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<1>
Accession Number
2010318801
Title
Surgical Atrial Fibrillation Ablation With and Without Left Atrium
Reduction for Patients Scheduled for Mitral Valve Surgery: A Prospective
Randomised Study.
Source
Heart Lung and Circulation. (no pagination), 2020. Date of Publication:
2020.
Author
Bogachev-Prokophiev A.V.; Ovcharov M.A.; Lavinykov S.O.; Pivkin A.N.;
Sharifulin R.M.; Afanasyev A.V.; Sapegin A.V.; Zheleznev S.I.
Institution
(Bogachev-Prokophiev, Ovcharov, Lavinykov, Pivkin, Sharifulin, Afanasyev,
Sapegin, Zheleznev) Heart Valves Surgery Department, E. Meshalkin National
Medical Research Center, Novosibirsk, Russian Federation
Publisher
Elsevier Ltd
Abstract
Background: The influence of left atrium (LA) enlargement on atrial
arrhythmia recurrence (AAR) after surgical ablation in patients with
mitral valve (MV) disease remains unresolved. Objective(s): Left
atrial size is critical to the success of concomitant atrial fibrillation
(AF) ablation in patients scheduled for MV surgery. However, a large LA
should not be a limiting factor when evaluating surgical candidates with
AF if they receive appropriate treatment during concomitant ablation. This
randomised study assessed whether adding LA reduction (LAR) to the maze
procedure for MV surgery patients can improve freedom from AAR.
 Method(s): From September 2014 to September 2017, 140 patients were
randomly assigned into two groups. The maze group underwent MV surgery
with concomitant surgical AF ablation (n=70). The maze + LA reduction
group underwent MV surgery with concomitant AF ablation and LA reduction
procedure (n=70). Rhythm outcomes were estimated by Holter monitoring,
according to Heart Rhythm Society guidelines. Result(s): The
concomitant LA reduction procedure did not increase early mortality and
complications rates. Significant differences in freedom from AAR were
observed at 24 months (maze, 78.4%; maze + LAR group, 92.3%; p=0.025). A
significant difference in LA volume was detected at discharge (p<0.0001);
however, it was not significantly different at 24 months (p=0.182).
 Conclusion(s): Adding LA reduction to the maze procedure led to
improvements in freedom from AAR for patients with AF and LA enlargement
scheduled for MV surgery. A concomitant LA reduction procedure did not
increase mortality and perioperative risk. Copyright © 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<2>
Accession Number
632793382
Title
Effects of foot massage and patient education in patients undergoing
coronary artery bypass graft surgery: A randomized controlled trial.
Source
Complementary therapies in clinical practice. 40 (pp 101215), 2020. Date
of Publication: 01 Aug 2020.
Author
Chandrababu R.; Nayak B.S.; Pai V.B.; N R.; George L.S.; Devi E.S.; George
A.
Institution
(Chandrababu, George) Manipal College of Nursing, Manipal Academy of
Higher Education, Manipal, Karnataka 576104, India
(Nayak) Manipal College of Nursing, Manipal Academy of Higher Education,
Manipal, Karnataka 576104, India
(Pai) Royal Papworth Hospital, NHS Foundation Trust, Cambridge Biomedical
Campus, Cambridge, United Kingdom
(N) Department of Data Science, Prasanna School of Public Health, Manipal
Academy of Higher Education, Manipal, Karnataka 576104, India
(George) Manipal College of Nursing, Manipal Academy of Higher Education,
Manipal, Karnataka 576104, India
(Devi) Manipal College of Nursing, Manipal Academy of Higher Education,
Manipal, Karnataka 576104, India
Publisher
NLM (Medline)
Abstract
BACKGROUND: Anxiety, pain, and fatigue are common postoperative problems
that disturb the recovery and quality of life in patients undergoing
coronary artery bypass graft (CABG) surgery. These postoperative problems
are associated with prolonged recovery and decreased quality of life. This
study was aimed at evaluating the combined effects of foot massage and
patient education on anxiety, fatigue, pain, self-efficacy, and quality of
life in patients undergoing CABG surgery. MATERIAL AND METHODS: In this
randomized controlled trial (RCT), 130 participants were randomly
allocated to experimental (n = 65) and control (n = 65) groups. The
experimental group received a combination of foot massage and patient
education as interventions and the control group received usual care of
the hospital. RESULT(S): The experimental group had a significant
decrease in anxiety (p = 0.001), fatigue (p = 0.001), pain (p = 0.001),
and increased self-efficacy (p = 0.001) and quality of life (p = 0.001).
 CONCLUSION(S): The combined form of foot massage and patient
education is effective in decreasing anxiety, fatigue, pain, and
increasing self-efficacy and the quality of life. These interventions will
support the recovery of patients and reduce their suffering. Copyright
© 2020 Elsevier Ltd. All rights reserved.

<3>
Accession Number
2007588917
Title
Self-expanding transcatheter aortic valve infolding: Current evidence,
diagnosis, and management.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2020.
Date of Publication: 2020.
Author
Ancona M.B.; Beneduce A.; Romano V.; Buzzatti N.; Russo F.; Bellini B.;
Ferri L.A.; Agricola E.; Landoni G.; Scandroglio A.M.; Chieffo A.;
Montorfano M.
Institution
(Ancona, Beneduce, Romano, Russo, Bellini, Ferri, Chieffo, Montorfano)
Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Buzzatti) Cardiac Surgery Unit, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Agricola) Echocardiography Unit, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Landoni, Scandroglio) Anesthesia and Intensive Care Department, IRCCS San
Raffaele Scientific Institute, Milan, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Prosthetic valve infolding is a rare but severe complication
of transcatheter aortic valve implantation (TAVI) with self-expanding
valves. However, currently available clinical data are limited and
fragmented. Objective(s): This report aims to provide a comprehensive
overview of this complication focusing on predisposing factors, clinical
presentation, diagnostic findings, treatment and clinical outcomes.
 Method(s): A systematic review of the literature was performed to
identify cases of infolding occurring during TAVI with self-expanding
valves published until August 2020. These data were pooled with all the
retrospectively identified infolding cases occurred at San Raffaele
Scientific Institute between December 2014 and August 2020.
 Result(s): A total of 34 cases were included. Among patients with
available data, 38% received a first-generation CoreValve, and 62% a
second-generation Evolut R (82%) or Evolut PRO (18%). Infolding occurred
mostly with >=29-mm valves (94%). Predisposing factors included
resheathing of a second-generation valve (82%), heavy calcification of the
native valve (65%), lack of predilatation (16%), Sievers type-1 bicuspid
aortic valve (11%), and improper valve loading (5%). Infolding resulted in
severe PVL causing hemodynamic instability (29%) or cardiac arrest (12%).
Postdilatation was the treatment strategy in 68%, while prosthesis
replacement with a new device in 23% of cases. Device success rate was
82%. Death and stroke occurred in 3% and 12% of cases. Conclusion(s):
Prosthetic valve infolding is typically observed after resheathing of a
large-size self-expanding TAVI. When infolding is timely diagnosed,
prosthesis removal and replacement should be pursued. Further studies are
required to precisely define predisposing factors to prevent this
complication. Copyright © 2020 Wiley Periodicals LLC.

<4>
Accession Number
2007586930
Title
Effects of remote ischemic preconditioning on platelet activation and
reactivity in patients undergoing cardiac surgery using cardiopulmonary
bypass: a randomized controlled trial.
Source
Platelets. (no pagination), 2020. Date of Publication: 2020.
Author
Cho Y.J.; Nam K.; Yoo S.J.; Lee S.; Bae J.; Park J.-Y.; Kim H.-R.; Kim
T.K.; Jeon Y.
Institution
(Cho, Nam, Yoo, Lee, Bae, Kim, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Seoul, South Korea
(Park) FACS Core Facility, Seoul National University College of Medicine,
Seoul, South Korea
(Kim) Department of Biomedical Sciences, BK21 FOUR Biomedical Science
Project, Seoul National University College of Medicine, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae
Medical Center, Seoul National University College of Medicine, Seoul,
South Korea
Publisher
Taylor and Francis Ltd.
Abstract
During cardiopulmonary bypass (CPB), platelet activation and dysfunction
are associated with adverse outcomes. Remote ischemic preconditioning
(RIPC) has been shown to attenuate platelet activation. We evaluated the
effects of RIPC on platelet activation during CPB in patients undergoing
cardiac surgery. Among 58 randomized patients, 26 in the RIPC group and 28
in the sham-RIPC group were analyzed. RIPC consisted of 4 cycles of 5-min
ischemia induced by inflation of pneumatic cuff pressure to 200 mmHg,
followed by 5-min reperfusion comprising deflation of the cuff on the
upper arm. Platelet activation was assessed using flow cytometry analysis
of platelet activation markers. The primary endpoint was the AUC of CD62P
expression during the first 3 h after initiation of CPB. Secondary
outcomes were the AUC of PAC-1 expression and monocyte-platelet aggregates
(MPA) during 3 h of CPB. The AUCs of CD62P expression during 3 h after
initiation of CPB were 219.4 +/- 43.9 and 211.0 +/- 41.2 MFI in the RIPC
and sham-RIPC groups, respectively (mean difference, 8.42; 95% CI, -14.8
and 31.7 MFI; p =.471). The AUCs of PAC-1 expression and MPA did not
differ between groups. RIPC did not alter platelet activation and
reactivity during CPB in patients undergoing cardiac
surgery. Copyright © 2020 Taylor & Francis Group, LLC.

<5>
Accession Number
2007586544
Title
Catheter ablation for atrial fibrillation in patients with end-stage heart
failure and eligibility for heart transplantation.
Source
ESC Heart Failure. (no pagination), 2020. Date of Publication: 2020.
Author
Sohns C.; Marrouche N.F.; Costard-Jackle A.; Sossalla S.; Bergau L.;
Schramm R.; Fuchs U.; Omran H.; Rubarth K.; Dumitrescu D.; Konietschke F.;
Rudolph V.; Gummert J.; Sommer P.; Fox H.
Institution
(Sohns, Bergau, Sommer) Clinic for Electrophysiology, Herz- und
Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Marrouche) Tulane Research Innovation for Arrhythmia Discoveries (TRIAD),
Heart and Vascular Institute, Tulane University School of Medicine, New
Orleans, LA, United States
(Costard-Jackle, Schramm, Fuchs, Omran, Gummert, Fox) Clinic for Thoracic
and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Sossalla) Department of Internal Medicine II, Cardiology, Pneumology,
Intensive Care, University Hospital Regensburg, Regensburg, Germany
(Rubarth, Konietschke) Department of Biometry and Clinical Epidemiology,
University Medical Center Berlin Charite, Berlin, Germany
(Dumitrescu, Rudolph) Clinic for General and Interventional
Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universitat
Bochum, Bad Oeynhausen, Germany
(Costard-Jackle, Dumitrescu, Rudolph, Gummert, Sommer, Fox) Heart Failure
Department, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad
Oeynhausen, Germany
Publisher
Wiley-Blackwell
Abstract
Aims: Timely referrals for transplantation and left ventricular assist
device (LVAD) play a key role in favourable outcomes in patients with
advanced heart failure (HF). The purpose of the Catheter Ablation for
atrial fibrillation in patientS with end-sTage heart faiLure and
Eligibility for Heart Transplantation (CASTLE-HTx) trial is to test the
hypothesis that atrial fibrillation (AF) ablation has beneficial effects
on mortality and morbidity during 'waiting time' for heart transplantation
(HTx) or to prolong the time span until LVAD implantation. Methods
and Results: CASTLE-HTx is a randomized evaluation of ablative treatment
of AF in patients with severe left ventricular dysfunction who are
candidates and eligible for HTx. The primary endpoint is the composite of
all-cause mortality, worsening of HF requiring a high urgent
transplantation, or LVAD implantation. The secondary study endpoints are
all-cause mortality, cardiovascular mortality, cerebrovascular accidents,
worsening of HF requiring unplanned hospitalization, AF burden reduction,
unplanned hospitalization due to cardiovascular reason, all-cause
hospitalization, quality of life, number of delivered implantable
cardioverter defibrillator therapies, time to first implantable
cardioverter defibrillator therapy, number of device-detected ventricular
tachycardia/ventricular fibrillation episodes, left ventricular function,
exercise tolerance, and percentage of right ventricular pacing.
Ventricular myocardial tissue will be obtained from patients who will
undergo LVAD implantation or HTx to assess the effect of catheter ablation
on human HF myocardium. CASTLE-HTx will randomize 194 patients over a
minimum time period of 2 years. Conclusion(s): CASTLE-HTx will
determine if AF ablation has beneficial effects on mortality in patients
with end-stage HF who are eligible for HTx. Copyright © 2020 The
Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of
European Society of Cardiology

<6>
Accession Number
2007586431
Title
Prevention of pressure injury in the operating room: Heels operating room
pressure injury trial.
Source
International Wound Journal. (no pagination), 2020. Date of Publication:
2020.
Author
Eberhardt T.D.; de Lima S.B.S.; de Avila Soares R.S.; Silveira L.B.T.D.;
Rossarola Pozzebon B.; Reis C.R.; dos Santos K.P.P.; Alves P.J.P.
Institution
(Eberhardt, de Lima, Silveira, Rossarola Pozzebon, Reis, dos Santos)
Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa
Maria, RS, Brazil
(Eberhardt) Instituto de Ciencias Biologicas, Universidade de Passo Fundo,
Passo Fundo, RS, Brazil
(de Avila Soares) Colegio Politecnico, Universidade Federal de Santa
Maria, Santa Maria, RS, Brazil
(Alves) Instituto de Ciencias da Saude, Universidade Catolica Portuguesa,
Porto, Portugal
Publisher
Blackwell Publishing Ltd
Abstract
The objective was to evaluate the efficacy of multi-layered silicone foam
(intervention) compared with transparent polyurethane film (control) in
preventing heel pressure injuries caused by surgical positioning of
individuals undergoing elective surgery. It was designed an intra-patient,
open, parallel, randomised controlled trial was conducted in a university
hospital in southern Brazil, from March 2019 to February 2020, with
patients undergoing elective surgeries of cardiac and gastrointestinal
specialties. The patients who met the selection criteria constituted,
simultaneously, a single group receiving the intervention and active
control, through paired analysis of the cutaneous sites (right heel and
left heel). The outcome was the occurrence of PI, within the follow-up
period was 72 hours. Brazilian Registry of Clinical Trials: RBR-5GKNG5.
There was analysis of 135 patients/270 heels, with an overall incidence of
36.7%. The pressure injury incidence was significantly lower in the
intervention group (26.7%), compared with the control group (P =.001);
relative risk of 0.57. In the intervention group, the estimated pressure
injury-free time (survival) was 57.5 hours and in the control group, 43.9
hours. It was concluded that Multi-layered silicone foam (intervention) is
more efficacious than transparent polyurethane film (control) in the
prevention of pressure injuries caused by surgical positioning of
individuals undergoing elective surgery. Copyright © 2020 The
Authors. International Wound Journal published by Medicalhelplines.com Inc
(3M) and John Wiley & Sons Ltd.

<7>
Accession Number
2007577717
Title
PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of
tricuspid regurgitation: a propensity-matched analysis.
Source
Clinical Research in Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Sugiura A.; Vogelhuber J.; Ozturk C.; Schwaibold Z.; Reckers D.; Goto T.;
Kavsur R.; Becher M.U.; Zimmer S.; Nickenig G.; Weber M.
Institution
(Sugiura, Vogelhuber, Ozturk, Schwaibold, Reckers, Kavsur, Becher, Zimmer,
Nickenig, Weber) Herzzentrum Bonn, Medizinische Klinik und Poliklinik II,
Universitatsklinikum Bonn, Venusberg-Campus 1, Bonn 53127, Germany
(Goto) Department of Clinical Epidemiology and Health Economics, School of
Public Health, University of Tokyo, TXP Medical Co. Ltd., Tokyo, Japan
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Transcatheter tricuspid valve repair (TTVR) is a promising
technique for the treatment of tricuspid regurgitation (TR). Data
comparing the performance of novel edge-to-edge devices (PASCAL and
MitraClip-XTR) are scarce. Method(s): We identified 80 consecutive
patients who underwent TTVR using either the PASCAL or MitraClip-XTR
system to treat symptomatic TR from July 2018 to June 2020. To adjust for
baseline imbalances, we performed a propensity score (PS) 1:1 matching.
The primary endpoint was a reduction in TR severity by at least one grade
at 30 days. Result(s): The PS-matched cohort (n = 44) was at
high-surgical risk (EuroSCORE II: 7.5% [interquartile range (IQR)
4.8-12.1%]) with a mean TR grade of 4.3 +/- 0.8 and median coaptation gap
of 6.2 mm [IQR 3.2-9.1 mm]. The primary endpoint was similarly observed in
both groups (PASCAL: 91% vs. MitraClip-XTR: 96%). Multiple device
implantation was the most common form (59% vs. 82%, p = 0.19), and the
occurrence of SLDA was comparable between the PASCAL and MitraClip-XTR
system (5.7% [2 of 35 implanted devices] vs. 4.4% [2 of 45 implanted
devices], p = 0.99). No periprocedural death or conversions to surgery
occurred, and 30-day mortality (5.0% vs. 5.0%, log-rank p = 0.99) and
3-month mortality (10.0% vs. 5.0%, log-rank p = 0.56) were similar between
both groups. During follow-up, functional NYHA class, 6-min walking
distance, and health status improved in both groups. Conclusion(s):
Both TTVR devices, PASCAL and MitraClip-XTR, appeared feasible and
comparable for an effective TR reduction. Randomized head-to-head
comparisons will help to further define the appropriate scope of
application of each system. Copyright © 2020, The Author(s).

<8>
Accession Number
2007577501
Title
The benefit of fibrosa layer stripping technique during minimally invasive
aortic valve replacement for calcified aortic valve stenosis-A randomized
controlled trial.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Zhou Y.; Zhang L.; Hua K.; Zhang J.; Yang X.
Institution
(Zhou, Zhang, Hua, Zhang, Yang) Department of Cardiac Surgery, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
Blackwell Publishing Inc.
Abstract
Background: Fibrosa layer stripping (FLS) technique is a new approach to
remove the calcified aortic valve. In this study, we aimed to assess the
effectiveness of the FLS technique by comparing it with the conventional
technique in minimally invasive aortic valve replacement (MIAVR).
 Method(s): A prospective, single-center, randomized controlled trial
was conducted at Beijing Anzhen Hospital. Seventy patients diagnosed with
severe calcific aortic stenosis were randomly assigned to undergo FLS (n =
35) or conventional (n = 35) technique to debride calcified aortic valve.
Preoperative profile, procedural parameters, and postoperative outcomes
were analyzed. Result(s): No significant difference was observed in
the preoperative profile between the two groups. Compared with the
conventional technique, the FLS technique had a significantly higher
indexed effective orifice area and lower mean gradient. Moreover, the FLS
technique was associated with significantly reduced aortic cross-clamp
time (41 [38-44] vs. 56 [51-60] min, p <.001), cardiopulmonary bypass
(CPB) time (63 [56-69] vs. 81 [75-84] min, p <.001), and operative time
(148 [141-156] vs. 173 [169-180] min, p <.001). Lastly, the length of
intensive care unit stay (1.2 +/- 0.4 vs. 1.5 +/- 0.8 days, p =.041) and
hospital stay (5.3 +/- 0.6 vs. 6.0 +/- 1.4 days, p =.020) was
significantly reduced in the FLS group compared with those in the
conventional group. Conclusion(s): FLS technique is effective in
removing calcified tissue during MIAVR and is associated with shorter
cross-clamp time and CPB time, and better hemodynamic performance than the
conventional technique. Copyright © 2020 Wiley Periodicals LLC

<9>
Accession Number
2007577416
Title
Development and validation of a model for predicting acute kidney injury
after cardiac surgery in patients of advanced age.
Source
Journal of Cardiac Surgery. (no pagination), 2020. Date of Publication:
2020.
Author
Hu P.; Chen Y.; Wu Y.; Song L.; Zhang L.; Li Z.; Fu L.; Liu S.; Ye Z.; Shi
W.; Liang X.
Institution
(Hu, Liang) The Second School of Clinical Medicine, Southern Medical
University, Guangzhou, China
(Hu, Chen, Wu, Song, Zhang, Li, Fu, Liu, Ye, Shi, Liang) Division of
Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of
Medical Sciences, Guangzhou, China
Publisher
Blackwell Publishing Inc.
Abstract
Objective: To develop a clinical model for predicting postoperative acute
kidney injury (AKI) in patients of advanced age undergoing cardiac
surgery. Method(s): A total of 848 patients (aged >= 60 years)
undergoing cardiac surgery were consecutively enrolled. Among them, 597
were randomly selected for the development set and the remaining 251 for
the validation set. AKI was the primary outcome. To develop a model for
predicting AKI, visualized as a nomogram, we performed logistic regression
with variables selected by Lasso regression analysis. The discrimination,
calibration, and clinical usefulness of the new model were assessed and
compared with those of Cleveland Clinic score and Simplified Renal Index
(SRI) score in the validation set. Result(s): The incidence of AKI
was 61.8% in the development set. The new model included seven variables
including preoperative serum creatinine, hypertension, preoperative uric
acid, New York Heart Association classification >= 3, cardiopulmonary
bypass time > 120 min, intraoperative red blood cell transfusion, and
postoperative prolonged mechanical ventilation. In the validation set, the
areas under the receiver operating characteristic curves for assessing
discrimination of the new model, Cleveland Clinic score, and SRI score
were 0.801, 0.670, and 0.627, respectively. Compared with the other two
scores, the new model presented excellent calibration according to the
calibration curves. Decision curve analysis presented the new model was
more clinically useful than the other two scores. Conclusion(s): We
developed and validated a new model for predicting AKI after cardiac
surgery in patients of advanced age, which may help clinicians assess
patients' risk for AKI. Copyright © 2020 The Authors. Journal of
Cardiac Surgery published by Wiley Periodicals LLC

<10>
Accession Number
2007575433
Title
Vitamin D for prevention of sternotomy healing complications: REINFORCE-D
trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 1018. Date of
Publication: December 2020.
Author
Cecrle M.; Cerny D.; Sedlackova E.; Mikova B.; Dudkova V.; Drncova E.;
Pokusova M.; Skalsky I.; Tamasova J.; Halacova M.
Institution
(Cecrle, Cerny, Halacova) Department of Clinical Pharmacy, Na Homolce
Hospital, Prague, Czechia
(Cecrle, Cerny) Institute of Pharmacology, 1st Faculty of Medicine,
Charles University, Prague, Czechia
(Sedlackova, Skalsky) Department of Cardiac Surgery, Na Homolce Hospital,
Prague, Czechia
(Mikova) Department of Radiology, Na Homolce Hospital, Prague, Czechia
(Dudkova, Drncova) Department of Clinical Biochemistry, Hematology and
Immunology, Na Homolce Hospital, Prague, Czechia
(Pokusova) Hospital Pharmacy, Na Homolce Hospital, Prague, Czechia
(Tamasova) Department of Medical Physics, Na Homolce Hospital, Prague,
Czechia
(Halacova) Department of Pharmacology, 2nd Faculty of Medicine, Charles
University, Prague, Czechia
Publisher
BioMed Central Ltd
Abstract
Background: Most cardiac surgery patients undergo median sternotomy during
open heart surgery. Sternotomy healing is an arduous, very complex, and
multifactorial process dependent on many independent factors affecting the
sternum and the surrounding soft tissues. Complication rates for median
sternotomy range from 0.5 to 5%; however, mortality rates from
complications are very variable at 7-80%. Low calcidiol concentration
below 80 nmol/L results in calcium absorptive impairment and carries a
risk of bone loss, which is considered as a risk factor in the sternotomy
healing process. The primary objective of this clinical trial is to
compare the incidence of all postoperative sternotomy healing
complications in two parallel patient groups administered cholecalciferol
or placebo. The secondary objectives are focused on general patient
recovery process: sternal bone healing grade at the end of the trial,
length of hospitalization, number of days spent in the ICU, number of days
spent on mechanical lung ventilation, and number of hospital readmissions
for sternotomy complications. Method(s): This clinical trial is
conducted as monocentric, randomized, double-blind, placebo-controlled,
with planned enrollment of 600 patients over 4 years, approximately 300 in
the placebo arm and 300 in the treatment arm. Males and females from 18 to
95 years of age who fulfill the indication criteria for undergoing cardiac
surgery with median sternotomy can be included in this clinical trial, if
they meet the eligibility criteria. Discussion(s): REINFORCE-D is the
first monocentric trial dividing patients into groups based on serum
calcidiol levels, and with dosing based on serum calcidiol levels. This
trial may help to open up a wider range of postoperative healing issues.
Trial registration: EU Clinical Trials Register, EUDRA CT No:
2016-002606-39. Registered on September 8, 2016. Copyright ©
2020, The Author(s).

<11>
[Use Link to view the full text]
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. 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. 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.
 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.

<12>
[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. 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. 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. CONCLUSION(S): Our
study suggests that the intraoperative analgesic efficacy is similar for
deep and superficial SAPB during VATS lobectomy.

<13>
Accession Number
633777706
Title
The effect of anticoagulant regimes on human 25-hepcidin concentrations
after cell salvage (CS) in coronary artery bypass grafting (CABG).
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State of the Art 2019. United Kingdom. 21 (2 SUPPL) (pp 57-58), 2020. Date
of Publication: 2020.
Author
Schmitz S.; Boer W.; Vander Laenen M.
Institution
(Schmitz, Boer, Vander Laenen) Ziekenhuis Oost Limburg, Genk, Belgium
Publisher
SAGE Publications Inc.
Abstract
Introduction: Hemolysis during cardiopulmonary bypass may lead to
iron-induced renal injury. Hepcidin, a disulfide rich antimicrobial
peptide, regulates circulating iron by promoting iron sequestration by
macrophages: hepcidin concentration is reduced by anemia and increased by
inflammation. Both citrate and heparin are widely used as anticoagulant in
CS but differ in mechanism of action. It was hypothesized thatAcid Citrate
dextrose-anticoagulant (ACD-A) leads to less inflammation and oxidative
stress in CS blood than heparin, by modifying the availability of
extracellular Ca2+ with a direct effect on intracellular signalling.
 Objective(s): Exploring the effects of anticoagulant choice for CS on
25-hepcidin concentrationsin adults undergoing elective on pump CABG.
 Method(s): After approval by the local ethics committee, a
prospective semi-blinded randomized controlled trial was conducted.
Patient allocation to 2 groups: heparin or ACD-A. Blood samples were taken
at 3 time points during the procedure: S1 just before incision, S2 after
weaning from the extracorporeal circuit and before the transfusion of CS
blood, and S3 after transfusion of CS blood. Result(s): 56 patients
were included (46 male, 10 female), 26 in the heparin group (22 men, 4
women) and 30 in the citrate group (24 men, 6 women). Mean age in the
heparin group was 69.0 years, while in the citrate group it was 66.3 years
(p=0.329). Hepcidin values (in ng/ml) did not differ significantly between
groups at S1 (citrate median 9.45 (4.25-19.72) heparin median 8.22 (4.79-
22.50) p=0.78) and at S2: citrate median 16.75 (8.37- 32.14) heparin
median 23.84 (9.69-29.57) p=0.66. At S3 median hepcidin in citrate group
was 15.80 (8.48-22.86) vs. in the heparin group 24.44 (11.68-29.44)
p=0.061. In both groups hepcidin values increased between S1 and S2
(citrate mean increase 7.65 p=0.001, heparin group mean 11.75, p=0.01) and
remained significantly higher than at S1 after infusion of the CS blood.
However, after CS transfusion hepcidin values fell by a mean of 3.12,
p=0.08 in the citrate group, but increased in the heparin group by a mean
of 0.40, p=0.81. Conclusion(s): In both groups hepcidin levels rose
after CABG, reflecting reactions to hemolysis and inflammation. There was
is a non-significant association between lower hepcidin values after CS
transfusion in the citrate group, compared to heparin. Compared to S2,
hepcidin actually dropped after CS transfusion in the citrate group, while
rising in the heparin group. These findings likely reflectimportant
differences in inflammatory state in CSreservoir, dependent on the choice
of anticoagulant. A recent study highlighted the effect of increased
hepcidin values during CABG on the incidence of AKI post-operatively.
Further studies investigating the value of citrate anticoagulation in CS
are warranted.

<14>
Accession Number
633777672
Title
Administration of intraoperative low dose morphine during cardiac surgery
significantly reduces time to extubation.
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State of the Art 2019. United Kingdom. 21 (2 SUPPL) (pp 52), 2020. Date of
Publication: 2020.
Author
Iddawela S.; Dissanayake P.; Dissanayake G.; Jayaweera N.
Institution
(Iddawela) University of Birmingham, Birmingham, United Kingdom
(Dissanayake, Dissanayake, Jayaweera) Department of Anaesthesiology,
Teaching Hospital Kandy, Kandy, Sri Lanka
Publisher
SAGE Publications Inc.
Abstract
Introduction: Morphine based cardiac anaesthesia has shown superior
recovery compared to alternatives (1, 2). However, its effects on
haemodynamic instability and respiratory depression are well documented,
particularly in higher doses (3). There is no research on intraoperative
dosing of morphine and effect on extubation, pain and ICU stay.
 Objective(s): To determine associations between dose of IV morphine
and time to extubation, pain score at extubation and ICU stay after
cardiac surgery. Method(s): Patients undergoing cardiac surgery at a
major tertiary care hospital in Kandy, Sri Lanka between 2015 and 2018
were prospectively recruited into a randomised study and allocated into
high dose (0.6 mg/kg) and low dose (0.2 mg/kg) groups. Allocation was
blinded. Demographics such as age, sex, height and weight were collected.
Intraoperative variables including cross clamp time, cardiopulmonary
bypass time and continuous monitoring of heart rate and blood pressure
were recorded. Postoperative variables collected included time to
extubation, pain score at extubation and ICU stay. Early extubation was
defined as a duration of less than 6 hours, as per Society of Thoracic
Surgeon guidelines (4). Pain at extubation was determined using a visual
analogue scale. Intergroup differences were assessed using the independent
samples T-test for continuous variables and Chi2 for categorical
variables. Multivariate binary logistic regression was used to determine
the association between dose of morphine and an early extubation.
 Result(s): One hundred and ninety patients were recruited, 95 into
the high dose arm and 95 into the low dose arm. Patients in the high dose
group were more likely to be older (57 years compared to 53 years,
p=0.012), with no other significant intergroup differences. Time to
extubation was significantly shorter in the low dose group (431 minutes
compared to 511 minutes, p=0.001). Multivariate regression demonstrated
dose of morphine was an independent predictor of early extubation (OR
2.139, 95% CI 1.059 - 4.320, p=0.03). Median pain score at extubation did
not differ significantly between the groups (p=0.731), nor did ICU stay
(p=0.549). Conclusion(s): Administration of low dose IV morphine
during cardiac surgery significantly reduces time to extubation,
potentially reducing ventilator-induced complications, costs and improve
clinical course in intensive care.

<15>
Accession Number
633777624
Title
Relocation of the Royal Papworth Hospital: Planning and reflections of the
road transfer of critical care patients.
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State of the Art 2019. United Kingdom. 21 (2 SUPPL) (pp 46), 2020. Date of
Publication: 2020.
Author
Herlekar R.; Jones M.; Dear B.; Fowles J.-A.; Vuylsteke A.
Institution
(Herlekar) School of Clinical Medicine, University of Cambridge,
Cambridge, United Kingdom
(Jones) Judge Business School, Cambridge, United Kingdom
(Dear, Fowles, Vuylsteke) Department of Anaesthesia and Intensive Care,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background: Royal Papworth Hospital completed its move from Papworth
Everard to the Cambridge Biomedical Campus on 7th May 2019. The move was
staggered across departments, with the critical care unit relocating ten
patients from bays to a single-room design in early May. This case series
examined two areas of the road transfer of the ten patients: a. Logistical
Operations b. Patient Safety Data was sourced from observational findings,
staff discussions and medical records. Case Presentation: Logistical
Operations: A two-day transfer plan was made for the weekend of 4-5th May.
However, two patients supported on ventricular-assist devices (VADs)
awaiting heart transplant were transferred mid-week to ensure their
availability for transplant at the new site. The transfer team consisted
of a consultant intensivist, critical care transfer nurse, driver and
additionally, a perfusionist for those patients on extracorporeal membrane
oxygenation and VADs. Measures were taken to enable continuity of care in
handover, an issue often cited in transfers (1): i. Bedside nurses
remained with their patients. ii. The electronic medical record system was
mirrored real-time at both sites. To reduce the overall transfer time, two
teams were used with staggered departures for the remaining eight patients
(Fig. 1). Departures and arrivals were coordinated by a lead nurse on both
sites. When transfers ran ahead of schedule, it was determined all
patients were to be moved on the first day, with each team successfully
carrying out an additional run. The mean transfer time for the eight
patients was 26.1 min+/-9.5 min for the 15.5-mile journey. Patient safety:
In order to systematically review patient status, a standardized form and
pre-transfer checklist were completed: an effective and recognised safety
measure (1). A VAD console was discovered to be vibrating abnormally in
certain positions prior to the transfer of one patient. For safety, this
was promptly replaced resulting in a short ten-minute delay in departure.
Equipment issues are the most common source of incidents in critical care
transfers (2). Moreover, transport arrangements should avoid disrupting
the intensive care plan of a patient (3). Courtesy of this, a patient was
weaned from mechanical ventilation as part of their ongoing management.
The patient required some additional time to be stabilised and
subsequently their transfer slot was adjusted to accommodate this. CAM-ICU
scores are used to diagnose delirium in critically ill patients and have
shown excellent reliability (4). It was initially thought a patient had
become delirious on arrival at the new site, though on review, this
patient and indeed no other patients had significant changes in CAM-ICU
from baseline. Conclusion(s): The success of the operation can be
attributed to effective planning with room for flexibility, allowing all
transfers to be completed on the first day, whilst not compromising
routine care. The use of a dedicated team was in line with best practice
(3). A limitation of this case series is that long-term endpoints such as
length of stay and mortality are difficult to evaluate since the transfer
represented a limited part of care.

<16>
Accession Number
633780961
Title
A mendelian randomization analysis of protein biomarkers and CVD in
persons with HIV.
Source
Topics in Antiviral Medicine. Conference: Conference on Retroviruses and
Opportunistic Infections, CROI 2020. United States. 28 (1) (pp 26-27),
2020. Date of Publication: 2020.
Author
Reilly C.; Pankow J.; Baker J.V.; Borges A.H.; Polizzotto M.; Sharma S.;
Safo S.
Institution
(Reilly, Pankow, Sharma, Safo) University of Minnesota, Minneapolis, MN,
United States
(Baker) Hennepin County Medical Center, Minneapolis, MN, United States
(Borges) Rigshospitalet, Copenhagen, Denmark
(Polizzotto) Kirby Institute, Sydney, NSW, Australia
Publisher
International Antiviral Society
Abstract
Background: Treated HIV+ persons have excess risk for CVD yet the
mechanisms explaining this remain poorly understood. Here we used a
Mendelian randomization (MR) approach to assess causality of circulating
proteins on CVD risk among participants in INSIGHT trials. Method(s):
We identified participants in 4 clinical trials conducted by INSIGHT
(FIRST, ESPRIT, SMART and START) who experienced a clinical event
(composite outcome of AIDS, serious non-AIDS including CVD, and death) and
individually matched them (1:2) with study-specific controls who did not.
Baseline plasma samples were used to measure protein levels using 5 panels
made by OLINK (panels: CVD2, CVD3, immune response, cardiometabolic and
inflammation). Genome-wide genotypic data was available for all. Proteins
that passed quality control were screened for an association with the CVD
outcome (MI, coronary revascularization, stroke, CVD death) while
controlling for matching, demographics, hypertension, diabetes and study
specific treatment group effects using a 5% significance level. Proteins
associated with CVD outcomes were then tested for an association with
genetic variants within 5Kb of the corresponding protein-coding gene while
controlling for matching, demographics and study. Significant SNPs
(family-wise p<5% for each protein) were used to construct haplotypes. The
number of copies of the most common haplotype was used as an instrumental
variable in a linear MR analysis (with a 5% level test). If only a single
significant SNP was detected, that SNP was used as an instrument. It can
be demonstrated that this protein screening approach controls the
family-wise error rate at 5% across all MR tests. Result(s): This
analysis included 1493 participants (500 cases; 131 with CVD) with mean
follow-up of 6 years. Of the 459 distinct proteins represented at least
once on the panels, 389 passed quality control measures. Of these
proteins, 89 were associated with CVD. Of these 89, 38 were associated
with at least 1 SNP in the corresponding gene. MR analysis detected IL6RA,
AXL, CHI3L1, SCGB3A2, GAS6 and IL1RL2 as potential causal factors that
impact CVD outcomes (replicating a previous finding for IL6RA among HIV-
people). Table 1 summarizes these associations of proteins/SNPs with CVD
risk. Conclusion(s): Application of MR methods demonstrated potential
causal effects of 6 proteins on CVD outcomes among a global population.
These proteins warrant further study as interventional targets. (Figure
Presented).

<17>
Accession Number
633787441
Title
SEXUAL DISORDERS AFTER HEART TRANSPLANT.
Source
Wiadomosci lekarskie (Warsaw, Poland : 1960). 73 (10) (pp 2277-2281),
2020. Date of Publication: 2020.
Author
Fuczylo K.; Piegza M.; Pudlo R.
Institution
(Fuczylo) STUDENTS SCIENTIFIC ASSOCIATION, DEPARTMENT OF PSYCHIATRY,
FACULTY OF MEDICAL SCIENCES IN ZABRZE, MEDICAL UNIVERSITY OF SILESIA,
TARNOWSKIE GORY, Poland
(Piegza, Pudlo) DEPARTMENT OF PSYCHIATRY, FACULTY OF MEDICAL SCIENCES IN
ZABRZE, MEDICAL UNIVERSITY OF SILESIA, TARNOWSKIE GORY, Poland
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim: To systematize and bring the reader closer to
knowledge about the occurrence of sexual disorders in people after heart
transplantation based on available bibliography. PATIENTS AND
METHODS: Material(s) and Method(s): A review of the literature on
this topic from the last 30 years made with using the PubMed database,
using a total of 17 articles. CONCLUSION(S): Conclusion(s): The
incidence of sexual dysfunction (SD) is higher in heart recipients than in
the general population and erectile dysfunction is the most common. When
the symptoms of dysfunction occur before the transplant - they do not
improve, rather they get worse, which reduces the improvement in the
quality of life of these patients compared to patients without sexual
dysfunction. Improvement in quality of life is observed in patients with
SD after heart transplantation, but not as pronounced as in subjects
without sexual dysfunction. Some patients notice an increase in libido,
with the genital response being insufficient or completely disappearing,
which results in a decrease in the quality of relationships between
partners and a deterioration in the quality of life. The cause of SD in
heart recipients is unclear, but it is associated with the type of
immunosuppression used, the level of sexual activity and the state of
health of patients prior to transplantation. Nowadays patients after
ortotrophic heart transplant live longer and their quality of life
improves, but not in sexual terms. The articles concerned almost
exclusively men, that is why the topic requires exploration in subsequent
research.

<18>
Accession Number
2010489643
Title
Stable ischemic heart disease: Re-appraisal of coronary revascularization
criteria in the light of contemporary evidence.
Source
Cardiovascular Diagnosis and Therapy. 10 (6) (pp 1992-2004), 2020. Date of
Publication: December 2020.
Author
Orsini E.; Nistri S.; Zito G.B.
Institution
(Orsini) Cardiothoracic and Vascular Department, Azienda Ospedaliera
Universitaria Pisana, Pisa, Italy
(Nistri) Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina,
Italy
(Zito) Cardiology Service, ASL Napoli 3 Sud, Pompei, Italy
Publisher
AME Publishing Company
Abstract
The term "stable ischemic heart disease" includes a variety of clinical
and pathophysiological situations resulting in different presentation
modalities, often with complex referral patterns, and with multiple
potential therapeutical options. Multifactorial pathogenesis and multiform
expressivity are poorly captured by the traditional vision of ischemic
heart disease (IHD) as the clogged pipes disease. The availability of
different technologies for studying patients with symptoms suggestive of
IHD, has shed a new light on the pathophysiology of the disease, but has
also allowed appropriate follow-up of patients allocated to different
therapeutical options. Though coronary revascularization has been one
primary treatment option for obstructive coronary artery disease (CAD),
the evidence for its efficacy in patients without acute presentation is
far from optimal. A number of studies and meta-analyses strongly support
the need for a personalized and optimized medical approach (including
functional assessment and therapy) before the tailored option of
revascularization in selected patients, in order to optimize its effects
on symptoms and outcome. Most recent data have expanded the need for a
more personalised approach to this complex situation, which should be
patient-centered and not focused on technologies. In this review, we
discuss the major pathophysiological factors and the most recent clinical
data and guidelines suggestions, needed for a critical re-appraisal of the
clinical decision-making to perform revascularization in patients with
stable IHD. Moreover we aimed at suggesting the potential role for future
studies to fill the existing knowledge gaps but also to counteract a
reductive, hydraulic view of chronic IHD, which seems to be still alive
and kicking, both in clinical and research communities, despite multiple
evidences and recommendations. Copyright © Cardiovascular
Diagnosis and Therapy. All rights reserved.

<19>
Accession Number
2005675663
Title
Preoperative carbohydrate loading on outcomes after cardiac surgery: A
flawed meta-analysis. comment on: "The effect of preoperative carbohydrate
loading on clinical and biochemical outcomes after cardiac surgery: A
systematic review and meta-analysis of randomized trials". Nutrients 2020,
12, 3105.
Source
Nutrients. 12 (12) (pp 1-3), 2020. Article Number: 3904. Date of
Publication: December 2020.
Author
Lobo D.N.; Joshi G.P.
Institution
(Lobo) Gastrointestinal Surgery, Nottingham Digestive Diseases Centre,
National Institute for Health Research (NIHR) Nottingham Biomedical
Research Centre, Nottingham University Hospitals NHS Trust and University
of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
(Lobo) MRC Versus Arthritis Centre for Musculoskeletal Ageing Research,
School of Life Sciences, University of Nottingham, Queen's Medical Centre,
Nottingham NG7 2UH, United Kingdom
(Joshi) Department of Anesthesiology and Pain Management, University of
Texas Southwestern Medical Center, Dallas, TX 75390-9068, United States
Publisher
MDPI AG

<20>
Accession Number
2005675662
Title
Reply to: "preoperative carbohydrate loading on outcomes after cardiac
surgery: A flawed meta-analysis. comment on: The effect of preoperative
carbohydrate loading on clinical and biochemical outcomes after cardiac
surgery: A systematic review and meta-analysis of randomized trials.
nutrients 2020, 12, 3904".
Source
Nutrients. 12 (12) (pp 1-3), 2020. Article Number: 3905. Date of
Publication: December 2020.
Author
Kotfis K.; Jamiol-Milc D.; Skonieczna-zydecka K.; Folwarski M.; Stachowska
E.
Institution
(Kotfis) Department of Anesthesiology, Intensive Therapy and Acute
Intoxications, Pomeranian Medical University, Szczecin 70-111, Poland
(Jamiol-Milc, Skonieczna-zydecka, Stachowska) Department of Human
Nutrition and Metabolomics, Pomeranian Medical University in Szczecin,
Szczecin 71-460, Poland
(Folwarski) Department of Clinical Nutrition and Dietetics, Medical
University of Gdansk, Gdansk 80-210, Poland
(Folwarski) Home Enteral and Parenteral Nutrition Unit, General Surgery,
Nicolaus Copernicus Hospital, Gdansk 80-210, Poland
Publisher
MDPI AG

<21>
Accession Number
633786579
Title
Acute and chronic kidney disease following congenital heart surgery: A
review.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 10 Dec 2020.
Author
Khuong J.N.; Wilson T.G.; Iyengar A.J.; d'Udekem Y.
Institution
(Khuong, Wilson, Iyengar) Heart Research Group, Murdoch Children's
Research Institute, Melbourne, Australia; Department of Paediatrics,
Faculty of Medicine, The University of Melbourne, Melbourne, Australia
(d'Udekem) Heart Research Group, Murdoch Children's Research Institute,
Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, The
University of Melbourne, Melbourne, Australia; Department of Cardiac
Surgery, The Royal Children's Hospital, Melbourne, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is an increasing prevalence of chronic kidney disease in
the population of adults currently living with congenital heart disease. A
significant proportion of children who undergo congenital heart surgery
experience post-operative acute kidney injury. Whether there is an
association between acute kidney injury following cardiac surgery in
childhood and development of chronic kidney disease is unclear.
 METHOD(S): Three electronic databases were searched to capture
relevant studies exploring the relationship between acute kidney injury
following congenital heart surgery in children and progression to chronic
kidney disease. RESULT(S): A literature search identified a total of
212 research articles, of which seven were selected for in-depth review.
 CONCLUSION(S): There is a likely association between acute kidney
injury in children undergoing congenital heart surgery and progression to
chronic kidney disease. Research should be developed to mitigate factors
contributing to postoperative acute kidney injury in neonates, infants and
children undergoing cardiac surgery. Better targeted follow-up protocols
to monitor renal function in children undergoing cardiac surgery should be
implemented. A universal definition for acute kidney injury and chronic
kidney disease is needed to improve detection and research in this
field. Copyright © 2020. Published by Elsevier Inc.

<22>
Accession Number
633786498
Title
Impact of Corticosteroids on Cardiopulmonary Bypass Induced Inflammation
in Children:A Meta-Analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 09 Dec 2020.
Author
Bronicki R.A.; Flores S.; Loomba R.S.; Checchia P.A.; Pollack U.;
Villarreal E.G.; Nickerson P.; Graham E.M.
Institution
(Bronicki, Flores, Checchia, Nickerson) Department of Pediatrics, Baylor
College of Medicine, Section of Critical Care Medicine and Cardiology,
Texas Children's Hospital, TX, Houston, United States
(Loomba) Department of Pediatrics, Chicago Medical School, Section of
Cardiology, Advocate Children's Hospital, Oak Lawn, United States
(Pollack) Depatment of Pediatrics, Hebrew University - Hadassah Medical
School, Hebrew University of Jerusalem, Hadassah Hebrew University Medical
Center, Jerusalem, Israel
(Villarreal) Department of Pediatrics, Baylor College of Medicine, Section
of Critical Care Medicine and Cardiology, Texas Children's Hospital,
Houston, TX, USA; Tecnologico de Monterrey, Escuela de Medicina y Ciencias
de la Salud, Monterrey, Nuevo Leon, Mexico
(Graham) Department of Pediatrics, Section of Cardiology, Medical
University of South Carolina, Charleston, SC, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Corticosteroids (CS) suppress the inflammatory response to
cardiopulmonary bypass in children undergoing cardiac surgery. What is
less clear is the impact of CS on the postoperative course.
 METHOD(S): A systematic review and meta-analysis of prospective
randomized blinded placebo-controlled trials of pediatric patients who
received CS or saline placebo prior to surgery was performed. Ten studies
met inclusion criteria for a total of 768 patients. In a pre-specified
subgroup analysis, studies that either were limited to Society of Thoracic
Surgeons - European Association for Cardio-Thoracic Surgery Congenital
Heart Surgery Mortality Categories 1 and 2 or excluded neonates were
eliminated and a secondary analysis was conducted, which consisted of 7
studies and 555 patients. RESULT(S): CS were associated with a
significant improvement in fluid balance at 24 and 36 hours following
surgery, with a mean difference of -15.2 ml/kg, 95% CI [-25.3 to -5.1
ml/kg], p = <0.01) and -5.7 ml/kg, 95% CI [-9.8 to -1.6 ml/kg], p = <0.01,
respectively. CS had no impact on the incidence of infection or mortality.
With the secondary analysis, CS were associated with a trend toward
significance in shortening the duration of mechanical ventilation (mean
difference -0.7 days, 95% CI [-1.7 to 0.1], p = 0.08). CONCLUSION(S):
CS were found to have a favorable impact on postoperative fluid balance
and may be associated with shortening the duration of mechanical
ventilation. While CS had no impact on mortality, they may be beneficial,
particularly in neonates and those undergoing high complexity
surgery. Copyright © 2020. Published by Elsevier Inc.

<23>
Accession Number
633784819
Title
A six-week inspiratory muscle training and aerobic exercise improves
respiratory muscle strength and exercise capacity in lung cancer patients
after video-assisted thoracoscopic surgery: A randomized controlled trial.
Source
Clinical rehabilitation. (pp 269215520980138), 2020. Date of Publication:
14 Dec 2020.
Author
Liu J.-F.; Kuo N.-Y.; Fang T.-P.; Chen J.-O.; Lu H.-I.; Lin H.-L.
Institution
(Liu, Fang, Lin) Department of Respiratory Care, Chang Gung University of
Science and Technology, Chiayi, Taiwan (Republic of China)
(Liu, Kuo) Department of Respiratory Therapy, Chang Gung Memorial
Hospital-Kaohsiung Medical Center and Chang Gung University College of
Medicine, Kaohsiung, Taiwan (Republic of China)
(Fang, Lin) Department of Respiratory Therapy, Chiai Chang Gung Memorial
Hospital, Chiayi, Taiwan (Republic of China)
(Chen) Department of Nursing, Tajen University, Pingtung, Taiwan (Republic
of China)
(Lu) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University
College of Medicine Kaohsiung, Kaohsiung, Taiwan (Republic of China)
(Lin) Department of Respiratory Therapy, Chang Gung University, Taoyuan,
Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the postoperative outcomes of inspiratory muscle
training and aerobic exercise, along with standard care, on lung cancer
patients undergoing video-assisted thoracoscopic surgery (VATS). DESIGN: A
parallel-group, single-blind randomized clinical trial. SETTING: Thoracic
surgery ward and outpatient clinic in a teaching hospital. SUBJECTS:
Overall 63 patients underwent VATS were randomly assigned to a triaging
(TG, n=32) or control group (CG, n=31). A total of 54 patients (TG, n=26;
CG, n=28) completed the study. INTERVENTION: TG: six-week threshold
inspiratory muscle training and aerobic exercise. CG: standard care. MAIN
MEASURES: Maximum inspiratory pressure (PImax), maximum expiratory
pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were
performed on the day of chest tube removal (baseline), and 2, 6, and
12weeks postoperatively. RESULT(S): The TG showed significant
improvement in PImax at week 6 (71.6+/-34.9 vs. 94.3+/-32.8cmH2O,
P=0.018), PEmax at week 2 (70.9+/-24.3 vs. 90.9+/-28.2cmH2O, P=0.015) and
week 12 (76.1+/-20.2 vs. 98.6+/-35.3cmH2O, P=0.012), the lung expansion
volume at week 2 (1080+/-433 vs 1457+/-624mL, P=0.02) and week 12
(1200+/-387 vs 1885+/-678mL, P<0.001), in addition to the 6MWT at week 2
(332+/-78 vs 412+/-74m, P=0.002), week 6 (360+/-70 vs 419+/-60m, P=0.007)
and week 12 (360+/-58 vs 402+/-65m, P=0.036). CONCLUSION(S): A six
weeks of inspiratory muscle training and aerobic exercise had improved
respiratory muscle strength and aerobic exercise postoperatively in lung
cancer patients after VATS as early as 2weeks.

<24>
Accession Number
2004200020
Title
Methods and clinical outcomes of in situ fenestration for aortic arch
revascularization during thoracic endovascular aortic repair.
Source
Vascular. 28 (4) (pp 333-341), 2020. Date of Publication: 01 Aug 2020.
Author
Li H.L.; Chan Y.C.; Jia H.Y.; Cheng S.W.
Institution
(Li, Chan, Cheng) Division of Vascular Surgery, Department of Surgery, The
University of Hong Kong-Shenzhen Hospital, Shenzhen, China
(Chan, Cheng) Division of Vascular Endovascular Surgery, Department of
Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong
Kong
(Jia) Department of Vascular Surgery, Chinese People's Liberation Army
General Hospital, Beijing, China
Publisher
SAGE Publications Ltd
Abstract
Objective: Despite endovascular advances in fenestrated and branched
devices, thoracic endovascular aortic repair (TEVAR) for arch pathologies
remains challenging. The aim of this study was to provide a contemporary
review on the current evidence for in situ fenestration during TEVAR and
to evaluate its short- and mid-term clinical outcome in the management of
arch pathology. Method(s): A systematic literature review on in situ
fenestration of thoracic aortic stent-graft from January 2003 to September
2018 was performed under the instruction of Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) Statement. Result(s):
Our initial search yielded 169 studies, of which 21 articles were relevant
to the topic and were finally included. One hundred and forty-five in situ
fenestration procedures in 99 patients were reviewed, involving 25
innominate arteries (17%), 33 left common carotid arteries (23%) and 87
left subclavian arteries (60%). Twelve patients (12/99, 12%) had
two-vessel fenestration and three-vessel fenestration was performed in 17
patients (17/99, 17%). Technical success was achieved in 136 arteries
(136/145, 93%). Talent/Valiant with monofilament twill woven polyester
fabric was the most common (50/99, 51%) stent-graft used for fenestration.
Three methods reported for in situ fenestration were needle, laser and
radiofrequency. Needle was the most frequently used device for
fenestration, which was performed in 60 patients (60/99, 61%). Three
patients (3/99, 3%) died with 30 days, none were in situ fenestration
TEVAR procedure-related. Perioperative complications including one (1%)
retrograde type A aortic dissection, two (2%) type II endoleaks, and three
(3%) strokes were reported. The pooled estimate for overall technical
success, perioperative mortality and stroke was 88.3% (95% CI,
78.6%-93.9%), 5.9% (95% CI, 2.5%-13.4%) and 9.5% (95% CI, 4.1%-20.6%),
respectively. Four patients (4/96, 4%) died during follow-up, none were
aortic-related. All the fenestration bridging stents were reportedly
patent, with only 1 (1/96, 1%) asymptomatic left subclavian stent
stenosis. Two patients (2/96, 2%) with type II endoleak from left
subclavian artery required secondary intervention. Conclusion(s): In
situ fenestration appeared to be a feasible and effective method to extend
proximal landing zone during TEVAR. It had an acceptable short-term result
with high technical success and low fenestration related morbidity.
Long-term durability data were lacking, and there was no high level
evidence to recommend the routine use of in situ fenestration TEVAR for
the management of arch pathology. Copyright © The Author(s) 2020.

<25>
Accession Number
2005198278
Title
Clinical outcomes associated with retrograde arterial perfusion in
minimally invasive mitral valve surgery: a systematic review.
Source
Perfusion (United Kingdom). 36 (1) (pp 11-20), 2021. Date of Publication:
January 2021.
Author
Burns D.J.P.; Birla R.; Vohra H.A.
Institution
(Burns) Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland,
OH, United States
(Birla) Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne, United
Kingdom
(Vohra) Cardiac Surgery, University Hospitals Bristol NHS Foundation
Trust, Bristol, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Introduction: Given several reports of an increased neurologic risk with
retrograde arterial perfusion in minimally invasive mitral valve surgery,
we sought to identify and synthesize the best available evidence on the
influence of perfusion strategy on post-operative clinical outcomes in
this population. Method(s): A systematic search of PubMed, EMBASE,
MEDLINE, and Cochrane library databases was performed to identify
publications comparing clinical outcomes associated with antegrade and
retrograde arterial perfusion in minimally invasive mitral valve surgery.
Pre-specified outcomes of interest were neurologic events, mortality, and
renal failure. The search was performed by two independent reviewers, with
data abstraction following. Result(s): Seven observational studies
were included in this review, with a total patient population of 5,385.
Six were retrospective cohort in design, with a single small prospective
cohort study identified. When available, adjusted publication-specific
risk estimates were abstracted and included preferentially over unadjusted
or reviewer-derived risk estimates. Meta-analysis was felt to be heavily
flawed in the context of few small studies identified and was not
performed. In adjusted estimates, there appeared to be an increased risk
of neurologic complications with retrograde arterial perfusion. There was
a null pattern apparent between arterial perfusion strategy and each of
30-day mortality and renal failure. Conclusion(s): Retrograde
arterial perfusion in minimally invasive mitral valve surgery may be
associated with an increased risk of neurologic events, without affecting
the risk of 30-day mortality or renal failure. Although these patterns
were identified, an overall paucity of evidence justifies further
study. Copyright © The Author(s) 2020.

<26>
Accession Number
2005154667
Title
Will high-dose heparin affect blood loss and inflammatory response in
patients undergoing cardiopulmonary bypass?.
Source
Perfusion (United Kingdom). 36 (1) (pp 63-69), 2021. Date of Publication:
January 2021.
Author
Braatz E.; Sesartic V.; Liska J.
Institution
(Braatz, Sesartic) Department of Perioperative Medicine Intensive Care,
Karolinska University Hospital, Stockholm, Sweden
(Liska) Department of Cardiothoracic Surgery, Karolinska University
Hospital, Stockholm, Sweden
Publisher
SAGE Publications Ltd
Abstract
Introduction: We performed a randomized study to investigate if a high
versus a standard dose of heparin dose during cardiopulmonary bypass could
affect intra- and post-operative bleeding and reduce the inflammatory
response. Method(s): A total of 30 patients undergoing elective
coronary artery bypass grafting were randomized into high or standard dose
of heparin during cardiopulmonary bypass. Blood loss was documented peri-
and post-operatively, and interleukin-6, tumor necrosis factor-alpha, and
C3 were measured in conjunction with cardiopulmonary bypass.
 Result(s): Data from 29 patients were analyzed after exclusion of one
patient. The mean initial bolus and total heparin doses were 43,000 +/-
5,800 IU versus 35,000 +/- 4,100 IU, (p < 0.001), and 58,000 +/- 9,500 IU
versus 45,000 +/- 7,900 IU, (p < 0.001) in the intervention and the
control group, respectively. The median intra-operative bleeding was 150
mL (interquartile range 100-325) in the control versus 225 mL (IQR
200-350) in the intervention group, p = 0.15. The median chest tube blood
loss 12 hour post-operatively was 300 mL (interquartile range 250-385) in
the control versus 450 mL (IQR 315-505) in the intervention group, p =
0.029. There was no significant difference between the control group and
the intervention group during cardiopulmonary bypass for the measured
inflammatory markers interleukin-6 (p = 0.98), tumor necrosis factor-alpha
(p = 0.72), or C3 (p = 0.13). Conclusion(s): This small study showed
a small increase of post-operative bleeding associated with higher heparin
dosage in conjunction with cardiopulmonary bypass but did not demonstrate
an effect of heparin on the inflammatory response to cardiopulmonary
bypass. Copyright © The Author(s) 2020.

<27>
Accession Number
2004988775
Title
Euthyroid sick syndrome in paediatric and adult patients requiring
extracorporeal circulatory support and the role of thyroid hormone
supplementation: a review.
Source
Perfusion (United Kingdom). 36 (1) (pp 21-33), 2021. Date of Publication:
January 2021.
Author
Nistal-Nuno B.
Institution
(Nistal-Nuno) Department of Anesthesiology, Complejo Hospitalario
Universitario de Santiago de Compostela, Santiago de Compostela, Spain
Publisher
SAGE Publications Ltd
Abstract
Non-thyroid disorders may modify thyroid hormone metabolism, resulting in
an 'euthyroid sick syndrome'. Studies determining the association of
cardiopulmonary bypass to thyroid function showed changes in line with
this euthyroid sick syndrome. In some cases, cardiovascular dysfunction
after cardiac surgery with cardiopulmonary bypass is comparable to that
noticed in hypothyroidism associated with low cardiac output and elevated
systemic vascular resistance. Numerous lines of research have proposed
that triiodothyronine can behave acutely as a positive inotropic and
vasodilator agent. The aim of this review is to present an update on the
current literature about in what clinical situations the use of thyroid
supplementation during the perioperative period of extracorporeal
circulation in the adult and paediatric populations may impact outcome to
any appreciable degree. The contribution of thyroid function in patients
undergoing a ventricular assist device implantation is additionally
reviewed and future study directions are proposed. This is a narrative
review, where the search strategy consisted on retrieving the articles
through an extensive literature search performed using electronic
databases from January 1978 up to September 2019. All controlled trials
randomly allocating to perioperative thyroid hormone administration in
children and adults undergoing extracorporeal circulation for cardiac
surgery were considered. Thyroid hormone supplementation may be
recommended particularly in selected paediatric sub-populations. There is
currently no firm evidence regarding the benefits of routine use of
thyroid hormone administration in cardiac adult patients. Further studies
are required to assess the beneficial effect of thyroid hormone on
patients with end-stage heart failure supported by ventricular assist
devices. Copyright © The Author(s) 2020.

<28>
Accession Number
633765724
Title
Effect of vitamin D supplementation on the postoperative convalescence of
pediatric cardiac surgical patients.
Source
Indian Journal of Critical Care Medicine. Conference: 26th Annual
Conference of Indian Society of Critical Care Medicine, ISCCM 2020. India.
24 (SUPPL 2) (pp S45), 2020. Date of Publication: February 2020.
Author
Bipin C.
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Vitamin D deficiency is highly prevalent in pediatric
population and also in children with congenital heart disease. The serum
level of vitamin D further decreases after congenital cardiac surgery with
cardiopulmonary bypass. Available data from many studies suggest that most
congenital heart disease (CHD) patients are vitamin D deficient following
cardiac surgery and that the immediate postoperative serum levels are
associated with the subsequent clinical course. Objective(s): The
study was planned to assess the role of vitamin D in improving
postoperative convalescence of the pediatric cardiac patients undergoing
open heart surgery with cardio pulmonary bypass (CPB) and also
simultaneously to study the vitamin D status preoperatively, after CPB and
postoperatively in these cyanotic congenital heart disease (CCHD)
children. Material(s) and Method(s): A total of 60 children from 6
months to 18 years of age with CCHD, tetralogy of fallot (TOF) who
underwent intra cardiac repair (ICR) with cardiopulmonary bypass (CPB)
were enrolled in this randomized controlled trial (RCT) study. Demographic
data, preoperative, intraoperative and postoperative variables were
compared between the study and the control groups. Result(s): All 60
study participants had vitamin D deficiency. Prevalence of severe vitamin
D insufficiency was 93.1%. When compared with the control group, study
group were more likely to have a higher serum vitamin D in the immediate
preoperative period (p = 0.0010), immediate postoperative period following
CPB (p = 0.0129), and 24-hour postoperative period (p = 0.0038). There was
statistically significant change in the serum vitamin D levels between the
two groups during CPB (p = 0.0067). Conclusion(s): Serum level of 25
(OH) vitamin D was severely low in CCHD children with TOF and also the
serum vitamin D level further decrease after ICR with cardiopulmonary
bypass in the study group. Preoperative vitamin D supplementation will
help in treating the deficiency.

<29>
Accession Number
633765690
Title
Effect of ultrasound guided ventilatory protective strategy on
intraoperative arterial oxygenation during thoracic surgery.
Source
Indian Journal of Critical Care Medicine. Conference: 26th Annual
Conference of Indian Society of Critical Care Medicine, ISCCM 2020. India.
24 (SUPPL 2) (pp S41-S42), 2020. Date of Publication: February 2020.
Author
Ghosh D.
Publisher
Wolters Kluwer Medknow Publications
Abstract
Objectives: One lung ventilation (OLV) is necessary to for surgical access
and to protect healthy lung during thoracic surgeries. A common
complication during OLV is impaired gas exchange causing tissue hypoxia.
Pressure controlled ventilation (PCV) with adjunctive use of pressure
support (PS) and positive end expiratory pressure (PEEP) is advocated to
maintain balance between hypoxemia and lung injury. Concurrent use of lung
ultrasonography to individualize PS may help to prevent iatrogenic lung
injury while further improving oxygenation. Lung ultrasound to assess
aeration correlate well with arterial blood gas (ABG) values obtained
simultaneously. We aimed to determine utility of ultrasound guided
ventilatory strategy on intraoperative oxygenation, other ABG parameters
during thoracic surgery. Study design, materials and methods: In
prospective, outcome-assessor blinded, randomized, comparative design, 40
patients (group I: 20, group II: 20) were posted for thoracic surgery
requiring minimum 1 hour of OLV. Left double lumen tube was used. In both
groups, patients were ventilated using predetermined strategies (A:
recommended parameters; B: ultrasound determined parameters) using 100%
O2. ABGs were analyzed at specific times (T1: 30 minutes after two lung
ventilation, T2: 30 minutes after OLV, T3: end of surgery). Primary
outcome was to compare PaO2 among groups at these timepoints. Secondary
outcomes were to assess other ABG parameters, airway pressures. Data was
analyzed using Chi-square test. Statistical significance was accepted at p
< 0.05. Result(s): Higher PaO2 was noted in group II vs in group I at
all timepoints and was statistically significant {T1: A-353.26 +/- 38.15
mm Hg, B-374.53 +/- 25.94 mm Hg (p < 0.05); T2: A-272.61 +/- 37.87 mm Hg,
B-321.68 +/- 35.22 mm Hg (p < 0.05); T3: A-295.26 +/- 40.08 mm Hg,
B-356.97 +/- 24.68 mm Hg (p < 0.05)}. Other parameters assessed also
showed better preservation of physiological status in group II.
 Conclusion(s): Gradual increase of PS in PCV targeted by
visualization of lung aeration using ultrasonography achieved better
intraoperative oxygenation when compared to standard PCV during OLV.

<30>
Accession Number
633765425
Title
The innovative use of a haemostatic gel to reduce the incidence of pelvic
collection after rectal cancer surgery: Can we enhance the enhanced
recovery program?.
Source
Techniques in Coloproctology. Conference: 13th European Colorectal
Congress. Switzerland. 24 (pp 655-656), 2020. Date of Publication: 2020.
Author
Stefan S.; Siddiqi N.; Naqvi S.; Rawlinson E.; Khan J.
Institution
(Stefan, Siddiqi, Naqvi, Rawlinson) Portsmouth Hospitals, Nhs Trust
(Khan) Anglia Ruskin University, Cambridge, United Kingdom
Publisher
Springer Science and Business Media, LLC
Abstract
Background/Aim Precision rectal cancer surgery leads to minimal blood loss
intraoperatively, however drains are still used in the postoperative
period and it's not very infrequent to see a descent output from these
drains on postoperative day 1-3. Pelvic resections have the potential to
leave behind a large raw surface which can cause capillary bleeding and
oozing postoperatively. These fluids are either absorbed by the
peritoneum, or drained via a surgical drain, or can form a postoperative
collection. The last 2 possibilities can lead to a delay in discharging
the patient home due to increased postoperative drainage output or
formation of pelvic sepsis-hence a reduced rate of compliance with the
enhanced recovery program (ERP) in colorectal surgery. Methods Previous
studies in resectional endoscopy and cardiothoracic surgery have revealed
a significant reduction of the post-procedural complications with use of a
haemostatic gel that reduces the oozing from capillaries and prevents
secondary haemorrhage. The product used in this study is PuraStat gel, 3-D
Matrix Europe SAS. This prospective cohort study has compared the results
of 10 consecutive cases of pelvic operations with use of PuraStat gel and
10 consecutive cases without PuraStat gel. The groups were compared for
postoperative drain output and recovery, complications and length of
hospital stay (LOS). Statistical analysis used SPSS paired samples t-test.
Results 20 patients with laparoscopic or robotic bowel resection
procedures were enrolled into this study. The mean age was 62 and 64 years
in group 1 and 2 respectively. Median BMI was 26.9 and 27.4. Median drain
outputs on day 1, day 2 and day 3 were 70:103 ml, 37:59 ml, 14:48 ml. The
median LOS was 5 days in both groups. Postoperative septic complications
were seen in 1:4 cases. Postoperative ileus was noted in 2:5 patients. R0
resection was achieved in all patients. The results for lymph node count
were similar in both groups. Conclusion PuraStat gel is a haemostatic
agent that has the capability to significantly reduce the pelvic oozing
and bleeding after rectal cancer surgery. A controlled randomised trial to
assess further the effects of this intervention is required.

<31>
Accession Number
633765041
Title
Meta-analysis to assess in-hospital and remote outcomes after VA-ECMO
implantation for refractory cardiogenic shock in heart transplantation
centres as compared to nontransplant units.
Source
Perfusion. Conference: EuroELSO Congress 2020. United Kingdom. 35 (1
SUPPL) (pp 109), 2020. Date of Publication: May 2020.
Author
Kowalewski M.; Zielinski K.; Raffa G.; Gozdek M.; Pilato M.; Alanazi M.;
Gilbers M.; Heuts S.; Natour E.; Bidar E.; Schreurs R.; Delnoij T.;
Driessen R.; Sels J.-W.; Van De Poll M.; Roakaerts P.; Meani P.; Maessen
J.; Suwalski P.; Lorusso R.
Institution
(Kowalewski, Zielinski, Suwalski) Cardiac Surgery, CSK MSWiA CMKP, Warsaw,
Poland
(Kowalewski, Alanazi, Gilbers, Heuts, Natour, Bidar, Schreurs, Delnoij,
Driessen, Sels, Van De Poll, Roakaerts, Meani, Maessen, Lorusso)
Maastricht University Medical Center (MUMC), Maastricht, Netherlands
(Raffa, Pilato) ISMETT, Palermo, Italy
(Gozdek) CM UMK, Torun, Poland
Publisher
SAGE Publications Inc.
Abstract
Objective: Cardiogenic shock (CS) that is refractory to inotropic support
remains a major concern in cardiology, heart surgery and intensive care.
It is almost universally fatal unless treated with mechanical support.
Because reported mortality rates on Veno-Arterial (V-A) Extracorporeal
Membrane Oxygenation (ECMO) vary from center to center, aim of the current
report is to assess if the outcomes differ between heart transplantation-(
HTX) performing centres and non-HTX units. Method(s): A systematic
search was performed according to PRISMA statement using PubMed/Medline
databases. Relevant articles were scrutinized and included in the
meta-analysis only if reporting in-hospital/30-day mortality and heart
transplantation status of the centre. Differences were then assessed by
means of subgroup meta-analysis. Result(s): 174 studies enrolling N =
13,308 ECMO patients were included. Of those, 20 series were performed in
non-HTx centres (1,016 pts. 7.8%). Overall, 5,353 patients survived to
hospital discharge which translated to estimated overall in-hospital
mortality of 57.2% (54.9-59.4%). Mortality rates were significantly higher
in non-HTx/VAD (65.5% [59.8-70.8%]) as compared to HTx/VAD centres (55.8%
[53.3-58.2%]); P< 0.001. Overall estimated late survival was 61.8%
(55.7-67.9%) without significant differences between non HTx/VAD as
compared to HTx/VAD centres: 66.5% (30.3-1.02%) vs 61.7% (55.5-67.8%)
respectively (p=0.797). No statistical differences were seen between HTx
and non-HTx with respect to ECMO duration, limb complications,
reoperations for bleeding, kidney injury and sepsis. Yet, weaning rates
were significantly higher across HTx vs non-HTx centres 58.7% (56.2-
61.1%) vs 48.9% (42.0-55.9%): p=0.010. Conclusion(s): There was an
apparent difference in survival after ECMO implantation for refractory
cardiogenic shock according to centre's transplantation status. (Figure
Presented).

<32>
Accession Number
633764986
Title
A systematic review: Does thiamine supplementation in pediatric cardiac
surgical patients impact on the need for ECMO?.
Source
Perfusion. Conference: EuroELSO Congress 2020. United Kingdom. 35 (1
SUPPL) (pp 234), 2020. Date of Publication: May 2020.
Author
Donnelly P.; Wylie G.; Begg C.; Davidson M.
Institution
(Donnelly, Wylie, Begg, Davidson) PICU, Royal Hospital for Children,
Glasgow, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Objective: Thiamine supplementation is an area of interest after a study
reported it conferred a 30% reduction in mortality in septic adults. The
question raised in our institution: Should we use thiamine in our
hypotensive paediatric post-operative cardiac patients and would this have
an impact on the need for ECMO? Methods: A literature review was performed
using EMBASE and MEDLINE databases. This search was limited to 'English
language' and 'Journal articles'. Result(s): The initial search
identified 359 articles. Abstracts were reviewed and duplicates (n=14)
removed. The remaining 53 articles were reviewed to identify clinical
trials. 7 articles remained. An RCT by Donninio et al (2016) evaluated
septic adults and found no difference in median 24hour lactate or
mortality. A post-hoc analysis of this paper (2017) reported those
receiving thiamine were less likely to need RRT. Marik et al (2017)
evaluated septic adults reporting that the combination of thiamine,
vitamin C and corticosteroids reduced end organ dysfunction and mortality.
Holmberg et al (2018) performed a retrospective cohort study of patients
with alcohol-use disorders. Thiamine supplementation reduced mortality. A
double-blind RCT by Balakrishnan (2018) evaluated septic adults after
cardiac surgery. A combination of thiamine, vitamin C and hydrocortisone
reduced vasopressor requirement. A retrospective cohort study by Woolum et
al (2018) evaluated the effect of thiamine on lactate clearance and
mortality in septic adults. Those receiving thiamine displayed improved
lactate clearance and survival. A retrospective cohort study by Shin et al
(2019) reported that early vitamin C and thiamine administration in septic
adults did not improve survival. No papers were identified that evaluate
thiamine in the paediatric/paediatric cardiac surgical/ or paediatric ECMO
populations. Conclusion(s): There is currently no evidence to support
the use of thiamine in paediatric post-operative cardiac patients.

<33>
Accession Number
633764922
Title
VA-ECMO support in a heart transplant center: Bridge to transplant and
bridge to recovery from severe primary graft dysfunction.
Source
Perfusion. Conference: EuroELSO Congress 2020. United Kingdom. 35 (1
SUPPL) (pp 128), 2020. Date of Publication: May 2020.
Author
Steffen S.; Gaiotto F.A.; Gaspar S.; Abaurre V.; Honorato R.; Lourenco
Filho D.; Marcondes-Braga F.; Bacal F.; Galas F.; Carvalho C.; Jatene F.
Institution
(Steffen, Gaiotto, Gaspar, Abaurre, Honorato, Lourenco Filho,
Marcondes-Braga, Bacal) Heart Transplant Unit, Heart Institute -
University of Sao Paulo, Sao Paulo, Brazil
(Galas) Intensive Care Unit, Heart Institute - University of Sao Paulo,
Sao Paulo, Brazil
(Carvalho) Pneumology, Heart Institute - University of Sao Paulo, Sao
Paulo, Brazil
(Jatene) Cardiovascular Surgery, Heart Institute - University of Sao
Paulo, Sao Paulo, Brazil
Publisher
SAGE Publications Inc.
Abstract
Objective: Heart Transplant is the definitive treatment of end-stage heart
failure. VA ECMO can be used as a bridge to transplant with good results,
and also may be used as a bridge do recovery due to Primary Graft
Dysfunction (PGD). The purpose of this study is to present our
perioperative experience with ECMO in the context of Heart Transplant.
 Method(s): We analyzed retrospectively all adult patients submitted
to heart transplant between January 2017 and March 2019. A total of 105
patients were operated in this period. Medical records were collected from
our electronic database. We screened patients who required VA ECMO as a
bridge to transplant or as a bridge to recovery after heart transplant
with PGD Results: 11 patients required perioperative VA-ECMO support. Of
those, 9 patients before transplant and 2 patients after transplant. The
mean age was 39.6 years within the preoperative group and 48 years within
the postoperative group. The main indication for transplant (45.4%) was
dilated cardiomyopathy. The overall mortality observed was 33% at the
preoperative group and 50% at the postoperative group. The group's
characteristics are listed at table 1. Conclusion(s): VA ECMO is a
safe, viable and not expensive support to bridge patients to heart
transplant who are worsening despite optimal medical therapy. A "hybrid"
configuration (figure 1) offers good support, with less limb and lung
complications, usually observed with peripheral femoral cannulation.VA
ECMO can be used as a bridge to recovery in patients with severe PGD,
showing satisfactory results. (Figure Presented).

<34>
Accession Number
633764914
Title
Extracorporeal membrane oxygenation in patients submitted to cardiac
surgery for mechanical complications of acute myocardial infarction.
Source
Perfusion. Conference: EuroELSO Congress 2020. United Kingdom. 35 (1
SUPPL) (pp 100), 2020. Date of Publication: May 2020.
Author
Massimi G.; Matteucci M.; Fina D.; Jiritano F.; Meani P.; Kowalewski M.;
Aldobayyan I.; Turkistani M.; Beghi C.; Lorusso R.
Institution
(Massimi, Matteucci, Fina, Jiritano, Kowalewski, Aldobayyan, Turkistani,
Lorusso) Cardiothoracic Surgery Department, Maastricht University Medical
Center (MUMC), Maastricht, Netherlands
(Meani) Cardiology Department, Maastricht University Medical Center
(MUMC), Maastricht, Netherlands
(Beghi) Cardiothoracic Surgery Department, Insubria University, Varese,
Italy
Publisher
SAGE Publications Inc.
Abstract
Objective: With the advent of percutaneous coronary intervention, there
has been a significant drop in the incidence of post-infarction mechanical
complications (AMI-MC). However, mortality in patients who developed these
complications remains high. In this setting, venoarterial extracorporeal
membrane oxygenation (ECMO) allowing restoration of hemodynamic stability
before surgery and/or providing cardiopulmonary support postoperatively in
case of persistent or de novo onset of refractory ventricular dysfunction,
may play a significant role. Method(s): A systematic review was
performed addressing all available reports published in the last fifteen
years describing the use of ECMO in patients undergoing cardiac surgery
for AMI-MC. The primary endpoint was in-hospital mortality. Patient's
preoperative clinical state, cardiac surgery procedures, ECMO implant
timing, modality, and outcome were also assessed. After removal of
non-pertinent records, 44 papers, including 114 patients, remained and
were examined. Result(s): The most common AMI-MC was LVFWR (43.9%),
followed by VSD (42.1%). Preoperative ECMO as a temporary bridge to
definitive surgery was applied in 95 patients (83.3%). As far as the
access was concerned, ECMO was mostly established peripherally.
Postoperativly, 73 subjects (64%) required ECMO for cardiopulmonary
support and decompression of the ventricle. Successful weaning from ECMO
was possible in the majority of the cases. In-hospital mortality was about
40% Conclusion(s): In the presence of AMI-MC the use of ECMO,
providing emergency hemodynamic stabilization, can potentially reverse an
otherwise lethal course. Furthermore ECMO, providing postoperative
ventricular unloading, may promote myocardial recovery and improve
surgical outcome.

<35>
Accession Number
633764796
Title
Cardiohelp system use in pediatric patients at centre with interfacility
mobile extracorporeal membrane oxygenation (ECMO) capability.
Source
Perfusion. Conference: EuroELSO Congress 2020. United Kingdom. 35 (1
SUPPL) (pp 276), 2020. Date of Publication: May 2020.
Author
Ignat T.; Hoschtitzky A.; Smith R.; Jackson T.; Desai A.; Frall D.;
Trimlett R.; Ledot S.; Passariello M.; Chan-Dominy A.
Institution
(Ignat, Desai, Frall, Chan-Dominy) Paediatric Intensive Care Unit, Royal
Brompton and Harefield NHS Foundation Trust, London, United Kingdom
(Hoschtitzky) Department of Congenital Heart Surgery, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Hoschtitzky) Department of Aortovascular Surgery, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Smith, Jackson) Department of Perfusion, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Trimlett) Department of Cardiothoracic Surgery, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Trimlett, Ledot, Passariello, Chan-Dominy) Adult Cardiothoracic Critical
Care and Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust,
London, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Objective: We report the use of Maquet's Cardiohelp system in children up
to early teenage years. and integrated utilisation of mobile ECMO
retrieval team (MERT) in the current era of ECMO as rescue therapy.
 Method(s): Electronic database of all paediatric patients under 16
years of age who received ECMO with use of Cardiohelp system between
January 2018 to December 2019 was analysed for demographics, set-up,
complications and outcome. Result(s): Cardiohelp system was used in
six (5F, 1M) of the 36 paediatric patients who received ECMO support.
Median weight was 35.6kg (range 28-53), with 4 preteenagers (8-10years)
and 2 teenagers. Modalities and indications for ECMO therapy were
venoarterial (VA)- ECMO for refractory cardiogenic shock due to acute
myocarditis, peripheral VA-ECMO for intractable tachyarrhythmias in
context of laminopathy-associated dilated cardiomyopathy, VA-ECMO for
difficult-to-control atrial tachyarrhythmias after Ebstein anomaly Cone's
repair and additional bidirectional Glenn, peripheral VA-ECMO for hypoxic
cardiopulmonary arrest as rescue bridge to venovenous (VV)-ECMO for severe
staphylococcal pneumonia, peripheral hybrid ECMO as rescue bridge to
VV-ECMO for influenza with staphylococcal pneumonia and septic shock, and
VV-ECMO for severe staphylococcal pneumonia with pseudomonal co-infection.
There were 2 interhospital transports by our MERT, and 11 intrahospital
transfers for interventions or CT imaging. Median ECMO therapy was 8 days
(range 4-25), with standard 3/8-inch tubing and flow rate range at
56-100ml/kg/min (1.89-5LPM). Two patients received haemofiltration via
ECMO circuit. Anticoagulation was with heparin as per protocol. There were
2 circuit changes in 2 patients at day 3. 30-day survival rate was 100%
(including 1 heart transplant after 8 days). 4 patients were discharged
home and 2 are still in-patient undergoing rehabilitation at 42 and 63
days. There were no circuit-related or transport-related complications
during the 1651 hours of Cardiohelp use. Conclusion(s): Cardiohelp
use is safe in paediatric patients and offers ease for inter- and
intrahospital transfers.

<36>
Accession Number
633771573
Title
Association between urinary dickkopf-3, AKI, and subsequent loss of kidney
function in patients undergoing cardiac surgery: An observational cohort
study.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2019. United States. 30 (pp 81-82), 2019. Date of Publication: 2019.
Author
Schunk S.J.; Zarbock A.; Kellum J.A.; Fliser D.; Speer T.; Zewinger S.
Institution
(Schunk, Speer, Zewinger) Saarland University Hospital, Homburg/Saar,
Germany
(Fliser) Department of Internal Medicine IV, Saarland University,
Homburg/Saar, Germany
(Kellum) University of Pittsburgh, Pittsburgh, PA, United States
(Zarbock) University Hospital Munster, Munster, Germany
Publisher
American Society of Nephrology
Abstract
Background: Cardiac surgery is associated with a high risk of
postoperative acute kidney injury (AKI) and subsequent loss of kidney
function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a
renal tubular stress marker, for preoperative identification of patients
at risk for AKI and subsequent kidney function loss. Method(s): The
study comprised consecutive patients who had elective cardiac surgery at
the Saarland University Medical Centre (Homburg, Germany; derivation
cohort) and those undergoing elective cardiac surgery who were enrolled in
the prospective RenalRIP multicentre trial (validation cohort) and who
were randomly assigned to remote ischaemic preconditioning or a sham
procedure. The association between the ratio of preoperative urinary
concentrations of DKK3 to creatinine (DKK3:creatinine) and postoperative
AKI, and subsequent kidney function loss was assessed. Result(s): In
the 733 patient in the derivation cohort, urinary concentrations of DKK3
to creatinine that were higher than 471 pg DKK3 per milligram of
creatinine were associated with significantly increased risk for AKI (OR
1.65, 95% CI 1.10-2.47, p=0.015), independent of baseline kidney function.
High urinary DKK3:creatinine concentrations were independently associated
with significantly lower kidney function at hospital discharge and after a
median follow-up of 820 days. In the RenalRIP trial, preoperative urinary
DKK3:creatinine concentrations higher than 471 pg/mg were associated with
a significantly higher risk for AKI (OR 1.94, 95% CI 1.08-3.47, p=0.026),
persistent renal dysfunction (OR 6.67, 1.67-26.61, p=0.0072), and dialysis
dependency (OR 13.57, 1.50-122.77, p=0.020) after 90 days compared with
DKK3:creatinine concentrations of 471 pg/mg or less. Urinary
DKK3:creatinine concentrations higher than 471 pg/mg were associated with
significantly higher risk for AKI and persistent renal dysfunction only in
patients having a sham procedure, but not remote ischaemic
preconditioning. Conclusion(s): Preoperative urinary DKK3 is an
independent predictor for postoperative AKI and for subsequent loss of
kidney function. Urinary DKK3 might aid in the identification of patients
in whom preventive treatment strategies are effective.

<37>
Accession Number
633769974
Title
Blood and urine biomarkers and CKD after cardiac surgery.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2019. United States. 30 (pp 91), 2019. Date of Publication: 2019.
Author
Menez S.; Moledina D.G.; Garg A.X.; Philbrook H.T.; McArthur E.; Jia Y.;
Liu C.; Obeid W.; Mansour S.; Koyner J.L.; Shlipak M.; Wilson F.P.; Coca
S.G.; Parikh C.R.
Institution
(Moledina, Mansour, Wilson) Yale School of Medicine, New Haven, CT, United
States
(Jia, Parikh) Johns Hopkins University, Newton, MA, United States
(Menez, Philbrook, Liu) Johns Hopkins University, School of Medicine,
Baltimore, MD, United States
(Koyner) University of Chicago, Chicago, IL, United States
(Shlipak) San Francisco VA Medical Center, San Francisco, CA, United
States
(Coca) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Garg) London Health Sciences Centre, London, ON, Canada
(McArthur) Institute for Clinical Evaluative Sciences, London, ON, Canada
(Obeid) John Hopkins University, Baltimore, MD, United States
Publisher
American Society of Nephrology
Abstract
Background: The use of blood and urine biomarkers of injury, inflammation
and repair in the post-operative period following cardiac surgery may help
identify patients at increased risk for longer-term adverse kidney
outcomes. We investigated the independent associations between candidate
biomarkers and CKD incidence or progression following cardiac surgery.
 Method(s): We prospectively enrolled adult patients undergoing
cardiac surgery (CABG or valve) in 2 academic centers from 2007-2010 as
part of the TRIBE-AKI Study. The cohort was separated into exploration
(Canada n=613) and replication (USA n=310) cohorts due to differences in
outcome ascertainment and lack of data integration. Top biomarkers were
identified from candidate post-operative biomarkers (32 blood, 8 urine) in
the exploration cohort and confirmed in the replication cohort, thereby
reducing model selection bias. Our primary outcome was a composite of CKD
incidence or progression. In those with a pre-operative eGFR>=60, CKD
incidence was defined as a 25% reduction in eGFR and a fall below 60. In
those with a pre-operative eGFR<60, CKD progression was defined as a 50%
reduction in eGFR or a fall below 15. Result(s): 172 (28.1%) patients
in the exploration cohort developed the primary outcome after a median
(IQR) follow-up of 5.61 (4.30-6.84) years. 8 biomarkers were associated
with the primary outcome, of which 3 remained significant after full
adjustment. Each log increase in post-operative levels of bFGF (HR 1.52
[1.19, 1.93]), N-terminal pro-BNP (HR 1.19 [1.01, 1.41]), and TNF-r1 (HR
1.75 [1.18, 2.59]) were independently associated with the primary outcome
(Table 1). Similar estimates were found in the replication cohort, with
pooled estimates showing little heterogeneity (I2=0). Conclusion(s):
Elevated post-operative levels of bFGF, NT pro-BNP, and TNF-r1 were
associated with the CKD outcome. These biomarkers provide additional value
in evaluating CKD incidence and progression after cardiac surgery. (Table
Presented).

<38>
Accession Number
2005672782
Title
Virtual reality on pulmonary function and functional independence after
coronary artery bypass grafting: Clinical trial.
Source
American Journal of Cardiovascular Disease. 10 (4) (pp 499-505), 2020.
Article Number: AJCD0113340. Date of Publication: 2020.
Author
Lima H.J.; Souza R.S.P.; E Santos A.S.M.S.; Borges D.L.; Guimaraes A.R.F.;
Ferreira G.V.D.B.A.; Barros R.M.; Cordeiro A.L.L.
Institution
(Lima, Souza, E Santos, Ferreira, Cordeiro) Faculdade Nobre, Feira de
Santana, Bahia, Brazil
(Borges) Hospital Universitario do Maranhao, Sao Luis, Maranhao, Brazil
(Guimaraes) Instituto Nobre de Cardiologia, Feira de Santana, Bahia,
Brazil
(Barros) Obras Sociais Irma Dulce, Salvador, Bahia, Brazil
(Cordeiro) Escola Bahiana de Medicina e Saude Publica, Salvador, Bahia,
Brazil
Publisher
E-Century Publishing Corporation
Abstract
Introduction: Coronary artery bypass grafing (CABG) is responsible for the
decrease in pulmonary function and functionality. In this case the virtual
reality is an alternative to reduce the impact of the surgical procedure.
 Objective(s): To evaluate the effect of virtual reality on pulmonary
function and functional independence in patients undergoing CABG.
Methodology: This is a clinical trial. In the preoperative period,
pulmonary function was assessed using maximum inspiratory pressure (MIP),
maximum expiratory pressure (MEP), vital capacity (VC), peak expiratory
flow (PEF) and functionality through the measurement of functional
independence (FIM) and time up and go (TUG). On the first postoperative
day, patients were randomized into two groups: the control group (CG),
submitted to con-ventional physiotherapy, and the virtual rehabilitation
group (VRG), increased through virtual reality. On the day of hospital
discharge, patients were reassessed. Result(s): 56 patients were
analyzed, 25 in the CG, with a mean age of 51 +/- 10 years, male
prevalence 17 (68%), 31 in the VRG aged 54 +/- 8 years, 21 (68%) men. All
variables showed an intragroup reduction. At the end, the MIP of the CG
was 74 +/- 15 vs 92 +/- 12 cmH<inf>2</inf> O of the VRG (P < 0.001), the
MEP of the GC was 54 +/- 14 vs 75 +/- 16 cmH<inf>2</inf> O of the VRG (P <
0.001), the VC was 1.9 +/- 0.6 ml/Kg in GC vs 2.4 +/- 0.7 ml/Kg in VRG (P
= 0.22), PEF in GC was 231 +/- 28 vs 311 +/- 26 L/min in VRG (P < 0.001),
TUG of CG 22 +/- 9.1 seconds vs 10 +/- 1.6 seconds in the VRG (P < 0.001),
the CG's FIM was 112 +/- 5 vs 120 +/- 3 in the GRV (P < 0.001).
 Conclusion(s): Based on the results obtained, it was found that the
intervention with virtual reality was effective in reducing the loss of
pulmonary function and functional independence after CABG. Copyright
© 2020, E-Century Publishing Corporation. All rights reserved.

<39>
Accession Number
2010480029
Title
The Effects of Volatile Anesthetics on Lung Ischemia-Reperfusion Injury:
Basic to Clinical Studies.
Source
Journal of Surgical Research. 260 (pp 325-344), 2021. Date of Publication:
April 2021.
Author
Oshima Y.; Otsuki A.; Endo R.; Nakasone M.; Harada T.; Takahashi S.;
Inagaki Y.
Institution
(Oshima) Department of Anesthesiology, Yonago Medical Center, Yonago,
Tottori, Japan
(Otsuki, Endo, Nakasone, Harada, Takahashi, Inagaki) Division of
Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori
University Faculty of Medicine, Yonago, Tottori, Japan
Publisher
Academic Press Inc.
Abstract
Case reports from as early as the 1970s have shown that intravenous
injection of even a small dose of volatile anesthetics result in fatal
lung injury. Direct contact between volatile anesthetics and pulmonary
vasculature triggers chemical damage in the vessel walls. A wide variety
of factors are involved in lung ischemia-reperfusion injury (LIRI), such
as pulmonary endothelial cells, alveolar epithelial cells, alveolar
macrophages, neutrophils, mast cells, platelets, proinflammatory
cytokines, and surfactant. With a constellation of factors involved, the
assessment of the protective effect of volatile anesthetics in LIRI is
difficult. Multiple animal studies have reported that with regards to
LIRI, sevoflurane demonstrates an anti-inflammatory effect in
immunocompetent cells and an anti-apoptotic effect on lung tissue.
Scattered studies have dismissed a protective effect of desflurane against
LIRI. While a single-center randomized controlled trial (RCT) found that
volatile anesthetics including desflurane demonstrated a lung-protective
effect in thoracic surgery, a multicenter RCT did not demonstrate a
lung-protective effect of desflurane. LIRI is common in lung
transplantation. One study, although limited due to its small sample size,
found that the use of volatile anesthetics in organ procurement surgery
involving "death by neurologic criteria" donors did not improve lung graft
survival. Future studies on the protective effect of volatile anesthetics
against LIRI must examine not only the mechanism of the protective effect
but also differences in the effects of different types of volatile
anesthetics, their optimal dosage, and the appropriateness of their use in
the event of marked alveolar capillary barrier damage. Copyright
© 2020 The Author(s)

<40>
Accession Number
2010440751
Title
Erdheim-Chester Disease With Extensive Pericardial Involvement: A Case
Report and Systematic Review.
Source
Cardiology Research. 11 (2) (pp 118-128), 2020. Date of Publication: 2020.
Author
Sanchez-Nadales A.; Anampa-Guzman A.; Navarro-Motta J.
Institution
(Sanchez-Nadales, Navarro-Motta) Department of Medicine, Advocate Illinois
Masonic Medical Center, Chicago, IL, United States
(Anampa-Guzman) Sociedad Cientifica de San Fernando, Faculty of Medicine,
Universidad Na- cional Mayor de San Marcos, Lima, Peru
(Sanchez-Nadales) Alejandro Sanchez-Nadales, Department of Medicine,
Advocate Illinois Masonic Medical Center, Chicago, IL, United States
Publisher
Elmer Press
Abstract
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis
characterized by systemic xanthogranulomatous infiltration. We described
the case of a female adult presenting with pericardial effusion.
Pericardial infiltration is the most frequent cardiac manifestation of ECD
and is the one discussed in this article. We found that the majority of
patients with pericardial infiltration needed a cardiovascular procedure.

<41>
Accession Number
633739389
Title
Multimodal prehabilitation as strategy for reduction of postoperative
complications after cardiac surgery: A randomised controlled trial
protocol.
Source
BMJ Open. 10 (12) (no pagination), 2020. Article Number: e039885. Date of
Publication: 22 Dec 2020.
Author
Coca-Martinez M.; Lopez-Hernandez A.; Montane-Muntane M.; Arguis M.J.;
Gimeno-Santos E.; Navarro-Ripoll R.; Perdomo J.; Lopez-Baamonde M.; Rios
J.; Moises J.; Sanz De La Garza M.; Sandoval E.; Romano B.; Sebio R.; Dana
F.; Martinez-Palli G.
Institution
(Coca-Martinez, Lopez-Hernandez, Montane-Muntane, Arguis, Navarro-Ripoll,
Perdomo, Lopez-Baamonde, Martinez-Palli) Anaesthesiology and Intensive
Care, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
(Arguis, Gimeno-Santos, Rios, Martinez-Palli) August Pi i Sunyer
Biomedical Research Institute (IDIBAPS), Barcelona, Catalunya, Spain
(Gimeno-Santos, Sebio, Dana) Prehabilitation Unit, Hospital Clinic de
Barcelona, Barcelona, Catalunya, Spain
(Rios) Biostatistics Unit, Universitat Autonoma de Barcelona, Facultat de
Medicina, Bellaterra, Catalunya, Spain
(Moises) Respiratory Medicine, Hospital Clinic de Barcelona, Barcelona,
Catalunya, Spain
(Sanz De La Garza) Department of Cardiology, Cardiovascular Institute,
Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
(Sandoval) Department of Cardiac Surgery, Cardiovascular Institute,
Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
(Romano) Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona,
Barcelona, Catalunya, Spain
Publisher
BMJ Publishing Group
Abstract
Introduction Prehabilitation programmes that combine exercise training,
nutritional support and emotional reinforcement (multimodal
prehabilitation) have demonstrated efficacy reducing postoperative
complications in the context of abdominal surgery. However, such
programmes have seldom been studied in cardiac surgery, one of the
surgeries associated with higher postoperative morbidity and mortality.
This trial will assess the feasibility and efficacy in terms of reduction
of postoperative complications and cost-effectiveness of a multimodal
prehabilitation programme comparing to the standard of care in cardiac
surgical patients. Methods and analysis This is a single-centre,
randomised, open-label, controlled trial with a 1:1 ratio. Consecutive 160
elective valve replacement and/or coronary revascularisation surgical
patients will be randomised to either standard of care or 4-6 weeks of
multimodal prehabilitation that will consist in (1) two times/week
supervised endurance and strength exercise training sessions, (2)
promotion of physical activity and healthy lifestyle, (3) respiratory
physiotherapy, (4) nutrition counselling and supplementation if needed,
and (5) weekly mindfulness sessions. Baseline, preoperative and 3-month
postoperative data will be collected by an independent blinded evaluator.
The primary outcome of this study will be the incidence of postoperative
complications. Ethics and dissemination This study has been approved by
the Ethics Committee of Clinical investigation of Hospital Clinic de
Barcelona (HCB/2017/0708). The results will be disseminated in a
peer-reviewed journal. Copyright © 2020 Author(s). Published by
BMJ.

<42>
Accession Number
633739322
Title
A key role for comprehensive geriatric assessment in aortic valve
replacement.
Source
BMJ Case Reports. 13 (12) (no pagination), 2020. Article Number: e237031.
Date of Publication: 22 Dec 2020.
Author
El-Shakankery K.H.; Mieiro L.
Institution
(El-Shakankery, Mieiro) Department of Medicine for Elderly People, Whipps
Cross Hospital, Barts Health NHS Trust, London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
As our population ages, the demand for surgical services in older people
is increasing exponentially. Shown to be indispensable in the care of
medical patients, use of the comprehensive geriatric assessment (CGA) is
also growing in the perioperative setting. We present the case of a
previously independent 82-year-old man who underwent a standard
preoperative assessment and surgical aortic valve replacement. In the 7
months that followed, prior to his death, he suffered a rapid functional
decline contributed to by slow postoperative recovery, delirium and
recurrent falls. Post-mortem revealed cardiac amyloid deposition and
extensive small vessel disease in the brain. This case highlights the
importance of the CGA in the perioperative management of older patients,
especially in identification and optimisation of geriatric syndromes and
consideration of less-invasive alternative treatments. We review the
existing literature on CGA use in cardiothoracic and vascular surgical
settings, drawing on experiences learnt from the above case. Copyright
© 2020 BMJ Publishing Group Limited. Published by BMJ.

<43>
Accession Number
2010489620
Title
Guidelines on prosthetic heart valve management in infective endocarditis:
A narrative review comparing American Heart Association/American College
of Cardiology and European Society of Cardiology guidelines.
Source
Annals of Translational Medicine. 8 (23) (no pagination), 2020. Article
Number: 1625. Date of Publication: December 2020.
Author
Satriano U.M.; Nenna A.; Spadaccio C.; Pollari F.; Fischlein T.; Chello
M.; Nappi F.
Institution
(Satriano, Nenna, Chello) Universita Campus Bio-Medico di Roma, Rome,
Italy
(Spadaccio) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Pollari) Klinikum Nurnberg, Paracelsus Medical University, Nuremberg,
Germany
(Fischlein) Paracelsus Medical University, Nuremberg, Germany
(Nappi) Centre Cardiologique du Nord de Saint-Denis, Paris, France
Publisher
AME Publishing Company
Abstract
Infective endocarditis (IE) represented over the last year a growing
medical and surgical concern. The changes in etiology and demographic of
the disease, which now includes also a large proportion of iatrogenic
conditions, has prompted new studies and updates in the guideline for IE
treatment. The increasing use of intravascular and intracardiac devices
has introduced new challenges in terms of both antibiotic resistance and
surgical treatment of prosthetic endocarditis. Also, patients with complex
congenital heart diseases, intravenous drug abusers and patients with
chronic renal failure under hemodialysis have been added to the list of
high-risk subjects for IE. Important aspects concerning the establishment
of the endocarditis team, the clinical management, the optimal medical
therapy and the indication and timing for surgery are arguments of debate
and controversy across the literature. In particular, the most adequate
strategy to be adopted in the context of concomitant neurological
complication remains greatly debated. Despite attempts to standardize the
practice in IE, the lack of powered randomized clinical evidence prevented
the achievement of a univocal consensus in several aspects of the
management of IE. This situation reflects in some differences in the
recommendation promoted by the European Society of Cardiology and American
Heart Association/American College of Cardiology. In this review, we will
compare the European Society of Cardiology and the American Heart
Association guidelines and discuss important aspects related to clinical
management and indications of for treatment. Copyright © Annals
of Translational Medicine. All rights reserved.

<44>
Accession Number
2010489600
Title
Safety of different carotid artery revascularization strategies in the
coronary artery bypass graft population: Study protocol for a systematic
review and network meta-analysis.
Source
Annals of Translational Medicine. 8 (23) (no pagination), 2020. Article
Number: 1605. Date of Publication: December 2020.
Author
Shen Y.; Jin S.; Lin C.; Shen J.; Hong Z.; Xue S.; Guo D.
Institution
(Shen, Lin, Xue, Guo) Department of Vascular Surgery, Institute of
Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
(Jin) Information and Technology Center, Taizhou Hospital of Zhejiang
Province, Wenzhou Medical University, Linhai, China
(Shen) Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang
Province, Wenzhou Medical University, Linhai, China
(Hong) Department of Orthopedics, Taizhou Hospital of Zhejiang Province,
Wenzhou Medical University, Linhai, China
Publisher
AME Publishing Company
Abstract
Background: Concomitant significant carotid artery occlusive diseases
(CAOD) increase the risk of perioperative stroke and death in patients who
undergo coronary artery bypass graft (CABG). Although several surgical
strategies can be used in the management of such patients, controversy
still surrounds which is the best option for CABG patients with
accompanying CAOD. Method(s): Literature searches will be conducted
covering articles published in PubMed, the Cochrane Central Register of
Controlled Trials, Web of Science, and Embase between January 1989 and
December 2019. Search results will be limited to articles published in
English. Six surgical strategies using carotid endarterectomy (CEA) or
carotid artery stenting (CAS) with different timings (i.e., before, after,
or combined with CABG) will be evaluated. Randomized controlled trials and
non-randomized studies comparing these strategies will be included. The
quality of studies will be critically appraised using the Cochrane
risk-of-bias tool or ROBINS-I tool. Since CEA and CAS have comparable
effectiveness for the treatment of significant CAOD, we will integrate
direct and indirect evidence using network meta-analysis (NMA) to create
hierarchies of the six surgical strategies based on their perioperative
safety. The primary outcomes will be the probability of perioperative
stroke and the probability of perioperative death. Additionally, we will
analyze the probability of perioperative myocardial infarction (MI) as a
secondary outcome. Pairwise meta-analyses and Bayesian network
meta-analyses will be performed for all related outcome measures. Subgroup
analyses, sensitivity analyses, and network meta-regression will be
conducted to assess the robustness of the findings. Discussion(s):
This NMA will summarize the direct and indirect evidence of perioperative
safety with the aim of providing a ranking of the various surgical
strategies. The results of this meta-analysis will provide useful
information on optimal surgical management of CABG patients with
concomitant significant CAOD. Copyright © Annals of Translational
Medicine. All rights reserved.

<45>
Accession Number
2010440901
Title
Association between apolipoprotein B and cardiovascular risk: A
meta-analysis of randomized controlled trials.
Source
Atherosclerosis. Conference: EAS 2020 Congress. 315 (pp e5), 2020. Date of
Publication: December 2020.
Author
Galimberti F.; Catapano A.L.; Cupido A.J.; Katzmann J.L.; Ference B.A.
Institution
(Galimberti, Cupido, Katzmann, Ference) MRC/BHF Cardiovascular
Epidemiology Unit, University of Cambridge, Department Of Public Health
And Primary Care, Cambridge, United Kingdom
(Galimberti, Catapano) Epidemiology and Preventive Pharmacology Service
(SEFAP), University of Milan, Department Of Pharmacological And
Biomolecular Sciences, Milan, Italy
(Catapano) IRCCS MultiMedica, Irccs Multimedica, Sesto S. Giovanni
(Milan), Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background and Aims: Recent evidence from Mendelian randomization studies
suggests that the clinical benefit of any lipid-lowering therapy should be
proportional to the absolute change in apolipoprotein B (apoB) containing
lipoproteins. We sought to compare and to estimate the magnitude of the
expected clinical benefit per unit reduction in apoB for several classes
of lipid-lowering therapies. Method(s): We conducted a study-level
meta-analysis of randomized trials evaluating statins, ezetimibe,
PCSK9-inhibitors, CETP-inhibitors, niacin, and fibrates. We included all
studies reporting apoB levels and cardiovascular (CV) outcomes, with at
least 1000 participants and 1-year follow-up. The primary outcome was
major CV events (MACEs). We estimated the relative risk (RR) of MACEs,
adjusted for study duration, for each class and in a combined analysis.
 Result(s): Twenty-five trials that enrolled 285,241 participants
(mean age: 63.3 years; female sex: 24.7%) who experienced 40,244 first
MACEs were included. The mean absolute difference in apoB between the
treatment and comparison groups at 1 year was 24.1 mg/dL. The pooled RR
per 30 mg/dL reduction in apoB levels was 0.79 (95% confidence intervals
(CI) 0.77-0.81) for MACEs, consisting of significant risk reduction in
non-fatal myocardial infarction (RR 0.76; 95%CI 0.73-0.79), coronary
revascularisation (0.78; 0.73-0.82), stroke (0.79; 0.76-0.81), and CV
death (0.87; 0.82-0.92). Conclusion(s): All the lipid-lowering
therapies are associated with very similar reductions in the risk of major
CV events per unit change in apoB, suggesting that the clinical benefit
may be proportional to the achieved absolute reduction in apoB, regardless
of the observed changes in other lipids. Copyright © 2020

<46>
[Use Link to view the full text]
Accession Number
2010440427
Title
LDL-cholesterol corrected for LP(A)-cholesterol, risk thresholds and
cardiovascular events.
Source
Atherosclerosis. Conference: EAS 2020 Congress. 315 (pp e34-e35), 2020.
Date of Publication: December 2020.
Author
Willeit P.; Yeang C.; Moriarty P.M.; Tschiderer L.; Varvel S.A.; Mcconnell
J.P.; Tsimikas S.
Institution
(Willeit) University of Cambridge, Department Of Public Health And Primary
Care, Cambridge, United Kingdom
(Willeit, Tschiderer) Medical University of Innsbruck, Department Of
Neurology, Innsbruck, Austria
(Yeang, Tsimikas) University of California San Diego, Division Of
Cardiovascular Medicine, Sulpizio Cardiovascular Center, La Jolla, United
States
(Moriarty) University of Kansas Medical Center, Division Of Clinical
Pharmacology, Department Of Internal Medicine, Kansas City, United States
(Varvel, Mcconnell) Salveo Diagnostics, Inc., Richmond, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background and Aims: Conventional "LDL-C" assays measure cholesterol
content in both LDL and lipoprotein(a) [Lp(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 (CVD) and to assess the impact of this
correction on classification of patients into guideline-recommended LDL-C
categories. Method(s): Lp(a) cholesterol content (Lp(a)-C) was
estimated as 30% of Lp(a) mass and subtracted from "LDL-C" to obtain
corrected LDL-C values (LDL-C<inf>corr30</inf>). Hazard ratios for CVD
(defined as coronary heart disease, stroke, or coronary revascularization)
were quantified by individual-patient-data meta-analysis of five statin
landmark trials from the Lipoprotein(a) Studies Collaboration (18,043
patients, 5,390 events, 4.7 years median follow-up). In a routine
laboratory database involving 531,144 patients, reclassification of
patients across guideline-recommended LDL-C categories when using
LDL-C<inf>corr30</inf> was assessed. Result(s): When comparing top
versus bottom quartiles, the multivariable-adjusted hazard ratio for CVD
was significant for "LDL-C" [1.17 (95% CI: 1.05-1.31, P=0.005)] but not
for LDL-C<inf>corr30</inf> [1.07 (0.93-1.22; P=0.36)]. In a routine
laboratory database, across, "LDL-C" categories of 70-<100, 100-<130,
130-<190, and >=190 mg/dL, significant proportions (95% CI) of
participants were re-assigned to lower LDL-C categories when
LDL-C<inf>corr30</inf> 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.
 Conclusion(s): "LDL-C" was associated with incident CVD only when
Lp(a)-C was included in its measurement. Refinement in techniques to
accurately-measure LDL-C, particularly in patients with elevated Lp(a)
levels, is warranted to assign risk to the responsible
lipoproteins. Copyright © 2020

<47>
Accession Number
633760679
Title
Infective endocarditis on a metallic valve with haemorrhagic infarcts: To
anticoagulate or not?.
Source
International Journal of Stroke. Conference: UK Stroke Forum Conference.
United Kingdom. 14 (4 SUPPL) (pp 37), 2019. Date of Publication: 2019.
Author
Hsu C.H.-W.; Basgaran A.; Sivagnanaratnam A.
Institution
(Hsu, Basgaran, Sivagnanaratnam) London North West University Healthcare
NHS Trust, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Introduction: Cerebrovascular complications occur in at least 25% of
patients with infective endocarditis. Early antibiotic therapy is key to
reducing the risk of embolisation. Meanwhile, thrombolysis and
anticoagulation are generally not recommended due to the risk of
haemorrhagic transformation. However, a serious dilemma is introduced in
cases where haemorrhagic transformation of embolic infarcts has already
occurred, and furthermore, in the context of a metallic valve, for which
anticoagulation is considered essential. Method(s): Our case combines
all three factors: a case of Kingella kingae (HACEK organism) endocarditis
on a metallic mitral valve, resulting in a septic thromboembolic shower
with splenic, renal and cortical infarcts. In addition, there were primary
haemorrhages and haemorrhagic transformation of the cortical infarct.
Given these findings, the immediate clinical dilemma was whether to
continue anticoagulation. Result(s): There are no randomised
controlled trials to date looking at the risks against the benefits of
anticoagulation in this scenario, given the infrequency of such a case. We
chose to hold anticoagulation for 48 hours. He remained neurologically and
radiologically unchanged, and thus anticoagulation was recommenced. He was
then transferred to the local cardiology centre for urgent valve
replacement. Conclusion(s): Our case highlights the challenges
surrounding anticoagulation in the context of a highrisk metallic valve,
infective vegetations and haemorrhagic infarcts. The risks and benefits of
anticoagulation must be continually reassessed. Close monitoring, repeat
scanning and early cardiac intervention are key to achieving optimal
patient outcome. It is also essential to have a multidisciplinary approach
that involves the stroke, cardiology, haematology, infectious diseases and
cardiothoracic surgery teams.

<48>
Accession Number
633760426
Title
Nanosystems for delivery of bioactive agents in vascular health.
Source
Journal of Vascular Access. Conference: International Congress on Vascular
Access, CIAV 2019. Portugal. 20 (2 SUPPL) (pp 7), 2019. Date of
Publication: 2019.
Author
Vieira P.; Andrade I.; Cruz R.
Institution
(Vieira, Cruz) Polytechnic Institute of Coimbra, ESTESC-Coimbra Health
School, Pharmacy, Portugal
(Andrade) Polytechnic Institute of Coimbra, ESTESC-Coimbra Health School,
Complementary Sciences, Portugal
Publisher
SAGE Publications Ltd
Abstract
Introduction: It is widely known that the incidence of cardiovascular
disease is increasing, a trend that is expected to continue in the future.
This coincides with an immense and increasing need for vascular grafts for
use as vessel replacement in vascular diseases. These factors result in
the need to investigate innovative therapies for reducing the risk of
vascular diseases. Nanoencapsulation systems made of biocompatible
materials for the delivery and release of bioactive compounds, ranging
from natural compounds such as green tea extract, limonene and curcumin to
peptides, growth factors, micro-RNA, among others, open doors to new
strategies for reducing (cardio)vascular complications. This study aims to
review the most recent scientific literature, published after 2010, on the
reduction of cardiovascular risk using nanosystems for delivery of
bioactive agents. Method(s): Advanced search in the databases B-on,
PubMed and PubMed Central for selection of relevant articles, followed by
a comparative analysis in terms of the encapsulated bioactive agent, model
of study used, and outcomes. Result(s): After using the inclusion
criteria, 13 relevant articles were selected for analysis, out of a total
of 211 articles. The most significant examples of the bioactive constructs
studied for enhancing cardiac function (in particular of the blood
vessels) include a polyethylene-based hydrogel combined with acid
fibroblast growth factor and neuregulin-1 therapy and hyaluronic
acid-based hydrogel combined with engineered stromal cell-derived factor
analogue, showing positive effects on induction of revascularization
through recruitment of endothelial progenitor cells. Conclusion(s):
The results of the studies showed cardiovascular improvement, evidencing
the capacity of induction of myocardial revascularization, facilitating
the anastomosis of the vessels. This ability to increase the number of
viable vessels and capillaries could be seen in future as a new
therapeutic option (alternative or adjuvant) to vascular grafts. The next
step in this approach would be to conduct clinical trials.

<49>
Accession Number
630834764
Title
Postpericardiotomy syndrome after cardiac operations.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (1) (pp
62-66), 2020. Date of Publication: 01 Jan 2020.
Author
Yuan S.-M.
Institution
(Yuan) Division of Cardiac Surgery, Department of Cardiothoracic Surgery,
First Hospital of Putian, Teaching Hospital, Fujian Medical University,
Chengxiang District, Fujian Province, China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
The postpericardiotomy syndrome (PPS) is an important cause of morbidity
and mortality following heart operation. This systematic review reviewed
the literature regarding PPS. It was found to occur on day 18.3 +/-15.9
after cardiac operations, most often after coronary artery bypass
grafting, and mitral valve replacement. The most common symptoms were
new/worsening pericardial effusions, pleuritic chest pain, and fever. The
inflammation markers, such as C-reactive protein and erythrocyte
sedimentation rate, were found to increase significantly in each patient
who had these parameters examined. The subjects were managed
conservatively in 472 (83.5%) patients, by surgical pericardial drainage
in 85 (15.0%) patients, by thora-/pericardio-centesis in 3 (0.5%)
patients, and were under surveillance without being treated in 5 (0.9%)
patients. Conservative treatment was likely to be associated with a higher
recovery rate. Surgical trauma and cardiopulmonary bypass trigger the
systemic inflammatory response, which results in antiheart autoantigen
release, and the deposited immune complex could be found in the
pericardial, pleural, and lung tissues, thereby provoking the occurrence
of PPS. Therapeutic options for the refractory cases are long-term oral
corticoids or pericardiectomy. Surgical intervention was warranted in 2.6%
of the cases due to cardiac tamponade. Copyright © 2020 College
of Physicians and Surgeons Pakistan. All rights reserved.

<50>
Accession Number
2001593954
Title
Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST
Guideline and Expert Panel Report.
Source
Chest. 155 (3) (pp 565-586), 2019. Date of Publication: March 2019.
Author
Klinger J.R.; Elliott C.G.; Levine D.J.; Bossone E.; Duvall L.; Fagan K.;
Frantsve-Hawley J.; Kawut S.M.; Ryan J.J.; Rosenzweig E.B.; Sederstrom N.;
Steen V.D.; Badesch D.B.
Institution
(Klinger) Brown University, Providence, RI, United States
(Elliott) Intermountain Healthcare and the University of Utah School of
Medicine, Murray, UT, United States
(Levine) University of Texas Health Science Center at San Antonio, San
Antonio, TX, United States
(Bossone) A. Cardarelli Hospital, Naples, Italy
(Duvall) OhioHealth/The Ohio State University, Columbus, OH, United States
(Fagan) University of South Alabama, Mobile, AL, United States
(Frantsve-Hawley) CHEST, Glenview, IL, United States
(Kawut) Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, United States
(Ryan) University of Utah, Salt Lake City, UT, United States
(Rosenzweig) Columbia University Medical Center, New York, NY, United
States
(Sederstrom) Children's Hospitals and Clinics of Minnesota, Minneapolis,
MN, United States
(Steen) Georgetown University Medical Center, Washington, DC, United
States
(Badesch) University of Colorado School of Medicine, Aurora, CO, United
States
Publisher
Elsevier Inc.
Abstract
Background: Pulmonary arterial hypertension (PAH) carries a poor prognosis
if not promptly diagnosed and appropriately treated. The development and
approval of 14 medications over the last several decades have led to a
rapidly evolving approach to therapy, and have necessitated periodic
updating of evidence-based treatment guidelines. This guideline statement,
which now includes a visual algorithm to enhance its clinical utility,
represents the fourth iteration of the American College of Chest
Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH.
 Method(s): The guideline panel conducted an updated systematic review
to identify studies published after those included in the 2014 guideline.
A systematic literature search was conducted using MEDLINE via PubMed and
the Cochrane Library. The quality of the body of evidence was assessed for
each critical or important outcome of interest using the Grading of
Recommendations Assessment, Development and Evaluation approach. Graded
recommendations and ungraded consensus-based statements were developed and
voted on using a modified Delphi technique to achieve consensus.
 Result(s): Two new recommendations on combination therapy and two
ungraded consensus-based statements on palliative care were developed. An
evidence-based and consensus-driven treatment algorithm was created to
guide the clinician through an organized approach to management, and to
direct readers to the appropriate area of the document for more detailed
information. Conclusion(s): Therapeutic options for the patient with
PAH continue to expand through basic discovery, translational science, and
clinical trials. Optimal use of new treatment options requires prompt
evaluation at an expert center, utilization of current evidence-based
guidelines, and collaborative care using sound clinical
judgment. Copyright © 2019 American College of Chest Physicians

<51>
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

<52>
Accession Number
633495453
Title
An evidence-based review of the use of vasoactive and inotropic
medications in post-operative paediatric patients after cardiac surgery
with cardiopulmonary bypass from 2000 to 2020.
Source
Cardiology in the Young. 30 (12) (pp 1757-1771), 2020. Date of
Publication: December 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, Duke Clinical Research
Institute, PO Box 17969, Durham, NC 27715, 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. 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.
 Result(s): The finalanalysis included 37 papers. Collectively,
selected studies reported on 12 different vasoactive andinotropic
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 endpointsdiffered
widely, limiting the ability to combine data for meta-analyses.
 Conclusion(s): Vasoactive andinotropic 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
inotropesfor 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. Copyright © 2020
The Author(s). Published by Cambridge University Press.

<53>
Accession Number
2010462409
Title
Frailty is highly prevalent in specific cardiovascular diseases and
females, but significantly worsens prognosis in all affected patients: A
systematic review.
Source
Ageing Research Reviews. 66 (no pagination), 2021. Article Number: 101233.
Date of Publication: March 2021.
Author
Marinus N.; Vigorito C.; Giallauria F.; Haenen L.; Jansegers T.; Dendale
P.; Feys P.; Meesen R.; Timmermans A.; Spildooren J.; Hansen D.
Institution
(Marinus, Haenen, Jansegers, Dendale, Feys, Meesen, Timmermans,
Spildooren, Hansen) REVAL, Rehabilitation Research Center, Faculty of
Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
(Dendale, Hansen) Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
(Marinus, Feys, Hansen) BIOMED, Biomedical Research Center, Hasselt
University, Diepenbeek, Belgium
(Vigorito, Giallauria) Department of Translational Medical Sciences,
Federico II University of Naples, Naples, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Cardiologists are more often confronted with older (>60 years)
cardiovascular disease (CVD) patients. These patients have particular
needs in clinical care because, for example, of frailty. However, it
remains to be established what is the prevalence of frailty in different
CVD's and how it relates to mortality. In this systematic review studies
were included if they: (i) examined subjects (men and women) aged >=60
years who suffered from any CVD with or without cardiac surgery, (ii.)
examined the presence of frailty with a well-defined frailty tool and
(iii.) reported prevalence rates of frailty. From thirty studies
comprising 96.841 participants, it is found that 1. Frailty is highly
common in older patients with CVD (in particular in females (approximately
1.6 times more than in males), in heart failure (up to 80 % of patients)
and aortic valve disease (up to 74 % of patients)), and 2. Frailty is
related to a 2.5-3.5-fold elevated mortality risk, even in patients with
less severe CVD (e.g. percutaneous coronary intervention). Moreover, there
is a lack of consistency on how to assess frailty as up to 20 different
tools/assessment batteries are currently used. It is concluded that
frailty should be assessed in all older CVD patients in a uniform manner
to enhance clinical care and outcomes. Copyright © 2020 Elsevier
B.V.

<54>
Accession Number
2010453712
Title
Calcium-Induced Autonomic Denervation in Patients With Post-Operative
Atrial Fibrillation.
Source
Journal of the American College of Cardiology. 77 (1) (pp 57-67), 2021.
Date of Publication: 05 Jan 2021.
Author
Wang H.; Zhang Y.; Xin F.; Jiang H.; Tao D.; Jin Y.; He Y.; Wang Q.; Po
S.S.
Institution
(Wang, Zhang, Xin, Jiang, Tao, Jin, He, Wang) Department of Cardiovascular
Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning,
China
(Po) Section of Cardiovascular Diseases and Heart Rhythm Institute,
University of Oklahoma Health Sciences Center, Oklahoma City, OK, United
States
Publisher
Elsevier Inc.
Abstract
Background: Post-operative atrial fibrillation (POAF) is associated with
worse long-term cardiovascular outcomes. Objective(s): This study
hypothesized that injecting calcium chloride (CaCl<inf>2</inf>) into the
major atrial ganglionated plexi (GPs) during isolated coronary artery
bypass grafting (CABG) can reduce the incidence of POAF by calcium-induced
autonomic neurotoxicity. Method(s): This proof-of-concept study
randomized 200 patients undergoing isolated, off-pump CABG to
CaCl<inf>2</inf> (n = 100) or sodium chloride (sham, n = 100) injection.
Two milliliters of CaCl<inf>2</inf> (5%) or sodium chloride (0.9%) was
injected into the 4 major atrial GPs during CABG. All patients received
7-day continuous telemetry and Holter monitoring. The primary outcome was
incidence of POAF (>=30 s) in 7 days. Secondary outcomes included length
of hospitalization, POAF burden, average ventricular rate during AF,
plasma level of inflammatory markers, and actionable antiarrhythmic
therapy to treat POAF. Result(s): The POAF incidence was reduced from
36% to 15% (hazard ratio: 0.366; 95% confidence interval: 0.211 to 0.635;
p = 0.001). Length of hospitalization did not differ between the 2 groups.
POAF burden (first 7 post-operative days), the use of amiodarone or
esmolol, and the incidence of atrial couplets and nonsustained atrial
tachyarrhythmias were significantly reduced in the CaCl<inf>2</inf> group.
Heart rate variability data showed a decrease in both high-frequency and
low-frequency power in the CaCl<inf>2</inf> group with a preserved
low-frequency/high-frequency ratio, suggesting that the
sympathetic/parasympathetic balance was not perturbed by CaCl<inf>2</inf>
injection. Conclusion(s): Injection of CaCl<inf>2</inf> into the 4
major atrial GPs reduced the POAF hazard by 63%. Inhibition of GP function
by Ca-mediated neurotoxicity may underlie the therapeutic effect. (Calcium
Autonomic Denervation Prevents Postoperative Atrial Fibrillation;
ChiCTR1800019276) Copyright © 2021 American College of Cardiology
Foundation

<55>
Accession Number
633760146
Title
Effect of ultrasound-guided-pressure-controlled ventilation on
intraoperative blood gas and ventilatory parameters during thoracic
surgery.
Source
Indian Journal of Anaesthesia. 64 (12) (pp 1047-1053), 2020. Date of
Publication: December 2020.
Author
Ghosh D.; Jain G.; Agarwal A.; Govil N.
Institution
(Ghosh, Jain, Agarwal, Govil) Department of Anaesthesiology and Critical
Care, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh,
Uttarakhand 249203, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Identifying an ideal intraoperative ventilation
strategy remains an area of research. We evaluated the effect of
ultrasound-guided-pressure-controlled ventilation (UG-PCV) on the
blood-gas and ventilatory parameters, during both two-lung ventilation
(TLV) and one-lung ventilation (OLV) for thoracic surgery of unilateral
pulmonary disease, compared with volume-targeted PCV (VT-PCV).
 Method(s): In a prospective, parallel-group and double-blinded
design, 40 consecutive patients were randomised into two groups. Group A:
Received VT-PCV at a tidal volume (TV) of 9 mL/kg for TLV and 5 mL/kg for
OLV; group B: Received UG-PCV at an inspiratory pressure (2 cmH2O
increments every 15 s) targeted to achieve the alveolar aeration at the
base of the dependent lung (ultrasound-guided), for both TLV/OLV,
respectively. Primary outcome included arterial oxygen partial pressure
(PaO2) measured at baseline before anaesthesia induction (T1), at 30 min
immediately before conversion from TLV to OLV (T2), at 30 min on OLV (T3)
and before terminating OLV at the end of surgery (T4). Statistical tool
included Mann-Whitney test. Result(s): The PaO2 (mmHg) was
significantly higher in group B (374.5 +/- 25.9, 321.7 +/- 35.2 and 357.0
+/- 24.7) as compared to group A (353.3 +/- 38.1, 272.6 +/- 37.9 and 295.3
+/- 40.1), at T2, T3 and T4, respectively. The acid-base status remained
preserved in group B, while gradual respiratory acidosis was observed in
group A. The bicarbonate levels remained uniform in all patients. The TV
and airway pressures were marginally higher in group B, with no
intraoperative complications. Conclusion(s): The UG-PCV mode offered
better oxygenation, homogenous acid-base balance and individualised
alveolar ventilation for thoracic surgery. Copyright © 2020
Indian Journal of Anaesthesia.

<56>
Accession Number
633760138
Title
A randomised controlled comparison of serratus anterior plane, pectoral
nerves and intercostal nerve block for post-thoracotomy analgesia in adult
cardiac surgery.
Source
Indian Journal of Anaesthesia. 64 (12) (pp 1018-1024), 2020. Date of
Publication: December 2020.
Author
Magoon R.; Kaushal B.; Chauhan S.; Bhoi D.; Bisoi A.; Khan M.
Institution
(Magoon, Kaushal, Chauhan) Department of Cardiac Anaesthesia, Cardio and
Neurosciences Center, New Delhi, India
(Bhoi) Department of Anaesthesiology, Pain Medicine and Critical Care, New
Delhi, India
(Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio and
Neurosciences Center, New Delhi, India
(Khan) Department of Biostatistics, AIIMS, New Delhi, India
(Kaushal) Department of Anaesthesia, Gandhi Medical College and Hamidia
Hospital, Bhopal, Madhya Pradesh 462001, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Enhanced recovery after cardiac surgery is centred
around multimodal analgesia which is becoming increasingly feasible with
the advent of safer regional analgesic techniques such as fascial plane
blocks. We designed this prospective, single-blind, randomised controlled
study to compare the efficacy of serratus anterior plane block (SAPB),
pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for
post-thoracotomy analgesia in cardiac surgery. Method(s): 100 adults
posted for cardiac surgery through a thoracotomy were randomly allocated
to one of the three groups: SAPB, Pecs II or, ICNB wherein the patients
received 2.5 mg/kg of 0.5% ropivacaine for ultrasound-guided block after
completion of surgery. Postoperatively, intravenous (IV) paracetamol was
used for multimodal and fentanyl was employed as rescue analgesia. Visual
analogue scale (VAS) was evaluated at 2, 4, 6, 8, 10 and 12 hours
post-extubation. Result(s): The early mean VAS scores at 2, 4 and 6
hours were comparable in the 3 groups. The late mean VAS (8, 10 and 12
hours) was significantly lower in the SAPB and Pecs II group compared with
that of the ICNB group (P value <0.05). The cumulative rescue fentanyl
dose was significantly higher in ICNB group compared to SAPB and Pecs II
group (P value <0.001). The SAPB group had the highest time to 1st rescue
analgesic requirement in contrast to the other groups. Conclusion(s):
SAPB and Pecs II blocks are simple single-shot effective alternatives to
ICNB with a prolonged analgesic duration following thoracotomy and can
potentially enhance pain-free recovery after cardiac surgery.
 Copyright © 2020 Indian Journal of Anaesthesia.

<57>
Accession Number
2010459950
Title
Comparison of CryoMaze With Cut-and-Sew Maze Concomitant With Mitral Valve
Surgery: A Randomized Noninferiority Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2020.
Date of Publication: 2020.
Author
Han J.; Wang H.; Wang Z.; Yin Z.; Zhang J.; Jin Y.; Han H.
Institution
(Han, Wang, Wang, Yin, Zhang, Jin, Han) Department of Cardiovascular
Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning
Province, China
Publisher
W.B. Saunders
Abstract
In this trial, we sought to evaluate the efficacy and safety of the
addition of the Maze performed by cryoablation (CryoMaze) to the mitral
valve surgeries. The trial is a randomized, single-center trial to
determine whether CryoMaze was noninferior to cut-and-sew maze procedure
(CSM) in patients with persistent or long-standing persistent atrial
fibrillation (AF), with a 15% margin to establish noninferiority. The
primary endpoint was freedom from AF off antiarrhythmic drugs (AADs) at 12
months. Secondary endpoints included freedom from AF off AADs at 3 and 6
months, and a composite of serious adverse events. Two hundred patients
were randomized to either CryoMaze (n = 100) or CSM (n = 100). Freedom
from AF was achieved in 85 % (95% confidence interval, 0.76-0.91) in the
CryoMaze group and 88% (95% confidence interval, 0.80-0.94) in the CSM
group, showing that CryoMaze was noninferior to CSM at 12 months (P value
for noninferiority = 0.0065). There was no significant difference in
serious adverse effects (n = 12 in CryoMaze; n = 17 in CSM; P = 0.315).
Perioperative bleeding and the length of surgery, ICU stay, postoperative
hospital stay; and the need for temporary pacing decreased significantly
in the CryoMaze group. CryoMaze was noninferior to CSM for efficacy and
safety for patients with persistent or long-standing persistent AF
undergoing mitral valve surgeries. CryoMaze significantly decreased
bleeding, the length of surgery, ICU and hospital stay, as well the need
for temporary pacing. (Chinese Clinical Trial Register number,
ChiCTR-IOR-16008112.) Copyright © 2020 Elsevier Inc.

<58>
Accession Number
2010427775
Title
Selection of the best of 2020 in interventional cardiology.
Source
REC: CardioClinics. (no pagination), 2020. Date of Publication: 2020.
Author
Ojeda S.; Romaguera R.; Cruz-Gonzalez I.; Moreno R.
Institution
(Ojeda) Servicio de Cardiologia, Hospital Universitario Reina Sofia;
Instituto Maimonides de Investigacion Biomedica (IMIBIC), Universidad de
Cordoba, Cordoba, Spain
(Romaguera) Servicio de Cardiologia, Hospital de Bellvitge, Institut
d'Investigacio de Bellvitge (IDIBELL), Universitat de Barcelona,
L'Hospitalet de Llobregat, Barcelona, Spain
(Cruz-Gonzalez) Departamento de Cardiologia, Hospital Clinico de
Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL),
Universidad de Salamanca, Salamanca, Spain
(Cruz-Gonzalez, Moreno) Centro de Investigacion en Red de Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain
(Moreno) Servicio de Cardiologia, Hospital Universitario La Paz; Instituto
de Investigacion del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
Publisher
Elsevier Espana S.L.
Abstract
This article reviews the most relevant studies in the field of
interventional cardiology in 2020. In the area of coronary intervention,
relevant information with respect to the percutaneous coronary
intervention (PCI) vs coronary artery bypass grafting for the left main
treatment has been published, as well as, the best approach in dealing
with complex bifurcation lesions. There have also been significant studies
regarding antiplatelet strategies in patients with acute coronary syndrome
undergoing PCI, which will potentially change our clinical practice.
Regarding stable angina, data point out that an initial conservative
treatment can be an appropriate strategy. Finally, coronary physiology
continues to generate a great interest in different clinical and
anatomical contexts. The advances in the field of intervention for
structural heart disease have continued to increase exponentially in the
last year. The first randomized trial assessing the optimal antithrombotic
treatment after transcatheter aortic valve implantation has been published
and that will have clinical implications. It also highlightes the
development and implantation of the first mitral and tricuspid
percutaneous prosthesis, as well as, the evidence in favour of left atrial
appendage closure in high-risk patients. Finally, this year has been
marked by the COVID-19 pandemic which has had an impact on the clinical
and research activities. Copyright © 2020

<59>
[Use Link to view the full text]
Accession Number
633761759
Title
Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve
Replacement in Patients with Symptomatic Severe Aortic Stenosis: SCOPE 2
Randomized Clinical Trial.
Source
Circulation. (pp 2431-2442), 2020. Date of Publication: 2020.
Author
Tamburino C.; Bleiziffer S.; Thiele H.; Scholtz S.; Hildick-Smith D.;
Cunnington M.; Wolf A.; Barbanti M.; Tchetche D.; Garot P.; Pagnotta P.;
Gilard M.; Bedogni F.; Van Belle E.; Vasa-Nicotera M.; Chieffo A.; Deutsch
O.; Kempfert J.; Sondergaard L.; Butter C.; Trillo-Nouche R.; Lotfi S.;
Mollmann H.; Joner M.; Abdel-Wahab M.; Bogaerts K.; Hengstenberg C.;
Capodanno D.
Institution
(Tamburino, Capodanno) Department of General Surgery and Medical-Surgical
Subspecialties, University of Catania, Catania 95124, Italy
(Bleiziffer) Department of Cardiothoracic Surgery, Heart and Diabetes
Center Northrhein-Westfalia, Bad Oeynhausen, Germany
(Scholtz) Department of Interventional Cardiology, Heart and Diabetes
Center Northrhein-Westfalia, Bad Oeynhausen, Germany
(Thiele, Abdel-Wahab) Department of Cardiology, Heart Center Leipzig at
University, Leipzig, Germany
(Hildick-Smith) Department of Cardiology, Brighton and Sussex University
Hospitals National Health Service Trust, Brighton, United Kingdom
(Cunnington) Department of Cardiology, Leeds General Infirmary, Leeds
Teaching Hospitals National Health Service Trust, United Kingdom
(Wolf) Department of Cardiology, Elisabeth Hospital Essen, Germany
(Barbanti) Department of Cardio-Thoracic-Vascular Diseases and
Transplantations, Azienda Ospedaliero-Universitaria Policlinico "g.
Rodolico-San Marco," Catania, Italy
(Tchetche) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
(Garot) Hopital Prive Jacques Cartier, Institut Cardio-vasculaire
Paris-Sud, Ramsay-Sante, Massy, France
(Pagnotta) Department of Cardiovascular Medicine, Humanitas Clinical and
Research Center, Milano, Italy
(Gilard) Department of Cardiology, Brest University Hospital, France
(Bedogni) Cardiology Department, Istituti di Ricovero e Cura A Carattere
Scientifico Policlinico San Donato, Milano, Italy
(Van Belle) Department of Cardiology, University Hospital, Lille, France
(Vasa-Nicotera) Department of Cardiology, Goethe University Hospital
Frankfurt, Frankfurt am Main, Germany
(Chieffo) Interventional Cardiology Unit, Istituti di Ricovero e Cura A
Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
(Deutsch) Department of Cardiovascular Surgery, German Heart Centre
Munich, Germany
(Kempfert) Deutsches Herzzentrum Berlin, Charite Universitatsmedizin,
Berlin, Germany
(Sondergaard) The Heart Center-Rigshospitalet, Copenhagen, Denmark
(Butter) Department of Cardiology, Heart Center Brandenburg in Bernau and
Brandenburg Medical School, Germany
(Trillo-Nouche) Servicio de Cardiologia, Complejo Hospitalario
Universitario de Santiago de Compostela, Spain
(Lotfi) Department of Cardiovascular Surgery, University Hospital RWTH
Aachen, Germany
(Mollmann) Department of Cardiology, St Johannes Hospital, Dortmund,
Germany
(Joner) Klinik fur Herz und Kreislauferkrankungen, Deutsches Herzzentrum
Munchen, Munich, Germany
(Bogaerts) Department of Public Health and Primary Care, I-BioStat, KU
Leuven, Belgium
(Bogaerts) I-BioStat, Universiteit Hasselt, Belgium
(Hengstenberg) Department of Internal Medicine II, Medical University of
Vienna, Austria
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Few randomized trials have compared bioprostheses for
transcatheter aortic valve replacement, and no trials have compared
bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and
Efficacy Comparison of Two TAVI Systems in a Prospective Randomized
Evaluation 2) was designed to compare the clinical outcomes of the ACURATE
neo and CoreValve Evolut bioprostheses for transcatheter aortic valve
replacement. Method(s): SCOPE 2 was a randomized trial performed at
23 centers in 6 countries between April 2017 and April 2019. Patients >=75
years old with an indication for transfemoral transcatheter aortic valve
replacement as agreed by the heart team were randomly assigned to receive
treatment with either the ACURATE neo (n=398) or the CoreValve Evolut
bioprostheses (n=398). The primary end point, powered for noninferiority
of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year.
The key secondary end point, powered for superiority of the ACURATE neo
bioprosthesis, was new permanent pacemaker implantation at 30 days.
 Result(s): Among 796 randomized patients (mean age, 83.2+/-4.3 years;
mean Society of Thoracic Surgeons Predicted Risk of Mortality score,
4.6+/-2.9%), clinical follow-up information was available for 778 (98%)
patients. Within 1 year, the primary end point occurred in 15.8% of
patients in the ACURATE neo group and in 13.9% of patients in the
CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95%
confidence limit, 6.1%; P=0.0549 for noninferiority). The 30-day rates of
new permanent pacemaker implantation were 10.5% in the ACURATE neo group
and 18.0% in the CoreValve Evolut group (absolute risk difference, -7.5%
[95% CI, -12.4 to -2.60]; P=0.0027). No significant differences were
observed in the components of the primary end point. Cardiac death at 30
days (2.8% versus 0.8%; P=0.03) and 1 year (8.4% versus 3.9%; P=0.01), and
moderate or severe aortic regurgitation at 30 days (10% versus 3%;
P=0.002) were significantly increased in the ACURATE neo group.
 Conclusion(s): Transfemoral transcatheter aortic valve replacement
with the self-expanding ACURATE neo did not meet noninferiority compared
with the self-expanding CoreValve Evolut in terms of all-cause death or
stroke at 1 year, and it was associated with a lower incidence of new
permanent pacemaker implantation. In secondary analyses, the ACURATE neo
was associated with more moderate or severe aortic regurgitation at 30
days and cardiac death at 30 days and 1 year. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03192813. Copyright © 2020 Lippincott Williams and Wilkins.
All rights reserved.

<60>
Accession Number
628159950
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 (Supplement 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.

<61>
Accession Number
614188736
Title
Protection Against Cerebral Embolism During Transcatheter Aortic Valve
Replacement.
Source
Journal of the American College of Cardiology. 69 (4) (pp 367-377), 2017.
Date of Publication: 31 Jan 2017.
Author
Kapadia S.R.; Kodali S.; Makkar R.; Mehran R.; Lazar R.M.; Zivadinov R.;
Dwyer M.G.; Jilaihawi H.; Virmani R.; Anwaruddin S.; Thourani V.H.; Nazif
T.; Mangner N.; Woitek F.; Krishnaswamy A.; Mick S.; Chakravarty T.;
Nakamura M.; McCabe J.M.; Satler L.; Zajarias A.; Szeto W.Y.; Svensson L.;
Alu M.C.; White R.M.; Kraemer C.; Parhizgar A.; Leon M.B.; Linke A.;
Al-Jilaihawi H.; Tuzcu E.M.; Babaliaros V.; Devireddy C.; Mavromatis K.;
Waksman R.; Pichard A.; Vallabhajosyula P.; Giri J.; Herrmann H.; Lasala
J.; Greenbaum A.; O'Neill W.; Eng M.; Rovin J.; Lin L.; Spriggs D.; Wong
S.-C.; Bergman G.; Salemi A.; Smalling R.; Kar B.; Loyalka P.; Lim D.S.;
Ragosta M.; Reisman M.; Don C.; Sharma S.; Kini A.; Dangas G.; Mahoney P.;
Morse A.; Stankewicz M.; Rodriguez E.; Frerker C.; Cohen D.
Institution
(Kapadia, Krishnaswamy, Mick, Svensson) Cleveland Clinic, Cleveland, Ohio,
United States
(Kodali, Lazar, Nazif, Alu, Leon) Columbia University Medical Center, New
York, New York, United States
(Makkar, Chakravarty, Nakamura) Cedars-Sinai Medical Center, Los Angeles,
California, United States
(Mehran) Mount Sinai School of Medicine, New York, New York, United States
(Zivadinov, Dwyer) Buffalo Neuroimaging Analysis Center, Buffalo, New
York, United States
(Jilaihawi) NYU Langone Medical Center, New York, New York, United States
(Virmani) CV Path Institute, Gaithersburg, Maryland, United States
(Anwaruddin, Szeto) University of Pennsylvania, Philadelphia,
Pennsylvania, United States
(Thourani) Emory University, Atlanta, Georgia
(Mangner, Woitek, Linke) Herzzentrum Leipzig GmbH-Universitatsklinik,
Leipzig, Germany
(McCabe) University of Washington, Seattle, Washington, United States
(Satler) Medstar Washington Hospital Center, Washington, DC, United States
(Zajarias) Washington University School of Medicine, St. Louis, Missouri,
United States
(White) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Kraemer) NAMSA, Minneapolis, Minnesota, United States
(Parhizgar) Claret Medical, Inc., Santa Rosa, California, United States
(Linke) Leipzig Heart Institute, Leipzig, Germany
Publisher
Elsevier Inc.
Abstract
Background Neurological complications after transcatheter aortic valve
replacement (TAVR) may be reduced with transcatheter cerebral embolic
protection (TCEP). Objectives This study evaluated the safety and efficacy
of TCEP during TAVR. Methods Nineteen centers randomized 363 patients
undergoing TAVR to a safety arm (n = 123), device imaging (n = 121), and
control imaging (n = 119). The primary safety endpoint consisted of major
adverse cardiac and cerebrovascular events (MACCE) at 30 days, and the
primary efficacy endpoint was reduction in new lesion volume in protected
brain territories on magnetic resonance imaging scans at 2 to 7 days.
Patients underwent neurocognitive assessments, and the debris captured was
analyzed. Results The rate of MACCE (7.3%) was noninferior to the
performance goal (18.3%, p<inf>noninferior</inf> < 0.001) and not
statistically different from that of the control group (9.9%; p = 0.41).
New lesion volume was 178.0 mm3 in control subjects and 102.8
mm3 in the device arm (p = 0.33). A post hoc multivariable
analysis identified pre-existing lesion volume and valve type as
predictors of new lesion volume. Strokes at 30 days were 9.1% in control
subjects and 5.6% in patients with devices (p = 0.25) Neurocognitive
function was similar in control subjects and patients with devices, but
there was a correlation between lesion volume and neurocognitive decline
(p = 0.0022). Debris found within filters in 99% of patients included
thrombus, calcification, valve tissue, artery wall, and foreign material.
Conclusions TCEP was safe, captured embolic debris in 99% of patients, and
did not change neurocognitive function. Reduction in new lesion volume on
magnetic resonance scans was not statistically significant. (Cerebral
Protection in Transcatheter Aortic Valve Replacement [SENTINEL];
NCT02214277) Copyright © 2017 American College of Cardiology
Foundation

<62>
Accession Number
604399108
Title
Improvement in quality of life in old people with aortic stenosis after
transcatheter aortic valve implantation.
Source
Current Signal Transduction Therapy. 9 (3) (pp 164-171), 2014. Date of
Publication: 01 Mar 2014.
Author
Li Y.; Guo W.; Zhang T.; Liu J.; Jia S.; Liu X.; Jia X.
Institution
(Li, Guo, Zhang, Liu, Jia, Liu, Jia) Department of Vascular Surgery,
Clinical Division of Surgery, Chinese PLA General Hospital, 28 Fuxing
Road, Beijing 100853, China
(Zhang, Liu) Department of Vascular Surgery, Peking University People's
Hospital, Beijing, China
Publisher
Bentham Science Publishers
Abstract
Background: This study aimed to compare the improvement in the quality of
life (QoL) in the long-term follow-up of 12 to 24 months after
transcatheter aortic valve implantation (TAVI) therapy for old people with
severe aortic stenosis. Method(s): According to the guidelines
provided by PRISMA, published studies till 15 June, 2014 were retrieved
from Google Scholar, Pubmed, Embase and CNKI. Health-related QoL was
evaluated at beginning and at 12 to 24 months with five kinds of
instruments. Funnel plots were used to test the potential publication
bias, and analyze the source of heterogeneity, such as meta-regression,
subgroup and sensitivity. Result(s): Our meta-analysis involved ten
studies with 1359 patients. Preprocedural summary 12-item Short Form
(SF-12) physical and mental scores showed a significant improvement after
one year after TAVI [weighted mean difference (WMD): -10.61, 95%
confidence interval (CI): -15.06, -6.15; WMD: -6.39, 95%CI: -9.08, -3.70;
respectively]. One year follow-up visit after TAVI revealed significantly
improved QoL compared to baseline in Kansas City Cardiomyopathy
Questionnaire (KCCQ) and EuroQol (EQ-5D) (WMD: -29.44, 95%CI: -33.29,
-26.58; WMD: -0.09, 95%CI: -0.12, -0.06; respectively). At 12 to 24
months, weighted mean 36-item Short-Form (SF-36) physical improved by
16.96 points (95%CI: -27.77, -6.16) and SF-36-mental improved by 5.57
points (95%CI: -9.96, -1.19); weighted mean Minnesota Living with Heart
Failure Questionnaire (MLHFQ) decreased by 22.29 points (95%CI: 16.09,
28.48). Conclusion(s): This technique provides a promising therapy
approach for old patients with severe symptomatic aortic stenosis in
high-risk surgery, and there are significant improvements for this group
in health-related quality of life in the follow-up. Copyright ©
2014 Bentham Science Publishers.

<63>
Accession Number
2010387260
Title
Continuous positive airway pressure treatment and anxiety in adults with
coronary artery disease and nonsleepy obstructive sleep apnea in the
RICCADSA trial.
Source
Sleep Medicine. 77 (pp 96-103), 2021. Date of Publication: January 2021.
Author
Celik Y.; Thunstrom E.; Strollo P.J.; Peker Y.
Institution
(Celik, Peker) Koc University Research Center for Translational Medicine
(KUTTAM), Istanbul, Turkey
(Thunstrom, Peker) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Sweden
(Strollo, Peker) Dept of Clinical Sciences, Respiratory Medicine and
Allergology, Faculty of Medicine, Lund University, Lund, Sweden
(Peker) Division of Pulmonary, Allergy, and Critical Care Medicine,
University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
Publisher
Elsevier B.V.
Abstract
Background: Anxiety and obstructive sleep apnea (OSA) coexist among adults
with coronary artery disease (CAD) following revascularization. Continuous
positive airway pressure (CPAP) is the first line treatment of OSA
patients with daytime sleepiness. The current study evaluated the effect
of CPAP on anxiety in CAD patients with nonsleepy OSA. Method(s): Two
hundred forty-four revascularized CAD patients with nonsleepy OSA
(apnea-hypopnea index >=15/h, Epworth Sleepiness Scale score <10) were
randomly assigned to CPAP or no-CPAP between 2005 and 2010. Zung
Self-rating Anxiety Scale (SAS) was administered at baseline and after 3
and 12 months with higher scores suggesting more anxiety. Result(s):
A total of 208 patients with complete SAS scores at baseline and 12-month
follow-up were included (CPAP, n = 103; no-CPAP, n = 105). In the
intention-to-treat analysis, CPAP had no significant effect on the SAS
scores. On-treatment analysis revealed a significant increase in the
median of delta SAS score (+3.75) after three months among the
participants using the device 2.8 h/day or more while there was a decline
in the median of delta SAS score (-1.25) in the non-adherent or no-CPAP
group (p = 0.031). The increase in the SAS score (+1.25) in the adherent
group, and the decline (-1.25 points) in the non-adherent/no-CPAP group
remained significant after one year (p = 0.011). Baseline SAS score
predicted non-adherence [adjusted odds ratio 1.11; 95% confidence interval
(CI) 1.04-1.18; p = 0.003], and there was an association between the
increase in the SAS scores and accumulated CPAP hours/day [standardized
beta = 0.144 (95% CI 0.005-0.695), p = 0.047]. Conclusion(s): Our
results suggest that anxiety should be considered in the management of CAD
patients with nonsleepy OSA following revascularization. Clinical trial
registration: NCT00519597. Copyright © 2020 Elsevier B.V.

<64>
Accession Number
2008345969
Title
Electromagnetic versus blind guidance of a postpyloric feeding tube in
critically ill children.
Source
Pediatrics. 146 (4) (no pagination), 2020. Article Number: e20193773. Date
of Publication: 01 Dec 2020.
Author
Jha P.; Rupp L.; Bonilla L.; Gelfond J.; Shah J.N.; Meyer A.D.
Institution
(Jha) Division of Critical Care, Department of Pediatrics, Children's
Hospital of Nevada, University Medical Center, Las Vegas, NV, United
States
(Jha) Department of Pediatrics, University of Nevada Las Vegas School of
Medicine, Las Vegas, NV, United States
(Rupp, Bonilla, Shah, Meyer) Pediatric Services, University Health System,
San Antonio, TX, United States
(Shah) Division of Pediatric Gastroenterology, University of Texas Health
San Antonio, San Antonio, TX, United States
(Meyer) Division of Pediatric Critical Care, Department of Pediatrics,
University of Texas Health San Antonio, San Antonio, TX, United States
(Gelfond) Department of Epidemiology and Biostatistics, University of
Texas Health San Antonio, San Antonio, TX, United States
Publisher
American Academy of Pediatrics
Abstract
BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a
time-consuming procedure associated with multiple attempts and radiation
exposure. Our objective with this study is to compare the time, attempts,
and radiation exposure using the electromagnetic versus blind method to
place a postpyloric feeding tube in critically ill children. Our
hypothesis is that using electromagnetic guidance decreases the procedure
time, number of x-rays, and number of attempts, compared to the blind
method. METHOD(S): Eleven pediatric nurses participated in a
randomized controlled intention-to-treat study at an academic pediatric
medical, surgical, and congenital cardiac ICU. University of Texas Health
Epidemiology and Biostatistics generated a randomization sequence with
sealed envelopes. A standard (2-sided) F-test of association between the
electromagnetic and blind method yielded 40 subjects with 86% power. Data
were analyzed with Fisher's exact test for categorical variables and the
Wilcoxon rank test for continuous variables, with data documented as
median (interquartile range [IQR]). RESULT(S): We randomly assigned
52 patients to either the electromagnetic (n = 28) or blind method (n =
24). The number of attempts and radiographs was at a median of 2 (IQR:
1-2.25) using the blind method, compared to the electromagnetic method at
a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with
the electromagnetic method, compared to only 66.7% with the blind
technique (P = .008). The total time required was 2.5 minutes (IQR:
2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR:
9.25-27.0) for the blind method (P = .001). CONCLUSION(S):
Electromagnetic guidance is a superior, faster, and overall safer method
to place a postpyloric feeding tube in critically ill
children. Copyright © 2020 by the American Academy of Pediatrics.

<65>
Accession Number
2008509573
Title
The protective effect of hypothermia on postoperative cognitive deficit
may be attenuated by prolonged coronary artery bypass time: Meta-analysis
and meta-regression.
Source
Advances in Clinical and Experimental Medicine. 29 (10) (pp 1211-1219),
2020. Date of Publication: 2020.
Author
Habibi V.; Habibi M.R.; Habibi A.; Zeydi A.E.
Institution
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Anesthesiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Student Research Committee, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Nasibeh School of Nursing
and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
Publisher
Wroclaw University of Medicine
Abstract
There is controversy about whether hypothermia during coronary artery
bypass grafting (CABG) surgery is effective in reducing postoperative
cognitive deficit (POCD). The objective of this study was to determine the
effect of hypothermia on POCD and to undertake a meta-regression to
determine whether moderator variables mediate the relationship between
hypothermia and POCD. We searched the Web of Science, PubMed database,
Scopus, and the Cochrane Library database (up to June 2017), and
systematically reviewed a list of retrieved articles. Our final review
includes only randomized controlled trials (RCTs) that compared
administration of hypothermia (34degreeC). Statistical analysis of the
risk ratio (RR) and corresponding 95% confidence interval (95% CI) was
used to report the overall effect. Mantel-Haenszel risk ratio (MH RR) and
corresponding 95% CI was used to report the overall effect and
meta-regression analysis. Eight RCTs were included in this study, with a
total of 1,474 patients. The POCD occurred in 36.06% of all cases. A wide
range of hypothermia (28-34degreeC) did not reduce the occurrence of POCD
(RR = 0.983 (95% CI = 0.881-1.143); Z = -0.304; P = 0.761; I2 =
38%). Shorter CPB time reduced the occurrence of POCD (MH log risk ratio =
-0.011 (95% CI = -0.021--0.0008); Z = -2.123; P = 0.033). Postoperative
cognitive deficit is a common event among CABG patients. Contrary to deep
hypothermia, mild hypothermia was significantly effective in reducing the
risk of POCD. The neuroprotective effect of hypothermia on POCD may be
attenuated by prolonged cardiopulmonary bypass (CPB) time. Copyright
© 2020 by Wroclaw Medical University This is an article distributed
under the terms of the Creative Commons Attribution 3.0 Unported (CC BY
3.0) (https://creativecommons.org/licenses/by/3.0/)

<66>
Accession Number
2008500782
Title
Influence of EPICardial adipose tissue in HEART diseases (EPICHEART)
study: Protocol for a translational study in coronary atherosclerosis.
Source
Revista Portuguesa de Cardiologia. 39 (11) (pp 625-633), 2020. Date of
Publication: November 2020.
Author
Mancio J.; Barros A.S.; Conceicao G.; Santa C.; Pessoa-Amorim G.; Bartosch
C.; Fragao-Marques M.; Ferreira W.; Carvalho M.; Ferreira N.; Vouga L.;
Miranda I.M.; Vitorino R.; Fontes-Carvalho R.; Manadas B.; Falcao-Pires
I.; Ribeiro V.G.; Leite-Moreira A.; Bettencourt N.
Institution
(Mancio, Barros, Conceicao, Pessoa-Amorim, Fragao-Marques, Miranda,
Vitorino, Fontes-Carvalho, Falcao-Pires, Leite-Moreira, Bettencourt)
Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC),
Faculty of Medicine, University of Porto, Portugal
(Mancio, Ferreira, Carvalho, Ferreira, Fontes-Carvalho, Ribeiro)
Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
(Santa, Manadas) CNC - Center for Neuroscience and Cell Biology,
University of Coimbra, Coimbra, Portugal
(Bartosch) Department of Pathology, Portuguese Oncology Institute of
Porto, Porto, Portugal
(Vouga) Department of Cardiothoracic Surgery, Centro Hospitalar de Vila
Nova de Gaia, Portugal
(Leite-Moreira) Cardiothoracic Surgery, Centro Hospitalar de Sao Joao,
Portugal
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: Accumulation of epicardial adipose tissue (EAT) is
associated with coronary artery disease (CAD) and increased risk of
coronary events in asymptomatic subjects and low-risk patients, suggesting
that EAT promotes atherosclerosis in its early stage. Recent studies have
shown that the presence of CAD affects the properties of adjacent EAT,
leading to dynamic changes in the molecular players involved in the
interplay between EAT and the coronary arteries over the history of the
disease. The role of EAT in late-stage CAD has not been investigated.
 Objective(s): In a comparative analysis with mediastinal and
subcutaneous adipose tissue, we aim to investigate whether the volume of
EAT assessed by computed tomography and its proteome assessed by SWATH-MS
mass spectrometry are associated with late stages of CAD in an elderly
cohort of severe aortic stenosis patients. Method(s): The EPICHEART
study (NCT03280433) is a prospective study enrolling patients with severe
degenerative aortic stenosis referred for elective aortic valve
replacement, whose protocol includes preoperative clinical, nutritional,
echocardiographic, cardiac computed tomography and invasive coronary
angiographic assessments. During cardiac surgery, samples of EAT and
mediastinal and subcutaneous thoracic adipose tissue are collected for
proteomics analysis by SWATH-MS. In addition, pericardial fluid and
peripheral and coronary sinus blood samples are collected to identify
circulating and local adipose tissue-derived biomarkers of CAD.
 Conclusion(s): We designed a translational study to explore the
association of EAT quantity and quality with advanced CAD. We expect to
identify new biochemical factors and biomarkers in the crosstalk between
EAT and the coronary arteries that are involved in the pathogenesis of
late coronary atherosclerosis, especially coronary calcification, which
might be translated into new therapeutic targets and imaging tools by
biomedical engineering. Copyright © 2020

<67>
Accession Number
2006942188
Title
A Systematic Review and Meta-Analysis of Transcarotid Artery
Revascularization with Dynamic Flow Reversal Versus Transfemoral Carotid
Artery Stenting and Carotid Endarterectomy.
Source
Annals of Vascular Surgery. 69 (pp 426-436), 2020. Date of Publication:
November 2020.
Author
Naazie I.N.; Cui C.L.; Osaghae I.; Murad M.H.; Schermerhorn M.; Malas M.B.
Institution
(Naazie, Malas) Division of Vascular and Endovascular Surgery, Department
of Surgery, University of California San Diego Health System, San Diego,
CA, United States
(Cui) School of Medicine, University of California San Diego, San Diego,
CA, United States
(Osaghae) Department of Epidemiology, Human Genetics and Environmental
Sciences, University of Texas Health Science Center School of Public
Health, Houston, TX, United States
(Murad) Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, United
States
(Schermerhorn) Division of Vascular and Endovascular Surgery, Department
of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical
School, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Transfemoral carotid artery stenting (TFCAS) was introduced as
a less invasive option for carotid revascularization in patients at high
risk for complications from carotid endarterectomy (CEA). The increased
perioperative stroke and death risk of TFCAS has however prevented TFCAS
from widespread acceptance as an alternative to CEA in high-risk patients.
Recent research suggests that transcarotid artery revascularization (TCAR)
may be associated with a low stroke and death risk and potentially meet
the needs of patients at high surgical risk. We aimed to estimate the
30-day risk of stroke or death of TCAR and compare it to TFCAS and CEA.
 Method(s): We searched PubMed, Cochrane, Embase, and Scopus for
studies of patients treated with TCAR. Meta-analysis was conducted when
appropriate. A logistic-normal random-effects model with logit
transformation was used to estimate the pooled event rates after TCAR.
Pooled Mantel-Haenszel odds ratios (ORs) of events comparing TCAR to TFCAS
and CEA were calculated using a fixed-effects model. Heterogeneity among
studies was quantified with the chi-squared statistic of the likelihood
ratio (LR) test that compares the random-effects and fixed-effects models.
 Result(s): Nine nonrandomized studies evaluating 4012 patients who
underwent TCAR were included. The overall 30-day risks after TCAR were
stroke/death, 1.89% (95% confidence interval [CI]: 1.50, 2.37); stroke,
1.34% (95% CI: 1.02,1.75); death, 0.76% (95% CI: 0.56, 1.08); myocardial
infarction (MI), 0.60% (95% CI: 0.23, 1.59); stroke/death/MI, 2.20% (95%
CI: 1.31, 3.69); cranial nerve injury (CNI), 0.31% (95% CI: 0.12, 0.83).
The failure rate of TCAR was 1.27% (95% CI: 0.32, 4.92). Two nonrandomized
studies suggested that TCAR was associated with lower risk of stroke and
death as compared with TFCAS (1.33% vs. 2.55%, OR: 0.52, 95% CI: 0.36,
0.74 and 0.76% vs. 1.46%, OR: 0.52, 95% CI: 0.32, 0.84, respectively).
Four nonrandomized studies suggested that TCAR was associated with a lower
risk of CNI (0.54% and 1.84%, OR: 0.52, 95% CI: 0.36, 0.74) than CEA, but
no statistically significant difference in the 30-day risk of stroke,
stroke/death, or stroke/death/MI. Conclusion(s): Among patients
undergoing TCAR with dynamic flow reversal for carotid stenosis the 30-day
risk of stroke or death was low. The perioperative stroke/death rate of
TCAR was similar to that of CEA while CNI risk was lower. Larger
prospective studies are needed to account for confounding factors and
provide higher certainty. Copyright © 2020 Elsevier Inc.

<68>
Accession Number
2006842701
Title
Long-Term Graft Patency After Off-Pump and On-Pump Coronary Artery Bypass:
A CORONARY Trial Cohort.
Source
Annals of Thoracic Surgery. 110 (6) (pp 2055-2061), 2020. Date of
Publication: December 2020.
Author
Yang L.; Lin S.; Zhang H.; Gu D.; Chen S.; Shi Y.; Zheng Z.
Institution
(Yang, Lin, Zhang, Gu, Chen, Shi, Zheng) National Clinical Research Center
of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Publisher
Elsevier Inc.
Abstract
Background: Randomized controlled trials have compared the early and
midterm prognosis of on-pump coronary artery bypass grafting (CABG) and
off-pump CABG. However the results are controversial, and there is limited
information on graft patency and long-term outcomes. Method(s):
Between May 2007 and October 2011, 349 patients were randomized to
off-pump or on-pump CABG as part of the CORONARY trial at Fuwai Hospital.
The primary outcome was coronary bypass graft patency, which was assessed
at a mean of 6.7 +/- 1.7 years after surgery by multidetector computed
tomography. A secondary endpoint was a composite outcome of death,
nonfatal myocardial infarction, repeat coronary revascularization, or
stroke; mean follow-up was 6.5 +/- 1.7 years. Graft patency was compared
between the off-pump and on-pump CABG treatment arms in 206 patients with
follow-up computed tomography. Result(s): During the follow-up period
107 patients were in the off-pump CABG group and 99 in the on-pump group.
These patients underwent a total of 723 grafts, and the overall rate of
graft patency did not differ significantly between the off-pump and
on-pump groups (87.4% vs 88.9%, P = .527). The patency rate of the
posterior descending branch was lower than average. Higher incidences of
mortality, nonfatal myocardial infarction, and repeat revascularization
were found in the off-pump patients; however it did not reach
significance. Conclusion(s): There were no statistical differences in
graft patency rates in off-pump versus on-pump CABG patients during
long-term follow-up. The on-pump CABG group appeared to have a better
long-term prognosis even with no statistical differences for the limited
study population. Copyright © 2020 The Society of Thoracic
Surgeons

<69>
Accession Number
2006749400
Title
Gut microbiota-derived trimethylamine N-oxide is associated with poor
prognosis in patients with heart failure.
Source
Medical Journal of Australia. 213 (8) (pp 374-379), 2020. Date of
Publication: 01 Oct 2020.
Author
Li W.; Huang A.; Zhu H.; Liu X.; Huang X.; Cai X.; Lu J.; Huang Y.
Institution
(Li, Huang, Zhu, Liu, Huang, Huang, Cai, Lu, Huang) Shunde Hospital of
Southern Medical University, Foshan (Guangdong), China
(Huang) George Institute for Global Health, Sydney, NSW, Australia
Publisher
John Wiley and Sons Inc
Abstract
Objective: Gut microbiota-produced trimethylamine N-oxide (TMAO) is a risk
factor for cardiovascular events. However, conflicting findings regarding
the link between plasma TMAO level and prognosis for patients with heart
failure have been reported. We examined the association of plasma TMAO
concentration with risk of major adverse cardiac events (MACEs) and
all-cause mortality in patients with heart failure. Study design:
Meta-analysis of prospective clinical studies. Data sources: We searched
electronic databases (PubMed, EMBASE) for published prospective studies
examining associations between plasma TMAO level and MACEs and all-cause
mortality in adults with heart failure. Data synthesis: Hazard ratios
(HRs) with 95% confidence intervals for associations between TMAO level
and outcomes were estimated in random effects models. In seven eligible
studies including a total of 6879 patients (median follow-up, 5.0 years)
and adjusted for multiple risk factors, higher plasma TMAO level was
associated with greater risks of MACEs (TMAO tertile 3 v tertile 1: HR,
1.68; 95% CI, 1.44-1.96; per SD increment: HR, 1.26; 95% CI, 1.18-1.36)
and of all-cause mortality (TMAO tertile 3 v tertile 1: HR, 1.67; 95% CI,
1.17-2.38; per SD increment: HR, 1.26; 95% CI, 1.07-1.48). Higher TMAO
level was also associated with greater risk of MACEs after adjusting for
estimated glomerular filtration rate (eGFR; six studies included);
however, the heterogeneity of studies in which risk was adjusted for eGFR
was significant (I2 = 76%). Conclusion(s): Elevated plasma
TMAO level in patients with heart failure is associated with poorer
prognoses. This association is only partially mediated by renal
dysfunction. Copyright © 2020 AMPCo Pty Ltd

<70>
Accession Number
2004841038
Title
Nursing guidelines on cardiac surgery and parents' anxiety: Randomized
clinical trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (4) (pp 437-444), 2020.
Date of Publication: 2020.
Author
Xavier I.B.M.; Biscarra V.B.; Piccoli A.B.; Rodrigues C.G.; Hirakata V.N.;
de Moraes M.A.P.; Pellanda L.C.
Institution
(Xavier, Biscarra, Piccoli, de Moraes, Pellanda) Instituto de
Cardiologia/Fundacao, Universitaria de Cardiologia - IC/FUC, Porto Alegre,
RS, Brazil
(Rodrigues, Pellanda) Universidade Federal de Ciencias da Saude de Porto
Alegre, Porto Alegre, RS, Brazil
(Hirakata) Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Objective: The preparation of parents of children who should undergo
cardiac surgery requires special treatment such as the explanations about
the event. This study aims to compare the effects of standardized nursing
guidelines with routine institutional orientation on the anxiety of
parents of children undergoing cardiac surgery. Method(s): Randomized
clinical trial. The sample consisted of parents of children who underwent
cardiac surgery from December 2010 to April 2011. Twenty-two parents were
randomized to the intervention group (IG) and received the standard
nursing guidelines and 22 participated in the control group (CG) and
received the routine guidelines from the institution. Anxiety was assessed
by the State-Trait Anxiety Inventory (STAI) applied in the preoperative
period, between 12 and 20 hours before surgery and before receiving
standard or institutional guidelines and 48 hours after surgery. The
analysis of variance (ANOVA) for repeated measures was performed to
evaluate the differences between the variations in STAI scores between the
groups during the studied period. The level of significance was 0.05.
 Result(s): There were no significant differences in baseline anxiety
scores between groups with regard to trait anxiety as well as state
anxiety: STAI-trait (CG 42.6+/-4.9 vs. IG 41.4+/-6.0, P=0.48); STAI-state
(CG 42.3+/-5.7 vs. IG 45.6+/-8.3, P=0.18). Likewise, the variation in
score after 48 hours was similar between groups (STAI-trait P=0.77;
STAI-state P=0.61). Conclusion(s): There were no significant
differences in the parents' anxiety levels when comparing the two types of
guidelines: the standard nursing and the institutional
orientation. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<71>
Accession Number
2003642921
Title
"The heart supporters": systematic review for ventricle assist devices in
congenital heart surgery.
Source
Heart Failure Reviews. 25 (6) (pp 1027-1035), 2020. Date of Publication:
01 Nov 2020.
Author
Comentale G.; Giordano R.; Pilato E.; D'Amore A.; Romano R.; Simeone S.;
Browning R.; Palma G.; Iannelli G.
Institution
(Comentale, Giordano, Pilato, D'Amore, Simeone, Palma, Iannelli) Division
of Cardiac Surgery, University of Napoli "Federico II", Sergio Pansini
ndegree5, Napoli 80131, Italy
(Romano) Division of Pediatrics, University of Napoli "Federico II",
Sergio Pansini ndegree5, Napoli 80131, Italy
(Browning) Division of Cardiovascular Perfusion, The Royal Brompton,
London, United Kingdom
Publisher
Springer
Abstract
Ventricular assist device (VAD) implantation is a widely used procedure in
children with cardiac failure refractory to medical therapy as a long-term
bridge to recovery or transplant. This strategy has proved to be of an
enormous advantage in the cure of these children. The aim of this review
is to evaluate the current strategies used for clinical monitoring of
paediatric patients with a VAD, focusing on the management of several
aspects such as anticoagulant and antiplatelet therapy, haemorrhagic and
thrombotic complications, as well as the effects that VADs have on the
exposure, effectiveness and the safety of drugs. The sources used for this
research are MEDLINE, PubMed and Cochrane Library. The use of key words
such as "paediatric ventricular assist device", "clinical management",
"anticoagulant therapy" and "infections" retrieved 146 papers. With the
application of the inclusion criteria, 42 articles have been selected, but
following further analysis, only 21 were eligible. The post-implant
process is still complicated due to the lack of guidelines regarding
clinical management and for the frequent occurrence of adverse events
including bleeding, infection and thromboembolic episodes. From these
findings, we can highlight the importance of establishing a suitable
antithrombotic therapy, as well as ensuring that the prevention and
treatment of infection are paramount during the management of these
patients. The clinical management of VAD paediatric children is complex
and challenging. At the moment, there are no guidelines regarding
strategies to adopt, but from the analysed surveys, it has been possible
to highlight a relative coherence between adopted therapies in different
centres worldwide. Copyright © 2019, Springer Science+Business
Media, LLC, part of Springer Nature.

<72>
Accession Number
633332716
Title
Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): Study protocol
for a multicentre randomised, blind, placebo-controlled trial.
Source
BMJ Open. 10 (11) (no pagination), 2020. Article Number: e040914. Date of
Publication: 03 Nov 2020.
Author
Ishii K.; Yokoyama Y.; Yonekawa Y.; Ebata T.
Institution
(Ishii, Yokoyama, Yonekawa, Ebata) Surgical Oncology, Nagoya University
Graduate School of Medicine, Nagoya, Japan
Publisher
BMJ Publishing Group
Abstract
Introduction Pancreaticoduodenectomy (PD) is a major gastroenterological
surgery that results in a substantial amount of blood loss. Several
studies have demonstrated that major blood loss during PD is associated
with both short-term and long-term poor outcomes. Administration of
perioperative tranexamic acid (TXA) has been reported to reduce
intraoperative blood loss in various surgeries, including cardiovascular
surgery and orthopaedic surgery. Nevertheless, the effect of perioperative
TXA use in patients undergoing PD has not been investigated. This study
aims to investigate the effect of TXA on blood loss during PD. Methods and
analysis A multicentre (six hospitals), randomised, blind
(patient-blinded, surgeon-blinded, anaesthesiologist-blinded,
monitor-blinded), placebo-controlled trial of TXA during PD was started in
September 2019. Patients undergoing PD for biliary, duodenal or pancreatic
diseases are randomly assigned to the TXA or placebo group. The
stratification factors are the institutions and preoperative clinical
diagnosis. Before skin incision, the participants in TXA group are
administrated 1 g TXA as a loading infusion followed by a maintenance
infusion of 125 mg/hour TXA until the end of surgery or 8 hours from the
incision. Participants in the placebo group are administrated the same
volume of saline that is indistinguishable from the TXA. The primary
outcome is blood loss during PD. The secondary outcomes are intraoperative
and postoperative (up to day 2) blood transfusions, operation time,
anaesthesia time, postoperative laboratory variables, length of hospital
stay, in-hospital and 90-day mortality and postoperative complications
occurring within 28 days of surgery or requiring readmission. To date, 115
patients of a planned 220 have been enrolled in the study. Ethics and
dissemination This protocol was approved by the Nagoya University Clinical
Research Review Board and is registered with Japan Registry of Clinical
Trials on 15 August 2019. The results of this trial will be disseminated
through peer-reviewed journals. Trial registration number
jRCTs041190062. Copyright © 2020 American Institute of Physics
Inc.. All rights reserved.

<73>
Accession Number
633130272
Title
Substitution of propofol for dexmedetomidine in the anaesthetic regimen
does not ameliorate the post-operative cognitive decline in elderly
patients.
Source
Indian Journal of Anaesthesia. 64 (10) (pp 880-886), 2020. Date of
Publication: October 2020.
Author
Chawdhary A.A.; Kulkarni A.; Nozari A.
Institution
(Chawdhary) Department of Anaesthesiology and Critical Care, Dr. Baba
Saheb Ambedkar Hospital and Medical College, Rohini, Delhi, India
(Kulkarni) Department of Anaesthesiology, Rajiv Gandhi Cancer Institute
and Research Centre, Rohini, Delhi, India
(Nozari) Department of Anaesthesiology, Boston University School of
Medicine, Boston, MA, United States
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Post-operative cognitive dysfunction (POCD) is a
poorly understood complication particularly observed in elderly patients,
with long-term poor outcome. The randomised study was to compare the
incidence of POCD in elderly with bispectral index (BIS)-guided
intra-operative use of either dexmedetomidine or propofol with
sevoflurane. Method(s): Eighty-seven patients, planned for
non-cardiac surgery under general anaesthesia, were included between June
2017 and March 2018. After exclusion of 7 patients, remaining 80 patients
were randomised into dexmedetomidine group and propofol group with 40
patients each. In both the groups, BIS-guided anaesthesia was provided.
Cognitive function was assessed by an anaesthesiologist using a battery of
neuropsychological tests at baseline pre-operatively, third and seventh
day after surgery. The data were entered into a Microsoft Excel
spreadsheet and analysis was performed using Statistical Package for
Social Sciences (SPSS) version 21. Result(s): Propofol group had a
non-significant lower incidence of POCD on third day and dexmedetomidine
group showed decreased incidence of POCD on seventh day, accompanied by
lower anaesthetic requirement (inhalational as well as intravenous)
concomitant with delayed emergence with an acceptable BIS value.
 Conclusion(s): Dexmedetomidine appeared to be anaesthetic sparing as
compared to propofol. BIS monitoring for titrating depth of anaesthesia
and hence the anaesthetic exposure is an invaluable tool as compared to
routine care anaesthesia for reducing POCD. The patients in both groups
did not develop significant POCD until the seventh post-operative
day. Copyright © 2020 Indian Journal of Anaesthesia 
Published by Wolters Kluwer - Medknow

<74>
Accession Number
2005976376
Title
Perioperative probiotic treatment decreased the incidence of postoperative
cognitive impairment in elderly patients following non-cardiac surgery: A
randomised double-blind and placebo-controlled trial.
Source
Clinical Nutrition. 40 (1) (pp 64-71), 2021. Date of Publication: January
2021.
Author
Wang P.; Yin X.; Chen G.; Li L.; Le Y.; Xie Z.; Ouyang W.; Tong J.
Institution
(Wang, Yin, Chen, Li, Le, Ouyang, Tong) Department of Anesthesiology, The
Third Xiangya Hospital of Central South University, Changsha, Hunan, China
(Wang, Tong) Hunan Province Key Laboratory of Brain Homeostasis, Third
Xiangya Hospital, Central South University, Changsha, Hunan, China
(Tong) Center for Experimental Medicine, Third Xiangya Hospital, Central
South University, Changsha, Hunan, China
(Xie) Geriatric Anesthesia Research Unit, Department of Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital and
Harvard Medical School, Charlestown, United States
Publisher
Churchill Livingstone
Abstract
Background: Given that population aging is a global health challenge, the
high prevalence of postoperative neurocognitive impairment in elderly
patients necessitates the development of novel simple and effective
prevention methods. Objective(s): To evaluate the effects of
perioperative application of oral probiotic as a prophylaxis for cognitive
impairment in elderly patients following non-cardiac surgery.
 Method(s): This randomised double-blind and placebo-controlled trial
included 120 elderly patients (in a modified intention-to-treat analysis)
scheduled for elective orthopaedic or colorectal surgery. Patients were
assigned to receive either probiotics or a placebo from hospital admission
until discharge. The primary endpoint was the incidence of postoperative
cognitive impairment, defined as a decrease of >=3 points in the
Mini-Mental State Examination (MMSE) scores from admission baseline to the
7th day post-surgery. Secondary endpoints included changes in plasma
interleukin-6 (IL-6) and cortisol, postoperative pain intensity,
postoperative sleep quality, gastrointestinal function recovery, and
faecal microbiota composition. Result(s): The incidence of
postoperative cognitive impairment in the probiotic group was
significantly lower than in the control group (3 of 59 patients [5.1%] vs.
10 of 61 patients [16.4%], P = 0.046). In addition, compared to
pre-surgery, the levels of plasma IL-6 and cortisol in the probiotic group
decreased more than in the control group 5-7 days after surgery (IL-6:
-117.90 +/- 49.15 vs. -14.93 +/- 15.21, P = 0.044; cortisol: -158.70 +/-
53.52 vs. 40.98 +/- 72.48, P = 0.010). Relative abundance at the genus
level in the faeces of the probiotic group also changed more than in that
of the control group during the perioperative period. In contrast,
postoperative pain intensity, sleep quality, and gastrointestinal function
recovery did not differ significantly between the two groups.
 Conclusion(s): Perioperative application of oral probiotic prevents
postoperative cognitive impairment in elderly patients following
non-cardiac surgery, possibly via the limitation of peripheral
inflammation and the stress response. Copyright © 2020 Elsevier
Ltd and European Society for Clinical Nutrition and Metabolism

<75>
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. 42 (12) (pp 2298-2310), 2020. Date of Publication:
December 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.
 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. 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. Copyright © 2020 Elsevier Inc.

<76>
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. 9 (6) (pp 3909-3914), 2020. Date of
Publication: 01 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). 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. 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. 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.

<77>
Accession Number
2010172651
Title
Impact of COPD on Outcomes After MitraClip for Secondary Mitral
Regurgitation: The COAPT Trial.
Source
JACC: Cardiovascular Interventions. 13 (23) (pp 2795-2803), 2020. Date of
Publication: 14 Dec 2020.
Author
Saxon J.T.; Cohen D.J.; Chhatriwalla A.K.; Kotinkaduwa L.N.; Kar S.; Lim
D.S.; Abraham W.T.; Lindenfeld J.; Mack M.J.; Arnold S.V.; Stone G.W.
Institution
(Saxon, Chhatriwalla, Arnold) Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Saxon, Cohen, Chhatriwalla, Arnold) University of Missouri-Kansas City,
Kansas City, MO, United States
(Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to examine the relationship between
chronic obstructive pulmonary disease (COPD) and outcomes after
transcatheter mitral valve repair (TMVr) for severe secondary mitral
regurgitation. Background(s): TMVr with the MitraClip improves
clinical and health-status outcomes in patients with heart failure and
severe (3+ to 4+) secondary mitral regurgitation. Whether these benefits
are modified by COPD is unknown. Method(s): COAPT (Cardiovascular
Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart
Failure Patients With Functional Mitral Regurgitation) was an open-label,
multicenter, randomized trial of TMVr plus guideline-directed medical
therapy (GDMT) versus GDMT alone. Patients on corticosteroids or
continuous oxygen were excluded. Multivariable models were used to examine
the associations of COPD with mortality, heart failure hospitalization
(HFH), and health status and to test whether COPD modified the benefit of
TMVr compared with GDMT. Result(s): Among 614 patients, 143 (23.2%)
had COPD. Among patients treated with TMVr, unadjusted analyses
demonstrated increased 2-year mortality in those with COPD (hazard ratio
[HR]: 2.08; 95% confidence interval [CI]: 1.33 to 3.26), but this
association was attenuated after risk adjustment (adjusted HR: 1.48; 95%
CI: 0.87 to 2.52). Although TMVr led to reduced 2-year mortality among
patients without COPD (adjusted HR: 0.47; 95% CI: 0.33 to 0.67), for
patients with COPD, 2-year all-cause mortality was similar after TMVr
versus GDMT alone (adjusted HR: 0.94; 95% CI: 0.54 to 1.65;
p<inf>int</inf> = 0.04), findings that reflect offsetting effects on
cardiovascular and noncardiovascular mortality. In contrast, TMVr reduced
HFH (adjusted HR: 0.48 [95% CI: 0.28 to 0.83] vs. 0.46 [95% CI: 0.34 to
0.63]; p<inf>int</inf> = 0.89) and improved both generic and
disease-specific health status to a similar extent compared with GDMT
alone in patients with and without COPD (p<inf>int</inf> >0.30 for all
scales). Conclusion(s): In the COAPT trial, COPD was associated with
attenuation of the survival benefit of TMVr versus GDMT compared with
patients without COPD. However, the benefits of TMVr on both HFH and
health status were similar regardless of COPD. (Cardiovascular Outcomes
Assessment of the MitraClip Percutaneous Therapy for Heart Failure
Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT];
NCT01626079) Copyright © 2020 American College of Cardiology
Foundation

<78>
Accession Number
2007563566
Title
A systematic review on durability and structural valve deterioration in
TAVR and surgical AVR.
Source
Acta Cardiologica. (no pagination), 2020. Date of Publication: 2020.
Author
Okutucu S.; Niazi A.K.; Oliveira D.; Fatihoglu S.G.; Oto A.
Institution
(Okutucu, Oto) Department of Cardiology, Memorial Ankara Hospital, Ankara,
Turkey
(Niazi) Department of Cardiovascular Surgery, Shalamar Medical & Dental
College, Lahore, Pakistan
(Oliveira) Department of Cardiology, Federal University of Pernambuco,
Recife, Brazil
(Fatihoglu) Department of Cardiology, Iskenderun State Hospital, Hatay,
Turkey
Publisher
Taylor and Francis Ltd.
Abstract
Mechanical valves and bioprosthetic heart valves are widely used for
aortic valve replacement (AVR). Mechanical valves are associated with risk
of bleeding because of oral anticoagulation, while the durability and
structural valve deterioration (SVD) represent the main limitation of the
bioprosthetic heart valves. The implantation of bioprosthetic heart valves
is increasing precipitously due aging population, and the widespread use
of transcatheter aortic valve replacement (TAVR). TAVR has become the
standard treatment for intermediate or high surgical risk patients and a
reasonable alternative to surgery for low risk patients with symptomatic
severe aortic stenosis. Moreover, TAVR is increasingly being used for
younger and lower-risk patients with longer life expectancy; therefore it
is important to ensure the valve durability for long-term transcatheter
aortic valves. Although the results of mid-term durability of the
transcatheter heart valves are encouraging, their long-term durability
remains largely unknown. This review summarises the definitions,
mechanisms, risk factors and assessment of SVD; overviews available data
on surgical bioprosthetic and transcatheter heart valves
durability. Copyright © 2020 Belgian Society of Cardiology.

<79>
Accession Number
633653081
Title
Goal-directed perfusion to reduce acute kidney injury after paediatric
cardiac surgery (GDP-AKIp): Study protocol for a prospective randomised
controlled trial.
Source
BMJ Open. 10 (12) (no pagination), 2020. Article Number: 039385. Date of
Publication: 10 Dec 2020.
Author
Zhang Y.; Zhou X.; Wang B.; Guo L.; Zhou R.
Institution
(Zhang, Zhou, Wang, Guo, Zhou) Anesthesiology, West China Hospital of
Sichuan University, Chengdu, China
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiac surgery-associated acute kidney injury (CS-AKI)
occurs in up to 40%~60% of paediatric patients and increases postoperative
morbidity and mortality. A goal-directed perfusion (GDP) strategy aimed at
maintaining indexed oxygen delivery (DO 2 i) above the critical threshold
(reported to be 260~300 mL/min/m 2 in adults) during cardiopulmonary
bypass (CPB), is effective in reducing the incidence of CS-AKI. However,
no clear standards of paediatric critical DO 2 i exist. Our prior
prospective cohort study exploring the critical DO 2 i threshold during
paediatric CPB has found the nadir DO 2 i <353 mL/min/m 2 was an
independent risk predictor of CS-AKI. Based on this background, this trial
is designed to further determine whether the implementation of the GDP
initiative aimed at maintaining DO 2 i >=360 mL/min/m 2 would reduce the
rate of CS-AKI in paediatrics and improve clinical outcome. Methods and
analysis This is a prospective, single-centre, randomised controlled
trial. In total, 166 paediatric patients undergoing cardiac surgery will
be randomly allocated to the GDP group or control group. Patients in the
GDP arm will be treated with a GDP strategy during CPB aimed to maintain
DO 2 i at >=360 mL/min/m 2 (to ensure safely above the risk DO 2 i
threshold we found). The perfusion strategy for patients in the control
arm will be factored on body surface area and temperature. The primary
outcome is the rate of postoperative CS-AKI (it is defined according to
paediatric Risk, Injury, Failure, Loss of renal function and End-stage
renal disease criteria). The secondary end points include: (1) the other
oxygen metabolism parameters during CPB; (2) major complication and
all-cause mortality (in-hospital or within 30 days postoperatively); (3)
short-term clinical outcomes (ie, time to extubation, mechanical
ventilation time, hospital stay). Ethics and dissemination The study has
been approved by the Biomedical Research Ethics committee of West China
Hospital of Sichuan University (approval number: 2019(863)). Results will
be disseminated through peer-reviewed publications and conferences. Trial
registration number ChiCTR2000029232. Copyright ©

<80>
Accession Number
633737735
Title
Remote ischemic preconditioning in the prevention of contrast induced
nephropathy in patients undergoing peripheral angiography: A pilot
randomized controlled trial.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2018. United States. 29 (pp 124), 2018. Date of Publication: 2018.
Author
Roy D.M.; Tang T.Y.; Aw T.
Institution
(Roy) Changi General Hospital, Singapore, Singapore
(Tang) Singapore General Hospital, Singapore, Singapore
(Aw) Changi Hospital, Singapore, Singapore
Publisher
American Society of Nephrology
Abstract
Background: Contrast induced nephropathy (CIN) is a leading cause of
hospital acquired acute Kidney injury (AKI). Remote ischemic
preconditioning (RIPC) has been found to be protective against AKI in
patients undergoing coronary surgery This project aims to evaluate the
potential of RIPC prior to vascular angiography in preventing CIN.
 Method(s): This study is a single centre, experimental, randomised
controlled trial of the effect of RIPC with the induction of brief
episodes of upper limb ischemia followed by reperfusion using blood
pressure cuffs to determine protection against CIN in advanced periphereal
arterial disease undergoing elective angiography. The inclusion criteria
for this study are: patients above age of 21 yrs undergoing elective
periphereal arterial angiography/ angioplasty who have an eGFR>= 45ml/min
and have given written informed consent. There are two arms of this trial:
Control and preconditioned arm (RIPC). Patients will be randomised 1:1.
Group 1(Control arm) : IV hydration with 0.9 normal saline (1ml/kg/ hour)
prior to angiographic procedure Group 2 (RIPC) : patients will receive IV
hydration prior to procedure, similar to control group. Additionally
patients will receive RIPC, where a blood pressure cuff will be placed
around one arm of the patientand inflated to a pressure of 250mm Hg for 5
minutes, deflated and allow arm to re-perfuse for 5 min. This is repeated
for atotal of 3 ischemia-reperfusion cycles. Patients in both arms had
serial measurements of serum creatinine as wellas serum cystatin and
urinary NGAL at 2 hours, 24 hours, 48 and 72 hours post procedure Results:
There was no signicant differences between Control and RIPC groups with
regards baseline characteristics. There was no reduction in development
CIN in the RIPC group compared to Control. Conclusion(s): RIPC did
not offer any protection against development of CIN in our group of
patients with eGFR >45ml/min over and above the standard therapy ie.
intravenous hydration. The protective effect of RIPC in patients with more
advanced chronic kidney disease needs further study.

<81>
Accession Number
633737136
Title
Risk factors for AKI in high-risk populations: systematic review and
meta-analyses.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2018. United States. 29 (pp 116-117), 2018. Date of Publication: 2018.
Author
Zafar W.; Garcia-Arce A.; Hu Y.; Kwiecien S.J.; Singh G.; Saunders S.;
Bucaloiu I.D.; Kirchner H.L.; Ho K.
Institution
(Zafar, Garcia-Arce, Hu, Kwiecien, Saunders) Geisinger, Dnville, PA,
United States
(Singh) Geisinger Medical Center-Nephrology, Danville, PA, United States
(Bucaloiu, Ho) Geisinger Medical Center, Danville, PA, United States
(Kirchner) Geisinger Clinic, Danville, PA, United States
Publisher
American Society of Nephrology
Abstract
Background: Predictive models help identify patients at increased risk for
Acute kidney injury (AKI) for preventive care. It is unclear how various
risk factors perform in different clinical settings. We systematically
reviewed predictive models for AKI in four high risk settings and
performed meta-analyses of common AKI risk factors Methods: We searched
MedLine, EMBASE, CINAHL and Cochrane Library, and performed hand searches
of the retrieved reference lists, from 2010 through 2017 for English
language studies of prediction models for hospital-acquired AKI (KDIGO,
AKIN or RIFLE criteria) in adult hospital populations, patients undergoing
cardiac surgery, patients in intensive care unit (ICU) and those
undergoing contrast procedures. PRISMA-P 2015 statement was used for data
extraction and study appraisal. For the meta-analyses of risk factors,
studies with insufficient or non-standardized data and unadjusted risk
factors were excluded. Random effects meta-analyses were used to assess
pooled adjusted odds ratio (OR) for diabetes (DM), congestive heart
failure (CHF) and chronic kidney disease (CKD) for developing AKI Results:
74 studies testing AKI prediction models in the four clinical settings
were included. Of these, 10 were in the general hospital setting, 8 were
in the ICU, 27 inpercutaneous coronary interventions, and 29 in cardiac
surgery. There was considerable heterogeneity among studies in the choice
and definition of predictors. Meta-analyses included 14 studies reporting
diabetes (135955 patients), 16 studies reporting CKD (137846 patients) and
22 studies reporting CHF (180224 patients). Stratified analyses based on
highrisk clinical settings were consistent with the overall results (Table
1) Conclusion(s): In the combined as well as sub-populations, DM,
CKD, and CHF are associated with increased risk for AKI. Analyses of
differential risk levels in sub-populations was limited by heterogeneity.
Using uniform definitions for AKI and its risk factors in the development
of predictive models for AKI is essential for their clinical application.

<82>
Accession Number
633736695
Title
Efficacy and safety of evolocumab in CKD: data from the fourier trial.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2018. United States. 29 (pp 68-69), 2018. Date of Publication: 2018.
Author
Charytan D.M.; Sabatine M.S.; Pedersen T.R.; Im K.; Pineda A.L.; Wasserman
S.M.; Sever P.; Keech A.C.; Giugliano R.P.
Institution
(Charytan) Brigham and Women's Hospital, Harvard Medical School,
Brookline, MA, United States
(Pedersen) Oslo University Hospital, Ulleval, Oslo, Norway
(Sabatine, Im, Giugliano) TIMI Study Group, Brigham and Women's Hospital,
Boston, MA, United States
(Sever) Imperial College London, London, United Kingdom
(Keech) NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Pineda, Wasserman) Amgen, Thousand Oaks, CA, United States
Publisher
American Society of Nephrology
Abstract
Background: The efficacy and safety of PCSK9 inhibition in patients (pts)
with CKD is undefined. We analyzed outcomes by kidney function in FOURIER.
 Method(s): FOURIER randomized 27564 pts with stable atherosclerosis
and LDLcholesterol (C) >=70 or non-HDL-C >=100 mg/dL to the PCSK9
inhibitor evolocumab or placebo. The primary endpoint (CV death, MI,
stroke, hospitalization for unstable angina, or coronary
revascularization), key secondary endpoint (CV death, MI or stroke), and
safety outcomes were analyzed by CKD stage estimated from baseline CKD-EPI
eGFR. Result(s): 8077 pts had eGFR >=90 mL/min/1.73m2, 15,034 stage 2
(eGFR 60-89), and 4443 >=stage 3 CKD (eGFR <60). Age and comorbidity
prevalence increased with worse CKD. LDL-C reduction with evolocumab vs
placebo at 48 weeks was similar across CKD groups at 58.2, 59.4 and 58.7,
respectively. In the placebo arm, the primary and key secondary endpoint
rates were higher with worsening CKD, especially those with >=stage 3 vs.
preserved kidney function (primary-16.1 vs. 12.2, P<0.01;
secondary-12.8vs. 7.1, P<0.001, Figure). Relative risk reduction (RRR)
with evolocumab was similar regardless of CKD stage (Pint=0.77 and 0.75,
respectively). However, the absolute RRs for the key secondary endpoint
tended to be larger among those with >=stage 3 CKD (2.5, 95 CI: 0.4-4.7)
compared with individuals with preserved kidney function (1.7, 95 CI
0.5-2.8). Adverse events, including eGFR decline >=30, were similar
regardless of CKD stage. Conclusion(s): LDL-C lowering and the
relative efficacy and safety of evolocumab was preserved across CKD groups
in patients with clinically evident atherosclerosis and hyperlipidemia on
statin therapy. Absolute reduction in CV death, MI or stroke with
evolocumab tended to be greater with more advanced CKD.

<83>
Accession Number
633736657
Title
Impact of intensive glycemic control in the development of AKI after
cardiac surgery: A randomized clinical trial.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2018. United States. 29 (pp 43), 2018. Date of Publication: 2018.
Author
Santana-Santos E.; De Fatima Vattimo M.; Da Fonseca C.D.; Bastos K.A.;
Menezes A.F.
Institution
(Santana-Santos) Nursing Department, Federal University of Sergipe,
Aracaju, Brazil
(De Fatima Vattimo) Medical and Surgical Departament, School of Nursing
University of Sao Paulo, Sao Paulo, Brazil
(Da Fonseca) Nursing School, Federal University of Sao Paulo, Sao Paulo,
Brazil
(Bastos, Menezes) Federal University of Sergipe, Aracaju -Sergipe, Brazil
Publisher
American Society of Nephrology
Abstract
Background: Hyperglycemia is directly linked to higher rates of morbidity
and mortality in hospitalized patients and is recognized as an important
risk factor for postoperative complications. We performed a randomized
controlled trial to evaluate the impact of an intensive glycemic control
strategy in the occurrence of acute kidney injury in patients undergoing
cardiac surgery. Method(s): Were included patients who presented
blood glucose greater than 200 mg/dl in the first 6 hours of admission to
the ICU. Patients aged less than 18 yo, diagnosed with congenital heart
disease and heart transplantation were excluded. The patients were
allocated in one of the groups: conventional group (CG), glucose target
between 140 and 180 mg/dl and the intensive group (IG), glucose target
between 90 and 110 mg/dl. The primary endpoint was AKI defined according
with KDIGO criteria. The secondary outcomes were mortality, need for
dialysis, renal function recovery, hypoglycemia, ICU discharge, length of
stay in ICU. Result(s): Were included 95 patients, 36 (37.9) in the
IG and 59 (62.1) in the CG. In the comparison between groups, no
significant difference was observed in relation to the surgical risk (p =
0.511) and the risk for acute kidney injury (p = 0.962), measured by the
EuroSCORE and Cleveland Clinic Score, respectively. Using vasoactive drugs
was higher in the IG as compared to CG (97.2 vs. 83.1; p = 0.047). There
was no difference in the incidence of AKI in IG, when compared with CG
(61.1 vs. 49.2; p = 0.294, respectively). Nevertheless, the return of
kidney function to the basal values was smaller in the IG as compared to
CG (41.7 vs. 69.5; p = 0.010, respectively). There was no found any
difference between the groups in relation to mortality (p = 0.066), need
for dialysis (p = 0.364) and episodes of hypoglycemia (p = 0.151). There
was a higher number of ICU discharges in the CG, when compared with IG
(98.3 vs. 86.1; p = 0.028, respectively) as well as shorter length of stay
in the ICU (4.2 +/- 3.0 vs. 5.7 +/- 4.2; p = 0.046, respectively).
 Conclusion(s): The intensive glycemic control strategy used in this
study was not associated with decrease in the incidence of acute kidney
injury in patients undergoing cardiac surgery also influenced negatively
in secondary outcomes.

<84>
Accession Number
633735217
Title
The risk of major adverse kidney events after AKI: A systematic review and
meta-analysis.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2018. United States. 29 (pp 428), 2018. Date of Publication: 2018.
Author
See E.J.; Jayasinghe K.C.; Johnson D.W.; Polkinghorne K.; Toussaint N.D.
Institution
(See, Johnson) Princess Alexandra Hospital, Greenslopes, QLD, Australia
(Jayasinghe) Monash Health, Clayton, NSW, Australia
(Polkinghorne) Monash Medical Centre, Monash University, Melbourne, VIC,
Australia
(Toussaint) Royal Melbourne Hospital, Parkville, VIC, Australia
Publisher
American Society of Nephrology
Abstract
Background: Acute kidney injury (AKI) is a common consequence of acute
illness and is associated with high morbidity and mortality. Robust
estimates of the long-term outcomes of AKI, using consensus definitions of
exposure, are needed to inform clinical practice and guide optimal
allocation of healthcare resources. Method(s): A systematic search
was performed through EMBASE, MEDLINE, and grey literature sources to
identify cohort studies reporting an association between AKI and chronic
kidney disease (CKD), end-stage kidney disease (ESKD) or death. All
studies published between 2004 and 2018 involving hospitalised adults were
eligible if they defined AKI according to consensus definitions (RIFLE,
AKIN, or KDIGO), included a non-AKI control group, and followed patients
for at least 1 year. Risk of bias was assessed using the Newcastle-Ottawa
Scale. Random effects meta-analysis was used to combine adjusted hazard
ratios between studies. Subgroup, sensitivity and meta-regression analyses
were performed to investigate potential sources of heterogeneity.
 Result(s): The systematic search retrieved 6369 citations, of which
81 studies comprising more than 2 million participants were eligible for
inclusion. One-third of studies were in cardiovascular surgery patients
and one-third were performed in Europe. Reporting of methods was
incomplete in many studies. The most common sources of bias were poor
representativeness of patient cohorts, and insufficient duration and
completeness of follow up. Funnel plot asymmetry reflected a lack of small
studies with negative effects. AKI was associated with a significantly
increased risk of death across all subgroups: angiography (HR 3.07, 95%CI
2.12-4.46), cardiovascular surgery (HR 1.75, 95%CI 1.55-1.98), intensive
care (HR 1.47, 95%CI 1.32-1.65), and hospital (HR 1.41, 95%CI 1.26-1.56).
The risk of death increased from stage 1 (HR 1.35, 95%CI 1.27-1.44) to
stage 3 (HR 2.76, 95%CI 2.28-3.35). AKI was associated with increased
risks of CKD (HR 2.86, 95%CI 2.09-3.91) and ESKD (HR 4.81, 95%CI
3.04-7.62). Heterogeneity between studies was high. Conclusion(s):
AKI was associated with inferior long-term survival and an increased risk
of adverse renal outcomes. The risk of a poort outcome increased with
greater AKI severity. Patients undergoing angiography and cardiovascular
surgery were at greatest risk.

<85>
Accession Number
633733594
Title
Peritoneal ultrafiltration for heart failure-experiences from a randomised
controlled trial.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2018. United States. 29 (pp 1100), 2018. Date of Publication: 2018.
Author
Dukka H.; Wilkie M.E.; Kalra P.A.; McIntyre C.W.; Davies S.J.; Selby N.M.;
Bhandari S.; Taal M.W.
Institution
(Dukka, Taal) Nephrology, Royal Derby Teaching Hospitals, Derby, United
Kingdom
(Kalra) Salford Royal Hospital NHS Trust, Salford, United Kingdom
(McIntyre) London Health Sciences Centre, London, ON, Canada
(Wilkie) Sheffield Teaching Hospitals, Sheffield, United Kingdom
(Selby, Taal) University of Nottingham, Derby, United Kingdom
(Davies) University Hospital of North Midlands, Stoke-on-Trent, United
Kingdom
(Bhandari) Hull and East Yorkshire Hospitals NHS Trust and Hull York
Medical School, East Yorkshire, United Kingdom
Publisher
American Society of Nephrology
Abstract
Background: Peritoneal ultrafiltration (PuF) is sometimes employed for
advanced heart failure (HF) with intractable fluid overload, but evidence
for its benefit is lacking. The Peritoneal Dialysis for Heart Failure
(PD-HF) study was a multi-centre RCT that aimed to address this. However,
the trial was stopped early due to inadequate recruitment. This abstract
describes trial activity and reasons for the study's failure with the aim
of informing future trial design. Method(s): The trial aimed to
recruit 130 participants from six UK centres, who had severe HF (NYHA
class 3 and 4) and CKD stage 3 and 4 on optimal medical treatment for >=4
weeks defined as being on ACE inhibitor or ARB, beta blockers and screened
for cardiac revascularization and /or resynchronization if appropriate.
Participants who were diuretic resistant were randomised to conventional
HF treatment or one overnight exchange of Icodextrin. Primary outcome was
change in six minute walk test (6MWT), between baseline and 28 weeks (end
of trial). Secondary outcomes were changes in cardiomyopathy questionnaire
(Kansas city) results, SF 36 health survey results, hospitalisation and
mortality. Result(s): Over a two year period approximately 290
patients were screened, 20 were eligible for the trial of which 10 were
recruited. Baseline characteristics of the recruited patients were: mean
age 70.1+/-8.4, all had NYHA class 3 HF, mean 6 MWT of 181.3+/-49.6 m (one
patient declined 6MWT), mean eGFR was 28.6+/-5.4ml/min/1.73m2. Of the 10
patients who were eligible but did not participate, some felt PD was too
difficult to cope with, some died before agreeing to participate or before
being approached whilst others were too unwell. The reasons for the high
number of ineligible patients was eGFR out of range (usually too high),
frailty and not being on optimal HF treatment. The investigators
identified reluctance of patients to consider invasive therapy and lack of
coordination between cardiology and renal services as the main
contributors to poor recruitment. Conclusion(s): Lessons learnt from
the PD-HF trial can be used in the planning of future studies in this
area. It is clear that any future trial should plan to use a much larger
number of sites to achieve recruitment targets and that coordination of
cardiology and renal care is essential.

<86>
Accession Number
633748922
Title
Impact of permissive hypercapnia on regional cerebral oxygen saturation
and postoperative cognitive function in patients undergoing cardiac valve
replacement.
Source
Annals of palliative medicine. 9 (6) (pp 4066-4073), 2020. Date of
Publication: 01 Nov 2020.
Author
Zhu L.; Shi H.; Zhu C.; Liu H.; Su Z.; Zhao Y.
Institution
(Zhu) Department of Anesthesiology, Nanjing Frist Hospital, Nanjing
Medical University, Nanjing, China; Department of Anesthesiology, The
Third People's Hospital of Kunshan, Kunshan, China
(Shi) Department of Anesthesiology, Nanjing Frist Hospital, Nanjing
Medical University, Nanjing, China
(Zhu, Liu, Su, Zhao) Department of Anesthesiology, Nanjing Frist Hospital,
Nanjing Medical University, Nanjing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac valve replacement (CVR) is currently the main surgical
treatment for patients with valvular heart diseases (VHD). Postoperative
cognitive dysfunction (POCD) is one of the most serious complications of
cardiac surgery. Permissive hypercapnia (PHC), an important
lung-protective ventilation strategy, has protective effects on vital
organs, including the heart, lungs, and central nervous system (CNS). The
main objective of this study is to assess the effect of the PHC
ventilation strategy on rSO2 and postoperative cognitive function in
patients undergoing CVR. METHOD(S): A total of 66 patients undergoing
CVR were included and randomly divided into the PHC ventilation group
(Group H, n=33) and conventional ventilation group (Group C, n=33).
Patients of both groups were subjected to conventional ventilation before
cardiopulmonary bypass (CPB). patients in Group H were subjected to the
PHC ventilation strategy to keep the partial pressure of carbon dioxide
(PaCO2) at 46-60 mmHg. RESULT(S): (I) Group H had a lower HR at T0
and T1 (P<0.05) and higher CO at T3 and T4 (P<0.05) than Group C. (II)
Group H had higher rSO2 at T4 (P<0.05), lower pH and lactate (Lac) at T4
(P<0.05), higher PaCO2 at T3 and T4 (P<0.05), and lower PaO2 at T3 and T4
(P<0.05). (III) Compared to 1 d before surgery, the MMSE scores of both
groups were lower 24 h after surgery (P<0.05). CONCLUSION(S): PHC can
increase the rSO2 of patients undergoing CVR, increase cerebral blood
flow, improve the cerebral oxygen supply/consumption balance, and play a
protective role in the brain. It has no significant impact on the
incidence of POCD.

<87>
Accession Number
633752322
Title
A systematic review of surgical procedures on thoracic myelopathy.
Source
Journal of orthopaedic surgery and research. 15 (1) (pp 595), 2020. Date
of Publication: 10 Dec 2020.
Author
Zhu S.; Wang Y.; Yin P.; Su Q.
Institution
(Zhu, Wang, Yin, Su) Capital Medical University Affiliated Beijing
Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Publisher
NLM (Medline)
Abstract
PURPOSE: The surgical treatment of thoracic myelopathy is still
controversial and also a challenge for spine surgeons. Therefore, the
objective of this study was to review the related literature on the
surgical treatment of thoracic myelopathy and try to define treatment
guidelines for spine surgeons on thoracic myelopathy. METHOD(S):
Relevant literatures were searched based on the PubMed, EMBASE, and
Cochrane Library between January 2008 and December 2018. Some data on the
characteristics of patients were extracted, including number of patients,
mean age, surgical procedures, blood loss, complications, and
pre-/post-operation modified JOA score. Recovery rate was used to assess
the effect of surgery outcome, and the safety was evaluated by blood loss
and incidence of complications. RESULT(S): Thirty-five studies met
the inclusion criteria and were retrieved. A total of 2183 patients were
included in our systematic review, with the average age of 55.2years.
There were 69.8% patients diagnosed as ossification of ligamentum flavum
(OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL),
9.3% as disk herniation (DH), and 0.9% as others including diffuse
idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS).
The volume of blood loss was more in the treatment of circumferential
decompression (CD) than posterior decompression (PD), and the incidence of
complications was higher in CD (P < 0.05). The volume of blood loss in
minimally invasive surgery (MIS) was lowest and the incidence of
complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35
in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD,
and 0.49 in MIS at the last follow-up. When focusing on the OLF
specifically, incidence of complications in PD was much lower than CD,
with less blood loss and higher recovery rate. Focusing on the OPLL
specifically, incidence of complications in PD was much lower than CD,
with less blood loss while there was no statistical difference in recovery
rate between these two methods. CONCLUSION(S): This systematic review
showed that posterior decompression for thoracic myelopathy is safer and
better than circumferential decompression according to the complication
rate and surgical outcome. And we should also consider the location of
compression before the operation.

<88>
Accession Number
2010454756
Title
Association of Age With 10-Year Outcomes After Coronary Surgery in the
Arterial Revascularization Trial.
Source
Journal of the American College of Cardiology. 77 (1) (pp 18-26), 2021.
Date of Publication: 05 Jan 2021.
Author
Gaudino M.; Di Franco A.; Flather M.; Gerry S.; Bagiella E.; Gray A.;
Pearcey L.; Saw T.-H.; Lees B.; Benedetto U.; Fremes S.E.; Taggart D.P.
Institution
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York City, NY, United States
(Flather, Pearcey, Saw) Norwich Medical School, University of East Anglia,
Norwich, United Kingdom
(Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Oxford, United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, United Kingdom
(Fremes) Department of Surgery, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: The association of age with the outcomes of bilateral internal
thoracic arteries (BITAs) versus single internal thoracic arteries (SITAs)
for coronary bypass grafting (CABG) remains to be determined.
 Objective(s): The purpose of this study was to evaluate the
association between age and BITA versus SITA outcomes in the Arterial
Revascularization Trial. Method(s): The primary endpoints were
all-cause mortality and a composite of major adverse events, including
all-cause mortality, myocardial infarction, or stroke. Secondary endpoints
were bleeding complications and sternal wound complications up to 6 months
after surgery. Multivariable fractional polynomials analysis and log-rank
tests were used. Result(s): Age did not affect any of the explored
outcomes in the overall BITA versus SITA comparison in the
intention-to-treat analysis and in the analysis based on the number of
arterial grafts received. However, when the intention-to-treat analysis
was restricted to the populations of patients between age 50 and 70 years,
younger patients in the BITA arm had a significantly lower incidence of
major adverse events (p = 0.03). Conclusion(s): Our results suggest
that BITA may improve long-term outcome in younger patients, although more
randomized data are needed to confirm this hypothesis. Copyright
© 2021 American College of Cardiology Foundation

<89>
Accession Number
633748180
Title
Automated Fastener vs Hand-tied Knots in Heart Valve Surgery: A Systematic
Review and Meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2020. Date of
Publication: 07 Dec 2020.
Author
Sazzad F.; Ler A.; Kuzemczak M.; Ng S.; Choong A.M.; Kofidis T.
Institution
(Sazzad, Choong) Department of Cardiac, Thoracic and Vascular Surgery,
National University Heart Centre, Singapore; Department of Surgery, Yong
Loo Lin School of Medicine, National University of Singapore, Singapore;
Cardiovascular Research Institute, National University of Singapore,
Singapore
(Ler) Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore; School of Medicine, National
University of Ireland, Galway, Ireland
(Kuzemczak) Chair of Emergency Medicine, Department of Medical Rescue,
Poznan University of Medical Sciences, Poznan, Poland; Peter Munk Cardiac
Centre, Division of Cardiology, Toronto General Hospital, University
Health Network, Toronto, Canada
(Ng) Cardiovascular Research Institute, National University of Singapore,
Singapore
(Kofidis) Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore; Department of Surgery, Yong Loo Lin
School of Medicine, National University of Singapore, Singapore;
Cardiovascular Research Institute, National University of Singapore,
Singapore. Electronic address: surtk@nus.edu.sg
Publisher
NLM (Medline)
Abstract
BACKGROUND: While several studies revealed that the Cor-knot automated
fastener reduces aortic cross-clamp and cardiopulmonary bypass times, the
influence of the device on postoperative morbidity and mortality still
needs to be evaluated. Our aim was to verify the hypothesis that the use
of the Cor-knot device for heart valve surgery reduces aortic cross-clamp
and cardiopulmonary bypass times which translate into reduced morbidity
and mortality. METHOD(S): Retrospective cohort studies and randomized
controlled trials reporting on the use of the automated fastener vs
hand-tied knots were reviewed. The following endpoints were compared:
aortic cross-clamp and cardiopulmonary bypass times, postoperative
valvular regurgitation, postoperative ejection fraction, prolonged
ventilator support, renal failure and mortality. RESULT(S): Eight
studies reporting data on 942 patients were included into the final
analysis. The Cor-knot device was associated with shorter cardiopulmonary
bypass (MD:-11.74, 95% CI:-14.54 to -8.93, p<0.00001) and aortic
cross-clamp times (MD:-14.36, 95% CI:-19.63 to -9.09, p<0.00001) in
minimally invasive heart valve procedures. Overall, a lower rate of
postoperative valvular regurgitation (RR: 0.40, 95% CI:0.26 to 0.62,
p<0.0001) and prolonged ventilator support (RR: 0.29, 95% CI:0.13 to 0.65,
p=0.003) were observed. No difference was observed in postoperative atrial
fibrillation, ejection fraction, renal failure and mortality.
 CONCLUSION(S): The use of the Cor-knot device in heart valve surgery
reduced aortic cross-clamp and cardiopulmonary bypass times. Furthermore,
as compared to hand-tie methods, the automated fastener may lead to
decreased rates of prolonged ventilator support and valvular
regurgitation, while being non-inferior in terms of other postoperative
outcomes and mortality. Copyright © 2020. Published by Elsevier
Inc.

<90>
Accession Number
2007674554
Title
New or Worsened Mitral Regurgitation After Surgical Aortic Valve
Replacement: A Systematic Review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. (no pagination), 2020.
Date of Publication: 2020.
Author
Kumar N.; Kumar J.E.; Hussain N.; Gorelik L.; Essandoh M.K.; Whitson B.A.;
Bhatt A.M.; Flores A.S.; Hachem A.; Sawyer T.R.; Iyer M.H.
Institution
(Kumar, Kumar, Hussain, Gorelik, Essandoh, Bhatt, Flores, Iyer) Department
of Anesthesiology, The Ohio State University Wexner Medical Center,
Columbus, OH, United States
(Kumar) The Ohio State University College of Medicine, Columbus, OH,
United States
(Whitson) Division of Cardiac Surgery, Department of Surgery, The Ohio
State University Wexner Medical Center, OH, United States
(Hachem, Sawyer) Central Michigan University College of Medicine, Mt.
Pleasant, MI, United States
Publisher
SAGE Publications Inc.
Abstract
Background: New or worsened mitral regurgitation (MR) is an uncommon yet
serious complication after surgical aortic valve replacement (SAVR). While
there have been numerous reports of its occurrence, there is little
consensus regarding its presentation and management. This systematic
review summarizes the evidence in the current literature surrounding new
or worsened MR after SAVR and analyzes its potential implications.
 Method(s): Databases were examined for all articles and abstracts
reporting on new or worsened MR after SAVR. Data collected included number
of patients studied; patient characteristics; incidences of new or
worsened MR; timing of diagnosis; and treatment. Result(s):
Thirty-six full-text citations were included in this review. The
prevalence of new or worsened MR after SAVR was 8.4%. Sixteen percent of
new MR occurrences were from an organic etiology, and 83% of new MR
occurrences were that of a functional etiology. Most diagnoses were made
in the late or unspecified postoperative period using echocardiography
(range: 0 minutes to 18 years postoperatively). While no patients died
from this complication, 7.7% of patients (16 out of 207) required emergent
procedural re-intervention. Conclusion(s): This systematic review
underscores the importance of identifying new or worsened MR following
SAVR and accurate scoring of MR severity to guide treatment. It also
outlines the associated clinical measures commonly documented following
this complication, and the usefulness of transesophageal echocardiography
for the detection of significant MR. These results reflect the current,
limited state of the literature on this topic and warrant further
investigation into MR detection and management strategies in SAVR
patients. Copyright © The Author(s) 2020.

<91>
Accession Number
619567760
Title
Effect of adaptive support ventilation weaning mode in conventional or
standard methods on respiratory and hemodynamic performance indices: A
randomized clinical trial.
Source
Trauma Monthly. 22 (5) (no pagination), 2017. Article Number: e37663. Date
of Publication: September 2017.
Author
Nouri J.M.; Sohrabi B.; Moradian S.T.; Ghiasi S.M.S.
Institution
(Nouri, Sohrabi, Moradian) Nursing Faculty, Baqiyatallah University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Ghiasi) Medical Faculty, Anesthetist, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Adaptive support ventilation (ASV) is one of the advanced
modes of ventilation. The available evidence regarding the process of
tracheal extubation indicates that staff working in intensive care unit
usually performs the weaning process according to their own experiences
and conventional methods. Objective(s): This study aimed to assess
the effect of weaning with adaptive support ventilation in two
conventional or standard methods on respiratory and hemodynamic
performance indices in patients undergoing coronary artery bypass graft
(CABG) surgery. Method(s): In this clinical trial, 100 patients
candidate for coronary artery bypass graft (CABG) surgery at Jamaran
hospital were allocated to experimental and control groups in 2015. Each
group had patients. The conventional method of ASV was used in the control
group without any intervention, while the standard method of ASV was
applied in the experimental group. The groups were compared in terms of
arterial blood gases, vital signs, atelectasis, and duration of weaning
process. Result(s): There was no statistically significant difference
between the experimental and control groups in terms of demographic
variables and disease history. Also, duration of mechanical ventilation
and weaning process, duration of the patient's trigger to the tracheal
extubation as well as other respiratory performance indicators and vital
signs were similar between the groups (P > 0.05). Conclusion(s): The
results of this study indicate that in stable patients who have no history
of lung problems, there is no need to apply the difficult weaning
protocol. These patients can be weaned without any
complication. Copyright © 2016, Trauma Monthly.

<92>
Accession Number
2005485541
Title
Perioperative Dexmedetomidine Supplement Decreases Delirium Incidence
After Adult Cardiac Surgery: A Randomized, Double-Blind, Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (2) (pp 449-457),
2021. Date of Publication: February 2021.
Author
Likhvantsev V.V.; Landoni G.; Grebenchikov O.A.; Ovezov A.M.; Skripkin
Y.V.; Lembo R.; Gaevskiy D.I.; Tereshina A.A.; Yavorovskiy A.G.
Institution
(Likhvantsev, Grebenchikov, Ovezov, Skripkin, Gaevskiy, Tereshina) Moscow
Regional Research and Clinical Institute, Moscow, Russian Federation
(Likhvantsev, Yavorovskiy) IM Sechenov First Moscow State Medical
University of the Ministry of Health of the Russian Federation (Sechenov
University), Moscow, Russian Federation
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Landoni, Lembo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Grebenchikov) VA Negovsky Research Institute of General Reanimatology,
Federal Research and Clinical Center of Intensive Care Medicine and
Rehabilitology, Moscow, Russian Federation
Publisher
W.B. Saunders
Abstract
Objective: Conflicting data exist on the effect of dexmedetomidine on
delirium. For the present study, a randomized trial was performed to
investigate the effect of perioperative dexmedetomidine on the rate of
postoperative delirium after cardiac surgery. Design(s): A randomized
controlled trial. Setting(s): University hospital.
 Participant(s): Patients (n = 169) undergoing elective cardiac
surgery (coronary artery bypass graft surgery, valve surgery, or combined
surgery) with cardiopulmonary bypass. Intervention(s): Patients
received a sevoflurane-based general anesthesia and were randomly assigned
1:1 to receive a dexmedetomidine infusion that started in the operating
room (0.7 mug/kg/h) and continued into the intensive care unit (0.4
mug/kg/h) or an equivolume infusion of placebo. Measurements and Main
Results: A decrease in the rate of delirium in the dexmedetomidine group
compared with the placebo group was demonstrated (6 of 84 [7.1%] v 16 of
85 [18.8%]; p = 0.02; odds ratio [OR] 0.33 [95% confidence interval {CI}
0.12-0.90]). Reduced intensive care unit and hospital lengths of stay also
were observed (18 [18-22] hours v 22 [18-39] hours; p = 0.002 and 17
[7-20] days v 19 [8-21] days; p = 0.04, respectively). Mortality at 30
days was 2 (2.4%) in both groups. On multivariate analysis, only
dexmedetomidine administration (OR 0.24 [95% CI 0.08-0.74]) and
cardiopulmonary bypass time (OR 1.02 [95% CI 1.01-1.03] for increases of 1
min) were independent predictors of delirium development.
 Conclusion(s): Dexmedetomidine administered during and after general
anesthesia for cardiac surgery with cardiopulmonary bypass decreased the
rate of postoperative delirium and intensive care unit and hospital
lengths of stay. Copyright © 2020 Elsevier Inc.

<93>
Accession Number
2005844445
Title
A Comparison of Different Remifentanil Effect-Site Concentrations to Allow
for Early Extubation After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (2) (pp 470-481),
2021. Date of Publication: February 2021.
Author
Khidr A.M.; Khalil M.A.; Abdulfattah D.; El Tahan M.R.
Institution
(Khidr, El Tahan) King Fahd Hospital of the University, College of
Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
(Khalil) King Fahd Hospital of the Imam Abdulrahman Bin Faisal University,
Al Khobar, Saudi Arabia
(Khalil) Faculty of Medicine, Cairo University, Cairo, Egypt
(Abdulfattah) Clinical Nursing Supervisor Operating Room, Day Surgery,
CSSD, Hemodialysis, and PDU, King Fahd Hospital of the Imam Abdulrahman
Bin Faisal University, Al Khobar, Saudi Arabia
Publisher
W.B. Saunders
Abstract
Objectives: Assess different remifentanil effect-site concentrations (Ce)
for readiness for extubation time after cardiac surgery. Design(s):
Prospective, randomized, blinded, controlled study. Design(s): Single
university hospital. Participant(s): Seventy-three patients scheduled
for cardiac surgery. Intervention(s): After ethical approval,
patients scheduled for cardiac surgery with target-controlled propofol
infusion were randomly assigned to receive remifentanil effect-site
concentrations (Ce) of 1, 2, or 3 ng/mL (n = 25, 25, and 23,
respectively). Measurements and Main Results: The primary endpoint
was readiness for extubation. Secondary outcomes were also recorded,
including the cumulative doses and number of changes of propofol and
remifentanil, hemodynamic variables, time to spontaneous eye opening and
breathing, actual extubation, incidences of light anesthesia and
myocardial ischemia, need for vasopressors and inotropes, and intensive
care unit (ICU) and hospital stays. There was no difference in the time to
readiness for extubation in any of the groups (0.1 ng/mL: 11.5 min (5-37);
0.2 ng/mL: 22 min (10-35); and 0.3 ng/mL: 21 min (10-49), p < 0.532);
however, there was a significant difference among the 3 groups regarding
the cumulative remifentanil doses (p < 0.001). Time to spontaneous eye
opening and breathing, actual extubation, use of vasopressors and
inotropes, incidences of light anesthesia and myocardial ischemia, and
length of ICU and hospital stay were similar for all groups. Forty-six of
the 73 patients were extubated on-table. Conclusion(s): Remifentanil
Ce 1, 2, and 3 ng/mL produced comparative effects on time to extubation
and hemodynamic responses to cardiac surgery. The 3 Ce resulted in
immediate on-table extubation in 50% of patients. Copyright ©
2020 Elsevier Inc.

<94>
Accession Number
2007443905
Title
The 2019 ERS/ESTS/EACTS/ESTRO Guidelines on the Management of Patients
With Malignant Pleural Mesothelioma.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (2) (pp 378-388),
2021. Date of Publication: February 2021.
Author
Gelzinis T.A.
Institution
(Gelzinis) University of Pittsburgh, Pittsburgh, PA, United States
Publisher
W.B. Saunders
Abstract
Malignant pleural mesothelioma is a rare aggressive cancer, with insidious
growth, and is associated with poor outcomes that have not improved over
the years. A task force made up of members of the European Respiratory
Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European
Association for Cardio-Thoracic Surgery (EACTS)/European Society for
Radiotherapy and Oncology (ESTRO) societies, who are experts in the field
of malignant mesothelioma, reviewed the literature from 2009 to 2018 to
update the 2009 guidelines concerning epidemiology, diagnosis, staging,
and treatment, including surgical, radiotherapy, and medical management,
as well as palliative care to provide the best evidence-based
recommendations for this patient population. Copyright © 2020
Elsevier Inc.

<95>
Accession Number
2007885047
Title
Intraoperative Remifentanil Infusion and Postoperative Pain Outcomes After
Cardiac Surgery-Results from Secondary Analysis of a Randomized,
Open-Label Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (2) (pp 458-466),
2021. Date of Publication: February 2021.
Author
Subramaniam K.; Ibarra A.; Ruppert K.; Mallikarjun K.; Orebaugh S.
Institution
(Subramaniam, Ibarra, Orebaugh) Department of Anaesthesiology and
Perioperative Medicine, University of Pittsburgh Medical Center,
Pittsburgh, United States
(Ruppert) Department of Epidemiology, Clinical and Translational Science
Institute, University of Pittsburgh, Pittsburgh, United States
(Mallikarjun) St Louis School of Medicine, Washington University, St
Louis, MO, United States
Publisher
W.B. Saunders
Abstract
Design: Report of secondary pain outcomes from a prospective, randomized,
open-label clinical trial that compared remifentanil and fentanyl on
perioperative hyperglycemic response in cardiac surgery. Setting(s):
Single institution, tertiary university hospital. Participant(s): The
study comprised 116 adult elective cardiac surgical patients.
 Intervention(s): Participants were randomly assigned to receive
either intermittent fentanyl boluses (F) or continuous remifentanil
infusion (R) intraoperatively. Measurements and Main Results:
Postoperative pain was evaluated with pain scores every 6 hours for 48
hours. Pain threshold to mechanical stimuli was measured around the
sternotomy incision at 48 and 96 hours. The development of chronic pain
was assessed using the numeric rating scale at 1, 3, 6, and 12 months
after discharge. The final analysis included 106 patients. Pain scores and
wound hyperalgesia were not significantly different postoperatively
between the groups. The incidence of chronic pain at 3 months was
comparable in both groups (61% in group F v 58% in group R; p = 0.79).
Pain of more-than-mild degree was seen in 13 (32%) patients in group F and
8 (19%) in group R (p = 0.25) at 3 months. Median pain scores were not
significantly different between the groups at 1, 3, 6, and 12 months after
discharge from the hospital. Conclusion(s): The present study's
findings suggested that intraoperative remifentanil infusion does not
significantly worsen pain outcomes in patients undergoing elective cardiac
surgery. Copyright © 2020 Elsevier Inc.

<96>
Accession Number
2007621416
Title
Postoperative Pain Management and the Incidence of Ipsilateral Shoulder
Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A
Prospective Audit.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (2) (pp 555-562),
2021. Date of Publication: February 2021.
Author
Hodge A.; Rapchuk I.L.; Gurunathan U.
Institution
(Hodge) Department of Anaesthesia and Perioperative Medicine, Royal
Brisbane and Women's Hospital, Brisbane, Queensland, Australia
(Hodge, Rapchuk) University of Queensland
(Rapchuk, Gurunathan) Department of Anaesthesia and Perfusion Services,
The Prince Charles Hospital, Brisbane, Queensland, Australia
Publisher
W.B. Saunders
Abstract
Objectives: Ipsilateral shoulder pain (ISP) is a common but variably
occurring (42%-85%) complication after thoracic surgery. Multiple
potential treatments, including upper limb blocks, intrapleural local
anaesthetic infiltration, and systemic opioids, have undergone trials,
with limited efficacy. Phrenic nerve infiltration is a potential
intervention that may prevent ISP. The aim of this study was to assess the
incidence and severity of ISP after thoracic surgery at the authors'
institution, where phrenic nerve infiltration is commonly used.
 Design(s): Observational cohort study. Setting(s): A single-
center study in a tertiary referral center in Brisbane, Australia.
 Participant(s): This study comprised all adult patients undergoing
thoracic surgery at a tertiary- care referral center from May to July
2018. Measurements and Main Results: Surgical procedures were divided
into open thoracotomy, video-assisted thoracic surgery (VATS) and
VATS-guided mini-thoracotomy. The primary outcome was a comparison of
incidence of ISP among the 3 types of surgical procedures. Data were
analyzed using Stata (StataCorp), with significance testing by
Kruskal-Wallis equality of populations rank test. A p value of < 0.05 was
deemed significant. Sixty thoracic surgeries were performed during the
audit period. Nineteen patients had thoracotomies performed for lobectomy
or pneumonectomy, all of whom received phrenic nerve infiltration. The
incidence of moderate-to-severe ipsilateral shoulder pain among the
thoracoctomy cohort was 15.8% (3/19). Of the 36 VATS procedures audited, 7
patients (19.4%) received infiltration of their phrenic nerve, none of
whom reported postoperative ISP. Of the remaining twenty-nine patients who
did not receive phrenic nerve infiltration, there were 4 cases of
moderate-to-severe ipsilateral shoulder pain (11.1%). Four of the 5
patients (80%) who underwent VATS-guided mini-thoracotomies received
phrenic nerve infiltration intraoperatively. Three patients reported
moderate-to-severe ISP and of these 3 patients, 2 patients had phrenic
nerve infiltration, and 1 patient did not receive infiltration. Overall,
there were no statistically significant differences in rest or dynamic
pain scores across the surgical groups at any time point. Mann-Whitney
test revealed that the participants with ISP were significantly older than
those without ISP (p = 0.006). However, there were no significant
differences in sex or body mass index between those with and without ISP.
 Conclusion(s): The authors observed a lower (15.8%) incidence of
moderate-to-severe ISP among their thoracotomy patients than reported in
prior literature. Injection of local anesthetic into the phrenic nerve fat
pad at the level of the diaphragm appeared to be an effective and safe
surgical intervention that may eliminate a significant cause of ISP. None
of the VATS patients who received phrenic nerve infiltration experienced
ISP. Postoperative pain in VATS is expected to be reduced by avoiding the
use of a rib spreader, severing of the intercostal nerves, and division of
muscle tissue, which may account for the lower observed rates of ISP in
the VATS cohort who did not receive phrenic nerve infiltration. Further
randomized controlled trials are warranted to establish if patients
undergoing various VATS procedures benefit from this
intervention. Copyright © 2020 Elsevier Inc.

<97>
Accession Number
2010397828
Title
Transradial vs transfemoral secondary access outcomes in transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
World Journal of Cardiology. 12 (11) (pp 571-583), 2020. Date of
Publication: 26 Nov 2020.
Author
Radhakrishnan S.L.; Ho K.K.L.
Institution
(Radhakrishnan) Division of General Medicine, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA 02215, United States
(Ho) Division of Cardiovascular Medicine, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA 02215, United States
Publisher
Baishideng Publishing Group Co
Abstract
BACKGROUND Complications of transcatheter aortic valve implantation (TAVI)
procedures include bleeding, vascular complications, and strokes. These
complications are often associated with the type of access used. The two
types of access in TAVI procedures are primary and secondary. The main use
of the primary access is for valve delivery, while secondary access is
used for angiography and hemodynamic monitoring. While there are many
options for primary access, those for secondary access are transfemoral
and transradial. AIM To compare outcomes between transradial vs
transfemoral secondary access (TFSA). METHODS A systematic search was
conducted using major databases (EMBASE, PubMed, Cochrane Central, Google
Scholar), which resulted in 5 studies that met the criteria for study
selection. Outcomes of interest were 30-d rates each of
major/life-threatening bleeding, vascular complications, strokes, and
mortality. All 5 studies were observational. Only adjusted or matched data
were used when available in this meta-analysis. RESULTS A total of 5065
patients underwent TAVI, with 1453 patients (28.7%) having undergone
transradial secondary access (TRSA) and 3612 patients (71.3%) TFSA.
Irrespective of the site of primary access, the odds of having major or
life-threatening bleeding were 60% lower in the TRSA group than the TFSA
group (P < 0.00001). The odds of having major vascular complications were
52% lower in the TRSA group (P < 0.0001) with no difference in minor
vascular complications between the 2 groups. Similarly, the odds of
mortality in 30-d after the procedure were 41% lower (P = 0.006) and the
odds of stroke were 54% lower (P = 0.001) in the TRSA group than the TFSA
group. CONCLUSION The transradial secondary approach appears to be a safer
alternative to the transfemoral secondary approach in TAVI
procedures. Copyright © The Author(s) 2020. Published by
Baishideng Publishing Group Inc. All rights reserved.

<98>
Accession Number
2010397827
Title
Rapid right ventricular pacing for balloon valvuloplasty in congenital
aortic stenosis: A systematic review.
Source
World Journal of Cardiology. 12 (11) (pp 540-549), 2020. Date of
Publication: 26 Nov 2020.
Author
Mylonas K.S.; Ziogas I.A.; Mylona C.S.; Avgerinos D.V.; Bakoyiannis C.;
Mitropoulos F.; Tzifa A.
Institution
(Mylonas) Department of Cardiothoracic Surgery, Yale New Haven Hospital,
New Haven, CT 06510, United States
(Ziogas) Medical School, Aristotle University of Thessaloniki,
Thessaloniki 54124, Greece
(Mylona) Department of Pediatrics, Trikala General Hospital, Trikala
42100, Greece
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Hospital, New York, NY 10065, United States
(Bakoyiannis) Division of Vascular Surgery, First Department of Surgery,
Laiko General Hospital, National and Kapodistrian University of Athens,
Athens 11527, Greece
(Mitropoulos) Department of Pediatric Cardiac Surgery, Mitera Children's
Hospital, Athens 15123, Greece
(Tzifa) Department of Pediatric Cardiology and Adult Congenital Heart
Disease, Mitera Children's Hospital, Athens 15123, Greece
Publisher
Baishideng Publishing Group Co
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) is a well-established
treatment modality for congenital aortic valve stenosis. AIM To evaluate
the role of rapid right ventricular pacing (RRVP) in balloon stabilization
during BAV on aortic regurgitation (AR) in pediatric patients. METHODS A
systematic review of the MEDLINE, Cochrane Library, and Scopus databases
was conducted according to the PRISMA guidelines (end-of-search date: July
8, 2020). The National Heart, Lung, and Blood Institute and
Newcastle-Ottawa scales was utilized for quality assessment. RESULTS Five
studies reporting on 72 patients were included. The studies investigated
the use of RRVP-assisted BAV in infants (> 1 mo) and older children, but
not in neonates. Ten (13.9%) patients had a history of some type of aortic
valve surgical or catheterization procedure. Before BAV, 58 (84.0%), 7
(10.1%), 4 (5.9%) patients had AR grade 0 (none), 1 (trivial), 2 (mild),
respectively. After BAV, 34 (49.3%), 6 (8.7%), 26 (37.7%), 3 (4.3%),
patients had AR grade 0, 1, 2, and 3 (moderate), respectively. No patient
developed severe AR after RRVP. One (1.4%) developed ventricular
fibrillation and was defibrillated successfully. No additional arrhythmias
or complications occurred during RRVP. CONCLUSION RRVP can be safely used
to achieve balloon stability during pediatric BAV, which could potentially
decrease AR rates. Copyright © The Author(s) 2020. Published by
Baishideng Publishing Group Inc. All rights reserved.

<99>
Accession Number
2007668844
Title
Effect of Preoperative Infusion of Levosimendan on Biomarkers of
Myocardial Injury and Haemodynamics After Paediatric Cardiac Surgery: A
Randomised Controlled Trial.
Source
Drugs in R and D. (no pagination), 2020. Date of Publication: 2020.
Author
Abril-Molina A.; Gomez-Luque J.M.; Perin F.; Esteban-Molina M.;
Ferreiro-Marzal A.; Fernandez-Guerrero C.; Ocete-Hita E.
Institution
(Abril-Molina, Gomez-Luque, Ocete-Hita) Pediatric Intensive Care Unit,
Hospital Universitario Virgen de las Nieves, University of Granada,
Granada, Spain
(Perin) Paediatric Cardiology Unit, Hospital Universitario Virgen de las
Nieves, Granada, Spain
(Esteban-Molina, Ferreiro-Marzal) Paediatric Cardiac Surgery Unit,
Hospital Universitario Virgen de las Nieves, Granada, Spain
(Fernandez-Guerrero) Pediatric Anesthesia Unit, Hospital Universitario
Virgen de las Nieves, Granada, Spain
Publisher
Adis
Abstract
Objective: The aim was to test the hypothesis that preoperative infusion
of levosimendan would decrease patients' cardiac biomarker profiles during
the immediate postoperative stage (troponin I and B-type natriuretic
peptide levels) more efficiently than placebo after cardiopulmonary
bypass. Method(s): In a randomised, placebo-controlled,
double-blinded study, 30 paediatric patients were scheduled for congenital
heart disease surgery. 15 patients (50%) received prophylactic
levosimendan and 15 patients (50%) received placebo from 12 h before
cardiopulmonary bypass to 24 h after surgery. Result(s): Troponin I
levels were higher in the placebo group at 0, 12, and 24 h after
cardiopulmonary bypass, although the mean differences between the study
groups and the 95% confidence intervals (CIs) for troponin I levels did
not present statistically significant differences at any of the three time
points considered (mean differences [95% CIs] - 3.32 pg/ml [- 19.34 to
12.70], - 2.42 pg/ml [- 19.78 to 13.95], and - 79.94 pg/ml [- 266.99 to
16.39] at 0, 12, and 24 h, respectively). A similar lack of statistically
significant difference was observed for B-type natriuretic peptide (mean
differences [95% CIs] 36.86 pg/dl [- 134.16 to 225.64], - 350.79 pg/dl [-
1459.67 to 557.45], and - 310.35 pg/dl [- 1505.76 to 509.82]). Lactic acid
levels were significantly lower with levosimendan; the mean differences
between the study groups and the 95% CIs for lactate levels present
statistically significant differences at 0 h (- 1.52 mmol/l [- 3.19 to -
0.25]) and 12 h (- 1.20 mmol/l [- 2.53 to - 0.10]) after cardiopulmonary
bypass. Oxygen delivery (DO<inf>2</inf>) was significantly higher at 12 h
and 24 h after surgery (mean difference [95% CI] 627.70
ml/min/m2 [122.34-1162.67] and 832.35 ml/min/m2
[58.15 to 1651.38], respectively). Conclusion(s): Levosimendan does
not significantly improve patients' postoperative troponin I and B-type
natriuretic peptide profiles during the immediate postoperative stage in
comparison with placebo, although both were numerically higher with
placebo. Levosimendan, however, significantly reduced lactic acid levels
and improved patients' DO<inf>2</inf> profiles. These results highlight
the importance of this new drug and its possible benefit with regard to
myocardial injury; however, evaluation in larger, adequately powered
trials is needed to determine the efficacy of levosimendan. Trial registry
number: EudraCT 2012-005310-19. Copyright © 2020, The Author(s).

<100>
Accession Number
2007661084
Title
Antithrombotic therapy with or without clopidogrel after transcatheter
aortic valve replacement. A meta-analysis of randomized controlled trials.
Source
Clinical Research in Cardiology. (no pagination), 2020. Date of
Publication: 2020.
Author
Pellegrini C.; Xhepa E.; Ndrepepa G.; Alvarez-Covarrubias H.; Kufner S.;
Lahmann A.L.; Rheude T.; Rai H.; Mayr N.P.; Schunkert H.; Kastrati A.;
Joner M.; Cassese S.
Institution
(Pellegrini, Xhepa, Ndrepepa, Alvarez-Covarrubias, Kufner, Lahmann,
Rheude, Rai, Schunkert, Kastrati, Joner, Cassese) Klinik Fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse, 36, Munich, Germany
(Schunkert, Kastrati, Joner) German Center for Cardiovascular Research
(DZHK), Partner Site Munich Heart Alliance, Munich, Germany
(Alvarez-Covarrubias) Hospital de Cardiologia, IMSS, Centro Medico
Nacional Siglo XXI, Mexico City, Cd. de Mexico, Mexico
(Lahmann) Facharztliche Praxis, Kardiologie Im Herzen Munchens, Tal 21,
Munich, Germany
(Mayr) Institut fur Anasthesiologie, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: To investigate the clinical outcomes associated with an
antithrombotic therapy with or without clopidogrel after transcatheter
aortic valve replacement (TAVR). Methods and Results: This is a
study-level meta-analysis including all randomized trials investigating
antithrombotic regimens after TAVR. The protocol was registered with
PROSPERO (CRD42020191036). We searched electronic scientific databases for
eligible studies. The primary outcome was all-cause death. Main secondary
outcome was major bleeding. Other outcomes were life-threatening (or
disabling) bleeding, myocardial infarction (MI) and stroke. Six eligible
trials randomly allocated 3056 TAVR patients to aspirin or oral
anticoagulation (OAC) with clopidogrel (n = 1525) versus aspirin and/or
OAC without clopidogrel (n = 1531). In the overall estimates, an
antithrombotic therapy with clopidogrel versus without displayed a
comparable risk of all-cause death [Risk Ratio-RR = 0.83, 95% Confidence
intervals-CI (0.57-1.20); P = 0.25] and major bleeding [RR = 1.33, 95% CI
(0.61-2.92); P = 0.39]. However, the combination of aspirin or OAC with
clopidogrel doubled the risk of major bleeding as compared to aspirin or
OAC without clopidogrel [RR = 2.08, 95% CI (1.27-3.42); P = 0.015, P for
interaction = 0.021]. Treatment strategies did not differ with respect to
the risk of life-threatening bleeding, MI and stroke. Conclusion(s):
In patients receiving TAVR, a therapeutic strategy of aspirin or OAC with
clopidogrel significantly increases the risk of major bleeding without
impact on mortality and ischemic outcomes compared to aspirin or OAC
without clopidogrel. The performance of different antithrombotic regimens
in terms of long-term clinical outcomes and bioprosthesis valve function
requires further investigation. Graphic abstract: Forest plots from
pairwise and network meta-analyses associated with an antithrombotic
therapy with or without clopidogrel Risk ratio for all outcomes of
interest calculated with the pairwise meta-analysis (left side) and for
main outcomes calculated with the network meta-analysis (right side) in
patients allocated to an antithrombotic therapy with clopidogrel or
without. The diamonds indicate the point estimate and the left and the
right ends of the lines the [95% CI]. CI: Confidence intervals; OAC; oral
anticoagulation. [Figure not available: see fulltext.] Copyright
© 2020, The Author(s).

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