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<1>
Accession Number
366014394
Title
Troponin T level and mortality risk after noncardiac surgery: Practical
implications of the VISION study.
Source
Polskie Archiwum Medycyny Wewnetrznej. 122 (10) (pp 499-503), 2012. Date
of Publication: 2012.
Author
Szczeklik W.; Devereaux P.J.
Institution
(Szczeklik) 2nd Department of Medicine, Jagiellonian University Medical
College, Krakow, Poland
(Devereaux) Departments of Clinical Epidemiology and Biostatistics and
Medicine, McMaster University, Hamilton, ON, Canada
Publisher
Medycyna Praktyczna Cholerzyn
Abstract
This review article presents the current state of knowledge about major
perioperative cardiovascular complications in noncardiac surgery patients
and the role of the currently available stratification models and
biomarkers in risk prediction. The authors discuss a recent paper
presented by the VISION Investigators in the June edition of the Journal
of the American Medical Association and its practical implications in
day-to-day perioperative practice. According to this study, the authors
conclude that troponin (Tn) measurement up to 3 days after noncardiac
surgery substantially improves perioperative risk estimation, and peak Tn
values (even the levels previously considered as normal) strongly predict
30-day mortality. One in 25 patients with a peak fourth generation
troponin T (TnT) measurement of 0.02 mug/l, 1 in 11 patients with a peak
TnT measurement of 0.03 to 0.29 mug/l, and 1 in 6 patients with a peak TnT
measurement of 0.30 mug/l or higher will die within 30 days of surgery.
Postoperative monitoring of TnT measurements substantially improves risk
stratification after noncardiac surgery and may help identify patients
requiring further therapeutic interventions. Copyright by Medycyna
Praktyczna, 2012.

<2>
Accession Number
364757989
Title
Statins in cardiac surgery.
Source
Southern African Journal of Anaesthesia and Analgesia. 18 (1) (pp 56),
2012. Date of Publication: 2012.
Author
Biccard D.L.
Institution
(Biccard) Perioperative Research Unit, Department of Anaesthetics,
University of Kwa-Zulu Natal, Durban, South Africa
Publisher
Medpharm Publications
Abstract
Background: Recent studies on the utility of statins in cardiac surgery
appear to show conflicting results. Most studies are either retrospective
or prospective observational, with small sample sizes. In order to address
these limitations, we systematically reviewed studies from 2008 to the
present, in order to determine the clinical utility of perioperative
statin use in cardiac surgery. Method(s): We searched PubMed for
studies reporting the use of statin therapy in cardiac surgery. The
outcomes of interest were postoperative mortality, non-fatal myocardial
infarction, acute renal injury, erebrovascular events, and atrial
fibrillation. An a priori decision was taken to conduct a subgroup
analysis of coronary artery bypass surgery (CABG) and valve replacement
surgery. Result(s): Statins were associated with a reduction in
all-cause mortality at 30 days in cardiac surgical patients (odds ratio
(OR) 0.65, [95% confidence interval (CI) 0.60-0.71]), and this was
consistent in both subgroups. Statins were associated with a reduction in
myocardial infarction in the CABG group [OR 0.73, (95% CI 0.48-1.13)], but
not in the valve group [OR 1.14, (95% CI 0.80-1.63)]. Statins were not
associated with protection from acute renal injury post-cardiac surgery
[OR 1.20, (95% CI 1.10-1.31)]. Statins were associated with significantly
less postoperative cerebrovascular events [OR 0.83, (95% CI 0.71-0.97)],
and this was consistent for both CABG and valve surgery. Statins were
associated with significantly less postoperative atrial fibrillation [OR
0.78, (95% CI 0.70-0.98)], which was evident following CABG. However,
there were insufficient data to determine its efficacy in valve surgery.
 Conclusion(s): Statins were associated with improved outcomes for
mortality, myocardial infarction, cerebrovascular accident, and atrial
fibrillation, following CABG. In valve surgery, statins were only
associated with improved outcomes for mortality and cerebrovascular
accident. The associated increase in acute renal injury needs further
investigation. © SASA.

<3>
Accession Number
633995863
Title
Clustering of patients with type 2 diabetes and established CV disease for
prediction of disease progression and MACE (SAVORTIMI 53 trial).
Source
Diabetologia. Conference: 56th Annual Meeting of the European Association
for the Study of Diabetes, EASD 2020. 63 (SUPPL 1) (pp S49), 2020. Date of
Publication: 2020.
Author
Aoki Y.; Hamren B.; Clegg L.E.; Stahre C.; Bhatt D.L.; Raz I.; Scirica
B.M.; Oscarsson J.; Carlsson B.
Institution
(Aoki, Hamren) Clinical and Quantitative Pharmacology, AstraZeneca,
Gothenburg, Sweden
(Clegg) Clinical and Quantitative Pharmacology, AstraZeneca, Gaithersburg,
United States
(Stahre, Oscarsson) Late CVRM, BioParmaceutical RandD, AstraZeneca,
Gothenburg, Sweden
(Bhatt, Scirica) Brigham and Women's Hospital Heart and Vascular Center,
Boston, United States
(Bhatt, Scirica) Harvard Medical School, Boston, United States
(Raz) Hadassah University Hospital, Jerusalem, Israel
(Carlsson) Research and Early Development, BioParmaceutical RandD,
AstraZeneca, Gothenburg, Sweden
Publisher
Springer Verlag
Abstract
Background and aims: Ahlqvist et al. proposed to apply k-means clustering
of five essential glycemic control-related variables to subgroup patients
with adult onset diabetes. Others have reported similar results indicating
that this methodology is robust in terms of identifying diabetes
subgroups. We aimed to investigate if clustering of diabetes essentially
according to the method Ahlqvist et al. can be applied to a patient cohort
with type 2 diabetes and established CV disease to investigate the
clinical utility of the clustering to predict risk for disease progression
and MACE. Material(s) and Method(s):We have used a subset of SAVOR
(Saxagliptin cardiovascular safety Phase-IV clinical trial) dataset that
was approved for the secondary use of data, including both active and
placebo arms. SAVOR included patients with type 2 diabetes. Type 1
diabetes was an exclusion criterion and patients on insulin therapy were
excluded to be able to calculate HOMA2.We focused on the patient
subpopulation who have established CV disease at baseline. As a result,
4644 patients with a mean follow up of 2.1 years and mean diabetes
duration of 8.69 years were included. We clustered the cohort essentially
according to Ahlqvist et al. into four subgroups using k-means clustering
with the following five covariates: HOMA2-IR, HOMA2-B, HbA1c, age at
diagnosis, and BMI. Disease progression was determined as addition of new
diabetic medications and cardiovascular event as the composite
six-pointMACE (cardiovascular death, myocardial infarction, Stroke,
Hospitalization for heart failure, Hospitalization for unstable angina,
coronary revascularization). The multivariate Cox proportional hazard
model was used to quantify the relative risk of each endpoint for the
clusters. Result(s): Patients from the SAVOR trial were successfully
clustered into four groups: severe insulin-deficient diabetes (SIDD) 17%,
severe insulin-resistant diabetes (SIRD) 17%, mild obesity-related
diabetes (MOD) 27%, mild age-related diabetes (MARD) 38%, replicating the
overall patterns of the baseline covariate values as presented by Ahlqvist
et al. The age and sex adjusted hazard ratios for the diabetes progression
for SIDD, SIRD, MOD as compared to MARD were 2.68 (95% confidence
interval, 2.29-3.13), 1.45 (1.23-1.70), 1.41 (1.20-1.65), respectively.
Similarly, the age and sex adjusted hazard ratios for the sixpoint MACE
were 1.34 (1.04-1.74), 1.33 (1.05-1.69), and 1.13 (0.89-1.43),
respectively. Conclusion(s):We show that diabetes subgroups defined
by Ahlqvist et al. can be reproduced in a randomized controlled trial
dataset of patients with type 2 diabetes with established CV disease.
Diabetes progression was predicted by the clustering but there were no
major differences with respect toMACE. Thus, we believe amore efficient
algorithmto segment diabetes population with established CV disease is
desirable in order to optimize the clinical care for the secondary
prevention of MACE in patients with diabetes.

<4>
Accession Number
633986047
Title
Prothrombin complex concentrate versus fresh frozen plasma in adults
undergoing heart surgery (prophesy)-a pragmatic pilot randomized
controlled trial.
Source
Vox Sanguinis. Conference: 36th International ISBT Congress. 115 (SUPPL 1)
(pp 37), 2020. Date of Publication: December 2020.
Author
Green L.; Roberts N.; Cooper J.; Chang I.; Gill R.; Klein A.; Agarwal S.;
Rossi A.; Sepehripour A.; Stanworth S.; Johnston A.; Monk V.; O'Brien B.
Institution
(Green) Haematology, NHS Blood and Transplant and Barts Health NHS Trust,
London, United Kingdom
(Roberts, Rossi, Sepehripour) Cardio Thoracic surgery, Barts Health NHS
Trust, London, United Kingdom
(Cooper) Statistics,William Harvey Research Institute, Heart Centre,Barts
and The London School of Medicine, Queen Mary University of London,
London, United Kingdom
(Chang) William Harvey Research Institute, Heart Centre,Barts and The
London School of Medicine, Queen Mary University of London, London, United
Kingdom
(Gill) Anaesthetics, Southampton General Hospital, Southampton, United
Kingdom
(Klein) Anaesthetics, Royal Papworth Hospital, Cambridge, United Kingdom
(Agarwal) Anaesthetics, Manchester Royal Infirmary, Manchester, United
Kingdom
(Stanworth) Haematology, NHS Blood and Transplant, Oxford, United Kingdom
(Johnston) Statistics,William Harvey Research Institute, Heart
Centre,Barts and The London School of Medicine, London, United Kingdom
(Monk) William Harvey Research Institute, Heart Centre,Barts and The
London School of Medicine, Queen Mary University of London, London, United
Kingdom
(O'Brien) Anaesthetics, Barts Health NHS Trust, London, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Background: Fresh Frozen Plasma (FFP) is the standard treatment for
clotting factor replacement in bleeding patients undergoing cardiac
surgery in the UK. However, prothrombin complex concentrate (PCC) is being
used off-license in this setting due to higher concentration of clotting
factor levels, smaller volume, and more rapid administration as compared
to FFP. Aim(s): PROPHESY is a pragmatic single-centre, pilot
randomized, controlled trial (RCT) that assessed the feasibility of
performing a large trial that will compare FFP with PCC in cardiac surgery
patients who are bleeding. Method(s): The trial was registered on the
EudraCT database (2018-003041-41) and Clinicaltrials.gov (NCT03715348).
Primary outcome was to evaluate the proportion of subjects who are
consented and receive the intervention. Secondary objectives were to
assess the delivery of different components of the trial, protocol
violation/compliance and ability to collect outcome data up to 90 days
after surgery. Inclusion criteria: Adult patients (>=18 years, not on
vitamin-K antagonists) undergoing cardiac surgery who develop active
bleeding that requires FFP transfusion within 24 hours of surgery, were
randomized by the transfusion laboratory to FFP (15 ml/kg) or PCC (500 IU
if <60 kg, 1000 IU if 61-90 kg, 1500 IU if >90 kg) using block
randomization. If bleeding continued after administration of the first
study dose, standard care was administered (no subsequent PCC dose was
given). Follow-up was 90 days after surgery. Result(s): From January
2019 to November 2019, 180 patients were screened, of which 134 were
consented, 54 (40% recruitment rate) received an intervention (25 FFP and
29 PCC) and 50 were appropriately randomised (25 on each arm). Of those
that were randomised, the median age was 66 years (SD 12), 64% were male
and 76% (PCC arm) and 80% (FFP) had elective surgery. There were 18 trial
protocol deviations relating to randomisation (n = 10), intervention (n =
3), documentation (n = 2) and research blood samples collection (n = 3).
In randomised patients 113 adverse events (55 PCC vs 58 FFP) and 19
serious adverse events (6 in 5 patients for PCC vs 13 in 8 patients for
FFP) were reported. There was no increase in thromboembolic event relating
to PCC. Mean days alive and out of hospital within 90 days was 71.8 (SE =
1.8) for PCC and 73.8 (SE = 1.7) for FFP. No randomised patients were
withdrawn from the study, 5 were lost to follow-up and 4 died (2 FFP and 2
PCC). Follow-up data up to 90 days were collected in 89% of randomised
patients. Summary/Conclusions: There have been no RCTs to date that have
compared the efficacy/safety of FFP versus PCC in cardiac surgery patients
who are bleeding and this pilot study demonstrates that it is feasible to
perform a large trial in the future.

<5>
Accession Number
633985258
Title
Patient blood management-recommendations from the international consensus
conference, Frankfurt/Main, Germany.
Source
Vox Sanguinis. Conference: 36th International ISBT Congress. 115 (SUPPL 1)
(pp 25), 2020. Date of Publication: December 2020.
Author
Mueller M.M.; Van Remoortel H.; Meybohm P.; Aranko K.; Murphy M.; Carson
J.; Vandekerckhove P.; Wood E.; Seifried E.
Institution
(Mueller) German Red Cross Blood Transfusion Service, Kassel, Germany
(Van Remoortel, Vandekerckhove) Centre for Evidence-Based Practice (CEBaP)
of the Belgian Red Cross, Mechelen, Belgium
(Meybohm) Clinics of Anaesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Wuerzburg, Wuerzburg, Germany
(Aranko) Finnish Red Cross Blood Service, Helsinki, Finland
(Murphy) Blood and Transplant, National Health Service, University of
Oxford, Oxford, United Kingdom
(Carson) Robert Wood Johnson Medical School, Rutgers University, New
Brunswick, NJ, United States
(Wood) Transfusion Research Unit, Dept. Epidemiology and Preventive
Medicine, Monash University, Melbourne, Australia
(Seifried) University Hospital, Goethe University, German Red Cross Blood
Transfusion Service, Frankfurt/Main, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Background: As in all fields of clinical medicine, establishing an
evidence base for patient blood management (PBM) is crucial for developing
guidelines and for defining directions for further research in high
quality patient-centred haemotherapy. Aim(s): The International
Consensus Conference (ICC) on PBM was held in to develop evidence-based
clinical and research recommendations for preoperative anaemia, red blood
cell (RBC) transfusion thresholds in adult patients and implementation of
PBM programmes. Method(s): An international scientific committee (SC)
defined 17 population-interventioncomparison- outcome (PICO) questions for
the three selected topics preoperative anaemia, red blood cell (RBC)
transfusion thresholds in adult patients and the implementation of PBM.
Based on these 17 PICO questions, literature searches were conducted in
four biomedical databases. The GRADE framework (= grading of
recommendations, assessment, development and evaluation) was used to
develop a systematic approach for the presentation of summaries of
evidence and for making clinical practice recommendations. Three expert
panels (EP) consisting of clinicians, scientists, nurses, patient
representatives and methodologists were established and used the methods
described above in order to develop recommendations driven by published
evidence. Result(s): Out of more than 17,500 literature citations,
data from 145 studies (63 randomised trials including more than 23,000
patients and 82 observational studies including more than 4 million
patients) was incorporated into the final analysis. The expert panel for
preoperative anaemia developed 4 clinical and 3 research recommendations.
A strong recommendation advocates for early detection and management of
preoperative anaemia before major elective surgery. For RBC transfusion
thresholds, 4 clinical and 6 research recommendations came out of the
process. Two strong clinical recommendations for RBC transfusion
thresholds advocate a haemoglobin concentration of <7 g/dl for critically
ill, but clinical stable adult intensive care patients independent of
septic shock and < 7.5 g/dl for adults undergoing cardiac surgery. For
implementation of PBM programmes, 2 clinical and 3 research
recommendations were developed. Research recommendations were made to
stimulate new relevant studies to address unanswered questions in PBM.
 Summary: This is the first ICC for PBM defining the evidence base for
three clinically important haemotherapy topics. The relative paucity of
strong evidence in current PBM literature underscores the ongoing struggle
to (a) find internationally accepted definitions e.g. for anaemia and (b)
execute internationally planned meaningful multicentre trials in the still
developing field of PBM. The clinical recommendations found here should be
considered for implementation in daily clinical practice.

<6>
Accession Number
2010150957
Title
Expanding enhanced recovery protocols for cardiac surgery to include the
patient voice: a scoping review protocol.
Source
Systematic Reviews. 10 (1) (no pagination), 2021. Article Number: 22. Date
of Publication: December 2021.
Author
Oravec N.; Arora R.C.; Bjorklund B.; Gregora A.; Monnin C.; Duhamel T.A.;
Kent D.E.; Schultz A.S.H.; Chudyk A.M.
Institution
(Oravec, Arora) Department of Surgery, Rady Faculty of Health Sciences,
Max Rady College of Medicine, University of Manitoba, AE101-820 Sherbrook
Street, Winnipeg, MB R3A 1R9, Canada
(Arora, Kent) Cardiac Sciences Program, CR 1005-St. Boniface Hospital, 369
Tache Avenue, Winnipeg, MB R2H 2A6, Canada
(Bjorklund, Gregora) Enhanced Recovery Protocols for Cardiac Surgery
Patient Researcher Group, St. Boniface Hospital, 369 Tache Avenue,
Winnipeg, MB R2H 2A6, Canada
(Monnin) Neil John Maclean Health Sciences Library, University of
Manitoba, 727 McDermot Avenue, Winnipeg R3E 3P5, Canada
(Duhamel) Faculty of Kinesiology and Recreation Management, 208 Active
Living Centre, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
(Duhamel) Institute of Cardiovascular Sciences, St. Boniface General
Hospital Albrechtsen Research Centre, 351 Tache Avenue, Winnipeg, MB R2H
2A6, Canada
(Schultz) College of Nursing, Rady Faculty of Health Sciences, University
of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2 N2, Canada
(Schultz, Chudyk) Health Services & Structural Determinants of Health
Research, St. Boniface Research Centre, Winnipeg, Canada
(Chudyk) Department of Family Medicine, Rady Faculty of Health Sciences,
University of Manitoba, 454-6 - 753 McDermot Avenue, Winnipeg, MB R3E 0
T6, Canada
Publisher
BioMed Central Ltd
Abstract
Background: Cardiac surgery is becoming increasingly common in older, more
vulnerable adults. A focus on timely and complete medical and functional
recovery has led to the development of enhanced recovery protocols (ERPs)
for a number of surgical procedures and subspecialties, including cardiac
surgery (ERAS Cardiac). An element that is often overlooked in the
development and implementation of ERPs is the involvement of key
stakeholder groups, including surgery patients and caregivers (e.g.,
family and/or friends). The aim of this study is to describe a protocol
for a scoping review of cardiac patient and caregiver preferences and
outcomes relevant to cardiac surgery ERPs. Method(s): Using Arksey
and O'Malley's et al six-stage framework for scoping review methodologies
with adaptions from Levac et al. (Represent Interv: 1-18, 2012), a scoping
review of existing literature describing patient- and caregiver-identified
preferences and outcomes as they relate to care received in the
perioperative period of cardiac surgery will be undertaken. The search for
relevant articles will be conducted using electronic databases (i.e., the
Cochrane Library, Medline, PsycINFO, Scopus, and Embase), as well as
through a search of the grey literature (e.g., CPG Infobase, Heart and
Stroke Foundation, ProQuest Theses and Dissertations, Google Advanced, and
Prospero). Published and unpublished full-text articles written in
English, published after the year 2000, and that relate to the research
question will be included. Central to the design of this scoping review is
our collaboration with two patient partners who possess lived experience
as cardiac surgery patients. Discussion(s): This review will identify
strategies that can be integrated into ERPs for cardiac surgery which
align with patient- and caregiver-defined values. Broadly, it is our goal
to demonstrate the added value of patient engagement in research to aid in
the success of system change processes. Copyright © 2021, The
Author(s).

<7>
Accession Number
2008564554
Title
Assessment of bipolar radiofrequency ablation combined with coronary
artery bypass surgery for management of atrial fibrillation in cardiac
patients.
Source
Heart Surgery Forum. 23 (6) (pp E826-E832), 2020. Date of Publication: 08
Oct 2020.
Author
Singab H.
Institution
(Singab) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, Ain Shams University, Ain Shams University Hospitals, Abbasia
Square, Cairo, Egypt
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Atrial fibrillation (AF) is a common problem in patients
undergoing coronary artery bypass graft (CABG). For AF ablation, bipolar
radiofrequency ablation (BRA) achieves complete transmural ablation lines
and reduces the risk of treatment failure. We analyzed the efficacy of BRA
for sinus rhythm restoration in patients with AF undergoing CABG.
 Method(s): This prospective study included patients with permanent or
paroxysmal AF scheduled to undergo BRA combined with CABG in our
institution from May 2014 to June 2020. After discharge from hospital, all
patients were seen every 6 months over 5 years to evaluate survival, sinus
rhythm restoration, and New York Heart Association (NYHA) class.
 Result(s): We enrolled 168 patients, 97 (57.7%) with permanent AF
(group I) and 71 (42.3%) with paroxysmal AF (group II) at 60 months. We
found that group II patients had better sinus rhythm restoration rates
after BRA with CABG than group I patients (P = .005). Overall mortality at
60 months was significantly lower in group II patients (2 [2.8%]) than
patients in group I (14 [14.4%]; P = .01). The survival rate was
significantly higher in group II than in group I (94% versus 72%; P =
.0003) as shown by Kaplan- Meier analysis. The 95% confidence interval of
the Cox hazards survival regression ratio was significantly different
between groups (0.1792 [0.04069 to 0.7896]; P = .006). Long-term AF (>3
years) before BRA with CABG and permanent AF type were identified as
predictors of post-BRA recurrent AF (P = .0001 and P = .005,
respectively). NYHA class improved significantly at 60 months compared
with baseline (P < .0001). Conclusion(s): This study identified
preoperative AF type and duration as predictors of the success of BRA
combined with CABG. Copyright © 2020 Forum Multimedia Publishing
LLC. All rights reserved.

<8>
Accession Number
633796619
Title
Guided relaxation-based virtual reality versus distraction-based virtual
reality or passive control for postoperative pain management in children
and adolescents undergoing Nuss repair of pectus excavatum: Protocol for a
prospective, randomised, controlled trial (FOREVR Peds trial).
Source
BMJ Open. 10 (12) (no pagination), 2020. Article Number: e040295. Date of
Publication: 30 Dec 2020.
Author
Olbrecht V.A.; Williams S.E.; O'Conor K.T.; Boehmer C.O.; Marchant G.W.;
Glynn S.M.; Geisler K.J.; Ding L.; Yang G.; King C.D.
Institution
(Olbrecht, O'Conor, Boehmer, Marchant, Glynn, Geisler) Department of
Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
(Williams, King) Division of Behavioral Medicine and Clinical Psychology,
Department of Pediatrics, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH, United States
(Ding, Yang) Divsion of Biostatistics and Epidemiology, Department of
Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
Publisher
BMJ Publishing Group
Abstract
Introduction Virtual reality (VR) offers an innovative method to deliver
non-pharmacological pain management. Distraction-based VR (VR-D) using
immersive games to redirect attention has shown short-term pain reductions
in various settings. To create lasting pain reduction, VR-based strategies
must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates
pain-relieving mind-body based guided relaxation with VR, a novel therapy
delivery mechanism. The primary aim of this study is to assess the impact
of daily VR-GR, VR-D and 360 video (passive control) on pain intensity. We
will also assess the impact of these interventions on pain unpleasantness,
anxiety and opioid and benzodiazepine consumption. The secondary aim of
this study will assess the impact of psychological factors (anxiety
sensitivity and pain catastrophising) on pain following VR. Methods and
analysis This is a single centre, prospective, randomised, clinical trial.
Ninety children/adolescents, aged 8-18 years, presenting for Nuss repair
of pectus excavatum will be randomised to 1 of 3 study arms (VR-GR, VR-D
and 360 video). Patients will use the Starlight Xperience (Google
Daydream) VR suite for 10 min. Patients randomised to VR-GR (n=30) will
engage in guided relaxation/mindfulness with the Aurora application.
Patients randomised to VR-D (n=30) will play 1 of 3 distraction-based
games, and those randomised to the 360 video (n=30) will watch the Aurora
application without audio instructions or sound. Primary outcome is pain
intensity. Secondary outcomes include pain unpleasantness, anxiety and
opioid and benzodiazepine consumption. Ethics and dissemination This study
follows Standard Protocol Items: Recommendations for Interventional Trials
guidelines. The protocol was approved by the Cincinnati Children's
Hospital Medical Center's institutional review board. Patient recruitment
began in July 2020. Written informed consent will be obtained for all
participants. All information acquired will be disseminated via scientific
meetings and published in peer-reviewed journals. Trial registration
number NCT04351776. Copyright © 2020 BMJ Publishing Group. All
rights reserved.

<9>
Accession Number
2010154591
Title
Clinical outcomes in nonagenarians undergoing transcatheter aortic valve
implantation: a systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2021. Date
of Publication: 2021.
Author
Noguchi M.; Ueyama H.; Ando T.; Takagi H.; Toshiki K.
Institution
(Noguchi) Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical
Center, Uyarasu, Japan
(Ueyama, Toshiki) Department of Medicine, Icahn School of Medicine at
Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Ando) Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
Springer Japan
Abstract
To compare the risk of procedural complications and mortality after
transcatheter aortic valve implantation (TAVI) in nonagenarians (age >= 90
years) compared to younger patients (< 90 years). Although TAVI could be
considered as a treatment option in nonagenarians, several previous
studies have shown conflicting outcomes between nonagenarians and younger
patients who underwent TAVI. We conducted a comprehensive literature
search through PubMed and EMBASE to investigate the clinical outcomes of
nonagenarians after TAVI. The outcomes of interest were short- and
long-term mortality and procedural complications. Our study identified 16
observational studies including a total of 179,565 patients (21,674
nonagenarian patients and 157,891 younger patients. Nonagenarians had a
significantly higher rate of short- (hazard ratio [HR], 95% confidence
interval [CI]: 1.48, 1.38-1.59; P < 0.001) and long-term mortality (HR,
95% CI: 1.34, 1.24-1.44; P < 0.001) than younger patients after TAVI.
Furthermore, there were significant differences in major and/or
life-threatening bleeding (risk ratio [RR], 95% CI: 1.21, 1.05-1.39; P =
0.008), stroke (HR, 95% CI: 1.24, 1.11-1.40; P < 0.001), and major
vascular complication (RR, 95% CI: 2.15, 1.35-3.42; P = 0.001) between
nonagenarians and younger patients after TAVI. Minor vascular
complication, myocardial infarction and permanent pacemaker implantation
rate were similar between the two groups. Nonagenarians had significantly
higher rate of short- and long-term mortality, major and/or
life-threatening bleeding, stroke, and major vascular complication after
TAVI. Although TAVI is a treatment option in nonagenarians, careful and
appropriate selection of patients is essential to improve clinical
outcomes. Copyright © 2021, Japanese Association of
Cardiovascular Intervention and Therapeutics.

<10>
Accession Number
2010153038
Title
Does the clinical effectiveness of Mitraclip compare with surgical repair
for mitral regurgitation?.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Khader A.A.; Allaf M.; Lu O.W.; Lazopoulos G.; Moscarelli M.; Kendall S.;
Salmasi M.Y.; Athanasiou T.
Institution
(Khader, Allaf) Department of Medicine, Imperial College London, London,
United Kingdom
(Lu) Division of Biosciences, University College London, London, United
Kingdom
(Lu) Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical
School, University of Melbourne, Melbourne, VIC, Australia
(Lazopoulos) Department of Cardio-thoracic Surgery, University Hospital of
Heraklion, Crete, Greece
(Moscarelli) Department of Cardiovascular Surgery, GVM Care and Research,
Lugo, Ravenna, Italy
(Kendall) Deparment of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
(Salmasi, Athanasiou) Department of Surgery and Cancer, Imperial College
London, London, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Background: Surgical repair of the mitral valve has long been the
established therapy for degenerative mitral regurgitation (MR). Newer
transcatheter methods over the last decade, such as the MitraClip, serve
to restore mitral function with reduced procedural burden and enhanced
recovery. This study aims to compare the shortterm and midterm outcomes of
MitraClip insertion with surgical repair for MR. Method(s): A
systematic review of the literature was conducted for studies comparing
outcomes between surgical repair and MitraClip. The initial search
returned 1850 titles, from which 12 studies satisfied the inclusion
criteria (one randomized controlled trial and 11 retrospective studies).
 Result(s): The final analysis comprised 4219 patients (MitraClip
1210; surgery 3009). Operative mortality was not different between the
groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23];
p =.317). Length of hospital stay was significantly shorter in the
MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI:
[0.77-0.99]; p <.001) with considerable heterogeneity (I2 >
90%; p <.001). The rate of reoperation on the mitral valve was lower in
the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p =.012) as was the
rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI:
[0.19-0.46]; p <.001) during midterm follow up. Long term survival (4-5
years) was also similar between both groups (hazard ratio = 0.70; 95% CI:
[0.35-1.41]; p =.323). Conclusion(s): This study highlights the
superior midterm durability of surgical valve repair for MR compared with
the MitraClip. Copyright © 2021 The Authors. Journal of Cardiac
Surgery published by Wiley Periodicals LLC

<11>
Accession Number
2010152247
Title
Regional anaesthesia quality indicators for adult patients undergoing
non-cardiac surgery: a systematic review.
Source
Anaesthesia. 76 (S1) (pp 89-99), 2021. Date of Publication: January 2021.
Author
Hamilton G.M.; MacMillan Y.; Benson P.; Memtsoudis S.; McCartney C.J.L.
Institution
(Hamilton, McCartney) Department of Anaesthesiology and Pain Medicine,
University of Ottawa, ON, Canada
(MacMillan, Benson) Department of Medicine, University of Ottawa, ON,
Canada
(Memtsoudis) Department of Anaesthesiology, Hospital for Special Surgery,
Weill Cornell Medical College, New York, NY, United States
Publisher
Blackwell Publishing Ltd
Abstract
Improvement in healthcare delivery depends on the ability to measure
outcomes that can direct changes in the system. An overview of quality
indicators within the field of regional anaesthesia is lacking. This
systematic review aims to synthesise available quality indicators, as per
the Donabedian framework, and provide a concise overview of evidence-based
quality indicators within regional anaesthesia. A systematic literature
search was conducted using the databases MEDLINE, Embase, CINAHL and
Cochrane from 2003 to present, and a prespecified search of regional
anaesthesia society websites and healthcare quality agencies. The quality
indicators relevant to regional anaesthesia were subdivided into
peri-operative structure, process and outcome indicators as per the
Donabedian framework. The methodological quality of the indicators was
determined as per the Oxford Centre for Evidence-Based Medicine's
framework. Twenty manuscripts met our inclusion criteria and, in total, 68
unique quality indicators were identified. There were 4 (6%) structure, 12
(18%) process and 52 (76%) outcome indicators. Most of the indicators were
related to the safety (57%) and effectiveness (19%) of regional
anaesthesia and were general in nature (60%). In addition, most indicators
(84%) were based on low levels of evidence. Our study is an important
first step towards describing quality indicators for the provision of
regional anaesthesia. Future research should focus on the development of
structure and process quality indicators and improving the methodological
quality and usability of these indicators. Copyright © 2021
Association of Anaesthetists

<12>
Accession Number
633988896
Title
Randomized Trial of Aspirin Versus Warfarin After Transcatheter Aortic
Valve Replacement in Low-Risk Patients.
Source
Circulation. Cardiovascular interventions. (pp
CIRCINTERVENTIONS120009983), 2021. Date of Publication: 11 Jan 2021.
Author
Rogers T.; Shults C.; Torguson R.; Shea C.; Parikh P.; Bilfinger T.; Cocke
T.; Brizzio M.E.; Levitt R.; Hahn C.; Hanna N.; Comas G.; Mahoney P.;
Newton J.; Buchbinder M.; Moreno R.; Zhang C.; Craig P.; Asch F.M.;
Weissman G.; Garcia-Garcia H.M.; Ben-Dor I.; Satler L.F.; Waksman R.
Institution
(Rogers, Torguson, Shea, Zhang, Craig, Ben-Dor, Satler, Waksman) Section
of Interventional Cardiology, MedStar Washington Hospital Center, R.T.,
P.C., I.B.-D.
(Rogers) Cardiovascular Branch, Division of Intramural Research, National
Heart, Lung, Blood Institute, National Institutes of Health, Bethesda,
United States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital Center
(Parikh) Department of Cardiology, Stony Brook University Hospital
(Bilfinger) Department of Cardiothoracic Surgery, Stony Brook University
Hospital
(Cocke) Department of Cardiology, Valley Hospital, Ridgewood, United
States
(Brizzio) Department of Cardiothoracic Surgery, Valley Hospital,
Ridgewood, United States
(Levitt) Henrico Cardiology Associates, HCA Virginia Health System. (R.L.)
(Hahn) Cardiothoracic Surgical Associates - Richmond, HCA Virginia Health
System. (C.H.)
(Hanna) Department of Cardiology, Sentara Norfolk General Hospital
(Comas) Department of Cardiothoracic Surgery, Sentara Norfolk General
Hospital
(Mahoney) Department of Cardiology, Sentara Norfolk General Hospital
(Newton) Department of Cardiothoracic Surgery, Sentara Norfolk General
Hospital
(Buchbinder) Department of Cardiology, Foundation for Cardiovascular
Medicine, San Diego, Mexico
(Moreno) Department of Cardiothoracic Surgery, Foundation for
Cardiovascular Medicine, San Diego, Mexico
(Asch) MedStar Health Research Institute, MedStar Washington Hospital
Center
(Weissman, Garcia-Garcia) Department of Cardiology, MedStar Washington
Hospital Center
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal antithrombotic regimen after transcatheter aortic
valve replacement remains unclear. METHOD(S): In this randomized
open-label study, low-risk patients undergoing transfemoral transcatheter
aortic valve replacement at 7 centers in the United States were randomized
1:1 to low-dose aspirin or warfarin plus low-dose aspirin for 30 days.
Patients who could not be randomized were enrolled in a separate registry.
Computed tomography or transesophageal echocardiography was performed at
30 days. The primary effectiveness end point was a composite of the
following at 30 days: hypoattenuated leaflet thickening, at least
moderately reduced leaflet motion, hemodynamic dysfunction (mean aortic
valve gradient >=20 mm Hg, effective orifice area <=1.0 cm2, dimensionless
valve index <0.35, or moderate or severe aortic regurgitation), stroke, or
transient ischemic attack. RESULT(S): Between July 2018 and October
2019, 94 patients were randomly assigned, 50 to aspirin and 44 to warfarin
plus aspirin, and 30 were enrolled into the registry. In the
intention-to-treat analysis of the randomized cohort, the composite
primary effectiveness end point was met in 26.5% for aspirin versus 7.0%
for warfarin plus aspirin (P=0.014; odds ratio, 4.8 [95% CI, 1.3-18.3]).
The rate of hypoattenuated leaflet thickening was 16.3% for aspirin versus
4.7% for warfarin plus aspirin (P=0.07; odds ratio, 4.0 [95% CI,
0.8-20.0]). There was no excess bleeding at 30 days with anticoagulation.
In the as-treated analysis of pooled randomized and registry cohorts, the
rate of hypoattenuated leaflet thickening was 16.7% for aspirin versus
3.1% for warfarin plus aspirin (P=0.011; odds ratio, 6.3 [95% CI,
1.3-30.6]). CONCLUSION(S): In low-risk transcatheter aortic valve
replacement patients, anticoagulation with warfarin may prevent
transcatheter heart valve dysfunction in the short term without excess
bleeding. Registration: URL: https://www.clinicaltrials.gov. Unique
identifier: NCT03557242.

<13>
Accession Number
2007735623
Title
Current Treatment Options in Cardiovascular Medicine Arrhythmia Section
From the His Bundle to the Left Bundle: Clinical Applications of
Conduction System Pacing.
Source
Current Treatment Options in Cardiovascular Medicine. 23 (1) (no
pagination), 2021. Article Number: 7. Date of Publication: January 2021.
Author
Chen A.Y.; Upadhyay G.A.
Institution
(Chen, Upadhyay) Center for Arrhythmia Care, Heart and Vascular Center,
The University of Chicago Medicine, The University of Chicago Pritzker
School of Medicine, Chicago, IL, United States
Publisher
Springer
Abstract
Purpose of review: Conduction system pacing (CSP) has emerged as a new
pacing strategy for patients with bradyarrhythmia as well as for
applications to deliver cardiac resynchronization therapy (CRT) in
patients with heart failure. The primary modes to achieve CSP include His
bundle pacing (HBP), pacing at the proximal left conduction system (LCS)
with left bundle branch area pacing (LBBAP), and left ventricular septal
pacing (LVSP). Studies involving conduction system pacing: This review
summarizes pertinent, prospective data currently available regarding CSP.
Currently, the majority of published data analyze outcomes after HBP and
are composed primarily of single-center prospective cohort studies. The
studies reviewed evaluated use of HBP in treatment of bradyarrhythmia,
post atrioventricular (AV) node ablation, and for CRT applications with
follow-up ranging from 12 to 24 months. Fewer studies currently exist in
reference to LBBAP or LCS pacing with no randomized data presently
available. Three LVSP prospective studies were reviewed with 6-24 months
of follow-up. Conclusion(s): CSP seeks to engage the His-Purkinje
system either at the His bundle or the proximal fascicular system.
Available data support a role for CSP in patients with bradyarrhythmia
indications, and with growing experience in CRT applications. Present data
best supports HBP, but LBBAP and LVSP may serve as alternative routes for
CSP going forward. Copyright © 2021, Springer Science+Business
Media, LLC, part of Springer Nature.

<14>
Accession Number
2008390997
Title
Impact of human immunodeficiency virus (HIV) infection in patients
undergoing cardiac surgery: A systematic review.
Source
Reviews in Cardiovascular Medicine. 21 (3) (pp 411-418), 2020. Date of
Publication: 30 Sep 2020.
Author
Dominici C.; Chello M.
Institution
(Dominici, Chello) Cardiovascular surgery, Campus Bio-Medico University of
Rome, Rome, Italy
Publisher
IMR Press Limited
Abstract
The clinical status and prognosis of patients with human immunodeficiency
virus (HIV) infection has dramatically changed in the recent years.
Cardiovascular diseases can be related to combined antiretroviral therapy
and to the aging of HIV-positive population, resulting in significant
mortality and morbidity in those patients. It is crucial to understand
whether the HIV-status affects the indications and outcomes of cardiac
surgery. A literature search was conducted through electronic databases up
to 15 May 2020 following PRISMA guidelines. Variables (i.e. patients
characteristics) and endpoints (i.e. postoperative complications) were
considered as defined in the original publications. All paper describing
post-operative outcomes after cardiac surgery were included.
Methodological quality of all included studies was assessed using the
Newcastle-Ottawa Scale, the Cochrane Risk of Bias tool and the US
Preventive Services Task Force grade. A total of eight studies were
included in this systematic review; five studies discussed the outcomes of
patients with HIV infection, while three studies compared results based on
HIV status. All evidences derived from retrospective observational studies
with high variability and poor-to-fair quality. Most patients underwent
surgical myocardial revascularization. HIV status is not associated with
differences in operative mortality (P = 0.32), postoperative mediastinitis
(P = 0.30) or pulmonary infective complications (P = 0.67). Cardiac
surgery can be considered safe in HIV-positive patients, and HIV status
alone should not be considered as a contraindication for cardiac surgery
and should not be considered a risk factor for postoperative mortality or
perioperative complications. Further studies are required for patients
with AIDS. Copyright ©2020 Dominici and Chello Published by IMR
Press.

<15>
Accession Number
2008509865
Title
Factors influencing the bias between blood gas analysis versus central
laboratory hemoglobin testing. A secondary analysis of a randomized
controlled trial.
Source
PLoS ONE. 15 (10 October) (no pagination), 2020. Article Number: e0240721.
Date of Publication: October 2020.
Author
Tanner L.; Lindau S.; Velten M.; Schlesinger T.; Wittmann M.; Kranke P.;
Berg K.; Piekarski F.; Fullenbach C.; Choorapoikayil S.; Hasenclever D.;
Zacharowski K.; Meybohm P.
Institution
(Tanner, Lindau, Berg, Piekarski, Fullenbach, Choorapoikayil, Hasenclever,
Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Goethe University Frankfurt,
Frankfurt am Main, Germany
(Velten, Wittmann) Department of Anesthesiology and Operative Intensive
Care Medicine, University Hospital Bonn, Rheinische
Friedrich-Wilhelms-University Bonn, Bonn, Germany
(Schlesinger, Kranke, Meybohm) Department of Anesthesiology, University
Hospital Wuerzburg, Wuerzburg, Germany
(Zacharowski) Institute for Medical Informatics, Statistics and
Epidemiology (IMISE), Medical Faculty of the University Leipzig, Leipzig,
Germany
Publisher
Public Library of Science
Abstract
Background Anemia is the most important complication during major surgery
and transfusion of red blood cells is the mainstay to compensate for life
threating blood loss. Therefore, accurate measurement of hemoglobin (Hb)
concentration should be provided in real-time. Blood Gas Analysis (BGA)
provides rapid point-of-care assessment using smaller sampling tubes
compared to central laboratory (CL) services. Objective This study aimed
to investigate the accuracy of BGA hemoglobin testing as compared to CL
services. Methods Data of the ongoing LIBERAL-Trial (Liberal transfusion
strategy to prevent mortality and anemia-associated ischemic events in
elderly non-cardiac surgical patients, LIBERAL) was used to assess the
bias for Hb level measured by BGA devices (ABL800 Flex
analyzer, GEM series and RapidPoint 500)
and CL as the reference method. For that, we analyzed pairs of Hb level
measured by CL and BGA within two hours. Furthermore, the impact of
various confounding factors including age, gender, BMI, smoker status,
transfusion of RBC, intraoperative hemodilution, and co-medication was
elucidated. In order to ensure adequate statistical analysis, only data of
participating centers providing more than 200 Hb pairs were used. Results
In total, three centers including 963 patients with 1,814 pairs of Hb
measurements were analyzed. Mean bias was comparable between ABL800 Flex
analyzer and GEM series: - 0.38 +/- 0.15 g/dl
whereas RapidPoint 500 showed a smaller bias (-0.09 g/dl) but
greater median absolute deviation (+/- 0.45 g/dl). In order to avoid
interference with different standard deviations caused by the different
analytic devices, we focused on two centers using the same BGA technique
(309 patients and 1,570 Hb pairs). A Bland-Altman analysis and LOWESS
curve showed that bias decreased with smaller Hb values in absolute
numbers but increased relatively. The smoker status showed the greatest
reduction in bias (0.1 g/dl, p<0.001) whereas BMI (0.07 g/dl, p = 0.0178),
RBC transfusion (0.06 g/dl, p<0.001), statins (0.04 g/dl, p<0.05) and beta
blocker (0.03 g/dl, p = 0.02) showed a slight effect on bias.
Intraoperative substitution of volume and other co-medications did not
influence the bias significantly. Conclusion Many interventions like
substitution of fluids, coagulating factors or RBC units rely on the
accuracy of laboratory measurement devices. Although BGA Hb testing showed
a consistently stable difference to CL, our data confirm that BGA devices
are associated with different bias. Therefore, we suggest that hospitals
assess their individual bias before implementing BGA as valid and stable
supplement to CL. However, based on the finding that bias decreased with
smaller Hb values, which in turn are used for transfusion decision, we
expect no unnecessary or delayed RBC transfusion, and no major impact on
the LIBERAL trial performance. Copyright © 2020 Tanner 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.

<16>
Accession Number
2010213274
Title
Unplanned hospital readmission after surgical treatment for thoracic
spinal stenosis: incidence and causative factors.
Source
BMC Musculoskeletal Disorders. 22 (1) (no pagination), 2021. Article
Number: 93. Date of Publication: December 2021.
Author
Wang H.; Wang L.; Sun Z.; Jiang S.; Li W.
Institution
(Wang, Wang, Sun, Jiang, Li) Orthopaedic Department of Peking, University
Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191,
China
(Wang, Wang, Sun, Jiang, Li) Beijing Key Laboratory of Spinal Disease
Research, Beijing, China
(Wang, Wang, Sun, Jiang, Li) Engineering Research Center of Bone and Joint
Precision Medicine Ministry of Education, Beijing, China
Publisher
BioMed Central Ltd
Abstract
Background: To assess the incidence and causative factors of unplanned
hospital readmission within 90 days after surgical treatment of thoracic
spinal stenosis (TSS). Method(s): Hospital administrative database
was queried to identify patients who underwent surgical treatment of TSS
from July 2010 through December 2017. All unplanned readmissions within 90
days of discharge were reviewed for causes and the rate of unplanned
readmissions was calculated. Patients of unplanned readmission were
matched 1:3 to a control cohort without readmission. Result(s):
Twenty-one patients (incidence of 1.7 % in 1239 patients) presented
unplanned hospital readmission within a 90-day period and enrolled as the
study group, 63 non-readmission patients (a proportion of 1: 3) were
randomly selected as the control group. Causes of readmission include
pseudomeningocele (8 patients; 38 %), CSF leakage combined with poor
incision healing (6 patients; 29 %), wound dehiscence (2 patient; 9 %),
surgical site infection (2 patients; 9 %), spinal epidural hematoma (1
patient; 5 %), inadequate original surgical decompression (2 patients; 9
%). Mean duration from re-admission to the first surgery was 39.6 +/- 28.2
days, most of the patients readmitted at the first 40 days (66.7 %, 14/21
patients). When compared to the non-readmitted patients, diagnosis of OPLL
+ OFL, circumferential decompression, dural injury, long hospital stay
were more to be seen in readmitted patients. Conclusion(s): The
incidence of 90-day unplanned readmission after surgical treatment for TSS
is 1.7 %, CSF leakage and pseudomeningocele were the most common causes of
readmission, the peak period of readmission occurred from 10 to 40 days
after surgery, patients should be closely followed up within this
period. Copyright © 2021, The Author(s).

<17>
Accession Number
2010760375
Title
A scoping review to identify competencies for transcatheter cardiovascular
procedures.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Muller Moran H.R.; Maurice-Ventouris M.; Alharbi M.; Harley J.M.;
Lachapelle K.J.
Institution
(Muller Moran) Department of Surgery, University of Manitoba, Winnipeg,
MB, Canada
(Muller Moran, Maurice-Ventouris, Alharbi, Harley, Lachapelle) Department
of Surgery, McGill University, Montreal, QC, Canada
Publisher
Mosby Inc.
Abstract
Objectives: Transcatheter procedures are increasingly being recognized as
a priority for cardiac surgeons and cardiac surgery trainees. The optimal
method of teaching these procedures during residency training has not been
established. We used an evidence-based approach to systematically review
the literature and identify competencies to inform future paradigms of
transcatheter training in cardiac surgery. Method(s): A scoping
review was conducted to retrieve relevant literature on the performance of
transcatheter cardiovascular procedures, identify competencies required by
surgical residents learning to perform these procedures, and develop a
preliminary list of competencies for consideration during transcatheter
training. MEDLINE, Scopus, and ERIC were queried until April 1, 2020,
using a systematic search strategy. No limitations were placed on
publication date or type. Result(s): A total of 1456 sources of
evidence were retrieved. After deduplication and screening, there remained
33 that were included in the scoping review, published between 2006 and
2020. The distribution of publication types included 10 comparative
studies (30.3% of total), 8 societal statements (24.2% of total), 5
surveys and 5 opinion articles (each 15.2% of total), 2 editorials and 2
descriptions of a simulator (each 6.1% of total), and 1 narrative review
(3.0% of total). From these, a total of 400 items were identified and
organized into 97 competencies. Conclusion(s): Evidence on the
competencies required to perform transcatheter cardiovascular procedures
is available from a variety of sources. The identified competencies may be
a useful resource for developing curricula and teaching transcatheter
procedures to cardiac surgery residents. Copyright © 2020 The
American Association for Thoracic Surgery

<18>
Accession Number
2010145067
Title
Efficacy of Valerian Extract on Sleep Quality after Coronary Artery bypass
Graft Surgery: A Triple-Blind Randomized Controlled Trial.
Source
Chinese Journal of Integrative Medicine. 27 (1) (pp 7-15), 2021. Date of
Publication: January 2021.
Author
Zare Elmi H.; Gholami M.; Saki M.; Ebrahimzadeh F.
Institution
(Zare Elmi) Student Research Committee, Lorestan University of Medical
Sciences, Khorramabad 6814993165, Iran, Islamic Republic of
(Gholami) School of Nursing and Midwifery, Lorestan University of Medical
Sciences, Khorramabad 6814993165, Iran, Islamic Republic of
(Saki) Social Determinants of Health Research Center, Lorestan University
of Medical Sciences, Khorramabad 6814993165, Iran, Islamic Republic of
(Ebrahimzadeh) Department of Biostatistics and Epidemiology, School of
Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad
6814993165, Iran, Islamic Republic of
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To assess the effect of valerian root extract on the sleep
quality of patients after coronary artery bypass graft (CABG) surgery.
 Method(s): The patients who participated in this triple-blind
clinical trial were selected by permuted block randomization. The
participants were assigned to the valerian (n=36) and placebo (n=36)
groups. The valerian group received 530 mg of valerian capsules for 30
nights after CABG surgery, and the placebo group received 530 mg of the
placebo capsules containing wheat flour. The Pittsburgh Sleep Quality
Index (PSQI), the prothrombin time (PT) and partial thromboplastin time
(PTT) were assessed on four occasions, including the baseline, the 3rd,
14th and 30th days following intervention. Result(s): The odds ratio
of worsened sleep quality significantly varied over time (the interaction
of time and group) in the valerian group compared to the placebo group in
various dimensions including total sleep quality (P=0.001), sleep latency
(P<0.01), sleep duration (P=0.020), sleep efficiency (P=0.001) and daytime
dysfunction (P=0.025). No significant difference was observed in the
alterations of the odds ratio of PT in the two groups over time.
(P=0.371). Conclusion(s): The consumption of oral valerian root
extract over 30 nights could significantly improve the patients' sleep
quality safely after CABG surgery. Copyright © 2020, The Chinese
Journal of Integrated Traditional and Western Medicine Press and
Springer-Verlag GmbH Germany, part of Springer Nature.

<19>
Accession Number
613930457
Title
Risk factors and prognosis of postpericardiotomy syndrome in patients
undergoing valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 878-885.e1),
2017. Date of Publication: 01 Apr 2017.
Author
van Osch D.; Dieleman J.M.; Bunge J.J.; van Dijk D.; Doevendans P.A.;
Suyker W.J.; Nathoe H.M.; Bredee J.J.; Buhre W.F.; van Herwerden L.A.;
Kalkman C.J.; van Klarenbosch J.; Moons K.G.; Numan S.C.; Ottens T.H.;
Roes K.C.; Sauer A.-M.C.; Slooter A.J.; Jacob K.A.; Nierich A.P.; Ennema
J.J.; Rosseel P.M.; van der Meer N.J.; van der Maaten J.M.; Cernak V.;
Hofland J.; van Thiel R.J.; Diephuis J.C.; Schepp R.M.; Haenen J.; de
Lange F.; Boer C.; de Jong J.R.; Tijssen J.G.
Institution
(van Osch, Doevendans, Nathoe) Department of Cardiology, University
Medical Center Utrecht, Utrecht, Netherlands
(Dieleman, van Dijk) Department of Anesthesiology and Intensive Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Suyker) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bunge) Department of Intensive Care, Erasmus Medical Center, Rotterdam,
Netherlands
Publisher
Mosby Inc.
Abstract
Objective The study aim was to investigate the long-term prognosis and
risk factors of postpericardiotomy syndrome (PPS). Methods We performed a
single-center cohort study in 822 patients undergoing nonemergent valve
surgery. Risk factors of PPS were evaluated using multivariable logistic
regression analysis. We also compared the incidence of reoperation for
tamponade at 1 year between patients with and without PPS. Main secondary
outcomes were hospital stay and mortality. Results Of the 822 patients,
119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per
point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was
associated with a lower risk of PPS, whereas preoperative treatment for
pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20)
was associated with a higher risk of PPS. The incidence of reoperation for
tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49;
95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2%
versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13
days (interquartile range, 9-18 days) versus 11 days (interquartile range,
8-15 days) (P = .001), respectively. Conclusions Despite longer hospital
stays and more short-term reoperations for tamponade, patients with PPS
had an excellent 1-year prognosis. Copyright © 2016 The American
Association for Thoracic Surgery

<20>
Accession Number
2004735854
Title
Effect of Tongguan Capsules () on Restenosis after Coronary Stent
Implantation: Study Protocol for A Randomized Controlled Trial.
Source
Chinese Journal of Integrative Medicine. 27 (1) (pp 16-23), 2021. Date of
Publication: January 2021.
Author
Zhou Y.-S.; Mao S.; Guo L.-H.; Gao X.-Y.; Zou X.; Zhang M.-Z.
Institution
(Zhou, Mao, Guo, Gao, Zou, Zhang) Key Discipline of Integrated Traditional
Chinese and Western Medicine, Second Clinical College, Guangzhou
University of Chinese Medicine, Guangzhou 510405, China
(Zhou, Mao, Guo, Gao, Zou, Zhang) Department of Critical Care Medicine,
Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
(Zhou) Doctoral Candidate of Guanzhou University of Chinese Medicine,
Guangzhou 510006, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Although percutaneous coronary intervention (PCI) had become
widely employed therapeutic procedure for coronary artery disease, stent
restenosis limited the benefits of this revascularization and the question
how to prevent such events remained unresolved. While numerous empirical
observations suggested Tongguan Capsules (), a patented Chinese Medicine,
could decrease frequency and duration of angina pectoris attacks, evidence
supporting its efficacy on restenosis remained inadequate.
 Objective(s): This trial was designed to determine whether Tongguan
Capsules would reduce restenosis rate in patients after successful stent
implantation. Method(s): Approximately 400 patients undergoing
percutaneous coronary stent deployment were enrolled and randomized to
control group or Tongguan Capsules (4.5 g/d) for 3 months. All patients
received standard anti-platelet, anti-coagulation and lipid-decreasing
treatments, concurrently. The primary clinical endpoint was the 12-month
incidence of the major adverse cardiovascular events (defined as cardiac
death, myocardial infarction, and recurrence of symptoms requiring
additional revascularization). The angiographic end point was restenosis
rate at 6 months. Conclusion(s): This study would provide important
evidence for the use of Tongguan Capsules in patients after stent
implantation in combination with routine therapies, which may
significantly reduce incidence of the restenosis so as to potentially
improve the clinical outcomes. (registration number: ChiCTR-TRC-
ChiCTR-IIR-17011407). Copyright © 2020, The Chinese Journal of
Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH
Germany, part of Springer Nature.

<21>
Accession Number
2010391790
Title
Dabigatran etexilate for the treatment of acute venous thromboembolism in
children (DIVERSITY): a randomised, controlled, open-label, phase 2b/3,
non-inferiority trial.
Source
The Lancet Haematology. 8 (1) (pp e22-e33), 2021. Date of Publication:
January 2021.
Author
Halton J.; Brandao L.R.; Luciani M.; Bomgaars L.; Chalmers E.; Mitchell
L.G.; Nurmeev I.; Sharathkumar A.; Svirin P.; Gorbatikov K.; Tartakovsky
I.; Simetzberger M.; Huang F.; Sun Z.; Kreuzer J.; Gropper S.; Reilly P.;
Brueckmann M.; Albisetti M.; Safina A.; Zapletal O.; Kuhn T.; Votava T.;
Felgenhauer J.; Amid A.; Saracco P.; Kiss C.; Halimeh S.; Reschke M.;
Wulff B.; David M.; Novak Z.; Trunina I.; Frisk T.; Glosli H.; Groll A.;
Lvova O.; Sasmaz I.; Sosothikul D.; Zilinskaite V.; Cockrell E.; Digtyar
V.; Hadacova I.; Palmu S.; Pawar A.; Annichino Bizzacchi J.M.; Caliskan
U.; Celkan T.; Dmytriiev D.; Druzgal C.H.; Onelda Elena G.; Kattamis A.;
Kavakli R.K.; Male C.; Ozdemir N.; Van Damme A.; Zvereva T.; Aarli A.;
Paredes Aguilera R.A.; Aytac S.; Carneiro J.; Chistolini A.; Mazzucconi
M.G.; Corrales-Medina F.; Couturaud F.; Croteau S.E.; Trenor III C.;
Damgaard M.; Dixon N.; Galustyan A.; Hak J.; Hoffmann M.; Kupesiz A.;
Labarque V.; van Geet C.; Lin M.-C.; Fu Y.-C.; Loggetto S.; Mondelaers V.;
Odri-Komazec I.; Revel-Vilk S.; Sevilla J.; Fuzzato Silva L.; Kerr Saraiva
J.; Montes Tapia F.F.; Woods-Swafford W.
Institution
(Halton) Children's Hospital of Eastern Ontario, University of Ottawa,
Ottawa, ON, Canada
(Brandao) The Hospital for Sick Children, Toronto, ON, Canada
(Luciani) Pediatric Hematology/Oncology Department, Pediatric Hospital
Bambino Gesu, Rome, Italy
(Bomgaars) Department of Pediatrics, Texas Children's Cancer and
Hematology Centers, Baylor College of Medicine, Houston, TX, United States
(Chalmers) Royal Hospital for Children, Glasgow, Scotland, United Kingdom
(Mitchell) Department of Pediatrics, University of Alberta, Edmonton, AB,
Canada
(Nurmeev) Pediatric Hospital, Republic of Tatarstan, Kazan Medical
University, Kazan, Russian Federation
(Sharathkumar) Stead Family Department of Pediatrics, University of Iowa
Carver College of Medicine, Iowa City, IA, United States
(Svirin) Pediatric Hematology Department, Municipal Children's Hospital
"Morozovskaya", Moscow, Russian Federation
(Gorbatikov) Pediatric Cardiovascular Surgery, Regional hospital #1,
Tyumen region, Russian Federation
(Tartakovsky) Therapeutic Area Cardiovascular Medicine, Boehringer
Ingelheim International, Ingelheim am Rhein, Germany
(Simetzberger) Clinical Operations, Boehringer Ingelheim RCV, Vienna,
Austria
(Huang) Translational Medicine and Clinical Pharmacology, Boehringer
Ingelheim Pharmaceuticals, Ridgefield, CT, United States
(Sun) Biostatistics and Data Sciences, Boehringer Ingelheim
Pharmaceuticals, Ridgefield, CT, United States
(Kreuzer) Boehringer Ingelheim Singapore, Singapore
(Gropper) Therapeutic Area Inflammation Medicine, Boehringer Ingelheim
International, Ingelheim, Germany
(Reilly) Therapeutic Area Cardiovascular Medicine, Boehringer Ingelheim
Pharmaceuticals, Ridgefield, CT, United States
(Brueckmann) Therapeutic Area Cardiovascular Medicine, Boehringer
Ingelheim International Pharma, Ingelheim, Germany
(Brueckmann) Faculty of Medicine Mannheim of the University of Heidelberg,
Mannheim, Germany
(Albisetti) Hematology Department, University Children's Hospital, Zurich,
Switzerland
Publisher
Elsevier Ltd
Abstract
Background: Dabigatran etexilate is a direct oral anticoagulant with
potential to overcome the limitations of standard of care in children with
venous thromboembolism. The aims of this clinical trial were to study the
appropriateness of a paediatric dabigatran dosing algorithm, and the
efficacy and safety of dabigatran dosed according to that algorithm versus
standard of care in treating children with venous thromboembolism.
 Method(s): DIVERSITY is a randomised, controlled, open-label,
parallel-group, phase 2b/3 non-inferiority trial done in 65 centres in 26
countries. Standard of care (low-molecular-weight heparins, unfractionated
heparin, vitamin K antagonists or fondaparinux) was compared with a
paediatric oral dabigatran dosing regimen (an age-adjusted and
weight-adjusted nomogram) in children younger than 18 years with acute
venous thromboembolism initially treated (5-21 days) with parenteral
anticoagulation, requiring anticoagulation therapy for at least 3 months.
Patients were randomised 1:2 (standard of care:dabigatran) and stratified
by age (12 to <18 years, 2 to <12 years, and birth to <2 years) via
interactive response technology. The primary composite efficacy endpoint
(intention-to-treat analysis) was the proportion of children with complete
thrombus resolution, and freedom from recurrent venous thromboembolism and
venous thromboembolism-related death. A non-inferiority margin of absolute
differences of 20% was used. Secondary endpoints included safety
(determined by major bleeding events [time-to-event analysis on the
treated set]), and pharmacokinetic-pharmacodynamic relationships
(descriptive analyses). This trial is registered with ClinicalTrials.gov,
NCT01895777 and is completed. Finding(s): 328 children were enrolled
between Feb 18, 2014, and Nov 14, 2019. 267 were randomly assigned (90
[34%] to standard of care and 177 [66%] to dabigatran) and included in the
analyses. Median exposure to standard of care was 85.0 days (IQR
80.0-90.0) and to dabigatran was 84.5 days (78.0-89.0). Similar
proportions of children treated with standard of care and dabigatran met
the composite efficacy endpoint (38 [42%] of 90 vs 81 [46%] of 177;
Mantel-Haenszel weighted difference, -0.04; 90% CI -0.14 to 0.07; p<0.0001
for non-inferiority). On-treatment bleeding events were reported in 22
(24%) of 90 children receiving standard of care and 38 (22%) of 176
children receiving dabigatran (hazard ratio [HR] 1.15, 95% CI 0.68 to
1.94; p=0.61); major bleeding events were similar between the groups (two
[2%] of 90 and four [2%] of 176; HR 0.94, 95% CI 0.17 to 5.16; p=0.95).
Pharmacokinetic-pharmacodynamic curves showed a linear relationship
between total dabigatran plasma concentration and diluted thrombin time
and ecarin clotting time, and a non-linear relationship with activated
partial thromboplastin time; curves were similar to those for adults.
Serious adverse events were reported for 18 (20%) of 90 children receiving
standard of care and 22 (13%) of 176 children receiving dabigatran. The
most common severe adverse events were vascular disorders (standard of
care three [3%] of 90, dabigatran two [1%] of 176), and gastrointestinal
disorders (standard of care two [2%] of 90 and dabigatran five [3%] of
176). One on-treatment death occurred in the standard of care group
(retroperitoneal bleeding, not considered treatment related by the study
investigators). Interpretation(s): An age-adjusted and
weight-adjusted dabigatran dosing algorithm was appropriate in children
aged birth to less than 18 years with venous thromboembolism. Dabigatran
was non-inferior to standard of care in terms of efficacy, with similar
pharmacokinetic-pharmacodynamic relationships as those seen in adults, and
might be a suitable alternative to standard of care. Funding(s):
Boehringer Ingelheim. Copyright © 2021 Elsevier Ltd

<22>
Accession Number
2007123876
Title
Adverse outcomes after major surgery in children with intellectual
disability.
Source
Developmental Medicine and Child Neurology. 63 (2) (pp 211-217), 2021.
Date of Publication: February 2021.
Author
Huang S.-Y.; Chang C.-C.; Lin C.-S.; Yeh C.-C.; Lin J.-A.; Cherng Y.-G.;
Chen T.-L.; Liao C.-C.
Institution
(Huang, Cherng) Department of Anesthesiology, Shuang Ho Hospital, Taipei
Medical University, New Taipei City, Taiwan (Republic of China)
(Huang, Chang, Lin, Lin, Cherng, Chen, Liao) Department of Anesthesiology,
School of Medicine, College of Medicine, Taipei Medical University,
Taipei, Taiwan (Republic of China)
(Chang, Lin, Liao) Department of Anesthesiology, Taipei Medical University
Hospital, Taipei, Taiwan (Republic of China)
(Chang, Lin, Chen, Liao) Anesthesiology and Health Policy Research Center,
Taipei Medical University Hospital, Taipei, Taiwan (Republic of China)
(Yeh) Department of Surgery, China Medical University Hospital, Taichung,
Taiwan (Republic of China)
(Yeh) Department of Surgery, University of Illinois, Chicago, IL, United
States
(Lin, Chen) Department of Anesthesiology, Wan Fang Hospital, Taipei
Medical University, Taipei, Taiwan (Republic of China)
(Lin, Liao) Center of Regional Anesthesia and Pain Medicine, Wan Fang
Hospital, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Liao) Research Center of Big Data and Meta-Analysis, Wan Fang Hospital,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Liao) School of Chinese Medicine, College of Chinese Medicine, China
Medical University, Taichung, Taiwan (Republic of China)
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To evaluate outcomes after major surgery in children and adolescents
with intellectual disability. Method(s): We used 2004 to 2013 claims
data from Taiwan's National Health Insurance programme to conduct a nested
cohort study, which included 220 292 surgical patients aged 6 to 17 years.
A propensity score matching procedure was used to select 2173 children
with intellectual disability and 21 730 children without intellectual
disability for comparison. Logistic regression was used to calculate the
adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the
postoperative complications and 30-day mortality associated with
intellectual disability. Result(s): Children with intellectual
disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI
1.48-3.15; p<0.001), sepsis (OR 1.67, 95% CI 1.28-2.18; p<0.001), and
30-day mortality (OR 2.04, 95% CI 1.05-3.93; p=0.013) compared with
children without intellectual disability. Children with intellectual
disability also had longer lengths of hospital stay (p<0.001) and higher
medical expenditure (p<0.001) when compared with children with no
intellectual disability. Interpretation(s): Children with
intellectual disability experienced more complications and higher 30-day
mortality after surgery when compared with children without intellectual
disability. There is an urgent need to revise the protocols for the
perioperative care of this specific population. What this paper adds:
Surgical patients with intellectual disability are at increased risk of
postoperative pneumonia, sepsis, and 30-day mortality. Intellectual
disability is associated with higher medical expenditure and increased
length of stay in hospital after surgical procedures. The influence of
intellectual disability on postoperative outcomes is consistent in both
sexes and those aged 10 to 17 years. Low income and a history of fractures
significantly impacts postoperative adverse events for patients with
intellectual disability. Copyright © 2020 Mac Keith Press

<23>
Accession Number
2005460529
Title
Vitamin C supplementation and C-reactive protein levels: Findings from a
systematic review and meta-analysis of clinical trials.
Source
Journal of Complementary and Integrative Medicine. 17 (4) (no pagination),
2021. Article Number: 20190151. Date of Publication: 01 Dec 2021.
Author
Safabakhsh M.; Emami M.R.; Zeinali Khosroshahi M.; Asbaghi O.; Khodayari
S.; Khorshidi M.; Alizadeh S.; Viri E.H.
Institution
(Safabakhsh, Emami, Alizadeh) Department of Clinical Nutrition, School of
Nutritional Sciences and Dietetics, Tehran University of Medical Sciences
(TUMS), Tehran, Iran, Islamic Republic of
(Zeinali Khosroshahi, Asbaghi) Lorestan University, Khurramabad, Lorestan,
Iran, Islamic Republic of
(Khodayari) Shahid Sadoughi University of Medical Science, Yazd, Iran,
Islamic Republic of
(Khorshidi) School of Nutrition and Dietetics, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Viri) Department of Nutrition and Dietetic, Islamic Azad University,
Science and Research Branch, Tehran, Iran, Islamic Republic of
Publisher
De Gruyter Open Ltd
Abstract
C-reactive protein (CRP) is an inflammatory biomarker which prognosticates
cardiovascular disease. Previous studies have reached mixed conclusions
regarding the effect of Vitamin C on reducing CRP or hs-CRP level. The
present systematic review and meta-analysis was conducted to resolve these
inconsistencies. Material(s) and Method(s): Related articles
published up to August 2018 were searched through PubMed, Scopus, Ovid,
ISI web of science, Embase, and Cochrane databases by relevant keywords.
Clinical trials which examined the effect of either Vitamin C
supplementation or Vitamin C-enriched foods on CRP and hs-CRP levels were
included. A total of 11 studies with 14 data sets involving 818 subjects
were included. Overall, the pooled analysis revealed that Vitamin C could
decrease CRP level relative to placebo group (Weighted mean difference
[WMD]=-0.73mg/L: 95% CI:-1.30 to-0.15, p=0.013) with a considerable
heterogeneity (I2=98%, p<0.001). Moreover, subgroup analyses revealed that
the beneficial effect of Vitamin C on CRP level alternation only was found
in male (p=0.003), non-smoker (p=0.041), healthy (p=0.029) and younger
participants (p=0.010). Vitamin C could improve CRP level only at doses of
less than 500mg/day (p=0.009). Regarding hs-CRP changes, the pooled
analysis did not show any significant effect of Vitamin C (WMD=-0.65mg/L:
95% CI:-2.03 to 0.72, p=0.35). This finding was confirmed by all subgroup
analyses expect for high quality articles in which hs-CRP level was
elevated after Vitamin C supplementation (p=0.026). In conclusion,
supplementation with Vitamin C might have a significant effect only on CRP
reduction. Further studies are needed to confirm this
effect. Copyright © 2020 2020 Walter de Gruyter GmbH,
Berlin/Boston.

<24>
Accession Number
633328020
Title
Effect of Catheter Ablation with Vein of Marshall Ethanol Infusion vs
Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS
Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 324 (16) (pp
1620-1628), 2020. Date of Publication: 27 Oct 2020.
Author
Valderrabano M.; Peterson L.E.; Swarup V.; Schurmann P.A.; Makkar A.;
Doshi R.N.; Delurgio D.; Athill C.A.; Ellenbogen K.A.; Natale A.; Koneru
J.; Dave A.S.; Giorgberidze I.; Afshar H.; Guthrie M.L.; Bunge R.; Morillo
C.A.; Kleiman N.S.
Institution
(Valderrabano, Peterson, Schurmann, Dave, Guthrie, Bunge, Kleiman) Houston
Methodist DeBakey Heart and Vascular Center and Research Institute,
Houston, TX, United States
(Swarup, Makkar) Arizona Heart Rhythm Center, Phoenix, United States
(Schurmann, Giorgberidze, Afshar) Michael E. DeBakey Veterans Affairs
Medical Center, Houston, TX, United States
(Doshi) Keck-USC University Hospital, University of Southern California,
Los Angeles, United States
(Delurgio) Emory St Joseph's Hospital, Emory University, Atlanta, GA,
United States
(Athill) Sharp Memorial Hospital, San Diego, CA, United States
(Ellenbogen, Koneru) Virginia Commonwealth University School of Medicine,
Richmond, United States
(Natale) Texas Cardiac Arrhythmia Institute, St David's Medical Center,
Austin, United States
(Morillo) Libin Cardiovascular Institute, University of Calgary, Calgary,
AB, Canada
Publisher
American Medical Association
Abstract
Importance: Catheter ablation of persistent atrial fibrillation (AF) has
limited success. Procedural strategies beyond pulmonary vein isolation
have failed to consistently improve results. The vein of Marshall contains
innervation and AF triggers that can be ablated by retrograde ethanol
infusion. Objective(s): To determine whether vein of Marshall ethanol
infusion could improve ablation results in persistent AF when added to
catheter ablation. Design, Setting, and Participant(s): The Vein of
Marshall Ethanol for Untreated Persistent AF (VENUS) trial was an
investigator-initiated, National Institutes of Health-funded, randomized,
single-blinded trial conducted in 12 centers in the United States.
Patients (N = 350) with persistent AF referred for first ablation were
enrolled from October 2013 through June 2018. Follow-up concluded in June
2019. Intervention(s): Patients were randomly assigned to catheter
ablation alone (n = 158) or catheter ablation combined with vein of
Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for
15% technical vein of Marshall ethanol infusion failures. Main
Outcomes and Measures: The primary outcome was freedom from AF or atrial
tachycardia for longer than 30 seconds after a single procedure, without
antiarrhythmic drugs, at both 6 and 12 months. Outcome assessment was
blinded to randomization treatment. There were 12 secondary outcomes,
including AF burden, freedom from AF after multiple procedures, perimitral
block, and others. Result(s): Of the 343 randomized patients (mean
[SD] age, 66.5 [9.7] years; 261 men), 316 (92.1%) completed the trial.
Vein of Marshall ethanol was successfully delivered in 155 of 185
patients. At 6 and 12 months, the proportion of patients with freedom from
AF/atrial tachycardia after a single procedure was 49.2% (91/185) in the
catheter ablation combined with vein of Marshall ethanol infusion group
compared with 38% (60/158) in the catheter ablation alone group
(difference, 11.2% [95% CI, 0.8%-21.7%]; P =.04). Of the 12 secondary
outcomes, 9 were not significantly different, but AF burden (zero burden
in 78.3% vs 67.9%; difference, 10.4% [95% CI, 2.9%-17.9%]; P =.01),
freedom from AF after multiple procedures (65.2% vs 53.8%; difference,
11.4% [95% CI, 0.6%-22.2%]; P =.04), and success achieving perimitral
block (80.6% vs 51.3%; difference, 29.3% [95% CI, 19.3%-39.3%]; P <.001)
were significantly improved in vein of Marshall-treated patients. Adverse
events were similar between groups. Conclusions and Relevance: Among
patients with persistent AF, addition of vein of Marshall ethanol infusion
to catheter ablation, compared with catheter ablation alone, increased the
likelihood of remaining free of AF or atrial tachycardia at 6 and 12
months. Further research is needed to assess longer-term efficacy. Trial
Registration: ClinicalTrials.gov Identifier: NCT01898221. Copyright
© 2020 American Medical Association. All rights reserved.

<25>
Accession Number
633322399
Title
The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for
Postoperative Analgesia in Elderly Patients With Postoperative Delirium
and Early Postoperative Cognitive Dysfunction: A Single-Center,
Prospective, Randomized, Double-Blind, Controlled Trial.
Source
Frontiers in Neuroscience. 14 (no pagination), 2020. Article Number:
549516. Date of Publication: 23 Oct 2020.
Author
Zhao W.; Hu Y.; Chen H.; Wang X.; Wang L.; Wang Y.; Wu X.; Han F.
Institution
(Zhao, Hu, Wang, Wang, Wang, Wu, Han) Department of Anesthesiology, The
Third Affiliated Hospital, Harbin Medical University, Harbin, China
(Zhao) Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun
Yat-sen University, Guangzhou, China
(Chen) Department of Anesthesiology, Heilongjiang Provincial Corps
Hospital, Chinese People's Armed Police Forces, Harbin, China
Publisher
Frontiers Media S.A.
Abstract
Background: Postoperative delirium (POD) and postoperative cognitive
dysfunction (POCD) are common complications after major surgery among
elderly patients. Dexmedetomidine (DEX) is less frequently explored for
its effects in patients with postoperative neurocognitive disorders. This
study investigated the effect and optimal dosage of DEX for
patient-controlled analgesia (PCA) on POD and early POCD after major
surgery among elderly patients. Method(s): Patients in four groups
received continuous infusion of DEX 0, 100, 200, and 400 mug with
sufentanil 150 mug for PCA immediately after surgery. POD and POCD were
assessed on postoperative days 1, 2, 3, and 7 by using the Confusion
Assessment Method (CAM) and Mini-Mental State Examination (MMSE) scales.
Furthermore, the incidence of POD and POCD of all the four groups in
postoperative 7 days classified by high risk factors (age, education,
surgical site, and surgical category), sedation level, postoperative pain
intensity, and side effects were assessed. Result(s): The overall
incidence rates of POD and early POCD 7 days after surgery were lower in
the DEX 200 mug 400 mug groups than in the DEX 0 mug and 100 mug groups (P
< 0.05). Compared with DEX 200 mug, DEX 400 mug reduced early POCD in
patients who underwent open surgery (P < 0.05). There were no intergroup
differences in the postoperative sedation level, pain intensity, and side
effects. Conclusion(s): The continuous infusion of DEX 200 mug or DEX
400 mug in PCA significantly decreased the incidence of POD and early POCD
after major surgery without increasing any side effects. Compared with DEX
200 mug, DEX 400 mug was preferred for reducing early POCD in patients who
underwent open surgery. © Copyright © 2020 Zhao, Hu, Chen,
Wang, Wang, Wang, Wu and Han.

<26>
Accession Number
2010583877
Title
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart
Disease: Executive Summary: A Report of the American College of
Cardiology/American Heart Association Joint Committee on Clinical Practice
Guidelines.
Source
Journal of the American College of Cardiology. 77 (4) (pp 450-500), 2021.
Date of Publication: 02 Feb 2021.
Author
Otto C.M.; Nishimura R.A.; Bonow R.O.; Carabello B.A.; Erwin J.P.; Gentile
F.; Jneid H.; Krieger E.V.; Mack M.; McLeod C.; O'Gara P.T.; Rigolin V.H.;
Sundt T.M.; Thompson A.; Toly C.
Publisher
Elsevier Inc.
Abstract
Aim: This executive summary of the valvular heart disease guideline
provides recommendations for clinicians to diagnose and manage valvular
heart disease as well as supporting documentation to encourage their use.
 Method(s): A comprehensive literature search was conducted from
January 1, 2010, to March 1, 2020, encompassing studies, reviews, and
other evidence conducted on human subjects that were published in English
from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality
Reports, and other selected database relevant to this guideline.
Structure: Many recommendations from the earlier valvular heart disease
guidelines have been updated with new evidence and provides newer options
for diagnosis and treatment of valvular heart disease. This summary
includes only the recommendations from the full guideline which focus on
diagnostic work-up, the timing and choice of surgical and catheter
interventions, and recommendations for medical therapy. The reader is
referred to the full guideline for graphical flow charts, text, and tables
with additional details about the rationale for and implementation of each
recommendation, and the evidence tables detailing the data considered in
developing these guidelines. Copyright © 2021 American College of
Cardiology Foundation and the American Heart Association, Inc.

<27>
Accession Number
2010573225
Title
A Randomized Comparison of Positional Stability: The EZ-Blocker Versus
Left-Sided Double-Lumen Endobronchial Tubes in Adult Patients Undergoing
Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Morris B.N.; Fernando R.J.; Garner C.R.; Johnson S.D.; Gardner J.C.;
Marchant B.E.; Johnson K.N.; Harris H.M.; Russell G.B.; Wudel L.J.;
Templeton T.W.
Institution
(Morris, Fernando, Garner, Johnson, Gardner, Marchant, Johnson, Harris,
Russell, Templeton) Department of Anesthesiology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Wudel) Department of Cardiothoracic Surgery, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Russell) Division of Public Health Sciences\Department of Biostatistics
and Data Science
Publisher
W.B. Saunders
Abstract
Objective: To assess if there is a difference in the repositioning rate of
the EZ-Blocker versus a left-sided double-lumen endobronchial tube (DLT)
in patients undergoing thoracic surgery and one-lung ventilation.
 Design(s): Prospective, randomized. Setting(s): Single center,
university hospital. Participant(s): One hundred sixty-three thoracic
surgery patients. Intervention(s): Patients were randomized to either
EZ-Blocker or a DLT. Measurements and Main Results: The primary
outcome was positional stability of either the EZ-Blocker or a left-sided
double-lumen endobronchial tube, defined as the number of repositionings
per hour of surgery and one-lung ventilation. Secondary outcomes included
an ordinal isolation score from 1 to 3, in which 1 was poor, up to 3,
which represented excellent isolation, and a visual analog postoperative
sore throat score (0-100) on postoperative days (POD) one and two. Rate of
repositionings per hour during one-lung ventilation and surgical
manipulation in left-sided cases was similar between the two devices: 0.08
+/- 0.15 v 0.11 +/- 0.3 (p = 0.57). In right-sided cases, the rate of
repositioning was higher in the EZ-Blocker group compared with DLT: 0.38
+/- 0.65 v 0.09 +/- 0.21 (p = 0.01). Overall, mean isolation scores for
the EZ-Blocker versus the DLT were 2.64 v 2.86 (p = 0.001) in left-sided
cases and 2.61 v 2.81(p = 0.01) in right-sided cases. Median sore throat
scores were 0 v 5 (p = 0.13) POD one and 0 v 5 (p = 0.006) POD two for the
EZ-Blocker and left-sided DLT, respectively. Conclusion(s): For
right-sided procedures, the positional stability of the EZ-Blocker is
inferior to a DLT. In left-sided cases, the rate of repositioning for the
EZ-Blocker and DLT are not statistically different. Copyright ©
2020 Elsevier Inc.

<28>
Accession Number
2010560307
Title
Higher versus lower mean arterial pressure target management in older
patients having non-cardiothoracic surgery: A prospective randomized
controlled trial.
Source
Journal of Clinical Anesthesia. 69 (no pagination), 2021. Article Number:
110150. Date of Publication: May 2021.
Author
Hu A.-M.; Qiu Y.; Zhang P.; Zhao R.; Li S.-T.; Zhang Y.-X.; Zheng Z.-H.;
Hu B.-L.; Yang Y.-L.; Zhang Z.-J.
Institution
(Hu, Zhang, Zheng, Zhang) Department of Anesthesiology, Shenzhen People's
Hospital, Shenzhen, China
(Hu, Zhang, Zheng, Zhang) The Second Clinical Medical College, Jinan
University, Shenzhen, China
(Hu, Zhang, Zheng, Zhang) First Affiliated Hospital, Southern University
of Science and Technology, Shenzhen, China
(Qiu) Department of Anesthesiology and Translational Neuroscience Center,
West China Hospital, Sichuan University, Chengdu, China
(Zhang) Department of Anesthesiology, Sichuan Provincial People's
Hospital, Chengdu, China
(Zhao) Department of Anesthesiology, Kunming Children's Hospital, Kunming,
China
(Li) Department of Anesthesiology, Jinan University-affiliated Shenzhen
Baoan Women's and Children's Hospital, Shenzhen, China
(Hu) Department of Anesthesiology, Affiliated Hospital of Guizhou Medical
University, Guiyang, China
(Yang) Department of Anesthesiology, Henan Provincial People's Hospital,
Zhengzhou University, Zhengzhou, China
Publisher
Elsevier Inc.
Abstract
Study objective: This study aimed to evaluate the effects of low versus
high mean arterial pressure (MAP) levels on the incidence of postoperative
delirium during non-cardiothoracic surgery in older patients.
 Design(s): Multicenter, randomized, parallel-controlled, open-label,
and assessor-blinded clinical trial. Setting(s): University hospital.
 Patient(s): Three hundred twenty-two patients aged >=65 with an
American Society of Anesthesiologists physical status of I-II who
underwent non-cardiothoracic surgery with general anaesthesia.
 Intervention(s): Participants were randomly assigned into a low-level
MAP (60-70 mmHg) or high-level MAP (90-100 mmHg) group during general
anaesthesia. The study was conducted from November 2016 to February 2020.
Participants were older patients having non-cardiothoracic surgery. The
follow-up period ranged from 1 to 7 days after surgery. The primary
outcome was the incidence of postoperative delirium. Main Result(s):
In total, 322 patients were included and randomized; 298 completed
in-hospital delirium assessments [median (interquartile range) age, 73
(68-77) years; 173 (58.1%) women]. Fifty-four (18.1%) patients total,
including 36 (24.5%) and 18 (11.9%) in the low-level and high-level MAP
groups [relative risk (RR) 0.48, 95% confidence interval (CI) 0.25 to
0.87, P = 0.02], respectively, experienced postoperative delirium. The
adjusted RR was 0.34 (95% CI 0.16 to 0.70, P < 0.01) in the multiple
regression analysis. High-level MAP was associated with a shorter delirium
span and a higher intraoperative urine volume than low-level MAP.
 Conclusion(s): In older patients during non-cardiothoracic surgery,
high-level blood pressure management might help reduce the incidence of
postoperative delirium. Copyright © 2020

<29>
Accession Number
2007982893
Title
Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 111 (2) (pp 544-554), 2021. Date of
Publication: February 2021.
Author
Eikelboom R.; Sanjanwala R.; Le M.-L.; Yamashita M.H.; Arora R.C.
Institution
(Eikelboom, Yamashita, Arora) Max Rady College of Medicine, University of
Manitoba, Winnipeg, Canada
(Sanjanwala, Yamashita, Arora) Cardiac Sciences Program, St. Boniface
Hospital, Winnipeg, MB, Canada
(Le) Libraries, University of Manitoba, Winnipeg, MB, Canada
(Yamashita, Arora) Institute of Cardiovascular Sciences, St. Boniface
Hospital Research Centre, Winnipeg, MB, Canada
Publisher
Elsevier Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) after cardiac surgery
is associated with longer hospital stay and increased in-hospital death
and stroke, but its long-term implications remain incompletely understood.
A systematic literature review was undertaken to investigate the impact of
POAF on long-term death and stroke in adult patients who undergo cardiac
operations. Method(s): Electronic databases (Cochrane, Embase, Ovid
MEDLINE, and PubMed) were queried from inception to October 2018. Included
studies compared long-term outcomes after cardiac operations in patients
with and without POAF. Adjusted and unadjusted meta-analyses examined
death, stroke, and major adverse cardiac and cerebrovascular events. Risk
of bias was evaluated with the Newcastle-Ottawa Scale. Result(s): The
inclusion criteria were met by 32 studies describing 155,575 patients who
had undergone cardiac operations. POAF occurred in 36,988 patients
(23.7%). Meta-analysis of 10 studies (44,367 patients) demonstrated
increased 1-year death in patients with POAF (odds ratio, 2.60; 95%
confidence interval, 2-3.38; P <.01). Aggregate adjusted hazard of death
(16 studies, n = 84,295) was also increased in patients with POAF (hazard
ratio, 1.25; 95% confidence interval, 1.2-1.3; P <.01).
 Conclusion(s): This systematic review and meta-analysis identified an
association between POAF and long-term death after cardiac surgery. More
comprehensive POAF prevention and management, including more stringent
follow-up for POAF recurrence after hospital discharge, may be indicated.
The included studies used inconsistent definitions of POAF and variable
exclusion criteria; however, estimates of heterogeneity are low.
Differences in preoperative comorbidities, such as age, ejection fraction,
and obesity, may not be fully accounted for in adjusted analyses. Future
work is required to delineate mechanisms linking POAF and death in this
population. Copyright © 2021 The Society of Thoracic Surgeons

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