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<1>
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

<2>
Accession Number
625445765
Title
Daytime variation of perioperative myocardial injury in non-cardiac
surgery and effect on outcome.
Source
Heart. 105 (11) (pp 826-833), 2019. Date of Publication: 01 Jun 2019.
Author
Du Fay De Lavallaz J.; Puelacher C.; Lurati Buse G.; Bolliger D.;
Germanier D.; Hidvegi R.; Walter J.E.; Twerenbold R.; Strebel I.;
Badertscher P.; Sazgary L.; Lampart A.; Espinola J.; Kindler C.;
Hammerer-Lercher A.; Thambipillai S.; Guerke L.; Rentsch K.; Buser A.;
Gualandro D.; Jakob M.; Mueller C.
Institution
(Du Fay De Lavallaz, Puelacher, Germanier, Hidvegi, Walter, Twerenbold,
Strebel, Badertscher, Sazgary, Thambipillai, Gualandro, Mueller)
Cardiovascular Research Institute Basel (CRIB) and Department of
Cardiology, University Hospital Basel, Basel, Switzerland
(Du Fay De Lavallaz, Puelacher, Germanier, Hidvegi, Walter, Sazgary)
Department of Internal Medicine, University Hospital Basel, University of
Basel, Basel, Switzerland
(Lurati Buse) Department of Anaesthesia, University Hospital Dusseldorf,
Dusseldorf, Germany
(Bolliger, Hidvegi, Lampart) Department of Anaesthesia, University
Hospital Basel, Basel, Switzerland
(Espinola, Kindler) Kantonsspital Aarau, Department of Anaesthesia, Aarau,
Switzerland
(Hammerer-Lercher) Department of Laboratory Medicine, Kantonsspital Aarau,
Aarau, Switzerland
(Guerke) Department of Vascular Surgery, University Hospital Basel,
University of Basel, Basel, Switzerland
(Rentsch) Department of Laboratory Medicine, University Hospital Basel,
University of Basel, Basel, Switzerland
(Buser) Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
(Buser) Department of Hematology, University Hospital Basel, University of
Basel, Basel, Switzerland, Switzerland
(Gualandro) Department of Cardiology, Instituto di Coracao, University of
Sao Paulo, Sao Paulo, Brazil, Brazil
(Jakob) Department of Traumatology and Orthopedics, Cardiovascular
Research Institute Basel (CRIB) and Department of Cardiology, University
Hospital Basel, University of Basel, Basel, Switzerland
Publisher
BMJ Publishing Group
Abstract
Objective Recently, daytime variation in perioperative myocardial injury
(PMI) has been observed in patients undergoing cardiac surgery. We aim at
investigating whether daytime variation also occurs in patients undergoing
non-cardiac surgery. Methods In a prospective diagnostic study, we
evaluated the presence of daytime variation in PMI in patients at
increased cardiovascular risk undergoing non-cardiac surgery, as well as
its possible impact on the incidence of acute myocardial infarction (AMI),
and death during 1-year follow-up in a propensity score-matched cohort.
PMI was defined as an absolute increase in high-sensitivity cardiac
troponin T (hs-cTnT) concentration of >=14 ng/L from preoperative to
postoperative measurements. Results Of 1641 patients, propensity score
matching defined 630 with similar baseline characteristics, half
undergoing non-cardiac surgery in the morning (starting from 8:00 to
11:00) and half in the afternoon (starting from 14:00 to 17:00). There was
no difference in PMI incidence between both groups (morning: 50, 15.8%
(95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9),
p=0.94), nor if analysing hs-cTnT release as a quantitative variable
(median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon
group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the
incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries
versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected
HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p
log-rank=0.03), whereas no difference in mortality emerged (p=0.70).
Conclusions Although there is no daytime variation in PMI in patients
undergoing non-cardiac surgery, the incidence of AMI during follow-up is
increased in afternoon surgeries and requires further study. Clinical
trial registration NCT02573532;Results. Copyright © Author(s) (or
their employer(s)) 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<3>
Accession Number
2007522911
Title
Pharmacological interventions for the prevention of renal injury in
surgical patients: a systematic literature review and meta-analysis.
Source
British Journal of Anaesthesia. 126 (1) (pp 131-138), 2021. Date of
Publication: January 2021.
Author
Pathak S.; Olivieri G.; Mohamed W.; Abbasciano R.; Roman M.; Tomassini S.;
Lai F.; Wozniak M.; Murphy G.J.
Institution
(Pathak, Olivieri, Mohamed, Abbasciano, Roman, Tomassini, Lai, Wozniak,
Murphy) Department of Cardiovascular Sciences, National Institute for
Health Research Leicester Biomedical Research Unit in Cardiovascular
Medicine, University of Leicester, Leicester, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: The aim of this systematic review was to summarise the results
of randomised controlled trials (RCTs) that have evaluated pharmacological
interventions for renoprotection in people undergoing surgery.
 Method(s): Searches were conducted to update a previous review using
the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to
August 23, 2019. RCTs evaluating the use of pharmacological interventions
for renal protection in the perioperative period were included. The
co-primary outcome measures were 30-day mortality and acute kidney injury
(AKI). Pooled effect estimates were expressed as risk ratios (RRs) (95%
confidence intervals). Result(s): We included 228 trials enrolling 56
047 patients. Twenty-three trials were considered to be at low risk of
bias across all domains. Atrial natriuretic peptides (14 trials; n=2207)
reduced 30-day mortality (RR: 0.63 [0.41, 0.97]) and AKI events (RR: 0.43
[0.33, 0.56]) without heterogeneity. These effects were consistent across
cardiac surgery and vascular surgery subgroups, and in sensitivity
analyses restricted to studies at low risk of bias. Inodilators (13
trials; n=2941) reduced mortality (RR: 0.71 [0.53, 0.94]) and AKI events
(RR: 0.65 [0.50, 0.85]) in the primary analysis and in cardiac surgery
cohorts. Vasopressors (4 trials; n=1047) reduced AKI (RR: 0.56 [0.36,
0.86]). Nitric oxide donors, alpha-2-agonists, and calcium channel
blockers reduced AKI in primary analyses, but not after exclusion of
studies at risk of bias. Overall, assessment of the certainty of the
effect estimates was low. Conclusion(s): There are multiple effective
pharmacological renoprotective interventions for people undergoing
surgery. Copyright © 2020 The Authors

<4>
Accession Number
2010572955
Title
Individual Patient Data from the Pivotal Randomized Controlled Trials of
Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial
Fibrillation (COMBINE AF): Design and Rationale: From the COMBINE AF (A
Collaboration between Multiple institutions to Better Investigate
Non-vitamin K antagonist oral anticoagulant use in Atrial Fibrillation)
Investigators.
Source
American Heart Journal. 233 (pp 48-58), 2021. Date of Publication: March
2021.
Author
Carnicelli A.P.; Hong H.; Giugliano R.P.; Connolly S.J.; Eikelboom J.;
Patel M.R.; Wallentin L.; Morrow D.A.; Wojdyla D.; Hua K.; Hohnloser S.H.;
Oldgren J.; Ruff C.T.; Piccini J.P.; Lopes R.D.; Alexander J.H.; Granger
C.B.
Institution
(Carnicelli, Hong, Giugliano, Connolly, Eikelboom, Patel, Wallentin,
Morrow, Wojdyla, Hua, Hohnloser, Oldgren, Ruff, Piccini, Lopes, Alexander,
Granger) Duke Clinical Research Institute, Box 3409, 200 Morris St,
Durham, AL NC 27701, United States
Publisher
Mosby Inc.
Abstract
Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are the
preferred class of medications for prevention of stroke and systemic
embolism in patients with atrial fibrillation unless contraindications
exist. Five large, international, randomized, controlled trials of NOACs
versus either warfarin or aspirin have been completed to date.
 Design(s): COMBINE AF incorporates de-identified individual patient
data from 77,282 patients with atrial fibrillation at risk for stroke
randomized to NOAC, warfarin, or aspirin from 5 pivotal randomized
controlled trials. All patients randomized in the constituent trials are
included. Variables common to >=3 of the constituent trials are included
in the master database. Individual trial data sets from the 4 coordinating
centers were combined at the Duke Clinical Research Institute. The final
database will be securely shared with the 4 academic coordinating centers.
The combined master database will be used to perform statistical analyses
aimed at better understanding underlying risk factors and outcomes in
patients with atrial fibrillation treated with oral anticoagulants, with a
special focus on patient subgroups and uncommon outcomes. The initial
analysis from COMBINE AF will be a network meta-analysis investigating the
relative efficacy and safety of pooled higher-dose NOACs versus pooled
lower-dose NOACs versus warfarin with respect to multiple time-to-event
efficacy and safety outcomes. COMBINE AF is registered with PROSPERO
(CRD42020178771). Conclusion(s): In conclusion, COMBINE AF provides a
rich and robust database consisting of individual patient data and will
offer opportunities to investigate oral anticoagulants across many patient
subgroups. Data sharing and collaboration across academic institutions and
investigators will serve as overarching themes. Copyright © 2020
Elsevier Inc.

<5>
Accession Number
633501378
Title
Rivaroxaban in patients with atrial fibrillation and a bioprosthetic
mitral valve.
Source
New England Journal of Medicine. 383 (22) (pp 2117-2126), 2020. Date of
Publication: 26 Nov 2020.
Author
Guimaraes H.P.; Lopes R.D.; De Barros Silva P.G.M.E.; Liporace I.L.;
Sampaio R.O.; Tarasoutchi F.; Hoffmann-Filho C.R.; De Lemos Soares
Patriota R.; Leiria T.L.L.; Lamprea D.; Precoma D.B.; Atik F.A.; Silveira
F.S.; Farias F.R.; Barreto D.O.; Almeida A.P.; Zilli A.C.; De Souza Neto
J.D.; Cavalcante M.A.; Figueira F.A.M.S.; Kojima F.C.S.; Damiani L.;
Santos R.H.N.; Valeis N.; Campos V.B.; Saraiva J.F.K.; Fonseca F.H.; Pinto
I.M.; Magalhaes C.C.; Ferreira J.F.M.; Alexander J.H.; Pavanello R.;
Cavalcanti A.B.; Berwanger O.
Institution
(Guimaraes, De Barros Silva, Kojima, Damiani, Santos, Valeis, Campos,
Pavanello, Cavalcanti, Berwanger) HCor Research Institute
(Liporace) Instituto Dante Pazzanese de Cardiologia, Brazil
(Sampaio, Tarasoutchi) Instituto do Coracao do Hospital das Clinicas,
Faculdade de Medicina, Universidade de Sao Paulo, Brazil
(Saraiva, Fonseca, Pinto, Magalhaes, Ferreira, Pavanello, Berwanger)
Sociedade de Cardiologia do Estado de Sao Paulo, Brazil
(Berwanger) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Hoffmann-Filho) Hospital Regional Hans Dieter Schmidt, Joinville, Brazil
(De Lemos Soares Patriota) Hospital Metropolitano Sul Dom Helder Camara,
Cabo de Santo Agostinho, Brazil
(Leiria) Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre,
Brazil
(Lamprea) Pronto Socorro Cardiologico Prof. Luiz Tavares, Procape, Brazil
(Figueira) Instituto de Medicina Integral Prof. Fernando Figueira, Recife,
Brazil
(Precoma) Sociedade Hospitalar Angelina Caron, Campina Grande do Sul,
Brazil
(Atik) Instituto de Cardiologia do Distrito Federal, Brasilia, Brazil
(Silveira) Centro de Pesquisa Clinica do Coracao, Aracaju, Brazil
(Farias) Quanta Diagnostico e Terapia, Curitiba, Brazil
(Barreto) Hospital Evangelico de Vila Velha, Vila Velha, Brazil
(Almeida) Unidade Medico Cirurgica-Unimec, Vitoria da Conquista, Brazil
(Zilli) Hospital de Caridade Sao Vicente de Paulo, Jundiai, Brazil
(De Souza Neto) Hospital de Messejana Dr. Carlos Alberto Studart Gomes,
Fortaleza, Brazil
(Cavalcante) Hospital Regional de Presidente Prudente, Universidade do
Oeste Paulista, Presidente Prudente, Brazil
(Saraiva) Instituto de Pesquisa Clinica de Campinas, Campinas, Brazil
(Lopes, Alexander) Duke Clinical Research Institute, Duke Health, Durham,
NC, United States
Publisher
Massachussetts Medical Society
Abstract
Background: The effects of rivaroxaban in patients with atrial
fibrillation and a bioprosthetic mitral valve remain uncertain.
 Method(s): In this randomized trial, we compared rivaroxaban (20 mg
once daily) with doseadjusted warfarin (target international normalized
ratio, 2.0 to 3.0) in patients with atrial fibrillation and a
bioprosthetic mitral valve. The primary outcome was a composite of death,
major cardiovascular events (stroke, transient ischemic attack, systemic
embolism, valve thrombosis, or hospitalization for heart failure), or
major bleeding at 12 months. Result(s): A total of 1005 patients were
enrolled at 49 sites in Brazil. A primary-outcome event occurred at a mean
of 347.5 days in the rivaroxaban group and 340.1 days in the warfarin
group (difference calculated as restricted mean survival time, 7.4 days;
95% confidence interval [CI], -1.4 to 16.3; P<0.001 for noninferiority).
Death from cardiovascular causes or thromboembolic events occurred in 17
patients (3.4%) in the rivaroxaban group and in 26 (5.1%) in the warfarin
group (hazard ratio, 0.65; 95% CI, 0.35 to 1.20). The incidence of stroke
was 0.6% in the rivaroxaban group and 2.4% in the warfarin group (hazard
ratio, 0.25; 95% CI, 0.07 to 0.88). Major bleeding occurred in 7 patients
(1.4%) in the rivaroxaban group and in 13 (2.6%) in the warfarin group
(hazard ratio, 0.54; 95% CI, 0.21 to 1.35). The frequency of other serious
adverse events was similar in the two groups. Conclusion(s): In
patients with atrial fibrillation and a bioprosthetic mitral valve,
rivaroxaban was noninferior to warfarin with respect to the mean time
until the primary outcome of death, major cardiovascular events, or major
bleeding at 12 months. Copyright © 2020 Massachusetts Medical
Society.

<6>
Accession Number
631894406
Title
Coronary Computed Tomography Angiography in the Clinical Workflow of
Athletes with Anomalous Origin of Coronary Arteries from the Contralateral
Valsalva Sinus.
Source
Journal of Thoracic Imaging. 36 (2) (pp 122-130), 2021. Date of
Publication: March 2021.
Author
Marano R.; Merlino B.; Savino G.; Natale L.; Rovere G.; Paciolla F.;
Muciaccia M.; Flammia F.C.; Larici A.R.; Palmieri V.; Zeppilli P.;
Manfredi R.
Institution
(Marano, Merlino, Savino, Natale, Larici, Manfredi) Department of
Diagnostic Imaging, Oncological Radiotherapy and Hematology, Diagnostic
Imaging Area, L.go Agostino Gemelli 8, Rome 00168, Italy
(Marano) Sports Medicine Unit - Orthopedics, Aging and Rehabilitation Area
(Palmieri, Zeppilli) Fondazione Policlinico Universitario Agostino Gemelli
IRCCS, Italy
(Rovere, Paciolla, Muciaccia, Flammia) Universita Cattolica Del Sacro
Cuore, Rome, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose:This study aimed to assess the role of coronary computed
tomography-angiography (CCTA) in the workflow of competitive sports
eligibility in a cohort of athletes with anomalous origin of the
left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery
(AORCA) in an attempt to outline relevant computed tomography features
likely to impact diagnostic assessment and clinic management.Materials and
Methods:Patients with suspected AOLCA/AORCA at transthoracic
echocardiography or with inconclusive transthoracic echocardiography
underwent CCTA to rule out/confirm and characterize the anatomic findings:
partially interarterial course or full-INT, high-take-off,
acute-take-off-angle (ATO), slit-like origin, intramural course (IM),
interarterial-course-length, and lumen-reduction/hypoplasia (HYPO).
 Result(s):CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3+/-11.0
y) and 22 AORCA (18 males; 29.1+/-16.5 y). Symptoms were present only in
13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest
electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal
stress-electrocardiogram. The INT course was observed in 15 athletes
(53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in
7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA
(50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No
statistically significant differences were found between
asymptomatic/symptomatic patients in the prevalence of partially INT/INT
courses, high-take-off/ATO, and slit-like ostium. A slightly significant
relationship between suspected proximal-IM (r=0.47, P<0.05) and
proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and
was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO).
All AOLCA/AORCA athletes were disqualified from competitive sports and
warned to avoid vigorous physical efforts. Surgery was recommended to all
AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent
surgery. No major cardiovascular event/ischemic symptoms/signs developed
during a mean follow-up of 49.6+/-39.5 months. Conclusion(s):CCTA
provides essential information for safe/effective clinical management of
athletes, with important prognostic/sport-activity
implications. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<7>
Accession Number
2006772498
Title
Transcatheter or surgical aortic valve implantation in chronic dialysis
patients: a German Aortic Valve Registry analysis.
Source
Clinical Research in Cardiology. 110 (3) (pp 357-367), 2021. Date of
Publication: March 2021.
Author
Farber G.; Bleiziffer S.; Doenst T.; Bon D.; Boning A.; Weiler H.;
Herrmann E.; Frerker C.; Beckmann A.; Mollmann H.; Ensminger S.;
Bekeredjian R.; Walther T.; Harringer W.; Katus H.A.; Hamm C.W.;
Beyersdorf F.; Bauer T.; Fichtlscherer S.
Institution
(Farber, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital, Friedrich Schiller University of Jena, Jena, Germany
(Bleiziffer) Clinic for Thoracic and Cardiovascular Surgery, Heart and
Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
(Bon, Herrmann) Institute of Biostatistics and Mathematical Modelling,
Goethe University Frankfurt, Frankfurt am Main, Germany
(Bon, Herrmann) German Center for Cardiovascular Research, DZHK, Partner
Site Rhein-Main, Frankfurt am Main, Germany
(Boning, Bauer) Department of Cardiology, University of Giessen, Giessen,
Germany
(Weiler, Fichtlscherer) Department of Cardiology, University Hospital
Frankfurt am Main, Frankfurt, Germany
(Frerker) Department of Internal Medicine III, University of Cologne,
Cologne, Germany
(Beckmann) German Society of Thoracic, Cardiac and Vascular Surgery
(Deutsche Gesellschaft fur Thorax-, Herz- und Gefaschirurgie, DGTHG),
Berlin, Germany
(Mollmann) Department of Cardiology, St.-Johannes-Hospital Dortmund,
Dortmund, Germany
(Ensminger) Department of Cardiac Surgery, University of Lubeck, Lubeck,
Germany
(Bekeredjian) Department of Cardiology, Robert-Bosch-Krankenhaus,
Stuttgart, Germany
(Walther) Department of Cardiothoracic Surgery, University Hospital
Frankfurt, Frankfurt, Germany
(Harringer) Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum
Braunschweig gGmbH, Brunswick, Germany
(Katus) Department of Cardiology, University Hospital Heidelberg,
Heidelberg, Germany
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Beyersdorf) Department of Cardiovascular Surgery, Faculty of Medicine,
Heart Centre Freiburg University, Freiburg, Germany
(Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: The aim of this study was to compare outcomes of transcatheter
and surgical aortic valve implantation in chronic dialysis patients with
aortic valve stenosis (AS). Background(s): Chronic dialysis patients
undergoing heart valve surgery are at higher risk for morbidity and
mortality. Whether interventional techniques can reduce this risk is
unclear because dialysis patients have thus far been excluded from
randomized trials. Method(s): Chronic dialysis patients with AS
enrolled in the German Aortic Valve Registry (GARY) between 2012 and 2015
were analyzed to compare transcatheter aortic valve implantation (TAVI n =
661) with surgical aortic valve replacement (SAVR n = 457). Propensity
scores for inverse probability of treatment weighting (IPTW) were used to
adjust the comparison of the two treatment groups for potential
confounders. Result(s): TAVI patients were older (78 +/- 7.3 vs. 69
+/- 10.2 years, p < 0.01, unadjusted) and had more comorbidities.
Mortality at 1 year was the same (TAVI: 33.4% vs. SAVR 35.0%, p = 0.72,
IPTW-adjusted) while it was lower with TAVI at 30 days (8.6% vs. 15.0%, p
= 0.02, IPTW-adjusted). TAVI patients required more pacemaker implantation
and showed more aortic regurgitation. SAVR patients required more blood
transfusions and had longer hospital stay. Diabetes mellitus, atrial
fibrillation, previous PCI, urgent procedure and EuroSCORE were associated
with elevated 30-day mortality. Atrial fibrillation and older age were
independent risk factor of 1-year mortality in both groups.
 Conclusion(s): Chronic dialysis patients with AS undergoing TAVI or
SAVR had the same 1-year mortality, although survival at 30 days was
better with TAVI. These results suggest that TAVI may improve
peri-procedural outcomes. Copyright © 2020, Springer-Verlag GmbH
Germany, part of Springer Nature.

<8>
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

<9>
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

<10>
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.

<11>
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.

<12>
Accession Number
634351560
Title
Predictive value of pulmonary function tests in cardiac surgery: A
systematic review and meta-analysis.
Source
Canadian Journal of Respiratory Therapy. Conference: Canadian Society of
Respiratory Therapists Annual Education Conference, 2019. Canada. 55 (pp
60-61), 2019. Date of Publication: 2019.
Author
Koshy M.; Varghese R.; Thomas S.
Institution
(Koshy, Varghese, Thomas) University of Rochester, Rochester, NY, United
States
Publisher
Canadian Society of Respiratory Therapists
Abstract
BACKGROUND: Pulmonary function tests (PFTs) help determine a patient's
candidacy for cardiac surgery; however, their predictive value on
postoperative outcomes is unclear. METHOD(S): We performed a
systematic literature review and study-level meta-analysis of prospective
trials evaluating patients undergoing all types of cardiac surgery. We
assessed the predictive values of PFTs on each of the following outcomes:
mortality, ventilation time, hospital length of stay (LOS), intensive care
unit (ICU) LOS and major adverse cardiovascular events (MACE). Abnormal
PFTs were defined as GOLD spirometry criteria >=2. We used eight
strategies to identify eligible trials including bibliographic database
searches of MEDLINE, PubMed, EMBASE and the Cochrane Controlled Trials
Registry until December of 2018. Two independent reviewers undertook
decisions about study eligibility and data abstraction. Data were pooled
using a Mantel-Haenzsel random effects model and statistical heterogeneity
was also calculated. Point estimates are reported with their associated
confidence intervals (CI). RESULT(S): Nine prospective trials
fulfilled our eligibility criteria representing 37,484 patients. We
detected an increased mortality with abnormal compared to normal PFTs
(2640 events; RR, 2.08 [CI, 1.28-3.38]; I2 = 62%; p = 0.003). Abnormal
PFTs also predicted a prolonged ventilation time exceeding 24 hours (242
events; RR, 2.64 [CI, 1.96-3.56]; I2 = 0%; p <= 0.00001) and hospital LOS
exceeding 7 days (384 events; RR, 2.95 [CI, 1.63-5.35]; I2 = 68%; p =
0.0004). There was no statistically significant difference in ICU LOS
greater than 24 hours (401 events; RR, 0.85 [CI, 0.40-1.83]; I2 = 68%; p =
0.68) or MACE (1517 events; RR, 2.83 [CI, 0.86-9.30]; I2 = 94%; p = 0.09).
 CONCLUSION(S): Abnormal PFTs were associated with increased mortality
compared to normal PFTS. Additionally, abnormal PFTs were associated with
increased hospital LOS and increased ventilation time. Abnormal PFTs were
not predictive of ICU LOS or major adverse cardiovascular events. The
implementation of PFTs prior to cardiac surgeries has shown great promise
as a tool for determining candidacy for patients undergoing such
procedures.

<13>
Accession Number
634345186
Title
Novel biomarkers in cardiovascular surgery.
Source
Biomarkers in Medicine. 15 (4) (pp 307-318), 2021. Date of Publication:
March 2021.
Author
Serra R.; Jiritano F.; Bracale U.M.; Ielapi N.; Licastro N.; Provenzano
M.; Andreucci M.; Rizzuto A.; Mastroroberto P.; Serraino G.F.
Institution
(Serra, Ielapi, Licastro) Department of Medical and Surgical Sciences,
University of Catanzaro, Italy
(Serra, Licastro, Rizzuto) Interuniversity Center of Phlebolymphology
(CIFL), International Research and Educational Program in Clinical and
Experimental Biotechnology, Department of Surgical and Medical Sciences
University Magna Graecia of Catanzaro, Viale Europa, Localita Germaneto,
Catanzaro 88100, Italy
(Jiritano, Mastroroberto, Serraino) Department of Experimental and
Clinical Medicine, University of Catanzaro, Italy
(Bracale) Department of Public Health, University of Naples Federico II,
Naples, Italy
(Ielapi) Sapienza University of Rome, Department of Public Health and
Infectious Disease, Roma, Italy
(Provenzano, Andreucci) Department of Health Sciences, University Magna
Graecia of Catanzaro, Catanzaro, Italy
Publisher
Future Medicine Ltd.
Abstract
Cardiovascular disease includes health problems related to the heart,
arteries and veins and is a significant healthcare problem worldwide.
Cardiovascular disease may be acute or chronic and relapses are frequent.
Biomarkers involved in this field may help clinicians and surgeons in
diagnosis and adequate decision making. Relevant articles searched in the
following databases Medline, Scopus, ScienceDirect, were retrieved and
analysed. Several biomarkers have been identified and we analyzed those of
most importance from a clinical and surgical point of view. Biomarkers can
better identify high-risk individuals, facilitate follow-up process,
provide information regarding prognosis and better tailor the most
appropriate surgical treatment. Copyright © 2021 Future Medicine
Ltd.

<14>
Accession Number
2010578981
Title
Efficacy of heart transplantation in patients with a failing Fontan: a
systematic review and meta-analysis.
Source
Cardiothoracic Surgeon. 29 (1) (no pagination), 2021. Article Number: 7.
Date of Publication: December 2021.
Author
Hassan W.; Kotak S.; Khatri M.; Ahmed A.; Ahmed J.; Ali S.S.; Khan T.M.
Institution
(Hassan, Kotak, Khatri, Ahmed, Ahmed, Ali) Department of Internal
Medicine, Dow University of Health Sciences, Baba e Urdu Road, Karachi,
Pakistan
(Khan) Pediatrics, Baylor College of Medicine, Houston, United States
(Khan) Pediatrics, Texas Children's Hospital, Houston, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: As the population of patients with Fontan palliation grows, so
does the number of patients with Fontan failure, necessitating heart
transplantation. However, due to mainly small-sized studies, outcomes
after heart transplantation in these patients remain unclear. The
objective of this study was to review the available literature and conduct
a meta-analysis to provide well-powered and generalizable estimates of
outcomes after heart transplantation in patients with a failing Fontan.
Main text: PubMed, Embase, and MEDLINE databases were searched for
original studies of patients with a failing Fontan who underwent heart
transplantation. The outcomes included were 1-year and 5-year survival,
acute rejection, renal dysfunction, sepsis, and multi-organ failure.
Proportions were pooled using random effects models to derive pooled
proportions (PPs) and corresponding 95% confidence intervals (CIs).
Meta-regression analysis was done to study the effects of age and gender
on key outcomes. Sixteen retrospective single-center cohort studies with
426 Fontan patients undergoing heart transplantation were included in this
meta-analysis. Pooled analysis of this study further revealed that 1-year
survival after heart transplantation was 79.9% ([75.8%, 83.7%];
I2 = 1.92%), and 5-year survival rate was 72.5% ([62.1%,
81.9%]; I2 = 72.12%). Secondary outcomes after heart
transplantation of failed Fontan procedure were acute rejection (PP 20%
[7.4%, 36.8%]; I2 = 72.48%), renal dysfunction (PP 31.3%
[10.5%, 57.2%]; I2 = 75.42%), multi-organ failure (PP 18.6%
[2.8 to 43.9%]; I2= 69.60%), and sepsis (PP 21.1% [9%, 36.8%];
I2 = 61.19%). Conclusion(s): Cardiac transplantation in
patients with a failing Fontan is associated with acceptable
interventional success and improved survival rates. Copyright ©
2021, The Author(s).

<15>
Accession Number
634350869
Title
Postoperative Cognitive Dysfunction and the Protective Effects of Enriched
Environment: A Systematic Review.
Source
Neurodegenerative Diseases. (no pagination), 2021. Date of Publication:
2021.
Author
Hua M.; Min J.
Institution
(Hua) First Clinical Medical College, Nanchang University, Nanchang, China
(Min) Department of Anesthesiology, First Affiliated Hospital of Nanchang
University, Nanchang, China
Publisher
S. Karger AG
Abstract
Background: Currently, the number of individuals who undergo surgery is
greatly increased. As a consequence, postoperative cognitive dysfunction
(POCD) has gradually gained more attention. Summary: POCD is a
perioperative complication requiring sensitive preoperative and
postoperative neuropsychiatric tests, and its incidence in both cardiac
and noncardiac surgery is high, especially in elderly individuals.
Surgical, patient, and anesthetic factors may all lead to the occurrence
and development of POCD. The key mechanism of POCD may be the inflammatory
response of the central nervous system during surgery, which is similar to
that of Alzheimer's disease (AD). Enriched environment (EE), a factor that
can significantly improve and prevent neurodegenerative diseases, may have
a beneficial effect on POCD. Key Messages: This review aims to elucidate
the mechanism of the occurrence and development of POCD, analyze the
possible influence of EE on POCD at the molecular level, and provide a
direction for its treatment. Copyright © 2021

<16>
Accession Number
634344695
Title
A Systematic Review of the Quality of Cardiovascular Surgery Studies Which
Extracted Data from MAUDE Database.
Source
Journal of vascular surgery. (no pagination), 2021. Date of Publication:
15 Feb 2021.
Author
Ziapour B.; Zaepfel C.; Iafrati M.D.; Suarez L.B.; Salehi P.
Institution
(Ziapour) Allegheny General Hospital Department of General Surgery 320 E
North Ave, Pittsburgh, United States
(Zaepfel) Tufts Medical Center 800 Washington Street # 1035 Boston
(Iafrati) Division of Vascular Surgery, Director of Vascular Center,
Cardiovascular Center at Tufts Medical Center, 800 Washington St., Boston,
United States
(Suarez) Cardiovascular Center at Tufts Medical Center
(Salehi) Chief of Vascular Surgery, Director of Vascular Network
Development, Co-Director, Aortic Program, Cardiovascular Center, Tufts
University School of Medicine, Tufts Medical Center800 Washington Street #
1035, Boston
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To investigate opportunities and limitations of using the
Manufacturer and User Facility Device Experience MAUDE database for
cardiovascular surgery research, we analyzed the quality of studies having
ever used MAUDE, in the field of cardiovascular surgery. METHOD(S):
We systematically searched the Cochrane Library, PubMed, EMBASE, and
Google Scholar for randomized and nonrandomized studies, from inception to
July 2019. Two authors evaluated the quality of the retrieved
observational studies, according to the National Institute of Health
quality assessment tool for either case-series or cross-sectional studies.
These tools quantify the quality of case-series and
cohorts/cross-sectional studies, respectively, with nine and 14 queries.
 RESULT(S): Fifty-eight studies were included in the final qualitative
review. Of 58 identified studies, 32 were case series, 8 were abstracts of
case-series, and 13 were reviews or case discussion with an included
series from MAUDE. Also, five articles were cross-sectional studies. 26
(81%) of 32 formal case-series were found to have poor quality. The most
common reasons for a poor-quality designation included; lack of
consecutive participants, undetermined comparability of participants, and
undetermined follow-up adequacy. Only one out of 5 cross-sectional studies
had fair quality, and 4 others were evaluated as poor-quality studies.
 CONCLUSION(S): Cardiovascular surgery studies using the MAUDE
database, whether case series or cross-sectional design, are mostly of
poor quality. Their low quality is partly caused by the poor study design,
but mainly by intrinsic limitations to the MAUDE database: Cases recruited
are not consecutive; patient characteristics are not detailed enough to
allow meaningful comparison of patient characteristics between different
patient entries; outcome measures are unclear; there is a limited
follow-up; time-to-event data are lacking. We conclude that the quality of
cardiovascular surgery publications that rely on data from MAUDE could be
improved if investigators were to extract all relevant data points from
MAUDE entries, then apply standard quality assessment tools in compiling
and reporting the data. MAUDE might be improved if it utilized medical
case report standards during the process of reporting and indexing adverse
events. To calculate the incidence rate of any adverse event, all
event-free cases, as well as all adverse events in patients using a
device, are required. Neither of these two variables is available in the
MAUDE for now. Copyright © 2021. Published by Elsevier Inc.

<17>
Accession Number
634331358
Title
Continuous Paravertebral Analgesia versus Continuous Epidural Analgesia
after Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: A Randomized
Controlled Trial.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2021. Date of Publication: 16 Feb 2021.
Author
Lai J.; Situ D.; Xie M.; Yu P.; Wang J.; Long H.; Lai R.
Institution
(Lai, Situ, Xie, Yu, Wang, Long, Lai) Collaborative Innovation Center for
Cancer Medicine, State Key Laboratory of Oncology in South China, Sun
Yat-Sen University Cancer Center, Guangzhou, China
(Lai, Xie, Yu, Wang, Lai) Department of Anesthesiology, Sun Yat-Sen
University Cancer Center, Guangzhou, China
(Situ, Long) Lung Cancer Research Institute, Sun Yat-sen University,
Guangzhou, China
(Situ, Long) Department of Thoracic Surgery, Sun Yat-Sen University Cancer
Center, Guangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Whether continuous thoracic epidural analgesia (TEA) and
continuous paravertebral block (PVB) have similar analgesic effects in
patients undergoing video-assisted thoracic surgery (VATS) lobectomy was
compared in this study. METHOD(S): In all, 86 patients undergoing
VATS lobectomy were enrolled in the prospective, randomized clinical
trial. Group E received TEA. Group P received PVB. The primary endpoint
was postoperative 24-hour visual rating scale (VAS) on coughing. Side
effects and postoperative complications were also analyzed.
 RESULT(S): Pain scores at rest or on coughing at 24 and 48 h
postoperatively were significantly lower in group E than in group P (P
<0.05). At 24 h postoperatively, more patients in group E suffered from
vomiting (32.6% vs 11.6%, P = 0.019), dizziness (55.8% vs 12.9%, P =
0.009), pruritus (27.9% vs 2.3%, P = 0.002), and hypotension (32.6% vs
4.7%, P = 0.002) than those in group P. Patients in group E were more
satisfied (P = 0.047). Four patients in group P and two patients in group
E suffered from pulmonary complications (P >0.05). The length of hospital
and intensive care unit (ICU) stays were not significantly different.
 CONCLUSION(S): Though TEA has more adverse events than PVB, it may be
superior to PVB in patients undergoing VATS lobectomy.

<18>
Accession Number
2010580298
Title
Meta-Analysis Comparing the Safety and Efficacy of Dual Versus Single
Antiplatelet Therapy After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiovascular Drugs. (no pagination), 2021. Date of
Publication: 2021.
Author
Shahid I.; Nizam M.A.; Usman M.S.; Khan M.S.; Fudim M.; Michos E.D.
Institution
(Shahid, Nizam) Department of Medicine, Ziauddin Medical University,
Shahra-e-Ghalib, Clifton, Karachi, Pakistan
(Usman) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan) Department of Medicine, University of Mississippi Medical Center,
Jackson, MS, United States
(Fudim) Division of Cardiology, Duke University Medical Center, Durham,
NC, United States
(Michos) Division of Cardiology, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
Adis

<19>
Accession Number
634355726
Title
Fate of patients with single ventricles who do not undergo the Fontan
procedure.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 17 Feb 2021.
Author
Zheng W.C.; Lee M.G.Y.; d'Udekem Y.
Institution
(Zheng, Lee) Department of Paediatrics, The University of Melbourne,
Melbourne, Australia; Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Australia
(d'Udekem) Department of Paediatrics, The University of Melbourne,
Melbourne, Australia; Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Australia; Division of Cardiac Surgery, Children's
National Hospital, Washington, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Fontan procedure, the last of a series of palliative
operations for patients born with single ventricles, is associated with a
significant late burden of complications. There are other strategies for
patients who are suboptimal candidates for Fontan completion, however the
long-term outcomes of these different surgical options have not been
clearly elucidated. We performed a systematic literature review to
establish the current role of other treatment approaches besides the
Fontan procedure. METHOD(S): MEDLINE and Embase databases were
systematically searched for articles describing the long-term outcomes of
patients with single ventricles who have not received the Fontan
procedure. RESULT(S): A total of 36 articles met all inclusion
criteria. There is a scarcity of contemporary data on the non-Fontan
cohort. Historical studies provided a significant contribution.
 CONCLUSION(S): Long-term survival in unoperated patients with single
ventricles is possible under the rare conditions of having balanced
hemodynamics. Up to half of patients may survive on only a
systemic-to-pulmonary artery shunt or bidirectional cavopulmonary shunt
for over 20 years with reasonable functional status. In patients with a
failing single ventricle, the bidirectional cavopulmonary shunt is an
excellent bridge to heart transplantation and may provide better
post-transplant survival than those with a Fontan circulation. Currently,
the Fontan procedure continues to be the best definitive palliation for
patients born with single ventricle lesions. However, for those with
borderline indications, other strategies should be carefully
considered. Copyright © 2021. Published by Elsevier Inc.

<20>
Accession Number
634355671
Title
Graft patency of a second conduit for coronary artery bypass surgery: a
network meta-analysis of randomized controlled trials.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2021.
Date of Publication: 17 Feb 2021.
Author
Yokoyama Y.; Kuno T.; Takagi H.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, USA; Department of Surgery, St. Luke's
University Health Network, PA, USA
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
NLM (Medline)
Abstract
It has been well documented that the use of the left internal thoracic
artery (LITA) to graft the left anterior descending (LAD) artery has a
significant benefit in coronary artery bypass graft (CABG) surgery.
However, what graft is the best as a second conduit to complement LITA-LAD
anastomosis remains uncertain. We thus conducted a network meta-analysis
of RCTs to compare graft patency of the radial artery (RA), the right
internal thoracic artery (RITA), the right gastroepiploic artery (RGEA),
conventional saphenous vein (C-SVG), and no-touch saphenous vein (NT-SVG)
as a second conduit in CABG. MEDLINE and EMBASE were searched through Aug
31st, 2020 to identify randomized controlled trials (RCTs) that
investigated graft patency of a second conduit in CABG. From each study,
we extracted the incidence rate ratios of the outcome. A total of 13 RCTs
were identified, including 3,728 patients and 2,773 angiographic results.
The graft failure rates were significantly lower in NT-SVG and RA compared
to C-SVG and RGEA. There was no significant difference among the other
comparisons. A sensitivity analysis restricting trials with >=3 years
angiographic follow-up time showed the graft failure rates were
significantly lower in NT-SVG and RA compared to C-SVG and RGEA, and a
sensitivity analysis restricting trials with >=5 years angiographic
follow-up time showed the graft failure rates were significantly lower in
NT-SVG and RA compared to C-SVG. In a network meta-analysis of the updated
outcomes from RCTs, NT-SVG and RA have better graft patency compared to
C-SVG and RGEA. Copyright © 2021. Published by Elsevier Inc.

<21>
Accession Number
634355114
Title
Association of intraoperative hypotension with postoperative morbidity and
mortality: systematic review and meta-analysis.
Source
BJS open. 5 (1) (no pagination), 2021. Date of Publication: 08 Jan 2021.
Author
Wijnberge M.; Schenk J.; Bulle E.; Vlaar A.P.; Maheshwari K.; Hollmann
M.W.; Binnekade J.M.; Geerts B.F.; Veelo D.P.
Institution
(Wijnberge, Schenk, Bulle, Hollmann, Geerts, Veelo) Department of
Anaesthesiology, Amsterdam University Medical Centre, Amsterdam,
Netherlands
(Wijnberge, Bulle, Vlaar, Binnekade) Department of Intensive Care,
Amsterdam University Medical Centre, Amsterdam, Netherlands
(Wijnberge, Vlaar, Hollmann) Laboratory of Experimental Intensive Care and
Anaesthesiology, Amsterdam University Medical Centre, Amsterdam,
Netherlands
(Maheshwari) Department of General Anaesthesiology, Outcomes Research,
Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative hypotension, with varying definitions in
literature, may be associated with postoperative complications. The aim of
this meta-analysis was to assess the association of intraoperative
hypotension with postoperative morbidity and mortality. METHOD(S):
MEDLINE, Embase and Cochrane databases were searched for studies published
between January 1990 and August 2018. The primary endpoints were
postoperative overall morbidity and mortality. Secondary endpoints were
postoperative cardiac outcomes, acute kidney injury, stroke, delirium,
surgical outcomes and combined outcomes. Subgroup analyses, sensitivity
analyses and a meta-regression were performed to test the robustness of
the results and to explore heterogeneity. RESULT(S): The search
identified 2931 studies, of which 29 were included in the meta-analysis,
consisting of 130 862 patients. Intraoperative hypotension was associated
with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent
confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84).
In the secondary analyses, intraoperative hypotension was associated with
cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR
2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of
88 per cent. When hypotension severity, outcome severity and study
population variables were added to the meta-regression, heterogeneity was
reduced to 50 per cent. CONCLUSION(S): Intraoperative hypotension
during non-cardiac surgery is associated with postoperative cardiac and
renal morbidity, and mortality. A universally accepted standard definition
of hypotension would facilitate further research into this
topic. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of BJS Society Ltd.

<22>
Accession Number
2010595017
Title
Is a fixed low-dose protamine better at reducing postoperative bleeding in
off pump coronary artery bypass grafting?.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2021. Date of
Publication: 2021.
Author
Murugesh W.R.; Prasad S.S.; Ramachandrappa Sujay K.; Dinesh Kumar U.S.
Institution
(Murugesh, Dinesh Kumar) Department of Cardiac Anaesthesia, JSS Medical
College and Hospital, Mysuru, India
(Prasad, Ramachandrappa Sujay) Department of CTVS, JSS Medical College and
Hospital, Mysuru, India
Publisher
SAGE Publications Inc.
Abstract
Context: Protamine is used ubiquitously in all cardiac surgeries for
reversal of heparin. Risk of postoperative bleeding is increased with
inadequate heparin reversal or due to anticoagulant side effects of
protamine; hence, it is important to dose protamine properly. This study
compares 80% protamine dose with full dose on postoperative bleeding and
transfusion needs in OPCAB. Aim(s): The aim of our study was to find
whether lower dose of protamine could reduce postoperative bleeding and
need for blood product transfusions in off pump coronary artery bypass
grafting as compared to the regular dose of protamine. Settings and
design: This was a double-blinded randomised controlled trial where
patients posted for off pump CABG meeting the inclusion criteria were
included in the study. Methods and material: Ninety patients were
randomised to two groups, group F receiving full dose of protamine of 1 mg
per mg heparin used, and group L received 0.8 mg per mg. Postoperative
activated clotting time, bleeding at 1 h, 4 h, 24 h and total drainage
till drains removal and blood product transfusion requirements were noted.
Statistical analysis used: SPSS software. Result(s): Both groups were
matched in demographics, preoperative cessation of heparin and aspirin and
platelet counts. Both groups received equal heparin dose, activated
clotting time before protamine, activated clotting time post protamine in
OT and ICU were equal as were the conduits used. There was no significant
difference between the groups in post-operative drainage over time or in
the need for blood product transfusions. Conclusion(s): Eighty per
cent of the dose of protamine can adequately reverse the heparin used
during off pump cardiac surgery without any increase in incidence of
postoperative bleeding or need for blood product
transfusions. Copyright © The Author(s) 2021.

<23>
Accession Number
2005998853
Title
Effect of high-intensity interval training on aerobic capacity and heart
rate control of heart transplant recipients: A systematic review with
meta-analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 36 (1) (pp 86-93), 2021. Date
of Publication: 2021.
Author
Conceicao L.S.R.; Gois C.O.; Fernandes R.E.S.; Martins-Filho P.R.S.; Neto
M.G.; Neves V.R.; Carvalho V.O.
Institution
(Conceicao, Gois, Fernandes, Carvalho) Universidade Federal de Sergipe,
Rua Claudio Batista, s/n, Bairro Sanatorio, Aracaju, Sergipe, SE
49060-100, Brazil
(Conceicao, Gois, Fernandes, Carvalho) Universidade Federal de Sergipe
(UFS), Sao Cristovao, Sergipe, Brazil
(Conceicao, Gois, Fernandes, Carvalho) The GREAT Group (GRupo de Estudos
em ATividade fisica), Universidade Federal de Sergipe (UFS), Sao
Cristovao, Sergipe, Brazil
(Martins-Filho) Investigative Pathology Laboratory, Universidade Federal
de Sergipe (UFS), Sao Cristovao, Sergipe, Brazil
(Neto) Department of Physical Therapy, Universidade Federal da Bahia
(UFBa), Salvador, Bahia, Brazil
(Neves) Universidade de Pernambuco (UPE), Pernambuco, Recife, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Heart transplantation (HTx) is the gold standard procedure
for selected individuals with refractory heart failure. High- intensity
interval training (HIIT) is safe and allows patients to exercise in high
intensity for longer time when compared to moderate- intensity continuous
training (MICT). The primary aim of this study was to perform a systematic
review and meta-analysis about the effect of HIIT compared to MICT on
exercise capacity, peak heart rate, and heart rate reserve in HTx
recipients. Secondarily, we pooled data comparing MICT and no exercise
training in these patients. Method(s): This systematic review
followed the standardization of the Preferred Reporting Items for
Systematic Reviews and Meta-analyses statement and the Cochrane
Collaboration Handbook. We presented the treatment effects of HIIT on the
outcomes of interest as mean difference (MD) and 95% confidence interval
(CI). Meta-analysis was performed using the random-effects, generic
inverse variance method. Result(s): HIIT improved peak oxygen
consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart
rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD =
4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on
peakVO<inf>2</inf> (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart
rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no
exercise training. Conclusion(s): Current available evidence suggests
that HIIT leads to improvements on peakVO<inf>2</inf>, peak heart rate,
and heart rate reserve compared to MICT in HTx recipients. However, the
superiority of HIIT should be tested in isocaloric
protocols. Copyright © 2021, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<24>
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

<25>
Accession Number
2005593270
Title
A meta-analysis comparing transaxillary and transaortic transcatheter
aortic valve replacement.
Source
General Thoracic and Cardiovascular Surgery. 69 (1) (pp 19-26), 2021. Date
of Publication: January 2021.
Author
Zhan Y.; Lofftus S.; Kawabori M.; Soin A.; Chen F.Y.
Institution
(Zhan, Lofftus, Kawabori, Soin, Chen) Division of Cardiac Surgery, Tufts
Medical Center, Tufts University School of Medicine, 800 Washington
Street, #266, Boston, MA 02111, United States
Publisher
Springer Japan
Abstract
Background: The alternative access route of choice for transcatheter
aortic valve replacement (TAVR) remains to be elucidated due to lack of
evidences. We performed a meta-analysis comparing the outcomes of two
common alternative access routes, transaxillary (TAx) and transaortic
(TAo) approaches. Method(s): The PubMed/MEDLINE, Embase, and Cochrane
library from inception to December 2018 were searched to identify the
articles reporting data on both TAx-TAVR and TAo-TAVR. Patients' baseline
characteristics, procedural outcomes, and clinical outcomes were extracted
from the articles and pooled for analysis. Result(s): Four studies, a
total of 750 (374 TAo and 376 TAx) patients were included in the study.
The two groups were similar in patients' baseline characteristics,
although the TAx group comprised few female patients. The two groups
differ in outcomes including 30-day mortality, rates of pacemaker implant
and acute kidney injury, and length of hospital stay. There were no
differences between the two groups with regard to device success,
paravalvular leak, stroke, vascular complications, and 1-year mortality.
 Conclusion(s): Compared with the TAo approach, the TAx approach is
associated with favorable short-term mortality, lower incidence of acute
kidney injury, and shorter length of hospital stay, but increased
pacemaker requirement. TAx could be considered over TAo as the preferred
alternative access for TAVR. Copyright © 2020, The Japanese
Association for Thoracic Surgery.

<26>
Accession Number
2011108097
Title
Standard versus long peripheral catheters for multiday IV therapy: A
randomized controlled trial.
Source
Pediatrics. 147 (2) (no pagination), 2021. Article Number: e2020000877.
Date of Publication: 01 Feb 2021.
Author
Qin K.R.; Ensor N.; Barnes R.; Englin A.; Nataraja R.M.; Pacilli M.
Institution
(Qin, Ensor, Nataraja, Pacilli) Department of Paediatric Surgery,
Australia
(Barnes, Englin) Department of Anaesthesia, Monash Children's Hospital,
Melbourne, Australia
(Qin, Ensor, Nataraja, Pacilli) Department of Paediatrics, Australia
(Nataraja, Pacilli) Department of Surgery, School of Clinical Sciences,
Monash University, Melbourne, Australia
(Qin, Ensor) Department of Surgery, Austin Health, Melbourne, Australia
Publisher
American Academy of Pediatrics
Abstract
OBJECTIVES: In children, intravenous therapy (IVT) is generally
administered via peripheral intravenous catheters (PIVCs) (2-6 cm in
length). There is evidence that PIVCs are unreliable after 2 days. Long
peripheral catheters (LPCs) (6-15 cm in length) could improve the delivery
of IVT. The aim of this trial was to determine if LPCs could decrease
catheter failure and the number of catheters in children receiving
multiday IVT. METHOD(S): This was an open-label randomized controlled
trial conducted at Monash Children's Hospital in Melbourne, Australia.
Participants were from the ages of 1 to 17 years, undergoing surgery and
requiring.48 hours of postoperative IVT. Participants were randomly
assigned to a 2.5-cm 22G PIVC or an 8-cm 22G LPC. RESULT(S):
Seventy-two children were randomly assigned, 36 received PIVCs, and 36
received LPCs. The median duration of IVT was 5.1 days and was similar
between groups (P =.9). Catheter failure was higher for PIVCs than LPCs
(66.7% vs 19.4%; relative risk [RR]: 3.4; P =.0001 or 187.9 vs 41.0
failures per 1000 catheter-days). Infiltration was the most common reason
for PIVC failure (33.3% vs 2.8%; RR: 12.0; P =.001). LPCs exhibited
superior life span (4.7 vs 3.5 days [median]; P =.01). Children with LPCs
were twice as likely to complete therapy with a single catheter (80.6% vs
38.9%; RR: 2.1; P =.0006). CONCLUSION(S): LPCs reduce catheter
failure and total catheters in children. They should be considered as the
first-line device for peripheral access in any child receiving prolonged
IVT. Copyright © 2021 by the American Academy of Pediatrics

<27>
Accession Number
2005419677
Title
Long-term effects of high-intensity training vs moderate intensity
training in heart transplant recipients: A 3-year follow-up study of the
randomized-controlled HITTS study.
Source
American Journal of Transplantation. 20 (12) (pp 3538-3549), 2020. Date of
Publication: December 2020.
Author
Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Bjorkelund E.; Authen
A.R.; Grov I.; Broch K.; Gullestad L.; Nytroen K.
Institution
(Rolid, Andreassen, Yardley, Gude, Bjorkelund, Authen, Grov, Broch,
Gullestad, Nytroen) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Rolid, Andreassen, Yardley, Gullestad, Nytroen) Institute of Clinical
Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(Rolid, Yardley) The Norwegian Health Association, Oslo, Norway
(Rolid, Broch, Gullestad, Nytroen) KG Jebsen Center for Cardiac Research,
University of Oslo, Norway and the Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
Publisher
Blackwell Publishing Ltd
Abstract
The randomized controlled High-Intensity Interval Training in De Novo
Heart Transplant Recipients in Scandinavia (HITTS) study compared 9 months
of high-intensity interval training (HIT) with moderate intensity
continuous training in de novo heart transplant recipients. In our 3-year
follow-up study, we aimed to determine whether the effect of early
initiation of HIT on peak oxygen consumption (VO<inf>2peak</inf>)
persisted for 2 years postintervention. The study's primary end point was
the change in VO<inf>2peak</inf> (mL/kg/min). The secondary end points
were muscle strength, body composition, heart rate response,
health-related quality of life, daily physical activity, biomarkers, and
heart function. Of 78 patients who completed the 1-year HITTS trial, 65
entered our study and 62 completed the study tests. VO<inf>2peak</inf>
increased from baseline to 1 year and leveled off thereafter. During the
intervention period, the increase in VO<inf>2peak</inf> was larger in the
HIT arm; however, 2 years later, there was no significant between-group
difference in VO<inf>2peak</inf>. However, the mean change in the
anaerobic threshold and extensor muscle endurance remained significantly
higher in the HIT group. Early initiation of HIT after heart
transplantation appears to have some sustainable long-term effects.
Clinical trial registration number: NCT01796379. Copyright © 2020
The Authors. American Journal of Transplantation published by Wiley
Periodicals LLC on behalf of The American Society of Transplantation and
the American Society of Transplant Surgeons

<28>
Accession Number
2006888072
Title
Impact of lipid levels and high-intensity statins on vein graft patency
after CABG: Midterm results of the ACTIVE trial.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3286-3293), 2020. Date of
Publication: December 2020.
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Division of Cardiac Surgery, Boca Raton Regional
Hospital, Florida Atlantic University, Boca Raton, FL, United States
(Ruel) Division of Cardiac Surgery, The University of Ottawa Heart
Institute, Ottawa, ON, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: High-dose atorvastatin did not improve 1-year vein graft
patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft
Events trial. However, it remains unknown whether high-intensity statins
may impact graft disease in the years that follow. Method(s): In the
trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80
mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the
choice of statin was left to the patient's physician. In this study of
participants who agreed to follow-up (N = 76), low-density lipoprotein
(LDL) levels were measured and graft patency was assessed 3 years after
surgery. Result(s): The rate of vein graft disease 3 years after
surgery was not significantly reduced with atorvastatin 80 mg during the
first postoperative year or the use of open-label high-intensity statin
thereafter (p = NS). However, a trend was observed between higher LDL
levels during the first postoperative year and a greater incidence of vein
graft disease at 3 years (p =.12). Among patients who had LDL levels more
than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease
at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl
(p =.15). Higher mean LDL levels during the first postoperative year were
associated with a higher rate of vein disease 3 years after surgery both
at the graft level (p =.03) and at the patient level (p =.03) in
multivariate analysis. Conclusion(s): Higher LDL levels during the
first postoperative year were associated with significantly greater vein
graft disease 3 years after CABG. Copyright © 2020 Wiley
Periodicals LLC

<29>
Accession Number
2010533944
Title
Infective endocarditis by Klebsiella species: a systematic review.
Source
Journal of Chemotherapy. (no pagination), 2021. Date of Publication: 2021.
Author
Ioannou P.; Miliara E.; Baliou S.; Kofteridis D.P.
Institution
(Ioannou, Miliara, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
(Baliou) National Hellenic Research Foundation, Athens, Greece
Publisher
Taylor and Francis Ltd.
Abstract
This study aimed to systematically analyze all cases of infective
endocarditis (IE) by Klebsiella species in the literature. A systematic
review of PubMed, Scopus and Cochrane library (through 27th
January 2021) for studies providing epidemiological, clinical,
microbiological as well as treatment data and outcomes of IE by Klebsiella
species was performed. In this review, a total of 66 studies were
included, providing data for 67 patients. A prosthetic valve was present
in 16.4%, while the most common causative pathogen was K. pneumoniae
followed by K. oxytoca. The aortic valve was the most commonly infected
intracardiac site, followed by the mitral valve. The diagnosis was based
on transthoracic echocardiography in 46.2%, while the diagnosis was set at
autopsy in 9.2% of included patients. Blood cultures were positive in
93.8%. Fever and sepsis were the most frequent clinical presentations,
followed by embolic phenomena, paravalvular abscess, and heart failure.
Cephalosporins, aminoglycosides, and carbapenems were the most frequently
used antimicrobials. Surgical treatment along with antimicrobials was
performed in 37.3% of included patients. Clinical cure was noted in 80.3%,
while the overall mortality was 19.4%. Infection at the aortic valve was
independently associated with mortality by IE. This systematic review
gives a comprehensive description of IE by Klebsiella and provides
information on epidemiology, clinical manifestations, therapeutic
strategies and their outcomes. Copyright © 2021 Edizioni
Scientifi che per l'Informazione su Farmaci e Terapia.

<30>
Accession Number
2010532882
Title
Is there an immunogenomic difference between thoracic and abdominal aortic
aneurysms?.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yap Z.J.; Sharif M.; Bashir M.
Institution
(Yap) Department of Anaesthetic, Dorset County Hospital, Dorset, United
Kingdom
(Sharif) Department of Molecular & Clinical Medicine, Ninewells Hospital
and Medical School, Dundee, United Kingdom
(Bashir) Department of Emergency Medicine and Surgery, Royal Blackburn
Teaching Hospital, Blackburn, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Background and Aim: Aortic aneurysms most commonly occur in the
infra-renal and proximal thoracic regions. While generally asymptomatic,
progressive aneurysmal dilation can become rapidly lethal when dissection
or ruptures occurs, highlighting the need for more robust screening.
Abdominal aortic aneurysm (AAA) is more prevalent compared to thoracic
aortic aneurysm (TAA). The true incidence of TAA is underreported due to
the absence of population screening and the silent nature of TAA. To
achieve the optimum survival rate in aortic aneurysms, knowledge of
natural course, genetic association, and surgical results are needed to be
applied with adequate medical treatment and careful selection of patients
for operation. The purpose of this paper is to provide a comprehensive
review of the literature on natural history, immunology, and genetic
differences between thoracic and AAAs. Method(s): The literature was
collected from OVID, SCOPUS, and PubMed. Result(s): (1) AAA expands
faster than TAA. AAA expands at approximately 0.3-0.45 cm annually,
depending on various factors (advancing age, diameter of aorta, smoking
etc.). TAA expands up to 0.3 cm annually in a non-bicuspid aortic valve
patient. (2) An increase in Matrix metallopeptidase 1, 2, 9, 12, 14 led to
degrading extracellular matrix of the aortic vessel wall. This
significantly contributed to the pathogenesis in AAA, whereas overactive
Transforming growth factor-beta played a major role in the pathogenesis of
TAA. Conclusion(s): In the future, genetic testing may be the gold
standard for tackling the geneticheterogeneity of aneurysms, therefore,
identifying at-risk individuals developing TAA andAAA
earlier. Copyright © 2021 Wiley Periodicals LLC

<31>
Accession Number
2010531540
Title
The risk of valve thrombosis is higher with intra-annular versus
supra-annular transcatheter aortic valve prosthesis. A meta-analysis from
randomized controlled trials.
Source
Clinical Research in Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Moreno R.; Unverdorben M.; Jurado-Roman A.; Galeote G.; Jimenez-Valero S.;
Arroyo-Ucar E.; Thiele H.
Institution
(Moreno, Jurado-Roman, Galeote, Jimenez-Valero) Interventional Cardiology,
Hospital La Paz, CIBER-CV, IdiPAZ, Paseo La Castellana, 261, Madrid 28046,
Spain
(Unverdorben) 43 Millstone Lane, Pottstown, PA 19465, United States
(Arroyo-Ucar) Hospital de Vinalopo, Elche, Spain
(Thiele) Heart Center Leipzig, University of Leipzig, Leipzig, Germany
Publisher
Springer Science and Business Media Deutschland GmbH

<32>
Accession Number
634093241
Title
A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial of
High-Dose, Short-Term Vitamin D Administration in the Prevention of Acute
Kidney Injury after Cardiac Surgery.
Source
CardioRenal Medicine. 11 (1) (pp 52-58), 2021. Date of Publication:
February 2021.
Author
Eslami P.; Hekmat M.; Beheshti M.; Baghaei R.; Mirhosseini S.M.;
Pourmotahari F.; Ziai S.A.; Foroughi M.
Institution
(Eslami, Foroughi) Cardiovascular Research Center, Shahid Beheshti
University of Medical Sciences, Saadat Abad, Tehran 19987-34383, Iran,
Islamic Republic of
(Hekmat, Beheshti, Baghaei, Mirhosseini, Pourmotahari) Clinical Research
and Development Center, Shahid Modarres Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ziai) Department of Pharmacology, School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
S. Karger AG
Abstract
Background: Acute kidney injury (AKI) after cardiac surgery is a
relatively common complication affecting short- A nd long-term survival.
The renoprotective effect of vitamin D (VitD) has been confirmed in
several experimental models. This study was conducted to evaluate the
effect of high-dose VitD administration in patients with VitD
insufficiency on the incidence of postoperative AKI, the urinary level of
tubular biomarkers, and serum anti-inflammatory biomarker after coronary
artery bypass graft. Design and Method: In this randomized double-blind
controlled clinical trial, the patients were randomly allocated to either
the VitD group (n = 50), receiving 150,000 IU VitD tablets daily for 3
consecutive days before surgery or the control group (n = 61), receiving
placebo tablets. Result(s): There was no difference in the incidence
of postoperative AKI between the groups. Both of the urinary levels of
interleukin-18 and kidney injury molecule-1 were significantly increased
after the operation (p < 0.001, for both). Also, the serum level of
interleukin-10 was increased after 3 days of VitD supplementation (p =
0.001). In comparison with the control group, it remained on a higher
level after the operation (p < 0.001) and the next day (p = 0.03). The
patients with AKI had more postoperative bleeding and received more blood
transfusion. Conclusion(s): VitD pretreatment was unable to impose
any changes in the incidence of AKI and the urinary level of renal
biomarkers. However, high-dose administration of VitD may improve the
anti-inflammatory state before and after the operation. Further studies
are needed to assess the renoprotective effect of VitD on coronary surgery
patients. Copyright © 2021 S. Karger AG, Basel. All rights
reserved.

<33>
Accession Number
2007577717
Title
PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of
tricuspid regurgitation: a propensity-matched analysis.
Source
Clinical Research in Cardiology. 110 (3) (pp 451-459), 2021. Date of
Publication: March 2021.
Author
Sugiura A.; Vogelhuber J.; Ozturk C.; Schwaibold Z.; Reckers D.; Goto T.;
Kavsur R.; Becher M.U.; Zimmer S.; Nickenig G.; Weber M.
Institution
(Sugiura, Vogelhuber, Ozturk, Schwaibold, Reckers, Kavsur, Becher, Zimmer,
Nickenig, Weber) Herzzentrum Bonn, Medizinische Klinik und Poliklinik II,
Universitatsklinikum Bonn, Venusberg-Campus 1, Bonn 53127, Germany
(Goto) Department of Clinical Epidemiology and Health Economics, School of
Public Health, University of Tokyo, TXP Medical Co. Ltd., Tokyo, Japan
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Transcatheter tricuspid valve repair (TTVR) is a promising
technique for the treatment of tricuspid regurgitation (TR). Data
comparing the performance of novel edge-to-edge devices (PASCAL and
MitraClip-XTR) are scarce. Method(s): We identified 80 consecutive
patients who underwent TTVR using either the PASCAL or MitraClip-XTR
system to treat symptomatic TR from July 2018 to June 2020. To adjust for
baseline imbalances, we performed a propensity score (PS) 1:1 matching.
The primary endpoint was a reduction in TR severity by at least one grade
at 30 days. Result(s): The PS-matched cohort (n = 44) was at
high-surgical risk (EuroSCORE II: 7.5% [interquartile range (IQR)
4.8-12.1%]) with a mean TR grade of 4.3 +/- 0.8 and median coaptation gap
of 6.2 mm [IQR 3.2-9.1 mm]. The primary endpoint was similarly observed in
both groups (PASCAL: 91% vs. MitraClip-XTR: 96%). Multiple device
implantation was the most common form (59% vs. 82%, p = 0.19), and the
occurrence of SLDA was comparable between the PASCAL and MitraClip-XTR
system (5.7% [2 of 35 implanted devices] vs. 4.4% [2 of 45 implanted
devices], p = 0.99). No periprocedural death or conversions to surgery
occurred, and 30-day mortality (5.0% vs. 5.0%, log-rank p = 0.99) and
3-month mortality (10.0% vs. 5.0%, log-rank p = 0.56) were similar between
both groups. During follow-up, functional NYHA class, 6-min walking
distance, and health status improved in both groups. Conclusion(s):
Both TTVR devices, PASCAL and MitraClip-XTR, appeared feasible and
comparable for an effective TR reduction. Randomized head-to-head
comparisons will help to further define the appropriate scope of
application of each system. Copyright © 2020, The Author(s).

<34>
Accession Number
633364533
Title
Robot-assisted coronary artery bypass surgery: a systematic review and
meta-analysis of comparative studies.
Source
Canadian journal of surgery. Journal canadien de chirurgie. 63 (6) (pp
E491-E508), 2020. Date of Publication: 01 Nov 2020.
Author
Hammal F.; Nagase F.; Menon D.; Ali I.; Nagendran J.; Stafinski T.
Institution
(Hammal, Nagase, Menon, Ali, Nagendran, Stafinski) From the Health
Technology & Policy Unit, School of Public Health, University of Alberta,
Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac
Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of
Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB
(Ali); and the Division of Cardiac Surgery, Department of Surgery,
Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB
(Nagendran)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Robot-assisted coronary bypass (RCAB) surgery has been
proposed as an alternative to conventional coronary artery bypass grafting
(C-CABG) for managing coronary heart disease, but the evidence on its
performance compared to other existing treatments is unclear. The aim of
this study was to assess, through a systematic review of comparative
studies, the safety and clinical effectiveness of RCAB compared to C-CABG
and other minimally invasive approaches for the treatment of coronary
heart disease. METHOD(S): We conducted a systematic review of primary
studies in the English-language literature comparing RCAB to existing
treatment options (C-CABG, minimally invasive direct coronary artery
bypass [MIDCAB] and port-access coronary artery bypass [PA-CAB]) following
Cochrane Collaboration guidelines. Meta-analyses were performed where
appropriate. RESULT(S): We reviewed 13 studies: 11 primary studies of
RCAB (v. C-CABG in 7, v. MIDCAB in 3 and v. PA-CAB in 1) and 2 multicentre
database studies (RCAB v. non-RCAB). The overall quality of the evidence
was low. Most studies showed no significant benefit of RCAB over other
treatments in a majority of outcome variables. Meta-analyses showed that
RCAB had lower rates of pneumonia or wound infection than C-CABG, and
shorter intensive care unit length of stay than C-CABG or MIDCAB.
Individual studies showed that RCAB had some better outcomes than C-CABG
(ventilation time, transfusion, postoperative pain, hospital length of
stay) or MIDCAB (transfusion, postoperative pain, time to return to normal
activities, physical functioning and hospital length of stay). The review
of the database studies showed that RCAB was statistically superior to
non-RCAB approaches in postoperative pain, renal failure, transfusion,
reoperation for bleeding, stroke and hospital length of stay; however, the
difference between the 2 groups in several of these outcomes was small.
 CONCLUSION(S): Although the findings from this review of comparative
studies of RCAB appear promising and suggest that RCAB may offer some
benefits to patients, in the absence of randomized controlled trials,
these results should be interpreted cautiously.

<35>
Accession Number
634315512
Title
Major infections after blood transfusion in isolated coronary arterybypass
surgery patients: A meta-analysis.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. United States. 136 (SUPPL 1) (pp 25), 2020. Date of
Publication: November 2020.
Author
Mosalem O.; Kherallah S.; Mujer M.; Agarwal P.; Varghese M.T.; Elshafie
A.; Garces C.C.; Abdelsamia M.; Rayamajhi S.
Publisher
American Society of Hematology
Abstract
BACKGROUND Blood transfusion in patients undergoing coronary artery bypass
surgery (CABG) remains highdespite advances in perioperative blood
conservation. Several studies have shown poorer clinicaloutcomes in
isolated CABG patients who receive blood products, including an increased
rate of renalfailure, non-fatal myocardial infarction, and death. Our
study sought to determine the impact of bloodtransfusion on sternal wound
infections and other major infections in patients who undergo
isolatedCABG. METHODS We performed a systematic search using PubMed,
Google Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without language
restriction until May 15, 2020. A random-effects model wasutilized to
calculate risk ratio (RR) and mean difference (MD) with 95% confidence
interval (CI). In patients undergoing isolated CABG, sternal wound
infections [RR 1.73 (95% CI: 1.35 to 2.20;p<0.0001)] and overall major
infections [RR 1.70 (95% CI: 1.39 to 2.08; p<0.0001)] were
significantlyhigher in those who received a periprocedural blood
transfusion. Thirty-day mortality was lower inpatients who did not receive
any transfusion [RR 2.46 (95% CI: 1.09-5.56;p=0.03)]. The test of
heterogeneity was low for clinical outcomes aside from 30-day mortality.
CONCLUSION Periprocedural blood transfusion is associated with an
increased risk of sternal wound infections and major infections and higher
30-day mortality in patients who undergo isolated CABG (Figure Presented).

<36>
Accession Number
634315006
Title
Capital Do-Re-Mi: A randomized trial of dobutamine compared to milrinone
in cardiogenic shock.
Source
Circulation. Conference: American Heart Association Resuscitation Science
Symposium, ReSS 2020. 142 (SUPPL 4) (no pagination), 2020. Date of
Publication: November 2020.
Author
Mathew R.; Santo P.D.; Marbach J.; Hutson J.; Simard T.; Jung R.; Merdad
A.; Almufleh A.; Weng W.; Abdel-Razek O.; Fernando S.; Kyeremanteng K.;
Bernick J.; Wells G.; Froeschl M.; Labinaz M.; May M.R.L.; Russo J.J.;
Hibbert B.M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cardiogenic shock (CS) is associated with significant
morbidity and mortality. Although inotropic support is a mainstay of
medical therapy for CS, little evidence exists to guide the selection of
inotropic agents in clinical practice. Method(s): In this double
blind randomized controlled trial, we assigned patients with SCAI class B
to E shock to either milrinone or dobutamine for inotropic support.
Therapy was titrated based on clinical, biochemical and hemodynamic
response as evaluated by the treating physician. The primary outcome was a
combined endpoint of in hospital mortality, non-fatal MI, stroke, new
initiation of renal replacement therapy (RRT), need for MCS or cardiac
transplant, or cardiac arrest with successful resuscitation. Secondary
outcomes included individual components of the primary outcome.
 Result(s): Among 192 participants, there was no significant
difference in the primary outcome, occurring in 49% (47 of 96) of patients
in the milrinone arm and 54% (52 of 96) patients in the dobutamine group
(RR 0.90, 95% CI of 0.69-1.19, p-value = 0.47). There were also no
differences in important secondary outcomes between milrinone and
dobutamine, including in-hospital mortality 37% (35 of 96) vs 43% (41 of
96) (RR 0.85, 95% CI 0.60-1.21, p-value = 0.38) or need for RRT 22%(21 of
96) vs 17% (16 of 96) (RR 1.31, 95% CI 0.73-2.36, p-value = 0.36).
 Conclusion(s): In this randomized clinical trial of milrinone and
dobutamine in CS, there was no difference in the primary composite outcome
or in important secondary outcomes. The selection of inotropic agent could
reasonably be based on physician comfort, cost and individual response to
therapy.

<37>
Accession Number
634314696
Title
Rapid and deep hematologic responses are associated with improved major
organ deterioration progression-free survival innewly diagnosed al
amyloidosis: Results from andromeda.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. United States. 136 (SUPPL 1) (pp 6-7), 2020. Date of
Publication: November 2020.
Author
Wechalekar A.D.; Palladini G.; Merlini G.; Comenzo R.L.; Jaccard A.; Tran
N.; Pei H.; Vasey S.Y.; Tromp B.; Weiss B.M.; Vermeulen J.; Kastritis E.
Publisher
American Society of Hematology
Abstract
Background: As immunoglobulin light chains present in AL amyloidosis are
considered to be toxicto involved organs, especially the heart, rapid and
deep hematologic remission with reduction of these light chains with
frontline therapy may be crucial to improving long-term clinical
outcomes.ANDROMEDA (NCT03201965) is the first phase 3 study in this
patient population to evaluate majororgan deterioration progression-free
survival (MOD-PFS), a composite endpoint of time to end-stagecardiac
disease (requiring cardiac transplant, left ventricular assist device, or
intra-aortic balloonpump); end-stage renal disease (requiring hemodialysis
or renal transplant); hematologicprogression per consensus guidelines1;
and death. Here, we report the impact of early and deephematologic
responses on MOD-PFS. Method(s): ANDROMEDA is a randomized,
open-label, active-controlled phase 3 study of patients with newly
diagnosed AL amyloidosis who received cyclophosphamide, bortezomib, an
ddexamethasone (VCd) +/- daratumumab subcutaneous (DARA SC; DARA 1800 mg
coformulated with recombinant human hyaluronidase PH20 in 15 mL). Key
eligibility criteria were newly diagnosed ALamyloidosis with measurable
hematologic disease, >=1 involved organ, cardiac stage I-IIIA, eGFR
>=20mL/min, and absence of symptomatic multiple myeloma. Disease
evaluations occurred every 4weeks during Cycles 1-6. Hematologic responses
were adjudicated by an Independent ReviewCommittee. Landmark analyses for
response were performed at 1 and 3 months (+/- 7 days). Analyses of
hematologic responses and MOD-PFS were performed on the intent-to-treat
analysis set. Patients with out a baseline or post-baseline assessment
were censored at randomization for the MOD-PFSanalysis. Hazard ratios and
corresponding 95% confidence intervals were estimated based on
Coxproportional hazard model. Result(s): A total of 388 patients were
randomized to DARA-VCd (n=195) or VCd alone (n=193).Baseline
characteristics were well balanced between groups. The proportions of
patients with heart and kidney involvement were 71% and 59%, respectively.
Median follow-up was 11.4 months (range,0.03-21.3+). For the 1- and
3-month landmark analysis, hematologic response was available for 356and
289 patients, respectively. Hematologic response rates by treatment group
at 1 and 3 months areshown in the Table. MOD-PFS was longer in patients
with complete response (CR)/very good partialresponse (VGPR) at 1 and 3
months vs patients with lower levels of response (Figure). CR/VGPR at 1and
3 months was associated with reduced risk of death or major organ
deterioration in amultivariate analysis adjusting for baseline difference
between involved and uninvolved free lightchains and cardiac stage, (HR:
0.399, P=0.0006 and HR: 0.262, P=0.0003, respectively). At 1 and 3months,
cardiac and renal response rates were higher in those who achieved early
and deephematologic responses (CR and VGPR). Conclusion(s): CR/VGPR
at 1 and 3 months was associated with a reduced risk of major
organdeterioration and death in patients with newly diagnosed AL
amyloidosis. These data confirm thatinitial therapy that achieves rapid
and deep hematological responses is essential to improving long-term
outcomes in AL amyloidosis.

<38>
Accession Number
634311490
Title
The fares study: A multicenter, randomized, active-control, pragmatic,
phase 2 pilot study comparing prothrombin complex concentrate versus
frozen plasma in bleeding adult cardiac surgical patients.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. United States. 136 (SUPPL 1) (pp 28-29), 2020. Date
of Publication: November 2020.
Author
Karkouti K.; Callum J.L.
Publisher
American Society of Hematology
Abstract
Introduction: Coagulopathic bleeding is a frequent complication of cardiac
surgery and can lead to excessive blood loss, blood product transfusion,
and bleeding-related complications. Hemostatic management in bleeding
surgical patients is evolving towards targeted therapy with purified
products undergoing pathogen reduction technology. Unlike frozen plasma
(FP), purified prothrombin complex concentrates (PCCs) do not require ABO
blood type matching or thawing, are pathogen-reduced, and are associated
with a lower risk of transfusion-associated circulatory
SJvertoadaandDtratnafusion-related acute lung injury. The FARES study will
compare the efficacy and safety of PCC (Octaplex; Octapharma) versus FP in
bleeding cardiac surgical patients with confirmed or suspected
coagulopathy. Preliminary non-randomized studies suggest PCC may be
superior to plasma for management of bleeding after cardiac surgery.
 Method(s): The randomized, active-control, single-blinded, pragmatic,
investigator-initiated, Phase 2 FARES pilot study will enrolled 120
bleeding adult cardiac surgery patients requiring coagulation factor
replacement from two hospitals to achieve 100 treated patients. The study
outline is shown in Figure 1. Patients were randomized to PCC or FP, with
two weight-based doses, for management of bleeding where coagulation
factor deficiency is known or suspected (patients over 50 kg were
transfused either 2000 IU of PCC or 4 units of plasma; patients under 50
kg were transfused 1500 IU of PCC or 3 units of plasma). Required second
doses will be given according to randomization group allocation, but all
patients will receive FP for their third and any subsequent doses. The
primary endpoint is hemostatic effectiveness and transfusion requirements.
Adverse events will be recorded from the beginning of surgery.
 Result(s): The study commenced in September of 2019 and completed
enrollment of the last patient in June of 2020. Results were monitored and
overseen by the Independent Data and Safety Monitoring Committee. The
database will be locked in August 2020 after 28 day follow-up is complete
for all patients. Statistical analysis plan is complete. The results will
inform a definitive, pragmatic, multicenter trial to determine if PCCs can
replace plasma for the management of coagulopathy in the bleeding cardiac
surgery patient. Conclusion(s): This study will determine the
feasibility, and inform the design and primary outcome parameter, of a
definitive Phase 3 trial comparing the efficacy and safety of PCC versus
FP in bleeding cardiac surgical patients requiring coagulation factor
replacement. The pilot study results will also be used in sample size
calculations and to aid detection of any safety issues.

<39>
Accession Number
634309649
Title
Reduction in absolute involved free light chain and difference between
involved and uninvolved free light chain is associated with prolonged
major organ deterioration progression-free survival in patients with newly
diagnosed al amyloidosis receiving bortezomib, cyclophosphamide, and
dexamethasone with or without daratumumab: results from andromeda.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. United States. 136 (SUPPL 1) (pp 48-50), 2020. Date
of Publication: November 2020.
Author
Comenzo R.L.; Kastritis E.; Palladini G.; Minnema M.C.; Wechalekar A.D.;
Jaccard A.; Sanchorawala V.; Lee H.C.; Gibbs S.D.; Mollee P.; Venner C.P.;
Lu J.; Schonland S.; Gatt M.; Suzuki K.; Kim K.; Cibeira M.T.; Beksac M.;
Libby E.; Valent J.; Hungria V.T.M.; Wong S.W.; Rosenzweig M.; Bumma N.;
Chauveau D.; Dimopoulos M.A.; Tran N.; Qin X.; Vasey S.Y.; Tromp B.; Weiss
B.M.; Vermeulen J.; Merlini G.
Publisher
American Society of Hematology
Abstract
Background: Systemic AL amyloidosis is characterized by the deposition of
insoluble amyloid fibrils produced by light chains synthesized by clonal
CD38+ plasma cells. Combining daratumumab (DARA) with bortezomib,
cyclophosphamide, and dexamethasone (VCd) has demonstrated significantly
improved outcomes in patients with AL amyloidosis. The classification of
hematologic complete response (CR) in this disease is evolving, and the
absolute reduction of the involved free light chain (iFLC) and the
difference between iFLC and uninvolved free light chain (dFLC) are being
recognized as very meaningful endpoints. Here, we present results from the
ANDROMEDA study (NCT03201965) to demonstrate the impact of achieving deep
reductions of iFLC and dFLC on major organ deterioration progression-free
survival (MOD-PFS), a novel, key secondary endpoint in this study.
 Method(s): Key eligibility criteria included newly diagnosed AL
amyloidosis with measurable hematologic disease (serum monoclonal protein
>=0.5 g/dL by protein electrophoresis or serum free light chain >=5.0
mg/dL with an abnormal kappa:lambda ratio or dFLC >=50 mg/L), >=1 involved
organ, cardiac stage I-IIIA, eGFR >=20 mL/min, and absence of symptomatic
multiple myeloma. Patients were randomized (1:1) to receive DARA-VCd or
VCd alone. All patients received bortezomib (1.3 mg/m2
subcutaneous [SC] weekly), cyclophosphamide (300 mg/m2 oral
[PO] or intravenous [IV] weekly), and dexamethasone (20-40 mg PO or IV
weekly) for six 28-day cycles. DARA SC (1800 mg, co-formulated with
recombinant human hyaluronidase PH20 in 15 mL) was administered by
injection weekly in Cycles 1-2, every other week in Cycles 3-6, and every
4 weeks thereafter for up to 24 cycles. Disease evaluations occurred every
4 weeks (Cycles 1-6) and every 8 weeks (after Cycle 7) until major organ
deterioration, death, end of study, or withdrawal. The primary endpoint
was overall (ie, at any time) hematologic CR rate, defined here as
normalization of FLC levels and ratio (FLCr) and negative serum and urine
immunofixation, confirmed at a subsequent visit; normalization of
uninvolved FLC level and FLCr were not required if iFLC<upper limit of
normal.1 - 2 The following criteria for deep hematological response were
evaluated: iFLC <20 mg/L regardless of FLCr3 and dFLC<10 regardless of
FLCr.4 MOD-PFS is a composite endpoint defined as any one of the following
events (whichever comes first): death; cardiac deterioration (requiring
cardiac transplant, left ventricular assist device or intra-aortic balloon
pump); end stage renal disease requiring hemodialysis or renal transplant;
or hematologic progression per consensus guidelines.1 Analyses of deep
hematological responses were performed on the intent-to-treat analysis
set; patients without a baseline assessment or post-baseline assessment
were considered non-responders. Descriptive statistics were used to
summarize overall response rates. Kaplan-Meier curves were plotted for
MOD-PFS by hematologic response status. Result(s): A total of 388
patients were randomized to receive DARA-VCd (n=195) or VCd alone (n=193).
Baseline characteristics were well balanced between treatment groups. The
median age was 64 years and 65% of patients had >2 organs involved. The
proportions of patients with heart and kidney involvement were 7 1% and
59%, respectively, and the proportions of patients with cardiac stage I,
II, and IIIA were 23%, 40%, and 37%, respectively. The median duration of
treatment was 9.6 months for DARA-VCd and 5.3 months for VCd. Median
follow-up was 11.4 months (range, 0.03- 21.3+). The rates of deep
hematological responses by all criteria strongly favored the DARA-VCd
treatment arm (Table). MOD-PFS was longer in patients achieving deep
hematological responses by all criteria (Figure). In addition, the
corresponding MOD-PFS was similar regardless of the hematological response
criteria used. Conclusion(s): Regardless of the criteria used, the
addition of DARA to VCd increased the rates of deep hematologic responses
in patients with newly diagnosed AL amyloidosis, which, in turn, was
associated with prolonged MOD-PFS. These results support the benefit of
DARA in this patient population.

<40>
Accession Number
633959441
Title
PICS-AICS Virtual Symposium.
Source
Pediatric Cardiology. Conference: PICS-AICS Virtual Symposium. 41 (6) (no
pagination), 2020. Date of Publication: August 2020.
Author
Anonymous
Publisher
Springer
Abstract
The proceedings contain 104 papers. The topics discussed include: surgical
treatment of infants with critical aortic stenosis; immediate vs. staged
multi-vessel PCI strategy for patients with STEMI and multi-vessel
disease: a systematic review and meta-analysis; atretic aortic
coarctation: usefulness of microcatheter and CTO wires; early results of
PT valve in native right ventricular outflow tract for patients with
severe pulmonary regurgitation; juxtaposition of atrial appendages and ASD
device closure - the truth in the lie; evaluation of short and
intermediate-term follow-up results of percutaneous closure of ventricular
septal defects using different devices: a single-center experience from
Mansoura, Egypt; hypoxemia following balloon pulmonary valvuloplasty for
critical pulmonary stenosis; and short-term outcomes of percutaneous
device closure of patent ductus arteriosus using the amplatzer duct
occluder device in comparison to the nitoccluder PDA-R device.

<41>
Accession Number
2011159578
Title
Role of targeted and universal mupirocin-based decolonization for
preventing surgical-site infections in patients undergoing cardiothoracic
surgery: A systematic review and meta-analysis.
Source
Experimental and Therapeutic Medicine. 21 (5) (pp 1-12), 2021. Date of
Publication: May 2021.
Author
WANG L.; JI Q.; HU X.
Institution
(WANG, JI) Departments of Operating Room, The First People's Hospital of
Lianyungang City, Lianyungang, Jiangsu 222002, China
(HU) Departments of Tongguan Operating Room, The First People's Hospital
of Lianyungang City, Lianyungang, Jiangsu 222002, China
Publisher
Spandidos Publications
Abstract
The purpose of the present study was to provide a systematic literature
review and pool evidence on the efficacy of mupirocin-based decolonization
protocol in reducing surgical-site infections (SSIs) in patients
undergoing cardiothoracic (CT) surgery based on their Staphylococcus (S.)
aureus carrier state. The PubMed, Embase, Ovid, BioMed Central, Cochrane
Central Register of Controlled Trials and Google Scholar databases were
searched for studies comparing mupirocin-based decolonization with
controls for reducing SSIs in patients following CT surgery. Studies were
grouped based on the targeted population of intervention, i.e. carriers or
all patients. A total of 17 studies were included. Of these, 8 studies
used targeted mupirocin-based decolonization, while universal
decolonization was performed in 9 studies. The results were conflicting
for studies performing targeted decolonization and it was not possible to
perform a meta-analysis due to non-homogenous studies. Pooled analysis of
34,859 patients indicated that universal mupirocin-based decolonization
significantly reduced the risk of all SSIs [risk ratio (RR): 0.54; 95% CI:
0.40,0.75; I2=73.35%]. The intervention significantly reduced the risk of
superficial SSIs (RR: 0.37; 95% CI: 0.25,0.55; I2=0%) but not of deep SSIs
(RR: 0.45; 95% CI: 0.19,1.09; I2=80.67%). The results indicated a
significantly reduced risk of S. aureus SSIs (SA-SSIs) with
mupirocin-based decolonization (RR: 0.44; 95% CI: 0.32,0.61; I2=0%) but
not for methicillin-resistant S. aureus (MRSA-SSIs; RR: 0.25; 95% CI:
0.05,1.28; I2=79.07%). Evidence on the role of targeted mupirocin-based
decolonization to reduce SSIs after CT surgery was non-coherent and
inconclusive. Analysis of low-quality retrospective studies suggested that
universal mupirocin-based decolonization may reduce all SSIs, superficial
SSIs and SA-SSIs, but not deep SSIs or MRSA-SSIs in patients after CT
surgery. Copyright © 2021 Spandidos Publications. All rights
reserved.

<42>
Accession Number
2011153828
Title
Rationale and design of the CLEAR-outcomes trial: Evaluating the effect of
bempedoic acid on cardiovascular events in patients with statin
intolerance.
Source
American Heart Journal. 235 (pp 104-112), 2021. Date of Publication: May
2021.
Author
Nicholls S.; Lincoff A.M.; Bays H.E.; Cho L.; Grobbee D.E.; Kastelein
J.J.; Libby P.; Moriarty P.M.; Plutzky J.; Ray K.K.; Thompson P.D.;
Sasiela W.; Mason D.; McCluskey J.; Davey D.; Wolski K.; Nissen S.E.
Institution
(Nicholls) Monash Cardiovascular Research Centre, Monash University,
Melbourne, Australia
(Lincoff, Cho, Mason, McCluskey, Davey, Wolski, Nissen) Department of
Cardiovascular Medicine, Cleveland
(Bays) Louisville Metabolic and Atherosclerosis Research Center,
Louisville, KY, United States
(Grobbee) University Medical Center Utrecht, Julius Center, Utrecht,
Netherlands
(Kastelein) Department of Vascular Medicine, University of Amsterdam
Academic Medical Center, Amsterdam, Netherlands
(Libby, Plutzky) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Moriarty) Clinical Pharmacology, University of Kansas Medical Center,
Kansas City, KS, United States
(Ray) Department of Primary Care & Public Health, Imperial College London,
London, United Kingdom
(Thompson) Division of Cardiology, Hartford Hospital, Hartford, CT, United
States
(Sasiela) Esperion Therapeutics, Ann Arbor, MI, United States
Publisher
Mosby Inc.
Abstract
Although statins play a pivotal role in the prevention of atherosclerotic
cardiovascular disease, many patients fail to achieve recommended lipid
levels due to statin-associated muscle symptoms. Bempedoic acid is an oral
pro-drug that is activated in the liver and inhibits cholesterol synthesis
in hepatocytes, but is not activated in skeletal muscle which has the
potential to avoid muscle-related adverse events. Accordingly, this agent
effectively lowers atherogenic lipoproteins in patients who experience
statin-associated muscle symptoms. However, the effects of bempedoic acid
on cardiovascular morbidity and mortality have not been studied. Study
design: Cholesterol Lowering via Bempedoic acid, an ACL-Inhibiting Regimen
(CLEAR) Outcomes is a randomized, double-blind, placebo-controlled
clinical trial. Included patients must have all of the following: (i)
established atherosclerotic cardiovascular disease or have a high risk of
developing atherosclerotic cardiovascular disease, (ii) documented statin
intolerance, and (iii) an LDL-C >=100 mg/dL on maximally-tolerated
lipid-lowering therapy. The study randomized 14,014 patients to treatment
with bempedoic acid 180 mg daily or matching placebo on a background of
guideline-directed medical therapy. The primary outcome is a composite of
the time to first cardiovascular death, nonfatal myocardial infarction,
nonfatal stroke, or coronary revascularization. The trial will continue
until 1620 patients experience a primary endpoint, with a minimum of 810
hard ischemic events (cardiovascular death, nonfatal myocardial infarction
or nonfatal stroke) and minimum treatment duration of 36 months and a
projected median treatment exposure of 42 months. Conclusion(s):
CLEAR Outcomes will determine whether bempedoic acid 180 mg daily reduces
the incidence of adverse cardiovascular events in high vascular risk
patients with documented statin intolerance and elevated LDL-C
levels. Copyright © 2020 Elsevier Inc.

<43>
Accession Number
634319759
Title
Pupillometric Monitoring of Nociception in Cardiac Anesthesia.
Source
Deutsches Arzteblatt international. 117 (49) (pp 833-840), 2020. Date of
Publication: 04 Dec 2020.
Author
Bartholmes F.; Malewicz N.M.; Ebel M.; Zahn P.K.; Meyer-Friessem C.H.
Institution
(Bartholmes) Klinik fur Anasthesie
Publisher
NLM (Medline)
Abstract
BACKGROUND: High-dose opioids are conventionally used for cardiac
anesthesia, but without monitoring of nociception. In non-cardiac surgical
procedures the intra - operative dose of opioids can be individualized and
reduced with pupillometric monitoring of the pupillary pain index (PPI;
scale 1-9). A randomized controlled trial was carried out to explore
whether pupillometry can be used for nociception monitoring in cardiac
anesthesia and whether it leads to opioid reduction. METHOD(S): A
sample of 57 cardiac surgery patients receiving continuously administered
sufentanil (initial dosage 0.7 mug*kg-1*h-1) was divided into a PPI group
(sufentanil reduction if PPI<3 up to a minimum of 0.15 mug*kg-1*h-1, n=32)
and a control group (standard anesthesia; n = 25). The primary outcome was
the time from the end of anesthesia to extubation. The secondary outcomes
were total intraoperative dose of sufentanil/noradrenaline, postoperative
pain intensity (numeric rating scale [NRS] 0-10) and intraoperative
awareness. German Clinical Trials Registry no. DRKS 00012329.
 RESULT(S): The primary outcome, extubation time, did not differ
between the two groups (1.14 h, 95% confidence interval [-0.99; 3.27], p =
0.592). Compared with the control patients (68% male, age 70 +/- 10.4
years, PPI 1.1 +/- 0.2), the mean sufentanil infusion rate in the PPI
patients (81% male, age 68 +/- 10.3 years, PPI 1.1 +/- 0.2) decreased by
81.8% (-0.68 mug*kg-1*h-1 [-0,7; -0.67], p<0.001) to the predetermined
minimum level, without intraoperative awareness. Moreover, the
noradrenaline dose was reduced by 56% (1235.51 mug [321.91; 2149.12], p =
0.005) and the postoperative pain intensity by 45% (2.11 NRS [0.93; 3.3]
after 24 h, p = 0.003). CONCLUSION(S): Pupillometry is appropriate
for nociception monitoring in cardiac anesthesia. Thereby a considerable
reduction of intraoperative opioids as well as increased intraoperative
hemodynamic stability was achieved and postoperative opioid-induced
hyperalgesia was prevented. The consistently low PPI scores, indicating
adequate analgesia, suggest that further reduction of opioid doses is
feasible.

<44>
Accession Number
2010583128
Title
Uniportal and three-portal video-assisted thoracic surgery pulmonary
lobectomy for early-stage lung cancer (UNIT trial): study protocol of a
single-center randomized trial.
Source
Trials. 22 (1) (no pagination), 2021. Article Number: 163. Date of
Publication: December 2021.
Author
Mendogni P.; Mazzucco A.; Palleschi A.; Rosso L.; Righi I.; Carrinola R.;
Damarco F.; Privitera E.; Fumagalli J.; Bonitta G.; Nosotti M.; Tosi D.
Institution
(Mendogni, Mazzucco, Palleschi, Rosso, Righi, Carrinola, Damarco,
Privitera, Bonitta, Nosotti, Tosi) Thoracic Surgery and Lung Transplant
Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,
University of Milan, Via Francesco Sforza 35, Milan, Italy
(Fumagalli) Department of Anesthesia and Critical Care, Fondazione IRCCS
Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Nosotti) Department of Pathophysiology and Transplantation, Universita
degli Studi di Milano, Milan, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) lobectomy is
currently the recommended approach for treating early-stage non-small cell
lung cancer (NSCLC). Different VATS approaches have been proposed so far,
and the actual advantages of one technique over the other are still under
debate. The aim of our study is to compare postoperative pain and
analgesic drug consumption in uniportal VATS and triportal VATS for
pulmonary lobectomy in early-stage lung cancer patients. Method(s):
This study is a single-center, prospective, two-arm, parallel-group,
randomized controlled trial. It is designed to compare uniportal
video-assisted thoracic surgery (u-VATS) and three-port video-assisted
thoracic surgery (t-VATS) in terms of postoperative pain. The trial will
enroll 120 patients with a 1:1 randomization. The primary outcome is the
assessment of analgesic drug consumption. Secondary outcomes are
postoperative pain measurement, evaluation of postoperative pulmonary
function, and metabolic recovery after pulmonary lobectomy.
 Discussion(s): The choice of which VATS approach to adopt for
treating patients undergoing pulmonary resection mostly depends on the
surgeon's preferences; therefore, it is hard to prove whether one VATS
technique is superior to the other. Moreover, postoperative analgesic
protocols vary consistently among different centers. To date, only a few
studies have evaluated the effects of the most popular VATS techniques.
There is no evidence about the difference between multiport VATS and
u-VATS in terms of postoperative pain. We hope that the results of our
trial will provide valuable information on the outcomes of these different
surgical approaches. Trial registration: ClinicalTrials.gov NCT03240250.
Registered on 07 August 2017; retrospectively registered. Copyright
© 2021, The Author(s).

<45>
Accession Number
2011151949
Title
Coexistence of Takayasu's Arteritis in Patients with Inflammatory Bowel
Diseases.
Source
Gastroenterology Research and Practice. 2021 (no pagination), 2021.
Article Number: 8831867. Date of Publication: 2021.
Author
De Almeida Martins C.; Caon A.E.R.; Facanali C.B.G.; Sobrado C.W.; Nahas
S.C.; Pereira R.M.R.; Margalit-Yehuda R.; Kopylov U.; Queiroz N.S.F.
Institution
(De Almeida Martins, Caon, Facanali, Sobrado, Nahas, Queiroz) Department
of Gastroenterology, Division of Colorectal Surgery, University of Sao
Paulo, School of Medicine, Sao Paulo, Brazil
(Pereira) Department of Rheumatology, University of Sao Paulo, School of
Medicine, Sao Paulo, Brazil
(Margalit-Yehuda, Kopylov) Gastroenterology Institute, Sheba Medical
Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel
Aviv, Israel
Publisher
Hindawi Limited
Abstract
Background. Takayasu's arteritis (TA) and inflammatory bowel disease (IBD)
are chronic inflammatory granulomatous disorders that have rarely been
concomitantly reported in case reports and small case series. Objective.
We report a series of seven cases of TA and IBD association in two
referral centers with a comprehensive review of literature. Methods. We
analyzed retrospectively the electronic medical charts of TA-IBD patients
at the University Hospital of Sao Paulo, Brazil, and at the Sheba Medical
Center at Tel Aviv University, Israel. Results. Overall, five patients had
Crohn's disease (DC) and two had ulcerative colitis (UC), and they were
mostly female and non-Asian. All patients developed IBD first and,
subsequently, TA. Two underwent colectomy and one ileocecectomy due to IBD
activity, while three required cardiovascular surgery due to TA activity.
Most patients are currently in clinical remission of both diseases with
conventional drug treatment. Conclusion. Although the coexistence of TA
and IBD is uncommon, both seem to be strongly associated through
pathophysiological pathways. Copyright © 2021 Camilla de Almeida
Martins et al.

<46>
Accession Number
634295315
Title
Understanding parents' decision-making on participation in clinical trials
in children's heart surgery: A qualitative study.
Source
BMJ Open. 11 (2) (no pagination), 2021. Article Number: e044896. Date of
Publication: 23 Feb 2021.
Author
Drury N.E.; Menzies J.C.; Taylor C.J.; Jones T.J.; Lavis A.C.
Institution
(Drury, Jones) Paediatric Cardiac Surgery, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Drury, Jones) Institute of Cardiovascular Sciences, University of
Birmingham, Birmingham, United Kingdom
(Menzies) Paediatric Intensive Care, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Taylor) Nuffield Department of Primary Care Health Sciences, University
of Oxford, Oxford, United Kingdom
(Lavis) Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives Few children undergoing heart surgery are recruited to clinical
trials and little is known about the views and attitudes of parents
towards trials. This study explored parents' perspectives on
decision-making about their child's participation in a clinical trial
during their elective cardiac surgery. Design Qualitative interview study.
Setting Single-centre substudy of a multicentre, double-blind, randomised
controlled trial to investigate the effects of remote ischaemic
preconditioning in children undergoing cardiac surgery. Participants
Parents of children approached to participate in the trial, both
consenters and decliners. Methods Semistructured interviews were conducted
face-to-face or by telephone following discharge, digitally
audio-recorded, transcribed and thematically analysed. Results Of 46
patients approached for the trial, 24 consenting and 2 declining parents
agreed to participate in an interview (21 mothers, 5 fathers). Parental
decision-making about research was influenced by (1) potential risks or
additional procedures; (2) personal benefit and altruism for the a
cardiac community'; (3) information, preparation, timing and approach; and
(4) trust in the clinical team and collaboration with researchers. All of
these were placed within the context of their understanding of the trial
and knowledge of research. Conclusions Parents of children undergoing
cardiac surgery attach value to clinical research and are supportive of
clinical trials when there is no or minimal perceived additional risk.
These findings enhance our understanding of the factors that influence
parents' decision-making and should be used to inform the design and
conduct of future paediatric surgical trials. Trial registration number
ISRCTN12923441; Pre-results. Copyright © Author(s) (or their
employer(s)) 2021.

<47>
[Use Link to view the full text]
Accession Number
634267739
Title
Intraoperative oxygen concentration and neurocognition after cardiac
surgery a randomized clinical trial.
Source
Anesthesiology. 134 (2) (pp 189-201), 2021. Date of Publication: February
2021.
Author
Shaefi S.; Shankar P.; Mueller A.L.; O'Gara B.P.; Spear K.; Khabbaz K.R.;
Bagchi A.; Chu L.M.; Banner-Goodspeed V.; Leaf D.E.; Talmor D.S.;
Marcantonio E.R.; Subramaniam B.
Institution
(Shaefi, Shankar, Mueller, O'Gara, Banner-Goodspeed, Talmor, Subramaniam)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
(Spear, Khabbaz, Chu) Division of Cardiac Surgery, Department of Surgery,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(Marcantonio) Division of General Medicine, Department of Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(Mueller, Bagchi) Department of Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Leaf) Division of Renal Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite evidence suggesting detrimental effects of
perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac
surgery. Hyperoxygenation may increase oxidative damage and neuronal
injury leading to potential differences in postoperative neurocognition.
Therefore, this study tested the primary hypothesis that intraoperative
normoxia, as compared to hyperoxia, reduces postoperative cognitive
dysfunction in older patients having cardiac surgery. Method(s): A
randomized double-blind trial was conducted in patients aged 65 yr or
older having coronary artery bypass graft surgery with cardiopulmonary
bypass. A total of 100 patients were randomized to one of two
intraoperative oxygen delivery strategies. Normoxic patients (n = 50)
received a minimum fraction of inspired oxygen of 0.35 to maintain a
Pao<inf>2</inf> above 70 mmHg before and after cardiopulmonary bypass and
between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients
(n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery,
irrespective of Pao<inf>2</inf> levels. The primary outcome was
neurocognitive function measured on postoperative day 2 using the
Telephonic Montreal Cognitive Assessment. Secondary outcomes included
neurocognitive function at 1, 3, and 6 months, as well as postoperative
delirium, mortality, and durations of mechanical ventilation, intensive
care unit stay, and hospital stay. Result(s): The median age was 71
yr (interquartile range, 68 to 75), and the median baseline neurocognitive
score was 17 (16 to 19). The median intraoperative Pao<inf>2</inf> was 309
(285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the
normoxia group (P < 0.001). The median Telephonic Montreal Cognitive
Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia
group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive
function at 1, 3, and 6 months, as well as secondary outcomes, were not
statistically different between groups. Conclusion(s): In this
randomized controlled trial, intraoperative normoxia did not reduce
postoperative cognitive dysfunction when compared to intraoperative
hyperoxia in older patients having cardiac surgery. Although the optimal
intraoperative oxygenation strategy remains uncertain, the results
indicate that intraoperative hyperoxia does not worsen postoperative
cognition after cardiac surgery. Copyright © 2020, the American
Society of Anesthesiologists, Inc. All Rights Reserved.

<48>
Accession Number
2010569545
Title
Ocular complications of perioperative anesthesia: a review.
Source
Graefe's Archive for Clinical and Experimental Ophthalmology. (no
pagination), 2021. Date of Publication: 2021.
Author
Singh R.B.; Khera T.; Ly V.; Saini C.; Cho W.; Shergill S.; Singh K.P.;
Agarwal A.
Institution
(Singh, Saini, Cho) Massachusetts Eye and Ear, Department of
Ophthalmology, Harvard Medical School, Boston, MA 02114, United States
(Singh) Department of Ophthalmology, Leiden University Medical Center,
Leiden, ZA 2333, Netherlands
(Khera) Department of Anesthesia, Critical Care and Pain Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215,
United States
(Ly) University of Arkansas for Medical Sciences, Little Rock, AR 72205,
United States
(Shergill) Department of Anesthesiology, Yale School of Medicine, New
Haven, CT 06510, United States
(Singh) Dayanand Medical College & Hospital, Ludhiana 141001, India
(Agarwal) Advanced Eye Center, Department of Ophthalmology, Post Graduate
Institute of Medical Education and Research (PGIMER), Sector 12,
Chandigarh 160012, India
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Ocular complications associated with anesthesia in ocular and non-ocular
surgeries are rare adverse events which may present with clinical
presentations vacillating between easily treatable corneal abrasions to
more serious complication such as irreversible bilateral vision loss. In
this review, we outline the different techniques of anesthetic delivery in
ocular surgeries and highlight the incidence and etiologies of associated
injuries. The changes in vision in non-ocular surgeries are mistaken for
residual sedation or anesthetics, therefore require high clinical
suspicion on part of the treating ophthalmologists, to ensure early
diagnosis, adequate and swift management especially in surgeries such as
cardiac, spine, head and neck, and some orthopedic procedures, that have a
comparatively higher incidence of ocular complications. In this article,
we review the literature for reports on the clinical incidence of
different ocular complications associated with anesthesia in non-ocular
surgeries and outline the current understanding of pathophysiological
processes associated with these adverse events. Copyright © 2021,
The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of
Springer Nature.

<49>
Accession Number
634334888
Title
Platelet Quiescence in Patients With Acute Coronary Syndrome Undergoing
Coronary Artery Bypass Graft Surgery.
Source
Journal of the American Heart Association. (pp e016602), 2021. Date of
Publication: 18 Feb 2021.
Author
Sarathy K.; Wells G.A.; Singh K.; Couture E.; Chong A.Y.; Rubens F.;
Lordkipanidze M.; Tanguay J.-F.; So D.
Institution
(Sarathy, Wells, Chong, Rubens, So) University of Ottawa Heart Institute
Ottawa Ontario Canada
(Singh) Gold Coast University Hospital Queensland Australia
(Couture) Universite de Sherbrooke Sherbrooke Quebec Canada
(Lordkipanidze, Tanguay) Montreal Heart Institute Montreal Quebec Canada
Publisher
NLM (Medline)
Abstract
Background The optimal antiplatelet strategy for patients with acute
coronary syndromes who require coronary artery bypass surgery remains
unclear. While a more potent antiplatelet regimen will predispose to
perioperative bleeding, it is hypothesized that through "platelet
quiescence," ischemic protection conferred by such therapy may provide a
net clinical benefit. Methods and Results We compared patients undergoing
coronary artery bypass surgery who were treated with a more potent
antiplatelet inhibition strategy with those with a less potent inhibition
through a meta-analysis. The primary outcome was all-cause mortality after
bypass surgery. The analysis identified 4 studies in which the
antiplatelet regimen was randomized and 6 studies that were nonrandomized.
Combining all studies, there was an overall higher mortality with weaker
strategies compared with more potent strategies (odds ratio, 1.38; 95% CI,
1.03-1.85; P=0.03). Conclusions Our findings support the concept of
platelet quiescence, in reducing mortality for patients with acute
coronary syndrome requiring coronary artery bypass surgery. This suggests
the routine up-front use of potent antiplatelet regimens in acute coronary
syndrome, irrespective of likelihood of coronary artery bypass graft.

<50>
Accession Number
634334347
Title
Door-to-unload: left ventricular unloading before reperfusion in
ST-elevation myocardial infarction.
Source
Future cardiology. (no pagination), 2021. Date of Publication: 18 Feb
2021.
Author
Parikh M.J.; Schuleri K.H.; Chakrabarti A.K.; O'Neill W.W.; Kapur N.K.;
Wohns D.H.
Institution
(Parikh, Wohns) Spectrum Health, Frederik Meijer Heart & Vascular
Institute, Grand Rapids, 100 Michigan Street NE, United States
(Schuleri, Chakrabarti) Abiomed, Inc., 22 Cherry Hill Drive, Danvers,
United States
(O'Neill) Henry Ford Health Systems, 2799 W Grand Blvd K14 Detroit, United
States
(Kapur) Tufts Medical Center ,800 Washington St, Boston, United States
Publisher
NLM (Medline)
Abstract
ST-elevation myocardial infarction treatment in the modern era has focused
on minimizing time of ischemia by reducing door-to-balloon time to limit
infarct size and improve survival. Although there have been significant
improvements in minimizing time to coronary reperfusion, the incidence of
heart failure following a myocardial infarction has remained high.
Preclinical studies have shown that unloading the left ventricle for 30
min prior to coronary reperfusion can reduce infarct size and promote
myocardial recovery. The DTU-STEMI randomized prospective trial will test
the hypothesis that left ventricular unloading for at least 30 min prior
to coronary reperfusion will improve infarct size and heart
failure-related events as compared with the current standard of care.

<51>
Accession Number
634322374
Title
Providing Epidemiologic Data in Lumbar Spine Imaging Reports Did Not
Affect Subsequent Utilization of Spine Procedures: Secondary Outcomes from
a Stepped-Wedge Randomized Controlled Trial.
Source
Pain medicine (Malden, Mass.). (no pagination), 2021. Date of Publication:
17 Feb 2021.
Author
Suri P.; Meier E.N.; Gold L.S.; Marcum Z.A.; Johnston S.K.; James K.T.;
Bresnahan B.W.; O'Reilly M.; Turner J.A.; Kallmes D.F.; Sherman K.J.; Deyo
R.A.; Luetmer P.H.; Avins A.L.; Griffith B.; Heagerty P.J.; Rundell S.D.;
Jarvik J.G.; Friedly J.L.
Institution
(Suri, Meier, Gold, Johnston, James, O'Reilly, Turner, Heagerty, Rundell,
Jarvik, Friedly) Clinical Learning, Evidence, and Research Center,
University of Washington, Seattle, WA
(Suri) Rehabilitation Care Services, VA Puget Sound Health Care System,
Seattle, WA
(Meier, Heagerty) Department of Biostatistics, University of Washington,
Seattle, WA
(Gold, Johnston, James, Bresnahan, O'Reilly, Jarvik) Department of
Radiology, School of Medicine, University of Washington, Seattle, WA
(Marcum) Department of Pharmacy, School of Pharmacy, University of
Washington, Seattle, WA
(Turner, Rundell, Friedly) Department of Rehabilitation Medicine,
University of Washington, Seattle, WA
(Turner) Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle, WA
(Kallmes, Luetmer) Department of Radiology Mayo Clinic, MN, Rochester
(Sherman) Kaiser Permanente Washington
(Deyo) Departments of Family Medicine and Internal Medicine, Oregon Health
& Science University, OR, Portland, United States
(Avins) Division of Research (ALA), Kaiser Permanente Northern California,
Oakland, CA, USA
(Griffith) Department of Radiology Henry Ford Hospital, MI, Detroit,
United States
(Jarvik) Department of Neurological Surgery, University of Washington,
Seattle, WA
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the effect of inserting epidemiologic information
into lumbar spine imaging reports on subsequent non-surgical and surgical
procedures involving the thoracolumbosacral spine and sacroiliac (SI)
joints. DESIGN: Analysis of secondary outcomes from the Lumbar Imaging
with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized
trial. SETTING: Primary care clinics within four integrated healthcare
systems in the United States. SUBJECTS: 238,886 patients aged >=18 years
who received lumbar diagnostic imaging between 2013-2016. METHOD(S):
Clinics were randomized to receive text containing age- and
modality-specific epidemiologic benchmarks indicating the prevalence of
common spine imaging findings in people without low back pain, inserted
into lumbar spine imaging reports (the "LIRE intervention"). The study
outcomes were receiving (1) any non-surgical lumbosacral or sacroiliac
spine procedure (lumbosacral epidural steroid injection, facet joint
injection, or facet joint radiofrequency ablation; or sacroiliac joint
injection) or (2) any surgical procedure involving the lumbar, sacral, or
thoracic spine (decompression surgery or spinal fusion or other spine
surgery). RESULT(S): The LIRE intervention was not significantly
associated with subsequent utilization of non-surgical lumbosacral or
sacroiliac spine procedures (odds ratio [OR]=1.01, 95% confidence interval
[CI] 0.93-1.09; p=0.79) or any surgical procedure (OR=0.99, 95CI
0.91-1.07; p=0.74) involving the lumbar, sacral, or thoracic spine. The
intervention was also not significantly associated with any individual
spine procedure. CONCLUSION(S): Inserting epidemiologic text into
spine imaging reports had no effect on non-surgical or surgical procedure
utilization among patients receiving lumbar diagnostic
imaging. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the American Academy of Pain Medicine.

<52>
Accession Number
634320815
Title
Human glycocalyx shedding: systematic review and critical appraisal.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2021. Date of
Publication: 17 Feb 2021.
Author
Hahn R.G.; Patel V.; Dull R.O.
Institution
(Hahn) Research Unit, Sodertalje Hospital, Karolinska Institute at
Danderyds Hospital (KIDS), Stockholm, Sweden
(Patel) Northwestern Medicine McHenry Hospital, Department of Internal
Medicine, McHenry 60050, United States
(Dull) Department of Anesthesiology, University of Arizona, College of
Medicine, AZ, Tucson, United States
(Dull) Department of Pathology, University of Arizona, College of
Medicine, AZ, Tucson, United States
(Dull) Department of Physiology, University of Arizona, College of
Medicine, AZ, Tucson, United States
(Dull) Department of Surgery, University of Arizona, College of Medicine,
AZ, Tucson, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The number of studies measuring breakdown products of the
glycocalyx in plasma has increased rapidly during the past decade. The
purpose of the present systematic review was to assess the current
knowledge concerning the association between plasma concentrations of
glycocalyx components and structural assessment of the endothelium.
 METHOD(S): We performed a literature review of Pubmed to determine
which glycocalyx components change in a wide variety of human diseases and
conditions. We also searched for evidence of a relationship between plasma
concentrations and the thickness of the endothelial glycocalyx layer as
obtained by imaging methods. RESULT(S): Out of 3,454 publications we
identified 228 that met our inclusion criteria. The vast majority
demonstrate an increase in plasma glycocalyx products. Sepsis and trauma
are most frequently studied, and comprise approximately 40 publications.
They usually report 3-4-foldt increased levels of glycocalyx degradation
products, most commonly of syndecan-1. Surgery shows a variable picture.
Cardiac surgery and transplantations are most likely to involve elevations
of glycocalyx degradation products. Structural assessment using imaging
methods show thinning of the endothelial glycocalyx layer in
cardiovascular conditions and during major surgery, but thinning only
correlates with the plasma concentrations of glycocalyx products. The few
structural assessments performed do not currently support that capillary
permeability is increased when the plasma levels of glycocalyx fragments
in plasma are increased. CONCLUSION(S): Shedding of glycocalyx
components is a ubiquitous process that occurs during both acute and
chronic inflammation with no sensitivity or specificity for a specific
disease or condition. Copyright This article is protected by
copyright. All rights reserved.

<53>
Accession Number
634319394
Title
Outcome Reporting in Cardiac Surgery Systematic Reviews.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 13 Feb 2021.
Author
Tyson N.; Kutywayo K.
Institution
(Tyson) Department of Cardiac Surgery, Nottingham University Hospitals,
Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB
(Kutywayo) Department of Thoracic Surgery, University Hospitals of
Leicester
Publisher
NLM (Medline)

<54>
Accession Number
634316525
Title
Effects of Dexmedetomidine on Perioperative Stress Response and Cellular
Immunity in Elderly Patients with Posterior Lumbar Surgery.
Source
Nano LIFE. (no pagination), 2021. Article Number: 2140001. Date of
Publication: 2021.
Author
Lin M.; Wang X.; Liu X.; Zhang H.; Liu S.; Huang C.
Institution
(Huang, Wang, Zhang, Liu) Department of Anesthesia, Zhabei District Centre
Hospital of Shanghai, 619 Zhonghuaxin Rd, Shanghai 200070, China
(Lin) Department of Anesthesia, People's Hospital of Suzhou New District,
95 Huashan Rd, Suzhou 215163, China
(Liu) Department of Spine Surgery, Zhabei District Centre Hospital of
Shanghai, 619 Zhonghuaxin Rd, Shanghai 200070, China
(Huang) Department of General Surgery, Huadong Hospital Affiliated to
Fudan University, 221 Yan'an West Rd, Shanghai 200040, China
Publisher
World Scientific
Abstract
The aim of this study was to investigate the effects of dexmedetomidine on
perioperative stress response and cellular immunity in elderly patients
with posterior lumbar surgery. Sixty patients with lumbar degenerative
disease requiring posterior lumbar surgery were included and randomly
divided into the dexmedetomidine group (the test group, n=30) and the
control group (n=30). After the experimental group entered the room,
dexmedetomidine was intravenously pumped 10min before induction of
anesthesia and dexmedetomidine was continuously pumped after anesthesia.
The control group replaced dexmedetomidine with the same amount of normal
saline, and the other operations were exactly the same as the experimental
group. Hemodynamic parameters were routinely monitored and the percentages
of T lymphocyte subsets were analyzed by flow cytometry. Samples for
stress response parameters were sent to the Clinical Laboratory of our
hospital, and perioperative pain, postoperative adverse reactions and
complications were evaluated during the study. The levels of postoperative
stress hormones, including noradrenaline (NE), epinephrine (E), cortisol
(Cor) and acetylcholine (Ach), were reduced in the test group compared
with those in the control group (P<0.05). Proportions of CD3+, CD4+, CD8+
and NK as well as the CD4+/CD8+ in the control group were significantly
decreased at postoperative Day 1 (T6), Day 3 (T7) and Day 7 (T8) compared
with those at preoperative Day 1 (T-1) (P<0.05), while the proportions of
CD4+ and NK in the test group were significantly increased at T6, T7 and
T8 compared with those at T-1 (P<0.05). The mean arterial pressure (MAP)
of the test group was decreased compared with that of the control group at
each time point (P<0.05). After the operation, the heart rate (HR) of the
patients in the test group was significantly decreased compared with the
control group (P<0.05) and the VAS score of the control group were
increased compared with the test group at each time point (P<0.05).
Dexmedetomidine can decrease the stress response and improve postoperative
cellular immune function in patients with posterior lumbar surgery by
reducing postoperative stress hormones to alleviate the postoperative
cellular immunosuppression and the pain in patients. Copyright ©
2021 World Scientific Publishing Company.

<55>
Accession Number
2007697880
Title
Prospective Evaluation of Malignancy in 17,708 Patients Randomized to
Ezetimibe Versus Placebo: Analysis From IMPROVE-IT.
Source
JACC: CardioOncology. 2 (3) (pp 385-396), 2020. Date of Publication:
September 2020.
Author
Giugliano R.P.; Gencer B.; Wiviott S.D.; Park J.-G.; Fuchs C.S.; Goessling
W.; Musliner T.A.; Tershakovec A.M.; Blazing M.A.; Califf R.; Cannon C.P.;
Braunwald E.
Institution
(Giugliano, Gencer, Wiviott, Park, Cannon, Braunwald) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Department of Medicine, Harvard Medical School, Boston, MA, United States
(Fuchs) Smilow Cancer Hospital at Yale New Haven, New Haven, CT, United
States
(Goessling) Division of Gastroenterology, Massachusetts General Hospital,
Boston, MA, United States
(Musliner, Tershakovec) Merck, Kenilworth, NJ, United States
(Blazing) Duke Clinical Research Institute, Durham, NC, United States
(Califf) Verily Life Sciences and Google Health, South San Francisco,
California, United States
Publisher
Elsevier Inc.
Abstract
Background: An increased risk of malignancy was reported with
simvastatin/ezetimibe in 1,873 patients in the SEAS (Simvastatin and
Ezetimibe in Aortic Stenosis) trial. Objective(s): The purpose of
this study was to clarify this unexpected finding in a larger sample size
of patients stabilized after acute coronary syndrome, we conducted a
prospective systematic analysis of malignancy events in IMPROVE-IT
(Improved Reduction of Outcomes: Vytorin Efficacy International Trial).
 Method(s): Within IMPROVE-IT, 17,708 patients post-acute coronary
syndrome were randomized to either ezetimibe 10 mg or matching placebo on
a background of simvastatin 40 mg who took >=1 dose of the study drug.
Suspected tumors (benign and malignant) reported by investigators or
identified from a review of adverse events were adjudicated by oncologists
without knowledge of drug assignment. The primary malignancy endpoint
included new, relapsing, or progressive malignancies (excluding
nonmelanotic skin malignancies). The secondary endpoint was death due to
malignancy. Result(s): In this trial, 1,470 patients developed the
primary malignancy endpoint during a median 6 years of follow-up. The most
common malignancy locations were prostate (18.9%), lung (16.8%), and
bladder (8.8%) with no differences by treatment group (p > 0.05 for each
location). Kaplan-Meier 7-year rates of malignancies were similar with
ezetimibe and placebo (10.2% vs. 10.3%; hazard ratio: 1.03; 95% confidence
interval: 0.93 to 1.14; p = 0.56), as were the rates for malignancy death
(3.8% vs. 3.6%; hazard ratio: 1.04; 95% confidence interval: 0.88 to 1.23;
p = 0.68). Conclusion(s): Among 17,708 patients receiving simvastatin
40 mg daily, those randomized to ezetimibe 10 mg daily had a similar
incidence of malignancy and deaths due to malignancy compared with those
receiving placebo during a median follow-up of 6 years (96,377
patient-years). (IMPROVE-IT: Examining Outcomes in Subjects With Acute
Coronary Syndrome: Vytorin [Ezetimibe/Simvastatin] vs Simvastatin
[P04103]; NCT00202878) Copyright © 2020 The Authors

<56>
Accession Number
2005169767
Title
Cardiovascular Safety of Degarelix Versus Leuprolide for Advanced Prostate
Cancer: The PRONOUNCE Trial Study Design.
Source
JACC: CardioOncology. 2 (1) (pp 70-81), 2020. Date of Publication: March
2020.
Author
Melloni C.; Slovin S.F.; Blemings A.; Goodman S.G.; Evans C.P.; Nilsson
J.; Bhatt D.L.; Zubovskiy K.; Olesen T.K.; Dugi K.; Clarke N.W.; Higano
C.S.; Roe M.T.
Institution
(Melloni, Roe) Department of Medicine, Division of Cardiology, Duke
Clinical Research Institute, Duke University Medical Center, Durham, NC,
United States
(Slovin) Department of Medicine, Division of Medical Oncology, Memorial
Sloan Kettering Cancer Center, New York, NY, United States
(Blemings) Ferring Pharmaceuticals A/S, Copenhagen, Denmark
(Goodman) Department of Medicine, Division of Cardiology, St. Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada
(Evans) Department of Urologic Surgery, University of California, Davis,
Sacramento, California, United States
(Nilsson) Department of Clinical Sciences Malmo, Lund University, Lund,
Sweden
(Bhatt) Division of Cardiovascular Medicine, Brigham and Women's Hospital
Heart and Vascular Center, Harvard Medical School, Boston, MA, United
States
(Zubovskiy, Olesen) Ferring Pharmaceuticals A/S, Parsippany, NJ, United
States
(Dugi) Ferring Pharmaceuticals A/S, Saint-Prex, Switzerland
(Clarke) Division of Urology, Institute of Cancer Sciences, University of
Manchester, United Kingdom
(Higano) Division of Medical Oncology, University of Washington and Fred
Hutchinson Cancer Research Center, Seattle, Washington, United States
Publisher
Elsevier Inc.
Abstract
Objectives: This study will compare the incidence of major adverse
cardiovascular events (MACEs) with androgen deprivation therapy (ADT)
among men with advanced prostate cancer who are being treated with a
gonadotropin-releasing hormone (GnRH) antagonist versus a GnRH agonist.
 Background(s): Treatment of advanced prostate cancer with ADT might
increase the risk of subsequent cardiovascular events among men with known
atherosclerotic cardiovascular disease (ASCVD), but a recent meta-analysis
suggested that this risk might be lower with ADT using a GnRH antagonist
versus a GnRH agonist. Method(s): PRONOUNCE is a multicenter,
prospective, randomized, open, blinded endpoint trial that will enroll
approximately 900 patients with advanced prostate cancer and pre-existing
ASCVD who will be treated with ADT. Participants will be randomized to
receive the GnRH antagonist degarelix or the GnRH agonist leuprolide as
ADT for 12 months. The primary endpoint is time from randomization to
first confirmed, adjudicated occurrence of a MACE, which is defined as a
composite of all-cause death, nonfatal myocardial infarction, or nonfatal
stroke through 12 months of ADT treatment. Baseline cardiovascular
biomarkers (high-sensitivity C-reactive protein, high-sensitivity troponin
T, and N-terminal pro-brain natriuretic peptide), as well as serial
inflammatory and immune biomarkers, will be evaluated in exploratory
analyses. Result(s): As of October 1, 2019, a total of 364 patients
have been enrolled. The mean age is 74 years, 90% are white, 80% have
hypertension or dyslipidemia, 30% diabetes mellitus, 40% have had a
previous myocardial infarction, and 65% have had previous
revascularization. Regarding prostate cancer features at randomization,
48% of the patients had localized disease, 23% had locally advanced
disease, and 18% had metastatic disease. Conclusion(s): PRONOUNCE is
the first prospective cardiovascular outcomes trial in advanced prostate
cancer that will delineate whether the risk of subsequent cardiovascular
events associated with ADT is lower with a GnRH antagonist versus a GnRH
agonist for men with pre-existing ASCVD. (A Trial Comparing Cardiovascular
Safety of Degarelix Versus Leuprolide in Patients With Advanced Prostate
Cancer and Cardiovascular Disease [PRONOUNCE]; NCT02663908) Copyright
© 2020 The Authors

<57>
Accession Number
2010148595
Title
Ablation guided by STAR-mapping in addition to pulmonary vein isolation is
superior to pulmonary vein isolation alone or in combination with
CFAE/linear ablation for persistent AF.
Source
Journal of Cardiovascular Electrophysiology. 32 (2) (pp 200-209), 2021.
Date of Publication: February 2021.
Author
Honarbakhsh S.; Schilling R.J.; Providencia R.; Dhillon G.; Bajomo O.;
Keating E.; Finlay M.; Hunter R.J.
Institution
(Honarbakhsh, Schilling, Providencia, Dhillon, Bajomo, Keating, Finlay,
Hunter) Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
(Hunter) Queen Mary University of London, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: The optimal ablation approach for persistent atrial
fibrillation (AF) remains unclear. Methods and Results: Objective was
to compare the long-term rates of freedom from AF/AT in patients that
underwent STAR mapping guided ablation against outcomes of patients
undergoing conventional ablation procedures. Patients undergoing ablation
for persistent AF as part of the Stochastic Trajectory Analysis of Ranked
signals (STAR) mapping study were included. Outcomes following 'pulmonary
vein isolation (PVI) plus STAR mapping guided ablation (STAR mapping
cohort) were compared to patients undergoing PVI alone ablation during the
same time period and also a propensity-matched cohort undergoing PVI plus
the addition of complex fractionated electrogram (CFAE) and/or linear
ablation ("conventional ablation"). Rates of procedural AF termination and
freedom from AF/AT during follow-up were compared. Sixty-five patients
were included in both the STAR cohort and propensity matched conventional
ablation cohort. AF termination rates were significantly higher in the
STAR cohort (51/65, 78.5%) than conventional ablation cohort (10/65,
15.4%) and PVI alone ablation cohort (13/50, 26.0%; STAR cohort vs. other
2 cohorts both p <.001). There was no significant difference in procedure
time between the three cohorts. During >=20 months follow-up a lower
proportion of patients had AF/AT recurrence in the STAR cohort (20.0%)
compared with the conventional ablation cohort (50.8%) or the PVI alone
ablation cohort (50.0%; both p <.05 compared to STAR cohort).
 Conclusion(s): Outcomes of PVI plus STAR mapping guided ablation was
superior to PVI alone or in combination with linear/CFAE ablation. A
multicenter randomized controlled trial is planned to confirm these
findings. Copyright © 2020 The Authors. Journal of Cardiovascular
Electrophysiology published by Wiley Periodicals LLC.

<58>
Accession Number
2010560307
Title
Higher versus lower mean arterial pressure target management in older
patients having non-cardiothoracic surgery: A prospective randomized
controlled trial.
Source
Journal of Clinical Anesthesia. 69 (no pagination), 2021. Article Number:
110150. Date of Publication: May 2021.
Author
Hu A.-M.; Qiu Y.; Zhang P.; Zhao R.; Li S.-T.; Zhang Y.-X.; Zheng Z.-H.;
Hu B.-L.; Yang Y.-L.; Zhang Z.-J.
Institution
(Hu, Zhang, Zheng, Zhang) Department of Anesthesiology, Shenzhen People's
Hospital, Shenzhen, China
(Hu, Zhang, Zheng, Zhang) The Second Clinical Medical College, Jinan
University, Shenzhen, China
(Hu, Zhang, Zheng, Zhang) First Affiliated Hospital, Southern University
of Science and Technology, Shenzhen, China
(Qiu) Department of Anesthesiology and Translational Neuroscience Center,
West China Hospital, Sichuan University, Chengdu, China
(Zhang) Department of Anesthesiology, Sichuan Provincial People's
Hospital, Chengdu, China
(Zhao) Department of Anesthesiology, Kunming Children's Hospital, Kunming,
China
(Li) Department of Anesthesiology, Jinan University-affiliated Shenzhen
Baoan Women's and Children's Hospital, Shenzhen, China
(Hu) Department of Anesthesiology, Affiliated Hospital of Guizhou Medical
University, Guiyang, China
(Yang) Department of Anesthesiology, Henan Provincial People's Hospital,
Zhengzhou University, Zhengzhou, China
Publisher
Elsevier Inc.
Abstract
Study objective: This study aimed to evaluate the effects of low versus
high mean arterial pressure (MAP) levels on the incidence of postoperative
delirium during non-cardiothoracic surgery in older patients.
 Design(s): Multicenter, randomized, parallel-controlled, open-label,
and assessor-blinded clinical trial. Setting(s): University hospital.
 Patient(s): Three hundred twenty-two patients aged >=65 with an
American Society of Anesthesiologists physical status of I-II who
underwent non-cardiothoracic surgery with general anaesthesia.
 Intervention(s): Participants were randomly assigned into a low-level
MAP (60-70 mmHg) or high-level MAP (90-100 mmHg) group during general
anaesthesia. The study was conducted from November 2016 to February 2020.
Participants were older patients having non-cardiothoracic surgery. The
follow-up period ranged from 1 to 7 days after surgery. The primary
outcome was the incidence of postoperative delirium. Main Result(s):
In total, 322 patients were included and randomized; 298 completed
in-hospital delirium assessments [median (interquartile range) age, 73
(68-77) years; 173 (58.1%) women]. Fifty-four (18.1%) patients total,
including 36 (24.5%) and 18 (11.9%) in the low-level and high-level MAP
groups [relative risk (RR) 0.48, 95% confidence interval (CI) 0.25 to
0.87, P = 0.02], respectively, experienced postoperative delirium. The
adjusted RR was 0.34 (95% CI 0.16 to 0.70, P < 0.01) in the multiple
regression analysis. High-level MAP was associated with a shorter delirium
span and a higher intraoperative urine volume than low-level MAP.
 Conclusion(s): In older patients during non-cardiothoracic surgery,
high-level blood pressure management might help reduce the incidence of
postoperative delirium. Copyright © 2020

<59>
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

<60>
Accession Number
2005546378
Title
Development of a new risk model for a prognostic prediction after
transcatheter aortic valve replacement.
Source
General Thoracic and Cardiovascular Surgery. 69 (1) (pp 44-50), 2021. Date
of Publication: January 2021.
Author
Maeda K.; Kuratani T.; Pak K.; Shimamura K.; Mizote I.; Miyagawa S.; Toda
K.; Sakata Y.; Sawa Y.
Institution
(Maeda, Kuratani, Shimamura, Miyagawa, Toda, Sawa) Department of
Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2
Yamada-oka, Suita, Osaka 565-0871, Japan
(Pak, Sakata) Division of Biostatistics, Center for Clinical Research,
National Center for Child Health and Development, Setagaya, Japan
(Mizote) Department of Cardiology, Osaka University Graduate School of
Medicine, Suita, Japan
Publisher
Springer Japan
Abstract
Background: Current guidelines for transcatheter aortic valve replacement
(TAVR) recommend that TAVR should be performed in patients with a life
expectancy > 1 year. However, it is challenging to estimate the patients'
life expectancy because it is related to various factors, including
frailty and nutritional status. Hypothesis: A new risk model can estimate
the prognosis of patients after TAVR. Method(s): We randomly divided
388 patients with aortic stenosis (AS) undergoing TAVR from October 2009
to August 2016 into two groups (2:1 ratio; training cohort, 259;
validation cohort, 129). Using 94 baseline factors in the training cohort,
we developed possible scoring models by the Cox proportional hazard
regression model with the overall survival as the endpoint. Then,
cross-validated 5-year C-statistics were calculated to assess the accuracy
of the model. Result(s): Of 94 baseline factors, 12 factors were
finally identified (5-year C-statistics in the training cohort:
0.709)-age, gender, body mass index, left ventricular ejection fraction, %
vital capacity, forced expiratory volume 1.0 (s) %, albumin, hemoglobin,
creatine, platelet, creatine kinase, and prothrombin time-international
normalized ratio. The cross-validated 1-, 3-, and 5-year C-statistics in
the validation cohort were 0.792, 0.758, and 0.778, respectively.
Furthermore, calibration plots in the validation cohort revealed that
5-year survival is well predicted (r = 0.962). Conclusion(s): The new
survival prediction model after TAVR could provide appropriate guidance
during decision making regarding the TAVR implementation. Copyright
© 2020, The Japanese Association for Thoracic Surgery.

<61>
Accession Number
2006130020
Title
The efficacy of early postoperative enteral immunonutrition on
T-lymphocyte count: A randomised control study in low-risk cardiac surgery
patients.
Source
Clinical Nutrition. 40 (2) (pp 372-379), 2021. Date of Publication:
February 2021.
Author
Svetikiene M.; Ringaitiene D.; Vezeliene J.; Isajevas V.; Trybe D.; Vicka
V.; Malickaite R.; Jurgauskiene L.; Norkuniene J.; Serpytis M.; Sipylaite
J.
Institution
(Svetikiene, Ringaitiene, Isajevas, Serpytis, Sipylaite) Department of
Anaesthesiology and Intensive Care, Institute of Clinical Medicine,
Faculty of Medicine, Vilnius University, Lithuania
(Svetikiene, Ringaitiene, Vezeliene, Isajevas, Vicka, Serpytis, Sipylaite)
Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
(Trybe, Vicka) Faculty of Medicine, Vilnius University, Vilnius, Lithuania
(Malickaite, Jurgauskiene) Clinic of Cardiac and Vascular Diseases,
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University,
Vilnius, Lithuania
(Norkuniene) Department of Mathematical Statistics, Faculty of Fundamental
Sciences, Vilnius Gediminas Technical University, Vilnius, Lithuania
Publisher
Churchill Livingstone
Abstract
Background: Patients undergoing cardiac surgery have a pronounced immune
response that leads to a reduction in cellular immunity. Immune-modulating
nutritional supplements are considered to be beneficial for patients
undergoing major surgery. However, due to the lack of studies in the
cardiac surgery population, the effect of immunonutrition remains unclear
in this patient group. Objective(s): Our purpose was to research the
efficacy of early postoperative enteral immunonutrition on T-lymphocyte
count in the cardiac surgery population. Method(s): This was a
randomised control study of low operative risk adult patients, who
underwent elective cardiac surgery. These patients were randomised into
immunonutrition and control groups. The immunonutrition group was
supplemented with immune nutrients for five postoperative days. The counts
of T-lymphocytes, as well as the counts for the CD4+ and CD8+ cell
subpopulations were determined on the day of surgery and on the sixth
postoperative day. Result(s): Fifty-five patients were enrolled in
the study, the mean age was 69.7 +/- 6.3 years, 28 (50.9%) of them were
males, the median operative risk was 1.75%. Twenty-seven (49.1%) were
randomised into the immunonutrition group. The control and the
immunonutrition groups were similar before the intervention. The counts of
the CD3+ T cells and CD4+ T cells on the sixth postoperative day were
significantly higher in the immunonutrition group compared to the control
group with 1.42 +/- 0.49 vs. 1.12 +/- 0.56 (*109/l), p = 0.035
and 1.02 +/- 0.36 vs. 0.80 +/- 0.43 (*109/l), p = 0.048,
respectively. Regression analysis was performed to determine the efficacy
of the immunonutrition on the counts of the CD3+ and CD4+ T cells; CD3+ T
and CD4+ T cell counts were increased to 0.264 (*109/l), p =
0.039 and 0.232 (*109/l), p = 0.021, respectively.
 Conclusion(s): Early postoperative immunonutrition increases the
count of the CD3+ and CD4+ T cells in cardiac surgical patients. Clinical
trials identifier number: NCT04047095 Copyright © 2020 Elsevier
Ltd and European Society for Clinical Nutrition and Metabolism

<62>
Accession Number
2006808738
Title
Topical versus low-dose systemic tranexamic acid in pediatric cardiac
surgery: A randomized clinical study.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3368-3373), 2020. Date of
Publication: December 2020.
Author
Hatami F.; Valizadeh N.; Salehi F.; Hosseinzadeh Maleki M.
Institution
(Hatami, Valizadeh, Salehi) Department of Cardiology, Cardiovascular
Diseases Research Center, Birjand University of Medical Sciences, Birjand,
Iran, Islamic Republic of
(Hosseinzadeh Maleki) Department of Cardiac Surgery, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: The current study aimed to compare the benefits of topical and
low-dose systemic tranexamic acid administration in pediatric cardiac
surgery. Method(s): A total of 117 children undergoing cardiac
surgery for congenital heart disease were assigned into three groups.
Patients in the systemic group received 20 mg/kg-1 tranexamic
acid through the cardiopulmonary bypass followed by another dose of 20
mg/kg-1 after cardiopulmonary bypass separation. Patients in
the topical group were administered with 50 mg/kg-1 tranexamic
acid poured into the pericardium, while the control group received no
antifibrinolytics. The outcome measures of bleeding and blood products
transfusion were recorded over the first 48 h postoperatively.
 Result(s): Chest tube drainage was significantly lower in both
topical and systemic groups than the control group, but it did not differ
between the case groups. Blood products requirement did not show a
difference between groups. Neurological or thromboembolic events did not
variate among the groups, and no deaths occurred in this study.
 Conclusion(s): Topical or systemic tranexamic acid administration
reduced postoperative blood loss effectively without adding an extra
risk. Copyright © 2020 Wiley Periodicals LLC

<63>
Accession Number
2006801919
Title
Costs of surgical ablation of atrial fibrillation in Ontario, Canada from
2006 to 2017.
Source
Journal of Cardiac Surgery. 35 (12) (pp 3451-3454), 2020. Date of
Publication: December 2020.
Author
Chow J.Y.; McClure G.; Belley-Cote E.P.; McIntyre W.F.; Singal R.K.;
Whitlock R.P.
Institution
(Chow, Belley-Cote, McIntyre) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure) Division of Vascular Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Singal) CVT Associates, Vancouver Island Health Authority, Victoria, BC,
Canada
(Whitlock) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: International guidelines currently recommend concomitant
surgical ablation of atrial fibrillation (AF) in patients with AF
undergoing cardiac surgery. However, a systematic review and meta-analysis
of 23 randomized controlled trials (RCTs) showed no significant difference
in mortality or stroke in patients who underwent surgical AF ablation
compared with those who did not (moderate-quality evidence).
 Method(s): We estimated the Ontario-wide costs of surgical AF
ablation between 2006 and 2017 using data from a systematic review and
meta-analysis of RCTs, estimates of case volumes from Ontario Health
Insurance Plan fee codes, the ongoing left atrial appendage occlusion
study III trial (NCT01561651), institutional costs from large academic
centers in Ontario, as well as professional fees based on the Ontario fee
schedule. Device costs were obtained from Canadian industry data with
expert input. Result(s): We estimated the average extra cost of
surgical AF ablation at $4,287 CAD (95% CI $4,113-4,619) per patient.
Procedural costs (equipment costs and physician remuneration) comprise
82.2% of this, while smaller portions relate to the increased need for
pacemaker (3.9%) and additional hospital length of stay (13.9%).
Approximately 2,391 patients underwent surgical AF ablation between 2006
and 2017, corresponding to an estimated $10.2 million in incremental cost
during that time span. Conclusion(s): Ontario taxpayers spend
significant financial resources on surgical ablation of AF, a procedure
lacking high-quality evidence demonstrating benefit in reducing mortality
or stroke. Further large prospective studies examining clinically
important outcomes are needed to justify its routine use in patient care
and to guide allocation of healthcare funds. Copyright © 2020
Wiley Periodicals LLC

<64>
Accession Number
634295964
Title
Safety and Efficacy of Human Chorionic Gonadotropin Hormone-Derivative
EA-230 in Cardiac Surgery Patients: A Randomized Double-Blind
Placebo-Controlled Study.
Source
Critical care medicine. (no pagination), 2021. Date of Publication: 15 Feb
2021.
Author
van Groenendael R.; Beunders R.; Hemelaar P.; Hofland J.; Morshuis W.J.;
van der Hoeven J.G.; Gerretsen J.; Wensvoort G.; Kooistra E.J.; Claassen
W.J.; Waanders D.; Lamberts M.G.A.; Buijsse L.S.E.; Kox M.; van Eijk L.T.;
Pickkers P.
Institution
(van Groenendael) Department of Intensive Care Medicine, Radboud
University Medical Center, Nijmegen, The Netherlands. Radboud Center for
Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen,
The Netherlands. Radboud Institute for Molecular Life Sciences (RIMLS),
Radboud University Medical Center, Nijmegen, The Netherlands. Department
of Anesthesiology, Pain and Palliative Medicine, Radboud University
Medical Center, Nijmegen, The Netherlands. Department of Cardiothoracic
Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Exponential Biotherapies, Inc. (EBI), The Hague, The Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine the safety and efficacy of human chorionic
gonadotropin hormone-derivative EA-230 in cardiac surgery patients.
Cardiac surgery induces systemic inflammation and may impair renal
function, affecting patient outcome. EA-230 exerted immunomodulatory and
renoprotective effects in preclinical models and was safe and showed
efficacy in phase I and II human studies. DESIGN: Double-blinded,
placebo-controlled, randomized study. SETTING: Collaboration of the
Cardiothoracic Surgery, Anesthesiology, and the Intensive Care departments
of a tertiary hospital in the Netherlands. PATIENTS: One hundred eighty
patients undergoing an on-pump coronary artery bypass procedure with or
without concomitant valve surgery. INTERVENTIONS: Ninety mg/kg/hr EA-230
or placebo administered during surgery. MEASUREMENTS AND MAIN RESULTS:
During the study, no safety concerns emerged. EA-230 did not modulate
interleukin-6 plasma concentrations (area under the curve 2,730 pg/mL x hr
[1,968-3,760] vs 2,680 pg/mL x hr [2,090-3,570] for EA-230 and placebo
group, respectively; p = 0.80). Glomerular filtration rate increased
following surgery (mean +/- SEM increase in the EA-230 vs placebo groups:
glomerular filtration rateiohexol measured using iohexol plasma clearance:
19 +/- 2 vs 16 +/- 2 mL/min/1.73 m2; p = 0.13 and estimated glomerular
filtration rate with the Modification of Diet in Renal Disease equation
using creatinine: 6 +/- 1 vs 2 +/- 1 mL/min/1.73 m2; p = 0.01). The
"injury" stage of the Risk, Injury, Failure, Loss of kidney function, and
End-stage kidney disease criteria for acute kidney injury was 7% in the
EA-230 group versus 18% in the placebo group (p = 0.07). In addition,
EA-230-treated patients had a less positive fluid balance compared with
placebo-treated patients (217 +/- 108 vs 605 +/- 103 mL; p = 0.01), while
the use of vasoactive agents was similar in both groups (p = 0.39).
Finally, hospital length of stay was shorter in EA-230 treated patients (8
d [7-11] vs 10 d [8-12]; p = 0.001). Efficacy results were more pronounced
in patients that had longer duration of surgery and thus longer duration
of study drug infusion. CONCLUSION(S): EA-230 was safe in patients
undergoing on-pump cardiac surgery. It did not modulate interleukin-6
plasma concentrations but appeared to exert beneficial renal and
cardiovascular effects and shortened in-hospital length of
stay. Copyright © by 2021 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<65>
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.

<66>
Accession Number
2010260830
Title
Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a
randomized noninferiority trial.
Source
Annals of Intensive Care. 11 (1) (no pagination), 2021. Article Number:
15. Date of Publication: December 2021.
Author
Franco R.A.; de Almeida J.P.; Landoni G.; Scheeren T.W.L.; Galas F.R.B.G.;
Fukushima J.T.; Zefferino S.; Nardelli P.; de Albuquerque Piccioni M.;
Arita E.C.T.C.; Park C.H.L.; Cunha L.C.C.; de Oliveira G.Q.; Costa
I.B.S.S.; Kalil Filho R.; Jatene F.B.; Hajjar L.A.
Institution
(Franco, de Almeida, Fukushima, Park, de Oliveira, Costa, Hajjar)
Intensive Care Unit, Cancer Institute (ICESP), University of Sao Paulo,
Sao Paulo, Brazil
(Landoni, Nardelli) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Scheeren) Department of Anesthesiology, University Medical Center,
Groningen, Netherlands
(Galas, Zefferino, de Albuquerque Piccioni) Department of Anesthesiology,
Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
(Arita, Cunha, Jatene) Division of Cardiovascular Surgery, Heart Institute
(InCor), University of Sao Paulo, Sao Paulo, Brazil
(Kalil Filho) Department of Cardiology, Heart Institute (InCor),
University of Sao Paulo, Sao Paulo, Brazil
(Hajjar) Department of Cardiopneumology, Instituto Do Coracao (InCor),
Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo,
Av. Dr. Eneas de Carvalho Aguiar, 44-05403-900, Sao Paulo, SP, Brazil
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The detrimental effects of inotropes are well-known, and in
many fields they are only used within a goal-directed therapy approach.
Nevertheless, standard management in many centers includes administering
inotropes to all patients undergoing cardiac surgery to prevent low
cardiac output syndrome and its implications. Randomized evidence in favor
of a patient-tailored, inotrope-sparing approach is still lacking. We
designed a randomized controlled noninferiority trial in patients
undergoing cardiac surgery with normal ejection fraction to assess whether
an dobutamine-sparing strategy (in which the use of dobutamine was guided
by hemodynamic evidence of low cardiac output associated with signs of
inadequate tissue perfusion) was noninferior to an inotrope-to-all
strategy (in which all patients received dobutamine). Result(s): A
total of 160 patients were randomized to the dobutamine-sparing strategy
(80 patients) or to the dobutamine-to-all approach (80 patients). The
primary composite endpoint of 30-day mortality or occurrence of major
cardiovascular complications (arrhythmias, acute myocardial infarction,
low cardiac output syndrome and stroke or transient ischemic attack)
occurred in 25/80 (31%) patients of the dobutamine-sparing group (p =
0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no
significant differences between groups regarding the incidence of acute
kidney injury, prolonged mechanical ventilation, intensive care unit or
hospital length of stay. Discussion(s): Although it is common
practice in many centers to administer inotropes to all patients
undergoing cardiac surgery, a dobutamine-sparing strategy did not result
in an increase of mortality or occurrence of major cardiovascular events
when compared to a dobutamine-to-all strategy. Further research is needed
to assess if reducing the administration of inotropes can improve outcomes
in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801.
Registered Feb 2nd, 2015.
https://clinicaltrials.gov/ct2/show/NCT02361801. Copyright ©
2021, The Author(s).

<67>
Accession Number
2010241033
Title
Structural and Functional Correlates of Gradient-Area Patterns in Severe
Aortic Stenosis and Normal Ejection Fraction.
Source
JACC: Cardiovascular Imaging. 14 (3) (pp 525-536), 2021. Date of
Publication: March 2021.
Author
Slimani A.; Roy C.; de Meester C.; Bouzin C.; Pasquet A.; Pouleur A.-C.;
Vancraeynest D.; Noirhomme P.; El Khoury G.; Gerber B.L.; Vanoverschelde
J.-L.
Institution
(Slimani, Roy, de Meester, Bouzin, Pasquet, Pouleur, Vancraeynest,
Noirhomme, El Khoury, Gerber, Vanoverschelde) Pole de Recherche
Cardiovasculaire, Institut de Recherche Experimentale et Clinique,
Universite Catholique de Louvain, Brussels, Belgium
(Slimani, Roy, de Meester, Bouzin, Pasquet, Pouleur, Vancraeynest,
Noirhomme, El Khoury, Gerber, Vanoverschelde) Divisions of Cardiology and
Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels,
Belgium
Publisher
Elsevier Inc.
Abstract
Objectives: The authors sought to characterize the functional and
structural myocardial phenotypes of patients with moderate-to-severe
aortic stenosis (AS) and to determine whether severe paradoxical
low-gradient AS (LG-AS) is specifically associated with left ventricular
(LV) remodeling and fibrosis. Background(s): Recently, it was
suggested that severe paradoxical LG-AS is a more advanced form of AS,
with greater reduction of longitudinal deformation, adverse LV remodeling,
and more interstitial fibrosis. Method(s): The study population
includes 147 patients with moderate-to-severe AS and a normal LV ejection
fraction, and 75 normal control subjects. They prospectively underwent
2-dimensional speckle-tracking echocardiography and cardiac magnetic
resonance to evaluate myocardial deformation, LV remodeling, and age- and
sex-adjusted extravascular volume fraction (ECV, %). Among AS patients, 18
had moderate AS, 74 had severe high-gradient AS (HG-AS), and 55 had severe
paradoxical LG-AS. Result(s): Reduced longitudinal and
circumferential deformation was observed in 21% and 6% of the AS patients,
respectively. Multivariate analyses identified increased ECV (s = 1.99; p
= 0.001) and the absence of normal LV geometry (s = -1.37; p = 0.007) and
as independent predictors of reduced longitudinal deformation. Increased
ECV was an independent predictor of reduced circumferential deformation (s
= 2.19; p = 0.001). Over a median follow-up of 29 months, reduced
longitudinal deformation (hazard ratio: 0.82; p = 0.023) and higher
transvalvular gradients (hazard ratio: 1.05; p < 0.001) increased the risk
of death or need for aortic valve replacement. LV hypertrophy was more
frequently observed among patients with severe HG-AS (65%) than among the
other AS patients (14%; p < 0.001). On average, ECV was within normal
limits and did not differ among gradient-area subgroups. When present,
increased ECV was associated with reduced longitudinal deformation.
 Conclusion(s): This study's data show that patients with severe
paradoxical LG-AS less frequently display reduced longitudinal
deformation, LV hypertrophy, or myocardial fibrosis than patients with
HG-AS. Also, interstitial fibrosis only occurs when reduced longitudinal
deformation and severe HG-AS are present together. Finally, this study
suggests that reduced longitudinal deformation and higher transvalvular
gradients adversely affect patients' outcomes. Copyright © 2021
American College of Cardiology Foundation

<68>
Accession Number
2007179105
Title
Edge-to-Edge Repair Versus Secondary Cord Cutting During Septal Myectomy
in Patients With Hypertrophic Obstructive Cardiomyopathy: A Pilot
Randomised Study.
Source
Heart Lung and Circulation. 30 (3) (pp 438-445), 2021. Date of
Publication: March 2021.
Author
Afanasyev A.V.; Bogachev-Prokophiev A.V.; Zheleznev S.I.; Sharifulin R.M.;
Zalesov A.S.; Budagaev S.A.
Institution
(Afanasyev, Bogachev-Prokophiev, Zheleznev, Sharifulin, Zalesov, Budagaev)
Heart Valves Surgery Department, Meshalkin National Medical Research
Center, Novosibirsk, Russian Federation
Publisher
Elsevier Ltd
Abstract
Background: To evaluate whether the Alfieri technique improves clinical
and haemodynamic results and compare it with transaortic mitral valve
secondary cord cutting in patients scheduled for septal myectomy for
severely symptomatic hypertrophic obstructive cardiomyopathy.
 Method(s): Forty-eight (48) patients with moderate-to-severe systolic
anterior motion (SAM)-mediated mitral regurgitation were randomly assigned
to the Alfieri or Cutting groups in addition to septal myectomy. The
primary endpoint was postoperative mean transmitral pressure gradient
(TPG). The secondary endpoints were residual left ventricular outflow
tract (LVOT) gradient after procedure, residual mitral regurgitation (MR),
postoperative SAM, repeating bypass, and survival. Result(s): There
were no 30-day mortality and ventricular septal defects. The postoperative
LVOT gradient was 15.4+/-7.6 mmHg and 11.1+/-4.9 mmHg (p=0.078) in the
Alfieri and Cutting groups, respectively. The Alfieri technique was
associated with higher peak (7.8+/-3.3 vs 4.7+/-2.8 mmHg; p=0.014) and
mean (3.9+/-1.7 vs 2.1+/-1.6 mmHg; p=0.013) TPG. The Cutting group was
associated with higher mild MR rate at discharge (six vs no patients;
p=0.009). One (1) patient (4.2%) in the Alfieri group required pacemaker
implantation owing to conduction disturbances (p=0.312). Two-year (2-year)
freedom from late mortality and sudden cardiac death rates were
95.5%+/-4.4% and 100% for the Alfieri and Cutting groups, respectively
(log rank, p=0.317). No patients had New York Heart Association functional
class III or IV or moderate or severe MR. The maximum LVOT gradient was
20.4+/-15.2 mmHg and 16.7+/-10.4 mmHg, respectively (p=0.330). There were
no reoperations during follow-up. Conclusion(s): Both techniques with
septal myectomy effectively eliminated SAM-induced MR and LVOT
obstructions in hypertrophic cardiomyopathy patients. Copyright ©
2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<69>
Accession Number
2006988023
Title
Meta-Analysis and Trial Sequential Analysis of Randomized Controlled
Trials for Multivessel PCI Versus Culprit Artery Only PCI in STEMI Without
Cardiogenic Shock.
Source
Current Problems in Cardiology. 46 (3) (no pagination), 2021. Article
Number: 100646. Date of Publication: March 2021.
Author
Rai D.; Tahir M.W.; Bandyopadhyay D.; Chowdhury M.; Kharsa A.; Pendala
V.S.; Ali H.; Naidu S.S.; Baibhav B.
Publisher
Mosby Inc.
Abstract
Background: Traditionally ST-elevation myocardial infarction (STEMI) with
multivessel coronary artery disease is treated with percutaneous coronary
intervention (PCI) to culprit lesion only. The benefit of multivessel (MV)
PCI among STEMI patients without cardiogenic shock is unclear.
 Method(s): PubMed, EMBASE, and Cochrane Database were searched from
1996 to 2019, for studies of patients with STEMI without cardiogenic
shock, who underwent PCI. Only randomized controlled trials comparing
culprit PCI to MV PCI vs culprit vessel PCI were included for pairwise
meta-analysis. All-cause mortality, cardiac mortality, reinfarction,
revascularization and major adverse cardiovascular events (MACE) were
compared. Trial sequential analysis (TSA) was performed for outcome
variables. Result(s): Nine randomized controlled trials contributed
6930 patients meeting inclusion criteria. Three thousand three hundred
seventy-six underwent MV PCI, and 3554 underwent culprit PCI. Our analysis
demonstrated no significant difference in all-cause mortality. MV PCI had
a lower risk of cardiac mortality, reinfarction, MACE and repeat
revascularization compared to culprit PCI (P values <0.05). TSA showed
futility for further trials to detect all-cause mortality benefit and lack
of firm evidence of benefit in cardiac mortality and re-infarction, but
firm evidence of benefit in revascularization and MACE.
 Conclusion(s): In conclusion, MV PCI strategy was beneficial in
reducing cardiac mortality, reinfarction, repeat revascularization, and
MACE but there was no all-cause mortality benefit when compared to culprit
only PCI strategy. Evidence for benefit in cardiac mortality and
re-infarction is not robust per TSA. Copyright © 2020 Elsevier
Inc.

<70>
Accession Number
2004120243
Title
ECMO and Right Ventricular Failure: Review of the Literature.
Source
Journal of Intensive Care Medicine. 36 (3) (pp 352-360), 2021. Date of
Publication: March 2021.
Author
Grant C.; Richards J.B.; Frakes M.; Cohen J.; Wilcox S.R.
Institution
(Grant, Frakes, Cohen, Wilcox) Boston MedFlight, Bedford, MA, United
States
(Richards) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Cohen) Department of Surgery, Brigham and Women's Hospital, Boston, MA,
United States
(Wilcox) Department of Emergency Medicine, Heart Center ICU, Massachusetts
General Hospital, Boston, MA, United States
Publisher
SAGE Publications Inc.
Abstract
Right ventricular (RV) failure is the inability of the RV to maintain
sufficient cardiac output in the setting of adequate preload, due to
either intrinsic injury to the RV or increased afterload. Medical
treatment of RV failure should include optimizing preload, augmenting
contractility with vasopressors and inotropes, and considering inhaled
pulmonary vasodilators. However, when medical therapies are insufficient,
mechanical circulatory support (MCS) is needed to maintain systemic and RV
perfusion. The data on MCS for isolated RV failure are limited, but
extracorporeal membrane oxygenation (ECMO) appears to be the most
efficient and effective modality. For patients with isolated RV failure
from acute hypoxemic respiratory failure, veno-venous (VV) ECMO is an
appropriate initial configuration, even if the patient is in shock. With
primary RV injury or RV failure with concomitant left ventricle (LV)
failure, however, venoarterial (VA) ECMO is indicated. Both modalities
provide indirect support to the RV by reducing preload, reducing RV wall
tension, and delivering oxygenated blood to the coronary circulation.
Peripheral cannulation is required in VV-ECMO and is most commonly used in
VA-ECMO, allowing for rapid cannulation even in emergencies. Changes in
pulsatility on an arterial catheter waveform can indicate changes in
clinical status including changes in myocardial function, inadequate
preload, worsening RV failure, and excessive VA-ECMO support leading to an
elevated LV afterload. Myocardial function may be improved by titration of
inotropes or vasodilators, utilization of an Impella or an intra-aortic
balloon counterpulsation support devices, or by changes in VA-ECMO
support. Copyright © The Author(s) 2020.

<71>
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.

<72>
Accession Number
2006161023
Title
Left Atrial or Transeptal Approach for Mitral Valve Surgery: A Systematic
Review and Meta-analysis.
Source
Current Problems in Cardiology. 46 (3) (no pagination), 2021. Article
Number: 100602. Date of Publication: March 2021.
Author
Harky A.; Kusu-Orkar T.-E.; Chan J.S.K.; Noshirwani A.; Savarimuthu S.;
Pousios D.; Muir A.D.
Institution
(Harky, Kusu-Orkar, Noshirwani, Pousios, Muir) Department of
cardiothoracic surgery, Liverpool Heart and Chest Hospital, Liverpool,
United Kingdom
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Chan) Division of Cardiology, Department of Medicine and Therapeutics,
Prince of Wales Hospital, Hong Kong
(Chan) Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
(Savarimuthu) Department of cardiothoracic surgery, Barts Heart Centre,
St. Bartholomew's Hospital, London, United Kingdom
Publisher
Mosby Inc.
Abstract
To compare outcomes of mitral valve surgery through conventional left
atriotomy and transeptal approach (TS). Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines were followed. Primary
outcomes were operative mortality and permanent pacemaker (PPM)
implantation; secondary outcomes were new onset of atrial fibrillation
(AF), stroke and operative times. Sixteen articles met the inclusion
criteria with 4537 patients. Cardiopulmonary bypass was longer with TS
(weighted mean differences - 16.44 minutes [-29.53, -3.36], P = 0.01).
Rates of PPM implantation (risk ratio 0.65 [0.47, 0.89], P = 0.007) and
new onset AF (risk ratio 0.87 [0.78, 0.97], P = 0.02) were higher with TS.
Subgroup analysis of isolated mitral valve surgery cohort showed no
difference in operative times, mortality, new onset of AF, stroke, and PPM
implantation. There is equal outcomes between both approaches during
isolated mitral valve surgery; however, TS was associated with longer
operative times and higher postoperative AF and PPM rates when pooling
combined procedures. A large randomized controlled trial is required to
confirm those findings. Copyright © 2020 Elsevier Inc.

<73>
Accession Number
2010129971
Title
Mortality in low-risk patients with aortic stenosis undergoing
transcatheter or surgical aortic valve replacement: A reconstructed
individual patient data meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (5) (pp 587-594),
2020. Date of Publication: 01 Nov 2020.
Author
Celik M.; Milojevic M.M.; Durko A.P.; Oei F.B.S.; Bogers A.J.J.C.; Mahtab
E.A.F.
Institution
(Celik, Milojevic, Durko, Oei, Bogers, Mahtab) Department of
Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Although the standard of care for patients with severe aortic
stenosis at low-surgical risk has included surgical aortic valve
replacement (SAVR) since the mid-1960s, many clinical studies have
investigated whether transcatheter aortic valve implantation (TAVI) can be
a better approach in these patients. As no individual study has been
performed to detect the difference in mortality between these 2 treatment
strategies, we did a reconstructive individual patient data analysis to
study the long-term difference in all-cause mortality. METHOD(S):
Randomized clinical trials and propensity score-matched studies that
included low-risk adult patients with severe aortic stenosis undergoing
either SAVR or TAVI and with reports on the mortality rates during the
follow-up period were considered. The primary outcome was all-cause
mortality of up to 5 years. RESULT(S): In the reconstructed
individual patient data analysis, there was no statistically significant
difference in all-cause mortality between TAVI and SAVR at 5 years of
follow-up [30.7% vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval
(CI) 0.96-1.48; P = 0.104]. However, landmark analyses in patients
surviving up to 1 year of follow-up showed significantly higher all-cause
mortality at 5 years of follow-up (27.5% vs 17.3%, HR 1.77, 95% CI
1.29-2.43; P < 0.001) in patients undergoing TAVI compared to patients
undergoing SAVR, respectively. CONCLUSION(S): This reconstructed
individual patient data analysis in low-risk patients with severe aortic
stenosis demonstrates that the 5-year all-cause mortality rates are higher
after TAVI than after SAVR, driven by markedly higher mortality rates
between 1 and 5 years of follow-up in the TAVI group. The present results
call for caution in expanding the TAVI procedure as the treatment of
choice for the majority of all low-risk patients until long-term data from
contemporary randomized clinical trials are available. Copyright
© 2020 The Author(s) 2020. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<74>
Accession Number
2010088354
Title
Intracoronary ALLogeneic heart STem cells to Achieve myocardial
Regeneration (ALLSTAR): A randomized, placebo-controlled, double-blinded
trial.
Source
European Heart Journal. 41 (36) (pp 3451-3458), 2020. Date of Publication:
21 Sep 2020.
Author
Makkar R.R.; Kereiakes D.J.; Aguirre F.; Kowalchuk G.; Chakravarty T.;
Malliaras K.; Francis G.S.; Povsic T.J.; Schatz R.; Traverse J.H.; Pogoda
J.M.; Smith R.R.; Marban L.; Ascheim D.D.; Ostovaneh M.R.; Lima J.A.C.;
DeMaria A.; Marban E.; Henry T.D.
Institution
(Makkar, Chakravarty, Marban, Henry) Smidt Heart Institute, Cedars-Sinai
Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, United
States
(Kereiakes) Christ Hospital, Cincinnati, 2139 Auburn Ave, Cincinnati, OH
45219, United States
(Aguirre) Prairie/St. Johns Hospital, Springfield, 800 E Carpenter St,
Springfield, IL 62769, United States
(Kowalchuk) Sanger Heart and Vascular, Charlotte, 1001 Blythe Blvd Ste
300, Charlotte, NC 28203, United States
(Malliaras) University of Athens, 17 Agiou Thoma street, Athens 11527,
Greece
(Francis) University of Minnesota Heart Care, Minneapolis, 6405 France Ave
S, Edina, MN 55435, United States
(Povsic) Duke University Hospital, Durham, 2301 Erwin Rd, Durham, NC
27710, United States
(Schatz) Scripps Green Hospital, 10666 N Torrey Pines Rd, San diego, CA
92037, United States
(Traverse) Minneapolis Heart Institute Foundation, 920 E 28th St Ste 100,
Minneapolis, MN 55407, United States
(Pogoda, Smith, Marban, Ascheim) 10Capricor Therapeutics, Los Angeles,
8840 Wilshire Blvd Ste 2, Beverly Hills, CA 90211, United States
(Ostovaneh, Lima) Johns Hopkins University, 3400 N Charles St, Baltimore,
MD 21218, United States
(DeMaria) University of California San Diego Medical Center, 200 W. Arbor
Drive, San Diego, CA 92103, United States
Publisher
Oxford University Press
Abstract
Aims Cardiosphere-derived cells (CDCs) are cardiac progenitor cells that
exhibit disease-modifying bioactivity in various models of cardiomyopathy
and in previous clinical studies of acute myocardial infarction (MI),
dilated cardiomyopathy, and Duchenne muscular dystrophy. The aim of the
study was to assess the safety and efficacy of intracoronary
administration of allogeneic CDCs in the multicentre, randomized,
double-blinded, placebo-controlled, intracoronary ALLogeneic heart STem
cells to Achieve myocardial Regeneration (ALLSTAR) trial. Methods and We
enrolled patients 4 weeks to 12 months after MI, with left ventricular
ejection fraction (LVEF) <_45% and LV results scar size >_15% of LV mass
by magnetic resonance imaging (MRI). A pre-specified interim analysis was
performed when 6-month MRI data were available. The trial was subsequently
stopped due to the low probability of detecting a significant treatment
effect of CDCs based on the primary endpoint. Patients were randomly
allocated in a 2:1 ratio to receive CDCs or placebo in the infarct-related
artery by stop-flow technique. The primary safety endpoint was the
occurrence, during 1-month post-intracoronary infusion, of acute
myocarditis attributable to allogeneic CDCs, ventricular tachycardia- or
ventricular fibrillation-related death, sudden unexpected death, or a
major adverse cardiac event (death or hospitalization for heart failure or
non-fatal MI or need for left ventricular assist device or heart
transplant). The primary efficacy endpoint was the relative percentage
change in infarct size at 12 months post-infusion as assessed by
contrast-enhanced cardiac MRI. We randomly allocated 142 eligible patients
of whom 134 were treated (90 to the CDC group and 44 to the placebo
group). The mean baseline LVEF was 40% and the mean scar size was 22% of
LV mass. No primary safety endpoint events occurred. There was no
difference in the percentage change from baseline in scar size (P = 0.51)
between CDCs and placebo groups at 6 months. Compared with placebo, there
were significant reductions in LV end-diastolic volume (P = 0.02), LV
end-systolic volume (P = 0.02), and N-terminal pro b-type natriuretic
peptide (NT-proBNP) (P = 0.02) at 6 months in CDC-treated patients.
Conclusion Intracoronary infusion of allogeneic CDCs in patients with
post-MI LV dysfunction was safe but did not reduce scar size relative to
placebo at 6 months. Nevertheless, the reductions in LV volumes and
NT-proBNP reveal disease-modifying bioactivity of CDCs. Copyright
© 2020 Oxford University Press. All rights reserved.

<75>
Accession Number
2006725744
Title
Relationships between mitral annular calcification and cardiovascular
events: A meta-analysis.
Source
Echocardiography. 37 (11) (pp 1723-1731), 2020. Date of Publication:
November 2020.
Author
Wang T.K.M.; Griffin B.P.; Xu B.; Rodriguez L.L.; Popovic Z.B.; Gillinov
M.A.; Pettersson G.B.; Desai M.Y.
Institution
(Wang, Griffin, Xu, Rodriguez, Popovic, Desai) Section of Cardiovascular
Imaging, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH,
United States
(Gillinov, Pettersson) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Mitral annular calcification (MAC) is prevalent in the aging
population, with recent renewed interest regarding its associations with
cardiovascular risk factors, outcomes, and influence on valvular heart
disease and interventions. This meta-analysis aimed to report the
relationships between MAC and cardiovascular mortality and morbidity
events. Method(s): Relevant studies were searched from PubMed,
Cochrane, and Embase databases until November 30, 2019. Associations
between MAC as a binary variable with death and cardiovascular events were
pooled using random-effects models. The main outcomes of interest were
all-cause and cardiovascular mortality, myocardial infarction, stroke,
heart failure, atrial fibrillation, and procedural outcomes.
 Result(s): Among 799 article abstracts and 122 full-text articles
screened, 26 (16 prospective and 10 retrospective) studies totaling 35 070
subjects were analyzed. MAC was associated with higher all-cause death,
hazard ratio (95% confidence interval) 1.76 (1.43-2.22), and
cardiovascular mortality 1.85 (1.45-23.5). It also positively correlated
with myocardial infarction 1.48 (1.22-1.79), stroke 1.51 (1.22-2.05),
incidental heart failure 1.55 (1.30-1.84), atrial fibrillation 1.75
(1.43-2.15), and their composite, major adverse cardiovascular events
(MACE). Finally, conversion to mitral valve replacement at time of cardiac
surgery was more in patients with MAC than without MAC, with odds ratio
(95% confidence interval) 2.82 (1.28-6.18). Conclusion(s): Mitral
annular calcification was overall associated with higher rates of death,
and both individual and composite cardiovascular events. The presence of
increasingly encountered MAC has significant clinical implications for
cardiovascular risk assessment and valvular interventions. Copyright
© 2020 Wiley Periodicals LLC

<76>
Accession Number
632892099
Title
Publication Performance in German Academic Heart Surgery.
Source
Thoracic and Cardiovascular Surgeon. 69 (1) (pp 19-25), 2021. Date of
Publication: 01 Jan 2021.
Author
Debus E.S.; Dolg M.; Reichenspurner H.; Grundmann R.T.
Institution
(Debus, Dolg, Grundmann) Herz-und Gefabetazentrum, Universitatsklinikum
Hamburg-Eppendorf, Martinistrabetae 52, Hamburg 20246, Germany
(Reichenspurner) Cardiovascular Surgery, Universitatsklinikum
Hamburg-Eppendorf, Hamburg, Germany
Publisher
Georg Thieme Verlag
Abstract
Background: This study was designed to evaluate the publication
performance of management teams consisting of chief and senior physicians
in German university cardiac surgery units over a 10-year period and to
facilitate benchmarking. Method(s): The cutoff date for consideration
of staffing from the unit Web site and publications was July 1, 2017. The
literature search was based on an evaluation of the PubMed database. The
5-year impact factor (IF) from 2016 was assigned to each journal.
 Result(s): Two thousand five hundred thirty-five publications
(average IF 3.02) were registered, published in 323 journals. Of a total
of 341 management team members, 235 (68.9%) published as first or last
author over the 10-year period. The number of publications from the units
divided into quintiles varied considerably with the first six units
contributing 39.0% of all publications and the last nine units 9.4%. With
a cumulative IF total of 3265, the publications of the first six units
accounted for 42.7% of the cumulative IF, the last unit quintile amounted
to 621 (8.1%) of the cumulative IF. When considering publications per
managing member, the first quintile averaged 11.9 publications (29.6 IF)
per managing member, the last quintile 3.3 publications (8.0 IF) per
member. Conclusion(s): The six units of the first quintile published
on average 3.6 times more per managing member than the nine units in the
last quintile and the average cumulative IF per member in the first
quintile was almost five times higher. Further investigation must show
whether this considerable difference in publication activity between the
university units is also observed in other operative fields. Copyright
© 2021 Georg Thieme Verlag. All rights reserved.

<77>
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.

<78>
[Use Link to view the full text]
Accession Number
2008004489
Title
Evaluation of Automated Delivery of Propofol Using a Closed-Loop
Anesthesia Delivery System in Patients Undergoing Thoracic Surgery: A
Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1089-1095),
2021. Date of Publication: April 2021.
Author
Sethi N.; Dutta A.; Puri G.D.; Panday B.C.; Sood J.; Gupta M.; Choudhary
P.K.; Sharma S.
Institution
(Sethi, Dutta, Panday, Sood, Gupta, Choudhary, Sharma) Department of
Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital,
New Delhi, India
(Puri) Department of Anaesthesia and Intensive Care, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objective: Automated propofol total intravenous anesthesia (TIVA)
administered by a closed-loop anesthesia delivery system (CLADS) exhibits
greater efficiency than conventional manual methods, but its use in major
thoracic surgery is limited. Design(s): Prospective, single-blind,
randomized controlled study. Setting(s): Single-center tertiary care
hospital. Participant(s): Patients undergoing thoracic surgery.
 Intervention(s): Patients were randomly allocated to receive
CLADS-driven (CLADS group) or manually controlled (manual group) propofol
TIVA. Measurements and Main Results: Anesthesia depth consistency
(primary objective) and anesthesia delivery performance, propofol usage,
work ergonomics, intraoperative hemodynamics, and recovery profile
(secondary objectives) were analyzed. No differences were found for
anesthesia depth consistency (percentage of time the bispectral index was
within +/- 10 of target) (CLADS group: 82.5% [78.5%-87.2%] v manual group:
86.5% [74.2%-92.5%]; p = 0.581) and delivery performance, including median
performance error (CLADS group: 3 [-4 to 6] v manual group: 1 [-2.5 to
6]); median absolute performance error (CLADS group: 10 [10-12] v manual
group:10 [8-12]); wobble (CLADS group: 10 [8-12] v manual group: 9
[6-10.5]); and global score (CLADS group: 24.2 [21.2-29.3] v manual group:
22.1 [17.3-32.3]) (p > 0.05). However, propofol requirements were
significantly lower in the CLADS group for induction (CLADS group: 1.27
+/- 0.21] mg/kg v manual group: 1.78 +/- 0.51 mg/kg; p = 0.014) and
maintenance (CLADS group: 4.02 +/- 0.99 mg/kg/h v manual group: 5.11 +/-
1.40 mg/kg/h; p = 0.025) of TIVA. Ergonomically, CLADS-driven TIVA was
found to be significantly superior to manual control (infusion adjustment
frequency/h) (manual infusion: 9.6 [7.8-14.9] v CLADS delivery [none]).
 Conclusion(s): In thoracic surgery patients, CLADS-automated propofol
TIVA confers significant ergonomic advantage along with lower propofol
usage. Copyright © 2020 Elsevier Inc.

<79>
Accession Number
2007883556
Title
Sublingual Sufentanil Tablet System Versus Continuous Morphine Infusion
for Postoperative Analgesia in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1125-1133),
2021. Date of Publication: April 2021.
Author
Van Tittelboom V.; Poelaert R.; Malbrain M.L.N.G.; La Meir M.; Staessens
K.; Poelaert J.
Institution
(Van Tittelboom, Poelaert) Department of Anesthesiology and Perioperative
Medicine, UZ Brussels, Jette, Belgium
(Malbrain) Department of Intensive Care, UZ Brussels, Faculty of Medicine
and Pharmacy, Jette, Belgium
(La Meir) Department of Cardiac Surgery, UZ Brussels, Faculty of Medicine
and Pharmacy, Jette, Belgium
(Staessens) Department of Perfusion, UZ Brussels, Jette, Belgium
(Poelaert) Department of Anesthesiology and Perioperative Medicine, UZ
Brussels, Faculty of Medicine and Pharmacy, Jette, Belgium
Publisher
W.B. Saunders
Abstract
Objective(s): To assess the effectiveness and side effects of a
patient-controlled sublingual sufentanil tablet system for postoperative
analgesia after cardiac surgery and to compare it to a nurse-controlled
continuous morphine infusion. Design(s): Prospective, open-label,
randomized controlled trial. Setting(s): Single university academic
center. Participant(s): Adult patients undergoing cardiac surgery,
which included a sternotomy. Intervention(s): Sublingual sufentanil
tablet system versus nurse-controlled continuous morphine infusion.
 Measurements and Main Results: A total of 483 cardiac surgery
patients were screened for eligibility, of whom 64 patients completed the
study. No statistically significant differences were found for baseline
characteristics between both groups. All mean numeric rating scale (NRS)
pain scores from after extubation until intensive care unit discharge were
<=3 in both groups. The cumulative mean NRS pain score from 24 hours after
extubation (primary outcome) (t = hours after extubation) was
significantly different in favor of the morphine group: (t = 0-24) (0.8
[0.7] v 1.3 [0.8]; p = 0.006). Later cumulative mean pain scores were also
in favor of the morphine group: (t = 24-48) (0.2 [0.3] v 0.6 [0.5]; p =
0.001) and (t = 48-63) (0.0 [0.0] v 0.1 [0.2]; p = 0.013). The cumulative
opioid dose (in milligrams intravenous morphine equivalents) was
significantly higher in the morphine group compared with the sublingual
sufentanil group (241.94 [218.73] v 39.84 [21.96]; p = 0.0001). No
differences were found for the incidences of postoperative nausea and
vomiting, sedation, hypoventilation, bradycardia, or hypotension between
both groups (secondary outcomes). Conclusion(s): Despite resulting in
statistically significantly higher pain scores, a patient-controlled
sublingual sufentanil tablet system offers adequate analgesia after
cardiac surgery and reduces opioid consumption when compared with
continuous morphine infusion. Copyright © 2020 Elsevier Inc.

<80>
Accession Number
2007481454
Title
Point-of-Care Platelet Function Monitoring: Implications for Patients With
Platelet Inhibitors in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1049-1059),
2021. Date of Publication: April 2021.
Author
Bolliger D.; Lance M.D.; Siegemund M.
Institution
(Bolliger) Department for Anesthesia, Prehospital Emergency Medicine and
Pain Therapy, University Hospital Basel, Basel, Switzerland
(Lance) Department of Anesthesiology, Intensive Care Unit and
Perioperative Medicine, Weill-Cornell Medicine-Qatar, Hamad Medical
Corporation, Doha, Qatar
(Siegemund) Intensive Care Medicine, University Hospital Basel, Basel,
Switzerland
Publisher
W.B. Saunders
Abstract
Although most physicians are comfortable managing the limited
anticoagulant effect of aspirin, the recent administration of potent
P2Y<inf>12</inf> receptor inhibitors in patients undergoing cardiac
surgery remains a dilemma. Guidelines recommend discontinuation of potent
P2Y<inf>12</inf> inhibitors 5- to- 7 days before surgery to reduce the
risk of postoperative hemorrhage. Such a strategy might not be feasible
before urgent surgery, due to ongoing myocardial ischemia or in patients
at high risk for thromboembolic events. Recently, different point-of-care
devices to assess functional platelet quality have become available for
clinical use. The aim of this narrative review was to evaluate the
implications and potential benefits of platelet function monitoring in
guiding perioperative management and therapeutic options in patients
treated with antiplatelets, including aspirin or P2Y<inf>12</inf> receptor
inhibitors, undergoing cardiac surgery. No objective superiority of one
point-of-care device over another was found in a large meta-analysis.
Their accuracy and reliability are generally limited in the perioperative
period. In particular, preoperative platelet function testing has been
used to assess platelet contribution to bleeding after cardiac surgery.
However, predictive values for postoperative hemorrhage and transfusion
requirements are low, and there is a significant variability between and
within these tests. Further, platelet function monitoring has been used to
optimize the preoperative waiting period after cessation of dual
antiplatelet therapy before urgent cardiac surgery. Furthermore, studies
assessing their value in therapeutic decisions in bleeding patients after
cardiac surgery are scarce. A general and liberal use of perioperative
platelet function testing is not yet recommended. Copyright ©
2020 The Authors

<81>
Accession Number
2007163541
Title
Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A
Meta-analysis.
Source
Pediatric Cardiology. 42 (2) (pp 225-233), 2021. Date of Publication:
February 2021.
Author
Farias J.S.; Villarreal E.G.; Flores S.; Mastropietro C.W.; Vogel M.;
Schulz K.; Culichia C.; Iliopoulos I.D.; Bronicki R.A.; Loomba R.S.
Institution
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Flores, Bronicki) Texas Children's Hospital, Houston, TX, United States
(Flores, Bronicki) Baylor College of Medicine, Houston, TX, United States
(Mastropietro) Riley's Children's Health, Indianapolis, IN, United States
(Mastropietro) Indiana University School of Medicine, Indianapolis, IN,
United States
(Vogel, Schulz, Culichia, Loomba) Chicago Medical School/Rosalind Franklin
University of Medicine and Science, North Chicago, IL, United States
(Vogel, Schulz, Culichia, Loomba) Advocate Children's Heart
Institute/Advocate Children's Hospital, Oak Lawn, IL, United States
(Iliopoulos) Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
(Villarreal) Department of Pediatrics, Tecnologico de Monterrey, Escuela
de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Publisher
Springer
Abstract
Vasopressin has been used to augment blood pressure; however,
cardiovascular effects after cardiac surgery have not been well
established. The primary objective of this study was to survey the current
literature and quantify the pooled effect of vasopressin on hemodynamic
parameters in children after pediatric cardiac surgery. A systematic
review was conducted to identify studies characterizing the hemodynamic
effects of vasopressin after pediatric cardiac surgery. Studies were
assessed and those of satisfactory quality with pre- and post-vasopressin
hemodynamics for each patient were included in the final analyses. 6
studies with 160 patients were included for endpoints during the first 2 h
of infusions. Patients who received vasopressin infusion had greater mean,
systolic, and diastolic blood pressures and lower heart rates at 2 h after
initiation. 8 studies with 338 patients were included for the effects at
24 h. Patients who received vasopressin infusion had lower central venous
pressures and decreased lactate concentrations 24 h after initiation. A
subset analysis for children with functionally univentricular hearts found
significant decrease in inotrope score and central venous pressure. A
subset analysis for neonates found significant decrease in inotrope score
and fluid balance. Vasopressin leads to decrease in heart rate and
increase in blood pressure in the first 2 h of initiation. Later effects
include decrease in inotrope score, central venous pressure, fluid
balance, and in lactate within the first 24 h. Findings vary in neonates
and in those with functionally univentricular hearts although beneficial
effects are noted in both. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<82>
[Use Link to view the full text]
Accession Number
633805972
Title
Exposure-Response Relationship of Tranexamic Acid in Cardiac Surgery.
Source
Anesthesiology. 134 (2) (pp 165-178), 2021. Date of Publication: 01 Feb
2021.
Author
Zufferey P.J.; Lanoiselee J.; Graouch B.; Vieille B.; Delavenne X.; Ollier
E.
Publisher
NLM (Medline)
Abstract
BACKGROUND: It is unclear whether high-dose regimens of tranexamic acid in
cardiac surgery (total dose, 80 to 100 mg/kg) confer a clinical advantage
over low-dose regimens (total dose, approximately 20 mg/kg), particularly
as tranexamic acid-associated seizure may be dose-related. The authors'
aim was to characterize the exposure-response relationship of this drug.
 METHOD(S): Databases were searched for randomized controlled trials
of intravenous tranexamic acid in adult patients undergoing
cardiopulmonary bypass surgery. Observational studies were added for
seizure assessment. Tranexamic acid concentrations were predicted in each
arm of each study using a population pharmacokinetic model. The
exposure-response relationship was evaluated by performing a model-based
meta-analysis using nonlinear mixed-effect models. RESULT(S):
Sixty-four randomized controlled trials and 18 observational studies
(49,817 patients) were included. Seventy-three different regimens of
tranexamic acid were identified, with the total dose administered ranging
from 5.5 mg/kg to 20 g. The maximum effect of tranexamic acid for
postoperative blood loss reduction was 40% (95% credible interval, 34 to
47%), and the EC50 was 5.6 mg/l (95% credible interval, 0.7 to 11 mg/l).
Exposure values with low-dose regimens approached the 80% effective
concentration, whereas with high-dose regimens, they exceeded the 90%
effective concentration. The predicted cumulative blood loss up to 48 h
postsurgery differed by 58 ml between the two regimens, and the absolute
difference in erythrocyte transfusion rate was 2%. Compared to no
tranexamic acid, low-dose and high-dose regimens increased the risk of
seizure by 1.2-fold and 2-fold, respectively. However, the absolute risk
increase was only clinically meaningful in the context of prolonged
open-chamber surgery. CONCLUSION(S): In cardiopulmonary bypass
surgery, low-dose tranexamic acid seems to be an appropriate regimen for
reducing bleeding outcomes. This meta-analysis has to be interpreted with
caution because the results are observational and dependent on the lack of
bias of the predicted tranexamic acid exposures and the quality of the
included studies. Copyright © 2020, the American Society of
Anesthesiologists, Inc. All Rights Reserved.

<83>
Accession Number
2008500329
Title
Critical Review and Meta-Analysis of Postoperative Sedation after Adult
Cardiac Surgery: Dexmedetomidine Versus Propofol.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1134-1142),
2021. Date of Publication: April 2021.
Author
Abowali H.A.; Paganini M.; Enten G.; Elbadawi A.; Camporesi E.M.
Institution
(Abowali, Paganini, Enten, Camporesi) Team Health Research Institute,
Tampa General Hospital, Tampa, FL, United States
(Elbadawi) University of Texas Medical Branch, Galveston, TX, United
States
Publisher
W.B. Saunders
Abstract
Objective: To evaluate reports from the published literature of all
randomized clinical trials (RCT) comparing postoperative sedation with
dexmedetomidine versus propofol in adult patients, after open cardiac
surgery. Design(s): A computerized search on Medline, EMBASE, Web of
Science, and Agency for Healthcare Research and Quality databases was
completed through June 2020. Meta-analysis of all published RCT comparing
dexmedetomidine versus propofol utilization in the postoperative phase,
using the standard Preferred Reporting Items for Systematic Reviews and
Meta-Analyses checklist. Setting(s): Assemblage and critical
discussion of 11 RCTs comparing postoperative sedation from standard
published reports from 2003 to 2019. Participant(s): The study
comprised 1,184 patients and analyzed critical discussion of time-based
parameters (time to extubation, intensive care unit length of stay, and
hospital length of stay) and nontime-dependent factors (delirium,
bradycardia, and hypotension). Measurements and Main Results: Time to
extubation was significantly reduced in the dexmedetomidine group
(standardized mean difference [SMD] = -0.70, 95% confidence interval [CI]
-0.98 to -0.42, p < 0.001); however, no difference in mechanical
ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.).
Dexmedetomidine significantly reduced the intensive care unit length of
stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not
translate into a reduced hospital length of stay (SMD = -1.13, 95% CI
-2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium
was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06,
N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p =
0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were
reported with propofol. Conclusion(s): Despite the ICU time
advantages afforded by dexmedetomidine over propofol, the former did not
seem to contribute to an overall reduction in hospital length of stay or
improvement in postoperative outcomes of heart valve surgery and CABG
patients. Copyright © 2020

<84>
[Use Link to view the full text]
Accession Number
2010671703
Title
Esmolol in Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1106-1114),
2021. Date of Publication: April 2021.
Author
Zangrillo A.; Bignami E.; Noe B.; Nardelli P.; Licheri M.; Gerli C.;
Crivellari M.; Oriani A.; Di Prima A.L.; Fominskiy E.; Di Tomasso N.;
Lembo R.; Landoni G.; Crescenzi G.; Monaco F.
Institution
(Zangrillo, Noe, Nardelli, Licheri, Gerli, Crivellari, Oriani, Di Prima,
Fominskiy, Di Tomasso, Lembo, Landoni, Monaco) Department of Anesthesia
and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Bignami) Anesthesiology, Critical Care and Pain Medicine Division,
Department of Medicine and Surgery, University of Parma, Parma, Italy
(Crescenzi) Department of Anaesthesia and Intensive Care Medicine,
Humanitas Clinical and Research Center - IRCCS, Milan, Rozzano, Italy
Publisher
W.B. Saunders
Abstract
Objective: To assess whether the administration of the ultra-short-acting
beta-blocker esmolol in cardiac surgery could have a cardioprotective
effect that translates into improved postoperative outcomes.
 Design(s): Single-center, double-blinded, parallel-group randomized
controlled trial. Setting(s): A tertiary care referral center.
 Participant(s): Patients undergoing elective cardiac surgery with
preoperative evidence of left ventricular end-diastolic diameter >60 mm
and/or left ventricular ejection fraction <50%. Intervention(s):
Patients were assigned randomly to receive either esmolol (1 mg/kg as a
bolus before aortic cross-clamping and 2 mg/kg mixed in the cardioplegia
solution) or placebo in a 1:1 allocation ratio. Measurements and Main
Results: The primary composite endpoint of prolonged intensive care unit
stay and/or in-hospital mortality occurred in 36/98 patients (36%) in the
placebo group versus 27/102 patients (27%) in the esmolol group (p =
0.13). In the esmolol group, a reduction in the maximum inotropic score
during the first 24 postoperative hours was observed (10 [interquartile
range 5-15] v 7 [interquartile range 5-10.5]; p = 0.04), as well as a
trend toward a reduction in postoperative low-cardiac-output syndrome
(13/98 v 6/102; p = 0.08) and the rate of hospital admission at one year
(26/95 v 16/96; p = 0.08). A trend toward an increase in the number of
patients with ejection fraction >=60% at hospital discharge also was
observed (4/95 v 11/92; p = 0.06). Conclusion(s): In the present
trial, esmolol as a cardioplegia adjuvant enhanced postoperative cardiac
performance but did not reduce a composite endpoint of prolonged intensive
care unit stay and/or mortality. Copyright © 2020 Elsevier Inc.

<85>
Accession Number
2010544203
Title
Long-term outcomes of postoperative atrial fibrillation following non
cardiac surgery: A systematic review and metanalysis.
Source
European Journal of Internal Medicine. 85 (pp 27-33), 2021. Date of
Publication: March 2021.
Author
Albini A.; Malavasi V.L.; Vitolo M.; Imberti J.F.; Marietta M.; Lip
G.Y.H.; Boriani G.
Institution
(Albini, Malavasi, Vitolo, Imberti, Boriani) Cardiology Division,
Department of Biomedical, Metabolic and Neural Sciences, University of
Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
(Vitolo, Lip) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
(Marietta) Department of Oncology and Haematology, University Hospital,
Modena, Italy
(Lip) Aalborg Thrombosis Research Unit, Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
Publisher
Elsevier B.V.
Abstract
Background: New-onset atrial fibrillation (AF) in non-cardiac
postoperative setting is common and is associated with a high risk of
in-hospital mortality and morbidity. The long-term risks of stroke,
mortality and AF recurrence rate in patients with postoperative AF (POAF)
are unclear. Method(s): We performed a systematic literature review
in electronic databases from inception to March 5th, 2020 of studies
reporting the incidence of stroke, mortality and AF recurrence in patients
with POAF. We confined our analysis to studies with a cohort of at least
150 patients with POAF and with a median follow-up of 12 months as a
minimum. Odds Ratios (OR) were pooled using a random-effects model.
 Result(s): Qualitative analysis included 8 studies (7 observational
cohort studies and 1 randomized controlled trial) enrolling 3,718,587
patients. Six studies underwent metanalysis comprising 17,684
postoperative patients with POAF and 2,169,248 postoperative patients
without POAF. The development of POAF conferred a four-fold increased risk
of stroke in the long-term [OR 4.05; 95% confidence interval (CI)
2.91-5.62]. Mortality in the two studies reporting long-term data was
higher in patients with POAF compared to those without POAF (OR 3.59; CI
95% 2.84-4.53). Data about recurrence were too heterogeneous to undergo
metanalysis. Conclusion(s): POAF is associated with a greater risk of
stroke and mortality over the long-term period. Studies focusing on AF
recurrence are needed to address the perception of POAF as a benign
transient entity. The increased mortality risk following POAF should
encourage systematic detection and prevention of this
arrhythmia. Copyright © 2020

<86>
Accession Number
2010511356
Title
Anesthetic Induction With Etomidate in Cardiac Surgical Patients: A
PRISMA-Compliant Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1073-1085),
2021. Date of Publication: April 2021.
Author
Yao Y.-T.; He L.-X.; Fang N.-X.; Ma J.
Institution
(Yao, He, Fang) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing, China
(Ma) Department of Pharmacy, Fuwai Hospital, National Center for
Cardiovascular Diseases, Peking Union Medical College and Chinese Academy
of Medical Sciences, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: This meta-analysis aimed to systematically review the effects
of etomidate (ETM) during anesthetic induction on patients undergoing
cardiac surgery. Design(s): Systematic review and meta-analysis.
 Setting(s): Operating room. Participant(s): Patients undergoing
cardiac surgery. Intervention(s): ETM or control drugs.
 Measurements and Main Results: PubMed, Cochrane Library, OVID, and
EMBASE were searched through August 31, 2020. Primary outcomes included
hemodynamic profiles and stress responses. Secondary outcomes included
morbidity, mortality, and postoperative recovery. For
continuous/dichotomous variables, treatment effects were calculated as
weighted mean difference (WMD)/odds ratio (OR) and 95% confidence interval
(CI). A database search yielded 18 randomized controlled trials including
1,241 patients. The present meta-analysis demonstrated that
ETM-anesthetized patients had lower heart rates (WMD, -3.31; 95% CI -5.43
to -1.19; p = 0.002), higher blood pressures (systolic blood pressure:
WMD, 12.02; 95% CI 6.24 to 17.80; p < 0.0001; diastolic blood pressure:
WMD, 5.23; 95% CI 2.39 to 8.08; p = 0.0003; mean arterial pressure (MAP):
WMD, 8.64; 95% CI 5.85 to 11.43; p < 0.00001), less requirement for
vasopressor (OR, 0.26; 95% CI 0.15 to 0.44; p < 0.00001), and more
nitroglycerin usage (OR, 14.89; 95% CI 4.92 to 45.08; p < 0.00001) during
anesthetic induction. Current meta-analysis also demonstrated that
single-dose ETM lowered cortisol levels transiently and did not have a
significant effect on endogenous norepinephrine and epinephrine levels and
was not associated with increased postoperative inotrope and/or
vasopressor requirement. Additionally, the meta-analysis suggested that
ETM anesthesia was associated with neither increased mortality nor
morbidity, except a higher incidence of transient adrenal insufficiency in
ETM recipients. Conclusion(s): The present meta-analysis suggested
that single-dose ETM during anesthetic induction could be associated with
more stable hemodynamics, transient and reversible lower cortisol levels,
and a higher adrenal insufficiency incidence, but not worse outcomes in
cardiac surgical patients. Copyright © 2020 Elsevier Inc.

<87>
Accession Number
2010510251
Title
Double-lumen endotracheal tubes and bronchial blockers exhibit similar
lung collapse physiology during lung isolation.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Moreault O.; Couture E.J.; Provencher S.; Somma J.; Lohser J.; Ugalde
P.A.; Lemieux J.; Lellouche F.; Bussieres J.S.
Institution
(Moreault, Couture, Lemieux, Lellouche, Bussieres) Department of
Anesthesiology and Critical Care, Universite Laval, Quebec City, QC,
Canada
(Provencher, Ugalde) Department of Respirology and Thoracic Surgery,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec
City, QC, Canada
(Moreault, Couture, Somma, Lemieux, Lellouche, Bussieres) Department of
Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec - Universite Laval, 2725, Chemin Sainte-Foy, Quebec City, QC G1V
4G5, Canada
(Lohser) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, BC, Canada
(Lellouche) Research Center, Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec City, QC, Canada
Publisher
Springer
Abstract
Purpose: Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers
(BB) are frequently used to allow one-lung ventilation (OLV) during
video-assisted thoracic surgery (VATS). Recently, faster lung collapse has
been documented with a BB than with a DL-ETT. The physiologic mechanisms
behind this faster collapse remained unknown. We aimed to measure ambient
air absorption (V<inf>resorb</inf>) and intra-bronchial pressure
(P<inf>airway</inf>) into the non-ventilated lung during OLV using DL-ETT
and BB. Method(s): Patients undergoing VATS and OLV for lung
resection were randomly assigned to have measurements made of
V<inf>resorb</inf> or P<inf>airway</inf> within the non-ventilated lung
using either a DL-ETT or BB. Result(s): Thirty-nine patients were
included in the analyses. The mean (standard error of the mean [SEM])
V<inf>resorb</inf> was similar in the DL-ETT and BB groups [504 (85) vs
630 (86) mL, respectively; mean difference, 126; 95% confidence interval
[CI], -128 to 380; P = 0.31]. The mean (SEM) P<inf>airway</inf> became
progressively negative in the non-ventilated lung in both the DL-ETT and
the BB groups reaching [-20 (5) and -31 (10) cmH<inf>2</inf>O,
respectively; mean difference, -11; 95% CI, -34 to 12; P = 0.44] at the
time of the pleural opening. Conclusion(s): During OLV before pleural
opening, entrainment of ambient air into the non-ventilated lung occurs
when the lumen of the lung isolation device is kept open. This phenomenon
is prevented by occluding the lumen of the isolation device before pleural
opening, resulting in a progressive build-up of negative pressure in the
non-ventilated lung. Future clinical studies are needed to confirm these
physiologic results and their impact on lung collapse and operative
outcomes. Trial registration: www.clinicaltrials.gov (NCT02919267);
registered 28 September 2016. Copyright © 2021, Canadian
Anesthesiologists' Society.

<88>
Accession Number
634270383
Title
Romiplostin for acute management of tacrolimus-induced itp after cardiac
transplantation.
Source
Pediatric Blood and Cancer. Conference: 2020 American Society of Pediatric
Hematology/Oncology Conference, ASPHO 2020. United States. 67 (SUPPL 2)
(no pagination), 2020. Date of Publication: June 2020.
Author
Larkin T.; Gipson D.; Black V.
Institution
(Larkin, Gipson, Black) University of Florida, Gainesville, FL, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Tacrolimus, a calcineurin inhibitor, is a widely utilized
immunosuppressive therapy to prevent rejection in solid organ
transplantation. Thrombopoietin analogue, Romiplostim, has been FDA
approved for treatment of chronic ITP in patients 1 year of age and older.
There are limited data for Romiplostim efficacy and safety in pediatric
acute ITP following solid organ transplantation. Objective(s): To
report the case of a pediatric cardiac transplant recipient who developed
refractory, acute ITP after eight years of treatment with tacrolimus and
was treated with a thrombopoietin analogue. Design/Method: Review of the
literature was performed using keywords "tacrolimus AND ITP," yielding 11
results inclusive of adult transplant recipients. Result(s): A
10-year-old Caucasian male with history of autism spectrum disorder and
hypoplastic left heart syndrome status-post cardiac transplant in 2012
presented with new-onset petechiae, bruising, and a platelet count of
3,000 cells/mm2. Viral PCRs for cytomegalovirus and Epstein-Barr virus
were negative. There was no evidence to suggest thrombotic
microangiopathy. He was treated with intravenous immunoglobulin (IVIG) 1
gm/kg twice for presumed ITP with no response in platelets, which remained
less than 3,000 despite IVIG infusions. He also received a three-day
course of Solumedrol 30 mg/kg with no clinical or laboratory response. Due
to concern for tacrolimus-induced ITP, patient was transitioned from
tacrolimus to cyclosporine based on cases in the adult literature and
exhibited no response 16 days following the immunosuppressant change. Bone
marrow notable for 50% hypocellularity with trilineage hematopoiesis, in
the setting of a persistent isolated thrombocytopenia. As adequate
megakaryocytes were present, he received one dose of subcutaneous
Romiplostim 1 mcg/kg to stimulate maturation. Peripheral counts obtained
one week following Romiplostim reflected platelets up to 186,000 cells/mm3
with coinciding improvement in clinical symptomatology.
 Conclusion(s): Tacrolimus may cause a refractory ITP in children on
chronic immunosuppression following solid organ transplantation.
Romiplostim, a fusion protein analog of thrombopoietin that has been
widely studied in adults with chronic ITP and recently FDA-approved for
children with chronic ITP, may also be an effective therapeutic approach
in cases of medication-induced refractory acute ITP when discontinuation
of the offending agent fails.Our patientwas on chronic tacrolimus when his
ITP occurred and failed to respond to multiple lines of standard
treatment. A single dose of Romiplostim triggered megakaryocyte maturation
with a sustained hematologic response at 6 months, suggesting that
thrombopoietin analogs are a safe potential therapy for refractory
medication-induced acute ITP in pediatric patients following solid organ
transplantation.

<89>
Accession Number
634270370
Title
Novel mutation in a child of the gale gene presenting with pancytopenia.
Source
Pediatric Blood and Cancer. Conference: 2020 American Society of Pediatric
Hematology/Oncology Conference, ASPHO 2020. United States. 67 (SUPPL 2)
(no pagination), 2020. Date of Publication: June 2020.
Author
Rodriguez A.; Maher O.M.; Pelaez L.; Silva J.G.
Institution
(Rodriguez, Maher, Pelaez, Silva) Nicklaus Children Hospital, Miami, FL,
United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Galactose epimerase deficiency (GALE deficiency galactosemia)
encodes UDP galactose-4-epimerase which allows the body to utilize
galactose and follows an autosomal recessive inheritance. Three types of
epimerase deficiency exist: Generalized, peripheral and intermediate with
different severities. One recent publication identified family members
that had GALE mutations in which individuals did not have clinical
galactosemia and presented with thrombocytopenia and intracranial
bleeding. Objective(s):We hereby describe a pediatric male patient
found to have new pathogenic mutation on the GALE gene that presented with
pancytopenia. Design/Method: A PUBMED search was conducted for queries
including GALE gene mutations, galactosemia, pancytopenia,
UPDgalactose-4-epimerase, galactose-1-phosphate. Relevant papers were
selected for literature review Results: A 2 year-old Hispanic male with
past medical history of mitral and tricuspid regurgitation with mitral
valve replacement and tricuspid valvuloplasty presentedwith incidental
pancytopenia in the setting of fever concerning for endocarditis.
Presenting laboratorieswere normocytic normochromic anemiawith hemoglobin
of 9.1 gm/dL, platelets of 11 K/uL and WBC of 1.8 10K/uL with an ANC of
864 10K/uL, patient also found to have hepatosplenomegaly. Differential
diagnosis included bone marrow suppression due to acute illness,
Hemophagocytic Lymphohistiocytosis (HLH) or leukemia. Bone marrow biopsy
showed a hyperactive marrow negative for malignancies; which results were
consistent with flow cytometry. Patient had no history of vision
impairment, hypotonia, developmental delays, weight loss, poor feeding or
jaundice and ate a well-balanced diet with milk products. Whole exome
sequencing showed a heterozygous mutation for c.151c>T p.Arg51Trp in
theGALE gene presumed to have a deleterious effect on protein function. In
addition, a variant of unknown clinical significance was found on the same
gene, c.710G>Ap.Gly237Asp. To evaluate clinical significance of these
mutations galactose-1-phosphate uridyltransferase (GALT) activity and
Galactose-1-phosphate levels were taken. Results showed increased levels
in Galactose-1-phosphate and normal limits of galactose-1-phosphate
uridyltransferase (GALT) activity. Patient was consulted to genetics and
started on a galactose and lactose free diet. Conclusion(s): To the
best of our knowledge, our patient carries a novel mutation in theGALE
gene that has not been previously reported in the literature. More
discoveries of gene mutation profiles can help to better understand the
mechanism and presentations of diseases therefore decreasing the time of
diagnosis and improving outcomes. Adam MP, ArdingerHH, Pagon RA, Wallace
SE, et al. Epimerase Deficiency Galactosemia 1993. PMID: 21290786 SeoA,
Gulsuner S, Pierce S, Ben-Harosh M, et al. Human molecular genetics. 2019
.Inherited thrombocytopenia associated with mutations of
UDP-galactose-4-epimerase 9 GALE PMID: 30247636.

<90>
Accession Number
634270164
Title
Ewing's sarcoma presenting as spontaneous hemothorax.
Source
Pediatric Blood and Cancer. Conference: 2020 American Society of Pediatric
Hematology/Oncology Conference, ASPHO 2020. United States. 67 (SUPPL 2)
(no pagination), 2020. Date of Publication: June 2020.
Author
Maniam G.; Batson A.; Omer L.; Bhaskaran S.; Zaid-Kaylani S.
Institution
(Maniam, Batson, Omer, Bhaskaran, Zaid-Kaylani) Texas Tech University
Health Sciences Center, School of Medicine, Amarillo, TX, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Ewing's sarcoma is a bone malignancy in the primitive
neuroectodermal tumor (PNET) family of tumors, which most commonly affects
pediatric and young adult population. The disease most commonly affects
the major long bones but is also notorious for affecting the pelvis and
ribs, with the ribs representing about 10% of primary lesions. However,
presentation as a spontaneous hemothorax is exceedingly rare.
 Objective(s): To discuss the unique case of Ewing's sarcoma
presenting as right hemothorax in a pediatric patient, and thereby
emphasize the importance of symptom recognition and clinical investigation
in such rare presentations. Design/Method: Case report and PubMed review
of literature. Data was collected retrospectively by analyzing hospital
records. Result(s): A 13-year-old-male presented with acute onset
dyspnea and chest pain. He had intermittent right-sided rib pain 1 week
prior to presentation. History was negative for cough, fevers,
lymphadenopathy, or weight loss. Physical exam revealed mild tachycardia
and moderate respiratory distresswith retractions; breath soundswere
markedly diminished throughout the right lung fields with dullness to
percussion from right subcostal margin to 2nd rib space. CBC revealed mild
anemia. CXR revealed large right loculated pleural effusion. CT
angiography of the chest revealed a large multiloculated right-sided
pleural effusion with compression atelectasis without underlying
pneumonia. Frank blood of about 600mL in volume was observed upon chest
tube placement consistent with massive hemothorax.MRI of the chest showed
generalized pleural thickening in the right lung involving both visceral
and parietal pleura. Video Assisted Thoracic Surgery was performed after
sufficient hemothorax drainage, with removal of a small mass from the 7th
right hemivertebrae. Immunohistochemical staining & genetic evaluation of
the mass revealed Ewing's sarcoma. Whole body PET/CT scan confirmed
malignancy of right chest wall and paratracheal region without
extra-thoracic involvement. Patient was started on chemotherapy according
to COGprotocol startingwith Vincristine, Doxorubicin and Cyclophosphamide
withMesna alternat alternating with Ifosfamide and Etoposide. To date, he
has completed cycle 6 of chemotherapy with good response. Repeat MRI
showed significant improvement in pleural thickening previously noted and
patient is now preparing for radiation therapy. Conclusion(s):
Spontaneous non-traumatic hemothorax in a pediatric patient should raise
suspicion of an underlying malignancy and requires a detailed
investigation. After stabilization of the patient, a diligent
investigation in terms of appropriate imaging and laboratory work up must
be employed.

<91>
Accession Number
634249206
Title
ESCR Abstracts.
Source
International Journal of Cardiovascular Imaging. Conference: European
Society of Cardiovascular Radiology Meeting, ESCR 2020. 36 (11) (no
pagination), 2020. Date of Publication: November 2020.
Author
Anonymous
Publisher
Springer Netherlands
Abstract
The proceedings contain 37 papers. The topics discussed include: improved
prognostic value of coronary CT angiography-derived plaque information and
clinical parameter on adverse cardiac outcome using machine learning; late
gadolinium enhancement in patients with tetralogy of fallot: a systematic
review; primary intrapericardial paraganglioma: multimodality diagnostic
process and imaging findings; T1 mapping of the remote non-infarct
myocardium for predicting adverse left ventricular remodeling following
STEMI; right ventricular strain variations in repaired tetralogy of fallot
patients with regards to pulmonary valve replacement; computed
tomography-derived myocardial extracellular volume: an early biomarker of
cardiotoxicity in esophageal cancer patients undergoing radiation therapy;
and validation of regional wall motion abnormality assessment methods
based on coronary CT angiographies with left ventricular function
regarding prediction of hemodynamically relevant stenoses with iFR.

<92>
Accession Number
634280687
Title
Frailty is highly common in patients with cardiovascular disease but lacks
uniformity in assessment: A systematic review.
Source
European Journal of Preventive Cardiology. Conference: 11th European
Association for Palliative Care Congress, EAPC 2020. 27 (1 SUPPL4) (pp
S54), 2020. Date of Publication: July 2020.
Author
Marinus N.; Vigorito C.; Giallauria F.; Dendale P.; Feys P.; Meesen R.;
Timmermans A.; Spildooren J.; Hansen D.
Institution
(Marinus, Feys) Faculty of Rehabilitation Sciences and Faculty of Medicine
and Life Sciences, Hasselt University, Diepenbeek, Belgium
(Vigorito, Giallauria) Department of Translational Medical Sciences,
Federico II University of Naples, Naples, Italy
(Dendale) Faculty of Medicine and Life Sciences and Heart Centre Hasselt,
Hasselt University and Jessa Hospital, Diepenbeek and Hasselt, Belgium
(Meesen, Timmermans, Spildooren) Faculty of Rehabilitation Sciences,
Hasselt University, Diepenbeek, Belgium
(Hansen) Faculty of Rehabilitation Sciences/Faculty of Medicine and Life
Sciences and Heart Centre Hasselt, Hasselt University and Jessa Hospital,
Diepenbeek and Hasselt, Belgium
Publisher
SAGE Publications Inc.
Abstract
Introduction: Clinicians are increasingly confronted with aged patients
(-70 years) with cardiovascular disease (CVD). Such ageing increases the
likelihood to suffer from frailty, which relates to significantly worse
outcomes. However, how frailty is assessed in older CVD patients, and the
exact prevalence of frailty, remains to be updated in a systematic manner.
 Purpose(s): To identify which tools are currently used to detect
frailty in CVD patients and to assess the prevalence of frailty in older
CVD patients. Method(s): This systematic review adhered to PRISMA
guidelines. Inclusion criteria were: (i) studies up to October 2019,
including patients (men and women) aged-60 years (ii.) suffering from any
CVD with or without cardiac surgery (iii.), which examined the presence of
frailty with a well-defined and validated frailty tool and (iv.) reported
prevalence rates of frailty in these patients. The methodological quality
of the included studies was assessed by validated instruments.
 Result(s): Nine studies of moderate-to-good methodological quality
with a total sample size of 7155 participants were included. The
prevalence of frailty ranged from 6% up to 75% depending on the type of
the frailty tool used and on the specific CVD. Four different frailty
tools (phenotype of Fried, Short Physical Performance Battery (SPPB),
Tilburg Frailty Index (TFI) and Canadian Study of Health and Aging
Clinical Frailty Scale (CSHA-CFS), which mainly focused on the physical
domain of frailty, were used. The highest prevalence rates of frailty were
reported in heart failure patients (75%). Conclusion(s): Frailty is a
significant issue in patients with CVD, especially in those with heart
failure. However, the lack of uniformity in defining frailty, as well as
the variety of factors associated with CVD, re-iterates the importance of
developing a well-defined and valid frailty assessment tool.

<93>
Accession Number
634280501
Title
Magnesium orotate improves symptoms, myocardial function, exercise
capacity and quality of life in operated valvular heart disease: Results
from a randomized, openlabel, case-control 2-year study.
Source
European Journal of Preventive Cardiology. Conference: 11th European
Association for Palliative Care Congress, EAPC 2020. 27 (1 SUPPL4) (pp
S5-S6), 2020. Date of Publication: July 2020.
Author
Gaisin I.I.; Gazimzyanova A.S.; Maximov N.I.; Galimova A.A.; Voronova
M.A.; Abseeva V.M.; Sabirzyanova E.R.; Chernikch E.A.; Korotaeva T.V.;
Gushchevarova M.A.; Kuznetcova I.A.
Institution
(Gaisin) State Medical Academy, Izhevsk, Russian Federation
(Gazimzyanova, Galimova, Voronova, Abseeva, Sabirzyanova, Chernikch,
Korotaeva, Gushchevarova, Kuznetcova) Clinical Diagnostic Centre of Udmurt
Republic, Izhevsk, Russian Federation
(Maximov) Izhevsk State Medical Academy, Izhevsk, Russian Federation
Publisher
SAGE Publications Inc.
Abstract
Background: Successful surgery for valvular heart disease prolongs life
and generally improves symptoms and cardiac function. Nevertheless,
myocardial dysfunction and health-related quality of life (QoL) impairment
may persist and worsen postoperatively. Purpose(s): We aimed to
evaluate the safety and efficacy of nonsteroidal anabolic magnesium
orotate (MO) in long-term treatment of patients with heart valve
prosthesis. Method(s): 220 patients [aged 58.6-4.5 years; 68% males;
65% NYHA class III, 35% NYHA FC II; 42% concomitant SCAD, 24% CABG; median
(IQR) 6-min walk distance (6-MWD) 348 (152a 442) m; mean (SE) left
ventricular ejection fraction (LVEF) 53.2 (2.0)%] 2a4 weeks after
conventional aortic (n=128) or mitral (n=92) valve replacement by
mechanical (95%) or biological (5%) prostheses (42% due to degenerative,
28% rheumatic, 16% myxomatous, 9% congenital valve diseases and 5%
infective endocarditis) were randomized 1:1 to receive either optimal
standard therapy (Vitamin K antagonists, ACEIs/ARBs, beta-blockers,
diuretics, MRAs, statins and digoxin) or magnesium orotate 500 mg t.i.d.
added to conventional treatment. Efficacy endpoints included changes from
preoperative baseline in 6-MWD, NYHA FC, echo-parameters, heart failure
hospitalizations and all-cause mortality. QoL was assessed by the Short
Form (SF-36 v.1) Health Survey. Result(s): There were no significant
differences between MO and control groups at baseline. Patients reported
poor postoperative QoL. At month 24, patients receiving MO (n=110) had a
mean increase in 6-MWD of 248 m (p<0.0001); control patients (n=110) had a
mean 6-MWD increase of 195 m (p<0.001), with a control-adjusted difference
of +53 m (p=0.008). NYHA status improved by two classes in 65% of MO vs.
53% of controls (p=0.020), by one class in 35% vs. 47% (p=0.020). MO
delayed the time to clinical worsening (p=0.0053) and reduced the heart
failure admissions (p=0.0035). Improvements were noted in controladjusted
changes in supraventricular (p=0.0015) and ventricular arrhythmias
(p=0.022) and in postoperative heart remodeling, e.g. in mean LVEF (+3.2%;
p=0.0082), left ventricular end-diastolic diameter (a 5.6 mm; p=0.0018)
and end-systolic diameter (a 3.5 mm; p=0.0055). Combination therapy with
MO was well tolerated. In both groups, SF-36 scores substantially rose
after follow-up. MO patients had significantly higher improvements in QoL
over time compared to controls. One patient died in the control group
(p=0.80). Conclusion(s): Long-term magnesium orotate therapy for
patients with heart valve prostheses improves symptom status, cardiac
function, exercise capacity and QoL. The study provides the evidence that
magnesium orotate is a new promising therapy in operated valvular heart
disease.

<94>
Accession Number
634280454
Title
Magnesium orotate is a new promising therapy for not closed atrial or
ventricular septal defect in pregnant patients.
Source
European Journal of Preventive Cardiology. Conference: 11th European
Association for Palliative Care Congress, EAPC 2020. 27 (1 SUPPL4) (pp
S104), 2020. Date of Publication: July 2020.
Author
Gaisin I.I.; Shilina L.V.; Samartceva E.S.; Garifullina O.P.; Smirnova
E.S.; Vavilkina Z.V.
Institution
(Gaisin) State Medical Academy, Izhevsk, Russian Federation
(Shilina, Samartceva, Garifullina, Smirnova, Vavilkina) Clinical
Diagnostic Centre of Udmurt Republic, Izhevsk, Russian Federation
Publisher
SAGE Publications Inc.
Abstract
Background: According to the ESC 2018 guidelines, women with unoperated
atrial or ventricular septal defect (ASD/VSD) have small increased risk of
maternal mortality or moderate increase in morbidity. Nevertheless,
maternal cardiac complications occur in 12% of completed pregnancies.
Offspring complications are more frequent than in the general population.
Magnesium orotate (MO) is a non-steroidal anabolic plus Mg2+ approved for
pregnant patients. Objective(s): To evaluate the safety and efficacy
of MO in pregnant women with not closed ASD/AVD. Method(s): We
studied 64 consecutive women with unoperated ASD (n=42) or VSD (n=22),
aged 26-7 years, who were referred to our regional
cardiology/cardiosurgery clinic before conception (n=29) or during the
first two months of pregnancy (n=35). Patients were randomized to control
group with conventional follow-up (n=32) and MO-group (n=32); in addition
to standard therapy, from 2nd trimester they received MO 1000 mg t.i.d.
for 1 week, followed by 500 mg t.i.d. The primary endpoints were a major
adverse cardiovascular event (MACE), which included death, heart failure
(HF), thrombo-embolic event, pulmonary arterial hypertension (PAH), and
arrhythmia and pregnancy outcomes. Baseline and outcome data were analysed
and compared for control patients vs. MO-group. Result(s): At
baseline, there were no significant differences between control and
MO-group. NYHA functional class I had 27 (84.4%) and 26 (81.3%) patients,
NYHA II had 5 (15.6%) and 6 (18.7%) patients, respectively (p>0.05).
Atrial and/or ventricular ectopic beats had 29 (90.6%) and 32 (100%)
patients (p>0.05). No maternal mortality and no thrombo-embolic event
occurred in both groups. In 15 control patients, at least one MACE
occurred (46.9%): 9 worsened or developed HF (28.1%), 3 had atrial flutter
(9.4%), 2 had ventricular tachyarrhythmias (6.3%), and 1 patient developed
PAH (3.1%). In MO-group, no patient developed a MACE (p=0.008). MO reduced
the HF occurrence during pregnancy (p=0.035). Improvements were noted in
control-adjusted changes in HF signs (a37.5%; p=0.012) and in frequency of
ectopic beats (a53.1%; p=0.006). Perinatal mortality rate was 0 in the
cohort, premature birth occurred in 8 controls (25%) followed by being
small for gestational age (n=5; 15.6%) vs. 0 in MO-group (p=0.032). MO had
no maternal and offspring adverse effects. Conclusion(s): Long-term
MO therapy for pregnant patients with not closed ASD/VSD prevents MACEs,
improves symptom status, and contributes to successful obstetric and
foetal outcomes. The study provides the evidence that metabolically acting
MO may be a new additional therapy for pregnant patients with congenital
heart disease.

<95>
Accession Number
634280252
Title
4% succinylated gelatine is associated with increased renal oxidative
stress in cardiac surgical patients: A pilot randomised controlled trial.
Source
Anaesthesia and Intensive Care. Conference: 2019 World Congress of
Intensive Care. Australia. 48 (2 SUPPL) (pp 34-35), 2020. Date of
Publication: November 2020.
Author
Smart L.; Boyd C.; Litton E.; Pavey W.; Mori T.; Barden A.; Ali U.; Ho
K.M.
Institution
(Smart, Boyd) Murdoch University, Murdoch, Australia
(Smart) Centre for Clinical Research in Emergency Medicine, Perth,
Australia
(Litton, Pavey, Ali) Fiona Stanley Hospital, Murdoch 6150, Australia
(Smart, Mori, Barden, Ho) University of Western Australia, Perth,
Australia
(Ho) Royal Perth Hospital, Perth, Australia
Publisher
SAGE Publications Inc.
Abstract
Introduction: Patients admitted to the intensive care unit (ICU) after
cardiac surgery frequently require intravenous fluid resuscitation and are
at risk of developing postoperative acute kidney injury (AKI). Colloids,
including 4% succinylated gelatine (GEL), are used commonly but their
safety is uncertain. Objectives/Aims: To provide preliminary evidence of
the effect of GEL vs. compound sodium lactate (CSL) for fluid
resuscitation on urinary biomarkers of AKI in adult ICU patients within 24
hours of cardiac surgery. Method(s): Patients who required at least
500mL fluid bolus after cardiac surgery were randomised to receive GEL or
CSL as the ongoing fluid for bolus therapy for 24 hours. Urinary
F2-isoprostanes concentration, a measure of renal oxidative stress, was
measured by gaschromatography-mass-spectrometry at baseline, one hour,
five hours and 24 hours after enrolment. Difference in concentrations over
time between groups was assessed using a mixed-effects regression model. A
p<0.05 for the interaction between time and treatment allocation was
considered significant. Result(s): Of the 40 participants recruited
(mean age 64 years), 31 (78%) were male and 29 (73%) had on-pump surgery.
Median EuroSCORE II-predicted mortality was 1.09% (Q1-Q3 0.80-1.82). There
was no significant difference between groups in these baseline variables.
The total median study fluid administered within 24 hours of enrolment was
similar (GEL 1250mL, Q1-Q3 500-1750 vs CSL 1000mL, Q1-Q3 500-1375;
p=0.42). Patients who received GEL had a significantly higher urine
concentration of F2-isoprostanes over time (p=0.036) compared to those who
only received CSL, with a significant post-hoc pair-wise difference at 24
hours (GEL geometric mean 37.3 nmol/L, 95% confidence interval [CI]
20.4-68.0 vs CSL geometric mean 8.6 nmol/L, 95% CI 5.0-14.8; p=0.002).
 Conclusion(s): Compared to using CSL for fluid resuscitation, use of
GEL was associated with an increase in renal oxidative stress within 24
hours after its administration in postoperative cardiac surgical patients.

<96>
Accession Number
634252014
Title
Progression to overt Coronary artery disease in Patients with Diabetes
Mellitus at High Coronary Risk: 5 year follow-up of the prospective
multicenter BARDOT Trial.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
Annual Congress of the European Association of Nuclear Medicine, EANM
2020. 47 (SUPPL 1) (pp S358-S359), 2020. Date of Publication: September
2020.
Author
Caobelli F.; Haaf P.; Haenny G.; Pfisterer M.; Zellweger M.
Institution
(Caobelli, Haaf, Haenny, Pfisterer, Zellweger) Universitatsspital Basel,
Basel, Switzerland
Publisher
Springer Berlin Heidelberg
Abstract
Aim/Introduction: The Basel Asymptomatic high-Risk Diabetics' Outcome
Trial (BARDOT) [1] demonstrated that asymptomatic diabetic patients with
an abnormal myocardial perfusion scintigraphy (MPS) were at increased risk
of major cardiac events (MACE) at 2-years follow-up. It remains unclear
whether this finding holds true even for a longer follow-up.
 Material(s) and Method(s): Four hundred patients with type-2 diabetes
and neither history nor symptoms of CAD were evaluated. They underwent
clinical evaluation and MPS with either physical or pharmacologic stress
test. Patients were followed up for 5 years. MPS-based diagnosis of CAD
was defined as summed stress score (SSS) >=4 and/or summed difference
score (SDS) >=2. A fully unremarkable scan was defined as SSS and SDS=0.
MACEs were defined as myocardial infarction, cardiac death or late
coronary revascularization. Patients with detectable CAD were randomly
assigned to medical or invasive treatment. Result(s): At baseline, an
abnormal MPS was found in 87 of 400 patients (22%). MACE within 5 years
occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal
scan (1.7%, p=0.009); 15 deaths were recorded. An abnormal MPS was a
predictor of MACEs occurrence: HR-(95% CI) 2.537 (1.238-5.199, p=0.011).
At Kaplan-Meyer analysis, patients with normal MPS had lower rates of
MACEs than patients with abnormal scans (p=0.016). Patients with SSS = 0
(n= 285) had also lower rate of all-cause death (2.5% vs. 7.1%, p=0.033).
Patients undergoing revascularization experienced significant lower rate
of MACE (n=2, 6.7%, p=0.007) and mortality (p=0.002) compared to those
treated with optimal medical therapy Conclusion(s): High-risk
asymptomatic patients with DM and normal MPS (78%) have a lower rate of
first manifestations of coronary artery disease (CAD) even at 5-years
follow-up. A SSS value =0 predicted a very low all-cause mortality rate,
similar to that of a normal population. Conversely, patients with abnormal
MPS at baseline (22%) have a 7-fold higher rate of progression to overt
CAD. Our results confirm that if patients with diabetes are clinically at
high risk of CAD as in BARDOT, they should be considered for ischemia
testing. A normal scan predicts a good 5-year outcome, while evidence
suggests that those with CAD should be treated with a combined invasive
and medical approach.

<97>
Accession Number
634271329
Title
24/7 telephone support after discharge for surgicalaortic valve
replacement as a potential lifesavingintervention-a clinical case from the
AVRre study.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare
2017. Sweden. 16 (SUPPL 1) (pp S18-S19), 2017. Date of Publication: May
2017.
Author
Danielsen S.O.; Moons P.; Tonnessen T.; Solheim S.; Leegaard M.; Lie I.
Institution
(Danielsen, Tonnessen) Oslo University Hospital, Dep.Cardiothoracic
Surgery, University of Oslo, Oslo, Norway
(Moons) KU Leuven, Leuven, Belgium
(Solheim) Oslo University Hospital, Department of Cardiology, Oslo, Norway
(Leegaard) Oslo and Akershus University College, Faculty of Nursing, Oslo,
Norway
(Lie) Oslo University Hospital, Dep.Cardiothoracic Surgery, Centre for
Patient Centered Heart-and Lung Research, Oslo, Norway
Publisher
SAGE Publications Inc.
Abstract
Introduction: A 55-year-old male with symptomaticsevere aortic stenosis
due to a bicuspid valve, havingdyspnoea and being in NYHA class II-III. He
had a historyof hypertension, hypercholesterolemia and left
ventricularhypertrophy. Mechanical valve was inserted by an
elective,uncomplicated surgical aortic valve replacement (sAVR).The
patient followed the traditional discharge pathwayfrom university hospital
to local hospital, and after a totallength of stay of 9 days, he was sent
home. Setting(s): The AVRre (aortic valve replacement
readmission)study. A randomized controlled trial to assess
theeffectiveness of a 24/7 telephone support to reduce
unplannedreadmissions after surgical aortic valve replacement in
auniversity hospital in Norway is in progress.Problem and solution: As per
protocol, two days afterdischarge, the project nurse (PN) contacted the
patient bytelephone. He reported symptoms including melena, but nostomach
pain, and he felt insecure and experienced increasingdiscomfort. The
patient was advised to discontinue the useof Tramadol (new from local
hospital) due to its possibleinteraction effects with use of Warfarin. The
phone calloccurred on a Friday, and his symptoms were monitored
bytelephone throughout the weekend. On Sunday, the patientcalled the 24/7
service and reported increasing symptomsof dyspnoea and tachycardia,
dizziness, and that he sufferedfrom anxiety. The PN organised referral to
a local emergencyprimary care centre. They referred him to a local
hospital, butthe referral was rejected and the patient went home.
Earlynext morning the patient visited his GP, and status includedincreased
CRP, elevated INR, lowered Hb and possible atrialfibrillation. The GP
discussed the case with the PN, and thepatient was finally admitted to the
local hospital.Pericardial effusion with significant negative effect on
diastolic function was found, and diagnosed as a life-threateningtamponade
condition. The patient was transferred to the university hospital for
thoracocentesis, and a total drainage of1100ml was observed. He was
transferred back to the localhospital after 2 days. During his stay at the
local hospital, thepatient called the PN several times because of his
diminishing trust in the local hospital and lack of convenient access
torelevant and secure information.Issue: Transfer of care for sAVR patient
takes placebetween different levels in the health-care system, with
avarying degree of competence and experience. Evidence inthe literature
indicates reduced patient safety and increasedmortality risk for high-risk
surgery populations when carefragmentation occurs.Conclusion/Implication
for practice: Care of the patientwas fragmented after discharge in a way
that endangeredhis life. The 24/7 telephone support system, that is
beingimplemented and tested, has served as a potential lifesaving
intervention for this patient.

<98>
Accession Number
634271300
Title
Impact of social support and comorbid disorderson health related quality
of life in men and womenafter cardiac surgery.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare
2017. Sweden. 16 (SUPPL 1) (pp S42-S43), 2017. Date of Publication: May
2017.
Author
Bjornnes A.K.; Parry M.; Lie I.; Leegaard M.
Institution
(Bjornnes) Oslo University Hospital, Department of Research and
Development, Division of Emergencies and Critical Care, Oslo, Norway
(Parry) UHN, University of Toronto, Lawrence S. Bloomberg Faculty of
Nursing, Toronto, Canada
(Lie) Oslo University Hospital, Department of Cardiothoracic Surgery,
Oslo, Norway
(Leegaard) Oslo and Akershus University College, Institute of Nursing,
Oslo, Norway
Publisher
SAGE Publications Inc.
Abstract
Background: Cardiac surgical practice has evolvedfrom isolated surgical
procedures towards more complexinterventions in older, frailer patients
with higher preoperativerisk profiles. Older individuals are in general
more exposedto widowhood, poorer health, physical immobility, andreduced
social support. Previous research examining the impact of social support
and comorbid disorders on healthrelated quality of life (HRQL) has been
inconclusive. Purpose(s): To describe the health related quality of
life(HRQL) in men and women undergoing cardiac surgery,and to explore
associations between HRQL, social supportand comorbid disorders.
 Method(s): This study was a secondary data analysis of arandomized
controlled trial in which 416 patients (23%women) scheduled for elective
coronary artery bypassgraft and/or valve surgery were recruited from two
separatecardiothoracic surgical units from March 2012 to September2013.
HRQL was assessed using the Health State DescriptiveSystem (15D)
preoperatively, then at two weeks, and at three,six and 12 months
following cardiac surgery. Linear mixedmodel analyses were performed to
explore associationsbetween HRQL, social support and comorbid disorders.
 Result(s): For the total sample, results demonstrated asignificant
improvement in 15D total score from twoweeks to three months post-surgery,
with only a gradualchange observed from three to 12 months. Adjusted for
age,women had a significantly lower 15D total score comparedto men at all
measure points. Not living with a partner/spouse was consistently
associated with a lower HRQL forwomen up to 12 months after cardiac
surgery. Comparedto baseline, improvements in breathing, usual
activities,distress, and sexual activity were noted in women; and formen,
improvements in vitality and mobility were found at 12months. For all
other dimensions, the distribution of scores inmen and women at 12 months
were not statistical significantfrom their scores prior to surgery.
Interestingly, at 12 months,30% (n=92) of the total sample reported lower
HRQLcompared to baseline. Both men and women associated back/neck
problems, depression and pain with lower HRQL. Conclusion(s): Women
who were living alone experienceddecreased HRQL and a slower recovery
compared to menfollowing cardiac surgery. Results demonstrate a need
forfollow-up and support to help these women manage theirsymptoms and
recovery after cardiac surgery.

<99>
Accession Number
634271278
Title
EuroHeartCare 2017.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare
2017. Sweden. 16 (SUPPL 1) (no pagination), 2017. Date of Publication: May
2017.
Author
Anonymous
Publisher
SAGE Publications Inc.
Abstract
The proceedings contain 163 papers. The topics discussed include: can a
multifaceted intervention including motivational interviewing improve
medication adherence, quality of life and mortality rates in older
patients undergoing coronary artery bypass surgery?; communication about
prognosis and end-of-life care in heart failure care; psychometric
properties of the hospital anxiety and depression scale in cardiac arrest
survivors; psychological distress and healthcare use in patients with
non-cardiac chest pain: does a history of cardiac disease matter?; urinary
catheter use and delirium after aortic valve therapy; psychosocial
interventions decrease depression and anxiety in individuals with diabetes
mellitus: a metaanalysis; sedentary lifestyle is associated with poor
appetite in patients with heart failure; and reasons for thirst and
interventions to reduce thirst from a heart failure patients perspective
in Sweden, japan and the Netherlands.

<100>
Accession Number
2011111957
Title
Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients
at Low Surgical Risk.
Source
Journal of the American College of Cardiology. 77 (9) (pp 1149-1161),
2021. Date of Publication: 09 Mar 2021.
Author
Leon M.B.; Mack M.J.; Hahn R.T.; Thourani V.H.; Makkar R.; Kodali S.K.;
Alu M.C.; Madhavan M.V.; Chau K.H.; Russo M.; Kapadia S.R.; Malaisrie
S.C.; Cohen D.J.; Blanke P.; Leipsic J.A.; Williams M.R.; McCabe J.M.;
Brown D.L.; Babaliaros V.; Goldman S.; Herrmann H.C.; Szeto W.Y.; Genereux
P.; Pershad A.; Lu M.; Webb J.G.; Smith C.R.; Pibarot P.
Institution
(Leon, Hahn, Kodali, Alu, Madhavan, Chau, Smith) Columbia University
Irving Medical Center/NewYork Presbyterian Hospital, New York, NY, United
States
(Leon, Hahn, Alu, Madhavan) Cardiovascular Research Foundation, New York,
NY, United States
(Mack, Brown) Baylor Scott & White Health, Plano, TX, United States
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Russo) Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Malaisrie) Northwestern University Feinberg School of Medicine, Chicago,
IL, United States
(Cohen) University of Missouri-Kansas City, Kansas City, MO, United States
(Blanke, Leipsic, Webb) St. Paul's Hospital, University of British
Columbia, Vancouver, BC, Canada
(Williams) NYU-Langone Medical Center, New York, NY, United States
(McCabe) University of Washington, Seattle, WA, United States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Goldman) Lankenau Institute for Medical Research, Main Line Health,
Wynnewood, PA, United States
(Herrmann, Szeto) University of Pennsylvania, Philadelphia, PA, United
States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Pershad) University of Arizona College of Medicine, Phoenix, AZ, United
States
(Lu) Edwards Lifesciences, Irvine, CA, United States
(Pibarot) Department of Medicine, Laval University, Quebec, QC, Canada
Publisher
Elsevier Inc.
Abstract
Background: In low surgical risk patients with symptomatic severe aortic
stenosis, the PARTNER 3 (Safety and Effectiveness of the SAPIEN 3
Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis) trial
demonstrated superiority of transcatheter aortic valve replacement (TAVR)
versus surgery for the primary endpoint of death, stroke, or
re-hospitalization at 1 year. Objective(s): This study determined
both clinical and echocardiographic outcomes between 1 and 2 years in the
PARTNER 3 trial. Method(s): This study randomly assigned 1,000
patients (1:1) to transfemoral TAVR with the SAPIEN 3 valve versus surgery
(mean Society of Thoracic Surgeons score: 1.9%; mean age: 73 years) with
clinical and echocardiography follow-up at 30 days and at 1 and 2 years.
This study assessed 2-year rates of the primary endpoint and several
secondary endpoints (clinical, echocardiography, and quality-of-life
measures) in this as-treated analysis. Result(s): Primary endpoint
follow-up at 2 years was available in 96.5% of patients. The 2-year
primary endpoint was significantly reduced after TAVR versus surgery
(11.5% vs. 17.4%; hazard ratio: 0.63; 95% confidence interval: 0.45 to
0.88; p = 0.007). Differences in death and stroke favoring TAVR at 1 year
were not statistically significant at 2 years (death: TAVR 2.4% vs.
surgery 3.2%; p = 0.47; stroke: TAVR 2.4% vs. surgery 3.6%; p = 0.28).
Valve thrombosis at 2 years was increased after TAVR (2.6%; 13 events)
compared with surgery (0.7%; 3 events; p = 0.02). Disease-specific health
status continued to be better after TAVR versus surgery through 2 years.
Echocardiographic findings, including hemodynamic valve deterioration and
bioprosthetic valve failure, were similar for TAVR and surgery at 2 years.
 Conclusion(s): At 2 years, the primary endpoint remained
significantly lower with TAVR versus surgery, but initial differences in
death and stroke favoring TAVR were diminished and patients who underwent
TAVR had increased valve thrombosis. (Safety and Effectiveness of the
SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic
Stenosis [PARTNER 3]; NCT02675114) Copyright © 2021 American
College of Cardiology Foundation

<101>
Accession Number
2011118716
Title
Clinical outcomes following surgical mitral valve repair or replacement in
patients with rheumatic heart disease: a meta-analysis.
Source
Annals of Translational Medicine. 9 (3) (no pagination), 2021. Article
Number: 204. Date of Publication: February 2021.
Author
Jiang Y.; Wang C.; Li G.; Chen S.
Institution
(Jiang, Wang, Li, Chen) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Publisher
AME Publishing Company
Abstract
Background: The clinical outcome of mitral valve repair (MVP) is
considerably more favorable than that of mitral valve replacement (MVR) in
patients with degenerative mitral disease. However, rheumatic heart
disease (RHD) is still the predominant cause of mitral valve surgery in
developing countries and the advantages of MVP in RHD have still not been
definitely proven. The aim of this meta-analysis was thus to evaluate the
suitability of MVP in patients with RHD. Considering the difference
between mechanical and biological valves, we distinguished them from each
other and compared them with MVP individually. Method(s): A
comparison of clinical outcomes of MVP and MVR in patients with RHD was
performed based on clinical trial data. Relevant articles published from
January 1, 1990 until March 1, 2020 were identified in Pubmed, Cochrane
Library, and China National Knowledge Infrastructure database (CNKI).
Studies that lacked direct comparisons between MVP and MVR were excluded.
 Result(s): A total of 16 studies with 8659 patients were included in
the analysis. The MVP group displayed lower early and long-term mortality,
and fewer valve-related events and major adverse events. However, this
patient group required more reoperations compared with the MVR group.
Similar results were observed after distinguishing between mechanical and
bioprosthetic valves to compare MVP with MVR (mech-valves), but no
statistically significant difference was identified in the reoperation
rate between MVP and MVR (bio-valves). MVP was further associated with
increased risk of mitral reoperation in patients undergoing concomitant
aortic valve replacement (AVR) surgery but without any improved early and
long-term survival. Conclusion(s): MVP and MVR are beneficial for
patients with RHD. For skilled surgeons, MVP can be performed for some
suitable patients with RHD and is preferred for elderly patients or
patients with contraindications of anticoagulation. However, MVR is more
appropriate when concomitant AVR is needed. Copyright © Annals of
Translational Medicine. All rights reserved.

<102>
Accession Number
2011118713
Title
Selective right middle and lower lobar blockade for minimally invasive
cardiac surgery: a prospective, single-center, randomized controlled
study.
Source
Annals of Translational Medicine. 9 (3) (no pagination), 2021. Article
Number: 254. Date of Publication: February 2021.
Author
Ren Y.; Lyu Y.; Yu Y.; Jin L.; Hu Y.; Guo K.; Cang J.
Institution
(Ren, Yu, Jin, Hu, Guo, Cang) Department of Anesthesia, Zhongshan
Hospital, Fudan University, Shanghai, China
(Lyu) Department of Anesthesia, Minhang Hospital, Fudan University,
Shanghai, China
Publisher
AME Publishing Company
Abstract
Background: Minimally invasive cardiac surgery (MICS) is increasingly
performed due to faster recovery time and lower postoperative
complications when compared with the traditional open surgery. However,
hypoxemia in lung isolation duration after cardiopulmonary bypass (CPB)
surgery has been the focus of anesthesiologists' attention. In the present
study, we designed a novel lung isolation strategy to improve oxygenation
using a bronchial blocker (BB) to isolate the right middle and lower lobes
and preserve the ventilated right upper lobe without affecting the
surgical field. Method(s): Patients who had undergone right lateral
mini-thoracotomy, a MICS, between August 2018 and February 2019, were
enrolled in this randomized controlled study. Patients were randomly
divided into a modified lung isolation group (group M) and a conventional
lung isolation group (group C). In group M, BBs were used to block the
bronchus intermedius, while left-sided double lumen endotracheal tubes
were used in group C to isolate the right lung. The primary outcome was to
determine the number of patients who required an increase in ventilation
volume due to hypoxemia during lung isolation after CPB. Result(s):
Sixty-one patients (30 in group C and 31 in group M) were enrolled. Five
patients in group M were converted to right lung isolation due to poor
surgical field exposure. During lung isolation after CPB, the number of
patients with hypoxemia was lower in group M than group C (5/31 vs. 15/30,
P=0.005). Conclusion(s): The novel modified lung isolation strategy
reduced the incidence of hypoxemia after CPB. Copyright © Annals
of Translational Medicine. All rights reserved.

<103>
Accession Number
2011114851
Title
Music Intervention in Pain Relief of Cardiovascular Patients in Cardiac
Procedures: A Systematic Review and Meta-analysis.
Source
Pain Medicine (United States). 21 (11) (pp 3055-3065), 2020. Date of
Publication: 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
Oxford University Press
Abstract
Background. Numerous meta-analyses have been conducted on music and pain,
but no studies have investigated music and cardiac procedural pain.
Objective. To assess the effects of music intervention on pain in cardiac
procedures in the published randomized controlled trials. Methods. 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. Results. 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. Conclusions. 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.

<104>
Accession Number
2011132227
Title
Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing
Cardiac Surgery With Electroencephalography Monitoring: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Alkhatip A.A.A.M.M.; Kamel M.G.; Farag E.M.; Elayashy M.; Farag A.; Yassin
H.M.; Bahr M.H.; Abdelhaq M.; Sallam A.; Kamal A.M.; Emady M.F.E.; Wagih
M.; Naguib A.A.; Helmy M.; Algameel H.Z.; Abdelkader M.; Mohamed H.;
Younis M.; Purcell A.; Elramely M.; Hamza M.K.
Institution
(Alkhatip) Department of Anaesthesia, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Alkhatip, Farag, Bahr, Abdelkader) Department of Anaesthesia, Beni-Suef
University Hospital and Faculty of Medicine, Beni-Suef University,
Beni-Suef, Egypt
(Kamel) Faculty of Medicine, Minia University, Minia, Egypt
(Elayashy, Abdelhaq, Kamal, Emady, Wagih, Naguib, Helmy, Mohamed, Hamza)
Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo,
Egypt
(Farag) Department of Anesthesia, King Abdullah Medical City - Holy
Capital, Makkah, Saudi Arabia
(Yassin) Department of Anesthesia, Faculty of Medicine, Fayoum University,
Fayoum, Egypt
(Sallam, Purcell) Department of Anaesthesia, Beaumont Hospital, Dublin,
Ireland
(Sallam) Department of Anaesthesia, Faculty of Medicine, Ain-Shams
University, Cairo, Egypt
(Algameel) Department of Anaesthesia, Aberdeen Royal Infirmary Hospital,
Aberdeen, United Kingdom
(Mohamed) Department of Anaesthesia, Royal Papworth Hospital, Cambridge,
United Kingdom
(Younis) Department of Anaesthesia, Cambridge University Hospital,
Cambridge, United Kingdom
(Elramely) Department of Anaesthesia, National Cancer Institute, Cairo
University, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgery for repair of congenital heart defects poses
unique hazards to the developing brain. Deep hypothermic circulatory
arrest (DHCA) is a simple and effective method for facilitating a
bloodless surgical field during congenital heart defect repair. There are,
however, some concerns that prolonged DHCA increases the risk of nervous
system injury. The electroencephalogram (EEG) is used in adult and, to a
lesser extent, pediatric cardiac procedures as a neuromonitoring method.
The present study was performed to assess outcomes following DHCA with EEG
monitoring in the pediatric population. Design(s): In this systematic
review and meta-analysis, the PubMed, Cochrane Central Register of
Controlled Trials, Scopus, Institute of Science Index, and Embase
databases were searched from inception for relevant articles. A fixed- or
random-effects model, as appropriate, was used. Setting(s): Surgical
setting. Participant(s): Pediatric population (<=18 y old).
 Intervention(s): DHCA (18degreeC) with EEG monitoring.
 Measurements and Main Results: Nineteen articles with 1,267 pediatric
patients <=18 years were included. The event rate of clinical and EEG
seizures among patients who underwent DHCA was 12.9% and 14.9%,
respectively. Mortality was found to have a 6.3% prevalence. A longer
duration of DHCA was associated with a higher risk of EEG seizure and
neurologic abnormalities. In addition, seizures were associated with
increased neurologic abnormalities and neurodevelopmental delay.
 Conclusion(s): EEG and neurologic abnormalities were common after
DHCA. A longer duration of DHCA was found to lead to more EEG seizure and
neurologic abnormalities. Moreover, EEG seizures were more common than
clinical seizures. Seizures were found to be associated with increased
neurologic abnormalities and neurodevelopmental delay. Copyright
© 2021 Elsevier Inc.

<105>
Accession Number
2011105914
Title
Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After
Transcatheter Aortic Valve Replacement: REFLECT II.
Source
JACC: Cardiovascular Interventions. 14 (5) (pp 515-527), 2021. Date of
Publication: 08 Mar 2021.
Author
Nazif T.M.; Moses J.; Sharma R.; Dhoble A.; Rovin J.; Brown D.; Horwitz
P.; Makkar R.; Stoler R.; Forrest J.; Messe S.; Dickerman S.; Brennan J.;
Zivadinov R.; Dwyer M.G.; Lansky A.J.
Institution
(Nazif, Moses) Columbia University Medical Center, New York, NY, United
States
(Dhoble) University of Texas Health Science Center, Houston, TX, United
States
(Sharma) Division of Cardiology, Stanford University, Stanford,
California, United States
(Rovin) Morton Plant Hospital, Clearwater, FL, United States
(Brown) Heart Hospital Baylor, Plano, TX, United States
(Horwitz) University of Iowa, Iowa City, IA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Stoler) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Forrest, Dickerman, Brennan, Lansky) Division of Cardiology, Yale School
of Medicine, New Haven, CT, United States
(Messe) Department of Neurology, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Zivadinov, Dwyer) Buffalo Neuroimaging Analysis Center, Department of
Neurology, State University of New York at Buffalo, Buffalo, NY, United
States
(Lansky) Barts Heart Centre, London and Queen Mary University of London,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: The REFLECT II (Randomized Evaluation of TriGuard 3 Cerebral
Embolic Protection After Transcatheter Aortic Valve Implantation) trial
was designed to investigate the safety and efficacy of the TriGUARD 3
(TG3) cerebral embolic protection in patients undergoing transcatheter
aortic valve replacement. Background(s): Cerebral embolization occurs
frequently following transcatheter aortic valve replacement and
procedure-related ischemic stroke occurs in 2% to 6% of patients at 30
days. Whether cerebral protection with TriGuard 3 is safe and effective in
reducing procedure-related cerebral injury is not known. Method(s):
This prospective, multicenter, single-blind, 2:1 randomized (TG3 vs. no
TG3) study was designed to enroll up to 345 patients. The primary 30-day
safety endpoint (Valve Academic Research Consortium-2 defined) was
compared with a performance goal (PG). The primary hierarchical composite
efficacy endpoint (including death or stroke at 30 days, National
Institutes of Health Stroke Scale score worsening in hospital, and
cerebral ischemic lesions on diffusion-weighted magnetic resonance imaging
at 2 to 5 days) was compared using the Finkelstein-Schoenfeld method.
 Result(s): REFLECT II enrolled 220 of the planned 345 patients
(63.8%), including 41 roll-in and 179 randomized patients (121 TG3 and 58
control subjects) at 18 US sites. The sponsor closed the study early after
the U.S. Food and Drug Administration recommended enrollment suspension
for unblinded safety data review. The trial met its primary safety
endpoint compared with the PG (15.9% vs. 34.4% (p < 0.0001). The primary
hierarchal efficacy endpoint at 30 days was not met (mean scores [higher
is better]: -8.58 TG3 vs. 8.08 control; p = 0.857). A post hoc
diffusion-weighted magnetic resonance imaging analysis of per-patient
total lesion volume above incremental thresholds showed numeric reductions
in total lesion volume >500 mm3 (-9.7%) and >1,000
mm3 (-44.5%) in the TG3 group, which were more pronounced among
patients with full TG3 coverage: -51.1% (>500 mm3) and -82.9%
(>1,000 mm3). Conclusion(s): The REFLECT II trial
demonstrated that the TG3 was safe compared with a historical PG but did
not meet its pre-specified primary superiority efficacy
endpoint. Copyright © 2021 American College of Cardiology
Foundation

<106>
Accession Number
2011068139
Title
Blood pressure and brain injury in cardiac surgery: A secondary analysis
of a randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 58 (5) (pp 1035-1044), 2020.
Date of Publication: 2020.
Author
Vedel A.G.; Holmgaard F.; Danielsen E.R.; Langkilde A.; Paulson O.B.; Ravn
H.B.; Rasmussen L.S.; Nilsson J.C.
Institution
(Vedel, Holmgaard, Ravn, Nilsson) Department of Cardiothoracic
Anaesthesiology, Heart Center, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Vedel, Rasmussen) Department of Anaesthesia, Center of Head and
Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Danielsen, Langkilde) Department of Radiology, Diagnostic Center,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Paulson) Neurobiology Research Unit, Neuroscience Center, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Brain dysfunction is a serious complication after cardiac
surgery. In the Perfusion Pressure Cerebral Infarcts trial, we allocated
cardiac surgery patients to a mean arterial pressure of either 70-80 or
40-50 mmHg during cardiopulmonary bypass (CPB). In this secondary
analysis, we compared selected cerebral metabolites using magnetic
resonance spectroscopy hypothesizing that a postoperative decrease in
occipital grey matter (GM) N-acetylaspartate-to-total-creatine ratio,
indicative of ischaemic injury, would be found in the high-target group.
 METHOD(S): Of the 197 patients randomized in the Perfusion Pressure
Cerebral Infarcts trial, 55 and 42 patients had complete and useful data
from GM and white matter (WM), respectively. Spectroscopies were done
preoperatively and on postoperative days 3-6. Cognitive function was
assessed prior to surgery, at discharge and at 3 months. We predefined the
statistical significance level to be 0.01. RESULT(S): A postoperative
decrease was found in GM N-acetylaspartate-to-total-creatine ratio in the
high-target group [mean difference -0.09 (95% confidence interval -0.14 to
-0.04), P = 0.014]. No significant differences were found in other
metabolite ratios investigated in GM or WM. No significant association was
found between changes in metabolite ratios and new cerebral infarcts, WM
lesion score or cognitive dysfunction. CONCLUSION(S): A higher mean
arterial pressure during CPB was associated with signs of impaired
cerebral metabolism, though not at the predefined significance level of
0.01. No significant association was found between metabolite ratio
changes and neuroradiological pathology or change in cognitive
function. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<107>
Accession Number
2011079104
Title
Does percutaneous transthoracic needle biopsy increase the risk of pleural
recurrence in patients with stage I lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (6) (pp 834-838),
2020. Date of Publication: 2020.
Author
Cheng D.; Wang Z.; Cui J.; Liu L.
Institution
(Cheng, Wang, Cui, Liu) West China School of Medicine, Sichuan University,
Chengdu, China
(Wang, Liu) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Does percutaneous
transthoracic needle biopsy (PTNB) increase the risk of pleural recurrence
in patients with stage I lung cancer? Altogether, 298 papers were found
using the reported search, of which 7 cohort studies and 1 meta-analysis
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers were tabulated.
Four cohort studies suggested an association between PTNB and pleural
recurrence in patients with stage I lung cancer, while the other 3 cohort
studies found that PTNB had no impact. One meta-analysis (the largest
study) including 5 of the cohort studies above concluded that PTNB
increased the risk of pleural recurrence among patients with stage I lung
cancer with subpleural lesions. Based on the available evidence, it was
suggested that there may be an association between PTNB and pleural
recurrence in patients with stage I lung cancer, especially for patients
with subpleural lesion. Copyright © 2020 Oxford University Press.
All rights reserved.

<108>
Accession Number
2010543371
Title
Minimally invasive (mini-thoracotomy) versus median sternotomy in redo
mitral valve surgery: A meta-analysis of observational studies.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2021. Date of
Publication: 2021.
Author
Hussain A.; Chacko J.; Uzzaman M.; Hamid O.; Butt S.; Zakai S.B.; Khan H.
Institution
(Hussain, Chacko, Hamid, Butt, Khan) Department of Cardiothoracic Surgery,
King's College Hospital, London, United Kingdom
(Uzzaman) Department of Cardiac Surgery, Queen Elizabeth Hospital,
Birmingham, United Kingdom
(Zakai) National Institute of Cardiovascular Diseases, Karachi, Pakistan
Publisher
SAGE Publications Inc.
Abstract
Objective: Redo mitral valve surgery has traditionally been performed via
a median sternotomy. It is often challenging and is associated with
increased perioperative mortality. Advances in cardiac surgical techniques
over the last two decades have led to an increase in the use of a
minimally invasive approach via a right anterolateral mini-thoracotomy as
opposed to a repeat median sternotomy. However, despite these advances,
there is no general consensus on the best form of entry, and as of yet,
there are no randomized controlled trials. We performed a meta-analysis of
observational studies to aid in determining the best approach for redo
mitral valve surgery. Method(s): The MEDLINE and EMBASE databases
were conducted up until 1 June 2020. Data regarding mortality, stroke,
reoperation for bleeding and length of hospital stay, wound infection and
cardiopulmonary bypass time were extracted and submitted to a
meta-analysis using random effects modelling and the I2-test
for heterogeneity. Seven retrospective observational studies were
included, enrolling a total of 1070 patients. Result(s): There were a
total of 1070 patients. Of these 364 had non-sternotomy approach compared
with 707 patients who had median sternotomy. Further subgroup analysis
revealed that 327 of the 364 patients had a mini-thoracotomy approach
while the remaining 37 patients had a full thoracotomy approach.
In-hospital mortality and length of stay were less in non-sternotomy group
compared to median sternotomy group. There were no differences in stroke,
CPB time and wound infections between the two groups. Conclusion(s):
Redo mitral valve surgery can be performed safely with satisfactory
outcomes via a mini-thoracotomy approach. This meta-analysis shows
comparable results with reduced in-hospital mortality and hospital length
of stay with a mini-thoracotomy approach. Copyright © The
Author(s) 2021.

<109>
Accession Number
2010541373
Title
Driveline damage and repair in continuous-flow left ventricular assist
devices: A systematic review.
Source
Artificial Organs. (no pagination), 2021. Date of Publication: 2021.
Author
D'Antonio N.D.; Maynes E.J.; Tatum R.T.; Prochno K.W.; Saxena A.; Maltais
S.; Samuels L.E.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(D'Antonio, Maynes, Tatum, Prochno, Saxena, Samuels, Morris, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Maltais) Division of Cardiac Surgery, Centre Hospitalie de l'Universite
de Montreal, Montreal, QC, Canada
Publisher
Blackwell Publishing Inc.
Abstract
With mounting time on continuous-flow left ventricular assist device
(CF-LVAD) support, patients occasionally sustain damage to the device
driveline. Outcomes associated with external and internal driveline damage
and repair are currently not well documented. We sought to evaluate the
outcomes of driveline damage and its repair. Electronic search was
performed to identify all relevant studies published over the past 20
years. Fifteen studies were selected for analysis comprising of 55
patients with CF-LVAD dysfunction due to driveline damage. Demographic and
perioperative variables along with outcomes including survival rates were
extracted and pooled for the systematic review. Most patients (53/55) were
supported on HeartMate II LVAD (Abbott Laboratories, Abbott Park, IL).
Internal damage was more commonly reported than external damage [69.1%
(38/55) vs. 30.9% (17/55), P =.01]. Median time to driveline damage was
1.9 years [IQR 1.0, 2.5]. Most patients presented with a CF-LVAD alarm
[94.5% (52/55)] and patients with internal driveline damage had a
significantly higher rate of alarm activation compared to that observed
for those with external damage [38/38 (100%) vs. 14/17 (82.4%), P =.04].
Patients with internal driveline dysfunction were more likely to
experience component wear compared to those with external driveline
dysfunction [10/38 (26.3%) vs. 0/17 (0%), P =.05]; 14.5% of patients
(8/55) underwent external repair of the driveline, 5.5% (3/55) were
treated with rescue tape, and 5.5% (3/55) were placed on an ungrounded
cable, indicating a short-to-shield event had occurred. A total of 49.1%
of patients (27/55) underwent CF-LVAD exchange, 5.5% (3/55) were weaned
off the CF-LVAD to explant, and 5.5% (3/55) underwent emergent heart
transplantation. The median length of hospital stay was 12 days [IQR 7,
12] and 30-day mortality rate was 14.5% (8/55). Driveline damage was more
commonly reported at an internal location and despite being a
well-recognized complication, mortality still appears high. Copyright
© 2021 International Center for Artificial Organs and Transplantation
and Wiley Periodicals LLC.

<110>
Accession Number
2011084680
Title
Meta-Analysis of Usefulness of Cerebral Embolic Protection During
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Ahmad Y.; Howard J.P.
Institution
(Ahmad) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Howard) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
One of the most feared complications of transcatheter aortic valve
implantation (TAVI) is stroke, with increased mortality and disability
observed in patients suffering a stroke after TAVI. There has been no
significant decline in stroke rates seen over the last 5 years; attention
has therefore been given to strategies for cerebral embolic protection.
With the emergence of new randomized trial data, we sought to perform an
updated systematic review and meta-analysis to examine the effect of
cerebral embolic protection during TAVI both on clinical outcomes and on
neuroimaging parameters. We performed a random-effects meta-analysis of
randomized clinical trials of cerebral embolic protection during TAVI. The
primary end point was the risk of stroke. The risk of stroke was not
significantly different with the use of cerebral embolic protection:
relative risk (RR) 0.88, 95% confidence interval (CI) 0.57 to 1.36, p =
0.566. Nor was there a significant reduction in the risk of disabling
stroke, non-disabling stroke or death. There was no significant difference
in total lesion volume on MRI with cerebral embolic protection: mean
difference -74.94, 95% CI -174.31 to 24.4, p = 0.139. There was also not a
significant difference in the number of new ischemic lesions on MRI: mean
difference -2.15, 95% -5.25 to 0.96, p = 0.176, although there was
significant heterogeneity for the neuroimaging outcomes. In conclusion,
cerebral embolic protection during TAVI is safe but there is no evidence
of a statistically significant benefit on clinical outcomes or
neuroimaging parameters. Copyright © 2021 The Author(s)

<111>
Accession Number
2011084455
Title
Intravenous iron supplement for iron deficiency in cardiac transplant
recipients (IronIC): A randomized clinical trial.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Brautaset Englund K.V.; Ostby C.M.; Rolid K.; Gude E.; Andreassen A.K.;
Gullestad L.; Broch K.
Institution
(Brautaset Englund, Ostby, Rolid, Gude, Andreassen, Gullestad, Broch)
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
(Brautaset Englund, Rolid, Gullestad) University of Oslo, Oslo, Norway
(Brautaset Englund, Rolid, Gude, Andreassen, Gullestad, Broch) K.G. Jebsen
Cardiac Research Center and Center for Heart Failure Research, Faculty of
Medicine, University of Oslo, Oslo, Norway
Publisher
Elsevier Inc.
Abstract
Aims: Heart transplant recipients have reduced exercise capacity despite
preserved graft function. The IronIC trial was designed to test the
hypothesis that intravenous iron therapy would improve peak oxygen
consumption in these patients. Methods and Results: This randomized,
placebo-controlled, double-blind trial was performed at our national
center for heart transplantation. One hundred and 2 heart transplant
recipients with a serum ferritin <100 microg/liter or 100 to 300
microg/liter, in combination with transferrin saturation of <20%, and
hemoglobin level >100 g/liter were enrolled >=1 year after
transplantation. A cardiopulmonary exercise test was performed before
administration of the study drug and at 6 months follow-up. The primary
endpoint was peak oxygen consumption. Key secondary outcomes included iron
status, handgrip strength, quality of life, and safety. Fifty-two patients
were randomized to receive ferric derisomaltose 20 mg/kg, and 50 to
placebo. The between-group difference in baseline-adjusted peak oxygen
consumption was 0.3 ml/kg/min (95% confidence interval -0.9 to 1.4, p =
0.66). In patients with a baseline ferritin <30 microg/liter, peak oxygen
consumption was significantly higher in the ferric derisomaltose arm. At 6
months, iron stores were restored in 86% of the patients receiving ferric
derisomaltose vs 20% in patients receiving placebo (p < 0.001). Quality of
life was significantly better in patients receiving ferric derisomaltose.
Twenty-seven adverse events occurred in the intravenous iron group vs 30
in the placebo group (p = 0.39). Conclusion(s): Intravenous iron
treatment did not improve peak oxygen consumption in heart transplant
recipients with ferritin <100 microg/liter or 100 to 300 microg/liter in
combination with transferrin saturation <20%. Trial registration number:
http//www.clinicaltrials.gov identifier NCT03662789. Copyright ©
2021 The Authors

<112>
Accession Number
2011084399
Title
Perioperative management of patients with pulmonary hypertension
undergoing non-cardiothoracic, non-obstetric surgery: a systematic review
and expert consensus statement.
Source
British Journal of Anaesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Price L.C.; Martinez G.; Brame A.; Pickworth T.; Samaranayake C.;
Alexander D.; Garfield B.; Aw T.-C.; McCabe C.; Mukherjee B.; Harries C.;
Kempny A.; Gatzoulis M.; Marino P.; Kiely D.G.; Condliffe R.; Howard L.;
Davies R.; Coghlan G.; Schreiber B.E.; Lordan J.; Taboada D.; Gaine S.;
Johnson M.; Church C.; Kemp S.V.; Wong D.; Curry A.; Levett D.; Price S.;
Ledot S.; Reed A.; Dimopoulos K.; Wort S.J.
Institution
(Price, Brame, Samaranayake, Garfield, McCabe, Mukherjee, Harries, Kempny,
Gatzoulis, Dimopoulos, Wort) National Pulmonary Hypertension Service,
Royal Brompton Hospital, London, United Kingdom
(Price, McCabe, Kempny, Gatzoulis, Reed, Dimopoulos, Wort) National Heart
and Lung Institute, Imperial College London, London, United Kingdom
(Martinez) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
(Brame, Mukherjee, Marino, Wong) Intensive Care unit and Pulmonary
Hypertension Service, London, United Kingdom
(Pickworth, Alexander, Aw) Department of Anaesthesia, Royal Brompton
Hospital, London, United Kingdom
(Garfield, Price, Ledot) Adult Intensive Care Unit, Royal Brompton
Hospital, London, United Kingdom
(Kiely, Condliffe) Pulmonary Vascular Disease Unit, Royal Hallamshire
Hospital, Sheffield, United Kingdom
(Howard, Davies) National Pulmonary Hypertension Service, Hammersmith
Hospital, London, United Kingdom
(Coghlan, Schreiber) National Pulmonary Hypertension Service, Royal Free
Hospital, London, United Kingdom
(Lordan) National Pulmonary Hypertension Service, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Taboada) Pulmonary Vascular Disease Unit, Royal Papworth Hospital,
Cambridge, United Kingdom
(Gaine) National Pulmonary Hypertension Unit, Mater Misericordiae
University Hospital, Dublin, Ireland
(Johnson, Church) Scottish Pulmonary Vascular Unit, NHS Golden Jubilee,
Clydebank, United Kingdom
(Kemp) Department of Respiratory Medicine, Royal Brompton Hospital,
London, United Kingdom
(Curry) Cardiothoracic Anaesthesia, University Hospital Southampton,
Southampton, Hampshire, United Kingdom
(Levett) Anaesthesia and Critical Care Research Area, Southampton NIHR
Biomedical Research Centre, University Hospital Southampton NHS Foundation
Trust, Southampton, United Kingdom
(Levett) Integrative Physiology and Critical Illness Group, Clinical and
Experimental Sciences, Faculty of Medicine, University of Southampton,
Southampton, United Kingdom
(Reed) Respiratory and Lung Transplantation, Harefield Hospital, Uxbridge,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: The risk of complications, including death, is substantially
increased in patients with pulmonary hypertension (PH) undergoing
anaesthesia for surgical procedures, especially in those with pulmonary
arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH).
Sedation also poses a risk to patients with PH. Physiological changes
including tachycardia, hypotension, fluid shifts, and an increase in
pulmonary vascular resistance (PH crisis) can precipitate acute right
ventricular decompensation and death. Method(s): A systematic
literature review was performed of studies in patients with PH undergoing
non-cardiac and non-obstetric surgery. The management of patients with PH
requiring sedation for endoscopy was also reviewed. Using a framework of
relevant clinical questions, we review the available evidence guiding
operative risk, risk assessment, preoperative optimisation, and
perioperative management, and identifying areas for future research.
 Result(s): Reported 30 day mortality after non-cardiac and
non-obstetric surgery ranges between 2% and 18% in patients with PH
undergoing elective procedures, and increases to 15-50% for emergency
surgery, with complications and death usually relating to acute right
ventricular failure. Risk factors for mortality include procedure-specific
and patient-related factors, especially markers of PH severity (e.g.
pulmonary haemodynamics, poor exercise performance, and right ventricular
dysfunction). Most studies highlight the importance of individualised
preoperative risk assessment and optimisation and advanced perioperative
planning. Conclusion(s): With an increasing number of patients
requiring surgery in specialist and non-specialist PH centres, a
systematic, evidence-based, multidisciplinary approach is required to
minimise complications. Adequate risk stratification and a
tailored-individualised perioperative plan is paramount. Copyright
© 2021 British Journal of Anaesthesia

<113>
Accession Number
2011084047
Title
Frequency, impact and predictors of access complications with plug-based
large-bore arteriotomy closure - A patient level meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Nuis R.-J.; Wood D.; Kroon H.; van Wiechen M.; Bigelow D.; Buller C.;
Daemen J.; de Jaegere P.; Krajcer Z.; Webb J.; Van Mieghem N.
Institution
(Nuis, Kroon, van Wiechen, Daemen, de Jaegere, Van Mieghem) Department of
Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
(Wood, Webb) Centre for Cardiovascular and Heart Valve Innovation, St.
Paul's and Vancouver General Hospital, Vancouver, Canada
(Bigelow, Buller) Clinical and Medical Affairs, Teleflex Inc., Exton, PA,
United States
(Krajcer) Baylor St Luke Hospital, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background/purpose: The MANTA is a dedicated plug-based large-bore
vascular closure device (VCD) providing safe hemostasis in most patients,
but data on the clinical impact and mechanisms of MANTA related
complications are limited. This study sought to determine the frequency,
impact and predictors of MANTA-related access complications.
Methods/materials: This patient-level meta-analysis included data from 2
medical device approval studies and 1 post-approval registry. The primary
endpoint was the composite of major and minor access complications.
Technical success was defined as hemostasis with MANTA closure device
without need for vascular surgery or stenting. Result(s): Eight
hundred ninety-one patients (mean age 80) underwent transcatheter aortic
valve replacement (n = 814), endovascular aortic repair (n = 71), balloon
aortic valvuloplasty (n = 4) or mechanical circulatory support (n = 2).
Technical success was 96.4% and median time to hemostasis was 31
(interquartile range: 17-76) seconds. The primary endpoint occurred 9.1%
and bailout vascular surgery or stenting was necessary in 32 patients
(3.6%). Female gender (OR: 2.63, CI: 1.46-4.73, p = 0.001), left femoral
access (OR: 2.18, CI: 1.17-4.06, p = 0.015) and unfavorable arteriotomy
phenotype (combination of a small femoral artery diameter with a deep
arteriotomy; OR 2.27: 1.26-4.10, p = 0.006) independently predicted access
complications. Access complications most often consisted of vessel
dissection, stenosis or occlusion and predominantly occurred in patients
with an unfavorable arteriotomy phenotype. Conclusion(s): Large-bore
arteriotomy closure with MANTA VCD provided fast and safe hemostasis with
an acceptable complication rate. Refined procedure planning and
risk-stratification may further improve MANTA VCD performance. Study
summary: This study of 891 patients undergoing percutaneous interventions
with large-bore arteriotomies showed that the MANTA closure device
provides safe and rapid hemostasis in >95%. Independent predictors of
MANTA failure were female gender, left femoral access and unfavorable
arteriotomy phenotype (i.e. combination of a small femoral artery diameter
with a deep arteriotomy). Patients exhibiting the latter were especially
at risk for vessel dissection, stenosis or closure. Copyright ©
2021

<114>
Accession Number
2011073139
Title
Optimal medical therapy with or without surgical revascularization and
long-term outcomes in ischemic cardiomyopathy.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Farsky P.S.; White J.; Al-Khalidi H.R.; Sueta C.A.; Rouleau J.L.; Panza
J.A.; Velazquez E.J.; O'Connor C.M.; Dabrowski R.; Djokovic L.; Drazner
M.; Haddad H.; Ali I.S.; Keltai M.; Naik A.; Sopko G.; Golba K.; Andersson
B.; Carson P.; Kukulski T.
Institution
(Farsky) Instituto Dante Pazzanese de Cardiologia and Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(White, Al-Khalidi) Duke Clinical Research Institute and Department of
Biostatics and Bioinformatics, Duke University School of Medicine, Durham,
NC, United States
(Sueta) Division of Cardiology, University of North Carolina, Chapel Hill,
NC, United States
(Rouleau) Department of Medicine, Montreal Heart Institute, Universite de
Montreal, Montreal, QC, Canada
(Panza) Westchester Medical Center and New York Medical College, Valhalla,
United States
(Velazquez) Department of Medicine, Yale University, New Haven, Conn,
United States
(O'Connor) Inova Heart and Vascular Institute, Fairfax, Va, United States
(Dabrowski) National Institute of Cardiology, Warsaw, Poland
(Djokovic) Dedinje Cardiovascular Institute, University of Belgrade School
of Medicine, Belgrade, Serbia
(Drazner) Department of Internal Medicine, University of Texas
Southwestern Medical Center, Dallas, Tex, United States
(Haddad) Department of Medicine, University of Saskatchewan, Saskatoon,
SK, Canada
(Ali) Section of Cardiac Surgery, Department of Cardiac Sciences, Libin CV
Institute, University of Calgary, Calgary, AB, Canada
(Keltai) George Gottsegen National Institute of Cardiology, Budapest,
Hungary
(Naik) CIMS Hospital, Ahmedabad, India
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, Md, United
States
(Golba) Medical University of Silesia, Katowice, Poland
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Carson) Washington VA Medical Center, Washington, DC, United States
(Kukulski) Silesian Center for Heart Diseases, Silesian Medical
University, Zabrze, Poland
Publisher
Mosby Inc.
Abstract
Objectives: Optimal medical therapy in patients with heart failure and
coronary artery disease is associated with improved outcomes. However,
whether this association is influenced by the performance of coronary
artery bypass grafting is less well established. Thus, the aim of this
study was to determine the possible relationship between coronary artery
bypass grafting and optimal medical therapy and its effect on the outcomes
of patients with ischemic cardiomyopathy. Method(s): The Surgical
Treatment for Ischemic Heart Failure trial randomized 1212 patients with
coronary artery disease and left ventricular ejection fraction 35% or less
to coronary artery bypass grafting with medical therapy or medical therapy
alone with a median follow-up over 9.8 years. For the purpose of this
study, optimal medical therapy was collected at baseline and 4 months, and
defined as the combination of 4 drugs: angiotensin-converting enzyme
inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1
antiplatelet drug. Result(s): At baseline and 4 months, 58.7% and
73.3% of patients were receiving optimal medical therapy, respectively.
These patients had no differences in important parameters such as left
ventricular ejection fraction and left ventricular volumes. In a
multivariable Cox model, optimal medical therapy at baseline was
associated with a lower all-cause mortality (hazard ratio, 0.78; 95%
confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months,
optimal medical therapy was also associated with a lower all-cause
mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P =
.04). There was no interaction between the benefit of optimal medical
therapy and treatment allocation. Conclusion(s): Optimal medical
therapy was associated with improved long-term survival and lower
cardiovascular mortality in patients with ischemic cardiomyopathy and
should be strongly recommended. Copyright © 2021 The American
Association for Thoracic Surgery

<115>
Accession Number
2010560475
Title
Incidence and recurrence of new-onset atrial fibrillation detected during
hospitalization for non-cardiac surgery: a systematic review and
meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
McIntyre W.F.; Vadakken M.E.; Rai A.S.; Thach T.; Syed W.; Um K.J.;
Ibrahim O.; Dalmia S.; Bhatnagar A.; Mendoza P.A.; Benz A.P.; Bangdiwala
S.I.; Spence J.; McClure G.R.; Huynh J.T.; Zhang T.; Inami T.; Conen D.;
Devereaux P.J.; Whitlock R.P.; Healey J.S.; Belley-Cote E.P.
Institution
(McIntyre, Vadakken, Rai, Bhatnagar, Benz, Bangdiwala, Spence, Zhang,
Conen, Devereaux, Whitlock, Healey, Belley-Cote) Population Health
Research Institute, McMaster University, Hamilton, ON, Canada
(McIntyre, Um, Ibrahim, Dalmia, Spence, Huynh, Conen, Devereaux, Whitlock,
Healey, Belley-Cote) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(McIntyre, Mendoza, Benz, Bangdiwala, Spence, Conen, Devereaux, Healey)
Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada
(Thach, Syed) Faculty of Health Sciences, McMaster University, Hamilton,
ON, Canada
(McClure, Whitlock) Department of Surgery, McMaster University, Hamilton,
ON, Canada
(Inami) Department of Cardiovascular Medicine, Nippon Medical School,
Tokyo, Japan
Publisher
Springer
Abstract
Purpose: This systematic review aimed to summarize reports of the
incidence and long-term recurrence of new-onset atrial fibrillation (AF)
associated with non-cardiac surgery. Sources: We searched CENTRAL, MEDLINE
and EMBASE from inception to November 2019. We included studies that
reported on the incidence of new-onset perioperative AF during
hospitalization for non-cardiac surgery and/or AF recurrence in such
patients following discharge. Reviewers screened articles and abstracted
data independently and in duplicate. We assessed study quality by
appraising methodology for collecting AF history, incident AF during
hospitalization, and AF recurrence after discharge. Principal findings:
From 39,233 citations screened, 346 studies that enrolled a total of
5,829,758 patients met eligibility criteria. Only 27 studies used
prospective, continuous inpatient electrocardiographic (ECG) monitoring to
detect incident AF. Overall, the incidence of postoperative AF during
hospitalization ranged from 0.004 to 50.3%, with a median [interquartile
range] of 8.7 [3.8-15.0]%. Atrial fibrillation incidence varied with type
of surgery. Prospective studies using continuous ECG monitoring reported
significantly higher incidences of AF than those that did not (13.9% vs
1.9%, respectively; P < 0.001). A total of 13 studies (25,726 patients)
with follow-up up to 5.4 years reported on AF recurrence following
hospital discharge; only one study used a prospective systematic
monitoring protocol. Recurrence rates ranged from 0 to 37.3%.
 Conclusion(s): Rates of AF incidence first detected following
non-cardiac surgery and long-term AF recurrence vary markedly. Differences
in the intensity of ECG monitoring and type of surgery may account for
this variation. Trial registration: PROSPERO (CRD42017068055); registered
1 September 2017. Copyright © 2021, Canadian Anesthesiologists'
Society.

<116>
Accession Number
2010554056
Title
Effectiveness of postural lung recruitment on postoperative atelectasis
assessed by lung ultrasound in children undergoing lateral thoracotomy
cardiac surgery with cardiopulmonary bypass.
Source
Pediatric Pulmonology. (no pagination), 2021. Date of Publication: 2021.
Author
He P.; Wu C.; Yang Y.; Zheng J.; Dong W.; Wu J.; Sun Y.; Zhang M.
Institution
(He, Wu, Yang, Zheng, Sun, Zhang) Department of Anesthesiology, School of
Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong
University, Shanghai, China
(Dong) Department of Cardio-Thoracic Surgery, School of Medicine, Shanghai
Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China
(Wu) Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, United
States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To assess the effects of postural lung recruitment maneuvers
on the postoperative atelectasis assessed by lung ultrasound (LUS)
compared with supine position recruitment maneuvers in children undergoing
right lateral thoracotomy cardiac surgery with cardiopulmonary bypass.
 Method(s): In this randomized and controlled trial, 84 patients aged
3 years or younger, scheduled for right lateral thoracotomy cardiac
surgery with cardiopulmonary bypass (CPB) were randomly allocated to
postural lung recruitment group or control group. The first LUS exam was
performed immediately upon completion of the cardiac surgery (T1), and a
repeat ultrasound exam started 1 min after lung recruitment maneuvers
(T2). The primary outcome was the incidence of significant atelectasis at
T2. Result(s): The incidence of significant atelectasis at T2 in the
postural lung recruitment maneuver group was lower compared with that in
the control group (30.2% vs. 58.1%; odds ratio: 0.31; 95% confidence
interval: 0.13-0.76; p =.009). The LUS scores for consolidations and
B-lines of the left lung were higher than those of the right lung in both
groups at T1. More significant reduction of the left LUS scores and sizes
of atelectatic areas were found in the postural lung recruitment group
than those in the control group. Conclusion(s): Postoperative
postural recruitment maneuver was more effective to improve reaeration of
lung than supine position recruitment maneuver in children undergoing
right lateral thoracotomy cardiac surgery with CPB. Copyright ©
2021 Wiley Periodicals LLC

<117>
[Use Link to view the full text]
Accession Number
2010486310
Title
Postoperative delirium after coronary artery bypass graft surgery:
Dexmedetomidine infusion alone or with the addition of oral melatonin.
Source
Egyptian Journal of Anaesthesia. 37 (1) (pp 62-68), 2021. Date of
Publication: 2021.
Author
Mahrose R.; ElSerwi H.; Maurice A.; Elsersi M.
Institution
(Mahrose, ElSerwi, Maurice, Elsersi) Department of Anesthesiology,
Intensive Care and Pain Management, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Postoperative delirium is a common complication of cardiac
surgery. This study aimed to assess the effect of supplementing
dexmedetomidine infusion with oral melatonin in prevention of
postoperative delirium after coronary artery bypass graft surgery.
 Method(s): 110 patients of both sexes above 60 years of age were
included. Anesthetic management was standardized. Patients were randomly
allocated into one of the two study groups, dexmedetomidine/melatonin (DM)
group or dexmedetomidine (D) group. Patients in the DM group received oral
Melatonin tablet 5 mg the night before surgery and same dose was repeated
every 24 hours for 3 postoperative days. After completion of surgery and
upon ICU arrival, patients in both groups received a bolus of 0.4
microg/kg dexmedetomidine followed by 0.2-0.7 microg/kg/h infusion, for 24
maximum hours. Delirium was assessed for 5 days postoperatively at 12 hr
intervals using confusion assessment method (CAM) for ICU and after
discharge from ICU to surgical ward using CAM. Delirious patients were
treated with IV haloperidol. Result(s): No significant differences
between studied groups regarding baseline, preoperative, intraoperative
and postoperative characteristics. Incidence of delirium was significantly
lower, onset significantly more delayed, and duration was significantly
shorter in group-DM as compared to group-D. No significant differences
between all cases, cases who had delirium, and cases who did not have
delirium in the two groups as regards extubation time, ICU stay, and
hospital stay. Conclusion(s): supplementing dexmedetomidine with
melatonin decreases incidence, delays onset, and shortens duration of
postoperative delirium in patients above 60 years of age undergoing CABG
surgery. Copyright © 2021 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<118>
Accession Number
2006053831
Title
Evaluation of sodium nitroprusside efficacy in decreasing the incidence
and duration of atrial fibrillation after coronary artery bypass grafting.
Source
Iranian Heart Journal. 22 (1) (pp 16-25), 2021. Date of Publication:
Winter 2021.
Author
Ariafar M.; Sheikhi M.A.; Ahmadi A.J.; Fassihi Z.; Dashti F.
Institution
(Ariafar, Fassihi) Department of Cardiology, Atherosclerosis Research
Center, Golestan Hospital, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Sheikhi) Department of Cardiac surgery, Atherosclerosis Research Center,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran, Islamic Republic of
(Ahmadi) Department of Cardiac anesthesiology, Atherosclerosis Research
Center, Golestan Hospital, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Dashti) Atherosclerosis Research Center, Golestan Hospital, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic
of
Publisher
Iranian Heart Association
Abstract
Background: The incidence of atrial fibrillation (AF) after coronary
artery bypass grafting (CABG) can leave irreparable sequelae; thus, the
prevention of this common arrhythmia has particular importance. The aim of
this prospective study was to evaluate the efficacy of sodium
nitroprusside (SNP) in lessening the incidence and duration of AF after
CABG. Method(s): This prospective double-blind randomized clinical
trial compared the efficacy of SNP in reducing the incidence and duration
of post-CABG AF between 2 groups of 30 patients each hospitalized in the
Heart Surgery Department of Golestan Hospital, Ahvaz, Iran, between
February 2017 and June 2017. Result(s): Post-CABG AF occurred in 8
(26.7%) patients in the control group and 2 (6.7%) in the SNP group (P =
0.038). The average surgery time in the control and SNP groups was 189.93
+/- 31.40 minutes and 167.47 +/- 13.48 minutes, respectively, which was
statistically significant (P = 0.001). The findings concerning
preoperative treatment drugs showed that 52% (26/50) of the patients
without AF had used clopidogrel, with 10% (1/10) of these patients
suffering AF (P = 0.015). The consumption of another agent, either
angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor
blockers (ARBs), was accompanied by AF in 3 (30%) patients, whereas the
use of another agent was not accompanied by AF in 32 (64%) patients (P =
0.046). Conclusion(s): This study demonstrated that the prophylactic
administration of SNP during the rewarming period in CABG significantly
reduced the incidence of postoperative AF and surgery time. Furthermore,
preoperative treatment drugs, including clopidogrel and ACE inhibitors or
ARBs played a significant role in reducing AF occurrence. Copyright
© 2021, Iranian Heart Association. All rights reserved.

<119>
Accession Number
2006053570
Title
WeChat-based education and rehabilitation program in unprotected left main
coronary artery disease patients after coronary artery bypass grafting: An
effective approach in reducing anxiety, depression, loss to follow-up, and
improving quality of life.
Source
Brazilian Journal of Medical and Biological Research. 54 (4) (pp 1-10),
2021. Article Number: e10370. Date of Publication: 2021.
Author
Ma C.; Wang B.; Zhao X.; Fu F.; Zheng L.; Li G.; Guo Q.
Institution
(Ma, Wang, Zhao, Fu, Zheng, Li) Department of Cardiovascular Surgery,
Second Affiliated Hospital, Harbin Medical University, Harbin,
Heilongjiang, China
(Guo) Ministry of Nursing, 4th Affiliated Hospital, Harbin Medical
University, Harbin, Heilongjiang, China
Publisher
Associacao Brasileira de Divulgacao Cientifica
Abstract
This study aimed to investigate the effect of WeChat-based education and
rehabilitation program (WERP) on anxiety, depression, health-related
quality of life (HRQoL), major adverse cardiac/cerebrovascular events
(MACCE)-free survival, and loss to follow-up rate in unprotected left main
coronary artery disease (ULMCAD) patients after coronary artery bypass
grafting (CABG). In this randomized controlled study, 140 ULMCAD patients
who underwent CABG were randomly assigned to WERP group (n=70) or control
care (CC) group (n=70). During the 12-month intervention period, anxiety
and depression (using hospital anxiety and depression scale (HADS)) and
HRQoL (using 12-Item Short-Form Health Survey (SF-12)) were assessed
longitudinally. During the total 36-month follow-up period (12-month
intervention and 24-month non-intervention periods), MACCE and loss to
follow-up were recorded. During the intervention period, HADS-anxiety
score at month 9 (M9) (P=0.047) and month 12 (M12) (P=0.034), anxiety rate
at M12 (P=0.028), and HADS-D score at M12 (P=0.048) were all reduced in
WERP group compared with CC group. As for HRQoL, SF-12 physical component
summary score at M9 (P=0.020) and M12 (P=0.010) and SF-12 mental component
summary score at M9 (P=0.040) and M12 (P=0.028) were all increased in WERP
group compared with CC group. During the total follow-up period, WERP
group displayed a trend of longer MACCE-free survival than that in CC
group but without statistical significance (P=0.195). Additionally, loss
to follow-up rate was attenuated in WERP group compared with CC group
(P=0.033). WERP serves as an effective approach in optimizing mental
health care and promoting life quality in ULMCAD patients after
CABG. Copyright © 2021, Associacao Brasileira de Divulgacao
Cientifica. All rights reserved.

<120>
Accession Number
634289725
Title
Effect of yugengtongyu granules in patients with stable coronary artery
disease on reducing adverse cardiovascular events: A double-blind
controlled trial.
Source
Journal of Alternative and Complementary Medicine. 27 (2) (pp 142-149),
2021. Date of Publication: February 2021.
Author
Wang D.; Li C.; Xu X.; Xu H.; Guo C.; Wang J.; Guo J.; Huang L.
Institution
(Wang, Xu) Cardiovascular Institute, Beijing University, Chinese Medicine
Affiliated Dongzhimen Hospital, Beijing, China
(Li, Wang, Huang) China-Japan Friendship Hospital, Beijing, China
(Xu) Department of Cardiology, Jiangxi Province Hospital of Integrated
Chinese and Western Medicine, Nanchang, China
(Guo) Shandong University of Chinese Medicine Affiliated Hospital, Jinan,
China
(Guo) Department of Cardiology, Shunyi Branch, Beijing Hospital of
Traditional Chinese Medicine, Beijing, China
Publisher
Mary Ann Liebert Inc.
Abstract
Objectives: To evaluate the effect of Yugengtongyu granules on reducing
the incidence of adverse cardiovascular events and improving quality of
life (QOL) in patients with stable coronary artery disease (SCAD).
 Method(s): A double-blind randomized controlled trial was conducted
among SCAD population. One hundred fourteen patients were randomly
assigned to experimental group (n = 57) and control group (n = 57)
following randomized block design. Combined with the basis of standard
treatment of SCAD, the experimental group and control group received
Yugengtongyu granules or placebo, respectively, twice daily for 6 months
and were followed for another 1 year (18 months in total from enrollment).
Major outcomes (any occurrence of cardiovascular death, nonfatal
myocardial infarction, or coronary revascularization), minor outcomes (any
occurrence of all-cause death, ischemic stroke, readmission due to
unstable angina, heart failure, or malignant arrhythmia), and composite
outcomes (union of major and minor outcomes) were used to evaluate
prognosis; Seattle Angina Questionnaire (SAQ) was applied to evaluate QOL,
and levels of low density lipoprotein-cholesterol (LDL-C) and high
sensitive C reacting protein (HS-CRP) in serum were tested.
 Result(s): The incidence of composite outcomes in the experimental
group was significantly lower than that in the control group (3 [5.2%] vs.
11 [19.2%], hazard ratio: 0.273, 95% confidence interval: 0.080-0.926, p =
0.022); major outcomes, minor outcomes, and independent events such as
nonfatal myocardial infarction showed lowering trend in experimental
group. Experimental group scored significantly higher than control group
in four dimensions of SAQ: Physical limitation, angina frequency,
treatment satisfaction, and disease perception at the third- and
sixth-month follow-up; there was no significant difference in serum level
of LDL or HS-CRP at all scheduled timepoints. Conclusion(s): The
addition of Yugengtongyu granules based on current standard treatment
reduced the incidence of composite outcomes and improved QOL in patients
with SCAD. The trial was registered in the Chinese Clinical Trial Registry
(ChiCTR-TRC-13004370). Copyright © 2021, Mary Ann Liebert, Inc.

<121>
[Use Link to view the full text]
Accession Number
634289140
Title
Safety and effectiveness of strategies to reduce radiation exposure to
proceduralists performing cardiac catheterization procedures: A systematic
review.
Source
JBI Evidence Synthesis. 19 (1) (pp 4-33), 2021. Date of Publication:
January 2021.
Author
Fernandez R.; Ellwood L.; Barrett D.; Weaver J.
Institution
(Fernandez, Ellwood) Centre for Evidence Based Initiatives in Health Care:
A JBI Centre of Excellence, Wollongong, NSW, Australia
(Fernandez, Ellwood) Centre for Research in Nursing and Health, St George
Hospital, Sydney, NSW, Australia
(Fernandez) School of Nursing, University of Wollongong, Sydney, NSW,
Australia
(Barrett) Interventional Cardiology, St Andrews Private Hospital, Ipswich,
QLD, Australia
(Weaver) Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Weaver) School of Medicine, University of New South Wales, Sydney, NSW,
Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The objective of this systematic review was to synthesize the
best available evidence on the effect of various radiation protection
strategies on radiation dose received by proceduralists performing cardiac
catheterization procedures involving fluoroscopy. Introduction: Cardiac
catheterization procedures under fluoroscopy are the gold standard
diagnostic and treatment method for patients with coronary artery disease.
The growing demand of procedures means that proceduralists are being
exposed to increasing amounts of radiation, resulting in an increased risk
of deterministic and stochastic effects. Standard protective strategies
and equipment such as lead garments reduce radiation exposure; however,
the evidence surrounding additional equipment is contradictory. Inclusion
criteria: Randomized controlled trials that compared the use of an
additional radiation protection strategy with conventional radiation
protection methods were considered for inclusion. The primary outcome of
interest was the radiation dose received by the proceduralist during
cardiac catheterization procedures. Method(s): A three-step search
was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library
(CENTRAL). Trials published in the English language with adult
participants were included. Trials published from database inception until
July 2019 were eligible for inclusion. The methodological quality of the
included studies was assessed using the JBI critical appraisal checklist
for randomized controlled trials. Quantitative data were extracted from
the included papers using the JBI data extraction tool. Results that could
not be pooled in meta-analysis were reported in a narrative form.
 Result(s): Fifteen randomized controlled trials were included in the
review. Six radiation protection strategies were assessed: Leaded and
unleaded pelvic or arm drapes, transradial protection board, remotely
controlled mechanical contrast injector, extension tubing for contrast
injection, real-time radiation monitor, and a reduction in frame rate to
7.5 frames per second. Pooled data from two trials demonstrated a
statistically significant decrease in the mean radiation dose (P<0.00001)
received by proceduralists performing transfemoral cardiac catheterization
on patients who received a leaded pelvic drape compared to standard
protection. One trial that compared the use of unleaded pelvic drapes
placed on patients compared to standard protection reported a
statistically significant decrease (P=0.004) in the mean radiation dose
received by proceduralists. Compared to standard protection, two trials
that used unleaded arm drapes for patients, one trial that used a remotely
controlled mechanical contrast injector, and one trial that used a
transradial protection board demonstrated a statistically significant
reduction in the radiation dose received by proceduralists. Similarly,
using a frame rate of 7.5 versus 15 frames per second and monitoring
radiation dose in real-time radiation significantly lowered the radiation
dose received by the proceduralist. One trial demonstrated no
statistically significant difference in proceduralist radiation dose among
those who used the extension tubing compared to standard protection (P=1).
 Conclusion(s): This reviewprovides evidence to support the use of
leaded pelvic drapes for patients as an additional radiation protection
strategy for proceduralists performing transradial or transfemoral cardiac
catheterization. Further studies on the effectiveness of using a lower
fluoroscopy framerate, real-timeradiationmonitor, and transradial
protection board are needed. Copyright © 2021 JBI.

<122>
Accession Number
2006087047
Title
A comprehensive systemic literature review of pericardial decompression
syndrome: Often unrecognized and potentially fatal syndrome.
Source
Current Cardiology Reviews. 17 (1) (pp 101-110), 2020. Date of
Publication: 2020.
Author
Amro A.; Mansoor K.; Amro M.; Sobeih A.; Suliman M.; Okoro K.; El-Hamdani
R.; Vilchez D.; El-Hamdani M.; Shweihat Y.R.
Institution
(Amro, Mansoor, Suliman, Okoro, El-Hamdani, Vilchez, El-Hamdani, Shweihat)
Internal Medicine Department, Joan C. Edwards School of Medicine, Marshall
University, Huntington, WV 25755, United States
(Amro) School of medicine, Misr University of Science and Technology,
Cairo, Egypt
(Sobeih) School of Medicine, AL-Najah University, Nablus, Palestine
Publisher
Bentham Science Publishers
Abstract
Background: Pericardial Decompression Syndrome (PDS) is defined as
paradoxical hemodynamic deterioration and/or pulmonary edema, commonly
associated with ventricular dys-function. This phenomenon was first
described by Vandyke in 1983. PDS is a rare but formidable complication of
pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as
an entity, has discrete literature; this review is to understand its
epidemiology, presentation, and management. Methodology: Medline: Science
Direct and Google Scholar databases were utilized to do a systemic
literature search. PRISMA protocol was employed. Abstracts, case reports,
case series and clinical studies were identified from 1983 to 2019. A
total of 6508 articles were reviewed, out of which, 210 were short-listed,
and after removal of duplicates, 49 manuscripts were included in this
review. For statistical analysis, patient data was tabulated in SPSS
version 20. Cases were divided into two categories surgical and
percutaneous groups. T-test was conducted for continuous variable and
chi-square test was conducted for categorical data used for analysis.
 Result(s): A total of 42 full-length case reports, 2 poster
abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1
case series of 5 patients were included in the study. A total of 59 cases
were included in this manuscript. Our data had 45.8% (n=27) males and
54.2% (n=32) females. The mean age of patients was 48.04 +/- 17 years.
Pericardiocentesis was performed in 52.5% (n=31) cases, and
pericardiostomy was performed in 45.8% (n=27). The most common
identifiable cause of pericardial effusion was found to be malignancy in
35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection
fraction, which ranged from 20%-75% with a mean of 55.8 +/- 14.6%, while
26 cases reported post-procedural ejection fraction which ranged from
10%-65% with a mean of 30% +/- 15.1%. Data was further divided into two
categories, namely, pericardiocentesis and peri-cardiostomy. The outcome
as death was significant in the pericardiostomy arm with a p-value of <
0.00. The use of inotropic agents for the treatment of PDS was more common
in needle pericardio-centesis with a p-value of 0.04. Lastly, the computed
recovery time did not yield any significance with a p-value of 0.275.
 Conclusion(s): Pericardial decompression syndrome is a rare condition
with high mortality. Operators performing pericardial drainage should be
aware of this complication following drainage of cardiac tamponade, since
early recognition and expeditious supportive care are the only therapeutic
modali-ties available for adequate management of this
complication. Copyright © 2021 Bentham Science Publishers.

<123>
Accession Number
634295922
Title
Comparison of the analgesic effect of quadratus lumborum block and
epidural block in open uterine surgery: a randomized controlled trial.
Source
Minerva anestesiologica. (no pagination), 2021. Date of Publication: 16
Feb 2021.
Author
She H.; Jiang P.; Zhu J.; Zhou Y.; Wang Y.; Kan M.; Wu J.
Institution
(She, Jiang, Zhu, Wang, Kan) Department of Anesthesiology, Affiliated
Hospital of Jiangsu University, Zhenjiang, China
(Zhou) Department of Surgery, Affiliated Hospital of Jiangsu University,
Zhenjiang, China
(Wu) Department of Anesthesiology, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Effective regional analgesia during open surgery could reduce
opioid consumption and enhance early recovery. We compared the effects of
the newly developed quadratus lumborum block (QLB) and the traditional
epidural block (EB) in open uterine surgery. METHOD(S): In this
randomized controlled trial, we included patients scheduled for elective
open uterine surgery during May-September 30, 2019. Patients received QLB
or EB for perioperative pain relief before general anesthesia.
Perioperative opioid consumption, and numeric rating scale (NRS, 0-10)
pain scores after surgery, heart rate (HR), mean arterial pressure (MAP),
ephedrine and urapidil use during surgery, lower limb muscle strength,
timing of first flatus and defecation, nausea, vomiting, and other
complications within 24 h post-surgery, were the primary and secondary
outcomes, respectively. RESULT(S): Data of 72 (86%; 36/group) of 83
eligible patients were analyzed. Remifentanil consumption during surgery
was higher in the QLB than in the EB group, while cumulative sufentanil
consumption within 24 h post-surgery was similar between both groups. NRS
pain scores at rest and during activity were higher at 1 h post-surgery,
and MAP was higher at 5, 15, and 30 min post-incision in the QLB than in
the EB group; HR was similar between groups. Lower ephedrine requirements,
higher lower limb muscle strength at 1 h post-surgery, and lower nausea
incidence were observed in the QLB group. CONCLUSION(S): QLB produces
a less intense but longer block and fewer side effects in the first 24 h
after open uterine surgery than those produced by EB.

<124>
Accession Number
634275373
Title
Safety and feasibility of lung biopsy in diagnosis of acute respiratory
distress syndrome: protocol for a systematic review and meta-analysis.
Source
BMJ open. 11 (2) (pp e043600), 2021. Date of Publication: 12 Feb 2021.
Author
Fukuda Y.; Sugimoto H.; Yamada Y.; Ito H.; Tanaka T.; Yoshida T.; Okamori
S.; Ando K.; Okada Y.
Institution
(Fukuda) Department of Medicine, Division of Respiratory Medicine and
Allergology, Showa University, School of Medicine, Tokyo, Japan
(Sugimoto) Department of Respiratory Medicine, Kobe Red Cross Hospital,
Kobe, Japan
(Yamada) Department of Healthcare Epidemiology, School of Public Health in
the Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Ito) Department of Pulmonology, Kameda Medical Center, Chiba, Japan
(Tanaka) Infection Control and Education Center, Nagasaki University
Hospital, Nagasaki, Japan
(Yoshida) Intensive Care Unit, Department of Anesthesiology, Jikei
University School of Medicine, Tokyo, Japan
(Okamori) Department of Medicine, Division of Pulmonary Medicine, Keio
University School of Medicine, Tokyo, Japan
(Ando) Department of Medicine, Division of Respiratory Medicine and
Allergology, Showa University, School of Medicine, Tokyo, Japan
(Okada) Primary Care and Emergency Medicine, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
(Okada) Preventive Services, School of Public Health, Kyoto University,
Kyoto, Japan
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a type of
acute respiratory failure characterised by non-cardiac pulmonary oedema
caused by various underlying conditions. ARDS is often pathologically
characterised by diffuse alveolar damage, and its pathological findings
have been reported to be associated with prognosis, although the adverse
effects of lung biopsies to obtain pathological findings are still
unclear. The purpose of this systematic review and meta-analysis is to
reveal the safety and feasibility of lung biopsy in the diagnosis of ARDS.
METHODS AND ANALYSIS: We will include studies that were published in
MEDLINE and Cochrane Central Register of Controlled Trials until 1 June
2020. We will include the reports for critically ill patients in an
intensive care unit or emergency department who undergo lung biopsy and
require a mechanical ventilation. Two review authors will independently
scan titles and abstracts of all identified studies. Furthermore, these
two authors will read and assess the full text of study reports to
identify trials that appeared broadly to address the subject of the
review. We will perform a risk of bias assessment using the McMaster
Quality Assessment Scale of Harms. ETHICS AND DISSEMINATION: This study
will be based on the published data, therefore, it does not require
ethical approval. The final results of the study will be published in a
peer-reviewed journal. TRIAL REGISTRATION NUMBER:
UMIN000040650. 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.

<125>
Accession Number
634273873
Title
Single- or dual-antiplatelet therapy after transcatheter aortic valve
replacement: A protocol of systematic review and meta-analysis.
Source
Medicine. 100 (6) (pp e24550), 2021. Date of Publication: 12 Feb 2021.
Author
Li H.; Wang Y.; Li L.; Dan B.
Institution
(Li) Qinghai People's Hospital, Qinghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The evidence related to bleeding and thromboembolic events
after transcatheter aortic valve replacement (TAVR) compared single
antiplatelet therapy (SAPT) with dual antiplatelet therapy (DAPT)
treatment are inconsistent. Moreover, there are some limitations such as
small sample size and the risk of bias in existing studies. We will
conduct a comprehensive systematic review and meta-analysis to explore the
safety and efficacy of SAPT or DAPT after TAVR. METHOD(S): A
comprehensive literature search of PubMed, EMBASE, The Cochrane Library,
Cochrane Central Register of Controlled Trials will be searched to
retrieve studies involving SAPT versus DAPT after TAVR. Two investigators
will independently select studies, extract data, and assess the quality of
the included study. Any disagreement will be resolved by the third
investigator. The study will use a random-effects model to pool the
results of all studies and use the relative risk and 95% confidence
intervals to summarize individual trial outcomes and estimate pooled
effect. The study will use the Grading of Recommendations Assessment,
Development, and Evaluation to assess the certainty of evidence.
 RESULT(S): This study will provide high-quality evidence for
treatment of TAVR in terms of effectiveness and safety.
 CONCLUSION(S): This systematic review aims to provide evidence for
treatment of TAVR in different antiplatelet therapies. REGISTRATION: The
systematic review and meta-analysis is registered in the OSF REGISTRIES
(10.17605/OSF.IO/Q42TE) international prospective register. Copyright
© 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

<126>
Accession Number
634277954
Title
Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart
Diseases-A Comprehensive Review.
Source
Thoracic and Cardiovascular Surgeon. 69 (1) (pp 83-91), 2021. Date of
Publication: 01 Jan 2021.
Author
De Martino A.; Milano A.D.; Bortolotti U.
Institution
(De Martino, Bortolotti) Section of Cardiac Surgery, University Hospital,
Pisa, Italy
(Milano) Department of Cardiac Surgery, University of Bari Aldo Moro,
Bari, Italy
Publisher
Georg Thieme Verlag
Abstract
Background: Reconstruction of cardiac structures has been the goal of many
surgeons even before the advent of open-heart procedures with
cardiopulmonary bypass. Unsatisfactory results with synthetic materials
has switched the attention to biological tissues, among which pericardium,
either autologous or of animal origin, has been widely used as patch
material. Method(s): We have reviewed the literature to assess the
effective role of pericardial tissue in the correction of various acquired
cardiac lesions. Particularly, special attention was given not only to
established techniques but also to detect any peculiar and unusual
application of pericardium. Result(s): Autologous pericardium is
frequently used as patch material particularly when limited valvular
lesions must be corrected, while xenograft pericardium appears
particularly useful in patients with endocarditis and extensive
destruction of the intracardiac structures by infection and abscesses.
Pericardium is an extremely versatile material owing to its pliability and
strength; however, it tends to calcify in the long term when in contact
with blood, although stability of the repair is maintained in most cases.
 Conclusion(s): Pericardium plays an important role in various cardiac
and aortic pathologies. Tissues resistant to fibrosis and calcification to
be used as patch material are the ideal solution for more successful
cardiac reconstruction procedures and will hopefully be provided by the
ongoing research. Copyright © 2021 Georg Thieme Verlag. All
rights reserved.

<127>
Accession Number
634280913
Title
Meta-Analysis of Prospective Studies of Risk stratification by Syntax
Score for Unprotected Left Main Coronary Artery Revascularization.
Source
The American journal of cardiology. (no pagination), 2021. Date of
Publication: 10 Feb 2021.
Author
Qureshi W.T.; Mir T.; Uddin M.M.; Nasir U.
Institution
(Qureshi) Division of Cardiology, University of Massachusetts School of
Medicine, MA, Worcester, United States
(Mir, Uddin) Internal Medicine, Detroit Medical Center Wayne State
University Detroit USA
(Nasir) Department of Internal Medicine, University of Connecticut, CT,
Hartford, United States
Publisher
NLM (Medline)

<128>
Accession Number
634273356
Title
Cardiothoracic Surgery in the Caribbean.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2021. Date
of Publication: 01 Feb 2021.
Author
Vinck E.E.; Ebels T.; Hittinger R.; Peterson T.F.
Institution
(Vinck) Department of Cardiovascular Surgery, Clinica Cardio VID,
Medellin, Colombia
(Ebels) Department of Cardiothoracic Surgery, Groningen UMC, Groningen,
Netherlands
(Hittinger) Department of Cardiovascular Surgery, Martinique University
Hospital, Martinique
(Peterson) Department of Surgery, Dr. Horacio Oduber Hospital, Oranjestad,
Aruba
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Despite being one of the main vacation destinations in the
world, health care in the Caribbean faces many difficulties. The
challenges involved in these islands' medical care range from low-resource
institutions to lack of specialized care. In the field of thoracic and
cardiac surgery, many limitations exist, and these include the lack of
access to cardiac surgery for many small islands and little governmental
funding for minimally invasive approaches in thoracic surgery.
 METHOD(S): Literature review was done using PubMed/ MEDLINE and
Google Scholar databases to identify articles describing the
characteristics of thoracic and cardiac surgery departments on Caribbean
islands. Articles on the history, current states of practice, and advances
in cardiothoracic surgery in the Caribbean were reviewed. RESULT(S):
Regardless of the middle to high-income profile of the Caribbean, there
are significant differences in the speed of technological growth in
cardiothoracic surgery from island to island, as well as disparities
between the quality of care and resources. Many islands struggle to
advance the field of cardiothoracic surgery both through lack of local
cardiac surgery centers and limited financial funding for minimally
invasive thoracic surgery. CONCLUSION(S): Cardiac and thoracic
surgery in the Caribbean depend not only on the support from local
government policies and proper distribution of healthcare budgets, but
efforts by the surgeons themselves to change and improve institutional
cultures. Although resource availability still remains a challenge, the
Caribbean remains an important region that deserves special attention with
regard to the unmet needs for long-term sustainability of chest surgery.

<129>
Accession Number
634272691
Title
Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch
Disease: a Comprehensive Review.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2021. Date
of Publication: 01 Feb 2021.
Author
Ribeiro T.S.; Gadelha H.P.; Santos M.A.D.
Institution
(Ribeiro, Gadelha) Department of Integrated Medicine, Onofre Lopes
University Hospital, Federal University of Rio Grande do Norte, Natal,
Brazil
(Santos) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate whether hybrid repair has supremacy over
conventional open repair in aortic arch diseases. METHOD(S): A
comprehensive search was undertaken in two major databases (PubMed and
MEDLINE) to identify all studies comparing the two surgical techniques in
five years, up to December 2018, that met the established criteria in this
study. The search returned 310 papers, and 305 were selected after
removing duplicates. The abstracts of the remaining articles were
assessed, resulting in 15 studies that went to full-text analysis. After
application of the inclusion and exclusion criteria, 8 papers remained for
the final revision. RESULT(S): Eight studies met the criteria, with
the inclusion of 1,837 patients. From a short-term perspective, hybrid
repair and conventional open repair had similar outcomes in terms of
postoperative mortality and acute neurological events. Hybrid repair was
associated with less respiratory complications and risk of new
intervention, as well as reduced hospital length of stay. Conventional
open repair showed better mid- and long-term outcomes. CONCLUSION(S):
Hybrid repair should be used in selected patients, with a high risk or
very high-risk profile for conventional surgery. Finally, since most of
the current data were obtained from limited to large samples, with narrow
follow-up and had great heterogeneity, the best approach to the aortic
arch is still variable. Therefore, the decision of the approach should be
individualized and evaluated by the whole Heart Team, considering the
expertise of the surgical team.

<130>
Accession Number
634257102
Title
Is vacuum-assisted closure therapy feasible for children with deep sternal
wound infection after cardiac surgery? The pooling results from current
literature.
Source
Artificial organs. (no pagination), 2021. Date of Publication: 10 Feb
2021.
Author
Wu Y.; Wang J.; Dai J.; Wang G.; Li H.; Li Y.; Wu C.; Wei G.
Institution
(Wu, Dai, Wang, Li, Li, Wu) Department of Cardiothoracic Surgery,
Children's Hospital of Chongqing Medical University, Chongqing, China
(Wu, Wang, Dai, Wang, Li, Li, Wu, Wei) Ministry of Education Key
Laboratory of Child Development and Disorders, China International Science
and Technology Cooperation Base of Child Development and Critical
Disorders, National Clinical Research Center for Child Health and
Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Vacuum-assisted closure (VAC) has been employed for children
with deep sternal wound infections (DSWI), however, the safety and
efficiency have not been determined. A meta-analysis is performed for
outcomes of VAC therapy in children with DSWI after cardiac surgery.
 METHOD(S): Electronic databases, including PubMed, Scopus, and
Cochrane Library CENTRAL were searched systematically from January 1990 to
October 2020 for the literature which reported the outcomes of VAC therapy
for children with DSWI after cardiac surgery. Meta-regression and subgroup
analyses were performed to find risk factors for prolonged length of VAC
therapy and hospital stay. RESULT(S): Eleven studies were included in
this study, involving 217 subjects. VAC therapy was performed due to
mediastinitis after congenital heart diseases repair. In children with
DSWI after cardiac surgery, length of VAC therapy and hospital stay were
11.1 days (95%CI, 9.6 to 12.5 days) and 29.8 days (95%CI, 22.8 to 36.9
days), respectively. Incidence of infectious and wound-related
complications was 8.5% (95%CI, 4.1% to 13.0%). Overall mortality in this
setting was 5.8% (95%CI, 2.5% to 9.1%). CONCLUSION(S): In conclusion,
in children with DSWI after cardiac surgery, length of VAC therapy and
hospital stay are 11.1 days and 29.8 days, respectively. Overall mortality
is 5.8%. Although not significant, delayed chest closure, complex CHD, and
Gram-negative bacilli/fungal infections may potentially contribute to
prolonged duration of VAC treatment. Copyright This article is
protected by copyright. All rights reserved.

<131>
Accession Number
634244715
Title
Biodegradable Polymer- versus Durable Polymer-Coated Sirolimus-Eluting
Stents: The Final 5-Year Outcomes of the I-LOVE-IT 2 Trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2020. Date of Publication: 11 Feb 2020.
Author
Xu K.; Xu B.; Guan C.; Jing Q.; Zheng Q.; Li X.; Wang H.; Zhao X.; Li Y.;
Li J.; Yang Y.; Han Y.
Institution
(Xu) General Hospital of Northern Theater Command, Shenyang, China
Publisher
NLM (Medline)
Abstract
AIMS: This analysis presents the final 5-year results of the I-LOVE-IT 2
trial, a noninferiority study comparing BP- sirolimus-eluting stent (SES)
with DP-SES in patients with coronary artery disease. METHODS AND RESULTS:
Overall, 2737 Chinese patients eligible for coronary stenting were treated
with BP- or DP-SES in a 2:1 ratio. Patients who were randomized to BP-SES
group were additionally re-randomized to receive either 6-month or
12-month dual antiplatelet therapy (DAPT) in a 1:1 ratio. The primary
endpoint was 12-month target lesion failure (TLF: cardiac death, target
vessel myocardial infarction, or clinically indicated target lesion
revascularization). At five years, overall follow-up rate was 90.8%, and
the cumulative incidence of TLF as the primary endpoint was similar
between BP-SES and DP-SES (hazard ratio [HR]: 1.01; 95% confidence
interval [CI]: 0.79 to 1.28), as was that for patient-oriented composite
endpoint (PoCE: all-cause death, all MI and any revascularization) (HR:
1.03, 95% CI: 0.86 to 1.23), or definite/probable ST (HR: 0.91, 95% CI:
0.70 to 1.77). Cumulative events also were similar between 6-month DAPT
and 12-month DAPT groups after BP-SES implantation. CONCLUSION(S):
I-LOVE-IT 2 has shown that the 5-year safety and efficacy of BP-SES and
DP-SES were similar, as were those between 6-month and 12-month of DAPT
after BP-SES implantations.

<132>
Accession Number
633647372
Title
Transcatheter Mitral Valve Repair in Patients with Heart Failure: A
Meta-Analysis.
Source
Cardiology (Switzerland). 146 (1) (pp 42-48), 2021. Date of Publication:
January 2021.
Author
Vallakati A.; Hasan A.K.; Boudoulas K.D.
Institution
(Vallakati, Hasan, Boudoulas) Division of Cardiovascular Medicine, Ohio
State University, 410 W 10th Avenue, Columbus, OH 43210, United States
Publisher
S. Karger AG
Abstract
Background: Severe secondary mitral regurgitation (MR) is associated with
poor prognosis in heart failure patients with left ventricular systolic
dysfunction. Few observational and randomized controlled studies
demonstrated the efficacy of transcatheter mitral valve repair in heart
failure patients with significant MR. A meta-Analysis of published studies
was performed to evaluate the role of transcatheter mitral valve repair
using the MitraClip device in heart failure patients with significant
secondary MR. Method(s): A literature search was performed using
PubMed, Cochran CENTRAL, and Embase databases using the search terms
"percutaneous mitral valve repair"or "transcatheter mitral valve
repair"and "heart failure."Studies that compared medical therapy plus
transcatheter mitral valve repair using MitraClip to medical therapy alone
in heart failure patients with significant secondary MR were included for
pooled analysis. A random-effects model with the Mantel-Haenszel method
was used to analyze the data. Result(s): Four studies, 2 randomized
controlled and 2 nonrandomized studies met the criteria for analysis.
Pooled analysis included a total of 1,421 patients, of which 746 patients
underwent transcatheter mitral valve repair and 675 patients received
medical therapy alone. When compared to medical therapy, transcatheter
mitral valve repair significantly decreased all-cause mortality (OR 0.58,
95% CI 0.37-0.91; p = 0.02). A trend toward significant reduction in
rehospitalizations (OR 0.35, 95% CI 0.12-1.00; p = 0.05) was also
observed. Periprocedural complications ranged from 7.5 to 12.6%.
 Conclusion(s): Evidence from pooled analysis suggests that
transcatheter mitral valve repair using MitraClip on top of medical
therapy, in appropriately selected symptomatic heart failure patients with
significant secondary MR, provides survival benefit and may decrease
hospitalizations when compared with guideline-directed medical therapy
alone. Copyright © 2021 S. Karger AG. All rights reserved.

<133>
Accession Number
633322641
Title
The Degree of the Predischarge Pulmonary Congestion in Patients
Hospitalized for Worsening Heart Failure Predicts Readmission and
Mortality.
Source
Cardiology (Switzerland). 146 (1) (pp 49-59), 2021. Date of Publication:
January 2021.
Author
Kleiner-Shochat M.; Kapustin D.; Fudim M.; Ambrosy A.P.; Glantz J.;
Kazatsker M.; Kleiner I.; Weinstein J.M.; Panjrath G.; Roguin A.; Meisel
S.R.
Institution
(Kleiner-Shochat, Glantz, Kazatsker, Roguin, Meisel) Heart Institute,
Hillel Yaffe Medical Center, POB 169, Hadera IS-38100, Israel
(Kleiner-Shochat, Glantz, Kazatsker, Roguin, Meisel) Ruth and Bruce
Rappaport Faculty of Medicine, Technion, Haifa, Israel
(Kapustin) University of Toronto Faculty of Medicine, Toronto, ON, Canada
(Fudim) Department of Cardiology, Duke University Medical Center, Durham,
NC, United States
(Ambrosy) Permanente Medical Group, San Francisco, CA, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Kleiner, Weinstein) Department of Cardiology, University Medical Center,
Beer Sheva, Israel
(Panjrath) Department of Medicine (Cardiology), George Washington
University School of Medicine and Health Sciences, Washington, DC, United
States
Publisher
S. Karger AG
Abstract
Background: Prediction of readmission and death after hospitalization for
heart failure (HF) is an unmet need. Aim(s): We evaluated the ability
of clinical parameters, NT-proBNP level and noninvasive lung impedance
(LI), to predict time to readmission (TTR) and time to death (TTD).
 Methods and Results: The present study is a post hoc analysis of the
IMPEDANCE-HF extended trial comprising 290 patients with LVEF <=45% and
New York Heart Association functional class II-IV, randomized 1:1 to
LI-guided or conventional therapy. Of all patients, 206 were admitted 766
times for HF during a follow-up of 57 +/- 39 months. The normal LI (NLI),
representing the "dry"lung status, was calculated for each patient at
study entry. The current degree of pulmonary congestion (PC) compared with
its dry status was represented by DELTALIR = ([measured LI/NLI]-1) x 100%.
Twenty-six parameters recorded during HF admission were used to predict
TTR and TTD. To determine the parameter which mainly impacted TTR and TTD,
variables were standardized, and effect size (ES) was calculated.
Multivariate analysis by the Andersen-Gill model demonstrated that
DELTALIRsubadmission/sub (ES = 0.72), DELTALIRsubdischarge/sub (ES
=-3.14), group assignment (ES = 0.2), maximal troponin during HF admission
(ES = 0.19), LVEF related to admission (ES =-0.22) and arterial
hypertension (ES = 0.12) are independent predictors of TTR (p 0.01,
chisup2/sup = 1,206). Analysis of ES showed that residual PC assessed by
aLIRsubdischarge/sub was the most prominent predictor of TTR. One percent
improvement in predischarge PC, assessed by aLIRsubdischarge/sub, was
associated with a likelihood of TTR increase by 14% (hazard ratio [HR]
1.14, 95% confidence interval [CI] 1.13-1.15, p 0.01) and TTD increase by
8% (HR 1.08, 95% CI 1.07-1.09, p 0.01). Conclusion(s): The degree of
predischarge PC assessed by aLIR is the most dominant predictor of TTR and
TTD. Copyright © 2021 S. Karger AG. All rights reserved.

<134>
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

<135>
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).

<136>
Accession Number
2007447736
Title
The effect of dexmedetomidine on the inflammatory response in children
undergoing repair of congenital heart disease: a randomized controlled
clinical trial.
Source
Egyptian Journal of Anaesthesia. 36 (1) (pp 297-304), 2020. Date of
Publication: 2020.
Author
Abdelrahman K.A.; Hassan S.A.; Mohammed A.A.; Abdelhakeem E.E.;
Abd-Elshafy S.K.; Salama R.H.; Abdalla E.M.
Institution
(Abdelrahman, Hassan, Mohammed, Abdelhakeem, Abd-Elshafy, Abdalla)
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Salama) Department of Biochemistry, Faculty of Medicine, Assiut
University, Assiut, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: The inflammatory response due to cardiopulmonary bypass (CBP)
activates different inflammatory pathways that affect multiple organs.
Dexmedetomidine is proved to affect inflammatory marker production.
 Objective(s): Evaluation of the effect of Dexmedetomidine on the
inflammatory response associated with pediatric open-heart surgery using
interleukin-6 (IL-6) and interferon-gamma (INF-) levels. Method(s):
61children aged between one to 8 years undergoing elective repair of
non-cyanotic congenital heart disease with CPB were randomly assigned into
two groups. The control group (31 patients) received normal saline,
whereas the Dex group (30 patients) received an initial bolus of
Dexmedetomidine 0.5 microg/kg followed immediately by infusion of 0.5
microg/kg/hr continued till the end of CPB. The level of IL-6 and INF- was
measured. Hemodynamic, ICU, and hospital data were recorded.
 Result(s): IL-6 and INF - levels were increased significantly with
time in control group, with no increase in their levels in the Dex group.
They were significantly lower in the Dex group compared to the control
group in samples taken during bypass, 6 h and 24 h after the operation
(the end of surgical procedure). There was a significant difference
between the groups regarding inotropic score and mechanical ventilation.
There was no significant difference between the groups regarding
complications, duration of ICU or hospital stay. Conclusion(s): The
use of Dexmedetomidine in pediatric cardiac surgery for non-cyanotic heart
disease had significantly attenuated the inflammatory response. It was
useful in decreasing the level of inflammatory mediators, inotropic
support, and duration of mechanical ventilation, but not the ICU or
hospital stay. Trial registration: https://clinicaltrials.gov.
(Identifier: NCT03163238). Copyright © 2020 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<137>
Accession Number
2010573233
Title
Outpatient Versus Inpatient Percutaneous Coronary Intervention in Patients
With Left Main Disease (from the EXCEL Trial).
Source
American Journal of Cardiology. 143 (pp 21-28), 2021. Date of Publication:
15 Mar 2021.
Author
Gaba P.; Serruys P.W.; Karmpaliotis D.; Lembo N.J.; Banning A.P.; Zhang
Z.; Morice M.-C.; Kandzari D.E.; Gershlick A.H.; Ben-Yehuda O.; Sabik
J.F.; Kappetein A.P.; Stone G.W.
Institution
(Gaba, Karmpaliotis, Lembo, Ben-Yehuda) NewYork-Presbyterian
Hospital/Columbia University Irving Medical Center, New York, NY, United
States
(Serruys) Department of Cardiology, National University of Ireland Galway
(NUIG), Galway, Ireland
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
(Karmpaliotis, Lembo, Zhang, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Morice) Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia, Georgia
(Gershlick) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, New York
Publisher
Elsevier Inc.
Abstract
Prior studies in patients with noncomplex coronary artery disease have
demonstrated the safety of percutaneous coronary intervention (PCI) in the
outpatient setting. We sought to examine the outcomes of outpatient PCI in
patients with unprotected left main coronary artery disease (LMCAD). In
the EXCEL trial, 1905 patients with LMCAD and site-assessed low or
intermediate SYNTAX scores were randomized to PCI with everolimus-eluting
stents versus coronary artery bypass grafting. The primary end point was
major adverse cardiovascular events (MACE; the composite of death, stroke,
or myocardial infarction). In this sub-analysis, outcomes at 30 days and 5
years were analyzed according to whether PCI was performed in the
outpatient versus inpatient setting. Among 948 patients with LMCAD
assigned to PCI, 935 patients underwent PCI as their first procedure,
including 100 (10.7%) performed in the outpatient setting. Patients who
underwent outpatient compared with inpatient PCI were less likely to have
experienced recent myocardial infarction. Distal left main bifurcation
disease involvement and SYNTAX scores were similar between the groups.
Comparing outpatient to inpatient PCI, there were no significant
differences in MACE at 30 days (4.0% vs 5.0% respectively, adjusted OR
0.52 95% CI 0.12 to 2.22; p = 0.38) or 5 years (20.6% vs 22.1%
respectively, adjusted OR 0.72, 95% CI 0.40 to 1.29; p = 0.27). Similar
results were observed in patients with distal left main bifurcation
lesions. In conclusion, in the EXCEL trial, outpatient PCI of patients
with LMCAD was not associated with an excess early or late hazard of MACE.
These data suggest that outpatient PCI may be safely performed in select
patients with LMCAD. Copyright © 2020 Elsevier Inc.

<138>
Accession Number
2010487834
Title
Intensive blood pressure treatment in coronary artery disease:
implications from the Systolic Blood Pressure Intervention Trial (SPRINT).
Source
Journal of Human Hypertension. (no pagination), 2021. Date of Publication:
2021.
Author
Zang J.; Liang J.; Zhuang X.; Zhang S.; Liao X.; Wu G.
Institution
(Zang) Department of Cardiology, The Third Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong, China
(Zang, Liang, Wu) Department of Cardiology, The Eighth Affiliated Hospital
of Sun Yat-sen University, Shenzhen, Guangdong, China
(Zang, Liang, Wu) Guangdong Innovative Engineering and Technology Research
Center for Assisted Circulation, Shenzhen, Guangdong, China
(Zhuang, Zhang, Liao) Department of Cardiology, The First Affiliated
Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
(Zhuang, Zhang, Liao, Wu) NHC Key Laboratory on Assisted Circulation, Sun
Yat-sen University, Guangzhou, Guangdong, China
Publisher
Springer Nature
Abstract
To investigate the optimal blood pressure (BP) in patients with coronary
artery disease (CAD), we conducted subgroup analysis using SPRINT data.
The study sample included 1206 participants with CAD (of whom 692
underwent coronary revascularization) and 8127 participants without CAD.
Participants were randomized into two groups (systolic BP target of 140 mm
Hg vs. 120 mm Hg). The primary outcome was a composite of cardiovascular
events. After a median follow-up of 3.9 years, the hazard ratios (HRs) for
the primary outcome were 0.65 (95% confidence interval (CI) 0.53-0.79) and
1.05 (95% CI 0.76-1.46) among those in the non-CAD and CAD subgroups,
respectively (P value for interaction 0.02). Intensive BP treatment was a
protective factor for all-cause death (HR 0.60, 95% CI 0.37-0.96) in the
CAD subgroup, compared with standard BP treatment. The HRs (95% CI) for
stroke were 3.57 (1.17-10.85) and 1.03 (0.29-3.62) among those in the
coronary revascularization and non-revascularization subgroups,
respectively (P value for interaction 0.13). For safety events, intensive
BP treatment increased the risk of hypotension (HR 2.00, 95% CI 1.06-3.79)
and electrolyte abnormalities (HR 2.38, 95% CI 1.25-4.56) in the CAD
subgroup, while the risk of serious adverse events did not increase (HR
1.03, 95% CI 0.88-1.20). These results suggest that positive benefits from
intensive BP treatment might be attenuated in patients with CAD who are
under better secondary prevention. The risk of stroke might increase at
the systolic BP target of 120 mm Hg in case of coronary revascularization,
although the confidence interval was wide. Copyright © 2021, The
Author(s).

<139>
Accession Number
2008594026
Title
A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia
(TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1096-1105),
2021. Date of Publication: April 2021.
Author
Beverstock J.; Park T.; Alston R.P.; Song C.C.A.; Claxton A.; Sharkey T.;
Hutton S.; Fathers J.; Cawley W.
Institution
(Beverstock, Park, Alston, Song, Claxton, Sharkey, Hutton, Fathers,
Cawley) College of Medicine and Veterinary Medicine, University of
Edinburgh, Edinburgh, United Kingdom
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: The primary objective of this study was to compare one-year
mortality in patients undergoing cardiac surgery with volatile anesthesia
or total intravenous anesthesia (TIVA). Secondary objectives were to
compare in-hospital and 30-day mortality, postoperative levels of creatine
kinase (CK-MB) and cardiac troponin, and durations of tracheal intubation,
intensive care unit (ICU) and hospital stays. Design(s): Systematic
review and meta-analysis of randomized controlled trials (RCTs).
 Setting(s): International, multi-institution centers.
 Participant(s): Adults patients undergoing heart surgery.
 Intervention(s): Volatile anesthesia and TIVA. Measurements and
Main Results: Meta-analysis found no statistically significant difference
between patients receiving TIVA and volatile anesthesia in one-year
mortality (n = 6440, OR = 1.22, 95% CI 0.97 to 1.54, p = 0.09, Z = 1.67,
I2 = 0%), troponin (n = 3127, SMD = 0.26, 95% CI -0.01 to 0.52,
p = 0.05, Z = 1.92, I2 = 90%) and CK-MB concentration 24h
postoperatively (n = 1214, SMD = 0.10, 95% CI -0.17 to 0.36, unadjusted p
= 0.48, Z = 0.71, I2 = 79%), or time to tracheal extubation (n
= 1059, SMD = 0.10, 95% CI -0.28 to 0.49, p = 0.60, Z = 0.53, I2 = 88%).
The durations of ICU stay (n = 2003, SMD = 0.29, 95% CI 0.01 to 0.57, p =
0.04, Z = 2.05, I2 = 88%) and hospital stay (n = 1214, SMD =
0.42, 95% CI 0.10 to 0.75, p = 0.01, Z = 2.53, I2 = 91%) were
shorter in the volatile anesthetic compared to TIVA group.
 Conclusion(s): No significant differences in mortality (in-hospital,
30-day, 1-year), troponin and CK-MB concentrations 24 h postoperatively,
or time to tracheal extubation were found between patients who had
volatile anesthesia or TIVA. Compared to TIVA, volatile anesthesia was
associated with shorter durations of hospital and ICU stays. Copyright
© 2020 Elsevier Inc.

<140>
Accession Number
631690144
Title
Effect of preoperative education and ICU tour on patient and family
satisfaction and anxiety in the intensive care unit after elective cardiac
surgery: A randomised controlled trial.
Source
BMJ Quality and Safety. 30 (3) (pp 228-235), 2021. Date of Publication: 01
Mar 2021.
Author
Lai V.K.W.; Ho K.M.; Wong W.T.; Leung P.; Gomersall C.D.; Underwood M.J.;
Joynt G.M.; Lee A.
Institution
(Lai, Wong, Leung, Gomersall, Joynt, Lee) Department of Anaesthesia and
Intensive Care, Chinese University of Hong Kong, Shatin, New Territories,
Hong Kong
(Ho) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, Shatin, New Territories, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
Publisher
BMJ Publishing Group
Abstract
Background Preoperative education may help participants to psychologically
prepare themselves for surgery, but the outcomes of such preparation have
rarely been assessed in patients requiring postoperative care in the
intensive care unit (ICU) as well as in family members. Objective To
assess the effect of a preoperative multifaceted education intervention on
patient and family satisfaction levels in the ICU and measures of
perioperative patients' anxiety and depression. Trial design
Single-centre, two-armed, parallel, superiority, randomised controlled
trial. Healthcare professionals in ICU and outcome assessor were blinded
to treatment allocation. Participants 100 elective coronary artery bypass
grafting+/-valve surgery patients and their family members. Interventions
Preoperative education comprising of a video and ICU tour in addition to
standard care (treatment), versus standard care (control). Outcomes
Patient and family satisfaction levels with ICU using validated PS-ICU23
and FS-ICU24 questionnaires (0-100), respectively; change in perioperative
anxiety and depression scores between 1 day presurgery and 3 days
postsurgery. Results Among 100 (50 treatment, 50 control) patients and 98
(49 treatment, 49 control) family members, 94 (48 treatment, 46 control)
patients and 94 (47 treatment, 47 control) family members completed the
trial. Preoperative education was associated with higher overall patient
(mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI
3.8 to 16.3) satisfaction scores. There was a weak association between
preoperative education and a reduction in patient's anxiety scores over
time (MD -1.7, 95% CI -3.5 to 0.0). However, there was no evidence of a
treatment effect on patient's depression scores over time (MD -0.6, 95% CI
-2.3 to 1.2). Conclusion Providing comprehensive preoperative information
about ICU to elective cardiac surgical patients improved patient and
family satisfaction levels and may decrease patients' anxiety levels.
Trial registration number ChiCTR-IOR-15006971. Copyright ©

<141>
[Use Link to view the full text]
Accession Number
633089585
Title
A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff
Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A
Prospective Randomized Controlled Study.
Source
Anesthesia and analgesia. 132 (3) (pp 827-835), 2021. Date of Publication:
01 Mar 2021.
Author
Yamada Y.; Tanabe K.; Nagase K.; Ishihara T.; Iida H.
Institution
(Yamada, Tanabe, Nagase, Iida) From the Department of Anesthesiology and
Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
(Ishihara) Gifu University Hospital Innovative and Clinical Research
Promotion Center, Gifu University, Gifu, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Double-lumen endobronchial tubes (DLTs) are used for one-lung
ventilation (OLV) during thoracic surgery. Overinflation into the
bronchial cuff causes damage to the tracheobronchial mucosa, whereas
underinflation leads to an incomplete collapse of the nonventilated lung
or incomplete ventilation of the ventilated lung. However, how to
determine the appropriate bronchial cuff volume and pressure during OLV is
unclear. The objective of this study is to compare the required bronchial
cuff volume for lung separation obtained by 2 different cuff inflation
methods under closed- and open-chest conditions. METHOD(S): A total
of 64 patients scheduled to undergo elective thoracic surgery requiring
OLV were recruited. Left DLTs were used for both right- and left-sided
surgery. The patients were randomly assigned to 1 of 2 inflation-type
groups to estimate the bronchial cuff volume. In the capnogram
waveform-guided bronchial cuff inflation group (capno group, n = 27), the
bronchial cuff was inflated until a capnometer sampling gas containing CO2
from the nonventilated lung displayed a flat line. The corresponding
bronchial cuff volume and pressure were then recorded. In the
pressure-guided bronchial cuff inflation group (pressure group, n = 29),
the bronchial cuff was inflated by a cuff inflator to a pressure of 20 cm
H2O. Lung separation was confirmed when a flat line of a capnometer was
observed after gas sampling from the nonventilated lung. RESULT(S):
Under closed-chest conditions, the bronchial cuff sealing volume for the
capno group was significantly lower than that for the pressure group (mean
[standard deviation {SD}], 1.00 [0.65] mL vs 1.44 [0.59] mL, mean
difference, -0.44; 97.5% confidence interval [CI], -0.78 to -0.11; P =
.010). Under open-chest conditions, the bronchial cuff sealing volume for
the capno group was also significantly lower than that for the pressure
group (mean [SD], 0.65 [0.66] mL vs 1.22 [0.45] mL, mean difference,
-0.58; 97.5% CI, -0.88 to -0.27; P < .001). CONCLUSION(S): The lowest
cuff volume providing an air-tight bronchial seal was obtained by the
capnogram waveform-guided bronchial cuff inflation method. Since the cuff
volume required to achieve an air-tight seal decreases after opening the
chest, readjustment of the bronchial cuff volume to prevent bronchial cuff
damage to the tracheobronchial mucosa after opening the chest may be
advisable. Copyright © 2020 International Anesthesia Research
Society.

<142>
Accession Number
634245938
Title
Variability in research productivity among Canadian surgical specialties.
Source
Canadian journal of surgery. Journal canadien de chirurgie. 64 (1) (pp
E76-E83), 2021. Date of Publication: 09 Feb 2021.
Author
Wang H.; Chu M.W.A.; Dubois L.
Institution
(Wang, Chu, Dubois) From the Department of Surgery, Western University,
London, Ont. (Wang, Chu, Dubois); the Division of Cardiac Surgery, Western
University, London, Ont. (Chu); and the Department of Epidemiology and
Biostatistics, Western University, London, Ont. (Dubois)
Publisher
NLM (Medline)
Abstract
Background: Academic productivity, as measured by number and impact of
publications, is central to the career advancement and promotion of
academic surgeons. We compared research productivity metrics among
specialties and sought factors associated with increased productivity.
 Method(s): Academic surgeons were identified through departmental
webpages and their scholarly metrics were collected through Scopus in a
standardized fashion. We collected total number of documents, h-index, and
average number of publications per year in the preceding 5 years. We
explored whether presence of a training program, graduate degree, academic
rank and size of the clinical group affected productivity metrics. Linear
regression was used for multivariable analysis. Result(s): We
collected data on 2172 surgeons from 15 separate academic centres across
Canada. Wide variability existed in metrics among specialties, with
cardiac and neurosurgery being the most productive, and vascular surgery
and plastic surgery being the least productive. The average number of
publications was 71, and the average h-index was 18.7. The average h-index
for cardiac surgery was 25.7 compared with 8.3 for vascular surgery (p <
0.001). Our multivariable model identified academic rank, surgical
specialty, graduate degree, presence of a training program, and larger
clinical group as being associated with increased academic productivity.
 Conclusion(s): There is variability in research productivity among
Canadian surgical specialties. Cardiac surgery and neurosurgery are
productive, whereas vascular surgery and plastic surgery are less
productive than other surgical disciplines. Obtaining a research-oriented
graduate degree, being part of a larger clinical group, and presence of a
training program were all associated with higher productivity, even after
adjusting for academic rank and specialty. Copyright © 2021 Joule
Inc. or its licensors.

<143>
Accession Number
2010744922
Title
Platelet Transfusion in Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Annals of Thoracic Surgery. 111 (2) (pp 607-614), 2021. Date of
Publication: February 2021.
Author
Yanagawa B.; Ribeiro R.; Lee J.; Mazer C.D.; Cheng D.; Martin J.; Verma
S.; Friedrich J.O.
Institution
(Yanagawa, Ribeiro, Lee, Verma) Division of Cardiac Surgery, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Mazer, Friedrich) Department of Critical Care and Medicine, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
(Cheng, Martin) Department of Anesthesia and Perioperative Medicine,
MEDICI Center, University of Western Ontario, London, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Blood transfusion is a well-established independent risk
factor for mortality in patients undergoing cardiac surgery but the impact
of platelet transfusion is less clear. We performed a systematic review
and meta-analysis of observational studies comparing outcomes of patients
who received platelet transfusion after cardiac surgery. Method(s):
We searched MEDLINE and EMBASE databases to January 2019 for studies
comparing perioperative outcomes in patients undergoing cardiac surgery
with and without platelet transfusion. Result(s): There were nine
observational studies reporting 101,511 patients: 12% with and 88% without
platelet transfusion. In unmatched/unadjusted studies, patients who
received platelet transfusion were older, with greater incidence of renal,
peripheral, and cerebrovascular disease, myocardial infarction, left
ventricular dysfunction, and anemia. They were more likely to have
nonelective, combined surgery; preoperative hemodynamic instability and
endocarditis; and more likely to be receiving clopidogrel preoperatively.
Perioperative complications were significantly increased without adjusting
for these baseline differences. After pooling only matched/adjusted data,
differences were not found between patients who did receive platelets and
patients who did not in operative mortality (risk ratio [RR] 1.26; 95%
confidence interval [CI], 0.69 to 2.32, P =.46, five studies), stroke (RR
0.94; 95% CI, 0.62 to 1.45; P =.79; five studies), myocardial infarction
(RR 1.29; 95% CI, 0.95 to 1.77; P =.11; three studies), reoperation for
bleeding (RR 1.20; 95% CI, 0.46 to 3.18; P =.71; three studies), infection
(RR 1.02; 95% CI, 0.86 to 1.20; P =.85; six studies); and perioperative
dialysis (RR 0.91; 95% CI, 0.63 to 1.32; P =.62; three studies).
 Conclusion(s): After accounting for baseline differences, platelet
transfusion was not linked with perioperative complications in cardiac
surgery patients. Given the small number of observational studies, these
findings should be considered hypothesis generating. Copyright ©
2021 The Society of Thoracic Surgeons

<144>
Accession Number
2010487954
Title
Vitamin D supplementation protects against reductions in plasma
25-hydroxyvitamin D induced by open-heart surgery: Assess-d trial.
Source
Physiological Reports. 9 (3) (no pagination), 2021. Article Number:
e14747. Date of Publication: February 2021.
Author
Barker T.; May H.T.; Doty J.R.; Lappe D.L.; Knowlton K.U.; Carlquist J.;
Konery K.; Inglet S.; Chisum B.; Galenko O.; Anderson J.L.; Muhlestein
J.B.
Institution
(Barker) Precision Genomics, Intermountain Healthcare, St. George, UT,
United States
(Barker) Nutrition and Integrative Physiology, University of Utah, Salt
Lake City, UT, United States
(May, Doty, Lappe, Knowlton, Carlquist, Konery, Inglet, Chisum, Galenko,
Anderson, Muhlestein) Heart Institute, Intermountain Healthcare, Salt Lake
City, UT, United States
(Doty, Lappe, Knowlton, Anderson, Muhlestein) School of Medicine,
University of Utah, Salt Lake City, UT, United States
Publisher
American Physiological Society
Abstract
Low vitamin D (serum or plasma 25-hydroxyvitamin D (25(OH)D)) is a global
pandemic and associates with a greater prevalence in all-cause and
cardiovascular mortality and morbidity. Open-heart surgery is a form of
acute stress that decreases circulating 25(OH)D concentrations and
exacerbates the preponderance of low vitamin D in a patient population
already characterized by low levels. Although supplemental vitamin D
increases 25(OH)D, it is unknown if supplemental vitamin D can overcome
the decreases in circulating 25(OH)D induced by open-heart surgery. We
sought to identify if supplemental vitamin D protects against the acute
decrease in plasma 25(OH)D propagated by open-heart surgery during
perioperative care. Participants undergoing open-heart surgery were
randomly assigned (double-blind) to one of two groups: (a) vitamin D (n =
75; cholecalciferol, 50,000 IU/dose) or (b) placebo (n = 75). Participants
received supplements on three separate occasions: orally the evening
before surgery and either orally or per nasogastric tube on postoperative
days 1 and 2. Plasma 25(OH)D concentrations were measured at baseline (the
day before surgery and before the first supplement bolus), after surgery
on postoperative days 1, 2, 3, and 4, at hospital discharge (5-8 days
after surgery), and at an elective outpatient follow-up visit at 6 months.
Supplemental vitamin D abolished the acute decrease in 25(OH)D induced by
open-heart surgery during postoperative care. Moreover, plasma 25(OH)D
gradually increased from baseline to day 3 and remained significantly
increased thereafter but plateaued to discharge with supplemental vitamin
D. We conclude that perioperative vitamin D supplementation protects
against the immediate decrease in plasma 25(OH)D induced by open-heart
surgery. ClinicalTrials.gov Identifier: NCT02460211. Copyright ©
2021 The Authors. Physiological Reports published by Wiley Periodicals LLC
on behalf of The Physiological Society and the American Physiological
Society

<145>
Accession Number
2011035457
Title
Bovine pericardial versus porcine stented replacement mitral valves: Early
hemodynamic performance and clinical results of a randomized comparison of
the Perimount and the Mosaic valves.
Source
Journal of Thoracic Disease. 13 (1) (pp 262-269), 2021. Date of
Publication: January 2021.
Author
Fu B.; Liu X.; Wei R.; Chen Q.; Guo Z.; Jiang N.
Institution
(Fu, Liu, Wei, Chen, Guo, Jiang) Department of Cardiovascular Surgery,
Tianjin Chest Hospital, Tianjin, China
(Fu, Liu, Wei) Tianjin Medical University, Tianjin, China
Publisher
AME Publishing Company
Abstract
Background: To compare the hemodynamic and clinical outcomes following
mitral valve replacement with the Perimount valve with those of the Mosaic
valve. Method(s): A total of 145 consecutive patients with rheumatic
heart valve disease who underwent single bioprosthetic mitral valve
replacement were randomized to receive either the Perimount (n=72) valve
or the Mosaic bioprosthesis (n=73). The mean age of patients was 72.1
years (range, 58-89 years) with a sex distribution of 55.2% female and
44.8% male. Patients underwent follow up transthoracic echocardiography at
3 months and 1 year postoperatively. We compared demographics,
preoperative clinical data, operative data, hemodynamic profiles, and
clinical outcomes. Result(s): The cross-clamp time was similar, with
50.7+/-15.3 minutes for the Perimount and 50.7+/-21.8 minutes for the
Mosaic bioprosthesis. The total bypass time was also similar, with
91.3+/-25.7 minutes for the Perimount and 87.8+/-25.6 minutes for the
Mosaic valve. The peak and mean pressure gradients were lower in the
Perimount group for all valve sizes and the difference was statistically
significant at 1 year. The effective orifice area (EOA) was slightly
larger in the Perimount valve (1.98+/-0.21 vs. 1.89+/-0.71 cm2, P=0.538)
postoperatively, but there was no significant difference at 1 year. There
were no differences in preoperative or postoperative left atrium diameter
(LAD), left ventricular diastolic diameter (LVDD), left ventricular
systolic diameter (LVSD), left ventricular ejection fraction (LVEF),
pulmonary artery pressure (PAP). The mortality and major complications
rate were similar between the two groups. Conclusion(s): The
Perimount prostheses is superior to the Mosaic prostheses after mitral
valve replacement, achieving statistically significant lower gradients and
larger EOA when compared on the basis of manufacturer-labeled valve sizes.
Both valves appear to provide satisfactory clinical results.
 Copyright © 2021 Journal of Thoracic Disease.

<146>
Accession Number
2011048374
Title
A randomized trial comparing the effects of sternal band and plate
fixation of the sternum with that of figure-of-8 wires on sternal edge
motion and quality of recovery after cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (6) (pp 863-870),
2021. Date of Publication: 2021.
Author
Royse A.G.; El-Ansary D.; Hoang W.; Lui E.; McCusker M.; Tivendale L.;
Yang Y.; Canty D.J.; Royse C.F.
Institution
(Royse, El-Ansary, Tivendale, Yang, Canty, Royse) Department of Surgery,
University of Melbourne, Parkville, VIC, Australia
(El-Ansary, Hoang, Tivendale, Royse) Department of Surgery, Royal
Melbourne Hospital, Melbourne, VIC, Australia
(Royse, El-Ansary, Royse) Department of Health Professions, Faculty of
Art, Design and Health, Swinburne University of Technology, Melbourne,
VIC, Australia
(Lui, McCusker) Department of Radiology, University of Melbourne,
Parkville, VIC, Australia
(Yang) Department of Intensive Care, Western Hospital, Melbourne, VIC,
Australia
(Canty) Department of Anaesthesia and Pain Management, Monash Medical
Centre, Melbourne, VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Royse) Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH,
United States
Publisher
Oxford University Press
Abstract
OBJECTIVES: We sought to compare the effects of conventional wire cerclage
with that of the band and plate fixation of the sternum. METHOD(S): A
parallel randomized open-label trial with 1:1 allocation ratio compared
healing after adult cardiac surgery using 'figure-of-8' stainless steel
wire cerclage or a band and plate system (plates). The primary end point
was maximal sternal edge displacement during active coughing of >_2 mm in
>_2 of 4 sites measured with ultrasound by 2 assessors blinded to the
other at 6 weeks postoperatively. Secondary end points at 12 weeks
included ultrasound assessment, computed tomography (CT) scan and
multidimensional assessment of quality of recovery using the Postoperative
Quality of Recovery Scale. RESULT(S): Of 50 patients, 26 received
plates and 24 wires. Two patients died and 1 withdrew consent leaving 25
plates and 22 wires for primary end point analysis. Operations included 37
coronary, 5 valve and 8 combined coronary and valve procedures. At 6
weeks, less sternal movement was observed in patients with plates than
those with wires, 4% (1/25) vs 32% (7/22), P = 0.018. Agreement between
observers was high, kappa = 0.850. At 12 weeks, less ultrasound motion was
seen in patients with plates, 0% (0/23) than those with wires, 25% (5/20),
P = 0.014. Recovery from pain was higher for patients with plates 92%
(22/24) than those with wires 67% (14/21), P = 0.004. CT bone edge
separation was less for plates 38% (9/24) than wires 71% (15/21), P =
0.036. CT mild bone synthesis or greater was similar between patients with
plates 21% (5/24) and wires 14% (3/21), P = 0.71. CONCLUSION(S):
Patients receiving the band and plate system had significantly less
sternal edge motion than those receiving wires, 6 and 12 weeks after
cardiac surgery and experienced less pain. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<147>
Accession Number
2011048373
Title
Is surgical resection of primary tumour superior to exploratory
thoracotomy without resection in treating lung cancer patients with
unexpected pleural metastasis detected during operation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (4) (pp 582-587),
2021. Date of Publication: 2021.
Author
Deng H.-Y.; Zheng X.; Zhu D.-X.; Zhou Q.
Institution
(Deng, Zheng, Zhu) Lung Cancer Center, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In lung cancer patients
with unexpected pleural metastasis detected during operation, is surgical
resection of primary tumour superior to exploratory thoracotomy without
resection in improving long-term survival?'. Altogether, 1443 papers were
found using the reported search, of which 1 meta-analysis and 10
retrospective observational cohort studies represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers were tabulated. One meta-analysis and 9 cohort
studies found that surgical resection of the primary tumour, on the
discovery of pleural metastases, yielded a better overall survival than
exploratory thoracotomy alone, while 1 cohort study showed no difference.
Six studies found that main tumour resection was an independent favourable
prognostic factor for overall survival in lung cancer patients with
unexpected pleural metastasis detected during operation, while 3 cohort
studies also showed improved progression-free survival over exploratory
thoracotomy. Therefore, we conclude that surgical resection of the primary
tumour is superior to exploratory thoracotomy in treating lung cancer
patients with unexpected pleural metastasis detected during
operation. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<148>
Accession Number
2011053267
Title
Virtual reality-assisted conscious sedation during transcatheter aortic
valve implantation: A randomised pilot study.
Source
EuroIntervention. 16 (12) (pp E1014-E1020), 2020. Date of Publication:
2020.
Author
Bruno R.R.; Lin Y.; Wolff G.; Polzin A.; Veulemans V.; Klein K.;
Westenfeld R.; Zeus T.; Kelm M.; Jung C.
Institution
(Bruno, Lin, Wolff, Polzin, Veulemans, Klein, Westenfeld, Zeus, Kelm,
Jung) Division of Cardiology Pulmonology and Vascular Medicine, Medical
Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
(Kelm) Cardiovascular Research Institute Dusseldorf (CARID), Dusseldorf,
Germany
Publisher
Europa Group
Abstract
Aims: Virtual reality (VR) has been used successfully in different
clinical settings to treat anxiety. This prospective, randomised pilot
study aimed to investigate the feasibility and safety of VR in patients
undergoing conscious sedation during transfemoral transcatheter aortic
valve implantation (TAVI). Methods and Results: Thirty-two patients
were included and randomised to VR intervention (n=16) or control (n=16).
In the intervention group, patient-selected relaxing 3D videos were
projected during the TAVI procedure; pain and anxiety before and after
TAVI were measured using visual analogue scales (VAS; 0-10). The median
age was 83 years (IQR 78.25-87). Patients' baseline characteristics did
not differ significantly between the groups. During TAVI under conscious
sedation, the median duration of VR intervention was 30.5 minutes (IQR
23.5-46); 81.3% of the patients watched the videos until device
implantation, 37.5% during the whole procedure. The VR intervention group
reported significantly less anxiety after the procedure (VAS 2 [IQR
0-3.75] vs 5 [IQR 2-8], p=0.04) than patients randomised to control. In
the intervention group, 93.8% would use VR during TAVI again. Nausea and
vomiting did not occur more frequently compared to control.
 Conclusion(s): VR interventions during TAVI to assist conscious
sedation are safe and feasible, even in very old and frail patients. In
this small cohort, there was a significant reduction in periprocedural
anxiety. Copyright © Europa Digital & Publishing 2020.

<149>
Accession Number
2010496735
Title
Aspirin Versus Dual Antiplatelet Therapy in Patients Undergoing
Trans-Catheter Aortic Valve Implantation, Updated Meta-Analysis.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2021. Date of
Publication: 2021.
Author
Alkhalil M.; Edwards R.; Puri R.; Kalra A.; Zaman A.; Das R.
Institution
(Alkhalil, Edwards, Zaman, Das) Department of Cardiothoracic Services,
Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
(Puri, Kalra) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Zaman) Newcastle University, Newcastle-upon-Tyne, United Kingdom
(Das) Northumbria University, Newcastle upon Tyne, United Kingdom
Publisher
Springer
Abstract
Background: The Antiplatelet Therapy for Patients Undergoing Transcatheter
Aortic-Valve Implantation (POPular TAVI) trial reported comparable
composite endpoints of ischemic events using aspirin compared to dual
antiplatelet therapy (DAPT). However, this trial was not powered to detect
individual differences in ischemic events. We sought to conduct a
meta-analysis to compare aspirin to DAPT on ischemic and bleeding events
following TAVI. Method(s): The MEDLINE database was searched from
inception until September 2020 and only randomized clinical trials of
patients receiving antiplatelet therapy following TAVI were included. The
treatment effect was reported as rate ratios (RRs) with 95% confidence
intervals. Result(s): Four randomized clinical trials of 1086 TAVI
patients were included. There was a 51% reduction in major or
life-threatening bleeding with aspirin compared with DAPT [RR 0.49, (95%CI
0.31 to 0.78)]. Aspirin was not associated with an increased risk of death
[RR 1.01, (95%CI 0.62 to 1.65)], cardiovascular death [RR 1.15, (95%CI
0.56 to 2.36)], ischemic stroke [RR 0.93, (95%CI 0.51 to 1.70)], or MI [RR
0.53, (95%CI 0.18 to 1.57)]. Conclusion(s): This meta-analysis
supports the use of aspirin as the optimal antiplatelet strategy following
TAVI procedures in reducing bleeding without an increase in ischemic
events compared with dual antiplatelet therapy. Copyright © 2021,
Springer Science+Business Media, LLC, part of Springer Nature.

<150>
Accession Number
2010483740
Title
Valve-in-valve transcatheter aortic valve replacement versus redo surgical
valve replacement for degenerated bioprosthetic aortic valve: An updated
meta-analysis comparing midterm outcomes.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Thandra A.; Abusnina W.; Jhand A.; Shaikh K.; Bansal R.; Pajjuru V.S.;
Al-Abdouh A.; Kanmanthareddy A.; Alla V.M.
Institution
(Thandra, Abusnina, Shaikh, Kanmanthareddy, Alla) Division of
Cardiovascular Diseases, Creighton University School of Medicine, Omaha,
NE, United States
(Jhand) Division of Cardiovascular Diseases, University of Nebraska
Medical Center, Omaha, NE, United States
(Bansal, Pajjuru) Division of Internal Medicine, Creighton University
School of Medicine, Omaha, NE, United States
(Al-Abdouh) Division of Internal Medicine, Saint Agnes Hospital,
Baltimore, MD, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Redo surgical aortic valve replacement (redo SAVR) and
valve-in-valve transcatheter aortic valve replacement (ViV TAVR) are the
two treatment strategies available for patients with severe symptomatic
bioprosthetic aortic valve dysfunction. Herein, we performed a systematic
review and meta-analysis comparing both early and mid-term outcomes of ViV
TAVR versus redo SAVR in patients with bioprosthetic aortic valve disease.
 Method(s): PubMed, Cochrane reviews, and Google scholar electronic
databases were searched and studies comparing ViV TAVR versus redo SAVR
were included. The primary outcome of interest was mid-term (1-5 years)
and 1-year all-cause mortality. Secondary outcomes included were 30-day
all-cause mortality, myocardial infarction, pacemaker implantation,
stroke, acute kidney injury, major or life-threatening bleeding, and
postprocedural aortic valve gradients. Pooled risk ratios (RR) with their
corresponding 95% confidence intervals (CIs) were calculated for all
outcomes using the DerSimonian-Laird random-effects model. Result(s):
Nine observational studies with a total of 2,891 individuals and mean
follow-up of 26 months met the inclusion criteria. There is no significant
difference in mid-term and 1-year mortality between ViV-TAVR and redo SAVR
groups with RR of 1.15 (95% CI 0.99-1.32; p =.06) and 1.06 (95% CI
0.69-1.61; p =.8). 30-day mortality rate was significantly lower in
ViV-TAVR group with RR of 0.65 (95% CI 0.45-0.93; p =.02). ViV-TAVR group
had lower 30-day bleeding, length of stay, and higher postoperative
gradients. Conclusion(s): Our study demonstrates a lower 30-day
mortality and similar 1-year and mid-term mortality for ViV TAVR compared
to redo SAVR despite a higher baseline risk. Given these findings and the
ongoing advances in the transcatheter therapeutics, VIV TAVR should be
preferred over redo SAVR particularly in those at intermediate-high
surgical risk. Copyright © 2021 Wiley Periodicals LLC.

<151>
Accession Number
2010454212
Title
Effect of institutional transcatheter aortic valve replacement volume on
mortality: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Kir D.; Shapero K.; Chatterjee S.; Grimshaw A.; Oddleifson A.; Spatz E.S.;
Goldsweig A.M.; Desai N.R.
Institution
(Kir, Shapero, Oddleifson) Department of Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Kir) Department of Cardiology, University of Miami/Jackson Memorial
Hospital, Miami, FL, United States
(Chatterjee) Hofmann Heart and Vascular Institute, Saint Francis Hospital
and Medical Center, Hartford, CT, United States
(Grimshaw) Harvey Cushing/John Hay Whitney Medical Library, Yale
University, New Haven, CT, United States
(Spatz, Desai) Center for Outcomes Research and Evaluation, Yale-New Haven
Hospital, New Haven, CT, United States
(Spatz, Desai) Section of Cardiovascular Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Goldsweig) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: We sought to conduct a systematic review and network
meta-analysis to examine the association between institutional
transcatheter aortic valve replacement (TAVR) volume and all-cause
mortality. Background(s): Since inception in 2011, there has been an
exponential increase in the number of TAVR centers across the world.
Multiple studies have questioned if a relationship exists between
institutional TAVR volume and patient outcomes. Method(s): We
performed a systematic literature search for relevant articles using a
combination of free text terms in the title/abstract related to volume,
TAVR, and patient outcomes. Two reviewers independently screened all
titles/abstracts for eligibility based on pre-specified criteria.
All-cause mortality data was pooled from eligible studies and centers were
categorized as low-(30-50 cases), intermediate-, or high-volume (75-130
cases) based on their annual TAVR volumes. Result(s): Our search
yielded an initial list of 11,153 citations, 120 full text studies were
reviewed and 7 studies met all inclusion and exclusion criteria, yielding
a total of 1,93,498 TAVRs. Categorized according to center's annual
volume; 25,062 TAVRs were performed in low-, 77,093 in intermediate- and
91,343 in high-volume centers. Network meta-analysis showed a relative
reduction in mortality rates of 37%, 23% and 19%, for high volume versus
low volume centers, high volume versus intermediate volume centers and
intermediate versus low volume centers, respectively. Conclusion(s):
Existing research clearly shows an inverse relationship between annual
TAVR procedural volume and all-cause mortality. We need to focus on
development of strong referral networks and consolidation rather than
expansion of existing TAVR centers to improve patient outcomes, while
ensuring adequate access-to-care. Copyright © 2021 Wiley
Periodicals LLC.

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