study (PELTA study).
Source
General Thoracic and Cardiovascular Surgery. 68 (11) (pp 1240-1251), 2020.
Date of Publication: 01 Nov 2020.
Author
Sasaki K.; Kumagai K.; Maeda K.; Akiyama M.; Ito K.; Matsuo S.; Katahira
S.; Suzuki T.; Suzuki Y.; Kaiho Y.; Sugawara Y.; Tsuji I.; Saiki Y.
Institution
(Sasaki, Maeda, Akiyama, Ito, Matsuo, Katahira, Suzuki, Suzuki, Saiki)
Division of Cardiovascular Surgery, Tohoku University Graduate School of
Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
(Kumagai, Saiki) Research Division of Sciences for Aortic Disease, Tohoku
University Graduate School of Medicine, Sendai, Japan
(Kaiho, Sugawara, Tsuji) Division of Epidemiology, Department of Health
Informatics and Public Health, Tohoku University School of Public Health,
Graduate School of Medicine, Sendai, Japan
Publisher
Springer Japan (E-mail: orders@springer.jp)
Abstract
Objective: To investigate the efficacy of prophylactic administration of
low-dose landiolol on postoperative atrial fibrillation (POAF) in patients
after cardiovascular surgery. Method(s): Consecutive 150 patients
over 70 years of age who underwent cardiovascular surgery for valvular,
ischemic heart, and aortic diseases were enrolled in this single-center
prospective randomized control study from 2010 to 2014. They were assigned
to three treatment groups: 1gamma group (landiolol at 1 mug/kg/min),
2gamma group (landiolol at 2 mug/kg/min), or control group (no landiolol).
In the two landiolol groups, landiolol hydrochloride was intravenously
administered for a period of 4 days postoperatively. Electrocardiography
was continuously monitored during the study period, and cardiologists
eventually assessed whether POAF occurred or not. Result(s): POAF
occurred in 24.4% of patients in the control group, 18.2% in 1gamma group,
and 11.1% in 2gamma group (p = 0.256). Multivariate logistic regression
analysis showed that the incidence of POAF tended to decrease depending on
the dose of landiolol (trend-p = 0.120; 1gamma group: OR = 0.786, 95% CI
0.257-2.404; 2gamma group: OR = 0.379, 95% CI 0.112-1.287). Subgroup
analysis showed a significant dose-dependent reduction in POAF among
categories of female sex, non-use of angiotensin II receptor blockers
(ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and
0.004). Conclusion(s): These findings indicate that prophylactic
administration of low-dose landiolol may not be effective for preventing
the occurrence of POAF in overall patients after cardiovascular surgery,
but the administration could be beneficial to female patients, patients
not using ARBs preoperatively, and those after valvular
surgery. Copyright © 2020, The Author(s).

<36>
Accession Number
633140363
Title
Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation
in Saphenous Vein Grafts: Randomized Controlled Trial.
Source
Journal of the American Heart Association. 9 (20) (pp e017434), 2020. Date
of Publication: 20 Oct 2020.
Author
Fahrni G.; Farah A.; Engstrom T.; Galatius S.; Eberli F.; Rickenbacher P.;
Conen D.; Mueller C.; Pfister O.; Twerenbold R.; Coslovsky M.; Cattaneo
M.; Kaiser C.; Mangner N.; Schuler G.; Pfisterer M.; Mobius-Winkler S.;
Jeger R.V.
Institution
(Fahrni, Rickenbacher, Conen, Mueller, Pfister, Twerenbold, Coslovsky,
Cattaneo, Kaiser, Pfisterer, Jeger) University Hospital Basel Switzerland
(Farah) Klinikum Westfalen Dortmund Germany
(Farah) Central Clinic Bad Berka Germany
(Engstrom) Rigshospitalet Copenhagen Denmark
(Galatius) Bispebjerg University Hospital Copenhagen Denmark
(Galatius) Gentofte Hospital Hellerup Denmark
(Eberli) Triemli Hospital Zurich Switzerland
(Conen) Population Health Research Institute McMaster University Hamilton
Canada
(Mangner) Herzzentrum Dresden Technische Universitat Dresden Dresden
Germany
(Mangner, Schuler, Mobius-Winkler) Heart Center University of Leipzig
Germany
(Mobius-Winkler) University of Jena Germany
Publisher
NLM (Medline)
Abstract
Background Efficacy data on drug-eluting stents (DES) versus bare-metal
stents (BMS) in saphenous vein grafts are controversial. We aimed to
compare DES with BMS among patients undergoing saphenous vein grafts
intervention regarding long-term outcome. Methods and Results In this
multinational trial, patients were randomized to paclitaxel-eluting or
BMS. The primary end point was major adverse cardiac events (cardiac
death, nonfatal myocardial infarction, and target-vessel revascularization
at 1 year. Secondary end points included major adverse cardiac events and
its individual components at 5-year follow-up. One hundred seventy-three
patients were included in the trial (89 DES versus 84 BMS). One-year major
adverse cardiac event rates were lower in DES compared with BMS (2.2%
versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03-0.64, P=0.01), which was
mainly driven by a reduction of subsequent myocardial infarctions and need
for target-vessel revascularization. Five-year major adverse cardiac event
rates remained lower in the DES compared with the BMS arm (35.5% versus
56.1%, hazard ratio, 0.40; 95% CI, 0.23-0.68, P<0.001). A
landmark-analysis from 1 to 5 years revealed a persistent benefit of DES
over BMS (hazard ratio, 0.33; 95% CI, 0.13-0.74, P=0.007) in terms of
target-vessel revascularization. More patients in the BMS group underwent
multiple target-vessel revascularization procedures throughout the study
period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8],
P=0.013). Enrollment was stopped before the target sample size of 240
patients was reached. Conclusions In this randomized controlled trial with
prospective long-term follow-up of up to 5 years, DES showed a better
efficacy than BMS with sustained benefits over time. DES may be the
preferred strategy in this patient population. Registration URL:
https://www.clinicaltrials.gov; Unique identifier: NCT00595647.

<37>
[Use Link to view the full text]
Accession Number
633116879
Title
Impact of atrial fibrillation on outcomes of patients treated by
transcatheter mitral valve repair: A systematic review and meta-analysis.
Source
Medicine. 99 (40) (pp e22195), 2020. Date of Publication: 02 Oct 2020.
Author
Sun F.; Liu H.; Zhang Q.; Lu F.; Zhan H.; Zhou J.
Institution
(Sun, Lu, Zhan, Zhou) Department of Cardiovascular Surgery
(Liu) Department of Emergency
(Zhang) Department of Endovascular Surgery, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Conflicting data have been reported related to the impact of
atrial fibrillation (AF) on outcomes after transcatheter mitral valve
repair with MitraClip (MC) implantation. In this study, we assessed the
prognosis of MC-treated patients according to the presence of pre-existing
AF. METHOD(S): Randomized and observational studies reporting
outcomes of pre-existing AF or sinus rhythm in patients undergoing MC
treatment were identified with an electronic search. Outcomes of interest
were short-and long-term mortality, stroke, bleeding, rehospitalization,
myocardial infarction (MI), cardiogenic shock, acute procedure success,
the hospital stay, and the number of Clips implanted. RESULT(S):
Eight studies (8466 individuals) were eligible. Compared to sinus rhythm,
long-term mortality, the risk of bleeding, rehospitalization, and longer
hospital stay were significantly higher in AF groups, whereas similar
correlations were found in the analysis of other outcomes.
 CONCLUSION(S): AF may be related with worse outcomes in patients
undergoing MC implantation, including long-term mortality, major bleeding,
and rehospitalization. AF should be taken into account when referring a
patient for MC treatment.

<38>
Accession Number
2007739488
Title
Effects of teriparatide and bisphosphonate on spinal fusion procedure: A
systematic review and network meta-analysis.
Source
PLoS ONE. 15 (9 September) (no pagination), 2020. Article Number:
e0237566. Date of Publication: September 2020.
Author
Cheng S.-H.; Kuo Y.-J.; Chen C.; Kang Y.-N.
Institution
(Cheng, Kuo) Department of Orthopedics, Wan Fang Hospital, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Cheng) Department of Orthopedics, Cheng Hsin General Hospital, Taipei,
Taiwan (Republic of China)
(Kuo) Department of Orthopedic Surgery, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen) Department of Public Health, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen, Kang) Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Chen) Division of Plastic Surgery, Department of Surgery, Wan Fang
Hospital, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Chen, Kang) Evidence-Based Medicine Center, Wan Fang Hospital, Taipei
Medical University, Taipei, Taiwan (Republic of China)
(Kang) Research Center of Big Data and Meta-Analysis, Wan Fang Hospital,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Kang) Institute of Health Policy & Management, College of Public Health,
National Taiwan University, Taipei, Taiwan (Republic of China)
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Giving patients anti-osteoporotic agents peri-operatively is a
well-accepted strategy to increase fusion rate and prevent complications.
The purpose of this study was to investigate effectiveness of teriparatide
and bisphosphonate on fusion surgery of thoracic and lumbar spine. Methods
We searched EMBASE and PubMed for randomized clinical trials (RCTs) and
prospective comparative studies using teriparatide or bisphosphonate in
peri-operative spinal fusion surgery. Our synthesized data of fusion rate,
Oswestry disability index (ODI), and adverse event in contrast-based
network meta-analysis. Pooled results were presented in risk ratio (RR) or
mean difference (MD) with 95% confidence interval (CI). Results Our search
hit eight RCTs and three prospective studies with 676 patients receiving
spinal surgery. Pooled result showed that teriparatide+Denosumab leads to
significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to
6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not
observe significant finding among placebo, teriparatide, and
bisphosphonate in the two network models. Conclusion This is the first
network meta-analysis providing an overview of the use of teriparatide and
bisphosphonate for spinal fusion surgery. Teriparatide treatments are
worth to be consider for spinal fusion surgery. Copyright © 2020
Cheng et al. This is an open access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<39>
Accession Number
2006708365
Title
Preoperative left stellate ganglion block: Does it offer
arrhythmia-protection during off-pump CABG surgery? A randomized clinical
trial.
Source
Egyptian Journal of Anaesthesia. 36 (1) (pp 194-200), 2020. Date of
Publication: 01 Jan 2020.
Author
Abd Allah E.; Bakr M.A.; Abdallah Abdelrahman S.; Taha A.M.; Kamel E.Z.
Institution
(Abd Allah, Bakr, Abdallah Abdelrahman, Kamel) Departments of Anesthesia
and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
(Taha) Cardiothoracic Surgery, Faculty of Medicine, Assiut University,
Assiut, Egypt
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Cardiac arrhythmias are not uncommon during and after coronary
artery bypass graft cardiac surgeries. Preliminary studies showed the
preventive effects of stellate ganglion block upon cardiac arrhythmias;
however, this could be the 1st study focusing upon
intraoperative arrhythmias during offpump coronary artery bypass graft
surgery as a main goal. Method(s): This is a randomized controlled
trial. The study involved forty adult patients undergoing elective offpump
coronary artery bypass graft surgery. Twenty patients received left SGB
with 10 ml of 2% lidocaine before induction of anesthesia (B group), and
twenty patients as a control group (A group). Intraoperative and 24-hours
postoperative electrocardiogram and hemodynamics were monitored, in
addition to the mean postoperative 24-hours inotropic score.
 Result(s): There was a significantly higher incidence of
intraoperative arrhythmias in the control group in the form of
bradyarrhythmia (25%), supraventricular tachycardia (30%), atrial
fibrillation (5%), ventricular tachycardia (10%), and ventricular
fibrillation (5%) in comparison to the block group where atrial
fibrillation occurred only in 4 patients (20%) with the p value of 0.007.
Mean arterial blood pressure and heart rate showed significantly lower
values in the SGB group intraoperatively. Postoperative mean 24-hour
inotropic score and hemodynamics showed insignificant differences.
 Conclusion(s): Preoperative left stellate ganglion block can decrease
incidence of arrhythmias during offpump coronary artery bypass graft
surgeries. The technique showed a safe profile upon hemodynamics during
the study period. Copyright © 2020 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<40>
Accession Number
2005267195
Title
Echocardiographic L-wave as a prognostic indicator in transcatheter aortic
valve replacement.
Source
International Journal of Cardiovascular Imaging. 36 (10) (pp 1897-1905),
2020. Date of Publication: 01 Oct 2020.
Author
Merdler I.; Richert E.; Hochstadt A.; Loewenstein I.; Morgan S.; Itach T.;
Topilsky Y.; Finkelstein A.; Laufer-Perl M.; Banai S.; Sadeh B.
Institution
(Merdler, Hochstadt, Loewenstein, Morgan, Itach, Topilsky, Finkelstein,
Laufer-Perl, Banai, Sadeh) Department of Cardiology, Tel-Aviv Sourasky
Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St,
Tel-Aviv 64239, Israel
(Richert) Tel Aviv University Medical School, Tel-Aviv, Israel
Publisher
Springer Science and Business Media B.V. (E-mail:
editorial@springerplus.com)
Abstract
This study applies L-wave measurements of mid-diastolic trans-mitral flow.
Although considered to be a marker of elevated filling pressure or delayed
myocardial relaxation, its clinical and prognostic value is yet to be
completely elucidated. It has been shown that transcatheter aortic valve
replacement (TAVR) induces reverse remodeling and improves diastolic
function and prognosis in patients with severe aortic stenosis (AS). Our
purpose was to evaluate the prognostic value of L-wave following TAVR. We
examined clinical and echocardiographic data of patients undergoing TAVR.
L-Wave presence and velocity were recorded at baseline and at 1 month and
6 months following TAVR. The effect of the procedure on L-wave
measurements and its impact on mortality and other clinical outcomes were
analyzed. A total of 502 patients (mean age 82.58 +/- 5.9) undergoing TAVR
were included. Patients with baseline L-wave (n = 68, 12%) had a smaller
stroke volume index by 5.7 +/- 2.3 ml/m2 (p = 0.01) as compared
to patients without L-wave at baseline. L-waves disappeared In 35% and 70%
of patients at 1 month and at 6 months respectively. Baseline L-wave
velocity was 34.8 +/- 11.5 (cm/s) and decreased significantly at follow-up
examinations. Patients with persistent L-wave following TAVR had higher
3-year adjusted mortality rates (HR 5.7, 95% CI 3.7-8.9, p < 0.001).
Multivariate analysis of survival was also statistically significant (p <
0.001). TAVR induces L-wave disappearance and a decrease in L-wave
velocity in patients with severe AS. L-wave persistence following TAVR is
an independent risk factor for mortality. Copyright © 2020,
Springer Nature B.V.

<41>
Accession Number
2004594703
Title
The effect of aromatherapy with rose and lavender on anxiety, surgical
site pain, and extubation time after open-heart surgery: A double-center
randomized controlled trial.
Source
Phytotherapy Research. 34 (10) (pp 2675-2684), 2020. Date of Publication:
01 Oct 2020.
Author
Babatabar Darzi H.; Vahedian-Azimi A.; Ghasemi S.; Ebadi A.; Sathyapalan
T.; Sahebkar A.
Institution
(Babatabar Darzi, Vahedian-Azimi, Ghasemi) Trauma Research Center, Nursing
Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ebadi) Behavioral Sciences Research Center, Life Style Institute, Nursing
Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Sathyapalan) Department of Academic Diabetes, Endocrinology and
Metabolism, Hull York Medical School, University of Hull, Hull, United
Kingdom
(Sahebkar) Halal Research Center of IRI, FDA, Tehran, Iran, Islamic
Republic of
(Sahebkar) Neurogenic Inflammation Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Biotechnology Research Center, Pharmaceutical Technology
Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
To determine the effect of aromatherapy with rose and lavender on the
patient outcomes after open-heart surgery (OHS). In the clinical trial,
patients were randomized to four groups. One group received routine care,
the placebo group received a cotton swab soaked in water and the other two
groups received either a cotton swab containing three drops of rose or
lavender essence (0.2 ml). A total of 160 patients were randomized into
four groups. Intergroup anxiety was not significantly different; however,
the reciprocal time-group effect was significant among the four groups.
The extubation time was significant among the four groups which related to
rose essence group compared with the control group (p <.001) and placebo
group (p =.029). The surgical site pain was significant in the rose
essence and lavender groups compared to the control group. Aromatherapy
can reduce extubation time, surgical site pain severity, and anxiety in
patients undergoing OHS. Copyright © 2020 John Wiley & Sons, Ltd.

<42>
Accession Number
632813872
Title
Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients
With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial
FIM-BGC-2014-01.
Source
Frontiers in Pharmacology. 11 (no pagination), 2020. Article Number: 1331.
Date of Publication: 26 Aug 2020.
Author
Guerrero-Orriach J.L.; Malo-Manso A.; Ramirez-Aliaga M.; Florez Vela A.I.;
Galan-Ortega M.; Moreno-Cortes I.; Gonzalez-Almendros I.;
Ramirez-Fernandez A.; Ariza-Villanueva D.; Escalona-Belmonte J.J.;
Quesada-Munoz G.; Sepulveda-Haro E.; Romero-Molina S.; Bellido-Estevez I.;
Gomez-Luque A.; Rubio-Navarro M.; Alcaide-Torres J.; Santiago-Fernandez
C.; Garrido-Sanchez L.; Cruz-Manas J.
Institution
(Guerrero-Orriach, Malo-Manso, Ramirez-Aliaga, Galan-Ortega,
Gonzalez-Almendros, Ramirez-Fernandez, Escalona-Belmonte, Quesada-Munoz,
Bellido-Estevez, Gomez-Luque, Alcaide-Torres, Santiago-Fernandez,
Garrido-Sanchez) Institute of Biomedical Research in Malaga [IBIMA],
Malaga, Spain
(Guerrero-Orriach, Malo-Manso, Ramirez-Aliaga, Florez Vela, Galan-Ortega,
Moreno-Cortes, Ramirez-Fernandez, Ariza-Villanueva, Escalona-Belmonte,
Quesada-Munoz, Sepulveda-Haro, Romero-Molina, Gomez-Luque, Rubio-Navarro,
Cruz-Manas) Department of Anaesthesiology, Virgen de la Victoria
University Hospital, Malaga, Spain
(Guerrero-Orriach, Bellido-Estevez, Gomez-Luque) Department of
Pharmacology and Pediatrics, School of Medicine, University of Malaga,
Malaga, Spain
(Alcaide-Torres, Santiago-Fernandez, Garrido-Sanchez) Unidad de Gestion
Clinica de Endocrinologia y Nutricion, Virgen de la Victoria University
Hospital, Malaga, Spain
(Santiago-Fernandez, Garrido-Sanchez) CIBER Fisiopatologia de la Obesidad
y Nutricion-CIBEROBN, Instituto de Salud Carlos III, Malaga, Spain
Publisher
Frontiers Media S.A. (c/o Michael Kenyon, ch. de la Pecholettaz 6,
Epalinges 1066, Switzerland. E-mail: info@frontiersin.org)
Abstract
Background: Low-cardiac output syndrome (LCOS) after cardiac surgery
secondary to systemic hypoperfusion is associated with a higher incidence
of renal and neurological damage. A range of effective therapies are
available for LCOS. The beneficial systemic effects of levosimendan
persist even after cardiac output is restored, which suggests an
independent cardioprotective effect. Method(s): A double-blind
clinical trial was conducted in patients with a confirmed diagnosis of
LCOS randomized into two treatment groups (levosimendan vs. dobutamine).
Monitoring of hemodynamic (cardiac index, systolic volume index, heart
rate, mean arterial pressure, central venous pressure, central venous
saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP,
troponin I); and renal parameters was performed using acute kidney injury
scale (AKI scale) and renal and brain ultrasound measurements [vascular
resistance index (VRI)] at diagnosis and during the first 48 h.
 Result(s): Significant differences were observed between groups in
terms of cardiac index, systolic volume index, NT-proBNP, and kidney
injury stage at diagnosis. In the levosimendan group, there were
significant variations in AKI stage after 24 and 48 h. No significant
differences were observed in the other parameters studied.
 Conclusion(s): Levosimendan showed a beneficial effect on renal
function in LCOS patients after cardiac surgery that was independent from
cardiac output and vascular tone. This effect is probably achieved by
pharmacological postconditioning. Clinical Trial Registration: EUDRA CT,
identifier 2014-001461-27.
https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-
27. © Copyright © 2020 Guerrero-Orriach, Malo-Manso,
Ramirez-Aliaga, Florez Vela, Galan-Ortega, Moreno-Cortes,
Gonzalez-Almendros, Ramirez-Fernandez, Ariza-Villanueva,
Escalona-Belmonte, Quesada-Munoz, Sepulveda-Haro, Romero-Molina,
Bellido-Estevez, Gomez-Luque, Rubio-Navarro, Alcaide-Torres,
Santiago-Fernandez, Garrido-Sanchez and Cruz-Manas.

<43>
Accession Number
2007008517
Title
The effect of levosimendan on postoperative bleeding and blood transfusion
in cardiac surgical patients: a PRISMA-compliant systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Yao Y.-T.; He L.-X.; Zhao Y.-Y.
Institution
(Yao, He, Zhao) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Levosimendan (LEVO), is an inotropic agent which has been
shown to be associated with better myocardial performance, and higher
survival rate in cardiac surgical patients. However, preliminary clinical
evidence suggested that LEVO increased the risk of post-operative bleeding
in patients undergoing valve surgery. Currently, there has been no
randomized controlled trials (RCTs) designed specifically on this issue.
Therefore, we performed present systemic review and meta-analysis.
 Method(s): Electronic databases were searched to identify all RCTs
comparing LEVO with Control (placebo, blank, dobutamine, milrinone, etc).
Primary outcomes include post-operative blood loss and re-operation for
bleeding. Secondary outcomes included post-operative transfusion of red
blood cells (RBC), fresh frozen plasma (FFP) and platelet concentrates
(PC). For continuous variables, treatment effects were calculated as
weighted mean difference (WMD) and 95% confidential interval (CI). For
dichotomous data, treatment effects were calculated as odds ratio (OR) and
95% CI. Result(s): Search yielded 15 studies including 1,528
patients. Meta-analysis suggested that, LEVO administration was not
associated with increased risk of reoperation for bleeding
post-operatively (OR = 1.01; 95%CI: 0.57 to 1.79; p = 0.97) and more blood
loss volume (WMD = 28.25; 95%CI: -19.21 to 75.72; p = 0.24). Meta-analysis
also demonstrated that, LEVO administration did not increase
post-operative transfusion requirement for RBC (rate: OR = 0.97; 95%CI:
0.72 to 1.30; p = 0.83 and volume: WMD = 0.34; 95%CI: -0.55 to 1.22; p =
0.46), FFP (volume: WMD = 0.00; 95%CI: -0.10 to 0.10; p = 1.00) and PC
(rate: OR = 1.01; 95%CI: 0.41 to 2.50; p = 0.98 and volume: WMD = 0.00;
95%CI: -0.05 to 0.04; p = 0.95). Conclusion(s): This meta-analysis
suggested that, peri-operative administration of LEVO was not associated
with increased risks of post-operative bleeding and blood transfusion
requirement in cardiac surgical patients. Copyright © The
Author(s) 2020.

<44>
Accession Number
2006953192
Title
Perspectives of Surgeons from Atlanta, USA.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Mohamed Ahmed E.; Chen E.P.
Institution
(Mohamed Ahmed, Chen) Division of Cardiothoracic Surgery, Department of
Surgery, Emory School of Medicine, Atlanta, GA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The COVID-19 pandemic in late 2019 quickly stretched health
care system across the globe. Mortalities, shortages in health care system
capacity, and lack of experience in similar circumstances required
innovation in the way health care is delivered. Health care systems
changed operating schedules, staff work pattern, and how patients are
cared for. The effects of these changes reached patients, staff and
training in different ways. Method(s): We searched the Pubmed and
EMBASE for articles related to COVID-19. We also searched local emails and
information provided to staff during the pandemic. Result(s): The
COVID-19 pandemic affected organizations, patients, and staff. The
organizations and staff had to adapt to the times to provide a safe and
appropriate service to our patients. Conclusion(s): The pandemic
challenged and changed the way we work as health care providers, and how
we train the future surgeons. Changes in the system were
effective. Copyright © 2020 Wiley Periodicals LLC

<45>
Accession Number
2005869927
Title
Transcatheter Versus Surgical Pulmonary Valve Replacement: A Systemic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1751-1761), 2020. Date of
Publication: November 2020.
Author
Ribeiro J.M.; Teixeira R.; Lopes J.; Costa M.; Pires A.; Goncalves L.
Institution
(Ribeiro, Teixeira, Lopes, Costa, Goncalves) Servico de Cardiologia,
Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
(Teixeira, Pires, Goncalves) Faculdade de Medicina da Universidade de
Coimbra, Coimbra, Portugal
(Pires) Servico de Cardiologia Pediatrica, Centro Hospitalar e
Universitario de Coimbra, Coimbra, Portugal
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Transcatheter pulmonary valve replacement (TPVR) has emerged
as an alternative to surgery in patients with pulmonary valve dysfunction.
 Method(s): We searched the Medline and Cochrane databases since their
inception to January 2019 as well as references from article, for all
publications comparing TPVR with surgical PVR (SPVR). Studies were
considered for inclusion if they reported comparative data regarding any
of the study endpoints. The primary endpoint was early mortality after
PVR. Secondary endpoints included procedure-related complications, length
of hospital stay, mortality during follow-up, infective endocarditis, need
for reintervention, post-PVR transpulmonary peak systolic gradient, and
significant pulmonary regurgitation. Result(s): There were no
differences in perioperative mortality between groups (0.2% vs 1.2%;
pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27,
I2 = 0%). However TPVR conferred a significant reduction in
procedure-related complications and length of hospital stay compared with
SPVR. Midterm mortality and the need for repeat intervention were similar
with both techniques, but pooled infective endocarditis was significantly
more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95%
confidence interval, 1.89-5.06; P < .001, I2 = 0%). TPVR was
associated with less significant PR and a trend towards a lower
transpulmonary systolic gradient during follow-up. Conclusion(s):
TPVR is a safe alternative to SPVR in selected patients and is associated
with a shorter length of hospital stay and fewer procedure-related
complications. At midterm follow-up TPVR was comparable with SPVR in terms
of mortality and repeat intervention but was associated with an increased
risk of infective endocarditis. Copyright © 2020 The Society of
Thoracic Surgeons

<46>
Accession Number
633190190
Title
Comparison of isoflurane, sevoflurane, and desflurane as inhalant
anesthetics in prairie rattlesnakes (Crotalus viridis).
Source
Journal of the American Veterinary Medical Association. 257 (9) (pp
945-949), 2020. Date of Publication: 01 Nov 2020.
Author
Kane L.P.; Chinnadurai S.K.; Vivirito K.; Strahl-Heldreth D.; Allender
M.C.
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To characterize induction and recovery characteristics of 3
commonly used inhalant anesthetics in prairie rattlesnakes (Crotalus
viridis): isoflurane, sevoflurane, and desflurane. ANIMALS: 12 healthy
adult prairie rattlesnakes. PROCEDURES: In a randomized crossover design,
snakes underwent anesthetic induction with 5% isoflurane, 8% sevoflurane,
or 18% desflurane, with a washout period of >= 7 days between anesthetic
events. Anesthetic depth parameters were recorded throughout induction and
recovery, including time to loss and return of righting reflex, muscle
tone, ability to intubate, response to pressure, and time to return to
spontaneous respiration. Every 5 minutes throughout the anesthetic
procedures, heart rate, respiratory rate, and percentage expired
anesthetic gas were recorded. RESULT(S): No snakes died during the
study. Sevoflurane anesthesia resulted in anesthetic gas avoidance
behavior in snakes during induction and had the significantly longest
recovery time to extubation and time to return of pressure response,
compared with the other inhalant anesthetics. Anesthesia with isoflurane
resulted in a significantly longer time to return of righting reflex,
compared with sevoflurane or desflurane. No significant difference was
noted in time to loss of pressure response among the 3 anesthetic gases.
Desflurane anesthesia resulted in the significantly quickest loss of
righting reflex among the anesthetic protocols; despite this, 4 of 12
desflurane anesthetized snakes did not achieve an anesthetic plane deep
enough for intubation. CONCLUSIONS AND CLINICAL RELEVANCE: Isoflurane and
sevoflurane, but not desflurane, inhalation anesthesia resulted in
consistent and predictable loss of righting reflex and induction of
anesthesia deep enough to allow intubation in snakes.

<47>
Accession Number
628521158
Title
Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic
Valve Implantation for Aortic Stenosis and Porcelain Aorta with a
Systematic Review of Transfemoral versus Transapical Approach.
Source
The Thoracic and cardiovascular surgeon. 68 (7) (pp 623-632), 2020. Date
of Publication: 01 Oct 2020.
Author
Useini D.; Haldenwang P.; Schlomicher M.; Christ H.; Naraghi H.;
Moustafine V.; Strauch J.
Institution
(Useini, Haldenwang, Schlomicher, Naraghi, Moustafine, Strauch) Department
of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum,
Germany
(Christ) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: We have aimed to analyze early and mid-term outcomes of
patients undergoing transapical/transfemoral transcatheter aortic valve
implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo)
in our institution. Additionally, we postulated that the TA approach may
be associated with a more favorable neurological outcome than the TF
approach; hence, a systematic literature review was conducted.
 METHOD(S): Between 2011 and 2017, 15 patients with PAo underwent
TA-TAVI and 4 patients with PAo TF-TAVI at our institution. The assessment
of PAo was done either intraoperatively after aborted sternotomy or via
computed tomography for elective TAVI. We conducted mid-term follow-up.
Furthermore, a systematic review was performed to compare the mortality
and neurological outcomes of TF and TA-TAVI approaches. RESULT(S):
TA/TF-TAVIs were performed with 100% device success, without paravalvular
leakage>=2 and without procedural death. The 30-day mortality/stroke rates
were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The 6-month,
1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%, 82%/66.6%,
and 50%/0%, respectively.The pooled results derived from the literature
review were as follows: The prevalence of PAo in the TAVI population is
9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI versus 16.2% in
TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI versus 6.3% in
TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9% in TF-TAVI.
 CONCLUSION(S): TA-TAVI shows promising early and mid-term outcomes
in patients with PAo. TF-TAVI performed in patients with PAo is likely to
be associated with higher rates of stroke than TA-TAVI. Copyright
Thieme. All rights reserved.

<48>
Accession Number
2008362882
Title
Remote ischemic preconditioning in isolated valve intervention. A pooled
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Moscarelli M.; Angelini G.D.; Emanueli C.; Suleiman S.; Pepe M.;
Contegiacomo G.; Punjabi P.P.
Institution
(Moscarelli, Emanueli, Punjabi) Imperial College London, National Heart
Lung Institute, United Kingdom
(Angelini, Suleiman) Clinical Sciences, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
(Contegiacomo) Dept of Cardiovascular surgery, GVM Care&Research, Bari,
Italy
(Pepe) Cardiology Unit, Department of Emergency and Organ Transplantation,
University of Bari Aldo Moro, Bari, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Recent studies have shown no benefits from remote ischemic
preconditioning (RIPC) in patients undergoing coronary artery bypass
surgery. One possible explanation is that given previous exposure to
angina and ischemia/reperfusion injury these patients, may be already
'naturally preconditioned'. The role of RIPC in a context of isolated
valve intervention, both surgical and particularly transcatheter is less
clear and remains under investigated, with few high-quality studies.
 Method(s): A systematic literature review identified 8 candidate
studies that met the meta-analysis criteria. We analyzed outcomes of 610
subjects (312 RIPC and 298 SHAM) with random effects modeling. Each study
was assessed for heterogeneity. The primary outcome was the extent of
periprocedural myocardial injury, as reflected by the area under the curve
for serum troponin concentration. Secondary endpoints included relevant
intra- and post-operative outcomes; sensitivity and high-quality subgroup
analysis was also carried out. Result(s): Six and two studies
reported the effect of RIPC in surgical and transcatheter valve
intervention. There was a significant difference between-group in terms of
periprocedural Troponin release (standardized mean difference (SMD: 0.74
[95% CI: 0.52; 0.95], p = 0.02) with no heterogeneity (chi2
2.40, I2 0%, p = 0.88). RIPC was not associated with any
improvement in post-operative outcomes. No serious adverse RIPC related
events were reported. Conclusion(s): RIPC seems to elicit overall
periprocedural cardioprotection in patients undergoing valvular
intervention, yet with no benefit on early clinical
outcomes. Copyright © 2020 Elsevier B.V.

<49>
Accession Number
633201704
Title
Impact of human immunodeficiency virus (HIV) infection in patients
undergoing cardiac surgery: a systematic review.
Source
Reviews in cardiovascular medicine. 21 (3) (pp 411-418), 2020. Date of
Publication: 30 Sep 2020.
Author
Dominici C.; Chello M.
Institution
(Dominici, Chello) Cardiovascular surgery, Campus Bio-Medico University of
Rome, Rome, Italy
Publisher
NLM (Medline)
Abstract
The clinical status and prognosis of patients with human immunodeficiency
virus (HIV) infection has dramatically changed in the recent years.
Cardiovascular diseases can be related to combined antiretroviral therapy
and to the aging of HIV-positive population, resulting in significant
mortality and morbidity in those patients. It is crucial to understand
whether the HIV-status affects the indications and outcomes of cardiac
surgery. A literature search was conducted through electronic databases up
to 15 May 2020 following PRISMA guidelines. Variables (i.e. patients
characteristics) and endpoints (i.e. postoperative complications) were
considered as defined in the original publications. All paper describing
post-operative outcomes after cardiac surgery were included.
Methodological quality of all included studies was assessed using the
Newcastle-Ottawa Scale, the Cochrane Risk of Bias tool and the US
Preventive Services Task Force grade. A total of eight studies were
included in this systematic review; five studies discussed the outcomes of
patients with HIV infection, while three studies compared results based on
HIV status. All evidences derived from retrospective observational studies
with high variability and poor-to-fair quality. Most patients underwent
surgical myocardial revascularization. HIV status is not associated with
differences in operative mortality (P = 0.32), postoperative mediastinitis
(P = 0.30) or pulmonary infective complications (P = 0.67). Cardiac
surgery can be considered safe in HIV-positive patients, and HIV status
alone should not be considered as a contraindication for cardiac surgery
and should not be considered a risk factor for postoperative mortality or
perioperative complications. Further studies are required for patients
with AIDS. Copyright © 2020 Dominici and Chello Published by IMR
press.

<50>
Accession Number
633197320
Title
Limitations in the Assessment of Prosthesis-Patient Mismatch.
Source
The Thoracic and cardiovascular surgeon. 68 (7) (pp 550-556), 2020. Date
of Publication: 01 Oct 2020.
Author
Amorim P.A.; Diab M.; Walther M.; Farber G.; Hagendorff A.; Bonow R.O.;
Doenst T.
Institution
(Amorim, Diab, Farber, Doenst) Department of Cardiothoracic Surgery,
Friedrich Schiller University Jena, Jena, Germany
(Walther) Department of Basic Sciences, University of Applied Sciences
Jena, Jena, Germany
(Hagendorff) Department of Internal Medicine, University Hospital Leipzig,
Leipzig, Germany
(Bonow) Division of Cardiology, Department of Medicine, Northwestern
University Feinberg School of Medicine Chicago, Chicago, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Prosthesis-patient mismatch (PPM) after aortic valve
replacement (AVR) may affect survival but data are conflicting. It is
assessed by relating effective orifice area (EOA) to body surface area
(EOAi). EOA is patient-specific as the result of flow-velocity times area
at the individual patient's outflow tract levels (LVOTA) divided by
trans-prosthetic flow velocity. However, some studies use projected EOAs
(i.e., valve size associated EOAs from other patient populations) to
assess how PPM affects outcome. METHOD(S): We analyzed 76 studies
addressing hemodynamic outcome and/or mortality after bioprosthetic AVR.
 RESULT(S): In 48 studies, projected or measured EOA for calculation
of EOAi and PPM assessment was used (of which 25 demonstrated an effect on
survival). We identified 28 additional studies providing measured EOA
values and the corresponding Bernoulli's pressure gradients after AVR.
Despite EOA being a patient-specific parameter, 77% of studies assessing a
PPM impact on survival used projected EOAs. The 28 studies are providing
measured EOA values and the corresponding Bernoulli's pressure gradients
in patients after AVR showed a highly significant, linear relationship
between EOA and Bernoulli's gradient. Considering this relationship, it is
surprising that relating EOA to body surface area (BSA) (EOAi) is standard
but relating pressure gradients to BSA is not. CONCLUSION(S): We
conclude that the majority of studies assessing PPM have used false
assumptions because EOA is a patient-specific parameter and cannot be
transferred to other patients. In addition, the use of EOAi to assess PPM
may not be appropriate and could explain the inconsistent relation between
PPM and survival in previous studies. Copyright Thieme. All rights
reserved.

<51>
Accession Number
2005249318
Title
The effect of interval training on oxidative stress indices among women in
preterm labor underwent coronary artery bypass graft.
Source
International Journal of Women's Health and Reproduction Sciences. 8 (4)
(pp 406-411), 2020. Date of Publication: October 2020.
Author
Hashemzadeh K.; Dehdilani M.; Gol M.K.
Institution
(Hashemzadeh) Department of Heart Surgery, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Dehdilani) Department of Anesthesiology, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Gol) Responsible for the Nursing Research Committee of Imam Reza
Hospital, Nursing and Midwifery Faculty, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
Aras Part Medical International Press (E-mail: publish@pmcaras.com)
Abstract
Objectives: Oxidative stress indices are one of the factors that cause and
exacerbate cardiovascular diseases in postpartum women, which can be
changed with interval training. Therefore, the current study aimed at
investigating the effect of interval training on oxidative stress indices
among women in preterm labor undergoing the coronary artery bypass graft
(CABG). Material(s) and Method(s): This randomized clinical trial was
conducted on 21 participants (the sample size was determined based on a
similar study) from December 2018 to May 2019 at Shahid Madani hospital of
Tabriz, Iran. After the random allocation of subjects to the training
(n=11) and control (n=10) groups, demographic information was collected
and their physical activity level was assessed using the Kaiser physical
activity survey before and after the intervention. In addition, the levels
of oxidative stress indices were measured 24 hours before and after the
intervention using the blood sample. The participants completed an
eight-week invention including 24 one-hour sessions according to the
available protocol. Finally, data were analyzed by means of statistical
tests such as the Shapiro-Wilk, Leven, and Student's t-test at a
significant level of <0.05. Result(s): The effect of the aerobic
exercise program on body weight loss, as well as body mass index (BMI) and
body fat percentage changes was significant in the training group
(P=0.011, P=0.004, and P=0.001, respectively). Based on the results, the
serum and urine levels of 8-hydroxy-2-deoxyguanosine reduced significantly
after the completion of the intervention (P=0.002 and P=0.001,
respectively) in the training group. Conclusion(s): In general,
aerobic exercise after CABG decreased the fat percentile, BMI, and
oxidative stress indices in the subjects. Thus, these trainings could
reduce oxidative stress indices by increasing tissue metabolism and oxygen
consumption. Copyright © 2020 The Author(s).

<52>
Accession Number
2008368781
Title
Pulmonary lobectomy for cancer: Systematic review and network
meta-analysis comparing open, video-assisted thoracic surgery, and robotic
approach.
Source
Surgery (United States). (no pagination), 2020. Date of Publication: 2020.
Author
Aiolfi A.; Nosotti M.; Micheletto G.; Khor D.; Bonitta G.; Perali C.;
Marin J.; Biraghi T.; Bona D.
Institution
(Aiolfi, Bonitta, Perali, Marin, Biraghi, Bona) Department of Biomedical
Science for Health, Division of General Surgery, University of Milan,
Istitituto Clinico Sant'Ambrogio, Milan, Italy
(Nosotti) Department of Pathophysiology and Transplantation, Thoracic
Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda - Ospedale
Maggiore Policlinico, Milan, Italy
(Micheletto) Department of Pathophysiology and Transplantation, INCO and
Department of General Surgery, University of Milan, Istituto Clinico
Sant'Ambrogio, Milan, Italy
(Khor) University of Maryland Medical Center, Baltimore, MD, United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background: Although minimally invasive lobectomy has gained worldwide
interest, there has been debate on perioperative and oncological outcomes.
The purpose of this study was to compare outcomes among open lobectomy,
video-assisted thoracic surgery lobectomy, and robotic lobectomy.
 Method(s): PubMed, EMBASE, and Web of Science databases were
consulted. A fully Bayesian network meta-analysis was performed.
 Result(s): Thirty-four studies (183,426 patients) were included;
88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted
thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. Compared
with open lobectomy, video-assisted thoracic surgery, lobectomy and
robotic lobectomy had significantly reduced 30-day mortality (risk ratio =
0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95%
credible intervals, 0.36-0.71), pulmonary complications (risk ratio =
0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95%
credible intervals, 0.51-0.88), and overall complications (risk ratio =
0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95%
credible intervals, 0.67-0.91). Compared with video-assisted thoracic
surgery lobectomy, open lobectomy, and robotic lobectomy had a
significantly higher total number of harvested lymph nodes (mean
difference = 1.46; 95% credible intervals, 0.30, 2.64 and mean difference
= 2.18; 95% credible intervals, 0.52-3.92) and lymph nodes stations (mean
difference = 0.37; 95% credible intervals, 0.08-0.65 and mean difference =
0.93; 95% credible intervals, 0.47-1.40). Positive resection margin and
5-year overall survival were similar across treatments. Intraoperative
blood loss, postoperative transfusion, hospital length of stay, and 30-day
readmission were significantly reduced for minimally invasive approaches.
 Conclusion(s): Compared with open lobectomy, video-assisted thoracic
surgery lobectomy, and robotic lobectomy seem safer with reduced 30-day
mortality, pulmonary, and overall complications with equivalent oncologic
outcomes and 5-year overall survival. Minimally invasive techniques may
improve outcomes and surgeons should be encouraged, when feasible, to
adopt video-assisted thoracic surgery lobectomy, or robotic lobectomy in
the treatment of lung cancer. Copyright © 2020 Elsevier Inc.

<53>
Accession Number
633201798
Title
Percutaneous balloon mitral valvotomy during pregnancy: a systematic
review and meta-analysis.
Source
Acta obstetricia et gynecologica Scandinavica. (no pagination), 2020. Date
of Publication: 18 Oct 2020.
Author
Sreerama D.; Surana M.; Moolchandani K.; Chaturvedula L.; Keepanasseril
A.; Pillai A.A.; Nair N.S.
Institution
(Sreerama, Surana, Moolchandani, Chaturvedula, Keepanasseril) Department
of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical
Education & Research (JIPMER), Puducherry, India
(Keepanasseril) School of Dentistry, Amrita Institute of Medical Sciences,
Kochi, India
(Keepanasseril) Department of Medicine, McMaster University, Hamilton,
Canada
(Pillai) Department of Cardiology, Jawaharlal Institute of Post-graduate
Medical Education & Research (JIPMER), Puducherry, India
(Nair) Biostatistics, Jawaharlal Institute of Post-graduate Medical
Education & Research (JIPMER), Puducherry, India
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The objectives were to systematically review the maternal
and fetal outcomes in pregnant women who underwent percutaneous balloon
mitral valvuloplasty (PBMV) during pregnancy. MATERIAL AND METHODS: A
search was conducted on Medline and Embase databases to identify studies
published between 2000 and 2018 that reported on maternal and fetal
outcomes following PBMV performed in pregnancy. Randomized controlled
trials, cohort studies, case-control studies, cross-sectional studies and
case series with four or more pregnancies in which PBMV was performed
during pregnancy were included. Reference lists from relevant papers and
reviews were also hand searched for relevant citations. A successful
procedure was defined as one where there was a reported improvement in the
valve area or reduction in the mitral valve gradient. A random-effects
model was used to derive pooled estimates of various outcomes and the
final estimates were reported as percentages with a 95% confidence
interval. RESULT(S): Twenty-one observational studies reporting 745
pregnancies were included in the review, with all of them having reported
outcomes without a comparison group. Most of the studies fell into the low
risk category as determined using Joanna Briggs Institute (JBI) critical
appraisal checklist for case series. Most of the studies (86%) were
reported from low to middle-income countries and PBMV was mostly performed
during the second trimester of pregnancy. Forty-three procedures (5.7%)
were unsuccessful; nearly half (n=19) of them reported among women with
the severe sub-valve disease (Wilkins sub valve score three or more).
There were 11 maternal deaths among those with suboptimal valve
anatomy(severe sub valve disease or Wilkin score >8). Mitral regurgitation
was the most common cardiac complication (12.7%; 95% CI 7.3-19.1%),
followed by restenosis (2.4%; 95% CI 0.02-7.2%). Pooled incidence of
cesarean section is 12.1% (95% CI 3.6- 23.8%), preterm delivery 3.9% (95%
CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birth weight 5.4%
(95% CI 0.2-14.7%). CONCLUSION(S): PBMV may be an effective and safe
procedure for optimizing outcomes in pregnant women with mitral stenosis
in the absence of severe sub-valve disease. Copyright This article is
protected by copyright. All rights reserved.

<54>
Accession Number
633195584
Title
Comparison of Heart Team vs Interventional Cardiologist Recommendations
for the Treatment of Patients with Multivessel Coronary Artery Disease.
Source
JAMA Network Open. (no pagination), 2020. Article Number: e2012749. Date
of Publication: 2020.
Author
Tsang M.B.; Schwalm J.D.; Gandhi S.; Sibbald M.G.; Gafni A.; Mercuri M.;
Salehian O.; Lamy A.; Pericak D.; Jolly S.; Sheth T.; Ainsworth C.;
Velianou J.; Valettas N.; Mehta S.; Pinilla N.; Yanagawa B.; Zhang L.; Chu
V.; Parry D.; Whitlock R.; Dyub A.; Cybulsky I.; Semelhago L.; Ioannou K.;
Hameed A.; Wright D.; Mulji A.; Darvish-Kazem S.; Gupta N.; Alshatti A.;
Natarajan M.K.
Institution
(Tsang, Schwalm, Sibbald, Salehian, Lamy, Jolly, Sheth, Ainsworth,
Velianou, Valettas, Mehta, Pinilla, Ioannou, Hameed, Wright, Mulji,
Darvish-Kazem, Alshatti, Natarajan) Division of Cardiology, Department of
Medicine, McMaster University, 1200 Fourth Ave, St Catharines, ON L2S 0A9,
Canada
(Gandhi, Gupta) Division of Cardiology, Department of Medicine, University
of Toronto, Toronto, ON, Canada
(Gandhi) Trillium Health Partners, Mississauga, ON, Canada
(Gafni) Center for Health Economics and Policy Analysis, Department of
Health Research Methods, Evidence and Impact, McMaster University,
Hamilton, ON, Canada
(Mercuri, Pericak, Zhang, Chu, Parry, Whitlock, Dyub, Cybulsky, Semelhago)
Division of Cardiovascular Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Yanagawa) Division of Cardiovascular Surgery, St Michael's Hospital,
Toronto, ON, Canada
(Yanagawa) Division of Cardiac Surgery, Department of Surgery, University
of Toronto, Toronto, ON, Canada
(Parry) Dunedin Hospital, Otago, New Zealand
(Ioannou) Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada
(Darvish-Kazem) Brampton Civic Hospital, William Osler Health System,
Brampton, ON, Canada
Publisher
American Medical Association (E-mail: shirley.martin@ama-assn.org)
Abstract
Importance: Although the heart team approach is recommended in
revascularization guidelines, the frequency with which heart team
decisions differ from those of the original treating interventional
cardiologist is unknown. Objective(s): To examine the difference in
decisions between the heart team and the original treating interventional
cardiologist for the treatment of patients with multivessel coronary
artery disease. Design, Setting, and Participant(s): In this
cross-sectional study, 245 consecutive patients with multivessel coronary
artery disease were recruited from 1 high-volume tertiary care referral
center (185 patients were enrolled through a screening process, and 60
patients were retrospectively enrolled from the center's database). A
total of 237 patients were included in the final virtual heart team
analysis. Treatment decisions (which comprised coronary artery bypass
grafting, percutaneous coronary intervention, and medication therapy) were
made by the original treating interventional cardiologists between March
15, 2012, and October 20, 2014. These decisions were then compared with
pooled-majority treatment decisions made by 8 blinded heart teams using
structured online case presentations between October 1, 2017, and October
15, 2018. The randomized members of the heart teams comprised experts from
3 domains, with each team containing 1 noninvasive cardiologist, 1
interventional cardiologist, and 1 cardiovascular surgeon. Cases in which
all 3 of the heart team members disagreed and cases in which procedural
discordance occurred (eg, 2 members chose coronary artery bypass grafting
and 1 member chose percutaneous coronary intervention) were discussed in a
face-to-face heart team review in October 2018 to obtain pooled-majority
decisions. Data were analyzed from May 6, 2019, to April 22, 2020.
 Main Outcomes and Measures: The Cohen kappa coefficient between the
treatment recommendation from the heart team and the treatment
recommendation from the original treating interventional cardiologist.
 Result(s): Among 234 of 237 patients (98.7%) in the analysis for whom
complete data were available, the mean (SD) age was 67.8 (10.9) years; 176
patients (75.2%) were male, and 191 patients (81.4%) had stenosis in 3
epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI,
24.5%-36.7%) in treatment decisions between the heart team and the
original treating interventional cardiologist occurred, with a Cohen kappa
of 0.478 (95% CI, 0.336-0.540; P =.006). The heart team decision was more
frequently unanimous when it was concordant with the decision of the
original treating interventional cardiologist (109 of 163 cases [66.9%])
compared with when it was discordant (28 of 71 cases [39.4%]; P <.001).
When the heart team agreed with the original treatment decision, there was
more agreement between the heart team interventional cardiologist and the
original treating interventional cardiologist (138 of 163 cases [84.7%])
compared with when the heart team disagreed with the original treatment
decision (14 of 71 cases [19.7%]); P <.001). Those with an original
treatment of coronary artery bypass grafting, percutaneous coronary
intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71
patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a
different treatment recommendation from the heart team than the original
treating interventional cardiologist; the difference across the 3 groups
was statistically significant (P =.002). Conclusions and Relevance:
The heart team's recommended treatment for patients with multivessel
coronary artery disease differed from that of the original treating
interventional cardiologist in up to 30% of cases. This subset of cases
was associated with a lower frequency of unanimous decisions within the
heart team and less concordance between the interventional cardiologists;
discordance was more frequent when percutaneous coronary intervention or
medication therapy were considered. Further research is needed to evaluate
whether heart team decisions are associated with improvements in outcomes
and, if so, how to identify patients for whom the heart team approach
would be beneficial.. Copyright © 2020 BMJ Publishing Group. All
rights reserved.

<55>
Accession Number
633194874
Title
Overall and Cause-Specific Mortality in Randomized Clinical Trials
Comparing Percutaneous Interventions with Coronary Bypass Surgery: A
Meta-analysis.
Source
JAMA Internal Medicine. (no pagination), 2020. Date of Publication: 2020.
Author
Gaudino M.; Hameed I.; Farkouh M.E.; Rahouma M.; Naik A.; Robinson N.B.;
Ruan Y.; Demetres M.; Biondi-Zoccai G.; Angiolillo D.J.; Bagiella E.;
Charlson M.E.; Benedetto U.; Ruel M.; Taggart D.P.; Girardi L.N.; Bhatt
D.L.; Fremes S.E.
Institution
(Gaudino, Hameed, Rahouma, Naik, Robinson, Ruan, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Hameed) Section of Cardiothoracic Surgery, Yale School of Medicine, New
Haven, CT, United States
(Farkouh) Peter Munk Cardiac Centre, University of Toronto, Toronto, ON,
Canada
(Demetres) Samuel J. Wood Library and C. V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Angiolillo) Division of Cardiology, Department of Medicine, University of
Florida College of Medicine-Jacksonville, Jacksonville, United States
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Charlson) Division of General Internal Medicine, Weill Cornell Medical
College, New York, NY, United States
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, Oxford, United Kingdom
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
Publisher
American Medical Association (E-mail: shirley.martin@ama-assn.org)
Abstract
Importance: Mortality is a common outcome in trials comparing percutaneous
coronary intervention (PCI) with coronary artery bypass grafting (CABG).
Controversy exists regarding whether all-cause mortality or cardiac
mortality is preferred as a study end point, because noncardiac mortality
should be unrelated to the treatment. Objective(s): To evaluate the
difference in all-cause and cause-specific mortality in randomized
clinical trials (RCTs) comparing PCI with CABG for the treatment of
patients with coronary artery disease. Data Sources: MEDLINE (1946 to
the present), Embase (1974 to the present), and the Cochrane Library (1992
to the present) databases were searched on November 24, 2019. Reference
lists of included articles were also searched, and additional studies were
included if appropriate. Study Selection: Articles were considered for
inclusion if they were in English, were RCTs comparing PCI with
drug-eluting or bare-metal stents and CABG for the treatment of coronary
artery disease, and reported mortality and/or cause-specific mortality.
Trials of PCI involving angioplasty without stenting were excluded. For
each included trial, the publication with the longest follow-up duration
for each outcome was selected. Data Extraction and Synthesis: For data
extraction, all studies were reviewed by 2 independent investigators, and
disagreements were resolved by a third investigator in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
guideline. Data were pooled using fixed- and random-effects models.
 Main Outcomes and Measures: The primary outcomes were all-cause and
cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were
performed for PCI trials using drug-eluting vs bare-metal stents and for
trials involving patients with left main disease. Result(s):
Twenty-three unique trials were included involving 13620 unique patients
(6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study
populations; mean age range, 60.0-71.0 years). The weighted mean (SD)
follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with
a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29)
and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but
also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41).
 Conclusions and Relevance: Percutaneous coronary intervention was
associated with higher all-cause, cardiac, and noncardiac mortality
compared with CABG at 5 years. The significantly higher noncardiac
mortality associated with PCI suggests that even noncardiac deaths after
PCI may be procedure related and supports the use of all-cause mortality
as the end point for myocardial revascularization trials.. Copyright
© 2020 American Medical Association. All rights reserved.

<56>
Accession Number
613192431
Title
The effect of combined conventional and modified ultrafiltration on
mechanical ventilation and hemodynamic changes in congenital heart
surgery.
Source
Journal of Research in Medical Sciences. 21 (8) (no pagination), 2016.
Article Number: 112. Date of Publication: 2016.
Author
Ziyaeifard M.; Alizadehasl A.; Aghdaii N.; Rahimzadeh P.; Masoumi G.;
Golzari S.E.J.; Fatahi M.; Gorjipur F.
Institution
(Ziyaeifard, Aghdaii) Departments of Cardiac Anesthesiology, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Alizadehasl) Departments of Cardiology, Rajaie Cardiovascular Medical and
Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Rahimzadeh) Departments of Anesthesiology and Pain Medicine, Hazrat Rasul
Medical Complex, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Masoumi) Department of Anesthesiology, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Golzari) Department of Anesthesiology and Intensive Care Medicine, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Fatahi, Gorjipur) Departments of Perfusion, Rajaie Cardiovascular Medical
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS)
Abstract
Background: Cardiopulmonary bypass is associated with increased fluid
accumulation around the heart which influences pulmonary and cardiac
diastolic function. The aim of this study was to compare the effects of
modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF)
on duration of mechanical ventilation and hemodynamic status in children
undergoing congenital heart surgery. Material(s) and Method(s): A
randomized clinical trial was conducted on 46 pediatric patients
undergoing cardiopulmonary bypass throughout their congenital heart
surgery. Arteriovenous MUF plus CUF was performed in 23 patients
(intervention group) and sole CUF was performed for other 23 patients
(control group). In MUF group, arterial cannula was linked to the filter
inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was
filtered and returned via cardioplegia line to the right atrium. Different
parameters including hemodynamic variables, length of mechanical
ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were
compared between the two groups. Result(s): At immediate post-MUF
phase, there was a statistically significant increase in the mean arterial
pressure, systolic blood pressure, and diastolic blood pressure (P < 0.05)
only in the study group. Furthermore, there was a significant difference
in time of mechanical ventilation (P = 0.004) and ICU stay (P = 0.007)
between the two groups. Inotropes including milrinone (P = 0.04),
epinephrine (P = 0.001), and dobutamine (P = 0.002) were used
significantly less frequently for patients in the intervention than the
control group. Conclusion(s): Administration of MUF following surgery
improves hemodynamic status of patients and also significantly decreases
the duration of mechanical ventilation and inotrope requirement within 48
h after surgery. Copyright © 2016 Journal of Research in Medical
Sciences.

<57>
Accession Number
361474618
Title
Adding omeprazole to clopidogrel reduced GI events and did not increase CV
events.
Source
Annals of Internal Medicine. 154 (6) (pp JC3-7), 2011. Date of
Publication: March 2011.
Author
Bhatt D.L.
Institution
(Bhatt) VA Boston Healthcare System, Boston, MA, United States
Publisher
American College of Physicians

<58>
Accession Number
2007697880
Title
Prospective Evaluation of Malignancy in 17,708 Patients Randomized to
Ezetimibe Versus Placebo: Analysis From IMPROVE-IT.
Source
JACC: CardioOncology. 2 (3) (pp 385-396), 2020. Date of Publication:
September 2020.
Author
Giugliano R.P.; Gencer B.; Wiviott S.D.; Park J.-G.; Fuchs C.S.; Goessling
W.; Musliner T.A.; Tershakovec A.M.; Blazing M.A.; Califf R.; Cannon C.P.;
Braunwald E.
Institution
(Giugliano, Gencer, Wiviott, Park, Cannon, Braunwald) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Department of Medicine, Harvard Medical School, Boston, MA, United States
(Fuchs) Smilow Cancer Hospital at Yale New Haven, New Haven, CT, United
States
(Goessling) Division of Gastroenterology, Massachusetts General Hospital,
Boston, MA, United States
(Musliner, Tershakovec) Merck, Kenilworth, NJ, United States
(Blazing) Duke Clinical Research Institute, Durham, NC, United States
(Califf) Verily Life Sciences and Google Health, South San Francisco,
California, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: An increased risk of malignancy was reported with
simvastatin/ezetimibe in 1,873 patients in the SEAS (Simvastatin and
Ezetimibe in Aortic Stenosis) trial. Objective(s): The purpose of
this study was to clarify this unexpected finding in a larger sample size
of patients stabilized after acute coronary syndrome, we conducted a
prospective systematic analysis of malignancy events in IMPROVE-IT
(Improved Reduction of Outcomes: Vytorin Efficacy International Trial).
 Method(s): Within IMPROVE-IT, 17,708 patients post-acute coronary
syndrome were randomized to either ezetimibe 10 mg or matching placebo on
a background of simvastatin 40 mg who took >=1 dose of the study drug.
Suspected tumors (benign and malignant) reported by investigators or
identified from a review of adverse events were adjudicated by oncologists
without knowledge of drug assignment. The primary malignancy endpoint
included new, relapsing, or progressive malignancies (excluding
nonmelanotic skin malignancies). The secondary endpoint was death due to
malignancy. Result(s): In this trial, 1,470 patients developed the
primary malignancy endpoint during a median 6 years of follow-up. The most
common malignancy locations were prostate (18.9%), lung (16.8%), and
bladder (8.8%) with no differences by treatment group (p > 0.05 for each
location). Kaplan-Meier 7-year rates of malignancies were similar with
ezetimibe and placebo (10.2% vs. 10.3%; hazard ratio: 1.03; 95% confidence
interval: 0.93 to 1.14; p = 0.56), as were the rates for malignancy death
(3.8% vs. 3.6%; hazard ratio: 1.04; 95% confidence interval: 0.88 to 1.23;
p = 0.68). Conclusion(s): Among 17,708 patients receiving simvastatin
40 mg daily, those randomized to ezetimibe 10 mg daily had a similar
incidence of malignancy and deaths due to malignancy compared with those
receiving placebo during a median follow-up of 6 years (96,377
patient-years). (IMPROVE-IT: Examining Outcomes in Subjects With Acute
Coronary Syndrome: Vytorin [Ezetimibe/Simvastatin] vs Simvastatin
[P04103]; NCT00202878) Copyright © 2020 The Authors

<59>
Accession Number
2007997171
Title
Effectiveness of Intravenous Dexmedetomidine vs. Fentanyl for Attenuation
of Haemodynamic Response to Pneumoperitoneum in Laparoscopic
Cholecystectomy: A Randomised Double Blind Study.
Source
Journal of Clinical and Diagnostic Research. 14 (10) (pp UC15-UC19), 2020.
Date of Publication: October 2020.
Author
Meena R.; Parashar C.; Jain P.; Soni M.
Institution
(Meena, Parashar, Jain, Soni) Department of Anaesthesia, Sawai Man Singh
Medical College, Attached Group of Hospitals, Jaipur, Rajasthan, India
Publisher
Journal of Clinical and Diagnostic Research
Abstract
Introduction: Laparoscopy is a widely performed minimal invasive surgical
procedure, wherein various haemodynamic changes are faced by
anaesthesiologists during Pneumoperitoneum (PNP). Aim(s): To compare
the effectiveness of dexmedetomidine vs fentanyl for attenuating the
haemodynamics response to PNP in Laparoscopic Cholecystectomy (LC).
 Material(s) and Method(s): A total of 84 patients of 18-50 years age,
American Society of Anaesthesiologists (ASA) Class I/II of either sex for
elective LC were included. The patients were divided into two groups (A,
B) of 42 patients each. Group A received dexmedetomidine and Group B
received fentanyl. Both the drugs were given as loading dose of one mug/kg
over ten min followed by maintenance 0.2 mug/kg/h throughout the surgery.
Haemodynamic parameters were recorded at different time intervals
throughout the surgery. In recovery room patients were observed for
postoperative analgesia by using Visual Analogue Scale (VAS), sedation
level using RAMSAY Sedation score at every 30 minutes till the time of
giving first rescue analgesia and side effects, if any. Result(s):
Intraoperatively, throughout the period of PNP, Group A showed
statistically better attenuation of haemodynamic responses in comparison
to Group B (p<0.05). After creating PNP, rise in MAP was observed in both
group A and group B, 99.38+/-6.32 and 103.43+/-9.81, respectively but this
rise was more in group B which was statistically significant (p<0.05).
Time to first rescue analgesia or mean duration of postoperative analgesia
(VAS>3) was significantly longer in dexmedetomidine group (102.14+/-32.50
minutes) than fentanyl group (42.86+/-15.03 minutes). There was better
control of pain but more sedation in Group A than in Group B.
 Conclusion(s): This study concludes that intravenously administered
dexmedetomidine shows better attenuation of haemodynamic responses to
CO<inf>2</inf> insufflation as compared to fentanyl. Dexmedetomidine also
provides better sedation and has more analgesic sparing
effect. Copyright © 2020 Journal of Clinical and Diagnostic
Research. All rights reserved.

<60>
Accession Number
2005153497
Title
Cardiovascular statistics-brazil 2020.
Source
Arquivos Brasileiros de Cardiologia. 115 (3) (pp 308-439), 2020. Date of
Publication: September 2020.
Author
Moraes De Oliveira G.M.; Caldeira Brant L.C.; Anne Polanczyk C.; Biolo A.;
Ramos Nascimento B.; Carvalho Malta D.; De Fatima Marinho De Souza M.;
Porto Soares G.; Xavier Junior G.F.; Julia Machline-Carrion M.; Sommer
Bittencourt M.; Pontes-Neto O.M.; Marcos Silvestre O.; Azeredo Teixeira
R.; Orismar Sampaio R.; Gaziano T.A.; Roth G.A.; Pinho Ribeiro A.L.
Institution
(Moraes De Oliveira, Porto Soares) Instituto do Coracao Edson Saad da
Universidade Federal do Rio de Janeiro UFRJ, Rio de Janeiro, Brazil
(Moraes De Oliveira) Disciplina de Cardiologia, Departamento de Clinica
Medica da, Faculdade de Medicina da Universidade Federal do Rio de Janeiro
UFRJ, Rio de Janeiro, Brazil
(Caldeira Brant, Ramos Nascimento, Pinho Ribeiro) Departamento de Clinica
Medica da, Faculdade de Medicina da, Universidade Federal de Minas Gerais
UFMG, Belo Horizonte, MG, Brazil
(Caldeira Brant, Ramos Nascimento, Pinho Ribeiro) Servico de Cardiologia e
Cirurgia Cardiovascular, Centro de Telessaude do Hospital das Clinicas da
Universidade Federal de Minas Gerais UFMG, Belo Horizonte, MG, Brazil
(Anne Polanczyk, Biolo) Universidade Federal do Rio Grande do Sul UFRS,
Porto Alegre, RS, Brazil
(Anne Polanczyk, Biolo) Servico de Cardiologia do Hospital Moinhos de
Vento, Porto Alegre, RS, Brazil
(Anne Polanczyk, Biolo) Hospital de Clinicas de Porto Alegre HCPA, Porto
Alegre, RS, Brazil
(Carvalho Malta, De Fatima Marinho De Souza, Azeredo Teixeira)
Universidade Federal de Minas Gerais UFMG, Belo Horizonte, MG, Brazil
(De Fatima Marinho De Souza) Organizacao Vital Strategies, Nova York,
United States
(Porto Soares) Curso de Medicina da Universidade de Vassouras, Vassouras,
Brazil
(Xavier Junior) Biblioteca da Faculdade de Medicina Universidade Federal
de Minas Gerais UFMG, Belo Horizonte, MG, Brazil
(Julia Machline-Carrion) ePHealth Primary Care Solutions, SC, Brazil
(Sommer Bittencourt) Divisao de Clinica Medica do Hospital Universitario
da Universidade de Sao Paulo, Sao Paulo, Brazil
(Sommer Bittencourt) Israelita de Ciencias da Saude Albert Einstein, Sao
Paulo, Brazil
(Pontes-Neto) Servico de Neurologia Vascular e Emergencias Neurologicas,
Divisao de Neurologia, Departamento de Neurociencias e Ciencias do
Comportamento Faculdade de Medicina de Ribeirao Preto da Universidade de
Sao Paulo USP, Sao Paulo, Brazil
(Marcos Silvestre) Universidade Federal do Acre UFAC, Rio Branco, AC,
Brazil
(Orismar Sampaio) Departamento de Cardiopneumologia da Faculdade de
Medicina da Universidade de Sao Paulo USP, Sao Paulo, Brazil
(Orismar Sampaio) Universidade de Sao Paulo USP, Sao Paulo, Brazil
(Orismar Sampaio) Unidade Clinica de Cardiopatias Valvares do Instituto do
Coracao Incor do Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo HCFMUSP, Sao Paulo, Brazil
(Gaziano) Brigham and Women's Hospital, Boston, United States
(Gaziano) Department of Medicine Cardiovascular, Harvard Medical School,
Boston, United States
(Roth) Global Health and Health Metrics Sciences, Institute for Health
Metrics and Evaluation IHME, WA, United States
(Roth) Division of Cardiology, University of Washington School of
Medicine, WA, United States
(Moraes De Oliveira, Pinho Ribeiro) Universidade Federal do Rio de
Janeiro, UFRJ, Cidade Universitaria, R Prof Rodolpho P. Rocco,
255-8degree. Andar-Sala 6, RJ 21941-913, Brazil
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)

<61>
Accession Number
2005018017
Title
"BAX602" in Preventing Surgical Adhesion after Extracorporeal Ventricular
Assist Device Implantation for Refractory Congestive Heart Failure: Study
Protocol for a Multicenter Randomized Clinical Trial.
Source
Cardiovascular Drugs and Therapy. 34 (5) (pp 651-657), 2020. Date of
Publication: 01 Oct 2020.
Author
Fukushima S.; Asakura K.; Hamasaki T.; Onda K.; Watanabe T.; Shiose A.;
Ono M.; Fukushima N.; Yamamoto H.; Fujita T.
Institution
(Fukushima, Fujita) Department of Cardiac Surgery, National Cerebral and
Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka 564-8565, Japan
(Asakura, Onda, Yamamoto) Department of Data Science, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Hamasaki) The Biostatistics Center and Department of Biostatistics and
Bioinformatics, George Washington University, Washington, DC, United
States
(Watanabe, Fukushima) Department of Transplant Medicine, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Shiose) Department of Cardiovascular Surgery, Kyushu University Hospital,
Fukuoka, Japan
(Ono) Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan
Publisher
Springer
Abstract
Background: The high surgical risk in redo cardiac surgery is largely
attributed to adhesions around the epicardium and the great vessels.
BAX602 is an adhesion prevention reagent composed of two synthetic
polyethylene glycols. Spraying BAX602 over the epicardium and the great
vessels reportedly contributes to adhesion prevention after pediatric
cardiac surgery. The present study aims to evaluate the safety and
effectiveness of BAX602 spray in patients undergoing extracorporeal
ventricular assist device implantation surgery to treat refractory
congestive heart failure. Methods and Design: This investigator-initiated,
multicenter, pivotal, two-arm, open-label, randomized trial will include a
total of 30 patients. The primary outcome measure is the severity of
adhesions, which will be evaluated during re-sternotomy surgery performed
2-12 weeks after the primary extracorporeal ventricular assist device
implantation surgery. The adhesion severity will be evaluated at five
predefined sites using a four-grade adhesion evaluation score (0 = no
adhesion; 1 = filmy and avascular adhesion; 2 = dense/vascular adhesion; 3
= cohesive adhesion). This measure will be summarized in two ways to
evaluate the effect of BAX602: (1) the total score of the severity of
adhesions at all five sites (ranging from 0 to 15), and (2) the total
number of sites with dense/vascular or cohesive adhesions (ranging from 0
to 5). Ethics and Dissemination: The study findings will be disseminated
at regional, national, and international conferences and through
peer-reviewed scientific journals. Trial Registration: The trial was
registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000038998)
on 6 January 2020. Copyright © 2020, The Author(s).

<62>
Accession Number
632980906
Title
Impact of physician's sex/gender on processes of care, and clinical
outcomes in cardiac operative care: A systematic review.
Source
BMJ Open. 10 (9) (no pagination), 2020. Article Number: e037139. Date of
Publication: 29 Sep 2020.
Author
Etherington N.; Deng M.; Boet S.; Johnston A.; Mansour F.; Said H.; Zheng
K.; Sun L.Y.
Institution
(Etherington, Boet, Sun) Clinical Epidemiology Program, Ottawa Hospital
Research Institute, Ottawa, Ontario, Canada
(Etherington, Deng, Boet, Mansour, Said) Department of Anaesthesiology and
Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
(Johnston, Sun) School of Epidemiology and Public Health, Faculty of
Medicine, University of Ottawa, Ottawa, Ontario, Canada
(Zheng, Sun) Division of Cardiac Anesthesiology, Department of
Anesthesiology and Pain Medicine, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Sun) Cardiovascular Research Program, Institute for Clinical Evaluative
Sciences, Ottawa, Ontario, Canada
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Objectives This systematic review aimed to assess the role of physician's
sex and gender in relation to processes of care and/or clinical outcomes
within the context of cardiac operative care. Design A systematic review.
Data sources Searches were conducted in PsycINFO, Embase and Medline from
inception to 6 September 2018. The reference lists of relevant systematic
reviews and included studies were also searched. Eligibility criteria for
selecting studies Quantitative studies of any design were included if they
were published in English or French, involved patients of any age
undergoing a cardiac surgical procedure and specifically assessed
differences in processes of care or clinical patient outcomes by
physician's sex or gender. Studies were screened in duplicate by two pairs
of independent reviewers. Outcome measures Processes of care, patient
morbidity and patient mortality. Results The search yielded 2095
publications after duplicate removal, of which two were ultimately
included. These studies involved various types of surgery, including
cardiac. One study found that patients treated by female surgeons compared
with male surgeons had a lower 30-day mortality. The other study, however,
found no differences in patient outcomes by surgeon's sex. There were no
studies that investigated anaesthesiologist's sex/gender. There were also
no studies investing physician's sex or gender exclusively in the cardiac
operating room. Conclusions The limited data surrounding the impact of
physician's sex/gender on the outcomes of cardiac surgery inhibits drawing
a robust conclusion at this time. Results highlight the need for primary
research to determine how these factors may influence cardiac operative
practice, in order to optimise provider's performance and improve outcomes
in this high-risk patient group. Copyright © 2020 Author(s) (or
their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<63>
Accession Number
632832429
Title
Conclusions of complete revascularization meta-analysis are challenged by
state-of-the-art methods.
Source
European Heart Journal. 41 (23) (pp 2223-2224), 2020. Date of Publication:
2020.
Author
Jobs A.; Schwarzer G.; Thiele H.
Institution
(Jobs) Department of Cardiology/Angiology/Intensive Care Medicine,
University Heart Center Lubeck, University Hospital Schleswig-Holstein,
Ratzeburger Allee 160, Lubeck 23538, Germany
(Jobs) German Center for Cardiovascular Research (DZHK),
Hamburg/Kiel/Lubeck, Lubeck Partner Site, Germany
(Jobs, Thiele) Department of Internal Medicine/Cardiology, Heart Center
Leipzig at University of Leipzig, Strumpellstr. 39, Leipzig 04289, Germany
(Schwarzer) Institute of Medical Biometry and Statistics, Faculty of
Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str.
26, Freiburg 79104, Germany
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
This commentary refers to 'Complete revascularization reduces
cardiovascular death in patients with ST-segment elevationmyocardial
infarction andmultivessel disease: Systematic review and meta-analysis of
randomized clinical trials' by Pavasini et al. Copyright © 2020
Oxford University Press. All rights reserved.

<64>
Accession Number
2008363359
Title
Meta-Analysis Comparing Culprit-Only Versus Complete Multivessel
Percutaneous Coronary Intervention in Patients With ST-Elevation
Myocardial Infarction.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Ullah W.; Zahid S.; Nadeem N.; Gowda S.; Munir S.; Saleem S.; Alraies
M.C.; Alam M.; Fischman D.L.
Institution
(Ullah, Nadeem, Munir) Abington Jefferson Health, Abington, PA, United
States
(Zahid) Rochester General Hospital, Rochester, NY, United States
(Gowda) University of South Dakota, Vermillion, SD, United States
(Saleem) University of Kentucky, Bowling Green, KY, United States
(Alraies) Detroit Medical Center, Detroit, MI, United States
(Alam) Baylor College of Medicine, Houston, TX, United States
(Fischman) Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
ST-segment elevation myocardial infarction (STEMI) in patients with
concomitant multivessel coronary artery disease is associated with poor
prognosis. We sought to determine the merits of percutaneous coronary
intervention of the culprit-only revascularization (COR) compared with
multivessel revascularization (MVR) approach. Multiple databases were
queried to identify relevant articles. Data were analyzed using a
random-effect model to calculate unadjusted odds ratio (OR) and relative
risk. A total of 28 studies comprising 26,892 patients, 18,377 in the COR
and 8,515 in the MVR group were included. The mean age of patients was 63
years, comprising 72% of male patients. The baseline characteristics of
the 2 treatment groups were comparable. On a median follow-up of 1-year,
COR was associated with a significantly higher odds of major adverse
cardiovascular events (MACE; OR 1.36, 95% confidence interval [CI] 1.10 to
1.70, p = 0.005), angina (OR 2.28, 95% CI 1.83 to 2.85, p <= 0.00001) and
revascularization (OR 1.76, 95% CI 1.22 to 2.54, p = 0.002) compared with
patients undergoing MVR for STEMI. The all-cause mortality (OR 1.18, 95%
CI 0.91 to 1.53, p = 0.22), cardiovascular mortality (OR 1.30, 95% CI 0.98
to 1.72, p = 0.07), rate of heart failure (OR 1.17, 95% CI 0.86 to 1.59, p
= 0.31), need for coronary artery bypass graft (CABG) (OR 1.47, 95% CI
0.82 to 2.64, p = 0.19), repeat myocardial infarction (MI) events (OR
1.23, 95% CI 0.93 to 1.64, p = 0.15) and risk of stroke (OR 1.27 95% CI
0.68 to 2.34, p = 0.45%) were similar between the two groups. A subgroup
analysis based on follow-up duration and study design mostly followed the
results of the pooled analysis except that the risk of repeat MI events
were significantly lower in the MVR group across RCTs (OR 1.46, 95% CI
1.10 to 1.94, p = 0.009). In contrast to the culprit-only approach, MVR in
patients with STEMI is associated with a significant reduction in MACE,
angina and need for revascularization. Copyright © 2020 Elsevier
Inc.

<65>
Accession Number
2008001844
Title
Structural Deterioration of Transcatheter Versus Surgical Aortic Valve
Bioprostheses in the PARTNER-2 Trial.
Source
Journal of the American College of Cardiology. 76 (16) (pp 1830-1843),
2020. Date of Publication: 20 Oct 2020.
Author
Pibarot P.; Ternacle J.; Jaber W.A.; Salaun E.; Dahou A.; Asch F.M.;
Weissman N.J.; Rodriguez L.; Xu K.; Annabi M.-S.; Guzzetti E.; Beaudoin
J.; Bernier M.; Leipsic J.; Blanke P.; Clavel M.-A.; Rogers E.; Alu M.C.;
Douglas P.S.; Makkar R.; Miller D.C.; Kapadia S.R.; Mack M.J.; Webb J.G.;
Kodali S.K.; Smith C.R.; Herrmann H.C.; Thourani V.H.; Leon M.B.; Hahn
R.T.
Institution
(Pibarot, Ternacle, Salaun, Annabi, Guzzetti, Beaudoin, Bernier, Clavel)
Institut Universitaire de Cardiologie et de Pneumologie de Quebec/Quebec
Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
(Jaber, Rodriguez, Kapadia) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
(Dahou, Alu, Kodali, Smith, Leon, Hahn) Columbia University Medical
Center/New York-Presbyterian Hospital, New York, NY, United States
(Dahou, Alu, Kodali, Smith, Leon, Hahn) Cardiovascular Research
Foundation, New York, NY, United States
(Asch, Weissman) MedStar Health Research Institute at Washington Hospital
Center, Washington, DC, United States
(Xu, Rogers) Edwards Lifesciences, Irvine, CA, United States
(Leipsic, Blanke, Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, NC, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Miller) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Mack) Baylor Scott & White Healthcare, Plano, TX, United States
(Herrmann) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, Georgia, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: It is unknown whether transcatheter valves will have similar
durability as surgical bioprosthetic valves. Definitions of structural
valve deterioration (SVD), based on valve related reintervention or death,
underestimate the incidence of SVD. Objective(s): This study sought
to determine and compare the 5-year incidence of SVD, using new
standardized definitions based on echocardiographic follow-up of valve
function, in intermediate-risk patients with severe aortic stenosis given
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR) in the PARTNER (Placement of Aortic Transcatheter
Valves) 2A trial and registry. Method(s): In the PARTNER 2A trial,
patients were randomly assigned to receive either TAVR with the SAPIEN XT
or SAVR, whereas in the SAPIEN 3 registry, patients were assigned to TAVR
with the SAPIEN 3. The primary endpoint was the incidence of SVD, that is,
the composite of SVD-related hemodynamic valve deterioration during
echocardiographic follow-up and/or SVD-related bioprosthetic valve failure
(BVF) at 5 years. Result(s): Compared with SAVR, the SAPIEN-XT TAVR
cohort had a significantly higher 5-year exposure adjusted incidence rates
(per 100 patient-years) of SVD (1.61 +/- 0.24% vs. 0.63 +/- 0.16%),
SVD-related BVF (0.58 +/- 0.14% vs. 0.12 +/- 0.07%), and all-cause
(structural or nonstructural) BVF (0.81 +/- 0.16% vs. 0.27 +/- 0.10%) (p
<= 0.01 for all). The 5-year rates of SVD (0.68 +/- 0.18% vs. 0.60 +/-
0.17%; p = 0.71), SVD-related BVF (0.29 +/- 0.12% vs. 0.14 +/- 0.08%; p =
0.25), and all-cause BVF (0.60 +/- 0.15% vs. 0.32 +/- 0.11%; p = 0.32) in
SAPIEN 3 TAVR were not significantly different to a propensity score
matched SAVR cohort. The 5-year rates of SVD and SVD-related BVF were
significantly lower in SAPIEN 3 versus SAPIEN XT TAVR matched cohorts.
 Conclusion(s): Compared with SAVR, the second-generation SAPIEN XT
balloon-expandable valve has a higher 5-year rate of SVD, whereas the
third-generation SAPIEN 3 has a rate of SVD that was not different from
SAVR. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves -
PII A [PARTNERII A]; NCT01314313; The PARTNER II Trial: Placement of
AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate
[PARTNERII S3i]; NCT03222128) Copyright © 2020 American College
of Cardiology Foundation

<66>
Accession Number
2007114271
Title
Cardiac resynchronization therapy for the failing systemic right
ventricle: A systematic review.
Source
International Journal of Cardiology. 318 (pp 74-81), 2020. Date of
Publication: 1 November 2020.
Author
Kharbanda R.K.; Moore J.P.; Taverne Y.J.H.J.; Bramer W.M.; Bogers
A.J.J.C.; de Groot N.M.S.
Institution
(Kharbanda, de Groot) Department of Cardiology, Erasmus MC, University
Medical Center, Rotterdam, Netherlands
(Kharbanda, Taverne, Bogers) Department of Cardiothoracic Surgery, Erasmus
MC, University Medical Center, Rotterdam, Netherlands
(Moore) Ahmanson/UCLA Adult Congenital Heart Disease Center, California,
Los Angeles, United States
(Taverne) Department of Anatomy, ERCATHAN, Erasmus MC, university Medical
Center, Rotterdam, Netherlands
(Bramer) Medical library Erasmus MC, University Medical Center, Rotterdam,
Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Patients with a systemic right ventricle (SRV) are at high risk for
development of heart failure early in life. An SRV is encountered in
patients with congenitally corrected transposition of the great arteries
(CCTGA) or dextro-transposition of the great arteries (DTGA) with previous
atrial switch repair (Mustard or Senning procedure). Progressive heart
failure is one of the leading cause of mortality in these patients.
Therefore, cardiac resynchronization therapy (CRT) has gained increasing
momentum for use in this challenging congenital heart disease (CHD)
population. However, current guidelines differ in recommendations for CRT
in patients with an SRV as evidence supporting CRT has thus far only been
described in case reports and retrospectively in relatively small study
populations. In fact, the European Society of Cardiology Guideline for the
management of grown-up congenital heart disease consider CRT to be
'experimental' in this population. This systematic review critically
summarizes current literature on CRT in SRV patients and provides future
perspectives for further research in this challenging and growing CHD
population. Copyright © 2020 The Authors

<67>
Accession Number
2006981181
Title
Improving health-related quality of life and adherence to health-promoting
behaviors among coronary artery bypass graft patients: a non-randomized
controlled trial study.
Source
Quality of Life Research. (no pagination), 2020. Date of Publication:
2020.
Author
Zafari Nobari S.; Vasli P.; Hosseini M.; Nasiri M.
Institution
(Zafari Nobari, Vasli, Hosseini) Department of Nursing, School of Nursing
and Midwifery, Shahid Beheshti University of Medical Sciences, Vali Asr
Ave., Niayesh Cross Road, Tehran, Iran, Islamic Republic of
(Nasiri) Department of Basic Sciences, School of Nursing and Midwifery,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Purpose: This study aimed to determine the impact of a healthy lifestyle
empowerment program on health-related quality of life and adherence to
health-promoting behaviors in coronary artery bypass graft patients.
 Method(s): This non-randomized controlled trial was conducted in 2019
on 97 coronary artery bypass graft patients in Iran. Participants were
selected by culturally pragmatic and non-randomized method and assigned to
healthy lifestyle empowerment program group (HLEPG) (n = 49) and
conventional education group (CEG) (n = 48). Data were collected by the
12-item short-form health survey (SF-12) and health-promoting lifestyle
profile II (HPLP2), which were administered at baseline and three-month
follow-up. The healthy lifestyle empowerment program and conventional
education as two interventions were performed for HLEPG and CEG,
respectively. Data analysis was performed using the paired t-test,
independent t-test, analysis of covariance and linear mixed method at the
0.05 significance level. Result(s): In the follow-up, both groups
showed a significant increase in the mean score of health-related quality
of life (p <= 0.001) but this increase was visibly greater in the HLEPG
(from 23.47 +/- 7.48 to 35.60 +/- 5.95) than in the CEG (from 22.93 +/-
5.93 to 27.6 +/- 4.90). The healthy lifestyle empowerment program also
significantly increased the mean score of adherence to health-promoting
behaviors in the HLEPG (p <= 0.001), whereas no such change was observed
in the CEG. The results of the linear mixed model showed that the
follow-up scores health-related quality of life and adherence to
health-promoting behaviors of the HLEPG were 27.26 and 7.56 units
significantly greater than the CEG after HLEP, respectively (p < 0.001).
 Conclusion(s): Considering the results of this study, health care
providers are recommended to devise and implement healthy lifestyle
empowerment programs to improve the health-related quality of life of
coronary artery bypass surgery patients. Clinical trial registration:
Registered at Iranian Registry of Clinical Trials
(IRCT20171213037860N1). Copyright © 2020, Springer Nature
Switzerland AG.

<68>
Accession Number
2005960674
Title
The long-term effects of prolonged intensive care stay postcardiac
surgery.
Source
Journal of Cardiac Surgery. 35 (11) (pp 3099-3107), 2020. Date of
Publication: 01 Nov 2020.
Author
Mackie-Savage U.F.; Lathlean J.
Institution
(Mackie-Savage, Lathlean) School of Health Sciences, Faculty of
Environmental and Life Sciences, University of Southampton, Southampton,
United Kingdom
(Mackie-Savage) Specialist Surgery Division, University College London
Hospital, University College London Hospitals NHS Trust, London, United
Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Short-term outcomes for those with a prolonged length of stay
(LOS) in intensive care (ITU) following cardiac surgery are poor, with
higher rates of in-hospital mortality and morbidity. Consequently,
discharge from hospital has been considered the key measure of success.
However, there has been a shift towards long-term outcomes, functional
recovery and quality of life (QoL) as measures of surgical quality. The
aim of this review is to compare and critique the findings of multiple
studies to determine the long-term effects of prolonged ITU stay
postcardiac surgery. Method(s): A computerized literature search of
CINAHL, EMBASE and Google Scholar databases, based on keywords "long-term
effects," "prolonged ITU stay," "cardiac surgery," with rigorous CASP
critique was undertaken. Result(s): The search yielded 12 papers
meeting the inclusion criteria, with eight retrospective and four
prospective studies. Eight of these 12 papers identified inferior
long-term survival or higher mortality rates for those who had prolonged
LOS in ITU in comparison to "normal" LOS or a control. The greatest burden
of mortality was 6 months to 1 year postdischarge. Three papers found that
quality of life was adversely affected or worse for those who had
experienced prolonged LOS in ITU. Conclusion(s): Further research is
required to provide better quality evidence into QoL, following prolonged
stay in ICU postcardiac surgery. The evidence reviewed suggests that the
risk of mortality in this demographic of patients is higher, especially
within the first year and, therefore, more frequent medical surveillance
of these patients is recommended. Copyright © 2020 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals LLC

<69>
Accession Number
2005875817
Title
The role of Cor-Knot in the future of cardiac surgery: A systematic
review.
Source
Journal of Cardiac Surgery. 35 (11) (pp 2987-2994), 2020. Date of
Publication: 01 Nov 2020.
Author
Jenkin I.; Prachee I.; Sokal P.A.; Harky A.
Institution
(Jenkin, Prachee) Medical Sciences Division, University of Oxford, Oxford,
United Kingdom
(Sokal) Department of Medicine, School of Medicine, University of
Liverpool, Liverpool, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The Cor-Knot automated fastener has been used to eliminate the
need for manual knot-tying in cardiac valve surgery for over a decade. We
review the current literature pertaining to Cor-Knot and discuss its
benefits and shortcomings with respect to cardiac valve surgery.
 Method(s): A comprehensive literature search was conducted to
identify articles discussing the use of automated fasteners and manually
tied knots in the setting of cardiac valve surgery. The search terms used
were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener",
"automated fastener", "aortic valve", "mitral valve", "minimally
invasive", and "titanium". These terms were used as keywords and, in
combination, as MeSH terms to maximize the output of literature searches.
Twenty-four relevant articles were identified and reviewed.
 Result(s): Current literature provides evidence to support the role
of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing
total operation times as compared with manual knot-tying. However, studies
to date fail to provide evidence for the translation of these
intraoperative advantages into improved patient outcomes. Moreover,
Cor-Knot is associated with a significant financial burden.
 Conclusion(s): A plethora of evidence exists to support the
intraoperative advantages provided by Cor-Knot. However, the literature is
yet to support its role in facilitating superior clinical outcomes as
compared with manual knot tying. Larger high-quality trials and studies
are required to provide evidence supporting the ongoing use of Cor-Knot in
valve surgery. Copyright © 2020 Wiley Periodicals LLC

<70>
Accession Number
2005875804
Title
Key methodological choices determine the results of randomized trials in
cardiac surgery: Every trial is perfectly designed to get the results it
gets.
Source
Journal of Cardiac Surgery. 35 (11) (pp 2881-2882), 2020. Date of
Publication: 01 Nov 2020.
Author
Gaudino M.; Zwischenberger B.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Zwischenberger) Department of Surgery, Duke University Medical Center,
Durham, NC, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)

<71>
Accession Number
2005840808
Title
Top 100 cited manuscripts in aortic valve replacement: A bibliometric
analysis.
Source
Journal of Cardiac Surgery. 35 (11) (pp 2943-2949), 2020. Date of
Publication: 01 Nov 2020.
Author
Oo S.; Fan K.H.; Khare Y.; Fan K.S.; Chan J.; Lam C.M.; Lai S.H.D.; Kwan
L.Y.A.
Institution
(Oo) Department of Cardiothoracic Surgery, University Hospitals Bristol
and Weston NHS Foundation Trust, Bristol, United Kingdom
(Fan, Khare) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Fan, Lai, Kwan) Department of Medical Education, University of London,
London, United Kingdom
(Chan) Department of Cardiothoracic Surgery, University Hospitals Coventry
and Warwickshire NHS Trust, Coventry, United Kingdom
(Lam) Department of General Surgery, Cardiff and Vale University Health
Board, Cardiff, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
This bibliometric analysis aims to identify publications and highlight the
key areas that have shaped modern clinical practices for aortic valve
replacement (AVR). In this paper, the top 100 most cited manuscripts for
AVR are analyzed. The Thomson Reuters Web of Science database was searched
using the terms "aortic valve replacement," "AVR," "sAVR," "tAVR," or
"TAVI." The results were ranked by citation number and the top 100
articles were further analyzed by evaluating the subject, author, journal,
year of publication, institution, and country of origin. Thirty-thousand
and eight hundred eligible papers were examined, with an accumulation of
81 851 citations in total and a mean citation of 819 per manuscript
(ranged: 344-4180). The New England Journal of Medicine had the most
manuscripts whereas Circulation had the most citations. The number of
citations has also significantly increased for articles published after
2000.The most cited manuscript highlighting the management of valvular
heart disease, was written by Baumgartner et al By providing the most
influential references, this work serves as a comprehensive guide to
topics of interest in the field of AVR. Copyright © 2020 Wiley
Periodicals LLC

<72>
Accession Number
2005737701
Title
Anticoagulation following mitral valve repair.
Source
Journal of Cardiac Surgery. 35 (11) (pp 2887-2894), 2020. Date of
Publication: 01 Nov 2020.
Author
Watt T.M.F.; Murray S.L.; Brescia A.A.; Burn D.A.; Wisniewski A.; Khan
S.P.; Romano M.A.; Bolling S.F.; The M.
Institution
(Watt, Murray, Brescia, Romano, Bolling) Department of Cardiac Surgery,
University of Michigan, Ann Arbor, MI, United States
(Burn) Department of Mathematics, Quinnipiac University, Hamden, CT,
United States
(Wisniewski) University of Toledo College of Medicine, Toledo, OH, United
States
(Khan) Department of Internal Medicine, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim: Anticoagulation after mitral valve repair is
controversial and guidelines are not well-established. This study
evaluated the association between postoperative warfarin use and
complications after mitral valve repair, including bleeding and
thromboembolic incidents, readmission, and mortality. Method(s): This
retrospective study investigated 1097 patients who underwent elective
mitral valve repair between April 2003 and March 2017, and was naive to
atrial fibrillation or prior cardiac surgery. This cohort had no other
indication for or against anticoagulation. About 775 patients were placed
on warfarin with international normalized ratio goal 2.5 and 322 patients
were not anticoagulated. The association between anticoagulation and
complications was assessed with univariate comparisons between groups and
multiple logistic regression. Result(s): Postoperative warfarin use
was associated with a reduced composite of bleeding and thromboembolic
complications (pulmonary embolism, TIA, stroke, pericardial effusion or
cardiac tamponade, gastrointestinal bleeding, and reoperation for
bleeding) with an odds ratio of 0.29 (95% confidence interval, 0.13-0.64,
P =.003). There was no difference in 30-day or 6-month mortality or
readmission rate between groups. Long-term survival estimates were
superior in the warfarin group (10-year: 92% vs 85%; log-rank P <.001).
 Conclusion(s): Our analysis showed that postoperative warfarin use
was associated with an overall reduced composite of bleeding and
thromboembolic incidents and superior long-term survival. These findings
suggest that anticoagulation with warfarin following mitral valve repair
may be a safe and effective means for avoiding postoperative complications
and that a large prospective randomized clinical trial is
warranted. Copyright © 2020 Wiley Periodicals LLC

<73>
Accession Number
2005158925
Title
Severe aortic stenosis and attrwt amyloidosis - beware in the aging: A
case report and review of the literature.
Source
Clinical Interventions in Aging. 15 (pp 1863-1872), 2020. Date of
Publication: 2020.
Author
Adam R.; Munteanu A.; Mititelu R.; Onciul S.; Deleanu D.; Iliescu V.A.;
Popescu B.A.; Jurcut R.
Institution
(Adam, Deleanu, Popescu, Jurcut) Department of Cardiology, "Prof. Dr. C.
C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest,
Romania
(Adam, Onciul, Iliescu, Popescu, Jurcut) "Carol Davila" University of
Medicine and Pharmacy, Bucharest, Romania
(Munteanu) Department of Cardiology, Emergency University Central Military
Hospital, Bucharest, Romania
(Mititelu) Department of Nuclear Medicine, Emergency University Central
Military Hospital, Bucharest, Romania
(Onciul) Department of Cardiology, Clinical Emergency Hospital, Bucharest,
Romania
(Iliescu) Department of Cardiovascular Surgery, "Prof. Dr. C.C. Iliescu"
Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
Publisher
Dove Medical Press Ltd (E-mail: angela@dovepress.com)
Abstract
Degenerative aortic valve (AV) disease is the most frequent valvular heart
disease slowly progressing to severe aortic stenosis (AS) which usually
requires aortic valve replacement. Another frequent condition, especially
among elderly people, is cardiac amy-loidosis (CA), particularly the
wild-type transthyretin cardiac amyloidosis (ATTRwt). Since both of these
diseases are considered a marker of ageing, there is a significant
proportion of elderly patients who associate both severe AS and CA. Recent
studies reported a high prevalence of both severe AS and CA (AS-CA) in
elderly patients referred for TAVR of 13-16%, carrying a worse prognosis.
The present case illustrates the diagnostic algorithm and the management
of ATTRwt CA in an elderly patient with severe paradoxical low-flow
low-gradient AS, accompanied by a review of the current literature about
the red flags which help identifying CA in patients with severe AS, as
well as the prognosis and management of these disease
association. Copyright © 2020 Adam et al.

<74>
Accession Number
2005155430
Title
Evaluation of the efficiency of indirect blood pressure measurement
methods in comparison to intra-arterial reading among Iranian individuals.
Source
International Cardiovascular Research Journal. 14 (3) (pp 108-113), 2020.
Article Number: e103852. Date of Publication: September 2020.
Author
Emami M.; Shafie D.; Vakhshoori M.; Eghbali-Babadi M.; Ahmadipour E.;
Khosravi A.
Institution
(Emami) Yazd Cardiovascular Research Institute, Yazd University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Shafie) Heart Failure Research Center, Cardiovascular Research Institute,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Vakhshoori) Interventional Cardiology Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Eghbali-Babadi) Nursing and Midwifery Care Research Center, School of
Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan,
Iran, Islamic Republic of
(Ahmadipour) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Khosravi) Hypertension Research Center, Isfahan Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
Iranian Cardiovascular Research Journal (E-mail: editor@icrj.ir)
Abstract
Background: Detecting the suitable non-invasive Blood Pressure (BP)
measurement method is a quandary in clinical settings for accurate
diagnosis of Hypertension (HTN) status. Objective(s): This study
aimed to evaluate the efficiency of indirect BP measurement methods in
comparison to the gold standard among Iranian patients admitted for
Coronary Angiography (CAG). Method(s): This observational study was
conducted on 150 CAG candidates randomly selected using the computerized
random numbers from March 2019 to September 2019. The participants' BPs
were measured via three different non-invasive methods, including brachial
and wrist oscillometric cuffs plus brachial sphygmomanometer, and the
results were compared to simultaneous intra-arterial reading as the gold
standard. The associations between different non-invasive BP measurements
and direct arterial BP reading were assessed using different statistical
analyses, including correlation coefficient, chi-square, independent and
paired t-test, and Analysis of Variance (ANOVA), as appropriated.
 Result(s): The mean age of the participants was 60.56 +/- 11.16
years. Both Systolic BP (SBP) and Diastolic BP (DBP) were positively
correlated to the gold standard reading in all measurement methods (P <
0.001). After adjustment for potential confounders, the findings revealed
no significant difference between the pre-defined BP measurement methods,
including brachial sphygmomanometer, brachial oscillometric, and wrist
oscillometric, and intra-arterial BP reading regarding the means of SBP
and DBP (P>0.05). Conclusion(s): The present study findings showed
that the selected solution was appropriate in terms of clinical aspects
for the patients undergoing CABG surgery with long surgical duration or
low Ejection Fraction (EF) and reduced the costs to half. Considering the
significant difference in the CK-MB level and the lower troponin level in
the combined group (not statistically significant), further studies are
required to confirm the clinical priority of the combined
solution. Copyright © 2020, Iranian Cardiovascular Research
Journal. All rights reserved.

<75>
Accession Number
633079094
Title
Electromagnetic Versus Blind Guidance of a Postpyloric Feeding Tube in
Critically Ill Children.
Source
Pediatrics. 146 (4) (no pagination), 2020. Date of Publication: 01 Oct
2020.
Author
Jha P.; Rupp L.; Bonilla L.; Gelfond J.; Shah J.N.; Meyer A.D.
Institution
(Jha) Division of Critical Care, Department of Pediatrics, Children's
Hospital of Nevada at University Medical Center, Las Vegas, Nevada;
(Jha) Department of Pediatrics, University of Nevada Las Vegas School of
Medicine, Las Vegas, NV, Mexico
(Rupp, Bonilla, Shah, Meyer) Pediatric Services, University Health System,
San Antonio, Texas; and
(Gelfond) Department of Epidemiology and Biostatistics, University of
Texas Health San Antonio, San Antonio, TX, Mexico
(Shah) Divisions of Pediatric Gastroenterology and
(Meyer) Pediatric Critical Care, Department of Pediatrics and
Publisher
NLM (Medline)
Abstract
BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a
time-consuming procedure associated with multiple attempts and radiation
exposure. Our objective with this study is to compare the time, attempts,
and radiation exposure using the electromagnetic versus blind method to
place a postpyloric feeding tube in critically ill children. Our
hypothesis is that using electromagnetic guidance decreases the procedure
time, number of x-rays, and number of attempts, compared to the blind
method. METHOD(S): Eleven pediatric nurses participated in a
randomized controlled intention-to-treat study at an academic pediatric
medical, surgical, and congenital cardiac ICU. University of Texas Health
Epidemiology and Biostatistics generated a randomization sequence with
sealed envelopes. A standard (2-sided) F-test of association between the
electromagnetic and blind method yielded 40 subjects with 86% power. Data
were analyzed with Fisher's exact test for categorical variables and the
Wilcoxon rank test for continuous variables, with data documented as
median (interquartile range [IQR]). RESULT(S): We randomly assigned
52 patients to either the electromagnetic (n = 28) or blind method (n =
24). The number of attempts and radiographs was at a median of 2 (IQR:
1-2.25) using the blind method, compared to the electromagnetic method at
a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with
the electromagnetic method, compared to only 66.7% with the blind
technique (P = .008). The total time required was 2.5 minutes (IQR:
2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR:
9.25-27.0) for the blind method (P = .001). CONCLUSION(S):
Electromagnetic guidance is a superior, faster, and overall safer method
to place a postpyloric feeding tube in critically ill
children. Copyright © 2020 by the American Academy of Pediatrics.

<76>
Accession Number
632982714
Title
Socioeconomic Status and Long-term Outcomes in Single Ventricle Heart
Disease.
Source
Pediatrics. 146 (4) (no pagination), 2020. Date of Publication: 01 Oct
2020.
Author
Bucholz E.M.; Sleeper L.A.; Goldberg C.S.; Pasquali S.K.; Anderson B.R.;
Gaynor J.W.; Cnota J.F.; Newburger J.W.
Institution
(Bucholz, Sleeper) Department of Cardiology, Boston Children's Hospital,
Boston, MA
(Bucholz, Sleeper, Newburger) Department of Pediatrics, Harvard Medical
School, Harvard University, Boston, MA
(Goldberg, Pasquali) Department of Pediatrics, University of Michigan and
C.S. Mott Children's Hospital, Ann Arbor, MI, United States
(Anderson) Division of Pediatric Cardiology, Department of Pediatrics,
Columbia University Irving Medical Center and NewYork-Presbyterian Morgan
Stanley Children's Hospital, New York City, NY, United States
(Gaynor) Division of Pediatric Cardiac Surgery, Cardiac Center, Children's
Hospital of Pennsylvania, Philadelphia, Pennsylvania; and
(Cnota) Department of Cardiology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States
(Newburger) Department of Cardiology, Boston Children's Hospital, Boston,
Massachusetts;
Publisher
NLM (Medline)
Abstract
BACKGROUND: Low socioeconomic status (SES) has emerged as an important
risk factor for higher short-term mortality and neurodevelopmental
outcomes in children with hypoplastic left heart syndrome and related
anomalies; yet little is known about how SES affects these outcomes over
the long-term. METHOD(S): We linked data from the Single Ventricle
Reconstruction trial to US Census Bureau data to analyze the relationship
of neighborhood SES tertiles with mortality and transplantation,
neurodevelopment, quality of life, and functional status at 5 and 6 years
post-Norwood procedure (N = 525). Cox proportional hazards regression and
linear regression were used to assess the association of SES with
mortality and neurodevelopmental outcomes, respectively. RESULT(S):
Patients in the lowest SES tertile were more likely to be racial
minorities, older at stage 2 and Fontan procedures, and to have more
complications and fewer cardiac catheterizations over follow-up (all P <
.05) compared with patients in higher SES tertiles. Unadjusted mortality
was highest for patients in the lowest SES tertile and lowest in the
highest tertile (41% vs 29%, respectively; log-rank P = .027). Adjustment
for patient birth and Norwood factors attenuated these differences
slightly (P = .055). Patients in the lowest SES tertile reported lower
functional status and lower fine motor, problem-solving, adaptive
behavior, and communication skills at 6 years (all P < .05). These
differences persisted after adjustment for baseline and post-Norwood
factors. Quality of life did not differ by SES. CONCLUSION(S): Among
patients with hypoplastic left heart syndrome, those with low SES have
worse neurodevelopmental and functional status outcomes at 6 years. These
differences were not explained by other patient or clinical
characteristics. Copyright © 2020 by the American Academy of
Pediatrics.

<77>
Accession Number
632252170
Title
Reliability and Influence on Decision Making of fully-automated vs.
semi-automated Software Packages for Procedural Planning in TAVI.
Source
Scientific reports. 10 (1) (pp 10746), 2020. Date of Publication: 01 Jul
2020.
Author
Meyer A.; Kofler M.; Montagner M.; Unbehaun A.; Sundermann S.; Buz S.;
Klein C.; Stamm C.; Solowjowa N.; Emmert M.Y.; Falk V.; Kempfert J.
Institution
(Meyer, Kofler, Montagner, Unbehaun, Sundermann, Buz, Stamm, Solowjowa,
Emmert, Falk, Kempfert) Department of Cardiothoracic and Vascular Surgery,
German Heart Center, Berlin, Germany
(Meyer, Stamm, Emmert, Falk, Kempfert) DZHK (German Centre for
Cardiovascular Research), partner site, Berlin, Germany
(Meyer, Unbehaun) Berlin Institute of Health (BIH), Berlin, Germany
(Kofler) Department of Cardiac Surgery, Medical University of Innsbruck,
Innsbruck, Austria
(Sundermann, Emmert, Falk) Department of Cardiovascular Surgery, Charite -
Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin,
Berlin Institute of Health, Humboldt-Universitat zu Berlin, Berlin,
Germany
(Klein) Department of Cardiology, German Heart Center, Berlin, Germany
(Falk) Translational Cardiovascular Technologies, Institute of
Translational Medicine, Department of Health Sciences and Technology,
Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
Publisher
NLM (Medline)
Abstract
Precise procedural planning is crucial to achieve excellent results in
patients undergoing Transcatheter aortic valve implantation (TAVI). The
aim of this study was to compare the semi-automated 3mensio (3m) software
to the fully-automated HeartNavigator3 (HN) software. We randomly selected
100 patients from our in-house TAVI-registry and compared aortic annulus
and perimeter as well as coronary distances between 3m-measurements and
post-hoc HN-measurements. Finally, we retrospectively simulated prosthesis
choice based on HN-measurements and analyzed the differences compared to
routinely used 3m based strategy. We observed significant differences
between the two software packages regarding area (3m 464+/-88mm2, HN
482+/-96mm2, p<0.001), perimeter (3m 77+/-7mm, HN 79+/-8mm, p<0.001) and
coronary distances (LCA: 3m 13+/-3mm, HN 12+/-3mm, p<0.001; RCA: 3m
16+/-3mm, HN 15+/-3mm, p<0.001). Prosthesis choice simulation based on
newly obtained HN-measurements would have led to a decision change in 18%
of patients, with a further reduction to 4% following manual adjustment of
HN-measurements. The fully-automatic HN-software provides higher values
for annular metrics and lower annulus-to-coronary-ostia distances compared
to 3m-software. Measurement differences did not influence clinical
outcome. Both, the HN-software and the 3m-software are sophisticated,
reliable and easy to use for the clinician. Manual adjustment of
HN-measurements may increase precision in complex aortic annulus anatomy.

<78>
Accession Number
2008355749
Title
TCT CONNECT-455 Reinterventions After Transcatheter Aortic Valve
Replacement With a Supra-Annular Self-Expanding Bioprosthesis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B195), 2020. Date of Publication:
27 Oct 2020.
Author
Grubb K.; Lisko J.; O'Hair D.; Merhi W.; Heiser J.; Chetcuti S.; Deeb G.;
Kleiman N.; Reardon M.
Institution
(Grubb) Emory University, Atlanta, Georgia
(Lisko) Emory University School of Medicine, Atlanta, Georgia
(O'Hair) Boulder Community Health, Boulder, CO, United States
(Merhi, Heiser) Spectrum Health, Grand Rapids, MI, United States
(Chetcuti, Deeb) University of Michigan, Ann Arbor, MI, United States
(Kleiman, Reardon) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative for patients with severe, symptomatic aortic stenosis.
Longer-term safety and durability concerns impact patient selection,
particularly in younger low-risk patients. This analysis examines 5-year
reintervention events after self-expanding TAVR and surgical aortic valve
replacement (SAVR). Method(s): Data were pooled from 5 trials
(CoreValve US Pivotal Extreme-Risk and High-Risk Trial and Continued
Access Studies, SURTAVI and SURTAVI Continued Access Study, and Evolut Low
Risk) including 5,631 TAVR and 1,839 SAVR patients. All patients underwent
annual echocardiography, and the decision to intervene was at the
physician's discretion. Kaplan-Meier analysis compared early and late
reinterventions and details were categorized by indication and treatment.
 Result(s): Reintervention occurred in 87 TAVRs and 18 SAVRs; 1-year
Kaplan-Meier reintervention rates were significantly higher for TAVR
versus SAVR but comparable between 1 and 5 years, although more
reinterventions occurred in SAVR patients after 1 year (Figure).
Paravalvular leak was most often the cause for reintervention after TAVR
and endocarditis after SAVR. Valve-in-valve reinterventions predominated,
except in endocarditis. [Formula presented] Conclusion(s): This post
hoc analysis of pooled data from more than 7,000 patients revealed low
rates of reintervention after TAVR and SAVR through 5 years, with early
reinterventions occurring more frequently with TAVR and late
reinterventions after SAVR. Further analyses of reinterventions per
indication and timing as well as outcomes of reintervention will be
provided at the time of the meeting. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2020

<79>
Accession Number
2008355683
Title
TCT CONNECT-292 A Comparison of Figure-of-8 Suture Versus Manual
Compression for Venous Access Closure After Cardiac Procedures: An Updated
Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B126-B127), 2020. Date of
Publication: 27 Oct 2020.
Author
Mujer M.T.; Flores J.A.; Chin B.R.; Fenando A.; Garces C.; Almalki T.;
Nerusu L.A.; Elshafie A.; Boumegouas M.; Charles L.; Robinson P.
Institution
(Mujer, Fenando, Garces, Almalki, Elshafie, Boumegouas, Charles) Michigan
State University, East Lansing, MI, United States
(Flores) University of the Philippines, Manila, Philippines
(Chin) Southern Philippines Medical Center, Davao City, Philippines
(Nerusu) Wayne State University College of Medicine, Detroit, MI, United
States
(Robinson) University of Connecticut, Farmington, CT, United States
Publisher
Elsevier Inc.
Abstract
Background: Manual compression is the current standard to achieve
post-procedural hemostasis in patients who need venous vascular access
closure after cardiovascular procedures. Figure-of-8 (F8) suture for
venous access closure has been reported to be a safe and efficacious
alternative to manual compression. Method(s): A systematic search was
done using PubMed, Google Scholar, Embase, Scopus, and without language
restriction up until April 15, 2020, for studies comparing F8 suture with
manual compression. Risk ratio (RR) and mean difference with 95%
confidence interval (CI) were calculated using a random effects model.
 Result(s): Time to achieve hemostasis was significantly reduced in
the F8 arm (mean difference: -21.04 min; 95% CI: -35.66 to -6.42 min; p =
0.005). Access site bleeding was significantly lower in the F8 group (RR:
0.35; 95% CI: 0.18 to 0.66; p = 0.001) along with a lower incidence of
hematoma formation (RR: 0.42; 95% CI: 0.26 to 0.67; p = 0.0003). There was
no significant difference in rates of fistula or pseudoaneurysm formation
between the 2 groups. Overall access site complications were lower in the
F8 arm (RR: 0.38; 95% CI: 0.26 to 0.55; p < 0.00001) and the effect was
more pronounced for sheaths >=10-F (RR: 0.33; 95% CI: 0.18 to 0.60; p =
0.0003). There was lower post-procedural protamine use in the F8 group
(RR: 0.07; 95% CI: 0.01 to 0.36; p = 0.001) (Figure). [Formula presented]
 Conclusion(s): For large-bore venous access closure, the F8 suture
results in a shortened time to achieve hemostasis along with a lower
overall risk of access site complications and post-procedural protamine
use. Categories: OTHER: Vascular Access: Endovascular Copyright ©
2020

<80>
Accession Number
2008355620
Title
TCT CONNECT-159 Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting for Left Main Coronary Artery Disease in Diabetic
Patients: A Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B68), 2020. Date of Publication:
27 Oct 2020.
Author
Kim J.; Alam M.
Institution
(Kim, Alam) Baylor College of Medicine, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Percutaneous coronary intervention (PCI) of the left main (LM)
coronary artery is emerging as a viable alternative to coronary artery
bypass grafting (CABG) in appropriate patients. However, there are limited
data comparing these 2 approaches for LM disease in diabetic patients.
This study attempts to delineate the optimal revascularization strategy in
this subgroup of patients by analyzing the existing data. Method(s):
A systematic search of the PubMed database was performed for studies
reporting outcomes of PCI using drug-eluting stents versus CABG for LM
disease in diabetic patients. A random-effects model was used to derive
hazard ratios (HRs) with 95% confidence intervals (CIs). Result(s):
Four randomized controlled trials and 8 observational studies met
inclusion criteria with 2,456 patients included in the PCI group and 2,776
patients in the CABG group. The average reported follow-up time was 4.0
years (range: 2.1 to 7.1 years). There was no difference between PCI and
CABG with regards to the composite endpoint of all-cause death, myocardial
infarction, and stroke (HR: 1.01; 95% CI: 0.82 to 1.24). Likewise,
all-cause death (HR: 1.12; 95% CI: 0.92 to 1.36) and cardiovascular death
(HR: 1.57; 95% CI: 0.69 to 3.55) did not differ between the 2 groups. The
incidence of stroke was lower with PCI (HR: 0.37; 95% CI: 0.23 to 0.62).
There was increased rate of major adverse cardiac and cerebrovascular
events, defined as the composite of all-cause death, myocardial
infarction, stroke, and repeat revascularization, in the PCI group (HR:
1.28; 95% CI: 1.11 to 1.48) and an increased rate of repeat
revascularization with PCI (HR: 2.98; 95% CI: 2.02 to 4.41).
 Conclusion(s): PCI and CABG were similar with regards to all-cause
mortality and the composite endpoint of all-cause death, myocardial
infarction, and stroke. While PCI had a lower rate of stroke, there was an
increased rate of major adverse cardiac and cerebrovascular events with
PCI compared to CABG that was primarily driven by increased rate of repeat
revascularization. These results support the concept that PCI is a viable
alternative to CABG for LM disease in select diabetic patients.
Categories: CORONARY: Complex and Higher Risk Procedures for Indicated
Patients (CHIP) Copyright © 2020

<81>
Accession Number
2008355619
Title
TCT CONNECT-3 Treatment With Icosapent Ethyl to Reduce Ischemic Events in
Patients With Prior Percutaneous Coronary Intervention: Insights From
REDUCE-IT PCI.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B1-B2), 2020. Date of Publication:
27 Oct 2020.
Author
Peterson B.; Bhatt D.; Steg P.; Miller M.; Brinton E.; Ketchum S.; Juliano
R.; Jiao L.; Doyle R.; Granowitz C.; Pinto D.; Giugliano R.; Budoff M.;
Tardif J.-C.; Verma S.; Ballantyne C.
Institution
(Peterson) Brigham and Women's Hospital, Brookline, MA, United States
(Bhatt) Brigham and Women's Hospital, Boston, MA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
Network, Departement Hospitalo-Universitaire FIRE, AP-HP, hopital Bichat,
Universite Paris-Diderot, Paris, France
(Miller) University of Maryland School of Medicine, Baltimore, MD, United
States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Ketchum, Jiao, Doyle, Granowitz) Amarin Pharma, Inc., Bridgewater
Township, NJ, United States
(Juliano) Amarin Pharma, Inc., Madison, NJ, United States
(Pinto) BIDMC, Boston, MA, United States
(Giugliano) Brigham & Women's Hospital, Boston, MA, United States
(Budoff) David Geffen School of Medicine, Harbor University of California,
Los Angeles, Los Angeles, CA, United States
(Tardif) Montreal Heart Institute, Montreal, QC, Canada
(Verma) St Michael's Hospital, Toronto, ON, Canada
(Ballantyne) Baylor College of Medicine, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Patients with a history of percutaneous coronary intervention
(PCI) are at increased risk for ischemic events despite statin therapy.
 Method(s): In a multicenter, double-blind, placebo-controlled trial,
statin-treated patients with triglycerides of 135 to 499 mg/dl, controlled
low-density lipoprotein (41 to 100 mg/dl), and either established
cardiovascular disease or diabetes plus other risk factors were randomized
to icosapent ethyl 4 g daily or placebo. In the overall trial, the primary
composite endpoint (cardiovascular death, myocardial infarction, stroke,
coronary revascularization, or hospitalization for unstable angina) and
the key secondary composite endpoint (cardiovascular death, myocardial
infarction, or stroke) were significantly reduced. Here we present the
subgroup of patients with a history of PCI. Result(s): A total of
8,179 patients were followed for 4.9 years (median), 3,408 (41.7%) of whom
had a prior PCI, with a median of 2.9 years (0.4 months to 30.7 years)
from PCI to randomization (in the 2,559 patients who had the date of PCI
recorded). The rate of the primary endpoint was reduced by 34% (20.8% with
icosapent ethyl vs. 29.4% with placebo [hazard ratio: 0.66; 95% confidence
interval: 0.58 to 0.76; p < 0.0001; number needed to treat = 12]). The
rate of the key secondary endpoint was also reduced by 34% (12.0% with
icosapent ethyl vs. 17.4% with placebo [hazard ratio: 0.66; 95% confidence
interval: 0.56 to 0.79; p < 0.0001; number need to treat = 19]). [Formula
presented] Conclusion(s): In statin-treated patients with elevated
triglycerides and a history of PCI, the addition of icosapent ethyl
significantly reduced ischemic events, with relative and absolute risk
reductions that were substantial. Categories: CORONARY:
Pharmacology/Pharmacotherapy Copyright © 2020

<82>
Accession Number
2008355616
Title
TCT CONNECT-158 Percutaneous Coronary Intervention With Drug Eluting
Stents Versus Coronary Artery Bypass Grafting in Patients With Impaired
Renal Function: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B67-B68), 2020. Date of
Publication: 27 Oct 2020.
Author
Tzoumas A.; Tzani A.; Doulamis I.; Iliopoulos D.; Briasoulis A.;
Kampaktsis P.
Institution
(Tzoumas) School of Medicine, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Iliopoulos) 4th Department of Cardiac Surgery Hygeia Hospital, Athens,
Greece
(Briasoulis) University of Iowa, Iowa City, IA, United States
(Kampaktsis) New York University, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: The optimal revascularization strategy in patients with
coronary artery disease and advanced chronic kidney disease (CKD) remains
controversial. Method(s): We performed a systematic review and
meta-analysis comparing the outcomes of patients with CKD after
percutaneous coronary intervention (PCI) with drug-eluting stents (DES)
vs. coronary artery bypass graft (CABG). Eligible studies included
patients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73
m2 and stable coronary artery disease or acute coronary
syndromes that underwent revascularization. Subgroup analyses according to
DES generation and dialysis status were performed. Result(s): A total
of 7,157 and 8,156 patients were included in the CABG and PCI arms,
respectively, across 16 eligible studies. Weighted mean age was 68.6 and
63.8 years for the CABG and PCI arms, respectively, and males represented
64% in both groups. 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 (hazard ratio [HR]: 1.28; 95% confidence interval
[CI]: 1.13 to 1.46; p < 0.01) (Figure 1A), cardiac mortality (HR: 1.59;
95% CI: 1.13 to 2.23; p = 0.01) (Figure 1B), myocardial infarction (HR:
1.89; 95% CI: 1.43 to 2.49; p < 0.01), and repeat revascularization (HR:
2.97; 95% CI: 2.20 to 3.97; p < 0.01). Risk for stroke was lower in the
PCI group (HR: 0.64; 95% CI: 0.50 to 0.81; p < 0.01). These results were
unchanged when first or second 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 to 1.73; p = 0.65). [Formula presented]
 Conclusion(s): In patients with advanced CKD, PCI is associated with
higher risk of mortality, myocardial infarction, 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. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2020

<83>
Accession Number
2008355562
Title
TCT CONNECT-161 Multi-Vessel Disease Percutaneous Coronary Intervention
Versus Coronary Artery Bypass Grafting in Patients With Chronic Kidney
Disease.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B69), 2020. Date of Publication:
27 Oct 2020.
Author
Abdelnabi M.; Almaghraby A.; El Amrawy A.
Institution
(Abdelnabi) Medical Research Institute, Alexandria University, Alexandria,
Egypt
(Almaghraby) Alexandria University, Alexandria, Egypt
(El Amrawy) Cardiology Department, Faculty of Medicine, Alexandria
University, Alexandria, Egypt
Publisher
Elsevier Inc.
Abstract
Background: Coronary revascularization is associated with better prognosis
in multivessel coronary artery disease (MV-CAD) chronic kidney disease
(CKD) patients. However, whether coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) is better remains unknown. The
study aimed to compare outcomes of multi-vessel PCI versus CABG in the
group of patients with CKD regarding in-hospital and 1-year major adverse
cardiovascular and cerebrovascular events (MACCE). Method(s): A
retrospective analysis of the data of patients with established CKD with
estimated glomerular filtration rate <60 ml/min with MV-CAD who underwent
PCI or CABG were compared as regards in-hospital and 1-year MACCE.
 Result(s): A total number of 565 patients were reviewed; 230 patients
had PCI whereas 335 patients had CABG. Comparing both groups regarding
in-hospital MACCE, patients who had mutlivessel PCI had significantly
lower in-hospital death, cerebrovascular events, and total MACCE than
patients who had CABG (p = 0.03, p = 0.01, and p = 0.04, respectively).
While comparing both groups regarding 1-year MACCE, patients who had
mutlivessel PCI had significantly lower cerebrovascular events and total
MACCE than patients who had CABG (p = 0.02 and p = 0.03, respectively).
[Formula presented] Conclusion(s): Contrary to previously published
data, in a retrospective study to determine which is better in CKD MV-CAD
patients, multi-vessel PCI for CKD patients and MV CAD had advantages over
CABG as regards in-hospital and 1-year cerebrovascular accidents
(stroke/transient ischemic attack) and total MACCE. Large randomized
controlled trials are needed to confirm our findings. CatEgories:
CORONARY: Cardiac and Coronary Artery Surgery and Hybrid
Revascularization Copyright © 2020

<84>
Accession Number
2008355553
Title
TCT CONNECT-343 Early Feasibility Study of Ventricular Restoration System
in Heart Failure Patients With FMR: 6-Month Outcomes.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B147-B148), 2020. Date of
Publication: 27 Oct 2020.
Author
Shreenivas S.; Martin S.; Nagaraj H.; Silva G.; Reisman M.; Don C.; Gada
H.; Grubb K.; Kereiakes D.; Sorajja P.; Burkhoff D.
Institution
(Shreenivas) The Christ Hospital, Cincinnati, Ohio, United States
(Martin) Pioneer Heart Institute, Lincoln, NE, United States
(Nagaraj) Nebraska Heart Institute, Lincoln, NE, United States
(Silva) Texas Heart Institute, Houston, TX, United States
(Reisman, Don) University of Washington, Seattle, WA, United States
(Gada) University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA,
United States
(Grubb) Emory University, Atlanta, Georgia
(Kereiakes) The Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Sorajja) Minneapolis Heart Institute, Minneapolis, MN, United States
(Burkhoff) NewYork-Presbyterian/Columbia University Medical Center, New
York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: The AccuCinch employs a catheter-based delivery system that
places a series of anchors connected by a cable into the basal myocardium,
which is then cinched, reducing the basal left ventricular (LV) dimensions
and volume. The CorCinch-FMR (Early Feasibility Study of the AccuCinch
Ventricular Repair System) study is a multicenter, nonrandomized,
prospective early feasibility study to evaluate the safety and performance
of the AccuCinch system. Method(s): After meeting baseline inclusion
criteria, 35 patients underwent the procedure. Acute and 30-day safety was
based on the incidence of major adverse cardiovascular and procedural
events. Changes in exercise capacity, quality of life, and
echocardiographic outcomes including LV size and mitral regurgitation (MR)
at 30, 90, and 180 days were also assessed. Result(s): The 35
included subjects were mean age 66 years; had mean LV ejection fraction
(EF) 33%; and had New York Heart Association functional class II (34%),
III (63%), and IV (3%). Procedures were completed successfully in 31
patients (88.6%) at 10 sites. In 4 cases, procedure ended before implant
attempt due to anatomic limitations. There was 1 device-related adverse
event through the 6-month follow-up-a pericardial effusion that was
resolved at time of procedure with pericardiocentesis. At 180 days, paired
analysis of follow-up data indicated reduction of LV end-systolic volume,
improved LVEF, and improvements in MR. Patients also experienced
improvements in quality of life and exercise tolerance (Table). [Formula
presented] Conclusion(s): AccuCinch ventricular restoration appears
feasible and safe, with consistent reductions in MR and LV volumes and
improvements of LVEF and clinical status. Early improvements in heart
failure clinical outcomes and LV volumes, independent of reductions of
functional MR, suggest that AccuCinch may provide benefit for heart
failure with reduced EF. These results have prompted initiation of a
pivotal randomized trial, CorCinch-HF (CorCinch-HF Repair System in
Patients Who Present With Symptomatic Nonischemic or Ischemic Dilated
Cardiomyopathy), to investigate the clinical utility of AccuCinch in
patients with heart failure with reduced EF without functional MR.
Categories: STRUCTURAL: Heart Failure Copyright © 2020

<85>
Accession Number
2008355539
Title
TCT CONNECT-475 In TAVI, the Less Antibiotics, the Better!.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B203), 2020. Date of Publication:
27 Oct 2020.
Author
Kosmas I.; Iakovou I.; Gkonteva M.; Aravanis N.; Sbarouni E.; Leontiadis
E.; Voudris V.
Institution
(Kosmas, Iakovou, Gkonteva, Aravanis, Leontiadis, Voudris) Onassis Cardiac
Surgery Center, Athens, Greece
(Sbarouni) Division of Interventional Cardiology, Onassis Cardiac Surgery
Center, Athens, Greece
Publisher
Elsevier Inc.
Abstract
Background: The strategy of preventing infections during TAVI is still
part of a lively debate. The aim of this study is to assess the impact of
antibiotics in the incidence of acute kidney injury (AKI) after
transcatheter aortic valve implantation (TAVI). Method(s): We
randomized 352 consecutive patients undergoing TAVI from November 2016 to
May 2020 (42 months) in 2 groups; in group A, the patients did not take
any antibiotics post TAVI, while in group B, prophylactic antibiotic
treatment post-TAVI was given. As for the exact protocol of our hospital,
the antibiotic therapy consists of 1 g vancomycin as an intravenous bolus
2 hours pre-TAVI (group A) and intravenous vancomycin 500 mg x4 +
intravenous ciprofloxacin 400 mg x2 for a 3-day period, starting from 2
hours before the intervention (group B). Moreover, linezolid was used
instead of vancomycin when the glomerular filtration rate was lower than
25 ml/min. The exclusion criteria were severe baseline chronic kidney
disease stage >G3 defined as a baseline glomerular filtration rate <60
ml/min/1.73 m2, surgical cutdown approach or other than femoral
access, and permanent peacemaker implantation. AKI was defined according
to the VARC-2 AKIN classification (an absolute increase in serum
creatinine of at least >0.3 mg/dl or a relative increase of >150% to 199%
within 48 hours after TAVI). Result(s): After the application of the
exclusion criteria, the 2 groups had 83 and 44 patients, respectively,
whereas there were no statistically significant differences in mean age,
mean weight, and mean contrast volume. The use of antibiotics in group B
led to a statistically significant increased incidence of AKI (38.6%) in
comparison with group A (13%), whereas there were no significant
differences regarding hospital length of stay (Figure). [Formula
presented] Conclusion(s): Using the least amount possible of
nephrotoxic drugs in patients of increased age undergoing TAVI seems
prudent. Further larger studies are needed to validate these findings.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2020

<86>
Accession Number
2008355519
Title
TCT CONNECT-140 Direct Implantation of a Supra-Annular Self-Expanding
Bioprostheses Has No Impact on 1-Year Clinical Outcomes.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B60-B61), 2020. Date of
Publication: 27 Oct 2020.
Author
Benetos G.; Drakopoulou M.; Karmpalioti M.; Stathogiannis K.; Xanthopoulou
M.; Latsios G.; Synetos A.; Kosmas I.; Katsimagklis G.; Mastrokostopoulos
A.; Danenberg H.; Tousoulis D.; Toutouzas K.
Institution
(Benetos) Ippokrateion Hospital Athens, Athens, Greece
(Drakopoulou, Synetos, Toutouzas) 1st Cardiology Department, Athens
Medical School, Hippokration General Hospital, Athens, Greece
(Karmpalioti, Xanthopoulou) Hippokration General Hospital, Athens, Greece
(Stathogiannis) University of Athens Medical School, Athens, Greece
(Latsios) Athens Medical School-Hippokration Hospital, Athens, Greece
(Kosmas) Onassis Cardiac Surgery Center, Athens, Greece
(Katsimagklis) Athens Naval Hospital, Athens, Greece
(Mastrokostopoulos) Naval Hospital, Athens, Greece
(Danenberg) Hadassah Hebrew University Medical Center, Jerusalem, Israel
(Tousoulis) 1st Cardiology Department, Athens Medical School, Athens,
Greece
Publisher
Elsevier Inc.
Abstract
Background: Randomized data comparing long-term outcomes in self-expanding
valves with or without pre-dilatation are lacking. In the present study,
we aimed to investigate the impact of direct implantation of a
self-expanding valve on 1-year clinical outcomes. Method(s): In the
DIRECT trial (Pre-dilatation in Transcatheter Aortic Valve Implantation
[TAVI] Trial), consecutive patients with severe aortic stenosis were
randomized at 4 tertiary centers to undergo TAVI with the use of
self-expanding prostheses with (pre-balloon aortic valvuloplasty
[pre-BAV]) or without pre-dilatation (no-BAV). The primary endpoint was
device success according to the Valve Academic Research Consortium-2
criteria. All-cause death, cardiac death, stroke, heart failure
hospitalizations, and permanent pacemaker implantation rates were recorded
at 1 year and compared between the 2 groups using Kaplan-Meier plots.
 Result(s): In a total of 171 patients who were randomized in 4
centers, 86 patients were allocated to the pre-BAV group and 85 patients
to the no-BAV TAVI group. The device success according to the Valve
Academic Research Consortium-2 criteria was non-inferior in the no-BAV
group compared to the pre-BAV group (65 of 85 [76.5%] for no-BAV versus 64
of 86 [74.4%] for pre-BAV, mean difference: 2.1%; 90% CI: -8.9 to 13). In
the no-BAV group 25 (29.4%) patients underwent post-balloon dilatation and
in the pre-BAV group 13 patients (15.1%) (p = 0.03). At 1 year, 4 deaths
were recorded in pre-BAV group (4.7%) and 3 deaths in no-BAV group (3.5%).
There was no difference in Kaplan-Meier plots between the two groups in
all-cause mortality (log-rank p = 0.72). Similarly, there was no
difference in 1-year incidence of stroke (log-rank p = 0.55), cardiac
death (log-rank p = 0.66), noncardiac death (log-rank p = 0.98), and heart
failure hospitalizations (log-rank p = 0.31). Lastly, there was no
difference in the incidence of permanent pacemaker implantation between
the 2 groups at 1 year (27 of 67 in the no-BAV group versus 20 of 69 in
the pre-BAV group, log-rank p = 0.24). Conclusion(s): Direct
implantation of a self-expanding supra-annular bioprostheses is
non-inferior to the procedure with pre-dilatation. Direct procedure has no
impact on clinical outcomes at 1 year. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2020

<87>
Accession Number
2008355487
Title
TCT CONNECT-463 Computed Tomography Angiography-Fluoroscopy Fusion Imaging
for the Guidance of Cerebral Embolic Protection Deployment During
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B198-B199), 2020. Date of
Publication: 27 Oct 2020.
Author
Wang D.; Basman C.; Pirelli L.; El-Haddad H.; Mihelis E.; Mehla P.; Patel
N.C.; Scheinerman J.; Kliger C.
Institution
(Wang, Basman, Pirelli, El-Haddad, Mihelis, Mehla, Patel, Scheinerman)
Lenox Hill Hospital, New York City, United States
(Kliger) Lenox Hill Heart and Lung, Northwell Health, New York, United
States
Publisher
Elsevier Inc.
Abstract
Background: To investigate whether placement of cerebral embolic
protection device (CEPD) guided by 3-dimensional computed tomography
angiography (CTA)-fluoroscopy fusion imaging results in decreased time to
deployment and usage of contrast media compared with standard fluoroscopy
alone. Method(s): In this prospective, single-center study, a total
of 40 consecutive patients who underwent transfemoral transcatheter aortic
valve replacement were randomized (1.5:1) to CTA-fluoroscopy fusion
imaging guidance (n = 24, FUSION+) versus standard imaging with only
fluoroscopic guidance (n = 16, FUSION-) for transradial placement of a
CEPD (Sentinel, Boston Scientific, Marlborough, Massachusetts).
 Result(s): There were no differences in baseline and/or procedural
characteristics between both groups. Ninety-eight percent of patients
underwent successful placement of both the carotid and brachiocephalic
filters. Comparing the 2 groups, the average time until deployment was
significantly lower in the FUSION+ group (4.4 +/- 2.0 minutes vs. 7.4 +/-
3.3 minutes, p < 0.01). Additionally, the amount of contrast media used
was also significantly lower in the FUSION+ group (1.1 +/- 5.1 ml vs. 16.3
+/- 7.6 ml, p < 0.01). There was no significant difference in debris
obtained in the filter and total radiation during the procedure. There
were no device-related adverse events in either group (Table). [Formula
presented] Conclusion(s): CTA-fluoroscopy fusion imaging for the
guidance of CEPD placement during transcatheter interventions requires
less contrast and results in less time for deployment than standard
imaging with fluoroscopy/angiography. Fusion imaging can play an important
role for the guidance of CEPD placement, as well as potentially other
structural heart disease interventions. Categories: IMAGING: Physiologic
Lesion Assessment Copyright © 2020

<88>
Accession Number
2008355486
Title
TCT CONNECT-491 Transcatheter Tricuspid Valve Replacement and Repair:
Pooled Analysis of the Outcomes and Complications of Novel Emerging
Treatments.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B210), 2020. Date of Publication:
27 Oct 2020.
Author
Khalid Y.; Dasu N.; Dasu K.
Institution
(Khalid) Rowan University, Voorhees, NJ, United States
(Dasu) Rowan SOM, Voorhees Township, NJ, United States
(Dasu) Syracuse University, Syracuse, United States
Publisher
Elsevier Inc.
Abstract
Background: Tricuspid regurgitation is a poor prognostic marker of
end-stage heart failure. Treatment options for severe tricuspid
regurgitation are currently limited because these procedures have the
highest mortality rates of all valve procedures. Transcatheter tricuspid
valve repair or replacement, on the other hand, are extremely promising
interventions due to the minimally invasive nature of these treatments.
The aim of this study is to examine the complications of these procedures
from day 0 of procedure to up to 1 year of follow-up. Method(s): Six
studies were included from 3 registries (TriVALVE, TRILUMINATE, and
TRAMI), surveying a total of 336 patients. Complications following the
procedures were pooled and analyzed. Result(s): From procedure to up
to 1 year, there was 14.3% mortality (49/342), 0.3% incidence of
myocardial infarction and transient ischemic attack/stroke (1/342), 2%
device embolization and/or leaflet detachment (7/342), 5.2% major/minor
bleeding (18/342), 0.9% acute kidney injury (3/342), and 1.1% infections
and arrhythmias (4/342). [Formula presented] Conclusion(s): Despite a
narrow sample size due to the novelty of these procedures and varying
lengths of follow-up (30 days to 1 year), transcatheter tricuspid valve
repair and replacement prove to be promising interventions. Research aimed
at further investigating transcatheter tricuspid valve repair or
replacement procedures and prospective clinical trials to establish these
treatments as mainstays for severe tricuspid regurgitation is necessary.
Categories: STRUCTURAL: Valvular Disease: Tricuspid Copyright ©
2020

<89>
Accession Number
2008355443
Title
TCT CONNECT-109 1-Year Outcomes With Lotus Edge: The REPRISE III Nested
Registry.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B48-B49), 2020. Date of
Publication: 27 Oct 2020.
Author
Gooley R.; Rajagopal V.; Kereiakes D.; Kleiman N.; Underwood P.; Allocco
D.; Rizik D.; Reardon M.
Institution
(Gooley) MonashHeart, Fitzroy, Victoria, Australia
(Rajagopal) Piedmont Heart Institute, Atlanta, Georgia
(Kereiakes) The Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Kleiman, Reardon) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Underwood) Boston Scientific, Phoenix, AZ, United States
(Allocco) Boston Scientific, Maple Grove, MN, United States
(Rizik) HonorHealth Heart Group, Scottsdale, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: The REPRISE III Nested Registry (R3NR) is a single-arm
registry within REPRISE III designed to evaluate acute performance of the
LOTUS Edge valve system for regulatory approval. Method(s): R3NR
enrolled 100 symptomatic subjects at 4 sites in the United States and
Australia with severe native aortic stenosis and high or extreme surgical
risk. The primary safety (30-day death, stroke, life-threatening/major
bleeding, stage 2/3 acute kidney injury, major vascular complications) and
primary effectiveness endpoints (1-year death, disabling stroke, and >=
moderate paravalvular leak [PVL]) were similar to REPRISE III randomized
controlled trial. Result(s): Data through 1-year follow-up is
available on the first 50 patients enrolled. The 30-day outcomes in the
full patient population (N = 100) will be available at the time of
presentation. In the first 50 patients, mean age was 80 years, 46% were
women, and Society of Thoracic Surgeons score averaged 3.7 +/- 2.3. At
baseline, 56% were New York Heart Association (NYHA) functional class III
or IV, mean aortic valve area was 0.71 +/- 0.16 cm2, and mean
aortic valve gradient was 45.9 +/- 12.4 mm Hg. At 1 year, there were 3
(6%) deaths, 1 (2%) disabling stroke, 3 (6%) life-threatening or disabling
bleeding, and no valve malpositioning events (Table). New pacemakers were
implanted in 17 of 50 patients (34%) at 1-year follow-up. In the first 50
patients, 1-year mean aortic valve area was 1.48 +/- 0.43 cm2 and mean
aortic valve gradient was 14.29 +/- 8.40 mm Hg. At 1 year, PVL was mild in
9.8% of patients; no patient had moderate or greater PVL and 98% were NYHA
functional class I/II. [Formula presented] Conclusion(s): The R3NR
supports the safety and effectiveness of LOTUS Edge and was the basis for
U.S. regulatory approval. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2020

<90>
Accession Number
2008355426
Title
TCT CONNECT-344 Transcatheter Mitral Valve Repair or Medical Therapy for
Severe Functional Mitral Regurgitation in Women Compared With Men: The
COAPT Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B148), 2020. Date of Publication:
27 Oct 2020.
Author
Kosmidou I.; Lindenfeld J.; Abraham W.; Rinaldi M.; Kapadia S.; Rajagopal
V.; Brieke A.; Rogers J.; Shahim B.; Redfors B.; Zhang Z.; Mack M.; Stone
G.
Institution
(Kosmidou) Columbia University Medical Center, New York, NY, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham) The Ohio State University Wexner Medical Center, Columbus, OH,
United States
(Rinaldi) Sanger Heart and Vascular Institute, Charlotte, NC, United
States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Rajagopal) Piedmont Heart Institute, Atlanta, Georgia
(Brieke) University of Denver, Aurora, CO, United States
(Rogers) University of California Davis Medical Center, Sacramento, CA,
United States
(Shahim, Redfors, Zhang) Cardiovascular Research Foundation, New York, NY,
United States
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Stone) Mount Sinai Heart Health System, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: The impact of sex on clinical outcomes in patients with heart
failure and moderate-severe or severe secondary mitral regurgitation
treated with transcatheter mitral valve repair with MitraClip +
guideline-directed medical therapy (device) versus guideline-directed
medical therapy alone (control) is unknown. Method(s): In COAPT
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure With Functional Mitral Regurgitation), patients were
randomized 1:1 to device versus control. Outcomes were examined by sex.
 Result(s): Among 614 patients, 221 (36.0%) were women. Compared with
men, women were younger and more frequently had nonischemic
cardiomyopathy. In a joint frailty model accounting for the competing risk
of death, the 2-year cumulative incidence of the primary endpoint of
recurrent heart failure hospitalization (HFH) was higher in men versus
women in the control group and similar between sexes in the device group
(Figure). A significant interaction was present between sex and treatment
modality for all HFH at 2 years. In sensitivity analyses landmarked at 1
year, a significant interaction between time from treatment and treatment
modality was present for all HFH in women (device vs. control: for 0 to 1
years: hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.39 to
0.84; and for 1 to 2 years: HR: 1.39; 95% CI: 0.83 to 2.33; p interaction
= 0.007) but not in men (device vs. control: for 0 to 1 years: HR: 0.48;
95% CI: 0.36 to 0.64; and for 1 to 2 years: HR: 0.33; 95% CI: 0.21 to
0.51; p interaction = 0.16). Female sex was independently associated with
a lower adjusted risk of death at 2 years (HR: 0.64; 95% CI: 0.46 to 0.90;
p = 0.011) irrespective of treatment modality (adjusted p interaction =
0.50). [Formula presented] Conclusion(s): In the COAPT trial,
transcatheter mitral valve repair with the MitraClip resulted in improved
clinical outcomes versus guideline-directed medical therapy, irrespective
of sex; however, the impact of transcatheter mitral valve repair in
reducing HFH was less pronounced in women versus men. Categories:
STRUCTURAL: Valvular Disease: Mitral Copyright © 2020

<91>
Accession Number
2008355389
Title
TCT CONNECT-468 Postoperative Atrial Fibrillation or Flutter Following
Transcatheter or Surgical Aortic Valve Replacement for Severe Aortic
Stenosis in Patients at Low Surgical Risk: An Analysis From the PARTNER 3
Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B200), 2020. Date of Publication:
27 Oct 2020.
Author
Shahim B.; Malaisrie S.C.; George I.; Thourani V.; Russo M.; Biviano A.;
Mack M.; Brown D.L.; Babaliaros V.; Guyton R.; Kodali S.; Nazif T.;
Genereux P.; Makkar R.; Williams M.; McCabe J.; Webb J.; Lu M.; Yu X.;
Leon M.; Kosmidou I.
Institution
(Shahim) Cardiovascular Research Foundation, New York, New York
(Malaisrie) Northwestern Medicine, Chicago, IL, United States
(George) Columbia University Medical Center/NewYork-Presbyterian, New
York, United States
(Thourani) Piedmont Heart Institute, Atlanta, Georgia
(Russo) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Biviano, Kodali, Kosmidou) Columbia University Medical Center, New York,
United States
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Brown) Baylor Scott & White The Heart Hospital Plano, Plano, TX, United
States
(Babaliaros) Emory University School of Medicine, Atlanta, Georgia
(Guyton) Emory University Hospital, Atlanta, Georgia
(Nazif, Leon) NewYork-Presbyterian/Columbia University Medical Center, New
York, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown, NJ, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Williams) NYU Langone Health, New York, United States
(McCabe) University of Washington Medical Center, Seattle, WA, United
States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Lu, Yu) Edwards Lifesciences, Irvine, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: We sought to determine the incidence and clinical impact of
new-onset postoperative atrial fibrillation or flutter (POAF) in low-risk
patients with severe aortic stenosis treated with transcatheter aortic
valve replacement (TAVR) or surgical aortic valve replacement (SAVR).
 Method(s): In the PARTNER 3 trial, patients with severe aortic
stenosis at low surgical risk were randomized to TAVR or SAVR. POAF was
defined as any atrial fibrillation occurring within the index
hospitalization. Analyses were performed in the as-treated population;
patients with preexistent AF were excluded. Outcomes at 2 years were
analyzed according to POAF. Result(s): Among 781 patients included in
the analysis, POAF occurred in 152 (19.5%) (TAVR: 18/415 [4.3%]; SAVR:
134/366 [36.6%]). Compared with patients without POAF, those with POAF
were older (74.7 vs. 73.0, p = 0.0013). At 2 years, patients with new POAF
had similar unadjusted rates of the primary composite outcome of all-cause
death, stroke or procedure/device or heart failure-related
rehospitalization (16.6% vs. 12.0%, p = 0.10), and the individual
endpoints of rehospitalization (12.1% vs. 8.7%, p = 0.19) and all-cause
death (2.7% vs. 2.6%, p = 0.93). In contrast, patients with new POAF had
higher rates of all bleeding (33.7% vs. 21.0%, p = 0.007) and major
bleeding (14.5% vs. 8.3%, p = 0.016) and a trend toward a higher rate of
stroke (4.6% vs. 2.1%, p = 0.07) at 2 years compared with patients without
POAF. In adjusted analyses, POAF did not predict the primary composite
outcome (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.64 to
1.92; p = 0.71), rehospitalization (HR: 1.24; 95% CI: 0.65 to 2.36; p =
0.51), all-cause death (HR: 0.97; 95% CI: 0.29 to 3.21; p = 0.96), stroke
(HR: 1.61; 95% CI: 0.5 to 5.18; p = 0.42), or bleeding (HR: 1.15; 95% CI:
0.0.80 to 1.66; p = 0.44) at 2 years. There was no interaction between
treatment modality and POAF on the primary composite outcome (p
interaction = 0.51). Conclusion(s): In the PARTNER 3 trial, in
low-risk patients undergoing TAVR or SAVR, the development of POAF was
more frequent following SAVR than TAVR and was not associated with
increased adjusted risk for the composite outcome of death, stroke, or
procedure/device or heart failure-related rehospitalization at 2 years,
irrespective of treatment modality. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2020

<92>
Accession Number
2008355383
Title
TCT CONNECT-326 Impact of Diabetes Mellitus in Patients Undergoing
Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The
COAPT Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B141), 2020. Date of Publication:
27 Oct 2020.
Author
Shahim B.; Chen S.; Redfors B.; Madhavan M.; Dogan O.; Kar S.; Lim S.;
Asch F.; Weissman N.; Cohen D.; Arnold S.; Liu M.; Lindenfeld J.; Abraham
W.; Mack M.; Stone G.
Institution
(Shahim, Redfors, Liu) Cardiovascular Research Foundation, New York, NY,
United States
(Chen) Columbia University Irving Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Madhavan) NewYork-Presbyterian Hospital/Columbia University Irving
Medical Center, New York, NY, United States
(Dogan) Columbia University Medical Center, New York, NY, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Lim) University of Virginia Medical Center, Charlottesvill, VA, United
States
(Asch) MedStar Health Research Institute, Washington, DC, United States
(Weissman) MedStar Health, Washington, DC, United States
(Cohen) University of Missouri-Kansas City School of Medicine, Kansas
City, MO, United States
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham) The Ohio State University Wexner Medical Center, Columbus, OH,
United States
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Stone) Mount Sinai Heart Health System, New York, New Yor, United States
Publisher
Elsevier Inc.
Abstract
Background: Diabetes mellitus (DM) is associated with worse outcomes in
patients with heart failure (HF). This study sought to determine whether
DM influences the outcomes after transcatheter mitral valve repair (TMVr)
in patients with HF and severe secondary mitral regurgitation.
 Method(s): The COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure With Functional Mitral
Regurgitation) trial randomized HF patients with 3+ or 4+ secondary mitral
regurgitation to TMVr with the MitraClip + guideline-directed medical
therapy (GDMT) versus GDMT alone. Two-year outcomes were evaluated in
patients with and without DM. Result(s): Of 614 patients, 229 (37.3%)
(106 TMVr and 123 GDMT) had DM. Patients with DM had higher 2-year rates
of death or HF hospitalization compared with those without DM (adjusted
hazard ratio: 1.28; 95% confidence interval: 1.01 to 1.63; p = 0.04).
Compared with GDMT alone, TMVr consistently reduced the 2-year risks of
composite death and HF hospitalization, including each individual endpoint
in patients with and without DM (Figure). The beneficial impact of TMVr
compared with GDMT alone on left ventricular remodeling and diastolic
function was consistent in patients with and without DM. Greater
improvements in health status and functional capacity were observed in
patients treated with TMVr compared with GDMT alone, irrespective of DM
status. [Formula presented] Conclusion(s): In the COAPT trial,
patients with HF and severe secondary mitral regurgitation in whom DM was
present had a higher risk of death and HF hospitalization than did
patients without DM. TMVr with MitraClip improved prognosis in patients
independent of DM. Categories: STRUCTURAL: Valvular Disease:
Mitral Copyright © 2020

<93>
Accession Number
2008355382
Title
TCT CONNECT-82 Prognostic Value of Serial Neutrophil-to-Lymphocyte Ratio
in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement:
The PARTNER I-II Trials and Registries.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B36-B37), 2020. Date of
Publication: 27 Oct 2020.
Author
Shahim B.; Redfors B.; Chen S.; Dahlen T.; Lindman B.; Kapadia S.; Gertz
Z.; Crowley A.; Li D.; Alu M.; Thourani V.; Kodali S.; Zajarias A.;
Babaliaros V.; Guyton R.; Elmariah S.; Herrmann H.; Mack M.; Leon M.;
George I.
Institution
(Shahim, Redfors, Crowley, Li, Alu) Cardiovascular Research Foundation,
New York, NY, United States
(Chen) Columbia University Irving Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Dahlen) Karolinska Institutet, Stockholm, Sweden
(Lindman) Vanderbilt University, Nashville, Tennessee
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Gertz) VCU, Richmond, VA, United States
(Thourani) Piedmont Heart Institute, Atlanta, Georgia
(Kodali) Columbia University Medical Center, New York, NY, United States
(Zajarias) Washington University School of Medicine, Saint Louis, MO,
United States
(Babaliaros) Emory University School of Medicine, Atlanta, Georgia
(Guyton) Emory University Hospital, Atlanta, Georgia
(Elmariah) BostonMAUnited States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Leon, George) NewYork-Presbyterian/Columbia University Medical Center,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Inflammation plays a key role in aortic valve calcification.
Neutrophil/lymphocyte ratio (NLR), a marker of systemic inflammation, has
been associated with coronary calcium score and arterial stiffness.
Whether NLR is associated with adverse outcomes after transcatheter aortic
valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for
aortic stenosis (AS), remains unknown. Method(s): Patients with
severe AS who received TAVR or SAVR in the PARTNER I, II, and S3 trials or
registries were included in the analysis. Baseline NLR was available in
5,881 patients undergoing TAVR or SAVR (median NLR: 3.4, interquartile
range: 2.4 to 4.9; mean NLR: 4.16, range: 0.5 to 24.9). NLR was evaluated
both as a continuous log-transformed variable and tertiles (low <2.70),
intermediate (2.70 to 4.20), or high (>4.20). No patients had baseline
infection. Result(s): High NLR was significantly associated with the
risk of death or rehospitalization at 3 years as well as death and
rehospitalization, separately (Figure). There were no significant
interactions among NLR level, treatment modality, or coronary artery
disease with adverse outcomes. In the randomized cohorts, NLR increased
more from baseline to 30 days after SAVR than TAVR (least squares means
0.9 vs. 0.2; p < 0.0001). Increase in NLR was associated with increased
risk of death or rehospitalization between 30 days and 3 years (adjusted
hazard ratio: 1.06 per 0.5-U NLR; 95% confidence interval [CI]: 1.04 to
1.07; p < 0.0001). NLR significantly decreased from baseline to 2 years in
the overall cohort (-0.69; 95% CI: 0.57 to 0.8; p < 0.0001), and similarly
between TAVR versus SAVR patients (mean diff. -0.1, 95% CI: -0.30 to 0.20;
p = 0.58). [Formula presented] Conclusion(s): In patients with severe
AS undergoing SAVR or TAVR, high baseline NLR and increase in NLR after 30
days was significantly associated with increased risk of 3-year adverse
outcomes. Further study is needed to fully characterize cardiac versus
valvular risk related to elevated NLR. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2020

<94>
Accession Number
2008355381
Title
TCT CONNECT-299 Long-Term Clinical Outcomes After Revascularization With
PCI and CABG for Left Main Disease in Elderly Versus Young Patients: The
EXCEL trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B129), 2020. Date of Publication:
27 Oct 2020.
Author
Song C.; Chen S.; Madhavan M.; Schampaert E.; Serruys P.; Lembo N.; Brown
W.; Buszman P.; Bochenek A.; Page P.; Dressler O.; Stone G.
Institution
(Song) Columbia University Irving Medical Center, New York, NY, United
States
(Chen) Columbia University Irving Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Madhavan) New York-Presbyterian Hospital/Columbia University Irving
Medical Center, New York, NY, United States
(Schampaert, Page) Hopital du Sacre-Coeur de Montreal, Montreal, QC,
Canada
(Serruys) National University of Ireland, Galway, Galway, Ireland
(Lembo) Columbia University, New York, NY, United States
(Brown) Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia
(Buszman) Medical University of Silesia, Katowice, Poland
(Bochenek) First Department of Cardiovascular Surgery, American Heart of
Poland University of Technology Department of Medicine Katowice Poland,
Katowice, Poland
(Dressler) Cardiovascular Research Foundation, New York, NY, United States
(Stone) Mount Sinai Heart Health System, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Five-year data from the randomized EXCEL (EXCEL Clinical
Trial) demonstrated no significant difference in the primary composite
outcome of death, stroke, or myocardial infarction after percutaneous
coronary intervention (PCI) and coronary artery bypass graft (CABG) in
patients with left main coronary artery disease and SYNTAX (Synergy
Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery)
scores <=32. The impact of age on these long-term clinical outcomes after
left main coronary artery disease revascularization remains unclear.
 Method(s): Patients were categorized according to whether they were
younger or older than 75 years at randomization, and outcomes were
examined using multivariable logistic regression with follow-up time
included as a log-transformed offset variable. Result(s): Among 1,905
randomized patients, 319 (16.7%) were older than 75 years. At 5 years, the
primary endpoint occurred more frequently in the PCI group than in the
CABG group among elderly patients (36.9% vs. 23.8%; adjusted odds ratio:
1.96; 95% confidence interval: 1.18 to 3.25) and was driven by
noncardiovascular deaths (p = 0.02), particularly due to late infections
and cancer. There was no significant difference in the primary endpoint
between revascularization strategies in the younger group (PCI vs. CABG:
19.1% vs. 18.3%; adjusted odds ratio: 1.05; 95% confidence interval: 0.81
to 1.36). The interaction between age and treatment arm (PCI vs. CABG) for
the occurrence of the 5-year primary endpoint was significant (p for
interaction = 0.03). Conclusion(s): Perhaps contrary to expectations,
in the EXCEL trial, patients >75 years of age had better 5-year outcomes
with CABG than with PCI, whereas major adverse cardiovascular event rates
were similar after both treatments in younger patients. However, the
difference in outcomes in the elderly were mainly attributable to
improbable differences in noncardiovascular deaths. Further studies are
required to confirm these observations. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2020

<95>
Accession Number
2008355356
Title
TCT CONNECT-295 Outcomes With Manta Device for Large-Bore Access Closure
After Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B127-B128), 2020. Date of
Publication: 27 Oct 2020.
Author
Megaly M.; Buda K.; Brilakis E.; Pershad A.; Louka B.; Saad M.; Abdelaziz
H.; Narayanan M.A.; Syed M.; Mentias A.; Titus J.; Garcia S.
Institution
(Megaly, Brilakis, Titus) Minneapolis Heart Institute, Minneapolis, MN,
United States
(Buda) Hennepin Healthcare, Minneapolis, MN, United States
(Pershad) University Medical Center Phoenix, Phoenix, AZ, United States
(Louka) Willis Knighton Health System, Shreveport, LA, United States
(Saad) Brown University, Providence, RI, United States
(Abdelaziz) Blackpool Victoria Hospital, Blackpool, United Kingdom
(Narayanan) Yale New Haven Hospital, New Haven, CT, United States
(Syed) Banner University College of Medicine, Phoenix, AZ, United States
(Mentias) University of Iowa Hospitals and Clinics, Iowa City, IA, United
States
(Garcia) Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
Publisher
Elsevier Inc.
Abstract
Background: Data comparing Manta to other vascular closure devices (VCDs)
after transcatheter aortic valve replacement is limited. Method(s): A
meta-analysis was performed of all published studies reporting the
outcomes of Manta versus other VCDs in transcatheter aortic valve
replacement patients. Outcomes included major and minor vascular
complications, major and minor bleeding, VCD failure, blood transfusion,
additional surgical or endovascular treatment, flow-limiting dissection,
hematomas, pseudoaneurysm, change in hemoglobin, and length of stay.
Definitions used were according to the Valve Academic Research
Consortium-2 consensus document. Result(s): Five observational
studies with a total of 1,410 patients (Manta: 601, other VCDs: 809) were
included. Three studies compared Manta with the ProGlide device (Abbot
Vascular), and 2 studies compared Manta with the Prostar XL device (Abbott
Vascular). The prevalence of moderate to severe calcification was higher
in the Manta group (31% vs. 21%; p = 0.01) than in the other VCDs group.
During the index hospitalization, there were no differences in all major
or minor complications between Manta and other VCDs. In a sensitivity
analysis, comparing Manta with ProGlide, the risks of major and minor
vascular complications, major and minor bleeding, and VCD failure were
similar for both devices. [Formula presented] Conclusion(s): In the
transcatheter aortic valve replacement population, although more often
used in calcified vessels, the safety profile and efficacy of the new
collagen-based VCD, Manta, is similar to currently available suture-based
VCDs ProGlide and Prostar XL. Categories: OTHER: Vascular Access:
Structural Copyright © 2020

<96>
Accession Number
2008355353
Title
TCT CONNECT-40 Ultrathin Bioresorbable Polymer Sirolimus-Eluting Stents
Versus Thin Durable Polymer Everolimus-Eluting Stents in Patients
Undergoing Coronary Revascularization (BIOFLOW V): 3-Year Results of the
Acute Coronary Syndrome Subgroup Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B17-B18), 2020. Date of
Publication: 27 Oct 2020.
Author
Kandzari D.; Doros G.; Garcia-Garcia H.; Bennett J.; Gharib E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Doros) Baim Institute for Clinical Research, Boston, MA, United States
(Garcia-Garcia) Washington Hospital Center, Chevy Chase, District of
Columbia
(Bennett) UZ Leuven, Leuven, Belgium
(Gharib) CAMC Clinical Trials Center, South Charleston, WV, United States
(Waksman) Medstar Heart Institute, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: Presentation with acute coronary syndrome (ACS) constitutes a
high-risk subset of patients with worse outcomes following percutaneous
coronary intervention (PCI) compared with stable coronary artery disease.
Clinical outcomes at 3 years were examined from the BIOFLOW-V trial
comparing an ultrathin strut (60 mum) bioresorbable polymer
sirolimus-eluting stent (BP SES) with a thin strut (81 mum) durable
polymer everolimus-eluting stent (DP EES) in subjects with ACS.
 Method(s): Among 1,334 patients randomized to treatment 2:1 to either
BP SES or DP EES, 676 (50.7%) patients with ACS (453 BP SES, 223 DP EES)
were identified. ACS was defined as presentation with unstable angina or
any baseline pre-procedure cardiac biomarker elevation. Target lesion
failure (TLF), individual component endpoints, and stent thrombosis (ST)
were evaluated. Periprocedural myocardial infarction (MI) was defined as a
>=50% increase of creatine kinase-myocardial band (CK-MB) (or troponin in
absence of CK-MB) over previous level with >3X ULN. Spontaneous MI was
defined as any CK-MB or troponin above the upper limit of normal with
associated ischemic symptoms, new electrocardiographic abnormalities of
ischemia, or new development of imaging evidence of MI or regional wall
motion abnormalities. All events were adjudicated by a blinded independent
clinical events committee. Result(s): Baseline clinical,
angiographic, and procedural characteristics of the ACS population were
similar between the 2 treatment groups. At 3 years, TLF occurred in 8.50%
(35/412) of patients receiving BP SES versus 16.50% (34/206) in patients
treated with DP EES, (p = 0.004); TLF component endpoints were as follows:
cardiac death, 0.98% versus 1.96% (p = 0.451); target vessel-related (TV)
MI, 4.68% versus 12.44% (p < 0.001); and clinically driven target lesion
revascularization, 4.40% versus 7.46% (p = 0.129). Rate of periprocedural
TV-MI was 3.21% versus 7.46% for DP EES (p = 0.024) and spontaneous TV-MI
was 1.48% versus 5.00% (p = 0.015). Definite/probable 3-year ST rates were
0.49% versus 2.00% in the BP SES and DP EES groups, respectively (p =
0.096). Late/very late definite/probable ST rates were 0% versus 1.87% (p
= 0.012). Conclusion(s): Among patients with ACS in the BIOFLOW-V
study, treatment with BP SES compared with DP EES was associated with a
significantly lower rate of 3-year TLF, a difference driven by
significantly lower target vessel-related MI. A trend toward lower ST was
also observed favoring BP SES with a significant difference in late/very
late ST. These findings support treatment with an ultrathin strut BP SES
in patients with ACS undergoing PCI. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2020

<97>
Accession Number
2008355342
Title
TCT CONNECT-127 Comparison of Procedural Outcomes in Transcatheter Aortic
Valve Replacement With Mechanically Expanded Valve Versus Self-Expandable
Valve: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B56), 2020. Date of Publication:
27 Oct 2020.
Author
Hafeez H.; Akhtar K.; Nasir Y.; Akhtar K.J.; Jafry A.; Singh V.P.; Haseeb
A.; Farooqi M.; Rousan T.
Institution
(Hafeez) The Wright Center for GME, Dunmore, PA, United States
(Akhtar) University of Oklahoma Health Sciences Center, Oklahoma City, OK,
United States
(Nasir) King Edward Medical University, Little Neck, NY, United States
(Akhtar) St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool,
United Kingdom
(Jafry) OU Health Sciences Center, Oklahoma City, OK, United States
(Singh) The Wright Center for GME, Scranton, PA, United States
(Haseeb) The Wright Center, Scranton, PA, United States
(Farooqi) King Edward Medical University, Dunmore, PA, United States
(Rousan) University of Oklahoma, Oklahoma City, OK, United States
Publisher
Elsevier Inc.
Abstract
Background: Mechanically expanded valve (MEV) was designed to reduce
paravalvular leak and to provide the ability to reposition during
transcatheter aortic valve replacement (TAVR). We have assessed recent
evidence on procedural outcomes between MEV and the self-expandable valve
(SEV). Method(s): Two independent researchers performed an extensive
search on PubMed and Ovid using keywords mechanically expanded,
self-expandable and TAVR yielding 530 studies. Ten studies with a total of
4,574 patients met the inclusion criteria. We compared procedural and
device outcomes including paravalvular leak, post-implant balloon
dilatation, implantation of >1 valve, prosthetic valve regurgitation >
grade 2/4, periprocedural myocardial infarction, and procedural mortality.
The results are reported as odds ratio (OR), 95% confidence interval (CI),
and p < 0.05. Result(s): In 4,574 patients undergoing TAVR, MEV and
SEV were implanted in 1,038 and 3,536 patients, respectively. MEV had a
statistically significant decrease in paravalvular leak (OR: 0.15; 95% CI:
0.04 to 0.64; p = 0.01), post-implant balloon dilatation (OR: 0.08; 95%
CI: 0.02 to 0.27; p < 0.0001), implantation of >1 valve (OR: 0.20; 95% CI:
0.05 to 0.73; p = 0.02), and prosthetic valve regurgitation > grade 2/4
(OR: 0.22; 95% CI: 0.10 to 0.48; p = 0.0002 ) (Figures 1A, 1B, 1C, and 1D,
respectively). Periprocedural myocardial infarction (OR: 0.56; 95% CI:
0.15 to 2.06; p = 0.38) and procedural mortality (OR: 1.81; 95% CI: 0.23
to 14.10; p = 0.57) (Figures 1E and 1F, respectively) showed no
statistically significant difference. [Formula presented]
 Conclusion(s): TAVR with MEV provides better procedural and device
outcomes as compared to SEV. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2020

<98>
Accession Number
2008355335
Title
TCT CONNECT-81 Late Outcomes After Transcatheter Aortic Valve Replacement
With a Mechanically Expanded Versus Self-Expandable Valve: 4-Year Results
From the REPRISE III Randomized Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B36), 2020. Date of Publication:
27 Oct 2020.
Author
Rizik D.; Meduri C.; Makkar R.; Bajwa T.; Cohen M.; Cannon L.; Van Mieghem
N.; Jobe R.; Herrmann H.; Cohen B.; Zorn T.; Lasala J.; Dewey T.;
Underwood P.; Allocco D.; Reardon M.
Institution
(Rizik) HonorHealth Heart Group, Scottsdale, AZ, United States
(Meduri) Piedmont Heart Institute, Atlanta, Georgia
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Bajwa) Aurora St Luke's Medical Center, Milwaukee, WI, United States
(Cohen) University of Miami Hospital, Miami, FL, United States
(Cannon) President, The Cardiac & Vascular Research Center, Charlevoix,
MI, United States
(Van Mieghem) Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
(Jobe) North Carolina Heart and Vascular, Raleigh, NC, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Cohen) Morristown Medical Center, Morristown, NJ, United States
(Zorn) University of Kansas Hospital, Kansas City, KS, United States
(Lasala) Barnes Jewish Hospital, St. Louis, MO, United States
(Dewey) Medical City Dallas, Dallas, TX, United States
(Underwood) Boston Scientific, Phoenix, AZ, United States
(Allocco) Boston Scientific, Maple Grove, MN, United States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, Houston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: REPRISE III is the first large randomized comparison of 2 TAVR
platforms: the mechanically expanded Lotus valve (Boston Scientific,
Marlborough, Massachusetts) and self-expanding CoreValve (CV) (Medtronic,
Dublin, Ireland). Lotus was superior for the primary effectiveness
endpoint (1-year death, disabling stroke, and >=moderate paravalvular leak
[PVL]) and noninferior to CV for the primary safety endpoint (30-day
death, stroke, life-threatening/major bleeding, stage 2/3 acute kidney
injury, major vascular complications). This analysis assessed long-term
(4-year) outcomes in REPRISE III. Method(s): REPRISE III randomized
high/extreme surgical-risk patients (2:1) to receive Lotus or CV for
severe, symptomatic aortic stenosis at 55 centers globally (n = 912; Lotus
= 607, CV = 305). Follow-up will continue through 5 years. Rates are
post-randomization in the intent-to-treat population. Result(s): At 4
years, all-cause mortality/disabling stroke rates were similar in Lotus-
and CV-randomized patients as were all-cause and cardiovascular mortality
(Table). Disabling stroke occurred less frequently in the Lotus compared
with the CV cohort; more Lotus than CV patients received a new permanent
pacemaker. At 4 years, valve areas were smaller and mean gradient higher
with Lotus than CV (area 1.51 +/- 0.48 cm2 vs. 1.77 +/- 0.47
cm2; gradient 12.33 +/- 7.27 mm Hg vs. 7.44 +/- 4.15 mm Hg;
both p < 0.01). Fewer patients had >= moderate PVL with Lotus than CV at 4
years (0.8% vs. 5.6%; p < 0.01). Similar improvements in New York Heart
Association functional class were found in each group. Additional details
will be available at the time of the presentation. [Formula presented]
 Conclusion(s): This 4-year analysis from the REPRISE III study
demonstrates durability of benefit after Lotus valve implantation.
Patients in both cohorts showed a significant improvement in functional
and health status, which were preserved over 4 years of follow-up.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2020

<99>
Accession Number
2008355315
Title
TCT CONNECT-328 Transcatheter Mitral Valve Repair in Patients With Heart
Failure in Young Versus Elderly Patients: Analysis From the COAPT Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B141-B142), 2020. Date of
Publication: 27 Oct 2020.
Author
Song C.; Madhavan M.; Lindenfeld J.; Abraham W.; Kar S.; Lim S.; Grayburn
P.; Kapadia S.; Kotinkaduwa L.; Mack M.; Stone G.
Institution
(Song) Columbia University Irving Medical Center, New York, NY, United
States
(Madhavan) NewYork-Presbyterian Hospital/Columbia University Irving
Medical Center, New York, NY, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham) The Ohio State University Wexner Medical Center, Columbus, OH,
United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Lim) University of Virginia Medical Center, Charlottesville, VA, United
States
(Grayburn) Baylor Scott & White The Heart Hospital, Plano, Texas
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Kotinkaduwa) Cardiovascular Research Foundation, New York, NY, United
States
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Stone) Mount Sinai Heart Health System, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: In the COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure With Functional Mitral
Regurgitation) trial, transcatheter mitral valve repair with the MitraClip
in patients with heart failure and moderate-to-severe or severe secondary
mitral regurgitation reduced the risk of heart failure hospitalizations
(HFH) and all-cause mortality versus maximally tolerated
guideline-directed medical therapy (GDMT) alone. There are limited data
regarding the effectiveness of MitraClip therapy in patients of advanced
age. Method(s): Patients were grouped by median age at randomization
(74 years) and by MitraClip treatment versus GDMT alone. The primary
endpoint of interest was the 2-year rate of death or HFH. Adjusted
comparisons of outcomes were performed using multivariable Cox regression
models. Result(s): Among 614 randomized patients, 317 (51.6%) were
>=74 years of age. In patients >=74 years, the 2-year rate of death or HFH
occurred less frequently in those who received MitraClip therapy versus in
those who received GDMT alone (51.7% vs. 69.6%; adjusted hazard ratio:
0.61; 95% confidence interval: 0.44 to 0.84; p = 0.003) as well as in
younger patients (37.3% vs. 64.5%; adjusted hazard ratio: 0.40; 95%
confidence interval: 0.28 to 0.58; p < 0.0001) (Figure). There was no
significant interaction between age and treatment modality for the primary
outcome (p interaction = 0.11). Death was also consistently reduced with
MitraClip treatment in young and elderly patients (p interaction = 0.32).
In contrast, elderly patients treated with MitraClip versus GDMT alone
tended to have a smaller reduction of HFH than younger patients did (p
interaction = 0.03). [Formula presented] Conclusion(s): MitraClip
treatment of moderate-to-severe and severe secondary mitral regurgitation
reduced the composite risk of death or HFH and improved survival
regardless of age group. As such, elderly and young patients with HF and
severe secondary mitral regurgitation will benefit from early referral for
edge-to-edge transcatheter mitral valve repair, although elderly patients
may not have as great a benefit from MitraClip in reducing HFH.
Categories: STRUCTURAL: Valvular Disease: Mitral Copyright © 2020

<100>
Accession Number
2008355293
Title
TCT CONNECT-304 Meta-Analysis of Long-Term Outcomes in Patients With
Diabetes Mellitus and Left Main Coronary Artery Disease Treated With
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B131), 2020. Date of Publication:
27 Oct 2020.
Author
Al-Abcha A.; Mujer M.T.; Boumegouas M.; Charles L.; Halbouni A.; Saleh Y.
Institution
(Al-Abcha, Mujer, Boumegouas, Charles, Saleh) Michigan State University,
East Lansing, MI, United States
(Halbouni) Detroit Medical Center/Wayne State University, Detroit, MI,
United States
Publisher
Elsevier Inc.
Abstract
Background: Diabetes mellitus is a major risk factor for coronary artery
disease. Coronary artery bypass graft (CABG) is the first-line treatment
for patients with left main coronary artery disease (LMCAD). There are
limited data about percutaneous coronary intervention (PCI) with
drug-eluting stent (DES) in diabetic patients with LMCAD. Method(s):
A meta-analysis of randomized controlled trials (RCTs) with a follow-up
duration of at least 5 years that evaluated PCI with DES versus CABG in
patients with LMCAD was conducted and a subgroup analysis in diabetic
patients was performed. The primary outcome was major adverse cardiac and
cerebrovascular events. Secondary outcomes included all-cause mortality,
myocardial infarction, stroke and repeat revascularization. Only 2 RCTs
(EXCEL [EXCEL Clinical Trial] and SYNTAX [Synergy Between Percutaneous
Coronary Intervention With Taxus and Cardiac Surgery]) reported the
secondary outcomes. Result(s): Four RCTs with a total of 1,079
patients were included. The median-weighted follow-up period was 5.9
years. Compared with CABG, PCI with DES in diabetes mellitus patients with
LMCAD was associated with a higher major adverse cardiac and
cerebrovascular events and an increased risk of repeat revascularization,
but a lower risk of stroke. All-cause mortality and myocardial infarction
were similar between the 2 groups. Test of heterogeneity was low for all
clinical outcomes (I2 = 0%) except for all-cause mortality
(Figure). [Formula presented] Conclusion(s): In patients with LMCAD
and diabetes mellitus, PCI with DES is associated with a significantly
higher long-term major adverse cardiac and cerebrovascular events and risk
of revascularization but a lower risk of stroke compared with CABG.
Further RCTs are needed to evaluate long-term outcomes of each
intervention in diabetic patients. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2020

<101>
Accession Number
2008355243
Title
TCT CONNECT-48 Cooling as an Adjunctive Therapy to Percutaneous
Intervention in Acute Myocardial Infarction: COOL-MI InCor Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B20-B21), 2020. Date of
Publication: 27 Oct 2020.
Author
Dallan L.A.; Giannetti N.; Rochitte C.E.; Polastri T.; Bernoche C.; Hajjar
L.A.; Lima F.; Nicolau J.C.; Tavares M.; Dae M.; Ribeiro E.; Kalil R.;
Lemos P.A.; Timerman S.
Institution
(Dallan) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Giannetti, Rochitte, Tavares, Kalil, Timerman) InCor - HCFMUSP, Sao
Paulo, Sao Paulo, Brazil
(Polastri, Bernoche, Lima) InCor - Heart Institute - HCFMUSP, Sao Paulo,
Sao Paulo, Brazil
(Hajjar) Instituto do Coracao (InCor) - Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Sao Paulo, Brazil
(Dae) University of California San Francisco, San Francisco, CA, United
States
(Ribeiro) Heart Institute-InCor, University of Sao Paulo, Sao Paulo, Sao
Paulo, Brazil
(Lemos) Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier Inc.
Abstract
Background: Endovascular therapeutic hypothermia (ETH) reduces the damage
caused by post-ischemia reperfusion injury syndrome in cardiac arrest;
however, its role in ST-segment elevation myocardial infarction (STEMI)
remains controversial. The aim of the study was to investigate the safety,
feasibility. and 30-day efficacy of ETH as adjunctive therapy to
percutaneous coronary intervention (PCI) in STEMI patients.
 Method(s): This was a prospective, controlled, randomized,
interventional trial of patients within 6 h of angina onset, with
anterior/inferior STEMI eligible for PCI. Subjects were randomized to
hypothermia group (primary PCI + HT) or control group (primary PCI) at 4:1
ratio. Primary safety outcomes: 1) door-to-balloon (DTB) delay; and 2)
major adverse cardiac events (MACE) at 30 days. The primary outcomes of
effectiveness were infarct size and left ventricular ejection fraction
(LVEF) at 30 days. Result(s): In total, 50 patients were included, 35
(70%) randomized to the hypothermia group and 15 (30%) to the control
group. All 35 patients attempted ETH (100%) had successful cooling, with
mean endovascular coronary reperfusion temperature of 33.1 +/- 0.9degreeC.
The mean ischemic time was 375 +/- 89.4 min in the hypothermia group and
359.5 +/- 99.4 min in the control group. The mean DTB was 92.1 +/- 20.5
min in the hypothermia group and 87 +/- 24.4 min in the control group. The
absolute difference of 5.1 min was not statistically significant (p =
0.509). MACE rates were similar between both groups (21.7% vs. 20%,
respectively; p = 0.237). In the comparison between the hypothermia and
control groups, no statistically significant differences were observed at
30 days between mean infarct size (13.9 +/- 8% vs. 13.8 +/- 10.8%,
respectively; p = 0.801) or mean final LVEF (43.3 +/- 11.2% vs. 48.3 +/-
10.9%, respectively; p = 0.194). Conclusion(s): Hypothermia as an
adjunctive therapy to primary PCI in STEMI is feasible and can be
implemented without delay in coronary reperfusion. Hypothermia was safe
regarding the incidence of MACE at 30 days. However, there was a higher
incidence of arrhythmia and in-hospital infection in the hypothermia
group, with no increase in mortality. Regarding efficacy, there was no
difference in infarct size or LVEF at 30 days that would suggest
additional myocardial protection with ETH. Categories: CORONARY: Acute
Coronary Syndromes Copyright © 2020

<102>
Accession Number
2008355225
Title
TCT CONNECT-111 Radial Versus Femoral Secondary Access for Transcatheter
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B49-B50), 2020. Date of
Publication: 27 Oct 2020.
Author
Das T.; Shin J.; Czarny M.; Resar J.; Hasan R.
Institution
(Das, Resar) Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Shin, Hasan) Johns Hopkins University, Baltimore, MD, United States
(Czarny) Johns Hopkins Hospital, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Background: Radial access (RA) is shown to reduce vascular and bleeding
complications when compared with femoral access (FA) for patients
undergoing percutaneous coronary intervention. Transcatheter aortic valve
replacement (TAVR) entails both large-bore arterial access for device
delivery and a secondary arterial access for hemodynamic and imaging
assessments. It is unknown whether RA versus FA for this secondary access
reduces the risk of procedural complications. Method(s): This was a
systematic review and meta-analysis of observational studies assessing RA
versus FA for secondary TAVR access. PubMed, Embase, the Cochrane Library,
and Web of Science were searched, as well as conference abstracts.
 Result(s): Searches yielded 521 relevant titles of which 6
manuscripts were ultimately included encompassing 6,132 patients. Most of
these studies were single-center efforts conducted from 2011 to 2018 and
enrolled fewer than 500 patients, the majority of whom were octogenarians
at intermediate to high surgical risk. Outcomes were reported up to 30
days post-TAVR. Meta-analysis showed that RA reduced the risk of major
vascular complications (odd ratio [OR]: 0.58; 95% confidence interval
[CI]: 0.43 to 0.77; p < 0.001; I2 0%) and major and life-threatening
bleeding (OR: 0.46; 95% CI: 0.36 to 0.59; p < 0.001; I2 = 0%) as compared
with FA for secondary TAVR access. A reduction was also observed in the
risk of acute kidney injury (OR: 0.45; 95% CI: 0.34 to 0.60; p < 0.001; I2
= 0%), stroke and transient ischemic attack (OR: 0.43; 95% CI: 0.27 to
0.67; p < 0.001; I2 = 0%), and 30-day mortality (OR: 0.55; 95% CI: 0.38 to
0.79; p = 0.001; I2 = 0%), but these associations may be related to
selection bias and confounding given the observational study designs.
 Conclusion(s): RA reduced the risk of major vascular and bleeding
complications when compared with FA for secondary access in TAVR. RA is
also associated with reduced risk of other adverse outcomes including
mortality in this analysis of observational data, but further evidence is
needed to determine whether these associations are directly related to the
access site strategy, ideally via randomized trials. Categories:
STRUCTURAL: Valvular Disease: Aortic Copyright © 2020

<103>
Accession Number
2008355222
Title
TCT CONNECT-129 Cups Overlapping Technique for TAVR Procedures With
Self-Expandable Valves.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B57), 2020. Date of Publication:
27 Oct 2020.
Author
Mendiz O.; Noc M.; Fava C.; Valdivieso L.; Gamboa P.; Lev G.
Institution
(Mendiz) Fundacion Favaloro, Buenos Aires, Argentina
(Noc) MC Medicor, Izola, Slovenia
(Fava, Valdivieso) Favaloro Foundation, Buenos Aires, Argentina
(Gamboa) Fundacion Favaloro, Buenos Aires, Argentina
(Lev) Favaloro Foundation University Hospital, Buenos Aires, Argentina
Publisher
Elsevier Inc.
Abstract
Background: Permanent pacemaker implantation (PPMI) is a transcatheter
aortic valve replacement (TAVR) limitation, especially for low risk and
younger patients. This study was designed to analyze 30-day PPMI rates
when using the cups overlapping technique for self-expandable valve
implantation during TAVR procedures. Method(s): For this analysis,
504 consecutive patients from 2 centers were included. Sixty-one patients
were excluded for the following reasons: 27 had previous PPMI, in 27 a
balloon-expandable valve was used, and in 6 a mechanical-expandable valve
was used. There was 1 implantation failure. In 382 (86.2%) patients the
conventional 3-cusps view for implantation was used and they were included
in the conventional strategy group (CON); in 61 (13.8%) right- and
left-cup overlapping projection was used and included in the overlap group
(OVL). The mean age was 79.8 +/- 7.9 years in the CON group and 81.4 +/-
6.5 years in OVL group; there were 49.2% males vs. 85.2%; 88.7% HTA vs.
85.2%, 21.9% diabetes vs. 22.9%; estimated glomerular filtration rate was
73.6 +/- 27.1 ml/m2 vs. 62.1 ml/m2, <60
ml/m2 29.3% vs. 29%, <45 ml/m2; and dialysis 2.1%
vs. 0%. Previous myocardial infarction was 19.4% in CON vs. 16.4% in OVL;
percutaneous coronary intervention occurred in 30.6% vs. 26.2%; and
coronary artery bypass graft in 17% vs. 13.1%. None of them were
significantly different. The Society for Thoracic Surgeons score was 4.7
in CON +/- 3.1 vs. 5.3 +/- 3.9 OVL; ANOVA 0.71 +/- 0.16 cm2 vs.
0.70 +/- 012 cm2; mean gradient was 41.6 +/- 12.4 vs. 40.8 +/-
11.9; left ventricular ejection fraction 55.3 +/- 11.4% vs. 54.3 +/-
10.2%; left ventricular ejection fraction <35% in 10% vs. 13.1%; previous
atrial fibrillation 16.7% vs. 26.2% (p = not significant); and right
bundle branch block 4.1% vs. 6.5% (p = NS). Result(s): Femoral access
was used in 97.6% in CON and 98.3% in OVL; subclavian 1% vs. 1.7%; apical
0.8% vs. 0%; and aortic 0.3% vs. 0%. Devices implanted for the CON group
were the CoreValve-Evolute R and Pro 93.1%, Acurate Neo 4.7%, Portico
1.3%, and JenaValve 0.8%; whereas for the OVL group the following valves
were used: Evolute RO and Pro 86.9%, Portico 8.2%, and Acurate Neo 4.9%.
Major adverse cardiac events at 30 days included death 3.1% vs. 4.9%;
acute myocardial infarction 0.3% vs. 0%; major stroke 0.78% vs. 0%; minor
stroke 0.3% vs. 0%; surgical aortic valve replacement 0.3% vs. 0% (all p =
not significant) and PPMI 30.9% vs. 6.5% (p = 0.0001) for CON and OVL
groups. Conclusion(s): In this series, the cups overlapping technique
decreases the 30-day PPMI rate without any significant major adverse
cardiac event rate difference in comparison with the conventional 3- cups
view for TAVR implantation. Therefore, a larger, multicenter and probably
randomized clinical trial would be needed to confirm safety and efficacy
of this new implantation strategy. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2020

<104>
Accession Number
2008355214
Title
TCT CONNECT-125 TAVR With a Supra-Annular, Self-Expandable Valve in
Intermediate Risk Patients: Follow-Up From the SURTAVI Randomized Trial
and Continued Access Registry.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B55), 2020. Date of Publication:
27 Oct 2020.
Author
Mahoney P.; Gada H.; Jilaihawi H.; Waksman R.; Reardon M.
Institution
(Mahoney) Sentara Heart Hospital, Norfolk, VA, United States
(Gada) UPMC Pinnacle, Harrisburg, PA, United States
(Jilaihawi) NYU Langone Health, New York, NY, United States
(Waksman) MedStar Washington Hospital Center, Washington, DC, United
States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, Houston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: The SURTAVI trial is a prospective, multicenter, randomized
clinical trial (RCT) that confirmed the noninferiority of transcatheter
aortic valve replacement (TAVR) to surgical aortic valve replacement for
the primary endpoint of all-cause mortality or disabling stroke at 2
years. Following completion of enrollment in the randomized trial,
eligible patients were enrolled in the SURTAVI continued access study
(CAS) in order to obtain additional data on the use of the second
generation Evolut-R bioprosthesis. Our aim was to compare clinical
outcomes and hemodynamics of patients in the CAS versus TAVR arm of the
RCT (TAVR-RCT). Method(s): Eligible patients were required to have a
predicted risk for 30-day surgical mortality of >=3% and <15%. The SURTAVI
RCT predominantly used the first-generation CoreValve (n = 724) and less
frequently next-generation Evolut R device (n = 139) whereas the SURTAVI
CAS treated 255 of 275 patients with Evolut R and only 20 patients with a
31-mm CoreValve device. Result(s): Baseline characteristics of the
CAS and RCT patients included mean age (79.0 +/- 6.1 vs. 79.9 +/- 6.2
years), sex (male: 46.2% vs. 57.6%), and mean Society of Thoracic Surgeons
score (4.1 +/- 1.5 vs. 4.4 +/- 1.5). When compared with the RCT results
without any adjustments, the 30-d and 2-y rates of all-cause mortality,
disabling stroke, aortic valve hospitalization, and permanent pacemaker
implantation were numerically lower in the CAS population (Table).
Hemodynamic performance was comparable between RCT and CAS patients at 2
years. [Formula presented] Conclusion(s): TAVR with the
supra-annular, self-expandable Evolut R prosthesis compared with
first-generation CoreValve in intermediate-risk patients resulted in
numerically improved 30-days and 2-years clinical outcomes, lower rates of
permanent pacemaker implantation and excellent hemodynamic performance.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2020

<105>
Accession Number
2008355206
Title
TCT CONNECT-143 Outcomes of Transcatheter Aortic Valve Replacement After
Prior Mitral Valve Surgery.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B61), 2020. Date of Publication:
27 Oct 2020.
Author
Gupta R.; Malik A.; Ranchal P.; Venkata V.S.; Aronow W.
Institution
(Gupta) Lehigh Valley Health Network, Macungie, PA, United States
(Malik) Westchester Medical Center & New York Medical College, Valhalla,
NY, United States
(Ranchal) Boston University, Boston, MA, United States
(Venkata) Cheshire Medical Center, Keene, NH, United States
(Aronow) Westchester Medical Center, Valhalla, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is as effective
as surgery in reducing mortality in patients with severe aortic stenosis.
Recent reports indicate that TAVR in patients with surgical mitral valve
prosthesis is associated with a worse prognosis. We sought to
systematically evaluate the outcomes of TAVR in patients with and without
prior mitral valve replacement (MVR) in a meta-analysis of trials and
registries. We performed a proportional analysis to look at the incidence
of outcomes in these patients. Method(s): A comprehensive literature
search was performed in PubMed, Embase, and Cochrane to identify relevant
trials. Our primary outcomes of interest were 30-day and 1-year mortality.
Secondary outcomes of interest were myocardial infarction, stroke, heart
failure rehospitalizations, re-intervention, device, and procedural
success. Result(s): Three studies with 35,247 patients were
identified. Compared to patients without prior MVR, patients with prior
MVR had no increase in 30-day or 1-year mortality. Patients with prior MVR
had a higher device and procedural success rate compared to patients
without prior MVR. There was no difference in the incidence of myocardial
infarction, stroke, heart failure rehospitalizations, and reinterventions
between the two groups. In patients undergoing TAVR with prior MVR, the
proportional analysis showed an incidence of 30-day mortality of 45.04 per
1,000 cases and 1-year mortality of 204.71 per 1,000 cases. Incidence of
new left bundle branch block was 213.33 per 1,000 cases whereas major and
minor bleed were 167.35 and 57.14 per 1,000 cases, respectively.
 Conclusion(s): Our study indicates that TAVR in patients with prior
MVR has comparable efficacy with no significant difference in rates of
adverse events compared to TAVR in patients without prior MVR. Higher
rates of left bundle branch block indicate a higher risk of conduction
disease post-TAVR patients with prior MVR and warrants close monitoring in
this patient population. The procedure appears safe; however, caution must
be used in managing perioperative anticoagulation in patients with prior
MVR to minimize bleeding complications. Categories: CORONARY: Complex and
Higher Risk Procedures for Indicated Patients (CHIP) Copyright ©
2020

<106>
Accession Number
2008355195
Title
TCT CONNECT-89 Impact of Pre-Existent Atrial Fibrillation on Clinical
Outcomes After Transcatheter or Surgical Aortic Valve Replacement for
Severe Aortic Stenosis: An Analysis From the PARTNER 3 Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B39), 2020. Date of Publication:
27 Oct 2020.
Author
Kosmidou I.; Malaisrie S.C.; George I.; Thourani V.; Biviano A.; Russo M.;
Brown D.L.; Babaliaros V.; Guyton R.; Kodali S.; McCabe J.; Williams M.;
Genereux P.; Lu M.; Yu X.; Shahim B.; Alu M.; Webb J.; Mack M.; Leon M.
Institution
(Kosmidou, Biviano, Kodali) Columbia University Medical Center, New York,
NY, United States
(Malaisrie) Northwestern Medicine, Chicago, IL, United States
(George) Columbia University Medical Center/New York-Presbyterian, New
York, NY, United States
(Thourani) Piedmont Heart Institute, Atlanta, Georgia
(Russo) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Brown) Baylor Scott & White - The Heart Hospital Plano, Plano, TX, United
States
(Babaliaros, Guyton) Emory University School of Medicine, Atlanta, Georgia
(McCabe) University of Washington Medical Center, Seattle, WA, United
States
(Williams) NYU Langone Health, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown, NJ, United States
(Lu, Yu) Edwards Lifesciences, Irvine, CA, United States
(Shahim, Alu) Cardiovascular Research Foundation, New York, NY, United
States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Leon) NewYork-Presbyterian/Columbia University Medical Center, New York,
NY, United States
Publisher
Elsevier Inc.
Abstract
Background: This study sought to determine the clinical impact of
pre-existent atrial fibrillation or flutter (AF) in low-risk patients with
severe aortic stenosis (AS) treated with transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR) in the
randomized PARTNER 3 trial. Method(s): Patients with severe AS at low
surgical risk were randomized 1:1 to TAVR versus SAVR. Analyses were
performed in the as-treated population. Clinical outcomes at 2 years were
analyzed according to pre-existent AF. Result(s): Among 948 patients
included in the analysis, 452 (47.7%) underwent SAVR and 496 (52.3%)
underwent TAVR. History of AF was present in 168 patients (17.6%) (88 of
452 [19.5%] and 80 of 496 [16.1%] treated with SAVR and TAVR,
respectively). Compared with patients without AF, patients with AF were
more frequently men and Caucasian, and had a more frequent history of
prior pacemaker implant and higher body mass index. At 2 years, patients
with AF had higher unadjusted rates of the composite outcome of death,
stroke, or rehospitalization (21.2% vs. 12.9%; p = 0.007) and
rehospitalization (15.3% vs. 9.4%; p = 0.03) but not all-cause death (3.8
vs. 2.6%; p = 0.45) or stroke (4.8% vs. 2.6%; p = 0.12). In adjusted
analyses, patients with AF had a higher risk for the composite outcome of
death, stroke, or rehospitalization (hazard ratio [HR]: 1.80; 95%
confidence interval [CI]: 1.20 to 2.71; p = 0.0046) and rehospitalization
(HR: 1.8; 95% CI: 0.12 to 2.90; p = 0.015), but not death (HR: 1.26; 95%
CI: 0.49 to 3.20; p = 0.63) or stroke (HR: 2.11; 95% CI: 0.86 to 5.23; p =
0.10). There was no interaction between treatment modality and AF on the
composite outcome (p inter = 0.83). Conclusion(s): In the PARTNER 3
trial, low surgical risk patients with severe AS and preexistent AF had
increased risk for the composite outcome of death, stroke, or
rehospitalization at 2 years compared with patients without AF,
irrespective of treatment with TAVR or SAVR. Categories: STRUCTURAL:
Valvular Disease: Aortic Copyright © 2020

<107>
Accession Number
2008355193
Title
TCT CONNECT-329 Impact of Transcatheter Mitral Valve Repair With the
MitraClip on 30-Day Renal Function and 2-Year Outcomes: The COAPT Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B142), 2020. Date of Publication:
27 Oct 2020.
Author
Beohar N.; Ailawadi G.; Kotinkaduwa L.; Redfors B.; Zhang Z.; Morgan L.G.;
Escolar E.; Kar S.; Lim S.; Mishell J.; Whisenant B.; Abraham W.;
Lindenfeld J.; Mack M.; Stone G.
Institution
(Beohar, Escolar) Mount Sinai Medical Center, Miami Beach, FL, United
States
(Ailawadi) University of Virginia, Charlottesville, VA, United States
(Kotinkaduwa, Redfors, Zhang) Cardiovascular Research Foundation, New
York, New York
(Morgan) 4Providence Heart, Columbia, SC, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Lim) University of Virginia Medical Center, Charlottesville, VA, United
States
(Mishell) Kaiser Permanente, San Francisco Medical Center, San Francisco,
CA, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Abraham) The Ohio State University Wexner Medical Center, Columbus, OH,
United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Mack) The Heart Hospital Baylor Plano, Dallas, TX, United States
(Stone) Mount Sinai Heart Health System, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Heart failure and severe (3+/4+) mitral regurgitation
adversely affect renal function (RF), a predictor of poor prognosis. The
impact of MitraClip (MC) on RF in high-risk patients with heart failure
and severe mitral regurgitation is unknown. Method(s): The COAPT
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure With Functional Mitral Regurgitation) trial randomized
614 heart failure patients to MC + guideline-directed medical therapy
(GDMT) or GDMT alone. Baseline chronic kidney disease was defined as
estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73
m2. Patients were stratified into 3 groups based on DELTAeGFR
from baseline to 30 days: improved (I) (>10% eGFR); no change (NC) (<10%
to <10%); and worsened (W) (>10%). Unadjusted and adjusted 30-day to
2-year outcomes, according to baseline RF and DELTAeGFR at 30 days, were
evaluated. Result(s): Among 606 patients with baseline eGFR, chronic
kidney disease was present in 467 (77.1%), including 229 of 300 (76.3%)
with MC and 238 of 306 (77.8%) with GDMT. Among 267 GDMT patients with
30-day eGFR data, I, NC, or W occurred, respectively, in 87 (32.6%), 88
(32.9%), and 92 (34.4%). Among 271 MC patients with 30-day eGFR data, I,
NC, or W occurred, respectively, in 95 (35.1%), 105 (38.7%), and 71
(26.2%) (p = 0.10). Independent predictors of W at 30 days are shown
(Figure A). Randomization to MC or GDMT alone were not independently
predictive of DELTAeGFR (W: p = 0.06; I: p = 0.18). All-cause death
between 30 days and 2 years was 25.3%, 32.0%, and 41.5% in I, NC, and W,
respectively (p trend = 0.004), with similar effects in with MC and GDMT
alone (p interaction = 0.98) (Figure B). Independent predictors of
all-cause death are shown in Figure A. [Formula presented]
 Conclusion(s): Chronic kidney disease was frequently found in COAPT
trial patients. RF improved, stayed the same, or deteriorated in
approximately one-third of patients for each. Both baseline RF and W RF
were independent predictors of long-term mortality. MC did not
significantly affect early DELTAeGFR, but it reduced long-term mortality
independent of early baseline RF and DELTAeGFR. Categories: STRUCTURAL:
Valvular Disease: Mitral Copyright © 2020

<108>
Accession Number
2008355175
Title
TCT CONNECT-157 Off-Pump Versus On-Pump Repeat Coronary Artery Bypass
Grafting: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B67), 2020. Date of Publication:
27 Oct 2020.
Author
Tzoumas A.; Giannopoulos S.; Kakargias F.; Kokkinidis D.; Giannakoulas G.;
Faillace R.; Bakoyiannis C.; Doulamis I.; Avgerinos D.
Institution
(Tzoumas, Kakargias) School of Medicine, Aristotle University of
Thessaloniki, Thessaloniki, Greece
(Giannopoulos) Rocky Mountain Regional VA Medical Center, University of
Colorado, Aurora, CO, United States
(Kokkinidis) Jacobi Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
(Giannakoulas) Department of Cardiology, Aristotle University of
Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
(Faillace) Jacobi Medical Center - Albert Einstein College of Medicine,
Bronx, NY, United States
(Bakoyiannis) First Department of Surgery, National and Kapodistrian
University of Athens, Laikon General Hospital, Athens, Greece
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: The optimal operative strategy in patients requiring repeat
coronary artery bypass grafting has not been established. Method(s):
We performed a systematic review and meta-analysis according to the
Preferred Reporting Items for Systemic Reviews and Meta-Analyses
guidelines comparing the outcomes of patients undergoing off-pump vs.
on-pump repeat coronary artery bypass grafting. Result(s):
Twenty-three studies comprising 2,085 and 3,245 patients in the off-pump
and the on-pump group, respectively, fulfilled the inclusion criteria of
this meta-analysis. Weighted mean age and male percentage were 65.2 years
vs. 66.4 years and 82.4% vs.84.08% in the off-pump and on-pump groups,
respectively. The off-pump technique was associated with significantly
reduced risk of perioperative mortality (odd ratio [OR]: 0.46; 95%
confidence interval [CI]: 0.34 to 0.61; I2 = 0.0%; p < 0.001) (defined as
in-hospital or 30-day mortality), myocardial infarction (OR: 0.48; 95% CI:
0.31 to 0.72; I2 = 0.0%; p < 0.001), acute kidney injury (OR: 0.55; 95%
CI: 0.38 to 0.80; I2 = 0.0%; p = 0.002), and atrial fibrillation (OR:
0.47; 95% CI: 0.36 to 0.60; I2 = 0.0%; p < 0.001) (Figure 1). Analysis
showed no significant difference in terms of 30-day stroke (OR: 0.59; 95%
CI: 0.28 to 1.24; I2 = 0.0%; p = 0.164) and 1-year (OR: 0.63; 95% CI: 0.36
to 1.10; I2 = 0.0%; p = 0.1) or 5-year mortality (OR: 0.73; 95% CI: 0.34
to 1.53; I2 = 0.0%; p = 0.399). [Formula presented] Conclusion(s): In
patients receiving repeat coronary revascularization, the off-pump
intervention was associated with favorable outcomes in terms of
perioperative mortality, myocardial infarction, acute kidney infection,
and atrial fibrillation. The use of cardiopulmonary bypass had no impact
on perioperative stroke or 1- and 5-year mortality. Categories: CORONARY:
Cardiac and Coronary Artery Surgery and Hybrid
Revascularization Copyright © 2020

<109>
Accession Number
2008355168
Title
TCT CONNECT-301 Incidence, Predictors, and Impact of Readmissions
Following PCI and CABG for Left Main Coronary Artery Disease: Analysis
From the EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B130), 2020. Date of Publication:
27 Oct 2020.
Author
Kosmidou I.; Shahim B.; Zhang Z.; Dressler O.; Redfors B.; Morice M.-C.;
Kandzari D.; Karmpaliotis D.; Brown W.; Lembo N.; Banning A.; Serruys P.;
Stone G.
Institution
(Kosmidou, Karmpaliotis) Columbia University Medical Center, New York, NY,
United States
(Shahim, Zhang, Dressler, Redfors) Cardiovascular Research Foundation, New
York, NY, United States
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Brown) Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia
(Lembo) NewYork-Presbyterian/Columbia University Medical Center, New York,
NY, United States
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Serruys) National University of Ireland, Galway, Galway, Ireland
(Stone) Mount Sinai Heart Health System, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: The incidence, predictors, and impact of hospital readmission
following percutaneous coronary intervention (PCI) and coronary artery
bypass graft (CABG) for treatment of left main coronary artery disease are
unknown. Method(s): In EXCEL (EXCEL Clinical Trial), 1,905 patients
with left main coronary artery disease were randomized to PCI with
everolimus-eluting stents versus CABG. Cumulative incidence of
readmissions in patients treated with PCI versus CABG was analyzed with a
joint frailty model to account for the competing risk of death. The impact
of readmission on 5-year mortality was determined in a time-adjusted Cox
proportional hazards model. Result(s): Within 5 years, 1,868
readmissions occurred in 851 of 1,882 patients (45.2%) who were discharged
alive after the index procedure (2.2 +/- 1.9 per patient; range 1 to 16),
more often due to noncardiac (59%) than cardiac (41%) causes. Readmissions
during 5-year follow-up were more common after PCI than CABG (Figure,
top). Female sex, diabetes, hypertension, congestive heart failure,
chronic obstructive pulmonary disease, chronic kidney disease, history of
anemia, multivessel coronary artery disease, and index PCI were
independent predictors of readmission. Readmission was an independent
predictor of subsequent all-cause death (adjusted hazard ratio: 4.02; 95%
confidence interval: 2.78 to 5.81; p < 0.0001), cardiac death (adjusted
hazard ratio: 4.14; 95% confidence interval: 2.08 to 8.23; p < 0.0001),
and noncardiac death (adjusted hazard ratio: 4.04; 95% confidence
interval: 2.61 to 6.25; p < 0.0001). A significant interaction was present
between readmissions and treatment with PCI versus CABG for the adjusted
risk all-cause death (Figure, bottom). [Formula presented]
 Conclusion(s): In the EXCEL trial, readmissions for any cause were
more frequent after PCI than CABG during 5-year follow-up. Readmissions
were associated with an increased risk of death after both procedures,
perhaps more so after PCI than CABG. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2020

<110>
Accession Number
2008355162
Title
TCT CONNECT-309 Three-Year Follow-up of PCI in Patients With True Left
Main Bifurcation Lesions.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B133), 2020. Date of Publication:
27 Oct 2020.
Author
Shugushev Z.; Safonova O.; Chepurnoi A.; Gitelzon E.; Baranovich V.;
Veretnik G.; Maximkin D.
Institution
(Shugushev, Chepurnoi, Gitelzon, Baranovich, Veretnik, Maximkin) Peoples'
Friendship University of Russia (RUDN University), Moscow, Russian
Federation
(Safonova) Peoples Friendship University of Russia, Moscow, Russian
Federation
Publisher
Elsevier Inc.
Abstract
Methods: This analysis involved 142 patients with true bifurcations of the
left main. Randomization separated patients to 2 main groups: group 1 (n =
52) included patients who received kissing-dilatation with traditional
noncompliance balloon catheters; and group 2 (n = 52) included patients
who received kissing-dilatation of the main bifurcation artery with
traditional noncompliance balloon catheters and a side branch with
drug-eluting balloon catheters. Retrospectively, the third control group
(group 3; n = 38) was formed, where the 2-stent technique was employed.
All patients from the main groups had previously performed "provisional T"
stenting and final "kissing balloon" dilation techniques. Coronary
angiography and optical coherence tomography were performed to evaluate
the results of all patients. Inclusion criteria included true left main
bifurcation stenoses according to quantitative coronary angiography and
optical coherence tomography and SYNTAX (Synergy Between Percutaneous
Coronary Intervention With Taxus and Cardiac Surgery) score <32. Primary
endpoints included incidence of major adverse cardiac events (MACE), a
composite of death, myocardial infarction, or reinterventions. Secondary
endpoints included the incidence of restenosis and late stent thrombosis.
 Result(s): The long-term results after 48 months were observed in 46
patients from group 1 and 48 patients from group 2. The total incidence of
MACE was 17.3% versus 6.25% in groups 1 and 2, respectively (p < 0.05).
When comparing the results in groups 2 and 3, the frequency of MACE was
6.25% versus 13.2%, respectively (p < 0.05). Restenosis of the side branch
of more than 50% according to quantitative coronary angiography was
detected in 8 patients (17.3%) from group 1 and in 2 patients (4.2%) from
group 2 (p < 0.05). In patients from group 1, the average minimal lumen
area in the side branch after 48 months, compared with data after
percutaneous coronary intervention, was 5.58 +/- 1.34 and 4.12 +/- 1.21
mm2, respectively (p < 0.05), and in the main branch 6.34 +/-
1.56 and 5.88 +/- 1.14 mm2, respectively (p > 0.05). In
patients from group 2, the average minimal lumen areas were, respectively,
5.38 +/- 1.24 and 5.12 +/- 1.44 mm2 in the side branch (p >
0.05) and 6.68 +/- 1.75 and 6.36 +/- 1.22 mm2 in the main
branch (p > 0.05). When comparing the data of minimal lumen area in the
side branch in groups 1 and 2, there was a significant difference (4.12
+/- 1.21 vs. 5.12 +/- 1.44 mm2; p < 0.05). There were no cases
of late thrombosis of the stents. Conclusion(s): The use of
drug-eluting balloon catheters for the provisional T stenting in patients
with true left main bifurcation stenosis is associated with significantly
lower frequency of MACE and side branch restenosis, according to optical
coherence tomography data, than use of traditional noncompliance balloon
catheters for the "kissing- dilatation" and 2-stent technique strategy are
in patients without left main bifurcation stenosis. Categories: CORONARY:
Drug-Eluting Balloons and Local Drug Delivery Copyright © 2020

<111>
Accession Number
2008355139
Title
TCT CONNECT-300 Rates and Impact of Stroke After Revascularization for
Left Main Coronary Artery Disease: The EXCEL Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty Second
Annual Symposium Transcatheter Cardiovascular Therapeutics
(TCT)-Abstracts. 76 (17 Supplement) (pp B129-B130), 2020. Date of
Publication: 27 Oct 2020.
Author
Madhavan M.; Redfors B.; Shahim B.; Elkind M.; Li D.; Crowley A.; Lembo
N.; Brown W.; Merkely B.; Pomar J.L.; Sabate M.; Mehran R.; Serruys P.;
Stone G.
Institution
(Madhavan, Lembo) NewYork-Presbyterian/Columbia University Medical Center,
New York, NY, United States
(Redfors, Shahim, Li, Crowley) Cardiovascular Research Foundation, New
York, NY, United States
(Elkind) Columbia University Irving Medical Center, New York, NY, United
States
(Brown) Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia
(Merkely) Semmelweis University, Cardiac and Vascular Center, Budapest,
Hungary
(Pomar, Sabate) Hospital Clinic Barcelona, Barcelona, Spain
(Mehran) Zena and Michael A. Weiner Cardiovascular Institute at Mount
Sinai School of Medicine, New York, NY, United States
(Serruys) National University of Ireland, Galway, Galway, Ireland
(Stone) Mount Sinai Heart Health System, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Stroke after revascularization for coronary artery disease is
associated with significant morbidity and mortality; however, the rates
and impact of stroke after percutaneous coronary intervention (PCI) and
coronary artery bypass graft (CABG) for left main coronary artery disease
have not been extensively studied. Method(s): In EXCEL (EXCEL
Clinical Trial), 1,905 patients with left main coronary artery disease
were randomized to PCI versus CABG. Time-dependent multivariable Cox
proportional hazards regression analysis was performed to examine the
association between stroke and all-cause mortality at 5 years.
 Result(s): A total of 948 patients were randomized to PCI and 957
patients were randomized to CABG. The overall 5-year stroke rate was 59
(3.3%), including 26 (2.9%) in the PCI arm and 33 (3.7%) in the CABG arm
(unadjusted hazard ratio: 0.78; 95% confidence interval: 0.47 to 1.30; p =
0.34) (Figure). In-hospital stroke was less common after PCI than CABG
(0.4% vs. 1.4%; risk ratio: 0.31; 95% confidence interval: 0.10 to 0.94; p
= 0.03) and similar between groups thereafter (2.6% vs. 2.4%; hazard
ratio: 1.09; 95% confidence interval: 0.60 to 1.97; p = 0.77). Chronic
kidney disease and peripheral vascular disease were independent predictors
of stroke at 5 years. By multivariable analysis development of stroke was
strongly associated with subsequent all-cause mortality during follow-up
(adjusted hazard ratio: 6.32; 95% confidence interval: 3.75 to 10.65; p <
0.0001), with similar impact after PCI and CABG (adjusted p for
interaction = 0.94). [Formula presented] Conclusion(s): In the EXCEL
trial, periprocedural stroke was less common after PCI than CABG, although
total stroke rates at 5 years were not significantly different between the
groups. Stroke after revascularization of left main coronary artery
disease was a strong predictor of subsequent mortality. Categories:
CORONARY: Complex and Higher Risk Procedures for Indicated Patients
(CHIP) Copyright © 2020

<112>
Accession Number
2008352106
Title
Sex-related differences in early- A nd long-term mortality after
transcatheter and surgical aortic valve replacement: A systematic review
and meta-analysis.
Source
Journal of Invasive Cardiology. 32 (8) (pp 295-301), 2020. Date of
Publication: August 2020.
Author
Parikh P.B.; Wang T.-Y.; Sharma N.; Kort S.; Skopicki H.A.; Gruberg L.;
Jeremias A.; Chikwe R.P.J.; Butler J.
Institution
(Parikh, Wang, Sharma, Kort, Skopicki, Gruberg, Jeremias, Butler)
Department of Medicine, Division of Cardiovascular Medicine, State
University of New York at Stony Brook, Stony Brook, NY, United States
(Chikwe) Division of Cardiothoracic Surgery, State University of New York
at Stony Brook, Stony Brook, NY, United States
(Chikwe) Division of Cardiothoracic Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
Publisher
Cliggott Publishing Co. (E-mail: adelsignore@hmpglobal.com)
Abstract
Background. Observational data suggest that early- A nd long-term outcomes
of transcatheter aortic valve replacement (TAVR) and surgical aortic valve
replacement (SAVR) differ significantly between men and women, but have
demonstrated conflicting results. This study sought to examine early- A nd
long-term mortality with TAVR and SAVR in women versus men. Methods.
Electronic search was performed until February 2018 for studies reporting
sex-specific mortality following TAVR or isolated SAVR. Data were pooled
using random-effects models. Outcomes included rates of early mortality
(in hospital or 30 days) and long term (1 year or longer). Results. With
35 studies, a total of 80,928 patients were included in our systematic
review and meta-analysis, including 40,861 men and 40,067 women. Pooled
analyses suggested considerable sex-related differences in longterm
mortality following TAVR and SAVR. Following SAVR, women had higher
long-term mortality (odds ratio [OR], 1.35; 95% confidence interval [CI],
1.16-1.56; P<.001) and a trend toward higher early mortality (OR, 1.69;
95% CI, 0.97-2.97; P=.07) compared to men. Following TAVR, women had lower
long-term mortality (OR, 0.78; 95% CI, 0.71-0.86; P<.001) and no
difference in early mortality (OR, 1.09; 95% CI, 0.96-1.23; P=.17)
compared to men. Conclusions. In this systematic review and meta-analysis,
women had higher long-term mortality and a trend toward higher early
mortality compared to men following SAVR. Following TAVR, women had lower
long-term mortality and no difference in early mortality compared with
men. Copyright © 2020 HMP Communications. All rights reserved.

<113>
Accession Number
2008352116
Title
Effect of preloading with high dose of rosuvastatin on serum levels of
inflammatory markers after percutaneous coronary intervention.
Source
Journal of Invasive Cardiology. 32 (9) (pp 335-341), 2020. Date of
Publication: September 2020.
Author
Slhessarenko J.R.; Hirata M.; Sousa A.; Bastos G.M.; Higa E.M.S.; Mouro
M.G.; Sobrera G.C.; Slhessarenko R.D.; Viana R.; Abizaid A.; Costa J.R.
Institution
(Slhessarenko, Hirata, Sousa, Bastos, Viana, Abizaid, Costa) Instituto
Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Hirata, Sobrera) Sao Paulo University (USP), Sao Paulo, Brazil
(Higa, Mouro) Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
(Slhessarenko) Federal University of Mato Grosso, Cuiaba, Brazil
Publisher
Cliggott Publishing Co. (E-mail: adelsignore@hmpglobal.com)
Abstract
Objectives. We sought to assess the effects of a high loading dose of
rosuvastatin (40 mg) on acute inflammatory response after coronary
stenting. Methods. Patients with stable coronary disease without statin
use (>=7 days) and undergoing elective percutaneous coronary intervention
(PCI) in a native coronary artery were randomized to receive a loading
dose of rosuvastatin (n = 64) or not (n = 61). Blood samples were obtained
before statin intake (time point A), 3 hours after medication (time point
B), and 3 hours after PCI (time point C). The primary goal was the
comparison in the variation of the serum inflammatory markers and their
gene expression at the different time points between the two groups.
Results. Baseline clinical, angiographic, and procedural characteristics
did not significantly differ between the groups, except for the more
frequent use of postdilation in the control group (73.4% vs 90.2%; P=.02).
Patients pretreated with statin showed a reduction in the serum levels of
interleukin (IL)-1beta (DELTA =-0.491 pg/mL; Pinteraction<.001), IL-6
(DELTA =-0.209 pg/mL; Pinteraction<.001), and plasminogen activator
inhibitor 1 (DELTA =-1.573 pg/mL; Pinteraction<.001) as well as in their
genetic expression, which was not observed in the control group. Regarding
high-sensitivity c-reactive protein, there was no significant variation in
its value from time point A to C in patients pretreated with statin
(P=.58) while it significantly increased in the control group (P=.04).
Conclusion. Among patients with stable coronary artery disease undergoing
PCI with stents, pretreatment with high dose of rosuvastatin resulted in
significant reduction in the serum levels of important inflammatory
markers and their genetic expression. Copyright © 2020 HMP
Communications. All rights reserved.

<114>
Accession Number
2007059270
Title
Clinical risk predictors in atrial fibrillation patients following
successful coronary stenting: ENTRUST-AF PCI sub-analysis.
Source
Clinical Research in Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Goette A.; Eckardt L.; Valgimigli M.; Lewalter T.; Laeis P.; Reimitz
P.-E.; Smolnik R.; Zierhut W.; Tijssen J.G.; Vranckx P.
Institution
(Goette) Medizinische Klinik II: Kardiologie Und Intensivmedizin, St.
Vincenz-Krankenhaus, Am Busdorf 2, Paderborn 33098, Germany
(Goette) Working Group of Molecular Electrophysiology, University Hospital
Magdeburg, Magdeburg, Germany
(Goette, Eckardt, Lewalter) Atrial Fibrillation Network, Munster, Germany
(Eckardt) Division of Electrophysiology, Department of Cardiology and
Angiology, University of Munster, Munster, Germany
(Valgimigli) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Lewalter) Department of Cardiology, Hospital Munich South, Munich,
Germany
(Lewalter) University of Bonn, Bonn, Germany
(Laeis, Reimitz, Smolnik, Zierhut) Daiichi Sankyo Europe, Munich, Germany
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, Netherlands
(Tijssen) Cardialysis, RotterdamNetherlands
(Vranckx) Department of Cardiology and Intensive Care, Jessa Ziekenhuis,
Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt,
Belgium
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Aims: This subgroup analysis of the ENTRUST-AF PCI trial
(ClinicalTrials.gov Identifier: NCT02866175; Date of registration: August
2016) evaluated type of AF, and CHA<inf>2</inf>DS<inf>2</inf>-VASc score
parameters as predictors for clinical outcome. Method(s): Patients
were randomly assigned after percutaneous coronary intervention (PCI) to
either edoxaban (60 mg/30 mg once daily [OD]; n = 751) plus a
P2Y<inf>12</inf> inhibitor for 12 months or a vitamin K antagonist [VKA]
(n = 755) plus a P2Y<inf>12</inf> inhibitor and aspirin (100 mg OD, for
1-12 months). The primary outcome was a composite of major/clinically
relevant non-major bleeding (CRNM) within 12 months. The composite
efficacy endpoint consisted of cardiovascular death, stroke, systemic
embolic events, myocardial infarction (MI), and definite stent thrombosis.
 Result(s): Major/CRNM bleeding event rates were 20.7%/year and
25.6%/year with edoxaban and warfarin, respectively (HR [95% CI]: 0.83
[0.654-1.047]). The event rates of composite outcome were 7.26%/year and
6.86%/year, respectively (HR [95% CI]): 1.06 [0.711-1.587]), and of
overall net clinical benefit were 12.48%/year and 12.80%/year,
respectively (HR [(95% CI]: 0.99 [(0.730; 1.343]). Increasing
CHA<inf>2</inf>DS<inf>2</inf>-VASc score was associated with increased
rates of all outcomes. CHA<inf>2</inf>DS<inf>2</inf>-VASc score >= 5 was a
marker for stent thrombosis. Paroxysmal AF was associated with a higher
occurrence of MI (4.87% versus 2.01%, p = 0.0024). Conclusion(s):
After PCI in AF patients, increasing CHA<inf>2</inf>DS<inf>2</inf>-VASc
score was associated with increased bleeding rates and
CHA<inf>2</inf>DS<inf>2</inf>-VASc score (>= 5) predicted the occurrence
of stent thrombosis. Paroxysmal AF was associated with MI. These findings
may have important clinical implications in AF patients. Copyright
© 2020, The Author(s).

<115>
Accession Number
633183839
Title
Precision implementation of early ambulation in elderly patients
undergoing off-pump coronary artery bypass graft surgery: a
randomized-controlled clinical trial.
Source
BMC geriatrics. 20 (1) (pp 404), 2020. Date of Publication: 14 Oct 2020.
Author
Cui Z.; Li N.; Gao C.; Fan Y.; Zhuang X.; Liu J.; Zhang J.; Tan Q.
Institution
(Cui, Zhuang, Liu, Zhang) Intensive Care Unit (ICU), Department of Cardiac
Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical
University, Jinan, Shandong 250021, China
(Li) Department of Gynecology, Shandong Provincial Hospital Affiliated to
Shandong First Medical University, Jinan, Shandong 250021, China
(Gao) Department of Biostatistics, School of Public Health, Cheeloo
College of Medicine, Shandong University, Jinan, Shandong 250012, China
(Fan) Department of Toxicological and Functional Test, Centers for Disease
Control and Prevention of Shandong, Jinan 250014, China
(Tan) Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong
Provincial Hospital Affiliated to Shandong First Medical University,
Jinan, Shandong 250021, China
(Tan) Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong
Provincial Hospital, Cheeloo College of Medicine, Shandong University,
Jinan, Shandong 250021, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although early ambulation (EA) is associated with improved
outcomes in post-operative patients, implementation of EA in elderly
patients is still a challenge. In this study, we aimed to design and
assess a precision early ambulation program for cardiac rehabilitation.
 METHOD(S): We conducted a single-center, randomized and controlled
clinical trial in elderly patients aged over 60years after off-pump
coronary artery bypass graft (OPCABG) surgery. Patients were randomly
assigned to a precision early ambulation (PEA) group or a routine
ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and
maximal oxygen uptake (VO2max) were used as a reference to formulate and
monitor the PEA regimen. The primary end-point was the postoperative
length of stay in hospital (PLOS). The secondary end-points included
90-day mortality, incidence of early discharge, laboratory tests, length
of ICU stay, the incidence of multiple organ complications and
post-traumatic stress disorder (PTSD). Ambulation outcomes were also
recorded. RESULT(S): In total, 178 patients were enrolled (n=89 per
group). In the intent-to-treat analysis, PLOS in the PEA group was shorter
than that in the Control group (9.04+/-3.08 versus 10.09+/-3.32days,
respectively. Mean difference 1.045days; 95% confidence interval [CI]
0.098-1.992; P=0.031 in the unadjusted model; mean difference 0.957days;
CI 0.007-1.907; P=0.048 in adjusted model). The incidence of early
discharge differed significantly between the PEA and control groups
(41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432;
CI 0.231-0.809; P=0.009 in unadjusted model; OR 0.466; CI 0.244-0.889,
P=0.02 in adjusted model). The time of first bowel movement, partial
pressure O2 and post-traumatic stress disorder score in the PEA group were
better than those in the Control group. Participants walked much longer
distances on day 3 in the PEA group than those in the Control group
(76.12+/-29.02 versus 56.80+/-24.40m, respectively, P < 0.001).
 CONCLUSION(S): APMHR and VO2max are valuable for implementation of
PEA according to an established security threshold. PEA after OPCAPG
surgery is safe and reliable for elderly patients, not only reducing the
hospital stay, but also improving their physiological and psychological
symptoms. TRIAL REGISTRATION: This study is a component of a protocol
retrospectively registered: Application of ERAS in cardiovascular surgery.
TRIAL REGISTRATION NUMBER: ChiCTR1800018167 . Date of registration: 3rd
September, 2018. URL of trial registry record:
http://www.chictr.org.cn/index.aspx.

<116>
Accession Number
633183065
Title
Intermittent antegrade warm-blood versus cold-blood cardioplegia in
children undergoing open heart surgery: a protocol for a randomised
controlled study (Thermic-3).
Source
BMJ open. 10 (10) (pp e036974), 2020. Date of Publication: 14 Oct 2020.
Author
Heys R.; Stoica S.; Angelini G.; Beringer R.; Evans R.; Ghorbel M.;
Lansdowne W.; Parry A.; Pieles G.; Reeves B.; Rogers C.; Saxena R.;
Sheehan K.; Smith S.; Walker-Smith T.; Tulloh R.M.; Caputo M.
Institution
(Heys) Bristol Trials Centre, Clincal Trials and Evaulation Unit, Bristol
Medical School, University of Bristol, Bristol, United Kingdom
(Heys, Angelini, Evans, Reeves, Rogers, Sheehan, Tulloh) National
Institute for Health Research Bristol Biomedical Research Centre,
University Hospitals Bristol NHS Foundation Trust and University of
Bristol, Bristol, United Kingdom
(Stoica, Beringer, Lansdowne, Parry, Pieles, Sheehan, Smith, Tulloh,
Caputo) Bristol Royal Hospital for Children, University Hospitals Bristol
NHS Foundation Trust, Bristol, United Kingdom
(Angelini, Ghorbel, Tulloh) University of Bristol, Bristol, United Kingdom
(Evans, Reeves, Rogers, Walker-Smith) Bristol Trials Centre, Clincal
Trials and Evaulation Unit, Bristol Medical School, University of Bristol,
Bristol, United Kingdom
(Saxena) Cardiac Intensive Care, Great Ormond Street Hospital For Children
NHS Foundation Trust, London, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Surgical repair of congenital heart defects often requires
the use of cardiopulmonary bypass (CPB) and cardioplegic arrest.
Cardioplegia is used during cardiac surgery requiring CPB to keep the
heart still and to reduce myocardial damage as a result of
ischaemia-reperfusion injury. Cold cardioplegia is the prevalent method of
myocardial protection in paediatric patients; however, warm cardioplegia
is used as part of usual care throughout the UK in adults. We aim to
provide evidence to support the use of warm versus cold blood cardioplegia
on clinical and biochemical outcomes during and after paediatric
congenital heart surgery. METHODS AND ANALYSIS: We are conducting a
single-centre randomised controlled trial in paediatric patients
undergoing operations requiring CPB and cardioplegic arrest at the Bristol
Royal Hospital for Children. We will randomise participants in a 1:1 ratio
to receive either 'cold-blood cardioplegia' or 'warm-blood cardioplegia'.
The primary outcome will be the difference between groups with respect to
Troponin T levels over the first 48 postoperative hours. Secondary
outcomes will include measures of cardiac function; renal function;
cerebral function; arrythmias during and postoperative hours;
postoperative blood loss in the first 12hours; vasoactive-inotrope score
in the first 48hours; intubation time; chest and wound infections; time
from return from theatre until fit for discharge; length of postoperative
hospital stay; all-cause mortality to 3 months postoperative; myocardial
injury at the molecular and cellular level. ETHICS AND DISSEMINATION: This
trial has been approved by the London - Central Research Ethics Committee.
Findings will be disseminated to the academic community through
peer-reviewed publications and presentation at national and international
meetings. Patients will be informed of the results through patient
organisations and newsletters to participants. TRIAL REGISTRATION NUMBER:
ISRCTN13467772; Pre-results. Copyright © Author(s) (or their
employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

<117>
Accession Number
633182329
Title
Closure of Iatrogenic Atrial Septal Defect Following Transcatheter Mitral
Valve Repair: The Randomized MITHRAS Trial.
Source
Circulation. (no pagination), 2020. Date of Publication: 15 Oct 2020.
Author
Lurz P.; Unterhuber M.; Rommel K.-P.; Kresoja K.-P.; Kister T.; Besler C.;
Fengler K.; Sandri M.; Daehnert I.; Thiele H.; von Roeder M.; Blazek S.
Institution
(Lurz, Thiele) Department of Internal Medicine/Cardiology, Heart Center
Leipzig at Leipzig University, Leipzig, Germany; Leipzig Heart Institute,
Leipzig, Germany
(Unterhuber, Rommel, Kresoja, Kister, Besler, Fengler, Sandri, von Roeder,
Blazek) Department of Internal Medicine/Cardiology, Heart Center Leipzig
at Leipzig University, Leipzig, Germany
(Daehnert) Department of Pediatric Cardiology, Heart Center Leipzig at
Leipzig University, Leipzig, Germany
Publisher
NLM (Medline)

<118>
Accession Number
633193632
Title
Meta-Analysis of Bioprosthetic Valve Thrombosis after Transcatheter Aortic
Valve Implantation.
Source
The American journal of cardiology. (no pagination), 2020. Date of
Publication: 13 Oct 2020.
Author
Rheude T.; Pellegrini C.; Stortecky S.; Marwan M.; Xhepa E.; Ammon F.;
Pilgrim T.; Mayr N.P.; Husser O.; Achenbach S.; Windecker S.; Cassese S.;
Joner M.
Institution
(Rheude, Pellegrini, Xhepa, Cassese) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Stortecky, Pilgrim, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Marwan, Ammon, Achenbach) Department of Cardiology,
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
(Mayr) Institut fur Anasthesiologie, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Husser) Klinik fur Innere Medizin I, Kardiologie, St. Johannes-Hospital
Dortmund, Dortmund, Germany
(Joner) Klinik fur Herz- und Kreislauferkrankungen, Deutsches Herzzentrum
Munchen, Technische Universitat Munchen, Munich, Germany; DZHK (German
Centre for Cardiovascular Research), partner site Munich Heart Alliance,
Munich, Germany
Publisher
NLM (Medline)
Abstract
Bioprosthetic valve thrombosis may complicate transcatheter aortic valve
implantation (TAVI). This meta-analysis sought to evaluate the prevalence
and clinical impact of subclinical leaflet thrombosis (SLT) and clinical
valve thrombosis (CVT) after TAVI. We summarized diagnostic strategies,
prevalence of SLT and/or CVT and estimated their impact on the risk of
all-cause death and stroke. Twenty studies with 12,128 patients were
included. The prevalence of SLT and CVT was 15.1% and 1.2%, respectively.
The risk of all-cause death was not significantly different between
patients with SLT (RR 0.77; p= 0.22) and CVT (RR 1.29; p= 0.68) compared
to patients without. The risk of stroke was higher in patients with CVT
(RR 7.51; p< 0.001) as compared to patients without, while patients with
SLT showed no significant increase in the risk of stroke (RR 1.81; p=
0.17). Reduced left ventricular function was associated with increased
prevalence, while oral anticoagulation was associated with reduced
prevalence of bioprosthetic valve thrombosis. Bioprosthetic valve
thrombosis is frequent after TAVI, but does not increase the risk of
death. Clinical valve thrombosis is associated with a significantly
increased risk of stroke. Future studies should focus on prevention and
treatment of bioprosthetic valve thrombosis. Copyright © 2020
Elsevier Ltd. All rights reserved.

<119>
Accession Number
633190561
Title
Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery
Patients.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. (no pagination), 2020. Date of Publication: 16 Oct 2020.
Author
Staveski S.L.; Pickler R.H.; Khoury P.R.; Ollberding N.J.; Donnellan A.L.;
Mauney J.A.; Lincoln P.A.; Baird J.D.; Gilliland F.L.; Merritt A.D.;
Presnell L.B.; Lanese A.R.; Lisanti A.J.; Large B.J.; Fineman L.D.; Gibson
K.H.; Mohler L.A.; Callow L.; Barnes S.S.; Whalen R.L.; Grant M.J.C.;
Sheppard C.; Kline-Tilford A.M.; Steadman P.W.; Shafland H.C.; Corlett
K.M.; Kelly S.P.; Ortman L.A.; Peyton C.E.; Hagstrom S.K.; Shields A.M.;
Nye T.; Alvarez T.C.E.; Justice L.B.; Kidwell S.T.; Redington A.N.; Curley
M.A.Q.
Institution
(Staveski) University of California San Francisco, School of Nursing, San
Francisco, CA
(Pickler) The Ohio State University College of Nursing, Columbus, OH
(Khoury, Donnellan, Justice, Kidwell) Cincinnati Children's Hospital
Medical Center, Heart Institute, Cincinnati, OH
(Ollberding) Division of Biostatistics and Epidemiology, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH
(Mauney) Department of Pediatrics, Critical Care Baylor College of
Medicine, TX, Houston
(Baird) Institute for Nursing and Interprofessional Research, Children's
Hospital Los Angeles, Los Angeles, CA
(Gilliland) Cardiovascular Intensive Care Unit, Department of Nursing,
John Hopkins All Children's Hospital, FL, St. Petersburg, United States
(Merritt) Cardiac Intensive Care Unit, Department of Nursing, Children's
National Health Systems, DC, WA
(Presnell) Cardiovascular Intensive Care Unit, Department of Nursing,
Lucile Packard Children's Hospital, Palo Alto, CA
(Lanese) Department of Child Health Evaluative Sciences, Hospital for Sick
Children, ON, Toronto, Canada
(Lisanti) Cardiac Nursing, Department of Nursing, Children's Hospital of
Philadelphia, Philadelphia, United States
(Large) Division of Cardiovascular Intensive Care, Phoenix Children's
Hospital, AZ, Phoenix, United States
(Fineman) Pediatric Intensive Care Unit, Department of Nursing, UCSF
Benioff Children's Hospital, San Francisco, CA
(Gibson) Cardiac Intensive Care Unit, Department of Nursing, Children's
Healthcare of Atlanta, Atlanta, United States
(Mohler) Cardiovascular Intensive Care Unit, Department of Nursing,
Children's Hospital of Orange County, Orange, CA
(Callow) Pediatric Cardiac Surgery, Department of Nursing, Congenital
Heart Center, Mott Children's Hospital, MI, Ann Arbor, United States
(Barnes) Department of Anesthesiology and Critical Care Medicine, John
Hopkins Hospital, MD, Baltimore, United States
(Grant) Pediatric Critical Care Services, Primary Children's Hospital, UT,
Salt Lake City, United States
(Sheppard) Pediatric Pulmonary Hypertension, Stollery Children's Hospital,
AB, Edmonton, Canada
(Kline-Tilford) Cardiovascular Surgery, Children's Hospital of Michigan,
MI, Detroit, United States
(Steadman) Cardiac Care Unit, Ann & Robert H. Lurie Children's Hospital of
Chicago, Chicago, Mexico
(Shafland) Cardiovascular Intensive Care Unit, Department of Nursing,
Children's Minnesota, MN, Minneapolis, United States
(Corlett) Cardiac Intensive Care Unit, Department of Nursing, Seattle
Children's Hospital, Seattle, WA
(Kelly) Pediatric Critical Care, Department of Nursing, Doernbecher
Children's Hospital, OR, Portland, Jamaica
(Ortman) Division of Critical Care, Department of Pediatrics, Omaha
Children's Hospital and Medical Center, Omaha, NE
(Peyton) Department of Nursing, Children's Hospital Heart Institute,
Children's Hospital Colorado, CO, Aurora, United States
(Hagstrom) Pediatric Critical Care, Department of Nursing, University of
Minnesota Masonic Children's Hospital, MN, Minneapolis, United States
(Shields) Cardiac Intensive Care, Department of Nursing, UPMC Children's
Hospital of Pittsburgh, Pittsburgh, United States
(Nye) Department of Nursing, Advocate Children's Hospital, Oak Lawn,
United States
(Alvarez) Research in Patient Services, Department of Nursing, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH
(Redington) Cardiology Clinic, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The objective of this study was to determine the prevalence of
ICU delirium in children less than 18 years old that underwent cardiac
surgery within the last 30 days. The secondary aim of the study was to
identify risk factors associated with ICU delirium in postoperative
pediatric cardiac surgical patients. DESIGN: A 1-day, multicenter
point-prevalence study of delirium in pediatric postoperative cardiac
surgery patients. SETTING: Twenty-seven pediatric cardiac and general
critical care units caring for postoperative pediatric cardiac surgery
patients in North America. PATIENTS: All children less than 18 years old
hospitalized in the cardiac critical care units at 06:00 on a randomly
selected, study day. INTERVENTIONS: Eligible children were screened for
delirium using the Cornell Assessment of Pediatric Delirium by the study
team in collaboration with the bedside nurse. MEASUREMENT AND MAIN
RESULTS: Overall, 181 patients were enrolled and 40% (n = 73) screened
positive for delirium. There were no statistically significant differences
in patient demographic information, severity of defect or surgical
procedure, past medical history, or postoperative day between patients
screening positive or negative for delirium. Our bivariate analysis found
those patients screening positive had a longer duration of mechanical
ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support
(55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4
vs 3 catheters; p = 0.001). Delirium-positive patients received more total
opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p < 0.001),
did not have an ambulation or physical therapy schedule (p = 0.02), had
not been out of bed in the previous 24 hours (p < 0.0002), and parents
were not at the bedside at time of data collection (p = 0.008). In the
mixed-effects logistic regression analysis of modifiable risk factors, the
following variables were associated with a positive delirium screen: 1)
pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total
opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3)
SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or
sedative administered in the previous 4 hours (odds ratio, 3.49;
1.32-9.28); 5) no progressive physical therapy or ambulation schedule in
their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at
bedside at time of data collection (odds ratio, 2.31; 1.01-5.31).
 CONCLUSION(S): We found delirium to be a common problem after cardiac
surgery with several important modifiable risk factors.

<120>
Accession Number
633189810
Title
The protective effect of hypothermia on postoperative cognitive deficit
may be attenuated by prolonged coronary artery bypass time: Meta-analysis
and meta-regression.
Source
Advances in clinical and experimental medicine : official organ Wroclaw
Medical University. (no pagination), 2020. Date of Publication: 16 Oct
2020.
Author
Habibi V.; Habibi M.R.; Habibi A.; Zeydi A.E.
Institution
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Anesthesiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Student Research Committee, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Nasibeh School of Nursing
and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
Publisher
NLM (Medline)
Abstract
There is controversy about whether hypothermia during coronary artery
bypass grafting (CABG) surgery is effective in reducing postoperative
cognitive deficit (POCD). The objective of this study was to determine the
effect of hypothermia on POCD and to undertake a meta-regression to
determine whether moderator variables mediate the relationship between
hypothermia and POCD. We searched the Web of Science, PubMed database,
Scopus, and the Cochrane Library database (up to June 2017), and
systematically reviewed a list of retrieved articles. Our final review
includes only randomized controlled trials (RCTs) that compared
administration of hypothermia (34degreeC). Statistical analysis of the
risk ratio (RR) and corresponding 95% confidence interval (95% CI) was
used to report the overall effect. Mantel-Haenszel risk ratio (MH RR) and
corresponding 95% CI was used to report the overall effect and
meta-regression analysis. Eight RCTs were included in this study, with a
total of 1,474 patients. The POCD occurred in 36.06% of all cases. A wide
range of hypothermia (28-34degreeC) did not reduce the occurrence of POCD
(RR = 0.983 (95% CI = 0.881-1.143); Z = -0.304; P = 0.761; I2 = 38%).
Shorter CPB time reduced the occurrence of POCD (MH log risk ratio =
-0.011 (95% CI = -0.021--0.0008); Z = -2.123; P = 0.033). Postoperative
cognitive deficit is a common event among CABG patients. Contrary to deep
hypothermia, mild hypothermia was significantly effective in reducing the
risk of POCD. The neuroprotective effect of hypothermia on POCD may be
attenuated by prolonged cardiopulmonary bypass (CPB) time.

<121>
Accession Number
633186117
Title
Long-term prognostic potential of microRNA-150-5p in optimally treated
heart failure patients with reduced ejection fraction. A pilot study.
Source
Minerva cardioangiologica. (no pagination), 2020. Date of Publication: 15
Oct 2020.
Author
Scrutinio D.; Conserva F.; Guida P.; Passantino A.
Institution
(Scrutinio) PaviaItaly
(Conserva, Guida, Passantino) PaviaItaly
(Conserva) Division of Nephrology, Dialysis and Transplantation Unit,
Department of Emergency and Organ Transplantation, University of Bari,
Bari, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: In a previous study, we found that miR-150-5p was specifically
downregulated in patients with advanced heart failure (HF). Here, we
investigated the long-term prognostic potential of miR-150-5p.
 METHOD(S): We studied optimally treated HF outpatients with reduced
ejection fraction. The primary outcome comprised the composite of death,
urgent heart transplantation (HT) and ventricular assist device (VAD)
implantation within 30 months. We used recursive partitioning analysis to
identify the optimal log miR-150-5p cut-off. The association of log
miR-150-5p with the primary outcome was examined using Cox regression
analysis. We used the Meta-Analysis Global Group in Chronic Heart Failure
(MAGGIC) risk score for adjustment in multivariable analysis. Finally, we
compared the global fit of three models (MAGGIC score+miR-150-5p, MAGGIC
score+NT-proBNP, and NT-proBNP+miR-150-5p) using Akaike Information
Criterion. RESULT(S): Recursive partitioning analysis identified the
value of -2.22 as the optimal cut-off for log miR-150-5p. Thirty-month
survival free of urgent HT/VAD implantation was 31% among the patients
with log miR-150-5p <-2.22 and 86% among those with log miR-150-5p >-2.22.
Crude hazard ratio (HR) of the primary outcome for log miR-150-5p
expression level < -2.22 was 6.70 (95%CI:2.31-19.38;p<.001). After
adjusting for the MAGGIC score in multivariable analysis, the HR was 4.40
(95%CI:1.52-12.77;p=.006). Adding log miR-150-5p to the MAGGIC score led
to an increase of 0.047 in C-index. The model combining miR-150-5p and
MAGGIC score had a 73% likelihood of representing the best-fit model of
those evaluated. CONCLUSION(S): Our data generate the hypothesis that
miR-150-5p may represent a novel risk marker in HF with reduced ejection
fraction.

<122>
Accession Number
633185993
Title
Should cardiac surgery be delayed in patients with uncorrected
hypothyroidism?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 15 Oct 2020.
Author
Ang Z.H.; Fong L.S.; Wolfenden H.D.; Grant P.W.
Institution
(Ang, Fong, Wolfenden, Grant) Department of Cardiothoracic Surgery, Prince
of Wales Hospital, NSW, Randwick, Australia
(Ang) Prince of Wales Clinical School, UNSW Sydney, NSW, Sydney, Australia
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: 'should cardiac surgery
be delayed in patients with uncorrected hypothyroidism?' A total of 1412
papers were found using the reported search, of which 7 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. There was limited
high-quality evidence with the majority of the studies being
retrospective. One propensity-matched analysis and 6 cohort studies
provided the evidence that there was no significant difference in the rate
of major adverse cardiac events including mortality based on thyroid
status. However, hypothyroidism and subclinical hypothyroidism were
associated with higher rates of postoperative atrial fibrillation. Based
on the available evidence, we conclude that cardiac surgery should not be
delayed to allow achievement of euthyroid status. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<123>
Accession Number
633183867
Title
Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve
Replacement in Patients with Symptomatic Severe Aortic Stenosis: The SCOPE
2 Randomized Clinical Trial.
Source
Circulation. (no pagination), 2020. Date of Publication: 15 Oct 2020.
Author
Tamburino C.; Bleiziffer S.; Thiele H.; Scholtz S.; Hildick-Smith D.;
Cunnington M.; Wolf A.; Barbanti M.; Tchetche D.; Garot P.; Pagnotta P.;
Gilard M.; Bedogni F.; Van Belle E.; Vasa-Nicotera M.; Chieffo A.; Deutsch
O.; Kempfert J.; Sondergaard L.; Butter C.; Trillo-Nouche R.; Lotfi S.;
Mollmann H.; Joner M.; Abdel-Wahab M.; Bogaerts K.; Hengstenberg C.;
Capodanno D.
Institution
(Tamburino, Capodanno) Department of General Surgery and Medical-Surgical
Subspecialties, University of Catania, Catania, Italy
(Bleiziffer) Department of Department of Cardiothoracic Surgery, Heart-and
Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
(Thiele, Abdel-Wahab) Department of Cardiology, Heart Center Leipzig at
University Leipzig, Leipzig, Germany
(Scholtz) Department of interventional Cardiology, Heart-and Diabetes
Center Northrhein-Westfalia, Bad Oeynhausen, Germany
(Hildick-Smith) Department of Cardiology, Brighton & Sussex University
Hospitals NHS Trust, Brighton, United Kingdom
(Cunnington) Department of Cardiology, Leeds General Infirmary, Leeds
Teaching Hospitals NHS Trust, Leeds, United Kingdom
(Wolf) Department of Cardiology, Elisabeth Hospital Essen, Essen, Germany
(Barbanti) Department of Cardio-Thoracic-Vascular Diseases and
Transplantation, Catania, Italy
(Tchetche) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
(Garot) Hopital Prive Jacques Cartier, Institut Cardio-vasculaire
Paris-Sud (ICPS), Massy, France
(Pagnotta) Department of Cardiovascular Medicine, Humanitas Clinical and
Research Center, Milano, Italy
(Gilard) Department of Cardiology, Brest University Hospital, Brest,
France
(Bedogni) Cardiology Department, IRCCS Policlinico San Donato, Milano,
Italy
(Van Belle) Department of Cardiology, University Hospital, Lille, France
(Vasa-Nicotera) Department of Cardiology, Goethe University Hospital
Frankfurt, Frankfurt am Main, Germany
(Chieffo) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Deutsch) Department of Cardiovascular Surgery, German Heart Centre
Munich, Munich, Germany
(Kempfert) Charite Universitatsmedizin, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Sondergaard) CopenhagenDenmark
(Butter) Department of Cardiology, Heart Center Brandenburg in Bernau and
Brandenburg Medical School, Germany
(Trillo-Nouche) Servicio de Cardiologia, Complejo Hospitalario
Universitario de Santiago de Compostela, Santiago de Compostela, Spain
(Lotfi) Department of Cardiovascular Surgery, University Hospital RWTH
Aachen, Aachen, Germany
(Mollmann) Department of Cardiology, St. Johannes Hospital, Dortmund,
Germany
(Joner) Klinik fur Herz- und Kreislauferkrankungen, Deutsches Herzzentrum
Munchen, Munich, Germany
(Bogaerts) Department of Public Health and Primary Care, I-BioStat, KU
Leuven, Leuven, Belgium and I-BioStat, Universiteit Hasselt, Hasselt,
Belgium
(Hengstenberg) Department of Internal Medicine II, Medical University of
Vienna, Vienna, Austria
Publisher
NLM (Medline)
Abstract
Background: There are few randomized trials comparing bioprostheses for
transcatheter aortic valve replacement (TAVR), and no trials compared TAVR
bioprostheses with supra-annular design. The SCOPE 2 trial was designed to
compare the clinical outcomes of the ACURATE neo and CoreValve Evolut
valves. Method(s): SCOPE 2 was a randomized trial performed at 23
centers in 6 countries between April 2017 and April 2019. Patients >=75
years with an indication for transfemoral TAVR as agreed by the Heart Team
were randomly assigned to receive treatment with either the ACURATE neo
(n=398) or the CoreValve Evolut bioprostheses (n=398). The primary
endpoint, powered for non-inferiority of the ACURATE neo valve, was
all-cause death or stroke at 1 year. The key secondary endpoint, powered
for superiority of the ACURATE neo valve, was new permanent pacemaker
implantation at 30 days. Result(s): Among 796 randomized patients
(mean age 83.2+/-4.3 years; mean STS-PROM score 4.6+/- 2.9%), clinical
follow-up information was available for 778 (98%) patients. Within 1 year,
the primary endpoint occurred in 15.8% of patients in the ACURATE neo
group and in 13.9% of patients in the CoreValve Evolut group (absolute
risk difference 1.8%, upper one-sided 95% confidence limit 6.1%, p=0.0549
for noninferiority). The 30-day rates of new permanent pacemaker
implantation were 10.5% in the ACURATE neo group and 18.0% in the
CoreValve Evolut group (absolute risk difference -7.5%, 95% confidence
interval -12.4 to -2.60, p=0.0027). No significant differences were
observed in the components of the primary endpoint. Cardiac death at 30
days (2.8% vs. 0.8%, p=0.03) and 1 year (8.4% vs. 3.9%, p=0.01), and
moderate or severe aortic regurgitation at 30 days (10% vs. 3%, p=0.002)
were significantly increased in the ACURATE neo group. Conclusion(s):
Transfemoral TAVR with the self-expanding ACURATE neo did not meet
non-inferiority compared to the self-expanding CoreValve Evolut in terms
of all-cause death or stroke at 1 year, and was associated with a lower
incidence of new permanent pacemaker implantation. In secondary analyses,
the ACURATE neo was associated with more moderate or severe aortic
regurgitation at 30 days and cardiac death at 30 days and 1 year. Clinical
Trial Registration: URL: https://clinicaltrials.gov/ Unique Identifier:
NCT03192813.

<124>
Accession Number
372984895
Title
Hoarseness after thyroidectomy: Blame the endocrine surgeon alone?.
Source
Hormones. 13 (1) (pp 5-15), 2014. Date of Publication: January - March
2014.
Author
Moris D.; Mantonakis E.; Makris M.; Michalinos A.; Vernadakis S.
Institution
(Moris, Mantonakis, Michalinos) First Department of Surgery, 'Laiko'
General Hospital, National and Kapodistrian University of Athens, Athens,
Greece
(Makris) Department of Surgery and Cancer, St Mary's Hospital, Imperial
College of London, London, United Kingdom
(Vernadakis) Department of General, Visceral and Transplantation Surgery,
University Hospital Essen, Essen, Germany
Publisher
Hellenic Endocrine Society (E-mail: info@springer-sbm.com)
Abstract
Objective: Hoarseness is a postoperative complication of thyroidectomy,
mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness
may also be brought about via vocal cord dysfunction (VCD) due to injury
of the vocal cords from manipulations during anesthesia, as well as from
psychogenic disorders and respiratory and upper-GI related infections. We
reviewed the literature aiming to explore these potential surgical and
non-surgical causes of hoarseness beyond thyroidectomy and the role of the
endocrine surgeon. Is he/she alone to blame? Methods/Material: The
MEDLINE/PubMed database was searched for publications with the medical
subject heading "hoarseness" and keywords "thyroidectomy", "RLN", "VCD" or
"intubation". We restricted our search till up to May 2013.
 Result(s): In our final review we included 80 articles and abstracts
that were accessible and available in English. We demonstrated the
incidence of hoarseness stemming from surgical and non-surgical causes and
also highlighted the role of intubation as a potential cause of
injury-related VCD. Conclusion(s): Hoarseness is a relatively common
complication of thyroidectomy, which can be attributed to many factors
including surgeon's error or injuries during intubation as well as to
other non-surgical causes. However, compared to procedures such as
cervical spine surgery, mediastinal surgery, esophagectomy and
endarterectomy, thyroidectomy would seem to be a procedure with a
relatively low rate of recurrent laryngeal nerve palsies (RLNPs). It is
often difficult to determine whether the degree of hoarseness after
thyroidectomy should be attributed only the surgical procedure itself or
to other causes, for example intubation and extubation maneuvers. The
differential diagnosis of postoperative hoarseness requires the use of
specific tools, such as stroboscopy and intra- and extralaryngeal
electromyography, while methods like acoustic voice analysis, with
estimation of maximum phonation time and phonation frequency range, can
distinguish between objective and subjective deterioration in the voice.
The importance of medical history should be also emphasized.

<125>
Accession Number
2006765640
Title
Impact of intravascular ultrasound findings in patients with a post PCI
fractional flow reserve <=0.85 on 2 year clinical outcome.
Source
International Journal of Cardiology. 317 (pp 33-36), 2020. Date of
Publication: 15 October 2020.
Author
van Zandvoort L.J.C.; Masdjedi K.; Neleman T.; Tovar Forero M.N.; Wilschut
J.; den Dekker W.; de Jaegere P.P.T.; Diletti R.; Zijlstra F.; Van Mieghem
N.M.; Daemen J.
Institution
(van Zandvoort, Masdjedi, Neleman, Tovar Forero, Wilschut, den Dekker, de
Jaegere, Diletti, Zijlstra, Van Mieghem, Daemen) Department of Cardiology,
Erasmus MC, Rotterdam, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background: Patients with a low post PCI fractional flow reserve (FFR) are
at increased risk for future adverse cardiac events. The aim of the
present study was to assess the impact of specific intravascular
ultrasound (IVUS) findings in patients with a low post percutaneous
coronary intervention (PCI) FFR on long-term clinical outcome.
 Method(s): In a subgroup analysis, 100 vessels with an FFR value
<=0.85 underwent post PCI IVUS to further assess the potential
determinants for low post PCI FFR. No further action was taken to improve
post PCI FFR. The primary endpoint of this study was the event free
survival of target vessel failure (TVF) at two years in patients with a
post PCI FFR <=0.85, which was defined as a composite of cardiac death,
target vessel myocardial infarction or target vessel revascularization.
 Result(s): In patients with a post PCI FFR <=0.85, TVF free survival
rates were 88.5% vs. 95.5% for patients with versus without residual
proximal lesions and 88.2% vs. 95.5% for patients with versus without
residual distal lesions respectively (HR = 2.53, 95% confidence interval
(CI) 0.52-12.25, p =.25 and HR = 2.60, 95% CI 0.54-12.59, p =.24
respectively). TVF free survival was 92.8% vs. 93.5% in patients with
versus without stent underexpansion >20% (HR = 1.01, 95% CI 0.21-4.88, p
=.99) and 89.3% vs. 97.8% in patients with versus without any residual
focal lesion including lumen compromising hematoma (HR = 4.64, 95% CI
0.55-39.22, p =.18). Conclusion(s): Numerically higher TVF rates were
observed in patients with a post PCI FFR <=0.85 and clear focal residual
disease as assessed with IVUS. Copyright © 2020

<126>
Accession Number
2005430186
Title
Perioperative outcomes of robot-assisted vs video-assisted and traditional
open thoracic surgery for lung cancer: A systematic review and network
meta-analysis.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
16 (5) (pp 1-14), 2020. Date of Publication: 01 Oct 2020.
Author
Hu J.; Chen Y.; Dai J.; Zhu X.; Gonzalez-Rivas D.; Jiang G.; Li H.; Zhang
P.
Institution
(Hu, Chen, Dai, Zhu, Gonzalez-Rivas, Jiang, Zhang) Department of Thoracic
Surgery, Shanghai Pulmonary Hospital, Tongji University School of
Medicine, Shanghai, China
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, Coruna, Spain
(Li) Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Background: The superiority of robot-assisted thoracic surgery (RATS) over
video-assisted thoracic surgery (VATS) and thoracotomy remains
controversial for lung cancer. Method(s): A network meta-analysis
(NMA) and pairwise meta-analysis (PMA) were performed to evaluate the
perioperative outcomes using five databases. Result(s): Thirty-two
studies involving 6593 patients were included for analysis. The NMA showed
that RATS had similar operative time, conversion rate to thoracotomy,
number of lymph node, postoperative morbidity, and length of hospital stay
with VATS, except for lower 30-day mortality. Compared with thoracotomy,
longer operative time and shorter hospital stay were observed in RATS, but
no significant difference was observed in number of lymph node,
postoperative morbidity, and 30-day mortality in both NMA and PMA. In
lobectomy/segmentectomy subgroup, all outcomes, except for operative time
of RATS vs VATS and number of lymph node, were similar with overall
analyses. Conclusion(s): RATS had comparable perioperative outcomes
with VATS and open surgery. Copyright © 2020 John Wiley & Sons
Ltd

<127>
Accession Number
2006945507
Title
Cancer risk in heart or lung transplant recipients: A comprehensive
analysis of 21 prospective cohorts.
Source
Cancer Medicine. (no pagination), 2020. Date of Publication: 2020.
Author
Ge F.; Li C.; Xu X.; Huo Z.; Wang R.; Wen Y.; Peng H.; Wu X.; Liang H.;
Peng G.; Li R.; Huang D.; Chen Y.; Xiong S.; Zhong R.; Cheng B.; Li J.; He
J.; Liang W.
Institution
(Ge, Li, Huo, Wang, Wen, Peng, Wu, Liang, Peng, Li, Huang, Chen, Xiong,
Zhong, Cheng, Li, He, Liang) Department of Thoracic Surgery and Oncology,
China State Key Laboratory of Respiratory Disease & National Clinical
Research Center for Respiratory Disease, the First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, China
(Ge) First Clinical School, Guangzhou Medical University, Guangzhou, China
(Xu, Peng, Li, Huang, Chen) Department of Transplantation, the First
Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
(Huo, Wang, Wen, Peng, Wu) Nanshan School, Guangzhou Medical University,
Guangzhou, China
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
We performed a meta-analysis to determine cancer risks at multiple sites
and their associations with tumor mutation burden (TMB), an index for
immunogenicity, in heart or lung transplant recipients. A comprehensive
search of PubMed, Web of Science, EMBASE, and Medline was conducted.
Random effects models were used to calculate standardized incidence ratios
(SIRs) versus the general population and to determine the risks of
different cancers. Weighted linear regression (WLR) was used to analyze
the associations between the SIRs and TMBs. (PROSPERO CRD42020159599).
Data from 21 studies including 116,438 transplant recipients (51,173 heart
transplant recipients and 65,265 lung transplant recipients) with a total
follow-up of 601,330.7 person-years were analyzed. Compared with the
general population, heart transplant recipients displayed a 3.13-fold
higher cancer risk [SIR: 3.13; 95% confidence interval (CI): 2.38-4.13; p
< 0.001]; lung transplant recipients displayed a 4.28-fold higher cancer
risk [SIR: 4.28; 95% CI: 3.18-5.77; p < 0.001]. The correlation
coefficients were 0.54 (p = 0.049) and 0.79 (p < 0.001) in heart and lung
transplant recipients, respectively, indicating that 29% and 63% of the
differences in the SIRs for cancer types might be explained by the TMBs.
Our study demonstrated that both heart and lung transplant recipients
displayed a higher risk of certain site-specific cancers. These findings
can provide individualized guidance for clinicians for detection of cancer
among heart or lung transplantation recipients. In addition, we provided
evidence that increased risks of post-transplant cancers can be attributed
to immunosuppression. Copyright © 2020 The Authors. Cancer
Medicine published by John Wiley & Sons Ltd.

<128>
Accession Number
2006880038
Title
Transfusion Use and Hemoglobin Levels by Blood Conservation Method After
Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1520-1526), 2020. Date of
Publication: November 2020.
Author
McNair E.D.; McKay W.P.; Mondal P.K.; Bryce R.D.T.
Institution
(McNair) Department of Pathology and Laboratory Medicine, College of
Medicine, University of Saskatchewan, Saskatoon, Canada
(McKay) Department of Anesthesiology, Perioperative Medicine, and Pain
Management, College of Medicine, University of Saskatchewan, Saskatoon,
Canada
(Mondal, Bryce) Department of Community Health and Epidemiology, CRSU,
College of Medicine, University of Saskatchewan, Saskatoon, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Guidelines recommend modified ultrafiltration (MUF) and cell
washing for blood conservation after cardiopulmonary bypass (CPB),
although information on outcomes is lacking. This research compared online
MUF (ultrafiltration of the patient's entire circulating volume) with
off-line MUF (ultrafiltration of the residual CPB volume) and
centrifugation (cell washing of the residual CPB volume). Method(s):
This prospective cohort study enrolled 99 consecutive patients, grouped by
method (group I, online MUF, n = 35; group II, off-line MUF, n = 30; group
III, centrifugation, n = 34). Primary outcome was transfusion by 18 hours.
Secondary outcomes were 18-hour hemoglobin levels, fluid balance (weight
change), and biomarker levels indicating coagulation and organ function.
 Result(s): By 18 hours, 22.9%, 6.7%, and 14.7% of group I, II, and
III patients, respectively, had undergone transfusion (P = .19).
Percentage weight gain differed by group (group I, 5.7%; group II, 1.3%;
group III, 4.5%; P < .0001). Baseline to 18-hour hemoglobin change also
differed by group, with the group I increase significantly exceeding that
of group II (P = .002) but not differing from group III (P = .36). After
adjustment for European System for Cardiac Operative Risk Evaluation II
(EuroSCORE), weight gain, and transfusion, only the group II to III
difference remained significant (P = .002). Conclusion(s): Online MUF
does not appear to offer a reduction in blood transfusion over other
methods. Although patients undergoing online MUF had greater improvement
in baseline to 18-hour hemoglobin compared with patients undergoing
off-line MUF, this benefit appeared attributable to fluid shifting.
Off-line MUF was associated with the least frequent transfusions. Although
online MUF does not appear to reduce blood transfusion, larger prospective
randomized controlled studies are required for confirmation. Copyright
© 2020 The Society of Thoracic Surgeons

<129>
Accession Number
2006130111
Title
Intraoperative transesophageal echocardiography in cardiovascular surgery.
Consensus document from the Spanish Society of Anesthesia and Critical
Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular
Surgery (SECCE).
Source
Cirugia Cardiovascular. 27 (5) (pp 190-218), 2020. Date of Publication: 01
Sep 2020.
Author
Carmona Garcia P.; Garcia Fuster R.; Mateo E.; Badia Gamarra S.; Lopez
Cantero M.; Gutierrez Carretero E.; Maestre M.L.; Legname V.; Fita G.;
Vives M.; Koller Bernhard T.; Sanchez Perez E.; Miralles Bagan J.;
Italiano S.; Darias-Delbey B.; Barrio J.M.; Hortal J.; Saez de Ibarra
J.I.; Hernandez A.
Institution
(Carmona Garcia) Servicio de Anestesiologia y Reanimacion, Hospital
Universitario la Fe, Valencia, Espana. Miembro del grupo de trabajo en
Ecografia de la Seccion de Cuidados Criticos de la SEDAR. Coordinadora del
grupo de trabajo en Ecocardiografia, transesofagica intraoperatoria de la
SEDAR
(Garcia Fuster) Servicio de Cirugia Cardiaca, Consorcio Hospital General
Universitario de Valencia, Espana. Coordinador del grupo de trabajo en
Ecocardiografia, transesofagica intraoperatoria de la SECCE
(Mateo) Servicio de Anestesiologia y Reanimacion, Consorcio Hospital
General Universitario de Valencia, Valencia, Spain
(Badia Gamarra) Servicio de Cirugia Cardiaca, Hospital Universitario Trias
y Pujol, Badalona, Spain
(Lopez Cantero) Servicio de Anestesiologia y Reanimacion, Hospital
Universitario la Fe, Valencia, Spain
(Gutierrez Carretero) Servicio de Cirugia Cardiaca, Hospital,
Universitario Virgen del Rocio, Sevilla, Spain
(Maestre) Seccion Cardiotoracica, Servicio de Anestesiologia y
Reanimacion, Hospital Sant Pau, Barcelona, Spain
(Legname) Servicio de Cirugia Cardiaca, Centro Medico Teknon, Barcelona,
Spain
(Fita) Seccion Cardiotoracica, Servicio de Anestesiologia y Reanimacion.
Hospital Clinic, Barcelona, Spain
(Vives) DESA. Seccion Cardiotoracica, Servicio de Anestesiologia y
Reanimacion, Hospital Universitario Dr Josep Trueta de Girona, Espana.
Miembro del grupo de trabajo en Ecografia de la Seccion de Cuidados
Criticos de la SEDAR
(Koller Bernhard, Italiano) Seccion Cardiotoracica, Servicio de
Anestesiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Sanchez Perez) EDAIC. Seccion de Cirugia Cardiaca, Servicio de Anestesia
y Reanimacion, Hospital General Universitario Gregorio Maranon, Madrid,
Espana. Miembro del grupo de trabajo en Ecografia de la Seccion de
Cuidados Criticos de la SEDAR
(Miralles Bagan) Seccion Cardiotoracica, Servicio Anestesiologia y
Reanimacion, Hospital Sant Pau, Barcelona, Spain
(Darias-Delbey) Servicio Anestesiologia y Reanimacion, Proceso del
Paciente, Cardioquirurgico, Complejo Hospitalario Universitario de
Canarias, Santa Cruz de Tenerife, Spain
(Barrio) Seccion Anestesia y Reanimacion Cardiovascular, Servicio de
Anestesia y Reanimacion, Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Hortal) Servicio de Anestesiologia y Reanimacion, Hospital General.
Universitario Gregorio Maranon, Madrid, Spain
(Saez de Ibarra) Servicio de Cirugia Cardiaca, Hospital Universitario Son
Espases, Palma de Mallorca, Spain
(Hernandez) Departamento de Anestesia y Cuidados Intensivos, Grupo
Policlinica, Ibiza, Espana. Miembro del grupo de trabajo en Ecografia de
la Seccion de Cuidados Criticos, de la SEDAR Representante del subcomite
de Educacion de EACTA, EDAIC, Codirector grupo EchoSim
Publisher
Elsevier Doyma
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows
an evaluation of cardiac morphology and function in real time and it is a
quality standard in cardiovascular surgery. It has become a fundamental
tool for both monitoring and diagnosis in the intraoperative period that
allows decide the correct surgical planning and pharmacological
management. The goal of this document is to answer the questions of when
and how the perioperative TEE should be performed in cardiovascular
surgery, what are their applications in the intraoperative, who should
perform it and how the information should be transmitted. The authors made
a systematic review of international guidelines, review articles and
clinical trials to answer by consensus to these questions. Copyright
© 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular

<130>
Accession Number
2005207320
Title
The effect of preoperative carbohydrate loading on clinical and
biochemical outcomes after cardiac surgery: A systematic review and
meta-analysis of randomized trials.
Source
Nutrients. 12 (10) (pp 1-21), 2020. Article Number: 3105. Date of
Publication: October 2020.
Author
Kotfis K.; Jamiol-Milc D.; Skonieczna-zydecka K.; Folwarski M.; Stachowska
E.
Institution
(Kotfis) Department of Anesthesiology, Intensive Therapy and Acute
Intoxications, Pomeranian Medical University, Szczecin 70-111, Poland
(Jamiol-Milc, Skonieczna-zydecka, Stachowska) Department of Human
Nutrition and Metabolomics, Pomeranian Medical University in Szczecin,
Szczecin 71-460, Poland
(Folwarski) Department of Clinical Nutrition and Dietetics, Medical
University of Gdansk, Gdansk 80-210, Poland
(Folwarski) Home Enteral and Parenteral Nutrition Unit, General Surgery,
Nicolaus Copernicus Hospital, Gdansk 80-210, Poland
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Background and aim: Preoperative fasting leads to metabolic stress and
causes insulin resistance in patients undergoing cardiac surgery. The aim
of this study was to assess the effect of preoperative oral carbohydrate
loading (OCH) on outcome in patients undergoing planned cardiac surgery by
systematically reviewing the literature and synthesizing evidence from
randomized controlled trials (RCTs). Method(s): Systematic search of
PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was
performed to identify relevant RCTs from databased inception until
05/03/2020. We included studies that compared outcome measures between OCH
with control (placebo or standard starvation). We conducted a
random-effect meta-analysis of clinical and biochemical parameters.
 Result(s): Nine studies (N = 9) were included with a total of 507
patients. OCH significantly decreased aortic clamping duration (n = 151,
standardized mean difference (SMD) = -0.28, 95% confidence interval (CI) =
-0.521 to -0.038, p = 0.023 and differences in means (DM) = -6.388, 95%CI
= -11.246 to -1.529, p = 0.010). Patients from treatment groups had
shorter intensive care unit (ICU) stay (n = 202, SMD = -0.542, 95%CI =
-0.789 to -0.295, p < 0.001 and DM = -25.925, 95%CI = -44.568 to -7.283, p
= 0.006) and required fewer units of insulin postoperatively (n = 85, SMD
= -0.349, 95%CI = -0.653 to -0.044, p = 0.025 and DM = -4.523, 95%CI =
-8.417 to -0.630, p = 0.023). The necessity to use inotropic drugs was
significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI =
0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a
significant effect. Conclusion(s): Preoperative OCH in patients
undergoing cardiac surgery demonstrated a 20% reduction in the use of
inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease
in aortic clamping duration and a 35% decrease of postoperative insulin
requirement. Copyright © 2020 by the authors. Licensee MDPI,
Basel, Switzerland.

<131>
Accession Number
2005197566
Title
The prospects of secondary moderate mitral regurgitation after aortic
valve replacement -meta-analysis.
Source
International Journal of Environmental Research and Public Health. 17 (19)
(pp 1-14), 2020. Article Number: 7335. Date of Publication: 01 Oct 2020.
Author
Bilbija I.; Matkovic M.; Cubrilo M.; Aleksic N.; Lazovic J.M.; Cumic J.;
Tutus V.; Jovanovic M.; Putnik S.
Institution
(Bilbija, Matkovic, Cubrilo, Aleksic, Putnik) Department for Cardiac
Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
(Bilbija, Matkovic, Aleksic, Putnik) Department of Surgery with
Anesthesiology, Faculty of Medicine, University of Belgrade, Belgrade
11000, Serbia
(Lazovic) Department for Biostatistics, Faculty of Medicine, University of
Belgrade, Belgrade 11000, Serbia
(Cumic, Tutus) Department for Anesthesiology and Intensive Care, Clinical
Center of Serbia, Belgrade 11000, Serbia
(Jovanovic) Institute for Cardiovascular Diseases Dedinje, Belgrade 11000,
Serbia
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
Aortic valve replacement for aortic stenosis represents one of the most
frequent surgical procedures on heart valves. These patients often have
concomitant mitral regurgitation. To reveal whether the moderate mitral
regurgitation will improve after aortic valve replacement alone, we
performed a systematic review and meta-analysis. We identified 27 studies
with 4452 patients that underwent aortic valve replacement for aortic
stenosis and had co-existent mitral regurgitation. Primary end point was
the impact of aortic valve replacement on the concomitant mitral
regurgitation. Secondary end points were the analysis of the left
ventricle reverse remodeling and long-term survival. Our results showed
that there was significant improvement in mitral regurgitation
postoperatively (RR, 1.65; 95% CI 1.36-2.00; p < 0.00001) with the average
decrease of 0.46 (WMD; 95% CI 0.35-0.57; p < 0.00001). The effect is more
pronounced in the elderly population. Perioperative mortality was higher
(p < 0.0001) and long-term survival significantly worse (p < 0.00001) in
patients that had moderate/severe mitral regurgitation preoperatively. We
conclude that after aortic valve replacement alone there are fair chances
but for only slight improvement in concomitant mitral regurgitation. The
secondary moderate mitral regurgitation should be addressed at the time of
aortic valve replacement. A more conservative approach should be followed
for elderly and high-risk patients. Copyright © 2020, MDPI AG.
All rights reserved.

<132>
[Use Link to view the full text]
Accession Number
632665532
Title
General Versus Local Anesthesia With Conscious Sedation in Transcatheter
Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial.
Source
Circulation. 142 (15) (pp 1437-1447), 2020. Date of Publication: 13 Oct
2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Lurz P.;
Eitel I.; Marquetand C.; Nef H.; Doerr O.; Vigelius-Rauch U.; Lauten A.;
Landmesser U.; Treskatsch S.; Abdel-Wahab M.; Sandri M.; Holzhey D.;
Borger M.; Ender J.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.; Fach
A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.; Funkat
A.-K.; Desch S.; Berggreen A.E.; Heringlake M.; de Waha-Thiele S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri,
Holzhey, Borger, Ender, Desch) Heart Center Leipzig at University of
Leipzig, Germany (H.T., H.-J.F., P.L., M.S., M.B.
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Holzhey,
Borger, Ender, Ruckert, Funkat, Desch) Leipzig Heart Institute, Germany
(H.T., H.-J.F., P.L., M.S., M.B., Y.R.
(Kurz, Eitel, Marquetand, Meyer-Saraei, Berggreen, Heringlake, de
Waha-Thiele) University Clinic Schleswig-Holstein and University Heart
Center Lubeck, Germany (T.K., I.E., C.M., R.M.-S., M.H.
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Frey, Konig,
Desch, de Waha-Thiele) German Center for Cardiovascular Research (DZHK),
Germany (T.K., I.E., C.M., U.L., R.M.-S., S.D., A.L
(Nef, Doerr, Vigelius-Rauch) Germany (H.N., Giesen, O.D
(Lauten, Landmesser, Treskatsch) Universitatsklinikum Charite, Campus
Benjamin Franklin, Germany (A.L., U.L., Berlin, Germany
(Ince, Oner) Universitatsklinikum Rostock, Germany (H.I.
(Hambrecht, Fach, Augenstein) Klinikum Links der Weser, Germany (R.H.,
A.F., Bremen, Germany
(Frey) University Clinic Schleswig-Holstein, Germany (N.F.), Kiel, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
University of Lubeck, Germany (I.R.K.
Publisher
NLM (Medline)
Abstract
BACKGROUND: In clinical practice, local anesthesia with conscious sedation
(CS) is performed in roughly 50% of patients undergoing transcatheter
aortic valve replacement. However, no randomized data assessing the safety
and efficacy of CS versus general anesthesia (GA) are available.
 METHOD(S): The SOLVE-TAVI (Comparison of Second-Generation
Self-Expandable Versus Balloon-Expandable Valves and General Versus Local
Anesthesia in Transcatheter Aortic Valve Implantation) trial is a
multicenter, open-label, 2x2 factorial, randomized trial of 447 patients
with aortic stenosis undergoing transfemoral transcatheter aortic valve
replacement comparing CS versus GA. The primary efficacy end point was
powered for equivalence (equivalence margin 10% with significance level
0.05) and consisted of the composite of all-cause mortality, stroke,
myocardial infarction, infection requiring antibiotic treatment, and acute
kidney injury at 30 days. RESULT(S): The primary composite end point
occurred in 27.2% of CS and 26.4% of GA patients (rate difference, 0.8
[90% CI, -6.2 to 7.8]; Pequivalence=0.015). Event rates for the individual
components were as follows: all-cause mortality, 3.2% versus 2.3% (rate
difference, 1.0 [90% CI, -2.9 to 4.8]; Pequivalence<0.001); stroke, 2.4%
versus 2.8% (rate difference, -0.4 [90% CI, -3.8 to 3.8];
Pequivalence<0.001); myocardial infarction, 0.5% versus 0.0% (rate
difference, 0.5 [90% CI, -3.0 to 3.9]; Pequivalence<0.001), infection
requiring antibiotics 21.1% versus 22.0% (rate difference, -0.9 [90% CI,
-7.5 to 5.7]; Pequivalence=0.011); acute kidney injury, 9.0% versus 9.2%
(rate difference, -0.2 [90% CI, -5.2 to 4.8]; Pequivalence=0.0005). There
was a lower need for inotropes or vasopressors with CS (62.8%) versus GA
(97.3%; rate difference, -34.4 [90% CI, -41.0 to -27.8]).
 CONCLUSION(S): Among patients with aortic stenosis undergoing
transfemoral transcatheter aortic valve replacement, use of CS compared
with GA resulted in similar outcomes for the primary efficacy end point.
These findings suggest that CS can be safely applied for transcatheter
aortic valve replacement. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT02737150.

<133>
Accession Number
632528602
Title
Intracoronary ALLogeneic heart STem cells to Achieve myocardial
Regeneration (ALLSTAR): a randomized, placebo-controlled, double-blinded
trial.
Source
European heart journal. 41 (36) (pp 3451-3458), 2020. Date of Publication:
21 Sep 2020.
Author
Makkar R.R.; Kereiakes D.J.; Aguirre F.; Kowalchuk G.; Chakravarty T.;
Malliaras K.; Francis G.S.; Povsic T.J.; Schatz R.; Traverse J.H.; Pogoda
J.M.; Smith R.R.; Marban L.; Ascheim D.D.; Ostovaneh M.R.; Lima J.A.C.;
DeMaria A.; Marban E.; Henry T.D.
Institution
(Makkar, Chakravarty, Marban, Henry) Smidt Heart Institute, Cedars-Sinai
Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
(Kereiakes) The Christ Hospital, Cincinnati, 2139 Auburn Ave, Cincinnati,
OH 45219, USA
(Aguirre) Prairie/St. Johns Hospital, 800 E Carpenter St, Springfield,
United States
(Kowalchuk) Sanger Heart & Vascular, 1001 Blythe Blvd Ste 300, Charlotte,
United States
(Malliaras) University of Athens, 17 Agiou Thoma street, Athens 11527,
Greece
(Francis) University of Minnesota Heart Care, Minneapolis, 6405 France Ave
S, Edina, MN 55435, USA
(Povsic) Duke University Hospital, 2301 Erwin Rd, Durham, United States
(Schatz) Scripps Green Hospital, 10666 N Torrey Pines Rd ,La Jolla, CA
92037, United States
(Traverse) Minneapolis Heart Institute Foundation, 920 E 28th St Ste 100,
Minneapolis, United States
(Pogoda, Smith, Marban, Ascheim) 10Capricor Therapeutics, Los Angeles,
8840 Wilshire Blvd Ste 2, Beverly Hills, CA 90211, USA
(Ostovaneh, Lima) ohns Hopkins University, 3400 N Charles St, Baltimore MD
21218, United States
(DeMaria) University of California San Diego Medical Center, 200 W. Arbor
Drive, San Diego, CA 92103, USA
Publisher
NLM (Medline)
Abstract
AIMS: Cardiosphere-derived cells (CDCs) are cardiac progenitor cells that
exhibit disease-modifying bioactivity in various models of cardiomyopathy
and in previous clinical studies of acute myocardial infarction (MI),
dilated cardiomyopathy, and Duchenne muscular dystrophy. The aim of the
study was to assess the safety and efficacy of intracoronary
administration of allogeneic CDCs in the multicentre, randomized,
double-blinded, placebo-controlled, intracoronary ALLogeneic heart STem
cells to Achieve myocardial Regeneration (ALLSTAR) trial. METHODS AND
RESULTS: We enrolled patients 4weeks to 12months after MI, with left
ventricular ejection fraction (LVEF) <=45% and LV scar size >=15% of LV
mass by magnetic resonance imaging (MRI). A pre-specified interim analysis
was performed when 6-month MRI data were available. The trial was
subsequently stopped due to the low probability of detecting a significant
treatment effect of CDCs based on the primary endpoint. Patients were
randomly allocated in a 2:1 ratio to receive CDCs or placebo in the
infarct-related artery by stop-flow technique. The primary safety endpoint
was the occurrence, during 1-month post-intracoronary infusion, of acute
myocarditis attributable to allogeneic CDCs, ventricular tachycardia- or
ventricular fibrillation-related death, sudden unexpected death, or a
major adverse cardiac event (death or hospitalization for heart failure or
non-fatal MI or need for left ventricular assist device or heart
transplant). The primary efficacy endpoint was the relative percentage
change in infarct size at 12months post-infusion as assessed by
contrast-enhanced cardiac MRI. We randomly allocated 142 eligible patients
of whom 134 were treated (90 to the CDC group and 44 to the placebo
group). The mean baseline LVEF was 40% and the mean scar size was 22% of
LV mass. No primary safety endpoint events occurred. There was no
difference in the percentage change from baseline in scar size (P=0.51)
between CDCs and placebo groups at 6months. Compared with placebo, there
were significant reductions in LV end-diastolic volume (P=0.02), LV
end-systolic volume (P=0.02), and N-terminal pro b-type natriuretic
peptide (NT-proBNP) (P=0.02) at 6months in CDC-treated patients.
 CONCLUSION(S): Intracoronary infusion of allogeneic CDCs in patients
with post-MI LV dysfunction was safe but did not reduce scar size relative
to placebo at 6months. Nevertheless, the reductions in LV volumes and
NT-proBNP reveal disease-modifying bioactivity of CDCs. TRIAL
REGISTRATION: Clinicaltrials.gov identifier: NCT01458405. Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. © The Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<134>
Accession Number
631241374
Title
Effect of volatile anesthetics on mortality and clinical outcomes in
patients undergoing coronary artery bypass grafting: a meta-analysis of
randomized clinical trials.
Source
Minerva anestesiologica. 86 (10) (pp 1065-1078), 2020. Date of
Publication: 01 Oct 2020.
Author
Zhang Y.-N.; Yang L.; Zhang W.-S.; Liu J.
Institution
(Zhang, Yang, Zhang) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu, China
(Zhang, Zhang, Liu) Laboratory of Anesthesia and Critical Care Medicine,
Translational Neuroscience Center, West China Hospital, Sichuan
University, Chengdu, China
(Zhang) Department of Anesthesiology, Affiliated Hospital of Zunyi Medical
University, Zunyi, China
(Liu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: It remains unclear whether intraoperative use of volatile
anesthetics has a positive effect on postoperative clinical outcomes in
patients undergoing coronary artery bypass grafting (CABG). Therefore, we
aimed to systematically analyze the long- and short-term mortality rates
and the clinical outcomes of volatile anesthesia compared to those of
total intravenous anesthesia (TIVA) in patients undergoing CABG. EVIDENCE
ACQUISITION: We queried the MEDLINE, Embase, and CENTRAL databases from
inception to October 2019 for relevant randomized clinical trials (RCTs)
on the intraoperative use of volatile anesthetics in patients undergoing
CABG. EVIDENCE SYNTHESIS: We pooled and analyzed 36 eligible RCTs with
10,308 patients and found that there was no significant difference in the
long- and short-term mortality rate between the use of volatile anesthesia
and TIVA during CABG. 30-day mortality, volatile group (39/2,824, 1.4%)
vs. TIVA group (35/2,786, 1.3%), RR=1.11, 95% CI [0.70, 1.74], P value for
effect =0.66, I2=0%, moderate-certainty evidence; One-year
mortality, volatile group (77/2,749, 2.8%) vs. TIVA group (78/2,731,
2.9%), RR=0.98, 95% CI [0.72, 1.34], P value for effect =0.90,
I2=0%, moderate-certainty evidence. Mechanical ventilation time
was reduced in volatile group (MD -0.65, 95% CI [-1.07, -0.24], P value
for effect =0.002, I2=26%). CONCLUSION(S): There is no
difference in the long- and short-term mortality and clinical outcomes
between intraoperative use of volatile anesthetics and TIVA during CABG.
However, volatile anesthetics may shorten the mechanical ventilation time.
There is a need for high-quality multicenter RCTs that specifically assess
factors that influence mortality and clinical outcomes.

<135>
Accession Number
2005530625
Title
Meta-analysis of two different surgical treatments of ischaemic mitral
regurgitation with the same outcome: mitral valve repair vs mitral valve
replacement.
Source
Acta Cardiologica. 71 (5) (pp 573-580), 2016. Date of Publication: 01 Oct
2016.
Author
Zhang H.; Liu Y.; Bin J.; Qiu S.; Chen F.
Institution
(Zhang, Liu) Department of Medical Ultrasound, Second Affiliated Hospital
of Guangzhou Medical University, Guangzhou, Guangdong, China
(Bin) Southern Medical University, Guangzhou, Guangdong, China
(Qiu, Chen) Department of Cardiology, Nanfang Hospital of Southern Medical
University, Guangzhou, Guangdong, China
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background Mitral valve replacement (MVR) and mitral valve repair (MVP)
are the most common clinical treatment for ischaemic mitral insufficiency
(IMR). But controversy exists on the optimal surgical strategy for IMR.
Methods A literature search was performed in OvidSP, PubMed and Cochrane
Library to find articles comparing MVP versus MVR for the treatment of
IMR. A meta-analysis was performed for the differences in short- and
long-term survival. Secondary outcomes analysed the postoperative left
ventricular diastolic diameter (LVDD), left ventricular ejection fraction
(LVEF) and the New York Heart Association (NYHA) class. Results Out of the
584 studies, we only included 12 articles. A total of 2953 patients were
enrolled, including 1731 patients in the MVP group and 1222 patients in
the MVR group. The total number of bioprosthesis valves was 1.2 times
(631/535) the number of mechanical valves. After surgery, LVDD and LVEF
had improved and the proportion of NYHA III-IV class declined, but the
differences between the two groups were not significant (P >0.05).
Shortterm survival in the MVP group was higher than that in the MVR group
(odds ratio [OR], 0.44; 95% confidence interval [CI] 0.32-0.60; P<
0.00001). Long-term survival was similar in both two groups (hazard ratio
[HR], 0.86; 95% CI 0.68-1.10, P= 0.24). Conclusion Both MVP and MVR can
play a role in reducing IMR and improving left ventricular function. The
short-term survival of MVP is better than MVR but long-term survival is
similar. Further exploration is needed to install optimal treatment of IMR
and individualized therapy. Copyright © 2016, © 2016 Taylor
and Francis Group LLC.

<136>
Accession Number
633161112
Title
The interactive effect of preoperative consultation and operating room
admission by a counselor on anxiety level and vital signs in patients
undergoing Coronary Artery Bypass Grafting surgery. A clinical trial
study.
Source
Investigacion y educacion en enfermeria. 38 (2) (no pagination), 2020.
Date of Publication: 01 Jul 2020.
Author
Shirdel Z.; Behzad I.; Manafi B.; Saheb M.
Institution
(Shirdel, Behzad, Manafi, Saheb) Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The purpose of this study was to provide appropriate
preoperative supportive conditions to improve anxiety and vital signs for
patients undergoing Coronary Artery Bypass Grafting -CABG- surgery.
 METHOD(S): This clinical trial study was performed on 90 patients
undergoing CABG surgery in Farshchian Hospital of Hamadan, Iran in 2019.
Sample was selected by convenience and were randomly divided into three
groups: control (n=30), intervention1 (n=30), and intervention2 (n=30).
The control group received only the routine preoperative counseling of
ward and admitted to the operating room as usual; the intervention1 and
intervention2 groups in addition received another two counseling sessions,
then the intervention1 group was admitted in the operating room as usual,
but the intervention2 group was admitted by the counselor in the operating
room. Data were collected using a three-part questionnaire including
demographic characteristics, vital signs chart, and the Spielberger's
State-Trait Anxiety Inventory. RESULT(S): The results showed that
there was a significant difference in the mean anxiety of the three groups
after admission in the operating room (intervention2 was lower than
intervention1 and control groups, p<0.001; and intervention 1 group was
lower than control group, p<0.001) and also there was a significant
difference between the mean systolic blood pressure, heart rate and
respiratory rate of the three groups (p <0.001) but the mean of the
variables of temperature and diastolic blood pressure in the three groups
were not significantly different (p=0.59 and p=0.225, respectively).
 CONCLUSION(S): Our results revealed preoperative consultation and
admission in the operating room by the consultant can reduce the level of
anxiety and stability of vital signs of patients undergoing
CABG. Copyright by the Universidad de Antioquia.

<137>
Accession Number
633159585
Title
Prophylactic corticosteroids for paediatric heart surgery with
cardiopulmonary bypass.
Source
The Cochrane database of systematic reviews. 10 (pp CD013101), 2020. Date
of Publication: 12 Oct 2020.
Author
Gibbison B.; Villalobos Lizardi J.C.; Aviles Martinez K.I.; Fudulu D.P.;
Medina Andrade M.A.; Perez-Gaxiola G.; Schadenberg A.W.; Stoica S.C.;
Lightman S.L.; Angelini G.D.; Reeves B.C.
Institution
(Gibbison) Department of Cardiac Anaesthesia and Intensive Care, Bristol
Heart Institute/University Hospitals Bristol NHS FT, Bristol, United
Kingdom
(Villalobos Lizardi, Aviles Martinez) Emergency Pediatric Department,
Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico
(Fudulu, Angelini) Department of Cardiac Surgery, University Hospital
Bristol NHS Trust, Bristol, United Kingdom
(Medina Andrade) Thoracic and Cardiovascular Department, Hospital Civil
Fray Antonio Alcalde de Guadalajara, Guadalajara, Mexico
(Perez-Gaxiola) Evidence-Based Medicine Department, Hospital Pediatrico de
Sinaloa, Culiacan, Mexico
(Schadenberg) Department of Paediatric Intensive Care, University Hospital
Bristol NHS Trust, Bristol, United Kingdom
(Stoica) Department of Paediatric Cardiac Surgery, University Hospital
Bristol NHS Trust, Bristol, United Kingdom
(Lightman) Henry Wellcome Laboratories for Integrative Metabolism and
Neuroscience, University of Bristol, Bristol, United Kingdom
(Reeves) School of Clinical Sciences, University of Bristol, Bristol,
United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Corticosteroids are routinely given to children undergoing
cardiac surgery with cardiopulmonary bypass (CPB) in an attempt to
ameliorate the inflammatory response. Their use is still controversial and
the decision to administer the intervention can vary by centre and/or by
individual doctors within that centre. OBJECTIVE(S): This review is
designed to assess the benefits and harms of prophylactic corticosteroids
in children between birth and 18 years of age undergoing cardiac surgery
with CPB. SEARCH METHOD(S): We searched CENTRAL, MEDLINE, Embase and
Conference Proceedings Citation Index-Science in June 2020. We also
searched four clinical trials registers and conducted backward and forward
citation searching of relevant articles. SELECTION CRITERIA: We included
studies of prophylactic administration of corticosteroids, including
single and multiple doses, and all types of corticosteroids administered
via any route and at any time-point in the perioperative period. We
excluded studies if steroids were administered therapeutically. We
included individually randomised controlled trials (RCTs), with two or
more groups (e.g. multi-drug or dose comparisons with a control group) but
not 'head-to-head' trials without a placebo or a group that did not
receive corticosteroids. We included studies in children, from birth up to
18 years of age, including preterm infants, undergoing cardiac surgery
with the use of CPB. We also excluded studies in patients undergoing heart
or lung transplantation, or both; studies in patients already receiving
corticosteroids; in patients with abnormalities of the
hypothalamic-pituitary-adrenal axis; and in patients given steroids at the
time of cardiac surgery for indications other than cardiac surgery. DATA
COLLECTION AND ANALYSIS: We used the Covidence systematic review manager
to extract and manage data for the review. Two review authors
independently assessed studies for inclusion, extracted data, and assessed
risks of bias. We resolved disagreements by consensus or by consultation
with a third review author. We assessed the certainty of evidence with
GRADE. MAIN RESULTS: We found 3748 studies, of which 888 were duplicate
records. Two studies had the same clinical trial registration number, but
reported different populations and interventions. We therefore included
them as separate studies. We screened titles and abstracts of 2868 records
and reviewed full text reports for 84 studies to determine eligibility. We
extracted data for 13 studies. Pooled analyses are based on eight studies.
We reported the remaining five studies narratively due to zero events for
both intervention and placebo in the outcomes of interest. Therefore, the
final meta-analysis included eight studies with a combined population of
478 participants. There was a low or unclear risk of bias across the
domains. There was moderate certainty of evidence that corticosteroids do
not change the risk of in-hospital mortality (five RCTs; 313 participants;
risk ratio (RR) 0.83, 95% confidence interval (CI) 0.33 to 2.07) for
children undergoing cardiac surgery with CPB. There was high certainty of
evidence that corticosteroids reduce the duration of mechanical
ventilation (six RCTs; 421 participants; mean difference (MD) 11.37 hours
lower, 95% CI -20.29 to -2.45) after the surgery. There was high-certainty
evidence that the intervention probably made little to no difference to
the length of postoperative intensive care unit (ICU) stay (six RCTs; 421
participants; MD 0.28 days lower, 95% CI -0.79 to 0.24) and
moderate-certainty evidence that the intervention probably made little to
no difference to the length of the postoperative hospital stay (one RCT;
176 participants; mean length of stay 22 days; MD -0.70 days, 95% CI -2.62
to 1.22). There was moderate certainty of evidence for no effect of the
intervention on all-cause mortality at the longest follow-up (five RCTs;
313 participants; RR 0.83, 95% CI 0.33 to 2.07) or cardiovascular
mortality at the longest follow-up (three RCTs; 109 participants; RR 0.40,
95% CI 0.07 to 2.46). There was low certainty of evidence that
corticosteroids probably make little to no difference to children
separating from CPB (one RCT; 40 participants; RR 0.20, 95% CI 0.01 to
3.92). We were unable to report information regarding adverse events of
the intervention due to the heterogeneity of reporting of outcomes. We
downgraded the certainty of evidence for several reasons, including
imprecision due to small sample sizes, a single study providing data for
an individual outcome, the inclusion of both appreciable benefit and harm
in the confidence interval, and publication bias. AUTHORS'
 CONCLUSION(S): Corticosteroids probably do not change the risk of
mortality for children having heart surgery using CPB at any time point.
They probably reduce the duration of postoperative ventilation in this
context, but have little or no effect on the total length of postoperative
ICU stay or total postoperative hospital stay. There was inconsistency in
the adverse event outcomes reported which, consequently, could not be
pooled. It is therefore impossible to provide any implications and
policy-makers will be unable to make any recommendations for practice
without evidence about adverse effects. The review highlighted the need
for well-conducted RCTs powered for clinical outcomes to confirm or refute
the effect of corticosteroids versus placebo in children having cardiac
surgery with CPB. A core outcome set for adverse event reporting in the
paediatric major surgery and intensive care setting is
required. Copyright © 2020 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<138>
Accession Number
2008363299
Title
Systematic review and consensus definitions for the Standardized Endpoints
in Perioperative Medicine (StEP) initiative: cardiovascular outcomes.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Beattie W.S.; Lalu M.; Bocock M.; Feng S.; Wijeysundera D.N.; Nagele P.;
Fleisher L.A.; Kurz A.; Biccard B.; Leslie K.; Howell S.; Grocott H.; Lamy
A.; Richards T.; Myles P.; Gan T.J.; Peyton P.; Sessler D.; Tramer M.;
Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti M.; Boney
O.; Haller G.; Grocott M.; Cook T.; Fleisher L.; Neuman M.; Story D.;
Gruen R.; Bampoe S.; Evered L.; Scott D.; Silbert B.; van Dijk D.; Kalkman
C.; Chan M.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Beattie S.;
Wijeysundera D.; Landoni G.; Bartlett R.J.; McMonnies R.; Gerstl J.; Jay
M.; Kishlyansky D.; Machina M.; Bobcock M.; Pearse R.; Mythen M.; Canet
J.; Moller A.; Gin T.; Schultz M.; Pelosi P.; Gabreu M.; Futier E.;
Creagh-Brown B.; Abbott T.; Klein A.; Corcoran T.; Cooper D.J.; Dieleman
S.; Diouf E.; McIlroy D.; Bellomo R.; Shaw A.; Prowle J.; Karkouti K.;
Billings J.; Mazer D.; Jayarajah M.; Murphy M.; Bartoszko J.; Sneyd R.;
Morris S.; George R.; Moonesinghe R.; Shulman M.; Lane-Fall M.; Nilsson
U.; Stevenson N.; Cooper J.D.; van Klei W.; Cabrini L.; Miller T.; Pace
N.; Jackson S.; Buggy D.; Short T.; Riedel B.; Gottumukkala V.; Alkhaffaf
B.; Johnson M.
Institution
(Beattie) Cardiovascular Anesthesia, University Health Network, University
of Toronto, Toronto, ON, Canada
(Lalu, Bocock, Feng) Department of Anesthesia, University of Ottawa,
Ottawa, ON, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute, St Michaels Hospital,
University of Toronto, Toronto, ON, Canada
(Nagele) Department of Anesthesia and Critical Care, University of
Chicago, Chicago, IL, United States
(Fleisher) Department of Anesthesiology and Critical Care, University of
Pennsylvania Health System, Philadelphia, PA, United States
(Kurz) Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
(Biccard) Department of Anesthesia and Perioperative Medicine, University
of Cape Town, Cape Town, South Africa
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic., Australia
(Howell) University of Leeds School of Medicine, Leeds, United Kingdom
(Landoni) Center for Intensive Care and Anesthesiology, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Richards) University of Western Australia, Perth, Australia
(Myles) Alfred Health and Monash University Department of Anaesthesia and
Perioperative Medicine, Melbourne, Vic., Australia
Publisher
Elsevier Ltd
Abstract
Background: Adverse cardiovascular events are a leading cause of
perioperative morbidity and mortality. The definitions of perioperative
cardiovascular adverse events are heterogeneous. As part of the
international Standardized Endpoints in Perioperative Medicine initiative,
this study aimed to find consensus amongst clinical trialists on a set of
standardised and valid cardiovascular outcomes for use in future
perioperative clinical trials. Method(s): We identified currently
used perioperative cardiovascular outcomes by a systematic review of the
anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase,
and Cochrane Library). We performed a three-stage Delphi consensus-gaining
process that involved 55 clinician researchers worldwide. Cardiovascular
outcomes were first shortlisted and the most suitable definitions
determined. These cardiovascular outcomes were then assessed for validity,
reliability, feasibility, and clarity. Result(s): We identified 18
cardiovascular outcomes. Participation in the three Delphi rounds was 100%
(n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine
cardiovascular outcomes was elicited from the consensus: myocardial
infarction, myocardial injury, cardiovascular death, non-fatal cardiac
arrest, coronary revascularisation, major adverse cardiac events,
pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These
nine cardiovascular outcomes were rated by the majority of experts as
valid, reliable, feasible, and clearly defined. Conclusion(s): These
nine consensus cardiovascular outcomes can be confidently used as
endpoints in clinical trials designed to evaluate perioperative
interventions with the goal of improving perioperative
outcomes. Copyright © 2020 British Journal of Anaesthesia

<139>
Accession Number
2008354259
Title
Skeletonized or Pedicled Harvesting of Left Internal Mammary Artery: A
Systematic Review and Meta-analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Kusu-Orkar T.-E.; Kermali M.; Masharani K.; Noshirwani A.; MacCarthy-Ofosu
B.; Oguamanam N.; Bin Saeid J.; Muir A.D.; Harky A.
Institution
(Kusu-Orkar) Department of Surgery, Pilgrim Hospital, Boston, United
Kingdom
(Kermali) Faculty of Medicine, St. George's, University of London, London,
United Kingdom
(Masharani, Noshirwani, MacCarthy-Ofosu, Bin Saeid, Muir, Harky)
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Oguamanam) Department of Cardiothoracic Surgery, Barts Heart Centre, St.
Bartholomew's Hospital, London, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
W.B. Saunders
Abstract
We sought to compare clinical outcomes in skeletonized versus pedicled
left internal mammary artery (LIMA) grafts in elective coronary artery
bypass grafting through a systematic review and meta-analysis. A
comprehensive electronic literature search of PubMed, Ovid, Embase, and
Scopus was conducted from inception to January 2020. Only short-term (30
days) studies which compared both techniques have been included in our
analysis. Primary outcomes were post anastomosis flow rate and sternal
wound infection rate (SWI); secondary outcomes were conduit length, acute
myocardial infarction and 30-day mortality. Thirteen articles with a total
of 6222 patients met the inclusion criteria. Except for the prevalence of
diabetes mellitus being significantly lower in the skeletonized cohort
(odds ratio [OR] 0.77 95% confidence interval [CI] [0.61, 0.97], P =
0.03), there were no differences in the preoperative demographics between
the 2 groups. The skeletonized LIMA conduit was significantly longer when
compared to the pedicled conduit (weighted mean difference -2.64 cm 95% CI
[-3.71, -1.56], P < 0.0001). SWI rates were not significantly different in
the skeletonized versus pedicled LIMA group (OR 0.71 95% CI [0.47, 1.06],
P = 0.10). New onset of acute myocardial infarction and 30-day mortality
rate was similar in the 2 groups (OR 1.04 and 0.97, respectively, P > 0.05
in both). The postanastomoses flow rate was higher in skeletonized LIMA
(Weighted Mean Difference -11.51 mL/min 95% CI [-20.54, -2.49], P < 0.01).
Harvesting the LIMA using the skeletonized technique is associated with
higher postanastomosis flow rates and longer conduit lengths; with no
difference in SWI and mortality rates when compared to the pedicled
technique. We suggest that this technique should be adopted, particularly
for BITA harvesting. However, further research is needed to provide
clearer indications for both methods. Copyright © 2020 Elsevier
Inc.

<140>
Accession Number
633159702
Title
Deep Sedation versus General Anaesthesia for Transcatheter Mitral Valve
Repair: An Individual-Patient Data Meta-analysis of Observational Studies.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2020. Date of Publication: 13 Oct 2020.
Author
Jobs A.; Grund S.; de Waha-Thiele S.; Ledwoch J.; Sievert H.; Rassaf T.;
Luedike P.; Kelm M.; Hellhammer K.; Horn P.; Westenfeld R.; Patzelt J.;
Langer H.F.; Lurz P.; Desch S.; Eitel I.; Thiele H.
Institution
(Jobs) Heart Center Leipzig at University of Leipzig, Department of
Internal Medicine/Cardiology, Leipzig Heart Institute, Leipzig, Germany
Publisher
NLM (Medline)
Abstract
AIMS: To compare general anaesthesia (GA) and deep sedation (DS) with
regard to safety and length of intensive care unit (ICU) stay in patients
undergoing percutaneous edge-to-edge mitral valve repair (PMVR). METHODS
AND RESULTS: Four studies comparing GA and DS in patients undergoing PMVR
were included in an individual patient data meta-analysis. Data were
pooled after multiple imputation. The composite safety endpoint of
all-cause death, stroke, pneumonia, or major to life-threatening bleeding
occurred in 87 of 626 (13.9%) patients with no difference between patients
treated with DS as compared to GA (56 and 31 events in 420 and 206
patients, respectively). In this regard, the odds ratio was 1.27 (95%
confidence interval, 0.78 to 2.09; p = 0.338) and 1.26 (95% confidence
interval, 0.49 to 3.22; p = 0.496) following the one-stage and two-stage
approach, respectively. Length of ICU stay was longer after GA as compared
to DS (ratio of days 3.08, 95% confidence interval, 2.18 to 4.36, p <
0.001 and 2.88, 95% confidence interval, 1.45 to 5.73, p = 0.016 following
the one-stage and two-stage approach, respectively). CONCLUSION(S):
Both, DS and GA might offer a similar safety profile. However, ICU stay
seems to be shorter after DS.

<141>
Accession Number
2006069930
Title
Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac
Surgery: A Sequential Matched Case-Controlled Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (11) (pp 2940-2947),
2020. Date of Publication: November 2020.
Author
Osawa E.A.; Cutuli S.L.; Cioccari L.; Bitker L.; Peck L.; Young H.;
Hessels L.; Yanase F.; Fukushima J.T.; Hajjar L.A.; Seevanayagam S.;
Matalanis G.; Eastwood G.M.; Bellomo R.
Institution
(Osawa, Bitker, Peck, Young, Hessels, Yanase, Eastwood, Bellomo)
Department of Intensive Care, Austin Hospital, Melbourne, Australia
(Cutuli) Department of Anesthesiology and Intensive Care, Fondazione
Policlinico Universitario A. Gemelli, Universita Cattolica del Sacro
Cuore, Rome, Italy
(Cioccari) Department of Intensive Care Medicine, University Hospital,
University of Bern, Bern, Switzerland
(Yanase) Australian and New Zealand Intensive Care Research Centre, Monash
University, School of Public Health and Preventive Medicine, Melbourne,
Australia
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center, Groningen, Netherlands
(Osawa, Fukushima, Hajjar) Department of Cardiology, Heart Institute
(InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de
Sao Paulo, Sao Paulo, Brazil
(Seevanayagam, Matalanis) Department of Cardiac Surgery, Austin Hospital,
Heidelberg, Melbourne, Australia
(Bellomo) Centre for Integrated Critical Care, School of Medicine, The
University of Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to test whether a bolus of magnesium followed
by continuous intravenous infusion might prevent the development of atrial
fibrillation (AF) after cardiac surgery. Design(s): Sequential,
matched, case-controlled pilot study. Setting(s): Tertiary university
hospital. Participant(s): Matched cohort of 99 patients before and
intervention cohort of 99 consecutive patients after the introduction of a
continuous magnesium infusion protocol. Intervention(s): The
magnesium infusion protocol consisted of a 10 mmol loading dose of
magnesium sulphate followed by a continuous infusion of 3 mmol/h over a
maximum duration of 96 hours or until intensive care unit discharge.
 Measurements and Main Results: The study groups were balanced except
for a lower cardiac index in the intervention cohort. The mean duration of
magnesium infusion was 27.93 hours (95% confidence interval [CI]:
24.10-31.76 hours). The intervention group had greater serum peak
magnesium levels: 1.72 mmol/L +/- 0.34 on day 1, 1.32 +/- 0.36 on day 2
versus 1.01 +/- 1.14 and 0.97 +/- 0.13, respectively, in the control group
(p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the
intervention group and 40 patients (40.4%) in the control group (odds
ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox
proportional hazards model, the hazard ratio for the development of AF was
significantly less in the intervention group (hazard ratio 0.45, 95% CI,
0.26-0.77; p = 0.004). Conclusion(s): The magnesium delivery strategy
was associated with a decreased incidence of postoperative AF in cardiac
surgery patients. These findings provide a rationale and preliminary data
for the design of future randomized controlled trials. Copyright
© 2020 Elsevier Inc.

<142>
Accession Number
2005884191
Title
CPAP Effects on Oxygen Delivery in One-Lung Ventilation During Minimally
Invasive Surgical Ablation for Atrial Fibrillation in The Supine Position.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (11) (pp 2931-2936),
2020. Date of Publication: November 2020.
Author
L'Acqua C.; Meli A.; Rondello N.; Polvani G.; Salvi L.
Institution
(L'Acqua, Rondello, Salvi) Department of Anesthesia and Intensive Care,
Centro Cardiologico Monzino IRCCS, Milano, Italy
(Meli) Department of Medical Surgical Pathophysiology and Organ
Transplantation, Universita' Degli Studi Di Milano Statale, Milano, Italy
(Polvani) Department of Cardiac Surgery, Centro Cardiologico Monzino
IRCCS, Milano, Italy
Publisher
W.B. Saunders
Abstract
Objective: In minimally invasive surgical ablation for atrial fibrillation
during video-assisted thoracoscopy surgery, one-lung ventilation (OLV)
with a double- lumen tube is commonly employed. In contrast with the
majority of thoracic procedures, the patient lies supine; thus, the
protective effect of gravity is lost and intrapulmonary shunt remains
high. To decrease intrapulmonary shunt and to increase oxygenation, many
strategies are utilized: high inspiratory fraction of oxygen
(F<inf>I</inf>O<inf>2</inf>), positive end-expiratory pressure on the
ventilated lung, and continuous positive airway pressure (CPAP) on the
deflated lung. Design(s): The authors performed a prospective,
single- center, randomized study to evaluate the effect of additional CPAP
in the nonventilated lung on oxygen delivery during surgical ablation for
atrial fibrillation via video-assisted thoracoscopy in the supine
position. Setting(s): University hospital Centro Cardiologico Monzino
IRCCS, Milano, Italy. Participant(s): Twenty-two patients scheduled
for minimally invasive surgical ablation for atrial fibrillation.
 Intervention(s): The patients underwent pressure-controlled
ventilation, adjusting inspiratory pressure to obtain a tidal volume of 7
mL/kg while keeping F<inf>I</inf>O<inf>2</inf> constantly 1.0, a
respiratory rate to maintain arterial partial pressure of carbon dioxide
(PaCO<inf>2</inf>) between 35 and 40 mmHg, and positive end-expiratory
pressure of 5 cmH<inf>2</inf>O. During OLV, inspiratory pressure was
reduced to obtain a tidal volume of 5 mL/kg, maintaining
F<inf>I</inf>O<inf>2</inf> of 1.0, a respiratory rate to maintain
PaCO<inf>2</inf> between 35 and 40 mmHg with capnothorax of 10
cmH<inf>2</inf>O. The patients were then randomized into the CPAP group
(CPAP 10 cmH<inf>2</inf>0 on deflated lung) and NO CPAP group. Inotropic
agents (dopamine or dobutamine) were used if cardiac index fell below 1.5
L/min/m2. Measurements and Main Results: Twenty-two
patients were enrolled, randomized, and completed the study. Median age
was 62 years. The difference in arterial partial pressure of oxygen
between the 2 groups was shy of significance, p = 0.16. Cardiac index
progressively increased during OLV until the end of the procedure in both
groups (p < 0.01) and was maintained above 1.5 mL/min/m2 during
the whole study time. Arterial oxygen content remained stable during the
entire procedure in both groups (p = 0.27). Oxygen delivery index
(DO<inf>2</inf>I) increased significantly during the procedure (p < 0.01);
nevertheless, the difference in DO<inf>2</inf>I between the CPAP and NO
CPAP group was nonsignificant (p = 0.61). Intrapulmonary shunt
(Q<inf>s</inf>/Q<inf>t</inf>) increased during OLV (p < 0.01 for the time
effect) and remained high until total lung ventilation was reintroduced.
No difference in Q<inf>s</inf>/Q<inf>t</inf> was observed between the CPAP
and NO CPAP groups (p = 0.98). Similarly, mean pulmonary artery pressure
increased significantly during OLV and remained high at the end of the
procedure in both groups (time effect p < 0.01). Conclusion(s):
During OLV for atrial fibrillation surgical ablation in the supine
position, CPAP on the deflated lung seemed to be ineffective to reduce
Q<inf>s</inf>/Q<inf>t</inf> or to increase arterial partial pressure of
oxygen and DO<inf>2</inf>I, provided cardiac output was maintained above
1.5 L/min/m2. Copyright © 2020 Elsevier Inc.

<143>
Accession Number
2005609049
Title
Catheter ablation of atrial tachycardias after mitral valve surgery: A
systematic review and meta-analysis.
Source
Journal of Cardiovascular Electrophysiology. 31 (10) (pp 2632-2641), 2020.
Date of Publication: 01 Oct 2020.
Author
Marazzato J.; Cappabianca G.; Angeli F.; Crippa M.; Golino M.; Ferrarese
S.; Beghi C.; De Ponti R.
Institution
(Marazzato, Cappabianca, Angeli, Crippa, Golino, Ferrarese, Beghi, De
Ponti) Department of Medicine and Surgery, Ospedale di Circolo, University
of Insubria, Varese, Italy
(Angeli) Department of Medicine and Cardiopulmonary Rehabilitation,
Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
Publisher
Blackwell Publishing Inc. (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail:
subscrip@blackwellpub.com)
Abstract
Introduction: Data regarding catheter ablation (CA) of atrial tachycardias
(ATs) occurring after mitral valve surgery (MVS) are scarce. The aim of
this study was to assess the safety and efficacy of CA of ATs in this
surgical population through a systematic review of the literature and
meta-analysis. Method(s): A systematic search on PubMed/MEDLINE,
EMBASE, and Web of Science was performed considering patients undergoing
CA for ATs occurring after MVS. Periprocedural thromboembolic and
hemorrhagic complications were assessed. The acute success and maintenance
of sinus rhythm (SR) at a mid (<24 months) and long-term follow-up (FU)
after CA were investigated along with the burden of arrhythmic recurrence
at FU. Result(s): Fourteen studies for a total of 227 patients were
considered. Three-dimensional (3D) mapping systems were used in all
studies. Only two major bleedings were recorded with a pooled estimate of
periprocedural major complications of 0%. The acute success after CA was
95% with a clear improvement over time. Although maintenance of SR was 71%
at a midterm FU, long-term efficacy was as low as 47% due to an increased
burden of atrial fibrillation (AF) recurrence despite multiple
procedures/patient. Conclusion(s): In this meta-analysis, CA of
postsurgical ATs after MVS proved safe and effective but with still a
significant burden of AF recurrence at more than 24 months of FU due to a
progressive atrial substrate deterioration. The improvement of procedural
success over time might suggest a learning curve in optimizing the use of
3D mapping systems. Copyright © 2020 Wiley Periodicals LLC

<144>
Accession Number
631696278
Title
Effect of continuous nursing interventions on valve noise-related anxiety
and quality of life in patients who underwent mechanical mitral valve
replacement.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 72), 2020. Date of
Publication: 06 May 2020.
Author
Chen Q.-Y.; Xu N.; Huang S.-T.; Lin Z.-W.; Cao H.; Chen L.-W.; Chen Q.
Institution
(Chen, Xu, Huang, Lin, Cao, Chen) Department of Cardiac Surgery, Fujian
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Xu, Huang, Chen, Chen) Department of Cardiovascular Surgery, Union
Hospital, Fujian Medical University, Fuzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The purpose of this study was to evaluate the effect of
continuous nursing interventions on valve noise-related anxiety in
patients undergoing mechanical mitral valve replacement (MVR) and to
analyze its impact on patient quality of life. METHOD(S): Ninety
patients who underwent mechanical MVR were divided into two groups. All
patients in group A received routine nursing care. In addition to this
intervention, an assigned nurse periodically provided patients in group B
with continuous nursing interventions and ongoing health consultations
during a 1-year follow-up. A hospital anxiety and depression (HAD) scale,
a customized questionnaire and a Short Form Health Status 36 (SF-36) score
questionnaire were used as the research tools. RESULT(S): The
postoperative HAD scores were better in group B than in group A, but the
differences in most of the data were not statistically significant between
the groups, except for HA sections 0-7 and 11-21. Based on the customized
questionnaire, the subjective disturbance level was significantly lower in
group B than in group A (the results of Q1 and Q4 were statistically
significant). With regard to the SF-36 scores, group B was superior to
group A in general health, emotional function and mental health, while the
other dimensions had no significant difference. CONCLUSION(S):
Compared with routine care, patients who received continuous care
intervention after mechanical MVR had fewer anxiety symptoms and better
quality of life.

<145>
Accession Number
632728134
Title
Different classes of videoscopes and direct laryngoscopes for double-lumen
tube intubation in thoracic surgery: A systematic review and network
meta-analysis.
Source
PloS one. 15 (8) (pp e0238060), 2020. Date of Publication: 2020.
Author
Kim Y.S.; Song J.; Lim B.G.; Lee I.O.; Won Y.J.
Institution
(Kim, Song, Lim, Lee, Won) Department of Anesthesiology and Pain Medicine,
Korea University Guro Hospital, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Double-lumen tube is commonly used in thoracic surgeries that
need one-lung ventilation, but its big size and stiff structure make it
harder to perform intubation than a conventional tracheal intubation tube.
 OBJECTIVE(S): To investigate the effectiveness and safety of
videoscopes for double-lumen tube insertion. The primary outcome was the
success rate of first attempt intubation. Secondary outcomes were
intubation time, malposition, oral mucosal damage, sore throat, and
external manipulation. DESIGN: Systematic review and network
meta-analysis. DATA SOURCES: Databases (Pubmed, Embase, Cochrane, Kmbase,
Web of science, Scopus) up to June 23, 2020 were searched. ELIGIBILITY:
Randomized controlled trials comparing different videoscopes for
double-lumen tube intubation were included in this study. METHOD(S):
We classified and lumped the videoscope devices into the following groups:
standard (non-channeled) videolaryngoscope, channeled videolaryngoscope,
videostylet, and direct laryngoscope. After assessing the quality of
evidence, we statistically analyzed and chose the best device based on the
surface under the cumulative ranking curve (SUCRA) by using STATA software
(version 16). RESULT(S): We included 23 studies (2012 patients).
Based on the success rate of the first attempt, a rankogram suggested that
the standard videolaryngoscope (76.4 of SUCRA) was the best choice,
followed by videostylet (65.5), channeled videolaryngoscope (36.1), and
direct laryngoscope (22.1), respectively. However, with regard to reducing
the intubation time, the best choice was videostylet, followed by a direct
laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope,
respectively. Direct laryngoscope showed the lowest incidence of
malposition but required external manipulation the most. Channeled
videolaryngoscope showed the highest incidence of oral mucosal damage, but
showed the lower incidence of sore throat than standard videolaryngoscope
or direct laryngoscope. CONCLUSION(S): Most videoscopes improved the
success rate of double-lumen tube intubation; however, they were
time-consuming (except videostylet) and had a higher malposition rate than
the direct laryngoscope.

<146>
[Use Link to view the full text]
Accession Number
632727030
Title
Effects of Massage on Postoperative Pain in Infants With Complex
Congenital Heart Disease.
Source
Nursing research. 69 (5S Suppl 1) (pp S36-S46), 2020. Date of Publication:
01 Sep 2020.
Author
Harrison T.M.; Brown R.; Duffey T.; Frey C.; Bailey J.; Nist M.D.; Renner
L.; Fitch J.
Institution
(Harrison) Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The
Ohio State University College of Nursing, Columbus. Roger Brown, PhD, is
Professor, University of Wisconsin-Madison School of Nursing. Travis
Duffey, LMT, is Licensed Massage Therapist, Nationwide Children's
Hospital, Columbus, Ohio. Corrie Frey, LMT, CIMI, CPMT, is Licensed
Massage Therapist, Nationwide Children's Hospital, Columbus, Ohio. Jacob
Bailey, BSN, RN, is Staff Nurse, COPC Ohio Center for Pediatrics, Dublin.
Marliese Dion Nist, PhD, RNC, is Postdoctoral Fellow, The Ohio State
University College of Nursing, Columbus, Ohio. Lauren Renner, MSN, RN,
CPNP, is APRN Clinical Leader, Nationwide Children's Hospital, Columbus,
Ohio. Jill Fitch, MD, is Pediatric Intensivist, Nationwide Children's
Hospital, Columbus, OH
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain management is an essential component of care for
pediatric patients following surgery. Massage reduces self-reported
postoperative pain in adults with heart disease but has received little
attention in postoperative pediatric patients with complex congenital
heart disease (CCHD). OBJECTIVE(S): The aim of the study was to
evaluate the effectiveness of massage compared to a rest period on
postoperative pain scores and physiological responses in infants with
CCHD. METHOD(S): We used a two-group randomized clinical trial design
with a sample of 60 infants with CCHD between 1 day and 12 months of age
following their first cardiothoracic surgery. Both groups received
standard postoperative care. Group 1 received a daily 30-minute
restriction of nonessential caregiving (quiet time), and Group 2 received
a daily 30-minute massage. Interventions continued for seven consecutive
days. Pain was measured six times daily using the Face, Legs, Activity,
Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of
analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and
oxygen saturations (SpO2) were recorded continuously. Daily averages, pre-
and postintervention FLACC scores, and physiological responses were
analyzed using descriptive statistics, generalized linear mixed models
repeated measures, latent growth models, and/or regression discontinuity
analysis. Fentanyl-equivalent narcotic values were used as a time-varying
covariate. RESULT(S): Adjusted pain scores were lower for the massage
group on all days except Day 7. Overall, there were no group effects on
level of pain or differential rate of change in pain. However, the massage
group had lower daily pain scores with small to medium effect size
differences, largest at Days 4, 5, and 6, and lower average daily HR and
RR. There was little difference between groups in SpO2. Infants
demonstrated immediate effects of massage, with HR and RR decreasing and
oxygen saturations increasing. DISCUSSION: This study provides beginning
evidence that postoperative massage may reduce pain and improve
physiological parameters in infants with congenital heart disease. This
nonpharmacological adjunct to pain management may provide a particular
benefit for this population by reducing demand on the cardiorespiratory
system.

<147>
Accession Number
632722144
Title
Clinical Implications of Physical Function and Resilience in Patients
Undergoing Transcatheter Aortic Valve Replacement.
Source
Journal of the American Heart Association. 9 (17) (pp e017075), 2020. Date
of Publication: 01 Sep 2020.
Author
Goel K.; O'Leary J.M.; Barker C.M.; Levack M.; Rajagopal V.; Makkar R.R.;
Bajwa T.; Kleiman N.; Linke A.; Kereiakes D.J.; Waksman R.; Allocco D.J.;
Rizik D.G.; Reardon M.J.; Lindman B.R.
Institution
(Goel, O'Leary, Barker, Levack, Lindman) Structural Heart and Valve Center
Vanderbilt University Medical Center Nashville TN
(Goel, O'Leary, Barker, Lindman) Cardiovascular Medicine Division
Vanderbilt University Medical Center Nashville TN
(Levack) Cardiac Surgery Department Vanderbilt University Medical Center
Nashville TN
(Rajagopal) Marcus Heart Valve Center Piedmont Heart Institute Atlanta GA
(Makkar) Cedars - Sinai Heart Institute Los Angeles CA
(Bajwa) Aurora Cardiovascular Services Aurora Sinai/Aurora St. Luke's
Medical Centers Milwaukee WI
(Kleiman, Reardon) Department of Cardiovascular Surgery Houston Methodist
DeBakey Heart and Vascular Center Houston TX
(Linke) Department of Internal Medicine and Cardiology Heart Center
Dresden Technical University of Dresden Germany
(Kereiakes) The Christ Hospital Heart and Vascular Center Lindner Research
Center Cincinnati OH
(Waksman) Section of Interventional Cardiology MedStar Washington Hospital
Center Washington DC
(Allocco) Clinical Sciences Boston Scientific Corp Marlborough MA
(Rizik) HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale
AZ
Publisher
NLM (Medline)
Abstract
Background Gait speed is a reliable measure of physical function and
frailty in patients with aortic stenosis undergoing transcatheter aortic
valve replacement (TAVR). Slow gait speed pre-TAVR predicts worse clinical
outcomes post-TAVR. The consequences of improved versus worsened physical
function post-TAVR are unknown. Methods and Results The REPRISE III
(Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through
Implantation of Lotus Valve System-Randomized Clinical Evaluation) trial
randomized high/extreme risk patients to receive a mechanically-expanded
or self-expanding transcatheter heart valve. Of 874 patients who underwent
TAVR, 576 with complete data at baseline and 1 year were included in this
analysis. Slow gait speed in the 5-m walk test was defined as <0.83 m/s. A
clinically meaningful improvement (>=0.1 m/s) in gait speed 1 year after
TAVR occurred in 39% of patients, 35% exhibited no change, and 26%
declined (>=0.1 m/s). Among groups defined by baseline/1-year post-TAVR
gait speeds, 1- to 2-year mortality or hospitalization rates were as
follows: 6.6% (normal/normal), 8.0% (slow/normal), 20.9% (normal/slow),
and 21.5% (slow/slow). After adjustment, slow gait speed at 1 year
(regardless of baseline speed) was associated with a 3.5-fold increase in
death/hospitalization between 1 and 2 years compared with those with
normal baseline/1-year gait speed. Patients whose slow gait speed
normalized at 1 year had no increased risk. One-year, but not baseline,
gait speed was associated with death or hospitalization between 1 and 2
years (adjusted hazard ratio, 0.83 per 0.1 m/s faster gait; 95% CI,
0.74-0.93, P=0.001). Conclusions Marked heterogeneity exists in the
trajectory of physical function after TAVR and this, more than baseline
function, has clinical consequences. Identifying and optimizing factors
associated with physical resilience after TAVR may improve outcomes.
Registration URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02202434.

<148>
[Use Link to view the full text]
Accession Number
2007636779
Title
Misplacement of transjugular intrahepatic portosystemic shunts: A surgical
challenge for liver transplantation?.
Source
Surgery (United States). (no pagination), 2020. Date of Publication: 2020.
Author
Addeo P.; Schaaf C.; Faitot F.; Terrone A.; Julliard O.; Besch C.; Serfaty
L.; Bachellier P.
Institution
(Addeo, Schaaf, Faitot, Terrone, Julliard, Bachellier)
Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pole des
Pathologies Digestives, Hepatiques et de la Transplantation, Hopital de
Hautepierre-Hopitaux Universitaires de Strasbourg, Universite de
Strasbourg, France
(Besch, Serfaty) Hepatology Department, Pole des Pathologies Digestives,
Hepatiques et de la Transplantation, Hopital de Hautepierre-Hopitaux
Universitaires de Strasbourg, Universite de Strasbourg, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The impact of transjugular intrahepatic portosystemic shunt
misplacement on outcomes of liver transplantation remains controversial.
We systematically reviewed the literature on the outcomes of liver
transplantation with transjugular intrahepatic portosystemic shunt
misplacement. Method(s): This systematic review was conducted
according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. The Cochrane library, PubMed, and Embase were
searched (January 1990-April 2020) for studies reporting patients
undergoing liver transplantation with transjugular intrahepatic
portosystemic shunt misplacement. Result(s): Thirty-six studies
reporting 181 patients who underwent liver transplantation with
transjugular intrahepatic portosystemic shunt misplacement were
identified. Transjugular intrahepatic portosystemic shunt was misplaced
with a variable degree of extension toward the inferior vena cava/right
heart in 63 patients (34%), the spleno/portal/superior mesenteric venous
confluence in 105 patients (58%), and both in 15 patients (8%).
Transjugular intrahepatic portosystemic shunt thrombosis was also present
in 21 cases (12%). The median interval between transjugular intrahepatic
portosystemic shunt placement and liver transplantation ranged from 1 day
to 6 years. Complete transjugular intrahepatic portosystemic shunt removal
was successfully performed in all but 12 (7%) patients in whom part of the
transjugular intrahepatic portosystemic shunt was left in situ. Cardiac
surgery under cardiopulmonary bypass was necessary to remove transjugular
intrahepatic portosystemic shunt from the right heart in 4 patients (2%),
and a venous graft interposition was necessary for a portal anastomosis in
5 patients (3%). Postoperative mortality (90 days) was 1.1% (2 patients),
and portal vein thrombosis developed postoperatively in 4 patients (2%).
 Conclusion(s): Misplaced transjugular intrahepatic portosystemic
shunt removal is possible in most cases during liver transplantation with
extremely low mortality and good postoperative outcomes. Preoperative
surgical strategy and intraoperative tailored surgical technique reduces
the potential consequences of transjugular intrahepatic portosystemic
shunt misplacement. Copyright © 2020 Elsevier Inc.

<149>
Accession Number
2007621416
Title
Postoperative Pain Management and the Incidence of Ipsilateral Shoulder
Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A
Prospective Audit.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Hodge A.; Rapchuk I.L.; Gurunathan U.
Institution
(Hodge) Department of Anaesthesia and Perioperative Medicine, Royal
Brisbane and Women's Hospital, Brisbane, Queensland, Australia
(Hodge, Rapchuk) University of Queensland
(Rapchuk, Gurunathan) Department of Anaesthesia and Perfusion Services,
The Prince Charles Hospital, Brisbane, Queensland, Australia
Publisher
W.B. Saunders
Abstract
Objectives: Ipsilateral shoulder pain (ISP) is a common but variably
occurring (42%-85%) complication after thoracic surgery. Multiple
potential treatments, including upper limb blocks, intrapleural local
anaesthetic infiltration, and systemic opioids, have undergone trials,
with limited efficacy. Phrenic nerve infiltration is a potential
intervention that may prevent ISP. The aim of this study was to assess the
incidence and severity of ISP after thoracic surgery at the authors'
institution, where phrenic nerve infiltration is commonly used.
 Design(s): Observational cohort study. Setting(s): A single-
center study in a tertiary referral center in Brisbane, Australia.
 Participant(s): This study comprised all adult patients undergoing
thoracic surgery at a tertiary- care referral center from May to July
2018. Measurements and Main Results: Surgical procedures were divided
into open thoracotomy, video-assisted thoracic surgery (VATS) and
VATS-guided mini-thoracotomy. The primary outcome was a comparison of
incidence of ISP among the 3 types of surgical procedures. Data were
analyzed using Stata (StataCorp), with significance testing by
Kruskal-Wallis equality of populations rank test. A p value of < 0.05 was
deemed significant. Sixty thoracic surgeries were performed during the
audit period. Nineteen patients had thoracotomies performed for lobectomy
or pneumonectomy, all of whom received phrenic nerve infiltration. The
incidence of moderate-to-severe ipsilateral shoulder pain among the
thoracoctomy cohort was 15.8% (3/19). Of the 36 VATS procedures audited, 7
patients (19.4%) received infiltration of their phrenic nerve, none of
whom reported postoperative ISP. Of the remaining twenty-nine patients who
did not receive phrenic nerve infiltration, there were 4 cases of
moderate-to-severe ipsilateral shoulder pain (11.1%). Four of the 5
patients (80%) who underwent VATS-guided mini-thoracotomies received
phrenic nerve infiltration intraoperatively. Three patients reported
moderate-to-severe ISP and of these 3 patients, 2 patients had phrenic
nerve infiltration, and 1 patient did not receive infiltration. Overall,
there were no statistically significant differences in rest or dynamic
pain scores across the surgical groups at any time point. Mann-Whitney
test revealed that the participants with ISP were significantly older than
those without ISP (p = 0.006). However, there were no significant
differences in sex or body mass index between those with and without ISP.
 Conclusion(s): The authors observed a lower (15.8%) incidence of
moderate-to-severe ISP among their thoracotomy patients than reported in
prior literature. Injection of local anesthetic into the phrenic nerve fat
pad at the level of the diaphragm appeared to be an effective and safe
surgical intervention that may eliminate a significant cause of ISP. None
of the VATS patients who received phrenic nerve infiltration experienced
ISP. Postoperative pain in VATS is expected to be reduced by avoiding the
use of a rib spreader, severing of the intercostal nerves, and division of
muscle tissue, which may account for the lower observed rates of ISP in
the VATS cohort who did not receive phrenic nerve infiltration. Further
randomized controlled trials are warranted to establish if patients
undergoing various VATS procedures benefit from this
intervention. Copyright © 2020 Elsevier Inc.

<150>
Accession Number
2007621164
Title
Peak Serum Chloride and Hyperchloremia in Patients Undergoing Cardiac
Surgery Is Not Explained by Chloride-Rich Intravenous Fluid Alone: A
Post-Hoc Analysis of the LICRA Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
McIlroy D.R.; Murphy D.; Shotwell M.S.; Bhatia D.
Institution
(McIlroy, Murphy, Bhatia) Alfred Hospital, Monash University, Melbourne,
Victoria, Australia
(McIlroy, Shotwell) Vanderbilt University Medical Center, Nashville, TN,
United States
Publisher
W.B. Saunders
Abstract
Objectives: With the exception of 0.9% saline, little is known about
factors that may contribute to increased serum chloride concentration
(S<inf>Cl</inf>-) in patients undergoing cardiac surgery. For
the present study, the authors sought to characterize the association
between administered chloride load from intravenous fluid and other
perioperative variables, with peak perioperative
S<inf>Cl</inf>-. Design(s): Secondary analysis of data
from a previously published controlled clinical trial in which patients
were assigned to a chloride-rich or chloride-limited perioperative fluid
strategy (NCT02020538). Setting(s): Academic medical center.
 Participant(s): The study comprised 1,056 adult patients with normal
preoperative S<inf>Cl</inf>- undergoing cardiac surgery.
 Intervention(s): None Measurements and Main Results: Peak
perioperative S<inf>Cl</inf>- and hyperchloremia, defined as
peak S<inf>Cl</inf>- >110 mmol/L, were selected as co-primary
endpoints. Regression modeling identified factors independently associated
with these endpoints. Mean (standard deviation) peak perioperative
S<inf>Cl</inf>- was 114 (5) mmol/L, and hyperchloremia occurred
in 824 (78.0%) of the cohort. In addition to administered volume of 0.9%
saline, multivariate linear and logistic regression modeling consistently
associated preoperative S<inf>Cl</inf>- (regression coefficient
0.5; 95% confidence interval [CI] 0.4-0.6 mmol/L; odds ratio 1.60; 95% CI
1.41-1.82 per 1 mmol/L increase) and cardiopulmonary bypass duration
(regression coefficient 0.1; 95% CI 0.1-0.2 mmol/L; odds ratio 1.12; 95%
CI 1.06-1.19 per 10 minutes) with both co-primary outcomes. Multivariate
modeling only explained approximately 50% of variability in peak
S<inf>Cl</inf>-. Conclusion(s): The present study's data
identified an association for both 0.9% saline administration and other
nonfluid variables with peak perioperative S<inf>Cl</inf>- and
hyperchloremia. Stand-alone strategies to limit administration of
chloride-rich intravenous fluid may have limited ability to prevent
hyperchloremia in this setting. Copyright © 2020 Elsevier Inc.

<151>
Accession Number
2007510341
Title
Systematic Review of the Association Between Worsening Renal Function and
Mortality in Patients With Acute Decompensated Heart Failure.
Source
Kidney International Reports. 5 (9) (pp 1486-1494), 2020. Date of
Publication: September 2020.
Author
Yamada T.; Ueyama H.; Chopra N.; Yamaji T.; Azushima K.; Kobayashi R.;
Kinguchi S.; Urate S.; Suzuki T.; Abe E.; Saigusa Y.; Wakui H.; Partridge
P.; Burger A.; Bravo C.A.; Rodriguez M.A.; Ivey-Miranda J.; Tamura K.;
Testani J.; Coca S.
Institution
(Yamada, Ueyama, Chopra, Burger) Department of Medicine, Mount Sinai Beth
Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Yamada, Yamaji, Azushima, Kobayashi, Kinguchi, Urate, Suzuki, Abe, Wakui,
Tamura) Department of Medical Science and Cardiorenal Medicine, Yokohama
City University Graduate School of Medicine, Yokohama, Japan
(Azushima) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore Medical School, Singapore
(Saigusa) Department of Biostatistics, Yokohama City University School of
Medicine, Yokohama, Japan
(Partridge) College of Arts and Sciences, University of Miami, Coral
Gables, FL, United States
(Bravo) Department of Medicine, Division of Cardiology, Columbia
University Medical Center, New York, NY, United States
(Rodriguez) Department of Medicine, Division of Cardiology, Albert
Einstein College of Medicine, Bronx, NY, United States
(Ivey-Miranda) Cardiology Hospital, XXI Century National Medical Center,
Mexican Social Security Institute, Mexico City, Mexico, Mexico
(Testani) Section of Cardiovascular Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Coca) Division of Nephrology, Department of Medicine, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc
Abstract
Introduction: Outcomes in acute decompensated heart failure (ADHF) have
remained poor. Worsening renal function (WRF) is common among patients
with ADHF. However, the impact of WRF on the prognosis is controversial.
We hypothesized that in patients with ADHF, the achievement of concomitant
decongestion would diminish the signal for harm associated with WRF.
 Method(s): We performed a systematic search of PubMed, EMBASE, and
the Cochrane Library up to December 2019 for studies that assessed signs
of decongestion in patients with WRF during ADHF admission. The primary
outcome was all-cause mortality and heart transplantation. Result(s):
Thirteen studies were selected with a pooled population of 8138 patients.
During the follow-up period of 60-450 days, 19.2% of patients died.
Unstratified, patients with WRF versus no WRF had a higher risk for
mortality (odds ratio [OR], 1.71 [95% confidence interval {CI},
1.45-2.01]; P < 0.0001). However, patients who achieved decongestion had a
similar prognosis (OR, 1.15 [95% CI, 0.89-1.49]; P = 0.30). Moreover,
patients with WRF who achieved decongestion had a better prognosis
compared with those without WRF or decongestion (OR, 0.63 [95% CI,
0.46-0.86]; P = 0.004). This tendency persisted for the sensitivity
analyses. Conclusion(s): Decongestion is a powerful effect modifier
that attenuates harmful associations of WRF with mortality. Future studies
should not assess WRF as an endpoint without concomitant assessment of
achieved volume status. Copyright © 2020 International Society of
Nephrology

<152>
Accession Number
2007431074
Title
The Rationale, Indications, Safety, and Use of Statins in the Pediatric
Population.
Source
Canadian Journal of Cardiology. 36 (9) (pp 1372-1383), 2020. Date of
Publication: September 2020.
Author
Khoury M.; McCrindle B.W.
Institution
(Khoury) Division of Pediatric Cardiology, Department of Pediatrics,
University of Alberta, Edmonton, AB, Canada
(McCrindle) Labatt Family Heart Center, Department of Pediatrics, The
Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Together with heart-healthy lifestyle habits, statins serve as the
cornerstone of primary and secondary prevention of atherosclerotic
cardiovascular disease in adults. Several conditions, most notably
familial hypercholesterolemia (FH), cause early dyslipidemia and vascular
disease, contributing to the development and progression of
atherosclerosis from childhood and increased cardiovascular risk. In
recent decades, studies increasingly have evaluated the safety and
efficacy of statins in such high-risk youth. The strongest evidence for
pediatric statin use is for the heterozygous FH population, whereby statin
use has been shown to lower low-density lipoprotein cholesterol
effectively, slow the progression of atherosclerosis and vascular
dysfunction, and significantly reduce cardiovascular risk in early
adulthood. Numerous meta-analyses and Cochrane reviews have demonstrated
that attributed adverse effects, including liver toxicity, myositis, and
rhabdomyolysis, occur no more frequently in youth receiving statins than
placebos, with no impact on growth or development. However, further
studies evaluating the long-term safety of pediatric statin use are
required. In the current review, we summarize the pediatric experience of
statin use to date, focusing on its utility for FH, Kawasaki disease,
post-heart transplantation, and other at-risk populations. Current
guidelines and indications for use are summarized, and the short- and
medium-term safety experience is reviewed. Finally, a clinical approach to
the indications, initiation, and monitoring of statins in youth is
provided. Copyright © 2020 Canadian Cardiovascular Society

<153>
Accession Number
2007138006
Title
Supra annular sizing for TAVR in bicuspid aortic valve stenosis: A
meta-analysis.
Source
Indian Heart Journal. 72 (4) (pp 309-311), 2020. Date of Publication: July
- August 2020.
Author
Kumar A.; Doshi R.; Shariff M.; Adalja D.; Vallabhajosyula S.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
(Adalja) Department of Medicine, Gotri Medical Education and Research
Center, Vadodara, Gujrat, India
(Vallabhajosyula) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier B.V.

<154>
Accession Number
2006765650
Title
Incidence, predictors and outcomes of valve-in-valve TAVI: A systematic
review and meta-analysis.
Source
International Journal of Cardiology. 316 (pp 64-69), 2020. Date of
Publication: 1 October 2020.
Author
Giordana F.; Bruno F.; Conrotto F.; Saglietto A.; D'Ascenzo F.; Grosso
Marra W.; Dvir D.; Webb J.; D'Onofrio A.; Camboni D.; Grubitzsch H.;
Duncan A.; Kaneko T.; Toggweiler S.; Latib A.; Nerla R.; Salizzoni S.; La
Torre M.; Trompeo A.; D'Amico M.; Rinaldi M.; De Ferrari G.
Institution
(Giordana, Bruno, Conrotto, Saglietto, D'Ascenzo, Grosso Marra, D'Amico,
De Ferrari) Division of Cardiology, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital and University of
Turin, Italy
(Salizzoni, La Torre, Trompeo, Rinaldi) Division of Cardiosurgery,
Cardiovascular and Thoracic Department, Citta della Salute e della Scienza
Hospital and University of Turin, Italy
(Dvir) University of Washington, Seattle, WA, United States
(Webb) Centre for Heart Valve Innovation, St Paul's Hospital, University
of British Columbia, Vancouver, BC, Canada
(D'Onofrio) Division of Cardiology, Monaldi Hospital, Naples, Italy
(Camboni) Department of Cardio-Thoracic Surgery, University Medical Center
Regensburg, Germany
(Grubitzsch) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
(Duncan) Royal Brompton Hospital, London, United Kingdom
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Switzerland
(Latib) Interventional Cardiology Unit, San Raffaele Scientific Institute,
Milan, Italy
(Nerla) Cardiovascular Department, Humanities Gavazzeni, Bergamo, Italy
(Latib) Department of Cardiology, Montefiore Medical Centre, New York,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Surgical aortic valve replacement has been the treatment of choice
for patients with aortic valve disease before the arrival of transcatheter
aortic valve replacement (TAVI), although limited by degeneration of the
bioprosthesis. "Redo" intervention itself is burdened by high risk of
complications and valve-in-valve (ViV) TAVI could be a valid strategy of
redo for patients with comorbidities. Methods and Results: Two
independent reviewers screened all studies investigating patients
undergoing ViV TAVI. Mortality at 30 days and at 1 year was the primary
end point. Of 286 studies identified, 26 articles were included in this
review with a total of 1448 patients. Median age was 78.8 years, 57.7%
male. Median STS score and Logistic EuroSCORE were 9.4% and 31.3%
respectively. Stenosis (45%) was the leading cause of prosthesis failure.
Transfemoral approach was preferred (76%), with a prevalence of balloon
expandable valves (73.3%). Mean follow up was 376 days. Overall and
cardiovascular mortality at 30 days was 6.5% and 5.5% respectively, while
at 1 year it was 14.5% and 8.9% respectively. At meta-regression analysis
study year (p <.001), Logistic EuroSCORE (p <.01) and valve diameter <= 21
mm (p <.05) at 30 days, and stenosis as reason for failure (p =.05) at 1
year were identified as possible predictors of survival.
 Conclusion(s): ViV TAVI offers a valid strategy to treat high risk
patients with a failure of bioprosthesis with satisfying results in terms
of short and mid-term mortality. Future studies are needed to find
predictors of long term survival and outcomes in lower risk
patients. Copyright © 2020 Elsevier B.V.

<155>
Accession Number
2006049780
Title
Mechanical Support in Early Cardiogenic Shock: What Is the Role of
Intra-aortic Balloon Counterpulsation?.
Source
Current Heart Failure Reports. (no pagination), 2020. Date of Publication:
2020.
Author
Kimman J.R.; Van Mieghem N.M.; Endeman H.; Brugts J.J.; Constantinescu
A.A.; Manintveld O.C.; Dubois E.A.; den Uil C.A.
Institution
(Kimman, Van Mieghem, Brugts, Constantinescu, Manintveld, Dubois, den Uil)
Department of Cardiology, Thorax Center, Erasmus University Medical
Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, Netherlands
(Endeman, Dubois, den Uil) Department of Intensive Care Medicine, Erasmus
University Medical Center, Rotterdam, Netherlands
Publisher
Springer
Abstract
Purpose of Review: We aim to summarize recent insights and provide an
up-to-date overview on the role of intra-aortic balloon pump (IABP)
counterpulsation in cardiogenic shock (CS). Recent Findings: In the
largest randomized controlled trial (RCT) of patients with CS after acute
myocardial infarction (AMICS), IABP did not lower mortality. However,
recent data suggest a role for IABP in patients who have persistent
ischemia after revascularization. Moreover, in the growing population of
CS not caused by acute coronary syndrome (ACS), multiple retrospective
studies and one small RCT report on significant hemodynamic improvement
following (early) initiation of IABP support, which allowed bridging of
most patients to recovery or definitive therapies like heart transplant or
a left ventricular assist device (LVAD). Summary: Routine use of IABP
in patients with AMICS is not recommended, but many patients with CS
either from ischemic or non-ischemic cause may benefit from IABP at least
for hemodynamic improvement in the short term. There is a need for a
larger RCT regarding the role of IABP in selected patients with ACS, as
well as in patients with non-ACS CS. Copyright © 2020, The
Author(s).

<156>
Accession Number
2005644577
Title
A pilot randomized-controlled trial evaluating the erector spinae plane
block in thoracic and breast surgery.
Source
Canadian Journal of Anesthesia. 67 (10) (pp 1371-1380), 2020. Date of
Publication: 01 Oct 2020.
Author
Uda Y.; Byrne K.; Brahmbhatt A.; Gotmaker R.; Lim D.; Konishi Y.; Eves
T.K.; Paxton E.; Barrington M.J.
Institution
(Uda, Brahmbhatt, Gotmaker, Konishi, Paxton, Barrington) Department of
Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Victoria
Parade, Fitzroy, PO Box 2900, Melbourne, VIC 3065, Australia
(Byrne) Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
(Brahmbhatt, Barrington) Department of Medicine and Radiology, Faculty of
Medicine, Dentistry and Health Sciences, University of Melbourne,
Melbourne, VIC, Australia
(Lim) Department of Pharmacy, St. Vincent's Hospital, Melbourne, VIC,
Australia
(Konishi) Department of Anesthesia, School of Medicine, Teikyo University,
Tokyo, Japan
(Eves) Department of Anatomy and Neuroscience, Faculty of Medicine,
Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC,
Australia
Publisher
Springer
Abstract
Purpose: This pilot study evaluated the feasibility of investigating the
effect of the erector spinae plane (ESP) block on the patient-centred
outcomes of quality of recovery-15 (QoR-15), and brief pain inventory
(BPI) in thoracic and breast surgery patients. Method(s): In this
randomized-controlled pilot trial, 82 patients undergoing video-assisted
thoracoscopic surgery (n = 77) and mastectomy (n = 5) received either
continuous ESP block with ropivacaine (ropivacaine group) or the same
procedure with 0.9% saline (saline group). All patients received surgical
intercostal block (thoracic surgery) or local anesthetic infiltration
(breast surgery). Feasibility as the primary outcome was evaluated on
recruitment (three patients per week), catheter retention (above 90% at 24
hr), and patient attrition (less than 10%). Secondary outcomes comprised
of QoR-15, BPI, and opioid consumption. Result(s): Recruitment rate
was 1.8 patients per week. Catheters were retained in 77 patients (94%) at
24 hr. At three months, five patients were lost to follow-up (6%). At 24
hr compared with baseline, the ropivacaine group had a smaller decline in
QoR-15 score (median difference, 14; 95% confidence interval [CI], 2 to
26; P = 0.02) and a smaller increase in BPI global score (median
difference, 14; 95% CI, 0 to 24; P = 0.048). There was no difference in
opioid consumption (P = 0.08). Conclusion(s): In this pilot study,
the target recruitment rate was not met, but catheter retention and
patient attrition rates were both satisfactory. A definitive trial with
QoR-15 as the primary outcome would require 300 study participants. Trial
registration: Australian New Zealand Clinical Trials Registry
(ID12618000701224); registered 30 April 2018. Copyright © 2020,
Canadian Anesthesiologists' Society.

<157>
Accession Number
2005235872
Title
Revascularization in cardiogenic shock.
Source
Herz. 45 (6) (pp 537-541), 2020. Date of Publication: 01 Sep 2020.
Author
Freund A.; Desch S.; Thiele H.
Institution
(Freund, Desch, Thiele) Department of Internal Medicine/Cardiology, Heart
Center Leipzig at University of Leipzig, Strumpellstr. 39, Leipzig 04289,
Germany
(Freund, Desch) German Center for Cardiovascular Research (DZHK), Berlin,
Germany
Publisher
Springer Medizin (E-mail: kundenservice@springermedizin.de)
Abstract
Approximately 10% of patients with acute myocardial infarction develop
cardiogenic shock. Randomized studies have shown a significant improvement
in survival with early revascularization, which now represents the most
important cornerstone in the treatment of infarct-related cardiogenic
shock. In the vast majority of cases, this is achieved by percutaneous
coronary intervention (PCI). In cases of complex coronary anatomy or
mechanical complications, the Heart Team should be consulted promptly. The
randomized CULPRIT-SHOCK study showed a survival advantage for patients
with multivessel coronary artery disease and a percutaneous
revascularization strategy who were treated by culprit-lesion-only PCI
compared with immediate multivessel PCI. There are currently few data on
anticoagulation and antiplatelet therapy in cardiogenic shock as well as
on active mechanical circulatory support in this setting. Copyright
© 2020, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<158>
Accession Number
2004841104
Title
The evolution of mitral valve surgery: The future in the hand of robots.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 555-564), 2020.
Date of Publication: 2020.
Author
Harky A.; Kwok H.T.; Fan K.S.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool, United Kingdom
(Kwok) Leicester Medical School, Leicester, United Kingdom
(Fan) St. George's, University of London, London, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To examine the current literature behind the evolution of
mitral valve surgery techniques and their impact on patient outcomes.
 Method(s): An electronic literature search among major databases was
performed (PubMed, Embase, Scopus, Cochrane, and Google scholar). All the
relevant articles were screened and identified to be included in this
narrative review. The main outcomes were postoperative morbidity, length
of in-hospital stay, and long-term mortality. Result(s): Minimally
invasive and robot-assisted approach to mitral valve repair and
replacements has shown great potential in improving surgical outcomes when
compared against traditional midline sternotomy. Selected patients can
benefit from percutaneous mitral valve surgery; however, more evidence is
required to ascertain its long-term outcomes. Conclusion(s): Current
evidence suggests that robotic and minimal invasive mitral valve surgeries
are increasing in practice with satisfactory perioperative and mortality
rates. However, long-term data is yet to be published to support current
practice. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<159>
Accession Number
2004841103
Title
Three-dimensional printing: Is it useful for cardiac surgery?.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 549-554), 2020.
Date of Publication: 2020.
Author
de Oliveira M.A.B.; Dos Santos C.A.; Brandi A.C.; Botelho P.H.H.; Braile
D.M.
Institution
(de Oliveira) Department of Cardiac Surgery, Hospital Santo Antonio and
Femina Cuiaba, Sinop, Mato Grosso, Brazil
(de Oliveira) Department of Cardiovascular Surgery, Universidade Federal
do Mato Grosso, Sinop, Mato Grosso, Brazil
(Dos Santos, Brandi, Botelho, Braile) Hospital de Base, Sao Jose do Rio
Preto, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Introduction: The medical use of three-dimensional (3-D) images has been a
topic in the literature since 1988, but 95% of papers on 3-D printing were
published in the last six years. The increase in publications is the
result of advances in 3-D printing methods, as well as of the increasing
availability of these machines in different hospitals. This paper sought
to review the literature on 3-D printing and to discuss thoughtful ideas
regarding benefits and challenges to its incorporation into cardiothoracic
surgeons' routines. Method(s): A comprehensive and systematic search
of the literature was performed in PubMed and included material published
as of March 2020. Result(s): Using this search strategy, 9,253
publications on 3-D printing and 497 on "heart" 3-D printing were
retrieved. Conclusion(s): 3-D printed models are already helping
surgeons to plan their surgeries, helping patients and their families to
understand complex anatomy, helping fellows and residents to practice
surgery, even for rare cases, and helping nurses and other health care
staff to better understand some conditions, such as heart
diseases. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<160>
Accession Number
2004841102
Title
State-of-the-art pediatric coronary artery bypass surgery: A literature
review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 539-548), 2020.
Date of Publication: 2020.
Author
Komarov R.; Ismailbaev A.; Chragyan V.; Kadyraliev B.; Sa M.P.B.O.;
Ruhparwar A.; Weymann A.; Zhigalov K.
Institution
(Komarov, Ismailbaev) Department of Cardiovascular Surgery, I.M. Sechenov
University Hospital, First Moscow State Medical University, Moscow,
Russian Federation
(Chragyan, Kadyraliev) Department of Cardiovascular Surgery, S.G. Sukhanov
Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical
University, Perm, Russian Federation
(Sa) Department of Cardiovascular Surgery, Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, PE, Brazil
(Ruhparwar, Weymann, Zhigalov) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To examine the results of various myocardial revascularization
techniques in pediatric patients to better understand the strategies for
surgical treatment of coronary artery pathologies. Method(s): We
analyzed 61 publications dedicated to the indications, methods, and
results of coronary bypass surgery in children. Due to the small size of
this cohort, case reports are also included in our review. Result(s):
The main indications for coronary bypass grafting in children are Kawasaki
disease, myocardial revascularization as a necessary procedure during the
congenital cardiac surgery, to manage intraoperative iatrogenic damage to
coronary arteries, and homozygous familial hypercholesterolemia. The use
of internal thoracic arteries as conduits for coronary bypass grafting in
children with Kawasaki disease showed significantly better results in
long-term functionality compared to autovenous conduits (87% and 44%,
respectively, P<0.001). Acute and late coronary events after arterial
switch operation for the transposition of the great arteries, anomalous
origin of the left coronary artery from the pulmonary artery, and left
main coronary artery atresia are the main congenital heart diseases where
surgical correction involves interventions on the coronary arteries.
 Conclusion(s): The internal thoracic artery is a reliable and durable
conduit that demonstrates proven growth potential in
children. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<161>
Accession Number
2004841038
Title
Nursing guidelines on cardiac surgery and parents' anxiety: Randomized
clinical trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 437-444), 2020.
Date of Publication: 2020.
Author
Xavier I.B.M.; Biscarra V.B.; Piccoli A.B.; Rodrigues C.G.; Hirakata V.N.;
de Moraes M.A.P.; Pellanda L.C.
Institution
(Xavier, Biscarra, Piccoli, de Moraes, Pellanda) Instituto de
Cardiologia/Fundacao, Universitaria de Cardiologia - IC/FUC, Porto Alegre,
RS, Brazil
(Rodrigues, Pellanda) Universidade Federal de Ciencias da Saude de Porto
Alegre, Porto Alegre, RS, Brazil
(Hirakata) Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: The preparation of parents of children who should undergo
cardiac surgery requires special treatment such as the explanations about
the event. This study aims to compare the effects of standardized nursing
guidelines with routine institutional orientation on the anxiety of
parents of children undergoing cardiac surgery. Method(s): Randomized
clinical trial. The sample consisted of parents of children who underwent
cardiac surgery from December 2010 to April 2011. Twenty-two parents were
randomized to the intervention group (IG) and received the standard
nursing guidelines and 22 participated in the control group (CG) and
received the routine guidelines from the institution. Anxiety was assessed
by the State-Trait Anxiety Inventory (STAI) applied in the preoperative
period, between 12 and 20 hours before surgery and before receiving
standard or institutional guidelines and 48 hours after surgery. The
analysis of variance (ANOVA) for repeated measures was performed to
evaluate the differences between the variations in STAI scores between the
groups during the studied period. The level of significance was 0.05.
 Result(s): There were no significant differences in baseline anxiety
scores between groups with regard to trait anxiety as well as state
anxiety: STAI-trait (CG 42.6+/-4.9 vs. IG 41.4+/-6.0, P=0.48); STAI-state
(CG 42.3+/-5.7 vs. IG 45.6+/-8.3, P=0.18). Likewise, the variation in
score after 48 hours was similar between groups (STAI-trait P=0.77;
STAI-state P=0.61). Conclusion(s): There were no significant
differences in the parents' anxiety levels when comparing the two types of
guidelines: the standard nursing and the institutional
orientation. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<162>
Accession Number
2004841037
Title
Which is the optimal frozen elephant trunk? A systematic review and
meta-analysis of outcomes in 2161 patients undergoing thoracic aortic
aneurysm surgery using e-vita open plus hybrid stent graft versus
thoraflexTM hybrid prosthesis.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 427-436), 2020.
Date of Publication: 2020.
Author
Harky A.; Fok M.; Bashir M.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Fok) Department of Vascular Surgery, Royal Liverpool Hospital, Liverpool,
United Kingdom
(Bashir) Vascular Surgery Department, Royal Blackburn Teaching Hospital,
Haslingden Rd, Blackburn, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To systematically review the rate of morbidity and mortality
associated with the use of E-vita hybrid stent graft and ThoraflexTM in
patients undergoing complex aortic surgery. Method(s): A
comprehensive search was undertaken among the four major databases to
identify published data about E-vita or ThoraflexTM in patients undergoing
repair of thoracic aortic aneurysms. Result(s): In total, 28 papers
were included in the study, encompassing a total of 2,161 patients (1,919
E-vita and 242 ThoraflexTM). Patients undergoing surgery with E-vita or
ThoraflexTM were of similar age and sex. The number of patients undergoing
non-elective repair with ThoraflexTM was higher than with E-vita (35.2%
vs. 28.7%, respectively). Cardiopulmonary bypass time was associated with
increasing mortality in E-vita patients, however a meta-analysis of
proportions showed higher 30-day mortality, permanent neurological
deficit, and one-year mortality for ThoraflexTM patients. Direct
statistical comparisons between E-vita and ThoraflexTM was not possible
due to heterogeneity of studies. Conclusion(s): Although there are
limited studies available, the available data suggests that mortality and
morbidity are lower for the E-vita device in thoracic aortic aneurysm
surgery than for ThoraflexTM. Long-term data of comparative studies do not
yet exist to assess viability of these procedures. Copyright ©
2020, Sociedade Brasileira de Cirurgia Cardiovascular. All rights
reserved.

<163>
[Use Link to view the full text]
Accession Number
632683350
Title
Outcome of Flow-Gradient Patterns of Aortic Stenosis after Aortic Valve
Replacement: An Analysis of the PARTNER 2 Trial and Registry.
Source
Circulation: Cardiovascular Interventions. 13 (7) (no pagination), 2020.
Article Number: e008792. Date of Publication: 01 Jul 2020.
Author
Salaun E.; Clavel M.-A.; Hahn R.T.; Jaber W.A.; Asch F.M.; Rodriguez L.;
Weissman N.J.; Gertz Z.M.; Herrmann H.C.; Dahou A.; Annabi M.-S.; Toubal
O.; Bernier M.; Beaudoin J.; Leipsic J.; Blanke P.; Ridard C.; Ong G.;
Rodes-Cabau J.; Webb J.G.; Zhang Y.; Alu M.C.; Douglas P.S.; Makkar R.;
Miller D.C.; Lindman B.R.; Thourani V.H.; Leon M.B.; Pibarot P.
Institution
(Salaun, Clavel, Dahou, Annabi, Toubal, Bernier, Beaudoin, Ridard, Ong,
Rodes-Cabau, Pibarot) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec/Quebec Heart and Lung Institute, Laval University,
2725 Chemin Sainte-Foy No. A2075, Quebec, Quebec G1V-4G5, Canada
(Hahn, Zhang, Alu, Leon) Columbia University Medical Center/New
York-Presbyterian Hospital, United States
(Hahn, Zhang, Alu, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Jaber, Rodriguez) Heart and Vascular Institute, Cleveland Clinic, OH,
United States
(Asch, Weissman, Thourani) MedStar Health Research Institute at Washington
Hospital Center, DC, United States
(Gertz) Division of Cardiology, Virginia Commonwealth University,
Richmond, United States
(Herrmann) University of Pennsylvania Medical Center, Philadelphia, United
States
(Leipsic, Blanke, Webb) St Paul's Hospital, Vancouver, BC, Canada
(Ong) Division of Cardiology, St Michael's Hospital, Toronto, ON, Canada
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, NC, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Miller) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University School of Medicine, CA, United States
(Lindman) Vanderbilt University Medical Center, Nashville, TN, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Although aortic valve replacement is associated with a major
benefit in high-gradient (HG) severe aortic stenosis (AS), the results in
low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe
AS may be subdivided in classical low-flow (left ventricular ejection
fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular
ejection fraction >=50% but stroke volume index <35 mL/m2) and
LG; and normal-flow (left ventricular ejection fraction >=50% and stroke
volume index >=35 mL/m2) and LG. The primary objective is to
determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter
Valves) and registry the outcomes after aortic valve replacement of the 4
flow-gradient groups. Method(s): A total of 3511 patients from the
PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry
(n=1601) were included. The flow-gradient pattern was determined at
baseline transthoracic echocardiography and classified as follows: (1) HG;
(2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The
primary end point for this analysis was the composite of (1) death; (2)
rehospitalization for heart failure symptoms and valve prosthesis
complication; or (3) stroke. Result(s): The distribution was HG, 2229
patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG,
247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year
rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8%
(P=0.002) and normal-flow-LG: 32.1% (P=0.05) but was not statistically
different from paradoxical low-flow-LG: 33.6% (P=0.18). There was no
significant difference in the 2-year rates of clinical events between
transcatheter aortic valve replacement versus surgical aortic valve
replacement in the whole cohort and within each flow-gradient group.
 Conclusion(s): The LG AS pattern was highly prevalent (36.5%) in the
PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS
and was associated with higher rates of death, rehospitalization, or
stroke at 2 years compared with the HG group. Clinical outcomes were as
good in the LG AS groups with preserved left ventricular ejection fraction
compared with the HG group. Copyright © 2020 Lippincott Williams
and Wilkins. All rights reserved.

<164>
Accession Number
632657083
Title
Robustness of the Comparative Observational Evidence Supporting Class I
and II Cardiac Surgery Procedures.
Source
Journal of the American Heart Association. 9 (17) (pp e016964), 2020. Date
of Publication: 01 Sep 2020.
Author
Gaudino M.; Hameed I.; Robinson N.B.; Naik A.; Weidenmann V.; Ruan Y.; Tam
D.; Girardi L.N.; Fremes S.
Institution
(Gaudino, Hameed, Robinson, Naik, Weidenmann, Ruan, Girardi) Department of
Cardiothoracic Surgery Weill Cornell Medicine New York NY
(Tam, Fremes) Schulich Heart Centre Sunnybrook Health Science University
of Toronto Toronto Ontario Canada
Publisher
NLM (Medline)
Abstract
Background Current cardiac surgery guidelines give Class I and II
recommendations to valve-sparing root replacement over the Bentall
procedure, mitral valve (MV) repair over replacement, and multiple
arterial grafting with bilateral internal thoracic artery based on
observational evidence. We evaluated the robustness of the observational
studies supporting these recommendations using the E value, an index of
unmeasured confounding. Methods and Results Observational studies cited in
the guidelines and in the 3 largest meta-analyses comparing the procedures
were evaluated for statistically significant effect measures. Two E values
were calculated: 1 for the effect-size estimate and 1 for the lower limit
of the 95% CI. Thirty-one observational studies were identified, and E
values were computed for 75 effect estimates. The observed effect
estimates for improved clinical outcomes with valve-sparing root
replacement versus the Bentall procedure, MV repair versus replacement,
and grafting with bilateral internal thoracic artery versus single
internal thoracic artery could be explained by an unmeasured confounder
that was associated with both the treatment and outcome by a risk ratio of
more than 16.77, 4.32, and 3.14, respectively. For MV repair versus
replacement and grafting with bilateral internal thoracic artery versus
single internal thoracic artery, the average E values were lower than the
effect sizes of the other measured confounders in 33.3% and 60.9% of the
studies, respectively. For valve-sparing root replacement versus the
Bentall procedure, no study reported effect sizes for associations of
other covariates with outcomes. Conclusions The E values for observational
evidence supporting the use of valve-sparing root replacement, MV repair,
and grafting with bilateral internal thoracic artery over the Bentall
procedure, MV replacement, and grafting with single internal thoracic
artery are relatively low. This suggests that small-to-moderate unmeasured
confounding could explain most of the observed associations for these
procedures.

<165>
Accession Number
632570404
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, ON,
Hamilton, Canada
(Gupta, Rochwerg, Whitlock) Department of Health Research Methods,
McMaster University, ON, Hamilton, Canada
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine, McMaster
University, ON, Hamilton, Canada
(Belley-Cote, Mehta, Schwalm, Whitlock) Population Health Research
Institute, ON, Hamilton, Canada
(Panchal, Pandey, Basha) Faculty of Health Sciences, McMaster University,
ON, Hamilton, Canada
(Pallo) Faculty of Sciences, McMaster University, ON, Hamilton, Canada
Publisher
NLM (Medline)
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 © The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<166>
Accession Number
632508010
Title
Ubiquinol supplementation in elderly patients undergoing aortic valve
replacement: biochemical and clinical aspects.
Source
Aging. 12 (15) (pp 15514-15531), 2020. Date of Publication: 31 Jul 2020.
Author
Orlando P.; Sabbatinelli J.; Silvestri S.; Marcheggiani F.; Cirilli I.;
Dludla P.V.; Molardi A.; Nicolini F.; Tiano L.
Institution
(Orlando, Silvestri, Marcheggiani, Cirilli, Dludla, Tiano) Department of
Life and Environmental Sciences, Universita Politecnica delle Marche, Via
Brecce Bianche, Ancona 60100, Italy
(Sabbatinelli) Department of Clinical and Molecular Sciences, DISCLIMO,
Universita Politecnica delle Marche, Ancona 60100, Italy
(Dludla) Biomedical Research and Innovation Platform, South African
Medical Research Council, Tygerberg 7505, South Africa
(Molardi, Nicolini) Cardiac Surgery Department, Parma University Hospital,
Parma 43126, Italy
Publisher
NLM (Medline)
Abstract
Epidemiological data show a rise in the mean age of patients affected by
heart disease undergoing cardiac surgery. Senescent myocardium reduces the
tolerance to ischemic stress and there are indications about
age-associated deficit in post-operative cardiac performance. Coenzyme Q10
(CoQ10), and more specifically its reduced form ubiquinol (QH), improve
several conditions related to bioenergetic deficit or increased exposure
to oxidative stress. This trial (Eudra-CT 2009-015826-13) evaluated the
clinical and biochemical effects of ubiquinol in 50 elderly patients
affected by severe aortic stenosis undergoing aortic valve replacement and
randomized to either placebo or 400 mg/day ubiquinol from 7 days before to
5 days after surgery. Plasma and cardiac tissue CoQ10 levels and oxidative
status, circulating troponin I, CK-MB (primary endpoints), IL-6 and S100B
were assessed. Moreover, main cardiac adverse effects, NYHA class,
contractility and myocardial hypertrophy (secondary endpoints) were
evaluated during a 6-month follow-up visit. Ubiquinol treatment
counteracted the post-operative plasma CoQ10 decline (p<0.0001) and
oxidation (p=0.038) and curbed the post-operative increase in troponin I
(QH, 1.90 [1.47-2.48] ng/dL; placebo, 4.03 [2.45-6.63] ng/dL; p=0.007)
related to cardiac surgery. Moreover, ubiquinol prevented the adverse
outcomes that might have been associated with defective left ventricular
ejection fraction recovery in elderly patients.

<167>
Accession Number
632105542
Title
Prehabilitation in patients awaiting elective coronary artery bypass graft
surgery - effects on functional capacity and quality of life: a randomized
controlled trial.
Source
Clinical rehabilitation. 34 (10) (pp 1256-1267), 2020. Date of
Publication: 01 Oct 2020.
Author
Steinmetz C.; Bjarnason-Wehrens B.; Baumgarten H.; Walther T.; Mengden T.;
Walther C.
Institution
(Steinmetz) Institute of Sport Science, Department of Training Science and
Kinesiology, University of Gottingen, Gottingen, Germany
(Bjarnason-Wehrens) Institute of Cardiology and Sports Medicine, German
Sport University Cologne, Cologne, Germany
(Baumgarten) Kerckhoff Heart Center, Department of Cardiothoracic Surgery,
Bad Nauheim, Germany
(Walther) Department of Cardiothoracic Surgery, University of Frankfurt,
Frankfurt am Main, Germany
(Mengden) Kerckhoff Heart Center, Department of Rehabilitation, Bad
Nauheim, Germany
(Walther) Department of Cardiology, University of Frankfurt, Frankfurt am
Main, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the impact of an exercise-based prehabilitation
(EBPrehab) program on pre- and postoperative exercise capacity, functional
capacity (FC) and quality of life (QoL) in patients awaiting elective
coronary artery bypass graft surgery (CABG). DESIGN: A two-group
randomized controlled trail. SETTING: Ambulatory prehabilitation.
SUBJECTS: Overall 230 preoperative elective CABG-surgery patients were
randomly assigned to an intervention (IG, n=88; n=27 withdrew after
randomization) or control group (CG, n=115). INTERVENTION: IG: two-week
EBPrehab including supervised aerobic exercise. CG: usual care. MAIN
MEASURES: At baseline (T1), one day before surgery (T2), at the beginning
(T3) and at the end of cardiac rehabilitation (T4) the following
measurements were performed: cardiopulmonary exercise test, six-minute
walk test (6MWT), Timed-Up-and-Go Test (TUG) and QoL (MacNew
questionnaire). RESULT(S): A total of 171 patients (IG, n=81; CG,
n=90) completed the study. During EBPrehab no complications occurred.
Preoperatively FC (6MWTIG: 443.0+/-80.1m to 493.5+/-75.5m, P=0.003; TUGIG:
6.9+/-2.0s to 6.1+/-1.8s, P=0.018) and QoL (IG: 5.1+/-0.9 to 5.4+/-0.9,
P<0.001) improved significantly more in IG compared to CG. Similar effects
were observed postoperatively in FC (6MWDIG: DELTA-64.7m, pT1-T3=0.013;
DELTA+47.2m, pT1-T4<0.001; TUGIG: DELTA+1.4s, pT1-T3=0.003).
 CONCLUSION(S): A short-term EBPrehab is effective to improve
perioperative FC and preoperative QoL in patients with stable coronary
artery disease awaiting CABG-surgery.ID: NCT04111744
(www.ClinicalTrials.gov; Preoperative Exercise Training for Patients
Undergoing Coronary Artery Bypass Graft Surgery- A Prospective Randomized
Trial).

<168>
[Use Link to view the full text]
Accession Number
632098208
Title
Postoperative Psychological Disorders Among Heart Transplant Recipients: A
Meta-Analysis and Meta-Regression.
Source
Psychosomatic medicine. 82 (7) (pp 689-698), 2020. Date of Publication: 01
Sep 2020.
Author
Loh A.Z.H.; Tan J.S.Y.; Tam J.K.C.; Zhang M.W.; Ho C.S.H.; Ho R.C.
Institution
(Loh) From the Departments of Psychological Medicine (Loh, Ho) and Surgery
(Tam), Yong Loo Lin School of Medicine (Tan), National University of
Singapore; Department of Cardiac, Thoracic and Vascular Surgery (Tam),
National University Heart Centre; Institute of Mental Health, National
Health Group (Zhang); Department of Psychological Medicine (Ho), National
University Health System; and Biomedical Institute for Global Health
Research and Technology (Ho), National University of Singapore, Singapore,
Singapore
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This meta-analysis evaluates the pooled prevalence of
depression, anxiety, adjustment disorder, and posttraumatic stress
disorder (PTSD) among heart transplant recipients globally and determines
underlying moderators. METHOD(S): The authors searched PubMed,
Embase, PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL databases
from inception to March 1, 2019, and 1321 records and 42 full-text
articles were selected and reviewed according to Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines. We calculated the
pooled prevalence proportion of depression, anxiety, adjustment disorder,
and PTSD using random-effects models. Meta-regression was performed to
identify important moderators that contribute to heterogeneity.
 RESULT(S): Twenty studies met the inclusion criteria and comprised
2169 patients. The pooled prevalence of depression was 21.6% (95%
confidence interval [CI] = 16.8%-27.3%), anxiety 11.1% (95% CI =
3.8%-28.5%), adjustment disorder 11.0% (95% CI = 3.1%-32.1%), and PTSD
13.5% (95% CI = 8%-21.8%). There was significant heterogeneity.
Meta-regression was conducted to account for the heterogeneity of the
prevalence proportion. Predisposing factors, for example, New York Heart
Association classes II and III/IV, steroid treatment, and acute rejection
of transplant (<3 months), were associated with high prevalence of
depression. Protective factors, for example, age and higher ejection
fraction after transplant of patients, were associated with low prevalence
of depression. Female sex, single status, and number of months since
transplant were associated with high prevalence of anxiety. Single status
was associated with high prevalence of both adjustment disorder and
transplant-related PTSD. CONCLUSION(S): The prevalence of psychiatric
conditions, particularly depression, is high in heart transplant
recipients. The identified protective and risk factors may guide
psychological interventions in heart transplant recipients.

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