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<1>
Accession Number
634101421
Title
Comparison of ringer's lactate and plasmalyte-a as cardiopulmonary bypass
prime for bypass associated acidosis in valve replacement surgeries.
Source
Annals of Cardiac Anaesthesia. 24 (1) (pp 36-41), 2021. Date of
Publication: January-March 2021.
Author
Surabhi S.; Kumar M.
Institution
(Surabhi, Kumar) Department of Anaesthesia and Intensive Care, Vardhman
Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: A wide range of acid base fluctuations are seen during
Cardiopulmonary bypass (CPB) and the development of metabolic acidosis is
well recognized. We conducted a study tocompare the metabolic effects of
Ringer lactate and Plasmalyte-A as CPB prime in causing bypass associated
acidosis in valve replacement surgeries. Method(s): We performed a
prospective, randomized controlled study on a total of 80 adult patients
undergoing CPB for valvular heart surgeries. The patients were randomized
into two groups: Group I (Ringer Lactate) and Group II (Plasmalyte-A).
Arterial blood samples were taken before initiating CPB, 30 minutes after
starting CPB, then every half hourly till termination of CPB and after
half an hour stay in the ICU post operatively to analyze primarily H+
ions, bicarbonates, lactate and strong ion difference. Results and
Discussion: The results were analyzed in a quantitative manner. In Ringer
Lactate group, during CPB, there was reduction in pH from 7.428 +/- 0.029
at T1 to 7.335 +/- 0.06 (P < 0.01) and 7.358 +/- 0.06 (P < 0.01) at T2 and
T3 respectively. Mean bicarbonates decreased in Ringer Lactate group
during CPB from 24.28 +/- 1.65 mEq/L at T1 to 20.98 +/- 2.97 mEq/L at T2
(P < 0.01). In Plasmalyte-A group, mean pH, bicarbonate, strong ion
difference (SID) were comparable at all time intervals (P > 0.05). In
Ringer Lactate group, maximum surge in mean blood lactate levels was seen
from 0.85 +/- 0.35 mmol/l at T1 to 4.29 +/- 1.78 mmol/L (P < 0.01) and
4.17 +/- 1.28 mmol/L (P < 0.01) at T2 and T3, respectively. Such surge was
not seen in Plasmalyte-A group. The mean SID decreased during the CPB in
Ringer Lactate group from 41.102 mEq/L at T1 to 35.66 mEq/L (P = 0.033) at
T2 implying metabolic acidosis. Numbered patients having hypotension and
arrhythmias were also higher in Ringer Lactate group again indicating
higher acidosis. Conclusion(s): The different composition of
Plasmalyte-A and Ringer Lactate have different metabolic implications for
patients undergoing cardiac surgery. Patients who received Plasmalyte-A as
cardiopulmonary bypass prime developed less metabolic acidosis. Hence we
conclude that Plasmalyte-A is the preferred cardiopulmonary bypass prime
in adult patients undergoing valve replacement surgeries. Copyright
© 2021 Wolters Kluwer Medknow Publications. All rights reserved.

<2>
Accession Number
634101417
Title
The synergistic effect of tranexamic acid and ethamsylate combination on
blood loss in pediatric cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 24 (1) (pp 17-23), 2021. Date of
Publication: January-March 2021.
Author
Abd El Baser I.I.; ElBendary H.M.; ElDerie A.
Institution
(Abd El Baser, ElBendary) Departments of Anesthesia and Surgical Intensive
Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
(ElDerie) Departments of Cardiothoracic Surgery, Faculty of Medicine,
Mansoura University, Mansoura, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Pediatric patients are at risk for bleeding after cardiac
surgery. Administration of antifibrinolytic agents reduces postoperative
blood loss. Objective(s): Evaluation of the efficacy of combined
administration of tranexamic acid (TXA) and ethamsylate in the reduction
of postoperative blood loss in pediatric cardiac surgery. Method(s):
This prospective randomized study included 126 children submitted for
cardiac surgery, and they were allocated into three groups: Control group
(n = 42); TXA group (n = 42):- received only TXA; and combined ethamsylate
TXA group (n = 42):- received a combination of TXA and ethamsylate. The
main collected data included sternal closure time, the needs for
intraoperative transfusion of blood and its products, the total amount of
blood loss, and the amount of the whole blood and its products transfused
to the patients in the first 24 postoperative hours. Result(s): Blood
loss volume in the first 24 postoperative hours was significantly smaller
in combined group than the TXA and control groups and was significantly
smaller in the TXA group than the control group. The sternal closure time
was significantly shorter in the combined group than the other 2 groups
and significantly shorter in TXA than the control group. The amount of
whole blood transfused to patients in the combined group during surgery
and in the first postoperative 24 h was significantly smaller than the
other 2 groups and smaller in TXA group than the control group during
surgery. Conclusion(s): Combined administration of ethamsylate and
TXA in pediatric cardiac surgery was more effective in reducing
postoperative blood loss and whole blood transfusion requirements than the
administration of TXA alone. Copyright © 2021 Wolters Kluwer
Medknow Publications. All rights reserved.

<3>
Accession Number
2005609285
Title
A European consensus statement on the use of four-factor prothrombin
complex concentrate for cardiac and non-cardiac surgical patients.
Source
Anaesthesia. 76 (3) (pp 381-392), 2021. Date of Publication: March 2021.
Author
Erdoes G.; Koster A.; Ortmann E.; Meesters M.I.; Bolliger D.; Baryshnikova
E.; Martinez Lopez De Arroyabe B.; Ahmed A.; Lance M.D.; Ranucci M.; von
Heymann C.; Agarwal S.; Ravn H.B.
Institution
(Erdoes) Department of Anaesthesiology and Pain Medicine, Inselspital,
Bern University Hospital, University of Bern, Switzerland
(Koster) Institute for Anaesthesiology, Heart and Diabetes Centre NRW,
Ruhr-University Bochum, Bad Oeynhausen, Germany
(Ortmann) Department of Anaesthesia, Kerckhoff Heart and Lung Centre, Bad
Nauheim, Germany
(Meesters) Department of Anaesthesiology, University Medical Centre
Utrecht, Netherlands
(Bolliger) Department of Anaesthesia, Prehospital Emergency Medicine, and
Pain Therapy, University Hospital Basel, Switzerland
(Baryshnikova, Ranucci) Department of Cardiovascular Anaesthesia and
Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese,
Milan, Italy
(Martinez Lopez De Arroyabe) Department of Cardiac Anaesthesia and
Intensive Care, Ca`Foncello Hospital of Treviso, Treviso, Italy
(Ahmed) Department of Anaesthesia, University Hospitals of Leicester NHS
Trust, United Kingdom
(Ahmed) Department of Cardiovascular Sciences, University of Leicester,
United Kingdom
(Lance) Hamad Medical Corporation, HMC, Anaesthesiology, ICU and
Peri-operative Medicine, Doha, Qatar
(von Heymann) Department of Anaesthesia, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain,
Berlin, Germany
(Agarwal) Department of Anaesthesia, Manchester University Hospitals,
Manchester, United Kingdom
(Ravn) Department of Cardiothoracic Anaesthesiology, Rigshospitalet,
Copenhagen University, Copenhagen, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Modern four-factor prothrombin complex concentrate was designed originally
for rapid targeted replacement of the coagulation factors II, VII, IX and
X. Dosing strategies for the approved indication of vitamin K
antagonist-related bleeding vary greatly. They include INR and
bodyweight-related protocols as well as fixed dose regimens. Particularly
in the massively bleeding trauma and cardiac surgery patient, four-factor
prothrombin complex concentrate is used increasingly for haemostatic
resuscitation. Members of the Transfusion and Haemostasis Subcommittee of
the European Association of Cardiothoracic Anaesthesiology performed a
systematic literature review on four-factor prothrombin complex
concentrate. The available evidence has been summarised for dosing,
efficacy, drug safety and monitoring strategies in different scenarios.
Whereas there is evidence for the efficacy of four-factor prothrombin
concentrate for a variety of bleeding scenarios, convincing safety data
are clearly missing. In the massively bleeding patient with coagulopathy,
our group recommends the administration of an initial bolus of 25
IU.kg-1. This applies for: the acute reversal of vitamin K
antagonist therapy; haemostatic resuscitation, particularly in trauma; and
the reversal of direct oral anticoagulants when no specific antidote is
available. In patients with a high risk for thromboembolic complications,
e.g. cardiac surgery, the administration of an initial half-dose bolus
(12.5 IU.kg-1) should be considered. A second bolus may be
indicated if coagulopathy and microvascular bleeding persists and other
reasons for bleeding are largely ruled out. Tissue-factor-activated,
factor VII-dependent and heparin insensitive point-of-care tests may be
used for peri-operative monitoring and guiding of prothrombin complex
concentrate therapy. Copyright © 2020 Association of
Anaesthetists

<4>
Accession Number
2010739036
Title
Dual energy imaging in cardiothoracic pathologies: A primer for
radiologists and clinicians.
Source
European Journal of Radiology Open. 8 (no pagination), 2021. Article
Number: 100324. Date of Publication: January 2021.
Author
Gupta A.; Kikano E.G.; Bera K.; Baruah D.; Saboo S.S.; Lennartz S.; Hokamp
N.G.; Gholamrezanezhad A.; Gilkeson R.C.; Laukamp K.R.
Institution
(Gupta, Kikano, Gilkeson) Department of Radiology, University Hospitals
Cleveland Medical Center/Case Western Reserve University, 11100 Euclid
Ave, Cleveland, OH 44106, United States
(Bera) Department of Biomedical Engineering, Case Western Reserve
University, Cleveland, OH, United States
(Baruah) Department of Radiology, Medical University of South Carolina,
Charleston, SC, United States
(Saboo) Department of Radiology, University Of Texas Health Science
Center, San Antonio, TX, United States
(Lennartz, Hokamp, Laukamp) Institute for Diagnostic and Interventional
Radiology, University Hospital Cologne, Cologne, Germany
(Gholamrezanezhad) Department of Radiology, Keck School of Medicine,
University of Southern California, Los Angeles, CA, United States
Publisher
Elsevier Ltd
Abstract
Recent advances in dual-energy imaging techniques, dual-energy subtraction
radiography (DESR) and dual-energy CT (DECT), offer new and useful
additional information to conventional imaging, thus improving assessment
of cardiothoracic abnormalities. DESR facilitates detection and
characterization of pulmonary nodules. Other advantages of DESR include
better depiction of pleural, lung parenchymal, airway and chest wall
abnormalities, detection of foreign bodies and indwelling devices,
improved visualization of cardiac and coronary artery calcifications
helping in risk stratification of coronary artery disease, and diagnosing
conditions like constrictive pericarditis and valvular stenosis.
Commercially available DECT approaches are classified into emission based
(dual rotation/spin, dual source, rapid kilovoltage switching and split
beam) and detector-based (dual layer) systems. DECT provide several
specialized image reconstructions. Virtual non-contrast images (VNC) allow
for radiation dose reduction by obviating need for true non contrast
images, low energy virtual mono-energetic images (VMI) boost contrast
enhancement and help in salvaging otherwise non-diagnostic vascular
studies, high energy VMI reduce beam hardening artifacts from metallic
hardware or dense contrast material, and iodine density images allow
quantitative and qualitative assessment of enhancement/iodine
distribution. The large amount of data generated by DECT can affect
interpreting physician efficiency but also limit clinical adoption of the
technology. Optimization of the existing workflow and streamlining the
integration between post-processing software and picture archiving and
communication system (PACS) is therefore warranted. Copyright ©
2021 The Authors

<5>
Accession Number
2005084633
Title
Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia
in adult and paediatric cardiac surgery: a systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). 35 (8) (pp 724-735), 2020. Date of
Publication: November 2020.
Author
Ler A.; Sazzad F.; Ong G.S.; Kofidis T.
Institution
(Ler, Sazzad, Ong, Kofidis) Department of Cardiac, Thoracic and Vascular
Surgery, National University Heart Centre, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Sazzad, Kofidis) Cardiovascular Research Institute, National University
of Singapore, Singapore
(Kofidis) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
SAGE Publications Ltd
Abstract
Background: In recent years, the use of del Nido cardioplegia, initially
intended for paediatric cardiac surgery, has been extended to adult
cardiac surgery in many institutions. Our aim was thus to compare the
outcomes of the use of del Nido cardioplegia with that of conventional
cardioplegia and discuss its role in both adult and paediatric cardiac
surgery. Method(s): A systematic literature search was conducted in
August 2019 on Medline (via PubMed), Embase and Cochrane electronic
databases according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Any retrospective studies and
randomised controlled trials that reported findings comparing the outcomes
of the use of del Nido cardioplegia with that of St. Thomas cardioplegia
were included. Result(s): We observed shorter aortic cross-clamp time
(mean difference: -15.18, confidence interval: -27.21 to -3.15, p = 0.01)
and cardiopulmonary bypass time (mean difference: -13.52, confidence
interval: -20.64 to -6.39, p = 0.0002) associated with the use of del Nido
cardioplegia in adult cardiac surgery as compared to St. Thomas
cardioplegia. Defibrillation rates were significantly lower in patients
who had been given del Nido cardioplegia, in both adult (relative risk:
0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric
patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p =
0.02). Conclusion(s): Del Nido cardioplegia may be a viable
alternative to the use of St. Thomas cardioplegia in both adult and
paediatric patients, providing similar postoperative outcomes while also
affording the additional advantage of shorter aortic cross-clamp time and
cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates
of defibrillation (in both adult and paediatric cardiac
surgery). Copyright © The Author(s) 2020.

<6>
Accession Number
2010385929
Title
HTK versus multidose cardioplegias for myocardial protection in adult
cardiac surgery: A meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Reynolds A.C.; Asopa S.; Modi A.; King N.
Institution
(Reynolds) Swansea University Medical School, Swansea, United Kingdom
(Asopa) South West Cardiothoracic Centre, University Hospitals Plymouth,
Plymouth, United Kingdom
(Modi) Sussex Cardiac Centre, Brighton and Sussex University Hospital,
Brighton, United Kingdom
(King) School of Biomedical Sciences, Faculty of Health, University of
Plymouth, Plymouth, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Background: Histidine-tryptophan-ketoglutarate (HTK) cardioplegia for
myocardial protection obviates the need for maintenance cardioplegia
doses, and thus allows for greater focus on procedure accuracy. The aim of
this meta-analysis is to evaluate the safety and efficacy of HTK versus
multidose cardioplegias during cardiac surgery in an adult population.
 Method(s): Electronic searches were performed using PubMed, Science
Direct, and Google Scholar databases. The key search terms included HTK
cardioplegia AND cardiac surgery AND adult. This was followed by a
meta-analysis investigating cardiopulmonary bypass (CPB) duration,
cross-clamp duration, spontaneous defibrillation, inotropic support,
mortality, atrial fibrillation, creatine kinase muscle brain band (CK-MB)
and troponin I (TnI). Result(s): Seven randomized controlled trials
(n = 804) were analyzed. Spontaneous defibrillation following aortic
cross-clamp removal significantly favored HTK (odds ratio [OR], 2.809; 95%
confidence interval [CI], 1.574 to 5.012; I2 = 0%; p <.01).
There were no other notable significant differences between HTK and
multidose cardioplegia in any of the parameters measured. In particular,
the OR for mortality was 1.237 (95% CI, 0.385 to 3.978; I2 =
0%; p =.721) and the mean difference for CPB duration overall was 2.072
min (95% CI, -2.405 to 6.548; I2 = 74%; p =.364).
 Conclusion(s): HTK is safe and effective during adult cardiac surgery
when compared with multidose cardioplegias for myocardial protection
during surgical correction of acquired pathology in the adult population.
HTK may, therefore, be suitable for complex cases or those of extensive
duration, without the prospect of increased postoperative morbidity or
mortality. Copyright © 2021 The Authors. Journal of Cardiac
Surgery published by Wiley Periodicals LLC

<7>
Accession Number
2010119020
Title
Short- and long-term functional results following drug-coated balloons
versus drug- eluting stents in small coronary vessels: The RESTORE
quantitative flow ratio study.
Source
International Journal of Cardiology. 327 (pp 45-51), 2021. Date of
Publication: 15 Mar 2021.
Author
Li L.; Guan C.; Meng S.; Bai Y.; Zhang Z.; Zou K.; Ruan Y.; Cao X.; Jia
R.; Guo C.; Escaned J.; Jin Z.; Xu B.
Institution
(Li, Meng, Ruan, Cao, Jia, Guo, Jin) Department of Cardiology, Beijing
Tiantan Hospital, Capital Medical University, Beijing, China
(Guan, Xu) Catheterization Laboratories, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing, China
(Bai) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases, Beijing, China
(Zhang) JetMed, Beijing, China
(Zou, Jin) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Escaned) Department of Cardiology, Hospital Clinico San Carlos, Madrid,
Spain
(Xu) National Clinical Research Centre for Cardiovascular Diseases,
Beijing, China
Publisher
Elsevier Ireland Ltd
Abstract
Background Immediate and long-term functional outcomes after percutaneous
treatment of small vessel disease (SVD) with drug-coated balloon (DCB)
versus drug-eluting stent (DES) remain unknown. The study sought to
investigate whether treatment of de novo SVD with DCB yields similar
functional results compared with DES, as judged with angiography-based
quantitative flow ratio (QFR). Methods and results QFR was measured at
pre-procedural, post-procedural and 9-month angiography in all available
subjects from the non-inferiority RESTORE SVD China trial, in which
patients were randomized to Restore DCB (n = 116) or Resolute DES (n =
114) study arms. Primary outcome of this analysis was 9-month QFR.
Pre-procedural, post-procedural and 9-month QFR was performed in 84.8%
(195/230), 83.0% (191/230) and 93.8% (181/193) cases, respectively. At 9
months, the QFR of DCB showed no significant difference to DES (0.88 +/-
0.23 vs. 0.92 +/- 0.12, p = 0.12). Both 9-month QFR and the QFR difference
between post-procedure and 9-month follow-up were correlated with
angiographic percentage of diameter stenosis and late loss, and predictive
of 2-year clinical outcome. Conclusions Treatment of coronary SVD with DCB
resulted in similar 9-month functional results compared with DES. This
study provides evidences to the value of QFR as a mean of evaluating
device performance after coronary revascularization. Clinical trial
registration URL: https://www.clinicaltrials.gov; ClinicalTrial.gov:
Identifier: NCT02946307. Copyright © 2020 Elsevier B.V.

<8>
Accession Number
2007626899
Title
Patient survival in severe low-flow, low-gradient aortic stenosis after
aortic valve replacement or conservative management.
Source
Journal of Cardiac Surgery. 36 (3) (pp 1030-1039), 2021. Date of
Publication: March 2021.
Author
Micali L.R.; Algargoosh S.; Parise O.; Parise G.; Matteucci F.; de Jong
M.; Ioanna Moula A.; Tetta C.; Gelsomino S.
Institution
(Micali, Algargoosh, Parise, Parise, Matteucci, de Jong, Ioanna Moula,
Tetta, Gelsomino) Department of Cardiothoracic Surgery, Cardiovascular
Research Institute Maastricht University, Maastricht, Netherlands
Publisher
Blackwell Publishing Inc.
Abstract
Background and aim: Classical and paradoxical low-flow, low-gradient
(LFLG) aortic stenosis (AS) are the most challenging subtypes of AS. The
current therapeutic options are aortic valve replacement (AVR) and
conservative management: AVR promotes long-term survival but is invasive,
while conservative management yields a poor prognosis but is noninvasive
since it uses no aortic valve replacement (noAVR). The present
meta-analysis investigated the rate of survival of patients with LFLG AS
undergoing either AVR or noAVR interventions. Method(s): The
meta-analysis compared the outcomes of AVR with those of noAVR in terms of
patient survival. In both groups, a meta-regression was conducted to
investigate the impact on patient survival of the left ventricular
ejection fraction (LVEF), either preserved (paradoxical LFLG AS) or
reduced (classical LFLG AS). Result(s): The relative risk of survival
between the AVR and noAVR groups was 1.99 [1.40, 2.82] (p =.0001),
suggesting that survival tends to be better in AVR patients than in noAVR
patients. The meta-regression revealed that a reduced LVEF may be related
to a higher survival in AVR patients when compared to a preserved LVEF (p
=.04). Finally, the analysis indicated that LVEF seems not to be
prognostic of survival in noAVR patients (p =.18). Conclusion(s):
Patients with LFLG AS have better survival if they undergo AVR. In AVR
patients, reduced LVEF rather than preserved LVEF is related to better
survival, whereas there seems to be no difference in prognostic value
between reduced and preserved LVEF in noAVR patients. Copyright ©
2020 The Authors. Journal of Renal Care published by 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. 36 (3) (pp 806-814), 2021. Date of
Publication: March 2021.
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
634167015
Title
A prospective randomized trial comparing biatrial and isolated left atrial
ablation in patients with long-standing persistent atrial fibrillation
undergoing CABG.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 445), 2020. Date of Publication:
November 2020.
Author
Kalybekova A.; Chernyavskyi A.; Lukinov V.
Institution
(Kalybekova, Chernyavskyi, Lukinov) Meshalkin National Medical Research
Center, Novosibirsk, Russian Federation
Publisher
Oxford University Press
Abstract
Purpose: To compare the efficacy and safety of left atrial ablation (LAA)
with those of biatrial ablation (BA) in patients with long-standing
persistent atrial fibrillation (AF) in common with CABG.
 Background(s): AF is the most common heart rhythm disorder, while CAD
is the most common cardiovascular disease. Chronic coronary syndrome and
atrial fibrillation coexist in many patients. Long-standing persistent
atrial fibrillation (AF) is frequent pathology in patients undergoing
CABG. Surgical ablation in such patients is currently an effective
treatment of AF. Pulmonary vein isolation (PVI) may reduce AF recurrences
in 70% of patients with paroxysmal form of AF. However, the efficacy of
ablation in patients with long-standing persistent AF is rather low.
Clinical studies have shown that the right atrium can also be involved in
the AF initiation and maintenance. Areas localized in both atrias are
characterized by rapid electrical activity, which is critical in the AF
persistence. Therefore, we have hypothesized that in long-standing
persistent AF BA could be more effective than isolated LAA.
 Method(s): Between 2016 and 2019, 116 patients with long-standing
persistent AF and CAD who underwent open-heart surgery were included in
this single blind prospective randomized study and divided into two
groups: 58 patients in group 1 underwent isolated LAA + CABG, and group II
(58 patients) - BA + CABG. All the patients had Reveal LINQ ICM System
(Medtronic, USA) implanted during the index procedure. The mean age was 65
[61; 67.75] years versus 62 [58; 66] years (p=0.050) and 83% versus 84%
(p>0.999) were men in BA and LAA groups, respectively. The follow-up time
was 22+/-3 months for two groups. The primary endpoint was freedom from AF
during 24-month follow-up based on 24-hour Holter monitoring ECG
registration and Reveal device data. Result(s): This study has
demonstrated that in CAD patients with longstanding persistent AF, PVI in
combination with multiple linear lesions in the right atrium while GABG
produce a significantly higher success rate than PVI alone. After 24
months, AF recurred in 38% of patients in the BA group and in 64% - in the
LAA group (p=0.010). Univariate logistic regression analysis showed
indicators as long axis of left atria in mm (OR 3.45, 95%; CI 1.77 to
7.64, p=0.001) in LAA group and (OR 2.02, 95%; CI 1.03 to 4.26, p=0.049)
in-group BA increases the risk of AF. Chronic kidney disease (OR 2.95, 95%
CI 1.05 to 9.22, p=0,048), and mitral regurgitation (OR 1.18, 95% CI 1.01
to 1.41, p=0.047) have been found the independent predictors of AF
recurrence in the LAA group. Arrhythmia on the third day after procedure
increases the risk of AF (OR 3.79, 95% CI 1.45 to 10. 58, p=0.008) in the
LAA group in a long-term follow-up. Conclusion(s): The study has
demonstrated that BA is more effective for treatment of long-standing
persistent AF in CAD patients undergoing CABG.

<11>
Accession Number
634166984
Title
Increasing use of ablation in the management of atrial fibrillation in
heart failure: Insights from a national database on 10 year trends in the
United States.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 395), 2020. Date of Publication:
November 2020.
Author
Narasimhan B.; Wu L.; Shah A.; Kantharia B.
Institution
(Narasimhan, Wu, Kantharia) Icahn School of Medicine at Mount Sinai, New
York, United States
(Shah) Cardiovascular and Heart Rhythm consultants, New York, United
States
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) is the most commonly encountered
arrhythmia in clinical practice, even more so among patients with heart
failure (HF). Results of the recent CABANA and CASTLE-AF trials indicate
significant improvements in ejection fraction, HF readmissions as well as
overall mortality with the incorporation of rhythm control strategies in
HF patients. These findings challenge existing notions of equivalency of
rate vs rhythm control strategies. In this study, we analyzed the impact
of this evidence on treatment practices and the short term outcomes of
ablation in this patient cohort. Method(s):We conducted a
retrospective study using the AHRQ-HCUP National Readmission Database for
the years 2005-2014. ICD 9 diagnosis codes were used to identify all adult
patients (>=18 years) undergoing AF ablation procedures as well as a
sub-cohort of patients with existing HF. Trends in the use of ablation
procedures, patient characteristics as well as details of short term
procedural outcomes were studied. Multivariate regression analysis was
utilized to adjust for confounders. Complications were defined as per the
Agency for healthcare research and quality guidelines. Independent risk
factors for in-hospital mortality were identified using proportional
hazards model. Result(s): Our results indicate a trend of rising
rates of AF ablation procedures overall with a peak in 2011 at 20,046 and
gradual downtrend thereafter (10,195 in 2005 to 11735 in 2014). Our data
revealed a consistent rise in ablation procedures among heart failure
patients during the same period (832 to 2245). A definite reduction in
peri-procedural mortality is noted (0.24% in 2005 to 0.17% in 2014, p=0.2)
- an improvement that is maximally apparent in the heart failure group
(2.49% to 0.4%, p=0.07). Overall complication rates however are
significantly increased overall with a proportional rise noted among HF
patients. Conclusion(s): Our data from a nationally representative
registry indicates an increasing utilization of ablation as a therapeutic
modality in the management of atrial fibrillation in HF. Future
prospective studies are required to assess the positive impact of these
changes in clinical practice as offset by their associated complications.

<12>
Accession Number
634166703
Title
Perioperative atrial fibrillation and risk of stroke after cardiac
surgery: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 518), 2020. Date of Publication:
November 2020.
Author
Wang M.K.; Chen P.; Meyre P.; Ali M.Z.; Heo R.; McIntyre W.; Healey J.;
Whitlock R.; Lamy A.; Devereaux P.J.; Conen D.
Institution
(Wang, McIntyre, Healey, Devereaux, Conen) McMaster University, Department
of Medicine, Hamilton, Canada
(Chen) University of British Columbia, Department of Medicine, Vancouver,
Canada
(Meyre) University of Basel, Department of Cardiology and Cardiovascular
Research, Basel, Switzerland
(Ali) Royal College of Surgeons in Ireland, Department of Medicine,
Dublin, Ireland
(Heo) McMaster University, Michael G. Degroote School of Medicine,
Hamilton, Canada
(Whitlock, Lamy) McMaster University, Department of Surgery, Hamilton,
Canada
Publisher
Oxford University Press
Abstract
Background: Perioperative atrial fibrillation (POAF) after cardiac surgery
has been associated with an increased risk of stroke. However, many
previous studies have not systematically excluded patients with
pre-existing AF. As such, the association between new-onset POAF and
stroke risk has not been well established. Purpose(s): To perform a
systematic review and meta-analysis on the short and long-term risks of
stroke in patients experiencing new-onset POAF after cardiac surgery.
 Method(s): We searched MEDLINE, EMBASE, and the Cochrane Library
databases for studies comparing the risk of stroke in patients with versus
without new-onset POAF after cardiac surgery. Studies were included in our
review if they enrolled >=100 patients and defined POAF as new-onset AF in
patients with no history of preoperative AF. Data were independently
extracted in duplicate. The quality of studies was assessed using the
Newcastle Ottawa Scale. Random-effects meta-analysis was used to calculate
summary risk ratios. Short-term stroke risk was calculated using events
occurring either in-hospital or <=30 days after surgery, and long-term
risk was calculated using events occurring >30 days after surgery.
 Result(s): After reviewing 11,791 citations, 46 studies met the
inclusion criteria. These studies included 364,822 patients, of which
76,388 (20.9%) developed new-onset POAF. The incidence of stroke was
higher among patients with POAF versus no POAF (n=44 studies; incidence
2.76% vs. 1.53%; relative risk (RR) 1.91, 95% CI 1.65-2.23; I2 = 78%). A
sensitivity analysis of high-quality studies alone yielded similar results
(n=9 studies; RR 1.74, 95% CI 1.31-2.30; I2 = 88%). Patients with POAF had
a higher incidence of stroke both in the short-term (n=35 studies; 2.71%
vs. 1.36%; RR 2.13, 95% CI 1.81-2.51; I2 = 69%) and long-term (n=20
studies; 1.6 vs. 1.0 per 100 patient-years; RR 1.39, 95% CI 1.24-1.57; I2
= 27%). The risk of stroke was increased in POAF patients across all types
of cardiac surgery performed, including isolated CABG (n=19 studies; RR
1.93, 95% CI 1.60-2.32; I2 = 62%), isolated transcatheter aortic valve
implantation (n=7 studies; RR 1.86, 95% CI 1.32-2.63; I2 = 0%), and
studies including multiple procedure types (n=16 studies; RR 1.90, 95% CI
1.44-2.51; I2 = 89%). Conclusion(s): New-onset POAF after cardiac
surgery is associated with an increased risk of stroke, both in the short
and long term. The absolute risk difference is small, and randomized
trials are needed to assess the efficacy and safety of treatment
interventions in this patient population.

<13>
Accession Number
634166616
Title
One-year echocardiographic outcomes of transcatheter aortic valve
implantation with or without predilatation of the aortic valve: Insights
from the multicenter, randomized DIRECT trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 65), 2020. Date of Publication:
November 2020.
Author
Karmpalioti M.; Benetos G.; Drakopoulou M.; Xanthopoulou M.; Stathogiannis
K.; Latsios G.; Synetos A.; Kalantzis C.; Voudris V.; Kosmas E.;
Mastrokostopoulos A.; Katsimagklis G.; Danenberg H.; Tousoulis D.;
Toutouzas K.
Institution
(Karmpalioti, Benetos, Drakopoulou, Xanthopoulou, Stathogiannis, Latsios,
Synetos, Kalantzis, Tousoulis, Toutouzas) Hippokration General Hospital,
Athens, Greece
(Voudris, Kosmas) Onassis Cardiac Surgery Center, Department of
Cardiology, Athens, Greece
(Mastrokostopoulos, Katsimagklis) Naval Hospital of Athens, Department of
Cardiology, Athens, Greece
(Danenberg) Hadassah-Hebrew University Medical Center, Department of
Cardiology, Jerusalem, Israel
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has become
the standard of care for high-risk and inoperable surgical patients and a
valid alternative in intermediate-risk patients with severe aortic
stenosis. The DIRECT trial (Predilatation in Transcatheter Aortic Valve
Implantation Trial) was a multicenter, randomized, clinical trial designed
to evaluate the safety and efficacy of TAVI with or without balloon aortic
valvuloplasty (BAV) in patients with symptomatic, severe aortic valve
stenosis. Purpose(s): To compare the one year echocardiographic
findings among patients, who underwent TAVI using a self-expanding valve
with or without BAV. Method(s): A total of 171 patients with severe
aortic stenosis were randomly assigned at 4 tertiary centers to undergo
TAVI with the use of selfexpanding prostheses with (pre-BAV) or without
pre-dilatation (no-BAV). Follow up transthoracic echocardiography was
performed 1 year after TAVI. Result(s): Of 171 patients, 86 patients
were randomized to pre-BAV group and 85 to no-BAV group. One year
echocardiographic follow up was available in 146 patients. In one year
follow up there was no significant difference between pre-BAV and no-BAV
group in aortic valve area (1.84+/-0.39cm2 vs.
1.85+/-0.44cm2, p=0.79), peak aortic valve gradient
(15.95+/-9.97 mmHg vs. 14.51+/-6.60 mmHg, p=0.35), mean aortic valve
gradient (8.37+/-5.01 mmHg vs. 7.99+/-4.04 mmHg, p=0.64), aortic valve
peak velocity (1.90+/-0.51 m/s vs. 1.80+/-0.42m/s, p=0.24), ejection
fraction (54.19+/-8.36% vs. 53.19+/-9.58%, p=0.52) and pulmonary artery
systolic pressure (41.86+/-14.34 mmHg vs. 40.71+/-12.40 mmHg, p=0.64). The
incidence of moderate or severe paravalvular regurgitation (PVL) in 1 year
follow up was 6.2% without significant difference between the 2 study
groups (5.7% in the no-BAV group vs. 6.6% in the pre-BAV group, p=0.83).
 Conclusion(s): Direct transcatheter aortic valve implantation has no
impact on one-year prosthesis function and PVL in patients undergoing TAVI
with self-expanding valve.

<14>
Accession Number
634166546
Title
Ranolazine as you have never seen it before: An antiarrhythmic for atrial
fibrillation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 555), 2020. Date of Publication:
November 2020.
Author
Sousa J.P.; Puga L.; Ribeiro J.; Lopes J.; Saleiro C.; Gomes R.; Campos
D.; Lourenco C.; Goncalves L.
Institution
(Sousa, Puga, Ribeiro, Lopes, Saleiro, Gomes, Campos, Lourenco, Goncalves)
Centro hospitalar de Coimbra, Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Currently available pharmacological options for rhythm control
in atrial fibrillation (AF) are overshadowed by suboptimal efficacy and
both frequent and potentially severe adverse events. Recent studies have
added evidence to the hypothesis that ranolazine might exert
antiarrhythmic effects, particularly in atrial tachyarrhythmias.
 Purpose(s): To perform a systematic review with meta-analysis in
order to ascertain the potential role of ranolazine in the management of
AF. Method(s): We systematically searched MEDLINE, Embase and Scopus
for randomized controlled trials (RCTs) and cohort studies addressing the
association between ranolazine and AF outcomes, published up until
December 1, 2019. The primary endpoint was incidence of AF, which was
evaluated under a ranolazine versus placebo design. In this regard,
patients in the setting of postcardiac surgery were further investigated
separately. Secondary endpoints included AF cardioversion outcomes, which
were addressed through comparison between ranolazine plus amiodarone and
amiodarone alone for proportional efficacy and temporal requirements
(time-to-cardioversion). The latter analysis was also undertaken in a
dose-sensitive fashion (<=1000mg vs. 1500mg of ranolazine). Tertiary
endpoints covered AF burden and episodes, in paroxysmal AF patients, and
safety outcomes, namely death, QTc interval prolongation and hypotension.
Study-specific odds ratios (ORs) were pooled using meta-analytic
techniques with a random-effects model. Result(s): A total of 10 RCTs
comprising 8.109 participants and 3 cohort studies encompassing 37.112
patients were regarded as eligible for evaluation. Ranolazine was found to
attenuate patients' odds of developing AF (OR 0.53, 95% CI: 0.41-0.69,
p<0.001, i2=58%). This effect held true, with an even larger effect size,
in the context of post-cardiac surgery (OR 0.34, 95% CI: 0.16-0.72,
p=0.005, i2=64%). Ranolazine increased the chances of successful AF
cardioversion when added to amiodarone over amiodarone alone (OR 6.67, 95%
CI: 1.49-29.89, p=0.01, i2=76%), while significantly reducing
time-to-cardioversion [SMD 9.54h, 95% CI: -13.3-5.75, p<0.001, i2=99%].
Interestingly, cardioversion was faster with <=1000mg of ranolazine (SMD
-13.16h, 95% CI: -15.07-11.25, p<0.001, i2=95%) than with 1500mg (SMD
-3.57h, 95% CI: -5.06-2.08, p<0.001, i2=23%). In paroxysmal AF, ranolazine
was also proved to significantly reduce both AF burden and episodes. There
were no safety signals regarding mortality odds, QTc interval prolongation
(mostly clinically insignificant) and hypotension (mostly transitory).
 Conclusion(s): Current evidence suggests that ranolazine provides an
effective and safe option for a chemical rhythm control strategy in AF
management, a field in which medical breakthroughs are desperately needed.

<15>
Accession Number
634164351
Title
Identifying high thrombotic risk in atrial fibrillation patients
undergoing percutaneous coronary intervention: Is there a benefit of
triple therapy?.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1451), 2020. Date of Publication:
November 2020.
Author
Bor W.L.; Zwart B.; De Veer A.J.W.M.; Mahmoodi B.K.; Kelder J.C.; Cannon
C.P.; Ten Berg J.M.
Institution
(Bor, De Veer, Mahmoodi, Kelder, Ten Berg) St Antonius Hospital,
Nieuwegein, Netherlands
(Zwart) Catharina Hospital, Eindhoven, Netherlands
(Cannon) Brigham and Women'S Hospital, Harvard Medical School, Boston,
United States
Publisher
Oxford University Press
Abstract
Introduction: Patients requiring concomittant use of oral anticoagulants
for atrial fibrillation and dual antiplatelet therapy after percutaneous
coronary intervention (PCI) are at increased risk of bleeding and
mortality. Omittance of aspirin (dual antithrombotic therapy, DAT) reduces
bleeding as compared to triple antithrombotic therapy (TAT), but might not
ascertain antithrombotic efficacy, especially in high-risk patients.
 Purpose(s): To identify a subgroup of patients at high thrombotic
risk that might benefit most from TAT over DAT. Method(s): The study
was performed in a combined cohort of two randomised controlled trials
(WOEST, RE-DUAL PCI) comparing TAT versus DAT after PCI. A Cox
proportional hazards model predictive for the composite thrombotic
endpoint of cardiovascular death, myocardial infarction (MI), stent
thrombosis, and ischaemic stroke was built by stepwise selection of
plausible predictor variables. Area under the receiver operating curve
(AUC) was obtained, and clinical outcomes (thrombotic endpoint, bleeding
[BARC 2,3+5], and all-cause mortality) were compared between the highest
quintile of predicted thrombotic risk (high risk) and the remainder of
patients (low-intermediate risk). Within the different risk groups, effect
of TAT versus DAT was compared. Result(s): A total of 3288 patients
in the combined WOEST and RE-DUAL cohorts were included in this analysis.
Approximately half underwent PCI for acute coronary syndrome. In 250
patients (7.6%) the composite thrombotic endpoint occurred during the
first year. The final Cox proportional hazards model predicting thrombotic
events contained: left ventricular ejection fraction, 3-vessel disease, MI
at index PCI, peripheral artery disease, prior stroke, left circumflex
coronary artery stenting, a history of MI, PCI to a bypass graft, and
platelet count. The discriminatory capacity of the ischaemic model was
fair (AUC 0.68, 95% confidence interval 0.64-0.71). Incidence of
thrombotic events and mortality was higher in the high-risk as compared to
low-intermediate risk patients (15.8% vs 5.6%, and 8.4% vs 3.2%,
respectively, both p<0.001), whereas bleeding was comparable (20.5% vs
19.6%, p=0.60). No statistically significant effect of TAT over DAT was
seen with regards to the thrombotic endpoint in both high and
lowintermediate risk patients (13.9% vs 17.0%, p=0.36, and 6.5% vs 5.0%,
p=0.11, respectively). Bleeding was significantly reduced with DAT versus
TAT in both high and low-intermediate risk patients (minus 12.8% and 8.1%,
both p<0.02). For low-intermediate risk patients a statistically
significant increase in mortality was found with TAT versus DAT (4.2% vs
2.5%, p=0.02), whereas this was not found in high-risk patients (7.2% vs
9.1%, p=0.47). Conclusion(s): No significant antithrombotic advantage
of TAT over DAT was found in high-risk patients. However, TAT increased
bleeding risk in all patients, and increased mortality in low-intermediate
risk patients.

<16>
Accession Number
634164220
Title
Ten-year all-cause death in elderly patients undergoing percutaneous
coronary intervention or coronary artery bypass grafting: A prespecified
subgroup analysis of the SYNTAX Extended Survival study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1490), 2020. Date of Publication:
November 2020.
Author
Ono M.; Takahashi K.; Hara H.; Gao C.; Wang R.; Kappetein P.; Mohr F.;
Mack M.; Holmes D.; Morice M.; Davierwala P.; Head S.; Onuma Y.; Thuijs
D.; Serruys P.
Institution
(Ono, Takahashi, Hara) Amsterdam UMC, Amsterdam, Netherlands
(Gao, Wang) Radboud University Medical Center, Department of Cardiology,
Nijmegen, Netherlands
(Kappetein, Head, Thuijs) Erasmus University Medical Centre, Department of
Cardiothoracic Surgery, Rotterdam, Netherlands
(Mohr, Davierwala) Heart Center of Leipzig, Department of Cardiac Surgery,
Leipzig, Germany
(Mack) Baylor University Medical Center, Department of Cardiothoracic
Surgery, Dallas, United States
(Holmes) Mayo Clinic, Department of Cardiovascular Diseases and Internal
Medicine, Rochester, United States
(Morice) Jacques Cartier Private Hospital, Departement of Cardiologie,
Massy, France
(Onuma) National University of Ireland, Department of Cardiology, Galway,
Ireland
(Serruys) Imperial College London, NHLI, London, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Coronary artery disease is the leading cause of death among
elderly men and women worldwide. The aging society worldwide will lead to
increasing numbers of elderly patients with multivessel coronary artery
disease. Although age is recognized as one of the most important factors
in a decision-making for revascularization of multivessel coronary artery
disease, the very long-term outcomes in patients undergoing
revascularization by percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) is still unclear. Objective(s): The aim
of the present study was to investigate the association between
revascularization strategies and 10-year outcomes in elderly patients.
 Method(s): The SYNTAX Extended Survival (SYNTAXES) study (NCT
03417050) is an investigator-driven extension of follow-up of a
multicentre, randomised controlled trial done in 85 hospitals across 18
North American and European countries, enrolling 1,800 patients with de
novo three-vessel disease (3VD) and/or left main coronary artery disease
(LMCAD) randomized to revascularization strategy with CABG versus PCI in
the SYNTAX trial. Patients were divided into two groups according to the
prespecified threshold of 70 years old; elderly patients (>70 years) and
non-elderly patients (<=70 years). The primary endpoint of this study was
all-cause death at 10 years. Result(s): Out of 1,800 patients, 575
patients (31.9%) were classified as elderly (>70 years). The mean age +/-
standard deviation (SD) of the elderly patients and the non-elderly
patients was 75.8+/-3.6 years and 60.1+/-7.4 years, respectively. Of note,
elderly patients were more frequently female than non-elderly patients
(33.6% vs. 17.1%, p<0.001). As expected, the elderly patients had higher
prevalence of chronic kidney disease (43.4% vs. 7.9%, p<0.001), had higher
anatomical SYNTAX score (30.2+/-11.8 vs 28.0+/-11.2 p<0.001) when compared
to those of the non-elderly patients. Up to 10 years, all-cause death
occurred in 42.7% and 18.9% in the elderly and non-elderly patients,
respectively (Log-rank p<0.001). The cubic spline curve showed an
exponentially increase in all-cause death at 10 years according to the
increase of age both in the PCI arm and the CABG arm. At 10 years, there
was no significant difference in the risk of all-cause death between CABG
vs. PCI either in elderly patients (41.5% vs. 44.0%; Log-rank p=0.53) or
non-elderly patients (16.6% vs. 21.1%; Logrank p=0.051).
 Conclusion(s): CABG and PCI were equipoise in terms of risk of
all-cause death at 10 years in patients with de novo 3VD and/or LMCAD
irrespective of their age when stratified according to the prespecified
threshold of 70 years old.

<17>
Accession Number
634164058
Title
Derivation and validation of a scoring system to predict after discharge
risk of cardiac events in patients with acute myocardial infarction
undergoing percutaneous coronary revascularization.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1628), 2020. Date of Publication:
November 2020.
Author
Corsini A.; Massarelli G.; Bruno M.; Bruno A.G.; Compagnone M.; Ghetti G.;
Saia F.; Galie N.; Taglieri N.
Institution
(Corsini, Massarelli, Bruno, Bruno, Compagnone, Ghetti, Saia, Galie,
Taglieri) University Hospital Policlinic S. Orsola-Malpighi,
Cardio-Thoraco-Vascular, Bologna, Italy
Publisher
Oxford University Press
Abstract
Background: In the acute coronary syndromes (ACS) setting, despite the
extensive use of coronary revascularization and P2Y12 inhibitors such as
prasugrel and ticagrelor, with a more pronounced inhibitory effect on
platelets than clopidogrel, the rate of death and recurrent myocardial
infarction (MI) at 1 year is still high. In this clinical setting the
development of a risk score which takes into account patient's and
procedural characteristics could represent a useful tool to identify
patients at high risk for ischaemic events at 1 year who could take
advantage from more aggressive secondary prevention strategies.
 Purpose(s): The aim of our study was to develop a risk score to
predict 1- year probability of after discharge cardiac events (recurrent
MI and cardiac death) in patients with acute MI treated with percutaneous
coronary intervention (PCI). Method(s): We prospectively enrolled all
consecutive patients hospitalized for acute MI between 2003 and 2017
treated with PCI with/without stent placement at our center. We excluded
patients who died in-hospital or who experienced in-hospital recurrent MI
and patients undergoing surgical revascularization by coronary artery
bypass graft (CABG). The patients of the final study cohort were therefore
randomly assigned to either a derivation sample (60%) or a validation
sample (40%). Based on the multivariate analysis we developed a point
system according to the "Framingham Risk Score" method. Result(s):
The final study cohort, represented by 4922 patients, was split in a
derivation sample of 2972 patients and in a validation sample of 1950
patients: in both groups the median age was around 70 years; the male
prevalence was 73%; 65% of patients were dagnosed with ST-segment
elevation MI. The clinical prediction score underlined as risk factors for
recurrent cardiac events older age, diabetes mellitus, peripheral arterial
disease, prior MI, Killip class >2 at presentation, higher platelet count
and creatinine values, lower left ventricular ejection fraction; radial
access and the use of second generation drug eluting stents resulted to be
protective. This model showed a good discrimination power in both the
derivation and the validation samples with an area under the curve (AUC)
of 0.75 and 0.71, respectively. The calibration showed a good concordance
between predicted and observed events in both the derivation and the
validation samples. Same results were observed in patients with/without
ST-segment elevation MI and in gender subgroups. Conclusion(s): The
present study, conducted retrospectively on a large population of patients
with acute MI treated with PCI enrolled prospectively, enabled us to
derivate and validate a risk score of cardiac death and recurrent MI at 1
year which took into account both clinical and procedural characteristics
and which demonstrated a good predictive performance.

<18>
Accession Number
634164045
Title
High-dose statin therapy and the risk of haemorrhagic stroke in Asian
patients with stable coronary artery disease: Insights from the REAL-CAD
study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1326), 2020. Date of Publication:
November 2020.
Author
Takahashi M.; Tsuchida K.; Sato Y.; Iimuro S.; Kario K.; Kimura T.; Nagai
R.
Institution
(Takahashi, Kario) Jichi Medical University, Cardiovascular Medicine,
Shimotsuke, Japan
(Tsuchida) Niigata City General Hospital, Department of Cardiology,
Niigata, Japan
(Sato) Keio University, School of Medicine, Department of Preventive
Medicine and Public Health, Tokyo, Japan
(Iimuro) International University of Health and Welfare, Innovation and
Research Support Center, Tokyo, Japan
(Kimura) Kyoto University, Graduate School of Medicine, Department of
Cardiovascular Medicine, Kyoto, Japan
(Nagai) Jichi Medical University, Shimotsuke, Japan
Publisher
Oxford University Press
Abstract
Background/Introduction: The REAL-CAD study identified that aggressive
lipid lowering with high-dose statin reduced cardiovascular events also in
Japanese patients with coronary artery disease (CAD). However, data from
the SPARCL trial found that the benefits of high-dose atorvastatin
treatment were partially offset by an increase in haemorrhagic stroke
(HS). Although meta-analysis showed statin does not increase HS in Western
countries, the evidence about the relation between statin and HS in Asian
countries is still conflicting. In addition, the CREDO-Kyoto score is one
of the prediction scorings for bleeding after coronary revascularization
and might be a useful tool for the prediction of HS in this cohort.
Recognizing the risk of HS and predicting of HS in the Asian cohort is
clinically important. Purpose(s): This study examined the factors
associated with HS using the REAL-CAD cohort. Furthermore, we evaluated
the performance of the CREDO-Kyoto bleeding risk score to predict HS in
this cohort. We also performed the corresponding analysis of ischaemic
stroke for reference purposes. Method(s): We sub-analysed the
REAL-CAD study, prospective, multicentre, randomized, open-label, blinded
endpoint study, in which 13,054 Japanese patients with stable CAD were
randomized to high-dose (4 mg/day) or low-dose (1 mg/day) pitavastatin.
Associations for stroke were determined using competing risk models: the
Fine and Gray subdistribution hazards model accounting for the competing
risk of death in models of haemorrhagic and ischaemic stroke in REAL-CAD
trial. Patients were categorized to low (score 0), moderate (score 1-2),
and high (score>3) according to CREDO-Kyoto bleeding score for predicting
of HS. Result(s): The HS events in high-dose group tended to be
higher than lowdose group (4mg vs. 1mg: 43 (0.7%) vs. 30 (0.5%)). The
associated factors of HS on univariate analysis were non-prior myocardial
(hazard ratio (HR): 0.62, 95% CI: 0.39-0.99) and non-prior cerebral (HR:
0.25, 95% CI: 0.09- 0.70) infarction, atrial fibrillation (HR: 2.4, 95%
CI: 1.2-4.7), prior HS (HR: 4.2, 95% CI: 1.5-11.8), anaemia (HR: 2.4, 95%
CI: 1.4-4.1), and nonstatins use before run-in period (HR: 0.52, 95% CI:
0.28-0.99). High-dose pitavastatin was not a correlate with HS. The
multivariate analysis revealed anaemia might have a relation with HS (HR:
4.3, 95% CI: 0.90-20.6). The number of HS was the highest in the high
CREDO-Kyoto bleeding score group (Figure 1, HR: 2.4, 95% CI: 1.3-4.6),
whereas there was no significant difference in the number of HS between
the moderate- and low-risk groups (HR: 1.4, 95% CI: 0.84-2.3).
 Conclusion(s): High-dose pitavastatin was not associated with the
incidence of HS in this large Japanese cohort with stable CAD. High
CREDOKyoto bleeding score was associated with HS as compared with low or
moderate scores, even each of the variables consisting of CREDO-Kyoto
score was not associated with HS.

<19>
Accession Number
634164023
Title
Fractional flow reserve (FFR) guided vs angiography guided coronary artery
bypass graft (CABG): A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1474), 2020. Date of Publication:
November 2020.
Author
Bruno F.; D'Ascenzo F.; Marengo G.; Manfredi R.; Conrotto F.; Gallone G.;
Omede P.; Montefusco A.; Pennone M.; Salizzoni S.; Rinaldi M.; Giustetto
C.; De Ferrari G.
Institution
(Bruno, D'Ascenzo, Marengo, Manfredi, Conrotto, Gallone, Omede,
Montefusco, Pennone, Giustetto, De Ferrari) Hospital Molinette of the
University Hospital S. Giovanni Battista, City University Hosp of Health
an, Cardiology, Turin, Italy
(Salizzoni, Rinaldi) A.O.U. Citta della Salute e della Scienza di Torino,
Cardiosurgery, Turin, Italy
Publisher
Oxford University Press
Abstract
Background: A strategy of percutaneous coronary intervention (PCI) driven
by FFR (Fractional Flow Reserve) has demonstrated to reduce adverse events
through the "deferring" of unnecessary stenting procedures compared to PCI
guided by angiographic evaluation of stenosis. Coronary Artery Bypass
Graft (CABG) represents another option for revascularization, being
superior to PCI in patients with diffuse disease. In this setting, some
evidence has been provided about physiological driven CABG procedures, but
studies reported contrasting results regarding clinical benefits and
outcomes at follow up. The aim of this meta-analysis is to evaluate
clinical and procedural impact of FFR versus angiographic guided surgical
revascularization and assess outcomes at follow up. Method(s): All
randomized controlled trials (RCTs) or observational studies with
multivariable adjustment or propensity matching were included. MACE (Major
Adverse Cardiac Events) was the primary end point, while its single
components (death, myocardial infarction and revascularization) along with
number of grafts and percent of off-pump CABG were the secondary ones. Of
86 studies identified, 4 articles were included in this review,
representing a combined total of 777 patients (426 angio-guided and 351
FFR-guided). Mean age was 66+/-2.1, 80% man, 74% hypertension, 71%
hyperlipidemia, 33% diabetes, 39% smokers. Mean EuroSCORE I was 2.7. 18% a
prior MI, and 25% a prior PCI. Coronary lesions were allocated as follow:
36% left anterior descending artery, 32% circumflex artery, 27% right
coronary artery. Mean follow up was 30 months. At the follow up, rates of
MACE did not differ (MACE OR 1.31:0.88-1.96), as those of death (OR
1.47:0.86-2.51), of MI (OR 1.80:0.89-3.63), and of target vessel
revascularization (1.03: 0.54-1.97.). FFR-guided CABG was associated with
more off-pump surgical procedure (OR 0.58, IC 0.34-0.97) and shorter
hospitalization time (8.2+/-2.49 vs 8,87+/-3,25 p<0.01). FFR- guided CABG
was associated more frequently with off-pump surgical procedure (OR
0.58:0.34-0.97) with fewer anastomes (2.5 vs 3), leading to higher rates
of global arteria revascularization in FFR group (56% vs. 45%) and higher
rates of venous grafts in angio-guided group (55% vs. 44%). Shorter
hospitalization time was recorded in FFR patients (8.2+/-2.49 vs
8,87+/-3,25 days, p<0.01). Graft patency at follow up was not
statistically higher in the FFR guided group (OR 0.67, CI 95% 0.32-1,39,
all CI 95%). Conclusion(s): FFR-guided surgical revascularization is
associated with more off-pump procedures, a lower number of surgical
anastomoses and more arterial grafts compared to angiography guided CABG.
These differences lead to a shorter hospitalization time in the FFR-guided
group compared to the angiography-guided group. No difference between two
groups in MACE, overall death and MI was observed during the follow up.
RCT with longer follow up are needed to evaluate long term outcomes.

<20>
Accession Number
634163962
Title
Efficacy of fractional flow reserve-guided percutaneous coronary
intervention for patients with angina pectoris: A network meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1469), 2020. Date of Publication:
November 2020.
Author
Shinohara H.; Kodera S.; Kiyosue A.; Ando J.; Morita H.; Komuro I.
Institution
(Shinohara, Kodera, Kiyosue, Ando, Morita, Komuro) University of Tokyo
Hospital, Tokyo, Japan
Publisher
Oxford University Press
Abstract
Background: Evaluation of hemodynamic parameters, such as fractional flow
reserve (FFR), is recommended before percutaneous coronary intervention
(PCI) for patients with angina pectoris (AP). However, the advantage of
FFR-guided PCI has not been fully established. A network metaanalysis
(NMA) synthesizes the results of studies on multiple competing
interventions. Moreover, no NMA has evaluated randomized controlled trials
for AP to compare FFR-guided PCI and other treatments. To clarify whether
FFR-guided PCI improves the prognosis in patients with AP, we performed
this study. Method(s): Multiple databases were searched for studies
published from 2000 to 2018. The search terms were based on Medical
Subject Headings and keywords including "angioplasty", "coronary artery
bypass", "percutaneous coronary intervention", "coronary disease", and
"randomized controlled trial". And an NMA was performed to compare
outcomes of FFRguided PCI, non-FFR-guided PCI, coronary artery bypass
grafting (CABG), and medical treatment (MT) for AP based on estimated odds
ratios (ORs). The primary endpoint was all-cause mortality. The secondary
endpoints were the occurrence of MI. Treatments were ranked by the surface
under the cumulative ranking curve. Result(s): The study included
18,093 patients from 15 randomized controlled trials. No evidence of
inconsistency was observed among the studies. The NMA showed that the
all-cause mortality of FFR-guided PCI was not significantly different from
that of the other treatment groups (CABG: OR, 1.1; 95% confidence interval
[CI], 0.67-1.7; non-FFR-guided PCI: OR, 0.85; 95% CI, 0.53-1.4; and MT:
OR, 0.83; 95% CI, 0.52-1.3). The NMA for myocardial infarction, which
included 13,548 patients from 11 randomized controlled trials, showed that
FFR-guided PCI tended to reduce the occurrence of myocardial infarction
compared with MT (OR, 0.60; 95% CI, 0.36- 1.0). According to the surface
under the cumulative ranking curve, CABG was the best treatment, followed
by FFR-guided PCI, non-FFR-guided PCI, and MT. Conclusion(s):
FFR-guided PCI for AP showed no significant prognostic improvement
compared with non-FFR-guided PCI, CABG, and MT. CABG was the best
treatment for AP, followed by FFR-guided PCI, non-FFRguided PCI, and MT.

<21>
Accession Number
634163931
Title
Multi-vessel disease percutaneous coronary intervention versus coronary
artery bypass grafting in patients with chronic kidney disease.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1516), 2020. Date of Publication:
November 2020.
Author
Hassan Abdelnabi M.; Almaghraby A.; El-Amrawy A.
Institution
(Hassan Abdelnabi) Medical Research Institute, Alexandria University,
Clinical and Experimental Internal Medicine Department, Alexandria, Egypt
(Almaghraby, El-Amrawy) Faculty of Medicine, Alexandria University,
Department of Cardiology, Alexandria, Egypt
Publisher
Oxford University Press
Abstract
Introduction: Coronary revascularization is associated with better
prognosis in multivessel coronary artery disease (MV-CAD) chronic kidney
disease (CKD) patients. However, whether coronary artery bypass grafting
(CABG) or percutaneous coronary intervention (PCI) is better remains
unknown. Aim of the study: To compare outcome of multi-vessel PCI versus
CABG in the group of patients with CKD regarding in-hospital and one-year
major adverse cardiovascular and cerebrovascular events (MACCE).
 Method(s): A retrospective analysis of the data of patients with
established CKD with eGFR less than 60 ml/min with MV-CAD who underwent
PCI or CABG were compared as regards in-hospital and one-year MACCE.
 Result(s): A total number of 565 patients were reviewed, 230 patients
had PCI while 335 patients had CABG. Comparing both groups regarding
inhospital MACCE, patients who had mutli-vessel PCI had significantly
lower in-hospital death, cerebrovascular events and total MACCE than
patients who had CABG (P-value = 0.03, 0.01, 0.04 respectively). While
comparing both groups regarding 1-year MACCE, patients who had
mutli-vessel PCI had significantly lower cerebrovascular events and total
MACCE than patients who had CABG (P-value = 0.02, 0.03 respectively).
 Conclusion(s): On the contrary to previously published data, in a
retrospective study to determine which is better in CKD MV-CAD patients,
Multivessel PCI for CKD patients and MVCAD had advantages over CABG as
regards in-hospital and 1-year cerebrovascular accidents (stroke/TIA) and
total MACCE. Large randomized controlled trials are needed to confirm our
findings.

<22>
Accession Number
634163920
Title
Prasugrel versus ticagrelor in patients with acute coronary syndrome
undergoing percutaneous coronary intervention; a meta-analysis of
randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1465), 2020. Date of Publication:
November 2020.
Author
Rodriguez Z.; Valdecanas A.; Palileo N.
Institution
(Rodriguez, Valdecanas, Palileo) St. Luke's Medical Center Quezon City,
Quezon City, Philippines
Publisher
Oxford University Press
Abstract
Background: Dual antiplatelet therapy (DAPT) with ASA and a P2Y12
inhibitor is the cornerstone of anti-thrombotic therapy for patients
undergoing PCI. The 2014 European Society of Cardiology (ESC)/European
Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial
revascularization recommend DAPT with prasugrel or ticagrelor over
clopidogrel, however, a comparison between the efficacy in reducing all
cause mortality and major bleeding of prasugrel versus ticagrelor is
sparse. Objective(s): To perform a meta-analysis of randomized
controlled trials (RCT) in the determination of the efficacy and safety of
prasugrel as compared to ticagrelor among ACS patients undergoing PCI.
 Method(s): Extensive search of PubMed, Cochrane Library, Ovid,
EMBASE, Google scholar, Medline and Herdin was done up to November 2019.
Studies were limited to RCTs comparing ticagrelor vs. prasugrel among
acute coronary syndrome (ACS) patients undergoing PCI. Outcome measures
include all-cause mortality and major bleeding. Statistical analysis was
done using Review manager V5.3. Result(s): Thirteen RCTs with 6086
patients were included in this study. Pooled analysis using random effects
model showed no difference in reduction of all-cause mortality between
prasugrel versus ticagrelor (92 vs 107, RR of 0.77, 95% CI of 0.58-1.02,
p-value of 0.07, I2 of 0%). Likewise, major bleeding (using BARC and TIMI
as defined by the Bleeding Academic Research Consortium scale and
Thrombolysis in Myocardial Infarction definitio) was similar between
prasugrel and ticagrelor (91 vs 111, RR of 0.83, 95% CI of 0.63-1.09,
p-value of 0.18, I2 of 0%). Conclusion(s): There were no significant
differences in the reduction of all cause mortality and major bleeding
among ACS patients undergoing PCI receiving prasugrel versus ticagrelor.
Our study may support the equal recommendation of both P2Y12 inhibitors as
in the above guidelines.

<23>
Accession Number
634163773
Title
Low-dose colchicine in patients treated with percutaneous coronary
interventions for myocardial infarction in the Colchicine Cardiovascular
Outcomes Trial (COLCOT).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1556), 2020. Date of Publication:
November 2020.
Author
L'Allier P.L.; Tardif J.C.; Kouz S.; Waters D.D.; Diaz R.; Maggioni A.P.;
Pinto F.J.; Gamra H.; Kiwan G.S.; Berry C.; Lopez-Sendon J.C.; Koenig W.;
Blondeau L.; Guertin M.C.; Roubille F.
Institution
(L'Allier, Tardif, Blondeau, Guertin) Montreal Heart Institute, Montreal,
Canada
(Kouz) CHRDL, Joliette, Canada
(Waters) San Francisco General Hospital, San Francisco, United States
(Diaz) Estudios Cardiologicos Latinoamerica (ECLA), Rosario, Argentina
(Maggioni) ANMCO Foundation For Your Heart, Florence, Italy
(Pinto) CHULN and Faculty of Medicine, University of Lisbon, Lisbon,
Portugal
(Gamra) Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Kiwan) Bellevue Hospital, Beirut, Lebanon
(Berry) Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
(Lopez-Sendon) University Hospital La Paz, Madrid, Spain
(Koenig) Deutsches Herzzentrum Muenchen, Technical University of Munich,
Munich, Germany
(Roubille) University of Montpellier, Montpellier, France
Publisher
Oxford University Press
Abstract
Background/Introduction: Experimental and clinical evidence supports the
role of inflammation in atherosclerosis and its complications. Colchicine
is an orally administered, potent anti-inflammatory medication that was
shown to significantly lower the risk of ischemic cardiovascular events
compared to placebo among subjects with a recent myocardial infarction
(MI) in the main COLCOT trial. Patients treated with percutaneous coronary
intervention (PCI) after MI represent an important subpopulation that may
derive particularly important benefits from colchicine. Purpose(s):
To assess the impact of low-dose colchicine on cardiovascular events in
subjects treated with PCI for an index MI. Method(s): We performed an
international, randomized, double-blind trial involving patients recruited
within 30 days after a MI (main COLCOT trial; n=4745). In this trial,
patients were eligible if they had a confirmed myocardial infarction
within 30 days before enrollment, had completed any planned percutaneous
revascularization procedures and were treated medically according to
national guidelines that included the intensive use of statins. Subjects
were randomly assigned to receive oral colchicine 0.5 mg once daily or
matching placebo. Among the entire COLCOT study population, 4408 subjects
were treated with PCI for the index MI and form the COLCOT-PCI study
population. We analyzed the time to the first positively adjudicated event
of the composite of CV death, resuscitated cardiac arrest, acute MI,
stroke or urgent hospitalization for angina requiring coronary
revascularization (primary endpoint). Result(s): In the main COLCOT
trial, low-dose colchicine led to a significantly lower risk of the
primary endpoint (hazard ratio, 0.77; 95% confidence interval [CI], 0.61
to 0.96; p=0.02). In the COLCOT-PCI subpopulation, low-dose colchicine was
associated with a large reduction in the risk of a primary endpoint event
(hazard ratio, 0.72; 95% confidence interval [CI], 0.57 to 0.92; p=0.008).
The hazard ratios for individual components of the composite primary
endpoint were 0.71 (95% CI, 0.37 to 1.33) for death from cardiovascular
causes, 0.84 (95% CI, 0.26 to 2.75) for resuscitated cardiac arrest, 0.90
(95% CI, 0.66 to 1.21) for myocardial infarction, 0.25 (95% CI, 0.08 to
0.76) for stroke, and 0.42 (95% CI, 0.25 to 0.71) for urgent
hospitalization for angina requiring coronary revascularization.
 Conclusion(s): Low-dose colchicine markedly reduces the risk of
ischemic cardiovascular events in patients treated with PCI for their
index MI.

<24>
Accession Number
2005998853
Title
Effect of high-intensity interval training on aerobic capacity and heart
rate control of heart transplant recipients: A systematic review with
meta-analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 36 (1) (pp 86-93), 2021. Date
of Publication: 2021.
Author
Conceicao L.S.R.; Gois C.O.; Fernandes R.E.S.; Martins-Filho P.R.S.; Neto
M.G.; Neves V.R.; Carvalho V.O.
Institution
(Conceicao, Gois, Fernandes, Carvalho) Universidade Federal de Sergipe,
Rua Claudio Batista, s/n, Bairro Sanatorio, Aracaju, Sergipe, SE
49060-100, Brazil
(Conceicao, Gois, Fernandes, Carvalho) Universidade Federal de Sergipe
(UFS), Sao Cristovao, Sergipe, Brazil
(Conceicao, Gois, Fernandes, Carvalho) The GREAT Group (GRupo de Estudos
em ATividade fisica), Universidade Federal de Sergipe (UFS), Sao
Cristovao, Sergipe, Brazil
(Martins-Filho) Investigative Pathology Laboratory, Universidade Federal
de Sergipe (UFS), Sao Cristovao, Sergipe, Brazil
(Neto) Department of Physical Therapy, Universidade Federal da Bahia
(UFBa), Salvador, Bahia, Brazil
(Neves) Universidade de Pernambuco (UPE), Pernambuco, Recife, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Heart transplantation (HTx) is the gold standard procedure
for selected individuals with refractory heart failure. High- intensity
interval training (HIIT) is safe and allows patients to exercise in high
intensity for longer time when compared to moderate- intensity continuous
training (MICT). The primary aim of this study was to perform a systematic
review and meta-analysis about the effect of HIIT compared to MICT on
exercise capacity, peak heart rate, and heart rate reserve in HTx
recipients. Secondarily, we pooled data comparing MICT and no exercise
training in these patients. Method(s): This systematic review
followed the standardization of the Preferred Reporting Items for
Systematic Reviews and Meta-analyses statement and the Cochrane
Collaboration Handbook. We presented the treatment effects of HIIT on the
outcomes of interest as mean difference (MD) and 95% confidence interval
(CI). Meta-analysis was performed using the random-effects, generic
inverse variance method. Result(s): HIIT improved peak oxygen
consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart
rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD =
4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on
peakVO<inf>2</inf> (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart
rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no
exercise training. Conclusion(s): Current available evidence suggests
that HIIT leads to improvements on peakVO<inf>2</inf>, peak heart rate,
and heart rate reserve compared to MICT in HTx recipients. However, the
superiority of HIIT should be tested in isocaloric
protocols. Copyright © 2021, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<25>
Accession Number
633924754
Title
The association of depression following percutanous coronary intervention
with adverse cardiovascular events: Protocol for a systematic review and
meta-analysis.
Source
Medicine (United States). 98 (2) (no pagination), 2019. Article Number:
e13952. Date of Publication: 2019.
Author
Zhao Y.; Tian J.; Tong T.; Gao R.; Liu Y.
Institution
(Liu) Graduate School of Beijing University of Chinese Medicine, Beijing,
China
(Liu, Liu) Cardiovascular Diseases Center, Xiyuan Hospital of China
Academy of Chinese Medical Sciences, Beijing, China
(Liu, Gao) Institute of Clinical Pharmacology of Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing, China
(Zhao) School of Chinese Medicine, Li Ka Shing Faculty of Medicine,
University of Hong Kong, Pokfulam, Hong Kong
(Tian) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Tong) Department of Mathematics, Hong Kong Baptist University, Kowloon
Tong, Hong Kong
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Percutanous coronary intervention (PCI) has been
increasingly used for patients suffered from severe coronary artery
disease. However, physical trauma and potential adverse events related to
the procedure often result in detrimental psychological stress.
Accumulating evidences have shown that depression is closely related to
coronary artery disease. However, the association of depression following
percutanous coronary intervention with adverse cardiovascular events is
still unknown. Objective(s): This review is designed to assess the
prognostic association of depression following PCI with adverse cardiac
events. Methods and analysis: The following databases will be searched,
PubMed, the EMBASE, CINAHL and Web of Science of English-language
publications from inception to 30 October 2018. Cross-referencing from
retrieved studies will be conducted additionally, and observational
studies were included. Two independent review authors will do the study
selection on the basis of the study eligibility criteria. Extracted data
will be used for quantitative and qualitative evidence synthesis as well
as to assess methodological quality of studies using the Newcastle-Ottawa
checklist. The primary objective of this review is adverse cardiac events,
presented as a composition of myocardial infarction, repeat coronary
revascularization, cardiac readmission, and cardiac death. The accumulated
evidence is evaluated and graded according to Grading of Recommendations,
Assessment, Development and Evaluation (GRADE). Result(s) and
Conclusion(s): This review will explain the association of depression
following percutanous coronary intervention with adverse cardiovascular
events, and provide physicians with scientific evidence for psychological
intervention in patients after PCI. Copyright © 2019 the
Author(s). Published by Wolters Kluwer Health, Inc.

<26>
Accession Number
2010964702
Title
Lung Injury After Neonatal Congenital Cardiac Surgery Is Mild and
Modifiable by Corticosteroids.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Kaskinen A.K.; Keski-Nisula J.; Martelius L.; Moilanen E.; Hamalainen M.;
Rautiainen P.; Andersson S.; Pitkanen-Argillander O.M.
Institution
(Kaskinen) Division of Pediatric Nephrology and Transplantation,
Children's Hospital and Pediatric Research Center, Helsinki University
Hospital and University of Helsinki, Helsinki, Finland
(Keski-Nisula, Rautiainen) Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Hospital and University of
Helsinki, Helsinki, Finland
(Martelius) Department of Radiology, HUS Medical Imaging Center,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Moilanen, Hamalainen) The Immunopharmacology Research Group, Faculty of
Medicine and Health Technology, Tampere University and Tampere University
Hospital, Tampere, Finland
(Andersson) Children's Hospital and Pediatric Research Center, Helsinki
University Hospital and Helsinki University, Helsinki, Finland
(Pitkanen-Argillander) Division of Pediatric Cardiology, Children's
Hospital, Helsinki University Hospital and University of Helsinki,
Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objectives: The present study was performed to determine whether lung
injury manifests as lung edema in neonates after congenital cardiac
surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates
postoperative lung injury in neonates after congenital cardiac surgery.
 Design(s): A supplementary report of a randomized, double-blinded,
placebo-controlled clinical trial. Setting(s): A pediatric tertiary
university hospital. Participant(s): Forty neonates (age <=28 days)
undergoing congenital cardiac surgery with cardiopulmonary bypass.
 Intervention(s): After anesthesia induction, patients were assigned
randomly to receive intravenously either 2 mg/kg methylprednisolone or
placebo b, which was followed by hydrocortisone or placebo bolus six hours
after weaning from CPB for five days as follows: 0.2 mg/kg/h for 48 hours,
0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24
hours. Measurements and Main Results: The chest radiography lung
edema score was lower in the SDC than in the placebo group on the first
postoperative day (POD one) (p = 0.03) and on PODs two and three (p =
0.03). Furthermore, a modest increase in the edema score of 0.9 was noted
in the placebo group, whereas the edema score remained at the preoperative
level in the SDC group. Postoperative dynamic respiratory system
compliance was higher in the SDC group until POD three (p < 0.01).
However, postoperative oxygenation; length of mechanical ventilation; and
tracheal aspirate biomarkers of inflammation and oxidative stress, namely
interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no
differences between the groups. Conclusion(s): The SDC regimen
reduced the development of mild and likely clinically insignificant
radiographic lung edema and improved postoperative dynamic respiratory
system compliance without adverse events, but it failed to improve
postoperative oxygenation and length of mechanical
ventilation. Copyright © 2021 Elsevier Inc.

<27>
Accession Number
2010436865
Title
Unusual presentation of empyema necessitans: case report and review of the
literature.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2021. Date
of Publication: 2021.
Author
White-Dzuro C.G.; Assi P.E.; Thomas H.C.; Thayer W.P.
Institution
(White-Dzuro, Thomas) Vanderbilt University School of Medicine, Nashville,
TN, United States
(White-Dzuro, Assi, Thayer) Department of Plastic Surgery, Vanderbilt
University Medical Center, D-4207 Medical Center North, 1161 21st Avenue
South, Nashville, TN 37212, United States
Publisher
Springer Japan
Abstract
Empyema necessitans is characterized by the extension of a pleural empyema
into adjacent structures beyond the pleural space. Although rare, it adds
significant complications to patients already suffering from pleural
empyema. Standard of surgical care has yet to be characterized or
described in the literature. Here, we describe the unusual presentation of
a 55-year-old man with methicillin-sensitive Staphylococcus aureus empyema
necessitans and outline both our surgical intervention and thoracic
reconstruction. We present our case's presentation, management, and
outcome. We then review the literature and describe a multidisciplinary
approach for management. Empyema necessitans is a very rare and morbid
condition requiring urgent intervention to promote optimal
outcomes. Copyright © 2021, The Japanese Association for Thoracic
Surgery.

<28>
Accession Number
2005928593
Title
Ecmo in cardiac arrest: A narrative review of the literature.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-15), 2021. Article Number: 534.
Date of Publication: 01 Feb 2021.
Author
De Charriere A.; Assouline B.; Scheen M.; Mentha N.; Banfi C.; Bendjelid
K.; Giraud R.
Institution
(De Charriere, Assouline, Scheen, Bendjelid, Giraud) Intensive Care Unit,
Geneva University Hospitals, Geneva 1205, Switzerland
(De Charriere, Assouline, Scheen, Mentha, Banfi, Bendjelid, Giraud)
Faculty of Medicine, University of Geneva, Geneva 1205, Switzerland
(Banfi, Bendjelid, Giraud) Geneva Hemodynamic Research Group, Geneva 1206,
Switzerland
(Banfi) Department of Cardio-Thoracic Surgery, Istituto Clinico
Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, and Chair of Cardiac
Surgery, University of Milan, Milan 20149, Italy
Publisher
MDPI AG
Abstract
Cardiac arrest (CA) is a frequent cause of death and a major public health
issue. To date, conventional cardiopulmonary resuscitation (CPR) is the
only efficient method of resuscitation available that positively impacts
prognosis. Extracorporeal membrane oxygenation (ECMO) is a complex and
costly technique that requires technical expertise. It is not considered
standard of care in all hospitals and should be applied only in
high-volume facilities. ECMO combined with CPR is known as ECPR
(extracorporeal cardiopulmonary resuscitation) and permits hemodynamic and
respiratory stabilization of patients with CA refractory to conventional
CPR. This technique allows the parallel treatment of the underlying
etiology of CA while maintaining organ perfusion. However, current
evidence does not support the routine use of ECPR in all patients with
refractory CA. Therefore, an appropriate selection of patients who may
benefit from this procedure is key. Reducing the duration of low blood
flow by means of performing high-quality CPR and promoting access to ECPR,
may improve the survival rate of the patients presenting with refractory
CA. Indeed, patients who benefit from ECPR seem to carry better
neurological outcomes. The aim of this present narrative review is to
present the most recent literature available on ECPR and to clarify its
potential therapeutic role, as well as to provide an in-depth explanation
of equipment and its set up, the patient selection process, and the
patient management post-ECPR. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<29>
Accession Number
2005928580
Title
Low-intensity resistance training with moderate blood flow restriction
appears safe and increases skeletal muscle strength and size in
cardiovascular surgery patients: A pilot study.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-13), 2021. Article Number: 547.
Date of Publication: 01 Feb 2021.
Author
Ogawa H.; Nakajima T.; Shibasaki I.; Nasuno T.; Kaneda H.; Katayanagi S.;
Ishizaka H.; Mizushima Y.; Uematsu A.; Yasuda T.; Yagi H.; Toyoda S.;
Hortobagyi T.; Mizushima T.; Inoue T.; Fukuda H.
Institution
(Ogawa, Shibasaki, Fukuda) Department of Cardiovascular Surgery, School of
Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293,
Japan
(Nakajima, Nasuno, Kaneda, Yagi, Toyoda, Inoue) Department of
Cardiovascular Medicine, School of Medicine, Dokkyo Medical University,
Shimotsuga-gun, Tochigi 321-0293, Japan
(Nakajima) Department of Medical KAATSU Training, Dokkyo Medical
University, Shimotsuga-gun, Tochigi 321-0293, Japan
(Katayanagi, Ishizaka, Mizushima, Mizushima) Department of Rehabilitation,
Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293,
Japan
(Uematsu) Department of Health and Sport Sciences, Premedical Sciences,
Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
(Yasuda) School of Nursing, Seirei Christopher University, Shizuoka,
Hamamatsu 433-8558, Japan
(Hortobagyi) University Medical Center Groningen, University of Groningen,
Groningen, Groningen 9713 GZ, Netherlands
Publisher
MDPI AG
Abstract
We examined the safety and the effects of low-intensity resistance
training (RT) with moderate blood flow restriction (KAATSU RT) on muscle
strength and size in patients early after cardiac surgery. Cardiac
patients (age 69.6 +/- 12.6 years, n = 21, M = 18) were randomly assigned
to the control (n = 10) and the KAATSU RT group (n = 11). All patients had
received a standard aerobic cardiac rehabilitation program. The KAATSU RT
group additionally executed low-intensity leg extension and leg press
exercises with moderate blood flow restriction twice a week for 3 months.
RT-intensity and volume were increased gradually. We evaluated the
anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI),
handgrip strength, knee extensor strength, and walking speed at baseline,
5-7 days after cardiac surgery, and after 3 months. A physician monitored
the electrocardiogram, rate of perceived exertion, and the color of the
lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer
were measured at baseline and after 3 months. There were no side effects
during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI,
walking speed, and knee extensor strength increased after 3 months with
KAATSU RT compared with baseline. Relatively low vs. high physical
functioning patients tended to increase physical function more after 3
months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard
cardiac rehabilitation can safely increase skeletal muscle strength and
size in cardiovascular surgery patients. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<30>
Accession Number
2010877963
Title
Clinical utility of enhanced recovery after surgery pathways in pediatric
spinal deformity surgery: Systematic review of the literature.
Source
Journal of Neurosurgery: Pediatrics. 27 (2) (pp 225-238), 2021. Date of
Publication: February 2021.
Author
Pennington Z.; Cottrill E.; Lubelski D.; Ehresman J.; Lehner K.; Groves
M.L.; Sponseller P.; Sciubba D.M.
Institution
(Pennington, Cottrill, Lubelski, Ehresman, Lehner, Groves, Sciubba)
Department of Neurosurgery, Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Sponseller) Department of Orthopaedic Surgery, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVES More than 7500 children undergo surgery for scoliosis each
year, at an estimated annual cost to the health system of $1.1 billion.
There is significant interest among patients, parents, providers, and
payors in identifying methods for delivering quality outcomes at lower
costs. Enhanced recovery after surgery (ERAS) protocols have been
suggested as one possible solution. Here the authors conducted a
systematic review of the literature describing the clinical and economic
benefits of ERAS protocols in pediatric spinal deformity surgery. METHODS
The authors identified all English-language articles on ERAS protocol use
in pediatric spinal deformity surgery by using the following databases:
PubMed/MEDLINE, Web of Science, Cochrane Reviews, EMBASE, CINAHL, and OVID
MEDLINE. Quantitative analyses of comparative articles using random
effects were performed for the following clinical outcomes: 1) length of
stay (LOS); 2) complication rate; 3) wound infection rate; 4) 30-day
readmission rate; 5) reoperation rate; and 6) postoperative pain scores.
RESULTS Of 950 articles reviewed, 7 were included in the qualitative
analysis and 6 were included in the quantitative analysis. The most
frequently cited benefits of ERAS protocols were shorter LOS, earlier
urinary catheter removal, and earlier discontinuation of
patient-controlled analgesia pumps. Quantitative analyses showed ERAS
protocols to be associated with shorter LOS (mean difference -1.12 days;
95% CI -1.51, -0.74; p < 0.001), fewer postoperative complications (OR
0.37; 95% CI 0.20, 0.68; p = 0.001), and lower pain scores on
postoperative day (POD) 0 (mean -0.92; 95% CI -1.29, -0.56; p < 0.001) and
POD 2 (-0.61; 95% CI -0.75, -0.47; p < 0.001). There were no differences
in reoperation rate or POD 1 pain scores. ERAS-treated patients had a
trend toward higher 30-day readmission rates and earlier discontinuation
of patient-controlled analgesia (both p = 0.06). Insufficient data existed
to reach a conclusion about cost differences. CONCLUSIONS The results of
this systematic review suggest that ERAS protocols may shorten
hospitalizations, reduce postoperative complication rates, and reduce
postoperative pain scores in children undergoing scoliosis surgery.
Publication biases exist, and therefore larger, prospective, multicenter
data are needed to validate these results. Copyright © AANS 2021,
except where prohibited by US copyright law.

<31>
Accession Number
2010356512
Title
Comparison of the in-vivo effect of two tranexamic acid doses on
fibrinolysis parameters in adults undergoing valvular cardiac surgery with
cardiopulmonary bypass - a pilot investigation.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 33. Date
of Publication: December 2021.
Author
Zhou Z.-F.; Zhai W.; Yu L.-N.; Sun K.; Sun L.-H.; Xing X.-F.; Yan M.
Institution
(Zhou, Zhai, Yu, Sun, Xing, Yan) Department of Anesthesiology, The Second
Affiliated Hospital, School of Medicine Zhejiang University, Hangzhou,
China
(Zhou) Department of Anesthesiology, Hangzhou Women's Hospital (The
Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou,
China
(Zhai) Department of Anesthesiology, Zhejiang Provincial People's Hospital
(People's Hospital of Hangzhou Medicine College), Hangzhou, China
(Sun) Department of Anesthesiology, Women's Hospital, School of Medicine
Zhejiang University, Hangzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: The blood saving efficacy of TXA in cardiac surgery has been
proved in several studies, but TXA dosing regimens were varied in those
studies. Therefore, we performed this study to investigate if there is a
dose dependent in-vivo effect of TXA on fibrinolysis parameters by
measurement of fibrinolysis markers in adults undergoing cardiac surgery
with CPB. Method(s): A double-blind, randomized, controlled
prospective trial was conducted from February 11, 2017 to May 05, 2017.
Thirty patients undergoing cardiac valve surgery were identified and
randomly divided into a placebo group, low-dose group and high-dose group
by 1: 1: 1. Fibrinolysis parameters were measured by plasma levels of
D-Dimers, plasminogen activator inhibitor-1 (PAI-1), thrombin activatable
fibrinolysis inhibitor (TAFI), plasmin-antiplasmin complex (PAP), tissue
plasminogen activator (tPA) and thrombomodulin (TM). Those proteins were
measured at five different sample times: preoperatively before the TXA
injection (T<inf>1</inf>), 5 min after the TXA bolus (T<inf>2</inf>), 5
min after the initiation of CPB (T<inf>3</inf>), 5 min before the end of
CPB (T<inf>4</inf>) and 5 min after the protamine administration
(T<inf>5</inf>). A Thrombelastography (TEG) and standard coagulation test
were also performed. Result(s): Compared with the control group, the
level of the D-Dimers decreased in the low-dose and high-dose groups when
the patients arrived at the ICU and on the first postoperative morning.
Over time, the concentrations of PAI-1, TAFI, and TM, but not PAP and tPA,
showed significant differences between the three groups (P < 0.05).
Compared with the placebo group, the plasma concentrations of PAI-1 and
TAFI decreased significantly at the T3 and T4 (P < 0.05); TAFI
concentrations also decreased at the T5 in low-dose group (P < 0.05).
Compared with the low-dose group, the concentration of TM increased
significantly at the T4 in high-dose group. Conclusion(s): The
in-vivo effect of low dose TXA is equivalent to high dose TXA on
fibrinolysis parameters in adults with a low bleeding risk undergoing
valvular cardiac surgery with cardiopulmonary bypass, and a low dose TXA
regimen might be equivalent to high dose TXA for those patients. Trial
registration: ChiCTR-IPR-17010303, Principal investigator: Zhen-feng ZHOU,
Date of registration: January 1, 2017. Copyright © 2021, The
Author(s).

<32>
Accession Number
2010039387
Title
Efficacy and safety of lowering LDL cholesterol in older patients: a
systematic review and meta-analysis of randomised controlled trials.
Source
The Lancet. 396 (10263) (pp 1637-1643), 2020. Date of Publication: 21 Nov
2020.
Author
Gencer B.; Marston N.A.; Im K.; Cannon C.P.; Sever P.; Keech A.; Braunwald
E.; Giugliano R.P.; Sabatine M.S.
Institution
(Gencer, Marston, Im, Braunwald, Giugliano, Sabatine) TIMI Study Group,
Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA,
United States
(Cannon) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, NSW,
Australia
Publisher
Lancet Publishing Group
Abstract
Background: The clinical benefit of LDL cholesterol lowering treatment in
older patients remains debated. We aimed to summarise the evidence of LDL
cholesterol lowering therapies in older patients. Method(s): In this
systematic review and meta-analysis, we searched MEDLINE and Embase for
articles published between March 1, 2015, and Aug 14, 2020, without any
language restrictions. We included randomised controlled trials of
cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by
the 2018 American College of Cardiology and American Heart Association
guidelines, with a median follow-up of at least 2 years and data on older
patients (aged >=75 years). We excluded trials that exclusively enrolled
participants with heart failure or on dialysis because guidelines do not
recommend lipid-lowering therapy in such patients who do not have another
indication. We extracted data for older patients using a standardised data
form for aggregated study-level data. We meta-analysed the risk ratio (RR)
for major vascular events (a composite of cardiovascular death, myocardial
infarction or other acute coronary syndrome, stroke, or coronary
revascularisation) per 1 mmol/L reduction in LDL cholesterol.
 Finding(s): Data from six articles were included in the systematic
review and meta-analysis, which included 24 trials from the Cholesterol
Treatment Trialists' Collaboration meta-analysis plus five individual
trials. Among 244 090 patients from 29 trials, 21 492 (8.8%) were aged at
least 75 years, of whom 11 750 (54.7%) were from statin trials, 6209
(28.9%) from ezetimibe trials, and 3533 (16.4%) from PCSK9 inhibitor
trials. Median follow-up ranged from 2.2 years to 6.0 years. LDL
cholesterol lowering significantly reduced the risk of major vascular
events (n=3519) in older patients by 26% per 1 mmol/L reduction in LDL
cholesterol (RR 0.74 [95% CI 0.61-0.89]; p=0.0019), with no statistically
significant difference with the risk reduction in patients younger than 75
years (0.85 [0.78-0.92]; p<inf>interaction</inf>=0.37). Among older
patients, RRs were not statistically different for statin (0.82
[0.73-0.91]) and non-statin treatment (0.67 [0.47-0.95];
p<inf>interaction</inf>=0.64). The benefit of LDL cholesterol lowering in
older patients was observed for each component of the composite, including
cardiovascular death (0.85 [0.74-0.98]), myocardial infarction (0.80
[0.71-0.90]), stroke (0.73 [0.61-0.87]), and coronary revascularisation
(0.80 [0.66-0.96]). Interpretation(s): In patients aged 75 years and
older, lipid lowering was as effective in reducing cardiovascular events
as it was in patients younger than 75 years. These results should
strengthen guideline recommendations for the use of lipid-lowering
therapies, including non-statin treatment, in older patients.
 Funding(s): None. Copyright © 2020 Elsevier Ltd

<33>
Accession Number
2010770133
Title
Mortality 10 Years After Percutaneous or Surgical Revascularization in
Patients With Total Coronary Artery Occlusions.
Source
Journal of the American College of Cardiology. 77 (5) (pp 529-540), 2021.
Date of Publication: 09 Feb 2021.
Author
Kawashima H.; Takahashi K.; Ono M.; Hara H.; Wang R.; Gao C.; Sharif F.;
Mack M.J.; Holmes D.R.; Morice M.-C.; Head S.J.; Kappetein A.P.; Thuijs
D.J.F.M.; Milojevic M.; Noack T.; Mohr F.-W.; Davierwala P.M.; Serruys
P.W.; Onuma Y.
Institution
(Kawashima, Takahashi, Ono, Hara) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Kawashima, Ono, Wang, Gao, Sharif, Serruys, Onuma) Department of
Cardiology, National University of Ireland, Galway, Galway, Ireland
(Wang, Gao) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
(Mack) Department of Cardiothoracic Surgery, Baylor Scott and White
Health, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, Hopital Prive Jacques Cartier,
Generale de Sante Massy, France
(Head, Kappetein, Thuijs, Milojevic) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Milojevic) Department of Cardiovascular Research, Dedinje Cardiovascular
Institute, Belgrade, Serbia
(Noack, Mohr, Davierwala) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: The long-term clinical benefit after percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG) in patients
with total occlusions (TOs) and complex coronary artery disease has not
yet been clarified. Objective(s): The objective of this analysis was
to assess 10-year all-cause mortality in patients with TOs undergoing PCI
or CABG. Method(s): This is a subanalysis of patients with at least 1
TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery
Extended Survival) study, which investigated 10-year all-cause mortality
in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial,
beyond its original 5-year follow-up. Patients with TOs were further
stratified according to the status of TO recanalization or
revascularization. Result(s): Of 1,800 randomized patients to the PCI
or CABG arm, 460 patients had at least 1 lesion of TO. In patients with
TOs, the status of TO recanalization or revascularization was not
associated with 10-year all-cause mortality, irrespective of the assigned
treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio [HR]: 0.992;
95% confidence interval [CI]: 0.474 to 2.075; p = 0.982; and CABG arm:
28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p = 0.330).
When TOs existed in left main and/or left anterior descending artery, the
status of TO recanalization or revascularization did not have an impact on
the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to
2.555; p = 0.837). Conclusion(s): At 10-year follow-up, the status of
TO recanalization or revascularization did not affect mortality,
irrespective of the assigned treatment and location of TOs. The present
study might support contemporary practice among high-volume chronic TO-PCI
centers where recanalization is primarily offered to patients for the
management of angina refractory to medical therapy when myocardial
viability is confirmed. (Synergy Between PCI With TAXUS and Cardiac
Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study:
TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the
Treatment of Narrowed Arteries [SYNTAX]; NCT00114972) Copyright ©
2021 American College of Cardiology Foundation

<34>
Accession Number
631990957
Title
Long-term and Temporal Outcomes of Transcatheter Versus Surgical
Aortic-valve Replacement in Severe Aortic Stenosis: A Meta-analysis.
Source
Annals of surgery. 273 (3) (pp 459-466), 2021. Date of Publication: 01 Mar
2021.
Author
Zhang X.-L.; Zhang X.-W.; Lan R.-F.; Chen Z.; Wang L.; Xu W.; Xu B.
Institution
(Zhang, Lan, Chen, Wang, Xu, Xu) Department of Cardiology, Affiliated Drum
Tower Hospital, Nanjing University School of Medicine, Nanjing, China
(Zhang) Department of Endocrinology, Affiliated Drum Tower Hospital,
Nanjing University School of Medicine, Nanjing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the 5-year and temporal performance of TAVR versus
SAVR. BACKGROUND: TAVR has become a valuable treatment for severe aortic
stenosis but the long-term safety and efficacy remain unclear.
 METHOD(S): Databases were searched until October 6, 2019 for
randomized trials with >=5 years' follow-up. Primary outcome was all-cause
mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were
pooled with random-effects models. RESULT(S): We included 4 trials
with 3,758 patients. TAVR was associated with a significantly higher
5-year all-cause mortality than SAVR (OR, 1.19; 95% CI, 1.03-1.37; P =
0.02). Landmark analysis showed no significant difference within 2 years
(OR, 0.92; 95% CI, 0.79-1.08; P = 0.33) but a statistically higher
mortality in TAVR between 2 and 5 years (OR, 1.32; 95% CI, 1.14-1.52; P =
0.0002), with significant difference between these 2 temporal phases (P
for interaction = 0.001). Similar interaction was found for cardiovascular
mortality and several other outcomes. Rates of all-cause mortality or
disabling stroke, permanent pacemaker implantation, aortic-valve
rehospitalization, and reintervention were higher, but rates of major
bleeding and new-onset fibrillation were lower in TAVR at 5 years. The
incidences of myocardial infarction, stroke, and transient ischemic attack
were not statistically different between TAVR and SAVR.
 CONCLUSION(S): TAVR was associated with a significantly higher
all-cause mortality at 5 years compared with SAVR. Of note, all-cause
mortality presented a characteristic temporal pattern showing increased
risk between 2 and 5 years but not within 2 years. Longer-term follow-up
data are warranted. Copyright © 2020 Wolters Kluwer Health, Inc.
All rights reserved.

<35>
Accession Number
634166325
Title
Complete versus culprit-only percutaneous coronary intervention in
patients with non-ST-segment elevation acute coronary syndrome: A
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2552), 2020. Date of Publication:
November 2020.
Author
Sakurai R.
Institution
(Sakurai) International University of Health and Welfare, School of
Medicine, Chiba, Japan
Publisher
Oxford University Press
Abstract
Background: The clinical benefit of complete or culprit-only percutaneous
coronary intervention (PCI) in patients with non-ST-segment elevation
acute coronary syndrome (NSTE-ACS) still remains controversial.
 Purpose(s): The purpose of this study was to investigate the clinical
outcomes of complete or culprit-only PCI in patients with unstable angina
and/or non-ST-segment elevation myocardial infarction. Method(s):
PubMed, the Cochrane Library, and Web of Science were queried to conduct a
meta-analysis. The same terms or relevant studies were also queried on the
website of the U.S. National Institute of Health and relevant reviews. The
primary endpoint was the incidence of major adverse cardiac events (MACE:
the composite of all-cause mortality, myocardial infarction, or coronary
revascularisation) during follow-up period, and the secondary endpoints
were the incidences of each component of MACE. When multiple follow-up
results were reported in the same study, the latest results were
abstracted. Pooled estimates were calculated using a random-effects model.
 Result(s): Nine studies (60345 patients) were included in this
meta-analysis. The risk of all-cause mortality (odds ratio (OR): 0.79, 95%
confidence interval (CI): 0.64-0.98, p=0.03) or coronary revascularisation
(OR: 0.71, 95% CI: 0.50-1.00, p=0.05) were lower in the complete PCI group
than in the culprit-only PCI group, whereas the risk of MACE (OR: 0.98,
95% CI: 0.65-1.49, p=0.94) or myocardial infarction (OR: 0.77, 95% CI:
0.54-1.08, p=0.13) was similar between the 2 groups. Conclusion(s):
In this meta-analysis, complete PCI is associated with a lower risk of
all-cause mortality or coronary revascularisation, and a similar risk of
MACE or myocardial infarction compared with culprit-only PCI in patients
with NSTE-ACS.

<36>
Accession Number
634166322
Title
Infective endocarditis after transcatheter or surgical aortic valve
implantation: Pooled results from three randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2602), 2020. Date of Publication:
November 2020.
Author
Lanz J.; Popma J.; Reardon M.; Pilgrim T.; Stortecky S.; Deeb M.; Yakubov
S.; Windecker S.
Institution
(Lanz, Pilgrim, Stortecky, Windecker) Bern University Hospital,
Inselspital, Bern, Switzerland
(Popma) Beth Israel Deaconess Medical Center, Boston, United States
(Reardon) Methodist Hospital, Houston, United States
(Deeb) University of Michigan Health System, Ann Arbor, United States
(Yakubov) OhioHealth Riverside Methodist Hospital, Columbus, United States
Publisher
Oxford University Press
Abstract
Background: Infective endocarditis is a rare complication of aortic valve
replacement with high morbidity and mortality. Data of randomized trials
comparing the incidence and outcomes between surgical (SAVR) and
transcatheter aortic valve replacement (TAVR) are scarce. Purpose(s):
To compare the frequency, timing and outcomes of infective endocarditis
after TAVR and SAVR from 3 prospective randomized trials and examine the
clinical outcomes. Method(s): Clinical data from the CoreValve
Pivotal High-Risk, the intermediate-risk SURTAVI and the Evolut Low Risk
randomized trials, which compared TAVR with a supra-annular,
self-expanding transcatheter valve to SAVR, was pooled. Cases of infective
endocarditis were independently adjudicated based on Duke's criteria
necessitating 2 major criteria, or 1 major and 3 minor criteria, or 5
minor criteria. Baseline clinical and procedural characteristics for
patients with and without endocarditis were obtained. The cumulative
incidence of endocarditis through 5 years after TAVR or SAVR was
determined using death as a competing risk. Kaplan- Meier estimates of
all-cause mortality and the composite of all-cause mortality or stroke
through 2 years were calculated for both treatment groups. Result(s):
Among 2249 TAVR patients, 12 cases of endocarditis (0.5%) were documented
and among 1828 SAVR patients, 21 (1.1%) over a mean follow-up time of
2.25+/-1.58 years. Baseline characteristics were well-balanced between the
TAVR and SAVR patients with endocarditis. The cumulative incidence of
endocarditis at 5 years was significantly different between the two groups
(figure). The prevalence of diabetes was significantly higher in patients
with endocarditis than in those without (57.6% vs. 34.2%, p=0.005). In
endocarditis patients the rate of all-cause mortality was 39.4% for TAVR
patients and 67.8% for SAVR patients at 2 years (log-rank p=0.133). The
rates of all-cause mortality or stroke were 55.0% for TAVR and 64.6% for
SAVR patients (log-rank p=0.078). Conclusion(s): In this pooled
analysis of three randomized trials comparing TAVR with a supra-annular,
self-expanding bioprosthesis to SAVR, overall rates of endocarditis were
low. The cumulative incidence of infective endocarditis at 5 years was
lower in the TAVR group. Mortality after endocarditis was high. (Figure
Presnted).

<37>
Accession Number
634166319
Title
Impact of caval vein implantation on severity of tricuspid regurgitation,
renal and hepatic function in patients with severe secondary tricuspid
regurgitation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2651), 2020. Date of Publication:
November 2020.
Author
Mattig I.; Hewing B.; Knebel F.; Stangl V.; Laule M.; Stangl K.; Dreger H.
Institution
(Mattig, Hewing, Knebel, Stangl, Laule, Stangl, Dreger) Charite
Universitatsmedizin Berlin, Berlin, Germany
Publisher
Oxford University Press
Abstract
Background: Severe tricuspid regurgitation (TR) is an important
determinant for functional capacity and survival. It frequently occurs in
patients with advanced heart failure resulting in progressive venous
congestion with cardiorenal and cardiohepatic syndrome. The prospective,
randomized TRICAVAL study reported the effect of inferior caval vein
implantation of an Edwards Sapien XT valve (CAVI) in comparison to optimal
medical therapy (OMT) in patients with severe TR. The study did not detect
a superior functional outcome after CAVI, but a significant improvement in
quality of life. Due to safety concerns, the study was stopped prematurely
after 4 periprocedural complications. Purpose(s): We hypothesised
that CAVI reduces reflux into the inferior vena cava and leads to an
increase in systolic right atrial pressure, which may result in an
improvement of TR severity. The present subanalysis of the TRICAVAL study
evaluates the impact of inferior caval vein implantation on TR severity,
right heart parameters and renal and hepatic function. Method(s):
Twenty-eight patients with severe TR were randomized in either CAVI group
(n=14) with caval vein implantation of an Edwards Sapien XT valve or OMT
group (n=14). Medical history, clinical examination, laboratory testing
and echocardiographic measurements were analysed in patients with
completed FUP (OMT [n = 10], CAVI [n = 8]). Follow-up examinations were
performed at baseline and three months after enrolment. Result(s):
After three months, the CAVI group exhibited a significant reduction of
systolic hepatic vein reflux volume (5.0 [1.3-11.0] ml vs. 14.0
[10.3-18.0] ml, p<0.05) and hepatic vein diameter (10.8 [10.0-12.0] mm vs.
14.0 [11.5-15.0] mm, p<0.05) in comparison to OMT. Compared to baseline,
CAVI improved body weight (80.7 [69.0-87.7] kg versus 75.5 [63.8-84.6] kg,
p<0.05) and abdominal circumference (101.5+/-13.8 cm versus 96.3+/-15.4
cm, p<=0.01) paralleled by a trend to lower doses of diuretics. However,
over the FUP period, there were no significant changes regarding TR
severity, right heart function and morphology as well as renal and hepatic
function within both groups, nor in the comparison between CAVI and OMT.
 Conclusion(s): As a proof of our concept, CAVI resulted in a decrease
in systolic hepatic vein reflux, hepatic vein diameter and clinical signs
of venous congestion. However, TR severity, right heart function and
morphology as well as renal and hepatic function remained stable.

<38>
Accession Number
634166314
Title
Percutaneous vs. surgical revascularization for patients with unprotected
left main stenosis: A meta-analysis of 5 years follow-up RCTs.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2549), 2020. Date of Publication:
November 2020.
Author
De Filippo O.; D'Ascenzo F.; Elia E.; Doronzo M.P.; Montefusco A.; Pennone
M.; Angelini F.; Franchin L.; Bruno F.; Salizzoni S.; Gaudino M.; Rinaldi
M.; De Ferrari G.M.
Institution
(De Filippo, D'Ascenzo, Elia, Doronzo, Montefusco, Pennone, Angelini,
Franchin, Bruno, Salizzoni, Rinaldi, De Ferrari) City of Health and
Science of Turin, Turin, Italy
(Gaudino) New York-Presbyterian Hospital, Weill Cornell Medical Center,
New York, United States
Publisher
Oxford University Press
Abstract
Introduction: 5-year survival of patients with ULM (Unprotected Left Main)
stenosis according to the choice of revascularization (percutaneous vs.
surgical) remains to be defined. Methods and Results: Randomized
Controlled Trials (RTCs) comparing Percutaneous Coronary Intervention
(PCI) vs. Coronary Artery Bypass Graft (CABG) with a follow-up of at least
5 years were included. All-cause death was the primary endpoint. MACCE (a
composite endpoint of allcause mortality, myocardial infarction [MI],
stroke and repeat revascularization) along with its single components and
cardiovascular (CV) death were the secondary ones. Analyses were
stratified according to use of first vs. last generation coronary stents.
Subgroup comparisons were performed according to Syntax Score (below or
above 33) and to age (using cutoffs of each trial's subgroup analysis). 4
RCTs with 4394 patients were identified: 2197 with last generation stents.
At 5 years rates of all-cause death did not differ (OR 0.93: 0.71-1.21),
as those of CV death and stroke. CABG reduced rates of MACCE (OR 0.69:
0.60-0.79), mainly driven by MI (OR 0.48: 0.36-0.65) and revascularization
(OR 0.53: 0.45-0.64). Benefit of CABG for MACCE was consistent, although
with different extent, across values of Syntax Score (OR 0.76: 0.59-0.97
for values <32 and OR 0.63: 0.47-0.84 for values >=33) while was not
evident for "younger" patients (OR 0.83: 0.65-1.07 vs. OR 0.65: 0.51-0.84
for "older" patients, all CI 95%). Conclusion(s): For patients with
ULM disease, PCI and CABG yielded same survival benefit at 5 years. CABG
reduced risk of MI, revascularization and MACCE especially in older
patients and in those with diffuse coronary disease.

<39>
Accession Number
634166241
Title
Anticoagulation with or without antiplatelet therapy after transcatheter
aortic valve replacement, when less is more: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2595), 2020. Date of Publication:
November 2020.
Author
Franchin L.; Vaira M.P.; Piroli F.; Angelini F.; Elia E.; Bocchino P.P.;
Conrotto F.; D'Ascenzo F.; Giustetto C.; De Ferrari G.M.
Institution
(Franchin, Vaira, Piroli, Angelini, Elia, Bocchino, Conrotto, D'Ascenzo,
Giustetto, De Ferrari) Hospital Citta Della Salute e della Scienza di
Torino, Turin, Italy
Publisher
Oxford University Press
Abstract
Background: About 40% of patients undergoing transcatheter aortic valve
replacement (TAVR) have a history of atrial fibrillation (AF) and an
additional 10% develop AF after TAVR. However, there is paucity of data
regarding the optimal antithrombotic regimen following TAVR in patients
with a clinical indication for oral anticoagulants (OAC). Purpose(s):
To compare the prognostic impact of OAC plus at least one antiplatelet
agent (APT) versus OAC therapy alone in patients undergoing TAVR.
 Method(s): We systematically searched the literature for studies
evaluating the comparative efficacy and safety of OAC + APT versus OAC
alone in TAVR. Random-effect meta-analysis was performed comparing
clinical outcomes between the two groups. All-cause mortality and
cardiovascular mortality were the efficacy outcomes. Stroke and major
bleeding, defined as Bleeding Academic Research Consortium bleeding types
3 to 5, constituted the safety outcome. Result(s): Overall, 398
titles and abstracts were identified through database searching. Four
observational studies were selected, for a total of 1929 patients. After a
median follow-up of 18.5 months (IQR 11.3-29.3), OAC + APT increased major
bleeding events compared to OAC alone (OR=1.79; 95% CI 1.21-2.66; P=0.004)
with no difference in stroke (OR 01.02; 95% CI 0.52-2.01; P=0.95),
all-cause mortality (OR=1.07; 95% CI 0.78- 1.47; P=0.66) and
cardiovascular mortality (OR=1.08; 95% CI 0.79-1.47; P=0.62).
 Conclusion(s): A combination strategy of OAC + APT provides increased
risk of bleeding compared to OAC therapy alone in patients undergoing TAVR
with similar outcomes in terms of stroke, all-cause mortality and
cardiovascular mortality; therefore, when feasible, it should be advised
not to add APT on top of OAC therapy in patients without other clinical
indications for APT treatment.

<40>
Accession Number
634166235
Title
Impact of chronic kidney disease on mid-term prognosis of stable angina
patients with high-dose or low-dose pitavastatin treatment: REAL-CAD
sub-study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2996), 2020. Date of Publication:
November 2020.
Author
Abe M.; Ozaki Y.; Takahashi H.; Akao M.; Kimura T.; Nagai R.
Institution
(Abe, Akao) Kyoto Medical Center, National Hospital Organization, Kyoto,
Japan
(Ozaki, Takahashi) Fujita Health University, School of Medicine, Toyoake,
Japan
(Kimura) Kyoto University, Graduate School of Medicine, Kyoto, Japan
(Nagai) Jichi Medical University, Tochigi, Japan
Publisher
Oxford University Press
Abstract
Background:We previously demonstrated that high-dose (4 mg/day) compared
with low-dose (1 mg/day) pitavastatin therapy significantly reduced
cardiovascular events in Japanese patients with stable coronary artery
disease in the Randomized Evaluation of Aggressive or Moderate Lipid
Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD)
study. However, little is known about whether the advantage of high-dose
statins over low-dose statins is consistent among non-, mild, and moderate
to severe chronic kidney disease (CKD) patients. Purpose(s): The aim
of this study was to clarify the effect of high-dose statins on
cardiovascular events in Japanese patients with or without CKD.
 Method(s): The REAL-CAD study is a prospective, multicenter,
randomized, open-label, blinded endpoint, physician-initiated superiority
trial. In this sub-analysis of REAL-CAD study, patients were categorized
into three groups according to estimated glomerular filtration rate
(eGFR). Patients on hemodialysis were excluded in this study. The primary
endpoint was a composite of cardiovascular death, non-fatal myocardial
infarction (MI), non-fatal ischemic stroke, or unstable angina requiring
emergency hospitalization. A secondary composite endpoint was defined as a
composite of the primary endpoint event or clinically-indicated coronary
revascularization excluding target-lesion revascularization.
 Result(s): The total population of the REAL-CAD study was 12,413
patients. After exclusion of patients lacking eGFR data, the numbers of
patients categorized into non-CKD (eGFR >=60 mL/min/1.73m2), mild CKD
(eGFR; 45- 60), and moderate to severe CKD (eGFR <45) were 7,778 (64%),
3,176 (26%), and 1,164 (10%), respectively. The median follow-up period
was 3.9 years. The baseline characteristics and medications were well
balanced between the two groups in each CKD group. While high-dose
compared to low-dose pitavastatin significantly reduced the primary
endpoint in non- CKD patients, the effect was not observed in mild CKD and
moderate to severe CKD patients (Figure 1). High-dose compared with
low-dose pitavastatin did not significantly reduce the secondary composite
endpoint in both mild and moderate to severe CKD patients as well.
High-dose pitavastatin significantly reduced the risks of MI and any
coronary revascularization in non-CKD patients, however, the effects were
diminished in mild CKD and moderate to severe CKD patients. There was no
significant difference between high-dose and low-dose pitavastatin
treatment in the risk of all-cause death, cardiovascular death, ischemic
stroke, or unstable angina requiring emergency hospitalization in patients
with or without CKD. Conclusion(s): Although high-dose pitavastatin
therapy significantly reduced cardiovascular events in non-CKD patients
with stable angina compared to low-dose pitavastatin, such beneficial
effects had diminished in Japanese patients with mild or moderate to
severe CKD patients. (Figure Presnted) .

<41>
Accession Number
634166226
Title
Ten-year all-cause death after percutaneous or surgical revascularization
for men and women with multivessel or left main coronary artery disease:
Insights from the SYNTAX extended survival study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2497), 2020. Date of Publication:
November 2020.
Author
Hara H.; Takahashi K.; Klaveren D.; Ono M.; Kawashima H.; Kappetein P.;
Mohr F.; Mack M.; Holmes D.; Morice M.; Davierwala P.; Head S.; Thuijs D.;
Onuma Y.; Serruys P.
Institution
(Hara, Takahashi, Ono, Kawashima) Amsterdam UMC - Location Academic
Medical Center, Amsterdam, Netherlands
(Klaveren, Kappetein, Head, Thuijs) Erasmus University Medical Centre,
Rotterdam, Netherlands
(Mohr, Davierwala) Heart Center of Leipzig, Leipzig, Germany
(Mack) Baylor University Medical Center, Dallas, United States
(Holmes) Mayo Clinic, Rochester, United States
(Morice) Jacques Cartier Private Hospital, Massy, France
(Onuma, Serruys) National University of Ireland, Galway, Ireland
Publisher
Oxford University Press
Abstract
Background: In patients with complex coronary artery disease (CAD), women
favored coronary artery bypass grafting surgery (CABG) compared to
percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial,
whereas mortality rates after PCI and CABG were not different in men. On
the other hand, poor outcomes of women undergoing PCI were not observed in
the PRECOMBAT and BEST trials. The long-term optimal revascularization
strategy according to gender has not been fully evaluated.
 Purpose(s): In the SYNTAX Extended Survival (SYNTAXES) study, no
significant difference existed in all-cause death between PCI and CABG at
10 years. This study aimed to assess treatment effect of PCI and CABG for
10-year all-cause death according to gender. Method(s): The SYNTAXES
study evaluated vital status up to 10 years in 1,800 patients with de novo
three-vessel disease (3VD) and/or left main coronary artery disease
(LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and
the pre-specified primary endpoint was allcause death at 10 years. In this
prespecified analysis, all-cause death at 10 years according to gender in
patients undergoing PCI or CABG was evaluated. Result(s): Of 1800
patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the
rate of mortality was significantly higher in the PCI arm at 5 years than
in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the
rates of mortality were not different at 10 years between the PCI and CABG
arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality
rate tended to be higher in the PCI arm at 10 years than in the CABG arm
(27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality
rates were not different at 5 years between the PCI and CABG arms (12.4%
vs. 12.3%; Log-rank p=0.957, Figure B). Conclusion(s): The efficacy
of CABG observed at 5 years disappeared at 10 years in women, whereas the
efficacy of CABG became apparent after 5 years in men. (Figure Presnted).

<42>
Accession Number
634166219
Title
Thirty-day incidence of stroke after transcatheter aortic valve
implantation: A meta-and network meta-analysis comparing self-expandable
versus balloon-expandable valve prostheses.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2593), 2020. Date of Publication:
November 2020.
Author
Seppelt P.C.; Mas-Peiro S.; De Rosa R.; Murray I.; Fichtlscherer S.;
Zeiher A.M.; Vasa-Nicotera M.
Institution
(Seppelt, Mas-Peiro, De Rosa, Murray, Fichtlscherer, Zeiher,
Vasa-Nicotera) University Hospital Frankfurt, Goethe University,
Department of Cardiology, Frankfurt am Main, Germany
Publisher
Oxford University Press
Abstract
Introduction: Stroke is a major and feared complication after
transcatheter aortic valve implantation (TAVI). So far it is unknown,
weather the valve deployment system itself has an impact on the incidence
of periinterventional stroke. We sought to identify the incidence of
30-day stroke after transfemoral TAVI with self-expandable (SE) and
balloon-expandable (BE) valves and performed a meta- and network
meta-analysis to analyze differences related to the valve deployment
system. Method(s): Overall 2706 articles were searched comparing
directly the performance of SE and BE TAVI valves, from which 7 were
included for analysis (one randomized controlled trial, 6 propensity score
matching studies) with a total number of 2488 patients. Meta-analysis used
random effects model and reported risk ratios (RRs). To compare different
type of valves a random-effects network meta-analysis based on a
frequentist framework for indirect and mixed comparisons was applied and
reported odds rations (ORs). Using P-Score the relative ranking
probability of each valve was estimated and the hierarchy of competing
valves was obtained. Result(s): Thirty-day incidence of stroke was
1.9% in SE (22 out of 1139, Medtronic CoreValve, Medtronic Evolut R and
Pro, Boston Scientific ACURATE neo and St. Jude Medical Portico) and 3.1%
in BE TAVI valves (42 out of 1349, Edwards Sapien 3 and XT) resulting in a
RR of 0.65, (95% confidence interval (CI) 0.51 to 0.82). In accordance
with the estimated P-Score CoreValve was the best effective for a
reduction of 30-day stroke (72,5%) whereas the worst were Sapien 3 and XT
(19.%). Combined direct and indirect evidence showed no superiority of
CoreValve compared with Sapien valves (OR 0.469, 95% CI 0.13-1.64)
concerning 30-day stroke incidence. Conclusion(s): Our meta-analysis
indicates a higher thirty-day incidence of stroke after TAVI with BE
valves compared to SE valves. Furthermore, we could not find evidence for
superiority of a specific valve system. Randomized controlled trials with
head to head comparison of SE and BE valves are needed to address this
open question.

<43>
Accession Number
634166185
Title
No impact of direct implantation of a self-expanding valve on one-year
clinical outcomes. Insights from the multicenter, randomized DIRECT trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2591), 2020. Date of Publication:
November 2020.
Author
Toutouzas K.; Benetos G.; Drakopoulou M.; Karmpalioti M.; Xanthopoulou M.;
Stathogiannis K.; Latsios G.; Synetos A.; Voudris V.; Kosmas E.;
Mastrokostopoulos A.; Katsimagklis G.; Danenberg H.; Vavuranakis M.;
Tousoulis D.
Institution
(Toutouzas, Drakopoulou, Karmpalioti, Xanthopoulou, Stathogiannis,
Latsios, Synetos, Tousoulis) Hippokration Hospital, University of Athens,
1st Department of Cardiology, Athens, Greece
(Benetos, Vavuranakis) University of Athens Medical School, Athens, Greece
(Voudris, Kosmas) Onassis Cardiac Surgery Center, Athens, Greece
(Mastrokostopoulos, Katsimagklis) Naval Hospital of Athens, Athens, Greece
(Danenberg) Hadassah University Medical Center, Jerusalem, Israel
Publisher
Oxford University Press
Abstract
Introduction: The DIRECT trial (Predilatation in Transcatheter Aortic
Valve Implantation Trial) evaluated in a randomized fashion the safety and
efficacy of direct (without balloon pre-dilatation) implantation of a
selfexpanding valve in all comers undergoing TAVI. Purpose(s): To
investigate the impact of direct implantation of a selfexpanding valve on
one-year clinical outcomes. Method(s): DIRECT trial randomized
consecutive patients with severe aortic stenosis at 4 tertiary centers to
undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or
without pre-dilatation (no-BAV). The primary endpoint was device success
according to the VARC-2 criteria. Secondary endpoints included
periprocedural mortality and stroke, new permanent pacemaker implantation
and vascular complications. All cause death, cardiac death, stroke and
heart failure hospitalizations were recorded at one year and compared
between the two groups using Kaplan-Meier plots. Result(s): In total
171 patients were randomized in 4 centers. In the intention to treat
analysis 86 patients were randomized to the pre-BAV group and 85 patients
to the no-BAV TAVI group. The device success according to the VARC-2
criteria was non-inferior in the no-BAV group compared to the pre-BAV
group (65/85 - 76.5% for no- BAV versus 64/86 - 74.4% for pre-BAV, mean
difference = 2.1%, 90% CI: -8.9 to 13). In the no-BAV group 25 (29.4%)
patients underwent post balloon dilatation and in the pre-BAV group 13
patients (15.1%) (p=0.03). At one year 4 deaths were recorded in pre-BAV
group (4.7%) and 3 deaths in no-BAV group (3.5%). There was no difference
in Kaplan-Meier plots between the two groups in all-cause mortality
(log-rank p=0.72, figure). Similarly, there was no difference in one-year
incidence of stroke (1 in pre-BAV and 2 in no-BAV group, log-rank p=0.55),
cardiac death (log-rank p=0.66), non-cardiac death (log-rank p=0.98) and
heart failure hospitalizations (1 in pre-BAV versus 3 in no-BAV group,
log-rank p=0.31). Lastly, there was no difference in the incidence of
permanent pacemaker implantation between the two groups at one year (27/67
in no-BAV group versus 20/69 in pre-BAV group, log-rank p=0.24)
 Conclusion(s): Direct transcatheter aortic valve implantation is
non-inferior to the procedure with pre-dilatation in self-expanding valve.
Despite the overall low rate of events, direct procedure has no impact on
clinical outcomes at one year.

<44>
Accession Number
634166142
Title
Impact of periprocedural myocardial infarction on 10-year mortality after
percutaneous coronary intervention or coronary artery bypass grafting for
multivessel or left main coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2491), 2020. Date of Publication:
November 2020.
Author
Hara H.; Takahashi K.; Ono M.; Gao C.; Wang R.; Kappetein P.; Mohr F.;
Mack M.; Holmes D.; Morice M.; Davierwala P.; Head S.; Thuijs D.; Onuma
Y.; Serruys P.
Institution
(Hara, Takahashi, Ono) Amsterdam UMC - Location Academic Medical Center,
Amsterdam, Netherlands
(Gao, Wang) University Hospital Nijmegen, Nijmegen, Netherlands
(Kappetein, Head, Thuijs) Erasmus University Medical Centre, Rotterdam,
Netherlands
(Mohr, Davierwala) Heart Center of Leipzig, Leipzig, Germany
(Mack) Baylor University Medical Center, Dallas, United States
(Holmes) Mayo Clinic, Rochester, United States
(Morice) Jacques Cartier Private Hospital, Massy, France
(Onuma, Serruys) National University of Ireland, Galway, Ireland
Publisher
Oxford University Press
Abstract
Background: Periprocedural myocardial infarction (PMI) occurs frequently
after both percutaneous coronary intervention (PCI) and bypass grafting
surgery (CABG) in patients with complex coronary artery disease (CAD), and
PMI has been shown to have a detrimental impact on mortality. On the other
hand, long-term impact of PMI on mortality has not been fully evaluated.
 Purpose(s): This study aimed to assess the impact of PMI according to
SCAI definition on 10-year all-cause death in patients with complex CAD.
 Method(s): The SYNTAX Extended Survival (SYNTAXES) study evaluated
vital status up to 10 years in 1800 patients with de novo three-vessel
disease and/or left main coronary artery disease randomized to treatment
with CABG or PCI in the SYNTAX trial. Blood was sampled for creatine
kinase (CK) pre- and post-revascularisation, and the cardiac specific MB
iso-enzyme (CK-MB) was determined only if the CK ratio >=2 x the upper
limit of normal (ULN). If the CK ratio <2 ULN, CK-MB assessment was not
mandated. In this analysis, patients with at least one blood sampling
within 48 hours of the procedure were included. PMI was defined as
follows; peak CK-MB measured within 48 hours of the procedure >=10 x ULN,
or >=5 x ULN with new Q-waves in 2 contiguous leads or new persistent left
bundle branch block. Result(s): Of 1800 patients, 1679 (93.2%)
patients were included. Of 877 patients treated with PCI, PMI occurred in
26 patients (3.0%), whereas 14 (1.7%) PMIs were observed in 802 patients
treated with CABG. Compared with patients without PMI, patients with PMI
presented with unstable angina more frequently (45.0% vs. 28.7, p=0.033),
and had a higher rate of bifurcation lesion (87.5% vs. 72.5, p=0.046). PMI
was associated with a higher all-cause mortality at 10 years compared with
no PMI (55.3% vs. 25.4%; Log-rank p<0.001, Figure), which was mainly
driven by a high mortality rate within 1 year. In patients undergoing PCI,
the mortality rates were significantly higher in patients with PMI not
only within 1 year (Logrank p<0.001) but also beyond one year (Log-rank
p=0.016), compare to patients without PMI (Figure). On the other hand, in
patients undergoing CABG, a higher mortality rate in patients with PMI was
observed until 1 year (Log-rank p<0.001), but the impact of PMI on
mortality beyond one year after CABG subsided (Log-rank p=0.308) (Figure
1). Conclusion(s): PMI was associated with a poor prognosis at 10
years. The impact of PMI on mortality was strong within one year. Of note,
the impact of PMI on mortality persisted beyond 1 year only in patients
undergoing PCI. Patients who were treated with PCI and suffered PMI need
careful follow-up beyond one year after revascularization. (Figure
Presnted).

<45>
Accession Number
634166129
Title
Anticoagulation and outcomes after surgical aortic valve replacement with
a biological prosthesis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2689), 2020. Date of Publication:
November 2020.
Author
Angleitner P.; Zinggl M.; Werner P.; Coti I.; Mach M.; Kocher A.; Laufer
G.; Andreas M.
Institution
(Angleitner, Zinggl, Werner, Coti, Mach, Kocher, Laufer, Andreas) Medical
University of Vienna, Vienna, Austria
Publisher
Oxford University Press
Abstract
Background: No strong recommendation exists regarding the use of
short-term anticoagulation after surgical aortic valve replacement (SAVR)
with a biological prosthesis. Purpose(s): Our aim was to analyze
outcomes of patients receiving warfarin versus low-molecular weight
heparin (LMWH) after isolated SAVR. Method(s): We retrospectively
analyzed all adult patients who underwent surgery between 2009 and 2017 at
our department (n=598). Exclusion criteria included pre-operative
anticoagulation, atrial fibrillation, dialysis, previous aortic valve
replacement, or active endocarditis. Patients who were discharged alive
were stratified according to the type of anticoagulation (warfarin, n=332,
55.5%; LMWH, n=266, 44.5%). Long-term survival during the follow-up period
was analyzed (median follow-up, 5.6 years). Result(s): Patients who
received warfarin had significantly lower logistic EuroSCORE and were
younger (Table 1). Warfarin was more frequently utilized between 2009 and
2014, whereas LMWH was more commonly used between 2015 and 2017.
Kaplan-Meier curves in Figure 1 show that patients who received warfarin
had significantly superior long-term survival (log-rank test: p=0.002).
Multivariable Cox proportional hazards regression analysis confirmed that
the use of warfarin was associated with significantly lower risk of
long-term mortality when compared with LMWH (hazard ratio [HR] 0.50, 95%
confidence interval [CI] 0.34-0.74, p=0.001). Covariables in this model
included logistic EuroSCORE, era, and duration of cardiopulmonary bypass.
 Conclusion(s): The present analysis suggests that the use of warfarin
is associated with significantly superior survival after SAVR with a
biological prosthesis. Our findings require validation in a prospective
randomized controlled trial. (Table Presented).

<46>
Accession Number
634166128
Title
The protective effects of radiofrequency pulmonary artery denervation on
the progression of chronic thromboembolic pulmonary hypertension.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2790), 2020. Date of Publication:
November 2020.
Author
Rudenko B.; Feshchenko D.
Institution
(Rudenko, Feshchenko) National Research Center for Preventive Medicine,
Cath Laboratory, Moscow, Russian Federation
Publisher
Oxford University Press
Abstract
This study aimed to assess the safety and efficacy of radiofrequency
pulmonary artery denervation with the Simplicity system in patients with
distal chronic thromboembolic pulmonary hypertension. Methods and
Results: 60 chronic thromboembolic pulmonary hypertension patients with
mean pulmonary artery pressure >25 mm Hg and absence of proximal artery
lesion defined by pulmonary angiography were randomized into 2 groups.
Group 1 included 30 patients who underwent pulmonary artery denervation
procedure. The other 30 patients were assigned to the control group (only
angio plus right heart catheterization). The procedure of pulmonary artery
denervation was performed at the lateral wall of main pulmonary artery and
ostium of the left and right pulmonary arteries using the electrode from
Simplicity denervation system. The programmed ablation parameters were
temperature >50degreeC and time = 120 s. Using the coronary guiding
technique, the tip of electrode was applied at each spot rotating the tip
with pace of 2 mm. The success was defined by decrease of mean pulmonary
artery pressure >10%, absence of complications. The primary end point was
comparison of mean pulmonary artery pressure change from baseline to 12
months in pulmonary artery denervation group compared with change from
baseline to 12 months in control group. The secondary point was change in
6-min walk distance and pulmonary vascular resistance at the 12-month
follow-up. There were no complications after pulmonary artery denervation.
The hemodynamic success was achieved in 93% of all cases. The mean number
of radiofrequency applications to achieve success was 10.3 per patient.
During follow-up period 3 patients died in pulmonary artery denervation
group: (1 died of gastro-intestinal bleeding, 2 - of right ventricular
failure) and 3 patients in control group. The mean decreases in the mean
pulmonary artery pressure were 8.7 mm Hg in the pulmonary artery
denervation group and 3.1 mm Hg in control group (p<0.05). After pulmonary
artery denervation in comparison with the control group was observed
significant decrease in pulmonary vascular resistance (8.3+/-2.8 WU vs.
11.2+/-3.7). 6-min walk distance significantly increased by 81 m after
pulmonary artery denervation and 29 m in control group (p<0.05). This
improvement was associated with significant improvements in the WHO
functional class. Conclusion(s): The usage of the Simplicity
denervation system in pulmonary artery denervation procedure is safe and
effective. Further studies are required to determine the role of pulmonary
artery denervation in the treatment of chronic thromboembolic pulmonary
hypertension. The next step of pulmonary artery denervation development
will be the use of this method combined with recommended treatment
(medical therapy, pulmonary endarterectomy and balloon pulmonary
angioplasty) as additional option, that may sufficiently improve outcomes
in some patients.

<47>
Accession Number
634166102
Title
Anticoagulation for mechanical aortic valve replacement: An international
survey.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2686), 2020. Date of Publication:
November 2020.
Author
Gupta S.; Belley-Cote E.; McEwen C.; Hou W.; Eikelboom J.; Whitlock R.
Institution
(Gupta) McMaster University, Cardiac Surgery, Hamilton, Canada
(Belley-Cote, Whitlock) Population Health Research Institute, Hamilton,
Canada
(McEwen, Hou, Eikelboom) McMaster University, Hamilton, Canada
Publisher
Oxford University Press
Abstract
Introduction: Mechanical valves are preferred over biologic valves in
younger patients because they are more durable but require long-term
anticoagulation which increases the risk of bleeding. For patients with a
mechanical aortic valve, the ACCP guidelines recommend a target INR of 2.5
(range 2.0-3.0) for all patients, whereas the ACC/AHA and ESC guidelines
recommend a higher target for selected patients with additional risk
factors for thromboembolism (TE). Data supporting the guideline
recommendations are largely historical and of low quality.
 Purpose(s): We surveyed physicians who manage anticoagulation for
patient with mechanical heart valves to determine their usual practice,
perceptions regarding guideline recommendations, and interest in
participating in a randomized controlled trial (RCT) comparing lower with
higher INR targets in patients with a mechanical aortic valve.
 Method(s): A 33-question web-based survey was sent to 75
cardiologists, cardiac surgeons and thrombosis specialists at centres in
Canada and internationally (western Europe, South America, and the United
States) who participated in previous anticoagulation trials led by
investigators at Mc- Master University. Result(s): Of the 55
respondents (73.3% response rate), 77.8% worked in academic teaching
hospitals. Respondents had been in practice for a mean of 23.6 years;
40.9% followed AHA/ACC guidelines, 34.1% followed the ACCP guidelines and
22.7% followed the ESC guidelines. In patients with a mechanical aortic
valve and no additional TE risk factors, 80% of respondents targeted an
INR of 2.5 (range 2.0-3.0); among patients with additional TE risk
factors, 48% targeted an INR of 2.5 (range 2.0-3.0) and 44% targeted an
INR of 3.0 (range 2.5-3.5). With respect to guidelines: 57.1% of
respondents agreed or strongly agreed that that the evidence for the
guidelines was contemporary, 53.1% agreed or strongly agreed that the
evidence was derived from patients with modern bi-leaflet mechanical
valves, and 57.2% of respondents agreed or strongly agreed that the
evidence was not of high quality. A majority of respondents (65.9%)
reported that they would accept an increase in TE risk to reduce the risk
of a major bleeding event; 86.4% are willing to randomize patients with a
mechanical aortic valve to a target INR of 2.0 (range 1.5-2.5) if they had
no risk factors for TE and 36.4% would randomize patients to a target INR
of 2.0 with additional risk factors for TE. Conclusion(s): Clinicians
who participated in the survey followed different guidelines and employed
different INR targets for patients with a mechanical aortic valve. A
majority of respondents would be willing to randomize these patients to
lower INR targets. (Figure Presnted).

<48>
Accession Number
634166074
Title
Computed tomography derived predictors of permanent pacemaker implantation
after transcatheter aortic valve implantation: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2582), 2020. Date of Publication:
November 2020.
Author
Maier O.; Zeus T.; Jung C.; Westenfeld R.; Polzin A.; Kelm M.; Veulemans
V.
Institution
(Maier, Zeus, Jung, Westenfeld, Polzin, Kelm, Veulemans) University
Hospital Duesseldorf, Duesseldorf, Germany
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a
wellestablished alternative to surgery for the treatment of patients with
severe symptomatic aortic stenosis at high and intermediate surgical risk.
Unfortunately, the occurrence of electrical conduction disturbances
remains one of the most frequent complications of the procedure. While the
impact of electrocardiographic and procedural predictors on PPI is well
examined, there is still a lack of knowledge regarding anatomical
predictors screened by multislice computed tomography (MSCT).
 Purpose(s): We performed a meta-analysis to summarize available
studies that reported the incidence of PPI after TAVI with new-generation
devices and provided raw data for preprocedural MSCT. Method(s): The
authors conducted a literature search in PubMed database until December
31, 2019 to identify studies that investigated preprocedural MSCT data and
rate of PPI following TAVI with new-generation devices. Twelve
observational studies (n=3133) met inclusion criteria for final analysis.
 Result(s): PPI was performed in 509 patients (16.2%) after TAVI,
mostly due to high degree atrioventricular (AV) block (80.8%). The rate of
PPI varied widely from 7.9% to 35.8% in individual studies. Regarding
secondary endpoints' analysis of relative risk (RR) and mean difference
(MD) electrocardiographic PPI-predictors after TAVI appeared to be
pre-existing atrial fibrillation (AF) (RR 1.21; 95% CI 1.05-1.40;
p=0.008), right bundle branch block (RBBB) (RR 4.22; 95% CI 3.30-5.41;
p<0.0001) and AV block grade I (RR 1.63; 95% CI 1.16-2.29; p=0.005).
Patients requiring PPI had larger annulus perimeter (MD 1.66 mm; 95% CI
0.67-2.66 mm; p=0.001) and shorter membranous septum length (MD -0.86 mm;
95% CI -1.74-0.02 mm; p=0.05) assessed by preprocedural MSCT. Concerning
calcium load of device landing zone, pacemaker dependent patients showed
increased calcification of the non-coronary cusp (MD 39.76 mm3; 95% CI
18.60- 60.93 mm3; p=0.0002), the left-coronary cusp (LCC) (MD 47.60 mm3;
95% CI 19.40-75.81 mm3; p=0.0009) and the total left ventricular outflow
tract (LVOT) (MD 19.17 mm3; 95% CI 6.68-31.66 mm3; p=0.003). Lower
implantation depth (MD 0.83 mm from NCC; 95% CI 0.20-1.47 mm; p=0.01) and
oversizing by annulus diameter/area (MD 1.76%; 95% CI 0.68-2.84%; p=0.001)
were procedural predictors of PPI following TAVI. Conclusion(s): This
structured meta-analysis proved PPI rate in 16.2% of patients following
TAVI. Beside well-known electrocardiographic (AF, RBBB, AV block grade I)
and procedural predictors (implantation depth, oversizing) this
meta-analysis showed for the first time that MSCT derived anatomical
values (annulus perimeter, membranous septum length) and distribution of
device landing zone's calcification (NCC, LCC, LVOT) are associated with
increased risk of PPI following TAVI.

<49>
Accession Number
634166066
Title
Comparative survival efficacy of mechanical and biological heart valve in
dialysis patients: A meta-analysis with the subgroup analysis of valve
positions.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2683), 2020. Date of Publication:
November 2020.
Author
Chi K.Y.; Chiang M.H.; Kang Y.N.; Wang S.T.; Li S.J.; Chan Y.T.; Chen
Y.C.; Chen W.C.
Institution
(Chi, Chiang, Wang, Chen) Taipei Medical University Hospital, Taipei,
Taiwan (Republic of China)
(Kang, Li) Wang-Fang Medical Center, Taipei, Taiwan (Republic of China)
(Chan, Chen) Shung Ho Hospital, New Taipei, Taiwan (Republic of China)
Publisher
Oxford University Press
Abstract
Background: To date, the optimal selection of prosthetic heart valve for
dialysis patients still remains controversial. Purpose(s): Since
previous meta-analyses on survival outcomes were with substantial
heterogeneity, we attempted to investigate the potential sources and
update the comparative survival efficacy of mechanical prosthesis (MP) and
bioprosthesis (BP) in dialysis patients. Method(s): We systematically
reviewed PubMed, Embase, Cochrane library, Web of Science, and
ClinicalTrials.gov from inception to February 1, 2020 for relevant
studies. Randomized controlled trials, prospective or retrospective
cohorts that involved dialysis patients undergoing heart valve replacement
were included. Studies that did not report comparative survival outcome of
two prostheses were excluded. To explore the potential sources of
heterogeneity, we conducted a subgroup analysis based on valve positions.
We also performed a meta-regression to delve into the effects of
study-level covariates on mid/long-term survival, which was defined as at
least 4-year follow-up. Result(s): A total of 20 retrospective
cohorts involving 8,398 participants (MP= 5900, BP= 2498) were included in
our study. Overall, MP was associated with a significant 16% reduction in
all-cause mortality, compared to BP (HR, 0.84; 95% CI, 0.73 to 0.98;
I2=43%; Figure). In the subgroup analysis, patients undergoing
isolated-aortic valve replacement (iso-AVR) with MP further exhibited an
even better mid/long-term survival efficacy with no statistical
heterogeneity being observed (HR, 0.64; 95% CI, 0.47 to 0.86; I2= 0%;
Figure). The involvement of mitral valve replacement (MVR) was a strong
mortality contributor (HR, 1.79; 95% CI, 1.40 to 2.28; I2= 0%). Moreover,
our meta-regression demonstrated that MVR proportion was the only
covariate that significantly affected mid/long-term survival (beta=
0.8473, p=0.046; Table). Conclusion(s): Compared to BP, MP might be a
reasonable choice for dialysis patients requiring AVR due to its better
mid/long-term survival efficacy. (Table Presented).

<50>
Accession Number
634166033
Title
Adenosine diphosphate receptor inhibitor monotherapy with ticagrelor or
clopidogrel following percutaneous coronary intervention: A systematic
review and meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2578), 2020. Date of Publication:
November 2020.
Author
Haghbayan H.; Durocher D.P.; Coomes E.A.; Lavi S.
Institution
(Haghbayan, Durocher, Lavi) London Health Sciences Centre, Division of
Cardiology, Department of Medicine, London, Canada
(Coomes) University of Toronto, Division of Infectious Diseases,
Department of Medicine, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background and purpose: In patients undergoing percutaneous coronary
intervention (PCI) with implantation of coronary stents, the risk of stent
thrombosis is mitigated with antiplatelet therapy. While current clinical
practice is to treat patients with dual antiplatelet therapy (DAPT)
combining aspirin with an adenosine diphosphate receptor inhibitor
(ADPri), prolonged therapy is associated with heightened bleeding risk.
Limiting DAPT to a shorter period after PCI, followed by ADPri
monotherapy, may be an attractive strategy for optimizing the balance
between thrombotic and bleeding risks. While several randomized controlled
trials (RCTs) have been published examining this strategy, the optimal
duration of abbreviated DAPT run-in and the ideal choice of ADPri remain
uncertain. Method(s): We undertook a systematic review and
meta-analysis of RCTs assessing abbreviated DAPT followed by ADPri
monotherapy post coronary stenting. Our primary outcomes were defined as
clinically important bleeding, major adverse cardiovascular events (MACE),
and all-cause mortality. We searched Ovid MEDLINE and EMBASE from their
inceptions to November 2019 with study selection and data extraction
performed in duplicate. We pooled data at one year using random effects
models; relative risks (RRs) with 95% confidence intervals (95% CIs) were
generated using the inverse variance method. Pre-specified sub-group
analyses were undertaken according to duration of DAPT and the primary
ADPri employed. Result(s): Four trials (n=29084) were eligible for
inclusion. Mean age was 65 years and 51.5% of patients were recruited in
the context of acute coronary syndrome. Following meta-analysis, the
occurrence of clinically significant bleeding events was significantly
lower in patients receiving ADPri monotherapy (4 studies; n=29084;
RR=0.60; 95% CI, 0.43-0.83; I2=73%; Figure-A), with no significant
difference in the rates of all-cause mortality (4 studies; n=29084;
RR=0.87; 95% CI, 0.71-1.06; I2=0%; Figure- B) or MACE (4 studies; n=29084;
RR=0.90; 95% CI, 0.79-1.03; I2=1%; Figure-C). In subgroup analysis, trends
toward lower rates of both all-cause mortality (2 studies; n=23082
participants; RR=0.81; 95% CI, 0.65-1.01; I2=0%; Figure-B) and MACE (2
studies; n=23082 participants; RR=0.90; 95% CI, 0.79-1.03; I2=25%;
Figure-C) were seen in the studies employing ticagrelor as opposed to
clopidogrel; however, neither analysis reached statistical significance
(p-values=0.06 and 0.19, respectively). There was no differential
treatment effect based on the duration of abbreviated DAPT prior to ADPri
monotherapy in sub-group analysis. Conclusion(s): Following PCI in
patients with coronary disease, an abbreviated course of DAPT followed by
ADPri monotherapy significantly reduces rates of bleeding with no
difference in rates of MACE or all-cause mortality. Future studies are
required to conclusively determine whether the use of ticagrelor in this
setting may also reduce rates of all-cause mortality. (Figure Presnted).

<51>
Accession Number
634166019
Title
Ticagrelor monotherapy beyond 1 month versus standard dual antiplatelet
therapy after drug-eluting coronary stenting: A pre-specified per-protocol
analysis of the GLOBAL LEADERS trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2577), 2020. Date of Publication:
November 2020.
Author
Gragnano F.; Zwahlen M.; Vranckx P.; Juni P.; Heg D.; Hamm C.; Steg P.G.;
Hagenbuch N.; Gargiulo G.; Van Geuns R.J.; Huber K.; Van Amsterdam R.;
Serruys P.W.; Valgimigli M.; Windecker S.
Institution
(Gragnano, Valgimigli, Windecker) Bern University Hospital, Inselspital,
Department of Cardiology, Bern, Switzerland
(Zwahlen, Hagenbuch) University of Bern, Institute of Social and
Preventive Medicine (ISPM), Bern, Switzerland
(Vranckx) Heart Centre Hasselt, Department of Cardiology and Critical Care
Medicine, Hasselt, Belgium
(Juni) St. Michael's Hospital, Department of Medicine, Applied Health
Research Centre (AHRC), Toronto, Canada
(Heg) University of Bern, Institute of Social and Preventive Medicine
(ISPM) and Clinical Trials Unit, Bern, Switzerland
(Hamm) Justus-Liebig University of Giessen, Department of Cardiology and
Angiology, Giessen, Germany
(Steg) Bichat APHP Site of Paris Nord University Hospital, Department of
Cardiology, Paris, France
(Gargiulo) Federico II University of Naples, Department of Advanced
Biomedical Sciences, Naples, Italy
(Van Geuns) Radboud University Medical Center, Department of Cardiology,
Nijmegen, Netherlands
(Huber) Wilhelminen Hospital, 3rd Medical Department, Cardiology, Vienna,
Austria
(Van Amsterdam) Cardyalisis B.V, Rotterdam, Netherlands
(Serruys) Imperial College London, Department of Cardiology, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Background: In the GLOBAL LEADERS trial, the intention-to-treat (ITT)
effect of ticagrelor monotherapy after 1 month of dual antiplatelet
therapy (DAPT) was not superior to that of 12-month DAPT followed by
aspirin alone in the prevention of 2-year all-cause mortality or new
Q-wave myocardial infarction (MI) after coronary stenting.
Intention-to-treat analyses can be affected by incomplete protocol
adherence. We present a prespecified per-protocol analysis.
 Purpose(s): To determine whether 1 month of ticagrelor plus aspirin
followed by 23 months of ticagrelor monotherapy is superior to 12 months
of DAPT followed by aspirin alone in the per-protocol population of the
GLOBAL LEADERS (NCT01813435). Method(s): The GLOBAL LEADERS compared
two antiplatelet strategies after drug-eluting stenting for stable
coronary artery disease or acute coronary syndromes. Per-protocol
population consisted of randomized patients fulfilling enrollment criteria
and receiving protocol-mandated treatment. Adherence to the allocated
antiplatelet therapy was evaluated at discharge, 30 days, and 3, 6, 12,
18, and 24 months, with non-adherence reasons categorized following a
hierarchical approach. A protocol-deviation was defined in the case of
high perceived bleeding/thrombotic risk, a medical decision without
evident clinical reason, patients unwilling to take study drugs,
prescription error, logistical issues, unclear reasons. Baseline
characteristics, including (but not limited to) age, sex, diabetes, prior
PCI, were used to construct time-varying inverse probabilities for not
deviation from the protocol to reconstruct a study population with no
protocol-deviations. Protocol deviators were artificially censored at the
time at which they deviated. The primary endpoint was the composite of
2-year all-cause mortality or nonfatal new Q-wave MI. We used a weighted
pooled logistic regression to estimate the per-protocol rate ratio (RR) of
experimental vs. control treatment for the primary endpoint.
 Result(s): Of the 15,968 randomized patients, 805 out of 7,980
(10.1%) in experimental group and 537 out of 7,988 (6.7%) in control group
were classified as protocol deviators and artificially censored by month
12, not contributing events in the second year. The events for the
adherence-adjusted analysis were 279 in experimental group and 325 in
control group (25 and 24 less than in ITT analysis, respectively). The
estimated adherenceadjusted RR was 0.87 (95% CI: 0.74-1.02; p=0.09),
comparable to the ITT RR (0.87; 95% CI: 0.75-1.01; p=0.07).
 Conclusion(s): At per-protocol analysis, ticagrelor monotherapy after
1 month of DAPT was not superior to conventional treatment, in line with
the previously reported ITT effect. Similar per-protocol and ITT effects
can be accounted for similar per-protocol and ITT populations, as a
substantial proportion of patients were non-adherent due to clinically
grounded reasons (anticipated in the protocol) and, accordingly, not
considered as protocol deviators.

<52>
Accession Number
634166000
Title
Randomized clinical trial comparing a rivaroxaban-based with an
antiplatelet-based strategy for cerebral embolization after TAVR (EARTH
TAVR)-a magnetic resonance imaging substudy of the GALILEO trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2623), 2020. Date of Publication:
November 2020.
Author
Froehlich G.M.; Falk V.; Endres M.; Stangl V.; Woehrle J.; Steinbeck L.;
Erbay A.; Rudolph T.; Geisler T.; Leistner D.; Nolte C.; Hausler G.;
Fiebach J.; Dangas G.; Landmesser U.
Institution
(Froehlich, Endres, Steinbeck, Erbay, Leistner, Nolte, Hausler, Fiebach,
Landmesser) Charite - Campus Benjamin Franklin, Berlin, Germany
(Falk) German Heart Center, Berlin, Germany
(Stangl) Charite - Campus Mitte (CCM), Cardiology, Berlin, Germany
(Woehrle) Heart Hospital Ulm, Cardiology, Ulm, Germany
(Rudolph) Heart Center at the University of Cologne, Cardiology, Cologne,
Germany
(Geisler) University Hospital of Tuebingen, Cardiology, Tuebingen, Germany
(Dangas) Mount Sinai School of Medicine, Cardiology, New York City, United
States
Publisher
Oxford University Press
Abstract
Background: Cerebral embolization in patients after Transcatheter Aortic
Valve Replacement (TAVR) represents a serious complication, that was
related to impaired bioprosthetic leaflet motion and new-onset atrial
fibrillation (AFib). Purpose(s): Hereafter we present the first
randomized study comparing the effect of an anticoagulation plus
antiplatelet with a dual antiplatelet antithrombotic treatment in patients
after TAVR on cerebral embolizations as assessed by serial cerebral
magnetic resonance imaging (MRI). Method(s): The Evaluation of
Cerebral Thrombembolism After TAVR (EARTH - TAVR) study was conducted as
an investigator initiated substudy of the multicenter, randomized, GALILEO
study. After successful TAVR, patients without indication for chronic
anticoagulation were randomly assigned to rivaroxaban 10mg plus
acetylsalicylic acid 75-100mg once-daily or clopidogrel 75mg plus
acetylsalicylic acid 75-100mg once-daily. Cerebral MRI scans were
performed pre-TAVR as a baseline, post-TAVR (within 24-48 hours after
TAVR) and 90 days after TAVR. The MRI protocol included diffusion-weighted
(DWI) and fluid-attenuated inversion recovery (FLAIR) imaging. Cerebral
embolic lesions were evaluated by an independent cerebral MRI core lab.
The primary outcome measure of this study was the occurrence and extent of
cerebral embolizations as measured by total volume of new ischaemic
cerebral lesions. Result(s): 36 patients were enrolled in the EARTH
and the GALILEO study. The DWI MRI scans revealed an increase of cerebral
lesions and volume post-TAVR by a median of 4.75 (95% NBCI 2.1-8.9) and
0.26cm3 (95% NBCI 0.11-0.59). On FLAIR imaging, lesion number and volume
increased by a median of 3 (95% NBCI 1.5-6) and 0.1 cm3 (95% NBCI
0.04-0.31). At the 90 days MRI scan, there was no statistically
significant change in cerebral lesions, if compared to the post-TAVR scan,
irrespective of the treatment arm. Conclusion(s): Thromboembolic
events occur largely in the periinterventional phase post TAVR.
Thereafter, the risk for additional cerebral embolization is low. An
additional rivaroxaban therapy beyond antiplatelet inhibition did not
impact on cerebral thromboembolism.

<53>
Accession Number
634165969
Title
Multiple vs single arterial grafting in coronary surgery among diabetic
patients: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2673), 2020. Date of Publication:
November 2020.
Author
Leite-Moreira J.P.; Saraiva F.A.; Barros A.S.; Leite-Moreira A.F.;
Lourenco A.P.
Institution
(Leite-Moreira, Saraiva, Barros, Lourenco) Faculty of Medicine, University
of Porto, Surgery and Physiology,Cardiovascular R and D Center, Porto,
Portugal
(Leite-Moreira) Sao Joao Hospital, Cardiothoracic Surgery, Porto, Portugal
Publisher
Oxford University Press
Abstract
Background and aim: The use of more than one arterial conduit in coronary
surgery has been widely associated with better long-term results. We
sought to investigate the benefits of Multiple Arterial Grafts (MAG) over
Single Arterial Grafts (SAG), among diabetic patients, in short and
long-term results throughout a meta-analysis of propensity score matching
(PSM) studies. Method(s): MEDLINE and ISI Web of Science were used to
find relevant literature (1960-2018). We included cohort studies with at
least 200 patients and that reported one of these outcomes: long-term
survival, early mortality or sternal wound infection (SWI). Survival was
collected through hazard ratio (HR) along with their variance and the
other endpoints using frequencies or odds ratio (OR) from the matched
sample. Fixed effect models were used to compute statistical combined
measures and 95% confidence intervals (CI). Result(s): Eleven studies
were included performing a total of 9670 diabetic patients: 4833 MAG and
4837 SAG (1:1 PSM in all studies). MAG group consisted in bilateral
internal mammary artery (BIMA) in 8 studies; single IMA (SIMA)+radial
artery (RA) in 5 studies; and one study reported several MAG approaches:
BIMA+RA+Gastroepiploic artery (GEA), SIMA+RA+GEA, SIMA+GEA or BIMA+GEA.
SAG group consisted in SIMA with or without saphenous vein graft in all
studies, except for one that included also patients with GEA instead of
SIMA. Ten studies reported longterm survival and mean follow-up time
ranged from 5 to 12 years (max. follow-up 30y). Overall, MAG had
significantly improved long-term survival compared with SAG (pooled
HR=0.79, 95% CI: 0.74-0.85, p<0.01). Inhospital mortality was reported by
6 studies (4202 patients: 2099 MAG and 2103 SAG) and occurred in 3.0% vs.
3.3% in MAG vs. SAG patients, respectively (pooled OR: 0.91, 95% CI:
0.65-1.29, p=0.60). SWI was reported by 6 studies (4432 patients: 2216 MAG
and 2216 SAG) and occurred in 2.8% vs. 2.2% in MAG vs. SAG patients,
respectively (pooled OR: 1.31, 95% CI: 0.90-1.92, p=0.15). Excluding one
article in which MAG group consisted in IMA+RA, the remaining 5 BIMA vs.
SIMA studies reported an higher risk of SWI in MAG group (pooled OR: 1.63,
95% CI: 1.07-2.49, p=0.02) Conclusion(s): Considering PSM studies,
MAG provides superior long-term survival compared to SAG in diabetic
patients. This surgical technique does not implement additional risk
regarding in-hospital mortality, but MAG with BIMA was associated with a
higher risk of SWI in this specific subgroup of patients. (Figure
Presnted).

<54>
Accession Number
634165931
Title
Outcomes after coronary artery bypass graft surgery: Systematic review and
meta-analysis comparing bilateral versus single internal thoracic artery
grafts.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2670), 2020. Date of Publication:
November 2020.
Author
Stefil M.; Gaudino M.; Benedetto U.; Gray A.; Gerry S.; Lees B.; Krzych
L.; Seevanayagam S.; Taggart D.; Flather M.
Institution
(Stefil, Flather) University of East Anglia, Norfolk and Norwich
University Hospital, Norwich, United Kingdom
(Gaudino) New York-Presbyterian Hospital, Weill Cornell Medical Center,
Department of Cardiothoracic Surgery, New York, United States
(Benedetto) Bristol Royal Infirmary and University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Gray) University of Oxford, Health Economics Research Centre, Nuffield
Department of Population Healthl, Oxford, United Kingdom
(Gerry) University of Oxford, Centre for Statistics in Medicine, Nuffield
Department of Orthopaedics,Rheumatology and Musculoskeletal Sciences,
Oxford, United Kingdom
(Lees, Taggart) John Radcliffe Hospital, University of Oxford, Nuffield
Department of Surgical Sciences, Oxford, United Kingdom
(Krzych) Medical University of Silesia, Department of Cardiac Surgery,
Katowice, Poland
(Seevanayagam) Austin Health and University ofMelbourne, Department of
Cardiac Surgery, Melbourne, Australia
Publisher
Oxford University Press
Abstract
Background: Patients with diabetes and/or obesity are at higher risk of
adverse outcomes following coronary artery bypass grafting (CABG). The use
of bilateral internal thoracic arteries (BITA) can potentially offer
survival benefit in higher risk patients compared to single internal
thoracic artery (SITA) in patients undergoing CABG, but the overall
evidence base for BITA has not influenced guidelines, and there are
concerns over increased risk of sternal wound complications.
 Method(s):We conducted a systematic review of the literature to
identify observational studies and randomised controlled trials (RCT)
comparing the efficacy (mortality) and safety (sternal wound infection) of
BITA and SITA in diabetic and obese patients. Result(s): We
identified 18 observational studies and one RCT to obtain data comparing
BITA and SITA in 19,589 diabetic patients, and two observational studies
and one RCT comparing BITA and SITA in 6972 obese patients. Pooled
analysis demonstrated significant mortality benefit of BITA compared to
SITA in diabetic patients (risk ratio [RR] 0.79; 95% confidence interval
[CI] 0.70, 0.90; Z=3.62, p=0.0003; I2=88%) (Figure 1a). Pooled analysis in
obese patients found no significant difference in mortality rates between
BITA and SITA (RR 0.73, 95% CI 0.47, 1.12; Z=1.43, p=0.15; I2=78%) (Figure
1b). A significantly higher rate of sternal wound complications following
BITA was observed in diabetic (RR 1.53, 95% CI 1.23, 1.90; Z=3.86,
p=0.0001; I2=4%) and obese patients (RR 2.24, 95% CI 1.63, 3.07; Z=5.00,
p<0.00001; I2=0%). Conclusion(s): BITA is associated with better
long-term survival in diabetic patients, but most of the supportive data
comes from observational studies. The effects of BITA grafting in patients
who are obese is uncertain due to low numbers. BITA is associated with
higher rates of sternal wound complications than SITA in both diabetic and
obese patients. Further research is needed to understand if BITA has a
role in higher risk patients undergoing CABG. (Figure Presnted).

<55>
Accession Number
634165892
Title
Post TAVR coronary revascularization guided by stress cardiac imaging and
impact on cardiovascular events.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2614), 2020. Date of Publication:
November 2020.
Author
Lattuca B.; Prunet E.; Huet F.; Akodad M.; Manna F.; Macia J.C.; Schmutz
L.; Gandet T.; Cayla G.; Leclercq F.
Institution
(Lattuca, Prunet, Schmutz, Cayla) University Hospital of Nimes, Cardiology
department, Nimes, France
(Huet, Akodad, Macia, Leclercq) Hospital Regional University of
Montpellier, Montpellier, France
(Manna) Department of Epidemiology, Medical statistics and Public Health,
Montpellier University Hospital, Montpellier, France
(Gandet) Department of Cardiac and Thoracic Surgery, Montpellier
University Hospital, Montpellier, France
Publisher
Oxford University Press
Abstract
Background: The prognostic impact of systematic revascularization of
asymptomatic coronary artery stenosis before transcatheter aortic valve
replacement (TAVR) is still debated Purpose: The main objectives of this
study were to evaluate the feasibility and the safety of a functional
evaluation of coronary artery disease (CAD) followed by a selective
ischemia-guided percutaneous coronary intervention (PCI) after TAVR.
 Method(s): This prospective, bi-centric, one-arm, open-label trial
included patients with severe aortic stenosis (AS) eligible for TAVR and
with significant CAD defined as one or more coronary stenosis >=70%.
Patients with left main stenosis >=50%, proximal left anterior descending
artery (LAD) stenosis >=90% or > class 2 Canadian cardiovascular society
angina pectoris were excluded. Coronary revascularization was not
performed before TAVR and myocardial ischemia was evaluated by stress
cardiac imaging one month after the procedure using Single-Photon Emission
Computed Tomography Myocardial Perfusion Imaging or Stress
Echocardiography using dobutamine infusion. The primary endpoint was the
composite of all cause of death, stroke, major bleeding (Bleeding Academic
Research Consortium (BARC) >=3), major vascular complication (Valve
Academic Research Consortium 2 criteria), myocardial infarction (MI) and
hospitalization for cardiac causes at 6 months following TAVR.
 Result(s): Between June 2016 and March 2019, 71 patients were
included with a complete follow-up in 66 patients. The mean age was
84+/-5.2 years and the mean Euroscore was 13+/-8.6. Stress cardiac imaging
could be achieved in 70% (n=46) of the patients and the main causes to not
perform it were patient refusal or secondary impaired medical condition.
Significant myocardial ischemia was observed in only 3 patients (4.5%), of
whom 2 patients had successful PCI. The primary endpoint occurred at 6
months in 15 patients (23%) including death in 6 patients (9%), stroke in
3 patients (5%) and major bleedings in 3 patients (5%). Acute MI was
observed in only 2 patients (3%) that had not-LAD proximal and severe
coronary stenosis (>=90%). Hospital readmission (n=27, 41%) was mostly
related to non-cardiac causes (n=18, 27%). Conclusion(s): In patients
scheduled to TAVR and with significant coronary disease, a strategy of
selective ischemia-guided coronary revascularization after TAVR appears
safe with a low rate of myocardial infarction and myocardial ischemia
requiring revascularization during follow-up. However, the poor adherence
of elderly patients to stress test could suggest to perform PCI of
proximal and severe coronary lesions. Large-scale and randomized trials
are warranted to validate this strategy.

<56>
Accession Number
634165878
Title
Intensive versus standard blood pressure control and vascular procedures:
Insights from the Systolic Blood Pressure Intervention Trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2724), 2020. Date of Publication:
November 2020.
Author
Byrne C.; Pareek M.; Rujic D.; Krogager M.L.; Kragholm K.H.;
Biering-Soerensen T.; Vaduganathan M.; Olesen T.B.; Olsen M.H.; Bhatt D.L.
Institution
(Byrne) Bispebjerg and Frederiksberg University Hospital, Department of
Cardiology, Copenhagen, Denmark
(Pareek, Biering-Soerensen, Vaduganathan, Bhatt) Brigham and Women'S
Hospital, Harvard Medical School, Heart and Vascular Center, Boston,
United States
(Rujic) Herlev and Gentofte Hospital, Department of Cardiology,
Copenhagen, Denmark
(Krogager, Kragholm) Aalborg University Hospital, Department of
Cardiology, Aalborg, Denmark
(Olesen) Odense University Hospital, Department of Endocrinology, Odense,
Denmark
(Olsen) Holbaek Hospital, Department of Internal Medicine, Holbaek,
Denmark
Publisher
Oxford University Press
Abstract
Background: The Systolic Blood Pressure Intervention Trial (SPRINT) found
that intensive versus standard blood pressure control reduced
cardiovascular (CV) morbidity and mortality. Previous studies have shown
that control of blood pressure reduces the risk of stroke and is one of
the most modifiable risk factors for carotid artery disease. On the other
hand, data on effect of blood pressure control on peripheral artery
disease are more diverse. In addition, it is unknown whether intensive
blood pressure control affects the risk of vascular procedures.
 Purpose(s): To assess the relationship between intensive blood
pressure control and incident vascular procedures. Method(s): SPRINT
was a randomized, controlled trial comprising 9,361 individuals >=50 years
of age at high CV risk but without diabetes who had a systolic BP (SBP)
130-180 mmHg. Patients were randomized to intensive (target SBP <120mmHg)
or standard antihypertensive treatment (target SBP <140mmHg). The primary
efficacy endpoint was the composite of acute coronary syndromes, stroke,
heart failure, or death from CV causes. The primary safety endpoint was
the composite of serious adverse events. We examined the risk of composite
and individual vascular procedures with intensive versus standard blood
pressure control. We further examined subgroup heterogeneity using
interaction analyses. Result(s): During a median follow-up time of
3.3 years (range 0-5.5 years), a total of 174 (1.9%) composite vascular
procedures were recorded. Intensive blood pressure control did not
significantly reduce the risk of composite vascular procedures (intensive
blood pressure control, 76 (1.6%) versus standard blood pressure control,
98 (2.1%), hazard ratio 0.76, 95% confidence interval, 0.57 to 1.03;
P=0.08) (Figure 1). Similarly, the risks of the individual endpoints of
carotid angioplasty, carotid endarterectomy, peripheral angioplasty or
thrombolysis, lower extremity amputation for ischemia and gangrene,
surgical or vascular procedure for abdominal aortic aneurysm, surgical or
vascular procedure for thoracic aortic aneurysm, and surgical or vascular
procedure for other problems were not significantly affected (P>=0.05 for
all). Intensive blood pressure control reduced the risk of peripheral
vascular surgery (intensive blood pressure control, 7 (0.2%) versus
standard blood pressure control, 21 (0.5%), hazard ratio 0.33, 95%
confidence interval, 0.14 to 0.77; P=0.01), though this was based on a
small number of events. The safety and efficacy of intensive BP lowering
was not modified by chronic kidney disease, age, sex, race, previous
cardiovascular disease, or baseline systolic blood pressure tertile
(P>=0.05 for all). Conclusion(s): In SPRINT, intensive versus
standard blood pressure control did not reduce the risk of composite
incident vascular procedures. (Figure Presnted) .

<57>
Accession Number
634165866
Title
Randomized clinical trial of surgical vs. percutaneous vs. hybrid
revasculatization in multivessel coronary artery disease: 3 years
follow-up (the HREVS Trial).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2664), 2020. Date of Publication:
November 2020.
Author
Ganyukov V.; Kochergin N.; Shilov A.; Tarasov R.; Skupien J.; Szot W.;
Kokov A.; Popov V.; Kozyrin K.; Barbarash O.; Barbarash L.; Musialek P.
Institution
(Ganyukov, Kochergin, Shilov, Tarasov, Kokov, Kozyrin, Barbarash,
Barbarash) Research Institute for Complex Issues of Cardiovascular
Diseases, Kemerovo, Russian Federation
(Skupien, Szot, Musialek) Jagiellonian University, School of Medicine,
Krakow, Poland
(Popov) Federal State Budgetary Institution A.V. Vishnevsky Institute of
Surgery, Moscow, Russian Federation
Publisher
Oxford University Press
Abstract
Aim: Optimal revascularization strategy in multi-vessel (MV) coronary
artery disease (CAD) eligible for percutaneous intervention (PCI) and
surgery remains unresolved. We evaluated, in a randomized clinical trial,
residual myocardial ischemia (RI) and clinical outcomes of MV-CAD
revascularization using coronary artery bypass grafting (CABG), hybrid
coronary revascularization (HCR) or MV-PCI. Material(s) and
Method(s): Consecutive MV-CAD patients (n=155) were randomized (1:1:1) to
conventional CABG (LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD
followed by PCI for remaining vessels) or MVPCI (everolimus-eluting CoCr
stents) under Heart Team agreement on equal technical and clinical
feasibility of each strategy. The primary endpoint was SPECT at 12 months
(primary endpoint of RI that the trial was powered for; a measure of
revascularization mid-term efficacy and an independent predictor of
long-term prognosis). The secondary endpoint was 3-year MACCE.
 Result(s): Baseline characteristics were similar between the study
arms. 5 (9.8%) patients in the HCR group required conversion to CABG. Data
are given respectively for the CABG, HCR and MV-PCI arm. Incomplete
revascularization rate was 8.0% vs. 7.7% vs. 5.7% (p=0.86). At 12 months,
RI was 5 (2,9)% vs. 5 (3,7)% vs. 6 (3,10)% (median; Q1,Q3) with
non-inferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs.
CABG). 3-year MACCE rate was similar (34.7% vs. 27.1% vs. 38%; p=0.18).
 Conclusion(s): In patients with MV-CAD amenable to CABG, HCR, and
MVPCI, endpoints of residual myocardial ischemia at 12 months and 3-year
MACCE were similar. (Figure Presnted).

<58>
Accession Number
634165857
Title
Stroke and mortality rates after valve-in-valve TAVR and comparison with
data from redo SAVR.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2611), 2020. Date of Publication:
November 2020.
Author
Macherey S.; Meertens M.; Eichel S.; Schipper J.; Mauri V.; Frerker C.;
Adam M.; Kuhn E.; Wahlers T.; Lee S.; Baldus S.; Schmidt T.
Institution
(Macherey, Meertens, Eichel, Schipper, Mauri, Frerker, Adam, Lee, Baldus,
Schmidt) Cologne University Hospital - Heart Center, Cologne, Germany
(Kuhn, Wahlers) Cologne University Hospital - Heart Center, Department of
Cardiothoracic Surgery, Cologne, Germany
Publisher
Oxford University Press
Abstract
Background and purpose: Early registry data described a potentially
increased risk for cerebrovascular events and mortality in patients
undergoing transcatheter aortic valve replacement (TAVR) as valve-in-valve
(viv) procedures. Further data of small patient cohorts described
divergent results for cerebrovascular events and mortality in patients
undergoing TAVR as viv procedures for failed surgical bioprotheses in
comparison with patients on redo surgical aortic valve replacement (SAVR).
We performed a meta-analysis of stroke rates and mortality for viv TAVR
procedures basing on the current literature. Method(s): We included
all case series (>=10 patients), case-control studies and randomized
controlled trials comparing viv TAVR and redo SAVR procedures with respect
to cerebrovascular events and mortality rates. Additionally, we included
all case series and registries with patients undergoing viv TAVR. After a
structured literature research, 17 studies were eligible. For statistical
analysis risk ratios and confidence intervals using Mantel- Haenszel test
and the I-statistic to quantify possible heterogeneity were calculated. A
P-value <0.05 was defined as statistical significant difference.
 Result(s): Eleven case series and registries reporting on stroke and
mortality in 8,509 patients undergoing viv TAVR were eligible for
analysis. The quantitative analysis of non-comparative studies showed a
calculated 30- day stroke rate of 2.2% and 30-day mortality rate of 4.2%
after viv TAVR. Data on the 1-year rates were sporadically reported,
therefore meta analysis was not appropriately feasible. Six studies
reporting on 498 participants undergoing viv TAVR (N=254) and redo SAVR
(N=244) were eligible. The median age ranged from 72.3 to 80.2 years for
viv TAVR and from 66.2 to 78.8 years for redo SAVR patients. The STS score
was 7.2-7.4% (viv TAVR) and 5.8-7.7% (redo SAVR), respectively. A total of
3/226 participants treated with viv TAVR and 4/214 patients undergoing
redo SAVR experienced a stroke during the first 30 postoperative days (N=4
trials, RR 0.86, 95% CI 0.20 to 3.59, p=0.83, I2 = 0%). None of the
studies reported sufficient data on the 1-year stroke incidence. The
30-day mortality was 4.3% for viv TAVR and 4.5% for redo SAVR patients.
This difference was not significantly different (N=6 trials, RR 0.90, 95%
CI 0.40 to 2.05, p=0.80, I2 = 0%). The 1-year mortality rates were 13.3%
and 13.6%, respectively (N=2 trials, RR 0.98, 95% CI 0.49 to 1.94, p=0.94,
I2 = 0%). Conclusion(s): In the current literature favorable stroke
and mortality rates at 30 days for patients undergoing viv TAVR are
documented. Similar stroke and mortality rates comparing viv TAVR and redo
SAVR patients at 30 days were found as well as similar 1-year mortality. A
selection bias for the viv TAVR and redo SAVR patients may exist, but
cannot be dissolved with this registry analysis, only showing a trend of
younger and lower risk patients receiving a redo SAVR procedure.

<59>
Accession Number
634165848
Title
Rise and fall of high-sensitivity cardiac troponin T after coronary artery
bypass grafting surgery in relation to current definitions of myocardial
infarction: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2663), 2020. Date of Publication:
November 2020.
Author
Denessen E.J.S.; Heuts S.; Vroemen W.H.M.; Sels J.W.; Segers P.; Bekers
O.; Van 't Hof A.W.J.; Maessen J.G.; Van Der Horst I.C.C.; Mingels A.M.A.
Institution
(Denessen, Vroemen, Bekers, Mingels) Maastricht University Medical Centre
(MUMC), Department of Clinical Chemistry, Maastricht, Netherlands
(Heuts, Segers, Maessen) Maastricht University Medical Centre (MUMC),
Department of Cardiothoracic Surgery, Maastricht, Netherlands
(Sels) Maastricht University Medical Centre (MUMC), Department of
Intensive Care and Cardiology, Maastricht, Netherlands
(Van 't Hof) Maastricht University Medical Centre (MUMC), Department of
Cardiology, Maastricht, Netherlands
(Van Der Horst) Maastricht University Medical Centre (MUMC), Department of
Intensive Care, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Background: Cardiac troponins are the preferred biomarkers for the
diagnosis of myocardial infarction (MI) and play an important role in
coronary artery bypass grafting (CABG) related MI (type 5 MI). Different
cutoff values, as defined by multiples of the 99th percentile upper
reference limit (URL) for isolated and non-isolated troponin elevations
have been proposed. Also, these definitions are based on arbitrarily
chosen and varying values (3rd and 4th Universal definition: 10xURL,
Society for Cardiovascular Angiography and Interventions (SCAI): 35 and
70xURL) and electrocardiographical or imaging findings. In addition to the
controversy in MI definitions, the introduction of high-sensitivity
cardiac troponin (hs-cTn) assays and their subsequent lower thresholds
warrant a thorough re-assessment of hs-cTn dynamics after CABG.
 Purpose(s): To evaluate the rise and fall of hs-cTn after CABG in
relation to the definitions of myocardial infarction. Method(s):
Studies published between 2008 and 2020 reporting hs-cTn concentrations in
relation to CABG were searched through Pubmed and reviewed by 2
independent screeners. The search terms were "coronary artery bypass" AND
"high-sensitivity cardiac troponin", including alternative names and
abbreviations. Inclusion criteria were the use of a hs-cTn assay in the
postoperative phase, either for cardiac troponin T or I. This study was
performed in agreement with the PRISMA guidelines. Result(s): Out of
37 screened studies, 15 studies were included (2860 patients). The overall
preoperative hs-cTnT concentration (median, 25th- 75th percentile) was
43.5 (16.3-57.9) ng/L. Subsequently, in >80% of CABG patients,
preoperative hs-cTnT was elevated >14 ng/L. Hs-cTnT was highly variable
over time, with a peak of 408.7 (14.9-717.2) ng/L 6-8 h after CABG.
Postoperative peak hs-cTnT concentrations rose >10xURL (Universal
definition) in 100% of CABG patients. Peak hs-cTnT >35xURL and +/-20%
>70xURL (SCAI definition) during the first 48 h was 30% and ~20%,
respectively (estimated from data depicted in Figure 1).
Electrocardiographic and imaging findings were available for only 1 study
(554 patients). Overall 30-day mortality was 1.7 (0.8-4.0)%, reported by 7
studies (2291 patients). Data regarding the association of hs-cTnT and
clinical outcome was reported by 1 study. As only 4 studies (217 patients)
reported on the results of hs-cTnI, using assays from different vendors, a
meta-analysis for hs-cTnI could not be performed. Conclusion(s): The
different definitions of type 5 MI propose arbitrarily chosen cTn cut-off
values, varying enormously between the definitions. The current thresholds
may not apply to the majority of CABG patients, since >80% had elevated
preoperative hs-cTnT. Furthermore, hs-cTnT obtained within 48 h after CABG
is highly variable over time. Therefore, further research is needed to
establish clinically relevant hs-cTn thresholds and timing of sampling for
a more accurate diagnosis of CABG procedure related MI. (Figure Presnted).

<60>
Accession Number
634165845
Title
Save your brain-does the sentinel cerebral protection device work?.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2610), 2020. Date of Publication:
November 2020.
Author
Dona C.; Kammerlander A.; Koschutnik M.; Nitsche C.; Dannenberg V.; Winter
M.P.; Siller-Matula J.; Andreas M.; Goliasch G.; Hengstenberg C.;
Mascherbauer J.
Institution
(Dona, Kammerlander, Koschutnik, Nitsche, Dannenberg, Winter,
Siller-Matula, Andreas, Goliasch, Hengstenberg, Mascherbauer) Medical
University of Vienna, Wien, Austria
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is increasingly
used for the treatment of severe symptomatic aortic stenosis (AS), also in
low-risk patients. Periprocedural embolic stroke is rare, but potentially
associated with considerable morbidity and mortality. Thus, there is great
interest in preventing any cerebral embolic event. At present, only one
cerebral embolic protection systems (CPS) is commercially available and
little is known about its efficacy in preventing stroke during TAVI. The
Sentinel CPS is a FDA-approved system consisting of two inter-connected
filters that are placed in the brachiocephalic trunk and the left carotid
artery via the right radial artery. Material(s) and Method(s):
Consecutive patients undergoing TAVI between 11/2018 and 11/2019 were
enrolled. Consecutive patients treated by one operator received the
Sentinel device, if anatomically possible. Periprocedural stroke rate, as
defined by VARC2-criteria, and mortality up to 7 days after procedure was
assessed. Descriptive statistics was performed to identify baseline
variables associated with elevated risk of stroke and Cox-regression
analysis was used to investigate its influence on outcome. Result(s):
268 patients (47.4% female, 81+/-7 years) were included. In 74 patients
(27.6%), a Sentinel CPS was used, in 63 (23.5%) it was positioned
correctly in the brachiocephalic trunk and left carotid artery. Only these
patients were considered Sentinel-protected. Patients with and without
Sentinel presented with similar baseline characteristics with regard to
age (no CPS vs CPS; 80.3 vs 81.5 years; p=0.233), sex (female 47.3% vs
47.7%; p=0.967), previous stroke (6.9% vs 3.2%; p=0.373), peripheral
artery disease (9.8% vs 4.8%; p=0.305), coronary artery disease (63.1% vs
57.1%; p=0.370), and kidney function (GFR 52 vs 56 ml/min/m2; p=0.283).
The EuroScore II (6% vs 6%; p=0.937), periprocedural predilation (48.3% vs
47.6; p=0.925), postdilation (29.3% vs 31.7%; p=0.707) and procedure time
(59min vs 66min; p=0.152) were not different. In total, 15 strokes (5.6%)
occurred, of which 9 (3.3%) were disabling strokes as defined by the
VARC2-criteria. In Sentinel-protected patients undergoing TAVI, no
periprocedural stroke was observed (no CPS 7.3% vs 0.0%; p=0.026).
 Conclusion(s): Our results suggest that Sentinel CPS significantly
reduces periprocedural stroke rates in patients undergoing TAVI compared
to patients without CPS. However, the study population is small and
randomized trials are still needed.

<61>
Accession Number
634165832
Title
Effects of diabetes and obesity in patients undergoing coronary artery
bypass graft surgery: Ten-year results from the Arterial Revascularisation
Trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2662), 2020. Date of Publication:
November 2020.
Author
Stefil M.; Taggart D.; Podesser B.; Benedetto U.; Gaudino M.; Gerry S.;
Gray A.; Lees B.; Krzych L.; Flather M.
Institution
(Stefil, Flather) University of East Anglia, Norfolk and Norwich
University Hospital, Norwich, United Kingdom
(Taggart, Lees) John Radcliffe Hospital, University of Oxford, Nuffield
Department of Surgical Sciences, Oxford, United Kingdom
(Podesser) Landesklinikum, St Polten, Medical University of Vienna, Centre
for Biomedical Research, Vienna, Austria
(Benedetto) Bristol Royal Infirmary, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Gaudino) New York-Presbyterian Hospital, Weill Cornell Medical Center,
Department of Cardiothoracic Surgery, New York, United States
(Gerry) University of Oxford, Centre for Statistics in Medicine, Nuffield
Department of Orthopaedics,Rheumatology and Musculoskeletal Sciences,
Oxford, United Kingdom
(Gray) University of Oxford, Health Economics Research Centre, Nuffield
Department of Population Health, Oxford, United Kingdom
(Krzych) Medical University of Silesia, Department of Cardiac Surgery,
Katowice, Poland
Publisher
Oxford University Press
Abstract
Background: Coronary artery bypass graft (CABG) surgery is an effective
way to manage advanced coronary heart disease. Diabetes is associated with
higher risk of mortality in patients undergoing CABG but the effects of
obesity, and the interactions between diabetes and obesity in the context
of CABG, have not been fully explored. Method(s): The Arterial
Revascularisation Trial (ART) compared ten-year mortality in patients
undergoing CABG randomised to single or bilateral internal thoracic
arterial grafts. Effects of diabetes and obesity on mortality and risk
(sternal wound complications) were explored. Diabetes was defined
according to clinical history at baseline and combined insulin and
non-insulin dependent patients, and obesity was defined as body mass index
(BMI) >=30kg/m2 at baseline. Result(s): Information on diabetes,
obesity and ten-year mortality were documented for 3094 patients who were
included in the analysis. Mean age was 64 years, 86% male, mean weight
82kg and BMI 28. Diabetes was documented in 24% and obesity in 30% and as
expected obese patients were more likely to be diabetic. The hazard ratios
(95% confidence intervals) for ten-year mortality using the no diabetes,
non-obese group as a reference were 1.33 (1.08, 1.64) (diabetes,
non-obese), 0.93 (0.75, 1.16) (no diabetes, obese) and 1.18 (0.91, 1.54)
(diabetes, obese) groups (Figure 1). Similar patterns of risk were
observed whether patients were randomised to receive single or bilateral
internal thoracic arteries and diabetes appeared to be the main driver of
elevated risk of early sternal wound complications following CABG.
 Conclusion(s): Obesity and diabetes are closely associated but our
analysis shows that patterns of risk of death after CABG are not additive
for these characteristics, and obesity may actually be associated with
lower death rates in patients with and without diabetes. These findings
will be explored further to understand mechanisms and interactions with
other factors. (Figure Presnted).

<62>
Accession Number
634165752
Title
Results of the multicenter, prospective, randomised STRENGTH (Study To
evaluate the use of RENalGuard to proTect patients at High risk of acute
kidney injury) study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2555), 2020. Date of Publication:
November 2020.
Author
Garot P.; Sievert H.; Mahfoud F.; Carrie D.; Lipiecki J.; Nickenig G.;
Remppis A.; Eckert S.; Fajadet J.; Morice M.C.
Institution
(Garot) Institut Cardiovasculaire Paris Sud, Quincy, France
(Sievert) Cardiovascular center Frankfurt, Frankfurt, Germany
(Mahfoud) Universitatsklinikum des Saarlandes und Medizinische Fakultat,
Homburg, Germany
(Carrie) Hopital Rangueil-Larrey, Toulouse, France
(Lipiecki) Pole Sante Republique, Clermont Ferrand, France
(Nickenig) Universitatsklinikum Bonn, Bonn, Germany
(Remppis) Herz- und Gefaszentrum, Bad Bevensen, Germany
(Eckert) Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad
Oeynhausen, Germany
(Fajadet) Clinic Pasteur, Toulouse, France
(Morice) CERC, Massy, France
Publisher
Oxford University Press
Abstract
Aim: Radio-contrast agents are widely used in coronary, peripheral and
structural interventions. Use of these iodine-containing agents can be
associated with contrast-induced acute kidney injury (CI-AKI) that can
cause substantial morbidity and mortality. The RenalGuard system induces a
forced diuresis with a matched hydration and has been shown beneficial in
patients requiring coronary angiogram and PCI. Method(s): STRENGTH is
a prospective, randomised (1:1), open-labeled, parallel-group, multicenter
(10 centers in Germany and France) study where patients at high risk of
CI-AKI were randomly assigned to RenalGuardR therapy or conventional
strategy including preventive hydration before complex percutaneous
cardiovascular intervention (PCI, peripheral and structural). In the
RenalGuard arm, matched fluid replacement was started 60 minutes
pre-procedure and maintained for up to 4 hours afterwards. Patients were
given an initial i.v. bolus of up to 250 ml of normal saline over 30
minutes and then an i.v. bolus of furosemide (0.5 mg/kg). To be enrolled,
patients had to have moderate to severe renal failure (defined as
15<=eGFR<=40 mL/min/m2) and a high-volume contrast requiring
cardiovascular procedure (estimated contrast volume>3 times eGFR value).
The main exclusion criterion was administration of iodine contrast media
within 5 days before index procedure. The primary endpoint was CI-AKI
defined as an increase in sCr >=0.3 mg/dL or an increase of 25% of basal
value or requiring dialysis within 5 days after procedure. The primary
analysis for efficacy is performed in a modified intention-to-treat basis.
The trial was designed and monitored by an independent CRO (Cardiovascular
European Research Center, CERC, Massy, France). Result(s): A total of
259 patients aged 79.1+/-8.8 yrs were included in the study. Among them,
129 were assigned to RenalGuard therapy and 130 to preventive saline
hydration. Their mean baseline eGFR was 32 (25; 37) vs. 33 (25; 39)
mL/min/m2, respectively (p=0.88). Total fluid intake volume within 24hrs
before the procedure was 2383+/-1146 vs. 1386+/-842mL, respectively
(p<0.0001). Procedure type was complex PCI (48%), TAVI (25%), peripheral
intervention (18%), other structural intervention (9%) with no difference
between groups (p=0.56). The total amount of contrast used for the
procedure was 116.3+/-68.2mL in the RenalGuard arm vs. 104.1+/-56.7 mL in
the conventional arm (p=0.26). A staged procedure was performed in 24
patients, including 16 in the RenalGuard and 8 in the control arm with a
mean interval from the first intervention of 43+/-29 days and 24+/-19
days, respectively. For this second procedure, the total amount of
contrast was 80+/-59 vs. 87+/-73mL. Conclusion(s): The primary and
secondary endpoints of the Study To evaluate the use of RENalGuard to
proTect patients at High risk of CI-AKI comparing RenalGuard therapy to
conventional hydration in 259 patients requiring complex percutaneous
cardiovascular intervention will be presented.

<63>
Accession Number
634170020
Title
Definitions and Clinical Trial Design Principles for Coronary Artery
Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations.
Source
Circulation. 143 (5) (pp 479-500), 2021. Date of Publication: 02 Feb 2021.
Author
Ybarra L.F.; Brilakis E.S.; Karmpaliotis D.; Azzalini L.; Grantham J.A.;
Kandzari D.E.; Mashayekhi K.; Spratt J.C.; Wijeysundera H.C.; Ali Z.A.;
Buller C.E.; Carlino M.; Cohen D.J.; Cutlip D.E.; De Martini T.; Di Mario
C.; Farb A.; Finn A.V.; Galassi A.R.; Gibson C.M.; Hanratty C.; Hill J.M.;
Jaffer F.A.; Krucoff M.W.; Lombardi W.L.; Maehara A.; Magee P.F.A.; Mehran
R.; Moses J.W.; Nicholson W.J.; Onuma Y.; Sianos G.; Sumitsuji S.;
Tsuchikane E.; Virmani R.; Walsh S.J.; Werner G.S.; Yamane M.; Rinfret S.;
Stone G.W.
Institution
(Ybarra) London Health Sciences Centre, Schulich School of Medicine and
Dentistry, Western University, ON
(Rinfret) McGill University Health Centre, McGill University, Montreal,
QC, France
(Brilakis) Minneapolis Heart Institute and Minneapolis Heart Institute
Foundation, Abbott Northwestern Hospital
(Karmpaliotis, Ali, Maehara, Moses) New York-Presbyterian
Hospital/Columbia University Medical Center, Z.A.A., A.M.
(Karmpaliotis, Ali, Maehara, Moses, Stone) Cardiovascular Research
Foundation, Z.A.A., A.M., NY
(Azzalini) Cardiac Catheterization Laboratory, Mount Sinai Hospital, NY
(Grantham) Saint Luke's Mid America Heart Institute, Kansas City, United
States
(Kandzari) Piedmont Heart Institute, Atlanta, United States
(Mashayekhi) Department of Cardiology and Angiology II University Heart
Center (K.M.), Freiburg, Bad Krozingen, Germany
(Spratt) St George's University Hospital NHS Trust, United Kingdom
(J.C.S.), London
(Wijeysundera) Schulich Heart Center, Sunnybrook Research Institute,
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences
Centre, Institute for Health Policy, Management, Evaluation (H.C.W.),
University of Toronto, ON, Canada
(Buller) St Michael's Hospital, Toronto, ON, United States
(Carlino) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, United States
(Cohen) Baim Institute for Clinical Research, Boston
(Cutlip) University of Missouri-Kansas City (D.E.C.)
(De Martini) Southern Illinois University School of Medicine, Memorial
Medical Center, Springfield
(Di Mario) Structural Interventional Cardiology, Careggi University
Hospital, Florence, United States
(Farb, Virmani) Department of Cardiovascular Pathology, CVPath Institute,
Gaithersburg, United States
(Farb) School of Medicine, University of Maryland
(Finn, Magee) US Food and Drug Administration, Silver Spring
(Galassi) Cardiology, Department of PROMISE, University of Palermo
(Gibson) Division of Cardiology, Department of Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston
(Hanratty) Belfast Health and Social Care Trust, United Kingdom (C.H.)
(Hill) Royal Brompton Hospital, United Kingdom (J.M.H.), London
(Jaffer) Cardiology Division, Massachusetts General Hospital
(Krucoff) Duke Clinical Research Institute and Duke University Medical
Center, Durham
(Lombardi) University of Washington
(Mehran, Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, NY
(Nicholson) WellSpan Health System, York
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Onuma) Department of Cardiology, National University of Ireland Galway,
United Kingdom (Y.O.)
(Sianos) AHEPA University Hospital, Thessaloniki, Greece
(Sumitsuji) Division of Cardiology for International Education and
Research, Osaka University Graduate School of Medicine, Japan (S.S.),
Suita, Japan
(Tsuchikane) Toyohashi Heart Center, Japan (E.T.), Aichi, Japan
(Walsh) Belfast Health and Social Care Trust, United Kingdom. Medizinische
Klinik I Klinikum Darmstadt GmbH, Germany (S.J.W.)
(Yamane) Saitama-Sekishinkai Hospital, Japan (M.Y.), Sayama, Japan
Publisher
NLM (Medline)
Abstract
Over the past 2 decades, chronic total occlusion (CTO) percutaneous
coronary intervention has developed into its own subspecialty of
interventional cardiology. Dedicated terminology, techniques, devices,
courses, and training programs have enabled progressive advancements.
However, only a few randomized trials have been performed to evaluate the
safety and efficacy of CTO percutaneous coronary intervention. Moreover,
several published observational studies have shown conflicting data. Part
of the paucity of clinical data stems from the fact that prior studies
have been suboptimally designed and performed. The absence of standardized
end points and the discrepancy in definitions also prevent consistency and
uniform interpretability of reported results in CTO intervention. To
standardize the field, we therefore assembled a broad consortium
comprising academicians, practicing physicians, researchers, medical
society representatives, and regulators (US Food and Drug Administration)
to develop methods, end points, biomarkers, parameters, data, materials,
processes, procedures, evaluations, tools, and techniques for CTO
interventions. This article summarizes the effort and is organized into 3
sections: key elements and procedural definitions, end point definitions,
and clinical trial design principles. The Chronic Total Occlusion Academic
Research Consortium is a first step toward improved comparability and
interpretability of study results, supplying an increasingly growing body
of CTO percutaneous coronary intervention evidence.

<64>
Accession Number
634159311
Title
Efficacy and safety of PCSK9 inhibition with evolocumab in reducing
cardiovascular events in patients with metabolic syndrome receiving statin
therapy: Secondary analysis from the FOURIER randomized clinical trial.
Source
JAMA Cardiology. 6 (2) (pp 139-147), 2021. Date of Publication: February
2021.
Author
Deedwania P.; Murphy S.A.; Scheen A.; Badariene J.; Pineda A.L.; Honarpour
N.; Keech A.C.; Sever P.S.; Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Deedwania) University of California, San Francisco, Fresno, 155 N Fresno
St, Fresno, CA 93701, United States
(Giugliano) TIMI Study Office, 60 Fenwood Rd, Hale BTM, Ste 7022, Boston,
MA 02115, United States
(Murphy, Sabatine, Giugliano) TIMI Study Group, Division of Cardiovascular
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Scheen) Department of Medicine, CHU Liege, Liege University, Liege,
Belgium
(Badariene) Clinic of Cardiac and Vascular Diseases, Institute of Clinical
Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
(Pineda, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, NHMRC Clinical Trials Centre, University of
Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Norway
Publisher
American Medical Association
Abstract
IMPORTANCE The PCSK9 inhibitor evolocumab reduced low-density lipoprotein
cholesterol and cardiovascular events in the FOURIER randomized clinical
trial. Patients with metabolic syndrome (MetS) are at increased
cardiovascular risk. OBJECTIVE To investigate outcomes with evolocumab in
patients with and without MetS. DESIGN, SETTING, AND PARTICIPANTS The
FOURIER trial randomized patients worldwide with stable atherosclerotic
cardiovascular disease receiving statin to evolocumab vs placebo with
follow-up for a median of 2.2 years. Data were collected February 2013 to
November 2016. For this prespecified analysis, patients with the requisite
data were stratified based on the National Cholesterol Education Program
Adult Treatment Panel III MetS criteria; in secondary analyses, patients
were further substratified by diabetes at baseline. Analysis was intention
to treat. Analysis began March 2018 and ended April 2020. INTERVENTIONS
Patients were randomized to evolocumab or placebo. MAIN OUTCOMES AND
MEASURES The primary end point was cardiovascular death, myocardial
infarction, stroke, hospitalization for unstable angina, or coronary
revascularization. The key secondary end point was cardiovascular death,
myocardial infarction, or stroke. RESULTS Of 27 342 patients (mean [SD]
age, 63 [9] years; 20 623 men [75.4%]) included in this analysis, 16 361
(59.8%) with baseline MetS were, when compared with patients without MetS,
at higher risk of cardiovascular events (adjusted hazard ratio [95% CI],
1.31 [1.18-1.46]; P < .001 for the primary and 1.38 [1.20-1.57]; P < .001
for the key secondary end point). Evolocumab reduced low-density
lipoprotein cholesterol similarly in patients with MetS (median
[interquartile range], 92 [79-109] mg/dL vs 30 [19-48] mg/dL; P < .001)
and without MetS (median [interquartile range], 92 [81-108] mg/dL vs 29
[18-44] mg/dl; P < .001). For the primary end point, the hazard ratios
(95% CI) with evolocumab vs placebo were 0.83 (0.76-0.91) and 0.89
(0.79-1.01) in patients with and without MetS (P for interaction = .39).
For the key secondary end point, the corresponding hazard ratios (95% CIs)
were 0.76 (0.68-0.86) and 0.86 (0.74-1.01) (P for interaction = .23),
respectively. Evolocumab did not increase the risk of new-onset diabetes
or other major safety outcomes including worsening glycemic control,
compared with placebo in patients with MetS. CONCLUSIONS AND RELEVANCE
Patients with atherosclerotic cardiovascular disease and MetS have
substantial residual risk of cardiovascular events despite statin therapy.
Evolocumab significantly reduced low-density lipoprotein cholesterol and
cardiovascular risk in patients with MetS without increasing new-onset
diabetes, worsening glycemic control, or other major safety events. These
data suggest the addition of evolocumab to statin therapy in patients with
atherosclerotic cardiovascular disease and MetS is safe and efficacious to
reduce residual cardiovascular risk. Copyright © 2020 American
Medical Association. All rights reserved.

<65>
Accession Number
2010977098
Title
Associations between mean arterial pressure during cardiopulmonary bypass
and biomarkers of cerebral injury in patients undergoing cardiac surgery:
Secondary results from a randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 32 (2) (pp 229-235),
2021. Date of Publication: 01 Feb 2021.
Author
Wiberg S.; Holmgaard F.; Blennow K.; Nilsson J.C.; Kjaergaard J.; Wanscher
M.; Langkilde A.R.; Hassager C.; Rasmussen L.S.; Zetterberg H.; Vedel A.G.
Institution
(Wiberg, Kjaergaard, Hassager) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Holmgaard, Nilsson, Wanscher, Vedel) Department of Cardiothoracic
Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Blennow, Zetterberg) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, The Sahlgrenska Academy,
University of Gothenburg, Molndal, Sweden
(Blennow, Zetterberg) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Langkilde) Department of Radiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Hassager, Rasmussen) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Zetterberg) Department of Neurodegenerative Disease, UCL Institute of
Neurology, London, United Kingdom
(Zetterberg) UK Dementia Research Institute, UCL, London, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Cardiac surgery is associated with risk of cerebral injury and
mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) is
suggested to be associated with cerebral injury. The 'Perfusion Pressure
Cerebral Infarcts' (PPCI) trial randomized patients undergoing coronary
artery bypass grafting (CABG) and/or aortic valve replacement to a MAP of
40-50 or 70-80 mmHg during CPB and found no difference in clinical or
imaging outcomes between the groups. We here present PPCI trial predefined
secondary end points, consisting of biomarkers of brain injury.
 Method(s): Blood was collected from PPCI trial patients at baseline,
24 and 48 h after induction of anaesthesia and at discharge from the
surgical ward. Blood was analysed for neuron-specific enolase, tau,
neurofilament light and the glial marker glial fibrillary acidic protein.
Linear mixed models were used to analyse differences in biomarker value
changes from baseline between the 2 MAP allocation groups. Result(s):
A total of 193 (98%) patients were included. We found no differences in
biomarker levels over time from baseline to discharge between the 2 MAP
allocation groups (PNSE = 0.14, PTau = 0.46, PNFL = 0.21, PGFAP = 0.13)
and the result did not change after adjustment for age, sex and type of
surgery. Conclusion(s): We found no significant differences in levels
of biomarkers of neurological injury in patients undergoing elective or
subacute CABG and/or aortic valve replacement randomized to either a
target MAP of 40-50 mmHg or a target MAP of 70-80 mmHg during CBP.
 Copyright © 2020 The Author(s).

<66>
Accession Number
2010968537
Title
Transcatheter reshaping of the mitral annulus in patients with functional
mitral regurgitation: One-year outcomes of the MAVERIC trial.
Source
EuroIntervention. 16 (13) (pp 1106-1113), 2021. Date of Publication: 2021.
Author
Worthley S.; Redwood S.; Hildick-Smith D.; Rafter T.; Whelan A.; Demarco
F.; Horrigan M.; Delacroix S.; Gregson J.; Erglis A.
Institution
(Worthley, Delacroix) St Andrews Hospital, Adelaide, SA, Australia
(Worthley, Delacroix) GenesisCare, Alexandria, NSW, Australia
(Redwood) St Thomas'Hospital, London, United Kingdom
(Hildick-Smith) Brighton and Sussex NHS Trust Brighton, United Kingdom
(Rafter) HeartCarePartners, Brisbane, QLD, Australia
(Whelan) HeartCare WA, Perth, WA, Australia
(Demarco) IRCCS Policlinico San Donato, Milan, Italy
(Horrigan) Austin Health, HeartCare Victoria, Melbourne, VIC, Australia
(Gregson) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
Publisher
Europa Group
Abstract
Aims: The aim of this study was to assess the one-year safety and efficacy
of the transcatheter ARTO system in the treatment of functional mitral
regurgitation (FMR). Methods and Results: MAVERIC is a multicentre,
prospective, non-randomised pre-commercial study. Eligible patients were
on guideline-recommended therapy for NYHA Class II-IV systolic heart
failure and had an FMR grade >=2+. The ARTO system was implanted in
forty-five (100%) patients. The primary safety composite endpoint (death,
stroke, myocardial infarction, device-related surgery, cardiac tamponade,
renal failure) at 30 days and one year was 4.4% (95% CI: 1.5-16.6) and
17.8% (95% CI: 9.3-32.4), respectively. Periprocedural complications
occurred in seven patients (15.5% [95% CI: 6.5-29.5]), and five patients
(11.1% [95% CI: 4.9-24.0]) died during one-year follow-up. Paired results
for 36 patients demonstrated that 24 (66.7%) had grade 3+/4+ mitral
regurgitation at baseline; however, only five (13.9%) and three (8.3%)
patients remained at grade 3+/4+ 30 days and one year post procedure
(p<0.0001). Echocardiographic parameters such as anteroposterior annulus
diameter decreased from 41.4 mm (baseline) to 36.0 and 35.3 mm at 30 days
and one year, respectively (p<0.0001). Twenty-five patients (69.4%) had
baseline NYHA Class III/IV symptoms decreasing significantly to nine
(25.0%) at 30 days and eight (22.2%) at one year post procedure
(p<0.0001). Conclusion(s): The ARTO transcatheter mitral valve repair
system is both safe and effective in decreasing FMR up to one year post
procedure. Copyright © Europa Digital & Publishing 2021. All
rights reserved.

<67>
Accession Number
2005975030
Title
Death and myocardial infarction following initial revascularization versus
optimal medical therapy in chronic coronary syndromes with myocardial
ischemia: A systematic review and meta-analysis of contemporary randomized
controlled trials.
Source
Journal of the American Heart Association. 10 (2) (pp 1-13), 2021. Article
Number: e019114. Date of Publication: 19 Jan 2021.
Author
Soares A.; Boden W.E.; Hueb W.; Brooks M.M.; Vlachos H.E.A.; O'Fee K.;
Hardi A.; Brown D.L.
Institution
(Soares, O'Fee, Brown) Department of Medicine, United States
(Brown) Cardiovascular Medicine, United States
(Soares, O'Fee, Hardi, Brown) Washington University School of Medicine,
St. Louis, MO, United States
(Boden) Veterans Affairs New England Healthcare System, Boston, MA, United
States
(Hueb) Heart Institute of the University of Sao Paolo, Sao Paolo, Brazil
(Brooks, Vlachos) Department of Epidemiology, University of Pittsburgh,
PA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In chronic coronary syndromes, myocardial ischemia is
associated with a greater risk of death and nonfatal myocardial infarction
(MI). We sought to compare the effect of initial revascularization with
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in
patients with chronic coronary syndrome and myocardial ischemia on
long-term death and nonfatal MI. METHODS AND RESULTS: Ovid Medline,
Embase, Scopus, and Cochrane Library databases were searched for
randomized controlled trials of PCI or CABG plus OMT versus OMT alone for
patients with chronic coronary syndromes. Studies were screened and data
were extracted independently by 2 authors. Random-effects models were used
to generate pooled treatment effects. The search yielded 7 randomized
controlled trials that randomized 10 797 patients. Median follow-up was 5
years. Death occurred in 640 of the 5413 patients (11.8%) randomized to
revascularization and in 647 of the 5384 patients (12%) randomized to OMT
(odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was
reported in 554 of 5413 patients (10.2%) in the revascularization arms
compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95%
CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was
significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P<0.001) but
was not reduced by PCI (OR, 0.92; 95% CI, 0.75-1.13; P=0.43)
(P-interaction <0.001). CONCLUSION(S): In patients with chronic
coronary syndromes and myocardial ischemia, initial revascularization with
PCI or CABG plus OMT did not reduce long-term mortality compared with OMT
alone. CABG plus OMT reduced nonfatal MI com-pared with OMT alone, whereas
PCI did not. Copyright © 2021 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<68>
Accession Number
2010472486
Title
Aspirin Alone Versus Dual Antiplatelet Therapy after Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2021. Date of
Publication: 2021.
Author
Lin X.; Wang S.; Wang L.; Guan Y.; Huang J.
Institution
(Lin, Guan) Zhejiang Chinese Medical University, Hangzhou, China
(Lin, Wang, Wang, Guan, Huang) Affiliated Hangzhou First People's
Hospital, Zhejiang University School of Medicine, Stress: No. 261, Huansha
Road, Hangzhou 310006, China
Publisher
Springer
Abstract
Background: The current American College of Cardiology and American Heart
Association (ACC/AHA) guidelines recommend dual antiplatelet therapy
(DAPT) with aspirin and clopidogrel for 6 months followed by lifelong
aspirin after transcatheter aortic valve replacement (TAVR). However,
studies that have DAPT with aspirin following TAVR have questioned this
recommendation as DAPT has been associated with more bleeding events
compared to aspirin. We performed a systematic review and meta-analysis of
all the RCTs comparing DAPT (aspirin plus clopidogrel) with aspirin alone
as antithrombotic treatment following transcatheter aortic valve
replacement. Method(s): The databases of Embase, PubMed, and Cochrane
library were searched from inception to Oct 1, 2020, and randomized
controlled trials (RCTs) reporting aspirin plus clopidogrel with aspirin
alone as antithrombotic treatment after TAVI were included. Revman 5.3 was
used to conduct the analysis. Result(s): After screening 152
articles, four studies involving 1086 patients (541 patients in the
aspirin group and 545 patients in the DAPT group) were included. The
results demonstrated that, at 30 days follow-up, compared with DAPT,
aspirin was not associated with a statistically significant difference in
the rate of bleeding events (RR = 1.22, 95% CI 0.62 to 2.39, P = 0.57),
all-cause mortality (RR = 1.21, 95% CI 0.52 to 2.84, P = 0.66), stroke (RR
= 0.81, 95% CI 0.24 to 2.79, P = 0.74), and MI (RR = 4.00, 95% CI 0.45 to
35.22, P = 0.21). However, at the 6 to 12 months follow-up, DAPT appeared
to increase the risk of bleeding events compared with aspirin alone (RR =
1.67, 95% CI 1.24 to 2.24, P < 0.001), and there was no significant
difference in the rate of all-cause mortality (RR = 0.89, 95% CI 0.53 to
1.48, P = 0.65), stroke (RR = 1.04, 95% CI 0.57 to 1.92, P = 0.90), and MI
(RR = 1.65, 95% CI 0.52 to 5.26, P = 0.40) among the two groups.
 Conclusion(s): Our systematic review and meta-analysis suggested that
aspirin alone could decrease the risk of bleeding and was not associated
with higher risk of mortality, stroke or myocardial infarction compared
with DAPT. Copyright © 2021, Springer Science+Business Media,
LLC, part of Springer Nature.

<69>
Accession Number
634149739
Title
A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative
Fluid Management Strategy Compared With Usual Care in Participants After
Cardiac Surgery: The Fluids After Bypass Study.
Source
Critical care medicine. (no pagination), 2021. Date of Publication: 28 Jan
2021.
Author
Parke R.L.; Gilder E.; Gillham M.J.; Walker L.J.C.; Bailey M.J.;
McGuinness S.P.
Institution
(Parke) Cardiothoracic and Vascular ICU, Auckland City Hospital, Auckland,
New Zealand. School of Nursing, Faculty of Medical and Health Sciences,
The University of Auckland, Auckland, New Zealand. Medical Research
Institute of New Zealand, Wellington, New Zealand. ANZIC-Research Centre,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: There is little evidence to guide fluid administration to
patients admitted to the ICU following cardiac surgery. This study aimed
to determine if a protocolized strategy known to reduce fluid
administration when compared with usual care reduced ICU length of stay
following cardiac surgery. DESIGN: Prospective, multicenter,
parallel-group, randomized clinical trial. SETTING: Five cardiac surgical
centers in New Zealand conducted from November 2016 to December 2018 with
final follow-up completed in July 2019. PATIENTS: Seven-hundred fifteen
patients undergoing cardiac surgery; 358 intervention and 357 usual care.
INTERVENTIONS: Randomization to protocol-guided strategy utilizing stroke
volume variation to guide administration of bolus fluid or usual care
fluid administration until desedation or up to 24 hours. Primary outcome
was length of stay in ICU. Organ dysfunction, mortality, process of care
measures, patient-reported quality of life, and disability-free survival
were collected up to day 180. MEASUREMENTS AND MAIN RESULTS: Overall 666
of 715 (93.1%) received at least one fluid bolus. Patients in the
intervention group received less bolus fluid (median [interquartile
range], 1,000mL [250-2,000 mL] vs 1,500mL [500-2,500 mL]; p < 0.0001) and
had a lower overall fluid balance (median [interquartile range], 319mL
[-284 to 1,274 mL] vs 673mL [38-1,641 mL]; p < 0.0001) in the intervention
period. There was no difference in ICU length of stay between the two
groups (27.9hr [21.8-53.5 hr] vs 25.6hr [21.9-64.6 hr]; p = 0.95). There
were no differences seen in development of organ dysfunction, quality of
life, or disability-free survival at any time points. Hospital mortality
was higher in the intervention group (4% vs 1.4%; p = 0.04).
 CONCLUSION(S): A protocol-guided strategy utilizing stroke volume
variation to guide administration of bolus fluid when compared with usual
care until desedation or up to 24 hours reduced the amount of fluid
administered but did not reduce the length of stay in ICU. Copyright
© by 2021 by the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. All Rights Reserved.

<70>
Accession Number
607283063
Title
Pulmonary vasodilators in the management of low cardiac output syndrome
after pediatric cardiac surgery.
Source
Current Vascular Pharmacology. 14 (1) (pp 37-47), 2016. Date of
Publication: 01 Jan 2016.
Author
Avila-Alvarez A.; Del Cerro Marin M.J.; Bautista-Hernandez V.
Institution
(Avila-Alvarez) Department of Neonatology, Complexo Hospitalario
Universitario de A Coruna, A Coruna, (CHUAC), A Coruna, Spain
(Del Cerro Marin) Department of Pediatric Cardiology, Hospital
Universitario Ramon y Cajal, Madrid, Spain
(Bautista-Hernandez) Department of Cardiovascular Surgery, Complexo
Hospitalario Universitario A Coruna (CHUAC), Congenital and Structural
Heart Disease, Instituto de Investigacion Biomedica A Coruna (INIBIC), A
Coruna, Spain
Publisher
Bentham Science Publishers
Abstract
Pulmonary hypertension is among the causes of low cardiac output syndrome
after neonatal and pediatric cardiac surgery. In the setting of transient
postoperative myocardial dysfunction, even a moderate elevation of
pulmonary pressure can result in heart dysfunction and circulatory
collapse. Although, specific pharmacological manipulation of pulmonary
vascular resistance is frequently required in the perioperative period,
there is no widely standardized management. In this review, a systematic
literature search of PubMed and MEDLINE databases using relevant terms was
performed. All clinical trials and relevant manuscripts, along with
important physiological, pharmacological, and evidence-based
considerations involving the use of pulmonary vasodilators in the
management of low cardiac output syndrome after cardiac surgery were
reviewed. This article addresses the fifth of eight topics comprising the
special issue entitled "Pharmacologic strategies with afterload reduction
in low cardiac output syndrome after pediatric cardiac
surgery". Copyright © 2016 Bentham Science Publishers.

<71>
Accession Number
2010818355
Title
Use of Pre- And Intensified Postprocedural Physiotherapy in Patients with
Symptomatic Aortic Stenosis Undergoing Transcatheter Aortic Valve
Replacement Study (the 4P-TAVR Study).
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 8894223. Date of Publication: 2021.
Author
Weber M.; Klein U.; Weigert A.; Schiller W.; Bayley-Ezziddin V.; Wirtz
D.C.; Welz A.; Werner N.; Grube E.; Nickenig G.; Sinning J.-M.; Ghanem A.
Institution
(Weber, Klein, Weigert, Werner, Grube, Nickenig, Sinning, Ghanem)
Department of Medicine II, Heart Center Bonn, University Hospital Bonn,
Bonn, Germany
(Schiller, Welz) Department of Cardiac Surgery, Heart Center Bonn,
University Hospital Bonn, Bonn, Germany
(Bayley-Ezziddin, Wirtz) Clinic for Orthopedics and Trauma Surgery,
University Hospital Bonn, Bonn, Germany
Publisher
Hindawi Limited
Abstract
Background. Physiotherapy prior to open-heart surgery lowers the rate of
pneumonia and length of the hospital stay. Pneumonia is a major
contributor to short-term mortality following transcatheter aortic valve
replacement (TAVR). Hence, we hypothesized that pre- and intensified
postprocedural physiotherapy in patients undergoing TAVR might impact the
net functional and clinical outcome. Methods and Results. The 4P-TAVR
study was a prospective, monocentric, randomized trial. The study was
designed to compare the efficacy and safety of intensified periprocedural
physiotherapy including inspiratory muscle training versus standard
postprocedural physiotherapy. Patients were randomized in a 1: 1 fashion.
108 patients were included and followed up for 90 days after TAVR. While
patients in group A (control group: 50 patients, age: 81.7 +/- 5.0 years,
52% male) did not receive physiotherapy prior to TAVR, group B
(intervention group: 58 patients, age: 82.2 +/- 5.82 years, 47% male)
participated in intensive physiotherapy. Compared to the control group,
patients in the interventional group showed a lower incidence of
postinterventional pneumonia (10 [20.0%] vs. 3 [5.1%], p=0.016) and had a
3-day shorter mean hospital stay (13.5 +/- 6.1 days vs. 10.1 +/- 4.7 days,
p=0.02). The primary composite endpoint of mortality and rehospitalization
was not different between the groups. Conclusion. Intensified
physiotherapy is safe and has positive effects on clinical outcomes up to
90 days after TAVR but has no impact on the primary combined endpoint of
mortality and rehospitalization. Longer follow-up, a multicenter design,
and a higher number of subjects are needed to confirm these preliminary
results. This trial is registered with DRKS00017239. Copyright ©
2021 M. Weber et al.

<72>
Accession Number
2010325983
Title
Pernicious pregnancy: Type B aortic dissection in pregnant women.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Rimmer L.; Mellor S.; Harky A.; Gouda M.; Bashir M.
Institution
(Rimmer, Bashir) Vascular Surgery Department, Royal Blackburn Teaching
Hospital, Blackburn, United Kingdom
(Mellor) College of Medical and Dental Sciences, University of Birmingham,
Birmingham, United Kingdom
(Harky) Liverpool Heart and Chest Hospital NHS Foundation Trust,
Liverpool, United Kingdom
(Gouda) Vascular & Endovascular Surgery, Mataria Teaching Hospital, Cairo,
Egypt
Publisher
Blackwell Publishing Inc.
Abstract
Background: Type B aortic dissection (TBAD) occurs seldomly, particularly
in pregnancy, but has disastrous consequences for both mother and fetus.
The focus of immediate surgical repair of type A aortic dissection due to
higher mortality of patients is less clear in its counterpart, TBAD, in
which management is controversial and debated. This article collates
knowledge so far on this rare event during pregnancy. Method(s): A
comprehensive literature search was performed in PubMed, Scopus, Google
Scholar, Embase, and Medline. Key search terms included "type B aortic
dissection," "pregnancy," and corresponding synonyms. Non-English papers
were excluded. Result(s): Risk factors for TBAD include aortic wall
stress due to hypertension, previous cardiac surgery, structural
abnormalities (bicuspid aortic valve, aortic coarctation), and connective
tissue disorders. In pregnancy, pre-eclampsia is a cause of increased
aortic wall stress. Management of this condition is often conservative,
but this is dependent on a number of factors, including gestation,
cardiovascular stability of the patient, and symptomology. In most cases,
a cesarean section before intervention is carried out unless certain
indications are present. Conclusion(s): Due to a scarce number of
cases across the decades, it is difficult to determine which management is
optimal. The gold-standard management of TBAD has traditionally been the
medical treatment for uncomplicated cases and open surgery for those
needing urgent intervention, but with the advent of techniques, such as
thoracic endovascular aortic repair, the management of these group of
patients continues to develop. Copyright © 2021 Wiley Periodicals
LLC

<73>
Accession Number
2010407138
Title
Balloon versus self-expandable transcatheter aortic valve implantation for
bicuspid aortic valve stenosis: A meta-analysis of observational studies.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Michel Pompeu B.O. S.A.; Simonato M.; Van den Eynde J.; Cavalcanti L.R.P.;
Alsagheir A.; Tzani A.; Fovino L.N.; Kampaktsis P.N.; Gallo M.; Laforgia
P.L.; Ruhparwar A.; Weymann A.; Hirji S.A.; Kaneko T.; H. L. Tang G.
Institution
(Michel Pompeu B.O., Cavalcanti) Division of Cardiovascular Surgery of
Pronto Socorro Cardiologico de Pernambuco-PROCAPE, University of
Pernambuco, Recife, Pernambuco, Brazil
(Simonato) Division of Cardiac Surgery, Escola Paulista de
Medicina-UNIFESP, Sao Paulo, Sao Paulo, Brazil
(Van den Eynde) Department of Cardiovascular Diseases, Unit of Cardiac
Surgery, University Hospitals Leuven, Leuven, Belgium
(Alsagheir) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Alsagheir) Division of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Tzani) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Fovino) Department of Cardiac, Thoracic and Vascular Sciences and Public
Health, University of Padova, Padova, Italy
(Kampaktsis) NYU Langone Medical Center, United States
(Gallo) Department of Cardiac Surgery, Cardiocentro Ticino, Lugano,
Switzerland
(Laforgia) I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan,
Italy
(Ruhparwar, Weymann) Department of Thoracic and Cardiovascular Surgery,
West German Heart and Vascular Center Essen, University Hospital of Essen,
University Duisburg-Essen, Essen, Germany
(Hirji, Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(H. L. Tang) Department of Cardiovascular Surgery, Mount Sinai Medical
Center, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: There is a rising trend for transcatheter aortic valve
implantation (TAVI) in bicuspid aortic stenosis patients. Data on the use
of self-expandable (SEV) vs. balloon-expandable (BEV) valves in these
patients are scarce. Therefore, we systematically compared clinical
outcomes in bicuspid aortic stenosis patients treated with SEV and BEV.
 Method(s): Data were extracted from PubMed/MEDLINE, EMBASE,
CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and
reference lists of relevant articles. Eight studies published from 2013 to
2020 including a total of 1,080 patients (BEV: n = 620; SEV: n = 460) were
selected. Primary endpoints were procedural, 30-day and 1-year mortality.
Secondary endpoints were new pacemaker implantation, annular rupture,
coronary obstruction, moderate-to-severe paravalvular leak, need of second
valve, stroke and acute kidney injury. Result(s): We found no
statistically significant difference in mortality between patients treated
with BEV vs. SEV during index procedure, at 30 days and at 1 year. BEVs
showed a statistically significant higher risk of annulus rupture (2.5%)
in comparison with SEV (0%) (OR 5.81 [95% CI, 3.78-8.92], p <.001). New
generation BEVs were also associated with significantly less paravalvular
leak when compared to new generation SEVs (OR 0.08 [95% CI, 0.02-0.35], p
=.001). Conclusion(s): This meta-analysis of observational studies of
TAVI for bicuspid valves, showed no difference in short- and mid-term TAVI
mortality with BEVs and SEVs. BEVs presented a higher risk of annular
rupture in comparison with SEV. Copyright © 2021 Wiley
Periodicals LLC.

<74>
Accession Number
634154934
Title
Silent brain infarcts and early cognitive outcomes after transcatheter
aortic valve implantation: a systematic review and meta-analysis.
Source
European heart journal. (no pagination), 2021. Date of Publication: 01 Feb
2021.
Author
Woldendorp K.; Indja B.; Bannon P.G.; Fanning J.P.; Plunkett B.T.; Grieve
S.M.
Institution
(Woldendorp, Indja, Bannon, Grieve) Faculty of Medicine and Health,
University of Sydney, Sydney NSW 2006, Australia
(Woldendorp, Bannon, Plunkett) Cardiothoracic Surgical Department, Royal
Prince Alfred Hospital, Sydney, Australia
(Woldendorp, Bannon, Plunkett) Baird Institute of Applied Heart and Lung
Research, 100 Carillon Avenue, Sydney, Australia
(Fanning) Prince Charles Hospital, Critical Care Research Group, Brisbane,
Australia
(Fanning) Faculty of Medicine, University of Queensland, Brisbane QLD
4072, Australia
(Grieve) Sydney Translational Imaging Laboratory, Charles Perkins Centre,
University of Sydney NSW 2006, Australia
(Grieve) Department of Radiology, Royal Prince Alfred Hospital,
Camperdown, Sydney, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Silent brain infarcts (SBIs) are frequently identified after
transcatheter aortic valve implantation (TAVI), when patients are screened
with diffusion-weighted magnetic resonance imaging (DW-MRI). Outside the
cardiac literature, SBIs have been correlated with progressive cognitive
dysfunction; however, their prognostic utility after TAVI remains
uncertain. This study's main goals were to explore (i) the incidence of
and potential risk factors for SBI after TAVI; and (ii) the effect of SBI
on early post-procedural cognitive dysfunction (PCD). METHODS AND RESULTS:
A systematic literature review was performed to identify all publications
reporting SBI incidence, as detected by DW-MRI after TAVI. Silent brain
infarct incidence, baseline characteristics, and the incidence of early
PCD were evaluated via meta-analysis and meta-regression models. We
identified 39 relevant studies encapsulating 2408 patients. Out of 2171
patients who underwent post-procedural DW-MRI, 1601 were found to have at
least one new SBI (pooled effect size 0.76, 95% CI: 0.72-0.81). The
incidence of reported stroke with focal neurological deficits was 3%.
Meta-regression noted that diabetes, chronic renal disease, 3-Tesla MRI,
and pre-dilation were associated with increased SBI risk. The prevalence
of early PCD increased during follow-up, from 16% at 10.0+/-6.3days to 26%
at 6.1+/-1.7months and meta-regression suggested an association between
the mean number of new SBI and incidence of PCD. The use of cerebral
embolic protection devices (CEPDs) appeared to decrease the volume of SBI,
but not their overall incidence. CONCLUSION(S): Silent brain infarcts
are common after TAVI; and diabetes, kidney disease, and pre-dilation
increase overall SBI risk. While higher numbers of new SBIs appear to
adversely affect early neurocognitive outcomes, long-term follow-up
studies remain necessary as TAVI expands to low-risk patient populations.
The use of CEPD did not result in a significant decrease in the occurrence
of SBI. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2021. For
permissions, please email: journals.permissions@oup.com.

<75>
Accession Number
2002117273
Title
Comparison between the effects of dexmedetomidine and midazolam on
postoperative cognitive impairment after coronary artery bypasses graft
surgery: A randomized clinical trial.
Source
Journal of Tehran University Heart Center. 14 (2) (pp 67-73), 2019. Date
of Publication: 14 Apr 2019.
Author
Rajaei M.; Tabari M.; Soltani G.; Alizadeh K.; Nazari A.; Noroozian M.;
Morovatdar N.
Institution
(Rajaei, Tabari, Soltani) Department of Anesthesiology, School of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Alizadeh) Department of Cardiac Surgery, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Nazari) Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Noroozian) Department of Psychiatry, School of Medicine, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Morovatdar) Clinical Research Unit, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Tehran Heart Center
Abstract
Background: Postoperative cognitive decline is a common complication
observed frequently after general anesthesia in the immediate
postoperative phase. We studied the effects of dexmedetomidine versus
midazolam during coronary artery bypass graft (CABG) surgery on cognitive
and memory function. Method(s): In this clinical trial, 42 elective
on-pump CABG candidates under general anesthesia, aged between 40 and 65
years, were enrolled randomly in 2 groups. Group A received 0.05-0.1 mg/kg
of midazolam and Group B received 1 microg/kg of dexmedetomidine. One day
before surgery, all the participants underwent the Persian version of the
Mini-Mental State Examination (MMSE) and the Persian version of the
Wechsler Memory Scale (WMS) test for a comparison of cognitive impairment
and memory functions. Both groups were given fentanyl and propofol for the
induction of anesthesia and muscle relaxants. The MMSE and WMS tests were
repeated 5 and 30 days after surgery. Result(s): The mean+/-SD of age
was 55.47+/-7.18 y in Group A and 55.39+/-6.08 y in Group B. Eighty
percent of the participants were men in both groups. There were no
significant differences between Group A and Group B in the MMSE and WMS
before surgery (89.04+/-14.30 vs. 97.10+/-18.10, respectively; P=0.059),
but the WMS was significantly different 30 days after surgery
(87.60+/-14.30 vs. 103.53+/-19.93, respectively; P=0.005). Group A showed
high cognitive impairment and low WMS scores compared with Group B
(P=0.005). Additionally, the MMSE results were not statistically different
between the 2 groups postoperatively (24.80+/-3.18 vs. 23.55+/-4.18,
respectively; P=0.394). Conclusion(s): Our results showed that
dexmedetomidine might have a lower impact on cognitive function than might
midazolam among patients undergoing CABG. Copyright © 2019,
Tehran Heart Center. All rights reserved.

<76>
Accession Number
2010725809
Title
A multicentre, randomised controlled clinical study of drug-coated
balloons for the treatment of coronary in-stent restenosis.
Source
EuroIntervention. 16 (4) (pp E328-E334), 2021. Date of Publication: 2021.
Author
Hamm C.W.; Dorr O.; Wohrle J.; Krackhardt F.; Ince H.; Zeus T.; Berland
J.; Piot C.; Roubille F.; Schult I.; Allocco D.J.; Nef H.
Institution
(Hamm, Dorr, Nef) Universitat Giessen, Giessen, Germany
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Hamm, Dorr, Nef) German Center for Cardiovascular Research (DZHK),
Partner Site Rhine-Main, Bad Nauheim, Germany
(Wohrle) Universitatsklinikum, Ulm, Germany
(Krackhardt) Charite Campus Virchow Klinikum, Universitatsmedizin Berlin,
Berlin, Germany
(Ince) Universitatsklinikum Rostock, Rostock, Germany
(Zeus) Universitatsklinikum Dusseldorf, Dusseldorf, Germany
(Berland) Clinique Saint Hilaire, Rouen, France
(Piot) Clinique du Millenaire, Montpellier, France
(Roubille) PhyMedExp, Universite de Montpellier, INSERM, CNRS, Cardiology
Department, CHU de Montpellier, Montpellier, France
(Schult) Hemoteq AG, Wurselen, Germany
(Allocco) Boston Scientific Corporation, Marlborough, MA, United States
Publisher
Europa Group
Abstract
Aims: Treatment of in-stent restenosis of coronary stents is challenging.
The use of drug-coated balloons (DCB) is a promising technique to treat
in-stent restenosis without adding another metal layer. The aim of the
AGENT ISR randomised trial is to evaluate angiographic and clinical
outcomes in patients with ISR of a previously treated lesion who were
treated with either a DCB with a new coating formulation (Agent) or a
standard DCB (SeQuent Please). Methods and Results: AGENT ISR is a
multicentre, randomised, open-label, non-inferiority study comparing the
Agent and SeQuent Please DCB. A total of 125 patients (mean age ~68 years,
18% female) with in-stent restenosis of a previously treated lesion <28 mm
in length were randomised at 11 sites in Europe to Agent (n=65) or SeQuent
Please (n=60). The primary endpoint, six-month in-stent late lumen loss,
in the Agent group (0.397+/-0.43 mm [n=51]) was non-inferior to that of
the SeQuent Please group (0.393+/-0.536 mm [n=49]), as the two-sided upper
95% confidence boundary for the difference between groups was less than
the pre-specified non-inferiority margin of 0.20 (difference 0.004, 95% CI
[-0.189, 0.196]; p<inf>non-inferiority</inf>=0.046). At one year,
mortality was 3.1% in Agent and 1.7% in SeQuent Please patients (p>0.99),
target lesion revascularisation 7.7% versus 10.0% (p=0.89), and stent
thrombosis 0% versus 3.3% (p=0.44). Similar improvements in quality of
life were seen in the two groups. Conclusion(s): In this head-to-head
comparison of two DCB, Agent proved to be non-inferior to SeQuent Please
for in-stent late lumen loss at six months. Copyright © Europa
Digital & Publishing 2020. All rights reserved.

<77>
Accession Number
2005908976
Title
Incidence, risk factors, and outcomes of coronary obstruction following
valve-in-valve transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
International Heart Journal. 62 (1) (pp 104-111), 2021. Date of
Publication: 2021.
Author
Gao Z.; Wang Y.; Qian D.; Jin J.
Institution
(Gao, Wang, Qian, Jin) Institute of Cardiovascular Diseases of PLA,
Chongqing, China
(Gao, Wang, Qian, Jin) Department of Cardiology, Xinqiao Hospital, Army
Medical University (Third Military Medical University), Chongqing, China
Publisher
International Heart Journal Association
Abstract
There is scant information about the incidence, risk factors, and outcomes
of coronary obstruction (CO) following valve-in-valve transcatheter aortic
valve replacement (VIV-TAVR). A meta-analysis of the published studies
from January 2000 to April 2020 was conducted, and the endpoint was CO. A
total of 2858 patients were enrolled in this study. The mean age was 77.7
+/- 9.8, and 39.9% of them were female. The Society of Thoracic Surgeons
(STS) score, European System for Cardiac Operative Risk Evaluation
(EuroSCORE), and Logistic EuroSCORE were 8.9 +/- 7.8, 16.0 +/- 10.9, and
26.3 +/- 16.3, respectively. The overall incidence of CO was 2.58%. CO
incidence between patients with prior stented and stentless valves were
significantly different (1.67% versus 7.17%), with an odds ratio (OR) of
0.25 and a 95% confidence interval (CI) of 0.14-0.44 (P < 0.00001). The
first-generation valves were significantly associated with higher CO
incidence compared with the second-generation valves (7.09% versus 2.03%;
OR, 2.44; 95%CI, 1.06-5.62; P = 0.04), while no statistical difference was
found between self-expandable valves and balloon-expandable valves (2.45%
versus 2.60%; OR, 0.99; 95%CI, 0.55-1.79; P = 0.98). Virtual transcatheter
to coronary ostia (VTC) distance (3.3 +/- 2.1 mm, n = 29 versus 5.8 +/-
2.4 mm, n = 169; mean difference, -2.70; 95%CI, -3.46 to -1.95; P <
0.00001) and the sinus of Valsalva (SOV) diameter (27.5 +/- 3.8 mm, n = 23
versus 32.3 +/- 4.0 mm, n = 101; mean difference, -3.80; 95%CI, -6.55 to
-1.05; P = 0.007) were enormously shorter in patients with CO. The
24-hour, in-hospital, and 30-day mortality of patients with CO were 10.5%,
30.8%, and 37.1%, respectively. In conclusion, device selections, VTC
distances, and SOV diameters may be important factors in assessing the CO
risk in VIV-TAVR. (Int Heart J 2021; 62: 104-111). Copyright ©
2021, International Heart Journal Association. All rights reserved.

<78>
Accession Number
2007589081
Title
The anti-adhesive effect of anti-VEGF agents in experimental models: A
systematic review.
Source
Wound Repair and Regeneration. 29 (1) (pp 168-182), 2021. Date of
Publication: January/February 2021.
Author
Giannis D.; Geropoulos G.; Ziogas I.A.; Gitlin J.; Oropallo A.
Institution
(Giannis) Institute of Health Innovations and Outcomes Research, The
Feinstein Institutes for Medical Research, Manhasset, NY, United States
(Giannis, Geropoulos, Ziogas) Surgery Working Group, Society of Junior
Doctors, Athens, Greece
(Geropoulos) Thoracic Surgery Department, University College London
Hospitals, NHS Foundation Trust, London, United Kingdom
(Ziogas) Aristotle University of Thessaloniki School of Medicine,
Thessaloniki, Greece
(Gitlin) The Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Northwell Health, Hempstead, NY, United States
(Oropallo) Department of Vascular Surgery, The Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park,
NY, United States
Publisher
Blackwell Publishing Inc.
Abstract
Adhesions constitute a major problem in abdominal-pelvic and thoracic
surgery with significant impact in the postoperative quality of life and
healthcare services utilization. Adhesiogenesis is the result of increased
fibrin formation, impaired fibrinolysis, angiogenesis, and fibrosis.
Despite the recent advancements, the ideal anti-adhesive agent remains to
be determined. To this end, we performed a comprehensive literature search
in PubMed, EMBASE, and Scopus databases to identify studies investigating
the antiadhesive role of anti-VEGF agents in peritoneal, pleural, and
pericardial experimental adhesion models. Fifteen studies were eligible
for inclusion with a total population of 602 animals (334 rats, 180
rabbits, and 88 mice). The majority of included studies (11/15) used
bevacizumab, while three studies used other anti-VEGF antibodies and one
study used an anti-VEGFR-antibody. A rat model was used in nine studies,
while rabbit (n = 3) or mouse (n = 3) models were used less frequently.
Eleven studies used peritoneal models, three studies used pleural models,
and one study used a pericardial model. The scales (n = 12) and interval
(Range: 1-42 days) used for the evaluation of adhesions varied between the
studies. All studies demonstrated a significant decrease in adhesion
scores between the anti-VEGF and control groups up to 42 days
postprocedure. VEGF blockade resulted in decreased fibrosis in four out of
five studies that used peritoneal models, while the effect on pleural
models depended on the pleurodesis agent and was significant between 7 and
28 days. The effect of anti-VEGF agents on anastomosis integrity depends
on the dose and the model that is used (inconclusive results).Current data
support the anti-adhesive role of Anti-VEGF agents in all three serosal
surfaces up to 6 weeks postprocedure. Further studies are needed to
confirm the anti-adhesive role of anti-VEGF agents in pleural and
pericardial adhesion experimental models and investigate any effect on
anastomosis integrity in peritoneal models. Copyright © 2020 by
the Wound Healing Society

<79>
Accession Number
2006942265
Title
Critical appraisal on the impact of preoperative rehabilitation and
outcomes after major abdominal and cardiothoracic surgery: A systematic
review and meta-analysis: Counting rules are critical.
Source
Surgery (United States). 168 (6) (pp 1178-1179), 2020. Date of
Publication: December 2020.
Author
Dunlop D.; Kyriacou E.; Jones J.R.A.; Boden I.; Berlowitz D.J.
Institution
(Dunlop, Kyriacou, Jones, Berlowitz) Physiotherapy Department, Austin
Health, Heidelberg, Vic, Australia
(Jones, Boden, Berlowitz) Department of Physiotherapy, The University of
Melbourne, Parkville, Vic, Australia
(Jones, Berlowitz) Institute for Breathing and Sleep, Heidelberg, Vic,
Australia
(Boden) Physiotherapy Department, Launceston General Hospital, Tas,
Australia
Publisher
Mosby Inc.

<80>
Accession Number
2006141100
Title
Commentary: Merging Old and New.
Source
Seminars in Thoracic and Cardiovascular Surgery. 32 (4) (pp 663-664),
2020. Date of Publication: Winter 2020.
Author
Miceli A.
Institution
(Miceli) Minimally invasive Cardiac Surgery Departement, Istituto Clinico
Sant'Ambrogio, Milano, Italy
Publisher
W.B. Saunders

<81>
Accession Number
2007355107
Title
Intralipid postconditioning in patients of cardiac surgery undergoing
cardiopulmonary bypass (iCPB): study protocol for a randomized controlled
trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 953. Date of
Publication: December 2020.
Author
Yuan Y.; Xiong H.; Zhang Y.; Yu H.; Zhou R.-H.
Institution
(Yuan, Xiong, Zhang, Yu, Zhou) Department of Anesthesiology, West China
Hospital of Sichuan University, No.37, Guoxue Xiang, Wu Hou District,
Chengdu, Sichuan 610041, China
Publisher
BioMed Central Ltd
Abstract
Background: Intralipid is a necessary fatty acid carrier that has been
safely used as an energy supplier in the clinic. It has played an
important role in rescuing the cardiac arrest caused by local anesthetic
toxicity. In recent years, experimental studies have shown that intralipid
postconditioning (ILPC) could reduce myocardial ischemic/reperfusion (I/R)
injuries. Our research group has innovatively conducted a pilot randomized
controlled trial (RCT), and the results showed that ILPC could reduce the
release of cTnT and CK-MB, biomarkers of myocardial I/R injury, in valve
replacement surgery. However, the potential effects of ILPC on the
clinical outcome of adult cardiac surgery patients are unclear. Intralipid
postconditioning in patients of cardiac surgery undergoing cardiopulmonary
bypass (iCPB) trial is aimed to further study whether ILPC could improve
short-term and long-term clinical outcome, as well as cardiac function in
adult cardiac surgery patients. Method(s): The iCPB trial is an
ongoing, single-center, prospective, double-blinded, large sample RCT. In
total, 1000 adults undergoing cardiac surgery will be randomly allocated
to either the ILPC group or the control group. The intervention group
received an intravenous infusion of 2 mL/kg of 20% intralipid
(medium-chain and long-chain fat emulsion injection C6~C24,
Pharmaceutical) within 10 min before aortic cross-unclamping, and the
control group received an equivalent volume of normal saline. The primary
endpoints are complex morbidity of major complications during
hospitalization and all-cause mortality within 30 days after surgery. The
secondary endpoints include (1) all-cause mortality 6 months and 1 year
postoperatively; (2) the quality of life within 1 year after surgery,
using the QoR-15 questionnaire; (3) the postoperative cardiac function
evaluated by LVEF, LVEDS, and LVEDD, and the myocardial injury evaluated
by CK-MB, cTnT, and BNP; and (4) short-term clinical outcomes during
hospitalization and total cost are also detailed evaluated.
 Discussion(s): The iCPB trial is the first to explore ILPC on the
clinical outcome of adult cardiac surgery patients. The results are
expected to provide potential evidences about whether ILPC could reduce
the morbidity and mortality and improve the cardiac function and quality
of life. Therefore, the results will provide a rationale for the
evaluation of the potentially clinically relevant benefit of intralipid
therapy. Trial registration: Chictr.org.cn ChiCTR1900024387. Prospectively
registered on 9 July 2019. Copyright © 2020, The Author(s).

<82>
Accession Number
2006954716
Title
Re: "Critical appraisal on the impact of preoperative rehabilitation and
outcomes after major abdominal and cardiothoracic surgery: A systematic
review and meta-analysis"-Counting rules are critical.
Source
Surgery (United States). 168 (6) (pp 1179), 2020. Date of Publication:
December 2020.
Author
Bundred J.R.; Kamarajah S.K.
Institution
(Bundred) Leeds Teaching Hospitals National Health Service Trust, Beckett
Street, Leeds, United Kingdom
(Kamarajah) Department of Hepatobiliary, Pancreatic and Transplant
Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, United
Kingdom
Publisher
Mosby Inc.

<83>
Accession Number
2005650331
Title
Evaluating the free radial forearm flap versus the pedicled pectoralis
major myocutaneous flap for oesophago-pharyngeal reconstruction: decision
making, outcome and literature review.
Source
European Journal of Plastic Surgery. 44 (1) (pp 33-40), 2021. Date of
Publication: February 2021.
Author
Karonidis A.; Tsoutsos D.
Institution
(Karonidis, Tsoutsos) Department of Plastic Surgery, Microsurgery & Burns
Unit, General Hospital of Athens "G. Gennimatas", Mesogeion 154, Athens
11527, Greece
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The successful reconstruction of oesophago-hypopharyngeal
defects is a challenge and the choice of the best reconstructive option is
still controversial. The purposes of this study were to evaluate the use
of the free radial forearm flap (RFF) or the pedicled pectoralis major
(PM) flap for oesophago-hypopharyngeal reconstruction and to review the
literature, considering the free flap option as the state of the art. The
decision making, outcome and common complications were assessed.
 Method(s): From 2013 to 2018, 15 sequential patients with laryngeal
carcinoma, 61 years and BMI 24.6, were included in this retrospective
study. They underwent laryngectomy-pharyngo/esophagectomy and immediate or
secondary pharyngoesophageal reconstruction. Nine patients underwent
reconstruction with RFF (group A) and six with PM flap (group B). We
excluded patients with history of thoracic and breast surgery and
synchronous malignancy. We used the SPSS v.21 for statistical analysis.
 Result(s): The duration of surgery for RFF was longer (731 min versus
435 min). Postoperatively, all patients received radiotherapy, whereas
chemotherapy was administered in one patient. The RFF was the procedure of
choice for stages III-IV and larger defects and the PM for stage II (p =
0.002). Overall complication rates, fistula, stricture and swallowing
dysfunction were found higher in group B, but not significant
(p<inf>Compl</inf> = 0.315, p<inf>Fist</inf> = 1.000,
p<inf>Strict/Swall</inf> = 0.143). Furthermore, the secondary PM
reconstructions had non-statistically significant even higher fistula and
swallowing dysfunction rates (p = 0.400). Both groups reported equal good
results in terms of oral alimentation and speech. Conclusion(s): We
found that the RFF and PM flap could provide comparable outcomes in
oesophago-pharyngeal reconstruction. The RFF seems to be a superior
reconstructive option for advanced disease and larger defects and is
associated with better swallowing and fewer complications Level of
evidence: Level III, therapeutic study. Copyright © 2020,
Springer-Verlag GmbH Germany, part of Springer Nature.

<84>
Accession Number
631335637
Title
Treatment-related complications in patients with esophageal cancer: A
systematic review and network meta-analysis.
Source
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and
Ireland. 19 (1) (pp 37-48), 2021. Date of Publication: 01 Feb 2021.
Author
Holakouie-Naieni K.; Mansournia M.A.; Doosti-Irani A.; Rahimi-Foroushani
A.; Haddad P.
Institution
(Holakouie-Naieni, Mansournia, Rahimi-Foroushani) Department of
Epidemiology and Biostatistics, School of Public Health, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Doosti-Irani) Department of Epidemiology, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran; Department of
Epidemiology and Biostatistics, School of Public Health, Tehran University
of Medical Sciences, Tehran, Iran. Electronic address:
a.doosti@umsha.ac.ir
(Haddad) Radiation Oncology Research Center, Cancer Institute, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this review was to compare the available treatments
of esophageal cancer, in terms of pulmonary, cardiovascular complications,
anastomotic leakage, and esophagitis after treatment in patients with
esophageal squamous cell carcinoma (SCC). METHOD(S): Medline, Web of
Science, Scopus, the Cochrane Library and Embase were searched. The
randomized controlled trials (RCT) that had compared the treatment
-related complications of treatments for esophageal SCC were included. We
included 39 randomized control trials in a network meta-analysis. The
Chi2-test was used to assess of heterogeneity. The loop-specific and
design-by-treatment interaction methods were used for assessment of
consistency assumption. The risk ratio with 95% confidence interval (CI)
was used to report the effect-sizes in the network meta-analysis.
 RESULT(S): The pulmonary complication, cardiac complication,
anastomotic leakage, and esophagitis were reported in 31, 11, 17, and 15
RCTs respectively. Video-assisted thoracoscopy + laparoscopy (VATS) was
rank as the first and second treatment in terms of lower risk for
pulmonary complication and anastomotic leakage. There was no statistically
significant difference between treatments in terms of lower risk of
cardiovascular complications. However, Surgery + Cisplatin + Fluorouracil
(SCF) was ranked as better treatment. 3-dimensional conformal radiotherapy
+ Docetaxel + Cisplatin (3DCRTDC) was the best treatment in terms of lower
risk for esophagitis. CONCLUSION(S): According to the results of this
study, it seems the risk of pulmonary, cardiovascular, anastomotic leakage
and esophagitis complications for VATS, SCF, surgery + radiotherapy (SRT),
and 3DCRTDC was lower than other treatments respectively in the
networks. Copyright © 2020 Royal College of Surgeons of Edinburgh
(Scottish charity number SC005317) and Royal College of Surgeons in
Ireland. Published by Elsevier Ltd. All rights reserved.

<85>
Accession Number
632414718
Title
Exercise after Heart Transplantation: Typical Alterations, Diagnostics and
Interventions.
Source
International journal of sports medicine. 42 (2) (pp 103-111), 2021. Date
of Publication: 01 Feb 2021.
Author
Schmidt T.; Bjarnason-Wehrens B.; Predel H.-G.; Reiss N.
Institution
(Schmidt, Reiss) Institute for Cardiovascular Research, Bad Rothenfelde,
Germany
(Schmidt, Bjarnason-Wehrens, Predel) Department of Preventive and
Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and
Sports Medicine, German Sport University Cologne, Cologne, Germany
Publisher
NLM (Medline)
Abstract
For the treatment of terminal heart failure, heart transplantation is
considered to be the gold standard, leading to significantly improved
quality of life and long-time survival. For heart transplant recipients,
the development and maintenance of good functional performance and
adequate exercise capacity is crucial for renewed participation and
integration in self-determined live. In this respect, typical
transplant-related alterations must be noted that play a significant role,
leading to restrictions both centrally and peripherally. Before patients
begin intensive and structured exercise training, a comprehensive
diagnosis of their exercise capacity should take place in order to
stratify the risks involved and to plan the training units accordingly.
Particularly endurance sports and resistance exercises are recommended to
counter the effects of the underlying disease and the immunosuppressive
medication. The performance level achieved can vary considerably depending
on their individual condition, from gentle activity through a
non-competitive-level to intensive competitive sports. This paper includes
an overview of the current literature on heart transplant recipients,
their specific characteristics, as well as typical cardiovascular and
musculoskeletal alterations. It also discusses suitable tools for
measuring exercise capacity, recommendations for exercise training,
required precautions and the performance level usually
achieved. Copyright Thieme. All rights reserved.

<86>
Accession Number
631803346
Title
Transcutaneous Stimulation of Auricular Branch of the Vagus Nerve
Attenuates the Acute Inflammatory Response After Lung Lobectomy.
Source
World journal of surgery. 44 (9) (pp 3167-3174), 2020. Date of
Publication: 01 Sep 2020.
Author
Salama M.; Akan A.; Mueller M.R.
Institution
(Salama, Akan, Mueller) Department of Thoracic Surgery, North Clinic,
Vienna 1210, Austria
(Salama, Mueller) Medical Faculty, Thoracic Surgery, Sigmund Freud
University, Vienna, Austria
(Salama, Mueller) Institute of Thoracic Oncology, Karl Landsteiner
Society, St. Poelten, Austria
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Systemic inflammation is a potentially debilitating
complication of thoracic surgeries with significant physical and economic
morbidity. There is compelling evidence for the role of the central
nervous system in regulating inflammatory processes through humoral
mechanisms. Activation of the afferent vagus nerve by cytokines triggers
anti-inflammatory responses. Peripheral electrical stimulation of the
vagus nerve in vivo during lethal endotoxemia in rats inhibited tumor
necrosis factor synthesis and prevented shock development. However, the
vagal regulatory role of systemic inflammation after lung lobectomy is
unknown. METHOD(S): One hundred patients who underwent lobectomy via
thoracotomy were recruited and equally randomized to treated group or
controls. Intermittent stimulation of the auricular branch of vagus nerve
in the triangular fossa was applied in the treated group using
neurostimulator V (Ducest, Germany), starting 24 h preoperatively and
continued till the 4th postoperative day (POD). Inflammatory interleukins
(IL) were analyzed using ELISA preoperatively, on the 1st and 4th POD.
 RESULT(S): On the 1st POD, patients who underwent neurostimulation
had reduced serum concentrations of CRP (p=0.01), IL6 (p=0.02) but
elevated IL10 (p=0.03) versus controls. On the 4th POD, serum
concentrations of CRP, IL6 and IL10 were similar in both groups. Moreover,
the treated group was associated with lower incidence of pneumonia
(p=0.04) and shorter hospitalization time (p=0.04) versus controls.
 CONCLUSION(S): Modulations in the brain stem caused by noninvasive
transcutaneous stimulation of the vagus nerve after lung lobectomy
attenuate the acute postsurgical inflammatory response by the regulation
of IL6 and IL10, resulting in reduced incidence of postoperative pneumonia
and short hospitalization time. CLINICAL TRIAL REGISTRY NUMBER:
NCT03204968.

<87>
Accession Number
632105542
Title
Prehabilitation in patients awaiting elective coronary artery bypass graft
surgery - effects on functional capacity and quality of life: a randomized
controlled trial.
Source
Clinical rehabilitation. 34 (10) (pp 1256-1267), 2020. Date of
Publication: 01 Oct 2020.
Author
Steinmetz C.; Bjarnason-Wehrens B.; Baumgarten H.; Walther T.; Mengden T.;
Walther C.
Institution
(Steinmetz) Institute of Sport Science, Department of Training Science and
Kinesiology, University of Gottingen, Gottingen, Germany
(Bjarnason-Wehrens) Institute of Cardiology and Sports Medicine, German
Sport University Cologne, Cologne, Germany
(Baumgarten) Kerckhoff Heart Center, Department of Cardiothoracic Surgery,
Bad Nauheim, Germany
(Walther) Department of Cardiothoracic Surgery, University of Frankfurt,
Frankfurt am Main, Germany
(Mengden) Kerckhoff Heart Center, Department of Rehabilitation, Bad
Nauheim, Germany
(Walther) Department of Cardiology, University of Frankfurt, Frankfurt am
Main, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the impact of an exercise-based prehabilitation
(EBPrehab) program on pre- and postoperative exercise capacity, functional
capacity (FC) and quality of life (QoL) in patients awaiting elective
coronary artery bypass graft surgery (CABG). DESIGN: A two-group
randomized controlled trail. SETTING: Ambulatory prehabilitation.
SUBJECTS: Overall 230 preoperative elective CABG-surgery patients were
randomly assigned to an intervention (IG, n=88; n=27 withdrew after
randomization) or control group (CG, n=115). INTERVENTION: IG: two-week
EBPrehab including supervised aerobic exercise. CG: usual care. MAIN
MEASURES: At baseline (T1), one day before surgery (T2), at the beginning
(T3) and at the end of cardiac rehabilitation (T4) the following
measurements were performed: cardiopulmonary exercise test, six-minute
walk test (6MWT), Timed-Up-and-Go Test (TUG) and QoL (MacNew
questionnaire). RESULT(S): A total of 171 patients (IG, n=81; CG,
n=90) completed the study. During EBPrehab no complications occurred.
Preoperatively FC (6MWTIG: 443.0+/-80.1m to 493.5+/-75.5m, P=0.003; TUGIG:
6.9+/-2.0s to 6.1+/-1.8s, P=0.018) and QoL (IG: 5.1+/-0.9 to 5.4+/-0.9,
P<0.001) improved significantly more in IG compared to CG. Similar effects
were observed postoperatively in FC (6MWDIG: DELTA-64.7m, pT1-T3=0.013;
DELTA+47.2m, pT1-T4<0.001; TUGIG: DELTA+1.4s, pT1-T3=0.003).
 CONCLUSION(S): A short-term EBPrehab is effective to improve
perioperative FC and preoperative QoL in patients with stable coronary
artery disease awaiting CABG-surgery.ID: NCT04111744
(www.ClinicalTrials.gov; Preoperative Exercise Training for Patients
Undergoing Coronary Artery Bypass Graft Surgery- A Prospective Randomized
Trial).

<88>
Accession Number
2010851857
Title
Sex Differences in cardiac rehabilitation completion? A sex, age, and
diagnosis matched cohort study.
Source
Canadian Journal of Cardiology. Conference: 2021 Canadian Women's Heart
Health Summit. 37 (2) (pp e17), 2021. Date of Publication: February 2021.
Author
Marzolini S.; Thangarasa M.; Oh P.; Colella T.J.F.
Institution
(Marzolini, Thangarasa, Oh, Colella) TorontoONCanada
Publisher
Elsevier Inc.
Abstract
Background: Cardiac Rehabilitation (CR) completion has been associated
with significant morbidity and mortality benefits. Women are more likely
than men to dropout of CR programming, and the extent to which age and
referring diagnosis drive this association is unknown. The purpose of this
study was to determine whether sex differences exist in CR completion in a
sex, age, diagnosis and year of entry to CR matched cohort of patients
enrolled in CR. Method(s): Consecutively enrolled women (n=1,055)
were matched to men from UHN/Toronto Rehab's electronic database records
(2006- 2017). Bivariate and logistic regression analyses were conducted to
determine correlates of dropout for all patients and men and women
separately. Result(s): Sex was not associated with CR dropout in
bivariate (F:30.4% and M:27%, p=0.8) or multivariate analysis (p=0.999).
However, a greater proportion of women (39.6%) than men (30.5%) withdrew
for medical issues (p=0.02). Women with greater wait-time to CR, who were
younger, more deconditioned with greater waist circumference were more
likely to prematurely withdraw. Men with greater wait-time to start CR,
who were not married, with higher depression score, greater cardiovascular
deconditioning, diabetes, a cancer diagnosis, and previous cardiac valve
surgery, were more likely to dropout. Conclusion(s): When matched for
age and diagnosis, there were no sex differences in CR completion, however
significantly more women dropout for medical reasons. The common
predictors of dropout for both sexes were greater wait-time, younger age,
and deconditioning. Targeted strategies to reduce barriers and
individualize CR programming are necessary to facilitate CR
completion. Copyright © 2020

<89>
Accession Number
634145445
Title
The role of multidisciplinary collaboration in the modern-day chest wall
reconstruction.
Source
British Journal of Surgery. Conference: International Surgical Congress of
the Association of Surgeons of Great Britain and Ireland, ASGBI 2020.
United Kingdom. 107 (SUPPL 4) (pp 72), 2020. Date of Publication: 2020.
Author
Vyas R.; Rollett R.; Arya R.; Rathinam S.
Institution
(Vyas, Rollett, Arya, Rathinam) University Hospitals of Leicester
Publisher
John Wiley and Sons Ltd
Abstract
Aims: In the era of early specialisation into Cardiothoracic Surgery,
there is an increasing trend towards teamwork between Plastic Surgery and
Thoracic Surgery in chest wall reconstruction. This study systematically
reviewed the literature on chest wall reconstruction, including outcomes
from a multidisciplinary approach compared with a Thoracic Surgeon-only
approach. Method(s): MEDLINE database was searched for English
language articles between 2013 and 2018 that researched chest wall
reconstruction with the use of flaps. All case reports and review articles
were excluded. Result(s): 15 papers fulfilled the criteria. 10 out of
15 (66.7%) documented a multidisciplinary approach with Plastic Surgeons.
In articles involving Plastic Surgery, 77.2% of all patients underwent
chest wall reconstruction with flaps, with 13 different flaps used;
non-Plastic Surgery articles had fewer varieties of flaps (seven) and
fewer patients undergoing flap reconstruction (65.3%). There was a
slightly higher median overall complication rate with the use of Plastic
Surgeons (24%) versus without Plastic Surgeons (18.7%); as well as a
higher flap-related complication rate (3.8% vs. 0%). Conclusion(s):
The majority of recent chest wall reconstruction studies demonstrate
multidisciplinary teamwork between Plastic and Thoracic Surgery, with a
higher incidence and a wider variety of soft tissue reconstruction
techniques utilised. The higher complication rate in the multidisciplinary
group may be explained by more radical resection margins in a higher risk
patient cohort, who benefit from advanced soft tissue reconstruction
techniques by Plastic Surgeons. Teamwork between specialties can be used
to inform service provision and management options in modern-day complex
surgeries to optimise outcomes.

<90>
Accession Number
634155039
Title
Cerebral oximetry and preventing neurological complication post-cardiac
surgery: a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 31 Jan 2021.
Author
Semrau J.S.; Motamed M.; Ross-White A.; Boyd J.G.
Institution
(Semrau, Boyd) Centre for Neuroscience Studies, Queen's University, ON,
Kingston, Canada
(Motamed) School of Medicine, Faculty of Health Sciences, Queen's
University, ON, Kingston, Canada
(Ross-White) Library Services, Queen's University, ON, Kingston, Canada
(Boyd) Kingston Health Sciences Centre, ON, Kingston, Canada
(Boyd) Department of Critical Care, Faculty of Health Sciences, Queen's
University, ON, Kingston, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This systematic review aims to provide an up-to-date summary
of the current literature examining the relationship between
intraoperative regional cerebral oxygen saturation and neurological
complications after cardiac surgery. METHOD(S): Observational and
interventional studies investigating the link between regional cerebral
oxygen saturation and postoperative delirium, cognitive dysfunction and
stroke were included. After database searching and study screening, study
characteristics and major findings were extracted. RESULT(S):
Twenty-seven studies were identified. Of the observational studies (n=17),
8 reported that regional cerebral oxygen desaturations were significantly
associated with neurological complications after cardiac surgery. Of the
interventional studies (n=10), 3 provided evidence for monitoring cerebral
oximetry during cardiac surgery as a means of reducing incidence of
postoperative cognitive dysfunction or stroke. There was significant
heterogeneity in the tools and rigor used to diagnose neurological
complications. CONCLUSION(S): Studies to date show an inconsistent
relationship between regional cerebral oxygen saturation and neurological
outcomes after cardiac surgery, and lack of clear benefit of targeting
cerebral oximetry to minimize neurological complications. Standardized
assessments, definitions of impairment and desaturation thresholds will
help determine the benefits of cerebral oximetry monitoring during cardiac
surgery. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<91>
Accession Number
634154940
Title
Oncological outcomes of unsuspected pN2 in patients with non-small-cell
lung cancer: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 01 Feb 2021.
Author
IJsseldijk M.A.; Ten Broek R.P.G.; Wiering B.; Hekma E.; de Roos M.A.J.
Institution
(IJsseldijk, Ten Broek) Division of Surgery, Radboud University Medical
Center, Nijmegen, Netherlands
(IJsseldijk, Ten Broek, Wiering) Division of Surgery, Slingeland
Ziekenhuis, Doetinchem, Netherlands
(Hekma, de Roos) Division of Surgery, Rijnstate Hospital, Arnhem,
Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Optimal treatment of stage IIIA (N2) non-small-cell lung
cancer (NSCLC) is controversial. Guidelines advise induction therapy
before surgical resection. A proportion of patients with cN0 NSCLC are
postoperatively upstaged due to unsuspected N2 disease. Survival of
unsuspected N2 NSCLC treated with surgery varies and technical feasibility
of video-assisted thoracic surgery (VATS) is unknown. The purpose of this
study was to assess prevalence and survival of unsuspected N2 NSCLC
treated with thoracotomy or VATS. METHOD(S): A systematic review and
meta-analysis was performed of all available literatures through Pubmed,
Cochrane, EMBASE, Web of Science, Trials registries and System for
Information on Grey Literature (SIGLE) from 2000 to 2019. Outcomes of
interest were prevalence, overall survival (OS) and disease-free survival
of unsuspected N2 NSCLC. Secondary outcomes were number of harvested lymph
nodes, postoperative complications and survival of unsuspected N2 NSCLC
treated with VATS. RESULT(S): Seventeen studies with patients with
clinical stage N0-1 and unsuspected pN2 NSCLC were included. Prevalence of
unsuspected pN2 was 8.6%. Three- and 5-year OS was 58% [95% confidence
interval (CI) 37-78%) (N=4337] and 35% (95% CI 28-43%) (N=4337). Three-
and 5-y ear disease-free survival was 48% (95% CI 30-66%) (N=109) and 35%
(95% CI 24-46%) (N=517). VATS resulted in a low complication rate with
similar 5-year OS as thoracotomy. CONCLUSION(S): In patients with
cN0-1 NSCLC, a minority has unsuspected pN2 NSCLC. Even for these
patients, 5-year OS and disease-free survival are reasonable. VATS with
adequate lymph node dissection is the treatment of choice when in
experienced hands. Adjuvant therapy should be provided in absence of
relevant comorbidity. Copyright © The Author(s) 2021. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<92>
Accession Number
2010402319
Title
Therapeutic Controversies in the Medical Management of Valvular Heart
Disease.
Source
Annals of Pharmacotherapy. (no pagination), 2021. Date of Publication:
2021.
Author
Barry A.R.; Wang E.H.Z.
Institution
(Barry) University of British Columbia, Vancouver, BC, Canada
(Barry) Chilliwack General Hospital, Lower Mainland Pharmacy Services,
Chilliwack, BC, Canada
(Wang) St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver,
BC, Canada
Publisher
SAGE Publications Inc.
Abstract
Objective: To evaluate the evidence for common therapeutic controversies
in the medical management of valvular heart disease (VHD). Data
Sources: A literature search of PubMed (inception to December 2020) was
performed using the terms angiotensin-converting enzyme (ACE) inhibitors
or angiotensin receptor blockers (ARBs) and aortic stenosis (AS); and
adrenergic beta-antagonists and aortic valve regurgitation (AR) or mitral
stenosis (MS). Study Selection and Data Extraction: Randomized controlled
trials (RCTs) and meta-analyses conducted in humans and published in
English that reported >=1 clinical outcome were included. Data
Synthesis: Nine articles were included: 3 RCTs and 1 meta-analysis for ACE
inhibitors/ARBs in AS, 1 RCT for beta-blockers in AR, and 4 RCTs for
beta-blockers in MS. Evidence suggests that ACE inhibitors/ARBs do not
increase the risk of adverse outcomes in patients with AS but may delay
valve replacement. beta-Blockers do not appear to worsen outcomes in
patients with chronic AR and may improve left-ventricular function in
patients with a reduced ejection fraction. beta-Blockers do not improve
and may actually worsen exercise tolerance in patients with MS in sinus
rhythm. Relevance to Patient Care and Clinical Practice: ACE
inhibitors/ARBs and beta-blockers can likely be safely used in patients
with AS or AR, respectively, who have a compelling indication. There is
insufficient evidence to recommend routine use of beta-blockers in
patients with MS without atrial fibrillation. Conclusion(s): Common
beliefs about the medical treatment of VHD are not supported by
high-quality data. There remains a need for larger-scale RCTs in the
medical management of VHD. Copyright © The Author(s) 2021.

<93>
Accession Number
634149743
Title
Improvement in Physical Function After Coronary Artery Bypass Graft
Surgery Using a Novel Rehabilitation Intervention: A RANDOMIZED CONTROLLED
TRIAL.
Source
Journal of cardiopulmonary rehabilitation and prevention. (no pagination),
2021. Date of Publication: 25 Jan 2021.
Author
Rengo J.L.; Savage P.D.; Hirashima F.; Leavitt B.J.; Ades P.A.; Toth M.J.
Institution
(Rengo) Division of Cardiology, Department of Medicine (Messrs Rengo and
Savage Drs Ades and Toth) and Division of Cardiothoracic Surgery,
Department of Surgery , College of Medicine, University of Vermont,
Burlington, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: Cardiorespiratory and skeletal muscle deconditioning occurs
following coronary artery bypass graft surgery and hospitalization.
Outpatient, phase 2 cardiac rehabilitation (CR) is designed to remediate
this deconditioning but typically does not begin until several weeks
following hospital discharge. Although an exercise program between
discharge and the start of CR could improve functional recovery,
implementation of exercise at this time is complicated by postoperative
physical limitations and restrictions. Our objective was to assess the
utility of neuromuscular electrical stimulation (NMES) as an adjunct to
current rehabilitative care following postsurgical discharge and prior to
entry into CR on indices of physical function in patients undergoing
coronary artery bypass graft surgery. METHOD(S): Patients were
randomized to 4 wk of bilateral, NMES (5 d/wk) to their quadriceps muscles
or no intervention (control). Physical function testing was performed at
hospital discharge and 4 wk post-discharge using the Short Physical
Performance Battery and the 6-min walk tests. Data from 37 patients (19
control/18 NMES) who completed the trial were analyzed. The trial was
registered at ClinicalTrials.gov (NCT03892460). RESULT(S): Physical
function measures improved from discharge to 4 wk post-surgery across our
entire cohort (P < .001). Patients randomized to NMES, however, showed
greater improvements in 6-min walk test distance and power output compared
with controls (P < .01). CONCLUSION(S): Our results provide evidence
supporting the utility of NMES to accelerate recovery of physical function
after coronary artery bypass graft surgery. Copyright © Copyright
© 2021 Wolters Kluwer Health, Inc. All rights reserved.

<94>
Accession Number
2010744730
Title
The Power and the Pitfalls of Randomized Clinical Trials.
Source
Annals of Thoracic Surgery. 111 (2) (pp 699-700), 2021. Date of
Publication: February 2021.
Author
Sundt T.M.
Institution
(Sundt) Division of Cardiac Surgery, Massachusetts General Hospital, 55
Fruit St, Cox 652, Boston, MA 02114, United States
Publisher
Elsevier Inc.

<95>
Accession Number
2005860894
Title
Perioperative individualized goal directed therapy for cardiac surgery: A
historical-prospective, comparative effectiveness study.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-11), 2021. Article Number: 400.
Date of Publication: January 2021.
Author
Ramsingh D.; Hu H.; Yan M.; Lauer R.; Rabkin D.; Gatling J.; Floridia R.;
Martinez M.; Dorotta I.; Razzouk A.
Institution
(Ramsingh, Hu, Yan, Lauer, Gatling, Martinez, Dorotta) Department of
Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
92354, United States
(Rabkin, Floridia, Razzouk) Department of Cardiothoracic Surgery, Loma
Linda University Medical Center, Loma Linda, CA 92354, United States
Publisher
MDPI AG
Abstract
Introduction: Cardiac surgery patients are at increased risk for
post-operative complications and prolonged length of stay. Perioperative
goal directed therapy (GDT) has demonstrated utility for non-cardiac
surgery, however, GDT is not common for cardiac surgery. We initiated a
quality improvement (QI) project focusing on the implementation of a GDT
protocol, which was applied from the immediate post-bypass period into the
intensive care unit (ICU). Our hypothesis was that this novel GDT protocol
would decrease ICU length of stay and possibly improve postoperative
outcomes. Method(s): This was a historical prospective, QI study for
patients undergoing cardiac surgery requiring cardiopulmonary bypass
(CPB). Integral to the QI project was education towards all associated
providers on the concepts related to GDT. The protocol involved
identifying patient specific targets for cardiac index and mean arterial
pressure. These targets were maintained from the post-CPB period to the
first 12 h in the ICU. Statistical comparisons were performed between the
year after GDT therapy was launched to the last two years prior to
protocol implementation. The primary outcome was ICU length of stay.
 Result(s): There was a significant decrease in ICU length of stay
when comparing the year after the protocol initiation to years prior, from
a median of 6.19 days to 4 days (2017 vs. 2019, p < 0.0001), and a median
of 5.88 days to 4 days (2018 vs. 2019, p < 0.0001). Secondary outcomes
demonstrated a significant reduction in total administered volumes of
inotropic medication(milrinone). All other vasopressors demonstrated no
differences across years. Hospital length of stay comparisons did not
demonstrate a significant reduction. Conclusion(s): These results
suggest that an individualized goal directed therapy for cardiac surgery
patients can reduce ICU length of stay and decrease amount of inotropic
therapy. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<96>
Accession Number
2010701998
Title
Comparing quality of life and postoperative pain after limited access and
conventional aortic valve replacement: Design and rationale of the LImited
access aortic valve replacement (LIAR) trial.
Source
Contemporary Clinical Trials Communications. 21 (no pagination), 2021.
Article Number: 100700. Date of Publication: March 2021.
Author
Klop I.D.G.; van Putte B.P.; Kloppenburg G.T.L.; Sprangers M.A.G.;
Nieuwkerk P.T.; Klein P.
Institution
(Klop, van Putte, Kloppenburg, Klein) Department of Cardiothoracic
Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
(van Putte) Department of Cardiothoracic Surgery, AMC Heart Centre,
Amsterdam University Medical Center, Amsterdam, Netherlands
(Sprangers, Nieuwkerk) Department of Medical Psychology, Amsterdam
University Medical Center/University of Amsterdam, Amsterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Surgical aortic valve replacement (SAVR) via limited access
approaches ('mini-AVR') have proven to be safe alternative for the
surgical treatment of aortic valve disease. However, it remains unclear
whether these less invasive approaches are associated with improved
quality of life and/or reduced postoperative pain when compared to
conventional SAVR via full median sternotomy (FMS). Study design: The
LImited access Aortic valve Replacement (LIAR) trial is a single-center,
single blind randomized controlled clinical trial comparing 2 arms of 80
patients undergoing limited access SAVR via J-shaped upper hemi-sternotomy
(UHS) or conventional SAVR through FMS. In all randomized patients, the
diseased native aortic valve is planned to be replaced with a rapid
deployment stented bioprosthesis. Patients unwilling or unable to
participate in the randomized trial will be treated conventionally via
SAVR via FMS and with implantation of a sutured valve prosthesis. These
patients will participate in a prospective registry. Study methods:
Primary outcome is improvement in cardiac-specific quality of life,
measured by two domains of the Kansas City Cardiomyopathy Questionnaire up
to one year after surgery. Secondary outcomes include, but are not limited
to: generic quality of life measured with the Short Form-36, postoperative
pain, perioperative (technical success rate, operating time) and
postoperative outcomes (30-day and one-year mortality), complication rate
and hospital length of stay. Conclusion(s): The LIAR trial is
designed to determine whether a limited access approach for SAVR
('mini-AVR') is associated with improved quality of life and/or reduced
postoperative pain compared with conventional SAVR through FMS. The study
is registered at ClinicalTrials.gov, number NCT04012060. Copyright
© 2021

<97>
Accession Number
2010691139
Title
Remote Ischemic Preconditioning in Non-cardiac Surgery: A Systematic
Review and Meta-analysis.
Source
Journal of Surgical Research. 261 (pp 261-273), 2021. Date of Publication:
May 2021.
Author
Lamidi S.; Baker D.M.; Wilson M.J.; Lee M.J.
Institution
(Lamidi) The Medical School, University of Sheffield, Sheffield, United
Kingdom
(Baker, Lee) Academic Directorate of General Surgery, Sheffield Teaching
Hospitals NHS FT, Sheffield, United Kingdom
(Wilson) School of Health and Related Research, University of Sheffield,
Sheffield, United Kingdom
(Lee) Department of Oncology and Metabolism, The Medical School,
University of Sheffield, Sheffield, United Kingdom
Publisher
Academic Press Inc.
Abstract
Background: Remote ischemic preconditioning (RIPC) may mitigate
physiological stress related to surgery. There is no clear consensus on
conduct of RIPC studies, or whether it is effective. The aim of this study
was to (i) assess delivery of RIPC, (ii) identify reported outcomes, (iii)
measure effect on key clinical outcomes. Method(s): This review was
registered on PROSPERO (CRD:42020180725). EMBASE and Medline databases
were searched, and results screened by two reviewers. Full-texts were
assessed for eligibility by two reviewers. Data extracted were methods of
RIPC and outcomes reported. Meta-analysis of key clinical events was
performed using a Mantel-Haenszel random effects model. The TIDieR
framework was used to assess intervention reporting, and Cochrane risk of
bias tool was used for all studies included. Result(s): Searches
identified 25 studies; 25 were included in the narrative analysis and 18
in the meta-analysis. RIPC was frequently performed by occluding arm
circulation (15/25), at 200 mmHg (9/25), with three cycles of 5 min
ischemia and 5 min of reperfusion (16/25). No study fulfilled all 12
TIDieR items (mean score 7.68). Meta-analysis showed no benefit of RIPC on
MI (OR 0.71 95% CI 0.48-1.04, I2 = 0%), mortality (OR 0.56, 95% CI
0.31-1.01, I2 = 0%), or acute kidney injury (OR 0.72 95% CI 0.48-1.08).
 Conclusion(s): RIPC could be standardized as 200 mmHg pressure in 3 x
5 min on and off cycles. The signal of benefit should be explored in a
larger well-designed randomized trial. Copyright © 2020 Elsevier
Inc.

<98>
Accession Number
2007468695
Title
Meta-analysis comparing outcomes of catheter ablation for ventricular
arrhythmia in ischemic versus nonischemic cardiomyopathy.
Source
PACE - Pacing and Clinical Electrophysiology. 44 (1) (pp 54-62), 2021.
Date of Publication: January 2021.
Author
Basu-Ray I.; Khanra D.; Shah S.K.; Mukherjee A.; Char S.V.; Jain B.; Bunch
T.J.; Gold M.; Adeboye A.A.; Saeed M.
Institution
(Basu-Ray, Adeboye) Department of Cardiology, Memphis VA Medical Center,
1030 Jefferson Ave, Memphis, TN 38104, United States
(Basu-Ray) School of Public Health, The University of Memphis, Memphis,
TN, United States
(Basu-Ray) Dept of Cardiology, All India Institute of Medical Sciences,
Rishikesh, UK, India
(Khanra, Jain) Department of Cardiology, Heart and Lung Centre, New Cross
Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
(Shah) Department of Cardiology, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Mukherjee) Department of Cardiology, NRS Medical College, Kolkata, India
(Char) Department of Cardiology, Life University, Marietta, GA, United
States
(Bunch) Department of Cardiology, University of Utah Hospital, University
of Utah School of Medicine, Salt Lake City, UT, United States
(Gold, Saeed) Department of Cardiology, Medical University of South
Carolina, Charleston, SC, United States
(Saeed) Department of Cardiology, Baylor College of Medicine, Houston, TX,
United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Catheter ablation is an effective treatment for ventricular
arrhythmia (VA) in ischemic cardiomyopathy (ICM). However, results in
non-ICM (NICM) patients are not satisfactory, and studies comparing
differences between NICM and ICM are limited. We conducted a meta-analysis
of procedural characteristics and long-term outcomes of catheter ablation
for VA, comparing results between ICM and NICM. Method(s): Studies in
the PubMed, EMBASE, and Cochrane databases were systematically reviewed.
Four studies reporting comparison of catheter ablation of VA between ICM
and NICM were examined. The Newcastle-Ottawa Scale was used to appraise
study quality. A random-effects model with inverse variance method was
used for comparisons. Result(s): Epicardial approach was
significantly more undertaken for the NICM group than in the ICM group
(odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.09-0.18; P
<.00001). Mean ablation time (P =.54), fluoroscopy time (P =.55), and
procedural time (P =.18) did not differ significantly between the ICM and
NICM groups. Procedural failure rates (OR: 0.46; 95% CI: 0.24-0.89; P
=.02) and VA recurrence rates (risk ratio [RR]: 0.68; 95% CI: 0.46-1.01; P
=.06) were significantly higher in the NICM group than in the ICM group.
However, all-cause mortality (RR: 1.37; 95% CI: 0.75-2.49; P =.31) did not
differ significantly between groups. Conclusion(s): Procedural
failure and VA recurrence rates were significantly higher in the NICM
group, despite significantly more frequent epicardial access. These
highlight the limitations of catheter ablation for VA in NICM, given our
current knowledge. Copyright © 2020 Wiley Periodicals LLC

<99>
Accession Number
2008580043
Title
Bioresorbable vascular scaffold versus metallic drug-eluting stent in
patients at high risk of restenosis: The COMPAREABSORB randomised clinical
trial.
Source
EuroIntervention. 16 (8) (pp 645-653), 2020. Date of Publication: 2020.
Author
Smits P.C.; Chang C.C.; Chevalier B.; West N.E.J.; Gori T.; Barbato E.;
Tarantin G.; Kocka V.; Achenbach S.; Dudek D.; Escaned J.; Wlodarczak A.;
Abdel-Wahab M.; Esposito G.; Tijssen J.G.P.; Morice M.-C.; Onuma Y.; Van
Geuns R.J.
Institution
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Chang, Onuma, Van Geuns) Thoraxcenter, Erasmus University Medical Center,
Rotterdam, Netherlands
(Chang) Division of Cardiology, Department of Medicine, Taipei Veterans
General Hospital, Taipei, Taiwan (Republic of China)
(Chevalier) Ramsay Generale de Sante, ICPS, Hopital Jacques Cartier,
Massy, France
(West) Department of Interventional Cardiology, Royal Papworth Hospital,
Cambridge, United Kingdom
(Gori) Center of Cardiology, Cardiology i, University Medical Center,
Johannes Gutenberg- University Mainz, DZHK Standort Rhein-Main, Mainz,
Germany
(Barbato) Cardiovascular Research Center OLV Hospital, Aalst, Belgium
(Barbato) Department of Advanced Biomedical Science, University Federico
II, Naples, Italy
(Tarantin) Interventional Cardiology Unit, Department of Cardiac, Thoracic
and Vascular Sciences, University of Padua, Padua, Italy
(Kocka) Cardiocenter, Third Faculty of Medicine, University Hospital
Kralovske Vinohrady, Charles University, Prague, Czechia
(Achenbach) Department of Cardiology, Universitatsklinikum Erlangen,
Erlangen, Germany
(Dudek) 2nd Department of Cardiology, Jagiellonian University Medical
College, Krakow, Poland
(Escaned) Hospital Clinico San Carlos IDISSC, Complutense University,
Madrid, Spain
(Wlodarczak) Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin,
Poland
(Abdel-Wahab) Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
(Abdel-Wahab) Heart Center Leipzig at the University of Leipzig, Leipzig,
Germany
(Esposito) Facolta di Medicina e Chirurgia, Universita Degli Studi di
Napoli Federico II, Naples, Italy
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Morice) Cardiovascular European Research Center, Massy, France
(Onuma) Cardialysis B.V., Rotterdam, Netherlands
(Van Geuns) Department of Cardiology, Radboud UMC, Nijmegen, Netherlands
Publisher
Europa Group
Abstract
Aims: The aim of this study was to investigate clinical outcomes of
patients at high risk of restenosis after implantation of a bioresorbable
vascular scaffold (BVS). Methods and Results: The COMPARE-ABSORB
trial was an investigator-initiated, prospective randomised study.
Patients at high risk of restenosis were randomly assigned to receive
either a BVS or an everolimus-eluting stent (EES). A dedicated
implantation technique was recommended for BVS. The primary endpoint was
target lesion failure (TLF), defined as the composite of cardiac death,
target vessel myocardial infarction (TVMI) or clinically indicated target
lesion revascularisation at one year. The enrolment was discontinued
prematurely because of a high thrombosis and TVMI rate in the BVS arm. A
total of 1,670 patients were recruited (BVS 848 patients and EES 822
patients). TLF occurred in 43 patients (5.1%) of the BVS group and 34
patients (4.2%) of the EES group (absolute difference 0.9%, 95% confidence
interval [CI]: -1.2%-3.0%, p non-inferiority <0.001). Definite or probable
device thrombosis (2.0% vs 0.6%, hazard ratio [HR] 3.32, 95% CI:
1.22-8.99, p=0.012) and TVMI (4.0% vs 2.1%, HR 1.96, 95% CI: 1.10-3.51,
p=0.02) were significantly higher in the BVS group than in the EES group.
 Conclusion(s): In patients at high risk of restenosis,
non-inferiority of BVS compared with EES in terms of TLF was met at one
year. BVS carried a higher risk of device thrombosis and TVMI than
EES. Copyright © 2020 EuroIntervention. All rights reserved.

<100>
Accession Number
2010850369
Title
Tidal volume during 1-lung ventilation: A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Peel J.K.; Funk D.J.; Slinger P.; Srinathan S.; Kidane B.
Institution
(Peel, Slinger) Department of Anesthesia, University of Toronto, Toronto,
ON, Canada
(Funk) Departments of Anesthesia and Medicine, University of Manitoba,
Winnipeg, MB, Canada
(Srinathan, Kidane) Section of Thoracic Surgery, Department of Surgery,
University of Manitoba, Winnipeg, MB, Canada
(Kidane) Department of Community Health Sciences, University of Manitoba,
Winnipeg, MB, Canada
(Kidane) Research Institute in Oncology and Hematology, Winnipeg, MB,
Canada
Publisher
Mosby Inc.
Abstract
Background: The selection of tidal volumes for 1-lung ventilation remains
unclear, because there exists a trade-off between oxygenation and risk of
lung injury. We conducted a systematic review and meta-analysis to
determine how oxygenation, compliance, and clinical outcomes are affected
by tidal volume during 1-lung ventilation. Method(s): A systematic
search of MEDLINE and EMBASE was performed. A systematic review and
random-effects meta-analysis was conducted. Pooled mean difference
estimated arterial oxygen tension, compliance, and length of stay; pooled
odds ratio was calculated for composite postoperative pulmonary
complications. Risk of bias was determined using the Cochrane risk of bias
and Newcastle-Ottawa tools. Result(s): Eighteen studies were
identified, comprising 3693 total patients. Low tidal volumes (5.6
[+/-0.9] mL/kg) were not associated with significant differences in
partial pressure of oxygen (-15.64 [-88.53-57.26] mm Hg; P =.67), arterial
oxygen tension to fractional intake of oxygen ratio (14.71 [-7.83-37.24];
P =.20), or compliance (2.03 [-5.22-9.27] mL/cmH2O; P =.58) versus
conventional tidal volume ventilation (8.1 [+/-3.1] mL/kg). Low versus
conventional tidal volume ventilation had no significant impact on
hospital length of stay (-0.42 [-1.60-0.77] days; P =.49). Low tidal
volumes are associated with significantly decreased odds of pulmonary
complications (pooled odds ratio, 0.40 [0.29-0.57]; P <.0001).
 Conclusion(s): Low tidal volumes during 1-lung ventilation do not
worsen oxygenation or compliance. A low tidal volume ventilation strategy
during 1-lung ventilation was associated with a significant reduction in
postoperative pulmonary complications. Copyright © 2020 The
American Association for Thoracic Surgery

<101>
Accession Number
2010819417
Title
Single versus dual antiplatelet therapy after transcatheter aortic valve
replacement: a meta-analysis of randomized clinical trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Ahmad Y.; Howard J.P.; Madhavan M.V.; Leon M.B.; Makkar R.R.
Institution
(Ahmad, Makkar) Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Howard) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Madhavan, Leon) Columbia University Medical Center, New York, NY, United
States
(Leon) Cardiovascular Research Foundation, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Guidelines recommend dual antiplatelet therapy (DAPT) after
transcatheter aortic valve replacement (TAVR) but guidelines predate the
publication of the largest randomized trial. There have been few trials in
the field to date, and with a small number of total patients; pooling
their results may therefore be helpful. Method(s): We systematically
identified all randomized trials comparing SAPT to DAPT after TAVR. The
primary endpoint was the risk of major bleeding. Secondary endpoints
included all bleeding, life-threatening bleeding, stroke, myocardial
infarction, death and cardiac death. Result(s): Four trials,
randomizing 1086 participants, were eligible (541 randomized to SAPT and
545 randomized to DAPT). The weighted mean follow-up was 9.1 months. The
risk of major bleeding was significantly increased after DAPT (relative
risk (RR) 2.36, 95% confidence interval (CI) 1.27 to 4.40, P = 0.007).
There was a similar increased risk for all bleeding (RR 1.65, 95% CI 1.24
to 2.19, P < 0.001), although not for life-threatening bleeding (RR 1.44,
95% CI 0.74 to 2.77, P = 0.282). There were no significant differences in
the risk of stroke, myocardial infarction (MI), death or cardiac death.
There was no heterogeneity observed for any endpoint (I2 =
0.0%). Conclusion(s): DAPT after TAVR is associated with an increased
risk of major bleeding and all bleeding. There is no evidence of a
significant difference between DAPT or SAPT for the risks of stroke, MI,
death or cardiac death. However, the total number of patients randomized
is small and the duration of follow-up is short. Larger scale randomized
trials with longer follow-up are required to assess for any potential
differences in ischemic endpoints or mortality. Copyright © 2021
The Authors

<102>
Accession Number
2010808672
Title
Risk factors and prognosis of adult-onset post-pump chorea.
Source
Journal of the Neurological Sciences. 422 (no pagination), 2021. Article
Number: 117328. Date of Publication: 15 Mar 2021.
Author
Ahn J.H.; Song J.; Choi I.; Youn J.; Cho J.W.
Institution
(Ahn, Song, Choi, Youn, Cho) Department of Neurology, Samsung Medical
Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro,
Gangnam-gu, Seoul 06351, South Korea
(Ahn, Song, Choi, Youn, Cho) Neuroscience Center, Samsung Medical Center,
81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
Publisher
Elsevier B.V.
Abstract
Objectives: Post-pump chorea (PPC), defined as the development of chorea
after major cardiac surgery utilizing cardiopulmonary bypass (CPB), has
been rarely reported in adults. Method(s): We compared 17 patients
with adult-onset PPC to controls who did not develop chorea after cardiac
surgery with CPB. Two patients were enrolled using hospital based data and
15 were collected by a systematic literature review. The controls without
chorea after CPB (n = 4208) were collected using hospital based data. We
described the clinical and surgical features of adult-onset PPC and
compared them with those of the controls. Result(s): Ten of 17 PPC
patients were male, the mean age was 46.8 years, and the mean onset
latency was 6.0 days. The adult-onset PPC patients were younger (46.8 +/-
16.7 vs. 59.1 +/- 15.0, p = 0.001), had a lower minimum body temperature
(23.3 +/- 5.5 vs. 29.7 +/- 3.7, p < 0.001) and a longer total circulatory
arrest time (63.7 +/- 7.5 vs. 21.0 +/- 14.6, p < 0.001) than controls.
Forty-three percentage of patients with adult-onset PPC had persistent
chorea on follow-up, and these patients showed a higher rate of abnormal
initial brain MRI compared with the patients with good clinical outcomes
(p = 0.041). Conclusion(s): The onset age, onset latency, underlying
disease, treatment response, and surgical features were variable among PPC
patients, while abnormal initial brain MRI was associated with persistent
chorea. Pooling more cases through multicenter efforts will hopefully
provide more knowledge on the underlying pathophysiology, prevention, and
management of PPC. Copyright © 2021 Elsevier B.V.

<103>
Accession Number
2010317931
Title
High-dose vitamin D versus placebo to prevent complications in COVID-19
patients: A structured summary of a study protocol for a randomised
controlled trial (CARED-TRIAL).
Source
Trials. 22 (1) (no pagination), 2021. Article Number: 111. Date of
Publication: December 2021.
Author
Mariani J.; Tajer C.; Antonietti L.; Inserra F.; Ferder L.; Manucha W.
Institution
(Mariani, Tajer, Antonietti) Hospital de Alta Complejidad en Red El Cruce
- Nestor Kirchner, Florencio Varela, Buenos Aires, Argentina
(Mariani, Tajer, Antonietti) Universidad Nacional Arturo Jauretche,
Florencio Varela, Buenos Aires, Argentina
(Inserra, Ferder) Maimonides University, Ciudad Autonoma de Buenos Aires,
Argentina
(Manucha) Consejo Nacional de Investigaciones Cientificas y Tecnicas,
Universidad Nacional de Cuyo, Instituto de Medicina y Biologia
Experimental de Cuyo (IMBECU), Mendoza, Argentina
Publisher
BioMed Central Ltd
Abstract
Objectives: To evaluate whether a single high dose of oral cholecalciferol
improves the respiratory outcomes as compared with placebo among adults
COVID-19 patients at moderate risk of clinical complications. Trial
design: The CARED trial is an investigator-initiated, multicentre,
randomized, parallel, two-arm, sequential, double-blind and
placebo-controlled clinical trial. It was planned as a pragmatic trial
since the inclusion criteria are broad and the study procedures are as
simple as possible, in order to be implemented in the routine clinical
practice in general wards in the pandemic setting and a middle-income
country context. The sequential design involves two stages. The first
stage will assess the effects of vitamin D supplementation on blood
oxygenation (physiological effects). The second stage will assess the
effects on clinical outcomes. Participant(s): Participants of either
gender admitted to general adult wards in 21 hospital sites located in
four provinces of Argentina are invited to participate in the study if
they meet the following inclusion criteria and none of the exclusion
criteria: Inclusion criteriaSARS-CoV-2 confirmed infection by
RT-PCR;Hospital admission at least 24 hours before;Expected
hospitalization in the same site >=24 hours;Oxygen saturation >=90%
(measured by pulse oximetry) breathing ambient air;Age >=45 years or at
least one of the following conditions: Hypertension; Diabetes; At least
moderate COPD or asthma; Cardiovascular disease (history of myocardial
infarction, percutaneous transluminal coronary angioplasty, coronary
artery bypass grafting or valve replacement surgery); Body mass index
>=30;Willingness to sign informed consent (online supplementary material 1
and 2). Exclusion criteria:Age <18 years;Women in childbearing age;>= 72
hs since current admission;Requirement for a high dose of oxygen (>5
litres/minute) or mechanical ventilation (non-invasive or
invasive);History of chronic kidney disease requiring haemodialysis or
chronic liver failure;Inability for oral intake.Chronic supplementation
with pharmacological vitamin D;Current treatment with
anticonvulsants;History of: Sarcoidosis; Malabsorption syndrome; Known
hypercalcemia or serum calcium >10.5 mg/dL;Life expectancy <6 months;Known
allergy to study medication;Any condition at discretion of investigator
impeding to understand the study and give informed consent. Intervention
and comparator: The intervention consists in a single oral dose of 500.000
IU of commercially available cholecalciferol soft gel capsules (5 capsules
of 100.000 IU) or matching placebo Main outcomes: The primary outcome for
the first stage is the change in the respiratory Sepsis-related Organ
Failure Assessment (SOFAr) score between pre-treatment value and the worst
value recorded during the first 7 seven days of hospitalization, the death
or discharge, whichever occurs first. The SOFAr score measured as the
ratio between the pulse oximetry saturation (SpO<inf>2</inf>) and
FiO<inf>2</inf> (27, 28) is used instead of the arterial partial pressure
of oxygen (PaO<inf>2</inf>). SOFAr score is a 4-points scale, with higher
values indicating deeper respiratory derangement as follows: 1
PaO<inf>2</inf> <400; 2 PaO<inf>2</inf> <300; 3 PaO<inf>2</inf> <200; 4
PaO<inf>2</inf> <100. The primary outcome for the second stage is the
combined occurrence of requirement >=40% of FiO<inf>2</inf>, invasive or
non-invasive ventilation, up to 30 days or hospital discharge.
Randomisation: A computer-generated random sequence and the treatment
assignment is performed through the web-based randomization module
available in the electronic data capture system (Castor). A randomization
ratio 1:1, stratified and with permuted blocks was used. Stratification
variables were diabetes (yes/no), age (<=60/>60 years) and the site.
Blinding (masking): Double-blind was achieved by using placebo soft gel
capsules with the same organoleptic properties as the active medication.
Central management of the medication is carried out by a pharmacist in
charge of packaging the study drug in unblinded fashion, who have no
contact with on-site investigators. Medication is packaged in opaque white
bottles, each containing five soft gel capsules of the active drug or
matching placebo, corresponding to complete individual treatment.
Treatment codes are kept under the pharmacist responsibility, and all
researchers are unaware of them. Numbers to be randomised (sample size):
The first stage is planned to include 200 patients (100 per group), the
second stage is planned to include 1064 additional patients. The total
sample size is 1264 patients. Trial Status: Currently the protocol version
is the number 1.4 (from October 13th, 2020). The recruitment is
ongoing since August 11th, 2020, and the first subject was enrolled on
August 14th. Since then, 21 sites located in four provinces of Argentina
were initiated, and 167 patients were recruited by January
11th, 2021. We anticipate to finish the recruitment for the
first stage in mid-February, 2021, and in August, 2021 for the second
stage. Trial registration: The study protocol is registered in
ClinicalTrials.gov (identifier number NCT04411446) on June 2, 2020. Full
protocol: The full protocol is attached as an additional file, accessible
from the Trials website (Additional file 1). In the interest in expediting
dissemination of this material, the familiar formatting has been
eliminated; this Letter serves as a summary of the key elements of the
full protocol. The study protocol has been reported in accordance with the
Standard Protocol Items: Recommendations for Clinical Interventional
Trials (SPIRIT) guidelines (Additional file 2). Copyright © 2021,
The Author(s).

<104>
Accession Number
634095505
Title
Mini-sternotomy versus conventional sternotomy for aortic valve
replacement: A randomised controlled trial.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: e041398. Date of
Publication: 29 Jan 2021.
Author
Hancock H.C.; Maier R.H.; Kasim A.; Mason J.; Murphy G.; Goodwin A.; Owens
W.A.; Akowuah E.
Institution
(Hancock, Maier) Newcastle Clinical Trials Unit, Newcastle University,
Newcastle Upon Tyne, Tyne and Wear, United Kingdom
(Kasim) Wolfson Research Institute for Health and Wellbeing, Durham
University, Stockton-on-Tees, Durham, United Kingdom
(Mason) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
(Murphy) Dept. of Cardiovasc. Sciences and Nihr Leicester Biomedical
Research Unit in Cardiovascular Medicine, University of Leicester,
Leicester, United Kingdom
(Goodwin, Owens, Akowuah) Department of Cardiothoracic Surgery, James Cook
Hospital, South Tees Hospitals Nhs Foundation Trust, Middlesbrough, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective To compare clinical and health economic outcomes after
manubrium-limited mini-sternotomy (intervention) and conventional median
sternotomy (usual care). Design A single-blind, randomised controlled
trial. Setting Single centre UK National Health Service tertiary hospital.
Participants Adult patients undergoing aortic valve replacement (AVR)
surgery. Interventions Intervention was manubrium-limited mini-sternotomy
performed using a 5-7 cm midline incision. Usual care was median
sternotomy performed using a midline incision from the sternal notch to
the xiphisternum. Primary and secondary outcome measures The primary
outcome was the proportion of patients who received a red cell transfusion
postoperatively and within 7 days of index surgery. Secondary outcomes
included proportion of patients receiving a non-red cell blood component
transfusion and number of units transfused within 7 days and during index
hospital stay, quality of life and cost-effectiveness analyses. Results
270 patients were randomised, received surgery and contributed to the
intention to treat analysis. No difference between mini and conventional
sternotomy in red-cell transfusion within 7 days was found; 23/135
patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0)
and risk difference 0.0 (95% CI -0.1 to 0.1). Mini-sternotomy reduced
chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306.9
mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size
and postoperative valve function were comparable between mini-sternotomy
and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe
aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in
longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp
times (64.1 min (SD 17.1) vs 46.3 min (SD 10.7)). Conventional sternotomy
was more cost-effective with only a 5.8% probability of mini-sternotomy
being cost-effective at a willingness to pay of 20 000/QALY (Quality
Adjusted Life Years). Conclusions AVR via mini-sternotomy did not reduce
red blood cell transfusion within 7 days following surgery when compared
with conventional sternotomy. Trial registration number ISRCTN29567910;
Results. Copyright ©

<105>
Accession Number
634095499
Title
Randomised controlled trial protocol for the PROTECT-CS Study: PROTein to
Enhance outComes of (pre)frail paTients undergoing Cardiac Surgery.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: ee037240. Date of
Publication: 29 Jan 2021.
Author
Rose A.V.; Duhamel T.; Hyde C.; Kent D.E.; Afilalo J.; Schultz A.S.H.;
Chudyk A.; Kehler D.S.; Dave M.; Arora R.C.
Institution
(Rose, Duhamel, Hyde, Kent, Dave) Faculty of Kinesiology and Recreation
Management, University of Manitoba, Winnipeg, MN, Canada
(Duhamel) Health, Leisure and Human Performance Research Institute,
University of Manitoba, Winnipeg, MN, Canada
(Duhamel, Arora) Institute of Cardiovascular Sciences, St. Boniface
General Hospital Albrechtsen Research Centre, Winnipeg, MN, Canada
(Kent, Dave, Arora) Cardiac Science Manitoba, St. Boniface Hospital,
Winnipeg, MN, Canada
(Afilalo) Department of Medicine, McGill University, Montreal, QC, Canada
(Schultz) College of Nursing, University of Manitoba, Winnipeg, MN, Canada
(Chudyk) Department of Family Medicine, University of Manitoba, Winnipeg,
MN, Canada
(Kehler) Department of Physiotherapy, Dalhousie University, Halifax, NS,
Canada
(Arora) Department of Surgery, University of Manitoba, Winnipeg, MN,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction In the past 20 years, the increasing burden of heart disease
in an ageing population has resulted in cardiac surgery (CS) being offered
to more frail and older patients with multiple comorbidities. Frailty and
malnutrition are key geriatric syndromes that impact postoperative
outcomes, including morbidity, mortality and prolonged hospital length of
stay. Enhanced recovery protocols (ERPs), such as prehabilitation, have
been associated with a reduction in complications after CS in vulnerable
patients. The use of nutritional ERPs may enhance short-term and long-term
recovery and mitigate frailty progression while improving patient-reported
outcomes. Methods and analysis This trial is a two-centre, double-blinded,
placebo, randomised controlled trial with blinded endpoint assessment and
intention-to-treat analysis. One-hundred and fifty CS patients will be
randomised to receive either a leucine-rich protein supplement or a
placebo with no supplemented protein. Patients will consume their assigned
supplement two times per day for approximately 2 weeks pre-procedure,
during in-hospital postoperative recovery and for 8 weeks following
discharge. The primary outcome will be the Short Physical Performance
Battery score. Data collection will occur at four time points including
baseline, in-hospital (pre-discharge), 2-month and 6-month time points
post-surgery. Ethics and dissemination The University of Manitoba
Biomedical Research Ethics Board (20 March 2018) and the St Boniface
Hospital Research Review Committee (28 June 2019) approved the trial
protocol for the primary site in Winnipeg, Manitoba, Canada. The second
site's (Montreal, Quebec) ethics has been submitted and pending approval
from the Research Ethics and New Technology Development Committee for the
Montreal Heart Institute (December 2020). Recruitment for the primary site
started February 2020 and the second site will begin January 2021. Data
gathered from the PROTein to Enhance outComes of (pre)frail paTients
undergoing Cardiac Surgery Study will be published in peer-reviewed
journals and presented at national and international conferences.
Knowledge translation strategies will be created to share findings with
stakeholders who are positioned to implement evidence-informed change.
Potential study impact Malnutrition and frailty play a crucial role in
post-CS recovery. Nutritional ERPs are increasingly being recognised as a
clinically relevant aspect of perioperative care. As such, this trial is
to determine if leucine-rich protein supplementation at key intervals can
mitigate frailty progression and facilitate enhanced postoperative
recovery. Trial registration number ClinicalTrials.gov Registry
(NCT04038294). Copyright ©

<106>
Accession Number
633340291
Title
How to screen for at-risk alcohol use in transplant patients? From
instrument selection to implementation of the AUDIT-C.
Source
Clinical transplantation. 35 (1) (pp e14137), 2021. Date of Publication:
01 Jan 2021.
Author
Verhalle L.; Van Bockstaele K.; Duerinckx N.; Vanhoof J.; Dierickx K.;
Neyens L.; Van Cleemput J.; Gryp S.; Kums D.; De Bondt K.; Schaevers V.;
Demuynck F.; Dewispelaere A.; Dobbels F.
Institution
(Verhalle, Van Bockstaele, Duerinckx, Vanhoof, Demuynck, Dewispelaere,
Dobbels) Academic Centre for Nursing and Midwifery, Department of Public
Health and Primary Care, KU Leuven, Leuven, Belgium
(Duerinckx, Van Cleemput, Gryp, Kums) Heart Transplant Program, Department
of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
(Vanhoof) University Psychiatric Center, UPC KU Leuven, Leuven, Belgium
(Dierickx, Neyens, De Bondt) Department of Nephrology, University
Hospitals Leuven, Leuven, Belgium
(Schaevers) Lung Transplant Program, University Hospitals Leuven, Leuven,
Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: Given that drinking >2-3 units of alcohol daily might already
have adverse health effects, regular screening of at-risk drinking is
warranted. We aimed to select and pilot a short instrument to accurately
screen for at-risk drinking in transplant patients. METHODOLOGY AND
RESULTS: Five consecutive steps were completed: A comprehensive literature
review identified 24 possible self-report instruments (step 1). These
instruments were scored on six yes/no criteria (ie, length, concept
measured, diagnostic accuracy, population, manual available, cost) (step
2). Four nurses piloted three instruments with the highest score and were
interviewed on their experiences with using the AUDIT-C, TWEAK, and Five
Shot. The AUDIT-C was the easiest to use and score, and items were clear.
Cognitive debriefings with 16 patients were conducted to verify clarity of
instructions and items, and suggestions were incorporated into a modified
version of the AUDIT-C (step 4). A convenience sample of 130
Dutch-speaking heart transplant patients completed the modified AUDIT-C
during a scheduled visit (Step 5), revealing that 27.6% of patients showed
at-risk drinking. CONCLUSION(S): The AUDIT-C might be a suitable
instrument to identify at-risk drinking in routine post-transplant
follow-up. Further validation, however, is indicated. Copyright ©
2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

<107>
Accession Number
631652324
Title
Effect of Nalmefene on Delayed Neurocognitive Recovery in Elderly Patients
Undergoing Video-assisted Thoracic Surgery with One Lung Ventilation.
Source
Current medical science. 40 (2) (pp 380-388), 2020. Date of Publication:
01 Apr 2020.
Author
Li M.-Y.; Chen C.; Wang Z.-G.; Ke J.-J.; Feng X.-B.
Institution
(Li, Chen, Wang, Ke) Department of Anesthesiology, Zhongnan Hospital,
Wuhan University, Wuhan 430071, China
(Feng) Department of Anesthesiology, Zhongnan Hospital, Wuhan University,
Wuhan 430071, China
Publisher
NLM (Medline)
Abstract
The intravenous use of nalmefene has been found to exert neuroprotective
effect in patients with severe traumatic brain injury and acute cerebral
infarction; nonetheless, it is unknown whether nalmefene alleviates
delayed neurocognitive recovery. Our purpose of the current research was
to clarify the impact of nalmefene on delayed neurocognitive recovery in
aged patients experiencing video-assisted thoracic surgery (VATS) with
intraoperative use of one lung ventilation (OLV). The present study
involved 120 patients undergoing selective VATS, randomized to accept
low-dose nalmefene (N1 group, n=40), high-dose nalmefene (N2 group, n=40)
or equal volume of physiologic saline (control group, n=40). A battery of
neuropsychological tests were used to estimate cognitive function 1 day
before surgery (t0) and 10 days after surgery or before discharge (t1).
Regional cerebral oxygen saturation (rSO2) was detected 5 min before
induction (t0), 5 min after induction (t1), 15 and 60 min after onset of
OLV (t2 and t3), and 15 min after termination of OLV (t4). The plasma
values of interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha
and adiponectin (ADP) were also detected prior to induction of anesthesia
(T0), 1 h, 2 h and 6 h after surgery (T1, T2, T3). On t1, delayed
neurocognitive recovery occurred in 5/40 (12.5%) patients of N1 group, in
5/40 (12.5%) patients of N2 group and in 13/40 (32.5%) patients of control
group (P0.05). There were no statistical differences in rSO2 among three
groups at different time points. At T1, T2 and T3, IL-1beta, IL-6 and
TNF-alpha values significantly increased and ADP value significantly
decreased (P0.05) in control group. In contrast, at T1, T2 and T3,
IL-1beta, IL-6 and TNF-alpha values decreased and ADP value decreased less
in N1 and N2 groups (P0.05). At T1, T2 and T3, IL-1beta, IL-6 and
TNF-alpha concentrations presented a trend of N2 group N1 group control
group and ADP presented a trend of N2 groupN1 groupcontrol group (P0.05).
The result of our present research supports the hypothesis that the
perioperative intravenous treatment with nalmefene to VATS with OLV
ameliorates postoperative cognitive function and decreases the incidence
of delayed neurocognitive recovery, most likely by suppression of
inflammatory responses.

<108>
Accession Number
2010851855
Title
Policy recommendations to address gaps in research for women with heart
disease, stroke and vascular cognitive impairment.
Source
Canadian Journal of Cardiology. Conference: 2021 Canadian Women's Heart
Health Summit. 37 (2) (pp e14), 2021. Date of Publication: February 2021.
Author
Menezes S.; Arango M.
Institution
(Menezes, Arango) OttawaONCanada
Publisher
Elsevier Inc.
Abstract
Background: Heart and brain conditions are inextricably linked; patients
with heart disease and/or stroke increase their risk for vascular
cognitive impairment (VCI) and vice versa. In Canada, 9 out of 10
individuals have at least one risk factor for heart conditions, stroke or
VCI. Many of these risks are experienced disproportionally by women,
resulting in worse health outcomes. Oftentimes, primary care duties also
fall on women who must balance between managing their health and
caregiving. Method(s): Heart & Stroke (H&S) reviewed existing
literature and conducted a scan of Canadian and global dementia strategies
and practices. H&S solicited strategic advice from a panel of experts
and women with caregiving and lived experience of heart-brain disease.
Literature evidence and insight from the panel fed into the development of
H&S recommendations for addressing heart disease, stroke and VCI in
women. Result(s): Research is lacking on the link between heart
diseases and VCI, especially in women. Healthcare practitioners don't
always adequately inform patients of treatment risks (i.e., heart surgery
can increase the risk of brain infarction). Treatment and rehabilitation
are also poorly tailored to individual needs. Knowledge gaps exist on the
interplay between modifiable risk factors and how altering the dose and
duration of these factors can impact the health of women and men.
 Conclusion(s): H&S recommends all sectors of Canadian society
work together to address gaps in heart-brain diseases in women.
Governments should support heart-brain research which considers sex-based
differences. Healthcare providers and institutions should tailor treatment
and rehabilitation approaches based on population specific needs and
risks. Copyright © 2020

<109>
Accession Number
634123402
Title
Antithrombotic therapy in patients after transcatheter aortic valve
replacement: A network meta-analysis.
Source
JACCP Journal of the American College of Clinical Pharmacy. Conference:
2020 ACCP Annual Meeting. 3 (8) (pp 1681-1682), 2020. Date of Publication:
2020.
Author
Barry A.; Turgeon R.
Institution
(Barry, Turgeon) Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, BC, Canada
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background: The objective of this systematic review with network
meta-analysis was to evaluate the optimal antithrombotic regimen in
patients after transcatheter aortic valve replacement (TAVR).
 Method(s): We searched MEDLINE, Embase, and CENTRAL (inception to
April 2020) without language restriction using the query: (TAVR or aortic
stenosis) and (platelet aggregation inhibitors or anticoagulants).
Included were randomized controlled trials (RCTs) that compared any
antithrombotic combination and reported >=1 outcome of interest. The
primary outcome was all-cause death. Secondary outcomes were
stroke/transient ischemic attack (TIA) and major bleeding based on Valve
Academic Research Consortium criteria. Two reviewers independently
screened articles, extracted data, and evaluated trials using the Cochrane
Risk of Bias tool. We performed Bayesian network meta-analyses (WinBUGS,
version 1.4.3) to estimate probability of each intervention being best
based on mean surface under the cumulative ranking curve, and calculate
odds ratios (OR) and 95% credible intervals (CrI). Result(s): From 24
articles, we included 6 RCTs (N = 2501), including 1 unpublished RCT.
Comparisons included: aspirin versus dual antiplatelet therapy (DAPT) (3
trials), anticoagulant+aspirin versus DAPT (1 trial),
anticoagulant+clopidogrel versus anticoagulant (1 trial), and
anticoagulant versus DAPT (1 trial). Mean age was 79-83 years and 49% were
female. Median follow-up was 6 months. Aspirin ranked best for all-cause
death and major bleeding, and second best for stroke/TIA. DAPT ranked best
for stroke/TIA. Anticoagulant+aspirin ranked worst for all-cause death and
major bleeding, and second worst for stroke/TIA. Anticoagulant ranked
worst for stroke/TIA. DAPT was significantly better versus
anticoagulant+aspirin for allcause death (OR 0.59, 95% CrI 0.39-0.87) and
major bleeding (OR 0.51, 95% CrI 0.28-0.91). Discussion(s): Overall
risk of bias was low. Most comparisons were imprecise. Direct/indirect
meta-analyses were generally consistent except for comparisons of
anticoagulant to DAPT and anticoagulant +aspirin. In post-TAVR patients,
aspirin appears to provide the optimal balance of thrombotic and bleeding
events. (Table Presented).

<110>
Accession Number
2010407218
Title
Long-term outcomes of transcatheter valve-in-valve replacement for failed
aortic bioprosthesis: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Abushouk A.I.; Saad A.M.; Isogai T.; Shekhar S.; Krishnaswamy A.; Yun J.;
Kapadia S.R.
Institution
(Abushouk, Saad, Isogai, Shekhar, Krishnaswamy, Yun, Kapadia) Department
of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic
Foundation, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc

<111>
Accession Number
634138910
Title
Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove
Cytokines, Chemokines, and Cell-derived Microvesicles.
Source
Anesthesiology. (no pagination), 2021. Date of Publication: 27 Jan 2021.
Author
Welsby I.J.; Norris P.J.; Mauermann W.J.; Podgoreanu M.V.; Conn C.M.;
Meade L.; Cannon T.; Keating S.M.; Silliman C.C.; Kehler M.; Schulte P.J.;
Kor D.J.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Removal of cytokines, chemokines, and microvesicles from the
supernatant of allogeneic erythrocytes may help mitigate adverse
transfusion reactions. Blood bank-based washing procedures present
logistical difficulties; therefore, we tested the hypothesis that
on-demand bedside washing of allogeneic erythrocyte units is capable of
removing soluble factors and is feasible in a clinical setting.
 METHOD(S): There were in vitro and prospective, observation cohort
components to this a priori planned substudy evaluating bedside allogeneic
erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory
data were collected from the first 75 washed units given to a subset of
patients nested in the intervention arm of a parent clinical trial. Paired
pre- and postwash samples from the blood unit bags were centrifuged. The
supernatant was aspirated and frozen at -70degreeC, then batch-tested for
cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and
neutral lipids (all previously associated with transfusion reactions) and
cell-free hemoglobin (possibly increased by washing). From the entire
cohort randomized to the intervention arm of the trial, bedside washing
was defined as feasible if at least 75% of prescribed units were washed
per protocol. RESULT(S): Paired data were available for 74 units.
Washing reduced soluble CD40 ligand (median [interquartile range]; from
143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to
2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90
[4.10 to 20.0] to 0.83 [0.33 to 2.80] x 106), while cell-free hemoglobin
concentration increased from 72.6 (53.6 to 171.6) mg/dl to 210.5 (126.6 to
479.6) mg/dl (P < 0.0001 for each). There was no effect on neutral lipids.
Bedside washing was determined as feasible for 80 of 81 patients (99%);
overall, 293 of 314 (93%) units were washed per protocol.
 CONCLUSION(S): Bedside erythrocyte washing was clinically feasible
and greatly reduced concentrations of soluble factors thought to be
associated with transfusion-related adverse reactions, increasing
concentrations of cell-free hemoglobin while maintaining acceptable (less
than 0.8%) hemolysis. Copyright © 2021, the American Society of
Anesthesiologists, Inc. All Rights Reserved.

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