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<1>
Accession Number
2004604073
Title
Efficacy of home versus centre-based cardiac rehabilitatioin improving
functional capacity and left ventricular ejection fraction in coronary
artery bypass graft (Cabg) patients.
Source
Indian Journal of Public Health Research and Development. 11 (5) (pp
165-171), 2020. Date of Publication: May 2020.
Author
Mujeeb K.F.M.; Kazi A.
Institution
(Mujeeb, Kazi) Department of Cardiovascular and Respiratory Physiotherapy,
Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences
(Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra 442001,
India
Publisher
Institute of Medico-Legal Publications
Abstract
Background: Coronary Artery Bypass Grafting (CABG) surgery is the most
commonly performed surgery for the coronary artery disease patients.
Cardiac Rehabilitation (CR) is an essential, useful and safe part of the
care for patients with coronary artery disease and who underwent CABG
surgery. Regular physical activity can improve functional capacity in
patients after CABG. Objective(s): To determine the efficacy of home
and centre-based cardiac rehabilitation in improving functional capacity
and left ventricular ejection fraction (LVEF) in patients underwent CABG
surgery. Material(s) and Method(s): Total twenty four (n=24) CABG
surgery participants were selected. They were divided into 2 groups by
utilizing convenient (purposive) sampling method. Group 'A' i.e.
centre-based (n=12, mean age: 53.83+/-7.61) and Group 'B' i.e. home-based
(n=12, mean age: 55.91+/-5.79). Both the groups received an eight (8)
weeks of CR program. Group-A participants attended a supervised structured
exercise training program for 3 days per week in hospital set-up. Group-B
participants were given an individualized tailored program of aerobic
exercises to do at home. All the participants were screened and evaluated
for baseline measurements and all the values were recorded at the day of
discharge from hospital. After 8 weeks of CR program participants were
re-assessed for LVEF and functional capacity. Result(s): Statistical
analysis was done by using SPSS 22.0. After an eight week of CR program,
significant improvements were observed in 6-MW distance, LVEF and Rate of
Perceived Exertion (RPE) (p=0.0001). Conclusion(s): The home-based
and centre-based cardiac rehabilitation programs were equally effective in
improving functional capacity and left ventricular ejection fraction in
CABG patients. Copyright © 2020, Indian Journal of Public Health
Research and Development. All rights reserved.

<2>
Accession Number
2004449445
Title
Comparative study between effects of epidural magnesium sulphate on
intraoperative and postoperative analgesic requirements in cancer thoracic
surgery: A randomized controlled trial.
Source
Indian Journal of Public Health Research and Development. 11 (3) (pp
1404-1410), 2020. Date of Publication: March 2020.
Author
Hussein A.A.; Ghobrial H.Z.; Kamel M.A.; Saied A.M.A.; Khattab M.;
Mohammed A.T.; Elhalwagy A.M.A.
Institution
(Hussein) Department of Anesthesiology, ICU,and Pain Management, Faculty
of Medicine, Cairo University, Cairo, Egypt
(Ghobrial, Khattab, Mohammed) Department of Anesthesiology, ICU and Pain
Management, Faculty of Medicine, Al Azhar University for Boys, Cairo,
Egypt
(Kamel, Saied, Elhalwagy) Department of Anesthesiology, ICU and Pain
Management, Faculty of Medicine, Sohag University, Sohag, Egypt
Publisher
Institute of Medico-Legal Publications
Abstract
Background: The epidural infusion of local anesthetic and opioid achieves
effective postoperative analgesia in thoracic surgery patients.
Nevertheless, high dose of opioids my induce dose-dependent undesired
effects. Recent reports showed that adjuvantepidural magnesium
administration significantly improve intra and postoperative analgesic
outcomes.T he present randomized trial aimed to assess the intra and
postoperative analgesic effect of continuousepidural infusion of magnesium
sulphate in patients undergoing elective cancer thoracic surgery.
 Method(s): Sixty ASA III patients undergoing elective cancer thoracic
surgery were randomized in 1:1 ratio to receive adjuvant epidural
magnesium sulphate or 0.9% sodium chloride solution. The primary outcomes
in the present study were intra and postoperative analgesic requirements,
and postoperative pain score. Result(s): The magnesium sulphate group
showed a statistically significant lower number of required fenanyl doses
than the control group (74.3% needed two or more doses in magnesium
sulphate group versus 94.4% in the control group, p =0.026). A similar
findings was observed for need for ketorolac 30mg (p =0.017). The
postoperative VAS was significantly lower inmagnesium sulphate groupfrom
the 12th hour (p =0.033) to the 48th hour
postoperatively (p <0.001). The magnesium sulphate group showed more
stable hemodynamics. No major side-effects were observed in any of the
study groups. Conclusion(s): Epidural magnesium sulphate is a potent
adjuvant analgesic thatreduced opioid consumption and postoperative pain
in patients undergoing thoracic surgery. Copyright © 2020, Indian
Journal of Public Health Research and Development. All rights reserved.

<3>
Accession Number
2004055079
Title
Early outcome of tricuspid valve repair using prosthetic ring annuloplasty
versus suture annuloplasty.
Source
Indian Journal of Public Health Research and Development. 10 (12) (pp
1526-1532), 2019. Date of Publication: December 2019.
Author
El-Zayadi M.M.; Mahmoud M.A.-D.; Osama A.; Helal A.
Institution
(El-Zayadi, Mahmoud, Osama, Helal) Cardiothoracic Surgery Department,
Faculty of Medicine, Cairo University, Egypt
Publisher
Institute of Medico-Legal Publications
Abstract
The purpose of this study is to compare the early outcome of tricuspid
valve repair using prosthetic ring annuloplasty versus suture
annuloplasty. Method(s): In the period between March 2016 and
September 2017, 40 patients with severe functional tricuspid regurgitation
(TR) secondary to rheumatic mitral with or without aortic valve pathology
divided into two equal groups underwent open heart surgery at Kasr Al-Aini
Hospitals, Cardiothoracic surgery department. Group (1) had tricuspid
valve repair using suture annuloplasty, while Group (2) had tricuspid
valve repair using prosthetic ring annuloplasty. All patients were
evaluated thoroughly preoperative, intra-operative, and post-operative.
Particular attention was paid to clinical and echocardiographic findings
of presence of tricuspid regurgitation (TR), its nature and degree,
postoperative intensive care unit (ICU) events, ICU stay, hospital stay
and follow up of the degree of TR post-operatively. Result(s):
Evaluation showed that there is no significant difference between results
of suture annuloplasty and prosthetic ring annuloplasty early
postoperative, while late postoperative studies had proven significantly
better outcomes with prosthetic ring annuloplasty than with suture
annuloplasty techniques concerning low rate of recurrent TR.
 Conclusion(s): we concluded that using prosthetic ring for tricuspid
valve repair was better than suture annuloplasty techniques as it was
associated with less frequent rates of late postoperative recurrent
TR. Copyright © 2019, Indian Journal of Public Health Research
and Development. All rights reserved.

<4>
Accession Number
2002768022
Title
Health-related quality of life for patients with cardiovascular disease
after a coronary artery bypass graft: A systematic review.
Source
Indian Journal of Public Health Research and Development. 10 (8) (pp
2606-2610), 2019. Date of Publication: August 2019.
Author
Sukartini T.; Arifin H.; Rohmah U.N.; Ramadhani D.R.
Institution
(Sukartini, Arifin, Rohmah, Ramadhani) Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia
Publisher
Institute of Medico-Legal Publications
Abstract
CABG can affect health-related quality of life (HRQoL) and it can take a
long time to improve. The following question was raised: 'How long does it
take for the HRQoL of patients with a Coronary Artery Bypass Graft (CBAG)
to increase?' The aim was to analyze the recent scientific production of
HRQoL in cardiovascular patients with CABG. The PRISMA approach was used
and we examined articles from Scopus, EBSCO and ProQuest that were
published between 2014 - 2018. We used "health related quality of life",
restricted our search to "coronary artery bypass graft" and used "after"
in the title, keywords and abstract connected by the Boolean operator
"AND". SF-36 was used to assess the HRQoL and it increased within six
months after CABG. This was influenced by self-control, obesity, age,
gender, emotions and personality. Improving the patient's quality of life
is key for the nurses to control so then the heart surgery patients become
prosperous and thus reduce their morbidity and mortality. Copyright
© 2019, Indian Journal of Public Health Research and Development. All
rights reserved.

<5>
Accession Number
2005006532
Title
Polymer-free drug-coated vs. bare-metal coronary stents in patients
undergoing non-cardiac surgery: a subgroup analysis of the LEADERS FREE
trial.
Source
Clinical Research in Cardiology. 110 (2) (pp 162-171), 2021. Date of
Publication: February 2021.
Author
Richardt G.; Abdelghani M.; Allali A.; Toelg R.; Abdellaoui M.; Krackhardt
F.; Wiseth R.; Morice M.-C.; Copt S.; Stoll H.-P.; Urban P.
Institution
(Richardt, Abdelghani, Allali, Toelg) Heart Center, Segeberger Kliniken,
Am Kurpark 1, Bad Segeberg 23795, Germany
(Abdelghani) Cardiology Department, Amesterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
(Abdelghani) Cardiology Department, Al-Azhar University, Cairo, Egypt
(Abdellaoui) Groupe Hospitalier Mutualiste de Grenoble (GHM), Grenoble,
France
(Krackhardt) Charite Campus Virchow Klinikum, Berlin, Germany
(Wiseth) Norwegian University of Science and Technology, Trondheim, Norway
(Morice) Cardiovascular European Research Center CERC, Massy, France
(Copt, Stoll) Biosensors Clinical Research, Morges, Switzerland
(Urban) Hopital LaTour, Geneva, Switzerland
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: To compare the outcomes of patients undergoing non-cardiac surgery
(NCS) after PCI with either a drug-coated stent (DCS) or a bare-metal
stent (BMS), followed by 1-month dual antiplatelet therapy and to explore
the impact of the timing of NCS. Method(s): This is a subgroup
analysis of the LEADERS FREE trial. The primary safety end point was a
composite of cardiac death, myocardial infarction, or stent thrombosis,
and the primary efficacy end point was clinically driven target lesion
revascularization (TLR). Result(s): Out of 2432 patients included in
the LEADERS FREE trial, 278 (11.4%) underwent NCS within 1 year after PCI.
Among NCS patients, the 1-year safety end point was numerically lower with
DCS; however, this difference was not significant as compared to BMS (4.7%
vs. 10.1%, HR: 0.459 [0.178-1.183], p = 0.099), clinically driven TLR was
significantly lower after DCS (2.4% vs. 8.3%, HR: 0.281 [0.079-0.996], p =
0.036), and BARC 3-5 bleeding was similar with DCS vs. BMS (10.2% vs.
7.5%, p = 0.438). In patients treated with BMS, NCS within 3 months after
PCI was associated with higher incidence of the safety end point than NCSs
performed later: 14.9% vs. 4.4%, HR: 3.586 [1.012-12.709], p = 0.034. The
timing of surgery had no impact on patients treated with DCS (4.7% vs.
4.7%, p = 0.947). Conclusion(s): Among patients undergoing NCS after
PCI, DCS-treated patients had a lower probability of clinically driven TLR
compared with BMS. However, there was no significant difference in the
occurrence of the primary composite safety end point or bleeding
complications. Early NCS after BMS-PCI was associated with impaired
safety, while the timing of NCS had no such influence after DCS
implantation. Graphic abstract: [Figure not available: see
fulltext.]. Copyright © 2020, Springer-Verlag GmbH Germany, part
of Springer Nature.

<6>
Accession Number
2010619767
Title
First in human experience with an epicardial beating heart device for
secondary mitral regurgitation.
Source
Journal of Thoracic and Cardiovascular Surgery. 161 (3) (pp 949-958.e4),
2021. Date of Publication: March 2021.
Author
Thourani V.H.; George I.; Rucinskas K.; Kalinauskas G.; Janusauskas V.;
Zakarkaite D.; Ailawadi G.; Smith R.; Mack M.J.
Institution
(Thourani) Department of Cardiovascular Surgery, Marcus Valve Center,
Piedmont Heart Institute, Atlanta, Ga, United States
(George) Division of Cardiothoracic Surgery, New York Presbyterian
Hospital-Columbia University Medical Center, New York, NY, United States
(Rucinskas, Kalinauskas, Janusauskas, Zakarkaite) Vilnius University
Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
(Ailawadi) Division of Cardiothoracic Surgery, University of Virginia,
Charlottesville, Va, United States
(Smith, Mack) Baylor Scott & White Heart and Vascular Hospital, Plano,
Tex, United States
Publisher
Mosby Inc.
Abstract
Objective: We describe a novel, off-pump, epicardial implant that is
intended to reshape both the mitral valve annulus and the left ventricle
(LV) in those with secondary mitral regurgitation (MR). Method(s):
Five patients underwent an epicardial implant with the Mitral Touch device
(Mitre Medical Corp, Morgan Hill, Calif), during concomitant off-pump
coronary artery bypass for secondary MR. The median age was 71.2 years; 4
patients had severe MR and 1 moderate. Patients were followed for 1 year
with transthoracic echocardiography and computed tomography. Safety,
cardiac remodeling, and MR were assessed by an independent core
laboratory. Result(s): One patient died within 30 days from
nondevice-related organ failure and the remaining 4 survived through
1-year follow-up. Implant technical success was 100% and took an average
of 52 minutes. Paired computed tomography showed mean left ventricular
end-systolic volume remodeling at 1 and 12 months of -35% and -31%,
respectively. They averaged left atrial end-systolic volume remodeling of
-12% and -15% at 1 and 12 months. Right ventricular end-systolic volume
changes of -19% and -8% and right atrial end-systolic volume remodeling of
-5% and 1%, at the 1- and 12-month time points were noted. Regurgitant
volume by transthoracic echocardiography decreased by 46% and 44% and the
ejection fraction from 34.6% to 32.1% and 39.5%, at 1 and 12 months,
respectively. There were no device-related complications reported to 1
year. Conclusion(s): The Epicardial Mitral Touch System for Mitral
Regurgitation (ENRAPT-MR) study demonstrates a first-in-man, off-pump,
epicardial repair of secondary MR. Procedural safety and geometric
correction of the mitral valve apparatus and LV was achieved. Further
studies in the United States are underway. Copyright © 2020 The
American Association for Thoracic Surgery

<7>
Accession Number
633005883
Title
Edoxaban versus Warfarin in Patients with Atrial Fibrillation at the
Extremes of Body Weight: An Analysis from the ENGAGE AF-TIMI 48 Trial.
Source
Thrombosis and Haemostasis. 121 (2) (pp 140-149), 2021. Date of
Publication: 01 Feb 2021.
Author
Boriani G.; Ruff C.T.; Kuder J.F.; Shi M.; Lanz H.J.; Antman E.M.;
Braunwald E.; Giugliano R.P.
Institution
(Boriani) Cardiology Division, Department of Biomedical, Metabolic and
Neural Sciences, University of Modena and Reggio Emilia, Modena University
Hospital, Modena, Italy
(Ruff, Kuder, Antman, Braunwald, Giugliano) Timi Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital and Department of
Medicine, Harvard Medical School, Boston, MA, United States
(Shi) Daiichi Sankyo Inc., Basking Ridge, NJ, United States
(Lanz) Daiichi Sankyo Europe GmbH, Munich, Germany
Publisher
Georg Thieme Verlag
Abstract
Background a The effects of anticoagulants at extremes of body weight (BW)
are not well described. The aim of this study was to analyze the
pharmacokinetics/pharmacodynamics and clinical outcomes in patients
randomized to warfarin, higher dose edoxaban (HDER), and lower dose
edoxaban (LDER) regimens at extremes of BW in ENGAGE AF-TIMI 48. Methods
and Results a We analyzed three BW groups: low BW (LBW: <5th percentile,
<=55 kg, N = 1,082), middle BW (MBW: 45th-55th percentile, 79.8-84 kg, N =
2,153), and high BW (HBW: >95th percentile, >=120 kg, N = 1,093). In the
warfarin arm, LBW patients had higher rates of stroke/systemic embolism
(SSE: 6.5 vs. 4.7 in MBW vs. 1.6% in HBW, P <inf>trend</inf>< 0.001),
major bleeding (MB: 9.3 vs. 7.7 vs. 6.5%, P <inf>trend</inf>= 0.08), and
worse net clinical outcome of systemic embolic event, MB, or death (31.5
vs. 19.1 vs. 16.0%, P <inf>trend</inf>< 0.0001). The time-in-Therapeutic
range with warfarin was lowest in LBW patients (63.0 vs. 69.3 vs. 70.1%
patients, P <inf>trend</inf>< 0.001). The pharmacokinetic/pharmacodynamic
profile of edoxaban was consistent across BW groups. The risk of SSE was
similar between HDER and warfarin for each of the three weight groups (P
<inf>int</inf>= 0.52, P <inf>int-Trend</inf>= 0.86). MB was reduced by
LDER versus warfarin (P <inf>int</inf>= 0.061, P <inf>int-Trend</inf>=
0.023), especially in LBW patients. Net clinical outcomes were improved by
HDER versus warfarin (P <inf>int</inf>= 0.087, P <inf>int-Trend</inf>=
0.027), especially in LBW patients. Conclusion a Patients with LBW in
ENGAGE AF-TIMI 48 had in general a more fragile clinical status and poorer
international normalized ratio control. The
pharmacokinetic/pharmacodynamic profile of edoxaban was consistent across
extremes of BW, resulting in similar efficacy compared with warfarin,
while major or clinically relevant non-MB and net outcomes were most
favorable with edoxaban as compared to warfarin in LBW
patients. Copyright © 2021 Georg Thieme Verlag. All rights
reserved.

<8>
Accession Number
2010081826
Title
Mechanical Versus Bioprosthetic Valve Replacement in the Tricuspid Valve
Position: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 30 (3) (pp 362-371), 2021. Date of
Publication: March 2021.
Author
Negm S.; Arafat A.A.; Elatafy E.E.; Fawzy H.F.
Institution
(Negm, Arafat, Elatafy, Fawzy) Cardiothoracic Surgery Department, Tanta
University, Egypt
Publisher
Elsevier Ltd
Abstract
Background: The ideal prosthesis for tricuspid valve replacement (TVR)
continues to be debated. There are few published data comparing mechanical
and bioprosthetic valves, and all are retrospective studies with
relatively small sample sizes. Aim(s): This study was conducted to
compare mechanical and bioprosthetic valves for TVR. Method(s): A
literature search of six databases (PubMed, EMBASE, Ovid, ScienceDirect,
JSTOR, and Wiley Blackwell's online library) was performed with the
keywords "tricuspid valve disease, tricuspid valve replacement and
(bioprosthetic or mechanical)". Primary outcomes were hospital mortality,
long-term survival, tricuspid valve reoperation, valve failure,
thrombosis, and thrombo-embolism. Risk ratio (RR) was used to compare
dichotomous parameters and time-to-event outcomes. "Survival and
re-interventions" were pooled using a meta-analysis of hazard ratios (HR).
Publication bias was accessed using a funnel plot. Result(s): A total
of 23 retrospective studies involving 945 mechanical and 1,332 biological
tricuspid prostheses were included. The studies were published between
January 2002 and September 2019. Hospital mortality (30-day mortality) did
not differ between groups (RR, 0.83; 95% confidence interval [CI],
0.66-1.05; p=0.12). Long-term survival was evaluated in 15 studies, and it
was not significantly different between patients with mechanical compared
with those with bioprosthetic valves (pooled HR, 0.97; 95% CI, 0.61-1.54;
p=0.88). Freedom from tricuspid valve reoperation was assessed in eight
studies, and no difference was found between the groups (pooled HR, 1.03;
95% CI, 0.63-1.69; p=0.89). Valve failure in the 5-year postoperative
period was evaluated by seven studies, and there was no statistically
significant difference between the two groups (pooled RR, 1.33; 95% CI,
0.42-4.27; p=0.63). Conclusion(s): The results of this meta-analysis
suggest an equal risk of 30-day and late mortality, reoperation, and
5-year valve failure in patients with mechanical versus biological TVR.
The choice of the prosthesis in the tricuspid position should depend
mainly on the patient's risk factors and no superiority of one prosthesis
over the other in this position. Copyright © 2020 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<9>
Accession Number
2010977230
Title
Early postoperative statin administration does not affect the rate of
atrial fibrillation after cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 57 (6) (pp 1154-1159), 2020.
Date of Publication: 01 Jun 2020.
Author
Khan J.A.; Laurikka J.O.; Jarvinen O.H.; Khan N.K.; Jarvela K.M.
Institution
(Khan, Laurikka, Jarvela) Department of Cardio-Thoracic Surgery, Tays
Heart Hospital, Tampere University Hospital, Tampere, Finland
(Laurikka, Jarvinen) Faculty of Medicine and Health Technology, Tampere
University, Tampere, Finland
(Khan) Centre for Vascular Surgery and Interventional Radiology, Tampere
University Hospital, Tampere, Finland
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: Postoperative atrial fibrillation is the most frequent
complication after cardiac surgery, and the use of statins in preventing
them is being extensively studied. The aim of this study was to
investigate whether a pause in the administration of statins affects the
occurrence of atrial fibrillation after cardiac surgery in a prospective
randomized and controlled setting. Method(s): A total of 301 patients
without chronic atrial fibrillation with prior statin medication scheduled
for elective or urgent cardiac surgery involving the coronary arteries
and/or heart valves were prospectively recruited and randomized for statin
re-initiation on either the first (immediate statin group) or the fifth
(late statin group) postoperative day, using the original medication and
dosage. The immediate statin group comprised 146 patients and the late
statin group 155 patients. Except for a somewhat higher rate of males (85%
vs 73%, P = 0.016) in the immediate statin group, the baseline
characteristics and the distribution of procedures performed within the
groups were comparable. The occurrence of postoperative atrial
fibrillation and the clinical course of the patients were compared between
the groups. Result(s): The incidence of atrial fibrillation was 46%
and the median delay after surgery before the onset of atrial fibrillation
was 3 days in both groups (P = NS). No differences were observed in the
frequency of the arrhythmia in any subgroup analyses or in other major
complications or clinical parameters. No adverse effects related to early
statin administration were detected. Conclusion(s): Early
re-initiation of statins does not appear to affect the occurrence of
postoperative atrial fibrillation. Copyright © 2020 The
Author(s).

<10>
Accession Number
2010468340
Title
Anesthetic protocol for right ventricular dysfunction management in heart
transplantation: systematic review, development and validation.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 46. Date
of Publication: December 2021.
Author
Barros L.N.; Uchoa R.B.; Mejia J.A.C.; Nunes R.R.; Barros D.A.S.N.;
Rodrigues Filho F.
Institution
(Barros, Mejia, Rodrigues Filho) State University of Ceara, Fortaleza,
Brazil
(Barros, Uchoa, Mejia, Rodrigues Filho) Dr Carlos Alberto Studart Gomes -
Messejana Hospital, Fortaleza, Brazil
(Barros, Nunes, Barros) Fortaleza General Hospital, Fortaleza, Brazil
(Rodrigues Filho) Professor in Professional Master's in Transplants, State
University of Ceara, Fortaleza, Brazil
Publisher
BioMed Central Ltd
Abstract
Background: Right Ventricular Dysfunction (RVD) is the most frequent
intraoperative hemodynamic complication in Heart Transplantation (HTx).
RVD occurs in 0.04-1.0% of cardiac surgeries with cardiotomy and in 20-50%
of HTx, with mortality up to 75%. No consensus has been established for
how anesthesiologists should manage RVD, with management methods many
times remaining unvalidated. Method(s): We conducted a systematic
review, following PRISMA guidelines, to create an anesthetic protocol to
manage RVD in HTx, using databases that include PubMed and Embase, until
September 2018 based on inclusion and exclusion criteria. The articles
screening for the systematic review were done two independent reviewers,
in case of discrepancy, we consulted a third independent reviewer. Based
on the systematic review, the anesthetic protocol was developed. The
instrument selected to perform the validation of the protocol was AGREE
II, for this purpose expert anesthetists were recruited to do this
process. The minimum arbitration score for domains validation cutoff of
AGREE II is arbitered to 70%. This study was registered at PROSPERO
(115600). Result(s): In the systematic review, 152 articles were
included. We present the protocol in a flowchart with six steps based on
goal-directed therapy, invasive monitoring, and transesophageal
echocardiogram. Six experts judged the protocol and validated it.
 Conclusion(s): The protocol has been validated by experts and new
studies are needed to assess its applicability and potential benefits on
major endpoints. Copyright © 2021, The Author(s).

<11>
Accession Number
2011014770
Title
The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane
Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Kaddoura R.; Omar A.S.; Ibrahim M.I.M.; Alkhulaifi A.; Lorusso R.;
Elsherbini H.; Soliman O.; Caliskan K.
Institution
(Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical
Corporation, Doha, Qatar
(Omar, Alkhulaifi) Department of Cardiothoracic Surgery/Cardiac Anesthesia
& ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
(Ibrahim) Faculty of Pharmacy, Qatar University, Doha, Qatar
(Lorusso) Maastricht University Medical Centre (MUMC) Cardiovascular
Research Institute, Maastricht (CARIM) Maastricht University, Roterdam,
Netherlands
(Elsherbini) Cardiology, Erasmus University Medical Center, Roterdam,
Netherlands
(Soliman) National University of Ireland Galway, Galway, Ireland
(Caliskan) Cardiology, Erasmus University Medical Center, Roterdam,
Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)
provides a temporary support system for patients with cardiogenic shock
refractory to conventional medical therapies. It has been reported that
levosimendan may facilitate VA-ECMO weaning and improve survival. The
primary objective of this review was to examine the effect of levosimendan
use on VA-ECMO weaning and mortality in critically ill patients on
VA-ECMO. Design(s): MEDLINE, EMBASE, and CENTRAL were searched. A
pair of reviewers identified eligible clinical trials. Two reviewers
extracted data and independently assessed the risk of bias. A
random-effect model was used to combine data. The primary outcome was the
success of weaning from VA-ECMO. Measurements and Main Results: Seven
studies of observational design, including a total of 630 patients, were
selected in the final analysis. The sample size ranged from ten-to-240
patients, with a mean age between 53 and 65 years, and more than half of
them underwent cardiac surgeries. The VA-ECMO durations varied between
four and 11.6 days. Overall, levosimendan use was significantly associated
with successful weaning compared with control (odds ratio [OR] 2.89, 95%
CI, 1.53-5.46; p<inf>overall effect</inf> = 0.001); I2 = 49%).
For survival, six studies (n = 617) were included in the meta-analysis
involving 326 patients in the levosimendan group and 291 in the comparator
group. Pooled results showed a significantly higher survival rate in the
levosimendan group (OR 0.46, 95% CI, 0.30-0.71; p<inf>overall effect</inf>
= 0.0004; I2 = 20%). Conclusion(s): Levosimendan therapy
was significantly associated with successful weaning and survival benefit
in patients with cardiogenic or postcardiotomy shock needing VA-ECMO
support for severe cardiocirculatory compromise. To date, there is limited
literature and absence of evidence from randomized trials addressing the
use of levosimendan in VA-ECMO weaning. This study may be considered a
hypothesis-generating research for randomized controlled trials to confirm
its findings. Copyright © 2021 The Authors

<12>
Accession Number
2010974301
Title
Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices
Considered for Heart Transplantation: Systematic Review and Individual
Participant Data Meta-analysis.
Source
Journal of Cardiac Failure. 27 (3) (pp 338-348), 2021. Date of
Publication: March 2021.
Author
daSilva-deAbreu A.; ALHAFEZ B.A.; CURBELO-PENA Y.; LAVIE C.J.; VENTURA
H.O.; LORO-FERRER J.F.; MANDRAS S.A.
Institution
(daSilva-deAbreu, LAVIE, VENTURA, MANDRAS) John Ochsner Heart and Vascular
Institute, Ochsner Clinic Foundation, New Orleans, LA, United States
(daSilva-deAbreu, LAVIE, VENTURA, MANDRAS) The University of Queensland
Ochsner Clinical School, New Orleans, LA, United States
(daSilva-deAbreu, LORO-FERRER) Doctoral School, Universidad de Las Palmas
de Gran Canaria, Las Palmas, Spain
(ALHAFEZ) Department of Internal Medicine, The Ohio State University,
Columbus, OH, United States
(CURBELO-PENA) Service of General Surgery, Consorci Sanitari de l'Alt
Penedes i Garraf, Barcelona, Spain
Publisher
Elsevier B.V.
Abstract
Background: Class II obesity (body mass index BMI >=35 kg/m2)
is a contraindication to heart transplantation (HT). Although few
single-center studies (case reports/series and small cohorts) have
reported promising outcomes of bariatric surgery (BS) in patients with
obesity and ventricular assist devices, low sample sizes have made their
analysis and interpretation challenging. Methods and Results: We
conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase,
PubMed, Google Scholar, and most relevant bariatric and heart failure
journals. We extracted baseline and outcome individual participant data
for every ventricular assist device patient undergoing BS with reported
postoperative BMI and their respective timepoints when BMI data were
measured. Fourteen references with 29 patients were included. The mean age
was 41.9 +/- 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy,
and 39.3% had reported perioperative adverse events. The mean pre-BS BMI
was 45.5 +/- 6.6 kg/m2 and decreased significantly during
follow-up (rho -0.671; P< .00001). Among 23 patients with documented
listing status, 78.3% were listed for HT. Thirteen of 28 patients (46.4%)
underwent HT at 14.4 +/- 7.0 months. There were no reported deaths for the
HT-free 1-year period. Median follow-up was 24 months (interquartile
range, 12-30 months). Twenty-two of 28 patients (78.6%) achieved the
composite outcome (BMI of<35 kg/m2/HT/listing for HT/myocardial
recovery) at 11 months (interquartile range, 3-17 months). Patients with a
BMI<45 kg/m2 had a higher chance of achieving the composite
outcome (P< .003). Conclusion(s): BS may help patients with obesity
and ventricular assist devices to lose a significant amount of weight and
improve their candidacy for HT or even achieve myocardial
recovery. Copyright © 2020 Elsevier Inc.

<13>
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.

<14>
Accession Number
2010851713
Title
Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral
Regurgitation.
Source
Journal of the American College of Cardiology. 77 (6) (pp 713-724), 2021.
Date of Publication: 16 Feb 2021.
Author
Bertrand P.B.; Overbey J.R.; Zeng X.; Levine R.A.; Ailawadi G.; Acker
M.A.; Smith P.K.; Thourani V.H.; Bagiella E.; Miller M.A.; Gupta L.; Mack
M.J.; Gillinov A.M.; Giustino G.; Moskowitz A.J.; Gelijns A.C.; Bowdish
M.E.; O'Gara P.T.; Gammie J.S.; Hung J.; Taddei-Peters W.C.; Buxton D.;
Caulder R.; Geller N.L.; Gordon D.; Jeffries N.O.; Lee A.; Moy C.S.;
Gombos I.K.; Ralph J.; Weisel R.D.; Gardner T.J.; Rose E.A.; Parides M.K.;
Ascheim D.D.; Moquete E.; Chang H.; Chase M.; Foo J.; Chen Y.; Goldfarb
S.; Kirkwood K.; Dobrev E.; Levitan R.; O'Sullivan K.; Overbey J.; Santos
M.; Williams D.; Weglinski M.; Williams P.; Wood C.; Ye X.; Nielsen S.L.;
Wiggers H.; Malgaard H.; Mack M.; Adame T.; Settele N.; Adams J.; Ryan W.;
Smith R.L.; Grayburn P.; Chen F.Y.; Nohria A.; Cohn L.; Shekar P.; Aranki
S.; Couper G.; Davidson M.; Bolman R.M.; Burgess A.; Conboy D.; Lawrence
R.; Noiseux N.; Stevens L.-M.; Prieto I.; Basile F.; Dionne J.; Fecteau
J.; Blackstone E.H.; Lackner P.; Berroteran L.; Dolney D.; Fleming S.;
Palumbo R.; Whitman C.; Sankovic K.; Sweeney D.K.; Geither C.; Doud K.;
Pattakos G.; Clarke P.A.; Argenziano M.; Williams M.; Goldsmith L.; Smith
C.R.; Naka Y.; Stewart A.; Schwartz A.; Bell D.; Van Patten D.; Sreekanth
S.; Alexander J.H.; Milano C.A.; Glower D.D.; Mathew J.P.; Harrison J.K.;
Welsh S.; Berry M.F.; Parsa C.J.; Tong B.C.; Williams J.B.; Ferguson T.B.;
Kypson A.P.; Rodriguez E.; Harris M.; Akers B.; O'Neal A.; Puskas J.D.;
Guyton R.; Baer J.; Baio K.; Neill A.A.; Voisine P.; Senechal M.; Dagenais
F.; O'Connor K.; Dussault G.; Ballivian T.; Keilani S.; Speir A.M.; Magee
P.; Ad N.; Keyte S.; Dang M.; Slaughter M.; Headlee M.; Moody H.; Solankhi
N.; Birks E.; Groh M.A.; Shell L.E.; Shepard S.A.; Trichon B.H.; Nanney
T.; Hampton L.C.; Mangusan R.; Michler R.E.; D'Alessandro D.A.; DeRose
J.J.; Goldstein D.J.; Bello R.; Jakobleff W.; Garcia M.; Taub C.; Spevak
D.; Swayze R.; Sookraj N.; Perrault L.P.; Basmadjian A.-J.; Bouchard D.;
Carrier M.; Cartier R.; Pellerin M.; Tanguay J.F.; El-Hamamsy I.; Denault
A.; Demers P.; Jonathan Lacharite S.R.; Horvath K.A.; Corcoran P.C.;
Siegenthaler M.P.; Murphy M.; Iraola M.; Greenberg A.; Sai-Sudhakar C.;
Hasan A.; McDavid A.; Kinn B.; Page P.; Sirois C.; Latter D.; Leong-Poi
H.; Bonneau D.; Errett L.; Peterson M.D.; Verma S.; Feder-Elituv R.; Cohen
G.; Joyner C.; Fremes S.E.; Moussa F.; Christakis G.; Karkhanis R.; Yau
T.; Farkouh M.; Woo A.; Cusimano R.J.; David T.; Feindel C.; Garrard L.;
Fredericks S.; Mociornita A.; Mullen J.C.; Choy J.; Meyer S.; Kuurstra E.;
Young C.A.; Beach D.; Villanueva R.; Atluri P.; Woo Y.J.; Mayer M.L.;
Bowdish M.; Starnes V.A.; Shavalle D.; Matthews R.; Javadifar S.; Romar
L.; Kron I.L.; Johnston K.; Dent J.M.; Kern J.; Keim J.; Burks S.; Gahring
K.; Bull D.A.; Desvigne-Nickens P.; Dixon D.O.; Haigney M.; Holubkov R.;
Jacobs A.; Miller F.; Murkin J.M.; Spertus J.; Wechsler A.S.; Sellke F.;
McDonald C.L.; Byington R.; Dickert N.; Ikonomidis J.S.; Williams D.O.;
Yancy C.W.; Fang J.C.; Giannetti N.; Richenbacher W.; Rao V.; Furie K.L.;
Miller R.; Pinney S.; Roberts W.C.; Walsh M.N.; Kilcullen N.; Hung D.;
Keteyian S.J.; Brawner C.A.; Aldred H.; Browndyke J.; Toulgoat-Dubois Y.
Institution
(Bertrand, Zeng, Levine, Hung) Division of Cardiology, Massachusetts
General Hospital, Boston, MA, United States
(Overbey, Bagiella, Gupta, Giustino, Moskowitz, Gelijns) Department of
Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Ailawadi) Section of Adult Cardiac Surgery, University of Virginia,
Charlottesville, VA, United States
(Acker) Division of Cardiovascular Surgery, Department of Surgery,
University of Pennsylvania School of Medicine, Philadelphia, PA, United
States
(Smith) Department of Surgery, Duke University Medical Center, Durham, NC,
United States
(Thourani) Cardiothoracic Surgery, Piedmont Heart Institute, Atlanta, GA,
United States
(Miller) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, MD, United
States
(Mack) Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott &
White Health, Plano, TX, United States
(Gillinov) Department of Thoracic & Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Bowdish) Department of Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
(Gammie) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Background: Whether to repair nonsevere tricuspid regurgitation (TR)
during surgery for ischemic mitral valve regurgitation (IMR) remains
uncertain. Objective(s): The goal of this study was to investigate
the incidence, predictors, and clinical significance of TR progression and
presence of >=moderate TR after IMR surgery. Method(s): Patients (n =
492) with untreated nonsevere TR within 2 prospectively randomized IMR
trials were included. Key outcomes were TR progression (either progression
by >=2 grades, surgery for TR, or severe TR at 2 years) and presence of
>=moderate TR at 2 years. Result(s): Patients' mean age was 66 +/- 10
years (67% male), and TR distribution was 60% <=trace, 31% mild, and 9%
moderate. Among 2-year survivors, TR progression occurred in 20 (6%) of
325 patients. Baseline tricuspid annular diameter (TAD) was not predictive
of TR progression. At 2 years, 37 (11%) of 323 patients had >=moderate TR.
Baseline TR grade, indexed TAD, and surgical ablation for atrial
fibrillation were independent predictors of >=moderate TR. However, TAD
alone had poor discrimination (area under the curve, <=0.65). Presence of
>=moderate TR at 2 years was higher in patients with MR recurrence (20%
vs. 9%; p = 0.02) and a permanent pacemaker/defibrillator (19% vs. 9%; p =
0.01). Clinical event rates (composite of >=1 New York Heart Association
functional class increase, heart failure hospitalization, mitral valve
surgery, and stroke) were higher in patients with TR progression (55% vs.
23%; p = 0.003) and >=moderate TR at 2 years (38% vs. 22%; p = 0.04).
 Conclusion(s): After IMR surgery, progression of unrepaired nonsevere
TR is uncommon. Baseline TAD is not predictive of TR progression and is
poorly discriminative of >=moderate TR at 2 years. TR progression and
presence of >=moderate TR are associated with clinical events. (Comparing
the Effectiveness of a Mitral Valve Repair Procedure in Combination With
Coronary Artery Bypass Grafting [CABG] Versus CABG Alone in People With
Moderate Ischemic Mitral Regurgitation, NCT00806988; Comparing the
Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in
People With Severe Chronic Ischemic Mitral Regurgitation,
NCT00807040) Copyright © 2021 American College of Cardiology
Foundation

<15>
Accession Number
634096179
Title
Corrigendum to: Clinical and Conceptual Approaches to interpreting the
findings of Systematic Review and Meta-Analysis of Mortality after
drug-eluting stents vs. coronary artery bypass grafting for left main
coronary artery disease.
Source
European heart journal. 42 (7) (pp 797), 2021. Date of Publication: 14 Feb
2021.
Author
Anonymous
Publisher
NLM (Medline)

<16>
Accession Number
633300344
Title
A randomized controlled trial comparing controlled reoxygenation and
standard cardiopulmonary bypass in paediatric cardiac surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 59 (2) (pp 349-358),
2021. Date of Publication: 29 Jan 2021.
Author
Caputo M.; Scott L.J.; Deave T.; Dabner L.; Parry A.; Angelini G.D.;
Sheehan K.; Stoica S.; Ellis L.; Harris R.; Rogers C.A.
Institution
(Caputo, Parry, Sheehan, Stoica) Department of Cardiac Surgery, Bristol
Royal Hospital for Children, University Hospitals Bristol NHS Foundation
Trust, Bristol, United Kingdom
(Caputo, Angelini) Department of Cardiac Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Scott, Dabner, Ellis, Harris, Rogers) Department of Cardiac Surgery,
Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of
Bristol, Bristol, United Kingdom
(Deave) Department of Cardiac Surgery, Centre for Health and Clinical
Research, University of the West of England, Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Controlled reoxygenation on starting cardiopulmonary bypass
(CPB) rather than hyperoxic CPB may confer clinical advantages during
surgery for congenital cyanotic heart disease. METHOD(S): A
single-centre, randomized controlled trial was carried out to compare the
effectiveness of controlled reoxygenation (normoxia) versus hyperoxic CPB
in children with congenital cyanotic heart disease undergoing open-heart
surgery (Oxic-2). The co-primary clinical outcomes were duration of
inotropic support, intubation time and postoperative intensive care unit
(ICU) and hospital stay. Analysis of the primary outcomes included data
from a previous trial (Oxic-1) conducted to the same protocol.
 RESULT(S): Ninety participants were recruited to Oxic-2 and 79 were
recruited to the previous Oxic-1 trial. There were no significant
differences between the groups for any of the co-primary outcomes:
inotrope duration geometric mean ratio (normoxia/hyperoxic) 0.97, 95%
confidence interval (CI) (0.69-1.37), P-value=0.87; intubation time hazard
ratio (HR) 1.03, 95% CI (0.74-1.42), P-value=0.87; postoperative ICU stay
HR 1.14 95% CI (0.77-1.67), P-value=0.52, hospital stay HR 0.90, 95% CI
(0.65-1.25), P-value=0.53. Lower oxygen levels were successfully achieved
during the operative period in the normoxic group. Serum creatinine levels
were lower in the normoxic group at day 2, but not on days 1, 3-5.
Childhood developmental outcomes were similar. In the year following
surgery, 85 serious adverse events were reported (51 normoxic group and 34
hyperoxic group). CONCLUSION(S): Controlled reoxygenation (normoxic)
CPB is safe but with no evidence of a clinical advantage over hyperoxic
CPB. CLINICAL TRIAL REGISTRATION NUMBER: Current Controlled
Trials-ISRCTN81773762. Copyright © The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<17>
Accession Number
634212850
Title
Effects of modified ultrafiltration and conventional ultrafiltration
combination on perioperative clinical outcomes in pediatric cardiac
surgery: A meta-analysis.
Source
Medicine. 100 (3) (pp e24221), 2021. Date of Publication: 22 Jan 2021.
Author
Hu J.; Li P.; Chen X.; Yan J.; Zhang J.; Zhang C.
Institution
(Hu, Yan, Zhang) Department of Anesthesiology
(Li) Department of Obstetrics
(Li) Hunan Engineering Research Center of Early Life Development and
Disease Prevention
(Chen, Zhang) Department of Cardiovascular Surgery, Xiangya Hospital,
Changsha, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: This meta-analysis was performed to review the effects of the
addition of modified ultrafiltration (MUF) and conventional
ultrafiltration (CUF) to CUF alone on postoperative hemoglobin, surgical
and ultrafiltration data, and postoperative clinical outcomes in pediatric
patients undergoing cardiac surgery. METHOD(S): A systematic search
was performed to identify randomized controlled clinical trials that
compared MUF and CUF combination with CUF alone in pediatric cardiac
surgery undergoing cardiopulmonary bypass (CPB) in PubMed, Embase,
Cochrane Library, and Web of Science without any language or date
limitation in February 2020. For each included trial, the primary outcomes
including post-CPB and postoperative hematocrit, surgical and
ultrafiltration data, postoperative clinical outcomes including volume of
chest tube drainage within 48 hours after surgery and perioperative blood
requirement, ventilation support duration, and length of stay day in the
intensive care unit (ICU) and hospital were collected and analyzed. The
analysis was conducted using STATA version 12.0. RESULT(S): A total
of 8 trials encompassing 405 patients were included in this analysis.
Analysis indicated that MUF + CUF increased the post-CPB hematocrit
(Standard mean difference, SMD = 1.85, 95% confidence interval, 95% CI
0.91-2.79). Meanwhile, ultrafiltration volume was higher in CUF+MUF
infants than CUF-alone infants (SMD = 1.46, 95% CI 0.51-2.41, P = .003).
The clinical outcomes, including postoperative hemodynamic changes, prime
volume, blood requirement, chest tube drainage volume, mechanical
ventilation duration, and ICU duration, were unclear because of the
unstable sensitivity analyses. CONCLUSION(S): Beneficial effects of
using MUF and CUF for pediatric cardiac surgery, including increase
post-CPB hematocrit and ultrafiltration volume when compared with CUF
alone. Meanwhile, MUF and CUF did not significantly influence the
postoperative hospital stay duration, CPB, and aortic occlusion
duration. Copyright © 2021 the Author(s). Published by Wolters
Kluwer Health, Inc.

<18>
[Use Link to view the full text]
Accession Number
2007393685
Title
Comparison of external jugular vein-based surface landmark approach and
ultrasound-guided approach for internal jugular venous cannulation: A
randomised crossover clinical trial.
Source
International Journal of Clinical Practice. 75 (3) (no pagination), 2021.
Article Number: e13783. Date of Publication: March 2021.
Author
Vinayagamurugan A.; Badhe A.S.; Jha A.K.
Institution
(Vinayagamurugan, Badhe, Jha) Anesthesiology and Critical Care, Jawaharlal
Institute of Postgraduate Medical Education and Research, Puducherry,
India
Publisher
Blackwell Publishing Ltd
Abstract
Background and objective: Historically, landmark techniques for central
venous access through the internal jugular vein (IJV) have yielded a
lesser success rate and higher complication rate than the ultrasound
(US)-guided approach. The purpose of this study is to assess the success
and safety of a novel external jugular vein (EJV)-based landmark (EJV-LM)
approach compared with the real-time US-guided approach for central venous
access through the IJV. Method(s): This was a prospective,
randomised, crossover trial performed in patients during elective cardiac
and non-cardiac surgery. Each resident randomly inserted a central venous
catheter using EJV-LM approach and real-time US-guided approach. The
primary outcome was first-attempt success. Secondary outcomes included
overall success rate, number of puncture attempts, cannulation time,
haematoma and mechanical complications. Result(s): A total of 188
patients were randomly assigned to the EJV-LM and US groups. The
demographic characteristics of the groups were comparable. The
first-attempt success was not different between EJV-LM and US-guided
techniques (79.8%; [95% CI: 70.2-87.4] vs 89.4% [95% CI 81.3-94.8]; P
=.06). The overall success rate was 100% with both techniques. There were
no differences in the number of puncture attempts with introducer needle
(1[1-3] vs 1[1-2]; P =.07). Cannulation time was longer in the EJV-LM
group compared with the US group (58.11 +/- 6.6 vs 44.27 +/- 5.28 seconds;
P =.0001). EJV-LM technique was associated with a higher occurrence of
overall complications compared with the US technique (12.8% [95% CI: 6.7-
21.2] vs 4.2% [95% CI: 1.1-10.5]; P =.03). No major mechanical
complications were observed with either techniques. Conclusion(s): In
patients with non-distorted neck anatomy and a visible EJV, IJV
catheterisation using the EJV-based LM approach and standard US-guided
technique yielded similar first-attempt and overall success rates.
Cannulation time was longer and complications occurred more frequently in
the EJV-based LM compared with the standard US-guided
technique. Copyright © 2020 John Wiley & Sons Ltd

<19>
Accession Number
631935270
Title
Music Intervention in Pain Relief of Cardiovascular Patients in Cardiac
Procedures: A Systematic Review and Meta-analysis.
Source
Pain medicine (Malden, Mass.). 21 (11) (pp 3055-3065), 2020. Date of
Publication: 01 Nov 2020.
Author
Wang Y.; Wei J.; Guan X.; Zhang Y.; Zhang N.; Mao M.; Du W.; Ren Y.; Shen
H.; Liu P.
Institution
(Wang, Guan, Zhang, Zhang, Zhang, Mao, Du, Ren, Shen, Liu) Longhua
Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai,
China
(Wang, Guan, Zhang, Mao, Shen) Shanghai University of Traditional Chinese
Medicine, Shanghai, China
(Wei) Shanghai Xuhui Central Hospital, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Numerous meta-analyses have been conducted on music and pain,
but no studies have investigated music and cardiac procedural pain.
 OBJECTIVE(S): To assess the effects of music intervention on pain in
cardiac procedures in the published randomized controlled trials.
 METHOD(S): This study was conducted according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All
the included randomized controlled studies were published between 1999 and
2016. Studies were obtained from electronic databases or by hand-searching
of related journals and reference lists. The main outcome was pain
intensity, and the secondary outcomes were vital signs such as heart rate,
respiration rate, systolic blood pressure, and diastolic blood pressure.
Risk of bias of the included studies was evaluated according to the
Cochrane Collaboration guidelines. RESULT(S): Analysis of 14 studies
indicated that music interventions had statistically significant effects
on decreasing pain scales (mean deviation [MD] = -1.84), heart rate (MD =
-2.62), respiration rate (MD = -2.57), systolic blood pressure (MD =
-5.11), and diastolic blood pressure (MD = 0.44). The subgroup analysis
method was used in all five outcomes. CONCLUSION(S): Considering all
the possible benefits, music intervention may provide an effective
complement for the relief of cardiac procedural pain. Copyright ©
The Author(s) 2020. Published by Oxford University Press on behalf of the
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.

<20>
Accession Number
2011051129
Title
Systematic Reviews and Meta-Analyses in Cardiac Surgery: Rules of the Road
- Part 1.
Source
Annals of Thoracic Surgery. 111 (3) (pp 754-761), 2021. Date of
Publication: March 2021.
Author
Gaudino M.; Fremes S.; Bagiella E.; Bangalore S.; Demetres M.; D'Ascenzo
F.; Biondi-Zoccai G.; Di Franco A.
Institution
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook
Health Sciences Centre, University of Toronto, Toronto, ON, Canada
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Bangalore) New York University Grossman School of Medicine, New York, NY,
United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(D'Ascenzo) Division of Cardiology, Citta della Salute e della Scienza,
University of Turin, Turin, Italy
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Elsevier Inc.
Abstract
The number of cardiac surgical meta-analyses and systematic reviews
published in the last decades has constantly increased, paralleling the
exponential growth observed in virtually all other medical fields.
Meta-analyses are open to methodological flaws, however, if best practices
are not strictly followed. Assessment of the appropriateness of the
research question is a crucial first step. Once a protocol has been
developed, this should be registered before the work is initiated. The
cornerstone of any systematic review or meta-analysis is a rigorous,
comprehensive, and most of all reproducible, search that follows a
prespecified and clear strategy. Eligibility criteria must be discussed
and agreed upon in advance to guide final study selection, which
ultimately lays the foundation for subsequent data extraction. In case of
missing or partially reported data, the authors of the original papers
should be contacted. Adherence to rigorous methodological rules at each of
these stages will warrant availability of good quality data for formal
statistical analyses. The aim of the first part of this expert review is
to discuss the limits and pitfalls of the meta-analytic approach and
provide guidance on how to perform trial-level meta-analyses, with
particular reference to the identification of an appropriate research
question, the definition and registration of the protocol, the search
strategy, the study selection, and the data abstraction. Copyright
© 2021 The Society of Thoracic Surgeons

<21>
Accession Number
2011063063
Title
Invasive methods for the diagnosis and management of intrathoracic
extramedullary hematopoiesis: A literature review.
Source
Respiratory Medicine and Research. 79 (no pagination), 2021. Article
Number: 100815. Date of Publication: May 2021.
Author
Georgakopoulou V.E.; Damaskos C.; Mantzouranis K.; Melemeni D.; Gkoufa A.;
Chlapoutakis S.; Garmpis N.; Sklapani P.; Aravantinou A.; Garmpi A.;
Trakas N.; Tsiafaki X.
Institution
(Georgakopoulou) Pulmonology Department, Laiko General Hospital, 17 Agiou
Thoma Street, Athens 11527, Greece
(Damaskos, Garmpis) Second Department of Propedeutic Surgery, Laiko
General Hospital, Medical School, National and Kapodistrian University of
Athens, Athens, Greece
(Damaskos, Garmpis) N.S. Christeas Laboratory of Experimental Surgery and
Surgical Research, Medical School, National and Kapodistrian University of
Athens, Athens, Greece
(Mantzouranis, Melemeni, Tsiafaki) 1st Pulmonology Department Sismanogleio
Hospital, Athens, Greece
(Gkoufa, Aravantinou) First Department of Internal Medicine, Laiko General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens, Greece
(Chlapoutakis) Department of Thoracic Surgery, Agios Savvas Hospital,
Athens, Greece
(Sklapani) Department of Cytology, Mitera Hospital, Athens, Greece
(Garmpi) First Department of Propedeutic Internal Medicine, Laiko General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens, Greece
(Trakas) Department of Biochemistry, Sismanogleio Hospital, Athens, Greece
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Extramedullary hematopoiesis is defined as hematopoiesis
occurring outside of the bone marrow. It usually compensates insufficient
bone marrow function or ineffective erythropoiesis and is observed mostly
in hematological disorders. Most common locations of extramedullary
hematopoiesis are the spleen, the liver and the lymph nodes. Intrathoracic
extramedullary hematopoiesis is rare presenting as bilateral lobulated
masses of lower paravertebral regions. This review summarizes the role of
invasive techniques in the diagnosis and management of intrathoracic EMH
and its complications. Method(s): An electronic search in PubMed and
Google Scholar was conducted with the keywords "intrathoracic
extramedullary hematopoiesis" AND "surgery" OR "video-assisted thoracic
surgery (VATS)" OR "medical thoracoscopy" OR "biopsy" OR "thoracotomy" OR
"image-guided biopsy" OR "median sternotomy", within 1970 to 2020 with the
limitation of English language to include those articles reporting data on
invasive techniques in intrathoracic extramedullary hematopoiesis.
 Result(s): Overall, 93 articles were originally identified using our
search criteria and from the reference list of the previously identified
documents. Following elimination of duplicates, 29 were excluded after
title, abstract or full text screening, since they did not report the use
of invasive techniques in the diagnosis and management of intrathoracic
extramedullary hematopoiesis. Conclusion(s): Although in some cases
radiological features are typical for the diagnosis of intrathoracic
extramedullary hematopoeisis, invasive methods such as bronchoscopy with
transbronchial biopsy, image-guided fine needle aspiration, endobronchial
ultrasound-guided fine needle aspiration of the mass and mediastinoscopy,
medical thoracoscopy, median sternotomy, video-assisted thoracoscopic
surgery and thoracotomy, are essential for definite diagnosis and
management. Copyright © 2021 SPLF and Elsevier Masson SAS

<22>
Accession Number
2011051828
Title
Tricuspid Valve Prosthesis Choice: The Only Railroad to the Truth is to
Conduct a Randomised Controlled Trial.
Source
Heart Lung and Circulation. 30 (3) (pp 321-323), 2021. Date of
Publication: March 2021.
Author
El-Gamel A.
Institution
(El-Gamel) Waikato Hospital, Hamilton, New Zealand
(El-Gamel) Department of Surgery, Auckland University, Auckland, New
Zealand
Publisher
Elsevier Ltd

<23>
Accession Number
2011051161
Title
An Approach to Diversity and Inclusion in Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. 111 (3) (pp 747-752), 2021. Date of
Publication: March 2021.
Author
Erkmen C.P.; Ortmeyer K.A.; Pelletier G.J.; Preventza O.; Cooke D.T.
Institution
(Erkmen, Ortmeyer) Department of Thoracic Medicine and Surgery, Lewis Katz
School of Medicine, Temple University, Philadelphia, PA, United States
(Pelletier) Department of Anesthesiology & Critical Care, Nemours
Children's Health System, Wilmington, DE, United States
(Preventza) Division of Cardiothoracic Surgery, Baylor College of
Medicine, Houston, TX, United States
(Cooke) Section of General Thoracic Surgery, Department of Surgery,
University of California, Davis Health, Sacramento, CA, United States
Publisher
Elsevier Inc.
Abstract
Executive Summary: While the United States (US) population at large is
rapidly diversifying, cardiothoracic surgery is among the least diverse
specialties in terms of racial and gender diversity. Lack of diversity is
detrimental to patient care, physician well-being, and the relevance of
cardiothoracic surgery on our nation's health. Recent events, including
the coronavirus disease 2019 pandemic and the Black Lives Matter protests,
have further accentuated the gross inequities that underrepresented
minorities face in our country and have reignited conversations on how to
address bias and systemic racism within our institutions. The field of
cardiothoracic surgery has a responsibility to adopt a culture of
diversity and inclusion. This kind of systemic change is daunting and
overwhelming. With bias ubiquitously entangled with everyday experiences,
it can be difficult to know where to start. The Society of Thoracic
Surgeons Workforce on Diversity and Inclusion presents this approach for
addressing diversity and inclusion in cardiothoracic surgery. This
framework was adapted from a model developed by the National Institute on
Minority Health and Health Disparities and includes information and
recommendations generated from our literature review on diversity and
inclusion. A MEDLINE search was conducted using keywords "diversity,"
"inclusion," and "surgery," and approaches to diversity and inclusion were
drawn from publications in medicine as well as non-healthcare fields.
Recommendations were generated and approved by The Society of Thoracic
Surgeons Executive Committee. We present an overarching framework that
conceptualizes diversity and inclusion efforts in a series of concentric
spheres of influence, from the global environment to the cardiothoracic
community, institution, and the individual surgeon. This framework
organizes the approach to diversity and inclusion, grouping interventions
by level while maintaining a broader perspective of how each sphere is
interconnected. We include the following key recommendations within the
spheres of influence: 1. In the global environment, it is important to
understand how cardiothoracic surgery compares to fields outside of
surgery and medicine overall in diversity and inclusion, and
cardiothoracic surgeons should look to and learn from advances in other
professions. 2. Professional societies that represent the cardiothoracic
community share a responsibility to prioritize specialty-wide action to
improve diversity in membership, mentorship, leadership, and
representation at annual meetings. 3. Each institution (including health
systems, medical schools, and clinical departments/sections) must perform
a self-assessment of diversity and implement program-specific strategies
to achieve diversity goals. 4. Individual surgeons can create cultures of
inclusion by assessing personal implicit biases and advocating for
diversity and inclusion. It is important to note that each of the spheres
of influence is interconnected. Interventions to improve diversity must be
coordinated across spheres for concerted change. Altogether, this
multilevel framework (global environment, cardiothoracic community,
institution, and individual) offers an organized approach for
cardiothoracic surgery to assess, improve, and sustain progress in
diversity and inclusion. Copyright © 2021 The Society of Thoracic
Surgeons

<24>
Accession Number
2010734659
Title
Sutureless versus conventional bioprostheses for aortic valve replacement
in severe symptomatic aortic valve stenosis.
Source
Journal of Thoracic and Cardiovascular Surgery. 161 (3) (pp 920-932),
2021. Date of Publication: March 2021.
Author
Fischlein T.; Folliguet T.; Meuris B.; Shrestha M.L.; Roselli E.E.;
McGlothlin A.; Kappert U.; Pfeiffer S.; Corbi P.; Lorusso R.; Fabre O.;
Pinaud F.; Troise G.; Kueri S.; Siepe M.; Bonaros N.; Tan E.; Andreas M.;
Garcia-Puente J.; Voisine P.; Rega F.; Girdauskas E.; Berastegui E.; Hanke
T.; Kats S.; Blasio A.; Muneretto C.; Repossini A.; Tribastone S.; De
Kerchove L.; Mikus E.; Solinas M.; Rambaldini M.; Chocron S.; De Bock D.;
Wang S.; Grabenwoeger M.; Raanani E.; Glauber M.; Maluenda G.; Ramlawi B.;
Bouchard D.; Johnston D.; Diegeler A.; Bitran D.; Teoh K.; Vincentelli A.;
Castillo J.C.; Albat B.; Oberwalder P.; Ramchandani M.; Heimansohn D.
Institution
(Fischlein, Pfeiffer) Klinikum Nurnberg, Cardiovascular Center, Paracelsus
Medical University, Nuremberg, Germany
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor,
Universite Paris 12, Creteil, Paris, France
(Meuris) UZ Gasthuisberg Leuven, University Hospital, Leuven, Belgium
(Shrestha) Hannover Medical School, Hannover, Germany
(Roselli) Heart, Vascular and Thoracic Institute, Cleveland Clinic,
Cleveland, OH, United States
(McGlothlin) Berry Consultants, LCC, Austin, Tex, United States
(Kappert) Herzzentrum Dresden GmbH Universitatsklinik, Dresden, Germany
(Pfeiffer) Schon Klinik Vogtareuth, Vogtareuth, Germany
(Corbi) Poitiers University Hospital, Poitiers, France
(Lorusso) Cardio-Thoracic Surgery Department, Heart and Vascular Center,
Maastricht University Medical Center (MUMC+), Cardiovascular Research
Institute Maastricht (CARIM), Maastricht, Netherlands
Publisher
Mosby Inc.
Abstract
Objective: Sutureless aortic valves are a novel option for aortic valve
replacement. We sought to demonstrate noninferiority of sutureless versus
standard bioprostheses in severe symptomatic aortic stenosis.
 Method(s): The Perceval Sutureless Implant Versus Standard-Aortic
Valve Replacement is a prospective, randomized, adaptive, open-label
trial. Patients were randomized (March 2016 to September 2018) to aortic
valve replacement with a sutureless or stented valve using conventional or
minimally invasive approach. Primary outcome was freedom from major
adverse cerebral and cardiovascular events (composite of all-cause death,
myocardial infarction, stroke, or valve reintervention) at 1 year.
 Result(s): At 47 centers (12 countries), 910 patients were randomized
to sutureless (n = 453) or conventional stented (n = 457) valves; mean
ages were 75.4 +/- 5.6 and 75.0 +/- 6.1 years, and 50.1% and 44.9% were
female, respectively. Mean +/- standard deviation Society of Thoracic
Surgeons scores were 2.4 +/- 1.7 and 2.1 +/- 1.3, and a ministernotomy
approach was used in 50.4% and 47.3%, respectively. Concomitant procedures
were performed with similar rates in both groups. Noninferiority was
demonstrated for major adverse cerebral and cardiovascular events at 1
year, whereas aortic valve hemodynamics improved equally in both groups.
Use of sutureless valves significantly reduced surgical times (mean
extracorporeal circulation times: 71.0 +/- 34.1 minutes vs 87.8 +/- 33.9
minutes; mean crossclamp times: 48.5 +/- 24.7 vs 65.2 +/- 23.6; both P
<.0001), but resulted in a higher rate of pacemaker implantation (11.1% vs
3.6% at 1 year). Incidences of perivalvular and central leak were similar.
 Conclusion(s): Sutureless valves were noninferior to stented valves
with respect to major adverse cerebral and cardiovascular events at 1 year
in patients undergoing aortic valve replacement (alone or with coronary
artery bypass grafting). This suggests that sutureless valves should be
considered as part of a comprehensive valve program. Copyright ©
2020 The American Association for Thoracic Surgery

<25>
Accession Number
2006021463
Title
Which target temperature for post-anoxic brain injury? A systematic review
from "real life" studies.
Source
Brain Sciences. 11 (2) (pp 1-10), 2021. Article Number: 186. Date of
Publication: February 2021.
Author
Minini A.; Annoni F.; Peluso L.; Bogossian E.G.; Creteur J.; Taccone F.S.
Institution
(Minini, Annoni, Peluso, Bogossian, Creteur, Taccone) Department of
Intensive Care, Erasmus Hospital, Universite Libre de Bruxelles (ULB),
Route de Lennik, 808, Brussels 1070, Belgium
Publisher
MDPI AG
Abstract
There is a persistent debate on the optimal target temperature to use
during cooling procedures in cardiac arrest survivors. A large randomized
clinical trial (RCT) including more than 900 patients showed that targeted
temperature management (TTM) at 33degree C had similar mortality and
unfavorable neurological outcome (UO) rates as TTM at 36degree C in
out-of-hospital cardiac arrest patients with any initial rhythm. Since
then, several observational studies have been published on the effects of
changes in target temperature (i.e., from 33 to 36degree C) on patients'
outcome. We performed a systematic literature search from 1 January 2014
to 4 December 2020 and identified nine retrospective studies (very low
levels of certainty; high risk of bias), including 3799 patients, that
evaluated TTM at 33degree C vs. TTM at 36degree C on the occurrence of UO
(n = seven studies) and mortality (n = nine studies). TTM at 33degree C
was associated with a lower risk of UO when studies assessing neurological
outcome with the Cerebral Performance Categories were analyzed (OR 0.80
[95% CIs 0.65-0.99]; p = 0.04). No differences in mortality were observed
within the two TTM strategies. These results suggest that an inappropriate
translation of TTM protocols from large well-conducted randomized trials
into clinical management may result in unexpected effects on patients'
outcome. As for all newly commercialized drugs, epidemiological studies
and surveillance programs with an adequate follow-up on large databases
are necessary to understand how RCTs are implemented into medical
practice. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<26>
Accession Number
2011048363
Title
Is it safe and effective to reduce the target anticoagulation range for
patients with mechanical prosthetic aortic valves?.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (6) (pp 904-909),
2021. Date of Publication: 2021.
Author
Mohamed W.; Asimakopoulos G.
Institution
(Mohamed) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Asimakopoulos) Department of Cardiac Surgery, Royal Brompton Hospital,
Sydney Street, London SW3 6NP, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Is it safe and effective
to reduce the target anticoagulation range for patients with mechanical
aortic valves?' Altogether 922 papers were found using the reported
search, of which 7 represented the best evidence to answer the clinical
question. Only studies that compared high (target international normalized
ratio 2-3) versus low (target international normalized ratio <2-3)
intensity anticoagulation were included. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. We conclude that there
is growing evidence for the reduction of the target anticoagulation range
for patients with mechanical prosthetic aortic valves, especially
bileaflet valves with presumed better haemodynamic properties. Several
large randomized controlled trials and a meta-analysis have concluded that
reducing the target international normalized ratio range (below the
conventional range of 2-3) for mechanical aortic valves in patients with
no thrombogenic risk factors produces less bleeding and does not increase
thromboembolic events. Copyright © The Author(s) 2020. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<27>
Accession Number
634162363
Title
Coronary artery aneurysms: outcomes following medical, percutaneous
interventional and surgical management.
Source
Open Heart. 8 (1) (no pagination), 2021. Article Number: 001440. Date of
Publication: 10 Feb 2021.
Author
Khubber S.; Chana R.; Meenakshisundaram C.; Dhaliwal K.; Gad M.; Kaur M.;
Banerjee K.; Verma B.R.; Shekhar S.; Khan M.Z.; Khan M.S.; Khan S.;
Sammour Y.; Tsutsui R.; Puri R.; Kalra A.; Bakaeen F.G.; Simpfendorfer C.;
Ellis S.; Johnston D.; Pettersson G.; Kapadia S.
Institution
(Khubber, Chana, Meenakshisundaram, Dhaliwal, Gad, Kaur, Verma, Shekhar,
Sammour, Tsutsui, Puri, Bakaeen, Simpfendorfer, Ellis, Johnston, Kapadia)
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Banerjee) Department of Internal Medicine, Geisinger Medical Center,
Danville, PA, United States
(Khan) Department of Medicine, West Virginia University, Morgantown, WV,
United States
(Khan) Medicine, John H Stroger Hospital of Cook County, Chicago, IL,
United States
(Khan) Department of Medicine, Guthrie Robert Packer Hospital, Sayre, PA,
United States
(Kalra) Cardiology, Cleveland Clinic, Cleveland, OH, United States
(Pettersson) Department of Cardiothoracic Surgery, Cleveland Clinic,
Cleveland, OH, United States
Publisher
BMJ Publishing Group
Abstract
Background Coronary artery aneurysms (CAAs) are increasingly diagnosed on
coronary angiography; however, controversies persist regarding their
optimal management. In the present study, we analysed the long-term
outcomes of patients with CAAs following three different management
strategies. Methods We performed a retrospective review of patient records
with documented CAA diagnosis between 2000 and 2005. Patients were divided
into three groups: medical management versus percutaneous coronary
intervention (PCI) versus coronary artery bypass grafting (CABG). We
analysed the rate of major cardiovascular and cerebrovascular events
(MACCEs) over a period of 10 years. Results We identified 458 patients
with CAAs (mean age 78+/-10.5 years, 74.5% men) who received medical
therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of
CAAs was 0.7% of the total catheterisation reports. The left anterior
descending was the most common coronary artery involved (38%). The median
follow-up time was 62 months. The total number of MACCE during follow-up
was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%)
in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier
survival analysis showed that CABG was associated with better MACCE-free
survival (p log-rank=0.03) than medical management. These results were
confirmed on univariate Cox regression, but not multivariate regression
(OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and
regression analyses showed that dual antiplatelet therapy (DAPT) and
anticoagulation were not associated with significant improvement in MACCE
rates. Conclusion Our analysis showed similar long-term MACCE risks in
patients with CAA undergoing medical, percutaneous and surgical
management. Further, DAPT and anticoagulation were not associated with
significant benefits in terms of MACCE rates. These results should be
interpreted with caution considering the small size and potential for
selection bias and should be confirmed in large, randomised
trials. Copyright © Author(s) (or their employer(s)) 2021. Re-use
permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<28>
Accession Number
2011016078
Title
Outcomes after surgery for functional tricuspid regurgitation: A
systematic review and meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 6 (1) (pp
10-18), 2020. Date of Publication: 01 Jan 2020.
Author
Veen K.M.; Etnel J.R.G.; Quanjel T.J.M.; Mokhles M.M.; Huygens S.A.;
Rasheed M.; Oei F.B.S.; Ten Cate F.J.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Veen, Etnel, Quanjel, Mokhles, Huygens, Rasheed, Oei, Bogers, Takkenberg)
Department of Cardiothoracic Surgery, Thoraxcenter, Rg-619, Erasmus Mc,
University Medical Center Rotterdam, Dr Molewaterplein 40, Rotterdam 3015
GD, Netherlands
(Ten Cate) Department of Cardiology, Thoraxcenter, Rg-619, Erasmus Mc,
University Medical Center Rotterdam, Dr Molewaterplein 40, Rotterdam 3015
GD, Netherlands
Publisher
Oxford University Press
Abstract
Aims: This study aims to provide a contemporary overview of outcomes after
tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR).
 Methods and Results: The literature was systematically searched for
papers published between January 2005 and December 2017 reporting on
clinical/echocardiographic outcomes after TV surgery for functional TR. A
random effects meta-analysis was conducted for outcome variables, and late
outcomes are visualized by pooled Kaplan-Meier curves. Subgroup analyses
were performed for studies with a within-study comparison of suture vs.
ring repair and flexible vs. rigid ring repair. Eighty-seven publications
were included, encompassing 13 184 patients (mean age: 62.1 +/- 11.8
years, 55% females). A mitral valve procedure was performed in 92% of
patients. Pooled mean follow-up was 4.0 +/- 2.8 years. Pooled early
mortality was 3.9% (95% CI: 3.2-4.6), and late mortality rate was
2.7%/year (95% CI: 2.0-3.5), of which approximately half was
cardiac-related 1.2%/year (95% CI: 0.8-1.9). Pooled risk of early
moderate-to-severe TR at discharge was 9.4% (95% CI: 7.0-12.1). Late
moderate-to-severe TR rate after discharge was 1.9%/year (95% CI:
1.0-3.5). Late reintervention rate was 0.3%/year (95% CI: 0.2-0.4).
Mortality and overall (early and late) TR rate were comparable between
suture vs. ring annuloplasty (14 studies), whereas overall TR rate was
higher after flexible ring vs. rigid ring annuloplasty (6 studies)
(7.5%/year vs. 3.9%/year, P = 0.002). Conclusion(s): This study shows
that patients undergoing surgery for functional tricuspid regurgitation
(FTR) have an acceptable early and late mortality. However, TR remains
prevalent after surgery. The results of this study can be used to inform
patients and clinicians about the expected outcome after surgery for FTR
and can results serve as a benchmark for the performance of emerging
transcatheter TV interventions. Copyright © 2019 Published on
behalf of the European Society of Cardiology. All rights reserved.

<29>
Accession Number
2011047119
Title
Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation
Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic
Aortic Valve.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Al-abcha A.; Saleh Y.; Boumegouas M.; Prasad R.; Herzallah K.; Baloch
Z.Q.; Abdelkarim O.; Rayamajhi S.; Abela G.S.
Institution
(Al-abcha, Boumegouas, Prasad, Rayamajhi) Department of Internal Medicine,
Michigan State University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist DeBakey Heart &
Vascular Center, Houston, TX, United States
(Herzallah) Department of Cardiology, Tufts Medical Center, Boston,
Massachusetts, Boston, United States
(Baloch, Abela) Department of Cardiology, Michigan State University, East
Lansing, MI, United States
(Saleh, Abdelkarim) Department of Cardiology, Alexandria University, Egypt
Publisher
Elsevier Inc.
Abstract
This meta-analysis was conducted to compare clinical outcomes of
valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-surgical aortic valve replacement (Redo-SAVR) in failed bioprosthetic
aortic valves. We conducted a comprehensive review of previous
publications of all relevant studies through August 2020. Twelve
observational studies were included with a total of 8,430 patients, and a
median-weighted follow-up period of 1.74 years. A pooled analysis of the
data showed no significant difference in all-cause mortality (OR 1.15; 95%
CI 0.93 to 1.43; p = 0.21), cardiovascular mortality, myocardial
infarction, permanent pacemaker implantation, and the rate of moderate to
severe paravalvular leakage between ViV-TAVI and Redo-SAVR groups. The
rate of major bleeding (OR 0.36; 95% CI 0.16 to 0.83, p = 0.02),
procedural mortality (OR 0.41; 95% CI 0.18 to 0.96, p = 0.04), 30-day
mortality (OR 0.58; 95% CI 0.45 to 0.74, p <0.0001), and the rate of
stroke (OR 0.65; 95% CI 0.52 to 0.81, p = 0.0001) were significantly lower
in the ViV- TAVI arm when compared with Redo-SAVR arm. The mean
transvalvular pressure gradient was significantly higher post-implantation
in the ViV-TAVI group when compared with the Redo-SAVR arm (Mean
difference 3.92; 95% CI 1.97 to 5.88, p < 0.0001). In conclusion, compared
with Redo-SAVR, ViV-TAVI is associated with a similar risk of all-cause
mortality, cardiovascular mortality, myocardial infarction, permanent
pacemaker implantation, and the rate of moderate to severe paravalvular
leakage. However, the rate of major bleeding, stroke, procedural mortality
and 30-day mortality were significantly lower in the ViV-TAVI group when
compared with Redo-SAVR. Copyright © 2021 Elsevier Inc.

<30>
Accession Number
2011046958
Title
Lung recruitment in the prone position after cardiac surgery: a randomised
controlled study.
Source
British Journal of Anaesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Martinsson A.; Houltz E.; Wallinder A.; Lindgren S.; Thoren A.
Institution
(Martinsson, Houltz, Lindgren, Thoren) Department of Anaesthesiology and
Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Wallinder) Department of Cardiothoracic Surgery, Sahlgrenska Academy,
University of Gothenburg, Sahlgrenska University Hospital, Gothenburg,
Sweden
Publisher
Elsevier Ltd
Abstract
Background: Atelectasis after cardiac surgery is common and promotes
ventilation/perfusion mismatch, infection, and delayed discharge from
critical care. Recruitment manoeuvres are often performed to reduce
atelectasis. In severe respiratory failure, recruitment manoeuvres in the
prone position may increase oxygenation, survival, or both. We compared
the effects of recruitment manoeuvres in the prone vs supine position on
lung aeration and oxygenation in cardiac surgical patients.
 Method(s): Subjects were randomised to recruitment manoeuvres (40 cm
H<inf>2</inf>O peak inspiratory pressure and 20 cm H<inf>2</inf>O PEEP for
30 s) in either the prone or supine position after uncomplicated cardiac
surgery. The co-primary endpoints were lung aeration (end-expiratory lung
volume measured by electrical impedance tomography (arbitrary units
[a.u.]) and lung oxygenation (ratio of arterial oxygen partial pressure to
fractional inspired oxygen [PaO<inf>2</inf>/FiO<inf>2</inf> ratio]).
Secondary outcomes included postoperative oxygen requirement and adverse
events. Result(s): Thirty subjects (27% female; age, 48-81 yr) were
recruited. Dorsal lung tidal volume was higher after prone recruitment
manoeuvres (363 a.u.; 95% confidence intervals [CI], 283-443; n=15) after
extubation, compared with supine recruitment manoeuvres (212 a.u.; 95% CI,
170-254; n=15; P<0.001). Prone recruitment manoeuvres increased dorsal
end-expiratory lung volume by 724 a.u. (95% CI, 456-992) after extubation,
compared with 163 a.u. decrease (95% CI, 73-252) after supine recruitment
manoeuvres (P<0.001). The PaO<inf>2</inf>/FiO<inf>2</inf> ratio after
extubation was higher after prone recruitment manoeuvres (46.6; 95% CI,
40.7-53.0) compared with supine recruitment manoeuvres (39.3; 95% CI,
34.8-43.8; P=0.04). Oxygen therapy after extubation was shorter after
prone (33 h [13]) vs supine recruitment manoeuvres (52 h [22]; P=0.01). No
adverse events occurred. Conclusion(s): Recruitment manoeuvres in the
prone position after cardiac surgery improve lung aeration and
oxygenation. Clinical trial registration: NCT03009331. Copyright
© 2021 British Journal of Anaesthesia

<31>
Accession Number
2011046903
Title
Structural valve degeneration: Redo or valve-in-valve? Enough
meta-analysis and retrospective studies, we need a randomised trial.
Source
Archives of Cardiovascular Diseases. (no pagination), 2021. Date of
Publication: 2021.
Author
Lebreton G.
Institution
(Lebreton) Department of cardio-thoracic surgery, Pitie-Salpetriere
hospital, Institute of CArdioMetabolism (ICAN), UMR 1166, Sorbonne
University, Paris, France
Publisher
Elsevier Masson s.r.l.

<32>
Accession Number
634237668
Title
Pharmacogenomics of the Efficacy and Safety of Colchicine in COLCOT.
Source
Circulation. Genomic and precision medicine. (no pagination), 2021. Date
of Publication: 09 Feb 2021.
Author
Dube M.-P.; Legault M.-A.; Lemacon A.; Lemieux Perreault L.-P.; Fouodjio
R.; Waters D.D.; Kouz S.; Pinto F.J.; Maggioni A.P.; Diaz R.; Berry C.;
Koenig W.; Lopez-Sendon J.; Gamra H.; Kiwan G.S.; Asselin G.; Provost S.;
Barhdadi A.; Sun M.; Cossette M.; Blondeau L.; Mongrain I.; Dubois A.;
Rhainds D.; Bouabdallaoui N.; Samuel M.; de Denus S.; L'Allier P.L.;
Guertin M.-C.; Roubille F.; Tardif J.-C.
Institution
(Dube, Lemacon, Sun) Montreal Heart Institute & Universite de Montreal
Beaulieu-Saucier Pharmacogenomics Centre & Universite de Montreal, Faculty
of Medicine, Department of Medicine, Universite de Montreal, Montreal,
Canada
(Legault) Montreal Heart Institute & Universite de Montreal
Beaulieu-Saucier Pharmacogenomics Centre & Universite de Montreal, Faculty
of Medicine, Department of Biochemistry and Molecular Medicine, Montreal,
Canada
(Lemieux Perreault, Fouodjio, Asselin, Provost, Barhdadi, Mongrain,
Dubois, de Denus) Montreal Heart Institute & Universite de Montreal
Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
(Waters) San Francisco General Hospital, San Francisco, CA
(Kouz) Centre Hospitalier Regional de Lanaudiere, Joliette, Canada
(Pinto) Santa Maria University Hospital (CHULN), CAML, CCUL, Faculdade de
Medicina da Universidade de Lisboa, Lisboa, Portugal
(Maggioni) Maria Cecilia Hospital, GVM Care & Research, Cotignola,
Ravenna, Italy
(Diaz) Estudios Clinicos Latinoamerica, Rosario, Argentina
(Berry) University of Glasgow & NHS Glasgow Clinical Research Facility,
Glasgow, United Kingdom
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen &
DZHK (German Centre for Cardiovascular Research), Munich & Institute of
Epidemiology and Medical Biometry, University of Ulm, partner site Munich
Heart Alliance, Ulm, Germany
(Lopez-Sendon) IdiPaz, UAM, Spain
(Gamra) Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Kiwan) Cardiology, Bellevue Medical Center, Beirut, Lebanon
(Cossette, Blondeau, Guertin) Montreal Heart Institute & Montreal Health
Innovation Coordinating Centre, Montreal, Canada
(Rhainds, L'Allier) Montreal Heart Institute, Montreal, Canada
(Bouabdallaoui, Samuel, Tardif) Montreal Heart Institute & Universite de
Montreal, Faculty of Medicine, Department of Medicine, Montreal, Canada
(Roubille) PhyMedExp (Physiologie et Medecine Experimentale du Coeur et
des Muscles), Universite de Montpellier, INSERM, Centre National de la
Recherche Scientifique, Cardiology Department, CHU de Montpellier,
Montpellier, France
Publisher
NLM (Medline)
Abstract
Background - The randomized, placebo-controlled COLchicine Cardiovascular
Outcomes Trial (COLCOT) has shown the benefits of colchicine 0.5 mg daily
to lower the rate of ischemic cardiovascular events in patients with a
recent myocardial infarction. Here, we conducted a post-hoc
pharmacogenomic study of COLCOT with the aim to identify genetic
predictors of the efficacy and safety of treatment with colchicine.
Methods - There were 1522 participants of European descent from the COLCOT
trial available for the pharmacogenomic study of COLCOT trial. The
pharmacogenomic study's primary cardiovascular (CV) endpoint was defined
as for the main trial, as time to first occurrence of CV death,
resuscitated cardiac arrest, myocardial infarction, stroke or urgent
hospitalization for angina requiring coronary revascularization. The
safety endpoint was time to the first report of gastrointestinal events.
Patients' DNA was genotyped using the Illumina Global Screening array
followed by imputation. We performed a genome-wide association study
(GWAS) in colchicine-treated patients. Results - None of the genetic
variants passed the GWAS significance threshold for the primary CV
endpoint conducted in 702 patients in the colchicine arm who were
compliant to medication. The GWAS for gastrointestinal events was
conducted in all 767 patients in the colchicine arm and found two
significant association signals, one with lead variant rs6916345 (hazard
ratio (HR)=1.89, 95% confidence interval (CI) 1.52-2.35, P=7.41x10-9) in a
locus which colocalizes with Crohn's disease, and one with lead variant
rs74795203 (HR= 2.51, 95% CI 1.82-3.47; P=2.70x10-8), an intronic variant
in gene SEPHS1. The interaction terms between the genetic variants and
treatment with colchicine versus placebo were significant. Conclusions -
We found two genomic regions associated with gastrointestinal events in
patients treated with colchicine. Those findings will benefit from
replication to confirm that some patients may have genetic predispositions
to lower tolerability of treatment with colchicine.

<33>
Accession Number
634226943
Title
Fever Associated with Dexmedetomidine in Adult Acute Care Patients: A
Systematic Review of the Literature.
Source
Journal of clinical pharmacology. (no pagination), 2021. Date of
Publication: 07 Feb 2021.
Author
Schurr J.W.; Ambrosi L.; Lastra J.L.; McLaughlin K.C.; Hacobian G.;
Szumita P.M.
Institution
(Schurr, Ambrosi, Lastra) Renaissance School of Medicine at Stony Brook
University, Stony Brook, NY
(McLaughlin, Hacobian, Szumita) Department of Pharmacy Services, Brigham
and Women's Hospital, MA, Boston
Publisher
NLM (Medline)
Abstract
Dexmedetomidine-associated fever has been reported in the literature and
can lead to lengthy work-ups and unnecessary antibiotic exposure. We
conducted a systematic review to evaluate and describe the evidence of
fever or hyperthermia caused by dexmedetomidine in adult patients. Data
Sources include PubMed/MEDLINE, EMBASE, CINAHL, and Web of Sciences.
English-language studies of any design published from inception through
April 2020 including conference abstracts were included. Target population
was hospitalized adult patients. Quality of evidence was determined based
on GRADE recommendations and risk of bias assessed using the Evidence
Project risk of bias tool. Naranjo scores were assessed to determine
likeliness of adverse event being caused by dexmedetomidine. All data was
extracted independently and with the guidance of a medical librarian. 488
total citations were found on formal search with 329 left after removal of
duplicates. Independent record screening was performed leaving 17
citations including 4 retrospective cohort studies, one case series, and
12 case reports. Quality of evidence ranged from very low to low for
identified analyses. Evidence with patient level data (case reports and
series) were combined to establish a cohort for descriptive results. The
median Naranjo score was 4 (range 3-8) and dexmedetomidine doses ranged
from 0.4-2mcg/kg/h. Obesity and cardiac surgery appear to be significant
risk factors. Dexmedetomidine-associated fever appears uncommon but the
true incidence is unknown. Clinicians should keep
dexmedetomidine-associated fever in their differential and stewardship
programs should consider assessing for this adverse effect in their
patient monitoring. This article is protected by copyright. All rights
reserved.

<34>
Accession Number
2005946197
Title
Postoperative neurocognitive disorders.
Source
Korean Journal of Anesthesiology. 74 (1) (pp 15-22), 2021. Date of
Publication: February 2021.
Author
Tasbihgou S.R.; Absalom A.R.
Institution
(Tasbihgou, Absalom) Department of Anesthesiology, University Medical
Center Groningen, University of Groningen, Groningen, Netherlands
Publisher
Korean Society of Anesthesiologists
Abstract
A decline in cognitive function is a frequent complication of major
surgery. Postoperative cognitive impairments have generally been divided
into short-(postoperative delirium) and long-term disturbances
(postoperative cognitive dysfunction [POCD]). Long-term impairments are
often subtle and overlooked. They need to be objectively assessed using
neuropsychological tests to be diagnosed. Although POCD has been the
subject of considerable research over the past decades, it remains
uncertain why some patients do not re-turn to preoperative levels of
cognitive function. Surgery and anesthesia have both been implicated to
play a role in POCD development, and certain patient-related factors, such
as advanced age and low preoperative baseline cognitive function, have
consistently been found to predict postoperative cognitive decline. This
article will present an overview of POCD and its etiology and provide
advice on possible strategies on its prevention. Copyright © The
Korean Society of Anesthesiologists, 2021.

<35>
Accession Number
2010977181
Title
Prospective use of ablation index for the ablation of right ventricle
outflow tract premature ventricular contractions: A proof of concept
study.
Source
Europace. 23 (1) (pp 91-98), 2021. Date of Publication: 01 Jan 2021.
Author
Gasperetti A.; Sicuso R.; Dello Russo A.; Zucchelli G.; Saguner A.M.;
Notarstefano P.; Soldati E.; Bongiorni M.G.; Della Rocca D.G.; Mohanty S.;
Carbucicchio C.; Duru F.; Di Biase L.; Natale A.; Tondo C.; Casella M.
Institution
(Gasperetti, Sicuso, Carbucicchio, Tondo, Casella) Heart Rhythm Center,
Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy
(Gasperetti, Saguner, Duru) Cardiology Department, Heart Center University
Hospital Zurich, Zurich, CH, Switzerland
(Dello Russo) Cardiology and Arrhythmology Clinic, Department of
Biomedical Sciences and Public Health, University Hospital 'Umberto
I-Lancisi-Salesi', Marche Polytechnic University, Ancona, IT, Italy
(Zucchelli, Soldati, Bongiorni) Second Division of Cardiovascular
Diseases, Cardio-Thoracic and Vascular Department, University Hospital of
Pisa, Pisa, IT, Italy
(Notarstefano) Cardiovascular and Neurological Department, San Donato
Hospital, Arezzo, IT, Italy
(Della Rocca, Mohanty, Natale) Texas Cardiac Arrhythmia Institute, St
David's Medical Center, Austin, TX, United States
(Di Biase) Cardiology Department, Montefiore-Einstein Center for Heart and
Vascular Care, Montefiore Medical Center, Alber Einstein College of
Medicine, Bronx, NY, United States
(Tondo) Department of Clinical Sciences and Community Health, University
of Milan, Milan, IT, Italy
(Casella) Cardiology and Arrhythmology Clinic, Department of Clinical,
Special and Dental Sciences, University Hospital 'Umberto
I-Lancisi-Salesi', Marche Polytechnic University, Ancona, Italy
Publisher
Oxford University Press
Abstract
Aims: Radiofrequency catheter ablation (RFCA) represents an effective
option for idiopathic premature ventricular contractions (PVCs) treatment.
Ablation Index (AI) is a novel ablation marker incorporating RF power,
contact force, and time of delivery into a single weighted formula. Data
regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was
to compare AI-guided and standard RFCA outcomes in patients with PVCs
originating from the right ventricle outflow tract (RVOT). Methods
and Results: Consecutive patients undergoing AI-guided RFCA of RVOT
idiopathic PVCs were prospectively enrolled. Radiofrequency catheter
ablation was performed following per-protocol target cut-offs of AI,
depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI
cut-off: 610). A multi-centre cohort of propensity-matched (age, sex,
ejection fraction, and PVC site) patients undergoing standard PVCs RFCA
was used as a comparator. Sixty AI-guided patients (44.2 +/- 18.0 years
old, 58% male, left ventricular ejection fraction 56.2 +/- 3.8%) were
enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in
the RVOT free wall area. Propensity match with 60 non-AI-guided patients
was performed. Acute outcomes and complications resulted comparable. At 6
months, arrhythmic recurrence was more common in non-AI-guided patients
whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free
wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation
Index guidance was associated with improved survival from arrhythmic
recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum
5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P =
0.039]. Conclusion(s): Ablation Index-guidance in idiopathic PVCs
ablation was associated with better arrhythmic outcomes at 6 months of
follow-up. Copyright © 2020 The Author(s).

<36>
Accession Number
2010356441
Title
Perioperative risk factors for recovery room delirium after elective
non-cardiovascular surgery under general anaesthesia.
Source
Perioperative Medicine. 10 (1) (no pagination), 2021. Article Number: 3.
Date of Publication: December 2021.
Author
Wu J.; Gao S.; Zhang S.; Yu Y.; Liu S.; Zhang Z.; Mei W.
Institution
(Wu, Gao, Zhang, Yu, Liu, Mei) Department of Anesthesiology, Tongji
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, 1095 Jiefang Avenue, Wuhan 430030, China
(Zhang) School of Medicine and Health Management, Tongji Medical College,
Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan
430030, China
Publisher
BioMed Central Ltd
Abstract
Background: Although postoperative delirium is a frequent complication of
surgery, little is known about risk factors for delirium occurring in the
post-anaesthesia care unit (PACU). The aim of this study was to determine
pre- and intraoperative risk factors for the development of recovery room
delirium (RRD) in patients undergoing elective non-cardiovascular surgery.
 Method(s): RRD was diagnosed according to the Confusion Assessment
Method for the Intensive Care Unit (CAM-ICU). We collected perioperative
data in 228 patients undergoing elective non-cardiovascular surgery under
general anaesthesia and performed univariate and multivariate logistic
regression to identify risk factors related to RRD. PACU and postoperative
events were recorded to assess the outcome of RRD. Result(s):
Fifty-seven patients (25%) developed RRD. On multivariate analysis,
maintenance of anaesthesia with inhalation anaesthetic agents (OR = 6.294,
95% CI 1.4-28.8, corrected p = 0.03), malignant primary disease (OR =
3.464, 95% CI = 1.396-8.592, corrected p = 0.018), American Society of
Anaesthesiologists Physical Status (ASA-PS) III-V (OR = 3.389, 95% CI =
1.401-8.201, corrected p = 0.018), elevated serum total or direct
bilirubin (OR = 2.535, 95% CI = 1.006-6.388, corrected p = 0.049), and
invasive surgery (OR = 2.431, 95% CI = 1.103-5.357, corrected p = 0.035)
were identified as independent risk factors for RRD. RRD was associated
with higher healthcare costs (31,428 yuan [17,872-43,674] versus 16,555
yuan [12,618-27,788], corrected p = 0.002), a longer median hospital stay
(17 days [12-23.5] versus 11 days [9-17], corrected p = 0.002), and a
longer postoperative stay (11 days [7-15] versus 7 days [5-10], corrected
p = 0.002]). Conclusion(s): Identifying patients at high odds for RRD
preoperatively would enable the formation of more timely postoperative
delirium management programmes. Copyright © 2021, The Author(s).

<37>
Accession Number
633218194
Title
Prehabilitation before elective coronary artery bypass grafting surgery: a
scoping review protocol.
Source
JBI evidence synthesis. 19 (2) (pp 469-476), 2020. Date of Publication: 16
Oct 2020.
Author
Olsen D.B.; Pedersen P.U.; Noergaard M.W.
Institution
(Olsen) Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Pedersen, Noergaard) Danish Centre of Systematic Reviews: A JBI Centre of
Excellence, Centre of Clinical Guidelines, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
(Noergaard) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The objective of this scoping review is to identify and map
existing preoperative interventions, referred to as prehabilitation, in
adult patients at home awaiting coronary bypass grafting (CABG) surgery.
This scoping review also seeks to examine the feasibility and patient
experiences in order to inform clinical practice and underpin a future
systematic review. INTRODUCTION: As patients age, comorbidities become
more common. Strategies to improve postoperative outcomes and to
accelerate recovery are required in patients undergoing CABG.
Prehabilitation refers to a proactive process of increasing functional
capacity before surgery to improve the patient's capacity to withstand
upcoming physiologic stress and thus avoid postoperative complications.
INCLUSION CRITERIA: This scoping review will consider any studies
including adult patients at home awaiting CABG surgery. Studies will
provide information on any prehabilitation intervention to optimize
preoperative physical and psychological health status. Studies conducted
in any setting will be included. METHOD(S): The methodology will
follow the JBI recommendations for scoping reviews. Any published or
unpublished source of information will be considered. Studies published in
English, German, Danish, Swedish, and Norwegian will be included, with no
geographical or cultural limitations. Retrieved papers will be screened by
two independent reviewers, and a standardized tool will be used to extract
data from each included source. The results will be presented as a map of
the data extracted in a tabular form together with a narrative summary to
provide a description of the existing evidence. Copyright © 2021
JBI.

<38>
Accession Number
634232932
Title
Long-term Safety of Tildrakizumab in Patients with Moderate to Severe
Plaque Psoriasis: Incidence of Confirmed Major Adverse Cardiovascular
Events Through 3 Years (148 Weeks) from Two Phase 3 Trials.
Source
Arthritis and Rheumatology. Conference: American College of Rheumatology
Convergence, ACR 2020. 72 (SUPPL 10) (pp 3291-3292), 2020. Date of
Publication: October 2020.
Author
Iversen L.; Griffiths C.E.M.; Peserico A.; Pau-Charles I.; Blauvelt A.;
Thaci D.; Reich K.
Institution
(Iversen) Aarhus University Hospital, Aarhus, Denmark
(Griffiths) University of Manchester, Manchester, United Kingdom
(Peserico) DIMED University of Padua, Padua, Italy
(Pau-Charles) Almirall R&D, Barcelona, Spain
(Blauvelt) Oregon Medical Research Center, Portland, OR, United States
(Thaci) Institute and Comprehensive Center for Inflammation Medicine,
University of Lubeck, Lubeck, Germany
(Reich) Translational Research in Inflammatory Skin Diseases, Institute
for Health Services Research in Dermatology and Nursing, University
Medical Center Hamburg-Eppendorf, and Skinflammation, Hamburg, Germany
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: Tildrakizumab (TIL) is a high-affinity
anti-interleukin-23p19 monoclonal antibody that is approved for the
treatment of moderate to severe plaque psoriasis. The objective of this
study was to evaluate major adverse cardiovascular events (MACE) in two
phase 3 trials: reSURFACE 1 (NCT01722331) and reSURFACE 2 (NCT01729754).
 Method(s): This is a post hoc pooled analysis of adult patients with
moderate to severe plaque psoriasis from two 3-part, parallel-group,
double-blinded, randomized controlled trials: reSURFACE 1 (64 week) and
reSURFACE 2 (52 week). Detailed methodology has previously been published.
Safety data over 148 weeks, pooled across trials and treatment groups,
were included. Groups were defined as placebo, etanercept (until week 28),
TIL 100 mg (100 mg only in >=1 part of the study), TIL 200 mg (200 mg only
in >=1 part of the study), continuous TIL 100 mg (100 mg throughout the
three double-blinded parts plus open-label extension), continuous TIL 200
mg (200 mg throughout all parts), TIL 100/200 mg (any TIL dose in >=1
part), and continuous TIL 100/200 mg (consistently exposed to TIL, but
dose change possible throughout all parts). Exposure-adjusted incidence
rates (EAIR) for confirmed MACE (including non-fatal myocardial
infarction, non-fatal stroke, unstable angina, coronary revascularization,
resuscitated cardiac arrest, and cardiovascular deaths that were confirmed
as "cardiovascular" or "sudden") were reported. Result(s): Overall,
928 patients on TIL 200 mg, 872 on TIL 100 mg, 316 on continuous TIL 200
mg, 352 on continuous TIL 100 mg, 543 on placebo, 1646 on TIL 100/200 mg,
808 on continuous TIL 100/200 mg, and 313 on etanercept were included.
EAIR for MACE were 0.54 (TIL 200 mg), 0.40 (TIL 100 mg), 0.29 (continuous
TIL 200 mg), 0.36 (continuous TIL 100 mg), 0.49 (placebo), 0.47 (TIL
100/200 mg), 0.35 (continuous TIL 100/200 mg), and 0.65 (etanercept) per
100 patient-years of exposure. Conclusion(s): Tildrakizumab had a
favorable long-term safety profile as demonstrated by a low rate of MACE
(comparable to etanercept and placebo) in patients with moderate to severe
plaque psoriasis.

<39>
Accession Number
2011051137
Title
Systematic Reviews and Meta-Analyses in Cardiac Surgery: Rules of the Road
- Part 2.
Source
Annals of Thoracic Surgery. 111 (3) (pp 762-770), 2021. Date of
Publication: March 2021.
Author
Gaudino M.; Fremes S.; Bagiella E.; Bangalore S.; Demetres M.; D'Ascenzo
F.; Biondi-Zoccai G.; Di Franco A.
Institution
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Fremes) Division of Cardiac Surgery, Schulich Heart Center, Sunnybrook
Health Sciences Center, University of Toronto, Toronto, ON, Canada
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Bangalore) New York University Grossman School of Medicine, New York, NY,
United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(D'Ascenzo) Division of Cardiology, Citta della Salute e della Scienza,
University of Turin, Turin, Italy
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Elsevier Inc.
Abstract
In the era of evidence-based medicine, systematic reviews and
meta-analyses are considered at the top of evidence hierarchy. Despite the
almost exponential increase in the number of published meta-analyses over
the course of the last decades, only a small minority of them are of high
quality, with major flaws involving every aspect of the meta-analytic
process. The strength of a meta-analysis is closely linked to the quality
of the included studies. Once preliminary phases are completed, it is
vital that selected papers undergo a thorough quality assessment, using
the most appropriate tools among those available. Analytical approaches
must be tailored to the nature of the extracted data and the specific
purpose of the meta-analysis. Appraisal of heterogeneity is a key step to
inform subgroup or meta-regression analyses. The solidity of the results
of the main analysis (especially in meta-analyses of observational studies
or studies with high heterogeneity) should be tested by means of pertinent
sensitivity analyses. Finally, the investigators should be aware of the
possibility of publication bias and make efforts to assess it using
qualitative and quantitative methods. The aim of the second part of this
expert review is to provide guidance on how to appropriately perform trial
level meta-analyses, with particular focus on the quality assessment of
the included studies, the choice of the appropriate statistical approach,
the methods to deal with heterogeneity (including subgroup,
meta-regression, and sensitivity analyses), and the appraisal of
publication bias. Copyright © 2021 The Society of Thoracic
Surgeons

<40>
Accession Number
2011040130
Title
Contemporary review of exercise in heart transplant recipients.
Source
Transplantation Reviews. 35 (2) (no pagination), 2021. Article Number:
100597. Date of Publication: April 2021.
Author
Guimaraes G.V.; Ribeiro F.; Arthuso F.Z.; Castro R.E.; Cornelissen V.;
Ciolac E.G.
Institution
(Guimaraes, Castro) Heart Institute, School of Medicine, University of Sao
Paulo (USP), Sao Paulo, Brazil
(Ribeiro) School of Health Sciences and Institute of Biomedicine - iBiMED,
University of Aveiro, Aveiro, Portugal
(Arthuso, Ciolac) Department of Physical Education, School of Sciences,
Sao Paulo State University (UNESP), Bauru, Brazil
(Cornelissen) Department of Rehabilitation Science, KU Leuven, Leuven,
Belgium
Publisher
W.B. Saunders
Abstract
Heart transplantation (HTx) is a therapeutic option for a selected group
of patients with end-stage heart failure. Although secondary prevention
including exercise therapy is recommended in the management of patients
following HTx, little information is available on their metabolic and
physiological consequences in HTx. Therefore, we aimed to conduct a
contemporary review the effectiveness of exercise therapy on functional
capacity, cardiovascular health and health-related quality of life for
adult HTx patients. We searched the database MEDLINE for articles
published between January 2015 and October 2020 and were able to include 6
studies involving 202 patients. Larger improvements in exercise capacity
were seen after high-intensity interval training and in patients with
evidence of cardiac reinnervation. Clinically relevant reductions were
observed for daytime and 24 h ambulatory blood pressure after exercise
training and following a single bout of aerobic exercise. Finally, limited
data suggest that quality of life is higher in HTx patients following
high-intensity training. In summary, the available evidence shows the
potential for exercise as a vital treatment in patients following HTx.
Yet, the scant data calls for more well-designed and adequately powered
studies to support its effectiveness and to unravel optimal exercise
characteristics, which would allow for more effective and person-tailored
exercise prescription. Copyright © 2021 Elsevier Inc.

<41>
Accession Number
2010195308
Title
Current clinical management of acute myocardial infarction complicated by
cardiogenic shock.
Source
Expert Review of Cardiovascular Therapy. 19 (1) (pp 41-46), 2021. Date of
Publication: 2021.
Author
El Nasasra A.; Zeymer U.
Institution
(El Nasasra, Zeymer) Medizinische Klinik B, Klinikum Ludwigshafen,
Ludwigshafen, Germany
(Zeymer) Institut Fur Herzinfarktforschung Ludwigshafen, Stiftung, Germany
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Cardiogenic shock (CS) remains the leading cause of death
among patients admitted with acute myocardial infarction (AMI). Early
restoration of blood flow of the infarct-related artery is of paramount
importance, either with percutaneous coronary intervention (PCI) or with
coronary artery bypass grafting (CABG). In addition, early risk
stratification is a critical task and required to guide complex decisions
on management and therapy of CS after AMI. The use of short-term
mechanical circulatory support (MCS) is increasing, although evidence for
their effectiveness is limited. Areas covered: We review the evidence for
early revascularization of the culprit-lesion and risk stratification in
patients with AMI complicated by cardiogenic shock. The current data for
the use of MCS will be discussed and put into clinical perspective. Expert
opinion: The SHOCK trial has introduced an early invasive strategy with
subsequent revascularization as standard of care in patients with AMI
complicated by CS. In clinical practice PCI is the by far the most often
used revascularization therapy in CS. Most important is restoration of
normal flow (so called TIMI 3 patency) of the infarct artery to reduce
mortality. Therefore, all efforts including intense antithrombotic therapy
should be made to achieve TIMI 3 patency. Around three quarters of
patients with CS have multivessel coronary artery disease. According to
the results of the CULPRIT-SHOCK trial PCI of the culprit lesion only is
recommended as the preferred revascularization strategy in these patients,
while additional lesions can be revascularized during a staged procedure.
Immediate multivessel PCI could be performed in some specific angiographic
scenarios, such as subtotal non-culprit lesions with reduced Thrombolysis
In Myocardial Infarction (TIMI)-flow, or multiple possible culprit
lesions. However, this should be considered on an individual basis. CABG
should be performed only in case of failed PCI and coronary anatomies not
suitable for PCI. However, small case series report good outcomes in
selected patients with CS undergoing CABG. Therefore, a randomized trial
comparing PCI and CABG in patients with CS and multivessel disease seems
warranted. Hopefully such a trial will take place to determine the optimal
revascularization therapy in CS. One problem might be to find a sufficient
number of cardiac surgeons who are willing to operate such high-risk
surgical patients. Copyright © 2021 Informa UK Limited, trading
as Taylor & Francis Group.

<42>
Accession Number
633940752
Title
Minimally invasive surgery versus transcatheter aortic valve replacement:
A systematic review and meta-analysis.
Source
Open Heart. 8 (1) (no pagination), 2021. Article Number: e001535. Date of
Publication: 17 Jan 2021.
Author
Sayed A.; Almotawally S.; Wilson K.; Munir M.; Bendary A.; Ramzy A.; Hirji
S.; Ibrahim Abushouk A.
Institution
(Sayed, Almotawally, Wilson, Munir) Faculty of Medicine, Ain Shams
University, Cairo, Egypt
(Bendary, Ramzy) Faculty of Medicine, Cardiology, Benha University, Benha,
Egypt
(Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Boston,
MA, United States
(Ibrahim Abushouk) Division of Cardiology, Beth Israel Deaconess Medical
Center, Boston, MA, United States
Publisher
BMJ Publishing Group
Abstract
Transcatheter aortic valve replacement (TAVR) has recently been approved
for use in patients who are at intermediate and low surgical risk.
Moreover, recent years have witnessed a renewed interest in minimally
invasive aortic valve replacement (miAVR). The present meta-analysis
compared the outcomes of TAVR and miAVR in the management of aortic
stenosis (AS). We conducted an electronic search across six databases from
2002 (TAVR inception) to December 2019. Data from relevant studies
regarding the clinical and length of hospitalisation outcomes were
extracted and analysed using R software. We identified a total of 11
cohort studies, of which seven were matched/propensity matched. Our
analysis demonstrated higher rates of midterm mortality (>=1 year) with
TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant
differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to
1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95%
CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to
experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet
less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69)
compared with miAVR. The duration of hospitalisation was significantly
longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading
of Recommendations Assessment, Development and Evaluation assessment
revealed <=moderate quality of evidence in all outcomes. TAVR was
associated with lower acute kidney injury rate and shorter length of
hospitalisation, yet higher risks of midterm mortality and paravalvular
leakage. Given the increasing adoption of both techniques, there is an
urgent need for head-to-head randomised trials with adequate follow-up
periods. Copyright © Author(s) (or their employer(s)) 2021.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<43>
Accession Number
2011008740
Title
3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With
Heart Failure.
Source
Journal of the American College of Cardiology. 77 (8) (pp 1029-1040),
2021. Date of Publication: 02 Mar 2021.
Author
Mack M.J.; Lindenfeld J.; Abraham W.T.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.K.; Grayburn P.A.; Rinaldi M.J.; Kapadia S.R.; Rajagopal V.;
Sarembock I.J.; Brieke A.; Rogers J.H.; Marx S.O.; Cohen D.J.; Weissman
N.J.; Stone G.W.
Institution
(Mack) Baylor Scott & White Heart Hospital Plano, Plano, TX, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute,
The Ohio State University, Columbus, OH, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Whisenant) Intermountain Medical Center, Murray, UT, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Rinaldi) Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC,
United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Rajagopal) Piedmont Hospital, Atlanta, GA, United States
(Sarembock) The Christ Hospital and Lindner Clinical Research Center,
Cincinnati, OH, United States
(Brieke) University of Colorado Hospital, Aurora, CO, United States
(Rogers) University of California Davis Medical Center, Sacramento, CA,
United States
(Marx) Columbia University Irving Medical Center, New York, NY, United
States
(Cohen) University of Missouri-Kansas City School of Medicine, Kansas
City, MO, United States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Weissman) Georgetown University, Washington, DC, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai and Cardiovascular Research Foundation,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: In the COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients with Functional
Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr)
resulted in fewer heart failure hospitalizations (HFHs) and lower
mortality at 24 months in patients with heart failure (HF) with mitral
regurgitation (MR) secondary to left ventricular dysfunction compared with
guideline-directed medical therapy (GDMT) alone. Objective(s): This
study determined if these benefits persisted to 36 months and if control
subjects who were allowed to cross over at 24 months derived similar
benefit. Method(s): This study randomized 614 patients with HF with
moderate-to-severe or severe secondary MR, who remained symptomatic
despite maximally tolerated GDMT, to TMVr plus GDMT versus GDMT alone. The
primary effectiveness endpoint was all HFHs through 24-month follow-up.
Patients have now been followed for 36 months. Result(s): The
annualized rates of HFHs per patient-year were 35.5% with TMVr and 68.8%
with GDMT alone (hazard ratio [HR]: 0.49; 95% confidence interval [CI]:
0.37 to 0.63; p < 0.001; number needed to treat (NNT) = 3.0; 95% CI: 2.4
to 4.0). Mortality occurred in 42.8% of the device group versus 55.5% of
control group (HR: 0.67; 95% CI: 0.52 to 0.85; p = 0.001; NNT = 7.9; 95%
CI: 4.6 to 26.1). Patients who underwent TMVr also had sustained 3-year
improvements in MR severity, quality-of-life measures, and functional
capacity. Among 58 patients assigned to GDMT alone who crossed over and
were treated with TMVr, the subsequent composite rate of mortality or HFH
was reduced compared with those who continued on GDMT alone (adjusted HR:
0.43; 95% CI: 0.24 to 0.78; p = 0.006). Conclusion(s): Among patients
with HF and moderate-to-severe or severe secondary MR who remained
symptomatic despite GDMT, TMVr was safe, provided a durable reduction in
MR, reduced the rate of HFH, and improved survival, quality of life, and
functional capacity compared with GDMT alone through 36 months. Surviving
patients who crossed over to device treatment had a prognosis comparable
to those originally assigned to transcatheter therapy. (Cardiovascular
Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart
Failure Patients with Functional Mitral Regurgitation [COAPT];
NCT01626079) Copyright © 2021 American College of Cardiology
Foundation

<44>
Accession Number
2010759701
Title
Cardiac surgery outcomes in patients with antecedent kidney, liver, and
pancreas transplantation: A meta-analysis.
Source
Reviews in Cardiovascular Medicine. 21 (4) (pp 589-599), 2020. Date of
Publication: December 2020.
Author
Bacusca A.E.; Enache M.; Tarus A.; Litcanu C.I.; Burlacu A.; Tinica G.
Institution
(Bacusca, Enache, Tarus, Litcanu, Tinica) Department of Cardiovascular
Surgery - Cardiovascular Diseases Institute, "Grigore T. Popa" University
of Medicine, Iasi 700115, Romania
(Burlacu) Department of Interventional Cardiology - Cardiovascular
Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi 700115,
Romania
Publisher
IMR Press Limited
Abstract
Cardiovascular events are among the most common causes of late death in
the transplant recipient (Tx) population. Moreover, major cardiac surgical
procedures are more challenging and risky due to immunosuppression and the
potential impact on the transplanted organ's functional capacity. We aimed
to assess open cardiac surgery safety in abdominal solid organ transplant
recipients, comparing the postoperative outcomes with those of
nontransplant (N-Tx) patients. Electronic databases of PubMed, EMBASE, and
SCOPUS were searched. The endpoints were: overall rate of infectious
complications (wound infection, septicemia, pneumonia), cardiovascular and
renal events (stroke, cardiac tamponade, acute kidney failure), 30-days,
5-years, and 10-years mortality post-cardiac surgery interventions in
patients with and without prior solid organ transplantation. This
meta-analysis included five studies. Higher rates of wound infection (Tx
vs. N-Tx: OR: 2.03, 95% CI: 1.54 to 2.67, I2 = 0%), septicemia
(OR: 3.91, 95% CI: 1.40 to 10.92, I2 = 0%), cardiac tamponade
(OR: 1.83, 95% CI: 1.28 to 2.62, I2 = 0%) and kidney failure
(OR: 1.70, 95 %CI: 1.44 to 2.02, I2 = 89%) in transplant
recipients were reported. No significant differences in pneumonia
occurrence (OR: 0.95, 95% CI: 0.71 to 1.27, I2 = 0%) stroke
(OR: 0.89, 95% CI: 0.54 to 1.48, I2 = 78%) and 30-day mortality
(OR: 1.92, 95% CI: 0.97 to 3.80, I2 = 0%) were observed.
Surprisingly, 5-years (OR: 3.74, 95% CI: 2.54 to 5.49, I2 = 0%)
and 10-years mortality rates were significantly lower in the N-Tx group
(OR: 3.32, 95% CI: 2.35 to 4.69, I2 = 0%). Our study reveals
that open cardiac surgery in transplant recipients is associated with
worse postoperative outcomes and higher long-term mortality
rates. Copyright © 2020 Bacusca et al. Published by IMR Press.

<45>
Accession Number
2011064614
Title
Ten years of non-vitamin K antagonists oral anticoagulants for stroke
prevention in atrial fibrillation: Is warfarin obsolete?.
Source
European Heart Journal, Supplement. 22 (pp O28-O41), 2020. Date of
Publication: 2020.
Author
Hammwohner M.; Goette A.
Institution
(Hammwohner, Goette) St. Vincenz-Hospital, Am Busdorf 2, Paderborn 33098,
Germany
(Goette) Working Group of Molecular Electrophysiology, University Hospital
Magdeburg, Magdeburg, Germany
Publisher
Oxford University Press
Abstract
Currently, four non-vitamin K antagonists oral anticoagulants (NOACs) are
available for stroke prevention in atrial fibrillation (AF). These have
been in clinical use for up to 10 years now. Besides data of the initial
phase III clinical trials, now clinical data, several sub-studies,
meta-analyses, and studies in special clinical settings and specific
patient populations are available. This review shall give an overview on
the history of NOAC development, sum up study data and 'real-world'
clinical data as well as discuss several special clinical settings like
NOAC treatment in patients that require coronary artery stenting or
cardioversion (CV). Furthermore, treatment considerations in special
patient populations like patients with renal impairment, obesity, or
patients requiring NOACs for secondary prevention are discussed. The
significance of NOAC treatment will be discussed under consideration of
the recently published 2020 ESC/EACTS Guidelines for the diagnosis and
management of AF. Copyright © The Author(s) 2020.

<46>
Accession Number
2011059434
Title
Design and rationale of a randomized trial of COBRA PzF stenting to REDUCE
duration of triple therapy (COBRA-REDUCE).
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Colleran R.; Joner M.; Cutlip D.; Urban P.; Maeng M.; Jauhar R.; Barakat
M.; Michel J.M.; Mehran R.; Kirtane A.J.; Maillard L.; Kastrati A.; Byrne
R.A.
Institution
(Colleran, Joner, Michel, Kastrati) Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Joner, Kastrati) German Centre for Cardiovascular Research (DZHK),
partner site Munich Heart Alliance, Munich, Germany
(Cutlip) Cardiology Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(Urban) La Tour Hospital, Geneva, Switzerland
(Urban) CERC (Cardiovascular European Research Center), Massy, France
(Maeng) Aarhus University Hospital, Aarhus, Denmark
(Mehran) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Kirtane) Department of Medicine, Columbia University Irving Medical
Center/New York Presbyterian Hospital, New York, NY, United States
(Kirtane) Cardiovascular Research Foundation, New York, NY, United States
(Maillard) GCS-ES Axium-Rambot, Clinique Axium, Aix en Provence, France
(Byrne) Cardiovascular Research Institute Dublin, Mater Private Hospital,
Dublin, Ireland
(Byrne) School of Pharmacy and Biomolecular Sciences, Royal College of
Surgeons University of Medicine and Health Sciences, Dublin, Ireland
(Jauhar) North Shore University Hospital, Manhasset New York, NY, United
States
(Barakat) Celonova Biosciences Inc., San Antonio, TX, United States
Publisher
Elsevier Inc.
Abstract
Background/purpose: A coronary stent with thromboresistant and pro-healing
properties such as the polymer polyzene F-coated (COBRA PzF) stent might
safely allow for a very short duration of triple therapy in patients
taking oral anticoagulation (OAC) who undergo coronary stenting.
 Method(s): The COBRA-REDUCE trial is a prospective, multinational,
randomized, open-label, assessor-blinded trial. A total of 996 patients at
high bleeding risk because of requirement for OAC (with a vitamin K
antagonist or non-vitamin K antagonist for any indication) will be
randomized at sites in the United States and Europe to treatment with the
COBRA-PzF stent followed by very short duration (14 days) DAPT or a Food
and Drug Administration (FDA)-approved new generation drug-eluting stent
followed by guideline-recommended DAPT duration (3 or 6 months). Two
co-primary endpoints will be tested at 6 months: a bleeding co-primary
endpoint (bleeding academic research consortium [BARC] >=2 bleeding beyond
14 days or after hospital discharge, whichever is later [superiority
hypothesis]) and a thrombo-embolic co-primary endpoint (the composite of
all-cause death, myocardial infarction, definite/probable stent thrombosis
or ischaemic stroke [non-inferiority hypothesis]). The trial is registered
at clinicaltrials.gov (NCT02594501). Conclusion(s): The COBRA-REDUCE
trial will determine whether coronary stenting with the COBRA PzF stent
followed by 14 days of clopidogrel will reduce bleeding without increasing
thrombo-embolic events compared with FDA-approved DES followed by 3-6
months clopidogrel in patients taking OAC and aspirin. Copyright
© 2021 The Authors

<47>
Accession Number
634222338
Title
Novel risk score for predicting recurrence of atrial fibrillation after
the Cryo-Maze procedure.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 07 Feb 2021.
Author
Kakuta T.; Fukushima S.; Minami K.; Saito T.; Kawamoto N.; Tadokoro N.;
Ikuta A.; Kobayashi J.; Fujita T.
Institution
(Kakuta, Fukushima, Saito, Kawamoto, Tadokoro, Ikuta, Kobayashi, Fujita)
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Research Center, Suita, Osaka, Japan
(Minami) Department of Surgical Intensive Care, National Cerebral and
Cardiovascular Research Center, Suita, Osaka, Japan
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study aimed to develop a novel risk score model for
quantitative prediction of the rate of atrial fibrillation (AF) recurrence
after the Cryo-Maze procedure in patients with persistent AF.
 METHOD(S): We enrolled 450 consecutive patients who underwent the
Cryo-Maze procedure for persistent AF concomitant with other cardiac
procedures in our institute between 2001 and 2019. We randomly divided the
cohort into two groups. We derived a model in a 'development cohort' (270
patients; 60%) and validated it in a 'test cohort' (180 patients; 40%) by
receiver operating characteristic curve analysis. RESULT(S): The
median follow-up was 5.2 (interquartile range: 2.0-9.9) years. The 1-, 5-,
10- and 15-year rates of freedom from AF recurrence in the entire cohort
were 91.4%, 83.5%, 76.2% and 57.1%, respectively. Risk factors for AF
recurrence examined by logistic regression analysis included F-wave
voltage in V1<0.2mV, preoperative AF duration >5years and left atrial
volume index >100ml/m2. Points were assigned to each risk factor according
to its odds ratio. A novel risk score model was developed using these
three variables and age, with a range up to 10 points. High score (>7)
predicted high rates of AF recurrence after the Cryo-Maze procedure. The
area under the receiver operating characteristic curve of the novel risk
model score was 0.78 (95% confidence interval: 0.65-0.91) in the test
cohort. CONCLUSION(S): Use of the Cryo-Maze procedure should be
carefully considered in patients with a higher model score because of a
higher risk of AF recurrence. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<48>
Accession Number
634200162
Title
Guidelines for enhanced recovery after cardiac surgery. Consensus document
of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE)
and Perfusionists (AEP).
Source
Revista espanola de anestesiologia y reanimacion. (no pagination), 2021.
Date of Publication: 01 Feb 2021.
Author
Pajares M.A.; Margarit J.A.; Garcia-Camacho C.; Garcia-Suarez J.; Mateo
E.; Castano M.; Lopez Forte C.; Lopez Menendez J.; Gomez M.; Soto M.J.;
Veiras S.; Martin E.; Castano B.; Lopez Palanca S.; Gabaldon T.; Acosta
J.; Fernandez Cruz J.; Fernandez Lopez A.R.; Garcia M.; Hernandez Acuna
C.; Moreno J.; Osseyran F.; Vives M.; Pradas C.; Aguilar E.M.; Bel Minguez
A.M.; Bustamante J.; Gutierrez E.; Llorens R.; Galan J.; Blanco J.;
Vicente R.
Institution
(Pajares, Lopez Forte, Osseyran, Vicente) Servicio de Anestesiologia,
Reanimacion y Terapeutica del Dolor, Hospital Universitari i Politecnic La
Fe, Valencia, Spain
(Margarit, Hernandez Acuna) Servicio de Cirugia Cardiaca, Hospital
Universitari de La Ribera, Valencia, Spain
(Garcia-Camacho) Unidad de Perfusion del Servicio de Cirugia Cardiaca,
Hospital Universitario Puerta del Mar, Cadiz, Spain
(Garcia-Suarez) Servicio de Anestesiologia, Reanimacion y Terapeutica del
Dolor, Hospital Universitario Puerta de Hierro, Madrid, Spain
(Mateo, Lopez Palanca, Gabaldon, Moreno) Servicio de Anestesiologia,
Reanimacion y Terapeutica del Dolor, Hospital General Universitario de
Valencia, Valencia, Spain
(Castano, Martin) Servicio de Cirugia Cardiaca, Complejo Asistencial
Universitario de Leon, Leon, Spain
(Lopez Menendez) Servicio de Cirugia Cardiaca, Hospital Ramon y Cajal,
Madrid, Spain
(Gomez, Fernandez Cruz) Servicio de Anestesiologia, Reanimacion y
Terapeutica del Dolor, Hospital Universitari de La Ribera, Valencia, Spain
(Soto) Unidad de Perfusion, Servicio de Cirugia Cardiaca, Hospital
Universitari de La Ribera, Valencia, Spain
(Veiras) Servicio de Anestesiologia, Reanimacion y Terapeutica del Dolor,
Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
(Castano) Servicio de Anestesiologia, Reanimacion y Terapeutica del Dolor,
Complejo Hospitalario de Toledo, Toledo, Spain
(Acosta) Servicio de Anestesiologia, Reanimacion y Terapeutica del Dolor,
Hospital Universitario Virgen del Rocio, Sevilla, Spain
(Fernandez Lopez) Servicio de Anestesiologia, Reanimacion y Terapeutica
del Dolor, Virgen Macarena, Sevilla, Spain
(Garcia, Galan) Servicio de Anestesiologia, Reanimacion y Terapeutica del
Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Vives) Servicio de Anestesiologia, Reanimacion y Terapeutica del Dolor,
Hospital Universitari Dr. Josep Trueta, Girona, Spain
(Pradas) Servicio de Cirugia Cardiaca, Hospital Universitari Dr. Josep
Trueta, Girona, Spain
(Aguilar) Servicio de Cirugia Cardiaca, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Bel Minguez) Servicio de Cirugia Cardiaca, Hospital Universitari i
Politecnic La Fe, Valencia, Spain
(Bustamante) Servicio de Cirugia Cardiaca, Hospital Clinico Universitario
de Valladolid, Valladolid, Spain
(Gutierrez) Servicio de Cirugia Cardiaca, Hospital Universitario Virgen
del Rocio, Sevilla, Spain
(Llorens) Servicio de Cirugia Cardiovascular, Hospiten Rambla, Santa Cruz
de Tenerife, Spain
(Blanco) Unidad de Perfusion, Servicio de Cirugia Cardiovascular, Hospital
Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
Publisher
NLM (Medline)

<49>
Accession Number
634197201
Title
Clinical Manifestations and Outcomes of Coronavirus Disease-19 in Heart
Transplant Recipients: A Multicenter Case Series with a Systematic Review
and Meta-Analysis.
Source
Transplant international : official journal of the European Society for
Organ Transplantation. (no pagination), 2021. Date of Publication: 04 Feb
2021.
Author
Granger C.; Guedeney P.; Arnaud C.; Guendouz S.; Cimadevilla C.; Kerneis
M.; Kerneis C.; Zeitouni M.; Verdonk C.; Legeai C.; Lebreton G.; Leprince
P.; Desire E.; Sorrentino S.; Silvain J.; Montalescot G.; Hazan F.;
Varnous S.; Dorent R.
Institution
(Granger, Guedeney, Kerneis, Zeitouni, Silvain, Montalescot) Sorbonne
Universite, ACTION Study Group, INSERM, Institut de cardiologie, Pitie
Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
(Arnaud, Cimadevilla, Kerneis, Verdonk, Dorent) Universite de Paris,
Departement de chirurgie cardiaque, Hopital Bichat, Assistance
Publique-Hopitaux de Paris, Paris, France
(Guendouz) Departement de cardiologie, Hopital Henri-Mondor, Assistance
Publique-Hopitaux de Paris, Creteil, France
(Legeai, Dorent) Agence de la Biomedecine, Direction Prelevement Greffe
Organes-Tissus, Saint Denis La Plaine, France
(Lebreton, Leprince, Desire, Hazan, Varnous) Sorbonne Universite,
Departement de chirurgie cardiaque, Institut de cardiologie, Pitie
Salpetriere Assistance Publique-Hopitaux de Paris, Paris, France
(Sorrentino) Division of Cardiology, Department of Medical and Surgical
Sciences, URT National Research Council (CNR), Magna Graecia" University,
Catanzaro, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Available data on clinical presentation and mortality of
coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients
remain limited. METHOD(S): We report a case series of
laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart
transplant centers (mean age 54.4+/-14.8 years; 66.7% males).
 RESULT(S): Hospital admission was required for 35 (89.7%) cases
including 14/39 (35.9%) cases being admitted in intensive care unit.
Immunosuppressive medications were reduced or discontinued in 74.4% of the
patients. After a median follow-up of 54 (19 - 80) days, death and death
or need for mechanical ventilation occurred in 25.6% and 33.3% of
patients, respectively. Elevated C-reactive protein and lung involvement
>=50% on chest computed tomography (CT) at admission were associated with
an increased risk of death or need for mechanical ventilation. Mortality
rate from March to June in the entire 3-center HT recipient cohort was 56%
higher in 2020 compared to the time-matched 2019 cohort (2% versus 1.28%,
p=0.15). In a meta-analysis including 4 studies, preexisting diabetes
mellitus (OR 3.60, 95% CI 1.43 - 9.06, I2 =0%, p=0.006) and chronic kidney
disease stage III or higher (OR 3.79, 95% CI 1.39 - 10.31, I2 = 0%,
p=0.009) were associated with increased mortality. CONCLUSION(S):
These findings highlight the aggressive clinical course of COVID-19 in HT
recipients. Copyright This article is protected by copyright. All
rights reserved.

<50>
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.

<51>
Accession Number
2007404781
Title
Associations between mean systemic filling pressure and acute kidney
injury: An observational cohort study following cardiac surgery.
Source
Acta Anaesthesiologica Scandinavica. 65 (3) (pp 373-380), 2021. Date of
Publication: March 2021.
Author
Neuman J.; Schulz L.; Aneman A.
Institution
(Neuman) Orange Base Hospital, Orange, NSW, Australia
(Schulz, Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
(Aneman) South Western Sydney Clinical School, University of New South
Wales, Sydney, NSW, Australia
(Aneman) Faculty of Medicine and Health Sciences, Macquarie University,
Sydney, NSW, Australia
Publisher
Blackwell Munksgaard
Abstract
Background: Venous congestion has been implied in cardiac
surgery-associated acute kidney injury (CSA-AKI). The mean systemic
filling pressure may provide a physiologically more accurate estimate of
renal venous pressure and renal perfusion pressure but its association
with CSA-AKI has not been reported. Method(s): Patients admitted to
ICU following cardiac surgery without pre-operative renal dysfunction were
included with monitoring of mean arterial pressure (MAP) and central
venous pressure (CVP) and cardiac output (CO) to calculate the mean
systemic filling pressure analogue (P<inf>msa</inf>). The AKI-KDIGO
guidelines were used to define CSA-AKI. Logistic regression models
including CO, heart rate, MAP, CVP and P<inf>msa</inf> were used to
ascertain the association with CSA-AKI and reported by odds ratio (OR)
with 95% confidence interval (95%CI) and area under the curve (AUROC).
 Result(s): One hundred and thirty patients (out of 221 screened) were
included of whom 66 (51%) developed CSA-AKI. Patients with CSA-AKI were
older, with greater weight and increased stay in ICU while the proportion
of comorbidities, type of surgical procedures, APACHE III scores and fluid
volumes administered were similar to patients without AKI. The
P<inf>msa</inf>, but not CVP, was associated with CSA-AKI (OR 1.2 95%CI
[1.16-1.25]). Renal perfusion pressure was associated with CSA-AKI
estimated as MAP-P<inf>msa</inf> (OR 0.81 [0.76-0.86]) and MAP-CVP (OR
0.89 [0.85-0.93]) with the former generating a higher AUROC (median
difference 0.10 [0.07-0.12], P <.001) in the regression model.
 Conclusion(s): The P<inf>msa</inf> in post-operative cardiac surgery
patients was associated with the development of CSA-AKI also when
incorporated into estimates of renal perfusion pressure. Copyright
© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published
by John Wiley & Sons Ltd

<52>
Accession Number
2010726954
Title
Complete revascularization reduces cardiovascular death in patients with
ST-segment elevation myocardial infarction and multivessel disease:
Systematic review and meta-analysis of randomized clinical trials.
Source
European Heart Journal. 41 (42) (pp 4103-4110), 2020. Date of Publication:
07 Nov 2020.
Author
Pavasini R.; Biscaglia S.; Barbato E.; Tebaldi M.; Dudek D.; Escaned J.;
Casella G.; Santarelli A.; Guiducci V.; Gutierrez-Ibanes E.; Di Pasquale
G.; Politi L.; Saglietto A.; D'Ascenzo F.; Campo G.
Institution
(Pavasini, Biscaglia, Tebaldi, Campo) Cardiovascular Institute, Azienda
Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124,
Italy
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Via Pansini, Naples 80131, Italy
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
ul. Sw Anny 12, Krakow 31-008, Poland
(Dudek, Campo) Maria Cecilia Hospital, GVM Care and Research, Via Corriera
1, Cotignola 48033, Italy
(Escaned) Hospital Clinico San Carlos IDISCC, Complutense University of
Madrid, Calle del Prof Martin Lagos s/n, Madrid 28040, Spain
(Casella, Di Pasquale) U.O.C. Cardiologia, Ospedale Maggiore, Largo
Nigrisoli 2, Bologna 40133, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Viale Luigi
Settembrini 2, Rimini 47923, Italy
(Guiducci) Interventional Cardiology Unit, S. Maria Nuova Hospital, Viale
Risorgimento 80, Reggio Emilia 42123, Italy
(Gutierrez-Ibanes) Servicio de Cardiologia, Hospital General Universitario
Gregorio Maranon, CIBERCV, Calle del Dr Esquerdo 46, Madrid 28007, Spain
(Gutierrez-Ibanes) Universidad Carlos III, Calle Madrid 126, Madrid 28903,
Spain
(Politi) Cardiologia Interventistica, ASST Rhodense, Corso Europa 250, Rho
20024, Italy
(Saglietto, D'Ascenzo) Division of Cardiology, A.O.U. Citta della Salute e
della Scienza, University of Turin, Corso Bramante 88/90, Turin 10126,
Italy
Publisher
Oxford University Press
Abstract
Aims The aim of this work was to investigate the prognostic impact of
revascularization of non-culprit lesions in patients with ST-segment
elevation myocardial infarction (STEMI) and multivessel disease by
performing a meta-analysis of available randomized clinical trials (RCTs).
Methods Data from six RCTs comparing complete vs. culprit-only
revascularization in STEMI patients with multivessel dis- and results ease
were analysed with random effect generic inverse variance method
meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95%
confidence interval (CI). The primary outcome was cardiovascular death.
Main secondary outcomes of interest were all-cause death, myocardial
infarction (MI), and repeated coronary revascularization. Overall, 6528
patients were included (3139 complete group, 3389 culprit-only group).
After a follow-up ranging between 1 and 3 years (median 2 years),
cardiovascular death was significantly reduced in the group receiving
complete revascularization (HR 0.62, 95% CI 0.39-0.97, I2 =
29%). The number needed to treat to prevent one cardiovascular death was
70 (95% CI 36-150). The secondary endpoints MI and revascularization were
also significantly reduced (HR 0.68, 95% CI 0.55-0.84, I2 = 0%
and HR 0.29, 95% CI 0.22-0.38, I2 = 36%, respectively). Needed
to treats were 45 (95% CI 37-55) for MI and 8 (95% CI 5-13) for
revascularization. All-cause death (HR 0.81, 95% CI 0.56-1.16,
I2 = 27%) was not affected by the revascularization strategy.
Conclusion In a selected study population of STEMI patients with
multivessel disease, a complete revascularization strategy is associated
with a reduction in cardiovascular death. This reduction is concomitant
with that of MI and the need of repeated revascularization. Copyright
© 2020 Oxford University Press. All rights reserved.

<53>
Accession Number
628212730
Title
Multivariate meta-analysis model for the difference in restricted mean
survival times.
Source
Biostatistics (Oxford, England). 22 (1) (pp 82-96), 2021. Date of
Publication: 28 Jan 2021.
Author
Weir I.R.; Tian L.; Trinquart L.
Institution
(Weir) Department of Biostatistics, Boston University School of Public
Health, MA, 801 Massachusetts Avenue, Boston, United States
(Tian) Department of Health Research and Policy, Stanford University, 150
Governor's Lane, Palo Alto, CA, USA
(Trinquart) Department of Biostatistics, Boston University School of
Public Health, MA, 801 Massachusetts Avenue, Boston, United States
Publisher
NLM (Medline)
Abstract
In randomized controlled trials (RCTs) with time-to-event outcomes, the
difference in restricted mean survival times (RMSTD) offers an absolute
measure of the treatment effect on the time scale. Computation of the
RMSTD relies on the choice of a time horizon, $\tau$. In a meta-analysis,
varying follow-up durations may lead to the exclusion of RCTs with
follow-up shorter than $\tau$. We introduce an individual patient data
multivariate meta-analysis model for RMSTD estimated at multiple time
horizons. We derived the within-trial covariance for the RMSTD enabling
the synthesis of all data by borrowing strength from multiple time points.
In a simulation study covering 60 scenarios, we compared the statistical
performance of the proposed method to that of two univariate meta-analysis
models, based on available data at each time point and based on
predictions from flexible parametric models. Our multivariate model yields
smaller mean squared error over univariate methods at all time points. We
illustrate the method with a meta-analysis of five RCTs comparing
transcatheter aortic valve replacement (TAVR) with surgical replacement in
patients with aortic stenosis. Over 12, 24, and 36 months of follow-up,
those treated by TAVR live 0.28 [95% confidence interval (CI) 0.01 to
0.56], 0.46 (95% CI $-$0.08 to 1.01), and 0.79 (95% CI $-$0.43 to 2.02)
months longer on average compared to those treated by surgery,
respectively. Copyright © The Author 2019. Published by Oxford
University Press. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<54>
Accession Number
2005887822
Title
Reverse remodeling after percutaneous transluminal septal myocardial
ablation in severe but asymptomatic LVOT obstruction (RASTA) study:
Rationale and design of transcatheter septal reduction in asymptomatic
patients with severe hypertrophic obstructive cardiomyopathy.
Source
Catheterization and Cardiovascular Interventions. 97 (3) (pp 488-492),
2021. Date of Publication: 15 Feb 2021.
Author
Arslan F.; Akdim F.; ten Berg J.M.
Institution
(Arslan, Akdim, ten Berg) Department of Cardiology, St. Antonius Hospital
Nieuwegein, Nieuwegein, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Objectives: The aim of this study is to evaluate the impact of
percutaneous transluminal septal myocardial ablation (PTSMA) on remodeling
in asymptomatic patients with hypertrophic obstructive cardiomyopathy
(HOCM) and severe left ventricular outflow tract (LVOT) obstruction.
 Background(s): Symptoms justify invasive treatment in HOCM patients
with LVOT obstruction. Adverse structural and functional changes
(remodeling) in the heart occur preceding heart failure and sudden cardiac
death. Early invasive treatment in asymptomatic patients may reverse
adverse remodeling to the same extent as in symptomatic patients.
 Method(s): Reverse remodeling after PTSMA in severe but asymptomatic
LVOT obstruction (RASTA) study is a prospective single-blind randomized
trial (ClinicalTrials.gov number: NCT04230551). Ten asymptomatic HOCM
patients with an exertional LVOT gradient >=50 mmHg (or >30 mmHg in rest)
are randomized 1:1 to PTSMA versus conservative therapy, in the absence of
mitral valve disease or other indications for cardiac surgery. Five
symptomatic (reference group) will undergo PTSMA according to the current
guidelines. Result(s): Remodeling is assessed using extensive cardiac
imaging with transthoracic echocardiography and late gadolinium
enhancement cardiac magnetic resonance at baseline and during follow-up at
1, 12, and 24 months. Extracellular volume fraction, global, and regional
strain analysis, geometry, pressure gradients and changes in
four-dimensional velocity mapping are primary parameters to study
(reversal of) adverse remodeling. Conclusion(s): The RASTA study
gives insight in cardiac remodeling that may occur in asymptomatic
patients after PTSMA. It will provide arguments whether to pursue (or not)
a larger trial with clinical endpoints in asymptomatic HOCM patients with
severe LVOT obstruction. Copyright © 2020 Wiley Periodicals LLC

<55>
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.

<56>
Accession Number
2010759395
Title
harvesting internal mammary artery: a narrative review.
Source
Journal of Cardiovascular Surgery. 61 (6) (pp 790-801), 2020. Date of
Publication: December 2020.
Author
Alol S.; Yang N.; Saeid J.B.; Zeinah M.; Harky A.
Institution
(Alol) School of Public health, Imperial College London, London, United
Kingdom
(Yang) Rutgers Robert Wood Johnson Medical school, New Brunswick, NJ,
United States
(Saeid, Zeinah, Harky) Department of Cardiothoracic Surgery, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Science,
University of Liverpool, Liverpool, United Kingdom
(Harky) liverpool Centre for Cardiovascular science, University of
Liverpool and Liverpool Heart and Chest Hospital, liverpool, United
Kingdom
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Scientific literature has highlighted the development of
surgical procedures with studies investigating optimal selection of
arterial conduit, ideal harvesting method and type of graft. There have
also been studies on the utility and efficiency of harvesting the internal
mammary artery (iMa) through minimally invasive techniques such as
endoscopic and robotic assisted methods. in the pursuit of a more total
and complete revascularization of the coronary arteries, surgeons have
also explored more extensive anastomosis techniques, i.e. sequential and
no-touch. This review analyzes the literature in order to better
understand the various methods for harvesting and using the iMa in
coronary artery bypass graft (CaBg) through outlining the pros and cons of
each methodology. evidenCe aCQuisiTion: literature search on PubMed and
google scholar was performed using search terms such as "CaBg," "iMa,"
"internal thoracic artery," "harvesting," "technique," and "approach."
Manuscripts in languages other than english were not considered.
Manuscripts that assess outcomes of iMa harvesting are reviewed and
included. evidenCe synThesis: a review of 48 studies, narrowed down from
150 articles that were retrieved, were used to evaluate current evidence
for different iMa harvesting techniques. This includes evidence comparing
various techniques: skeletonized and pedicled harvesting, minimally
invasive techniques for harvesting; free arterial and in-situ grafts;
no-aortic touch technique sequential grafting. ConClusions: each technique
and harvesting method is associate with various advantages and
disadvantages. Common patterns in patient outcomes were identified for
many of the techniques. This review provides a summary and overview of the
current evidence base for CAGB surgery and identifies gaps in the evidence
base to direct future research. Copyright © 2020 ediZioni Minerva
MediCa

<57>
Accession Number
2010726516
Title
Comparison of the effect of single vs dual antiplatelet agents on
post-operative haemorrhage after renal transplantation: A systematic
review and meta-analysis.
Source
Transplantation Reviews. 35 (1) (no pagination), 2021. Article Number:
100594. Date of Publication: January 2021.
Author
Lee T.; D'Souza K.; Hameed A.; Yao J.; Lam S.; Chadban S.; Ying T.;
Celermajer D.; Sandroussi C.; Pleass H.C.C.; Laurence J.M.
Institution
(Sandroussi, Laurence) RPA Institute of Academic Surgery, University of
Sydney, RPA Institute of Academic Surgery, Level 9 E, Tranplantation
Services, Missenden Road, Camperdwon, NSW 2050, Australia
(Lee, Hameed, Pleass, Laurence) Department of Surgery, Westmead Hospital,
Corner of Hawkesbury Rd and Darcy, Westmead, NSW 2145, Australia
(Lee, Yao, Lam, Sandroussi, Pleass, Laurence) Royal Prince Alfred
Hospital, Missenden Road, Camperdwon, NSW 2050, Australia
(Chadban, Ying) Department of Renal Medicine, Royal Prince Alfred
Hospital, Camperdwon, NSW 2050, Australia
(D'Souza, Chadban, Ying, Celermajer) University of Sydney Medical School,
Australia
(Celermajer) Department of Cardiology, Royal Prince Alfred Hospital,
Camperdwon, NSW 2050, Australia
Publisher
W.B. Saunders
Abstract
Objectives: A significant proportion of renal transplant patients have
cardiovascular comorbidities for which they receive treatment with
antiplatelet agents. The aim of this study was to systematically review
the current literature reporting perioperative outcomes for patients
receiving dual antiplatelet therapy compared to single antiplatelet
therapy at the time of kidney transplantation with particular reference to
the risks of postoperative haemorrhage. Material(s) and Method(s):
Embase, Medline and Cochrane databases were utilized to identify articles
reporting outcomes of renal transplant recipients on single antiplatelet
therapy and dual antiplatelet therapy. These outcomes were compared using
a random effects model meta-analysis where appropriate. Result(s):
Six articles were incorporated in the analysis, including 130 receiving
dual antiplatelet therapy, and 781 in the single antiplatelet therapy
group. There was a significantly higher risk of post-operative
haemorrhagic events in the dual antiplatelet therapy group compared to the
single antiplatelet therapy group (RR 1.58, 95% CI 1.19-2.09, p = 0.001).
Post-operative cardiovascular event rates were similar between both groups
in individual studies, although this could not be quantitatively analysed.
 Conclusion(s): The use of dual antiplatelet therapy was associated
with a higher risk of post-operative haemorrhage compared to the use of
single antiplatelet therapy without increased rates of surgical
intervention. However, the use of dual antiplatelet therapy may provide
protection from cardiovascular events in an inherently higher risk patient
group. Copyright © 2020

<58>
Accession Number
2011031271
Title
Considerations on the use of MitraClip in the treatment of mitral
regurgitation.
Source
European Heart Journal, Supplement. 22 (pp L101-L104), 2021. Date of
Publication: 2021.
Author
Musumeci G.; Rossini R.
Institution
(Musumeci) Cardiology Unit, Ospedale Mauriziano, Torino, Italy
(Rossini) Cardiology Unit, Santa Croce & Carle Hospital, Cuneo, Italy
Publisher
Oxford University Press
Abstract
Mitral regurgitation (MR) is, by occurrence, the second most common
valvular heart disease in the Western world, with a significant impact on
prognosis and mortality. A significant number of patients with significant
mitral incompetence cannot be submitted to conventional surgery due to
high surgical risk. The need for an adequate therapeutical strategy
prompted the development of innovative endovascular techniques. Among
them, the MitraClip percutaneous system, mimicking the 'edge-to-edge'
surgical technique introduced by Alfieri in 2003 has emerged as the
treatment of choice in patients not suitable for conventional surgery.
Since its introduction, this procedure has been effectively carried out in
more than 35 000 patients. The evidences from the first randomized
clinical trial, EVEREST II, suggested that the MitraClip system is
effective in improving survival and quality of life in patients with
severe MR. Further randomized trials, MITRA-FR and COAPT, added some more
information, showing that an appropriate patient selection, close
attention to the specific anatomical characteristics of the mitral valve,
and adequate experience of the centre providing the treatment, are
important determinants of the outcome of the procedure. Copyright
© The Author(s) 2020.

<59>
Accession Number
2011078704
Title
Anesthesia Management for Pediatrics with Congenital Heart Diseases Who
Undergo Cardiac Catheterization in China.
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 8861461. Date of Publication: 2021.
Author
Xie C.-M.; Yao Y.-T.
Institution
(Xie) Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital,
Affiliated Cardiovascular Hospital, Kunming Medical University, Kunming
650000, China
(Yao) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of
Medical Sciences, Beijing 10037, China
Publisher
Hindawi Limited
Abstract
Objectives. The goal of this study was to summarize anesthesia management
for pediatrics with congenital heart diseases who undergo cardiac
catheterization procedure in China. Methods. The relevant articles were
identified through computerized searches in the CNKI, Wanfang, VIP, and
PubMed databases through May 2020, using different combinations of
keywords: "congenital heart
diseases,""pediatric,""children,""anesthesia,""cardiac
catheterization,""interventional therapy,""interventional
treatment,""interventional examination,"and "computed tomography."Results.
The database searches identified 48 potentially qualified articles, of
which 25 (9,738 patients in total) were determined to be eligible and
included. The authors collect data from the article information.
Anesthesia methods included endotracheal intubation or laryngeal mask
ventilation general anesthesia, monitored anesthesia care, and combined
with sacral canal block. Anesthesia-related complications occurred in
7.41% of the patients and included dysphoria, respiratory depression,
nausea, vomiting, cough, increased respiratory secretion, and airway
obstruction. The incidence of procedure-related complications was 12.14%,
of which the most common were arrhythmia and hypotension. Conclusions. For
pediatric patients with congenital heart diseases who undergo cardiac
catheterization procedures in China, arrhythmia and hypotension are the
most common procedure-related complications. Monitored anesthesia care is
the commonly used anesthesia methods, and dysphoria, cough, nausea,
vomiting, and respiratory depression are frequent complications associated
with anesthesia. Copyright © 2021 Chun-Mei Xie and Yun-Tai Yao.

<60>
Accession Number
2010759709
Title
Determinants of acute kidney injury after cardiac surgery: A systematic
review.
Source
Reviews in Cardiovascular Medicine. 21 (4) (pp 601-610), 2020. Date of
Publication: December 2020.
Author
Tinica G.; Brinza C.; Covic A.; Popa I.V.; Tarus A.; Bacusca A.E.; Burlacu
A.
Institution
(Tinica, Brinza, Tarus, Bacusca) Department of Cardiovascular Surgery,
Cardiovascular Diseases Institute, Iasi 700503, Romania
(Tinica, Brinza, Covic, Popa, Tarus, Bacusca, Burlacu) Grigore T. Popa,
University of Medicine, Iasi 700115, Romania
(Covic) Nephrology Clinic, Dialysis, Renal Transplant Center, 'C.I.
Parhon' Hospital, Iasi 700507, Romania
(Burlacu) Department of Interventional Cardiology, Cardiovascular Diseases
Institute, Iasi 700503, Romania
Publisher
IMR Press Limited
Abstract
Acute kidney injury following cardiac surgery (CS-AKI) represents a severe
postoperative complication, negatively impacting short-term and long-term
mortality. Due to the lack of a specific treatment, effective prevention
remains the most powerful tool to overcome the CS-AKI burden. Improving
the preventive strategies is possible by establishing appropriate
preoperative risk profiles. Various clinical models were proposed as a
means to assist physicians in stratifying the risk of CS-AKI. However,
these models are used for predicting severe forms of CS-AKI, while their
predictive power for mild forms is insufficient. Our paper represents the
first systematic approach to review all proposed preoperative risk factors
and their predictive power. Our strategy is the starting point for
selecting and comparing the predictive elements to be integrated into
future risk models. Heart failure, chronic hyperglycemia, anemia, obesity,
preoperative exposure to nephrotoxic drugs or contrast media,
inflammation, proteinuria, and pre-existing kidney disease were
systematically reviewed and were found to be associated with an increased
risk of postoperative CS-AKI. As no externally validated and universally
accepted risk models currently exist, the clinical judgment and a good
knowledge of the preoperative risk factors in the light of new evidence
may help personalize preoperative risk profiles as the cornerstone of
prevention measures. Copyright © 2020 Tinica et al. Published by
IMR Press.

<61>
Accession Number
634189689
Title
Comparison of major bleeding in patients with acute coronary syndrome that
underwent coronary artery bypass grafting treated with clopidogrel or
ticagrelor: A systematic review and meta-analysis.
Source
F1000Research. 9 (no pagination), 2020. Article Number: 99. Date of
Publication: 2020.
Author
Tamara F.; Heriansyah T.; Pikir B.S.; Fajar J.K.; Rohman M.S.; Purnamasari
Y.; Ilmawan M.; Mahdi B.A.; Mahendra A.I.; Mazen M.; Yamin M.
Institution
(Rohman) Brawijaya Cardiovascular Research Center, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya, Malang, East Java 65145, Indonesia
(Purnamasari, Ilmawan) Faculty of Medicine, Universitas Brawijaya, Malang,
East Java 65145, Indonesia
(Mahdi) Department of Internal Medicine, Faculty of Medicine, Universitas
Airlangga, Surabaya, East Java 60115, Indonesia
(Tamara, Fajar, Mahendra, Mazen) Brawijaya Internal Medicine Research
Center, Department of Internal Medicine, Faculty of Medicine, Universitas
Brawijaya, Malang, East Java 65145, Indonesia
(Heriansyah) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
(Yamin) Division of Cardiovascular Medicine, Department of Internal
Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Jakarta
16424, Indonesia
(Pikir) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Airlangga, Surabaya, East Java 60115, Indonesia
Publisher
F1000 Research Ltd
Abstract
Background: There is controversy among physicians regarding the use of
dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients
treated with coronary artery bypass grafting (CABG). Moreover, the
evidence of previous studies about this topic remained inconclusive. This
study aimed to perform a meta-analysis concerning the relation between the
risk of major bleeding and the use of different DAPT (clopidogrel or
ticagrelor) in ACS patients treated with CABG. Method(s): A
meta-analysis was conducted during March to October 2019. Searches were
carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor
covariate in our present study was DAPT (clopidogrel or ticagrelor), and
the outcome measure was the risk of major bleeding. Sub-group analysis was
also performed, where data were classified into pre- and post-CABG.
Furthermore, to determine the correlation and effect estimation, data were
analyzed using fixed or random effect model. Result(s): A total of 13
studies consisting 34,015 patients treated with clopidogrel and 32,661
patients treated with ticagrelor was included in our study. Our pooled
calculation revealed that the incidence of major bleeding was not
different significantly between clopidogrel and ticagrelor. In pre- and
post-CABG sub-groups, our results also found no significant difference in
major bleeding incidence between clopidogrel and ticagrelor groups.
 Conclusion(s): Our meta-analysis clarifies that clopidogrel, compared
to ticagrelor, or vice versa, is not associated with the risk of major
bleeding in ACS patients treated with CABG. Copyright © 2020
Rohman MS et al.

<62>
Accession Number
2011015178
Title
Meta-Analysis of Transcatheter Aortic Valve Implantation in Patients With
Stenotic Bicuspid Versus Tricuspid Aortic Valve.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Majmundar M.; Kumar A.; Doshi R.; Shah P.; Arora S.; Shariff M.; Adalja
D.; Visco F.; Amin H.; Vallabhajosyula S.; Gullapalli N.; Kapadia S.R.;
Kalra A.; Panaich S.S.
Institution
(Majmundar) Department of Internal Medicine, Metropolitan Hospital Center,
New York Medical College, New York, NY, United States
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Doshi, Gullapalli) Department of Internal Medicine, University of Nevada
Reno School of Medicine, Reno, NV, United States
(Shah) Department of Internal Medicine, Dhiraj Hospital, Sumandeep
Vidyapeeth, Vadodara, Gujarat, India
(Arora) Department of Cardiology, Case Western Reserve University,
Cleveland, OH, United States
(Adalja) Department of Medicine, GMERS Gotri Medical College, Vadodara,
Gujarat, India
(Visco) Division of Cardiology, Department of Internal Medicine,
Metropolitan Hospital Center, New York Medical College, New York, NY,
United States
(Amin) Division of Pulmonary and Critical Care, Metropolitan Hospital
Center, New York Medical College, New York, NY, United States
(Vallabhajosyula) Section of Intervention Cardiology, Division of
Cardiovascular Medicine, Department of Medicine, Emory University School
of Medicine, Atlanta, Georgia, United States
(Kapadia, Kalra) Department of Cardiovascular Medicine, Heart, Vascular
and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Kalra) Section of Cardiovascular Research, Heart, Vascular and Thoracic
Department, Cleveland Clinic Akron General, Akron, OH, United States
(Panaich) Department of Cardiovascular Medicine, University of Iowa
Hospitals and Clinics, Iowa City, IA, United States
Publisher
Elsevier Inc.
Abstract
Most of the trials investigating the role of transcatheter aortic valve
implantation (TAVI) across various strata of risk categories have excluded
patients with bicuspid aortic stenosis (BAS) due to its anatomical
complexities. The aim of this study was to perform a meta-analysis with
meta-regression of studies comparing clinical, procedural, and
after-procedural echocardiographic outcomes in BAS versus tricuspid aortic
stenosis (TAS) patients who underwent TAVI. We searched the PubMed and
Cochrane databases for relevant articles from the inception of the
database to October 2019. Continuous and categorical variables were pooled
using inverse variance and Mantel-Haenszel method, respectively, using the
random-effect model. To rate the certainty of evidence for each outcome,
we used the GRADE (Grading of Recommendations, Assessment, Development,
and Evaluations) approach. Nineteen articles were included in the final
analysis. There was no difference in the risk of 30-day mortality, 1-year
mortality, 30-day cardiovascular mortality, major and/or life-threatening
bleeding, major vascular complications, acute kidney injury, permanent
pacemaker implantation, device success, annular rupture, after-procedural
aortic valve area, and mean pressure gradient between the 2 groups. BAS
patients who underwent TAVI had a higher risk of 30-day stroke, conversion
to surgery, need for second valve implantation, and moderate to severe
paravalvular leak. In conclusion, the present meta-analysis supports the
feasibility of TAVI in surgically ineligible patients with BAS. However,
the incidence of certain procedural complications such as stroke,
conversion to surgery, second valve implantation, and paravalvular leak is
higher among BAS patients compared with TAS patients, which must be
discussed with the patient during the decision-making
process. Copyright © 2021 Elsevier Inc.

<63>
Accession Number
633133634
Title
Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants
and Children: Current Evidence.
Source
European Journal of Pediatric Surgery. 31 (1) (pp 54-64), 2021. Date of
Publication: 01 Feb 2021.
Author
Kiblawi R.; Zoeller C.; Zanini A.; Ure B.M.; Dingemann J.; Kuebler J.F.;
Schukfeh N.
Institution
(Kiblawi, Zoeller, Ure, Dingemann, Kuebler, Schukfeh) Department of
Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strabetae 1,
Hannover, Niedersachsen 30625, Germany
(Zanini) Department of Pediatric Surgery, University of Witwatersrand,
Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Publisher
Georg Thieme Verlag
Abstract
Introduction The pros and cons of video-assisted thoracoscopic versus
conventional thoracic surgery in infants and children are still under
debate. We assessed reported advantages and disadvantages of
video-assisted thoracoscopy in pediatric surgical procedures, as well as
the evidence level of the available data. Materials and Methods A
systematic literature search was performed to identify manuscripts
comparing video-assisted thoracoscopic and the respective conventional
thoracic approach in classic operative indications of pediatric surgery.
Outcome parameters were analyzed and graded for level of evidence
(according to the Oxford Centre of Evidence-Based Medicine). Results A
total of 48 comparative studies reporting on 12,709 patients, 11
meta-analyses, and one pilot randomized controlled trial including 20
patients were identified. More than 15 different types of advantages for
video-assisted thoracoscopic surgery were described, mostly with a level
of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery
was associated with shorter hospital stay, shorter postoperative
ventilation, and shorter time to chest drain removal. Mortality rate and
severe complications did not differ between thoracoscopic and conventional
thoracic pediatric surgery, except for congenital diaphragmatic hernia
repair with a lower mortality and higher recurrence rate after
thoracoscopic repair. The most frequently reported disadvantage for
video-assisted thoracoscopic surgery was longer operative time. Conclusion
The available data point toward improved recovery in pediatric
video-assisted thoracoscopic surgery despite longer operative times.
Further randomized controlled trials are needed to justify the widespread
use of video assisted thoracoscopy in pediatric surgery. Copyright
© 2021 Georg Thieme Verlag. All rights reserved.

<64>
Accession Number
2010903822
Title
Comparison of intravascular ultrasound-guided with angiography-guided
double kissing crush stenting for patients with complex coronary
bifurcation lesions: Rationale and design of a prospective, randomized,
and multicenter DKCRUSH VIII trial.
Source
American Heart Journal. 234 (pp 101-110), 2021. Date of Publication: April
2021.
Author
Ge Z.; Kan J.; Gao X.-F.; Kong X.-Q.; Zuo G.-F.; Ye F.; Tian N.-L.; Lin
S.; Liu Z.-Z.; Sun Z.-Q.; He P.-C.; Wei L.; Yang W.; He Y.-Q.; Xue Y.-Z.;
Wang L.-M.; Miao L.-F.; Pu J.; Sun Y.-W.; Nie S.-P.; Tao J.-H.; Wen S.-Y.;
Yang Q.; Su X.; Yao Q.-C.; Huang Y.-J.; Xia Y.; Shen F.-R.; Qiu C.-G.; Mao
Y.-L.; Liu Q.; Hu X.-Q.; Du Z.-M.; Nie R.-Q.; Han Y.-L.; Zhang J.-J.; Chen
S.-L.
Institution
(Ge, Kan, Gao, Kong, Zuo, Ye, Tian, Lin, Liu, Zhang, Chen) Division of
Cardiology, Nanjing First hospital, Nanjing, China
(Sun) Division of Cardiology, Daqing Oilfield General Hospital, Daqing,
China
(He) Division of Cardiology, Guangdong Provincial People's Hospital,
Guangzhou, China
(Wei) Division of Cardiology, Harbin First Hospital, Harbin, China
(Yang) Division of Cardiology, The 4th Affiliated Hospital of Harbin
Medical University, Harbin, China
(He) Division of Cardiology, China-Japan Friendship Hospital, Changchun,
China
(Xue) Division of Cardiology, Liaocheng People's Hospital, Liaocheng,
China
(Wang) Division of Cardiology, Mudanjiang Cardiovascular Hospital,
Mudanjiang, China
(Miao) Division of Cardiology, Beijing Huaxin Hospital, the First Hospital
of Tsinghua University, Beijing, China
(Pu) Division of Cardiology, Renji Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China
(Sun) Division of Cardiology, Shanghai Fourth People's Hospital, Shanghai,
China
(Nie) Division of Cardiology, Beijing Anzhen Hospital, Capital Medical
Hospital, Beijing, China
(Tao) Division of Cardiology, Sichuan Province People's Hospital, Chengdu,
China
(Wen) Division of Cardiology, Tianjin 4th People's Hospital, Tianjin,
China
(Yang) Division of Cardiology, Tianjin Medical University General
Hospital, Tianjin, China
(Su) Division of Cardiology, Wuhan Asia heart Hospital, Wuhan, China
(Yao) Division of Cardiology, Shenzhen Hospital, The University of Hong
Kong, Shenzhen, China
(Huang) Division of Cardiology, XuZhou Central Hospital, Xuzhou, China
(Xia) Division of Cardiology, The Affiliated Hospital of Xuzhou Medical
University, Xuzhou, China
(Shen) Division of Cardiology, Zhejiang Greentown Cardiovascular Hospital,
Zhejiang, China
(Qiu) Division of Cardiology, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Mao) Division of Cardiology, The 7th People's Hospital of Zhengzhou,
Zhengzhou, China
(Liu) Division of Cardiology, Fuwai Hospital Chinese Academy of Medical
Science, Shenzhen, China
(Hu) Division of Cardiology, The Second Xiangya Hospital of Central South
University, Changsha, China
(Du) Division of Cardiology, The First Affiliated Hospital of Zhongshan
University, Guangzhou, China
(Nie) Division of Cardiology, Sun Yat-Sen Memorial Hospital, Zhongshan
University, Guangzhou, China
(Han) Division of Cardiology, General Hospital of Northern Theater
Command, Shenyang, China
Publisher
Mosby Inc.
Abstract
Background: Double kissing (DK) crush approach for patients with coronary
bifurcation lesions, particularly localized at distal left main or lesions
with increased complexity, is associated with significant reduction in
clinical events when compared with provisional stenting. Recently,
randomized clinical trial has demonstrated the net clinical benefits by
intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent
in all-comers. However, the improvement in clinical outcome after DK crush
treatment guided by IVUS over angiography guidance for patients with
complex bifurcation lesions have never been studied in a randomized
fashion. Trial design: DKCRUSH VIII study is a prospective, multicenter,
randomized controlled trial designed to assess superiority of IVUS-guided
vs angiography-guided DK crush stenting in patients with complex
bifurcation lesions according to DEFINITION criteria. A total of 556
patients with complex bifurcation lesions will be randomly (1:1 of ratio)
assigned to IVUS-guided or angiography-guided DK crush stenting group. The
primary end point is the rate of 12-month target vessel failure, including
cardiac death, target vessel myocardial infarction, or clinically driven
target vessel revascularization. The secondary end points consist of the
individual component of primary end point, all-cause death, myocardial
infarction, and in-stent restenosis. The safety end point is the incidence
of definite or probable stent thrombosis. An angiographic follow-up will
be performed for all patients at 13 months and clinical follow-up will be
continued annually until 3 years after the index procedure.
 Conclusion(s): DKCRUSH VIII trial is the first study designed to
evaluate the differences in efficacy and safety between IVUS-guided and
angiography-guided DK crush stenting in patients with complex true
bifurcation lesions. This study will also provide IVUS-derived criteria to
define optimal DK crush stenting for bifurcation lesions at higher
complexity. Copyright © 2021 Elsevier Inc.

<65>
[Use Link to view the full text]
Accession Number
2010096536
Title
COVID-19 in solid organ transplant recipients: A systematic review and
meta-analysis of current literature.
Source
Transplantation Reviews. 35 (1) (no pagination), 2021. Article Number:
100588. Date of Publication: January 2021.
Author
Raja M.A.; Mendoza M.A.; Villavicencio A.; Anjan S.; Reynolds J.M.;
Kittipibul V.; Fernandez A.; Guerra G.; Camargo J.F.; Simkins J.; Morris
M.I.; Abbo L.A.; Natori Y.
Institution
(Raja, Anjan, Fernandez, Camargo, Simkins, Morris, Abbo, Natori)
Department of Medicine, Division of Infectious Disease, University of
Miami Miller School of Medicine, Miami, FL, United States
(Mendoza, Villavicencio, Kittipibul) Department of Medicine, Division of
Internal Medicine, University of Miami Miller School of Medicine, Miami,
FL, United States
(Anjan, Guerra, Simkins, Abbo, Natori) Miami Transplant Institute, Jackson
Health System, Miami, FL, United States
(Reynolds) Department of Health Informatics, Calder Memorial Library,
University of Miami Miller School of Medicine Miami, FL, United States
(Guerra) Department of Medicine, Division of Nephrology, University of
Miami Miller School of Medicine Miami, FL, United States
Publisher
W.B. Saunders
Abstract
Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a
worldwide pandemic. Early studies in solid organ transplant (SOT)
recipients suggested a wide variety of presentations, however, there
remains a paucity of robust data in this population. We conducted a
systematic review and meta-analysis of SOT recipients with SARS-CoV-2
infection from January 1st t October 9th, 2020.
Pooled incidence of symptoms, treatments and outcomes were assessed. Two
hundred and fifteen studies were included for systematic review and 60 for
meta-analysis. We identified 2,772 unique SOT recipients including 1,500
kidney, 505 liver, 141 heart and 97 lung. Most common presenting symptoms
were fever and cough in 70.2% and 63.8% respectively. Majority (81%)
required hospital admission. Immunosuppressive medications, especially
antimetabolites, were decreased in 76.2%. Hydroxychloroquine and
interleukin six antagonists were administered in59.5% and 14.9%
respectively, while only few patients received remdesivir and convalescent
plasma. Intensive care unit admission was 29% from amongst hospitalized
patients. Only few studies reported secondary infections. Overall
mortality was 18.6%. Our analysis shows a high incidence of hospital
admission in SOT recipients with SARS-CoV-2 infection. As management of
SARS-CoV-2 continues to evolve, long-term outcomes among SOT recipients
should be assessed in future studies. Copyright © 2020

<66>
Accession Number
2006796464
Title
Current trends in vena cava reconstructive techniques with major liver
resection: a systematic review.
Source
Langenbeck's Archives of Surgery. 406 (1) (pp 25-38), 2021. Date of
Publication: February 2021.
Author
Baimas-George M.; Tschuor C.; Watson M.; Sulzer J.; Salibi P.; Iannitti
D.; Martinie J.B.; Baker E.; Clavien P.-A.; Vrochides D.
Institution
(Baimas-George, Tschuor, Watson, Sulzer, Salibi, Iannitti, Martinie,
Baker, Vrochides) Division of Hepatopancreatobiliary Surgery, Department
of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive;
Suite 600, Charlotte, NC 28204, United States
(Tschuor, Clavien) Department of Surgery & Transplantation, University
Hospital of Zurich, Zurich, Switzerland
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Historically, invasion of the inferior vena cava (IVC)
represented advanced and often unresectable hepatic disease. With surgical
and anesthetic innovations, IVC resection and reconstruction have become
feasible in selected patients. This review assesses technical variations
in reconstructive techniques and post-operative management.
 Method(s): A comprehensive literature search was performed according
to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English;
(ii) at least three cases; (iii) hepatic IVC resection and reconstruction
(January 2015-March 2020). Primary outcomes were reconstructive technique,
anti-thrombotic regimen, post-operative IVC patency, and infection.
Secondary outcomes included post-operative complications and malignant
disease survival. Result(s): Fourteen articles were included allowing
for investigation of 351 individual patients. Analysis demonstrated
significant heterogeneity in surgical reconstructive technique,
anti-thrombotic management, and post-operative monitoring of patency.
There was increased utilization of ex vivo approaches and decreased use of
venovenous bypass compared with previously published reviews.
 Conclusion(s): This review of literature published between 2015 and
2020 reveals persistent heterogeneity of hepatic IVC reconstructive
techniques and peri-operative management. Increased utilization of ex vivo
approaches and decreased use of venovenous bypass point towards improved
operative techniques, peri-operative management, and anesthesia. In order
to gain evidence for consensus on management, a registry would be
beneficial. Copyright © 2020, Springer-Verlag GmbH Germany, part
of Springer Nature.

<67>
Accession Number
2006988157
Title
Clinical Safety Profile of Transendocardial Catheter Injection Systems: A
Plea for Uniform Reporting.
Source
Cardiovascular Revascularization Medicine. 22 (pp 100-108), 2021. Date of
Publication: January 2021.
Author
Raval A.N.; Pepine C.J.
Institution
(Raval) Department of Medicine and Biomedical Engineering, University of
Wisconsin School of Medicine and Public Health, Madison, WI, United States
(Pepine) Division of Cardiovascular Medicine, University of Florida,
Gainsville, FL, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to characterize the clinical safety
profile of transendocardial injection catheters (TIC) reported in the
published literature. Background(s): Transendocardial delivery is a
minimally invasive approach to deliver potential therapeutic agents
directly into the myocardium. The rate of adverse events across TIC is
uncertain. Method(s): A systematic search was performed for trial
publications using TIC. Procedure-associated adverse event data were
abstracted, pooled and compared across catheters for active treatment and
placebo injected patients. The transendocardial injection associated
serious adverse events (TEI-SAE) was defined as the composite of death,
myocardial infarction, stroke or transient ischemic attack within 30 days
and cardiac perforation causing death or requiring evacuation, serious
intraprocedural arrhythmias and serious coronary artery or peripheral
vascular complications. Result(s): The search identified 4 TIC
systems: a helical needle (HN), an electro-anatomically tracked straight
needle (EAM-SN), a straight needle without tracking elements (SN), and a
curved needle (CN). Of 1799 patients who underwent transendocardial
injections, the combined TEI-SAE was 3.4% across all catheters, and 1.1%,
3.3%, 7.1%, and 8.3% for HN, EAM-SN, SN and CN, respectively. However, TIC
procedure duration and post procedural cardiac biomarker levels were
reported in only 24% and 36% of published trials, respectively.
 Conclusion(s): Transendocardial injection is associated with varied
TEI-SAE but the data are very limited. The HN catheter appeared to be
associated with lower TEI-SAE, versus other catheters. Procedure duration
and post procedure cardiac biomarker levels were under-reported. Clearly,
standardized, procedure-related event reporting for trials involving
transcatheter delivery would improve our understanding of complications
across different systems. Copyright © 2020 Elsevier Inc.

<68>
Accession Number
2007789947
Title
Ischemic functional mitral regurgitation: from pathophysiological concepts
to current treatment options. A systemic review for optimal strategy.
Source
General Thoracic and Cardiovascular Surgery. 69 (2) (pp 213-229), 2021.
Date of Publication: February 2021.
Author
Nappi F.; Nenna A.; Mihos C.; Spadaccio C.; Gentile F.; Chello M.; Matzui
Y.
Institution
(Nappi) Cardiac Surgery, Centre Cardiologique du Nord, 36 Rue des Moulins
Gemeaux, Saint-Denis 93200, France
(Nenna, Chello) Cardiovascular Surgery, Universita Campus Bio-Medico di
Roma, Rome, Italy
(Mihos) Echocardiography Laboratory, Columbia University, Mount Sinai
Heart Institute, Miami, United States
(Spadaccio) Cardiothoracic Surgery, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Gentile) Cardiovascular Disease Diagnostic Medical Center, Naples, Italy
(Matzui) Cardiovascular and Thoracic Surgery, Hokkaido University Graduate
School of Medicine, Sapporo, Japan
Publisher
Springer Japan
Abstract
Objective: The current treatment of ischemic functional mitral
regurgitation (FMR) remains debated due to differences in inclusion
criteria of randomized studies and baseline characteristics. Also, the
role of left ventricular pathophysiology and the role of subvalvular
apparatus have not been thoroughly investigated in recent literature.
 Method(s): A literature search was performed from PubMed inception to
June 2020. Result(s): Novel concepts of pathophysiology, such as the
proportionate/disproportionate conceptual framework, the role of papillary
muscles and left ventricular dysfunction, the impact of myocardial
ischemia and revascularization, left ventricular remodeling, and the
effect of restrictive annuloplasty or subvalvular procedures have been
reviewed. Conclusion(s): The clinical benefits associated with the
use of MitraClip is more evident in patients with disproportionate FMR
with greater and sustained left ventricular reverse remodeling.
Importantly, in the absence of myocardial revascularization, expansion of
myocardial scar tissue and non-perfused areas of ischemic myocardium occur
with time, and this impact on outcomes with a longer follow-up period
cannot be quantified. In advanced phases of FMR, neither mitral ring
annuloplasty nor percutaneous therapies could significantly modify the
established pathoanatomic alterations. Copyright © 2021, The
Japanese Association for Thoracic Surgery.

<69>
Accession Number
2004682562
Title
Antihyperglycemic therapies and cardiovascular outcomes in patients with
type 2 diabetes mellitus: State of the art and future directions.
Source
Trends in Cardiovascular Medicine. 31 (2) (pp 101-108), 2021. Date of
Publication: February 2021.
Author
Kato E.T.; Das S.R.; McGuire D.K.
Institution
(Kato) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Japan
(Das, McGuire) Department of Internal Medicine, University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75930,
United States
Publisher
Elsevier Inc.
Abstract
Type 2 diabetes mellitus is a progressive chronic disease and is an
established risk factor for cardiovascular disease. Until recently, the
cardiovascular safety and efficacy of antihyperglycemic drugs remained
uncertain. However, after the changes in regulatory guidance in 2008, a
wealth of data has been generated, expanding the focus of the treatment of
diabetes from blood glucose control to the prevention of macro-and
microvascular complications and improvement in mortality. This article
will review cardiovascular outcome trials of antihyperglycemic agents and
provide overview of ongoing trials. Copyright © 2020

<70>
Accession Number
2004613127
Title
Resuming Anticoagulation Following Hospitalization for Gastrointestinal
Bleeding Is Associated with Reduced Thromboembolic Events and Improved
Mortality: Results from a Systematic Review and Meta-Analysis.
Source
Digestive Diseases and Sciences. 66 (2) (pp 554-566), 2021. Date of
Publication: February 2021.
Author
Tapaskar N.; Pang A.; Werner D.A.; Sengupta N.
Institution
(Tapaskar) Department of Medicine, University of Chicago Medicine,
Chicago, United States
(Pang) Department of Medicine, New York University Langone Health, 550
First Avenue, New York, NY 10022, United States
(Werner) The John Crerar Library, University of Chicago, 5730 S Ellis Ave,
Chicago, IL 60637, United States
(Sengupta) Section of Gastroenterology, Hepatology, and Nutrition,
University of Chicago Medicine, 5841 S Maryland Avenue, MC 4076, Chicago,
IL 60637, United States
Publisher
Springer
Abstract
Background: Systemic anticoagulants are widely prescribed for prevention
and treatment of thromboembolism, but are commonly complicated by
gastrointestinal bleeding (GIB). Limited data exist on the management of
anticoagulation after hospitalization for GIB and the subsequent risks of
recurrent GIB, thromboembolism, and mortality. Method(s): We
performed a systematic review and meta-analysis of studies to determine
risk of recurrent GIB, thromboembolism, and mortality after resuming
anticoagulation following GIB. PubMed, EMBASE, and Scopus were searched
for randomized controlled trials and cohort studies in patients with
atrial fibrillation, venous thromboembolism, or valvular heart disease who
received long-term warfarin or direct oral anticoagulants before
experiencing GIB. Studies were included if data were available on
anticoagulation management and outcomes of recurrent GIB, thromboembolism,
and mortality following GIB. Result(s): A total of 5354 studies were
reviewed of which 10 were included in the meta-analysis. There were 2080
patients who resumed anticoagulation and 2296 patients who discontinued
anticoagulation post-index GIB. Resumption of anticoagulation was
associated with a significant increase in recurrent GIB (OR 1.646, 95% CI
1.035-2.617, p = 0.035). There was a significant decrease in
thromboembolic events in patients who resumed anticoagulation compared to
those who did not (OR 0.340, 95% CI 0.178-0.652, p = 0.001, I2
= 62.7%). Resumption of anticoagulation was associated with a significant
reduction in all-cause mortality (OR 0.499, 95% CI 0.419-0.595, p <
0.0001). Conclusion(s): While resumption of anticoagulation following
index GIB was associated with a significant increase in recurrent GIB, it
was also associated with a significant decrease in thromboembolic events
and all-cause mortality. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<71>
Accession Number
2003583404
Title
Predicting mortality with cardiac troponins: Recent insights from
meta-analyses.
Source
Diagnosis. 8 (1) (no pagination), 2021. Date of Publication: 01 Feb 2021.
Author
Lippi G.; Cervellin G.; Sanchis-Gomar F.
Institution
(Lippi) Section of Clinical Biochemistry, University of Verona, Piazzale
LA Scuro, Verona 37134, Italy
(Cervellin) Emergency Department, University Hospital of Parma, Parma,
Italy
(Sanchis-Gomar) Department of Physiology, Faculty of Medicine, University
of Valencia, INCLIVA Biomedical Research Institute, Valencia, Spain
Publisher
Walter de Gruyter GmbH
Abstract
The introduction of cardiac troponin (cTn) testing in clinical practice
has been one of the most important breakthroughs that have occurred in the
recent history of laboratory medicine. Although it is now uncontestable
that cTn values are essential for diagnosing acute coronary syndrome
(ACS), solid evidence is also emerging that assessment of either cardiac
troponin I (cTnI) or T (cTnT) may provide valuable prognostic information
in the general healthy population, as well as in patients with a vast
array of cardiac and extra-cardiac diseases. We have hence performed a
critical review of the scientific literature for identifying meta-analyses
which have investigated the potential contribution of cTns in predicting
the risk of death in health and disease. According to the articles
identified with our research, we can conclude that increased cTn values
may be considered independent risk factors for all-cause mortality in the
general population, as well as in patients with ACS, in those undergoing
revascularization procedures, or with stable coronary artery disease
(CAD), heart failure (HF) and atrial fibrillation (AF). Measurement of cTn
may then be helpful for stratifying the mortality risk in non-cardiac
hospitalized patients, in those with critical illness or sepsis, syncope,
stroke, acute aortic dissection, pulmonary diseases, brain injury, renal
failure, vascular and non-cardiac surgery. Although this evidence has
notable clinical implications, the cost-effectiveness of population
screening with high-sensitivity (hs) cTn immunoassays has not been proven
so far. Copyright © 2019 Walter de Gruyter GmbH, Berlin/Boston
2019.

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

<73>
Accession Number
2010856331
Title
Bedtime hypertension treatment improves cardiovascular risk reduction: The
Hygia Chronotherapy Trial.
Source
European Heart Journal. 41 (48) (pp 4565-4576), 2020. Date of Publication:
21 Dec 2020.
Author
Hermida R.C.; Crespo J.J.; Dominguez-Sardina M.; Otero A.; Moya A.; Rios
M.T.; Sineiro E.; Castineira M.C.; Callejas P.A.; Pousa L.; Salgado J.L.;
Duran C.; Sanchez J.J.; Fernandez J.R.; Mojon A.; Ayala D.E.
Institution
(Hermida, Crespo, Rios, Sineiro, Castineira, Callejas, Pousa, Salgado,
Sanchez, Fernandez, Mojon, Ayala) Bioengineering & Chronobiology
Laboratories, Atlantic Research Center for Information and Communication
Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicacion,
Campus Universitario, Vigo 36310, Spain
(Crespo, Dominguez-Sardina, Rios, Callejas, Pousa, Salgado, Duran)
Estructura de Xestion Integrada de Vigo, Servicio Galego de Saude
(SERGAS), Vigo 36214, Spain
(Otero) Servicio de Nefrologia, Complejo Hospitalario Universitario,
Estructura de Xestion Integrada de Ourense, Verin e O Barco de Valdeorras,
Servicio Galego de Saude (SERGAS), Ourense 32005, Spain
(Moya, Sineiro) Estructura de Xerencia Integrada Pontevedra e O Salnes,
Servicio Galego de Saude (SERGAS), Pontevedra 36156, Spain
(Castineira) Estructura de Xestion Integrada de Lugo, Cervo e Monforte de
Lemos, Servicio Galego de Saude (SERGAS), Lugo 27002, Spain
(Sanchez) Estructura de Xestion Integrada de Santiago de Compostela,
Servicio Galego de Saude (SERGAS), Santiago de Compostela 15701, Spain
Publisher
Oxford University Press
Abstract
Aims The Hygia Chronotherapy Trial, conducted within the clinical primary
care setting, was designed to test whether bedtime in comparison to usual
upon awakening hypertension therapy exerts better cardiovascular disease
(CVD) risk reduction. Methods and results In this multicentre, controlled,
prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470
women, 60.5 +/- 13.7 years of age) were assigned (1:1) to ingest the
entire daily dose of >_1 hypertension medications at bedtime (n = 9552) or
all of them upon awakening (n = 9532). At inclusion and at every scheduled
clinic visit (at least annually) throughout follow-up, ambulatory blood
pressure (ABP) monitoring was performed for 48 h. During the 6.3-year
median patient follow-up, 1752 participants experienced the primary CVD
outcome (CVD death, myocardial infarction, coronary revascularization,
heart failure, or stroke). Patients of the bedtime, compared with the
upon-waking, treatment-time regimen showed significantly lower hazard
ratio - adjusted for significant influential characteristics of age, sex,
type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep
systolic blood pressure (BP) mean, sleep-time relative systolic BP
decline, and previous CVD event - of the primary CVD outcome [0.55 (95% CI
0.50-0.61), P < 0.001] and each of its single components (P < 0.001 in all
cases), i.e. CVD death [0.44 (0.34-0.56)], myocardial infarction [0.66
(0.52-0.84)], coronary revascularization [0.60 (0.47-0.75)], heart failure
[0.58 (0.49-0.70)], and stroke [0.51 (0.41-0.63)]. Conclusion Routine
ingestion by hypertensive patients of >_1 prescribed BP-lowering
medications at bedtime, as opposed to upon waking, results in improved ABP
control (significantly enhanced decrease in asleep BP and increased
sleeptime relative BP decline, i.e. BP dipping) and, most importantly,
markedly diminished occurrence of major CVD events. Copyright ©
The Author(s) 2019.

<74>
Accession Number
634169065
Title
Patient values and preferences on valve replacement for aortic stenosis: A
systematic review.
Source
Heart. (no pagination), 2021. Article Number: 318334. Date of Publication:
2021.
Author
Heen A.F.; Lytvyn L.; Shapiro M.; Guyatt G.H.; Siemieniuk R.A.C.; Zhang
Y.; Manja V.; Vandvik P.O.; Agoritsas T.
Institution
(Heen) Department of Medicine, Innlandet Hospital Trust Gjovik Hospital,
Brumunddal, Norway
(Lytvyn, Guyatt, Siemieniuk, Zhang, Agoritsas) Department of Health
Research Methods Evidence, and Impact, McMaster University Faculty of
Health Sciences, Hamilton, ON, Canada
(Shapiro) ChicagoILUnited States
(Manja) Department of Surgery, University of California Davis, Sacramento,
CA, United States
(Manja) Department of Medicine, Veterans Affairs Northern California
Health Care System, Mather, CA, United States
(Vandvik) Institute of Health and Society, University of Oslo, Oslo,
Norway
(Agoritsas) Division of General Internal Medicine, Department of Medicine,
University Hospitals of Geneva, Geneva, Switzerland
Publisher
BMJ Publishing Group
Abstract
The review aims to summarise evidence addressing patients' values,
preferences and practical issues on deciding between transcatheter aortic
valve insertion (TAVI) and surgical aortic valve replacement (SAVR) for
aortic stenosis. We searched databases and grey literature until June
2020. We included studies of adults with aortic stenosis eliciting values
and preferences about treatment, excluding medical management or
palliative care. Qualitative findings were synthesised using thematic
analysis, and quantitative findings were narratively described. Evidence
certainty was assessed using CERQual (Confidence in the Evidence from
Reviews of Qualitative Research) and GRADE (Grading of Recommendations
Assessment, Development and Evaluation). We included eight studies.
Findings ranged from low to very low certainty. Most studies only
addressed TAVI. Studies addressing both TAVI and SAVR reported on factors
affecting patients' decision-making along with treatment effectiveness,
instead of trade-offs between procedures. Willingness to accept risk
varied considerably. To improve their health status, participants were
willing to accept higher mortality risk than current evidence suggests for
either procedure. No study explicitly addressed valve reintervention, and
one study reported variability in willingness to accept shorter duration
of known effectiveness of TAVI compared with SAVR. The most common themes
were desire for symptom relief and improved function. Participants
preferred minimally invasive procedures with shorter hospital stay and
recovery. The current body of evidence on patients' values, preferences
and practical issues related to aortic stenosis management is of
suboptimal rigour and reports widely disparate results regarding patients'
perceptions. These findings emphasise the need for higher quality studies
to inform clinical practice guidelines and the central importance of
shared decision-making to individualise care fitted to each patient.
 Copyright © Author(s) (or their employer(s)) 2021. No commercial
re-use. See rights and permissions. Published by BMJ.

<75>
Accession Number
634138910
Title
Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove
Cytokines, Chemokines, and Cell-derived Microvesicles.
Source
Anesthesiology. 134 (3) (pp 395-404), 2021. Date of Publication: 01 Mar
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.

<76>
Accession Number
634091186
Title
Restrictive Transfusion Strategy after Cardiac Surgery.
Source
Anesthesiology. 134 (3) (pp 370-380), 2021. Date of Publication: 01 Mar
2021.
Author
Zeroual N.; Blin C.; Saour M.; David H.; Aouinti S.; Picot M.-C.; Colson
P.H.; Gaudard P.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recent guidelines on transfusion in cardiac surgery suggest
that hemoglobin might not be the only criterion to trigger transfusion.
Central venous oxygen saturation (Svo2), which is related to the balance
between tissue oxygen delivery and consumption, may help the decision
process of transfusion. We designed a randomized study to test whether
central Svo2-guided transfusion could reduce transfusion incidence after
cardiac surgery. METHOD(S): This single center, single-blinded,
randomized controlled trial was conducted on adult patients after cardiac
surgery in the intensive care unit (ICU) of a tertiary university
hospital. Patients were screened preoperatively and were assigned randomly
to two study groups (control or Svo2) if they developed anemia (hemoglobin
less than 9 g/dl), without active bleeding, during their ICU stay.
Patients were transfused at each anemia episode during their ICU stay
except the Svo2 patients who were transfused only if the pretransfusion
central Svo2 was less than or equal to 65%. The primary outcome was the
proportion of patients transfused in the ICU. The main secondary endpoints
were (1) number of erythrocyte units transfused in the ICU and at study
discharge, and (2) the proportion of patients transfused at study
discharge. RESULT(S): Among 484 screened patients, 100 were
randomized, with 50 in each group. All control patients were transfused in
the ICU with a total of 94 transfused erythrocyte units. In the Svo2
group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to
0.153]; P < 0.001 vs. controls), with a total of 65 erythrocyte units. At
study discharge, eight patients of the Svo2 group remained nontransfused
and the cumulative count of erythrocyte units was 96 in the Svo2 group and
126 in the control group. CONCLUSION(S): A restrictive transfusion
strategy adjusted with central Svo2 may allow a significant reduction in
the incidence of transfusion. Copyright © 2021, the American
Society of Anesthesiologists, Inc. All Rights Reserved.

<77>
Accession Number
2005115335
Title
Coronary artery disease in dialysis patients: evidence synthesis,
controversies and proposed management strategies.
Source
Journal of Nephrology. 34 (1) (pp 39-51), 2021. Date of Publication:
February 2021.
Author
Burlacu A.; Genovesi S.; Basile C.; Ortiz A.; Mitra S.; Kirmizis D.;
Kanbay M.; Davenport A.; van der Sande F.; Covic A.
Institution
(Burlacu) Department of Interventional Cardiology, Cardiovascular Diseases
Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
(Genovesi) Nephrology Unit, San Gerardo Hospital, Monza, Italy, University
of Milan-Bicocca, Milan, Italy
(Basile) Division of Nephrology, Miulli General Hospital, Via Battisti
192, Acquaviva delle Fonti, Taranto 74121, Italy
(Basile) Associazione Nefrologica Gabriella Sebastio, Martina Franca,
Italy
(Ortiz) FRIAT and REDINREN, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
(Mitra) Manchester Academy of Health Sciences Centre, Manchester
University Hospitals Foundation Trust and University of Manchester, Oxford
Road, Manchester, United Kingdom
(Kirmizis) Department of Nephrology, Colchester General Hospital, Essex,
United Kingdom
(Kanbay) Department of Medicine, Division of Nephrology, Koc University
School of Medicine, Istanbul, Turkey
(Davenport) Division of Medicine, UCL Centre for Nephrology, Royal Free
Hospital, University College London, London, United Kingdom
(van der Sande) Division of Nephrology, Department of Internal Medicine,
University Hospital Maastricht, Maastricht, Netherlands
(Covic) Nephrology Clinic, Dialysis and Renal Transplant Center-'C.I.
Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine,
Iasi, Romania
(Covic) The Academy of Romanian Scientists (AOSR), Bucharest, Romania
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and
mortality among patients with end-stage renal disease (ESRD). Clustering
of traditional atherosclerotic and non-traditional risk factors drive the
excess rates of coronary and non-coronary CVD in this population. The
incidence, severity and mortality of coronary artery disease (CAD) as well
as the number of complications of its therapy is higher in dialysis
patients than in non-chronic kidney disease patients. Given the lack of
randomized clinical trial evidence in this population, current practice is
informed by observational data with a significant potential for bias.
Furthermore, guidelines lack any recommendation for these patients or
extrapolate them from trials performed in non-dialysis patients. Patients
with ESRD are more likely to be asymptomatic, posing a challenge to the
correct identification of CAD, which is essential for appropriate risk
stratification and management. This may lead to "therapeutic nihilism",
which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL
Working Group reviews the diagnostic work-up and therapy of chronic
coronary syndromes, unstable angina/non-ST elevation and ST-elevation
myocardial infarction in dialysis patients, outlining unclear issues and
controversies, discussing recent evidence, and proposing management
strategies. Indications of antiplatelet and anticoagulant therapies,
percutaneous coronary intervention and coronary artery bypass grafting are
discussed. The issue of the interaction between dialysis session and
myocardial damage is also addressed. Copyright © 2020, Italian
Society of Nephrology.

<78>
Accession Number
2010564076
Title
Congenital aortic stenosis: A treatment under debate.
Source
Cirugia Cardiovascular. 28 (1) (pp 48-52), 2021. Date of Publication: 01
Jan 2021.
Author
Bellot R.; Rios L.; Portela F.
Institution
(Bellot, Rios, Portela) Servicio de Cirugia Cardiaca Infantil, Hospital
Materno-Infantil, Las Palmas de Gran Canaria, Spain
Publisher
Elsevier Doyma
Abstract
Congenital aortic valve stenosis is a common and long-term heart disease
during the life of the patient, knowing that when it begins at an early
age it will often require reoperation. There are two treatment modalities:
percutaneous balloon valvuloplasty and surgical valvuloplasty, both
applicable from the neonatal period. The unfavorable results of surgery in
the first series led to the adoption of a preference for percutaneous
treatment, which offered similar management of the aortic valve in a less
invasive way and with less morbidity and mortality. However, advances in
perioperative care and, above all, in surgical techniques currently used
have allowed an improvement in these results, with recent series showing a
benefit of surgical treatment over percutaneous treatment. This benefit is
mainly based on the ability to perform a directed opening of the
commissures under direct vision, in addition to being able to act on the
leaflets. Current mortality rates are comparable with both treatments, but
the greater durability of the repair justifies a more invasive treatment.
The role of percutaneous valvuloplasty will continue to be critical in
selected groups of patients, such as those with ventricular dysfunction.
This article will describe a case of congenital aortic stenosis operated
on in the neonatal period in our center as a starting point for a review
of the current literature and open the debate on the best management of
this pathology: balloon or scalpel? Copyright © 2020 Sociedad
Espanola de Cirugia Cardiovascular y Endovascular

<79>
Accession Number
2010470434
Title
Propofol plus low-dose dexmedetomidine infusion and postoperative delirium
in older patients undergoing cardiac surgery.
Source
British Journal of Anaesthesia. 126 (3) (pp 665-673), 2021. Date of
Publication: March 2021.
Author
Momeni M.; Khalifa C.; Lemaire G.; Watremez C.; Tircoveanu R.; Van Dyck
M.; Kahn D.; Rosal Martins M.; Mastrobuoni S.; De Kerchove L.; Zango S.H.;
Jacquet L.-M.
Institution
(Momeni, Khalifa, Lemaire, Watremez, Tircoveanu, Van Dyck, Kahn, Rosal
Martins) Department of Anaesthesiology;, Cliniques Universitaires Saint
Luc, Universite Cathlique de Louvain, Institut de Recherche Experimentale
et Clinique (IREC), Brussels, Belgium
(Mastrobuoni, De Kerchove) Department of Cardiac Surgery;, Cliniques
Universitaires Saint Luc, Universite Cathlique de Louvain, Institut de
Recherche Experimentale et Clinique (IREC), Brussels, Belgium
(Zango) Department of Epidemiology and Statistics;, Cliniques
Universitaires Saint Luc, Universite Cathlique de Louvain, Institut de
Recherche Experimentale et Clinique (IREC), Brussels, Belgium
(Jacquet) Department of Intensive Care Unit;, Cliniques Universitaires
Saint Luc, Universite Cathlique de Louvain, Institut de Recherche
Experimentale et Clinique (IREC), Brussels, Belgium
Publisher
Elsevier Ltd
Abstract
Background: Postoperative delirium (POD) is a frequent complication in
older patients. Dexmedetomidine might be effective in decreasing the
incidence of POD. We hypothesised that adding low-dose rate
dexmedetomidine infusion to a propofol sedation regimen would have fewer
side-effects and would counteract the possible delirium producing
properties of propofol, resulting in a lower risk of POD than propofol
with placebo. Method(s): In this double-blind placebo-controlled
trial, patients >=60 yr old undergoing on-pump cardiac surgery were
randomised 1:1 to the following postoperative sedative regimens: a
propofol infusion and dexmedetomidine (0.4 mug kg-1
h-1) or a propofol infusion and saline 0.9% (placebo group).
The study drug was started at chest closure and continued for 10 h. The
primary endpoint was in-hospital POD, assessed using the Confusion
Assessment Method and chart review method. Result(s): POD over the
course of hospital stay occurred in 31/177 (18%) and 33/172 (19%) patients
in the dexmedetomidine and placebo arm, respectively (P=0.687; odds
ratio=0.89; 95% confidence interval, 0.52-1.54). The incidence of POD in
the intensive care alone, or on the ward alone, was also not significantly
different between the groups. Subjects in the dexmedetomidine group spent
less median time in a delirious state (P=0.026). Median administered
postoperative norepinephrine was significantly higher in the
dexmedetomidine group (P<0.001). One patient in the dexmedetomidine group
and 10 patients in the placebo group died in the hospital.
 Conclusion(s): Adding low-dose rate dexmedetomidine to a sedative
regimen based on propofol did not result in a different risk of
in-hospital delirium in older patients undergoing cardiac surgery. With a
suggestion of both harm and benefit in secondary outcomes, supplementing
postoperative propofol with dexmedetomidine cannot be recommended based on
this study. Clinical trial registration: NCT03388541. Copyright ©
2020 British Journal of Anaesthesia

<80>
Accession Number
2010447866
Title
Postoperative hemodynamics after high spinal block with or without
intrathecal morphine in cardiac surgical patients: a randomized-controlled
trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Bhat I.; Arya V.K.; Mandal B.; Jayant A.; Dutta V.; Rana S.S.
Institution
(Bhat, Arya, Mandal) Department of Anaesthesiology and Intensive Care,
Post Graduate Institute of Medical Education and Research, Chandigarh,
India
(Arya, Dutta) Department of Anesthesiology, Perioperative and Pain
Medicine, Max Rady College of Medicine, University of Manitoba, St.
Boniface Hosptial, Winnipeg, MB, Canada
(Jayant) Department of Anaesthesiology and Critical Care Medicine, Amrita
Institute of Medical Sciences, Kochi, India
(Rana) Department of Cardiothoracic and Vascular Surgery, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
Springer
Abstract
Purpose: There is some evidence for the use of intrathecal morphine as a
means to provide prolonged analgesia in selective cardiac surgical
patients; however, the hemodynamic effects of intrathecal morphine are not
well defined. This study was designed to study the effect of intrathecal
morphine on hemodynamic parameters in cardiac surgery patients.
 Method(s): In a prospective, double-blind study, 100 adult cardiac
surgical patients were randomized to receive either intrathecal 40 mg of
0.5% hyperbaric bupivacaine alone (intrathecal bupivacaine [ITB] group, n
= 50) or intrathecal 250 microg of morphine added to 40 mg of 0.5%
bupivacaine (intrathecal bupivacaine and morphine [ITBM] group, n = 50).
Hemodynamic data, pain scores, rescue analgesic use, spirometry, and
vasopressor use were recorded every four hours after surgery for 48 hr.
The primary outcome was the incidence of vasoplegia in each group, which
was defined as a cardiac index > 2.2 L.min-1.m-2
with the requirement of vasopressors to maintain the mean arterial
pressure > 60 mmHg with the hemodynamic episode lasting > four hours.
 Result(s): Eighty-seven patients were analyzed (ITB group, n = 42,
and ITBM group, n =45). The incidence of vasoplegia was higher in the ITBM
group than in the ITB group [14 (31%) vs 5 (12%), respectively; relative
risk, 2.6; 95% confidence interval [CI], 1.0 to 6.6; P = 0.04]. The mean
(standard deviation [SD]) duration of vasoplegia was significantly longer
in the ITBM group than in the ITB group [8.9 (3.0) hr vs 4.3 (0.4) hr,
respectively; difference in means, 4.6; 95% CI, 3.7 to 5.5; P < 0.001].
 Conclusion(s): Intrathecal morphine added to bupivacaine for high
spinal anesthesia increases the incidence and duration of vasoplegia in
cardiac surgery patients. Trial registration: www.clinicaltrials.gov
(NCT02825056); registered 19 June 2016. Copyright © 2021,
Canadian Anesthesiologists' Society.

<81>
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

<82>
Accession Number
2010379991
Title
Short-term Effects of Alfacalcidol on Hospital Length of Stay in Patients
Undergoing Valve Replacement Surgery: A Randomized Clinical Trial.
Source
Clinical Therapeutics. 43 (1) (pp e1-e18), 2021. Date of Publication:
January 2021.
Author
Naguib S.N.; Sabry N.A.; Farid S.F.; Alansary A.M.
Institution
(Naguib, Sabry, Farid) Department of Clinical Pharmacy, Faculty of
Pharmacy, Cairo University, Cairo, Egypt
(Alansary) Department of Anesthesiology and Critical Care, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Vitamin D deficiency is highly prevalent in critically ill
patients, and has been associated with more prolonged length of hospital
stay and poor prognosis. Patients undergoing open-heart surgery are at
higher risk due to the associated life-threatening postoperative
complications. This study investigated the effect of alfacalcidol
treatment on the length of hospital stay in patients undergoing
valve-replacement surgery. Method(s): This single-center, randomized,
open-label, controlled trial was conducted at El-Demerdash Cardiac Academy
Hospital (Cairo, Egypt), from April 2017 to January 2018. This study
included adult patients undergoing valve-replacement surgery who were
randomized to the intervention group (n = 47; alfacalcidol 2 mug/d started
48 h before surgery and continued throughout the hospital stay) or to the
control group (n = 42). The primary end points were lengths of stay (LOS)
in the intensive care unit (ICU) and in the hospital. Secondary end points
were the prevalence of postoperative hospital-acquired infections, cardiac
complications, and in-hospital mortality. Finding(s): A total of 86
patients were included in the final analysis, with 51 (59.3%) being
vitamin D deficient on hospital admission. Treatment with alfacalcidol was
associated with a statistically significant decrease in ICU LOS (hazard
ratio = 1.61; 95% CI, 1.77-2.81; P = 0.041) and hospital LOS (hazard ratio
= 1.63; 95% CI, 1.04-2.55; P = 0.034). Treated patients had a
significantly lower postoperative infection rate than did the control
group (35.5% vs 56.1%; P = 0.017). The median epinephrine dose was lower
in the intervention group compared to that in the control group (5.9 vs
8.2 mg; P = 0.019). The rate of in-hospital mortality was not
significantly different between the 2 groups. Implications: Early
treatment with 2 mug of alfacalcidol in patients undergoing
valve-replacement surgery is promising and well tolerated. This effect may
be attributed to its immunomodulatory and cardioprotective mechanisms.
ClinicalTrials.gov identifier: NCT04085770. Copyright © 2020
Elsevier Inc.

<83>
Accession Number
2008398244
Title
Cardiac Surgery and Small Island States: A Bridge Too Far?.
Source
Annals of Thoracic Surgery. 111 (3) (pp 931-936), 2021. Date of
Publication: March 2021.
Author
Vervoort D.; Vinck E.E.; Tiwari K.K.; Tapaua N.
Institution
(Vervoort) Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Johns Hopkins University, Baltimore,
MD, United States
(Vinck) Department of Surgery, El Bosque University, Bogota, Colombia
(Vinck) Dr. Horacio Oduber Hospitaal, Oranjestad, Aruba
(Tiwari) Department of Cardiothoracic Surgery, ADK Hospital, Male,
Maldives
(Tapaua) Department of Surgery, University of Papua New Guinea, Papua New
Guinea
Publisher
Elsevier Inc.
Abstract
Background: Small island developing states (SIDS) make up nearly 1% of the
world's population, with 65 million people across 58 countries. Small
island developing states have some of the highest rates of rheumatic heart
disease in addition to a substantial burden of congenital heart defects
and a growing burden of ischemic heart disease. Here, we present an
overview of cardiac surgical services in SIDS, with a focus on Papua New
Guinea, the Maldives, and Aruba. Method(s): We performed a literature
review using the PubMed/MEDLINE and Google Scholar databases to identify
articles describing cardiac surgery services in SIDS. Case studies of the
history and current state of cardiac surgery in Papua New Guinea, the
Maldives, and Aruba were developed and informed by local clinical
experience. Result(s): Nine SIDS have independent cardiac surgical
centers and 5 SIDS have local centers supported by visiting teams. Papua
New Guinea started cardiac surgery in 1993 and is served by a public
center, performing nearly 100 cardiac surgeries per year. The Maldives
introduced cardiac surgery services in 2018, with 1 local cardiac surgeon
supported by Nepalese cardiac surgeons, performing 33 cardiac surgeries in
15 months. In Aruba, no local cardiac center exists and over 150 patients
are sent abroad for cardiac surgery, representing 12% of total health
spending. Conclusion(s): Small island developing states have limited
availability of cardiac surgery but pressing clinical needs. Independent
cardiac centers exist with acceptable outcomes and lower costs than
foreign treatment, which suggests the need to strengthen regionalization
models to deliver cardiac surgical care in SIDS. Copyright © 2021
The Society of Thoracic Surgeons

<84>
Accession Number
632880212
Title
Utilization and procedural adverse outcomes associated with Watchman
device implantation.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 23 (2)
(pp 247-253), 2021. Date of Publication: 05 Feb 2021.
Author
Khalil F.; Arora S.; Killu A.M.; Tripathi B.; DeSimone C.V.; Egbe A.;
Noseworthy P.A.; Kapa S.; Mulpuru S.; Gersh B.; Mohamad A.; Friedman P.;
Holmes D.; Deshmukh A.J.
Institution
(Khalil, Killu, DeSimone, Egbe, Noseworthy, Kapa, Mulpuru, Gersh, Mohamad,
Friedman, Holmes, Deshmukh) Department of Cardiovascular Medicine, Mayo
Clinic, 200 First Street SW, Rochester, United States
(Arora) Division of Cardiology, Case Western Reserve University,
Cleveland, OH, USA
(Tripathi) Department of Cardiology, University of Arizona, AZ, Phoenix,
United States
Publisher
NLM (Medline)
Abstract
AIMS : The Food and Drug Administration (FDA) approval of the Watchman
device [percutaneous left atrial appendage occlusion (LAAO)] has resulted
in the widespread use of this procedure in many centres across the USA. We
sought to estimate the nationwide utilization and frequency of adverse
outcomes associated with Watchman device implantation. The objective of
this study was to evaluate the Watchman device implantation
peri-procedural complications and comparison of the results with the
previous studies. METHODS AND RESULTS : The National Inpatient Sample
(NIS) was queried for all hospitalizations with a primary diagnosis of
atrial fibrillation or atrial flutter during the year 2016 with
percutaneous LAAO during the same admission (ICD-10 code-02L73DK). The
frequency of peri-procedural complications, including mortality,
procedure-related stroke, major bleeding requiring blood transfusion, and
pericardial effusion, was assessed. We compared the complication rates
with the published randomized controlled trials and the European Watchman
registry. An estimated 5175 LAAO procedures were performed in 2016. The
majority of procedures was performed in males (59.1%), age >=75years
(58.7%), and White (83.1%). The overall complication rate was 1.9%. The
in-hospital mortality was 0.29%. Pericardial effusion requiring
pericardiocentesis was the most frequent complication (0.68%). Bleeding
requiring transfusion was noted in 0.1% of device implants. The rates of
post-procedure stroke and systemic embolism were 0% and 0.29%,
respectively. CONCLUSION : Percutaneous LAAO with the Watchman device in
the USA is associated with low in-hospital complications and a similar
safety profile to a recently published EWOLUTION cohort. The complication
rates were lower than those reported in the major randomized clinical
trials (RCTs). We report the frequency of peri-procedural complications of
the LAAO using the Watchman device from the NIS database. We also compare
the frequency of peri-procedural complications with the previously
published RCTs and EWOLUTION cohort. Our findings are in concordance with
findings from EWOLUTION cohort and compare favourably with
RCTs. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<85>
Accession Number
634165671
Title
Feasibility and safety of oversizing self-expandable valves for
transcatheter aortic valve implantation, according to aortic annulus
maximal diameter.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1952), 2020. Date of Publication:
November 2020.
Author
Jourdi B.; Trimech T.R.; Fradi S.; Ghostine S.
Institution
(Jourdi, Trimech, Fradi, Ghostine) Marie Lannelongue Hospital, Le Plessis
Robinson, France
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) can lead to
paravalvular leak (PVL) in 15% to 20% of cases, which remains an important
prognostic factor and an independent predictor of mortality in short and
long-term follow-up. Objective(s): To evaluate feasibility and safety
of oversizing Medtronic Self- Expandable Valve (Dvalve), calculated
according to the aortic annulus maximal diameter (Dmax), on the incidence
of PVL and in-hospital mortality after TAVI. Method(s):We
retrospectively analyzed the data of 610 patients treated with TAVI
between January 2016 and December 2018. A group of 45 patients of the
oversized group (October 2017 to December 2018) accordingly to the Dmax,
when (Dvalve - Dmax) <2 mm in the absence of contraindication was
compared to a control group of 213 patients whose prosthesis size had been
chosen according to the aortic annulus perimeter (January 2016 to
September 2017). Result(s): In the "oversized" group, no patient had
a significant PVL after TAVI compared with the control group (0% vs.
7.51%; p=0.041). Balloon post-dilatation was significantly less frequent
in the "oversized" group (0% vs. 10.3%; p=0.012). Per-procedural
irradiation and the average length of in-hospital stay were significantly
lower (PDS = 2,296.05+/-1,667.94 cGy mm2 vs. 4,568+/-1,352.84
cGy mm2; p<0.001; and 5.23+/-1.74 days vs. 6.33+/-3.23 days;
p=0.029, respectively). No case of annulus rupture occurred in the
"oversized" group. The incidences of high-degree atrioventricular block
with definitive pacing and in-hospital mortality were similar between the
two groups. Conclusion(s): Oversizing the self-expandable valve,
according to the aortic annulus maximal diameter, significantly reduced
PVL after TAVI, balloon post-dilatation, per-procedural irradiation, and
the length of hospital stay, without increasing the risk of mechanical,
rhythmic, conductive and coronary occlusion complications. It does not
increase the in-hospital mortality rate either. Randomized controlled
trials are needed to establish a firm conclusion about its feasibility and
safety.

<86>
Accession Number
634165661
Title
Echocardiographic assessment of functional changes of prosthetic valve
after transcatheter aortic valve implantation in one year follow up:
Insights from the multicenter, randomized DIRECT trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1951), 2020. Date of Publication:
November 2020.
Author
Toutouzas K.; Karmpalioti M.; Benetos G.; Drakopoulou M.; Xanthopoulou M.;
Stathogiannis K.; Latsios G.; Synetos A.; Bei E.; Voudris V.; Kosmas E.;
Mastrokostopoulos A.; Katsimagklis G.; Danenberg H.; Tousoulis D.
Institution
(Toutouzas, Karmpalioti, Benetos, Drakopoulou, Xanthopoulou,
Stathogiannis, Latsios, Synetos, Bei, Tousoulis) 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: The DIRECT trial (Predilatation in Transcatheter Aortic
Valve Implantation (TAVI) 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 investigate by echocardiography
the functional changes of self-expanding prosthetic valves during the
first year after TAVI with or without BAV. Method(s): One hundred
seventy one consecutive patients with severe aortic stenosis were enrolled
at 4 centers and randomized to TAVI using selfexpanding prostheses with
(pre-BAV) or without pre-dilatation (no-BAV). Transthoracic
echocardiography was obtained at baseline, 30 days and 1 year after TAVI.
 Result(s): Of 171 patients, 86 patients were randomized to pre-BAV
group and 85 to no-BAV group. Over the one year, 7 (4%) patients died and
in 18 (10%) there was no available paired 30 day/1 year echo. At baseline
echocardiography the peak and mean aortic valve gradient and the aortic
valve area (AVA) in no-BAV group were 77.31+/-22.56 mmHg, 47.23+/-14.98
mmHg and 0.69+/-0.16 cm2 and in pre-BAV group 81.97+/-23.17
mmHg, 49.39+/-14.78 mmHg and 0.65+/-0.15 cm2 respectively. One
year after TAVI, patients in no-BAV and pre-BAV group showed stable peak
and mean aortic valve gradients similar to those at 30 days (from
16.36+/-7.88 to 14.51+/-6.6 mmHg vs. 17.17+/-8.88 to 15.95+/-9.97 mmHg and
from 8.87+/-4.23 to 7.99+/-4.04 mmHg vs. 9.39+/-4.79 to 8.38+/-5.02 mmHg
respectively, P<0.001 vs. baseline). The AVA was similarly stable in one
year follow up in no-BAV group (from 1.85+/-0.43 cm2 to
1.85+/-0.44cm2, P<0.001 vs. baseline) and in pre-BAV group (from
1.86+/-0.49 cm2 to 1.84+/-0.39cm2, P<0.001 vs. baseline). The
incidence of moderate or severe paravalvular regurgitation remained
unchanged in both groups (from 4.7% to 5.7% in no-BAV group and from 5.8%
to 6.6% in pre-BAV group). Conclusion(s): In both pre-BAV and no-BAV
groups the improvement in hemodynamics of self-expanding prosthetic valves
remained durable during the one year echocardiographic follow up
assessment.

<87>
Accession Number
634165658
Title
Meta-analysis confirms improvement of hospitalizations and all-cause
mortality of transcatheter mitral valve repair in functional mitral
regurgitation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2002), 2020. Date of Publication:
November 2020.
Author
Noutsias M.; Matiakis M.; Bigalke B.; Sedding D.; Rigopoulos A.
Institution
(Noutsias) University Hospital Halle, Martin-Luther-University
Halle-Wittenberg, Halle, Germany
(Matiakis, Sedding, Rigopoulos) University Clinic Halle (Saale),
Mid-German Heart Center, Department of Internal Medicine III (KIM-III),
Halle, Germany
(Bigalke) Department Campus Benjamin Franklin, Berlin, Germany
Publisher
Oxford University Press
Abstract
Background: Moderate-to-severe or severe functional mitral regurgitation
(FMR) is associated with higher rates of hospitalizations and with
increased mortality in heart failure (HF). Transcatheter mitral valve
repair by MitraClipR implantation (TMVrMC) may effectively reduce severe
MR, and is associated with symptomatic improvement. However, the long-term
clinical effects of this procedure are not well defined. Aim(s): We
analyzed outcomes for rehospitalization and survival in HF patients with
moderate-to-severe or severe FMR treated by either medical treatment (MT)
only versus TMVrMC+MT by meta-analysis. Methods and Results: By
systematic search of bibliographic databases, we evaluated publications
comparing HF patients with FMR treated by MT only versus treatment by MT
combined with TMVrMC. Studies with a minimum of 25 enrolled patients and a
follow/up period of at least 12 months were deemed eligible for this
meta-analysis. We identified n=7 studies enrolling 2,884 HFrEF patients,
divided into two study arms: TMVrMC+MT (n=1,618), versus FMR patients
receiving MT only (n=1,266). At 12 months, there was a significant
reduction in all-cause mortality favoring TMVrMC+MT (OR: 0.65; CI 95%
0.53-0.79), compared with the MT only patients. At 24 months, a
significant reduction of all-cause mortality in the TMVrMC+MT patient
group (OR: 0.54; CI: 95%: 0.43-0.67; p<0.001) was calculated. TMVrMC+MT
was associated with significantly lower rates of unplanned re-admissions
for heart failure compared with MT only at 12 months (OR: 0.69; 95%; CI
0.53-0.89; p<0.001) and at 24 months (OR: 0.53; 95% CI: 0.39-0.71;
p<0.001). In one publication, a survival benefit of TMVrMC+MT over MT
alone was shown at 5 years post intervention (HR: 0.75; 95% CI: 0.69-0.94;
p=0.012) after weighting for propensity score and controlling for age.
 Conclusion(s): This meta-analysis on n=2,884 patients with
moderate-tosevere or severe FMR reveals that TMVrMC+MT, as compared with
MT alone, is associated with a significant reduction of rehospitalizations
and improvement of survival up to 24 months after MitraClip implantation.
However, the discordant results of 2 randomized controlled trials
(MITRA-FR and COAPT) warrant further clarification, i.e. of the eligible
FMR patient profiles who might benefit from TMVrMC+MT in terms of
improvement of prognosis. These data imply additional evidence for TMVrMC
in eligible HF patients with relevant FMR, which might be important for an
update of the corresponding guidelines.

<88>
Accession Number
634165635
Title
Left heart Impella-device to bridge acute mitral regurgitation to
MitraClip-procedure: A novel implementation of percutaneous mechanical
circulatory support.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1849), 2020. Date of Publication:
November 2020.
Author
Vandenbriele C.; Balthazar T.; Wilson J.; Ledot S.; Smith R.; Caetano
A.F.; Adriaenssens T.; Goetschalckx K.; Janssens S.; Dubois C.; Jacobs S.;
Meyns B.; Davies S.; Price S.
Institution
(Vandenbriele, Wilson, Ledot, Smith, Caetano, Davies, Price) Royal
Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London,
United Kingdom
(Balthazar, Adriaenssens, Goetschalckx, Janssens, Dubois, Jacobs, Meyns)
University Hospitals (UZ) Leuven, Leuven, Belgium
Publisher
Oxford University Press
Abstract
Background: Acute mitral regurgitation (MR) is an emergency, often
requiring urgent surgery. Severe acute MR presenting with hemodynamic
collapse is usually caused by papillary muscle rupture or dysfunction
after acute myocardial infarction (AMI) or chordal rupture, resulting in
flail mitral leaflet(s). Preoperative stabilization is complex due to
concomitant hemodynamic collapse and hypoxic respiratory failure. Finding
the right balance between both preload and inotropic support is
challenging. When patients are too sick for immediate surgical
intervention, mechanical circulatory support can be considered because of
its ability to both unload and reduce of cardiac work while increasing
coronary perfusion and cardiac output. Nevertheless, even after initial
stabilization, surgical risk remains high in critically ill acute severe
MR patients and transcatheter treatments such as MitraClip are
increasingly being explored. Method(s): Between August 2017 and
September 2019, patients presenting with acute severe mitral regurgitation
and considered too ill for immediate surgical intervention (EURO-II score
>11.2% plus pulmonary oedema necessitating mechanical ventilation and/or
hemodynamic instability), were selected for an Impella-assisted LV
unloading technique as bridge to MitraClip-procedure. Five patients were
selected for the combined left Impella/MitraClip-procedure in two tertiary
cardiac ICUs. Result(s): The mean age was 72 years. The cause of MR
was ischemic in 20% and all patients presented in cardiogenic shock state,
necessitating mechanical ventilation. The overall cardiac operative risk
assessment (Euro-II) score predicted a 35% chance of in-hospital
mortality. Cardiac output was severely impaired (mean LVOT VTI 8.2 cm).
All patients were on inotropic support and supported by an Impella-CP pVAD
(mean flow 2.5 Liter per minute; mean 6.3 days of support). In all cases,
we managed to reduce the LVEDP below 15 mmHg using the combination of
medical therapy (afterload reduction, inotropes), mechanical ventilation
and pVAD-therapy. The MR was significantly reduced by a
MitraClip-procedure in each Impella supported patient. The overall
survival at discharge was 80%. One patient with late referral and multiple
organ failure at presentation deceased due to refractory cardiogenic
shock. Overall, severe MR was reduced to grade 1+ and all four patients
survived 6 months after discharge with only one readmission for
decompensated heart failure. Conclusion(s): A combined strategy of
Impella and MitraClip appears to be a novel, feasible alternative for
patients presenting with acute, severe MR unable to proceed to a
corrective surgical procedure at presentation due to severe left
ventricular forward flow failure. In these cases, the early initiation of
pVAD-support may reduce the risk of development of irreversible end- organ
damage and dysfunction. Exploration in a larger, randomised population is
warranted to investigate this strategy further.

<89>
Accession Number
634165608
Title
Incidence, predictors and outcomes of Valve-in-valve (ViV) Transcatheter
aortic valve replacement (TAVR): A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1947), 2020. Date of Publication:
November 2020.
Author
Bruno F.; D'Ascenzo F.; Giordana F.; Saglietto A.; Conrotto F.; De Filippo
O.; Grosso Marra W.; Salizzoni S.; Trompeo A.; La Torre M.; D'Amico M.;
Rinaldi M.; Giustetto C.; De Ferrari G.
Institution
(Bruno, D'Ascenzo, Giordana, Saglietto, Conrotto, De Filippo, Grosso
Marra, Salizzoni, D'Amico, Giustetto, De Ferrari) Hospital Molinette of
the University Hospital S. Giovanni Battista/City, University Hosp of
Health an, Cardiology, Turin, Italy
(Trompeo, La Torre, Rinaldi) A.O.U. Citta Della Salute e Della Scienza di
Torino, Cardiosurgery, Turin, Italy
Publisher
Oxford University Press
Abstract
Background: Surgical aortic valve replacement has been the treatment of
choice for patients with aortic valve disease before the arrival of
transcatheter aortic valve replacement (TAVI), although limited by
degeneration of the bioprosthesis. "Redo" intervention itself is burdened
by high risk of complications and valve-in-valve (ViV) TAVI could be a
valid strategy of redo for patients with comorbidities. The aim of this
meta-analysis is to give an overview of the state of the art of ViV TAVI
in high-risk patients, analyzing efficacy, safety, intra-hospital outcomes
and 1-year outcomes and assess predictors of survival at short and
mid-term follow up. Method(s): Two independent reviewers screened all
studies investigating patients undergoing ViV TAVI. PubMed database was
searched for reports published in English according to the following
highly sensitive strategy: (Transcatheter[All Fields] AND "aortic"[All
Fields]) AND valve-in-valve[All Fields] AND "implantation"[All Fields] NOT
(review[pt] OR editorial[pt] OR letter[pt])AND "humans"[MeSH Terms]).
Mortality at 30 days and at 1 year were the primary end point, while
procedural and short-term outcomes and echocardiographic parameters at
hospital discharge were the secondary end points. Result(s): Of 286
studies identified, 26 articles were included, with a total of 1448
patients. Median age was 78.8 years, 57.7% of the patients were male.
Median STS-predicted risk of mortality was 9.4% while median Logistic
EuroSCORE was 31.3%. Median age of bioprosthesis was 10 years with 84.6%
of stented valves. Stenosis (45%), followed by regurgitation (31%) and
mixed defects (21%) were the causes of prosthesis failure. Diameter of the
degenerated valve was <=21 mm in 25.4%, 22-25 mm in 55% and >25mm in 11.7%
of the patients. Transfemoral approach was preferred (76%), with a
prevalence of balloon expandable valve (73.3%). Mean post procedural
gradient was 16.7+/-0.8 mmHg. Mean follow up was 376 days. Overall and
cardiovascular mortality at 30 days was 6.5% and 5.5% respectively, while
at 1 year it was 14.5% and 8.9% respectively. Regarding short-term
outcomes, overall bleeding (10.4%), pacemaker implantation (9.4%) and
vascular complications (8.3%) were the most common periprocedural
complications, while stroke (2.3%), myocardial infarction (2.7%) and
coronary obstruction (2.8%) were less frequent. At meta-regression
analysis study year (p<0.001), Logistic Euroscore (p<0.01) and valve
diameter <=21 mm (p<0.05) at 30 days, and stenosis as reason for failure
(p=0.05) at 1 year were identified as possible predictors of survival.
 Conclusion(s): Percutaneous valve-in-valve aortic valve implantation
offers a valid strategy to treat high risk patients with a degenerative
bioprosthesis. Short and mid-term outcomes are substantially
superimposable to those of TAVI, except for coronary obstruction which
appears more frequent. Future studies are needed to find predictors of
long- term survival and outcomes in lower risk patients.

<90>
Accession Number
634165599
Title
Real world use of cerebral protection in patients undergoing transfemoral
transcatheter aortic valve replacement.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1946), 2020. Date of Publication:
November 2020.
Author
Stachon P.S.; Kaier K.K.; Zehender M.Z.; Bode C.B.; Von Zur Muehlen C.M.
Institution
(Stachon, Zehender, Bode, Von Zur Muehlen) University Heart Center,
Department of Cardiology and Angiology I, Freiburg, Germany
(Kaier) University of Freiburg, Institute of Medical Biometry and Medical
Informatics, University Medical Center, Freiburg, Germany
Publisher
Oxford University Press
Abstract
Aims: Preventing strokes is an important aim in TAVR (transcatheter aortic
valve replacement) procedures. Embolic protection devices may protect from
cardiac embolisms during TAVR, but use and outcomes in clinical practice
remain controversial. Methods and result: Isolated transfemoral TAVR
procedures performed in Germany with or without cerebral protection
devices were extracted from a comprehensive nationwide billing dataset. In
the most recent years available, 2015 and 2017, 41,654 TAVR procedures
were analyzed. The overall share of procedures employing cerebral
protection devices was 3.7%. In order to compare outcomes, which may be
related to the use of a cerebral protection device, a risk-adjusted
comparison was performed. The risk of in-hospital mortality did not differ
(OR 0.71, 95% CI 0.47-1.17, p=0.103). Moreover, there were no differences
in in-hospital cerebral events: the risk for stroke did not differ in
patients receiving a cerebral protection device (OR 1.07, 95% CI
0.75-1.12, p=0.714). Risk for delirium was similar in both groups (OR
0.95, 95% CI 0.71-1.16, p=0.621). Conclusion(s): Based on our
findings and previous studies the routine use of cerebral protection
devices should be performed with caution until further data from
randomized controlled trials show a reliable reduction of strokes or
cerebral failure such as delirium or long-term cognitive decline.

<91>
Accession Number
634165595
Title
Long-term survival with tafamidis in patients with transthyretin amyloid
cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2142), 2020. Date of Publication:
November 2020.
Author
Damy T.; Elliott P.; Gundapaneni B.; See Tai S.; Sultan M.B.; Drachman
B.M.
Institution
(Damy) Henri Mondor University Hospital Chenevier APHP, French Referral
Center for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid
Research Ins, Creteil, France
(Elliott) University College London, London, United Kingdom
(Gundapaneni, See Tai, Sultan) Pfizer Inc, New York, United States
(Drachman) University of Maryland, School of Medicine, Baltimore, United
States
Publisher
Oxford University Press
Abstract
Background: The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial
(ATTR-ACT), demonstrated that tafamidis was an effective treatment for
patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Tafamidis,
at an 80 mg daily dose, was subsequently approved in several countries for
the treatment of ATTR-CM. Patients who completed ATTR-ACT were eligible to
enroll in an ongoing long-term extension study (LTE) which provides
additional data on the long-term efficacy of tafamidis. Purpose(s):
To assess the long-term benefit of tafamidis in patients with ATTR-CM and
to determine median survival times with treatment. Method(s):
Patients with ATTR-CM who completed ATTR-ACT (in which they were
randomized to tafamidis meglumine 80 mg, 20 mg or placebo for 30 months)
could enroll in the ongoing LTE in which patients continued to be treated
with the same dose of tafamidis or, if previously treated with placebo,
were randomized to tafamidis meglumine 80 mg or 20 mg. Tafamidis free acid
61 mg is a new formulation (bioequivalent to tafamidis meglumine 80 mg)
developed for patient convenience and all patients in the LTE transitioned
to tafamidis free acid 61 mg as of 1 Aug, 2018. Allcause mortality (with
heart transplant or cardiac mechanical assist device [CMAD] implantation
counted as death) was assessed using a Cox proportional hazards model (as
of 1 Aug, 2019). Patients treated with tafamidis meglumine 80 mg in
ATTR-ACT and the LTE who transitioned to tafamidis free acid 61 mg
(tafamidis 80/61 mg) were compared with patients treated with placebo in
ATTR-ACT who transitioned to tafamidis in the LTE (placebo/tafamidis).
 Result(s): There were a total of 176 tafamidis 80/61 mg patients and
177 placebo/tafamidis patients. Median treatment duration was 51.9 months
with tafamidis 80/61 mg and 51.4 months with placebo/tafamidis. With
tafamidis 80/61 mg, there were 75 (42.6%) all-cause deaths; consisting of
67 (38.1%) deaths, 6 (3.4%) heart transplants, and 2 (1.1%) CMAD
implantations. With placebo/tafamidis, there were 108 (61.0%) all-cause
deaths; consisting of 102 (57.6%) deaths and 6 (3.4%) heart transplants.
There was a significant reduction of 41.1% in the risk of all-cause
mortality with tafamidis 80/61 mg compared with placebo/tafamidis (hazard
ratio [95% CI], 0.5888 [0.4370, 0.7931]; P=0.0004). Median survival time
with placebo/tafamidis was 35.8 months but was not reached with tafamidis
80/61 mg. Conclusion(s): Treatment with tafamidis significantly
improves long-term survival in patients with ATTR-CM. The comparatively
poorer survival in patients treated with placebo in ATTR-ACT who
transitioned to tafamidis in the LTE highlights the importance of early
diagnosis and treatment.

<92>
Accession Number
634165514
Title
Early intervention or watchful waiting for asymptomatic severe aortic
stenosis: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1989), 2020. Date of Publication:
November 2020.
Author
Ullah W.U.; Gowda S.G.; Khan M.S.K.; Sattar Y.S.; Al-Khadra Y.A.; Rashid
M.R.; Mohamed M.O.M.; Alkhouli M.A.; Kapadia S.K.; Bagur R.B.; Mamas
M.A.M.; Alraies M.C.A.
Institution
(Ullah) Abington Jefferson Health, Abington, United States
(Gowda) University of South Dakota, Sioux Falls, United States
(Khan) Mercy Saint Vincent Medical Center, Michigan, United States
(Sattar) Icahn School of Medicine, Mount Sinai Elmhurst Hospital, New
York, United States
(Al-Khadra, Kapadia) Cleveland Clinic Foundation, Cleveland, United States
(Rashid, Mohamed, Mamas) Keele University, Keele, United Kingdom
(Alkhouli) Mayo Clinic, Rochester, United States
(Bagur) London Health Sciences Centre, ON, Canada
(Alraies) Detroit Medical Center, Detroit, United States
Publisher
Oxford University Press
Abstract
Background: The management of patients with severe but asymptomatic aortic
stenosis (AS) is a challenge of daily practice. Evidence on early aortic
valve replacement (AVR) versus symptom-driven approach is controversial.
 Method(s): Electronic databases were searched and articles comparing
early-AVR with conservative management for severe asymptomatic AS were
identified. The pooled unadjusted odds ratio (OR) was computed using a
random-effects model. Result(s): A total of 10 studies
(observational=9, and randomized clinical trials=1) consisting of 5,291
patients were included. On a mean follow up duration of 4 years, the odds
of early-AVR vs conservative management were in favour for early
intervention in terms of cardiovascular mortality (OR 0.26, 95% CI
0.13-0.53, p=0.0002, figure-1) and all-cause mortality (OR 0.27, 95% CI:
0.17-0.41, p<=00001). The number needed to treat (NNT) by performing early
AVR (either SAVR or TAVR) to prevent one death secondary to either
cardiovascular or all-cause was 8 (95% CI: 6-10), and 5 (95% CI, 4.2-5.4)
respectively. The odds of all-cause mortality in a selected patient
population undergoing surgical AVR (SAVR) (OR 0.17, 95% CI 0.10-0.29,
p<=0.00001) or transcatheter AVR (TAVR) (OR 0.45, 95% CI 0.31-0.64,
p<=0.0001) were significantly lower compared to patients who were managed
conservatively. A subgroup sensitivity analysis based on severe vs. very
severe AS and early vs. symptom based AVR also mirrored the findings of
overall results. Conclusion(s): Patients with asymptomatic aortic
valve stenosis have lower odds of all-cause and cardiovascular mortality
when managed with early-AVR compared to conservative management.

<93>
Accession Number
634165389
Title
A randomized surgical trial of mitral valve repair with leaflet resection
versus leaflet preservation on functional mitral stenosis-primary results
of the CAMRA CardioLink-2 trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1980), 2020. Date of Publication:
November 2020.
Author
Chan V.; Mazer C.D.; Mesana T.; De Varennes B.E.; Gregory A.J.; Bouchard
D.; Zuo F.; Mohamad Ali F.; Tsang W.; Latter D.A.; Juni P.; Teoh H.; Quan
A.; Leong-Poi H.; Verma S.
Institution
(Chan, Mesana) University of Ottawa Heart Institute, Ottawa, Canada
(Mazer) St. Michael's Hospital, Anesthesia, Toronto, Canada
(De Varennes) Mcgill University, Montreal, Canada
(Gregory) Libin Cardiovascular Institute of Alberta, Calgary, Canada
(Bouchard) Montreal Heart Institute, Montreal, Canada
(Zuo, Juni) St. Michael's Hospital, Applied Health Research Centre,
Toronto, Canada
(Mohamad Ali, Tsang, Leong-Poi) St. Michael's Hospital, Cardiology,
Toronto, Canada
(Latter, Teoh, Quan, Verma) St. Michael's Hospital, Cardiac Surgery,
Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: The gold standard treatment for mitral valve regurgitation due
to prolapse involves surgery with annuloplasty and either leaflet
resection or leaflet preservation, with placement of artificial
neochordae. It has been suggested that leaflet resection may be prone to
functional mitral stenosis, whereby a patient may have a higher mitral
gradient at peak exercise compared to a leaflet preservation strategy.
Although both techniques are widely used, there has been no prospective
randomized study conducted to compare these two techniques, particularly
in regard to functional mitral stenosis. Method(s): A total of 104
patients with posterior leaflet prolapse were randomized to undergo mitral
repair with either leaflet resection (N=54) or leaflet preservation (N=50)
at 7 specialized Canadian cardiac centers. Patient age, proportion of
female patients, and mean Society of Thoracic Surgeons risk score was
63.9+/-10.4 years, 19%, and 1.4% for those who underwent leaflet
resection, and 66.3+/-10.8 years, 16%, and 1.9% for those who underwent
leaflet preservation, respectively. The primary endpoint was the mean
trans-mitral repair gradient at peak exercise 12-months after repair.
 Result(s): Baseline characteristics were similar between the groups.
At 12-months, the mean trans-mitral repair gradient at peak exercise in
patients who underwent leaflet resection and preservation was 9.1+/-5.2
and 8.3+/-3.3 mmHg (P=0.4), respectively. The two groups had similar mean
mitral valve gradient at rest (3.2+/-1.9 mmHg following resection and
3.1+/-1.1 mmHg following leaflet preservation, P=0.7). There was no
between-group difference for the 6-minute walk distance (451+/-147 m and
481+/-95 m for the resection and preservation groups, respectively,
P=0.3). Conclusion(s): We report the first prospective surgical
randomized trial to evaluate commonly used mitral valve repair strategies
for posterior leaflet prolapse. Leaflet resection and leaflet preservation
both yield acceptable results with no difference in postoperative valve
gradient and functional status 12-months after surgical mitral valve
repair.

<94>
Accession Number
634165368
Title
Transcatheter aortic valve replacement for bicuspid aortic valve stenosis
with first- and new-generation bioprostheses: A systematic review and
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1927), 2020. Date of Publication:
November 2020.
Author
Ueshima D.; Nai Fovino L.N.F.; Brener S.J.B.; Pavei A.P.; Fraccaro C.F.;
Napodano M.N.; Tarantini G.T.
Institution
(Ueshima) Kameda Medical Center, Chiba, Japan
(Nai Fovino, Pavei, Fraccaro, Napodano, Tarantini) University of Padova,
Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences,
Padua, Italy
(Brener) New York Methodist Hospital, Cardiology, Brooklyn, United States
Publisher
Oxford University Press
Abstract
Background: Subjects with bicuspid aortic valve (BAV) have been excluded
from transcatheter aortic valve re- placement (TAVR) randomized trials.
 Method(s): With this meta-analysis of observational studies we first
compared TAVR outcomes of BAV vs. tricuspid aortic valve (TAV) patients,
stratifying the results by device generation. Then, we looked for
differences between balloon-expandable (BE) and self-expandable (SE)
bioprostheses in BAV patients. Primary outcome was 30-day mortality.
Secondary outcomes were 30-day stroke, moderate-severe paravalvular
leakage, new pacemaker im- plantation, vascular complications and 1-year
mortality. Result(s): Thirteen studies (11,032 patients, 7291 TAV and
3741 BAV) and seven studies (706 patients, 367 treated with BE, 339 with
SE valve) met inclusion criteria. Thirty-day (OR=1.13; 95% CI: 0.88-1.46,
p=0.33) and 1- year mortality (OR=1.02; 95% CI: 0.77-1.37, p=0.87) were
similar between patients receiving TAVR for BAV or TAV. Subjects treated
for BAV were at higher risk of conversion to conventional surgery
(OR=2.35; 95% CI: 1.30- 4.23, p=0.005), implantation of a second valve
(OR=2.06; 95% CI: 1.31- 3.25; p=0.002), moderate/severe paravalvular
leakage (PVL) (OR=1.67; 95% CI: 1.29-2.17; p=0.0001) and device failure
(OR=1.26; 95% CI: 1.02- 1.56; p=0.04). Rates of adverse events decreased
significantly with the use of new-generation devices, but outcome
differences remained consistent. BAV patients treated with BE vs. SE
valves had similar 30-day and 1-year mortality, stroke and moderate-severe
PVL. Balloon-expandable valves were associated with lower rates of a
second valve and new pacemaker implantation but carried higher risk of
annular rupture. Conclusion(s): BAV patients treated with TAVR had
similar 30-day and 1- year mortality as well as stroke and new pacemaker
implantation rates compared to TAV subjects, but carried higher risk of
moderate/severe PVL, conver- sion to surgery and device failure. Event
rates significantly decreased with the use of new-generation devices, but
TAVR still showed better procedural results in TAV compared to BAV.

<95>
Accession Number
634165346
Title
Rivaroxaban in patients undergoing surgical mitral valve repair.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1976), 2020. Date of Publication:
November 2020.
Author
Sadeghipour P.; Noohi F.; Hosseini S.; Kordrostami S.; Shafe O.; Moosavi
J.; Rokni M.; Tashakori Beheshti A.; Rezaei Y.
Institution
(Sadeghipour, Noohi, Hosseini, Kordrostami, Shafe, Moosavi, Rokni,
Tashakori Beheshti, Rezaei) Rajaie Cardiovascular Medical and Research
Center, Tehran, Iran, Islamic Republic of
Publisher
Oxford University Press
Abstract
Background: The role of the non-vitamin K antagonist oral anticoagulants
has here been scarcely studied In patients undergoing mitral valve repair
(MVre). Method(s): In the present mixed cohort study, the safety and
efficacy of rivaroxaban (prospective analysis) were compared with those of
warfarin (retrospective analysis) in patients undergoing MVre.
 Result(s): Study flow chart were presented In Figure. Dissimilarities
in baseline characteristics necessitated propensity score matching, in
which 104 patients in each group were compared. No major bleeding or
cerebrovascular accident occurred during the 1-year follow-up. Clinically
relevant nonmajor bleeding was reported in 2 patients in the rivaroxaban
group and 4 patients in the warfarin group, a difference non-statistically
significant before and after propensity score matching (P=0.371 and
P=0.407, respectively). The type of anticoagulation did not predict the
1-year outcome (HR: 2.165, 95% CI: 0.376 to 12.460; P=0.387).
 Conclusion(s): In this mixed cohort study, rivaroxaban was both safe
and efficient in patients with MVre. Such preliminary results should
prompt larger randomized controlled trials.

<96>
Accession Number
634165335
Title
Meta-analysis and meta-regression of early aortic valve replacement versus
watchful waiting in asymptomatic severe aortic stenosis: A 2020 boost of
evidence.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1975), 2020. Date of Publication:
November 2020.
Author
Costa G.; Oliveiros B.; Goncalves L.; Teixeira R.
Institution
(Costa, Goncalves, Teixeira) Centro Hospitalar Universitario de Coimbra,
Coimbra, Portugal
(Oliveiros) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Current guidelines recommend aortic-valve replacement (AVR) as
the only effective therapy for severe symptomatic aortic stenosis (AS)
patients. Nevertheless, management and timing of intervention in
asymptomatic AS remains a controversial topic, with sparse evidence to
support the recommendations (level C). Purpose(s): To assess an
early-AVR strategy in asymptomatic severe AS, comparing it with a watchful
waiting (WW) strategy Methods: We systematically searched PubMed, Embase
and Cochrane databases, in February 2020, for both interventional or
observational studies comparing early-AVR withWWin the treatment of
asymptomatic severe AS. Random-effects meta-analysis for early-AVR
andWWwere performed. Meta-regression was used to assess the influence of
study characteristics on the outcome. Result(s): Eight studies were
included (seven registry-based or unrandomized studies and one randomized
clinical trial) providing a total of 3985 patients, and 1232 pooled
all-cause deaths (172 in early-AVR and 1060 in watchful waiting).
Meta-analysis showed a significantly lower all-cause mortality for the
early-AVR compared with WW group (pooled OR 0.24 [0.17, 0.32], P<0.01)
although with a moderate amount of heterogeneity between studies in the
magnitude of effect (I2=57%, P=0.02). The early-AVR patients also
displayed a lower cardiovascular mortality (pooled OR 0.27 [0.15, 0.48],
P<0.01) plus a lower heart failure hospitalization rate (pooled OR 0.27
[0.06, 0.65], P<0.007). No difference in clinical thromboembolic event
rate (stroke or myocardial infarction) was noted. The meta-regression for
all cause mortality based on possible confounders such as time of
follow-up, age, gender, diabetes mellitus, coronary artery disease, left
ventricular ejection fraction, and mean peak aortic jet velocity showed
that effect sizes reported by the individual studies seem to be
independent from the covariates considered (P>0.05). Conclusion(s):
Our 2020 pooled data reinforces the previous evidence suggesting the
benefit of early-AVR in asymptomatic patients with severe AS.

<97>
Accession Number
634165326
Title
Genotype/Phenotype correlation and prognosis for undescribed ACTC1
missense variants.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2075), 2020. Date of Publication:
November 2020.
Author
Cicerchia M.N.; Ochoa J.P.; Cardenas-Reyes I.; Fernandez Ferro G.; Brogger
M.N.; Fernandez X.; Garcia Hernandez S.; Garcia D.; Salazar Mendiguchia
J.; Ortiz M.; Monserrat L.
Institution
(Cicerchia, Ochoa, Cardenas-Reyes, Fernandez Ferro, Brogger, Fernandez,
Garcia Hernandez, Garcia, Salazar Mendiguchia, Ortiz, Monserrat) Health in
Code, A Coruna, Spain
Publisher
Oxford University Press
Abstract
Purpose: Establish the genotype/phenotype correlation for missense
undescribed variants in ACTC1, and evaluate their prognostic implications.
 Method(s): A systematic screening for the ACTC1 gene was performed
using NGS in 17,683 individuals with inherited cardiovascular disease,
6,984 of them with hypertrophic cardiomyopathy, 3,507 with dilated
cardiomyopathy, and 760 left ventricular non-compaction. These phenotypes
were clinically diagnosed by each center prior to the genetic study.
Frequency of the variants was compared with gene gnomAD and ClinVar
databases. A systematic review of the literature was performed to search
for previously reported variants. We evaluated available follow up data
and constructed Kaplan-Meier survival curves free from cardiovascular
death (sudden death, Heart transplant, heart failure death, appropriate
ICD discharge and stroke related death). Log-rank test was used to compare
event-free survival time between males and females. Result(s): 39
missense variants were identified in 283 carriers (125 index cases; 158
first-degree relatives). Twenty-two have not been previously described or
identified in public databases. 17 have been reported in gnomAD or
Clinvar. Carriers phenotypes were: 120 HCM; 43 LVNC; 16 DCM; three had
cardiac septal defect and two had sudden death. Some of the carriers had
overlapped or combined phenotypes: 7 HCM and LVNC, 7 septal defects and
LVNC, 3 HCM and septal defects, 4 MCD and LVNC. 24 were healthy carriers,
and we have no phenotypic data of the remaining individuals. Family
studies were performed in 12 families out of the 22 undescribed variants,
showing cosegregation in 8 variants. One case was "de novo".
Interestingly, a rare variant, previously identified as VUS in ClinVar,
showed a clearly cosegregation with HCM. The Leu10Met variant with a
frequency of 9/282084 alleles in gnomAD (1/15671 individuals) was
identified in 20 index cases, which represents 1/884 of all the genotyped
(0.11%), and 1/387 patients with HCM (0.35%). We found it in 2/9289
patients with other phenotypes (p<0.001). 51 patients (18%) presented an
event during follow up. In several cases, carriers developed early atrial
fibrillation. The survival curve shows adverse events from the first
decade of life, with a 10% cumulative rate of events at age 40, 80%
survival at age 60, and a 60% survival at age 70. No significant
differences in the incidence of cardiovascular death between men and women
were observed. Conclusion(s): HCM is the most frequent phenotype in
carriers of ACTC1 variants, followed by LVNC, and DCM. Septal defects are
not rare, and they are usually described in combination with
cardiomyopathies. Disease course seems to have a good prognosis. Sudden
death is an exception at early ages and appears to be associated with
severe morphological expression. Given the presence of cosegregation with
disease in rare variants, many of the ACTC1 variants may have an
incomplete penetrance, and late disease expression.

<98>
Accession Number
634165320
Title
Clinical outcomes from antihypertensive therapies in moderate or severe
aortic stenosis: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1923), 2020. Date of Publication:
November 2020.
Author
Sen J.; Chung E.; Neil C.; Marwick T.
Institution
(Sen, Neil, Marwick) Baker Heart and Diabetes Institute, Melbourne,
Australia
(Chung) University of Toronto, Graduate Department of Pharmaceutical
Sciences, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: Hypertension can negatively affect prognosis in moderate or
severe aortic stenosis (AS), but antihypertensive therapy (AHT) is often
avoided due to possible deleterious effects such as reduced coronary
perfusion, left ventricular dysfunction and haemodynamic compromise.
 Purpose(s): We systematically assessed and compared clinical outcomes
in adults with moderate or severe AS treated with and without AHT.
 Method(s): Two independent reviewers performed screening, data
extraction and risk of bias assessments from a systematic search of the
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and grey
literature without language restrictions up to September 9, 2019.
Conflicts were resolved by the third reviewer. Outcomes of interest
included mortality, left ventricular (LV) mass index, systolic blood
pressure, diastolic blood pressure, and LV ejection fraction.
Meta-analysis with pooled effect sizes using random-effects model, were
estimated in R. Result(s): Of 3,024 citations, 30 studies (26,224
patients) were included in the qualitative synthesis and 23 studies in
meta-analysis. AHT was associated with favourable clinical outcomes and
was well tolerated. AHT was associated with lower risk of all-cause
mortality (Risk Ratio (RR)=0.69, 95% CI: 0.53-0.90, p=0.01, Figure). The
effect size appears to differ with type of aortic valve replacement (AVR).
AHT was associated with lower risk of acute kidney injury
post-transcatheter AVR (RR=0.13, 95% CI:0.05- 0.35, p=0.007). Favourable
outcomes such as improved haemodynamic and echocardiographic parameters
were demonstrated in some studies, but when pooled in meta-analysis, the
differences did not reach statistical significance. However, heterogeneity
was significant across studies. Conclusion(s): This is the first
systematic review and meta-analysis to demonstrate that AHT is safe and
has a clinical benefit in patients with advanced stages of AS with
significant improvement in survival or reduction in mortality without
haemodynamic compromise. Further studies are required to determine the
best AHT for patients with moderate or severe AS.

<99>
Accession Number
634165312
Title
Hemoglobin level at stabilization is associated with long-term all-cause
mortality in patients with left-sided endocarditis, a POET substudy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 2018), 2020. Date of Publication:
November 2020.
Author
Pries-Heje M.; Hasselbalch R.B.; Ihleman N.; Gill S.; Bruun N.E.; Elming
H.; Jensen K.; Oestergaard L.; Helweg-Larsen J.; Fosboel E.L.; Koeber L.;
Toender N.; Moser C.; Iversen K.; Bundgaard H.
Institution
(Pries-Heje, Ihleman, Oestergaard, Fosboel, Koeber, Iversen, Bundgaard)
Rigshospitalet, Copenhagen University Hospital, Department of Cardiology,
Copenhagen, Denmark
(Hasselbalch) Herlev Hospital, Emergency Department, Herlev, Denmark
(Gill) Odense University Hospital, Department of Cardiology, Odense,
Denmark
(Bruun, Elming) Zealand University Hospital, Department of Cardiology,
Roskilde, Denmark
(Jensen) Aarhus University Hospital, Department of Cardiology, Aarhus,
Denmark
(Helweg-Larsen) Rigshospitalet -Copenhagen University Hospital, Department
of Infectious Diseases, Copenhagen, Denmark
(Toender) Hillerod Hospital, Department of Cardiology, Hillerod, Denmark
(Moser) Rigshospitalet, Copenhagen University Hospital, Department of
Clinical Microbiology, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Background: Left-sided infectious endocarditis (IE) has a high 1-year
mortality. Anemia is a common finding in patients with IE, yet little is
known about frequency, severity, and associated outcomes in this setting.
 Purpose(s): To examine the relationship between Hemoglobin (Hgb)
level measured at IE stabilization (time of randomization) in the Partial
Oral versus intravenous Antibiotic Treatment of Endocarditis (POET) trial
-and long-term all-cause mortality. Method(s): In the POET trial, 400
patients with left-sided IE were randomized, after medical and/or surgical
stabilization, to conventional antibiotic treatment or partial oral
treatment. Only non-surgically treated patients were considered in this
study. Patients were divided by quartiles into four groups based on Hgb
level at randomization. Result(s): We examined 248 patients with
non-surgically treated IE. Median time from diagnosis of IE to
randomization was 14 days (IQ 12-19). At long-term follow-up (median 3.2
years, IQ 2.18-4.60), 71 patients had died (28.6%). Patients in the lowest
quantile (Hgb <=6.0 mmol) had a HR of 4.17 (95% CI 1.81-9.61, p<0.001) for
death compared to patients in the highest quantile (Hgb >7.5 mmol/L). This
association remained significant after multivariable adjustment for age,
sex, renal disease, C-Reactive Protein, and Prosthetic heart valve (HR
2.69, 95% CI 1.11-6.50); p=0.028). Conclusion(s): Low Hemoglobin
level at stabilization in patients with IE was associated with an
increased risk of long-term mortality. Whether intensified treatment of
anemia in patients with IE could improve long-term outcome requires
investigation.

<100>
Accession Number
634165169
Title
Transcatheter versus surgical aortic valve replacement: An updated
systematic review and meta-analysis with a focus on outcomes by sex.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1961), 2020. Date of Publication:
November 2020.
Author
Dagan M.; Yeung T.; Stehli J.; Stub D.; Walton A.S.; Duffy S.J.
Institution
(Dagan, Yeung, Stehli, Stub, Walton, Duffy) Alfred Hospital, Melbourne,
Australia
Publisher
Oxford University Press
Abstract
Background and purpose: Women at increased surgical risk have been shown
to have better outcomes with transcatheter aortic valve implantation
(TAVI) as compared to surgical valve replacement (SAVR). With the scope of
TAVI moving into low-surgical risk patients we aimed to update the current
literature to include the new low-risk randomized controlled trial data in
investigating outcomes by sex. Method(s): We systematically searched
MedlineOVID, PubMed, Cochrane Central Register of Controlled Trials,
ClinicalTrials.gov and reference lists for relevant randomised controlled
trials (RCTs) comparing TAVI to SAVR published prior to October 7th 2019.
Data extraction was performed by two independent authors and included
trial design details, baseline characteristics and outcome data stratified
by sex. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
Quantitative synthesis of pooled data was performed using Mantel-Haenszel
fixed or random effects model. Q-statistic and the I2 test were used for
assessment of heterogeneity. Result(s): Our search yielded eight RCTs
included in the final quantitative synthesis. The overall pooled cohort
was 8,040, of whom 41.4% were female. Women had significantly lower rates
of one-year all-cause mortality and one-year composite endpoint with TAVI
as compared to SAVR. The selective mortality benefit with TAVI over SAVR
in women did not persist to five-years. At 30-days, women demonstrated
lower rates of major bleeding and acute kidney injury following TAVI
compared to SAVR. For men, these outcomes were similar regardless of type
of intervention. Both sexes were at increased risk of major vascular
complications with TAVI as compared to SAVR, however women demonstrated
nearly double the odds of major vascular complication with TAVI compared
to men. Conclusion(s): Our updated meta-analysis demonstrates that at
one-year women undergoing TAVI have significantly lower mortality and
better safety outcomes compared to those undergoing SAVR. These benefits
are not seen in men. In the new low-risk era, these results are ever more
important for guiding appropriate patient selection.

<101>
Accession Number
634165099
Title
Transcarotid trancatheter aortic valve implantation under local anesthesia
in real life, a retrospective observational comparison with femoral
access.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 1955), 2020. Date of Publication:
November 2020.
Author
Trimech T.R.; El Jourdi B.; Fradi S.; Ghostine S.
Institution
(Trimech, El Jourdi, Fradi, Ghostine) Marie Lannelongue Hospital, Le
Plessis Robinson, France
Publisher
Oxford University Press
Abstract
Background: Trans-femoral approach is the most commonly used access for
trans-catheter aortic valve implantation (TAVI). However, in case of
unsuitability, several alterative access routes have been described,
namely trans-axillary, trans-aortic and trans-apical. The trans-carotid
approach, rarely used, can be of particular help. Purpose(s): To
compare trans-carotid with trans-femoral access for TAVI, regarding
epidemiological, clinical, procedural features and in hospital prognosis.
 Method(s): We retrospectively analyzed the data of 1272 patients
treated with TAVI between January 2013 and December 2019. Patients were
divided into 2 groups and compared according to the vascular approach:
trans-carotid group (n=84) and trans-femoral group (n=1188).
 Result(s): The trans-carotid group, representing 6.6% of all patients
undergoing TAVI, had significantly more hypertension (89.9% vs 75.8%;
p=0.002), history of coronary artery disease (78.6% vs 50.5%; p<0.001),
peripheral arteriopathy (58.7% vs 9.3%; p<0.0001), ischemic stroke (24% vs
10.5%; p=0.03), chronic obstructive pulmonary disease (30.8% vs 18.4%;
p=0.004), surgical aortic valve replacement (12% vs 4.3%; p=0.008) and
contralateral carotid endarterectomy (4% vs 0.4%; p=0.012). Average scores
of LOGISTIC EUROSCORE and EUROSCORE II were significantly higher in this
group (respectively 22.4 vs 15.2 and 8.3 vs 5.56; p<0.0001) and patients
were more frequently considered by the Heart Team as at high surgical risk
(91.3% vs 68.2%; p<0.0001). When performing TAVI, balloon predilatation
and postdilatation were significantly less frequent in the trans-carotid
group (respectively 13.3% vs 26.4%; p=0.03 and 21.7% vs 37.6%; p=0.006).
However, there was no significant difference between the 2 groups
concerning neither the implantation of self-expanding/balloon-expandable
valves nor in the fluoroscopy time and dose-area product averages. On
post-procedural echocardiographic findings, transaortic mean gradient
average and the incidence of significant paravalvular leak were similar.
During intra-hospital follow-up, patients in the trans-carotid group had
significantly less vascular complications (9.3% vs 23%; p=0.02) and less
urgent need of endovascular repair (0% vs 15.8%; p=0.013) without any
impact on the need for transfusion. However, the incidence of atrial
fibrillation was significantly higher (17.4% vs 9.4%; p=0.036). There was
no significant difference between the two groups for the incidence of
haemodynamic and neurological complications, high-degree atrioventricular
block and inhospital mortality. Conclusion(s): According to our
study, trans-carotid TAVI under local anesthesia can be feasible and safe,
especially in more friable patients at higher risk. It was associated with
lower incidence of vascular complications but a higher incidence of atrial
fibrillation, without impact on in-hospital mortality. Randomized
controlled trials are needed to establish a firm conclusion about this
novel approach. ESC.

<102>
Accession Number
634164732
Title
The association of digoxin with mortality in ischemic heart failure: A
secondary analysis of the STICH trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 882), 2020. Date of Publication:
November 2020.
Author
Pandya L.; Brown D.L.
Institution
(Pandya, Brown) Washington University, School of Medicine, St Louis,
United States
Publisher
Oxford University Press
Abstract
Background: Digoxin, one of the first treatments for symptoms of
congestive heart failure (CHF), is currently used in the management of
persistent CHF symptoms as well as for ventricular rate control in atrial
fibrillation. Current guidelines suggest digoxin as an adjunct to optimal
medical therapy for symptomatic improvement in CHF. However, the data
regarding the effect of digoxin use on mortality continue to be
conflicting. Purpose(s): The aim of this retrospective study was to
evaluate the association of digoxin therapy with mortality in patients
with ischemic heart failure defined by severe left ventricular (LV)
dysfunction and coronary artery disease (CAD) in the Surgical Treatment
for Ischemic Heart Failure (STICH) trial. Method(s): STICH randomized
1012 patients with CAD and LV ejection fraction<35% to coronary artery
bypass graft (CABG) surgery and medical therapy vs. medical therapy alone.
Factors predictive of digoxin use were identified with a binomial logistic
regression model. Multivariable Cox proportional hazards modelling was
performed with digoxin use modelled as a segmented time-dependent
covariate. The model was adjusted for baseline clinical characteristics
(including age, race, hypertension, hyperlipidemia, diabetes mellitus,
peripheral vascular disease, NYHA heart failure class, previous myocardial
infarction, atrial fibrillation, creatinine level, smoking status, and
STICH treatment group) and stratified based on sex. All covariates were
verified to meet the proportional hazards assumption. The primary outcome
was all-cause mortality. Secondary outcomes included death and
hospitalization due to cardiovascular causes. Relative risks were
expressed as adjusted hazard ratios (aHR) with 95% confidence intervals
(CI). Result(s): Of the 1012 patients, 351 (35% [36% of male patients
and 27% of female patients]) reported digoxin use for some duration during
the study period. Significant predictors of digoxin use included minority
status, NYHA class, previous myocardial infarction, and baseline diagnosis
of hypertension, diabetes, or atrial fibrillation. At a mean follow-up of
9.8 years, 566 patients (55.7%) experienced all-cause mortality and 387
patients (38.1%) died due to cardiovascular causes. The adjusted Cox
proportional hazards model demonstrated that digoxin use was independently
associated with an increased risk of all-cause mortality (aHR 1.22, 95%
CI: 1.00-1.49, P=0.049). Digoxin use was also associated with increased
risk of cardiovascular death (aHR 1.29, 95% CI: 1.02-1.64, P=0.032). There
was no impact of digoxin on hospitalization for cardiovascular causes.
 Conclusion(s): Use of digoxin in patients with ischemic heart failure
was associated with an increased risk of both all-cause and cardiovascular
death.

<103>
Accession Number
634164531
Title
10-year outcomes of triple-site versus standard cardiac resynchronization
therapy randomized trial (TRUST CRT).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 811), 2020. Date of Publication:
November 2020.
Author
Mazurek M.; Jedrzejczyk-Patej E.; Kowalski O.; Sredniawa B.; Sokal A.;
Pruszkowska-Skrzep P.; Pluta S.; Kukulski T.; Szulik M.; Stabryla-Deska
J.; Kalarus Z.; Lenarczyk R.
Institution
(Mazurek, Jedrzejczyk-Patej, Kowalski, Sredniawa, Sokal,
Pruszkowska-Skrzep, Pluta, Kukulski, Szulik, Stabryla-Deska, Lenarczyk)
Silesian Centre for Heart Diseases, Department of Cardiology, Congenital
Heart Diseases and Electrotherapy, Zabrze, Poland
(Kalarus) Silesian Centre for Heart Diseases, Department of Cardiology,
School of Medicine with the Division of Dentistry, Zabrze, Poland
Publisher
Oxford University Press
Abstract
Background: Triple-Site versus Standard Cardiac Resynchronization Therapy
Randomized Trial (TRUST CRT) was initiated in 2009 to verify the
hypothesis whether triple-site (single right, double left) cardiac
resynchronization therapy (CRT) may be superior to conventional,
biventricular resynchronization in patients with advanced heart failure.
 Objective(s): To report 6-month outcomes and 10-year survival in
TRUST CRT. Method(s): 100 consecutive patients with moderate to
severe heart failure, ejection fraction of 35% or less, electrical and
mechanical dyssynchrony, were randomly assigned in a 1:1 fashion to
triple-site CRT defibrillator (TRIV) or to conventional CRT-D. The primary
objective evaluated response-rate, defined as the 6-month's combined end
point of alive status, freedom from hospitalization for heart failure or
heart transplantation, relative>=10% increase in ejection fraction, >=10%
in peak oxygen consumption, and >=10% in 6-minute walking distance. The
secondary objective was to assess the occurrence of major adverse
cardiovascular events (hospitalization for exacerbated heart failure
requiring modification of pharmacotherapy, heart transplant or death) at
month 6 and during remote observation. Result(s): At month 6, the
response-rate was higher in triple-site than conventional CRT-D group
(51.1 vs. 26.5%, P=0.014). There were 2 deaths or heart failure events in
the triple-site group (4%) as compared with 8 in the group assigned to
conventional CRT-D (16%). A triple-site resynchronization resulted in 12%
absolute risk reduction for secondary end point (hazard ratio 0.25; 95
percent confidence interval, 0.05 to 1.17, P=0.056, in comparison with the
conventional CRT-D group). After 10 years of observation (median follow up
of 7.1 years; range: 1.2-10.4) 57 patients (58.2%) died: 24 (53.3%) in the
triple-site group, 31 (60.8%) in the conventional group (P=0.46) and 2
patients with and ICD (failed CRT implantation) [Figure].
 Conclusion(s): In patients with advanced heart failure, triple-site
resynchronization combined with an ICD did not result in better survival
than conventional resynchronization therapy in a median observation of 7.1
years. (Figure Presented).

<104>
Accession Number
634164516
Title
Efficacy of epicardial and endocardial ablation in the prevention of
ventricular tachycardia in arrythmogenic right ventricular
cardiomyopathy-a meta analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. 41 (SUPPL 2) (pp 761), 2020. Date of Publication:
November 2020.
Author
Sattar Y.; Ullah W.; Mamtani S.; Alraies C.
Institution
(Sattar, Mamtani) Icahn School of Medicine at Mount Sinai, New York,
United States
(Ullah) Abington Memorial Hospital, Abington, United States
(Alraies) Wayne State University, Detroit, United States
Publisher
Oxford University Press
Abstract
Introduction: Ventricular tachycardia is a major complication associated
with increased risk of sudden cardiac death in arrhythmogenic ventricular
cardiomyopathy. Recurrence of VT status post catheter endocardial ablation
with conventional mapping is a evolving discussion in management of VT
prevention in ARVC. With the evolution of new mapping techniques to locate
ectopic foci of VT, a combination of endo- and epicardial catheter
ablation have proven to be efficacious in the prevention of frequency of
VT recurrence and its duration. Method(s): Using PubMed, Ovid
(MEDLINE) and Cochrane database we searched using the MeSH terms
including: "arrhythmogenic right ventricular cardiomyopathy",
"arrhythmogenic right ventricular dysplasia", "monomorphic ventricular
tachycardia", "polymorphic ventricular Tachycardia", "endocardial catheter
ablation", "epicardial catheter ablation". The primary outcomes were to
assess VT frequency and duration status post endocardial or epicardial or
a combination of both types of ablation. The secondary outcome includes
sudden cardiac arrest or sudden cardiac death after procedure. ANOVA with
post HOC analysis was performed using SPSS v.26 (IBM Corp, NY, USA)
Results: A total of 33 studies included 1437 patients with a mean
male=67%. The data analysis showed a mean VT prevention for endocardial
ablation was 65%, epicardial 78%, and for combined epi-endocardial was 89%
(figure-1). The mean procedural mortality rate was 2%. In order to test
the hypothesis that combined epi-endocardial ablation was more successful
in the prevention of VT recurrence, we performed a one-way analysis of
variance (ANOVA). The analysis was statistically significant
F(2,14)=5.879, 95% CI, p=0.014. Post Hoc test (Tukey HSD test) with
multiple comparisons indicated that patients who underwent combined
epiendocardial ablation experienced a statistically significant difference
in VT prevention of 89% (95% CI p=0.01) compared to only endocardial
ablation, mean VT prevention of 65% (95% CI, p=0.189) or only epicardial,
mean VT prevention of 78% (95% CI, p=0.353). Conclusion(s): With new
mapping techniques, use of endocardial, and epicardial ablation is linked
to decrease VT frequency, duration, ICD shocks, and sudden cardiac death
in patients with ARVC in cohorts with prior failure of antiarrhythmics.
(Figure Presented).

<105>
Accession Number
633930595
Title
Instantaneous wave-free ratio guided multivessel revascularisation during
percutaneous coronary intervention for acute myocardial infarction: Study
protocol of the randomised controlled iMODERN trial.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: e044035. Date of
Publication: 15 Jan 2021.
Author
Beijnink C.W.H.; Thim T.; Van Der Heijden D.J.; Klem I.; Al-Lamee R.; Vos
J.L.; Koop Y.; DIjkgraaf M.G.W.; Beijk M.A.M.; Kim R.J.; Davies J.; Raposo
L.; Baptista S.B.; Escaned J.; Piek J.J.; Maeng M.; Van Royen N.; Nijveldt
R.
Institution
(Beijnink, Vos, Koop, Van Royen, Nijveldt) Cardiology, Radboudumc,
Nijmegen, Netherlands
(Thim, Maeng) Department of Cardiology, Aarhus University Hospital, Aarhus
N, Denmark
(Van Der Heijden) Cardiology, Medisch Centrum Haaglanden, Den Haag,
Netherlands
(Klem, Kim) Cardiology, Duke University Medical Center, Durham, NC, United
States
(Al-Lamee) Cardiology, Imperial College London Faculty of Medicine,
London, United Kingdom
(DIjkgraaf) Clinical Epidemiology, Biostatistics and Bioinformatics,
Amsterdam UMC - Locatie AMC, Amsterdam, Netherlands
(Beijk, Piek) Cardiology, Amsterdam UMC Locatie AMC, Amsterdam,
Netherlands
(Davies) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Raposo) Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa,
Portugal
(Baptista) Cardiology Department, Hospital Fernando Fonseca, Amadora,
Portugal
(Escaned) Interventional Cardiology, Hospital Clinico Universitario San
Carlos, Madrid, Spain
Publisher
BMJ Publishing Group
Abstract
Introduction Recent randomised clinical trials showed benefit of
non-culprit lesion revascularisation in ST-elevation myocardial infarction
(STEMI) patients. However, it remains unclear whether revascularisation
should be performed at the index procedure or at a later stage. Methods
and analysis The instantaneous wave-free ratio (iFR) Guided Multivessel
Revascularisation During Percutaneous Coronary Intervention for Acute
Myocardial Infarction trial is a multicentre, randomised controlled
prospective open-label trial with blinded evaluation of endpoints. After
successful primary percutaneous coronary intervention (PCI), eligible
STEMI patients with residual non-culprit lesions are randomised, to
instantaneous wave-free ratio guided treatment of non-culprit lesions
during the index procedure versus deferred cardiac MR-guided management
within 4 days to 6 weeks. The primary endpoint of the study is the
combined occurrence of all-cause death, recurrent myocardial infarction
and hospitalisation for heart failure at 12 months follow-up. Clinical
follow-up includes questionnaires at 3 months and outpatient visits at 6
months and 12 months after primary PCI. Furthermore, a cost-effectiveness
analysis will be performed. Ethics and dissemination Permission to conduct
this trial has been granted by the Medical Ethical Committee of the
Amsterdam University Medical Centres (loc. VUmc, ID NL60107.029.16). The
primary results of this trial will be shared in a main article and
subgroup analyses or spin-off studies will be shared in secondary papers.
Trial registration number NCT03298659. Copyright © 2021 BMJ
Publishing Group. All rights reserved.

<106>
Accession Number
2010977348
Title
Ticagrelor-based antiplatelet regimens in patients treated with coronary
artery bypass grafting: A meta-analysis of randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 520-528), 2020.
Date of Publication: 01 Mar 2020.
Author
Von Scheidt M.; Bongiovanni D.; Tebbe U.; Nowak B.; Stritzke J.; Zhao Q.;
Zhu Y.; Kastrati A.; Cassese S.; Schunkert H.
Institution
(Von Scheidt, Kastrati, Cassese, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Von Scheidt, Bongiovanni, Kastrati, Schunkert) DZHK (German Center for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Bongiovanni) Medical Department i, Cardiology, Klinikum Rechts der Isar,
Technical University, Munich, Germany
(Tebbe) Department of Cardiology, Angiology, and Intensive Care Medicine,
District Hospital Lippe-Detmold, Detmold, Germany
(Nowak) CCB, Cardiovascular Center Bethanien, Frankfurt, Germany
(Stritzke) Lanserhof Sylt, Marienstein Privatklinik, List, Germany
(Zhao, Zhu) Ruijin Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The optimal antiplatelet strategy in patients undergoing CABG
remains unclear. This is the first meta-analysis investigating the
clinical outcomes associated with ticagrelor-based antiplatelet regimens
in patients receiving CABG. METHOD(S): Relevant scientific databases
were searched for studies investigating antiplatelet regimens after CABG
from inception until April 1, 2019. Studies which randomly assigned CABG
patients to either ticagrelor-based or control antiplatelet regimens were
eligible. The primary outcome of this analysis was all-cause death. The
main secondary outcome was MI. Other outcomes of interest were cardiac
death, major adverse cardiac events, stroke and bleeding. This study is
registered with PROSPERO, number CRD42019122192. RESULT(S): Five
trials comprising 3996 patients (2002 assigned to ticagrelor-based and
1994 to control antiplatelet regimens) were eligible for quantitative
synthesis. The median follow-up was 12 months. Control antiplatelet
regimens consisted of either aspirin or clopidogrel or both. As compared
to control, ticagrelor-based regimens reduced the risk of all-cause death
[0.61 (0.43-0.87); P = 0.007], cardiac death [0.58 (0.39-0.86); P = 0.007]
and major adverse cardiac events [0.79 (0.63-0.98); P = 0.03], without
difference in the risk of MI [0.76 (0.50-1.18); P = 0.22], stroke [0.99
(0.56-1.78); P = 0.98] or bleeding [1.04 (0.95-1.14); P = 0.41]. There was
a treatment effect modification for the primary outcome associated with
trials enrolling predominantly patients with acute coronary syndrome (P
for interaction = 0.038). CONCLUSION(S): In patients receiving CABG,
ticagrelor-based regimens reduce mortality and major adverse cardiac
events without excess bleeding risk as compared with aspirin monotherapy
or the combination of aspirin and clopidogrel. The benefit of
ticagrelor-based regimens is more relevant in those studies enrolling
predominantly patients with acute coronary syndrome. These findings
require further confirmation in randomized trials focused on this subset
of patients and powered for clinical outcomes. Copyright © 2019
The Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<107>
Accession Number
2010977345
Title
Mini-extracorporeal circulation surgery produces less inflammation than
off-pump coronary surgery.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 496-503), 2020.
Date of Publication: 01 Mar 2020.
Author
Permanyer E.; Munoz-Guijosa C.; Padro J.-M.; Ginel A.; Montiel J.;
Sanchez-Quesada J.L.; Vila L.; Camacho M.
Institution
(Permanyer) Department of Cardiac Surgery, Quironsalud Teknon Heart
Institute, Barcelona, Spain
(Permanyer, Padro, Ginel, Montiel) Department of Cardiac Surgery, Hospital
de la Santa Creu i Sant Pau, Research Institute Hospital Sant Pau, IIB
Sant Pau, Barcelona, Spain
(Munoz-Guijosa) Department of Cardiac Surgery, University Hospital Germans
Trias i Pujol, Badalona, Spain
(Sanchez-Quesada) Cardiovascular Research Group, CIBERDEM, Research
Institute Hospital Sant Pau, IIB Sant Pau, Barcelona, Spain
(Vila, Camacho) Laboratory of Angiology, Vascular Biology and
Inflammation, Research Institute Hospital Sant Pau, IIB Sant Pau,
Barcelona, Spain
(Camacho) Genomics of Complex Diseases, Research Institute Hospital Sant
Pau, IIB Sant Pau, Barcelona, Spain
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Both off-pump coronary artery bypass grafting surgery (OPCABG)
and mini-extracorporeal circulation (MECC) have been associated with lower
morbidity and mortality and less inflammation than conventional
cardiopulmonary bypass. However, studies comparing the 2 techniques are
scarce and the results are controversial. We compared the clinical
outcomes and inflammatory response of low-risk patients undergoing
coronary bypass grafting with MECC versus OPCABG. METHOD(S): We
conducted a prospective, randomized study in patients undergoing coronary
heart surgery. Two hundred and thirty consecutive low-risk patients were
randomly assigned to either receive OPCABG (n = 117) or MECC (n = 113).
Clinical outcomes and postoperative biochemical results were analysed in
both groups. We also analysed 19 circulating inflammatory markers in a
subgroup of 40 patients at 4 perioperative time points. The area under the
curve for each marker was calculated to monitor differences in the
inflammatory response. RESULT(S): No significant differences were
found between groups regarding perioperative clinical complications and no
deaths occurred during the trial. Plasma levels in 9 of the 19
inflammatory markers were undetectable or showed no temporal variation, 3
were higher in the MECC group [interleukin (IL)-10, macrophage
inflammatory protein-1beta and epidermal growth factor] and 7 were higher
in the OPCABG group (growth regulator oncogene, IL-6, IL-8, soluble CD40
ligand, monocyte chemoattractant protein-1, monocyte chemoattractant
protein-3 and tumour necrosis factor-alpha). Differences in 2
proinflammatory cytokines, IL-6 and monocyte chemoattractant protein 1,
between the 2 surgical procedures were statistically significant.
 CONCLUSION(S): No clinical differences were observed between in
low-risk patients undergoing MECC or OPCABG surgery, but OPCABG was
associated with an increased release of proinflammatory cytokines compared
with MECC. Studies in larger cohorts and in patients at higher risk are
needed to confirm these findings. Clinical trial registration number:
NCT02118025. Copyright © 2019 The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<108>
Accession Number
2010977229
Title
Impact of minimally invasive extracorporeal circulation on coagulation - a
randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 57 (6) (pp 1145-1153), 2020.
Date of Publication: 01 Jun 2020.
Author
Modrau I.S.; Halle D.R.; Nielsen P.H.; Kimose H.H.; Greisen J.R.; Kremke
M.; Hvas A.-M.
Institution
(Modrau, Halle, Nielsen, Kimose) Department of Cardiothoracic and Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Modrau, Kimose, Greisen, Hvas) Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark
(Greisen, Kremke) Department of Anaesthesiology and Intensive Care, Aarhus
University Hospital, Aarhus, Denmark
(Hvas) Department of Clinical Biochemistry, Aarhus University Hospital,
Aarhus, Denmark
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: Minimally invasive extracorporeal circulation (MiECC) is
suggested to have favourable impact on blood loss compared to conventional
extracorporeal circulation. We aimed to compare the impact of both systems
on coagulation. Method(s): Randomized trial comparing endogenous
thrombin-generating potential early after elective coronary surgery
employing either MiECC group (n = 30) or conventional extracorporeal
circulation group (n = 30). Secondary outcomes were in vivo thrombin
generation, bleeding end points and haemodilution, as well as morbidity
and mortality up to 30-day follow-up. Result(s): Compared to the
conventional extracorporeal circulation group, the MiECC group showed (i)
a trend towards a higher early postoperative endogenous
thrombin-generating potential (P = 0.06), (ii) lower intraoperative levels
of thrombin-antithrombin complex and prothrombin fragment 1 + 2 (P <
0.001), (iii) less haemodilution early postoperatively as measured by
haematocrit and weight gain, but without correlation to coagulation
factors or bleeding end points. Moreover, half as many patients required
postoperative blood transfusion in the MiECC group (17% vs 37%, P = 0.14),
although postoperative blood loss did not differ between groups (P =
0.84). Thrombin-antithrombin complex levels (rs = 0.36, P = 0.005) and
prothrombin fragment 1 + 2 (rs = 0.45, P < 0.001), but not early
postoperative endogenous thrombin-generating potential (rs = 0.05, P =
0.72), showed significant correlation to increased transfusion
requirements. The MiECC group demonstrated significantly lower levels of
creatine kinase-MB, lactate dehydrogenase and free haemoglobin indicating
superior myocardial protection, less tissue damage and less haemolysis,
respectively. Perioperative morbidity and 30-day mortality did not differ
between groups. Conclusion(s): Conventional but not MiECC is
associated with significant intraoperative thrombin generation despite
full heparinization. No correlation between coagulation factors or
bleeding end points with the degree of haemodilution could be ascertained.
ClinicalTrials.gov identifier: NCT03216720. Copyright © 2020 The
Author(s).

<109>
Accession Number
634169074
Title
Association of Effective Regurgitation Orifice Area to Left Ventricular
End-Diastolic Volume Ratio with Transcatheter Mitral Valve Repair
Outcomes: A Secondary Analysis of the COAPT Trial.
Source
JAMA Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Lindenfeld J.; Abraham W.T.; Grayburn P.A.; Kar S.; Asch F.M.; Lim D.S.;
Nie H.; Singhal P.; Sundareswaran K.S.; Weissman N.J.; Mack M.J.; Stone
G.W.
Institution
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, 1215 21st Ave S, Ste 5309, Nashville, TN 37232, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Kar) Center of Advanced Cardiac and Vascular Interventions, Los Angeles,
CA, United States
(Asch) MedStar Health Research Institute, Hyattsville, MD, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Nie, Singhal, Sundareswaran) Abbott, Santa Clara, CA, United States
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
(Mack) Baylor Scott and White Heart Hospital Plano, Plano, TX, United
States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
American Medical Association
Abstract
Importance: Transcatheter mitral valve repair (TMVr) plus maximally
tolerated guideline-directed medical therapy (GDMT) reduced heart failure
(HF) hospitalizations (HFHs) and all-cause mortality (ACM) in symptomatic
patients with HF and secondary mitral regurgitation (SMR) compared with
GDMT alone in the Cardiovascular Outcomes Assessment of the MitraClip
Percutaneous Therapy for Heart Failure Patients With Functional Mitral
Regurgitation (COAPT) trial but not in a similar trial, Multicenter Study
of Percutaneous Mitral Valve Repair MitraClip Device in Patients With
Severe Secondary Mitral Regurgitation (MITRA-FR), possibly because the
degree of SMR relative to the left ventricular end-diastolic volume index
(LVEDVi) was substantially lower. Objective(s): To explore
contributions of the degree of SMR using the effective regurgitation
orifice area (EROA), regurgitant volume (RV), and LVEDVi to the benefit of
TMVr in the COAPT trial. Design, Setting, and Participant(s): This
post hoc secondary analysis of the COAPT randomized clinical trial
performed December 27, 2012, to June 23, 2017, evaluated a subgroup of
COAPT patients (group 1) with characteristics consistent with patients
enrolled in MITRA-FR (n = 56) (HF with grade 3+ to 4+ SMR, left
ventricular ejection fraction of 20%-50%, and New York Heart Association
function class II-IV) compared with remaining (group 2) COAPT patients (n
= 492) using the end point of ACM or HFH at 24 months, components of the
primary end point, and quality of life (QOL) (per the Kansas City
Cardiomyopathy Questionnaire overall summary score) and 6-minute walk
distance (6MWD). The same end points were evaluated in 6 subgroups of
COAPT by combinations of EROA and LVEDVi and of RV relative to LVEDVi.
 Intervention(s): Interventions were TMVr plus GDMT vs GDMT alone.
 Result(s): A total of 548 participants (mean [SD] age, 71.9 [11.2]
years; 351 [64%] male) were included. In group 1, no significant
difference was found in the composite rate of ACM or HFH between TMVr plus
GDMT vs GDMT alone at 24 months (27.8% vs 33.1%, P =.83) compared with a
significant difference at 24 months (31.5% vs 50.2%, P <.001) in group 2.
However, patients randomized to receive TMVr vs those treated with GDMT
alone had significantly greater improvement in QOL at 12 months (mean [SD]
Kansas City Cardiomyopathy Questionnaire summary scores: group 1: 18.36
[5.38] vs 0.43 [4.00] points; P =.01; group 2: 16.54 [1.57] vs 5.78 [1.82]
points; P <.001). Group 1 TMVr-randomized patients vs those treated with
GDMT alone also had significantly greater improvement in 6MWD at 12 months
(mean [SD] paired improvement: 39.0 [28.6] vs -48.0 [18.6] m; P =.02).
Group 2 TMVr-randomized patients vs those treated with GDMT alone tended
to have greater improvement in 6MWD at 12 months, but the difference did
not reach statistical significance (mean [SD] paired improvement: 35.0
[7.7] vs 16.0 [9.1] m; P =.11). Conclusions and Relevance: A small
subgroup of COAPT-resembling patients enrolled in MITRA-FR did not achieve
improvement in ACM or HFH at 24 months but had a significant benefit on
patient-centered outcomes (eg, QOL and 6MWD). Further subgroup analyses
with 24-month follow-up suggest that the benefit of TMVr is not fully
supported by the proportionate-disproportionate hypothesis. Trial
Registration: ClinicalTrials.gov Identifier: NCT01626079. Copyright
© 2021 American Medical Association. All rights reserved.

<110>
Accession Number
365978005
Title
Glargine did not reduce CV events more than standard care in patients with
dysglycemia.
Source
Annals of Internal Medicine. 157 (6) (pp JC3-10), 2012. Date of
Publication: 18 Sep 2012.
Author
Anonymous
Publisher
American College of Physicians

<111>
Accession Number
2007982523
Title
Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated
Meta-Analysis and Meta-Regression of Interventional Trials.
Source
Mayo Clinic Proceedings. 96 (2) (pp 304-313), 2021. Date of Publication:
February 2021.
Author
Bernasconi A.A.; Wiest M.M.; Lavie C.J.; Milani R.V.; Laukkanen J.A.
Institution
(Bernasconi) Global Organization for EPA and DHA Omega-3s (GOED), Salt
Lake City, UT, United States
(Wiest) Department of Statistical Science, University of Idaho, Moscow,
ID, United States
(Lavie, Milani) Department of Cardiovascular Diseases, John Ochsner Heart
and Vascular Institute, Ochsner Clinical School, The University of
Queensland School of Medicine, New Orleans, LA, United States
(Laukkanen) Institute of Public Health and Clinical Nutrition, University
of Eastern Finland, Kuopio, Finland, Faculty of Sport and Health Sciences,
University of Jyvaskyla, Jyvaskyla, Finland, Department of Medicine,
Central Finland Health Care District, Jyvaskyla, Finland
Publisher
Elsevier Ltd
Abstract
Objectives: To quantify the effect of eicosapentaenoic (EPA) and
docosahexaenoic (DHA) acids on cardiovascular disease (CVD) prevention and
the effect of dosage. Method(s): This study is designed as a random
effects meta-analysis and meta-regression of randomized control trials
with EPA/DHA supplementation. This is an update and expanded analysis of a
previously published meta-analysis which covers all randomized control
trials with EPA/DHA interventions and cardiovascular outcomes published
before August 2019. The outcomes included are myocardial infarction (MI),
coronary heart disease (CHD) events, CVD events (a composite of MI,
angina, stroke, heart failure, peripheral arterial disease, sudden death,
and non-scheduled cardiovascular surgical interventions), CHD mortality
and fatal MI. The strength of evidence was assessed using the Grading of
Recommendations Assessment, Development, and Evaluation framework.
 Result(s): A total of 40 studies with a combined 135,267 participants
were included. Supplementation was associated with reduced risk of MI
(relative risk [RR], 0.87; 95% CI, 0.80 to 0.96), high certainty number
needed to treat (NNT) of 272; CHD events (RR, 0.90; 95% CI, 0.84 to 0.97),
high certainty NNT of 192; fatal MI (RR, 0.65; 95% CI, 0.46 to 0.91]),
moderate certainty NNT = 128; and CHD mortality (RR, 0.91; 95% CI, 0.85 to
0.98), low certainty NNT = 431, but not CVD events (RR, 0.95; 95% CI, 0.90
to 1.00). The effect is dose dependent for CVD events and MI.
 Conclusion(s): Cardiovascular disease remains the leading cause of
death worldwide. Supplementation with EPA and DHA is an effective
lifestyle strategy for CVD prevention, and the protective effect probably
increases with dosage. Copyright © 2020 Mayo Foundation for
Medical Education and Research

<112>
Accession Number
2010930521
Title
Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing
Invasive Management.
Source
JACC: Cardiovascular Interventions. 14 (4) (pp 361-373), 2021. Date of
Publication: 22 Feb 2021.
Author
Gragnano F.; Branca M.; Frigoli E.; Leonardi S.; Vranckx P.; Di Maio D.;
Monda E.; Fimiani L.; Fioretti V.; Chianese S.; Esposito F.; Franzese M.;
Scalise M.; D'Angelo C.; Scalise R.; De Blasi G.; Ando G.; Esposito G.;
Calabro P.; Windecker S.; Pedrazzini G.; Valgimigli M.
Institution
(Gragnano, Windecker, Valgimigli) Department of Cardiology, Inselspital,
University of Bern, Bern, Switzerland
(Gragnano, Di Maio, Monda, Calabro) Division of Cardiology, Department of
Translational Medicine, University of Campania "Luigi Vanvitelli,",
Caserta, Italy
(Branca, Frigoli) Clinical Trials Unit, University of Bern, Bern,
Switzerland
(Leonardi) University of Pavia and Fondazione IRCCS Policlinico S. Matteo,
Pavia, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, University of Hasselt,
Hasselt, Belgium
(Fimiani, D'Angelo, Scalise, De Blasi, Ando) Unit of Cardiology,
Department of Clinical and Experimental Medicine, University of Messina,
Messina, Italy
(Fioretti, Chianese, Esposito, Franzese, Scalise, Esposito) Department of
Advanced Biomedical Sciences, Federico II University of Naples, Naples,
Italy
(Pedrazzini, Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero
Cantonale, Lugano, Switzerland
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the impact of access-site
crossover in patients with acute coronary syndrome undergoing invasive
management via radial or femoral access. Background(s): There are
limited data on the clinical implications of access-site crossover.
 Method(s): In the MATRIX (Minimizing Adverse Haemorrhagic Events by
Transradial Access Site and Systemic Implementation of Angiox)-Access
trial, 8,404 patients with acute coronary syndrome were randomized to
radial or femoral access. Patients undergoing access-site crossover or
successful access site were investigated. Thirty-day coprimary outcomes
were a composite of death, myocardial infarction, or stroke (major adverse
cardiovascular events [MACE]) and a composite of MACE or Bleeding Academic
Research Consortium type 3 or 5 bleeding (net adverse clinical events
[NACE]). Result(s): Access-site crossover occurred in 183 of 4,197
patients (4.4%) in the radial group (mainly to femoral access) and 108 of
4,207 patients (2.6%) in the femoral group (mainly to radial access). In
multivariate analysis, the risk for coprimary outcomes was not
significantly higher with radial crossover compared with successful radial
(MACE: adjusted rate ratio [adjRR]: 1.25; 95% confidence interval [CI]:
0.81 to 1.93; p = 0.32; NACE: adjRR: 1.40; 95% CI: 0.94 to 2.06; p =
0.094) or successful femoral access (MACE: adjRR: 1.17; 95% CI: 0.76 to
1.81; p = 0.47; NACE: adjRR: 1.26; 95% CI: 0.86 to 1.86; p = 0.24). Access
site-related Bleeding Academic Research Consortium type 3 or 5 bleeding
was higher with radial crossover than successful radial access. Femoral
crossover remained associated with higher risks for MACE (adjRR: 1.84; 95%
CI: 1.18 to 2.87; p = 0.007) and NACE (adjRR: 1.69; 95% CI: 1.09 to 2.62;
p = 0.019) compared with successful femoral access. Results remained
consistent after excluding patients with randomized access not attempted.
 Conclusion(s): Crossover from radial to femoral access abolishes the
bleeding benefit offered by the radial over femoral artery but does not
appear to increase the risk for MACE or NACE compared with successful
radial or femoral access. (Minimizing Adverse Haemorrhagic Events by
Transradial Access Site and Systemic Implementation of Angiox [MATRIX];
NCT01433627) Copyright © 2021 American College of Cardiology
Foundation

<113>
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.

<114>
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.

<115>
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.

<116>
Accession Number
2010217281
Title
Sternal closure with single compared with double or figure of 8 wires in
obese patients following cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. 36 (3) (pp 1072-1082), 2021. Date of
Publication: March 2021.
Author
Shafi A.M.A.; Abuelgasim E.; Abuelgasim B.; Iddawela S.; Harky A.
Institution
(Shafi) Department of Cardiothoracic Surgery, St Bartholomew's Hospital,
Barts Heart Centre, London, United Kingdom
(Abuelgasim, Abuelgasim) Faculty of Medicine, Imperial College London,
London, United Kingdom
(Iddawela) Department of Respiratory Medicine, University Hospitals
Birmingham, Birmingham, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Health and Life
Sciences, University of Liverpool, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: Sternal instability and wound infections are major causes of
morbidity following cardiac surgery, which is further amplified in high
risk patients that include diabetics and patients with high body mass
index (BMI). We compare the different outcomes of different sternal wire
closure techniques following median sternotomy for cardiac surgery in
obese patients. Method(s): A comprehensive electronic literature
search was undertaken according to PRISMA guidelines from inception to
July 2020 to identify all published data comparing single wire sternal
closure to either double wire or figure-of-8 techniques following median
sternotomy for cardiac surgery in obese patients, defined as a BMI >= 30.
 Result(s): Eight studies met the final inclusion criteria; single
wire versus double wire sternal closure (n = 2) and single wire versus
figure-of-8 wire closure (n = 6). Higher rate of sternal instability was
noted in single wire versus double wire closure (22/150 [14.7%] patients
vs. 6/150 [4%] patients, p = 0.003, odd ratio [OR] 0.25 [95% confidence
interval [CI] 0.10-0.63]). Similarly, sternal instability was higher in
single wire vs figure-of-8 wire closure technique (33/2422 [1.3%] vs.
11/8035 [0.1%], p = 0.04 OR 0.30 [95% CI, 0.09-0.96]), respectively.
 Conclusion(s): There is benefit in the use of either double or
figure-of-8 sternal wire closure techniques over single wire closure in
terms of sternal instability. However, as the studies were limited, larger
scale comparative studies are required to provide a solid evidence base
for choosing the optimal sternal closure technique in this high risk group
of patients. Copyright © 2021 Wiley Periodicals LLC

<117>
Accession Number
2010173210
Title
Midterm outcomes of transaortic and transapical TAVI in patients with
unsuitable vascular anatomy for femoral access: A propensity score inverse
probability weight study.
Source
Journal of Cardiac Surgery. 36 (3) (pp 872-878), 2021. Date of
Publication: March 2021.
Author
Casado A.P.; Barili F.; D'Auria F.; Raviola E.; Parolari A.; Le Houerou
D.; Romano M.
Institution
(Casado, Barili) Department of Cardiovascular Surgery, A. O. Santa Croce e
Carle, Cuneo, Italy
(Casado, Raviola, Le Houerou) Department of Cardiovascular Surgery,
Hopital Prive Jacques Cartier, Massy, France
(D'Auria) Department of Cardiovascular Surgery, A. O. Maggiore della
Carita, Novara, Italy
(Raviola) Department of Cardiac Surgery, GVM Care & Research, Maria
Cecilia Hospital, Cotignola, Italy
(Parolari, Romano) Department of Cardiac Surgery, Policlinico S. Donato
IRCCS, University of Milan, Milan, Italy
Publisher
Blackwell Publishing Inc.
Abstract
Aims: Transaortic (TAo) and transapical (TA) implantation can be used in
transcatheter aortic valve implantation (TAVI) when the transfemoral (TF)
approach is precluded. We compare the safety and efficacy of these
alternative techniques. Method(s): From October 2007 to February
2016, TAo and TA patients' data were collected. Propensity score inverse
probability of treatment weight (IPTW) method was employed to minimize the
impact of no-randomization bias. Result(s): From our single-center
non-TF-TAVI registry, 282 patients were included: 235 (83.3%) underwent
TAo and 47 (16.7%) TA. Differences in baseline characteristics were
statistically significant in age, sex, risk profile according to
logistic-EuroSCORE, and previous cardiac surgery. No difference in
hospital morbidity and mortality, but lower stroke-rate in TAo (1.27% vs.
8.5% p <.01) was observed. This was confirmed at logistic regression after
IPTW adjustment (odds ratio [OR]: 0.16, 95% CI 0.03-0.71, p =.01),
together with reduced risk of the paravalvular leak (PVL) (OR: 0.14, 95%
confidence interval [CI]: 0.02-0.81, p =.02). Kaplan-Meier estimates did
not demonstrate differences in long-term mortality among access routes
(logrank test p =.13). At the IPTW-Cox regression model, long-term
mortality was related to New York Heart Association III-IV (hazard ratio
[HR]: 2.92, 95% CI: 1.15-7.40, p =.026), chronic renal failure (HR: 3.25;
95% CI: 1.02-10.32 p =.046), previous transient ischemic attack/stroke
(HR: 2.29, 95% CI: 1.25-4.20 p =.007). Sapien-3 device resulted to be a
protective factor, reducing long-term mortality (HR: 0.18, 95% CI 0.04-
0.90 p =.03). Conclusion(s): TAo is safe and feasible in case of
contraindication to femoral approach demonstrating comparable midterm
outcomes to TA, thus representing a central access alternative, to
increase the overall safety of high-risk TAVI procedures. Copyright
© 2021 Wiley Periodicals LLC

<118>
Accession Number
2010153038
Title
Does the clinical effectiveness of Mitraclip compare with surgical repair
for mitral regurgitation?.
Source
Journal of Cardiac Surgery. 36 (3) (pp 1103-1119), 2021. Date of
Publication: March 2021.
Author
Khader A.A.; Allaf M.; Lu O.W.; Lazopoulos G.; Moscarelli M.; Kendall S.;
Salmasi M.Y.; Athanasiou T.
Institution
(Khader, Allaf) Department of Medicine, Imperial College London, London,
United Kingdom
(Lu) Division of Biosciences, University College London, London, United
Kingdom
(Lu) Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical
School, University of Melbourne, Melbourne, VIC, Australia
(Lazopoulos) Department of Cardio-thoracic Surgery, University Hospital of
Heraklion, Crete, Greece
(Moscarelli) Department of Cardiovascular Surgery, GVM Care and Research,
Lugo, Ravenna, Italy
(Kendall) Deparment of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
(Salmasi, Athanasiou) Department of Surgery and Cancer, Imperial College
London, London, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Background: Surgical repair of the mitral valve has long been the
established therapy for degenerative mitral regurgitation (MR). Newer
transcatheter methods over the last decade, such as the MitraClip, serve
to restore mitral function with reduced procedural burden and enhanced
recovery. This study aims to compare the shortterm and midterm outcomes of
MitraClip insertion with surgical repair for MR. Method(s): A
systematic review of the literature was conducted for studies comparing
outcomes between surgical repair and MitraClip. The initial search
returned 1850 titles, from which 12 studies satisfied the inclusion
criteria (one randomized controlled trial and 11 retrospective studies).
 Result(s): The final analysis comprised 4219 patients (MitraClip
1210; surgery 3009). Operative mortality was not different between the
groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23];
p =.317). Length of hospital stay was significantly shorter in the
MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI:
[0.77-0.99]; p <.001) with considerable heterogeneity (I2 >
90%; p <.001). The rate of reoperation on the mitral valve was lower in
the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p =.012) as was the
rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI:
[0.19-0.46]; p <.001) during midterm follow up. Long term survival (4-5
years) was also similar between both groups (hazard ratio = 0.70; 95% CI:
[0.35-1.41]; p =.323). Conclusion(s): This study highlights the
superior midterm durability of surgical valve repair for MR compared with
the MitraClip. Copyright © 2021 The Authors. Journal of Cardiac
Surgery published by Wiley Periodicals LLC

<119>
Accession Number
2007514186
Title
Postoperative resuscitation with hypertonic saline or hyperoncotic albumin
in patients following cardiac surgery: A review of the literature.
Source
Journal of Cardiac Surgery. 36 (3) (pp 1040-1049), 2021. Date of
Publication: March 2021.
Author
Otero T.M.N.; Aljure O.D.; Yu S.
Institution
(Otero, Yu) Department of Anesthesiology, Banner University Medical
Center, University of Arizona College of Medicine, Tucson, AZ, United
States
(Aljure) Department of Anesthesiology, Miller School of Medicine,
University of Miami, Miami, FL, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Over-resuscitation in postcardiac surgery patients is
associated with significant morbidity and mortality. Accordingly, there is
a growing interest in hyperoncotic albumin and hypertonic saline for
resuscitation in patients following cardiac surgery. In this article, we
will review the use of hyperosmolar fluid therapies for resuscitation in
postcardiac surgical patients from the current literature. Method(s):
A literature search was conducted in MEDLINE (PubMed) utilizing keywords,
narrowing publications from 2009 to 2020. Result(s): Patients
receiving concentrated albumin after cardiac surgery required less fluid
bolus therapy, less time on vasopressors, and had a lower positive fluid
balance compared with patients receiving crystalloids. There was no
difference in mortality in those given 20% albumin compared with
crystalloids postcardiac surgery. Patients administered hypertonic saline
following cardiac surgery had increased urinary output but its effect on
total fluid and body weight was not significantly different compared with
crystalloids. Conclusion(s): In this analysis, publications on
resuscitation with hyperoncotic albumin and hypertonic saline in patients
following cardiac surgery were reviewed. While there is data supporting
the use of alternative fluid therapies in other critically ill
populations, the limited literature focused on concentrated albumin and
hypertonic saline for resuscitation following cardiac surgery is
equivocal. Copyright © 2020 Wiley Periodicals LLC

<120>
Accession Number
2010920415
Title
Mortality in patients with cardiogenic shock supported with VA ECMO: A
systematic review and meta-analysis evaluating the impact of etiology on
29,289 patients.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Alba A.C.; Foroutan F.; Buchan T.A.; Alvarez J.; Kinsella A.; Clark K.;
Zhu A.; Lau K.; McGuinty C.; Aleksova N.; Francis T.; Stanimirovic A.;
Vishram-Nielsen J.; Malik A.; Ross H.J.; Fan E.; Rac V.E.; Rao V.; Billia
F.
Institution
(Alba, Foroutan, Buchan, Alvarez, Kinsella, Clark, Zhu, Lau, McGuinty,
Aleksova, Vishram-Nielsen, Malik, Ross, Rac, Rao, Billia) Ted Rogers
Center of Excellence, Peter Munk Cardiac Centre, Toronto, ON, Canada
(Francis, Stanimirovic) Toronto Health Economics and Technology Assessment
(THETA) Collaborative, Institute of Health Policy, Management and
Evaluation, Dalla Lana School of Public Health
(Fan) Interdepartmental Division of Critical Care Medicine, University of
Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is
associated with variable outcomes. In this meta-analysis, we evaluated the
mortality after VA ECMO across multiple etiologies of cardiogenic shock
(CS). METHOD(S): In June 2019, we performed a systematic search
selecting observational studies with >=10 adult patients reporting on
short-term mortality (30-day or mortality at discharge) after initiation
of VA ECMO by CS etiology published after 2009. We performed meta-analyses
using random effect models and used metaregression to evaluate mortality
across CS etiology. RESULT(S): We included 306 studies (29,289
patients): 25 studies on after heart transplantation (HTx) (771 patients),
13 on myocarditis (906 patients), 33 on decompensated heart failure (HF)
(3,567 patients), 64 on after cardiotomy shock (8,231 patients), 10 on
pulmonary embolism (PE) (221 patients), 80 on acute myocardial infarction
(AMI) (7,774 patients), and 113 on after cardiac arrest [CA] (7,814
patients). With moderate certainty on effect estimates, we observed
significantly different mortality estimates for various etiologies (p <
0.001), which is not explained by differences in age and sex across
studies: 35% (95% CI: 29-42) for after HTx, 40% (95% CI: 33-46) for
myocarditis, 53% (95% CI: 46-59) for HF, 52% (95% CI: 38-66) for PE, 59%
(95% CI: 56-63) for cardiotomy, 60% (95% CI: 57-64) for AMI, 64% (95% CI:
59-69) for post-in-hospital CA, and 76% (95% CI: 69-82) for
post-out-of-hospital CA. Univariable metaregression showed that variation
in mortality estimates within etiology group was partially explained by
population age, proportion of females, left ventricle venting, and CA.
 CONCLUSION(S): Using an overall estimate of mortality for patients
with CS requiring VA ECMO is inadequate given the differential outcomes by
etiology. To further refine patient selection and management to improve
outcomes, additional studies evaluating patient characteristics impacting
outcomes by specific CS etiology are needed. Copyright © 2021
International Society for Heart and Lung Transplantation

<121>
Accession Number
2005416289
Title
Access site related vascular complications with third generation
transcatheter heart valve systems.
Source
Catheterization and Cardiovascular Interventions. 97 (2) (pp 325-332),
2021. Date of Publication: 01 Feb 2021.
Author
Ruge H.; Burri M.; Erlebach M.; Lange R.
Institution
(Ruge, Burri, Erlebach, Lange) Department of Cardiovascular Surgery,
German Heart Center, TUM, INSURE (Institute for Translational Cardiac
Surgery), Munich, Germany
(Ruge, Burri, Erlebach, Lange) Department of Cardiovascular Surgery,
German Heart Center Munich, TUM, Munich, Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This study examines the impact of anatomical and procedural
factors on Valve Academic Research Consortium-2-defined vascular
complications at the femoral access site in transcatheter aortic valve
replacement (TAVR) with third generation transcatheter heart valve
(THV)-systems. Background(s): Randomized clinical trials reported on
vascular complications with current THV-systems. However, clinical
presentation and consequences of these events are not well studied.
 Method(s): All patients who underwent a transfemoral TAVR using an
Edwards Sapien3/Sapien3ultra or a Medtronic Evolut-R/Evolut-PRO have been
identified from our institutional database. Only procedures utilizing the
PerClose-ProGlide vascular closure device were included. Risk factors for
vascular complications were analyzed with a logistic regression model.
Preoperative and procedural data were collected. The postoperative course
of patients with and without vascular complications was compared.
 Result(s): A total of 878 patients met the inclusion criteria. Of
these, 152 patients (17.3%) had an access-site related vascular
complication (87 major complications, 9.9%).
Sheath-to-femoral-artery-ratio (SFAR) (OR per 0.1 increase = 1.35, p
<.001) and more than 2 vessel entries with large bore sheaths (OR = 1.76,
p =.029) were independent risk factors for vascular complications. Female
gender (OR = 1.44, p =.07) and two vessel entries with large bore sheaths
(OR = 1.2, p =.53) increased the risk, although no statistical
significance was shown. Age (OR = 1.07, p =.62), body mass index (OR = 1.1
per 5 points, p =.32) and vessel wall calcification at puncture site (OR =
0.93, p =.7) had no influence on vascular complications. Patients with
vascular complications had a higher need for blood transfusion (p <.001)
and a higher in-hospital mortality (2.6 vs. 0.4%, p =.019).
 Conclusion(s): Procedural risk assessment should include SFAR
calculation and consider the need for large bore sheath exchange. This
might reduce the vascular trauma, lower vascular complication rates and
improve the clinical outcome after TAVR. Copyright © 2020 The
Authors. Catheterization and Cardiovascular Interventions published by
Wiley Periodicals LLC.

<122>
Accession Number
2004101424
Title
Late clinical outcomes of myocardial hybrid revascularization versus
coronary artery bypass grafting for complex triple-vessel disease:
Long-term follow-up of the randomized MERGING clinical trial.
Source
Catheterization and Cardiovascular Interventions. 97 (2) (pp 259-264),
2021. Date of Publication: 01 Feb 2021.
Author
Esteves V.; Oliveira M.A.P.; Feitosa F.S.; Mariani J.; Campos C.M.; Hajjar
L.A.; Lisboa L.A.; Jatene F.B.; Filho R.K.; Lemos Neto P.A.
Institution
(Esteves, Mariani, Campos, Lemos Neto) Department of Interventional
Cardiology, Heart Institute - InCor, University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Oliveira, Lisboa, Jatene) Division of Cardiovascular Surgery, Heart
Institute - InCor, University of Sao Paulo Medical School, Sao Paulo,
Brazil
(Feitosa, Hajjar, Filho) Division of Clinical Cardiology, Heart Institute
- InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
(Mariani, Campos, Lemos Neto) Interventional Cardiology, Hospital
Israelita Albert Einstein, Sao Paulo, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This article aimed to compare the outcomes after hybrid
revascularization with conventional coronary artery bypass grafting (CABG)
surgery. Background(s): The concept of hybrid coronary
revascularization combines the advantages of CABG and percutaneous
coronary intervention to improve the treatment of patients with complex
multivessel disease. Method(s): The Myocardial hybrid
revascularization versus coronary artERy bypass GraftING for complex
triple-vessel disease-MERGING study is a pilot randomized trial that
allocated 60 patients with complex triple-vessel disease to treatment with
hybrid revascularization or conventional CABG (2:1 ratio). The primary
outcome was the composite of all-cause death, myocardial infarction,
stroke, or unplanned repeat revascularization at 2 years. Result(s):
Clinical and anatomical characteristics were similar between groups. After
a mean follow-up of 802 +/- 500 days, the primary endpoint rate was 19.3%
in the hybrid arm and 5.9% in the CABG arm (p = NS). The incidence of
unplanned revascularization increased over time in both groups, reaching
14.5 versus 5.9% in the hybrid and in the CABG groups, respectively (p
=.4). Of note, in the hybrid group, there were no reinterventions driven
by the occurrence of stent restenosis. Conclusion(s): Hybrid
myocardial was feasible but associated with increasing rates of major
adverse cardiovascular events during 2 years of clinical follow-up, while
the control group treated with conventional surgery presented with low
rates of complications during the same period. In conclusion, before more
definitive data arise, hybrid revascularization should be applied with
careful attention in practice, following a selective case-by-case
indication. Copyright © 2020 Wiley Periodicals, Inc.

<123>
Accession Number
632850312
Title
Transesophageal echocardiography during endovascular procedures for
thoracic aorta diseases: sensitivity and specificity analysis.
Source
The Journal of cardiovascular surgery. 62 (1) (pp 79-86), 2021. Date of
Publication: 01 Feb 2021.
Author
Nana P.N.; Brotis A.G.; Tsolaki V.; Spanos K.; Mpatzalexis K.; Zakynthinos
E.; Giannoukas A.D.; Kouvelos G.N.
Institution
(Nana) Department of Vascular Surgery, Faculty of Medicine, School of
Health Sciences, Larissa University Hospital, University of Thessaly,
Greece
(Brotis) Department of Neurosurgery, Faculty of Medicine, School of Health
Sciences, Larissa University Hospital, University of Thessaly, Greece
(Tsolaki, Zakynthinos) Intensive Care Unit, Faculty of Medicine, School of
Health Sciences, Larissa University Hospital, University of Thessaly,
Greece
(Spanos, Mpatzalexis, Giannoukas, Kouvelos) Department of Vascular
Surgery, Faculty of Medicine, School of Health Sciences, Larissa
University Hospital, University of Thessaly, Greece
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The widespread use of endovascular repair in thoracic aorta
(TEVAR) pathologies has ameliorated postoperative outcomes. This
meta-analysis was designed to investigate the intra-operative use of
transesophageal echocardiography (TEE) compared to angiography in patients
undergoing TEVAR. EVIDENCE ACQUISITION: The meta-analysis was conducted
using the Preferred Reporting Items for Systematic Reviews and
Meta-Analysis statement (PRISMA) guidelines. A data search of the English
literature was conducted, using PubMed, EMBASE and CENTRAL databases,
until November 30, 2019. The Grading of Recommendations, Assessment,
Development and Evaluation (GRADE) approach was used to evaluate the
quality of evidence and the summary of findings for each of the included
outcomes. EVIDENCE SYNTHESIS: The final analysis included 7 articles (183
patients). All patients underwent TEVAR using intra-operative TEE and
angiography. The sensitivity and specificity rates of entry points were
0.624 (95% CI: 0.145-0.97) and 0.377 (95% CI: 0.029-0.856), respectively.
Regarding the detection of adequate guidewire advancement, the sensitivity
was 0.778 (95% CI: 0.288-939) and specifity 0.346 (95% CI: 0.019-0.844).
TEE could detect endograft incomplete deployment within acceptable rates
of sensitivity and specifity, estimated at 0.616 (95% CI: 0.141-0.971) and
0.365 (95% CI: 0.028-0.845), respectively. The intra-operative detection
of endoleaks presented a sensitivity estimated at 0.875 (0.51-0.998) and
specificity at 0.698 (95% CI: 0.284-0.904). CONCLUSION(S): Despite
the limitations of this analysis, TEE may be evaluated in the current
endovascular era, as a useful tool, providing adequate information, on
graft deployment and early endoleaks.

<124>
Accession Number
633415196
Title
Mini or full sternotomy for aortic valve repair? A systematic review of
the literature.
Source
The Journal of cardiovascular surgery. 62 (1) (pp 19-24), 2021. Date of
Publication: 01 Feb 2021.
Author
Murana G.; Pacini D.
Institution
(Murana) Unit of Cardiac Surgery, Cardio-Thoracic-Vascular Department, S.
Orsola Hospital, Alma Mater Studiorum, University of Bologna, Bologna,
Italy
(Pacini) Unit of Cardiac Surgery, Cardio-Thoracic-Vascular Department, S.
Orsola Hospital, Alma Mater Studiorum, University of Bologna, Bologna,
Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Minimally invasive aortic valve replacement is becoming a
standard treatment. The possibility of extending this approach to more
demanding aortic root pathologies is being debated with limited evidence.
Attaining comfort in a complex aortic repair is a "dogma" that should
always be achieved. Perhaps, the patient's condition, the aortic anatomy
and the expertise creates the fundamental principles that achieve stable
results over time. EVIDENCE ACQUISITION: Selection of literature articles
was performed using PubMed databases from inception to July 2020. We
excluded editorials and expert opinions, review articles, congenital heart
disease, and other types of valve repair. According to the limited studies
available, case reports were included. EVIDENCE SYNTHESIS: We identified 7
studies from 2015 to 2020 with the number of patients spanning 1 to 117
from single centers' experiences. Three were case reports with aortic
repair of a bicuspid aortic valve. A total of 259 mini-AVr patients were
analyzed. CONCLUSION(S): In this review article, we sought to analyze
and report the experience and results of a currently available series on
aortic valve repair (with or without associated aortic root procedures)
using mini sternotomy. Early- and long-term data will be reported and
discussed in terms of survival and aortic valve function.

<125>
[Use Link to view the full text]
Accession Number
632727030
Title
Effects of Massage on Postoperative Pain in Infants With Complex
Congenital Heart Disease.
Source
Nursing research. 69 (5S Suppl 1) (pp S36-S46), 2020. Date of Publication:
01 Sep 2020.
Author
Harrison T.M.; Brown R.; Duffey T.; Frey C.; Bailey J.; Nist M.D.; Renner
L.; Fitch J.
Institution
(Harrison) Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The
Ohio State University College of Nursing, Columbus. Roger Brown, PhD, is
Professor, University of Wisconsin-Madison School of Nursing. Travis
Duffey, LMT, is Licensed Massage Therapist, Nationwide Children's
Hospital, Columbus, Ohio. Corrie Frey, LMT, CIMI, CPMT, is Licensed
Massage Therapist, Nationwide Children's Hospital, Columbus, Ohio. Jacob
Bailey, BSN, RN, is Staff Nurse, COPC Ohio Center for Pediatrics, Dublin.
Marliese Dion Nist, PhD, RNC, is Postdoctoral Fellow, The Ohio State
University College of Nursing, Columbus, Ohio. Lauren Renner, MSN, RN,
CPNP, is APRN Clinical Leader, Nationwide Children's Hospital, Columbus,
Ohio. Jill Fitch, MD, is Pediatric Intensivist, Nationwide Children's
Hospital, Columbus, OH
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain management is an essential component of care for
pediatric patients following surgery. Massage reduces self-reported
postoperative pain in adults with heart disease but has received little
attention in postoperative pediatric patients with complex congenital
heart disease (CCHD). OBJECTIVE(S): The aim of the study was to
evaluate the effectiveness of massage compared to a rest period on
postoperative pain scores and physiological responses in infants with
CCHD. METHOD(S): We used a two-group randomized clinical trial design
with a sample of 60 infants with CCHD between 1 day and 12 months of age
following their first cardiothoracic surgery. Both groups received
standard postoperative care. Group 1 received a daily 30-minute
restriction of nonessential caregiving (quiet time), and Group 2 received
a daily 30-minute massage. Interventions continued for seven consecutive
days. Pain was measured six times daily using the Face, Legs, Activity,
Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of
analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and
oxygen saturations (SpO2) were recorded continuously. Daily averages, pre-
and postintervention FLACC scores, and physiological responses were
analyzed using descriptive statistics, generalized linear mixed models
repeated measures, latent growth models, and/or regression discontinuity
analysis. Fentanyl-equivalent narcotic values were used as a time-varying
covariate. RESULT(S): Adjusted pain scores were lower for the massage
group on all days except Day 7. Overall, there were no group effects on
level of pain or differential rate of change in pain. However, the massage
group had lower daily pain scores with small to medium effect size
differences, largest at Days 4, 5, and 6, and lower average daily HR and
RR. There was little difference between groups in SpO2. Infants
demonstrated immediate effects of massage, with HR and RR decreasing and
oxygen saturations increasing. DISCUSSION: This study provides beginning
evidence that postoperative massage may reduce pain and improve
physiological parameters in infants with congenital heart disease. This
nonpharmacological adjunct to pain management may provide a particular
benefit for this population by reducing demand on the cardiorespiratory
system.

<126>
Accession Number
633865980
Title
Efficacy of citrulline supplementation to decrease the risk of pulmonary
hypertension after congenital heart disease surgery. A local experience.
Source
Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina). 77 (4)
(pp 249-253), 2020. Date of Publication: 01 Dec 2020.
Author
Silvera Ruiz S.; Grosso C.L.; Tablada M.; Cabrera M.; Dodelson de Kremer
R.; Juaneda E.; Larovere L.E.
Institution
(Silvera Ruiz) Centro de Estudio de las Metabolopatias Congenitas
(CEMECO), Hospital de Ninos de la Santisima Trinidad, Facultad de Ciencias
Medicas. Universidad Nacional de Cordoba, Cordoba, Argentina
(Grosso) Universidad Nacional de Cordoba. Facultad de Ciencias Medicas.
Ministerio de Salud de la Provincia de Cordoba. Hospital de Ninos de la
Santisima Trinidad. Centro de Estudio de las Metabolopatias Congenitas
(CEMECO). Cordoba, Argentina. 3 Universidad Nacional de Cordoba. Facultad
de Ciencias Medicas. Catedra de Clinica Pediatrica. Cordoba, Argentina
(Tablada) Universidad Nacional de Cordoba. Facultad de Ciencias
Agropecuarias. Catedra de Estadistica y Biometria. Cordoba, Argentina
(Cabrera, Juaneda) Ministerio de Salud de la Provincia de Cordoba.
Hospital de Ninos de la Santisima Trinidad. Servicio de Cardiologia.
Cordoba, Argentina
(Dodelson de Kremer) Universidad Nacional de Cordoba. Facultad de Ciencias
Medicas. Ministerio de Salud de la Provincia de Cordoba. Hospital de Ninos
de la Santisima Trinidad. Centro de Estudio de las Metabolopatias
Congenitas (CEMECO). Cordoba, Argentina. 3 Universidad Nacional de
Cordoba. Facultad de Ciencias Medicas. Catedra de Clinica Pediatrica.
Cordoba, Argentina
(Larovere) Universidad Nacional de Cordoba. Facultad de Ciencias Medicas.
Ministerio de Salud de la Provincia de Cordoba. Hospital de Ninos de la
Santisima Trinidad. Centro de Estudio de las Metabolopatias Congenitas
(CEMECO). Cordoba, Argentina. 2 Consejo Nacional de Investigacion
Cientifica y Tecnica (CONICET), Ministerio de Ciencia, Tecnologia e
Innovacion. Argentina. 3 Universidad Nacional de Cordoba. Facultad de
Ciencias Medicas. Catedra de Clinica Pediatrica. Cordoba, Argentina
Publisher
NLM (Medline)
Abstract
Introduction: Pulmonary hypertension (PH) is a major cause of
morbi-mortality among patients with congenital heart disease (CHD) and
also a potentially severe complication after surgical repair. Oral
citrulline, a precursor to NO synthesis, is safe and efficacious for
decreasing the risk of postoperative PH. Objective(s): Objetive: The
aim of the present study was to investigate in pediatric patients the
changes of plasma citrulline, arginine, homocysteine and nitric oxide (NO)
metabolites and pulmonary artery pressures (PAP) pre-post cardiac surgery
in order to describe our population status with regard to the risk of
pulmonary hypertension and look for potential biomarkers for early
detection and treatment. Main results/Discussion: 16 Argentine pediatric
patients with CHD undergoing cardiopulmonary bypass were randomized in two
groups: (A) with and (B) without perioperative citrulline supplementation.
We found that plasma citrulline median levels before surgery were lower in
both groups respect to referential values, probably due to the poor
nutritional status of our patients; only group A surpassed post-surgery
the minimum recommended level to avoid PH. Furthermore, none of the
patients in group A showed mean PAP higher than 20 mmHg, whereas in group
B, 67% of the measurements were >= than the reference level.
 Conclusion(s): We reaffirm that citrulline supplementation it is
effective in reducing postoperative pulmonary hypertension and biomarkers
could evidence patient status as a translational medicine
application. Copyright Universidad Nacional de Cordoba.

<127>
Accession Number
2005998852
Title
Total arterial coronary bypass graft surgery is associated with better
long-term survival in patients with multivessel coronary artery disease: A
systematic review with meta-analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 36 (1) (pp 78-85), 2021. Date
of Publication: 2021.
Author
Rayol S.C.; Van Den Eynde J.; Cavalcanti L.R.P.; Neto A.C.E.; Rad A.A.;
Amabile A.; Filho W.B.; Ruhparwar A.; Zhigalov K.; Weymann A.; Filho
D.C.S.; Sa M.P.B.O.
Institution
(Rayol, Cavalcanti, Neto, Sa) Division of Cardiovascular Surgery,
Pronto-Socorro Cardiologico de Pernambuco-PROCAPE, Recife, Pernambuco,
Brazil
(Rayol, Cavalcanti, Neto, Filho, Sa) University of Pernambuco-UPE, Recife,
Pernambuco, Brazil
(Van Den Eynde) Department of Cardiovascular Diseases, Research Unit of
Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
(Rad) Imperial College London School of Medicine, London, United Kingdom
(Amabile) Department of Cardiac Surgery, University of Chicago Medicine,
Chicago, United States
(Filho) Instituto do Coracao-InCor, Universidade de Sao Paulo-USP, Sao
Paulo, Sao Paulo, Brazil
(Ruhparwar, Zhigalov, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen University Duisburg-Essen, Essen, Germany
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: The benefit of total arterial revascularization (TAR) in
coronary artery bypass grafting (CABG) remains a controversial issue. This
study sought to evaluate whether there is any difference on the long-term
results of TAR and non-TAR CABG patients. Method(s): The Medical
Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica
dataBASE (EMBASE), Cochrane Central Register of Controlled Trials
(CENTRAL/CCTR), Clinical Trials. gov, Scientific Electronic Library Online
(SciELO), Literatura Latino-Americana e do Caribe em Ciencias da Saude
(LILACS), and Google Scholar databases were searched for studies published
by October 2020. Randomized clinical trials and observational studies with
propensity score matching comparing TAR versus non-TAR CABG were included.
Random-effects meta-analysis was performed. The current barriers to
implementation of TAR in clinical practice and measures that can be used
to optimize outcomes were reviewed. Result(s): Fourteen publications
(from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941
patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio
(HR) for long-term mortality (over 10 years) was lower in the TAR group
than in the non- TAR group (random effect model: HR 0.676, 95% confidence
interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of
treatment effect among the studies for mortality, and none of the studies
had a particular impact on the summary result. The result was not
influenced by age, sex, or comorbidities. We identified low risk of
publication bias related to this outcome. Conclusion(s): This review
found that TAR presents the best long- term results in patients who
undergo CABG. Given that many patients are likely to benefit from TAR, its
use should be encouraged. Copyright © 2021, Sociedade Brasileira
de Cirurgia Cardiovascular. All rights reserved.

<128>
Accession Number
2010985258
Title
Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal
Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in
Canada.
Source
CJC Open. (no pagination), 2021. Date of Publication: 2021.
Author
Grunau B.; Shemie S.D.; Wilson L.C.; Dainty K.N.; Nagpal D.; Hornby L.;
Lamarche Y.; van Diepen S.; Kanji H.D.; Gould J.; Saczkowski R.; Brooks
S.C.
Institution
(Grunau) Department of Emergency Medicine and Centre for Health Evaluation
and Outcome Sciences, University of British Columbia and St Paul's
Hospital, Vancouver, BC, Canada
(Shemie) Division of Critical Care Medicine, McGill University, Montreal,
QC, Canada
(Shemie, Wilson, Hornby) Deceased Donation, Canadian Blood Services,
Ottawa, ON, Canada
(Dainty) Patient-Centred Outcomes, North York General Hospital, Toronto,
ON, Canada
(Dainty) Institute of Health Policy Management and Evaluation, University
of Toronto, Toronto, ON, Canada
(Nagpal) Divisions of Cardiac Surgery and Critical Care Medicine, Western
University, London, ON, Canada
(Hornby) Children's Hospital of Eastern Ontario Research Institute,
Ottawa, ON, Canada
(Lamarche) Divisions of Cardiac Surgery and Critical Care Medicine,
University of Montreal, Montreal, QC, Canada
(van Diepen) Department of Critical Care and Division of Cardiology,
Department of Medicine, University of Alberta, Edmonton, AB, Canada
(Kanji) Division of Critical Care Medicine, University of British
Columbia, Vancouver, BC, Canada
(Gould) Department of Emergency Medicine, Dalhousie University, Saint
John, NB, Canada
(Saczkowski) Division of Cardiac Surgery, Kelowna General Hospital,
Kelowna, BC, Canada
(Brooks) Department of Emergency Medicine, Queen's University, Kingston,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a
therapeutic option for refractory cardiac arrest. We sought to perform an
environmental scan to describe ECPR utilization in Canada and perceived
barriers for application to out-of-hospital cardiac arrest (OHCA).
 Method(s): This was a national cross-sectional study. We identified
all cardiovascular surgery- and extracorporeal membrane oxygenation
(ECMO)-capable hospitals in Canada and emergency medical services (EMS)
agencies delivering patients to those centres. We requested the medical
lead from each hospital's ECMO service and each EMS agency to submit data
regarding ECMO and ECPR utilization, as well as perceived barriers to ECPR
provision for OHCA. Result(s): We identified and received survey data
from 39 of 39 Canadian hospital institutions and 21 of 22 EMS agencies. Of
hospitals, 38 (97%) perform ECMO and 27 (69%) perform ECPR (74% of which
perform <=5 cases per year). Of the 18 (46%) sites offering ECPR for OHCA,
8 apply a formal protocol for eligibility and initiation procedures. EMS
agencies demonstrate heterogeneity with intra-arrest transport practices.
The primary rationale for nontransport of refractory OHCA is that
hospital-based care offers no additional therapies. Perceived barriers to
the use of ECPR for OHCA were primarily related to limited evidence
supporting its use, rather than resources required. Conclusion(s):
Many Canadian cardiovascular surgery- or ECMO-equipped hospitals use ECPR;
roughly half employ ECPR for OHCAs. Low case volumes and few formal
protocols indicate that this is not a standardized therapy option in most
centres. Increased application may be dependent on a stronger evidence
base including data from randomized clinical trials currently
underway. Copyright © 2020 Canadian Cardiovascular Society

<129>
Accession Number
2010942184
Title
Meta-Analysis of Population Characteristics and Outcomes of Patients
Undergoing Pericardiectomy for Constrictive Pericarditis.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Tzani A.; Doulamis I.P.; Tzoumas A.; Avgerinos D.V.; Koudoumas D.; Siasos
G.; Vavuranakis M.; Klein A.; Kampaktsis P.N.
Institution
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Tzoumas) Medical School, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Avgerinos) Onassis Cardiac Surgery Center, Athens, Greece
(Koudoumas) Department of Surgery, Division of Cardiothoracic Surgery,
University of Utah, Salt lake city, UT, United States
(Siasos, Vavuranakis) 1st Cardiology Clinic, National and Kapodistrian
University of Athens Medical School, Greece
(Klein) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Kampaktsis) Division of Cardiology, New York University Langone Medical
Center, NY, NY, United States
Publisher
Elsevier Inc.
Abstract
We sought to systematically describe the epidemiology, etiology, clinical
and operative characteristics as well as outcomes of patients who
underwent pericardiectomy for constrictive pericarditis in the
contemporary era. We conducted a systematic search of the MEDLINE, Embase,
and Cochrane databases from their inception to April 1, 2020 for studies
assessing the outcomes of pericardiectomy in patients with constrictive
pericarditis. Studies with patients enrolled before 1985, pediatric
patients or studies including >10% tuberculous pericarditis were excluded.
The impact of pericarditis etiology on outcomes was evaluated with a
meta-analysis. We analyzed 27 eligible studies and 2,114 patients.
Etiology was most commonly idiopathic (50.2%), followed by after-cardiac
surgery (26.2%) and radiation (6.9%). Patients were mostly men (76%), mean
age 58 and with advanced symptoms (NYHA III/IV 70.1%). Total
pericardiectomy was preferred (85.8%) and concomitant cardiac surgery was
relatively common (23.8%). Operative mortality was 6.9% and 5-year
mortality was 32.7%. Radiation and after-cardiac surgery patients had 3
and 2 times higher long-term risk for mortality respectively compared with
idiopathic. A sensitivity analysis did not result in changes in the
results. Thirty percent of included studies had more than low bias
primarily originating from follow up and selection. Pericardiectomy is
therefore performed mostly in middle-aged men with advanced symptoms and
low co-morbidity burden and still caries significant operative mortality.
Radiation and after-cardiac surgery patients have a significantly higher
mortality risk compared with idiopathic. Several methodological issues and
significant heterogeneity limit the generalization of these data and
randomized controlled trials may have to be considered. Copyright
© 2021 Elsevier Inc.

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