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<1>
Accession Number
624788881
Title
A multicenter randomized controlled trial of Zephyr Endobronchial Valve
treatment in heterogeneous emphysema (LIBERATE).
Source
American Journal of Respiratory and Critical Care Medicine. 198 (9) (pp
1151-1164), 2018. Date of Publication: 01 Nov 2018.
Author
Criner G.J.; Sue R.; Wright S.; Dransfield M.; Rivas-Perez H.; Wiese T.;
Sciurba F.C.; Shah P.L.; Wahidi M.M.; De Oliveira H.G.; Morrissey B.;
Cardoso P.F.G.; Hays S.; Majid A.; Pastis N.; Kopas L.; Vollenweider M.;
Michael McFadden P.; Machuzak M.; Hsia D.W.; Sung A.; Jarad N.;
Kornaszewska M.; Hazelrigg S.; Krishna G.; Armstrong B.; Shargill N.S.;
Slebos D.-J.
Institution
(Criner) Department of Thoracic Medicine and Surgery, Lewis Katz School of
Medicine, Temple University, Philadelphia, PA, United States
(Sue, Wright) St. Joseph's Hospital and Medical Center, Phoenix, AZ,
United States
(Dransfield) University of Alabama, Birmingham UAB Lung Health Center,
Birmingham, AZ, United States
(Rivas-Perez, Wiese) Department of Medicine, University of Louisville,
Louisville, KY, United States
(Sciurba) Division of Pulmonary, Allergy and Critical Care Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Shah) Royal Brompton Hospital and Imperial College, London, United
Kingdom
(Wahidi) Duke University Medical Center, Duke University, Durham, NC,
United States
(De Oliveira) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(Morrissey) Division of Pulmonary, Critical Care and Sleep Medicine,
University of California, Davis, Sacramento, CA, United States
(Cardoso) Instituto do Coracao, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Hays) University of California, San Francisco, San Francisco, CA, United
States
(Majid) Interventional Pulmonology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Pastis) Medical University of South Carolina, Charleston, SC, United
States
(Kopas) Pulmonary Critical Care and Sleep Medicine Consultants, Houston
Methodist, Houston, TX, United States
(Vollenweider) Orlando Health Pulmonary and Sleep Medicine Group, Orlando
Regional Medical Center, Orlando, FL, United States
(Michael McFadden) Keck School of Medicine, University of Southern
California, Los Angeles, CA, United States
(Machuzak) Center for Major Airway Diseases, Cleveland Clinic, Cleveland
Clinic Foundation, Respiratory Institute, Cleveland, OH, United States
(Hsia) Los Angeles Biomedical Research Institute, Harbor-University of
California Los Angeles, Torrance, CA, United States
(Sung) Stanford Hospital and Clinics, Stanford, CA, United States
(Jarad) University Hospital Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Kornaszewska) Department of Cardiothoracic Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Hazelrigg) Division of Cardiothoracic Surgery, Department of Surgery,
Southern Illinois University School of Medicine, Springfield, IL, United
States
(Krishna) Palo Alto Medical Foundation, El Camino Hospital, Mountain View,
CA, United States
(Armstrong) QST Consultations Ltd., Allendale, MI, United States
(Shargill) Pulmonx Corporation, Redwood City, CA, United States
(Slebos) Department of Pulmonary Diseases, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
American Thoracic Society
Abstract
Rationale: This is the first multicenter randomized controlled trial to
evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV)
in patients with little to no collateral ventilation out to 12 months.
<br/>Objective(s): To evaluate the effectiveness and safety of Zephyr EBV
in heterogeneous emphysema with little to no collateral ventilation in the
treated lobe. <br/>Method(s): Subjects were enrolled with a 2:1
randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at
12 months was the DELTAEBV-SoC of subjects with a post-bronchodilator FEV1
improvement from baseline of greater than or equal to 15%. Secondary
endpoints included absolute changes in post-bronchodilator
FEV<inf>1</inf>, 6-minute-walk distance, and St. George's Respiratory
Questionnaire scores. <br/>Measurements and Main Results: A total of 190
subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and
16.8% SoC subjects had a DFEV1 greater than or equal to 15% (P < 0.001).
DEBV-SoC at 12 months was statistically and clinically significant: for
FEV<inf>1</inf>, 0.106 L (P < 0.001); 6-minute-walk distance, +39.31 m (P
= 0.002); and St. George's Respiratory Questionnaire, -7.05 points (P =
0.004). Significant DELTAEBV-SoC were also observed in hyperinflation
(residual volume, 2522 ml; P < 0.001), modified Medical Research Council
Dyspnea Scale (20.8 points; P < 0.001), and the BODE (body mass index,
airflow obstruction, dyspnea, and exercise capacity) index (-1.2 points).
Pneumothorax was the most common serious adverse event in the treatment
period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths
occurred in the EBV group during this phase, and one each in the EBV and
SoC groups between 46 days and 12 months. <br/>Conclusion(s): Zephyr EBV
provides clinically meaningful benefits in lung function, exercise
tolerance, dyspnea, and quality of life out to at least 12 months, with an
acceptable safety profile in patients with little or no collateral
ventilation in the target lobe.<br/>Copyright &#xa9; 2018 by the American
Thoracic Society.

<2>
Accession Number
601059650
Title
Procalcitonin and intestinal ischemia: A review of the literature.
Source
World Journal of Gastroenterology. 20 (47) (pp 17773-17778), 2014. Date of
Publication: 21 Dec 2014.
Author
Cosse C.; Sabbagh C.; Kamel S.; Galmiche A.; Regimbeau J.-M.
Institution
(Cosse, Sabbagh, Kamel) INSERM U1088, Jules Verne University of Picardie,
Amiens 80054, France
(Cosse, Sabbagh, Regimbeau) Department of Digestive and Oncological
Surgery, Amiens University Hospital, Jules Verne University of Picardie,
Place Victor Pauchet, Amiens cedex 01 F-80054, France
(Cosse, Regimbeau) Clinical Research Center, Amiens University Hospital,
Amiens Cedex 01 80054, France
(Kamel, Galmiche) Department of Biochemistry, Amiens University Hospital,
Jules Verne University of Picardie, Amiens F-80054, France
(Regimbeau) EA4294, Jules Verne University of Picardie, Amiens F-80054,
France
Publisher
WJG Press
Abstract
Intestinal ischemia is common after emergency gastrointestinal or
cardiovascular surgery. At present, there are no diagnostic tools for the
early diagnosis of intestinal ischemia. In the last decade, procalcitonin
(PCT) has been suggested as a marker of this condition. Here, we review
the use of PCT as a diagnostic tool for intestinal ischemia. Two reviewers
independently searched the PubMed and EMBASE databases for articles on
intestinal ischemia and PCT. They then considered (1) the criteria
applicable to preclinical and clinical data; and (2) PCT's predictive
value in the diagnosis of intestinal ischemia. Article quality was rated
according to the STAndards for Reporting of Diagnostic accuracy. Between
1993 and 2014, seven studies (including two preclinical studies and five
clinical studies) dealt with the use of PCT to diagnose intestinal
ischemia. Procalcitonin's sensitivity, specificity, positive predictive
value and negative predictive value ranged between 72% and 100%; 68% and
91%; 27% and 90% and 81% and 100%, respectively. The area under the
receiver operating characteristic curve ranged from 0.77 to 0.92. In view
of the preclinical and clinical data, we consider that PCT can be used in
daily practice as a tool for diagnosing intestinal ischemia.<br/>Copyright
&#xa9; 2014 Baishideng Publishing Group Inc. All rights reserved.

<3>
Accession Number
600483876
Title
History and present status of pulmonary metastasectomy in colorectal
cancer.
Source
World Journal of Gastroenterology. 20 (40) (pp 14517-14526), 2014. Date of
Publication: 28 Oct 2014.
Author
Treasure T.; Milosevic M.; Fiorentino F.; Pfannschmidt J.
Institution
(Treasure) Clinical Operational Research Unit, University College London,
Gower St., London WC1E 6BT, United Kingdom
(Milosevic) Clinic for Thoracic Surgery, Institute for Pulmonary Diseases
of Vojvodina, University of Novi Sad, Novi Sad 402920, Serbia
(Fiorentino) Department of Cardiothoracic Surgery, National Heart and Lung
Institute, Imperial College, London W12 0NN, United Kingdom
(Pfannschmidt) HELIOS Klinikum Emil Von Behring, Lungenklinik Heckeshorn,
Berlin 14165, Germany
Publisher
WJG Press
Abstract
Clinical practice with respect to metastatic colorectal cancer differs
from the other two most common cancers, breast and lung, in that routine
surveillance is recommended with the specific intent of detecting liver
and lung metastases and undertaking liver and lung resections for their
removal. We trace the history of this approach to colorectal cancer by
reviewing evidence for effectiveness from the 1950s to the present day.
Our sources included published citation network analyses, the documented
proposal for randomised trials, large systematic reviews, and
meta-analysis of observational studies. The present consensus position has
been adopted on the basis of a large number of observational studies but
the randomised trials proposed in the 1980s and 1990s were either not
done, or having been done, were not reported. Clinical opinion is the
mainstay of current practice but in the absence of randomised trials there
remains a possibility of selection bias. Randomised controlled trials
(RCTs) are now routine before adoption of a new practice but RCTs are
harder to run in evaluation of already established practice. One such
trial is recruiting and shows that controlled trial are
possible.<br/>Copyright &#xa9; 2014 Baishideng Publishing Group Inc. All
rights reserved.

<4>
Accession Number
2011176863
Title
The role of radiotherapy in patients with solid tumours after solid organ
transplantation: a systematic review.
Source
The Lancet Oncology. 22 (3) (pp e93-e104), 2021. Date of Publication:
March 2021.
Author
Mazzola R.; Cuccia F.; Bertani A.; Tubin S.; Conaldi P.G.; Corradini S.;
Tolia M.; Guba M.; Alongi F.
Institution
(Mazzola, Cuccia, Alongi) Advanced Radiation Oncology Department, IRCCS
Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
(Bertani) Department for the Treatment and Study of Cardiothoracic
Diseases and Cardiothoracic Transplantation, Division of Thoracic Surgery
and Lung Transplantation, IRCCS-ISMETT, Palermo, Italy
(Conaldi) Department of Research, IRCCS-ISMETT, Palermo, Italy
(Tubin) MedAustron Center for Ion Therapy and Research, Wiener Neustadt,
Austria
(Corradini) Department of Radiation Oncology, University Hospital,
Ludwig-Maximilian University of Munich, Munich, Germany
(Guba) Department of General, Visceral and Transplantation Surgery,
Ludwig-Maximilian University of Munich, Munich, Germany
(Tolia) Radiotherapy Department, School of Medicine, University of Crete,
Herakleion, Greece
(Alongi) Radiation Oncology, University of Brescia, Brescia, Italy
Publisher
Lancet Publishing Group
Abstract
For patients diagnosed with cancer who have previously received an organ
transplant, radiotherapy represents a challenging clinical scenario
without well established care algorithms. Immunosuppressive therapy can be
a cause for concern among clinicians treating this category of patients.
Potential immune modulation following irradiation could affect recipient
organ tolerance and the outcomes of the transplantation itself. The main
aim of this systematic review was to define the safety and effectiveness
of radiotherapy in patients diagnosed with cancer who have previously
received an organ transplant. We searched PubMed and Embase for articles
published between Jan 1, 1995, and April 30, 2020 for studies in patients
who had undergone radiotherapy for post-transplantation malignancies. The
Review is framed by the PICO (population, intervention, control, and
outcomes) criteria, and primarily focuses on modern treatment
techniques.<br/>Copyright &#xa9; 2021 Elsevier Ltd

<5>
Accession Number
2006032869
Title
Comparison of atorvastatin and rosuvastatin on preventing
contrast-induced-nephropathy in patients undergoing primary percutaneous
coronary intervention: A multi-centric randomized triple-blind clinical
trial.
Source
Signa Vitae. 17 (1) (pp 44-50), 2021. Date of Publication: 2021.
Author
Bagheri R.K.; Keihanian F.; Eshraghi A.; Ahmadi M.; Amirsoleimani H.
Institution
(Bagheri, Ahmadi) Cardiology Department, Faculty of Medicine, Ghaem
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Keihanian, Amirsoleimani) Cardiology Department, Imam Reza & Ghaem
Hospital, Faculty of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
(Keihanian) Pharmaceutical Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
(Eshraghi) Cardiology Department, Faculty of Medicine, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Pharmamed Mado Ltd
Abstract
Background: Patients with Contrast-Induced-Nephropathy (CIN) are at a
greater risk of in-hospital complications, longer hospitalization, and
long-term mortality in comparison with those without CIN. Despite many
studies on the helpful effects of statins in preventing
contrast-nephropathy, there is not enough evidence comparing different
statins in inhibiting CIN. So, we planned this study to compare the
efficacy of rosuvastatin and atorvastatin in prevention of
contrast-induced nephropathy. <br/>Method(s): This was a randomized
clinical trial. The efficacy of two known statins, atorvastatin and
rosuvastatin were compared in prevention of CIN in patients with
ST-Elevation Myocardial Infarction (STEMI) who underwent Primary
Percutaneous Intervention (PPCI) between May 2015 and April 2016 in Qaem
and Imam Reza hospital, Mashhad, Iran. Subjects were divided randomly to
80-mg atorvastatin or 40-mg rosuvastatin group before PPCI. Participants'
characteristics including echocardiographic, laboratory and demographic
data were recorded and incidence of CIN was assessed. <br/>Result(s): Two
hundred cases with STEMI undergoing PPCI were recruited in the study and
randomized to 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102)
group before PPCI. The incidence of CIN was 5.67% (n = 13) in all
participants; 6.3% (n = 7) in the rosuvastatin group and 5.1% (n = 6) in
the atorvastatin group. There was a significant difference between
creatinine and Glomerular Filtration Rate (GFR) after 48 hours of PPCI.
Creatinine was lower and GFR was higher in the rosuvastatin group (P =
0.029, P = 0.005). <br/>Conclusion(s): There was a little trend for
prevention of CIN in patients after PPCI in rosuvastatin group compared to
atorvastatin group, in full dose. However, this preference was not
clinically relevant.<br/>Copyright &#xa9; 2021 The Authors. Published by
MRE Press.

<6>
Accession Number
2004348527
Title
Pericardial complications and postcardiac injury syndrome after
cardiovascular implantable electronic device placement: A meta-analysis
and systematic review.
Source
Herz. 45 (Supplement 1) (pp 58-66), 2020. Date of Publication: December
2020.
Author
Verma B.R.; Banerjee K.; Noll A.; Ala C.K.; Badar M.; Kwon D.; Jellis
C.L.; Hachamovitch R.; Hussein A.; Klein A.L.
Institution
(Verma, Banerjee, Noll, Ala, Badar, Kwon, Jellis, Hachamovitch, Hussein,
Klein) Heart and Vascular Institute, Center for the Diagnosis and
Treatment of Pericardial Disease, Department of Cardiovascular Medicine,
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500
Euclid Avenue, Desk J1, Cleveland, OH 44195, United States
Publisher
Springer Medizin
Abstract
Background: Postcardiac injury syndrome (PCIS) is an emerging condition
including pericarditis with or without pericardial effusion after an
injury to cardiac tissue. Data are lacking on its incidence and clinical
predictors after cardiovascular implantable electronic device (CIED)
placement. We therefore performed this meta-analysis to determine the
incidence of PCIS. <br/>Method(s): Medline, Embase, and Cochrane CENTRAL
databases were searched according to PRISMA guidelines from February 2007
to February 2017 for studies evaluating pericardial complications
subsequent to CIED implantation. Primary outcome was the total number of
cases of pericarditis, pericardial effusion, and cardiac tamponade
documented. <br/>Result(s): Of 2931 references, 22 articles (enrolling
188,944 patients) were included. Pooled estimates from random-effects
analysis showed an overall incidence of 5.82 per 1000 patients (95%
confidence interval [CI], 4.33-8.17) at 30 days, and 1.60 per 1000 (95%
CI: 0.13-3.07) at 1 year. Advanced age and prior coronary artery bypass
graft (CABG) surgery were associated with increased rates of pericardial
complications. <br/>Conclusion(s): Our analysis revealed that CIED
implantations are associated with a low incidence (0.6%) of pericardial
complications at 30 days. Patients with advanced age and prior CABG are
high-risk patients for pericardial complications.<br/>Copyright &#xa9;
2019, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<7>
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. <br/>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. <br/>Setting(s): Surgical
setting. <br/>Participant(s): Pediatric population (<=18 y old).
<br/>Intervention(s): DHCA (18degreeC) with EEG monitoring.
<br/>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.
<br/>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.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<8>
Accession Number
2010670022
Title
Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A
Systematic Review of the Literature.
Source
Journal of Clinical Pharmacology. (no pagination), 2021. Date of
Publication: 2021.
Author
Schurr J.W.; Ambrosi L.; Lastra J.L.; McLaughlin K.C.; Hacobian G.;
Szumita P.M.
Institution
(Schurr, Ambrosi, Lastra) Renaissance School of Medicine at Stony Brook
University, Stony Brook, NY, United States
(McLaughlin, Hacobian, Szumita) Department of Pharmacy Services, Brigham
and Women's Hospital, Boston, MA, United States
Publisher
Blackwell Publishing Inc.
Abstract
Dexmedetomidine-associated fever has been reported in the literature and
can lead to lengthy workups and unnecessary antibiotic exposure. We
conducted a systematic review to evaluate and describe the evidence of
fever or hyperthermia caused by dexmedetomidine in adult patients. Data
sources included PubMed/MEDLINE, EMBASE, CINAHL, and Web of Sciences.
English-language studies of any design published from inception through
April 2020 including conference abstracts were included. The target
population was hospitalized adult patients. Quality of evidence was
determined based on GRADE recommendations and risk of bias assessed using
the Evidence Project Risk of Bias tool. Naranjo scores were assessed to
determine the likeliness of adverse event being caused by dexmedetomidine.
All data were extracted independently and with the guidance of a medical
librarian. Four hundred and eighty-eight total citations were found on
formal search, with 329 left after removal of duplicates. Independent
record screening was performed, leaving 17 citations including 4
retrospective cohort studies, 1 case series, and 12 case reports. Quality
of evidence ranged from very low to low for identified analyses. Evidence
with patient-level data (case reports and series) were combined to
establish a cohort for descriptive results. The median Naranjo score was 4
(range, 3 to 8), and dexmedetomidine doses ranged from 0.1 to 2 mug.h/kg.
Obesity and cardiac surgery appear to be significant risk factors.
Dexmedetomidine-associated fever appears uncommon, but the true incidence
is unknown. Clinicians should keep dexmedetomidine-associated fever in
their differential, and stewardship programs should consider assessing for
this adverse effect in their patient monitoring.<br/>Copyright &#xa9;
2021, The American College of Clinical Pharmacology

<9>
Accession Number
2010606383
Title
Delirium in older adults is associated with development of new dementia: a
systematic review and meta-analysis.
Source
International Journal of Geriatric Psychiatry. (no pagination), 2021. Date
of Publication: 2021.
Author
Pereira J.V.-B.; Aung Thein M.Z.; Nitchingham A.; Caplan G.A.
Institution
(Pereira, Aung Thein) Faculty of Medicine, University of New South Wales,
Sydney, Australia
(Nitchingham, Caplan) Department of Geriatric Medicine, Prince of Wales
Hospital, Prince of Wales Clinical School University of New South Wales,
Sydney, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: Observational studies have examined the association between
delirium and development of new dementia. However, no recent review has
collectively assessed the available evidence quantitatively and
qualitatively. We systematically reviewed and critically evaluated the
literature regarding the association between delirium and dementia, and
calculated the odds of developing new dementia after having delirium.
<br/>Method(s): This systematic review and meta-analysis was conducted
according to Preferred reporting items for systematic reviews and
meta-analyses guidelines. MEDLINE, EMBASE and PsycINFO, were searched for
English-language articles that compared the incidence of new dementia in
older adult (>=65) inpatients with delirium, to inpatients without
delirium. A random effects model was used for meta-analysis, and overall
effect size was calculated using reported raw data of event counts. The
Newcastle-Ottawa Quality Assessment scale assessed risk of bias.
<br/>Result(s): Six observational studies met eligibility criteria, with
follow-up times ranging from six months to five years. Four looked at hip
fracture surgical patients; one was on cardiac surgery patients and one
examined geriatric medical patients. All studies excluded patients with
pre-existing dementia. Pooled meta-analysis revealed that older adult
inpatients who developed delirium had almost twelve times the odds of
subsequently developing new dementia compared to non-delirious patients
(OR = 11.9 [95% CI: 7.29-19.6]; p < 0.001). <br/>Conclusion(s): Older
adult inpatients who develop delirium are at significant risk of
subsequently developing dementia. This emphasises the importance of
delirium prevention and cognitive monitoring post-delirium. The included
studies mainly examined post-surgical patients-further research on medical
and intensive care unit cohorts is warranted. Future studies should assess
whether delirium duration, severity and subtype influence the risk of
developing dementia.<br/>Copyright &#xa9; 2021 John Wiley & Sons Ltd.

<10>
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

<11>
[Use Link to view the full text]
Accession Number
2007540395
Title
Antioxidant treatment to reduce mortality and serious adverse events in
adult surgical patients: A systematic review with meta-analysis and trial
sequential analysis.
Source
Acta Anaesthesiologica Scandinavica. 65 (4) (pp 438-450), 2021. Date of
Publication: April 2021.
Author
Pedersen S.S.; Fabritius M.L.; Kongebro E.K.; Meyhoff C.S.
Institution
(Pedersen, Fabritius, Kongebro, Meyhoff) Department of Anaesthesia and
Intensive Care, Bispebjerg and Frederiksberg Hospital, University of
Copenhagen, Copenhagen, Denmark
(Pedersen, Meyhoff) Copenhagen Center for Translational Research,
Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital,
Copenhagen, Denmark
Publisher
Blackwell Munksgaard
Abstract
Background: Hyperoxia during anesthesia can increase cellular oxidative
stress, and perioperative antioxidant treatment may reduce the resulting
damage. The aim of this review was to evaluate risks and benefits of
antioxidant treatment in surgical patients. We hypothesized that
antioxidant treatment reduced mortality compared to placebo/no
intervention. <br/>Method(s): This systematic review with meta-analyses
and trial sequential analysis (TSA) was conducted using Cochrane standards
and GRADE methodology. Randomized clinical trials comparing perioperative
antioxidant treatment vs. placebo/no intervention in adults were included.
Primary outcome was mortality at longest follow-up. <br/>Result(s):
Ninety-seven trials with 8156 patients were included. The most common
interventions were N-Acetylcysteine (36 trials) and vitamin C (29 trials).
Trials were primarily performed during cardiac surgery (53 trials).
Fifty-six trials with 4890 patients reported information on mortality (243
events). The meta-analysis of mortality at longest follow-up showed a
reduced mortality in antioxidant treated patients (RR 0.74, 95% CI 0.59;
0.94, I² 0%), however, TSA-adjusted CI was broadened
(0.55-1.02) and only 31% of the required information size was reached.
Furthermore, in the subgroup of three trials with overall low risk of bias
the RR for mortality was 1.18 (95% CI 0.39, 3.63). Based on GRADE, our
findings are of low quality of evidence due to high risk of bias,
imprecision, and indirectness. <br/>Conclusion(s): We found a 26% relative
risk reduction of mortality in surgical patients treated with antioxidants
but the quality of evidence supporting our findings is low and influenced
by clinical heterogeneity and high risk of systematic- and random
errors.<br/>Copyright &#xa9; 2020 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<12>
Accession Number
2007099096
Title
Effects of switching from clopidogrel to prasugrel at the chronic phase
after coronary stenting on antiplatelet action and vascular endothelial
function: Switch-Pras study.
Source
Heart and Vessels. 36 (4) (pp 442-451), 2021. Date of Publication: April
2021.
Author
Masuyama T.; Sakuma M.; Waku R.; Hirose S.; Kitahara K.; Naganuma J.;
Yazawa H.; Toyoda S.; Abe S.; Nakajima T.; Inoue T.
Institution
(Masuyama, Sakuma, Waku, Hirose, Kitahara, Naganuma, Yazawa, Toyoda, Abe,
Nakajima, Inoue) Department of Cardiovascular Medicine, School of
Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi
321-0293, Japan
Publisher
Springer Japan
Abstract
Compared to clopidogrel, prasugrel has a lower incidence of ischemic
events following percutaneous coronary intervention (PCI) because of an
early reduction during the acute phase in P2Y12 reaction units (PRU). The
objective of this study was to compare the antiplatelet effect and
vascular endothelial function of both drugs during the chronic phase after
PCI. Patients who had undergone PCI and were confirmed to have no
restenosis by follow-up coronary angiography under dual anti-platelet
therapy with clopidogrel (75 mg/day) and aspirin (100 mg/day) were
randomized to either continue clopidogrel or switch to prasugrel (3.75
mg/day). At baseline, prior to randomization we determined the CYP2C19
genotype. At the baseline and 24 weeks after randomization, the P2Y12
reactivity unit (PRU) was measured using the VerifyNowTM P2Y12 assay.
Endothelial function was evaluated by flow-mediated vasodilation (FMD) and
reactive hyperemia peripheral arterial tonometry (RH-PAT), while and
circulating CD34+/CD133+/CD45^low progenitor cells were measured
by flow cytometric analysis. Serum high-sensitivity C-reactive protein
(hsCRP) level was also measured. The PRU was reduced significantly in the
prasugrel group (P = 0.0008), especially in patients who were intermediate
or poor metabolizers based on the CYP2C19 genotype (P < 0.0001). This
reduction was not observed in the clopidogrel group. The number of
CD34+/CD133+/CD45^low cells increased in the clopidogrel group
(P = 0.008), but not in the prasugrel group. The hsCRP, FMD and reactive
hyperemia index measured by RH-PAT did not change in either group.
Prasugrel is potentially better than clopidogrel for preventing thrombotic
events, although clopidogrel may have an advantage over prasugrel in terms
of preventing atherosclerotic events. Proper use of thienopyridine drugs
based on the CYP2C19 genotype has promising clinical
potential.<br/>Copyright &#xa9; 2020, The Author(s).

<13>
Accession Number
2004838338
Title
Validation process of a high-resolution database in a paediatric intensive
care unit-Describing the perpetual patient's validation.
Source
Journal of Evaluation in Clinical Practice. 27 (2) (pp 316-324), 2021.
Date of Publication: April 2021.
Author
Mathieu A.; Sauthier M.; Jouvet P.; Emeriaud G.; Brossier D.
Institution
(Mathieu, Sauthier, Jouvet, Emeriaud, Brossier) Pediatric Intensive Care
Unit, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
(Mathieu, Sauthier, Jouvet, Emeriaud, Brossier) CHU Sainte Justine
Research Institute, CHU Sainte Justine, Montreal, QC, Canada
(Brossier) CHU de Caen, Pediatric Intensive Care Unit, Caen, France
(Brossier) Universite Caen Normandie, school of medicine, Caen, France
(Brossier) Laboratoire de Psychologie Caen Normandie, Universite Caen
Normandie, Caen, France
Publisher
Blackwell Publishing Ltd
Abstract
Rationale: High data quality is essential to ensure the validity of
clinical and research inferences based on it. However, these data quality
assessments are often missing even though these data are used in daily
practice and research. Aims and objectives: Our objective was to evaluate
the data quality of our high-resolution electronic database (HRDB)
implemented in our paediatric intensive care unit (PICU). <br/>Method(s):
We conducted a prospective validation study of a HRDB in a 32-bed
paediatric medical, surgical, and cardiac PICU in a tertiary care
freestanding maternal-child health centre in Canada. All patients admitted
to the PICU with at least one vital sign monitored using a
cardiorespiratory monitor connected to the central monitoring station.
<br/>Result(s): Between June 2017 and August 2018, data from 295 patient
days were recorded from medical devices and 4645 data points were video
recorded and compared to the corresponding data collected in the HRDB.
Statistical analysis showed an excellent overall correlation
(R² = 1), accuracy (100%), agreement (bias = 0, limits of
agreement = 0), completeness (2% missing data), and reliability (ICC = 1)
between recorded and collected data within clinically significant
pre-defined limits of agreement. Divergent points could all be explained.
<br/>Conclusion(s): This prospective validation of a representative sample
showed an excellent overall data quality.<br/>Copyright &#xa9; 2020 John
Wiley & Sons, Ltd.

<14>
Accession Number
634410174
Title
Minimal invasive extracorporeal circulation and reduced anticoagulation
strategies-less bleeding after coronary surgery?.
Source
Biomedizinische Technik. Conference: 2020 Annual Meeting of the German
Society of Biomedical Engineering. Germany. 65 (SUPPL 1) (pp S181), 2020.
Date of Publication: 2020.
Author
Adrian B.; Jan S.; Jens S.; Dietrich M.; Michal S.; Harald H.
Institution
(Adrian, Jan, Jens, Dietrich, Michal, Harald) MediClin Heart Center
Coswig, Germany
Publisher
De Gruyter
Abstract
Introduction Excessive postoperative bleeding is still a common
complication after heart surgery with extracorporeal circulation (ECC).
Studies show that the use of minimally invasive extracorporeal circulation
(MiECC) can improve perioperative hemostasis and reduce postoperative
bleeding complications. Further studies also found a positive effect of
reduced heparin doses on the incidence and amount of postoperative
bleeding. In the present study we combined MiECC and reduced ACT targets
(reduced anticoagulation: 300 seconds) vs. Full-AC (full anticoagulation:
450 seconds) and hypothesized that reduced anticoagulation intensity
reduces the amount and occurrence of excessive postoperative bleeding.
Methods In this prospective randomized study we examined 106 patients
undergoing aortocoronary bypass surgery. The ACT target was controlled by
the Haemostasis Management System (Medtronic International, Tolochenaz,
CH). The primary endpoint "postoperative bleeding" was measured with the
electronic chest drainage system Thopaz + TM (Medela, Switzerland) and
digitally processed for the study. As secondary endpoint hemostasis was
investigated by endogenous thrombin potential (ETP) and
thromboclastography (TEG). In addition, thromboembolic complications and
serious adverse events were monitored. Results ACT values and
heparin/protamine doses were significantly lower in the study group. The
study group had significantly less bleeding (Diff-Median 24 h: -92 ml
[290-4478] p = 0.026) and 403 ml less over the entire drainage period (851
ml [372 - 1869] vs. 1275 ml [445 - 4886] p = 0.003). Both TEG and ETP
showed improved postoperative coagulation characteristics, but no signs of
hypercoagulopathy or hyperfibrinolysis. There were no differences between
the groups in terms of thromboembolic complications or increased incidence
of re-operations and serious adverse event. Conclusion Since bleeding
volumes were significantly reduced and no negative side effects associated
with lower heparin levels occurred, we consider the reduction of ACT in
combination with MiECC as a measure to reduce postoperative bleeding in
ACVB surgery.

<15>
Accession Number
2011270684
Title
The effect of remote ischaemic conditioning on blood pressure response: A
systematic review and meta-analysis.
Source
International Journal of Cardiology: Hypertension. 8 (no pagination),
2021. Article Number: 100081. Date of Publication: March 2021.
Author
Baffour-Awuah B.; Dieberg G.; Pearson M.J.; Smart N.A.
Institution
(Baffour-Awuah, Pearson, Smart) Clinical Exercise Physiology, School of
Science and Technology, Faculty of Science, Agriculture, Business and Law,
University of New England, Armidale, NSW 2351, Australia
(Dieberg) Biomedical Sciences, School of Science and Technology, Faculty
of Science, Agriculture, Business and Law, University of New England,
Armidale, NSW 2351, Australia
Publisher
Elsevier B.V.
Abstract
Background: Previous work has evaluated the effect of remote ischaemic
conditioning (RIC) in a number of clinical conditions (e.g. cardiac
surgery and acute kidney injury), but only one analysis has examined blood
pressure (BP) changes. While individual studies have reported the effects
of acute bouts and repeated RIC exposure on resting BP, efficacy is
equivocal. We conducted a systematic review and meta-analysis to evaluate
the effects of acute and repeat RIC on BP. <br/>Method(s): A systematic
search was performed using PubMed, Web of Science, EMBASE, and Cochrane
Library of Controlled Trials up until October 31, 2020. Additionally,
manual searches of reference lists were performed. Studies that compared
BP responses after exposing participants to either an acute bout or
repeated cycles of RIC with a minimum one-week intervention period were
considered. <br/>Result(s): Eighteen studies were included in this
systematic review, ten examined acute effects while eight investigated
repeat effects of RIC. Mean differences (MD) for outcome measures from
acute RIC studies were: systolic BP 0.18 mmHg (95%CI -0.95, 1.31; p =
0.76), diastolic BP -0.43 mmHg (95%CI -2.36, 1.50; p = 0.66), MAP -1.73
mmHg (95%CI -3.11, -0.34; p = 0.01) and HR -1.15 bpm (95%CI -2.92, 0.62; p
= 0.20). Only MAP was significantly reduced. Repeat RIC exposure showed
non-significant change in systolic BP -3.23 mmHg (95%CI -6.57, 0.11; p =
0.06) and HR -0.16 bpm (95%CI -7.08, 6.77; p = 0.96) while diastolic BP
-2.94 mmHg (95%CI -4.08, -1.79; p < 0.00001) and MAP -3.21 mmHg (95%CI
-4.82, -1.61; p < 0.0001) were significantly reduced. <br/>Conclusion(s):
Our data suggests repeated, but not acute, RIC produced clinically
meaningful reductions in diastolic BP and MAP.<br/>Copyright &#xa9; 2021

<16>
Accession Number
634412619
Title
The diagnostic accuracy of procalcitonin in infectious patients after
cardiac surgery: a systematic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 22 (4) (pp 305-312),
2021. Date of Publication: 01 Apr 2021.
Author
Li Q.; Zheng S.; Zhou P.Y.; Xiao Z.; Wang R.; Li J.
Institution
(Li, Zheng, Zhou, Xiao, Wang) Department of the Cardiovascular Surgery
(Li) School of Nursing, Southern Medical University, Guangzhou, China
Publisher
NLM (Medline)
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) induces an acute
inflammatory response that may lead to a systemic inflammatory response
syndrome. The interest in procalcitonin (PCT) in the diagnosis of
bacterial infection in patients after cardiac surgery remains less
defined. The aim of this meta-analysis is to prospectively examine the
discriminatory power of PCT as markers of infection in hospitalized
patients with after cardiac surgery. The bivariate generalized nonlinear
mixed-effect model and the hierarchical summary receiver operating
characteristic model were used to estimate the pooled sensitivity,
specificity and summary receiver operating characteristic curve. The
pooled sensitivity and specificity were 0.81 (95% CI 0.75-0.87) and 0.78
(95% CI 0.73-0.83), respectively. The pooled positive likelihood ratio,
and negative likelihood ratio of PCT were 3.74 (95% CI 2.98-4.69) and 0.24
(95% CI 0.17-0.32), respectively. The pooled area under the summary
receiver operating characteristic curve of PCT using the HSROC method was
0.87 (95% CI 0.84- 0.90). This study indicated that PCT is a promising
marker for the diagnosis of sepsis for those patients who undergo cardiac
surgery.<br/>Copyright &#xa9; 2020 Italian Federation of Cardiology -
I.F.C. All rights reserved.

<17>
Accession Number
2011267296
Title
Optimal interval and duration of CAM-ICU assessments for delirium
detection after cardiac surgery.
Source
Journal of Clinical Anesthesia. 71 (no pagination), 2021. Article Number:
110233. Date of Publication: August 2021.
Author
Hamadnalla H.; Sessler D.I.; Troianos C.A.; Fang J.; Rivas E.; Ma C.;
Mascha E.J.; Turan A.
Institution
(Hamadnalla, Sessler, Fang, Rivas, Ma, Mascha, Turan) Department of
Outcomes Research, Cleveland Clinic, OH, United States
(Troianos) Anesthesiology Institute, Cleveland Clinic, OH, United States
(Ma, Mascha) Department of Quantitative Health Sciences, Cleveland Clinic,
OH, United States
(Turan) Department of General Anesthesiology, Cleveland Clinic, OH, United
States
(Hamadnalla) Department of Anesthesiology, Pain Management & Perioperative
Medicine, Henry Ford Health System, MI, United States
(Rivas) Department of Anesthesiology, Hospital Clinic de Barcelona,
Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS),
University of Barcelona, Barcelona, Spain
Publisher
Elsevier Inc.
Abstract
Study objective: Our goal was to determine when postoperative delirium
first occurs, and to assess evaluation strategies that reliably detect
delirium with lowest frequency of testing'. <br/>Design(s): This was a
retrospective study that used a database from a five-center randomized
trial. <br/>Setting(s): Postoperative cardiothoracic ICU and surgical
wards. <br/>Participant(s): Adults scheduled for elective coronary artery
bypass and/or valve surgery. Intervention and measurements: Postoperative
delirium was assessed using CAM-ICU questionnaires twice daily for 5 days
or until hospital discharge. Data were analyzed using frequency tables and
Kaplan-Meier time-to-event estimators, the latter being used to summarize
time to first positive CAM-ICU over POD1-5 for all patients for various
evaluation strategies, including all assessments, only morning assessment,
and only afternoon assessments. Sensitivity for various strategies were
compared using McNemar's test for paired proportions. <br/>Main Result(s):
A total of 95 of 788 patients (12% [95% CI, 10% to 15%]) had at least 1
episode of delirium within the first 5 postoperative days. Among all
patients with delirium, 65% were identified by the end of the first
postoperative day. Delirium was detected more often in the mornings (10%
of patients) than evenings (7% of patients). Compared to delirium
assessments twice daily for five days, we found that twice daily
assessments for 4 days detected an estimated 97% (95% CI 91%, 99%) of
delirium. Measurements twice daily for three days detected 90% (82%, 95%)
of delirium. <br/>Conclusion(s): Postoperative delirium is common, and
CAM-ICU assessments twice daily for 4 days, versus 5 days, detects nearly
all delirium with 20% fewer assessments. Four days of assessment may
usually be sufficient for clinical and research purposes.<br/>Copyright
&#xa9; 2021

<18>
Accession Number
634378365
Title
Systematic review of endovascular stent grafting versus open surgical
repair for the elective treatment of arch/descending thoracic aortic
aneurysms.
Source
BMJ Open. 11 (3) (no pagination), 2021. Article Number: e043323. Date of
Publication: 04 Mar 2021.
Author
McCarthy A.; Gray J.; Sastry P.; Sharples L.; Vale L.; Cook A.; McMeekin
P.; Freeman C.; Catarino P.; Large S.
Institution
(McCarthy, Gray, McMeekin) Health and Life Sciences, Northumbria
University, Newcastle upon Tyne, United Kingdom
(Sastry) Cardiothoracic Surgery, John Radcliffe Hospital, Oxford,
Oxfordshire, United Kingdom
(Sharples) Medical Statistics, London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Vale) Health Economics Group, Population Health Sciences Institute,
Newcastle University, Tyne and Wear, Newcastle upon Tyne, United Kingdom
(Cook) Wessex Institute, University of Southampton, Southampton,
Hampshire, United Kingdom
(Cook) Southampton Clinical Trials Unit, University of Southampton,
Southampton, Hampshire, United Kingdom
(Cook) University Hospital Southampton NHS Foundation Trust, Southampton,
United Kingdom
(Freeman) Papworth Trials Unit Collaboration, Papworth Hospital NHS
Foundation Trust, Cambridge, United Kingdom
(Catarino, Large) Cardiac Surgery, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective To review comparisons of the effectiveness of endovascular stent
grafting (ESG) against open surgical repair (OSR) for treatment of chronic
arch or descending thoracic aortic aneurysms (TAA). Design Systematic
review and meta-analysis Data sources MEDLINE, EMBASE, CENTRAL, WHO
International Clinical Trials Routine data collection, current controlled
trials, clinical trials and the NIHR portfolio were searched from January
1994 to March 2020. Eligibility criteria for selective studies All
identified studies that compared ESG and OSR, including randomised
controlled trials (RCTs), quasi-randomised and non-RCTs, comparative
cohort studies and case-control studies matched on main outcomes were
sought. Participants had to receive elective treatments for
arch/descending (TAA). Studies were excluded where other thoracic aortic
conditions (eg, rupture or dissection) were reported, unless results for
patients receiving elective treatment for arch/descending TAA reported
separately. Data extraction and synthesis Data were extracted by one
reviewer and checked by another. Risk of Bias was assessed using the
ROBINS-I tool. Meta-analysis was conducted using random effects. Where
meta-analysis not appropriate, results were reported narratively. Results
Five comparative cohort studies met inclusion criteria, reporting 3955 ESG
and 21 197 OSR patients. Meta-analysis of unadjusted short-term (30 day)
all-cause mortality favoured ESG (OR 0.75; 95% CI 0.55 to 1.03)).
Heterogeneity identified between larger and smaller studies. Sensitivity
analysis of four studies including only descending TAA showed no
statistical significance (OR 0.73, 95% CI 0.45 to 1.18)), moderate
heterogeneity. Meta-analysis of adjusted short-term all-cause mortality
favoured ESG (OR 0.71, 95% CI 0.51 to 0.98)), no heterogeneity.
Longer-term (beyond 30 days) survival from all-cause mortality favoured
OSR in larger studies and ESG in smaller studies. Freedom from
reintervention in the longer-term favoured OSR. Studies reporting
short-term non-fatal complications suggest fewer events following ESG.
Conclusions There is limited and increasingly dated evidence on the
comparison of ESG and OSR for treatment of arch/descending TAA. PROSPERO
registration number CRD42017054565.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

<19>
Accession Number
634378356
Title
Measurement and prognosis of frail patients undergoing transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
BMJ Open. 11 (3) (no pagination), 2021. Article Number: e040459. Date of
Publication: 04 Mar 2021.
Author
Li Z.; Dawson E.; Moodie J.; Martin J.; Bagur R.; Cheng D.; Kiaii B.;
Hashi A.; Bi R.; Yeschin M.; John-Baptiste A.
Institution
(Li, Dawson, Martin, Bagur, Cheng, Yeschin, John-Baptiste) Department of
Epidemiology and Biostatistics, Western University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Department of
Anesthesia and Perioperative Medicine, Western University, London, ON,
Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Western
University, London, ON, Canada
(Cheng) Department of Medicine, Division of Critical Care Medicine, London
Health Sciences Centre, London, ON, Canada
(Kiaii) Department of Surgery, Division of Cardiac Surgery, London Health
Sciences Centre, London, ON, Canada
(Hashi) Faculty of Sciences, Western University, London, ON, Canada
(Bi, John-Baptiste) Schulich Interfaculty Program in Public Health,
Western University, London, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Objectives Our objectives were to review the literature to identify
frailty instruments in use for transcatheter aortic valve implantation
(TAVI) recipients and synthesise prognostic data from these studies, in
order to inform clinical management of frail patients undergoing TAVI.
Methods We systematically reviewed the literature published in 2006 or
later. We included studies of patients with aortic stenosis, diagnosed as
frail, who underwent a TAVI procedure that reported mortality or clinical
outcomes. We categorised the frailty instruments and reported on the
prevalence of frailty in each study. We summarised the frequency of
clinical outcomes and pooled outcomes from multiple studies. We explored
heterogeneity and performed subgroup analysis, where possible. We also
used Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) to assess the overall certainty of the estimates. Results Of 49
included studies, 21 used single-dimension measures to assess frailty, 3
used administrative data-based measures, and 25 used multidimensional
measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was
the most commonly used single-dimension frailty measure and the Fried or
modified Fried phenotype were the most commonly used multidimensional
measures. Meta-analyses of studies that used either the Fried or modified
Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to
11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The
GRADE system suggests very low certainty of the respective estimates.
Conclusions Frailty instruments varied across studies, leading to a wide
range of frailty prevalence estimates for TAVI recipients and substantial
heterogeneity. The results provide clinicians, patients and healthcare
administrators, with potentially useful information on the prognosis of
frail patients undergoing TAVI. This review highlights the need for
standardisation of frailty measurement to promote consistency. PROSPERO
registration number CRD42018090597.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2021.

<20>
Accession Number
2011258678
Title
Efficacy and safety of icosapent ethyl in hypertriglyceridaemia: A recap.
Source
European Heart Journal, Supplement. 22 (pp J21-J33), 2020. Date of
Publication: 2020.
Author
Parhofer K.G.; Chapman M.J.; Nordestgaard B.G.
Institution
(Parhofer) Medizinische Klinik IV, Groshadern, Klinikum der Universitat
Munchen, Marchioninistr. 15, Munchen 81377, Germany
(Chapman) Endocrinology Metabolism Division, Pitie-Salpetriere University
Hospital, Sorbonne University, National Institute for Health and Medical
Research (INSERM), 47-83, Boulevard de l'Hopital 75651, Paris, France
(Nordestgaard) Department of Clinical Biochemistry, Copenhagen General
Population Study, Herlev and Gentofte Hospital, Copenhagen University
Hospital, Borgmester Ib Juuls Vej 1, Herlev, Denmark
(Nordestgaard) Department of Clinical Medicine, Faculty of Health and
Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen,
Denmark
Publisher
Oxford University Press
Abstract
Although low-density lipoprotein cholesterol lowering is effective in
atherosclerotic cardiovascular disease (ASCVD) prevention, considerable
'lipid-associated' residual risk remains, particularly in patients with
mild-to-moderate hypertriglyceridaemia (2-10 mmol/L; 176-880 mg/dL).
Triglyceride (TG)-rich lipoproteins carry both TGs and cholesterol
(remnant-cholesterol). At TG levels >5 mmol/L (440 mg/dL) vs. <1 mmol/L
(88 mg/dL) or remnant-cholesterol >2.3 mmol/L (89 mg/dL) vs. <0.5 mmol/L
(19 mg/dL), risk is ~1.5-fold elevated for aortic stenosis, 2-fold for
all-cause mortality, 3-fold for ischaemic stroke, 5-fold for myocardial
infarction (MI), and 10-fold for acute pancreatitis. Furthermore,
Mendelian randomization studies indicate that elevated TG-rich
lipoproteins are causally related to increased risk of ASCVD and even
all-cause mortality. While genetic and epidemiological data strongly
indicate that TG-rich lipoproteins are causally linked to ASCVD,
intervention data are ambiguous. Fibrates, niacin and low-dose omega-3
fatty acids have all been used in outcome trials, but have failed to
demonstrate clear benefit in combination with statins. Whether the lack of
additional benefit relates to methodological issues or true failure is
indeterminate. Importantly, a recent intervention trial evaluating a high
dose of eicosapentaenoic-acid showed clear benefit. Thus, REDUCE-IT
evaluated the effect of icosapent ethyl (4 g/day) on cardiovascular
outcomes in 8179 high-risk patients with moderate TG elevation on statin
therapy. Over a median duration of 4.9 years, the relative risk for the
primary endpoint (composite of cardiovascular death, non-fatal MI,
non-fatal stroke, coronary revascularization, or unstable angina) was
reduced by 25% (absolute risk 17.2% vs. 22.0%; P < 0.0001; number needed
to treat 21). High-dose icosapent ethyl intervention therefore confers
substantial cardiovascular benefit in high-risk patients with moderate
hypertriglyceridaemia on statin therapy.<br/>Copyright &#xa9; The
Author(s) 2020.

<21>
Accession Number
2011267283
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: 2021.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Institution
(Yokoyama, Kuno) Department of Surgery, St. Luke's University Health
Network, Mount Sinai Beth Israel, Fountain Hill, PA, United States
(Kuno) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Medicine, Icahn School of Medicine at Mount Sinai,
New York City, NY, United States
Publisher
W.B. Saunders
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
August 31, 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 3728 patients and 2773 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.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<22>
Accession Number
634405498
Title
Noninvasive diagnosis of liver fibrosis in the complex cardiac
malformation survivors - a review of the literature.
Source
Medical ultrasonography. (no pagination), 2020. Date of Publication: 29
Dec 2020.
Author
Mares R.-C.; Marginean C.O.
Institution
(Mares) Pediatrics Department, University of Medicine, Pharmacy, Sciences
and Technology George Emil Palade from Targu Mures.
(Marginean) Pediatrics Department, University of Medicine, Pharmacy,
Sciences and Technology George Emil Palade from Targu Mures
Publisher
NLM (Medline)
Abstract
The aim of this review is to summarize the information on the pathogenesis
and diagnosis of congestive liver disease sec-ondary to the Fontan and
Glenn surgery for complex cardiac malformations, focusing on non-invasive
diagnostic modalities. We performed an electronic database search (Pubmed,
Web of Science) with the data range from 2001 to 2020. We selected the
studies that addressed the pathogenesis of congestive liver disease
secondary to cardiac malformations and articles regarding noninvasive
methods of determining liver fibrosis in this group. We found that
conventional imaging methods do not allow the detection of the initial
stages of liver fibrosis. Elastography results are altered by congestion
and cut-off values are not yet validated. More studies are required in
order to provide evidence-based guidelines regarding the non-invasive
diagnosis of hepatic fibrosis secondary to congenital heart disease.
Patients with congenital cardiac malformations require close monitoring
and early diagnosis of liver complications to allow prompt therapeutic
intervention.

<23>
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. <br/>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. <br/>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. <br/>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). <br/>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)<br/>Copyright &#xa9; 2021 American College of Cardiology
Foundation

<24>
Accession Number
2006021463
Title
Which target temperature for post-anoxic brain injury? A systematic review
from "real life" studies.
Source
Brain Sciences. 11 (2) (pp 1-10), 2021. Article Number: 186. Date of
Publication: February 2021.
Author
Minini A.; Annoni F.; Peluso L.; Bogossian E.G.; Creteur J.; Taccone F.S.
Institution
(Minini, Annoni, Peluso, Bogossian, Creteur, Taccone) Department of
Intensive Care, Erasmus Hospital, Universite Libre de Bruxelles (ULB),
Route de Lennik, 808, Brussels 1070, Belgium
Publisher
MDPI AG
Abstract
There is a persistent debate on the optimal target temperature to use
during cooling procedures in cardiac arrest survivors. A large randomized
clinical trial (RCT) including more than 900 patients showed that targeted
temperature management (TTM) at 33degree C had similar mortality and
unfavorable neurological outcome (UO) rates as TTM at 36degree C in
out-of-hospital cardiac arrest patients with any initial rhythm. Since
then, several observational studies have been published on the effects of
changes in target temperature (i.e., from 33 to 36degree C) on patients'
outcome. We performed a systematic literature search from 1 January 2014
to 4 December 2020 and identified nine retrospective studies (very low
levels of certainty; high risk of bias), including 3799 patients, that
evaluated TTM at 33degree C vs. TTM at 36degree C on the occurrence of UO
(n = seven studies) and mortality (n = nine studies). TTM at 33degree C
was associated with a lower risk of UO when studies assessing neurological
outcome with the Cerebral Performance Categories were analyzed (OR 0.80
[95% CIs 0.65-0.99]; p = 0.04). No differences in mortality were observed
within the two TTM strategies. These results suggest that an inappropriate
translation of TTM protocols from large well-conducted randomized trials
into clinical management may result in unexpected effects on patients'
outcome. As for all newly commercialized drugs, epidemiological studies
and surveillance programs with an adequate follow-up on large databases
are necessary to understand how RCTs are implemented into medical
practice.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<25>
Accession Number
2005975030
Title
Death and myocardial infarction following initial revascularization versus
optimal medical therapy in chronic coronary syndromes with myocardial
ischemia: A systematic review and meta-analysis of contemporary randomized
controlled trials.
Source
Journal of the American Heart Association. 10 (2) (pp 1-13), 2021. Article
Number: e019114. Date of Publication: 19 Jan 2021.
Author
Soares A.; Boden W.E.; Hueb W.; Brooks M.M.; Vlachos H.E.A.; O'Fee K.;
Hardi A.; Brown D.L.
Institution
(Soares, O'Fee, Brown) Department of Medicine, United States
(Brown) Cardiovascular Medicine, United States
(Soares, O'Fee, Hardi, Brown) Washington University School of Medicine,
St. Louis, MO, United States
(Boden) Veterans Affairs New England Healthcare System, Boston, MA, United
States
(Hueb) Heart Institute of the University of Sao Paolo, Sao Paolo, Brazil
(Brooks, Vlachos) Department of Epidemiology, University of Pittsburgh,
PA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In chronic coronary syndromes, myocardial ischemia is
associated with a greater risk of death and nonfatal myocardial infarction
(MI). We sought to compare the effect of initial revascularization with
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in
patients with chronic coronary syndrome and myocardial ischemia on
long-term death and nonfatal MI. METHODS AND RESULTS: Ovid Medline,
Embase, Scopus, and Cochrane Library databases were searched for
randomized controlled trials of PCI or CABG plus OMT versus OMT alone for
patients with chronic coronary syndromes. Studies were screened and data
were extracted independently by 2 authors. Random-effects models were used
to generate pooled treatment effects. The search yielded 7 randomized
controlled trials that randomized 10 797 patients. Median follow-up was 5
years. Death occurred in 640 of the 5413 patients (11.8%) randomized to
revascularization and in 647 of the 5384 patients (12%) randomized to OMT
(odds ratio [OR], 0.97; 95% CI, 0.86-1.09; P=0.60). Nonfatal MI was
reported in 554 of 5413 patients (10.2%) in the revascularization arms
compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95%
CI, 0.57-0.99; P=0.04). In subgroup analysis, nonfatal MI was
significantly reduced by CABG (OR, 0.35; 95% CI, 0.21-0.59; P<0.001) but
was not reduced by PCI (OR, 0.92; 95% CI, 0.75-1.13; P=0.43)
(P-interaction <0.001). <br/>CONCLUSION(S): In patients with chronic
coronary syndromes and myocardial ischemia, initial revascularization with
PCI or CABG plus OMT did not reduce long-term mortality compared with OMT
alone. CABG plus OMT reduced nonfatal MI com-pared with OMT alone, whereas
PCI did not.<br/>Copyright &#xa9; 2021 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<26>
Accession Number
2010254241
Title
Time to surgery in thoracic cancers and prioritization during COVID-19: A
systematic review.
Source
Journal of Thoracic Disease. 12 (11) (pp 6640-6654), 2020. Date of
Publication: November 2020.
Author
Fligor S.C.; Tsikis S.T.; Wang S.; Ore A.S.; Allar B.G.; Whitlock A.E.;
Calvillo-Ortiz R.; Arndt K.; Callery M.P.; Gangadharan S.P.
Institution
(Fligor, Tsikis, Wang, Ore, Allar, Whitlock, Calvillo-Ortiz, Arndt,
Callery, Gangadharan) Department of Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
Publisher
AME Publishing Company
Abstract
Background: Coronavirus disease 2019 (COVID-19) has overwhelmed hospital
resources worldwide, requiring widespread cancellation of non-emergency
operations, including lung and esophageal cancer operations. In the United
States, while hospitals begin to increase surgical volume and tackle the
backlog of cases, the specter of a "second wave," with a potential vaccine
months to years away, highlights the ongoing need to triage cases based
upon the risk of surgical delay. We synthesize the available literature on
time to surgery and its impact on outcomes along with a critical appraisal
of the released triage guidelines in the United States. <br/>Method(s): We
performed a systematic literature review using PubMed according to
preferred reporting items for systematic reviews and meta-analyses
guidelines evaluating relevant literature from the past 15 years.
<br/>Result(s): Out of 679 screened abstracts, 12 studies investigating
time to surgery in lung cancer were included. In stage I-II lung cancer,
delayed resection beyond 6 to 8 weeks is consistently associated with
lower survival. No identified evidence justifies a 2 cm cutoff for
immediate versus delayed surgery. For stage IIIa lung cancer, time to
surgery greater than 6 weeks after neoadjuvant therapy is similarly
associated with worse survival. For esophageal cancer, 254 abstracts were
screened and 23 studies were included. Minimal literature addresses
primary esophagectomy, but time to surgery over 8 weeks is associated with
lower survival. In the neoadjuvant setting, longer time to surgery is
associated with increased pathologic complete response, but also decreased
survival. The optimal window for esophagectomy following neoadjuvant
therapy is 6 to 8 weeks. <br/>Conclusion(s): In the setting of the
COVID-19 pandemic, timely resection of lung and esophageal cancer should
be prioritized whenever possible based upon local resources and
disease-burden.<br/>Copyright &#xa9; Journal of Thoracic Disease. All
rights reserved.

<27>
Accession Number
2010254231
Title
Comparing the rate of fiberoptic bronchoscopy use with a video double
lumen tube versus a conventional double lumen tube-a randomized controlled
trial.
Source
Journal of Thoracic Disease. 12 (11) (pp 6533-6541), 2020. Date of
Publication: November 2020.
Author
Onifade A.; Lemon-Riggs D.; Smith A.; Pak T.; Pruszynski J.; Reznik S.;
Moon T.S.
Institution
(Onifade, Lemon-Riggs, Smith, Pak, Moon) Department of Anesthesia and Pain
Management, University of Texas, Southwestern Medical Center, Dallas, TX,
United States
(Pruszynski, Reznik) Department of Cardiothoracic Surgery, University of
Texas, Southwestern Medical Center, Dallas, TX, United States
Publisher
AME Publishing Company
Abstract
Background: Double lumen endotracheal tubes (DLT) are commonly used to
provide single lung ventilation during thoracic surgery. A fiberoptic
bronchoscope (FOB) is typically used to confirm accurate DLT placement.
Accounting for initial purchase, maintenance, repair and cleaning, the use
of an FOB can cost as much as $312 per procedure. The VivaSight DLT
(VS-DLT) incorporates a built-in camera, which is aimed at reducing FOB
use and its associated costs. In this study, we compared the rate of FOB
use when intubating using either a VS-DLT or a conventional DLT (c-DLT).
<br/>Method(s): This is a randomized controlled comparative study
performed at a public county teaching hospital. A total of 50 patients
were enrolled and randomly assigned to either a c-DLT (n=25) or a VS-DLT
(n=25). The primary outcome was the rate of FOB use. Secondary outcomes
included time to correct tube placement and incidence of malposition
during surgery. <br/>Result(s): Use of the VS-DLT required significantly
less FOB use (28%) compared to use of the c-DLT (100%). While there was no
difference in the ease of intubation, the time to correct tube placement
was significantly faster using a VS-DLT (54 vs. 156 s, P<0.001).
Additionally, the incidence of tube malposition was significantly reduced
in the VS-DLT group. <br/>Conclusion(s): This study demonstrated a
significantly lower rate of FOB use when using a VS-DLT compared to a
c-DLT. Placement of the VS-DLT was significantly quicker and malposition
during surgery occurred significantly less than with the c-DLT. While
intubating with a VS-DLT provides clinical benefits, it may not result in
significant cost reductions when compared to a c-DLT.<br/>Copyright &#xa9;
Journal of Thoracic Disease. All rights reserved.

<28>
Accession Number
2010235482
Title
Continuous ultrafiltration during extracorporeal circulation and its
effect on lactatemia: A randomized controlled trial.
Source
PLoS ONE. 15 (11 November) (no pagination), 2020. Article Number:
e0242411. Date of Publication: November 2020.
Author
Garcia-Camacho C.; Marin-Paz A.-J.; Lagares-Franco C.; Abellan-Hervas
M.-J.; Sainz-Otero A.-M.
Institution
(Garcia-Camacho) Cardiovascular Surgery Unit, Puerta del Mar University
Hospital, Andalusian Health Service, Cadiz, Andalusia, Spain
(Marin-Paz) Nursing and Physiotherapy Department, Faculty of Nursing,
University of Cadiz, Algeciras, Spain
(Lagares-Franco) Department of Statistics and Operative Research,
University of Cadiz, Cadiz, Andalusia, Spain
(Abellan-Hervas, Sainz-Otero) Nursing and Physiotherapy Department,
Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
Publisher
Public Library of Science
Abstract
Introduction Hyperlactatemia occurs during or after extracorporeal
circulation in the form of lactic acidosis, increasing the risk of
postoperative complications and the mortality rate. The aim of this study
was to evaluate whether continuous high-volume hemofiltration with volume
replacement through a polyethersulfone filter during the extracorporeal
circulation procedure decreases postoperative lactatemia and its
consequences. Materials and methods This was a randomized controlled
trial. Patients were randomly divided into two groups of 32: with or
without continuous high-volume hemofiltration through a polyethersulfone
membrane. Five patients were excluded from each group during the study
period. The sociodemographic characteristics, filter effects, and blood
lactate levels at different times during the procedure were evaluated.
Secondary endpoints were studied, such as the reduction in the intubation
time and time spent in ICU. Results Lactatemia measurements performed
during the preoperative and intraoperative phases were not significantly
different between the two groups. However, the blood lactate levels in the
postoperative period and at 24 hours in the intensive care unit showed a
significant reduction and a possible clinical benefit in the hemofiltered
group. Following extracorporeal circulation, the mean lactate level was
higher (difference: 0.77 mmol/L; CI 0.95: 0.01-1.53) in the
nonhemofiltered group than in the hemofiltered group (p<0.05). This effect
was greater at 24 hours (p = 0.019) in the nonhemofiltered group
(difference: 1.06 mmol/L; CI 0.95: 0.18-1.93) than in the hemofiltered
group. The reduction of lactatemia is associated with a reduction of
inflammatory mediators and intubation time, with an improvement in liver
function. Conclusions The use and control of continuous high-volume
hemofiltration through a polyethersulfone membrane during heart-lung
surgery could potencially prevent postoperative complications. The
reduction of lactatemia implied a reduction in intubation time, a decrease
in morbidity and mortality in the intensive care unit and a shorter
hospital stay.<br/>Copyright &#xa9; 2020 Garcia-Camacho et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<29>
Accession Number
2005551743
Title
The pharmacological approach to oncologic patients with acute coronary
syndrome.
Source
Journal of Clinical Medicine. 9 (12) (pp 1-15), 2020. Article Number:
3926. Date of Publication: December 2020.
Author
Radmilovic J.; Di Vilio A.; D'andrea A.; Pastore F.; Forni A.; Desiderio
A.; Ragni M.; Quaranta G.; Cimmino G.; Russo V.; Scherillo M.; Golino P.
Institution
(Radmilovic, Di Vilio, D'andrea, Pastore, Forni, Desiderio, Ragni,
Quaranta) Unit of Cardiology and Intensive Coronary Care, "Umberto I"
Hospital, Nocera Inferiore 84014, Italy
(Di Vilio, D'andrea, Cimmino, Russo, Golino) Unit of Cardiology,
Department of Translational Medical Sciences, University of Campania
"Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
(Scherillo) Unit of Cardiology and Intensive Coronary Care, "San Pio"
Hospital, Benevento 82100, Italy
Publisher
MDPI AG
Abstract
Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer,
especially in the first 6 months after their diagnosis, as well as in
advanced metastatic stages. Lung, gastric, and pancreatic cancers are the
most frequent malignancies associated with ACS. Chemotherapy and
radiotherapy exert prothrombotic, vasospastic, and proinflammatory
actions. The management of cancer patients with ACS is quite challenging:
percutaneous revascularization is often underused, and antiplatelet and
anticoagulant pharmacological therapy should be individually tailored to
the thrombotic risk and to the bleeding complications. Sometimes
oncological patients also show different degrees of thrombocytopenia,
which further complicates the pharmacological strategies. The aim of this
review is to summarize the current evidence regarding the treatment of ACS
in cancer patients and to suggest the optimal management and therapy to
reduce the risk of adverse coronary events after ACS in this high-risk
population.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI,
Basel, Switzerland.

<30>
Accession Number
2010715991
Title
Intercostal nerve cryoablation versus thoracic epidural for postoperative
analgesia following pectus excavatum repair: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (4) (pp 486-498),
2020. Date of Publication: 01 Oct 2020.
Author
Daemen J.H.T.; De Loos E.R.; Vissers Y.L.J.; Bakens M.J.A.M.; Maessen
J.G.; Hulsewe K.W.E.
Institution
(Daemen, De Loos, Vissers, Bakens, Hulsewe) Department of Thoracic
Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Centre, Maastricht, Netherlands
(Maessen) Faculty of Health, Medicine and Life Sciences (FHML),
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Minimally invasive pectus excavatum repair via the Nuss
procedure is associated with significant postoperative pain that is
considered as the dominant factor affecting the duration of
hospitalization. Postoperative pain after the Nuss procedures is commonly
controlled by thoracic epidural analgesia. Recently, intercostal nerve
cryoablation has been proposed as an alternative method with long-acting
pain control and shortened hospitalization. The subsequent objective was
to systematically review the outcomes of intercostal nerve cryoablation in
comparison to thoracic epidural after the Nuss procedure. <br/>METHOD(S):
Six scientific databases were searched. Data concerning the length of
hospital stay, operative time and postoperative opioid usage were
extracted. If possible, data were submitted to meta-analysis using the
mean of differences, random-effects model with inverse variance method and
I2 test for heterogeneity. <br/>RESULT(S): Four observational and 1
randomized study were included, enrolling a total of 196 patients.
Meta-analyses demonstrated a significantly shortened length of hospital
stay [mean difference -2.91 days; 95% confidence interval (CI) -3.68 to
-2.15; P < 0.001] and increased operative time (mean difference 40.91 min;
95% CI 14.42-67.40; P < 0.001) for cryoablation. Both analyses
demonstrated significant heterogeneity (both I2 = 91%; P < 0.001).
Qualitative analysis demonstrated the amount of postoperative opioid usage
to be significantly lower for cryoablation in 3 out of 4 reporting
studies. <br/>CONCLUSION(S): Intercostal nerve cryoablation during the
Nuss procedure may be an attractive alternative to thoracic epidural
analgesia, resulting in shortened hospitalization. However, given the low
quality and heterogeneity of studies, more randomized controlled trials
are needed.<br/>Copyright &#xa9; 2020 The Author(s) 2020. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<31>
Accession Number
2010715983
Title
Short-term outcome of the intuity rapid deployment prosthesis: A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 31 (4) (pp 427-436),
2020. Date of Publication: 01 Oct 2020.
Author
Klop I.D.G.; Kougioumtzoglou A.M.; Kloppenburg G.T.L.; Van Putte B.P.;
Sprangers M.A.G.; Klein P.; Nieuwkerk P.T.
Institution
(Klop, Kloppenburg, Van Putte, Klein) Department of Cardiothoracic
Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Kougioumtzoglou, Van Putte) Department of Cardiothoracic Surgery,
Amsterdam University Medical Centers, Academic Medical Center, Amsterdam,
Netherlands
(Sprangers, Nieuwkerk) Department of Psychology, Amsterdam University
Medical Centers, Academic Medical Center, University of Amsterdam,
Amsterdam Public Health Research Institute, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Limited access aortic valve replacement is an alternative
approach for the treatment of calcified aortic valve disease. To
facilitate limited access aortic valve replacement, rapid deployment valve
prostheses have been developed aiming to reduce surgical impact. This
systematic review gives an overview of current literature regarding the
INTUITY or INTUITY Elite rapid deployment biological valve prosthesis.
<br/>Method(s): Cochrane, Embase and MEDLINE were searched to identify
relevant studies. All studies reporting on patients who underwent isolated
or combined surgical aortic valve replacement with the INTUITY or INTUITY
Elite valve prosthesis were considered eligible. Primary end points were
technical success rate, 30-day mortality, cerebrovascular accident,
paravalvular leak and permanent pacemaker implantation. Secondary end
points included procedural data such as aortic cross-clamping time,
cardiopulmonary bypass time and procedural approach. <br/>Result(s): A
total of 16 articles fulfilled the inclusion and exclusion criteria and
comprised 4.184 patients. Thirty-day mortality was 2.7% (1.9-3.7%),
cerebrovascular accident 2.6% (1.4-4.7%), permanent pacemaker implantation
7.9% (6.6-9.5%) and severe postoperative paravalvular leak requiring a
reintervention 3.3% (1.7-6.1%). Technical success rate varied between
93.9% and 100%. Conventional median sternotomy was most commonly
performed, ranging from 21.7% to 89.6%. Upper hemi-sternotomy was
performed more often than anterior right thoracotomy, ranging from 10.4%
to 63.3% and 2.2% to 26.1%. The mean transvalvular pressure gradient
ranged between 9.0 and 10.3 mmHg at 1 year postoperatively.
<br/>Conclusion(s): This review demonstrates that the technical success
rate of the INTUITY or INTUITY Elite rapid deployment valve system is
high, also in limited access aortic valve replacement. Mortality and
cerebrovascular accident rates are low, but the need for postoperative
permanent pacemaker implantation and reintervention rate for paravalvular
leakage is increased.<br/>Copyright &#xa9; 2020 The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<32>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; The Author(s) 2021.

<33>
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. <br/>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.
<br/>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.<br/>Copyright
&#xa9; 2021, The Author(s).

<34>
Accession Number
2007541500
Title
Anticoagulation With or Without Antiplatelet Therapy Following
Transcatheter Aortic Valve Replacement for Patients With Atrial
Fibrillation: A Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 24 (pp 42-47), 2021. Date of
Publication: March 2021.
Author
Yokoyama Y.; Briasoulis A.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Briasoulis) Division of Cardiology, Heart failure and Transplantation,
University of Iowa, IA, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Although current guidelines recommend oral anticoagulants
(OAC) with or without antiplatelet therapy (APT) following transcatheter
aortic valve replacement (TVAR) in patients with an indication for
long-term anticoagulation therapy, the optimal antithrombotic strategy
remains unknown in these population. Herein, we conducted a meta-analysis
comparing the outcome of OAC alone versus OAC with APT following TAVR in
patients with atrial fibrillation (AF). <br/>Method(s): MEDLINE and EMBASE
were searched through May 2020 to identify clinical trials that
investigated OAC alone versus OAC with APT following TAVR in patients with
AF. From each study, we extracted the hazard ratios (HRs) or risk ratios
of major or life threatening bleeding, stroke, all-cause mortality and
cardiovascular mortality. <br/>Result(s): 1 randomized controlled trial
and 3 observational studies were identified, which enrolled a total of
2032 patients with AF who underwent TAVR assigned to the OAC group (n =
722) or OAC with APT group (n = 1310). Pooled analyses demonstrated the
rate of major or life threatening bleeding was significantly lower in the
OAC group compared to the OAC with APT group (HR [95% Confidence Interval
[CI] = 0.54 [0.38-0.77], P =.0006]). However, the rate of stroke was
similar in both groups (HR [95% CI] = 1.22 [0.80-1.87], P =.36). All-cause
and cardiovascular mortalities were also similar in both groups.
<br/>Conclusion(s): We observed that OAC with APT following TAVR in
patients with AF increased the risk of bleeding compared to OAC alone
without decreasing the risk of stroke.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<35>
Accession Number
2011078704
Title
Anesthesia Management for Pediatrics with Congenital Heart Diseases Who
Undergo Cardiac Catheterization in China.
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 8861461. Date of Publication: 2021.
Author
Xie C.-M.; Yao Y.-T.
Institution
(Xie) Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital,
Affiliated Cardiovascular Hospital, Kunming Medical University, Kunming
650000, China
(Yao) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of
Medical Sciences, Beijing 10037, China
Publisher
Hindawi Limited
Abstract
Objectives. The goal of this study was to summarize anesthesia management
for pediatrics with congenital heart diseases who undergo cardiac
catheterization procedure in China. Methods. The relevant articles were
identified through computerized searches in the CNKI, Wanfang, VIP, and
PubMed databases through May 2020, using different combinations of
keywords: "congenital heart
diseases,""pediatric,""children,""anesthesia,""cardiac
catheterization,""interventional therapy,""interventional
treatment,""interventional examination,"and "computed tomography."Results.
The database searches identified 48 potentially qualified articles, of
which 25 (9,738 patients in total) were determined to be eligible and
included. The authors collect data from the article information.
Anesthesia methods included endotracheal intubation or laryngeal mask
ventilation general anesthesia, monitored anesthesia care, and combined
with sacral canal block. Anesthesia-related complications occurred in
7.41% of the patients and included dysphoria, respiratory depression,
nausea, vomiting, cough, increased respiratory secretion, and airway
obstruction. The incidence of procedure-related complications was 12.14%,
of which the most common were arrhythmia and hypotension. Conclusions. For
pediatric patients with congenital heart diseases who undergo cardiac
catheterization procedures in China, arrhythmia and hypotension are the
most common procedure-related complications. Monitored anesthesia care is
the commonly used anesthesia methods, and dysphoria, cough, nausea,
vomiting, and respiratory depression are frequent complications associated
with anesthesia.<br/>Copyright &#xa9; 2021 Chun-Mei Xie and Yun-Tai Yao.

<36>
Accession Number
632557863
Title
Use of thromboelastography to monitor effects of the hemocoagulase on the
blood coagulation in patients after thoracic surgery.
Source
Annals of palliative medicine. 9 (4) (pp 2090-2095), 2020. Date of
Publication: 01 Jul 2020.
Author
Lin C.; Zhang J.; Yang X.; Cheng J.; Sun L.; Jiang M.
Institution
(Lin, Zhang, Yang, Cheng, Sun, Jiang) Department of Blood Transfusion,
First Affiliated Hospital of Soochow University, Suzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Over the past few years, snake venom thrombin-like
preparations which possess the advantages of low toxicity, fast onset, and
long-lasting efficacy have been commonly used as hemostatic drugs in
clinical surgery. However, recently, cases of hypofibrinogenemia and
bleeding after using the hemocoagulase have been reported and cannot be
ignored. Our study used thromboelastography (TEG) to monitor the
hemocoagulase effects of blood coagulation status in patients after
thoracic surgery. <br/>METHOD(S): Patients suffering thoracic surgery in
the First Affiliated Hospital of Soochow University between June 2018 and
June 2019 were selected and grouped based on the results of postoperative
TEG. The patients with low coagulation index (CI) detected by the TEG were
set as the low CI group, and randomly selected patients with normal CI
were set as the control group and matched in gender, age, and disease type
with patients in the low CI group. The general condition, disease type,
preoperative blood coagulation routine, type of hemocoagulase used,
postoperative blood coagulation status, and blood transfusion status of
the two groups were separately analyzed. <br/>RESULT(S): The preoperative
fibrinogen (FIB) content in the low CI group was significantly lower than
that in the control group (P<0.01). Of the 43 patients, 41 had no bleeding
according to indicators like increased drainage. Two had a bleeding
tendency, and were thus clinically discontinued from hemocoagulase and
supplemented with FIB, fresh frozen plasma, and cryoprecipitate; their
drainage volume was significantly reduced, and reexamination of TEG showed
normal coagulation status. <br/>CONCLUSION(S): For patients with
preoperative low FIB or a lower limit of normal value, hemocoagulase
should be used with caution; after using this type of thrombin, applying
TEG for the timely monitoring of a patient's coagulation status is
optimally recommended.

<37>
Accession Number
631593388
Title
Comparison of third generation balloon-expandable Edwards Sapien 3 versus
self-expandable Evolut R in transcatheter aortic valve implantation: a
meta-analysis.
Source
Annals of palliative medicine. 9 (3) (pp 700-708), 2020. Date of
Publication: 01 May 2020.
Author
Li Y.-M.; Tsauo J.-Y.; Liao Y.-B.; Zhao Z.-G.; Chen M.
Institution
(Li, Tsauo, Liao, Zhao, Chen) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu 610041, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The 3rd generations of transcatheter heart valve system,
including Edwards SAPIEN S3 (ES3) and Medtronic's Evolut R, has been
developed to specifically improve the safety of transcatheter aortic valve
implantation (TAVI). The aim of this work was to provide a summary effect
estimate of the peri-procedural characteristics and clinical outcome of
patients treated with ES3 versus the Evolut R. <br/>METHOD(S): We
conducted a literature search of PubMed, Ovid and EMBASE (2002 to 2018).
Two authors extracted the data independently. The safety and feasibility
of Sapien 3 and Evolut R were compared by odds ratios (ORs) with 95%
confidence intervals (CIs) in inverse variance method. <br/>RESULT(S):
After a multi-step assessment, a total 6 studies were finally included,
yielding 1,664 patients, of which, 768 (46%) used ES3 and 896 (54%) used
Evolut R. There was no statistical difference with device success rate (OR
1.15, 95% CI: 0.70-1.91, I2 =0%), 30-day mortality [OR: 0.72 (0.33-1.57),
I2 =0%], pre-dilation rate, 30-day stroke, bleeding complication (BC)
(major and life-threating), major vascular complication (VC), and
paravalvular leakage between the two groups. However, the ES3 group was
associated with a higher risk of acute kidney injury (AKI), higher mean
aortic valve gradient and better mean left ventricular ejection fraction
(LVEF) after TAVR procedure. Moreover, the Evolut R group had a higher
rate of post-dilation and new permanent pacemaker implantation (PPMI).
<br/>CONCLUSION(S): Both devices had demonstrated excellent procedural
success rate and short-term safety. At 30-day follow-up, both devices
shared similar rates of mortality, BC, VC, stroke, and paravalvular
leakage (PVL). However, the rate of AKI was higher in the ES3 group, and
the rate of PPM was higher in the Evolut R group.

<38>
Accession Number
634395272
Title
The effect of Remote Ischemic Preconditioning (RIPC) on myocardial injury
and inflammation in patients with severe aortic valve stenosis undergoing
Transcatheter Aortic Valve Replacement, (TAVI).
Source
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese.
(no pagination), 2021. Date of Publication: 19 Feb 2021.
Author
Halapas A.; Kapelouzou A.; Chrissoheris M.; Pattakos G.; Cokkinos D.V.;
Spargias K.
Institution
(Halapas, Chrissoheris, Pattakos, Spargias) THV Department, Heart Team
Hygeia Hospital Athens Greece, Athens, Greece
(Kapelouzou, Cokkinos) Center of Clinical, Experimental Surgery,
Translation Research. Biomedical Research Foundation Academy of Athens
(BRFAA), Soranou Efesiou 4, Athens 11527, Greece
Publisher
NLM (Medline)
Abstract
BACKGROUND: Remote ischemic preconditioning (RIPC) is being evaluated as a
strategy to reduce cardiac injury and inflammation in patients undergoing
diverse cardiac invasive and; surgical procedures. However, it is unclear
whether RIPC has protective effects in patients; undergoing the
transfemoral transcatheter aortic valve implantation (TF-TAVI) procedure.
<br/>METHOD(S): Between September 2013 and September 2015, 55 consecutive
patients were prospectively randomly assigned to receive SHAM
preconditioning (SHAM, 22 patients) or Remote Ischemic Preconditioning
(RIPC) (4 cycles of 5 min intermittent leg ischemia and 5 min reperfusion,
33 patients) prior TF-TAVI. The primary endpoint was to determine the
serum levels of: hs-cTn-I (necrosis), CK-18 (apoptosis) and IL-1b
(inflammation). Quantification was performed using commercially available
ELISA kits. Patients were sampled 1-day pre TF-TAVI and 24-hours post
TF-TAVI. Secondary endpoints included: total mortality, incidence of
periprocedural clinical acute myocardial infarction (AMI), acute kidney
injury (AKI) and stroke. <br/>RESULT(S): 22 SHAM patients and 33 RIPC
patients were finally analyzed. Our data revealed no significant
differences in serum levels of hs-cTn-I and CK-18 among groups. However,
in the RIPC group the IL1b level increase was significantly lower 24h post
TF-TAVI, (p<0.01). There were no significant differences between groups in
the secondary endpoints at the follow-up interval of 1 month. No
RIPC-related adverse events were observed. <br/>CONCLUSION(S): Our data
suggest that RIPC did not exhibit significant cardiac or kidney protective
effects regarding necrosis and apoptosis in patients undergoing TF-TAVI.
However, an important anti-inflammatory effect was detected in RIPC
group.<br/>Copyright &#xa9; 2021 Hellenic Society of Cardiology. Published
by Elsevier B.V. All rights reserved.

<39>
Accession Number
634396081
Title
Effect of nurse-initiated forced-air warming blanket on the reduction of
hypothermia complications following coronary artery bypass grafting: a
randomized clinical trial.
Source
European journal of cardiovascular nursing : journal of the Working Group
on Cardiovascular Nursing of the European Society of Cardiology. (no
pagination), 2020. Date of Publication: 14 Dec 2020.
Author
Bezerra A.S.M.; Santos V.B.; Lopes C.T.; de Barros A.L.B.L.
Institution
(Bezerra, Santos, Lopes, de Barros) Escola Paulista de Enfermagem,
Universidade Federal de Sao Paulo (EPE-UNIFESP), Departamento de
Enfermagem Clinica e Cirurgica and Programa de Pos Graduacao em
Enfermagem, 754 Napoleao de Barros St, Vila Clementino 04024-002, Brazil
(Bezerra) Instituto Dante Pazzanese de Cardiologia (IDPC), Divisao de
Enfermagem. 500 Dr Dante Pazzanese Av 04012-909, Brazil
Publisher
NLM (Medline)
Abstract
AIMS: To evaluate the effect of postoperative forced-air warming (FAW) on
the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial
infarction (AMI), and blood product transfusion in hypothermic patients
following on-pump CABG and compare temperatures associated with the use of
FAW and warming with a sheet and wool blanket. METHODS AND RESULTS: A
randomized clinical trial conducted with 200 patients undergoing isolated
on-pump CABG from January to November 2018. Patients were randomly
assigned into an Intervention Group (IG, FAW, n=100) and Control Group
(CG, sheet and blanket, n=100). The tympanic temperature of all patients
was measured over a 24-h period. ExB was the primary outcome, while
arrhythmia, AMI, and blood product transfusion were secondary outcomes.
The effect of the interventions on the outcomes was investigated through
using bivariate logistic regression, with a level of significance of 5%.
The IG was 79% less likely to experience bleeding than the CG [odds ratio
(OR)=0.21, confidence interval (CI) 95% 0.12-0.39, P<0.001]; the
occurrence of AMI in the IG was 94% lower than that experienced by the CG
(OR=0.06, CI 95% 0.01-0.48, P<0.001); and the IG was also 77% less likely
to experience arrhythmia than the CG (OR=0.23, CI 95% 0.12-0.47, P<0.001);
no difference was found between groups in terms of blood product
transfusion (P<0.279). <br/>CONCLUSION(S): These findings show that FAW
can be used following CABG until patients reach normothermia to avoid
undesirable clinical outcomes. TRIAL REGISTRATION: REBeC
RBR-5t582g.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<40>
Accession Number
2010474044
Title
Comparison of cardiac rehabilitation (exercise + education), exercise
only, and usual care for patients with coronary artery disease: A
non-randomized retrospective analysis.
Source
Pharmacology Research and Perspectives. 9 (1) (no pagination), 2021.
Article Number: e00711. Date of Publication: February 2021.
Author
Hu Y.; Li L.; Wang T.; Liu Y.; Zhan X.; Han S.; Huang L.
Institution
(Hu, Wang, Liu, Zhan, Han) Healthcare Center, Hainan General Hospital
(Hainan Affiliated Hospital of Hainan Medical University), Hainan, China
(Li) Department of Pediatrics, Hainan General Hospital (Hainan Affiliated
Hospital of Hainan Medical University), Hainan, China
(Huang) Department of Neurology, Hainan General Hospital (Hainan
Affiliated Hospital of Hainan Medical University), Hainan, China
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac rehabilitation program is well-established but the Rehabilitation
After Myocardial Infarction Trial (RAMIT) is reported that it does not
affect mortality and morbidity of patients after myocardial infarction
during follow-up period. The objectives of the study were to compare
functional walking capacity, risk factor control, and morbidities in
follow-up for cardiac rehabilitation (exercise + education), exercise
only, and usual care among patients with coronary artery disease. A total
of 492 male and female patients (age range: 45-73 years) with coronary
artery disease after myocardial infarction or underwent percutaneous
coronary intervention or coronary artery bypass grafting surgeries
referred to cardiac rehabilitation were included in the study. Patients
were participating in a cardiac rehabilitation program (exercise +
education, CRP cohort, n = 125), exercise only (USC cohort, n = 182), or
usual care (NCR cohort, n = 185). Data regarding incremental shuttle walk
test, lipid profile, the Patient Health Questionnaire 9, and morbidities
in follow-up of patients were retrospectively collected and analyzed.
After completion of 1 year, cardiac rehabilitation program (p < 0.0001, q
= 20.939) and exercise (p < 0.0001, q = 6.059) were successfully increased
incremental shuttle walk test. After completion of 1 year, cardiac
rehabilitation program reduced low-density lipoprotein (p = 0.007, q =
3.349) and depressive symptoms (p < 0.0001, q = 5.649). Morbidities were
reported fewer in the patients of CRP cohort than those of USC (p = 0.003,
q = 3.427) and NCR (p = 0.003, q = 4.822) cohorts after completion of 1
year of program. Cardiac rehabilitation program (exercise +education)
improved functional walking capacity, controlled risk factors, and reduced
morbidities of patients with coronary artery disease than exercise only
and usual care (Level of evidence: III).<br/>Copyright &#xa9; 2021 The
Authors. Pharmacology Research & Perspectives published by British
Pharmacological Society and American Society for Pharmacology and
Experimental Therapeutics and John Wiley & Sons Ltd.

<41>
Accession Number
2005760781
Title
Micronutrient status during paediatric critical illness: A scoping review.
Source
Clinical Nutrition. 39 (12) (pp 3571-3593), 2020. Date of Publication:
December 2020.
Author
Marino L.V.; Valla F.V.; Beattie R.M.; Verbruggen S.C.A.T.
Institution
(Marino) Department of Dietetics/Speech & Language Therapy, NIHR
Biomedical Research Centre Southampton, University Hospital Southampton
NHS Foundation Trust and School of Health Sciences, University of
Southampton, Southampton, United Kingdom
(Valla) Paediatric Intensive Care Unit, Hopital Femme Mere Enfant, CarMEN
INSERM UMR 1060 Hospices Civils de Lyon, Lyon-Bron, France
(Beattie) Department of Paediatric Gastroenterology, Southampton
Children's Hospital, NIHR Biomedical Research Centre Southampton,
University Hospital Southampton NHS Foundation Trust, Southampton, United
Kingdom
(Verbruggen) Intensive Care, Department of Paediatrics and Paediatric
Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam,
Netherlands
Publisher
Churchill Livingstone
Abstract
Background: No evidence based recommendations for micronutrient
requirements during paediatric critical illness are available, other than
those arising from recommended nutrient intakes (RNI) for healthy children
and expert opinion. <br/>Objective(s): The objective of this review is to
examine the available evidence from micronutrient status in critically ill
children considering studies which describe 1) micronutrient levels, 2)
associations between micronutrient levels and clinical outcome, and 3)
impact on clinical outcome with micronutrient supplementation during PICU
admission. <br/>Design(s): Scoping review. Eligibility criteria: Any study
which used a qualitative and quantitative design considering causes and
consequences of micronutrient levels or micronutrient supplementation
during paediatric critical illness. Sources of evidence: NICE Healthcare
Databases Advanced Search website (https://hdas.nice.org.uk/) was used as
a tool for multiple searches, with a content analysis and charting of data
extracted. <br/>Result(s): 711 records were identified, 35 were included
in the review. Studies evaluated serum micronutrient status was determined
on admission day in majority of patients. A content analysis identified (n
= 49) initial codes, (n = 14) sub-categories and (n = 5) overarching
themes during critical illness, which were identified as: i) low levels of
micronutrients, ii) causes of aberrant micronutrient levels, iii)
associations between micronutrients levels and outcome, iv)
supplementation of micronutrients. <br/>Conclusion(s): During critical
illness, micronutrients should be provided in sufficient amounts to meet
reference nutrient intakes for age. Although, there is insufficient data
to recommend routine supplementations of micronutrients at higher doses
during critical illness, the 'absence of evidence should not imply
evidence of absence', and well designed prospective studies are urgently
needed to elucidate paediatric micronutrient requirements during critical
illness. The absence of reliable biomarkers make it challenging to
determine whether low serum levels are reflective of a true deficiency or
as a result redistribution, particularly during the acute phase of
critical illness. As more children continue to survive a PICU admission,
particularly those with complex diseases micronutrient supplementation
research should also be inclusive of the recovery phase following critical
illness.<br/>Copyright &#xa9; 2020 The Author(s)

<42>
Accession Number
2005551875
Title
Outcomes of mechanical circulatory support for giant cell myocarditis: A
systematic review.
Source
Journal of Clinical Medicine. 9 (12) (pp 1-11), 2020. Article Number:
3905. Date of Publication: December 2020.
Author
Patel P.M.; Saxena A.; Wood C.T.; O'malley T.J.; Maynes E.J.; Entwistle
J.W.C.; Massey H.T.; Pirlamarla P.R.; Alvarez R.J.; Cooper L.T.; Eduardo
Rame J.; Tchantchaleishvili V.
Institution
(Patel, Saxena, Wood) Sidney Kimmel Medical College, Thomas Jefferson
University, Philadelphia, PA 19107, United States
(O'malley, Maynes, Entwistle, Massey, Eduardo Rame, Tchantchaleishvili)
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson
University, Philadelphia, PA 19107, United States
(Pirlamarla, Alvarez) Division of Cardiology, Department of Medicine,
Thomas Jefferson University, Philadelphia, PA 19107, United States
(Cooper) Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville,
FL 32224, United States
Publisher
MDPI AG
Abstract
Treatment of giant cell myocarditis (GCM) can require bridging to
orthotopic heart transplantation (OHT) or recovery with mechanical
circulatory support (MCS). Since the roles of MCS and immunotherapy are
not well-defined in GCM, we sought to analyze outcomes of patients with
GCM who required MCS. A systematic search was performed in June 2019 to
identify all studies of biopsy-proven GCM requiring MCS after 2009. We
identified 27 studies with 43 patients. Patient-level data were extracted
for analysis. Median patient age was 45 (interquartile range (IQR): 32-57)
years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart
failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular
(BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43)
of patients who received immunotherapy, 81.5% (22/27) used steroids
combined with at least one other immunosuppressant. Cyclosporine was the
most common non-steroidal agent, used in 40.7% (11/27) of regimens.
Immunosuppression was initiated before MCS in 59.3% (16/27) of cases,
after MCS in 29.6% (8/27), and not specified in 11.1% (3/27).
Immunosuppression started prior to MCS was associated with significantly
better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients
received bridge-to-transplant MCS; 39.5% (17/43) received
bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104
(58-255) days from diagnosis. GCM recurrence after OHT was reported in
8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically
supported patients with GCM. Survival and bridge to recovery appear better
in patients on immunosuppression, especially if initiated before
MCS.<br/>Copyright &#xa9; 2020 by the authors. Licensee MDPI, Basel,
Switzerland.

<43>
Accession Number
2007171799
Title
Comparative Effects of Single-Dose Cardioplegic Solutions Especially in
Repeated Doses During Minimally Invasive Aortic Valve Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 16 (1) (pp 80-89), 2021. Date of Publication: January 2021.
Author
Gunaydin S.; Akbay E.; Gunertem O.E.; McCusker K.; Kunt A.T.; Onur M.A.;
Ozisik K.
Institution
(Gunaydin, Gunertem, Kunt, Ozisik) Department of Cardiovascular Surgery,
Ankara City Hospital, Turkey
(Akbay, Onur) Faculty of Science, Hacettepe University, Ankara, Turkey
(McCusker) New York Medical College, Valhalla, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: This study aims to compare del Nido cardioplegia (DNC) and
histidine-tryptophan-ketoglutarate (HTK) cardioplegic solutions in
minimally invasive aortic valve replacement (mini-AVR) surgery to discuss
the safety level of myocardial protection and rationale for redosing
intervals. <br/>Method(s): During the period from January 2017 to June
2019, 200 patients undergoing mini-AVR (solely or with concomitant
procedures) were prospectively randomized to DNC (n = 100) and HTK (n =
100), both up to 90 minutes ischemic time. Patients with ischemic time
over 90 minutes, needing a redosing, were further analyzed in 2 subgroups
with DNC-R (n = 30) and HTK-R (n = 36). Sensitive biomarkers, in addition
to routine biochemistry, were also documented at baseline (T1), after
cessation of cardiopulmonary bypass (T2), and on the first postoperative
day (T3). Transmural myocardial biopsies were sampled for staining.
<br/>Result(s): No statistical differences could be demonstrated in DNC
and HTK groups with up to 90 minutes cross-clamp times in routine
biochemical measurements and basic perioperative clinical outcomes. DNC-R
showed significantly more arrhythmia/AV block incidence resulting in more
extended intensive care unit (ICU) stay. Interleukin-6 and syndecan-1 in
DNC and DNC-R groups were substantially higher at T2. Aquaporin-4 levels
were significantly lower in the DNC-R group, demonstrating unsatisfactory
response of cells to an excessive volume at T2. <br/>Conclusion(s): DNC
and HTK provided acceptable myocardial protection as single-dose
applications. DNC-R had significantly unbalanced levels of biomarkers, and
more arrhythmia/AV block incidence resulting in more extended ICU stay.
For patients who may need redosing HTK may be preferable to
DNC.<br/>Copyright &#xa9; The Author(s) 2020.

<44>
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. <br/>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.
<br/>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). <br/>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.

<45>
Accession Number
634383609
Title
Nationwide Analysis to Determine Mechanical Circulatory Support Device Use
in Mechanical Complications of Acute Myocardial Infarction.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Shaik A.; Gonuguntla K.; Perosevic N.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Without timely reperfusion therapy, acute myocardial
infarction (AMI) can lead to mechanical complications (MC) such as
papillary muscle rupture (PMR), ventricular septal rupture (VSR), free
wall rupture (FWR). Mechanical circulatory support (MCS) devices such as
intra-aortic balloon pump (IABP), Impella and extracorporeal membrane
oxygenation (ECMO) are used in cardiogenic shock associated with
AMI-MC.Hypothesis: As per the SHOCK-II trial use of MCS in MI complicated
cardiogenic shock showed no difference in mortality. We sought to
determine the rates of AMI-MC, MCS device placements and outcomes
associated with them. <br/>Method(s): The Nationwide Inpatient Sample was
queried from 2010 to 2014 using ICD-9 codes with a primary diagnosis of
AMI. We also used diagnosis and procedure codes for MC and MCS devices. We
excluded patients with NSTEMI. <br/>Result(s): From 2010 to 2014, we
identified 3158 hospitalizations related to AMI-MC with a mean age of
64+/-13.4 years. Majority were men 69% with 75% Caucasian with an
in-hospital mortality rate of 37%. Use of MCS was most common in males
(67%), Caucasians (77%), and with an age group of 50-70 years (54%). Of
these patients, PMR was noted in 13%, VSR in 31% and FWR in 56%. Rates of
MCS devices were 38% (IABP 35%, Impella 3% and ECMO 4%). Overall use of
MCS for FWR, VSR, PMR were 15%, 61%, 80%. Percentage of MC requiring IABP,
Impella, ECMO were as follows; FWR (15%, 0.6%, 0.3%), VSR (58%, 7%, 6%),
PMR (70%, 5%, 12%). Patients that received cardiac transplant was 0.2%.
In-hospital mortality among patients who received MCS to those who did not
receive MCS were 59% vs 24%; p<0.001, among patients who received IABP to
those who did not receive any MCS were 54% vs 24%; p<0.001 and among
patients who received Impella to no MCS were 86% vs 24%; p<0.001.
<br/>Conclusion(s): Based on the results, FWR was the most common MC. MCS
were most commonly used in PMR followed by VSR, with IABP being the most
common type. Patients on MCS had increased in-hospital mortality compared
to those without MCS. Large randomized trials are needed to determine the
effectiveness of these devices in predicting outcomes associated with
AMI-MC.

<46>
Accession Number
634383423
Title
Variation in Coding for Major Cardiac Diagnoses and Procedures in Cardiac
Research Using the National Inpatient Sample.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Ostrominski J.W.; Amione-Guerra J.; Hernandez B.; Michalek J.; Prasad A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Code selection is crucial to the accuracy and
reproducibility of studies using administrative data, however a
comprehensive assessment of coding trends for major cardiac diagnoses and
procedures is lacking.Hypothesis: Given the absence of consensus
guidelines for administrative code utilization, heterogeneity in code
selection for major cardiovascular diagnoses and procedures will be
uncovered. <br/>Method(s): We queried PubMed, CINAHL, Scopus, Medline, and
the HCUP Publication Search from inception through March 1st, 2018 for all
publications using the National Inpatient Sample (NIS), featuring a
primary focus on the heart. ICD-9-CM codes reported for acute myocardial
infarction (AMI), heart failure (HF), atrial fibrillation (AF),
percutaneous coronary intervention (PCI), and coronary artery bypass
grafting (CABG) were collected and analyzed for accuracy and consistency.
All studies were also evaluated for adherence to required methodological
practices as per previously reported methods. <br/>Result(s): Of 2637
articles identified, 445 were included in the observational analysis. 399
articles (84%) did not adhere to one or more research practices required
by the AHRQ, however overall adherence was superior for publications in
higher impact journals (P = 0.0019). Heterogeneity in code utilization was
observed for each diagnosis and procedure assessed, with up to 37 unique
case definitions reported for HF and PCI. Nonspecific codes were included
in 39 (8.8%) studies, and coding heterogeneity increased throughout the
study period (P<inf>trend</inf> < 0.001 for all cardiac diagnoses and
procedures). Coding schema endorsed by national-level clinical guidance
documents were infrequently represented, reported in only 8.9% and 1.3% of
AMI and HF articles, respectively. Upon reintroduction into the NIS for
the period of 2008 to 2012, selected unique case definitions for AMI were
found to yield significantly different estimates of AMI incidence.
<br/>Conclusion(s): Substantial heterogeneity in code selection exists for
major cardiac diagnoses and procedures, with important implications for
the accuracy and generalizability of analyses using the NIS. Further
efforts are required to establish consensus protocols to ensure
consistency in code utilization.

<47>
Accession Number
634383402
Title
Outcomes of Left Heart Decompression in Children on Veno-Arterial
Extracorporeal Membrane Oxygenation: A Systematic Review and
Meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Mahajan S.; Lewis D.; Schneider J.; Lester J.; Dipak K.; Epstein S.M.;
Sweberg T.; Kulkarni A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Left heart decompression (LD) is performed in patients on
veno-arterial extra-corporeal membrane oxygenation (ECMO) to decrease
myocardial wall stress, enhance recovery and decrease complications. Data
on outcomes following LD however, are unclear. We sought to evaluate
outcomes of death(D) and hospital parameters with a systematic review and
meta-analysis (SR-MA) in children without congenital heart disease (CHD)
who underwent LD on ECMO. <br/>Method(s): We included citations in non-CHD
patients <21 years age on ECMO, from a MESH search for ECMO, LD and D in
CINAHL, CINAHL PLUS and MEDLINE, in English up to January 31, 2020. Case
reports, systematic reviews, database duplicates and CHD outcomes were
excluded. Cochrane ROBINS-I risk of bias (ROB) tool for non-randomized
studies was used to assess ROB. <br/>Result(s): The search yielded 300
citations, reduced to 36 full text screening of which 7 met inclusion
criteria. All were observational retrospective analysis (5 single centers,
2 registries). ROB was critical in 3 studies, and low in 2 (not assessed
in 2 abstracts). Of 1,789 included pts, 1,575 were in registries. Median
age on ECMO was 6 years and weight 18.7 (range 3-92) kgs. Main diagnoses
consisted of myocarditis (n=636,36%) and dilated cardiomyopathy
(n=919,52%). Overall, 659 pts died and 75 underwent heart transplantation.
Time from ECMO to LD was 15.5 hours (0-113.7 hrs). Dynamic left atrial
(LA) LD was performed in 239 pts(13%), static in 135(8%), LA drain in
150(8%) and atrial septal stent in 17(1%). Median LA pressure at the time
of decompression was 21 mm Hg. Pts who underwent LD were found to have
lower odds ratio for D compared to pts who did not (OR 0.73
[0.5-1.0],I² 0%). There was inadequate data to assess outcomes
of number of days on ECMO (1 study-LD 17+28 vs non-LD 6+4 days),
mechanical ventilation (1 study- LD 32+49 vs non-LD 14+19 d), ICU stay (1
study-LD 52+55 vs non-LD 18+10 d) and total length of stay (1 study-LD
60+55 vs non-LD 27+33 d). <br/>Conclusion(s): Our systematic review and
meta-analysis found that survival was better in non-CHD pts on ECMO who
underwent LD compared to pts who did not. Further outcome analysis was
limited by inadequate data. Larger registry level analysis is necessary to
assess this further.

<48>
Accession Number
634383164
Title
Gemella Morbillorum Infective Endocarditis: A Systematic Review.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Steinberger J.; Mohamed M.; Sudhakar R.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Gemella morbillorum is a facultative anaerobic gram positive
bacterium that resides as normal flora in the oral cavity and
gastrointestinal system. This organism has uncommonly presented as an
etiology of infective endocarditis, with varying reports of resistance and
complications. <br/>Method(s): Transparent Reporting of Systematic Reviews
and Meta-Analyses (PRISMA) guidelines were followed for the systematic
review. A medical librarian (T.R.S) versed in evidence-based medicine
systematically searched databases for studies assessing Gemella
morbillorum infective endocarditis in patients. Publication year included
inception until December 31, 2019. Using Rayyan software, 134 abstracts
were screened for eligibility after duplicates were removed. Inclusion
criteria was age greater than 18 years old, infective endocarditis with
positive culture for Gemella morbillorum, and publication in English. 39
full text articles were reviewed for eligibility, and 38 were included in
the final analysis. <br/>Result(s): A total of 40 cases of infective
endocarditis caused by Gemella morbillorum were identified. The average
age of the patients was 54 years old, 72.5% were male patients (29), 20%
female (8), 7.5% unknown sex (3). Native valve endocarditis (NVE) was
present in 28 of the cases, with prosthetic valve involvement in 5 cases.
Left sided endocarditis was more common than right sided with 70% of cases
(28) and 12.5% (5) respectively, with 17.5% (7) of cases not listing which
valve was infected on echocardiography. The most common predisposing risk
factor was thought to be poor dentition in 9 cases. The most common
antibiotic regimen in penicillin susceptible NVE was concordant with most
recent guidelines, a beta lactam with gentamicin or vancomycin in 57.5% of
the cases (23). Complications occurred in 65% of cases (26), with most
common complication being need for surgical intervention occurring in 30%
of the cases (12). <br/>Conclusion(s): Gemella morbillorum infective
endocarditis cases reported in literature had a high burden of
complications with nearly two thirds of cases. Most common was the need
for surgery with valve replacement. Antibiotic regimens in the most recent
endocarditis guidelines were effective in treatment for a majority of the
cases.

<49>
[Use Link to view the full text]
Accession Number
634383151
Title
In-Hospital Complications and Outcomes of Leadless Pacemaker Implantation:
A Propensity-Score Matched Analysis from Nationwide Database.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Mohammed M.; Noheria A.; Sheldon S.; Reddy M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There are no randomized controlled trials that compared the
outcomes of leadless pacemaker (L-PPM) implantation with transvenous
pacemaker (TV-PPM) and there is scarcity of data on real world outcomes.
<br/>Method(s): We queried National Inpatient Sample to identify all adult
patients who had primary discharge diagnosis of conduction disorders or
tachy-arrhythmias and excluded patients who had a concomitant procedure
for valve replacement, coronary artery bypass grafting, ablation and/or
cardiac implantable electronic device removal so that complications can be
attributed to the pacemaker implantation. We included only procedures from
November 2016 to December 2017 as Micra was the only available L-PPM
during that period. For the comparison cohort we selected patients, during
the same time period, who had a procedure code for single chamber
pacemaker implantation in conjunction with right ventricular lead
placement. We performed 1:1 propensity score matching and the variables
used for matching are marked with asterisk in Table 1. All the codes used
to identify complications has been previously validated from the Micra
Post-approval registry and Coverage with Evidence Study. <br/>Result(s):
Total of 1,305 patients for L-PPM and 13,905 patients in the TV-PPM group
were included. Baseline characteristics with standardized mean difference
before and after matching are shown in Table 1. Briefly, patients in L-PPM
group were younger but had higher co-morbidities compared to TV-PPM group.
The complications before and after matching are shown in Table 2.
<br/>Conclusion(s): In conclusion, we found no significant difference
between in-hospital complications after propensity score matching, with
the exception of deep venous thrombosis. There was no difference between
length of stay but cost for L-PPM was significantly higher. In this
real-world analysis, we found that the leadless PPM implantation is safe
in comparison to transvenous PPM.

<50>
[Use Link to view the full text]
Accession Number
634381554
Title
Effect of Empagliflozin on Total Events of Myocardial Infarctions by
Subtype in the EMPA-REG OUTCOME Trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Fitchett D.H.; Zinman B.; Inzucchi S.E.; Wanner C.; Anker S.D.; Pocock S.;
Kaspers S.; George J.T.; Johansen O.E.; Jamal W.; Mattheus M.; Vedin O.;
Hantel S.; Lund S.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In EMPA-REG OUTCOME, the sodium-glucose transporter
inhibitor, empagliflozin (EMPA), reduced the risk of first cardiovascular
(CV) events primarily CV mortality and hospitalization for heart failure
in patients with type 2 diabetes (T2D) and established atherosclerotic
cardiovascular disease. In analyses including total events, EMPA also
reduced the risk of myocardial infarction (MI). Here we report the effects
of EMPA on the total number of MIs by subtype. <br/>Method(s): Patients
were randomized to receive EMPA 10 mg, EMPA 25 mg, or placebo. We assessed
the effect of pooled EMPA versus placebo on total (first plus recurrent)
events of fatal and non-fatal MI using a negative binomial model with
robust confidence intervals (CI) that preserves randomization and accounts
for the within-patient correlation of multiple events. Post-hoc, we
analyzed established subtypes of MI: Type 1: Typically related to
plaque-rupture or thrombus; Type 2: Supply-demand; Type 3: Sudden-death
related (i.e., fatal MI); Type 4: Percutaneous coronary intervention
related; and Type 5: Coronary artery bypass graft related. Except type 3
MIs, MIs were non-fatal. The MIs, including subtypes, were centrally
adjudicated and could be assigned to more than one subtype.
<br/>Result(s): 7,020 patients were treated. Overall, there was 421 total
events of MIs. Specifically, 299, 86, 26, 19, and 1 of the MIs were
classified as type 1, 2, 3, 4, and 5 MIs, respectively (not mutually
exclusive). Overall, EMPA reduced the risk of total events of MI by 21%
versus placebo (rate ratio [95% CI], EMPA versus placebo: 0.79 [0.620;
0.998], p=0.0486; each MI only counted once). The overall reduction in
total events of MIs by EMPA was driven by the effect on type 1 and 2 MIs,
as well as type 3 MIs, with limited number of type 4 and 5 MIs (Figure).
<br/>Conclusion(s): EMPA reduced the risk of total MI events with
consistent effects across the most common etiologies, the type 1
(plaque-rupture or thrombus) and 2 (supply-demand) MIs.

<51>
[Use Link to view the full text]
Accession Number
634381513
Title
Increased Serum Immunoglobulin G4 Level is a Novel Predictor of
Cardiovascular Events Independent of Established Risk Factors: Results
from the Real-cad Study.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Sakamoto A.; Aizawa K.; Uemura K.; Komuro I.; Matsuyama Y.; Nagai R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Inflammation is a mediator of atherosclerosis progression.
However, it remains unclear whether immunoglobulin G4 (IgG4)-related
immuno-inflammation may play a specific role in cardiovascular disease.
<br/>Method(s): We used a case-cohort design to analyze the association of
serum IgG4 levels with future cardiovascular events. The sample included
561 cases of the primary end point, defined as cardiovascular death,
myocardial infarction, ischemic stroke, or unstable angina, and a random
subcohort of 1688 (1409 males; mean age, 68.1 +/- 8.4 years), of whom 73
were also cases, selected from 12413 eligible participants with stable
coronary artery disease in the Randomized Evaluation of Aggressive or
Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery
Disease (REAL-CAD) study. <br/>Result(s): This case-cohort study had a
median follow-up of 3.9 years (interquartile range [IR] 2.9-4.6). Serum
IgG4 levels at baseline were 45.3 mg/dL (IR 37.9-58.9), and 845 (50%) took
high-dose statins in the subcohort sample. In Cox regression using age,
gender, statin dose, high-sensitivity C-reactive protein (hsCRP), body
mass index, estimated glomerular filtration rate (eGFR), hypertension,
diabetes, and serum lipid profiles, including low-density lipoprotein
cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and
triglycerides, as covariates, the highest IgG4 quartile was predictive of
the primary end point at 4 years (hazard ratio [HR] 1.44, 95% confidence
interval [CI] 1.03-2.00, P=0.031), compared with the lowest quartile.
Similar results were observed for the secondary end point, a composite of
the primary end point plus coronary revascularization (HR 1.60, 95% CI
1.16-2.20, P=0.004). <br/>Conclusion(s): Elevated serum IgG4 level at
baseline predicted long-term cardiovascular outcomes independent of
established risk factors and high-dose statin therapy in patients with
stable CAD. Serum IgG4 may reflect residual cardiovascular risk.

<52>
Accession Number
634381503
Title
Cardiovascular Benefits of Apabetalone: A Metaanalysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Li H.L.; Feng Q.; Fei Y.; Cheung B.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Apabetalone is a novel drug that reduces inflammation and
thrombosis by inhibiting bromodomain and extra-terminal proteins (BET).
Three phase II trials suggested benefits whereas the recent phase III
BETonMACE trial did not. To reconcile these differences, we performed a
meta-analysis of all trials on apabetalone. <br/>Method(s): MEDLINE,
EMBASE, Cochrane Library, and ClinialTrials.gov were searched for
randomized controlled trials of apabetalone up to May 05, 2020. The
outcomes of interest were major adverse cardiovascular events (MACE) and
hospitalization for heart failure. The secondary outcomes were death,
myocardial infarction (MI), coronary revascularization, high-density
lipoprotein (HDL) and apolipoprotein A-I (apoA-I). Pooled risk ratios
(RRs) or mean differences (MD) in a fixed-effects model were generated
using the "meta" package in R (version 3.6.3). <br/>Result(s): Four trials
(median follow-up 3-26.5 months) with altogether 3223 patients were
included. All patients had coronary artery disease and received standard
statin therapy. Apabetalone significantly reduced MACE (RR 0.78, 95% CI:
0.63-0.96) and hospitalization for heart failure (RR 0.48, 95% CI:
0.33-0.70) compared to placebo (Fig.). No significant differences were
observed for death (RR 0.87, 95% CI: 0.63-1.21), MI (RR 0.82, 95% CI:
0.62-1.10), or coronary revascularization (RR 0.67, 95% CI: 0.31-1.49).
Apabetalone increased ApoA-I (MD 2.82%, 95% CI: 1.36-4.28) and HDL (MD
0.04%, 95% CI: 0.02-0.07). <br/>Conclusion(s): Although the BETonMACE
trial failed to demonstrate significant benefits, our meta-analysis shows
that apabetalone reduces MACE and hospitalization for heart failure in
patients with coronary artery disease. Larger outcome trials are urgently
needed to investigate the benefits of epigenetic modulation through BET
protein inhibition.

<53>
Accession Number
634381500
Title
Promises of Transcatheter Tricuspid Valvular Interventions in Patients
with Clinically Significant Tricuspid Regurgitation: A Meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Bookani K.R.; Nso N.; Radparvar F.; Ricciardi M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Clinically significant tricuspid regurgitation is common
especially in patients with structural heart disease and is independently
associated with poor outcomes. Several transcatheter interventions for
tricuspid valve repair are under investigation. We aimed to illustrate and
summarize the efficacy and safety of these interventions. <br/>Method(s):
We conducted a literature search for relevant clinical registries and
trials published until April 2020. We searched PubMed, Scopus, Web of
Science, and Cochrane CENTRAL. We performed the analysis of continuous
outcomes using the mean difference (MD) while used the risk ratio (RR) for
analysis of dichotomous outcomes. We included the following outcomes:
Tricuspid annular plane systolic excursion (TAPSE), Vena Contracta (VC),
Tricuspid Annulus diameter (TAD), Tricuspid regurgitation volume (TRV),
Left ventricular ejection fraction (LVEF), and mortality rates. The
random-effects model was used for the analysis of heterogeneous data,
while homogeneous data were analyzed under the fixed-effects model.
<br/>Result(s): We obtained fifteen clinical registries/trials and
included a total of 1329 patients. We found that tricuspid valve
interventional devices improved LVEF (MD = 1.46%, 95% CI [0.45, 2.47],
p=0.005), led to smaller VC (MD = -4.69, 95% CI [-5.50, -3.88], p=0.005),
lower TRV (MD = -11.68, 95% CI [-21.25, -2.11], p=0.02), and smaller TAD
(MD = -3.78mm, 95% CI [-5.09, -2.47], p<0.001). No significant difference
was noted regarding TAPSE (MD=0.07mm, 95% CI [-0.29, 0.44], p=0.7).
Results of the six minutes walking test showed that patients could walk 40
more meters after intervention (MD = 40.64, 95% CI [23.89, 57.40],
p<0.001). Pooled mortality rate was 8.2%, stroke 1%, and bleeding 5%
during the mean 12 months follow up. <br/>Conclusion(s): Transcatheter
tricuspid valve repair devices prove to be effective interventions in
decreasing regurgitation and improving functional capacity in patients
with clinically significant TR. Mortality (8% during mean 12 months follow
up) seems to be related to underlying cardiovascular disease.

<54>
Accession Number
634381479
Title
Ace-inhibitors and Vasoplegia in the Post Cabg Population/valvular Surgery
Population: An Updated Systematic Review and Meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Nouthe B.; Ouankou C.N.; Spaziano M.; Sia Y.T.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Chronic use of ACE-i has been presented as a risk factor of
post operative vasoplegia after cardiac surgery. However, a recent meta
analysis of studies in the general cardiac surgery population identified
renal failure as the only pre-operative risk factor for vasoplegia. We
sought to systematically review the relationship of chronic ACE-i and
vasoplegia in patients undergoing CABG/valve surgery.Hypothesis: Studies
on vasoplegia after CABG/valve surgery were extracted by a research
librarian (registered review CRD42017072923) before bias and quality of
studies were assessed. We adjudicated vasoplegia as MAP < 60 mmHg and use
of at least one non dopaminergic vasoactive drug up to 4 hours post
operatively. Otherwise, studies reported vasoplegia as MAP < 60 mmHg, CI >
2.5 l/min/m2 and SVR < 600 dynes/sec/cm2 in the CSICU. We pooled the
incidence of vasoplegia then completed a meta-analysis with random effect
model using RevMan and Stata. <br/>Method(s): Of the 2337 articles
obtained (1940 non relevant, 22 reviews, 5 duplicates and 5 editorials),
we pre-selected 365 abstracts and summarized data from 8,818 patients out
of 7 articles selected after full text review. <br/>Result(s): All but one
study looked at patients with LVEF > 40%. The pooled incidence of
vasoplegia was 11.2% (95% CI 4.7-28.2). The OR of vasoplegia in patients
on chronic ACE-i was 1.74 (95% CI: 1.47-2.06). We could not investigate
the importance of pre-existing renal failure on the risk of post operative
vasoplegia in patients on ACE-i. Accounting for substantial heterogeneity
the Egger test was in favour of small-study effects due to the number of
cases of vasoplegia and the size of the cohorts studied (p=0.073).
<br/>Conclusion(s): The risk of vasoplegia seems to be higher in patients
on ACE-i undergoing CABG/valve surgery in this population. Two RCT's (161
patients) did not prove the benefit of temporary discontinuation of RAS
blockade on the incidence of distributive shock during the first days
after surgery. Because ACE-i are frequently prescribed in patients
awaiting CABG, our work calls for larger and more elaborated studies to
reduce the risk of vasoplegia.

<55>
[Use Link to view the full text]
Accession Number
634381450
Title
N-acetylcysteine for the Prevention of Atrial Fibrillation after
Noncardiac Thoracic Surgery: A Double-blind, Randomized,
Placebo-controlled Trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Amar D.; Zhang H.; Chung M.K.; Tan K.S.; Desiderio D.P.; Park B.; Pedoto
A.; Roistacher N.; Isbell J.; Molena D.; Milne G.; Meyers B.F.; Rusch
V.W.; Jones D.R.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Adding N-acetylcysteine (NAC) to amiodarone may mitigate
inflammation and oxidative stress, preventing postoperative atrial
fibrillation (POAF). NAC, reported to reduce cardiac surgery POAF, has not
been tested in major thoracic surgery. <br/>Method(s): Patients at high
risk for POAF (BNP>=25pg/ml, male, age>=75, or history of AF) who
underwent major thoracic surgery (n=154) were randomized to amiodarone +
NAC (n=78) or amiodarone + placebo (n=76). Begun on arrival to the PACU
were amiodarone 150 mg iv then 1 g/24 h iv x 48 h, and NAC or placebo
bolus 50 mg/kg iv then 50 mg/kg/24 h iv x 48 h. The primary endpoint was
sustained AF >30 s by telemetry (first 72 h) or symptoms within 7 days of
surgery; patients with the primary endpoint underwent home ECG monitoring.
Secondary endpoints were AF up to 1-year post discharge and systemic
markers of inflammation. <br/>Result(s): Baseline characteristics were
similar between arms (Table). POAF occurred in 15/78 NAC patients (19%)
and 13/76 placebo patients (17%) (p=0.8). The trial was stopped at the
interim analysis for futility. Regardless of treatment, of 28 patients
with POAF, 3/28 (11%) were discharged in AF, and 1/28 (4%) met the primary
endpoint after discharge. At 1-year, 7/28 patients with POAF (25%) had
recurrent episodes of AF, and 1 developed persistent AF-none developed
stroke. Inflammatory markers were similar between treatment arms; however,
regardless of NAC, on postoperative day 2, patients with POAF (n=28) had
higher CRP (p=0.008) and IL-6 (p=0.001) than patients without POAF
(n=126). <br/>Conclusion(s): Compared to amiodarone alone, NAC +
amiodarone did not reduce the incidence of POAF nor markers of
inflammation early after major thoracic surgery. Recurrent AF episodes are
common among patients with POAF within 1-year of surgery.

<56>
Accession Number
634381440
Title
Nitric Oxide Delivery during Cardiopulmonary Bypass Reduces Acute Kidney
Injury: Randomized Trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Kamenshchikov N.O.; Podoksenov Y.K.; Anfinogenova Y.J.; Kozlov B.N.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Acute kidney injury (AKI) is a serious complication of
cardiac surgery with cardiopulmonary bypass (CPB). Postoperative AKI
develops in 30% to 52% of cardiac surgery patients and 2% to 5% of these
patients require renal replacement therapy.Hypothesis: We hypothesized
that nitric oxide treatment during cardiac surgery with CPB can decrease
AKI incidence in adult patients. The aim of study was to evaluate the
effects of nitric oxide supplementation to CPB circuit on the development
of cardiac surgery-associated AKI. <br/>Method(s): A prospective
randomized controlled study included 96 patients with moderate risk of
renal complications who underwent elective cardiac surgery with CPB. The
study protocol was registered at www.clinicaltrials.gov (#NCT03527381).
Patients were randomly assigned to either the nitric oxide supplementation
to CPB circuit (NO-treatment group, n = 48) or the usual care (control
group, n = 48). 40-ppm nitric oxide was administered in NO-treatment group
during the entire CPB period. The primary outcome was AKI incidence.
<br/>Result(s): Nitric oxide treatment was associated with a significant
decrease in AKI incidence (10 (20.8%) versus 20 (41.6%); RR 0.5 (95% CI
0.26-0.95; p=0.023) and a higher urine output during CPB (2.6 [2.1;5.08]
versus 1.7 [0.80;2.50] mL/kg/h; p = 0.0002). Urinary neutrophil
gelatinase-associated lipocalin levels were significantly lower in
NO-treatment group 4 h after surgery: 1.12 [0.75;5.8] versus 4.62
[2.02;34.55] ng/mL; p = 0.005. Concentrations of nitric oxide metabolites
in NO-treatment group significantly increased at 5 min post-clamping, 5
min after declamping, and at the end of surgery. The concentrations of
proinflammatory and anti-inflammatory mediators and free plasma hemoglobin
did not significantly differ between groups. <br/>Conclusion(s): Nitric
oxide administration to patients at moderate risk of renal complications
undergoing elective cardiac surgery with CPB was associated with a
decrease in AKI incidence. The implications of study for clinical practice
expand the array of methods, which may be used for prevention of AKI in
cardiac surgery patients.

<57>
Accession Number
634381420
Title
Conventional versus Right Mini-thoracotomy versus Robotic Mitral Valve
Replacement/repair; Insights from a Network Meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Benefits and risks of minimally invasive cardiac surgery
(MICS) through right mini-thoracotomy and robotic surgery for mitral valve
are not fully understood. We conducted a network meta-analysis comparing
the perioperative and long-term outcomes of mitral valve surgery via
conventional sternotomy, MICS and robot. <br/>Method(s): MEDLINE and
EMBASE were searched through March 15th, 2020 to identify randomized
controlled trials (RCTs) and propensity-score matched (PSM) trials that
investigated perioperative and long-term outcomes after mitral surgery via
conventional sternotomy, MICS and robot. Subanalyses were conducted by
restricting trials, in which mitral valve repair was tried first for all
patients. <br/>Result(s): Our systematic literature search identified 2
RCTs and 21 PSM trials. MICS was related to significant decrease in PM
([RR] [95% confidence interval [CI] =0.56 [0.40-0.78]] and SSI (RR [95%CI]
=0.53 [0.33-0.85) compared to conventional sternatomy. Re-exploration for
bleeding was significantly higher in robot compared to sternotomy (RR [95%
CI] =1.56 [1.03-2.37]), and transfusion was higher in sternotomy compared
to MICS (RR [95%CI] =1.63 [1.27-2.08]). No significant differences were
observed in perioperative mortality, MI, stroke, and LCOS among there
procedures. Similarly, there were no significant differences in long-term
survival and mitral valve reoperation. Suanalyses by restricting trials in
which mitral valve repair tried first for all patients showed MICS was
related to significant increase in mitral valve reoperation compared to
conventional sternotomy (hazard ratio [95%CI] =7.33 [1.54-34.97])
(Figure). <br/>Conclusion(s): Our network metaanalysis demonstrated
similar long-term survival and mitral valve reoperation. However, MICS was
related to significant increase in mitral valve reoperation after mitral
valve repair compared to conventional sternotomy.

<58>
[Use Link to view the full text]
Accession Number
634381411
Title
Impact of Different Annuloplasty Methods for Tricuspid Regurgitation; A
Network Meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although moderate-severe tricuspid valve regurgitation (TR) is
an independent risk factor for progressive heart failure and increased
mortality, the best method for tricuspid repair remains controversial. As
such, we conducted a network meta-analysis to compare early and late
outcomes for suture, flexible band, and rigid ring as tricuspid
annuloplasty (TAP) in patients with TR. <br/>Method(s): MEDLINE and EMBASE
were searched through February 15th, 2020 to identify randomized
controlled trials (RCTs) and observational trials that investigated early
and late outcomes after TAP for TR. The outcomes of interest were
perioperative mortality, long-term survival and TR recurrence. TR
recurrence was defined as at least moderate (TR grade 2) on serial
echocardiogram. <br/>Result(s): Our systematic literature search
identified 2 RCTs and 16 observational trials, including 6,788 patients
who underwent TAP. Median follow-up period was 1-7.4 year. There were no
significant differences of perioperative and long-term all-cause mortality
among three TAP methods. Suture TAP was associated with a significant
increase in TR recurrence compared to rigid ring TAP (Hazard ratio, 2.31;
95% Confidence Interval, 1.40-3.80; p =0.001) (Figure). There were no
significant differences were observed in other comparisons in TR
recurrence. <br/>Conclusion(s): Our network meta-analysis demonstrated
significant reduction in TR recurrence for rigid ring TAP compared to
Suture TAP. However, there was no significant mortality difference among
suture, flexible band, and rigid ring TAP.

<59>
[Use Link to view the full text]
Accession Number
634381405
Title
Network Meta-analysis of Randomized Controlled Trials for Graft Patency of
a Second Conduit for Coronary Artery Bypass Surgery.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: 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),
and saphenous vein (SVG) as a second conduit in CABG. <br/>Method(s):
MEDLINE and EMBASE were searched through February 8th, 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 (IRR) of the outcome. <br/>Result(s): A total of 11 RCTs were
identified, including 3,434 patients and 2,171 angiographic results. There
was no significant difference of IRR in graft failure among the 4 groups
(vs. SVG: RA, IRR [95%CI] =0.66 [0.41-1.07]; RGEA, IRR [95% CI] =2.12
[0.54-8.38]; RITA, IRR [95% CI] =0.71 [0.32-1.60]). (Figure) Sensitivity
analyses restricting trials with >=3 years angiographic follow-up time or
>=5 years angiographic follow-up time showed no significant differences of
IRR in graft failure among the four groups in both analyses.
<br/>Conclusion(s): In a network meta-analysis of the updated outcomes
from RCTs, no significant differences were observed in graft patency with
the use of RA, RITA, RGEA or SVG as a second conduit in CABG.

<60>
[Use Link to view the full text]
Accession Number
634381296
Title
Reduction with Evolocumab in Complex Coronary Disease Requiring
Revascularization: Insights from the FOURIER Trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Oyama K.; Furtado R.; Fagundes A.; Zelniker T.A.; Tang M.; Kuder J.;
Murphy S.A.; Hamer A.; Wang H.; Keech A.C.; Pedersen T.R.; Giugliano R.;
Sabatine M.S.; Bergmark B.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Although PCSK9 inhibitors induce plaque regression and
reduce the risk of coronary revascularization overall, their ability to
specifically reduce the risk of complex coronary atherosclerosis requiring
revascularization has not been explored. <br/>Method(s): FOURIER was a
randomized trial of the PCSK9 inhibitor evolocumab vs. placebo in 27,564
patients with ASCVD on statin therapy (median achieved LDL-C 32 mg/dL vs.
89 mg/dL) followed for a median of 2.2 years. The study database was
blindly reviewed to assess characteristics of coronary revascularization
procedures. Complex revascularization was the composite of complex PCI
(per GLOBAL LEADERS criteria, at least one of: multivessel PCI, 3 or more
stents implanted, 3 or more lesions treated, bifurcation PCI with 2 or
more stents, or total stent length >60 mm) or CABG. PCI complications
included no-reflow, side branch loss, thrombus formation, major
dissection, or perforation. The effects of evolocumab on types of
revascularization and PCI complications were evaluated using Cox
proportional hazards models. <br/>Result(s): 1724 patients underwent
revascularization procedures during follow-up. Evolocumab reduced the risk
of non-complex PCI by 22% (HR 0.78; 95%CI 0.70-0.88; P<0.001) and the risk
of complex revascularization by 29% (HR 0.71; 95%CI 0.61-0.84; P<0.001),
including complex PCI by 33% (HR 0.67; 95%CI 0.54-0.84; P<0.001) and CABG
by 24% (HR 0.76; 95%CI 0.60-0.96; P=0.019; Figure). The incidence of
reported PCI complications tended to be lower with evolocumab (HR 0.74;
95% CI 0.49-1.11). <br/>Conclusion(s): Adding evolocumab to statin therapy
reduced the risk of developing complex coronary disease requiring
revascularization, including complex PCI and CABG individually. Together
with prior coronary imaging findings, these data suggest very aggressive
LDL-C lowering to <1 mmol/L has beneficial effects on coronary
atherosclerosis burden, anatomical complexity, and the need for
intervention.

<61>
Accession Number
634381292
Title
Impact of Revascularization Strategy on the Prognosis of Young and
Middle-aged Patients with Coronary Artery Disease.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Jin C.; Liu X.; Wang Y.; Qiu H.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Despite increasing incidence and mortality of CAD among
young and mid-age patients (age <= 65), the optimum revascularization
strategy remains unclear. We compared outcomes of PCI and CABG in this
patient group. <br/>Method(s): "Coronary artery bypass" and "percutaneous
coronary intervention" were used to identify articles in PubMed and
Cochrane database published prior to February 2, 2020. Both RCTs and
observational studies (OSs) comparing PCI and CABG with data of patients
or subgroups patients <= 65 years of age were included. The quality of
study data was assessed by RoB2 and Newcastle-Ottawa Scale (NOS). The
primary end point was all-cause mortality. Secondary endpoint includes MI,
stroke, repeat revascularization (RR), and a composite endpoint of major
adverse cardiac cerebral events (MACCE). We calculated odds ratio using
Mantel-Haenszel method with random effects. <br/>Result(s): A total of 10
RCTs and 20 OSs with 31226 CAD patients were included in our analysis, of
which 1 RCT and 4 OSs focused on population <= 65 years old while the rest
provided subgroup data. The risk of bias RCTs were low to middle, and
quality ratings of OSs were 4-8 by NOS. Compared to CABG, PCI was
associated with a higher risk of mortality (OR 1.42, 95% CI 1.24-1.62,
P<0.001), MACCE (OR 1.99, P<0.001), MI (OR 2.13, P = 0.011), and RR (OR
3.88, P<0.001). The risk of stroke is similar in both groups (OR 0.883, P=
0.506). However, after stratification, mortality rate is similar in
studies with follow-up period <= 3 years. (OR 1.27, P=0.255) but remain
significant with longer follow-up (OR 1.41, P<0.001). <br/>Conclusion(s):
Compared to PCI, CABG is associated with lower all-cause mortality in
young and middle-aged CAD patients, especially with long follow-up
indicating superior long-term survival. Given the longer life-expectancy
in this age group, the advantage of CABG is even more prominent. However,
given the retrospective nature of this study, dedicated RCT is needed to
further address this question.

<62>
[Use Link to view the full text]
Accession Number
634381231
Title
Meta-analysis of Dual Antiplatelet Theraphyversus Single Antiplatelet
Theraphyafter Transcatheter Aortic Valve Implatation A Popular Forecast.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Costa G.; Goncalves L.; Teixeira R.P.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite improving experience and techniques, ischemic and
bleeding complications after transcatheter aortic valve implantation
(TAVI) remain prevalent and affect survival. Recent guidelines recommend
dual antiplatelet therapy (DAPT) in the initial period after TAVI.
Explorative studies have suggested DAPT is associated with higher rate of
major bleeding without a decrease in thromboembolic complications.
<br/>Purpose(s): To compare DAPT (aspirin plus clopidogrel) versus single
antiplatelet therapy (SAPT) (as aspirin) alone as antithrombotic treatment
following TAVI for the prevention of cerebrovascular events, bleeding
events and all-cause death. <br/>Method(s): We systematically searched
PubMed, Embase and Cochrane databases, in April 2020, for both
interventional or observational studies comparing DAPT with (SAPT)
following TAVI. Random-effects and meta-analysis for DAPT and SAPT were
performed. <br/>Result(s): Nine studies were included (six registry-based
or unrandomized studies and three randomized clinical trials) providing a
total of 19389 patients, and 631 pooled stroke or transient ischemic
attack. There was no statistically difference between DAPT and SAPT for
the prevention of cerebrovascular events after TAVI (pooled OR 1.04 [0.85,
1.26], P=0.04, I²= 0%). Similarly, there was a similar rate of
all-cause mortality (pooled OR 1.07 [0.81, 1.42], P=0.33, I2= 50%).
Furthermore, the rate of major bleeding or life-threatening events was
significantly higher for the DAPT compared with SAPT group (pooled OR 1.46
[1.19, 1.78], P<0.01, I²= 79%), although with a considerable
amount of heterogeneity between studies in the magnitude of effect.
<br/>Conclusion(s): Our pooled data suggests that after TAVI, the clinical
benefit of DAPT compared to SAPT is questionable. The POPular-TAVI trial
Cohort A is expected to clarify this research question during 2020.

<63>
[Use Link to view the full text]
Accession Number
634381227
Title
Antithrombotic Therapy after Transcatheter Aortic Valve Implantation in
Patients with Concomitant Indications for Long-term Oral Anticoagulation:
A Systemic Review and Meta-analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Costa G.; Goncalves L.; Teixeira R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Ischemic and bleeding complications after transcatheter aortic
valve implantation (TAVI) remain prevalent and affect survival. Atrial
fibrillation (AF) is common in patients undergoing TAVI and constitutes an
indication for long-term oral anticoagulation (OAC). Current guidelines on
antithrombotic treatment in patients who have an indication for OAC after
TAVI are based on expert opinion and suggest the use of vitamin K
antagonist (VKA) either alone or in combination with aspirin or
clopidogrel. <br/>Purpose(s): To compare OAC (VKA or direct oral
anticoagulant) versus OAC in combination with single antiplatelet therapy
(SAPT), either aspirin or clopidogrel, as antithrombotic treatment
following TAVI in patients with an indication for long-term OAC or the
prevention of cerebrovascular events, bleeding events and all-cause
mortality. <br/>Method(s): We systematically searched PubMed, Embase and
Cochrane databases, in April 2020, for both interventional or
observational studies comparing OAC with OAC plus SAPT. Random-effects
meta-analysis for OAC and OAC combined with SAPT were performed.
<br/>Result(s): Four studies were included (three registry-based and one
randomized clinical trial) providing a total of 1218 patients, and 69
pooled cerebrovascular events. There was no statistical difference between
OAC and OAC plus SAPT for the prevention of cerebrovascular events after
TAVI (pooled OR 0.89 [0.51, 1.55], P=0.69, I²= 0%) - Figure.
Similarly, there was a similar rate of all-cause mortality (pooled OR 0.98
[0.72, 1.35], P=0.91, I²= 0%). Furthermore, the rate of major
bleeding or life-threatening events was significantly lower for OAC
compared with the combined therapy (pooled OR 0.45 [0.29, 0.70], P<0.01,
I2= 5%). <br/>Conclusion(s): Our pooled data suggests that for patients
with indication for long-term oral anticoagulation after TAVI, the routine
use of double anti-thrombotic therapy (SAPT+OAC) compared to the use of
OAC, conferred an increased risk of bleeding.

<64>
Accession Number
634381224
Title
Icosapent Ethyl Reduces Ischemic Events in Patients with Prior Coronary
Artery Bypass Grafting: REDUCE-IT CABG.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Verma S.; Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.;
Ketchum S.; Juliano R.; Jiao L.; Doyle R.; Granowitz C.; Gibson C.M.;
Pinto D.S.; Giugliano R.P.; Budoff M.J.; Mason P.P.; Tardif J.-C.;
Ballantyne C.M.; Zenati M.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with a prior history of coronary artery bypass
grafting (CABG) are at high risk for future ischemic events despite statin
therapy. <br/>Method(s): REDUCE-IT, a multicenter, double-blind,
placebo-controlled trial, randomized statin-treated patients with elevated
triglycerides (135-499 mg/dL), controlled LDL (41-100 mg/dL), and either
established cardiovascular disease or diabetes plus other risk factors to
receive icosapent ethyl 4g daily or placebo. In the overall trial, the
primary composite endpoint (cardiovascular death, myocardial infarction,
stroke, coronary revascularization, hospitalization for unstable angina)
and the key secondary composite endpoint (cardiovascular death, myocardial
infarction, stroke) were significantly reduced. Here we examine the
subgroup of patients with a history of CABG. <br/>Result(s): A total of
8,179 randomized patients were followed for 4.9 years (median), 1837
(22.5%) of whom had a prior CABG, with a median of 5.1 years (0.7 months
to 33.3 years) from CABG to randomization (in the 1263 patients who had
the date of CABG recorded). The rate of the primary endpoint was reduced
by 24% [22.0% with icosapent ethyl versus 28.2% with placebo (hazard ratio
[HR]=0.76; 95% confidence interval [CI], 0.63-0.92; p=0.004; number needed
to treat [NNT]=16)]. The rate of the key secondary endpoint was reduced by
31%: [14.7% with icosapent ethyl versus 20.7% with placebo (HR=0.69; 95%
CI, 0.56-0.87; p=0.001; NNT=17)]. <br/>Conclusion(s): In statin-treated
patients with a history of prior CABG, the addition of icosapent ethyl
significantly reduced ischemic events, with both large relative and
absolute risk reductions.

<65>
Accession Number
634381004
Title
Efficacy of Lowering Low-density Lipoprotein Cholesterol in Elderly
Subjects: A Systematic Review and Metaanalysis of Randomized Controlled
Trials.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Gencer B.; Marston N.A.; Im K.; Sever P.S.; Keech A.C.; Giugliano R.;
Sabatine M.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The clinical benefit from LDL-C lowering therapy in the
elderly remains debated. <br/>Aim(s): To synthesize the efficacy of
lowering LDL-C in patients aged >=75 years in the light of most recently
published data. <br/>Method(s): Medline database was searched for the most
recent evidence (2015-2020). The key inclusion criterion was a randomized
controlled cardiovascular outcome trial testing an LDL-C lowering therapy
with data available in patients aged >=75 years at randomization. For
efficacy, we meta-analyzed the risk ratio (RR) of major vascular events (a
composite of cardiovascular (CV) death, myocardial infarction, stroke or
coronary revascularization) per 1-mmol/L reduction in LDL-C.
<br/>Result(s): Among 244,090 patients from 29 trials, 21,492 (8.8%) were
elderly; 11,750 from statin trials, 6209 from ezetimibe trials, and 3533
from PCSK9 inhibitor trials. Median follow-up ranged from 2.2-6.0 years.
LDL-C lowering therapy significantly reduced major vascular events
(n=3519) in the elderly by 26% per 1-mmol/L LDL-C reduction (RR 0.74
[0.61-0.89], P=0.002), which was at least as good as the magnitude of
effect seen in the non-elderly patients (RR 0.85 [0.78-0.92];
Pinteraction=0.24). Amongst the elderly, the RR was similar for statin
(0.81 [0.70-0.94]) and non-statin therapy (0.67 [0.47-0.95];
P<inf>in</inf>t<inf>era</inf>ction=0.60). The benefit of LDL-C lowering in
the elderly was observed for each component of the composite, including CV
death (RR 0.85 [0.73-0.996], P=0.045), myocardial infraction (RR 0.80
[0.70-0.92], P=0.001), stroke (RR 0.71 [0.58-0.87], P=0.001) and coronary
revascularization (RR 0.78 [0.63-0.96], P=0.017). <br/>Conclusion(s): In
patients 75 years and older, lipid-lowering therapy is as effective in
reducing CV events as it is in younger adults. These results should
strengthen guideline recommendations for the use of lipid-lowering
therapies, including non-statin therapy, in the elderly.

<66>
Accession Number
634380857
Title
Initial Revascularization in Chronic Coronary Syndromes with Myocardial
Ischemia.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Soares A.; Boden W.E.; Hueb W.; Brooks M.M.; Vlachos H.A.; Hardi A.; Brown
D.L.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Ischemic heart disease is the leading cause of death
worldwide. It is unknown whether initial revascularization using
percutaneous coronary intervention (PCI) or coronary artery bypass graft
surgery (CABG) plus optimal medical therapy (OMT) in patients with chronic
coronary syndromes (CCS), obstructive coronary artery disease (CAD) and
myocardial ischemia improves hard clinical outcomes compared to OMT
alone.Hypothesis: In CCS patients with obstructive CAD and documented
myocardial ischemia, initial revascularization plus OMT does not reduce
death or nonfatal myocardial infarction (MI) compared to OMT alone.
<br/>Method(s): We searched Ovid Medline, Embase, Scopus, and Cochrane
Library databases from inception to March 2020 for randomized controlled
trials (RCTs) of PCI or CABG and OMT vs OMT alone for CCS patients in whom
stents and statins were used in more than 50% of patients. Random-effects
models were used to estimate average treatment effects across trials. The
co-primary outcomes were all-cause death and nonfatal MI at 5 years.
<br/>Result(s): Six RCTs were identified that randomized 10,020 CCS
patients. At 5 years, among 5,025 CCS patients assigned to
revascularization plus OMT, there were 492 deaths (9.8%) compared to 482
deaths among 4,995 patients (9.6%) assigned to OMT (OR, 1.01, 95% CI:
0.88-1.16; P=0.87). There were 521 nonfatal MIs (10.3%) in those assigned
to revascularization plus OMT compared with 593 MIs (11.9%) in those
assigned to OMT arms (OR, 0.78, 95% CI: 0.58-1.05; P=0.10). In subgroup
analysis, nonfatal MI was not reduced by PCI plus OMT (OR, 0.95, 95% CI:
0.74-1.23, P=0.71) but was significantly reduced in studies of CABG plus
OMT compared to OMT alone (OR, 0.38, 95% CI: 0.23-0.64, P<0.001). The
overall effect of CABG on reducing nonfatal MI was significantly greater
than that of PCI (P=0.002). <br/>Conclusion(s): In patients with CCS and
myocardial ischemia, initial revascularization with PCI or CABG plus OMT
was not associated with a reduction in death at 5 years compared to OMT
alone. CABG plus OMT reduced nonfatal MI compared to OMT alone whereas PCI
did not. These findings suggest important differences in MI outcomes
between those who undergo CABG vs. PCI, but no overall difference in
mortality compared with OMT alone.

<67>
Accession Number
634380234
Title
Peri-Procedural and 45-Day Outcomes in the Roll-In Cohort of the Amplatzer
Amulet Ide Trial of Left Atrial Appendage Occlusion.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Gopinathannair R.; Koerber S.M.; Akella K.; Lakkireddy D.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The Amulet IDE trial is an ongoing, randomized, worldwide
trial, enrolled but following patients with non-valvular atrial
fibrillation (AF) at high risk of stroke. The study is comparing the
safety and effectiveness of the AmplatzerTM AmuletTM left atrial appendage
(LAA) Occluder to the Watchman device. At US sites, the implanting
physicians only had experience with the Watchman device; therefore, up to
three roll-in subjects with Amplatzer Amulet device implantation were
permitted prior to randomization. The purpose of this analysis is to
describe the peri-procedural outcomes for the roll-in cohort.
<br/>Method(s): Roll-in subjects met the same eligibility criteria and
have the same data collection requirements as randomized subjects. Adverse
events were adjudicated by an independent clinical events committee and
LAA occlusion was assessed by an independent core laboratory based on the
45-day TEE. Major adverse events included all cause death, ischemic
stroke, systemic embolism or device-/procedure-related events requiring
open cardiac surgery or major endovascular intervention within 7 days post
implant or hospital discharge, whichever is later. <br/>Result(s): From
August 2016 to November 2018, 201 patients with non-valvular AF at high
risk of stroke and bleeding were enrolled at 82 sites as roll-in subjects.
Mean age was 74.2 +/- 7.5 years and 62% of subjects were male. The
Amplatzer Amulet device was successfully deployed in 99% of subjects.
Major adverse events within 7 days or hospital discharge occurred in 2.5%
of patients and included death (n=3), ischemic stroke (n=1) and vascular
access site bleeding (n=1). The majority (79%) of patients were discharged
on antiplatelet therapy only or no anti-thrombotic medication. TEE
follow-up at the 45-day visit revealed adequate (<= 5 mm jet) occlusion of
the appendage in 98.9% (178/180) of patients. Device-related thrombus
(DRT) was identified by the core laboratory in 6 patients (3%); no patient
experienced a thrombo-embolic event. <br/>Conclusion(s): In the roll-in
cohort, with implanting physicians having no prior experience using the
AmplatzerTM AmuletTM device, there was a low rate of procedural
complications and high rates of both implant success and adequate LAA
sealing at follow up.

<68>
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Accession Number
634380061
Title
Intraoperative Nicardipine Use during Rewarming in Norwood Procedures.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Parchment N.; Holmes S.D.; Kahntroff S.; Niemiec T.; Savarese A.; Donahue
B.; Chaves A.; Rosenthal G.L.; Deatrick K.B.; Kaushal S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Postoperative tissue edema Norwood procedures contributes
significantly to outcomes. As nicardipine preserves ventricular function
after hypothermic ischemic arrest, nicardipine treatment could support
post-Norwood ventricular function, and decrease edema to improve patient
outcomes. <br/>Method(s): All Norwood procedures completed at a single
institute between 1/1/2012 - 12/31/2019 were retrospectively reviewed, and
the use of nicardipine during rewarming was initiated midway through the
study period. We investigated the effects of nicardipine during rewarming
on 12-month postoperative mortality, postoperative intubation times, open
chest duration, and disposition at discharge. <br/>Result(s): Thirty-six
Norwood procedures were completed, of whom 14 received nicardipine
intraoperatively during the rewarming period. The nicardipine group
demonstrated significantly lower 12-month postoperative mortality (0% vs
32%, p-value: 0.028) and significantly greater discharges to home (64% vs
18%, p-value: 0.005). The nicardipine group had lower median length of
postoperative intubation (123 vs 146 hrs, p-value: 0.311) and open sternum
time (2 [1-3] vs 3 [2-5] days, p-value: 0.067), but these analyses did not
reach statistical significance (Fig 1). <br/>Conclusion(s): This study
demonstrates the safety of nicardipine treatment during Norwood and
significant decrease 12-month mortality and increase in discharge to home,
with potential for reduced post-Norwood intubation and open sternum times.
This study provides the basis for a prospective randomized controlled
trial to demonstrate survival benefit provided by intraoperative
nicardipine usage during Norwoods.

<69>
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Accession Number
634380053
Title
Population Characteristics and Outcomes of Patients with Constrictive
Pericarditis Undergoing Pericardiectomy in the Contemporary Era: A
Systematic Review and Metaanalysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Tzani A.; Doulamis I.P.; Tzoumas A.; Avgerinos D.V.; Kampaktsis P.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Studies have described the changing landscape of patients
with constrictive pericarditis (CP) in the modern era, however no
systematic review or meta-analysis has been performed. <br/>Method(s): We
systematically searched the MEDLINE, Embase and Cochrane databases from
their inception to April 1, 2020 for studies assessing the characteristics
and outcomes patients with CP undergoing pericardiectomy. A metaanalysis
was performed to assess the impact of CP etiology on outcomes.
<br/>Result(s): We analyzed 27 eligible studies and 2114 patients.
Etiology was most commonly idiopathic (50.2%), post-cardiac surgery
(26.2%) and radiation (6.9%)(Figure 1A-B). Patients were mostly men (76%),
with a mean age of 58 years and with advanced symptoms (NYHA III/IV
70.1%). Total pericardiectomy was preferred (85.8%) (Figure 1C-D) and
concomitant cardiac surgery was relatively common (23.8%). Operative
mortality was 6.9% and 5-year mortality was 32.7% (Table 1). Radiation and
post-cardiac surgery patients had higher long-term risk for mortality
respectively compared to idiopathic pericarditis (HR: 2.15; 95% CI:
1.21-1.36, p=.01 and HR: 3.21; 95% CI: 1.56-6.50, p<01, respectively).
Thirty percent of included studies had more than low bias. A sensitivity
analysis did not result in changes in the results. <br/>Conclusion(s):
Pericardiectomy is performed mostly in middle-aged men with advanced
symptoms and low comorbidity burden and still carries a significant
operative mortality. Radiation and post-cardiac surgery patients have a
significantly higher risk compared to idiopathic. Several methodological
issues and significant heterogeneity limit the generalization of these
data.

<70>
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Accession Number
634380024
Title
Pericardial Tamponade in Patients with Influenza Infection: A Systematic
Review of Published Cases.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Desai R.; Raina J.S.; Itare V.; Jain A.; Singh S.; Bhuva R.; Malik F.A.;
Shah V.; Hassan F.A.; Sachdeva R.; Kumar G.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Literature reported cardiac tamponade in patients with
influenza virus infection, which incited us to understand patient-level
demographics, courses and outcomes. <br/>Method(s): Systematic literature
search was performed until May 2020 to review post-influenza cardiac
tamponade cases. <br/>Result(s): Twenty five publications reported 28
patients (M:F::12:15, age range: 4-69 yrs, 9 pediatric) who had
post-influenza cardiac tamponade as shown in Table 1. Nine (32.1%)
patients had dyspnea and 7 (25%) had chest pain. Onset of tamponade after
flu ranged from 1 day-6 weeks. 22 (78.5%) and 3 (10.7%) were infected with
Influenza A and B strains respectively. Troponin-T (n=7) ranged from 0.03
ng/dL-10.50 ng/dL. Twelve (42.8%) patients were treated with influenza
therapy; 8 (28.5%) with Pseltamivir, 2 (7.1%) with Oseltamivir followed by
Peramivir, 1 (3.5%) with Zanamivir, 1 (3.5%) with Zanamivir followed by
Peramivir. Pericardiocentesis was done in 25 (89.2%) patients. Seventeen
(57.1%) patients required mechanical circulatory/respiratory support: 13
intubations, 3 ECMO, 2 CPR, 1 external defibrillation and 1 noninvasive
ventilation. Twenty-three (82.1%) patients recovered while 4 (14.2%)
patients died. <br/>Conclusion(s): This systematic review of patient-level
data showed high recovery rate with early diagnosis and timely
pericardiocentesis and nearly 14% of mortality rate.

<71>
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Accession Number
634379724
Title
Network Meta-analysis of Duration of Antiplatelet Therapy Following
Transcatheter Aortic Valve Replacement.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Yokoyama Y.; Kuno T.; Briasoulis A.; Mori M.; Iwagami M.; Takagi H.;
Bangalore S.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although current guidelines recommend dual antiplatelet
therapy (DAPT) for 3 to 6 months following transcatheter aortic valve
replacement (TAVR), there are no studies directly comparing outcomes of
different durations of DAPT following TAVR. <br/>Method(s): Pubmed and
EMBASE were searched through May 2020 to identify clinical studies that
investigated single antiplatelet therapy (SAPT) versus DAPT use following
TAVR. Studies using oral anticoagulants and antiplatelet therapy
concomitantly were excluded. The DAPT group was subdivided by the duration
of DAPT. We extracted the risk ratios (RRs) of major or life-threatening
bleeding, stroke, and all-cause mortality. <br/>Result(s): Three
randomized controlled trials, two propensity-score matched studies, and
one observational study were identified, yielding a total of 1,833
patients who underwent TAVR assigned to the SAPT group (n=918), 3-month
DAPT group (n=151), or 6-month DAPT group (N=764). Pooled analyses
demonstrated that the rates of major or life-threatening bleeding were
significantly higher in the 6-month DAPT group compared with the SAPT
group (RR [95% CI] =2.54 [1.49-4.33], P =0.007) while no such difference
was observed between the SAPT vs. 3-month DAPT groups or the 3-month DAPT
vs. 6-month DAPT groups (Figure). P-scores were 98.1% (SAPT), 32.3%
(3-month DAPT), and 19.6% (6-month DAPT). The rates of stroke and
all-cause mortality were similar among the groups. <br/>Conclusion(s): In
our network meta-analysis, we observed that DAPT for 6 months following
TAVR was associated with increased risk of bleeding without decreasing the
risk of stroke compared with SAPT, while there was no difference between
DAPT for 3 months and 6 months.

<72>
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Accession Number
634379521
Title
A Meta-Analysis of Early versus Delayed Revascularization among Patients
with Non-st-segment Elevation Myocardial Infarction.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Faisaluddin M.; Thakkar S.J.; Kumar A.; Alweis R.; Barssoum K.; Mohammed
Y.N.; Patel H.P.; Patel R.; Doshi R.P.; Arora S.; Panaich S.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Several randomized control trials (RCTs) have compared early
versus delayed coronary revascularization in non-ST-segment elevation
myocardial infarction (NSTEMI) and have reported contradicting
results.Hypothesis: We performed a meta-analysis of all the available RCTs
to date to determine the best strategy in NSTEMI. <br/>Method(s): We
performed a comprehensive search of PubMed, EMBASE, and Cochrane databases
for all RCTs comparing an early versus delayed revascularization in
NSTEMI. The primary endpoint was all-cause mortality. The secondary
endpoints were re-infarction and refractory ischemia. We used the
Paule-Mandel (PM) estimator of Tau with Knapp-Hartung adjustment to
calculate relative risk (RR) with a 95% confidence interval (CI).
<br/>Result(s): Thirteen RCTs were included in the final analysis. The
median time between randomization and angiography ranged from 0.5 to 14 h
in the early group and 18.3 to 86.0 h in the delayed group. There was no
difference in mortality (5.7% vs 6.6%; RR 0.90; 95% CI 0.78-1.04; p =
0.83) (PANEL A) as well as rate of re-infarction (6.7% vs. 7.7%; RR 0.83;
95% CI 0.10-6.71; p = <0.001) (PANEL B) among both the strategy. However,
early revascularization was associated with a reduction in refractory
ischemia (4.8% vs 7.4%; RR 0.64; 95% CI 0.44-0.94; p=0.002) (PANEL
C)Conclusions: Early revascularization for NSTEMI does not reduce the risk
of mortality or re-infarction compared with delayed revascularization.
Nonetheless, an early invasive approach does decrease the rate of
refractory ischemia in NSTEMI.

<73>
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Accession Number
634379494
Title
Effects of Evolocumab in Patients with Prior Percutaneous Coronary
Intervention: An Analysis from the Fourier Trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Furtado R.H.; Fagundes A.A.; Oyama K.; Zelniker T.A.; Tang M.; Kuder J.F.;
Murphy S.A.; Wang H.; Hammer A.; Keech A.C.; Pedersen T.R.; Giugliano R.;
Sabatine M.S.; Bergmark B.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Among patients with atherosclerotic cardiovascular disease
(ASCVD), those with history of PCI represent an important population for
potential high risk for cardiovascular (CV) events. We examined the
clinical efficacy of the PCSK9 inibitor evolocumab in patients with prior
PCI. <br/>Method(s): FOURIER randomized 27,564 patients with ASCVD on
statin therapy to evolocumab or placebo with a median follow-up of 2.2
yrs. The primary end point (PEP) was the composite of CV death, MI,
stroke, unstable angina, or coronary revascularization; major coronary
events were the composite of coronary death, MI, or coronary
revascularization. The risk of events in patients with and without a
history of PCI were compared in the placebo arm. The clinical benefit of
evolocumab vs. placebo was compared using a Cox proportional hazards
model. <br/>Result(s): 17,073 (62%) patients had prior PCI at baseline.
Among patients in the placebo arm, those with prior PCI (N=8563) had a
1.6x higher rate of the PEP (16.8 vs 10.7%; adjusted HR 1.61; 95% CI
1.42-1.84 P<0.0001) and nearly double the rate of major coronary events
(14.5 vs. 7.8%; P<0.0001; adjusted HR 1.72; 95% CI 1.49-1.99; Figure
left). In patients with prior PCI, evolocumab reduced the risk of the PEP
by 16% (HR 0.84; 95% CI 0.77-0.91; P<0.0001) and of major coronary events
by 18% (HR 0.82; 95% CI 0.75-0.90, P<0.0001; Figure right), including a
30% reduction in fatal or non-fatal MI (P<0.001) and a 24% reduction in
coronary revascularization (P<0.001). After the first year, there was a
25% reduction in major coronary events (HR 0.75, 95% CI 0.66-0.86,
P<0.0001). The absolute risk reduction at 3 years with evolocumab for
major coronary events was 2.8% in patients with prior PCI vs. 0.3% in
those without. <br/>Conclusion(s): In a contemporary cohort with ASCVD on
statin therapy, patients with prior PCI were at heightened risk for
coronary events. Evolocumab was highly effective in this group, reducing
major coronary events by 18% with a NNT at 3 years of only 36.

<74>
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Accession Number
634379403
Title
Using Machine Learning to Improve Survival Prediction after Heart
Transplantation.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Ayers B.; Sandhold T.; Gosev I.; Prasad S.; Kilic A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Prior risk models for predicting survival after orthotopic
heart transplantation (OHT) have displayed only modest discriminatory
capability. With increasing interest in the application of machine
learning (ML) to predictive analytics in clinical medicine, this study
aimed to evaluate whether modern ML techniques could improve risk
prediction in OHT. <br/>Method(s): Data from the United Network for Organ
Sharing registry was collected for all adult patients that underwent OHT
from 2000 through 2019. The primary outcome was one-year post-transplant
mortality. Dimensionality reduction and data re-sampling were employed
during training. The final ensemble model was created from 100 different
models of each algorithm: deep neural network, logistic regression,
adaboost, and random forest. Discriminatory capability was assessed using
area under receiver-operating-characteristic curve (AUROC), net
reclassification index (NRI), and decision curve analysis (DCA).
<br/>Result(s): Of the 33,657 study patients, 26,926 (80%) were randomly
selected for the training set and 6,731 (20%) as a separate testing set.
One-year mortality was balanced between cohorts (11.0% vs 11.3%). The
optimal model performance was a final ensemble ML model. This model
demonstrated an improved AUROC of 0.764 (95% CI, 0.745-0.782) in the
testing set as compared to the other models (Figure). Additionally, the
final model demonstrated an improvement of 72.9% +/-3.8% (p<0.001) in
predictive performance as assessed by NRI compared to logistic regression.
The DCA showed the final ensemble method improved risk prediction across
the entire spectrum of predicted risk as compared to all other models
(p<0.001). <br/>Conclusion(s): An ensemble ML model was able to achieve
greater predictive performance as compared to individual ML models as well
as logistic regression for predicting survival after OHT. This analysis
demonstrates the promise of ML techniques in risk prediction in OHT.

<75>
Accession Number
634379373
Title
Empagliflozin Reduces the Total Burden of Cardiovascular Events Including
Recurrent Events in the EMPA-REG OUTCOME Trial.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Fitchett D.H.; Inzucchi S.E.; Zinman B.; Wanner C.; Anker S.D.; Pocock S.;
Kaspers S.; George J.T.; Johansen O.E.; Jamal W.; Hantel S.; Lund S.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In EMPA-REG OUTCOME, empagliflozin (EMPA) reduced the risk
of major adverse cardiovascular (CV) events (MACE), CV mortality and
hospitalization for heart failure (HHF) in analyses of first events in
patients with type 2 diabetes (T2D) and atherosclerotic CV disease
(ASCVD). We assessed the effect of EMPA on the total burden of CV events.
<br/>Method(s): Patients were randomized to EMPA 10 mg, EMPA 25 mg, or
placebo. We assessed the effects of EMPA pooled vs placebo on any (first
plus recurrent) adjudicated CV event (composite of myocardial infarction
(MI), stroke, coronary revascularization (CR), hospitalization for
unstable angina, transient ischemic attack, HHF, and CV death) using a
negative binomial model. <br/>Result(s): Among 7,020 treated patients
(mean [SD] age 63 [9] years), there were 2,142 total adjudicated CV
events, most frequently CR (585), MI (421), and HHF (321). EMPA reduced
the risk of total adjudicated CV events by 24% vs placebo (event rate
ratio (95% CI): 0.76 (0.67, 0.87), p<0.0001) (Figure). Risk reductions
were driven predominantly by reductions in HHF (0.58 (0.42, 0.81),
p=0.0012), MI (0.79 (0.620, 0.998), p=0.0486), and CV death (0.62 (0.49,
0.77), p<0.0001). The estimated number of total CV events prevented with
EMPA was 414.4, and the number of patients needed to treat over 3 years to
prevent one event was 10.2 (6.6, 22.7). <br/>Conclusion(s): EMPA produced
a sizeable risk reduction in the total burden of any adjudicated CV
outcome, including HHF, MI and CV death, in patients with T2D and ASCVD.

<76>
Accession Number
634379358
Title
Plasma B-type Natriuretic Peptide Levels Are Associated with Future
Cardiovascular Events in Patients with Type 2 Diabetes Mellitus Without
Known Cardiovascular Disease.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Ikeda S.; Shinohara K.; Enzan N.; Matsushima S.; Tohyama T.; Funakoshi K.;
Kishimoto J.; Itoh H.; Komuro I.; Tsutsui H.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: B-type natriuretic peptide (BNP) is known to predict future
cardiovascular (CV) events in patients with known CV disease. However,
these associations have not been investigated in patients with type 2
diabetes mellitus (T2DM) without known CV disease. We investigated whether
BNP levels are associated with CV events among T2DM patients without known
CV disease using the dataset of EMPATHY study.Methods and Results: The
EMPATHY was a randomized controlled trial of intensive statin therapy in
T2DM patients without known CV disease. CV events were defined as
composite of cardiac (acute coronary syndrome and coronary
revascularization [excluding heart failure]), cerebral, and vascular
events. A total of 4704 patients without CV events or death during the
first 12 months were included and 114 CV events occurred during a median
follow-up of 37.8 months. The patients were divided based on quartile of
baseline BNP levels (Q1: <7.4, Q2: 7.4-14.8, Q3: 14.8-28.7, Q4: >=28.7
[pg/mL]). Compared to the lowest quartile of BNP, only the highest
quartile was associated with increased risk for CV events after adjustment
(HR 2.96, 95% CI 1.29-6.79, p=0.010). Using this highest quartile cutoff,
we categorized BNP <28.7 pg/mL as low BNP and BNP >=28.7 pg/mL as high BNP
Compared to patients with low BNP, the adjusted HRs for CV events were
2.12 (95% CI 1.35-3.34, p=0.001) in patients with high BNP at baseline and
2.64 (95% CI 1.67-4.17, p<0.001) in those with high BNP at 12 months. In
analysis using serial measurement, patients who had repeatedly high BNP or
had low BNP at baseline and high BNP at 12 months were in significantly
higher risk for CV events compared to those who had repeatedly low BNP (HR
3.28, 95% CI 1.90-5.66, p<0.001 or HR 2.65, 95% CI 1.44-4.87, p=0.002,
respectively), whereas those who had high BNP at baseline and low BNP at
12 months were not (HR 1.99, 95% CI 0.90-4.39, p=0.089).
<br/>Conclusion(s): Increased BNP levels were associated with higher risk
of CV events (excluding heart failure) in T2DM patients without known CV
disease. HR for CV events was greater in patients with repeatedly high BNP
than in those with high BNP at only one of the two measurements,
suggesting that serial BNP measurement may be more useful for predicting
future CV events in T2DM patients.

<77>
Accession Number
634379356
Title
Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention
in Patients Presenting with Acute Coronary Syndrome with Culprit
Unprotected Left Main Artery.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Barssoum K.; Kumar A.; Rai D.; Kharsa A.; Chowdhury M.; Thakkar S.J.; Rao
M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Outcomes of coronary artery bypass grafting (CABG) versus (vs)
percutaneous coronary intervention (PCI) in patients presenting with acute
coronary syndromes (ACS) with unprotected left main (ULM) as culprit
vessel are not well represented in major clinical trials. We performed a
meta-analysis and meta-regression of studies that compared the outcomes of
CABG vs PCI in ULM in ACS. <br/>Method(s): Medline, EmCare, CINHAL,
Cochrane database, and Google Scholar were searched for studies comparing
CABG vs PCI in patients who presented with ACS and was found to have ULM
as culprit vessel. Our primary outcome was mortality at longest follow up.
Our secondary Outcome was repeat revascularization at longest follow up.
We used PM method with HKSJ adjustment to estimate risk ratio (RR) with
95% confidence interval (CI). Heterogeneity was assessed using
I² statistics. Multivariable meta-regression analysis was used
to account for heterogeneity. History of smoking, diabetes, hypertension
and previous PCI was used for multivariable regression. R version 3.6.2
was used for all statistical analysis. <br/>Result(s): A total of 8
studies met our inclusion criteria. The follow up period varied from 6
months to 10 years. There was no significant difference in the risk of
mortality between CABG vs PCI; RR: 1.31, CI: 0.76 - 2.27, I²=
71%. However, the PCI as compared to CABG was associated with higher risk
repeat revascularization at longest follow up; RR: 2.64, 95% CI: 1.56 to
4.46, I²= 60%. Meta-regression analysis reported previous PCI
to be associated with lower mortality with CABG [P value =0.01], while
history of diabetes was associated with higher mortality with CABG [P
value <0.001]. <br/>Conclusion(s): CABG vs PCI in ULM in ACS is associated
with similar risk of mortality. Previous PCI and non-diabetics were
associated with higher mortality with PCI as compared to CABG. However PCI
as compared to CABG was associated with higher risk of repeat
revascularizations.

<78>
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Accession Number
634379339
Title
Thirty Days Major Adverse Cardiac Events Following Percutaneous Coronary
Intervention Versus Coronary Artery Bypass Grafting in Non-ste-acute
Coronary Syndrome: A Meta-analysis with Meta-regression.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Barssoum K.; Kumar A.; Rai D.; Kharsa A.; Chowdhury M.; Thakkar S.J.;
Tahir M.W.; Rao M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimum revascularization modality in multi-vessel and
left main disease patients presenting with non-ST elevation acute coronary
syndrome (non-STE-ACS) is not well studied. The current recommendations
are based on studies that primarily included patients with stable angina.
Patients with non-STE-ACS were under-represented in clinical trials. We
performed a meta-analysis of studies comparing coronary artery bypass
grafting (CABG) vs. percutaneous coronary intervention (PCI) in
non-STE-ACS, and reporting 30 days major adverse cardiac events (MACE).
<br/>Method(s): We searched Medline, EmCare, CINAHL, Cochrane database,
and Google Scholar for relevant articles. We excluded studies that
included patients with stable coronary artery disease and ST elevation
myocardial infarction. Our primary outcome was 30 days MACE defined as
all-cause death, stroke, repeat revascularization and re-infarction. We
used the Paule-Mandel method with the Hartung-Knapp-Sidik-Jonkman
adjustment to estimate risk ratio (RR) with a 95% confidence interval
(CI). Heterogeneity was assessed using Higgin's I² statistics.
To account for heterogeneity a meta-regression analysis was performed.
<br/>Result(s): Five observational studies met our inclusion criteria
summing to a total number of 7161 patients. At 30 days, there was no
difference between CABG vs. PCI in terms of MACE, RR: 0.96, 95% CI 0.38 to
2.39, I²= 81% (Panel A). A meta-regression analysis reported
that a history of PCI was associated with a lower risk of MACE with CABG
compared to PCI (Panel B). <br/>Conclusion(s): At 30 days, there was no
difference in MACE between the CABG and PCI groups. However, a history of
PCI was associated with a lower risk of MACE in patients who underwent
CABG.

<79>
Accession Number
634379330
Title
Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous
Coronary Intervention in Patients with Non-st Elevation Acute Coronary
Syndrome.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Barssoum K.; Kumar A.; Rai D.; Kharsa A.; Chowdhury M.; Elkaryoni A.;
Thakkar S.J.; Tahir M.W.; Rao M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Long term outcomes of culprit multi-vessel and left main
patients who presented with Non-ST Elevation Acute Coronary Syndrome
(NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) are not well defined. Randomized
trials comparing the two modalities constituted mainly of patients with
stable coronary artery disease (SCAD). We performed a meta-analysis of
studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS.
<br/>Method(s): Medline, EmCare, CINAHL, Cochrane databases were queried
for relevant articles. Studies that included patients with SCAD and
ST-elevation myocardial infarction were excluded. Our primary outcome was
major adverse cardiac events (MACE) at 3-5 years, defined as a composite
of all-cause mortality, stroke, re-infarction and repeat
revascularization. The secondary outcome was re-infarction at 3 to 5
years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman
adjustment to estimate risk ratio (RR) with 95% confidence interval (CI).
Heterogeneity was assessed using Higgin's I2 statistics. All statistical
analysis was carried out using R version 3.6.2Results: Four observational
studies met our inclusion criteria with a total number of 6695 patients.
At 3 to 5 years, the PCI group was associated with a higher risk of MACE
as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I²=0%
(PANEL A). The PCI group also had a higher risk of re-infarctions during
the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I²=0%
(PANEL B). <br/>Conclusion(s): In this meta-analysis, CABG was associated
with a lower risk of MACE and re-infarctions as compared to PCI during 3
to 5 years follow up period.

<80>
Accession Number
2011221270
Title
Cardiovascular mortality and morbidity in patients undergoing percutaneous
coronary intervention after out-of-hospital cardiac arrest: A systematic
review and meta-analysis.
Source
EuroIntervention. 16 (15) (pp E1245-E1253), 2021. Date of Publication:
2021.
Author
Spirito A.; Gargiulo G.; Siontis G.C.M.; Mitsis A.; Billinger M.;
Windecker S.; Valgimigli M.
Institution
(Spirito, Gargiulo, Siontis, Mitsis, Billinger, Windecker, Valgimigli)
Department of Cardiology, Inselspital, Bern University Hospital, Bern,
Switzerland
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Valgimigli) Cardiocentro Ticino, Lugano, Switzerland
Publisher
Europa Group
Abstract
Aims: The aim of this meta-analysis was to appraise the burden of
cardiovascular mortality and morbidity among patients undergoing
percutaneous coronary intervention (PCI) after out-of-hospital cardiac
arrest (OHCA). <br/>Methods and Results: This was a meta-analysis of
studies assessing the cardiovascular mortality or at least one other
pre-defined outcome in OHCA patients undergoing PCI. Forty-nine studies
with a total of 301,902 patients (73,634 OHCA and 228,268 non-OHCA
patients) were included. Compared to non-OHCA patients, all-cause
mortality was higher in OHCA patients (29% vs 4%). The cause of 39% of
deaths among OHCA patients was cardiovascular: PCI was more frequently
unsuccessful (9.2% vs 7.6%) and there were higher rates of stent
thrombosis (2.9% vs 0.8%), myocardial infarction (1.7% vs 1.4%), relevant
bleeding (10.2% vs 2.1%) and stroke (1.7% vs 0.5%). OHCA patients compared
to non-OHCA patients had a higher risk of all-cause mortality (risk ratio
[RR] 6.4, 95% CI: 5.5-7.4), cardiovascular death (4.6, 1.1-19),
unsuccessful coronary revascularisation (1.4, 1.1-1.7), stent thrombosis
(3.8, 0.6-22.7), myocardial infarction (1.4, 1.1-1.7), relevant bleeding
(3.2, 2.5-4.1) and stroke (3.1, 2.3-4.3). <br/>Conclusion(s): Almost one
third of OHCA patients undergoing PCI die and more than one third of the
fatalities are attributable to cardiovascular causes. The burden of
ischaemic and bleeding complications was consistently higher and the
success rates of PCI lower among OHCA as compared to non-OHCA
patients.<br/>Copyright &#xa9; Europa Digital & Publishing 2021. All
rights reserved.

<81>
Accession Number
2010666010
Title
Monitoring the Impact of Aggressive Glycemic Intervention during Critical
Care after Cardiac Surgery with a Glycemic Expert System for
Nurse-Implemented Euglycemia: The MAGIC GENIE Project.
Source
Journal of Diabetes Science and Technology. 15 (2) (pp 251-264), 2021.
Date of Publication: 2021.
Author
Rao R.H.; Perreiah P.L.; Cunningham C.A.
Institution
(Rao, Perreiah, Cunningham) Division of Endocrinology, Medicine Service
Line, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
Publisher
SAGE Publications Inc.
Abstract
A novel, multi-dimensional protocol named GENIE has been in use for
intensive insulin therapy (IIT, target glucose <140 mg/dL) in the surgical
intensive care unit (SICU) after open heart surgery (OHS) at VA Pittsburgh
since 2005. Despite concerns over increased mortality from IIT after the
publication of the NICE-SUGAR Trial, it remains in use, with ongoing
monitoring under the MAGIC GENIE Project showing that GENIE performance
over 12 years (2005-2016) aligns with the current consensus that IIT with
target blood glucose (BG) <140 mg/dL is advisable only if it does not
provoke severe hypoglycemia (SH). Two studies have been conducted to
monitor glucometrics and outcomes during GENIE use in the SICU. One
compares GENIE (n = 382) with a traditional IIT protocol (FORMULA, n =
289) during four years of contemporaneous use (2005-2008). The other
compares GENIE's impact overall (n = 1404) with a cohort of patients who
maintained euglycemia after OHS (euglycemic no-insulin [ENo-I], n = 111)
extending across 12 years (2005-2016). GENIE performed significantly
better than FORMULA during contemporaneous use, maintaining lower
time-averaged glucose, provoking less frequent, severe, prolonged, or
repetitive hypoglycemia, and achieving 50% lower one-year mortality, with
no deaths from mediastinitis (0 of 8 cases vs 4 of 9 on FORMULA). Those
benefits were sustained over the subsequent eight years of exclusive use
in OHS patients, with an overall one-year mortality rate (4.2%) equivalent
to the ENo-I cohort (4.5%). The results of the MAGIC GENIE Project show
that GENIE can maintain tight glycemic control without provoking SH in
patients undergoing OHS, and may be associated with a durable survival
benefit. The results, however, await confirmation in a randomized control
trial.<br/>Copyright &#xa9; 2021 Diabetes Technology Society.

<82>
Accession Number
2006148595
Title
Minimally invasive congenital cardiac surgery: A large volume european
experience.
Source
Congenital Heart Disease. 15 (3) (pp 127-139), 2020. Date of Publication:
2020.
Author
Guariento A.; Doulamis I.P.; Blitzer D.; Cattapan C.; Padalino M.A.; Vida
V.L.
Institution
(Guariento) Labatt Family Heart Centre, Department of Cardiovascular
Surgery, The Hospital for Sick Children, University of Toronto, Toronto
M5G 1X8, Canada
(Guariento, Cattapan, Padalino, Vida) Pediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and
Public Health, University of Padua, Padua 35128, Italy
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Department of Surgery, Harvard Medical School, Boston 02115, United States
(Blitzer) Department of Surgery, Columbia University Medical Center, New
York, NY 10032, United States
Publisher
Tech Science Press
Abstract
Background: In an effort to reduce postoperative trauma and achieve more
cosmetic results, minimally invasive approaches to correct congenital
heart anomalies have been recently proposed and increasingly adopted. Here
we describe our experience for the past 23 years. <br/>Method(s): Patients
who underwent a surgical procedure between February 1996 and March 2019
with a minimally invasive approach for the correction of congenital heart
disease in our center were included in this study. A statistical analysis
was carried out to compare the results of the different minimally invasive
techniques. A meta-analysis was conducted to compare our results in
patients undergoing atrial septal defect repair with those from other
groups. <br/>Result(s): There were 1002 patients included. A midline lower
mini-sternotomy was performed in 45% of patients (n = 455), a right
anterior mini-thoracotomy in 36% (n = 356) and a right lateral
mini-thoracotomy in 19% (n = 191). The procedures were atrial septal
defect repair (n = 575, 57%), ventricular septal defect repair (n = 218,
22%), and correction of atrioventricular defect (n = 82, 8%) or partial
anomalous pulmonary venous return (n = 70, 7%). Post-cardiotomy syndrome
was the most frequent complication (n = 40, 4%). No difference was
observed between the approaches in terms of complications and
peri-operative outcomes, and when these were compared with the results of
other centers. <br/>Conclusion(s): Patients undergoing surgical repair of
congenital heart disease through a minimally invasive approach have
excellent outcomes, regardless of the approach used.<br/>Copyright &#xa9;
2020, Tech Science Press. All rights reserved.

<83>
Accession Number
2010693429
Title
Clinical manifestations and outcomes of coronavirus disease-19 in heart
transplant recipients: a multicentre case series with a systematic review
and meta-analysis.
Source
Transplant International. (no pagination), 2021. Date of Publication:
2021.
Author
Granger C.; Guedeney P.; Arnaud C.; Guendouz S.; Cimadevilla C.; Kerneis
M.; Kerneis C.; Zeitouni M.; Verdonk C.; Legeai C.; Lebreton G.; Leprince
P.; Desire E.; Sorrentino S.; Silvain J.; Montalescot G.; Hazan F.;
Varnous S.; Dorent R.
Institution
(Granger, Guedeney, Kerneis, Zeitouni, Silvain, Montalescot) ACTION Study
Group, INSERM UMRS_1166, Institut de Cardiologie, Pitie Salpetriere,
Assistance Publique-Hopitaux de Paris, Sorbonne Universite, Paris, France
(Arnaud, Cimadevilla, Kerneis, Verdonk, Dorent) Departement de Chirurgie
Cardiaque, Hopital Bichat, Assistance Publique-Hopitaux de Paris,
Universite de Paris, Paris, France
(Guendouz) Departement de Cardiologie, Hopital Henri-Mondor, Assistance
Publique-Hopitaux de Paris, Creteil, France
(Legeai, Dorent) Agence de la Biomedecine, Direction Prelevement Greffe
Organes-Tissus, Saint Denis La Plaine, France
(Lebreton, Leprince, Desire, Hazan, Varnous) Departement de Chirurgie
Cardiaque, Institut de Cardiologie, Pitie Salpetriere Assistance
Publique-Hopitaux de Paris, Sorbonne Universite, Paris, France
(Sorrentino) Division of Cardiology, Department of Medical and Surgical
Sciences, URT National Research Council (CNR), Magna Graecia University,
Catanzaro, Italy
Publisher
Blackwell Publishing Ltd
Abstract
Available data on clinical presentation and mortality of coronavirus
disease-2019 (COVID-19) in heart transplant (HT) recipients remain
limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT
recipients from 3 French heart transplant centres (mean age 54.4 +/- 14.8
years; 66.7% males). Hospital admission was required for 35 (89.7%) cases
including 14/39 (35.9%) cases being admitted in intensive care unit.
Immunosuppressive medications were reduced or discontinued in 74.4% of the
patients. After a median follow-up of 54 (19-80) days, death and death or
need for mechanical ventilation occurred in 25.6% and 33.3% of patients,
respectively. Elevated C-reactive protein and lung involvement >=50% on
chest computed tomography (CT) at admission were associated with an
increased risk of death or need for mechanical ventilation. Mortality rate
from March to June in the entire 3-centre HT recipient cohort was 56%
higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P =
0.15). In a meta-analysis including 4 studies, pre-existing diabetes
mellitus (OR 3.60, 95% CI 1.43-9.06, I² = 0%, P = 0.006) and
chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39-10.31,
I² = 0%, P = 0.009) were associated with increased mortality.
These findings highlight the aggressive clinical course of COVID-19 in HT
recipients.<br/>Copyright &#xa9; 2021 Steunstichting ESOT. Published by
John Wiley & Sons Ltd

<84>
Accession Number
634392612
Title
An assessment of the effectiveness of regional analgesia after VATS
measured by an objective method for assessing testosterone, cortisol,
alpha-amylase, sIgA and beta-endorphin levels - a randomised controlled
trial.
Source
Endokrynologia Polska. (no pagination), 2021. Date of Publication: 23 Feb
2021.
Author
Bialka S.; Sliwczynska M.; Marciniak A.; Czyzewski D.; Misiolek H.
Institution
(Bialka, Sliwczynska, Marciniak, Misiolek) Department of Anaesthesiology,
Intensive Care and Emergency Medicine, Faculty of Medical Sciences in
Zabrze, Medical University of Silesia, Katowice, Poland, 3-go Maja 13-15,
41-800 Zabrze, Poland
(Czyzewski) Chair and Department of Thoracic Surgery, Faculty of Medical
Sciences in Zabrze, Medical University of Silesia, Katowice, Poland, 3-go
Maja 13-15, 41-800 Zabrze, Poland
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Thoracic surgeries are associated with intense postoperative
pain. General opioid analgesia is still the main anaesthetic method. Due
to the large number of opioid-induced side effects, alternative methods of
pain relief are sought. One of them is the use of balanced analgesia,
which consists of regional analgesia, non-opioid painkillers and small
doses of opioids. <br/>OBJECTIVE(S): An assessment of the effectiveness of
preoperative thoracic paravertebral block (ThPVB) in the treatment of
postoperative pain after video-assisted thoracic surgery (VATS) by
measuring hormone levels in blood serum or saliva. DESIGN: A randomised,
open-label study. SETTING: A single university hospital. the study was
conducted between May 2018 and September 2019. PARTICIPANTS: In total, 119
patients scheduled for elective video-assisted thoracic surgery.
INTERVENTIONS: Preoperative thoracic paravertebral block with 0.5%
bupivacaine, followed by postoperative oxycodone combined with nonopioid
analgesics. Follow-up period: first 24 hours and one, two and six months
after surgery. MAIN OUTCOME MEASURES: Pain intensity measured using the
Numerical Rating Scale (NRS) and the levels of the following hormones:
testosterone, cortisol, alpha-amylase activity, sIgA and beta-endorphin.
<br/>RESULT(S): A total of 119 patients were randomised into two groups
and, of these, 49 were subsequently excluded from the analysis. The final
analysis included 37 patients from the study group and 33 from the control
group. There were no statistically significant differences in the analysed
parameters the relative change T1-T0. There was a tendency towards
statistical significance in the relative change T2-T0 in testosterone
levels. At rest, no statistically significant differences were found
between groups and time in the percentage of patients with NRS >= 1.
During cough, the percentage of patients with NRS >= 1 was higher at T1
and T2 time points in the ThPVB group. Of the factors considered, only
alpha-amylase levels statistically significantly increased the chance for
higher NRS score after a month [OR = 1.013; 95% PU: 1.001 - 1.025; p <
0.01]. <br/>CONCLUSION(S): ThPVB is effective and safe for patients
undergoing VATS. It can be an effective alternative for general
anaesthesia using high doses of opioids. TRIAL REGISTRATION:
ClinicalTrials.gov as No. NCT04414488.

<85>
Accession Number
2010977098
Title
Associations between mean arterial pressure during cardiopulmonary bypass
and biomarkers of cerebral injury in patients undergoing cardiac surgery:
Secondary results from a randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 32 (2) (pp 229-235),
2021. Date of Publication: 01 Feb 2021.
Author
Wiberg S.; Holmgaard F.; Blennow K.; Nilsson J.C.; Kjaergaard J.; Wanscher
M.; Langkilde A.R.; Hassager C.; Rasmussen L.S.; Zetterberg H.; Vedel A.G.
Institution
(Wiberg, Kjaergaard, Hassager) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Holmgaard, Nilsson, Wanscher, Vedel) Department of Cardiothoracic
Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Blennow, Zetterberg) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, The Sahlgrenska Academy,
University of Gothenburg, Molndal, Sweden
(Blennow, Zetterberg) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Langkilde) Department of Radiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Hassager, Rasmussen) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Zetterberg) Department of Neurodegenerative Disease, UCL Institute of
Neurology, London, United Kingdom
(Zetterberg) UK Dementia Research Institute, UCL, London, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Cardiac surgery is associated with risk of cerebral injury and
mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) is
suggested to be associated with cerebral injury. The 'Perfusion Pressure
Cerebral Infarcts' (PPCI) trial randomized patients undergoing coronary
artery bypass grafting (CABG) and/or aortic valve replacement to a MAP of
40-50 or 70-80 mmHg during CPB and found no difference in clinical or
imaging outcomes between the groups. We here present PPCI trial predefined
secondary end points, consisting of biomarkers of brain injury.
<br/>Method(s): Blood was collected from PPCI trial patients at baseline,
24 and 48 h after induction of anaesthesia and at discharge from the
surgical ward. Blood was analysed for neuron-specific enolase, tau,
neurofilament light and the glial marker glial fibrillary acidic protein.
Linear mixed models were used to analyse differences in biomarker value
changes from baseline between the 2 MAP allocation groups. <br/>Result(s):
A total of 193 (98%) patients were included. We found no differences in
biomarker levels over time from baseline to discharge between the 2 MAP
allocation groups (PNSE = 0.14, PTau = 0.46, PNFL = 0.21, PGFAP = 0.13)
and the result did not change after adjustment for age, sex and type of
surgery. <br/>Conclusion(s): We found no significant differences in levels
of biomarkers of neurological injury in patients undergoing elective or
subacute CABG and/or aortic valve replacement randomized to either a
target MAP of 40-50 mmHg or a target MAP of 70-80 mmHg during
CBP.<br/>Copyright &#xa9; 2020 The Author(s).

<86>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; Annals of
Translational Medicine. All rights reserved.

<87>
Accession Number
2011117800
Title
The Association Between Frailty and Delirium Among Hospitalized Patients:
An Updated Meta-Analysis.
Source
Journal of the American Medical Directors Association. 22 (3) (pp
527-534), 2021. Date of Publication: March 2021.
Author
Zhang X.-M.; Jiao J.; Xie X.-H.; Wu X.-J.
Institution
(Zhang, Jiao, Wu) Department of Nursing, Chinese Academy of Medical
Sciences-Peking Union Medical College, Peking Union Medical College
Hospital (Dongdan Campus), Beijing, China
(Xie) Shenzhen Second People's Hospital, Shenzhen, China
Publisher
Elsevier Inc.
Abstract
Objective: The aim of our meta-analysis was to update evidence for the
association between frailty and delirium in different types of
hospitalized patients, given the large volume of new studies with
inconsistent results. <br/>Design(s): Systematic review and meta-analysis.
Setting and Participants: In this updated meta-analysis, we searched 3
databases (Embase, PubMed, and the Cochrane Library) for observational
studies, exploring the association between frailty and delirium from
database inception to September 21, 2020, among hospitalized patients.
Relevant data were extracted from the studies that were included. A random
effects model was conducted to synthesize and pool the effect size of
frailty on delirium due to different frailty score instruments, different
countries, and various delirium assessments that were used. The
participants enrolled in this meta-analysis were hospitalized patients.
Measures: Delirium risk due to frailty. <br/>Result(s): A total of 30
independent studies from 9 countries, consisting of 217,623 patients, was
identified, and the prevalence of frailty ranged from 16.20% to 78.00%.
Frail patients exhibited an increased risk for delirium compared to those
without frailty [odds ratio (OR) 2.96, 95% confidence interval (CI)
2.36-3.71]. In addition, different types of hospitalized patients had
various OR values, which were 2.43 for selective surgical patients (95% CI
1.88-3.14), 3.61 for medical patients (95% CI 3.61-7.89), 3.76 for urgent
surgical patients (95% CI 2.88-4.92), and 6.66 for emergency or critical
illness patients (95% CI 1.41-31.47). Subgroup analysis based on the
frailty score instrument showed the association still existed when using
the Clinical Frailty Scale (OR 4.07, 95% CI 2.71-6.11), FRAIL Scale (OR
2.83, 95% CI 1.56-5.13), Frailty Index (OR 6.15, 95% CI 3.75-10.07),
frailty phenotype (OR 2.30, 95%CI 1.35-5.66), or Erasmus Frailty Score (OR
2.79, 95% CI 1.63-4.77). However, an association between frailty and
delirium was not observed when the Edmonton Frail Scale was used (OR 1.45,
95% CI 0.91-2.30). Conclusions and Implications: A 2.96-fold incremental
risk of delirium in frail patients underscores the need for early
screening of frailty and comprehensive delirium prevention. Appropriate
interventions by clinicians should be performed to manage delirium,
potentially reducing adverse clinical outcomes for hospitalized
patients.<br/>Copyright &#xa9; 2021

<88>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2021, Sociedade Brasileira
de Cirurgia Cardiovascular. All rights reserved.

<89>
Accession Number
2010977336
Title
Non-intubated spontaneous ventilation in video-assisted thoracoscopic
surgery: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 428-437), 2020.
Date of Publication: 01 Mar 2020.
Author
Wen Y.; Liang H.; Qiu G.; Liu Z.; Liu J.; Ying W.; Liang W.; He J.
Institution
(Wen, Liang, Liu, Liu, Ying, Liang, He) Department of Thoracic Surgery and
Oncology, The First Affiliated Hospital of Guangzhou Medical University,
State Key Laboratory of Respiratory Disease, National Clinical Research
Center for Respiratory Disease, Guangzhou Institute of Respiratory Health,
Guangzhou, China
(Wen, Qiu) Nanshan School, Guangzhou Medical University, Panyu District,
Guangzhou, China
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
It remains unclear whether non-intubated video-assisted thoracoscopic
surgery (VATS) is comparable or advantageous compared with conventional
intubated VATS. Thus, we systematically assessed the feasibility and
safety of non-intubated VATS compared with intubated VATS perioperatively
for the treatment of different thoracic diseases. An extensive search of
literature databases was conducted. Perioperative outcomes were compared
between 2 types of operations. The time trend of the overall results was
evaluated through a cumulative meta-analysis. Subgroup analyses of
different thoracic diseases and study types were examined. Twenty-seven
studies including 2537 patients were included in the analysis. A total of
1283 patients underwent non-intubated VATS; intubated VATS was performed
on the other 1254 patients. Overall, the non-intubated VATS group had
fewer postoperative overall complications [odds ratios (OR) 0.505; P <
0.001]; shorter postoperative fasting times [standardized mean difference
(SMD) -2.653; P < 0.001]; shorter hospital stays (SMD -0.581; P < 0.001);
shorter operative times (SMD -0.174; P = 0.041); shorter anaesthesia times
(SMD -0.710; P < 0.001) and a lower mortality rate (OR 0.123; P = 0.020).
Non-intubated VATS may be a safe and feasible alternative to intubated
VATS and provide a more rapid postoperative rehabilitation time than
conventional intubated VATS.<br/>Copyright &#xa9; 2019 The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<90>
Accession Number
2006836173
Title
Outcome of hybrid compared to conventional revascularization in
multivessel coronary artery disease: A matched-group comparison of 3-year
outcome following hybrid myocardial revascularization, conventional
coronary artery bypass grafting, and percutaneous coronary intervention.
Source
Scandinavian Cardiovascular Journal. 54 (6) (pp 376-382), 2020. Date of
Publication: 2020.
Author
Modrau I.S.; Nielsen P.H.; Nielsen D.V.; Christiansen E.H.; Hoffmann T.;
Parner E.T.; Benhassen L.L.
Institution
(Modrau, Nielsen, Hoffmann, Benhassen) Department of Cardiothoracic and
Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
(Modrau, Hoffmann, Benhassen) Department of Clinical Medicine, Faculty of
Health, Aarhus University, Aarhus, Denmark
(Nielsen) Department of Anaesthesiology and Intensive Care, Aarhus
University Hospital, Aarhus, Denmark
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Parner) Department of Public Health, Section for Biostatistics, Aarhus
University, Aarhus, Denmark
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: Evaluation of 3-year clinical outcome of hybrid myocardial
revascularization (HMR) compared to conventional revascularization
strategies in patients with multivessel coronary artery disease involving
the proximal left anterior descending artery. Design. Retrospective
matched cohort study based on a prospective feasibility study including
103 elective patients undergoing staged HMR from October 2010 until
February 2012. The Western Denmark Heart Registry was used to identify
patients who underwent coronary artery bypass grafting (CABG) and
multivessel percutaneous coronary intervention (PCI) by matching on number
of diseased vessels, age and comorbidity score. Primary endpoint was the
composite rate of major adverse cardiovascular and cerebrovascular events
(MACCE) at 3-year follow-up. Secondary endpoints included individual MACCE
components, acute kidney injury, and cardiovascular readmissions. Results.
There was no difference between MACCE in the three groups (HMR 31.1%; CABG
20.4%; PCI 20.4%, p =.11). Estimates of repeat revascularization were
significantly increased with HMR versus CABG. In the CABG group, fewest
patients required cardiovascular readmissions though with the highest
incidence of acute kidney injury. Conclusions. HMR was not superior with
respect to MACCE compared with CABG and PCI. It may, however, represent a
safe alternative to conventional revascularization treatment considering
the specific procedure-associated morbidity.<br/>Copyright &#xa9; 2020
Informa UK Limited, trading as Taylor & Francis Group.

<91>
Accession Number
2007505571
Title
Postoperative analgesic effect of acupotomy combined with
patient-controlled analgesia in patients undergoing video-assisted
thoracoscopic surgery: a study protocol for a randomized controlled trial.
Source
Trials. 21 (1) (no pagination), 2020. Article Number: 998. Date of
Publication: December 2020.
Author
Jiang C.; Li Y.; Li X.; Guo J.; Guo M.; Yu S.; Lin Z.
Institution
(Jiang, Li, Guo, Guo, Yu, Lin) Fujian Provincial Hospital, Fuzhou, Fujian,
China
(Li) Outpatient Department of Guoyitang affiliated to Fujian University of
Traditional Chinese Medicine, Fuzhou, Fujian, China
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative acute pain is a common issue following thoracic
surgery. Acupotomy is a common and safe intervention method for pain
treatment in clinical practice. In previous preliminary experiments, we
found that acupotomy has a good clinical effect and good safety in the
treatment of pain after thoracoscopic surgery. However, due to a lack of a
rigorous design and an adequate sample size, its efficacy still requires
further confirmation. The purpose of this study will be to explore the
efficacy and safety of acupotomy combined with patient-controlled
analgesia (PCA) for the treatment of pain after video-assisted thoracic
surgery (VATS). <br/>Method(s): The study will be a single-centre,
parallel group, randomized controlled trial. Seventy patients with
significant pain after thoracoscopic surgery with a visual analogue scale
(VAS) score >= 7 will be included and randomly distributed into two
groups: G1, the acupotomy combined with PCA group; and G2, the
conventional PCA group. The primary outcome measure is pain scores at rest
and coughing evaluated with the VAS by a blinded observer in the
postanaesthesia care unit (PACU) and postoperatively at 1, 2, 4, 8, 12,
24, 48, and 72 h. The secondary outcome measures are postoperative
requirements for rescue analgesia, the cumulative amount of
self-administered analgesics, the level of sedation (LOS), the Bruggemann
comfort scale (BCS), and the functional activity score (FAS) concerning
adverse effects and patient satisfaction. <br/>Discussion(s): This trial
has the potential to identify an innovative and effective analgesic method
for postoperative pain management for VATS. The findings may advocate for
the inclusion of the treatment of comorbid pain after thoracoscopy in
current pain management practice guidelines. Trial registration: Chinese
Clinical Trial Registry ChiCTR1900027191. Registered on 4 November
2019.<br/>Copyright &#xa9; 2020, The Author(s).

<92>
Accession Number
2007087010
Title
Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac
Autonomic Function.
Source
Obesity Surgery. 31 (3) (pp 1381-1386), 2021. Date of Publication: March
2021.
Author
Gil S.; Pecanha T.; Dantas W.S.; Murai I.H.; Merege-Filho C.A.A.; de
Sa-Pinto A.L.; Pereira R.M.R.; de Cleva R.; Santo M.A.; Rezende D.A.N.;
Kirwan J.P.; Gualano B.; Roschel H.
Institution
(Gil, Pecanha, Dantas, Murai, Merege-Filho, Rezende, Gualano, Roschel)
Applied Physiology & Nutrition Research Group; Laboratory of Assessment
and Conditioning in Rheumatology; Faculdade de Medicina FMUSP,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Dantas, Kirwan) Integrated Physiology and Molecular Medicine Laboratory,
Pennington Biomedical Research Center, Louisiana State University, Baton
Rouge, LA, United States
(de Sa-Pinto, Pereira, Gualano, Roschel) Rheumatology Division, Hospital
das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao
Paulo, Sao Paulo, Brazil
(de Cleva, Santo) Department of Digestive Surgery, School of Medicine,
University of Sao Paulo, Sao Paulo, Brazil
Publisher
Springer
Abstract
Background: Bariatric surgery improves cardiovascular health, which might
be partly ascribed to beneficial alterations in the autonomic nervous
system. However, it is currently unknown whether benefits from surgery on
cardiac autonomic regulation in post-bariatric patients can be further
improved by adjuvant therapies, namely exercise. We investigated the
effects of a 6-month exercise training program on cardiac autonomic
responses in women undergoing bariatric surgery. <br/>Method(s): Sixty-two
women eligible for bariatric surgery were randomly allocated to either
standard of care (control) or an exercise training intervention. At
baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we
assessed chronotropic response to exercise (CR%; i.e., percentage change
in heart rate from rest to peak exercise) and heart rate recovery (HRR30s,
HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post
exercise) after a maximal exercise test. <br/>Result(s): Between-group
absolute changes revealed higher CR% (DELTA = 8.56%, CI95% 0.22-19.90, P =
0.04), HRR30s (DELTA = 12.98 beat/min, CI95% 4.29-21.67, P = 0.01), HRR60s
(DELTA = 22.95 beat/min, CI95% 11.72-34.18, P = 0.01), and HRR120s (DELTA
= 34.54 beat/min, CI95% 19.91-49.17, P < 0.01) in the exercised vs.
non-exercised group. <br/>Conclusion(s): Our findings demonstrate that
exercise training enhanced the benefits of bariatric surgery on cardiac
autonomic regulation. These results highlight the relevance of exercise
training as a treatment for post-bariatric patients, ensuring optimal
cardiovascular outcomes.<br/>Copyright &#xa9; 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<93>
Accession Number
2006892770
Title
The effect of advanced recovery room care on postoperative outcomes in
moderate-risk surgical patients: a multicentre feasibility study.
Source
Anaesthesia. 76 (4) (pp 480-488), 2021. Date of Publication: April 2021.
Author
Ludbrook G.; Lloyd C.; Story D.; Maddern G.; Riedel B.; Richardson I.;
Scott D.; Louise J.; Edwards S.
Institution
(Ludbrook, Lloyd, Maddern) Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, Australia
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Riedel, Richardson) Department of Anaesthetics, Peri-operative and Pain
Medicine, the Peter MacCallum Cancer Centre, University of Melbourne,
Melbourne, Australia
(Scott) School of Medicine, Western Sydney University, Sydney, Australia
(Louise, Edwards) Adelaide Health Technology Assessment, University of
Adelaide, Adelaide, Australia
Publisher
Blackwell Publishing Ltd
Abstract
Postoperative complications are common and may be under-recognised. It has
been suggested that enhanced postoperative care in the recovery room may
reduce in-hospital complications in moderate- and high-risk surgical
patients. We investigated the feasibility of providing advanced recovery
room care for 12-18 h postoperatively in the post-anaesthesia care unit.
The primary hypothesis was that a clinical trial of advanced recovery room
care was feasible. The secondary hypothesis was that this model may have a
sustained impact on postoperative in-hospital and post-discharge events.
This was a multicentre, prospective, feasibility before-and-after trial of
moderate-risk patients (predicted 30-day mortality of 1-4%) undergoing
non-cardiac surgery and who were scheduled for postoperative ward care.
Patients were managed using defined assessment checklists and goals of
care in an advanced recovery room care setting in the immediate
postoperative period. This utilised existing post-anaesthesia care unit
infrastructure and staffing, but extended care until the morning of the
first postoperative day. The advanced recovery room care trial was deemed
feasible, as defined by the recruitment and per protocol management of >
120 patients. However, in a specialised cancer centre, recruitment was
slow due to low rates of eligibility according to narrow inclusion
criteria. At a rural site, advanced recovery room care could not be
commenced due to logistical issues in establishing a new model of care. A
definitive randomised controlled trial of advanced recovery room care
appears feasible and, based on the indicative data on outcomes, we believe
this is warranted.<br/>Copyright &#xa9; 2020 Association of Anaesthetists

<94>
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.<br/>Copyright &#xa9; 2021, Associacao Brasileira de Divulgacao
Cientifica. All rights reserved.

<95>
Accession Number
634149739
Title
A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative
Fluid Management Strategy Compared With Usual Care in Participants After
Cardiac Surgery: The Fluids After Bypass Study.
Source
Critical care medicine. 49 (3) (pp 449-461), 2021. Date of Publication: 01
Mar 2021.
Author
Parke R.L.; Gilder E.; Gillham M.J.; Walker L.J.C.; Bailey M.J.;
McGuinness S.P.
Institution
(Parke, Gilder, Gillham, Walker, McGuinness) Cardiothoracic and Vascular
ICU, Auckland City Hospital, Auckland, New Zealand
(Parke, Gilder) School of Nursing, Faculty of Medical and Health Sciences,
University of Auckland, Auckland, New Zealand
(Parke, McGuinness) Medical Research Institute of New Zealand, Wellington,
New Zealand
(Parke, Bailey, McGuinness) ANZIC-Research Centre, Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC,
Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: There is little evidence to guide fluid administration to
patients admitted to the ICU following cardiac surgery. This study aimed
to determine if a protocolized strategy known to reduce fluid
administration when compared with usual care reduced ICU length of stay
following cardiac surgery. DESIGN: Prospective, multicenter,
parallel-group, randomized clinical trial. SETTING: Five cardiac surgical
centers in New Zealand conducted from November 2016 to December 2018 with
final follow-up completed in July 2019. PATIENTS: Seven-hundred fifteen
patients undergoing cardiac surgery; 358 intervention and 357 usual care.
INTERVENTIONS: Randomization to protocol-guided strategy utilizing stroke
volume variation to guide administration of bolus fluid or usual care
fluid administration until desedation or up to 24 hours. Primary outcome
was length of stay in ICU. Organ dysfunction, mortality, process of care
measures, patient-reported quality of life, and disability-free survival
were collected up to day 180. MEASUREMENTS AND MAIN RESULTS: Overall 666
of 715 (93.1%) received at least one fluid bolus. Patients in the
intervention group received less bolus fluid (median [interquartile
range], 1,000mL [250-2,000 mL] vs 1,500mL [500-2,500 mL]; p < 0.0001) and
had a lower overall fluid balance (median [interquartile range], 319mL
[-284 to 1,274 mL] vs 673mL [38-1,641 mL]; p < 0.0001) in the intervention
period. There was no difference in ICU length of stay between the two
groups (27.9hr [21.8-53.5 hr] vs 25.6hr [21.9-64.6 hr]; p = 0.95). There
were no differences seen in development of organ dysfunction, quality of
life, or disability-free survival at any time points. Hospital mortality
was higher in the intervention group (4% vs 1.4%; p = 0.04).
<br/>CONCLUSION(S): A protocol-guided strategy utilizing stroke volume
variation to guide administration of bolus fluid when compared with usual
care until desedation or up to 24 hours reduced the amount of fluid
administered but did not reduce the length of stay in ICU.<br/>Copyright
&#xa9; 2021 by the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. All Rights Reserved.

<96>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; The Author(s) 2021. Published by Oxford
University Press on behalf of BJS Society Ltd.

<97>
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.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2021.

<98>
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. <br/>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). <br/>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.<br/>Copyright &#xa9;
2021 The Authors

<99>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright
&#xa9; 2021 British Journal of Anaesthesia

<100>
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. <br/>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. <br/>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.<br/>Copyright &#xa9;
2021

<101>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2021 The American
Association for Thoracic Surgery

<102>
Accession Number
2011063063
Title
Invasive methods for the diagnosis and management of intrathoracic
extramedullary hematopoiesis: A literature review.
Source
Respiratory Medicine and Research. 79 (no pagination), 2021. Article
Number: 100815. Date of Publication: May 2021.
Author
Georgakopoulou V.E.; Damaskos C.; Mantzouranis K.; Melemeni D.; Gkoufa A.;
Chlapoutakis S.; Garmpis N.; Sklapani P.; Aravantinou A.; Garmpi A.;
Trakas N.; Tsiafaki X.
Institution
(Georgakopoulou) Pulmonology Department, Laiko General Hospital, 17 Agiou
Thoma Street, Athens 11527, Greece
(Damaskos, Garmpis) Second Department of Propedeutic Surgery, Laiko
General Hospital, Medical School, National and Kapodistrian University of
Athens, Athens, Greece
(Damaskos, Garmpis) N.S. Christeas Laboratory of Experimental Surgery and
Surgical Research, Medical School, National and Kapodistrian University of
Athens, Athens, Greece
(Mantzouranis, Melemeni, Tsiafaki) 1st Pulmonology Department Sismanogleio
Hospital, Athens, Greece
(Gkoufa, Aravantinou) First Department of Internal Medicine, Laiko General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens, Greece
(Chlapoutakis) Department of Thoracic Surgery, Agios Savvas Hospital,
Athens, Greece
(Sklapani) Department of Cytology, Mitera Hospital, Athens, Greece
(Garmpi) First Department of Propedeutic Internal Medicine, Laiko General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens, Greece
(Trakas) Department of Biochemistry, Sismanogleio Hospital, Athens, Greece
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Extramedullary hematopoiesis is defined as hematopoiesis
occurring outside of the bone marrow. It usually compensates insufficient
bone marrow function or ineffective erythropoiesis and is observed mostly
in hematological disorders. Most common locations of extramedullary
hematopoiesis are the spleen, the liver and the lymph nodes. Intrathoracic
extramedullary hematopoiesis is rare presenting as bilateral lobulated
masses of lower paravertebral regions. This review summarizes the role of
invasive techniques in the diagnosis and management of intrathoracic EMH
and its complications. <br/>Method(s): An electronic search in PubMed and
Google Scholar was conducted with the keywords "intrathoracic
extramedullary hematopoiesis" AND "surgery" OR "video-assisted thoracic
surgery (VATS)" OR "medical thoracoscopy" OR "biopsy" OR "thoracotomy" OR
"image-guided biopsy" OR "median sternotomy", within 1970 to 2020 with the
limitation of English language to include those articles reporting data on
invasive techniques in intrathoracic extramedullary hematopoiesis.
<br/>Result(s): Overall, 93 articles were originally identified using our
search criteria and from the reference list of the previously identified
documents. Following elimination of duplicates, 29 were excluded after
title, abstract or full text screening, since they did not report the use
of invasive techniques in the diagnosis and management of intrathoracic
extramedullary hematopoiesis. <br/>Conclusion(s): Although in some cases
radiological features are typical for the diagnosis of intrathoracic
extramedullary hematopoeisis, invasive methods such as bronchoscopy with
transbronchial biopsy, image-guided fine needle aspiration, endobronchial
ultrasound-guided fine needle aspiration of the mass and mediastinoscopy,
medical thoracoscopy, median sternotomy, video-assisted thoracoscopic
surgery and thoracotomy, are essential for definite diagnosis and
management.<br/>Copyright &#xa9; 2021 SPLF and Elsevier Masson SAS

<103>
Accession Number
2011051828
Title
Tricuspid Valve Prosthesis Choice: The Only Railroad to the Truth is to
Conduct a Randomised Controlled Trial.
Source
Heart Lung and Circulation. 30 (3) (pp 321-323), 2021. Date of
Publication: March 2021.
Author
El-Gamel A.
Institution
(El-Gamel) Waikato Hospital, Hamilton, New Zealand
(El-Gamel) Department of Surgery, Auckland University, Auckland, New
Zealand
Publisher
Elsevier Ltd

<104>
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.<br/>Copyright &#xa9; 2021,
The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of
Springer Nature.

<105>
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%.
<br/>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.<br/>Copyright &#xa9; 2021, Canadian Anesthesiologists'
Society.

<106>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; The
Author(s) 2021.

<107>
Accession Number
2010284327
Title
The International Society for Minimally Invasive Cardiothoracic Surgery
Expert Consensus Statement on Transcatheter and Surgical Aortic Valve
Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of
Randomized and Propensity-Matched Studies.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 16 (1) (pp 3-16), 2021. Date of Publication: January 2021.
Author
Thourani V.H.; Edelman J.J.; Holmes S.D.; Nguyen T.C.; Carroll J.; Mack
M.J.; Kapadia S.; Tang G.H.L.; Kodali S.; Kaneko T.; Meduri C.U.; Forcillo
J.; Ferdinand F.D.; Fontana G.; Suwalski P.; Kiaii B.; Balkhy H.; Kempfert
J.; Cheung A.; Borger M.A.; Reardon M.; Leon M.B.; Popma J.J.; Ad N.
Institution
(Thourani) Department of Cardiovascular Surgery, Marcus Heart and Vascular
Center, Piedmont Heart and Vascular Institute, Atlanta, GA, United States
(Edelman) Department of Cardiac Surgery, Fiona Stanley Hospital,
University of Western Australia, Perth, Australia
(Holmes, Ad) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, MD, United States
(Nguyen) Division of Adult Cardiothoracic Surgery, University of
California, San Francisco, CA, United States
(Carroll) Division of Cardiology, University of Colorado, Denver, CO,
United States
(Mack) Department of Cardiology, Baylor Health Care System, Heart Hospital
Baylor Plano, Dallas, TX, United States
(Kapadia) Department of Cardiology, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
(Kodali, Leon) Division of Cardiology, Columbia University Medical Center,
New York, NY, United States
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Meduri) Division of Cardiology, Marcus Heart and Vascular Center,
Piedmont Heart Institute, Atlanta, GA, United States
(Forcillo) Department of Cardiac Surgery, Centre Hospitalier de
l'Universite de Montreal (CHUM), Montreal, Canada
(Ferdinand) Department of Cardiothoracic Surgery, University of Pittsburgh
School of Medicine $and$ UPMC Hamot Heart and Vascular Institute,
University of Pittsburgh Medical Center, PA, United States
(Fontana) Cardiovascular Institute, Los Robles Hospital and Medical
Center, Thousand Oaks, CA, United States
(Suwalski) Department of Cardiac Surgery, Central Clinical Hospital of the
Ministry of Interior and Administration, Centre of Postgraduate Medical
Education, Warsaw, Poland
(Kiaii) Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA,
United States
(Balkhy) Section of Cardiac Surgery, University of Chicago Medicine, IL,
United States
(Kempfert) Department of Cardiac Surgery, German Heart Institute, Berlin,
Germany
(Cheung) Department of Cardiac Surgery, The University of British
Columbia, St. Paul's Hospital, Vancouver, Canada
(Borger) Department of Cardiac Surgery, Leipzig Heart Centre, Germany
(Reardon) Department of Cardiac Surgery, Methodist DeBakey Heart &
Vascular Center, Houston, TX, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Ad) Cardiovascular Surgery, Adventist White Oak Medical Center, Silver
Spring, MD, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: There is an increasing amount of evidence supporting use of
transcatheter aortic valve replacement (TAVR) for treatment of aortic
stenosis in patients at low or intermediate risk for surgical aortic valve
replacement (SAVR). TAVR is now approved for use in all patient cohorts.
Despite this, there remains debate about the relative efficacy of TAVR
compared with SAVR in lower-risk cohorts and various subgroups of
patients. We performed a systematic review and meta-analysis of randomized
controlled trials (RCTs) and propensity-matched trials to guide a
consensus among expert cardiologists and surgeons. <br/>Method(s): Studies
comparing TAVR and SAVR in low- and intermediate-risk patients were
identified by a thorough search of the major databases. Mortality, stroke,
and other perioperative outcomes were assessed at 30 days and 1 year.
<br/>Result(s): Early mortality was lower in TAVR compared to SAVR in
RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs
1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98,
I² = 0%). No difference in mortality between TAVR and SAVR was
identified in intermediate-risk patients at early or later time points.
Incidence of perioperative stroke in 3 low-risk RCTs was significantly
lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81,
I² = 0%). There was no difference in stroke for
intermediate-risk patients between TAVR and SAVR. The expert panel of
cardiologists and cardiac surgeons provided recommendations for TAVR and
SAVR in various clinical scenarios. <br/>Conclusion(s): In RCTs comparing
TAVR and SAVR in low-risk patients, early mortality and stroke were lower
in TAVR, but did not differ at 1 year. There was no difference in
mortality and stroke in intermediate-risk patients. The Multidisciplinary
Heart Team must consider individual patient characteristics and
preferences when recommending TAVR or SAVR. The decision must consider the
long-term management of each patient's aortic valve disease.<br/>Copyright
&#xa9; The Author(s) 2021.

<108>
[Use Link to view the full text]
Accession Number
634380680
Title
Gender Disparities Based on Time to Revascularization in the Treatment of
Non-st-segment Elevation Myocardial Infarction: An Analysis of 748,439
Nstemi Admissions.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Yerasi C.; Case B.C.; Wang Y.; Forrestal B.; Hahm J.; Dolman S.; Weintraub
W.S.; Waksman R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Multiple studies on Non-ST-segment elevation myocardial
infarction (NSTEMI) have shown that women tend to have delayed
revascularization, with associated worse outcomes, when compared to men.
However, there are no studies to date, evaluating the clinical
characteristics and outcomes of men versus (vs.) women based on time to
revascularization. <br/>Method(s): The study cohort was obtained from the
2016 Nationwide Readmissions Database. We used the International
Classification of Diseases, Tenth Revision, to identify patients who
underwent diagnostic angiography and subsequently received either
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG). Finally, mortality and 30-day readmissions rates based on
gender and time to revascularization were extracted. <br/>Result(s): In
2016, there were a total of 748,439 weighted admissions for NSTEMI (57%
men and 43% women). Compared to men, women were older and had higher
percentage of baseline comorbidities. Women tended to be managed less
invasively with only 45% undergoing coronary angiogram as compared to 54%
in men (p<0.001). Furthermore, there was a difference in revascularization
rates, PCI (men 30% vs. women 21%, p<0.001) or CABG (men 10% vs. women 5%,
p<0.001). Majority of men (34%) were revascularized by PCI on same day
while majority of women (30%) were revascularized next-day of admission.
In both men and women, patients with more comorbidities tend to have delay
in revascularization. Compared to men, in-hospital mortality and 30-day
readmission is higher in women as the revascularization is delayed (Figure
1). <br/>Conclusion(s): Currently there exists wide disparity among men
and women in the treatment of NSTEMI. Women tend to have worse outcomes as
the revascularization gets delayed. Randomized clinical trials are needed
to evaluate if a strategy of urgent revascularization (<90 minutes) in
women is associated with improved outcomes.

<109>
[Use Link to view the full text]
Accession Number
634380646
Title
Propitious Temporal Changes in Clinical Outcomes after Transcatheter
Compared to Surgical Aortic Valve Replacement; A Meta-Analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Panchal A.; Kyvernitakis A.; Doyle M.; Biederman R.W.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Treatment for severe aortic stenosis has rapidly evolved
over the past decade, in both transcatheter aortic valve replacement
(TAVR) technique and surgical aortic valve replacement (SAVR), resulting
in improved clinical outcomes. We sought to determine and compare the
temporal changes and 1-year outcomes between these groups. <br/>Method(s):
We searched the Medline MESH database using the keywords "aortic
stenosis", "atrial fibrillation" and "stroke". We performed a
meta-analysis and created funnel plots to compare TAVR with SAVR
population for post-procedural stroke, all-cause and cardiovascular (CV)
mortality at 1-year. <br/>Result(s): Out of >50 studies, we included 20
meeting criteria for analysis with total population of >65000 patients, of
which 61067 had TAVR and 4162 had SAVR. AFib prevalence was higher in TAVR
vs SAVR patients (38% vs 27%; p< 0.0001). By funnel plotting,
post-procedural stroke at 1-year was 3.1% in TAVR and 5% in SAVR patients
(NS). All-cause mortality at 1 year was 12.5% in TAVR and 10.3 % in SAVR
patients, and CV mortality at 1-year was 7.4% in TAVR and 6.2% in SAVR
patients (NS for both). <br/>Conclusion(s): While there is a trend over
the last 14 years for overall improvement in both SAVR and TAVR outcomes,
via meta-analysis, despite a higher prevalence of AFib in TAVR vs SAVR,
there is statistical overlap in the confidence intervals supporting no
distinct separation in stroke risk, all-cause mortality or adjudicated CV
mortality at 1 year between groups. To our knowledge, this represents the
largest study over the longest time period that points towards potential
benefit at the individual level but as a socio-economic consideration, no
distinction between SAVR vs TAVR.

<110>
[Use Link to view the full text]
Accession Number
634380616
Title
Allergy Associated Myocardial Infarction: A Comprehensive Review of
Clinical Presentation, Diagnosis and Management of Kounis Syndrome.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Roumeliotis A.; Davlouros P.; Anastasopoulou M.; Tsigkas G.; Hahalis G.;
Kounis N.G.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Kounis syndrome (KS) is defined as acute coronary syndrome
(ACS) in the context of a hypersensitivity reaction. Patients may present
with normal coronary arteries (Type I), established coronary artery
disease (Type II) or in-stent thrombosis and restenosis (Type
III).Hypothesis: We sought to investigate the clinical presentation,
underlying pathophysiology, diagnosis and medical management of patients
with KS. <br/>Method(s): We searched PubMed until 1/1/2020 for case
reports of KS. Patients with age <18 years, noncoronary vascular
manifestations and without an established KS diagnosis were excluded.
Information regarding patient demographics, medical history, clinical
presentation, allergic reaction trigger, angiographic results as well as
management were manually extracted from every report. All data were pulled
in a combined data set and descriptive statistics were analyzed.
<br/>Result(s): Out of the 269 unique patients with KS, 157 (58.4%) had
Type I, 64 (23.8%) Type II and 18 (6.7%) Type III while 30 (11.2%) could
not be classified. Their mean age was 54.1 years and 190 (70.6%) were
male. The majority presented with a combination of cardiac and allergic
symptoms [Panel A] and medication was the most commonly reported trigger
[Panel B]. Electrocardiographically, 75.1% of cases had ST segment
elevation with only 3.3% demonstrating no abnormalities. Coronary imaging
was available in 228 (84.8%) patients showing occlusive lesions (32.5%),
vascular spasm (16.2%), or normal coronary arteries (51.3%). Percutaneous
coronary intervention or coronary artery bypass grafting was performed in
70 (29.4%) of the 238 patients with available information.
<br/>Conclusion(s): Hypersensitivity induced ACS is most frequently
triggered by medications, and the majority of patients have patent
coronary arteries suggesting microvascular dysfunction. KS should be
considered in the differential diagnosis of myocardial infarction with
non-obstructive coronary arteries.

<111>
[Use Link to view the full text]
Accession Number
634380609
Title
Duration of Dual Antiplatelet Therapy in Coronary Heart Disease: A
60,000-patient Meta-analysis of Randomised Controlled Trials.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Bularga A.; Meah M.; Doudesis D.; Shah A.S.; Mills N.L.; Lee K.K.; Newby
D.E.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Dual antiplatelet therapy (DAPT) is the cornerstone of
pharmacological treatment for patients with acute coronary syndrome (ACS)
and in those undergoing percutaneous coronary intervention for stable
coronary disease. Despite widespread use, the optimal duration of DAPT
remains uncertain. We present an updated meta-analysis comparing outcomes
in short-term DAPT (<= 6 months) versus long-term DAPT (>= 12 months).
<br/>Method(s): Four major databases were searched for randomised
controlled trials of interest. The primary outcome was all-cause
mortality. Secondary safety outcomes included any bleeding and major
bleeding. Efficacy outcomes included cardiovascular death, myocardial
infarction, stent thrombosis, coronary revascularization and thrombotic
stroke. Further subgroup analysis stratified by index presentation and a
sensitivity analysis to evaluate shorter duration DAPT (<=3 months) was
performed. <br/>Result(s): Nineteen randomised controlled trials were
included (n=60,879) of which 8 compared shorter duration DAPT (<=3 months)
with standard duration (12 months) (n=38,036). Short-term DAPT was
associated with an apparent modest increase in myocardial infarction (risk
ratio [RR] 1.09; 95% confidence interval [CI], 0.98-1.22) with a major
reduction in bleeding (RR 0.68; 95% CI, 0.55-0.83) for major bleeding and
(RR 0.66; 95% CI, 0.56-0.77 for any bleeding) and an overall apparent
reduction in all-cause mortality (RR 0.90; 95% CI 0.81-1.01). These
associations persisted when comparing shorter duration DAPT to standard
duration. Subgroup analysis of patients with stable disease or ACS
identified no significant heterogenicity in efficacy, safety or mortality
outcomes. <br/>Conclusion(s): In the largest meta-analysis to date
comparing duration of DAPT, we show that short (<= 6 months) and shorter
(<= 3 months) DAPT is associated with continuing trends for small
reductions in all-cause mortality irrespective of index presentation.

<112>
[Use Link to view the full text]
Accession Number
634380365
Title
Predictors of Permanent Pacemaker Insertion after TAVR: A Systematic
Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Gupta R.; Malik A.H.; Aronow W.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter Aortic Valve Replacement (TAVR) has evolved as
the standard of care for patient with severe aortic stenosis. Conduction
abnormalities leading to permanent pacemaker (PPM) implantation is one of
the most common complication after TAVR. The aim of this analysis is to
evaluate the predictors associated with increased risk of PPM implantation
after TAVR. <br/>Method(s): A comprehensive literature search was
performed in PubMed, Embase, and Cochrane to identify relevant trials.
Summary effects were calculated using a DerSimonian and Laird
random-effects model as odds ratio with 95% confidence intervals for all
the clinical endpoints. <br/>Result(s): 37 observational studies with
71455 patients were identified. The incidence of PPM implantation after
TAVR in our analysis was 22%. The risk of PPM implantation after TAVR was
more in men, it increased with increasing age, and in patients with
diabetes mellitus, presence of right bundle branch block , baseline
atrioventricular conduction block, and left anterior fascicular block.
Significant predictors of PPM insertion post TAVR included the presence of
high calcium volume in the area below left and non-coronary cusp, use of
self-expandable valve over balloon-expandable valve, depth of implant,
valve size/annulus size, pre-dilatation balloon valvuloplasty and
post-implant balloon dilation. However, the risk did not increase with
atrial fibrillation, left bundle branch block, baseline interventricular
conduction delay, change in QRS duration after the procedure and with the
presence of high calcium in the area below right coronary cusp.
<br/>Conclusion(s): Our meta-analysis identified 14 factors that were
significantly associated with increased risk of PPM insertion after TAVR.
Early identification of high-risk populations and targeting modifiable
risk factors can help to reduce the rate of PPM insertion after TAVR.

<113>
[Use Link to view the full text]
Accession Number
634380285
Title
Safety of Direct Oral Anticoagulants Compared to Warfarin for Atrial
Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association Scientific Sessions,
AHA 2020. 142 (SUPPL 3) (no pagination), 2020. Date of Publication:
November 2020.
Author
Hage A.; Dolan D.; Nasr V.G.; Castelo-Branco L.; Motta-Calderon D.;
Ghandour H.; Papatheodorou S.; Chu M.W.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The evidence for use of direct oral anticoagulants (DOACs)
in the management of post-operative cardiac surgery atrial fibrillation
(POAF) is limited and mostly founded on clinical trials that excluded this
patient population.Hypothesis: We performed a systematic review and
meta-analysis of clinical trials and observational studies to evaluate the
hypothesis that DOACs are safe compared to warfarin for the
anticoagulation of patients with POAF. <br/>Method(s): We searched PubMed,
EMBASE, Web of Science, clinicaltrials.gov, and the Cochrane Library for
clinical trials and observational studies comparing DOAC with warfarin in
patients >=18 years old who had post-cardiac surgery atrial fibrillation.
Primary outcomes included stroke, systemic embolization, bleeding, and
mortality, with secondary outcome of hospital readmission. We performed a
random-effects meta-analysis. <br/>Result(s): We found 3 clinical trials,
1 prospective and 12 retrospective cohort studies eligible for inclusion
with a total of 10,538 patients (3,207 DOAC patients and 7,331 warfarin
patients). The meta-analysis for the primary outcomes showed significantly
lower risk of stroke with DOAC use (6 studies, 7143 patients, RR 0.64; 95%
CI 0.50 to 0.81, I2: 0.0%) compared to warfarin, a trend towards lower
risk of systemic embolization (4 studies, 7289 patients, RR 0.64, 95% CI
0.41 to 1.01, I2: 31.99%) and similar risks of bleeding (14 studies, 10182
patients, RR 0.91; 95% CI 0.74 to 1.10, I2: 26.6%) and mortality (12
studies, 9843 patients, relative risk [RR] 1.01; 95% CI 0.74 to 1.37, I2:
26.5%) The secondary outcome of hospital readmission had similar risk
between groups. <br/>Conclusion(s): Current evidence suggests that DOACs,
compared to warfarin, in the management of atrial fibrillation after
cardiac surgery is associated with lower risk of stroke and a strong trend
for lower risk of systemic embolization, and no evidence of increased risk
for hospital readmission, bleeding or mortality.

<114>
Accession Number
634365069
Title
A Study on the Impact of the Novel Biochemical Parameter-Calcium Score in
Preventing the Progression of the Cardiovascular Diseases to Invasive
Interventions.
Source
Journal of nutritional science and vitaminology. 66 (Supplementement) (pp
S11-S17), 2020. Date of Publication: 2020.
Author
K Thomas A.; Radhakrishnan D.
Institution
(K Thomas) Home Science Department, C.M.S College
(Radhakrishnan) St. Theresa's College
Publisher
NLM (Medline)
Abstract
Cardiovascular diseases is increasing its pace day by day. Though the
traditional biomarkers are made available the novel biomarkers are being
incorporated to predict the risk of cardiovascular diseases for earlier
detection. The present study aimed to investigate the impact of calcium
score level the novel biochemical parameter in preventing the progression
of the cardiovascular patients to PTCA (percutaneous transluminal coronary
angioplasty) and CABG (coronary artery bypass grafting). Four hundred
cardiovascular patients irrespective of sex were randomly selected from
Visakhapatnam district Andhrapradesh. Information of subjects was
collected using an interview schedule. Data collected were consolidated
and tabulated. From this group a sub sample of 50 patients was selected
and grouped as primordial, secondary and post PTCA. The subjects were then
analyzed for their biochemical parameters before and after intervention.
Statistical analysis was done and interpreted. An extensive evidence of
calcium score was shown among 61.2% of the cardiovascular patients, a
minimum evidence of 22.2% and moderate evidence of about 16.5%. The paired
sample t-test is employed to observe any statistical significant
difference between the before and after treatment effects. The analysis
for the calcium score level was found to be significantly lower (mean
difference=424.0134; t=13.297; df=49; p=0.01) in post intervention
(mean=88.3766+/-88.40) than pre-intervention (512.39+/-260.79812). The
present study identified calcium score the novel biochemical parameter as
a key preventive measure among the usual biochemical management conducted
by the clinicians to diagnosis and confirm the progression of the disease.

<115>
Accession Number
2011210337
Title
Transesophageal echocardiography during endovascular procedures for
thoracic aorta diseases: Sensitivity and specificity analysis.
Source
Journal of Cardiovascular Surgery. 62 (1) (pp 79-86), 2021. Date of
Publication: February 2021.
Author
NANA P.N.; BROTIS A.G.; TSOLAKI V.; SPANOS K.; MPATZALEXIS K.; ZAKYNTHINOS
E.; GIANNOUKAS A.D.; KOUVELOS G.N.
Institution
(NANA, SPANOS, MPATZALEXIS, GIANNOUKAS, KOUVELOS) Department of Vascular
Surgery, Faculty of Medicine, School of Health Sciences, University of
Thessaly, Larissa University Hospital, Larissa, Greece
(BROTIS) Department of Neurosurgery, Faculty of Medicine, School of Health
Sciences, University of Thessaly, Larissa University Hospital, Larissa,
Greece
(TSOLAKI, ZAKYNTHINOS) Intensive Care Unit, Faculty of Medicine, School of
Health Sciences, Larissa University Hospital, University of Thessaly,
Larissa, Greece
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The widespread use of endovascular repair in thoracic aorta
(TEVAR) pathologies has ameliorated postoperative outcomes. This
meta-analysis was designed to investigate the intra-operative use of
transesophageal echocardiography (TEE) compared to angiography in patients
undergoing TEVAR. EVIDENCEACQUISITION: The meta-analysis was conducted
using the Preferred Reporting Items for Systematic Reviews and
Meta-Analysis statement (PRISMA) guidelines. Adata search of the English
literature was conducted, using PubMed, EMBASEand CENTRALdatabases, until
November 30, 2019. The Grading of Recommendations, Assessment, Development
and Evaluation (GRADE) approach was used to evaluate the quality of
evidence and the summary of findings for each of the included outcomes.
EVIDENCE SYNTHESIS: The final analysis included 7 articles (183 patients).
All patients underwent TEVAR using intra-operative TEE and angiography.
The sensitivity and specificity rates of entry points were 0.624 (95% CI:
0.145-0.97) and 0.377 (95% CI: 0.029-0.856), respectively. Regarding the
detection of adequate guidewire advancement, the sensitivity was 0.778
(95% CI: 0.288-939) and specifity 0.346 (95% CI: 0.019-0.844). TEE could
detect endograft incomplete deployment within acceptable rates of
sensitivity and specifity, estimated at 0.616 (95% CI: 0.141-0.971) and
0.365 (95% CI: 0.028-0.845), respectively. The intra-operative detection
of endoleaks presented a sensitivity estimated at 0.875 (0.51-0.998) and
specificity at 0.698 (95% CI: 0.284-0.904). <br/>CONCLUSION(S): Despite
the limitations of this analysis, TEEmay be evaluated in the current
endovascular era, as a useful tool, providing adequate information, on
graft deployment and early endoleaks.<br/>Copyright &#xa9; 2021 Edizioni
Minerva Medica. All rights reserved.

<116>
Accession Number
2011208222
Title
Efficacy of systemic lidocaine on postoperative quality of recovery and
analgesia after video-assisted thoracic surgery: A randomized controlled
trial.
Source
Journal of Clinical Anesthesia. 71 (no pagination), 2021. Article Number:
110223. Date of Publication: August 2021.
Author
Yao Y.; Jiang J.; Lin W.; Yu Y.; Guo Y.; Zheng X.
Institution
(Yao, Jiang, Lin, Yu, Guo, Zheng) Department of Anesthesiology, Shengli
Clinical Medical College of Fujian Medical University, Fuzhou, Fujian,
China
Publisher
Elsevier Inc.
Abstract
Study objective: Intraoperative systemic lidocaine has become widely
accepted as an adjunct to general anesthesia, associated with
opioid-sparing and enhanced recovery. We hypothesized that perioperative
systemic lidocaine improves postoperative pain and enhances the quality of
recovery (QoR) in patients following video-assisted thoracic surgery
(VATS). <br/>Design(s): Prospective, single-center, double-blind,
randomized placebo-controlled clinical trial. <br/>Setting(s): Single
institution, tertiary university hospital. <br/>Patient(s): Adult patients
aged 18 to 65 undergoing VATS were eligible for participation.
<br/>Intervention(s): Patients enrolled in this study were randomized to
receive either system lidocaine (a bolus of 1.5 mg kg^-1,
followed by an infusion of 2 mg kg^-1 h^-1 until the
end of the surgical procedure) or identical volumes and rates of 0.9%
saline. Measurements: The primary outcome was a global QoR-15 score 24 h
after surgery. Secondary outcomes included postoperative pain score,
cumulative opioid consumption, emergence time, length of PACU stay,
adverse events, and patient satisfaction. <br/>Main Result(s): There was
no difference in the global QoR-15 scores at 24 h postoperatively between
the lidocaine and saline groups (median 117, IQR 113.5-124, vs. median
116, IQR 111-120, P = 0.067), with a median difference of 3 (95% CI 0 to
6, P = 0.507). Similarly, postoperative pain scores, postoperative
cumulative opioid consumption, PACU length of stay, the occurrence of
PONV, and patient satisfaction were comparable between the two groups (all
P > 0.05). <br/>Conclusion(s): Our current findings do not support using
perioperative systemic lidocaine as a potential strategy to improve
postoperative pain and enhance QoR in patients undergoing VATS. Trial
registration: Chinese Clinical Trial Registry (identifier:
ChiCTR1900027515).<br/>Copyright &#xa9; 2021 Elsevier Inc.

<117>
Accession Number
2006134466
Title
Comprehensive comparisons among inotropic agents on mortality and risk of
renal dysfunction in patients who underwent cardiac surgery: A network
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Medicine. 10 (5) (pp 1-12), 2021. Article Number:
1032. Date of Publication: 01 Mar 2021.
Author
Chen W.-C.; Lin M.-H.; Chen C.-L.; Chen Y.-C.; Chen C.-Y.; Lin Y.-C.; Hung
C.-C.
Institution
(Chen) Graduate Institute of Biomedical Sciences, China Medical
University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan (Republic of
China)
(Chen, Chen, Chen, Lin) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, China Medical University Hospital, No. 2,
Yude Rd., North Dist., Taichung 404332, Taiwan (Republic of China)
(Chen) Department of Education, China Medical University Hospital, No. 2,
Yude Rd., North Dist., Taichung 404332, Taiwan (Republic of China)
(Lin, Hung) Department of Pharmacy, China Medical University, No. 100,
Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan (Republic of
China)
(Chen) Department of Pharmacy, China Medical University Hsinchu Hospital,
China Medical University, No. 199, Sec. 1, Xinglong Rd., Hsinchu County,
Zhubei 30272, Taiwan (Republic of China)
(Lin) School of Medicine, China Medical University, No. 91, Hsueh-Shih
Road, Taichung 40402, Taiwan (Republic of China)
(Hung) Department of Pharmacy, China Medical University Hospital, No. 2
Yude Road, Taichung 40447, Taiwan (Republic of China)
(Hung) Department of Healthcare Administration, Asia University, 500,
Lioufeng Rd., Wufeng, Taichung 41354, Taiwan (Republic of China)
Publisher
MDPI AG
Abstract
Several kinds of inotropes have been used in critically ill patients to
improve hemodynamics and renal dysfunction after cardiac surgery; however,
the treatment strategies for reducing mortality and increasing renal
protection in patients who underwent cardiac surgery remain controversial.
Therefore, we performed a comprehensive network meta-analysis to overcome
the lack of head-to-head comparisons. A systematic database was searched
up to 31 December 2020, for randomized controlled trials that compared
different inotropes on mortality outcomes and renal protective effects
after cardiac surgery. A total of 29 trials were included and a
frequentist network meta-analysis was performed. Inconsistency analyses,
publication bias, and subgroup analyses were also conducted. Compared with
placebo, use of levosimendan significantly decreased the risks of
mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56-0.97)
and risk of acute renal injury (OR: 0.61; 95% CI: 0.45-0.82), especially
in low systolic function patients. Use of levosimendan also ranked the
best treatment based on the P-score (90.1%), followed by placebo (64.5%),
milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam
(17.0%). Taking all the available data into consideration, levosimendan
was a safe renal-protective choice for the treatment of patients
undergoing cardiac surgery, especially for those with low systolic
function.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<118>
Accession Number
2010636470
Title
The best approach for functional tricuspid regurgitation: A network
meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Di Mauro M.; Lorusso R.; Parolari A.; Ravaux J.M.; Bonalumi G.; Guarracini
S.; Ricci F.; Benedetto U.; Calafiore A.M.
Institution
(Di Mauro, Lorusso, Ravaux) Cardio-Thoracic Surgery Unit, Heart and
Vascular Centre, Maastricht University Medical Centre (MUMC),
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Parolari) IRCCS Policlinic S. Donato and Department of Biomedical
Sciences for Health, UOC of University Cardiac Surgery and Translational
Research, University of Milan, Milan, Italy
(Bonalumi) Department of Cardiac Surgery, Centro Cardiologico
Monzino-IRCCS, Milan, Italy
(Guarracini) Department of Cardiovascular Disease, "Pierangeli" Hospital,
Pescara, Italy
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences, "G.
d'Annunzio" University, Chieti, Italy
(Ricci) Department of Clinical Sciences, Lund University, Malmo, Sweden
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
Bristol University, Bristol, United Kingdom
(Calafiore) Department of Cardiac Surgery, Gemelli Molise, Campobasso,
Italy
Publisher
Blackwell Publishing Inc.
Abstract
Objective: For many years, functional tricuspid regurgitation (FTR) was
considered negligible after treatment of left-sided heart valve surgery.
The aim of the present network meta-analysis is to summarize the results
of four approaches to establish the possible gold standard.
<br/>Method(s): A systematic search was performed to identify all
publications reporting the outcomes of four approaches for FTR, not
tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA),
rigid rings (RRA). All studies reporting at least one the four endpoints
(early and late mortality, early and late moderate or more TFR) were
included in a Bayesian network meta-analysis. <br/>Result(s): There were
31 included studies with 9663 patients. Aggregate early mortality was 5.3%
no TA, 7.2% SA, 6.6% FRA, and 6.4% RRA; early TR moderate-or-more was
9.6%, 4.8%, 4.6%, and 3.8%; late mortality was 22.5%, 18.2%, 11.9%, and
11.9%; late TR moderate-or-more was 27.9%, 18.3%, 14.3%, and 6.4%. Rigid
or semirigid ring annuloplasty was the most effective approach for
decreasing the risk of late moderate or more FTR (-85% vs. no TA; -64% vs.
SA; -32% vs. FRA). Concerning late mortality, no significant differences
were found among different surgical approaches; however, flexible or rigid
rings reduced significantly the risk of late mortality (78% and 47%,
respectively) compared with not performing TA mortality. No differences
were found for early outcomes. <br/>Conclusion(s): Ring annuloplasty seems
to offer better late outcomes compare to either suture annuloplasty or not
performing TA. In particular rigid or semirigid rings provide more stable
FTR across time.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<119>
Accession Number
2010606836
Title
Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary
Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus
Suffering from Left Main Coronary Disease: A Meta-Analysis.
Source
Diabetes Therapy. (no pagination), 2021. Date of Publication: 2021.
Author
Wang H.; Wei Y.; Li X.; Jhummun V.; Ahmed M.A.
Institution
(Wang, Wang, Wei, Li) Department of Cardiology, The People's Hospital of
Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
(Jhummun) Nanjing Medical University, Nanjing, Jiangsu, China
(Ahmed) Department of Cardiology, Peking University People's Hospital,
Beijing, China
Publisher
Adis
Abstract
Introduction: In this meta-analysis, we aimed to systematically compare
the 10-year outcomes of percutaneous coronary intervention (PCI) versus
coronary artery bypass grafting (CABG) in patients with type 2 diabetes
mellitus (T2DM) suffering from left main coronary artery disease (LMCD).
<br/>Method(s): Medical Literature Analysis and Retrieval System Online
(MEDLINE), http://www.ClinicalTrials.gov, Excerpta Medica dataBASE
(EMBASE), Cochrane Central, Web of Science, and Google scholar were
searched for publications comparing 10-year outcomes of PCI versus CABG in
patients with T2DM suffering from LMCD. Cardiovascular outcomes were
considered as the clinical endpoints. Statistical analysis was carried out
using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence
intervals (CI) were used to represent the data after analysis.
<br/>Result(s): Eight studies (three randomized trials and five
observational studies) with a total number of 3835 participants with T2DM
were included in this analysis; 2340 participants were assigned to the PCI
group and 1495 participants were assigned to the CABG group. Results of
this analysis showed that mortality (RR 0.85, 95% CI 0.73-1.00; P = 0.05),
myocardial infarction (RR 0.53, 95% CI 0.35-0.80; P = 0.002), repeated
revascularization (RR 0.34, 95% CI 0.26-0.46; P = 0.00001), and target
vessel revascularization (RR 0.26, 95% CI 0.18-0.38; P = 0.00001) were
significantly higher with PCI when compared to CABG in these patients with
diabetes and LMCD. Major adverse cardiac and cerebrovascular events were
also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49-0.92;
P = 0.01). However, CABG was associated with a significantly higher risk
of stroke (RR 2.16, 95% CI 1.39-3.37; P = 0.0007). <br/>Conclusion(s):
During a long-term follow-up time period of 10 years, PCI was associated
with worse clinical outcomes compared to CABG in these patients with T2DM
suffering from LMCD. However, a significantly higher risk of stroke was
observed with CABG. This piece of information might be vital in order to
carefully choose and prevent complications following revascularization in
such patients.<br/>Copyright &#xa9; 2021, The Author(s).

<120>
Accession Number
2011216217
Title
Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of
Society of Cardiovascular Anesthesiologists Members to Explore the
Rationale and Beliefs Driving Current Clinical Decision-Making.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
McIlroy D.R.; Roman B.; Billings F.T.; Bollen B.A.; Fox A.; Geube M.; Liu
H.; Shore-Lesserson L.; Zarbock A.; Shaw A.D.
Institution
(McIlroy, Billings) Vanderbilt University Medical Center, Nashville, TN,
United States
(McIlroy) Monash University, Commercial Road, Melbourne, Victoria,
Australia
(Roman) Ochsner Medical Center, New Orleans, LA, United States
(Bollen) Missoula Anesthesiology and The International Heart Institute of
Montana, Missoula, MT, United States
(Fox) UT Southwestern Medical Center, Dallas, TX, United States
(Geube) Cleveland Clinic, Cleveland, OH, United States
(Liu) University of California Davis Health, Sacramento, CA, United States
(Shore-Lesserson) Zucker School of Medicine at Hofstra Northwell,
Manhasset, NY, United States
(Zarbock) University Hospital Munster, Munster, Germany
(Shaw) University of Alberta, Edmonton, AB, Canada
Publisher
W.B. Saunders
Abstract
Objectives: The authors sought to (1) characterize the rationale
underpinning anesthesiologists' use of various perioperative strategies
hypothesized to affect renal function in adult patients undergoing cardiac
surgery, (2) characterize existing belief about the quality of evidence
addressing the renal impact of these strategies, and (3) identify
potentially renoprotective strategies for which anesthesiologists would
most value a detailed, evidence-based review. <br/>Design(s): Survey of
perioperative practice in adult patients undergoing cardiac surgery.
<br/>Setting(s): Online survey. <br/>Participant(s): Members of the
Society of Cardiovascular Anesthesiologists (SCA). <br/>Intervention(s):
None. Measurements & Main Results: The survey was distributed to more than
2,000 SCA members and completed in whole or in part by 202 respondents.
Selection of target intraoperative blood pressure (and relative
hypotension avoidance) was the strategy most frequently reported to
reflect belief about its potential renal effect (79%; 95% CI: 72-85). Most
respondents believed the evidence supporting an effect on renal injury of
intraoperative target blood pressure during cardiac surgery was of high or
moderate quality. Other factors, including a specific nonrenal rationale,
surgeon preference, department- or institution-level decisions, tradition,
or habit, also frequently were reported to affect decision making across
queried strategies. Potential renoprotective strategies most frequently
requested for inclusion in a subsequent detailed, evidence-based review
were intraoperative target blood pressure and choice of vasopressor agent
to achieve target pressure. <br/>Conclusion(s): A large number of
perioperative strategies are believed to variably affect renal injury in
adult patients undergoing cardiac surgery, with wide variation in
perceived quality of evidence for a renal effect of these
strategies.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<121>
Accession Number
634376953
Title
Mitral valve surgery: current status and future prospects of the minimally
invasive approach.
Source
Expert review of medical devices. (no pagination), 2021. Date of
Publication: 24 Feb 2021.
Author
Van Praet K.M.; Kempfert J.; Jacobs S.; Stamm C.; Akansel S.; Kofler M.;
Sundermann S.H.; Nazari Shafti T.Z.; Jakobs K.; Holzendorf S.; Unbehaun
A.; Falk V.
Institution
(Van Praet, Kempfert, Jacobs, Stamm, Akansel, Kofler, Sundermann, Nazari
Shafti, Unbehaun, Falk) Department of Cardiothoracic and Vascular Surgery,
German Heart Center Berlin, Berlin, Germany
(Van Praet, Kempfert, Sundermann, Nazari Shafti, Falk) German Center for
Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
(Sundermann, Falk) Department of Cardiothoracic Surgery, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Nazari Shafti, Falk) Berlin Institute of Health (BIH), Berlin, Germany
(Jakobs) Institute for Anesthesiology, German Heart Center Berlin, Berlin,
Germany
(Holzendorf) Department of Perfusion, German Heart Center Berlin, Berlin,
Germany
(Falk) Department of Health Sciences, ETH Zurich, Translational
Cardiovascular Technologies, Switzerland
Publisher
NLM (Medline)
Abstract
Introduction. During the past five years the approach to procedural
planning, operative techniques and perfusion strategies for minimally
invasive mitral valve surgery (MIMVS) has evolved. With the goal to
provide a maximum of patient safety the procedure has been modified
according to individual patient characteristics and is largely based on
preoperative imaging.Areas covered. In this review article we describe the
important factors in image based therapy planning and simulation,
different access strategies, the operative key-steps, a rationale use of
devices, and highlight a few future developments in the field of MIMVS.
Published studies were identified through pearl growing, citation chasing,
a search of PubMed using the systematic review methods filter, and the
authors' topic knowledge.Expert opinion. With the help of expert teams
including surgeons specialized in mitral repair, anesthesiologists and
perfusionists a broad spectrum of mitral valve pathologies and related
pathologies can be treated with excellent functional outcomes. Avoiding
procedure related complications is the key for success for any MIMVS
program.

<122>
Accession Number
634378951
Title
Ten-year all-cause mortality according to smoking status in patients with
severe coronary artery disease undergoing surgical or percutaneous
revascularization.
Source
European journal of preventive cardiology. (no pagination), 2020. Date of
Publication: 30 Nov 2020.
Author
Takahashi K.; Thuijs D.J.F.M.; Gao C.; Ono M.; Holmes D.R.; Mack M.J.;
Morice M.-C.; Mohr F.-W.; Curzen N.; Davierwala P.M.; Milojevic M.;
Dawkins K.D.; Wykrzykowska J.J.; de Winter R.J.; McEvoy J.W.; Onuma Y.;
Head S.J.; Kappetein A.P.; Serruys P.W.
Institution
(Takahashi, Ono, Wykrzykowska, de Winter) Department of Cardiology,
Amsterdam Universities Medical Centers, Location Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Thuijs, Milojevic, Head, Kappetein) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Gao) Department of Cardiology, Radboud Medical Center, Nijmegen,
Netherlands
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, MN, Rochester, United States
(Mack) Department of Cardiothoracic Surgery, Baylor Scott & White Health,
TX, Dallas, United States
(Morice) Hopital prive Jacques Cartier, Generale de Sante Massy, Paris,
France
(Mohr, Davierwala) University Department of Cardiac Surgery, Heart Centre
Leipzig, Leipzig, Germany
(Curzen) Department of Cardiology, Coronary Research Group, University
Hospital Southampton NHS FT, Southampton, United Kingdom
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Dawkins) Shockwave Medical Inc, 5403 Betsy Ross Dr Santa Clara, CA 95054,
Santa Clara, CA, USA
(Wykrzykowska) Department of Cardiology, University Medical Centre
Groningen, University of Groningen, Groningen, Netherlands
(McEvoy, Onuma, Serruys) Department of Cardiology, National University of
Ireland, Galway (NUIG), Galway, Ireland
Publisher
NLM (Medline)
Abstract
AIMS: To evaluate the impact of various smoking status on 10-year
all-cause mortality and to examine a relative treatment benefit of
coronary artery bypass grafting (CABG) vs. percutaneous coronary
intervention (PCI) according to smoking habits. METHODS AND RESULTS: The
SYNTAX Extended Survival study evaluated vital status up to 10years in
1800 patients with de novo three-vessel disease and/or left main coronary
artery disease randomized to CABG or PCI in the SYNTAX trial. In the
present analysis, patients were divided into three groups (current,
former, or never smokers), and the primary endpoint of 10-year all-cause
mortality was assessed according to smoking status. Smoking status was
available in 1793 (99.6%) patients at the time of randomization, of whom
363 were current smokers, 798 were former smokers, and 632 were never
smokers. The crude rates of 10-year all-cause mortality were 29.7% in
current smokers, 25.3% in former smokers, and 25.9% in never smokers
(Log-rank P=0.343). After adjustment for imbalances in baseline
characteristics, current smokers had a significantly higher risk of
10-year all-cause mortality than never smokers [adjusted hazard ratio
(aHR): 2.29; 95% confidence interval (CI): 1.60-3.27; P<0.001], whereas
former smokers did not. PCI was associated with a higher risk of all-cause
mortality than CABG among current smokers (HR: 1.60; 95% CI: 1.09-2.35;
P=0.017), but it failed to show a significant interaction between
revascularization strategies and smoking status (Pinteraction=0.910).
<br/>CONCLUSION(S): Current smokers had a higher adjusted risk of 10-year
all-cause mortality, whereas former smokers did not. The treatment effect
of CABG vs. PCI did not differ significantly according to smoking status.
CLINICAL TRIAL REGISTRATION: SYNTAX: ClinicalTrials.gov reference:
NCT00114972; SYNTAX Extended Survival. ClinicalTrials.gov reference:
NCT03417050.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<123>
Accession Number
634377463
Title
Prediction of recurrent event in patients with coronary heart disease: the
EUROASPIRE Risk Model.
Source
European journal of preventive cardiology. (no pagination), 2020. Date of
Publication: 29 Dec 2020.
Author
De Bacquer D.; Ueda P.; Reiner Z.; De Sutter J.; De Smedt D.; Lovic D.;
Gotcheva N.; Fras Z.; Pogosova N.; Mirrakhimov E.; Lehto S.; Jernberg T.;
Kotseva K.; Ryden L.; Wood D.; De Backer G.
Institution
(De Bacquer, De Smedt, De Backer) Department of Public Health and Primary
Care, Ghent University, Gent 9000, Belgium
(Ueda, Ryden) Department of Medicine, Karolinska Institutet, Solna,
Stockholm, Sweden
(Ueda, Reiner) Department of Internal Medicine, University Hospital Center
Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
(De Sutter) Department of Internal Medicine and Paediatrics, Ghent
University, Ghent, Belgium
(De Sutter) Department of Cardiology, AZ Maria Middelares Ghent, Ghent,
Belgium
(Lovic) Cardiology Department, School of Medicine, Clinic for Internal
Disease Intermedica, Hypertensive Centre, Singidunum University, Nis,
Serbia
(Gotcheva) Department of Cardiology, National Heart Hospital, Sofia,
Bulgaria
(Fras) Department of Vascular Medicine, Division of Medicine, University
Medical Centre Ljubljana, Ljubljana, Slovenia
(Fras) Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
(Pogosova) National Medical Research Centre of Cardiology of the Ministry
of Healthcare of the Russian Federation, Moscow, Russian Federation
(Mirrakhimov) Kyrgyz State Medical Academy, Bishkek, Kyrgyztan
(Mirrakhimov) National Centre of Cardiology and Internal Medicine named
after academician Mirrakhimov MM, Bishkek, Kyrgyztan
(Lehto) Varkaus Hospital, Varkaus, Finland
(Jernberg) Department of Clinical Sciences, Danderyd Hospital, Karolinska
Institutet, Stockholm, Sweden
(Kotseva, Wood) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
(Kotseva, Wood) National University of Ireland, Galway, Ireland
Publisher
NLM (Medline)
Abstract
AIMS: Most patients with established atherosclerotic cardiovascular
disease (CVD) are at very high risk for developing recurrent events. Since
this risk varies a lot between patients there is a need to identify those
in whom an even more intensive secondary prevention strategy should be
envisaged. Using data from the EUROASPIRE IV and V cohorts of coronary
heart disease (CHD) patients from 27 European countries, we aimed at
developing and internally and externally validating a risk model
predicting recurrent CVD events in patients aged < 75years. METHODS AND
RESULTS: Prospective data were available for 12 484 patients after a
median follow-up time of 1.7years. The primary endpoint, a composite of
fatal CVD or new hospitalizations for non-fatal myocardial infarction
(MI), stroke, heart failure, coronary artery bypass graft, or percutaneous
coronary intervention (PCI), occurred in 1424 patients. The model was
developed based on data from 8000 randomly selected patients in whom the
association between potential risk factors and the incidence of the
primary endpoint was investigated. This model was then validated in the
remaining 4484 patients. The final multivariate model revealed a higher
risk for the primary endpoint with increasing age, a previous
hospitalization for stroke, heart failure or PCI, a previous diagnosis of
peripheral artery disease, self-reported diabetes and its glycaemic
control, higher non-high-density lipoprotein cholesterol, reduced renal
function, symptoms of depression and anxiety and living in a higher risk
country. The model demonstrated excellent internal validity and proved
very adequate in the validation cohort. Regarding external validity, the
model demonstrated good discriminative ability in 20 148 MI patients
participating in the SWEDEHEART register. Finally, we developed a risk
calculator to estimate risks at 1 and 2years for patients with stable CHD.
<br/>CONCLUSION(S): In patients with CHD, fatal and non-fatal rates of
recurrent CVD events are high. However, there are still opportunities to
optimize their management in order to prevent further disease or death.
The EUROASPIRE Risk Calculator may be of help to reach this
goal.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<124>
Accession Number
358101968
Title
Candesartan cilexetil in the treatment of chronic heart failure.
Source
Vascular Health and Risk Management. 5 (pp 257-264), 2009. Date of
Publication: 2009.
Author
Baguet J.-P.; Barone-Rochette G.; Neuder Y.
Institution
(Baguet, Barone-Rochette, Neuder) Department of Cardiology, University
Hospital, 38043 Grenoble, France
Publisher
Dove Medical Press Ltd
Abstract
The prevalence of heart failure is ever increasing around the world,
particularly due to aging populations. Despite improvements in treatment
over the last 20 years, the prognosis for heart failure remains poor.
Among the treatments recommended for chronic heart failure,
angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are
crucial, provided of course that they are not contraindicated. However,
angiotensin II receptor blockers (ARBs) can also be a beneficial treatment
option. Candesartan is a particular ARB, characterized by a strong binding
affinity to the angiotensin II type 1 receptor and slow dissociation. The
benefits of candesartan have been demonstrated by the CHARM programme,
which showed that candesartan significantly reduces the incidence of
cardiovascular death, hospital admissions for decompensated heart failure,
and all-cause mortality in chronic heart failure patients with altered
left ventricular systolic function, when added to standard therapies or as
an alternative to ACE inhibitors when these are poorly tolerated.
Furthermore, candesartan can protect against myocardial infarction, atrial
fibrillation and diabetes. Tolerance to candesartan is good, but blood
pressure and serum potassium and creatinine levels must be monitored.
&#xa9; 2009 Baguet et al, publisher and licensee Dove Medical Press Ltd.

<125>
Accession Number
2006915441
Title
Patient blood management interventions do not lead to important clinical
benefits or cost-effectiveness for major surgery: a network meta-analysis.
Source
British Journal of Anaesthesia. 126 (1) (pp 149-156), 2021. Date of
Publication: January 2021.
Author
Roman M.A.; Abbasciano R.G.; Pathak S.; Oo S.; Yusoff S.; Wozniak M.;
Qureshi S.; Lai F.Y.; Kumar T.; Richards T.; Yao G.; Estcourt L.; Murphy
G.J.
Institution
(Roman, Abbasciano, Pathak, Yusoff, Wozniak, Lai, Kumar, Murphy)
Department of Cardiovascular Sciences and National Institute for Health
Research Leicester Biomedical Research Unit in Cardiovascular Medicine,
College of Life Sciences, University of Leicester, Leicester, United
Kingdom
(Oo) Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS
Foundation Trust, Liverpool, United Kingdom
(Qureshi) Department of Cardiothoracic Surgery, University Hospitals of
Nottingham, Nottingham, United Kingdom
(Richards) Faculty of Health and Medical Sciences, University of Western
Australia, Perth, Australia
(Yao) Biostatistics Research Group, Department of Health Sciences, College
of Life Sciences, University of Leicester, Leicester, United Kingdom
(Estcourt) Haematology/Transfusion Medicine, NHS Blood, and Transplant,
John Radcliffe Hospital, Headington, Oxford, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Patient blood management (PBM) interventions aim to improve
clinical outcomes by reducing bleeding and transfusion. We assessed
whether existing evidence supports the routine use of combinations of
these interventions during and after major surgery. <br/>Method(s): Five
systematic reviews and a National Institute of Health and Care Excellence
health economic review of trials of common PBM interventions enrolling
participants of any age undergoing surgery were updated. The last search
was on June 1, 2019. Studies in trauma, burns, gastrointestinal
haemorrhage, gynaecology, dentistry, or critical care were excluded. The
co-primary outcomes were: risk of receiving red cell transfusion and
30-day or hospital all-cause mortality. Treatment effects were estimated
using random-effects models and risk ratios (RR) with 95% confidence
intervals (CIs). Heterogeneity assessments used I². Network
meta-analyses used a frequentist approach. The protocol was registered
prospectively (PROSPERO CRD42018085730). <br/>Result(s): Searches
identified 393 eligible randomised controlled trials enrolling 54 917
participants. PBM interventions resulted in a reduction in exposure to red
cell transfusion (RR=0.60; 95% CI 0.57, 0.63; I²=77%), but had
no statistically significant treatment effect on 30-day or hospital
mortality (RR=0.93; 95% CI 0.81, 1.07; I²=0%). Treatment
effects were consistent across multiple secondary outcomes, sub-groups and
sensitivity analyses that considered clinical setting, type of
intervention, and trial quality. Network meta-analysis did not demonstrate
additive benefits from the use of multiple interventions. No trial
demonstrated that PBM was cost-effective. <br/>Conclusion(s): In
randomised trials, PBM interventions do not have important clinical
benefits beyond reducing bleeding and transfusion in people undergoing
major surgery.<br/>Copyright &#xa9; 2020 The Authors

<126>
Accession Number
2004694099
Title
Detection of periodontal microorganisms in coronary atheromatous plaque
specimens of myocardial infarction patients: A systematic review and
meta-analysis.
Source
Trends in Cardiovascular Medicine. 31 (1) (pp 69-82), 2021. Date of
Publication: January 2021.
Author
Joshi C.; Bapat R.; Anderson W.; Dawson D.; Hijazi K.; Cherukara G.
Institution
(Joshi, Anderson, Hijazi, Cherukara) Institute of Dentistry, School of
Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen,
United Kingdom
(Bapat) School of Dentistry, International Medical University, Kuala
Lumpur, Malaysia
(Dawson) Department of Cardiovascular Medicine, School of Medicine,
Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Microbial translocation from inflamed periodontal pockets into
coronary atheroma via systemic circulation is one of the proposed pathways
that links periodontitis and myocardial infarction (MI). The purpose of
this systematic review is to determine the reported prevalence of
periodontal microorganisms in coronary atheroma and/or aspirated clot
samples collected from MI patients with periodontal disease. Methodology:
The "Preferred Reporting Items for Systematic Reviews and Meta-Analyses"
(PRISMA) guidelines were followed. Six databases were systematically
searched using Medical Subject Headings/Index and Entree terms. After a
thorough screening, fourteen publications spanning over ten years
(2007-2017) were eligible for this systematic review and meta-analysis.
<br/>Result(s): Out of 14 included studies, 12 reported presence of
periodontal bacterial DNA in coronary atherosclerotic plaque specimens.
Overall, Porphyromonas gingivalis and Aggregatibacter
actinomycetemcomitans were the most frequently detected periodontal
bacterial species. Meta-analysis revealed that the prevalence of P.
gingivalis was significantly higher than A. actinomycetemcomitans in
coronary atheromatous plaque samples. Apart from periodontal microbes, DNA
from a variety of other microbes e.g. Pseudomonas fluorescens,
Streptococcus species, Chlamydia pneumoniae were also recovered from the
collected samples. <br/>Conclusion(s): Consistent detection of periodontal
bacterial DNA in coronary atheroma suggests their systemic dissemination
from periodontal sites. It should further be investigated whether they are
merely bystanders or induce any structural changes within coronary
arterial walls.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<127>
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. <br/>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. <br/>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). <br/>Conclusion(s): The novel modified lung isolation strategy
reduced the incidence of hypoxemia after CPB.<br/>Copyright &#xa9; Annals
of Translational Medicine. All rights reserved.

<128>
Accession Number
633857045
Title
Rationale and design of the ADAPT-TAVR trial: A randomised comparison of
edoxaban and dual antiplatelet therapy for prevention of leaflet
thrombosis and cerebral embolisation after transcatheter aortic valve
replacement.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: 042587. Date of
Publication: 05 Jan 2021.
Author
Park H.; Kang D.-Y.; Ahn J.-M.; Kim K.W.; Wong A.Y.T.; Lam S.C.C.; Yin
W.-H.; Wei J.; Lee Y.-T.; Kao H.-L.; Lin M.-S.; Ko T.-Y.; Kim W.-J.; Kang
S.H.; Ko E.; Kim D.-H.; Koo H.J.; Yang D.H.; Kang J.-W.; Jung S.C.; Lee
J.-H.; Yun S.-C.; Park S.-J.; Park D.-W.
Institution
(Park, Kang, Ahn, Ko, Kim, Park, Park) Division of Cardiology, Asan
Medical Center, Songpa-gu, Seoul, South Korea
(Kim) Asan Image Metrics, Clinical Trial Center, Asan Institute for Life
Sciences, Asan Medical Center, Songpa-gu, Seoul, South Korea
(Kim, Koo, Yang, Kang, Jung) Department of Radiology and Research
Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, South Korea
(Wong, Lam) Division of Cardiology, Department of Medicine, Queen Mary
Hospital, Pok Fu Lam, Hong Kong
(Yin, Wei) Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
(Republic of China)
(Lee, Kao, Lin) Division of Cardiology, Department of Internal Medicine,
National Taiwan University Hospital, Taipei, Taiwan (Republic of China)
(Ko) Division of Cardiology, Department of Internal Medicine, Hsin-Chu
Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan (Republic of
China)
(Kim, Kang) Department of Cardiology, CHA Bundang Medical Center,
Seongnam, Gyeonggi-do, South Korea
(Lee) Department of Neurology, Asan Medical Center, Songpa-gu, Seoul,
South Korea
(Yun) Department of Biostatistics, Asan Medical Center, Songpa-gu, Seoul,
South Korea
Publisher
BMJ Publishing Group
Abstract
Introduction Optimal antithrombotic strategy following transcatheter
aortic valve replacement (TAVR) is still unknown. We hypothesised that the
direct factor Xa inhibitor edoxaban can potentially prevent subclinical
leaflet thrombosis and cerebral embolisation compared with conventional
dual antiplatelet therapy (DAPT) in patients undergoing TAVR. Methods and
analysis The ADAPT-TAVR trial is an international, multicentre,
randomised, open-label, superiority trial comparing edoxaban-based
strategy and DAPT strategy in patients without an indication for oral
anticoagulation who underwent successful TAVR. A total of 220 patients are
randomised (1:1 ratio), 1-7 days after successful TAVR, to receive either
edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction
criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg
daily) for 6 months. The primary endpoint was an incidence of leaflet
thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6
months post-TAVR. The key secondary endpoints were the number of new
lesions and new lesion volume on brain diffusion-weighted MRI and the
changes in neurological and neurocognitive function assessment between
immediate post-TAVR and 6 months of study drug administration. Detailed
clinical information on thromboembolic and bleeding events were also
assessed. Ethics and dissemination Ethic approval has been obtained from
the Ethics Committee/Institutional Review Board of Asan Medical Center
(approval number: 2017-1317) and this trial is also approved by National
Institute of Food and Drug Safety Evaluation of Republic of Korea
(approval number: 31511). Results of this study will be disseminated in
scientific publication in reputed journals. Trial registration number
NCT03284827.<br/>Copyright &#xa9;

<129>
Accession Number
2010845660
Title
Impact of Elevated Glycosylated Haemoglobin on Outcomes following CABG in
Patients with Diabetes Mellitus.
Source
Pakistan Journal of Medical and Health Sciences. 14 (4) (pp 1167-1169),
2020. Date of Publication: October 2020.
Author
Ali F.; Khilji S.A.; Tahir S.
Institution
(Ali) Consultant Cardiologist
(Khilji) Associate Professor of Cardiac Surgery
(Tahir) Resident, Faisalabad Institute of Cardiology, Faisalabad, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Objective: To determine the impact of HbA1c on clinical outcome after
coronary artery bypass graft surgery in patients with diabetes mellitus.
<br/>Study Design: Randomized control trial. Place and Duration of study:
Department of Cardiac Surgery, Faisalabad Institute of cardiology,
Faisalabad from 1^st June 2019 to 30^th June 2020.
Methodology: Five hundred patients who underwent isolated coronary artery
bypass graft surgery were included and stratified into two groups
according to HbA1c levels. Control group have patients with HbA1c levels
less than 7% while Study group have patients with HbA1c levels greater
than 7%. Postoperative atrial fibrillation (AF), myocardial infarction
(MI), hospital stay, time on ventilator, stroke, wound infection,
in-hospital and 30 day mortality were recorded and compared.
<br/>Result(s): There are statistically significant results in terms of
hospital stay, time on ventilator and wound infection (p-value 0.001).
<br/>Conclusion(s): HbA1c is good predictor of in hospital morbidity, so
it is necessary to have strict glycaemic control to prevent postoperative
complications.<br/>Copyright &#xa9; 2020 Lahore Medical And Dental
College. All rights reserved.

<130>
Accession Number
2008354259
Title
Skeletonized or Pedicled Harvesting of Left Internal Mammary Artery: A
Systematic Review and Meta-analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33 (1) (pp 10-18), 2021.
Date of Publication: Spring 2021.
Author
Kusu-Orkar T.-E.; Kermali M.; Masharani K.; Noshirwani A.; MacCarthy-Ofosu
B.; Oguamanam N.; Bin Saeid J.; Muir A.D.; Harky A.
Institution
(Kusu-Orkar) Department of Surgery, Pilgrim Hospital, Boston, United
Kingdom
(Kermali) Faculty of Medicine, St. George's, University of London, London,
United Kingdom
(Masharani, Noshirwani, MacCarthy-Ofosu, Bin Saeid, Muir, Harky)
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Oguamanam) Department of Cardiothoracic Surgery, Barts Heart Centre, St.
Bartholomew's Hospital, London, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
W.B. Saunders
Abstract
We sought to compare clinical outcomes in skeletonized versus pedicled
left internal mammary artery (LIMA) grafts in elective coronary artery
bypass grafting through a systematic review and meta-analysis. A
comprehensive electronic literature search of PubMed, Ovid, Embase, and
Scopus was conducted from inception to January 2020. Only short-term (30
days) studies which compared both techniques have been included in our
analysis. Primary outcomes were post anastomosis flow rate and sternal
wound infection rate (SWI); secondary outcomes were conduit length, acute
myocardial infarction and 30-day mortality. Thirteen articles with a total
of 6222 patients met the inclusion criteria. Except for the prevalence of
diabetes mellitus being significantly lower in the skeletonized cohort
(odds ratio [OR] 0.77 95% confidence interval [CI] [0.61, 0.97], P =
0.03), there were no differences in the preoperative demographics between
the 2 groups. The skeletonized LIMA conduit was significantly longer when
compared to the pedicled conduit (weighted mean difference -2.64 cm 95% CI
[-3.71, -1.56], P < 0.0001). SWI rates were not significantly different in
the skeletonized versus pedicled LIMA group (OR 0.71 95% CI [0.47, 1.06],
P = 0.10). New onset of acute myocardial infarction and 30-day mortality
rate was similar in the 2 groups (OR 1.04 and 0.97, respectively, P > 0.05
in both). The postanastomoses flow rate was higher in skeletonized LIMA
(Weighted Mean Difference -11.51 mL/min 95% CI [-20.54, -2.49], P < 0.01).
Harvesting the LIMA using the skeletonized technique is associated with
higher postanastomosis flow rates and longer conduit lengths; with no
difference in SWI and mortality rates when compared to the pedicled
technique. We suggest that this technique should be adopted, particularly
for BITA harvesting. However, further research is needed to provide
clearer indications for both methods.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<131>
Accession Number
2007255406
Title
Long-Term Outcomes of Left Main Coronary Artery Disease Treated With
Drug-Eluting Stents vs Coronary Artery Bypass Grafting: A Meta-Analysis
and Systematic Review.
Source
Cardiovascular Revascularization Medicine. 23 (pp 14-19), 2021. Date of
Publication: February 2021.
Author
Al-abcha A.; Saleh Y.; Mujer M.; Herzallah K.; Abela G.S.
Institution
(Al-abcha, Mujer) Department of Internal Medicine, Michigan State
University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist Hospital, Houston, TX,
United States
(Herzallah) Department of Cardiology, Tufts Medical Center, Boston, MA,
United States
(Abela) Department of Internal Medicine, Division of Cardiology, Michigan
State University, East Lansing, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: Currently, DES is a reasonable treatment option for LMCA
disease but CABG continues to be first-line treatment. Multiple randomized
clinical trials (RCTs) have compared outcomes between these two treatment
modalities. Recently, these trials published their long-term results with
conflicting findings. <br/>Method(s): We conducted a systematic review and
meta-analysis of RCTs that compared DES vs CABG in patients with LMCA
disease. We only included trials with follow up duration of at least 5
years. The primary outcome was all-cause mortality. Secondary outcomes
included risk of cardiac death, myocardial infarction (MI), stroke and
repeat revascularization. <br/>Result(s): We included a total of 4 RCTs.
The median-weighted follow up period was 6.5 years. There was no
significant difference between DES and CABG in all-cause mortality (Risk
ratio (RR) 1.10; 95% confidence interval (CI) 0.92 to 1.31; p = 0.28),
risk of cardiac death (RR of 1.08, 95% CI 0.84 to 1.38; p = 0.56), total
MI (RR of 1.22, 95% CI 0.96 to 1.56; p = 0.11), and stroke (RR of 0.85,
95% CI 0.46 to 1.57; p = 0.60). The risk of repeat revascularization (RR
of 1.75, 95% CI 1.50 to 2.03; p < 0.00001), and non-periprocedural MI (RR
of 2.13, 95% CI 1.53 to 2.97; p < 0.00001) were significantly higher in
the DES arm. <br/>Conclusion(s): DES has similar long-term outcomes
compared to CABG in terms of all-cause mortality, cardiac death, total MI
and stroke; but was associated with a higher risk of repeat
revascularization, and non-periprocedural MI.<br/>Copyright &#xa9; 2020
Elsevier Inc.

<132>
Accession Number
2007179403
Title
Drug-Eluting Stents Versus Bare-Metal Stents in Large Coronary Artery
Revascularization: Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 23 (pp 42-49), 2021. Date of
Publication: February 2021.
Author
Changal K.H.; Mir T.; Khan S.; Nazir S.; Elzanatey A.; Meenakshisundaram
C.; Mubbasher S.; Sheikh M.A.
Institution
(Changal, Nazir, Mubbasher) Cardiovascular Medicine, University of Toledo
Health Sciences, United States
(Mir) Internal Medicine, Detroit Medical Center, Wayne State University,
United States
(Khan) Internal Medicine, Mercy St. Vincent medical Center, Toledo, OH,
United States
(Elzanatey, Meenakshisundaram) Internal Medicine, University of Toledo
Health Sciences, United States
(Sheikh) Cardiovascular Medicine and Interventional Cardiology, Promedica
Toledo Hospital, United States
Publisher
Elsevier Inc.
Abstract
Objectives: We aim to determine if drug eluting stents (DES) are better
than bare-metal stents (BMS) in large coronary artery (diameter >= 3 mm)
percutaneous coronary intervention (PCI). <br/>Background(s): DES have
become the standard of care for PCI in coronary artery disease (CAD).
However, the superiority of DES over BMS in large vessel CAD is not clear
and previous studies have shown conflicting results. <br/>Method(s):
Randomized controlled trials (RCTs) comparing outcomes of PCI with BMS and
DES for large vessel CAD were identified from the year 2000 to August
2019. The outcomes were studied individually and included all-cause
mortality, myocardial infarction (MI), target lesion revascularization
(TLR), and stent thrombosis. Aggregated odds ratio and 95% CI were
calculated using a random-effects model. <br/>Result(s): Eight RCTs were
included (4 with data for first-generation DES, 3 with data for
second-generation DES, and 1 with data for both first- and
second-generation DES). Compared to BMS, second generation DES had a
significantly lower rate of all-cause mortality (2.4% vs. 3.9%, OR 0.74,
95% CI 0.56-0.98, P 0.04), TLR (3.5% vs. 8.6% OR 0.38 95% CI 0.28-0.53, P
< 0.001), and MI (2.1% vs. 2.9% OR 0.73 95% CI 0.53-1.0, P 0.05). The
difference in all-cause mortality was not seen with first-generation DES.
<br/>Conclusion(s): Newer DES are associated with a lower mortality, TLR,
and MI and thus should be preferred over BMS for large coronary artery
PCI.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<133>
Accession Number
2011180639
Title
Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting
Surgical Revascularization.
Source
Journal of the American College of Cardiology. 77 (10) (pp 1277-1286),
2021. Date of Publication: 16 Mar 2021.
Author
Nakashima C.A.K.; Dallan L.A.O.; Lisboa L.A.F.; Jatene F.B.; Hajjar L.A.;
Soeiro A.M.; Furtado R.H.M.; Dalcoquio T.F.; Baracioli L.M.; Lima F.G.;
Giraldez R.R.C.V.; Silva B.A.; Costa M.S.S.; Strunz C.M.C.; Dallan L.R.P.;
Barbosa C.J.D.G.; Britto F.A.B.; Farkouh M.E.; Gurbel P.A.; Nicolau J.C.
Institution
(Nakashima, Dallan, Lisboa, Jatene, Hajjar, Soeiro, Furtado, Dalcoquio,
Baracioli, Lima, Giraldez, Silva, Costa, Strunz, Dallan, Nicolau)
Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Furtado) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Barbosa) Hospital do Coracao do Brasil, Brasilia, Brazil
(Britto, Farkouh) Hospital das Clinicas, Faculdade de Medicina,
Universidade Federal de Uberlandia, Minas Gerais, Brazil
(Britto, Farkouh) Peter Munk Cardiac Centre and Heart and Stroke Richard
Lewar Centre, University of Toronto, Toronto, ON, Canada
(Gurbel) Sinai Center for Thrombosis Research and Drug Development, Sinai
Hospital of Baltimore, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Background: Dual antiplatelet therapy is recommended for patients with
acute coronary syndromes (ACS). Approximately 10% to 15% of these patients
will undergo coronary artery bypass graft (CABG) surgery for index events,
and current guidelines recommend stopping clopidogrel at least 5 days
before CABG. This waiting time has clinical and economic implications.
<br/>Objective(s): This study aimed to evaluate if a platelet
reactivity-based strategy is noninferior to standard of care for 24-h
post-CABG bleeding. <br/>Method(s): In this randomized, open label
noninferiority trial, 190 patients admitted with ACS with indications for
CABG and on aspirin and P2Y<inf>12</inf> receptor inhibitors, were
assigned to either control group, P2Y<inf>12</inf> receptor inhibitor
withdrawn 5 to 7 days before CABG, or intervention group, daily
measurements of platelet reactivity by Multiplate analyzer (Roche
Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day
after platelet reactivity normalization (pre-defined as >=46 aggregation
units). <br/>Result(s): Within the first 24 h of CABG, the median chest
tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and
350 ml (IQR: 255 to 500 ml) in the intervention and control groups,
respectively (p for noninferiority <0.001). The median waiting period
between the decision to undergo CABG and the procedure was 112 h (IQR: 66
to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the
intention-to-treat analysis, a 6.4% decrease in the median in-hospital
expenses was observed in the intervention group (p = 0.014), with 11.2%
decrease in the analysis per protocol (p = 0.003). <br/>Conclusion(s): A
strategy based on platelet reactivity-guided is noninferior to the
standard of care in patients with ACS awaiting CABG regarding
peri-operative bleeding, significantly shortens the waiting time to CABG,
and decreases hospital expenses. (Evaluation of Platelet Aggregability in
the Release of CABG in Patients With ACS With DAPT;
NCT02516267)<br/>Copyright &#xa9; 2021 American College of Cardiology
Foundation

<134>
Accession Number
2011153652
Title
COVID-19 Mortality in Transplant Recipients.
Source
International Journal of Organ Transplantation Medicine. 11 (4) (pp
145-162), 2020. Date of Publication: 2020.
Author
Alfishawy M.; Elbendary A.; Mohamed M.; Nassar M.
Institution
(Alfishawy) Infectious Diseases Consultants and Academic Researchers of
Egypt (IDCARE), Cairo, Egypt
(Alfishawy) Aswan Heart Centre, Aswan, Egypt
(Elbendary) Dermatology Department, Kasr Alainy Faculty of Medicine,
Cairo, Egypt
(Mohamed) Nephrology Division, University of Tennessee Health Science
Center, Memphis, TN, United States
(Nassar) Internal Medicine Department, Beni Suef University, Beni Suef,
Egypt
Publisher
Iranian Society for Organ Transplantation
Abstract
Background: Organ transplant recipients are vulnerable to multiple
infectious agents and in a world with a circulating SARS-CoV-2 virus, it
would be expected that patients who are immunosuppressed would have higher
mortality. <br/>Objective(s): To determine the COVID-19 mortality in
transplant recipients. <br/>Method(s): We conducted a search in PubMed and
Google scholar databases using the keywords for COVID-19 and
transplantation. All related studies between January 1, 2020 and May 7,
2020 were reviewed. All relevant published articles related to COVID-19 in
transplant recipients were included. <br/>Result(s): 46 articles were
included; they studied a total of 320 transplant patients-220 kidney
transplant recipients, 42 liver, 19 heart, 22 lung, 8 HSCT, and 9 dual
organ transplant recipients. The overall mortality rate was 20% and was
variable among different organs and different countries. 65 transplant
recipients died of complications attributable to COVID-19; 33 were males
(15% of males in this cohort), 8 females (8% of females in this cohort),
and 24 whose sex was not determined. They had a median age of 66 (range:
32-87) years. The median transplantation duration was 8 years (range: 30
days to 20 years). The most frequent comorbidity reported was
hypertensions followed by diabetes mellitus, obesity, malignancy, ischemic
heart disease, and chronic obstructive pulmonary disease. The most
frequent cause of death reported was acute respiratory distress syndrome.
<br/>Conclusion(s): Transplant recipients in our cohort had a high
mortality rate. However, outcomes were not the same in different countries
based on outbreak settings. Mortality was noted in elder patients with
comorbidities.<br/>Copyright &#xa9; 2020, International Journal of Organ
Transplantation Medicine. All Rights Reserved.

<135>
Accession Number
634359231
Title
Bridging Two Worlds: Application of Organizational Theory to Cardiac
Surgery.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 16 Feb 2021.
Author
Lee S.; Park J.; Kilic A.
Institution
(Lee, Park) Tepper School of Business, Carnegie Mellon University,
Pittsburgh, United States
(Kilic) Division of Cardiac Surgery, University of Pittsburgh Medical
Center, Pittsburgh, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: This review summarizes applications of organizational theory
and management research to cardiac surgery as it relates to patient
outcomes and the adoption of new technology. <br/>METHOD(S): A total of 17
papers published in top organizational theory and management journals from
2000-2020 that examined the cardiac surgery care setting were included.
Findings were classified according to two major outcomes of interest:
patient care and new technology adoption patterns. Findings were further
stratified based on whether predictors of these outcomes were individual-,
team-, or organizational-level factors. <br/>RESULT(S): A growing number
of studies in the organizational theory and management literature has been
using the cardiovascular care setting as a research context. Applying the
various theoretical lens of organizational theory, these studies have
studied how individual-, team-, and organizational-level factors influence
1) patient care outcomes such as patient mortality rates, readmission
rates, post-surgery complication rates, surgery duration, and
length-of-stay and 2) the adoption of new technologies or the abandonment
of old technologies. Examples of these factors include task
specialization, multi-siting, attribution, team familiarity dispersion,
distribution of failure, workload, responsibility complementarity,
expertise, team learning processes, technology status, organizational
missions, and organizational status. <br/>CONCLUSION(S): Well-established
and studied principles from the fields of organizational theory and
management research can provide unique and valuable insights into how care
processes, individual attributes, systems-related factors, and the
interplay between such factors affect cardiac surgical patient outcomes
and clinical care. Expanding collaboration between these fields and
clinicians in cardiac surgery seems prudent.<br/>Copyright &#xa9; 2021.
Published by Elsevier Inc.