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<1>
Accession Number
2005875817
Title
The role of Cor-Knot in the future of cardiac surgery: A systematic
review.
Source
Journal of Cardiac Surgery. 35 (11) (pp 2987-2994), 2020. Date of
Publication: 01 Nov 2020.
Author
Jenkin I.; Prachee I.; Sokal P.A.; Harky A.
Institution
(Jenkin, Prachee) Medical Sciences Division, University of Oxford, Oxford,
United Kingdom
(Sokal) Department of Medicine, School of Medicine, University of
Liverpool, Liverpool, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The Cor-Knot automated fastener has been used to eliminate the
need for manual knot-tying in cardiac valve surgery for over a decade. We
review the current literature pertaining to Cor-Knot and discuss its
benefits and shortcomings with respect to cardiac valve surgery.
 Method(s): A comprehensive literature search was conducted to
identify articles discussing the use of automated fasteners and manually
tied knots in the setting of cardiac valve surgery. The search terms used
were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener",
"automated fastener", "aortic valve", "mitral valve", "minimally
invasive", and "titanium". These terms were used as keywords and, in
combination, as MeSH terms to maximize the output of literature searches.
Twenty-four relevant articles were identified and reviewed.
 Result(s): Current literature provides evidence to support the role
of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing
total operation times as compared with manual knot-tying. However, studies
to date fail to provide evidence for the translation of these
intraoperative advantages into improved patient outcomes. Moreover,
Cor-Knot is associated with a significant financial burden.
 Conclusion(s): A plethora of evidence exists to support the
intraoperative advantages provided by Cor-Knot. However, the literature is
yet to support its role in facilitating superior clinical outcomes as
compared with manual knot tying. Larger high-quality trials and studies
are required to provide evidence supporting the ongoing use of Cor-Knot in
valve surgery. Copyright © 2020 Wiley Periodicals LLC

<2>
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.
 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. 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%. 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. Copyright ©
2020 Elsevier Inc.

<3>
Accession Number
2008398361
Title
Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity
Score Analysis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Ali U.S.; Lan N.S.R.; Gilfillan M.; Ho K.; Pavey W.; Dwivedi G.; Slimani
E.K.; Edelman J.; Merry C.; Larbalestier R.
Institution
(Ali, Gilfillan, Pavey, Slimani, Edelman, Merry, Larbalestier) Department
of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia
(Lan, Dwivedi) Department of Cardiology, Fiona Stanley Hospital, Perth,
WA, Australia
(Ho) Medical School, University of Western Australia, School of Veterinary
& Life Sciences, Murdoch University and Intensive Care Unit, Royal Perth
Hospital, Perth, WA, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: The role of intra-aortic balloon pumps (IABP) in high-risk
patients undergoing coronary artery bypass graft (CABG) surgery remains
controversial. We report the 5-year experience from a new Australian
centre. Method(s): We retrospectively analysed 690 patients
undergoing urgent isolated CABG surgery at a Western Australian tertiary
centre from February 2015 to May 2020. De-identified data was obtained
from the Australia & New Zealand Society of Cardiothoracic Surgeons
database. Patients were stratified according to preoperative IABP use. A
propensity score was created for the probability of IABP use and a
propensity adjusted analysis was performed using logistic regression. The
primary outcome was 30-day mortality. Secondary outcomes were
postoperative inhospital outcomes. Result(s): Preoperative IABP was
used in 78 patients (11.3%). After propensity score adjustment, in a
subgroup of patients with reduced ejection fraction or left main disease,
30-day mortality (7.0% vs 2.0%, OR 6.03, 95% CI 1.89-19.28, p=0.002) was
significantly higher in the IABP group. Red blood cell transfusions (19.7%
vs 12.6%, OR 1.86, 95% CI 1.02-3.35, p=0.039), prolonged inotrope use
(78.9% vs 50.9%, OR 6.11, 95% CI 2.77-13.48, p<0.001), prolonged invasive
ventilation (28.2% vs 3.4%, OR 20.2, 95% CI 8.24-49.74, p<0.001),
mesenteric ischaemia (2.8% vs 0%, OR 4.52, 95% CI 1.15-17.77, p=0.031) and
multisystem organ failure (1.3% vs 0.7%, OR 25.68, 95% CI 2.55-258.34,
p=0.006) were significantly higher in the IABP group. Conclusion(s):
In patients undergoing isolated CABG surgery, preoperative IABP use was
associated with increased 30-day mortality and adverse outcomes. Large
randomised controlled trials are required to confirm our
findings. Copyright © 2020

<4>
Accession Number
2007108576
Title
The Cost of Innovation and Evidence in Cardiac Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 15 (5) (pp 395-396), 2020. Date of Publication: 01 Sep 2020.
Author
Chikwe J.; Gaudino M.
Institution
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Gaudino) Division of Cardiac Surgery, Weill Cornell, New York, NY, United
States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
This review summarizes a systematic analysis of 216 randomized trials of
cardiovascular interventions performed during 2008-2019, according to the
source of trial funding. The systematic analysis showed that on average
the results of each trial would change significance if only 5 patients
experienced different outcomes. Industry-sponsored trials were more likely
to use composite endpoints, noninferiority designs, and twice as likely as
nonindustry trials to report results favoring the device arm. Over 80% of
industry trials used reporting strategies or "spin" suggesting the device
arm was advantageous versus fewer than half of non-industry trials. The
review discusses the implications of these findings. Copyright ©
The Author(s) 2020.

<5>
Accession Number
2007099388
Title
Parachute tricuspid valve: a systematic review.
Source
Orphanet Journal of Rare Diseases. 15 (1) (no pagination), 2020. Article
Number: 305. Date of Publication: 01 Dec 2020.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, 389 Longdejing Street,
Chengxiang District, Putian, Fujian Province 351100, China
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: A parachute tricuspid valve is a very rare congenital cardiac
anomaly. Its morphological features and clinical implications have not
been sufficiently described so far. The purpose of the present systematic
review is to disclose the morphological and clinical characteristics of
parachute tricuspid valve, and to discuss its diagnostic methods,
treatments and patients' outcomes. Main body: The Preferred Reporting
Items for Systematic Reviews and Meta-analyses (PRISMA) statement
guidelines were followed in this systematic review. Publications were
systematically searched in the PubMed, Highwire Press, and the Cochrane
Library databases. By comprehensive retrieval of the pertinent literature
published between 1979 and 2019, 13 reports were collected with 14
patients recruited into this study. Their ages ranged from neonate to 52
years old with a median age of 23 years. Tricuspid valve regurgitation of
a less-than-severe degree was seen in 6 (60%) patients, tricuspid valve
stenosis was present in 3 (30%) patients and normally functioning
tricuspid valve was noted in 1 (10%) patient. All patients had a single
papillary muscle in the right ventricle. The chordae tendineae could be
normal in length and thickness, or elongated, or shortened and thickened.
Forty percent of the patients were asymptomatic or with only mild symptoms
and did not need a surgical or interventional therapy, and 6 (60%)
patients were indicated for a surgical/interventional treatment due to
their severe presenting symptoms, associated congenital heart defects, and
the resultant severe right ventricular inflow obstruction and (or)
tricuspid stenosis. Patients' outcomes varied depending on the substantial
status of the patients with a survival rate of 70% and mortality rate of
30%. Conclusion(s): A few patients with a parachute tricuspid valve
are asymptomatic or only with mild symptoms and a surgical or
interventional treatment is not required. The surgical/interventional
indications for parachute tricuspid valve patients are their severe
presenting symptoms, associated congenital heart defects, and the
resultant severe right ventricular inflow obstruction and (or) tricuspid
stenosis. The survival rate of this patient setting is
satisfactory. Copyright © 2020, The Author(s).

<6>
Accession Number
2007099096
Title
Effects of switching from clopidogrel to prasugrel at the chronic phase
after coronary stenting on antiplatelet action and vascular endothelial
function: Switch-Pras study.
Source
Heart and Vessels. (no pagination), 2020. Date of Publication: 2020.
Author
Masuyama T.; Sakuma M.; Waku R.; Hirose S.; Kitahara K.; Naganuma J.;
Yazawa H.; Toyoda S.; Abe S.; Nakajima T.; Inoue T.
Institution
(Masuyama, Sakuma, Waku, Hirose, Kitahara, Naganuma, Yazawa, Toyoda, Abe,
Nakajima, Inoue) Department of Cardiovascular Medicine, School of
Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi
321-0293, Japan
Publisher
Springer Japan (E-mail: orders@springer.jp)
Abstract
Compared to clopidogrel, prasugrel has a lower incidence of ischemic
events following percutaneous coronary intervention (PCI) because of an
early reduction during the acute phase in P2Y12 reaction units (PRU). The
objective of this study was to compare the antiplatelet effect and
vascular endothelial function of both drugs during the chronic phase after
PCI. Patients who had undergone PCI and were confirmed to have no
restenosis by follow-up coronary angiography under dual anti-platelet
therapy with clopidogrel (75 mg/day) and aspirin (100 mg/day) were
randomized to either continue clopidogrel or switch to prasugrel (3.75
mg/day). At baseline, prior to randomization we determined the CYP2C19
genotype. At the baseline and 24 weeks after randomization, the P2Y12
reactivity unit (PRU) was measured using the VerifyNowTM P2Y12 assay.
Endothelial function was evaluated by flow-mediated vasodilation (FMD) and
reactive hyperemia peripheral arterial tonometry (RH-PAT), while and
circulating CD34+/CD133+/CD45low progenitor cells were measured
by flow cytometric analysis. Serum high-sensitivity C-reactive protein
(hsCRP) level was also measured. The PRU was reduced significantly in the
prasugrel group (P = 0.0008), especially in patients who were intermediate
or poor metabolizers based on the CYP2C19 genotype (P < 0.0001). This
reduction was not observed in the clopidogrel group. The number of
CD34+/CD133+/CD45low cells increased in the clopidogrel group
(P = 0.008), but not in the prasugrel group. The hsCRP, FMD and reactive
hyperemia index measured by RH-PAT did not change in either group.
Prasugrel is potentially better than clopidogrel for preventing thrombotic
events, although clopidogrel may have an advantage over prasugrel in terms
of preventing atherosclerotic events. Proper use of thienopyridine drugs
based on the CYP2C19 genotype has promising clinical
potential. Copyright © 2020, The Author(s).

<7>
Accession Number
2007087010
Title
Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac
Autonomic Function.
Source
Obesity Surgery. (no pagination), 2020. Date of Publication: 2020.
Author
Gil S.; Pecanha T.; Dantas W.S.; Murai I.H.; Merege-Filho C.A.A.; de
Sa-Pinto A.L.; Pereira R.M.R.; de Cleva R.; Santo M.A.; Rezende D.A.N.;
Kirwan J.P.; Gualano B.; Roschel H.
Institution
(Gil, Pecanha, Dantas, Murai, Merege-Filho, Rezende, Gualano, Roschel)
Applied Physiology & Nutrition Research Group; Laboratory of Assessment
and Conditioning in Rheumatology; Faculdade de Medicina FMUSP,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Dantas, Kirwan) Integrated Physiology and Molecular Medicine Laboratory,
Pennington Biomedical Research Center, Louisiana State University, Baton
Rouge, LA, United States
(de Sa-Pinto, Pereira, Gualano, Roschel) Rheumatology Division, Hospital
das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao
Paulo, Sao Paulo, Brazil
(de Cleva, Santo) Department of Digestive Surgery, School of Medicine,
University of Sao Paulo, Sao Paulo, Brazil
Publisher
Springer
Abstract
Background: Bariatric surgery improves cardiovascular health, which might
be partly ascribed to beneficial alterations in the autonomic nervous
system. However, it is currently unknown whether benefits from surgery on
cardiac autonomic regulation in post-bariatric patients can be further
improved by adjuvant therapies, namely exercise. We investigated the
effects of a 6-month exercise training program on cardiac autonomic
responses in women undergoing bariatric surgery. Method(s): Sixty-two
women eligible for bariatric surgery were randomly allocated to either
standard of care (control) or an exercise training intervention. At
baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we
assessed chronotropic response to exercise (CR%; i.e., percentage change
in heart rate from rest to peak exercise) and heart rate recovery (HRR30s,
HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post
exercise) after a maximal exercise test. Result(s): Between-group
absolute changes revealed higher CR% (DELTA = 8.56%, CI95% 0.22-19.90, P =
0.04), HRR30s (DELTA = 12.98 beat/min, CI95% 4.29-21.67, P = 0.01), HRR60s
(DELTA = 22.95 beat/min, CI95% 11.72-34.18, P = 0.01), and HRR120s (DELTA
= 34.54 beat/min, CI95% 19.91-49.17, P < 0.01) in the exercised vs.
non-exercised group. Conclusion(s): Our findings demonstrate that
exercise training enhanced the benefits of bariatric surgery on cardiac
autonomic regulation. These results highlight the relevance of exercise
training as a treatment for post-bariatric patients, ensuring optimal
cardiovascular outcomes. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<8>
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Accession Number
633135798
Title
Current state of noninvasive, continuous monitoring modalities in
pediatric anesthesiology.
Source
Current opinion in anaesthesiology. 33 (6) (pp 781-787), 2020. Date of
Publication: 01 Dec 2020.
Author
van Wijk J.J.; Weber F.; Stolker R.J.; Staals L.M.
Institution
(van Wijk, Weber, Staals) Department of Anesthesiology, Erasmus MC Sophia
Children's Hospital
(Stolker) Department of Anesthesiology, Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The last decades, anesthesia has become safer, partly
due to developments in monitoring. Advanced monitoring of children under
anesthesia is challenging, due to lack of evidence, validity and size
constraints. Most measured parameters are proxies for end organ function,
in which an anesthesiologist is actually interested. Ideally, monitoring
should be continuous, noninvasive and accurate. This present review
summarizes the current literature on noninvasive monitoring in noncardiac
pediatric anesthesia. RECENT FINDINGS: For cardiac output (CO) monitoring,
bolus thermodilution is still considered the gold standard. New
noninvasive techniques based on bioimpedance and pulse contour analysis
are promising, but require more refining in accuracy of CO values in
children. Near-infrared spectroscopy is most commonly used in cardiac
surgery despite there being no consensus on safety margins. Its place in
noncardiac anesthesia has yet to be determined. Transcutaneous
measurements of blood gases are used mainly in the neonatal intensive care
unit, and is finding its way to the pediatric operation theatre.
Especially CO2 measurements are accurate and useful. SUMMARY: New
techniques are available to assess a child's hemodynamic and respiratory
status while under anesthesia. These new monitors can be used as
complementary tools together with standard monitoring in children, to
further improve perioperative safety.

<9>
Accession Number
633284772
Title
A single center randomized control trial of intravenous lidocaine for the
management of traumatic rib fractures.
Source
Canadian Journal of Emergency Medicine. Conference: 2020 CAEP/ACMU.
Canada. 22 (Supplement 1) (pp S41), 2020. Date of Publication: May 2020.
Author
Patton P.; Vogt K.; Parry N.; Priestap F.; Ball I.
Institution
(Patton, Vogt, Parry, Priestap, Ball) Western University, London, ON,
Canada
Publisher
Cambridge University Press
Abstract
Introduction: Traumatic rib fractures (RF) are acommon occurrence with 10%
incidence in all trauma patients and are associated with significant
morbidity and mortality. Adequate analgesia is paramount for preventing
pulmonary complications and reducing morbidity and mortality. There is
evidence of intravenous (IV) lidocaine's effectiveness and safety in the
post-operative thoracic and abdominal surgical patient and we hypothesize
that it may be ideal in trauma patients with RF. We evaluated IV
lidocaine's analgesic efficacy in this population. Method(s): A
single-centre, double-blind, randomized control trial comparing a 72-96
hour IV lidocaine infusion plus standard analgesics to placebo infusion
plus standard analgesics. Participants were adult trauma patients
diagnosed with two or more RFs requiring hospital admission. A total of 36
patients were enrolled over 5 months in 2019. The study was powered to
detect a 20% reduction in pain scores, which is determined to be
clinically significant. Result(s): The primary outcome was mean pain
score at rest and with movement, as measured on the Visual Analog Scale
(VAS). There were consistent trends toward reduced VAS pain scores at rest
and with movement in the lidocaine group as compared to placebo group with
mean scores of 3.49 [SD 2.02 95% CI] and 7.08 [SD 1.71 95% CI] in the
lidocaine group and 3.83 [SD 1.93 95% CI] and 8.03 [SD 1.44 95% CI] in the
placebo group, at rest (p value 0.624) and with movement (p value 0.110),
respectively . Secondary outcomes were patient satisfaction as measured on
the VAS which demonstrated a score of 7.79 [SD 1.82 95% CI] in the
lidocaine group and 6.63 [SD 1.77 95% CI] (p = 112) in the placebo group,
and total morphine equivalents (ME) used (including breakthrough doses)
that demonstrated a trend towards a reduction in the lidocaine group with
210.9 mg [SD 180.0 95% CI] compared to the placebo with total ME used of
309.9 mg [SD 221.8 95% CI]. Other secondary outcomes were protocol
adherence, incidence of respiratory failure, hospital and ICU length of
stay, mortality, incidence of lidocaine toxicity, and treatment regimens
(non-opioid analgesics). Conclusion(s): These results demonstrate a
trend towards lidocaine's analgesic benefit during rest and the critical
times of patient movement and mobility, which has been demonstrated to be
paramount in the reduction of respiratory complications from rib
fractures. The results also tend towards a reduction in morphine
equivalents, although the trial was not powered to demonstrate this.

<10>
Accession Number
633285752
Title
Cyclosporine does not affect cytokine release in response to
extracorporeal circulation in coronary artery bypass grafting.
Source
Critical Care. Conference: 40th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 24 (Supplement 1) (no pagination), 2020.
Date of Publication: 2020.
Author
Grins E.G.; Jovinge S.J.
Institution
(Grins) Skane University Hospital, Lund, Department of Cardiothoracic
Surgery, Anesthesia and Intensive Care, Lund, Sweden
(Jovinge) Fredrik Meijer Heart and Vascular Institute, Spectrum Health,
Grand Rapids, MI, United States
Publisher
BioMed Central Ltd
Abstract
Introduction: Acute kidney injury (AKI) due to ischemia-reperfusion
affects onethird of the patients in cardiac surgery. We investigated the
potential role of Cyclosporine (CsA) to prevent postoperative AKI and
mitigate inflammatory response to extracorporeal circulation (ECC).
 Method(s): Double-blind, randomized, placebo-controlled single-center
study. Patients (n=67) scheduled for elective cardiac surgery were
randomized to 2,5 mg/kg CsA or placebo before the surgery. The primary
objective was to assess the role of CsA to reduce the incidence of
postoperative AKI. The secondary objective was to study CsA induced
changes in the inflammatory response to ECC. Result(s): All enrolled
patients were analyzed. Postoperative AKI was more pronounced in the
Cyclosporine group compared to placebo. OR=5.03 (1.76-15.74), 95% CI. The
cytokine production in response to ECC was not affected by Cyclosporine
(Figure 1). Conclusion(s): In patients undergoing cardiac surgery, a
single preoperative dose of CsA does not prevent the postoperative
decrease in renal function. CsA does not alter cytokine release in
response to extracorporeal circulation. Elevated post-ECC levels of
pro-inflammatory cytokine IL-6 are associated with kidney dysfunction and
may be predictive.

<11>
Accession Number
633282934
Title
Percutaneous coronary intervention at centers with and without on-site
surgical backup: A meta-analysis and meta-regression.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2019
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2019. United States. 12 (SUPPL 1) (no pagination),
2019. Date of Publication: April 2019.
Author
Buhari O.; Onyekwelu C.; Villablanca-Spineto P.; Kakkar A.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Guidelines recommend that Percutaneous coronary intervention
(PCI) should be performed in hospitals with onsite cardiac surgery (CS).
However, emerging data suggest that there is no significant difference in
clinical outcomes following primary, or elective PCI between the two
groups. We performed a meta-analysis and meta-regression to assess the
safety and efficacy of performing PCI in centers with, and without on-site
CS. Method(s): We conducted electronic database searches in PubMed,
CENTRAL, EMBASE. The Cochrane Register, Google Scholar databases, and the
scientific session abstracts were searched for eligible studies. Risk
ratios and 95% confidence intervals were computed with the Mantel-
Haenszel method. Fixed-effect models were used; if heterogeneity (I )>25
was identified, effects were obtained with random models. Meta-regression
analyses were performed to determine whether the effects of PCI without
on-site CS were modulated by pre-specified study-level factors Results:
Twenty-seven studies were included with total n=8,558,618 patients. No
significant difference was observed for all-cause mortality (RR 1.02, 95%
CI 0.86-1.21, p=0.82, I2 =97.2%), cardiovascular mortality
rates (RR 1.18, 95% CI 0.93-1.50, p=0.17, I 2.98%), myocardial infarction
rates (RR 0.89, 95% CI 0.62-1.29, p=0.55, I2= 88.5%), repeat
revascularization (RR 0.87, 95% CI 0.43-1.76, p=0.69,
I2=98.8%), stroke (RR 1.28, 95% CI 0.56-2.91, p=0.55, I 98.8%),
shock (RR 0.76, 95% CI 0.43-1.35, p=0.35, I2 = 93.7%),
mechanical circulatory support (RR 0.83, 95% CI 0.46- 1.50, p=0.53, I
99.8%), bleeding (RR 0.88, 95% CI 0.43-1.81, p=0.73, I2
=99.6%), and emergency CABG (RR 0.97, 95% CI 0.64-146, p= 0.87,
I2 =84.1%). In a meta-regression analysis, the effect of PCI
without on-site CS, baseline clinical features did not affect the
long-term all-cause mortality outcome. Conclusion(s): There was no
significant difference in complications rates, and clinical outcomes for
PCI performed at centers without on-site CS compared to centers with
on-site CS.

<12>
Accession Number
633282760
Title
The burden of sternal wound infections following coronary artery bypass
graft surgery in medicare patients.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: 2019
Scientific Sessions of American Heart Association's Quality of Care and
Outcomes Research, QCOR 2019. United States. 12 (SUPPL 1) (no pagination),
2019. Date of Publication: April 2019.
Author
Saunders R.; Bluher M.; Lankiewicz J.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Since 2008, the Centers for Medicare and Medicaid Services
(CMS) have not reimbursed costs associated with sternal wound infections
(SWI) that follow coronary artery bypass graft surgery (CABG). Beginning
FY 2015, the Hospital-Acquired Condition (HAC) Reduction Program, mandated
by the Affordable Care Act, requires the CMS to reduce hospital payments
by 1 percent for hospitals that rank among the lowest-performing 25
percent with regard to HACs. SWI resulting from CABG was added to the
program in FY 2016. The cost of treating SWIs is thus absorbed by the
hospital, making optimized SWI prophylaxis an important part of hospital
care. Here the burden of SWI following CABG in the Medicare population is
calculated and the impact of improved prophylaxis quantified.
 Method(s): Literature review identified publications presenting the
incidence of surgical site infections (including superficial and deep
SWIs), the time required to treat SWIs, and the costs of providing post
CABG care. Key parameters to estimate the burden of SWIs were: CABG
procedures per year, SWI rate, ratio of superficial to deep SWIs, length
of stay, hospital time to treat SWIs, and the cost per day of intensive
care unit (ICU) and general ward. A previously presented Markov model was
adapted to estimate the yearly burden of SWIs after CABG procedures, with
costs in 2016 USD. As antibiotic prophylaxis is essentially ubiquitous for
patients undergoing CABG, data on other methods of reducing the SWI were
considered. Single-patient-use electrocardiogram cable and lead (ECG)
systems have recently been shown to significantly reduce the incidence of
surgical site infection after CABG. The risk reduction at 30-days post
CABG was 18.8% over reusable ECG. Result(s): The number of Medicare
beneficiaries totals approximately 55.3 million people, with an annual
rate of CABG of circa 178 procedures per 100,000 beneficiaries. Isolated
CABG procedures under Medicare thus total 98,434. The SWI rate was
reported to be between 1 and 4%, with deep SWI representing up to 40.75%
of SWI cases. Using an SWI rate of 2.5% at 30 days, 20% of which are DSWI,
indicated the burden of SWIs was $88.5 million. This included an
additional 4,443 ICU and 21,443 general ward days, as well as over 1,000
readmissions. At the higher end of estimates, SWI could be costing
providers $115.0 million. Assuming a 18.8% reduction in the SWI rate at 30
days, providers could save $12.6 million going up to $26.8 million ($271
per procedure) at the higher end of estimates. At a $6 incremental cost,
single-patient-use ECG could represent a 45-fold return on investment.
 Conclusion(s): Superficial and deep SWIs after CABG procedures in the
Medicare population come at considerable cost to providers. Preventing SWI
has advantages for both patients and providers.

<13>
Accession Number
633289188
Title
Reiki protocol for preoperative anxiety, depression, and well-being: a
non-randomized controlled trial.
Source
Revista da Escola de Enfermagem da U S P. 54 (pp e03630), 2020. Date of
Publication: 2020.
Author
Santos C.B.R.D.; Gomes E.T.; Bezerra S.M.M.D.S.; Puschel V.A.A.
Institution
(Santos, Bezerra) Universidade de Pernambuco, PE, Recife, Brazil
(Gomes, Puschel) Universidade de Sao Paulo, Escola de Enfermagem, Sao
Paulo, Brazil
Publisher
NLM (Medline)

<14>
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. Objective(s): To identify
factors influencing physical activity in patients after cardiac surgery.
 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.
 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. 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. Copyright © 2020 Elsevier Inc.

<15>
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. 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. 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. 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. Copyright
© The Author(s) 2020.

<16>
Accession Number
2007145670
Title
Sensitivity of lung ultrasound for the detection of pneumothorax one day
after pulmonary resection-a prospective observational study.
Source
European Surgery - Acta Chirurgica Austriaca. (no pagination), 2020. Date
of Publication: 2020.
Author
Galetin T.; Schieren M.; Marks B.; Defosse J.; Stoelben E.
Institution
(Galetin, Stoelben) Lung Clinic, Thoracic Surgery, Medical Centre
Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200,
Cologne 51109, Germany
(Schieren, Defosse) Department of Anaesthesiology and Intensive Care
Medicine, Medical Centre Cologne-Merheim, University Witten/Herdecke,
Cologne, Germany
(Marks) Department of Radiology, Medical Centre Cologne-Merheim,
University Witten/Herdecke, Cologne, Germany
Publisher
Springer (E-mail: journals@springer.at)
Abstract
Background: Chest X-ray (CXR) after thoracic surgery contributes to
patient discomfort and costs and is of limited therapeutic value. Lung
ultrasound (LU) for pneumothorax may be an alternative to CXR, but
diagnostic accuracy data are heterogeneous and biased by insufficient
sonographic technique and patient selection. Reported sensitivities range
from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day
after thoracic surgery under routine conditions. Method(s): We
performed a prospective observational study (trial-ID DRKS00014557).
Consecutive patients undergoing lung resection received standardized LU in
addition to routine CXR on the first postoperative day. Ultrasound
examiner and radiologist were blinded to corresponding X-ray and
ultrasound findings. CXR was used as reference to determine diagnostic
test performance of ultrasound. The conformity of sonography- and
routine-based therapeutic decisions was evaluated. Result(s): A total
of 68 patients were examined. The mean duration of ultrasound was 145+/-
64s. CXR identified 23 patients with pneumothorax with a mean
apex-to-cupola size of 1.5+/- 1.0cm. Ultrasound detected 18 patients with
pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence
interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative
predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44;
0.68]. Air leakage via chest tube correlated weakly with CXR (spearman's
rho= 0.26) and moderately with LU (rho= 0.43). The conformity between
sonographically based recommendations and the actual therapy based on
routine diagnostics was 96%. Conclusion(s): Sensitivity of ultrasound
for pneumothorax detection nearly reached CXR and resulted in equally safe
patient management. Our data can serve as a pilot study for upcoming
larger-scaled controlled trials. Copyright © 2020, The Author(s).

<17>
Accession Number
633291479
Title
Effect of High-Intensity Interval Training on Aerobic Capacity and Heart
Rate Control of Heart Transplant Recipients: a Systematic Review with
Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2020. Date
of Publication: 28 Oct 2020.
Author
Conceicao L.S.R.; Gois C.O.; Fernandes R.E.S.; Martins-Filho P.R.S.; Gomes
M.; Neves V.R.; Carvalho V.O.
Institution
(Conceicao, Gois, Fernandes, Carvalho) Department of Physical Therapy,
Universidade Federal de Sergipe (UFS), Sao Cristovao, Sergipe, Brazil
(Conceicao, Gois, Fernandes, Carvalho) Post-Graduation Program in Health
Sciences, Universidade Federal de Sergipe (UFS), Sao Cristovao, Sergipe,
Brazil
(Conceicao, Gois, Fernandes, Carvalho) GREAT Group (GRupo de Estudos em
ATividade fisica), Universidade Federal de Sergipe (UFS), Sao Cristovao,
Sergipe, Brazil
(Martins-Filho) Investigative Pathology Laboratory, Universidade Federal
de Sergipe (UFS), Sao Cristovao, Sergipe, Brazil
(Gomes) Department of Physical Therapy, Universidade Federal da Bahia
(UFBa), Salvador, Bahia, Brazil
(Neves) Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Heart transplantation (HTx) is the gold standard procedure
for selected individuals with refractory heart failure. Highintensity
interval training (HIIT) is safe and allows patients to exercise in high
intensity for longer time when compared to moderateintensity continuous
training (MICT). The primary aim of this study was to perform a systematic
review and meta-analysis about the effect of HIIT compared to MICT on
exercise capacity, peak heart rate, and heart rate reserve in HTx
recipients. Secondarily, we pooled data comparing MICT and no exercise
training in these patients. METHOD(S): This systematic review
followed the standardization of the Preferred Reporting Items for
Systematic Reviews and Metaanalyses statement and the Cochrane
Collaboration Handbook. We presented the treatment effects of HIIT on the
outcomes of interest as mean difference (MD) and 95% confidence interval
(CI). Metaanalysis was performed using the random-effects, generic inverse
variance method. RESULT(S): HIIT improved peak oxygen consumption
(peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD =
3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI
-0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5;
95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6,
9.6; P=0.006) were found comparing HIIT and no exercise training.
 CONCLUSION(S): Current available evidence suggests that HIIT leads to
improvements on peakVO2, peak heart rate, and heart rate reserve compared
to MICT in HTx recipients. However, the superiority of HIIT should be
tested in isocaloric protocols.

<18>
Accession Number
633289672
Title
Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as
Alternative Strategy for Nonparticipation in Clinic-Based Cardiac
Rehabilitation Among Elderly Patients in Europe: A Randomized Clinical
Trial.
Source
JAMA cardiology. (no pagination), 2020. Date of Publication: 28 Oct 2020.
Author
Snoek J.A.; Prescott E.I.; van der Velde A.E.; Eijsvogels T.M.H.;
Mikkelsen N.; Prins L.F.; Bruins W.; Meindersma E.; Gonzalez-Juanatey
J.R.; Pena-Gil C.; Gonzalez-Salvado V.; Moatemri F.; Iliou M.-C.; Marcin
T.; Eser P.; Wilhelm M.; Van't Hof A.W.J.; de Kluiver E.P.
Institution
(Snoek, van der Velde, de Kluiver) Isala Heart Center, Zwolle, Netherlands
(Snoek) Sports Medicine Department Isala, Zwolle, Netherlands
(Prescott, Mikkelsen) Department of Cardiology, Bispebjerg Frederiksberg
University Hospital, Copenhagen, Denmark
(Eijsvogels) Radboud Institute for Health Sciences, Department of
Physiology, Radboud University Medical Center, Nijmegen, Netherlands
(Prins) Diagram, Zwolle, Netherlands
(Meindersma) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Gonzalez-Juanatey, Pena-Gil, Gonzalez-Salvado) Department of Cardiology,
Hospital Clinico Universitario de Santiago, Instituto de Investigacion
Sanitaria, Madrid, Spain
(Moatemri, Iliou) Department of Cardiac Rehabilitation, Assistance
Publique Hopitaux de Paris, Paris, France
(Marcin, Eser, Wilhelm) Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Van't Hof) Department of Cardiology, Maastricht University Medical Center
and Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Van't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
Publisher
NLM (Medline)
Abstract
Importance: Although nonparticipation in cardiac rehabilitation is known
to increase cardiovascular mortality and hospital readmissions, more than
half of patients with coronary artery disease in Europe are not
participating in cardiac rehabilitation. Objective(s): To assess
whether a 6-month guided mobile cardiac rehabilitation (MCR) program is an
effective therapy for elderly patients who decline participation in
cardiac rehabilitation. Design, Setting, and Participant(s): Patients
were enrolled in this parallel multicenter randomized clinical trial from
November 11, 2015, to January 3, 2018, and follow-up was completed on
January 17, 2019, in a secondary care system with 6 cardiac institutions
across 5 European countries. Researchers assessing primary outcome were
masked for group assignment. A total of 4236 patients were identified with
a recent diagnosis of acute coronary syndrome, coronary revascularization,
or surgical or percutaneous treatment for valvular disease, or documented
coronary artery disease, of whom 996 declined to start cardiac
rehabilitation. Subsequently, 179 patients who met the inclusion and
exclusion criteria consented to participate in the European Study on
Effectiveness and Sustainability of Current Cardiac Rehabilitation
Programmes in the Elderly trial. Data were analyzed from January 21 to
October 11, 2019. Intervention(s): Six months of home-based cardiac
rehabilitation with telemonitoring and coaching based on motivational
interviewing was used to stimulate patients to reach exercise goals.
Control patients did not receive any form of cardiac rehabilitation
throughout the study period. Main Outcomes and Measures: The primary
outcome parameter was peak oxygen uptake (Vo2peak) after 6 months.
 Result(s): Among 179 patients randomized (145 male [81%]; median age,
72 [range, 65-87] years), 159 (89%) were eligible for primary end point
analysis. Follow-up at 1 year was completed for 151 patients (84%). Peak
oxygen uptake improved in the MCR group (n=89) at 6 and 12 months (1.6
[95% CI, 0.9-2.4] mL/kg-1/min-1 and 1.2 [95% CI, 0.4-2.0] mL/kg-1/min-1,
respectively), whereas there was no improvement in the control group
(n=90) (+0.2 [95% CI, -0.4 to 0.8] mL/kg-1/min-1 and +0.1 [95% CI, -0.5 to
0.7] mL/kg-1/min-1, respectively). Changes in Vo2peak were greater in the
MCR vs control groups at 6 months (+1.2 [95% CI, 0.2 to 2.1]
mL/kg-1/min-1) and 12 months (+0.9 [95% CI, 0.05 to 1.8] mL/kg-1/min-1).
The incidence of adverse events was low and did not differ between the MCR
and control groups. Conclusions and Relevance: These results suggest
that a 6-month home-based MCR program for patients 65 years or older with
coronary artery disease or a valvular intervention was safe and beneficial
in improving Vo2peak when compared with no cardiac rehabilitation. Trial
Registration: trialregister.nl Identifier: NL5168.

<19>
Accession Number
633286401
Title
Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as
Biomarkers for Cardiovascular Surgery Procedures: A Literature Review.
Source
Reviews on recent clinical trials. (no pagination), 2020. Date of
Publication: 27 Oct 2020.
Author
Serra R.; Ielapi N.; Licastro N.; Provenzano M.; Andreucci M.; Bracale
U.M.; Jiritano F.; de Franciscis S.; Mastroroberto P.; Serraino G.F.
Institution
(Serra, Ielapi, Licastro, de Franciscis) Interuniversity Center of
Phlebolymphology (CIFL). International Research and Educational Program in
Clinical and Experimental Biotechnology" at the Department of Surgical and
Medical Sciences University Magna Graecia of Catanzaro, Viale Europa 88100
Catanzaro. Italy
(Provenzano, Andreucci) Department of Health Sciences, University of
Catanzaro
(Bracale) Department of Public Health, University of Naples "Federico II"
(Jiritano, Mastroroberto, Serraino) Department of Experimental and
Clinical Medicine, University of Catanzaro
Publisher
NLM (Medline)
Abstract
BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) and the
platelet-to-lymphocyte ratio (PLR) have been studied so far as prognostic
factors of cardiovascular diseases. Their role interplayed with
endothelial inflammation, has emerged as optimal predictors for major
cardiovascular disease events and as prognostic factors for
post-procedural outcomes. METHOD(S): A review of the current
literature was undertaken to investigate the relationship between NLR and
PLR with percutaneous, cardiac surgery, and vascular surgery procedures.
 RESULT(S): Our findings show that perioperative NLR and PLR levels
are significantly correlated with patient morbidity and mortality rates.
 CONCLUSION(S): These biomarkers have several attractive
characteristics, as they are inexpensive and quickly available, and they
can contribute to the early identification of patients at high risk for
periprocedural adverse events. Copyright© Bentham Science
Publishers; For any queries, please email at epub@benthamscience.net.

<20>
Accession Number
630600451
Title
Efficacy of paravertebral block techniques in thoracic surgery: Systematic
literature review.
Source
Colombian Journal of Anesthesiology. 48 (1) (pp 20-29), 2020. Date of
Publication: 01 Jan 2020.
Author
Cadavid-Puentes A.M.; Casas-Arroyave F.D.; Palacio-Montoya L.M.;
Valencia-Gallon E.
Institution
(Cadavid-Puentes, Casas-Arroyave) Anesthesiology and Reanimation Division,
Universidad de Antioquia, Hospital Universitario San Vicente Fundacion,
Calle 64 No. 51D-154, Medellin, Colombia
(Palacio-Montoya, Valencia-Gallon) IPS Universitaria, Universidad de
Antioquia, Medellin, Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: revcolanest@scare.org.co)
Abstract
Introduction:Postoperative pain in thoracic surgery in adults is usually
severe, and to control it there are many analgesic methods that include
paravertebral blockade (PVB). Until now, there is no clarity on which is
the most effective technique to perform this blockade.
 Objective(s):To describe the different PVB techniques and its
analgesic effect in thoracic surgery. Method(s):A systematic review
of the literature was performed. We included studies that analyzed
patients in open chest surgery and used PVB as analgesic technique. The
Cochrane and Grading of Recommendation Assessment, Development and
Evaluation strategies were used to analyze biases and evidence. The
results are presented graphically by means of a visual analog scale (VAS)
pain and opioid consumption equivalent to morphine for each technique
found. We summarize the results with a qualitative approach without
meta-analysis. Result(s):A total of 38 articles were analyzed (2188
patients). 13 using PVB guided by surface anatomy (SA-PVB), 7
Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and
the remaining using PVB performed under direct visualization by the
surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and
US-PVB, and greater than 5 in studies with S-PVB; however, opioid
consumption in the postoperative period was similar between the techniques
described. Conclusion(s):PVB can be performed through 4 techniques.
Techniques of US-PVB or SA-PVB have shown better consistency to manage
postoperative acute pain in thoracic surgery. Copyright © 2019
Sociedad Colombiana de Anestesiologia y Reanimacion (S.C.A.R.E.).
Published by Wolters Kluwer.

<21>
Accession Number
628886804
Title
Perioperative use of levosimendan in patients undergoing cardiac surgery:
Systematic review and meta-analysis.
Source
Colombian Journal of Anesthesiology. 47 (3) (pp 142-153), 2019. Date of
Publication: 01 Jul 2019.
Author
Oliveros H.; Garcia H.; Rubio C.; Navarrete J.
Institution
(Oliveros) Universidad de la Sabana, Campus Puente del Comun, Chia,
Cundinamarca, Colombia
(Garcia, Rubio, Navarrete) Hospital Militar Central, Bogota, Colombia
(Garcia, Rubio, Navarrete) Universidad Militar Nueva Granada, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: revcolanest@scare.org.co)
Abstract
Introduction: Patients undergoing cardiac surgery frequently develop low
cardiac output syndrome (LCOS). Multiple interventions including
levosimendan have been used in the prevention and treatment of LCOS.
Preliminary studies reported lower mortality respect to placebo or other
inotropes, however, recently, 3 clinical trials found no benefit against
this outcome. Objective(s): Our objective was to evaluate the
evidence of levosimendan on mortality and secondary outcomes in patients
undergoing cardiac surgery, and to determine the sources of heterogeneity.
 Method(s): We conducted a systematic review and meta-analysis of the
clinical trials that evaluated the efficacy of levosimendan in patients
undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality
and other outcomes such as kidney injury with dialysis requirement and
LCOS, using fixed and random effects models. The risk of bias was assessed
and the sources of heterogeneity were explored. Result(s): Of 47
studies identified, 14 studies were selected (n=2752). Regarding the
mortality outcome and use of levosimendan, only a decrease was found in
the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While
high-quality studies, there was no protective effect (OR 0.99, 95% CI
0.70-1.40) with an I2 = 0%. The quality of the studies and
ejection fraction were the main sources of heterogeneity.
 Conclusion(s): In high-quality studies, the use of levosimendan in
patients undergoing cardiovascular surgery has no effect on 30-day
mortality. There was a protective effect on postoperative renal failure
with dialysis. Copyright © 2019 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.).

<22>
Accession Number
2007891817
Title
Implications of Alternative Definitions of Peri-Procedural Myocardial
Infarction After Coronary Revascularization.
Source
Journal of the American College of Cardiology. 76 (14) (pp 1609-1621),
2020. Date of Publication: 6 October 2020.
Author
Gregson J.; Stone G.W.; Ben-Yehuda O.; Redfors B.; Kandzari D.E.; Morice
M.-C.; Leon M.B.; Kosmidou I.; Lembo N.J.; Brown W.M.; Karmpaliotis D.;
Banning A.P.; Pomar J.; Sabate M.; Simonton C.A.; Dressler O.; Kappetein
A.P.; Sabik J.F.; Serruys P.W.; Pocock S.J.
Institution
(Gregson, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone, Ben-Yehuda, Redfors, Leon, Kosmidou, Lembo, Karmpaliotis,
Dressler) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Ben-Yehuda, Redfors, Leon, Kosmidou, Lembo, Karmpaliotis)
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center,
New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Kandzari, Brown) Piedmont Heart Institute, Atlanta, Georgia, United
States
(Morice) Ramsay Generale deSante, Hopital Prive Jacques Cartier, Massy,
France
(Banning) Oxford University Hospitals, Oxford, United Kingdom
(Pomar, Sabate) Hospital Clinic, Barcelona, Spain
(Simonton) PCICHUCK LLC, Charlotte, NC, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) National University of Ireland, Galway (NUIG), Galway, Ireland
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Varying definitions of procedural myocardial infarction (PMI)
are in widespread use. Objective(s): This study sought to determine
the rates and clinical relevance of PMI using different definitions in
patients with left main coronary artery disease randomized to percutaneous
coronary intervention (PCI) versus coronary artery bypass grafting (CABG)
surgery in the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial.
 Method(s): The pre-specified protocol definition of PMI
(PMI<inf>Prot</inf>) required a large elevation of creatine kinase-MB
(CK-MB), with identical threshold for both procedures. The Third Universal
Definition of MI (types 4a and 5) (PMI<inf>UD</inf>) required lesser
biomarker elevations but with supporting evidence of myocardial ischemia,
different after PCI and CABG. For the PMI<inf>UD</inf>, troponins were
used preferentially (available in 49.5% of patients), CK-MB otherwise. The
multivariable relationship between each PMI type and 5-year mortality was
determined. Result(s): PMI<inf>Prot</inf> occurred in 34 of 935
(3.6%) patients after PCI and 56 of 923 (6.1%) patients after CABG
(difference -2.4%; 95% confidence interval [CI]: -4.4% to -0.5%; p =
0.015). The corresponding rates of PMI<inf>UD</inf> were 37 (4.0%) and 20
(2.2%), respectively (difference 1.8%; 95% CI: 0.2% to 3.4%; p = 0.025).
Both PMI<inf>Prot</inf> and PMI<inf>UD</inf> were associated with 5-year
cardiovascular mortality (adjusted hazard ratio [HR]: 2.18 [95% CI: 1.13
to 4.23] and 2.87 [95% CI: 1.44 to 5.73], respectively).
PMI<inf>Prot</inf> was associated with a consistent hazard of
cardiovascular mortality after both PCI and CABG (p<inf>interaction</inf>
= 0.86). Conversely, PMI<inf>UD</inf> was strongly associated with
cardiovascular mortality after CABG (adjusted HR: 11.94; 95% CI: 4.84 to
29.47) but not after PCI (adjusted HR: 1.14; 95% CI: 0.35 to 3.67)
(p<inf>interaction</inf> = 0.004). Results were similar for all-cause
mortality and with varying PMI<inf>UD</inf> biomarker definitions. Only
large biomarker elevations (CK-MB >=10x upper reference limit and troponin
>=70x upper reference limit) were associated with mortality.
 Conclusion(s): The rates of PMI after PCI and CABG vary greatly with
different definitions. In the EXCEL trial, the pre-specified
PMI<inf>Prot</inf> was associated with similar hazard after PCI and CABG,
whereas PMI<inf>UD</inf> was strongly associated with mortality after CABG
but not after PCI. (EXCEL Clinical Trial [EXCEL];
NCT01205776) Copyright © 2020 American College of Cardiology
Foundation

<23>
Accession Number
2004547566
Title
Comparison of revascularization strategies in patients with acute coronary
syndrome and multivessel coronary disease: A systematic review and network
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 96 (4) (pp E447-E454),
2020. Date of Publication: 01 Oct 2020.
Author
Khan M.S.; Khan A.R.; Khan A.I.; Seo M.; Yasmin F.; Usman M.S.; Moustafa
A.; Schmid C.H.; Kalra A.; Ikram S.
Institution
(Khan, Moustafa) Department of Medicine, The Miriam Hospital and Warren
Alpert Medical School of Brown University, Providence, RI, United States
(Khan) Division of Cardiology, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Khan) Jamia Institute of Medical Sciences, Jamia University, New Delhi,
India
(Seo) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
(Yasmin, Usman) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Schmid) Department of Biostatistics, Brown University School of Public
Health, Providence, RI, United States
(Kalra) Division of Cardiology, Cleveland Clinic, Cleveland, OH, United
States
(Ikram) Division of Cardiovascular Medicine, University of Louisville
School of Medicine, Louisville, KY, United States
Publisher
John Wiley and Sons Inc (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail: info@wiley.com)
Abstract
Background: Whether revascularization should be performed as multivessel
intervention at the time of index procedure (MV-index), staged procedure
(MV-staged), or culprit only intervention (COI) in patients with
multivessel disease (MVD) presenting with acute coronary syndrome (ACS) is
unclear. We performed a systematic review and network meta-analysis of
randomized controlled trials to assess the optimal revascularization
strategy in this patient population. Method(s): PubMed, Embase, and
Cochrane Central databases were systematically searched to identify all
relevant studies. The outcomes assessed were major cardiac adverse events
(MACE), all-cause mortality, cardiovascular mortality, myocardial
infarction (MI), and revascularization. A Bayesian random-effects network
meta-analysis was used to calculate odds ratio (OR) with credible interval
(CrI). Result(s): Thirteen studies with 8,066 patients were included
in the analysis. There was a decreased risk of MACE (MV-index vs. COI: OR,
0.35; 95% CrI, 0.23-0.55; MV-staged vs COI: OR, 0.52; 95% CrI, 0.31-0.81)
and revascularization (MV-index vs. COI: OR, 0.27; 95% CrI, 0.15-0.49;
MV-staged vs. COI: OR, 0.38; 95% CrI, 0.19-0.70) with MV-index
intervention and MV-staged intervention compared with COI. However,
MV-index intervention and not MV-staged intervention was associated with a
decreased risk of MI (MV-index vs. COI: OR, 0.35; 95% CrI, 0.12-0.93;
MV-staged vs. COI: OR, 0.65; 95% CrI, 0.24-1.59) compared with COI.
 Conclusion(s): Our analysis suggests that multivessel intervention
either at index procedure or as staged intervention may be more
efficacious compared to COI in patients with MVD presenting with
ACS. Copyright © 2020 Wiley Periodicals, Inc.

<24>
Accession Number
631989764
Title
Cardiac structural changes after transcatheter aortic valve replacement:
Systematic review and meta-analysis of cardiovascular magnetic resonance
studies.
Source
Journal of Cardiovascular Magnetic Resonance. 22 (1) (no pagination),
2020. Article Number: 41. Date of Publication: 01 Jun 2020.
Author
Mehdipoor G.; Chen S.; Chatterjee S.; Torkian P.; Ben-Yehuda O.; Leon
M.B.; Stone G.W.; Prince M.R.
Institution
(Mehdipoor, Chen, Ben-Yehuda, Leon, Stone) Cardiovascular Research
Foundation, New York, NY, United States
(Chen, Ben-Yehuda, Leon) Department of Cardiology, Columbia University
College of Physicians and Surgeons, New York, NY, United States
(Chatterjee) Hoffman Heart Institute, Saint Francis Hospital, University
of Connecticut, Hartford, CT, United States
(Torkian) Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Prince) Department of Radiology, Weill Cornell Medical Collegeand New
York Presbyterian Hospital, 416 East 55th Street, New York, NY 10022,
United States
(Prince) Department of Radiology, Columbia University College of
Physicians and Surgeons, New York, NY, United States
Publisher
BioMed Central Ltd (United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is increasingly
used to treat patients with severe aortic stenosis (AS). Cardiovascular
magnetic resonance imaging (CMR) provides reliable and reproducible
estimates for assessment of cardiac structure and function after TAVR. The
goal of this study was to conduct a systematic review and meta-analysis of
the literature to assess left ventricular (LV) volumes, mass and function
by CMR after TAVR. Method(s): Using Meta-analysis of Observational
Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase
for studies reporting CMR findings before and at least 1 month after TAVR.
Main factors of interest were LV end-diastolic volume index (LVEDVi), LV
end-systolic volume index (LVESVi), LV mass index (LVMi), and left
ventricular ejection fraction (LVEF). Standardized mean differences (SMD)
were pooled by random effects meta-analytic techniques. Result(s): Of
453 screened publications, 10 studies (published between 2012 and 2018)
were included. A total of 305 patients completed pre- and post-TAVR
follow-up CMR (mean age range 78.6-85.0 years, follow-up range 6-15
months). Random effects analysis showed TAVR resulted in reduced LVEDVi
(SMD: -0.25, 95% CI: - 0.43 to - 0.07, P = 0.006), LVESVi (SMD: -0.24, 95%
CI: - 0.44 to - 0.05, P = 0.01), LVMi (SMD: -0.82, 95% CI: - 1.0 to -
0.63, P < 0.001) and increased LVEF (SMD: 22, 95% CI: 6 to 38%, P =
0.006). Heterogeneity across studies was low (I2: 0%, Pheterogeneity >
0.05 for all). The median reduction was 4 ml/m2 (IQR: 3.1 to 8.2) for
LVEDVi, 5 ml/m2 (IQR: 3.0 to 6.0) for LVESVi, and 15.1 g/m2 (IQR: 11.8 to
18.3) for LVMi. The median increase for LVEF was 3.4% (IQR 1.0 to 4.6%).
 Conclusion(s): CMR demonstrates reverse LV remodeling occurrs within
6-15 months after TAVR, with reductions in LVEDVi, LVESVi and LVMi, and
increased LVEF. Copyright © 2020 The Author(s).

<25>
Accession Number
631068940
Title
Does Bilateral Internal Mammary Artery Grafting Better Suit Patients With
Diabetes?- Two Different Ways to Explore Outcomes.
Source
Circulation journal : official journal of the Japanese Circulation
Society. 84 (3) (pp 436-444), 2020. Date of Publication: 25 Feb 2020.
Author
Wang C.; Li P.; Zhang F.; Kong Q.; Li J.
Institution
(Wang, Li, Zhang, Kong, Li) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University
Publisher
NLM (Medline)
Abstract
BACKGROUND: This analysis compared short-term mortality, sternal wound
infection (SWI), and long-term survival outcomes in diabetic patients who
underwent coronary artery bypass grafting (CABG) with bilateral (BIMA) vs.
single (SIMA) internal mammary artery, as well as in diabetic vs.
non-diabetic patients undergoing BIMA grafting.Methods and
Results:Nineteen studies were included in the study, covering 21,143
different patients. Of these patients, 6,464 underwent CABG with BIMA,
10,264 underwent CAGB with SIMA, 11,584 had diabetes, and 6,717 did not.
Compared with SIMA, BIMA had a significantly lower risk of in-hospital
mortality (odds ratio [OR] 0.73, P=0.02), but a significantly higher risk
of SWI (OR 1.30, P=0.04). However, compared with non-diabetic patients who
underwent CABG with BIMA, diabetic patients with BIMA grafting did not
have significantly higher risks of either mortality (OR 1.22, P=0.53) or
SWI (OR 1.10, P=0.72). No significant differences were detected with
different harvesting techniques. Longer term, BIMA was associated with a
significantly higher rate of survival than SIMA (hazard ratio [HR] 0.76,
P<0.001). CONCLUSION(S): Results from the 2 types of comparisons
indicate that BIMA is a preferable option for diabetic patients, even
though it has a higher risk of infection. CABG with BIMA is also
associated with a long-term survival benefit.

<26>
Accession Number
630803864
Title
Angiography- vs. physiology-guided complete revascularization in patients
with ST-elevation myocardial infarction and multivessel disease: who is
the better gatekeeper in this setting? A meta-analysis of randomized
controlled trials.
Source
European heart journal. Quality of care & clinical outcomes. 6 (3) (pp
199-200), 2020. Date of Publication: 01 Jul 2020.
Author
Gallone G.; Angelini F.; Fortuni F.; Gnecchi M.; De Filippo O.; Baldetti
L.; Giannini F.; Colombo A.; D'Ascenzo F.; De Ferrari G.M.
Institution
(Gallone, Angelini, De Filippo, D'Ascenzo, De Ferrari) Division of
Cardiology, Department of Internal Medicine, 10126 Turino, Citta della
Salute e della Scienza ,Corso Bramante 88/90, Italy
(Fortuni, Gnecchi) Coronary Care Unit, Laboratory of Clinical and
Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Fortuni, Gnecchi) Unit of Cardiology, Department of Molecular Medicine,
University of Pavia, Pavia, Italy
(Baldetti) Unit of Cardiovascular Interventions, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Giannini, Colombo) Interventional Cardiology Unit, GVM Care & Research
Maria Cecilia Hospital, Cotignola, Italy
Publisher
NLM (Medline)

<27>
Accession Number
626540941
Title
Ischemia and perioperative infarction.
Source
Colombian Journal of Anesthesiology. 46 (Supplement 2) (pp 39-45), 2018.
Date of Publication: 01 Mar 2018.
Author
Navarro-Vargas J.R.; Borrero L.M.G.
Institution
(Navarro-Vargas) School of Medicine, Universidad Nacional de Colombia,
Bogota, Colombia
(Navarro-Vargas) Hospital Universitario de Colombia, Universidad Nacional
de Colombia, Bogota, Colombia
(Borrero) Sindicato Antioqueno de Anestesiologia (Anestesiar), Medellin,
Colombia
(Navarro-Vargas) National Resuscitation Committee, Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.), Carrera 15a No. 120-74, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: revcolanest@scare.org.co)
Abstract
Introduction: Perioperative medicine has provided anesthetists with a
proactive role in the prevention of perioperative complications, in
particular cardiovascular events such as myocardial injury after
non-cardiac surgery. Objective(s): Using cardiovascular risk
concepts, pre-operative assessment for non-cardiac surgery, optimization
of the hemodynamic status, determination of differences between elective
and urgent patients, monitoring, close follow-up after surgery, and
measurements of ultrasensitive troponin in the first 48 hours
postoperatively, anesthetists are now able to identify and address early
clinical manifestations of perioperative ischemia and myocardial
infarction (MI) in patients at risk. Material(s) and Method(s):
Narrative review: Queries in various databases on perioperative ischemia
and non-fatal infarction in Pubmed, Science Direct, and Ovid.
 Result(s): The analysis of cardiac troponin levels is of the utmost
importance in the prognosis of perioperative MI. Diagnosis can be made
earlier, and it has been shown that the majority of these perioperative
events have their onset within the first 48 hours of the postoperative
period, when the physiological stress is highest in patients taken to
non-cardiac surgery. Copyright © 2018 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.). Published by Wolters Kluwer.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

<28>
Accession Number
633276925
Title
Simple intraoperative thromboelastography-guided transfusion algorithm
reduces blood product utilization in cardiac surgery: A randomized
controlled trial.
Source
Anaesthesia and Intensive Care. Conference: Australian and New Zealand
College of Anaesthetists Annual Scientific Meeting. Australia. 45 (5) (pp
642), 2017. Date of Publication: September 2017.
Author
Luk T.-H.; Tsui C.; Wong J.; So M.-C.; Ng S.-K.; Underwood M.; Gin T.
Institution
(Luk, Tsui, Wong, Ng, Gin) Department of Anaesthesia and Intensive Care,
Prince of Wales Hospital, Hong Kong
(So, Underwood) Division of Cardiothoracic Surgery, Chinese University of
Hong Kong, Hong Kong
Publisher
SAGE Publications Inc.
Abstract
Introduction: Clinician-determined hemostatic blood product administration
after cardiac surgery is often empirically guided, resulting in
unnecessary transfusions. Allogeneic transfusions, in turn, are
independently associated with morbidity and mortality. Transfusion
protocols using point-of-care tests such as thromboelastography (TEG) can
provide goal-directed hemostatic therapy and reduce transfusions; but
prior studies were limited by complex algorithms and mixed results.
Therefore, we examined the effects of a simple intraoperative TEG-guided
algorithm on blood product utilization and postoperative bleeding.
 Method(s): According to transfusion strategy, we prospectively
randomized 80 patients undergoing single or multiple valve surgery with or
without coronary artery bypass grafting into TEG-guided group (n=40) or
standard clinical practice i.e. according to clinical assessment and/or
laboratory test results (control group, n=40). In the TEG group, a
heparinase-modified, kaolin-activated TEG measured during rewarming phase
of cardiopulmonary bypass was used to guide intraoperative blood product
transfusion. A second set of TEG was performed after protamine and blood
product administration to evaluate the coagulation status of the patient
just before leaving the operating room. Result(s): Baseline
characteristics including medications, surgical complexity, bypass &
clamping times, and laboratory values were similar between groups.
Intraoperatively, the proportion of patients in the TEG-guided group
receiving blood product transfusions was less than that of controls (32.5%
vs 55.0%, p=0.04). Translating this into clinical practice, the number of
patients we need to treat with TEG-guided transfusion algorithm to prevent
one unit of allogeneic transfusion is 4.4. TEG-guided group received
significantly fewer median units of fresh frozen plasma, platelets and
total blood products as compared to control group (all p<0.05). For the
postoperative outcomes, there were no differences in blood loss as
measured by mediastinal drain output 3, 6, 12 hours postoperatively, as
well as surgical re-exploration rate. TEG group had a trend towards
shorter intensive care unit stay and less respiratory complications but
these results did not reach significance (p=0.10 and p=0.055
respectively). Furthermore, an analysis of second set TEG parameters
showed that longer R time of the second set TEG correlated with increased
early blood loss at 3 hours (r=0.26, p=0.03), postoperative packed cell
transfusion (r=0.37, p=0.002) and blood product usage (r=0.26, p=0.04).
Second set TEG parameters correlated significantly with abnormal
postoperative standard coagulation test values (R time & APTT [r=0.34,
p=0.005]; maximum amplitude & platelet count [r=0.39, p=0.002]).
 Conclusion(s): Using a routinely performed TEG measurement to guide
transfusions reduced blood product requirements in complex cardiac
surgery, without altering postoperative blood loss or re-exploration rate.
Our results also showed that TEG parameters correlated with postoperative
coagulation test values and predicted early blood loss, thus providing an
insight in the use of TEG to identify patients who will bleed more and
enable individualized hemostatic therapy. Adopting this clinically
applicable TEG algorithm can potentially decrease allogeneic
transfusion-related complications and hospital costs.

<29>
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.
 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.
 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%. 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.

<30>
Accession Number
2008415374
Title
Mortality in trials on transcatheter aortic valve implantation versus
surgical aortic valve replacement: A pooled meta-analysis of
Kaplan-Meier-derived individual patient data.
Source
European Journal of Cardio-thoracic Surgery. 58 (2) (pp 221-229), 2020.
Date of Publication: 01 Aug 2020.
Author
Barili F.; Freemantle N.; Casado A.P.; Rinaldi M.; Folliguet T.; Musumeci
F.; Gerosa G.; Parolari A.
Institution
(Barili, Casado) Department of Cardiac Surgery, S. Croce Hospital, Cuneo,
Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: This meta-analysis of Kaplan-Meier-estimated individual
patient data was designed to evaluate the effects of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on
the long-term all-cause mortality rate, to examine the potential
time-varying effect and to model their hazard ratios (HRs) over time.
Moreover, we sought to compare traditional meta-analytic tools and
estimated individual patient data meta-analyses. METHOD(S): Trials
comparing TAVI versus SAVR were identified through Medline, Embase,
Cochrane databases and specialist websites. The primary outcome was death
from any cause at follow-up. Enhanced secondary analyses of survival
curves were performed estimating individual patient time-to-event data
from published Kaplan-Meier curves. Treatments were compared with the
random effect Cox model in a landmark framework and fully parametric
models. RESULT(S): We identified 6 eligible trials that included 6367
participants, randomly assigned to undergo TAVI (3252) or SAVR (3115).
According to the landmark analysis, the incidence of death in the first
year after implantation was significantly lower in the TAVI group
[risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99;
P = 0.04], whereas there was a reversal of the HR after 40 months
(risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P = 0.04) favouring
SAVR over TAVI. This time-varying trend of HRs was also confirmed by a
fully parametric time-to-event model. Traditional meta-analytic tools were
shown to be biased because they did not intercept heterogeneity and the
time-varying effect. CONCLUSION(S): The mortality rates in trials of
TAVI versus SAVR are affected by treatments with a time-varying effect.
TAVI is related to better survival in the first months after implantation
whereas, after 40 months, it is a risk factor for all-cause
mortality. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<31>
Accession Number
2005017101
Title
Effectiveness of nursing intervention on early complications for patients
undergoing coronary catheterization.
Source
International Journal of Pharmaceutical Research. 12 (2) (pp 2271-2280),
2020. Date of Publication: April-June 2020.
Author
Mustafa M.A.A.-K.; Hassan H.S.
Institution
(Mustafa) Faculty of Nursing, University of Kufa, Iraq
(Hassan) Adult Health Nursing Department, University of Baghdad-College of
Nursing, Iraq
Publisher
Advanced Scientific Research
Abstract
Objective: To evaluate the early complications through utilization of
observation check list form to check (hematoma, bleeding, back pain,
urinary retention, and vasovagal stimulation post coronary angiography,
contrast reaction). Method(s): randomized clinical trial (RCT) was
conducted for patients' undergoing coronary catheterization at Al Najaf
Center for Cardiac Surgery and Cardiac Catheterization, the study has been
carried out during the period 2th September 2019 to
5th March 2020. The sample consisted of (100) patients has been
randomly divided into two groups of 50 patients each. The experimental
group consisted of 50 patients who are exposed to nursing interventions by
the researcher. The group, that who have not to exposed to nursing
interventions by the researcher, are considered the control group. The
instrument construction and consisted of three parts, (part I): the
socio-demographic characteristics and comprised of (8) items, (part II):
the clinical characteristics (part III): early complications' checklist
for patients undergoing coronary catheterization and comprised of (27)
items divided into (6) content areas (Hematoma, bleeding, back pain,
urinary discomfort, contrast reaction, vasovagal reaction) for each
patient. Result(s): The study results indicated that significant
difference between the period of measurements of hematoma, and vasovagal
reflex in the patients of experimental group (i.e. the patients return to
normal though out the period of measurements). While the results indicated
that significant difference between the period of measurements of
hematoma, back pain, urine discomfort, and vasovagal reflex in the
patients of control group (i.e. the patients deteriorated though out the
period of measurements). Conclusion(s): The study confirm that the
nursing intervention would be helpful to come up with a better nursing
guideline for managing patients' hematoma, back pain, and vasovagal reflex
after cardiac catheterization .Recommendations: Standardized nursing
procedures should be used to guide the nurses in dealing with patients
with coronary catheterization, and the standards bill of for such
practices should be created and presented to all ties in which such
practices are performed. Copyright © 2020, Advanced Scientific
Research. All rights reserved.

<32>
Accession Number
633173863
Title
Beta blockers versus calcium channel blockers for provocation of
vasospastic angina after drug-eluting stent implantation: A multicentre
prospective randomised trial.
Source
Open Heart. 7 (2) (no pagination), 2020. Article Number: e001406. Date of
Publication: 21 Oct 2020.
Author
Sawano M.; Katsuki T.; Kitai T.; Tamita K.; Obunai K.; Ikegami Y.; Yamane
T.; Ueda I.; Endo A.; Maekawa Y.; Kawamura A.; Fukuda K.; Kohsaka S.
Institution
(Sawano, Katsuki, Ueda, Fukuda, Kohsaka) Department of Cardiology, Keio
University, School of Medicine, Shinjuku-ku, Tokyo, Japan
(Sawano) Department of Cardiology, Tokyo Dental College, Ichikawa General
Hospital, Ichikawa, Japan
(Kitai, Yamane) Department of Cardiovascular Medicine, Kobe City Medical
Center, General Hospital, Kobe, Japan
(Tamita) Department of Cardiology, Nishinomiya Watanabe Cardiovascular
Center, Nishinomiya, Hyogo, Japan
(Obunai) Department of Cardiology, Tokyo Bay Urayasu, Ichikawa Medical
Center, Ichikawa, Japan
(Ikegami) Department of Cardiology, National Hospital, Organisation Tokyo
Medical Center, Meguro-ku, Tokyo, Japan
(Endo) Department of Cardiology, Saiseikai Central Hospital, Minato-ku,
Tokyo, Japan
(Maekawa) Division of Cardiology, Internal Medicine III, Hamamatsu
University, School of Medicine, Hamamatsu, Shizuoka, Japan
(Kawamura) Department of Cardiology, International University of Health
and Welfare, Faculty of Medicine, Graduate School of Medicine, Narita,
Chiba, Japan
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Background Drug-eluting stent-induced vasospastic angina (DES-VSA) has
emerged as a novel complication in the modern era of percutaneous coronary
intervention (PCI). Although beta blockers (BBs) are generally recommended
for coronary heart disease, they may promote incidence of DES-VSA. This
study aimed to compare the effects of calcium channel blockers (CCBs)
perceived to be protective against DES-VSA and BBs on subsequent coronary
events after second-generation drug-eluting stent implantation. Methods In
this multicentre prospective, randomised study, 52 patients with coronary
artery disease who underwent PCI for a single-vessel lesion with
everolimus-eluting stent placement were randomised into post-stenting BB
(N=26) and CCB (N=26) groups and followed for 24 months to detect any
major cardiovascular events (MACE). A positive result on acetylcholine
provocation testing during diagnostic coronary angiography (CAG) at 9
months was the primary endpoint for equivalence. MACE included all-cause
death, non-fatal myocardial infarction, unstable angina, cerebrovascular
disease or coronary revascularisation for stable coronary artery disease
after index PCI. Results At 9 months, 42 patients (80.8%) underwent
diagnostic coronary angiography and acetylcholine provocation testing.
Among them, seven patients in each group were diagnosed with definite
vasospasm (intention-to-treat analysis 26.9% vs 26.9%, risk difference 0
(-0.241, 0.241)). Meanwhile, the secondary endpoint, 24-month MACE, was
higher in the CCB group (19.2%) than in the BB group (3.8%) (p=0.01). In
detail, coronary revascularisation for stable coronary artery disease was
the predominant endpoint that contributed to the greater proportion of
MACE in the CCB group (CCB (19.2%) vs BB (3.8%), p=0.03). Conclusions The
incidence of acetylcholine-induced coronary artery spasms did not differ
between patients receiving BBs or CCBs at 9 months after PCI. However, a
higher incidence of 2-year MACE was observed in the CCB group, suggesting
the importance of BB administration. Trial registration number This study
was registered at the Japanese University Hospital Medical Information
Network (UMIN) Clinical Trial Registry (The Prospective Randomized Trial
for Optimizing Medical Therapy After Stenting: Calcium-Beta Trial;
UMIN000008321,
https://upload.umin.ac.jp/cgi-open-bin/ctr-e/ctr-view.cgi?recptno=R0000095
36). Copyright © Author(s) (or their employer(s)) 2020.

<33>
Accession Number
2008415379
Title
Intraoperative localization of cardiac conduction tissue regions using
real-time fibre-optic confocal microscopy: First in human trial.
Source
European Journal of Cardio-thoracic Surgery. 58 (2) (pp 261-268), 2020.
Date of Publication: 01 Aug 2020.
Author
Kaza A.K.; Mondal A.; Piekarski B.; Sachse F.B.; Hitchcock R.
Institution
(Kaza, Mondal, Piekarski) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
(Sachse, Hitchcock) Department of Biomedical Engineering, University of
Utah, Salt Lake City, UT, United States
(Sachse) Nora Eccles Harrison Cardiovascular Research and Training
Institute, University of Utah, Salt Lake City, UT, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of this study was to evaluate the feasibility and
safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium
dye for the intraoperative location of conduction tissue regions during
paediatric heart surgery. METHOD(S): The pilot study included 6
patients undergoing elective surgery for the closure of isolated secundum
atrial septal defect aged 30 days to 21 years. FCM imaging was integrated
within the normal intraoperative protocol for atrial septal defect repair.
Fluorescein sodium dye was applied on the arrested heart. FCM images were
acquired at the atrioventricular node region, sinus node region and right
ventricle (RV). Total imaging time was limited to 3 min. Any adverse
events related to the study were recorded and analysed. Subjects received
standard postoperative care. Trained reviewers (n = 9) classified,
de-identified and randomized FCM images (n = 60) recorded from the
patients as presenting striated, reticulated or indistinguishable
microstructures. The reliability of reviewer agreement was assessed using
Fleiss' kappa. RESULT(S): The FCM imaging instruments were integrated
effectively into the cardiac surgery operating room. All adverse events
found in the study were deemed expected and not related to FCM imaging.
Reticulated myocardial microstructures were found during FCM imaging at
atrioventricular node and sinus node regions, while striated
microstructures were observed in RV. Reliability of agreement of reviewers
classifying the FCM images was high (Fleiss' kappa: 0.822).
 CONCLUSION(S): FCM using fluorescein sodium dye was found to be safe
for use during paediatric heart surgery. The study demonstrates the
potential for FCM to be effective in identifying conduction tissue regions
during congenital heart surgery. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

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

<35>
Accession Number
2008414463
Title
Fibrinogen and fibrin degradation products' levels in cardiopulmonary
bypass with mild-hypothermia versus normothermia.
Source
Journal of Cellular and Molecular Anesthesia. 5 (3) (pp 157-163), 2020.
Date of Publication: July 2020.
Author
Ghasemzade B.; Ghodrati M.; Kachuian N.; Banakar Y.; Gorjipour F.; Zarei
A.A.; Zaree H.
Institution
(Ghasemzade) Department of Cardiac Surgery, Shahid Faghihi Hospital,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ghodrati) Department of Anesthesiology and Critical Care, Shahid Beheshti
Hospital, Qom University of Medical Sciences, Qom, Iran, Islamic Republic
of
(Kachuian) Department of Cardiac Surgery, Imam Hussein a.s. Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Banakar) MRI Hospital, Shiraz University of Medical Sciences, Shiraz,
Iran, Islamic Republic of
(Gorjipour) Department of Perfusion, Imam Hussein a.s. Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Zarei) Physiology Department, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Zaree) Department of Anesthesiology and Critical Care, Shahid Faghihi
hospital, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center (E-mail: contact@icdr.ac.ir)
Abstract
Background: Coagulation cascades are activated during Cardiopulmonary
Bypass (CPB) and their proper monitoring and maintenance determine the
outcomes of operation to a big extent. Here, we assessed serum fibrinogen
and Fibrin Degradation Products (FDP) in adult patients undergoing CABG
with using CPB, either with hypothermia or normothermia. Material(s)
and Method(s): In a cross-sectional study, 80 adult patients' candidate
for elective CABG were randomly assigned into two groups: hypothermia and
normothermia to assess fibrinogen and FDP, perioperatively.
 Result(s): Patients included 32 men (80%) in the hypothermia group
and 26 men (60%) in the normothermia with the mean age of 61.43 +/- 12.64
years. The mean temperature in the hypothermia group was 32.33 +/- 1.44
and 35.33 +/- 0.71 in the normothermic group. Differences in fibrinogen
levels between the two groups were not significant (Fib before CPB,
P=0.893, and Fib after declamping, P=0.057). The serum level of FDP before
and during CPB was not significantly different in hypothermia and
normothermia groups (P=0.412, P=0.778, respectively). Conclusion(s):
During cardiac surgery in hypothermia and normothermia conditions rate of
fibrinogen decreased 25% after declamping in each group; this decrease
seems to be due to hemodilution. FDP levels were similar in both
groups. Copyright © 2020 IOP Publishing Ltd

<36>
Accession Number
2008414462
Title
The effect of oral triiodothyronine in outcome of pediatric congenital
cardiac surgery.
Source
Journal of Cellular and Molecular Anesthesia. 5 (3) (pp 150-156), 2020.
Date of Publication: July 2020.
Author
Tehrani R.B.; Farzin A.O.; Fani K.; Heidarpour A.
Institution
(Tehrani, Farzin) Department of Cardiovascular Surgery, Shahid Modarres
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Fani) Anesthesiology Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Heidarpour) Obstetrician and Gynecologist, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center (E-mail: contact@icdr.ac.ir)
Abstract
Background: Cardiac surgery especially in small children is associated
with a marked decrease in thyroid hormone levels consistent with the
phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of
the present study was to determine if oral triiodothyronine could reduce
the length of ICU stay, vasoactive inotropic score (VIS), and promote
ejection fraction in infants and children undergoing cardiac surgery with
CPB. Material(s) and Method(s): In a double-blind clinical trial, one
hundred and twenty children aged 6 to 60 months and scheduled for
different types of cardiac surgery with CPB, were randomized into two
groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5%
dextrose water (placebo group), immediately after anesthesia and 24 hours
after surgery. The perioperative serum thyroid hormone levels and
hemodynamic variables were determined. The intubation time, ICU stay
length, ICU inotropic use, and cardiac ejection fraction was recorded.
 Result(s): The basic demographic data were comparable in two groups.
No significant side effects or adverse reactions were seen due to hormone
therapy. Intubation time, ICU stay, and VIS values were significantly
shorter between the two groups. Conclusion(s): In children undergoing
cardiac surgery with CPB, perioperative oral small-dose triiodothyronine
therapy could improve clinical indices of perioperative
care. Copyright © 2020 IOP Publishing Ltd

<37>
Accession Number
629385587
Title
Complex interaction of obesity, intentional weight loss and heart failure:
A systematic review and meta-analysis.
Source
Heart. 106 (1) (pp 58-68), 2020. Date of Publication: January 2020.
Author
Mahajan R.; Stokes M.; Elliott A.; Munawar D.A.; Khokhar K.B.;
Thiyagarajah A.; Hendriks J.; Linz D.; Gallagher C.; Kaye D.; Lau D.;
Sanders P.
Institution
(Mahajan, Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Centre for Heart Rhythm Disorders, University of
Adelaide, Adelaide, SA, Australia
(Mahajan) Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale,
SA, Australia
(Stokes, Elliott, Munawar, Khokhar, Thiyagarajah, Hendriks, Linz,
Gallagher, Lau, Sanders) Department of Cardiology, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Kaye) Heart Research, Baker IDI Heart and Diabetes Institute, Melbourne,
VIC, Australia
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Objective The aim of the meta-analysis was to determine the association of
obesity and heart failure (HF) and the cardiac impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obese subjects. Methods MEDLINE, Embase and Web of
Science were searched up to 3 April 2018. Studies reporting association
and prognostic impact of obesity in HF and the impact of intentional
weight loss following bariatric surgery on cardiac structure and
myocardial function in obesity were included in the meta-analysis. Results
4959 citations were reviewed. After exclusions, 29 studies were analysed.
A 'J curve' relationship was observed between body mass index (BMI) and
risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to
2.31), p<0.001, n=11). Although 'obesity paradox' was observed for
all-cause mortality, the overweight group was associated with lower
cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with
no significant differences across other BMI groups. Intentional weight
loss induced by bariatric surgery in obese patients (n=9) without
established HF, atrial fibrillation or known coronary artery disease, was
associated with a reduction in left ventricular mass index (p<0.0001),
improvement in left ventricular diastolic function (p<=0.0001) and a
reduction in left atrial size (p=0.02). Conclusions Despite the increased
risk of HF with obesity, an 'obesity paradox' is observed for all-cause
mortality. However, the nadir for CV mortality is observed in the
overweight group. Importantly, intentional weight loss was associated with
improvement in indices of cardiac structure and myocardial function in
obese patients. Trial registration number APP 74412. Copyright ©
Author(s) (or their employer(s)) 2020. No commercial re-use. See rights
and permissions. Published by BMJ.

<38>
Accession Number
627158451
Title
A meta-analysis of randomized controlled trials to compare long-term
clinical outcomes of bioabsorbable polymer and durable polymer
drug-eluting stents.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 5 (2) (pp
105-113), 2019. Date of Publication: April 2019.
Author
Mridha N.; Subhaharan D.; Niranjan S.; Rashid M.K.; Psaltis P.; Singh K.
Institution
(Mridha, Subhaharan, Niranjan, Singh) Department of Cardiology, Gold Coast
University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
(Mridha, Niranjan, Singh) Department of Medicine, Griffith University,
Parklands Dr, Southport, QLD 4215, Australia
(Mridha, Subhaharan, Niranjan, Singh) School of Medicine, Bond University,
14 University Dr, Robina, QLD 4226, Australia
(Rashid) Department of Medicine, Mc Master University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Psaltis, Singh) Department of Medicine, University of Adelaide, North
Terrace, Adelaide, SA 5000, Australia
(Psaltis) Department of Medicine, South Australian Health and Medical
Research Institute, North Terrace, Adelaide, SA 5000, Australia
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
Aims The durable polymer (DP) of a drug-eluting stent (DES) serves no
function once drug elution is complete. To ascertain the benefits of
bioabsorbable polymer (BP) over DP-DESs requires a longer follow-up
period, to overcome the time taken for polymer absorption. The primary aim
of this meta-analysis was to compare the safety and efficacy of BP-DES
with the DP-DES over mid (2 years) to long-term (3-5 years) follow-up.
Methods and results A thorough computer-based search was performed using
Ovid MEDLINE, EMBASE, Google Scholar, and PubMed databases. We only
included randomized controlled studies comparing clinical outcomes between
BP-DESs and DP-DESs. Only studies where data were available for a minimum
of 2 years were included. A separate analysis of 2-year outcomes and 3- to
5-year outcomes were conducted. Data from 6 and 8 studies were included in
3- to 5-year and 2-year follow-up, respectively. There were no differences
between stent groups in cardiac mortality, stent thrombosis (ST), target
lesion revascularization, target vessel failure, and reinfarction rates
for either 2-year or 3- to 5-year follow-up. Subgroup analysis according
to strut thickness (<100 mum, >100 mum) of BP-DES demonstrated similar
results. The analyses of ST and very late ST favoured BP-DESs but did not
reach statistically significant level. Conclusion There were no
differences in clinical outcomes between BP-DESs and DP-DESs over mid- and
long-term follow-up. Copyright © Published on behalf of the
European Society of Cardiology. All rights reserved.

<39>
Accession Number
602896003
Title
The impact of Peplau's therapeutic communication model on anxiety and
depression in patients candidate for coronary artery bypass.
Source
Clinical Practice and Epidemiology in Mental Health. 10 (1) (pp 159-165),
2014. Date of Publication: 2014.
Author
Zarea K.; Maghsoudi S.; Dashtebozorgi B.; Hghighizadeh M.H.; Javadi M.
Institution
(Zarea, Dashtebozorgi) Chronic Disease Care Research Center, Nursing and
Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran, Islamic Republic of
(Maghsoudi) Alzahra Heart Charity Hospital, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Hghighizadeh) School of Health, Ahvaz Jundishapur University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Javadi) Research Center for Nursing and Midwifery Care in Family Health,
School of Nursing and Midwifery, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
Publisher
Bentham Science Publishers
Abstract
Background and Objective: Anxiety and depression are among the
psychological disorders in heart surgeries. Establishing a simple
communication is essential to reduce anxiety and depression. Hence, the
objective of the present studywas to examine the impact of Peplau
therapeutic communication model on anxiety and depression in patients, who
were candidate for coronary artery bypass in Al-Zahra Heart Hospital,
Shiraz during 2012-2013. Method(s): This is a clinical trial in which
74 patients were randomly divided into intervention and control groups,
each consisted of 37 patients. Anxiety and depression levels were assessed
before, and two and four months after intervention using the Hospital
Anxiety and Depression Scale (HADS). Seven therapeutic communication
sessions were held in four stages. Data were analyzed with the SPSS
(version 16) using analysis of covariance. Result(s): The mean
anxiety and depression levels decreased in the intervention group after
the therapeutic communication (p<0.01). Anxiety scores in the intervention
group before and after intervention were 10.23 and 9.38, respectively.
While the corresponding scores in the control group were 10.26 and 11.62,
respectively. Depression scores in the intervention group before and after
intervention were 11 and 9.13, respectively. The corresponding scores in
the control group were 11.30 and 12.08, respectively. Conclusion(s):
The results demonstrated the positive role of therapeutic communication in
reducing anxiety and depression of the patients. Therefore, the
therapeutic communication is recommended as a simple, cost effective and
efficient method in this area. Copyright © Zarea et al.; Licensee
Bentham Open.

<40>
Accession Number
362920897
Title
Influenza vaccination reduced cardiovascular events in patients
hospitalized with an acute coronary syndrome.
Source
Annals of Internal Medicine. 155 (10) (pp JC5-5), 2011. Date of
Publication: 20111115.
Author
Phrommintikul A.; Kuanprasert S.; Wongcharoen W.
Institution
(Phrommintikul) Chiang Mai University, Chiang Mai, Thailand
Publisher
American College of Physicians

<41>
Accession Number
2006765591
Title
The Serratus Anterior Plane Study: Continuous Deep Serratus Anterior Plane
Block for Mitral Valve Surgery Performed in Right Minithoracotomy.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (11) (pp 2975-2982),
2020. Date of Publication: November 2020.
Author
Toscano A.; Capuano P.; Costamagna A.; Burzio C.; Ellena M.; Scala V.;
Pasero D.; Rinaldi M.; Brazzi L.
Institution
(Toscano, Capuano, Costamagna, Burzio, Ellena, Scala, Brazzi) Department
of Anesthesia and Critical Care, Citta della Salute e della Scienza di
Torino, University of Turin, Turin, Italy
(Pasero) Department of Medical, Surgical and Experimental Science,
University of Sassari, Sassari, Italy
(Rinaldi) Department of Cardiovascular and Thoracic Surgery, Citta della
Salute e della Scienza di Torino, University of Turin, Turin, Italy
Publisher
W.B. Saunders
Abstract
Objective: Regional anesthesia with thoracic wall blocks could represent
an opioid-sparing alternative for mitral valve surgery in right
minithoracotomy (mini-MVS). For the present study, an opioid-free
analgesia using continuous deep serratus anterior plane block was compared
with intravenous morphine. Design(s): Prospective, observational
cohort study. Setting(s): Azienda Ospedaliero Universitaria Citta
della Salute e della Scienza di Torino, University of Turin, Italy.
 Participant(s): The present study enrolled patients who underwent
mini-MVS from March to October 2019 (63 patients) and divided them into
the following 2 groups, according to pain control strategy: a morphine
group and a serratus anterior plane (SAP) group. Intervention(s):
Primary outcomes were pain evaluation and total postoperative opioid
consumption, and secondary outcomes were incidence of postoperative nausea
and vomiting, time to extubation, mechanical ventilation duration, and
bowel dysfunction. Measurements and Main Results: The mean number
rating scale at 24 hours was 2.15 (95% confidence interval [CI] 1.22-3.09)
in the SAP group versus 3.23 (95% CI 2.28-4.29) in the morphine group (p =
0.07), whereas the mean number rating scale at 48 hours was significantly
less in the SAP group compared with the morphine group (1.77 [95% CI
0.99-2.54] v 3.23 [95% CI 2.13-4.33], respectively; p = 0.03). Mean
morphine consumption at 48 postoperative hours was 12.98 mg (95% CI
10.90-15.05 mg) in the morphine group and 2.22 mg (95% CI 0.99-3.44 mg) in
the SAP group; p < 0.01. Cumulative morphine consumption at 24
postoperative hours was 10.44 mg (95% CI 8.36-12.52) in the morphine group
and 1.16 mg (95% CI 0.37-1.95) in the SAP group; p < 0.01. There were no
significant differences for secondary outcomes. Conclusion(s):
Continuous deep serratus anterior plane block seems to be a valid
alternative to intravenous opioids in terms of efficacy for patients
undergoing mini-MVS with a lower opioid requirement. Copyright ©
2020 Elsevier Inc.

<42>
Accession Number
2007063508
Title
Long-term follow-up of percutaneous coronary intervention versus coronary
artery bypass grafting in left main coronary artery disease: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Garg A.; Rout A.; Raheja H.; Hakeem H.; Sharma S.
Institution
(Garg, Sharma) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Rout) Division of Cardiology, Einstein Medical Center Philadelphia,
Philadelphia, PA, United States
(Raheja) Division of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Hakeem) Division of Cardiology, Newark Beth Israel Medical center,
Newark, NJ, United States
Publisher
John Wiley and Sons Inc (Postfach 10 11 61, 69451 Weinheim, Boschstrabe
12, 69469 Weinheim, Deutschland 69469, Germany. E-mail: info@wiley.com)
Abstract
Objectives: We conducted a systematic review and meta-analysis to evaluate
the long-term outcomes of PCI compared to CABG in patients with LMCAD.
 Background(s): Recent data from randomized controlled trials (RCTs)
has raised concerns regarding the long-term efficacy and safety of
percutaneous coronary intervention (PCI) compared with coronary artery
bypass grafting (CABG) in patients with left main coronary artery disease
(LMCAD). Method(s): We searched MEDLINE and EMBASE databases for
published RCTs comparing PCI using stenting with CABG in patients with
LMCAD. Preferred reporting items for systematic review and meta-analysis
guidelines were used for the present study. End-points of interest were
all-cause mortality, cardiovascular (CV) mortality, myocardial infarction
(MI), stroke, and repeat revascularization at longest available follow-up.
Relevant data were collected and pooled odds ratio (OR) with 95%
confidence intervals (CI) was calculated using random-effects model.
 Result(s): Five RCTs including a total of 4,499 patients were
included in the final analysis. Mean duration of follow-up was 96 months.
The risks of all-cause mortality [OR 1.09 (95% CI 0.88-1.34)] and
cardiovascular mortality [1.14 (0.88-1.47)] were comparable between PCI
and CABG. There were no statistically significant differences between PCI
and CABG for MI [1.52 (0.98-2.37)] and stroke [0.84 (0.48-1.45)].
Conversely, repeat revascularization was significantly higher with PCI as
compared with CABG [1.82 (1.49-2.22)]. Conclusion(s): At long-term
follow-up, PCI is associated with similar risks of mortality but a higher
risk of repeat revascularization compared with CABG in LMCAD. Long-term
risk of MI with PCI compared to CABG needs to be further explored in
future studies. Copyright © 2020 Wiley Periodicals LLC

<43>
Accession Number
2006052978
Title
Clopidogrel drug interactions: a review of the evidence and clinical
implications.
Source
Expert Opinion on Drug Metabolism and Toxicology. 16 (11) (pp 1079-1096),
2020. Date of Publication: 01 Nov 2020.
Author
Lee C.H.; Franchi F.; Angiolillo D.J.
Institution
(Lee, Franchi, Angiolillo) Division of Cardiology, University of Florida
College of Medicine-Jacksonville, Jacksonville, FL, United States
(Lee) Division of Cardiology, Department of Internal Medicine, Veterans
Health Service Medical Center, Seoul, South Korea
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Introduction: Patients with cardiovascular disease are commonly affected
by a number of comorbidities leading to a high prevalence of polypharmacy.
Polypharmacy increases the probability of drug-drug interactions (DDIs).
Amongst these, DDIs involving clopidogrel, the most commonly utilized
platelet P2Y<inf>12</inf> inhibitor, is a topic of potential clinical
concern. Areas covered: This article reviews DDIs between clopidogrel and
drugs which are widely used in clinical practice. In particular, drugs
shown to interfere with the pharmacodynamic and pharmacokinetic effects of
clopidogrel and the clinical implications of these findings are reviewed.
These drugs include inhibitors of gastric acid secretion, statins, calcium
channel blockers, antidiabetic agents, and antimicrobial agents. For the
references, we searched PubMed, EMBASE, or the Cochrane Library. Expert
opinion: Clopidogrel-drug interactions are common. Most of these DDIs are
limited to laboratory findings showing an impact on clopidogrel-induced
antiplatelet effects. While variability in clopidogrel-induced
antiplatelet effects is known to affect clinical outcomes, with high
platelet reactivity being associated with thrombotic complications among
patients undergoing coronary stenting, most studies assessing the clinical
implications of clopidogrel-drug interactions have not shown to
significantly affect outcomes. However, awareness of these DDIs remains
important for optimizing the selection of concomitant
therapies. Copyright © 2020 Informa UK Limited, trading as Taylor
& Francis Group.

<44>
Accession Number
2005489713
Title
Clinical outcomes and serologic response in solid organ transplant
recipients with COVID-19: A case series from the United States.
Source
American Journal of Transplantation. 20 (11) (pp 3225-3233), 2020. Date of
Publication: 01 Nov 2020.
Author
Fung M.; Chiu C.Y.; DeVoe C.; Doernberg S.B.; Schwartz B.S.; Langelier C.;
Henrich T.J.; Yokoe D.; Davis J.; Hays S.R.; Chandran S.; Kukreja J.; Ng
D.; Prostko J.; Taylor R.; Reyes K.; Bainbridge E.; Bond A.; Chin-Hong P.;
Babik J.M.
Institution
(Fung, Chiu, DeVoe, Doernberg, Schwartz, Langelier, Henrich, Yokoe, Davis,
Bainbridge, Bond, Chin-Hong, Babik) Division of Infectious Disease,
Department of Medicine, University of California San Francisco, San
Francisco, CA, United States
(Chiu, Ng, Reyes) Department of Laboratory Medicine, University of
California, San Francisco, CA, United States
(Chiu) UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco,
CA, United States
(Langelier) Chan Zuckerberg Biohub, San Francisco, CA, United States
(Henrich) Division of Experimental Medicine, University of California San
Francisco, San Francisco, CA, United States
(Hays) Division of Pulmonary, Critical Care, Allergy and Sleep Medicine,
Department of Medicine, University of California San Francisco, San
Francisco, CA, United States
(Chandran) Division of Nephrology, Department of Medicine, University of
California San Francisco, San Francisco, CA, United States
(Kukreja) Division of Adult Cardiothoracic Surgery, Department of Surgery,
University of California San Francisco, San Francisco, CA, United States
(Prostko, Taylor) Abbott Laboratories, Inc, Abbott Park, IL, United States
Publisher
Blackwell Publishing Ltd (E-mail: info@royensoc.co.uk)
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by SARS
coronavirus 2 (SARS-CoV-2) has caused significant morbidity and mortality
for patients and stressed healthcare systems worldwide. The clinical
features, disease course, and serologic response of COVID-19 among
immunosuppressed patients such as solid organ transplant (SOT) recipients,
who are at presumed risk for more severe disease, are not well
characterized. We describe our institutional experience with COVID-19
among 10 SOT patients, including the clinical presentation, treatment
modalities, and outcomes of 7 renal transplant recipients, 1 liver
transplant recipient, 1 heart transplant recipient, and 1 lung transplant
recipient. In addition, we report the serologic response in SOT
recipients, documenting a positive IgG response in all 7 hospitalized
patients. We also review the existing literature on COVID-19 in SOT
recipients to consolidate the current knowledge on COVID-19 in the SOT
population for the transplant community. Copyright © 2020 The
American Society of Transplantation and the American Society of Transplant
Surgeons

<45>
Accession Number
2005126876
Title
Comparison of Anticoagulants for Postoperative Atrial Fibrillation After
Coronary Artery Bypass Grafting: A Pilot Study.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 25 (6) (pp
523-530), 2020. Date of Publication: 01 Nov 2020.
Author
Chapin T.W.; Leedahl D.D.; Brown A.B.; Pasek A.M.; Sand M.G.; Loy M.L.;
Dyke C.M.
Institution
(Chapin, Leedahl) Pharmacy Services, Sanford Health, Fargo, ND, United
States
(Brown, Pasek, Sand, Dyke) University of North, Dakota School of Medicine
and Health Sciences, Grand Forks, ND, United States
(Loy) Pharmacy Services, Essentia Health, Fargo, ND, United States
(Dyke) Cardiothoracic Surgery, Sanford Health, Fargo, ND, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Direct-acting oral anticoagulants are indicated for the
treatment of nonvalvular atrial fibrillation, but their use in patients
after undergoing cardiac surgery is poorly defined despite a high
prevalence of postoperative atrial fibrillation in this population.
 Method(s): Patients diagnosed with postoperative atrial fibrillation
were prospectively randomized to warfarin or apixaban. Safety, efficacy,
and economic outcomes were evaluated until their 4- to 6-week
postoperative appointment. Result(s): While this pilot study was not
powered to determine a difference in safety or efficacy, adverse event
rates were similar to the published literature. It was noted that a
patient's course of therapy when utilizing apixaban was significantly less
costly than warfarin when including medication, bridging, and laboratory
expenses. Conclusion(s): Apixaban and warfarin both appeared to be
safe and effective for anticoagulation throughout the duration of this
pilot study in treating postoperative atrial fibrillation after coronary
artery bypass grafting. Apixaban was associated with significantly less
expense when bridging and monitoring costs were included in addition to
medication expense. Copyright © The Author(s) 2020.

<46>
Accession Number
633263453
Title
Prevention and treatment of pulmonary congestion in patients undergoing
venoarterial extracorporeal membrane oxygenation for cardiogenic shock.
Source
European heart journal. 41 (38) (pp 3753-3761), 2020. Date of Publication:
07 Oct 2020.
Author
Lusebrink E.; Kupka D.; Scherer C.; Hagl C.; Zimmer S.; Luedike P.; Thiele
H.; Westermann D.; Massberg S.; Schafer A.; Orban M.
Institution
(Lusebrink, Orban, Kupka, Scherer, Massberg, Orban) Intensive Care Unit,
Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen,
Marchioninistrase 15, Munich 81377, Germany
(Lusebrink, Orban, Kupka, Scherer, Massberg, Orban) DZHK (German Center
for Cardiovascular Research), Medizinische Klinik und Poliklinik I,
Klinikum der Universitat Munchen, partner site Munich Heart
AllianceMarchioninistrase 15, Munich 81377, Germany
(Hagl) Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat
Munchen, Marchioninistrase 15, Munich 81377, Germany
(Zimmer) Medizinische Klinik und Poliklinik II, Universitatsklinikum Bonn,
Sigmund-Freud-Strase 25, Bonn 53127, Germany
(Luedike) Department of Cardiology and Vascular Medicine, West German
Heart and Vascular Center, University Hospital Essen, Hufelandstrase 55,
Essen 45122, Germany
(Thiele) Heart Center Leipzig at University of Leipzig, Department of
Internal Medicine/Cardiology, Leipzig Heart Institute, Strumpellstrase 39,
Leipzig 04289, Germany
(Westermann) Klinik fur Allgemeine und Interventionelle Kardiologie,
Universitatsklinikum Hamburg-Eppendorf, Martinistrase 52, Hamburg 20251,
Germany
(Schafer) Klinik fur Kardiologie und Angiologie, Medizinische Hochschule
Hannover ,Carl-Neuberg-Strase 1, Hannover 30625, Germany
Publisher
NLM (Medline)
Abstract
Cardiogenic shock is still a major driver of mortality on intensive care
units and complicates ~10% of acute coronary syndromes with contemporary
mortality rates up to 50%. In the meantime, percutaneous circulatory
support devices, in particular venoarterial extracorporeal membrane
oxygenation (VA-ECMO), have emerged as an established salvage intervention
for patients in cardiogenic shock. Venoarterial extracorporeal membrane
oxygenation provides temporary circulatory support until other treatments
are effective and enables recovery or serves as a bridge to ventricular
assist devices, heart transplantation, or decision-making. In this
critical care perspective, we provide a concise overview of VA-ECMO
utilization in cardiogenic shock, considering rationale, critical care
management, as well as weaning aspects. We supplement previous literature
by focusing on therapeutic issues related to the vicious circle of
retrograde aortic VA-ECMO flow, increased left ventricular (LV) afterload,
insufficient LV unloading, and severe pulmonary congestion limiting
prognosis in a relevant proportion of patients receiving VA-ECMO
treatment. We will outline different modifications in percutaneous
mechanical circulatory support to meet this challenge. Besides a strategy
of running ECMO at lowest possible flow rates, novel therapeutic options
including the combination of VA-ECMO with percutaneous microaxial pumps or
implementation of a venoarteriovenous-ECMO configuration based on an
additional venous cannula supplying towards pulmonary circulation are most
promising among LV unloading and venting strategies. The latter may even
combine the advantages of venovenous and venoarterial ECMO therapy,
providing potent respiratory and circulatory support at the same time.
However, whether VA-ECMO can reduce mortality has to be evaluated in the
urgently needed, ongoing prospective randomized studies EURO-SHOCK
(NCT03813134), ANCHOR (NCT04184635), and ECLS-SHOCK (NCT03637205). These
studies will provide the opportunity to investigate indication, mode, and
effect of LV unloading in dedicated sub-analyses. In future, the Heart
Teams should aim at conducting a dedicated randomized trial comparing
VA-ECMO support with vs. without LV unloading strategies in patients with
cardiogenic shock. Copyright Published on behalf of the European
Society of Cardiology. All rights reserved. © The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

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

<48>
Accession Number
631867997
Title
Efficacy of Evolocumab on Cardiovascular Outcomes in Patients with Recent
Myocardial Infarction: A Prespecified Secondary Analysis from the FOURIER
Trial.
Source
JAMA Cardiology. 5 (8) (pp 952-957), 2020. Date of Publication: August
2020.
Author
Gencer B.; MacH F.; Murphy S.A.; De Ferrari G.M.; Huber K.; Lewis B.S.;
Ferreira J.; Kurtz C.E.; Wang H.; Honarpour N.; Keech A.C.; Sever P.S.;
Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Gencer, Murphy, Sabatine, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, 60 Fenwood Rd, Hale Building, Boston, MA 02115, United States
(Gencer, MacH) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(De Ferrari) Division of Cardiology Citta della Salute e della Scienza,
Department of Medical Sciences, University of Torino, Turin, Italy
(Huber) Department of Medicine, Cardiology and Intensive Care Medicine and
Sigmund, Freud University, Medical School, Vienna, Austria
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ferreira) Hospital de Santa Cruz, Lisbon, Portugal
(Kurtz, Wang, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Publisher
American Medical Association (E-mail: shirley.martin@ama-assn.org)
Abstract
Importance: The 2018 American Heart Association/American College of
Cardiology Multisociety Guideline on the Management of Blood Cholesterol
identified patients with recent (past 12 months) myocardial infarction
(MI) as very high risk, in whom a PCSK9 inhibitor is reasonable to add to
maximally tolerated statin combined with ezetimibe if their low-density
lipoprotein cholesterol level is 70 mg/dL or greater or non-high-density
lipoprotein cholesterol level is 100 mg/dL or greater. Objective(s):
To examine the clinical efficacy of evolocumab in patients with recent MI.
 Design, Setting, and Participant(s): This was a prespecified
secondary analysis of the Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, in which
27 564 patients with atherosclerotic cardiovascular disease treated with a
statin were randomized to evolocumab vs placebo. Patients with prior MI
with a known date (n = 22320) were stratified as having a recent MI
(within 12 months of randomization) or a remote MI (more than 12 months
prior to randomization). Per protocol, patients with MI within 4 weeks
prior to randomization were excluded from the FOURIER trial. Data were
collected from February 2013 to November 2016, and data were analyzed from
May 2019 to February 2020. Main Outcomes and Measures: The primary
composite end point was cardiovascular death, MI, stroke, hospitalization
for unstable angina, or coronary revascularization. The key secondary
composite end point was cardiovascular death, MI, or stroke.
 Result(s): Of 22320 included patients, 17516 (78.5%) were male, and
the mean (SD) age was 62.2 (9.0) years. Compared with 16609 patients with
a remote MI, 5711 patients with a recent MI were younger and more likely
to be treated with high-intensity statin (77.3% [4415] vs 69.3% [11506]).
In the placebo arm, the 3-year Kaplan-Meier rate for the primary end point
was 17.2% in patients with recent MI compared with 14.4% in those with
remote MI (adjusted HR, 1.45; 95% CI, 1.29-1.64; P <.001). Similarly, the
3-year Kaplan-Meier rates for the key secondary end point was also higher
in those with recent MI (10.9% vs 9.5%; adjusted HR, 1.45; 95% CI,
1.24-1.69; P <.001). In patients with a recent MI, evolocumab reduced the
risk of the primary and key secondary end points by 19% (hazard ratio
[HR], 0.81; 95% CI, 0.70-0.93) and 25% (HR, 0.75; 95% CI, 0.62-0.91),
respectively. In patients with a remote MI, evolocumab reduced the risk of
the primary and key secondary end points by 8% (HR, 0.92; 95% CI,
0.84-1.01; P for interaction =.13) and 15% (HR, 0.85; 95% CI, 0.76-0.96; P
for interaction =.24), respectively. Given the higher event rates in
patients with a recent MI, the absolute risk reductions over 3 years with
evolocumab were 3.7% in those with recent MI vs 1.1% in those with remote
MI for the primary end point and 3.2% vs 1.3%, respectively, for the key
secondary end point. Conclusions and Relevance: Patients with a
recent MI were at higher risk of cardiovascular events and tended to
experience greater absolute risk reductions with evolocumab than those
with remote MIs. These findings support the concept in US and European
guidelines to aggressively lower low-density lipoprotein cholesterol
levels in very high-risk patients, such as those with a recent MI. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633. Copyright
© 2020 American Medical Association. All rights reserved.

<49>
Accession Number
2008415173
Title
Mechanistic insights into the superior clinical efficacy of prasugrel over
ticagrelor.
Source
European Heart Journal. 41 (33) (pp 3153-3155), 2020. Date of Publication:
01 Sep 2020.
Author
Schupke S.; Kastrati A.
Institution
(Schupke, Kastrati) ISAResearch Center, Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Schupke, Kastrati) DZHK, Partner Site Munich Heart Alliance, Munich,
Germany
Publisher
Oxford University Press (E-mail: jnls.cust.serv@oupjournals.org)
Abstract
This editorial refers to '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'+, by B.
Schnorbus et al., on page 3144. Copyright Published on behalf of the
European Society of Cardiology. All rights reserved. © The Author(s)
2020.

<50>
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 (E-mail: jnls.cust.serv@oupjournals.org)
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. Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. © The Author(s) 2020.

<51>
Accession Number
633270737
Title
Different physiotherapy protocols after coronary artery bypass graft
surgery: A randomized controlled trial.
Source
Physiotherapy research international : the journal for researchers and
clinicians in physical therapy. (pp e1882), 2020. Date of Publication: 25
Oct 2020.
Author
Ribeiro B.C.; Poca J.J.G.D.; Rocha A.M.C.; Cunha C.N.S.D.; Cunha K.D.C.;
Falcao L.F.M.; Torres D.D.C.; Rocha L.S.O.; Rocha R.S.B.
Institution
(Ribeiro, Poca, Rocha, Cunha, Cunha, Falcao, Rocha) Biological and Health
Sciences Center, Para State University, Belem, Brazil
(Torres) State Public Foundation Gaspar Vianna Clinical Hospital, Belem,
Brazil
(Rocha) Universitary Center of Para, Belem, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND AND PURPOSE: The aim of this study was to investigate the
influence of different physiotherapy protocols on heart rate variability
(HRV) and hospital length of stay in older adults undergoing coronary
artery bypass graft (CABG). METHOD(S): Randomized controlled trial
with allocation and researcher blinding and intention-to-treat analysis.
Forty-eight patients undergoing CABG were randomly assigned to a control
group (CG), early mobilization group (EMG), or virtual reality group
(VRG). CG performed respiratory physiotherapy and metabolic exercises, the
EMG performed cycle ergometer exercises and ambulation, and the VRG
performed the same activities as the EMG, with the addition of two
Nintendo Wii games during 3 postoperative days. The variables of heart
rate variability on preoperative and fourth postoperative day, and time of
discharge of hospital was analyzed. RESULT(S): The VRG presented a
shorter hospital length of stay (p = 0.03). The CG showed a decline in HRV
from the preoperative period to fourth postoperative day on square root of
the mean of the squared differences between successive RR intervals (33.18
+/- 9.89-9.74 +/- 6.88, p < 0.05), standard deviation of all RR intervals
(25.48 +/- 7.50-15.23 +/- 11.27, p < 0.05), and dispersion of points
perpendicular to identity line (28.26 +/- 21.6-2.73 +/- 1.31, p < 0.05).
The EMG and VRG presented a higher cardiac autonomic modulation compared
to the CG (p < 0.05), with improved parasympathetic activity.
 CONCLUSION(S): Different protocols of physiotherapy intervention
affected autonomic modulation of the heart rate and hospital length of
stay in patients undergoing CABG. Copyright © 2020 John Wiley &
Sons Ltd.

<52>
[Use Link to view the full text]
Accession Number
633265261
Title
General Versus Local Anesthesia with Conscious Sedation in Transcatheter
Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial.
Source
Circulation. (pp 1437-1447), 2020. Date of Publication: 2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Lurz P.;
Eitel I.; Marquetand C.; Nef H.; Doerr O.; Vigelius-Rauch U.; Lauten A.;
Landmesser U.; Treskatsch S.; Abdel-Wahab M.; Sandri M.; Holzhey D.;
Borger M.; Ender J.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.; Fach
A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.; Funkat
A.-K.; Desch S.; Berggreen A.E.; Heringlake M.; De Waha-Thiele S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri,
Holzhey, Borger, Ender, Desch) Heart Center Leipzig at University of
Leipzig, Germany
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri,
Holzhey, Borger, Ender, Ruckert, Funkat, Desch) Leipzig Heart Institute,
Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, Berggreen, Heringlake, De
Waha-Thiele) University Clinic Schleswig-Holstein, University Heart Center
Lubeck, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Frey, Konig,
Desch, De Waha-Thiele) German Center for Cardiovascular Research (DZHK),
Germany
(Nef, Doerr, Vigelius-Rauch) Universitatsklinikum Marburg/Giesen, Giesen,
Germany
(Lauten, Landmesser, Treskatsch) Universitatsklinikum Charite, Campus
Benjamin Franklin, Berlin, Germany
(Ince, Oner) Universitatsklinikum Rostock, Germany
(Hambrecht, Fach, Augenstein) Klinikum Links der Weser, Bremen, Germany
(Frey) University Clinic Schleswig-Holstein, Kiel, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
University of Lubeck, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
Background: In clinical practice, local anesthesia with conscious sedation
(CS) is performed in roughly 50% of patients undergoing transcatheter
aortic valve replacement. However, no randomized data assessing the safety
and efficacy of CS versus general anesthesia (GA) are available.
 Method(s): The SOLVE-TAVI (Comparison of Second-Generation
Self-Expandable Versus Balloon-Expandable Valves and General Versus Local
Anesthesia in Transcatheter Aortic Valve Implantation) trial is a
multicenter, open-label, 2x2 factorial, randomized trial of 447 patients
with aortic stenosis undergoing transfemoral transcatheter aortic valve
replacement comparing CS versus GA. The primary efficacy end point was
powered for equivalence (equivalence margin 10% with significance level
0.05) and consisted of the composite of all-cause mortality, stroke,
myocardial infarction, infection requiring antibiotic treatment, and acute
kidney injury at 30 days. Result(s): The primary composite end point
occurred in 27.2% of CS and 26.4% of GA patients (rate difference, 0.8
[90% CI, -6.2 to 7.8]; P<inf>equivalence</inf>=0.015). Event rates for the
individual components were as follows: all-cause mortality, 3.2% versus
2.3% (rate difference, 1.0 [90% CI, -2.9 to 4.8];
P<inf>equivalence</inf><0.001); stroke, 2.4% versus 2.8% (rate difference,
-0.4 [90% CI, -3.8 to 3.8]; P<inf>equivalence</inf><0.001); myocardial
infarction, 0.5% versus 0.0% (rate difference, 0.5 [90% CI, -3.0 to 3.9];
P<inf>equivalence</inf><0.001), infection requiring antibiotics 21.1%
versus 22.0% (rate difference, -0.9 [90% CI, -7.5 to 5.7];
P<inf>equivalence</inf>=0.011); acute kidney injury, 9.0% versus 9.2%
(rate difference, -0.2 [90% CI, -5.2 to 4.8];
P<inf>equivalence</inf>=0.0005). There was a lower need for inotropes or
vasopressors with CS (62.8%) versus GA (97.3%; rate difference, -34.4 [90%
CI, -41.0 to -27.8]). Conclusion(s): Among patients with aortic
stenosis undergoing transfemoral transcatheter aortic valve replacement,
use of CS compared with GA resulted in similar outcomes for the primary
efficacy end point. These findings suggest that CS can be safely applied
for transcatheter aortic valve replacement. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT02737150. Copyright © 2020 Lippincott Williams and Wilkins.
All rights reserved.

<53>
Accession Number
364898500
Title
Efficacy of an intravenous bolus of morphine 2.5 versus morphine 7.5 mg
for procedural pain relief in postoperative cardiothoracic patients in the
intensive care unit: A randomised double-blind controlled trial.
Source
Anaesthesia and Intensive Care. 40 (3) (pp 417-426), 2012. Date of
Publication: May 2012.
Author
Ahlers S.J.G.M.; Van Gulik L.; Van Dongen E.P.A.; Bruins P.; Van De Garde
E.M.W.; Van Boven W.J.; Tibboel D.; Knibbe C.A.J.
Institution
(Van Gulik, Van Dongen, Bruins) Department of Anaesthesiology, Intensive
Care and Pain Management, Netherlands
(Ahlers, Van De Garde, Knibbe) Department of Clinical Pharmacy, St.
Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands
(Van Boven) Department of Cardiothoracic Surgery, Netherlands
(Tibboel) Intensive Care and Department of Pediatric Surgery, Erasmus
Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
Publisher
Australian Society of Anaesthetists (United States. E-mail:
claims@sagepub.com)
Abstract
As pain in the intensive care unit (ICU) is still common despite important
progress in pain management, we studied the efficacy of an intravenous
bolus of morphine 2.5 vs 7.5 mg for procedural pain relief in patients
after cardiothoracic surgery in the ICU. In a prospective double-blind
randomised study, 117 ICU patients after cardiothoracic surgery were
included. All patients were treated according a pain titration protocol
for pain at rest, consisting of continuous morphine infusions and
paracetamol, applied during the entire ICU stay. On the first
postoperative day, patients were randomised to intravenous morphine 2.5
(n=59) or 7.5 mg (n=58) 30 minutes before a painful intervention (turning
of patient and/or chest drain removal). Pain scores using the numeric
rating scale (Numeric Rating Scale, range 0 to 10) were rated at rest
(baseline) and around the painful procedure. At rest (baseline), overall
incidence of unacceptable pain (Numeric Rating Scale >=4) was low (Numeric
Rating Scale >4; 14 vs 17%, P=0.81) for patients allocated to morphine 2.5
and 7.5 mg respectively. For procedure-related pain, there was no
difference in incidence of unacceptable pain (28 vs 22%, P=0.53) mean pain
scores (2.6 [95% confidence interval 2.0 to 3.2] vs 2.7 [95% confidence
interval 2.0 to 3.4]) between patients receiving morphine 2.5 and 7.5 mg
respectively. In intensive care patients after cardiothoracic surgery with
low pain levels for pain at rest, there was no difference in efficacy
between intravenous morphine 2.5 mg or morphine 7.5 mg for pain relief
during a painful intervention.

<54>
Accession Number
361866737
Title
Myocardial injury in remifentanil-based anaesthesia for off-pump coronary
artery bypass surgery: An equipotent dose of sevoflurane versus propofol.
Source
Anaesthesia and Intensive Care. 39 (3) (pp 418-425), 2011. Date of
Publication: May 2011.
Author
Kim T.-Y.; Kim D.-K.; Yoon T.-G.; Lim J.-A.; Woo N.-S.; Chee H.-K.; Shin
J.-K.; Song M.-G.; Kim S.-H.
Institution
(Kim, Kim, Yoon, Lim, Woo, Chee, Shin, Song, Kim) Department of
Anaesthesiology and Pain Medicine, Konkuk University School of Medicine,
Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea
(Chee) Department of Cardiovascular and Thoracic Surgery, South Korea
(Kim) Department of Anaesthesiology, South Korea
Publisher
Australian Society of Anaesthetists (United States. E-mail:
claims@sagepub.com)
Abstract
This randomised controlled trial compared the effect of equipotent
anaesthetic doses of sevoflurane (S group) versus propofol (P group),
during remifentanil-based anaesthesia for off-pump coronary artery bypass
surgery, on myocardial injury. Either sevoflurane or propofol was titrated
to maintain bispectral index values between 40 and 50. In both groups, a
targeted concentration of remifentanil 20 ng.ml-1 was
maintained during anaesthesia. The concentrations of creatine kinase MB
and troponin I were measured before the start of surgery, on admission to
the intensive care unit, and at 12 and 24 hours after intensive care unit
admission. The postoperative values of creatine kinase MB (S group:
15.08+/-18.97, 20.78+/-20.92, 12.76+/-12.82 vs 2.09+/-1.54
ng.ml-1; P group: 10.99+/-13.15, 27.16+/-56.55, 11.88+/-18.80
vs 1.84+/-1.67 ng.ml-1) and troponin I (S group: 3.56+/-5.19,
5.66+/-7.89, 3.35+/-4.55 vs 0.52+/-1.90 ng.ml-1; P group:
2.42+/-3.33, 4.11+/-6.01, 3.04+/-5.31 vs 0.43+/-1.28 ng.ml-1)
were significantly higher than preoperative values in both groups but
there were no significant differences between the two groups. There were
no significant differences in time to extubation (S group, 476+/-284
minutes; P group, 450+/-268 minutes) and intensive care unit length of
stay (S group, 2775+/-1449 minutes; P group, 2797+/-1534 minutes) between
the two groups. In conclusion, sevoflurane and propofol at equipotent
doses guided by bispectral index with remifentanil 20 ng.ml-1
had similar creatine kinase MB and troponin I values.

<55>
Accession Number
632860784
Title
Effect of the Different Mechanical Mitral Valve Sounds on the Patients'
Quality of Life.
Source
Thoracic and Cardiovascular Surgeon. 68 (6) (pp 492-497), 2020. Date of
Publication: 01 Sep 2020.
Author
Huang J.-S.; Hong Z.-N.; Sun K.-P.; Cao H.; Chen Q.
Institution
(Huang, Hong, Sun, Chen) Department of Cardiovascular Surgery, Union
Hospital, Fujian Medical University, Fuzhou, Fujian, China
(Cao) Department of Cardiac Surgery, Fujian Provincial Maternity and
Children's Hospital, Affiliated Hospital of Fujian Medical University,
Fuzhou, Fujian, China
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The purpose of this study was to compare the opening and
closing sounds of three different mechanical mitral valves and to analyze
their effects on the quality of life of patients. Methods Ninety patients
who underwent mechanical mitral valve replacement (MVR) were divided into
three groups: those who received Advancing the Standard (ATS), St. Jude
Medical (SJM), or Carbomedics (CM) mechanical valves. The sound pressure
of the different valves was measured with a microphone. A detailed,
self-designed questionnaire with a 1 to 10 analog scale and the 36-item
Short Form Health Survey (SF-36) score was used to assess the quality of
life of the patients. Result The sound pressure measured by ATS was 64.4
+/- 3.1 dB, while that measured by SJM, and CM was 64.5 +/- 4.7 and 67.2
+/- 5.3 dB, respectively. The overall subjective interference score in the
ATS group was the lowest compared with that in the SJM and CM groups (ATS:
1.3 +/- 0.9 dB, SJM: 3.9 +/- 1.6 dB, CM: 4.1 +/- 1.5 dB). Relatives and
nonfamily members of the ATS group also had the lowest analog scale
scores. Specific questions showed that the ATS valve had the least impact
on sleep and daily life (impact on sleep: ATS: 4/30, SJM: 9/30, CM: 11/30,
impact on daily life: ATS: 2/30, SJM: 8/30, CM: 8/30). The SF-36 score
showed that there were significant differences in social functioning,
role-emotional, mental health, and vitality. Conclusion Patients receiving
ATS mechanical MVR may be less disturbed by valve noise than those
receiving SJM or CM mechanical MVR in a single Chinese cardiac
center. Copyright © 2020 Association for Computing Machinery. All
rights reserved.

<56>
Accession Number
632556478
Title
Utility value estimates in cardiovascular disease and the effect of
changing elicitation methods: A systematic literature review.
Source
Health and Quality of Life Outcomes. 18 (1) (no pagination), 2020. Article
Number: 251. Date of Publication: 27 Jul 2020.
Author
Betts M.B.; Rane P.; Bergrath E.; Chitnis M.; Bhutani M.K.; Gulea C.; Qian
Y.; Villa G.
Institution
(Betts, Bergrath, Chitnis) Evidence Synthesis, Modeling and Communication
Evidera Inc, Waltham, MA, United States
(Rane) Amgen Inc, Global Health Economics, Thousand Oaks, CA, United
States
(Bhutani) BresMed Health Solutions Ltd., Gurugram, Haryana, India
(Gulea) Evidence Synthesis, Modeling and Communication, Evidera, London,
United Kingdom
(Qian) Amgen Inc Intercontinental HQ-Value, Access and Policy, Thousand
Oaks, CA, United States
(Villa) Amgen (Europe) GmbH, Global Health Economics, Zug, Switzerland
Publisher
BioMed Central Ltd (United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Objective: Identify the most recent utility value estimates for
cardiovascular disease (CVD) via systematic literature review (SLR) and
explore trends in utility elicitation methods in the last 6 years.
 Method(s): This SLR was updated on January 25, 2018, and identified
studies reporting utilities for myocardial infarction (MI), stroke,
angina, peripheral artery disease (PAD), and any-cause revascularization
by searching Embase, PubMed, Health Technology Assessment Database, and
grey literature. Result(s): A total of 375 studies reported CVD
utilities (pre-2013 vs post-2013: MI, 38 vs 32; stroke, 86 vs 113; stable
angina, 8 vs 9; undefined/unstable angina, 23 vs 8; PAD, 29 vs 13;
revascularization, 54 vs 40). Median average utilities for MI, stroke, and
revascularization increased over time (pre-2013 vs post-2013: MI, 0.71 vs
0.79; stroke, 0.63 vs 0.64; revascularization, 0.76 vs 0.81); angina and
PAD showed a decrease in median values over time (stable angina, 0.83 vs
0.72; undefined/unstable angina, 0.70 vs 0.69; PAD, 0.76 vs 0.71). The
proportion of utility estimates from trials increased across health states
(pre-2013 vs post-2013: 22.5% vs 37.2%), as did the proportion of trials
using the EuroQol Five Dimensions Questionnaire (EQ-5D; pre-2013 vs
post-2013: 73.8% vs 91.4%). Use of methods such as the standard gamble,
time trade-off, and Health Utilities Index has declined.
 Conclusion(s): Health state utilities for cardiovascular health
states have changed in the last 6 years, likely due to changes in the
types of studies conducted, the patient populations evaluated, and
possibly changing utility elicitation methods. The EQ-5D has been used
more frequently. Copyright © 2020 The Author(s).

<57>
Accession Number
2004453523
Title
Permanent pacemaker implantation in pediatric heart transplant recipients:
A systematic review and evidence quality assessment.
Source
Pediatric Transplantation. 24 (3) (no pagination), 2020. Article Number:
e13698. Date of Publication: 01 May 2020.
Author
Mylonas K.S.; Repanas T.; Athanasiadis D.I.; Voulgaridou A.; Sfyridis
P.G.; Bakoyiannis C.; Kapelouzou A.; Avgerinos D.V.; Tzifa A.; Kalangos A.
Institution
(Mylonas, Sfyridis, Kalangos) Department of Pediatric Cardiac Surgery,
Mitera Children's Hospital, HYGEIA Group, Athens, Greece
(Mylonas, Tzifa) Department of Pediatric Cardiology and Adult Congenital
Heart Disease, Mitera Children's Hospital, HYGEIA Group, Athens, Greece
(Repanas) Department of Cardiology, Augusta Hospital, Dusseldorf, Germany
(Athanasiadis) Department of Surgery, Indiana University School of
Medicine, Indianapolis, IN, United States
(Voulgaridou) Department of Pediatrics, Kavala General Hospital, Kavala,
Greece
(Bakoyiannis) Division of Vascular Surgery, Laikon General Hospital,
National and Kapodistrian University of Athens, Athens, Greece
(Kapelouzou) Clinical, Experimental Surgery & Translational Research,
Biomedical Research Foundation Academy of Athens, Athens, Greece
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Hospital, Weill Cornell Medicine, New York City, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Bradyarrhythmias are a common complication following pediatric OHT and may
require permanent pacemaker implantation (PPM). The purpose of this study
was to investigate the incidence, predictors, and outcomes of children
undergoing PPM implantation following OHT. A PRISMA-compliant systematic
literature review was performed using the PubMed database and the Cochrane
Library (end-of-search date: January 27, 2019). The Newcastle-Ottawa scale
and the Joanna Briggs Institute tool were used to assess the quality of
cohort studies and case reports, respectively. We analyzed data from a
total of 11 studies recruiting 7198 pediatric patients who underwent heart
transplant. PPM implantation was performed in 1.9% (n = 137/7,198; 95% CI:
1.6-2.2) of the patients. Most patients underwent dual-chamber pacing
(46%, 95% CI: 32.6-59.7). Male-to-female ratio was 1.3:1. Mean patient age
at the time of OHT was 10.1 +/- 6.3. Overall, biatrial anastomosis was
used in 62.2% (95% CI: 52.8-70.6) of the patients. The bicaval technique
was performed in the remaining 37.8% (95% CI: 29.4-47.1). Sinus node
dysfunction was the most frequent indication for PPM implantation (54.4%;
95% CI: 42.6-65.7) followed by AV block (45.6%; 95% CI: 34.3-57.3). The
median time interval between OHT and PPM implantation ranged from 17 days
to 12.5 years. All-cause mortality was 27.9% (95% CI: 18.6-39.6) during a
median follow-up of 5 years. PPM implantation is rarely required after
pediatric OHT. The most common indication for pacing is sinus node
dysfunction, and patients undergoing biatrial anastomosis may be more
likely to require PPM. Copyright © 2020 Wiley Periodicals, Inc.

<58>
Accession Number
2003975862
Title
Open Versus Closed Pleura Internal Mammary Artery Harvesting and Early
Pulmonary Function After Coronary Artery Bypass Grafting.
Source
Heart Lung and Circulation. 29 (9) (pp 1412-1417), 2020. Date of
Publication: September 2020.
Author
Rezk M.E.; Elgazzar M.A.; Abo Youssef S.M.; Emeraa A.S.; Elkafoury A.E.;
Moussa H.H.
Institution
(Rezk, Elgazzar, Emeraa) Benha University, Faculty of Medicine,
Cardiothoracic Department, Benha, Egypt
(Abo Youssef) Benha University, Faculty of Medicine, Chest Department,
Benha, Egypt
(Elkafoury) Mahalla Cardiac Center, El Mahalla El Kubra, Egypt
(Moussa) Kafr Elsheikh University, Faculty of Medicine, Chest Department,
Benha, Egypt
Publisher
Elsevier Ltd
Abstract
Background: The internal mammary artery is the vessel of choice for
myocardial revascularisation during coronary artery bypass grafting
(CABG). Although it is possible to harvest the left internal mammary
artery (LIMA) without opening the left pleura, pleurotomy is usually
performed to provide adequate exposure and allow the placement of the LIMA
medial to the upper lobe, preventing any undue tension on the mammary
pedicle. However, the intact pleura technique may have a lower risk of
postoperative pulmonary complications. We aimed to study the effects of
both procedures on pulmonary function and the incidence of complications.
 Method(s): One hundred patients with ischaemic heart disease
indicated for CABG were included and divided into two groups. The closed
pleural technique group included 50 patients with preservation of the
pleural integrity during mammary harvesting. The open pleural procedure
group included 50 patients without preservation of pleural integrity.
Spirometry was done pre- and postoperatively in both groups and
postoperative pulmonary complications in both groups were recorded and
analysed. Result(s): Internal mammary harvesting with preservation of
pleural integrity during CABG in patients in the closed pleural procedure
group showed significant improvement in forced expiratory volume in the
first second (FEV1%), forced vital capacity (FVC%), and FEV1/FVC compared
with the corresponding values in patients in the open pleural procedure
group, on day 5 postoperatively, at discharge, and at day 30. There were
fewer complications in preservation of pleural integrity with regard to
lung atelectasis and pleural effusion, which were significantly lower in
patients in the open pleural procedure group. Conclusion(s):
Preservation of pleural integrity has beneficial effects on pulmonary
function and has fewer associated pulmonary complications. Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<59>
Accession Number
2003511565
Title
Upstream anticoagulation for patients with ST-elevation myocardial
infarction undergoing primary percutaneous coronary intervention: Insights
from the TOTAL trial.
Source
Catheterization and Cardiovascular Interventions. 96 (3) (pp 519-525),
2020. Date of Publication: 01 Sep 2020.
Author
Cantor W.J.; Lavi S.; Dzavik V.; Cairns J.; Cheema A.N.; Della Siega A.;
Moreno R.; Stankovic G.; Kedev S.; Natarajan M.K.; Levi Y.; Yuan F.; Jolly
S.S.
Institution
(Cantor) Division of Cardiology, Southlake Regional Health Centre,
University of Toronto, Toronto, ON, Canada
(Lavi, Levi) University of Western Ontario, London Health Sciences Centre,
London, ON, Canada
(Dzavik) Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
(Cairns) University of British Columbia, Vancouver, BC, Canada
(Cheema) St Michael's Hospital, Toronto, ON, Canada
(Della Siega) Victoria Heart Institute Foundation, Victoria, BC, Canada
(Moreno) University Hospital La Paz, Madrid, Spain
(Stankovic) Clinical Center of Serbia and Department of Cardiology,
Medical Faculty, University of Belgrade, Belgrade, Serbia
(Kedev) University Clinic of Cardiology, Sts. Cyril and Methodius
University, Skopje, North Macedonia
(Natarajan, Yuan, Jolly) McMaster University and the Population Health
Research Institute, Hamilton Health Sciences, Hamilton, 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: To assess the relationship between preprocedural
anticoagulation use and clinical and angiographic outcomes.
 Background(s): For patients with ST-elevation myocardial infarction
(STEMI) undergoing primary percutaneous coronary intervention (PCI), the
optimal timing of anticoagulant administration remains uncertain.
 Method(s): Patients enrolled in the TOTAL trial were stratified based
on whether or not they had received any parenteral anticoagulant prior to
randomization and PCI. Baseline and procedural characteristics were
compared. For one-year clinical outcomes, Cox proportional modeling
adjusted on a propensity score was used to analyze differences between
groups. Angiographic endpoints were analyzed by logistic regression models
adjusted for propensity scores. Result(s): In the trial, 10,064
patients were enrolled and underwent PCI. Preprocedural anticoagulation
was used in 6,381 patients (63%).The most common anticoagulant was
intravenous unfractionated heparin (5,188, 81%). Patients who received
preprocedural anticoagulation had higher rates of TIMI-2-3 or TIMI-3 flow
and lower grades of thrombus prior to PCI. Pretreatment with
anticoagulation was associated with lower use of bailout thrombectomy, GP
IIb/IIIa inhibitors, and intra-aortic balloon pump. After adjustment,
preprocedural anticoagulation was associated with lower rates of CABG and
minor bleeding at 1 year but there were no significant differences in
death, stroke, recurrent MI, cardiogenic shock, or congestive heart
failure. Conclusion(s): Preprocedural anticoagulation is associated
with improved flow and reduced thrombus in the IRA prior to PCI, less
bailout thrombectomy during PCI but no difference in death, recurrent
infarction, or heart failure at 1 year. Copyright © 2019 Wiley
Periodicals, Inc.

<60>
Accession Number
2007114271
Title
Cardiac resynchronization therapy for the failing systemic right
ventricle: A systematic review.
Source
International Journal of Cardiology. 318 (pp 74-81), 2020. Date of
Publication: 1 November 2020.
Author
Kharbanda R.K.; Moore J.P.; Taverne Y.J.H.J.; Bramer W.M.; Bogers
A.J.J.C.; de Groot N.M.S.
Institution
(Kharbanda, de Groot) Department of Cardiology, Erasmus MC, University
Medical Center, Rotterdam, Netherlands
(Kharbanda, Taverne, Bogers) Department of Cardiothoracic Surgery, Erasmus
MC, University Medical Center, Rotterdam, Netherlands
(Moore) Ahmanson/UCLA Adult Congenital Heart Disease Center, California,
Los Angeles, United States
(Taverne) Department of Anatomy, ERCATHAN, Erasmus MC, university Medical
Center, Rotterdam, Netherlands
(Bramer) Medical library Erasmus MC, University Medical Center, Rotterdam,
Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Patients with a systemic right ventricle (SRV) are at high risk for
development of heart failure early in life. An SRV is encountered in
patients with congenitally corrected transposition of the great arteries
(CCTGA) or dextro-transposition of the great arteries (DTGA) with previous
atrial switch repair (Mustard or Senning procedure). Progressive heart
failure is one of the leading cause of mortality in these patients.
Therefore, cardiac resynchronization therapy (CRT) has gained increasing
momentum for use in this challenging congenital heart disease (CHD)
population. However, current guidelines differ in recommendations for CRT
in patients with an SRV as evidence supporting CRT has thus far only been
described in case reports and retrospectively in relatively small study
populations. In fact, the European Society of Cardiology Guideline for the
management of grown-up congenital heart disease consider CRT to be
'experimental' in this population. This systematic review critically
summarizes current literature on CRT in SRV patients and provides future
perspectives for further research in this challenging and growing CHD
population. Copyright © 2020 The Authors

<61>
Accession Number
2006989271
Title
Comparison of anterior, posterior, and anterior combined with posterior
surgical treatment of thoracic and lumbar spinal tuberculosis: a
systematic review.
Source
Journal of International Medical Research. 48 (2) (no pagination), 2019.
Date of Publication: 2019.
Author
Bian Z.; Gui Y.; Feng F.; Shen H.; Lao L.
Institution
(Bian, Gui, Feng, Shen, Lao) Department of Spine Surgery, Renji Hospital,
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: This study was performed to compare different surgical
approaches in the treatment of spinal tuberculosis. Method(s): We
conducted a literature search to identify and analyze papers published
from January 1966 to April 2018 relevant to comparison of the anterior,
posterior, and anterior combined with posterior approaches in the
treatment of spinal tuberculosis of the thoracic and lumbar regions.
 Result(s): Twenty-five studies involving 2295 patients were
identified in this systematic review. The operative time was significantly
longer in the anterior combined with posterior approach than in the other
two approaches. Blood loss was significantly greater in the anterior
combined with posterior approach (1125.0 +/- 275.5 mL) than in the
posterior approach (710.4 +/- 192.4 mL). The difference in correction of
the kyphosis angle among the three procedures was not significant. The
overall surgical and transthoracic complications were significantly lower
in the posterior approach. The clinical outcome of all patients improved,
but there was no significant difference among the three procedures.
 Conclusion(s): Blood loss, overall surgical and transthoracic
complications, and the operative time are different among the three
approaches. Therefore, different factors must be carefully assessed in
deciding among the three procedures. Copyright © The Author(s)
2019.

<62>
Accession Number
2007963088
Title
Meta-Analysis of Aspirin Monotherapy Versus Dual Antiplatelet Therapy
After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 135 (pp 187-188), 2020. Date of
Publication: 15 Nov 2020.
Author
Osman M.; Syed M.; Balla S.; Kheiri B.; Golwala H.; Zahr F.
Institution
(Osman, Syed, Balla) Division of Cardiology, West Virginia University
School of Medicine, Morgantown, WV, United States
(Kheiri, Golwala, Zahr) Knight Cardiovascular Institute, Oregon Health and
Science University, Portland, OR, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<63>
Accession Number
2007950068
Title
Meta-Analysis of Complete versus Culprit-Only Revascularization in
Patients with ST-Segment Elevation Myocardial Infarction and Multivessel
Coronary Disease.
Source
American Journal of Cardiology. 135 (pp 40-49), 2020. Date of Publication:
15 Nov 2020.
Author
Levett J.Y.; Windle S.B.; Filion K.B.; Cabaussel J.; Eisenberg M.J.
Institution
(Levett, Windle, Filion, Cabaussel, Eisenberg) Center of Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill
University, Montreal, QC, Canada
(Levett, Filion, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Filion) Department of Medicine, McGill University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital/McGill
University, Montreal, QC, Canada
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Approximately half of patients with ST-segment elevation myocardial
infarction (STEMI) present with noninfarct related multivessel coronary
artery disease (CAD) during primary percutaneous coronary intervention
(PCI). However, questions remain concerning whether patients with STEMI
and multivessel CAD should routinely undergo complete revascularization.
Our objective was to compare the risks of major cardiovascular outcomes
and procedural complications in patients with STEMI and multivessel CAD
randomized to complete revascularization versus culprit-only PCI. We
conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) comparing complete revascularization to culprit-only PCI.
RCTs were identified via a systematic search of MEDLINE, Embase, and
Cochrane CENTRAL. Count data were pooled using DerSimonian and Laird
random-effects models with inverse variance weighting to obtain relative
risks (RRs) and 95% confidence intervals (CIs). A total of 9 RCTs (n =
6,751) were included, with mean/median follow-up times ranging from 6 to
36 months. Compared with culprit-only PCI, complete revascularization was
associated with a substantial reduction in major adverse cardiovascular
events (13.1% vs 22.1%; RR: 0.54; 95%CI: 0.43 to 0.66), repeat myocardial
infarction (4.9% vs 6.8%; RR: 0.64; 95%CI: 0.48 to 0.84), and repeat
revascularization (3.7% vs 12.3%; RR: 0.33; 95%CI: 0.25 to 0.44). Complete
revascularization may have beneficial effects on all-cause and
cardiovascular mortality, but 95%CIs were wide. Findings for stroke, major
bleeding, and contrast-induced acute kidney injury were inconclusive. In
conclusion, complete coronary artery revascularization appears to confer
benefit over culprit-only PCI in patients with STEMI and multivessel CAD,
and should be considered a first-line strategy in these
patients. Copyright © 2020 The Author(s)

<64>
Accession Number
2007560748
Title
Impact of cognitive behavioral therapy on depression symptoms after
transcatheter aortic valve replacement: A randomized controlled trial.
Source
International Journal of Cardiology. 321 (pp 61-68), 2020. Date of
Publication: 15 Dec 2020.
Author
Edwards K.S.; Chow E.K.H.; Dao C.; Hossepian D.; Johnson A.G.; Desai M.;
Shah S.; Lee A.; Yeung A.C.; Fischbein M.; Fearon W.F.
Institution
(Edwards, Dao, Shah, Yeung, Fearon) Department of Medicine, Stanford
University, United States
(Chow, Desai) Quantitative Sciences Unit, Stanford University, United
States
(Hossepian, Johnson) PGSP-Stanford Psy.D. Consortium, Palo Alto
University, United States
(Lee, Fischbein) Department of Cardiothoracic Surgery, Stanford
University, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Depression is a significant concern after cardiac surgery and
has not been studied in patients undergoing transcatheter aortic valve
replacement (TAVR). We sought to examine the prevalence of pre-procedure
depression and anxiety symptoms and explore whether brief bedside
cognitive behavioral therapy (CBT) could prevent post-TAVR psychological
distress. Method(s): We prospectively recruited consecutive TAVR
patients and randomized them to receive brief CBT or treatment as usual
(TAU) during their hospitalization. Multi-level regression techniques were
used to evaluate changes by treatment arm in depression, anxiety, and
quality of life from baseline to 1 month post-TAVR adjusted for sex, race,
DM, CHF, MMSE, and STS score. Result(s): One hundred and forty six
participants were randomized. The mean age was 82 years, and 43% were
female. Self-reported depression and anxiety scores meeting cutoffs for
clinical level distress were 24.6% and 23.2% respectively. Both TAU and
CBT groups had comparable improvements in depressive symptoms at 1-month
(31% reduction for TAU and 35% reduction for CBT, p =.83). Similarly, both
TAU and CBT groups had comparable improvements in anxiety symptoms at
1-month (8% reduction for TAU and 11% reduction for CBT, p =.1). Quality
of life scores also improved and were not significantly different between
the two groups. Conclusion(s): Pre-procedure depression and anxiety
may be common among patients undergoing TAVR. However, TAVR patients show
spontaneous improvement in depression and anxiety scores at 1-month follow
up, regardless of brief CBT. Further research is needed to determine
whether more tailored CBT interventions may improve psychological and
medical outcomes. Copyright © 2020 Elsevier B.V.

<65>
Accession Number
2007059270
Title
Clinical risk predictors in atrial fibrillation patients following
successful coronary stenting: ENTRUST-AF PCI sub-analysis.
Source
Clinical Research in Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Goette A.; Eckardt L.; Valgimigli M.; Lewalter T.; Laeis P.; Reimitz
P.-E.; Smolnik R.; Zierhut W.; Tijssen J.G.; Vranckx P.
Institution
(Goette) Medizinische Klinik II: Kardiologie Und Intensivmedizin, St.
Vincenz-Krankenhaus, Am Busdorf 2, Paderborn 33098, Germany
(Goette) Working Group of Molecular Electrophysiology, University Hospital
Magdeburg, Magdeburg, Germany
(Goette, Eckardt, Lewalter) Atrial Fibrillation Network, Munster, Germany
(Eckardt) Division of Electrophysiology, Department of Cardiology and
Angiology, University of Munster, Munster, Germany
(Valgimigli) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Lewalter) Department of Cardiology, Hospital Munich South, Munich,
Germany
(Lewalter) University of Bonn, Bonn, Germany
(Laeis, Reimitz, Smolnik, Zierhut) Daiichi Sankyo Europe, Munich, Germany
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, Netherlands
(Tijssen) Cardialysis, RotterdamNetherlands
(Vranckx) Department of Cardiology and Intensive Care, Jessa Ziekenhuis,
Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt,
Belgium
Publisher
Springer Science and Business Media Deutschland GmbH (E-mail:
info@springer-sbm.com)
Abstract
Aims: This subgroup analysis of the ENTRUST-AF PCI trial
(ClinicalTrials.gov Identifier: NCT02866175; Date of registration: August
2016) evaluated type of AF, and CHA<inf>2</inf>DS<inf>2</inf>-VASc score
parameters as predictors for clinical outcome. Method(s): Patients
were randomly assigned after percutaneous coronary intervention (PCI) to
either edoxaban (60 mg/30 mg once daily [OD]; n = 751) plus a
P2Y<inf>12</inf> inhibitor for 12 months or a vitamin K antagonist [VKA]
(n = 755) plus a P2Y<inf>12</inf> inhibitor and aspirin (100 mg OD, for
1-12 months). The primary outcome was a composite of major/clinically
relevant non-major bleeding (CRNM) within 12 months. The composite
efficacy endpoint consisted of cardiovascular death, stroke, systemic
embolic events, myocardial infarction (MI), and definite stent thrombosis.
 Result(s): Major/CRNM bleeding event rates were 20.7%/year and
25.6%/year with edoxaban and warfarin, respectively (HR [95% CI]: 0.83
[0.654-1.047]). The event rates of composite outcome were 7.26%/year and
6.86%/year, respectively (HR [95% CI]): 1.06 [0.711-1.587]), and of
overall net clinical benefit were 12.48%/year and 12.80%/year,
respectively (HR [(95% CI]: 0.99 [(0.730; 1.343]). Increasing
CHA<inf>2</inf>DS<inf>2</inf>-VASc score was associated with increased
rates of all outcomes. CHA<inf>2</inf>DS<inf>2</inf>-VASc score >= 5 was a
marker for stent thrombosis. Paroxysmal AF was associated with a higher
occurrence of MI (4.87% versus 2.01%, p = 0.0024). Conclusion(s):
After PCI in AF patients, increasing CHA<inf>2</inf>DS<inf>2</inf>-VASc
score was associated with increased bleeding rates and
CHA<inf>2</inf>DS<inf>2</inf>-VASc score (>= 5) predicted the occurrence
of stent thrombosis. Paroxysmal AF was associated with MI. These findings
may have important clinical implications in AF patients. Copyright
© 2020, The Author(s).

<66>
Accession Number
2007001446
Title
Assessment of Disease Progression in Patients With Repaired Tetralogy of
Fallot Using Cardiac Magnetic Resonance Imaging: A Systematic Review.
Source
Heart Lung and Circulation. 29 (11) (pp 1613-1620), 2020. Date of
Publication: November 2020.
Author
Mohamed I.; Stamm R.; Keenan R.; Lowe B.; Coffey S.
Institution
(Mohamed, Stamm, Coffey) Department of Medicine - HeartOtago, Dunedin
School of Medicine, University of Otago, Dunedin, New Zealand
(Keenan) Pacific Radiology Group, Christchurch, New Zealand
(Keenan) Department of Radiology, University of Otago, Christchurch, New
Zealand
(Lowe) Auckland District Health Board, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Aims: Tetralogy of Fallot (ToF) is the most common cyanotic congenital
heart disease with a growing population of adult survivors. Late pulmonary
outflow tract and pulmonary valve postoperative complications are
frequent, leading to long-term risks such as right heart failure and
sudden death secondary to arrhythmias. Cardiac magnetic resonance imaging
(CMR) is the gold standard for assessment of cardiac function in patients
with repaired ToF. We aimed to determine the most useful CMR predictors of
disease progression and the optimal frequency of CMR. Methods and
Results: We systematically reviewed PubMed from inception until 29 April
2019 for longitudinal studies assessing the relationship between CMR
features and disease progression in repaired ToF. Fourteen (14) studies
were identified. Multiple studies showed that impaired right and left
ventricular function predict subsequent disease progression. Right
ventricular end diastolic volume, while being associated with disease
progression when analysed alone, was generally not associated with disease
progression on multivariate analysis. Severity of tricuspid regurgitation
and pulmonary regurgitation likewise did not show a consistent association
with subsequent events. A number of non-CMR factors were also identified
as being associated with disease progression, in particular QRS duration
and older age at repair. Restrictive right ventricular physiology was not
consistently an independent predictor of events. Conclusion(s):
Impaired right and left ventricular function are the most consistent
independent predictors of disease progression in repaired ToF. The optimal
timing of repeat cardiac imaging remains controversial. Large scale
prospective studies will provide important information to guide clinical
decision making in this area. Copyright © 2020 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<67>
Accession Number
2006892966
Title
Diagnostic accuracy of viscoelastic point-of-care identification of
hypofibrinogenaemia in cardiac surgical patients: A systematic review.
Source
Anaesthesia and Intensive Care. 48 (5) (pp 339-353), 2020. Date of
Publication: 01 Sep 2020.
Author
Gibbs N.M.; Weightman W.M.
Institution
(Gibbs, Weightman) Department of Anaesthesia, Sir Charles Gairdner
Hospital, Nedlands, Australia
(Gibbs) The University of Western Australia, Nedlands, Australia
Publisher
SAGE Publications Inc. ( United States. E-mail: claims@sagepub.com)
Abstract
Hypofibrinogenaemia during cardiac surgery may increase blood loss and
bleeding complications. Viscoelastic point-of-care tests provide more
rapid diagnosis than laboratory measurement, allowing earlier treatment.
However, their diagnostic test accuracy for hypofibrinogenaemia has never
been reviewed systematically. We aimed to systematically review their
diagnostic test accuracy for the identification of hypofibrinogenaemia
during cardiac surgery. Two reviewers assessed relevant articles from
seven electronic databases, extracted data from eligible articles and
assessed quality. The primary outcomes were sensitivity, specificity and
positive and negative predictive values. A total of 576 articles were
screened and 81 full texts were assessed, most of which were clinical
agreement or outcome studies. Only 10 diagnostic test accuracy studies
were identified and only nine were eligible (ROTEMdelta 7; TEG5000 1;
TEG6S 1, n = 1820 patients) (ROTEM, TEM International GmbH, Munich,
Germany; TEG, Haemonetics, Braintree, MA, USA). None had a low risk of
bias. Four ROTEM studies with a fibrinogen threshold less than 1.5-1.6 g/l
and FIBTEM threshold A10 less than 7.5-8 mm had point estimates for
sensitivity of 0.61-0.88; specificity 0.54-0.94; positive predictive value
0.42-0.70; and negative predictive value 0.74-0.98 (i.e. false positive
rate 30%-58%; false negative rate 2%-26%). Two ROTEM studies with higher
thresholds for both fibrinogen (<2 g/l) and FIBTEM A10 (<9.5 mm) had
similar false positive rates (25%-46%), as did the two TEG studies
(15%-48%). This review demonstrates that there have been few diagnostic
test accuracy studies of viscoelastic point-of-care identification of
hypofibrinogenaemia in cardiac surgical patients. The studies performed so
far report false positive rates of up to 58%, but low false negative
rates. Further diagnostic test accuracy studies of viscoelastic
point-of-care identification of hypofibrinogenaemia are required to guide
their better use during cardiac surgery. Copyright © The
Author(s) 2020.

<68>
Accession Number
2006834454
Title
Symptom-orientated oral hygiene for children after heart transplantation:
Effectiveness of a standardized prophylactic program.
Source
Pediatric Transplantation. 24 (7) (no pagination), 2020. Article Number:
e13845. Date of Publication: 01 Nov 2020.
Author
Schulz-Weidner N.; Bulski J.C.; Siahi-Benlarbi R.; Bauer J.; Logeswaran
T.; Jux C.; Wetzel W.-E.; Kramer N.
Institution
(Schulz-Weidner, Bulski, Siahi-Benlarbi, Wetzel, Kramer) Department of
Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig
University, Giessen, Germany
(Bauer, Logeswaran, Jux) Pediatric Heart Centre, Justus Liebig University,
Giessen, Germany
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Children with CHD, especially heart-transplanted patients, are predisposed
to have caries lesions, gingivitis and other oral findings like gingival
hyperplasia. The aim of the study was the implementation of a specific
oral hygiene program in these patients and its effect on the improvement
of oral health, especially gingival overgrowth. For this, we used a newly
developed systematic GHI to evaluate and describe this gingival
alteration. Thirty-three children, aged 6 to 15 years with cardiac
transplants (9 girls, 24 boys), were examined and introduced into a
specific oral hygiene program. Each child showed evidence of gingival
hyperplasia. They were randomly divided into three groups with the
following oral care measurements: Group ZZ tooth brushing, Group ZZS tooth
brushing and mouth rinsing, Group ZZSS tooth brushing, mouth rinsing and
the use of an additional single and sulcus toothbrush. A significant
decline of all oral health parameters could be proven in all groups.
Gingival hyperplasia (GHI) improved as well as plaque accumulation (QHI).
The children who used in addition to toothbrushing rinsing solutions
and/or additional miniature toothbrushes showed better parameters of the
gingival hygiene indexes from the baseline examination until the end of
the study. The results show that any infant with cardiac transplant has to
be introduced into an individualized oral hygiene program underlining the
need of comprehensive dental care in cooperation with pediatric
cardiology. Copyright © 2020 Wiley Periodicals LLC

<69>
Accession Number
2006803806
Title
Short- and Long-term Outcomes in Dialysis Patients Undergoing
Transcatheter Aortic Valve Implantation: A Systematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. 36 (11) (pp 1754-1763), 2020. Date of
Publication: November 2020.
Author
Kuno T.; Takagi H.; Ando T.; Ueyama H.; Fujisaki T.; Kodaira M.; Numasawa
Y.; Briasoulis A.; Hayashida K.
Institution
(Kuno, Ueyama) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Ando) Center for Interventional Vascular Therapy, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Fujisaki) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai St Luke's and West, New York, NY, United States
(Kodaira, Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga
Hospital, Ashikaga, Japan
(Briasoulis) Division of Cardiovascular Medicine, Section of Heart Failure
and Transplantation, University of Iowa, Iowa City, IA, United States
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
main treatment for symptomatic severe aortic stenosis, but patients on
dialysis have been excluded from major randomized controlled trials. Our
aim was to compare mortality and procedure-related complications after
TAVI in patients with end-stage renal disease (ESRD) on dialysis vs those
without. Method(s): EMBASE and MEDLINE were searched through November
2019 to investigate the comparative outcomes between patients with ESRD on
dialysis and those without who underwent TAVI. The main outcomes were
short-term (30-day/in-hospital) mortality and procedural complications,
and long-term (>6 months) all-cause mortality. Result(s): Our search
identified 10 observational studies enrolling 128,094 (5399 on dialysis)
patients who underwent TAVI. Dialysis patients had a significantly higher
rate of short-term and long-term mortality than nondialysis patients (odds
ratio [95% confidential interval]: 2.18 [1.64-2.89], P < 0.001,
I2 = 60%; 1.91 [1.46-2.50], P < 0.001, I2 = 80%,
respectively). In addition, dialysis patients had significantly higher
rates of short-term life-threatening and/or major bleeding, permanent
pacemaker implantation, and device failure compared with nondialysis
patients (odds ratio [95% confidential interval]: 1.90 [1.24-2.90], P <
0.001, I2 = 67%; 1.33 [1.15-1.53], P < 0.001, I2 =
0%; 2.08 [1.05-4.10], P = 0.03, respectively), but did not have
significantly higher rates of vascular complications and stroke.
 Conclusion(s): Dialysis patients had significantly higher rates of
short- and long-term mortality, short-term life-threatening and/or major
bleeding, permanent pacemaker implantation, and device failure compared
with nondialysis patients. Careful selection of patients who would benefit
from TAVI among patients with ESRD requiring dialysis is necessary to
prevent high rates of postprocedural complications. Copyright ©
2020 Canadian Cardiovascular Society

<70>
Accession Number
2008363299
Title
Systematic review and consensus definitions for the Standardized Endpoints
in Perioperative Medicine (StEP) initiative: cardiovascular outcomes.
Source
British Journal of Anaesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Beattie W.S.; Lalu M.; Bocock M.; Feng S.; Wijeysundera D.N.; Nagele P.;
Fleisher L.A.; Kurz A.; Biccard B.; Leslie K.; Howell S.; Grocott H.; Lamy
A.; Richards T.; Myles P.; Gan T.J.; Peyton P.; Sessler D.; Tramer M.;
Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti M.; Boney
O.; Haller G.; Grocott M.; Cook T.; Fleisher L.; Neuman M.; Story D.;
Gruen R.; Bampoe S.; Evered L.; Scott D.; Silbert B.; van Dijk D.; Kalkman
C.; Chan M.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Beattie S.;
Wijeysundera D.; Landoni G.; Bartlett R.J.; McMonnies R.; Gerstl J.; Jay
M.; Kishlyansky D.; Machina M.; Bobcock M.; Pearse R.; Mythen M.; Canet
J.; Moller A.; Gin T.; Schultz M.; Pelosi P.; Gabreu M.; Futier E.;
Creagh-Brown B.; Abbott T.; Klein A.; Corcoran T.; Cooper D.J.; Dieleman
S.; Diouf E.; McIlroy D.; Bellomo R.; Shaw A.; Prowle J.; Karkouti K.;
Billings J.; Mazer D.; Jayarajah M.; Murphy M.; Bartoszko J.; Sneyd R.;
Morris S.; George R.; Moonesinghe R.; Shulman M.; Lane-Fall M.; Nilsson
U.; Stevenson N.; Cooper J.D.; van Klei W.; Cabrini L.; Miller T.; Pace
N.; Jackson S.; Buggy D.; Short T.; Riedel B.; Gottumukkala V.; Alkhaffaf
B.; Johnson M.
Institution
(Beattie) Cardiovascular Anesthesia, University Health Network, University
of Toronto, Toronto, ON, Canada
(Lalu, Bocock, Feng) Department of Anesthesia, University of Ottawa,
Ottawa, ON, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute, St Michaels Hospital,
University of Toronto, Toronto, ON, Canada
(Nagele) Department of Anesthesia and Critical Care, University of
Chicago, Chicago, IL, United States
(Fleisher) Department of Anesthesiology and Critical Care, University of
Pennsylvania Health System, Philadelphia, PA, United States
(Kurz) Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
(Biccard) Department of Anesthesia and Perioperative Medicine, University
of Cape Town, Cape Town, South Africa
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic., Australia
(Howell) University of Leeds School of Medicine, Leeds, United Kingdom
(Landoni) Center for Intensive Care and Anesthesiology, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Richards) University of Western Australia, Perth, Australia
(Myles) Alfred Health and Monash University Department of Anaesthesia and
Perioperative Medicine, Melbourne, Vic., Australia
Publisher
Elsevier Ltd
Abstract
Background: Adverse cardiovascular events are a leading cause of
perioperative morbidity and mortality. The definitions of perioperative
cardiovascular adverse events are heterogeneous. As part of the
international Standardized Endpoints in Perioperative Medicine initiative,
this study aimed to find consensus amongst clinical trialists on a set of
standardised and valid cardiovascular outcomes for use in future
perioperative clinical trials. Method(s): We identified currently
used perioperative cardiovascular outcomes by a systematic review of the
anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase,
and Cochrane Library). We performed a three-stage Delphi consensus-gaining
process that involved 55 clinician researchers worldwide. Cardiovascular
outcomes were first shortlisted and the most suitable definitions
determined. These cardiovascular outcomes were then assessed for validity,
reliability, feasibility, and clarity. Result(s): We identified 18
cardiovascular outcomes. Participation in the three Delphi rounds was 100%
(n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine
cardiovascular outcomes was elicited from the consensus: myocardial
infarction, myocardial injury, cardiovascular death, non-fatal cardiac
arrest, coronary revascularisation, major adverse cardiac events,
pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These
nine cardiovascular outcomes were rated by the majority of experts as
valid, reliable, feasible, and clearly defined. Conclusion(s): These
nine consensus cardiovascular outcomes can be confidently used as
endpoints in clinical trials designed to evaluate perioperative
interventions with the goal of improving perioperative
outcomes. Copyright © 2020 British Journal of Anaesthesia

<71>
Accession Number
632755640
Title
Bilateral ultrasound-guided thoracic erector spinae plane blocks using a
programmed intermittent bolus improve opioid-sparing postoperative
analgesia in pediatric patients after open cardiac surgery: A randomized,
double-blind, placebo-controlled trial.
Source
Regional Anesthesia and Pain Medicine. 45 (10) (pp 805-812), 2020. Date of
Publication: 01 Oct 2020.
Author
Macaire P.; Ho N.; Nguyen V.; Phan Van H.; Dinh Nguyen Thien K.; Bringuier
S.; Capdevila X.
Institution
(Macaire) Anesthesia and Pain Department, Vinmec International Hospital,
Hanoi, Vietnam
(Ho, Nguyen) Department of Cardiac Surgery, Vinmec Central Park
International Hospital, Ho Chi Minh City, Vietnam
(Phan Van, Dinh Nguyen Thien) Department of Pharmacology, Forensic
Medicine Center, Ho Chi Minh City, Vietnam
(Bringuier) Department of Biostatistics, Hopital Lapeyronie, Montpellier,
France
(Capdevila) Anesthesiology and Critical Care Department, Neurosciences
Institute, Inserm U1051, Hopital Lapeyronie, Montpellier, France
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Background Postoperative pain after pediatric cardiac surgery is usually
treated with intravenous opioids. Recently, the focus has been on
postoperative regional analgesia with the introduction of
ultrasound-guided erector spinae plane blocks (ESPBs). We hypothesized
that bilateral ESPB with a programmed intermittent bolus (PIB) regimen
decreases postoperative morphine consumption at 48 hours and improves
analgesia in children who undergo cardiac surgery. Methods This
randomized, double-blind, placebo-controlled study comprised 50 children
who underwent cardiac surgery through midline sternotomy. The patients
were allocated randomly into two groups: ultrasound-guided bilateral ESPB
at the level of T3-T4 transverse process then PIB with saline infusion
(group 1, n=23) or PIB with 0.2% ropivacaine (group 2, n=27). Intravenous
morphine at 30 mug/kg/hour was used as rescue analgesia. Postoperative
pain was assessed using the COMFORT-B score for extubation, drain removal,
and mobilization, and the FLACC (Face, Legs, Activity, Cry, Consolability)
scale at 0, 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48 hours after surgery.
Adverse events were noted. Results The total dose of morphine in 48 hours
was significantly decreased in patients receiving a bilateral ESPB with
ropivacaine (120+/-320 mug/kg) compared with patients with saline infusion
(512+/-560 mug/kg; p=0.03). Fourteen per cent of patients required rescue
analgesia with morphine in group 2 compared with 41% in group 1 (p=0.05).
The patients in group 2 demonstrated significantly reduced COMFORT-B
scores at extubation, drain removal, and mobilization compared with those
in group 1 and had reduced FLACC scale levels at 20 and 24 hours
postoperatively (p=0.05 and p=0.001, respectively). No differences were
reported for extubation and drain removal times or for length of hospital
stay. In addition, vomiting episodes were decreased in group 2 (p=0.01).
Conclusions In pediatric cardiac surgery, the results of this study
confirm our hypothesis that bilateral ESPB analgesia with ropivacaine
decreases the postoperative morphine consumption at 48 hours and
demonstrates better postoperative analgesia compared with a control group.
Trial registration number NCT03593642. Copyright ©

<72>
Accession Number
632651146
Title
Critical Coarctation of the Aorta in Selective Fetal Growth Restriction
and the Role of Coronary Stent Implantation.
Source
Fetal Diagnosis and Therapy. 47 (10) (pp 740-748), 2020. Date of
Publication: 01 Oct 2020.
Author
Gijtenbeek M.; Haak M.C.; Ten Harkel A.D.J.; Bokenkamp R.; Eyskens B.;
Ortibus E.; Meyns B.; Gewillig M.; Lewi L.
Institution
(Gijtenbeek, Haak) Division of Fetal Medicine, Department of Obstetrics,
Leiden University Medical Center, Leiden, Netherlands
(Ten Harkel, Bokenkamp) Department of Pediatric Cardiology, Leiden
University Medical Center, Leiden, Netherlands
(Meyns) Department of Cardiac Surgery, University Hospitals Leuven,
Leuven, Belgium
(Eyskens, Gewillig) Department of Pediatrics, Pediatric Cardiology,
University Hospitals Leuven, Leuven, Belgium
(Eyskens, Ortibus, Gewillig, Lewi) Department of Development and
Regeneration, Cluster Woman and Child, Biomedical Sciences, Ku Leuven,
Leuven, Belgium
(Ortibus) Department of Pediatrics, Pediatric Neurology, University
Hospitals Leuven, Leuven, Belgium
(Meyns) Department of Cardiovascular Sciences, Biomedical Sciences, Ku
Leuven, Leuven, Belgium
(Lewi) Department of Obstetrics and Gynecology, Obstetrics University
Hospitals Leuven, Leuven, Belgium
Publisher
S. Karger AG
Abstract
Monochorionic twins are at increased risk of congenital heart defects
(CHDs). Up to 26% have a birth weight 1,500 g, a CHD requiring neonatal
surgery, therefore, poses particular challenges. Objective(s): The
aim of the study was to describe pregnancy characteristics, perinatal
management, and outcome of monochorionic twins diagnosed with critical
coarctation of the aorta (CoA). Method(s): We included monochorionic
twins diagnosed with critical CoA (2010-2019) at 2 tertiary referral
centers, and we systematically reviewed the literature regarding CoA in
monochorionic twins. Result(s): Seven neonates were included. All
were the smaller twin of pregnancies complicated by selective fetal growth
restriction. The median gestational age at birth was 32 weeks (28-34).
Birth weight of affected twins ranged as 670-1,800 g. One neonate
underwent coarctectomy at the age of 1 month (2,330 g). Six underwent
stent implantation, performed between day 8 and 40, followed by definitive
coarctectomy between 4 and 9 months in 4. All 7 developed normally, except
for 1 child with neurodevelopmental delay. Three co-twins had pulmonary
stenosis, of whom 1 required balloon valvuloplasty. The literature review
revealed 10 cases of CoA, all in the smaller twin. Six cases detected in
the first weeks after birth were treated with prostaglandins alone, by
repeated transcatheter angioplasty or by surgical repair, with good
outcome in 2 out of 6. Conclusion(s): CoA specifically affects the
smaller twin of growth discordant monochorionic twin pairs. Stent
implantation is a feasible bridging therapy to surgery in these low birth
weight neonates. Copyright © 2020 S. Karger AG, Basel.

<73>
Accession Number
2008368781
Title
Pulmonary lobectomy for cancer: Systematic review and network
meta-analysis comparing open, video-assisted thoracic surgery, and robotic
approach.
Source
Surgery (United States). (no pagination), 2020. Date of Publication: 2020.
Author
Aiolfi A.; Nosotti M.; Micheletto G.; Khor D.; Bonitta G.; Perali C.;
Marin J.; Biraghi T.; Bona D.
Institution
(Aiolfi, Bonitta, Perali, Marin, Biraghi, Bona) Department of Biomedical
Science for Health, Division of General Surgery, University of Milan,
Istitituto Clinico Sant'Ambrogio, Milan, Italy
(Nosotti) Department of Pathophysiology and Transplantation, Thoracic
Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda - Ospedale
Maggiore Policlinico, Milan, Italy
(Micheletto) Department of Pathophysiology and Transplantation, INCO and
Department of General Surgery, University of Milan, Istituto Clinico
Sant'Ambrogio, Milan, Italy
(Khor) University of Maryland Medical Center, Baltimore, MD, United States
Publisher
Mosby Inc. (E-mail: periodical.service@mosby.com)
Abstract
Background: Although minimally invasive lobectomy has gained worldwide
interest, there has been debate on perioperative and oncological outcomes.
The purpose of this study was to compare outcomes among open lobectomy,
video-assisted thoracic surgery lobectomy, and robotic lobectomy.
 Method(s): PubMed, EMBASE, and Web of Science databases were
consulted. A fully Bayesian network meta-analysis was performed.
 Result(s): Thirty-four studies (183,426 patients) were included;
88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted
thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. Compared
with open lobectomy, video-assisted thoracic surgery, lobectomy and
robotic lobectomy had significantly reduced 30-day mortality (risk ratio =
0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95%
credible intervals, 0.36-0.71), pulmonary complications (risk ratio =
0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95%
credible intervals, 0.51-0.88), and overall complications (risk ratio =
0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95%
credible intervals, 0.67-0.91). Compared with video-assisted thoracic
surgery lobectomy, open lobectomy, and robotic lobectomy had a
significantly higher total number of harvested lymph nodes (mean
difference = 1.46; 95% credible intervals, 0.30, 2.64 and mean difference
= 2.18; 95% credible intervals, 0.52-3.92) and lymph nodes stations (mean
difference = 0.37; 95% credible intervals, 0.08-0.65 and mean difference =
0.93; 95% credible intervals, 0.47-1.40). Positive resection margin and
5-year overall survival were similar across treatments. Intraoperative
blood loss, postoperative transfusion, hospital length of stay, and 30-day
readmission were significantly reduced for minimally invasive approaches.
 Conclusion(s): Compared with open lobectomy, video-assisted thoracic
surgery lobectomy, and robotic lobectomy seem safer with reduced 30-day
mortality, pulmonary, and overall complications with equivalent oncologic
outcomes and 5-year overall survival. Minimally invasive techniques may
improve outcomes and surgeons should be encouraged, when feasible, to
adopt video-assisted thoracic surgery lobectomy, or robotic lobectomy in
the treatment of lung cancer. Copyright © 2020 Elsevier Inc.

<74>
Accession Number
2008037684
Title
Atrial Fibrillation and Transcatheter Repair of Functional Mitral
Regurgitation: Evidence From a Meta-Regression.
Source
JACC: Cardiovascular Interventions. 13 (20) (pp 2374-2384), 2020. Date of
Publication: 26 Oct 2020.
Author
Kaur S.; Sadana D.; Patel J.; Gad M.; Sankaramangalam K.; Krishnaswamy A.;
Miyasaka R.; Harb S.C.; Kapadia S.R.
Institution
(Kaur, Patel, Gad) Department of Internal Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Sadana) Department of Pulmonary and Critical Care, Cleveland Clinic,
Cleveland, OH, United States
(Sankaramangalam) Department of Internal Medicine, Saint Peter's
University Hospital/Rutgers Robert Wood Johnson Medical School, New
Brunswick, NJ, United States
(Krishnaswamy, Kapadia) Department of Interventional Cardiology, Cleveland
Clinic, Cleveland, OH, United States
(Miyasaka, Harb) Department of Cardiovascular Imaging, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The aim of this study was to assess the impact of atrial
fibrillation (AF) on mortality and efficacy in patients with functional
mitral regurgitation (FMR) undergoing MitraClip implantation.
 Background(s): AF is a common arrhythmia in patients with severe FMR
undergoing transcatheter mitral valve repair with the MitraClip device.
Although AF has been consistently shown to be associated with poor
outcomes after mitral valve surgery, the impact of AF on outcomes of
MitraClip placement in patients with FMR has not been well studied.
 Method(s): Prospective, retrospective registries, observational
studies, and randomized controlled trials on MitraClip reporting AF and
FMR as one of the variables from inception until January 2019 were
included. Result(s): Of the initial 1,694 studies, 15 studies met the
inclusion criteria. From a total of 5,184 patients, 2,105 patients were
identified to have FMR and AF. All-cause 30-day mortality in patients with
FMR was 3.7% (95% confidence interval: 2.87 to 4.66) and 1-year mortality
was 17.9% (95% confidence interval: 16.01 to 19.71). The meta-regression
analysis studying the impact of AF among patients with FMR treated with
the MitraClip demonstrated no difference in mortality at 30 days but
demonstrated significantly increased mortality at 1 year (95% confidence
interval: 0.0006 to 0.0027) (p = 0.004). AF did not influence procedural
success. Conclusion(s): This meta-regression identifies AF as an
independent negative predictor of long-term mortality after MitraClip
implantation in patients with FMR. The mechanism of worse outcomes in
patients with AF requires further study. Copyright © 2020
American College of Cardiology Foundation

<75>
Accession Number
2008037683
Title
Baseline Functional Capacity and Transcatheter Mitral Valve Repair in
Heart Failure With Secondary Mitral Regurgitation.
Source
JACC: Cardiovascular Interventions. 13 (20) (pp 2331-2341), 2020. Date of
Publication: 26 Oct 2020.
Author
Malik U.I.; Ambrosy A.P.; Ku I.A.; Mishell J.M.; Kar S.; Lim D.S.;
Whisenant B.K.; Cohen D.J.; Arnold S.V.; Kotinkaduwa L.N.; Lindenfeld J.;
Abraham W.T.; Mack M.J.; Stone G.W.
Institution
(Malik, Ambrosy, Ku, Mishell) Department of Cardiology, The Permanente
Medical Group, San Francisco, CA, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Whisenant) Intermountain Medical Center Heart Institute, Salt Lake City,
UT, United States
(Cohen, Arnold) University of Missouri-Kansas City School of Medicine,
Kansas City, MO, United States
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The aim of this study was to determine the prognostic utility
of baseline functional status and its impact on the outcomes of
transcatheter mitral valve repair (TMVr) in patients with heart failure
(HF) with secondary mitral regurgitation (SMR). Background(s): The
COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous
Therapy for Heart Failure Patients With Functional Mitral Regurgitation)
trial demonstrated that TMVr with the MitraClip in patients with HF with
moderate to severe or severe SMR improved health-related quality of life.
The clinical utility of a baseline assessment of functional status for
evaluating prognosis and identifying candidates likely to derive a robust
benefit from TMVr has not been previously studied in patients with HF with
SMR. Method(s): The COAPT study was a multicenter, randomized,
controlled, parallel-group, open-label trial of TMVr with the MitraClip
plus guideline-directed medical therapy (GDMT) versus GDMT alone in
patients with HF, left ventricular ejection fraction 20% to 50%, and
moderate to severe or severe SMR. Baseline functional status was assessed
by 6-min walk distance (6MWD). Result(s): Patients with 6MWD less
than the median (240 m) were older, were more likely to be female, and had
more comorbidities. After multivariate modeling, age (p = 0.005), baseline
hemoglobin (p = 0.007), and New York Heart Association functional class
III/IV symptoms (p < 0.0001) were independent clinical predictors of 6MWD.
Patients with 6MWD <240 m versus >=240 m had a higher unadjusted and
adjusted rate of the 2-year composite of all-cause death or HF
hospitalization (64.4% vs. 48.6%; adjusted hazard ratio: 1.53; 95%
confidence interval: 1.19 to 1.98; p = 0.001). However, there was no
interaction between baseline 6MWD and the relative effectiveness of TMVr
plus GDMT versus GDMT alone with respect to the composite endpoint (p =
0.633). Conclusion(s): Baseline assessment of functional capacity by
6MWD was a powerful discriminator of prognosis in patients with HF with
SMR. TMVr with the MitraClip provided substantial improvements in clinical
outcomes for this population irrespective of baseline functional
capacity. Copyright © 2020 American College of Cardiology
Foundation

<76>
Accession Number
2008037680
Title
NYHA Functional Classification and Outcomes After Transcatheter Mitral
Valve Repair in Heart Failure: The COAPT Trial.
Source
JACC: Cardiovascular Interventions. 13 (20) (pp 2317-2328), 2020. Date of
Publication: 26 Oct 2020.
Author
Giustino G.; Lindenfeld J.; Abraham W.T.; Kar S.; Lim D.S.; Grayburn P.A.;
Kapadia S.R.; Cohen D.J.; Kotinkaduwa L.N.; Weissman N.J.; Mack M.J.;
Stone G.W.
Institution
(Giustino, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University
College of Medicine, Columbus, OH, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Cohen) University of Missouri-Kansas City School of Medicine, Kansas
City, MO, United States
(Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Weissman) Georgetown University, Washington, DC, United States
(Mack) Baylor Scott and White Heart Hospital Plano, Plano, TX, United
States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate the outcomes of
MitraClip implantation versus guideline-directed medical therapy (GDMT) in
patients with secondary mitral regurgitation (SMR) according to baseline
functional status as assessed by the widely used New York Heart
Association (NYHA) functional classification. Background(s): Patients
with heart failure (HF) and impaired functional status at baseline have
poor prognosis. Whether the effects of transcatheter repair of secondary
SMR in patients with HF are influenced by baseline functional status is
unknown. Method(s): In the COAPT (Cardiovascular Outcomes Assessment
of the MitraClip Percutaneous Therapy for Heart Failure Patients with
Functional Mitral Regurgitation) trial, patients with HF with moderate to
severe or severe SMR who remained symptomatic despite maximally tolerated
GDMT were randomized to MitraClip implantation versus GDMT alone. Outcomes
were evaluated according to baseline functional status as assessed using
the NYHA functional classification. The primary endpoint of interest was
the rate of death or HF-related hospitalization (HFH) at 2 years in
time-to-first-event analyses. Result(s): Among 613 randomized
patients, 240 were in NYHA functional class II (39.2%), 322 were in NYHA
functional class III (52.5%), and 51 were in ambulatory NYHA functional
class IV (8.3%). Rates of death or HFH were progressively higher with
increasing NYHA functional class. Compared with GDMT alone, MitraClip
implantation resulted in lower 2-year rates of death or HFH consistently
in patients in NYHA functional class II (39.7% vs. 63.7%; hazard ratio
[HR]: 0.54; 95% confidence interval [CI]: 0.37 to 0.77), NYHA functional
class III (46.6% vs. 65.5%; HR: 0.60; 95% CI: 0.45 to 0.82), and NYHA
functional class IV (66.7% vs. 85.2%; HR: 0.55; 95% CI: 0.28 to 1.10;
p<inf>interaction</inf> = 0.86). Greater improvements in quality of life
at 2 years were observed in patients treated with the MitraClip compared
with GDMT irrespective of baseline functional status. Conclusion(s):
The NYHA functional classification provides prognostic utility in patients
with HF and moderate to severe or severe SMR. In the COAPT trial, the
benefits of MitraClip implantation were consistent in patients with better
or worse functional status as assessed by NYHA functional class.
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT
Trial] [COAPT]; NCT01626079) Copyright © 2020

<77>
Accession Number
2008423685
Title
Double-lumen oropharyngeal cannula for sedation in percutaneous aortic
valve implant with transesophageal echocardiography. Case report.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S18), 2020. Date of Publication:
October 2020.
Author
Neto C.N.; Abizaid A.; Junior J.A.P.; Nascimento V.T.N.S.; Siqueira D.;
Amin R.R.L.
Institution
(Neto, Abizaid, Junior, Nascimento, Siqueira, Amin) Hospital do Coracao -
HCOR, SaO Paulo, Brazil
Publisher
W.B. Saunders
Abstract
Introduction: The prevalence and severity of aortic valve disease
increases in the elderly population. Transfemoral transcatheter aortic
valve implantation (TAVI) has been gaining space as an alternative method
even in mild cases to conventional open aortic valve replacement surgery.
In many centers, conscious sedation as an alternative to general
anesthesia to these procedures. Therefore, the use transesophageal
echocardiography (TEE) is a concern when conscious sedation is performed.
In this case report, we describe for the first time the use of a
double-lumen oropharyngeal cannula to support sedation in a patient
undergoing TAVI and TEE monitoring. Method(s): Case report:
72-year-old male patient, 58kg, 178 cm tall, physical status ASA 3,
Euroescore II 1,81%, with severe aortic stenosis (Aortic valve orifice
area = 0.5cm2, maximum and mean gradient = 58mmHg and 31mmHg,
respectively) underwent elective percutaneous aortic valve implantation
with transfemoral vascular access. After standard monitoring, sedation was
started with intravenous infusion of dexmedetomidine and propofol titrated
to effect. The cannula was inserted right after loss of consciousness,
connecting one of its lines to the capnograph and the other one to the
supplemental oxygen source with a continuous flow of 3L/min. Right after,
TEE probe was passed through the cannula to the upper esophagus.(Figure 1)
A: CO2 exhaled line monitoring; B: O2 line administration; C: Lumen used
to keep a better patency of the airway during spontaneous ventilation; D:
Lumen used to pass the TEE probe. Throughout the procedure, patient was
maintained on spontaneous ventilation, maintaining BIS values below 60.
Data collection includes: ETCO2, mean arterial pressure, heart rate, BIS
values, SatO2 and arterial blood gases. The examiner was also questioned
subjectively the comfort of handling the TEE probe during the exam (easy,
moderate or difficult) and also checking for possible oral cavity trauma
due use of the cannula during procedure. Result(s): The procedure
went without any complications. No soft tissue lesions were found The
examiner considered the handling of the probe with the presence of the
cannula easy. Discussion(s): The oropharyngeal cannula was feasible
to support sedation in this patient for TAVI with TEE monitoring. However,
further studies with a larger number of patients and randomized trials
comparing different techniques are still needed to confirm our
results. Copyright © 2020

<78>
Accession Number
2008423667
Title
Effect of remote ischaemic conditioning on coagulation function as
measured by rotational thromboelastometry and whole blood impedance
aggregometry in off-pump coronary artery bypass surgery: a randomised
controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S14-S15), 2020. Date of
Publication: October 2020.
Author
Jung D.E.; Nam K.; Bahk J.; Jeon Y.
Institution
(Jung, Nam, Bahk, Jeon) Seoul National University Hospital, Department of
Anesthesiology and Pain Medicine, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Introduction: Remote ischaemic conditioning (RIC) has been shown to
prevent platelet activation during ablation for atrial fibrillation. In
the recent Remote Ischaemic Preconditioning with Postconditioning Outcome
trial, RIC was associated with more postoperative transfusion in the
off-pump coronary artery bypass graft surgery (OPCAB) subgroup. Transient
tourniquet application on the limb affects the coagulation system;
however, it remains unknown whether RIC affects the coagulation system
during OPCAB. Method(s): A total of 58 patients undergoing OPCAB were
randomised to the RIC or control group. In the RIC group, four cycles of 5
min of ischaemia and 5 min of reperfusion were applied twice to the upper
arm after the induction of anaesthesia (preconditioning), and after the
completion of coronary anastomoses (postconditioning). Whole blood
impedance aggregometry (Multiplate) and rotational thromboelastometry
(ROTEM) were performed before the induction of anaesthesia, at the end of
surgery, and at postoperative day 1. Result(s): The decrease in
whole-blood aggregation by adenosine diphosphate at the end of surgery was
greater in the RIC group than in the control group, but this effect was
not statistically significant (46.7 [21.4] vs. 45.8 [22.6] U, P=0.880). In
ROTEM analysis, the EXTEM area under the velocity curve was lower in the
RIC group than in the control group at the end of surgery (3,567
[1,399-5,794] vs. 5,693 [4,718-6,179] mm*100, respectively; P=0.03).
However, there was no difference in other Multiplate or ROTEM parameters.
An increased tendency of perioperative bleeding was identified in the RIC
group. Discussion(s): Although some parameters indicated a tendency
for hypocoagulation in the RIC group at the end of surgery, most effects
were not statistically significant. RIC does not significantly affect
perioperative platelet aggregability and coagulation in patients
undergoing OPCAB. Copyright © 2020

<79>
[Use Link to view the full text]
Accession Number
2008423660
Title
A comparison of volatile anaesthesia and total intravenous anaesthesia
(tiva) on outcome from cardiac surgery: a systematic review and
meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S22), 2020. Date of Publication:
October 2020.
Author
Beverstock J.; Park T.; Song C.C.A.; Alston R.P.; Claxton A.; Sharkey T.;
Hutton S.; Fathers J.; Cawley W.
Institution
(Beverstock, Park, Song, Alston, Claxton, Sharkey, Hutton, Fathers,
Cawley) College of Medicine and Veterinary Medicine, University of
Edinburgh, Edinburgh, United Kingdom
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: Previous research has suggested that volatile anaesthetics
may exert a cardioprotective effect on patients undergoing cardiac
surgery. Despite there being many randomised controlled trials (RCTs)
comparing volatile anaesthesia to TIVA, recent systematic reviews and
meta-analyses have failed to reach a consensus on whether its use results
in improved clinical outcomes. The primary objective of this study was to
compare one-year mortality in adult patients undergoing cardiac surgery
with either volatile anaesthesia or TIVA. Secondary objectives were to
compare in-hospital and 30-day mortality, postoperative levels of creatine
kinase (CK-MB) and cardiac troponin, and durations of tracheal intubation,
intensive care unit (ICU) and hospital stays. Method(s): A systematic
search of bibliographic databases returned 37 RCTs that met predetermined
criteria for inclusion in this study. Data on mortality; cardiac troponin
and CK-MB levels 24 h postoperatively; time to tracheal extubation;
durations of stays in ICU and hospital was extracted from these for
meta-analysis in RevMan5. Results are presented as mean differences or
odds ratios with 95% confidence intervals. Result(s): Meta-analysis
found no statistically significant difference between the two anaesthetic
groups in incidence of mortality, cardiac troponin and CK-MB levels 24 h
postoperatively or time to tracheal extubation (Table 1). While length of
ICU stay initially appeared statistically significant, after applying
Bonferroni's correction it was not. However, a significant reduction in
the durations of hospital stay of patients in the volatile anaesthesia
group was found. Copyright © 2020

<80>
[Use Link to view the full text]
Accession Number
2008423659
Title
Hemodynamic effects of levosimendan in cardiac surgery patients: a
systemic review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S24), 2020. Date of Publication:
October 2020.
Author
Terbeck S.; Friess J.O.; Gunsch D.P.; Heinisch P.P.; Lenz A.; Carrel T.;
Eberle B.; Erdos G.
Institution
(Terbeck, Friess, Gunsch, Eberle, Erdos) Department of Anaesthesiology and
Pain Medicine, Inselspital, Bern University Hospital, University of Bern,
Bern, Switzerland
(Heinisch, Lenz, Carrel) Department of Cardiovascular Surgery,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
Publisher
W.B. Saunders
Abstract
Introduction: Levosimendan is a potent inodilator agent. The net effect of
haemodynamic changes may result in a hyperdynamic state with low systemic
vascular resistance. To assess the haemodynamic effects in cardiac surgery
patients treated with levosimendan we conducted a systemic review. Our
hypothesis was that levosimendan improves cardiac function, but also
triggers a systemic vasodilatation. Method(s): Systematic review with
meta-analysis. English-language literature with access to full texts and
supplements in US National Library of Medicine (PUBMED), MEDLINE, EMBASE,
and CENTRAL was searched systematically from 2006 until July 2018.
Included randomized controlled trials, case-matched or retrospective
studies providing at least two sequentially measured haemodynamic
variables in adult patients undergoing cardiac surgery with cardio
pulmonary bypass and treated with levosimendan in comparison to
alternative drugs or devices. Result(s): Cardiac index significantly
increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardised
mean difference (95% CI); p = 0.003] from baseline to postoperative day
(POD) 1, and by 0.75 (0.25 to 1.25; p = 0.003) from baseline to POD 7,
when corrected for the standardized mean difference (SMD) at baseline by a
multivariate mixed effects meta-analysis model. With the correction for
baseline differences, other haemodynamic variables, especially the
systemic vascular resistance did not significantly differ until POD 1
[-0.17 (-0.64 to 0.30), p=0.48] and POD 7 [-0.13 (-0.61 to 0.34), p=0.58]
between the levosimendan and the comparator group. Discussion(s):
Levosimendan increased cardiac index in patients undergoing cardiac
surgery. Although levosimendan has inodilator properties, this
meta-analysis finds no clinical evidence that levosimendan produces
vasopressor-resistant vasoplegic syndrome. Hypotension seems not to be
statistically relevant. Copyright © 2020

<81>
Accession Number
2008423655
Title
Adding objectivity to submaximal exercise testing by assessment of heart
rate recovery-a healthy volunteer study - II (SEARCH-II).
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S15-S16), 2020. Date of
Publication: October 2020.
Author
Minhas H.; Morton C.; Shelley B.
Institution
(Minhas, Morton, Shelley) University of Glasgow, Academic Unit of
Anaesthesia, Glasgow, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: Exercise testing is a widely used preoperative risk
assessment tool in thoracic and vascular surgery. Submaximal exercise
tests (SETs) offer an easier to conduct and better tolerated alternative
to 'maximal' cardiopulmonary exercise testing (1). Quantifying heart rate
recovery (HRR) is a potentially objective method of assessing
cardiopulmonary fitness following SETs. HRR1 and HRR2 (calculated as heart
rate (HR) on exercise cessation minus HR at 1 and 2 minutes of rest) are
commonly used methods for quantifying HRR, however previous work indicates
they may be effort dependent (2,3). This study assessed the
reproducibility of a novel effort correction of HRR1 and HRR2 across
different modes of SET. Method(s): Thirty-one healthy volunteers
underwent three SETs of differing modalities in a randomised order; Bike,
Step and Walk test. Individuals on beta blockers or with contraindications
for exercise testing were excluded. HR was measured at 30 second intervals
for 6 minutes of rest following cessation of exercise. HRR was quantified
using HRR1 and HRR2. Effort corrected (EC) versions were produced by
dividing raw HRR1 and HRR2 by the effort ratio (HR on exercise cessation
divided by age-predicted maximum HR). Reproducibility was assessed by
calculating Pearson's correlation coefficient (r) and the intra-class
correlation coefficient (ICC). Result(s): The median age of the study
population was 26 (range 18 - 74) years with 16.1% of the population
possessing chronic co-morbidities. Raw HRR1 and HRR2 demonstrated poor
reproducibility across all three comparisons. Effort correction improved
the reproducibility HRR1, showing moderate reproducibility. Despite a
modest improvement, the reproducibility of EC-HRR2 remained poor (Table
1.) Discussion: Effort correction improved the reproducibility of both
HRR1 and HRR2 suggesting EC methods may be a superior way of quantifying
HRR. Further work is required to explore the effect of differing exercise
times on reproducibility of novel EC methods for quantifying HRR.
Ascertaining this will allow adoption of a standardised protocol for SETs.
Future work could be to assess the use of novel EC methods as
perioperative risk predictors in patient cohorts. Copyright ©
2020

<82>
Accession Number
2008423644
Title
Extracorporeal hemadsorption versus glucocorticoids during cardiopulmonary
bypass: a prospective, randomized, controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S25), 2020. Date of Publication:
October 2020.
Author
Stupica G.T.; Sostaric M.; Bosnic Z.; Podbregar M.
Institution
(Stupica, Sostaric, Podbregar) University Medical Center, Clinical
department of anesthesiology and perioperative intensive therapy,
Ljubljana, Slovenia
(Sostaric, Podbregar) University of Ljubljana, Faculty of Medicine,
Ljubljana, Slovenia
(Bosnic) University of Ljubljana, Faculty of Computer and Information
Science, Ljubljana, Slovenia
(Podbregar) General and teaching hospital, Department of internal
intensive medicine, Celje, Slovenia
Publisher
W.B. Saunders
Abstract
Introduction: Cardiopulmonary bypass (CPB) surgery initiates systemic
inflammatory response syndrome, which in 2-10% of all cases can be
considerably severe. This complex chain of events might contribute to the
development of postoperative complications. Different therapeutic
interventions that can reduce inflammatory reactions during CPB have been
used, in hope for improvement of patient outcome after open-heart surgery.
Extracorporeal hemadsorption might reduce the inflammatory reaction in CPB
surgery. Glucocorticoids, on the other hand, have been used for years
during open-heart surgery for alleviation of systemic inflammation after
CPB. We compared intraoperative hemadsorption and methylprednisolone, with
usual care, during complex cardiac surgery on CPB, for inflammatory
responses, hemodynamics, and perioperative course. Method(s):
Seventy-six patients with prolonged CPB were recruited and randomized,
with 60 included in the final analysis. The allocation was into three
groups: Methylprednisolone group (n=20; 1g of methylprednisolone added in
CPB priming solution), Cytosorb group (n=20; CytoSorb adsorber,
Cytosorbents Europe GmbH, Germany, installed in CPB circuit), and Control
group (n=20, usual care, neither methylprednisolone nor CytoSorb during
CPB). Pro-inflammatory (TNF-a, IL-1b, IL-6, IL-8) and anti-inflammatory
(IL-10) cytokines, complement C5a, CD64 and CD163 expression by immune
cells were analyzed within the first five postoperative days, in addition
to hemodynamic and clinical outcome parameters. Result(s):
Methylprednisolone group, compared to Cytosorb and Control, had
significantly lower levels of TNF-a (until end of the surgery, p<0.001),
IL-6 (until 48h post-surgery, p<0.001) and IL-8 (until 24h post-surgery,
p<0.016). CD64 expression on monocytes was highest in the Cytosorb group
and lasted until 5. postoperative day (p<0.016). IL-10 concentration
(until end of surgery) and CD163 expression on monocytes (until 48h
post-surgery) were highest in the Methylprednisolone group (p<0.016, for
all measurements between three groups). No differences between groups in
cardiac index or clinical outcome parameters were found.
 Discussion(s): In this clinical trial, we have confirmed that
intraoperative use of a median dose of methylprednisolone during CPB more
effectively ameliorates systemic inflammatory responses after adult
cardiac surgery. This is seen by reductions in pro-inflammatory and
increases in anti-inflammatory mediators when compared to both uses of
CytoSorb adsorber for hemadsorption and usual treatment (Control).
However, methylprednisolone did not provide better short-term clinical
outcome. Hemadsorption itself, compared with usual care, caused higher
prolonged expression of CD64 on monocytes and higher expression of CD163
on granulocytes, which only lasted until end of surgery. The use of
CytoSorb adsorber seems to be safe and well-tolerated. We haven't observed
an association between its application and significant thrombocytopenia or
more significant decrease in albumin concentration. Copyright ©
2020

<83>
Accession Number
2008423643
Title
Glucose-Insulin-potassium (GIK) Morbidity and mortality effects in cardiac
surgery: a systematic review and meta-analysis of randomized trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S40-S41), 2020. Date of
Publication: October 2020.
Author
Schorer R.; Putzu A.; Keli-Barcelos G.; Licker M.J.
Institution
(Schorer, Putzu, Keli-Barcelos, Licker) Geneva University Hospitals,
Geneva, Switzerland
Publisher
W.B. Saunders
Abstract
Introduction: Although experimental studies strongly support the
cardioprotective effects of glucose-insulin-potassium (GIK) infusion,
clinical trials have yielded mixed results due to the heterogeneity of
patient populations as well as varying GIK administration patterns. An
updated systematic review and meta-analysis were conducted to assess the
impact of GIK treatment on postoperative complications in patients
undergoing on- or off-pump cardiac surgery. Method(s): We searched
MEDLINE, Embase and the Cochrane Central Register without language
restrictions for studies from inception to March, 2020. We included
randomized controlled trials that compared GIK infusion as
cardioprotective measure to conventional treatment or placebo in adults
undergoing on- or off-pump cardiac surgery. Postoperative myocardial
infarct (PMI) was the main study endpoint; secondary outcomes were
in-hospital mortality, postoperative complications, as well as duration of
mechanical ventilation, intensive care stay and hospital stay.
Postoperative glycemia and cardiac index were also examined. The study was
registered with PROSPERO (NdegreeCRD42019117728). We computed risk ratios
(RR) or mean differences (MD) with 95% confidence intervals (CI) and
heterogeneity was estimated using I2 statistic. Result(s):
From 47 studies, 5'872 participants were pooled for meta-analysis. The
incidence of PMI was 5.9% and 8.3% in the GIK and Control groups,
respectively (n = 20, RR [95% CI] = 0.83 [0.65 to 1.04] I2 =
0). Compared to control treatment, GIK infusion was associated with lower
hospital mortality (n = 19, RR [95%CI] = 0.64 [0.43 to 0.97],
I2 = 0), reduced acute kidney injury (n = 6, RR [95%CI] = 0.59
[0.4 to 0.87, I2 = 0), fewer atrial fibrillation (n = 23, RR
[95%CI] = 0.75 [0.6 to 0.94], I2 = 0.58), as well as a shorter
duration of mechanical ventilation (n = 14, MD [95%CI] = -1.77 [-3.04 to
-0.49] hours, I2 = 0.96), shorter stay in intensive care (n =
20, MD [95%CI] = -5.39 [-9.34 to -1.44] hours, I2 = 0.99) and
faster hospital discharge (n = 19, MD [95%CI] = -0.84 [-1.6 to -0.08]
days, I2 = 0.95). Discussion(s): A recent systematic
review and meta-analysis restricted to part of the literature published on
the topic since 2000 concluded to a strong effect of GIK on PMI [1]. While
the analysis of our augmented corpus of literature did not find any such
association in patients undergoing cardiac surgery, perioperative
administration of GIK was associated with improved postoperative clinical
outcomes as reflected by lower in-hospital mortality and morbidity as well
as lesser utilization of hospital resources. Further clinical studies are
warranted to ascertain the effectiveness of GIK in minimizing myocardial
injuries and to explore the specific dosage and timing of GIK
infusion. Copyright © 2020

<84>
[Use Link to view the full text]
Accession Number
2008423642
Title
Impact of pulmonary artery catheter hemodynamic monitoring on
post-operative morbidity and mortality in elective bentall procedures.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S47), 2020. Date of Publication:
October 2020.
Author
Pasquier V.; Deletombe B.; Bedague D.; Albaladejo P.; Durand M.
Institution
(Pasquier, Deletombe, Bedague, Albaladejo, Durand) Centre Hospitalier
Universitaire Grenoble Alpes, Grenoble, France
Publisher
W.B. Saunders
Abstract
Introduction: Because of debated effectiveness and safety, the
perioperative use of pulmonary artery catheter (PAC) has decreased in
cardiac surgery (1). However, PAC keeps some specifics indications in high
risk cardiac surgery (2). This study evaluates the impact of perioperative
PAC monitoring on postoperative morbidity and mortality after Bentall
procedures. Method(s): We designed a single center retrospective
observational study comparing patients undergoing Bentall procedure with
or without perioperative CAP monitoring. Patients included had no major
risk of hemodynamic complications (Left ventricular ejection fractions
(LVEF) > 40%, no pulmonary arterial hypertension, no history of cardiac
surgery). Primary endpoint was a composite criteria of postoperative
morbidities and mortality defined by the occurrence of any the following:
death in hospital, cardiac dysfunction (myocardial infarction or
congestive heart failure), cerebral dysfunction (stroke or
encephalopathy), renal dysfunction (acute kidney injury or dialysis), or
pulmonary dysfunction (acute respiratory distress syndrome). Epidemiology
of CAP use, others postoperative complications, biological markers
(lactates, troponin), hemodynamic management and length of stay in
intensive care unit (ICU) and hospital were also assessed. Result(s):
Among the 134 patients enrolled between 2012 and 2019, the primary
endpoint occurred in 29 of 59 PAC patients vs. 17 of 75 patients without
PAC (49.2%, 95% confidence interval (CI), 37-62, vs 22.7%, 95% CI, 15-33;
P<0.01). The PAC group had an increased risk of cardiac (22% vs 2.7%,
P<0.01) and cerebral dysfunction (22% vs 6.7%, P=0.02). No difference was
found between patients with and without PAC for hospital mortality (1.7%
in PAC group vs 0%, P=0.44), renal (33.9% in PAC group vs 18.7%, P=0.07)
and pulmonary dysfunction (1.7% in PAC group vs 0%, P=0.44). PAC patients
were significantly older (65.5 vs 59.7 years old, P<0.01), had higher
EuroSCORE 2 (2.7 vs 1.8, P=0.02) and a lower LVEF (57.7% vs 65.1%,
P<0.01). In PAC group, we also founded more frequent postoperative use of
Dobutamine (35.6% vs 4%, P<0.01), Norepinephrine (61% vs 33.3%, P<0.01)
and first 24 hours volume expansion (69.5% vs 46.7%, P=0.01). In PAC
patients, the length of stay in ICU (4.9 days vs 3.2 without PAC, P=0.01)
and in hospital (15.9 days vs 11.9 without PAC, P<0.01) were significantly
higher. In multivariate logistic regression analysis, with independent
factors (CAP use, length of cardiopulmonary bypass, EuroSCORE 2), CAP use
was not associated with the occurrence of primary endpoint (adjusted odds
ratio 2.07, 95% CI [0.9-4.7], P=0.08). Discussion(s): In our study, a
PAC was used in a highest risk group. The use of PAC was associated with
increased postoperative mortality and morbidity in univariate but not in
multivariate analysis. A randomized clinical trial is needed to clarify
the link between CAP use and postoperative complications. Copyright
© 2020

<85>
[Use Link to view the full text]
Accession Number
2008423641
Title
Cardiac output monitoring with uncalibrated pulse contour method
(PROAQT/PULSIOFLEX) after major cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S45-S46), 2020. Date of
Publication: October 2020.
Author
Esteve C.; Guillet L.; Moury P.H.; Durand M.; Albaladejo P.
Institution
(Esteve, Guillet, Moury, Durand, Albaladejo) CHU Grenoble Alpes, Grenoble,
France
Publisher
W.B. Saunders
Abstract
Introduction: The ProAQT/Pulsioflex (PF) is an arterial pressure-derived
continuous cardiac output monitoring technique. This study aimed to
evaluate the PF after major cardiac surgery. Method(s): This was an
ancillary study of the SUCCES study (clinical trial number: 02782520), a
prospective randomized study whose purpose was to compare the hemodynamic
effect of a fluid challenge with hypertonic saline or lactated Ringer's.
Inclusion criteria were patients requiring a Swan-Ganz catheter (SGc) for
cardiac surgery and requiring fluid challenge during the postoperative
period. Cardiac index (CI) was monitored simultaneously in patients by the
PF or by an SGc continuous thermodilution. Statistical analysis was
performed using linear regression and Bland-Altman analysis. Intermethod
agreement during volume expansion was assessed using the Kappa statistic.
 Result(s): The data of 22 patients were reviewed. We analyzed 12,734
pairs of measurements. CI values were slightly but significantly different
between the SGc system (2.52 +/- 0.52, 95% confidence interval of the
mean: 2.51-2.53 L/min/m2) and the PF (2.58 +/- 0.72, 95%
confidence interval of the mean: 2.57-2.59 L/min/m2), p <
0.001. The correlation coefficient was R = 0.86 (95% confidence interval =
0.84 to 0.88, p <0.001), the bias was -0.06 L/min, and limits of agreement
were -1.18 to 1.05 L/min, with a percentage of error of 44%. Response to
volume expansion was considered as positive for 12 (75%) cases in the SGc
group and for 2 (12%) cases in the PF group (weighted Kappa -0.09; 95%
confidence interval = -0.35 to 0.17). Discussion(s): The concordance
between PF and SGc is moderate after cardiac surgery. The PF did not
correctly track changes in CI during fluid expansion. Copyright ©
2020

<86>
Accession Number
2008423610
Title
Use of a new human fibrinogen concentrate (FIBRYGA) In cardiac surgeries:
first real-world experience in France based on temporary authorization.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 35th EACTA
Annual Congress. 34 (Supplement 1) (pp S43-S44), 2020. Date of
Publication: October 2020.
Author
Stephan F.; Gutermann L.; Pennetier M.; Djabarouti S.; Fardini Y.; Clerson
P.; Belmokhtar C.; Hebert G.
Institution
(Stephan) Unite de soin intensif, Hopital Marie Lannelongue, Le Plessis
Robinson, France
(Gutermann, Hebert) Service Pharmacie et Sterilisation, Hopital Marie
Lannelongue, Le Plessis Robinson, France
(Pennetier) Pharmacie Clinique, Hotel Dieu, Nantes, France
(Djabarouti) Service des Produits de Sante en Essais Cliniques, Hopital
Haut-Leveque - Groupe Hospitalier Sud, Pessac, France
(Fardini, Clerson) Soladis Clinical Studies, Roubaix, France
(Belmokhtar) Octapharma France, Boulogne-Billancourt, France
Publisher
W.B. Saunders
Abstract
Introduction: The objective of the study was to describe the conditions of
use of FIBRYGA 1g, a new, highly purified, human fibrinogen concentrate
(HFC) recently granted a temporary import authorization for use in
congenital and acquired fibrinogen deficiencies in France. Method(s):
Observational, non-interventional, non-comparative, retrospective study
conducted in 3 French hospital centres using FIBRYGA. Data from patients
with fibrinogen deficiency having received FIBRYGA from December 2017 to
July 2019 were retrieved from their medical files. Indications,
modalities, efficacy and safety outcomes were recorded. Indications
presented here encompassed bleeding during cardiac surgery (SB) or
administration to prevent bleeding during cardiac surgery. Treatment
success was defined as control of the bleeding or haemoglobin loss <20%
for bleeding treatment and as absence of major perioperative haemorrhage
for pre-surgical prevention. Result(s): This analysis included 52
patients who underwent cardiac surgery (aortic dissection repair, aortic
surgery, cardiac valvuloplasty, coronary bypass, complex aortic surgery or
heart transplantation). Patients were aged 64.9 +/- 12.3 years and 69%
were male. All presented an acquired fibrinogen deficiency requiring
administration of HFC. Indications were SB (n=26, 50%) and prevention of
SB (n=26, 50%). Mean total doses of HFC were 1.85 +/- 0.97 g for SB and
2.27 +/- 1.37 g for prevention of SB. Success rates were 100% (95%
confidence interval [CI] 100 -100%] and 92.3% [95%CI 82.1-100%]
respectively. Overall tolerance was good. Discussion(s): The use of
FIBRYGA was associated with favourable efficacy outcomes in cardiac
surgery. As recently shown in a randomized control trial, these real-world
data supported the place of HFC as an alternative from cryoprecipitate for
the management of bleedings in patients with acquired hypofibrigenemia in
cardiac surgery. Copyright © 2020

<87>
Accession Number
2008418492
Title
An invited commentary "Effect of acute normovolemic hemodilution on
coronary artery bypass grafting: A systematic review and meta-analysis of
22 randomized trials".
Source
Annals of Medicine and Surgery. 60 (pp 173-174), 2020. Date of
Publication: December 2020.
Author
Hua Lei C.; Wedam Atogebania J.
Institution
(Hua Lei) Department of Surgery, The Second Affiliated Hospital of Hainan
Medical University, Hainan-Haikou 570311, China
(Wedam Atogebania) Department of Surgery, The First Affiliated Hospital of
Hainan Medical University, Haikou 570100, China
Publisher
Elsevier Ltd

<88>
Accession Number
2008414201
Title
Redevelopment and validation of the SYNTAX score II to individualise
decision making between percutaneous and surgical revascularisation in
patients with complex coronary artery disease: secondary analysis of the
multicentre randomised controlled SYNTAXES trial with external cohort
validation.
Source
The Lancet. 396 (10260) (pp 1399-1412), 2020. Date of Publication: 31 Oct
2020.
Author
Takahashi K.; Serruys P.W.; Fuster V.; Farkouh M.E.; Spertus J.A.; Cohen
D.J.; Park S.-J.; Park D.-W.; Ahn J.-M.; Kappetein A.P.; Head S.J.; Thuijs
D.J.; Onuma Y.; Kent D.M.; Steyerberg E.W.; van Klaveren D.
Institution
(Takahashi) Department of Cardiology, Amsterdam Universities Medical
Centers, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Serruys, Onuma) Department of Cardiology, National University of Ireland,
Galway, Ireland
(Fuster) Zena and Michael Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Fuster) Centro Nacional De Investigaciones Cardiovasculares Carlos III,
Madrid, Spain
(Farkouh) Peter Munk Cardiac Centre and The Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Spertus, Cohen) University of Missouri-Kansas City, Kansas City, MO,
United States
(Park, Park, Ahn) Department of Cardiology, Asan Medical Center, Seoul,
South Korea
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(van Klaveren) Department of Public Health, Erasmus University Medical
Centre, Rotterdam, Netherlands
(Kent) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, MA, United States
(Steyerberg) Department of Biomedical Data Sciences, Leiden, Netherlands
(Steyerberg) University Medical Centre, Leiden, Netherlands
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Randomised controlled trials are considered the gold standard
for testing the efficacy of novel therapeutic interventions, and typically
report the average treatment effect as a summary result. As the result of
treatment can vary between patients, basing treatment decisions for
individual patients on the overall average treatment effect could be
suboptimal. We aimed to develop an individualised decision making tool to
select an optimal revascularisation strategy in patients with complex
coronary artery disease. Method(s): The SYNTAX Extended Survival
(SYNTAXES) study is an investigator-driven extension follow-up of a
multicentre, randomised controlled trial done in 85 hospitals across 18
North American and European countries between March, 2005, and April,
2007. Patients with de-novo three-vessel and left main coronary artery
disease were randomly assigned (1:1) to either the percutaneous coronary
intervention (PCI) group or coronary artery bypass grafting (CABG) group.
The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox
regression to develop a clinical prognostic index for predicting death
over a 10-year period, which was combined, in a second stage, with
assigned treatment (PCI or CABG) and two prespecified effect-modifiers,
which were selected on the basis of previous evidence: disease type
(three-vessel disease or left main coronary artery disease) and anatomical
SYNTAX score. We used similar techniques to develop a model to predict the
5-year risk of major adverse cardiovascular events (defined as a composite
of all-cause death, non-fatal stroke, or non-fatal myocardial infarction)
in patients receiving PCI or CABG. We then assessed the ability of these
models to predict the risk of death or a major adverse cardiovascular
event, and their differences (ie, the estimated benefit of CABG versus PCI
by calculating the absolute risk difference between the two strategies) by
cross-validation with the SYNTAX trial (n=1800 participants) and external
validation in the pooled population (n=3380 participants) of the FREEDOM,
BEST, and PRECOMBAT trials. The concordance (C)-index was used to measure
discriminative ability, and calibration plots were used to assess the
degree of agreement between predictions and observations. Finding(s):
At cross-validation, the newly developed SYNTAX score II, termed SYNTAX
score II 2020, showed a helpful discriminative ability in both treatment
groups for predicting 10-year all-cause deaths (C-index=0.73 [95% CI
0.69-0.76] for PCI and 0.73 [0.69-0.76] for CABG) and 5-year major adverse
cardiovascular events (C-index=0.65 [0.61-0.69] for PCI and C-index=0.71
[0.67-0.75] for CABG). At external validation, the SYNTAX score II 2020
showed helpful discrimination (C-index=0.67 [0.63-0.70] for PCI and
C-index=0.62 [0.58-0.66] for CABG) and good calibration for predicting
5-year major adverse cardiovascular events. The estimated treatment
benefit of CABG over PCI varied substantially among patients in the trial
population, and the benefit predictions were well calibrated.
 Interpretation(s): The SYNTAX score II 2020 for predicting 10-year
deaths and 5-year major adverse cardiovascular events can help to identify
individuals who will benefit from either CABG or PCI, thereby supporting
heart teams, patients, and their families to select optimal
revascularisation strategies. Funding(s): The German Heart Research
Foundation and the Patient-Centered Outcomes Research
Institute. Copyright © 2020 Elsevier Ltd

<89>
Accession Number
2008417187
Title
Meta-Analysis of Bioprosthetic Valve Thrombosis After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Rheude T.; Pellegrini C.; Stortecky S.; Marwan M.; Xhepa E.; Ammon F.;
Pilgrim T.; Mayr N.P.; Husser O.; Achenbach S.; Windecker S.; Cassese S.;
Joner M.
Institution
(Rheude, Pellegrini, Xhepa, Cassese, Joner) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Stortecky, Pilgrim, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Marwan, Ammon, Achenbach) Department of Cardiology,
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
(Husser) Klinik fur Innere Medizin I, Kardiologie, St. Johannes-Hospital
Dortmund, Dortmund, Germany
(Mayr) Institut fur Anasthesiologie, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Joner) DZHK (German Centre for Cardiovascular Research), Munich Heart
Alliance, Munich, Germany
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Bioprosthetic valve thrombosis may complicate transcatheter aortic valve
implantation (TAVI). This meta-analysis sought to evaluate the prevalence
and clinical impact of subclinical leaflet thrombosis (SLT) and clinical
valve thrombosis (CVT) after TAVI. We summarized diagnostic strategies,
prevalence of SLT and/or CVT and estimated their impact on the risk of
all-cause death and stroke. Twenty studies with 12,128 patients were
included. The prevalence of SLT and CVT was 15.1% and 1.2%, respectively.
The risk of all-cause death was not significantly different between
patients with SLT (relative risk [RR] 0.77; p = 0.22) and CVT (RR 1.29; p
= 0.68) compared with patients without. The risk of stroke was higher in
patients with CVT (RR 7.51; p <0.001) as compared with patients without,
while patients with SLT showed no significant increase in the risk of
stroke (RR 1.81; p = 0.17). Reduced left ventricular function was
associated with increased prevalence, while oral anticoagulation was
associated with reduced prevalence of bioprosthetic valve thrombosis.
Bioprosthetic valve thrombosis is frequent after TAVI, but does not
increase the risk of death. Clinical valve thrombosis is associated with a
significantly increased risk of stroke. Future studies should focus on
prevention and treatment of bioprosthetic valve thrombosis. Copyright
© 2020 Elsevier Inc.

<90>
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.
 Design(s): Subgroup analysis of a randomized clinical trial.
 Setting(s): Tertiary hospital. Participant(s): Patients weighing
between seven and 15 kg. Intervention(s): None. 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.
 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. Copyright © 2020 Elsevier Inc.

<91>
Accession Number
633132939
Title
Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic
Valve Implantation for Aortic Stenosis and Porcelain Aorta with a
Systematic Review of Transfemoral versus Transapical Approach.
Source
Thoracic and Cardiovascular Surgeon. 68 (7) (pp 623-632), 2020. Date of
Publication: 01 Oct 2020.
Author
Useini D.; Haldenwang P.; Schlomicher M.; Christ H.; Naraghi H.;
Moustafine V.; Strauch J.
Institution
(Useini, Haldenwang, Schlomicher, Naraghi, Moustafine, Strauch) Department
of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil,
Buerkle-de-la-Camp-Platz-1, Bochum 44789, Germany
(Christ) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background aWe have aimed to analyze early and mid-term outcomes of
patients undergoing transapical/transfemoral transcatheter aortic valve
implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo)
in our institution. Additionally, we postulated that the TA approach may
be associated with a more favorable neurological outcome than the TF
approach; hence, a systematic literature review was conducted. Methods
aBetween 2011 and 2017, 15 patients with PAo underwent TA-TAVI and 4
patients with PAo TF-TAVI at our institution. The assessment of PAo was
done either intraoperatively after aborted sternotomy or via computed
tomography for elective TAVI. We conducted mid-term follow-up.
Furthermore, a systematic review was performed to compare the mortality
and neurological outcomes of TF and TA-TAVI approaches. Results
aTA/TF-TAVIs were performed with 100% device success, without paravalvular
leakage >= 2 and without procedural death. The 30-day mortality/stroke
rates were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The
6-month, 1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%,
82%/66.6%, and 50%/0%, respectively. The pooled results derived from the
literature review were as follows: The prevalence of PAo in the TAVI
population is 9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI
versus 16.2% in TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI
versus 6.3% in TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9%
in TF-TAVI. Conclusion aTA-TAVI shows promising early and mid-term
outcomes in patients with PAo. TF-TAVI performed in patients with PAo is
likely to be associated with higher rates of stroke than
TA-TAVI. Copyright © 2020 Georg Thieme Verlag. All rights
reserved.

<92>
Accession Number
2007883806
Title
Meta-Analysis Comparing Angiography-Guided Versus FFR-Guided Coronary
Artery Bypass Grafting.
Source
American Journal of Cardiology. 135 (pp 184-185), 2020. Date of
Publication: 15 Nov 2020.
Author
Changal K.; Patel M.; Salman F.N.U.; Nazir S.; Gupta R.
Institution
(Changal, Nazir, Gupta) Department of Cardiovascular Medicine, University
of Toledo, OH, United States
(Patel) Department of Medicine, University of Toledo, OH, United States
(Salman) Department of Medicine, Mercy Health St. Vincent Medical Center,
Toledo, OH, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)

<93>
Accession Number
2005290381
Title
High-flow nasal cannula vs conventional oxygen therapy for
postcardiothoracic surgery.
Source
Respiratory Care. 65 (11) (pp 1730-1737), 2020. Date of Publication: 2020.
Author
Wang Y.; Huang D.; Ni Y.; Liang Z.
Institution
(Wang, Huang, Ni, Liang) Department of Respiratory and Critical Care
Medicine, West China School of Medicine and West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Publisher
American Association for Respiratory Care (E-mail: info@aarc.org)
Abstract
BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is widely used
in extubated patients. We aim to evaluate the effect of HFNC compared with
conventional oxygen therapy in adults after cardiothoracic surgery.
 METHOD(S): We conducted a literature search in PubMed, Embase, and
ClinicalTrials for randomized controlled trials that compared HFNC with
conventional oxygen therapy in extubated patients after cardiothoracic
surgery. RESULT(S): Eight studies with 1,086 subjects were included.
Compared with conventional oxygen therapy, HFNC was associated with a
significant reduction in the need for escalation of respiratory support
(risk ratio 0.40, 95% CI 0.26-0.61, P <.001), re-intubation rate (risk
ratio 0.35, 95% CI 0.13-0.96, P 5.04), and length of hospital stay (mean
difference -0.48, 95% CI -0.95 to -0.01, P 5.05). No significant
differences were found for the length of ICU stay (mean difference -0.09,
95% CI -0.21 to -0.04, P 5.18), pulmonary complications (risk ratio 0.85,
95% CI 0.48-1.48, P 5.56), or mortality rate (risk ratio 0.54, 95% CI
0.12-2.53, P 5.44). CONCLUSION(S): HFNC may significantly reduce the
need for the escalation of respiratory support and re-intubation rate, and
might reduce the hospital stay. More high-quality randomized controlled
trials are needed to further validate our results. Copyright ©
2020 Daedalus Enterprises.

<94>
Accession Number
633261873
Title
Atrial nitroso-redox balance and refractoriness following on-pump cardiac
surgery: A randomised trial of atorvastatin.
Source
Cardiovascular research. (no pagination), 2020. Date of Publication: 24
Oct 2020.
Author
Jayaram R.; Jones M.; Reilly S.; Crabtree M.J.; Pal N.; Goodfellow N.;
Nahar K.; Simon J.; Carnicer R.; DeSilva R.; Ratnatunga C.; Petrou M.;
Sayeed R.; Roalfe A.; Channon K.M.; Bashir Y.; Betts T.; Hill M.; Casadei
B.
Institution
(Jayaram, Reilly, Crabtree, Pal, Goodfellow, Nahar, Simon, Carnicer,
Channon, Casadei) Division of Cardiovascular Medicine, Radcliffe
Department of Medicine, University of Oxford, Oxford, United Kingdom
(Jones, Bashir, Betts) Cardiology, Oxford Heart Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(DeSilva, Ratnatunga, Petrou, Sayeed) Cardiothoracic Surgery, Oxford Heart
Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United
Kingdom
(Roalfe) Nuffield Department of Primary Care Health Sciences, University
of Oxford, United Kingdom
(Hill) Clinical Trial Service Unit, Nuffield Department of Population
Health, University of Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: Systemic inflammation and increased activity of atrial
NOX2-containing NADPH oxidases have been associated with the new onset of
atrial fibrillation (AF) after cardiac surgery. In addition to lowering
LDL-cholesterol, statins exert rapid anti-inflammatory and antioxidant
effects, the clinical significance of which remains controversial. METHODS
AND RESULTS: We first assessed the impact of cardiac surgery and
cardiopulmonary bypass (CPB) on atrial nitroso-redox balance by measuring
NO synthase (NOS) and GTP Cyclohydrolase -1 (GCH-1) activity, biopterin
content, and superoxide production in paired samples of the right atrial
appendage obtained before (PRE) and after CPB and reperfusion (POST) in
116 patients. The effect of perioperative treatment with atorvastatin
(80mg once daily) on these parameters, blood biomarkers and the
postoperative atrial effective refractory period (AERP) was then evaluated
in a randomized, double-blind, placebo-controlled study in 80 patients
undergoing cardiac surgery on CPB.CPB and reperfusion led to a significant
increase in atrial superoxide production (74% CI, 71-76%, n=46 paired
samples, P<0.0001) and a reduction in atrial tetrahydrobiopterin (BH4)
(34% CI, 33-35%, n=36 paired samples, P<0.01), and in GCH-1 (56% CI,
55-58%, n=26 paired samples, P<0.001) and NOS activity (58% CI, 52-67%,
n=20 paired samples, P<0.001). Perioperative atorvastatin treatment
prevented the effect of CPB and reperfusion on all parameters but had no
significant effect on the postoperative right AERP, troponin release, or
NT-pro BNP after cardiac surgery. CONCLUSION(S): Perioperative statin
therapy prevents post-reperfusion atrial nitroso-redox imbalance in
patients undergoing on-pump cardiac surgery but has no significant impact
on postoperative atrial refractoriness, perioperative myocardial injury,
or markers of postoperative LV function.Clinical Trial Registration
information: https://clinicaltrials.gov/ct2/show/NCT01780740.
TRANSLATIONAL PERSPECTIVE: Increased atrial ROS production is associated
with both incident and prevalent AF, with experimental findings suggesting
it may have a causal role in AF induction and AF-induced electrical
remodelling. Statin therapy causes a reduction in myocardial and vascular
ROS production and as such it may prevent the new onset of AF after
cardiac surgery. In patients undergoing on-pump cardiac surgery, we show
that perioperative administration of statins prevents myocardial
nitroso-redox imbalance after reperfusion without affecting atrial
refractoriness or perioperative myocardial injury. These findings suggest
that targeting myocardial nitroso-redox imbalance would be unlikely to
prevent postoperative complications in patients undergoing on-pump cardiac
surgery. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<95>
Accession Number
633260809
Title
Comparison of External Jugular Vein based surface landmark approach and
Ultrasound guided approach for Internal Jugular Venous cannulation: A
randomized cross over clinical trial.
Source
International journal of clinical practice. (pp e13783), 2020. Date of
Publication: 23 Oct 2020.
Author
Vinayagamurugan A.; Badhe A.S.; Jha A.K.
Institution
(Vinayagamurugan) Jawaharlal Institute of Postgraduate Medical Education
and Research, Puducherry, India
(Badhe, Jha) Jawaharlal Institute of Postgraduate Education and Research,
Puducherry, India
Publisher
NLM (Medline)
Abstract
BACKGROUND AND OBJECTIVE: Historically, landmark techniques for central
venous access through the internal jugular vein (IJV) have yielded a
lesser success rate and higher complication rate than the ultrasound (US)
guided approach. The purpose of this study to assess the success and
safety of a novel external jugular vein (EJV) based LM (EJV-LM) approach
compared to the real-time US-guided approach for central venous access
through the internal jugular vein. METHOD(S): This was a prospective,
randomized, cross over trial performed in patients during elective cardiac
and non-cardiac surgery. Each resident randomly inserted a central venous
catheter using EJV-LM approach and real-time US-guided approach. The
primary outcome was first attempt success. Secondary outcomes included
overall success rate, number of puncture attempts, cannulation time,
hematoma and mechanical complications. RESULT(S): A total of 188
patients were randomly assigned to the EJV-LM and US groups. The
demographic characteristics of the groups were comparable. The first
attempt success was not different between EJV-LM and US-guided technique
{79.8%; (95% CI: 70.2-87.4) vs 89.4% (95% CI 81.3-94.8); p=0.06}. The
overall success rate was 100% with both techniques. There were no
differences in the number of puncture attempts with introduce needle
{1(1-3) vs 1(1-2); p=0.07). Cannulation time was longer in the EJV-LM
group compared to the US group (58.11+/-6.6 vs. 44.27+/-5.28 seconds;
P=0.0001). EJV-LM technique was associated to a higher occurrence of
overall complications compared to the US technique {12.8% (95% CI :6.7-
21.2) vs 4.2% (95% CI:1.1-10.5); P=0.03}. No major mechanical
complications were observed with either technique. CONCLUSION(S): In
patients with non-distorted neck anatomy and a visible EJV, IJV
catheterization using the EJV-based LM approach and standard US-guided
technique yielded similar first attempt and overall success rates.
Cannulation time was longer and complications occurred more frequently in
the EJV-based LM compared to the standard US-guided
technique. Copyright This article is protected by copyright. All
rights reserved.

<96>
Accession Number
632930532
Title
Transcatheter versus surgical aortic valve replacement in patients with
cardiac surgery: Meta-analysis and systematic review of the literature.
Source
Journal of Cardiovascular Development and Disease. 7 (3) (no pagination),
2020. Article Number: 36. Date of Publication: September 2020.
Author
Latif A.; Lateef N.; Ahsan M.J.; Kapoor V.; Usman R.M.; Cooper S.;
Andukuri V.; Mirza M.; Ashfaq M.Z.; Khouzam R.
Institution
(Latif, Lateef, Ahsan, Kapoor, Cooper, Andukuri, Mirza, Ashfaq) Department
of Internal Medicine, Creighton University, Omaha, NE 68124, United States
(Usman) Department of Internal Medicine, University of Tennessee, Memphis,
TN 38152, United States
(Khouzam) Department of Cardiology, University of Tennessee, Memphis, TN
38152, United States
Publisher
MDPI AG (E-mail: diversity@mdpi.com)
Abstract
The number of patients with severe aortic stenosis (AS) and a history of
prior cardiac surgery has increased. Prior cardiac surgery increases the
risk of adverse outcomes in patients undergoing aortic valve replacement.
To evaluate the impact of prior cardiac surgery on clinical endpoints in
patients undergoing transcatheter aortic valve replacement (TAVR) versus
surgical aortic valve replacement (SAVR), we performed a literature search
using PubMed, Embase, Google Scholar, and Scopus databases. The clinical
endpoints included in our study were 30-day mortality, 1-2-year mortality,
acute kidney injury (AKI), bleeding, stroke, procedural time, and duration
of hospital stay. Seven studies, which included a total of 8221 patients,
were selected. Our study found that TAVR was associated with a lower
incidence of stroke and bleeding complications. There was no significant
difference in terms of AKI, 30-day all-cause mortality, and 1-2-year
all-cause mortality between the two groups. The average procedure time and
duration of hospital stay were 170 min less (p <= 0.01) and 3.6 days
shorter (p < 0.01) in patients with TAVR, respectively. In patients with
prior coronary artery bypass graft and severe AS, both TAVR and SAVR are
reasonable options. However, TAVR may be associated with a lower incidence
of complications like stroke and perioperative bleeding, in addition to a
shorter length of stay. Copyright © 2020 by the authors.

<97>
Accession Number
2004343017
Title
Randomized trial of a left ventricular assist device as destination
therapy versus guideline-directed medical therapy in patients with
advanced heart failure. Rationale and design of the SWEdish evaluation of
left Ventricular Assist Device (SweVAD) trial.
Source
European Journal of Heart Failure. 22 (4) (pp 739-750), 2020. Date of
Publication: 01 Apr 2020.
Author
Karason K.; Lund L.H.; Dalen M.; Bjorklund E.; Grinnemo K.; Braun O.;
Nilsson J.; van der Wal H.; Holm J.; Hubbert L.; Lindmark K.; Szabo B.;
Holmberg E.; Dellgren G.
Institution
(Karason) Departments of Cardiology and Transplantation, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Lund, Dalen) Departments of Cardiology and Cardiothoracic Surgery,
Karolinska University Hospital, Stockholm, Sweden
(Bjorklund, Grinnemo) Departments of Cardiology and Cardiothoracic
Surgery, Uppsala University Hospital, Uppsala, Sweden
(Braun, Nilsson) Departments of Cardiology and Cardiothoracic Surgery,
Skane University Hospital, Lund, Sweden
(van der Wal, Holm) Departments of Cardiology and Cardiothoracic Surgery,
Linkoping University Hospital, Linkoping, Sweden
(Hubbert) Health, Medicine and Caring Sciences, Linkoping University,
Norrkoping, Sweden
(Lindmark) Department of Cardiology, Umea University Hospital, Umea,
Sweden
(Szabo) Department of Cardiology, Orebro University Hospital, Orebro,
Sweden
(Holmberg) Regional Cancer Centre West, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Dellgren) Departments of Cardiothorax Surgery and Transplantation,
Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Aims: Patients with advanced heart failure (AdHF) who are ineligible for
heart transplantation (HTx) can become candidates for treatment with a
left ventricular assist device (LVAD) in some countries, but not others.
This reflects the lack of a systematic analysis of the usefulness of LVAD
systems in this context, and of their benefits, limitations and
cost-effectiveness. The SWEdish evaluation of left Ventricular Assist
Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized,
non-blinded, multicentre trial that will examine the impact of assignment
to mechanical circulatory support with guideline-directed LVAD destination
therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs.
guideline-directed medical therapy (GDMT) on survival in a population of
AdHF patients ineligible for HTx. Method(s): A total of 80 patients
will be recruited to SweVAD at the seven university hospitals in Sweden.
The study population will comprise patients with AdHF (New York Heart
Association class IIIB-IV, INTERMACS profile 2-6) who display signs of
poor prognosis despite GDMT and who are not considered eligible for HTx.
Participants will be followed for 2 years or until death occurs. Other
endpoints will be determined by blinded adjudication. Patients who remain
on study-assigned interventions beyond 2 years will be asked to continue
follow-up for outcomes and adverse events for up to 5 years.
 Conclusion(s): The SweVAD study will compare survival, medium-term
benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will
provide a valuable reference point to guide destination therapy strategies
for patients with AdHF ineligible for HTx. Copyright © 2020
European Society of Cardiology

<98>
Accession Number
632998659
Title
Non-vitamin K antagonist oral anticoagulants (NOACs) after transcatheter
aortic valve replacement (TAVR): a network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2020 (10) (no pagination), 2020.
Article Number: CD013745. Date of Publication: 01 Oct 2020.
Author
Al Said S.; Kaier K.; Nury E.; Alsaid D.; Meder B.; Gibson C.M.; Bax J.;
Meerpohl J.J.; Katus H.
Institution
(Al Said, Meder, Katus) Department for Internal Medicine III Cardiology
Angiology and Pneumology, University Hospital Heidelberg, Heidelberg,
Germany
(Kaier) Institute for Medical Biometry and Statistics, Faculty of Medicine
and Medical Center, University of Freiburg, Freiburg, Germany
(Nury, Alsaid) Institute for Evidence in Medicine, Medical Center -
University of Freiburg, Faculty of Medicine, University of Freiburg,
Freiburg, Germany
(Al Said, Meder, Katus) DZHK (German Centre for Cardiovascular Research),
partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg,
Germany
(Gibson) Cardiology Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Meerpohl) Institute for Evidence in Medicine, Medical Center - University
of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg,
Germany
Publisher
John Wiley and Sons Ltd (E-mail: cs-journals@wiley.co.uk)
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To evaluate the efficacy and safety of NOACs
after TAVR in patients with and without an indication for anticoagulation.
An NMA will be conducted to assess the comparative effectiveness of
multiple interventions and to rank interventions after TAVR. Copyright
© 2020 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<99>
Accession Number
2007852635
Title
Efficacy and safety of trimetazidine after percutaneous coronary
intervention (ATPCI): a randomised, double-blind, placebo-controlled
trial.
Source
The Lancet. 396 (10254) (pp 830-838), 2020. Date of Publication: 19 - 25
September 2020.
Author
Ferrari R.; Ford I.; Fox K.; Challeton J.P.; Correges A.; Tendera M.;
Widimsky P.; Danchin N.
Institution
(Ferrari) Cardiovascular Centre, University of Ferrara, Ospedale di Cona,
Ferrara, Italy
(Ferrari) Maria Cecilia Hospital, Cotignola, Ravenna, Italy
(Ford) Robertson Centre for Biostatistics, University of Glasgow, Glasgow,
United Kingdom
(Fox) National Heart and Lung Institute, Imperial College London, London,
United Kingdom
(Fox) Royal Brompton Hospital, London, United Kingdom
(Challeton, Correges) Institut de Recherches Internationales Servier,
Suresnes, France
(Tendera) Department of Cardiology and Structural Heart Disease, Medical
University of Silesia, Katowice, Poland
(Widimsky) Cardiocenter, Third Faculty of Medicine, Charles University,
Prague, Czechia
(Danchin) Department of Cardiology, Hopital Europeen Georges Pompidou,
Assistance Publique-Hopitaux de Paris, Paris, France
(Danchin) Universite Paris-Descartes, Paris, France
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Angina might persist or reoccur despite successful
revascularisation with percutaneous coronary intervention (PCI) and
antianginal therapy. Additionally, PCI in stable patients has not been
shown to improve survival compared with optimal medical therapy.
Trimetazidine is an antianginal agent that improves energy metabolism of
the ischaemic myocardium and might improve outcomes and symptoms of
patients who recently had a PCI. In this study, we aimed to assess the
long-term potential benefits and safety of trimetazidine added to standard
evidence-based medical treatment in patients who had a recent successful
PCI. Method(s): We did a randomised, double-blind,
placebo-controlled, event-driven trial of trimetazidine added to standard
background therapy in patients who had undergone successful PCI at 365
centres in 27 countries across Europe, South America, Asia, and north
Africa. Eligible patients were aged 21-85 years and had had either
elective PCI for stable angina or urgent PCI for unstable angina or non-ST
segment elevation myocardial infarction less than 30 days before
randomisation. Patients were randomly assigned by an interactive web
response system to oral trimetazidine 35 mg modified-release twice daily
or matching placebo. Participants, study investigators, and all study
staff were masked to treatment allocation. The primary efficacy endpoint
was a composite of cardiac death; hospital admission for a cardiac event;
recurrence or persistence of angina requiring an addition, switch, or
increase of the dose of at least one antianginal drug; or recurrence or
persistence of angina requiring a coronary angiography. Efficacy analyses
were done according to the intention-to-treat principle. Safety was
assessed in all patients who had at least one dose of study drug. This
study is registered with the EU Clinical Trials Register (EudraCT
2010-022134-89). Finding(s): From Sept 17, 2014, to June 15, 2016,
6007 patients were enrolled and randomly assigned to receive either
trimetazidine (n=2998) or placebo (n=3009). After a median follow-up of
47.5 months (IQR 42.3-53.3), incidence of primary endpoint events was not
significantly different between the trimetazidine group (700 [23.3%]
patients) and the placebo group (714 [23.7%]; hazard ratio 0.98 [95% CI
0.88-1.09], p=0.73). When analysed individually, there were no significant
differences in the incidence of the components of the primary endpoint
between the treatment groups. Similar results were obtained when patients
were categorised according to whether they had an elective or urgent PCI.
1219 (40.9%) of 2983 patients in the trimetazidine group and 1230 (41.1%)
of 2990 patients in the placebo group had serious treatment-emergent
adverse events. Frequencies of adverse events of interest were similar
between the groups. Interpretation(s): Our results show that the
routine use of oral trimetazidine 35 mg twice daily over several years in
patients receiving optimal medical therapy, after successful PCI, does not
influence the recurrence of angina or the outcome; these findings should
be taken into account when considering the place of trimetazidine in
clinical practice. However, the long-term prescription of this treatment
does not appear to be associated with any statistically significant safety
concerns in the population studied. Funding(s):
Servier. Copyright © 2020 Elsevier Ltd

<100>
Accession Number
2006763491
Title
Comparison of postoperative outcomes following multidetector computed
tomography based vs transesophageal echocardiography based annulus sizing
for transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Echocardiography. 37 (10) (pp 1617-1626), 2020. Date of Publication: 01
Oct 2020.
Author
Tang G.; Lv Q.; He X.
Institution
(Tang, Lv, He) Department of Echocardiography, The Affiliated Hospital of
Qingdao University, Qingdao, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The purpose of this paper was to evaluate the difference in
postoperative outcomes following multidetector computed tomography (MDCT)
and transesophageal echocardiography (TEE)-based annulus sizing for
transcatheter aortic valve replacement (TAVR). Method(s): Electronic
search of PubMed, Biomed Central, Scopus, and Google Scholar databases was
conducted until August 15, 2019. We included all types of studies
comparing MDCT-based annulus sizing with TEE-based annulus sizing and
assessing paravalvular regurgitation (PVR). Data were summarized using the
Mantel-Haenszel odds ratio (OR) with 95% confidence intervals (CI).
 Result(s): A total of six studies were included. Pooled analysis of
431 participants in the MDCT group and 509 participants in the TEE group
demonstrated that MDCT-based annulus sizing is associated with a
significantly lower incidence of more than moderate PVR as compared to
2DTEE-based sizing (OR: 0.31, 95% CI: 0.18-0.54, P <.0001; I2 =
0%). There was no statistical difference in annulus rupture (OR: 0.57, 95%
CI: 0.12-2.66, P =.91; I2 = 0%), procedural mortality (OR:
0.97, 95% CI: 0.19-4.86, P =.97; I2 = 0%), and 30-day mortality
(OR: 0.63, 95% CI: 0.26-1.50, P =.29; I2 = 0%) with MDCT or
2DTEE-based annulus sizing. Compared with 3DTEE, the incidence of PVR in
the MDCT group was lower, but there was no statistical difference in
30-day mortality. Conclusion(s): Use of MDCT in comparison with 2DTEE
is associated with significantly lower incidence of more than moderate PVR
after TAVR. There seems to be no difference in annulus rupture and 30-day
mortality with either imaging modality. Copyright © 2020 The
Authors. Echocardiography published by Wiley Periodicals LLC

<101>
Accession Number
2005249318
Title
The effect of interval training on oxidative stress indices among women in
preterm labor underwent coronary artery bypass graft.
Source
International Journal of Women's Health and Reproduction Sciences. 8 (4)
(pp 406-411), 2020. Date of Publication: October 2020.
Author
Hashemzadeh K.; Dehdilani M.; Gol M.K.
Institution
(Hashemzadeh) Department of Heart Surgery, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Dehdilani) Department of Anesthesiology, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Gol) Responsible for the Nursing Research Committee of Imam Reza
Hospital, Nursing and Midwifery Faculty, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
Aras Part Medical International Press (E-mail: publish@pmcaras.com)
Abstract
Objectives: Oxidative stress indices are one of the factors that cause and
exacerbate cardiovascular diseases in postpartum women, which can be
changed with interval training. Therefore, the current study aimed at
investigating the effect of interval training on oxidative stress indices
among women in preterm labor undergoing the coronary artery bypass graft
(CABG). Material(s) and Method(s): This randomized clinical trial was
conducted on 21 participants (the sample size was determined based on a
similar study) from December 2018 to May 2019 at Shahid Madani hospital of
Tabriz, Iran. After the random allocation of subjects to the training
(n=11) and control (n=10) groups, demographic information was collected
and their physical activity level was assessed using the Kaiser physical
activity survey before and after the intervention. In addition, the levels
of oxidative stress indices were measured 24 hours before and after the
intervention using the blood sample. The participants completed an
eight-week invention including 24 one-hour sessions according to the
available protocol. Finally, data were analyzed by means of statistical
tests such as the Shapiro-Wilk, Leven, and Student's t-test at a
significant level of <0.05. Result(s): The effect of the aerobic
exercise program on body weight loss, as well as body mass index (BMI) and
body fat percentage changes was significant in the training group
(P=0.011, P=0.004, and P=0.001, respectively). Based on the results, the
serum and urine levels of 8-hydroxy-2-deoxyguanosine reduced significantly
after the completion of the intervention (P=0.002 and P=0.001,
respectively) in the training group. Conclusion(s): In general,
aerobic exercise after CABG decreased the fat percentile, BMI, and
oxidative stress indices in the subjects. Thus, these trainings could
reduce oxidative stress indices by increasing tissue metabolism and oxygen
consumption. Copyright © 2020 The Author(s).

<102>
Accession Number
2005008023
Title
A systematic review of the instruments used for evaluating causal beliefs
and perceived heart risk factors.
Source
Journal of Tehran University Heart Center. 15 (3) (pp 88-97), 2020. Date
of Publication: 03 Sep 2020.
Author
Saeidi M.; Komasi S.; Compare A.
Institution
(Saeidi) Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Komasi) Clinical Research Development Center, Imam Reza Hospital,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
(Compare) Department of Human and Social Sciences, University of Bergamo,
Italy
Publisher
Tehran Heart Center (E-mail: abbasi.hesam@gmail.com)
Abstract
Background: The etiologies and causal beliefs of heart disease are
considered one of the 5 dimensions of health self-regulatory model. Thus,
the present study aimed to review the literature and screen the
appropriate tools for evaluating the causal beliefs and perceived heart
risk factors (PHRFs). Method(s): The review samples encompassed all
published articles from 1992 to March 2017. A systematic search was
conducted across 6 databases: the Web of Science, Scopus, Medline, EBSCO,
ProQuest, PsycINFO, and Google Scholar. The qualitative evaluation of the
articles was examined using the checklists of the Critical Appraisal
Skills Programme (CASP) by 2 independent investigators. After the
application of the criteria for inclusion in the study, 22 studies were
obtained according to the PRISMA guidelines. Result(s): A total of 10
504 (50.5% male) patients at an average age of 57.85+/-10.75 years
participated in 22 studies under review. The results of the systematic
review showed that 22 tools were available to measure PHRFs. The
instruments were categorized into 4 groups of valid scales (6 studies),
invalid questionnaires (6 studies), checklists (3 studies), and open-ended
single items (7 studies). Only 23.2% of the measuring instruments were
sufficiently valid. Conclusion(s): The results of this systematic
review showed that a limited number of valid tools were available to
measure PHRFs. Considering the importance of studying cardiac patients'
perception of the etiology of disease and the paucity of standards and
valid grading scales, it seems necessary to design and provide tools with
broader content that can cover all aspects of patients'
beliefs. Copyright © 2020, Tehran Heart Center. All rights
reserved.

<103>
Accession Number
2004975778
Title
Pleural Effusions After Congenital Cardiac Surgery Requiring Readmission:
A Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 41 (6) (pp 1145-1152), 2020. Date of Publication: 01
Aug 2020.
Author
Hughes A.; Carter K.; Cyrus J.; Karam O.
Institution
(Hughes, Carter) Division of Pediatric Cardiology, Children's Hospital of
Richmond at VCU, Richmond, VA, United States
(Cyrus) Tompkins-McCaw Library for the Health Sciences, VCU Libraries,
Virginia Commonwealth University, Richmond, VA, United States
(Karam) Division of Pediatric Critical Care Medicine, Children's Hospital
of Richmond at VCU, Richmond, VA, United States
Publisher
Springer
Abstract
Patients with congenital heart disease (CHD) are surviving longer thanks
to improved surgical techniques and increasing knowledge of natural
history. Pleural effusions continue to be a complication that affect many
surgical patients and are associated with increased morbidity, many times
requiring readmission and additional invasive procedures. The risks for
development of pleural effusion after hospital discharge are ill-defined,
which leads to uncertainty related to strategies for prevention. Our
primary objective was to determine, in patients with CHD requiring
cardiopulmonary bypass, the prevalence of post-surgical pleural effusions
leading to readmission. The secondary objective was to identify risk
factors associated with post-surgical pleural effusions requiring
readmission. We identified 4417 citations; 10 full-text articles were
included in the final review. Of the included studies, eight focused on
single-ventricle palliation, one looked at Tetralogy of Fallot patients,
and another on pleural effusion in the setting of post-pericardiotomy
syndrome. Using a random-effect model, the overall prevalence of pleural
effusion requiring readmission was 10.2% (95% CI 4.6; 17.6). Heterogeneity
was high (I2 = 91%). In a subpopulation of patients after
single-ventricle palliation, the prevalence was 13.0% (95% CI 6.0;21.0),
whereas it was 3.0% (95% CI 0.4;6.75) in patients mostly with
biventricular physiology. We were unable to accurately assess risk
factors. A better understanding of this complication with a focus on
single-ventricle physiology will allow for improved risk stratification,
family counseling, and earlier recognition of pleural effusion in this
patient population. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<104>
Accession Number
2004465251
Title
Diagnostic value of myocardial strain using two-dimensional
speckle-tracking echocardiography in acute cardiac allograft rejection: A
systematic review and meta-analysis.
Source
Echocardiography. 37 (4) (pp 561-569), 2020. Date of Publication: 01 Apr
2020.
Author
Zhu S.; Li M.; Tian F.; Wang S.; Li Y.; Yin P.; Zhang L.; Xie M.
Institution
(Zhu, Li, Tian, Wang, Li, Zhang, Xie) Department of Ultrasound, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Zhu, Li, Tian, Wang, Li, Zhang, Xie) Hubei Province Key Laboratory of
Molecular Imaging, Wuhan, China
(Yin) Epidemiology and Health Statistics, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Two-dimensional speckle-tracking echocardiography (2D STE) has
been demonstrated to have certain diagnostic utility in heart
transplantation (HTX) patients with acute cardiac allograft rejection
(ACAR). The aim of the systematic review and meta-analysis was to evaluate
the diagnostic value of common strain parameters for ACAR in HTX patients.
 Method(s): After conducting a database search, we selected studies
evaluating left ventricular global longitudinal strain (GLS),
circumferential strain (CS), radial strain (RS), and free wall right
ventricular longitudinal strain (RV FW) in rejection group vs
rejection-free group. Result(s): After reviewing 886 publications,
seven studies were finally included in the meta-analysis, representing the
data of 1173 pairs of endomyocardial biopsy and echocardiographic
examination. Heart transplantation patients with rejection had
significantly lower GLS than rejection-free subjects (weighted mean
difference -2.32 (95% CI, -3.41 to -1.23; P '.001). Heart transplantation
patients with rejection had significantly lower CS than rejection-free
subjects (weighted mean difference -2.49 (95% CI, -4.05 to -0.91; P
=.0019). In addition, HTX patients with rejection also had significantly
lower RV FW (weighted mean difference -4.90 (95% CI, -6.15 to -3.65; P
'.001). Conclusion(s): The meta-analysis and systematic review
demonstrate that myocardial strain parameters derived from 2D STE may be
useful in detecting ACAR in HTX patients. The present results provide
encouraging evidence to consider the routine use of GLS, CS, and RV FW as
markers of graft function involvement during ACAR. Copyright ©
2020 Wiley Periodicals, Inc.

<105>
Accession Number
2008357218
Title
Methylene blue reduces incidence of early postoperative cognitive
disorders in elderly patients undergoing major non-cardiac surgery: An
open-label randomized controlled clinical trial.
Source
Journal of Clinical Anesthesia. 68 (no pagination), 2021. Article Number:
110108. Date of Publication: February 2021.
Author
Deng Y.; Wang R.; Li S.; Zhu X.; Wang T.; Wu J.; Zhang J.
Institution
(Deng, Zhang) Department of Anesthesiology, Shanghai Cancer Center, Fudan
University, Shanghai 200032, China
(Wang, Li, Wang) Department of Anesthesiology, Huashan Hospital, Fudan
University, Shanghai 200040, China
(Zhu) Department of Psychiatry, Huashan Hospital, Fudan University,
Shanghai 200040, China
(Wu) Department of Neurology, Huashan Hospital, Fudan University, Shanghai
200040, China
(Zhang) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai 200032, China
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Study objective: The purpose of the present study was to investigate
whether methylene blue (MB) could reduce the incidences of postoperative
delirium (POD) and early postoperative cognitive dysfunction (POCD) in
elderly patients undergoing major non-cardiac surgery. Design(s):
Prospective, randomized, open-label clinical trial. Setting(s):
University-affiliated hospital. Patient(s): Two hundred and
forty-eight elderly patients scheduled for non-cardiac surgery.
 Intervention(s): Elderly patients undergoing non-cardiac major
surgery were randomly assigned to MB group (n = 124), who receiving
intravenous infusion of 2 mg/kg MB within 60 min immediately after
anesthetic induction, or control group (n = 124), who receiving equal
volume saline in the same way. Measurements: All patients were evaluated
with delirium and neuropsychological batteries before and after surgery,
as well as perioperative adverse events. Two plasma biomarkers superoxide
dismutase (SOD) and homocysteine (HCY) were measured pre- and
post-operatively. Main Result(s): There were total 39
cases(15.7%)experienced POD. The incidence of POD in MB group was
significantly less than that in control group (7.3% vs. 24.2%, OR = 0.24,
95%CI: 0.11-0.53, p < 0.001). The incidence of early POCD at postoperative
7th day in MB group was also less than that in control group (16.1% vs.
40.2%, OR = 0.30, 95% CI: 0.16-0.57, p < 0.001). The adverse events were
comparable in both groups. In addition, there was no significant
correlation between POD/POCD and levels of SOD or HCY. Conclusion(s):
We conclude that intraoperative intravenous 2 mg/kg MB could significantly
reduce the incidences of POD and early POCD in elderly surgical patients,
while not remarkably increase incidence of perioperative adverse events,
suggesting MB may be clinically effective and safe for prevention of early
postoperative neurocognitive disorders. Copyright © 2020 Elsevier
Inc.

<106>
Accession Number
631778648
Title
Effect of ulinastatin on post-operative blood loss and allogeneic
transfusion in patients receiving cardiac surgery with cardiopulmonary
bypass: a prospective randomized controlled study with 10-year follow-up.
Source
Journal of cardiothoracic surgery. 15 (1) (pp 98), 2020. Date of
Publication: 14 May 2020.
Author
Zhang P.; Lv H.; Qi X.; Xiao W.; Xue Q.; Zhang L.; Li L.; Shi J.
Institution
(Zhang) Department of Surgery, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, 167 Beilishi Rd., Xicheng District, Beijing 100037,
China
(Lv, Xiao, Xue, Zhang, Li, Shi) Department of Anaesthesiology, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, 167 Beilishi Rd., Xicheng District, Beijing 100037,
China
(Qi) Department of Anaesthesiology, People's Hospital of Ningxia Hui
Autonomous Region, 148 Huaiyuanxi Rd. Xixia District, Yinchuan, Ningxia
Hui Autonomous Region 750021, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Major bleeding and allogeneic transfusion leads to negative
outcomes in patients receiving cardiac surgery with cardiopulmonary bypass
(CPB). Ulinastatin, a urine trypsin inhibitor, relieves systemic
inflammation and improves coagulation profiles with however sparse
evidence of its effects on blood loss and allogeneic transfusion in this
specific population. METHOD(S): In this prospective randomized
controlled trial, 426 consecutive patients receiving open heart surgery
with CPB were randomly assigned into three groups to receive ulinastatin
(group U, n=142), tranexamic acid (group T, n=143) or normal saline (group
C, n=141). The primary outcome was the total volume of post-operative
bleeding and the secondary outcome included the volume and exposure of
allogeneic transfusion, the incidence of stroke, post-operative myocardial
infarction, renal failure, respiratory failure and all-cause mortality. A
ten-year follow-up was carried on to evaluate long-term safety.
 RESULT(S): Compared with placebo, ulinastatin significantly reduced
the volume of post-operative blood loss within 24h (688.39+/-393.55ml vs
854.33+/-434.03ml MD -165.95ml, 95%CI -262.88ml to -69.01ml, p<0.001) and
the volume of allogeneic erythrocyte transfusion (2.57+/-3.15 unit vs
3.73+/-4.21 unit, MD-1.16 unit, 95%CI -2.06units to -0.26units, p=0.002).
The bleeding and transfusion outcomes were comparable between the
ulinastatin group and the tranexamic acid group. In-hospital outcomes and
10-year follow-up showed no statistical difference in mortality and major
morbidity among groups. CONCLUSION(S): Ulinastatin reduced
post-operative blood loss and allogeneic erythrocyte transfusion in heart
surgery with CPB. The mortality and major morbidity was comparable among
the groups shown by the 10-year follow-up. TRIAL REGISTRATION: The trial
was retrospectively registered on February 2, 2010. TRIAL REGISTRATION
NUMBER: https://www.clinicaltrials.gov Identifier: NCT01060189.

<107>
Accession Number
632857060
Title
Is the Use of BIMA in CABG Sub-Optimal? A Review of the Current Clinical
and Economic Evidence Including Innovative Approaches to the Management of
Mediastinitis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 26 (5) (pp
229-239), 2020. Date of Publication: 21 Oct 2020.
Author
Bayer N.; Hart W.M.; Arulampalam T.; Hamilton C.; Schmoeckel M.
Institution
(Bayer, Schmoeckel) Asklepios Klinik St Georg, Hamburg, Germany
(Hart, Arulampalam, Hamilton) ManchesterUnited Kingdom
Publisher
NLM (Medline)
Abstract
Bilateral internal mammary artery (BIMA) in coronary artery bypass
grafting (CABG) has traditionally been limited. This review looks at the
recent outcome data on BIMA in CABG focusing on the management of risk
factors for mediastinitis, one of the potential barriers for more
extensive BIMA utilization. A combination of pre-, intra- and
postoperative strategies are essential to reduce mediastinitis. Limited
data indicate that the incidence of mediastinitis can be reduced using
closed incision negative-pressure wound therapy as a part of these
strategies with the possibility of offering patients best treatment
options by extending BIMA to those with a higher risk of mediastinitis.
Recent economic data imply that the technology may challenge the current
low uptake of BIMA by reducing the short-term cost differentials between
single internal mammary artery and BIMA. Given that most published
randomized controlled trials and meta-analyses of observational long-term
outcome data favor BIMA, if short-term complications of BIMA including
mediastinitis can be controlled adequately, there may be opportunities for
more extensive use of BIMA leading to improved long-term outcomes. An
ongoing study looking at BIMA in high-risk patients may provide evidence
to support the hypothesis that mediastinitis should not be a factor in
limiting the use of BIMA in CABG.

<108>
Accession Number
632839252
Title
Short-term outcome of the intuity rapid deployment prosthesis: a
systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 31 (4) (pp 427-436),
2020. Date of Publication: 01 Oct 2020.
Author
Klop I.D.G.; Kougioumtzoglou A.M.; Kloppenburg G.T.L.; van Putte B.P.;
Sprangers M.A.G.; Klein P.; Nieuwkerk P.T.
Institution
(Klop, Kloppenburg, van Putte, Klein) Department of Cardiothoracic
Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Kougioumtzoglou, van Putte) Department of Cardiothoracic Surgery,
Amsterdam University Medical Centers, Academic Medical Center, Amsterdam,
Netherlands
(Sprangers, Nieuwkerk) Department of Psychology, Amsterdam University
Medical Centers, Academic Medical Center, University of Amsterdam,
Amsterdam Public Health Research Institute, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Limited access aortic valve replacement is an alternative
approach for the treatment of calcified aortic valve disease. To
facilitate limited access aortic valve replacement, rapid deployment valve
prostheses have been developed aiming to reduce surgical impact. This
systematic review gives an overview of current literature regarding the
INTUITY or INTUITY Elite rapid deployment biological valve prosthesis.
 METHOD(S): Cochrane, Embase and MEDLINE were searched to identify
relevant studies. All studies reporting on patients who underwent isolated
or combined surgical aortic valve replacement with the INTUITY or INTUITY
Elite valve prosthesis were considered eligible. Primary end points were
technical success rate, 30-day mortality, cerebrovascular accident,
paravalvular leak and permanent pacemaker implantation. Secondary end
points included procedural data such as aortic cross-clamping time,
cardiopulmonary bypass time and procedural approach. RESULT(S): A
total of 16 articles fulfilled the inclusion and exclusion criteria and
comprised 4.184 patients. Thirty-day mortality was 2.7% (1.9-3.7%),
cerebrovascular accident 2.6% (1.4-4.7%), permanent pacemaker implantation
7.9% (6.6-9.5%) and severe postoperative paravalvular leak requiring a
reintervention 3.3% (1.7-6.1%). Technical success rate varied between
93.9% and 100%. Conventional median sternotomy was most commonly
performed, ranging from 21.7% to 89.6%. Upper hemi-sternotomy was
performed more often than anterior right thoracotomy, ranging from 10.4%
to 63.3% and 2.2% to 26.1%. The mean transvalvular pressure gradient
ranged between 9.0 and 10.3mmHg at 1 year postoperatively.
 CONCLUSION(S): This review demonstrates that the technical success
rate of the INTUITY or INTUITY Elite rapid deployment valve system is
high, also in limited access aortic valve replacement. Mortality and
cerebrovascular accident rates are low, but the need for postoperative
permanent pacemaker implantation and reintervention rate for paravalvular
leakage is increased. Copyright © The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<109>
Accession Number
632782065
Title
A systematic evaluation on reporting quality of modern studies on
pulmonary heart valve implantation in large animals.
Source
Interactive cardiovascular and thoracic surgery. 31 (4) (pp 437-445),
2020. Date of Publication: 01 Oct 2020.
Author
Uiterwijk M.; Vis A.; de Brouwer I.; van Urk D.; Kluin J.
Institution
(Uiterwijk, Vis, de Brouwer, van Urk, Kluin) Department of Cardiothoracic
Surgery, Amsterdam University Medical Center, University of Amsterdam,
Heart Center, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Before new heart valves can be implanted safely in humans,
animal experiments have to be performed. These animal experiments have to
be clearly designed, analysed and reported to assess the accuracy and
importance of the findings. We aimed to provide an overview of the
reporting and methodological quality of preclinical heart valve research.
 METHOD(S): We conducted a systematic literature search on biological
and mechanical pulmonary valve implantations in large animals. We used the
Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines to
score the quality of reporting in each article. We compared the scores
before and after the introduction of the ARRIVE guidelines (2010).
 RESULT(S): We screened 348 articles, of which 31 articles were
included. The included articles reported a mean of 54.7% adequately scored
ARRIVE items (95% confidence interval 52.2-57.3%). We did not identify a
difference in reporting quality (54.7% vs 54.8%) between articles
published before and after 2010. We found an unclear (lack of description)
risk of selection bias, performance bias and detection bias.
 CONCLUSION(S): The reporting quality of studies that implanted
bioprosthetic or mechanical valves in the pulmonary position in the large
animal model is not on the desired level. The introduction of the ARRIVE
guidelines in 2010 did not improve the reporting quality in this field of
research. Hereby, we want to emphasize the importance of clearly
describing the methods and transparently reporting the results in animal
experiments. This is of great importance for the safe translation of new
heart valves to the clinic. CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO
(CRD42019147895). Copyright © The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<110>
Accession Number
632692350
Title
Blood pressure and brain injury in cardiac surgery: a secondary analysis
of a randomized trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 58 (5) (pp 1035-1044),
2020. Date of Publication: 01 Nov 2020.
Author
Vedel A.G.; Holmgaard F.; Danielsen E.R.; Langkilde A.; Paulson O.B.; Ravn
H.B.; Rasmussen L.S.; Nilsson J.C.
Institution
(Vedel, Holmgaard, Ravn, Nilsson) epartment of Cardiothoracic
Anaesthesiology, Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Vedel, Rasmussen) epartment of Anaesthesia, Center of Head and
Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Danielsen, Langkilde) epartment of Radiology, Diagnostic Center,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Paulson) Neurobiology Research Unit, Neuroscience Center, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Brain dysfunction is a serious complication after cardiac
surgery. In the Perfusion Pressure Cerebral Infarcts trial, we allocated
cardiac surgery patients to a mean arterial pressure of either 70-80 or
40-50mmHg during cardiopulmonary bypass (CPB). In this secondary analysis,
we compared selected cerebral metabolites using magnetic resonance
spectroscopy hypothesizing that a postoperative decrease in occipital grey
matter (GM) N-acetylaspartate-to-total-creatine ratio, indicative of
ischaemic injury, would be found in the high-target group. METHOD(S):
Of the 197 patients randomized in the Perfusion Pressure Cerebral Infarcts
trial, 55 and 42 patients had complete and useful data from GM and white
matter (WM), respectively. Spectroscopies were done preoperatively and on
postoperative days 3-6. Cognitive function was assessed prior to surgery,
at discharge and at 3months. We predefined the statistical significance
level to be 0.01. RESULT(S): A postoperative decrease was found in GM
N-acetylaspartate-to-total-creatine ratio in the high-target group [mean
difference -0.09 (95% confidence interval -0.14 to -0.04), P=0.014]. No
significant differences were found in other metabolite ratios investigated
in GM or WM. No significant association was found between changes in
metabolite ratios and new cerebral infarcts, WM lesion score or cognitive
dysfunction. CONCLUSION(S): A higher mean arterial pressure during
CPB was associated with signs of impaired cerebral metabolism, though not
at the predefined significance level of 0.01. No significant association
was found between metabolite ratio changes and neuroradiological pathology
or change in cognitive function. CLINICAL TRIAL REGISTRATION NUMBER:
Clinicaltrials.gov: NCT02185885. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<111>
Accession Number
2006109685
Title
Outcomes with MANTA Device for Large-Bore Access Closure after
Transcatheter Aortic Valve Replacement: A Meta-Analysis.
Source
Structural Heart. 4 (5) (pp 420-426), 2020. Date of Publication: 02 Sep
2020.
Author
Megaly M.; Buda K.G.; Brilakis E.S.; Pershad A.; Louka B.; Saad M.;
Abdelaziz H.K.; Anantha Narayanan M.; Syed M.; Mentias A.; Omer M.;
Alexander J.; Titus J.; Garcia S.
Institution
(Megaly, Brilakis, Omer, Alexander, Titus, Garcia) Minneapolis Heart
Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Megaly, Buda) Division of Cardiology, Hennepin Healthcare, Minneapolis,
MN, United States
(Pershad) Division of Cardiology, Banner University Medical Center,
University of Arizona, Phoenix, AZ, United States
(Louka) Division of Cardiology, Willis Knighton Medical Center,
Shreveport, LA, United States
(Saad, Abdelaziz) Division of Cardiology, Ain Shams University, Cairo,
Egypt
(Saad) Division of Cardiology, The Warren Alpert School of Medicine at
Brown University, Providence, RI, United States
(Abdelaziz) Lancashire Cardiac Center, Blackpool Victoria Hospital,
Blackpool, United Kingdom
(Anantha Narayanan) Division of Vascular Medicine, Yale-New Haven
Hospital, New Haven, CT, United States
(Syed) Division of Cardiology, University of Toledo, Toledo, OH, United
States
(Mentias) Division of Cardiology, Cleveland Clinic Foundation, Cleveland,
OH, United States
Publisher
Bellwether Publishing, Ltd. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: Data comparing MANTA to other vascular closure devices (VCDs)
after TAVR is limited. Method(s): We performed a meta-analysis of all
published studies reporting the outcomes of MANTA vs. other VCDs in TAVR
patients. Outcomes included major and minor vascular complications, major
and minor bleeding, VCD failure, blood transfusion, additional surgical or
endovascular treatment, flow-limiting dissection, hematomas,
pseudoaneurysm, change in hemoglobin, and length of stay (LOS).
Definitions used were according to the "Valve Academic Research
Consortium-2 consensus document" (VARC-2). Result(s): We included
five observational studies with a total of 1,410 patients (MANTA n = 601,
other VCDs = 809). Three studies compared MANTA to the Proglide device
(Abbot Vascular, CA, USA), and two studies compared MANTA to the Prostar
XL device (Abbott Vascular, IL, USA). The prevalence of moderate to severe
calcification was higher in the MANTA group (31% vs. 21%, p = 0.01)
compared with other VCDs group. During the index hospitalization, there
was no difference in all major or minor complications between MANTA and
other VCDs. In a sensitivity analysis, comparing MANTA to Proglide, the
risk of major and minor vascular complications, major and minor bleeding,
and VCD failure was similar for both devices. Conclusion(s): In the
TAVR population, although more used in calcified vessels, the safety
profile and efficacy of the new collagen-based VCD, MANTA, is similar to
currently available suture based VCD's Proglide and Prostar
XL. Copyright © 2020 Cardiovascular Research Foundation.

<112>
Accession Number
2005924536
Title
Predictive model of in-hospital mortality in left-sided infective
endocarditis.
Source
Revista Espanola de Cardiologia. 73 (11) (pp 902-909), 2020. Date of
Publication: November 2020.
Author
Garcia-Granja P.E.; Lopez J.; Vilacosta I.; Sarria C.; Dominguez F.;
Ladron R.; Olmos C.; Saez C.; Vilches S.; Garcia-Arribas D.; Cobo-Marcos
M.; Ramos A.; Maroto L.; Gomez I.; Carrasco M.; Garcia-Pavia P.; San Roman
J.A.
Institution
(Garcia-Granja, Lopez, Ladron, Gomez, Carrasco, San Roman) Servicio de
Cardiologia, Instituto de Ciencias del Corazon (ICICOR), Hospital Clinico
Universitario Valladolid, Valladolid, Spain
(Garcia-Granja, Lopez, Dominguez, Cobo-Marcos, Garcia-Pavia, San Roman)
CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
(Vilacosta, Olmos, Garcia-Arribas) Servicio de Cardiologia, Instituto
Cardiovascular, Hospital Clinico San Carlos, Instituto de Investigacion
Sanitaria del Hospital Clinico San Carlos (IdSSC), Madrid, Spain
(Sarria, Saez) Servicio de Medicina Interna, Hospital Universitario La
Princesa, Madrid, Spain
(Dominguez, Vilches, Cobo-Marcos, Garcia-Pavia) Unidad de Insuficiencia
Cardiaca y Cardiopatias Familiares, Servicio de Cardiologia, Hospital
Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
(Ramos) Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna,
Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
(Maroto) Servicio de Cirugia Cardiaca, Instituto Cardiovascular, Hospital
Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital
Clinico San Carlos (IdSSC), Madrid, Spain
(Garcia-Pavia) Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon,
Madrid, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Infective endocarditis (IE) is a complex
disease with high in-hospital mortality. Prognostic assessment is
essential to select the most appropriate therapeutic approach; however,
international IE guidelines do not provide objective assessment of the
individual risk in each patient. We aimed to design a predictive model of
in-hospital mortality in left-sided IE combining the prognostic variables
proposed by the European guidelines. Method(s): Two prospective
cohorts of consecutive patients with left-sided IE were used. Cohort 1 (n
= 1002) was randomized in a 2:1 ratio to obtain 2 samples: an adjustment
sample to derive the model (n = 688), and a validation sample for internal
validation (n = 314). Cohort 2 (n = 133) was used for external validation.
 Result(s): The model included age, prosthetic valve IE,
comorbidities, heart failure, renal failure, septic shock, Staphylococcus
aureus, fungi, periannular complications, ventricular dysfunction, and
vegetations as independent predictors of in-hospital mortality. The model
showed good discrimination (area under the ROC curve = 0.855; 95%CI,
0.825-0.885) and calibration (P value in Hosmer-Lemeshow test = 0.409),
which were ratified in the internal (area under the ROC curve = 0.823;
95%CI, 0.774-0.873) and external validations (area under the ROC curve =
0.753; 95%CI, 0.659-0.847). For the internal validation sample (observed
mortality: 29.9%) the model predicted an in-hospital mortality of 30.7%
(95%CI, 27.7-33.7), and for the external validation cohort (observed
mortality: 27.1%) the value was 26.4% (95%CI, 22.2-30.5).
 Conclusion(s): A predictive model of in-hospital mortality in
left-sided IE based on the prognostic variables proposed by the European
Society of Cardiology IE guidelines has high discriminatory
ability. Copyright © 2019 Sociedad Espanola de Cardiologia

<113>
Accession Number
633233881
Title
Mortality in trials on transcatheter aortic valve implantation versus
surgical aortic valve replacement: A pooled meta-analysis of
Kaplan-Meier-derived individual patient data.
Source
European Journal of Cardio-thoracic Surgery. 58 (2) (pp 221-229), 2020.
Date of Publication: 01 Aug 2020.
Author
Barili F.; Freemantle N.; Casado A.P.; Rinaldi M.; Folliguet T.; Musumeci
F.; Gerosa G.; Parolari A.
Institution
(Barili, Casado) Department of Cardiac Surgery, S. Croce Hospital, Cuneo,
Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: This meta-analysis of Kaplan-Meier-estimated individual
patient data was designed to evaluate the effects of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on
the long-term all-cause mortality rate, to examine the potential
time-varying effect and to model their hazard ratios (HRs) over time.
Moreover, we sought to compare traditional meta-analytic tools and
estimated individual patient data meta-analyses. METHOD(S): Trials
comparing TAVI versus SAVR were identified through Medline, Embase,
Cochrane databases and specialist websites. The primary outcome was death
from any cause at follow-up. Enhanced secondary analyses of survival
curves were performed estimating individual patient time-to-event data
from published Kaplan-Meier curves. Treatments were compared with the
random effect Cox model in a landmark framework and fully parametric
models. RESULT(S): We identified 6 eligible trials that included 6367
participants, randomly assigned to undergo TAVI (3252) or SAVR (3115).
According to the landmark analysis, the incidence of death in the first
year after implantation was significantly lower in the TAVI group
[risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99;
P = 0.04], whereas there was a reversal of the HR after 40 months
(risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P = 0.04) favouring
SAVR over TAVI. This time-varying trend of HRs was also confirmed by a
fully parametric time-to-event model. Traditional meta-analytic tools were
shown to be biased because they did not intercept heterogeneity and the
time-varying effect. CONCLUSION(S): The mortality rates in trials of
TAVI versus SAVR are affected by treatments with a time-varying effect.
TAVI is related to better survival in the first months after implantation
whereas, after 40 months, it is a risk factor for all-cause
mortality. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<114>
[Use Link to view the full text]
Accession Number
633226554
Title
Neuromuscular electrical stimulation in early rehabilitation of patients
with postoperative complications after cardiovascular surgery: A
randomized controlled trial.
Source
Medicine. 99 (42) (pp e22769), 2020. Date of Publication: 16 Oct 2020.
Author
Sumin A.N.; Oleinik P.A.; Bezdenezhnykh A.V.; Ivanova A.V.
Publisher
NLM (Medline)
Abstract
BACKGROUND: To evaluate the effectiveness of neuromuscular electrical
stimulation (NMES) in early rehabilitation of patients with postoperative
complications after cardiovascular surgery. METHOD(S): 37 patients
(25 men and 12 women) aged 45 to 70 years with postoperative complications
after cardiovascular surgery were included in the study. Eighteen patients
underwent NMES daily since postoperative day 3 until discharge in addition
to standard rehabilitation program (NMES group), and 19 patients underwent
standard rehabilitation program only (non-NMES group). The primary outcome
was the knee extensors strength at discharge in NMES group and in control.
Secondary outcomes were the handgrip strength, knee flexor strength, and
cross-sectional area (CSA) of the quadriceps femoris in groups at
discharge. RESULT(S): Baseline characteristics were not different
between the groups. Knee extensors strength at discharge was significantly
higher in the NMES group (28.1 [23.8; 36.2] kg on the right and 27.45
[22.3; 33.1] kg on the left) than in the non-NMES group (22.3 [20.1; 27.1]
and 22.5 [20.1; 25.9] kg, respectively; P < .001). Handgrip strength, knee
flexor strength, quadriceps CSA, and 6 minute walk distance at discharge
in the groups had no significant difference. CONCLUSION(S): This
pilot study shows a beneficial effect of NMES on muscle strength in
patients with complications after cardiovascular surgery. The use of NMES
showed no effect on strength of non-stimulated muscle, quadriceps CSA, and
distance of 6-minute walk test at discharge.Further blind randomized
controlled trials should be performed with emphasis on the effectiveness
of NEMS in increasing muscle strength and structure in these patients.

<115>
Accession Number
633225626
Title
The Effect of Melatonin on the Serum Level of Interleukin 6 and
Interleukin 9 in Coronary Artery Bypass Grafting Surgery.
Source
Asian journal of anesthesiology. 58 (1) (pp 35-44), 2020. Date of
Publication: 01 Mar 2020.
Author
Jouybar R.; Setoodeh M.; Saravi Z.F.; Ahmadi S.; Karami A.; Khademi S.;
Izadpanah A.; Jannati M.; Shafa M.; Asadpour E.; Masih F.; Malekzadeh M.
Institution
(Jouybar, Karami) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Setoodeh, Izadpanah) Anesthesiology and Critical Care Research Center,
Shiraz University of Medical Science, Shiraz, Iran, Islamic Republic of
(Saravi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Ahmadi) Fasa University of Medical Science, Fasa, Iran, Islamic Republic
of
(Khademi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Jannati, Shafa) Assosiated Professor of Cardiovascular Surgery,
Cardiovascular Research Center, Shiraz University of Medical Science,
Shiraz, Iran, Islamic Republic of
(Asadpour) Assosiated Professor of Pharmacology, Anesthesiology and
Critical Care Research Center, Shiraz University of Medical Science,
Shiraz, Iran, Islamic Republic of
(Masih) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Malekzadeh) Shiraz Institute for Cancer Research, School of Medicine,
Shiraz University of Medical Science, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Cardiopulmonary bypass has been recognized as one of the main
causes of systemic inflammatory response syndrome, leading to
post-operative complications. The aim of this study was to investigate the
effect of melatonin on the serum levels of interleukin 6 (IL-6) and IL-9
in patients undergoing coronary artery bypass grafting surgery.
 METHOD(S): Forty-four patients undergoing elective coronary artery
bypass surgery were randomly allocated into two study groups of melatonin
(n = 23) and placebo (n = 21). Patients in the melatonin group received
two melatonin tablet, 5 mg daily for 3 days before surgery, 10 mg tablet
(two doses of 5 mg) 1 h before induction of anesthesia and finally, 10 mg
melatonin tablet in the intensive care unit, placebo group patients
received placebo at the same time periods. Serum levels of IL-9 and IL-6
were measured as baseline (T1), before induction of anesthesia (T2), 6 and
24 h after off pump (T3, T4). Data were analyzed using SPSS 23 software
(IBM Corp., Armonk, NY, USA). RESULT(S): The mean serum level of IL-6
was significantly lower in the melatonin group at T3 and T4 (p < 0.05).
Also, in both groups, serum levels of IL-6 in T3 showed a significant
increase compared to T1. Serum levels of IL-9 had no significant
difference between the two groups at T1, T2, T3, and T4.
 CONCLUSION(S): The results of this study showed that pre-operative
melatonin administration could modify inflammatory cytokines secretion
such as IL-6 while it has no significant effect on the serum levels of IL-
9. Neither of the changes was clinically significant.

<116>
Accession Number
633233298
Title
Intraoperative localization of cardiac conduction tissue regions using
real-time fibre-optic confocal microscopy: First in human trial.
Source
European Journal of Cardio-thoracic Surgery. 58 (2) (pp 261-268), 2020.
Date of Publication: 01 Aug 2020.
Author
Kaza A.K.; Mondal A.; Piekarski B.; Sachse F.B.; Hitchcock R.
Institution
(Kaza, Mondal, Piekarski) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
(Sachse, Hitchcock) Department of Biomedical Engineering, University of
Utah, Salt Lake City, UT, United States
(Sachse) Nora Eccles Harrison Cardiovascular Research and Training
Institute, University of Utah, Salt Lake City, UT, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of this study was to evaluate the feasibility and
safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium
dye for the intraoperative location of conduction tissue regions during
paediatric heart surgery. METHOD(S): The pilot study included 6
patients undergoing elective surgery for the closure of isolated secundum
atrial septal defect aged 30 days to 21 years. FCM imaging was integrated
within the normal intraoperative protocol for atrial septal defect repair.
Fluorescein sodium dye was applied on the arrested heart. FCM images were
acquired at the atrioventricular node region, sinus node region and right
ventricle (RV). Total imaging time was limited to 3 min. Any adverse
events related to the study were recorded and analysed. Subjects received
standard postoperative care. Trained reviewers (n = 9) classified,
de-identified and randomized FCM images (n = 60) recorded from the
patients as presenting striated, reticulated or indistinguishable
microstructures. The reliability of reviewer agreement was assessed using
Fleiss' kappa. RESULT(S): The FCM imaging instruments were integrated
effectively into the cardiac surgery operating room. All adverse events
found in the study were deemed expected and not related to FCM imaging.
Reticulated myocardial microstructures were found during FCM imaging at
atrioventricular node and sinus node regions, while striated
microstructures were observed in RV. Reliability of agreement of reviewers
classifying the FCM images was high (Fleiss' kappa: 0.822).
 CONCLUSION(S): FCM using fluorescein sodium dye was found to be safe
for use during paediatric heart surgery. The study demonstrates the
potential for FCM to be effective in identifying conduction tissue regions
during congenital heart surgery. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<117>
Accession Number
633109677
Title
Intermittent antegrade warm-blood versus cold-blood cardioplegia in
children undergoing open heart surgery: A protocol for a randomised
controlled study (Thermic-3).
Source
BMJ Open. 10 (10) (no pagination), 2020. Article Number: e036974. Date of
Publication: 14 Oct 2020.
Author
Heys R.; Stoica S.; Angelini G.; Beringer R.; Evans R.; Ghorbel M.;
Lansdowne W.; Parry A.; Pieles G.; Reeves B.; Rogers C.; Saxena R.;
Sheehan K.; Smith S.; Walker-Smith T.; Tulloh R.M.R.; Caputo M.
Institution
(Heys, Evans, Reeves, Rogers, Walker-Smith) Bristol Trials Centre, Clincal
Trials and Evaulation Unit, Bristol Medical School, University of Bristol,
Bristol, United Kingdom
(Heys, Angelini, Evans, Reeves, Rogers, Sheehan, Tulloh) National
Institute for Health Research Bristol Biomedical Research Centre,
University Hospitals Bristol Nhs Foundation Trust, University of Bristol,
Bristol, United Kingdom
(Stoica, Beringer, Lansdowne, Parry, Pieles, Sheehan, Smith, Tulloh,
Caputo) Bristol Royal Hospital for Children, University Hospitals Bristol
Nhs Foundation Trust, Bristol, United Kingdom
(Angelini, Ghorbel, Tulloh) Bristol Heart Institue, University of Bristol,
Bristol, United Kingdom
(Saxena) Cardiac Intensive Care, Great Ormond Street Hospital for Children
Nhs Foundation Trust, London, United Kingdom
Publisher
BMJ Publishing Group (E-mail: support@bmj.com)
Abstract
Introduction Surgical repair of congenital heart defects often requires
the use of cardiopulmonary bypass (CPB) and cardioplegic arrest.
Cardioplegia is used during cardiac surgery requiring CPB to keep the
heart still and to reduce myocardial damage as a result of
ischaemia-reperfusion injury. Cold cardioplegia is the prevalent method of
myocardial protection in paediatric patients; however, warm cardioplegia
is used as part of usual care throughout the UK in adults. We aim to
provide evidence to support the use of warm versus cold blood cardioplegia
on clinical and biochemical outcomes during and after paediatric
congenital heart surgery. Methods and analysis We are conducting a
single-centre randomised controlled trial in paediatric patients
undergoing operations requiring CPB and cardioplegic arrest at the Bristol
Royal Hospital for Children. We will randomise participants in a 1:1 ratio
to receive either a cold-blood cardioplegia' or a warm-blood
cardioplegia'. The primary outcome will be the difference between groups
with respect to Troponin T levels over the first 48 postoperative hours.
Secondary outcomes will include measures of cardiac function; renal
function; cerebral function; arrythmias during and postoperative hours;
postoperative blood loss in the first 12 hours; vasoactive-inotrope score
in the first 48 hours; intubation time; chest and wound infections; time
from return from theatre until fit for discharge; length of postoperative
hospital stay; all-cause mortality to 3 months postoperative; myocardial
injury at the molecular and cellular level. Ethics and dissemination This
trial has been approved by the London - Central Research Ethics Committee.
Findings will be disseminated to the academic community through
peer-reviewed publications and presentation at national and international
meetings. Patients will be informed of the results through patient
organisations and newsletters to participants. Trial registration number
ISRCTN13467772; Pre-results. Copyright © 2020 BMJ. All rights
reserved.

<118>
Accession Number
2007044667
Title
Prevention of post-cardiac surgery vitamin D deficiency in children with
congenital heart disease: a pilot feasibility dose evaluation randomized
controlled trial.
Source
Pilot and Feasibility Studies. 6 (1) (no pagination), 2020. Article
Number: 159. Date of Publication: 01 Dec 2020.
Author
McNally J.D.; O'Hearn K.; Fergusson D.A.; Lougheed J.; Doherty D.R.;
Maharajh G.; Weiler H.; Jones G.; Khamessan A.; Redpath S.; Geier P.;
McIntyre L.; Lawson M.L.; Girolamo T.; Menon K.
Institution
(McNally, Menon) Department of Pediatrics, Division of Critical Care,
University of Ottawa, Ottawa, Canada
(McNally) CHEO, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
(O'Hearn) Children's Hospital of Eastern Ontario Research Institute,
Ottawa, Canada
(Fergusson) Department of Medicine, University of Ottawa, Ottawa, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Canada
(Lougheed) Department of Pediatrics, Division of Cardiology, University of
Ottawa, Ottawa, Canada
(Doherty) Children's Health Ireland at Temple Street, Dublin, Ireland
(Maharajh, Girolamo) Department of Pediatric Surgery, Division of
Cardiovascular Surgery, University of Ottawa, Ottawa, Canada
(Weiler) School of Human Nutrition, Faculty of Agricultural and
Environmental Sciences, McGill University, Montreal, Canada
(Jones) School of Medicine, Department of Biomedical and Molecular
Sciences, Queen's University, Kingston, Canada
(Khamessan) Euro-Pharm International Canada Inc., Montreal, Canada
(Redpath) Department of Pediatrics, Division of Neonatology, University of
Ottawa, Ottawa, Canada
(Geier) Department of Pediatrics, Division of Nephrology, University of
Ottawa, Ottawa, Canada
(McIntyre) Department of Medicine (Division of Critical Care), Ottawa
Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Canada
(Lawson) Department of Pediatrics, Division of Endocrinology, University
of Ottawa, Ottawa, Canada
Publisher
BioMed Central Ltd ( United Kingdom. E-mail: info@biomedcentral.com)
Abstract
Background: The vast majority of children undergoing cardiac surgery have
low vitamin D levels post-operative, which may contribute to greater
illness severity and worse clinical outcomes. Prior to the initiation of a
large phase III clinical trial focused on clinical outcomes, studies are
required to evaluate the feasibility of the study protocol, including
whether the proposed dosing regimen can safely prevent post-operative
vitamin D deficiency in this high-risk population. Method(s): We
conducted a two-arm, double-blind dose evaluation randomized controlled
trial in children requiring cardiopulmonary bypass for congenital heart
disease. Pre-operatively, participants were randomized to receive
cholecalciferol representing usual care (< 1 year = 400 IU/day, > 1 year =
600 IU/day) or a higher dose approximating the Institute of Medicine
tolerable upper intake level (< 1 year = 1600 IU/day, > 1 year = 2400
IU/day). The feasibility outcomes were post-operative vitamin D status
(primary), vitamin D-related adverse events, accrual rate, study
withdrawal rate, blinding, and protocol non-adherence. Result(s):
Forty-six children were randomized, and five withdrew prior to surgery,
leaving 41 children (21 high dose, 20 usual care) in the final analysis.
The high dose group had higher 25-hydroxyvitamin D concentrations both
intraoperatively (mean difference + 25.9 nmol/L; 95% CI 8.3-43.5) and
post-operatively (mean difference + 17.2 nmol/L; 95% CI 5.5-29.0). Fewer
participants receiving high-dose supplementation had post-operative serum
25-hydroxyvitamin D concentrations under 50 nmol/L, compared with usual
care (RR 0.31, 95% CI 0.11-0.87). Post-operative vitamin D status was
associated with the treatment arm and the number of doses received. There
were no cases of hypercalcemia, and no significant adverse events related
to vitamin D. While only 75% of the target sample size was recruited
(limited funding), the consent rate (83%), accrual rate (1.5 per site
month), number of withdrawals (11%), and ability to maintain blinding
support feasibility of a larger trial. Conclusion(s): Pre-operative
daily high-dose supplementation improved vitamin D status pre-operatively
and at time of pediatric ICU admission. The protocol for a more definitive
trial should limit enrollment of children with at least 30 days between
randomization and surgery to allow adequate duration of supplementation or
consider a loading dose. Trial registration: ClinicalTrials.gov,
NCT01838447. Registered on April 24, 2013. Copyright © 2020, The
Author(s).

<119>
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. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Elevated low-density lipoprotein cholesterol (LDL-C) is
associated with increased cardiovascular events, especially in high-risk
populations. 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). 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). 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. 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. Copyright © 2020

<120>
Accession Number
2008396867
Title
Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art
Review.
Source
Annals of Thoracic Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Vervoort D.; Swain J.D.; Pezzella A.T.; Kpodonu J.
Institution
(Vervoort) Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
United States
(Swain) Division of Cardiovascular Surgery, Department of Surgery,
Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
(Pezzella) International Children's Heart Fund, Boca Raton, FL, United
States
(Kpodonu) Division of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: sinfo-f@elsevier.com)
Abstract
Background: Six billion people in low- and middle-income countries (LMICs)
lack timely or ready access to safe and affordable cardiac surgical care
when needed, which remains a low priority on the global public health and
global surgery agenda. Here, we report the results of a state-of-the-art
review of cardiac surgical care in LMICs to highlight the important
milestones and current progress as well as the challenges associated with
the expansion of sustainable global cardiac surgery for those in need.
 Method(s): A literature review was performed searching the
PubMed/MEDLINE and Google Scholar databases using a combination of cardiac
surgery, global health, and LMIC keywords. The Institute for Health
Metrics and Evaluation Global Burden of Disease Results Tool was used to
assess the global burden of disease related to cardiovascular surgical
diseases. Result(s): High-income countries are estimated to have more
than 100 times as many cardiac surgeons per million population compared
with low-income countries. There are more than 4000 cardiac centers
worldwide, but less than 1 center per 10 million population in LMICs.
Approximately 1.5 million cardiac operations are performed globally, of
which a disproportionally low number are in LMICs. Despite the high costs
associated with cardiac operations, recent data suggest the favorable
cost-effectiveness thereof in LMICs. Opportunities arise to sustainably
integrate cardiac surgery in holistic health systems strengthening
interventions. Conclusion(s): Skepticism underlying the need,
feasibility, and cost-effectiveness of cardiac surgery in LMICs prevails,
but recent advances, successful case studies, and existing data illustrate
the potential of expanding cardiac care globally. Copyright ©
2020 The Society of Thoracic Surgeons

<121>
Accession Number
633235307
Title
Treatment strategies in ischaemic left ventricular dysfunction: a network
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 21 Oct 2020.
Author
Gaudino M.; Hameed I.; Khan F.M.; Tam D.Y.; Rahouma M.; Yongle R.; Naik
A.; Di Franco A.; Demetres M.; Petrie M.C.; Jolicoeur E.M.; Girardi L.N.;
Fremes S.E.
Institution
(Gaudino, Hameed, Khan, Rahouma, Yongle, Naik, Di Franco, Girardi)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY, NY,
United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science University
of Toronto, ON, Toronto, Canada
(Demetres) Weill Cornell Medicine, Samuel J. Wood Library and C.V. Starr
Biomedical Information Centre, NY, NY, United States
(Petrie) Institute of Cardiovascular and Medical Sciences, British Heart
Foundation Glasgow Cardiovascular Research Centre, University of Glasgow,
Glasgow, United Kingdom
(Jolicoeur) Montreal Heart Institute, QC, Montreal, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The optimal revascularization strategy for patients with
ischaemic left ventricular systolic dysfunction (iLVSD) remains
controversial. We aimed to compare percutaneous coronary intervention
(PCI), coronary artery bypass grafting (CABG) and medical therapy (MT) in
a network meta-analysis. METHOD(S): All randomized controlled trials
and observational studies comparing any combination of PCI, CABG and MT in
patients with iLVSD were analysed in a frequentist network meta-analysis
(generic inverse variance method). Primary outcome was mortality at
longest available follow-up. Secondary outcomes were cardiac death,
stroke, myocardial infarction (MI) and repeat revascularization (RR).
 RESULT(S): Twenty-three studies were included (n=23 633; 4 randomized
controlled trials). Compared to CABG, PCI was associated with higher
mortality [incidence rate ratio (IRR) 1.32, 95% confidence interval (CI)
1.13-1.53], cardiac death (IRR 1.65, 95% CI 1.18-2.33), MI (IRR 2.18, 95%
CI 1.70-2.80) and RR (IRR 3.75, 95% CI 2.89-4.85). Compared to CABG, MT
was associated with higher mortality (IRR 1.52, 95% CI 1.26-1.84), cardiac
death (IRR 3.83, 95% CI 2.12-6.91), MI (IRR 3.22, 95% CI 1.52-6.79) and RR
(IRR 3.37, 95% CI 1.67-6.79). Compared to MT, PCI was associated with
lower cardiac death (IRR 0.43, 95% CI 0.24-0.78). CABG ranked as the best
revascularization strategy for mortality, cardiac death, MI and RR; MT
ranked as the strategy associated with the lowest incidence of stroke.
Left ventricular ejection fraction, year of study, use of drug-eluting
stents did not affect relative treatment effects. CONCLUSION(S): CABG
appears to be the best therapy for iLVSD, although mainly based on
observational data. Definitive randomized controlled trials comparing CABG
and PCI in iLVSD are required.132414. Copyright © The Author(s)
2020. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<122>
Accession Number
633230987
Title
Polygenic contribution to low-density lipoprotein cholesterol levels and
cardiovascular risk in monogenic familial hypercholesterolemia.
Source
Circulation: Genomic and Precision Medicine. (pp 515-523), 2020. Article
Number: e002919. Date of Publication: 2020.
Author
Trinder M.; Paquette M.; Cermakova L.; Ban M.R.; Hegele R.A.; Baass A.;
Brunham L.R.
Institution
(Trinder, Brunham) Centre for Heart Lung Innovation, University of British
Columbia, Vancouver, Canada
(Paquette, Baass) Nutrition, Metabolism and Atherosclerosis Clinic,
Institut de Recherches Cliniques de Montreal, Quebec, Canada
(Cermakova, Ban) Healthy Heart Program Prevention Clinic, St Paul's
Hospital, Vancouver, BC, Canada
(Ban, Hegele) Departments of Medicine and Biochemistry, Schulich School of
Medicine and Dentistry and Robarts Research Institute, Western University,
London, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: customerservice@lww.com)
Abstract
BACKGROUND: Familial hypercholesterolemia (FH) is a common autosomal
codominant genetic disorder, which causes elevated levels of low-density
lipoprotein cholesterol (LDL-C) and increased risk of premature
atherosclerotic cardiovascular disease (ASCVD). Even among individuals
with monogenic FH, there is substantial interindividual variability in
LDL-C levels and risk of ASCVD. We assessed the influence of an LDL-C
polygenic score on levels of LDL-C and risk of ASCVD for individuals with
monogenic FH. METHOD(S): We constructed a weighted LDL-C polygenic
score, composed of 28 single-nucleotide variants, for individuals with
monogenic FH from the British Columbia FH (n=262); Nutrition, Metabolism
and Atherosclerosis Clinic (n=552); and UK Biobank cohorts (n=306). We
assessed the association between LDL-C polygenic score with LDL-C levels
and ASCVD risk using linear regression and Cox-proportional hazard models,
respectively. ASCVD was defined as myocardial infarction, coronary or
carotid revascularization, transient ischemic attack, or stroke. The
results from individual cohorts were combined in fixed-effect
meta-analyses. RESULT(S): Levels of LDL-C were significantly
associated with LDL-C polygenic score in the Nutrition, Metabolism and
Atherosclerosis Clinic cohort, UK Biobank cohort, and in the meta-analysis
(beta [95% CI]=0.13 [0.072-0.19] per a 20% increase in LDL-C polygenic
score percentile, P<0.0001). Additionally, an elevated LDL-C polygenic
score (>=80th percentile) was associated with a trend towards increased
ASCVD risk in all 3 cohorts individually. This association was
statistically significant in the meta-analysis (hazard ratio [95% CI]=1.48
[1.02-2.14], P=0.04). CONCLUSION(S): Polygenic contributions to LDL-C
explain some of the heterogeneity in clinical presentation and ASCVD risk
for individuals with FH. Copyright © 2020 Lippincott Williams and
Wilkins. All rights reserved.

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