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<1>
Accession Number
2004762539
Title
10 khz high-frequency spinal cord stimulation for chronic thoracic pain: A
multicenter case series and a guide for optimal anatomic lead placement.
Source
Pain Physician. 23 (4) (pp E369-E376), 2020. Date of Publication:
July-August 2020.
Author
Sayed D.; Foster J.; Nairizi A.; Sills S.; Miller A.
Institution
(Sayed, Foster) Department of Anesthesiology, University of Kansas Medical
Center, Kansas City, KS, United States
(Nairizi) Nevada Advanced Pain Specialists, Reno, NV, United States
(Sills) Touchstone Interventional Pain Center, Medford, OR, United States
(Miller) School of Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Surgical options for thoracic pain are limited and carry
significant risk and morbidity. Spinal cord stimulation has the potential
to be used for treatment of thoracic pain, as it has been useful for
treating multiple types of chronic pain. Conventional tonic stimulation is
limited in the treatment of thoracic pain, as it can produce paresthesia
that is difficult to localize. Conversely, high-frequency spinal cord
stimulation (HF-SCS) does not activate dorsal column Abeta fibers and does
not produce paresthesia, and thus may be more beneficial in treating
thoracic back pain not manageable with tonic stimulation.
 Objective(s): To evaluate (1) the efficacy of 10 kHz HF-SCS for
patients with chronic thoracic pain; and (2) appropriate paresthesia-free
lead placement and programming targets for 10 kHz HF-SCS for patients with
chronic thoracic pain. Study Design: Retrospective case series.
 Setting(s): Multisite academic medical center or pain clinic.
 Method(s): A retrospective chart review was performed on 19 patients
with thoracic back pain who underwent HF-SCS implantation. These patients
had lead placement and stimulation between the T1-T6 vertebral levels.
Outcome measures collected include location of device implant, stimulation
settings, and pain scores at baseline, end of trial, and 1, 6, and 12
months postimplant. Followup phone calls collected information on if the
patient reported functional improvement, improved sleep, or decreased pain
medication usage. A Wilcoxon signed-rank test compared differences in mean
pain scores across time points. Result(s): Significantly decreased
Visual Analog Scale scores were observed with 17/19 (89.5%) patients
demonstrating response to therapy (>50% reduction in pain scores). These
results were sustained relative to baseline at 1, 6, and 12 months
postimplant, depending on length of followup. Many patients also reported
functional improvement (17/19), improved sleep (14/19), and reduction in
use of pain medications after implantation (9/19). A total of 15/19
patients reported best relief when contacts over T1 or T2 vertebrae were
used for stimulation. Limitation(s): This study is limited by its
retrospective design. Additionally, including documentation from multiple
sites may be prone to selection and abstraction bias. Data were also not
available for all patients at all time points. Conclusion(s): HF-SCS
may be a viable option for significant, long-lasting pain relief for
thoracic back pain. There may also be evidence for anatomically based lead
placement and programming for thoracic back pain. Randomized, controlled
trials with extended follow-up are needed to further evaluate this
therapy. Copyright © 2020, American Society of Interventional
Pain Physicians. All rights reserved.

<2>
Accession Number
633122328
Title
Effect of Tropisetron on Prevention of Emergence Delirium in Patients
after Noncardiac Surgery: A Trial Protocol.
Source
JAMA Network Open. 3 (10) (no pagination), 2020. Article Number: 13443.
Date of Publication: October 2020.
Author
Sun Y.; Lin D.; Wang J.; Geng M.; Xue M.; Lang Y.; Cui L.; Hao Y.; Mu S.;
Wu D.; Liang L.; Wu A.
Institution
(Sun, Lin, Wang, Geng, Xue, Hao, Mu, Wu, Wu) Department of Anesthesiology,
Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu,
Chaoyang District, Beijing 100020, China
(Lang) Department of Anesthesiology, Beijing Civil Aviation General
Hospital, Beijing, China
(Cui) Department of Anesthesiology, Beijing Huairou District Hospital of
Traditional Chinese Medicine, Beijing, China
(Liang) Department of Clinical Epidemiology and Tobacco Dependence
Treatment Research, Beijing Chaoyang Hospital, Capital Medical University,
Beijing Institute of Respiratory Medicine, No. 8 Gongti Nanlu, Chaoyang
District, Beijing 100020, China
Publisher
American Medical Association
Abstract
Importance: Postoperative delirium is a frequent disorder for patients
undergoing surgery and is associated with poor outcomes. Delirium may
occur in the immediate period after anesthesia administration and surgery.
Tropisetron, which is frequently administrated for postoperative nausea
and vomiting, is also a partial agonist of alpha7 nicotinic acetylcholine
receptors associated with neuroprotective effects. Tropisetron may be the
potential pharmacological treatment to decrease delirium after noncardiac
surgery. Objective(s): To perform a randomized clinical trial to
determine the efficacy and safety of tropisetron for prevention of
emergence delirium in patients undergoing noncardiac surgery. Design,
Setting, and Participant(s): This single-center, 2-arm randomized,
double-blind, placebo-controlled trial will include 1508 patients
undergoing noncardiac surgery. The intervention group will receive 5 mg of
intravenous tropisetron before anesthesia induction, and patients in the
control group will receive a placebo. The primary end point is the
incidence of emergence delirium within 1 hour after tracheal tube removal,
measured by the Confusion Assessment Method for the Intensive Care Unit
score. The main secondary outcome is the incidence of postoperative
delirium measured at 3 days of follow-up. An intention-to-treat principle
will be used for all analyses. Discussion(s): Delirium remains the
most common neuropsychiatric complication for patients after surgery. This
will be the first randomized clinical study to evaluate whether
tropisetron is effective in preventing emergence delirium. Results from
this study will provide evidence for alteration of daily practice. Trial
Registration: ClinicalTrials.gov Identifier: NCT04027751. Copyright
© 2020Sun Y et al. JAMA Network Open.

<3>
Accession Number
2008415074
Title
Comparison of interleukin-6, C-reactive protein, and low-density
lipoprotein cholesterol as biomarkers of residual risk in contemporary
practice: Secondary analyses from the cardiovascular inflammation
reduction trial.
Source
European Heart Journal. 41 (31) (pp 2952-2961), 2020. Date of Publication:
14 Aug 2020.
Author
Ridker P.M.; MacFadyen J.G.; Glynn R.J.; Bradwin G.; Hasan A.A.; Rifai N.
Institution
(Ridker, MacFadyen, Glynn) Division of Preventive Medicine, Center for
Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard
Medical School, Brigham and Women's Hospital, 900 Commonwealth Avenue,
Boston, MA 02215, United States
(Ridker) Cardiovascular Division, Brigham and Women's Hospital, 75 Francis
Street, Boston, MA 02115, United States
(Bradwin, Rifai) Department of Laboratory Medicine, Boston Children's
Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
(Hasan) National Heart Lung and Blood Institute, 9000 Rockville Pike,
Bethesda, MD 20892, United States
Publisher
Oxford University Press
Abstract
Aims In epidemiologic cohorts initiated >30 years ago, inflammatory
biomarkers, such as interleukin-6 (IL-6) and high-sensitivity C-reactive
protein (hsCRP) were shown to independently predict future cardiovascular
events with a magnitude of effect comparable to that of low-density
lipoprotein cholesterol (LDLC). Whether aggressive contemporary therapy
for atherosclerosis has altered these relationships is unknown yet has
major implications for future drug development. Methods Interleukin-6,
hsCRP, and LDLC were measured at baseline in up to 4168 North American
patients enrolled in the and results contemporary Cardiovascular
Inflammation Reduction Trial with prior myocardial infarction or
multivessel coronary disease who additionally had diabetes or metabolic
syndrome and were followed for a period of up to 5 years for incident
major recurrent cardiovascular events and all-cause mortality.
Three-quarters of the cohort were previously revascularized and the great
majority was taking statins, angiotensin blocking agents, beta-blockers,
and antithrombotic agents. Participants were randomly allocated to
low-dose methotrexate 15 mg weekly or to placebo. Randomized use of
methotrexate had no effect on event rates nor plasma levels of IL-6,
hsCRP, or LDL over time. Yet, baseline levels of IL-6, hsCRP, and LDLC
were all predictors of major recurrent cardiovascular events; adjusted
hazard ratios [HR; 95% confidence interval (CI)] for the lowest to highest
baseline quartiles of IL-6 were 1.0 (referent), 1.66 (1.18-2.35), 1.92
(1.36-2.70), and 2.11 (1.49-2.99; P < 0.0001), while adjusted HRs for
increasing quartiles of hsCRP were 1.0 (referent), 1.28 (0.92-1.79), 1.73
(1.25-2.38), and 1.79 (1.28-2.50; P < 0.0001) and adjusted HRs for
increasing quartiles of LDLC were 1.0 (referent), 1.12 (0.78-1.62), 1.25
(0.87-1.79), and 2.38 (1.72-3.30; P < 0.0001). Effect estimates were not
statistically different in these analyses for comparisons between IL-6,
hsCRP, or LDLC, although IL-6 was the strongest predictor of all-cause
mortality. The highest absolute risks were observed among those with
elevated levels of both cholesterol and inflammation [HR 6.4 (95% CI
2.9-14.1) for those in the top quartiles of baseline IL-6 and LDLC, HR 4.9
(95% CI 2.6-9.4) for those in the top quartiles of baseline hsCRP and
LDLC, both P < 0.0001]. Conclusion Despite aggressive contemporary
secondary prevention efforts, the relationships between inflammation,
cholesterol, and cardiovascular risk are largely unchanged from those
described two decades ago. These data are consistent with the hypothesis
that future treatments for atherosclerosis may require a combination of
inflammation inhibition and additional cholesterol reduction. Clinical
trial ClinicalTrials.gov NCT01594333. Copyright © The Author(s)
2020.

<4>
Accession Number
2006151257
Title
Transcatheter vs surgical aortic valve replacement in low to intermediate
surgical risk aortic stenosis patients: A systematic review and
meta-analysis of randomized controlled trials.
Source
Clinical Cardiology. 43 (12) (pp 1414-1422), 2020. Date of Publication:
December 2020.
Author
Zhang D.; Mao X.; Liu D.; Zhang J.; Luo G.; Luo L.
Institution
(Zhang, Mao, Liu, Zhang, Luo, Luo) Department of Cardiovascular Surgery,
The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is regarded as
the most superior alternative treatment approach for patients with aortic
stenosis (AS) who are associated with high surgical risk, whereas the
effectiveness of TAVR vs surgical aortic valve replacement (SAVR) in low
to intermediate surgical risk patients remained inconclusive. This study
aimed to determine the best treatment strategies for AS with low to
intermediate surgical risk based on published randomized controlled trials
(RCTs). Hypothesis and Methods: RCTs that compared TAVR vs SAVR in AS
patients with low to intermediate surgical risk were identified by PubMed,
EmBase, and the Cochrane library from inception till April 2019. The
pooled relative risks (RRs) with 95% confidence intervals (CIs) were
calculated for the data collected using random-effects models.
 Result(s): Seven RCTs with a total of 6929 AS patients were enrolled.
We noted that TAVR significantly increased the risk of transient ischemic
attack (TIA) (RR: 1.43; 95%CI: 1.04-1.96; P =.029), and permanent
pacemaker implantation (RR: 3.00; 95%CI: 1.70-5.30; P <.001). However,
TAVR was associated with lower risk of post-procedural bleeding (RR: 0.57;
95%CI: 0.33-0.98; P =.042), new-onset or worsening of atrial fibrillation
(RR: 0.32; 95%CI: 0.23-0.45; P <.001), acute kidney injury (RR: 0.40;
95%CI: 0.25-0.63; P <.001), and cardiogenic shock (RR: 0.34; 95%CI:
0.19-0.59; P <.001). The risk of aortic-valve reintervention at 1- (RR:
2.63; 95%CI: 1.34-5.15; P =.005), and 2 years (RR: 3.19; 95%CI: 1.63-6.24;
P =.001) in low to intermediate surgical risk patients who received TAVR
was significantly increased than those who received SAVR.
 Conclusion(s): These findings indicated that low to intermediate
surgical risk patients who received TAVR had low risk of complications,
whereas the risk of TIA, permanent pacemaker implantation, and
aortic-valve reintervention was increased. Copyright © 2020 The
Authors. Clinical Cardiology published by Wiley Periodicals LLC.

<5>
Accession Number
2007545157
Title
Remote ischemic preconditioning effects on inflammatory markers and
myocardial protection in coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). (no pagination), 2020. Date of Publication:
2020.
Author
Gorjipour F.; Saeedzadeh T.; Toloueitabar Y.; Kachoueian N.; Bahlouli
Ghashghaei S.; Mortazian M.; Dehghani Firoozabadi M.; Jadbabaie A.;
Tirgarfakheri K.; Motamednejad A.; Totonchi Z.
Institution
(Gorjipour, Kachoueian, Jadbabaie) Department of Cardiac Surgery, Imam
Hossein Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Gorjipour) Iranian Scientific Society of Extracorporeal Technology,
Rajaie Cardiovascular Medical and Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Saeedzadeh) Department of Biological Sciences, North Tehran Branch,
Islamic Azad University, Tehran, Iran, Islamic Republic of
(Toloueitabar, Bahlouli Ghashghaei, Tirgarfakheri, Motamednejad, Totonchi)
Rajaie Cardiovascular Medical and Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Mortazian) AJA University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Dehghani Firoozabadi) Department of Anesthesiology, Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
SAGE Publications Ltd
Abstract
Background: Induction of short episodes of ischemia to remote organs,
namely upper or lower limbs, literally known as remote ischemic
preconditioning (RIPC) has been suggested as a preconditioning approach to
ameliorate ischemia/reperfusion injury (IRI). RIPC has been demonstrated
to effectively protect various vital organs, including heart, against the
next ischemic events in preclinical studies. However, human studies are
required to approve its clinical applicability. Present study was
performed to evaluate the effect of RIPC on the myocardial protection and
inflammatory response markers in patients undergoing coronary artery
bypass graft surgery Methods: In this randomized clinical trial, 43
coronary artery bypass graft (CABG) patients from Imam Hossein educational
hospital were allocated in two groups, RIPC (21 patients) and control (22
patients). Serum level of interleukin (IL)-4, IL-8, and IL-10, interferon
(IFN)-gamma and Cardiac Troponin-I (cTnI) were measured in (1) after
induction of anesthesia (before incision of skin), (2) after separation
from CPB and (3) 24 hours after ICU arrival. Result(s): increase pack
cell transfusions were observed in control group in ICU. Serum level of
IL-10 at 24 hours after ICU admission was significantly higher in the RIPC
group. Significantly lower amounts of IL-8 at post-CPB time were observed
in the RIPC group in comparison with control. Conclusion(s): RIPC
regulates the circulatory inflammatory cytokines, IL-8 decrement and IL-10
elevation, which could be translated into protection against IRI. However,
further studies with larger sample sizes with careful consideration of
parameters such as use of propofol as an anesthetic in the patients should
be conducted to consolidate the findings from the current
study. Copyright © The Author(s) 2020.

<6>
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Accession Number
2007540285
Title
A mortality risk score for heart transplants after contemporary
ventricular assist device bridging.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Huckaby L.V.; Seese L.M.; Hickey G.; Sultan I.; Kilic A.
Institution
(Huckaby, Seese, Sultan, Kilic) Division of Cardiac Surgery, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Hickey) Division of Cardiology, University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: We sought to derive a risk score for 1-year mortality
following orthotopic heart transplantation (OHT) in patients bridged with
a contemporary centrifugal left ventricular assist device (LVAD).
 Method(s): Adult patients (>=18 years) in the United Network for
Organ Sharing database undergoing OHT between 2010 and 2019 who were
bridged with a HeartWare or HeartMate III device were included. Derivation
and validation cohorts were randomly assigned with a 2:1 ratio. Threshold
analysis and multivariable logistic regression were utilized to obtain
adjusted odds ratios for 1-year post-OHT mortality. A risk score was
generated using these adjusted odds ratios in the derivation cohort and
the predictive performance of the composite index was evaluated in the
validation set. Result(s): A total of 3434 patients were identified.
In the derivation cohort, the mean age was 53.5 +/- 12.1 years and 1758
(76.8%) were male; 1789 (78.1%) were bridged with a HeartWare device.
Multivariable logistic regression revealed that recipient age >=50 years,
bilirubin level >=2.4 mg/dl, ischemic time >=4 h, and preoperative
hemodialysis predicted 1-year post-transplant mortality. Stratification
into risk groups in the validation cohort revealed significant differences
in postoperative renal failure, stroke, and short-term mortality. One-year
post-transplant mortality was 5%, 6.7%, and 14.8% in the low-, moderate-,
and high-risk categories, respectively (p <.001). Conclusion(s):
Among patients bridged to OHT with newer generation centrifugal LVADs,
older age, increasing bilirubin, longer ischemic time, and pre-OHT
dialysis independently predicted post-transplant mortality. The composite
risk score based on these factors may assist in patient selection and
prognostication in those supported with contemporary LVADs. Copyright
© 2020 Wiley Periodicals LLC

<7>
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Accession Number
2007540281
Title
Open heart surgery in an infant with hereditary spherocytosis and a review
of literature.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Menon S.; Saxena M.S.; Rajalakshmi M.S.
Institution
(Menon) Division of Pediatric Cardiac Surgery, Department of
Cardiovascular and Thoracic surgery, Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
(Saxena) Department of Cardiovascular and Thoracic surgery, Sree Chitra
Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram,
Kerala, India
(Rajalakshmi) Department of Pathology, Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
Publisher
Blackwell Publishing Inc.
Abstract
Hemolytic anemia often challenges congenital heart surgery. Hereditary
spherocytosis is a rare familial hemolytic anemia. When associated with
congenital heart disease, the safe performance of cardiopulmonary bypass
becomes a priority. The increased risk of hemolysis during cardiopulmonary
bypass could potentially lead to significant secondary organ damage. Till
now, only very few reports of successful repair of a congenital heart
defect in patients with hereditary spherocytosis have been reported. We
report the only case of successful repair of a congenital heart defect in
an infant with hereditary spherocytosis. Copyright © 2020 Wiley
Periodicals LLC

<8>
Accession Number
2007514186
Title
Postoperative resuscitation with hypertonic saline or hyperoncotic albumin
in patients following cardiac surgery: A review of the literature.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Otero T.M.N.; Aljure O.D.; Yu S.
Institution
(Otero, Yu) Department of Anesthesiology, Banner University Medical
Center, University of Arizona College of Medicine, Tucson, AZ, United
States
(Aljure) Department of Anesthesiology, Miller School of Medicine,
University of Miami, Miami, FL, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Over-resuscitation in postcardiac surgery patients is
associated with significant morbidity and mortality. Accordingly, there is
a growing interest in hyperoncotic albumin and hypertonic saline for
resuscitation in patients following cardiac surgery. In this article, we
will review the use of hyperosmolar fluid therapies for resuscitation in
postcardiac surgical patients from the current literature. Method(s):
A literature search was conducted in MEDLINE (PubMed) utilizing keywords,
narrowing publications from 2009 to 2020. Result(s): Patients
receiving concentrated albumin after cardiac surgery required less fluid
bolus therapy, less time on vasopressors, and had a lower positive fluid
balance compared with patients receiving crystalloids. There was no
difference in mortality in those given 20% albumin compared with
crystalloids postcardiac surgery. Patients administered hypertonic saline
following cardiac surgery had increased urinary output but its effect on
total fluid and body weight was not significantly different compared with
crystalloids. Conclusion(s): In this analysis, publications on
resuscitation with hyperoncotic albumin and hypertonic saline in patients
following cardiac surgery were reviewed. While there is data supporting
the use of alternative fluid therapies in other critically ill
populations, the limited literature focused on concentrated albumin and
hypertonic saline for resuscitation following cardiac surgery is
equivocal. Copyright © 2020 Wiley Periodicals LLC

<9>
Accession Number
633609348
Title
Safety and feasibility of early resistance training following median
sternotomy: The safe-arms study.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 35th
Annual Scientific Meeting of the American Association of Cardiovascular
and Pulmonary Rehabilitation, AACVPR 2020. United States. 40 (5) (pp E36),
2020. Date of Publication: September 2020.
Author
Stacey Pengelly J.M.; Boggett S.; Bryant A.; Royse A.; Royse C.; Williams
G.; El-Ansary D.
Institution
(Stacey Pengelly, El-Ansary) Swinburne University of Technology,
Melbourne, Australia
(Stacey Pengelly) Charles Sturt University, Bathurst, Australia
(Boggett, Bryant, Royse, Royse, Williams, El-Ansary) University of
Melbourne, Melbourne, Australia
(Royse) Royal Melbourne Hospital, Melbourne, Australia
(Royse) Outcomes Research Consortium Cleveland Clinic, Cleveland, OH,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Emerging evidence demonstrating the safety and feasibility
of unweighted upper limb movements following median sternotomy has led
calls for less restrictive sternal precautions to be adopted. However,
current sternal precautions often discourage the use of the upper limbs,
impacting physical and functional recovery following surgery. Cardiac
rehabilitation resistance training tends to be implemented much more
conservatively than the American College of Sports Medicine's guidelines
recommend, which is likely attributed to the lack of evidence
investigating its effect on sternal healing. Purpose(s): To determine
whether early post-operative upper-limb resistance exercises are safe and
feasible in regard to sternal healing and pain, when commenced two weeks
following cardiac surgeries via median sternotomy. Design(s):
Sub-study of a pilot randomised controlled trial, resistance training arm.
 Method(s): The study population was the resistance training
intervention group of the Supervised Early Resistance study. Six upper
limb exercises (seated row, shoulder pulldown, shoulder press, bicep curl,
triceps dip and lateral raise), commenced at 20lbs for 12 repetitions,
were assessed at 2-, 8- and 14- weeks postoperatively. Sternal edge motion
in the lateral (coronal plane) and anterior-posterior (sagittal plane)
directions were measured using real-time ultrasound at the mid and lower
sternum, at 6 and 10 cm from the sternal notch, respectively. Maximal pain
was recorded during exercise, using a Visual Analogue Scale (0-10). As
movement >2mm may compromise bone healing, exercises were deemed safe if
micromotion did not exceed 2mm. HREC ethical approval was granted by the
Melbourne Health prior to commencement of recruitment (ID: 2017.266).
Prospective ANZCTR registration (ACTRN12617001430325p). Result(s):
Sixteen post-sternotomy patients (n=15 males, n=1 female; 71.3+/- 6.2
years) who participated in the resistance arm of the SEcReT study were
included. The resistance training intervention was commenced 14.5 days
(IQR= 2.5 days) following surgery. Maximum sternal micromotion occurred in
the coronal plane (lateral movement) in contrast to the sagittal plane
(anterior-posterior movement) for all six exercises. The greatest median
micromotion occurred during the bicep curl (median= 1.5mm; IQR= 1.9mm) at
the mid-sternum in the lateral direction and the shoulder pulldown
(median= 0.5mm; IQR= 1.1mm) at the lower-sternum in the anterior-posterior
direction. Sternal pain at rest was 0/10 at all three time points and did
not increase with exercise. Ultrasound inter-rater reliability for lateral
micromotion (ICC=0.73; 95% CI=0.58-0.83) and anterior-posterior
micromotion (ICC=0.83; 95% CI=0.73-0.89) was moderate-good.
 Conclusion(s): Supervised early bilateral upper limb resistance
training is safe and feasible with respect to sternal micromotion and
pain, when performed on machines that move in one plane in a controlled
environment. Sternal micromotion did not exceed 2mm during the bicep curl,
triceps dip, lateral raise, shoulder pulldown, shoulder press and seated
row at 2-, 8- or 14-weeks post-operatively. The safety on unsupervised
home-based exercises are unknown. Scientific Posters.

<10>
Accession Number
633609343
Title
Cardiac rehabilitation following median sternotomy in the elderly: A
systematic review with meta-analysis.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 35th
Annual Scientific Meeting of the American Association of Cardiovascular
and Pulmonary Rehabilitation, AACVPR 2020. United States. 40 (5) (pp
E50-E51), 2020. Date of Publication: September 2020.
Author
Stacey Pengelly J.M.; Stacey Pengelly M.J.; Lin K.-Y.; Karri R.; Royse C.;
Royse A.; Bryant A.; Williams G.; El-Ansary D.
Institution
(Stacey Pengelly, El-Ansary) Swinburne University of Technology,
Melbourne, Australia
(Stacey Pengelly) Charles Sturt University, Bathurst, Australia
(Stacey Pengelly) Central Queensland University, Cairns, Australia
(Lin) National Cheng Kung University, Tainan, Taiwan (Republic of China)
(Karri, Royse, Royse, Bryant, Williams, El-Ansary) University of
Melbourne, Melbourne, Australia
(Royse) Outcomes Research Consortium Cleveland Clinic, Cleveland, OH,
United States
(Royse) Royal Melbourne Hospital, Melbourne, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: More than 1.5 million cardiac operations are performed
annually, worldwide. Patients undergoing these procedures are typically
elderly with multiple co-morbidities, which places them at a higher risk
of post-operative cognitive and functional decline. Whilst exercise has
beneficial effects on effects on exercise capacity, inflammation,
autonomic function, muscular strength, the exercise prescription and
outcome measures used in elderly cardiac patients following median
sternotomy are unknown. Purpose(s): To identify the exercise
parameters (frequency, duration, intensity and mode) and outcome measures
used in cardiac rehabilitation programs, in elderly patients following
median sternotomy and their compliance with international cardiac
rehabilitation guidelines. Design(s): A systematic review with
meta-analysis. Method(s): Five electronic databases were searched for
relevant key terms. Studies eligible for inclusion were published in
English between 1997- September 2018, evaluating the physiological or
cognitive effects of post-operative cardiac rehabilitation exercise
interventions in elderly patients (>=65 years) following cardiac surgeries
via median sternotomy (valve surgery and/or coronary artery bypass
grafting). Two independent researchers assessed articles for relevance and
eligibility prior to data extraction and quality appraisal, with a third
independent reviewer for overall agreement. Data extraction was undertaken
using the Law and MacDermid Quantitative Review form and guidelines,
whilst study quality and risk of bias was assessed using a modified Downs
and Black tool. Result(s): Study quality appraisal was undertaken on
11 studies. Exercise parameters for the included studies ranged from 1
week to 6 months in program duration, 1-7 days/week, for 30-120 minutes at
a light-moderate intensity. Aerobic training interventions in seven
studies, met two out of three cardiac rehabilitation guidelines
(Australian, American and/or European). However, the eight studies stating
inclusion of resistance training interventions, lacked sufficient detail
to establish adherence. Meta-analysis was performed using two randomised
controlled trials, with outcome measure variability limiting study
inclusion suitability. A higher volume of exercise was shown to have a
positive effect on functional capacity, assessed using the 6-minute walk
test (6MWT) (mean difference = 26.97 m; 95% confidence interval [CI],
6.96-46.97; p = 0.008; I2 = 0%). Furthermore, the addition of resistance
exercise to traditional aerobic programs may lead to more significant
improvements in functional capacity than aerobic exercise alone. No
significant improvement was shown between additional exercise compared to
standard care in improving VO2peak, maximal power output or quality of
life. No studies evaluated the impact of exercise on cognitive recovery,
thus it remains unknown. Conclusion(s): In the elderly cardiac
population, higher volume of exercise training improves physical recovery
beyond that of standard care. Whilst the physiological benefits of aerobic
exercise have been extensively researched, there is a lack of evidence
surrounding resistance training following cardiac surgery. The high
prevalence of cognitive impairment warrants investigation into the effects
of exercise on cognitive recovery.

<11>
Accession Number
633609338
Title
Resistance training following median sternotomy: A systematic review with
meta-analysis.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 35th
Annual Scientific Meeting of the American Association of Cardiovascular
and Pulmonary Rehabilitation, AACVPR 2020. United States. 40 (5) (pp E50),
2020. Date of Publication: September 2020.
Author
Stacey Pengelly J.M.; Stacey Pengelly M.J.; Lin K.-Y.; Royse C.; Royse A.;
Bryant A.; Williams G.; El-Ansary D.
Institution
(Stacey Pengelly, El-Ansary) Swinburne University of Technology,
Melbourne, Australia
(Stacey Pengelly) Charles Sturt University, Bathurst, Australia
(Stacey Pengelly) Central Queensland University, Cairns, Australia
(Lin) National Cheng Kung University, Tainan, Taiwan (Republic of China)
(Royse, Royse, Bryant, Williams, El-Ansary) University of Melbourne,
Melbourne, Australia
(Royse) Outcomes Research Consortium Cleveland Clinic, Cleveland, OH,
United States
(Royse) Royal Melbourne Hospital, Melbourne, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Despite no evidence to suggest that restricting upper limb
and trunk movements improves bone healing and prevents sternal
complications, sternal precautions are typically prioritised over exercise
for 8 to 12 weeks following surgery. Resistance training may play a role
in the reduction of inflammation, cognitive dysfunction and sarcopenia,
which can persist for several months after surgery. Furthermore,
resistance training augments improvements in cardiovascular fitness,
muscle strength, quality of life and the ability to perform activities of
daily living. However the disconnect between current sternal precautions,
cardiac rehabilitation resistance training guidelines and emerging
evidence is problematic for clinicians delivering evidence-based exercise
interventions. Purpose(s): To determine how resistance training is
defined, applied, progressed and evaluated in the median sternotomy
cardiac population; and its subsequent effect on physical and functional
recovery. Design(s): A systematic review with meta-analysis.
 Method(s): Five electronic databases were searched for relevant key
terms. Studies eligible for inclusion were published in English and
evaluated the effect of resistance training on physical and functional
recovery in adults (>=18 years) undergoing cardiac surgery via median
sternotomy (valve surgery and/or coronary artery bypass grafting). Two
independent researchers assessed articles for relevance and eligibility
prior to data extraction and quality appraisal, with a third independent
reviewer for overall agreement. Data extraction was undertaken using the
Law and MacDermid Quantitative Review form and guidelines, whilst study
quality and risk of bias was assessed using a modified Downs and Black
tool. Result(s): Quality appraisal of the 18 included studies found
that the definition of 'resistance' was primarily defined as callisthenic
or range of motion-type exercises. No studies met all ACSM resistance
training guidelines and the inadequate reporting of the weights and
exercises used in the resistance training interventions did not allow for
interpretation. However, session frequency (2-3 days/week) and program
duration (4-6 months) were met by ten and five studies, respectively.
Meta-analysis was performed on seven studies investigating the effects of
resistance training alone after cardiac involving median sternotomy. When
comparing aerobic and resistance training interventions, there was no
statistically significant improvement in cardiopulmonary capacity measures
of VO2peak and treadmill time (mean difference= 0.24; 95% CI= -0.32-0.80;
p=0.40; I2=58%) or anthropometric measures of body mass index and body
weight (mean difference= -0.06; 95% CI= -0.36-0.24; p = 0.91; I2 = 0%).
However, the addition of resistance training to standard care showed a
trend toward 6-minute walk distance improvement (mean difference= 13.76m;
95% CI= -4.07-31.59; p=0.13; I2=54%). Conclusion(s): Resistance
training shows potential in optimising patient physical and functional
recovery following cardiac surgeries via median sternotomy through
improved neurogenesis, neuromuscular control and muscle activation
patterns. However, the effect of early resistance training on sternal
healing remains unknown and further research to inform clinical guidelines
in required.

<12>
Accession Number
633609330
Title
Effect of smoking on changes in cardiorespiratory fitness in cardiac
rehabilitation.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 35th
Annual Scientific Meeting of the American Association of Cardiovascular
and Pulmonary Rehabilitation, AACVPR 2020. United States. 40 (5) (pp E35),
2020. Date of Publication: September 2020.
Author
Mahoney K.; Bolivar H.; Savage P.; Ades P.; Gaalema D.
Institution
(Mahoney, Bolivar, Savage, Ades, Gaalema) University of Vermont,
Burlington, VT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Continued smoking in patients with cardiovascular disease
greatly increases risk for subsequent cardiac events. Smoking is
associated with reduced aerobic capacity and lower adherence to secondary
prevention strategies like cardiac rehabilitation (CR). Physical fitness
among smokers attending CR is understudied despite being at a higher risk
of future mortality and morbidity. Examining changes in fitness among
lower-socioeconomic status (SES) patients, who are more likely to be
current smokers, can help inform this understudied area. Purpose(s):
We examined the role of smoking at the time of hospitalization and changes
in cardiorespiratory fitness levels during CR. Design(s): Secondary
analysis of data from two randomized clinical trials testing interventions
to increase CR attendance in individuals of lower SES. Method(s):
Peak Metabolic Equivalents of Task (METpeak) was determined via a
symptom-limited exercise tolerance test (ETT) at entry and exit from CR.
Baseline demographics, self-reported smoking status, qualifying cardiac
event (surgical vs. non-surgical), and number of CR sessions completed
were collected. Smokers were defined as patients reporting smoking at
hospitalization. T-tests and Chi-square tests were used to examine
baseline differences and changes in METpeak over time. Multiple linear
regression was used to examine the impact of baseline smoking status on
change in METpeak controlling for age, sex, surgical diagnosis, number of
CR sessions completed, and baseline body mass index (BMI) and METpeak.
 Result(s): The study sample included 120 patients (mean age
58.5+/-8.9 yrs, 33% female, 94% Caucasian). Individuals that were smokers
(N=38) at the time of hospitalization were younger (55.9+/-8.8 yrs vs.
59.6+/-8.8 yrs, p=0.034), completed fewer CR sessions (21 vs. 27, p=0.02)
and had a lower mean BMI (30.4 vs. 34.0, p=0.015) compared to non/former
smokers. There was no difference in METpeak at entry to CR (5.3 smokers
vs. 5.1 non/former smokers, p=0.68). For the entire sample, mean METpeak
improved during CR (5.1 to 6.6, p<.001). In the regression analysis,
smoking predicted smaller METpeak change (beta = -0.963, p=0.012), as did
older age (beta =-0.056, p=0.009), higher BMI (beta =-0.052, p=0.039), and
higher intake METpeak (beta =-.184, p=.012). Larger METpeak change was
predicted by more CR sessions completed (beta =0.044; p<0.0001). Sex and
surgical status were not significant predictors (ps>.05).
 Conclusion(s): After adjusting for confounders including baseline
fitness, smoking at the time of hospitalization was a significant
predictor of smaller changes in METpeak during CR program, suggesting that
smoking negatively impacts improvements in cardiorespiratory fitness.
Smoking cessation should remain a top priority for patients entering CR.

<13>
Accession Number
633609293
Title
Systematic review of interventions designed to maintain or increase
physical activity post-cardiac rehabilitation phase ii.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 35th
Annual Scientific Meeting of the American Association of Cardiovascular
and Pulmonary Rehabilitation, AACVPR 2020. United States. 40 (5) (pp E47),
2020. Date of Publication: September 2020.
Author
Graham H.L.; Prue-Owens K.; Kirby J.; Ramesh M.
Institution
(Graham, Prue-Owens, Kirby, Ramesh) University of Colorado Colorado
Springs, Colorado Springs, CO, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: CVD continues to be the number one cause of death in the US
and globally. Individuals with a history of a cardiac event are at
increased risk for a repeat event. Physical inactivity creates health
problems for individuals with chronic heart disease. Evidence shows
exercise which is a central component of Cardiac Rehabilitation Phase II
(CRII), decreases hospital readmission and mortality up to 50%. Adherence
to exercise is lacking within months following CRII completion.
 Purpose(s): The purpose of this review was to evaluate interventions
designed to assist individuals diagnosed with Myocardial Infarction (MI),
Coronary Artery Bypass Graft (CABG), Coronary Artery Disease (CAD), and
Percutaneous Coronary Intervention (PCI) to maintain physical activity
(PA) post-CRII. Secondary aims include an update of prior reviews and to
inform health care providers of effective PA maintenance interventions
available. Design(s): Systematic Review. Method(s): This review
was designed according to the Preferred Items for Systematic Reviews and
Metanalysis Guidelines (PRISMA). Multiple databases for the literature
search included PubMed, PsychInfo, Cinahl, Medline, Cochrane, and Scopus.
Key words included exercise, physical activity, adherence, maintenance,
cardiac rehabilitation, and intervention. Primary research articles
published in English with participants 18 years and older who completed a
CRII program and participated in an intervention study to maintain or
increase PA were eligible for inclusion. Review papers and studies with
patients enrolled in CRI or CRIII were excluded. Two individuals reviewed
all studies meeting inclusion criteria and agreed on the selection. A
third individual was involved when there was a lack of consensus. Quality
and risk for bias were assessed according to the Downs and Black
Checklist. Result(s): A systematic search of electronic databases
including a hand-search of peer-reviewed articles published between 2000
and 2019 yielded 19 randomized control trials retained for descriptive
analysis. The study interventions were categorized in to one of three
domains; 1) cognitive behavioral interventions 2) physical activity
interventions, and 3) combined cognitive & physical activity intervention.
Thirteen (68%) of the studies reported significant PA outcomes following
participation in an intervention. The average age was 61.3 years, and
76.8% were males. Most studies were published outside the US. Objective
outcome measurements were used for approximately half of the studies and
self-reported PA outcomes for most of the studies. The outcome
measurements used varied considerably. Conclusion(s): Interventions
designed to help individuals maintain PA post- CRII appear promising. The
interventions studied varied widely. Most studies included interventions
designed according to a cognitive-behavioral theory. Healthcare providers
should consider encouraging patients to enroll in an intervention designed
to maintain PA post-CRII.

<14>
Accession Number
633615537
Title
Music therapy as an adjunct in cardiac device lead extraction procedures:
A randomized controlled trial.
Source
Applied nursing research : ANR. 56 (pp 151376), 2020. Date of Publication:
01 Dec 2020.
Author
Blichfeldt-AEro S.C.; Knutsen T.M.; Hagen H.M.; Diep L.M.; Trondalen G.;
Halvorsen S.
Institution
(Blichfeldt-AEro) Centre for Research in Music and Health (CREMAH),
Norwegian Academy of Music, PB 5190, NO-0363 Oslo, Norway
(Knutsen, Hagen) Department of Cardiology, Oslo University Hospital
Ulleval, Kirkeveien 166, Oslo 0450, Norway
(Diep) Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo
University Hospital, Oslo, Norway
(Trondalen) Centre for Research in Music and Health (CREMAH), Norwegian
Academy of Music, PB 5190, NO-0363 Oslo, Norway
(Halvorsen) Department of Cardiology, Oslo University Hospital Ulleval,
Kirkeveien 166, 0450 Oslo, Norway; Faculty of Medicine, University of
Oslo, Klaus Torgards vei 3, 0372 Oslo, Norway
Publisher
NLM (Medline)
Abstract
BACKGROUND: Evidence of music therapy as an effective supportive therapy
in invasive cardiac procedures is increasing, but more research is needed.
AIMS: To evaluate the impact of music therapy on stress responses during
cardiac device lead extraction procedures performed in local anaesthesia.
 METHOD(S): Sixty-four patients undergoing cardiac implantable
electronic device lead extraction at Oslo University Hospital Ulleval from
March 2018 to September 2019 were randomized to music therapy (n=32) or
control (n=32). Primary endpoints were patient satisfaction with pain
management and average pain intensity during the procedure. Secondary
endpoints were average anxiety intensity, need for analgesic/anxiolytic
drugs, blood pressure, heart and respiration rate. RESULT(S): All
patients in the music therapy group completed the intervention. Patient
satisfaction with pain management was 10.00 (8.00, 10.00) in the music
therapy vs. 10.00 (9.00, 10.00) in the control group (p=0.85), and average
level of pain 0.89 (0.22, 1.13) vs. 0.96 (0.36, 1.58), respectively
(p=0.38). Average anxiety score was 1.00 (0.33, 2.17) in the music therapy
vs 1.67 (0.71, 3.35) in the control group (p=0.056). The use of
analgesic/anxiolytic drugs and physiological parameters were similar
across groups. CONCLUSION(S): In this study of music therapy during
cardiac device lead extractions, no effect was found on patient
satisfaction with pain management or average pain level. A decrease in
patient anxiety of borderline significance was observed in the music
therapy group. More studies with more sensitive measures of pain and
anxiety are needed to determine the value of music therapy in invasive
cardiac procedures. Copyright © 2020 Elsevier Inc. All rights
reserved.

<15>
Accession Number
633551512
Title
Findings of a feasibility study of pre-operative pulmonary rehabilitation
to reduce post-operative pulmonary complications in people with chronic
obstructive pulmonary disease scheduled for major abdominal surgery.
Source
F1000Research. 9 (no pagination), 2020. Article Number: 172. Date of
Publication: 2020.
Author
Pattinson K.T.S.; Marlow L.L.; Lee A.H.Y.; Hedley E.; Grocott M.P.;
Steiner M.C.; Young J.D.; Rahman N.M.; Snowden C.P.
Institution
(Pattinson, Marlow, Lee, Young) Nuffield Division of Anaesthetics,
Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, United Kingdom
(Marlow) Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
(Hedley, Rahman) Division of Experimental Medicine, Nuffield Department of
Medicine, University of Oxford, Oxford, United Kingdom
(Grocott) Clinical and Experimental Sciences, Faculty of Medicine,
University of Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia Perioperative and Critical Care Research Group,
Southampton National Institute of Health Research (NIHR) Biomedical
Research Centre, University Hospital Southampton, Southampton, United
Kingdom
(Steiner) Leicester Respiratory Biomedical Research Centre, Department of
Respiratory Sciences, University of Leicester, Leicester, United Kingdom
(Snowden) The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman
Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
Publisher
F1000 Research Ltd
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) are
at increased risk of complications and death following surgery. Pulmonary
complications are particularly prominent. Pulmonary rehabilitation is a
course of physical exercise and education that helps people with COPD
manage their condition. Although proven to improve health outcomes in
patients with stable COPD, it has never been formally tested as a
pre-surgical intervention in patients scheduled for non-cardiothoracic
surgery. If a beneficial effect were to be demonstrated, pulmonary
rehabilitation for pre-surgical patients with COPD might be rapidly
implemented across the National Health Service, as pulmonary
rehabilitation courses are already well established across much of the
United Kingdom (UK). Method(s): We performed a feasibility study to
test study procedures and barriers to identification and recruitment to a
randomised controlled trial testing whether pulmonary rehabilitation,
delivered before major abdominal surgery in a population of people with
COPD, would reduce the incidence of post-operative pulmonary
complications. This study was run in two UK centres (Oxford and Newcastle
upon Tyne). Result(s): We determined that a full randomised
controlled trial would not be feasible, due to failure to identify and
recruit participants. We identified an unmet need to identify more
effectively patients with COPD earlier in the surgical pathway. Service
evaluations suggested that barriers to identification and recruitment
would likely be the same across other UK hospitals. Conclusion(s):
Although pulmonary rehabilitation is a potentially beneficial intervention
to prevent post-operative pulmonary complications, a randomised controlled
trial is unlikely to recruit sufficient participants to answer our study
question conclusively at the present time, when spirometry is not
automatically conducted in all patients planned for surgery. As pulmonary
rehabilitation is a recommended treatment for all people with COPD,
alternative study methods combined with earlier identification of
candidate patients in the surgical pathway should be considered. Trial
registration: ISRCTN29696295, 31/08/2017 Copyright © 2020 Marlow
LL et al.

<16>
Accession Number
2010268586
Title
Thoracic endoscopic spine surgery: A comprehensive review.
Source
International Journal of Spine Surgery. 14 (5) (pp 762-771), 2020. Date of
Publication: 01 Oct 2020.
Author
Fiani B.; Siddiqi I.; Reardon T.; Sarhadi K.; Newhouse A.; Gilliland B.;
Davati C.; Villait A.
Institution
(Fiani) Desert Regional Medical Center, Palm Springs, CA, United States
(Siddiqi) Western University of Health Sciences College of Osteopathic
Medicine, Pomona, CA, United States
(Reardon) University of Pikeville, Kentucky College of Osteopathic
Medicine, Pikeville, KY, United States
(Sarhadi) Miller School of Medicine, University of Miami, Miami, FL,
United States
(Newhouse) Rush University Medical Center, Chicago, IL, United States
(Gilliland) Alabama College of Osteopathic Medicine, Dothan, AL, United
States
(Davati) New York Institute of Technology College of Osteopathic Medicine,
Glen Head, NY, United States
(Villait) Midwestern University, Arizona College of Osteopathic Medicine,
Glendale, AZ, United States
Publisher
ISASS
Abstract
Background: From the 1990s, there has been growth in the literature
demonstrating the feasibility of minimally invasive approaches for
treating diverse spinal disorders. There is still much work to be done in
circumnavigating the technical challenges and elucidating relative
advantages of endoscopic techniques in spine surgery. In this
comprehensive literature review, we discuss the history, advantages,
disadvantages, approaches, and technology of, and critically examine
peer-reviewed studies specifically addressing, endoscopic thoracic spinal
surgery. Method(s): Literature review was conducted with the key
words ''endoscopic,'' ''minimally invasive,'' and ''thoracic spinal
surgery,'' using PubMed, Web of Science, and Google Scholar.
 Result(s): Review of 241 thorascopic procedures showed a success rate
of 98% to 100%, low morbidity, and favorable complication profile. Review
of 115 thoracic fixation procedures demonstrated high success rate, and
87% of screw positions were rated ''good.'' Review of 55 full endoscopic
uniportal decompressions showed sufficient decompression in most patients.
Match pair analysis of 34 patients comparing video-assisted thoracoscopy
surgery (VATS) or posterior spinal fusion reported the VATS group had
increased operative duration but reduced blood loss. Conclusion(s):
Based on our literature review, there is a high rate of positive outcomes
with endoscopic thoracic spine surgery, which reduces tissue dissection,
intraoperative blood loss, and epidural fibrosis. However, the technical
challenge highlights the importance of further training and innovation in
this rapidly evolving field. Copyright © International Society
for the Advancement of Spine Surgery

<17>
Accession Number
633616562
Title
Coronary Computed Tomography Angiography Compared With Single Photon
Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to
Optimal Medical Therapy in Patients Presenting With Stable Angina: The
RESCUE Trial.
Source
Journal of the American Heart Association. (pp e017993), 2020. Date of
Publication: 05 Dec 2020.
Author
Stillman A.E.; Gatsonis C.; Lima J.A.C.; Liu T.; Snyder B.S.; Cormack J.;
Malholtra V.; Schnall M.D.; Udelson J.E.; Hoffmann U.; Woodard P.K.
Institution
(Stillman) Department of Radiology and Imaging Sciences Emory University
Atlanta GA
(Gatsonis, Liu) Department of Biostatistics Brown University School of
Public Health Providence RI
(Gatsonis, Liu, Snyder, Cormack) Center for Statistical Sciences Brown
University School of Public Health Providence RI
(Lima) Departments of Medicine and Radiology Johns Hopkins University
Baltimore MD
(Malholtra) Pulse Heart Institute Tacoma WA
(Schnall) Department of Radiology University of Pennsylvania Boston MA
(Udelson) Division of Cardiology Tufts-New England Medical Center Boston
MA
(Hoffmann) Department of Radiology Massachusetts General Hospital Boston
MA
(Woodard) Mallinckrodt Institute of Radiology Washington University School
of Medicine St. Louis MO
Publisher
NLM (Medline)
Abstract
Background The RESCUE (Randomized Evaluation of Patients with Stable
Angina Comparing Utilization of Noninvasive Examinations) trial was a
randomized, controlled, multicenter, comparative efficacy outcomes trial
designed to assess whether initial testing with coronary computed
tomographic angiography (CCTA) is noninferior to single photon emission
computed tomography (SPECT) myocardial perfusion imaging in directing
patients with stable angina to optimal medical therapy alone or optimal
medical therapy with revascularization. Methods and Results The end point
was first major adverse cardiovascular event (MACE) (cardiac death or
myocardial infarction), or revascularization. Noninferiority margin for
CCTA was set a priori as a hazard ratio (HR) of 1.3 (95% CI=0, 1.605). One
thousand fifty participants from 44 sites were randomized to CCTA (n=518)
or SPECT (n=532). Mean follow-up time was 16.2 (SD 7.9) months. There were
no cardiac-related deaths. In patients with a negative CCTA there was 1
acute myocardial infarction; in patients with a negative SPECT examination
there were 2 acute myocardial infarctions; and for positive CCTA and
SPECT, 1 acute myocardial infarction each. Participants in the CCTA arm
had a similar rate of MACE or revascularization compared with those in the
SPECT myocardial perfusion imaging arm, (HR, 1.03; 95% CI=0.61-1.75)
(P=0.19). CCTA segment involvement by a stenosis of >=50% diameter was a
better predictor of MACE and revascularization at 1 year (P=0.02) than the
percent reversible defect size by SPECT myocardial perfusion imaging. Four
(1.2%) patients with negative CCTA compared with 14 (3.2%) with negative
SPECT had MACE or revascularization (P=0.03). Conclusions There was no
difference in outcomes of patients who had stable angina and who underwent
CCTA in comparison to SPECT as the first imaging test directing them to
optimal medical therapy alone or with revascularization. CCTA was a better
predictor of MACE and revascularization. Registration Information URL:
https://www.clinicaltrials.gov/. Identifier: NCT01262625.

<18>
Accession Number
633615520
Title
Myocardial Protection in Adult Cardiac Surgery with del Nido versus Blood
Cardioplegia: A Systematic Review and Meta-analysis.
Source
Heart, lung & circulation. (no pagination), 2020. Date of Publication: 03
Dec 2020.
Author
Misra S.; Srinivasan A.; Jena S.S.; Bellapukonda S.
Institution
(Misra, Jena, Bellapukonda) Department of Anesthesiology and Critical
Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar,
Odisha, India
(Srinivasan) Department of Pharmacology, All India Institute of Medical
Sciences (AIIMS), Bhubaneswar, Odisha, India
Publisher
NLM (Medline)
Abstract
BACKGROUND: Myocardial protection in adult cardiac surgery is commonly
achieved with either multidose blood cardioplegia or single-dose del Nido
crystalloid cardioplegia. AIM: The aim of this systematic review and
meta-analysis was to compare the outcomes of del Nido cardioplegia versus
blood cardioplegia in adult cardiac surgery. METHOD(S): All
English-language articles were searched in MEDLINE (PubMed), the Cochrane
Central Register of Controlled Trials (CENTRAL), and Google Scholar up to
March 2020, to identify randomised control trials, prospective
observational studies, and retrospective analyses (with or without
propensity matching) reporting any or all of the primary and secondary
endpoints. The primary endpoint was all-cause mortality. Secondary
endpoints included cardiopulmonary bypass (CPB) and aortic cross-clamp
(AoX) time; cardioplegia volume; need for defibrillation after AoX
release; intraoperative glucose; postoperative myocardial enzyme release;
postoperative left ventricular ejection fraction (LVEF); incidence of
postoperative acute kidney injury (AKI), atrial fibrillation (AF), stroke,
and low cardiac output syndrome (LCOS); postoperative blood transfusion;
duration of mechanical ventilation; and length of Intensive Care Unit
(ICU) and hospital stay. RESULT(S): Twenty-nine (29) studies were
included. There was no difference in the primary outcome of mortality
between the two groups (odds ratio [OR], 1.18; 95% confidence interval
[CI], 0.82-1.72 [p=0.37]). del Nido cardioplegia was associated with
significantly shorter CPB (mean difference [MD], -7.42 minutes; 95% CI,
-12.53 to -2.31 [p=0.004]) and AoX times (MD, -6.39 minutes; 95% CI,
-10.30 to -2.48 [p=0.001]), and lower cardioplegia volumes. Significantly
fewer patients required defibrillation after AoX release in the del Nido
group. Intraoperative glucose homeostasis was better preserved in the del
Nido group. Postoperative cardiac troponin T release and the number of
patients needing transfusions were less in the del Nido group. No
differences were seen in postoperative LVEF, or in the incidence of AKI,
stroke, AF, and LCOS. Duration of mechanical ventilation, and length of
ICU and hospital stay were similar. CONCLUSION(S): Although this
meta-analysis failed to find any mortality benefits with del Nido
cardioplegia, significant benefits were seen in a number of intraoperative
and postoperative variables. del Nido cardioplegia is a safe and
favourable alternative to blood cardioplegia in adult cardiac
surgery. Copyright © 2020 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights
reserved.

<19>
Accession Number
2007545174
Title
Cerebral oximetry in adult cardiac surgery to reduce the incidence of
neurological impairment and hospital length-of-stay: A prospective,
randomized, controlled trial.
Source
Journal of the Intensive Care Society. (no pagination), 2020. Date of
Publication: 2020.
Author
Bennett S.R.; Smith N.; Bennett M.R.
Institution
(Bennett) King Faisal Cardiac Center, National Guard Hospital, King
Abdulaziz Medical City, Jeddah, Saudi Arabia
(Smith) Department of Anaesthesia and Intensive Care, Castle Hill
Hospital, Hull and East Yorkshire Hospital Trust, Cottingham, United
Kingdom
(Bennett) Department of Medicine, Manchester University Foundation Trust,
Manchester, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has
been shown to reduce neurological dysfunction and hospital length-of-stay
after adult cardiac surgery in some but not all studies. We audited
maintaining cerebral saturations at or above baseline and showed improved
neurological and length-of-stay outcomes. Our hypothesis for this study
was that our NIRS protocol would improve neurological and length-of-stay
outcomes. Method(s): This prospective, single centre, double-blinded
controlled study randomized 182 consecutive patients, scheduled for
cardiac surgery using cardiopulmonary bypass. Participants were randomized
by concealed envelope prior to anaesthesia. NIRS study group were managed
perioperatively using our NIRS protocol of 8 interventions, increase
cardiac output, normocapnia, increase mean arterial pressure, increase
inspired oxygen, depth of anaesthesia, blood transfusion, correction of
bypass cannula, change of surgical plan to restore levels equal to or
above baseline. The control group had standard management without NIRS.
Primary outcomes were neurological impairment (early and late) and
hospital length-of-stay. Secondary outcomes were ventilation times,
intensive care length-of-stay, major organ dysfunction and mortality.
 Result(s): 91 patients entered each group. There was a significant
improvement in self-reported six-month general functionality in the NIRS
group (p = 0.016). Early neurological dysfunction and hospital
length-of-stay was the same in both groups. Of the secondary outcomes only
Intensive Care length-of-stay was statistically significant, being shorter
in the NIRS group (p = 0.026). Conclusion(s): Maintaining cerebral
saturations above baseline reduces time spent in Intensive Care and may
improve long term functional recovery but not stroke, major organ
dysfunction and mortality. Copyright © The Intensive Care Society
2020.

<20>
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.
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

<21>
Accession Number
2005634061
Title
New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 29 (10) (pp 1542-1553), 2020. Date of
Publication: October 2020.
Author
Indja B.; Woldendorp K.; Vallely M.P.; Grieve S.M.
Institution
(Indja, Grieve) Sydney Translational Imaging Laboratory, Heart Research
Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW,
Australia
(Indja, Woldendorp, Grieve) Faculty of Medicine and Health, The University
of Sydney, Sydney, NSW, Australia
(Vallely) Division of Cardiac Surgery, The Ohio State University,
Columbus, OH, United States
(Grieve) Department of Radiology, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: New-onset atrial fibrillation (NOAF) is a well-recognised,
although variably reported complication following surgical aortic valve
replacement (SAVR). Rates of NOAF following transcatheter aortic valve
implantation (TAVI) seem to be notably less than SAVR, even though this
population is typically older and of higher risk. The aim of this study
was to determine the prevalence of NOAF in both these populations and
associated postoperative outcomes. Method(s): We conducted a
systematic review and meta-analysis of studies reporting rates of NOAF
post SAVR or TAVI, along with early postoperative outcomes. Twenty-five
(25) studies with a total of 13,010 patients were included in the final
analysis. Result(s): The prevalence of NOAF post SAVR was 0.4 (95% CI
0.36-0.44) and post TAVI 0.15 (95% CI 0.11-0.18). NOAF was associated with
an increased risk of postoperative cerebrovascular accident (CVA) for SAVR
and TAVI (RR 1.44 95% CI 1.01-2.06 and RR 2.24 95% CI 1.46-3.45
respectively). NOAF was associated with increased mortality in the TAVI
group (RR 3.02 95% CI 1.55-5.9) but not the SAVR group (RR 1.00, 95% CI
0.54-1.84). Hospital length of stay was increased for both TAVI and SAVR
patients with NOAF (MD 2.54 days, 95% CI 2.0-3.00) and (MD 1.64 days, 95%
CI 0.04-3.24 respectively). Conclusion(s): The prevalence of NOAF is
significantly less following TAVI, as compared to SAVR. While NOAF is
associated with increased risk of postoperative stroke for both groups,
for TAVI alone NOAF confers increased risk of early
mortality. Copyright © 2020 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<22>
Accession Number
2005476212
Title
A review of heart valve disease research in Malaysia.
Source
Medical Journal of Malaysia. 75 (6) (pp 722-730), 2020. Date of
Publication: November 2020.
Author
Khoo P.L.Z.; Poon J.S.; Tan G.J.S.; Awang Y.; Chan K.M.J.
Institution
(Khoo, Poon) Newcastle University Medicine Malaysia, Iskandar Puteri,
Johor, Malaysia
(Tan) The Ipswich Hospital, East Suffolk and North Essex NHS Foundation
Trust, Suffolk, United Kingdom
(Awang, Chan) Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Hospital,
Kuala Lumpur, Malaysia
(Chan) National Heart and Lung Institute, Imperial College London, Royal
Brompton Campus, Chelsea Wing, London, United Kingdom
Publisher
Malaysian Medical Association
Abstract
Introduction: Heart valve disease comprises a cluster of conditions
affecting the aortic, mitral, pulmonary and tricuspid valves. This paper
reviews all the research on heart valve disease in Malaysia published
between the years 20002016. Method(s): The methodology was based on
the search process described in the paper, "Bibliography of clinical
research in Malaysia: methods and brief results". The search databases
included PubMed, Scopus and several Malaysian journals such as MyJurnal
and UKM Journal Repository, by using the following keywords: (heart valve
disease OR infective endocarditis OR rheumatic heart disease) and
(Malaysia). Result(s): In all 94 papers were identified of which 39
papers were selected and reviewed on the basis of their relevance. The
local studies contributed to the knowledge and understanding of the
epidemiology, aetiology, pathophysiology, clinical presentations,
investigations, treatment, and outcomes of heart valve disease in the
country. Discussion(s): The clinical relevance of the studies
performed in the country is discussed along with recommendations for
future research. Copyright © 2020, Malaysian Medical Association.
All rights reserved.

<23>
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
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.

<24>
Accession Number
2008471440
Title
A comparative clinical radiological study using platelet Rich Fibrin and
MTA in pulpotomy of first permanent immature molars.
Source
Journal of Clinical and Diagnostic Research. 14 (11) (pp ZC01-ZC05), 2020.
Date of Publication: November 2020.
Author
Alawwad M.; Altinawi M.; Rekab M.S.; Kosyreva T.; Almokaddam H.; Katbeh I.
Institution
(Alawwad, Altinawi) Department of Paediatric Dentistry, Faculty of Dental
Medicine, Damascus University, Damascus, Syrian Arab Republic
(Rekab) Department of Endodontics, Faculty of Dental Medicine, Damascus
University, Damascus, Syrian Arab Republic
(Kosyreva, Almokaddam, Katbeh) Department of Paediatric Dentistry and
Orthodontics, RUDN University, Peoples' Friendship University of Russia,
Moscow, Russian Federation
Publisher
Journal of Clinical and Diagnostic Research
Abstract
Introduction: Maintaining a vital pulp of immature permanent teeth is an
essential and important requirement for dentin formation. Every effort
must be made to preserve the vitality of teeth with incomplete apices to
maintain the physiological apex generation process as much as possible.
Pulpotomy is considered as one of the successful procedures to maintain
that process in immature teeth. Aim(s): To evaluate the treatment
success of pulpotomy of first immature molars with irreversible pulpitis
using Platelet-Rich Fibrin (PRF) or Mineral Trioxide Aggregate (MTA),
monitoring the teeth for 1 year. Material(s) and Method(s): A
randomised clinical and radiological double-blinded evaluation was
conducted in the Department of Paediatric Dentistry at Damascus
University. The research sample consisted of 24 first permanent immature
molars in 20 children between age group of 6-8 years. Each of them had at
least one first permanent immature molar with irreversible pulpitis. The
research sample was randomly divided into two equal groups according to
the treatment method: 1) pulpotomy with PRF; and 2) pulpotomy using MTA.
Treatment were evaluated through periodic reviews and clinical and
radiological examinations of the treated teeth by three specialists to
assess treatment success. The treatment outcome was determined in terms of
success or failure during two study periods (after six months and after
one year), McNemar's and Chi-square tests were applied using IBM SPSS v.
20.0. The significance level was set at p<0.05. Result(s): Chi-square
test showed that there were no statistically significant differences in
the treatment success or failure between the treatment groups after six
months and one year follow-up p>0.05. After analysing the results
statistically using McNemar's test, it was observed that the treatment
success rate after one year (50%, n=6) was lesser than that after six
months (100%, n=12) in the MTA treatment group (p=0.031*). In the
treatment group using PRF, no significant difference (p=0.125) were
observed in the success or failure of treatment between the two studied
time periods (after six months and one year). Overall, the success rate of
MTA was slightly higher than the success rate of PRF at the two study time
periods (after six months and one year), the difference however was not
statistically significant. Conclusion(s): Performing first immature
molar pulpotomy using MTA had a slightly higher success rate than PRF
pulpotomy. Copyright © 2020 Journal of Clinical and Diagnostic
Research. All rights reserved.

<25>
Accession Number
2008393554
Title
Antimicrobial surgical prophylaxis: Still an issue in paediatrics.
Source
Journal of Global Antimicrobial Resistance. 23 (pp 224-227), 2020. Date of
Publication: December 2020.
Author
Bedir Demirdag T.; Cura Yayla B.C.; Tezer H.; Tapisiz A.
Institution
(Bedir Demirdag, Cura Yayla, Tezer, Tapisiz) Gazi University, Faculty of
Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
Publisher
Elsevier Ltd
Abstract
Objectives: Antimicrobial prophylaxis (AP) is an important means of
reducing surgical site infections. The goal of this study was to evaluate
the perioperative AP in paediatric practice and its compliance with
surgical prophylaxis guidelines. Method(s): A prospective study was
conducted at Gazi University Faculty of Medicine, between September 2015
and April 2016. Paediatric patients who underwent surgical procedures were
included in the study. Surgical AP was evaluated. Result(s): During
the entire study period, 466 children underwent surgery at our centre; 433
(92.7%) received antimicrobial prophylaxis. Overall adherence to the
guidelines regarding surgical prophylaxis was 22.1%. The rate of
administration of surgical prophylaxis was significantly lower, and the
duration was shorter when the surgical procedure was clean (P = 0.002).
When the duration of the procedure was longer, the rate of administration
of prophylaxis was higher (P = 0.000). The duration of postoperative
prophylaxis was longer than recommended in 72.2% of the patients. In the
multivariate analysis, application errors increased with longer surgical
time (P = 0.01, OR 2.18, 95% CI 1.19-4.03). Conclusion(s): High rates
of misapplication of antimicrobial surgical prophylaxis were observed in
this study. Awareness and usage of guidelines should be encouraged. The
education of clinicians should be supported by studies regarding surgical
prophylaxis in children. Copyright © 2020 The Authors

<26>
Accession Number
2010210726
Title
Effect of family presence on stress response after bypass surgery.
Source
Heart and Lung. 50 (2) (pp 193-201), 2021. Date of Publication: 01 Mar
2021.
Author
Koyuncu A.; Yava A.; Yamak B.; Orhan N.
Institution
(Koyuncu, Yava) Nursing Department, Hasan Kalyoncu University, Faculty of
HealthSciences, Gaziantep, Turkey
(Yamak, Orhan) Gaziantep Medikal Park Hospital, Gaziantep, Turkey
Publisher
Mosby Inc.
Abstract
Background: Coronary artery bypass grafting (CABG) is a major surgery that
may cause severe surgical stress response (SR). Although the presence of
family members in intensive care unit (ICU) is known to benefit intensive
care patients socially and emotionally, its effects on surgical SR are
unknown. Objective(s): To investigate the effect of an informed
family member (IFM)'s presence in the awakening process in ICU on
patients' SR after CABG. Method(s): A nonrandomized controlled
clinical study was completed with a total of 73 patients: 37 patients in
the control (CG) and 36 in the intervention group (IG) underwent CABG
surgery. In the CG patients, no family members were taken into the ICU
during the awakening process and routine care and treatment practices were
continued. In the IG patients, besides routine care and treatment
practices, an IFM was taken into the ICU during the awakening process in
accordance with the research method. Groups were statistically compared in
terms of serum cortisol level which is the one of the main indicators of
surgical SR, state anxiety, sedative drug requirements, and duration of
intubation, sedation, and ICU stay. A p value <0.05 was accepted as
statistically significant. Result(s): Presence of an IFM in the ICU
was found to be effective in decreasing serum cortisol level, state
anxiety, sedative drug requirements, and the duration of intubation,
sedation, and ICU stay (p<0.05). Conclusion(s): In CABG, the presence
of IFM in ICU is effective in reducing SR. Copyright © 2020

<27>
Accession Number
2007505571
Title
Postoperative analgesic effect of acupotomy combined with
patient-controlled analgesia in patients undergoing video-assisted
thoracoscopic surgery: a study protocol for a randomized controlled trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 998. Date of
Publication: December 2020.
Author
Jiang C.; Li Y.; Li X.; Guo J.; Guo M.; Yu S.; Lin Z.
Institution
(Jiang, Li, Guo, Guo, Yu, Lin) Fujian Provincial Hospital, Fuzhou, Fujian,
China
(Li) Outpatient Department of Guoyitang affiliated to Fujian University of
Traditional Chinese Medicine, Fuzhou, Fujian, China
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative acute pain is a common issue following thoracic
surgery. Acupotomy is a common and safe intervention method for pain
treatment in clinical practice. In previous preliminary experiments, we
found that acupotomy has a good clinical effect and good safety in the
treatment of pain after thoracoscopic surgery. However, due to a lack of a
rigorous design and an adequate sample size, its efficacy still requires
further confirmation. The purpose of this study will be to explore the
efficacy and safety of acupotomy combined with patient-controlled
analgesia (PCA) for the treatment of pain after video-assisted thoracic
surgery (VATS). Method(s): The study will be a single-centre,
parallel group, randomized controlled trial. Seventy patients with
significant pain after thoracoscopic surgery with a visual analogue scale
(VAS) score >= 7 will be included and randomly distributed into two
groups: G1, the acupotomy combined with PCA group; and G2, the
conventional PCA group. The primary outcome measure is pain scores at rest
and coughing evaluated with the VAS by a blinded observer in the
postanaesthesia care unit (PACU) and postoperatively at 1, 2, 4, 8, 12,
24, 48, and 72 h. The secondary outcome measures are postoperative
requirements for rescue analgesia, the cumulative amount of
self-administered analgesics, the level of sedation (LOS), the Bruggemann
comfort scale (BCS), and the functional activity score (FAS) concerning
adverse effects and patient satisfaction. Discussion(s): This trial
has the potential to identify an innovative and effective analgesic method
for postoperative pain management for VATS. The findings may advocate for
the inclusion of the treatment of comorbid pain after thoracoscopy in
current pain management practice guidelines. Trial registration: Chinese
Clinical Trial Registry ChiCTR1900027191. Registered on 4 November
2019. Copyright © 2020, The Author(s).

<28>
Accession Number
632775219
Title
Advancement of a standardised enteral feeding protocol in functional
single ventricle patients following stage i palliation using
cerebro-somatic near-infrared spectroscopy.
Source
Cardiology in the Young. 30 (11) (pp 1649-1658), 2020. Date of
Publication: November 2020.
Author
Raymond T.T.; Valle S.; Garza J.; Yeramaneni S.; Wurtz E.; Sample B.;
Kozak N.; Stigall W.; Gatlin S.; Burton G.
Institution
(Raymond, Wurtz, Sample, Kozak, Burton) Department of Pediatrics, Cardiac
Intensive Care, Medical City Children's Hospital, Dallas, TX, United
States
(Valle, Yeramaneni) HCA Research Institute at Medical City Children's
Hospital, Dallas, TX, United States
(Garza) Children's Health, Division of Cardiology, Dallas, TX, United
States
(Stigall) Pediatric Critical Care, Cook Children's Hospital, Fort Worth,
TX, United States
(Gatlin) Department of Pediatrics, Division of Cardiology, Arkansas
Children's Hospital, Little Rock, AR, United States
Publisher
Cambridge University Press
Abstract
Introduction: Infants with single ventricle following stage I palliation
are at risk for poor nutrition and growth failure. We hypothesise a
standardised enteral feeding protocol for these infants that will result
in a more rapid attainment of nutritional goals without an increased
incidence of gastrointestinal co-morbidities. Material(s) and
Method(s): Single-centre cardiac ICU, prospective case series with
historical comparisons. Feeding cohort consisted of consecutive patients
with a single ventricle admitted to cardiac ICU over 18 months following
stage I palliation (n = 33). Data were compared with a control cohort and
admitted to the cardiac ICU over 18 months before feeding protocol
implementation (n = 30). Feeding protocol patients were randomised: (1)
protocol with cerebro-somatic near-infrared spectroscopy feeding
advancement criteria (n = 17) or (2) protocol without cerebro-somatic
near-infrared spectroscopy feeding advancement criteria (n = 16).
 Result(s): Median time to achieve goal enteral volume was
significantly higher in the control compared to feeding cohort. There were
no significant differences in enteral feeds being held for feeding
intolerance or necrotising enterocolitis between cohorts. Feeding cohort
had significant improvements in discharge nutritional status (weight,
difference admit to discharge weight, weight-for-age z score, volume, and
caloric enteral nutrition) and late mortality compared to the control
cohort. No infants in the feeding group with cerebro-somatic near-infrared
spectroscopy developed necrotising enterocolitis versus 4/16 (25%) in the
feeding cohort without cerebro-somatic near-infrared spectroscopy (p =
0.04). Conclusion(s): A feeding protocol is a safe and effective
means of initiating and advancing enteral nutrition in infants following
stage I palliation and resulted in improved nutrition delivery, weight
gain, and nourishment status at discharge without increased incidence of
gastrointestinal co-morbidities. Copyright © 2020 Cambridge
University Press. All rights reserved.

<29>
Accession Number
2005555431
Title
More than garden variety: Massive vegetations from infective endocarditis.
Source
Pathogens. 9 (12) (pp 1-7), 2020. Article Number: 998. Date of
Publication: December 2020.
Author
Radcliffe C.; Oen-Hsiao J.; Grant M.
Institution
(Radcliffe, Oen-Hsiao, Grant) Yale School of Medicine, New Haven, CT
06510, United States
(Oen-Hsiao) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale New Haven Hospital, New Haven, CT 06510, United States
(Grant) Section of Infectious Diseases, Department of Internal Medicine,
Yale New Haven Hospital, New Haven, CT 06510, United States
Publisher
MDPI AG
Abstract
Infective endocarditis classically involves non-sterile vegetations on
valvular surfaces in the heart. Feared complications include embolization
and acute heart failure. Surgical intervention achieves source control and
alleviates valvular regurgitation in complicated cases. Vegetations >1 cm
are often intervened upon, making massive vegetations uncommon in modern
practice. We report the case of a 39-year-old female with history of
intravenous drug abuse who presented with a serpiginous vegetation on the
native tricuspid valve and methicillin-resistant Staphylococcus aureus
bacteremia. The vegetation grew to 5.6 cm by hospital day two, and she
successfully underwent a tricuspid valvectomy. Six weeks of intravenous
vancomycin therapy were completed without adverse events. To better
characterize other dramatic presentations of infective endocarditis, we
performed a systematic literature review and summarized all case reports
involving >=4 cm vegetations. Copyright © 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<30>
Accession Number
633606427
Title
The Ross Operation in Neonates: A Meta-Analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 01 Dec 2020.
Author
Rajab T.K.; Zorrilla-Vaca A.; Kavarana M.; Mokashi S.; Sainathan S.
Institution
(Rajab, Kavarana) Section of Pediatric Cardiothoracic Surgery, Department
of Surgery, Medical University of South Carolina, SC, Charleston, United
States
(Zorrilla-Vaca) Department of Anesthesiology and Perioperative Medicine,
University of Texas MD Anderson Cancer Center, TX, Houston
(Mokashi) Division of Cardiac Surgery, Department of Surgery, Creighton
University, Omaha, NE
(Sainathan) Section of Pediatric Cardiac Surgery, Department of Surgery,
University of North Carolina, Chapel Hill
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Ross operation is the preferred treatment for aortic valve
replacement in children. However, previous studies indicate that the
outcomes in neonates are poor. This meta-analysis examines the pooled
outcomes of the Ross operation in neonates. METHOD(S): Four major
databases (PubMed/MEDLINE, EMBASE, Scopus and ScienceDirect) were searched
from inception until 5/1/2020 for studies describing outcomes of the Ross
operation in neonates. The primary outcome was early mortality. The
secondary outcomes were late mortality, and mechanical support.
Random-effects models were used to account for possible heterogeneity
between the studies and continuity corrections were used to include zero
total event trials. RESULT(S): Eighteen studies comprising outcomes
data on 181 neonates were included in the analysis. Meta-analysis showed a
pooled early mortality rate of 24% (95% confidence interval [CI] = 12% -
38%, I2=52%, P for heterogeneity=0.01). Meta-regression analysis showed
that more recently published studies reported significantly worse early
mortality (p = 0.03). The late mortality rate was 43%. The pooled
incidence of postoperative mechanical support was 15% (95% CI = 5% - 28%,
I2=28%, P for heterogeneity=0.22). There was no evidence for publication
bias according to Egger's test (bias coefficient=0.21, P=0.57).
 CONCLUSION(S): The neonatal Ross operation carries a high early
mortality rate. The treatment of unrepairable aortic valves in neonates
remains an unsolved problem in congenital cardiac surgery. Copyright
© 2020. Published by Elsevier Inc.

<31>
Accession Number
633604903
Title
Evidence-based indications of platelet-rich plasma therapy.
Source
Expert review of hematology. (no pagination), 2020. Date of Publication:
04 Dec 2020.
Author
Gupta S.; Paliczak A.; Delgado D.
Institution
(Gupta) Queen's University, ON, 99 University Ave, Kingston, Canada
(Paliczak) ON, Vita Medical Aesthetics Center. Medical Aesthetician. 27
Rean Drive, Toronto, United States
(Delgado) University of Toronto. 585 University Ave, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Platelet-rich plasma (PRP) is an autologous blood-derived
product that contains platelet concentrations at least 2/3 times above the
normal level and includes platelet-related growth factors. The concept of
PRP began in the 1970s in the field of hematology to treat patients with
thrombocytopenia. In the 1980s and 1990s, PRP began to be used in surgical
procedures such as maxillofacial surgery and plastic surgery. Since then,
PRP had been used in orthopedic procedures, cardiac surgery, sports
injuries, plastic surgery, gynecology, urology, and more recently in
medical aesthetics. Areas covered: This review analyzes the mechanisms of
action, current indications, clinical evidence, safety and future
directions of PRP in the management of various medical conditions. The
literature search methodology included using medical subject headings
terms to search in PubMed. Articles used were screened and critically
appraised by the co-authors of this review. Expert Opinion: Platelet-rich
plasma is a therapeutic option used to treat many medical conditions. PRP
could be used alone or in combination with other procedures. The
effectiveness and safety of PRP has been demonstrated in many medical
scenarios, however there is limited availability of large randomized
clinical trials.

<32>
[Use Link to view the full text]
Accession Number
2007540395
Title
Antioxidant treatment to reduce mortality and serious adverse events in
adult surgical patients: A systematic review with meta-analysis and trial
sequential analysis.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2020. Date of
Publication: 2020.
Author
Pedersen S.S.; Fabritius M.L.; Kongebro E.K.; Meyhoff C.S.
Institution
(Pedersen, Fabritius, Kongebro, Meyhoff) Department of Anaesthesia and
Intensive Care, Bispebjerg and Frederiksberg Hospital, University of
Copenhagen, Copenhagen, Denmark
(Pedersen, Meyhoff) Copenhagen Center for Translational Research,
Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital,
Copenhagen, Denmark
Publisher
Blackwell Munksgaard
Abstract
Background: Hyperoxia during anesthesia can increase cellular oxidative
stress, and perioperative antioxidant treatment may reduce the resulting
damage. The aim of this review was to evaluate risks and benefits of
antioxidant treatment in surgical patients. We hypothesized that
antioxidant treatment reduced mortality compared to placebo/no
intervention. Method(s): This systematic review with meta-analyses
and trial sequential analysis (TSA) was conducted using Cochrane standards
and GRADE methodology. Randomized clinical trials comparing perioperative
antioxidant treatment vs. placebo/no intervention in adults were included.
Primary outcome was mortality at longest follow-up. Result(s):
Ninety-seven trials with 8156 patients were included. The most common
interventions were N-Acetylcysteine (36 trials) and vitamin C (29 trials).
Trials were primarily performed during cardiac surgery (53 trials).
Fifty-six trials with 4890 patients reported information on mortality (243
events). The meta-analysis of mortality at longest follow-up showed a
reduced mortality in antioxidant treated patients (RR 0.74, 95% CI 0.59;
0.94, I2 0%), however, TSA-adjusted CI was broadened
(0.55-1.02) and only 31% of the required information size was reached.
Furthermore, in the subgroup of three trials with overall low risk of bias
the RR for mortality was 1.18 (95% CI 0.39, 3.63). Based on GRADE, our
findings are of low quality of evidence due to high risk of bias,
imprecision, and indirectness. Conclusion(s): We found a 26% relative
risk reduction of mortality in surgical patients treated with antioxidants
but the quality of evidence supporting our findings is low and influenced
by clinical heterogeneity and high risk of systematic- and random
errors. Copyright © 2020 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<33>
[Use Link to view the full text]
Accession Number
2007540289
Title
Prothrombin complex concentrate vs. fresh frozen plasma in adult patients
undergoing heart surgery - a pilot randomised controlled trial (PROPHESY
trial).
Source
Anaesthesia. (no pagination), 2020. Date of Publication: 2020.
Author
Green L.; Roberts N.; Cooper J.; Agarwal S.; Brunskill S.J.; Chang I.;
Gill R.; Johnston A.; Klein A.A.; Platton S.; Rossi A.; Sepehripour A.;
Stanworth S.; Monk V.; O'Brien B.
Institution
(Green) Blizard Institute, Barts and the London School of Medicine, Queen
Mary University of London, London, United Kingdom
(Cooper, Chang, Johnston, Monk) William Harvey Research Institute, Barts
and the London School of Medicine, Queen Mary University of London,
London, United Kingdom
(Green, Platton) NHS Blood and Transplant, London, United Kingdom
(Green) Department of Haematology, Barts Health NHS Trust, London, United
Kingdom
(Roberts, Brunskill, Rossi, Sepehripour) Department of Cardiac Surgery,
Barts Health NHS Trust, London, United Kingdom
(O'Brien) Department of Anaesthesia, Barts Health NHS Trust, London,
United Kingdom
(Agarwal) Department of Anaesthesia, Manchester Royal Infirmary,
Manchester, United Kingdom
(Agarwal) Systematic Review Initiative, NHS Blood and Transplant, Oxford,
United Kingdom
(Stanworth) NHS Blood and Transplant, Oxford, United Kingdom
(Gill) Department of Anaesthesia, University Hospital Southampton,
Southampton, United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
(Stanworth) Department of Haematology, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland Clinic, OH, United
States
Publisher
Blackwell Publishing Ltd
Abstract
There is equipoise regarding the use of prothrombin complex concentrate
vs. fresh frozen plasma in bleeding patients undergoing cardiac surgery.
We performed a pilot randomised controlled trial to determine the
recruitment rate for a large trial, comparing the impact of prothrombin
complex concentrate vs. fresh frozen plasma on haemostasis (1 h and 24 h
post-intervention), and assessing safety. Adult patients who developed
bleeding within 24 h of cardiac surgery that required coagulation factor
replacement were randomly allocated to receive prothrombin complex
concentrate (15 IU.kg-1 based on factor IX) or fresh frozen
plasma (15 ml.kg-1). If bleeding continued after the first
administration of prothrombin complex concentrate or fresh frozen plasma
administration, standard care was administered. From February 2019 to
October 2019, 180 patients were screened, of which 134 (74.4% (95%CI
67-81%)) consented, 59 bled excessively and 50 were randomly allocated; 25
in each arm, recruitment rate 35% (95%CI 27-44%). There were 23 trial
protocol deviations, 137 adverse events (75 prothrombin complex
concentrate vs. 62 fresh frozen plasma) and 18 serious adverse events (5
prothrombin complex concentrate vs. 13 fresh frozen plasma). There was no
increase in thromboembolic events with prothrombin complex concentrate. No
patient withdrew from the study, four were lost to follow-up and two died.
At 1 h after administration of the intervention there was a significant
increase in fibrinogen, Factor V, Factor XII, Factor XIII,
alpha<inf>2</inf>-antiplasmin and antithrombin levels in the fresh frozen
plasma arm, while Factor II and Factor X were significantly higher in the
prothrombin complex concentrate group. At 24 h, there were no significant
differences in clotting factor levels. We conclude that recruitment to a
larger study is feasible. Haemostatic tests have provided useful insight
into the haemostatic changes following prothrombin complex concentrate or
fresh frozen plasma administration. A definitive trial is needed to
ascertain the benefits and safety for each. Copyright © 2020 The
Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of
Association of Anaesthetists

<34>
Accession Number
2006988204
Title
Risk Factors for Mortality and Ventricular Tachycardia in Patients With
Repaired Tetralogy of Fallot: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 36 (11) (pp 1815-1825), 2020. Date of
Publication: November 2020.
Author
Possner M.; Tseng S.Y.; Alahdab F.; Bokma J.P.; Lubert A.M.; Khairy P.;
Murad M.H.; Ben Ali W.; Prokop L.J.; Czosek R.J.; Veldtman G.R.; Alsaied
T.
Institution
(Possner, Tseng, Lubert, Czosek, Veldtman, Alsaied) Heart Institute,
Cincinnati Children`s Hospital Medical Center, Cincinnati, OH, United
States
(Possner, Tseng, Lubert, Czosek, Veldtman, Alsaied) University of
Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH,
United States
(Alahdab, Murad) Mayo Evidence-based Practice Center, Mayo Clinic,
Rochester, MN, United States
(Bokma) Department of Cardiology, Academic Medical Center Amsterdam,
Netherlands
(Khairy) Department of Cardiology, Montreal Heart Institute, Universite de
Montreal, Montreal, Canada
(Ben Ali) Division of Cardiac Surgery, CHU-ME Sainte Justine and the
Montreal Heart Institute, Universite de Montreal, Montreal, Canada
(Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Veldtman) Adult Congenital Heart Disease, Heart Centre, King Faisal
Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Publisher
Elsevier Inc.
Abstract
Background: Patients with repaired tetralogy of Fallot (rTOF) have
increased risk for mortality, sudden cardiac death, and ventricular
tachycardia (VT). The aim of this systematic review and meta-analysis is
to offer an updated analysis of risk factors following significant changes
in surgical and perioperative management. Method(s): A meta-analysis
based on the published literature between 2008 and 2018 was conducted.
Endpoints were VT, cardiac mortality/VT, and all-cause mortality/VT.
Studies with >=100 patients and >=10 events were included. Result(s):
Fifteen studies including 7218 patients (average age 27.5 years) were
analyzed. Risk factors for VT included older age (per 1 year, odds ratio
[OR]: 1.039; 95% confidence interval [CI]: 1.025-1.053), older age at
corrective surgery (per 1 year, OR: 1.034; CI: 1.017-1.051), previous
palliative shunt (OR: 3.063; CI: 1.525-6.151), number of thoracotomies
(OR: 1.416; CI: 1.249-1.604), longer QRS duration (per 1 ms, OR: 1.031;
CI: 1.008-1.055), and at least moderate right-ventricular dysfunction (OR:
2.160; CI_ 1.311-3.560). Additional risk factors for cardiac death/VT were
previous ventriculotomy (OR: 2.269; CI: 1.226-4.198), lower
left-ventricular ejection fraction (per 1%, OR: 1.049; CI: 1.029-1.071),
and higher right-ventricular end diastolic volume (per 1 mL/m2,
OR: 1.009; CI: 1.002-1.016). Supraventricular tachycardia/atrial
fibrillation was an additional risk factor for all-cause mortality/VT (OR:
1.939; CI: 1.088-3.457). Conclusion(s): The study highlights the
importance of preservation of biventricular systolic function on late
outcomes. Ventricular function appears to have a greater impact on
outcomes than the severity of pulmonary regurgitation alone in this
patient population. Copyright © 2020 Canadian Cardiovascular
Society

<35>
Accession Number
2005670271
Title
Safety and effectiveness of riociguat for chronic thromboembolic pulmonary
hypertension in real-world clinical practice: interim data from
post-marketing surveillance in Japan.
Source
Pulmonary Circulation. 10 (3) (no pagination), 2020. Date of Publication:
2020.
Author
Tanabe N.; Ogo T.; Hatano M.; Kigawa A.; Sunaya T.; Sato S.
Institution
(Tanabe) Department of Respirology, Chiba University, Chiba, Japan
(Ogo) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Hatano) Department of Cardiovascular Medicine, The University of Tokyo,
Tokyo, Japan
(Kigawa) Medical Affairs Pulmonology and Cardiology, Bayer Yakuhin, Ltd,
Osaka, Japan
(Sunaya) Data Sciences and Analytics, Research and Development Japan,
Bayer Yakuhin, Ltd, Osaka, Japan
(Sato) Pharmacovigilance and Medical Governance, Medical Affairs, Bayer
Yakuhin, Ltd, Osaka, Japan
Publisher
SAGE Publications Ltd
Abstract
This multicenter, prospective, non-interventional study
(ClinicalTrials.gov: NCT02117791) evaluated the safety and effectiveness
of riociguat for chronic thromboembolic pulmonary hypertension in Japanese
clinical practice, registering all patients with chronic thromboembolic
pulmonary hypertension treated with riociguat following its launch in
Japan in April 2014. Safety was assessed by analyzing the adverse drug
reactions. Effectiveness measurements included the assessment of change in
World Health Organization functional class, six-minute walk test, and
hemodynamics. Overall, 1031 patients were included in the safety analysis
with 811 (78.7%) patients in World Health Organization functional class
II/III. The mean treatment duration was 591.4 days (median 441.0 days).
Adverse drug reactions were reported in 19.5% of patients, the most common
being hypotension (5.9%), headache (3.0%), dizziness (1.9%), and
gastroesophageal reflux disease (1.5%). Serious adverse drug reactions
were reported in 2.1% of patients. Estimated survival was 97.0% at one
year, 95.8% at two years, and 94.4% at three years. The effectiveness
analysis (n = 1027) showed significant increases from baseline in
six-minute walking distance, and significant reductions from baseline in
mean pulmonary arterial pressure and pulmonary vascular resistance. These
interim results of riociguat in Japanese patients with chronic
thromboembolic pulmonary hypertension demonstrated a safety profile that
was generally consistent with those of pivotal clinical studies. The study
is ongoing, and will continue to provide insights into the safety and
effectiveness of riociguat in real-world practice. Copyright ©
The Author(s) 2020.

<36>
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
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.

<37>
[Use Link to view the full text]
Accession Number
632699395
Title
Left ventricular mass reduction and hypertrophy regression following renal
artery revascularization: a meta-analysis.
Source
Journal of hypertension. 39 (1) (pp 4-11), 2021. Date of Publication: 01
Jan 2021.
Author
Cuspidi C.; Tadic M.; Sala C.; Quarti-Trevano F.; Gherbesi E.; Mancia G.;
Grassi G.
Institution
(Cuspidi, Quarti-Trevano, Mancia, Grassi) Department of Medicine and
Surgery, University of Milano-Bicocca
(Cuspidi) Clinical Research Unit, Istituto Auxologico Italiano, Milan,
Italy
(Tadic) Department of Cardiology, University Hospital 'Dr Dragisa Misovic
- Dedinje', Belgrade, Serbia
(Sala, Gherbesi) Department of Clinical Sciences and Community Health,
University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di
Milano, Milan, Italy
Publisher
NLM (Medline)
Abstract
AIM: Few echocardiographic studies have focused on regression of left
ventricular hypertrophy (LVH) in patients with renal artery stenosis after
revascularization, with inconsistent results. We performed a systematic
meta-analysis of these studies in order to offer a comprehensive
information on this topic. METHOD(S): The PubMed, OVID-MEDLINE, and
Cochrane library databases were analyzed to search English-language
articles published from 1 January 1990 up to 31 March 2020. Studies were
identified by crossing the following terms: 'renal artery stenosis',
'renovascular hypertension', 'fibromuscular dysplasia', 'renal artery
stenting', 'renal artery surgery' with 'cardiac damage', 'hypertensive
heart disease' 'left ventricular mass', 'left ventricular hypertrophy',
'echocardiography'. RESULT(S): A total of 726 hypertensive patients
with renal artery stenosis (mean age 61 years, 64% men, 98% treated, 10%
with fibromuscular dysplasia) were included in 13 studies. Baseline and
postintervention pooled mean LVM values were 220 +/- 15 and 203 +/- 19 g,
respectively (SMD -0.24 +/- 0.06, CI -0.37 to -0.21, P<0.0001);
corresponding values for LV mass index were 129.0 +/- 6 and 115 +/- 7 g/m,
respectively (SMD -0.28 +/- 0.04, CI -0.36 to 0.21, P < 0.0001). Renal
revascularization was associated with a 40% lower risk of LVH. This trend
was accompanied by a reduction in the number of antihypertensive drugs
(SMD -0.27 +/- 0.04, CI -0.37 to 0.17, P < 0.0001). CONCLUSION(S):
The present meta-analysis suggests that renal artery revascularization
added to antihypertensive therapy promotes a favourable effect on LV
structure, as reflected by a significant decrease in absolute and indexed
LV mass index as well by a lower risk of LVH. Limitations include: high
prevalence of modest renal artery stenosis (>=50%); small sample of
fibromuscular dysplasia; lack of randomized design of most studies.

<38>
Accession Number
2007495769
Title
Short-term and long-term outcomes of revascularization interventions for
patients with severely reduced left ventricular ejection fraction: a
meta-analysis.
Source
ESC Heart Failure. (no pagination), 2020. Date of Publication: 2020.
Author
Pei J.; Wang X.; Xing Z.; Zheng K.; Hu X.
Institution
(Pei, Wang, Xing, Hu) Department of Cardiovascular Medicine, The Second
Xiangya Hospital, Central South University, 139 Middle Renmin Road,
Changsha, Hunan 410011, China
(Xing) Department of Emergency Medicine, Second Xiangya Hospital, Central
South University, Changsha, China
(Zheng) Department of Cardiovascular Medicine, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
Publisher
Wiley-Blackwell
Abstract
Aims: This meta-analysis aimed to determine whether coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI) should be
preferred in patients with severely reduced left ventricular (LV) ejection
fraction. Methods and Results: We searched the PubMed, EMBASE, and
Cochrane Library databases from the conception of the databases till 1 May
2020 for studies on patients with severely reduced LV ejection fraction
undergoing CABG and PCI. The primary clinical endpoints were 30 day and
long-term mortalities. The secondary endpoints were 30 day and long-term
incidences of myocardial infarction (MI) and stroke, long-term
cardiovascular mortality, and repeat revascularization. Eighteen studies
involving 11 686 patients were analysed. Compared with PCI, CABG had lower
long-term mortality [hazard ratio (HR): 0.70, 95% confidence interval
(CI): 0.61-0.80, P < 0.01], cardiovascular mortality (HR: 0.60, 95% CI:
0.43-0.85, P < 0.01), MI (HR: 0.51, 95% CI: 0.36-0.72, P < 0.01), and
repeat revascularization (HR: 0.32, 95% CI: 0.23-0.47, P < 0.01) risk.
Significant differences were not observed for long-term stroke (HR: 1.18,
95% CI: 0.74-1.87, P = 0.49), 30 day mortality (HR: 1.18, 95% CI:
0.89-1.56, P = 0.25), and MI (HR: 0.42, 95% CI: 0.16-1.11, P = 0.08) risk.
CABG was associated with a higher risk of stroke within 30 days (HR: 2.88,
95% CI: 1.07-7.77, P = 0.04). In a subgroup analysis of propensity
score-matched studies, CABG was associated with a higher long-term risk of
stroke (HR: 1.61, 95% CI: 1.20-2.16, P < 0.01). Conclusion(s): Among
patients with severely reduced LV ejection fraction, CABG resulted in a
lower mortality rate and an increased risk of stroke. Copyright ©
2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on
behalf of European Society of Cardiology

<39>
Accession Number
2008502943
Title
622 Renal Resistive Index and Acute Kidney Injury During Mechanical
Circulatory Support.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S317), 2020. Date of
Publication: January 2020.
Author
Barua S.; Muthiah K.; Macdonald P.; Hayward C.
Institution
(Barua, Muthiah, Macdonald, Hayward) St Vincent's Hospital Sydney,
Australia
Publisher
Elsevier Ltd
Abstract
Background: Renal resistive index (RRI) predicts acute kidney injury (AKI)
in select populations. We performed a systematic review of RRI and AKI in
patients undergoing temporary or durable mechanical circulatory support.
 Method(s): 9 articles, totaling 1036 patients, described RRI in
cardiopulmonary bypass (CPB) for cardiac surgery. One article described
RRI in 5 patients with pulsatile left ventricular assist device (LVAD).
 Finding(s): There was a significant drop in mean RRI (0.79 vs 0.6)
prior to- and 1 week following implantation of LVAD in all 5 patients,
associated with improvement in eGFR at 15.6+/-10.9 months follow-up. In
patients undergoing CPB, AKI within 7 days of cardiac surgery ranged from
23-74%. There was no significant difference in mean RRI pre-CPB between
no-AKI and AKI patients. At 0-2h post CPB separation, there was a
significant difference in means in all except one study (no AKI RRI mean
0.64-0.68, AKI RRI mean 0.68-0.79). ROC AUC for AKI between 0.7-0.91. At
RRI cut-offs between 0.67-0.74, sensitivity ranged 49-94% and specificity
ranged 64-92% for developing AKI. Three studies reported RRI at 4h and 24h
post CPB. Two had significant difference in mean RRI between AKI and
no-AKI, with a smaller difference than 0-2h RRI. Conclusion(s): These
findings suggest RRI, particularly acutely following CPB separation, is
useful in predicting AKI in patients post CPB. In pulsatile LVAD, there is
reduction in RRI as well as improvement in renal function, however this is
less clinically relevant given contemporary LVAD systems use continuous,
rather than pulsatile flow. Copyright © 2020

<40>
Accession Number
2008502848
Title
514 National Cardiac Registries: A Systematic Review.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S268), 2020. Date of
Publication: January 2020.
Author
Dawson L.; Biswas S.; Stub D.; Lefkovits J.; Burchill L.; Reid C.;
Eccleston D.
Institution
(Dawson, Lefkovits, Burchill, Eccleston) Royal Melbourne Hospital,
Melbourne, Australia
(Biswas, Stub, Lefkovits, Reid) Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: There has been exponential growth in the number and scale of
national cardiovascular disease registries. We aimed to provide a
comprehensive outline of contemporary national cardiac registries across
all subspecialties. Method(s): We performed a systematic literature
review by searching OvidMedline in August 2019 to identify registries
relating to six pre-specified domains (Table). To be included, the
registry had to be national in nature, actively collecting data, and
publishing either peer-reviewed publications or online reports.
 Result(s): A total of 24,076 records were identified from six
domain-specific Medline searches; 24,057 abstracts were screened with
19,435 non-relevant records excluded; 4,624 full texts were screened with
4,473 non-relevant texts excluded; and 151 registries met inclusion
criteria. Of these, 15 related to cardiac surgery, 27 to arrhythmia (17
device, 5 ablation, 7 atrial fibrillation), 21 to congenital heart disease
(14 general, 2 interventional, 4 surgical, and 1 disease specific), 43 to
coronary disease or percutaneous coronary intervention (22 PCI, 21 CAD),
27 to heart failure (13 heart failure, 5 transplant, 2 mechanical support,
7 disease specific), and 18 to structural intervention (3 any, 13 TAVI, 2
mitral intervention). Quality scoring using the Monash University Clinical
Quality Registry Grading System (a composite of data completeness,
definitions, reliability and validation), demonstrated marked
heterogeneity in quality between registries. Conclusion(s): Cardiac
registries have seen rapid growth, however the use and quality among
various subspecialties differs markedly across world regions. Given the
multiple benefits, clinicians, funders and health bureaucrats should be
encouraged to focus on the range, quality and uptake of national
registries. [Formula presented] Copyright © 2020

<41>
Accession Number
2008502810
Title
296 Cardiac MRI of Patients with Implanted Devices - Diagnostic
Improvement Using Wide Band Late Gadolinium Enhancement Imaging.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S166), 2020. Date of
Publication: January 2020.
Author
Hamilton-Craig C.; Neill J.; Bi X.; Jin J.; Kellman P.; Haqqani H.;
Stugnell W.
Institution
(Hamilton-Craig, Neill, Haqqani, Stugnell) The Prince Charles Hospital &
University Of Queensland, Brisbane, Australia
(Jin) Siemens Healthineers, Sydney, Australia
(Bi) Siemens Medical Solutions USA, Inc., United States
(Kellman) National Heart Lung and Blood Institute, Bethesda, United States
Publisher
Elsevier Ltd
Abstract
Background: Cardiac magnetic resonance (CMR) with Late Gadolinium
Enhancement (LGE) is used to evaluate myocardial scar and differentiate
cardiomyopathies. However, implanted devices cause susceptibility
artefacts often rendering the images uninterpretable. We scanned 31
consecutive cases with implanted devices and substantial susceptibility
artefact using a novel Wide Band LGE sequence and evaluated the clinical
utility for evaluation of myocardial scar. Method(s): 31 consecutive
stress scans CMR clinically referred for evaluation of myocardial scar
were performed on a 1.5T system (MAGNETOM Aera, Siemens Healthcare).
Standard breath-held magnitude inversion recovery (Mag-LGE) images were
performed 10 minutes after 1.5mg/kg gadobutrol (Gadovist). This was
compared to a free-breathing motion corrected Wide Band LGE (WB-LGE)
prototype sequence with 4Khz-6KHz increased bandwidth (WIP 1325, Siemens
Healthineers). Level-3 expert reader blindly evaluated both sets of images
in a randomized order. Image quality and diagnostic confidence were
measured on a Likert rating scale from 1 (poor) to 3 (very good).
 Result(s): 28 cases had implanted MRI conditional pacemakers or
defibrillators, 2 cases with mechanical heart valves, and 1 with a
shoulder implant. WideBand imaging was successful in all (100%) cases,
demonstrating clinical feasibility. Image quality score for Mag-LGE was
1.033 (poor), compared to 2.866 for WB-LGE (p<0.001). In 30/31 cases (97%)
the WB-LGE imaging was superior and provided diagnostic clinical
information not available on standard Mag-LGE imaging, with only 1 case
having persistent artefact. Conclusion(s): Wide-Band LGE imaging
provide diagnostic CMR imaging of myocardial scar in cases where standard
LGE imaging is poor or uninterpretable. [Formula presented] Copyright
© 2020

<42>
Accession Number
2008502768
Title
491 Fate of "Low Risk" Chest Pain Patients Discharged From the Emergency
Department.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S259), 2020. Date of
Publication: January 2020.
Author
Tait J.; Chow C.; Figtree G.; Celermajer D.; Patel S.
Institution
(Tait, Chow, Figtree, Celermajer, Patel) Royal Prince Alfred Hospital,
Camperdown, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: Patients with chest pain comprise a large proportion of ED
presentations and place a major burden on healthcare resources. Here, we
aimed to describe the characteristics of patients presenting to a large
urban ED with "low risk" chest pain, with a particular focus on
re-presentations. Method(s): Single-centre, retrospective database
review of patients presenting throughout 2016 to the Royal Prince Alfred
Hospital ED was performed. The primary outcomes of interest were final
diagnosis, frequency of re-presentation within one year and reason for
re-presentation. Result(s): A total of 4000 patients with chest pain
presented to Royal Prince Alfred Hospital ED in 2016. Over half of these
were not admitted. From those who were discharged, 250 patients were
randomly selected for further analysis (55% male, median age was 56, IQ
range 16 to 88). 134 (53.6%) had one or more major cardiovascular risk
factors. 40% were discharged with GP follow-up only, 33% were referred to
a cardiologist for further testing and 27% were discharged home with no
specific medical follow-up arranged. Over 40% of patients re-presented to
the ED within a year. Of these, 86% presented for non-cardiac reasons and
14% presented with cardiac issues (including 3 patients presenting with an
ACS requiring coronary stenting). Conclusion(s): Although low risk
chest pain patients frequently re-present to ED, most are due to
non-cardiac causes. This suggests that current chest pain pathways
appropriately identify chest pain patients who are safe for
discharge. Copyright © 2020

<43>
Accession Number
2008502566
Title
693 Are Indigenous Australian Females at Particular Disadvantage in Terms
of Ischaemic Heart Disease?.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S348), 2020. Date of
Publication: January 2020.
Author
Wiemers P.; Murdoch D.; Savage M.; Raffel O.
Institution
(Wiemers, Murdoch, Savage, Raffel) The Prince Charles Hospital, Coorparoo,
Australia
(Wiemers, Murdoch, Savage, Raffel) The University of Queensland, Brisbane,
Australia
Publisher
Elsevier Ltd
Abstract
Background: There is evidence to suggest Indigenous Australian females are
at comparatively greater disadvantage than Indigenous Australian males in
terms of ischaemic heart disease (IHD). We explored data in this regard.
 Method(s): A search of the literature was undertaken utilising
relevant databases. Reference lists of retrieved articles were examined to
identify additional relevant studies. Result(s): Framingham risk
prediction equations have been demonstrated to perform more poorly when
applied to Indigenous Australian females when compared to males,
underestimating risk. A greater disparity in prevalence rates of smoking,
obesity and diabetes has also been shown in the Indigenous Australian
female population. Indigenous Australian females have been demonstrated to
be over-represented in published coronary artery bypass grafting (CABG)
series to date. Our group reporting on percutaneous coronary intervention
(PCI) at a metropolitan centre demonstrated that Indigenous Australian
females were again over-represented in comparison to non-Indigenous
females. Additionally Indigenous Australian females presented at a similar
age to Indigenous Australian males, differing from the non-indigenous
cohort (females significantly older). Historical data suggests higher
standardised mortality ratios comparing to the non-Indigenous population
for Indigenous Australian females than males. More recent data suggest
these ratios do not differ significantly. Conclusion(s): Indigenous
Australian females have been shown to be over-represented in reported
revascularisation series to date. Variations in risk factor profiles are
likely one contributor. Despite this, more recent mortality data does not
suggest greater disparity from IHD deaths in female Indigenous Australians
compared to males. Copyright © 2020

<44>
Accession Number
2008502375
Title
395 Prognostic Value of Global Longitudinal Strain for Patients Undergoing
Cardiac Resynchronisation Therapy: a Systematic Review.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S215-S216), 2020.
Date of Publication: January 2020.
Author
Appadurai V.; D'Elia N.; Mew T.; Tomlinson S.; Chan J.; Scalia G.
Institution
(Appadurai, Mew, Tomlinson, Chan, Scalia) The Prince Charles Hospital,
Chermside, Australia
(Appadurai, Mew, Tomlinson, Scalia) The University of Queensland, St
Lucia, Australia
(D'Elia) The Alfred Hospital, Melbourne, Australia
(D'Elia) Baker Heart and Diabetes Institute, Melbourne, Australia
(Chan) Griffith University, Southport, Australia
Publisher
Elsevier Ltd
Abstract
Background: Cardiac resynchronisation therapy (CRT) is an important
adjunct to optimal medical therapy in heart failure patients. Myocardial
fibrosis/scar burden are important factors that adversely affect the
prognosis from CRT at a myocardial substrate level. Speckle-tracking
echocardiography utilising global longitudinal strain (GLS) is a
non-invasive imaging modality with good correlation to myocardial scar/
fibrosis burden. Our objective was to consolidate the existing evidence
for GLS as a prognostic marker in heart failure patients undergoing CRT
implantation. Method(s): A systematic review was performed of PUBMED,
EMBASE and Cochrane Database from 2000-2020 using keywords: "global
longitudinal strain", "deformation imaging", "speckle-tracking
echocardiography", "cardiac resynchronisation therapy", "biventricular
pacing" with 646 results. After title, abstract and full text reviews, 8
studies met inclusion criteria for GLS as predictor of primary endpoint of
all-cause mortality, rehospitalisations, left ventricular assist device or
heart transplantation. Due to significant between study heterogeneity a
meta-analysis was not performed. Result(s): Of the 3,651 patients
with symptomatic heart failure and CRT implantation, mean age 52-70 years
(+/- 10-15), 70-76% men, 48-60% ischemic cardiomyopathy and majority of
patients NYHA class III-IV. Mean LVEF 22-29% (+/- 3-9%) and GLS 6.5-8.9%
(+/- 2.7-3.9%). Declining GLS and lower quartiles of GLS were found to be
predictors of the primary combined endpoint in CRT patients.
 Conclusion(s): This systematic review demonstrated that GLS is a
prognostic marker of all-cause mortality, rehospitalisations, LVAD or
heart transplantation, in patients undergoing CRT
implantation. Copyright © 2020

<45>
Accession Number
2008502318
Title
394 Prognostic Value of Global Longitudinal Strain for Individuals with
Primary Severe Mitral Regurgitation Undergoing Mitral Valve Surgery: a
Systematic Review and Meta-analysis.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S215), 2020. Date of
Publication: January 2020.
Author
Appadurai V.; D'Elia N.; Chang D.; Holland D.; Stanton T.
Institution
(Appadurai) The Prince Charles Hospital, Queensland Health, Chermside,
Australia
(Appadurai, Chang) The University of Queensland, St Lucia, Australia
(D'Elia) The Alfred Hospital, Melbourne, Australia
(D'Elia) Baker Heart and Diabetes Institute, Melbourne, Australia
(Chang, Holland, Stanton) Department of Cardiology, Sunshine Coast
University Hospital, Birtinya, Australia
(Holland, Stanton) School of Medicine, Griffith University, Birtinya,
Australia
Publisher
Elsevier Ltd
Abstract
Background: Surgical intervention is indicated for primary severe mitral
regurgitation (PSMR). Prognostic determinants of outcome in this
population have traditionally depended on left ventricular ejection
fraction (LVEF) and left ventricular volumes. Speckle tracking
echocardiography employing global longitudinal strain (GLS) is a sensitive
parameter of myocardial dysfunction and is an established prognostic
marker in myopathic processes. A systematic review and meta-analysis was
performed to determine the prognostic value of GLS for individuals with
PSMR undergoing mitral valve surgery for all-cause mortality.
 Method(s): Systematic reviews of the Pubmed, EMBASE and the Cochrane
Library from 1980-2020 were performed incorporating MeSH terms; "mitral
valve", "global longitudinal strain", "speckle tracking echocardiography",
"mitral regurgitation", "left ventricular dysfunction", "mitral valve
surgery" and "myocardial deformation". Result(s): There were 2,299
results after duplicate removal, after title and abstract review there
were 29 articles suitable for full text review, of these, 3 studies, that
had 1,547 patients, met inclusion criteria. The mean age ranged 61-65
(IQR+/-12), 54-64% male, 4-20% concomitant bypass grafting, 25-46%
hypertensive and 3-14% diabetic. Mean LVEF 62-65% (3-8%) and GLS 21%
(2-4%). A reduced GLS in PSMR patients prior to surgery was an independent
predictor of all-cause mortality [HR 1.12 [95% CI:1.06-1.17]].
 Conclusion(s): Our systematic review and meta-analysis demonstrated
the prognostic value of GLS to predict all-cause mortality in patients
with PSMR undergoing surgical intervention. [Formula
presented] Copyright © 2020

<46>
Accession Number
2008502179
Title
010 Resistance Training Avoidance- a Benefit or Barrier to Recovery
following Cardiac Surgery Via Median Sternotomy?.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S41-S42), 2020. Date
of Publication: January 2020.
Author
Pengelly J.; Boggett S.; Bryant A.; Royse C.; Royse A.; Williams G.;
El-Ansary D.
Institution
(Pengelly, Royse, Royse, El-Ansary) Swinburne University of Technology,
Hawthorn, Australia
(Pengelly) Charles Sturt University, Bathurst, Australia
(Boggett, Bryant, Royse, Royse, Williams, El-Ansary) University of
Melbourne, Parkville, Australia
(Royse, Royse) Royal Melbourne Hospital, Parkville, Australia
(Royse) Outcomes Research Consortium, Cleveland Clinic, Cleveland, United
States
(El-Ansary) Clinical Research Institute, Westmead Private Hospital,
Westmead, Australia
Publisher
Elsevier Ltd
Abstract
Background: Sternal precautions typically restrict upper limb movement for
1-6 weeks and resistance training for 6-12 weeks post-sternotomy. This is
based on the belief that mechanical forces generated by upper limb
movements act in direct opposition to the wire suture holding strength,
seen in early cadaver studies. However, the safety, feasibility and
reliability of resistance training on sternal micromotion is unknown.
 Method(s): This is a nested study within a pilot randomised
controlled trial comparing standard care to a 12-week resistance training
program. Sixteen adults following first-time cardiac surgery via median
sternotomy, who were randomised to the resistance training group
participated. Sternal micromotion was assessed using sternal ultrasound of
the mid- and lower- sternum during a cough and six dynamic bilateral upper
limb resistance exercises at 2-, 8- and 14- weeks postoperatively,
performed on CAM-machines at a base resistance of 20lbs (9kg).
Participant-reported pain was recorded using a Visual Analogue Scale.
Intra-class correlation coefficients (ICC) were used to calculate
inter-rater reliability of sternal ultrasound image analysis.
 Result(s): The biceps curl (M=1.5mm; IQR=1.9mm) and shoulder pulldown
(M=0.5mm; IQR=1.1mm) resulted in the greatest median micromotion in the
lateral and anterior-posterior directions, respectively. No increase in
pain from rest was reported by any participant. Inter-rater reliability
for lateral (ICC=0.73; 95% CI=0.58-0.83) and anterior-posterior (ICC=0.83;
95% CI=0.73-0.89) sternal edge micromotion was moderate-to-good.
 Conclusion(s): Physical and functional postoperative recovery is
impacted by movement restrictions recommended within current sternal
precautions. This study determined that bilateral upper limb exercises
performed on CAM-resistance machines is safe in regard to sternal
micromotion (<2mm) and pain as early as two weeks
post-sternotomy. Copyright © 2020

<47>
Accession Number
2008502126
Title
049 Can Antihypertensive Therapies be used in Patients with Moderate or
Severe Aortic Stenosis?.
Source
Heart Lung and Circulation. Conference: Abstracts for the 68th Cardiac
Society of Australia and New Zealand Annual Scientific Meeting, the
International Society for Heart Research Australasian Section Annual
Scientific Meeting and the 14th Annual Australia and New Zealand
Endovascular Therapies Meeting. 29 (Supplement 2) (pp S60), 2020. Date of
Publication: January 2020.
Author
Sen J.; Chung E.; Neil C.; Marwick T.
Institution
(Sen, Neil, Marwick) Baker Heart and Diabetes Institute, Melbourne,
Australia
(Chung) University of Toronto, Toronto, Canada
Publisher
Elsevier Ltd
Abstract
Background: Hypertension can negatively affect prognosis in moderate or
severe aortic stenosis (AS), but antihypertensive therapy (AHT) is often
avoided due to possible deleterious effects such as reduced coronary
perfusion, left ventricular dysfunction and haemodynamic compromise.
 Purpose(s): We systematically assessed and compared clinical outcomes
in adults with moderate or severe AS treated with and without AHT.
 Method(s): Two independent reviewers performed screening, data
extraction and risk of bias assessments from a systematic search of the
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and grey
literature without language restrictions up to September 9, 2019.
Conflicts were resolved by the third reviewer. Outcomes of interest
included mortality, left ventricular (LV) mass index, systolic blood
pressure, diastolic blood pressure, and LV ejection fraction.
Meta-analysis with pooled effect sizes using random-effects model, were
estimated in R. Result(s): Of 3,024 citations, 30 studies (26,224
patients) were included in the qualitative synthesis and 23 studies in
meta-analysis. AHT was associated with favourable clinical outcomes and
was well tolerated. AHT was associated with lower risk of all-cause
mortality (Risk Ratio (RR)=0.69, 95% CI: 0.53-0.90, p=0.01, Figure 1). The
effect size appears to differ with type of aortic valve replacement (AVR).
AHT was associated with lower risk of acute kidney injury
post-transcatheter AVR (RR=0.13, 95% CI:0.05-0.35, p=0.007). Favourable
outcomes such as improved haemodynamic and echocardiographic parameters
were demonstrated in some studies. However, heterogeneity was significant
across studies. Conclusion(s): AHT appears to be safe and has a
clinical benefit in patients with moderate or severe AS. Copyright
© 2020

<48>
Accession Number
2010254241
Title
Time to surgery in thoracic cancers and prioritization during COVID-19: A
systematic review.
Source
Journal of Thoracic Disease. 12 (11) (pp 6640-6654), 2020. Date of
Publication: November 2020.
Author
Fligor S.C.; Tsikis S.T.; Wang S.; Ore A.S.; Allar B.G.; Whitlock A.E.;
Calvillo-Ortiz R.; Arndt K.; Callery M.P.; Gangadharan S.P.
Institution
(Fligor, Tsikis, Wang, Ore, Allar, Whitlock, Calvillo-Ortiz, Arndt,
Callery, Gangadharan) Department of Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
Publisher
AME Publishing Company
Abstract
Background: Coronavirus disease 2019 (COVID-19) has overwhelmed hospital
resources worldwide, requiring widespread cancellation of non-emergency
operations, including lung and esophageal cancer operations. In the United
States, while hospitals begin to increase surgical volume and tackle the
backlog of cases, the specter of a "second wave," with a potential vaccine
months to years away, highlights the ongoing need to triage cases based
upon the risk of surgical delay. We synthesize the available literature on
time to surgery and its impact on outcomes along with a critical appraisal
of the released triage guidelines in the United States. Method(s): We
performed a systematic literature review using PubMed according to
preferred reporting items for systematic reviews and meta-analyses
guidelines evaluating relevant literature from the past 15 years.
 Result(s): Out of 679 screened abstracts, 12 studies investigating
time to surgery in lung cancer were included. In stage I-II lung cancer,
delayed resection beyond 6 to 8 weeks is consistently associated with
lower survival. No identified evidence justifies a 2 cm cutoff for
immediate versus delayed surgery. For stage IIIa lung cancer, time to
surgery greater than 6 weeks after neoadjuvant therapy is similarly
associated with worse survival. For esophageal cancer, 254 abstracts were
screened and 23 studies were included. Minimal literature addresses
primary esophagectomy, but time to surgery over 8 weeks is associated with
lower survival. In the neoadjuvant setting, longer time to surgery is
associated with increased pathologic complete response, but also decreased
survival. The optimal window for esophagectomy following neoadjuvant
therapy is 6 to 8 weeks. Conclusion(s): In the setting of the
COVID-19 pandemic, timely resection of lung and esophageal cancer should
be prioritized whenever possible based upon local resources and
disease-burden. Copyright © Journal of Thoracic Disease. All
rights reserved.

<49>
Accession Number
2010254231
Title
Comparing the rate of fiberoptic bronchoscopy use with a video double
lumen tube versus a conventional double lumen tube-a randomized controlled
trial.
Source
Journal of Thoracic Disease. 12 (11) (pp 6533-6541), 2020. Date of
Publication: November 2020.
Author
Onifade A.; Lemon-Riggs D.; Smith A.; Pak T.; Pruszynski J.; Reznik S.;
Moon T.S.
Institution
(Onifade, Lemon-Riggs, Smith, Pak, Moon) Department of Anesthesia and Pain
Management, University of Texas, Southwestern Medical Center, Dallas, TX,
United States
(Pruszynski, Reznik) Department of Cardiothoracic Surgery, University of
Texas, Southwestern Medical Center, Dallas, TX, United States
Publisher
AME Publishing Company
Abstract
Background: Double lumen endotracheal tubes (DLT) are commonly used to
provide single lung ventilation during thoracic surgery. A fiberoptic
bronchoscope (FOB) is typically used to confirm accurate DLT placement.
Accounting for initial purchase, maintenance, repair and cleaning, the use
of an FOB can cost as much as $312 per procedure. The VivaSight DLT
(VS-DLT) incorporates a built-in camera, which is aimed at reducing FOB
use and its associated costs. In this study, we compared the rate of FOB
use when intubating using either a VS-DLT or a conventional DLT (c-DLT).
 Method(s): This is a randomized controlled comparative study
performed at a public county teaching hospital. A total of 50 patients
were enrolled and randomly assigned to either a c-DLT (n=25) or a VS-DLT
(n=25). The primary outcome was the rate of FOB use. Secondary outcomes
included time to correct tube placement and incidence of malposition
during surgery. Result(s): Use of the VS-DLT required significantly
less FOB use (28%) compared to use of the c-DLT (100%). While there was no
difference in the ease of intubation, the time to correct tube placement
was significantly faster using a VS-DLT (54 vs. 156 s, P<0.001).
Additionally, the incidence of tube malposition was significantly reduced
in the VS-DLT group. Conclusion(s): This study demonstrated a
significantly lower rate of FOB use when using a VS-DLT compared to a
c-DLT. Placement of the VS-DLT was significantly quicker and malposition
during surgery occurred significantly less than with the c-DLT. While
intubating with a VS-DLT provides clinical benefits, it may not result in
significant cost reductions when compared to a c-DLT. Copyright ©
Journal of Thoracic Disease. All rights reserved.

<50>
Accession Number
2010235482
Title
Continuous ultrafiltration during extracorporeal circulation and its
effect on lactatemia: A randomized controlled trial.
Source
PLoS ONE. 15 (11 November) (no pagination), 2020. Article Number:
e0242411. Date of Publication: November 2020.
Author
Garcia-Camacho C.; Marin-Paz A.-J.; Lagares-Franco C.; Abellan-Hervas
M.-J.; Sainz-Otero A.-M.
Institution
(Garcia-Camacho) Cardiovascular Surgery Unit, Puerta del Mar University
Hospital, Andalusian Health Service, Cadiz, Andalusia, Spain
(Marin-Paz) Nursing and Physiotherapy Department, Faculty of Nursing,
University of Cadiz, Algeciras, Spain
(Lagares-Franco) Department of Statistics and Operative Research,
University of Cadiz, Cadiz, Andalusia, Spain
(Abellan-Hervas, Sainz-Otero) Nursing and Physiotherapy Department,
Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
Publisher
Public Library of Science
Abstract
Introduction Hyperlactatemia occurs during or after extracorporeal
circulation in the form of lactic acidosis, increasing the risk of
postoperative complications and the mortality rate. The aim of this study
was to evaluate whether continuous high-volume hemofiltration with volume
replacement through a polyethersulfone filter during the extracorporeal
circulation procedure decreases postoperative lactatemia and its
consequences. Materials and methods This was a randomized controlled
trial. Patients were randomly divided into two groups of 32: with or
without continuous high-volume hemofiltration through a polyethersulfone
membrane. Five patients were excluded from each group during the study
period. The sociodemographic characteristics, filter effects, and blood
lactate levels at different times during the procedure were evaluated.
Secondary endpoints were studied, such as the reduction in the intubation
time and time spent in ICU. Results Lactatemia measurements performed
during the preoperative and intraoperative phases were not significantly
different between the two groups. However, the blood lactate levels in the
postoperative period and at 24 hours in the intensive care unit showed a
significant reduction and a possible clinical benefit in the hemofiltered
group. Following extracorporeal circulation, the mean lactate level was
higher (difference: 0.77 mmol/L; CI 0.95: 0.01-1.53) in the
nonhemofiltered group than in the hemofiltered group (p<0.05). This effect
was greater at 24 hours (p = 0.019) in the nonhemofiltered group
(difference: 1.06 mmol/L; CI 0.95: 0.18-1.93) than in the hemofiltered
group. The reduction of lactatemia is associated with a reduction of
inflammatory mediators and intubation time, with an improvement in liver
function. Conclusions The use and control of continuous high-volume
hemofiltration through a polyethersulfone membrane during heart-lung
surgery could potencially prevent postoperative complications. The
reduction of lactatemia implied a reduction in intubation time, a decrease
in morbidity and mortality in the intensive care unit and a shorter
hospital stay. Copyright © 2020 Garcia-Camacho et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<51>
Accession Number
633598384
Title
Pupillometry pain index decreases intraoperative sufentanyl administration
in cardiac surgery: a prospective randomized study.
Source
Scientific reports. 10 (1) (pp 21056), 2020. Date of Publication: 03 Dec
2020.
Author
Berthoud V.; Nguyen M.; Appriou A.; Ellouze O.; Radhouani M.; Constandache
T.; Grosjean S.; Durand B.; Gounot I.; Bahr P.-A.; Martin A.; Nowobilski
N.; Bouhemad B.; Guinot P.-G.
Institution
(Berthoud, Nguyen, Appriou, Ellouze, Radhouani, Constandache, Grosjean,
Durand, Gounot, Bahr, Martin, Nowobilski, Bouhemad, Guinot)
Anaesthesiology and Critical Care Department, Dijon University Hospital, 2
Bd Marechal de Lattre de Tassigny, Dijon 21000, France
(Nguyen, Bouhemad, Guinot) University of Burgundy Franche-Comte, Dijon
21000, France
Publisher
NLM (Medline)
Abstract
Pupillometry has proven effective for the monitoring of intraoperative
analgesia in non-cardiac surgery. We performed a prospective randomized
study to evaluate the impact of an analgesia-guided pupillometry algorithm
on the consumption of sufentanyl during cardiac surgery. Fifty patients
were included prior to surgery. General anesthesia was standardized with
propofol and target-controlled infusions of sufentanyl. The standard group
consisted of sufentanyl target infusion left to the discretion of the
anesthesiologist. The intervention group consisted of sufentanyl target
infusion based on the pupillary pain index. The primary outcome was the
total intraoperative sufentanyl dose. The total dose of sufentanyl was
lower in the intervention group than in the control group and (55.8 microg
[39.7-95.2] vs 83.9 microg [64.1-107.0], p=0.04). During the postoperative
course, the cumulative doses of morphine (mg) were not significantly
different between groups (23 mg [15-53] vs 24 mg [17-46]; p=0.95). We
found no significant differences in chronic pain at 3 months between the 2
groups (0 (0%) vs 2 (9.5%) p=0.49). Overall, the algorithm based on the
pupillometry pain index decreased the dose of sufentanyl infused during
cardiac surgery.Clinical trial number: NCT03864016.

<52>
Accession Number
2005551875
Title
Outcomes of mechanical circulatory support for giant cell myocarditis: A
systematic review.
Source
Journal of Clinical Medicine. 9 (12) (pp 1-11), 2020. Article Number:
3905. Date of Publication: December 2020.
Author
Patel P.M.; Saxena A.; Wood C.T.; O'malley T.J.; Maynes E.J.; Entwistle
J.W.C.; Massey H.T.; Pirlamarla P.R.; Alvarez R.J.; Cooper L.T.; Eduardo
Rame J.; Tchantchaleishvili V.
Institution
(Patel, Saxena, Wood) Sidney Kimmel Medical College, Thomas Jefferson
University, Philadelphia, PA 19107, United States
(O'malley, Maynes, Entwistle, Massey, Eduardo Rame, Tchantchaleishvili)
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson
University, Philadelphia, PA 19107, United States
(Pirlamarla, Alvarez) Division of Cardiology, Department of Medicine,
Thomas Jefferson University, Philadelphia, PA 19107, United States
(Cooper) Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville,
FL 32224, United States
Publisher
MDPI AG
Abstract
Treatment of giant cell myocarditis (GCM) can require bridging to
orthotopic heart transplantation (OHT) or recovery with mechanical
circulatory support (MCS). Since the roles of MCS and immunotherapy are
not well-defined in GCM, we sought to analyze outcomes of patients with
GCM who required MCS. A systematic search was performed in June 2019 to
identify all studies of biopsy-proven GCM requiring MCS after 2009. We
identified 27 studies with 43 patients. Patient-level data were extracted
for analysis. Median patient age was 45 (interquartile range (IQR): 32-57)
years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart
failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular
(BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43)
of patients who received immunotherapy, 81.5% (22/27) used steroids
combined with at least one other immunosuppressant. Cyclosporine was the
most common non-steroidal agent, used in 40.7% (11/27) of regimens.
Immunosuppression was initiated before MCS in 59.3% (16/27) of cases,
after MCS in 29.6% (8/27), and not specified in 11.1% (3/27).
Immunosuppression started prior to MCS was associated with significantly
better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients
received bridge-to-transplant MCS; 39.5% (17/43) received
bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104
(58-255) days from diagnosis. GCM recurrence after OHT was reported in
8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically
supported patients with GCM. Survival and bridge to recovery appear better
in patients on immunosuppression, especially if initiated before
MCS. Copyright © 2020 by the authors. Licensee MDPI, Basel,
Switzerland.

<53>
Accession Number
2010062913
Title
Thromboelastometry-guided intraoperative haemostatic management reduces
bleeding and red cell transfusion after paediatric cardiac surgery.
Source
British Journal of Anaesthesia. 114 (1) (pp 91-102), 2015. Date of
Publication: January 2015.
Author
Nakayama Y.; Nakajima Y.; Tanaka K.A.; Sessler D.I.; Maeda S.; Iida J.;
Ogawa S.; Mizobe T.
Institution
(Nakayama, Nakajima, Maeda, Iida, Ogawa, Mizobe) Department of
Anaesthesiology and Intensive Care, Kyoto Prefectural University of
Medicine, Kyoto, Japan
(Tanaka) Department of Anaesthesiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
Publisher
Elsevier Ltd
Abstract
Background: Thromboelastometric evaluation of coagulation might be useful
for prediction and management of bleeding after paediatric cardiac
surgery. We tested the hypothesis that the use of a
thromboelastometry-guided algorithm for blood product management reduces
blood loss and transfusion requirements. Method(s): We studied 78
patients undergoing paediatric cardiac surgery with cardiopulmonary bypass
(CPB) for the initial 12 h after operation. Stepwise multiple linear
regression was used to develop an algorithm to guide blood product
transfusions. Thereafter, we randomly assigned 100 patients to
conventional or algorithm-guided blood product management, and assessed
bleeding and red cell transfusion requirements. Result(s): CPB time,
post-bypass rotational thromboelastometry (ROTEM) EXTEM
amplitude at 10 min (A10), and FIBTEM-A10 were independently associated
with chest tube drainage volume during the initial 12 h after operation.
Discriminative analysis determined cut-off values of 30 mm for EXTEM-A10
and 5 mm for FIBTEM-A10, and estimated optimal intraoperative fresh-frozen
plasma and platelet concentrate transfusion volumes.
Thromboelastometry-guided post-bypass blood product management
significantly reduced postoperative bleeding (9 vs 16 ml kg-1,
P<0.001) and packed red cell transfusion requirement (11 vs 23 ml
kg-1, P=0.005) at 12 h after surgery, and duration of critical
care stay (60 vs 71 h, P=0.014). Conclusion(s): Rotational
thromboelastometry-guided early haemostatic intervention by rapid
intraoperative correction of EXTEM-A10 and FIBTEM-A10 reduced blood loss
and red cell transfusion requirements after CPB, and reduced critical care
duration in paediatric cardiac surgical patients. Clinical trial
registration: UMIN Clinical Trials Registry UMIN000006832 (December 4,
2011). Copyright © 2015 The Author(s)

<54>
Accession Number
2010082656
Title
Percutaneous Coronary Intervention With Drug Eluting Stents Versus
Coronary Artery Bypass Graft Surgery in Patients With Advanced Chronic
Kidney Disease: A Systematic Review and Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Doulamis I.P.; Tzani A.; Tzoumas A.; Iliopoulos D.C.; Kampaktsis P.N.;
Briasoulis A.
Institution
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Tzoumas) Medical School, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Iliopoulos) Department of Cardiothoracic Surgery, Hygeia Medical Center,
Athens, Greece
(Kampaktsis) Division of Cardiology, New York University Langone Medical
Center, New York, NY, United States
(Briasoulis) University of Iowa Hospitals and Clinics, Iowa City, IA,
United States
Publisher
W.B. Saunders
Abstract
Tomicron perform a systematic review and meta-analysis of the available
literature comparing safety and efficacy outcomes between percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) and coronary
artery bypass grafting (CABG) in patients with chronic kidney disease
(CKD). Eligible studies included patients with eGFR < 60 mL/min/1.73
m2 that underwent revascularization. Subgroup analyses
according to DES generation and dialysis status were performed. A total of
7157 and 8156 patients were included in the CABG and PCI arms respectively
across 16 studies eligible studies. Weighted mean age was 68.6 and 63.8
years for the CABG and PCI arms, respectively. Mean follow-up time was 3.2
and 2.9 years respectively. Compared to CABG, PCI was associated with
increased risk for all-cause mortality (hazard ratio [HR]: 1.28, 95%
confidence interval [CI]: 1.13, 1.46; P < 0.01), cardiac mortality (HR:
1.59, 95% CI: 1.13, 2.23; P = 0.01), myocardial infarction (MI) (HR: 1.89,
95% CI: 1.43, 2.49; P < 0.01), and repeat revascularization (HR: 2.97, 95%
CI: 2.20, 3.97; P < 0.01). Risk for stroke was lower (HR: 0.64, 95% CI:
0.50, 0,81; P < 0.01) in the PCI group. These results were unchanged when
1st or 2nd DES were used. A subgroup analysis showed no difference in
all-cause mortality for DES PCI vs CABG in dialysis patients (HR: 1.11,
95% CI: 0.71, 1.73; P = 0.65). In patients with CKD, PCI is associated
with higher risk of mortality, MI, and repeat revascularization compared
with CABG and regardless of DES generation. Risk of stroke is higher with
CABG. Type of revascularization had no impact on survival of dialysis
patients. Copyright © 2020 Elsevier Inc.

<55>
Accession Number
633586461
Title
Interval estimation of the overall treatment effect in randomeffects
meta-analyses: Recommendations from a simulation study comparing
frequentist, Bayesian, and bootstrap methods.
Source
Research synthesis methods. (no pagination), 2020. Date of Publication: 02
Dec 2020.
Author
Weber F.; Knapp G.; Glass A.; Kundt G.; Ickstadt K.
Institution
(Weber, Glass, Kundt) Institute for Biostatistics and Informatics in
Medicine and Ageing Research, Rostock University Medical Center, Rostock,
Germany
(Knapp, Ickstadt) Department of Statistics, TU Dortmund University,
Dortmund, Germany
Publisher
NLM (Medline)
Abstract
There exists a variety of interval estimators for the overall treatment
effect in a random-effects meta-analysis. A recent literature review
summarizing existing methods suggested that in most situations, the
Hartung-Knapp/Sidik-Jonkman (HKSJ) method was preferable. However, a
quantitative comparison of those methods in a common simulation study is
still lacking. Thus, we conduct such a simulation study for continuous and
binary outcomes, focusing on the medical field for application. Based on
the literature review and some new theoretical considerations, a
practicable number of interval estimators is selected for this comparison:
the classical normalapproximation interval using the DerSimonian-Laird
heterogeneity estimator, the HKSJ interval using either the Paule-Mandel
or the Sidik-Jonkman heterogeneity estimator, the Skovgaard higher-order
profile likelihood interval, a parametric bootstrap interval, and a
Bayesian interval using different priors. We evaluate the performance
measures (coverage and interval length) at specific points in the
parameter space, i. e. not averaging over a prior distribution. In this
sense, our study is conducted from a frequentist point of view. We confirm
the main finding of the literature review, the general recommendation of
the HKSJ method (here with the Sidik-Jonkman heterogeneity estimator). For
metaanalyses including only 2 studies, the high length of the HKSJ
interval limits its practical usage. In this case, the Bayesian interval
using a weakly informative prior for the heterogeneity may help. Our
recommendations are illustrated using a realworld meta-analysis dealing
with the efficacy of an intramyocardial bone marrow stem cell
transplantation during coronary artery bypass grafting. This article is
protected by copyright. All rights reserved.

<56>
Accession Number
615332267
Title
Effect of CPAP on diastolic function in coronary artery disease patients
with nonsleepy obstructive sleep apnea: A randomized controlled trial.
Source
International Journal of Cardiology. 241 (pp 12-18), 2017. Date of
Publication: 15 Aug 2017.
Author
Glantz H.; Johansson M.C.; Thunstrom E.; Guron C.W.; Uzel H.; Saygin M.;
Herlitz J.; Peker Y.
Institution
(Glantz) Dept. of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Johansson, Guron) Dept. of Molecular and Clinical Medicine/Clinical
Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
(Thunstrom, Peker) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Sweden
(Thunstrom) Dept. of Cardiology, Sahlgrenska University Hospital/Ostra,
Gothenburg, Sweden
(Uzel) Dept. of Cardiology, Sahlgrenska University Hospital/Molndal,
Gothenburg, Sweden
(Saygin) Dept. of Physiology, Faculty of Medicine, Suleyman Demirel
University, Isparta, Turkey
(Herlitz) Center of Prehospital Care of Western Sweden, University College
of Boras, Sweden
(Peker) Dept. of Pulmonary Medicine, Marmara University, Istanbul, Turkey
Publisher
Elsevier Ireland Ltd
Abstract
Background Obstructive sleep apnea (OSA) has been associated with worse
diastolic function in patients with coronary artery disease (CAD). This
analysis determined whether continuous positive airway pressure (CPAP)
treatment would improve diastolic function in CAD patients with nonsleepy
OSA. Methods Between December 2005 and November 2010, 244 revascularized
CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) >= 15/h,
Epworth Sleepiness Scale [ESS] score < 10) were randomly assigned to CPAP
or no-CPAP. Echocardiographic measurements were obtained at baseline, and
after 3 and 12 months. Results A total of 171 patients with preserved left
ventricular ejection fraction (>= 50%), no atrial fibrillation or severe
valve abnormalities, and technically adequate echocardiograms at baseline
and follow-up visits were included (CPAP, n = 87; no-CPAP, n = 84). In the
intention-to-treat analysis, CPAP had no significant effect on
echocardiographic parameters of mild (enlarged left atrium or decreased
diastolic relaxation velocity) or worse (increased E/e filling index
[presumed elevated left ventricular filling pressure]) diastolic function.
Post-hoc analysis revealed a significant association between CPAP usage
for >= 4 h/night and an increase in diastolic relaxation velocity at 12
months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p =
0.039) after adjustment for age, sex, body mass index, and left atrium
diameter at baseline. Conclusions CPAP did not improve diastolic
dysfunction in CAD patients with nonsleepy OSA. However, good CPAP
adherence was significantly associated with an increase in diastolic
relaxation velocity after one year. Copyright © 2017 Elsevier
Ireland Ltd

<57>
[Use Link to view the full text]
Accession Number
633004707
Title
Prognostic Value of Cardiac Magnetic Resonance-Derived Right Ventricular
Remodeling Parameters in Pulmonary Hypertension: A Systematic Review and
Meta-Analysis.
Source
Circulation: Cardiovascular Imaging. 13 (7) (no pagination), 2020. Article
Number: e010568. Date of Publication: 01 Jul 2020.
Author
Dong Y.; Pan Z.; Wang D.; Lv J.; Fang J.; Xu R.; Ding J.; Cui X.; Xie X.;
Wang X.; Chen, Md Y.; Guo X.
Institution
(Dong, Pan, Wang, Lv, Fang, Xu, Ding, Cui, Xie, Wang, Guo) Department of
Cardiology, First Affiliated Hospital of Zhejiang University School of
Medicine, No.79 Qing Chun Rd, Hangzhou 310006, China
(Chen, Md) Department of Cardiology, West China Hospital, Sichuan
University, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background Cardiac right ventricular remodeling plays a substantial role
in pathogenesis, progression, and prognosis of pulmonary hypertension.
Cardiac magnetic resonance is considered an excellent tool for evaluation
of right ventricle. However, value of right ventricular remodeling
parameters derived from cardiac magnetic resonance in predicting adverse
events is controversial. Methods The Pubmed (MEDLINE), Embase, Cochrane
Library, Web of Science, China National Knowledge Infrastructure platform
(CNKI), China Science and Technology Journal Database (VIP), and Wanfang
databases were systematically searched until November 2019. Studies
reporting hazard ratios (HRs) for all-cause death and composite end point
of pulmonary hypertension were included. Univariate HRs were extracted
from the included studies to calculate pooled HRs of each right
ventricular remodeling parameter. Results Eight studies with 1120 patients
examining all-cause death (female: 44%-92%, age: 40-67 years old,
follow-up time: 27-48 months) and 10 studies with 604 patients examining
composite end point (female: 60%-83%, age: 29-57 years old, follow-up
time: 10-68 months) met the criteria. Right ventricular ejection fraction
was the only parameter which could predict both all-cause death (pooled
HR=0.95; P=0.014) and composite end point (pooled HR=0.95; P<0.001),
although right ventricular end-diastolic volume index (pooled HR=1.01;
P<0.001), right ventricular end-systolic volume index (pooled HR=1.01,
P=0.045), and right ventricular mass index (pooled HR=1.03, P=0.032) only
predicted composite outcome. Similar results were observed when we
conducted the meta-analysis among patients with World Health Organization
type I of pulmonary hypertension. Conclusions Cardiac magnetic
resonance-derived right ventricular remodeling parameters have independent
prognostic value for all-cause death and composite end point of patients
with pulmonary hypertension. Right ventricular ejection fraction was the
strongest prognostic factor among all the right ventricular remodeling
parameters. Right ventricular mass index, right ventricular end-diastolic
volume index, and right ventricular end-systolic volume index also
demonstrated prognostic value. Copyright © 2020 Lippincott
Williams and Wilkins. All rights reserved.

<58>
[Use Link to view the full text]
Accession Number
632879279
Title
The Conundrum of Right Ventricular Remodeling and Outcome in Pulmonary
Hypertension.
Source
Circulation: Cardiovascular Imaging. 13 (7) (no pagination), 2020. Article
Number: e011208. Date of Publication: 01 Jul 2020.
Author
Ostenfeld E.; Kjellstrom B.
Institution
(Ostenfeld, Kjellstrom) Department of Clinical Sciences Lund, Clinical
Physiology and Skane University Hospital, Lund University, Lund SE-221 85,
Sweden
(Kjellstrom) Swedish Pulmonary Arterial Hypertension Registry, Uppsala
Clinical Research Centre, Uppsala University, Sweden
Publisher
Lippincott Williams and Wilkins

<59>
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
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 ©

<60>
Accession Number
632366180
Title
Effect of C-Reactive Protein on Lipoprotein(a)-Associated Cardiovascular
Risk in Optimally Treated Patients with High-Risk Vascular Disease: A
Prespecified Secondary Analysis of the ACCELERATE Trial.
Source
JAMA Cardiology. 5 (10) (pp 1136-1143), 2020. Date of Publication: October
2020.
Author
Puri R.; Nissen S.E.; Arsenault B.J.; St John J.; Riesmeyer J.S.; Ruotolo
G.; McErlean E.; Menon V.; Cho L.; Wolski K.; Lincoff A.M.; Nicholls S.J.
Institution
(Puri, Puri, Nissen, Menon, Cho, Lincoff) Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, OH, United States
(Puri, Puri, Nissen, St John, McErlean, Menon, Wolski, Lincoff) Cleveland
Clinic Coordinating Center for Clinical Research, Cleveland Clinic,
Cleveland, OH, United States
(Arsenault) Quebec Heart and Lung Institute, Universite de Laval, Quebec,
Canada
(Riesmeyer, Ruotolo) Eli Lilly, Indianapolis, IN, United States
(Nicholls) MonashHeart, Department of Cardiology, Monash University,
Clayton, VIC, Australia
Publisher
American Medical Association
Abstract
Importance: Although lipoprotein(a) (Lp[a]) is a causal genetic risk
factor for atherosclerotic cardiovascular disease, it remains unclear
which patients with established atherosclerotic cardiovascular disease
stand to benefit the most from Lp(a) lowering. Whether inflammation can
modulate Lp(a)-associated cardiovascular (CV) risk during secondary
prevention is unknown. Objective(s): To examine whether
Lp(a)-associated CV risk is modulated by systemic inflammation in
optimally treated patients at high risk of CV disease. Design,
Setting, and Participant(s): A prespecified secondary post hoc analysis of
the double-blind, multicenter randomized clinical Assessment of Clinical
Effects of Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib
in Patients at a High Risk for Vascular Outcomes (ACCELERATE) trial was
conducted between October 1, 2012, and December 31, 2013; the study was
terminated October 12, 2015. The study was conducted at 543 academic and
community hospitals in 36 countries among 12 092 patients at high risk of
CV disease (acute coronary syndrome, stroke, peripheral arterial disease,
or type 2 diabetes with coronary artery disease) with measurable Lp(a) and
high-sensitivity C-reactive protein (hsCRP) levels during treatment.
Statistical analysis for this post hoc analysis was performed from
September 26, 2018, to March 28, 2020. Intervention(s): Participants
received evacetrapib, 130 mg/d, or matching placebo. Main Outcomes
and Measures: The ACCELERATE trial found no significant benefit or harm of
evacetrapib on 30-month major adverse cardiovascular events (CV death,
myocardial infarction [MI], stroke, coronary revascularization, or
hospitalization for unstable angina). This secondary analysis evaluated
rates of CV death, MI, and stroke across levels of Lp(a). Result(s):
High-sensitivity C-reactive protein and Lp(a) levels were measured in 10
503 patients (8135 men; 8561 white; 10 134 received concurrent statins;
mean [SD] age, 64.6 [9.4] years). In fully adjusted analyses, in patients
with hsCRP of 2 mg/L or more but not less than 2 mg/L, increasing
quintiles of Lp(a) were significantly associated with greater rates of
death, MI, and stroke (P =.006 for interaction). Each unit increase in log
Lp(a) levels was associated with a 13% increased risk of CV death,
nonfatal MI, or stroke only in those with hsCRP levels of 2 mg/L or more
(P =.008 for interaction). There was also a significant stepwise
relationship between increasing Lp(a) quintiles and time to first CV
death, MI, or stroke (log-rank P <.001) when hsCRP levels were 2 mg/L or
more but not less than 2 mg/L. Sensitivity analyses in the ACCELERATE
placebo-treated group yielded similar significant associations exclusively
in the group with hsCRP of 2 mg/L or more. Conclusions and Relevance:
Elevated Lp(a) levels during treatment are related to CV death, MI, and
stroke when hsCRP levels are 2 mg/L or more but not less than 2mg/L. This
finding suggests a potential benefit of lowering Lp(a) in patients with
residual systemic inflammation despite receipt of optimal medical therapy.
Trial Registration: ClinicalTrials.gov Identifier:
NCT01687998. Copyright © 2020 American Medical Association. All
rights reserved.

<61>
Accession Number
632365929
Title
Natural History of Asymptomatic Severe Aortic Stenosis and the Association
of Early Intervention with Outcomes: A Systematic Review and
Meta-analysis.
Source
JAMA Cardiology. 5 (10) (pp 1102-1112), 2020. Date of Publication: October
2020.
Author
Gahl B.; Celik M.; Head S.J.; Vanoverschelde J.-L.; Pibarot P.; Reardon
M.J.; Van Mieghem N.M.; Kappetein A.P.; Juni P.; Da Costa B.R.
Institution
(Gahl) Clinical Trial Unit Bern, University of Bern, Bern, Switzerland
(Head, Celik, Head, Kappetein) Department of Cardiothoracic Surgery,
Erasmus Medical Center, Rotterdam, Netherlands
(Head, Head) Medtronic, Maastricht, Netherlands
(Vanoverschelde) Pole de Recherche Cardiovasculaire, Institut de Recherche
Experimentale et Clinique, Universite Catholique de Louvain, Brussels,
Belgium
(Vanoverschelde) Division of Cardiology, Cliniques Universitaires
Saint-Luc, Brussels, Belgium
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United
States
(Van Mieghem) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Juni) Department of Medicine and Institute of Health Policy, Management
and Evaluation, Applied Health Research Centre (AHRC), Toronto, ON, Canada
(Da Costa) Institute of Health Policy, Management and Evaluation, Applied
Health Research Centre (AHRC), Toronto, ON, Canada
(Da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
Publisher
American Medical Association
Abstract
Importance: Whether intervention should be performed in patients with
asymptomatic severe aortic stenosis (AS) remains debated.
 Objective(s): To meta-analyze the natural history of asymptomatic
severe AS and examine the association of early intervention with survival.
 Data Sources: PubMed, Embase, and Cochrane databases were searched
from inception to February 1, 2020. Study Selection: Observational studies
of adult patients with asymptomatic severe AS. Data Extraction and
Synthesis: Two investigators independently extracted study and patient
characteristics, follow-up time, events, and prognostic indicators of
events. Random-effects models were used to derive pooled estimates.
 Main Outcomes and Measures: The meta-analysis on natural history was
performed on the primary end point of all-cause death occurring during a
conservative treatment period, with secondary end points consisting of
cardiac death, death due to heart failure, sudden death, development of
symptoms, development of an indication for aortic valve intervention, and
aortic valve intervention. The primary end point for the meta-analysis of
early intervention vs a conservative strategy was all-cause death during
long-term follow-up. Finally, meta-analysis was performed on the
association of prognostic indicators with the composite of death or aortic
valve intervention found in multivariable models. Result(s): A total
of 29 studies with 4075 patients with 11901 years of follow-up were
included. Pooled rates per 100 patients per year were 4.8 (95% CI,
3.6-6.4) for all-cause death, 3.0 (95% CI, 2.2-4.1) for cardiac death, 2.0
(95% CI, 1.3-3.1) for death due to heart failure, 1.1 (95% CI, 0.6-2.1)
for sudden death, 18.1 (95% CI, 12.8-25.4) for an indication for aortic
valve intervention, 18.5 (95% CI, 13.4-25.5) for development of symptoms,
and 19.2 (95% CI, 15.5-23.8) for aortic valve intervention. Early
intervention was associated with a significant reduction in long-term
mortality (hazard ratio, 0.38; 95% CI, 0.25-0.58). Factors associated with
worse prognosis were severity of AS, low-flow AS, left ventricular damage,
and atherosclerotic risk factors. Conclusions and Relevance: Data
from observational studies and a recent randomized clinical trial suggest
that many patients with asymptomatic severe AS develop an indication for
aortic valve intervention, and their deaths are mostly cardiac but not
only sudden. Other end points besides sudden death should be considered
during the decision to perform early intervention that are associated with
improved survival. Copyright © 2020 American Medical Association.
All rights reserved.

<62>
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.
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.

<63>
Accession Number
2005534459
Title
Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in
Low-Risk Patients.
Source
Heart Lung and Circulation. 29 (10) (pp 1527-1533), 2020. Date of
Publication: October 2020.
Author
Koshy A.N.; Murphy A.; Farouque O.; Horrigan M.; Yudi M.B.
Institution
(Koshy, Murphy, Farouque, Horrigan, Yudi) Department of Cardiology, Austin
Health, Melbourne, Vic, Australia
(Koshy, Murphy, Farouque, Horrigan, Yudi) The University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
revolutionised the treatment of severe aortic stenosis (AS), though its
safety and efficacy in low-risk patients remains to be established.
 Method(s): A systematic review of PubMed, Medline and EMBASE
identified four randomised controlled trials (RCTs) in patients at low
surgical risk comparing TAVR to surgical aortic valve replacement (SAVR).
A meta-analysis was performed with a primary outcome of a composite of
all-cause mortality and stroke at longest available follow-up.
 Result(s): A total of four RCTs with 2,836 patients was included in
the final analysis. 1,363 patients were randomised to SAVR and 1,473 to
TAVR. The composite of all-cause mortality and stroke was significantly
lower in patients undergoing TAVR compared with SAVR (OR 0.59, 95%CI
0.37-0.95, p=0.03) with low heterogeneity (I2=31%). The
difference in the primary composite outcome was driven by a difference in
mortality (OR 0.66, 95%CI 0.44-0.98, p=0.04; I2=0%) without
significant differences in stroke (OR 0.75 95%CI 0.45-1.26, p=0.28;
I2=37%). Weighted absolute risk difference (ARD) of the primary
composite outcome also favoured TAVR (ARD -2.0% 95%CI -3.3 to -0.7%,
p=0.002) with a number needed to treat (NNT) of 50 to prevent one death or
stroke. Patients undergoing TAVR had a significantly higher risk of
permanent pacemaker implantation (OR 3.9, 95%CI 1.8-8.4, p<0.001,
I2=84%) and moderate or severe paravalvular leak (OR 5.0, 95%CI
1.6-15.7, p=0.01; I2=19%). Conclusion(s): In patients with severe AS
at low surgical risk, the rate of the composite of death and stroke was
significantly lower with TAVR than with SAVR. Longer term follow-up with a
focus on the impact of permanent pacemaker (PPM) implantation,
paravalvular leak (PVL) and structural valve deterioration is essential
before the use of TAVR can be generalised to the broader population of
patients with AS. Copyright © 2020 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<64>
Accession Number
2007495540
Title
Effectivity of dexamethasone in patients undergoing off-pump coronary
artery bypass surgery.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2020. Date of
Publication: 2020.
Author
Hanafy D.A.; Harta I.K.A.P.; Prasetya I.M.I.; Busroh P.W.; Soetisna T.W.;
Wartono D.A.; Tjubandi A.; Herlambang B.
Institution
(Hanafy, Harta, Busroh, Soetisna, Wartono, Tjubandi, Herlambang) National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Prasetya) RSUP Sanglah Hospital, Denpasar, Bali, Indonesia
Publisher
SAGE Publications Inc.
Abstract
Background: Based on our previous pilot study, systemic inflammatory
response syndrome is more common in off-pump compared to on-pump coronary
artery bypass. Therefore, we conducted a clinical trial of dexamethasone
in patients undergoing off-pump coronary artery bypass. Method(s):
Sixty consecutive patients undergoing off-pump coronary artery bypass were
enrolled from August 2018 to January 2019 and randomized to a
dexamethasone or placebo group of 30 each. Clinical outcomes were
analyzed. Result(s): There was a lower incidence of major adverse
cardiac events in the dexamethasone group compared to the placebo group
(17% versus 43%, p = 0.024). Clinical outcomes in the dexamethasone group
were better than those in the placebo group, in terms of duration of
mechanical ventilation (p = 0.029), intensive care unit stay (p = 0.028),
hospital stay (p = 0.04), and vasoactive-inotropic score (p = 0.045).
There were significant differences in inflammatory markers between the two
groups: interleukin-6 (p = 0.0001), procalcitonin (p = 0.0001), and
C-reactive protein (p = 0.0001) were lower in the dexamethasone group.
There was a significant association between the incidence of major adverse
cardiac events and both interleukin-6 (p = 0.005) and procalcitonin (p =
0.007). Conclusion(s): Preoperative dexamethasone in patients
undergoing off-pump coronary artery bypass is effective in improving
clinical outcomes and controlling the postoperative inflammatory
reaction. Copyright © The Author(s) 2020.

<65>
Accession Number
2007490831
Title
Posture Dependent Hypoxia Following Lobectomy: The Achilles Tendon of the
Lung Surgeon?.
Source
Journal of Investigative Surgery. (no pagination), 2020. Date of
Publication: 2020.
Author
Krassas A.; Tzifa A.; Boulia S.; Iliadis K.
Institution
(Krassas, Iliadis) Thoracic Surgery Department, "HYGEIA" Hospital, Athens,
Greece
(Tzifa) Congenital Heart Disease Department, "MITERA" Hospital, Athens,
Greece
(Tzifa) Department of Imaging Sciences, King's College, London, United
Kingdom
(Boulia) Pulmonology Department, "EVANGELISMOS" Hospital, Athens, Greece
Publisher
Taylor and Francis Ltd.
Abstract
Background: Platypnoea-Orthodeoxia Syndrome is an uncommon phenomenon
characterized by dyspnea/arterial desaturation in the standing position,
resolving in recumbency. Some patients present with Platypnoea-Orthodeoxia
Syndrome in the early-or-late post-operative period after major lung
resection (lobectomy/pneumonectomy). The main cause of
Platypnoea-Orthodeoxia Syndrome is an intracardiac anomaly (Patent Foramen
Ovalis/Atrial Septal Defect) leading to right-to-left shunt.
 Objective(s): To identify the causes of post-lobectomy
Platypnoea-Orthodeoxia Syndrome, and the possible pathophysiologic
mechanism. Method(s): A Pubmed database-EMBASE systematic review was
performed in order to find all reports, reporting the occurrence of
dyspnea/hypoxemia after lobectomy. Result(s): 8 studies were found
concerning ten patients during the period from 1983-2019.There was 6
male/4 female. The mean age was 62 years. All patients underwent resection
of the right lung. The time-interval between the operation and the
Platypnoea-Orthodeoxia Syndrome was from 2 days to 3 years. A Patent
Foramen Ovalis was present in 90% and in 10% an Atrial Septal Defect was
diagnosed. The mean Right Atrial Pressure was 7.5 mmHg, the mean Left
Atrial Pressure was 6.6 mmHg and the mean Pulmonary artery pressure was
18.5 mmHg. The mean size of the interatrial communication was 1.62 cm. The
inter-atrial communication was closed by open-chest surgical procedure in
3 cases (30%) and in 7 patients (70%) a percutaneous transcatheter device
was implanted. Conclusion(s): Platypnoea-Orthodeoxia Syndrome after
lobectomy is a rare cause of post-operative dyspnea/hypoxia. It is the
result of right-to-left shunt via an interatrial communication.
Mediastinal relocation, stretching of the atrial septum and aortic root
dilatation are among the functional elements necessary for the
Platypnoea-Orthodeoxia Syndrome manifestation. Copyright © 2020
Taylor & Francis Group, LLC.

<66>
Accession Number
633464834
Title
Motor Impairment in Children With Congenital Heart Defects: A Systematic
Review.
Source
Pediatrics. 146 (6) (no pagination), 2020. Date of Publication: 01 Dec
2020.
Author
Bolduc M.-E.; Dionne E.; Gagnon I.; Rennick J.E.; Majnemer A.;
Brossard-Racine M.
Institution
(Bolduc, Dionne, Gagnon, Majnemer) School of Physical and Occupational
Therapy
(Bolduc, Dionne, Brossard-Racine) Advances in Brain and Child Development
Research Laboratory, The Research Institute of the McGill University
Health Centre, Montreal, Canada; and
(Rennick) Ingram School of Nursing
(Rennick, Majnemer, Brossard-Racine) Departments of Pediatrics and
(Rennick) Department of Nursing, Montreal Children's Hospital, McGill
University Health Centre, Montreal, Canada
(Majnemer, Brossard-Racine) Neurology and Neurosurgery, McGill University,
Montreal, Canada
(Brossard-Racine) School of Physical and Occupational Therapy
Publisher
NLM (Medline)
Abstract
CONTEXT: With improvements in survival rates in newborns with congenital
heart defects (CHDs), focus has now shifted toward enhancing
neurodevelopmental outcomes across their life span. OBJECTIVE(S): To
systematically review the prevalence and extent of motor difficulties in
infants, children, and adolescents with CHD requiring open-heart surgery.
DATA SOURCES: Data sources included Embase, Medline and the Cumulative
Index to Nursing and Allied Health Literature. STUDY SELECTION: Original
studies published between 1997 and 2019 examining gross and/or fine motor
skills in children born with a CHD requiring open-heart surgery were
selected. DATA EXTRACTION: The prevalence of motor impairments and mean
scores on standardized motor assessments were extracted. Findings were
grouped in 5 categories on the basis of the age of the children.
 RESULT(S): Forty-six original studies were included in this
systematic review. The prevalence of mild to severe motor impairments
(scores <-1 SD below normative data or controls) across childhood ranged
from 12.3% to 68.6%, and prevalence ranged from 0% to 60.0% for severe
motor impairments (<-2 SDs). Although our results suggest that the overall
prevalence of motor impairments <-1 SD remains rather constant across
childhood and adolescence, severe motor impairments (<-2 SDs) appear to be
more prevalent in younger children. LIMITATIONS: Variability in sampling
and methodology between the reviewed studies is the most important
limitation of this review. CONCLUSION(S): The results of this review
highlight that infants with CHD have an increased risk of motor
impairments across infancy, childhood, and adolescence. These findings
stress the importance of systematic screening or evaluation of motor
skills across childhood and adolescence in children with
CHD. Copyright © 2020 by the American Academy of Pediatrics.

<67>
Accession Number
2005497629
Title
Activation of pi3k/akt/hif-1alpha signaling is involved in lung protection
of dexmedetomidine in patients undergoing video-assisted thoracoscopic
surgery: A pilot study.
Source
Drug Design, Development and Therapy. 14 (pp 5155-5166), 2020. Date of
Publication: 2020.
Author
Zhu L.; Zhang Y.; Zhang Z.; Ding X.; Gong C.; Qian Y.
Institution
(Zhu, Zhang, Zhang, Ding, Gong, Qian) Department of Anesthesiology and
Perioperative Medicine, First Affiliated Hospital with Nanjing Medical
University, Nanjing 210029, China
Publisher
Dove Medical Press Ltd
Abstract
Background: Lung resection and one lung ventilation (OLV) during
video-assisted thor-acoscopic surgery (VATS) may lead to acute lung
injury. Dexmedetomidine (DEX), a highly selective alpha<inf>2</inf>
adrenergic receptor agonist, improves arterial oxygenation in adult
patients undergoing thoracic surgery. The aim of this pilot study was to
explore possible mechanism related to lung protection of DEX in patients
undergoing VATS. Patients and Methods: Seventy-four patients
scheduled for VATS were enrolled in this study. Three timepoints (before
anesthesia induction (T<inf>0</inf>), 40 min after OLV (T<inf>1</inf>),
and 10 min after two-lung ventilation (T<inf>2</inf>)) of arterial blood
gas were obtained. Meanwhile, lung histopathologic examination,
immunohistochemistry analysis (occludin and ZO-1), levels of tumor
necrosis factor (TNF)-alpha and interleukin (IL)-6 in lung tissue and
plasma, and activation of phosphoinositide-3-kinase
(PI3K)/AKT/hypoxia-inducible factor (HIF)-1alpha signaling were detected.
Postoperative outcomes including duration of withdrawing the pleural
drainage tube, length of hospital stay, hospitalization expenses, and
postoperative pulmonary complications (PPCs) were also recorded.
 Result(s): Sixty-seven patients were randomly divided into DEX group
(group D, n=33) and control group (group N, n=34). DEX improved
oxygenation at T<inf>1</inf> and T<inf>2</inf> (group D vs group N;
T<inf>1</inf>: 191.8 +/- 49.8 mmHg vs 159.6 +/- 48.1 mmHg, P = 0.009;
T<inf>2</inf>: 406.0 mmHg [392.2--423.7] vs 374.5 mmHg [340.2-378.2], P =
0.001). DEX alleviated the alveolar capillary epithelial structure damage,
increased protein expression of ZO-1 and occludin, inhibited elevation of
the expression of TNF-alpha and IL-6 in lung tissue and plasma, and
increased protein expression of p-PI3K, p-AKT and HIF-1alpha. Dex
administered had better postoperative outcomes with less risk of PPCs and
hospitalization expenses as well as shorter duration of withdrawing the
pleural drainage tube and length of hospital stay. Conclusion(s):
Activation of PI3K/Akt/HIF-1alpha signaling might be involved in lung
protection of DEX in patients undergoing VATS. Copyright © 2020
Zhu et al.

<68>
Accession Number
2010203073
Title
Long-term outcomes of patients with stable coronary disease and chronic
kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or
Surgery Study II Trial.
Source
Nephrology Dialysis Transplantation. 35 (8) (pp 1369-1376), 2020. Date of
Publication: 01 Aug 2020.
Author
Lima E.G.; Charytan D.M.; Hueb W.; de Azevedo D.F.C.; Garzillo C.L.;
Favarato D.; Linhares Filho J.P.P.; Martins E.B.; Batista D.V.; Rezende
P.C.; Hueb A.C.; Franchini Ramires J.A.; Filho R.K.
Institution
(Lima, Hueb, de Azevedo, Garzillo, Favarato, Linhares Filho, Martins,
Batista, Rezende, Hueb, Franchini Ramires, Filho) Department of Clinical
Cardiology, Heart Institute (InCor), University of Sao Paulo, Sao Paulo,
Brazil
(Charytan) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Oxford University Press
Abstract
Background. Chronic kidney disease (CKD) is associated with a worse
prognosis in patients with stable coronary artery disease (CAD); however,
there is limited randomized data on long-term outcomes of CAD therapies in
these patients. We evaluated long-term outcomes of CKD patients with CAD
who underwent randomized therapy with medical treatment (MT) alone,
percutaneous coronary intervention (PCI) or coronary artery bypass graft
surgery (CABG). Methods. Baseline estimated glomerular filtration rate
(eGFR) was obtained in 611 patients randomized to one of three therapeutic
strategies in the Medicine, Angioplasty, or Surgery Study II trial.
Patients were categorized in preserved renal function and mild or moderate
CKD groups depending on their eGFR (>=90, 89-60 and 59-30 mL/min/1.73
m2, respectively). The primary clinical endpoint, a composite
of overall death and myocardial infarction, and its individual components
were analyzed using proportional hazards regression (Clinical Trial
registration information: http://www.controlled-trials.com. Registration
number: ISRCTN66068876). Results. Of 611 patients, 112 (18%) had preserved
eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The
primary endpoint occurred in 29.5, 32.4 and 44.7% (P 1/4 0.02) for
preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality
incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and
moderate CKD, respectively (P 1/4 0.001). For preserved eGFR, there was no
significant difference in outcomes between therapies. For mild CKD, the
primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P
1/4 0.006) [adjusted hazard ratio (HR) 1/4 0.26, 95% confidence interval
(CI) 0.07-0.88; P 1/4 0.03 for PCI versus MT; and adjusted HR 1/4 0.48;
95% CI 0.31-0.76; P 1/4 0.002 for CABG versus MT]. We also observed higher
mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG
(19.0%) groups (P 1/4 0.015) among mild CKD subjects (adjusted HR 1/4
0.44, 95% CI 0.25-0.76; P 1/4 0.003 for CABG versus MT; adjusted HR 1/4
0.56, 95% CI 0.07-4.28; P 1/4 0.58 for PCI versus MT). Results were
similar with moderate CKD group but did not achieve significance.
Conclusions. Coronary interventional therapy, both PCI and CABG, is
associated with lower rates of events compared with MT in mild CKD
patients >10 years of follow-up. More study is needed to confirm these
benefits in moderate CKD. Copyright © 2020 Oxford University
Press. All rights reserved.

<69>
Accession Number
2010169614
Title
Comparing functional capacity after inpatient cardiac rehabilitation
programme in coronary artery bypass graft surgery patients with and
without diabetes.
Source
European Journal of Molecular and Clinical Medicine. 7 (2) (pp 1303-1310),
2020. Date of Publication: September 2020.
Author
Lalwani L.; Quazi Z.; Gaidhane A.; Quazi N.
Institution
(Lalwani) Dept. of Cardiovascular and Respiratory Sciences, Ravi Nair
Physiotherapy College(RNPC), Datta Meghe Institute of Medical
Sciences(DMIMS), Sawangi, Wardha, India
(Quazi, Gaidhane) Dept. of Community Medicine, Jawaharlal Nehru Medical
College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, India
(Quazi) Dept. of Physiology, Jawaharlal Nehru Medical College, Datta Meghe
Institute of Medical Sciences, Sawangi, Wardha, India
Publisher
Ubiquity Press
Abstract
Introduction -Functional Capacity (FC) is a valid measure of physical
fitness in health and disease and should be evaluated at the start and at
the end of Cardiac rehabilitation programs (CRPs). However after
comprehensive literature search we have not came across any of studies on
diabetic patients comparing FC after inpatient rehabilitation. So this
study was undertaken with the aim to compare the FC after inpatient CRPs
in coronary artery bypass graft (CABG) surgery patients with and without
diabetes using 6 minute walk test. Objective(s): Comparison of FC
after inpatient CRPs in CABG patients with and without diabetes by
performing 6 minute walk test (6MWT) using distance walked, % predicted
distance and mean peak VO2. Methods and methodology: observational type of
study conducted at tertiary care hospital, total of 32 subjects
{Experimental group-16 in diabetes (DM) and Control group-16 in
non-diabetes (non-DM)}. Stable CABG surgery patient were included.
Exclusive criteria were graft taken from leg, lower leg amputation,
unstable hemodynamic, Peripheral Vascular Diseases (PVD), BMI >30 kg/cm2
and Lower limb disability were excluded . FC using 6MWT was evaluated at
the end of phase 1 CRP in both groups .6MWT was done using ATS
guidelines.% predicted distance and mean peak VO2 calculated using
equation. Result- The experimental group patients had statistically
significantly less functional capacity as compared to the control group.
Conclusion- In experimental group i.e. DM Patients functional capacity is
decreased after inpatient cardiac rehabilitation in CABG
patients. Copyright © 2020 Ubiquity Press. All rights reserved.

<70>
Accession Number
2010166536
Title
Does Blood Transfusion Have an Effect on Outcomes After Aortic Valve
Replacement Surgery?.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Bayliss C.D.; Maier R.; Kasim A.; Hancock H.; Akowuah E.
Institution
(Bayliss, Akowuah) Department of Cardiothoracic Surgery, The James Cook
University Hospital, Middlesbrough, United Kingdom
(Maier, Hancock) Newcastle Clinical Trials Unit, Newcastle University,
Newcastle upon Tyne, United Kingdom
(Kasim) Department of Anthropology, Durham University, Durham, United
Kingdom
Publisher
Elsevier Ltd
Abstract
Objective: Long-term outcomes following surgical aortic valve replacement
(AVR) are excellent. However, there is a significant early morbidity
burden. Red cell transfusion is common in the perioperative period and
deleterious effects of receiving a transfusion on early postoperative
morbidity are well described in observational studies. This study aimed to
assess the effect of transfusion on ischaemic or infective outcomes after
aortic valve replacement. Method(s): Data from 270 patients enrolled
in the Manubrium-limited ministernotomy versus conventional sternotomy for
aortic valve replacement (MAVRIC) randomised controlled trial was used to
create two cohorts, patients that received red cell transfusions following
AVR and those that did not. Propensity score matching was performed to
limit the effect of confounding variables. Strict transfusion thresholds
were maintained, with patients receiving a transfusion if haemoglobin
concentration fell below 80 g/L, or if significant bleeding or
haemodynamic instability occurred. The primary outcome was a composite of
ischaemic event (myocardial infarction, permanent stroke, gut ischaemia or
acute kidney injury) or serious infection (sepsis, endocarditis,
respiratory tract or wound infection). Patients were followed for 12 weeks
following surgery. Result(s): Sixty-three (63) of 270 patients
received a red cell transfusion (23.3%). Transfused patients had
significantly lower body mass index (BMI), a higher proportion of females,
a lower preoperative haemoglobin and haematocrit, a higher EuroSCORE II
score, worse renal function and were more likely to have undergone urgent
surgery compared to the unadjusted control cohort. Once matched, there was
no difference in the primary outcome between cohorts. There was a
significantly increased length of hospital stay in the transfused group
(median 7 days transfused, median 5 days not-transfused, p=0.001).
 Conclusion(s): Red cell transfusion, using a transfusion threshold of
80 g/L, does not appear to be associated with adverse ischaemic or
infective outcomes after aortic valve replacement. Copyright ©
2020

<71>
[Use Link to view the full text]
Accession Number
2007481878
Title
Sitagliptin for the prevention and treatment of perioperative
hyperglycaemia in patients with type 2 diabetes undergoing cardiac
surgery: A randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2020. Date of
Publication: 2020.
Author
Cardona S.; Tsegka K.; Pasquel F.J.; Jacobs S.; Halkos M.; Keeling W.B.;
Davis G.M.; Fayfman M.; Albury B.; Urrutia M.A.; Galindo R.J.; Migdal
A.L.; Macheers S.; Guyton R.A.; Vellanki P.; Peng L.; Umpierrez G.E.
Institution
(Cardona, Tsegka, Pasquel, Jacobs, Davis, Fayfman, Albury, Urrutia,
Galindo, Migdal, Vellanki, Umpierrez) Department of Medicine, Emory
University, Atlanta, GA, United States
(Halkos, Keeling, Macheers, Guyton) Joseph B. Whitehead Department of
Surgery, Emory University, Atlanta, GA, United States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA,
United States
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To assess whether treatment with sitagliptin, starting before surgery
and continued during the hospital stay, can prevent and reduce the
severity of perioperative hyperglycaemia in patients with type 2 diabetes
undergoing coronary artery bypass graft (CABG) surgery. Material(s)
and Method(s): We conducted a double-blinded, placebo-controlled trial in
adults with type 2 diabetes randomly assigned to receive sitagliptin or
matching placebo starting 1 day prior to surgery and continued during the
hospital stay. The primary outcome was difference in the proportion of
patients with postoperative hyperglycaemia (blood glucose [BG] > 10 mmol/L
[>180 mg/dL]) in the intensive care unit (ICU). Secondary endpoints
included differences in mean daily BG in the ICU and after transition to
regular wards, hypoglycaemia, hospital complications, length of stay and
need of insulin therapy. Result(s): We included 182 participants
randomized to receive sitagliptin or placebo (91 per group, age 64 +/- 9
years, HbA1c 7.6% +/- 1.5% and diabetes duration 10 +/- 9 years). There
were no differences in the number of patients with postoperative BG
greater than 10 mmol/L, mean daily BG in the ICU or after transition to
regular wards, hypoglycaemia, hospital complications or length of stay.
There were no differences in insulin requirements in the ICU; however,
sitagliptin therapy was associated with lower mean daily insulin
requirements (21.1 +/- 18.4 vs. 32.5 +/- 26.3 units, P =.007) after
transition to a regular ward compared with placebo. Conclusion(s):
The administration of sitagliptin prior to surgery and during the hospital
stay did not prevent perioperative hyperglycaemia or complications after
CABG. Sitagliptin therapy was associated with lower mean daily insulin
requirements after transition to regular wards. Copyright © 2020
John Wiley & Sons Ltd

<72>
Accession Number
633558834
Title
Risk Factors of Postoperative Delirium in Older Adult Spine Surgery
Patients: A Meta-Analysis.
Source
AORN journal. 112 (6) (pp 650-661), 2020. Date of Publication: 01 Dec
2020.
Author
Baek W.; Kim Y.M.; Lee H.
Publisher
NLM (Medline)
Abstract
This literature review identifies factors that may place older adult
patients at risk for developing delirium after spine surgery. We conducted
a meta-analysis according to PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines. Using a variety of
electronic databases, we identified five studies for inclusion that
represent 645 patients who were 65 years or older. The pooled incidence
rate of postoperative delirium was 13.0%. Factors associated with
developing postoperative delirium included preoperative opioid use,
cervical spine surgery versus lumbar or thoracic spine surgery, spine
fusion versus simple spine surgery, hypertension, cerebrovascular disease,
pulmonary disease, duration of surgery, and infused IV fluid volume.
Nurses who provide perioperative care for older adult patients undergoing
spine surgery should be aware of the potential risk factors of delirium to
ensure patient safety. Further research is required to clearly delineate
the risk factors for postoperative delirium in older adults. Copyright
© AORN, Inc, 2020.

<73>
Accession Number
633567894
Title
Multicentre randomised phase II study of the perioperative administration
of flurbiprofen axetil in patients with non-small cell lung cancer: study
protocol of the FLAX Study.
Source
BMJ open. 10 (11) (pp e040969), 2020. Date of Publication: 30 Nov 2020.
Author
Sakamaki K.; Watanabe K.; Woo T.; Masuda M.
Institution
(Sakamaki) Center for Data Science, Yokohama City University, Yokohama,
Japan
(Watanabe) General Thoracic Surgery, National Hospital Organisation
Yokohama Medical Center, Yokohama, Japan
(Woo) Respiratory Center, Yokohama City University Medical Center,
Yokohama, Japan
(Masuda) Surgery, Yokohama City University, Yokohama, Japan
Publisher
NLM (Medline)
Abstract
INTRODUCTION: In patients with non-small cell lung cancer, surgical
treatment with postoperative adjuvant chemotherapy is performed. However,
the improvement of overall survival achieved by postoperative adjuvant
chemotherapy may be insufficient in consideration of the deterioration of
quality of life (QOL). Considering the relationships among surgical
treatments, inflammation and carcinogenesis, non-steroidal
anti-inflammatory drugs (NSAIDs) are a candidate postoperative treatment
for preventing recurrence and maintaining QOL. In this study, we
investigate the effects of the perioperative administration of
flurbiprofen axetil on postoperative recurrence in patients with non-small
cell lung cancer. METHODS AND ANALYSIS: This study is a multicentre,
parallel group, open label, randomised controlled trial. Patients
clinically suspected of non-small cell lung cancer are randomly assigned
to the flurbiprofen axetil group or the no-NSAIDs group. A total of 420
patients (210 per group) will be registered. The primary analysis will
evaluate the treatment effect of flurbiprofen axetil on postoperative
recurrence. ETHICS AND DISSEMINATION: The study protocol was approved by
the Clinical Research Review Board of Saitama Medical University in
September 2019 (No. 192002) and will be approved by each institutional
review board of all participating institutions before patient enrolment.
This study complies with the latest version of the Declaration of
Helsinki, Clinical Trial Act and related notifications. Results will be
published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: Japan
Registry of Clinical Trials (jRCTs031190167; Pre-results)
(https://jrct.niph.go.jp/). Copyright © Author(s) (or their
employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<74>
Accession Number
633518089
Title
Open-label, single-centre, cluster-randomised controlled trial to Evaluate
the Potential Impact of Computerisedantimicrobial stewardship (EPIC) on
the antimicrobial use after cardiovascular surgeries: EPIC trial study
original protocol.
Source
BMJ Open. 10 (11) (no pagination), 2020. Article Number: e039717. Date of
Publication: 26 Nov 2020.
Author
Yuan X.; Chen K.; Zhao W.; Yu F.; Diao X.; Chen X.; Hu S.
Institution
(Yuan, Chen, Hu) State Key Laboratory of Cardiovascular Disease, National
Centre for Cardiovascular Diseases, Beijing, China
(Yuan, Chen, Hu) Department of Cardiovascular Surgery, Fuwai Hospital,
Chinese Academy of Medical Science and Peking Union Medical College,
Beijing, China
(Zhao, Yu, Diao) Information Centre, Fuwai Hospital, Chinese Academy of
Medical Science and Peking Union Medical College, Beijing, China
(Hu) National Clinical Research Centre of Cardiovascular Diseases, State
Key Lab. of Cardiovasc. Disease, Fuwai Hospital, National Centre for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Chen) Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical
Science and Peking Union Medical College, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Inappropriate antimicrobial use increases the prevalence of
antimicrobial-resistant bacteria. Surgeons are reluctant to implement
recommendations of guidelines in clinical practice. Antimicrobial
stewardship (AMS) is effective in antimicrobial management, but it remains
labour intensive. The computerised decision support system (CDSS) has been
identified as an effective way to enable key elements of AMS in clinical
settings. However, insufficient evidence is available to evaluate the
efficacy of computerised AMS in surgical settings. Methods and analysis
The Evaluate of the Potential Impact of Computerised AMS trial is an
open-label, single-centre, two-Arm, cluster-randomised, controlled trial,
which aims to determine whether a multicomponent CDSS intervention reduces
overall antimicrobial use after cardiovascular surgeries compared with
usual clinical care in a specialty hospital with a big volume of
cardiovascular surgeries. Eighteen cardiovascular surgical teams will be
randomised 1:1 to either the intervention or the control arm. The
intervention will consist of (1) re-evaluation alerts and decision support
for the duration of antimicrobial treatment decision, (2) re-evaluation
alerts and decision support for the choice of antimicrobial, (3) quality
control audit and feedback. The primary outcome will be the overall
systemic antimicrobial use measured in days of therapy (DOT) per admission
and DOT per 1000 patient-days over the whole intervention period (6
months). Secondary outcomes include a series of indices to evaluate
antimicrobial use, microbial resistance, perioperative infection outcomes,
patient safety, resource consumption, and user compliance and
satisfaction. Ethics and dissemination The Ethics Committee in Fuwai
Hospital approved this study (2020-1329). The results of the trial will be
submitted for publication in a peer-reviewed journal. Trial registration
number NCT04328090. Copyright © 2020 BMJ. All rights reserved.

<75>
Accession Number
633574352
Title
Effect of Yugengtongyu Granules in Patients with Stable Coronary Artery
Disease on Reducing Adverse Cardiovascular Events: A Double-Blind
Controlled Trial.
Source
Journal of alternative and complementary medicine (New York, N.Y.). (no
pagination), 2020. Date of Publication: 01 Dec 2020.
Author
Wang D.; Li C.; Xu X.; Xu H.; Guo C.; Wang J.; Guo J.; Huang L.
Institution
(Wang, Xu) Cardiovascular Institute, Beijing University of Chinese
Medicine Affiliated Dongzhimen Hospital, Beijing, China
(Li, Wang, Huang) China-Japan Friendship Hospital, Beijing, China
(Xu) Department of Cardiology, Jiangxi Province Hospital of Integrated
Chinese and Western Medicine, Nanchang, China
(Guo) Shandong University of Chinese Medicine Affiliated Hospital, Jinan,
China
(Guo) Department of Cardiology, Shunyi Branch of Beijing Hospital of
Traditional Chinese Medicine, Beijing, China
Publisher
NLM (Medline)
Abstract
Objectives: To evaluate the effect of Yugengtongyu granules on reducing
the incidence of adverse cardiovascular events and improving quality of
life (QOL) in patients with stable coronary artery disease (SCAD).
 Method(s): A double-blind randomized controlled trial was conducted
among SCAD population. One hundred fourteen patients were randomly
assigned to experimental group (n=57) and control group (n=57) following
randomized block design. Combined with the basis of standard treatment of
SCAD, the experimental group and control group received Yugengtongyu
granules or placebo, respectively, twice daily for 6 months and were
followed for another 1 year (18 months in total from enrollment). Major
outcomes (any occurrence of cardiovascular death, nonfatal myocardial
infarction, or coronary revascularization), minor outcomes (any occurrence
of all-cause death, ischemic stroke, readmission due to unstable angina,
heart failure, or malignant arrhythmia), and composite outcomes (union of
major and minor outcomes) were used to evaluate prognosis; Seattle Angina
Questionnaire (SAQ) was applied to evaluate QOL, and levels of low density
lipoprotein-cholesterol (LDL-C) and high sensitive C reacting protein
(HS-CRP) in serum were tested. Result(s): The incidence of composite
outcomes in the experimental group was significantly lower than that in
the control group (3 [5.2%] vs. 11 [19.2%], hazard ratio: 0.273, 95%
confidence interval: 0.080-0.926, p=0.022); major outcomes, minor
outcomes, and independent events such as nonfatal myocardial infarction
showed lowering trend in experimental group. Experimental group scored
significantly higher than control group in four dimensions of SAQ:
physical limitation, angina frequency, treatment satisfaction, and disease
perception at the third- and sixth-month follow-up; there was no
significant difference in serum level of LDL or HS-CRP at all scheduled
timepoints. Conclusion(s): The addition of Yugengtongyu granules
based on current standard treatment reduced the incidence of composite
outcomes and improved QOL in patients with SCAD. The trial was registered
in the Chinese Clinical Trial Registry (ChiCTR-TRC-13004370).

<76>
Accession Number
633570710
Title
A systematic review of risk prediction models for perioperative mortality
after thoracic surgery.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 30 Nov 2020.
Author
Taylor M.; Hashmi S.F.; Martin G.P.; Shackcloth M.; Shah R.; Booton R.;
Grant S.W.
Institution
(Taylor, Hashmi, Shah) Department of Cardiothoracic Surgery, Wythenshawe
Hospital, Manchester University Hospital Foundation Trust, Manchester,
United Kingdom
(Martin) Division of Informatics, Imaging and Data Science, Faculty of
Biology, Medicine and Health, Manchester Academic Heath Science Centre,
University of Manchester, Manchester, United Kingdom
(Shackcloth) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Booton) Department of Respiratory Medicine, Wythenshawe Hospital,
Manchester University Hospital Foundation Trust, Manchester, United
Kingdom
(Grant) Division of Cardiovascular Sciences, University of Manchester,
ERC, Manchester University Hospitals Foundation Trust, Manchester, United
Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Guidelines advocate that patients being considered for
thoracic surgery should undergo a comprehensive preoperative risk
assessment. Multiple risk prediction models to estimate the risk of
mortality after thoracic surgery have been developed, but their quality
and performance has not been reviewed in a systematic way. The objective
was to systematically review these models and critically appraise their
performance. METHOD(S): The Cochrane Library and the MEDLINE database
were searched for articles published between 1990 and 2019. Studies that
developed or validated a model predicting perioperative mortality after
thoracic surgery were included. Data were extracted based on the checklist
for critical appraisal and data extraction for systematic reviews of
prediction modelling studies. RESULT(S): A total of 31 studies
describing 22 different risk prediction models were identified. There were
20 models developed specifically for thoracic surgery with two developed
in other surgical specialties. A total of 57 different predictors were
included across the identified models. Age, sex and pneumonectomy were the
most frequently included predictors in 19, 13 and 11 models, respectively.
Model performance based on either discrimination or calibration was
inadequate for all externally validated models. The most recent data
included in validation studies were from 2018. Risk of bias (assessed
using Prediction model Risk Of Bias ASsessment Tool) was high for all
except two models. CONCLUSION(S): Despite multiple risk prediction
models being developed to predict perioperative mortality after thoracic
surgery, none could be described as appropriate for contemporary thoracic
surgery. Contemporary validation of available models or new model
development is required to ensure that appropriate estimates of operative
risk are available for contemporary thoracic surgical
practice. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<77>
Accession Number
633570379
Title
What are the endovascular options and outcomes for repair of ascending
aortic or aortic arch pathology?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 30 Nov 2020.
Author
Sharma V.J.; Prakash M.; Lin Z.; Lo C.
Institution
(Sharma, Prakash, Lin, Lo) Department of Cardiothoracic Surgery, Waikato
District Health Board, Hamilton, New Zealand
(Sharma, Prakash, Lin, Lo) Waikato Institute of Surgery Education and
Research (WISER), Hamilton, New Zealand
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'in patients with
ascending aortic or aortic arch disease what are the outcomes with
endovascular repair in terms of survival, complications and
reintervention?' Altogether 585 papers were found using the reported
search, of which 9 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. We found that the endovascular operative techniques with
the greatest evidence were ascending aortic chimney grafts (AACs),
branched thoracic endovascular aortic repair (bTEVAR) aortic grafts and
fenestrated TEVAR (fTEVAR) aortic grafts. The best evidence available were
small case-series or retrospective cohort studies (n<100), with 1
systematic review, at a short follow-up period (range 0-5years).
Intraoperatively, these techniques have a high technical success rate
(84-100%). We found rates of endoleak comparable between AAC (7.4-16%) and
bTEVAR/fenestrated TEVAR (11.1-21.4%). Stroke rates are higher in bTEVAR
(3.1-42% vs 1-26% in AACs), attributed to more proximal pathology and
technically challenging procedures. Following the immediate postoperative
period, the 30-day mortality is 0-10.8% and patency is 97-100%. Stroke and
reintervention rates remain higher in the bTEVAR group (3.1-42.0% and
0.5-33.3%) compared to the AAC group (1.0-11.1% and 6.7-16.7%). The 3- and
5-year survival ranges from 59% to 90%, but is driven by non-aortic
pathology in a high-risk population; 3-year freedom from aortic death is
93-97%. Patency is 97-100% at up to 3years, conformation and supra-aortic
occlusions thereafter remain unknown. We conclude that AACs, bTEVARs and
fenestrated TEVARs are safe endovascular options in high-risk elective
patients, with results comparable to open or hybrid repair. They remain
unverified in acute settings or in patients fit for open
intervention. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<78>
Accession Number
633557420
Title
Parental experiences of their infant's hospital admission undergoing
cardiac surgery: a systematic review.
Source
Acta paediatrica (Oslo, Norway : 1992). (no pagination), 2020. Date of
Publication: 30 Nov 2020.
Author
de Man M.A.C.P.; Segers E.W.; Schappin R.; van der Leeden K.; Wosten-van
Asperen R.M.; Breur H.; de Weerth C.; van den Hoogen A.
Institution
(de Man, Segers, van der Leeden, Wosten-van Asperen, Breur, van den
Hoogen) Wilhelmina Children's Hospital, University Medical Centre Utrecht,
Netherlands
(Schappin) Department of Development and Education of Youth in Diverse
Societies, Utrecht University, Netherlands
(de Weerth) Donders Institute for Brain, Cognition and Behaviour, Radboud
University Medical Center, Nijmegen, Netherlands
Publisher
NLM (Medline)
Abstract
AIM: To explore parents' experiences of parenting a child hospitalised
with congenital heart disease (CHD) and undergoing surgery.
 METHOD(S): Five electronic databases were systematically searched for
articles describing the experiences of parents with a child with a CHD. A
thematic analysis approach was used to identify the most common themes.
 RESULT(S): A total of 188 articles were identified. Eight studies
were included in the review. Four themes emerged, including balancing the
parental role, experiencing anticipatory grief, decreasing parental stress
using coping strategies, and professional support. CONCLUSION(S):
Having a child with CHD undergoing heart surgery is a stressful experience
due to, among other things, the different situation-related parenting role
during the hospital stay and feelings of anticipatory grief. Health care
professionals in the PICU have an essential role in supporting parents and
understanding the needs that are crucial for the parents in order to
provide better support and reduce stress and anxiety. More qualitative
research regarding the pathway from the prenatal diagnosis through the
early childhood period is warranted. Copyright This article is
protected by copyright. All rights reserved.

<79>
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
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.

<80>
Accession Number
2010046868
Title
Incidence and Predictors of Structural Valve Deterioration after
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Journal of Interventional Cardiology. 2020 (no pagination), 2020. Article
Number: 4075792. Date of Publication: 2020.
Author
Long Y.-X.; Liu Z.-Z.
Institution
(Long, Liu) Department of Cardiology, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
Publisher
Hindawi Limited
Abstract
Background. Transcatheter aortic valve replacement (TAVR), widely used as
an alternative therapy in patients with severe aortic stenosis, is
expected to be offered to low-risk patents with a longer life expectancy.
The durability of transcatheter aortic valve is becoming of increasing
importance. Method. PubMed, Embase, and Cochrane CENTRAL from the
inception to March 2020 were systematically screened for studies reporting
on structural valve deterioration (SVD) in TAVR patients. Incidence of SVD
was diagnosed according to the latest European consensus as the primary
end point. Predictors of SVD evaluated at multivariable analysis and
cumulative incidence function (CIF) of SVD were the secondary end point.
Result. Twelve studies encompassing 10031 patients evaluating the
incidence of SVD were included, with a follow-up between 1 and 8 years.
The pooled incidence of SVD was 4.93% (95% CI, 2.75%-7.70%, I2 = 96%) at 1
year and 8.97% (95% CI, 6.89%-11.29%, I2 = 86%) in the long term (>=5
years). Subgroup analysis was performed to identify the valve type that
may result in partial heterogeneity. SVD was more frequent in patents with
a valve diameter of <26 mm (HR: 3.57, 1.47-8.69), oral anticoagulants
(OAC), exposure at discharge (OR: 0.48, 0.38-0.61), or by a disease of
renal dysfunction (OR 1.42, 1.03-1.96). Conclusion. SVD represents
infrequent events after TAVR in the long term (>5 years), occurring more
commonly in renal dysfunction patients, with small valve diameter and
without OAC exposure. There may be an underestimation of the incidence if
we assume death as a competing risk. Copyright © 2020 Yu-Xiang
Long and Zeng-Zhang Liu.

<81>
Accession Number
2006970404
Title
Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic
review and meta-analysis of the impact of GDHT on post-operative pulmonary
complications.
Source
Perioperative Medicine. 9 (1) (no pagination), 2020. Article Number: 30.
Date of Publication: 01 Dec 2020.
Author
Dushianthan A.; Knight M.; Russell P.; Grocott M.P.W.
Institution
(Dushianthan, Knight, Russell, Grocott) General Intensive Care Unit,
University Hospital Southampton NHS Foundation Trust, Southampton SO16
6YD, United Kingdom
(Dushianthan, Grocott) Anaesthesia Perioperative and Critical Care
Research Group, Southampton NIHR Biomedical Research Centre, University
Hospital Southampton/University of Southampton, Southampton, United
Kingdom
(Dushianthan, Grocott) Clinical and Experimental Sciences, Faculty of
Medicine, University of Southampton, Southampton, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Perioperative goal-directed haemodynamic therapy (GDHT),
defined as the administration of fluids with or without inotropes or
vasoactive agents against explicit measured goals to augment blood flow,
has been evaluated in many randomised controlled trials (RCTs) over the
past four decades. Reported post-operative pulmonary complications
commonly include chest infection or pneumonia, atelectasis, acute
respiratory distress syndrome or acute lung injury, aspiration
pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the
substantial clinical literature in this area, it remains unclear whether
their incidence is reduced by GDHT. This systematic review aims to
determine the effect of GDHT on the respiratory outcomes listed above, in
surgical patients. Method(s): We searched the Cochrane Central
Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical
trial registries up until January 2020. We included all RCTs reporting
pulmonary outcomes. The primary outcome was post-operative pulmonary
complications and secondary outcomes were specific pulmonary complications
and intra-operative fluid input. Data synthesis was performed on Review
Manager and heterogeneity was assessed using I2 statistics.
 Result(s): We identified 66 studies with 9548 participants reporting
pulmonary complications. GDHT resulted in a significant reduction in total
pulmonary complications (OR 0.74, 95% CI 0.59 to 0.92). The incidence of
pulmonary infections, reported in 45 studies with 6969 participants, was
significantly lower in the GDHT group (OR 0.72, CI 0.60 to 0.86).
Pulmonary oedema was recorded in 23 studies with 3205 participants and was
less common in the GDHT group (OR 0.47, CI 0.30 to 0.73). There were no
differences in the incidences of pulmonary embolism or acute respiratory
distress syndrome. Sub-group analyses demonstrated: (i) benefit from GDHT
in general/abdominal/mixed and cardiothoracic surgery but not in
orthopaedic or vascular surgery; and (ii) benefit from fluids with
inotropes and/or vasopressors in combination but not from fluids alone.
Overall, the GDHT group received more colloid (+280 ml) and less
crystalloid (-375 ml) solutions than the control group. Due to clinical
and statistical heterogeneity, we downgraded this evidence to moderate.
 Conclusion(s): This systematic review and meta-analysis suggests that
the use of GDHT using fluids with inotropes and/or vasopressors, but not
fluids alone, reduces the development of post-operative pulmonary
infections and pulmonary oedema in general, abdominal and cardiothoracic
surgical patients. This evidence was graded as moderate. PROSPERO registry
reference: CRD42020170361. Copyright © 2020, The Author(s).

<82>
Accession Number
2005437106
Title
Worst lead ST deviation and resolution of ST elevation at one hour for
prediction of myocardial salvage, infarct size, and microvascular
obstruction in patients with ST-elevation myocardial infarction treated
with primary percutaneous coronary intervention.
Source
Annals of Noninvasive Electrocardiology. 25 (6) (no pagination), 2020.
Article Number: e12784. Date of Publication: November 2020.
Author
Stensjoen A.L.; Hommerstad A.; Halvorsen S.; Arheden H.; Engblom H.;
Erlinge D.; Larsen A.-I.; Sejersten Ripa M.; Clemmensen P.; Atar D.; Hall
T.S.
Institution
(Stensjoen, Hommerstad, Halvorsen, Atar, Hall) Department of Cardiology,
Oslo University Hospital Ulleval, Oslo, Norway
(Halvorsen, Atar) Institute of Clinical Sciences, University of Oslo,
Oslo, Norway
(Arheden, Engblom) Department of Clinical Sciences, Clinical Physiology,
Skane University Hospital, Lund, Sweden
(Erlinge) Department of Clinical Sciences, Cardiology, Lund University,
Lund, Sweden
(Larsen) Department of Cardiology, Stavanger University Hospital,
Stavanger, Norway
(Larsen) Department of Clinical Science, University of Bergen, Bergen,
Norway
(Sejersten Ripa) Novo Nordisk A/S, Soborg, Denmark
(Sejersten Ripa, Clemmensen) Department of Cardiology, The Heart Centre,
University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
(Clemmensen) Department of Medicine, Division of Cardiology,
Nykoebing-Falster Hospital, University of Southern Denmark, Odense,
Denmark
(Clemmensen) Institute of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Clemmensen) Department of General and Intervention Cardiology, University
Heart Center, Hamburg-Eppendorf, Germany
Publisher
Blackwell Publishing Inc.
Abstract
Background: ECG changes after revascularization predicts improved outcome
for patients with ST-elevation myocardial infarction (STEMI). Worst lead
residual (WLR) ST deviation and resolution of worst lead ST elevation (rST
elevation) are simple measures that can be obtained early after PCI. The
objective of the current study was to investigate whether simple ECG
measures, obtained one hour following PCI, could predict cardiac magnetic
resonance (CMR)-derived myocardial salvage index (MSI), infarct size (IS),
and microvascular obstruction (MVO) in patients with STEMI included in the
MITOCARE trial. Method(s): The MITOCARE trial included 165 patients
with a first-time STEMI presenting within six hours of symptom onset. The
current analysis included patients that had an ECG recorded at baseline
and one hour after PCI and underwent CMR imaging after 3-5 days.
Independent core laboratories determined WLR ST deviation, rST elevation,
and the CMR variables (MSI, IS, and MVO). Result(s): 83 patients with
a mean age of 61 years were included. 83.1% were males and 41% had
anterior infarctions. In logistic regression models, WLR ST deviation was
a statistically significant predictor of IS (OR 2.2, 95% CI 1.3-3.8) and
MVO (OR 2.8, 95% CI 1.5-5.2), but not of MSI (OR 0.8, 95% CI 0.5-1.2). rST
elevation showed a trend toward a significant association with IS (OR 0.3,
95% CI 0.1-1.0), but not with the other CMR variables. Conclusion(s):
WLR ST deviation one hour after PCI was a predictor of IS and MVO. WLR ST
deviation, a measure easily obtained from ECGs following PCI, may provide
important prognostic information in patients with STEMI. Copyright
© 2020 The Authors. Annals of Noninvasive Electrocardiology published
by Wiley Periodicals LLC

<83>
Accession Number
2005419677
Title
Long-term effects of high-intensity training vs moderate intensity
training in heart transplant recipients: A 3-year follow-up study of the
randomized-controlled HITTS study.
Source
American Journal of Transplantation. 20 (12) (pp 3538-3549), 2020. Date of
Publication: December 2020.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Bjorkelund E.; Authen
A.R.; Grov I.; Broch K.; Gullestad L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Gude, Bjorkelund, Authen, Grov, Broch,
Gullestad, Nytroen) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Rolid, Andreassen, Yardley, Gullestad, Nytroen) Institute of Clinical
Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(Rolid, Yardley) The Norwegian Health Association, Oslo, Norway
(Rolid, Broch, Gullestad, Nytroen) KG Jebsen Center for Cardiac Research,
University of Oslo, Norway and the Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
Publisher
Blackwell Publishing Ltd
Abstract
The randomized controlled High-Intensity Interval Training in De Novo
Heart Transplant Recipients in Scandinavia (HITTS) study compared 9 months
of high-intensity interval training (HIT) with moderate intensity
continuous training in de novo heart transplant recipients. In our 3-year
follow-up study, we aimed to determine whether the effect of early
initiation of HIT on peak oxygen consumption (VO<inf>2peak</inf>)
persisted for 2 years postintervention. The study's primary end point was
the change in VO<inf>2peak</inf> (mL/kg/min). The secondary end points
were muscle strength, body composition, heart rate response,
health-related quality of life, daily physical activity, biomarkers, and
heart function. Of 78 patients who completed the 1-year HITTS trial, 65
entered our study and 62 completed the study tests. VO<inf>2peak</inf>
increased from baseline to 1 year and leveled off thereafter. During the
intervention period, the increase in VO<inf>2peak</inf> was larger in the
HIT arm; however, 2 years later, there was no significant between-group
difference in VO<inf>2peak</inf>. However, the mean change in the
anaerobic threshold and extensor muscle endurance remained significantly
higher in the HIT group. Early initiation of HIT after heart
transplantation appears to have some sustainable long-term effects.
Clinical trial registration number: NCT01796379. Copyright © 2020
The Authors. American Journal of Transplantation published by Wiley
Periodicals LLC on behalf of The American Society of Transplantation and
the American Society of Transplant Surgeons

<84>
Accession Number
2006170945
Title
Left atrial appendage exclusion is effective in reducing postoperative
stroke after mitral valve replacement.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3395-3402), 2020. Date of
Publication: December 2020.
Author
Jiang S.; Zhang H.; Wei S.; Zhang L.; Gong Z.; Li B.; Wang Y.
Institution
(Jiang, Zhang, Wei, Zhang, Gong, Li, Wang) Department of Cardiovascular
Surgery, Chinese PLA General Hospital, Beijing, China
(Zhang, Wei) Department of Cardiovascular Surgery, PLA Medical School,
Beijing, China
Publisher
Blackwell Publishing Inc.
Abstract
Objective: This study aimed to evaluate the role of surgical left atrial
appendage (LAA) exclusion in the prevention of stroke after mitral valve
replacement (MVR). Method(s): We retrospectively reviewed clinical
data of 860 patients who received MVR in our center from January 2008 to
January 2013. The patients were randomly assigned to two surgical groups,
namely LAA exclusion group (n = 521) and LAA nonexclusion group (n = 339)
according to whether concurrent surgical exclusion of the LAA was to be
undertaken or not before surgery in a blind fashion. MVR was performed by
two experienced surgeons. The LAA was explored during the operation and
mural thrombus removed in all cases. The LAA was left intact in
nonocclusion group whereas the neck of the LAA was closed with a two-layer
continued suture in exclusion group. The incidence of early postoperative
ischemic stroke between the two groups was compared. Result(s): The
patients' age was 53 +/- 12 years, with 48.1% male and 67.9% with
rheumatic disease. Mural thrombosis was seen in 18.8% of the patients and
atrial fibrillation (AF) coexisted in 62.4%. All operations were
successfully performed and no difference was noted in in-hospital
mortality, re-exploration for bleeding, and other major complications
between the two groups. The incidence of ischemic stroke in LAA exclusion
group was significantly lower than in nonexclusion group (0.6% vs. 2.7%, p
=.011). The subgroup multivariate analysis showed that LAA exclusion
significantly reduced the risk of postoperative stroke in patients with AF
(odds ratio [OR] = 0.070, 95% confidence interval [CI]: 0.006-0.705, p
=.025) but not in non-AF patients (OR = 1.902, 95% CI: 0.171-21.191, p
=.601). Conclusion(s): Concurrent LAA exclusion during MVR is a safe
and effective way to reduce postoperative ischemic stroke, particularly in
patients with AF. Copyright © 2020 Wiley Periodicals LLC

<85>
Accession Number
2006170892
Title
Coronary artery bypass grafting: Factors affecting outcomes.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3503-3511), 2020. Date of
Publication: December 2020.
Author
Kusu-Orkar T.-E.; Kermali M.; Oguamanam N.; Bithas C.; Harky A.
Institution
(Kusu-Orkar) Department of Surgery, Queens Medical Center, Nottingham,
United Kingdom
(Kermali, Bithas) Faculty of Medicine, St. George's University of London,
London, United Kingdom
(Oguamanam) Department of Emergency Medicine, East Sussex Healthcare NHS
Trust, Seaford, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Liverpool Center for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: Coronary artery bypass grafting forms the bulk of a cardiac
surgeon's workload. An extensive amount of research has been undertaken to
improve the outcomes of this procedure. This literature review aimed to
summarize key areas that influence coronary artery bypass grafting in
modern day practice. Method(s): A comprehensive electronic search was
done using PubMed, Ovid, SCOPUS, Embase and google scholar from inception
to July 2020. Articles were included if they discussed factors affecting
outcomes in coronary bypass grafting (CABG). Case reports, expert opinion,
and editorials were excluded. Result(s): There are many factors that
influence and predict outcomes following coronary artery bypass surgery.
Age, diabetes, and isolated systolic hypertension were preoperative
factors with strong correlation to mortality and morbidity rates post
CABG. In addition to these, the degree of renal failure and heart failure
correlated with poorer operative results. The use of the left internal
mammary artery has transformed outcomes and has proven advantage over
venous conduit use. Newer minimal invasive techniques have the potential
to further optimize outcomes. Conclusion(s): The numerous and complex
factors which impair outcomes following CABG need to be further researched
and addressed using larger trials and possible optimization of
multi-disciplinary team approach to further improve long term
outcomes. Copyright © 2020 Wiley Periodicals LLC

<86>
Accession Number
2006111693
Title
Outcomes in minimally invasive double valve surgery.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3486-3502), 2020. Date of
Publication: December 2020.
Author
Brown L.J.; Mellor S.L.; Niranjan G.; Harky A.
Institution
(Brown, Mellor) Birmingham Medical School, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, United Kingdom
(Niranjan, Harky) Department of Cardiothoracic Surgery, Liverpool Heart
and Chest, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Objective: To review current literature evidence on outcomes of minimally
invasive double valve surgeries (MIS). Method(s): A comprehensive
electronic literature search was done from inception to 20th June 2020
identifying articles that discussed outcomes of minimally invasive
approach in double valve surgeries either as a solo cohort or as
comparative to conventional sternotomies. No limit was placed on time and
place of publication and the evidence has been summarized in narrative
manner within the manuscript. Result(s): Majority of current
literature reported similar perioperative and clinical outcomes between
MIS and conventional median sternotomy; except that MIS has better
cosmetic effects and pain control. Nevertheless, minimal invasive
techniques are associated with longer cardiopulmonary bypass and aortic
cross-clamp times which may have impact on the reported outcomes and
overall morbidity and mortality rates. Conclusion(s): Minimally
invasive double valve surgery continues to develop, but scarcity in the
literature suggests uptake is slow, possibly due to the learning curve
associated with MIS. Many outcomes appear to be comparable to conventional
sternotomy. There is need for larger, multi-center, and randomized trial
to fully evaluate and establish the early, mid- and long-term morbidity
and mortality rates associated with both techniques. Copyright ©
2020 Wiley Periodicals LLC

<87>
Accession Number
2007465742
Title
Thirty-day incidence of stroke after transfemoral transcatheter aortic
valve implantation: meta-analysis and mixt-treatment comparison of
self-expandable versus balloon-expandable valve prostheses.
Source
Clinical Research in Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Seppelt P.C.; Mas-Peiro S.; De Rosa R.; Dimitriasis Z.; Zeiher A.M.;
Vasa-Nicotera M.
Institution
(Seppelt, Mas-Peiro, De Rosa, Dimitriasis, Zeiher, Vasa-Nicotera) Division
of Cardiology, Department of Medicine III, University Hospital, Goethe
University Frankfurt, Frankfurt am Main, Germany
(Seppelt, Mas-Peiro, Dimitriasis, Zeiher, Vasa-Nicotera) DZHK partner site
Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: Stroke is a major complication after transcatheter aortic valve
implantation (TAVI). Although multifactorial, it remains unknown whether
the valve deployment system itself has an impact on the incidence of early
stroke. We performed a meta- and network analysis to investigate the
30-day stroke incidence of self-expandable (SEV) and balloon-expandable
(BEV) valves after transfemoral TAVI. Methods and Results: Overall,
2723 articles were searched directly comparing the performance of SEV and
BEV after transfemoral TAVI, from which 9 were included (3086 patients).
Random effects models were used for meta- and network meta-analysis based
on a frequentist framework. Thirty-day incidence of stroke was 1.8% in SEV
and 3.1% in BEV (risk ratio of 0.62, 95% confidence interval (CI)
0.49-0.80, p = 0.004). Treatment ranking based on network analysis
(P-score) revealed CoreValve with the best performance for 30-day stroke
incidence (75.2%), whereas SAPIEN had the worst (19.0%). However, network
analysis showed no inferiority of SAPIEN compared with CoreValve (odds
ratio 2.24, 95% CI 0.70-7.2). Conclusion(s): Our analysis indicates
higher 30-day stroke incidence after transfemoral TAVI with BEV compared
to SEV. We could not find evidence for superiority of a specific valve
system. More randomized controlled trials with head-to-head comparison of
SEV and BEV are needed to address this open question. Graphic abstract:
[Figure not available: see fulltext.]. Copyright © 2020, The
Author(s).

<88>
Accession Number
2007027010
Title
Prosthesis-patient mismatch after mitral valve replacement: A pooled
meta-analysis of Kaplan-Meier-derived individual patient data.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3477-3485), 2020. Date of
Publication: December 2020.
Author
Tomsic A.; Arabkhani B.; Schoones J.W.; Etnel J.R.G.; Marsan N.A.; Klautz
R.J.M.; Palmen M.
Institution
(Tomsic, Arabkhani, Klautz, Palmen) Department of Cardiothoracic Surgery,
Leiden University Medical Centre, Leiden, Netherlands
(Schoones) Walaeus Library, Leiden University Medical Centre, Leiden,
Netherlands
(Etnel) Department of Cardiothoracic Surgery, Erasmus University Medical
Centre, Rotterdam, Netherlands
(Marsan) Department of Cardiology, Leiden University Medical Centre,
Leiden, Netherlands
Publisher
Blackwell Publishing Inc.
Abstract
Objective: The hemodynamic effect and early and late survival impact of
prosthesis-patient mismatch (PPM) after mitral valve replacement remains
insufficiently explored. Method(s): Pubmed, Embase, Web of Science,
and Cochrane Library databases were searched for English language original
publications. The search yielded 791 potentially relevant studies. The
final review and analysis included 19 studies compromising 11,675
patients. Result(s): Prosthetic effective orifice area was calculated
with the continuity equation method in 7 (37%), pressure half-time method
in 2 (10%), and partially or fully obtained from referenced values in 10
(53%) studies. Risk factors for PPM included gender (male), diabetes
mellitus, chronic renal disease, and the use of bioprostheses. When
pooling unadjusted data, PPM was associated with higher perioperative
(odds ratio [OR]: 1.66; 95% confidence interval [CI]: 1.32-2.10; p <.001)
and late mortality (hazard ratio [HR]: 1.46; 95% CI: 1.21-1.77; p <.001).
Moreover, PPM was associated with higher late mortality when Cox
proportional-hazards regression (HR: 1.97; 95% CI: 1.57-2.47; p <.001) and
propensity score (HR: 1.99; 95% CI: 1.34-2.95; p <.001) adjusted data were
pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84-1.22; p =.88) or
severe (HR: 1.19; 95% CI: 0.89-1.58; p =.24) PPM were not related to
higher late mortality when adjusted data were pooled individually. PPM was
associated with higher systolic pulmonary pressures (mean difference: 7.88
mmHg; 95% CI: 4.72-11.05; p <.001) and less pulmonary hypertension
regression (OR: 5.78; 95% CI: 3.33-10.05; p <.001) late after surgery.
 Conclusion(s): Mitral valve PPM is associated with higher
postoperative pulmonary artery pressure and might impair perioperative and
overall survival. The relation should be further assessed in properly
designed studies. Copyright © 2020 The Authors. Journal of
Cardiac Surgery published by Wiley Periodicals LLC

<89>
Accession Number
2006897670
Title
Preoperative extracorporeal membrane oxygenation for postinfarction
ventricular septal defect: Case series of three patients with a literature
review.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3626-3630), 2020. Date of
Publication: December 2020.
Author
Artemiou P.; Gasparovic I.; Bezak B.; Hudec V.; Glonek I.; Hulman M.
Institution
(Artemiou, Gasparovic, Bezak, Hudec, Glonek, Hulman) Department of Cardiac
Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular
Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
Publisher
Blackwell Publishing Inc.
Abstract
The mortality rate after the development of postinfarction ventricular
septal defect (VSD) remains high, despite progress in pharmacologic
therapy, invasive cardiology, and surgical techniques. We present three
cases of preoperative venoarterial extracorporeal membrane oxygenation as
a bridge to reparative surgical repair in patients with cardiogenic shock
who would otherwise require emergent cardiac surgery with an associated
risk. Two patients were discharged, whereas the third patient died due to
pulmonary artery rupture after a right ventricular assist device
implantation, despite the fact that he had a successful bridge to
reparative surgery and VSD repair. Finally, a review of the current
literature concerning the use of preoperative venoarterial extracorporeal
membrane oxygenation as a bridge to reparative surgery is
provided. Copyright © 2020 Wiley Periodicals LLC

<90>
Accession Number
2006888072
Title
Impact of lipid levels and high-intensity statins on vein graft patency
after CABG: Midterm results of the ACTIVE trial.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3286-3293), 2020. Date of
Publication: December 2020.
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Division of Cardiac Surgery, Boca Raton Regional
Hospital, Florida Atlantic University, Boca Raton, FL, United States
(Ruel) Division of Cardiac Surgery, The University of Ottawa Heart
Institute, Ottawa, ON, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: High-dose atorvastatin did not improve 1-year vein graft
patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft
Events trial. However, it remains unknown whether high-intensity statins
may impact graft disease in the years that follow. Method(s): In the
trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80
mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the
choice of statin was left to the patient's physician. In this study of
participants who agreed to follow-up (N = 76), low-density lipoprotein
(LDL) levels were measured and graft patency was assessed 3 years after
surgery. Result(s): The rate of vein graft disease 3 years after
surgery was not significantly reduced with atorvastatin 80 mg during the
first postoperative year or the use of open-label high-intensity statin
thereafter (p = NS). However, a trend was observed between higher LDL
levels during the first postoperative year and a greater incidence of vein
graft disease at 3 years (p =.12). Among patients who had LDL levels more
than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease
at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl
(p =.15). Higher mean LDL levels during the first postoperative year were
associated with a higher rate of vein disease 3 years after surgery both
at the graft level (p =.03) and at the patient level (p =.03) in
multivariate analysis. Conclusion(s): Higher LDL levels during the
first postoperative year were associated with significantly greater vein
graft disease 3 years after CABG. Copyright © 2020 Wiley
Periodicals LLC

<91>
Accession Number
2006808738
Title
Topical versus low-dose systemic tranexamic acid in pediatric cardiac
surgery: A randomized clinical study.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3368-3373), 2020. Date of
Publication: December 2020.
Author
Hatami F.; Valizadeh N.; Salehi F.; Hosseinzadeh Maleki M.
Institution
(Hatami, Valizadeh, Salehi) Department of Cardiology, Cardiovascular
Diseases Research Center, Birjand University of Medical Sciences, Birjand,
Iran, Islamic Republic of
(Hosseinzadeh Maleki) Department of Cardiac Surgery, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: The current study aimed to compare the benefits of topical and
low-dose systemic tranexamic acid administration in pediatric cardiac
surgery. Method(s): A total of 117 children undergoing cardiac
surgery for congenital heart disease were assigned into three groups.
Patients in the systemic group received 20 mg/kg-1 tranexamic
acid through the cardiopulmonary bypass followed by another dose of 20
mg/kg-1 after cardiopulmonary bypass separation. Patients in
the topical group were administered with 50 mg/kg-1 tranexamic
acid poured into the pericardium, while the control group received no
antifibrinolytics. The outcome measures of bleeding and blood products
transfusion were recorded over the first 48 h postoperatively.
 Result(s): Chest tube drainage was significantly lower in both
topical and systemic groups than the control group, but it did not differ
between the case groups. Blood products requirement did not show a
difference between groups. Neurological or thromboembolic events did not
variate among the groups, and no deaths occurred in this study.
 Conclusion(s): Topical or systemic tranexamic acid administration
reduced postoperative blood loss effectively without adding an extra
risk. Copyright © 2020 Wiley Periodicals LLC

<92>
Accession Number
2006801919
Title
Costs of surgical ablation of atrial fibrillation in Ontario, Canada from
2006 to 2017.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3451-3454), 2020. Date of
Publication: December 2020.
Author
Chow J.Y.; McClure G.; Belley-Cote E.P.; McIntyre W.F.; Singal R.K.;
Whitlock R.P.
Institution
(Chow, Belley-Cote, McIntyre) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure) Division of Vascular Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Singal) CVT Associates, Vancouver Island Health Authority, Victoria, BC,
Canada
(Whitlock) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: International guidelines currently recommend concomitant
surgical ablation of atrial fibrillation (AF) in patients with AF
undergoing cardiac surgery. However, a systematic review and meta-analysis
of 23 randomized controlled trials (RCTs) showed no significant difference
in mortality or stroke in patients who underwent surgical AF ablation
compared with those who did not (moderate-quality evidence).
 Method(s): We estimated the Ontario-wide costs of surgical AF
ablation between 2006 and 2017 using data from a systematic review and
meta-analysis of RCTs, estimates of case volumes from Ontario Health
Insurance Plan fee codes, the ongoing left atrial appendage occlusion
study III trial (NCT01561651), institutional costs from large academic
centers in Ontario, as well as professional fees based on the Ontario fee
schedule. Device costs were obtained from Canadian industry data with
expert input. Result(s): We estimated the average extra cost of
surgical AF ablation at $4,287 CAD (95% CI $4,113-4,619) per patient.
Procedural costs (equipment costs and physician remuneration) comprise
82.2% of this, while smaller portions relate to the increased need for
pacemaker (3.9%) and additional hospital length of stay (13.9%).
Approximately 2,391 patients underwent surgical AF ablation between 2006
and 2017, corresponding to an estimated $10.2 million in incremental cost
during that time span. Conclusion(s): Ontario taxpayers spend
significant financial resources on surgical ablation of AF, a procedure
lacking high-quality evidence demonstrating benefit in reducing mortality
or stroke. Further large prospective studies examining clinically
important outcomes are needed to justify its routine use in patient care
and to guide allocation of healthcare funds. Copyright © 2020
Wiley Periodicals LLC

<93>
Accession Number
633508931
Title
Low-Density Lipoprotein Cholesterol Corrected for Lipoprotein(a)
Cholesterol, Risk Thresholds, and Cardiovascular Events.
Source
Journal of the American Heart Association. 9 (23) (pp e016318), 2020. Date
of Publication: 01 Dec 2020.
Author
Willeit P.; Yeang C.; Moriarty P.M.; Tschiderer L.; Varvel S.A.; McConnell
J.P.; Tsimikas S.
Institution
(Willeit, Tschiderer) Department of Neurology Medical University of
Innsbruck Innsbruck Austria
(Willeit) Department of Public Health and Primary Care University of
Cambridge Cambridge UK
(Yeang, Tsimikas) Division of Cardiovascular Medicine Sulpizio
Cardiovascular Center University of California, San Diego La Jolla CA
(Moriarty) Division of Clinical Pharmacology Department of Internal
Medicine University of Kansas Medical Center Kansas City MO
(Varvel, McConnell) Salveo Diagnostics, Inc Richmond VA
Publisher
NLM (Medline)
Abstract
Background Conventional "low-density lipoprotein cholesterol (LDL-C)"
assays measure cholesterol content in both low-density lipoprotein and
lipoprotein(a) particles. To clarify the consequences of this
methodological limitation for clinical care, our study aimed to compare
associations of "LDL-C" and corrected LDL-C with risk of cardiovascular
disease and to assess the impact of this correction on the classification
of patients into guideline-recommended LDL-C categories. Methods and
Results Lipoprotein(a) cholesterol content was estimated as 30% of
lipoprotein(a) mass and subtracted from "LDL-C" to obtain corrected LDL-C
values (LDL-Ccorr30). Hazard ratios for cardiovascular disease (defined as
coronary heart disease, stroke, or coronary revascularization) were
quantified by individual-patient-data meta-analysis of 5 statin landmark
trials from the Lipoprotein(a) Studies Collaboration (18 043 patients;
5390 events; 4.7 years median follow-up). When comparing top versus bottom
quartiles, the multivariable-adjusted hazard ratio for cardiovascular
disease was significant for "LDL-C" (1.17; 95% CI, 1.05-1.31; P=0.005) but
not for LDL-Ccorr30 (1.07; 95% CI, 0.93-1.22; P=0.362). In a routine
laboratory database involving 531 144 patients, reclassification of
patients across guideline-recommended LDL-C categories when using
LDL-Ccorr30 was assessed. In "LDL-C" categories of 70 to <100, 100 to
<130, 130 to <190, and >=190 mg/dL, significant proportions (95% CI) of
participants were reassigned to lower LDL-C categories when LDL-Ccorr30
was used: 30.2% (30.0%-30.4%), 35.1% (34.9%-35.4%), 32.9% (32.6%-33.1%),
and 41.1% (40.0%-42.2%), respectively. Conclusions "LDL-C" was associated
with incident cardiovascular disease only when lipoprotein(a) cholesterol
content was included in its measurement. Refinement in techniques to
accurately measure LDL-C, particularly in patients with elevated
lipoprotein(a) levels, is warranted to assign risk to the responsible
lipoproteins.

<94>
[Use Link to view the full text]
Accession Number
633088898
Title
The Use of Central Venous to Arterial Carbon Dioxide Tension Gap for
Outcome Prediction in Critically Ill Patients: A Systematic Review and
Meta-Analysis.
Source
Critical care medicine. 48 (12) (pp 1855-1861), 2020. Date of Publication:
01 Dec 2020.
Author
Al Duhailib Z.; Hegazy A.F.; Lalli R.; Fiorini K.; Priestap F.;
Iansavichene A.; Slessarev M.
Institution
(Al Duhailib) 1Division of Critical Care, Department of Medicine, Western
University, London Health Sciences Centre, London, ON, Canada. 2Department
of Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada. 3Department of Critical Care Medicine, King Faisal
Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 4Department
of Anesthesia and Perioperative Medicine, Western University, London
Health Sciences Centre, London, ON, Canada. 5Department of Pediatrics,
Western University, London Health Sciences Centre, London, ON, Canada.
6Health Science Library, London Health Sciences Centre, Victoria Campus,
London, ON, Canada. 7Department of Medical Biophysics, Western University,
London, ON, Canada. 8Brain and Mind Institute, Western University, London,
ON, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: In this systematic review and meta-analysis, we assessed
whether a high CO2 gap predicts mortality in adult critically ill patients
with circulatory shock. DATA SOURCES: A systematic search of MEDLINE and
EMBASE electronic databases from inception to October 2019. STUDY
SELECTION: Studies from adult (age >= 18 yr) ICU patients with shock
reporting CO2 gap and outcomes of interest. Case reports and conference
abstracts were excluded. DATA EXTRACTION: Data extraction and study
quality assessment were performed independently in duplicate. DATA
SYNTHESIS: We used the Newcastle-Ottawa Scale to assess methodological
study quality. Effect sizes were pooled using a random-effects model. The
primary outcome was mortality (28 d and hospital). Secondary outcomes were
ICU length of stay, hospital length of stay, duration of mechanical
ventilation, use of renal replacement therapy, use of vasopressors and
inotropes, and association with cardiac index, lactate, and central venous
oxygen saturation. CONCLUSION(S): We included 21 studies (n = 2,155
patients) from medical (n = 925), cardiovascular (n = 685), surgical (n =
483), and mixed (n = 62) ICUs. A high CO2 gap was associated with
increased mortality (odds ratio, 2.22; 95% CI, 1.30-3.82; p = 0.004) in
patients with shock, but only those from medical and surgical ICUs. A high
CO2 gap was associated with higher lactate levels (mean difference 0.44
mmol/L; 95% CI, 0.20-0.68 mmol/L; p = 0.0004), lower cardiac index (mean
difference, -0.76L/min/m; 95% CI, -1.04 to -0.49L/min/m; p = 0.00001), and
central venous oxygen saturation (mean difference, -5.07; 95% CI, -7.78 to
-2.37; p = 0.0002). A high CO2 gap was not associated with longer ICU or
hospital length of stays, requirement for renal replacement therapy,
longer duration of mechanical ventilation, or higher vasopressors and
inotropes use. Future studies should evaluate whether resuscitation aimed
at closing the CO2 gap improves mortality in shock.

<95>
Accession Number
632956813
Title
A Randomized Controlled Trial of Prasugrel for Prevention of Early
Saphenous Vein Graft Thrombosis.
Source
The Journal of invasive cardiology. 32 (12) (pp E305-E312), 2020. Date of
Publication: 01 Dec 2020.
Author
Danek B.A.; Karatasakis A.; Abdullah K.; Iwnetu R.; Kalsaria P.; Shunk K.;
Zimmet J.; Vidovich M.; Bavry A.A.; Rangan B.V.; Roesle M.; Griza D.;
Stanley K.; Banerjee S.; Khalili H.; Brilakis E.S.; Abdullah S.M.
Institution
(Abdullah) Shuaib Abdullah, MD, Veterans Affairs North Texas Health Care
System, 4500 South Lancaster, 111A, Dallas, TX 75216 USA
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To test whether administration of prasugrel after coronary
artery bypass grafting (CABG) reduces saphenous vein graft (SVG)
thrombosis. Use of aspirin after CABG improves graft patency, but
administration of other antiplatelet agents has yielded equivocal results.
 METHOD(S): We performed a double-blind trial randomizing patients to
prasugrel or placebo after CABG at four United States centers. Almost all
patients were receiving aspirin. Follow-up angiography, optical coherence
tomography (OCT), intravascular ultrasound (IVUS), and near-infrared
spectroscopy (NIRS) were performed at 12 months. The primary efficacy
endpoint was prevalence of OCT-detected SVG thrombus. The primary safety
endpoint was incidence of Global Utilization of Streptokinase and t-PA for
Occluded Coronary Arteries (GUSTO) severe bleeding. RESULT(S): The
study was stopped early due to slow enrollment after randomizing 84
patients. Mean age was 64 +/- 6 years; 98% of the patients were men.
Follow-up angiography was performed in 59 patients. IVUS was performed in
52 patients, OCT in 53 patients, and NIRS in 33 patients. Thrombus was
identified by OCT in 56% vs 50% of patients in the prasugrel vs placebo
groups, respectively (P=.78). Angiographic SVG failure occurred in 24% of
patients in the prasugrel arm vs 40% in the placebo arm (P=.19). The
1-year incidence of major adverse cardiovascular events was 14.3% vs 2.4%
in the prasugrel and placebo groups, respectively (P=.20), without
significant differences in GUSTO severe bleeding (P=.32).
 CONCLUSION(S): Early SVG failure occurred in approximately one-third
of patients. Prasugrel did not decrease prevalence of SVG thrombus 12
months after CABG.

<96>
Accession Number
632731091
Title
Time-to-treatment initiation of colchicine and cardiovascular outcomes
after myocardial infarction in the Colchicine Cardiovascular Outcomes
Trial (COLCOT).
Source
European heart journal. 41 (42) (pp 4092-4099), 2020. Date of Publication:
07 Nov 2020.
Author
Bouabdallaoui N.; Tardif J.-C.; Waters D.D.; Pinto F.J.; Maggioni A.P.;
Diaz R.; Berry C.; Koenig W.; Lopez-Sendon J.; Gamra H.; Kiwan G.S.;
Blondeau L.; Orfanos A.; Ibrahim R.; Gregoire J.C.; Dube M.-P.; Samuel M.;
Morel O.; Lim P.; Bertrand O.F.; Kouz S.; Guertin M.-C.; L'Allier P.L.;
Roubille F.
Institution
(Bouabdallaoui, Tardif, Ibrahim, Gregoire, Dube, Samuel, L'Allier)
Montreal Heart Institute, Canada and Universite de Montreal, 5000 Belanger
Street, Montreal, QC H1T 1C8, Canada
(Waters) San Francisco General Hospital, CA
(Pinto) Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de
Medicina da Universidade de Lisboa, Lisboa, Portugal
(Maggioni) ANMCO Research Center, Firenze, Italy
(Diaz) Estudios Clinicos Latinoamerica, Rosario, Argentina
(Berry) University of Glasgow and NHS Glasgow Clinical Research Facility,
Glasgow, United Kingdom
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), partner site
Munich Heart Alliance, Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Germany
(Lopez-Sendon) IdiPaz, UAM, Spain
(Gamra) Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Kiwan) Bellevue Medical Center, Beirut, Lebanon
(Blondeau, Orfanos, Guertin) Montreal Health Innovations Coordinating
Center (MHICC), Montreal, Canada
(Morel) Division of Cardiovascular Medicine, Nouvel Hopital Civil,
Strasbourg University Hospital, Strasbourg, France
(Morel) INSERM (French National Institute of Health and Medical Research),
UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
(Lim) Department of Cardiology, AP-HP, Hopital Universitaire Henri-Mondor
and INSERM U955, Universite Paris-Est Creteil, Creteil, France
(Bertrand) Institut de Cardiologie et Pneumologie de Quebec, Quebec City,
Canada
(Kouz) Centre Hospitalier Regional de Lanaudiere, Joliette, Canada
(Roubille) Universite de Montpellier, INSERM, CNRS, CHU de Montpellier,
France
Publisher
NLM (Medline)
Abstract
AIMS: The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated
the benefits of targeting inflammation after myocardial infarction (MI).
We aimed to determine whether time-to-treatment initiation (TTI)
influences the beneficial impact of colchicine. METHODS AND RESULTS: In
COLCOT, patients were randomly assigned to receive colchicine or placebo
within 30days post-MI. Time-to-treatment initiation was defined as the
length of time between the index MI and the initiation of study
medication. The primary efficacy endpoint was a composite of
cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent
hospitalization for angina requiring coronary revascularization. The
relationship between endpoints and various TTI (<3, 4-7 and >8days) was
examined using multivariable Cox regression models. Amongst the 4661
patients included in this analysis, there were 1193, 720, and 2748
patients, respectively, in the three TTI strata. After a median follow-up
of 22.7months, there was a significant reduction in the incidence of the
primary endpoint for patients in whom colchicine was initiated < Day 3
compared with placebo [hazard ratios (HR)=0.52, 95% confidence intervals
(CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated
between Days 4 and 7 (HR=0.96, 95% CI 0.53-1.75) or > Day 8 (HR=0.82, 95%
CI 0.61-1.11). The beneficial effects of early initiation of colchicine
were also demonstrated for urgent hospitalization for angina requiring
revascularization (HR=0.35), all coronary revascularization (HR=0.63), and
the composite of cardiovascular death, resuscitated cardiac arrest, MI, or
stroke (HR=0.55, all P<0.05). CONCLUSION(S): Patients benefit from
early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION:
COLCOT ClinicalTrials.gov number, NCT02551094. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<97>
Accession Number
632570384
Title
Influence of Valve Type and Antiplatelet Regimen on Platelet Reactivity
After TAVI: Subanalysis of the REAC-TAVI Trial.
Source
The Journal of invasive cardiology. 32 (12) (pp 446-452), 2020. Date of
Publication: 01 Dec 2020.
Author
Trejo-Velasco B.; Cruz-Gonzalez I.; Tello-Montoliu A.; Baz-Alonso J.A.;
Salvadores P.J.; Moreno R.; Romaguera R.; Molina-Navarro E.; Paredes-Galan
E.; De-Miguel-Castro A.; Bastos-Fernandez G.; Ortiz-Saez A.;
Fernandez-Barbeira S.; Iniguez-Romo A.; Jimenez-Diaz V.A.
Institution
(Jimenez-Diaz) Cardiovascular Research Unit & Cardiology Department,
Hospital Alvaro Cunqueiro, University Hospital of Vigo, Estrada de Clara
Campoamor, 341, 36312, Vigo, Spain. sooner_79@hotmail.com or
victor.alfonso.jimenez.diaz@sergas.es
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Ticagrelor has proven more effective than clopidogrel at
attaining a maintained suppression of high platelet reactivity (HPR) in
aortic stenosis patients undergoing transcatheter aortic valve
implantation (TAVI). This study aims to assess the influence of implanted
valve type on the degree of platelet reactivity (PR) after TAVI.
 METHOD(S): This study is a prespecified analysis of REAC-TAVI, a
prospective, multicenter study that included patients on dual-antiplatelet
therapy with aspirin and clopidogrel before TAVI. Patients with HPR (n =
48) were randomized to aspirin and clopidogrel or aspirin and ticagrelor
for 3 months, while those without HPR (n = 20) were continued on aspirin
and clopidogrel. PR was measured 6 hours, 24 hours, 5 days, 30 days, and
90 days after TAVI with VerifyNow assay. Bioprosthetic valves were
classified as balloon-expandable valve (BEV), self-expandable valve (SEV),
or other. RESULT(S): Sixty-eight patients comprising 32 BEVs, 28
SEVs, and 8 other valves were included. Devices were larger and
postdilation was more frequent in the SEV group. Follow-up PR was lower in
patients treated with ticagrelor vs those treated with clopidogrel at all
time points after TAVI, including patients without baseline HPR (P<.001).
PR after TAVI was similar in the three groups. Major cardiovascular
adverse events, stroke, and hemorrhagic complications were comparable
across the different bioprosthesis groups at 4-month follow-up.
 CONCLUSION(S): The effect of valve type on PR after TAVI is similar
across the spectrum of most transcatheter valves. In our sample,
ticagrelor achieved a faster and more effective reduction in PR than
clopidogrel in patients with HPR undergoing TAVI, irrespective of valve
type.

<98>
Accession Number
633546516
Title
Systematic review of viscoelastic testing (Teg/ Rotem) in obstetrics and
recommendations for future studies.
Source
Research and Practice in Thrombosis and Haemostasis. Conference:
International Society on Thrombosis and Haemostasis Congress, ISTH 2020.
United States. 4 (SUPPL 1) (pp 1276-1277), 2020. Date of Publication: July
2020.
Author
Amgalan A.; Allen T.; Othman M.; Ahmadzia H.
Institution
(Amgalan) Georgetown University, School of Medicine, Washington, United
States
(Allen) Duke University Hospital, Department of Anesthesiology, Durham,
United States
(Othman) Queen's University School of Medicine, Department of Biomedical
and Molecular Sciences, Kingston, Canada
(Othman) St. Lawrence College, School of Baccalaureate Nursing, Kingston,
Canada
(Ahmadzia) George Washington University, School of Medicine and Health
Sciences, Department of Obstetrics and Gynecology, Washington, United
States
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Thromboelastography (TEG) and rotational thromboelastometry
(ROTEM) are point-of-care viscoelastic devices that use whole blood
samples to assess coagulation and fibrinolysis. These devices have been
studied extensively and are recommended in cardiac surgery, but there is
limited robust evidence supporting its use in obstetrics. The hesitancy
toward its routine use in obstetrics may be due to the current lack of
randomized controlled trials and large observational studies. Aim(s):
The study aims to systematically review published studies that
investigated TEG/ROTEM use in pregnancy or peripartum, and to provide
recommendations for future studies to fill current research gaps.
 Method(s): We performed a systematic review of all published studies
on viscoelastic testing in obstetrics by searching Ovid Medline and
utilizing the reference list of relevant articles. Included studies were
original research, utilizing TEG or ROTEM during the peripartum period or
during pregnancy, and published in English. Studies that did not mention
TEG/ROTEM or did not use it in women during pregnancy or the peripartum
period were excluded. Result(s): A total of 63 studies, spanning 24
years from 1995 to 2019 and with a total of 59,272 participants, were
included. 42 (67%) of the studies used TEG and 21 (33%) used ROTEM. To
date, there are a total of two randomized controlled trials on TEG/ROTEM
use in obstetrics. Conclusion(s): TEG and ROTEM can detect the
hypercoagulable changes associated with pregnancy and can be used to guide
therapy for PPH. Variability between study protocols and results suggests
the need for future large prospective high-quality studies with
standardized protocols to investigate the utility of TEG/ROTEM in
assessing risk for thrombosis and hemorrhage as well as in guiding
prophylaxis and treatment in obstetric patients. We provide concrete
recommendations for future studies in this regard.

<99>
Accession Number
633544215
Title
Fatal intracerebral hemorrhage in a patient on warfarin: A case report.
Source
Research and Practice in Thrombosis and Haemostasis. Conference:
International Society on Thrombosis and Haemostasis Congress, ISTH 2020.
United States. 4 (SUPPL 1) (pp 1027), 2020. Date of Publication: July
2020.
Author
Rosa A.B.R.; Praxedes M.F.S.; Almeida B.C.S.; Medeiros A.F.; Ribeiro A.L.;
Martins M.A.P.
Institution
(Rosa, Almeida, Ribeiro, Martins) Faculdade De Medicina, Universidade
Federal De Minas Gerais, Belo Horizonte, Brazil
(Praxedes) Colegiado De Enfermagem, Universidade Federal do Reconcavo Da
Bahia, Belo Horizonte, Brazil
(Medeiros) Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
(Martins) Faculdade De Farmacia, Universidade Federal De Minas Gerais,
Belo Horizonte, Brazil
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Warfarin remains an important therapeutic alternative in low
and middle-income countries. However, it increases the risk of
intracerebral hemorrhage (ICH) which is associated with significant
morbidity and mortality. Aim(s): To present a case of fatal ICH in a
patient on warfarin. Method(s): The patient had been recruited for
the control arm of a clinical trial (NCT01006486-ClinicalTrials. gov)
designed to assess the impact of an anticoagulation clinic in Brazil. She
provided a signed informed consent. Result(s): A 42-year- old
non-white woman was on warfarin for stroke prevention for five years due
to atrial fibrillation and prosthetic heart valves. Target INR was
2.5-3.0. There was no history of major bleeding, but she had several
episodes of minor bleedings, including hematomas, nose and gum bleeding.
Comorbidities included systemic arterial hypertension, hypothyroidism,
heart failure, rheumatic cardiomyopathy, dyslipidemia, pulmonary
thromboembolism and depression. She was taking chronically nine
medications and acetaminophen was eventually used. Vitamin K intake was
regular. There was no report of alcohol consumption or smoking. Time in
therapeutic range was 33.7%. The patient began a progressive holocranial
headache. She was admitted in an emergency hospital in the very next day
with nausea, vomits and consciousness impairment. Warfarin dose was
70mg/week. There were no signs of hemodynamic impairment or infection.
Spontaneous hematomas began to appear in her right thigh. She was scored
with 3 points by the Glasgow Coma Scale. A computed cranial tomography
revealed a rounded image sized 4.0cm per 2.8cm in the left cerebellar
lobar area, with liquid interface in its interior. Additionally, there was
a spontaneous subarachnoid bleeding invading ventricular space and
cerebral edema. INR value at admission was 5.25. The patient died two days
later presenting an irreversible asystole despite the prompt assistance.
 Conclusion(s): This case reinforces the need of close monitoring and
educational interventions to prevent complications in a patient with a
complex clinical condition.

<100>
Accession Number
633542562
Title
The fares study: A multicenter, randomized, active-control, pragmatic,
phase 2 pilot study comparing prothrombin complex concentrate versus
frozen plasma in bleeding adult cardiac surgical patients.
Source
Research and Practice in Thrombosis and Haemostasis. Conference:
International Society on Thrombosis and Haemostasis Congress, ISTH 2020.
United States. 4 (SUPPL 1) (pp 378), 2020. Date of Publication: July 2020.
Author
Karkouti K.; Callum J.
Institution
(Karkouti) Toronto General Hospital, Toronto, Canada
(Callum) Sunnybrook Health Sciences Centre, University of Toronto,
Department of Laboratory Medicine and Pathobiology, Toronto, Canada
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Coagulopathic bleeding is a frequent complication of cardiac
surgery and can lead to excessive blood loss, blood product transfusion
and bleeding-related complications. Hemostatic management in bleeding
surgical patients is evolving towards targeted therapy with purified
products undergoing pathogen reduction technology. Unlike frozen plasma
(FP), purified prothrombin complex concentrates (PCC) do not require ABO
matching or thawing, are pathogen-reduced, and associated with lower risk
of transfusion-associated circulatory overload and transfusion-related
acute lung injury. Aim(s): The FARES study will compare the efficacy
and safety of PCC (Octaplex; Octapharma) versus FP in bleeding cardiac
surgical patients. Method(s): The randomized, active-control,
single-blinded, pragmatic, investigator-initiated, Phase 2 FARES pilot
study will enrol 120 bleeding adult cardiac surgery patients requiring
coagulation factor replacement from two hospitals. The study outline is
shown in Figure 1. Patients will be randomized to PCC or FP, with two
weight-based doses, for management of bleeding where coagulation factor
deficiency is known or suspected. Required second doses will be given
according to randomisation group allocation, but all patients will receive
FP for third or subsequent doses. Primary endpoint is hemostatic
effectiveness and transfusion requirements. Adverse events will be
recorded from the beginning of surgery. Result(s): Results will be
monitored and overseen by the IDSMC on an ongoing basis. The study is
expected to end Q2 2020. As of January 31 2020, 70 patients have been
enrolled in the study. Conclusion(s): This study will determine the
feasibility, and inform the design and primary outcome parameter, of a
definitive Phase 3 trial comparing the efficacy and safety of the PCC
Octaplex versus FP in bleeding cardiac surgical patients requiring
coagulation factor replacement. The pilot study results will also be used
in sample size calculations, and to aid detection of any early safety
issues.

<101>
Accession Number
633542559
Title
The association of prothrombin complex concentrates with transfusion
requirement and postoperative outcomes in cardiac surgery: A post-hoc
analysis of the fibres randomized controlled trial.
Source
Research and Practice in Thrombosis and Haemostasis. Conference:
International Society on Thrombosis and Haemostasis Congress, ISTH 2020.
United States. 4 (SUPPL 1) (pp 125-126), 2020. Date of Publication: July
2020.
Author
Bartoszko J.; Karkouti K.; Callum J.
Institution
(Bartoszko) University of Toronto, Department of Anesthesia and Pain
Management, Toronto, Canada
(Karkouti) University Health Network, Sinai Health System, and Women's
College Hospital, Department of Anesthesia and Pain Management, Toronto,
Canada
(Callum) Sunnybrook Health Sciences Centre, Department of Laboratory
Medicine and Molecular Diagnostics, Toronto, Canada
(Callum) University of Toronto, Department of Laboratory Medicine and
Pathobiology, Toronto, Canada
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Coagulopathy after cardiopulmonary bypass (CPB) is common and
associated with bleeding and adverse outcomes. The mainstay of therapy for
coagulation factor deficiency is frozen plasma (FP), however prothrombin
complex concentrates (PCCs) may be simpler to administer and more
effective. Aim(s): To describe the association of comparable PCC or
FP doses with transfusion requirements and adverse outcomes after cardiac
surgery. Method(s): This was a post-hoc analysis of the FIBRES
randomized controlled trial (Effect of Fibrinogen Concentrate vs.
Cryoprecipitate on Blood Component Transfusion after Cardiac Surgery) with
ethics approval. The primary outcome was RBC transfusion within 24 hours
of CPB. Secondary outcomes included platelet transfusion within 24 hours
of CPB and adverse outcomes. Associations were examined with the use of
multivariable models adjusted for creatinine clearance, hemoglobin, BMI,
age, sex, heart failure, study arm, critical status, surgical complexity
and urgency. Result(s): Of the 735 patients in FIBRES, 416 received
PCC (n=72, 17%) or FFP (n=344, 83%) (Table 1). A total of 66 (16%)
experienced thromboembolic events and 54 (13%) fluid overload or
respiratory events within 28 days; 145 (35%) renal events within 7 days;
78 (19%) surgical re-exploration. Each unit of FP was associated with
increased adjusted odds (aOR) of RBC transfusion [aOR 1.50 (95% CI, 1.29,
1.75), p< 0.01], while each 500 units of PCC was protective [aOR 0.70 (95%
CI, 0.60, 0.83), p< 0.01]. Each unit of FP was associated with an
increased adjusted odds of platelet transfusion [aOR 1.41 (95% CI 1.14,
1.73), p< 0.01], while each 500 units of PCC was protective [aOR 0.81 (95%
CI, 0.71, 0.93), p< 0.01]. PCC use was not associated with an increase in
adverse events (Figure 1). Conclusion(s): PCC use was associated with
transfusion avoidance, without increases in adverse events. PCCs appear to
confer hemostatic advantages to FP in this setting, however randomized
trials are needed. (Figure Presented).

<102>
Accession Number
633541018
Title
Fibrinogen supplementation in patients with acquired hypofibrinogenaemia:
Meta-analysis and systematic review.
Source
Research and Practice in Thrombosis and Haemostasis. Conference:
International Society on Thrombosis and Haemostasis Congress, ISTH 2020.
United States. 4 (SUPPL 1) (pp 354-355), 2020. Date of Publication: July
2020.
Author
Rahe-Meyer N.; Collins P.; Fenger-Eriksen C.; Innerhofer P.; Fries M.;
Ranucci M.
Institution
(Rahe-Meyer) Franziskus Hospital Bielefeld, Clinic for Anesthesiology and
Operational Intensive Care, Bielefeld, Germany
(Collins) Cardiff University, School of Medicine, Cardiff, United Kingdom
(Fenger-Eriksen) Aarhus University Hospital, Department of
Anaesthesiology, Aarhus, Denmark
(Innerhofer) Medical University Innsbruck, Department of Anaesthesiology
and Critical Care Medicine, Innsbruck, Austria
(Fries) CSL Behring, Philadelphia, United States
(Ranucci) IRCCS Policlinico San Donato, Department of Cardiothoracic
-Vascular Anesthesia and Intensive Care, Milan, Italy
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: Hypofibrinogenaemia is associated with poor patient outcomes
in various clinical settings including trauma, cardiac surgery and
obstetric haemorrhage; however, no study to date has combined data from
multiple bleeding indications. Aim(s): To systematically assess the
evidence for the efficacy and safety of fibrinogen supplementation in
coagulopathic bleeding patients with low fibrinogen levels, and analyse
whether fibrinogen supplementation leads to improved outcomes in these
patients. Method(s): EMBASE and PubMed/Medline databases were
searched for parallel-group randomised controlled trials with patients
receiving fibrinogen supplementation to manage severe haemorrhage due to
acquired hypofibrinogenemia (until June 2018). Trials comparing treatment
with fibrinogen concentrate (FCH) or cryoprecipitate with any another
treatment were eligible; trials involving prophylacticfibrinogen
supplementation were excluded. The primary endpoint was patient mortality.
 Result(s): Fifteen studies were identified, including 1195 patients
(n = 586 received fibrinogen supplementation; n = 609 received a
comparator). Baseline fibrinogen levels were comparable, and 14 studies
used FCH. Bleeding indications included cardiac surgery (n = 563; 47.1%),
obstetric haemorrhage (n = 299; 25.0%) and trauma (n = 270; 22.6%). The
risk ratio (RR) for in-hospital and/or <= 30-day mortality was 0.57 (14
studies; 95% confidence interval [CI] 0.32-1.02); this result was not
significant (p = 0.058) but trended towards lower mortality with
fibrinogen supplementation versus comparator. A similar pattern was shown
for other efficacy endpoints (Figure), with incidence of platelet
transfusion associated with significant benefit versus comparator (12
studies; RR 0.68; 95% CI 0.49-0.93; p = 0.017). No significant difference
was identified in thromboembolic event occurrence between groups (p =
0.256). Overall risk of bias was high in all studies. Conclusion(s):
Results for all endpoints trended in favour of fibrinogen supplementation
versus comparator, with no safety signals identified. The significantly
reduced incidence of platelet transfusion with fibrinogen supplementation
suggests reduced blood loss versus comparator. Study funded by: CSL
Behring. Medical writing support provided by Hanna Mourad-Agha of
Fishawack Communications, funded by CSL. (Figure Presented).

<103>
Accession Number
2007447736
Title
The effect of dexmedetomidine on the inflammatory response in children
undergoing repair of congenital heart disease: a randomized controlled
clinical trial.
Source
Egyptian Journal of Anaesthesia. 36 (1) (pp 297-304), 2020. Date of
Publication: 2020.
Author
Abdelrahman K.A.; Hassan S.A.; Mohammed A.A.; Abdelhakeem E.E.;
Abd-Elshafy S.K.; Salama R.H.; Abdalla E.M.
Institution
(Abdelrahman, Hassan, Mohammed, Abdelhakeem, Abd-Elshafy, Abdalla)
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Salama) Department of Biochemistry, Faculty of Medicine, Assiut
University, Assiut, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: The inflammatory response due to cardiopulmonary bypass (CBP)
activates different inflammatory pathways that affect multiple organs.
Dexmedetomidine is proved to affect inflammatory marker production.
 Objective(s): Evaluation of the effect of Dexmedetomidine on the
inflammatory response associated with pediatric open-heart surgery using
interleukin-6 (IL-6) and interferon-gamma (INF-) levels. Method(s):
61children aged between one to 8 years undergoing elective repair of
non-cyanotic congenital heart disease with CPB were randomly assigned into
two groups. The control group (31 patients) received normal saline,
whereas the Dex group (30 patients) received an initial bolus of
Dexmedetomidine 0.5 microg/kg followed immediately by infusion of 0.5
microg/kg/hr continued till the end of CPB. The level of IL-6 and INF- was
measured. Hemodynamic, ICU, and hospital data were recorded.
 Result(s): IL-6 and INF - levels were increased significantly with
time in control group, with no increase in their levels in the Dex group.
They were significantly lower in the Dex group compared to the control
group in samples taken during bypass, 6 h and 24 h after the operation
(the end of surgical procedure). There was a significant difference
between the groups regarding inotropic score and mechanical ventilation.
There was no significant difference between the groups regarding
complications, duration of ICU or hospital stay. Conclusion(s): The
use of Dexmedetomidine in pediatric cardiac surgery for non-cyanotic heart
disease had significantly attenuated the inflammatory response. It was
useful in decreasing the level of inflammatory mediators, inotropic
support, and duration of mechanical ventilation, but not the ICU or
hospital stay. Trial registration: https://clinicaltrials.gov.
(Identifier: NCT03163238). Copyright © 2020 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<104>
Accession Number
2007470239
Title
Recommendations from the Italian intersociety consensus on Perioperative
Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and
preoperative care.
Source
Perioperative Medicine. 9 (1) (no pagination), 2020. Article Number: 37.
Date of Publication: December 2020.
Author
Piccioni F.; Droghetti A.; Bertani A.; Coccia C.; Corcione A.; Corsico
A.G.; Crisci R.; Curcio C.; Del Naja C.; Feltracco P.; Fontana D.;
Gonfiotti A.; Lopez C.; Massullo D.; Nosotti M.; Ragazzi R.; Rispoli M.;
Romagnoli S.; Scala R.; Scudeller L.; Taurchini M.; Tognella S.; Umari M.;
Valenza F.; Petrini F.
Institution
(Piccioni) Department of Critical and Supportive Care, Fondazione IRCCS
Istituto Nazionale dei Tumori, via Venezian 1, Milan 20133, Italy
(Droghetti) Division of Thoracic Surgery - ASST Mantova, Mantova, Italy
(Bertani) Division of Thoracic Surgery and Lung Transplantation,
Department for the Treatment and Study of Cardiothoracic Diseases and
Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
(Coccia) Department of Anesthesia and Critical Care Medicine, National
Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
(Corcione) Department of Critical Care Area Monaldi Hospital, Ospedali dei
Colli, Naples, Italy
(Corsico) Division of Respiratory Diseases, IRCCS Policlinico San Matteo
Foundation and Department of Internal Medicine and Therapeutics,
University of Pavia, Pavia, Italy
(Crisci) Department of Thoracic Surgery, University of L'Aquila, L'Aquila,
Italy
(Curcio) Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital,
Naples, Italy
(Del Naja) Department of Thoracic Surgery, IRCCS Casa Sollievo della
Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
(Feltracco) Department of Medicine, Anaesthesia and Intensive Care,
University Hospital of Padova, Padua, Italy
(Fontana) Thoracic Surgery Unit - San Giovanni Bosco Hospital - Torino,
Turin, Italy
(Gonfiotti) Thoracic Surgery Unit, University Hospital Careggi, Florence,
Italy
(Lopez) Thoracic Surgery Unit, V Fazzi Hospital, Lecce, Italy
(Massullo) Anesthesiology and Intensive Care Unit, Azienda Ospedaliero
Universitaria S. Andrea, Rome, Italy
(Nosotti) Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca'
Granda Ospedale Maggiore Policlinico, Milan, Italy
(Ragazzi) Department of Morphology, Surgery and Experimental Medicine,
Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
(Rispoli) Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi
Hospital, Naples, Italy
(Romagnoli) Department of Health Science, Section of Anesthesia and
Critical Care, University of Florence, Florence, Italy
(Romagnoli) Department of Anesthesia and Critical Care, Careggi University
Hospital, Florence, Italy
(Scala) Pneumology and Respiratory Intensive Care Unit, San Donato
Hospital, Arezzo, Italy
(Scudeller) Clinical Epidemiology Unit, Scientific Direction, Fondazione
IRCCS San Matteo, Pavia, Italy
(Taurchini) Department of Thoracic Surgery, IRCCS Casa Sollievo della
Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
(Tognella) Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona,
Italy
(Umari) Combined Department of Emergency, Urgency and Admission, Cattinara
University Hospital, Trieste, Italy
(Valenza) Department of Critical and Supportive Care, Fondazione IRCCS
Istituto Nazionale dei Tumori, Milan, Italy
(Valenza) Department of Oncology and Onco-Hematology, University of Milan,
Milan, Italy
(Petrini) Department of Anaesthesia, Perioperative Medicine, Pain Therapy,
RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital,
Chieti, Italy
Publisher
BioMed Central Ltd
Abstract
Introduction: Anesthetic care in patients undergoing thoracic surgery
presents specific challenges that necessitate standardized,
multidisciplionary, and continuously updated guidelines for perioperative
care. Method(s): A multidisciplinary expert group, the Perioperative
Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from
19 Italian centers, was established to develop recommendations for
anesthesia practice in patients undergoing thoracic surgery (specifically
lung resection for cancer). The project focused on preoperative patient
assessment and preparation, intraoperative management (surgical and
anesthesiologic care), and postoperative care and discharge. A series of
clinical questions was developed, and PubMed and Embase literature
searches were performed to inform discussions around these areas, leading
to the development of 69 recommendations. The quality of evidence and
strength of recommendations were graded using the United States
Preventative Services Task Force criteria. Result(s): Recommendations
for preoperative care focus on risk assessment, patient preparation
(prehabilitation), and the choice of procedure (open thoracotomy vs.
video-assisted thoracic surgery). Conclusion(s): These
recommendations should help pulmonologists to improve preoperative
management in thoracic surgery patients. Further refinement of the
recommendations can be anticipated as the literature continues to
evolve. Copyright © 2020, The Author(s).

<105>
Accession Number
2010082676
Title
Personalized Blood Pressure Management During Cardiac Surgery With
Cerebral Autoregulation Monitoring: A Randomized Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Hogue C.W.; Brown C.H.; Hori D.; Ono M.; Nomura Y.; Balmert L.C.;
Srdanovic N.; Grafman J.; Brady K.
Institution
(Hogue) Department of Anesthesiology, Bluhm Cardiovascular Institute,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Brown) Department of Anesthesiology & Critical Care Medicine, Division of
Cardiac Anesthesia, The Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Hori, Nomura) Department of Cardiovascular Surgery, Saitama Medical
Center, Jichi Medical University, Saitama, Japan
(Ono) Department of Cardiac Surgery, Methodist Hospital, San Antonio, TX,
United States
(Balmert, Srdanovic) Department of Preventative Medicine, Biostatistics,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Grafman) Department of Physical Medicine & Rehabilitation, Neurology,
Cognitive Neurology and Alzheimer's Center, Department of Psychiatry,
Feinberg School of Medicine & Department of Psychology, Weinberg College
of Arts and Sciences, Northwestern University, Chicago, IL, United States
(Brady) Department of Anesthesiology, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
Publisher
W.B. Saunders
Abstract
The purpose of this study was to determine if setting mean arterial
pressure (MAP) targets during cardiopulmonary bypass (CPB) based on
individualized cerebral autoregulation data reduces the frequency of
neurological complications compared with usual care. Patients (n = 460) >=
55 years old at risk for neurological complications were randomized to
have MAP targets during CPB to be above the lower limit of transcranial
Doppler determined cerebral autoregulation versus usual institutional
practices. The primary outcome was the frequency of the composite endpoint
of clinical stroke, or new brain magnetic resonance imaging-detected
ischemic injury, or cognitive decline 4-6 weeks after surgery from
baseline. Secondary outcomes were components of the primary composite
outcome and clinically detected delirium. Complete outcome data were
available from 194 patients (stroke assessments, n = 460; magnetic
resonance imaging data, n = 164; cognitive data n = 336). There was no
difference between groups in the frequency of the composite neurological
end-point or its components (P = 0.752). Compared with the usual care
there was a 45% reduction in the frequency of clinically detected delirium
in the autoregulation group (8.2% vs 14.9%, risk ratio = 0.55, 95%
confidence interval = 0.32, 0.93, P = 0.035) and improved performance on
test of memory 4-6 weeks after surgery from baseline (P = 0.019). Basing
MAP during CPB on cerebral autoregulation monitoring did not reduce the
frequency of the primary neurological outcome in high-risk patients
compared with usual care but it was associated with a reduction in the
frequency of delirium and better performance on tests of memory 4-6 weeks
after surgery. Copyright © 2020

<106>
Accession Number
2010081826
Title
Mechanical Versus Bioprosthetic Valve Replacement in the Tricuspid Valve
Position: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Negm S.; Arafat A.A.; Elatafy E.E.; Fawzy H.F.
Institution
(Negm, Arafat, Elatafy, Fawzy) Cardiothoracic Surgery Department, Tanta
University, Egypt
Publisher
Elsevier Ltd
Abstract
Background: The ideal prosthesis for tricuspid valve replacement (TVR)
continues to be debated. There are few published data comparing mechanical
and bioprosthetic valves, and all are retrospective studies with
relatively small sample sizes. Aim(s): This study was conducted to
compare mechanical and bioprosthetic valves for TVR. Method(s): A
literature search of six databases (PubMed, EMBASE, Ovid, ScienceDirect,
JSTOR, and Wiley Blackwell's online library) was performed with the
keywords "tricuspid valve disease, tricuspid valve replacement and
(bioprosthetic or mechanical)". Primary outcomes were hospital mortality,
long-term survival, tricuspid valve reoperation, valve failure,
thrombosis, and thrombo-embolism. Risk ratio (RR) was used to compare
dichotomous parameters and time-to-event outcomes. "Survival and
re-interventions" were pooled using a meta-analysis of hazard ratios (HR).
Publication bias was accessed using a funnel plot. Result(s): A total
of 23 retrospective studies involving 945 mechanical and 1,332 biological
tricuspid prostheses were included. The studies were published between
January 2002 and September 2019. Hospital mortality (30-day mortality) did
not differ between groups (RR, 0.83; 95% confidence interval [CI],
0.66-1.05; p=0.12). Long-term survival was evaluated in 15 studies, and it
was not significantly different between patients with mechanical compared
with those with bioprosthetic valves (pooled HR, 0.97; 95% CI, 0.61-1.54;
p=0.88). Freedom from tricuspid valve reoperation was assessed in eight
studies, and no difference was found between the groups (pooled HR, 1.03;
95% CI, 0.63-1.69; p=0.89). Valve failure in the 5-year postoperative
period was evaluated by seven studies, and there was no statistically
significant difference between the two groups (pooled RR, 1.33; 95% CI,
0.42-4.27; p=0.63). Conclusion(s): The results of this meta-analysis
suggest an equal risk of 30-day and late mortality, reoperation, and
5-year valve failure in patients with mechanical versus biological TVR.
The choice of the prosthesis in the tricuspid position should depend
mainly on the patient's risk factors and no superiority of one prosthesis
over the other in this position. Copyright © 2020 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<107>
Accession Number
633550333
Title
Effect of Renin-angiotensin System Inhibitors on Acute Kidney Injury among
Patients undergoing Cardiac Surgery: A Review and Meta-analysis.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2020.
Date of Publication: 25 Nov 2020.
Author
Zhou H.; Xie J.; Zheng Z.; Ooi O.C.; Luo H.
Institution
(Zhou) School of Management, University of Science and Technology of
China, Hefei, China
(Xie) School of Management, Technical University of Munich, Heilbronn,
Germany
(Zheng) Lee Kong Chian School of Business, Singapore Management
University, Singapore
(Ooi, Luo) Department of Cardiac, Thoracic & Vascular Surgery, National
University Hospital, Singapore
Publisher
NLM (Medline)
Abstract
Acute kidney injury (AKI) is a frequent complication of cardiac surgery,
which can lead to higher mortality and long-term renal function
impairment. The effect of perioperative renin-angiotensin system
inhibitors (RASi) therapy on AKI incidence in patients undergoing cardiac
surgery remains controversial. We reviewed related studies in PubMed,
Scopus, and Cochrane Library from inception to February 2020. Two
randomized controlled trials (RCTs) and 21 cohort studies were included in
the meta-analysis, involving 76,321 participants. The pooled odds ratio
and 95% confidence interval were calculated using the DerSimonian and
Laird random-effects model. The results showed no significant association
between perioperative RASi therapy and postoperative AKI in patients
undergoing cardiac surgery. We highlighted the limitations of existing
studies and called for well-designed large-scale RCTs to verify the
conclusion. Copyright © 2020 Elsevier Ltd. All rights reserved.

<108>
Accession Number
633547035
Title
Comparison of cryomaze with cut-and-sew maze concomitant with mitral valve
surgery: a randomized noninferiority trial.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2020.
Date of Publication: 24 Nov 2020.
Author
Han J.; Wang H.; Wang Z.; Yin Z.; Zhang J.; Jin Y.; Han H.
Institution
(Han, Wang, Wang, Yin, Zhang, Jin, Han) Department of Cardiovascular
Surgery, General Hospital of Northern Theater Command, Liaoning Province,
Shenyang 110016, China
Publisher
NLM (Medline)
Abstract
In this trial, we sought to evaluate the efficacy and safety of the
addition of the Maze performed by cryoablation (CryoMaze) to the mitral
valve surgeries. The trial is a randomized, single-center trial to
determine whether CryoMaze was noninferior to cut-and-sew Maze procedure
(CSM) in patients with persistent or longstanding persistent atrial
fibrillation (AF), with a 15% margin to establish non-inferiority. The
primary endpoint was freedom from AF off anti-arrhythmic drugs (AADs) at
12 months. Secondary endpoints included freedom from AF off AADs at 3 and
6 months, and a composite of serious adverse events. 200 patients were
randomized to either CryoMaze (n=100) or CSM (n=100). Freedom from AF was
achieved in 85 % (95% CI, 0.76-0.91) in the CryoMaze group and 88% (95%
CI, 0.80-0.94) in the CSM group, showing that CryoMaze was non-inferior to
CSM at 12 months (P-value for non-inferiority=0.0065). There was no
significant difference in serious adverse effects(n=12 in CryoMaze; n=17
in CSM;P=0.315). Perioperative bleeding and the length of surgery, ICU
stay, postoperative hospital stay; and the need for temporary pacing
decreased significantly in the CryoMaze group. CryoMaze was non-inferior
to CSM for efficacy and safety for patients with persistent or
long-standing persistent AF undergoing mitral valve surgeries. CryoMaze
significantly decreased bleeding, the length of surgery, ICU and hospital
stay as well the need for temporary pacing.(Chinese Clinical Trial
Register number, ChiCTR-IOR-16008112). Copyright © 2020.
Published by Elsevier Inc.

<109>
Accession Number
633537683
Title
Investigating the effect of acupressure on the patients' anxiety before
open-heart surgery: A randomized clinical trial.
Source
Journal of acupuncture and meridian studies. (no pagination), 2020. Date
of Publication: 23 Nov 2020.
Author
Khoram B.; Yoosefinejad A.K.; Rivaz M.; Najafi S.S.
Institution
(Khoram) Student Research Committee, School of Nursing and Midwifery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Yoosefinejad) Physical Therapy Department, School of Rehabilitation
Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Rivaz, Najafi) Department of medical surgical Nursing, School of Nursing
and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Anxiety is a common complaint of patients before diagnostic or
therapeutic invasive procedures, especially before open-heart surgery. The
most well-known method to reduce anxiety is the use of sedatives, which
have pronounced side effects. OBJECTIVE(S): The purpose of this study
was to determine the effect of acupressure on anxiety in patients
undergoing open heart surgery. METHOD(S): This is a randomized
clinical trial study conducted on 90 patients who were candidates for
open-heart surgery. The patients were randomly assigned into either
intervention or control groups. Acupressure intervention was applied at
three real acupoint over two consecutive days in the intervention group.
The control group received acupressure on sham points. We used Spielberger
State-Trait Anxiety Inventory to assess anxiety in our study.
 RESULT(S): The results showed that before acupressure,there was no
statistically significant difference between state anxiety scores and
intergroup traits (p-value>0.05), and this difference was only significant
in state anxiety after the second intervention. State and trait anxiety
were significant before and after the intervention in the test group
(p-value<0.05), but these changes in the control group did not show a
statistically significant difference (p-value>0.05).After completing the
second phase of the intervention at the actual sites, systolic blood
pressure (p-value=0.007) and heart rate (p-value=0.001) decreased
significantly. However, acupressure did not have a significant effect on
diastolic blood pressure in any of the groups (p-value >0.05).
 CONCLUSION(S): Based on the results of this study, the application of
acupressure in patients who are candidates for open-heart surgery can
reduce their state anxiety. Copyright © 2020. Published by
Elsevier B.V.

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