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<1>
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Accession Number
633174521
Title
Cardiovascular outcomes in patients with co-existing coronary artery
disease and rheumatoid arthritis: A systematic review and meta-analysis.
Source
Medicine (United States). 99 (14) (no pagination), 2020. Article Number:
e19658. Date of Publication: 2020.
Author
Wang H.; Li X.; Gong G.
Institution
(Wang, Li, Gong) Department of Cardiology, People's Hospital of Guangxi
Zhuang Autonomous Region, Nanning, Guangxi 530021, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Through this analysis, we aimed to systematically compare the
cardiovascular outcomes observed in patients with co-existing coronary
artery disease (CAD) and rheumatoid arthritis (RA).
<br/>Method(s):Mendeley, Web of Science (WOS), MEDLINE, Cochrane central,
EMBASE, Google scholar, and http://www.ClinicalTrials.gov were searched
for English-based publications on CAD and RA. Selective cardiovascular
outcomes were the endpoints in this analysis. The statistical software
RevMan 5.3 was used for data assessment. Risk ratios (RR) with 95%
confidence intervals (CI) were used to represent each subgroup analysis.
<br/>Result(s):One thousand four hundred forty six (1446) participants had
co-existing CAD and RA whereas 205,575 participants were in the control
group (only CAD without RA). This current analysis showed that the risk of
asymptomatic or stable angina was similar in CAD patients with versus
without RA (RR: 0.98, 95% CI: 0.84 - 1.14; P = .78). However, all-cause
mortality (RR: 1.47, 95% CI: 1.34 - 1.61; P = 0.00001), cardiac death (RR:
1.51, 95% CI: 1.05 - 2.17; P = .03) and congestive heart failure (RR:
1.41, 95% CI: 1.27 - 1.56; P = .00001) were significantly higher in CAD
patients with RA. However, multi-vessel disease (RR: 2.03, 95% CI: 0.57 -
7.26; P = .28), positive stress test (RR: 1.69, 95% CI: 0.70 - 4.08; P =
.24), and ischemic events (RR: 1.18, 95% CI: 0.81 - 1.71; P = .40) were
similar in both groups. The risk for myocardial infarction, repeated
revascularization, and the probability of patients undergoing percutaneous
coronary intervention (PCI) (RR: 1.20, 95% CI: 0.75 - 1.93; P = .45) were
also similar in CAD patients with versus without RA. When we considered
outcomes only in those patients who underwent revascularization by PCI,
all-cause mortality (RR: 1.43, 95% CI: 1.29 - 1.60; P = .00001) was still
significantly higher in CAD patients with RA. <br/>Conclusion(s):This
analysis showed a significantly higher mortality risk in CAD patients with
RA when compared to the control group. Congestive heart failure also
significantly manifested more in CAD patients with co-existing RA.
However, the risks all the other cardiovascular outcomes were similar in
both groups. Nevertheless, due to the several limitations of this
analysis, this hypothesis should be confirmed in forthcoming trials based
on larger numbers of CAD patients with co-existing RA.<br/>Copyright
&#xa9; 2020 Lippincott Williams and Wilkins. All rights reserved.

<2>
Accession Number
632651250
Title
Systematic Review of Clinical Decision Support Systems for Prehospital
Acute Coronary Syndrome Identification.
Source
Critical Pathways in Cardiology. 19 (3) (pp 119-125), 2020. Date of
Publication: 01 Sep 2020.
Author
Knoery C.R.; Heaton J.; Polson R.; Bond R.; Iftikhar A.; Rjoob K.;
McGilligan V.; Peace A.; Leslie S.J.
Institution
(Knoery, Heaton, Leslie) Division of Rural Health and Wellbeing,
University of the Highlands and Islands, Centre for Health Science, Old
Perth Road, Inverness IV2 3JH, United Kingdom
(Knoery, Leslie) Cardiac Unit, NHS Highland, Inverness, United Kingdom
(Polson) Highland Health Sciences Library, University of the Highlands and
Islands, Centre for Health Science, Inverness, United Kingdom
(Bond, Iftikhar, Rjoob) Ulster University, Jordanstown Campus,
Newtownabbey, Northern Ireland, United Kingdom
(McGilligan, Peace) Centre for Personalised Medicine, Ulster University,
Londonderry, Northern Ireland, United Kingdom
(Peace) Altnagelvin Cardiology Department, Altnagelvin Hospital, Northern
Ireland, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Timely prehospital diagnosis and treatment of acute coronary
syndrome (ACS) are required to achieve optimal outcomes. Clinical decision
support systems (CDSS) are platforms designed to integrate multiple data
and can aid with management decisions in the prehospital environment. The
review aim was to describe the accuracy of CDSS and individual components
in the prehospital ACS management. <br/>Method(s): This systematic review
examined the current literature regarding the accuracy of CDSS for ACS in
the prehospital setting, the influence of computer-aided decision-making
and of 4 components: electrocardiogram, biomarkers, patient history, and
examination findings. The impact of these components on sensitivity,
specificity, and positive and negative predictive values was assessed.
<br/>Result(s): A total of 11,439 articles were identified from a search
of databases, of which 199 were screened against the eligibility criteria.
Eight studies were found to meet the eligibility and quality criteria.
There was marked heterogeneity between studies which precluded formal
meta-analysis. However, individual components analysis found that patient
history led to significant improvement in the sensitivity and negative
predictive values. CDSS which incorporated all 4 components tended to show
higher sensitivities and negative predictive values. CDSS incorporating
computer-aided electrocardiogram diagnosis showed higher specificities and
positive predictive values. <br/>Conclusion(s): Although heterogeneity
precluded meta-analysis, this review emphasizes the potential of ACS CDSS
in prehospital environments that incorporate patient history in addition
to integration of multiple components. The higher sensitivity of certain
components, along with higher specificity of computer-aided
decision-making, highlights the opportunity for developing an integrated
algorithm with computer-aided decision support.<br/>Copyright &#xa9; 2020
Lippincott Williams and Wilkins. All rights reserved.

<3>
Accession Number
625678931
Title
Targeting elevated left ventricular end-diastolic pressure following
primary percutaneous coronary intervention for ST-segment elevation
myocardial infarction - a phase one safety and feasibility study.
Source
European Heart Journal: Acute Cardiovascular Care. 9 (7) (pp 758-763),
2020. Date of Publication: October 2020.
Author
Khan A.A.; Davies A.J.; Whitehead N.J.; McGee M.; Al-Omary M.S.; Baker D.;
Bhagwandeen R.; Renner I.; Majeed T.; Hatton R.; Collins N.J.; Attia J.;
Boyle A.J.
Institution
(Khan, Davies, Whitehead, McGee, Al-Omary, Baker, Bhagwandeen, Hatton,
Collins, Attia, Boyle) John Hunter Hospital, Newcastle, Australia
(Khan, Al-Omary, Renner, Majeed, Collins, Attia, Boyle) The University of
Newcastle, Australia
(Khan, Majeed, Collins, Attia, Boyle) Hunter Medical Research Institute,
Newcastle, Australia
Publisher
SAGE Publications Inc.
Abstract
Introduction: Elevated left ventricular end diastolic pressure (LVEDP) is
an independent predictor of mortality and heart failure in patients with
ST-segment elevation myocardial infarction (STEMI). Whether lowering
elevated LVEDP improves outcomes remains unknown. <br/>Method(s): This
non-randomized, single blinded study with prospective enrolment and
sequential group allocation recruited patients undergoing primary
percutaneous coronary intervention for STEMI with LVEDP 20 mmHg measured
immediately after primary percutaneous coronary intervention. The
intervention arm (n=10) received furosemide 40 mg intravenous bolus plus
escalating doses of glyceryl trinitrate (100 microg per min to a maximum
of 1000 microg) during simultaneous measurement of LVEDP. The control
group (n=10) received corresponding normal saline boluses with
simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy
endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate
needed to reduce LVEDP by 20%. Safety endpoint was symptomatic
hypotension (systolic blood pressure < 90 mmHg). <br/>Result(s): From 1
April 2017 to 23 August 2017 we enrolled 20 patients (age: 64+/-9 years,
males: 60%, n=12, anterior STEMI: 65%, n=13). The mean LVEDP for the whole
cohort (n=20) was 29+/-4 mmHg (intervention group: 28+/-3 mmHg vs. control
group: 31+/-5 mmHg; p=0.1). The LVEDP dropped from 28+/-3 to 16+/-2 mmHg
in the glyceryl trinitrate + furosemide group (p <0.01) but remained
unchanged in the control group. The median dose of glyceryl trinitrate
required to produce 20% reduction in LVEDP in the intervention group was
200 microg (range: 100-800). One patient experienced asymptomatic decline
in systolic blood pressure to below 90 mmHg. There was no correlation
between LVEDP and left ventricular ejection fraction. <br/>Conclusion(s):
The administration of glyceryl trinitrate plus furosemide in patients with
elevated LVEDP following primary percutaneous coronary intervention for
STEMI safely reduces LVEDP.<br/>Copyright &#xa9; The European Society of
Cardiology 2018.

<4>
Accession Number
2008414201
Title
Redevelopment and validation of the SYNTAX score II to individualise
decision making between percutaneous and surgical revascularisation in
patients with complex coronary artery disease: secondary analysis of the
multicentre randomised controlled SYNTAXES trial with external cohort
validation.
Source
The Lancet. 396 (10260) (pp 1399-1412), 2020. Date of Publication: 31 Oct
2020.
Author
Takahashi K.; Serruys P.W.; Fuster V.; Farkouh M.E.; Spertus J.A.; Cohen
D.J.; Park S.-J.; Park D.-W.; Ahn J.-M.; Kappetein A.P.; Head S.J.; Thuijs
D.J.; Onuma Y.; Kent D.M.; Steyerberg E.W.; van Klaveren D.
Institution
(Takahashi) Department of Cardiology, Amsterdam Universities Medical
Centers, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Serruys, Onuma) Department of Cardiology, National University of Ireland,
Galway, Ireland
(Fuster) Zena and Michael Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Fuster) Centro Nacional De Investigaciones Cardiovasculares Carlos III,
Madrid, Spain
(Farkouh) Peter Munk Cardiac Centre and The Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Spertus, Cohen) University of Missouri-Kansas City, Kansas City, MO,
United States
(Park, Park, Ahn) Department of Cardiology, Asan Medical Center, Seoul,
South Korea
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(van Klaveren) Department of Public Health, Erasmus University Medical
Centre, Rotterdam, Netherlands
(Kent) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, MA, United States
(Steyerberg) Department of Biomedical Data Sciences, Leiden, Netherlands
(Steyerberg) University Medical Centre, Leiden, Netherlands
Publisher
Lancet Publishing Group
Abstract
Background: Randomised controlled trials are considered the gold standard
for testing the efficacy of novel therapeutic interventions, and typically
report the average treatment effect as a summary result. As the result of
treatment can vary between patients, basing treatment decisions for
individual patients on the overall average treatment effect could be
suboptimal. We aimed to develop an individualised decision making tool to
select an optimal revascularisation strategy in patients with complex
coronary artery disease. <br/>Method(s): The SYNTAX Extended Survival
(SYNTAXES) study is an investigator-driven extension follow-up of a
multicentre, randomised controlled trial done in 85 hospitals across 18
North American and European countries between March, 2005, and April,
2007. Patients with de-novo three-vessel and left main coronary artery
disease were randomly assigned (1:1) to either the percutaneous coronary
intervention (PCI) group or coronary artery bypass grafting (CABG) group.
The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox
regression to develop a clinical prognostic index for predicting death
over a 10-year period, which was combined, in a second stage, with
assigned treatment (PCI or CABG) and two prespecified effect-modifiers,
which were selected on the basis of previous evidence: disease type
(three-vessel disease or left main coronary artery disease) and anatomical
SYNTAX score. We used similar techniques to develop a model to predict the
5-year risk of major adverse cardiovascular events (defined as a composite
of all-cause death, non-fatal stroke, or non-fatal myocardial infarction)
in patients receiving PCI or CABG. We then assessed the ability of these
models to predict the risk of death or a major adverse cardiovascular
event, and their differences (ie, the estimated benefit of CABG versus PCI
by calculating the absolute risk difference between the two strategies) by
cross-validation with the SYNTAX trial (n=1800 participants) and external
validation in the pooled population (n=3380 participants) of the FREEDOM,
BEST, and PRECOMBAT trials. The concordance (C)-index was used to measure
discriminative ability, and calibration plots were used to assess the
degree of agreement between predictions and observations. <br/>Finding(s):
At cross-validation, the newly developed SYNTAX score II, termed SYNTAX
score II 2020, showed a helpful discriminative ability in both treatment
groups for predicting 10-year all-cause deaths (C-index=0.73 [95% CI
0.69-0.76] for PCI and 0.73 [0.69-0.76] for CABG) and 5-year major adverse
cardiovascular events (C-index=0.65 [0.61-0.69] for PCI and C-index=0.71
[0.67-0.75] for CABG). At external validation, the SYNTAX score II 2020
showed helpful discrimination (C-index=0.67 [0.63-0.70] for PCI and
C-index=0.62 [0.58-0.66] for CABG) and good calibration for predicting
5-year major adverse cardiovascular events. The estimated treatment
benefit of CABG over PCI varied substantially among patients in the trial
population, and the benefit predictions were well calibrated.
<br/>Interpretation(s): The SYNTAX score II 2020 for predicting 10-year
deaths and 5-year major adverse cardiovascular events can help to identify
individuals who will benefit from either CABG or PCI, thereby supporting
heart teams, patients, and their families to select optimal
revascularisation strategies. <br/>Funding(s): The German Heart Research
Foundation and the Patient-Centered Outcomes Research
Institute.<br/>Copyright &#xa9; 2020 Elsevier Ltd

<5>
Accession Number
2008352078
Title
Cardiogenic shock: A systematic review of clinical trials registered with
clinicaltrials.gov.
Source
Journal of Invasive Cardiology. 32 (4) (pp E86-E96), 2020. Date of
Publication: April 2020.
Author
Shaffer A.; Sheikh O.; Prasad A.
Institution
(Shaffer, Sheikh, Prasad) University of Texas Health Science Center at San
Antonio, San Antonio, TX, United States
Publisher
Cliggott Publishing Co.
Abstract
Background. Despite a range of devices, medical interventions, and
revascularization techniques utilized in cardiogenic shock (CS), there is
a lack of evidence guiding management. We sought to characterize the
contemporary trials through utilization of the ClinicalTrials.gov
database. Methods. We investigated all phase II-IV interventional trials
in the ClinicalTrials.gov database through June 29, 2019 that enrolled
patients with CS. Published trials investigating medical interventions
were evaluated for methodological quality using the Jadad scoring system.
Results. The initial query yielded 28 registered studies, of which 28
directly studied CS through whole or subgroup analyses. Of these, five
were withdrawn or terminated, while 13 were recruiting, not yet
recruiting, or were of unknown recruitment status. The remaining 10 were
published and had a median patient size of 69 patients and a median site
size of 6. Of the published studies, all-cause mortality was the most
common primary endpoint (60%), including composite endpoints that included
mortality. The remaining endpoints examined surrogate hemodynamic
parameters of cardiac function through echocardiography. The mean Jadad
score of the published trials investigating pharmacological therapies was
2.42. Of the trials investigating device therapies or revascularization
methods, all were randomized, parallel-arm studies that were open label.
Conclusions. Modern trials vary from single center to multicenter and are
small in size. The primary endpoints were clinical, focusing on mortality
and restoration of cardiac output or cardiac index. Methodological quality
varies in the trials focused on pharmacologic therapy. Trials with devices
or revascularization do not employ blinding, but do employ
randomization.<br/>Copyright &#xa9; 2020 HMP Communications. All rights
reserved.

<6>
Accession Number
2006910736
Title
Effect of selenium added to the cardioplegic solution on cardiac
protection in coronary artery bypass grafting surgeries: A randomized,
double-blinded, clinical trial study.
Source
Iranian Red Crescent Medical Journal. 21 (10) (no pagination), 2019.
Article Number: 92737. Date of Publication: October 2019.
Author
Shafa M.; Azemati S.; Abasi M.; Hemati R.
Institution
(Shafa, Azemati, Abasi, Hemati) Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to
the development of myocardial damage and dysfunction. Selenium is the main
cofactor for many antioxidant enzymes. Selenium level is decreased during
heart surgeries affecting the cardiopulmonary pump, which in turn can
aggravate the organ and heart dysfunction and mortality.
<br/>Objective(s): The aim of this study was to evaluate the cardiac
protective effects of adding selenium to cardioplegia solution in these
surgeries. <br/>Method(s): In this randomized, double-blind, clinical
trial study that was conducted in the department of cardiac surgery of
Shiraz University of Medical Sciences (SUMS) in Shiraz, Iran, 67 elected
CABG patients were allocated to the two control or selenium groups. In the
intervention group, 1000 microg sodium selenite was added to cardioplegia
solution. The same amount of normal saline was added to the cardioplegia
solution in the control group. Arterial blood samples were withdrawn
before anesthesia induction (T1), immediately after the surgery (T2), as
well as, 6 and 24 hours after the surgery (T3 and T4 respectively), to
determine the CK-MB and Troponin I levels. <br/>Result(s): According to
our findings, the CK-MB and Troponin I cardiac enzyme levels were
significantly different, considering different time points (P < 0.05).
Despite lower enzyme levels in the selenium group, the differences were
not statistically significant between the two groups (P > 0.05). There
were also no significant differences between the two groups regarding
systolic and diastolic blood pressures. <br/>Conclusion(s): The
administration of 1000 microg sodium selenite via cardioplegia solution
had no significant cardioprotective effect during coronary bypass surgery
in CABG patients.<br/>Copyright &#xa9; 2019, Author(s). This is an
open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 International License
(http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and
redistribute the material just in noncommercial usages, provided the
original work is properly cited

<7>
Accession Number
2010098341
Title
Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left
Bundle Branch Block After Transcatheter Aortic Valve Replacement.
Source
Cardiovascular Revascularization Medicine. 21 (10) (pp 1299-1304), 2020.
Date of Publication: October 2020.
Author
Megaly M.; Abraham B.; Abdelsalam M.; Saad M.; Omer M.; Elbadawi A.;
Mentias A.; Narayanan M.A.; Gafoor S.; Brilakis E.S.; Goessl M.;
Cavalcante J.L.; Garcia S.; Kapadia S.; Pershad A.; Sorajja P.; Sengupta
J.
Institution
(Megaly, Omer, Brilakis, Goessl, Cavalcante, Garcia, Sorajja, Sengupta)
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis,
MN, United States
(Megaly, Omer, Goessl, Cavalcante, Garcia, Sorajja) Valve Science Center,
Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
(Megaly, Omer) Division of Cardiovascular Medicine, Hennepin Healthcare,
Minneapolis, MN, United States
(Abraham) Division of Internal Medicine, Ascension St. John Hospital,
Detroit, MI, United States
(Abdelsalam) Division of Internal Medicine, Temple University/Conemaugh
Memorial Medical Center, Johnstown, PA, United States
(Saad) Division of Cardiovascular Medicine, The Warren Alpert School of
Medicine at Brown University, Providence, RI, United States
(Saad) Division of Cardiology, Ain Shams University, Cairo, Egypt
(Elbadawi) Division of Cardiology, University of Texas Medical Branch,
Galveston, TX, United States
(Mentias) Division of Cardiovascular Medicine, Roy and Lucille J. Carver
College of Medicine, University of Iowa Hospitals and Clinics, Iowa City,
IA, United States
(Narayanan) Division of Vascular Medicine, Yale-New Haven Hospital, New
Haven, CT, United States
(Gafoor) Heart and Vascular Institute, Swedish Medical Centre, Seattle,
WA, United States
(Kapadia) Division of Cardiology, Cleveland Clinic Foundation, Cleveland,
OH, United States
(Pershad) Division of Cardiology, Banner University Medical Center,
Phoenix, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: The impact of new-onset persistent left bundle branch block
(LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause
mortality has been controversial. <br/>Method(s): We conducted a
systematic review and meta-analysis of eleven studies (7398 patients)
comparing the short- and long- outcomes in patients who had new-onset LBBB
after TAVR vs. those who did not. <br/>Result(s): During a mean follow-up
of 20.5 +/- 14 months, patients who had new-onset persistent LBBB after
TAVR had a higher incidence of all-cause mortality (29.7% vs. 23.6%; OR
1.28 (1.04-1.58), p = 0.02), rehospitalization for heart failure (HF)
(19.5% vs. 17.3%; OR 1.4 (1.13-1.73), p = 0.002), and permanent pacemaker
implantation (PPMi) (19.7% vs. 7.1%; OR 2.4 (1.64-3.52), p < 0.001)
compared with those who did not. Five studies (4180 patients) reported
adjusted hazard ratios (HR) for all-cause mortality; new LBBB remained
associated with a higher risk of mortality (adjusted HR 1.43 (1.08-1.9), p
< 0.01, I² = 81%). <br/>Conclusion(s): Post-TAVR persistent
LBBB is associated with higher PPMi, HF hospitalizations, and all-cause
mortality. While efforts to identify patients who need post-procedural
PPMi are warranted, more studies are required to evaluate the best
follow-up and treatment strategies, including the type of pacing device if
required, to improve long-term outcomes in these patients.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<8>
Accession Number
2010024727
Title
Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary
Mitral Regurgitation: The COAPT Trial.
Source
Journal of the American College of Cardiology. 76 (22) (pp 2595-2606),
2020. Date of Publication: 01 Dec 2020.
Author
Ben-Yehuda O.; Shahim B.; Chen S.; Liu M.; Redfors B.; Hahn R.T.; Asch
F.M.; Weissman N.J.; Medvedofsky D.; Puri R.; Kapadia S.; Sannino A.;
Grayburn P.; Kar S.; Lim S.; Lindenfeld J.; Abraham W.T.; Mack M.J.; Stone
G.W.
Institution
(Ben-Yehuda, Shahim, Chen, Liu, Redfors, Hahn, Stone) Cardiovascular
Research Foundation, New York, NY, United States
(Chen, Hahn) Columbia University Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Asch, Weissman, Medvedofsky) Medstar Health Research Institute,
Washington, DC, United States
(Puri, Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Sannino, Grayburn, Mack) Baylor Scott & White Health, Plano, TX, United
States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Lindenfeld) Vanderbilt University Medical Center, Nashville, TN, United
States
(Abraham) Ohio State University Medical Center, Columbus, OH, United
States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Pulmonary hypertension worsens prognosis in patients with
heart failure (HF) and secondary mitral regurgitation (SMR).
<br/>Objective(s): This study sought to determine whether baseline
pulmonary hypertension influences outcomes of transcatheter mitral valve
repair (TMVr) in patients with HF with SMR. <br/>Method(s): In the COAPT
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients with Functional Mitral Regurgitation) trial,
614 patients with HF with moderate-to-severe or severe SMR were randomized
to TMVr with the MitraClip plus guideline-directed medical therapy (GDMT)
(n = 302) versus GDMT alone (n = 312). Baseline pulmonary artery systolic
pressure (PASP) estimated from echocardiography was categorized as
substantially increased (>=50 mm Hg) versus not substantially increased
(<50 mm Hg). <br/>Result(s): Among 528 patients, 184 (82 TMVr, 102 GDMT)
had PASP of >=50 mm Hg (mean: 59.1 +/- 8.8 mm Hg) and 344 (171 TMVr, 173
GDMT) had PASP of <50 mm Hg (mean: 36.3 +/- 8.1 mm Hg). Patients with PASP
of >=50 mm Hg had higher 2-year rates of death or HF hospitalization (HFH)
compared to those with PASP of <50 mm Hg (68.8% vs. 49.1%; adjusted hazard
ratio: 1.52; 95% confidence interval: 1.17 to 1.97; p = 0.002). Rates of
death or HFH were reduced by TMVr versus GDMT alone, irrespective of
baseline PASP (p<inf>interaction</inf> = 0.45). TMVr reduced PASP from
baseline to 30 days to a greater than GDMT alone (adjusted least squares
mean: -4.0 vs. -0.9 mm Hg; p = 0.006), a change that was associated with
reduced risk of death or HFH between 30 days and 2 years (adjusted hazard
ratio: 0.91 per -5 mm Hg PASP; 95% confidence interval: 0.86 to 0.96; p =
0.0009). <br/>Conclusion(s): Elevated PASP is associated with a worse
prognosis in patients with HF with severe SMR. TMVr with the MitraClip
reduced 30-day PASP and 2-year rates of death or HFH compared with GDMT
alone, irrespective of PASP.<br/>Copyright &#xa9; 2020 American College of
Cardiology Foundation

<9>
Accession Number
2003332120
Title
Role of prophylactic magnesium supplementation in prevention of
postoperative atrial fibrillation in patients undergoing coronary artery
bypass grafting: A systematic review and meta-analysis of 20 randomized
controlled trials.
Source
Journal of Atrial Fibrillation. 12 (1) (no pagination), 2019. Date of
Publication: 2019.
Author
Garg J.; Turagam M.; Chaudhary R.; Gupta R.; Nazir T.; Bozorgnia B.;
Lakkireddy D.
Institution
(Chaudhary) Department of Medicine, Mayo Clinic, Rochester, MN, United
States
(Garg) Division of `Cardiology, Cardiac Arrhythmia Service, Medical
College of Wisconsin, Milwaukee, WI, United States
(Turagam) Helmsley Electrophysiology Center, Icahn School of Medicine,
Mount Sinai Hospital, New York, NY, United States
(Chaudhary) Peter Lee Associates, Sydney, Australia
(Gupta) Department of Medicine, Westchester Medical Center, New York
Medical College, Valhalla, NY, United States
(Nazir, Bozorgnia) Division of Cardiology, Lehigh Valley Health Network,
Allentown, PA, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, KS, United States
Publisher
CardioFront LLC
Abstract
Background: Several randomized trials have evaluated the efficacy of
prophylactic magnesium (Mg) supplementation in prevention of
post-operative atrial fibrillation (POAF) in patients undergoing cardiac
artery bypass grafting (CABG). We aimed to determine the role of
prophylactic Mg in 3 different settings (intraoperative, postoperative,
intraoperative plus postoperative) in prevention of POAF. <br/>Method(s):
A systemic literature search was performed (until January 19, 2019) using
PubMed, EMBASE, Web of Science, and Cochrane Central Register of
Controlled Trials to identify trials evaluating Mg supplementation post
CABG. Primary outcome of our study was reduction in POAF post CABG.
<br/>Result(s): We included a total of 2,430 participants (1,196 in the Mg
group and 1,234 in the placebo group) enrolled in 20 randomized controlled
trials. Pooled analysis demonstrated no reduction in POAF between the two
groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I²=42.9%). In
subgroup analysis, significant reduction in POAF was observed with
postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04;
I²=17.6%) but not with intraoperative or intraoperative plus
postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27;
I²=49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58;
I²=51.8%, respectively). <br/>Conclusion(s): Magnesium
supplementation, especially in the postoperative period, is an effective
strategy in reducing POAF following CABG.<br/>Copyright &#xa9; 2019
CardioFront LLC. All rights reserved.

<10>
Accession Number
2004335129
Title
Meta-analysis of bivalirudin versus heparin in transradial coronary
interventions.
Source
Catheterization and Cardiovascular Interventions. 96 (6) (pp 1240-1248),
2020. Date of Publication: November 2020.
Author
Kheiri B.; Rao S.V.; Osman M.; Simpson T.F.; Barbarawi M.; Zayed Y.;
Dhillon H.N.; Alkhouli M.; Golwala H.; Zahr F.; Bhatt D.L.; Stone G.W.;
Cigarroa J.E.
Institution
(Kheiri, Simpson, Golwala, Zahr, Cigarroa) Knight Cardiovascular
Institute, Oregon Health & Science University, Portland, OR, United States
(Rao) The Duke Clinical Research Institute, Durham, NC, United States
(Osman, Alkhouli) Division of Cardiology, West Virginia University School
of Medicine, Morgantown, WV, United States
(Barbarawi, Zayed, Dhillon) Division of Cardiology, Hurley Medical
Center/Michigan State University, Flint, MI, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, New York, United States
(Stone) Cardiovascular Research Foundation, New York, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We sought to evaluate the efficacy and safety of bivalirudin
versus heparin in patients with coronary artery disease undergoing
transradial artery coronary intervention (TRI). <br/>Background(s):
Bivalirudin and radial artery access are independently associated with
improved cardiovascular outcomes. However, data supporting a strategy of
combining both to achieve additive improvements in cardiovascular outcomes
provide conflicting results. <br/>Method(s): A systematic search was
performed to identify randomized controlled trials (RCTs) of bivalirudin,
in which vascular access sites were reported. The primary outcome was net
adverse clinical events (NACE) at 30 days. Secondary outcomes were
long-term NACE, short-, and long-term major adverse cardiovascular events,
all-cause mortality, myocardial infarction, unplanned revascularization,
stent thrombosis, and major bleeding. <br/>Result(s): We identified 10
RCTs, including 16,328 patients who underwent TRI (mean age 64.6 +/- 15.7
years, 72.5% male). Bivalirudin use was associated with decreased 30-day
NACE compared with heparin (6.3 vs. 7.4%; risk ratio [RR] = 0.87; 95%
confidence interval [CI] = 0.76-0.99; p =.04; number needed to treat =
91). No significant interactions were observed based on clinical
presentation, administration of P2Y<inf>12</inf> inhibitors, or
glycoprotein IIb/IIIa-receptor inhibitors (GPI) use. There were no
significant differences between groups in any prespecified secondary
outcomes. There was, however, a significant reduction of major bleeding in
the bivalirudin group compared with heparin when used in combination with
routine GPI (RR = 0.41; 95% CI = 0.19-0.90; p =.03). <br/>Conclusion(s):
Among patients undergoing TRI, use of bivalirudin was associated with
significantly reduced 30-day NACE compared with heparin. There was no
significant difference in long term NACE, ischemic, or bleeding events
compared with heparin.<br/>Copyright &#xa9; 2020 Wiley Periodicals, Inc.

<11>
Accession Number
2005425430
Title
Transcatheter aortic valve implantation in patients with severe aortic
valve stenosis at low surgical risk: A health technology assessment.
Source
Ontario Health Technology Assessment Series. 20 (14) (pp 1-148), 2020.
Date of Publication: 2020.
Publisher
Health Quality Ontario
Abstract
Background Surgical aortic valve replacement (SAVR) is the conventional
treatment for patients with severe aortic valve stenosis at low surgical
risk. Transcatheter aortic valve implantation (TAVI) is a less invasive
procedure. We conducted a health technology assessment (HTA) of TAVI for
patients with severe aortic valve stenosis at low surgical risk, which
included an evaluation of effectiveness, safety, cost-effectiveness, the
budget impact of publicly funding TAVI, and patient preferences and
values. Methods We used the 2016 Health Quality Ontario HTA on
TAVI² as a source of eligible studies and performed a
systematic literature search for studies published since the 2016 review.
Eligible primary studies identified both through the 2016 HTA and through
our complementary literature search were used in a de novo analysis. We
assessed the risk of bias of each included study using the Cochrane
risk-of-bias tool and the quality of the body of evidence according to the
Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
Working Group criteria. An applicable, previously conducted
cost-effectiveness analysis was available, so we did not conduct a primary
economic evaluation. We analyzed the budget impact of publicly funding
TAVI in people at low surgical risk in Ontario. We also performed a
literature survey of the quantitative evidence of preferences and values
of patients for TAVI. The Canadian Agency for Drugs and Technologies in
Health (CADTH) conducted a review to evaluate the qualitative literature
on patient and provider preferences and values for TAVI. To contextualize
the potential value of TAVI, we spoke with people with severe aortic valve
stenosis. Results We identified two randomized controlled trials that
compared TAVI (transfemoral route) and SAVR in patients with severe aortic
valve stenosis at low surgical risk. Both studies have an ongoing
follow-up of 10 years, but 1-year and limited 2-year follow-up results are
currently available. At 30 days, compared with SAVR, TAVI had a slightly
lower risk of mortality (risk difference -0.8%, 95% confidence interval
[CI] -1.5% to -0.1%, GRADE: Moderate) and disabling stroke (risk
difference -0.8%, 95% CI -1.8% to -0.2%, GRADE: Moderate), and resulted in
more patients with symptom improvement (risk difference 11.8%, 95% CI 8.2%
to 15.5%, GRADE: High) and in a greater improvement in quality of life
(GRADE: High). At 1 year, TAVI and SAVR were similar with regard to
mortality (GRADE: Low), although TAVI may result in a slightly lower risk
of disabling stroke (GRADE: Moderate). Both TAVI and SAVR resulted in a
similar improvement in symptoms and quality of life at 1 year (GRADE:
Moderate). Compared with SAVR, TAVI had a higher risk of some
complications and a lower risk of others. Device-related costs for TAVI
(about $25,000) are higher than for SAVR (about $6,000). A published
cost-effectiveness analysis conducted from an Ontario Ministry of Health
perspective showed TAVI to be more expensive and, on average, slightly
more effective (i.e., it was associated with more quality-adjusted
life-years [QALYs]) than SAVR. Compared with SAVR, the incremental
cost-effectiveness ratios (ICERs) were $27,196 per QALY and $59,641 per
QALY for balloon-expandable and self-expanding TAVI, respectively.
Balloon-expandable TAVI was less costly (by $2,330 on average) and
slightly more effective (by 0.02 QALY on average) than self-expanding
TAVI. Among the three interventions, balloon-expandable TAVI had the
highest probability of being cost-effective. It was the preferred option
in 53% and 59% of model iterations, at willingness-to-pay values of
$50,000 and $100,000 per QALY, respectively. Self-expanding TAVI was
preferred in less than 10% of iterations. The budget impact of publicly
funding TAVI in Ontario is estimated to be an additional $5 to $8 million
each year for the next 5 years. The budget impact could be significantly
reduced with reductions in the device price. We did not find any
quantitative or qualitative evidence on patient preferences and values
specific to the low-risk surgical group. Among a mixed or generally
high-risk and population, people typically preferred the less invasive
nature and the faster recovery time of TAVI compared with SAVR, and people
were satisfied with the TAVI procedure. Patients with severe aortic valve
stenosis at low surgical risk and their caregivers perceived that TAVI
minimized pain and recovery time. Most patients who had TAVI returned to
their usual activities more quickly than they would have if they had had
SAVR. Our direct patient and caregiver consultations indicated a
preference for TAVI over SAVR. Conclusions Both TAVI (transfemoral route)
and SAVR resulted in improved patient symptoms and quality of life during
the 1 year of follow-up. The TAVI procedure is less invasive and resulted
in greater symptom improvement and quality of life than SAVR 30 days after
surgery. The TAVI procedure also resulted in a small improvement in
mortality and disabling stroke at 30 days. At 1 year, TAVI and SAVR were
similar with regard to mortality, although TAVI may result in a slightly
lower risk of disabling stroke. According to the study authors, longer
follow-up is needed to better understand how long TAVI valves last and to
draw definitive conclusions on the long-term outcomes of TAVI compared
with SAVR beyond 1 year. The TAVI procedure might be cost-effective for
patients at low surgical risk; however, there is some uncertainty in this
result. We estimated that the additional cost to provide public funding
for TAVI in people with severe aortic valve stenosis at low surgical risk
would range from about $5 million to $8 million over the next 5 years.
Among a mixed or generally high-risk population, people typically
preferred the less invasive nature and the faster recovery time of TAVI
compared with SAVR.<br/>Copyright &#xa9; Queen's Printer for Ontario,
2020.

<12>
Accession Number
2007371725
Title
Techniques for blood loss estimation in major non-cardiac surgery: a
systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2020. Date of
Publication: 2020.
Author
Tran A.; Heuser J.; Ramsay T.; McIsaac D.M.; Martel G.
Institution
(Tran, Heuser, Martel) Department of Surgery, University of Ottawa,
Ottawa, ON, Canada
(Ramsay, McIsaac, Martel) Ottawa Hospital Research Institute, The Ottawa
Hospital - General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
(McIsaac) Department of Anesthesiology, University of Ottawa, Ottawa, ON,
Canada
Publisher
Springer
Abstract
Purpose: Estimated blood loss (EBL) is an important tool in clinical
decision-making and surgical outcomes research. It guides perioperative
transfusion practice and serves as a key predictor of short-term
perioperative risks and long-term oncologic outcomes. Despite its
widespread clinical and research use, there is no gold standard for blood
loss estimation. We sought to systematically review and compare techniques
for intraoperative blood loss estimation in major non-cardiac surgery with
the objective of informing clinical estimation and research standards.
Source: A structured search strategy was applied to Ovid Medline, Embase,
and Cochrane Library databases from inception to March 2020, to identify
studies comparing methods of intraoperative blood loss in adult patients
undergoing major non-cardiac surgery. We summarized agreement between
groups of pairwise comparisons as visual estimation vs formula estimation,
visual estimation vs other, and formula estimation vs other. For each of
these comparisons, we described tendencies for higher or lower EBL values,
consistency of findings, pooled mean differences, standard deviations, and
confidence intervals. Principle findings: We included 26 studies involving
3,297 patients in this review. We found that visual estimation is the most
frequently studied technique. In addition, visual techniques tended to
provide lower EBL values than formula-based estimation or other
techniques, though this effect was not statistically significant in pooled
analyses likely due to sample size limitations. When accounting for the
contextual mean blood loss, similar case-to-case variation exists for all
estimation techniques. <br/>Conclusion(s): We found that significant
case-by-case variation exists for all methods of blood loss evaluation and
that there is significant disagreement between techniques. Given the
importance placed on EBL, particularly for perioperative prognostication
models, clinicians should consider the universal adoption of a practical
and reproducible method for blood loss evaluation. Trial registration:
PROSPERO (CRD42015029439); registered: 18 November 2015.PROSPERO
(CRD42015029439); registered: 18 November 2015.<br/>Copyright &#xa9; 2020,
Canadian Anesthesiologists' Society.

<13>
Accession Number
2007103936
Title
Feasibility of Perioperative eHealth Interventions for Older Surgical
Patients: A Systematic Review.
Source
Journal of the American Medical Directors Association. 21 (12) (pp
1844-1851.e2), 2020. Date of Publication: December 2020.
Author
Jonker L.T.; Haveman M.E.; de Bock G.H.; van Leeuwen B.L.; Lahr M.M.H.
Institution
(Jonker, Haveman, van Leeuwen) Department of Surgery, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(Jonker, de Bock, Lahr) Department of Epidemiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
Publisher
Elsevier Inc.
Abstract
Objectives: EHealth interventions are increasingly being applied in
perioperative care but have not been adequately studied for older surgical
patients who could potentially benefit from them. Therefore, we evaluated
the feasibility of perioperative eHealth interventions for this
population. <br/>Design(s): A systematic review of prospective
observational and interventional studies was conducted. Three electronic
databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and
July 2019. Study quality was assessed by Methodological Index for
Non-Randomized Studies (MINORS) with and without control group. Setting
and Participants: Studies of surgical patients with an average age >=65
years undergoing any perioperative eHealth intervention with active
patient participation (with the exception of telerehabilitation following
orthopedic surgery) were included. Measures: The main outcome measure was
feasibility, defined as a patient's perceptions of usability,
satisfaction, and/or acceptability of the intervention. Other outcomes
included compliance and study completion rate. <br/>Result(s): Screening
of 1569 titles and abstracts yielded 7 single-center prospective studies
with 223 patients (range n = 9-69 per study, average age 66-74 years)
undergoing oncological, cardiovascular, or orthopedic surgery. The median
MINORS scores were 13.5 of 16 for 6 studies without control group, and 14
of 24 for 1 study with a control group. Telemonitoring interventions were
rated as "easy to use" by 89% to 95% of participants in 3 studies.
Patients in 3 studies were satisfied with the eHealth intervention and
would recommend it to others. Acceptability (derived from consent rate)
ranged from 71% to 89%, compliance from 53% to 86%, and completion of
study follow-up from 54% to 95%. Conclusions and Implications: Results of
7 studies involving perioperative eHealth interventions suggest their
feasibility and encourage further development of technologies for older
surgical patients. Future feasibility studies require clear definitions of
appropriate feasibility outcome measures and a comprehensive description
of patient characteristics such as functional performance, level of
education, and socioeconomic status.<br/>Copyright &#xa9; 2020 AMDA - The
Society for Post-Acute and Long-Term Care Medicine

<14>
Accession Number
2006725744
Title
Relationships between mitral annular calcification and cardiovascular
events: A meta-analysis.
Source
Echocardiography. 37 (11) (pp 1723-1731), 2020. Date of Publication:
November 2020.
Author
Wang T.K.M.; Griffin B.P.; Xu B.; Rodriguez L.L.; Popovic Z.B.; Gillinov
M.A.; Pettersson G.B.; Desai M.Y.
Institution
(Wang, Griffin, Xu, Rodriguez, Popovic, Desai) Section of Cardiovascular
Imaging, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH,
United States
(Gillinov, Pettersson) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Mitral annular calcification (MAC) is prevalent in the aging
population, with recent renewed interest regarding its associations with
cardiovascular risk factors, outcomes, and influence on valvular heart
disease and interventions. This meta-analysis aimed to report the
relationships between MAC and cardiovascular mortality and morbidity
events. <br/>Method(s): Relevant studies were searched from PubMed,
Cochrane, and Embase databases until November 30, 2019. Associations
between MAC as a binary variable with death and cardiovascular events were
pooled using random-effects models. The main outcomes of interest were
all-cause and cardiovascular mortality, myocardial infarction, stroke,
heart failure, atrial fibrillation, and procedural outcomes.
<br/>Result(s): Among 799 article abstracts and 122 full-text articles
screened, 26 (16 prospective and 10 retrospective) studies totaling 35 070
subjects were analyzed. MAC was associated with higher all-cause death,
hazard ratio (95% confidence interval) 1.76 (1.43-2.22), and
cardiovascular mortality 1.85 (1.45-23.5). It also positively correlated
with myocardial infarction 1.48 (1.22-1.79), stroke 1.51 (1.22-2.05),
incidental heart failure 1.55 (1.30-1.84), atrial fibrillation 1.75
(1.43-2.15), and their composite, major adverse cardiovascular events
(MACE). Finally, conversion to mitral valve replacement at time of cardiac
surgery was more in patients with MAC than without MAC, with odds ratio
(95% confidence interval) 2.82 (1.28-6.18). <br/>Conclusion(s): Mitral
annular calcification was overall associated with higher rates of death,
and both individual and composite cardiovascular events. The presence of
increasingly encountered MAC has significant clinical implications for
cardiovascular risk assessment and valvular interventions.<br/>Copyright
&#xa9; 2020 Wiley Periodicals LLC

<15>
Accession Number
631658377
Title
Clinical Prognosis of Right-Sided Infective Endocarditis not Associated
with Cardiac Devices or Intravenous Drug use: a Cohort Study and
Meta-Analysis.
Source
Scientific reports. 10 (1) (pp 7179), 2020. Date of Publication: 28 Apr
2020.
Author
Rigau P.V.; Moral S.; Bosch D.; Morales M.; Frigola J.M.; Albert X.;
Robles R.; Ballesteros E.; Roque M.; Aboal J.; Brugada R.
Institution
(Rigau, Moral, Bosch, Morales, Frigola, Albert, Robles, Aboal, Brugada)
Cardiology Department, Hospital Universitari Doctor Josep Trueta, Girona,
Spain
(Ballesteros) Radiology Department, Centre d'Atencio Primaria Pare Claret,
Institut Catala de la Salut, Barcelona, Spain
(Roque) Iberoamerican Cochrane Centre, Biomedical Research Institute Sant
Pau (IIB Sant Pau), CIBER Epidemiologia y Salud Publica (CIBERESP),
Barcelona, Spain
Publisher
NLM (Medline)
Abstract
Right-sided infective endocarditis (RSIE), classically associated with
intravenous drug use or intracardiac devices, is considered a
good-prognosis infective endocarditis (IE) form. However, predisposing
factors and prognosis for "NODID" RSIE (NOt associated with cardiac
Devices or Intravenous Drug use) remain unclear. The aim of this study was
to evaluate predisposing factors and prognosis of NODID RSIE compared to
other RSIE forms. A retrospective cohort study (January 2008-January 2019)
was conducted in a reference center on 300 patients diagnosed with IE.
Endocarditis-related events were defined as related to IE in mortality or
open-heart surgery during follow-up. A review and meta-analysis of
associated literature (January 2008-January 2019) were also performed.
Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE
(39%). Use of intravascular catheters (23% vs 3%; p=0.027) and congenital
heart diseases (18% vs 0%; p=0.019) were associated with NODID RSIE. This
group had a higher in-hospital mortality (23% vs 3%; p=0.027) and
endocarditis-related event rates (41% vs 6%; p=0.001) than non-NODID RSIE.
Furthermore, NODID RSIE was independently associated with in-hospital
endocarditis-related events (OR=19.29; 95%CI:2.23-167.16; p=0.007). Our
meta-analysis evaluated four studies and identified 96 cases (30%) of
NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated
higher in-hospital mortality (RR=2.81; 95%CI:1.61-4.90; p<0.001; I2=0.0%)
and necessity of open-heart surgery (RR=13.89; 95%CI:4.14-46.60; p<0.001;
I2=0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has
the highest endocarditis-related event rate and in-hospital mortality
among RSIE cases and therefore should not be considered a good-prognosis
IE.

<16>
Accession Number
630797914
Title
Effect of Eye Masks on Pain and Sleep Quality in Patients Undergoing
Cardiac Surgery: A Randomized Controlled Trial.
Source
Critical care nurse. 40 (1) (pp 27-35), 2020. Date of Publication: 01 Feb
2020.
Author
Mahran G.S.; Leach M.J.; Abbas M.S.; Abbas A.M.; Ghoneim A.M.
Institution
(Mahran) Critical Care Nursing Department, Faculty of Nursing, Assiut
University, Ghada Shalaby Mahran is a lecturer of critical care, Egypt
(Leach) Department of Rural Health, Division of Health Sciences,
University of South Australia, Matthew J. Leach is a senior research
fellow, Adelaide, SA, Australia
(Abbas) Department of Anesthesia and Intensive Care, Faculty of Medicine,
Assiut University, Mostafa Samy Abbas is an assistant professor
(Abbas) Department of Obstetrics and Gynecology, Faculty of Medicine,
Assiut University, Ahmed M. Abbas is an assistant professor
(Ghoneim) Department of Cardio-thoracic Surgery, Faculty of Medicine,
Assiut University, Ahmed Mohamed Ghoneim is a professor
Publisher
NLM (Medline)
Abstract
BACKGROUND: Impaired sleep is a common complaint among patients undergoing
major surgery and may be a contributing factor in postoperative pain. The
provision of eye masks to patients after cardiac surgery may reduce
postoperative pain through improvements in sleep quality.
<br/>OBJECTIVE(S): To examine the effect of nocturnal eye masks on
postoperative pain and sleep quality in cardiac surgical patients.
<br/>METHOD(S): In this randomized controlled trial, 70 adult patients who
had undergone cardiac surgery requiring immediate postoperative care in
the intensive care unit were randomly assigned to sleep with or without
nocturnal eye masks for the first 3 nights in the unit. A visual analog
scale was used to assess pain intensity, and the Arabic version of the
Richards-Campbell Sleep Questionnaire was used to assess subjective sleep
quality. <br/>RESULT(S): A total of 66 patients completed the trial. A
statistically significant difference was found between groups in mean
total Richards-Campbell Sleep Questionnaire score over the 3-day study
period (P = .001), with the intervention group reporting better sleep
quality. A statistically significant difference was also found between
groups in mean pain score on days 1, 2, and 3 (P < .001), with the
intervention group having less pain. <br/>CONCLUSION(S): Nocturnal eye
masks are a simple, low-risk, low-cost intervention that may contribute to
reductions in perceived pain in cardiac surgery patients.<br/>Copyright
&#xa9;2020 American Association of Critical-Care Nurses.

<17>
Accession Number
633531569
Title
Effects of a preoperative forced-air warming system for patients
undergoing video-assisted thoracic surgery: A randomized controlled trial.
Source
Medicine. 99 (48) (pp e23424), 2020. Date of Publication: 25 Nov 2020.
Author
Xiao Y.; Zhang R.; Lv N.; Hou C.; Ren C.; Xu H.
Institution
(Xiao, Zhang, Lv, Hou) Department of Operation Room
(Ren, Xu) Department of Anaesthesiology, Liaocheng People's Hospital,
Liaocheng, Shandong, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The incidence of intraoperative hypothermia is still high
despite the proposal of different preventive measures during thoracoscopic
surgery. This randomized control study evaluated the effects of 30-minute
prewarming combined with a forced-air warming system during surgery to
prevent intraoperative hypothermia in patients undergoing video-assisted
thoracic surgery under general anesthesia combined with erector spinae
nerve block. <br/>METHOD(S): Ninety-eight patients were randomly and
equally allocated to prewarming or warming groups (n = 49 each). The
primary outcome was the incidence of intraoperative hypothermia. Secondary
outcomes were core temperature, irrigation and infused fluid, estimated
blood loss, urine output, type of surgery, intraoperative anesthetic
dosage, hemodynamics, recovery time, the incidence of postoperative
shivering, thermal comfort, postoperative sufentanil consumption and pain
intensity, patient satisfaction, and adverse events. <br/>RESULT(S): The
incidence of intraoperative hypothermia was significantly lower in the
prewarming group than the warming group (12.24% vs 32.65%, P = .015). Core
temperature showed the highest decrease 30 minutes after surgery start in
both groups; however, the rate was lower in the prewarming than in the
warming group (0.31 +/- 0.04degreeC vs 0.42 +/- 0.06degreeC, P < .05).
Compared with the warming group, higher core temperatures were recorded
for patients in the prewarming group from T1 to T6 (P < .05).
Significantly fewer patients with mild hypothermia were in the prewarming
group (5 vs 13, P = .037) and recovery time was significantly reduced in
the prewarming group (P < .05). Although the incidence of postoperative
shivering was lower in the prewarming group, it was not statistically
significant (6.12% vs 18.37%, P = .064). Likewise, the shivering severity
was similar for both groups. Thermal comfort was significantly increased
in the prewarming group, although patient satisfaction was comparable
between the 2 groups (P > .05). No adverse events occurred associated with
the forced-air warming system. Both groups shared similar baseline
demographics, type of surgery, total irrigation fluid, total infused
fluid, estimated blood loss, urine output, intraoperative anesthetic
dosage, hemodynamics, duration of anesthesia and operation time,
postoperative sufentanil consumption, and pain intensity.
<br/>CONCLUSION(S): In patients undergoing video-assisted thoracic
surgery, prewarming for 30 minutes before the induction of anesthesia
combined with a forced-air warming system may improve perioperative core
temperature and the thermal comfort, although the incidence of
postoperative shivering and severity did not improve.

<18>
Accession Number
2010129975
Title
Should cardiac surgery be delayed in patients with uncorrected
hypothyroidism?.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (5) (pp 618-621),
2020. Date of Publication: 01 Nov 2020.
Author
Ang Z.H.; Fong L.S.; Wolfenden H.D.; Grant P.W.
Institution
(Ang, Fong, Wolfenden, Grant) Department of Cardiothoracic Surgery, Prince
of Wales Hospital, Randwick, NSW, Australia
(Ang) Prince of Wales Clinical School, Unsw Sydney, Sydney, NSW, Australia
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: 'should cardiac surgery
be delayed in patients with uncorrected hypothyroidism?' A total of 1412
papers were found using the reported search, of which 7 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. There was limited
high-quality evidence with the majority of the studies being
retrospective. One propensity-matched analysis and 6 cohort studies
provided the evidence that there was no significant difference in the rate
of major adverse cardiac events including mortality based on thyroid
status. However, hypothyroidism and subclinical hypothyroidism were
associated with higher rates of postoperative atrial fibrillation. Based
on the available evidence, we conclude that cardiac surgery should not be
delayed to allow achievement of euthyroid status. <br/>Copyright &#xa9;
2020 The Author(s) 2020. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
2010129971
Title
Mortality in low-risk patients with aortic stenosis undergoing
transcatheter or surgical aortic valve replacement: A reconstructed
individual patient data meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (5) (pp 587-594),
2020. Date of Publication: 01 Nov 2020.
Author
Celik M.; Milojevic M.M.; Durko A.P.; Oei F.B.S.; Bogers A.J.J.C.; Mahtab
E.A.F.
Institution
(Celik, Milojevic, Durko, Oei, Bogers, Mahtab) Department of
Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Although the standard of care for patients with severe aortic
stenosis at low-surgical risk has included surgical aortic valve
replacement (SAVR) since the mid-1960s, many clinical studies have
investigated whether transcatheter aortic valve implantation (TAVI) can be
a better approach in these patients. As no individual study has been
performed to detect the difference in mortality between these 2 treatment
strategies, we did a reconstructive individual patient data analysis to
study the long-term difference in all-cause mortality. <br/>METHOD(S):
Randomized clinical trials and propensity score-matched studies that
included low-risk adult patients with severe aortic stenosis undergoing
either SAVR or TAVI and with reports on the mortality rates during the
follow-up period were considered. The primary outcome was all-cause
mortality of up to 5 years. <br/>RESULT(S): In the reconstructed
individual patient data analysis, there was no statistically significant
difference in all-cause mortality between TAVI and SAVR at 5 years of
follow-up [30.7% vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval
(CI) 0.96-1.48; P = 0.104]. However, landmark analyses in patients
surviving up to 1 year of follow-up showed significantly higher all-cause
mortality at 5 years of follow-up (27.5% vs 17.3%, HR 1.77, 95% CI
1.29-2.43; P < 0.001) in patients undergoing TAVI compared to patients
undergoing SAVR, respectively. <br/>CONCLUSION(S): This reconstructed
individual patient data analysis in low-risk patients with severe aortic
stenosis demonstrates that the 5-year all-cause mortality rates are higher
after TAVI than after SAVR, driven by markedly higher mortality rates
between 1 and 5 years of follow-up in the TAVI group. The present results
call for caution in expanding the TAVI procedure as the treatment of
choice for the majority of all low-risk patients until long-term data from
contemporary randomized clinical trials are available. <br/>Copyright
&#xa9; 2020 The Author(s) 2020. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<20>
Accession Number
2010088354
Title
Intracoronary ALLogeneic heart STem cells to Achieve myocardial
Regeneration (ALLSTAR): A randomized, placebo-controlled, double-blinded
trial.
Source
European Heart Journal. 41 (36) (pp 3451-3458), 2020. Date of Publication:
21 Sep 2020.
Author
Makkar R.R.; Kereiakes D.J.; Aguirre F.; Kowalchuk G.; Chakravarty T.;
Malliaras K.; Francis G.S.; Povsic T.J.; Schatz R.; Traverse J.H.; Pogoda
J.M.; Smith R.R.; Marban L.; Ascheim D.D.; Ostovaneh M.R.; Lima J.A.C.;
DeMaria A.; Marban E.; Henry T.D.
Institution
(Makkar, Chakravarty, Marban, Henry) Smidt Heart Institute, Cedars-Sinai
Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United
States
(Kereiakes) Christ Hospital, Cincinnati, 2139 Auburn Ave, Cincinnati, OH
45219, United States
(Aguirre) Prairie/St. Johns Hospital, Springfield, 800 E Carpenter St,
Springfield, IL 62769, United States
(Kowalchuk) Sanger Heart and Vascular, Charlotte, 1001 Blythe Blvd Ste
300, Charlotte, NC 28203, United States
(Malliaras) University of Athens, 17 Agiou Thoma street, Athens 11527,
Greece
(Francis) University of Minnesota Heart Care, Minneapolis, 6405 France Ave
S, Edina, MN 55435, United States
(Povsic) Duke University Hospital, Durham, 2301 Erwin Rd, Durham, NC
27710, United States
(Schatz) Scripps Green Hospital, 10666 N Torrey Pines Rd, San diego, CA
92037, United States
(Traverse) Minneapolis Heart Institute Foundation, 920 E 28th St Ste 100,
Minneapolis, MN 55407, United States
(Pogoda, Smith, Marban, Ascheim) 10Capricor Therapeutics, Los Angeles,
8840 Wilshire Blvd Ste 2, Beverly Hills, CA 90211, United States
(Ostovaneh, Lima) Johns Hopkins University, 3400 N Charles St, Baltimore,
MD 21218, United States
(DeMaria) University of California San Diego Medical Center, 200 W. Arbor
Drive, San Diego, CA 92103, United States
Publisher
Oxford University Press
Abstract
Aims Cardiosphere-derived cells (CDCs) are cardiac progenitor cells that
exhibit disease-modifying bioactivity in various models of cardiomyopathy
and in previous clinical studies of acute myocardial infarction (MI),
dilated cardiomyopathy, and Duchenne muscular dystrophy. The aim of the
study was to assess the safety and efficacy of intracoronary
administration of allogeneic CDCs in the multicentre, randomized,
double-blinded, placebo-controlled, intracoronary ALLogeneic heart STem
cells to Achieve myocardial Regeneration (ALLSTAR) trial. Methods and We
enrolled patients 4 weeks to 12 months after MI, with left ventricular
ejection fraction (LVEF) <_45% and LV results scar size >_15% of LV mass
by magnetic resonance imaging (MRI). A pre-specified interim analysis was
performed when 6-month MRI data were available. The trial was subsequently
stopped due to the low probability of detecting a significant treatment
effect of CDCs based on the primary endpoint. Patients were randomly
allocated in a 2:1 ratio to receive CDCs or placebo in the infarct-related
artery by stop-flow technique. The primary safety endpoint was the
occurrence, during 1-month post-intracoronary infusion, of acute
myocarditis attributable to allogeneic CDCs, ventricular tachycardia- or
ventricular fibrillation-related death, sudden unexpected death, or a
major adverse cardiac event (death or hospitalization for heart failure or
non-fatal MI or need for left ventricular assist device or heart
transplant). The primary efficacy endpoint was the relative percentage
change in infarct size at 12 months post-infusion as assessed by
contrast-enhanced cardiac MRI. We randomly allocated 142 eligible patients
of whom 134 were treated (90 to the CDC group and 44 to the placebo
group). The mean baseline LVEF was 40% and the mean scar size was 22% of
LV mass. No primary safety endpoint events occurred. There was no
difference in the percentage change from baseline in scar size (P = 0.51)
between CDCs and placebo groups at 6 months. Compared with placebo, there
were significant reductions in LV end-diastolic volume (P = 0.02), LV
end-systolic volume (P = 0.02), and N-terminal pro b-type natriuretic
peptide (NT-proBNP) (P = 0.02) at 6 months in CDC-treated patients.
Conclusion Intracoronary infusion of allogeneic CDCs in patients with
post-MI LV dysfunction was safe but did not reduce scar size relative to
placebo at 6 months. Nevertheless, the reductions in LV volumes and
NT-proBNP reveal disease-modifying bioactivity of CDCs.<br/>Copyright
&#xa9; 2020 Oxford University Press. All rights reserved.

<21>
Accession Number
2010119061
Title
Functional and Echocardiographic Improvement After Transcatheter Repair
for Tricuspid Regurgitation: A Systematic Review and Pooled Analysis.
Source
JACC: Cardiovascular Interventions. (pp 2719-2729), 2020. Date of
Publication: 2020.
Author
Montalto C.; Sticchi A.; Crimi G.; Laricchia A.; Khokhar A.; Giannini F.;
Ferlini M.; Colombo A.; Latib A.; Mangieri A.
Institution
(Montalto, Crimi, Ferlini) Division of Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Sticchi, Crimi) Campus Bio-Medico di Roma, Rome, Italy
(Sticchi, Crimi, Laricchia, Khokhar, Giannini, Colombo, Mangieri) GVM Care
and Research, Maria Cecilia Hospital, Cotignola, Italy
(Crimi) Interventional Cardiology Unit, Thoraco Vascular Department
(DICATOV), IRCCS Policlinico San Martino, Genova, Italy
(Latib) Montefiore Medical Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the feasibility, efficacy,
and clinical outcomes of transcatheter repair of tricuspid regurgitation
(TR) in a pooled analysis of interventional studies. <br/>Background(s):
New percutaneous devices are available to treat severe TR, but the
evidence is sparse and limited to smaller cohorts. <br/>Method(s): Several
electronic databases were searched for interventional studies involving
percutaneous repair of TR. Devices used were the Cardioband, FORMA,
MitraClip, PASCAL, and Trialign. Outcomes included in the final analysis
were successful implantation, residual severe TR, post-procedural New York
Heart Association (NYHA) functional class III or IV, 6-min walk distance,
and echocardiographic parameters. Subgroup and meta-regression analysis
were performed to further explore residual heterogeneity. <br/>Result(s):
Seven studies and 454 patients undergoing transcatheter tricuspid valve
repair were included in the pooled analysis; 95% of patients had at least
severe TR, and 91% were in NYHA functional class III or IV. Successful
implantation was achieved in 86% of patients. At the longest follow-up
available (weighted mean 265 days), 9% had died. Compared with baseline, a
significantly lower proportion of patients had at least severe TR
(relative risk: 0.38; 95% confidence interval: 0.20 to 0.70; p = 0.004)
and were in NYHA functional class III or IV (relative risk: 0.23; 95%
confidence interval: 0.20 to 0.30; p < 0.001). Patients also experienced
increases in 6-min walk distance (mean difference +64.6 m; p < 0.001) and
significant reductions in tricuspid valve annular diameter (mean
difference -3 mm; p < 0.001), while left and right ventricular function
did not change significantly. <br/>Conclusion(s): A strategy of
transcatheter repair for severe TR appears to be feasible, effective, and
associated with improved clinical outcomes at mid-term
follow-up.<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<22>
Accession Number
2010119020
Title
Short- and long-term functional results following drug-coated balloons
versus drug- eluting stents in small coronary vessels: The RESTORE
quantitative flow ratio study.
Source
International Journal of Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Li L.; Guan C.; Meng S.; Bai Y.; Zhang Z.; Zou K.; Ruan Y.; Cao X.; Jia
R.; Guo C.; Escaned J.; Jin Z.; Xu B.
Institution
(Li, Meng, Ruan, Cao, Jia, Guo, Jin) Department of Cardiology, Beijing
Tiantan Hospital, Capital Medical University, Beijing, China
(Guan, Xu) Catheterization Laboratories, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing, China
(Bai) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases, Beijing, China
(Zhang) JetMed, Beijing, China
(Zou, Jin) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Escaned) Department of Cardiology, Hospital Clinico San Carlos, Madrid,
Spain
(Xu) National Clinical Research Centre for Cardiovascular Diseases,
Beijing, China
Publisher
Elsevier Ireland Ltd
Abstract
Background Immediate and long-term functional outcomes after percutaneous
treatment of small vessel disease (SVD) with drug-coated balloon (DCB)
versus drug-eluting stent (DES) remain unknown. The study sought to
investigate whether treatment of de novo SVD with DCB yields similar
functional results compared with DES, as judged with angiography-based
quantitative flow ratio (QFR). Methods and results QFR was measured at
pre-procedural, post-procedural and 9-month angiography in all available
subjects from the non-inferiority RESTORE SVD China trial, in which
patients were randomized to Restore DCB (n = 116) or Resolute DES (n =
114) study arms. Primary outcome of this analysis was 9-month QFR.
Pre-procedural, post-procedural and 9-month QFR was performed in 84.8%
(195/230), 83.0% (191/230) and 93.8% (181/193) cases, respectively. At 9
months, the QFR of DCB showed no significant difference to DES (0.88 +/-
0.23 vs. 0.92 +/- 0.12, p = 0.12). Both 9-month QFR and the QFR difference
between post-procedure and 9-month follow-up were correlated with
angiographic percentage of diameter stenosis and late loss, and predictive
of 2-year clinical outcome. Conclusions Treatment of coronary SVD with DCB
resulted in similar 9-month functional results compared with DES. This
study provides evidences to the value of QFR as a mean of evaluating
device performance after coronary revascularization. Clinical trial
registration URL: https://www.clinicaltrials.gov; ClinicalTrial.gov:
Identifier: NCT02946307.<br/>Copyright &#xa9; 2020 Elsevier B.V.

<23>
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. <br/>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). <br/>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.].<br/>Copyright &#xa9; 2020, The
Author(s).

<24>
Accession Number
633533102
Title
Positive expiratory pressure in postoperative cardiac patients in
intensive care: A randomized controlled trial.
Source
Clinical rehabilitation. (pp 269215520972701), 2020. Date of Publication:
24 Nov 2020.
Author
Pieczkoski S.M.; de Oliveira A.L.; Haeffner M.P.; Azambuja A.C.M.; Sbruzzi
G.
Institution
(Pieczkoski, Azambuja, Sbruzzi) Postgraduate Program in Human Movement
Sciences, Universidade Federal do Rio Grande do Sul, RS, Porto Alegre,
Brazil
(de Oliveira, Sbruzzi) Physiotherapy Course, Universidade Federal do Rio
Grande do Sul, RS, Porto Alegre, Brazil
(Haeffner, Sbruzzi) Hospital de Clinicas de Porto Alegre, RS, Porto
Alegre, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate effectiveness of positive expiratory pressure
blow-bottle device compared to expiratory positive airway pressure and
conventional physiotherapy on pulmonary function in postoperative cardiac
surgery patients in intensive care unit. DESIGN: A randomized controlled
trial. SETTINGS: Tertiary care. SUBJECTS: 48 patients (16 in each group;
aged 64.5+/-9.1years, 38 male) submitted to cardiac surgery.
INTERVENTIONS: Patients were randomized into conventional physiotherapy
(G1), positive expiratory pressure blow-bottle device (G2) or expiratory
positive airway pressure, both associated with conventional physiotherapy
(G3). G2 and G3performed three sets of 10 repetitions in each session for
each technique. MAIN MEASURES: Pulmonary function (primary); respiratory
muscle strength, radiological changes, pulmonary complications, length of
intensive care unit and hospital stay (secondary) assessed preoperatively
and on the 3rd postoperative day. <br/>RESULT(S): Pulmonary function
(except for forced expiratory volume in one second/ forced vital capacity
% predicted) and respiratory muscle strength showed significant reduction
from the preoperative to the 3rd postoperative in all groups (P<0.001),
with no difference between groups (P>0.05). Regarding radiological
changes, length of intensive care unit stay and length of hospital stay,
there was no significant difference between groups (P>0.05).
<br/>CONCLUSION(S): Both positive expiratory pressure techniques
associated with conventional physiotherapy were similar, but there was no
difference regarding the use of positive expiratory pressure compared to
conventional physiotherapy. CLINICAL TRIAL REGISTRATION NUMBER:
NCT03639974.https://clinicaltrials.gov/ct2/show/NCT03639974.

<25>
Accession Number
633530666
Title
Reduction in acute kidney injury post cardiac surgery using balanced
forced diuresis: a randomized, controlled trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2020.
Date of Publication: 25 Nov 2020.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Cardiothoracic Surgeon, American Hospital, Dubai, United Arab
Emirates
(Giri) Cardiothoracic Anaesthesiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Wrigley) Interventional Cardiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Specialist Registrar Cardiothoracic Surgery, Heart
and Lung Centre, Wolverhampton, United Kingdom
(Sharman) Research and Development Department, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Beare) Senior Clinical Perfusionist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nevill) Statistics, Faculty of Education, Health and Wellbeing,
University of Wolverhampton, Wolverhampton, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Our goal was to investigate the efficacy of balanced forced
diuresis in reducing the rate of acute kidney injury (AKI) in cardiac
surgical patients requiring cardiopulmonary bypass (CPB), using the
RenalGuard (RG) system. <br/>METHOD(S): Patients at risk of developing AKI
(history of diabetes and/or anaemia; estimated glomerular filtration rate
20-60ml/min/1.73 m2; anticipated CPB time >120min; log EuroSCORE > 5) were
randomized to the RG system group (n=110) or managed according to current
practice (control = 110). The primary end point was the development of AKI
within the first 3 postoperative days as defined by the RIFLE (Risk,
Injury, Failure, Loss of kidney function, End-stage renal disease)
criteria. <br/>RESULT(S): There were no significant differences in
preoperative and intraoperative characteristics between the 2 groups.
Postoperative AKI rates were significantly lower in the RG system group
compared to the control group [10% (11/110) vs 20.9% (23/110); P=0.025].
This effect persisted even after controlling for a number of potential
confounders (odds ratio 2.82, 95% confidence interval 1.20-6.60; P=0.017)
when assessed by binary logistic regression analysis. The mean volumes of
urine produced during surgery and within the first 24h postoperatively
were significantly higher in the RG system group (P<0.001). There were no
significant differences in the incidence of blood transfusions, atrial
fibrillation and infections and in the median duration of intensive care
unit stays between the groups. The number needed to treat with the RG
system to prevent AKI was 9 patients (95% confidence interval 6.0-19.2).
<br/>CONCLUSION(S): In patients at risk for AKI who had cardiac surgery
with CPB, the RS RG system significantly reduced the incidence of AKI and
can be used safely and reproducibly. Larger studies are required to
confirm cost benefits. Clinical trial registration number:
NCT02974946.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<26>
Accession Number
633530362
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: 25 Nov 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,
Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
Publisher
NLM (Medline)
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. <br/>METHOD(S): This systematic review with meta-analyses
and trial sequential analysis (TSA) was conducted using Cochrane standards
and GRADE methodology. Randomised clinical trials comparing perioperative
antioxidant treatment vs. placebo/no intervention in adults were included.
Primary outcome was mortality at longest follow-up. <br/>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 to 1.02) and
only 31% of the required information size was reached. Further, 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. <br/>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.<br/>Copyright This article is protected by copyright. All rights
reserved.

<27>
Accession Number
2008361172
Title
Postdischarge Pain Management After Thoracic Surgery: A Patient-Centered
Approach.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1714-1721), 2020. Date of
Publication: November 2020.
Author
Abrams B.A.; Murray K.A.; Mahoney K.; Raymond K.M.; McWilliams S.K.;
Nichols S.; Mahmoudi E.; Mayes L.M.; Fernandez-Bustamante A.; Mitchell
J.D.; Meguid R.A.; Zanotti G.; Bartels K.
Institution
(Abrams, Mahoney, Mayes, Fernandez-Bustamante, Bartels) Department of
Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora,
CO, United States
(Murray) Center for Outcomes Research and Evaluation, Maine Medical Center
Research Institute, Portland, ME, United States
(Raymond, McWilliams) Department of Psychiatry, University of Colorado,
Anschutz Medical Campus, Aurora, CO, United States
(Nichols) Department of Pharmacy Practice, College of Pharmacy, University
of New England, Portland, ME, United States
(Mahmoudi) Department of Family Medicine, University of Michigan, Ann
Arbor, MI, United States
(Mitchell, Meguid, Bartels) Department of Surgery, University of Colorado,
Anschutz Medical Campus, Aurora, CO, United States
(Zanotti) St. Vincent Hospital, Heart Center of Indiana, Indianapolis, IN,
United States
Publisher
Elsevier Inc.
Abstract
Background: Postoperative analgesia is paramount to recovery after
thoracic surgery, and opioids play an invaluable role in this process.
However, current 1-size-fits-all prescribing practices produce large
quantities of unused opioids, thereby increasing the risk of nonmedical
use and overdose. This study hypothesized that patient and perioperative
characteristics, including 24-hour before-discharge opioid intake, could
inform more appropriate postdischarge prescriptions after thoracic
surgery. <br/>Method(s): This prospective observational cohort study was
conducted in 200 adult thoracic surgical patients. The cohort was divided
into 3 groups on the basis of 24-hour before-discharge opioid intake in
morphine milligram equivalents (MME): (1) no (0 MME), (2) low (>0 to
<=22.5 MME), or (3) high (>22.5 MME) before-discharge opioid intake.
Logistic regression was used to analyze the association of patient and
perioperative characteristics with self-reported after-discharge opioid
use. <br/>Result(s): Univariate analysis showed that preoperative opioid
use, 24-hour before-discharge acetaminophen and gabapentinoid intake, and
24-hour before-discharge opioid intake were associated with higher
after-discharge opioid use. Multivariable modeling demonstrated that
24-hour before-discharge opioid intake was most significantly associated
with after-discharge opioid use. For example, compared with patients who
took high amounts of opioids before discharge, patients who took no
opioids before discharge were 99% less likely to take a high amount of
opioids after discharge compared with taking none (odds ratio, 0.011; 95%
confidence interval, 0.003 to 0.047; P < .001). <br/>Conclusion(s):
Assessment of 24-hour before-discharge opioid intake may inform patient
requirements after discharge. Opioid prescriptions after thoracic surgery
can thereby be targeted on the basis of anticipated needs.<br/>Copyright
&#xa9; 2020 The Society of Thoracic Surgeons

<28>
[Use Link to view the full text]
Accession Number
631966439
Title
Prognostic Value of Resting Distal-To-Aortic Coronary Pressure in Clinical
Practice.
Source
Circulation: Cardiovascular Interventions. 13 (5) (no pagination), 2020.
Article Number: e007868. Date of Publication: 01 May 2020.
Author
Ahn J.-M.; Park D.-W.; Kim S.-O.; Kang D.-Y.; Lee C.-H.; Lee P.H.; Lee
S.-W.; Park S.-W.; Park S.-J.
Institution
(Ahn, Park, Kang, Lee, Lee, Park, Park) Department of Cardiology, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
(Kim) Department of Clinical Epidemiology and Biostatistics, University of
Ulsan College of Medicine, Seoul, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Keimyung
University Dongsan Hospital, Daegu, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The resting distal-To-Aortic coronary pressure ratio (Pd/Pa)
is a universally available, hyperemia-free physiological index of coronary
stenosis. We investigated clinical outcomes according to resting Pd/Pa
versus hyperemic fractional flow reserve (FFR). <br/>Method(s): From the
IRIS-FFR (Interventional Cardiology Research Incooperation Society
Fractional Flow Reserve) registry, 7014 lesions in 4707 patients with
valid resting Pd/Pa and FFR were included in this study. The primary
outcome was major adverse cardiac events (MACE; a composite of cardiac
death, myocardial infarction, and repeat intervention). The MACE rate was
compared among resting Pd/Pa <=0.92 and FFR <=0.80. A marginal Cox model
accounted for correlated data in patients with multiple lesions.
<br/>Result(s): During a median follow-up of 2.0 years, 223 MACEs
occurred. Resting Pd/Pa was an independent predictor for the occurrence of
MACE (adjusted hazard ratio [aHR], 1.89 [95% CI, 1.32-2.71]; P=0.001) over
clinical and angiographic variables. When resting Pd/Pa and FFR were added
into a multivariable model, MACE was no longer significantly associated
with resting Pd/Pa (aHR, 1.35 [95% CI, 0.93-1.97]; P=0.12) but remained to
be associated with FFR (aHR, 2.34 [95% CI, 1.56-3.54]; P<0.001). Compared
with lesions with normal value of resting Pa/Pa and FFR, lesions with
abnormal values of either resting Pd/Pa (aHR, 2.12 [95% CI, 1.17-3.84];
P=0.014) or FFR (aHR, 2.32 [95% CI, 1.52-3.55]; P<0.001) or both (aHR,
2.37 [95% CI, 1.57-3.57]; P<0.001) showed a significantly increased risk
of the occurrence of MACE. <br/>Conclusion(s): Resting Pd/Pa appeared to
be a less-robust prognostic index than FFR. Resting Pd/Pa could be used as
a prognostic index when hyperemic agents are contraindicated or not easily
available. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT01366404.<br/>Copyright &#xa9; 2020 Lippincott Williams and
Wilkins. All rights reserved.

<29>
Accession Number
2007665453
Title
Different classes of videoscopes and direct laryngoscopes for double-lumen
tube intubation in thoracic surgery: A systematic review and network
meta-analysis.
Source
PLoS ONE. 15 (8 August) (no pagination), 2020. Article Number: e0238060.
Date of Publication: August 2020.
Author
Kim Y.S.; Song J.; Lim B.G.; Lee I.O.; Won Y.J.
Institution
(Kim, Song, Lim, Lee, Won) Department of Anesthesiology and Pain Medicine,
Korea University Guro Hospital, Seoul, South Korea
Publisher
Public Library of Science
Abstract
Background: Double-lumen tube is commonly used in thoracic surgeries that
need one-lung ventilation, but its big size and stiff structure make it
harder to perform intubation than a conventional tracheal intubation tube.
<br/>Objective(s): To investigate the effectiveness and safety of
videoscopes for double-lumen tube insertion. The primary outcome was the
success rate of first attempt intubation. Secondary outcomes were
intubation time, malposition, oral mucosal damage, sore throat, and
external manipulation. <br/>Design(s): Systematic review and network
meta-analysis Data sources: Databases (Pubmed, Embase, Cochrane, Kmbase,
Web of science, Scopus) up to June 23, 2020 were searched. Eligibility:
Randomized controlled trials comparing different videoscopes for
double-lumen tube intubation were included in this study. <br/>Method(s):
We classified and lumped the videoscope devices into the following groups:
standard (non-channeled) videolaryngoscope, channeled videolaryngoscope,
videostylet, and direct laryngoscope. After assessing the quality of
evidence, we statistically analyzed and chose the best device based on the
surface under the cumulative ranking curve (SUCRA) by using STATA software
(version 16). <br/>Result(s): We included 23 studies (2012 patients).
Based on the success rate of the first attempt, a rankogram suggested that
the standard videolaryngoscope (76.4 of SUCRA) was the best choice,
followed by videostylet (65.5), channeled videolaryngoscope (36.1), and
direct laryngoscope (22.1), respectively. However, with regard to reducing
the intubation time, the best choice was videostylet, followed by a direct
laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope,
respectively. Direct laryngoscope showed the lowest incidence of
malposition but required external manipulation the most. Channeled
videolaryngoscope showed the highest incidence of oral mucosal damage, but
showed the lower incidence of sore throat than standard videolaryngoscope
or direct laryngoscope. <br/>Conclusion(s): Most videoscopes improved the
success rate of double-lumen tube intubation; however, they were
time-consuming (except videostylet) and had a higher malposition rate than
the direct laryngoscope.<br/>Copyright: &#xa9; 2020 Kim 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.

<30>
Accession Number
2005869927
Title
Transcatheter Versus Surgical Pulmonary Valve Replacement: A Systemic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1751-1761), 2020. Date of
Publication: November 2020.
Author
Ribeiro J.M.; Teixeira R.; Lopes J.; Costa M.; Pires A.; Goncalves L.
Institution
(Ribeiro, Teixeira, Lopes, Costa, Goncalves) Servico de Cardiologia,
Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
(Teixeira, Pires, Goncalves) Faculdade de Medicina da Universidade de
Coimbra, Coimbra, Portugal
(Pires) Servico de Cardiologia Pediatrica, Centro Hospitalar e
Universitario de Coimbra, Coimbra, Portugal
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter pulmonary valve replacement (TPVR) has emerged
as an alternative to surgery in patients with pulmonary valve dysfunction.
<br/>Method(s): We searched the Medline and Cochrane databases since their
inception to January 2019 as well as references from article, for all
publications comparing TPVR with surgical PVR (SPVR). Studies were
considered for inclusion if they reported comparative data regarding any
of the study endpoints. The primary endpoint was early mortality after
PVR. Secondary endpoints included procedure-related complications, length
of hospital stay, mortality during follow-up, infective endocarditis, need
for reintervention, post-PVR transpulmonary peak systolic gradient, and
significant pulmonary regurgitation. <br/>Result(s): There were no
differences in perioperative mortality between groups (0.2% vs 1.2%;
pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27,
I² = 0%). However TPVR conferred a significant reduction in
procedure-related complications and length of hospital stay compared with
SPVR. Midterm mortality and the need for repeat intervention were similar
with both techniques, but pooled infective endocarditis was significantly
more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95%
confidence interval, 1.89-5.06; P < .001, I² = 0%). TPVR was
associated with less significant PR and a trend towards a lower
transpulmonary systolic gradient during follow-up. <br/>Conclusion(s):
TPVR is a safe alternative to SPVR in selected patients and is associated
with a shorter length of hospital stay and fewer procedure-related
complications. At midterm follow-up TPVR was comparable with SPVR in terms
of mortality and repeat intervention but was associated with an increased
risk of infective endocarditis.<br/>Copyright &#xa9; 2020 The Society of
Thoracic Surgeons

<31>
[Use Link to view the full text]
Accession Number
633452430
Title
Postoperative Psychological Disorders among Heart Transplant Recipients: A
Meta-Analysis and Meta-Regression.
Source
Psychosomatic Medicine. 82 (7) (pp 689-698), 2020. Date of Publication: 01
Sep 2020.
Author
Loh A.Z.H.; Tan J.S.Y.; Tam J.K.C.; Zhang M.W.; Ho C.S.H.; Ho R.C.
Institution
(Loh, Zhang, Ho, Ho) Departments of Psychological Medicine, National
University of Singapore, Tower Block, 1E Kent Ridge Rd, Singapore 119228,
Singapore
(Tam) Department of Surgery, National University of Singapore, Singapore
(Tan) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Tam) Department of Cardiac Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
(Zhang) Institute of Mental Health, National Health Group, Singapore
(Ho) Department of Psychological Medicine, National University Health
System, Singapore
(Ho) Biomedical Institute for Global Health Research and Technology,
National University of Singapore, Singapore, Singapore
Publisher
Lippincott Williams and Wilkins
Abstract
Objective This meta-analysis evaluates the pooled prevalence of
depression, anxiety, adjustment disorder, and posttraumatic stress
disorder (PTSD) among heart transplant recipients globally and determines
underlying moderators. Methods The authors searched PubMed, Embase,
PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL databases from
inception to March 1, 2019, and 1321 records and 42 full-text articles
were selected and reviewed according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines. We calculated the pooled
prevalence proportion of depression, anxiety, adjustment disorder, and
PTSD using random-effects models. Meta-regression was performed to
identify important moderators that contribute to heterogeneity. Results
Twenty studies met the inclusion criteria and comprised 2169 patients. The
pooled prevalence of depression was 21.6% (95% confidence interval [CI] =
16.8%-27.3%), anxiety 11.1% (95% CI = 3.8%-28.5%), adjustment disorder
11.0% (95% CI = 3.1%-32.1%), and PTSD 13.5% (95% CI = 8%-21.8%). There was
significant heterogeneity. Meta-regression was conducted to account for
the heterogeneity of the prevalence proportion. Predisposing factors, for
example, New York Heart Association classes II and III/IV, steroid
treatment, and acute rejection of transplant (<3 months), were associated
with high prevalence of depression. Protective factors, for example, age
and higher ejection fraction after transplant of patients, were associated
with low prevalence of depression. Female sex, single status, and number
of months since transplant were associated with high prevalence of
anxiety. Single status was associated with high prevalence of both
adjustment disorder and transplant-related PTSD. Conclusions The
prevalence of psychiatric conditions, particularly depression, is high in
heart transplant recipients. The identified protective and risk factors
may guide psychological interventions in heart transplant
recipients.<br/>Copyright &#xa9; 2020 Lippincott Williams &Wilkins.

<32>
Accession Number
2005452537
Title
Statins administration for primary prevention of stroke and coronary
artery disease: A scientific statement of the international college of
cardiology.
Source
World Heart Journal. 11 (4) (pp 255-260), 2019. Date of Publication: 2019.
Author
Singh R.B.; Fedacko J.; Elkilany G.N.; Palmiero P.; Hristova K.;
Cornelissen G.
Institution
(Singh) Halberg Hospital and Research Institute, Moradabad, India
(Fedacko) PJ Safaric University, Kosice, Slovakia
(Elkilany) Tanta University, Egypt
(Elkilany) Kings College Hospital, London, United Kingdom
(Elkilany) Almousa DCH, Dubai, United Arab Emirates
(Palmiero) ASL BRINDISI, Cardiology Equipe, District of Brindisi,
Brindisi, Italy
(Hristova) National Heart Hospital University, Sofia, Bulgaria
(Cornelissen) Halberg Chronobiology Center, University of Minnesota
Medical School, Minneapolis, United States
Publisher
Nova Science Publishers, Inc.

<33>
Accession Number
2007357205
Title
Cost-effectiveness analysis of mitral valve repair with the MitraClip
delivery system for patients with mitral regurgitation: a systematic
review.
Source
Heart Failure Reviews. (no pagination), 2020. Date of Publication: 2020.
Author
Rezapour A.; Azari S.; Arabloo J.; Pourasghari H.; Behzadifar M.; Alipour
V.; Omidi N.; Sadeghian S.; Aghajani H.; Bragazzi N.L.
Institution
(Rezapour, Azari, Arabloo, Alipour) Health Management and Economics
Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Azari, Pourasghari) Hospital Management Research Center, Iran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Behzadifar) Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Omidi) Department of Cardiology, Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sadeghian, Aghajani) Department of Interventional Cardiology, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Bragazzi) Laboratory for Industrial and Applied Mathematics (LIAM),
Department of Mathematics and Statistics, York University, Toronto, Canada
Publisher
Springer
Abstract
To assess the cost-effectiveness of mitral valve repair with the MitraClip
delivery system for patients with mitral regurgitation and heart failure,
a systematic literature search was conducted in various electronic
databases to January 3, 2020. Eligibility criteria are the population
(patients with mitral regurgitation (MR)), intervention (transcatheter
mitral valve repair using the MitraClip), comparator (conventional medical
treatment), outcomes, and designs (Model-based or trial-based full
economic evaluations).The quality of included studies was assessed using
the CHEERS checklist. Mortality and survival rate, quality-adjusted life
year (QALY), life years gained (LYG), total cost, and the incremental
cost-effectiveness ratio (ICER) regarding the use of MitraClip System were
considered as the key outcomes. Eight articles were eligible for full-text
assessment. Ultimately, a total of seven studies were considered in the
current systematic review. Results demonstrated that MitraClip reduces
mortality rate and increases survival rate. The mortality rate at 1 year
and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively.
Total cost data based on 2019 USD show that the MitraClip has the highest
cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The
results showed that in all selected countries, willingness-to-pay (WTP)
thresholds are upper than the cost per QALY; also, the highest ICER for
the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy
($10,616/QALY). To conclude, evidence from this systematic review suggests
that MitraClip Delivery System improved both life expectancy and QALY
compared with medical treatment in patients at high surgical risk and it
was also a cost-effective treatment option for patients with mitral
regurgitation.<br/>Copyright &#xa9; 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<34>
Accession Number
2007355107
Title
Intralipid postconditioning in patients of cardiac surgery undergoing
cardiopulmonary bypass (iCPB): study protocol for a randomized controlled
trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 953. Date of
Publication: December 2020.
Author
Yuan Y.; Xiong H.; Zhang Y.; Yu H.; Zhou R.-H.
Institution
(Yuan, Xiong, Zhang, Yu, Zhou) Department of Anesthesiology, West China
Hospital of Sichuan University, No.37, Guoxue Xiang, Wu Hou District,
Chengdu, Sichuan 610041, China
Publisher
BioMed Central Ltd
Abstract
Background: Intralipid is a necessary fatty acid carrier that has been
safely used as an energy supplier in the clinic. It has played an
important role in rescuing the cardiac arrest caused by local anesthetic
toxicity. In recent years, experimental studies have shown that intralipid
postconditioning (ILPC) could reduce myocardial ischemic/reperfusion (I/R)
injuries. Our research group has innovatively conducted a pilot randomized
controlled trial (RCT), and the results showed that ILPC could reduce the
release of cTnT and CK-MB, biomarkers of myocardial I/R injury, in valve
replacement surgery. However, the potential effects of ILPC on the
clinical outcome of adult cardiac surgery patients are unclear. Intralipid
postconditioning in patients of cardiac surgery undergoing cardiopulmonary
bypass (iCPB) trial is aimed to further study whether ILPC could improve
short-term and long-term clinical outcome, as well as cardiac function in
adult cardiac surgery patients. <br/>Method(s): The iCPB trial is an
ongoing, single-center, prospective, double-blinded, large sample RCT. In
total, 1000 adults undergoing cardiac surgery will be randomly allocated
to either the ILPC group or the control group. The intervention group
received an intravenous infusion of 2 mL/kg of 20% intralipid
(medium-chain and long-chain fat emulsion injection C6~C24,
Pharmaceutical) within 10 min before aortic cross-unclamping, and the
control group received an equivalent volume of normal saline. The primary
endpoints are complex morbidity of major complications during
hospitalization and all-cause mortality within 30 days after surgery. The
secondary endpoints include (1) all-cause mortality 6 months and 1 year
postoperatively; (2) the quality of life within 1 year after surgery,
using the QoR-15 questionnaire; (3) the postoperative cardiac function
evaluated by LVEF, LVEDS, and LVEDD, and the myocardial injury evaluated
by CK-MB, cTnT, and BNP; and (4) short-term clinical outcomes during
hospitalization and total cost are also detailed evaluated.
<br/>Discussion(s): The iCPB trial is the first to explore ILPC on the
clinical outcome of adult cardiac surgery patients. The results are
expected to provide potential evidences about whether ILPC could reduce
the morbidity and mortality and improve the cardiac function and quality
of life. Therefore, the results will provide a rationale for the
evaluation of the potentially clinically relevant benefit of intralipid
therapy. Trial registration: Chictr.org.cn ChiCTR1900024387. Prospectively
registered on 9 July 2019.<br/>Copyright &#xa9; 2020, The Author(s).

<35>
Accession Number
633521046
Title
Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart
Surgery in Muslim Patients (Shia and Sunni).
Source
The journal of pastoral care & counseling : JPCC. 74 (4) (pp 234-240),
2020. Date of Publication: 01 Dec 2020.
Author
Fasihizadeh H.; Nasiriani K.
Institution
(Fasihizadeh) Department of Nursing, Research Center for Nursing and
Midwifery Care, Shahid Sadoughi University of Medical Sciences and Health
Services, Iran, Islamic Republic of
(Nasiriani) Department of Nursing, Research Center for Nursing and
Midwifery Care, Mother and Newborn Health Research Center, Shahid Sadoughi
University of Medical Sciences and Health Services, Iran, Islamic Republic
of
Publisher
NLM (Medline)
Abstract
The process of removal of a chest tube can cause pain and anxiety.
Spiritual care can be considered as a component of nursing care,
especially in the pain and anxiety relating to such procedures. This study
was a randomized clinical trial. Eighty patients completed the study. The
findings showed significant differences in anxiety and pain between groups
(p=0.001). Spiritual care reduced anxiety and pain caused by chest tube
removal in patients (Shia and Sunni Islam) undergoing heart surgery.

<36>
Accession Number
633519803
Title
Continuous ultrafiltration during extracorporeal circulation and its
effect on lactatemia: A randomized controlled trial.
Source
PloS one. 15 (11) (pp e0242411), 2020. Date of Publication: 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, alusian 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
NLM (Medline)
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. <br/>RESULT(S): 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. <br/>CONCLUSION(S): 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.

<37>
Accession Number
2005512447
Title
Efficacy of fractional flow reserve-guided percutaneous cornary
intervention for patients with angina pectoris a network meta-analysis.
Source
International Heart Journal. 61 (6) (pp 1097-1106), 2020. Date of
Publication: 2020.
Author
Shinohara H.; Kodera S.; Kiyosue A.; Ando J.; Morita H.; Komuro I.
Institution
(Shinohara, Kodera, Kiyosue, Ando, Morita, Komuro) Department of
Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
Publisher
International Heart Journal Association
Abstract
Evaluation of hemodynamic parameters, such as fractional flow reserve
(FFR), is recommended before percutaneous coronary intervention (PCI) for
patients with angina pectoris (AP). However, the advantage of FFR-guided
PCI has not been fully established. This study was performed to confirm
whether FFR-guided PCI im-proves the prognosis compared with other
treatments. Multiple databases were searched for studies published from
2000 to 2018, and a network meta-analysis (NMA) was performed to compare
outcomes of FFR-guided PCI, non-FFR-guided PCI, coronary artery bypass
grafting (CABG), and medical treatment (MT) for AP based on estimated odds
ratios (ORs). The study included 18,093 patients from 15 randomized
controlled trials (RCTs). No evidence of inconsistency was observed among
the studies. The NMA showed that the all-cause mortality of FFR-guided PCI
was not significantly different from that of the other treatment groups
(CABG: OR, 1.1; 95% confidence interval [CI], 0.67-1.7; non-FFR-guided
PCI: OR, 0.85; 95% CI, 0.53-1.4; and MT: OR, 0.83; 95% CI, 0.52-1.3). The
NMA for the composite of all-cause mortality and myocardial infarction,
which included 15,454 patients from 12 RCTs, showed that FFR-guided PCI
significantly reduced the composite outcome compared with non-FFR-guided
PCI and MT (non-FFR-guided PCI: OR, 0.66; 95% CI, 0.46-0.95 and MT: OR,
0.66; 95% CI, 0.46-0.95). Although FFR-guided PCI for AP did not show
significant prognostic improvement compared with non-FFR-guided PCI, CABG,
and MT, FFR-guided PCI may significantly reduce the composite of all-cause
mortality and myocardial infarction compared with non-FFR-guided PCI and
MT.<br/>Copyright &#xa9; 2020, International Heart Journal Association.
All rights reserved.

<38>
Accession Number
2007442422
Title
Valve-in-valve transcatheter aortic valve replacement to treat multijet
paravalvular regurgitation: A case series and review.
Source
Clinical Cardiology. (no pagination), 2020. Date of Publication: 2020.
Author
Randall M.H.; Lewandowski T.J.; Choi C.; Beaver T.M.
Institution
(Randall, Lewandowski) Department of Medicine, Division of Cardiovascular
Medicine, University of Florida, Gainesville, FL, United States
(Choi) North Florida/South Georgia Veterans Health System, Medical
Service, Cardiology Section Gainesville, Gainesville, FL, United States
(Beaver) Department of Surgery, Division of Thoracic and Cardiovascular
Surgery, University of Florida, Gainesville, FL, United States
Publisher
John Wiley and Sons Inc
Abstract
Treatment advances for severe symptomatic aortic stenosis including
transcatheter and open surgical valve replacement have improved patient
survival, length of stay, and speed to recovery. However, paravalvular
regurgitation (PVR) is occasionally seen and when moderate or greater in
severity is associated with an at least 2-fold increase in 1 year
mortality. While several treatment approaches focused on single-jet PVR
have been described in the literature, few reports describe multijet PVR.
Multijet PVR can successfully be treated with a variety of catheter-based
options including valve-in-valve (ViV) transcatheter aortic valve
replacement (TAVR). We present two patients with at least moderate PVR
following aortic valve replacement who were successfully treated with ViV
TAVR along with a review of literature highlighting our rationale for
utilizing each management approach. Multijet PVR can be treated
successfully with ViV TAVR, but additional options such as self-expanding
occluder devices and bioprosthetic valve fracture have a role as
adjunctive treatments to achieve optimal results. The etiology of multijet
PVR can differ between patients, this heterogeneity underscores the
paucity of data to guide treatment strategies. Therefore, successful
treatment of multijet PVR requires familiarity with available therapeutic
options to achieve optimal results and, by extension, decrease patient
mortality.<br/>Copyright &#xa9; 2020 The Authors. Clinical Cardiology
published by Wiley Periodicals LLC.

<39>
Accession Number
2008357218
Title
Methylene blue reduces incidence of early postoperative cognitive
disorders in elderly patients undergoing major non-cardiac surgery: An
open-label randomized controlled clinical trial.
Source
Journal of Clinical Anesthesia. 68 (no pagination), 2021. Article Number:
110108. Date of Publication: February 2021.
Author
Deng Y.; Wang R.; Li S.; Zhu X.; Wang T.; Wu J.; Zhang J.
Institution
(Deng, Zhang) Department of Anesthesiology, Shanghai Cancer Center, Fudan
University, Shanghai 200032, China
(Wang, Li, Wang) Department of Anesthesiology, Huashan Hospital, Fudan
University, Shanghai 200040, China
(Zhu) Department of Psychiatry, Huashan Hospital, Fudan University,
Shanghai 200040, China
(Wu) Department of Neurology, Huashan Hospital, Fudan University, Shanghai
200040, China
(Zhang) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai 200032, China
Publisher
Elsevier Inc.
Abstract
Study objective: The purpose of the present study was to investigate
whether methylene blue (MB) could reduce the incidences of postoperative
delirium (POD) and early postoperative cognitive dysfunction (POCD) in
elderly patients undergoing major non-cardiac surgery. <br/>Design(s):
Prospective, randomized, open-label clinical trial. <br/>Setting(s):
University-affiliated hospital. <br/>Patient(s): Two hundred and
forty-eight elderly patients scheduled for non-cardiac surgery.
<br/>Intervention(s): Elderly patients undergoing non-cardiac major
surgery were randomly assigned to MB group (n = 124), who receiving
intravenous infusion of 2 mg/kg MB within 60 min immediately after
anesthetic induction, or control group (n = 124), who receiving equal
volume saline in the same way. Measurements: All patients were evaluated
with delirium and neuropsychological batteries before and after surgery,
as well as perioperative adverse events. Two plasma biomarkers superoxide
dismutase (SOD) and homocysteine (HCY) were measured pre- and
post-operatively. <br/>Main Result(s): There were total 39
cases(15.7%)experienced POD. The incidence of POD in MB group was
significantly less than that in control group (7.3% vs. 24.2%, OR = 0.24,
95%CI: 0.11-0.53, p < 0.001). The incidence of early POCD at postoperative
7th day in MB group was also less than that in control group (16.1% vs.
40.2%, OR = 0.30, 95% CI: 0.16-0.57, p < 0.001). The adverse events were
comparable in both groups. In addition, there was no significant
correlation between POD/POCD and levels of SOD or HCY. <br/>Conclusion(s):
We conclude that intraoperative intravenous 2 mg/kg MB could significantly
reduce the incidences of POD and early POCD in elderly surgical patients,
while not remarkably increase incidence of perioperative adverse events,
suggesting MB may be clinically effective and safe for prevention of early
postoperative neurocognitive disorders.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<40>
Accession Number
2008418492
Title
An invited commentary "Effect of acute normovolemic hemodilution on
coronary artery bypass grafting: A systematic review and meta-analysis of
22 randomized trials".
Source
Annals of Medicine and Surgery. 60 (pp 173-174), 2020. Date of
Publication: December 2020.
Author
Hua Lei C.; Wedam Atogebania J.
Institution
(Hua Lei) Department of Surgery, The Second Affiliated Hospital of Hainan
Medical University, Hainan-Haikou 570311, China
(Wedam Atogebania) Department of Surgery, The First Affiliated Hospital of
Hainan Medical University, Haikou 570100, China
Publisher
Elsevier Ltd

<41>
Accession Number
2008361236
Title
Dextran- Versus Crystalloid-Based Prime in Cardiac Surgery: A Prospective
Randomized Pilot Study.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1541-1547), 2020. Date of
Publication: November 2020.
Author
Barbu M.; Kolsrud O.; Ricksten S.-E.; Dellgren G.; Zetterberg H.; Blennow
K.; Bjork K.; Thoren A.; Hansson C.; Jeppsson A.
Institution
(Barbu) Department of Cardiology, Blekinge Hospital, Karlskrona, Sweden
(Barbu, Dellgren, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Kolsrud, Dellgren, Bjork, Hansson, Jeppsson) Department of Cardiothoracic
Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
(Ricksten, Thoren) Department of Cardiothoracic Anaesthesia and Intensive
Care, Sahlgrenska University Hospital, Gothenburg, Sweden
(Ricksten) Department of Anesthesiology and Intensive Care, Institute of
Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
(Zetterberg, Blennow) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Zetterberg, Blennow) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, Sahlgrenska Academy, University
of Gothenburg, Molndal, Sweden
Publisher
Elsevier Inc.
Abstract
Background: The optimum priming fluid for the cardiopulmonary bypass (CPB)
circuit is still debated. We compared a new hyperoncotic priming solution
containing dextran 40, which has an electrolyte composition that mimics
extracellular fluid, with a standard crystalloid-based prime.
<br/>Method(s): Eighty cardiac surgery patients were included in this
double-blind, randomized, single-center study. Patients were randomized to
either a dextran-based prime or a crystalloid prime containing Ringer's
acetate and mannitol. The primary end point was colloid oncotic pressure
in serum during CPB. Secondary end points included fluid balance, bleeding
and transfusion requirements, pulmonary function, hemolysis, systemic
inflammation, and markers of renal, hepatic, myocardial, and brain injury.
Blood samples were collected before, during, and after CPB.
<br/>Result(s): Colloid oncotic pressure was higher in the dextran group
than in the crystalloid prime group during CPB (18.8 +/- 2.9 versus 16.4
+/- 2.9 mm Hg; P <.001) and 10 minutes after CPB (19.2 +/- 2.7 versus 16.8
+/- 2.9 mm Hg; P <.001). Patients in the dextran group required less
intravenous fluid during CPB (1090 +/- 499 versus 1437 +/- 543 mL; P
=.004) and net fluid balance was less positive 12 hours after surgery
(1431 +/- 741 versus 1901 +/- 922 mL; P =.014). Plasma-free hemoglobin was
significantly lower in the dextran group 2 hours after CPB (0.18 +/- 0.11
versus 0.41 +/- 0.33; P =.001). There were no significant differences in
bleeding, transfusion requirements, organ function, systemic inflammation,
or brain and myocardial injury markers between groups at any time point.
<br/>Conclusion(s): Our results suggest that a hyperoncotic dextran-based
priming solution preserves intraoperative colloid oncotic pressure
compared with crystalloid prime. Larger studies with clinically valid end
points are necessary to evaluate hyperoncotic prime solutions
further.<br/>Copyright &#xa9; 2020 The Society of Thoracic Surgeons

<42>
Accession Number
2005480292
Title
Avoidance of routine endotracheal suction in subjects ventilated for <= 12
hours following elective cardiac surgery.
Source
Respiratory Care. 65 (12) (pp 1838-1846), 2020. Date of Publication: 2020.
Author
Gilder E.; McGuinness S.P.; Cavadino A.; Jull A.; Parke R.L.
Institution
(Gilder, McGuinness, Parke) Cardiothoracic and Vascular Intensive Care
Unit, Auckland City Hospital, Grafton, Auckland, New Zealand
(Gilder, Jull, Parke) School of Nursing, Faculty of Medical and Health
Sciences, University of Auckland, Grafton, Auckland, New Zealand
(McGuinness, Parke) Australian and New Zealand Intensive Care Research
Centre, Monash University, Melbourne, VIC, Australia
(Cavadino) School of Population Health, University of Auckland, Grafton,
Auckland, New Zealand
(McGuinness, Parke) Medical Research Institute of New Zealand, Wellington
Hospital, Newtown, Wellington, New Zealand
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Mechanical ventilation requires an endotracheal tube. Airway
management includes endotracheal suctioning, a frequent procedure for
patients in the ICU. Associated risks of endotracheal suctioning include
hypoxia, atelectasis, and infection. There is currently no evidence about
the safety of avoiding endotracheal suction. We aimed to assess the safety
of avoiding endotracheal suction, including at extubation, in cardiac
surgical patients who were mechanically ventilated for <= 12 h.
<br/>METHOD(S): We conducted a single-center, noninferiority, randomized
controlled trial in a cardiac ICU in a metropolitan tertiary teaching
hospital. Subjects were assigned to either avoidance of endotracheal
suction or to usual care including endotracheal suctioning during
mechanical ventilation. In total, we screened 468 patients and randomized
249 subjects (usual care, n = 125; intervention, n = 124). Subjects were
elective cardiac surgical patients anticipated to receive <= 12 h of
mechanical ventilation. The primary outcome was the P<inf>aO2</inf>
/F<inf>IO2</inf> on room air 6 h after extubation, with a noninferiority
margin of 10% (lower bound of one-sided 95% CI to be < 30).
<br/>RESULT(S): There were no differences in group characteristics at
baseline. The primary analysis was a per-protocol analysis performed on
154 subjects. The median P<inf>aO2</inf> /F<inf>IO2</inf> was 323 for the
intervention group and 311 for the stand-ard care group (median difference
= 12, one-sided 95% CI -14.3). The results were consistent when using an
intention-to-treat analysis and a 97.5% CI. There were no differences
between groups in complications or safety measures, including the
escalation of oxygen therapy. <br/>CONCLUSION(S): Endotracheal suctioning
can be safely minimized or avoided in low-risk patients who have had
cardiac surgery and are expected to be ventilated for < 12 h after
surgery.<br/>Copyright &#xa9; 2020 Daedalus Enterprises.

<43>
Accession Number
2005017101
Title
Effectiveness of nursing intervention on early complications for patients
undergoing coronary catheterization.
Source
International Journal of Pharmaceutical Research. 12 (2) (pp 2271-2280),
2020. Date of Publication: April-June 2020.
Author
Mustafa M.A.A.-K.; Hassan H.S.
Institution
(Mustafa) Faculty of Nursing, University of Kufa, Iraq
(Hassan) Adult Health Nursing Department, University of Baghdad-College of
Nursing, Iraq
Publisher
Advanced Scientific Research
Abstract
Objective: To evaluate the early complications through utilization of
observation check list form to check (hematoma, bleeding, back pain,
urinary retention, and vasovagal stimulation post coronary angiography,
contrast reaction). <br/>Method(s): randomized clinical trial (RCT) was
conducted for patients' undergoing coronary catheterization at Al Najaf
Center for Cardiac Surgery and Cardiac Catheterization, the study has been
carried out during the period 2^th September 2019 to
5^th March 2020. The sample consisted of (100) patients has been
randomly divided into two groups of 50 patients each. The experimental
group consisted of 50 patients who are exposed to nursing interventions by
the researcher. The group, that who have not to exposed to nursing
interventions by the researcher, are considered the control group. The
instrument construction and consisted of three parts, (part I): the
socio-demographic characteristics and comprised of (8) items, (part II):
the clinical characteristics (part III): early complications' checklist
for patients undergoing coronary catheterization and comprised of (27)
items divided into (6) content areas (Hematoma, bleeding, back pain,
urinary discomfort, contrast reaction, vasovagal reaction) for each
patient. <br/>Result(s): The study results indicated that significant
difference between the period of measurements of hematoma, and vasovagal
reflex in the patients of experimental group (i.e. the patients return to
normal though out the period of measurements). While the results indicated
that significant difference between the period of measurements of
hematoma, back pain, urine discomfort, and vasovagal reflex in the
patients of control group (i.e. the patients deteriorated though out the
period of measurements). <br/>Conclusion(s): The study confirm that the
nursing intervention would be helpful to come up with a better nursing
guideline for managing patients' hematoma, back pain, and vasovagal reflex
after cardiac catheterization .Recommendations: Standardized nursing
procedures should be used to guide the nurses in dealing with patients
with coronary catheterization, and the standards bill of for such
practices should be created and presented to all ties in which such
practices are performed.<br/>Copyright &#xa9; 2020, Advanced Scientific
Research. All rights reserved.

<44>
Accession Number
2004671110
Title
Network Analysis of Outcomes in Patients Undergoing Transcatheter Aortic
Valve Replacement for Stenotic Bicuspid Aortic Valves According to Valve
Type.
Source
Cardiovascular Revascularization Medicine. 21 (9) (pp 1076-1085), 2020.
Date of Publication: September 2020.
Author
Quintana R.A.; Monlezun D.; Davogustto G.; Saenz H.; Lugo Baruqui D.;
Denktas A.E.; Jneid H.; Paniagua D.
Institution
(Quintana) Andreas Gruentzig Cardiovascular Center, Division of
Cardiology, Department of Medicine, Emory University School of Medicine,
Atlanta, GA, United States
(Monlezun) Department of Internal Medicine, McGovern Medical School,
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Davogustto) Division of Cardiology, Department of Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
(Saenz) Division of Geriatrics, Department of Internal Medicine,
University of California San Diego, San Diego, CA, United States
(Lugo Baruqui) Department of Internal Medicine, Mount Sinai Medical
Center, Miami, FL, United States
(Denktas, Jneid, Paniagua) Division of Cardiology, Department of Medicine,
Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: It is currently unknown if outcomes after transcatheter aortic
valve replacement (TAVR) differ according to the prosthetic valve deployed
in patients with bicuspid aortic valves (BAV). <br/>Objective(s): This
study evaluated valve-specific outcomes post-TAVR in patients with BAV.
<br/>Method(s): Literature search was performed using the Cochrane
databases, PubMed, ClinicalTrials, SCOPUS and EMBASE databases from
inception until July 2018. We computed risk ratios and their 95%
confidence intervals for all outcomes of interest. For each outcome, the
data were pooled using a multivariate random-effects meta-analysis
including multiple treatment as well as direct and indirect comparisons.
<br/>Result(s): Ten studies enrolling a total of 1547 BAV patients
undergoing TAVR using 6 different prosthetic valve types were analyzed.
There were no significant differences in 30-day all-cause mortality,
life-threatening bleeding and device success among the diverse prosthetic
valve types implanted. However, 2nd generation balloon-expandable valves
had consistently lower risk of moderate-to-severe prosthetic valve
regurgitation. <br/>Conclusion(s): In patients with BAV, there were no
significant differences in 30-day all-cause mortality after TAVR among the
various prosthetic valve types.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<45>
Accession Number
2004664348
Title
Cost-Effectiveness of Transcatheter Aortic Valve Intervention (TAVI)
Compared to Surgical Aortic Valve Replacement (SAVR) in Low- to
Intermediate-Surgical-Risk Patients.
Source
Cardiovascular Revascularization Medicine. 21 (9) (pp 1164-1168), 2020.
Date of Publication: September 2020.
Author
Azraai M.; Gao L.; Ajani A.E.
Institution
(Azraai, Ajani) Royal Melbourne Hospital, Melbourne, Australia
(Azraai, Ajani) University of Melbourne, Melbourne, Australia
(Gao) Deakin University, Melbourne, Australia
(Ajani) NHMRC Centre of Clinical Research Excellence in Therapeutics,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
Publisher
Elsevier Inc.
Abstract
Introduction: Transcatheter aortic valve intervention (TAVI) is known to
be non-inferior to surgical aortic valve replacement (SAVR) in
low-intermediate surgical risk patients. This present systematic review
was conducted to analyse the cost-effectiveness of TAVI in this patient
population. <br/>Method(s): Four electronic databases from January 2010 to
November 2019 were used to identify relevant cost-effectiveness studies of
TAVI versus SAVR in low-intermediate risk patients. The primary endpoints
were the incremental cost-effectiveness ratio (ICER) and the probability
of cost effectiveness. The eligible studies for the present systematic
review included those in which the cost-effectiveness data were measured
or projected for TAVI and SAVR. <br/>Result(s): Eight studies were
included in this review, where six studies involved intermediate risk
patients and two studies with low risk patients. The reported ICER for
TAVI compared to SAVR in low-intermediate risk patients were below the
ICER threshold of acceptability in all studies. The probability of TAVI
being cost-effective compared to SAVR ranged from 78%-97%.
<br/>Conclusion(s): TAVI is likely to be a cost-effective alternative to
SAVR in low-intermediate risk patients. More studies on low risk patients
is needed.<br/>Copyright &#xa9; 2020

<46>
Accession Number
2007355116
Title
Prone positioning in non-intubated patients with COVID-19 associated acute
respiratory failure, the PRO-CARF trial: A structured summary of a study
protocol for a randomised controlled trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 940. Date of
Publication: December 2020.
Author
Ibarra-Estrada M.A.; Marin-Rosales M.; Garcia-Salcido R.; Aguirre-Diaz
S.A.; Vargas-Obieta A.; Chavez-Pena Q.; Lopez-Pulgarin J.A.;
Mijangos-Mendez J.C.; Aguirre-Avalos G.
Institution
(Ibarra-Estrada, Vargas-Obieta, Chavez-Pena, Mijangos-Mendez) Intensive
Care Unit, COVID-19 Unit, Hospital Civil Fray Antonio Alcalde,
Guadalajara, Jalisco, Mexico
(Marin-Rosales) Internal Medidine, COVID-19 Unit, Hospital General de
Occidente, Zapopan, Jalisco, Mexico
(Garcia-Salcido) COVID-19 Unit, Hospital Civil Fray Antonio Alcalde,
Guadalajara, Jalisco, Mexico
(Aguirre-Diaz) Infectious Diseases Department, Hospital Civil Fray Antonio
Alcalde, Guadalajara, Jalisco, Mexico
(Chavez-Pena, Lopez-Pulgarin, Aguirre-Avalos) Centro Universitario de
Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco,
Mexico
(Lopez-Pulgarin, Aguirre-Avalos) Intensive Care Unit, COVID-19 Unit,
Hospital Civil "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico
Publisher
BioMed Central Ltd
Abstract
Objectives: To assess the effect of prone positioning therapy on
intubation rate in awake patients with COVID-19 and acute respiratory
failure. Trial design: This is a two-center parallel group, superiority,
randomized (1:1 allocation ratio) controlled trial. <br/>Participant(s):
All patients admitted to the Hospital Civil de Guadalajara and Hospital
General de Occidente in Mexico for COVID-19 associated acute respiratory
failure and in need of supplementary oxygen through high-flow nasal
cannula are screened for eligibility. Inclusion criteria: all adult
patients admitted to the COVID-19 unit who test positive for COVID-19 by
PCR-test and in need for oxygen are eligible for inclusion. Randomization
starts upon identification of requirement of a fraction of inspired oxygen
>=30% for an oxygen capillary saturation of >=90% Exclusion criteria: less
than 18 years-old, pregnancy, patients with immediate need of invasive
mechanical ventilation (altered mental status, fatigue), vasopressor
requirement to maintain median arterial pressure >65 mmHg,
contraindications for prone positioning therapy (recent abdominal or
thoracic surgery or trauma, facial, pelvic or spine fracture, untreated
pneumothorax, do-not-resuscitate or do-not-intubate order, refusal or
inability of the patient to enroll in the study. Intervention and
comparator: Patients of the intervention group will be asked to remain in
a prone position throughout the day as long as possible, with breaks
according to tolerance. Pillows will be offered for maximizing comfort at
chest, pelvis and knees. Monitoring of vital signs will not be suspended.
Inspired fraction of oxygen will be titrated to maintain a capillary
saturation of 92%-95%. For patients in the control group, prone
positioning will be allowed as a rescue therapy. Staff intensivists will
monitor the patient's status in both groups on a 24/7 basis. All other
treatment will be unchanged and left to the attending physicians. Main
outcomes: Endotracheal intubation rate for mechanical ventilation at 28
days. Randomisation: Patients will be randomly allocated to either prone
positioning or control group at 1:1 ratio. Such randomization will be
computer generated and stratified by center with permuted blocks and
length of 4. Blinding (masking): Due to logistical reasons, only principal
investigators and the data analyst will be blinded to group assignment.
Numbers to be randomised (sample size): With an intubation rate of 60%
according to recent reports from some American centers, and assuming a
decrease to 40% to be clinically relevant, we calculated a total of 96
patients per group, for a beta error of 0.2, and alpha of 0.5. Therefore,
we plan to recruit 200 patients, accounting for minimal losses to follow
up, with 100 non-intubated patients in the prone position group and a 100
in the control group. Trial Status: The local registration number is
048-20, with the protocol version number 2.0. The date of approval is 3rd
May 2020. Recruitment started on 3^rd May and is expected to end
in December 2020. Trial registration: The protocol was retrospectively
registered under the title: "Prone Positioning in Non-intubated Patients
With COVID-19 Associated Acute Respiratory Failure. The PRO-CARF trial" in
ClinicalTrials.gov with the registration number: NCT04477655. Registered
on 20 July 2020. Full protocol: The full protocol is attached as an
additional file, accessible from the Trials website (Additional file 1).
In the interest in expediting dissemination of this material, the familiar
formatting has been eliminated; this Letter serves as a summary of the key
elements of the full protocol. The study protocol has been reported in
accordance with the Standard Protocol Items: Recommendations for Clinical
Interventional Trials (SPIRIT) guidelines (Additional file
2).<br/>Copyright &#xa9; 2020, The Author(s).

<47>
[Use Link to view the full text]
Accession Number
633490894
Title
Comparison of the intraoperative analgesic efficacy between
ultrasound-guided deep and superficial serratus anterior plane block
during video-assisted thoracoscopic lobectomy: A prospective randomized
clinical trial.
Source
Medicine. 99 (47) (pp e23214), 2020. Date of Publication: 20 Nov 2020.
Author
Moon S.; Lee J.; Kim H.; Kim J.; Kim S.
Institution
(Moon, Kim) Department of Anesthesiology and Pain Medicine, School of
Medicine, Kyungpook National University
(Lee, Kim, Kim) Department of Anesthesiology and Pain Medicine, Yeungnam
University College of Medicine
(Kim) Department of Anesthesiology and Pain Medicine, Keimyung University
School of Medicine, Daegu, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: The serratus anterior plane block (SAPB) is a novel method
that provides lateral chest wall analgesia. There are 2 methods of SAPB;
deep and superficial SAPB. Each of these methods has been demonstrated to
provide effective perioperative analgesia in thoracic surgery. The aim of
this study was to compare the intraoperative hemodynamic and analgesic
benefits of deep versus superficial SAPB during video-assisted thoracic
surgery (VATS) lobectomy. <br/>METHOD(S): We performed a prospective,
randomized, patient/assessor-blinded trial. We included patients who were
20 to 75 years of age and scheduled to undergo VATS lobectomy with
American Society of Anesthesiologists physical status 1 or 2. Patients
were randomly allocated to receive either ultrasound-guided deep SAPB
(Group D) or superficial SAPB (Group S). The primary outcome was
intraoperative remifentanil consumption. We also recorded intraoperative
systolic blood pressure (SBP), heart rate (HR), emergence time, and doses
of rescue drugs used to manage hemodynamic instability. <br/>RESULT(S):
Data for 50 patients undergoing 3-port VATS lobectomy were analyzed.
Intraoperative remifentanil consumption did not differ significantly
between Group D (n = 25, 715.62 +/- 320.36 mug) and group S (n = 25,
721.08 +/- 294.48 mug) (P = .97). Additionally, there were no significant
differences between the 2 groups in SBP and HR at any time point,
emergence time, or amount of rescue drugs used. <br/>CONCLUSION(S): Our
study suggests that the intraoperative analgesic efficacy is similar for
deep and superficial SAPB during VATS lobectomy.

<48>
Accession Number
2010066828
Title
The 5% Lidocaine Patch for Decreasing Postoperative Pain and Rescue Opioid
Use in Sternotomy: A Prospective, Randomized, Double-blind Trial.
Source
Clinical Therapeutics. (no pagination), 2020. Date of Publication: 2020.
Author
Nahm F.S.; Han W.K.; Park S.; Han S.; Park K.-H.; Lim C.
Institution
(Park) Division of Intensive Care, Sheikh Khalifa Specialty Hospital, Ras
Al Khaimah, United Arab Emirates
(Nahm, Han, Park, Han) Department of Anesthesiology and Pain Medicine,
Seoul National University Bundang Hospital, Seongnam, South Korea
(Nahm, Han) Department of Anesthesiology and Pain Medicine, Seoul National
University College of Medicine, Seoul, South Korea
(Park, Lim) Department of Thoracic and Cardiovascular Surgery, Seoul
National University College of Medicine, Seoul, South Korea
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Poststernotomy pain (PSP), a primary concern after sternotomy,
can negatively affect patients' satisfaction with surgery and quality of
life. Many clinical trials have been conducted to examine the usefulness
of lidocaine patches (LPs) for postoperative pain control for multiple
types of surgery; however, the results of these trials are inconsistent.
In addition, little is known about the use of LPs after cardiac procedures
that require sternotomy. This prospective, double-blind,
placebo-controlled trial aimed to determine the efficacy of the 5% LP
application at the sternotomy site for reducing PSP and rescue opioid
consumption. <br/>Method(s): The patients were randomly assigned to
receive either the 5% LP or the placebo patch on each side of the incision
site immediately after the surgery. The intensity of pain at 6, 12, 24,
and 48 h after the patch application; the total dose of rescue opioids;
incidence of nausea, vomiting, and sleep disturbance; and use of
antiemetics were compared between the 2 groups. <br/>Finding(s):
Fifty-seven (31 in the LP group and 26 in the placebo group) patients were
included. The pain intensity was significantly lower in the LP group at
each time point (66%-68% pain reduction, P < 0.001, interaction of time x
treatment P = 0.69). In addition, the total dose of rescue opioids used
for 48 h was significantly lower in the L group (27.2% reduction, P =
0.008). No significant differences were found in other outcome variables
between the 2 groups. Implications: The application of a 5% LP on each
side of the sternotomy site can reduce PSP and additional opioid use
without significant adverse effects in patients undergoing sternotomy.
Thus, it can be considered as a standard and routine modality along with
other analgesic medications for the management of PSP. Clinical Trial
Registry in South Korea identifier: KCT0000476.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<49>
Accession Number
2007712970
Title
Effects of stem cells on non-ischemic cardiomyopathy: a systematic review
and meta-analysis of randomized controlled trials.
Source
Cytotherapy. 22 (12) (pp 699-711), 2020. Date of Publication: December
2020.
Author
Xia L.; Zeng L.; Pan J.; Ding Y.
Institution
(Xia, Pan, Ding) Department of Clinical Medicine, School of Medicine,
Zhejiang University City College, Hangzhou, China
(Zeng) Department of Pharmacology, School of Medicine, Zhejiang University
City College, Hangzhou, China
Publisher
Elsevier B.V.
Abstract
Background aims: To assess the impacts of stem cell therapy on clinical
outcomes in patients with non-ischemic cardiomyopathy (NICM). The effect
of stem cell therapy on prognosis is unclear and controversial.
<br/>Method(s): The authors performed a systematic review and
meta-analysis of the effects of autologous stem cell transplantation in
patients with NICM on a composite outcome of all-cause mortality and heart
transplantation, left ventricular ejection fraction (LVEF), left
ventricular end-diastolic diameter (LVEDD), New York Heart Association
(NYHA) classification, 6-minute walk test (6-MWT) distance and serum brain
natriuretic peptide (BNP) level, considering studies published before
March 19, 2020. <br/>Result(s): Twelve trials with 623 subjects met
inclusion criteria. Compared with the control group, stem cell therapy
improved LVEF (weighted mean difference [WMD], 4.08%, 95% confidence
interval [CI], 1.93-6.23, P = 0.0002) and 6-MWT distance (WMD, 101.49 m,
95% CI, 45.62-157.35, P = 0.0004) and reduced BNP level (-294.94 pg/mL,
95% CI, -383.97 to -205.90, P < 0.00001) and NYHA classification (-0.70,
95% CI, -0.98 to -0.43, P < 0.00001). However, LVEDD showed no significant
difference between the two groups (WMD, -0.09 cm, 95% CI, -0.23 to 0.06, P
= 0.25). In 10 studies (535 subjects) employing the intracoronary route
for cell delivery, mortality and heart transplantation were decreased
(risk ratio [RR], 0.73, 95% CI, 0.52-1.00, P = 0.05). Furthermore, in four
studies (248 subjects) with peripheral CD34+ cells, either all-cause
mortality (RR, 0.44, 95% CI, 0.23-0.86, P = 0.02) or mortality and heart
transplantation (RR, 0.45, 95% CI, 0.27-0.77, P = 0.003) improved in the
treatment group compared with the control. The trial sequential analysis
suggested the information size of LVEF, 6-WMT and BNP has been adequate
for evidencing the benefits of stem cells on NICM. However, to determine
the potential survival benefit, more clinical data are required to make
the statistical significance in meta-analysis more conclusive.
<br/>Conclusion(s): This meta-analysis demonstrates that stem cell therapy
may improve survival, exercise capacity and cardiac ejection fraction in
NICM, which suggests that stem cells are a promising option for NICM
treatment.<br/>Copyright &#xa9; 2020 International Society for Cell & Gene
Therapy

<50>
Accession Number
632732833
Title
The effectiveness of aromatherapy on preoperative anxiety in adults: A
systematic review and meta-analysis of randomized controlled trials.
Source
International journal of nursing studies. 111 (pp 103747), 2020. Date of
Publication: 01 Nov 2020.
Author
Guo P.; Li P.; Zhang X.; Liu N.; Wang J.; Yang S.; Yu L.; Zhang W.
Institution
(Guo, Zhang, Liu, Wang, Yang, Yu, Zhang) School of Nursing, Jilin
University, No. 965 Xinjiang, Street, Changchun, Jilin Province 130021,
China
(Li) Second Hospital of Jilin University, Changchun, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Preoperative anxiety is very common in adults awaiting all
types of surgical procedures, which can interfere with the start and
completion of surgery and increase the risk of postoperative
complications. In this context, many researchers and clinical
practitioners have attempted to use aromatherapy to help adults reduce
preoperative anxiety. <br/>OBJECTIVE(S): To investigate systematically the
efficacy of aromatherapy on preoperative anxiety in adults. DESIGN: A
systematic review and meta-analysis of randomized controlled trials was
undertaken. DATA SOURCES: PubMed, Embase, Cochrane Library, Web of
Science, PsycINFO and CINAHL were comprehensively searched from their
inception to June 2020. REVIEW METHODS: Studies on the use of aromatherapy
for treating preoperative anxiety in adults were included. Two reviewers
assessed the risk of bias of the included studies independently using the
Cochrane Collaboration 'Risk of Bias' tool. Overall meta-analysis and five
subgroup analyses regarding the type of control, the type of aroma
preparations, delivery mode, session length and surgery type were
performed using RevMan 5.3. The Higgins' I2 (%) statistic was used to
measure heterogeneity. A funnel plot and Egger's test were used to
evaluate publication bias. <br/>RESULT(S): Twenty studies comprising 1717
participants were included. The meta-analysis indicated that aromatherapy
could significantly ameliorate preoperative anxiety (standard mean
difference=-0.57, 95% confidence interval [-0.75, -0.39], p<0.00001) for
adults awaiting surgical procedures, compared to placebo control,
conventional care and no intervention. The subgroup analysis based on the
surgery type showed that aromatherapy had a great improvement on
preoperative anxiety for patients awaiting cardiac surgery and relatively
low-risk surgery. Lavender oil, citrus species preparations and rose oil
were the three most commonly used aroma preparations that could
significantly improve preoperative anxiety. Most delivery modes of
aromatherapy, including inhalation, massage, and oral administration, were
effective. Moreover, short length (<=20 min per session) aromatherapy
showed a better effect on preoperative anxiety (mean difference=-5.84, 95%
confidence interval [-8.09, -3.59], p<0.00001) than aromatherapy lasting
more than 20-minutes per session (mean difference=-2.15, 95% confidence
interval [-3.81, -0.49], p = 0.01). <br/>CONCLUSION(S): Aromatherapy is an
effective intervention for reducing preoperative anxiety in adults.
Short-length aromatherapy inhalation seems to be more worthy of being
recommended in clinical settings. More well-designed randomized controlled
trials containing a wider range of surgical types and participants from
more countries are needed to verify our findings before we can make strong
recommendations.<br/>Copyright &#xa9; 2020. Published by Elsevier Ltd.

<51>
Accession Number
629353731
Title
The effects of multimedia education on postoperative delirium in patients
undergoing coronary artery bypass graft: A randomized clinical trial.
Source
Nursing in critical care. 25 (6) (pp 346-352), 2020. Date of Publication:
01 Nov 2020.
Author
Fahimi K.; Abbasi A.; Zahedi M.; Amanpour F.; Ebrahimi H.
Institution
(Fahimi) Shahid Sayyad Shirazi Hospital, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Abbasi) Department of Nursing, School of Nursing and Midwifery, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
(Zahedi) Ischemic Disorders Research Center, Golestan University of
Medical Sciences, Gorgan, Iran, Islamic Republic of
(Amanpour) Clinical Research Development Unit, Bahar Hospital, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
(Ebrahimi) Randomized Controlled Trial Research Center, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients undergoing cardiac surgeries are at high risk of
developing delirium. AIMS AND OBJECTIVES: The present study aimed to
determine the effects of multimedia education on postoperative delirium in
patients undergoing a coronary artery bypass graft. DESIGN: This study was
a randomized clinical trial. <br/>METHOD(S): In this study, 110 patients
undergoing a coronary artery bypass graft were assigned to two groups,
control and intervention. Patients in the intervention group received
multimedia education, and those in the control group received routine
training. The inclusion criteria were experiencing the coronary artery
bypass graft for the first time and non-development of post-operative
cardiogenic shock or myocardial rupture. After measuring the level of
consciousness, patients were examined in terms of delirium using the
confusion assessment method for the ICU scale twice a day from admission
to discharge from the ICU. The data were statistically analysed using chi2
test and Fisher's exact test. <br/>RESULT(S): Patients of both groups were
matched in terms of demographics. The highest incidence of delirium was
observed on the first day after surgery in the intervention group (14.5%)
and in the morning of the second day after surgery (29.1%) in the control
group. Moreover, there was a significant difference between the two groups
in the incidence of delirium in the morning of the second, third, and
fourth days after surgery as it was higher in the control group over these
days. <br/>CONCLUSION(S): Considering the lower incidence of
post-operative delirium in patients who experienced multimedia education
rather than control group, the use of this non-pharmaceutical method is
recommended to prevent delirium in such patients. RELEVANCE TO CLINICAL
PRACTICE: Delirium is also an acute organic brain syndrome that often
leads to complicated conditions after cardiac surgeries. Fortunately,
delirium is a preventable issue. The implementation of multimedia
education as a non-pharmacological approach had positive effects on
patients' delirium.<br/>Copyright &#xa9; 2019 British Association of
Critical Care Nurses.

<52>
Accession Number
2006057947
Title
The Quality of Peer-Reviewed Publications on Surgery for Early Stage Lung
Cancer Within the Veterans Health Administration.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (4) (pp 1066-1073),
2020. Date of Publication: Winter 2020.
Author
Welp A.M.; Abbott S.E.; Samson P.; Cameron R.B.; Cornwell L.D.; Harpole
D.; Moghanaki D.
Institution
(Welp) Virginia Commonwealth University School of Medicine, Richmond, VA,
United States
(Abbott) Hunter Holmes McGuire VA Medical Center, Richmond, VA, United
States
(Samson) Department of Radiation Oncology, Washington University in St.
Louis/Barnes-Jewish Hospital, St. Louis, MO, United States
(Cameron) Division of Cardiothoracic Surgery, Department of Surgery,
University of California Los Angeles, Los Angeles, CA, United States
(Cameron) Department of Cardiothoracic Surgery, West Los Angeles VA
Medical Center, Los Angeles, CA, United States
(Cornwell) Division of Cardiothoracic Surgery, Department of Surgery,
Baylor College of Medicine, Houston, TX, United States
(Cornwell) Operative Care Line, Michael E. DeBakey VA Medical Center,
Houston, TX, United States
(Harpole) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Harpole) Department of Cardiothoracic Surgery, Durham VA Medical Center,
Durham, NC, United States
(Moghanaki) Department of Radiation Oncology, Emory University School of
Medicine, Atlanta, Georgia, Georgia
(Moghanaki) Department of Radiation Oncology, Atlanta VA Health Care
System, Decatur, Georgia, Georgia
Publisher
W.B. Saunders
Abstract
The peer-reviewed literature is often referenced to generalize outcomes
for lung cancer surgeries performed within the Veterans Health
Administration (VHA) and include assessments following resection of early
stage non-small-cell lung cancer (NSCLC). We sought to determine the
reliability of these reports that are publicly available. A systematic
review was undertaken to identify PubMed indexed articles that report
postoperative outcomes following surgical resections for stage I NSCLC
within the VHA. Only studies that reported American Joint Committee on
Cancer staging were included. Eleven studies spanning 49 years (1966-2015)
met the inclusion criteria. Two reported findings from national VHA
databases while 9 reported outcomes from single institutions. Reporting of
outcomes and prognostic factors varied widely between studies and were
frequently omitted. This made it difficult to evaluate prognostic factors
that may be associated with a wide range of 30- and 90-day perioperative
mortality (0-3.8% and 0-6.4%), 3- and 5-year cause-specific survival
(72-92% and 32-84%), and 3- and 5- year overall survival (47-85.7% and
24-74%). The quality of peer-reviewed literature that reports outcomes
following thoracic surgery for stage I NSCLC in the VHA is inconsistent
and precludes accurate assessments for generalizations about the quality
of care in this healthcare system. Efforts to develop a dedicated outcome
tracking and registry system can provide more meaningful evidence to
identify areas for improvement for this often-curable
malignancy.<br/>Copyright &#xa9; 2020

<53>
[Use Link to view the full text]
Accession Number
2010044042
Title
Rationale and design of a randomized clinical trial comparing safety and
efficacy of myval transcatheter heart valve versus contemporary
transcatheter heart valves in patients with severe symptomatic aortic
valve stenosis: The LANDMARK trial.
Source
American Heart Journal. 232 (pp 23-38), 2021. Date of Publication:
February 2021.
Author
Kawashima H.; Soliman O.; Wang R.; Ono M.; Hara H.; Gao C.; Zeller E.;
Thakkar A.; Tamburino C.; Bedogni F.; Neumann F.-J.; Thiele H.;
Abdel-Wahab M.; Morice M.-C.; Webster M.; Rosseel L.; Mylotte D.; Onuma
Y.; Wijns W.; Baumbach A.; Serruys P.W.
Institution
(Kawashima, Soliman, Wang, Ono, Hara, Gao, Zeller, Rosseel, Mylotte,
Onuma, Wijns, Serruys) Department of Cardiology, National University of
Ireland, Galway (NUIG), Galway, Ireland
(Kawashima, Ono, Hara) Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
(Wang, Gao) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Thakkar) Meril Life Sciences Pvt. Ltd., India
(Tamburino) Ferrarotto Hospital, Policlinico Hospital and University of
Catania, Catania, Italy
(Bedogni) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Neumann) Department of Cardiology & Angiology II, University Heart Center
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Thiele, Abdel-Wahab) Heart Center Leipzig at University of Leipzig and
Leipzig Heart Institute, Leipzig, Germany
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud,
Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy, France
(Webster) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Baumbach) William Harvey Research Institute, Queen Mary University of
London, and Barts Heart Centre, London, United Kingdom
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Mosby Inc.
Abstract
Background: The recent approval of transcatheter aortic valve replacement
(TAVR) in patients with low operative risk has paved the way for the
introduction of novel and potentially improved technologies. The safety
and efficacy of these novel technologies should be investigated in
randomized control trials against the contemporary TAVR devices. The
objective of the LANDMARK trial is to compare the balloon-expandable Myval
transcatheter heart valve (THV) series with contemporary THV (SAPIEN THV
and Evolut THV series) series in patients with severe symptomatic native
aortic stenosis. Methods/Design: The LANDMARK trial
(ClinicalTrials.govNCT04275726, EudraCT number 2020-000,137-40) is a
prospective, randomized, multinational, multicenter, open-label, and
noninferiority trial of approximately 768 patients treated with TAVR via
the transfemoral approach. Patients will be allocated in a 1:1
randomization to Myval THV series (n = 384) or to contemporary THV (n =
384) (either of SAPIEN THV or Evolut THV series). The primary combined
safety and efficacy endpoint is a composite of all-cause mortality, all
stroke (disabling and nondisabling), bleeding (life-threatening or
disabling), acute kidney injury (stage 2 or 3), major vascular
complications, prosthetic valve regurgitation (moderate or severe), and
conduction system disturbances (requiring new permanent pacemaker
implantation), according to the Valve Academic Research Consortium-2
criteria at 30-day follow-up. All patients will have follow-up to 10 years
following TAVR. The LANDMARK trial is the first randomized head-to-head
trial comparing Myval THV series to commercially available THVs in
patients indicated for TAVR. We review prior data on head-to-head
comparisons of TAVR devices and describe the rationale and design of the
LANDMARK trial.<br/>Copyright &#xa9; 2020 The Authors

<54>
Accession Number
2007424830
Title
Implantable cardioverter-defibrillators in cardiac transplant recipients:
A systematic review from the Electrophysiology Collaborative Consortium
for Meta-analysis-ELECTRAM investigators.
Source
PACE - Pacing and Clinical Electrophysiology. (no pagination), 2020. Date
of Publication: 2020.
Author
Garg J.; Shah K.; Turagam M.K.; Tzou W.; Gopinathannair R.; Natale A.;
Lakkireddy D.
Institution
(Garg) Division of Cardiology, Cardiac Arrhythmia Service, Medical College
of Wisconsin, Milwaukee, WI, United States
(Shah) Department of Cardiovascular Medicine, Beaumont Hospital, Oakland
University William Beaumont School of Medicine, Royal Oak, MI, United
States
(Turagam) Cardiac Arrhythmia Service, Helmsley Electrophysiology Center,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Tzou) Division of Cardiology, Section of Cardiac Electrophysiology,
University of Colorado School of Medicine, Aurora, CO, United States
(Gopinathannair, Lakkireddy) Division of Electrophysiology, Kansas City
Heart Rhythm Institute and Research Foundation, Kansas City, KS, United
States
(Natale) Division of Electrophysiology, Texas Cardiac Arrhythmia Institute
at St. David's Medical Center, Austin, TX, United States
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: Implantable cardioverter-defibrillator (ICD) in patients
with heart failure with reduced ejection fraction reduces mortality
secondary to malignant arrhythmias. Whether cardiac transplant patients
considered high risk for sudden death (SD) derive similar benefits remains
controversial. <br/>Method(s): Systematic search, without language
restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and
ClinicalTrials.gov was performed from inception to June 4, 2020, for
studies that had reported outcomes in patients who had ICD implanted after
cardiac transplant. The outcomes studied were as follows: (a) SD and (b)
appropriate and inappropriate ICD therapies. <br/>Result(s): Seven studies
(from 1983 through 2018) with a total of 338 cardiac transplant patients
who received ICD met study inclusion criteria. The mean age was 48.37 +/-
14.85 years, and 70.4% were men. The pooled incidence of SD was 16.3% (95%
CI 6.2-29.0%; I²= 66%). Appropriate and inappropriate ICD
therapies were observed in 12.1% (95% CI 5.3-20.4; I²= 0%) and
3.5% (95% CI 0.11-9.58%; I²= 0%), respectively during the
follow-up period (27.48 +/- 24.27 months). The most common cause for SD
was heart failure (15.6%), followed by electromechanical disassociation,
malignant ventricular arrhythmias (4.7% each, respectively), and cardiac
allograft vasculopathy (CAV) (3.1%). Furthermore, approximately 60%
(10/17) of patients with appropriate ICD shocks had CAV.
<br/>Conclusion(s): Despite, low incidence of arrhythmic mortality, there
remains an increased burden of ventricular arrhythmias, as evident by a
12% appropriate ICD shock rates, suggesting ICD might be a practical
decision in selected cardiac transplant patients deemed high risk of SD
(i.e., patients with advanced CAV and left ventricular systolic
dysfunction).<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<55>
Accession Number
633132931
Title
Limitations in the Assessment of Prosthesis-Patient Mismatch.
Source
Thoracic and Cardiovascular Surgeon. 68 (7) (pp 550-556), 2020. Article
Number: 185256oc. Date of Publication: 01 Oct 2020.
Author
Amorim P.A.; Diab M.; Walther M.; Farber G.; Hagendorff A.; Bonow R.O.;
Doenst T.
Institution
(Amorim, Diab, Farber, Doenst) Department of Cardiothoracic Surgery,
Friedrich Schiller University Jena, Jena, Germany
(Walther) Department of Basic Sciences, University of Applied Sciences
Jena, Jena, Germany
(Hagendorff) Department of Internal Medicine, University Hospital Leipzig,
Leipzig, Germany
(Bonow) Division of Cardiology, Department of Medicine, Northwestern
University Feinberg, Germany
(Doenst) Department of Cardiothoracic Surgery, University Hospital Jena,
Am Klinikum 1, Jena 07747, Germany
Publisher
Georg Thieme Verlag
Abstract
Background aProsthesis-patient mismatch (PPM) after aortic valve
replacement (AVR) may affect survival but data are conflicting. It is
assessed by relating effective orifice area (EOA) to body surface area
(EOAi). EOA is patient-specific as the result of flow-velocity times area
at the individual patient's outflow tract levels (LVOT <inf>A</inf>)
divided by trans-prosthetic flow velocity. However, some studies use
projected EOAs (i.e., valve size associated EOAs from other patient
populations) to assess how PPM affects outcome. Methods aWe analyzed 76
studies addressing hemodynamic outcome and/or mortality after
bioprosthetic AVR. Results aIn 48 studies, projected or measured EOA for
calculation of EOAi and PPM assessment was used (of which 25 demonstrated
an effect on survival). We identified 28 additional studies providing
measured EOA values and the corresponding Bernoulli's pressure gradients
after AVR. Despite EOA being a patient-specific parameter, 77% of studies
assessing a PPM impact on survival used projected EOAs. The 28 studies are
providing measured EOA values and the corresponding Bernoulli's pressure
gradients in patients after AVR showed a highly significant, linear
relationship between EOA and Bernoulli's gradient. Considering this
relationship, it is surprising that relating EOA to body surface area
(BSA) (EOAi) is standard but relating pressure gradients to BSA is not.
Conclusion aWe conclude that the majority of studies assessing PPM have
used false assumptions because EOA is a patient-specific parameter and
cannot be transferred to other patients. In addition, the use of EOAi to
assess PPM may not be appropriate and could explain the inconsistent
relation between PPM and survival in previous studies.<br/>Copyright
&#xa9; 2020 Georg Thieme Verlag. All rights reserved.

<56>
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. <br/>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.
<br/>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. <br/>Conclusion(s):
Activation of PI3K/Akt/HIF-1alpha signaling might be involved in lung
protection of DEX in patients undergoing VATS.<br/>Copyright &#xa9; 2020
Zhu et al.

<57>
Accession Number
2007411144
Title
Right ventricular outflow tract reconstruction with Medtronic Freestyle
valve in the Ross procedure: A systematic review with meta-analysis.
Source
Artificial Organs. (no pagination), 2020. Date of Publication: 2020.
Author
Van den Eynde J.; Michel Pompeu B. O. S.a.; Callahan C.P.; Dimagli A.;
Vervoort D.; Kampaktsis P.N.; Zhigalov K.; Ruhparwar A.; Weymann A.
Institution
(Van den Eynde) Department of Cardiovascular Diseases, Unit of Cardiac
Surgery, University Hospitals Leuven, Leuven, Belgium
(Michel Pompeu B. O.) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco, PROCAPE, University of Pernambuco, Recife,
Brazil
(Callahan) Hospital for Sick Children, University of Toronto, Toronto, ON,
Canada
(Dimagli) School of Clinical Sciences, Bristol Heart Institute, University
of Bristol, Bristol, United Kingdom
(Vervoort) Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, United States
(Kampaktsis) Department of Medicine, New York University Langone Medical
Center, New York, NY, United States
(Zhigalov, Ruhparwar, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
Blackwell Publishing Inc.
Abstract
Cryopreserved pulmonary homografts (PH) are the current gold standard for
right ventricular outflow tract (RVOT) reconstruction in the Ross
procedure. Unfortunately, their use is limited by a relatively scarce
availability and high cost. Porcine stentless xenografts (SX) such as the
Medtronic Freestyle SX are increasingly being used, although it is unclear
whether the hemodynamic performance and the long-term durability are
satisfactory. The present systematic review followed the Preferred
Reporting Items for Systematic reviews and Meta-Analysis statement. The
pooled treatment effects were calculated using a weighted
DerSimonian-Laird random-effects model. We also evaluated the effect of
time after RVOT reconstruction on valve gradients using meta-regression.
Six studies with a total of 156 patients met the inclusion criteria. The
pooled estimates for the pooled follow-up of 37 months were: 1.3%
operative mortality, 94.8% overall survival, 7.5% structural valve
deterioration, 5.2% reintervention, 73.3% asymptomatic, and 1.5% moderate
or severe pulmonary insufficiency. Peak valve gradients were significantly
correlated with time after RVOT, increasing during follow-up. Three
studies compared PH with SX, one concluded that the SX is an acceptable
alternative for RVOT reconstruction, whereas two concluded that this
valvular substitute had inferior performance. The Freestyle SX can be
considered as an alternative to PH, although it might be associated with
more reinterventions, higher peak valve pressure gradients, and pulmonary
valve dysfunction.<br/>Copyright &#xa9; 2020 International Center for
Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC

<58>
Accession Number
2007404360
Title
Efficacy of Transcutaneous Electrical Nerve Stimulation for Postoperative
Pain, Pulmonary Function, and Opioid Consumption Following Cardiothoracic
Procedures: A Systematic Review.
Source
Neuromodulation. (no pagination), 2020. Date of Publication: 2020.
Author
Cardinali A.; Celini D.; Chaplik M.; Grasso E.; Nemec E.C.
Institution
(Cardinali, Celini, Chaplik, Grasso, Nemec) Sacred Heart University,
Fairfield, CT, United States
Publisher
Blackwell Publishing Inc.
Abstract
Objective: Transcutaneous electrical nerve stimulation (TENS) is a
minimally invasive method for treating pain. In the most recent review
published in 2012, TENS was associated with increased pain relief
following cardiothoracic surgery when compared to standard multimodal
analgesia. The purpose of this systematic review and meta-analysis is to
determine if adding TENS to current pain management practices decreases
pain and analgesic use and improves pulmonary function for
postcardiothoracic surgery patients. <br/>Material(s) and Method(s):
CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, PubMed, and
ClinicalTrials.gov were searched using specific keywords. Covidence was
used to screen, select studies, and extract data by two independent
reviewers. The Cochrane Risk of Bias tool assessed risk of bias. Visual
analog scale (VAS) and pulmonary function data were exported for
meta-analysis using a random effects model. <br/>Result(s): The search
yielded 38 articles. Eight randomized controlled trials met inclusion
criteria for the literature review. Five studies were included in the
meta-analysis of pain at 24, 48, and 72 hours postoperatively. Data were
analyzed using the standard mean difference (SMD). TENS had a significant
impact on VAS at rest (-0.76 SMD [95% confidence interval, CI = -1.06 to
-0.49], p < 0.00001) and with coughing (-1.11 SMD [95% CI = -1.64 to
-0.56], p < 0.0001). FEV1 improved after 72 hours (1.00 SMD [95% CI =
0.66-1.35], p < 0.00001), as did forced vital capacity (1.16 SMD [95% CI =
0.23-2.10], p = 0.01). <br/>Conclusion(s): The addition of TENS therapy to
multimodal analgesia significantly decreases pain following cardiothoracic
surgery, increases the recovery of pulmonary function, and decreases the
use of analgesics.<br/>Copyright &#xa9; 2020 International Neuromodulation
Society

<59>
Accession Number
2007397634
Title
Percutaneous balloon mitral valvotomy during pregnancy: A systematic
review and meta-analysis.
Source
Acta Obstetricia et Gynecologica Scandinavica. (no pagination), 2020. Date
of Publication: 2020.
Author
Sreerama D.; Surana M.; Moolchandani K.; Chaturvedula L.; Keepanasseril
A.; Pillai A.A.; Nair N.S.
Institution
(Sreerama, Surana, Moolchandani, Chaturvedula, Keepanasseril) Department
of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical
Education & Research (JIPMER), Puducherry, India
(Keepanasseril) School of Dentistry, Amrita Institute of Medical Sciences,
Kochi, India
(Keepanasseril) Department of Medicine, McMaster University, Hamilton,
Canada
(Pillai) Department of Cardiology, Jawaharlal Institute of Postgraduate
Medical Education & Research (JIPMER), Puducherry, India
(Nair) Biostatistics, Jawaharlal Institute of Postgraduate Medical
Education & Research (JIPMER), Puducherry, India
Publisher
Wiley-Blackwell
Abstract
Introduction: The objective of this study was to systematically review the
maternal and fetal outcomes in pregnant women who underwent percutaneous
balloon mitral valvuloplasty (PBMV) during pregnancy. <br/>Material(s) and
Method(s): A search was conducted on MEDLINE and Embase databases to
identify studies published between 2000 and 2018 that reported on maternal
and fetal outcomes following PBMV performed in pregnancy. Randomized
controlled trials, cohort studies, case-control studies, cross-sectional
studies and case series with four or more pregnancies in which PBMV was
performed during pregnancy were included. Reference lists from relevant
articles were also hand-searched for relevant citations. A successful
procedure was defined as one where there was a reported improvement in the
valve area or reduction in the mitral valve gradient. A random effects
model was used to derive pooled estimates of various outcomes and the
final estimates were reported as percentages with a 95% confidence
interval (95% CI). <br/>Result(s): Twenty-one observational studies
reporting 745 pregnancies were included in the review, all of them having
reported outcomes without a comparison group. Most of the studies fell
into the low-risk category as determined using the Joanna Briggs Institute
(JBI) critical appraisal checklist for case series. Most of the studies
(86%) were reported from low- to middle-income countries and PBMV was
mostly performed during the second trimester of pregnancy. Forty-three
procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported
among women with the severe subvalve disease (Wilkins subvalve score 3 or
more). There were 11 maternal deaths among those with suboptimal valve
anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation
was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%),
followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of
cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95%
CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4%
(95% CI 0.2%-14.7%). <br/>Conclusion(s): PBMV may be an effective and safe
procedure for optimizing outcomes in pregnant women with mitral stenosis
in the absence of severe subvalve disease.<br/>Copyright &#xa9; 2020
Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
Published by John Wiley & Sons Ltd

<60>
Accession Number
2007396266
Title
Effects of platelet-rich plasma on the healing of sternal wounds: A
meta-analysis.
Source
Wound Repair and Regeneration. (no pagination), 2020. Date of Publication:
2020.
Author
Yao D.; Feng G.; Zhao F.; Hao D.
Institution
(Yao, Feng, Zhao, Hao) No. 3 Department of Burns and Plastic Surgery and
Wound Healing Center, The Fourth Medical Center of Chinese PLA General
Hospital, Beijing, China
Publisher
Blackwell Publishing Inc.
Abstract
Sternal wound infection (SWI) is a devastating complication after cardiac
surgery. Platelet-rich plasma (PRP) may have a positive impact on sternal
wound healing. A systematic review with meta-analyses was performed to
evaluate the clinical effectiveness of topical application of autologous
PRP for preventing SWI and promoting sternal wound healing compared to
placebo or standard treatment without PRP. Relevant studies published in
English or Chinese were retrieved from the Cochrane Central Register of
Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of
Science, Springer Link, and the WHO International Clinical Trials Registry
Platform (ICTRP) using the search terms "platelet-rich plasma" and
"sternal wound" or "thoracic incision." References identified through the
electronic search were screened, the data were extracted, and the
methodological quality of the included studies was assessed. The
meta-analysis was performed for the following outcomes: incidence of SWI,
incidence of deep sternal wound infection (DSWI), postoperative blood loss
(PBL), and other risk factors. In the systematic review, totally 10
comparable studies were identified, involving 7879 patients. The
meta-analysis for the subgroup of retrospective cohort studies (RSCs)
showed that the incidence of SWI and DSWI in patients treated with PRP was
significantly lower than that in patients without PRP treatment. However,
for the subgroup of randomized controlled trials (RCTs), there was no
significant difference in the incidence of SWI or DSWI after intervention
between the PRP and control groups. There was no significant difference in
PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in-situ
recurrences were reported. According to the results, PRP could be
considered as a candidate treatment to prevent SWI and DSWI. However, the
quality of the evidence is too weak, and high-quality RCTs are needed to
assess its efficacy on preventing SWI and DSWI.<br/>Copyright &#xa9; 2020
The Wound Healing Society

<61>
[Use Link to view the full text]
Accession Number
2007393685
Title
Comparison of external jugular vein-based surface landmark approach and
ultrasound-guided approach for internal jugular venous cannulation: A
randomised crossover clinical trial.
Source
International Journal of Clinical Practice. (no pagination), 2020. Date of
Publication: 2020.
Author
Vinayagamurugan A.; Badhe A.S.; Jha A.K.
Institution
(Vinayagamurugan, Badhe, Jha) Anesthesiology and Critical Care, Jawaharlal
Institute of Postgraduate Medical Education and Research, Puducherry,
India
Publisher
Blackwell Publishing Ltd
Abstract
Background and objective: Historically, landmark techniques for central
venous access through the internal jugular vein (IJV) have yielded a
lesser success rate and higher complication rate than the ultrasound
(US)-guided approach. The purpose of this study is to assess the success
and safety of a novel external jugular vein (EJV)-based landmark (EJV-LM)
approach compared with the real-time US-guided approach for central venous
access through the IJV. <br/>Method(s): This was a prospective,
randomised, crossover trial performed in patients during elective cardiac
and non-cardiac surgery. Each resident randomly inserted a central venous
catheter using EJV-LM approach and real-time US-guided approach. The
primary outcome was first-attempt success. Secondary outcomes included
overall success rate, number of puncture attempts, cannulation time,
haematoma and mechanical complications. <br/>Result(s): A total of 188
patients were randomly assigned to the EJV-LM and US groups. The
demographic characteristics of the groups were comparable. The
first-attempt success was not different between EJV-LM and US-guided
techniques (79.8%; [95% CI: 70.2-87.4] vs 89.4% [95% CI 81.3-94.8]; P
=.06). The overall success rate was 100% with both techniques. There were
no differences in the number of puncture attempts with introducer needle
(1[1-3] vs 1[1-2]; P =.07). Cannulation time was longer in the EJV-LM
group compared with the US group (58.11 +/- 6.6 vs 44.27 +/- 5.28 seconds;
P =.0001). EJV-LM technique was associated with a higher occurrence of
overall complications compared with the US technique (12.8% [95% CI: 6.7-
21.2] vs 4.2% [95% CI: 1.1-10.5]; P =.03). No major mechanical
complications were observed with either techniques. <br/>Conclusion(s): In
patients with non-distorted neck anatomy and a visible EJV, IJV
catheterisation using the EJV-based LM approach and standard US-guided
technique yielded similar first-attempt and overall success rates.
Cannulation time was longer and complications occurred more frequently in
the EJV-based LM compared with the standard US-guided
technique.<br/>Copyright &#xa9; 2020 John Wiley & Sons Ltd

<62>
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. (pp e016318), 2020. Date of
Publication: 23 Nov 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.

<63>
Accession Number
633508737
Title
Sufentanil blunts the myocardial stress induced by tracheal intubation in
older adult patients with coronary heart disease better than equipotent
fentanyl.
Source
Annals of palliative medicine. (no pagination), 2020. Date of Publication:
17 Nov 2020.
Author
Yang Y.; Teng X.; Zhu J.
Institution
(Yang, Teng, Zhu) Department of Anesthesiology, Shengjing Hospital, China
Medical University, Shenyang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: To evaluate the role of sufentanil and fentanyl in the
prevention of cardiovascular responses to endotracheal intubation in
elderly patients with coronary heart disease (CHD). <br/>METHOD(S): Fifty
CHD patients scheduled for coronary artery bypass grafting (CABG)
(off-pump) under general anesthesia were randomly divided into two groups
to receive either 0.4 microg/kg of sufentanil (n=35) or 4 microg/kg of
fentanyl (n=36) in a double-blind manner. Under local anesthesia, an
invasive arterial catheter is used to monitor systolic blood pressure
(SBP), diastolic blood pressure (DBP), and mean arterial blood pressure
(MAP). Laryngoscopy and tracheal intubation were successfully performed
within 30 seconds. MAP and heart rate (HR) were recorded before anesthesia
induction, immediately before intubation, at intubation, and 1, 3, 5 min
after tracheal intubation. Rate pressure product (RPP) is calculated by
SBP multiple HR. <br/>RESULT(S): Patients in the fentanyl group showed a
significant increase in MAP, HR, and RPP associated with tracheal
intubation. However, the cardiovascular stimulation induced by tracheal
intubation was attenuated in the sufentanil group. <br/>CONCLUSION(S):
Laryngoscope and endotracheal intubation may cause adverse increases in
blood pressure (BP) and HR in elderly patients with CHD, resulting in an
imbalance of myocardial oxygen consumption and supply and myocardial
ischemia. Anesthesia induction with sufentanil 0.4 microg/kg is more
potential than fentanyl 4 microg/kg to attenuate the cardiovascular
intubation response.

<64>
Accession Number
633507150
Title
Associations between mean arterial pressure during cardiopulmonary bypass
and biomarkers of cerebral injury in patients undergoing cardiac surgery:
secondary results from a randomized controlled trial.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 22 Nov 2020.
Author
Wiberg S.; Holmgaard F.; Blennow K.; Nilsson J.C.; Kjaergaard J.; Wanscher
M.; Langkilde A.R.; Hassager C.; Rasmussen L.S.; Zetterberg H.; Vedel A.G.
Institution
(Wiberg, Kjaergaard, Hassager) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Holmgaard, Nilsson, Wanscher, Vedel) Department of Cardiothoracic
Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Blennow, Zetterberg) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, Sahlgrenska Academy at the
University of Gothenburg, Molndal, Sweden
(Blennow, Zetterberg) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Langkilde) Department of Radiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Hassager, Rasmussen) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Zetterberg) Department of Neurodegenerative Disease, UCL Institute of
Neurology, London, United Kingdom
(Zetterberg) UK Dementia Research Institute at UCL, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Cardiac surgery is associated with risk of cerebral injury and
mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) is
suggested to be associated with cerebral injury. The 'Perfusion Pressure
Cerebral Infarcts' (PPCI) trial randomized patients undergoing coronary
artery bypass grafting (CABG) and/or aortic valve replacement to a MAP of
40-50 or 70-80mmHg during CPB and found no difference in clinical or
imaging outcomes between the groups. We here present PPCI trial predefined
secondary end points, consisting of biomarkers of brain injury.
<br/>METHOD(S): Blood was collected from PPCI trial patients at baseline,
24 and 48h after induction of anaesthesia and at discharge from the
surgical ward. Blood was analysed for neuron-specific enolase, tau,
neurofilament light and the glial marker glial fibrillary acidic protein.
Linear mixed models were used to analyse differences in biomarker value
changes from baseline between the 2 MAP allocation groups. <br/>RESULT(S):
A total of 193 (98%) patients were included. We found no differences in
biomarker levels over time from baseline to discharge between the 2 MAP
allocation groups (PNSE = 0.14, PTau = 0.46, PNFL = 0.21, PGFAP = 0.13)
and the result did not change after adjustment for age, sex and type of
surgery. <br/>CONCLUSION(S): We found no significant differences in levels
of biomarkers of neurological injury in patients undergoing elective or
subacute CABG and/or aortic valve replacement randomized to either a
target MAP of 40-50mmHg or a target MAP of 70-80mmHg during
CBP.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<65>
Accession Number
633507094
Title
Mitral valve surgery after a failed MitraClip procedure.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 22 Nov 2020.
Author
Melillo F.; Baldetti L.; Beneduce A.; Agricola E.; Margonato A.; Godino C.
Institution
(Melillo, Baldetti, Beneduce, Agricola, Margonato, Godino)
Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
(Agricola, Margonato) Vita-Salute San Raffaele University, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Among patients undergoing transcatheter mitral valve repair
with the MitraClip device, a relevant proportion (2-6%) requires open
mitral valve surgery within 1year after unsuccessful clip implantation.
The goal of this review is to pool data from different reports to provide
a comprehensive overview of mitral valve surgery outcomes after the
MitraClip procedure and estimate in-hospital and follow-up mortality.
<br/>METHOD(S): All published clinical studies reporting on surgical
intervention for a failed MitraClip procedure were evaluated for inclusion
in this meta-analysis. The primary study outcome was in-hospital
mortality. Secondary outcomes were in-hospital adverse events and
follow-up mortality. Pooled estimate rates and 95% confidence intervals
(CIs) of study outcomes were calculated using a DerSimionian-Laird binary
random-effects model. To assess heterogeneity across studies, we used the
Cochrane Q statistic to compute I2 values. <br/>RESULT(S): Overall, 20
reports were included, comprising 172 patients. Mean age was 70.5years
(95% CI 67.2-73.7years). The underlying mitral valve disease was
functional mitral regurgitation in 50% and degenerative mitral
regurgitation in 49% of cases. The indication for surgery was persistent
or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas
6% of patients presented with mitral stenosis. At the time of the
operation, 80% of patients presented in New York Heart Association
functional class III-IV. Despite favourable intraoperative results,
in-hospital mortality was 15%. The rate of periprocedural cerebrovascular
accidents was 6%. At a mean follow-up of 12months, all-cause death was
26.5%. Mitral valve replacement was most commonly required because the
possibility of valve repair was jeopardized, likely due to severe valve
injury after clip implantation. <br/>CONCLUSION(S): Surgical intervention
after failed transcatheter mitral valve intervention is burdened by high
in-hospital and 1-year mortality, which reflects reflecting the high-risk
baseline profile of the patients. Mitral valve replacement is usually
required due to leaflet injury.<br/>Copyright &#xa9; The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<66>
Accession Number
633506732
Title
Single anti-platelet versus dual anti-platelet therapy after transcatheter
aortic valve replacement: A meta-analysis of randomized trials.
Source
The American journal of cardiology. (no pagination), 2020. Date of
Publication: 19 Nov 2020.
Author
Elbadawi A.; Thakker R.; Abuzaid A.A.; Khalife W.; Goel S.S.; Gilani S.;
Alasnag M.; Elgendy I.Y.
Institution
(Elbadawi, Khalife, Gilani) Department of Cardiovascular Medicine,
University of Texas Medical Branch, Galveston, TX, United States
(Thakker) Division of Internal Medicine, University of Texas Medical
Branch, Galveston, TX, United States
(Abuzaid) Division of Cardiology, University of California San Francisco,
San Francisco, CA
(Goel) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Center, TX, Houston
(Alasnag) Cardiac Center-King Fahd Armed Forces Hospital, Jeddah, Saudi
Arabia
(Elgendy) Division of Cardiology, Weill Cornell Medicine-Qatar, Doha,
Qatar
Publisher
NLM (Medline)

<67>
Accession Number
633495453
Title
An evidence-based review of the use of vasoactive and inotropic
medications in postoperative paediatric patients after cardiac surgery
with cardiopulmonary bypass from 2000 to 2020.
Source
Cardiology in the Young. (no pagination), 2020. Date of Publication: 2020.
Author
King C.E.; Thompson E.J.; Foote H.P.; Zimmerman K.O.; Hill K.D.;
Chamberlain R.; Hornik C.P.
Institution
(King, Thompson, Foote, Zimmerman, Hill, Chamberlain, Hornik) Department
of Pediatrics, Duke University, School of Medicine, Durham, NC, United
States
(Zimmerman, Hornik) Duke Clinical Research Institute, Durham, NC, United
States
Publisher
Cambridge University Press
Abstract
Background: Infants with moderate-to-severe CHD frequently undergo
cardiopulmonary bypass surgery in childhood. Morbidity and mortality are
highest in those who develop post-operative low cardiac output syndrome.
Vasoactive and inotropic medications are mainstays of treatment for these
children, despite limited evidence supporting their use. <br/>Method(s):
To help inform clinical practice, as well as the conduct of future trials,
we performed a systematic review of existing literature on inotropes and
vasoactives in children after cardiac surgery using the PubMed and EMBASE
databases. We included studies from 2000 to 2020, and the patient
population was defined as birth -18 years of age. Two reviewers
independently reviewed studies to determine final eligibility.
<br/>Result(s): The final analysis included 37 papers. Collectively,
selected studies reported on 12 different vasoactive and inotropic
medications in 2856 children. Overall evidence supporting the use of these
drugs in children after cardiopulmonary bypass was limited. The majority
of studies were small with 30/37 (81%) enrolling less than 100 patients,
29/37 (78%) were not randomised, and safety and efficacy endpoints
differed widely, limiting the ability to combine data for meta-analyses.
<br/>Conclusion(s): Vasoactive and inotropic support remain critical parts
of post-operative care for children after cardiopulmonary bypass surgery.
There is a paucity of data for the selection and dosing of vasoactives and
inotropes for these patients. Despite the knowledge gaps that remain,
numerous recent innovations create opportunities to rethink the conduct of
clinical trials in this high-risk population.<br/>Copyright &#xa9; 2020
BMJ Publishing Group. All rights reserved.

<68>
Accession Number
2010048028
Title
Management of heparin-induced thrombocytopenia: systematic reviews and
meta-analyses.
Source
Blood Advances. 4 (20) (pp 5184-5193), 2020. Date of Publication: 23 Oct
2020.
Author
Morgan R.L.; Ashoorion V.; Cuker A.; Begum H.; Ross S.; Martinez N.; Chong
B.H.; Linkins L.A.; Warkentin T.E.; Wiercioch W.; Nieuwlaat R.; Schunemann
H.; Santesso N.
Institution
(Morgan, Begum, Ross, Wiercioch, Nieuwlaat, Schunemann, Santesso)
Department of Health Research Methods, Evidence and Impact McMaster
University, Hamilton, ON, Canada
(Ashoorion) Michael G. DeGroote Centre for Medicinal Cannabis Research,
McMaster University, Hamilton, ON, Canada
(Cuker) Department of Medicine, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
(Cuker) Department of Pathology and Laboratory Medicine, Perelman School
of Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Martinez) Independent Researcher, Atlanta, GA, United States
(Chong) Department of Haematology, University of New South Wales, Sydney,
NSW, Australia
(Linkins, Warkentin, Schunemann) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Wiercioch, Nieuwlaat, Schunemann, Santesso) Michael G. DeGroote Cochrane
Canada Centre, McMaster University, Hamilton, ON, Canada
Publisher
American Society of Hematology
Abstract
Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse drug
reaction occurring in,0.1% to 7% of patients receiving heparin products
depending on the patient population and type of heparin. Management of HIT
is highly dependent on a sequence of tests for which clinicians may or may
not have the results when care decisions need to be made. We conducted
systematic reviews of the effects of management strategies in persons with
acute HIT, subacute HIT A or B, and remote HIT. We searched Medline,
EMBASE, and the Cochrane Database through July 2019 for previously
published systematic reviews and primary studies. Two investigators
independently screened and extracted data and assessed the certainty of
the evidence using the Grading of Recommendations Assessment, Development
and Evaluation approach. We found primarily noncomparative studies and
case series assessing effects of treatments, which led to low to very low
certainty evidence. There may be little to no difference in the effects
between nonheparin parenteral anticoagulants and direct oral
anticoagulants in acute HIT. The benefits of therapeutic-intensity may be
greater than prophylactic-intensity anticoagulation. Using inferior vena
cava filters or platelet transfusion may result in greater harm than not
using these approaches. Evidence for management in special situations,
such as for patients undergoing cardiovascular interventions or renal
replacement therapy, was also low to very low certainty. Additional
research to evaluate nonheparin anticoagulants is urgently needed, and the
development of novel treatments that reduce thrombosis without increasing
hemorrhage should be a priority.<br/>Copyright &#xa9; 2020 by The American
Society of Hematology

<69>
Accession Number
2007713199
Title
Cost of Thoracotomy Approach: An Analysis of the LATERAL Trial.
Source
Annals of Thoracic Surgery. 110 (5) (pp 1512-1519), 2020. Date of
Publication: November 2020.
Author
Mokadam N.A.; McGee E.; Wieselthaler G.; Pham D.T.; Bailey S.H.; Pretorius
G.V.; Boeve T.J.; Ismyrloglou E.; Strueber M.
Institution
(Mokadam) Division of Cardiac Surgery, The Ohio State University Wexner
Medical Center, Columbus, OH, United States
(McGee) Department of Thoracic and Cardiovascular Surgery, Loyola
University Medical Center, Maywood, IL, United States
(Wieselthaler) Department of Surgery, University of California San
Francisco, San Francisco, CA, United States
(Pham) Department of Surgery, Northwestern University Feinberg School of
Medicine, Chicago, IL, United States
(Bailey) Department of Thoracic and Cardiac Surgery, Allegheny General
Hospital, Pittsburgh, PA, United States
(Pretorius) Department of Surgery, University of California San Diego, La
Jolla, CA, United States
(Boeve) Department of Cardiothoracic Surgery, Spectrum Health, Grand
Rapids, MI, United States
(Ismyrloglou) Department of Cardiac Rhythm and Heart Failure, Medtronic
Bakken Research Center BV, Maastricht, Netherlands
(Strueber) Department of Cardiothoracic Surgery, Newark Beth Israel
Medical Center, Newark, NJ, United States
Publisher
Elsevier Inc.
Abstract
Background: Less invasive techniques for left ventricular assist device
implantation have been increasingly prevalent over past years and have
been associated with improved clinical outcomes. The procedural economic
impact of these techniques remains unknown. We sought to study and report
economic outcomes associated with the thoracotomy implantation approach.
<br/>Method(s): The LATERAL clinical trial evaluated the safety and
efficacy of the thoracotomy approach for implantation of the HeartWare
centrifugal-flow ventricular assist device system (HVAD). We collected
UB-04 forms in parallel to the trial, allowing analysis of index
hospitalization costs. All charges were converted to costs using
hospital-specific cost-to-charge ratios and were subsequently compared
with Medicare cost data for the same period (2015-2016). Because
thoracotomy implants were off-label for all left ventricular assist
devices during that period, the Medicare cohort was assumed to consist
predominately of traditional sternotomy patients. <br/>Result(s):
Thoracotomy patients demonstrated decreased costs compared with sternotomy
patients during the index hospitalization. Mean total index
hospitalization costs for thoracotomy were $204,107 per patient,
corresponding to 21.6% reduction (P < .001) and $56,385 savings per
procedure compared with sternotomy. Across almost all cost categories,
thoracotomy implants were less costly. <br/>Conclusion(s): In LATERAL, a
clinical trial evaluating the safety and efficacy of the thoracotomy
approach for HVAD, costs were lower than those reported in Medicare
patient claims occurring over the same period. Because Medicare data can
be presumed to consist of predominately sternotomy procedures, thoracotomy
appears less expensive than traditional sternotomy.<br/>Copyright &#xa9;
2020 The Society of Thoracic Surgeons

<70>
Accession Number
633144843
Title
An economic model to assess the value of triclosan-coated sutures in
reducing the risk of surgical-site infection in coronary artery bypass
graft in India.
Source
Journal of Indian College of Cardiology. 10 (2) (pp 79-84), 2020. Date of
Publication: April-June 2020.
Author
Mahajan N.; Pillai R.; Chopra H.; Grover A.; Kohli A.
Institution
(Mahajan, Pillai) Medical Affairs, Clinical Operations and Device Safety,
Johnson and Johnson Pvt. Ltd, Mumbai, Maharashtra, India
(Chopra, Grover, Kohli) Medical Affairs, Clinical Operations and Device
Safety, Johnson and Johnson Pvt. Ltd, Mumbai, Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: The incidence of surgical site infections (SSIs) is higher in
India compared to the rest of the world. In patients undergoing coronary
artery bypass graft (CABG), the risk is even higher. SSI following CABG is
associated with an additional length of stay (LOS) resulting in additional
costs, thus causing a significant economic burden on patients and society.
We aimed to determine the additional costs and LOS due to SSIs after CABG
and to evaluate the efficacy of triclosan-coated sutures (TCS) in reducing
the SSI rate. Methodology: A systematic literature search of available
evidence for both epidemiologic and economic data related to the incidence
of SSI (from 1998 to 2018) and efficacy of TCS (from 2000 to 2018)
respectively, were gathered. We compared 100 surgeries from private and
public hospitals for CABG and calculated cost-effectiveness of TCS in
comparison to conventional nonantimicrobial-coated sutures (NCS) using a
decision-tree cost model. <br/>Result(s): Three studies were analyzed out
of 109 citations for the analysis of SSI incidence and for the efficacy of
TCS versus NCS, five studies were included. We performed a one-way
sensitivity analysis to calculate the impact of efficacy (%) and SSI
incidences (%) and cost of NCS and TCS on cost savings depicted by Tornado
charts. Sensitivity analysis on the comparison of TCS with NCS, a base
cost saving of CABG for a private hospital was INR 14,476 and public
hospital INR 4145. <br/>Conclusion(s): The use of TCS reduced SSI
incidence and cost savings for CABG surgeries in both public and private
sectors in India.<br/>Copyright &#xa9; 2020 Journal of Indian College of
Cardiology <br/> Published by Wolters Kluwer - Medknow.

<71>
Accession Number
2008606338
Title
Effects of empagliflozin on first and recurrent clinical events in
patients with type 2 diabetes and atherosclerotic cardiovascular disease:
a secondary analysis of the EMPA-REG OUTCOME trial.
Source
The Lancet Diabetes and Endocrinology. 8 (12) (pp 949-959), 2020. Date of
Publication: December 2020.
Author
McGuire D.K.; Zinman B.; Inzucchi S.E.; Wanner C.; Fitchett D.; Anker
S.D.; Pocock S.; Kaspers S.; George J.T.; von Eynatten M.; Johansen O.E.;
Jamal W.; Mattheus M.; Elsasser U.; Hantel S.; Lund S.S.
Institution
(McGuire) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Parkland Health and
Hospital System, Dallas, TX, United States
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Toronto, ON, Canada
(Fitchett) St Michael's Hospital, Division of Cardiology, University of
Toronto, Toronto, ON, Canada
(Inzucchi) Section of Endocrinology, Yale University School of Medicine,
New Haven, CT, United States
(Wanner) Wurzburg University Clinic, Wurzburg, Germany
(Anker) Department of Cardiology (CVK), Berlin Institute of Health Center
for Regenerative Therapies, German Centre for Cardiovascular Research
(DZHK) partner site Berlin, Charite - Universitatsmedizin Berlin, Berlin,
Germany
(Pocock) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Kaspers, George, von Eynatten, Jamal, Lund) Boehringer Ingelheim
International, Ingelheim, Germany
(Johansen) Boehringer Ingelheim Norway KS, Asker, Norway
(Mattheus) Boehringer Ingelheim Pharma, Ingelheim, Germany
(Elsasser, Hantel) Boehringer Ingelheim Pharma, Biberach, Germany
Publisher
Lancet Publishing Group
Abstract
Background: Patients with type 2 diabetes and atherosclerotic
cardiovascular disease are at high clinical risk. We assessed the effect
of the sodium-glucose co-transporter-2 inhibitor, empagliflozin, on total
cardiovascular events and admissions to hospital in the EMPA-REG OUTCOME
trial. <br/>Method(s): The EMPA-REG OUTCOME trial was a randomised,
double-blind, non-inferiority trial of patients (aged >=18 years) with
type 2 diabetes and atherosclerotic cardiovascular disease done between
August, 2010, and April, 2015. Participants were randomly assigned (1:1:1)
to empagliflozin 10 mg or 25 mg, or placebo. The primary outcome was major
adverse cardiovascular events: a composite of cardiovascular death,
non-fatal stroke, or non-fatal myocardial infarction. As prespecified, the
effects of pooled empagliflozin versus placebo were assessed on total
(first plus recurrent) events of major adverse cardiovascular events,
fatal or non-fatal myocardial infarction, fatal or non-fatal stroke, and
admission to hospital for heart failure. We also did post-hoc analyses on
additional cardiovascular and admission to hospital outcomes. We used
statistical models that preserve randomisation and account for correlation
of recurrent events, including negative binomial regression, as
prespecified for the primary analyses. The EMPA-REG OUTCOME trial is
registered with ClinicalTrials.gov, NCT01131676, and is closed to accrual.
<br/>Finding(s): In the EMPA-REG OUTCOME trial, 7020 patients were
randomly assigned and treated with empagliflozin 10 mg (n=2345),
empagliflozin 25 mg (n=2342), or placebo (n=2333) and followed up for a
median of 3.2 years (IQR 2.2 to 3.6) in the pooled empagliflozin group and
3.1 years (2.2 to 3.5) in the placebo group. Analysing total (first plus
recurrent) events, empagliflozin versus placebo reduced the risk of major
adverse cardiovascular events (rate ratio [RR] 0.78 [95% CI 0.67 to 0.91];
p=0.0020; 12.88 [95% CI 3.74 to 22.02] events prevented per 1000
patient-years); fatal or non-fatal myocardial infarction (0.79 [0.62 to
0.998]; p=0.049; 4.97 [-0.68 to 10.61] events prevented per 1000
patient-years); the composite of fatal or non-fatal myocardial infarction,
or coronary revascularisation (0.80 [0.67 to 0.95]; p=0.012; 11.65 [1.25
to 22.05] events prevented per 1000 patient-years); admission to hospital
for heart failure (0.58 [0.42 to 0.81]; p=0.0012; 9.67 [3.07 to 16.28]
events prevented per 1000 patient-years); and all-cause admission to
hospital (0.83 [0.76 to 0.91]; p<0.0001; 50.41 [26.20 to 74.63] events
prevented per 1000 patient-years). For outcomes significantly reduced with
empagliflozin, risk reductions were numerically larger for total events
than for first events. Total fatal or non-fatal stroke was not
significantly different between treatment groups (RR 1.10 [95% CI 0.82 to
1.49]; p=0.52). <br/>Interpretation(s): Empagliflozin reduced the total
burden of cardiovascular complications and all-cause admission to hospital
in patients with type 2 diabetes and atherosclerotic cardiovascular
disease. <br/>Funding(s): The Boehringer Ingelheim and Lilly
Alliance.<br/>Copyright &#xa9; 2020 Elsevier Ltd

<72>
Accession Number
2010034281
Title
Use of an Aortic Valve Replacement Simulation Model to Understand Hospital
Costs and Resource Utilization Associated With Rapid-Deployment Valves.
Source
Clinical Therapeutics. (no pagination), 2020. Date of Publication: 2020.
Author
Cotroneo A.; Novelli E.; Barbieri G.; Freddi R.; Bobbio M.; Stelian E.;
Visetti E.; Martinelli G.L.
Institution
(Cotroneo, Novelli, Bobbio, Stelian, Visetti, Martinelli) Clinica San
Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy
(Barbieri) Edwards Lifesciences, Milan, Italy
(Freddi) Centre for Research on Health and Social Care Management
(CERGAS), SDA Bocconi School of Management, Milan, Italy
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Aortic stenosis (AS) is the most common cause of adult valvular
heart disease. In the past decade, minimally invasive surgery (MIS) to
treat AS has gained popularity, especially if performed in combination
with rapid deployment valves (RDVs), which shorten cross-clamp time (XCT).
This study examines specific outcomes and related costs of aortic valve
replacement (AVR) before and after the introduction of RDVs.
<br/>Method(s): We used the AVR simulator, an economic model developed to
correlate cost and resource utilization associated with the adoption of
RDVs, to compare 2 scenarios: (1) a current scenario based on standard AVR
practices and (2) a proposed scenario based on increasing use of RDVs and
an MIS approach. Both scenarios involved 3 subgroups of patients treated
with (1) conventional AVR, (2) MIS, and (3) AVR combined with a coronary
artery bypass graft. The current scenario (status quo) involved patients
treated with traditional biological valves, and the proposed scenario
involved patients who underwent implantation with an RDV. The AVR
simulator was fed with real-world input data to estimate complication
rates and resource consumption in the proposed scenario. Real-world input
data for this analysis were obtained from patients diagnosed with a
symptomatic heart valve disease between 2015 and 2018, at
Clinica-San-Gaudenzio, Novara, Italy. Lastly, the AVR simulator estimated
hospital savings by comparing the 2 scenarios. <br/>Finding(s): A total of
132 patients underwent implantation with a traditional biological valve,
and 107 were treated with a commercial valve system. The RDV was
associated with an increase of 52% of patients undergoing MIS, which
generated a 6.1-h reduction of XCT and a total savings of 6695. RDVs also
reduced intensive care unit (ICU) and hospital ward length of stay (LOS),
leading to savings of 677 and 595 per patient, respectively. Mortality and
blood transfusions also improved. The savings for the hospital (related to
shorter XCT, hospital ward LOS, and ICU LOS) amounted to 144.111. Our
findings were consistent with data gathered from our real-word setting,
and results of a sensitivity analysis indicate that our findings were
robust across different possible situations. Implications: Switching to
RDVs and MIS procedures for AVRs was associated with a reduction of costs
related to XCT, hospital ward LOS, and ICU LOS. Hospitals can upload
literature- and experience-based clinical and cost values to the AVR
simulator to estimate a hospital's performance with the introduction of
RDVs compared with standard biological valves. This study was not
randomized, so more extensive studies could confirm our results in the
future.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<73>
Accession Number
2008415374
Title
Mortality in trials on transcatheter aortic valve implantation versus
surgical aortic valve replacement: A pooled meta-analysis of
Kaplan-Meier-derived individual patient data.
Source
European Journal of Cardio-thoracic Surgery. 58 (2) (pp 221-229), 2020.
Date of Publication: 01 Aug 2020.
Author
Barili F.; Freemantle N.; Casado A.P.; Rinaldi M.; Folliguet T.; Musumeci
F.; Gerosa G.; Parolari A.
Institution
(Barili, Casado) Department of Cardiac Surgery, S. Croce Hospital, Cuneo,
Italy
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Rinaldi) Department of Cardiac Surgery, AOU "Citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Gerosa) Department of Cardiac Surgery, University of Padua, Padua, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico S. Donato, University of Milan, Milan, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: This meta-analysis of Kaplan-Meier-estimated individual
patient data was designed to evaluate the effects of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on
the long-term all-cause mortality rate, to examine the potential
time-varying effect and to model their hazard ratios (HRs) over time.
Moreover, we sought to compare traditional meta-analytic tools and
estimated individual patient data meta-analyses. <br/>METHOD(S): Trials
comparing TAVI versus SAVR were identified through Medline, Embase,
Cochrane databases and specialist websites. The primary outcome was death
from any cause at follow-up. Enhanced secondary analyses of survival
curves were performed estimating individual patient time-to-event data
from published Kaplan-Meier curves. Treatments were compared with the
random effect Cox model in a landmark framework and fully parametric
models. <br/>RESULT(S): We identified 6 eligible trials that included 6367
participants, randomly assigned to undergo TAVI (3252) or SAVR (3115).
According to the landmark analysis, the incidence of death in the first
year after implantation was significantly lower in the TAVI group
[risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99;
P = 0.04], whereas there was a reversal of the HR after 40 months
(risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P = 0.04) favouring
SAVR over TAVI. This time-varying trend of HRs was also confirmed by a
fully parametric time-to-event model. Traditional meta-analytic tools were
shown to be biased because they did not intercept heterogeneity and the
time-varying effect. <br/>CONCLUSION(S): The mortality rates in trials of
TAVI versus SAVR are affected by treatments with a time-varying effect.
TAVI is related to better survival in the first months after implantation
whereas, after 40 months, it is a risk factor for all-cause
mortality.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<74>
Accession Number
2007151997
Title
Performance and Safety of Transfemoral TAVI With SAPIEN XT in Australian
Patients With Severe Aortic Stenosis at Intermediate Surgical Risk:
SOLACE-AU Trial.
Source
Heart Lung and Circulation. 29 (12) (pp 1839-1846), 2020. Date of
Publication: December 2020.
Author
Yong G.; Walton T.; Ng M.; Gurvitch R.; Worthley S.; Whitbourn R.; Jepson
N.; Bhindi R.; Shang K.; Sinhal A.
Institution
(Yong) Fiona Stanley Hospital, Perth, WA, Australia
(Walton) Alfred Health, Melbourne, Vic, Australia
(Ng) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Gurvitch) Royal Melbourne Hospital, Melbourne, Vic, Australia
(Worthley) GenesisCare Cardiology, Sydney, NSW, Australia
(Whitbourn) St Vincent's Hospital Melbourne & Melbourne University,
Melbourne, Vic, Australia
(Jepson) Prince of Wales Public Hospital and Eastern Heart Clinic, Sydney,
NSW, Australia; University of NSW, Sydney, NSW, Australia
(Bhindi) North Shore Private Hospital, Sydney, NSW, Australia
(Shang) Edwards Lifesciences, Irvine, CA, United States
(Sinhal) Flinders Medical Centre, Flinders University, Adelaide, SA,
Australia
Publisher
Elsevier Ltd
Abstract
Background: To determine the safety and performance of the SAPIEN XT
transcatheter heart valve (THV) in Australian patients with severe aortic
stenosis (AS) and intermediate surgical risk. <br/>Method(s): Eligible
patients in this multi-centre, prospective, consecutively enrolled,
non-randomised, clinical trial, received transcatheter aortic valve
replacement via femoral artery access. Follow-up visits were at discharge,
30 days, and 6, 12, and 24 months. The primary endpoint was Valve Academic
Research Consortium-2 composite safety at 30 days: all-cause mortality,
all stroke, life-threatening bleeding, acute kidney injury-Stage 3,
coronary artery obstruction requiring intervention, major vascular
complication, and valve-related dysfunction requiring repeat procedure.
Other endpoints were device success (successful vascular access, delivery,
and deployment; correct position; intended performance mean aortic valve
gradient <20 mmHg, mild or less paravalvular aortic regurgitation [PAR];
and only one valve implanted) and New York Heart Association functional
class (NYHA). Kaplan-Meier (KM) estimates were calculated for the primary
endpoint. <br/>Result(s): At baseline, mean patient (N=199) age was 85.5
years, mean Society of Thoracic Surgeon score was 5.9, and 78.4% were in
NYHA class III/IV. The primary composite endpoint KM estimate was 12.1%.
Device success was 88.8%. SAPIEN XT was implanted in the proper location
in 98.5% (n=2: valve-in-valve procedures, n=1: no implant due to left main
coronary artery occlusion). No device malfunctions were reported. The post
procedure PAR was mild or less in 93.8% of patients. Mean aortic gradient
decreased from baseline (50.0 mmHg) to 2 years (10.3 mmHg). Most patients
(90.9%) were in NYHA class I/II at 30 days. New permanent pacemaker rate
was 8.1%. Stroke at 30 days was 3.5% (1.5% disabling). <br/>Conclusion(s):
SAPIEN XT was safe and improved heart failure symptoms and valve
haemodynamics in this cohort of Australian patients.<br/>Copyright &#xa9;
2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<75>
Accession Number
2005955195
Title
Closed-incision negative-pressure wound management in surgery-literature
review and recommendations.
Source
European Surgery - Acta Chirurgica Austriaca. 52 (6) (pp 249-267), 2020.
Date of Publication: December 2020.
Author
Smolle M.A.; Nischwitz S.P.; Hutan M.; Trunk P.; Lumenta D.; Bernhardt
G.A.
Institution
(Smolle, Bernhardt) Department of Orthopaedics and Trauma, Medical
University of Graz, Auenbruggerplatz 5, Graz 8036, Austria
(Nischwitz, Lumenta) Division of Plastic, Aesthetic and Reconstructive
Surgery, Medical University of Graz, Graz, Austria
(Hutan) Department of Surgery, Landesklinikum Hainburg, Hainburg/Donau,
Austria
(Trunk) Department of Cardiovascular Surgery, Ljubljana University Medical
Centre, Ljubljana, Slovenia
(Nischwitz) COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM
RESEARCH Forschungsgesellschaft mbH, Graz, Austria
Publisher
Springer
Abstract
Background: Wound healing deficits and subsequent surgical site infections
are potential complications after surgical procedures, resulting in
increased morbidity and treatment costs. Closed-incision negative-pressure
wound therapy (ciNPWT) systems seem to reduce postoperative wound
complications by sealing the wound and reducing tensile forces.
<br/>Material(s) and Method(s): We conducted a collaborative English
literature review in the PubMed database including publications from 2009
to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and
trauma, general surgery, plastic surgery, cardiac surgery and vascular
surgery). With literature reviews, case reports and expert opinions
excluded, the remaining 59 studies were critically summarized and
evaluated with regard to their level of evidence. <br/>Result(s): Of nine
studies analysed in orthopaedics and trauma, positive results of ciNPWT
were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10
(100%) of studies analysed in plastic, vascular and general surgery,
respectively, a positive effect of ciNPWT was observed. On the contrary,
only 4 of 12 studies from cardiac surgery discovered positive effects of
ciNPWT (33.3%). <br/>Conclusion(s): ciNPWT is a promising treatment
modality to improve postoperative wound healing, notably when facing
increased tensile forces. To optimise ciNPWT benefits, indications for its
use should be based on patient- and procedure-related risk
factors.<br/>Copyright &#xa9; 2020, The Author(s).

<76>
Accession Number
2005084633
Title
Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia
in adult and paediatric cardiac surgery: a systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). 35 (8) (pp 724-735), 2020. Date of
Publication: November 2020.
Author
Ler A.; Sazzad F.; Ong G.S.; Kofidis T.
Institution
(Ler, Sazzad, Ong, Kofidis) Department of Cardiac, Thoracic and Vascular
Surgery, National University Heart Centre, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Kofidis) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
SAGE Publications Ltd
Abstract
Background: In recent years, the use of del Nido cardioplegia, initially
intended for paediatric cardiac surgery, has been extended to adult
cardiac surgery in many institutions. Our aim was thus to compare the
outcomes of the use of del Nido cardioplegia with that of conventional
cardioplegia and discuss its role in both adult and paediatric cardiac
surgery. <br/>Method(s): A systematic literature search was conducted in
August 2019 on Medline (via PubMed), Embase and Cochrane electronic
databases according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Any retrospective studies and
randomised controlled trials that reported findings comparing the outcomes
of the use of del Nido cardioplegia with that of St. Thomas cardioplegia
were included. <br/>Result(s): We observed shorter aortic cross-clamp time
(mean difference: -15.18, confidence interval: -27.21 to -3.15, p = 0.01)
and cardiopulmonary bypass time (mean difference: -13.52, confidence
interval: -20.64 to -6.39, p = 0.0002) associated with the use of del Nido
cardioplegia in adult cardiac surgery as compared to St. Thomas
cardioplegia. Defibrillation rates were significantly lower in patients
who had been given del Nido cardioplegia, in both adult (relative risk:
0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric
patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p =
0.02). <br/>Conclusion(s): Del Nido cardioplegia may be a viable
alternative to the use of St. Thomas cardioplegia in both adult and
paediatric patients, providing similar postoperative outcomes while also
affording the additional advantage of shorter aortic cross-clamp time and
cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates
of defibrillation (in both adult and paediatric cardiac
surgery).<br/>Copyright &#xa9; The Author(s) 2020.

<77>
Accession Number
2004701089
Title
Clinical application of a new ternary polymer, SEC-1 coatTM, for pediatric
cardiopulmonary bypass circuits: a prospective randomized pilot study.
Source
Perfusion (United Kingdom). 35 (8) (pp 826-832), 2020. Date of
Publication: November 2020.
Author
Hasegawa T.; Oshima Y.; Yokoyama S.; Akimoto A.; Misaka Y.; Akiyama S.
Institution
(Hasegawa) Department of Pediatric Critical Care Medicine, Hyogo
Prefectural Kobe Children's Hospital, Kobe, Japan
(Hasegawa, Oshima, Yokoyama, Akimoto, Misaka, Akiyama) Department of
Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe,
Japan
Publisher
SAGE Publications Ltd
Abstract
Objective: The use of biocompatible materials to reduce the systemic
activation of inflammation and coagulation pathways is expanding rapidly.
However, there have been few clinical studies of biocompatible circuits
for pediatric cardiopulmonary bypass. This pilot study aimed to
preliminarily evaluate the biocompatibility of SEC-1 coatTM (SEC) for
cardiopulmonary bypass circuits in pediatric cardiac surgery.
<br/>Method(s): Twenty infants undergoing cardiac surgery for isolated
ventricular septal defects at Kobe Children's Hospital were assigned
randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control
group, n = 10) circuit. Perioperative data and the following markers were
prospectively analyzed: platelet counts and interleukin-6, interleukin-8,
C3a, beta-thromboglobulin, and thrombin-antithrombin complex levels.
<br/>Result(s): Neither patient characteristics nor postoperative clinical
outcomes differed significantly between the SEC and control groups.
Platelet counts markedly decreased during cardiopulmonary bypass in both
groups, but were significantly better preserved in the SEC group. Fewer
patients needed postoperative platelet transfusions in the SEC group.
After cardiopulmonary bypass termination, serum levels of
beta-thromboglobulin and thrombin-antithrombin complex were significantly
lower in the SEC than in the control group. Although the differences were
not statistically significant, serum levels of interleukin-6,
interleukin-8, and C3a had a tendency toward being lower in the SEC group,
with good preservation of leukocyte counts, fibrinogen, and antithrombin
III. <br/>Conclusion(s): SEC-1 coatTM for cardiopulmonary bypass circuits
have good biocompatibility with regard to platelet preservation and in
terms of attenuating inflammatory reaction or coagulation activation
during pediatric cardiac surgery. It can be beneficial in pediatric as
well as adult cardiac surgery.<br/>Copyright &#xa9; The Author(s) 2020.

<78>
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. <br/>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. <br/>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. <br/>Intervention(s): Participants
received evacetrapib, 130 mg/d, or matching placebo. <br/>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). <br/>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. <br/>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.<br/>Copyright &#xa9; 2020 American Medical Association. All
rights reserved.

<79>
Accession Number
2008399649
Title
An invited commentary on: "Effect of acute normovolemic hemodilution on
coronary artery bypass grafting: A systematic review and meta-analysis of
22 randomized trials".
Source
International Journal of Surgery. 84 (pp 87-88), 2020. Date of
Publication: December 2020.
Author
Akay S.; Akay H.
Institution
(Akay, Akay) Emergency Medicine Clinic, University of Health Sciences,
Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
Publisher
Elsevier Ltd

<80>
Accession Number
633490671
Title
Low-tidal volume mechanical ventilation against no ventilation during
cardiopulmonary bypass in heart surgery (MECANO): a randomized controlled
trial.
Source
Chest. (no pagination), 2020. Date of Publication: 17 Nov 2020.
Author
Nguyen L.S.; Estagnasie P.; Merzoug M.; Brusset A.; Law Koune J.-D.;
Aubert S.; Waldmann T.; Naudin C.; Grinda J.-M.; Gibert H.; Squara P.
Institution
(Nguyen, Estagnasie, Brusset, Squara) Critical Care Department, CMC
Ambroise Pare, Neuilly-sur-Seine, France; Research & Innovation Department
of CMC Ambroise Pare (RICAP)
(Merzoug, Naudin) Research & Innovation Department of CMC Ambroise Pare
(RICAP)
(Law Koune, Gibert) Research & Innovation Department of CMC Ambroise Pare
(RICAP); Anesthesiology Department, CMC Ambroise Pare, Neuilly-sur-Seine,
France
(Aubert, Waldmann, Grinda) Research & Innovation Department of CMC
Ambroise Pare (RICAP); Cardiothoracic Surgery Department, CMC Ambroise
Pare, Neuilly-sur-Seine, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative pulmonary complications are common after cardiac
surgery and have been related to lung collapsus during cardiopulmonary
bypass (CPB). There is no consensus on the effects of maintaining
mechanical ventilation during CPB to decrease these complications.
RESEARCH QUESTION: To determine whether maintaining low-tidal ventilation
(3 mL/kg 5 times per minute, with positive end expiratory pressure 5
cmH2O) during CPB (VENT strategy) was superior to a resting-lung strategy,
with no ventilation (noV strategy), regarding postoperative pulmonary
complications, including mortality. STUDY DESIGN AND METHODS: In a
randomized controlled trial, patients undergoing cardiac surgery at a
single center from May 2017 to August 2019 were randomized between VENT
and noV strategy during CPB (1:1 ratio). Apart from CPB phase,
perioperative ventilation procedures were standardized. <br/>RESULT(S):
The study included 1501 patients (68.8 +/-10.3 years, 1152 (76.7%) men,
EuroSCORE II 2.3 +/-2.7). There were 756 patients in the VENT strategy
group and there were no differences in baseline characteristics and types
of procedures between the two groups. Intention-to-treat analysis yielded
no significant difference between VENT and noV groups regarding incidence
of the primary composite outcome combining death, early respiratory
failure, ventilation support beyond day 2 and reintubation with 112/756,
14.8% in the VENT group versus 133/745, 17.9% in the noV group,
odds-ratio(OR)=0.80 (95% confidence interval=0.61-1.05, p =0.11). Strict
per-protocol analyses on 1338 (89.1%) patients with equally distributed
preoperative characteristics yielded similar results (OR=0.81 (0.60-1.09),
p=0.16). Post-hoc analysis on the subgroup of isolated coronary artery
bypass graft (CABG) procedures (n=725), showed that VENT was superior to
noV strategy regarding the primary outcome (OR=0.56 (0.37-0.84), p=0.005).
INTERPRETATION: Among patients undergoing cardiac surgery with CPB,
continuation of low-tidal volume ventilation was not superior to no
ventilation during CPB, with respect to postoperative complications,
including death, early respiratory failure, ventilation support beyond day
2 and reintubation.<br/>Copyright &#xa9; 2020. Published by Elsevier Inc.

<81>
Accession Number
633486556
Title
The impact of transfusions on mortality after transcatheter or surgical
aortic valve replacement.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 17 Nov 2020.
Author
Mumtaz M.; Wyler von Ballmoos M.C.; Deeb G.M.; Popma J.J.; Van Mieghem
N.M.; Kleiman N.S.; Gleason T.G.; Chawla A.; Hockmuth D.; Zorn G.L.;
Tadros P.; Li S.; Reardon M.J.
Institution
(Mumtaz) University of Pittsburgh Medical Center Pinnacle Heath,
Cardiovascular and Thoracic Surgery, Harrisburg, United States
(Wyler von Ballmoos, Kleiman, Reardon) Department of Cardiothoracic
Surgery, Houston Methodist DeBakey Heart and Vascular Center, TX, Houston
(Deeb) Cardiac Surgery, University of Michigan Hospitals, MI, Ann Arbor,
United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, MA, Boston
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Centre, Rotterdam, Netherlands
(Gleason) University of Pittsburgh Medical Center, Pittsburgh, United
States
(Chawla, Hockmuth) Iowa Heart Center, IA, Des Moines, United States
(Zorn, Tadros) University of Kansas Medical Center, Kansas City, United
States
(Li) Clinical, Mounds View, MN, Medtronic Plc
Publisher
NLM (Medline)
Abstract
BACKGROUND: An increasing body of evidence suggests that packed red blood
cell (PRBC) transfusion may be associated with increased morbidity and
mortality following transcatheter (TAVR) and surgical aortic valve
replacement (SAVR). It remains unclear if PRBC transfusion is a surrogate
marker or truly an independent risk factor for mortality following aortic
valve replacement in different populations. <br/>METHOD(S): The SURTAVI
trial randomized 1660 patients with symptomatic, severe aortic stenosis at
intermediate risk for operative death to TAVR or SAVR. Baseline
characteristics and outcomes including all-cause and cardiovascular
mortality at 30 days and thereafter were compared between participants
with and without PRBC transfusion. Cox proportional hazard models with
time-varying covariates were fitted to estimate the effect of PRBC
transfusion on mortality after adjustment for comorbidities and procedural
complications. <br/>RESULT(S): Patients receiving PRBC were older, more
commonly female and frail, with more comorbidities. Baseline STS PROM was
higher in the transfused group. After adjustment for these differences,
PRBC transfusion was associated with mortality at 30 days, but not
thereafter. The effect of PRBC on mortality (HR 1.04 (95% CI: 0.96, 1.11);
p=0.304) at 30 days was not independent of procedural complications (HR
21.04 (95% CI:7.26, 60.95); p<0.001). <br/>CONCLUSION(S): Poor health
status, procedural complications, PRBC transfusion and mortality are
correlated with each other. PRBC transfusion did not independently
increase risk for mortality. In this intermediate-risk population,
transfusion appears to be a risk marker of chronic conditions and
periprocedural complications as opposed to a risk factor for
postprocedural mortality.<br/>Copyright &#xa9; 2020. Published by Elsevier
Inc.

<82>
Accession Number
633483135
Title
The intraoperative use of recombinant activated factor VII in arterial
switch operations.
Source
Cardiology in the Young. (no pagination), 2020. Date of Publication: 2020.
Author
Zink J.; Spigel Z.A.; Ibarra C.; Gottlieb E.A.; Adachi I.; Mery C.M.;
Imamura M.; Heinle J.S.; Mckenzie E.D.; Fraser C.D.; Binsalamah Z.M.
Institution
(Zink, Spigel, Ibarra, Adachi, Imamura, Heinle, Mckenzie, Binsalamah)
Texas Children's Hospital, Houston, TX, United States
(Gottlieb, Mery, Fraser) Dell Children's Medical Center of Central Texas,
Austin, TX, United States
Publisher
Cambridge University Press
Abstract
Background: The rate of bleeding complications following arterial switch
operation is too low to independently justify a prospective randomised
study for benefit from recombinant factor VIIa. We aimed to evaluate
factor VIIa in a pilot study. <br/>Method(s): We performed a retrospective
cohort study of patients undergoing arterial switch operation from 2012 to
2017. Nearest-neighbour propensity score matching on age, gender, weight,
and associated cardiac defects was used to match 27 controls not receiving
recombinant factor VIIa to 30 patients receiving recombinant factor VIIa.
Fisher's exact test was performed to compare categorical variables.
Wilcoxon's rank-sum test was used to compare continuous variables between
cohorts. <br/>Result(s): Post-operative thrombotic complications were not
associated with factor VIIa administration (Odds Ratio (OR) 0.28, 95% CI
0.005-3.77, p = 0.336), nor was factor VIIa administration associated with
any re-explorations for bleeding. No intraoperative transfusion volumes
were different between the recombinant factor VIIa cohort and controls.
Post-operative prothrombin time (10.8 [10.3-12.3] versus 15.9 [15.1-17.2],
p < 0.001) and international normalised ratio (0.8 [0.73-0.90] versus 1.3
[1.2-1.4], p < 0.001]) were lower in recombinant factor VIIa cohort
relative to controls. <br/>Conclusion(s): In spite of a higher post-bypass
packed red blood cell transfusion requirement, patients receiving
recombinant factor VIIa had a similar incidence of bleeding
post-operatively. With no difference in thrombotic complications, and with
improved post-operative laboratory haemostasis, a prospective randomised
study is warranted to evaluate recombinant factor VIIa.<br/>Copyright
&#xa9; The Author(s), 2020. Published by Cambridge University Press.

<83>
Accession Number
633481933
Title
Transcatheter Mitral Valve Repair in Patients with and without Cardiac
Resynchronization Therapy: The COAPT Trial.
Source
Circulation: Heart Failure. (pp 600-608), 2020. Article Number: 7293. Date
of Publication: 2020.
Author
Kosmidou I.; Lindenfeld J.; Abraham W.T.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.K.; Kipperman R.M.; Boudoulas K.D.; Redfors B.; Shahim B.;
Zhang Z.; Mack M.J.; Stone G.W.
Institution
(Kosmidou, Redfors, Shahim, Zhang, Stone) Clinical Trials Center, Icahn
School of Medicine at Mount Sinai, Cardiovascular Research Foundation,
1700 Broadway, 9th floor, New York, NY 10019, United States
(Kosmidou, Redfors) NewYork-Presbyterian Hospital, Columbia University
Irving Medical Center, Nashville, TN, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Abraham, Boudoulas) Division of Cardiovascular Medicine, Ohio State
University, Columbus, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Mishell) Kaiser Permanente, San Francisco Hospital, CA, United States
(Whisenant) Intermountain Heart Center, Salt Lake City, UT, United States
(Kipperman) Gagnon Cardiovascular Institute, Morristown Medical Center,
NJ, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the COAPT trial (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients With Functional
Mitral Regurgitation), treatment of heart failure (HF) patients with
moderate-severe or severe secondary mitral regurgitation with
transcatheter mitral valve repair (TMVr) using the MitraClip plus
guideline-directed medical therapy (GDMT) reduced 2-year rates of HF
hospitalization and all-cause mortality compared with GDMT alone. Whether
the benefits of the MitraClip extend to patients with previously implanted
cardiac resynchronization therapy (CRT) is unknown. We sought to examine
the effect of prior CRT in patients enrolled in COAPT. <br/>Method(s):
Patients (N=614) with moderate-severe or severe secondary mitral
regurgitation who remained symptomatic despite maximally tolerated doses
of GDMT were randomized 1:1 to the MitraClip (TMVr arm) versus GDMT only
(control arm). Outcomes were assessed according to prior CRT use.
<br/>Result(s): Among 614 patients, 224 (36.5%) had prior CRT (115 and 109
randomized to TMVr and control, respectively) and 390 (63.5%) had no CRT
(187 and 203 randomized to TMVr and control, respectively). Patients with
CRT had similar 2-year rates of the composite of death or HF
hospitalization compared with those without CRT (57.6% versus 55%,
P=0.32). Death or HF hospitalization at 2 years was lower with TMVr versus
control treatment in patients with prior CRT (48.6% versus 67.2%, hazard
ratio, 0.60 [95% CI, 0.42-0.86]) and without CRT (42.5% versus 66.9%,
hazard ratio, 0.52 [95% CI, 0.39-0.69]; adjusted Pinteraction=0.23). The
effects of TMVr with the MitraClip on reducing the 2-year rates of
all-cause death (adjusted Pinteraction=0.14) and HF hospitalization
(adjusted Pinteraction=0.82) were also consistent in patients with and
without CRT as were improvements in quality-of-life and exercise capacity.
<br/>Conclusion(s): In the COAPT trial, TMVr with the MitraClip improved
the 2-year prognosis of patients with HF and moderate-severe or severe
secondary mitral regurgitation who remained symptomatic despite maximally
tolerated GDMT, regardless of prior CRT implantation. Registration: URL:
https://www.clinicaltrials.gov. Unique identifier: NCT01626079.
<br/>Copyright &#xa9; 2020 American Heart Association, Inc.

<84>
Accession Number
2006904582
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention in unprotected left main coronary artery disease: A
systematic review.
Source
Reviews in Cardiovascular Medicine. 21 (1) (pp 65-73), 2020. Date of
Publication: 30 Mar 2020.
Author
MacOvei L.; Magopet R.; Tanasa A.; Raileanu C.; Prisacariu C.; Presura
M.R.; Balasanian M.O.
Institution
(MacOvei, Magopet, Tanasa, Raileanu, Prisacariu, Balasanian) Institute of
Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, Iasi 700503,
Romania
(MacOvei, Tanasa, Prisacariu, Balasanian) University of Medicine and
Pharmacy Grigore T. Popa, Iasi 700115, Romania
(Presura) Cardiology Clinic of Piatra Neamt General Hospital, Neamt
610136, Romania
Publisher
IMR Press Limited
Abstract
This is an open access article under the CC BY-NC 4.0 license
(https://creativecommons.org/licenses/by-nc/4.0/). Critical lesion of the
unprotected left main coronary disease carries a tremendous mortality
burden, often associated with a diabetes status or multivessel disease,
with coronary artery bypass grafting being the standard treatment for over
40 years. Percutaneous coronary intervention with drug eluting stents
should be taken into consideration and could be a better option for
patients with low SYNTAX score as validated by the recently published
studies. This review summarizes the major randomized clinical trials and
meta-analyses concerning the debate regarding percutaneous coronary
intervention with drug eluting stents versus coronary artery bypass
grafting for unprotected left main coronary disease, along with the latest
European and American revascularization guidelines and tries to shed light
on this matter. The most results advocate that there is no convincing
difference in survival rate for both therapies, especially in patients
with isolated left main disease but with fewer major ischemic events for
coronary artery bypass grafting when compared with percutaneous coronary
intervention in multivessel coronary artery disease, at the rate of a
higher stroke incidence. The gaps in evidence are also highlighted,
especially the lack of randomized clinical trials with new generation drug
eluting stents versus coronary artery bypass grafting or those regarding
the best revascularization strategy for an acute coronary syndrome when
unprotected left main coronary disease is involved.<br/>Copyright &#xa9;
2020 IMR Press Limited. All rights reserved.

<85>
Accession Number
632830806
Title
The role of fractional flow reserve in coronary artery bypass graft
surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (5) (pp 671-678),
2020. Date of Publication: 2020.
Author
Jayakumar S.; Bilkhu R.; Ayis S.; Nowell J.; Bogle R.; Jahangiri M.
Institution
(Jayakumar, Bilkhu, Nowell, Jahangiri) Department of Cardiothoracic
Surgery, St George's Hospital, London, United Kingdom
(Ayis) Department of Biostatistics, King's College London, London, United
Kingdom
(Bogle) Department of Cardiology, Clinical Academic Group, St George's
Hospital, London, United Kingdom
(Jahangiri) Department of Cardiothoracic Surgery, St George's Hospital,
Blackshaw Road, London SW17 0QT, United Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Fractional flow reserve (FFR) measures the drop in perfusion
pressure across a stenosis, therefore representing its physiological
effect on myocardial blood flow. Its use is widespread in percutaneous
coronary interventions, though its role in coronary artery bypass graft
(CABG) surgery remains uncertain. This systematic review and meta-analysis
aims to evaluate current evidence on outcomes following FFR-guided CABG
compared to angiography-guided CABG. <br/>METHOD(S): A literature search
was conducted following PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) guidelines to identify all relevant articles.
Patient demographics and characteristics were extracted. The following
outcomes were analysed: repeat revascularization, myocardial infarction
(MI) and all-cause mortality. Pooled relative risks were analysed and
their 95% confidence intervals (CIs) were estimated using random-effects
models; P-value <0.05 was considered statistically significant.
Heterogeneity was assessed with Cochran's Q score and quantified by
I² index. <br/>RESULT(S): Nine studies with 1146 patients (FFR:
574, angiography: 572) were included. There was no difference in MI or
repeat revascularization between the 2 groups (relative risk 0.76, 95% CI
0.41-1.43; P = 0.40, and relative risk 1.28, 95% CI 0.75-2.19; P = 0.36,
respectively). There was a significant reduction in all-cause mortality in
the FFR-guided CABG group compared to angiography-guided CABG, which was
not specifically cardiac related (relative risk 0.58, 95% CI 0.38-0.90; P
= 0.02). <br/>CONCLUSION(S): There was no reduction in repeat
revascularization or postoperative MI with FFR. In this fairly small
cohort, FFR-guided CABG provided a reduction in mortality, but this was
not reported to be due to cardiac causes. There may be a role for FFR in
CABG, but large-scale randomized trials are required to establish its
value.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<86>
Accession Number
632764897
Title
A Randomized Trial to Compare Serratus Anterior Plane Block and Erector
Spinae Plane Block for Pain Management following Thoracoscopic Surgery.
Source
Pain Medicine (United States). 21 (6) (pp 1248-1254), 2020. Date of
Publication: 01 Jun 2020.
Author
Ekinci M.; Ciftci B.; Golboyu B.E.; Demiraran Y.; Bayrak Y.; Tulgar S.
Institution
(Ekinci, Ciftci, Demiraran) Department of Anesthesiology and Reanimation,
Istanbul Medipol University, Mega Medipol University Hospital, Istanbul
34040, Turkey
(Golboyu) Department of Anesthesiology and Reanimation, Manisa State
Hospital, Manisa, Turkey
(Bayrak) Department of Thoracic Surgery, Istanbul Medipol University, Mega
Medipol University Hospital, Istanbul, Turkey
(Tulgar) Department of Anesthesiology, Faculty of Medicine, Maltepe
University, Istanbul, Turkey
Publisher
Oxford University Press
Abstract
Objective: Comparison of ultrasound (US)-guided erector spinae plane block
(ESPB) and serratus anterior plane block (SAPB) in video-Assisted thoracic
surgery (VATS) patients. The primary outcome was to compare perioperative
and postoperative (48 hours) opioid consumption. <br/>Method(s): A total
of 60 patients were randomized into two groups (N = 30): An ESPB group and
an SAPB group. All the patients received intravenous patient-controlled
postoperative analgesia and ibuprofen 400 mg intravenously every eight
hours. Visual analog scale (VAS) scores, opioid consumption, and adverse
events were recorded. <br/>Result(s): Intraoperative and postoperative
opioid consumption at 0-8, 8-16, and 16-24 hours and rescue analgesic use
were significantly lower in the ESPB group (P < 0.05). Static/dynamic VAS
scores were significantly lower in the ESPB group (P < 0.05). There was no
significant difference between static VAS scores at the fourth hour. There
were no differences between adverse effects. Block procedure time and
one-Time puncture success were similar between groups (P > 0.05 each).
<br/>Conclusion(s): US-guided ESPB may provide better pain control than
SAPB after VATS. Question: Even though there are studies about analgesia
management after VATS, clinicians want to perform the technique that is
both less invasive and more effective. <br/>Finding(s): This randomized
trial showed that US-guided ESPB provides effective analgesia compared
with SAPB. Meaning: Performing single-injection ESPB reduces VAS scores
and opioid consumption compared with SAPB.<br/>Copyright &#xa9; 2020
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.

<87>
Accession Number
632736772
Title
Efficiency of thyroid function test in the prediction of atrial
fibrillation following open heart surgery.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (7) (pp
740-744), 2020. Date of Publication: July 2020.
Author
Ozturk S.; Kayacioglu I.; Sensoz Y.; Ozdemir K.; Ozturk I.
Institution
(Ozturk, Kayacioglu, Sensoz, Ozdemir) Department of Cardiovascular
Surgery, Siyami Ersek Chest and Cardiovascular Surgery Education and
Research Hospital, Istanbul, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Objective: To analyse the efficiency of thyroid function tests (thyroid
stimulating hormone, thyroxine and tri-iodothyronine) on prediction of
postoperative atrial fibrillation. <br/>Study Design: Meta-analysis. Place
of Study: Siyami Ersek Chest and Cardiovascular Surgery Education and
Research Hospital, Istanbul, Turkey. Methodology: Literature review was
carried out in PubMed, Science Direct and Ovid Database. No date
limitations was applied. Trials, which evaluated the preoperative levels
of thyroid stimulating hormone, thyroxine and tri-iodothyronine in cardiac
surgery patients, were included. Only the articles in English language
were reviewed. We evaluated the results with fix or random effect models
according to the presence of heterogeneity (I2 >25%). <br/>Result(s): Five
hundred and forty-seven articles were obtained after screening of
databases. After checking over the titles and abstracts, five trials were
included which covered 380 patients and complied with inclusion criteria.
According to results of analysis, there was no significant relationship
between postoperative atrial fibrillation and thyroid stimulating hormone
(SMD: 0.38, 95%CI -0.46-1.23, p=0.375), and also thyroxine (SMD: 0.006,
95% CI -0.29-0.30, p=0.966). However, tri-iodothyronine (SMD: -1.06, 95%
CI -2.08- -0.03, p=0.04) was correlated with development of atrial
fibrillation. Heterogeneity was observed in three parameters
(I²; for TSH: 92.45%, for T3: 93.08% and for T4: 31.78%).
<br/>Conclusion(s): Preoperative levels of tri-iodothyronine was an
effective parameter for predicting postoperative atrial fibrillation after
cardiac surgery, but there was a need of larger trials for eliminating
heterogeneity for all of the parameters of thyroid function
tests.<br/>Copyright &#xa9; 2020 PeerJ Inc.. All rights reserved.

<88>
Accession Number
2006954716
Title
Re: "Critical appraisal on the impact of preoperative rehabilitation and
outcomes after major abdominal and cardiothoracic surgery: A systematic
review and meta-analysis"-Counting rules are critical.
Source
Surgery (United States). 168 (6) (pp 1179), 2020. Date of Publication:
December 2020.
Author
Bundred J.R.; Kamarajah S.K.
Institution
(Bundred) Leeds Teaching Hospitals National Health Service Trust, Beckett
Street, Leeds, United Kingdom
(Kamarajah) Department of Hepatobiliary, Pancreatic and Transplant
Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, United
Kingdom
Publisher
Mosby Inc.

<89>
Accession Number
2006942265
Title
Critical appraisal on the impact of preoperative rehabilitation and
outcomes after major abdominal and cardiothoracic surgery: A systematic
review and meta-analysis: Counting rules are critical.
Source
Surgery (United States). 168 (6) (pp 1178-1179), 2020. Date of
Publication: December 2020.
Author
Dunlop D.; Kyriacou E.; Jones J.R.A.; Boden I.; Berlowitz D.J.
Institution
(Dunlop, Kyriacou, Jones, Berlowitz) Physiotherapy Department, Austin
Health, Heidelberg, Vic, Australia
(Jones, Boden, Berlowitz) Department of Physiotherapy, The University of
Melbourne, Parkville, Vic, Australia
(Jones, Berlowitz) Institute for Breathing and Sleep, Heidelberg, Vic,
Australia
(Boden) Physiotherapy Department, Launceston General Hospital, Tas,
Australia
Publisher
Mosby Inc.

<90>
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.<br/>Copyright &#xa9; 2020 Yu-Xiang
Long and Zeng-Zhang Liu.

<91>
Accession Number
2007794437
Title
Neutrophil Gelatinase-Associated Lipocalin Measured on Clinical Laboratory
Platforms for the Prediction of Acute Kidney Injury and the Associated
Need for Dialysis Therapy: A Systematic Review and Meta-analysis.
Source
American Journal of Kidney Diseases. 76 (6) (pp 826-841.e1), 2020. Date of
Publication: December 2020.
Author
Albert C.; Zapf A.; Haase M.; Rover C.; Pickering J.W.; Albert A.; Bellomo
R.; Breidthardt T.; Camou F.; Chen Z.; Chocron S.; Cruz D.; de Geus
H.R.H.; Devarajan P.; Di Somma S.; Doi K.; Endre Z.H.; Garcia-Alvarez M.;
Hjortrup P.B.; Hur M.; Karaolanis G.; Kavalci C.; Kim H.; Lentini P.;
Liebetrau C.; Lipcsey M.; Martensson J.; Muller C.; Nanas S.; Nickolas
T.L.; Pipili C.; Ronco C.; Rosa-Diez G.J.; Ralib A.; Soto K.;
Braun-Dullaeus R.C.; Heinz J.; Haase-Fielitz A.
Institution
(Albert, Braun-Dullaeus) University Clinic for Cardiology and Angiology,
Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
(Zapf) Department of Medical Biometry and Epidemiology, University Medical
Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
(Haase) Faculty of Medicine, Otto-von-Guericke University, Magdeburg,
Germany
(Albert, Haase, Albert) Diaverum Renal Services Germany, Potsdam, Germany
(Rover, Heinz) Department of Medical Statistics, University Medical Center
Gottingen, Gottingen, Germany
(Pickering) Department of Medicine, University of Otago Christchurch;
Emergency Department, Christchurch Hospital, Christchurch, New Zealand
(Albert) Department for Nephrology and Endocrinology, Klinikum Ernst von
Bergmann, Potsdam, Germany
(Bellomo) Department of Intensive Care, The Austin Hospital, Melbourne,
Australia
(Bellomo) Centre for Integrated Critical Care, The University of
Melbourne, Melbourne, Australia
(Breidthardt, Muller) Department of Internal Medicine, University Hospital
Basel, Basel, Switzerland
(Breidthardt, Muller) Department of Nephrology, University Hospital Basel,
Basel, Switzerland
(Breidthardt, Muller) Department of Cardiology, University Hospital Basel,
Basel, Switzerland
(Camou) Service de reanimation medicale, hopital Saint-Andre, CHU de
Bordeaux, France
(Chen) Department of Critical Care Medicine, Nanfang Hospital, Southern
Medical University, Guangdong, China
(Chocron) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Cruz) Division of Nephrology-Hypertension, University of California, San
Diego, CA, United States
(de Geus) Department of Intensive Care, Erasmus University Medical Center,
Rotterdam, Netherlands
(Devarajan) Division of Nephrology and Hypertension, Cincinnati Children's
Hospital, University of Cincinnati, Cincinnati, OH, United States
(Di Somma) Emergency Medicine, Department of Medical-Surgery Sciences and
Translational Medicine, Sapienza' University of Rome S. Andrea Hospital,
Rome, Italy
(Doi) Department of Emergency and Critical Care Medicine, The University
of Tokyo, Tokyo, Japan
(Endre) Department of Nephrology, Prince of Wales Hospital and Clinical
School, University of New South Wales, Sydney, Australia
(Garcia-Alvarez) Department of Anesthesiology, Hospital de la Santa Creu i
Sant Pau, Barcelona, Spain
(Hjortrup) Department of Intensive Care, Copenhagen University Hospital,
Copenhagen, Denmark
(Hur, Kim) Department of Laboratory Medicine, Konkuk University School of
Medicine, Seoul, South Korea
(Karaolanis) Vascular Unit, First Department of Surgery, "Laiko" General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens, Greece
(Kavalci) Emergency Department, Baskent University Faculty of Medicine,
Ankara, Turkey
(Lentini) Department of Nephrology and Dialysis, San Bassiano Hospital,
Bassano del Grappa, Italy
(Liebetrau) Department of Cardiology, Kerckhoff Clinic, Bad Nauheim,
Germany
(Lipcsey) CIRRUS, Hedenstierna laboratory, Anaesthesiology and Intensive
care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
(Martensson) Section of Anaesthesia and Intensive Care Medicine,
Department of Physiology and Pharmacology, Karolinska Institutet,
Stockholm, Sweden
(Nanas, Pipili) First Critical Care Department, 'Evangelismos' General
Hospital, National and Kapodistrian University of Athens, Athens, Greece
(Nickolas) Columbia University Vagelos College of Physicians and Surgeons,
New York, NY, United States
(Ronco) Department of Nephrology, Dialysis & Transplantation, University
of Padova, Vicenza, Italy
(Ronco) International Renal Research Institute, San Bortolo Hospital,
Vicenza, Italy
(Rosa-Diez) Department of Nephrology, Dialysis and Transplantation,
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
(Ralib) Department of Anaesthesiology and Intensive Care, International
Islamic University Malaysia, Pahang, Malaysia
(Soto) Department of Nephrology, Hospital Fernando Fonseca, Lisbon,
Portugal
(Soto) CEAUL, Centro de Estatistica e Aplicacoes da Universidade de
Lisboa, Lisbon, Portugal
(Haase-Fielitz) Department of Cardiology, Immanuel Diakonie Bernau, Heart
Center Brandenburg, Brandenburg Medical School Theodor Fontane, Faculty of
Health Sciences, University of Potsdam, Potsdam, Germany
Publisher
W.B. Saunders
Abstract
Rationale & Objective: The usefulness of measures of neutrophil
gelatinase-associated lipocalin (NGAL) in urine or plasma obtained on
clinical laboratory platforms for predicting acute kidney injury (AKI) and
AKI requiring dialysis (AKI-D) has not been fully evaluated. We sought to
quantitatively summarize published data to evaluate the value of urinary
and plasma NGAL for kidney risk prediction. <br/>Study Design:
Literature-based meta-analysis and individual-study-data meta-analysis of
diagnostic studies following PRISMA-IPD guidelines. Setting & Study
Populations: Studies of adults investigating AKI, severe AKI, and AKI-D in
the setting of cardiac surgery, intensive care, or emergency department
care using either urinary or plasma NGAL measured on clinical laboratory
platforms. Selection Criteria for Studies: PubMed, Web of Science,
Cochrane Library, Scopus, and congress abstracts ever published through
February 2020 reporting diagnostic test studies of NGAL measured on
clinical laboratory platforms to predict AKI. <br/>Data Extraction:
Individual-study-data meta-analysis was accomplished by giving authors
data specifications tailored to their studies and requesting standardized
patient-level data analysis. Analytical Approach: Individual-study-data
meta-analysis used a bivariate time-to-event model for interval-censored
data from which discriminative ability (AUC) was characterized. NGAL
cutoff concentrations at 95% sensitivity, 95% specificity, and optimal
sensitivity and specificity were also estimated. Models incorporated as
confounders the clinical setting and use versus nonuse of urine output as
a criterion for AKI. A literature-based meta-analysis was also performed
for all published studies including those for which the authors were
unable to provide individual-study data analyses. <br/>Result(s): We
included 52 observational studies involving 13,040 patients. We analyzed
30 data sets for the individual-study-data meta-analysis. For AKI, severe
AKI, and AKI-D, numbers of events were 837, 304, and 103 for analyses of
urinary NGAL, respectively; these values were 705, 271, and 178 for
analyses of plasma NGAL. Discriminative performance was similar in both
meta-analyses. Individual-study-data meta-analysis AUCs for urinary NGAL
were 0.75 (95% CI, 0.73-0.76) and 0.80 (95% CI, 0.79-0.81) for severe AKI
and AKI-D, respectively; for plasma NGAL, the corresponding AUCs were 0.80
(95% CI, 0.79-0.81) and 0.86 (95% CI, 0.84-0.86). Cutoff concentrations at
95% specificity for urinary NGAL were >580 ng/mL with 27% sensitivity for
severe AKI and >589 ng/mL with 24% sensitivity for AKI-D. Corresponding
cutoffs for plasma NGAL were >364 ng/mL with 44% sensitivity and >546
ng/mL with 26% sensitivity, respectively. <br/>Limitation(s): Practice
variability in initiation of dialysis. Imperfect harmonization of data
across studies. <br/>Conclusion(s): Urinary and plasma NGAL concentrations
may identify patients at high risk for AKI in clinical research and
practice. The cutoff concentrations reported in this study require
prospective evaluation.<br/>Copyright &#xa9; 2020 National Kidney
Foundation, Inc.

<92>
Accession Number
2005924501
Title
The Use of Topical Nitroglycerin to Facilitate Radial Arterial Catheter
Insertion in Children: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 34 (12) (pp 3354-3360),
2020. Date of Publication: December 2020.
Author
Hasanin A.; Aboelela A.; Mostafa M.; Mansour R.M.; Kareem A.
Institution
(Hasanin, Aboelela, Mostafa, Mansour, Kareem) Department of Anesthesia and
Critical Care Medicine, Cairo University, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether the use of topical nitroglycerin patch
increases radial artery diameter and facilitate cannulation in children.
<br/>Design(s): Randomized controlled trial. <br/>Setting(s): Cairo
University Hospital. <br/>Participant(s): Children aged 2 to 8 years old
scheduled for cardiac surgery. <br/>Intervention(s): In the nitroglycerin
group (n = 20), a gauze-covered, half-sized nitroglycerin patch (5 mg) was
applied at the site of radial pulsation 1 hour before induction of
anesthesia. In the control group (n = 20), a gauze pad was applied to the
bare skin at the site of radial pulsation with no intervention.
<br/>Measurements and Main Results: The primary outcome was the diameter
of the radial artery in both limbs using ultrasonography. Other outcomes
included the degree of arterial palpability, number of arterial punctures,
and incidence of successful first puncture cannulation. The radial artery
diameter increased after 30 minutes and 60 minutes compared with the
baseline value in the nitroglycerin group in both limbs, whereas no change
was reported in the radial artery diameter in the control group. The
nitroglycerin group showed a greater incidence of successful first
cannulation trial, a fewer number of trials, and a shorter cannulation
time compared with the control group. There were no significant
hypotensive episodes in any patient. <br/>Conclusion(s): Local application
of a half-sized, 5 mg nitroglycerin patch for 60 minutes in children
increased the radial artery diameter bilaterally, increased the rate of
first trial success, and decreased the time needed for arterial
cannulation without significant hypotensive episodes.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<93>
Accession Number
633471359
Title
Updates on cardiac transplant and LVAD implants across the UK and Europe.
Source
Heart Asia. Conference: 2nd Asia Pacific Advanced Heart Failure Forum,
APAHFF 2018. Hong Kong. 11 (SUPPL 1) (pp A2), 2019. Date of Publication:
April 2019.
Author
Tsui S.S.L.
Institution
(Tsui) Department of Cardiothoracic Surgery, Royal Papworth Hospital,
Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Whilst there has recently been unprecedented growth in heart transplants
(HTx) in North America, the number has been static or falling in most
European countries. These have resulted in significant increases in the
waiting times. In the UK, an Urgent Heart Allocation Scheme has been in
existence since 2001. With a growing number of heart failure patients on
temporary mechanical circulatory support (MCS) devices, a Super Urgent
category was introduced in 2016. So far, ~15% of HTx in the UK are
performed under this new category and the median waiting time has been >>7
days. Post-transplant 30 day survival has been reassuring. However,
ongoing monitoring will be required to ensure effectiveness. The other
major development has been donation after circulatory death (DCD) HTx. To
date, ~100 DCD HTx have been performed worldwide, with 70 of these being
in the UK. Growing waiting lists have led to increased implantation of
bridge-to-transplant left ventricular assist devices (LVAD). However, the
extended waiting times for donor hearts in stable patients mean that
patients being bridged are effectively having destination therapy by
default. Whilst destination therapy is approved in some countries, the
available evidence has not been accepted by other countries. The Swedish
Evaluation of LVAD as Permanent Treatment in End-stage Heart Failure
(SweVAD) is a prospective randomised study comparing LVAD therapy with
optimal medical therapy. Recruitment commenced in 2016 with the aim of
randomising 74 patients. Outcomes and adverse events associated with
implantable MCS will further improve as new devices using novel pumping
mechanisms with lower shear stress are in development to address inherent
limitations of current devices.

<94>
Accession Number
2010039387
Title
Efficacy and safety of lowering LDL cholesterol in older patients: a
systematic review and meta-analysis of randomised controlled trials.
Source
The Lancet. 396 (10263) (pp 1637-1643), 2020. Date of Publication: 21 Nov
2020.
Author
Gencer B.; Marston N.A.; Im K.; Cannon C.P.; Sever P.; Keech A.; Braunwald
E.; Giugliano R.P.; Sabatine M.S.
Institution
(Gencer, Marston, Im, Braunwald, Giugliano, Sabatine) TIMI Study Group,
Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA,
United States
(Cannon) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, NSW,
Australia
Publisher
Lancet Publishing Group
Abstract
Background: The clinical benefit of LDL cholesterol lowering treatment in
older patients remains debated. We aimed to summarise the evidence of LDL
cholesterol lowering therapies in older patients. <br/>Method(s): In this
systematic review and meta-analysis, we searched MEDLINE and Embase for
articles published between March 1, 2015, and Aug 14, 2020, without any
language restrictions. We included randomised controlled trials of
cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by
the 2018 American College of Cardiology and American Heart Association
guidelines, with a median follow-up of at least 2 years and data on older
patients (aged >=75 years). We excluded trials that exclusively enrolled
participants with heart failure or on dialysis because guidelines do not
recommend lipid-lowering therapy in such patients who do not have another
indication. We extracted data for older patients using a standardised data
form for aggregated study-level data. We meta-analysed the risk ratio (RR)
for major vascular events (a composite of cardiovascular death, myocardial
infarction or other acute coronary syndrome, stroke, or coronary
revascularisation) per 1 mmol/L reduction in LDL cholesterol.
<br/>Finding(s): Data from six articles were included in the systematic
review and meta-analysis, which included 24 trials from the Cholesterol
Treatment Trialists' Collaboration meta-analysis plus five individual
trials. Among 244 090 patients from 29 trials, 21 492 (8.8%) were aged at
least 75 years, of whom 11 750 (54.7%) were from statin trials, 6209
(28.9%) from ezetimibe trials, and 3533 (16.4%) from PCSK9 inhibitor
trials. Median follow-up ranged from 2.2 years to 6.0 years. LDL
cholesterol lowering significantly reduced the risk of major vascular
events (n=3519) in older patients by 26% per 1 mmol/L reduction in LDL
cholesterol (RR 0.74 [95% CI 0.61-0.89]; p=0.0019), with no statistically
significant difference with the risk reduction in patients younger than 75
years (0.85 [0.78-0.92]; p<inf>interaction</inf>=0.37). Among older
patients, RRs were not statistically different for statin (0.82
[0.73-0.91]) and non-statin treatment (0.67 [0.47-0.95];
p<inf>interaction</inf>=0.64). The benefit of LDL cholesterol lowering in
older patients was observed for each component of the composite, including
cardiovascular death (0.85 [0.74-0.98]), myocardial infarction (0.80
[0.71-0.90]), stroke (0.73 [0.61-0.87]), and coronary revascularisation
(0.80 [0.66-0.96]). <br/>Interpretation(s): In patients aged 75 years and
older, lipid lowering was as effective in reducing cardiovascular events
as it was in patients younger than 75 years. These results should
strengthen guideline recommendations for the use of lipid-lowering
therapies, including non-statin treatment, in older patients.
<br/>Funding(s): None.<br/>Copyright &#xa9; 2020 Elsevier Ltd

<95>
Accession Number
2010069814
Title
Preoperative vitamin D level predicts operative mortality after cardiac
surgery.
Source
E Journal of Cardiovascular Medicine. 8 (3) (pp 146-151), 2020. Date of
Publication: September 2020.
Author
Kunt A.T.; Tumer N.B.; Ozisik K.; Gunaydin S.
Institution
(Kunt) Kirikkale University, Faculty of Medicine, Department of
Cardiovascular Surgery, Kirikkale, Turkey
(Tumer, Ozisik, Gunaydin) University of Health Sciences Turkey, Ankara
City Hospital, Clinic of Cardiovascular Surgery, Ankara, Turkey
Publisher
Galenos Publishing House
Abstract
Objectives: The present study aimed to analyze the prognostic value of
preoperative serum vitamin D level in patients who underwent coronary
artery bypass graft (CABG) surgery. <br/>Material(s) and Method(s): The
data of 360 adult patients who underwent isolated CABG surgery were
retrospectively reviewed. We reached the data of preoperative serum
vitamin D [25-hydroxyvitamin D (25-OHD)] values of 305 patients. The
patient population was divided into two groups based on preoperative serum
25-OHD levels with a normal range of 25-75 nmol/L (group I: patients with
preoperative serum 25-OHD level <25 nmol/L and group II: patients with
preoperative serum 25-OHD level >=25 nmol/L). The effect of preoperative
25-OHD level on operative mortality (mortality which occurred during the
first 30 days after the operation) was determined using regression
analysis and the results were expressed as Odds ratio (OR) with a 95%
confidence interval (CI). A p value <0.05 was considered statistically
significant. <br/>Result(s): In the present study, operative mortality was
3.93% (n=12). One hundred and fifty seven patients (51.5%) had serum
25-OHD levels <25 nmol/L. The mean serum 25-OHD levels were significantly
lower in females than in males (p<0.001). On logistic regression analysis,
preoperative serum 25-OHD level was found to be independently associated
with operative mortality (OR: 0.201, 95% CI: 0.043- 0.935; p=0.041).
<br/>Conclusion(s): The presence of vitamin D deficiency seems to be an
independent predictor of operative mortality after cardiac surgery in this
retrospective study; however, prospective randomized trials are warranted
to clarify the effect of preoperative vitamin D supplementation on
postoperative outcomes in cardiac surgical patients.<br/>&#xa9; Copyright
2020 by Heart and Health Foundation of Turkey (TUSAV) / E Journal of
Cardiovascular Medicine published by Galenos Publishing House.

<96>
Accession Number
2010069797
Title
Our experience in anesthesia management in operations for congenital
pediatric cardiac diseases.
Source
E Journal of Cardiovascular Medicine. 8 (1) (pp 35-44), 2020. Date of
Publication: March 2020.
Author
Ozyaprak B.; Ata F.; Dayioglu M.; Anarat K.; Kaydul M.; Apaydin Y.; Gamli
M.; Karaca U.; Secici S.; Eris C.; Ata Y.; Kahraman N.; Erkan G.; Eroglu
A.
Institution
(Ozyaprak, Ata, Anarat, Kaydul, Apaydin, Gamli, Karaca) University of
Health Sciences Turkey, Bursa Yuksek Ihtisas Training and Research
Hospital, Clinic of Anesthesiology and Reanimation, Bursa, Turkey
(Dayioglu) Gazi University, Faculty of Medicine, Department of
Anesthesiology and Reanimation, Division of Intensive Care, Ankara, Turkey
(Secici) University of Health Sciences Turkey, Bursa Yuksek Ihtisas
Training and Research Hospital, Clinic of Pediatric Cardiovasculary
Surgery, Bursa, Turkey
(Eris, Ata, Kahraman) University of Health Sciences Turkey, Bursa Yuksek
Ihtisas Training and Research Hospital, Clinic of Cardiovasculary Surgery,
Bursa, Turkey
(Erkan) University of Health Sciences Turkey, Ahi Evren Training and
Research Hospital, Clinic of Anesthesiology and Reanimation Trabzon,
Turkey
(Eroglu) Karadeniz Technical University, Department of Anesthesiology and
Reanimation, Trabzon, Turkey
Publisher
Galenos Publishing House
Abstract
Objectives: Surgical treatment of congenital heart diseases (CHDs) is
performed in many centers today. We aimed to review the pediatric cardiac
surgery cases performed in our center and contribute to the literature
with our data. <br/>Material(s) and Method(s): In this study, 92 patients
who underwent palliative and complete correction for CHDs between March
2016 and March 2019 were evaluated retrospectively. <br/>Result(s): A
total of 92 patients, 37 (40.2%) females and 55 (59.8%) males, were
retrospectively examined for this study. The number of patients under and
over 1 year of age were 74 (80.44%) and 18 (19.56%), respectively. The
most common congenital cardiac anomaly was ventricular septal defect
(28.26%). All surgical procedures were classified according to complexity
based on the Aristotle Basic Scoring system to find that 45 patients
underwent Level 2, 23 patients underwent Level 4, 13 patients underwent
Level 1 and 11 patients underwent Level 3 surgeries. Among our patients,
78.2% and 21.8% were operated with and without cardiopulmonary bypass
(CPB), respectively. There were no significant differences between patient
age groups in terms of operation time, CPB time and cross-clamp time, but
the difference between the same parameters according to complexity level
was statistically significant (p<0.05). As the complexity level increased,
the durations were prolonged. Postoperative complications were found to be
increased under 1 year of age and at high complexity levels (Levels 3 and
4). Similarly, it was found that mortality significantly increased under 1
year of age and with high complexity levels (p<0.05). <br/>Conclusion(s):
In surgical procedures for CHDs, complexity levels according to Aristotle
Basic Scoring System and the patient's age are effective factors on
outcome. We believe that it is necessary to share the experiences of the
centers working in this field and to conduct randomized studies with
larger sample sizes.<br/>&#xa9; Copyright 2020 by Heart and Health
Foundation of Turkey (TUSAV) / E Journal of Cardiovascular Medicine
published by Galenos Publishing House.

<97>
Accession Number
633475993
Title
Individualized, Intraoperative Dosing of Fibrinogen Concentrate for the
Prevention of Bleeding in Neonatal and Infant Cardiac Surgery Using
Cardiopulmonary Bypass (FIBCON): A Phase 1b/2a Randomized Controlled
Trial.
Source
Circulation. Cardiovascular interventions. (pp
CIRCINTERVENTIONS120009465), 2020. Date of Publication: 20 Nov 2020.
Author
Siemens K.; Hunt B.J.; Harris J.; Nyman A.G.; Parmar K.; Tibby S.M.
Institution
(Siemens, Harris, Nyman, Tibby) Department of Paediatric Intensive Care,
Evelina London Children's Hospital, United Kingdom (K.S.
(Hunt, Parmar) Department of Haematology, United Kingdom (B.J.H., St
Thomas' Hospital, London
Publisher
NLM (Medline)
Abstract
BACKGROUND: Mediastinal bleeding is common following pediatric
cardiopulmonary bypass surgery for congenital heart disease. Fibrinogen
concentrate (FC) represents a potential therapy for preventing bleeding.
<br/>METHOD(S): We performed a single-center, phase 1b/2a, randomized
controlled trial on infants 2.5 to 12 kg undergoing cardiopulmonary bypass
surgery, aimed at (1) demonstrating the feasibility of an intraoperative
point-of-care test, rotational thromboelastometry, to screen out patients
at low risk of postoperative bleeding and then guide individualized FC
dosing in high-risk patients and (2) determining the dose, safety, and
efficacy of intraoperative FC supplementation. Screening occurred
intraoperatively 1-hour before bypass separation using the rotational
thromboelastometry variable fibrinogen thromboelastometry maximum clot
firmness (FibTEM-MCF; fibrinogen contribution to clot firmness). If
FibTEM-MCF >=7 mm, patients entered the monitoring cohort. If FibTEM-MCF
<=6 mm, patients were randomized to receive FC/placebo (2:1 ratio).
Individualized FC dose calculation included weight, bypass circuit volume,
hematocrit, and intraoperative measured and desired FibTEM-MCF. The
coprimary outcomes, measured 5 minutes post-FC administration were
FibTEM-MCF (desired range, 8-13 mm) and fibrinogen levels (desired range,
1.5-2.5 g/L). Secondary outcomes were thrombosis and thrombosis-related
major complications and postoperative 24-hour mediastinal blood loss.
<br/>RESULT(S): We enrolled 111 patients (cohort, n=21; FC, n=60; placebo,
n=30); mean (SD) age, 6.4 months (5.8); weight, 5.9 kg (2.0).
Intraoperative rotational thromboelastometry screening effectively
excluded low-risk patients, in that none in the cohort arm (FibTEM-MCF,
>=7 mm) demonstrated clinically significant early postoperative bleeding
(>10 mL/kg per 4 hours). Among randomized patients, the median (range) FC
administered dose was 114 mg/kg (51-218). Fibrinogen levels increased from
a mean (SD) of 0.91 (0.22) to 1.7 g/L (0.41). The postdose fibrinogen
range was 1.2 to 3.3 g/L (72% within the desired range). The corresponding
FibTEM-MCF values were as follows: pre-dose, 5.3 mm (1.9); post-dose, 13
mm (3.2). Ten patients (8 FC and 2 placebo) exhibited 12 possible
thromboses; none were clearly related to FC. There was an overall
difference in mean (SD) 24-hour mediastinal drain loss: cohort, 12.6 mL/kg
(6.4); FC, 11.6 mL/kg (5.2); placebo, 17.1 mL/kg (14.3; ANOVA P=0.02).
<br/>CONCLUSION(S): Intraoperative, individualized dosing of FC appears
feasible. The need for individualized dosing is supported by the finding
that a 4-fold variation in FC dose is required to achieve therapeutic
fibrinogen levels. Registration: URL: https://eudract.ema.europa.eu/;
Unique identifier: 2013-003532-68. URL: https://www.isrctn.com/; Unique
identifier: 50553029.

<98>
Accession Number
633475533
Title
Does metformin improve the efficacy of standard epidermal growth factor
receptor-tyrosine kinase inhibitor treatment for patients with advanced
non-small-cell lung cancer?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2020.
Date of Publication: 19 Nov 2020.
Author
Lin Z.; Li G.; Xu X.; Mei J.
Institution
(Lin, Li, Xu, Mei) West China School of Medicine, Sichuan University,
Chengdu, China
(Lin, Mei) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Mei) Sichuan University, Western China Collaborative Innovation Center
for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu,
China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether metformin improved
the efficacy of standard epidermal growth factor receptor-tyrosine kinase
inhibitor (EGFR-TKI) treatment for patients with epidermal growth factor
receptor (EGFR)-mutated advanced non-small-cell lung cancer. A total of 99
papers were found using the reported search, of which 4 represented the
best evidence to answer this clinical question. The authors, journal,
publication date, country, study type, treatment regimen, relevant
outcomes and results of these papers are tabulated. We concluded that the
addition of metformin to EGFR-TKI might improve the survival of patients
with EGFR-mutated non-small-cell lung cancer and diabetes mellitus type 2.
However, for non-diabetic non-small-cell lung cancer patients with EGFR
mutation, the efficiency of additional metformin in EGFR-TKI treatment
remains unclear because of the conflicting results of only 2 available
studies.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<99>
Accession Number
633467482
Title
Effect of Soft Silicone Foam Dressings on Intraoperatively Acquired
Pressure Injuries: A Randomized Study in Patients Undergoing Spinal
Surgery.
Source
Wound management & prevention. 66 (11) (pp 22-29), 2020. Date of
Publication: 01 Nov 2020.
Author
Yang T.-Y.; Shin S.H.
Institution
(Yang) College of Nursing Science, Kyung Hee University, Seoul, South
Korea
(Shin) College of Nursing Science, East-West Nursing Research Institute,
Kyung Hee University, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
The use of prophylactic dressings to help prevent intraoperatively
acquired pressure injuries (IAPIs) merits further study. PURPOSE: To
examine how the use of a soft silicone foam dressing affects the
development of IAPIs in patients undergoing spinal surgery to obtain
baseline data supporting evidence-based nursing care. <br/>METHOD(S):
Using a self-controlled study design, 64 patients requiring thoracic or
lumbar surgery on a Wilson frame at a hospital in Seoul, South Korea, were
recruited between February 12 and September 1, 2018; 50 patients were
eligible. Basic demographic, health, and surgical data were obtained.
Before surgery, the left or right side chest and iliac crest areas were
randomly assigned to be covered with a soft silicone foam dressing. The
areas were assessed at 2 time points: immediately after and 30 minutes
after surgery. If an IAPI was present at 30 minutes after surgery, all
sites were reevaluated after 7 days. <br/>RESULT(S): The majority of
participants were male (26 participants, 52%). Average patient age was
62.54 (+/- 13.83) years, with a body mass index of 24.32 (+/- 4.23) kg/m2.
Average length of surgery was 218.4 (+/- 137) minutes. Immediately after
surgery, 26 IAPIs were observed and there was a significant difference
between dressed and non-dressed chest areas for the number of IAPIs (4%
vs. 28%; P = .002). After 30 minutes, the total number of IAPIs was 20 and
the difference between IAPIs in the iliac crest area was significant
between dressed and non-dressed areas (0% vs. 14%; P = .012). After 1
week, there were no chest or iliac crest IAPIs in the areas that had been
covered by a dressing; however, 8 chest (61.5%) and 4 iliac crest (30.8%)
area IAPIs remained when no dressing had been applied. The majority of
IAPIs were stage 1 at all assessment times. After 1 week, 1 IAPI had
evolved into a stage 3 injury. <br/>CONCLUSION(S): The results of this
study show that many stage 1 IAPIs do resolve over time and that use of
soft silicone foam dressings during spinal surgery can significantly
reduce IAPI rates. Additional longitudinal studies are needed to help
guide postoperative skin assessment intervals and increase the
understanding about the evolution of stage 1 IAPIs.