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<1>
Accession Number
632515911
Title
Correlation between Age and Surgical Approach for Thoracic and Lumbar
Hemivertebra.
Source
Indian Journal of Neurosurgery. 9 (2) (pp 115-121), 2020. Date of
Publication: 01 Aug 2020.
Author
Nikova A.; Chatzipaulou V.; Malkots B.; Mustafa R.M.; Valsamidou C.;
Birbilis T.
Institution
(Nikova, Chatzipaulou, Malkots, Mustafa, Valsamidou, Birbilis) Department
of Neurosurgery, Democritus University of Thrace Medical School, Dragana,
Alexandroupolis 68100, Greece
Publisher
Georg Thieme Verlag
Abstract
Objective Hemivertebra (HV) is a congenital defect of the formation of the
spinal vertebra, which can result in scoliosis or kyphosis along with the
related symptomatology of spine deformity. More often than not, it is
linked to other abnormalities and requires attention. Its management is
surgical and it is of great importance for the physician to choose the
right approach at the right time, due to its deteriorative prognosis.
Methods Due to the interest of the subject, the authors investigated the
world literature between 1990 and 2018 and found 45 articles, reporting
thoracic, thoracolumbar, and lumbar HV in children and its postsurgical
outcome, aiming to show whether the approaches are equal in terms of the
final outcome. Results The chosen surgical method depends much on the
level of the pathology. Despite this fact, after analyzing the included
data, we found that the surgical techniques are unequal with regard to the
purpose of achieving improvement. Age, caudal and cranial curves,
segmental kyphosis, and scoliosis are factors playing a major role in
this. Conclusion If not treated, HV leads to deterioration and
dysfunction. The most optimal result, however, is achieved only when the
surgical approach is applied according to age and rest of the accompanying
factors, which should be considered in future management
planning.<br/>Copyright &#xa9; 2020 Neurological Surgeons' Society of
India.

<2>
Accession Number
2008415172
Title
Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial
function, inflammatory parameters, and platelet function in patients with
acute coronary syndrome undergoing coronary artery stenting: A randomized,
blinded, parallel study.
Source
European Heart Journal. 41 (33) (pp 3144-3152), 2020. Date of Publication:
01 Sep 2020.
Author
Schnorbus B.; Daiber A.; Jurk K.; Warnke S.; Koenig J.; Lackner K.J.;
Munzel T.; Gori T.
Institution
(Schnorbus, Daiber, Munzel, Gori) Zentrum fur Kardiologie, Kardiologie I,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Schnorbus, Jurk) Center for Thrombosis and Hemostasis,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Daiber, Munzel, Gori) Deutsches Zentrum fur Herz-Kreislauferkrankungen
(DZHK), Standort Rhein-Main, Partnereinrichtung Mainz, Langenbeckstrase 1,
Mainz 55131, Germany
(Warnke) Interdisciplinary Center for Clinical Trials (IZKS),
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Koenig) Institute of Medical Biostatistics, Epidemiology and Informatics,
University Medical Center, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
(Lackner) Institute of Clinical Chemistry and Laboratory Medicine,
Universitatsmedizin Mainz, Johannes Gutenberg-University Mainz,
Langenbeckstrase 1, Mainz 55131, Germany
Publisher
Oxford University Press
Abstract
Aims In a randomized, parallel, blinded study, we investigate the impact
of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial
function in patients undergoing stenting for an acute coronary syndrome.
Methods The primary endpoint of the study was the change in
endothelium-dependent flow-mediated dilation (FMD) following and results
stenting. A total of 90 patients (age 62 +/- 9 years, 81 males, 22
diabetics, 49 non-ST elevation myocardial infarctions) were enrolled.
There were no significant differences among groups in any clinical
parameter. Acutely before stenting, all three drugs improved FMD without
differences between groups (P = 0.73). Stenting blunted FMD in the
clopidogrel and ticagrelor group (both P < 0.01), but not in the prasugrel
group. During follow-up, prasugrel was superior to clopidogrel [mean
difference 2.13, 95% confidence interval (CI) 0.68-3.58; P = 0.0047] and
ticagrelor (mean difference 1.57, 95% CI 0.31-2.83; P = 0.0155), but this
difference was limited to patients who received the study therapy 2 h
before stenting. Ticagrelor was not significantly superior to clopidogrel
(mean difference 0.55, 95% CI -0.73 to 1.82; P = 0.39). No significant
differences were seen among groups for low-flow-mediated dilation. Plasma
interleukin (IL)-6 (P = 0.02 and P = 0.01, respectively) and platelet
aggregation reactivity in response to adenosine diphosphate (P = 0.002 and
P = 0.035) were lower in the prasugrel compared to clopidogrel and
ticagrelor group. Conclusion As compared to ticagrelor and clopidogrel,
therapy with prasugrel in patients undergoing stenting for an acute
coronary syndrome is associated with improved endothelial function,
stronger platelet inhibition, and reduced IL-6 levels, all of which may
have prognostic implications. This effect was lost in patients who
received the study medication immediately after stenting.<br/>Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. &#xa9; The Author(s) 2020.

<3>
Accession Number
2007704343
Title
Impact of prosthesis-patient mismatch on early and late outcomes after
mitral valve replacement: a meta-analysis.
Source
Journal of Geriatric Cardiology. 17 (8) (pp 455-475), 2020. Date of
Publication: 2020.
Author
Tan M.-W.; Bai Y.-F.; Liu X.-H.; Xu Z.-Y.; An Z.; Ma Y.; Zhao L.-B.; Li
B.-L.
Institution
(Tan, Bai, Liu, Xu, An, Ma, Zhao, Li) Department of Cardiothoracic
Surgery, Changhai Hospital, Naval Military Medical University, Second
Military Medical University), Shanghai, China
Publisher
Science Press
Abstract
Background Prognostic significance of prosthesis-patient mismatch (PPM)
after mitral valve replacement (MVR) remains uncertain because of the
limited studies reporting inconsistent or even contrary results. This
meta-analysis pooled results of all available studies comparing early and
late prognoses between patients with significant mitral PPM and those
without. Methods Studies were identified by searching Pubmed, Excerpta
Medica Database, Cochrane Central Register of Controlled Trials, and
ClinicalTrials.gov. Impact of PPM on postoperative hemodynamic results,
thirty-day mortality, overall mortality, mortality of thirty-day
survivors, and primary morbidity after MVR was evaluated via
meta-analysis. Robustness of pooled estimates, source of heterogeneity,
and publication bias were assessed via sensitivity analyses,
meta-regression as well as subgroup analysis stratified according to
methodological or clinical heterogeneity, or sequential omission method,
and funnel plot or Begg's and Egger's tests, respectively. Results
Nineteen cohort studies involving 9302 individuals (PPM group: n = 5109,
Control group: n = 4193) were included for meta-analysis. Total PPM and
severe PPM prevalence were 3.8%-85.9% and 1%-27%, with a mean value of
54.9% and 14.1%, respectively. As compared with control group, mitral PPM
group demonstrated a poorer postoperative hemodynamic status of higher
mean and peak residual transprosthetic pressure gradients (TPG), higher
postoperative systolic pulmonary artery pressure (SPAP) and less
reduction, higher postoperative pulmonary hypertension (PH) prevalence and
less PH regression, smaller net atrioventricular compliance, less NYHA
class decrease, higher postoperative functional tricuspid regurgitation
prevalence and less regression. The PPM group also revealed a higher
thirty-day mortality, long-term overall mortality, mortality of thirty-day
survivors, and postoperative congestive heart failure prevalence, which
were positively correlated with the severity of PPM if it was classified
into tri-level subgroups. Left ventricular end-diastolic diameter,
postoperative atrial fibrillation (AF) prevalence, and the AF regression
were analogous between groups. Most pooled estimates were robust according
to sensitivity analyses. Male patients and bioprosthesis implantation
proportion were prominent source of between-study heterogeneity on
thirty-day mortality. Publication bias was not significant in tests for
all the outcomes, except for SPAP and TPG. Conclusions Mitral PPM would
result in poorer postoperative hemodynamics and worse early and late
prognosis. Severe PPM must be avoided since deleterious impact of mitral
PPM was severity dependent.<br/>Copyright &#xa9;2020 JGC All rights
reserved;

<4>
Accession Number
2007704273
Title
Peri-operative blood transfusion in elective major surgery: incidence,
indications and outcome - an observational multicentre study.
Source
Blood Transfusion. 18 (4) (pp 261-279), 2020. Date of Publication: July
2020.
Author
Unal D.; Senayli Y.; Polat R.; Spahn D.R.; Toraman F.; Alkis N.
Institution
(Unal, Polat) Department of Anaesthesiology and Reanimation, University of
Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey
(Senayli) Department of Anaesthesiology and Reanimation, "Ankara Gulhane"
Teaching Hospital, Ankara, Turkey
(Spahn) Institute of Anaesthesiology, University of Zurich, University
Hospital Zurich, Zurich, Switzerland
(Toraman) Department of Anaesthesiology, "Acibadem Mehmet Ali Aydinlar"
University School of Medicine, Istanbul, Turkey
(Alkis) Department of Anaesthesiology and Reanimation, Ankara University
Medical Faculty, Ankara, Turkey
Publisher
Edizioni SIMTI
Abstract
Background - Patients' demographic and epidemiological characteristics
local variations in clinicians' knowledge and experience and types of
surgery can influence peri-operative transfusion practices. Sharing data
on transfusion practices and recipients may improve patients' care and
implementation o Patient Blood Management (PBM). Materials and methods -
This was a multicentre, prospective, observational cross-sectional study
that included 61 centres. Clinical and transfusion data of patients
undergoing major elective surgery were collected; transfusion predictors
and patients' outcomes were analysed. Results - Of 6,121 patients, 1,579
(25.8%) received a peri-operative transfusion A total of 5,812 blood
components were transfused: red blood cells (RBC) fresh-frozen plasma and
platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases,
respectively). Pre-operative anaemia was identified in 2,019 (33%)
patients. Half of the RBC units were used by patients in the age group
45-69 years. Specific procedures with the highest RBC use were coronary
artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%)
Low haemoglobin concentration was the most common indication fo
intra-operative RBC transfusion (57%) and plasma and platelet transfusions
were mostly initiated for acute bleeding (61.3% and 61.1%, respectively)
The RBC transfusion rate in study centres varied from 2% to 72%. RBC
transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23%
(n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC
transfusion episodes. Pre-operative haemoglobin, increased blood loss,
open surgery and duration of surgery were the main independent predictors
o intra-operative RBC transfusion. Low pre-operative haemoglobin
concentration was independently associated with post-operative pulmonary
complications. Conclusions - These findings identified areas for
improvement in peri-operative transfusion practice and PBM implementation
in Turkey. IMTIPRO Sr<br/>Copyright &#xa9; SIMTIPRO Srl

<5>
Accession Number
2007030669
Title
Comparing erector spinae plane block with serratus anterior plane block
for minimally invasive thoracic surgery: a randomised clinical trial.
Source
British Journal of Anaesthesia. 125 (5) (pp 802-810), 2020. Date of
Publication: November 2020.
Author
Finnerty D.T.; McMahon A.; McNamara J.R.; Hartigan S.D.; Griffin M.; Buggy
D.J.
Institution
(Finnerty, McMahon, McNamara, Hartigan, Griffin, Buggy) Division of
Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland
(Finnerty, Buggy) School of Medicine, University College Dublin, Dublin,
Ireland
(Finnerty, Buggy) EU COST Action 15204 Euro-Periscope, Brussels, Belgium
(Buggy) Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Ltd
Abstract
Background: Minimally invasive thoracic surgery causes significant
postoperative pain. Erector spinae plane (ESP) block and serratus anterior
plane (SAP) block promise effective thoracic analgesia compared with
systemically administered opioids, but have never been compared in terms
of terms of quality of recovery and overall morbidity after minimally
invasive thoracic surgery. <br/>Method(s): Sixty adult patients undergoing
minimally invasive thoracic surgery were randomly assigned to receive
either single-shot ESP or SAP block before surgery using levobupivacaine
0.25%, 30 ml. The primary outcome was quality of patient recovery at 24 h,
using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes
included area under the curve (AUC) of pain verbal rating scale (VRS) over
time, time to first opioid analgesia, postoperative 24 h opioid
consumption, in-hospital comprehensive complication index (CCI) score and
hospital stay. <br/>Result(s): The QoR-15 score was higher among ESP
patients compared with those in the SAP group, mean (standard deviation):
114 (16) vs 102 (22) (P=0.02). Time (min) to first i.v. opioid analgesia
in recovery was 32.6 (20.6) in ESP vs 12.7 (9.5) in SAP (P=0.003). AUC at
rest was 92 (31) mm h^-1 vs 112 (35) in ESP and SAP (P=0.03),
respectively, whereas AUC on deep inspiration was 107 mm h^-1
(32) vs 129 (32) in ESP and SAP (P=0.01), respectively. VRS pain on
movement in ESP and SAP at 24 h was, median (25-75% range): 4 (2-4) vs 5
(3-6) (P=0.04), respectively. Opioid consumption at 24 h postoperatively
was 29 (31) vs 39 (34) (P=0.37). Median (25-75%) CCI in ESP and SAP was 1
(0-2) vs 4 (0-26) (P=0.03), whereas hospital stay was 3 (2-6) vs 6 (3-9)
days (P=0.17), respectively. <br/>Conclusion(s): Compared with SAP, ESP
provides superior quality of recovery at 24 h, lower morbidity, and better
analgesia after minimally invasive thoracic surgery. Clinical trial
registration: NCT 03862612.<br/>Copyright &#xa9; 2020 British Journal of
Anaesthesia

<6>
Accession Number
2005802674
Title
Early mobilization reduces delirium after coronary artery bypass graft
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 28 (9) (pp 566-571), 2020. Date
of Publication: 01 Nov 2020.
Author
Shirvani F.; Naji S.A.; Davari E.; Sedighi M.
Institution
(Shirvani, Naji, Davari) Department of Nursing and Midwifery, Isfahan
(Khorasgan) Branch, Islamic Azad University, Isfahan, Iran, Islamic
Republic of
(Sedighi) Department of Neuroscience, Faculty of Advanced Technologies in
Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
SAGE Publications Inc. (United States)
Abstract
Background: Postoperative delirium is common in patients undergoing
coronary artery bypass grafting, characterized by cognitive decline. This
study aimed to evaluate the effect of early planned mobilization on
delirium after coronary artery bypass grafting. <br/>Method(s): This
double-blind randomized clinical trial enrolled 92 consecutive patients
who underwent coronary artery bypass grafting from September to December
2018. The patients were divided into two groups of 46: a mobilization
protocol was applied in the intervention group in the first 2 days after
surgery; the control group received routine nursing care only. Demographic
data, medical records, and Neecham confusion scores were analyzed.
<br/>Result(s): Patients in the control group used cigarettes (31.1% vs.
11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p =
0.002) more frequently, had longer intubation times (11.91 +/- 3.87 vs.
10.23 +/- 2.71 h, p = 0.020), and fewer blood components infused (15.6%
vs. 33.3%, p = 0.05). More patients in the intervention group had normal
function on the 2nd postoperative day compared to the control group (25
vs. 2, respectively, p = 0.001). The intervention group had significantly
higher Neecham scores on postoperative day 2 (22.49 +/- 2.03 vs. 26.82 +/-
2.10, p = 0.001). Multivariable analysis showed significant associations
between Neecham score and age (p = 0.022), ejection fraction (p = 0.015),
myocardial infarction (p = 0.016), systolic pressure (p = 0.009), and
diastolic pressure (p = 0.008). <br/>Conclusion(s): Early planned
mobilization was effective in reducing postoperative delirium in patients
undergoing coronary artery bypass grafting.<br/>Copyright &#xa9; The
Author(s) 2020.

<7>
Accession Number
2008393980
Title
Influence of LDL-Cholesterol Lowering on Cardiovascular Outcomes in
Patients With Diabetes Mellitus Undergoing Coronary Revascularization.
Source
Journal of the American College of Cardiology. 76 (19) (pp 2197-2207),
2020. Date of Publication: 10 Nov 2020.
Author
Farkouh M.E.; Godoy L.C.; Brooks M.M.; Mancini G.B.J.; Vlachos H.; Bittner
V.A.; Chaitman B.R.; Siami F.S.; Hartigan P.M.; Frye R.L.; Boden W.E.;
Fuster V.
Institution
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
(Godoy) Instituto do Coracao, Faculdade de Medicina FMUSP, Universidade de
Sao Paulo, Sao Paulo, SP, Brazil
(Brooks, Vlachos) Epidemiology Data Center, University of Pittsburgh,
Pittsburgh, PA, United States
(Mancini) Division of Cardiology, Department of Medicine, University of
British Columbia, Vancouver, BC, Canada
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Chaitman) Center for Comprehensive Cardiovascular Care, St. Louis
University School of Medicine, St. Louis, MO, United States
(Siami) BostonMAUnited States
(Hartigan) Yale University and VA West Haven, West Haven, CT, United
States
(Frye) Mayo Clinic, Rochester, MN, United States
(Boden) Boston University School of Medicine, VA New England Healthcare
System, VA Boston-Jamaica Plain Campus, Boston, MA, United States
(Fuster) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares, Madrid,
Spain
Publisher
Elsevier Inc.
Abstract
Background: Elevated low-density lipoprotein cholesterol (LDL-C) is
associated with increased cardiovascular events, especially in high-risk
populations. <br/>Objective(s): This study sought to evaluate the
influence of LDL-C on the incidence of cardiovascular events either
following a coronary revascularization procedure (percutaneous coronary
intervention [PCI] or coronary artery bypass grafting [CABG]) or optimal
medical therapy alone in patients with established coronary heart disease
and type 2 diabetes (T2DM). <br/>Method(s): Patient-level pooled analysis
of 3 randomized clinical trials was undertaken. Patients with T2DM were
categorized according to the levels of LDL-C at 1 year following
randomization. The primary endpoint was major adverse cardiac or
cerebrovascular events ([MACCE] the composite of all-cause mortality,
nonfatal myocardial infarction, and nonfatal stroke). <br/>Result(s): A
total of 4,050 patients were followed for a median of 3.9 years after the
index 1-year assessment. Patients whose 1-year LDL-C remained >=100 mg/dl
experienced higher 4-year cumulative risk of MACCE (17.2% vs. 13.3% vs.
13.1% for LDL-C between 70 and <100 mg/dl and LDL-C <70 mg/dl,
respectively; p = 0.016). When compared with optimal medical therapy
alone, patients with PCI experienced a MACCE reduction only if 1-year
LDL-C was <70 mg/dl (hazard ratio: 0.61; 95% confidence interval: 0.40 to
0.91; p = 0.016), whereas CABG was associated with improved outcomes
across all 1-year LDL-C strata. In patients with 1-year LDL-C >=70 mg/dl,
patients undergoing CABG had significantly lower MACCE rates as compared
with PCI. <br/>Conclusion(s): In patients with coronary heart disease with
T2DM, lower LDL-C at 1 year is associated with improved long-term MACCE
outcome in those eligible for either PCI or CABG. When compared with
optimal medical therapy alone, PCI was associated with MACCE reductions
only in those who achieved an LDL-C <70 mg/dl.<br/>Copyright &#xa9; 2020

<8>
Accession Number
2007171799
Title
Comparative Effects of Single-Dose Cardioplegic Solutions Especially in
Repeated Doses During Minimally Invasive Aortic Valve Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2020. Date of Publication: 2020.
Author
Gunaydin S.; Akbay E.; Gunertem O.E.; McCusker K.; Kunt A.T.; Onur M.A.;
Ozisik K.
Institution
(Gunaydin, Gunertem, Kunt, Ozisik) Department of Cardiovascular Surgery,
Ankara City Hospital, Turkey
(Akbay, Onur) Faculty of Science, Hacettepe University, Ankara, Turkey
(McCusker) New York Medical College, Valhalla, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: This study aims to compare del Nido cardioplegia (DNC) and
histidine-tryptophan-ketoglutarate (HTK) cardioplegic solutions in
minimally invasive aortic valve replacement (mini-AVR) surgery to discuss
the safety level of myocardial protection and rationale for redosing
intervals. <br/>Method(s): During the period from January 2017 to June
2019, 200 patients undergoing mini-AVR (solely or with concomitant
procedures) were prospectively randomized to DNC (n = 100) and HTK (n =
100), both up to 90 minutes ischemic time. Patients with ischemic time
over 90 minutes, needing a redosing, were further analyzed in 2 subgroups
with DNC-R (n = 30) and HTK-R (n = 36). Sensitive biomarkers, in addition
to routine biochemistry, were also documented at baseline (T1), after
cessation of cardiopulmonary bypass (T2), and on the first postoperative
day (T3). Transmural myocardial biopsies were sampled for staining.
<br/>Result(s): No statistical differences could be demonstrated in DNC
and HTK groups with up to 90 minutes cross-clamp times in routine
biochemical measurements and basic perioperative clinical outcomes. DNC-R
showed significantly more arrhythmia/AV block incidence resulting in more
extended intensive care unit (ICU) stay. Interleukin-6 and syndecan-1 in
DNC and DNC-R groups were substantially higher at T2. Aquaporin-4 levels
were significantly lower in the DNC-R group, demonstrating unsatisfactory
response of cells to an excessive volume at T2. <br/>Conclusion(s): DNC
and HTK provided acceptable myocardial protection as single-dose
applications. DNC-R had significantly unbalanced levels of biomarkers, and
more arrhythmia/AV block incidence resulting in more extended ICU stay.
For patients who may need redosing HTK may be preferable to
DNC.<br/>Copyright &#xa9; The Author(s) 2020.

<9>
Accession Number
2007163541
Title
Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A
Meta-analysis.
Source
Pediatric Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Farias J.S.; Villarreal E.G.; Flores S.; Mastropietro C.W.; Vogel M.;
Schulz K.; Culichia C.; Iliopoulos I.D.; Bronicki R.A.; Loomba R.S.
Institution
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Flores, Bronicki) Texas Children's Hospital, Houston, TX, United States
(Flores, Bronicki) Baylor College of Medicine, Houston, TX, United States
(Mastropietro) Riley's Children's Health, Indianapolis, IN, United States
(Mastropietro) Indiana University School of Medicine, Indianapolis, IN,
United States
(Vogel, Schulz, Culichia, Loomba) Chicago Medical School/Rosalind Franklin
University of Medicine and Science, North Chicago, IL, United States
(Vogel, Schulz, Culichia, Loomba) Advocate Children's Heart
Institute/Advocate Children's Hospital, Oak Lawn, IL, United States
(Iliopoulos) Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
(Villarreal) Department of Pediatrics, Tecnologico de Monterrey, Escuela
de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Publisher
Springer
Abstract
Vasopressin has been used to augment blood pressure; however,
cardiovascular effects after cardiac surgery have not been well
established. The primary objective of this study was to survey the current
literature and quantify the pooled effect of vasopressin on hemodynamic
parameters in children after pediatric cardiac surgery. A systematic
review was conducted to identify studies characterizing the hemodynamic
effects of vasopressin after pediatric cardiac surgery. Studies were
assessed and those of satisfactory quality with pre- and post-vasopressin
hemodynamics for each patient were included in the final analyses. 6
studies with 160 patients were included for endpoints during the first 2 h
of infusions. Patients who received vasopressin infusion had greater mean,
systolic, and diastolic blood pressures and lower heart rates at 2 h after
initiation. 8 studies with 338 patients were included for the effects at
24 h. Patients who received vasopressin infusion had lower central venous
pressures and decreased lactate concentrations 24 h after initiation. A
subset analysis for children with functionally univentricular hearts found
significant decrease in inotrope score and central venous pressure. A
subset analysis for neonates found significant decrease in inotrope score
and fluid balance. Vasopressin leads to decrease in heart rate and
increase in blood pressure in the first 2 h of initiation. Later effects
include decrease in inotrope score, central venous pressure, fluid
balance, and in lactate within the first 24 h. Findings vary in neonates
and in those with functionally univentricular hearts although beneficial
effects are noted in both.<br/>Copyright &#xa9; 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<10>
Accession Number
2004925503
Title
Systematic Review: Treatment for Addictive Disorder in Transplant
Patients.
Source
American Journal on Addictions. 29 (6) (pp 445-462), 2020. Date of
Publication: November 2020.
Author
Luchsinger W.; Zimbrean P.
Institution
(Luchsinger, Zimbrean) Yale University School of Medicine, New Haven, CT,
United States
(Zimbrean) Yale New Haven Hospital, New Haven, CT, United States
Publisher
Wiley Blackwell
Abstract
Background and Objectives: The number of patients with substance use
disorders in need for organ transplantation is expected to increase.
Patients with addictive disorders are considered a higher risk of negative
outcomes after organ transplantation due to the impact of substance use
upon medical status and adherence with treatment. The goal of this
systematic review was to assess the current literature on treatment for
addiction transplant candidates and recipients. <br/>Method(s): We
conducted a literature search within four databases PubMed, MEDLINE,
EMBASE, and PsycINFO for publications dated 1/1/1988 to 12/31/2018.
<br/>Result(s): Out of 3108 articles identified through database
screening, 39 were included in the qualitative synthesis. Sixteen studies
described addiction treatment in groups over five patients. All the
articles included liver transplant patients, with only two studies
including patients who needed a kidney or a heart transplant. Nine
articles described treatment of alcohol use disorder exclusively, five
focused on treatment of opioid use disorders. Although 9 of 16 studies
were prospective, the variability of the treatment intervention, outcome
measures, and control group when applicable prohibited a meaningful
meta-analysis of the results. Eight articles that described the case
reports are analyzed separately. Discussion and <br/>Conclusion(s):
Promising treatment options for alcohol use disorder have been reported
but more studies are needed to confirm their effectiveness and their
feasibility. Methadone appears effective for opioid disorder in transplant
patients. Scientific Significance: To the best of our knowledge, this is
the first systematic review on the treatment of addictive disorders in
transplant patients. (Am J Addict 2020;29:445-462).<br/>Copyright &#xa9;
2020 American Academy of Addiction Psychiatry

<11>
Accession Number
633361723
Title
Inotropic agents and vasodilator strategies for the treatment of
cardiogenic shock or low cardiac output syndrome.
Source
The Cochrane database of systematic reviews. 11 (pp CD009669), 2020. Date
of Publication: 05 Nov 2020.
Author
Uhlig K.; Efremov L.; Tongers J.; Frantz S.; Mikolajczyk R.; Sedding D.;
Schumann J.
Institution
(Uhlig, Schumann) Department of Anaesthesiology and Surgical Intensive
Care, Martin-Luther-University Halle-Wittenberg ,Halle/Saale, Germany
(Efremov, Mikolajczyk) Institute for Medical Epidemiology, Biometrics and
Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical
School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale),
Germany
(Tongers, Sedding) Cardiology, Angiology and Intensive Care Medicine,
University Hospital Halle (Saale), Halle (Saale), Germany
(Frantz) Department of Internal Medicine I, University Hospital Wurzburg,
Wurzburg, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS)
are potentially life-threatening complications of acute myocardial
infarction (AMI), heart failure (HF) or cardiac surgery. While there is
solid evidence for the treatment of other cardiovascular diseases of acute
onset, treatment strategies in haemodynamic instability due to CS and LCOS
remains less robustly supported by the given scientific literature.
Therefore, we have analysed the current body of evidence for the treatment
of CS or LCOS with inotropic and/or vasodilating agents. This is the
second update of a Cochrane review originally published in 2014.
<br/>OBJECTIVE(S): Assessment of efficacy and safety of cardiac care with
positive inotropic agents and vasodilator agents in CS or LCOS due to AMI,
HF or after cardiac surgery. <br/>SEARCH METHOD(S): We conducted a search
in CENTRAL, MEDLINE, Embase and CPCI-S Web of Science in October 2019. We
also searched four registers of ongoing trials and scanned reference lists
and contacted experts in the field to obtain further information. No
language restrictions were applied. SELECTION CRITERIA: Randomised
controlled trials (RCTs) enrolling patients with AMI, HF or cardiac
surgery complicated by CS or LCOS. DATA COLLECTION AND ANALYSIS: We used
standard methodological procedures according to Cochrane standards. MAIN
RESULTS: We identified 19 eligible studies including 2385 individuals
(mean or median age range 56 to 73 years) and three ongoing studies. We
categorised studies into 11 comparisons, all against standard cardiac care
and additional other drugs or placebo. These comparisons investigated the
efficacy of levosimendan versus dobutamine, enoximone or placebo;
enoximone versus dobutamine, piroximone or epinephrine-nitroglycerine;
epinephrine versus norepinephrine or norepinephrine-dobutamine; dopexamine
versus dopamine; milrinone versus dobutamine and dopamine-milrinone versus
dopamine-dobutamine. All trials were published in peer-reviewed journals,
and analyses were done by the intention-to-treat (ITT) principle. Eighteen
of 19 trials were small with only a few included participants. An
acknowledgement of funding by the pharmaceutical industry or missing
conflict of interest statements occurred in nine of 19 trials. In general,
confidence in the results of analysed studies was reduced due to relevant
study limitations (risk of bias), imprecision or indirectness. Domains of
concern, which showed a high risk in more than 50% of included studies,
encompassed performance bias (blinding of participants and personnel) and
bias affecting the quality of evidence on adverse events. All comparisons
revealed uncertainty on the effect of inotropic/vasodilating drugs on
all-cause mortality with a low to very low quality of evidence. In detail,
the findings were: levosimendan versus dobutamine (short-term mortality:
RR 0.60, 95% CI 0.36 to 1.03; participants = 1701; low-quality evidence;
long-term mortality: RR 0.84, 95% CI 0.63 to 1.13; participants = 1591;
low-quality evidence); levosimendan versus placebo (short-term mortality:
no data available; long-term mortality: RR 0.55, 95% CI 0.16 to 1.90;
participants = 55; very low-quality evidence); levosimendan versus
enoximone (short-term mortality: RR 0.50, 0.22 to 1.14; participants = 32;
very low-quality evidence; long-term mortality: no data available);
epinephrine versus norepinephrine-dobutamine (short-term mortality: RR
1.25; 95% CI 0.41 to 3.77; participants = 30; very low-quality evidence;
long-term mortality: no data available); dopexamine versus dopamine
(short-term mortality: no deaths in either intervention arm; participants
= 70; very low-quality evidence; long-term mortality: no data available);
enoximone versus dobutamine (short-term mortality RR 0.21; 95% CI 0.01 to
4.11; participants = 27; very low-quality evidence; long-term mortality:
no data available); epinephrine versus norepinephrine (short-term
mortality: RR 1.81, 0.89 to 3.68; participants = 57; very low-quality
evidence; long-term mortality: no data available); and dopamine-milrinone
versus dopamine-dobutamine (short-term mortality: RR 1.0, 95% CI 0.34 to
2.93; participants = 20; very low-quality evidence; long-term mortality:
no data available). No information regarding all-cause mortality were
available for the comparisons milrinone versus dobutamine, enoximone
versus piroximone and enoximone versus epinephrine-nitroglycerine.
AUTHORS' <br/>CONCLUSION(S): At present, there are no convincing data
supporting any specific inotropic or vasodilating therapy to reduce
mortality in haemodynamically unstable patients with CS or LCOS.
Considering the limited evidence derived from the present data due to a
high risk of bias and imprecision, it should be emphasised that there is
an unmet need for large-scale, well-designed randomised trials on this
topic to close the gap between daily practice in critical care of
cardiovascular patients and the available evidence. In light of the
uncertainties in the field, partially due to the underlying methodological
flaws in existing studies, future RCTs should be carefully designed to
potentially overcome given limitations and ultimately define the role of
inotropic agents and vasodilator strategies in CS and LCOS.<br/>Copyright
&#xa9; 2020 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<12>
Accession Number
2008411169
Title
Anatomy versus physiology-guided ablation for persistent atrial
fibrillation.
Source
Journal of Atrial Fibrillation. 12 (6) (no pagination), 2020. Date of
Publication: 2020.
Author
Deshmukh A.; Zhong L.; Slusser J.; Xiao P.; Zhang P.; Hodge D.; Hocini M.;
McLeod C.; Bradley D.; Munger T.; Packer D.; Cha Y.-M.
Institution
(Deshmukh, Zhong, Xiao, Zhang, McLeod, Bradley, Munger, Packer, Cha)
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United
States
(Hocini) Bordeaux University Hospital, LIRYC Institute, Pessac, France
(Slusser, Hodge) Department of Health Sciences Research, Mayo Clinic,
Rochester, MN, United States
Publisher
CardioFront LLC
Abstract
Background: Pulmonary vein isolation remains the cornerstone of atrial
fibrillation (AF) ablation. However, due to high recurrence rates,
especially in patients with persistent AF, PV antral isolation,
complemented by linear ablation, autonomic modulation, and ablation of
complex fractionated electrograms, have been attempted to increase the
odds of success. However, the optimum approach for a complementary
strategy in addition to PVI for persistent AF is unknown. <br/>Method(s):
We performed a prospective randomized trial by assigning 92 patients with
persistent AF in 1:1 ratio to pulmonary-vein isolation plus ablation of
electrograms showing complex fractionated activity (45 patients), or
pulmonary-vein isolation plus additional linear ablation across the left
atrial roof and mitral valve isthmus (47 patients). The duration of
follow-up was five years. The primary endpoint was freedom from any
documented recurrence of atrial fibrillation after a single ablation
procedure. <br/>Result(s): At a 12-month follow-up, 9 (23%) patients had
AF recurrence in the linear ablation and 8 (21%) patients in the CFAE
groups. At a mean follow-up duration of 59+/-36 months, 48.3% of patients
in the linear ablation group and 44.6% of patients in the CFAE group were
free from AF (p=0.403). There were no significant differences between the
two groups for independent predictors of freedom from AF. The overall
procedure time and radiation exposure were higher in the PVI+linear
ablation group. There were five adverse events noted, two in the linear
group (pericardial effusion not requiring drain) and 3 in the CFAE group
(1 pseudoaneurysm, one effusion requiring pericardiocentesis and one
effusion nor requiring drain). <br/>Conclusion(s): Among patients with
persistent atrial fibrillation, we found no difference in maintenance of
sinus rhythm in either linear ablation or ablation of complex fractionated
electrograms was performed in addition to pulmonary vein isolation in
short- and long-term follow-up.<br/>Copyright &#xa9; 2020 CardioFront LLC.
All rights reserved.

<13>
Accession Number
2008509573
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. 29 (10) (pp 1211-1219),
2020. Date of Publication: 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
Wroclaw University of Medicine
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.<br/>Copyright
&#xa9; 2020 by Wroclaw Medical University This is an article distributed
under the terms of the Creative Commons Attribution 3.0 Unported (CC BY
3.0) (https://creativecommons.org/licenses/by/3.0/)

<14>
Accession Number
2008566461
Title
The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain
After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Xu Z.; Dai S.-H.; Jiang J.-L.; He L.-L.; Zheng J.-Q.; Yu H.
Institution
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) Department of Anesthesiology, West
China Hospital, Sichuan University, Chengdu, China
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) The Research Units of West China
(2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Sternal incisions can generate persistent and intense
post-sternotomy pain. Propofol has been shown to improve postoperative
analgesia, but the preventive effect on persistent pain after cardiac
surgery is unknown. The hypothesis of the present study was that
intraoperative propofol-based anesthesia compared with volatile anesthesia
could reduce the risk of chronic pain after cardiac surgery.
<br/>Design(s): A single-center, two-arm, patient-and-evaluator-blinded,
randomized controlled trial. <br/>Setting(s): A single major urban
teaching and university hospital. <br/>Patient(s): Five-hundred adult
patients undergoing cardiac surgery via sternotomy randomly were assigned.
With six withdrawals from the study and five from surgery, 244 in the
total intravenous anesthesia group and 245 in the volatile group were
included in the modified intention-to-treat analysis.
<br/>Intervention(s): Patients randomly were assigned to receive either
propofol-based total intravenous anesthesia or volatile anesthesia during
surgery. <br/>Measurements and Main Results: The primary outcomes were the
incidence of pain at three, six, and 12 months after surgery defined as
pain score >0 on the numeric rating scale. The secondary outcomes included
acute pain, opioid use during the first 72 hours after surgery, and
quality of life. The use of propofol did not significantly affect chronic
pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence
interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%,
difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v
20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with
volatile anesthetics. Furthermore, there were no differences in acute pain
score; morphine-equivalent consumption during the first 72 hours; and
quality of life at three, six, and 12 months after surgery.
<br/>Conclusion(s): Intraoperative administration of propofol did not
reduce persistent pain after cardiac surgery compared with volatile
anesthetics.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<15>
Accession Number
2008500329
Title
Critical Review and Meta-Analysis of Postoperative Sedation after Adult
Cardiac Surgery: Dexmedetomidine Versus Propofol.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Abowali H.A.; Paganini M.; Enten G.; Elbadawi A.; Camporesi E.M.
Institution
(Abowali, Paganini, Enten, Camporesi) Team Health Research Institute,
Tampa General Hospital, Tampa, FL, United States
(Elbadawi) University of Texas Medical Branch, Galveston, TX, United
States
Publisher
W.B. Saunders
Abstract
Objective: To evaluate reports from the published literature of all
randomized clinical trials (RCT) comparing postoperative sedation with
dexmedetomidine versus propofol in adult patients, after open cardiac
surgery. <br/>Design(s): A computerized search on Medline, EMBASE, Web of
Science, and Agency for Healthcare Research and Quality databases was
completed through June 2020. Meta-analysis of all published RCT comparing
dexmedetomidine versus propofol utilization in the postoperative phase,
using the standard Preferred Reporting Items for Systematic Reviews and
Meta-Analyses checklist. <br/>Setting(s): Assemblage and critical
discussion of 11 RCTs comparing postoperative sedation from standard
published reports from 2003 to 2019. <br/>Participant(s): The study
comprised 1,184 patients and analyzed critical discussion of time-based
parameters (time to extubation, intensive care unit length of stay, and
hospital length of stay) and nontime-dependent factors (delirium,
bradycardia, and hypotension). <br/>Measurements and Main Results: Time to
extubation was significantly reduced in the dexmedetomidine group
(standardized mean difference [SMD] = -0.70, 95% confidence interval [CI]
-0.98 to -0.42, p < 0.001); however, no difference in mechanical
ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.).
Dexmedetomidine significantly reduced the intensive care unit length of
stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not
translate into a reduced hospital length of stay (SMD = -1.13, 95% CI
-2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium
was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06,
N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p =
0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were
reported with propofol. <br/>Conclusion(s): Despite the ICU time
advantages afforded by dexmedetomidine over propofol, the former did not
seem to contribute to an overall reduction in hospital length of stay or
improvement in postoperative outcomes of heart valve surgery and CABG
patients.<br/>Copyright &#xa9; 2020

<16>
Accession Number
2008476891
Title
Clinical outcomes of the self-expandable Evolut R valve versus the
balloon-expandable SAPIEN 3 valve in transcatheter aortic valve
implantation; a meta-analysis and systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Al-abcha A.; Saleh Y.; Charles L.; Prasad R.; Baloch Z.Q.; Hasan M.A.;
Abela G.S.
Institution
(Al-abcha, Charles, Prasad) Department of Internal Medicine, Michigan
State University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist Hospital, Houston, TX,
United States
(Baloch, Abela) Department of Internal Medicine, Division of Cardiology,
Michigan State University, East Lansing, MI, United States
(Hasan) Department of Cardiology, Ochsner Clinic, New Orleans, LA, United
States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is now indicated
in patients with symptomatic aortic stenosis and low, moderate, and high
surgical risk. There are multiple types of valves available in TAVR.
SAPIEN 3, and Evolut R are two of the most commonly used valves.
<br/>Method(s): We conducted a systematic review and meta-analysis of all
studies that compared SAPIEN 3 vs Evolut R in patients undergoing TAVR.
The primary endpoint of this meta-analysis was 30-day mortality. Secondary
outcomes included major of life-threatening bleeding, risk of stroke, need
of permanent pacemaker implantation, and risk of moderate to severe
paravalvular regurgitation (PVR). <br/>Result(s): We included a total of 9
studies. One study was a randomized clinical trial, five were prospective
observational studies and three were retrospective. 30-day mortality rate
was similar between SAPIEN 3 and Evolut R (odds ratio (OR) 1.19; 95%
confidence interval (CI) 0.72 to 1.93; p = 0.47). The risk of major or
life-threatening bleeding (OR of 0.83, 95% CI 0.50 to 1.39; p = 0.48), and
the risk of stroke (OR of 0.82, 95% CI 0.38 to 1.78; p = 0.62) were also
similar between the two types of valves. Compared to SAPIEN 3, Evolut R
was associated with statistically significant risk of permanent pacemaker
implantation (OR of 1.40, 95% CI 1.15 to 1.70; p = 0.0007), and moderate
to severe PVR (OR of 2.56, 95% CI 1.14 to 5.74; p = 0.02).
<br/>Conclusion(s): At 30 day follow up, both Evolut R and SAPIEN 3 shared
similar risks of 30-day mortality, major or life-threatening bleeding, and
stroke; however greater odds of pacemaker placement implantation and
moderate to severe PVR were associated with Evolut R.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<17>
Accession Number
2007179059
Title
Application of the Hybrid Operating Room in Surgery: A Systematic Review.
Source
Journal of Investigative Surgery. (no pagination), 2020. Date of
Publication: 2020.
Author
Jin H.; Liu J.
Institution
(Jin) The Second Department of General Surgery, Zhuhai People's Hospital
(Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong,
China
(Liu) Zhuhai Health Bureau, Zhuhai, Guangdong, China
Publisher
Taylor and Francis Ltd.
Abstract
Background and objective: The hybrid operating room has been widely
applied in surgery, including neurology, general surgery, gynecology, and
obstetrics. By reviewing application of the hybrid operating room in
different categories of surgery, we aim to summarize both advantages and
disadvantages of the hybrid operating room and discuss what to do for
further improving the application of it. <br/>Method(s): We searched
related literature in websites including Pubmed, MEDLINE, Web of science,
using the keywords "hybrid operating room", "surgery", "technique",
"intervention", and "radiology". All the searched papers were screened and
underwent quality evaluation. The eventually selected papers were
carefully read, with related information extracted and summarized.
<br/>Result(s): After screening and assessment, a total of 29 literature
was collected. Application of the hybrid operating room in general
surgery, neurosurgery, thoracic surgery, urology, gynecologic and
obstetrics surgery, and cardiovascular surgery was summarized. Both
advantages and disadvantages of the hybrid operating room were discussed
in order to improve application of the hybrid operating room in surgery.
<br/>Conclusion(s): Surgeries performed in the hybrid operating room take
advantages over those conventional operating rooms mainly in terms of
higher procedure accuracy, less operative time, and less risk of
hemorrhage during the transportation between radiology departments and
operating suites. Further efforts should be made to reduce radiation
exposure from imaging systems equipped in the hybrid operating room and
increase cost-effectiveness ratio of the hybrid operating
room.<br/>Copyright &#xa9; 2020 Taylor & Francis Group, LLC.

<18>
Accession Number
633364533
Title
Robot-assisted coronary artery bypass surgery: a systematic review and
meta-analysis of comparative studies.
Source
Canadian journal of surgery. Journal canadien de chirurgie. 63 (6) (pp
E491-E508), 2020. Date of Publication: 01 Nov 2020.
Author
Hammal F.; Nagase F.; Menon D.; Ali I.; Nagendran J.; Stafinski T.
Institution
(Hammal, Nagase, Menon, Ali, Nagendran, Stafinski) From the Health
Technology & Policy Unit, School of Public Health, University of Alberta,
Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac
Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of
Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB
(Ali); and the Division of Cardiac Surgery, Department of Surgery,
Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB
(Nagendran)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Robot-assisted coronary bypass (RCAB) surgery has been
proposed as an alternative to conventional coronary artery bypass grafting
(C-CABG) for managing coronary heart disease, but the evidence on its
performance compared to other existing treatments is unclear. The aim of
this study was to assess, through a systematic review of comparative
studies, the safety and clinical effectiveness of RCAB compared to C-CABG
and other minimally invasive approaches for the treatment of coronary
heart disease. <br/>METHOD(S): We conducted a systematic review of primary
studies in the English-language literature comparing RCAB to existing
treatment options (C-CABG, minimally invasive direct coronary artery
bypass [MIDCAB] and port-access coronary artery bypass [PA-CAB]) following
Cochrane Collaboration guidelines. Meta-analyses were performed where
appropriate. <br/>RESULT(S): We reviewed 13 studies: 11 primary studies of
RCAB (v. C-CABG in 7, v. MIDCAB in 3 and v. PA-CAB in 1) and 2 multicentre
database studies (RCAB v. non-RCAB). The overall quality of the evidence
was low. Most studies showed no significant benefit of RCAB over other
treatments in a majority of outcome variables. Meta-analyses showed that
RCAB had lower rates of pneumonia or wound infection than C-CABG, and
shorter intensive care unit length of stay than C-CABG or MIDCAB.
Individual studies showed that RCAB had some better outcomes than C-CABG
(ventilation time, transfusion, postoperative pain, hospital length of
stay) or MIDCAB (transfusion, postoperative pain, time to return to normal
activities, physical functioning and hospital length of stay). The review
of the database studies showed that RCAB was statistically superior to
non-RCAB approaches in postoperative pain, renal failure, transfusion,
reoperation for bleeding, stroke and hospital length of stay; however, the
difference between the 2 groups in several of these outcomes was small.
<br/>CONCLUSION(S): Although the findings from this review of comparative
studies of RCAB appear promising and suggest that RCAB may offer some
benefits to patients, in the absence of randomized controlled trials,
these results should be interpreted cautiously.

<19>
Accession Number
2007160567
Title
Diabetic retinopathy predicts cardiovascular mortality in diabetes: a
meta-analysis.
Source
BMC Cardiovascular Disorders. 20 (1) (no pagination), 2020. Article
Number: 478. Date of Publication: 01 Dec 2020.
Author
Xu X.-H.; Sun B.; Zhong S.; Wei D.-D.; Hong Z.; Dong A.-Q.
Institution
(Xu, Sun, Zhong) Department of Endocrinology, The Second Affiliated
Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
310009, China
(Wei, Hong, Dong) Department of Cardiovascular Surgery, The Second
Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou,
Zhejiang 310009, China
Publisher
BioMed Central Ltd (United Kingdom)
Abstract
Background: The prognostic significance of diabetic retinopathy (DR) for
cardiovascular diseases (CVD) remained unclear. Therefore, we performed
this meta-analysis to assess whether DR predicted CVD mortality in
diabetic patients. <br/>Method(s): We searched PubMed, Embase, Web of
Science and Cochrane Library for cohort studies reporting the association
of DR and CVD mortality. Then we pooled the data for analysis.
<br/>Result(s): After screening the literature, 10 eligible studies with
11,239 diabetic subjects were finally included in quantitative synthesis.
The pooled risk ratio (RR) of DR, mild DR, and severe DR for CVD mortality
was 1.83 (95% confidence interval (CI): 1.42, 2.36; p < 0.001), 1.13 (95%
CI 0.81, 1.59; p = 0.46), and 2.26 (1.31, 3.91; p = 0.003), respectively,
compared to those without DR. In type 2 DM, the patients with DR had a
significantly higher CVD mortality (RR: 1.69; 95% CI 1.27, 2.24; p <
0.001). Subgroup analysis also showed a significantly higher CVD mortality
in DR according to various regions, study design, data source, and
follow-up period (all RR > 1; all P values < 0.05). Data from 2 studies
showed no significant correlation of DR and CVD mortality in diabetic
patients receiving cardiovascular surgery (RR: 2.40; 95% CI 0.63, 9.18; P
= 0.200). <br/>Conclusion(s): DR is a risk marker of cardiovascular death,
and severe DR predicts a doubled mortality of CVD in diabetes. These
findings indicate the importance of early identification and management of
diabetic patients with DR to reduce the risk of death.<br/>Copyright
&#xa9; 2020, The Author(s).

<20>
Accession Number
632820527
Title
Intravenous iron therapy for patients with preoperative iron deficiency or
anaemia undergoing cardiac surgery reduces blood transfusions: A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (2) (pp 141-151),
2020. Date of Publication: 01 Aug 2020.
Author
Gupta S.; Panchal P.; Gilotra K.; Wilfred A.M.; Hou W.; Siegal D.;
Whitlock R.P.; Belley-Cote E.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, Hamilton,
ON, Canada
(Gupta, Whitlock) Department of Health Research Methods, Evidence and
Impact, McMaster University, Hamilton, ON, Canada
(Panchal, Gilotra, Wilfred, Hou) Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Siegal, Belley-Cote) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Siegal, Whitlock, Belley-Cote) Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) David Braley Cardiac, Vascular and Stroke Research
Institute, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: The benefits of preoperative intravenous (IV) iron treatment
in cardiac surgery patients with preoperative anaemia or iron deficiency
have not been well-established. We performed a systematic review and
meta-analysis to determine the effects of treating preoperative anaemia or
iron deficiency with IV iron in adult cardiac surgery patients.
<br/>METHOD(S): We searched Cochrane Central Register of Controlled
Trials, Medical Literature Analysis and Retrieval Systems Online and
Excerpta Medica Database for randomized controlled trials (RCTs) and
observational studies comparing IV iron to oral iron or no iron. We
performed title and abstract, full-text screening, data extraction and
risk of bias assessment independently and in duplicate. We pooled data
using a random effects model and evaluated the overall quality of
evidence. <br/>RESULT(S): We identified 4 RCTs and 7 observational
studies. Pooled data from observational studies suggested a benefit of IV
iron compared to no iron on mortality [relative risk 0.39, 95% confidence
interval (CI) 0.23-0.65; P < 0.001, very low quality], units transfused
per patient (mean difference -1.22, 95% CI -1.85 to -0.60; P < 0.001, very
low quality), renal injury (relative risk 0.50, 95% CI 0.36-0.69; P <
0.001, very low quality) and hospital length of stay (mean difference
-4.24 days, 95% CI -6.86 to -1.63; P = 0.001, very low quality). Pooled
data from RCTs demonstrated a reduction in the number of patients
transfused with IV iron compared to oral or no iron (relative risk 0.81,
95% CI 0.70-0.94; P = 0.005, moderate quality). The pooled estimates of
effect from RCTs for mortality, hospital length of stay, units transfused
per patient and renal injury were consistent in direction with
observational studies. <br/>CONCLUSION(S): This meta-analysis suggests
that IV iron improves postoperative morbidity in adult cardiac surgery
patients with preoperative anaemia or iron deficiency. A large, rigorous,
placebo-controlled, double-blinded, multicentre trial is needed to clarify
the role of IV iron in this patient population.<br/>Copyright &#xa9; The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<21>
Accession Number
631496003
Title
Proposal for Updated Nomenclature and Classification of Potential
Causative Mechanism in Patent Foramen Ovale-Associated Stroke.
Source
JAMA Neurology. 77 (7) (pp 878-886), 2020. Date of Publication: July 2020.
Author
Tobis J.M.; Elgendy A.Y.; Saver J.L.; Amin Z.; Boudoulas K.D.; Carroll
J.D.; Elgendy I.Y.; Grunwald I.Q.; Gertz Z.M.; Hijazi Z.M.; Horlick E.M.;
Kasner S.E.; Kent D.M.; Kumar P.; Kavinsky C.J.; Liebeskind D.S.; Lutsep
H.; Mojadidi M.K.; Messe S.R.; Mas J.-L.; Mattle H.P.; Meier B.; Mahmoud
A.; Mahmoud A.N.; Nietlispach F.; Patel N.K.; Rhodes J.F.; Reisman M.;
Sommer R.J.; Sievert H.; Sondergaard L.; Zaman M.O.; Thaler D.
Institution
(Elgendy) Division of Cardiovascular Medicine, Department of Medicine,
University of Florida, Gainesville, United States
(Saver, Liebeskind) Comprehensive Stroke Center, David Geffen School of
Medicine, Department of Neurology, University of California, Los Angeles,
Los Angeles, United States
(Amin) Children's Hospital of Georgia, Department of Pediatric Cardiology,
Augusta University, Augusta, GA, United States
(Boudoulas) Division of Cardiovascular Medicine, Department of Medicine,
Ohio State University, Columbus, United States
(Carroll) Division of Cardiology, Department of Medicine, University of
Colorado, Denver, Aurora, United States
(Elgendy) Division of Cardiology, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Grunwald, Sievert) Cardiovascular Center Frankfurt, Frankfurt, Germany
(Grunwald, Sievert) Anglia Ruskin University, Chelmsford, United Kingdom
(Gertz, Mojadidi, Patel) Division of Cardiovascular Medicine, Department
of Medicine, Virginia Commonwealth University, Richmond, United States
(Hijazi) Sidra Heart Center, Sidra Medicine, Weill Cornell Medical
College, Doha, Qatar
(Horlick) Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, University of
Toronto, Toronto, ON, Canada
(Kasner, Messe) Perelman School of Medicine, Department of Neurology,
University of Pennsylvania, Philadelphia, United States
(Kent, Thaler) Department of Neurology, Tufts University School of
Medicine, Boston, MA, United States
(Tobis, Kumar) David Geffen School of Medicine, Division of Cardiology,
Department of Medicine, University of California, Los Angeles, 10833 Le
Conte Ave, Factor Bldg CHS, Room B-976, Los Angeles, CA 90095, United
States
(Kavinsky) Division of Cardiology, Rush University Medical Center,
Chicago, IL, United States
(Lutsep) Department of Neurology, Oregon Health and Science University,
Portland, United States
(Mas) Sainte-Anne Hospital, Department of Neurology, Departement
Hospitalo-Universitaire NeuroVasc Sorbonne Paris-Cite, Institut National
de la Sante, Recherche Medicale 894, Paris, France
(Mattle) Department of Neurology, University Hospital of Bern, Bern,
Switzerland
(Meier) Department of Cardiology, University Hospital of Bern, Bern,
Switzerland
(Mahmoud, Zaman) Department of Medicine, University of Florida,
Gainesville, United States
(Mahmoud, Reisman) Division of Cardiology, Department of Medicine,
University of Washington Medical Center, Seattle, United States
(Nietlispach) CardioVascular Center Zurich, Hirslanden Klinik im Park,
Zurich, Switzerland
(Rhodes) Medical University of South Carolina, Charleston, United States
(Sommer) Herbert and Sandi Feinberg Interventional Cardiology and Heart
Valve Center, Columbia University Medical Center, New York, NY, United
States
(Sondergaard) Department of Cardiology, Rigshospitalet, Copenhagen,
Denmark
Publisher
American Medical Association
Abstract
Importance: Recent epidemiologic and therapeutic advances have transformed
understanding of the role of and therapeutic approach to patent foramen
ovale (PFO) in ischemic stroke. Patent foramen ovale is likely responsible
for approximately 5% of all ischemic strokes and 10% of those occurring in
young and middle-aged adults. Observations: Randomized clinical trials
have demonstrated that, to prevent recurrent ischemic stroke in patients
with PFO and an otherwise-cryptogenic index ischemic stroke, PFO closure
is superior to antiplatelet medical therapy alone; these trials have
provided some evidence that, among medical therapy options, anticoagulants
may be more effective than antiplatelet agents. <br/>Conclusions and
Relevance: These new data indicate a need to update classification schemes
of causative mechanisms in stroke, developed in an era in which an
association between PFO and stroke was viewed as uncertain. We propose a
revised general nomenclature and classification framework for
PFO-associated stroke and detailed revisions for the 3 major stroke
subtyping algorithms in wide use.<br/>Copyright &#xa9; 2020 American
Medical Association. All rights reserved.

<22>
Accession Number
2007049939
Title
Cardiopulmonary bypass and internal thoracic artery: Can roller or
centrifugal pumps change vascular reactivity of the graft? The IPITA
study: A randomized controlled clinical trial.
Source
PLoS ONE. 15 (7 July) (no pagination), 2020. Article Number: e0235604.
Date of Publication: July 2020.
Author
Fouquet O.; Van Dang S.; Baudry A.; Meisnerowski P.; Robert P.; Pinaud
F.R.; Binuani P.; Chretien J.-M.; Henrion D.; Baufreton C.; Loufrani L.
Institution
(Fouquet, Van Dang, Baudry, Meisnerowski, Pinaud, Binuani, Baufreton)
Department of Thoracic and Cardiovascular Surgery, University Hospital,
Angers, France
(Fouquet, Van Dang, Baudry, Meisnerowski, Robert, Pinaud, Binuani,
Henrion, Baufreton, Loufrani) Mitovasc Institute Cnrs Umr 6214, University
of Angers, INSERM U1083, Angers, France
(Chretien) Clinical Research Department, University Hospital, Angers,
France
Publisher
Public Library of Science
Abstract
Background Cardiopulmonary bypass (CPB) induces a systemic inflammatory
response (SIRS) and affects the organ vascular bed. Experimentally, the
lack of pulsatility alters myogenic tone of resistance arteries and
increases the parietal inflammatory response. The purpose of this study
was to compare the vascular reactivity of the internal thoracic arteries
(ITAs) due to the inflammatory response between patients undergoing
coronary artery bypass grafting (CABG) under CPB with a roller pump or
with a centrifugal pump. Methods Eighty elective male patients undergoing
CABG were selected using one or two internal thoracic arteries under CPB
with a roller pump (RP group) or centrifugal pump (CFP group). ITA samples
were collected before starting CPB (Time 1) and before the last coronary
anastomosis during aortic cross clamping (Time 2). The primary endpoint
was the endotheliumdependent relaxation of ITAs investigated using
wire-myography. The secondary endpoint was the parietal inflammatory
response of arteries defined by the measurements of superoxide levels,
leukocytes and lymphocytes rate and gene expression of inflammatory
proteins using. Terminal complement complex activation (SC5b-9) and
neutrophil activation (elastase) analysis were performed on arterial blood
at the same times. Results Exposure time of ITAs to the pump flow was
respectively 43.3 minutes in the RP group and 45.7 minutes in the CFP
group. Acetylcholine-dependent relaxation was conserved in the two groups
whatever the time. Gene expression of C3 and C4a in the artery wall
decreased from Time 1 to Time 2. No oxidative stress was observed in the
graft. There was no difference between the groups concerning the
leukocytes and lymphocytes rate. SC5b-9 and elastase increased between
Time 1 and Time 2. Conclusion Endothelium-dependent relaxation of the
internal thoracic arteries was preserved during CPB whatever the type of
pump used. The inflammatory response observed in the blood was not found
in the graft wall within this time frame.<br/>Copyright &#xa9; 2020
Fouquet et al.

<23>
Accession Number
2005972998
Title
Characteristics and outcomes of gastrointestinal bleeding in patients with
continuous-flow left ventricular assist devices: A systematic review.
Source
Artificial Organs. 44 (11) (pp 1150-1161), 2020. Date of Publication: 01
Nov 2020.
Author
Carlson L.A.; Maynes E.J.; Choi J.H.; Hallett A.M.; Horan D.P.; Weber
M.P.; Deb A.K.; Patel S.; Samuels L.E.; Morris R.J.; Entwistle J.W.; Todd
Massey H.; Tchantchaleishvili V.
Institution
(Carlson, Maynes, Choi, Hallett, Horan, Weber, Patel, Samuels, Morris,
Entwistle, Todd Massey, Tchantchaleishvili) Division of Cardiac Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Deb) Philadelphia College of Osteopathic Medicine, Philadelphia, PA,
United States
Publisher
Blackwell Publishing Inc.
Abstract
Gastrointestinal bleeding (GIB) is a common adverse event after
continuous-flow left ventricular assist device (CF-LVAD) implantation. We
sought to evaluate patterns of GIB development and related outcomes in
CF-LVAD recipients. An electronic search was performed to identify all
articles related to GIB in the setting of CF-LVAD implantation. A total of
34 studies involving 1087 patients were pooled for analysis. Mean patient
age was 60 years (95% CI 57-64) and 24% (95% CI 21-28%) were female. The
mean time from CF-LVAD implantation to the first GIB was 54 days (95% CI
24-84) with 40% (95% CI 34-45%) of patients having multiple episodes of
GIB. Anemia was present in 75% (95% CI 41-93%) and the most common
etiology of bleeding was arteriovenous malformations (36% [95% CI
24-50%]). The mean duration of follow-up was 14.6 months (95% CI 6.9-22.3)
during which the all-cause mortality rate was 21% (95% CI 12-36%) and the
mortality rate from GIB was 4% (95% CI 2-9%). Thromboembolic events
occurred in 32% (95% CI 22-44%) of patients with an ischemic stroke rate
of 16% (95% CI 3-51%) and a pump thrombosis rate of 8% (95%CI 3-22%).
Heart transplantation was performed in 31% (95% CI 18-47%) of patients,
after which 0% (95% CI 0-10%) experienced recurrent GIB. GIB is a major
source of morbidity among CF-LVAD recipients. While death due to GIB is
rare, cessation of anticoagulation during treatment increases the risk of
subsequent thrombotic events. Heart transplant in these patients appears
to reliably resolve the risk of future GIB.<br/>Copyright &#xa9; 2020
International Center for Artificial Organs and Transplantation and Wiley
Periodicals, Inc.

<24>
Accession Number
2007088784
Title
Efficacy of a novel surgical manikin for simulating emergency surgical
procedures.
Source
American Surgeon. 85 (12) (pp 1318-1326), 2019. Date of Publication:
December 2019.
Author
Garcia D.F.V.; Domingues C.A.; Collet E Silva F.S.; Mori N.D.; Brasel
K.J.; Kortbeek J.; Ali J.; Poggetti R.S.
Institution
(Garcia, Collet E Silva, Mori, Poggetti) Discipline of Trauma Surgery,
Department of Surgery, University of Sao Paulo, Medical School, Sao Paulo,
Brazil
(Garcia, Domingues, Collet E Silva, Mori, Poggetti) Brazilian Committee on
Trauma, American College of Surgeons, Sao Paulo, Brazil
(Brasel) Division of Trauma, Critical Care and Acute Care Surgery, School
of Medicine, Oregon Health and Science University, Portland, OR, United
States
(Kortbeek) Departments of Surgery, Anaesthesia and Critical Care,
University of Calgary, Alberta Health Services, Calgary, Canada
(Ali) Division of General Surgery Trauma Program, St. Michael's Hospital,
Toronto, Canada
Publisher
Southeastern Surgical Congress
Abstract
The practical component of the Advanced Trauma Life Support (ATLS) course
typically includes a TraumaMan manikin. This manikin is expensive; hence,
a low-cost alternative (SurgeMan) was developed in Brazil. Our primary
objective was to compare user satisfaction among SurgeMan, TraumaMan, and
porcine models during the course. Our secondary objective was to determine
the user satisfaction scores for SurgeMan. This study included 36 ATLS
students and nine instructors (4:1 ratio). Tube thoracostomy,
cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage
were performed on all the three models. The participants then rated their
satisfaction both after each activity and after the course. The porcine
and TraumaMan models fared better than SurgeMan for all skills except
pericardiocentesis. In the absence of ethical or financial constraints, 58
per cent of the students and 66 per cent of the instructors indicated
preference for the porcine model. When ethical and financial factors were
considered, no preference was evident among the students, whereas 66 per
cent of instructors preferred SurgeMan over the others. The students gave
all three models an overall adequacy rating of >80 per cent; the
instructors gave only the animal models an adequacy rating of <80 per
cent. Although the users were more satisfied with TraumaMan than with
SurgeMan, both were considered acceptable for the ATLS
course.<br/>Copyright &#xa9; 2019 Southeastern Surgical Congress. All
rights reserved.

<25>
Accession Number
2007166849
Title
Off-label Use for Direct Oral Anticoagulants: Valvular Atrial
Fibrillation, Heart Failure, Left Ventricular Thrombus, Superficial Vein
Thrombosis, Pulmonary Hypertension-a Systematic Review.
Source
Annals of Pharmacotherapy. (no pagination), 2020. Date of Publication:
2020.
Author
Brokmeier H.; Kido K.
Institution
(Brokmeier) Mayo Clinic School of Health Sciences, Rochester, MN, United
States
(Kido) West Virginia University School of Pharmacy, Morgantown, WV, United
States
Publisher
SAGE Publications Inc.
Abstract
Objective: To evaluate clinical literature for direct oral anticoagulants
(DOACs) therapy for non-Food and Drug Administration approved indications.
<br/>Data Sources: Articles from MEDLINE, Cochrane Library, Google
Scholar, and OVID databases were reviewed from 1946 through September 4,
2020. Study Selection and Data Extraction: Fully published studies
assessing DOACs for atrial fibrillation (AF) with valvular heart disease
(VHD), heart failure (HF), left ventricular thrombus (LVT), superficial
vein thrombosis (SVT), or pulmonary hypertension (PH) were evaluated.
<br/>Data Synthesis: Our review showed that DOACs are safe to use in
patients with AF and VHD except for mitral stenosis or mechanical heart
valve. Rivaroxaban 2.5 mg twice daily should be used with caution in
patients with HF with reduced ejection fraction until further evaluation
is performed. Four retrospective studies for DOAC use in patients with LVT
showed conflicting results. One phase 3 randomized controlled trial showed
noninferiority of rivaroxaban to fondaparinux for SVT treatment. The use
of DOACs for pulmonary arterial hypertension was not evaluated in any
clinical study, but 2 retrospective studies for the use of DOACs in
patients with chronic thromboembolic PH (CTEPH) showed similar efficacy
between DOACs and warfarin. Relevance to Patient Care and Clinical
Practice: This review provides clinicians with a comprehensive literature
review surrounding DOAC use in common off-label indications.
<br/>Conclusion(s): DOACs can be considered for AF complicated by VHD
except for mitral stenosis or mechanical valve replacement. DOACs
(especially rivaroxaban) are considered as an alternative therapy for SVT
and CTEPH. Further prospective studies for DOAC uses are needed for HF or
LVT.<br/>Copyright &#xa9; The Author(s) 2020.

<26>
Accession Number
2007166825
Title
Management of large bore access complications in the era of trans-catheter
aortic valve replacement.
Source
Vascular. (no pagination), 2020. Date of Publication: 2020.
Author
Parker M.H.; Mukherjee D.; Ryan L.
Institution
(Parker) Department of Surgery, General Surgery, Inova Fairfax, Fairfax,
VA, United States
(Mukherjee) Department of Surgery, Vascular Surgery, Inova Fairfax,
Fairfax, VA, United States
(Ryan) Department of Surgery, Cardiothoracic Surgery, Inova Fairfax,
Fairfax, VA, United States
Publisher
SAGE Publications Ltd
Abstract
Objectives: Trans-catheter aortic valve replacement is a commonplace
procedure for patients with aortic valvular stenosis who are at a high
risk for surgery, evidenced by the 34,892 trans-catheter aortic valve
replacements performed in 2016. Trans-catheter aortic valve replacement's
rate of major vascular complications with second-generation closure
devices is 4.5% according to a meta-analysis of 10,822 patients. To manage
those complications, percutaneous approaches to arterial repairs show
shorter length of stay, higher rate of direct to home discharge and
equivalent outcomes at long-term follow-up. This study's goal is to show
that one center's vascular access strategy can decrease open repairs and
improve patient outcomes. <br/>Method(s): Our team began accessing the
mid-common femoral artery at least 1-2 cm proximal to the takeoff of the
profunda femoris. This allowed an endovascular stent to be deployed if
necessary via contralateral femoral access. We performed a completion
angiogram following every trans-catheter aortic valve replacement to
ensure no arterial complications. We conducted a retrospective review of a
prospectively maintained database for all trans-catheter aortic valve
replacement cases at a tertiary care center from 1 January 2016 to 30 June
2018. <br/>Result(s): A total of 699 trans-catheter aortic valve
replacement procedures were performed with 25/31 (80.6%) cases met
inclusion criteria. An increase was noted in the number of stent
procedures versus cutdown procedures over time (P < 0.001). A decrease was
noted in the number of vascular surgery team activations following
trans-catheter aortic valve replacement (P = 0.004). A non-significant
trend was noted toward a shorter median length of stay for the stent group
(P = 0.149). There was no increase in 30-day mortality rate (0.0% for both
groups) or 30-day readmissions (4/15 (26.7%) for stents vs. 2/10 (20.0%)
for open repairs; P > 0.999). <br/>Conclusion(s): This strategy is safe
and feasible to implement and reduces the number of open repairs following
trans-catheter aortic valve replacement, activation of surgical resources,
and possibly the length of stay.<br/>Copyright &#xa9; The Author(s) 2020.

<27>
Accession Number
2007157422
Title
Rivaroxaban Versus Warfarin in Patients with Mechanical Heart Valves:
Open-Label, Proof-of-Concept trial-The RIWA study.
Source
American Journal of Cardiovascular Drugs. (no pagination), 2020. Date of
Publication: 2020.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Schonhofen I.S.; Travassos K.S.O.;
Pereira L.V.; Filho J.A.L.; Neto M.G.; Junior R.A.; Roever L.
Institution
(Duraes, Neto, Junior) PPGMS/Federal University of Bahia, UFBA, Bahia,
Salvador, Brazil
(Duraes, de Souza Lima Bitar, Junior) Medical School, Federal University
of Bahia, FAMEB/UFBA, Largo do Terreiro de Jesus, XV de Novembro Square,
s/n, Salvador, Bahia CEP 40026-010, Brazil
(Schonhofen, Filho) General Hospital Roberto Santos/SUS-Bahia, Salvador,
Bahia, Brazil
(Travassos) Bahiana School of Medicine and Public Health, EBMSP, Salvador,
Bahia, Brazil
(Pereira) Nursing School, Federal University of Bahia, UFBA, Salvador,
Bahia, Brazil
(Roever) Federal University of Uberlandia, Minas Gerais, Uberlandia, Minas
Gerais, Brazil
Publisher
Adis
Abstract
Background and Purpose: To date, vitamin K antagonists are the only
available oral anticoagulants in patients with mechanical heart valves. In
this way, we developed a pilot trial with rivaroxaban. <br/>Method(s): The
RIWA study was a proof-of-concept, open-label, randomized clinical trial
and was designed to assess the incidence of thromboembolic and bleeding
events of the rivaroxaban-based strategy (15 mg twice daily) in comparison
to dose-adjusted warfarin. Patients were randomly assigned in a 1:1 ratio
and were followed prospectively for 90 days. <br/>Result(s): A total of 72
patients were enrolled in the present study. Of these, 44 patients were
randomized: 23 patients were allocated to the rivaroxaban group and 21 to
the warfarin group. After 90 days of follow-up, the primary outcome
occurred in one patient (4.3%) in the rivaroxaban group and three patients
(14.3%) in the warfarin group (risk ratio [RR] 0.27; 95% confidence
interval [CI] 0.02-2.85; P = 0.25). Minor bleeding (without
discontinuation of medical therapy) occurred in six patients (26.1%) in
the rivaroxaban group versus six patients (28.6%) in the warfarin group
(RR 0.88; 95% CI 0.23-3.32; P = 0.85). One patient in the warfarin group
died from myocardial infarction. No cases of hemorrhagic stroke, valve
thrombosis, peripheral embolic events, or new intracardiac thrombus were
related in both groups. <br/>Conclusion(s): In this pilot study,
rivaroxaban 15 mg twice daily had thromboembolic and bleeding events
similar to warfarin in patients with mechanical heart valves. These data
confirm the authors' proof-of-concept and suggest that a larger trial with
a similar design is not unreasonable. ClinicalTrial.gov identifier:
NCT03566303.<br/>Copyright &#xa9; 2020, Springer Nature Switzerland AG.

<28>
[Use Link to view the full text]
Accession Number
633093586
Title
Postoperative pain therapy with hydromorphone; comparison of
patient-controlled analgesia with target-controlled infusion and standard
patient-controlled analgesia: A randomised controlled trial.
Source
European journal of anaesthesiology. 37 (12) (pp 1168-1175), 2020. Date of
Publication: 01 Dec 2020.
Author
Wehrfritz A.; Ihmsen H.; Fuchte T.; Kim M.; Kremer S.; Weiss A.; Schuttler
J.; Jeleazcov C.
Institution
(Wehrfritz) From the Department of Anaesthesiology, University Hospital
Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Germany
(AW, HI, TF, Erlangen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The challenge of managing acute postoperative pain is the well
tolerated and effective administration of analgesics with a minimum of
side effects. The standard therapeutic approach is patient-controlled
analgesia (PCA) with systemic opioids. To overcome problems of oscillating
opioid concentrations, we studied patient-controlled analgesia by
target-controlled infusion (TCI-PCA) as an alternative. <br/>OBJECTIVE(S):
To compare efficacy, safety and side effects of standard PCA with TCI-PCA
for postoperative pain therapy with hydromorphone. DESIGN: Single-blinded,
randomised trial. SETTING: University Hospital, Germany from December 2013
to April 2015. PARTICIPANTS: Fifty adults undergoing cardiac surgery.
INTERVENTIONS: Postoperative pain therapy on the ICU was managed with
intravenous (i.v.) hydromorphone and patients randomised to TCI-PCA with
target plasma concentrations between 0.8 and 10 ng ml, or PCA with bolus
doses of 0.2 mg. Pain was regularly assessed using the 11-point numerical
rating scale (NRS). Blood pressure, heart rate, oxygen saturation and
cardiac output were continuously monitored, and adverse events were
registered throughout the study. MAIN OUTCOME MEASURES: NRS pain ratings,
hydromorphone doses, haemodynamic effects and side effects.
<br/>RESULT(S): NRS pain ratings, total doses of hydromorphone and
haemodynamic data did not differ significantly between TCI-PCA and PCA.
The number of bolus doses during PCA was significantly higher than the
number of target increases during TCI-PCA (P = 0.006). The number of
negative requests was also significantly higher during PCA than during
TCI-PCA (P = 0.02). The respiratory rate on the first postoperative
morning was 25 +/- 6 min during TCI-PCA, compared with 19 +/- 4 min during
PCA (P = 0.022). Nausea occurred in 30% after TCI-PCA and 24% after PCA (P
= 0.46). <br/>CONCLUSION(S): TCI-PCA was effective and well tolerated in
acute postoperative pain management after cardiac surgery. Further studies
are needed to evaluate this approach in clinical practice. TRIAL
REGISTRATION: EudraCT Number: 2013-002875-16, and ClinicalTrials.gov
Identifier: NCT02035709.

<29>
Accession Number
627868541
Title
Efficacy and safety of drug-eluting stenting compared with bypass grafting
in diabetic patients with multivessel and/or left main coronary artery
disease.
Source
Scientific reports. 9 (1) (pp 7268), 2019. Date of Publication: 13 May
2019.
Author
Xin X.; Wang X.; Dong X.; Fan Y.; Shao W.; Lu X.; Xiao P.
Institution
(Xin, Shao, Lu) Department of Cardiology, Affiliated Sir Run Run Hospital
of Nanjing Medical University, Nanjing, China
(Wang) Department of Geriatric Cardiology, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
(Dong) Department of Biostatistics, School of Public Health, Southeast
University, Nanjing, China
(Fan) Clinical Metabolomics Center, School of Traditional Chinese
Pharmacy, China Pharmaceutical University, Nanjing, China
(Xiao) Department of Cardiology, Affiliated Sir Run Run Hospital of
Nanjing Medical University, Nanjing, China
Publisher
NLM (Medline)
Abstract
Although percutaneous coronary intervention (PCI) with drug-eluting stents
(DESs) and bypass grafting are generally believed to be superior
revascularization strategies in patients with coronary artery disease
(CAD), the optimal strategy for diabetic patients is still controversial.
This meta-analysis was performed to compare two methods of
revascularization for patients with diabetes mellitus with left main
coronary artery lesions or disease in multiple coronary arteries. Compared
with the coronary artery bypass grafting (CABG) group, those receiving
PCI-DES showed a greater risk of major adverse cardiovascular events
(MACEs) (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.01-1.25,
P=0.03), major adverse cardiac and cerebrovascular events (MACCEs) (HR:
1.85, 95% CI: 1.58-2.16; P<0.001), stroke (HR: 1.15, 95% CI: 1.02-1.29,
P=0.02), myocardial infarction (MI) (HR: 1.48, 95% CI: 1.04-2.09, P=0.03),
and repeat revascularization (HR: 3.23, 95% CI: 1.37-7.59, P=0.007). CABG
for diabetic patients with multivessel and/or left main CAD was superior
to PCI-DES with regard to MACEs, MACCEs, MI, repeat revascularization and
stroke, but there was no clear difference in all-cause mortality.

<30>
Accession Number
633351582
Title
Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol
for a multicentre randomised, blind, placebo-controlled trial.
Source
BMJ open. 10 (11) (pp e040914), 2020. Date of Publication: 03 Nov 2020.
Author
Ishii K.; Yokoyama Y.; Yonekawa Y.; Ebata T.
Institution
(Ishii, Yokoyama, Yonekawa, Ebata) Surgical Oncology, Nagoya University
Graduate School of Medicine, Nagoya, Japan
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Pancreaticoduodenectomy (PD) is a major gastroenterological
surgery that results in a substantial amount of blood loss. Several
studies have demonstrated that major blood loss during PD is associated
with both short-term and long-term poor outcomes. Administration of
perioperative tranexamic acid (TXA) has been reported to reduce
intraoperative blood loss in various surgeries, including cardiovascular
surgery and orthopaedic surgery. Nevertheless, the effect of perioperative
TXA use in patients undergoing PD has not been investigated. This study
aims to investigate the effect of TXA on blood loss during PD. METHODS AND
ANALYSIS: A multicentre (six hospitals), randomised, blind
(patient-blinded, surgeon-blinded, anaesthesiologist-blinded,
monitor-blinded), placebo-controlled trial of TXA during PD was started in
September 2019. Patients undergoing PD for biliary, duodenal or pancreatic
diseases are randomly assigned to the TXA or placebo group. The
stratification factors are the institutions and preoperative clinical
diagnosis. Before skin incision, the participants in TXA group are
administrated 1g TXA as a loading infusion followed by a maintenance
infusion of 125mg/hour TXA until the end of surgery or 8hours from the
incision. Participants in the placebo group are administrated the same
volume of saline that is indistinguishable from the TXA. The primary
outcome is blood loss during PD. The secondary outcomes are intraoperative
and postoperative (up to day 2) blood transfusions, operation time,
anaesthesia time, postoperative laboratory variables, length of hospital
stay, in-hospital and 90-day mortality and postoperative complications
occurring within 28 days of surgery or requiring readmission. To date, 115
patients of a planned 220 have been enrolled in the study. ETHICS AND
DISSEMINATION: This protocol was approved by the Nagoya University
Clinical Research Review Board and is registered with Japan Registry of
Clinical Trials on 15 August 2019. The results of this trial will be
disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER:
jRCTs041190062.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<31>
Accession Number
633351487
Title
Systematic review of pre-clinical therapies for post-operative atrial
fibrillation.
Source
PloS one. 15 (11) (pp e0241643), 2020. Date of Publication: 2020.
Author
Seo C.; Michie C.; Hibbert B.; Davis D.R.
Institution
(Seo, Michie, Hibbert, Davis) Department of Medicine, Division of
Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Post-operative atrial fibrillation (POAF) is a frequent
cardiothoracic surgery complication that increases hospital stay,
mortality and costs. Despite decades of research, there has been no
systematic overview and meta-analysis of preclinical therapies for POAF in
animal models. <br/>METHOD(S): We performed a systematic search of MEDLINE
and EMBASE from their inception through September 2020 to determine the
effect of preclinical POAF therapies on primary efficacy outcomes using a
prospectively registered protocol (CRD42019155649). Bias was assessed
using the SYRCLE tool and CAMARADES checklist. <br/>RESULT(S): Within the
26 studies that fulfilled our inclusion criteria, we identified 4
prevention strategies including biological (n = 5), dietary (n = 2),
substrate modification (n = 2), and pharmacological (n = 17) interventions
targeting atrial substrate, cellular electrophysiology or inflammation.
Only one study altered more than 1 pathophysiological mechanism. 73%
comprised multiple doses of systemic therapies. Large animal models were
used in 81% of the studies. Preclinical therapies altogether attenuated
atrial fibrosis (SMD -2.09; 95% confidence interval [CI] -2.95 to -1.22; p
< 0.00001; I2 = 47%), AF inducibility (RR 0.40; 95% CI 0.21 to 0.79; p =
0.008; I2 = 39%), and AF duration (SMD -2.19; 95% CI -3.05 to -1.32; p <
0.00001; I2 = 50%). However, all the criteria needed to evaluate the risk
of bias was unclear for many outcomes and only few interventions were
independently validated by more than 1 research group. <br/>CONCLUSION(S):
Treatments with therapies targeting atrial substrate, cellular
electrophysiology or inflammation reduced POAF in preclinical animal
models compared to controls. Improving the quality of outcome reporting,
independently validating promising approaches and targeting complimentary
drivers of POAF are promising means to improve the clinical translation of
novel therapies for this highly prevalent and clinically meaningful
disease.

<32>
Accession Number
2005414717
Title
Effect of pre-existing left bundle branch block on post-procedural
outcomes of transcatheter aortic valve replacement: A meta-analysis of
comparative studies.
Source
American Journal of Cardiovascular Disease. 10 (4) (pp 294-300), 2020.
Article Number: AJCD0113732. Date of Publication: 2020.
Author
Shoar S.; Batra S.; Gulraiz A.; Ikram W.; Javed M.; Hosseini F.; Naderan
M.; Shoar N.; John J.; Modukuru V.R.; Sharma S.K.
Institution
(Shoar) Department of Clinical Research, ScientificWriting Corporation,
Houston, TX, United States
(Batra) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Gulraiz) Department of Medicine, Nishtar Medical University, Multan,
Pakistan
(Ikram, Javed) Department of Medicine, Lahore Medical and Dental College,
Lahore, Pakistan
(Hosseini) Faculty of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Naderan) Faculty of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Shoar) Faculty of Medicine, Kashan University of Medical Sciences,
Kashan, Iran, Islamic Republic of
(John) Department of Medicine, Dr. Somervell C.S.I. Medical College and
Hospital, Trivandrum, Karakonam, Kerala, India
(Modukuru) Department of Surgery, Metropolitan Hospital, New York College
of Medicine, Manhattan, NY, United States
(Sharma) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, NY, United States
Publisher
E-Century Publishing Corporation
Abstract
Background: As an established procedure for patients with aortic valve
stenosis and a high surgical risk profile, transcatheter aortic valve
replacement (TAVR) can be associated with conductance abnormalities.
However, data regarding the impact of pre-existing left bundle branch
block (LBBB) on post-TAVR outcome is scarce. <br/>Objective(s): We
conducted this meta-analysis to pool available data in the literature on
the impact of pre-existing LBBB on the clinical outcomes of patients
undergoing TAVR. <br/>Method(s): We queried Medline/PubMed, Scopus, and
Cochrane Library to identify comparative studies of patients with and
without a pre-existing LBBB undergoing TAVR for aortic stenosis. Risk
ratio (RR) and the corresponding 95% confidence interval (95% CI) were
estimated to measure the effect of pre-existing LBBB on developing
post-procedure stroke, permanent pacemaker implantation (PPM), or
moderate/severe aortic regurgitation (AR). <br/>Result(s): Data of three
clinical trials encompassing 4,668 patients undergoing TAVR were included
in this meta-analysis. Patients with pre-existing LBBB prior to TAVR had
an increased risk of developing moderate/severe AR (RR = 1.04 [0.79-1.37];
P = 0.77), stroke (RR = 1.72 [0.61-4.85]; P = 0.31), and a need for PPM
implantation (RR = 4.43 [0.43-45.64]; P = 0.21) following TAVR.
<br/>Conclusion(s): Preexisting LBBB seems to increase the risk of
developing stroke, aortic regurgitation, and the need for a permanent
pacemaker implantation. However, due to scarcity of data and high
heterogeneity among the current studies, further clinical trials are
warranted.<br/>Copyright &#xa9; 2020, E-Century Publishing Corporation.
All rights reserved.

<33>
Accession Number
2005406099
Title
Rules of pediatric fluid therapy: Non-systematic review.
Source
International Journal of Pharmaceutical Research. 12 (2) (pp 2609-2614),
2020. Date of Publication: April-June 2020.
Author
Hussein H.A.; Alhamaidah M.F.; Alkhfaji H.; Roomi A.B.
Institution
(Hussein) Nasiriya Heart Center, Cardiac Intensive Care Unit, Iraq
(Hussein, Alhamaidah, Alkhfaji) Department of Anesthesia, College of
Health and Medical Technology, Al-Ayen University, Iraq
(Alhamaidah) Rifayee Hospital, Iraq
(Alkhfaji) Bent AL Huda hospital, Iraq
(Roomi) Ministry of Education, Directorate of Education Thi-Qar, Iraq
(Roomi) College of Health and Medical Technology, Al-Ayen University, Iraq
Publisher
Advanced Scientific Research
Abstract
As an influential role in any surgical plan, intravenous infusion of IV
fluids or blood transfusion for pediatrics undergoing for elective surgery
has been considered with dramatic effects on the results of surgical
intervention. In their nature, IV fluids generally are drugs, therefore it
is imperative that those interested in cardiac surgery patients have a
good understanding of physiology and pharmacology of these drugs, in
addition to physiological differences between adults and children with
regard to body water and blood volume must be understood. Anesthetic
management must include which type of fluid? How much to be infused, and
the tonicity of used fluid, these three aspects are the main in fluid
therapy plane. Optimal outcomes after surgery, such as shortened
hospitalization and reduced morbidity rate, can be getting from precise
planning before starting the surgical intervention. Avoiding hypovolemia
or hypervolemia in perioperative period can be achieved by using a mixture
of different types of IV fluids, and this will be an ideal plan for fluid
therapy the common recommendations in fluid type had been trending to use
the Isotonic crystalloids with low glucose contents. If hypoglycemia is
expected, Dextrose infusion is recommended under glucose level monitoring.
To avoid accidental hypervolemia and related complications, using of
modern techniques in fluid infusion such syringe pump, has been strongly
suggested recently during surgery.<br/>Copyright &#xa9; 2020, Advanced
Scientific Research. All rights reserved.

<34>
Accession Number
2008390997
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
IMR Press Limited
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.<br/>Copyright &#xa9;2020 Dominici and Chello Published by IMR
Press.

<35>
Accession Number
2008493607
Title
Intraoperative thermal insulation in off-pump coronary artery bypass
grafting surgery: a prospective, double blind, randomized controlled,
single-center study.
Source
Annals of Translational Medicine. 8 (19) (no pagination), 2020. Article
Number: 21037. Date of Publication: October 2020.
Author
Jin L.; Han X.; Yu Y.; Xu L.; Wang H.; Guo K.
Institution
(Jin, Han, Yu, Xu, Wang, Guo) Department of Anesthesia, Zhongshan
Hospital, Fudan University, Shanghai, China
Publisher
AME Publishing Company
Abstract
Background: About 50% patients who underwent off-pump coronary artery
bypass grafting (OPCAB) experienced perioperative hypothermia. Pre-warming
and intraoperative infusion of amino acid injection are the most popular
perioperative insulation measures in recent years, but neither of them can
completely prevent intraoperative hypothermia. The objective is to
investigate the effect of preoperative warming and/ or intraoperative
infusion of amino acid injection on body temperature in patients
undergoing OPCAB. <br/>Method(s): A prospective, double blind, randomized
controlled, single-center study. Seventy-two patients were randomly
divided into 4 groups: control group, pre-warming group, amino-acid group
and multi-mode group. Pre-warming and multi-mode group were pre-heated
with warming blankets and forced-air warming system before induction.
After that, amino-acid and multi-mode group were infused with 18-amino
acid solution. The perioperative temperature and complications were
monitored. <br/>Result(s): The temperature of control and amino-acid group
decreased significantly, but amino-acid group recovered to preoperative
level faster. The temperature of pre-warming group was stable, and that in
multi-mode group increased at 60 min after the start of surgery. There was
a significant difference in temperature at each time, and no difference in
the incidence of complications between the groups. <br/>Conclusion(s):
Preoperative warming and/or intraoperative infusion of amino acid
injection can effectively reduce hypothermia in OPCAB surgery. Pre-warming
before anesthesia is more effective, and the combination of the two
methods has the best effect.<br/>Copyright &#xa9; Annals of Translational
Medicine. All rights reserved.

<36>
Accession Number
2007175054
Title
Role of Using a Thromboelastometry-Based Protocol for Transfusion
Management in Combined Coronary Artery Bypass Grafting and Valve Surgery:
A Randomized Clinical Trail.
Source
Indian Journal of Hematology and Blood Transfusion. (no pagination), 2020.
Date of Publication: 2020.
Author
Khalaf-Adeli E.; Pourfathollah A.A.; Noohi F.; Alizadeh-Ghavidel A.;
Bakhshandeh-Abkenar H.; Shamriz R.; Alavi S.M.
Institution
(Khalaf-Adeli, Pourfathollah) Blood Transfusion Research Center, High
Institute for Research and Education in Transfusion Medicine, Tehran,
Iran, Islamic Republic of
(Pourfathollah) Departments of Immunology, Faculty of Medicine, Tarbiat
Modares University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Noohi) Cardiac Intervention Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Alizadeh-Ghavidel) Heart Valve Disease Research Center, Rajaie
Cardiovascular Medical and Research Center, University of Medical
Sciences, IranTehran, Iran, Islamic Republic of
(Bakhshandeh-Abkenar, Alavi) Rajaie Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Mellat park, Valiasr Avenue,
Tehran, Iran, Islamic Republic of
(Shamriz) Coagulation Laboratory, Iranian Blood Transfusion Organization,
Tehran, Iran, Islamic Republic of
Publisher
Springer
Abstract
The aim of this study was to evaluate the impact of using a
thromboelastometry-based protocol on transfusion requirements in patients
undergoing combined coronary artery bypass grafting (CABG) and valve
surgery. 80 adult patients scheduled for elective combined CABG and valve
surgery were included in this clinical trial study. Patients were randomly
allocated to the thromboelastometry (ROTEM) (n = 40) or control groups (n
= 40). In the ROTEM group, transfusion was directed according to a
thromboelastometry-based protocol. In the control group, transfusion was
conducted according to the routine practices including conventional
coagulation testing and clinical judgments. Finally, transfusion
requirements were compared between groups. Use of thromboelastometry-
based protocol resulted in 67% reduction in blood products units'
consumption as well as 23% in the percentage of patients transfused. This
reduction was especially evident in relation to fresh frozen plasma (FFP)
and platelet consumption. No significant differences were found both in
the percentage of patients receiving RBC and number of transfused RBC
units. Using thromboelastometry tests incorporated a protocol results in
reduction of transfusion requirements in patients undergoing elective
combined CABG and valve surgery.<br/>Copyright &#xa9; 2020, Indian Society
of Hematology and Blood Transfusion.

<37>
Accession Number
2007174720
Title
Impact of atrial fibrillation on the outcomes of transcatheter mitral
valve repair using MitraClip: a systematic review and meta-analysis.
Source
Heart Failure Reviews. (no pagination), 2020. Date of Publication: 2020.
Author
Shah S.; Raj V.; Abdelghany M.; Mena-Hurtado C.; Riaz S.; Patel S.; Wiener
H.; Chaudhuri D.
Institution
(Shah, Raj, Chaudhuri) Department of Medicine, Division of Cardiology,
State University of New York Upstate Medical University, 750 E Adams
Street, Syracuse, NY 13210, United States
(Abdelghany) Pioneer Valley Cardiology, University of Massachusetts/
Baystate Medical Center, Mercy Medical Center, Springfield, MA, United
States
(Mena-Hurtado) Department of Medicine, Division of Cardiology, Yale
University School of Medicine, New Haven, CT, United States
(Riaz) Department of Medicine, State University of New York Upstate
Medical University, Syracuse, NY, United States
(Patel) Department of Pulmonary, Allergy and Critical care, University of
Alabama at Birmingham, Birmingham, AL, United States
(Wiener) Department of Epidemiology, University of Alabama at Birmingham
School of Public Health, Birmingham, AL, United States
Publisher
Springer
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral
regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In
this systematic review, we aimed to investigate the outcomes of TMVR using
MitraClip in AF patients. We performed a systematic search using PubMed,
SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for
studies that reported outcomes following MitraClip, in patients with AF
versus without AF. Seven studies with a total of 7678 patients met the
inclusion criteria. The risk of 1-year all-cause mortality following TMVR
was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p <= 0.001).
Similarly, the risk of heart failure hospitalization was higher in
patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of
bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p <=
0.001). The risk of procedural failure, in-hospital mortality,
cardiovascular mortality, and stroke was not significantly different
between the two groups. The higher risk of all-cause mortality, HF
hospitalization, and risk of bleeding in AF patients undergoing MitraClip
warrants attention.<br/>Copyright &#xa9; 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<38>
Accession Number
633351216
Title
Reduction in Revascularization with Icosapent Ethyl: Insights from
REDUCE-IT REVASC.
Source
Circulation. (no pagination), 2020. Date of Publication: 05 Nov 2020.
Author
Peterson B.E.; Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson
T.A.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz C.;
Gibson C.M.; Pinto D.; Giugliano R.P.; Budoff M.J.; Tardif J.-C.; Verma
S.; Ballantyne C.M.
Institution
(Peterson, Bhatt, Giugliano) Brigham and Women's Hospital Heart and
Vascular Center, Harvard Medical School, Boston MA
(Steg) Universite de Paris, AP-HP (Assistance Publique-Hopitaux de Paris),
Hopital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM
U-1148, Paris, France
(Miller) Department of Medicine, University of Maryland School of
Medicine, MD, Baltimore, United States
(Brinton) Utah Lipid Center, UT, Salt Lake City, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, United States
(Ketchum, Juliano, Jiao, Doyle, Granowitz) Amarin Pharma, Inc. (Amarin),
Bridgewater, United States
(Gibson, Pinto) Baim Clinical Research Institute, MA, Boston
(Budoff) David Geffen School of Medicine, Lundquist Institute, Torrance,
CA
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, ON, Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine; Center
for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX
Publisher
NLM (Medline)
Abstract
Background: Patients with elevated triglycerides despite statin therapy
have increased risk for ischemic events, including coronary
revascularizations. <br/>Method(s): REDUCE-IT, a multicenter,
double-blind, placebo-controlled trial, randomized statin-treated patients
with elevated triglycerides (135-499 mg/dL), controlled LDL (41-100
mg/dL), and either established cardiovascular disease or diabetes plus
other risk factors to receive icosapent ethyl 4 g daily or placebo. The
primary and key secondary composite endpoints were significantly reduced.
Prespecified analyses examined all coronary revascularizations, recurrent
revascularizations, and revascularization subtypes. <br/>Result(s): A
total of 8,179 randomized patients were followed for 4.9 years (median).
First revascularizations were reduced to 9.2% (22.5/1000 patient-years)
with icosapent ethyl versus 13.3% (33.7/1000 patient-years) with placebo
(hazard ratio [HR]=0.66; 95% confidence interval (CI), 0.58-0.76;
p<0.0001; number needed to treat [NNT4.9y]=24); similar reductions were
observed in total (first and subsequent) revascularizations (negative
binomial rate ratio [RR] 0.64; 95% CI, 0.56-0.74; p<0.0001), and across
elective, urgent, and emergent revascularizations. Icosapent ethyl
significantly reduced percutaneous coronary intervention (PCI) (HR=0.68;
95% CI, 0.59-0.79; p<0.0001) and coronary artery bypass grafting (CABG)
(HR=0.61; 95% CI, 0.45-0.81; p=0.0005). <br/>Conclusion(s): Icosapent
ethyl reduced the need for first and subsequent coronary
revascularizations in statin-treated patients with elevated triglycerides
and increased cardiovascular risk. To our knowledge, icosapent ethyl is
the first non-LDL-lowering treatment that has been shown to reduce CABG in
a blinded, randomized trial. Clinical Trial Registration: URL:
https://clinicaltrials.gov Unique Identifier: NCT01492361.

<39>
[Use Link to view the full text]
Accession Number
633346601
Title
Heart transplantation from brain dead donors: A systematic review of
animal models.
Source
Transplantation. (pp 2272-2289), 2020. Date of Publication: 2020.
Author
See Hoe L.E.; Wells M.A.; Bartnikowski N.; Obonyo N.G.; Millar J.E.; Khoo
A.; Ki K.K.; Shuker T.; Ferraioli A.; Colombo S.M.; Chan W.; McGiffin
D.C.; Suen J.Y.; Fraser J.F.
Institution
(See Hoe, Wells, Bartnikowski, Obonyo, Millar, Khoo, Ki, Shuker,
Ferraioli, Colombo, Chan, McGiffin, Suen, Fraser) Critical Care Research
Group, Prince Charles Hospital, Brisbane, QLD, Australia
(See Hoe, Millar, Khoo, Ki, Shuker, Ferraioli, Colombo, Chan, Suen,
Fraser) Faculty of Medicine, University of Queensland, Brisbane, QLD,
Australia
(Wells) School of Medical Science, Griffith University, Gold Coast, QLD,
Australia
(Bartnikowski) Faculty of Science and Engineering, Queensland University
of Technology, Brisbane, QLD, Australia
(Obonyo) Wellcome Trust Centre for Global Health Research, Imperial
College London, London, United Kingdom
(Millar) Wellcome-Wolfson Institute for Experimental Medicine, Queen's
University Belfast, Belfast, United Kingdom
(Colombo) Department of Pathophysiology and Transplantation, Universita
Degli Studi di Milano, Milan, Italy
(McGiffin) Cardiothoracic Surgery and Transplantation, Alfred Hospital,
Melbourne, VIC, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Despite advances in mechanical circulatory devices and pharmacologic
therapies, heart transplantation (HTx) is the definitive and most
effective therapy for an important proportion of qualifying patients with
end-stage heart failure. However, the demand for donor hearts
significantly outweighs the supply. Hearts are sourced from donors
following brain death, which exposes donor hearts to substantial
pathophysiological perturbations that can influence heart transplant
success and recipient survival. Although significant advances in recipient
selection, donor and HTx recipient management, immunosuppression, and
pretransplant mechanical circulatory support have been achieved, primary
graft dysfunction after cardiac transplantation continues to be an
important cause of morbidity and mortality. Animal models, when
appropriate, can guide/inform medical practice, and fill gaps in knowledge
that are unattainable in clinical settings. Consequently, we performed a
systematic review of existing animal models that incorporate donor brain
death and subsequent HTx and assessed studies for scientific rigor and
clinical relevance. Following literature screening via the U.S National
Library of Medicine bibliographic database (MEDLINE) and Embase, 29
studies were assessed. Analysis of included studies identified marked
heterogeneity in animal models of donor brain death coupled to HTx, with
few research groups worldwide identified as utilizing these models.
General reporting of important determinants of heart transplant success
was mixed, and assessment of posttransplant cardiac function was limited
to an invasive technique (pressure-volume analysis), which is limitedly
applied in clinical settings. This review highlights translational
challenges between available animal models and clinical heart transplant
settings that are potentially hindering advancement of this field of
investigation.<br/>Copyright &#xa9; 2020 Lippincott Williams and Wilkins.
All rights reserved.

<40>
Accession Number
2005142615
Title
Effects of progressive muscle relaxation exercise, cold application and
local anesthesia performed before chest tube removal on pain and comfort
levels and vital sings of the patient.
Source
Turkiye Klinikleri Journal of Medical Sciences. 40 (3) (pp 285-296), 2020.
Date of Publication: 2020.
Author
Ozcan N.; Karagozoglu S.
Institution
(Ozcan) Department of Nursing, Sivas Cumhuriyet University Institute of
Health Sciences, Sivas, Turkey
(Ozcan) Department of Thoracic Surgery, Sivas Cumhuriyet University,
Faculty of Medicine, Sivas, Turkey
(Karagozoglu) Division of Nursing, Department of Fundamentals of Nursing,
Sivas Cumhuriyet University Faculty of Health Sciences, Sivas, Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: This study was conducted to examine the effect of progressive
muscle relaxation exercise, cold application and local anaesthesia before
chest tube removal on pain, comfort level and life findings of the
patient. <br/>Material(s) and Method(s): In the sam-ple of the controlled
experimental study, 160 patients in whom a chest tube was placed in the
chest surgery service of a university hospital for any reason and who met
the inclusion criteria were included. In the study, three intervention
groups (progressive muscle relaxation exer-cise, cold application and
local anaesthesia) and a control group were constituted and 40 individuals
were assigned to each group. Pain in-tensity and comfort level were
measured in 5 minutes before chest tube removal, immediately after tube
removal and 15 minutes after tube removal in all groups and hemodynamic
indicators were recorded as well. Patient Information Form, Visual
Analogue Scale (VAS), Comfort Scale and Vital Signs Monitoring Form were
used to collect the data. <br/>Result(s): Immediately after removing the
chest tube, it was found that the pain in the relaxation exercise and
control group increased compared to before, the comfort decreased; the
pain in the cold application and local anaesthesia group significantly
decreased (p<0.001, p<0.001), the comfort in the same group increased and
this situation continued after 15 minutes. <br/>Conclusion(s): In our
study, it was observed that cold application and local anaesthesia
significantly re-duced pain and comfort level compared to other methods
during chest tube removal. In this context, it has been proposed to use
cold application and local anesthesia as a primary method in chest tube
removal.<br/>Copyright &#xa9; 2020 by Turkiye Klinikleri.

<41>
Accession Number
2004099217
Title
The hemodynamic effect of different left ventricular unloading techniques
during veno-arterial extracorporeal life support: a systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). 35 (7) (pp 664-671), 2020. Date of
Publication: 01 Oct 2020.
Author
Meuwese C.L.; de Haan M.; Zwetsloot P.-P.; Braithwaite S.; Ramjankhan F.;
van der Heijden J.; Hermens J.; Cremer O.; Broome M.; Donker D.W.
Institution
(Meuwese, van der Heijden, Hermens, Cremer, Donker) Department of
Intensive Care Medicine, University Medical Center Utrecht, Utrecht,
Netherlands
(de Haan) Department of Anesthesiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Zwetsloot) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Braithwaite) Department of Cardio-Anesthesiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Ramjankhan) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Broome) ECMO Department, Karolinska University Hospital, Stockholm,
Sweden
(Broome) Division of Anesthesia and Intensive Care, Department of
Physiology and Pharmacology, Karolinska University Hospital, Stockholm,
Sweden
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Pulmonary edema and left ventricular thrombosis may arise
during veno-arterial extracorporeal life support due to an increase in
cardiac load. This mechanical stress can be reduced through different left
ventricular unloading techniques. We set out to quantitatively summarize
the hemodynamic effects of available methods in patients treated with
veno-arterial extracorporeal life support. <br/>Method(s): Literature was
systematically searched for studies reporting left ventricular unloading
during veno-arterial extracorporeal life support as reflected by changes
in left atrial pressure, pulmonary capillary wedge pressure, diastolic
pulmonary artery pressure, or left ventricular end-diastolic pressure. For
studies including 10 patients per group, changes in these parameters were
pooled using (1) standardized mean differences and (2) ratio of means.
Assessment of potential bias was performed for all studies.
<br/>Result(s): Eight studies met the inclusion criteria. Reported
techniques included use of intra-aortic balloon pump (n = 1), micro-axial
blood pump (Impella, n = 2), left ventricular venting (n = 1),
and atrial septostomy (n = 4). Overall, left ventricular unloading was
associated with a statistically significant reduction in preload
parameters (standardized mean differences = -1.05 (95% confidence interval
= -1.24 to -0.86) and ratio of means = 0.60 (0.47 to 0.76)). Effect sizes
were strongest for micro-axial blood pump and atrial septostomy
(standardized mean differences = -1.11 (-1.55 to -0.68) and -1.22 (-1.47
to -0.96), and ratio of means = 0.58 (0.39 to 0.86) and 0.54 (0.36 to
0.83), respectively). <br/>Conclusion(s): Left ventricular unloading was
associated with a significant reduction in left ventricular preload
parameters in the setting of veno-arterial extracorporeal life support.
This effect may be most pronounced for micro-axial blood pump and atrial
septostomy.<br/>Copyright &#xa9; The Author(s) 2020.

<42>
Accession Number
632980346
Title
Interleukin-6 in patients with cardiac myxoma.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (8) (pp
849-852), 2020. Date of Publication: 01 Aug 2020.
Author
Yuan S.-M.; Lin H.-Z.
Institution
(Yuan) Department of Cardiothoracic Surgery, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
(Lin) Department of Clinical Laboratory, First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province,
China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
The relationships between interleukin (IL)-6 and cardiac myxoma remain to
be clarified. This article systematically reviewed the IL-6 properties in
cardiac myxoma patients based on retrieval of pertinent literature
published between 1998 and 2018. Significant differences were found in
circulating IL-6 values between preoperation and 1 and 6 months after
operation. Preoperative circulating IL-6 correlated significantly with
tumour volume (r=0.8552, p=0.003), while there were no significant
correlations with maximal tumour dimension (r=0.2443, p=0.190). No
correlation was found between circulating IL-6 at 1 and 6 months after
tumour resection with either tumour volume or with maximal tumour
dimension. The positive rate of immunostaining of IL-6 in cardiac myxoma
tissues was 93.3%. Overproduction of IL-6 is responsible for the
inflammatory presentations, constitutional symptoms, and recurrence and
distal embolisation of cardiac myxoma. Cardiac myxoma could be a cellular
source of IL-6 release. Cardiac myxoma resection is an absolute choice of
eliminating IL-6 production in these patients.<br/>Copyright &#xa9; 2020
College of Physicians and Surgeons Pakistan. All rights reserved.

<43>
Accession Number
2008451067
Title
Factors influencing physical activity after cardiac surgery: An
integrative review.
Source
Heart and Lung. (no pagination), 2020. Date of Publication: 2020.
Author
Lee S.; Collins E.G.
Institution
(Lee, Collins) University of Illinois at Chicago, College of Nursing, 845
S. Damen Ave., Chicago, IL 60612, United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background: Physical activity can optimize patient outcomes after cardiac
surgery, but postoperative patients' physical activity generally has been
inadequate. No review studies have focused on factors influencing cardiac
patients' postoperative physical activity. <br/>Objective(s): To identify
factors influencing physical activity in patients after cardiac surgery.
<br/>Method(s): This study was conducted following Whittemore and Knafl's
methodology. CINAHL, MEDLINE, PsychINFO, Scopus, and Embase were searched
and selected studies were analyzed using the Matrix Method.
<br/>Result(s): In 12 studies, factors facilitating physical activity
included personal, socio-environmental, and intervention-related factors.
Barriers to physical activity included personal, socio-environmental, and
cardiac rehabilitation program-related factors. The most common predictor
of physical activity was male sex, and the most frequent barrier was
comorbidities. <br/>Conclusion(s): This study revealed facilitators and
barriers that significantly influenced physical activity after cardiac
surgery. Healthcare providers and exercise guideline developers should
consider our findings when devising physical activity strategies for
postoperative cardiac patients.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<44>
Accession Number
2007163048
Title
Pre-bypass levosimendan in ventricular dysfunction-effect on right
ventricle.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Kumar D.; Yadava O.P.; Ahlawat V.; Kundu A.; Yadav A.; Prakash A.
Institution
(Kumar, Yadava, Ahlawat, Kundu, Yadav, Prakash) Department of Cardiac
Surgery, National Heart Institute, New Delhi, India
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: Levosimendan is an effective calcium sensitizer with
complementary mechanisms of action: calcium sensitization and opening of
adenosine triphosphate-dependent potassium channels, both on the
sarcolemma of the smooth muscle cells in the vasculature and on the
mitochondria of cardiomyocytes. Levosimendan has a long-acting metabolite
with a half-life of approximately 80 h. There have been a few small
studies on this drug regarding right ventricular function. In view of
this, we investigated the effect of levosimendan on right ventricular
function in patients with coronary artery disease. <br/>Method(s): This
was a prospective, randomized, double-blind study on 50 patients with
coronary artery disease and severe left ventricular dysfunction (left
ventricular ejection fraction <=35%) undergoing elective off-pump coronary
artery bypass. <br/>Result(s): Levosimendan had an inotropic effect on
right ventricular myocardium and a vasodilatory effect on blood vessels.
It caused a decline in pulmonary vascular resistance (p < 0.018), right
ventricular systolic pressure (p < 0.001), and pulmonary artery systolic
pressure (p < 0.001), and improved right ventricular diastolic function as
shown by the decrease in right ventricular Tei index (p < 0.001), right
ventricular end-diastolic pressure, and the ratio of early diastolic
tricuspid inflow to tricuspid lateral annular velocity (p < 0.006).
However, we found no beneficial effects on intensive care unit or hospital
stay (p = 0.164, p = 0.349, respectively) nor a mortality benefit.
<br/>Conclusion(s): Levosimendan has salutary effects on right ventricular
function in patients with severe left ventricular dysfunction undergoing
coronary artery bypass, in terms of improved hemodynamic
parameters.<br/>Copyright &#xa9; The Author(s) 2020.

<45>
Accession Number
2005928771
Title
Exploring mechanisms of action in clinical trials of complex surgical
interventions using mediation analysis.
Source
Clinical Trials. 17 (6) (pp 654-663), 2020. Date of Publication: 01 Dec
2020.
Author
Sharples L.; Papachristofi O.; Rex S.; Landau S.
Institution
(Sharples, Papachristofi, Rex) Department of Medical Statistics, London
School of Hygiene and Tropical Medicine, London, United Kingdom
(Papachristofi) Novartis Pharma AG, Basel, Switzerland
(Rex) University of Sheffield, Sheffield, United Kingdom
(Landau) King's College London, London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Surgical interventions allow for tailoring of treatment to
individual patients and implementation may vary with surgeon and
healthcare provider. In addition, in clinical trials assessing two
competing surgical interventions, the treatments may be accompanied by
co-interventions. <br/>Aim(s): This study explores the use of causal
mediation analysis to (1) delineate the treatment effect that results
directly from the surgical intervention under study and the indirect
effect acting through a co-intervention and (2) to evaluate the benefit of
the surgical intervention if either everybody in the trial population
received the co-intervention or nobody received it. <br/>Method(s): Within
a counterfactual framework, relevant direct and indirect effects of a
surgical intervention are estimated and adjusted for confounding via
parametric regression models, for the situation where both mediator and
outcome are binary, with baseline stratification factors included as fixed
effects and surgeons as random intercepts. The causal difference in
probability of a successful outcome (estimand of interest) is calculated
using Monte Carlo simulation with bootstrapping for confidence intervals.
Packages for estimation within standard statistical software are reviewed
briefly. A step by step application of methods is illustrated using the
Amaze randomised trial of ablation as an adjunct to cardiac surgery in
patients with irregular heart rhythm, with a co-intervention (removal of
the left atrial appendage) administered to a subset of participants at the
surgeon's discretion. The primary outcome was return to normal heart
rhythm at one year post surgery. <br/>Result(s): In Amaze, 17% (95%
confidence interval: 6%, 28%) more patients in the active arm had a
successful outcome, but there was a large difference between active and
control arms in the proportion of patients who received the
co-intervention (55% and 30%, respectively). Causal mediation analysis
suggested that around 1% of the treatment effect was attributable to the
co-intervention (16% natural direct effect). The controlled direct effect
ranged from 18% (6%, 30%) if the co-intervention were mandated, to 14%
(2%, 25%) if it were prohibited. Including age as a moderator of the
mediation effects showed that the natural direct effect of ablation
appeared to decrease with age. <br/>Conclusion(s): Causal mediation
analysis is a useful quantitative tool to explore mediating effects of
co-interventions in surgical trials. In Amaze, investigators could be
reassured that the effect of the active treatment, not explainable by
differential use of the co-intervention, was significant across
analyses.<br/>Copyright &#xa9; The Author(s) 2020.

<46>
Accession Number
2003388374
Title
Early Emotional, Behavioural and Social Development of Infants and Young
Children with Congenital Heart Disease: A Systematic Review.
Source
Journal of Clinical Psychology in Medical Settings. 27 (4) (pp 686-703),
2020. Date of Publication: 01 Dec 2020.
Author
Clancy T.; Jordan B.; de Weerth C.; Muscara F.
Institution
(Clancy) Department of Pediatrics, University of Melbourne, Melbourne,
Australia
(Jordan, Muscara) Brain and Mind, Murdoch Children's Research Institute,
Melbourne, Australia
(Jordan, Muscara) The Royal Children's Hospital, Melbourne, Australia
(de Weerth) Donders Institute for Brain, Cognition and Behaviour, Radboud
University Medical Center, Nijmegen, Netherlands
Publisher
Springer
Abstract
The experiences of diagnosis of congenital heart disease (CHD), cardiac
surgery and hospitalisation(s) are distressing and represent a significant
stressor for a child and family, which may impact psychosocial
development. This systematic review provides a synthesis of psychosocial
outcomes of infants and young children with congenital heart disease who
had cardiac surgery early in life. Twenty-eight studies related to infant
and young children's psychosocial development, specifically emotional,
social and behavioural functioning were identified. Variability was
related to methodological factors including differences in study design,
varying measurement tools and heterogeneous samples. Despite these
limitations, the majority of studies were of high quality. The most common
finding was a high prevalence of low-severity emotional and behavioural
dysregulation. Young children with severe CHD or comorbid conditions
experienced greater impairment, with higher rates of externalising
behaviour problems, although internalising behaviour problems were also
evident. This review integrates findings from literature in the past 28
years on the psychosocial well-being of infants and young children with
CHD and demonstrates a risk for emotional, social and behavioural
development difficulty, and, importantly, that symptoms of psychosocial
impairment are detectable very early in infancy. We advocate for
assessment and monitoring of emotional and behavioural regulation and
social development to be routinely conducted from infancy to enable
prevention and early intervention.<br/>Copyright &#xa9; 2019, Springer
Science+Business Media, LLC, part of Springer Nature.

<47>
Accession Number
633339815
Title
Early use of hemoadsorption in patients after out-of hospital cardiac
arrest - a matched pair analysis.
Source
PloS one. 15 (11) (pp e0241709), 2020. Date of Publication: 2020.
Author
Akin M.; Garcheva V.; Sieweke J.-T.; Flierl U.; Daum H.C.; Bauersachs J.;
Schafer A.
Institution
(Akin, Garcheva, Sieweke, Flierl, Daum, Bauersachs, Schafer) Department of
Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School,
Hannover, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pro- and anti-inflammatory mediators are released during and
after cardiac arrest, which may be unfavourable. Small case-series and
observational studies suggested that unselective hemoadsorption may reduce
inadequately high cytokine levels during sepsis or cardiac surgery. We
aimed to assess the effect of cytokine adsorbtion on mortality in patients
following out-of-hospital cardiac arrest by comparing a patient cohort
with hemoadsorption after resuscitation for out-of-hospital cardiac arrest
to a control cohort without adsorption within the HAnnover COling REgistry
(HACORE). <br/>METHOD(S): We adopted an early routine use of
hemoadsorption in patients after out-of-hospital cardiac arrest with
increased vasopressor need and performed a 1:2 match according to age,
gender, time to return of spontaneous circulation, initial
left-ventricular ejection fraction, extracorporeal membrane-oxygenation or
left-ventricular unloading by Impella, need for renal replacement therapy,
admission lactate, pH, glomerular filtration rate to patients without an
adsorber from HACORE. The primary endpoint was 30-day mortality.
<br/>RESULT(S): Twenty-four patients receiving hemoadsorption were matched
to 48 patients without hemoadsorption (mean age 62+/-13 years, 83% male).
While there was no significant difference in baseline parameters, 30-day
mortality was higher in patients treated with hemoadsorption than in the
matched control group (83% vs 65%, Log rank p = 0.011).
<br/>CONCLUSION(S): Routine use of hemoadsorption did not reduce, but
seems to be associated with higher 30-day mortality in patients after
OHCA. Prior to routine adoption in daily practice, hemoadsorption should
be evaluated in properly sized randomized controlled trials.

<48>
Accession Number
2008420110
Title
Clinical and conceptual approaches to interpreting the findings of
systematic review and meta-analysis of mortality after drug-eluting stents
vs. coronary artery bypass grafting for left main coronary artery disease.
Source
European Heart Journal. 41 (28) (pp 2710-2711), 2020. Date of Publication:
21 Jul 2020.
Author
Jayaraj R.; Kumaraswamy C.; Shaw P.
Institution
(Jayaraj) Department of Artificial Intelligence, Nanjing University of
Information Science and Technology (NUIST), Jiangsu, China
(Jayaraj, Shaw) Northern Territory Medical Program (NTMP), College of
Medicine and Public Health, Flinders University, Cdu Campus, Ellengowan
Drive, Darwin, NT 0909, Australia
(Kumaraswamy) School of Public Health, University of Adelaide, North
Terrace Campus, Adelaide, SA 5005, Australia
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)

<49>
Accession Number
2007174470
Title
Safety and Effectiveness of Del Nido Cardioplegia in Comparison to
Blood-Based St. Thomas Cardioplegia in Congenital Heart Surgeries: A
Prospective Randomized Controlled Study.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (6) (pp
720-726), 2020. Date of Publication: November 2020.
Author
Haranal M.; Chin H.C.; Sivalingam S.; Raja N.; Mohammad Shaffie M.S.;
Namasiwayam T.K.; Fadleen M.; Fakhri N.
Institution
(Haranal, Chin, Sivalingam) Department of Pediatric Cardiac Surgery,
National Heart Institute, Kuala Lumpur, Malaysia
(Raja, Mohammad Shaffie, Namasiwayam) Department of Cardiac Anesthesia,
National Heart Institute, Kuala Lumpur, Malaysia
(Fadleen) Department of Perfusion Sciences, National Heart Institute,
Kuala Lumpur, Malaysia
(Fakhri) Department of Clinical Research, National Heart Institute, Kuala
Lumpur, Malaysia
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Background: To compare the safety and effectiveness of del Nido
cardioplegia with blood-based St Thomas Hospital (BSTH) cardioplegia in
myocardial protection in congenital heart surgery. <br/>Method(s): It is a
prospective, open-labeled, randomized controlled study conducted at
National Heart Institute, Kuala Lumpur from July 2018 to July 2019. All
patients with simple and complex congenital heart diseases (CHD) with good
left ventricular function (left ventricular ejection fraction [LVEF] >50%)
were included while those with LVEF <50% were excluded. A total of 100
patients were randomized into two groups of 50 each receiving either del
Nido or BSTH cardioplegia. Primary end points were the spontaneous return
of activity following aortic cross-clamp release and ventricular function
between two groups. Secondary end point was myocardial injury as assessed
by troponin T levels. <br/>Result(s): Cardiopulmonary bypass and aortic
cross-clamp time, return of spontaneous cardiac activity following the
aortic cross-clamp release, the duration of mechanical ventilation, and
intensive care unit stay were comparable between two groups. Statistically
significant difference was seen in the amount and number of cardioplegia
doses delivered (P <.001). The hemodilution was significantly less in the
del Nido complex CHD group compared to BSTH cardioplegia (P =.001) but no
difference in blood usage (P =.36). The myocardial injury was lesser
(lower troponin T release) with del Nido compared to BSTH cardioplegia (P
=.6). <br/>Conclusion(s): Our study showed that both del Nido and BSTH
cardioplegia are comparable in terms of myocardial protection. However,
single, less frequent, and lesser volume of del Nido cardioplegia makes it
more suitable for complex repair.<br/>Copyright &#xa9; The Author(s) 2020.

<50>
Accession Number
633343013
Title
Association of Circulating Monocyte Chemoattractant Protein-1 Levels With
Cardiovascular Mortality: A Meta-analysis of Population-Based Studies.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 04 Nov 2020.
Author
Georgakis M.K.; de Lemos J.A.; Ayers C.; Wang B.; Bjorkbacka H.; Pana
T.A.; Thorand B.; Sun C.; Fani L.; Malik R.; Dupuis J.; Engstrom G.;
Orho-Melander M.; Melander O.; Boekholdt S.M.; Zierer A.; Elhadad M.A.;
Koenig W.; Herder C.; Hoogeveen R.C.; Kavousi M.; Ballantyne C.M.; Peters
A.; Myint P.K.; Nilsson J.; Benjamin E.J.; Dichgans M.
Institution
(Georgakis, Malik, Dichgans) Institute for Stroke and Dementia Research,
University Hospital, Ludwig-Maximilians-University, Munich, Germany
(Georgakis) Graduate School for Systemic Neurosciences,
Ludwig-Maximilians-University, Munich, Germany
(de Lemos, Ayers) Division of Cardiology, University of Texas Southwestern
Medical Center, Dallas, United States
(Wang, Dupuis) Department of Biostatistics, Boston University School of
Public Health, Boston, MA
(Bjorkbacka, Engstrom, Orho-Melander, Melander, Nilsson) Department of
Clinical Sciences Malmo, Lund University, Malmo, Sweden
(Pana, Myint) Institute of Applied Health Sciences, School of Medicine,
Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United
Kingdom
(Thorand, Elhadad) Research Unit of Molecular Epidemiology, German
Research Center for Environmental Health, Helmholtz Zentrum
MunchenNeuherberg, Germany
(Thorand, Herder, Peters) German Center for Diabetes Research,
Munchen-Neuherberg, Germany
(Sun, Hoogeveen, Ballantyne) Department of Medicine, Baylor College of
Medicine, Houston, TX
(Fani, Kavousi) Department of Epidemiology, Erasmus MC University Medical
Center, Rotterdam, Netherlands
(Boekholdt) University of Amsterdam, Department of Cardiology, Amsterdam,
Netherlands
(Zierer, Elhadad, Peters) Institute of Epidemiology, German Research
Center for Environmental Health, Helmholtz Zentrum MunchenNeuherberg,
Germany
(Elhadad, Koenig, Peters) German Research Center for Cardiovascular
Disease, Partner Site of Munich Heart Alliance, Munich, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Ulm, Germany
(Herder) Institute for Clinical Diabetology, German Diabetes Center,
Leibniz Center for Diabetes Research at Heinrich Heine University
Dusseldorf, Dusseldorf, Germany
(Herder) Department of Endocrinology and Diabetology, Medical Faculty,
Heinrich Heine University Dusseldorf, Dusseldorf, Germany
(Peters) Institute of Medical Information Sciences, Biometry and
Epidemiology, Ludwig-Maximilians-University, Munich, Germany
(Benjamin) Section of Cardiovascular Medicine and Preventive Medicine,
Department of Medicine, Boston University School of Medicine, Boston, MA
(Benjamin) Department of Epidemiology, Boston University School of Public
Health, Boston, MA
(Benjamin) Framingham Heart Study, National Heart, Lung, Blood Institute
and Boston University, Framingham, MA, United States
(Dichgans) Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
(Dichgans) German Centre for Neurodegenerative Diseases, Munich, Germany
Publisher
NLM (Medline)
Abstract
Importance: Human genetics and studies in experimental models support a
key role of monocyte-chemoattractant protein-1 (MCP-1) in atherosclerosis.
Yet, the associations of circulating MCP-1 levels with risk of coronary
heart disease and cardiovascular death in the general population remain
largely unexplored. <br/>Objective(s): To explore whether circulating
levels of MCP-1 are associated with risk of incident coronary heart
disease, myocardial infarction, and cardiovascular mortality in the
general population. Data Sources and Selection: Population-based cohort
studies, identified through a systematic review, that have examined
associations of circulating MCP-1 levels with cardiovascular end points.
Data Extraction and Synthesis: Using a prespecified harmonized analysis
plan, study-specific summary data were obtained from Cox regression models
after excluding individuals with overt cardiovascular disease at baseline.
Derived hazard ratios (HRs) were synthesized using random-effects
meta-analyses. <br/>Main Outcomes and Measures: Incident coronary heart
disease (myocardial infarction, coronary revascularization, and unstable
angina), nonfatal myocardial infarction, and cardiovascular death (from
cardiac or cerebrovascular causes). <br/>Result(s): The meta-analysis
included 7 cohort studies involving 21401 individuals (mean [SD] age, 53.7
[10.2] years; 10012 men [46.8%]). Mean (SD) follow-up was 15.3 (4.5) years
(326392 person-years at risk). In models adjusting for age, sex, and
race/ethnicity, higher MCP-1 levels at baseline were associated with
increased risk of coronary heart disease (HR per 1-SD increment in MCP-1
levels: 1.06 [95% CI, 1.01-1.11]; P=.01), nonfatal myocardial infarction
(HR, 1.07 [95% CI, 1.01-1.13]; P=.02), and cardiovascular death (HR, 1.12
[95% CI, 1.05-1.20]; P<.001). In analyses comparing MCP-1 quartiles, these
associations followed dose-response patterns. After additionally adjusting
for vascular risk factors, the risk estimates were attenuated, but the
associations of MCP-1 levels with cardiovascular death remained
statistically significant, as did the association of MCP-1 levels in the
upper quartile with coronary heart disease. There was no significant
heterogeneity; the results did not change in sensitivity analyses
excluding events occurring in the first 5 years after MCP-1 measurement,
and the risk estimates were stable after additional adjustments for
circulating levels of interleukin-6 and high-sensitivity C-reactive
protein. <br/>Conclusions and Relevance: Higher circulating MCP-1 levels
are associated with higher long-term cardiovascular mortality in
community-dwelling individuals free of overt cardiovascular disease. These
findings provide further support for a key role of MCP-1-signaling in
cardiovascular disease.

<51>
Accession Number
633343007
Title
Long term outcomes of percutaneous or surgical treatment in left main
disease.
Source
Minerva cardioangiologica. (no pagination), 2020. Date of Publication: 04
Nov 2020.
Author
Chiabrando J.G.; Vescovo G.M.; Lombardi M.; Del Buono M.G.; Romeo F.J.;
Berrocal D.H.; Biondi-Zoccai G.; Guzman L.; Abbate A.
Institution
(Chiabrando) Interventional Cardiology Service, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina
(Chiabrando) Health Science Statistics Applied Laboratory (LEACS),
Pharmacology and Toxicology Department, School of Medicine, University of
Buenos Aires, Buenos Aires, Argentina
(Vescovo) Department of Cardiac Thoracic, Vascular Sciences and Public
Health, University of Padua, Padua, Italy
(Lombardi, Del Buono, Abbate) VCU Pauley Heart Center, Virginia
Commonwealth University, VA, Richmond, United States
(Lombardi, Del Buono) Department of Cardiovascular and Thoracic Sciences,
Catholic University of the Sacred Heart, Rome, Italy
(Romeo, Berrocal) Interventional Cardiology Service, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) NapoliItaly
(Guzman) Wake Forest University, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Long term efficacy and safety of either surgical or
percutaneous treatment left main coronary artery disease treatment is
lacking. <br/>METHOD(S): We conducted a systematic review and
meta-analysis of the most updated randomized clinical trials that compared
the efficacy of coronary artery bypass surgery (CABG) or percutaneous
coronary intervention (PCI) for the Left Main Coronary Artery (LMCA)
disease. <br/>RESULT(S): We identified 6 studies, providing data on 5812
patients. The mean follow-up was 6.7 years. PCI was associated with an
increased risk of major vascular events (MACE) (IRR 1.24, 95% confidence
interval (CI) [1.03-1.67], p<0.01), and coronary revascularization (IRR
1.69, 95% CI [1.42-2.03], p<0.01) compared to CABG. Furthermore, all-cause
death, MI and stroke events were not statistically different between the
two therapeutic revascularization methodologies (IRR 1.06, 95% CI
[0.90-1.24], p=0.47, IRR 1.35, 95% CI [0.84-2.16], p=0.03 and IRR 0.66,
95% CI [0.43-1.01], p=0.05, respectively). <br/>CONCLUSION(S): LMCA PCI
has an overall same survival compared to CABG in the long term follow up.
Nevertheless, MACE and revascularization events were more frequent in PCI
compared to CABG.

<52>
Accession Number
633342941
Title
Pulmonary function and quality of life after aortic valve replacement
through ministernotomy: a prospective randomized study.
Source
Kardiologia polska. (no pagination), 2020. Date of Publication: 27 Oct
2020.
Author
Gofus J.; Vobornik M.; Koblizek V.; Smolak P.; Myjavec A.; Vojacek J.;
Pojar M.
Publisher
NLM (Medline)

<53>
Accession Number
633342388
Title
Long-term Healthcare Expenditures over Time for Tissue and Mechanical
Aortic Valve Replacement.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 31 Oct 2020.
Author
Nguyen T.C.; Walker T.; Gunnarsson C.; Moore M.; Keuffel E.L.
Institution
(Nguyen) University of Texas (Houston), Memorial Hermann Medical Center
(Walker, Moore) Edwards Lifesciences
(Gunnarsson) Gunnarsson Consulting
(Keuffel) Health Finance & Access Initiative
Publisher
NLM (Medline)
Abstract
BACKGROUND: Guidelines currently indicate surgical aortic valve
replacement (SAVR) to treat severe cases of aortic stenosis (AS),
particularly for low- to medium-risk patients. While several studies have
compared health outcomes of tissue and mechanical SAVR, this economic
simulation model estimates the difference in long-term healthcare costs
associated with tissue relative to mechanical SAVR. <br/>METHOD(S): The
deterministic and Monte Carlo simulation models used literature-based
epidemiological and cost inputs to calculate annual expenditures related
to SAVR for up to 25 years after initial surgery. A series of three cohort
studies across different age groups provided the health outcome
probabilities for tissue valve patients. Outcome probabilities for
mechanical valve patients were based on relative risks reported in
comparative meta-analyses or large cohort studies. <br/>RESULT(S):
Relative to mechanical SAVR, the expected net discounted savings for a
patient receiving tissue SAVR at age 45/55/65 are $12,266/$15,462/$16,008
($US, 2018) over a 25-year horizon (95% confidence intervals exceed $0).
For a 45-year-old tissue SAVR patient, the estimated per patient cost
difference (relative to mechanical SAVR) of re-operation over 25 years
($16,201) were offset by expected savings on anti-coagulation monitoring
($26,257) over the same period. In a sensitivity analysis in which
mortality risk is assumed equal, significant long-term savings associated
with tissue SAVR still accrue in each of the three age cohorts.
<br/>CONCLUSION(S): Payers, providers and the health system may
financially benefit from the use of tissue valves as significant savings
were associated with the use of tissue valves relative to mechanical
valves for SAVR.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<54>
Accession Number
633340291
Title
How to screen for at risk alcohol use in transplant patients? from
instrument selection to implementation of the AUDIT-C.
Source
Clinical transplantation. (pp e14137), 2020. Date of Publication: 03 Nov
2020.
Author
Verhalle L.; Van Bockstaele K.; Duerinckx N.; Vanhoof J.; Dierickx K.;
Neyens L.; Van Cleemput J.; Gryp S.; Kums D.; De Bondt K.; Schaevers V.;
Demuynck F.; Dewispelaere A.; Dobbels F.
Institution
(Verhalle, Van Bockstaele, Duerinckx, Vanhoof, Demuynck, Dewispelaere,
Dobbels) Academic Centre for Nursing and Midwifery, Department of Public
Health and Primary Care, KU Leuven, Leuven, Belgium
(Duerinckx, Van Cleemput, Gryp, Kums) Heart Transplant Program, Department
of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
(Vanhoof, Dierickx) University Psychiatric Center, UPC KU Leuven, Leuven,
Belgium
(Neyens, De Bondt) Department of Nephrology, University Hospitals Leuven,
Leuven, Belgium
(Schaevers) Lung Transplant Program, University Hospitals Leuven, Leuven,
Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: Given that drinking > 2- 3 units of alcohol daily might
already have adverse health effects, regular screening of at risk drinking
is warranted. We aimed to select and pilot a short instrument to
accurately screen for at risk drinking in transplant patients. METHODOLOGY
AND RESULTS: Five consecutive steps were completed: A comprehensive
literature review identified 24 possible self-report instruments (step 1).
These instruments were scored on six yes/no criteria (i.e. length, concept
measured, diagnostic accuracy, population, manual available, cost) (step
2). Four nurses piloted three instruments with the highest score, and were
interviewed on their experiences with using the AUDIT-C, TWEAK and
Five-Shot. The AUDIT-C was the easiest to use and score, and items were
clear. Cognitive debriefings with 16 patients were conducted to verify
clarity of instructions and items, and suggestions were incorporated into
a modified version of the AUDIT-C (step 4). A convenience sample of 130
Dutch-speaking heart transplant patients completed the modified AUDIT-C
during a scheduled visit (Step 5), revealing that 27.6% of patients showed
at risk drinking. <br/>CONCLUSION(S): The AUDIT-C might be a suitable
instrument to identify at risk drinking in routine post-transplant
follow-up. Further validation, however, is indicated.<br/>Copyright This
article is protected by copyright. All rights reserved.

<55>
Accession Number
633337562
Title
Long-Axis In-Plane Approach Versus Short-Axis Out-of-Plane Approach for
Ultrasound-Guided Central Venous Catheterization in Pediatric Patients: A
Randomized Controlled Trial*.
Source
Pediatric Critical Care Medicine. (pp E996-E1001), 2020. Date of
Publication: 2020.
Author
Takeshita J.; Tachibana K.; Nakajima Y.; Nagai G.; Fujiwara A.; Hamaba H.;
Matsuura H.; Yamashita T.; Shime N.
Institution
(Takeshita, Tachibana, Nagai, Fujiwara, Hamaba, Matsuura, Yamashita)
Department of Anesthesiology, Osaka Prefectural Hospital Organization,
Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
(Takeshita, Nakajima) Department of Anesthesiology, Kansai Medical
University Hospital, Hirakata, Osaka, Japan
(Shime) Department of Emergency and Critical Care Medicine, Institute of
Biomedical and Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Objectives: The aim of this study was to compare the occurrence of
posterior wall puncture between the long-axis in-plane and the short-axis
out-of-plane approaches in a randomized controlled trial of pediatric
patients who underwent cardiovascular surgery under general anesthesia.
<br/>Design(s): Prospective randomized controlled trial. <br/>Setting(s):
Operating room of Osaka Women's and Children's Hospital. <br/>Patient(s):
Pediatric patients less than 5 years old who underwent cardiovascular
surgery. <br/>Intervention(s): Ultrasound-guided central venous
catheterization using the long-axis in-plane approach and short-axis
out-of-plane approach. <br/>Measurements and Main Results: The occurrence
of posterior wall puncture was compared between the long-axis in-plane and
short-axis out-of-plane approaches for ultrasound-guided central venous
catheterization. Patients were randomly allocated to a long-axis group or
a short-axis group and underwent ultrasound-guided central venous
catheterization in the internal jugular vein using either the long-axis
in-plane approach (long-axis group) or the short-axis out-of-plane
approach (short-axis group). After exclusion, 97 patients were allocated
to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall
puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and
short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56;
p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6%
(31/48) in the long-axis and short-axis groups, respectively (relative
risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20
minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and
short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p
= 0.98). <br/>Conclusion(s): The long-axis in-plane approach for
ultrasound-guided central venous catheterization is a useful technique for
avoiding posterior wall puncture in pediatric patients, compared with the
short-axis out-of-plane approach.<br/>Copyright &#xa9; 2020 Lippincott
Williams and Wilkins. All rights reserved.

<56>
Accession Number
633276915
Title
Pilot randomised controlled trial of the impact of preoperative focused
cardiac ultrasound on mortality, cardiac morbidity and health care costs
after fractured neck of femur surgery (ECHONOF II Pilot.
Source
Anaesthesia and Intensive Care. Conference: Australian and New Zealand
College of Anaesthetists Annual Scientific Meeting. Australia. 45 (5) (pp
638), 2017. Date of Publication: September 2017.
Author
Canty D.; Heiberg J.; Yang Y.; Margale S.; Nanjappa N.; Palmer A.; Scott
D.; Maier A.; Chuan A.; French C.; Royse A.; Royse C.
Institution
(Canty) University of Melbourne and Monash, Dep. Anaesthesia Royal
Melbourne, Monash Medical Centre, Australia
(Heiberg, Yang) University of Melbourne, Australia
(Margale, Nanjappa) Queen Elizabeth Hospital, Adelaide, Australia
(Palmer) Menzies Research Institute, TAS, Australia
(Scott) University of Melbourne and St Vincent's Hospital, Melbourne,
Australia
(Maier, French, Royse, Royse) University of Melbourne, Royal Melbourne
Hospital, Australia
(Chuan) University of New South Wales, Liverpool Hospital, Australia
Publisher
SAGE Publications Inc.
Abstract
Background: Fractured neck of femur (hip fracture) surgery is common and
associated with high mortality and morbidity, principally due to prevalent
heart disease that is often unrecognised and inadequately treated before
surgery. Focused cardiac ultrasound (FCU) is a form of transthoracic
echocardiography (TTE) used for non-invasive assessment of cardiac disease
before surgery that frequently alters important perioperative cardiac
diagnosis and management and may be associated with lower mortality(1).
This pilot study aimed to assess feasibility, calibrate the primary
composite outcome and determine group separation, prior to a multi-centre
random control trial (RCT) (n=1900) of the impact of preoperative FCU on
postoperative mortality and morbidity after hip fracture surgery.
<br/>Method(s): Recruitment occurred between February 1 and December 21,
2016 at the Royal Melbourne Hospital, with other sites activated during
the period (Western General Hospital, The Prince Charles Hospital and The
Queen Elizabeth Hospital). Inclusion criteria included participants aged
>18 years scheduled for unilateral repair of hip fracture. Exclusion
criteria included additional or re-do surgery, known or suspected
metastatic cancer or unlikely to survive>24 hours, or previous documented
TTE within 30 days of admission. Participants were randomised to either
receive (FCU group) or not (controls) before surgery. FCU was performed by
independent operators proficient in FCU, and followed the iHeartScan
protocol (University of Melbourne), which has been validated in the
perioperative setting. The primary outcome was 30-day composite outcome of
mortality, acute kidney injury, non-fatal myocardial infarction, stroke,
pulmonary embolism and cardiac arrest. Secondary outcomes included impact
of FCU on diagnosis and management by the anaesthetist and inpatient
hospital costs. The feasibility aims included recruitment of >1 patient
per week per site during active recruitment, a screening:recruitment ratio
of <4:1, group separation of 20% relative difference, and protocol
compliance >80%, including performance of FCU, and 30 day data collection.
<br/>Result(s): Of the 175 participants screened, 100 were included, with
a screening:recruitment ratio of 1.7 (1.4-1.9). The average recruitment
rate per site exceeded 1 participant/week/site at 1.3 (range 1.2 to 3.6).
No Abstracts of Papers patients were withdrawn leaving 100 participants
with complete 30 day outcome data. One patient in the FCU group did not
receive a FCU but remained in the study as intention to treat. The 30-day
composite outcome was less in the FCU group (14% v 26%, relative
difference = 46% CI 16.7%- 128%). The principal contributor to the primary
outcome was death (6% v 12%,) and none of the other outcomes contributed
excessively: acute kidney injury (2% v 11%), pulmonary embolus (4% v 7%),
stroke (2% v 0%), myocardial infarction (0%) and cardiac arrest (0%).
Anaesthesia diagnosis and management data was available in 87%. FCU led to
a change in diagnosis of cardiorespiratory pathology in 54%, and
management in 28%. <br/>Conclusion(s): This pilot study has established
feasibility, calibrated the primary outcome and showed sufficient group
separation favoring FCU and supports a large scale RCT.

<57>
Accession Number
2002488807
Title
Prolonged versus brief balloon inflation during arterial angioplasty for
de novo atherosclerotic disease: a systematic review and meta-analysis.
Source
CVIR Endovascular. 2 (1) (no pagination), 2019. Article Number: 29. Date
of Publication: 01 Dec 2019.
Author
Rockley M.; Jetty P.; Radonjic A.; Rockley K.; Wells G.; Fergusson D.
Institution
(Rockley, Jetty, Radonjic, Rockley) Division of Vascular and Endovascular
Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital
- Civic Campus, Ottawa K1Y4E9, Canada
(Wells) Cardiovascular Research Methods Centre, University of Ottawa Heart
Institute, Ottawa K1Y4W7, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa K1H8L6, Canada
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Objective: Angioplasty is a fundamental treatment for atherosclerotic
disease and may be performed as the sole therapy in small vessel disease.
However, the ideal duration of balloon inflation has not yet been
identified. Our study investigated whether prolonged inflation of at least
1-min duration, when compared with brief inflation, affects residual
stenosis after arterial angioplasty. Data sources and methods: Two
independent reviewers conducted a systematic review of EMBASE, MEDLINE,
CENTRAL, trial registries and grey literature, using pre-specified search
syntax. Data abstraction and quantitative analysis was performed
independently, according to pre-specified criteria. The primary outcome
was residual stenosis after initial angioplasty, in addition to other
pre-specific clinical and radiographic outcomes. All analyses were
stratified by coronary, cerebrovascular, and peripheral territory. The
study protocol is published and registered on PROSPERO (CRD42018092702).
<br/>Result(s): Six relevant articles were identified, of which one
investigated peripheral vascular angioplasty and five investigated
coronary artery angioplasty, encompassing 1496 procedures. The studies
were at moderate risk of bias. Minimal heterogeneity within coronary
studies allowed for subgroup meta-analysis. Prolonged inflation was
significantly associated with lower risk of residual stenosis
post-inflation in the pooled coronary trials (RR 1.76 [95% CI 1.46-2.12],
I² = 0%, p < 0.001) in addition to approaching significance in
the peripheral vascular trial (RR 2.40 [95% CI 0.94-6.13], p = 0.07).
Prolonged inflation was associated with less risk of arterial dissection
and need for adjunctive procedures such as stenting. Following adjunctive
procedures, less residual stenosis was still observed in the prolonged
angioplasty group in the reported coronary studies. Follow-up data did not
reveal a significant difference in the presence of restenosis, however
there was a long-term benefit of prolonged inflation in reducing overall
severity of stenosis. <br/>Discussion(s): This is the first review
investigating outcomes related to duration of balloon inflation. Both
coronary and peripheral vascular evidence are in agreement that prolonged
angioplasty balloon inflation greater than 60 s appears to be associated
with improved immediate post-inflation results. However, long-term data is
heterogeneous and inconsistently reported. We propose further
investigation to address outstanding long-term outcomes, particularly in
small vessel territories such as tibial vessels where angioplasty is often
used as the only endovascular therapy. Trial registration: This protocol
has been registered with the International Prospective Register of
Systematic Reviews (PROSPERO: CRD42018092702) prior to conduct of the
review.<br/>Copyright &#xa9; 2019, The Author(s).

<58>
Accession Number
633027989
Title
Outcomes after corrective surgery for congenital dextro-transposition of
the arteries using the arterial switch technique: A scoping systematic
review.
Source
Systematic Reviews. 9 (1) (no pagination), 2020. Article Number: 231. Date
of Publication: 07 Oct 2020.
Author
Morfaw F.; Leenus A.; Mbuagbaw L.; Anderson L.N.; Dillenburg R.; Thabane
L.
Institution
(Morfaw, Leenus, Mbuagbaw, Anderson, Thabane) Department of Health
Research Methods Evidence and Impact, McMaster University, Hamilton, ON,
Canada
(Morfaw) Department of Obstetrics and Gynecology, Faculty of Medicines and
Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
(Morfaw) Faculty of Health Sciences, University of Bamenda, Bamenda,
Cameroon
(Mbuagbaw, Thabane) Biostatistics Unit/FSORC, St Joseph
Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing,
Hamilton, ON L8N 4A6, Canada
(Mbuagbaw) Centre for Development of Best Practices in Health, Yaounde
Central Hospital, Yaounde, Cameroon
(Dillenburg, Thabane) Departments of Pediatrics and Anesthesia, McMaster
University, Hamilton, ON, Canada
Publisher
BioMed Central Ltd (United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Dextro-transposition of the great arteries (d-TGA) is the most
frequent cyanotic congenital heart pathology in neonates. Surgical
correction of this condition is possible using the arterial switch
operation (ASO) which was first performed by Jatene in 1975.
<br/>Objective(s): The aim of this study was to summarise the evidence on
short-(less than 1 year), medium-(1-20 years), and long-term (more than 20
years) outcomes of children with d-TGA treated with the ASO. The primary
outcome was survival. Secondary outcomes were freedom from cardiac
reoperations, occurrence of aortic insufficiency, pulmonary stenosis,
coronary artery anomalies, neuropsychological development problems and
quality of life. <br/>Method(s): We searched MEDLINE, EMBASE, CINAHL,
LILACS, and reference lists of included articles for studies reporting
outcomes after ASO for d-TGA. Screening, data extraction and risk of bias
assessment were done independently by two reviewers. We pooled data using
a random-effects meta-analysis of proportions and, where not possible,
outcomes were synthesized narratively. We used the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) system to
assess the certainty of the evidence for each outcome. <br/>Main
Result(s): Following ASO for TGA, short-term survival was 92.0% (95% CI
91.0-93.0%; I 2 = 85.8%, 151 studies, 30,186 participants; moderate
certainty evidence). Medium-term survival was 90.0% (95% CI 89.0-91.0%; I
2 = 84.3%, 133 studies; 23,686 participants, moderate certainty evidence),
while long-term survival was 87.0% (95% CI 80.0-92.0 %; I 2 = 84.5%, 4
studies, 933 participants, very low certainty evidence). Evaluation of the
different secondary outcomes also showed satisfactory results in the
short, medium and long term. Subgroup analysis suggests slightly higher
survival following ASO for TGA in the second surgical era (1998 to 2018)
than in the first surgical era (1975 to 1997) in the short and medium term
[93.0% (95% CI 92.0-94.0) vs 90.0% (95% CI 89.0-92.0) and 93.0% (95% CI
91.0-94.0) vs 88.0% (87.0-90.0%) respectively] but not in the long term
[81.0% (95% CI 76.0-86.0%) vs 89.0% (80.0-95.0%)]. <br/>Conclusion(s):
Pooled data from many sources suggests that the ASO for d-TGA leads to
high rates of survival in the short, medium, and long term.<br/>Copyright
&#xa9; 2020 The Author(s).

<59>
Accession Number
2007244236
Title
Effects of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy on
Postoperative Renal Function in Cardiac Surgery.
Source
Heart Lung and Circulation. 29 (11) (pp 1656-1667), 2020. Date of
Publication: November 2020.
Author
De Bono J.A.; Conte S.M.; Newcomb A.E.
Institution
(De Bono, Newcomb) Cardiothoracic Unit, St Vincent's Hospital Melbourne,
Melbourne, Vic, Australia
(Conte) Cardiology Unit, St Vincent's Hospital Sydney, Sydney, NSW,
Australia
Publisher
Elsevier Ltd
Abstract
A Best Evidence Topic in cardiac surgery was written according to a
structured protocol. The question addressed was-"In patients who undergo
cardiac surgery, is preoperative angiotensin-converting enzyme inhibitor
therapy associated with postoperative renal dysfunction?" Altogether, 339
papers were found using the reported search. Ten (10) were chosen which
best answered the clinical question. The papers were evaluated for bias
and heterogeneity using validated tools and the collected results analysed
qualitatively. Evidence in the current literature is inconclusive that
preoperative administration of angiotensin-converting enzyme inhibitor
therapy affects postoperative renal dysfunction in patients undergoing
cardiac surgery.<br/>Copyright &#xa9; 2020 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<60>
Accession Number
2006822740
Title
Learning From Controversy: Contemporary Surgical Management of Aortic
Valve Endocarditis.
Source
Clinical Medicine Insights: Cardiology. 14 (no pagination), 2020. Date of
Publication: 2020.
Author
Nappi F.; Avtaar Singh S.S.; Timofeeva I.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Avtaar Singh) Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Timofeeva) Department of Imaging, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Aortic valve replacement is the commonest cardiac surgical operation
performed worldwide for infective endocarditis (IE). Long-term durability
and avoidance of infection relapse are goals of the procedure. However, no
detailed guidelines on prosthesis selection and surgical strategies guided
by the comprehensive evaluation of the extension of the infection and its
microbiological characteristics, clinical profile of the patient, and risk
of infection recurrence are currently available. Conventional mechanical
or stented xenografts are the preferred choice for localized aortic
infection. However, in cases of complex IE with the involvement of the
root or the aortomitral continuity, the use of homograft is suggested
according to the surgeon and center experience. Homograft use should be
counterbalanced against the risk of structural degeneration. Prosthetic
bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are
also potentially suitable alternatives. Further development of
preservation techniques enabling longer durability of allogenic
substitutes is required. We evaluate the current evidence for the use of
valve substitutes in aortic valve endocarditis and propose an
evidence-based algorithm to guide the choice of therapy. We performed a
systemic review to clarify the contemporary surgical management of aortic
valve endocarditis.<br/>Copyright &#xa9; The Author(s) 2020.

<61>
Accession Number
2006804003
Title
Pregnancy after heart transplantation: A second-generation transmission of
the gift of life.
Source
Journal of Heart and Lung Transplantation. 39 (11) (pp 1321-1322), 2020.
Date of Publication: November 2020.
Author
Tzatzaki E.; Spartalis E.; Spartalis M.
Institution
(Tzatzaki, Spartalis) Division of Cardiology, Onassis Cardiac Surgery
Center, Athens, Greece
(Spartalis) Laboratory of Experimental Surgery and Surgical Research,
Medical School, University of Athens, Athens, Greece
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<62>
Accession Number
2005193059
Title
Acute kidney injury and risk of CKD and hypertension after pediatric
cardiac surgery.
Source
Clinical Journal of the American Society of Nephrology. 15 (10) (pp
1403-1412), 2020. Date of Publication: October 2020.
Author
Zappitelli M.; Parikh C.R.; Kaufman J.S.; Go A.S.; Kimmel P.L.; Hsu C.-Y.;
Coca S.G.; Chinchilli V.M.; Greenberg J.H.; Moxey-Mims M.M.; Ikizler T.A.;
Cockovski V.; Dyer A.-M.; Devarajan P.
Institution
(Zappitelli) Hospital for Sick Children, Peter Gilgan Centre for Research
and Learning, 686 Bay St., 6th floor, Room 06. 9708, Toronto, ON M5G 0A4,
Canada
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, United
States
(Zappitelli, Cockovski) Hospital for Sick Children, University of Toronto,
Toronto, ON, Canada
(Parikh) Division of Nephrology, Department of Internal Medicine, School
of Medicine, Johns Hopkins University, Baltimore, MD, United States
(Kaufman) Veterans Affairs New York Harbor Healthcare System, New York
University School of Medicine, New York, NY, United States
(Go, Hsu) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Go, Hsu) Division of Nephrology, Department of Medicine, University of
California San Francisco, San Francisco, CA, United States
(Kimmel) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Coca) Division of Nephrology, Department of Medicine, Icahn School of
Medicine, Mount Sinai, NY, United States
(Chinchilli, Dyer) Department of Public Health Sciences, Division of
Biostatistics and Bioinformatics, College of Medicine, Pennsylvania State
University, Hershey, PA, United States
(Greenberg) Division of Nephrology, Department of Pediatrics, Yale
University, New Haven, CT, United States
(Moxey-Mims) Division of Nephrology, Children's National Hospital,
Washington, DC, United States
(Ikizler) Division of Nephrology and Hypertension, Department of Medicine,
Vanderbilt University Medical Center, Nashville, TN, United States
(Ikizler) Tennessee Valley Healthcare System, Veterans Affairs Medical
Center, Veteran's Health Administration, Nashville, TN, United States
(Ikizler) Vanderbilt Center for Kidney Disease, Vanderbilt University
Medical Center, Nashville, TN, United States
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, OH, United States
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives The association of AKI after pediatric cardiac
surgery with long-term CKD and hypertension development is unclear. The
study objectives were to determine whether AKI after pediatric cardiac
surgery is associated with incident CKD and hypertension. Design, setting,
participants, & measurements This was a prospective cohort study of
children of 1 month to 18 years old who were undergoing cardiac surgery at
two tertiary care centers (Canada, United States). Participants were
recruited before cardiac surgery and were followed during hospitalization
and at 3, 12, 24, 36, and 48 months after discharge. Exposures were
postoperative AKI, based on the Kidney Disease Improving Global Outcomes
(KDIGO) definition, and age,2 years old at surgery. Outcomes and measures
were CKD (low eGFR or albuminuria for age) and hypertension (per the 2017
American Academy of Pediatrics guidelines) at follow-up, with the
composite outcome of CKD or hypertension. Results Among 124 participants,
57 (46%) developed AKI. AKI versus non-AKI participants had a median
(interquartile range) age of 8 (4.8-40.8) versus 46 (6.0-158.4) months,
respectively, and higher preoperative eGFR. From the 3-to 48-month
follow-up, the cohort prevalence of CKD was high (17%-20%); hypertension
prevalence was also high (22%-30%). AKI was not significantly associated
with the development of CKD throughout followup. AKI was associated with
hypertension development at 12 months after discharge (adjusted relative
risk, 2.16; 95% confidence interval, 1.18 to 3.95), but not at subsequent
visits. Children aged,2yearsoldatsurgeryhada significantly higher
prevalence of hypertension during follow-up than older children (40%
versus 21% at 3-month follow-up; 32% versus 13% at 48-month follow-up).
Conclusions CKD and hypertension burden in the 4 years after pediatric
cardiac surgery is high. Young age at surgery, but not AKI, is associated
with their development.<br/>Copyright &#xa9; 2020 by the American Society
of Nephrology.

<63>
Accession Number
2008450239
Title
The effect of transcatheter mitral valve repair on short-term mortality in
patients with chronic kidney disease - A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2020. Date of
Publication: 2020.
Author
Dave P.; Abunassar J.G.; Sayed N.; Sharma S.; Babiolakis C.S.; Bisleri G.;
Abuzeid W.
Institution
(Dave) Department of Internal Medicine, Kingston Health Sciences Centre,
Queen's University, Kingston, ON, Canada
(Abunassar, Abuzeid) Division of Cardiology, Kingston Health Sciences
Centre, Queen's University, Kingston, ON, Canada
(Sayed, Sharma) Department of Medicine, Undergraduate School of Medicine,
Queen's University, Kingston, ON, Canada
(Babiolakis) Department of Medicine, Division of Cardiology, Queen's
University, Kingston, ON, Canada
(Bisleri) Department of Surgery, Division of Cardiac Surgery, Kingston
Health Sciences Centre, Queen's University, Kingston, ON, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Transcatheter Mitral Valve Repair (TMVr) offers clinically significant
benefit to select symptomatic patients with severe mitral regurgitation
(MR). We conducted a systematic review and meta-analysis of clinical
trials and observational studies to identify the effect of pre-procedural
Chronic Kidney disease (CKD) on short-term mortality in TMVr. We found CKD
is a predictor of 30-day mortality in patients undergoing TMVr.
Specifically, a GFR < 30 mL/min conveys a significant increase in 30-day
mortality. This is significant for patient selection, prognostication, as
well as identifies an area of need for further research. Summary for
annotated table of contents: A systematic review and meta-analysis looking
at short-term mortality in patients undergoing Transcatheter Mitral Valve
Repair with chronic kidney disease. Findings show severe renal disease is
associated with increased 30-day mortality.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<64>
Accession Number
2007157250
Title
Venous or arterial samples for activated clotting time measurements: a
systematic review.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Iddawela S.; Swamy P.; Member S.; Harky A.
Institution
(Iddawela) Department of Respiratory Medicine, University Hospitals
Birmingham, Birmingham, United Kingdom
(Swamy) GKT School of Medical Education, King's College London, London,
United Kingdom
(Member) Lancashire School of Medicine and Dentistry, University of
Central Lancashire, Greenbank Building, Preston, Lancashire, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Health and life
sciences, University of Liverpool, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Harky) Department of Cardiac Surgery, Alder Hey Children Hospital,
Liverpool, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The systematic review aims to investigate the effect of
sampling source on activated clotting time (ACT) measurement within
cardiovascular surgery and cardiac catheterisation. It also examines the
evidence surrounding novel clot assessment techniques and associated
sampling variation. <br/>Method(s): A comprehensive electronic search was
conducted using PubMed, MEDLINE, Scopus, Cochrane database, and Google
Scholar until 20th June 2020. All studies reporting sampling source
variability of ACT in cardiac surgery, vascular surgery and cardiac
catheterisation were included. <br/>Result(s): Fourteen studies were
included in the systematic review. Inconsistent reports of variability
were seen in cardiac surgery and cardiac catheterisation. There were no
studies directly examining ACT variability in vascular surgery. Novel clot
assessment techniques have been validated in cardiac surgery, but
measurements vary depending on sampling source. <br/>Conclusion(s):
Sampling source should be kept consistent to facilitate effective
haemostatic strategies. More research is needed regarding variability in
vascular surgery and novel clot assessment techniques.<br/>Copyright
&#xa9; The Author(s) 2020.

<65>
Accession Number
2005561570
Title
Transcatheter aortic valve replacement and percutaneous coronary
intervention versus surgical aortic valve replacement and coronary artery
bypass grafting in patients with severe aortic stenosis and concomitant
coronary artery disease: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 96 (5) (pp 1113-1125),
2020. Date of Publication: 01 Nov 2020.
Author
Kotronias R.A.; Bray J.H.; Scarsini R.; Rajasundaram S.;
Terentes-Printzios D.; De Maria G.L.; Kharbanda R.K.; Mamas M.A.; Bagur
R.; Banning A.P.
Institution
(Kotronias, Bray, Scarsini, Rajasundaram, Terentes-Printzios, De Maria,
Kharbanda, Banning) Oxford Heart Centre, Oxford University Hospitals NHS
Foundation Trust, Oxford, Oxfordshire, United Kingdom
(Kotronias) Department of Cardiovascular Medicine, University of Oxford,
Oxford, Oxfordshire, United Kingdom
(Scarsini) Department of Medicine, Division of Cardiology, University of
Verona, Verona, Italy
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Keele University, UK and Heart Centre, Thomas Jefferson
University, Philadelphia, United States
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, Western University, London, ON, Canada
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 performed a systematic review and meta-analysis to evaluate
the early and midterm outcomes of patients who underwent surgical aortic
valve replacement (SAVR) and coronary artery bypass grafting (CABG)
against patients who had transcatheter aortic valve replacement (TAVR) and
percutaneous coronary intervention (PCI). <br/>Background(s): Contemporary
guidelines suggest that surgical or percutaneous revascularization of
significant coronary artery disease (CAD) in patients with severe aortic
stenosis (AS) is a reasonable strategy. <br/>Method(s): We conducted a
comprehensive search of Medline and Embase to identify studies comparing a
percutaneous transcatheter versus a surgical approach. Random effects
meta-analyses using the Mantel-Haenszel method were performed to estimate
the effect of percutaneous compared surgical strategies using aggregate
data. <br/>Result(s): Six studies reporting on 1770 participants were
included in the meta-analysis. There were no significant differences in
effect estimates for early and midterm mortality (OR: 0.78; 95% CI,
0.50-1.20 and OR: 1.09; 95% CI, 0.80-1.49, respectively) or myocardial
infarction (OR: 0.52; 95% CI, 0.20-1.33 and OR: 1.34; 95% CI, 0.67-2.65,
respectively). No significant difference was shown for peri-procedural
stroke (OR: 0.80; 95% CI, 0.35-1.87). A transcatheter approach had a
higher rate of major vascular complications (OR: 14.44; 95% CI,
4.42-47.16), but a lower rate of acute kidney injury (OR: 0.41; 95% CI,
0.19-0.91). <br/>Conclusion(s): Our analysis suggests that a percutaneous
transcatheter approach confers similar outcomes compared to a surgical
approach in patients with severe AS and CAD. However, our findings are
based on low quality studies and should serve as hypothesis generating. In
the absence of adequately powered studies yielding high level evidence,
individualized decision making should be based on surgical risk
assessment.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC.

<66>
Accession Number
2004551269
Title
Three contemporary thin-strut drug-eluting stents implanted in severely
calcified coronary lesions of participants in a randomized all-comers
trial.
Source
Catheterization and Cardiovascular Interventions. 96 (5) (pp E508-E515),
2020. Date of Publication: 01 Nov 2020.
Author
Buiten R.A.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; van Houwelingen K.G.;
Danse P.W.; Schotborgh C.E.; Stoel M.G.; Scholte M.; Linssen G.C.M.; de
Man F.H.A.F.; von Birgelen C.
Institution
(Buiten, Ploumen, Zocca, van Houwelingen, Stoel, de Man, von Birgelen)
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente,
Enschede, Netherlands
(Buiten, Ploumen, Zocca, Doggen, von Birgelen) Department of Health
Technology and Services Research, Faculty BMS, Technical Medical Centre,
University of Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Scholte) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
(Linssen) Department of Cardiology, Hospital Group Twente, Almelo and
Hengelo, Netherlands
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
Objective: The objective was to assess the 2-year clinical performance of
three drug-eluting stents in all-comer patients with severely calcified
coronary lesions. <br/>Background(s): Severe lesion calcification
increases cardiovascular event risk after coronary stenting, but there is
a lack of data on the clinical outcome of all-comers with severely
calcified lesions who were treated with more recently introduced
drug-eluting stents. <br/>Method(s): The BIO-RESORT trial
(clinicaltrials.gov: NCT01674803) randomly assigned 3,514 all-comer
patients to biodegradable polymer Synergy everolimus-eluting stents (EES)
or Orsiro sirolimus-eluting stents (SES), versus durable polymer Resolute
Integrity zotarolimus-eluting stents (ZES). In a post hoc analysis, we
assessed 783 patients (22.3%) with at least one severely calcified target
lesion. <br/>Result(s): At 2-year follow-up (available in 99% of
patients), the main composite endpoint target vessel failure occurred in
19/252 (7.6%) of the EES and in 33/265 (12.6%) of the ZES-treated patients
(p =.07). Target vessel failure occurred in 24/266 (9.1%) of the
SES-treated patients (vs. ZES: p =.21). There was a difference in target
vessel revascularization, which was required in EES in 6/252 (2.4%)
patients and in ZES in 20/265 (7.7%) patients (p =.01); the target vessel
revascularization rate in SES was 9/266 (3.4%, vs. ZES: p =.04).
Multivariate analysis showed that implantation of EES, but not SES, was
independently associated with lower target vessel revascularization rates
than in ZES. <br/>Conclusion(s): In BIO-RESORT participants with severely
calcified target lesions, treatment with EES was associated with a lower
2-year target vessel revascularization rate than treatment with
ZES.<br/>Copyright &#xa9; 2020 The Authors. Catheterization and
Cardiovascular Interventions published by Wiley Periodicals, Inc.

<67>
Accession Number
2003783139
Title
Outcomes with retrograde versus antegrade chronic total occlusion
revascularization.
Source
Catheterization and Cardiovascular Interventions. 96 (5) (pp 1037-1043),
2020. Date of Publication: 01 Nov 2020.
Author
Megaly M.; Ali A.; Saad M.; Omer M.; Xenogiannis I.; Werner G.S.;
Karmpaliotis D.; Russo J.J.; Yamane M.; Garbo R.; Gagnor A.; Ungi I.;
Rinfret S.; Pershad A.; Wojcik J.; Garcia S.; Mashayekhi K.; Sianos G.;
Galassi A.R.; Burke M.N.; Brilakis E.S.
Institution
(Megaly, Omer, Xenogiannis, Garcia, Burke, Brilakis) Minneapolis Heart
Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Omer) Department of Cardiovascular Medicine, Hennepin Healthcare,
Minneapolis, MN, United States
(Ali) Department of Medicine, Mercy Hospital and Medical Center, Chicago,
IL, United States
(Saad) Division of Cardiovascular Medicine, The Warren Alpert School of
Medicine at Brown University, Providence, RI, United States
(Saad) Department of Cardiovascular Medicine, Ain Shams University
Hospitals, Cairo, Egypt
(Werner) Medizinische Klinik I (Cardiology and Intensive Care), Klinikum
Darmstadt GmbH, Darmstadt, Germany
(Karmpaliotis, Russo) Department of Cardiology, Columbia University, New
York, NY, United States
(Yamane) Department of Cardiology, Sayama Hospital, Saitama, Japan
(Garbo) Department of Invasive Cardiology, San Giovanni Bosco Hospital,
Turin, Italy
(Gagnor) Department of Invasive Cardiology, Maria Vittoria Hospital,
Turin, Italy
(Ungi) Division of Invasive Cardiology, University of Szeged, Second
Department of Internal Medicine and Cardiology Center, Szeged, Hungary
(Rinfret) Division of Interventional Cardiology, McGill University Health
Centre, Montreal, Canada
(Pershad) Division of Cardiology, Banner-University Medical Center,
Phoenix, AZ, United States
(Wojcik) Department of Cardiology, Hospital of Invasive Cardiology
IKARDIA, Naleczow, Poland
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Sianos) First Department of Cardiology, AHEPA University Hospital,
Thessaloniki, Greece
(Galassi) Department of Clinical and Experimental Medicine,
Catheterization Laboratory and Cardiovascular Interventional Unit,
Cannizzaro Hospital, University of Catania, Catania, Italy
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: The aim of the study was to evaluate the outcomes of
retrograde versus antegrade approach in chronic total occlusion (CTO)
percutaneous coronary intervention (PCI). <br/>Background(s): The
retrograde approach has increased the success rate of CTO PCI but has been
associated with a higher risk for complications. <br/>Method(s): We
conducted a meta-analysis of studies published between 2000 and August
2019 comparing the in-hospital and long-term outcomes with retrograde
versus antegrade CTO PCI. <br/>Result(s): Twelve observational studies
(10,240 patients) met our inclusion criteria (retrograde approach 2,789
patients, antegrade approach 7,451 patients). Lesions treated with the
retrograde approach had higher J-CTO score (2.8 vs. 1.9, p <.001).
Retrograde CTO PCI was associated with a lower success rate (80.9% vs.
87.4%, p <.001). Both approaches had similar in-hospital mortality, urgent
revascularization, and cerebrovascular events. Retrograde CTO PCI was
associated with higher risk of in-hospital myocardial infarction (MI; odds
ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p <.001), urgent
pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p =.002), and
contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p <.001). During
a mean follow-up of 48 +/- 31 months retrograde crossing had similar
mortality (OR 1.79, 95% CI 0.84-3.81, p =.13), but a higher incidence of
MI (OR 2.07, 95% CI 1.1-3.88, p =.02), target vessel revascularization (OR
1.92, 95% CI 1.49-2.46, p <.001), and target lesion revascularization (OR
2.08, 95% CI 1.33-3.28, p =.001). <br/>Conclusion(s): Compared with
antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions
and is associated with a higher risk for acute and long-term adverse
events.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<68>
Accession Number
633322012
Title
Outcomes of Cochlear Implantation in Patients with Jervell and
Lange-Nielsen Syndrome: A Systematic Review and Narrative Synthesis.
Source
The journal of international advanced otology. 16 (3) (pp 456-462), 2020.
Date of Publication: 01 Dec 2020.
Author
Metcalfe C.; Muzaffar J.; Monksfield P.; Bance M.
Institution
(Metcalfe, Muzaffar, Monksfield) University Hospitals Birmingham NHS
Foundation Trust, Queen Elizabeth Hospital Birmingham, United Kingdom
(Bance) Department of Clinical Neurosciences, University of Cambridge,
Cambridge, United Kingdom
Publisher
NLM (Medline)
Abstract
Establish outcomes following cochlear implantation (CI) in patients with
Jervell and Lange-Nielsen Syndrome (JLNS). Methods Systematic review and
narrative synthesis. Databases searched on Medline, Pubmed, Embase, Web of
Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on
language or year of publication. Review conducted in accordance with the
PRISMA statement. Searches identified 63 abstracts and 19 full texts. Of
these, 9 studies met inclusion criteria reporting outcomes in 66 patients
with at least 72 implants. Hearing outcomes were generally good. Mortality
secondary to cardiac complications within the follow up period occurred in
at least five cases (7.6%), though three of these were thought to be
unrelated to surgery. Potentially dangerous arrhythmias without associated
morbidity were also noted in at least five patients. The methodological
quality of included studies was modest, predominantly consisting of case
reports and non-controlled case series with small numbers of patients. All
studies were OCEBM grade IV. One study contributed 41/66 patients (62%).
Hearing outcomes following CI in JLNS are generally good with the majority
of patients experiencing useful hearing improvement. Significant
peri-operative cardiac risks exist and should be discussed with the
patient and family during pre-operative counselling and prompt thorough
investigation, pre-operative optimisation and peri-operative monitoring.

<69>
[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. <br/>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. <br/>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. <br/>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.

<70>
Accession Number
633185993
Title
Should cardiac surgery be delayed in patients with uncorrected
hypothyroidism?.
Source
Interactive cardiovascular and thoracic surgery. 31 (5) (pp 618-621),
2020. Date of Publication: 01 Nov 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.<br/>Copyright &#xa9; The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<71>
Accession Number
633074481
Title
Mortality in low-risk patients with aortic stenosis undergoing
transcatheter or surgical aortic valve replacement: a reconstructed
individual patient data meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 31 (5) (pp 587-594),
2020. Date of Publication: 01 Nov 2020.
Author
Celik M.; Milojevic M.M.; Durko A.P.; Oei F.B.S.; Bogers A.J.J.C.; Mahtab
E.A.F.
Institution
(Celik, Milojevic, Durko, Oei, Bogers, Mahtab) Department of
Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Although the standard of care for patients with severe aortic
stenosis at low-surgical risk has included surgical aortic valve
replacement (SAVR) since the mid-1960s, many clinical studies have
investigated whether transcatheter aortic valve implantation (TAVI) can be
a better approach in these patients. As no individual study has been
performed to detect the difference in mortality between these 2 treatment
strategies, we did a reconstructive individual patient data analysis to
study the long-term difference in all-cause mortality. <br/>METHOD(S):
Randomized clinical trials and propensity score-matched studies that
included low-risk adult patients with severe aortic stenosis undergoing
either SAVR or TAVI and with reports on the mortality rates during the
follow-up period were considered. The primary outcome was all-cause
mortality of up to 5years. <br/>RESULT(S): In the reconstructed individual
patient data analysis, there was no statistically significant difference
in all-cause mortality between TAVI and SAVR at 5years of follow-up [30.7%
vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.96-1.48;
P=0.104]. However, landmark analyses in patients surviving up to 1year of
follow-up showed significantly higher all-cause mortality at 5years of
follow-up (27.5% vs 17.3%, HR 1.77, 95% CI 1.29-2.43; P<0.001) in patients
undergoing TAVI compared to patients undergoing SAVR, respectively.
<br/>CONCLUSION(S): This reconstructed individual patient data analysis in
low-risk patients with severe aortic stenosis demonstrates that the 5-year
all-cause mortality rates are higher after TAVI than after SAVR, driven by
markedly higher mortality rates between 1 and 5years of follow-up in the
TAVI group. The present results call for caution in expanding the TAVI
procedure as the treatment of choice for the majority of all low-risk
patients until long-term data from contemporary randomized clinical trials
are available.<br/>Copyright &#xa9; The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<72>
Accession Number
632017165
Title
Structural durability of early-generation Transcatheter aortic valve
replacement valves compared with surgical aortic valve replacement valves
in heart valve surgery: a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 127), 2020. Date of
Publication: 08 Jun 2020.
Author
Ler A.; Ying Y.J.; Sazzad F.; Choong A.M.T.L.; Kofidis T.
Institution
(Ler, Ying, Sazzad, Choong, Kofidis) Department of Cardiac, Thoracic and
Vascular Surgery, National University Heart Centre, 9th Floor ,Tower Block
,1E Kent Ridge Road 119228, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Ying) School of Medicine, Queen's University Belfast, Belfast, United
Kingdom
(Sazzad, Choong, Kofidis) Department of Surgery, Yong Loo Lin School of
Medicine, National University of Singapore, Kent Ridge Road, Singapore
(Sazzad, Choong, Kofidis) National University Health System (NUHS), 5
Lower Kent Ridge Road ,Kent Ridge Road 119228, Singapore
(Choong, Kofidis) Cardiovascular Research Institute, National University
of Singapore, 14 Medical Drive 117599, Singapore
Publisher
NLM (Medline)
Abstract
BACKGROUND: The current treatment for aortic stenosis includes open
surgical aortic valve replacement (SAVR) as well as endovascular
transcatheter aortic valve replacement (TAVR). This study aims to compare
the 1-year, 2-3year and 5-year structural durability of TAVR valves with
that of SAVR valves. <br/>METHOD(S): A systematic literature search was
conducted in July 2019 on Medline (via PubMed), Embase and Cochrane
electronic databases according to the PRISMA guidelines. <br/>RESULT(S):
Thirteen randomized controlled trials were included. From the
meta-analysis, we observed higher rates of 1-year (OR: 7.65, CI: 4.57 to
12.79, p<0.00001), 2-3-year (OR: 13.49, CI: 5.66 to 32.16, p<0.00001) and
5-year paravalvular regurgitation (OR: 14.51, CI: 4.47 to 47.09,
p<0.00001) associated with the TAVR valves than the SAVR valves. There
were also higher rates of 1-year (OR: 5.00, CI: 3.27 to 7.67, p<0.00001),
2-3-year (OR: 8.14, CI: 3.58 to 18.50, p<0.00001) and 5-year moderate or
severe aortic regurgitation (MD: 14.65, CI: 4.55 to 47.19, p<0.00001), and
higher rates of 1-year (OR: 3.55, CI: 1.86 to 6.77, p=0.0001), 2-3-year
(OR: 3.55, CI: 1.86 to 6.77, p=0.0001) and 5-year reintervention (OR:
3.55, CI: 1.22 to 10.38, p=0.02) in the TAVR valves as compared to SAVR
valves. <br/>CONCLUSION(S): TAVR valves appear to be more susceptible to
structural valve deterioration and thus potentially less structurally
durable than SAVR valves, given that they may be associated with higher
rates of moderate or severe aortic regurgitation, paravalvular
regurgitation and reintervention in the 1-year-, 2-3year, and 5-year
period.

<73>
Accession Number
2007166946
Title
Aortic valve replacement plus revascularization: The battle of surgical
versus transcatheter approach still rages.
Source
Catheterization and Cardiovascular Interventions. 96 (5) (pp 1126-1127),
2020. Date of Publication: 01 Nov 2020.
Author
Tarantini G.; Fraccaro C.
Institution
(Tarantini, Fraccaro) Department of Cardiac, Thoracic, Vascular Science
and Public Health, University of Padova, Padova, Italy
Publisher
John Wiley and Sons Inc (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail: info@wiley.com)
Abstract
The current guidelines for primary aortic valve disease suggest, with
different class of recommendation, concomitant coronary artery
revascularization in all candidates to aortic valve replacement with
angiographic evidence of significant coronary artery diameter stenosis
(>=70%, >=50% for left main stenosis) both for surgical or transcatheter
approach. Initial (non-patient-level) pooled data analyses suggest that a
percutaneous transcatheter approach confers similar outcomes compared to a
surgical approach in patients with severe AS and CAD. Further scientific
evidences from RCTs are warranted to clarify the prognostic impact of CAD
on TAVR candidates and to identify the most appropriate revascularization
strategy.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC.

<74>
Accession Number
2008470817
Title
Comparison of outcomes following transfemoral versus trans-subclavian
approach for transcatheter aortic valve Implantation: A meta-analysis.
Source
IJC Heart and Vasculature. 31 (no pagination), 2020. Article Number:
100668. Date of Publication: December 2020.
Author
Al-Balah A.; Naqvi D.; Houbby N.; Chien L.; Sen S.; Athanasiou T.; Yousuf
Salmasi M.
Institution
(Al-Balah, Naqvi, Houbby, Chien) Faculty of Medicine, Imperial College
London, United Kingdom
(Sen) Department of Surgery, Imperial College London, United Kingdom
(Athanasiou, Yousuf Salmasi) Department of Cardiology, Imperial College
Healthcare Trust, London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: The subclavian artery is an alternative access route for
transcatheter aortic valve implantation (TAVI), with a potential advantage
in patients unsuitable for traditional access routes such as the femoral
artery. This study aimed to determine the safety and efficacy of the
trans-subclavian (TSc) compared to the trans-femoral (TF) approach.
<br/>Method(s): A systematic review was conducted on two online databases:
Embase and Medline. The initial search returned 508 titles. Nine
observational studies were included: n = 2938 patients (2382 TF and 556
TSc). <br/>Result(s): Both TSc and TF groups were comparable for: 30-day
mortality (Odds ratio, OR 0.75, 95% CI 0.49 - 1.16, p = 0.195);
in-hospital stroke (OR 1.05, 95% CI 0.60-1.85, p = 0.859); myocardial
infarction (OR 1.97, 95% CI 0.74-5.23, p = 0.176); paravalvular leaks (OR
1.20, 95% CI 0.76-1.90, p = 0.439); rates of postoperative permanent
pacemaker implantation (OR 1.49, 95% CI 0.92-2.41, p = 0.105); in-hospital
bleeding and meta-analysis demonstrated no significant difference between
access points (OR 3.44, 95% CI 0.35-34.22, p = 0.292). Procedural time was
found to be longer in the TSc group (SMD 1.02; 95% CI 0.815-1.219, p <
0.001). Major vascular complications were significantly higher in the TF
group (OR 0.55, 95% CI 0.32-0.94, p = 0.029). Meta regression found no
influence of the covariates on the outcomes. <br/>Conclusion(s):
Subclavian access is both a safe and feasible alternative access route for
TAVI with lower risks of major vascular complications. This study supports
the use of subclavian access as a viable alternative in patient groups
where transfemoral TAVI is contraindicated.<br/>Copyright &#xa9; 2020 The
Author(s)

<75>
Accession Number
2008442791
Title
Antiplatelet therapy and coronary artery bypass grafting: A systematic
review and network meta-Analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (3) (pp 354-363),
2020. Date of Publication: 01 Sep 2020.
Author
Gupta S.; Belley-Cote E.P.; Panchal P.; Pandey A.; Basha A.; Pallo L.;
Rochwerg B.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Whitlock) Department of Surgery, McMaster University, Hamilton,
ON, Canada
(Gupta, Rochwerg, Whitlock) Department of Health Research Methods,
Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Mehta, Schwalm, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Panchal, Pandey, Basha) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Pallo) Faculty of Sciences, McMaster University, Hamilton, ON, Canada
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2020 Oxford University Press. All
rights reserved.

<76>
Accession Number
2008411115
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.
Institution
(Kane, Vivirito, Strahl-Heldreth, Allender) Department of Veterinary
Clinical Medicine, University of Illinois, College of Veterinary Medicine,
Urbana, IL 61802, United States
(Chinnadurai) Chicago Zoological Society, Brookfield Zoo, Brookfield, IL
60513, United States
Publisher
American Veterinary Medical Association (E-mail: avmainfo@avma.org)
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. RESULTS 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.<br/>Copyright &#xa9; 2020 American
Veterinary Medical Association. All rights reserved.

<77>
Accession Number
2008453611
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: October 2020.
Author
Zhang Y.-N.; Yang L.; Zhang W.-S.; Liu J.
Institution
(Zhang, Yang, Zhang, Liu) 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
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
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%). <br/>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.<br/>Copyright
&#xa9; 2020 EDIZIONI MINERVA MEDICA.

<78>
Accession Number
633332128
Title
Sitagliptin for the Prevention and Treatment of Perioperative
Hyperglycaemia in Patients with Type 2 Diabetes Undergoing Cardiac
Surgery: A Randomised Controlled Trial.
Source
Diabetes, obesity & metabolism. (no pagination), 2020. Date of
Publication: 02 Nov 2020.
Author
Cardona S.; Tsegka K.; Pasquel F.J.; Jacobs S.; Halkos M.; Keeling W.B.;
Davis G.M.; Fayfman M.; Albury B.; Urrutia M.A.; Galindo R.J.; Migdal
A.L.; Macheers S.; Guyton R.A.; Vellanki P.; Peng L.; Umpierrez G.E.
Institution
(Cardona, Tsegka, Pasquel, Jacobs, Davis, Fayfman, Albury, Urrutia,
Galindo, Migdal, Vellanki, Umpierrez) Department of Medicine, Emory
University, Atlanta, Georgia
(Halkos, Keeling, Macheers, Guyton) Joseph B. Whitehead Department of
Surgery, Emory University, Atlanta, Georgia, NCT
(Peng) Rollins School of Public Health, Emory University, Atlanta, Georgia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Hyperglycaemia is associated with increased incidence of
perioperative complications. We assessed whether treatment with
sitagliptin, starting before surgery and continued during the hospital
stay, can prevent and reduce the severity of perioperative hyperglycaemia
in patients with type 2 diabetes undergoing coronary artery bypass graft
(CABG) surgery. MARTIALS AND METHODS: We conducted a double-blinded,
placebo-control trial in adults with type 2 diabetes randomly assigned to
receive sitagliptin or matching placebo starting one day prior to surgery
and continued during the hospital stay. The primary outcome was difference
in the proportion of patients with postoperative hyperglycaemia (blood
glucose [BG] >10mmol/L [>180mg/dL]) in the intensive care unit (ICU).
Secondary endpoints included differences in mean daily BG in the ICU and
after transition to regular wards, hypoglycaemia, hospital complications,
length of stay, and need of insulin therapy. <br/>RESULT(S): We included
182 participants randomised to receive sitagliptin or placebo (91 per
group, age 64+/-9years, HbA1C: 7.6+/-1.5%, and diabetes duration:
10+/-9years). There were no differences in number of patients with
postoperative BG >10mmol/L, mean daily BG in the ICU or after transition
to regular floors, hypoglycaemia, hospital complications or length of
stay. There were no differences on insulin requirements in the ICU;
however, sitagliptin therapy was associated with lower mean daily insulin
requirements (21.1+/-18.4 vs 32.5+/-26.3 units, p=0.007) after transition
to regular floor compared to placebo. <br/>CONCLUSION(S): The
administration of sitagliptin prior to surgery and during the hospital
stay, did not prevent perioperative hyperglycaemia or complications after
CABG. Sitagliptin therapy was associated with lower mean daily insulin
requirements after transition to regular floors. This article is protected
by copyright. All rights reserved.

<79>
Accession Number
633331882
Title
Institutional Red Blood Cell Transfusion Rates Are Correlated Following
Endovascular and Surgical Cardiovascular Procedures: Evidence That Local
Culture Influences Transfusion Decisions.
Source
Journal of the American Heart Association. (pp e016232), 2020. Date of
Publication: 03 Nov 2020.
Author
Apostolidou E.; Kolte D.; Kennedy K.F.; Beale C.E.; Abbott J.D.; Ehsan A.;
Gurm H.S.; Carson J.L.; Mamdani S.; Aronow H.D.
Institution
(Apostolidou, Abbott, Mamdani, Aronow) Division of Cardiology Alpert
Medical School of Brown University Providence RI
(Kolte) Division of Cardiology Massachusetts General Hospital and Harvard
Medical School Boston MA
(Kennedy) Statistical Consultant to the Cardiovascular Institute Kansas
City MO
(Beale) St. Anne's Hospital Fall River MA
(Ehsan) Division of Cardiothoracic Surgery Alpert Medical School of Brown
University Providence RI
(Gurm) Division of Cardiology University of Michigan Ann Arbor MI
(Carson) Division of Internal Medicine Robert Wood Johnson University
Hospital New Brunswick NJ
Publisher
NLM (Medline)
Abstract
Background The relationship between local hospital culture and transfusion
rates following endovascular and surgical cardiovascular procedures has
not been well studied. Methods and Results Patients undergoing coronary
revascularization, aortic valve replacement, lower extremity peripheral
vascular intervention, or carotid artery revascularization from up to 852
US hospitals in the Nationwide Readmissions Database were identified.
Crude and risk-standardized red blood cell transfusion rates were
determined for each procedure. Pearson correlation coefficients were
calculated between respective procedural transfusion rates. Median odds
ratios were estimated to reflect between-hospital variability in red blood
cell transfusion rates following the same procedure for a given patient.
There was wide variation in red blood cell transfusion rates across
different procedures, from 2% following carotid endarterectomy to 29%
following surgical aortic valve replacement. For surgical and endovascular
modalities, transfusion rates at the same hospital were highly correlated
for aortic valve replacement (r=0.67; P<0.001), moderately correlated for
coronary revascularization (r=0.56; P<0.001) and peripheral vascular
intervention (r=0.51; P<0.001), and weakly correlated for carotid artery
revascularization (r=0.19, P<0.001). Median odds ratios were all >2,
highest for coronary artery bypass graft surgery and surgical aortic valve
replacement, indicating substantial site variation in transfusion rates.
Conclusions After adjustment for patient-related factors, wide variation
in red blood cell transfusion rates remained across surgical and
endovascular procedures employed for the same cardiovascular condition.
Transfusion rates following these procedures are highly correlated at
individual hospitals and vary widely across hospitals. In aggregate, these
findings suggest that local institutional culture significantly influences
the decision to transfuse following invasive cardiovascular procedures and
highlight the need for randomized data to inform such decisions.

<80>
Accession Number
633318176
Title
Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac
surgery patients: systematic review and meta-analysis.
Source
BMJ open. 10 (10) (pp e038364), 2020. Date of Publication: 31 Oct 2020.
Author
Norhayati M.N.; Shaiful Bahari I.; Zaharah S.; Nik Hazlina N.H.; Mohammad
Aimanazrul Z.; Irfan M.
Institution
(Norhayati) Department of Family Medicine, School of Medical Sciences,
University Sains Malaysia, Health CampusKubang Kerian, Malaysia
(Shaiful Bahari, Mohammad Aimanazrul) Department of Family Medicine,
School of Medical Sciences, University Sains Malaysia, Health CampusKubang
Kerian, Malaysia
(Zaharah, Nik Hazlina, Irfan) Women's Health Development Unit, School of
Medical Sciences, University Sains Malaysia, Health CampusKubang Kerian,
Malaysia
(Irfan) Department of Zoology, Pir Mehr Ali Shah, Arid Agriculture
University, Rawalpindi, Pakistan
Publisher
NLM (Medline)
Abstract
PURPOSE: Postoperative atrial fibrillation (POAF) is a potentially lethal
and morbid complication after open heart surgery. This systematic review
and meta-analysis aimed to investigate metoprolol compared with other
treatments for prophylaxis against POAF. <br/>METHOD(S): We searched
CENTRAL, MEDLINE, EMBASE and trial registries for randomised controlled
trials that evaluated metoprolol for preventing the occurrence of POAF
after surgery against other treatments or placebo. Random-effects model
was used for estimating the risk ratios (RRs) and mean differences with
95% CIs. <br/>RESULT(S): Nine trials involving 1570 patients showed
metoprolol reduced POAF compared with placebo (416 patients; RR 0.46, 95%
CI 0.33 to 0.66; I2=21%; risk difference (RD) -0.19, 95% CI -0.28 to
-0.10). However, metoprolol increased the risk of POAF compared with
carvedilol (159 patients; RR 1.59, 95% CI 1.20 to 2.12; I2=4%; RD 0.13,
95% CI 0.06 to 0.20). There was no difference when compared with sotalol
or amiodarone. The occurrence of cardiovascular conditions after drugs
administration or death between the groups was not different. The overall
quality of evidence was moderate to high. Subgroup analysis and funnel
plot were not performed. <br/>CONCLUSION(S): Metoprolol is effective in
preventing POAF compared with placebo and showed no difference with class
III antiarrhythmic drugs. Death and thromboembolism are associated with
open heart surgery, but not significant in relation to the use of
metoprolol. PROSPERO REGISTRATION NUMBER: CRD42019131585.<br/>Copyright
&#xa9; Author(s) (or their employer(s)) 2020. Re-use permitted under CC
BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

<81>
Accession Number
633306154
Title
Factors influencing the bias between blood gas analysis versus central
laboratory hemoglobin testing. A secondary analysis of a randomized
controlled trial.
Source
PloS one. 15 (10) (pp e0240721), 2020. Date of Publication: 2020.
Author
Tanner L.; Lindau S.; Velten M.; Schlesinger T.; Wittmann M.; Kranke P.;
Berg K.; Piekarski F.; Fullenbach C.; Choorapoikayil S.; Hasenclever D.;
Zacharowski K.; Meybohm P.
Institution
(Tanner, Lindau, Berg, Piekarski, Fullenbach, Choorapoikayil, Zacharowski,
Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Goethe University Frankfurt,
Frankfurt am Main, Germany
(Velten, Wittmann) Department of Anesthesiology and Operative Intensive
Care Medicine, University Hospital Bonn, Rheinische
Friedrich-Wilhelms-University Bonn, Bonn Germany
(Schlesinger, Kranke, Meybohm) Department of Anesthesiology, University
Hospital Wuerzburg, Wuerzburg, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology (IMISE), Medical Faculty of the University Leipzig, Leipzig,
Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Anemia is the most important complication during major surgery
and transfusion of red blood cells is the mainstay to compensate for life
threating blood loss. Therefore, accurate measurement of hemoglobin (Hb)
concentration should be provided in real-time. Blood Gas Analysis (BGA)
provides rapid point-of-care assessment using smaller sampling tubes
compared to central laboratory (CL) services. <br/>OBJECTIVE(S): This
study aimed to investigate the accuracy of BGA hemoglobin testing as
compared to CL services. <br/>METHOD(S): Data of the ongoing LIBERAL-Trial
(Liberal transfusion strategy to prevent mortality and anemia-associated
ischemic events in elderly non-cardiac surgical patients, LIBERAL) was
used to assess the bias for Hb level measured by BGA devices (ABL800 Flex
analyzer, GEM series and RapidPoint 500) and CL as the reference method.
For that, we analyzed pairs of Hb level measured by CL and BGA within two
hours. Furthermore, the impact of various confounding factors including
age, gender, BMI, smoker status, transfusion of RBC, intraoperative
hemodilution, and co-medication was elucidated. In order to ensure
adequate statistical analysis, only data of participating centers
providing more than 200 Hb pairs were used. <br/>RESULT(S): In total,
three centers including 963 patients with 1,814 pairs of Hb measurements
were analyzed. Mean bias was comparable between ABL800 Flex analyzer and
GEM series: - 0.38 +/- 0.15 g/dl whereas RapidPoint 500 showed a smaller
bias (-0.09 g/dl) but greater median absolute deviation (+/- 0.45 g/dl).
In order to avoid interference with different standard deviations caused
by the different analytic devices, we focused on two centers using the
same BGA technique (309 patients and 1,570 Hb pairs). A Bland-Altman
analysis and LOWESS curve showed that bias decreased with smaller Hb
values in absolute numbers but increased relatively. The smoker status
showed the greatest reduction in bias (0.1 g/dl, p<0.001) whereas BMI
(0.07 g/dl, p = 0.0178), RBC transfusion (0.06 g/dl, p<0.001), statins
(0.04 g/dl, p<0.05) and beta blocker (0.03 g/dl, p = 0.02) showed a slight
effect on bias. Intraoperative substitution of volume and other
co-medications did not influence the bias significantly.
<br/>CONCLUSION(S): Many interventions like substitution of fluids,
coagulating factors or RBC units rely on the accuracy of laboratory
measurement devices. Although BGA Hb testing showed a consistently stable
difference to CL, our data confirm that BGA devices are associated with
different bias. Therefore, we suggest that hospitals assess their
individual bias before implementing BGA as valid and stable supplement to
CL. However, based on the finding that bias decreased with smaller Hb
values, which in turn are used for transfusion decision, we expect no
unnecessary or delayed RBC transfusion, and no major impact on the LIBERAL
trial performance.

<82>
Accession Number
633331018
Title
Meta-analysis Evaluating the Utility of Colchicine in Secondary Prevention
of Coronary Artery Disease.
Source
The American journal of cardiology. (no pagination), 2020. Date of
Publication: 30 Oct 2020.
Author
Xia M.; Yang X.; Qian C.
Institution
(Xia, Qian) Department of Cardiology, Affiliated Hospital of Southwest
Medical University, Sichuan Province, China
(Yang) Department of Medical Records, Central Hospital of Enshi Autonomous
Prefecture, Hubei Province, Enshi 445000, China
Publisher
NLM (Medline)
Abstract
Colchicine has shown potential therapeutic benefits in cardiovascular
conditions owing to its broad anti-inflammatory properties. Here, we
performed a meta-analysis to determine the efficacy and safety of
colchicine in patients with coronary artery disease (CAD). A systematical
search in electronic databases of PubMed, The Cochrane Library and Scopus
were carried out to identify eligible studies. Only randomized controlled
trials (RCTs) evaluating the cardiovascular effects of colchicine in CAD
patients were included. Study-level data of cardiovascular outcomes or
adverse events were pooled using random-effect models. We finally included
5 RCTs with follow-up duration >=6 months, comprising a total of 11,790
patients with CAD. Compared with placebo or no treatment, colchicine
administration was associated with a significantly lower incidence of
major adverse cardiovascular events (relative risk [RR] 0.65, 95%
confidence interval [CI] 0.52-0.82). Such a benefit was not modified by
the clinical phenotype of CAD (P for interaction=0.34). Colchicine
treatment also decreased the risk of myocardial infarction (RR 0.73, 95%
CI 0.55-0.98), coronary revascularization (RR 0.61, 95% CI 0.42-0.89) and
stroke (RR 0.47, 95% CI 0.28-0.81) in CAD patients, but with no impact on
cardiovascular mortality. In addition, the rates of common adverse events
were generally similar between colchicine and control groups, including
noncardiovascular deaths (RR 1.50, 95% CI 0.93-2.40) and gastrointestinal
symptoms (RR 1.05, 95% CI 0.91-1.22). In conclusion, the results of our
meta-analysis demonstrated that colchicine treatment may reduce the risk
of future cardiovascular events in CAD patients.<br/>Copyright &#xa9;
2020. Published by Elsevier Inc.

<83>
Accession Number
633324119
Title
Use of dornase alfa in the paediatric intensive care unit: Current
literature and a national cross-sectional survey.
Source
European Journal of Hospital Pharmacy. (no pagination), 2020. Date of
Publication: 2020.
Author
Den Hollander B.; Linssen R.S.N.; Cortjens B.; Van Etten-Jamaludin F.S.;
Van Woensel J.B.M.; Bem R.A.
Institution
(Den Hollander, Linssen, Cortjens, Van Woensel, Bem) Pediatric Intensive
Care Unit, Emma Children's Hospital, Amsterdam UMC, Location AMC,
Amsterdam 1105 AZ, Netherlands
(Van Etten-Jamaludin) Research Support, Medical Library, Amsterdam UMC,
Location AMC, Amsterdam, North Holland, Netherlands
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Objectives: Airway mucus obstruction is a major challenge in children
admitted to the paediatric intensive care unit (PICU). We aimed to
evaluate the evidence and contemporary use of the mucolytic medication
dornase alfa for non-cystic fibrosis conditions in the PICU.
<br/>Method(s): (1) We performed a systematic review with searches in
PubMed, EMBASE, and the Cochrane Library. Study selection: for quality
assessment and data synthesis, we included only randomised controlled
trials (RCTs) that compared dornase alfa to standard care or placebo in
critically-ill paediatric patients (<18 years of age) in the PICU.
However, non-randomised controlled studies and case series are also
discussed. Data extraction: data were extracted independently by multiple
reviewers using data extraction forms. The primary outcome was duration of
mechanical ventilation. Data synthesis: The GRADE approach was used for
quality assessment. No meta-analysis could be performed. (2) A national
cross-sectional survey among all seven PICUs in the Netherlands was also
performed. <br/>Result(s): The systematic review yielded only one RCT,
comparing dornase alfa with normal saline in children after cardiac
surgery. In this study, dornase alfa led to a reduction in duration of
mechanical ventilation by approximately 1 day (36% reduction). In
addition, we found nine retrospective observational and case studies. The
survey revealed high current use of dornase alfa in Dutch PICUs: 42% of
the respondents reported prescribing dornase alfa at least once every
week. Only 4% of the respondents reported having access to a local PICU
dornase alfa protocol. <br/>Conclusion(s): The off-label use of dornase
alfa in the PICU is frequent without strong evidence or local protocols,
highlighting the need for further research on the effectiveness of this
mucolytic agent. <br/>Copyright &#xa9; European Association of Hospital
Pharmacists 2020. Re-use permitted under CC BY. Published by BMJ.

<84>
Accession Number
633317258
Title
Comparisons of Nonhyperemic Pressure Ratios: Predicting Functional Results
of Coronary Revascularization Using Longitudinal Vessel Interrogation.
Source
JACC. Cardiovascular interventions. (no pagination), 2020. Date of
Publication: 24 Oct 2020.
Author
Omori H.; Kawase Y.; Mizukami T.; Tanigaki T.; Hirata T.; Kikuchi J.; Ota
H.; Sobue Y.; Miyake T.; Kawamura I.; Okubo M.; Kamiya H.; Hirakawa A.;
Kawasaki M.; Nakagawa M.; Tsuchiya K.; Suzuki Y.; Ito T.; Terashima M.;
Kondo T.; Suzuki T.; Escaned J.; Matsuo H.
Institution
(Omori, Kawase, Tanigaki, Hirata, Kikuchi, Ota, Sobue, Miyake, Kawamura,
Okubo, Kamiya, Kawasaki, Nakagawa, Tsuchiya, Kondo, Matsuo) Department of
Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
(Mizukami) Department of Cardiovascular Medicine, Gifu Heart Center, Gifu,
Japan; Clinical Research Institute for Clinical Pharmacology and
Therapeutics, Showa University, Tokyo, Japan
(Hirakawa) Department of Biostatistics and Bioinformatics, Graduate School
of Medicine, University of Tokyo, Tokyo, Japan
(Suzuki, Ito) Department of Cardiovascular Medicine, Nagoya Heart Center,
Nagoya, Japan
(Terashima, Suzuki) Department of Cardiovascular Medicine, Toyohashi Heart
Center, Toyohashi, Japan
(Escaned) Hospital Clinico San Carlos IDISSC and Universidad Complutense
de Madrid, Madrid, Spain
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to investigate the accuracy of
pre-percutaneous coronary intervention (PCI) predicted nonhyperemic
pressure ratios (NHPRs) with actual post-PCI NHPRs and to assess the
efficacy of PCI strategy using pre-PCI NHPR pull back. BACKGROUND:
Predicting the functional results of PCI is feasible using pre-PCI
longitudinal vessel interrogation with the instantaneous wave-free ratio
(iFR), a pressure-based, adenosine-free NHPR. However, the reliability of
novel NHPRs (resting full-cycle ratio [RFR] and diastolic pressure ratio
[dPR]) for this purpose remains uncertain. <br/>METHOD(S): In this
prospective, multicenter, randomized controlled trial, vessels were
randomly assigned to receive pre-PCI iFR, RFR, or dPR pull back (50
vessels each). The pre-PCI predicted NHPRs were compared with actual NHPRs
after contemporary PCI using intravascular imaging. The number and the
total length of treated lesions were compared between NHPR pull
back-guided and angiography-guided strategies. <br/>RESULT(S): The
predicted NHPRs were strongly correlated with actual NHPRs: iFR, r = 0.83
(95% confidence interval: 0.72 to 0.90; p < 0.001); RFR, r = 0.84 (95%
confidence interval: 0.73 to 0.91; p < 0.001), and dPR, r = 0.84 (95%
confidence interval: 0.73 to 0.91; p < 0.001). The number and the total
length of treated lesions were lower with the NHPR pull back strategy than
with the angiography-guided strategy, leading to physiological
improvement. <br/>CONCLUSION(S): Predicting functional PCI results on the
basis of pre-procedural RFR and dPR pull backs yields similar results to
iFR. Compared with an angiography-guided strategy, a pull back-guided PCI
strategy with any of the 3 NHPRs reduced the number and the total length
of treated lesions. (Study to Examine Correlation Between Predictive Value
and Post PCI Value of iFR, RFR and dPR; UMIN000033534).<br/>Copyright
&#xa9; 2020. Published by Elsevier Inc.

<85>
Accession Number
633317005
Title
Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With
Atrial Fibrillation After TAVR.
Source
JACC. Cardiovascular interventions. (no pagination), 2020. Date of
Publication: 26 Oct 2020.
Author
Kawashima H.; Watanabe Y.; Hioki H.; Kozuma K.; Kataoka A.; Nakashima M.;
Nagura F.; Nara Y.; Yashima F.; Tada N.; Naganuma T.; Yamawaki M.;
Yamanaka F.; Shirai S.; Mizutani K.; Tabata M.; Ueno H.; Takagi K.;
Yamamoto M.; Hayashida K.
Institution
(Kawashima) Department of Cardiology, Teikyo University School of
Medicine, Tokyo, Japan; Amsterdam UMC, University of Amsterdam, Heart
Center; Department of Clinical and Experimental Cardiology, Amsterdam
Cardiovascular Sciences, Amsterdam, the Netherlands; Department of
Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
(Watanabe, Hioki, Kozuma, Kataoka, Nakashima, Nagura, Nara) Department of
Cardiology, Teikyo University School of Medicine, Tokyo, Japan
(Yashima) Department of Cardiology, Saiseikai Utsunomiya Hospital,
Tochigi, Japan; Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan
(Tada) Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
(Naganuma) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Yamawaki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Yamanaka) Department of Cardiology, Shonan Kamakura General Hospital,
Kanagawa, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Japan
(Mizutani) Department of Cardiovascular Medicine, Osaka City University
Graduate School of Medicine, Osaka, Japan
(Tabata) Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa
Medical Center, Chiba, Japan
(Ueno) Department of Cardiology, Toyama University Hospital, Toyama, Japan
(Takagi) Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
(Yamamoto) Department of Cardiology, Toyohashi Heart Center, Toyohashi,
Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to compare long-term all-cause
mortality between direct oral anticoagulants (DOACs) and vitamin K
antagonists (VKAs) in patients with atrial fibrillation (AF) after
transcatheter aortic valve replacement (TAVR). BACKGROUND: The optimal
anticoagulant agent for patients with AF after TAVR has not been
clarified. <br/>METHOD(S): OCEAN (Optimized Transcatheter Valvular
Intervention) is a prospective, multicenter, observational cohort registry
comprising 2,588 patients who underwent TAVR between October 2013 and May
2017. Of these, 403 patients (15.6%) with AF on anticoagulant therapy were
identified, of whom 227 (56.3%) were prescribed DOACs and 176 (43.7%) were
prescribed VKAs. Patients who successfully discharged after TAVR were
stratified into DOAC and VKA groups on the basis of the prescription of
anticoagulant agents, and the analyses started from discharge.
<br/>RESULT(S): In total, 33.3% of patients were men. The mean age was
84.4 +/- 4.7 years, and the average CHA2DS2-VASc score was 5.1 +/- 1.1.
The median follow-up duration was 568 days. A multivariate Cox regression
model and inverse probability of treatment weighting based on the
propensity score demonstrated that the DOAC group was significantly
associated with a lower incidence of all-cause mortality compared with the
VKA group (10.3% vs. 23.3%; Cox-adjusted hazard ratio: 0.391; 95%
confidence interval: 0.204 to 0.749; p = 0.005; and 10.2% vs 20.6%;
inverse probability of treatment weighting-adjusted hazard ratio: 0.531;
95% confidence interval: 0.294 to 0.961; p = 0.036, respectively).
<br/>CONCLUSION(S): Compared with VKAs, DOACs might be associated with
lower long-term all-cause mortality in patients with concomitant AF who
are successfully discharged after TAVR. This finding warrants
investigation in ongoing prospective randomized trials.<br/>Copyright
&#xa9; 2020 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<86>
Accession Number
633311688
Title
Effects of platelet-rich plasma on the healing of sternal wounds: a
meta-analysis.
Source
Wound repair and regeneration : official publication of the Wound Healing
Society [and] the European Tissue Repair Society. (no pagination), 2020.
Date of Publication: 31 Oct 2020.
Author
Yao D.; Feng G.; Zhao F.; Hao D.
Institution
(Yao, Feng, Zhao, Hao) No.3 Department of Burns and Plastic Surgery and
Wound Healing Center, Fourth Medical Center of Chinese PLA General
Hospital, Beijing, China
Publisher
NLM (Medline)
Abstract
Sternal wound infection (SWI) is a devastating complication after cardiac
surgery. Platelet-rich plasma (PRP) may have a positive impact on sternal
wound healing. A systematic review with meta-analyses was performed to
evaluate the clinical effectiveness of topical application of autologous
PRP for preventing SWI and promoting sternal wound healing compared to
placebo or standard treatment without PRP. Relevant studies published in
English or Chinese were retrieved from the Cochrane Central Register of
Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of
Science, Springer Link, and the WHO International Clinical Trials Registry
Platform (ICTRP) using the search terms "platelet-rich plasma" and
"sternal wound" or "thoracic incision". References identified through the
electronic search were screened, the data were extracted, and the
methodological quality of the included studies was assessed. The
meta-analysis was performed for the following outcomes: incidence of SWI,
incidence of deep sternal wound infection (DSWI), postoperative blood loss
(PBL), and other risk factors. In the systematic review, totally 10
comparable studies were identified, involving 7879 patients. The
meta-analysis for the subgroup of retrospective cohort studies (RSCs)
showed that the incidence of SWI and DSWI in patients treated with PRP was
significantly lower than that in patients without PRP treatment. However,
for the subgroup of randomized controlled trials (RCTs), there was no
significant difference in the incidence of SWI or DSWI after intervention
between the PRP and control groups. There was no significant difference in
PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in-situ
recurrences were reported. According to the results, PRP could be
considered as a candidate treatment to prevent SWI and DSWI. However, the
quality of the evidence is too weak, and high-quality RCTs are needed to
assess its efficacy on preventing SWI and DSWI. This article is protected
by copyright. All rights reserved.

<87>
Accession Number
633310732
Title
Consensus for Thoracoscopic Left Upper Lobectomy-Essential Components and
Targets for Simulation.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 27 Oct 2020.
Author
Bryan D.S.; Ferguson M.K.
Institution
(Bryan) Department of Surgery, University of Chicago, Chicago, Mexico
(Ferguson) Section of Thoracic Surgery, Department of Surgery, University
of Chicago, Chicago, Mexico
Publisher
NLM (Medline)
Abstract
BACKGROUND: Simulation based training is valuable component of
cardiothoracic surgical education. Effective curriculum development
requires consensus on procedural components and focused attention on
specific learning objectives. Through use of a Delphi process, we
established consensus on the steps of VATS left upper lobectomy and
identified targets for simulation. <br/>METHOD(S): Experienced thoracic
surgeons were randomly selected for participation. Surgeons voted and
commented on the necessity of individual steps comprising VATS left upper
lobectomy. Steps with greater than 80% of participants in agreement of
their necessity were determined to have established "consensus".
Participants voted on the physical and/or cognitive complexity of each,
and chose steps most amenable to focused simulation. <br/>RESULT(S):
Thirty thoracic surgeons responded and joined in the voting process. 20
operative steps were identified, with surgeons reaching consensus on the
necessity of 19. Components deemed most difficult and amenable to
simulation included those related to dissection and division of the
bronchus, artery, and vein. <br/>CONCLUSION(S): Through a Delphi process,
surgeons with a variety of practice patterns can achieve consensus on the
operative steps of left upper lobectomy, and agreement on those most
appropriate for simulation. This information can be implemented in the
development of targeted simulation for VATS lobectomy.<br/>Copyright
&#xa9; 2020. Published by Elsevier Inc.

<88>
Accession Number
2008416700
Title
Effects of Coronavirus Disease 2019 on Solid Organ Transplantation.
Source
Transplantation Proceedings. 52 (9) (pp 2642-2653), 2020. Date of
Publication: November 2020.
Author
Aziz H.; Lashkari N.; Yoon Y.C.; Kim J.; Sher L.S.; Genyk Y.; Kwon Y.K.
Institution
(Aziz, Lashkari, Kim, Sher, Genyk, Kwon) Division of Hepatobiliary,
Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
United States
(Yoon) Department of Surgery, Incheon St. Mary's Hospital, The Catholic
University of Korea, Seoul, Korea, South Korea
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: As the novel coronavirus, severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), has emerged as a viral pandemic, data on the
clinical characteristics and outcomes of patients with SARS-CoV-2
infection undergoing solid organ transplant are emerging. The objective of
this systematic review was to assess currently published literature
relating to the management, clinical course, and outcome of SARS-CoV-2
infection in liver, kidney, and heart solid organ transplant recipients.
<br/>Method(s): We conducted a systematic review to assess currently
published literature relating to the management, clinical course, and
outcome of SARS-CoV-2 infection in liver, kidney, and heart solid organ
transplant recipients. Articles published through June 2020 were searched
in the MEDLINE, ClinicalTrials.gov, and PubMed databases. We identified 49
eligible studies comprising a total of 403 solid organ transplant
recipients. <br/>Result(s): Older age, male sex, and preexisting
comorbidities, including hypertension and/or diabetes, were the most
common prevailing characteristics among the solid organ transplant
recipients. Clinical presentation ranged from mild to severe disease,
including multiorgan failure and death. We found an overall mortality rate
of 21%. <br/>Conclusion(s): Our analysis suggests no increase in overall
mortality or worse outcome in solid organ transplant recipients receiving
immunosuppressive therapy compared with mortality in the general surgical
population with SARS-CoV-2. Our findings suggest that transplant surgery
and its immunosuppressive effects should not be a deterrent to proper
surgical care for patients in the SARS-CoV-2 era.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<89>
Accession Number
2005677011
Title
Prednisone and azathioprine in patients with inflammatory cardiomyopathy:
systematic review and meta-analysis.
Source
ESC Heart Failure. 7 (5) (pp 2278-2296), 2020. Date of Publication: 01 Oct
2020.
Author
Timmermans P.; Barradas-Pires A.; Ali O.; Henkens M.; Heymans S.; Negishi
K.
Institution
(Timmermans) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Timmermans) University Hospital Gasthuisberg, Leuven, Belgium
(Barradas-Pires) Royal Brompton and Harefield NHS Foundation Trust,
London, United Kingdom
(Ali) Detroit Medical Center, Department of Cardiology, Wayne State
University School of Medicine, United States
(Henkens, Heymans) Department of Cardiology, CARIM School for
Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences,
Maastricht University, Maastricht, Netherlands
(Heymans) Department of Cardiovascular Sciences, Centre for Molecular and
Vascular Biology, Catholic University of Leuven, Leuven, Belgium
(Negishi) Menzies Institute for Medical Research, University of Tasmania,
Hobart, Australia
(Negishi) Nepean Clinical School, The University of Sydney, Kingswood,
Sydney, Australia
Publisher
Wiley-Blackwell (E-mail: info@wiley.com)
Abstract
Aims Chronic non-viral myocarditis, also called inflammatory
cardiomyopathy, can be treated with immune suppression on tops of optimal
medical therapy (OMT) for heart failure, using a combination of
prednisolone and azathioprine (IPA). However, there has been inconsistency
in the effects of immunosuppression treatment. This meta-analysis is the
first to evaluate all available data of the effect of this treatment on
left ventricular ejection fraction (LVEF) and the combined clinical
endpoint of cardiovascular mortality and/or heart transplantation-free
survival. Methods and results All trials with using IPA vs. OMT in this
syndrome were searched using OVID Medline and ClinicalTrials. gov,
following the PRISMA guidelines. Missing data were retrieved after
contacting the corresponding authors. All data was reviewed and analysed
using and standard meta-analysis methods. A random effect model was used
to pool the effect sizes. A total of four trials (three randomised
controlled trials and one propensity-matched retrospective registry)
including 369 patients were identified. IPA on top of OMT did not improve
LVEF [mean difference 9.9% (95% confidence interval -1.8, 21.7)] with
significant heterogeneity. When we limited our pooled estimate to the
published studies only, significant LVEF improvement by IPA was observed
[14% (1.4, 26.6)]. No cardiovascular mortality benefit was observed with
the intervention [risk ratio 0.34 (0.08, 1.51)]. Conclusions At the
moment, there is insufficient evidence supporting functional and
prognostic benefits of IPA added to OMT in virus negative inflammatory
positive cardiomyopathy. Further adequate-powered well-designed
prospective RCTs should be warranted to explore the potential effects of
adding immunosuppressive therapy to OMT.<br/>Copyright &#xa9; 2020 The
Heart Failure Association of the European Society of Cardiology / John
Wiley & Sons Ltd

<90>
Accession Number
2007958547
Title
Updated meta-analysis on the efficacy of genotype-guided antiplatelet
therapy versus standard therapy for patients undergoing PCI.
Source
Thrombosis Research. 196 (pp 398-399), 2020. Date of Publication: December
2020.
Author
Sahashi Y.; Kuno T.; Bangalore S.
Institution
(Sahashi) Department of Cardiology, Gifu University Graduate School of
Medicine, Gifu, Japan
(Sahashi) Department of Health Data Science, Graduate School of Data
Science, Yokohama City University, Yokohama, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Bangalore) New York University School of Medicine, New York, NY, United
States
Publisher
Elsevier Ltd

<91>
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. <br/>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. <br/>Setting(s): University hospital Centro Cardiologico Monzino
IRCCS, Milano, Italy. <br/>Participant(s): Twenty-two patients scheduled
for minimally invasive surgical ablation for atrial fibrillation.
<br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<92>
Accession Number
2008417122
Title
Combined Use of Rotational Thromboelastometry (Rotem) and Platelet
Impedance Aggregometry (Multiplate Analyzer) in Cyanotic and Acyanotic
Infants and Children Undergoing Cardiac Surgery With Cardiopulmonary
Bypass: Subgroup Analysis of a Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Dieu A.; Van Regemorter V.; Detaille T.; Houtekie L.; Eeckhoudt S.;
Khalifa C.; Kahn D.; Clement De Clety S.; Poncelet A.; Momeni M.
Institution
(Dieu, Van Regemorter, Khalifa, Kahn, Momeni) Department of
Anesthesiology, Cliniques Universitaires Saint Luc, Universite Catholique
de Louvain, Brussels, Belgium
(Detaille, Houtekie, Clement De Clety) Department of Pediatric Intensive
Care Unit, Cliniques Universitaires Saint Luc, Universite Catholique de
Louvain, Brussels, Belgium
(Eeckhoudt) Department of Hematology, Laboratoires des Hopitaux
Universitaires de Bruxelles, Universite Libre de Bruxelles, Brussels,
Belgium
(Poncelet) Department of Cardiac Surgery, Cliniques Universitaires Saint
Luc, Universite Catholique de Louvain, Brussels, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: Few studies have investigated the Multiplate platelet function
analyzer in pediatrics. The authors evaluated Multiplate combined with
Rotem in terms of guiding platelet transfusion after pediatric cardiac
surgery with cardiopulmonary bypass (CPB). The authors further compared
coagulation parameters between cyanotic and acyanotic patients.
<br/>Design(s): Subgroup analysis of a randomized clinical trial.
<br/>Setting(s): Tertiary hospital. <br/>Participant(s): Patients weighing
between seven and 15 kg. <br/>Intervention(s): None. <br/>Measurements and
Main Results: Rotem and Multiplate tests were performed (1) after
anesthesia induction, (2) upon CPB separation, and (3) upon intensive care
unit arrival. Among a total of 59 subjects, 9 patients required platelet
transfusion. In multivariate linear regression, analysis EXTEM maximum
clot firmness upon CPB separation was associated with the volume of
transfused platelets (regression coefficient = -0.348 [95% confidence
interval -1.006 to -0.028]; p = 0.039). No such association was found for
the Multiplate test. Acyanotic and cyanotic heart disease were present in
32 and 27 children, respectively. There were no significant differences
between these two groups in terms of platelet count and function.
Postoperative blood loss was significantly higher in the cyanotic group
compared with the acyanotic arm (p = 0.015; difference [95% confidence
interval -2.40 {-4.20 to -0.60}]). There were no differences between
groups regarding transfusion of allogeneic blood products.
<br/>Conclusion(s): This study showed that Rotem, but not Multiplate
results, were associated with platelet transfusion in pediatric cardiac
surgery with no intake of platelet inhibitors. The usefulness of combining
these tests in platelet transfusion decision-making needs to be evaluated
in larger populations.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<93>
Accession Number
2005213502
Title
Effect of age on clinical outcomes following on-/off-pump coronary artery
bypass: Meta- analysis and meta-regression.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 797-814), 2020.
Date of Publication: 2020.
Author
Mauldon H.; Dieberg G.; Smart N.; King N.
Institution
(Mauldon, King) University of Plymouth, Ringgold Standard Institution,
Plymouth, United Kingdom
(Dieberg, Smart) University of New England, Ringgold Standard Institution,
Armidale, Australia
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: There is currently much debate about which patients would
benefit more after on- or off-pump coronary artery bypass grafting (CABG).
The aim of this meta-analysis and meta-regression is to investigate the
effect of age on short-term clinical outcomes after these approaches.
<br/>Method(s): To identify potential studies, systematic searches were
carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of
Science, and the Cochrane Central Register of Controlled Trials (CENTRAL).
The search strategy included the key concepts of "cardiopulmonary bypass"
AND "coronary artery bypass grafting" AND "off pump" OR "on pump". This
was followed by a meta-analysis and meta-regression investigating the
effect of age on the incidences of stroke, myocardial infarction (MI), and
mortality. <br/>Result(s): Thirty-seven studies including 15,324
participants were analysed. Overall, there was a significant odds
reduction for patients receiving off-pump CABG suffering a stroke (odds
ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048);
however, when patients were subdivided according to different age bands,
this difference disappeared. There were also no significant differences in
the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR
0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no
significant relationship between age and stroke (P=0.652), age and
mortality (P=548), and age and MI (P=0.464). <br/>Conclusion(s): Patients
undergoing CABG are becoming older and may suffer from multiple
comorbidities increasing their risk profile. However, with respect to
short-term clinical outcomes, the patient's age does not help in
determining whether off- or on-pump is superior.<br/>Copyright &#xa9;
2020, Sociedade Brasileira de Cirurgia Cardiovascular. All rights
reserved.

<94>
Accession Number
2005213500
Title
Transcaval access to the abdominal aorta: Indications of interest to
surgeons and a comprehensive literature review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 781-788), 2020.
Date of Publication: 2020.
Author
Lozano Sanchez F.S.; Gonzalez I.C.; Calvo R.S.; Sanchez Fernandez P.L.
Institution
(Lozano Sanchez, Calvo) Department of Angiology and Vascular Surgery,
Hospital Universitario de Salamanca, Salamanca, Spain
(Gonzalez, Sanchez Fernandez) Department of Cardiology, Hospital
Universitario de Salamanca, Salamanca, Spain
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
We performed a review of the literature (until August 01, 2019) on the
occasion of the first transcaval approach for transcatheter aortic valve
implantation in our hospital. This review focuses mainly on the
indications of this alternative access route to the aorta. It may be
useful for vascular surgeons in selected cases, such as the treatment of
endoleaks after endovascular aneurysm repair and thoracic endovascular
aneurysm repair. We describe historical aspects of transcaval access to
the aorta, experimental studies, available case series and outcomes.
Finally, we summarize the most significant technical aspects of this
little-known access.<br/>Copyright &#xa9; 2020, Sociedade Brasileira de
Cirurgia Cardiovascular. All rights reserved.

<95>
Accession Number
2005213499
Title
The current management of cardiac tumours: A comprehensive literature
review.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 770-780), 2020.
Date of Publication: 2020.
Author
Joshi M.; Kuma S.; Noshirwani A.; Harky A.
Institution
(Joshi, Noshirwani) Countess of Chester Hospital, Chester, United Kingdom
(Kuma) Aintree University Hospital, Liverpool, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To understand the current evidence and guidelines behind the
appropriate management of cardiac tumours. <br/>Method(s): A comprehensive
electronic literature search has been performed in major databases
-PubMed, Embase, Scopus, Ovid, and Google Scholar. All articles that
discussed all different forms of cardiac tumours, their clinical
presentation, diagnosis, and management methods have been critically
appraised in this narrative review. <br/>Result(s): All relevant studies
have been summarized in appropriate sections within our review. Cardiac
tumours are rare but can be catastrophic and life-threatening if not
identified and managed on timely manner. Utilization of all the available
imaging methods can be of equivocal importance, relevant to each cardiac
tumour. Surgical excision is the ultimate treatment method, however
histopathological results can guide the adjunct treatment.
<br/>Conclusion(s): Early detection of cardiac tumours has significant
effect on planning the method of intervention. Technological advancements
and increased availability of imaging modalities have enabled earlier and
more accurate detection of these tumours. Novel medical therapies,
recommendations for screening, and operative techniques have all
contributed to overall improving knowledge of these tumours and ultimately
patient outcomes.<br/>Copyright &#xa9; 2020, Sociedade Brasileira de
Cirurgia Cardiovascular. All rights reserved.

<96>
Accession Number
2005213483
Title
Comparison between the effects of bretschneiders htk solution and cold
blood cardioplegia on systemic endothelial functions in patients who
undergo coronary artery bypass surgery: A prospective randomized and
controlled trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 634-643), 2020.
Date of Publication: 2020.
Author
Mercan I.; Dereli Y.; Topcu C.; Tanyeli O.; Isik M.; Gormus N.; Ozturk
E.Y.
Institution
(Mercan) Department of Cardiovascular Surgery, Konya Training and Research
Hospital, Konya, Turkey
(Dereli, Tanyeli, Isik, Gormus) Department of Cardiovascular Surgery,
Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
(Topcu) Department of Biochemistry, Necmettin Erbakan University, Meram
Faculty of Medicine, Konya, Turkey
(Ozturk) Department of Public Health, Necmettin Erbakan University, Meram
Faculty of Medicine, Konya, Turkey
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (E-mail:
revista@sbccv.org.br)
Abstract
Objective: To investigate the effects of Bretschneiders
histidine-tryptophan-ketoglutarate (HTK) solution and cold blood
cardioplegia on systemic endothelial functions. <br/>Method(s): A total of
50 patients who underwent isolated coronary artery bypass surgery between
March 2018 and May 2018 were randomly divided into two groups -group 1
(Bretschneiders HTK solution, n=25) and group 2 (cold blood cardioplegia,
n=25). Data related to the indicators of endothelial dysfunction were
recorded. Flow-mediated dilation was measured together with the assessment
of the values of endothelin-1, von Willebrand factor, and asymmetric
dimethylarginine to identify endothelial dysfunction. Then, the two groups
were compared regarding these values. <br/>Result(s): The most significant
result of our study was that the endothelin-1 level was significantly
higher in group 2 than in group 1 (P<0.001). The value of flow-mediated
dilation was found to increase to a lesser degree on the postoperative
days compared to the value at the day of admission in group 1 (P=0.002 and
P=0.030, respectively). <br/>Conclusion(s): Cardiopulmonary bypass leads
to endothelial dysfunction. Our results revealed that Bretschneiders HTK
solution causes less severe endothelial injury than cold blood
cardioplegia.<br/>Copyright &#xa9; 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<97>
Accession Number
633302521
Title
Impact of baseline body mass index on the efficacy and safety of
tofacitinib in patients with psoriatic arthritis.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology, EULAR 2020. Germany. 79 (SUPPL 1) (pp 1717-1718), 2020. Date
of Publication: June 2020.
Author
Ritchlin C.T.; Ogdie A.; Giles J.T.; Gomez-Reino J.J.; Helliwell P.;
Stockert L.; Young P.; Joseph W.; Mundayat R.; Graham D.; Woolcott J.;
Romero A.B.
Institution
(Ritchlin) University of Rochester Medical Center, Rochester, United
States
(Ogdie) University of Pennsylvania, Philadelphia, United States
(Giles) Columbia University, New York, United States
(Gomez-Reino) Hospital Clinico Universitario, Santiago de Compostela,
Spain
(Helliwell) University of Leeds, Leeds, United Kingdom
(Stockert, Young, Joseph) Pfizer Inc, Collegeville, United States
(Mundayat, Graham, Woolcott) Pfizer Inc, Groton, United States
(Romero) Pfizer Inc, Barcelona, Spain
Publisher
BMJ Publishing Group
Abstract
Background: Obesity is highly prevalent in PsA (~45%)1 and is associated
with a reduced response to TNF inhibitors.2 Tofacitinib is an oral Janus
kinase inhibitor for the treatment of PsA. <br/>Objective(s): This post
hoc analysis assessed tofacitinib efficacy and safety in patients (pts)
with PsA by baseline (BL) body mass index (BMI) category. <br/>Method(s):
Data were pooled from two placebo (PBO)-controlled, double-blind, Phase 3
studies in pts with active PsA and an inadequate response to >=1
conventional synthetic DMARD (OPAL Broaden [12 months; NCT01877668]) or to
>=1 TNF inhibitor (OPAL Beyond [6 months; NCT01882439]).3,4 This analysis
included pts randomised to tofacitinib 5 mg twice daily (BID), tofacitinib
10 mg BID or PBO, stratified by BL BMI: <25 kg/m2, >=25-<30 kg/m2,
>=30-<35 kg/m2, or >=35 kg/m2. Efficacy and safety were reported to Month
(M)3. M3 efficacy outcomes included ACR20/50/70 and HAQ-DI responses,
dactylitis and enthesitis resolution rates and changes from BL in HAQ-DI,
Short Form-36 Version 2 (SF-36v2) Physical (PCS) and Mental Component
Summary (MCS) scores, and Functional Assessment of Chronic Illness
Therapy-Fatigue (FACIT-F) scores. Safety outcomes included adverse events
(AEs), such as cardiovascular (CV) events and changes in lipid levels and
liver function tests (LFTs). <br/>Result(s): This analysis included 710
pts; 43.8% were obese (BMI >=30). At BL, 161 (22.7%) pts had a BMI <25,
238 (33.5%) had a BMI >=25-<30, 186 (26.2%) had a BMI >=30-<35 and 125
(17.6%) had a BMI >=35. Most pts were white (92.5-96.8%), middle-aged
(mean: 44.5-51.2 yrs) and female (49.5-65.6%). Greater proportions of
obese pts were from Russia/Eastern Europe (35.0%) and USA/Canada (31.8%),
vs the rest of world. At BL, higher BMI correlated with an increased
prevalence of metabolic syndrome (4.3% in BMI <25 to 76.0% in BMI >=35)
and CRP levels >2.87 mg/L (49.1% in BMI <25 to 84.0% in BMI >=35). Higher
proportions of pts (42.5-47.9%) in BL BMI categories <35 reported no prior
biologic DMARD use, vs pts with a BL BMI >=35 (33.6%). At M3, efficacy
improvements were greater in tofacitinib-treated pts vs PBO-treated pts
(Figure 1). In pts with a BL BMI >=35, a trend towards fewer pts
responding was observed (Figure 1) and mean changes from baseline in
SF-36v2 PCS and MCS and FACIT-F generally appeared lower (Figure 2) vs pts
in lower BL BMI categories. Up to M3, the proportions of pts with AEs, and
percentage change from BL in lipid levels and LFTs, were generally similar
across all BL BMI categories. Three CV events were reported: non-fatal
cerebrovascular accident, transient ischemic attack (both tofacitinib 5 mg
BID, BMI >=30-<35) and coronary artery revascularisation (PBO; BMI >=35).
Limitations include the 3-month observation time, particularly for safety
findings, thus longer observation times are warranted. <br/>Conclusion(s):
Regardless of BL BMI, tofacitinib demonstrated greater efficacy than PBO
at M3 in pts with PsA. Similar to other advanced therapies,2 reduced
efficacy was generally observed in tofacitinib and PBO pts with a BL BMI
>=35. Tofacitinib safety appeared consistent across all BL BMI categories.

<98>
Accession Number
2007149852
Title
IMPROV-ED trial: eHealth programme for faster recovery and reduced
healthcare utilisation after CABG.
Source
Netherlands Heart Journal. (no pagination), 2020. Date of Publication:
2020.
Author
van Steenbergen G.J.; van Veghel D.; ter Woorst J.; van Lieshout D.;
Dekker L.
Institution
(van Steenbergen, van Veghel, ter Woorst, Dekker) Catharina Heart Center,
Catharina Hospital, Eindhoven, Netherlands
(van Lieshout) Dutch Heart Foundation, The Hague, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: After coronary artery bypass grafting (CABG), healthcare
utilisation is high and is partly unplanned. eHealth applications have
been proposed to reduce healthcare consumption and to enable patients to
get actively involved in their recovery. This way, healthcare expenses can
be reduced and the quality of care can be improved. <br/>Objective(s): We
aim to evaluate whether the use of an eHealth programme can reduce
unplanned healthcare utilisation and improve mental and physical health in
the first 6 weeks after discharge in patients who underwent CABG. In
addition, patient satisfaction and use of the eHealth programme will be
evaluated. <br/>Method(s): For this single-centre randomised controlled
trial, at least 280 patients referred for CABG will be included at the
preoperative outpatient clinic and randomised to an intervention or
control group. The intervention group will have access to an eHealth
programme, which consists of online educational videos developed by the
Dutch Heart Foundation and postoperative video consultations with a
physician. The control group will receive standard care and will not have
access to the eHealth programme. The primary endpoint is healthcare
utilisation; other endpoints include anxiety, duration of recovery,
quality of life and patient satisfaction. Participants will complete
several questionnaires at 6 time points during the study. <br/>Result(s):
Patient enrolment started in February 2020 and completion of the follow-up
period is expected in August 2021. <br/>Conclusion(s): This randomised
trial was initiated to test the hypothesis that patients who are partaking
in our eHealth programme use less unplanned care and experience a better
quality of life, less anxiety and a faster recovery than
controls.<br/>Copyright &#xa9; 2020, The Author(s).

<99>
Accession Number
633300344
Title
A randomized controlled trial comparing controlled reoxygenation and
standard cardiopulmonary bypass in paediatric cardiac surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 30 Oct 2020.
Author
Caputo M.; Scott L.J.; Deave T.; Dabner L.; Parry A.; Angelini G.D.;
Sheehan K.; Stoica S.; Ellis L.; Harris R.; Rogers C.A.
Institution
(Scott, Dabner, Ellis, Harris, Rogers) Department of Cardiac Surgery,
Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of
Bristol, Bristol, United Kingdom
(Deave) Department of Cardiac Surgery, Centre for Health and Clinical
Research, University of the West of England, Bristol, United Kingdom
(Parry, Sheehan, Stoica) Department of Cardiac Surgery, Bristol Royal
Hospital for Children, University Hospitals Bristol NHS Foundation Trust,
Bristol, United Kingdom
(Angelini) Department of Cardiac Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Controlled reoxygenation on starting cardiopulmonary bypass
(CPB) rather than hyperoxic CPB may confer clinical advantages during
surgery for congenital cyanotic heart disease. <br/>METHOD(S): A
single-centre, randomized controlled trial was carried out to compare the
effectiveness of controlled reoxygenation (normoxia) versus hyperoxic CPB
in children with congenital cyanotic heart disease undergoing open-heart
surgery (Oxic-2). The co-primary clinical outcomes were duration of
inotropic support, intubation time and postoperative intensive care unit
(ICU) and hospital stay. Analysis of the primary outcomes included data
from a previous trial (Oxic-1) conducted to the same protocol.
<br/>RESULT(S): Ninety participants were recruited to Oxic-2 and 79 were
recruited to the previous Oxic-1 trial. There were no significant
differences between the groups for any of the co-primary outcomes:
inotrope duration geometric mean ratio (normoxia/hyperoxic) 0.97, 95%
confidence interval (CI) (0.69-1.37), P-value=0.87; intubation time hazard
ratio (HR) 1.03, 95% CI (0.74-1.42), P-value=0.87; postoperative ICU stay
HR 1.14 95% CI (0.77-1.67), P-value=0.52, hospital stay HR 0.90, 95% CI
(0.65-1.25), P-value=0.53. Lower oxygen levels were successfully achieved
during the operative period in the normoxic group. Serum creatinine levels
were lower in the normoxic group at day 2, but not on days 1, 3-5.
Childhood developmental outcomes were similar. In the year following
surgery, 85 serious adverse events were reported (51 normoxic group and 34
hyperoxic group). <br/>CONCLUSION(S): Controlled reoxygenation (normoxic)
CPB is safe but with no evidence of a clinical advantage over hyperoxic
CPB. CLINICAL TRIAL REGISTRATION NUMBER: Current Controlled
Trials-ISRCTN81773762.<br/>Copyright &#xa9; The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.