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<1>
Accession Number
2010773139
Title
Scores for preoperative risk evaluation of postoperative mortality.
Source
Best Practice and Research: Clinical Anaesthesiology. 35 (1) (pp 115-134),
2021. Date of Publication: May 2021.
Author
Kivrak S.; Haller G.
Institution
(Kivrak, Haller) Division of Anaesthesia, Department of Acute Care
Medicine, Geneva University Hospitals and Faculty of Medicine, University
of Geneva, Geneva, Switzerland
(Haller) Health Services Management and Research Unit, Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
3004, Australia
Publisher
Bailliere Tindall Ltd
Abstract
Preoperative risk evaluation scores are used prior to surgery to predict
perioperative risks. They are also a useful tool to help clinicians
communicate the risk-benefit balance of the procedure to patients. This
review identifies and assesses the existing preoperative risk evaluation
scores (also called prediction scores) of postoperative mortality in all
types of surgery (emergency or scheduled) in an adult population. We
systematically identified studies using the MEDLINE, Ovid EMBASE and
Cochrane databases and published studies reporting the development and
validation of preoperative predictive scores of postoperative mortality.
We assessed usability, the level of evidence of the studies performed for
external validation, and the predictive accuracy of the scores identified.
We found 26 scores described within 60 different reports. The most
suitable scores with the highest validity identified for anaesthesia
practice were the Preoperative Score to Predict Postoperative Mortality
(POSPOM), the Universal ACS NSQIP surgical risk calculator (ACS-NSQUIP),
the Clinical Frailty Scale (CFS) and the American Society of
Anesthesiologists Physical Status (ASA-PS) classification system. While
other scores identified in this review could also be endorsed, their level
of validity and generalizability to the general surgical population should
be carefully considered. Copyright © 2020 Elsevier Ltd

<2>
Accession Number
2011175975
Title
The burden of infective endocarditis in Portugal in the last 30 years - a
systematic review of observational studies.
Source
Revista Portuguesa de Cardiologia. 40 (3) (pp 205-217), 2021. Date of
Publication: March 2021.
Author
de Sousa C.; Ribeiro R.M.; Pinto F.J.
Institution
(de Sousa, Pinto) Centro Cardiovascular da Universidade de Lisboa (CCUL),
Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
(de Sousa) Servico de Cardiologia, Centro Hospitalar Barreiro Montijo
(CHBM), EPE, Barreiro, Portugal
(Ribeiro) Laboratorio de Biomatematica, Instituto de Medicina Preventiva,
Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
(Pinto) Departamento Coracao e Vasos, Centro Hospitalar e Universitario
Lisboa Norte (CHULN), EPE, Lisboa, Portugal
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: Infective endocarditis affects cardiac valves or devices and
has a potentially uncertain prognosis. Little information is available on
the epidemiology of this disease in Portugal. Objective(s): A
systematic review of all evidence published in the last 30 years to assess
epidemiological data in patients hospitalized with infective endocarditis
in Portuguese hospital centers. Method(s): Extensive search of all
published evidence using Medline, Scopus, general search databases and in
addition Portuguese medical journals was performed. All relevant studies
in Portuguese or English that reported short- or long-term mortality were
included. Result(s): Eighteen retrospective cohort studies (15
medical and three surgical series) were included with a total of 1872
patients assessed. The medical series included 1279 patients. Older males
with predominant native left heart valve involvement were identified.
Staphylococcus and streptococcus were the most frequent reported
pathogens. Surgical intervention was performed on average in 29.8% of
cases. The short-term mortality rate ranged from three to 37.2% (average
21.9%). Surgical cases involved older males with affected native left
heart valves, emergent/urgent indication was dominant and short-term
mortality ranged from 13.6 to 16%. Conclusion(s): The current study
provides a descriptive analysis of the published series of infective
endocarditis in Portugal over the last 30 years. Therefore, it may serve
as a starting point for the development and implementation of a
multicentric prospective registry on infective endocarditis patients in
Portugal that will allow a better and more accurate characterization of
this special patient population. Copyright © 2021 Sociedade
Portuguesa de Cardiologia

<3>
Accession Number
2010524740
Title
Anemia is associated with increased risk of contrast-induced acute kidney
injury: A Systematic Review and Meta-analysis.
Source
Bioengineered. 12 (1) (pp 648-661), 2021. Date of Publication: 2021.
Author
Liang W.; Yu C.J.; Wang Q.Y.; Yu J.
Institution
(Liang, Wang, Yu) Department of Cardiology, Lanzhou University Second
Hospital, Lanzhou University, Lanzhou, China
(Yu) Medical Records Department, Lanzhou University First Hospital,
Lanzhou University, Lanzhou, China
Publisher
Bellwether Publishing, Ltd.
Abstract
Previous studies have identified numerous risk factors of contrast-induced
acute kidney injury (CI-AKI) in patients undergoing coronary angiography.
However, the association between anemia and CI-AKI remains conflicting.
Thus, we conducted a meta-analysis to further clarify the relationship
between anemia and CI-AKI. PubMed, EMBASE and Web of Science were
systematically searched from inception to June 2020 to identify eligible
studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs)
were used to estimate the correlation between anemia and CI-AKI. The
potential publication bias was estimated using funnel plot and Begg's
test. A total of 13 studies (five case-control studies and eight cohort
studies) comprising 27,135 patients were included. The pooled results
showed that anemia was a significant risk factor of CI-AKI (OR, 1.82; 95%
CI, 1.27-2.61). Moreover, the results of subgroup analyses and sensitivity
analyses were basically consistent with the overall pooled result. Funnel
plot and Begg's test indicated that there existed potential publication
bias, but the result of trim and filled analysis showed that the pooled
results kept stable after adding 'missing' studies. This meta-analysis
suggested that anemia may be correlated with an increased incidence of
CI-AKI in patients undergoing coronary angiography. However, our
conclusions should be interpreted with caution due to some limitations.
Therefore, further high-quality trials should be conducted to confirm our
findings. Copyright © 2021 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<4>
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. 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.
 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. 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. Copyright
© The Author(s) 2021.

<5>
Accession Number
2007027352
Title
Effect of Albumin Addition to Cardiopulmonary Bypass Prime on Outcomes in
Children Undergoing Open-Heart Surgery (EACPO Study)-A Randomized
Controlled Trial.
Source
World Journal for Pediatric and Congenital Heart Surgery. 12 (1) (pp
61-69), 2021. Date of Publication: January 2021.
Author
Rauf A.; Joshi R.K.; Aggarwal N.; Agarwal M.; Kumar M.; Dinand V.; Joshi
R.
Institution
(Rauf, Joshi) Department of Pediatric Intensive Care, Sir Ganga Ram
Hospital, New Delhi, Delhi, India
(Joshi, Aggarwal, Agarwal, Kumar) Department of Pediatric Cardiac
Sciences, Sir Ganga Ram Hospital, New Delhi, Delhi, India
(Dinand) Department of Research, Sir Ganga Ram Hospital, New Delhi, Delhi,
India
Publisher
SAGE Publications Inc.
Abstract
Background: There is a paucity of literature regarding the association of
high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB)
and outcomes, and no consensus exists regarding the composition of optimal
CPB priming solution. This study aimed to examine the impact of high
oncotic pressure priming by the addition of 20% human albumin on outcomes.
 Method(s): Double-blinded, randomized controlled study was done in
the pediatric cardiac intensive care unit of a tertiary care hospital.
Consecutive children with congenital heart diseases admitted for
open-heart surgery were randomized into two groups, where the study group
received an additional 20% albumin to conventional blood prime before CPB
initiation. Result(s): We enrolled 39 children in the high oncotic
prime (added albumin) group and 37 children in the conventional prime
group. In the first 24-hour postoperative period, children in the albumin
group had significantly lower occurrence of hypotension (28.2% vs 54%, P
=.02), requirement of fluid boluses (25.6% vs 54%, P =.006), and lactate
clearance time (6 vs 9 hours, P <.001). Albumin group also had
significantly higher platelet count (x103/microL) at 24 hours
(112 vs 91, P =.02). There was no significant difference in intra-CPB
hemodynamic parameters and incidence of acute kidney injury. In subgroup
analysis based on risk category, significantly decreased intensive care
unit stay (4 vs 5 days, P =.04) and hospital stay (5 vs 7 days, P =.002)
were found in the albumin group in low-risk category. Conclusion(s):
High oncotic pressure CPB prime using albumin addition might be beneficial
over conventional blood prime, and our study does provide a rationale for
further studies. Copyright © The Author(s) 2020.

<6>
Accession Number
2010119061
Title
Functional and Echocardiographic Improvement After Transcatheter Repair
for Tricuspid Regurgitation: A Systematic Review and Pooled Analysis.
Source
JACC: Cardiovascular Interventions. 13 (23) (pp 2719-2729), 2020. Date of
Publication: 14 Dec 2020.
Author
Montalto C.; Sticchi A.; Crimi G.; Laricchia A.; Khokhar A.; Giannini F.;
Ferlini M.; Colombo A.; Latib A.; Mangieri A.
Institution
(Montalto, Crimi, Ferlini) Division of Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Sticchi, Crimi) Campus Bio-Medico di Roma, Rome, Italy
(Sticchi, Crimi, Laricchia, Khokhar, Giannini, Colombo, Mangieri) GVM Care
and Research, Maria Cecilia Hospital, Cotignola, Italy
(Crimi) Interventional Cardiology Unit, Thoraco Vascular Department
(DICATOV), IRCCS Policlinico San Martino, Genova, Italy
(Latib) Montefiore Medical Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the feasibility, efficacy,
and clinical outcomes of transcatheter repair of tricuspid regurgitation
(TR) in a pooled analysis of interventional studies. Background(s):
New percutaneous devices are available to treat severe TR, but the
evidence is sparse and limited to smaller cohorts. Method(s): Several
electronic databases were searched for interventional studies involving
percutaneous repair of TR. Devices used were the Cardioband, FORMA,
MitraClip, PASCAL, and Trialign. Outcomes included in the final analysis
were successful implantation, residual severe TR, post-procedural New York
Heart Association (NYHA) functional class III or IV, 6-min walk distance,
and echocardiographic parameters. Subgroup and meta-regression analysis
were performed to further explore residual heterogeneity. Result(s):
Seven studies and 454 patients undergoing transcatheter tricuspid valve
repair were included in the pooled analysis; 95% of patients had at least
severe TR, and 91% were in NYHA functional class III or IV. Successful
implantation was achieved in 86% of patients. At the longest follow-up
available (weighted mean 265 days), 9% had died. Compared with baseline, a
significantly lower proportion of patients had at least severe TR
(relative risk: 0.38; 95% confidence interval: 0.20 to 0.70; p = 0.004)
and were in NYHA functional class III or IV (relative risk: 0.23; 95%
confidence interval: 0.20 to 0.30; p < 0.001). Patients also experienced
increases in 6-min walk distance (mean difference +64.6 m; p < 0.001) and
significant reductions in tricuspid valve annular diameter (mean
difference -3 mm; p < 0.001), while left and right ventricular function
did not change significantly. Conclusion(s): A strategy of
transcatheter repair for severe TR appears to be feasible, effective, and
associated with improved clinical outcomes at mid-term
follow-up. Copyright © 2020 American College of Cardiology
Foundation

<7>
Accession Number
2010962591
Title
Prospective model for predicting renal recovery in cardiac surgery
patients with acute kidney injury requiring renal replacement therapy.
Source
Nephrology. (no pagination), 2021. Date of Publication: 2021.
Author
Hu P.; Song L.; Liang H.; Chen Y.; Wu Y.; Zhang L.; Li Z.; Fu L.; Tao Y.;
Liu S.; Ye Z.; Fu X.; Liang X.
Institution
(Hu, Liang) The Second School of Clinical Medicine, Southern Medical
University, Guangzhou, China
(Hu, Song, Liang, Chen, Wu, Zhang, Li, Fu, Tao, Liu, Ye, Fu, Liang)
Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong
Academy of Medical Sciences, Guangzhou, China
(Hu) Division of Nephrology, Yixing People's Hospital, Yixing, Jiangsu,
China
Publisher
Blackwell Publishing
Abstract
Aim: To develop a model for predicting renal recovery in cardiac surgery
patients with acute kidney injury (AKI) requiring renal replacement
therapy (RRT). Method(s): Data from a prospective randomized
controlled trial, conducted in a tertiary hospital to compare the survival
effect of two dosages of hemofiltration for continuous RRT in cardiac
surgery patients between 20 March 2012 and 9 August 2015, were used to
develop the model. The outcome was renal recovery defined as alive and
dialysis-free 90 days after RRT initiation. Multivariate logistic
regression with a stepwise backward selection of variables based on Akaike
Information Criterion was applied to develop the model, which was
internally validated using bootstrapping. Model discrimination,
calibration and clinical value were assessed using the concordance index
(C-Index), calibration plots and decision curve analysis, respectively.
 Result(s): Totally, 211 patients with AKI requiring RRT (66.8% male)
with median age of 57 years were included. The incidence of renal recovery
was 33.2% (n = 70). The model included six variables: body mass index
stratification, baseline estimated glomerular filtration rate,
hypertension, sepsis, mean arterial pressure and mechanical ventilation.
The C-Index for this model was 0.807 (95% CI, 0.744-0.870). After
correction by the bootstrap, the C-Index was 0.780 (95% CI, 0.720-0.845).
The calibration plots indicated good consistency between actual
observations and model prediction of renal recovery. Decision curve
analysis demonstrated the model was clinical usefulness.
 Conclusion(s): We developed and validated a model to predict the
chance of renal recovery in cardiac surgery patients with AKI requiring
RRT. Copyright © 2021 The Authors. Nephrology published by John
Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of
Nephrology.

<8>
Accession Number
2010860383
Title
Racial and socioeconomic disparities in congenital heart surgery: A
research article.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Richardson C.J.; Itua P.; Duong T.; Lewars J.; Tiesenga F.
Institution
(Richardson) Department of Internal Medicine, Saint James School of
Medicine, The Quarter, Anguilla
(Itua) Department of Internal Medicine, All Saints University School of
Medicine, Roseau, Dominica
(Duong) Department of Internal Medicine, Windsor University School of
Medicine, Cayon, Saint Kitts and Nevis
(Lewars) Department of Internal Medicine, Saint James School of Medicine,
Arnos Vale, Saint Vincent and the Grenadines
(Tiesenga) Department of General Surgery, West Suburban Hospital Medical
Center, Oak Park, IL, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Though the modern era has proven to be reassuring with the
advancement of perioperative care leading to improved survival, congenital
heart disease (CHD) continues to underscore its significance in the lives
of newborns and families worldwide. Particularly, CHD has
disproportionately afflicted vulnerable minorities such as Black and
Hispanic populations from the standpoint of ethnic disparities in
mortality following heart surgery, increased resource utilization, and
longer durations of stay. This study aims to identify and provide insight
regarding the relationships between the aforementioned factors to develop
targeted strategies of intervention to mitigate the outcomes for patients
of these specific populations. Method(s): Free, current peer-reviewed
literature from databases such as the American Heart Association, The
European Heart Journal, Science Direct, and PubMed regarding CHD, racial
disparities, and socioeconomic variances were accessed. The study was
narrowed to a patient population including only infants without
chromosomal anomalies or those that passed away before hospital discharge.
 Result(s): Having private insurance and maternal education showed
positive correlations with positive outcomes of patients post congenital
heart surgery. Teaching hospitals were linked with increased mortality and
complications. Male infants showed higher rates of complications.
Hispanics had increased odds of complications. Black patients had
increased risk for failures in being rescued. Conclusion(s): Race
plays a major role in the disparities in CHD, it is imperative to evaluate
the socioeconomic contributors, surgical efforts, and provisions in place
regarding minority patients. The apparency of these disparities, and
willingness to invoke changes in practice has the potential for
improvements in outcomes for these patients. Copyright © 2021
Wiley Periodicals LLC

<9>
Accession Number
2010857046
Title
Invasive therapy versus conservative therapy for patients with stable
coronary artery disease: An updated meta-analysis.
Source
Clinical Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Vij A.; Kassab K.; Chawla H.; Kaur A.; Kodumuri V.; Jolly N.; Doukky R.
Institution
(Vij, Kassab, Doukky) Division of Cardiology, Cook County Health, Chicago,
IL, United States
(Vij, Doukky) Department of Medicine, Rush Medical college, Chicago, IL,
United States
(Chawla) Division of Cardiology, MedStar Union Memorial Hospital,
Baltimore, MD, United States
(Kaur) Department of Pathology, University of Chicago-Northshore,
Evanston, IL, United States
(Kodumuri) Division of Cardiology, Ascension All Saints Hospital, Racine,
WI, United States
(Jolly) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Heart disease remains the leading cause of death in the United
States. Although there are clear indications for revascularization in
patients with acute coronary syndromes, there is debate regarding the
benefits of revascularization in stable ischemic heart disease. We sought
to perform a comprehensive meta-analysis to assess the role of
revascularization compared to conservative medical therapy alone in
patients with stable ischemic heart disease. Hypothesis: There is no
significant difference in all-cause mortality or cardiovascular mortality
between invasive and medical arms. Method(s): We performed a
systematic literature search from January 2000 to June 2020. Our
literature search yielded seven randomized controlled trials. We analyzed
a total of 12 013 patients (6109 in revascularization arm and 5904 in
conservative medical therapy arm). Primary outcome was all-cause
mortality. Secondary outcomes included major adverse cardiac events (MACE)
(death, myocardial infarction [MI], or stroke), cardiovascular mortality,
MI, and stroke. Additional subgroup analysis for all-cause mortality was
performed comparing percutaneous coronary intervention (PCI) with bare
metal stent versus conservative therapy; and PCI with drug eluting stent
versus conservative therapy. Result(s): There was no statistically
significant difference in primary outcome of all-cause mortality between
either arm (odds ratio [OR] = 0.95; 95% CI [confidence interval], 0.83 to
1.08; p =.84). There were statistically significant lower rates of MACE
(death, MI or stroke) in the revascularization arm when compared to
conservative arm. Conclusion(s): Our analysis did not show any
survival advantage of an initial invasive strategy over conservative
medical therapy in patients with stable coronary artery disease
(CAD). Copyright © 2021 The Authors. Clinical Cardiology
published by Wiley Periodicals LLC.

<10>
Accession Number
634619105
Title
Association between admission bodymass index and outcomes in critically
ill children: A systematic review and meta-analysis.
Source
Journal of Parenteral and Enteral Nutrition. Conference: ASPEN Nutrition
Science and Practice Conference. 45 (SUPPL 1) (pp S236), 2021. Date of
Publication: March 2021.
Author
Toh S.; Ong C.; Sultana R.; Kirk A.H.P.; Koh J.C.; Lee J.H.
Institution
(Toh, Sultana) Duke-NUS Medical School, Singapore, Singapore
(Ong, Kirk, Koh, Lee) KKWomen's and Children's Hospital, Singapore,
Singapore
Publisher
John Wiley and Sons Inc.
Abstract
Purpose: The impact of nutritional status on admission to the pediatric
intensive care unit (PICU) on clinical outcomes remains unclear.We
conducted a systematic review with the aim to summarize the overall impact
of PICU admission body mass index (BMI) on outcomes of critically ill
children. Method(s):We searched the following medical databases from
inception throughMay 2020: PubMed, Excerpta Medica database (Embase),
Cumulative Index of Nursing and Allied Health Literature (CINAHL),
Cochrane Library, and Web of Science. Studies on patients <=18 years old
admitted to a PICU that investigated the effect of BMI on mortality, PICU
or hospital length of stay (LOS), or duration of mechanical ventilation
(MV) were included. Underweight, overweight, and obese groups were defined
based on each study's criteria. Result(s): There was a total of 21558
patients from 20 included studies. 12936 (60.0%), 2965 (13.8%), 2182
(10.1%), 3348 (15.5%) were normal weight, underweight, overweight, and
obese patients, respectively. There were 14 studies with mixed PICU
patient cohorts, three studies with specialized surgical cohorts
(congenital heart disease and liver transplantation), and three studies
with specialized medical cohorts (burns, extracorporeal membrane
oxygenation, oncology patients). Pooling from all studies, mortality odds
were not increased in underweight [Odds ratio (OR) 1.32, 95% confidence
interval (CI) 0.89-1.98; p = 0.171)] and overweight/obese patients (OR
1.10, 95% CI 0.86-1.42; p = 0.446), relative to normal weight patients.
There was no difference in duration ofMV, PICU and hospital LOSbetween all
three weight categories. Sensitivity analysis including only studies that
applied BMI z-scores in nutritional classification (n = 5) revealed that
underweight patients had higher mortality odds compared to normal weight
patients (OR 1.61, 95% CI 1.35-1.92; p < 0.001), while studies applying
BMI percentiles instead did not show any differences in mortality between
theweight groups. Limiting to 1681 patients across studies comprised of
mixed PICU cohorts, excluding specialized cohorts (e.g., congenital heart
surgeries, burns) (n = 6), underweight patients had an increased odds of
mortality compared to normal weight patients (OR 1.33, 95% CI 1.06-1.67; p
= 0.012). Conclusion(s): Our systematic review did not reveal any
association between PICU admission BMI status and outcomes in critically
ill children. Given the heterogeneity of studies (i.e., variations in BMI
definitions and patient cohorts across included studies), further
investigation with standardized nutritional status classification on
admission, stratified by patient subgroups, will be needed to clarify the
association between nutritional status and clinical outcomes of PICU
patients.

<11>
Accession Number
634619965
Title
The cardiac effects of pectus excavatum.
Source
Cardiovascular Journal of Africa. Conference: PASCAR, SA Heart and Africa
PCR Congress. South Africa. 30 (5 SUPPL) (pp S40), 2019. Date of
Publication: 2019.
Author
Schewitz I.
Institution
(Schewitz) Waterfall City Hospital, Johannesburg, South Africa
Publisher
Clinics Cardive Publishing (PTY)Ltd
Abstract
Introduction: Pectus excavatum has been recognised since its description
by Leonardo Davinci. By and large it has been considered a cosmetic
condition and the cardiac effects have been ignored. Since 1949 the
Ravitch procedure has been the standard operation to correct the
condition. This is an invasive, destructive procedure which yields average
cosmetic results. As such, the procedure is seldomly performed. However,
with the minimally invasive endoscopic Nuss procedure, the number of
procedures performed has increased exponentially. The marked
cardiopulmonary improvement in patients soon led clinicians to investigate
the reason for the improvement, demonstrating that cardiac compression of
the right ventricle effects cardiac output. Method(s): This is a
literature search based on the work of Drs Pilegaard, Satur and
Jaroszewski. Interpretation of cardiopulmonary exercise testing will be
presented as well as the cause of exercise dysfunction. Result(s):
The pre-operative cardiac index was below the control group, normalising 3
years after repair. Echocardiography demonstrated an increase in the right
atrial size and in the right ventricular ejection fraction.
 Conclusion(s): Increased severity of a pectus excavatum leads to a
progressive decrease in cardiac output. Repair of a pectus excavatum leads
to early improvement in cardiac function which is sustained in long-term
follow-up.

<12>
Accession Number
2011524440
Title
Patient-ventilator asynchrony in conventional ventilation modes during
short-term mechanical ventilation after cardiac surgery: Randomized
clinical trial.
Source
Multidisciplinary Respiratory Medicine. 15 (no pagination), 2020. Article
Number: 650. Date of Publication: 28 Jan 2020.
Author
Leite W.S.; Novaes A.; Bandeira M.; Ribeiro E.O.; dos Santos A.M.; de
Moura P.H.; Morais C.C.; Rattes C.; Richtrmoc M.K.; Souza J.; de Lima
G.H.C.; Modolo N.S.P.; Goncalves A.C.E.; Gonzalez C.A.R.; do Amparo
Andrade M.; de Andrade A.D.; Brandao D.C.; Campos S.L.
Institution
(Leite, Novaes, Bandeira, Ribeiro, dos Santos, de Moura, Rattes,
Richtrmoc, Souza, de Lima, do Amparo Andrade, de Andrade, Brandao, Campos)
Department of Physical Therapy, Universidade Federal de Pernambuco,
Recife, Pernambuco, Brazil
(Morais) Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Modolo, Goncalves) Department of Anaesthesiology, Institute of
Bioscience, School of Medicine, UNESP-Universidade Estadual Paulista,
Botucatu, Sao Paulo, Brazil
(Gonzalez) Hospital Monsenhor Walfredo Gurgel, Natal, Rio Grande do Norte,
Brazil
Publisher
Page Press Publications
Abstract
Introduction and aim: Studies regarding asynchrony in patiients in the
cardiac postoperative period are still only a few. The main objective of
our study was to compare asynchronies incidence and its index (AI) in 3
different modes of ventilation (volume-controlled ventilation [VCV],
pressure-controlled ventilation [PCV] and pressure-support ventilation
[PSV]) after ICU admission for postoperative care. Method(s): A
prospective parallel randomised trialin the setting of a non-profitable
hospital in Brazil. The participants were patients scheduled for cardiac
surgery. Patients were randomly allocated to VCV or PCV modes of
ventilation and later both groups were transitioned to PSV mode.
 Result(s): All data were recorded for 5 minutes in each of the three
different phases: T1) in assisted breath, T2) initial spontaneous breath
and T3) final spontaneous breath, a marking point prior to extubation.
Asynchronies were detected and counted by visual inspection method by two
independent investigators. Reliability, inter-rater agreement of
asynchronies, asynchronies incidence, total and specific asynchrony
indexes (AIt and AI<inf>specific</inf>) and odds of AI >=10% weighted by
total asynchrony were analysed. A total of 17 patients randomly allocated
to the VCV (n= 9) or PCV (n=8) group completed the study. High inter-rated
agreement for AI<inf>t</inf> (ICC 0.978; IC<inf>95</inf>%, 0,963-0.987)
and good reliability (r=0.945; p<0.001) were found. Eighty-two % of
patients presented asynchronies, although only 7% of their total breathing
cycles were asynchronous. Early cycling and double triggering had the
highest rates of asynchrony with no difference between groups. The highest
odds of AI >=10% were observed in VCV regardless the phase: OR 2.79
(1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009
and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. Conclusion(s): There
was a high incidence of breathing asynchrony in postoperative cardiac
patients, especially when initially ventilated in VCV. VCV group had a
higher chance of AI >=10% and this chance remained high in the following
PSV phases. Copyright © The Author(s), 2020

<13>
Accession Number
2011535562
Title
Comparison of dynamic needle tip positioning versus conventional long-axis
in-plane techniques for ultrasound-guided internal jugular venous
catheterization: A randomized controlled trial.
Source
Minerva Anestesiologica. 87 (3) (pp 294-301), 2021. Date of Publication:
March 2021.
Author
LEE S.; CHANG J.-E.; OH Y.; YANG H.-J.; BAE J.; CHO Y.-J.; JEON Y.; NAM
K.; KIM T.-K.
Institution
(LEE, OH, YANG, BAE, CHO, JEON, NAM) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University,
College of Medicine, Seoul, South Korea
(CHANG, OH, YANG, KIM) Department of Anesthesiology and Pain Medicine,
Seoul Metropolitan Government, Seoul National University, Boramae Medical
Center, College of Medicine, Seoul, South Korea
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Continuous visualization of the needle tip is essential for
successful ultrasound-guided central venous catheterization, and the
dynamic needle tip positioning (DNTP) technique enables it. The aim of
this randomized, dual-center trial was to compare the first-attempt
success rate of ultrasound-guided internal jugular catheterization between
the DNTP and conventional long-axis in-plane (LAX-IP) techniques.
 METHOD(S): Patients undergoing cardiac surgery at two tertiary
teaching hospitals were randomly allocated to either the DNTP or LAX-IP
group. Internal jugular venous catheterization was performed by four
anesthesiologists. The primary outcome was the first-attempt success rate
of central venous catheterization. Procedural time and complications
related to catheterization were compared as secondary outcomes.
 RESULT(S): In total, 142 patients were analysed. The first-attempt
success rate was significantly higher in the DNTP group (59/72, 81.9%)
than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence
interval 1.09-5.15; P=0.028). In addition, the needle was redirected less
frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural
time was comparable between the groups. No significant differences were
observed in complications related to catheterization, including posterior
wall puncture, carotid artery puncture, or hematoma. CONCLUSION(S):
The DNTP technique resulted in a significantly higher success rate on the
first attempt at internal jugular venous catheterization and required less
frequent redirection of the needle during the procedure than the
conventional LAX-IP technique. Copyright © 2021 Edizioni Minerva
Medica. All rights reserved.

<14>
Accession Number
2006826189
Title
Management of coronary artery disease in the setting of transcatheter
aortic valve replacement.
Source
Heart International. 14 (1) (pp 24-28), 2020. Date of Publication: 2020.
Author
Katta N.; Abbott J.D.; Kalra A.; Alenezi F.; Goldsweig A.; Aronow H.;
Velagapudi P.
Institution
(Katta, Goldsweig, Velagapudi) University of Nebraska Medical Center,
Omaha, NE, United States
(Abbott, Aronow) Brown University, Providence, RI, United States
(Kalra) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Alenezi) Duke University, Durham, NC, United States
Publisher
Touch Medical Media
Abstract
Aortic stenosis and coronary artery disease (CAD) frequently co-exist, as
they share a common pathophysiology and risk factors. Due to lack of
randomised controlled trials (RCTs) and exclusion of significant CAD in
transcatheter aortic valve replacement (TAVR) trials, the optimal method
of revascularisation of CAD in patients undergoing TAVR remains unknown.
Observational studies and meta-analyses have shown varied results in
outcomes for patients with CAD undergoing TAVR, and no significant
difference in post-TAVR outcomes in patients who underwent
revascularisation either prior to or during TAVR versus those who did not.
However, some observational studies have shown that patients with lower
residual SYNTAX score (rSS) post-revascularisation have better outcomes
post-TAVR compared to those with higher rSS. RCTs are needed to clearly
understand whether revascularisation is beneficial in these patients.
Until then, management of CAD in patients undergoing TAVR must be
individualised based on discussion with the heart team. Copyright
© Touch Medical Media 2020.

<15>
Accession Number
2010936436
Title
Effects of preoperative nutrition and multimodal prehabilitation on
functional capacity and postoperative complications in surgical lung
cancer patients: a systematic review.
Source
Supportive Care in Cancer. (no pagination), 2021. Date of Publication:
2021.
Author
Ferreira V.; Lawson C.; Ekmekjian T.; Carli F.; Scheede-Bergdahl C.;
Chevalier S.
Institution
(Ferreira, Scheede-Bergdahl) Department of Kinesiology and Physical
Education, McGill University, Montreal, QC, Canada
(Lawson, Chevalier) School of Human Nutrition, McGill University,
Macdonald-Stewart Building, MS2-043, Macdonald Campus, 21111 Lakeshore
Road, Ste-Anne-de-Bellevue, Montreal, QC H9X 3V9, Canada
(Ekmekjian) Medical Libraries, McGill University Health Center, Montreal,
QC, Canada
(Carli) Department of Anesthesia, McGill University Health Centre,
Montreal, QC, Canada
(Chevalier) Research Institute of the McGill University Health Centre,
Montreal, QC, Canada
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To determine the effect of preoperative nutrition and
multimodal prehabilitation on clinical and functional outcomes in surgical
lung cancer patients. Method(s): We searched MEDLINE, Cochrane
Library and CENTRAL, EMBASE, Scopus, and clinical trial registries
(clinicaltrials.gov, International Clinical Trials Registry Platform and
Google Scholar) to identify studies involving a preoperative
nutrition-based intervention or multimodal prehabilitation (nutrition with
exercise) of at least 7 days, in lung cancer patients awaiting surgery.
Studies must have reported results on at least one of the following
outcomes: functional capacity, pulmonary function, postoperative
complications, and length of hospital stay. The quality of included
studies was assessed using the Cochrane risk of bias assessment tool for
randomized trials and the modified Newcastle-Ottawa scale for
non-controlled trials. Result(s): Five studies were included (1
nutrition-only and 4 multimodal prehabilitation studies). Due to
substantial heterogeneity in the interventions across studies, a
meta-analysis was not conducted. Findings suggest that multimodal
prehabilitation, compared with standard hospital care, is associated with
improvements in both functional walking capacity and pulmonary function
during the preoperative period; however it does not appear to have an
effect on postoperative outcomes. Rather, the finding of significantly
lower rates of postoperative complications in the intervention group was
unique to the nutrition-only study. Conclusion(s): Multimodal
prehabilitation programs that combine nutrition and exercise may have
beneficial effects on various physical function outcomes in patients with
lung cancer awaiting surgery. Optimizing preoperative nutrition may have
postoperative benefits which remain to be confirmed. Copyright ©
2021, The Author(s), under exclusive licence to Springer-Verlag GmbH
Germany, part of Springer Nature.

<16>
Accession Number
634612758
Title
Meta-Analysis Comparing Valve in Valve Transcatheter Mitral Valve
Replacement vs. Redo Surgical Mitral Valve Replacement for Degenerating
Bioprosthetic Valves.
Source
The American journal of cardiology. (no pagination), 2021. Date of
Publication: 15 Mar 2021.
Author
Zahid S.; Ullah W.; Khan M.U.; Sarvepalli D.; Inayat A.; Khan S.; Khan
M.Z.
Institution
(Zahid) Rochester General Hospital, NY, United States
(Ullah) Abington Jefferson, United States
(Khan, Khan) West Virginia University, United States
(Sarvepalli) Gunter Medical College, India
(Inayat) Sisters of Charity Hospital, NY, United States
(Khan) St. Vincent Medical Center, OH, United States
Publisher
NLM (Medline)

<17>
Accession Number
606743480
Title
Improving wound healing and preventing surgical site complications of
closed surgical incisions: A possible role of incisional negative pressure
wound therapy. A systematic review of the literature.
Source
International Wound Journal. 13 (6) (pp 1260-1281), 2016. Date of
Publication: December 2016.
Author
Scalise A.; Calamita R.; Tartaglione C.; Pierangeli M.; Bolletta E.;
Gioacchini M.; Gesuita R.; Di Benedetto G.
Institution
(Scalise, Calamita, Tartaglione, Pierangeli, Bolletta, Gioacchini, Di
Benedetto) Department of Plastic and Reconstructive Surgery, Universita
Politecnica delle Marche, Ancona, Italy
(Gesuita) Interdepartmental Centre of Epidemiology, Biostatistics and
Medical Informatics (EBI Centre), Universita Politecnica delle Marche,
Ancona, Italy
Publisher
Blackwell Publishing Ltd
Abstract
Advances in preoperative care, surgical techniques and technologies have
enabled surgeons to achieve primary closure in a high percentage of
surgical procedures. However, often, underlying patient comorbidities in
addition to surgical-related factors make the management of surgical
wounds primary closure challenging because of the higher risk of
developing complications. To date, extensive evidence exists, which
demonstrate the benefits of negative pressure dressing in the treatment of
open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT)
technology as delivered by PrevenaTM (KCI USA, Inc., San Antonio, TX) and
Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new
investigation on possible prophylactic measures to prevent complications
via application immediately after surgery in high-risk, clean, closed
surgical incisions. A systematic review was performed to evaluate INPWT's
effect on surgical sites healing by primary intention. The primary
outcomes of interest are an understanding of INPWT functioning and
mechanisms of action, extrapolated from animal and biomedical engineering
studies and incidence of complications (infection, dehiscence, seroma,
hematoma, skin and fat necrosis, skin and fascial dehiscence or
blistering) and other variables influenced by applying INPWT (re-operation
and re-hospitalization rates, time to dry wound, cost saving) extrapolated
from human studies. A search was conducted for published articles in
various databases including PubMed, Google Scholar and Scopus Database
from 2006 to March 2014. Supplemental searches were performed using
reference lists and conference proceedings. Studies selection was based on
predetermined inclusion and exclusion criteria and data extraction
regarding study quality, model investigated, epidemiological and clinical
characteristics and type of surgery, and the outcomes were applied to all
the articles included. 1 biomedical engineering study, 2 animal studies,
15 human studies for a total of 6 randomized controlled trials, 5
prospective cohort studies, 7 retrospective analyses, were included. Human
studies investigated the outcomes of 1042 incisions on 1003 patients. The
literature shows a decrease in the incidence of infection, sero-haematoma
formation and on the re-operation rates when using INPWT. Lower level of
evidence was found on dehiscence, decreased in some studies, and was
inconsistent to make a conclusion. Because of limited studies, it is
difficult to make any assertions on the other variables, suggesting a
requirement for further studies for proper recommendations on
INPWT. Copyright © 2015 Medicalhelplines.com Inc and John Wiley &
Sons Ltd.

<18>
Accession Number
2008570774
Title
Multiple pulmonary artery mycotic aneurysms and septic emboli in a patient
with tricuspid valve vegetation and infective endocarditis.
Source
Radiology Case Reports. 16 (1) (pp 128-131), 2021. Date of Publication:
January 2021.
Author
Liang C.; Bista B.
Institution
(Liang, Bista) University of California Irvine Medical Center, Department
of Radiological Sciences, Orange, CA 92868, United States
Publisher
Elsevier Inc.
Abstract
Mycotic pulmonary artery aneurysms are rare infectious aneurysmal
dilatations of the pulmonary arteries in patients with risk factors of
intravenous drug use, endocarditis, or congenital heart disease. Timely
diagnosis is crucial given high mortality rate associated with this
condition. We present a rare case of a 24-year old male with history of
intravenous drug use who presented with fever, hypoxia, and bacteremia.
The patient was subsequently diagnosed with infective endocarditis with
septic vegetations of the tricuspid valve. Computed tomography angiogram
demonstrated multiple bilateral mycotic pulmonary artery aneurysms and
associated pulmonary septic emboli in this patient with infective
endocarditis. Treatment options for mycotic pulmonary artery aneurysms are
variable and include conservative management, endovascular coil
intervention, or surgical resections. Presence of hemoptysis and
increasing aneurysm size may warrant aggressive
intervention. Copyright © 2020

<19>
Accession Number
2008363359
Title
Meta-Analysis Comparing Culprit-Only Versus Complete Multivessel
Percutaneous Coronary Intervention in Patients With ST-Elevation
Myocardial Infarction.
Source
American Journal of Cardiology. 139 (pp 34-39), 2021. Date of Publication:
15 Jan 2021.
Author
Ullah W.; Zahid S.; Nadeem N.; Gowda S.; Munir S.; Saleem S.; Alraies
M.C.; Alam M.; Fischman D.L.
Institution
(Ullah, Nadeem, Munir) Abington Jefferson Health, Abington, PA, United
States
(Zahid) Rochester General Hospital, Rochester, NY, United States
(Gowda) University of South Dakota, Vermillion, SD, United States
(Saleem) University of Kentucky, Bowling Green, KY, United States
(Alraies) Detroit Medical Center, Detroit, MI, United States
(Alam) Baylor College of Medicine, Houston, TX, United States
(Fischman) Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Elsevier Inc.
Abstract
ST-segment elevation myocardial infarction (STEMI) in patients with
concomitant multivessel coronary artery disease is associated with poor
prognosis. We sought to determine the merits of percutaneous coronary
intervention of the culprit-only revascularization (COR) compared with
multivessel revascularization (MVR) approach. Multiple databases were
queried to identify relevant articles. Data were analyzed using a
random-effect model to calculate unadjusted odds ratio (OR) and relative
risk. A total of 28 studies comprising 26,892 patients, 18,377 in the COR
and 8,515 in the MVR group were included. The mean age of patients was 63
years, comprising 72% of male patients. The baseline characteristics of
the 2 treatment groups were comparable. On a median follow-up of 1-year,
COR was associated with a significantly higher odds of major adverse
cardiovascular events (MACE; OR 1.36, 95% confidence interval [CI] 1.10 to
1.70, p = 0.005), angina (OR 2.28, 95% CI 1.83 to 2.85, p <= 0.00001) and
revascularization (OR 1.76, 95% CI 1.22 to 2.54, p = 0.002) compared with
patients undergoing MVR for STEMI. The all-cause mortality (OR 1.18, 95%
CI 0.91 to 1.53, p = 0.22), cardiovascular mortality (OR 1.30, 95% CI 0.98
to 1.72, p = 0.07), rate of heart failure (OR 1.17, 95% CI 0.86 to 1.59, p
= 0.31), need for coronary artery bypass graft (CABG) (OR 1.47, 95% CI
0.82 to 2.64, p = 0.19), repeat myocardial infarction (MI) events (OR
1.23, 95% CI 0.93 to 1.64, p = 0.15) and risk of stroke (OR 1.27 95% CI
0.68 to 2.34, p = 0.45%) were similar between the two groups. A subgroup
analysis based on follow-up duration and study design mostly followed the
results of the pooled analysis except that the risk of repeat MI events
were significantly lower in the MVR group across RCTs (OR 1.46, 95% CI
1.10 to 1.94, p = 0.009). In contrast to the culprit-only approach, MVR in
patients with STEMI is associated with a significant reduction in MACE,
angina and need for revascularization. Copyright © 2020 Elsevier
Inc.

<20>
Accession Number
2008334639
Title
Effect of preparative rehabilitation on recovery after cardiac surgery: A
systematic review.
Source
Annals of Physical and Rehabilitation Medicine. 64 (2) (no pagination),
2021. Article Number: 101391. Date of Publication: March 2021.
Author
Yau D.K.W.; Underwood M.J.; Joynt G.M.; Lee A.
Institution
(Yau, Joynt, Lee) Department of Anaesthesia and Intensive Care, The
Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma
Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong
Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery, The
Chinese University of Hong Kong, 7/F Main Clinical Block and Trauma
Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong
Kong
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Physical prehabilitation (preparative rehabilitation) programs
may have beneficial effects on enhancing physical strength and functional
status before surgery, but their effects on postoperative recovery are
unclear. Objective(s): This systematic review investigated the
effectiveness of physical prehabilitation programs before cardiac surgery
on postoperative recovery and other perioperative outcomes.
 Method(s): We searched for reports of randomised controlled trials of
any prehabilitation programs that included physical activity or an
exercise training component in adults undergoing elective cardiac surgery,
published in any language, from six bibliographic databases (last search
on June 20, 2019). We assessed trials for risk of bias, overall certainty
of evidence and quality of intervention reporting using the Cochrane Risk
of Bias Assessment Tool, GRADE system and the Template for Intervention
Description and Replication checklist and guide, respectively.
 Result(s): All 7 studies (726 participants) were at high risk of bias
because of lack of blinding. The quality of prehabilitation reporting was
moderate because program adherence was rarely assessed. The timing of
prehabilitation ranged from 5 days to 16 weeks before surgery and from
face-to-face exercise prescription to telephone counselling and
monitoring. We found uncertain effects of prehabilitation on postoperative
clinical outcomes (among the many outcomes assessed): perioperative
mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to
5.95; I2 = 0%; low-certainty evidence) and postoperative atrial
fibrillation (relative risk 0.75, 95% CI 0.38 to 1.46; I2 =
50%; very low-certainty evidence). However, prehabilitation may improve
postoperative functional capacity and slightly shorten the hospital stay
(mean difference -0.66 days, 95% CI -1.29 to -0.03; I2 = 45%;
low-certainty evidence). Conclusion(s): Despite the high
heterogeneity among physical prehabilitation trials and the uncertainty
regarding robust clinical outcomes, physical prehabilitation before
cardiac surgery seems to enhance selected postoperative functional
performance measures and slightly reduce the hospital length of stay after
cardiac surgery. Copyright © 2020 Elsevier Masson SAS

<21>
Accession Number
2008607262
Title
A systematic review of effects of recorded music listening during exercise
on physical activity adherence and health outcomes in patients with
coronary heart disease.
Source
Annals of Physical and Rehabilitation Medicine. 64 (2) (no pagination),
2021. Article Number: 101447. Date of Publication: March 2021.
Author
Chair S.Y.; Zou H.; Cao X.
Institution
(Chair, Zou, Cao) Faculty of Medicine, The Nethersole School of Nursing,
The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Exercise training is a key facet of cardiac rehabilitation and
is associated with irrefutable benefits for individuals with coronary
heart disease. However, compliance with and adherence to such
interventions are challenging among this population. The incorporation of
music into exercise training may be a potential approach to address this
issue. Objective(s): This study aimed to evaluate the effects of
recorded music listening during exercise on adherence to physical activity
and health outcomes in individuals with coronary heart disease.
 Method(s): A systematic review was conducted by searching 7 English
databases for reports of randomized controlled trials and
quasi-experimental studies evaluating the effects of recorded music
listening during exercise on adherence to physical activity and physical,
psychological, and cognitive outcomes in adults with coronary heart
disease. Two reviewers independently screened records for eligibility,
extracted data, and assessed the quality of reports by using the Effective
Public Health Practice Project Quality Assessment Tool tool.
 Result(s): We identified 7 studies involving 293 participants (mean
age 62.6 to 72 years, men: 57% to 80%). All but one study included
relatively small samples (17 to 56). The overall quality was weak for 3
studies, moderate for 2, and strong for 2. Several reviewed studies showed
significant effects of music on attendance at exercise-based cardiac
rehabilitation (1 of 2 studies), maintenance of physical activity after
intervention (1 study), perceived exertion (2 of 3 studies), exercise
capacity (1 of 3 studies), heart rate during exercise (1 of 2 studies),
male waist circumference (1 of 2 studies), mood (2 of 3 studies), and
cognitive function (1 study) as compared with controls.
 Conclusion(s): This review provides relatively limited evidence for
the potential benefits of recorded music listening during exercise in
individuals with coronary heart disease. The findings should be carefully
interpreted and generalised. Further rigorous-designed research addressing
the limitations of current literature is needed. Copyright © 2020
Elsevier Masson SAS

<22>
Accession Number
2007411144
Title
Right ventricular outflow tract reconstruction with Medtronic Freestyle
valve in the Ross procedure: A systematic review with meta-analysis.
Source
Artificial Organs. 45 (4) (pp 338-345), 2021. Date of Publication: April
2021.
Author
Van den Eynde J.; Michel Pompeu B. O. S.A.; Callahan C.P.; Dimagli A.;
Vervoort D.; Kampaktsis P.N.; Zhigalov K.; Ruhparwar A.; Weymann A.
Institution
(Van den Eynde) Department of Cardiovascular Diseases, Unit of Cardiac
Surgery, University Hospitals Leuven, Leuven, Belgium
(Michel Pompeu B. O.) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco, PROCAPE, University of Pernambuco, Recife,
Brazil
(Callahan) Hospital for Sick Children, University of Toronto, Toronto, ON,
Canada
(Dimagli) School of Clinical Sciences, Bristol Heart Institute, University
of Bristol, Bristol, United Kingdom
(Vervoort) Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, United States
(Kampaktsis) Department of Medicine, New York University Langone Medical
Center, New York, NY, United States
(Zhigalov, Ruhparwar, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
Blackwell Publishing Inc.
Abstract
Cryopreserved pulmonary homografts (PH) are the current gold standard for
right ventricular outflow tract (RVOT) reconstruction in the Ross
procedure. Unfortunately, their use is limited by a relatively scarce
availability and high cost. Porcine stentless xenografts (SX) such as the
Medtronic Freestyle SX are increasingly being used, although it is unclear
whether the hemodynamic performance and the long-term durability are
satisfactory. The present systematic review followed the Preferred
Reporting Items for Systematic reviews and Meta-Analysis statement. The
pooled treatment effects were calculated using a weighted
DerSimonian-Laird random-effects model. We also evaluated the effect of
time after RVOT reconstruction on valve gradients using meta-regression.
Six studies with a total of 156 patients met the inclusion criteria. The
pooled estimates for the pooled follow-up of 37 months were: 1.3%
operative mortality, 94.8% overall survival, 7.5% structural valve
deterioration, 5.2% reintervention, 73.3% asymptomatic, and 1.5% moderate
or severe pulmonary insufficiency. Peak valve gradients were significantly
correlated with time after RVOT, increasing during follow-up. Three
studies compared PH with SX, one concluded that the SX is an acceptable
alternative for RVOT reconstruction, whereas two concluded that this
valvular substitute had inferior performance. The Freestyle SX can be
considered as an alternative to PH, although it might be associated with
more reinterventions, higher peak valve pressure gradients, and pulmonary
valve dysfunction. Copyright © 2020 International Center for
Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC

<23>
Accession Number
633710049
Title
Objective Risk Assessment vs Standard Care for Acute Coronary Syndromes: A
Randomized Clinical Trial.
Source
JAMA Cardiology. 6 (3) (pp 304-313), 2021. Date of Publication: March
2021.
Author
Chew D.P.; Hyun K.; Morton E.; Horsfall M.; Hillis G.S.; Chow C.K.; Quinn
S.; D'Souza M.; Yan A.T.; Gale C.P.; Goodman S.G.; Fox K.; Brieger D.
Institution
(Chew, Morton, Horsfall) College of Medicine and Public Health, Flinders
University of South Australia, Adelaide, Australia
(Hyun, Chow, D'Souza) Westmead Applied Research Centre, Faulty of Medicine
and Health, University of Sydney, Sydney, Australia
(Hyun) Department of Cardiology, Westmead Hospital, Sydney, Australia
(Hillis) School of Medicine, University of Western Australia, Perth,
Australia
(Quinn) Department of Health Science and Biostatistics, Swinburne
University of Technology, Melbourne, Australia
(Yan, Goodman) St Michael's Hospital, Department of Medicine, University
of Toronto, Toronto, ON, Canada
(Gale) Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Brieger) Cardiology Department, Concord Repatriation General Hospital,
Sydney, Australia
Publisher
American Medical Association
Abstract
Importance: Although international guidelines recommend use of the Global
Registries of Acute Coronary Events (GRACE) risk score (GRS) to guide
acute coronary syndrome (ACS) treatment decisions, the prospective utility
of the GRS in improving care and outcomes is unproven. Objective(s):
To assess the effect of routine GRS implementation on guideline-indicated
treatments and clinical outcomes of hospitalized patients with ACS.
 Design, Setting, and Participant(s): Prospective cluster
(hospital-level) randomized open-label blinded end point (PROBE) clinical
trial using a multicenter ACS registry of acute care cardiology services.
Fixed sampling of the first 10 patients within calendar month, with either
ST-segment elevation or non-ST-segment elevation ACS. The study enrolled
patients from June 2014 to March 2018, and data were analyzed between
February 2020 and April 2020. Intervention(s): Implementation of
routine risk stratification using the GRS and guideline recommendations.
 Main Outcomes and Measures: The primary outcome was a performance
score based on receipt of early invasive treatment, discharge prescription
of 4 of 5 guideline-recommended pharmacotherapies, and cardiac
rehabilitation referral. Clinical outcomes included a composite of
all-cause death and/or myocardial infarction (MI) within 1 year.
 Result(s): This study enrolled 2318 patients from 24 hospitals and
was stopped prematurely owing to futility. Of the patients enrolled,
median age was 65 years (interquartile range, 56-74 years), 29.5% were
women (n = 684), and 62.9% were considered high risk (n = 1433). Provision
of all 3 measures among high-risk patients did not differ between the
randomized arms (GRS: 424 of 717 [59.9%] vs control: 376 of 681 [55.2%];
odds ratio [OR], 1.04; 95% CI, 0.63-1.71; P =.88). The provision of early
invasive treatment was increased compared with the control arm (GRS: 1042
of 1135 [91.8%] vs control: 989 of 1183 [83.6%]; OR, 2.26; 95% CI,
1.30-3.96; P =.004). Prescription of 4 of 5 guideline-recommended
pharmacotherapies (GRS: 864 of 1135 [76.7%] vs control: 893 of 1183
[77.5%]; OR, 0.97; 95% CI, 0.68-1.38) and cardiac rehabilitation (GRS: 855
of 1135 [75.1%] vs control: 861 of 1183 [72.8%]; OR, 0.68; 95% CI,
0.32-1.44) were not different. By 12 months, GRS intervention was not
associated with a significant reduction in death or MI compared with the
control group (GRS: 96 of 1044 [9.2%] vs control: 146 of 1087 [13.4%]; OR,
0.66; 95% CI, 0.38-1.14). Conclusions and Relevance: Routine GRS
implementation in cardiology services with high levels of clinical care
was associated with an increase in early invasive treatment but not other
aspects of care. Low event rates and premature study discontinuation
indicates the need for further, larger scale randomized studies. Trial
Registration: anzctr.org.au Identifier: ACTRN12614000550606. Copyright
© 2020 American Medical Association. All rights reserved.

<24>
Accession Number
2011438402
Title
Identifying the association between tacrolimus exposure and toxicity in
heart and lung transplant recipients: A systematic review.
Source
Transplantation Reviews. 35 (2) (no pagination), 2021. Article Number:
100610. Date of Publication: April 2021.
Author
Braithwaite H.E.; Darley D.R.; Brett J.; Day R.O.; Carland J.E.
Institution
(Braithwaite, Darley, Brett, Day) St Vincent's Clinical School, UNSW
Medicine, University of New South Wales, Sydney, Australia
(Darley) Lung Transplant Unit, St Vincent's Hospital Darlinghurst, Sydney,
Australia
(Brett, Day, Carland) Department of Clinical Pharmacology and Toxicology,
St Vincent's Hospital, Sydney, Australia
(Carland) Department of Pharmacology, School of Medical Sciences,
University of New South Wales, Sydney, Australia
Publisher
W.B. Saunders
Abstract
Aims: Tacrolimus is the cornerstone of immunosuppression management in
heart and lung transplant recipients, improving overall survival. However,
tacrolimus-associated toxicities, including nephrotoxicity, neurotoxicity,
new-onset diabetes mellitus after transplant (NODAT), and gastrointestinal
toxicity, are known contributors to increased post-transplant morbidity
outcomes and reduced graft and recipient survival rates. The aim of this
systematic review was to identify correlations between pharmacokinetic
measures of tacrolimus exposure in heart and lung recipients and
tacrolimus toxicities. Method(s): MEDLINE, Embase, the Cochrane
Library, CENTRAL and WHO Clinical Trial Registries were searched for
published studies evaluating tacrolimus toxicities and their correlation
to pharmacokinetic monitoring parameters in thoracic transplant
recipients. Studies were reviewed by two authors, with data extracted for
evaluation. Risk of bias was assessed using the PEDro scale for randomised
control trials and the Newcastle Ottawa Scale for non-randomised cohort
studies. Result(s): Eighteen studies were eligible; a randomised
control trial, 11 observational cohort studies, and 6 case series or
studies. Of these, 9 studies were in heart transplant recipients alone and
5 in lung transplant recipients alone, 2 studies were in heart and lung
transplant recipients and 2 were heart, lung, liver or renal transplant
recipients. Studies used variable criteria to define toxicities.
Tacrolimus trough concentration (C<inf>0</inf>) was the marker of
tacrolimus exposure most commonly used. Ten studies reported on
nephrotoxicity. Elevated tacrolimus C<inf>0</inf> was associated with
acute kidney injury occurrence and severity in three observational
studies. Increasing C<inf>0</inf> was a predictor of renal impairment in 6
studies. One study found that for each 5 ng/mL per year of tacrolimus
exposure, defined by consecutive AUC, eGFR declined by 1.3
mL/min/1.73m2 (p < 0.001). Comparatively, 2 studies failed to
find a significant association between nephrotoxicity and tacrolimus
exposure. Seven studies reported on neurotoxicity, including
neuro-encephalopathies, polyneuropathies and symptomatic change in
neurological status. Neurotoxicity occurred both with tacrolimus
C<inf>0</inf> within therapeutic range and with supratherapeutic
C<inf>0</inf>. No significant association was found between NODAT and
tacrolimus C<inf>0</inf> in two studies. One study reported on
gastrointestinal toxicity, with supratherapeutic C<inf>0</inf> and
elevated peak concentration in one lung transplant recipient three days
prior to symptom development. Conclusion(s): No clearly defined
relationship between tacrolimus exposure and toxicities is described in
the literature. Studies with clear toxicity criteria and pharmacokinetic
markers of tacrolimus exposure are required to provide valuable
information that may optimise tacrolimus therapy, helping to reduce
toxicities in heart and lung transplant recipients. Copyright ©
2021 Elsevier Inc.

<25>
Accession Number
2008476014
Title
Predictive value of early cardiac magnetic resonance imaging functional
and geometric indexes for adverse left ventricular remodelling in patients
with anterior ST-segment elevation myocardial infarction: A report from
the CIRCUS study.
Source
Archives of Cardiovascular Diseases. 113 (11) (pp 710-720), 2020. Date of
Publication: November 2020.
Author
Pezel T.; Besseyre des Horts T.; Schaaf M.; Croisille P.; Biere L.;
Garcia-Dorado D.; Jossan C.; Roubille F.; Cung T.-T.; Prunier F.; Meyer
E.; Amaz C.; Derumeaux G.; de Poli F.; Hovasse T.; Gilard M.; Bergerot C.;
Thibault H.; Ovize M.; Mewton N.
Institution
(Pezel) Inserm, UMRS 942, Department of Cardiology, Lariboisiere Hospital,
Paris University, AP-HP, Paris 75010, France
(Pezel) Division of Cardiology, Johns-Hopkins University, Baltimore, MD
21287-0409, United States
(Besseyre des Horts, Schaaf, Jossan, Amaz, Bergerot, Thibault, Ovize,
Mewton) Inserm 1407, Clinical Investigation Centre and Heart Failure
Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon,
universite Claude-Bernard Lyon 1, Bron 69677, France
(Croisille) Radiology Department, University Hospital of Saint-Etienne,
Saint-Priest-en-Jarez 42270, France
(Biere, Prunier) Cardiology Division, University Hospital of Angers,
Angers 49100, France
(Garcia-Dorado) CIBERCV, Hospital Universitari Vall d'Hebron & Research
Institute, Universitat Autonoma de Barcelona, Barcelona 08035, Spain
(Roubille, Cung) UMR5203, UMR661, Cardiology Division, University Hospital
of Montpellier, University of Montpellier 1 and 2, Montpellier 34295,
France
(Meyer) Rangeuil Hospital, University Hospital of Toulouse, Paul-Sabatier
University, Toulouse 31400, France
(Derumeaux) DHU-ATVB, Henri-Mondor Hospital, Paris-Est Creteil University,
AP-HP, Creteil 94010, France
(de Poli) Cardiology Division, Haguenau Hospital, Haguenau 67500, France
(Hovasse) Cardiology Division, Jacques-Cartier Institute, Massy 91300,
France
(Gilard) Department of Cardiology, Brest University Hospital, Brest 29200,
France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Postinfarction adverse left ventricular (LV) remodelling is
strongly associated with heart failure events. Conicity index, sphericity
index and LV global functional index (LVGFI) are new LV remodelling
indexes assessed by cardiac magnetic resonance (CMR). Aim(s): To
assess the predictive value of the new indexes for 1-year adverse LV
remodelling in patients with anterior ST-segment elevated myocardial
infarction (STEMI). Method(s): CMR studies were performed in 129
patients with anterior STEMI (58 +/- 12 years; 78% men) from the
randomized CIRCUS trial (CMR substudy) treated with primary percutaneous
coronary intervention and followed for the occurrence of major adverse
cardiovascular events (MACE) (death or hospitalization for heart failure).
Conicity index, sphericity index, LVGFI, infarct size and microvascular
obstruction (MVO) were assessed by CMR performed 5 +/- 4 days after
coronary reperfusion. Adverse LV remodelling was defined as an increase in
LV end-diastolic volume of >=15% by transthoracic echocardiography at 1
year. Result(s): Adverse LV remodelling occurred in 27% of patients
at 1 year. Infarct size and MVO were significantly predictive of adverse
LV remodelling: odds ratio [OR] 1.03, 95% confidence interval [CI]
1.01-1.05 (P < 0.001) and OR 1.12, 95% CI 1.05-1.22 (P < 0.001),
respectively. Among the newly tested indexes, only LVGFI was significantly
predictive of adverse LV remodelling (OR 1.10, 95% CI 1.03-1.16; P =
0.001). In multivariable analysis, infarct size remained an independent
predictor of adverse LV remodelling at 1 year (OR 1.05, 95% CI 1.02-1.08;
P < 0.001). LVGFI and infarct size were associated with occurrence of
MACE: OR 1.21, 95% CI 1.08-1.37 (P < 0.001) and OR 1.02, 95% CI 1.00-1.04
(P = 0.018), respectively. Conicity and sphericity indexes were not
associated with MACE. Conclusion(s): LVGFI was associated with
adverse LV remodelling and MACE 1 year after anterior STEMI. Copyright
© 2020

<26>
Accession Number
2008403682
Title
Hepatocyte Growth Factor Mimetic ANG-3777 for Cardiac Surgery-Associated
Acute Kidney Injury.
Source
Kidney International Reports. 5 (12) (pp 2325-2332), 2020. Date of
Publication: December 2020.
Author
Ayad S.; Neylan J.F.; Mayne T.J.; Gouveia D.; Swaminathan M.
Institution
(Ayad) Cleveland Clinic, Anesthesiology Institute, Outcomes Research,
Cleveland, OH, United States
(Neylan, Mayne, Gouveia) Angion Biomedica Corporation, Uniondale, NY,
United States
(Swaminathan) Duke University, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Nearly one-third of patients undergoing cardiac surgery
involving cardiopulmonary bypass (CPB) experience cardiac
surgery-associated (CSA) acute kidney injury (AKI); 5% require renal
replacement therapy. ANG-3777 is a hepatocyte growth factor mimetic. In
vitro, ANG-3777 reduces apoptosis and increases cell proliferation,
migration, morphogenesis, and angiogenesis in injured kidneys. In animal
models, ANG-3777 mitigates the effects of renal damage secondary to
ischemia reperfusion injury and nephrotoxic chemicals. Phase 2 data in AKI
of renal transplantation have shown improved renal function and comparable
safety relative to placebo. The Guard Against Renal Damage (GUARD) study
is a phase 2 proof of concept trial of ANG-3777 in CSA-AKI.
 Method(s): GUARD is a 240-patient, multicenter, double-blind,
randomized placebo-controlled trial to assess the efficacy and safety of
ANG-3777 in patients at elevated pre-surgery risk for AKI undergoing
coronary artery bypass graft (CABG) or heart valve repair/replacement
requiring CPB. Subjects are randomized 1:1 to receive ANG-3777 (2 mg/kg)
or placebo. Study drug is dosed via 4 daily intravenous 30-minute
infusions. The first dose is administered less than 4 hours after
completing CPB, second at 24 +/- 2 hours post-CPB, with two subsequent
doses at 24 +/- 2 hours after the previous dose. Result(s): The
primary efficacy endpoint is percent change from baseline serum creatinine
to mean area under the curve from days 2 through 6. Secondary endpoints
include change in estimated glomerular filtration rate from baseline to
day 30, the proportion of patients diagnosed with AKI by stage through day
5, and the length of CSA-AKI hospitalization. Safety will include adverse
events and laboratory measures. Conclusion(s): This phase 2 study of
ANG-3777 provides data to develop a phase 3 registrational study in this
medically complex condition. Copyright © 2020 International
Society of Nephrology

<27>
Accession Number
2008362965
Title
Aortic valve sparing surgery. Results to 9 years.
Source
Cirugia Cardiovascular. 27 (6) (pp 236-245), 2020. Date of Publication: 01
Nov 2020.
Author
Alvarez-Cabo R.; Vigil-Escalera C.; Escalera A.E.; Meana B.; Martin M.; de
la Hera J.M.; Salmeron C.; Diaz R.; Hernandez-Vaquero D.; Meca J.; Mencia
P.; Zabala M.; Callejo F.; Llosa J.C.; Morales C.; Silva J.
Institution
(Alvarez-Cabo, Vigil-Escalera, Escalera, Meana, Salmeron, Diaz,
Hernandez-Vaquero, Meca, Mencia, Zabala, Callejo, Llosa, Morales, Silva)
Servicio de Cirugia Cardiaca, Area del Corazon, Hospital Universitario
Central de Asturias (HUCA), Oviedo, Asturias, Spain
(Martin, de la Hera) Servicio de Cardiologia, Area del Corazon, Hospital
Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: Clinical practice guidelines recommend, in
young patients and experienced centers, aortic valve sparing surgery for
the treatment of aortic regurgitation as an alternative to aortic valve
replacement. It is a complex surgery, but demanded more frequently. We
must consider it as a therapeutic option and explain its results.
 Method(s): Prospective, non randomized, analysis of 138 patients
operated on with aortic valve sparing surgery (2011-2019). Result(s):
They presented: mean-age 58.1+/-14.2 years, 33 (23.9%) women, 9 (6.5%)
emerging; EUROSCORE-II: 3.35+/-2.9, EUROSCORE-LOGISTIC: 9.29+/-7. Valve
morphology was: 83 (60.1%)-tricuspid, 44 (31.9%)-bicuspid, 11
(8%)-unicuspid. Procedures performed: (valve-reimplantation [DAVID] +
aortic-plasty): 78 (56.5%); (aortic-remodeling [YACOUB] + aortic-plasty):
22 (15.9%); aortic-plasty+supracoronary-tube: 15 (10.9%); aortic-plasty:
23 (16.7%). The 69.36% of aortic leafleats required multiple techniques:
(63.5%) central-plication, (10.3%) decalcification and (20.9%)
pericardium-plasty. There was reoperation for bleeding 4 (2.9%). Eight
(5.8%) patients died in the immediate postoperative period (3.9% of
electives). Preoperative aortic regurgitation was: I-II(18.1%), III(17.4%)
and IV(64.5%). Intra-operative regurgitation grade II persisted in 16
(11.6%) patients, converting to aortic prostheses. The mean follow-up was
44.2+/-28.6 (median 42.5) months. At 9 years they are free of aortic
regurgitation >= III: 83.5% (whole-series); 84.6% (aortic-root-treatment
[DAVID+YACOUB]) vs. 81.9% (no-aortic-root-treatment) (p=0.4); 88.8%
(DAVID), 63.2% (YACOUB), 85.7% (aortic-plasty+supracoronary-tube) and
78.3% (aortic-plasty) (p=0.22); 63.5% (pericardium-plasty) vs. 97.7%
(without pericardium-plasty) (p<0.0001). And they are free of
re-operation: 88.4% (whole-series); 89.7% (aortic-root-treatment
[DAVID+YACOUB]) vs. 85.8% (no-aortic-root-treatment) (p=0.27); 89.5%
(DAVID), 93.3% (YACOUB), 92.8% (aortic-plasty+supracoronary-tube) and
78.3% (aortic-plasty) (p=0.24); 71.5% (pericardium-plasty) vs.
100%(without pericardium-plasty) (p<0.0001). At follow-up there were
endocarditis in 2 (1.75%) patients, there were no thromboembolic events.
 Conclusion(s): The durability of aortic valve sparing surgery is
good, without significant differences between different types of
techniques; the use of heterologous pericardium is the main cause of
reduced durability. Copyright © 2020 Sociedad Espanola de Cirugia
Cardiovascular y Endovascular

<28>
Accession Number
631235516
Title
Meta-Analysis of cardiovascular superiority trials published in the New
England Journal of Medicine to elucidate the concept of superiority
margin.
Source
Postgraduate Medical Journal. 97 (1146) (pp 227-233), 2021. Date of
Publication: 01 Apr 2021.
Author
Gamad N.; Shafiq N.; Malhotra S.
Institution
(Gamad, Shafiq, Malhotra) Department of Pharmacology, Institute of Medical
Education and Research, Chandigarh, India
Publisher
BMJ Publishing Group
Abstract
Objective To show that overpowered trials claim statistical significance
detouring clinical relevance and warrant the need of superiority margin to
avoid such misinterpretation. Design Selective review of articles
published in the New England Journal of Medicine between 1 January 2015
and 31 December 2018 and meta-Analysis following Preferred Reporting Items
for Systematic Reviews and Meta-Analyses checklist. Eligibility criteria
for selecting studies and methods Published superiority trials evaluating
cardiovascular diseases and diabetes mellitus with positive efficacy
outcome were eligible. Fixed effects meta-Analysis was performed using
RevMan V.5.3 to calculate overall effect estimate, pooled HR and it was
compared with mean clinically significant difference. Results Thirteen
eligible trials with 164 721 participants provided the quantitative data
for this review. Largely, the primary efficacy endpoint in these trials
was the composite of cardiovascular death, non-fatal myocardial
infarction, unstable angina requiring rehospitalisation, coronary
revascularisation and fatal or non-fatal stroke. The pooled HR was 0.86
(95% CI 0.84 to 0.89, I 2 =45%) which was lower than the mean clinically
significant difference of 0.196 (19.6%, range: 0.09375-0.35) of these
studies. There was a wide 95% CI in these studies from 0.56 to 0.99. The
upper margin of CI in most of the studies was close to the line of no
difference. Absolute risk reduction was small (1.19% to 2.3%) translating
to a high median number needed to treat of 63 (range: 43 to 84) over a
follow-up duration of 2.95 years. Conclusions The results of this
meta-Analysis indicate that overpowered trials give statistically
significant results undermining clinical relevance. To avoid such misuse
of current statistical tools, there is a need to derive superiority
margin. We hope to generate debate on considering clinically significant
difference, used to calculate sample size, as superiority margin.
 Copyright ©

<29>
Accession Number
634091186
Title
Restrictive Transfusion Strategy after Cardiac Surgery.
Source
Anesthesiology. 134 (3) (pp 370-380), 2021. Date of Publication: 01 Mar
2021.
Author
Zeroual N.; Blin C.; Saour M.; David H.; Aouinti S.; Picot M.-C.; Colson
P.H.; Gaudard P.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recent guidelines on transfusion in cardiac surgery suggest
that hemoglobin might not be the only criterion to trigger transfusion.
Central venous oxygen saturation (Svo2), which is related to the balance
between tissue oxygen delivery and consumption, may help the decision
process of transfusion. We designed a randomized study to test whether
central Svo2-guided transfusion could reduce transfusion incidence after
cardiac surgery. METHOD(S): This single center, single-blinded,
randomized controlled trial was conducted on adult patients after cardiac
surgery in the intensive care unit (ICU) of a tertiary university
hospital. Patients were screened preoperatively and were assigned randomly
to two study groups (control or Svo2) if they developed anemia (hemoglobin
less than 9 g/dl), without active bleeding, during their ICU stay.
Patients were transfused at each anemia episode during their ICU stay
except the Svo2 patients who were transfused only if the pretransfusion
central Svo2 was less than or equal to 65%. The primary outcome was the
proportion of patients transfused in the ICU. The main secondary endpoints
were (1) number of erythrocyte units transfused in the ICU and at study
discharge, and (2) the proportion of patients transfused at study
discharge. RESULT(S): Among 484 screened patients, 100 were
randomized, with 50 in each group. All control patients were transfused in
the ICU with a total of 94 transfused erythrocyte units. In the Svo2
group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to
0.153]; P < 0.001 vs. controls), with a total of 65 erythrocyte units. At
study discharge, eight patients of the Svo2 group remained nontransfused
and the cumulative count of erythrocyte units was 96 in the Svo2 group and
126 in the control group. CONCLUSION(S): A restrictive transfusion
strategy adjusted with central Svo2 may allow a significant reduction in
the incidence of transfusion. Copyright © 2021, the American
Society of Anesthesiologists, Inc. All Rights Reserved.

<30>
Accession Number
2011343153
Title
The direct comparison of inhaled versus intravenous levosimendan in
children with pulmonary hypertension undergoing on-cardiopulmonary bypass
cardiac surgery: A randomized, controlled, non-inferiority study.
Source
Journal of Clinical Anesthesia. 71 (no pagination), 2021. Article Number:
110231. Date of Publication: August 2021.
Author
Abdelbaser I.; Mageed N.A.; Elfayoumy S.I.; Elgamal M.-A.F.; Elmorsy M.M.;
Taman H.I.
Institution
(Abdelbaser, Mageed, Elmorsy, Taman) Department of Anesthesia and Surgical
Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Elfayoumy) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Portsaid University, Portsaid, Egypt
(Elgamal) Department of Cardiac Surgery, Faculty of Medicine, Mansoura
University, Mansoura, Egypt
Publisher
Elsevier Inc.
Abstract
Study objective: Pulmonary arterial hypertension is commonly seen in
children with left to right intracardiac shunts and affects the outcomes
of cardiac surgery. Our study aimed to compare the efficacy of inhaled
levosimendan (LS) versus intravenous LS in reducing elevated pulmonary
artery pressure (PAP) in children scheduled for cardiac surgery.
 Design(s): Non-inferiority, prospective, randomized, blinded,
controlled study. Setting(s): Operative room and intensive care unit
(ICU), institutional children's hospital of Mansoura Faculty of Medicine,
Egypt. Patient(s): 50 patients of either sex, aged 1 to 5 years
undergoing surgical repair of intracardiac left to right shunt complicated
by pulmonary hypertension were recruited for the study.
 Intervention(s): In the intravenous LS group, patients received
intravenous infusion of LS a rate of 0.1 mug/kg/min and in the inhaled LS
group, LS (36 mug/kg/6 h) was delivered by nebulization. Measurements: The
primary endpoint was systolic PAP, while the secondary endpoints were the
heart rate, mean arterial blood pressure, dose of norepinephrine, time to
extubation and ICU length of stay. Main Result(s): Both intravenous
and inhaled routes of LS similarly reduced the high systolic PAP over all
time points of measurement and intravenous LS was associated with higher
heart rate, lower arterial pressure and the need for a higher dose of
norepinephrine than the inhaled LS. Conclusion(s): Inhalation of LS
is non-inferior to intravenous LS in reducing high PAP in children who
underwent on-pump cardiac surgery and it is associated with less
tachycardia and hypotension with reduced need for vasoactive
drugs. Copyright © 2021 Elsevier Inc.

<31>
Accession Number
2010842047
Title
Serum potassium levels provide prognostic information in symptomatic heart
failure beyond traditional clinical variables.
Source
ESC Heart Failure. (no pagination), 2021. Date of Publication: 2021.
Author
Toledo C.C.; Vellosa Schwartzmann P.; Miguel Silva L.; da Silva Ferreira
G.; Bianchini Cardoso F.; Citelli Ribeiro V.; Paim L.R.; Antunes-Correa
L.M.; Carvalho Sposito A.; Matos Souza J.R.; Modolo R.; Nadruz W.;
Fernandes de Carvalho L.S.; Coelho-Filho O.R.
Institution
(Toledo, Miguel Silva, da Silva Ferreira, Bianchini Cardoso, Citelli
Ribeiro, Paim, Antunes-Correa, Carvalho Sposito, Matos Souza, Modolo,
Nadruz, Fernandes de Carvalho, Coelho-Filho) Faculty of Medical Science,
University of Campinas, Sao Paulo, Brazil
(Antunes-Correa) School of Physical Education, University of Campinas, Sao
Paulo, Brazil
(Vellosa Schwartzmann) Cardiology Unit, Unimed Hospital, Ribeirao Preto,
Sao Paulo, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Aims: Despite of recent advances in the pharmacological treatment, heart
failure (HF) maintains significant morbidity and mortality rates. While
serum potassium disorders are common and associated with adverse outcomes,
the exact recommended potassium level for patients with HF are not
entirely established. We aimed to investigate the prognostic role of
potassium levels on a cohort of patients with symptomatic chronic HF.
 Methods and Results: Patients with symptomatic chronic HF were
identified at the referral to 6 min walking test (6MWT) and were
prospectively followed up for cardiovascular events. Clinical and
laboratorial data were retrospectively obtained. The primary endpoint was
the composite of cardiovascular death, hospitalization due to HF, and
heart transplantation. The cohort included 178 patients with HF with the
mean age of 51 +/- 12.76 years, 39% were female, 85% of non-ischaemic
cardiomyopathy, and 38% had New York Heart Association Class III with a
relatively high Meta-Analysis Global Group in Chronic Heart Failure
(MAGGIC) score (12.91 +/- 6.6). The mean left ventricular ejection
fraction was 39.98 +/- 15.79%, and the mean 6MWT distance was 353 +/- 136
m. After a median follow-up of 516 days, there were 22 major
cardiovascular events (4 cardiovascular deaths, 13 HF admissions, and 5
heart transplants). Patients were stratified according to cut-point level
of serum potassium of 4.7 mmol/L to predict combined cardiac events based
on receiver operating characteristic analysis. Individuals with higher
potassium levels had worse renal function (glomerular filtration rate, K
<= 4.7: 102.8 +/- 32.2 mL/min/1.73 m2 vs. K > 4.7: 85.42 +/-
36.2 mL/min/1.73 m2, P = 0.004), higher proportion of New York
Heart Association Class III patients (K <= 4.7: 28% vs. K > 4.7: 48%, P =
0.0029), and also higher MAGGIC score (K <= 4.7: 12.08 +/- 5.7 vs. K >
4.7: 14.9 +/- 7.9, P = 0.0089), without significant differences on the
baseline pharmacological HF treatment. Both potassium levels [hazard ratio
(HR) 4.26, 95% confidence interval (CI) 1.59-11.421, P = 0.003] and 6MWT
distance (HR 0.99, 95% CI 0.993-0.999, P = 0.01) were independently
associated with the primary outcome. After adjustments for MAGGIC score
and 6MWT distance, potassium levels > 4.7 mmol/L maintained a significant
association with outcomes (HR 3.57, 95% CI 1.305-9.807, P = 0.013).
Patients with K > 4.7 mmol/L were more likely to present clinical events
during the follow-up (log rank = 0.005). Adding potassium levels to the
model including 6MWT and MAGGIC significantly improved the prediction of
events over 2 years (integrated discrimination index 0.105, 95% CI
0.018-0.281, P = 0.012 and net reclassification index 0.447, 95% CI
0.077-0.703, P = 0.028). Conclusion(s): Potassium levels were
independently associated with worse outcomes in patients with chronic
symptomatic HF, also improving the accuracy model for prognostic
prediction when added to MAGGIC score and 6MWT distance. The potassium
levels above 4.7 mmol/L might identify those patients at an increased risk
of cardiovascular events. Copyright © 2021 The Authors. ESC Heart
Failure published by John Wiley & Sons Ltd on behalf of European Society
of Cardiology.

<32>
Accession Number
2010832647
Title
Percutaneous coronary intervention in saphenous vein grafts after coronary
artery bypass grafting: a systematic review and meta-analysis.
Source
Scandinavian Cardiovascular Journal. (no pagination), 2021. Date of
Publication: 2021.
Author
Ferrari G.; Geijer H.; Cao Y.; Souza D.; Samano N.
Institution
(Ferrari, Samano) Department of Cardiothoracic and Vascular Surgery and
University Health Care Research Center, Faculty of Medicine and Health,
Orebro University, Orebro, Sweden
(Geijer) Department of Radiology, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Cao) Clinical Epidemiology and Biostatistics, School of Medical Sciences,
Orebro University, Orebro, Sweden
(Souza) Department of Cardiothoracic and Vascular Surgery, Faculty of
Medicine and Health, Orebro University, Orebro, Sweden
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: To investigate the results of percutaneous coronary
intervention (PCI) in saphenous vein grafts after coronary artery bypass
grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were
searched for relevant articles published between 1 January 2000 and 29
February 2020. The PICO (population, intervention, comparison, outcome)
model was applied in constructing the clinical question. Two independent
researchers performed the literature search. Thirty-six articles were
identified and subjected to a quality assessment. The primary outcomes of
the meta-analysis were long-term in-stent restenosis and long-term major
adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95%
CI: 4.2-14.7%) and MACE was 35.3% (95% CI: 27-43.7%) at mean time 2.7 +/-
1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%;
95% CI: 2.9-12.5%), 30-day MACE (4.3%; 95% CI: 2.5-6.1%), and 1-year MACE
(15.5%; 95% CI: 11.7-19.3%). The use of drug-eluting stents resulted in
better outcomes at least in term of in-stent restenosis, while the benefit
of using embolic protection devices was questionable. Conclusions. PCI of
a stenosed or occluded saphenous vein graft is a challenge for
interventional cardiologists, and is still associated with relatively high
rates of restenosis, MACE, and procedural failure. All efforts to enhance
the results are warranted, including improved quality of the venous grafts
used during CABG. Copyright © 2021 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<33>
Accession Number
2007627575
Title
Veno-Arterial Extracorporeal Life Support in Heart Transplant and
Ventricle Assist Device Centres. Meta-analysis.
Source
ESC Heart Failure. 8 (2) (pp 1064-1075), 2021. Date of Publication: April
2021.
Author
Kowalewski M.; Zielinski K.; Gozdek M.; Raffa G.M.; Pilato M.; Alanazi M.;
Gilbers M.; Heuts S.; Natour E.; Bidar E.; Schreurs R.; Delnoij T.;
Driessen R.; Sels J.W.; van de Poll M.; Roekaerts P.; Pasierski M.; Meani
P.; Maessen J.; Suwalski P.; Lorusso R.
Institution
(Kowalewski, Pasierski, Suwalski) Department of Cardiac Surgery, Central
Clinical Hospital of the Ministry of Interior, Centre of Postgraduate
Medical Education, Woloska 137 Str, Warsaw 02-507, Poland
(Kowalewski, Alanazi, Gilbers, Heuts, Natour, Bidar, Schreurs, Maessen,
Lorusso) Cardio-Thoracic Surgery Department, Maastricht University Medical
Centre, Maastricht, Netherlands
(Kowalewski, Gozdek) Thoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
(Zielinski) Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Gozdek) Department of Cardiology and Internal Medicine, Collegium
Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Raffa, Pilato) Department for the Treatment and Study of Cardiothoracic
Diseases and Cardiothoracic Transplantation, ISMETT-IRCCS, Palermo, Italy
(Delnoij, Driessen, Sels, Meani) Cardiology Department, Maastricht
University Medical Centre, Maastricht, Netherlands
(Delnoij, Driessen, Sels, van de Poll, Roekaerts, Meani) Department of
Intensive Care, Maastricht University Medical Centre, Maastricht,
Netherlands
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), University
of Maastricht, Maastricht, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Aims: Because reported mortality on veno-arterial (V-A) extracorporeal
life support (ECLS) substantially varies between centres, the aim of the
current analysis was to assess the outcomes between units performing heart
transplantation and/or implanting ventricular assist device (HTx/VAD) vs.
non-HTx/VAD units in patients undergoing V-A ECLS for cardiogenic shock.
 Methods and Results: Systematic search according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses was performed
using PubMed/MEDLINE databases until 30 November 2019. Articles reporting
in-hospital/30-day mortality and centre's HTx/VAD status were included.
In-hospital outcomes and long-term survival were analysed in subgroup
meta-analysis. A total of 174 studies enrolling n = 13 308 patients were
included with 20 series performed in non-HTx/VAD centres (1016 patients,
7.8%). Majority of patients underwent V-A ECLS for post-cardiotomy shock
(44.2%) and acute myocardial infarction (20.7%). Estimated overall
in-hospital mortality was 57.2% (54.9-59.4%). Mortality rates were higher
in non-HTx/VAD [65.5% (59.8-70.8%)] as compared with HTx/VAD centres
[55.8% (53.3-58.2%)], P < 0.001. Estimated late survival was 61.8%
(55.7-67.9%) without differences between non-HTx/VAD and HTx/VAD centres:
66.5% (30.3-1.02%) vs. 61.7% (55.5-67.8%), respectively (P = 0.797). No
differences were seen with respect to ECLS duration, limb complications,
and reoperations for bleeding, kidney injury, and sepsis. Yet, weaning
rates were higher in HTx/VAD vs. non-HTx/VAD centres: 58.7% (56.2-61.1%)
vs. 48.9% (42.0-55.9%), P = 0.010. Estimated rate of bridge to heart
transplant was 6.6% (5.2-8.3%) with numerical, yet not statistically
significant, difference between non-HTx/VAD [2.7% (0.8-8.3%)] as compared
with HTx/VAD [6.7% (5.3-8.6%)] (P = 0.131). Conclusion(s): Survival
after V-A ECLS differed according to centre's HTx/VAD status. Potentially
different risk profiles of patients must be taken account for before
definite conclusions are drawn. Copyright © 2020 The Authors. ESC
Heart Failure published by John Wiley & Sons Ltd on behalf of the European
Society of Cardiology

<34>
Accession Number
2007586544
Title
Catheter ablation for atrial fibrillation in patients with end-stage heart
failure and eligibility for heart transplantation.
Source
ESC Heart Failure. 8 (2) (pp 1666-1674), 2021. Date of Publication: April
2021.
Author
Sohns C.; Marrouche N.F.; Costard-Jackle A.; Sossalla S.; Bergau L.;
Schramm R.; Fuchs U.; Omran H.; Rubarth K.; Dumitrescu D.; Konietschke F.;
Rudolph V.; Gummert J.; Sommer P.; Fox H.
Institution
(Sohns, Bergau, Sommer) Clinic for Electrophysiology, Herz- und
Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Marrouche) Tulane Research Innovation for Arrhythmia Discoveries (TRIAD),
Heart and Vascular Institute, Tulane University School of Medicine, New
Orleans, LA, United States
(Costard-Jackle, Schramm, Fuchs, Omran, Gummert, Fox) Clinic for Thoracic
and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Sossalla) Department of Internal Medicine II, Cardiology, Pneumology,
Intensive Care, University Hospital Regensburg, Regensburg, Germany
(Rubarth, Konietschke) Department of Biometry and Clinical Epidemiology,
University Medical Center Berlin Charite, Berlin, Germany
(Dumitrescu, Rudolph) Clinic for General and Interventional
Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universitat
Bochum, Bad Oeynhausen, Germany
(Costard-Jackle, Dumitrescu, Rudolph, Gummert, Sommer, Fox) Heart Failure
Department, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad
Oeynhausen, Germany
Publisher
John Wiley and Sons Inc
Abstract
Aims: Timely referrals for transplantation and left ventricular assist
device (LVAD) play a key role in favourable outcomes in patients with
advanced heart failure (HF). The purpose of the Catheter Ablation for
atrial fibrillation in patientS with end-sTage heart faiLure and
Eligibility for Heart Transplantation (CASTLE-HTx) trial is to test the
hypothesis that atrial fibrillation (AF) ablation has beneficial effects
on mortality and morbidity during 'waiting time' for heart transplantation
(HTx) or to prolong the time span until LVAD implantation. Methods
and Results: CASTLE-HTx is a randomized evaluation of ablative treatment
of AF in patients with severe left ventricular dysfunction who are
candidates and eligible for HTx. The primary endpoint is the composite of
all-cause mortality, worsening of HF requiring a high urgent
transplantation, or LVAD implantation. The secondary study endpoints are
all-cause mortality, cardiovascular mortality, cerebrovascular accidents,
worsening of HF requiring unplanned hospitalization, AF burden reduction,
unplanned hospitalization due to cardiovascular reason, all-cause
hospitalization, quality of life, number of delivered implantable
cardioverter defibrillator therapies, time to first implantable
cardioverter defibrillator therapy, number of device-detected ventricular
tachycardia/ventricular fibrillation episodes, left ventricular function,
exercise tolerance, and percentage of right ventricular pacing.
Ventricular myocardial tissue will be obtained from patients who will
undergo LVAD implantation or HTx to assess the effect of catheter ablation
on human HF myocardium. CASTLE-HTx will randomize 194 patients over a
minimum time period of 2 years. Conclusion(s): CASTLE-HTx will
determine if AF ablation has beneficial effects on mortality in patients
with end-stage HF who are eligible for HTx. Copyright © 2020 The
Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of
European Society of Cardiology

<35>
Accession Number
633598384
Title
Pupillometry pain index decreases intraoperative sufentanyl administration
in cardiac surgery: a prospective randomized study.
Source
Scientific reports. 10 (1) (pp 21056), 2020. Date of Publication: 03 Dec
2020.
Author
Berthoud V.; Nguyen M.; Appriou A.; Ellouze O.; Radhouani M.; Constandache
T.; Grosjean S.; Durand B.; Gounot I.; Bahr P.-A.; Martin A.; Nowobilski
N.; Bouhemad B.; Guinot P.-G.
Institution
(Berthoud, Nguyen, Appriou, Ellouze, Radhouani, Constandache, Grosjean,
Durand, Gounot, Bahr, Martin, Nowobilski, Bouhemad, Guinot)
Anaesthesiology and Critical Care Department, Dijon University Hospital, 2
Bd Marechal de Lattre de Tassigny, Dijon 21000, France
(Nguyen, Bouhemad, Guinot) University of Burgundy Franche-Comte, Dijon
21000, France
Publisher
NLM (Medline)
Abstract
Pupillometry has proven effective for the monitoring of intraoperative
analgesia in non-cardiac surgery. We performed a prospective randomized
study to evaluate the impact of an analgesia-guided pupillometry algorithm
on the consumption of sufentanyl during cardiac surgery. Fifty patients
were included prior to surgery. General anesthesia was standardized with
propofol and target-controlled infusions of sufentanyl. The standard group
consisted of sufentanyl target infusion left to the discretion of the
anesthesiologist. The intervention group consisted of sufentanyl target
infusion based on the pupillary pain index. The primary outcome was the
total intraoperative sufentanyl dose. The total dose of sufentanyl was
lower in the intervention group than in the control group and (55.8 microg
[39.7-95.2] vs 83.9 microg [64.1-107.0], p=0.04). During the postoperative
course, the cumulative doses of morphine (mg) were not significantly
different between groups (23 mg [15-53] vs 24 mg [17-46]; p=0.95). We
found no significant differences in chronic pain at 3 months between the 2
groups (0 (0%) vs 2 (9.5%) p=0.49). Overall, the algorithm based on the
pupillometry pain index decreased the dose of sufentanyl infused during
cardiac surgery.Clinical trial number: NCT03864016.

<36>
Accession Number
634606928
Title
Effect of remote ischaemic preconditioning on mortality and morbidity
after non-cardiac surgery: meta-analysis.
Source
BJS open. 5 (2) (no pagination), 2021. Date of Publication: 05 Mar 2021.
Author
Wahlstrom K.L.; Bjerrum E.; Gogenur I.; Burcharth J.; Ekeloef S.
Institution
(Wahlstrom, Bjerrum, Gogenur, Burcharth, Ekeloef) Department of Surgery,
Centre for Surgical Science, Zealand University Hospital, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: Remote ischaemic preconditioning (RIPC) has been shown to have
a protective role on vital organs exposed to reperfusion injury. The aim
of this systematic review was to evaluate the effects of non-invasive RIPC
on clinical and biochemical outcomes in patients undergoing non-cardiac
surgery. METHOD(S): A systematic literature search of PubMed, EMBASE,
Scopus, and Cochrane databases was carried out in February 2020. RCTs
investigating the effect of non-invasive RIPC in adults undergoing
non-cardiac surgery were included. Meta-analyses and trial sequential
analyses (TSAs) were performed on cardiovascular events, acute kidney
injury, and short- and long-term mortality. RESULT(S): Some 43 RCTs
including 3660 patients were included. The surgical areas comprised
orthopaedic, vascular, abdominal, pulmonary, neurological, and urological
surgery. Meta-analysis showed RIPC to be associated with fewer
cardiovascular events in non-cardiac surgery (13 trials, 1968 patients,
421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P=0.03).
Meta-analyses of the effect of RIPC on acute kidney injury (12 trials,
1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P=0.50; I2 = 9 per
cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65,
0.37 to 1.12; P=0.12; I2 = 0 per cent), and long-term mortality (4 trials,
1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P=0.56; I2 = 0 per cent)
showed no significant differences for RIPC compared with standard
perioperative care in non-cardiac surgery. However, TSAs showed that the
required information sizes have not yet been reached. CONCLUSION(S):
Application of RIPC to non-cardiac surgery might reduce cardiovascular
events, but not acute kidney injury or all-cause mortality, but currently
available data are inadequate to confirm or reject an assumed intervention
effect. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of BJS Society Ltd.

<37>
Accession Number
2006844143
Title
Constrictive pericarditis: 21 years' experience and review of literature.
Source
Pan African Medical Journal. 38 (no pagination), 2021. Article Number:
141. Date of Publication: 08 Feb 2021.
Author
Karima T.; Nesrine B.Z.; Hatem L.; Skander B.O.; Raouf D.; Selim C.
Institution
(Karima, Nesrine, Hatem, Selim) Department of Cardiac Surgery, Military
Hospital of Tunis, Tunis, Tunisia
(Skander, Raouf) Department of Cardiac Surgery, La Rabta Hospital, Tunis,
Tunisia
Publisher
African Field Epidemiology Network
Abstract
To the best of our knowledge there are no publications about Tunisian
experience in constrictive pericarditis (CP); the aim of this study was
therefore to review our twenty-one years' experience in terms of clinical
and surgical outcomes and risk factors of death after pericardiectomy. An
analytic bicentric and retrospective study carried out on 25 patients (20
male) with CP underwent pericardiectomy, collected over a 21-years period.
The mean age was 40.46+/-16.74 years [7.5-72]. The commonest comorbid
factor was tabagism (52%). The most common etiology was tuberculosis (n =
11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%).
Pericardiectomy was performed in all our patients within 2.9+/-3.19 months
after confirmation of diagnosis. It was subtotal in 96% of cases. The
commonest postoperative complications are pleural effusion (20%). Dyspnea
was regressed within 1.8 months in 80% of cases and clinical signs of
right heart failure within a mean duration of 1.62 months in 53% of cases.
Perioperative mortality was 12% (3 deaths), late mortality was 4% (1
patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over
class II and right ventricular dysfunction are the prognostic factors of
mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no
impact on mortality. CP is a rare disease, with non-specific clinical
signs. Pericardiectomy is effective with a significant improvement of the
functional status of patients and favorable outcome at short and long term
nevertheless hospital mortality is not negligible and depends on many
factors. Copyright © Taamallah Karima et al.

<38>
Accession Number
2010933537
Title
Coronary artery bypass graft surgery versus stenting for patients with
chronic kidney disease and complex coronary artery disease: a systematic
review and meta-analysis.
Source
Therapeutic Advances in Chronic Disease. 12 (no pagination), 2021. Date of
Publication: 2021.
Author
Cui K.; Liu H.; Yuan F.; Xu F.; Zhang M.; Wang W.; Zhang D.; Tian J.; Lyu
S.; Dou K.
Institution
(Cui) Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Liu, Yuan, Xu, Zhang, Zhang, Wang, Zhang, Tian) Department of Cardiology,
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of
Heart, Lung and Blood Vessel Diseases, Beijing, China
(Lyu) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2
Anzhen Road, Chaoyang District, Beijing 100029, China
(Dou) Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037,
China
Publisher
SAGE Publications Ltd
Abstract
Background: The relative role of coronary artery bypass grafting (CABG)
and percutaneous coronary intervention (PCI) with stent implantation in
patients with chronic kidney disease (CKD) and complex coronary artery
disease (CAD) remains debatable due to the lack of randomized controlled
trials (RCTs). We therefore performed this meta-analysis to compare the
outcomes of the two strategies in CKD patients with multivessel and/or
left main disease. Method(s): Electronic databases including PubMed,
EMBASE and Cochrane Library were comprehensively searched to identify the
eligible subgroup analysis of RCTs and propensity-matched registries. The
primary endpoint was all-cause mortality during the longest follow-up.
 Result(s): Five subgroup analyses of RCTs and six propensity-matched
registries involving 26,441 patients were analyzed. Overall, the strategy
of CABG was associated with lower risks of long-term mortality [odds ratio
(OR) 0.83, 95% confidence interval (CI) 0.74-0.93], myocardial infarction
(OR, 0.41; 95% CI, 0.27-0.62), and repeat revascularization (OR, 0.25; 95%
CI, 0.16-0.39) compared with PCI in CKD patients with complex CAD.
However, CABG was slightly associated with higher risk of stroke than PCI
(OR, 1.33; 95% CI, 1.00-1.77). Nonetheless, the higher stroke risk in the
CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI,
0.37-2.25) (>3 years). Conclusion(s): This meta-analysis supports the
current guideline advising CABG for patients with CKD and complex CAD. At
the expense of slightly increased risk of stroke, CABG reduces the
incidences of long-term all-cause death, myocardial infarction and repeat
revascularization compared with PCI. Copyright © The Author(s),
2021.

<39>
Accession Number
634603085
Title
P2Y12 inhibitor monotherapy after coronary stenting according to type of
P2Y12 inhibitor.
Source
Heart. (no pagination), 2021. Date of Publication: 2021.
Author
Kim J.; Jang W.J.; Lee W.S.; Choi K.H.; Lee J.M.; Park T.K.; Yang J.H.;
Choi J.-H.; Song Y.B.; Choi S.-H.; Gwon H.-C.; Lee S.H.; Oh J.-H.; Chun
W.J.; Park Y.H.; Im E.-S.; Jeong J.-O.; Cho B.R.; Oh S.K.; Yun K.H.; Cho
D.-K.; Lee J.-Y.; Koh Y.-Y.; Bae J.-W.; Choi J.W.; Yoon H.J.; Lee S.U.;
Cho J.H.; Choi W.G.; Rha S.-W.; Hahn J.-Y.
Institution
(Kim, Choi, Lee, Park, Yang, Choi, Song, Choi, Gwon, Lee, Hahn) Division
of Cardiology, Department of Medicine, Samsung Medical Center,
Sungkyunkwan University, School of Medicine, Seoul, South Korea
(Jang) Division of Cardiology, Department of Internal Medicine, Ewha
Womans University, College of Medicine, Seoul Hospital, Seoul, South Korea
(Lee) Department of Cardiology, Chung-Ang University Hospital, Seoul,
South Korea
(Oh, Chun, Park) Department of Cardiology, Samsung Changwon Hospital,
Sungkyunkwan University, School of Medicine, Seoul, South Korea
(Im) Division of Cardiology, Dongsuwon General Hospital, Suwon, South
Korea
(Jeong) Department of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Cho) Department of Cardiology, Kangwon National University Hospital,
Chuncheon, South Korea
(Oh, Yun) Department of Cardiology, Wonkwang University Hospital, Iksan,
South Korea
(Cho) Department of Cardiology, Myongji Hospital, Goyang, South Korea
(Lee) Department of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan
University, School of Medicine, Seoul, South Korea
(Koh) Department of Cardiology, Chosun University Hospital, Gwangju, South
Korea
(Bae) Division of Cardiology, Department of Internal Medicine, Chungbuk
National University Hospital, Cheongju, South Korea
(Choi) Division of Cardiology, Seoul Eulji Hospital, Eulji University,
College of Medicine, Seoul, South Korea
(Yoon) Department of Cardiology, Keimyung University, Dongsan Medical
Center, Daegu, South Korea
(Lee) Department of Cardiology, Kwangju Christian Hospital, Gwangju, South
Korea
(Cho) Division of Cardiology, Saint Carollo Hospital, Suncheon, South
Korea
(Choi) Department of Cardiology, Konkuk University, Chungju Hospital,
Chungju, South Korea
(Rha) Department of Cardiology, Korea University, Guro Hospital, Seoul,
South Korea
(Kim, Choi, Lee, Park, Yang, Choi, Song, Choi, Gwon, Lee, Hahn)
Cardiology, Samsung Medical Center, Seoul 135-710, South Korea
(Jang) Cardiology, Chung-Ang University Hospital, Seoul, South Korea
Publisher
BMJ Publishing Group
Abstract
Objective: To compare P2Y12 inhibitor monotherapy after 3-month dual
antiplatelet therapy (DAPT) with 12-month DAPT according to the type of
P2Y12 inhibitor in patients undergoing percutaneous coronary intervention
(PCI). Method(s): The Smart Angioplasty Research Team: Comparison
Between P2Y12 Antagonist Monotherapy vs Dual Antiplatelet Therapy in
Patients Undergoing Implantation of Coronary Drug-Eluting Stents
(SMART-CHOICE) randomised trial compared 3-month DAPT followed by P2Y12
inhibitor monotherapy with 12-month DAPT. In this trial, 2993 patients
undergoing successful PCI with drug-eluting stent were enrolled in Korea.
As a prespecified analysis, P2Y12 inhibitor monotherapy after 3-month DAPT
versus 12-month DAPT were compared among patients receiving clopidogrel
and those receiving potent P2Y12 inhibitor (ticagrelor or prasugrel),
respectively. The primary endpoint was a composite of all-cause death,
myocardial infarction or stroke at 12 months after the index procedure.
 Result(s): Among 2993 patients (mean age 64 years), 58.2% presented
with acute coronary syndrome. Clopidogrel was prescribed in 2312 patients
(77.2%) and a potent P2Y12 inhibitor in 681 (22.8%). There were no
significant differences in the primary endpoint between the P2Y12
inhibitor monotherapy group and the DAPT group among patients receiving
clopidogrel (3.0% vs 3.0%; HR: 1.02; 95% CI 0.64 to 1.65; p=0.93) as well
as among patients receiving potent P2Y12 inhibitors (2.4% vs 0.7%; HR:
3.37; 95% CI 0.77 to 14.78; p=0.11; interaction p=0.1). Among patients
receiving clopidogrel, P2Y12 inhibitor monotherapy compared with DAPT
showed consistent treatment effects across various subgroups for the
primary endpoint. Among patients receiving potent P2Y12 inhibitors, the
rate of bleeding (Bleeding Academic Research Consortium types 2- 5) was
significantly lower in the P2Y12 inhibitor monotherapy group than in the
DAPT group (1.5% vs 5.0%; HR: 0.33; 95% CI 0.12 to 0.87; p=0.03).
 Conclusion(s): Compared with 12-month DAPT, clopidogrel monotherapy
after 3-month DAPT showed comparable cardiovascular outcomes in patients
undergoing PCI. Trial registration number: NCT02079194. Copyright
© Author(s) (or their employer(s)) 2021. No commercial re-use. See
rights and permissions. Published by BMJ.

<40>
Accession Number
634600813
Title
A comparison of two different management plans for patients requiring both
carotid endarterectomy and coronary artery bypass grafting.
Source
Cardiovascular journal of Africa. 32 (pp 1-4), 2021. Date of Publication:
16 Mar 2021.
Author
Ecevit A.N.; Karaca O.G.; Kalender M.; Bekmezci M.; Sungur M.A.; Darcin
O.T.
Institution
(Ecevit) Bilkent City Hospital, Yuksek Ihtisas Cardiovascular Surgery
Hospital, Ankara, Turkey
(Karaca) Department of Cardiovascular Surgery, Medical Faculty of Duzce
University, Duzce, Turkey
(Kalender) Department of Cardiovascular Surgery, Derince Training and
Research Hospital, Kocaeli, Turkey
(Bekmezci) Dr Ali Kemal Belviranli Obstetric and Gynecology Hospital,
Konya, Turkey
(Sungur) Department of Biostatistics and Medical Informatics, Medical
Faculty of Duzce University, Duzce, Turkey
(Darcin) Department of Cardiovascular Surgery, Antalya Training and
Research Hospital, Antalya, Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: Carotid endarterectomy (CEA) is a prophylactic operation that
is used to mitigate the risk of stroke caused by embolism of
atherosclerotic plaques in the carotid bifurcation. Previously, the large,
multicentre, randomised, controlled GALA study found no significant
differences in clinical outcomes between patients treated using general or
local anaesthesia. While this study provided important insights into
disease outcomes based on treatment modalities, it did not answer
questions regarding the safety of CEA under local anaesthesia in patients
at high risk for cardiovascular complications. Here, we examined the use
of two different management plans in patients requiring both carotid
endarterectomy and coronary artery bypass grafting (CABG), in terms of
their effects on hospital mortality. METHOD(S): Thirty-four patients
consecutively operated on in our cardiovascular department were included
in this analysis. The patients were divided into two groups based on the
anaesthetic management plan. The first group consisted of patients who
underwent CEA and CABG under general anaesthesia in the same session (GA
group); the second group consisted of patients who initially underwent CEA
under cervical block anaesthesia followed by CABG under general
anaesthesia in a separate session (CB-GA group). These two groups were
compared in terms of postoperative complications and hospital mortality.
 RESULT(S): The incidence of postoperative myocardial infarction was
higher in the CB-GA group, with four patients experiencing postoperative
myocardial infarction, compared to no patients in the GA group.
 CONCLUSION(S): For patients requiring CEA and CABG, performing both
operations under general anaesthesia in the same session was safer than
initially performing CEA under cervical block anaesthesia followed by CABG
under general anaesthesia.

<41>
Accession Number
634599174
Title
Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular
Calcification: A Systematic Review.
Source
Journal of the American Heart Association. (pp e018514), 2021. Date of
Publication: 17 Mar 2021.
Author
Alexis S.L.; Malik A.H.; El-Eshmawi A.; George I.; Sengupta A.; Kodali
S.K.; Hahn R.T.; Khalique O.K.; Zaid S.; Guerrero M.; Bapat V.N.; Leon
M.B.; Adams D.H.; Tang G.H.L.
Institution
(Alexis, El-Eshmawi, Sengupta, Adams, Tang) Department of Cardiovascular
Surgery Mount Sinai Health System New York NY
(Malik) Department of Medicine Westchester Medical Center Valhalla NY
(George) Division of Cardiac Surgery New York Presbyterian
Hospital/Columbia University Medical Center New York NY
(Kodali, Hahn, Khalique, Leon) Division of Cardiology New York
Presbyterian Hospital/Columbia University Medical Center New York NY
(Zaid) Department of Cardiology Westchester Medical Center Valhalla NY
(Guerrero) Division of Cardiology Mayo Clinic Rochester MN
(Bapat) Department of Cardiothoracic Surgery, Minneapolis Heart Institute
Abbott Northwestern Hospital Minneapolis MN
Publisher
NLM (Medline)
Abstract
Mitral annular calcification with mitral valve disease is a challenging
problem that could necessitate surgical mitral valve replacement (SMVR).
Transcatheter mitral valve replacement (TMVR) is emerging as a feasible
alternative in high-risk patients with appropriate anatomy. PubMed,
Embase, and Cochrane Central Register of Controlled Trials were searched
from inception to December 25, 2019 for studies discussing SMVR or TMVR in
patients with mitral annular calcification; 27 of 1539 articles were
selected for final review. TMVR was used in 15 studies. Relevant data were
available on 82 patients who underwent hybrid transatrial TMVR, and 354
patients who underwent transapical or transseptal TMVR. Outcomes on SMVR
were generally reported as small case series (447 patients from 11
studies); however, 1 large study recently reported outcomes in 9551
patients. Patients who underwent TMVR had a shorter median follow-up of 9
to 12 months (range, in-hospital-19 months) compared with patients with
SMVR (54 months; range, in-hospital-120 months). Overall, those undergoing
TMVR were older and had higher Society of Thoracic Surgeons risk scores.
SMVR showed a wide range of early (0%-27%; median 6.3%) and long-term
mortality (0%-65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years,
62.4%). The median in-hospital, 30-day, and 1-year mortality rates were
16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and
9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular
calcification is a complex disease and TMVR, with a versatile option of
transatrial approach in patients with challenging anatomy, offers a
promising alternative to SMVR in high-risk patients. However, further
studies are needed to improve technology, patient selection, operative
expertise, and long-term outcomes.

<42>
Accession Number
2010963257
Title
Anticoagulation management of postoperative atrial fibrillation after
cardiac surgery: A systematic review.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yao R.J.R.; Hawkins N.M.; Lavaie Y.; Deyell M.W.; Andrade J.G.; Bashir J.
Institution
(Yao, Lavaie) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Hawkins, Deyell, Andrade) Division of Cardiology, University of British
Columbia, Vancouver, BC, Canada
(Bashir) Division of Cardiovascular Surgery, University of British
Columbia, Vancouver, BC, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) often complicates
cardiac surgery and is associated with increased mortality and risk of
thromboembolism. However, the optimal oral anticoagulation (OAC) strategy
is uncertain. We performed a systematic review to examine the OAC practice
patterns and efficacy in these circumstances. Method(s): MEDLINE and
EMBASE were searched from 2000 to 2019 using the search terms cardiac
surgical procedures, cardiac surgery, postoperative complications, atrial
fibrillation, atrial flutter, and terms for anticoagulants. Collected data
included anticoagulation patterns (time of initiation, type, and duration)
and outcomes (stroke, bleeding, and mortality). Result(s): From 763
records, 4 prospective and 13 retrospective studies were included totaling
44,908 patients with 8929 (19.9%) who developed POAF. Anticoagulation
rates ranged from 4% to 43% (mean 21% overall). Sixteen studies used
warfarin, 3 nonvitamin K OAC (NOAC), and 2 both. Four studies reported the
use of bridging unfractionated or low-molecular-weight heparin.
Concomitant antiplatelet therapy was reported in half the studies, ranging
from 80% to 99%. OAC use was associated with lower risk of thromboembolic
events in two retrospective studies (including a national Danish cohort
with 2108 patients with POAF). Patients discharged on warfarin experienced
reduced mortality in a large, single center, retrospective analysis, but
no association was observed in the Danish cohort. Conclusion(s):
There is wide practice variation in the uptake, timing of initiation,
duration, and choice of OAC for POAF following cardiac surgery. The
evidence is largely retrospective and insufficient to assess the efficacy
of different OAC strategies. Further studies are warranted to guide
clinical practice. Copyright © 2021 Wiley Periodicals LLC

<43>
Accession Number
2010933939
Title
Absence of electrocardiographic left ventricular hypertrophy and poor
outcome in patients undergoing transcatheter aortic valve replacement-A
systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Martha J.W.; Pranata R.; Yonas E.; Wibowo A.; Akbar M.R.
Institution
(Martha, Pranata, Wibowo, Akbar) Department of Cardiology and Vascular
Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum
Pusat Hasan Sadikin, Bandung, Indonesia
(Pranata) Faculty of Medicine, Universitas Pelita Harapan, Tangerang,
Indonesia
(Yonas) Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
Publisher
Blackwell Publishing Inc.
Abstract
Objective: This systematic review and meta-analysis aimed to evaluate
whether the absence of electrocardiographic (ECG) left ventricular
hypertrophy (LVH) was associated with poor outcome in patients undergoing
transcatheter aortic valve replacement (TAVR). Method(s): We
performed systematic review search on PubMed, Embase, and Scopus up until
January 22, 2021. The key exposure was the absence of ECG LVH, defined as
the absence of LVH by electrocardiographic criteria. The outcome of
interest was composite poor outcome, which is a composite of mortality
and/or rehospitalization after TAVR. The effect estimate was reported as
hazard ratio (HR). In addition, we generate sensitivity and specificity,
positive and negative likelihood ratio (PLR and NLR), diagnostic odds
ratio (DOR), and area under curve (AUC). Result(s): There are four
studies comprising of 827 patients included in this systematic review and
meta-analysis. The prevalence of poor outcome in this pooled analysis was
30%. The absence of ECG LVH was associated with increased poor outcome in
patients undergoing TAVR (HR: 1.86, [1.34, 2.57], p <.001; I2:
0%). Absence of ECG LVH was associated with a sensitivity of 0.75 [0.64,
0.83], specificity of 0.42 [0.30, 0.55], PLR of 1.3 [1.1, 1.5], NLR of
0.60 [0.45, 0.80], DOR 2 [1, 5], and AUC of 0.66 [0.62, 0.70]. Fagan's
nomogram indicates in a 22% prevalence of poor outcome in the included
studies, the absence of ECG LVH and ECG LVH was associated with 27% and
15% posttest probability for poor outcome, respectively.
 Conclusion(s): Absence of ECG LVH was associated with poor outcome in
patients undergoing TAVR. Copyright © 2021 The Authors. Journal
of Cardiac Surgery published by Wiley Periodicals LLC

<44>
Accession Number
2010888347
Title
The effects of neuro-linguistic programming and guided imagery on the pain
and comfort after open-heart surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Dogan A.; Saritas S.
Institution
(Dogan) Department of Nursing, Faculty of Health Sciences, Toros
University, Mersin, Turkey
(Saritas) Department of Surgical Nursing, Faculty of Nursing, Inonu
University, Malatya, Turkey
Publisher
Blackwell Publishing Inc.
Abstract
Objective: The present study aims to evaluate the effects of
neuro-linguistic programming (NLP) and guided imagery on postoperative
pain and comfort after open-heart surgery. Method(s): In the current,
prospective, randomized, single-blind clinical study, the participants
received NLP with a new behavior formation technique or the guided imagery
relaxation technique using an audio compact disc for a duration of 30 min.
 Result(s): The patients in the NLP group had significantly lower
posttest pain levels, compared to the patients in the guided imagery and
control groups. Moreover, the patients in the guided imagery group had
significantly higher posttest comfort levels, compared to the patients in
the NLP and control groups. Conclusion(s): The application of both
NLP and guided imagery interventions resulted in reduced postoperative
pain and increased postoperative comfort levels after open-heart
surgery. Copyright © 2021 Wiley Periodicals LLC

<45>
Accession Number
2011442914
Title
Does contingent biofeedback improve cardiac interoception? A preregistered
replication of Meyerholz, Irzinger, Withoft, Gerlach, and Pohl (2019)
using the heartbeat discrimination task in a randomised control trial.
Source
PLoS ONE. 16 (3 March) (no pagination), 2021. Article Number: e0248246.
Date of Publication: March 2021.
Author
Rominger C.; Grassmann T.M.; Weber B.; Schwerdtfeger A.R.
Institution
(Rominger, Grasmann, Weber, Schwerdtfeger) Institute of Psychology,
University of Graz, Graz, Austria
(Rominger) Otto Loewi Research Center, Section of Physiology, Medical
University of Graz, Graz, Austria
Publisher
Public Library of Science
Abstract
Meyerholz, Irzinger, Withoft, Gerlach, and Pohl (2019) reported on a
comparably large effect (d = 1.21) of a contingent biofeedback procedure
on cardiac accuracy as assessed by the heartbeat tracking task. However,
this task has recently been criticized as a measure of interoceptive
accuracy. We aimed to replicate this finding by using the well-validated
heartbeat discrimination task and to compare the biofeedback with a deep
breathing and a control condition (viewing a film clip). The trial was
preregistered at open science framework (https://osf.io/9fxn6). Overall,
93 participants were randomized to one of the three conditions and the
heartbeat discrimination task was presented prior and after the 20-minutes
training sessions. The study had a power of .86 to detect a medium-sized
effect in the biofeedback group and a power of .96 to detect a
medium-sized interaction of intervention group and time. A general
tendency for improvement in heartbeat detection accuracy was found across
intervention groups (d = 0.19, p = .08); however, groups did not differ
significantly. In particular, there was no significant interaction of
intervention group and time (f = .00, p = .98) and no reliable effect for
the biofeedback group (d = 0.15, p = .42). One limitation is that a
different, but well-validated task was used to quantify interoceptive
accuracy. This study suggests that biofeedback might not improve
interoceptive accuracy in the cardiac domain, but effects seem to depend
on the specific task applied. Copyright © 2021 Rominger et al.

<46>
Accession Number
613003182
Title
The efficacy of pre-emptive dexmedetomidine versus amiodarone in
preventing postoperative junctional ectopic tachycardia in pediatric
cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 614-620), 2016. Date of
Publication: October-December 2016.
Author
El-Shmaa N.S.; El Amrousy D.; El Feky W.
Institution
(El-Shmaa) Department of Anesthesia and Surgical ICU, Faculty of Medicine,
Tanta University, Tanta, Egypt
(El Amrousy) Department of Pediatrics, Tanta University Hospital, Tanta,
Egypt
(El Feky) Department of Cardiothoracic Surgery, Tanta University Hospital,
Tanta, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Objective: The objective of this study was to assess the effectiveness of
pre-emptive dexmedetomidine versus amiodarone in preventing junctional
ectopic tachycardia (JET) in pediatric cardiac surgery. Design(s):
This is a prospective, controlled study. Setting(s): This study was
carried out at a single university hospital. Subjects and Methods: Ninety
patients of both sexes, American Society of Anesthesiologists Physical
Status II and III, age range from 2 to 18 years, and scheduled for
elective cardiac surgery for congenital and acquired heart diseases were
selected as the study participants. Intervention(s): Patients were
randomized into three groups (30 each). Group I received dexmedetomidine 1
mcg/kg diluted in 100 ml of normal saline intravenously (IV) over a period
of 20 min, and the infusion was completed 10 min before the induction
followed by a 0.5 mcg/kg/h infusion for 72 h postoperative, Group II
received amiodarone 5 mg/kg diluted in 100 ml of normal saline IV over a
period of 20 min, and the infusion was completed 10 min before the
induction followed by a 10-15 mcg/kg/h infusion for 72 h postoperative,
and Group III received 100 ml of normal saline IV. Primary outcome was the
incidence of postoperative JET. Secondary outcomes included
vasoactive-inotropic score, ventilation time (VT), pediatric cardiac care
unit stay, hospital length of stay, and perioperative mortality.
 Measurements and Main Results: The incidence of JET was significantly
reduced in Group I and Group II (P = 0.004) compared to Group III. Heart
rate while coming off from cardiopulmonary bypass (CPB) was significantly
low in Group I compared to Group II and Group III (P = 0.000). Mean VT,
mean duration of Intensive Care Unit stay, and length of hospital stay
(day) were significantly short (P = 0.000) in Group I and Group II
compared to Group III (P = 0.000). Conclusion(s): Perioperative use
of dexmedetomidine and amiodarone is associated with significantly
decreased incidence of JET as compared to placebo without significant side
effects.

<47>
Accession Number
633652880
Title
A novel method to interpret early phase trials shows how the narrowing of
the coronary sinus concordantly improves symptoms, functional status and
quality of life in refractory angina.
Source
Heart. 107 (1) (pp 41-46), 2021. Date of Publication: 01 Jan 2021.
Author
Jolicoeur E.M.; Verheye S.; Henry T.D.; Joseph L.; Doucet S.; White C.J.;
Edelman E.; Banai S.
Institution
(Jolicoeur, Doucet) Department of Medicine, Interventional Cardiology,
Montreal Heart Institute, Montreal, QC, Canada
(Verheye) Antwerp Cardiovascular Institute, ZNA Middelheim Hospital,
Antwerpen, Belgium
(Henry) The Carl and Edyth Lindner Center for Research and Education, The
Christ Hospital, Cincinnati, OH, United States
(Joseph) Department of Epidemiology and Biostatistics, McGill University,
Montreal, QC, Canada
(White) The John Ochsner Heart and Vascular Institute, Ochsner Clinical
School, University of Queensland, New Orleans, LA, United States
(Edelman) Institute for Medical Engineering and Science, Cambridge, MA,
United States
(Edelman) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Banai) The Tel Aviv Medical Center, The Tel Aviv University Medical
School, Tel Aviv, Israel
Publisher
BMJ Publishing Group
Abstract
Background Reduction of the coronary sinus was shown to improve angina in
patients unsuitable for revascularisation. We assessed whether a
percutaneous device that reduces the diameter of the coronary sinus
improved outcomes across multiple endpoints in a phase II trial. Methods
We conducted a novel analysis performed as a post hoc efficacy analysis of
the COSIRA (Coronary Sinus Reducer for Treatment of Refractory Angina)
trial, which enrolled patients with Canadian Cardiovascular Society (CCS)
class 3-4 refractory angina. We used four domains: symptoms (CCS Angina
Scale), functionality (total exercise duration), ischaemia (imaging) and
health-related quality of life. For all domains, we specified a meaningful
threshold for change. The primary endpoint was defined as a probability of
>=80% that the reducer exceeded the meaningful threshold on two or more
domains (group-level analysis) or that the average efficacy score in the
reducer group exceeded the sham control group by at least two points
(patient-level analysis). Results We randomised 104 participants to either
a device that narrows to coronary sinus (n=52) or a sham implantation
(n=52). The reducer group met the prespecified criteria for concordance at
the group level and demonstrated improvement in symptoms (0.59 CCS grade,
95% credible interval (CrI)=0.22 to 0.95), total exercise duration
(+27.9%, 95% CrI=2.8% to 59.8%) and quality of life (stability +11.2
points, 95% CrI=3.3 to 19.1; perception +11.0, 95% CrI=3.3 to 18.7).
Conclusions The reducer concordantly improved symptoms, functionality and
quality of life compared with a sham intervention in patients with angina
unsuitable for coronary revascularisation. Concordant analysis such as
this one can help interpret early phase trials and guide the decision to
pursue a clinical programme into a larger confirmatory trial. Trail
registration number ClinicalTrials.gov identifier:
NCT01205893. Copyright © 2021 BMJ Publishing Group. All rights
reserved.

<48>
Accession Number
2006772498
Title
Transcatheter or surgical aortic valve implantation in chronic dialysis
patients: a German Aortic Valve Registry analysis.
Source
Clinical Research in Cardiology. 110 (3) (pp 357-367), 2021. Date of
Publication: March 2021.
Author
Farber G.; Bleiziffer S.; Doenst T.; Bon D.; Boning A.; Weiler H.;
Herrmann E.; Frerker C.; Beckmann A.; Mollmann H.; Ensminger S.;
Bekeredjian R.; Walther T.; Harringer W.; Katus H.A.; Hamm C.W.;
Beyersdorf F.; Bauer T.; Fichtlscherer S.
Institution
(Farber, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital, Friedrich Schiller University of Jena, Jena, Germany
(Bleiziffer) Clinic for Thoracic and Cardiovascular Surgery, Heart and
Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
(Bon, Herrmann) Institute of Biostatistics and Mathematical Modelling,
Goethe University Frankfurt, Frankfurt am Main, Germany
(Bon, Herrmann) German Center for Cardiovascular Research, DZHK, Partner
Site Rhein-Main, Frankfurt am Main, Germany
(Boning, Bauer) Department of Cardiology, University of Giessen, Giessen,
Germany
(Weiler, Fichtlscherer) Department of Cardiology, University Hospital
Frankfurt am Main, Frankfurt, Germany
(Frerker) Department of Internal Medicine III, University of Cologne,
Cologne, Germany
(Beckmann) German Society of Thoracic, Cardiac and Vascular Surgery
(Deutsche Gesellschaft fur Thorax-, Herz- und Gefaschirurgie, DGTHG),
Berlin, Germany
(Mollmann) Department of Cardiology, St.-Johannes-Hospital Dortmund,
Dortmund, Germany
(Ensminger) Department of Cardiac Surgery, University of Lubeck, Lubeck,
Germany
(Bekeredjian) Department of Cardiology, Robert-Bosch-Krankenhaus,
Stuttgart, Germany
(Walther) Department of Cardiothoracic Surgery, University Hospital
Frankfurt, Frankfurt, Germany
(Harringer) Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum
Braunschweig gGmbH, Brunswick, Germany
(Katus) Department of Cardiology, University Hospital Heidelberg,
Heidelberg, Germany
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Beyersdorf) Department of Cardiovascular Surgery, Faculty of Medicine,
Heart Centre Freiburg University, Freiburg, Germany
(Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: The aim of this study was to compare outcomes of transcatheter
and surgical aortic valve implantation in chronic dialysis patients with
aortic valve stenosis (AS). Background(s): Chronic dialysis patients
undergoing heart valve surgery are at higher risk for morbidity and
mortality. Whether interventional techniques can reduce this risk is
unclear because dialysis patients have thus far been excluded from
randomized trials. Method(s): Chronic dialysis patients with AS
enrolled in the German Aortic Valve Registry (GARY) between 2012 and 2015
were analyzed to compare transcatheter aortic valve implantation (TAVI n =
661) with surgical aortic valve replacement (SAVR n = 457). Propensity
scores for inverse probability of treatment weighting (IPTW) were used to
adjust the comparison of the two treatment groups for potential
confounders. Result(s): TAVI patients were older (78 +/- 7.3 vs. 69
+/- 10.2 years, p < 0.01, unadjusted) and had more comorbidities.
Mortality at 1 year was the same (TAVI: 33.4% vs. SAVR 35.0%, p = 0.72,
IPTW-adjusted) while it was lower with TAVI at 30 days (8.6% vs. 15.0%, p
= 0.02, IPTW-adjusted). TAVI patients required more pacemaker implantation
and showed more aortic regurgitation. SAVR patients required more blood
transfusions and had longer hospital stay. Diabetes mellitus, atrial
fibrillation, previous PCI, urgent procedure and EuroSCORE were associated
with elevated 30-day mortality. Atrial fibrillation and older age were
independent risk factor of 1-year mortality in both groups.
 Conclusion(s): Chronic dialysis patients with AS undergoing TAVI or
SAVR had the same 1-year mortality, although survival at 30 days was
better with TAVI. These results suggest that TAVI may improve
peri-procedural outcomes. Copyright © 2020, Springer-Verlag GmbH
Germany, part of Springer Nature.

<49>
Accession Number
2011412219
Title
Predictors of prosthetic valve endocarditis following transcatheter aortic
valve replacement: A meta-analysis.
Source
Heart Surgery Forum. 24 (1) (pp E101-E107), 2021. Date of Publication: 13
Jan 2021.
Author
Jiang W.; Wu W.; Guo R.; Xie M.; Yim W.Y.; Wang Y.; Hu X.
Institution
(Jiang) Department of Gastroenterology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
(Wu) Department of Gastroenterology, Zhongnan Hospital, Wuhan University,
Wuhan, China
(Guo, Xie, Yim, Wang, Hu) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has gained
increasing acceptance for patients with aortic disease. A rare but fatal
complication prosthetic valve endocarditis (PVE) could greatly influence
the clinical outcomes of TAVR. This meta-analysis aims to pin down the
predictors of PVE in TAVR patients. Method(s): We performed a
systematic search for studies that reported the incidence and risk factors
of PVE after TAVR. Data on studies, patients, baseline characteristics,
and procedural characteristics were abstracted. Crude risk ratios (RRs)
and 95% confidence intervals for each predictor were calculated by the use
of random-effects models. Heterogeneity assumption was assessed by an
I2 test. Result(s): We obtained data from 8 studies that
included 68,805 TAVR patients, of whom 1,256 (1.83%) were diagnosed with
PVE after TAVR. 280 patients died within the 30-days of PVE diagnosis and
the pooled in-hospital mortality was 22.3%. The summary estimates
indicated an increased risk of PVE after TAVR for males (RR 1.53, P =
.0001); for patients with orotracheal intubation (RR 1.65, P = .01), new
pacemaker implantation (RR 1.46, P = .003), and residual aortic
regurgitation (>=2 grade) (RR 1.62, P = .05); while older age (RR 0.97, P
= .0007) and implantation of a self-expandable valve (RR 0.74, P = .02)
were associated with a lower risk of PVE after TAVR. Conclusion(s):
Clinical characteristics and periprocedure factors including age, male
sex, valve type, orotracheal intubation, pacemaker implantation, and
residual regurgitation were proven to be associated with the occurrence of
PVE-TAVR. Clinicians should pay particular attention to PVE when treating
TAVR patients with these predictors. Copyright © 2021 Forum
Multimedia Publishing LLC. All rights reserved.

<50>
Accession Number
2010883978
Title
Comparison of non-intubated and intubated video-assisted thoracoscopic
surgeries of major pulmonary resections for lung cancer-a meta-analysis.
Source
World Journal of Surgical Oncology. 19 (1) (no pagination), 2021. Article
Number: 87. Date of Publication: December 2021.
Author
Xue W.; Duan G.; Zhang X.; Zhang H.; Zhao Q.; Xin Z.; He J.
Institution
(Xue, Duan, Zhang, Zhang, Zhao, Xin, He) Department of Thoracic Surgery,
Hebei Province General Hospital, No 348, Heping Road West, Xinhua
District, Shijiazhuang 050000, China
Publisher
BioMed Central Ltd
Abstract
Objective: The aim of this study was to compare the safety feasibility and
safety feasibility of non-intubated (NIVATS) and intubated video-assisted
thoracoscopic surgeries (IVATS) during major pulmonary resections.
 Method(s): A meta-analysis of eight studies was conducted to compare
the real effects of two lobectomy or segmentectomy approaches during major
pulmonary resections. Result(s): Results showed that the patients
using NIVATS had a greatly shorter hospital stay and chest-tube placement
time (weighted mean difference (WMD): - 1.04 days; 95% CI - 1.50 to -
0.58; P < 0.01) WMD - 0.71 days; 95% confidence interval (CI), - 1.08 to -
0.34; P < 0.01, respectively) while compared to those with IVATS. There
were no significant differences in postoperative complication rate,
surgical duration, and the number of dissected lymph nodes. However,
through the analysis of highly selected patients with lung cancer in early
stage, the rate of postoperative complication in the NIVATS group was
lower than that in the IVATS group [odds ratio (OR) 0.44; 95% CI
0.21-0.92; P = 0.03, I2 = 0%]. Conclusion(s): Although the
comparable postoperative complication rate was observed for major thoracic
surgery in two surgical procedures, the NIVATS method could significantly
shorten the hospitalized stay and chest-tube placement time compared with
IVATS. Therefore, for highly selected patients, NIVATS is regarded as a
safe and technically feasible procedure for major thoracic surgery. The
assessment of the safety and feasibility for patients undergoing NIVATS
needs further multi-center prospective clinical trials. Copyright
© 2021, The Author(s).

<51>
Accession Number
2005945338
Title
Comparing vancomycin-tranexamic acid paste to vancomycin-normal saline
paste in reducing post coronary artery bypass graft surgery bleeding.
Source
International Cardiovascular Research Journal. 14 (4) (pp 137-141), 2020.
Article Number: e103103. Date of Publication: 2020.
Author
Mirmohammadsadeghi A.; Asadollahi H.
Institution
(Mirmohammadsadeghi, Asadollahi) Cardiovascular Surgery Department,
Isfahan University of Medical Sciences (IUMS), Isfahan, Iran, Islamic
Republic of
Publisher
Iranian Cardiovascular Research Journal
Abstract
Background: Postoperative bleeding is a common problem, specially in
cardiac surgery. The bone edges at the sternotomy site are one of the
major sites of bleeding. Previously, some materials, such as vancomycin
paste, have been applied to the sternum prior to the closure of sternum in
order to reduce postoperative hemorrhage. In addition, fibrinolytic drugs,
such as tranexamic acid, have been used locally to reduce postoperative
bleeding. Objective(s): This study aimed to assess the effect of
vancomycin paste made with tranexamic acid on reducing postoperative
mediastinal bleeding. Method(s): In this double-blind clinical trial,
all patients undergoing on-pump coronary artery bypass graft surgery were
included and divided into two groups by simple randomization method. In
the control group, two grams of vancomycin paste were made with two mls of
normal saline solution. In the intervention group, two grams of vancomycin
paste were made with two mls (containing 200 mgs) of tranexamic acid. The
paste in each group was applied to the sternal bone edges just prior to
sternal closure. Both groups were compared in terms of demographic data,
operation data, packed red blood cell transfusion, hemoglobin change, and
amount of postoperative bleeding 12, 24, and 48 hours post-surgery.
Postoperative sternal wound infection and dehiscence were also evaluated
two months after the surgery. Comparisons were done using independent
t-test, Fisher's exact test, and Mann-Whitney test using the SPSS
software, version 22. Result(s): Fifty patients completed the trial.
Both groups were similar regarding the demographic data and operation
data, such as pump time and operation duration. The amount of
postoperative bleeding was respectively 268, 624, and 844 mls in the
control group and 174, 362, and 485 mls in the invention group 12, 24, and
48 hours after the operation (P < 0.001). The results revealed no
significant difference between the two groups concerning postoperative
transfusion and hemoglobin changes. Postoperative sternal wound
complications, including infection and dehiscence, were not seen in any of
the study groups. Conclusion(s): In comparison to vancomycin paste
alone, vancomycin-tranexamic acid paste had a significantly superior
effect on the reduction of post-coronary artery bypass graft surgery
bleeding. Copyright © 2020, Iranian Cardiovascular Research
Journal. All rights reserved.

<52>
Accession Number
2005922697
Title
Effect of buteyko breathing technique and incentive spirometer on breath
control pause in post cardiac surgery patients.
Source
Rawal Medical Journal. 45 (4) (pp 970-973), 2020. Date of Publication:
October-December 2020.
Author
Afshan N.; Ahmad S.; Shahid S.; Fatima A.
Institution
(Afshan, Ahmad, Shahid, Fatima) University Institute of Physical Therapy,
The University of lahore, Lahore, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: To compare the effects of Buteyko breathing technique and
Incentive Spirometer on breath control pause in post-cardiac surgery
patients. Methodology: This Randomized Controlled Trial included 48
postoperative cardiac surgery patients, Data were collected using
Purposive Sampling technique from the Sharif Medical City Hospital by a
Questionnaire. The study was completed in 9 months and data were analyzed
with SPSS software. Result(s): Out of 48 patients, 26(54.2%) were
male and 22(45.8%) female and 8 were drop-outs. They were divided in two
groups of 20 in each group; Group A (Buteyko breathing technique) and
Group B Incentive Spirometer. Pre-Treatment Control Pause Group A had
13(65%) sereiosly sick patients and 07(35%) were sick patients with other
complication and on medication and in Group B, 06(30%) were seriously sick
and 14(70%) were sick patients with other complication and on medication.
Post-Treatment Control Pause Group A had 5(25%) patients in poor health
without serious organic disease and 15(75%) were in good health. In Group
B, 2(10%) patients had poor health without serious organic disease and
18(90%) had good health (p=0.01). Conclusion(s): There was
significant variation in control pause (breath holding time) of
post-cardiac surgery patients after using Incentive Spirometer when
compared to the Buteyko breathing technique. Incentive spirometer was
better than Buteyko breathing technique for improving control pause in
Post-operative cardiac patients. Copyright © 2020, Pakistan
Medical Association. All rights reserved.

<53>
Accession Number
2011342120
Title
Efficacy and safety of edoxaban in patients early after surgical
bioprosthetic valve implantation or valve repair: A randomized clinical
trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Shim C.Y.; Seo J.; Kim Y.J.; Lee S.H.; De Caterina R.; Lee S.; Hong G.-R.;
Lee C.J.; Shin D.-H.; Ha J.-W.; Suh Y.J.; Choi J.Y.; Cho I.-J.; Roh Y.H.
Institution
(Shim, Seo, Hong) Division of Cardiology, Severance Cardiovascular
Hospital, Yonsei University College of Medicine, Seoul, South Korea
(Kim) Department of Radiology, Research Institute of Radiological Science,
Severance Hospital, Yonsei University College of Medicine, Seoul, South
Korea
(Lee, Lee) Division of Cardiovascular Surgery, Department of Thoracic and
Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(De Caterina) Cardio-Thoracic and Vascular Department, Pisa University
Hospital and University of Pisa, Pisa, Italy
Publisher
Mosby Inc.
Abstract
Objective: Early warfarin anticoagulation is recommended in patients
undergoing surgical bioprosthetic valve implantation or valve repair. It
is unclear whether non-vitamin K antagonist oral anticoagulants can be a
full alternative to warfarin. This study aimed to compare efficacy and
safety of edoxaban with warfarin in patients early after surgical
bioprosthetic valve implantation or valve repair. Method(s): The
Explore the Efficacy and Safety of Edoxaban in Patients after Heart Valve
Repair or Bioprosthetic Valve Replacement study was a prospective,
randomized (1:1), open-label, clinical trial conducted from December 2017
to September 2019. Patients were randomly assigned to receive edoxaban (60
mg or 30 mg once daily) or warfarin for the first 3 months after surgical
bioprosthetic valve implantation or valve repair. The primary efficacy
outcome was a composite of death, clinical thromboembolic events, or
asymptomatic intracardiac thrombosis. The primary safety outcome was the
occurrence of major bleeding. Result(s): Of 220 participants, 218
(109 per group) were included in the modified intention-to-treat analysis.
The primary efficacy outcome occurred in 4 patients (3.7%) taking warfarin
and none taking edoxaban (risk difference, -0.0367; 95% confidence
interval, -0.0720 to -0.0014; P < .001 for noninferiority). The primary
safety outcome occurred in 1 patient (0.9%) taking warfarin and 3 patients
(2.8%) taking edoxaban (risk difference, 0.0183; 95% confidence interval,
-0.0172 to 0.0539; P = .013 for noninferiority). Conclusion(s):
Edoxaban is noninferior to warfarin for preventing thromboembolism and is
potentially comparable for risk of major bleeding during the first 3
months after surgical bioprosthetic valve implantation or valve
repair. Copyright © 2021 The American Association for Thoracic
Surgery

<54>
Accession Number
2007621164
Title
Peak Serum Chloride and Hyperchloremia in Patients Undergoing Cardiac
Surgery Is Not Explained by Chloride-Rich Intravenous Fluid Alone: A
Post-Hoc Analysis of the LICRA Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (5) (pp 1321-1331),
2021. Date of Publication: May 2021.
Author
McIlroy D.R.; Murphy D.; Shotwell M.S.; Bhatia D.
Institution
(McIlroy, Murphy, Bhatia) Alfred Hospital, Monash University, Melbourne,
Victoria, Australia
(McIlroy, Shotwell) Vanderbilt University Medical Center, Nashville, TN,
United States
Publisher
W.B. Saunders
Abstract
Objectives: With the exception of 0.9% saline, little is known about
factors that may contribute to increased serum chloride concentration
(S<inf>Cl</inf>-) in patients undergoing cardiac surgery. For
the present study, the authors sought to characterize the association
between administered chloride load from intravenous fluid and other
perioperative variables, with peak perioperative
S<inf>Cl</inf>-. Design(s): Secondary analysis of data
from a previously published controlled clinical trial in which patients
were assigned to a chloride-rich or chloride-limited perioperative fluid
strategy (NCT02020538). Setting(s): Academic medical center.
 Participant(s): The study comprised 1,056 adult patients with normal
preoperative S<inf>Cl</inf>- undergoing cardiac surgery.
 Intervention(s): None Measurements and Main Results: Peak
perioperative S<inf>Cl</inf>- and hyperchloremia, defined as
peak S<inf>Cl</inf>- >110 mmol/L, were selected as co-primary
endpoints. Regression modeling identified factors independently associated
with these endpoints. Mean (standard deviation) peak perioperative
S<inf>Cl</inf>- was 114 (5) mmol/L, and hyperchloremia occurred
in 824 (78.0%) of the cohort. In addition to administered volume of 0.9%
saline, multivariate linear and logistic regression modeling consistently
associated preoperative S<inf>Cl</inf>- (regression coefficient
0.5; 95% confidence interval [CI] 0.4-0.6 mmol/L; odds ratio 1.60; 95% CI
1.41-1.82 per 1 mmol/L increase) and cardiopulmonary bypass duration
(regression coefficient 0.1; 95% CI 0.1-0.2 mmol/L; odds ratio 1.12; 95%
CI 1.06-1.19 per 10 minutes) with both co-primary outcomes. Multivariate
modeling only explained approximately 50% of variability in peak
S<inf>Cl</inf>-. Conclusion(s): The present study's data
identified an association for both 0.9% saline administration and other
nonfluid variables with peak perioperative S<inf>Cl</inf>- and
hyperchloremia. Stand-alone strategies to limit administration of
chloride-rich intravenous fluid may have limited ability to prevent
hyperchloremia in this setting. Copyright © 2020 Elsevier Inc.

<55>
Accession Number
634537095
Title
Angiographic Patency of Coronary Artery Bypass Conduits: A Network
Meta-Analysis of Randomized Trials.
Source
Journal of the American Heart Association. 10 (6) (pp e019206), 2021. Date
of Publication: 16 Mar 2021.
Author
Gaudino M.; Hameed I.; Robinson N.B.; Ruan Y.; Rahouma M.; Naik A.;
Weidenmann V.; Demetres M.; Y Tam D.; Hare D.L.; Girardi L.N.;
Biondi-Zoccai G.; E Fremes S.
Institution
(Gaudino, Hameed, Robinson, Ruan, Rahouma, Naik, Weidenmann, Girardi)
Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
(Demetres) Weill Cornell Medicine New York NY, Samuel J. Wood Library and
C.V. Starr Biomedical Information Centre
(Y Tam, E Fremes) Schulich Heart Centre Sunnybrook Health Science
University of Toronto Toronto Ontario Canada
(Hare) Department of Cardiology Austin Health Melbourne Australia
(Biondi-Zoccai) Department of Medico-Surgical Sciences and Biotechnologies
Sapienza University Rome Italy
(Biondi-Zoccai) Mediterranea Cardiocentro Naples Italy
Publisher
NLM (Medline)
Abstract
Background Several randomized trials have compared the patency of coronary
artery bypass conduits. All of the published studies, however, have
performed pairwise comparisons and a comprehensive evaluation of the
patency rates of all conduits has yet to be published. We set out to
investigate the angiographic patency rates of all conduits used in
coronary bypass surgery by performing a network meta-analysis of the
current available randomized evidence. Methods and Results A systematic
literature search was conducted for randomized controlled trials comparing
the angiographic patency rate of the conventionally harvested saphenous
vein, the no-touch saphenous vein, the radial artery (RA), the right
internal thoracic artery, or the gastroepiploic artery. The primary
outcome was graft occlusion. A total of 4160 studies were retrieved of
which 14 were included with 3651 grafts analyzed. The weighted mean
angiographic follow-up was 5.1 years. Compared with the conventionally
harvested saphenous vein, both the RA (incidence rate ratio [IRR] 0.54;
95% CI, 0.35-0.82) and the no-touch saphenous vein (IRR 0.55; 95% CI,
0.39-0.78) were associated with lower graft occlusion. The RA ranked as
the best conduit (rank score for RA 0.87 versus 0.85 for no-touch
saphenous vein, 0.23 for right internal thoracic artery, 0.29 for
gastroepiploic artery, and 0.25 for the conventionally harvested saphenous
vein). Conclusions Compared with the conventionally harvested saphenous
vein, only the RA and no-touch saphenous vein grafts are associated with
significantly lower graft occlusion rates. The RA ranks as the best
conduit. Registration URL: https://www.crd.york.ac.uk/prospero; Unique
identifier: CRD42020164492.

<56>
Accession Number
634536684
Title
Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement:
A Systematic Review.
Source
Journal of the American Heart Association. 10 (6) (pp e019854), 2021. Date
of Publication: 16 Mar 2021.
Author
Sengupta A.; Yazdchi F.; Alexis S.L.; Percy E.; Premkumar A.; Hirji S.;
Bapat V.N.; Bhatt D.L.; Kaneko T.; Tang G.H.L.
Institution
(Sengupta, Alexis, Tang) Department of Cardiovascular Surgery Mount Sinai
Hospital New York NY
(Yazdchi, Percy, Premkumar, Hirji, Kaneko) Division of Cardiac Surgery
Brigham and Women's Hospital Boston MA
(Bapat) Minneapolis Heart Institute Foundation Minneapolis MN
(Bhatt) Brigham and Women's Heart & Vascular CenterHarvard Medical School
Boston MA
Publisher
NLM (Medline)
Abstract
Bioprosthetic mitral structural valve degeneration and failed mitral valve
repair (MVr) have traditionally been treated with reoperative mitral valve
surgery. Transcatheter mitral valve-in-valve (MVIV) and valve-in-ring
(MVIR) replacement are now feasible, but data comparing these approaches
are lacking. We sought to compare the outcomes of (1) reoperative mitral
valve replacement (redo-MVR) and MVIV for structural valve degeneration,
and (2) reoperative mitral valve repair (redo-MVr) or MVR and MVIR for
failed MVr. A literature search of PubMed, Embase, and the Cochrane
Library was conducted up to July 31, 2020. Thirty-two studies involving 25
832 patients were included. Redo-MVR was required in =35% of patients
after index surgery at 10 years, with 5% to 15% 30-day mortality. MVIV
resulted in >95% procedural success with 30-day and 1-year mortality of 0%
to 8% and 11% to 16%, respectively. Recognized complications included left
ventricular outflow tract obstruction (0%-6%), valve migration (0%-9%),
and residual regurgitation (0%-6%). Comparisons of redo-MVR and MVIV
showed no statistically significant differences in mortality (11.3% versus
11.9% at 1 year, P=0.92), albeit higher rates of major bleeding and
arrhythmias with redo-MVR. MVIR resulted in 0% to 34% mortality at 1 year,
whereas both redo-MVr and MVR for failed repairs were performed with
minimal mortality and durable long-term results. MVIV is therefore a
viable alternative to redo-MVR for structural valve degeneration, whereas
redo-MVr or redo-MVR is preferred for failed MVr given the suboptimal
results with MVIR. However, not all patients will be candidates for
MVIV/MVIR because anatomical restrictions may preclude transcatheter
options from adequately addressing the underlying pathology.

<57>
Accession Number
634511076
Title
Meta-Analysis of Stroke and Mortality Rates in Patients Undergoing
Valve-in-Valve Transcatheter Aortic Valve Replacement.
Source
Journal of the American Heart Association. 10 (6) (pp e019512), 2021. Date
of Publication: 16 Mar 2021.
Author
Macherey S.; Meertens M.; Mauri V.; Frerker C.; Adam M.; Baldus S.;
Schmidt T.
Institution
(Macherey, Meertens, Mauri, Frerker, Adam, Baldus, Schmidt) Department III
of Internal Medicine University Hospital of Cologne Cologne Germany
Publisher
NLM (Medline)
Abstract
Background During the past decade, the use of transcatheter aortic valve
replacement (TAVR) was extended beyond treatment-naive patients and
implemented for treatment of degenerated surgical bioprosthetic valves.
Selection criteria for either valve-in-valve (viv) TAVR or redo surgical
aortic valve replacement are not well established, and decision making on
the operative approach still remains challenging for the interdisciplinary
heart team. Methods and Results This review was intended to analyze all
studies on viv-TAVR focusing on short- and mid-term stroke and mortality
rates compared with redo surgical aortic valve replacement or native TAVR
procedures. A structured literature search and review process led to 1667
potentially relevant studies on July 1, 2020. Finally, 23 studies
fulfilled the inclusion criteria for qualitative analysis. All references
were case series either with or without propensity score matching and
registry analyses. Quantitative synthesis of data from 8509 patients
revealed that viv-TAVR is associated with mean 30-day stroke and mortality
rates of 2.2% and 4.2%, respectively. Pooled data analysis showed no
significant differences in 30-day stroke rate, 30-day mortality, and
1-year mortality between viv-TAVR and comparator treatment (native TAVR
[n=11 804 patients] or redo surgical aortic valve replacement [n=498
patients]). Conclusions This review is the first one comparing the risk
for stroke and mortality rates in viv-TAVR procedures with native TAVR
approach and contributes substantial data for the clinical routine.
Moreover, this systematic review is the most comprehensive analysis on
ischemic cerebrovascular events and early mortality in patients undergoing
viv-TAVR. In this era with increasing numbers of bioprosthetic valves used
in younger patients, viv-TAVR is a suitable option for the treatment of
degenerated bioprostheses.

<58>
Accession Number
634510960
Title
Prognosis of Claims- Versus Trial-Based Ischemic and Bleeding Events
Beyond 1 Year After Coronary Stenting.
Source
Journal of the American Heart Association. 10 (6) (pp e018744), 2021. Date
of Publication: 16 Mar 2021.
Author
Butala N.M.; Faridi K.F.; Secemsky E.A.; Song Y.; Curtis J.; Gibson C.M.;
Kazi D.; Shen C.; Yeh R.W.
Institution
(Butala, Secemsky, Kazi, Shen, Yeh) Richard A. and Susan F. Smith Center
for Outcomes Research in Cardiology Division of Cardiovascular Medicine
Beth Israel Deaconess Medical Center Boston MA
(Butala) Cardiology Division Department of Medicine Massachusetts General
HospitalHarvard Medical School Boston MA
(Faridi, Curtis) Section of Cardiovascular Medicine Department of Medicine
Yale School of Medicine New Haven CT
(Song, Gibson, Yeh) Baim Institute for Clinical Research Boston MA
Publisher
NLM (Medline)
Abstract
Background It is unknown whether clinical events identified with
administrative claims have similar prognosis compared with
trial-adjudicated events in cardiovascular clinical trials. We compared
the prognostic significance of claims-based end points in context of
trial-adjudicated end points in the DAPT (Dual Antiplatelet Therapy)
study. Methods and Results We matched 1336 patients aged >=65 years who
received percutaneous coronary intervention in the DAPT study with the
CathPCI registry linked to Medicare claims. We compared death at 21 months
post-randomization using Cox proportional hazards models among patients
with ischemic events (myocardial infarction or stroke) and bleeding events
identified by: (1) both trial adjudication and claims; (2) trial
adjudication only; and (3) claims only. A total of 47 patients (3.5%) had
ischemic events identified by both trial adjudication and claims, 24
(1.8%) in trial adjudication only, 15 (1.1%) in claims only, and 1250
(93.6%) had no ischemic events, with annualized unadjusted mortality rates
of 12.8, 5.5, 14.9, and 1.26 per 100 person-years, respectively. A total
of 44 patients (3.3%) had bleeding events identified with both trial
adjudication and claims, 13 (1.0%) in trial adjudication only, 65 (4.9%)
in claims only, and 1214 (90.9%) had no bleeding events, with annualized
unadjusted mortality rates of 11.0, 16.8, 10.7, and 0.95 per 100
person-years, respectively. Among patients with no trial-adjudicated
events, patients with events in claims only had a high subsequent adjusted
mortality risk (hazard ratio (HR) ischemic events: 31.5; 95% CI,
8.9-111.9; HR bleeding events 23.9; 95% CI, 10.7-53.2). Conclusions In
addition to trial-adjudicated events, claims identified additional
clinically meaningful ischemic and bleeding events that were
prognostically significant for death.

<59>
Accession Number
632921243
Title
Effects of different positive end-expiratory pressure titrating strategies
on oxygenation and respiratory mechanics during one- lung ventilation: a
randomized controlled trial.
Source
Annals of palliative medicine. 10 (2) (pp 1133-1144), 2021. Date of
Publication: 01 Feb 2021.
Author
Xu D.; Wei W.; Chen L.; Li S.; Lian M.
Institution
(Xu) Department of Anesthesiology, Shanghai General Hospital of Nanjing
Medical University, Shanghai, China
(Wei, Chen, Lian) Department of Anesthesiology, Shanghai General Hospital,
Shanghai Jiao Tong University, Shanghai, China
(Li) Department of Anesthesiology, Shanghai General Hospital of Nanjing
Medical University, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Positive end-expiratory pressure (PEEP) is widely used to
reduce the risk of hypoxemia and atelectasis during one-lung ventilation
(OLV); however, the optimal strategy for PEEP titrating remains
unclear.The purpose of the study was to investigate the effects of
different PEEP titrating strategies on oxygenation and respiratory
mechanics during OLV. METHOD(S): Patients undergoing thoracic surgery
with general anesthesia were randomly allocated into five groups. In P0
group, PEEP was set to zero; in PLIP2 group, PEEP was set to 2 cmH2O plus
the pressure of lower inflection point (LIP) of pressure-volume (P-V)
curve; in PLIPS group, PEEP was titrated to achieve maximum static
compliance from the averaged LIP pressure value; in groups PSTAT and PDYN,
the incremental PEEP values were titrated to achieve maximum static
compliance or maximum dynamic compliance from 4 cmH2O. Hemodynamic
measurements, respiratory mechanics, and blood gas analyses were recorded
at the beginning of OLV, OLV 15 min, OLV 30 min, OLV 45 min, and OLV 60
min. Also, the intrapulmonary shunt (Qs/Qt), physiological dead space to
tidal volume ratio (VD/VT), and oxygenation index (OI) were calculated and
compared. RESULT(S): Seventy-five patients consented to participate
in this study. Dynamic compliance, peak inspiratory pressure (PIP), and
plateau inspiratory pressure (Pplat) increased after PEEP titration during
OLV. PIP, Qs/ Qt, and OI showed no differences among groups. Group PDYN
showed lower Pplat, lower driving pressure, and higher dynamic compliance
when compared with zero PEEP group. CONCLUSION(S): The PEEP titrating
strategy according to dynamic compliance can improve respiratory
mechanics, whereas it has no significant effects on oxygenation, dead
space ratio, and intrapulmonary shunt, suggesting that it is better during
OLV for thoracic surgery.

<60>
Accession Number
633151479
Title
Impact of renin-angiotensin system blocker after aortic valve
replacement-a systematic review and meta-analysis.
Source
Annals of palliative medicine. 10 (2) (pp 1244-1252), 2021. Date of
Publication: 01 Feb 2021.
Author
Zeng L.; Li J.; Yang J.; Liao Y.; Chen M.
Institution
(Zeng, Yang) West China Hospital, Sichuan University, Chengdu, China
(Li, Chen) Department of Cardiology, West China Hospital, Chengdu, China
(Liao) Department of Cardiology, West China Hospital, Chengdu, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Data reporting the impact of renin-angiotensin system
inhibitor (RASi) after aortic valve replacement (AVR) is controversy.
 METHOD(S): The PubMed database was systematically searched for
studies reporting the mortality and hazard ratios (HRs) of RASi following
surgical and transcatheter AVR (SAVR, TAVR). Random-effects model was used
when the I2 statistic was more than 50% and its P value was less than
0.05, otherwise, the fixed-effects model was conducted. RESULT(S):
Nine articles incorporating 33,063 patients were eligible. Patients having
the description of RASi were associated with lower all-cause mortality at
30 days (OR, 0.80, 95% CI, 0.69 to 0.94), 1 year (OR, 0.75, 95% CI, 0.69
to 0.81) and beyond 1 year (OR, 0.52, 95% CI, 0.38 to 0.73) after AVR.
Consistently, patients with RASi had lower risk for all-cause mortality
(HR, 0.87, 95% CI, 0.84 to 0.91) beyond 1 year following AVR albeit
adjusting confounders. Interestingly, beneficial effect of RASi was still
observed in patients with preserved ejection fraction following TAVR (HR,
0.90, 95% CI, 0.87 to 0.94). In addition, patients taking RASi had lower
cardiovascular mortality than those patients without RASi after TAVR (30
days, OR, 0.63, 95% CI, 0.44 to 0.90; 1 year, OR, 0.60, 95% CI, 0.50 to
0.73; beyond 1 year, OR, 0.63, 95% CI, 0.54 to 0.74). CONCLUSION(S):
Patients with RASi exhibited better short- and long-term survival
following AVR compared to those patients without RASi, which warranted
further studies to support such findings.

<61>
Accession Number
633616681
Title
Global Fractional Flow Reserve Value Predicts 5-Year Outcomes in Patients
With Coronary Atherosclerosis But Without Ischemia.
Source
Journal of the American Heart Association. 9 (24) (pp e017729), 2020. Date
of Publication: 15 Dec 2020.
Author
Fournier S.; Collet C.; Xaplanteris P.; Zimmermann F.M.; Toth G.G.; Tonino
P.A.L.; Pijls N.H.J.; Colaiori I.; Di Gioia G.; Barbato E.; Juni P.;
Fearon W.F.; De Bruyne B.
Institution
(Fournier, Collet, Xaplanteris, Colaiori, Di Gioia, Barbato, De Bruyne)
Cardiovascular Center Aalst Aalst Belgium
(Fournier, De Bruyne) Department of Cardiology Lausanne University
Hospital Lausanne Switzerland
(Fournier, Di Gioia, Barbato) Department of Advanced Biomedical Sciences
University of Naples Federico II Naples Italy
(Zimmermann, Tonino, Pijls) Department of Cardiology Catharina Hospital
Eindhoven the Netherlands
(Toth) University Heart Centre GrazMedical University Graz Graz Austria
(Pijls) Department of Biomedical Engineering Eindhoven University of
Technology Eindhoven the Netherlands
(Juni) Applied Health Research Centre Li Ka Shing Knowledge Institute of
St. Michael's Hospital Toronto Ontario Canada
(Juni) Department of Medicine University of Toronto Ontario Canada
(Fearon) Stanford University School of Medicine Stanford CA
Publisher
NLM (Medline)
Abstract
Background Global fractional flow reserve (FFR) (ie, the sum of the FFR
values in the 3 major coronary arteries) is a physiologic correlate of
global atherosclerotic burden. The objective of the present study was to
investigate the value of global FFR in predicting long-term clinical
outcome of patients with stable coronary artery disease but no
ischemia-inducing stenosis. Methods and Results We studied major adverse
cardiovascular events (MACEs: all-cause death, myocardial infarction, and
any revascularization) after 5 years in 1122 patients without significant
stenosis (all FFR >0.80; n=275) or with at least 1 significant stenosis
successfully treated by percutaneous coronary intervention (ie,
post-percutaneous coronary intervention FFR >0.80; n=847). The patients
were stratified into low, mid, or high tertiles of global FFR (<=2.80,
2.80-2.88, and >=2.88). Patients in the lowest tertile of global FFR
showed the highest 5-year MACE rate compared with those in the mid or high
tertile of global FFR (27.5% versus 22.0% and 20.9%, respectively;
log-rank P=0.040). The higher 5-year MACE rate was mainly driven by a
higher rate of revascularization in the low global FFR group (16.4% versus
11.3% and 11.8%, respectively; log-rank P=0.038). In a multivariable
model, an increase in global FFR of 0.1 unit was associated with a
significant reduction in the rates of MACE (hazard ratio [HR], 0.988; 95%
CI, 0.977-0.998; P=0.023), myocardial infarction (HR, 0.982; 95% CI,
0.966-0.998; P=0.032), and revascularization (HR, 0.985; 95% CI,
0.972-0.999; P=0.040). Conclusions Even in the absence of
ischemia-producing stenoses, patients with a low global FFR, physiologic
correlate of global atherosclerotic burden, present a higher risk of MACE
at 5-year follow-up.

<62>
Accession Number
612844581
Title
Interposed abdominal compression-cardiopulmonary resuscitation after
cardiac surgery.
Source
Interactive cardiovascular and thoracic surgery. 19 (6) (pp 985-989),
2014. Date of Publication: 01 Dec 2014.
Author
Li J.; Wang J.; Li T.
Institution
(Li) Cardiovascular Center of Hainan Medical College, Affiliated Hospital
of Hainan Medical College, Haikou, China
(Wang) Cardiovascular Center of Hainan Medical College, Affiliated
Hospital of Hainan Medical College, Haikou, China
(Li) Cardiovascular Center of Hainan Medical College, Affiliated Hospital
of Hainan Medical College, Haikou, China
Abstract
OBJECTIVES: The management of cardiac arrest after cardiac surgery differs
from the management of cardiac arrest under other circumstances. In other
studies, interposed abdominal compression-cardiopulmonary resuscitation
(IAC-CPR) resulted in a better outcome compared with conventional CPR. The
aim of the present study was to determine the feasibility, safety and
efficacy of IAC-CPR compared with conventional CPR in patients with
cardiac arrest after cardiac surgery.
METHODS: Data on all cardiac surgical patients who suffered a sudden
cardiac arrest during the first 24 h after surgery were collected
prospectively. Cardiac arrest was defined as the cessation of cardiac
mechanical activity with the absence of a palpable central pulse, apnoea
and unresponsiveness, including ventricular fibrillation, asystole and
pulseless electrical activity. Forty patients were randomized to either
conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially
performed by compressing the abdomen midway between the xiphoid and the
umbilicus during the relaxation phase of chest compression. If spontaneous
circulation was not restored after 10-15 min, the surgical team would
immediately proceed to resternotomy. The endpoints of the study were
safety, return of spontaneous circulation (ROSC) >5 min, survival to
hospital discharge and survival for 6 months.
RESULTS: With IAC-CPR, there were more patients in terms of ROSC, survival
to hospital discharge, survival for 6 months and fewer CPR-related
injuries compared with patients who underwent conventional CPR.
CONCLUSIONS: IAC-CPR is feasible and safe and may be advantageous in cases
of cardiac arrest after cardiac surgery. Copyright © The Author
2014. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<63>
[Use Link to view the full text]
Accession Number
634597667
Title
Effects of corticosteroids on new-onset atrial fibrillation after cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Medicine. 100 (11) (pp e25130), 2021. Date of Publication: 19 Mar 2021.
Author
Liu L.; Jing F.-Y.; Wang X.-W.; Li L.-J.; Zhou R.-Q.; Zhang C.; Wu Q.-C.
Institution
(Liu, Li, Zhou, Zhang) Department of Cardiothoracic Surgery ICU
(Jing, Wu) Department of Cardiology
(Wang) Department of Cardiothoracic Surgery, First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Zhang) Centre for Clinical Pharmacology, William Harvey Research
Institute, Queen Mary University of London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) occurs commonly after
cardiac surgery. Studies suggest that corticosteroid can reduce the
incident of POAF. However, the results remain controversial. This
meta-analysis aimed to evaluate the efficacy and safety corticosteroid on
the prevention of POAF following cardiac surgery. METHOD(S):
Randomized controlled trials were identified through a systematic
literature search. Two investigators independently searched articles,
extracted data, and assessed the quality of included studies. Primary
outcome was the incidence of POAF as well as length of hospital stay and
intensive care unit stay, wound and other infection, mortality, duration
of ventilation, myocardial infarction, gastrointestinal complications,
high blood sugar, stroke, and postoperative bleeding. RESULT(S):
Fourteen studies with 13,803 patients were finally involved in the present
study. Overall, corticosteroid significantly decreased the risk of POAF
(relative risk [RR], 0.7; 95% confidence interval [CI], 0.55-0.89; P =
.003). There were no significant differences in the incidence of length of
intensive care unit stay (RR, -2.32; 95% CI, -5.44 to 0.80; P = .14) and
hospital stay (RR, -0.43; 95% CI, -0.84 to -0.02; P = .04), infections
(RR, 1.01; 95% CI, 0.83-1.23; P = .9), mortality (RR, 0.87; 95% CI,
0.71-1.06; P = .16), duration of ventilation (RR, -0.29; 95% CI, -0.65 to
0.07; P = .12), gastrointestinal complications (RR, 1.26; 95% CI,
0.91-1.76; P = .16), high blood sugar (RR, 1.98; 95% CI, 0.91-4.31; P =
.09), stroke (RR, 0.9; 95% CI, 0.69-1.18; P = .45), postoperative bleeding
(RR -44.54; 95% CI, -115.28 to 26.20; P = .22) and myocardial infarction
(RR, 1.71; 95% CI, 0.96-1.43; P = .12). CONCLUSION(S): Our review
suggests that the efficacy of corticosteroid might be beneficial to POAF
development in patients undergoing cardiac surgery. The strength of this
association remains uncertain because of statistical and clinical
heterogeneity among the included studies. Copyright © 2021 the
Author(s). Published by Wolters Kluwer Health, Inc.

<64>
Accession Number
634597421
Title
The effect of in-hospital physiotherapy on handgrip strength and physical
activity levels after cardiac valve surgery: a randomized controlled
trial.
Source
Annals of palliative medicine. 10 (2) (pp 2217-2223), 2021. Date of
Publication: 01 Feb 2021.
Author
Chen J.; Zhang T.; Bao W.; Zhao G.; Chen Z.
Institution
(Chen, Zhang, Bao, Zhao) Department of Rehabilitation Medicine, First
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Chen) Department of Rehabilitation Medicine, First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients who undergo cardiac valve surgery undertake routine
physical therapy program. Despite its routine use, its influence on
physical activity level post- surgery has not been illustrated. This study
was to investigate whether 5 days of in-hospital physiotherapy could
improve physical activity levels after cardiac valve surgery.
 METHOD(S): The study is a single-blind randomized controlled trial
which performed in Cardiothoracic Surgery Department. Patients who
underwent cardiac valve surgery (n=34) for confirmed cardiac valve
disorders were assessed during hospitalization. The intervention group
received a daily post-operative physiotherapy intervention, consisting of
individualized mobilization, breathing exercises, ambulation with or
without a walking aid. There was no physiotherapy treatment in the control
group. Measurements: physical activity was assessed with the handgrip
strength test and the timed up and go test. RESULT(S): The treatment
group showed significantly greater handgrip strength [20.58 (7.17) vs.
12.96 (4.65) kg] and less time on the timed up and go test [5.92 (2.91)
vs. 6.53 (1.60) s] compared to the control group on the 5th post-operative
day. Whilst there was no significant difference on the timed up and go
test between the 2 groups, handgrip strength on the 5th post-operative day
was significantly different between the 2 groups. CONCLUSION(S):
Patients who received physiotherapy during hospitalization showed
increased levels of handgrip strength and physical activity on the 5th day
after cardiac valve surgery compared to the control group. The clinical
value of increased levels of physical activity after in-hospital
physiotherapy following cardiac valve surgery requires further
investigation.

<65>
[Use Link to view the full text]
Accession Number
634596851
Title
Impact of time factor and patient characteristics on the efficacy of PCI
vs CABG for left main coronary disease: A meta-analysis.
Source
Medicine. 100 (10) (pp e25057), 2021. Date of Publication: 12 Mar 2021.
Author
Qiu M.; Ding L.; Zhan Z.; Zhou H.
Institution
(Qiu, Zhou) Department of General Medicine, Shenzhen Longhua District
Central Hospital, Shenzhen, China
(Ding) Department of Cardiology, First Affiliated Hospital of Yangtze
University, Jingzhou, China
(Zhan) Class 3, Clinical medicine, Second Clinical Medical College,
Southern Medical University
Publisher
NLM (Medline)
Abstract
BACKGROUND: The impact of time factor and patient characteristics on the
efficacy of percutaneous coronary intervention (PCI) with drug-eluting
stents vs. coronary-artery bypass grafting (CABG) for left main coronary
disease is unclear. METHOD(S): We searched PubMed and Embase for
related trials. Two outcomes of interest were major adverse cardiac or
cerebrovascular events (MACCE, defined as a composite of all-cause
mortality, myocardial infarction, stroke, or unplanned revascularization)
and a composite of all-cause mortality, myocardial infarction, or stroke.
We conducted random-effects meta-analysis stratified by follow-up duration
and 7 factors of interest related to patient characteristics.
Random-effects meta-regression was performed to calculate P values for
trend and those for subgroup differences. RESULT(S): We included 11
articles from 5 trials. Compared with CABG, PCI increased MACCE at the end
of 3-year (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.04-1.40,
I2 = 0) and 5-year (HR 1.33, 95% CI 1.20-1.48, I2 = 0) follow-up, but did
not increase all-cause mortality, myocardial infarction, or stroke. The
logarithm of HR of PCI vs CABG for MACCE increased as follow-up duration
increased (beta = 0.057, P = .025). PCI vs CABG consistently increased
5-year MACCE across various subgroups defined by 7 factors of interest
(Psubgroup ranged from .156 to .830). CONCLUSION(S): The long-term
benefit of CABG vs PCI on MACCE in patients with left main coronary
disease is consistent across patients with different clinical
characteristics. The relative benefit of CABG on MACCE is driven by that
of CABG on unplanned revascularization, and becomes greater as time goes
on. Copyright © 2021 the Author(s). Published by Wolters Kluwer
Health, Inc.

<66>
Accession Number
2011472992
Title
The management of deep sternal wound infection: Literature review and
reconstructive algorithm.
Source
JPRAS Open. 28 (pp 77-89), 2021. Date of Publication: June 2021.
Author
Hever P.; Singh P.; Eiben I.; Eiben P.; Nikkhah D.
Institution
(Hever, Singh, Eiben, Eiben, Nikkhah) Department of Plastic Surgery, Royal
Free London NHS Foundation Trust, Pond Street, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Deep sternal wound infection (DSWI) is an important complication of open
thoracic surgery, with a reported incidence of 0.5-6%. Given its
association with increased morbidity, mortality, inpatient duration,
financial burden, and re-operation rates, an aggressive approach to
treatment is mandated. Flap reconstruction has become the standard of
care, with studies demonstrating improved outcomes with reduced mortality
and resource usage in patients undergoing early versus delayed flap
reconstruction. Despite this, no evidence-based standard for the
management of DSWI exists. We performed a thorough review of the
literature to identify principles in management, using a PRISMA compliant
methodology. Ovid-Embase, Medline and PubMed databases were searched for
relevant papers using the search terms "deep sternal wound infection," and
"post-sternotomy mediastinitis" to December 2019. Duplicates were removed,
and the search narrowed to look at specific areas of interest i.e.
negative pressure wound therapy, flap reconstruction, and rigid fixation.
The reference list of included articles underwent full text review. No
randomized controlled trials were identified. We review the current
management techniques for patients with DSWI, and raise awareness for the
need for further high quality studies, and a standardized national
cardiothoracic-plastic surgery guideline to guide management. Based on our
findings and the authors' own experience in this area, we provide
evidence-based recommendations. We also propose a reconstructive
algorithm. Copyright © 2021

<67>
Accession Number
2006825662
Title
Single and repeated intrapleural ropivacaine administration: A plasma
concentration and pharmacodynamics study.
Source
Journal of Pain Research. 14 (pp 785-791), 2021. Date of Publication:
2021.
Author
Chen Y.; Cai Y.; Ye Y.; Xia Y.; Papadimos T.J.; Liu L.; Xu X.; Wang Q.;
Shi K.; Wu Y.
Institution
(Chen, Cai, Ye, Liu, Wang, Shi, Wu) Department of Anesthesiology, The
First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
(Xia, Papadimos) Department of Anesthesiology, The Ohio State University
Wexner Medical Center, Columbus, OH, United States
(Xu) WenzhouChina
Publisher
Dove Medical Press Ltd
Abstract
Background: Intrapleural analgesia has been increasingly recommended for
postoperative analgesia after thoracic surgery. However, the analgesic
effect provided by a single intra- pleural administration is time limited.
This study reports the efficacy and safety of repeated intrapleural 0.75%
ropivacaine administration after thoracoscopic surgery. Method(s):
Twenty patients were randomly divided into two groups: a single
administration group receiving a single intrapleural injection of 0.75%
ropivacaine 15 mL (single admin- istration group, SA group), and a
repeated administration group with an intrapleural injection of 0.75%
ropivacaine 15 mL every 4h for 4 doses (repeated administration group, RA
group). The primary outcomes of this study were the peak plasma
concentration of ropiva- caine and 24h morphine consumption. The secondary
outcomes were pain score, patient satisfaction, extubation time, hospital
length of stay, and adverse reactions. Result(s): In SA group, the
highest plasma concentration after intrapleural administration of 0.75%
ropivacaine 15 mL was 1345+/-364 microg/L. The highest plasma
concentration in RA group after the fourth administration was 1864+/-492
microg/L. The 24h morphine consumption in RA group was significantly less
than that in SA group (9.0+/-5.66 vs 15.9+/-3.48 mg, P=0.004). The NRS
scores at rest and while coughing of patients in RA group were
significantly lower than those in SA group at 5, 9, 13, 17 and 24h after
operation. The patients in RA group had higher satisfaction than those in
SA group. There was no significant difference in postoperative adverse
events, drainage tube placement days and hospital length of stay between
the two groups. Conclusion(s): Repeated intrapleural administration
with 0.75% ropivacaine, 15 mL every 4h for 4 doses after video-assisted
thoracoscopic lobectomies, can provide a more durable and more effective
analgesic effect than single intrapleural administration. Repeated
intrapleural administration of ropivacaine is an effective postoperative
method of analgesia resulting in higher patient satisfaction. Moreover, it
was also able to keep the plasma concentration of ropivacaine within a
possible safe range. Copyright © 2021 Chen et al.

<68>
Accession Number
2011498911
Title
Predicting Readmission to Intensive Care After Cardiac Surgery Within
Index Hospitalization: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Kimani L.; Howitt S.; Tennyson C.; Templeton R.; McCollum C.; Grant S.W.
Institution
(Kimani, Howitt, McCollum, Grant) Division of Cardiovascular Sciences,
University of Manchester, ERC, Manchester University Hospital Foundation
Trust, Manchester, United Kingdom
(Howitt, Templeton) Department of Cardiothoracic Anaesthesia and Critical
Care, Wythenshawe Hospital, Manchester University Hospital Foundation
Trust, Manchester, United Kingdom
(Tennyson) Department of Cardiothoracic Surgery, Blackpool Victoria
Hospital, Blackpool, United Kingdom
Publisher
W.B. Saunders
Abstract
Readmission to the cardiac intensive care unit after cardiac surgery has
significant implications for both patients and healthcare providers.
Identifying patients at risk of readmission potentially could improve
outcomes. The objective of this systematic review was to identify risk
factors and clinical prediction models for readmission within a single
hospitalization to intensive care after cardiac surgery. PubMed, MEDLINE,
and EMBASE databases were searched to identify candidate articles. Only
studies that used multivariate analyses to identify independent predictors
were included. There were 25 studies and five risk prediction models
identified. The overall rate of readmission pooled across the included
studies was 4.9%. In all 25 studies, in-hospital mortality and duration of
hospital stay were higher in patients who experienced readmission.
Recurring predictors for readmission were preoperative renal failure, age
>70, diabetes, chronic obstructive pulmonary disease, preoperative left
ventricular ejection fraction <30%, type and urgency of surgery, prolonged
cardiopulmonary bypass time, prolonged postoperative ventilation,
postoperative anemia, and neurologic dysfunction. The majority of
readmissions occurred due to respiratory and cardiac complications. Four
models were identified for predicting readmission, with one external
validation study. As all models developed to date had limitations, further
work on larger datasets is required to develop clinically useful models to
identify patients at risk of readmission to the cardiac intensive care
unit after cardiac surgery. Copyright © 2021 Elsevier Inc.

<69>
Accession Number
2008509573
Title
The protective effect of hypothermia on postoperative cognitive deficit
may be attenuated by prolonged coronary artery bypass time: Meta-analysis
and meta-regression.
Source
Advances in Clinical and Experimental Medicine. 29 (10) (pp 1211-1219),
2020. Date of Publication: 2020.
Author
Habibi V.; Habibi M.R.; Habibi A.; Zeydi A.E.
Institution
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Anesthesiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Student Research Committee, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Nasibeh School of Nursing
and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
Publisher
Wroclaw University of Medicine
Abstract
There is controversy about whether hypothermia during coronary artery
bypass grafting (CABG) surgery is effective in reducing postoperative
cognitive deficit (POCD). The objective of this study was to determine the
effect of hypothermia on POCD and to undertake a meta-regression to
determine whether moderator variables mediate the relationship between
hypothermia and POCD. We searched the Web of Science, PubMed database,
Scopus, and the Cochrane Library database (up to June 2017), and
systematically reviewed a list of retrieved articles. Our final review
includes only randomized controlled trials (RCTs) that compared
administration of hypothermia (34degreeC). Statistical analysis of the
risk ratio (RR) and corresponding 95% confidence interval (95% CI) was
used to report the overall effect. Mantel-Haenszel risk ratio (MH RR) and
corresponding 95% CI was used to report the overall effect and
meta-regression analysis. Eight RCTs were included in this study, with a
total of 1,474 patients. The POCD occurred in 36.06% of all cases. A wide
range of hypothermia (28-34degreeC) did not reduce the occurrence of POCD
(RR = 0.983 (95% CI = 0.881-1.143); Z = -0.304; P = 0.761; I2 =
38%). Shorter CPB time reduced the occurrence of POCD (MH log risk ratio =
-0.011 (95% CI = -0.021--0.0008); Z = -2.123; P = 0.033). Postoperative
cognitive deficit is a common event among CABG patients. Contrary to deep
hypothermia, mild hypothermia was significantly effective in reducing the
risk of POCD. The neuroprotective effect of hypothermia on POCD may be
attenuated by prolonged cardiopulmonary bypass (CPB) time. Copyright
© 2020 by Wroclaw Medical University This is an article distributed
under the terms of the Creative Commons Attribution 3.0 Unported (CC BY
3.0) (https://creativecommons.org/licenses/by/3.0/)

<70>
Accession Number
2005729357
Title
The clinical utility of remote ischemic preconditioning in protecting
against cardiac surgery-associated acute kidney injury: A pilot randomized
clinical trial.
Source
Advances in Clinical and Experimental Medicine. 29 (2) (pp 189-196), 2020.
Date of Publication: 01 Feb 2020.
Author
Stokfisz K.; Ledakowicz-Polak A.; Zagorski M.; Jander S.; Przybylak K.;
Zielinska M.
Institution
(Stokfisz, Ledakowicz-Polak, Przybylak, Zielinska) Intensive Cardiac
Therapy Clinic, Department of Invasive Cardiology and Electrocardiology,
Medical University of Lodz, Lodz, Poland
(Zagorski, Jander) Cardiosurgery Clinic, Department of Cardiology and
Cardiosurgery, Medical University of Lodz, Lodz, Poland
Publisher
Wroclaw University of Medicine
Abstract
Background. Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-known, serious complication and a well-recognized independent risk
factor for higher morbidity and mortality among patients undergoing
cardiac surgery. Objectives. The aim of the study was to assess the
efficacy of remote ischemic preconditioning (RIPC) in reducing the
incidence of CSA-AKI, measured with the standard creatinine technique and
using neutrophil gelatinase-associated lipocalin (NGAL) serum
concentrations as a potential new biomarker of kidney damage. The ethics
committee of the Medical University of Lodz prospectively approved the
protocol (approval No. RNN/286/13/KE). The study was retrospectively
registered with the U.S. National Institutes of Health - NIH (29 June
2017; ClinicalTrials.gov identifier: NCT03205410). Material and methods.
We conducted a prospective single-center double-blind randomized and
controlled tudy. Data was collected from patients admitted to the
Cardiosurgery Clinic at the Medical University of Lodz (Poland) between
January and December 2014, scheduled for elective cardiac surgery (an
off-pump coronary artery bypass). A total of 28 patients were randomized
to receive either RIPC (n = 14) or sham RIPC (n = 14). After the induction
of anesthesia, the patients assigned to the RIPC group underwent 3 cycles
of 5-minute inflation to 200 mm Hg and 5-minute deflation of the upper-arm
cuff. The control group had a deflated cuff placed on the upper arm for 30
min. The authors measured the patients' serum creatinine concentration to
check for the occurrence of a CSA-AKI within 48 h after cardiac surgery,
and NGAL serum concentration to check its level within 3 h after the
operation. Results. Fewer patients in RIPC group developed CSA-AKI within
48 h after cardiac surgery than in the control group (29% vs 93%; p =
0.003). Fewer patients in the RIPC group presented an increase in NGAL 3 h
after surgery (medians: 124 vs 176.7; p = 0.0003). Conclusions. In
patients undergoing an off-pump coronary artery bypass, RIPC significantly
reduces the occurrence of CSA-AKI and protects against increased
postoperative NGAL levels. Copyright © 2020 by Wroclaw Medical
University.

<71>
Accession Number
2004358741
Title
Distribution of polymorphisms in the CYP2C19 and ABCB1 genes among
patients with acute coronary syndrome in Lower Silesian population.
Source
Advances in Clinical and Experimental Medicine. 28 (12) (no pagination),
2019. Date of Publication: 2019.
Author
Wojcik T.; Szymkiewicz P.; Wisniewski J.; Lebioda A.; Jonkisz A.; Gamian
A.; Kuliczkowski W.; Sciborski K.; Mysiak A.; Protasiewicz M.
Institution
(Wojcik, Szymkiewicz, Kuliczkowski, Sciborski, Mysiak, Protasiewicz)
Department and Clinic of Cardiology, Wroclaw Medical University, Poland
(Wisniewski, Gamian) Department and Section of Biochemistry, Wroclaw
Medical University, Poland
(Lebioda, Jonkisz) Section of Molecular Techniques, Wroclaw Medical
University, Poland
Publisher
Wroclaw University of Medicine
Abstract
Background. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel
administered totreat patients with acute coronary syndrome (ACS) is still
being used. However, despite theproven efficacy of this treatment regimen,
thromboembolic complications have been observed insome individuals.
Thereason for this phenomenon is linked totheso-called increased
responsiveness ofplatelets despite high platelet resistance (HPR). A
significant role in HPR is attributed to genetically determined
differences in the absorption and activation of clopidogrel. Objectives.
Theaim of thestudy was toassess theincidence ofpolymorphisms of the ABCB1
and CYPC19 genes that encode proteins involved intheabsorption and
metabolism of clopidogrel. Material and methods. The analysis was
performed in 199 consecutive patients from Lower Silesian voivodeship
(Poland) who underwent coronary angioplasty with stenting for ACS. The
single nucleotide polymorphism of the CYP2C19 and ABCB1 genes was
performed using a mini sequencing or restriction fragment length
polymorphism method. Results. Theresults of this study revealed thehigh
incidence ofpatients who may be unresponsive toantiplatelet treatment due
togenetic causes. TheCYPC19*2 allele intheform ofhomozygote ormutation
heterozygote appeared in26.1% of thestudy population. ABCB1 (C3435C>T)
polymorphism was associated with 84% ofpatients. Thetotal incidence
ofallelic disorders of low drug absorption and metabolism reached 14.6%.
Conclusions. Thedata obtained should prompt clinicians touse more recent
antiplatelet agents (ticagrelor orprasugrel) first, instead of
clopidogrel. Copyright © 2019 by Wroclaw Medical University.

<72>
Accession Number
612122942
Title
The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during
cardiopulmonary bypass - Randomized trial.
Source
Advances in Clinical and Experimental Medicine. 23 (6) (pp 919-924), 2014.
Date of Publication: 01 Nov 2014.
Author
Guclu C.Y.; Unver S.; Aydinli B.; Kazanci D.; Dilber E.; Ozgok A.
Institution
(Guclu, Unver, Aydinli, Kazanci, Dilber, Ozgok) Turkiye Yuksek Ihtisas
Education and Research Hospital, Clinic of Anesthesia and Reanimation,
Ankara, Turkey
Publisher
Wroclaw University of Medicine
Abstract
Background. Neuropsychological and neurological deficits are still major
causes of mortality and morbidity after cardiac surgery. These
complications are thought to be caused by embolisms and cerebral hypoxia.
Thus, continuous neuromonitoring is essential during cardiac surgery due
to cerebral oxygen desaturation during different periods. Near-infrared
spectrophotometry (NIRS), a non-invasive method, appears to offer many
advantages for monitoring cerebral oxygenation and hemodynamics.
Desaturation of cerebral oxygen may occur at the beginning of
cardiopulmonary bypass (CPB) or during the low perfusion and rewarming
stages if not corrected. Objectives. This study was designed to assess the
effects of sevoflurane on cerebral protection during CPB. Material and
Methods. Eighty patients were divided into two groups. Anesthesia was
maintained either with fentanyl and midazolam (total intravenous
anesthesia, TIVA) or with one minimum alveolar concentration of
sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute
decrease in saturation of 20% from baseline cerebral saturation. When
desaturation occurred, PaCO<inf>2</inf>, hematocrit and PaO<inf>2</inf>
levels were checked and corrected. If desaturation continued, anesthetic
depth was increased to reserve saturation with 50-100 mg of propofol. NIRS
values and hemodynamics were recorded at predetermined time intervals.
Results. Cerebral oxygen saturation values on the right side were higher
in the sevoflurane group than in the TIVA group. The values on the left
side were higher in the sevoflurane group than in the TIVA group, and
meaningful differences were seen at the lowest temperature and at
36degreeC. Conclusions. Oxygen saturation was higher in the sevoflurane
group than in the TIVA group. Thus, the effect of sevoflurane was useful
for maintaining cerebral oxygen saturation during CBP. ©
Copyright by Wroclaw Medical University.

<73>
Accession Number
2011425386
Title
Everolimus for the Prevention of Calcineurin-Inhibitor-Induced Left
Ventricular Hypertrophy After Heart Transplantation (RADTAC Study).
Source
JACC: Heart Failure. 9 (4) (pp 301-313), 2021. Date of Publication: April
2021.
Author
Anthony C.; Imran M.; Pouliopoulos J.; Emmanuel S.; Iliff J.W.; Moffat
K.J.; Ross J.; Graham R.M.; Kotlyar E.; Muthiah K.; Keogh A.M.; Hayward
C.S.; Macdonald P.; Jabbour A.
Institution
(Anthony, Imran, Pouliopoulos, Emmanuel, Iliff, Graham, Kotlyar, Muthiah,
Keogh, Hayward, Macdonald, Jabbour) Heart and Lung Transplant Unit, St.
Vincent's Hospital, Sydney, Australia
(Pouliopoulos, Graham, Hayward, Macdonald, Jabbour) Victor Chang Cardiac
Research Institute
(Moffat, Ross) Medical Imaging Department, St. Vincent's Hospital, Sydney,
Australia
(Graham, Kotlyar, Muthiah, Keogh, Hayward, Macdonald, Jabbour) Faculty of
Medicine, University of New South Wales, Sydney, New South Wales,
Australia
Publisher
Elsevier Inc.
Abstract
Objectives: This study aimed to determine the safety and efficacy of
combined low-dose everolimus and low-dose tacrolimus compared with
standard-dose tacrolimus in attenuating left ventricular hypertrophy (LVH)
after orthotopic heart transplantation (OHT). Background(s):
Calcineurin inhibitors (CNIs) such as tactrolimus are important in
preventing cardiac allograft rejection and reducing mortality after OHT.
However CNIs are causatively linked to the development of LVH, and are
associated with nephrotoxicity and vasculopathy. CNI-sparing agents such
as everolimus have been hypothesized to inhibit adverse effects of CNIs.
 Method(s): In this prospective, randomized, open-label study, OHT
recipients were randomized at 12 weeks after OHT to a combination of
low-dose everolimus and tacrolimus (the RADTAC group) or standard-dose
tacrolimus (the TAC group), with both groups coadministered mycophenolate
and prednisolone. The primary endpoint was LVH indexed as the change in
left ventricular mass (DELTALVM) by cardiovascular magnetic resonance
(CMR) imaging from 12 to 52 weeks. Secondary endpoints included CMR-based
myocardial performance, T1 fibrosis mapping, blood pressure, and renal
function. Safety endpoints included episodes of allograft rejection and
infection. Result(s): Forty stable OHT recipients were randomized.
Recipients in the RADTAC group had significantly lower tacrolimus levels
compared with the TAC group (6.5 +/- 3.5 mug/l vs. 8.6 +/- 2.8 mug/l; p =
0.02). The mean everolimus level in the RADTAC group was 4.2 +/- 1.7
mug/l. A significant reduction in LVM was observed in the RADTAC group
compared with an increase in LVM in the TAC group (DELTALVM = -13.0 +/-
16.8 g vs. 2.1 +/- 8.4 g; p < 0.001). Significant differences were also
noted in secondary endpoints measuring function and fibrosis (DELTA
circumferential strain = -2.9 +/- 2.8 vs. 2.1 +/- 2.3; p < 0.001; DELTAT1
mapping values = -32.7 +/- 51.3 ms vs. 26.3 +/- 90.4 ms; p = 0.003). No
significant differences were observed in blood pressure (DELTA mean
arterial pressure = 4.2 +/- 18.8 mm Hg vs. 2.8 +/- 13.8 mm Hg; p = 0.77),
renal function (DELTA creatinine = 3.1 +/- 19.9 mumol/l vs. 9 +/- 21.8
mumol/l; p = 0.31), frequency of rejection episodes (p = 0.69), or
frequency of infections (p = 0.67) between groups. Conclusion(s): The
combination of low-dose everolimus and tacrolimus compared with
standard-dose tacrolimus safely attenuates LVH in the first year after
cardiac transplantation with an observed reduction in CMR-measured
fibrosis and an improvement in myocardial strain. Copyright ©
2021 American College of Cardiology Foundation

<74>
Accession Number
2011412244
Title
Tricuspid valve replacement: Mechanical or biological prostheses? A
systematic review and meta-analysis.
Source
Heart Surgery Forum. 24 (2) (pp E209-E214), 2021. Date of Publication: 03
Mar 2021.
Author
Cheng Z.; Fang T.; Wang D.; Guo Y.
Institution
(Cheng, Guo) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Fang) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, Sichuan 610041, China
(Wang) First School of Clinical Medicine, Lanzhou University, Lanzhou
730000, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Tricuspid valve replacement (TVR) is seldom performed in
cardiac valve surgery, and there currently are no clinical guidelines as
to which type of prostheses is better in tricuspid valve position. This
meta-analysis was performed to compare the results of mechanical and
biological prostheses for TVR. Method(s): We searched the Pubmed,
Cochrane, and Embase clinical trial databases to collect all related
studies published from January 1, 2000 to July 31, 2020. A random-effects
model was used to evaluate the odds ratios (OR) and its 95% confidence
intervals (CI) of time-to-event related effects of the surgical
procedures; every study's quality was evaluated by the Newcastle-Ottawa
Scale (NOS). Result(s): A total of 13 retrospective studies,
including 1453 patients were analyzed. There were no statistically
differences between mechanical and biological prostheses with respect to
prosthetic valve failure [OR = 0.84, 95% CI(0.54, 1.28), P = .41],
bleeding [OR = 0.84, 95% CI(0.54,1.28), P = .41], reoperation [OR = 1.02,
95% CI(0.58,1.78), P = .95], early mortality [OR = 1.35, 95%
CI(0.82,2.25), P = .24] and longtime survival [OR = 1.09, 95% CI(0.70,
1.69), P = .70], but a significant difference can be seen in mechanical
prostheses with a higher risk of thrombosis [OR = 0.17, 95% CI(0.05,
0.60), P = .006, I2 = 0%]. Conclusion(s): In tricuspid
valve position, mechanical valve prostheses have a higher risk of
thrombosis than biological prostheses, but no statistical differences
between mechanical and biological prostheses with respect to prosthetic
valve failure, bleeding, reoperation, early mortality, and long-term
survival. The valve disease and patient's age and risk factors are the
most important considerations in the decision-making process. The more
specific conclusion needs to be further proved by large-sample,
multi-center, randomized, double-blind and control trials. Copyright
© 2021 Forum Multimedia Publishing LLC. All rights reserved.

<75>
Accession Number
2011412208
Title
Efficacy of histidine-tryptophan-ketoglutarate solution versus blood
cardioplegia in cardiac surgical procedures: A randomized controlled ,
parallel group study.
Source
Heart Surgery Forum. 24 (1) (pp E170-E176), 2021. Date of Publication: 13
Jan 2021.
Author
Ali I.; Hassan A.; Shokri H.; Khorshid R.
Institution
(Ali, Hassan, Khorshid) Cardiothoracic Surgery Department, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
(Shokri) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: In cardiac surgery, myocardial protection is required during
cross-clamping followed by reperfusion. The use of cardioplegic solutions
helps preserve myocardial energy stores, hindering electrolyte
disturbances and acidosis during periods of myocardial ischaemia. This
study aimed to compare the efficacy and safety between the
histidine-tryptophan-ketoglutarate (HTK) solution and blood cardioplegia
in various cardiac surgeries. Method(s): Three-hundred-twenty
patients aged 30-70 years old undergoing various cardiac surgeries were
randomized into the HTK group and the blood cardioplegia group. The
ventilation time, total bypass time, cross-clamp time, length of intensive
care unit (ICU) or hospital stay, and postoperative complications were
analyzed. Result(s): The total bypass time and cross-clamp time were
significantly shorter in the HTK group than in the blood cardioplegia
group (P < 0.001). Segmental wall motion abnormalities (SWMA) at
postoperative echocardiography were significantly higher in in the blood
cardioplegia group (P = 0.008). The number of patients requiring DC Shock
was significantly higher in the HTK group (P < 0.001). The number of
patients requiring inotropic support was significantly higher in the blood
cardioplegia group (P < 0.001). The length of ICU, hospital stay, and
ventilation time were significantly longer in the blood cardioplegia group
than in the HTK group (P = 0.004, P < 0.001, P < 0.001, respectively). The
number of patients requiring prolonged ventilation was significantly
higher in the blood cardioplegia group compared with the HTK group (P =
0.022). There was no significant difference between the study groups
regarding electrocardiographic changes, 30-day mortality, and 30-day
readmission. Conclusion(s): The use of HTK cardioplegia was
associated with significantly shorter cross-clamp time, bypass time,
duration of mechanical ventilation, length of ICU stay, and length of
hospital stay. It is associated with less incidence of postoperative
segmental wall abnormalities and less need for inotropic support than
blood cardioplegia. Custodiol cardioplegia is a safe and feasible option
that can be used as an effective substitute for blood cardioplegia to
enhance myocardial protection. Copyright © 2021 Forum Multimedia
Publishing LLC. All rights reserved.

<76>
Accession Number
2011288449
Title
Effectiveness of preoperative breathing exercise interventions in patients
undergoing cardiac surgery: A systematic review.
Source
Revista Portuguesa de Cardiologia. 40 (3) (pp 229-244), 2021. Date of
Publication: March 2021.
Author
Rodrigues S.N.; Henriques H.R.; Henriques M.A.
Institution
(Rodrigues) Lisbon University, Lisbon, Portugal
(Rodrigues, Henriques, Henriques) Lisbon Nursing School, Lisbon, Portugal
(Rodrigues) Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto,
Portugal
(Henriques) ISAMB_Lisbon Medical School, Lisbon, Portugal
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Postoperative pulmonary complications are a common cause of morbidity and
mortality in patients undergoing cardiac surgery, leading to an increase
in length of hospital stay and healthcare costs. This systematic
literature review aims to determine whether patients undergoing cardiac
surgery who undergo preoperative breathing exercise training have better
postoperative outcomes such as respiratory parameters, postoperative
pulmonary complications, and length of hospital stay. Systematic searches
were performed in the CINAHL, Cochrane Central Register of Controlled
Trials, Cochrane Clinical Answers, Cochrane Database of Systematic
Reviews, MEDLINE and MedicLatina databases. Studies were included if they
examined adult patients scheduled for elective cardiac surgery, who
underwent a preoperative breathing exercise training aimed at improving
breathing parameters, preventing postoperative pulmonary complications,
and reducing hospital length of stay. This systematic review was based on
Cochrane and Prisma statement recommendations in the design, literature
search, analysis, and reporting of the review. The search yielded 608
records. Eleven studies met the inclusion criteria. Ten studies were
randomized controlled trials and one was an observational cohort study.
Data from 1240 participants was retrieved from these studies and
meta-analysis was performed whenever possible. A preoperative breathing
intervention on patients undergoing cardiac surgery may help improve
respiratory performance after surgery, reduce postoperative pulmonary
complications and hospital length of stay. However, more trials are needed
to support and strengthen the evidence. Copyright © 2021
Sociedade Portuguesa de Cardiologia

<77>
Accession Number
2006074466
Title
Effect of Dexmedetomidine on Delirium in Elderly Surgical Patients: A
Meta-analysis of Randomized Controlled Trials.
Source
Annals of Pharmacotherapy. 55 (5) (pp 624-636), 2021. Date of Publication:
May 2021.
Author
Lin C.; Tu H.; Jie Z.; Zhou X.; Li C.
Institution
(Lin, Tu, Zhou, Li) Huazhong University of Science and Technology Union
Shenzhen Hospital, Shenzhen, Guangdong, China
(Jie) Guangdong Medical University, Zhanjiang, Guangdong, China
Publisher
SAGE Publications Inc.
Abstract
Objective: The purpose of this meta-analysis is to assess the effect of
dexmedetomidine on delirium in elderly surgical patients. Data
Sources: The Cochrane Library, Web of Science, PubMed, EMBASE, and Google
Scholar were searched (January 1, 2000, to February 4, 2020) for
randomized controlled trials (RCTs). Study Selection and Data Extraction:
RCTs without language restrictions were included if delirium incidence was
assessed in elderly surgical patients receiving dexmedetomidine.
Intervention and basic information were extracted. Data Synthesis: 21
studies were included. Dexmedetomidine reduced delirium occurrence (risk
ratio [RR] = 0.55; 95% CI = 0.45 to 0.67) in elderly surgical patients
with sufficient evidence from trial sequential analysis. Dexmedetomidine
did not prevent delirium incidence for cardiac surgery (RR = 0.71; 95% CI
= 0.44 to 1.15) with insufficient evidence. Dexmedetomidine decreased
mortality incidence (RR = 0.47; 95% CI = 0.25 to 0.89), shortened the
length of intensive care unit (ICU; standard mean difference [SMD] =
-0.46) and hospital stays (SMD = -0.41), and increased bradycardia
incidence (RR = 1.60). Relevance to Patient Care and Clinical Practice:
This review revealed that dexmedetomidine could reduce delirium incidence
for elderly noncardiac surgical patients, and the effect of
dexmedetomidine on delirium for elderly cardiac surgical patients needs
further studies to guide clinicians. Conclusion(s): Dexmedetomidine
reduced delirium incidence in elderly surgical patients. The efficacy of
dexmedetomidine on delirium for elderly cardiac surgical patients warrants
further studies. Furthermore, dexmedetomidine was associated with an
increased bradycardia incidence, shorter length of ICU/hospital stays, and
a lower incidence of mortality. Copyright © The Author(s) 2020.

<78>
Accession Number
2007726724
Title
Near Infrared Spectroscopy in Anemia Detection and Management: A
Systematic Review.
Source
Transfusion Medicine Reviews. 35 (1) (pp 22-28), 2021. Date of
Publication: January 2021.
Author
Crispin P.; Forwood K.
Institution
(Crispin) John Curtin School of Medical Research, Australian National
University, Acton, ACT, Australia
(Crispin) Haematology Department, Canberra Hospital, Garran, ACT,
Australia
(Forwood) Haematology Department, Dunedin Hospital, Dunedin, New Zealand
Publisher
W.B. Saunders
Abstract
Red cell transfusions are intended to improve oxygen delivery to tissues.
Although studies comparing hemoglobin concentration triggers for
transfusion have been done, the hemoglobin threshold for clinical benefit
remains uncertain. Direct measurement of tissue oxygenation with
non-invasive near infrared spectroscopy has been proposed as a more
physiological transfusion trigger, but its clinical role remains unclear.
This systematic review examined the role of near infrared spectroscopy for
detection of anemia and guiding transfusion decisions. Abstracts were
identified up until May 2019 through searches of PubMed, EMBASE and The
Web of Science. There were 69 studies meeting the inclusion criteria, most
(n = 65) of which were observational studies. Tissue oxygen saturation had
been measured in a wide range of clinical settings, with neonatal
intensive care (n = 26) and trauma (n = 7) being most common. Correlations
with hemoglobin concentration and tissue oxygenation were noted and there
were correlations between changes in red cell mass and changes in tissue
oxygenation through blood loss or transfusion. The value of tissue
oxygenation for predicting transfusion was determined in only four
studies, all using muscle oxygen saturation in the adult trauma setting.
The overall sensitivity was low at 34% (27%-42%) and while it had better
specificity at 78% (74%-82%), differing and retrospective approaches
create a high level of uncertainty with respect to these conclusions.
There were four prospective randomized studies involving 540 patients, in
cardiac and neurological surgery and in neonates that compared near
infrared spectroscopy to guide transfusion decisions with standard
practice. These showed a reduction in the number of red cells transfused
per patient (OR: 0.44 [0.09-0.79]), but not the number of patients who
received transfusion (OR: 0.71 [0.46-1.10]), and no change in clinical
outcomes. Measuring tissue oxygen saturation has potential to help guide
transfusion; however, there is a lack of data upon which to recommend
widespread implementation into clinical practice. Standardization of
measurements is required and greater research into levels at which tissue
oxygenation may lead to adverse clinical outcomes would help in the design
of future clinical trials. Copyright © 2020 Elsevier Inc.

<79>
Accession Number
2008574687
Title
Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies
Evaluating Point-of-Care Tests of Coagulopathy in Cardiac Surgery.
Source
Transfusion Medicine Reviews. 35 (1) (pp 7-15), 2021. Date of Publication:
January 2021.
Author
Wozniak M.J.; Abbasciano R.; Monaghan A.; Lai F.Y.; Corazzari C.; Tutino
C.; Kumar T.; Whiting P.; Murphy G.J.
Institution
(Wozniak, Abbasciano, Monaghan, Lai, Corazzari, Kumar, Murphy) Department
of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre
in Cardiovascular Medicine, University of Leicester, Clinical Sciences
Wing, Glenfield General Hospital, Leicester, United Kingdom
(Corazzari, Tutino) Cardiac Surgery Unit, Insubria University, Varese,
Italy
(Whiting) Centre for Research Synthesis and Decision Analysis (CReSyDA),
Bristol Medical School, University of Bristol, Bristol, United Kingdom
Publisher
W.B. Saunders
Abstract
Treatment guidelines recommend the routine use of point-of-care diagnostic
tests for coagulopathy in the management of cardiac surgery patients at
risk of severe bleeding despite uncertainty as to their diagnostic
accuracy. We performed a systematic review and meta-analysis of studies
that evaluated the diagnostic accuracy of viscoelastometry, platelet
function tests, and modified thromboelastography (TEG) tests, for
coagulopathy in cardiac surgery patients. The reference standard included
resternotomy for bleeding, transfusion of non-red cell components, or
massive transfusion. We searched MEDLINE, EMBASE, CINAHL, and Clinical
Trials.gov, from inception to June 2019. Study quality was assessed using
QUADAS-2. Bivariate models were used to estimate summary sensitivity and
specificity with (95% confidence intervals). All 29 studies (7440
participants) included in the data synthesis evaluated the tests as
predictors of bleeding. No study evaluated their role in the management of
bleeding. None was at low risk of bias. Four were judged as low concern
regarding applicability. Pooled estimates of diagnostic accuracy were;
Viscoelastic tests, 12 studies, sensitivity 0.61 (0.44, 0.76), specificity
0.83 (0.70, 0.91) with significant heterogeneity. Platelet function tests,
12 studies, sensitivity 0.63 (0.53, 0.72), specificity 0.75 (0.64, 0.84)
with significant heterogeneity. TEG modification tests, 3 studies,
sensitivity 0.80 (0.67, 0.89), specificity 0.76 (0.69, 0.82) with no
evidence of heterogeneity. Studies reporting the highest values for
sensitivity and specificity had important methodological limitations. In
conclusion, we did not demonstrate predictive accuracy for commonly used
point-of-care devices for coagulopathic bleeding in cardiac surgery.
However, the certainty of the evidence was low. Copyright © 2020

<80>
Accession Number
2010759701
Title
Cardiac surgery outcomes in patients with antecedent kidney, liver, and
pancreas transplantation: A meta-analysis.
Source
Reviews in Cardiovascular Medicine. 21 (4) (pp 589-599), 2020. Date of
Publication: December 2020.
Author
Bacusca A.E.; Enache M.; Tarus A.; Litcanu C.I.; Burlacu A.; Tinica G.
Institution
(Bacusca, Enache, Tarus, Litcanu, Tinica) Department of Cardiovascular
Surgery - Cardiovascular Diseases Institute, "Grigore T. Popa" University
of Medicine, Iasi 700115, Romania
(Burlacu) Department of Interventional Cardiology - Cardiovascular
Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi 700115,
Romania
Publisher
IMR Press Limited
Abstract
Cardiovascular events are among the most common causes of late death in
the transplant recipient (Tx) population. Moreover, major cardiac surgical
procedures are more challenging and risky due to immunosuppression and the
potential impact on the transplanted organ's functional capacity. We aimed
to assess open cardiac surgery safety in abdominal solid organ transplant
recipients, comparing the postoperative outcomes with those of
nontransplant (N-Tx) patients. Electronic databases of PubMed, EMBASE, and
SCOPUS were searched. The endpoints were: overall rate of infectious
complications (wound infection, septicemia, pneumonia), cardiovascular and
renal events (stroke, cardiac tamponade, acute kidney failure), 30-days,
5-years, and 10-years mortality post-cardiac surgery interventions in
patients with and without prior solid organ transplantation. This
meta-analysis included five studies. Higher rates of wound infection (Tx
vs. N-Tx: OR: 2.03, 95% CI: 1.54 to 2.67, I2 = 0%), septicemia
(OR: 3.91, 95% CI: 1.40 to 10.92, I2 = 0%), cardiac tamponade
(OR: 1.83, 95% CI: 1.28 to 2.62, I2 = 0%) and kidney failure
(OR: 1.70, 95 %CI: 1.44 to 2.02, I2 = 89%) in transplant
recipients were reported. No significant differences in pneumonia
occurrence (OR: 0.95, 95% CI: 0.71 to 1.27, I2 = 0%) stroke
(OR: 0.89, 95% CI: 0.54 to 1.48, I2 = 78%) and 30-day mortality
(OR: 1.92, 95% CI: 0.97 to 3.80, I2 = 0%) were observed.
Surprisingly, 5-years (OR: 3.74, 95% CI: 2.54 to 5.49, I2 = 0%)
and 10-years mortality rates were significantly lower in the N-Tx group
(OR: 3.32, 95% CI: 2.35 to 4.69, I2 = 0%). Our study reveals
that open cardiac surgery in transplant recipients is associated with
worse postoperative outcomes and higher long-term mortality
rates. Copyright © 2020 Bacusca et al. Published by IMR Press.

<81>
Accession Number
2011015178
Title
Meta-Analysis of Transcatheter Aortic Valve Implantation in Patients With
Stenotic Bicuspid Versus Tricuspid Aortic Valve.
Source
American Journal of Cardiology. 145 (pp 102-110), 2021. Date of
Publication: 15 Apr 2021.
Author
Majmundar M.; Kumar A.; Doshi R.; Shah P.; Arora S.; Shariff M.; Adalja
D.; Visco F.; Amin H.; Vallabhajosyula S.; Gullapalli N.; Kapadia S.R.;
Kalra A.; Panaich S.S.
Institution
(Majmundar) Department of Internal Medicine, Metropolitan Hospital Center,
New York Medical College, New York, NY, United States
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
(Doshi, Gullapalli) Department of Internal Medicine, University of Nevada
Reno School of Medicine, Reno, NV, United States
(Shah) Department of Internal Medicine, Dhiraj Hospital, Sumandeep
Vidyapeeth, Vadodara, Gujarat, India
(Arora) Department of Cardiology, Case Western Reserve University,
Cleveland, OH, United States
(Adalja) Department of Medicine, GMERS Gotri Medical College, Vadodara,
Gujarat, India
(Visco) Division of Cardiology, Department of Internal Medicine,
Metropolitan Hospital Center, New York Medical College, New York, NY,
United States
(Amin) Division of Pulmonary and Critical Care, Metropolitan Hospital
Center, New York Medical College, New York, NY, United States
(Vallabhajosyula) Section of Intervention Cardiology, Division of
Cardiovascular Medicine, Department of Medicine, Emory University School
of Medicine, Atlanta, Georgia, Georgia
(Kapadia, Kalra) Department of Cardiovascular Medicine, Heart, Vascular
and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Kalra) Section of Cardiovascular Research, Heart, Vascular and Thoracic
Department, Cleveland Clinic Akron General, Akron, OH, United States
(Panaich) Department of Cardiovascular Medicine, University of Iowa
Hospitals and Clinics, Iowa City, IA, United States
Publisher
Elsevier Inc.
Abstract
Most of the trials investigating the role of transcatheter aortic valve
implantation (TAVI) across various strata of risk categories have excluded
patients with bicuspid aortic stenosis (BAS) due to its anatomical
complexities. The aim of this study was to perform a meta-analysis with
meta-regression of studies comparing clinical, procedural, and
after-procedural echocardiographic outcomes in BAS versus tricuspid aortic
stenosis (TAS) patients who underwent TAVI. We searched the PubMed and
Cochrane databases for relevant articles from the inception of the
database to October 2019. Continuous and categorical variables were pooled
using inverse variance and Mantel-Haenszel method, respectively, using the
random-effect model. To rate the certainty of evidence for each outcome,
we used the GRADE (Grading of Recommendations, Assessment, Development,
and Evaluations) approach. Nineteen articles were included in the final
analysis. There was no difference in the risk of 30-day mortality, 1-year
mortality, 30-day cardiovascular mortality, major and/or life-threatening
bleeding, major vascular complications, acute kidney injury, permanent
pacemaker implantation, device success, annular rupture, after-procedural
aortic valve area, and mean pressure gradient between the 2 groups. BAS
patients who underwent TAVI had a higher risk of 30-day stroke, conversion
to surgery, need for second valve implantation, and moderate to severe
paravalvular leak. In conclusion, the present meta-analysis supports the
feasibility of TAVI in surgically ineligible patients with BAS. However,
the incidence of certain procedural complications such as stroke,
conversion to surgery, second valve implantation, and paravalvular leak is
higher among BAS patients compared with TAS patients, which must be
discussed with the patient during the decision-making
process. Copyright © 2021 Elsevier Inc.

<82>
Accession Number
2010836947
Title
Meta-Analysis Comparing the Safety and Efficacy of Single vs Dual
Antiplatelet Therapy in Post Transcatheter Aortic Valve Implantation
Patients.
Source
American Journal of Cardiology. 145 (pp 111-118), 2021. Date of
Publication: 15 Apr 2021.
Author
Ullah W.; Zghouzi M.; Ahmad B.; Biswas S.; Zaher N.; Sattar Y.; Pacha
H.M.; Goldsweig A.M.; Velagapudi P.; Fichman D.L.; Prasad A.; Alraies M.C.
Institution
(Ullah) Abington Jefferson Health, Abington, Pennsylvnia
(Zghouzi, Ahmad, Zaher, Alraies) Detroit Medical Center, Heart Hospital,
Detroit, MI, United States
(Biswas) Rochester Regional Health, Rochester, NY, United States
(Sattar) Icahn school of medicine at Mount Sinai Elmhurst Hospital New
York, NY, United States
(Pacha) University of Texas Health Science Center, Houston, TX, United
States
(Goldsweig, Velagapudi) University of Nebraska Medical Center, Omaha, NE,
United States
(Fichman) Thomas Jefferson University Hospital, Philadelphia
(Prasad) University of Texas Health San Antonio Texas, TX, United States
Publisher
Elsevier Inc.
Abstract
The relative safety and efficacy of aspirin versus dual antiplatelet
therapy (DAPT; aspirin+clopidogrel) in patients who underwent
transcatheter aortic valve implantation (TAVI) and did not have a
long-term indication for oral anticoagulation remains controversial.
Digital databases were searched to identify relevant articles. The major
safety end point was bleeding, while the efficacy end points included
after-TAVI ischemic and thrombotic events. Data were analyzed using a
random effect model to calculate the pooled unadjusted odds ratio (OR) for
dichotomous outcomes. Eleven studies comprising 4805 patients (aspirin
2258, DAPT 2547) were included in the quantitative analysis. Patients
receiving aspirin-alone had significantly lower odds of all cause bleeding
(OR 0.41, 95% CI 0.29 to. 057, p <0.00001), major vascular bleeding (OR
0.51, 95% CI 0.34 to 0.77, p = 0.001), Valve Academic Research Consortium
2 (VARC-2) major bleeding (OR 0.50, 95% CI 0.30 to 0.83 p = 0.008), VARC-2
minor bleeding (OR 0.55, 95% CI 0.31 to 0.97, p = 0.04), transfusion
requirement (OR 0.39, 95%CI 0.15 to 0.0.98, p = 0.05) and major vascular
complications (OR0.41, 95% CI 0.26 to 0.66, p = 0.0002) compared with
after-TAVI patients receiving both aspirin and clopidogrel. These was no
significant difference in the odds of VARC-2 life threatening bleeding (OR
0.52, 95% CI 0.25 to 1.07, p = 0.08), prosthetic valve thrombosis (OR
1.17, 95% CI 0.22 to 6.30, p = 0.85), cardiac tamponade (OR 0.77, 95% CI
0.20 to 2.98, p = 0.70), conversion to open procedure (OR 1.99, 95 % CI
0.42 to 9.44, p = 0.39), MI (OR 0.79 95% CI 0.38 to 1.64, p = 0.52),
transient ischemic attack (TIA) (OR 0.89, 95% CI 0.12 to 6.44, p = 0.91),
major stroke (OR 0.68 95 % CI 0.43 to 1.08, p = 0.10), disabling stroke
(0R 1.01, 95% CI 0.41 to 2.48, p = 0.99), cardiovascular mortality (OR
0.81 95% CI 0.38 to 1.74, p = 0.59) and all-cause mortality (OR 0.86, 95%
CI 0.63 to 1.16, p = 0.31) between the 2 groups. In conclusion, after-TAVI
patients who received aspirin alone had lower bleeding events with no
significant differences in mortality and stroke rate compared with those
who received DAPT. Copyright © 2021 Elsevier Inc.

<83>
Accession Number
2011471721
Title
Impact of COVID-19 infection on the cardiovascular system: An
evidence-based analysis of risk factors and outcomes.
Source
Best Practice and Research: Clinical Anaesthesiology. (no pagination),
2021. Date of Publication: 2021.
Author
Kaye A.D.; Spence A.L.; Mayerle M.; Sardana N.; Clay C.M.; Eng M.R.; Luedi
M.M.; Carroll Turpin M.A.; Urman R.D.; Cornett E.M.
Institution
(Kaye) Department of Anesthesiology and Pharmacology, Toxicology, and
Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA
71103, United States
(Spence) Department of Pharmaceutical Sciences, Regis University School of
Pharmacy, Denver, CO 80221, United States
(Mayerle) Regis University School of Pharmacy, Denver, CO 80221, United
States
(Sardana) Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln W,
Piscataway, NJ 08854, United States
(Clay) LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103,
United States
(Eng) Department of Anesthesiology, LSU Health Sciences Center, 1542
Tulane Avenue, New Orleans, LA 70112, United States
(Luedi) Bern University Hospital Inselspital, University of Bern, Bern,
Switzerland
(Carroll Turpin) Department of Biomedical Sciences, College of Medicine,
University of Houston, Health 2 Building, Room 8037, United States
(Urman) Department of Anesthesiology, Perioperative and Pain Medicine,
Harvard Medical School, Brigham and Women's Hospital, 75 Francis St,
Boston, MA 02115, United States
(Cornett) Department of Anesthesiology, LSU Health Shreveport, 1501 Kings
Highway, Shreveport, LA 71103, United States
Publisher
Bailliere Tindall Ltd
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known
as COVID-19, emerged in late 2019 in Wuhan, China. The World Health
Organization declared the virus a pandemic on March 11, 2020. Disease
progression from COVID-19 infection has shown significant symptom
manifestations within organ systems beyond the respiratory system. The
literature has shown increasing evidence of cardiovascular involvement
during disease course and an associated increase in mortality among
infected patients. Although the understanding of this novel virus is
continually evolving, it is currently proposed that the mechanism by which
the SARS-CoV-2 virus contributes to cardiovascular manifestations involves
the ACE2 transmembrane protein. The protein ACE2 is highly expressed in
blood vessel pericytes, and infection can result in microvascular
dysfunction and subsequent acute coronary syndromes. Complications
involving the cardiovascular system include myocardial infarction,
arrhythmias, shock, and heart failure. In this evidence-based review, we
discuss risk factors of cardiovascular involvement in COVID-19 infection,
pathophysiology of COVID-19-related cardiovascular infection, and injury,
COVID-19 effects on the cardiovascular system and corresponding
treatments, and hematologic effects of COVID-19 and COVID-19 in heart
transplant patients. Clinicians managing COVID-19 patients should
appreciate the potential cardiovascular effects related to the disease
process. Copyright © 2021 Elsevier Ltd

<84>
Accession Number
2011452215
Title
RenalGuard system and conventional hydration for preventing
contrast-associated acute kidney injury in patients undergoing cardiac
interventional procedures: A systematic review and meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Wang Y.; Guo Y.
Institution
(Wang, Guo) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: Contrast-associated acute kidney injury (CA-AKI) can increase
the mortality of patients undergoing transcatheter aortic valve
replacement (TAVR) or percutaneous coronary intervention (PCI). The
purpose of this paper was to compare the efficacy of the RenalGuard System
and conventional hydration regimen in preventing CA-AKI in patients with
TAVR or PCI. Method(s): We searched PubMed, Embase, Web of Science,
and the Cochrane Central Register of Clinical Trials (last updated July
11, 2020) for suitable reports. The primary outcome was the occurrence of
CA-AKI. The secondary outcomes were renal replacement therapy (RRT), major
cardiovascular events (MACEs), and other adverse complications.
 Result(s): The search strategy yielded 270 studies (with data for
2067 participants). In the subgroup of PCI, low incidence of CA-AKI (6.7%
vs 15.7%; 95%CI: 0.27 to 0.54; I2 = 8%; P < 0.00001) associate
with RenalGuard group (RG) rather than control group (CG). Similarly, in
the subgroup of TAVR, a low incidence of CA-AKI (15.6% vs 26.9%; 95%CI:
0.35 to 0.82; I2 = 88%; P = 0.004) relates to RG. However, this
result is highly heterogeneous. Compare with conventional hydration,
RenalGuard significantly reduce the incidence of pulmonary edema
(1.5%vs4.1%; 95%CI: 0.18 to 0.72; I2 = 0%; P = 0.004).
 Conclusion(s): RenalGuard System can lessen the risk of CA-AKI and
RRT in patients undergoing PCI. But for patients experiencing TAVR, due to
unique hemodynamic effects, the role of RenalGuard remains questionable.
RenalGuard is more secure than conventional hydration. Future work should
elucidate the feasibility and safety of this prophylactic intervention in
cardiac interventional therapy. Copyright © 2021

<85>
Accession Number
2011317711
Title
Visual loss in patients undergoing cardiac surgery.
Source
Journal of Clinical Anesthesia. 71 (no pagination), 2021. Article Number:
110229. Date of Publication: August 2021.
Author
Zhang B.; He L.-X.; Yao Y.-T.
Institution
(Zhang) Department of Anesthesiology, Tianjin Union Medical Center,
Tianjin, China
(He, Yao) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Peking Union Medical College and Chinese
Academy of Medical Sciences, Beijing, China
Publisher
Elsevier Inc.

<86>
Accession Number
2011412421
Title
Right ventricular failure after left ventricular assist device
implantation: A review of the literature.
Source
Journal of Thoracic Disease. 13 (2) (pp 1256-1269), 2021. Date of
Publication: February 2021.
Author
Coco V.L.; De Piero M.E.; Massimi G.; Chiarini G.; Raffa G.M.; Kowalewski
M.; Maessen J.; Lorusso R.
Institution
(Coco, De Piero, Massimi, Chiarini, Kowalewski, Maessen, Lorusso)
Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht
University Medical Centre, Maastricht, Netherlands
(De Piero) Department of Anesthesia, Intensive Care, San Giovanni, Turin,
Italy
(Massimi) Department of Cardiac Surgery, Circolo Hospital, University of
Insurbia, Varese, Italy
(Chiarini) Division of Anesthesiology, Intensive Care and Emergency
Medicine, Spedali Civili University, Brescia, Italy
(Raffa) Depart. for the Treatment and Study of Cardiothoracic Diseases and
Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
(Kowalewski) Thoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
(Maessen, Lorusso) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
Publisher
AME Publishing Company
Abstract
Right ventricular failure (RVF) following left ventricular assist device
(LVAD) implantation remains a major complication which may significantly
impair patient outcome. The genesis of RVF is, however, multifactorial,
and the mechanisms underlying such a condition have not been fully
elucidated, making its prevention challenging and the course not always
predictable. Although preoperative risks factors can be associated with RV
impairment, the physiologic changes after the LV support, can still hamper
the function of the RV. Current medical treatment options are limited and
sometimes, patients with a severe post-LVAD RVF may be unresponsive to
pharmacological therapy and require more aggressive treatment, such as
temporary RV support. We retrieved 11 publications which we assessed and
divided in groups based on the RV support [extracorporeal membrane
oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart
with ProtekDuo cannula]. The current review comprehensively summarizes the
main studies of the literature with particular attention to the RV
physiology and its changes after the LVAD implantation, the predictors and
prognostic score as well as the different modalities of temporary
mechanical cardio-circulatory support, and its effects on patient
prognosis for RVF in such a setting. In addition, it provides a decision
making of the pre-, intra and post-operative management in high- and
moderate- risk patients. Copyright © 2021 Journal of Thoracic
Disease. All rights reserved.

<87>
Accession Number
2011412415
Title
Estimating the risk of conversion from video-assisted thoracoscopic lung
surgery to thoracotomy-a systematic review and meta-analysis.
Source
Journal of Thoracic Disease. 13 (2) (pp 812-823), 2021. Date of
Publication: February 2021.
Author
Power A.D.; Merritt R.E.; Abdel-Rasoul M.; Moffatt-Bruce S.D.; D'Souza
D.M.; Kneuertz P.J.
Institution
(Power, Merritt, Moffatt-Bruce, D'Souza, Kneuertz) Division of Thoracic
Surgery, Department of Surgery, The Ohio State University Wexner Medical
Center, Columbus, OH, United States
(Abdel-Rasoul) Center for Biostatistics, The Ohio State University College
of Medicine, Columbus, OH, United States
Publisher
AME Publishing Company
Abstract
Background: Understanding the risk of conversion from video-assisted
thoracic surgery (VATS) to thoracotomy is important when considering
patient selection and preoperative surgical risk assessment. This review
aims to estimate the rate of intraoperative conversions to thoracotomy,
predictive factors, and associated outcomes for VATS anatomic lung
resections. Method(s): PubMed/MEDLINE and EMBASE were searched
systematically in May of 2020. Observational studies examining conversions
of VATS anatomic resections to thoracotomy were included. Conversion
rates, causes, risk factors, and post-operative outcomes were reviewed and
analyzed in aggregate. Result(s): Twenty retrospective studies were
reviewed, with a total of 72,932 patients undergoing VATS anatomic lung
resection. The median conversion rate was 9.6% (95% CI: 6.6-13.9%). Nine
studies reported a total of 114 emergency conversions, with a median
incidence rate of 1.3% (95% CI: 0.6-2.8%). The most common reasons for
thoracotomy were vascular injury/bleeding, difficulty lymph node
dissection, and adhesions, accounting for 27.9%, 26.2% and 19% of
conversions, respectively. Risk factors for conversion varied, but
frequently included nodal disease, large tumors, and induction therapy.
The risk of complications (OR 2.06; 95% CI: 1.77-2.40) and mortality (OR
4.11; 95% CI: 1.59-10.61) were significantly increased following
conversions. There was also a significant increase in chest tube duration
and length of stay following conversion. Conclusion(s): The risk of
conversion to thoracotomy may be as high as one in ten patients undergoing
VATS anatomic lung resections, but may vary significantly based on patient
selection. Although emergent conversions are rare, the need for
thoracotomy may significantly increase postoperative morbidity and
mortality. Copyright © 2021 Journal of Thoracic Disease. All
rights reserved.

<88>
Accession Number
2011311274
Title
Recent achievements in transcatheter closure of ventricular septal
defects: A systematic review of literature and a meta-analysis.
Source
Kardiologia Polska. 79 (2) (pp 161-169), 2021. Date of Publication: 25 Feb
2021.
Author
Werynski P.; Skorek P.; Wojcik A.; Rudek-Budzynska A.; Dziewulska A.;
Rudzinski A.
Institution
(Werynski, Skorek, Wojcik, Rudek-Budzynska, Dziewulska, Rudzinski)
Department of Pediatric Cardiology, Polish-American Institute of
Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
Publisher
Medycyna Praktyczna Cholerzyn
Abstract
Background Ventricular septal defect (VSD) is one of the most common
congenital heart defects. Currently, surgery remains the treatment of
choice. However, transcatheter techniques for closing of various types of
VSDs have become an alternative. aims The objective of our study was to
present the outcomes of transcatheter closure of various types of VSD
based on a systematic review of recent publications. methods A systematic
review of studies published in English between January 2014 and March 2020
was performed using the PubMed database (MEDLINE) independently by 2
reviewers. Data on success and complication rates were extracted. Studies
including fewer than 5 patients and those with acquired VSD were excluded
from the analysis. results Finally, 44 studies were included for analysis,
with a total number of 4050 patients. The pooled estimate of the overall
success rate based on the random effects model was 97.96% (95% CI,
97.37-98.56; Q test P <0.001; I2 = 50%). Early residual shunt
was the most common complication with a pooled estimate rate of 22.25%
(95% CI, 16.46-28.05; P <0.001; I2 = 95%). However, only 92
patients had permanent VSD. Complete atrioventricular block constituted
the most dangerous complication, and the pooled estimate rates were
assessed as 0.64% (95% CI, 0.39-0.88; I2 = 0%) for transient
VSD and 0.32% (95% CI, 0.15-0.49; P >0.99; I2 = 0%) for
permanent VSD. conclusions Transcatheter closure of selected VSDs appears
to be an effective and safe method of treatment. Recent studies have shown
high rates of successful interventions with a low incidence of
complications. Copyright by the Author(s), 2021

<89>
Accession Number
2011132919
Title
The effect of carotid revascularization on the ophthalmic artery flow:
Systematic review and meta-analysis.
Source
International Angiology. 40 (1) (pp 23-28), 2021. Date of Publication:
February 2021.
Author
Nana P.; Spanos K.; Antoniou G.; Kouvelos G.; Vasileiou V.; Tsironi E.;
Giannoukas A.
Institution
(Nana, Spanos, Kouvelos, Giannoukas) Department of Vascular Surgery,
Faculty of Medicine, School of Health Sciences, University Hospital of
Larissa, University of Thessaly, Larissa, Greece
(Antoniou) Department of Vascular and Endovascular Surgery, The Royal
Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United
Kingdom
(Antoniou) Division of Cardiovascular Sciences, School of Medical
Sciences, University of Manchester, Manchester, United Kingdom
(Vasileiou, Tsironi) Department of Ophthalmology, Faculty of Medicine,
School of Health Sciences, University Hospital of Larissa, University of
Thessaly, Larissa, Greece
Publisher
Edizioni Minerva Medica
Abstract
Introduction: High-grade internal carotid stenosis results in impaired
flow dynamics in the ocular circulation that may lead to a rare clinical
entity; ophthalmic ischemic syndrome (OIS). The aim of this study was to
investigate hemodynamic changes in the ophthalmic circulation after
carotid revascularization, assessed with duplex ultrasonography (DUS), and
their potential impact on ocular function in patients suffering from OIS.
 Evidence Acquisition: A systematic review of the literature was
performed according to the PRISMA guidelines. Medline, Embase and Central
databases were searched. Evidence Synthesis: The analysis included
fourteen cohort studies (589 patients) reporting on the hemodynamic effect
of carotid revascularization on the ophthalmic circulation using DUS.
Eighty-five per cent of patients were treated for symptomatic carotid
stenosis. The pre- and postoperative ophthalmological evaluation was
recorded in four studies (227 out of 358 patients [63%] diagnosed with
OIS). Reversed ophthalmic artery (OA) flow prior to carotid
revascularization was present in 86 cases (24%). Following carotid
revascularization, a significant increase in peak systolic velocity (PSV)
(mean difference [MD] 14.712 cm/s, 95% confidence interval [CI]
10.566-18.858, P<0.001, I2=96%) and a significant anterograde
restoration of flow in the OA (OR: 2.047, 95% CI: 1.72-2.42, P<0.001,
I2=0%) were recorded. Carotid revascularization resulted in
regression of ischemic symptoms in 93.1% of patients (95% CI: 56.4-99.3%),
P=0.001, I2=82%). Conclusion(s): Carotid revascularization
may be associated with a significant flow restoration and PSV increase in
the OA; as well as clinical improvement in ischemic ophthalmic symptoms in
patients with OIS. Copyright © 2020 EDIZIONI MINERVA MEDICA.

<90>
Accession Number
2008590912
Title
Management of Prosthesis-patient Mismatch after Aortic Valve Replacement.
Source
E Journal of Cardiovascular Medicine. 7 (2) (pp 60-65), 2020. Date of
Publication: June 2020.
Author
Demirsoy E.; Demir I.; Ugur M.
Institution
(Demirsoy) Sisli Kolan International Hospital, Clinic of Cardiovascular
Surgery, Istanbul, Turkey
(Demir) Istanbul University Istanbul Faculty of Medicine, Department of
Cardiovascular Surgery, Istanbul, Turkey
(Ugur) Sancaktepe Martyr, Ilhan Varank Training and Research Hospital,
Clinic of Cardiovascular Surgery, Istanbul, Turkey
Publisher
Galenos Publishing House
Abstract
Valve prostheses have played an important role in the past four decades in
the management of patients with valvular heart disease. Many of the
devices have been used for valve replacement and they have introduced new
clinical problems. One of these problems is prosthesis-patient mismatch
(PPM) which is associated with increased mid- and long-term mortality
after surgical aortic valve replacement (AVR) and transcatheter aortic
valve implantation. The aim of this study was to systematically review the
literature on the importance, prevention and feasibility of PPM in AVR and
percutaneous-AVR. The articles about PPM published between 2003-2018 were
analyzed. The results of surgical and transcatheter methods were discussed
together to prevent PPM. © Copyright 2019 by Heart and Health
Foundation of Turkey (TUSAV)

<91>
Accession Number
2010797074
Title
Intranasal administration of 40 and 80 units of insulin does not cause
hypoglycemia during cardiac surgery: a randomized controlled trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Roque P.; Nakadate Y.; Sato H.; Sato T.; Wykes L.; Kawakami A.; Yokomichi
H.; Matsukawa T.; Schricker T.
Institution
(Roque, Wykes) School of Human Nutrition, McGill University,
Ste-Anne-de-Bellevue, Montreal, QC, Canada
(Nakadate) Department of Anesthesiology, University of Yamanashi, 1110
Shimokato, Chuo, Yamanashi 409-3898, Japan
(Sato, Sato, Kawakami, Schricker) Department of Anesthesia, McGill
University Health Centre Glen Site, Royal Victoria Hospital, Montreal, QC,
Canada
(Yokomichi, Matsukawa) Department of Health science, University of
Yamanashi, Shimokato, Chuo, Yamanashi, Japan
Publisher
Springer
Abstract
Purpose: Intranasal insulin administration may improve cognitive function
in patients with dementia and may prevent cognitive problems after
surgery. Although the metabolic effects of intranasal insulin in
non-surgical patients have been studied, its influence on glucose
concentration during surgery is unknown. Method(s): We conducted a
randomized, double-blind, placebo-contolled trial in patients scheduled
for elective cardiac surgery. Patients with type 2 diabetes mellitus
(T2DM) and non-T2DM patients were randomly allocated to one of three
groups (normal saline, 40 international units [IU] of intranasal insulin,
and 80 IU intranasal insulin). Insulin was given after the induction of
general anesthesia. Glucose and plasma insulin concentrations were
measured in ten-minute intervals during the first hour and every 30 min
thereafter. The primary outcome was the change in glucose concentration 30
min after intranasal insulin administration. Result(s): A total of
115 patients were studied, 43 of whom had T2DM. In non-T2DM patients, 40
IU intranasal insulin did not affect glucose concentration, while 80 IU
intranasal insulin led to a statistically significant but not clinically
important decrease in blood glucose levels (mean difference, 0.4
mMol.L-1; 95% confidence interval, 0.1 to 0.7). In T2DM
patients, neither 40 IU nor 80 IU of insulin affected glucose
concentration. No hypoglycemia (< 4.0 mMol.L-1) was observed
after intranasal insulin administration in any patients. In non-T2DM
patients, changes in plasma insulin were similar in the three groups. In
T2DM patients, there was an increase in plasma insulin concentrations ten
minutes after administration of 80 IU of intranasal insulin compared with
saline. Conclusion(s): In patients with and without T2DM undergoing
elective cardiac surgery, intranasal insulin administration at doses as
high as 80 IU did not cause clinically important hypoglycemia. Trial
registration: www.ClinicalTrials.gov (NCT02729064); registered 5 April
2016. Copyright © 2021, Canadian Anesthesiologists' Society.

<92>
Accession Number
2010795825
Title
A narrative review of platelet-rich plasma (PRP) in reproductive medicine.
Source
Journal of Assisted Reproduction and Genetics. (no pagination), 2021. Date
of Publication: 2021.
Author
Sharara F.I.; Lelea L.-L.; Rahman S.; Klebanoff J.S.; Moawad G.N.
Institution
(Sharara, Rahman) Virginia Center for Reproductive Medicine, 11150 Sunset
Hills Rd, Suite 100, Reston, VA 20190, United States
(Sharara, Moawad) Department of Obstetrics and Gynecology, George
Washington University, Washington, DC, United States
(Lelea) Department of Obstetrics and Gynecology, University of Central
Florida-HCA Consortium, Orlando, FL, United States
(Klebanoff) Department of Obstetrics and Gynecology, Main Line Health
Wynnewood, Wynnewood, PA, United States
(Moawad) The Center for Endometriosis and Advanced Pelvic Surgery,
Washington, DC, United States
Publisher
Springer
Abstract
Purpose: Platelet-rich plasma (PRP) has become a novel treatment in
various aspects of medicine including orthopedics, cardiothoracic surgery,
plastic surgery, dermatology, dentistry, and diabetic wound healing. PRP
is now starting to become an area of interest in reproductive medicine
more specifically focusing on infertility. Poor ovarian reserve,
menopause, premature ovarian failure, and thin endometrium have been the
main areas of research. The aim of this article is to review the existing
literature on the effects of autologous PRP in reproductive medicine
providing a summation of the current studies and assessing the need for
additional research. Method(s): A literature search is performed
using PubMed, MEDLINE, and CINAHL Plus to identify studies focusing on the
use of PRP therapy in reproductive medicine. Articles were divided into 3
categories: PRP in thin lining, PRP in poor ovarian reserve, and PRP in
recurrent implantation failure. Result(s): In women with thin
endometrium, the literature shows an increase in endometrial thickness and
increase in chemical and clinical pregnancy rates following autologous PRP
therapy. In women with poor ovarian reserve, autologous intraovarian PRP
therapy increased anti-Mullerian hormone (AMH) levels and decreased
follicle-stimulating hormone (FSH), with a trend toward increasing
clinical and live birth rates. This trend was also noted in women with
recurrent implantation failure. Conclusion(s): Limited literature
shows promise in increasing endometrial thickness, increasing AMH, and
decreasing FSH levels, as well as increasing chemical and clinical
pregnancy rates. The lack of standardization of PRP preparation along with
the lack of large randomized controlled trials needs to be addressed in
future studies. Until definitive large RCTs are available, PRP use should
be considered experimental. Copyright © 2021, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<93>
Accession Number
633652679
Title
Predictors of pacemaker implantation after transcatheter aortic valve
implantation according to kind of prosthesis and risk profile: a
systematic review and contemporary meta-analysis.
Source
European heart journal. Quality of care & clinical outcomes. 7 (2) (pp
143-153), 2021. Date of Publication: 15 Mar 2021.
Author
Bruno F.; D'Ascenzo F.; Vaira M.P.; Elia E.; Omede P.; Kodali S.; Barbanti
M.; Rodes-Cabau J.; Husser O.; Sossalla S.; Van Mieghem N.M.; Bax J.;
Hildick-Smith D.; Munoz-Garcia A.; Pollari F.; Fischlein T.; Budano C.;
Montefusco A.; Gallone G.; De Filippo O.; Rinaldi M.; la Torre M.;
Salizzoni S.; Atzeni F.; Pocar M.; Conrotto F.; De Ferrari G.M.
Institution
(Bruno, D'Ascenzo, Vaira, Elia, Omede, Budano, Montefusco, Gallone, De
Filippo, Conrotto, De Ferrari) Division of Cardiology, Cardiovascular and
Thoracic Department, Citta della Salute e della Scienza Hospital and
University of Turin, Italy
(Kodali) Department of Cardiology, Division of Cardiology, New
York-Presbyterian Hospital, Columbia University Medical Center, NY, NY,
United States
(Barbanti) Department of Cardiology, C.A.S.T. Policlinic G. Rodolico
Hospital, University of Catania, Catania, Italy
(Rodes-Cabau) Department of Cardiology, Quebec Heart and Lung Institute,
Laval University, Quebec City, QC, Canada
(Husser) DortmundGermany
(Sossalla) Department for Internal Medicine II, Cardiology, Pneumology,
Intensive Care, University Hospital Regensburg, Regensburg, Germany
(Van Mieghem) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Bax) Department of Cardiology, Heart Lung Center, Leiden University
Medical Center, Leiden, Netherlands
(Hildick-Smith) Department of Cardiology, Sussex Cardiac Centre, Brighton
and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
(Munoz-Garcia) Department of Cardiology, Hospital Virgen de la Victoria,
Malaga, Spain
(Pollari, Fischlein) Department of Cardiac Surgery, Cardiovascular Center,
Klinikum Nurnberg - Paracelsus Medical University, Breslauer Str. 201,
Nuremberg, Germany
(Rinaldi, la Torre, Salizzoni, Atzeni, Pocar) Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital and University of
Turin, Italy
Publisher
NLM (Medline)
Abstract
AIMS: Permanent pacemaker implantation (PPI) may be required after
transcatheter aortic valve implantation (TAVI). Evidence on PPI prediction
has largely been gathered from high-risk patients receiving
first-generation valve implants. We undertook a meta-analysis of the
existing literature to examine the incidence and predictors of PPI after
TAVI according to generation of valve, valve type, and surgical risk.
METHODS AND RESULTS: We made a systematic literature search for studies
with >=100 patients reporting the incidence and adjusted predictors of PPI
after TAVI. Subgroup analyses examined these features according to
generation of valve, specific valve type, and surgical risk. We obtained
data from 43 studies, encompassing 29 113 patients. Permanent pacemaker
implantation rates ranged from 6.7% to 39.2% in individual studies with a
pooled incidence of 19% (95% CI 16-21). Independent predictors for PPI
were age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01-1.09],
left bundle branch block (LBBB) (OR 1.45, 95% CI 1.12-1.77), right bundle
branch block (RBBB) (OR 4.15, 95% CI 3.23-4.88), implantation depth (OR
1.18, 95% CI 1.11-1.26), and self-expanding valve prosthesis (OR 2.99, 95%
CI 1.39-4.59). Among subgroups analysed according to valve type, valve
generation and surgical risk, independent predictors were RBBB,
self-expanding valve type, first-degree atrioventricular block, and
implantation depth. CONCLUSION(S): The principle independent
predictors for PPI following TAVI are age, RBBB, LBBB, self-expanding
valve type, and valve implantation depth. These characteristics should be
taken into account in pre-procedural assessment to reduce PPI rates.
PROSPERO ID CRD42020164043. Copyright Published on behalf of the
European Society of Cardiology. All rights reserved. © The Author(s)
2020. For permissions, please email: journals.permissions@oup.com.

<94>
Accession Number
634493053
Title
Effectiveness of Standard Local Anesthetic Bupivacaine and Liposomal
Bupivacaine for Postoperative Pain Control in Patients Undergoing Truncal
Incisions: A Randomized Clinical Trial.
Source
JAMA Network Open. (no pagination), 2021. Article Number: e210753. Date of
Publication: 2021.
Author
Sandhu H.K.; Miller C.C.; Tanaka A.; Estrera A.L.; Charlton-Ouw K.M.
Institution
(Sandhu, Miller, Tanaka, Estrera, Charlton-Ouw) McGovern Medical School,
University of Texas Health Science Center, Houston, United States
(Tanaka, Estrera) Memorial Hermann Hospital, Texas Medical Center,
Houston, United States
(Charlton-Ouw) HCA Houston Healthcare, Gulf Coast Division, Houston, TX,
United States
(Charlton-Ouw) Department of Clinical Sciences, University of Houston,
College of Medicine, 1200 Binz St, Houston, TX 77004, United States
Publisher
American Medical Association
Abstract
Importance: Liposomal bupivacaine for pain relief is purported to last 3
days compared with 8 hours with standard bupivacaine. However, its
effectiveness is unknown in truncal incisions for cardiothoracic or
vascular operations. Objective(s): To compare the effectiveness of
single-administration standard bupivacaine vs liposomal bupivacaine in
patients undergoing truncal incisions. Design, Setting, and
Participant(s): This randomized clinical trial enrolled patients
undergoing sternotomy, thoracotomy, minithoracotomy, and laparotomy from a
single cardiovascular surgery department in an academic medical center
between November 2012 and June 2018. The study was powered to detect a
Cohen effect size of 0.35 with a power of greater than 80%. Data analysis
was performed from July to December 2018. Intervention(s): Patients
were randomized to standard bupivacaine or liposomal bupivacaine.
 Main Outcomes and Measures: Pain was assessed over 3 postoperative
days by the Numeric Rating Scale (NRS). Adjunctive opioids were converted
to morphine equivalents units (MEU). NRS scores were compared using
Wilcoxon rank-sum (3-day area under the curve) and 2-way nonparametric
mixed models (daily scale score) to assess time-by-group interaction.
Secondary outcomes included cumulative opioid consumption. Result(s):
A total of 280 patients were analyzed, with 140 in each group
(single-administration standard bupivacaine vs liposomal bupivacaine).
Mean (SD) age was 60.2 (14.4) years, and 101 of 280 patients (36%) were
women. Irrespective of treatment assignment, pain decreased by a mean of
approximately 1 point per day over 3 days (beta = -0.87; SE = 0.11; mixed
model regression P <.001). Incision type was associated with pain with
patients undergoing thoracotomy (including minithoracotomy) reporting
highest median (interquartile range [IQR]) pain scores on postoperative
days 1 (liposomal vs standard bupivacaine, 6 [4-8] vs 5 [3-7]; P =.049,
Wilcoxon rank-sum) and 2 (liposomal vs standard bupivacaine, 5 [4-7] vs 4
[2-6]; P =.003, Wilcoxon rank-sum) but not day 3 (liposomal vs standard
bupivacaine, 3 [2-6] vs 3 [1-5]; P =.10, Wilcoxon rank-sum), irrespective
of treatment group. Median (IQR) 3-day cumulative NRS was 12.0 (8.0-16.5)
for bupivacaine and 13.5 (9.0-17.0) for liposomal bupivacaine (P =.15,
Wilcoxon rank-sum) Furthermore, use of opioids was greater following
liposomal bupivacaine compared with standard bupivacaine (median [IQR],
41.5 [21.3-73.8] MEU vs 33.0 [17.8-62.5] MEU; P =.03, Wilcoxon rank-sum).
On multivariable analysis, no interaction by incision type was observed
for mean pain scores or opioid use. Conclusions and Relevance: In
this randomized clinical trial involving truncal incisions for
cardiovascular procedures, liposomal bupivacaine did not provide improved
pain control and did not reduce adjunctive opioid use compared with
conventional bupivacaine formulation over 3 postoperative days. Trial
Registration: ClinicalTrials.gov Identifier: NCT02111746. Copyright
© 2021 American Medical Association. All rights reserved.

<95>
Accession Number
634492872
Title
Intermediate-Term Outcomes of Endoscopic or Open Vein Harvesting for
Coronary Artery Bypass Grafting: The REGROUP Randomized Clinical Trial.
Source
JAMA Network Open. (no pagination), 2021. Date of Publication: 2021.
Author
Zenati M.A.; Bhatt D.L.; Stock E.M.; Hattler B.; Wagner T.H.; Bakaeen
F.G.; Biswas K.
Institution
(Zenati) Division of Cardiac Surgery, Department of Surgery, Veterans
Affairs Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, 1400 VFWPkwy, Boston, MA 02132, United States
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Stock) Cooperative Studies Program, Perry Point/Baltimore Coordinating
Center, Office of Research and Development, US Department of Veterans
Affairs, Perry Point, MD, United States
(Hattler) VA Eastern Colorado Healthcare System, Denver, United States
(Wagner) VA Health Economics Resource Center, Department of Surgery,
Stanford University, Palo Alto, CA, United States
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Biswas) Perry Point Cooperative Studies Program Coordinating Center,
Office of Research and Development, US Department of Veterans Affairs,
Perry Point, MD, United States
(Biswas) Department of Epidemiology and Public Health, University of
Maryland, School of Medicine, Baltimore, United States
Publisher
American Medical Association

<96>
Accession Number
633725343
Title
Myocardial Injury After Balloon Predilatation Versus Direct Transcatheter
Aortic Valve Replacement: Insights From the DIRECTAVI Trial.
Source
Journal of the American Heart Association. 9 (24) (pp e018405), 2020. Date
of Publication: 15 Dec 2020.
Author
Akodad M.; Roubille F.; Marin G.; Lattuca B.; Macia J.-C.; Delseny D.;
Gandet T.; Robert P.; Schmutz L.; Piot C.; Maupas E.; Robert G.; Targosz
F.; Albat B.; Cayla G.; Leclercq F.
Institution
(Akodad, Roubille, Macia, Delseny, Robert, Leclercq) Department of
Cardiology Montpellier University Hospital Montpellier France
(Akodad, Roubille) PhyMedExp INSERM U1046CNRS UMR 9214 Montpellier France
(Marin) Department of Medical Information Montpellier University Hospital
Montpellier France
(Lattuca, Schmutz, Cayla) Department of Cardiology CHU NimesMontpellier
University Nimes France
(Gandet, Albat) Department of Cardiovascular Surgery University Hospital
of Montpellier France
(Piot) Millenaire Clinic Montpellier France
(Maupas) Franciscaines Clinic Nimes France
(Robert) St Pierre Clinic Perpignan France
(Targosz) Perpignan Hospital Perpignan France
Publisher
NLM (Medline)
Abstract
Background Myocardial injury is associated with higher mortality after
transcatheter aortic valve replacement (TAVR) and might be increased by
prior balloon aortic valvuloplasty (BAV). We aimed to evaluate the impact
of prior BAV versus direct prosthesis implantation on myocardial injury
occurring after (TAVR) with balloon-expandable prostheses. Methods and
Results The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation)
trial, an open-label randomized study, demonstrated noninferiority of TAVR
without BAV (direct TAVR group) compared with systematic BAV (BAV group)
with the Edwards SAPIEN 3 valve. High-sensitivity troponin was assessed
before and the day after the procedure. Incidence of myocardial injury
after the procedure (high-sensitivity troponin elevation >15x the upper
reference limit [14 ng/L]) was the main end point. Impact of myocardial
injury on 1-month adverse events (all-cause mortality, stroke, major
bleeding, major vascular complications, transfusion, acute kidney injury,
heart failure, pacemaker implantation, and aortic regurgitation) was
evaluated. Preprocedure and postprocedure high-sensitivity troponin levels
were available in 211 patients. The mean age of patients was 83 years
(78-87 years), with 129 men (61.1%). Mean postprocedure high-sensitivity
troponin was 124.9+/-81.4 ng/L in the direct TAVR group versus
170.4+/-127.7 ng/L in the BAV group (P=0.007). Myocardial injury occurred
in 42 patients (19.9%), including 13 patients (12.2%) in the direct TAVR
group and 29 (27.9%) in the BAV group (P=0.004). BAV increased by 2.8-fold
(95% CI, 1.4-5.8) myocardial injury probability. Myocardial injury was
associated with 1-month adverse events (P=0.03). Conclusions BAV increased
the incidence and magnitude of myocardial injury after TAVR with
new-generation balloon-expandable valves. Myocardial injury was associated
with 1-month adverse events. These results argue in favor of direct SAPIEN
3 valve implantation. Registration URL: https://www.Clinicaltrials.gov;
Unique identifier: NCT02729519.

<97>
Accession Number
633140363
Title
Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation
in Saphenous Vein Grafts: Randomized Controlled Trial.
Source
Journal of the American Heart Association. 9 (20) (pp e017434), 2020. Date
of Publication: 20 Oct 2020.
Author
Fahrni G.; Farah A.; Engstrom T.; Galatius S.; Eberli F.; Rickenbacher P.;
Conen D.; Mueller C.; Pfister O.; Twerenbold R.; Coslovsky M.; Cattaneo
M.; Kaiser C.; Mangner N.; Schuler G.; Pfisterer M.; Mobius-Winkler S.;
Jeger R.V.
Institution
(Fahrni, Rickenbacher, Conen, Mueller, Pfister, Twerenbold, Coslovsky,
Cattaneo, Kaiser, Pfisterer, Jeger) University Hospital Basel Switzerland
(Farah) Klinikum Westfalen Dortmund Germany
(Farah) Central Clinic Bad Berka Germany
(Engstrom) Rigshospitalet Copenhagen Denmark
(Galatius) Bispebjerg University Hospital Copenhagen Denmark
(Galatius) Gentofte Hospital Hellerup Denmark
(Eberli) Triemli Hospital Zurich Switzerland
(Conen) Population Health Research Institute McMaster University Hamilton
Canada
(Mangner) Herzzentrum Dresden Technische Universitat Dresden Dresden
Germany
(Mangner, Schuler, Mobius-Winkler) Heart Center University of Leipzig
Germany
(Mobius-Winkler) University of Jena Germany
Publisher
NLM (Medline)
Abstract
Background Efficacy data on drug-eluting stents (DES) versus bare-metal
stents (BMS) in saphenous vein grafts are controversial. We aimed to
compare DES with BMS among patients undergoing saphenous vein grafts
intervention regarding long-term outcome. Methods and Results In this
multinational trial, patients were randomized to paclitaxel-eluting or
BMS. The primary end point was major adverse cardiac events (cardiac
death, nonfatal myocardial infarction, and target-vessel revascularization
at 1 year. Secondary end points included major adverse cardiac events and
its individual components at 5-year follow-up. One hundred seventy-three
patients were included in the trial (89 DES versus 84 BMS). One-year major
adverse cardiac event rates were lower in DES compared with BMS (2.2%
versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03-0.64, P=0.01), which was
mainly driven by a reduction of subsequent myocardial infarctions and need
for target-vessel revascularization. Five-year major adverse cardiac event
rates remained lower in the DES compared with the BMS arm (35.5% versus
56.1%, hazard ratio, 0.40; 95% CI, 0.23-0.68, P<0.001). A
landmark-analysis from 1 to 5 years revealed a persistent benefit of DES
over BMS (hazard ratio, 0.33; 95% CI, 0.13-0.74, P=0.007) in terms of
target-vessel revascularization. More patients in the BMS group underwent
multiple target-vessel revascularization procedures throughout the study
period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8],
P=0.013). Enrollment was stopped before the target sample size of 240
patients was reached. Conclusions In this randomized controlled trial with
prospective long-term follow-up of up to 5 years, DES showed a better
efficacy than BMS with sustained benefits over time. DES may be the
preferred strategy in this patient population. Registration URL:
https://www.clinicaltrials.gov; Unique identifier: NCT00595647.

<98>
Accession Number
633050525
Title
Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Heart Association. 9 (19) (pp e017460), 2020. Date
of Publication: 20 Oct 2020.
Author
Faroux L.; Junquera L.; Mohammadi S.; Del Val D.; Muntane-Carol G.; Alperi
A.; Kalavrouziotis D.; Dumont E.; Paradis J.-M.; Delarochelliere R.;
Rodes-Cabau J.
Institution
(Faroux, Junquera, Mohammadi, Del Val, Muntane-Carol, Alperi,
Kalavrouziotis, Dumont, Paradis, Delarochelliere, Rodes-Cabau) Quebec
Heart and Lung InstituteLaval University Quebec City Quebec Canada
Publisher
NLM (Medline)
Abstract
Background Some concerns remain regarding the safety of transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement. We
aimed to compare the risk of 30-day complications and death in
transcarotid/transsubclavian versus transfemoral transcatheter aortic
valve replacement recipients. Methods and Results Data from 20 studies,
including 79 426 patients (16 studies) and 3992 patients (4 studies) for
the evaluation of the unadjusted and adjusted impact of the arterial
approach were sourced, respectively. The use of a
transcarotid/transsubclavian approach was associated with an increased
risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI,
1.90-2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI,
1.05-2.22). The pooled results deriving from unadjusted data showed an
increased risk of 30-day death (RR, 1.46; 95% CI, 1.22-1.74) and bleeding
(RR, 1.53; 95% CI, 1.18-1.97) in patients receiving transcatheter aortic
valve replacement through a transcarotid/transsubclavian access (compared
with the transfemoral group), but the associations between the arterial
access and death (OR, 1.22; 95% CI, 0.89-1.69), bleeding (OR, 1.05; 95%
CI, 0.68-1.61) were no longer significant when using adjusted data. No
significant effect of the arterial access on vascular complication was
observed in unadjusted (RR, 0.84; 95% CI, 0.66-1.06) and adjusted (OR,
0.79; 95% CI, 0.53-1.17) analyses. Conclusions Transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement were
associated with an increased risk of stroke compared with the transfemoral
approach. However, these nonfemoral arterial alternative accesses were not
associated with an increased risk of 30-day death, bleeding, or vascular
complication when taking into account the confounding factors.

<99>
Accession Number
631299900
Title
Minute ventilation stabilization during all pressure-control / support
mechanical ventilation modes.
Source
Physiological research. 69 (2) (pp 275-282), 2020. Date of Publication: 30
Apr 2020.
Author
Candik P.; Depta F.; Imrecze S.; Sabol F.; Kolesar A.; Jankajova M.;
Pauliny M.; Benova J.; Galkova K.; Donic V.; Torok P.
Institution
(Candik) Department of Human Physiology, Faculty of Medicine, Safarik
University, Slovak Republic, Kosice
Publisher
NLM (Medline)
Abstract
The main goal of our prospective randomized study was comparing compare
the effectiveness of ventilation control method "Automatic proportional
minute ventilation (APMV) "versus manually set pressure control
ventilation modes in relationship to lung mechanics and gas exchange. 80
patients undergoing coronary artery bypass grafting (CABG) were randomized
into 2 groups. 40 patients in the first group No.1 (APMV group) were
ventilated with pressure control (PCV) or pressure support ventilation
(PSV) mode with APMV control. The other 40 patients (control group No.2)
were ventilated with synchronized intermittent mandatory ventilation
(SIMV-p) or pressure control modes (PCV) without APMV. Ventilation control
with APMV was able to maintain minute ventilation more precisely in
comparison with manual control (p<0.01), similarly deviations of ETCO(2)
were significantly lower (p<0.01). The number of manual corrections of
ventilation settings was significantly lower when APMV was used (p<0.01).
The differences in lung mechanics and hemodynamics were not statistically
significant. Ventilation using APMV is more precise in maintaining minute
ventilation and gas exchange compared with manual settings. It required
less staff intervention, while respiratory system mechanics and
hemodynamics are comparable. APMV showed as effective and safe method
applicable on top of all pressure control ventilation modes.

<100>
Accession Number
2011433504
Title
Efficacy and Safety of Direct Oral Anticoagulants in Solid Organ
Transplant Recipients: A Meta-Analysis.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 2021. 40 (4
Supplement) (pp S281), 2021. Date of Publication: April 2021.
Author
Zakko J.; Lampert B.; Kahwash R.; Hasan A.K.; Franco V.; Emani S.; Haas
G.; Ganapati A.; Whitson B.; Mokadam N.; Benza R.; Vallakati A.
Institution
(Zakko, Lampert, Kahwash, Hasan, Franco, Emani, Haas, Ganapati, Whitson,
Mokadam, Benza, Vallakati) Cardiovascular Diseases, The Ohio State
University, Columbus, OH, United States
Publisher
Elsevier Inc.
Abstract
Purpose: There is limited evidence comparing direct oral anticoagulants
(DOACs) and warfarin in solid organ transplant recipients. We performed a
pooled analysis to study the safety of DOACS in this patient population.
 Method(s): We searched PubMed, Embase, and Scopus databases from
their inception to July 31, 2020 using the search terms "heart transplant"
or "lung transplant" or "liver transplant" or kidney transplant" or
"pancreas transplant" and "direct oral anticoagulant" for literature
search. Random effects model with Mantel-Haenszel method was used to pool
data of major bleeding, clinically relevant non-major bleeding, venous
thromboembolism, and stroke. Result(s): We identified five studies
which compared DOACs with warfarin. Pooled analysis included 489 patients,
of which 259 patients received DOACs and 500 patients received warfarin.
When compared to warfarin, the use of direct oral anticoagulants was
associated with decreased risk of composite bleed (RR 0.49, 95% CI 0.32 -
0.76, p =0.002)(Figure 1). There were no differences in rates of major
bleeding (RR 0.55, 95% CI 0.20 - 1.49, p =0.24) or venous thromboembolism
(RR 0.65, 95% CI 0.25 - 1.70, p =0.38) between the two groups.
 Conclusion(s): Evidence from pooled analysis suggests that DOACs are
comparable to warfarin in terms of safety in solid organ transplant
recipients. Further research is warranted to conclusively determine
whether DOACs are safe alternatives to warfarin for anticoagulation in
solid organ transplant recipients. Copyright © 2021

<101>
Accession Number
2011432367
Title
Nutritional Supplementation and Neuromuscular Electrical Stimulation in
Lung Transplant Patients.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 2021. 40 (4
Supplement) (pp S359-S360), 2021. Date of Publication: April 2021.
Author
Timofte I.; Wells C.; Hersi K.; Ryan A.; Varghese A.M.; Vesselinov R.;
Iacono A.; Assadi J.; Davis D.; Li G.; Herr D.; Harrington T.; Griffith
B.; Lau C.; Krupnick A.; Madathil R.; Rabin J.; Alon G.; Parker E.; Baer
D.; Magder L.; Terrin M.L.; Verceles A.
Institution
(Timofte, Hersi, Varghese, Iacono, Assadi, Harrington, Verceles) Pulmonary
and Critical Care Medicine, University of Maryland Medical Center,
Baltimore, MD, United States
(Wells, Alon) Physical Therapy, University of Maryland Medical Center,
Baltimore, MD, United States
(Ryan, Vesselinov, Li, Parker, Magder, Terrin) Epidemiology, University of
Maryland Medical Center, Baltimore, MD, United States
(Davis) Radiology, University of Maryland Medical Center, Baltimore, MD,
United States
(Herr, Rabin) Critical Care Medicine, University of Maryland Medical
Center, Baltimore, MD, United States
(Griffith, Madathil) Cardiothoracic Surgery, University of Maryland
Medical Center, Baltimore, MD, United States
(Lau, Krupnick) Thoracic Surgery, University of Maryland Medical Center,
Baltimore, MD, United States
(Baer) Clinical Nutrition, University of Maryland Medical Center,
Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Purpose: Intensive rehabilitation is recognized as an essential component
to successful outcomes for recovery after a major cardio-thoracic surgery.
We developed a multi-modal rehabilitation program that combines a physical
therapy protocol with neuromuscular electric stimulation and nutrition
supplementation to achieve improved functional outcomes for patients
requiring lung transplantation. Method(s): Patients are randomized to
the treatment arm or usual care 72 hours after transplant. Both groups
undergo a global assessment of functional capabilities prior to transplant
and at 72 hours post-transplantation. Patients in the treatment arm
received additional physical therapy plus therapy with an electrical
device and nutrition supplementation with essential amino acids. All
patients received computed tomography to measure change in lower extremity
skeletal muscle area. Muscle cross sectional area was measured at 1/3rd of
the distance from the femoral tuberosity to the knee articulation.
 Result(s): Preliminary results for six patients are presented in
Figure 1. All patients had decreases in muscle cross-sectional area at 14
days post transplant. Compared to the standard of care group, the
treatment group decreased average time of intubation (1.00+/-0.0 vs
2.33+/-1.4 days), average ICU length of stay (6.33+/-4.2 vs 8.33+/-7.5
days), and average hospital length of stay (17.00+/-2.6 vs 23.30+/-9.0
days). Conclusion(s): We intend to use the data obtained from this
pilot study to develop a larger, randomized interventional trial
evaluating the effects of an intense multimodal rehabilitation program in
improving long-term patient outcomes (including patient and graft
survival) in cardiothoracic transplant recipients and as well as hospital
length of stay and rate of early re-admission. Copyright © 2021

<102>
Accession Number
2011430389
Title
Health Related Quality of Life in Iron Deficient Heart Transplant
Recipients Receiving Intravenous Iron Supplement: A Prespecified Secondary
Endpoint in the IronIC Trial.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 2021. 40 (4
Supplement) (pp S281-S282), 2021. Date of Publication: April 2021.
Author
Englund K.B.; Oestby C.M.; Rolid K.; Gude E.; Andreassen A.K.; Gullestad
L.; Broch K.
Institution
(Englund, Oestby, Rolid, Gude, Andreassen, Gullestad, Broch) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Publisher
Elsevier Inc.
Abstract
Purpose: Health related quality of life (HRQoL) is reduced in heart
transplant (HTx) recipients compared to that of healthy individuals.
Intravenous iron supplement improves quality of life in patients with
heart failure and iron deficiency (ID). The IronIC trial was designed to
test if a single dose of ferric derisomaltose, formerly known as iron
isomaltoside, could improve exercise capacity in HTx recipients. HRQoL was
a prespecified secondary endpoint. Method(s): In the IronIC trial we
randomized 102 HTx recipients with ID to ferric derisomaltose or placebo.
ID was defined as ferritin <100mug/l, or ferritin 100-300mug/l in
combination with transferrin saturation of <20%. HRQoL was assessed at
baseline and at 6 months follow-up using two validated questionnaires:
EQ-5D-3L and SF-36v2.The EQ-5D-3L consists of the EQ-Visual Analogue Scale
rated from 0-100, and the EQ-5D descriptive system, which we converted to
a summary index using a Swedish value set. The SF-36v2 consists of 36
questions, which can be converted to 2 norm-based sum scores: the physical
component summary (PCS) and the mental component summary (MCS). A minimal
clinically important difference (MCID) was defined as >=2 for the SF-36
PCS, and >=3 for the SF-36 MCS. Result(s): There was no between-group
difference in peak oxygen consumption in the IronIC trial. However, HRQoL
was improved in the ferric derisomaltose group compared to controls at
follow-up. A significant between group difference was found in the EQ-5D
index (Figure 1A), the EQ-5D-VAS (Figure 1B), and the SF-36 MCS (Figure
1C). The SF-36 MCS MCID was also significant. The SF-36 PCS (Figure 1D)
and the SF-36 PCS MCID were not significantly different between the groups
at follow up. Conclusion(s): The prespecified secondary outcome HRQoL
was better in the ferric derisomaltose group. These findings suggest a
possible approach to improve HRQoL in HTx recipients, and could provide
the basis for a trial designed to assess this issue. Copyright ©
2021

<103>
Accession Number
2011430373
Title
Inhaled Selective Pulmonary Vasodilators for Advanced Heart Failure
Therapies.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 2021. 40 (4
Supplement) (pp S12), 2021. Date of Publication: April 2021.
Author
Ghadimi K.; Cappiello J.; Cooter M.; Levy J.H.; Schroder J.N.; Bryner B.;
Shah S.H.; Rajagopal S.; Devore A.D.; Patel C.B.; Milano C.A.
Institution
(Ghadimi, Cooter, Levy) Anesthesiology & Critical Care, Duke University
Medical Center, Durham, NC, United States
(Cappiello) Respiratory Care, Duke University Medical Center, Durham, NC,
United States
(Schroder, Bryner, Milano) Surgery, Duke University Medical Center,
Durham, NC, United States
(Shah, Rajagopal, Devore, Patel) Medicine, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Purpose: Inhaled pulmonary vasodilators (iPVD) are commonly used to lower
PVR to modify the risk of acute RV failure in durable LVAD implantation or
orthotopic heart transplantation (OHT). While inhaled nitric oxide (iNO)
is the iPVD gold standard, inhaled epoprostenol (Veletri) has been
introduced as a cost-conscious alternative without high-grade evidence.
Thus, we conducted an investigation to primarily determine if inhaled
epoprostenol is equivalent to iNO in the ability to modify acute RVF after
advanced heart failure therapies. Method(s): Our group has enrolled
232 patients (LVAD, N=100; OHT, N=132) in a triple-blinded (clinician,
subject, statistician) randomized controlled trial conducted between May
2017-October 2020 (NCT03081052). Participants were grouped into strata
according to key clinical prognostic features. Within each stratum,
subjects were assigned either iNO or inhaled epoprostenol via 1:1
randomization. To assess equivalency between the two treatment arms for
our primary outcome analysis, we will calculate absolute and relative risk
estimates and corresponding confidence intervals (CI). If the CI do not
contain the margin of difference (15%), then we will conclude there is
sufficient evidence that the risk of the primary outcome in each treatment
arm is similar. For each secondary outcome, we will construct univariable
effect estimates and corresponding CI, which will allow for assessment of
difference between treatment arms. In the case that patients have switched
to the other treatment arm, we will perform an intent-to-treat (ITT)
analysis without reclassifying treatment assignment. To verify ITT
results, we will perform a per-protocol analysis. Endpoints: Primary.LVAD:
Moderate or Severe RVF (defined by INTERMACS, up to 21-days after
surgery); OHT: PGD-RV treated with RVAD or VA-ECMO, up to 30-days after
surgery. Secondary. Duration of postoperative mechanical ventilation, iPVD
duration/cost, ICU and hospital lengths-of-stay, postoperative acute
kidney injury, and 30-day mortality. Copyright © 2021

<104>
Accession Number
2011429885
Title
Extracorporeal Membrane Oxygenation for Early Graft Dysfunction Following
Heart Transplantation: A Systematic Review and Meta-Analysis.
Source
Journal of Heart and Lung Transplantation. Conference: ISHLT 2021. 40 (4
Supplement) (pp S85-S86), 2021. Date of Publication: April 2021.
Author
Aleksova N.; Buchan T.A.; Foroutan F.; Zhu A.; Noly P.; Carrier M.;
Marasco S.F.; Pozzi M.; Lehmann S.; Jawad K.; Defontaine A.; Baron O.;
Loforte A.; Checco E.D.; Absi D.O.; Kawabori M.; Mastroianni M.A.;
Simonenko M.; Marichev A.; Sponga S.; Livi U.; Orchanian-Cheff A.; Ross
H.J.; Guyatt G.; Billia F.; Alba A.C.
Institution
(Aleksova, Buchan, Foroutan, Ross, Billia, Alba) Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, Toronto, ON,
Canada
(Zhu) University of Toronto, Toronto, ON, Canada
(Noly, Carrier) Department of Cardiac Surgery, Montreal Heart Institute,
Montreal, QC, Canada
(Marasco) Department of Cardiothoracic Surgery, The Alfred Hospital,
Melbourne, Australia
(Pozzi) Service de Chirurgie Cardiaque, Hospices Civils de Lyon, Hopital
Louis Pradel, Lyon, France
(Lehmann, Jawad) Heart Center, University of Leipzig, Leipzig, Germany
(Defontaine, Baron) Centre Hospitalier Universitaire de Nantes, Nantes,
France
(Loforte, Checco) Cardio-Thoracic-Vascular Department, S. Orsola
University Hospital, Bologna, Italy
(Absi) University Hospital Fundacion Favaloro, Buenos Aires, Argentina
(Kawabori, Mastroianni) Department of Cardiovascular Surgery, Tufts
Medical Center, Boston, MA, United States
(Simonenko, Marichev) Almazov National Medical Research Centre, St.
Petersburg, Russian Federation
(Sponga, Livi) Cardiothoracic Department, University Hospital of Udine,
Udine, Italy
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, ON, Canada
(Guyatt) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Purpose: Early graft dysfunction (EGD) is a major cause of morbidity and
mortality following heart transplantation (HT). Severe EGD often includes
the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Studies evaluating its effectiveness are mostly single centre observations
with variable outcomes. This systematic review and meta-analysis appraises
the available evidence and evaluates prognosis in HT patients with EGD
requiring VA-ECMO. Method(s): We conducted a systematic search of
Ovid Medline, Embase and the Cochrane databases to 05/15/2020. Studies of
adults who received VA-ECMO during their index hospitalization after HT
and reported on mortality at any timepoint were included. We included
observational studies published after 2009, in any language, as abstracts
or full texts. Outcomes of interest were short-term mortality, 1-year
mortality and VA-ECMO complications. We used QUIPS to assess risk of bias
and GRADE to assess the quality of the evidence. Data was pooled using
random-effects models. Result(s): We included 50 studies of 1472
patients with 504 short-term mortality events. Most studies were
retrospective (94%), single centre (88%), and at low/acceptable risk of
bias overall (76%). Pooled short-term mortality was 33% (95%CI: 27-38%,
I2 =76%) and 1-year mortality was 46% (95%CI: 37-54%,
I2 =81%). Risk of bias, publication type, recruitment
timeframe, and use of VA-ECMO for only primary graft dysfunction as per
the ISHLT definition did not explain heterogeneity in subgroup analyses.
Reported VA-ECMO complications were 38% (95%CI: 27-49%) for dialysis, 36%
(95%CI: 26-47%) for bleeding, 22% (95%CI: 14-31%) for infection and 5%
(95%CI: 1-10%) for limb ischemia. Conclusion(s): One-third of HT
patients with EGD supported with VA-ECMO are at risk of short-term death.
An individual patient data meta-analysis is warranted to further
understand the mortality risk and gain insight into risk factors
associated with outcomes in this population. Copyright © 2021

<105>
Accession Number
2011421606
Title
ES03.05 Surgery as a Component of Local Consolidative Therapy.
Source
Journal of Thoracic Oncology. Conference: 2020 World Conference on Lung
Cancer. Singapore. 16 (3 Supplement) (pp S68-S69), 2021. Date of
Publication: March 2021.
Author
Antonoff M.
Institution
(Antonoff) Surgery, University of Texas MD Anderson Cancer Center,
Houston/TX/US
Publisher
Elsevier Inc.
Abstract
Historically, treatment for non-small cell lung cancer (NSCLC) has been
stage-dependent, with surgery typically considered the standard of care
for stage I disease and a potential component of multi-modality care for
stages II-III. By contrast, for stage IV disease, therapy aimed at
prolongation of life has included systemic treatments, including
chemotherapy, and, in recent years, targeted agents and immunotherapy. For
metastatic disease, surgery has previously had a fairly limited role.
However, oligometastatic disease may offer a potential opportunity for
more aggressive local options. The distinct tumor biology and limited
disease burden may be associated with improved outcomes.1 The
landmark oligometastatic trial published by Gomez in 20162
aimed to assess the effect of local consolidative therapy (LCT) on
progression-free survival (PFS) of patients with 3 or fewer metastases who
received standard first-line chemotherapy, and patients were randomized to
LCT vs maintenance treatment. LCT improved PFS and time to development of
new metastatic lesions. Moreover, comprehensive LCT (cLCT) was also shown
to improve overall survival (OS).3 A subsequent review from our
institution of 194 patients, including those both on and off the
oligometastatic clinical trial, aimed to identify those patients who would
derive greatest benefit from LCT.4 This study revealed that
cLCT was associated with improved OS, with median survival of 29 months
for cLCT compared to 23 months for those with subcomprehensive LCT or no
LCT. Moreover, lower intrathoracic stage, non-squamous histology, and
absence of bone metastases were all associated with improved OS after
cLCT, theoretically identifying those patients most likely to benefit from
aggressive local therapy-which can consist of surgery or radiation. In
terms of surgery itself, we next aimed to evaluate the outcomes of
operative pulmonary resection as LCT in oligometastatic
disease,5 using radiotherapy as a benchmark comparator.
Evaluating patients with 3 or fewer synchronous metastases and received
LCT to all sites, we analyzed survival and progression. Surgery to the
primary tumor was performed in 28% after a median of 3.7 months. 90-day
post-treatment mortality after surgery was 0%, and, after a median
follow-up of 57 months, median OS after surgery was greater than 55
months. Median OS for radiation in this group was 23 months. Thus, it was
concluded that surgery should remain a component of LCT for operable
oligometastatic NSCLC patients, and it should be considered in randomized
trial for patients with metastatic disease. While surgery has demonstrated
survival benefits in the oligometastatic population, the potential
complexity of these procedures cannot be overstated. In our institutional
experience, thoracotomies have been required in more than 4/5 of
operations, and adhesions and hilar fibrosis have been common. Events such
as need for proximal pulmonary arterial control and unplanned changes in
extent of operation are not infrequent, and the majority of cases have
been reported as more difficult than usual. Thus, proper patient selection
for surgery is imperative, as is preparation for the types of resources
potentially needed for these cases. Despite surgical complexity, ability
to achieve negative margins and to safely manage the patients
perioperatively has been reassuring. Given the success of surgery as a
component of LCT, surgery has become an important part of ongoing clinical
trials evaluating LCT after novel agents for metastatic NSCLC. The
LONESTAR trial6 aims to evaluate the benefits of LCT after
immunotherapy, in that patients receive 12 weeeks of ipilumimab and
nivolumab, after which those individuals with non-progressive disease are
randomized to LCT + continued immunotherapy vs continued immunotherapy
alone. While radiation is required to at least one disease site, surgery
to the primary site of disease is emphasized whenever possible. Similar to
the LONESTAR trial, the NORTHSTAR trial is investigating the role of LCT
after tyrosine-kinase inhibitor therapy for patients with EGFR-mutant
metastatic NSCLC. Patients who have non-progressive disease after 6-12
weeks of osimertinib are randomized to LCT vs continued targeted therapy,
again, offering surgery whenever feasible to the primary site of
disease.7 More recently, the BRIGHTSTAR trial was initiated,
evaluating the role of LCT after 8 weeks of brigatinib for patients with
metastatic ALK-mutated NSCLC, with the primary endpoints of safety and
feasibility and secondary endpoints of PFS, OS, and time to
progression.8 A number of patients have already undergone
surgery on each of these trials, with promising perioperative outcomes.
Despite the potential for innovation and expanded surgical indications,
consideration must be given to the safety and potential technical
challenges in such cases. We must consider issues related to fibrosis,
adhesions, and sclerotic lymph nodes, as well as our limitations in
identifying those patients with residual disease vs complete response.
Surgery as LCT for oligometastatic NSCLC represents an exciting frontier
for thoracic surgery, as a potential opportunity to help patients with
advanced disease. Implications for training and resource allocation remain
ever pertinent, and surgery needs to be considered as a potential
therapeutic component in novel clinical trials in even advanced disease.
References: 1. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol.
1995 Jan;13(1):8-10. 2. Gomez DR et al. Local consolidative therapy versus
maintenance therapy or observation for patients with oligometastatic
non-small-cell lung cancer without progression after first-line systemic
therapy: a multicentre, randomised, controlled, phase 2 study. Lancet
Oncol. 2016 Dec;17(12):1672-1682. 3. Gomez DR et al. Local Consolidative
Therapy Vs. Maintenance Therapy or Observation for Patients With
Oligometastatic Non-Small-Cell Lung Cancer: Long-Term Results of a
Multi-Institutional, Phase II, Randomized Study. J Clin Oncol. 2019 Jun
20;37(18):1558-1565. 4. Mitchell KG et al. Improved Overall Survival With
Comprehensive Local Consolidative Therapy in Synchronous Oligometastatic
Non-Small-Cell Lung Cancer. Clin Lung Cancer. 2020 Jan;21(1):37-46.e7. 5.
Mitchell KG et al. Pulmonary resection is associated with long-term
survival and should remain a therapeutic option in oligometastatic lung
cancer. J Thorac Cardiovasc Surg. 2020 Mar 25:S0022-5223(20)30633-4. 6.
Phase III Trial of (LCT) After Nivolumab and Ipilimumab, 7. Elamin YY et
al. Randomized phase II trial of osimertinib with or without local
consolidation therapy (LCT) for patients with EGFR-mutant metastatic NSCLC
(NORTHSTAR). Annals of Oncology (2018)29 (suppl_8):viii493-viii547. 8.
Elamin Y et al. BRIGHTSTAR: A pilot trial of local consolidative therapy
(LCT) with brigatinib in tyrosine kinase inhibitor (TKI)-naive
ALK-rearranged advanced NSCLC.Journal of Clinical Oncology 2020
38:15_suppl, 9624-9624 Keywords: Surgery, OLIGOMETASTATIC,
NSCLC Copyright © 2021

<106>
Accession Number
2011421440
Title
ES12.02 Defining High Risk.
Source
Journal of Thoracic Oncology. Conference: 2020 World Conference on Lung
Cancer. Singapore. 16 (3 Supplement) (pp S77-S78), 2021. Date of
Publication: March 2021.
Author
Tammemagi M.
Institution
(Tammemagi) Health Sciences, Brock University, Canada/AB/CA
Publisher
Elsevier Inc.
Abstract
Globally, lung cancer is the leading cause of cancer death. The National
Lung Screening Trial and NELSON trial have shown that LDCT screening can
reduce lung cancer mortality by >=20%. This finding can have major public
health impact. However, lung cancer screening is most effective when
applied to high-risk individuals. Consequently, defining eligibility to
select individuals for screening is important in determining screening
programs' effectiveness. This abstract discusses select topics in defining
high risk and determining eligibility for lung cancer screening. Two
general approaches to determining eligibility exist. The first uses
categories of age, pack-years and smoking quit-years (CATage-PKYR-QY).
This method does not quantify risk. Examples include NLST, USPSTF2013 and
USPSTF2020, CMS and NELSON criteria. The second method uses mathematical
models describing the relationship between predictors and lung cancer. and
risk is quantified. Because this approach uses many predictors, models
continuous variables, and in some models handles non-linear relationships,
they have generally been found to be superior to CATage-PKYR-QY
approaches. Examples include the Bach, PLCOm2012 and LCRAT models.
1-3 Comparisons of the USPSTF selection criteria versus
model-risk-based approaches have been made by the CISNET Lung Group using
micro-simulation modeling.4 Because modeling makes unrealistic
assumptions, such as 100% participation and adherence, perhaps the best
evidence to date instead comes from the International Lung Screening
Trial, which prospectively enrolled >4000 individuals by USPSTF2013
criteria or PLCOm2012 risk.5 At PLCOm2012 >=1.7%/6y both
criteria selected the same number for screening. Both criteria were
positive for 3018 individuals. Three cancers were detected in the
USPSTF+/PLCOm2012- group, and 23 cancers were detected in the
PLCOm2012+/USPSTF- group. The PLCOm2012 cancer detected rate was 18.5%
(95%CI 11.5%-26.7%) higher than the USPSTF criteria. Given the average age
at enrollment was 63.01 for USPSTF+ and 65.38 for PLCOm2012+ and assuming
average death ages for USPSTF+ and PLCOm2012+ were 78 and 76 years
(assumes greater comorbidities and competing deaths in PLCOm2012+ group),
a crude calculation estimates 41.5 more life-years-gained per 1000 scans
by the PLCOm2012 criteria. The USPSTF2013 and USPSTF2020 criteria lead to
race and gender disparities, that for Whites versus Blacks is undone using
the PLCOm2012 and for men versus women are reduced. The CREST study
applied USPSTF criteria and PLCOm2012 to a community-based case series of
883 lung cancer patients in the University of Illinois Hospital and Health
Sciences System in Chicago.6 For the USPSTF2020 in Whites and
Blacks the criteria sensitivities were 75.4% and 70.6% and for PLCOm2012
>=1.0%/6y (equivalent to USPSTF2020) were 82.5% and 82.8%, respectively.
For the USPSTF2020 in men and women the criteria sensitivities were 71.8%
and 64.6% and for PLCOm2012 >=1.0%/6y were 80.9% and 76.7%. NLST results
demonstrate that below a PLCOm2012 risk of 0.64%/6y there is no lung
cancer mortality benefit conferred by LDCT screening. Indeed, there were
more deaths in the LDCT arm. In the PLCO Trial there were 74,218 smokers.
4777 (6.4%) of them had PKYR >=20 and <30 and QY<=15, representing the
incremental group added by the USPSTF2020 criteria. Of these, 1025 (21.5%)
have PLCOm2012 risks <0.65%/6y, and only 2 lung cancers were observed in
this group (0.2%/6y). This sizeable group has risks so low that according
to NLST results they have no benefit. Expansion of screening needs to be
done effectively. Note that these results are based on real people and
real data. Should biomarkers be used as the first stage for determining
eligibility? To date, we are aware of only one biomarker test that has
been evaluated in a RCT for selecting individuals for lung cancer
screening: Early Diagnosis of Lung Cancer Scotland trial, which evaluated
an autoantibody panel.7 In the intervention arm (N=6088),
individuals who tested positive (n=598) received a LDCT screen;
test-negative and controls (N=6121) received regular care. 71 lung cancer
were detected in the control arm and only 56 were detected in intervention
arm. Sensitivity was only 32.1%. The cancer detection rate was 0.9% in 2
years and early stage occurred in 41% of cases. These findings compare
poorly against pilots using PLCOm2012 for enrollment, for example,
Manchester Lung Health Check had 3.0% detection in 1 year and 80% early
stage8; Ontario Health (Cancer Care Ontario) pilot had 1.9% in
1 year and 71% early stage9. Cost-effectiveness analysis found
no scenario in which the biomarker was more favourable. Because of greater
accuracy and cheaper cost, the PLCOm2012 dominated the biomarker. Thus, in
such scenarios, biomarker combined with prediction model may be superior,
or biomarker may be useful to identify those at high risk who do not
qualifying by other criteria. 1. Bach PB, Kattan MW, Thornquist MD, et al.
Variations in lung cancer risk among smokers. Journal of the National
Cancer Institute 2003;95:470-8. 2. Tammemagi MC, Katki HA, Hocking WG, et
al. Selection criteria for lung-cancer screening. The New England journal
of medicine 2013;368:728-36. 3. Katki HA, Kovalchik SA, Berg CD, Cheung
LC, Chaturvedi AK. Development and Validation of Risk Models to Select
Ever-Smokers for CT Lung Cancer Screening. JAMA 2016. 4. Meza R, Jeon J,
Toumazis I, et al. Evaluation of the Benefits and Harms of Lung Cancer
Screening With Low-Dose Computed Tomography: A Collaborative Modeling
Study for the U.S. Preventive Services Task Force. Rockville, MD.2020. 5.
Lam S, Myers R, Ruparel M, et al. PL02.02 - Lung Cancer Screenee Selection
by USPSTF Versus PLCOm2012 Criteria - Interim ILST Findings. Journal of
Thoracic Oncology 2019;Vol 14, Issue 10, S4. 6. Pasquinelli MM, Tammemagi
MC, Kovitz KL, et al. Risk Prediction Model Versus United States
Preventive Services Task Force Lung Cancer Screening Eligibility Criteria:
Reducing Race Disparities. J Thorac Oncol 2020. 7. Sullivan FM, Mair FS,
Anderson W, et al. Earlier diagnosis of lung cancer in a randomised trial
of an autoantibody blood test followed by imaging. Eur Respir J 2020. 8.
Crosbie PA, Balata H, Evison M, et al. Implementing lung cancer screening:
baseline results from a community-based 'Lung Health Check' pilot in
deprived areas of Manchester. Thorax 2019;74:405-9. 9. Darling GE,
Tammemagi MC, Schmidt H, et al. Organized Lung Cancer Screening Pilot:
Informing a Province-wide Program in Ontario, Canada. The Annals of
thoracic surgery 2020. Copyright © 2021

<107>
Accession Number
2011421189
Title
P19.08 Clinical Outcome of Local Treatment in Synchronous Oligometastatic
Non-Small Cell Lung Cancer: A Preliminary Analysis of Prospective Data.
Source
Journal of Thoracic Oncology. Conference: 2020 World Conference on Lung
Cancer. Singapore. 16 (3 Supplement) (pp S358), 2021. Date of Publication:
March 2021.
Author
Zhu X.; Li S.; Zheng Z.
Institution
(Zhu, Li, Zheng) Radiation Oncology, Zhujiang Hospital of Southern Medical
University, Guangzhou/CN
Publisher
Elsevier Inc.
Abstract
Introduction: Advanced non-small cell lung cancer (NSCLC) is a
heterogeneous disease, a large number of retrospective studies suggested
that patients with oligometastases may achieve long-term survival from
aggressive local treatment. However, relevant prospective studies were
limited. Therefore, we prospectively evaluated the role of local treatment
in synchronous oligometastatic NSCLC. Method(s): We prospectively
identified 50 NSCLC patients newly diagnosed with synchronous
oligometastases (<=5)in two centers between 11/2017 and 12/2019, among
whom there were 24 patients from a randomized clinical trial NCT03119519.
Patients were given first-line systemic therapy according to the latest
NCCN guidelines with either local radiotherapy or surgery to thoracic
primary tumor and/or radiotherapy to metastases. They were divided into
combined therapies (Tx), systemic Tx and untreated groups. Kaplan Meier
Survival analysis was used to compare progression free survival (PFS) and
overall survival (OS) among the groups. Result(s): Median age of all
patients was 61 years old (range: 27-80 years) and median follow up was
5.7 months (range: 0.5-23.3 months). A total of 10 deaths were observed.
In the combined Tx group, 23 patients received radiotherapy, and 2
patients received primary surgical resection. The median OS of the
combined Tx group (n = 25), the systemic Tx group (n = 19) and the
untreated group (n = 6) was 18.47 months, not reached, 3.27 months,
respectively. Compared with the untreated group, the combined group and
the systemic Tx group had better OS (hazard ratio [HR] = 0.1047, p =
0.0001; HR = 0.1125, p= 0.0006). However, the patients in the combined
group did not show significant OS advantage compared with those in the
systemic Tx group (HR = 1.376, p= 0.667). In addition, we conducted an ITT
analysis in clinical trial NCT03119519, in which 8 progression events were
observed. There was no significant difference in PFS between the combined
group (n = 13) and the systemic Tx group (n = 11) (13.2 months vs. not
reached, HR = 1.317, p= 0.7015; 1-year PFS: 74% vs. 54%, p=0.7015,
respectively). Conclusion(s): Current analysis shows that the
addition of local treatment to first-line systemic Tx does not improve PFS
and OS. More samples, further updated data and selection of potential
beneficer are necessary. Funding(s): 81972853, 81572279, 2016J004,
LC2019ZD009, 2018CR033. Keywords: oligometastases, Thoracic Radiotherapy,
non-small cell lung cancer Copyright © 2021

<108>
Accession Number
2011420945
Title
FP01.01 Uniportal Versus Multiportal Video-Assisted Thoracoscopic Surgery
for Non-Small Cell Lung Cancer: An Updated Meta-Analysis.
Source
Journal of Thoracic Oncology. Conference: 2020 World Conference on Lung
Cancer. Singapore. 16 (3 Supplement) (pp S186), 2021. Date of Publication:
March 2021.
Author
Magouliotis D.; Fergadi M.; Spiliopoulos K.; Athanassiadi K.
Institution
(Magouliotis, Spiliopoulos) Department of Cardiothoracic Surgery,
University of Thessaly, Larissa/GR
(Fergadi) University of Thessaly, Larissa/GR
(Athanassiadi) Thoracic Surgery, Evangelismos General Hospital, Alimos/GR
Publisher
Elsevier Inc.
Abstract
Introduction: Minimally invasive surgical techniques have become the
standard approach for treating patients with non-small cell lung cancer.
In this context, the uniportal video-assisted thoracoscopic surgery
(UVATS) approach has been proposed as a feasible alternative to the
multiport VATS to perform feasibly and safely a wide range of thoracic
surgical operations, including lobectomy for non-small cell lung cancer.
As the number of studies comparing the feasibility and safety of UVATS and
MVATS increases, it is necessary to reevaluate whether the results between
the two techniques are at least equivalent. The purpose of the present
study was to summarize and analyze the existing data by comparing the
surgical outcomes of UVATS and MVATS, in order to provide the best
evidence that is currently available. Method(s): A thorough
literature search was performed in three databases: (i) Pubmed (Medline),
(ii) Cochrane Central Register of Controlled Studies (CENTRAL), and (iii)
Scopus (ELSEVIER) (last search: April 20th, 2020). Original
studies that evaluated perioperative and long-term outcomes of UVATS
versus MVATS were identified, from January 1990 to April 2020. The
perioperative, along with the oncologic and long-term survival outcomes
were calculated according to either a fixed and a random effect model,
appropriately. The Q statistics and I2 statistic were used to
test for heterogeneity among the studies. Result(s): Twenty studies
were included, incorporating a total of 1,469 patients treated with UVATS
and 3,231 treated with MVATS. The incidence of complications was lower in
patients treated with UVATS [OR: 0.76 (95% CI: 0.62, 0.93); p=0.008]. The
chest tube duration was significantly decreased in the UVATS group (WMD:
-0.63 [95% CI:-1.03, -0.23]; p=0.002). L.O.S. was also lower in the UVATS
patient group (WMD: -0.54 [-0.94, -0.13]; p=0.009), along with the
reported levels of postoperative pain [WMD: -0.57 (95% CI:-0.97, -0.18);
p=0.004]. No significant differences were found regarding the M.O.T., mean
blood loss, the number of resected lymph nodes, the 30-day mortality,
along with the survival at one and three years postoperatively. [Formula
presented] Conclusion(s): The present meta-analysis indicates that
UVATS is associated with enhanced outcomes in patients undergoing surgery
for lung cancer. However, the decision regarding the procedure of choice
should be made based on the shared decision-making process. Well-designed,
randomized studies, comparing UVATS to MVATS, are necessary to further
assess their long-term clinical outcomes. Keywords: lung cancer, Uniportal
VATS, Video-assisted thoracoscopic surgery Copyright © 2021

<109>
Accession Number
2010885862
Title
Velocity-pressure loops can estimate intrinsic and pharmacologically
induced changes in cardiac afterload during non-cardiac surgery. An
observational study.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2021. Date
of Publication: 2021.
Author
Le Gall A.; Gayat E.; Joachim J.; Cohen S.; Hong A.; Mateo J.; Buxin C.;
Millasseau S.; Mebazaa A.; Vallee F.
Institution
(Le Gall, Gayat, Joachim, Cohen, Hong, Mateo, Buxin, Mebazaa, Vallee)
Department of Anaesthesiology and Intensive Care, Lariboisiere - Saint
Louis Hospitals, 02 rue Ambroise Pare, Paris 75010, France
(Gayat, Mebazaa, Vallee) Inserm, UMRS-942, Paris Diderot University, 02,
rue Ambroise Pare, Paris 75010, France
(Le Gall, Vallee) M3DISIM, Inria-Saclay, Palaiseau, France
(Le Gall, Vallee) LMS, Ecole Polytechnique, CNRS, Palaiseau, France
(Millasseau) Pulse Wave Consulting, 72 B rue de Montignon, Saint Leu La
Foret 95320, France
Publisher
Springer Science and Business Media B.V.
Abstract
Purpose: Continuous measurement of aortic pressure and aortic flow
velocity signals in the operating theatre allows us to draw
velocity-pressure (Vel-Pre) loops. The global afterload angle (GALA),
derived from the Vel-Pre loops, has been linked to cardiac afterload
indicators. As age is the major determinant of constitutive arterial
stiffness, we aimed to describe (1) the evolution of the GALA according to
age in a large cohort of anesthetized patients and (2) GALA variations
induced by haemodynamic interventions. Method(s): We included
patients for whom continuous monitoring of arterial pressure and cardiac
output were indicated. Fluid challenges or vasopressors were administered
to treat intra-operative hypotension. The primary endpoint was the
comparison of the GALA values between young and old patients. The
secondary endpoint was the difference in the GALA values before and after
haemodynamic interventions. Result(s): We included 133 anaesthetized
patients: 66 old and 67 young patients. At baseline, the GALA was higher
in the old patients than in young patients (38 +/- 6 vs. 25 +/- 4 degrees;
p < 0.001). The GALA was positively associated with age (p < 0.001), but
the mean arterial pressure (MAP) and cardiac output were not. The GALA did
not change after volume expansion, regardless of the fluid response, but
it did increase after vasopressor administration. Furthermore, while a
vasopressor bolus led to a similar increase in MAP, phenylephrine induced
a more substantial increase in the GALA than noradrenaline (+ 12 +/-
5degree vs. + 8 +/- 5degree; p = 0.01). Conclusion(s): In non-cardiac
surgery, the GALA seems to be associated with both intrinsic rigidity
(reflected by age) and pharmacologically induced vasoconstriction changes
(by vasopressors). In addition, the GALA can discriminate the differential
effects of phenylephrine and noradrenaline. These results should be
confirmed in a prospective, ideally randomized, trial. Copyright
© 2021, The Author(s), under exclusive licence to Springer Nature
B.V.

<110>
Accession Number
2006798049
Title
Late survival benefit of percutaneous coronary intervention compared with
medical therapy in patients with coronary chronic total occlusion: A
10-year follow-up study.
Source
Journal of the American Heart Association. 10 (6) (no pagination), 2021.
Article Number: e019022. Date of Publication: 2021.
Author
Park T.K.; Choi K.H.; Lee J.M.; Yang J.H.; Song Y.B.; Hahn J.-Y.; Choi
J.-H.; Gwon H.-C.; Lee S.H.; Choi S.-H.
Institution
(Park, Lee, Choi, Lee, Yang, Song, Hahn, Choi, Gwon, Lee, Choi) Division
of Cardiology, Department of Medicine, Heart Vascular and Stroke
Institute, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: As an initial treatment strategy, percutaneous coronary
intervention (PCI) for coronary chronic total occlusion (CTO) did not show
midterm survival benefits compared with optimal medical therapy (OMT). We
sought to evaluate the benefit of PCI compared with OMT in patients with
CTO over extended long-term follow-up. METHODS AND RESULTS: Between March
2003 and February 2012, 2024 patients with CTO were enrolled in a
single-center registry and followed for =10 years. We excluded patients
with CTO who underwent coronary artery bypass graft (n=477) and classified
patients into the CTO-PCI group (n=883) or OMT group (n=664) according to
initial treatment strategy. Patients with multivessel disease received PCI
for obstructive non-CTO lesions in both groups. In the CTO-PCI group, 699
patients (79.2%) underwent successful revascularization. The CTO-PCI group
had a lower 10-year rate of cardiac death (10.4% versus 22.3%; hazard
ratio [HR], 0.44 [95% CI, 0.32-0.59]; P<0.001) than the OMT group. After
propensity score matching analyses, the CTO-PCI group had a lower 10-year
rate of cardiac death (13.6% versus 20.8%; HR, 0.64 [95% CI, 0.45-0.91];
P=0.01) than the OMT group. The relative reduction in cardiac death at 10
years was mainly driven by a relative reduction between 3 and 10 years
(8.3% versus 16.6%; HR, 0.43 [95% CI, 0.27-0.71]; P<0.001) but not at 3
years (5.7% versus 5.0%; HR, 1.12 [95% CI, 0.63-2.00]; P=0.71). The
beneficial effects of CTO-PCI were consistent among subgroups.
 CONCLUSION(S): As an initial treatment strategy, CTO-PCI might reduce
late cardiac death compared with OMT in patients with CTO. Extended
follow-up of randomized trials may confirm the findings of the present
study. Copyright © 2020 The Authors.

<111>
Accession Number
2006784432
Title
Effect of propofol in cardioplegia solution on biomarkers of myocardial
injury in coronary artery bypass grafting surgery: A randomized
double-blind clinical trial.
Source
Journal of Health and Translational Medicine. 24 (1) (pp 30-36), 2021.
Date of Publication: 2021.
Author
Reza J.; Gholam A.H.; Reza K.; Hojatollah N.; Elham A.; Zahra E.
Institution
(Reza, Gholam, Hojatollah, Elham, Zahra) Anesthesiology and Critical Care
Research Center, Shiraz University of Medical Science, Shiraz, Iran,
Islamic Republic of
(Reza) Health Human Resources Research Center, Department of Health in
Disasters and Emergencies, School of Management and Information Sciences,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Faculty of Medicine, University of Malaya
Abstract
Introduction: Coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to
the development of myocardial damage and dysfunction. It is assumed that
propofol, a general anesthetic agent, has a protective role against
oxidative stress. The aim of this study was to evaluate the effect of
propofol on myocardial protection when added to cardioplegic solution in
patients undergoing CABG. Method(s): In this prospective and
double-blind RCT study, 120 patients undergoing CABG surgery were randomly
assigned into two equal groups. In one group, we added 1200 microg/min
(ultimate dose 4 microg/ml) propofol to cardioplegic solution and in the
control group, an equal volume of normal saline was added to cardioplegic
solution. Serum levels of CPK-MB and Troponin I were checked at four time
points, including: just after induction (T1) as baseline, after chest
closure (T2), 6 hours after arrival to ICU (T3) and 24 hours after ICU
admission (T4). Result(s): Cardiac enzyme levels had significant
increase over time in both groups (p-value <0.05). It was observed that
the enzyme levels in the propofol group increased less compared with the
control group; however, this difference was not significant. Both groups
were also similar in incidence of post-operative arrhythmia and need for
use of IABP. Conclusion(s): Adding a dose of 1200 microg/min
(ultimate dose 4 microg/mL) propofol to cardioplegia solution does not
have an effect on CPK-MB & troponin I level. Copyright © 2021,
Faculty of Medicine, University of Malaya. All rights reserved.

<112>
Accession Number
634575472
Title
Association Between Cerebral Desaturation and Postoperative Delirium in
Thoracotomy With One-Lung Ventilation: A Prospective Cohort Study.
Source
Anesthesia and analgesia. (no pagination), 2021. Date of Publication: 15
Mar 2021.
Author
Cui F.; Zhao W.; Mu D.-L.; Zhao X.; Li X.-Y.; Wang D.-X.; Jia H.-Q.; Dai
F.; Meng L.
Institution
(Cui, Mu, Wang) From the Department of Anesthesiology and Critical Care,
Peking University First Hospital, Beijing, China
(Zhao, Jia) Department of Anesthesiology, Fourth Hospital of Hebei Medical
University, Shijiazhuang, China
(Zhao) Department of Anesthesiology, Second Xiangya Hospital, Central
South University, Changsha, China
(Zhao, Meng) Department of Anesthesiology, Yale University School of
Medicine, New Haven, CT, United States
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Dai) Department of Biostatistics, Yale University School of Public
Health, New Haven, CT, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The association between cerebral desaturation and
postoperative delirium in thoracotomy with one-lung ventilation (OLV) has
not been specifically studied. METHOD(S): A prospective observational
study performed in thoracic surgical patients. Cerebral tissue oxygen
saturation (Scto2) was monitored on the left and right foreheads using a
near-infrared spectroscopy oximeter. Baseline Scto2 was measured with
patients awake and breathing room air. The minimum Scto2 was the lowest
measurement at any time during surgery. Cerebral desaturation and
hypersaturation were an episode of Scto2 below and above a given threshold
for >=15 seconds during surgery, respectively. The thresholds based on
relative changes by referring to the baseline measurement were <80%, <85%,
<90%, <95%, and <100% baseline for desaturation and >105%, >110%, >115%,
and >120% baseline for hypersaturation. The thresholds based on absolute
values were <50%, <55%, <60%, <65%, and <70% for desaturation and >75%,
>80%, >85%, and >90% for hypersaturation. The given area under the
threshold (AUT)/area above the threshold (AAT) was analyzed. Delirium was
assessed until postoperative day 5. The primary analysis was the
association between the minimum Scto2 and delirium using multivariable
logistic regression controlled for confounders (age, OLV time, use of
midazolam, occurrence of hypotension, and severity of pain). The secondary
analysis was the association between cerebral desaturation/hypersaturation
and delirium, and between the AUT/AAT and delirium using multivariable
logistic regression controlled for the same confounders. Multiple testing
was corrected using the Holm-Bonferroni method. We additionally monitored
somatic tissue oxygen saturation on the forearm and upper thigh.
 RESULT(S): Delirium occurred in 35 (20%) of 175 patients (65 +/- 6
years old). The minimum left or right Scto2 was not associated with
delirium. Cerebral desaturation defined by <90% baseline for left Scto2
(odds ratio [OR], 5.82; 95% confidence interval [CI], 2.12-19.2; corrected
P =.008) and <85% baseline for right Scto2 (OR, 4.27; 95% CI, 1.77-11.0;
corrected P =.01) was associated with an increased risk of delirium.
Cerebral desaturation defined by other thresholds, cerebral
hypersaturation, the AUT/AAT, and somatic desaturation and hypersaturation
were all not associated with delirium. CONCLUSION(S): Cerebral
desaturation defined by <90% baseline for left Scto2 and <85% baseline for
right Scto2, but not the minimum Scto2, may be associated with an
increased risk of postthoracotomy delirium. The validity of these
thresholds needs to be tested by randomized controlled
trials. Copyright © 2021 International Anesthesia Research
Society.

<113>
Accession Number
634570004
Title
The Effect of Home Care Training on Anxiety and Vital Signs Levels in
Coronary Artery Bypass Grafting Patients: A Randomized Clinical Trial.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. (no pagination), 2021. Date of
Publication: 10 Mar 2021.
Author
Shirdel Z.; Behzad I.; Manafi B.; Sahebi M.
Institution
(Shirdel) Student Research Committee, Department of Operating Room,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Behzad) Department of Operating Room, School of Paramedicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Manafi) Department of Heart Surgery, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Sahebi) Farshchian Hospital, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
PURPOSE: Patients after coronary artery bypass grafting (CABG) require
special care at home, and not being aware of this need before surgery can
result in anxiety. This study aimed to determine the effect of home care
training on the level of anxiety and vital signs in CABG patients. DESIGN:
The study was a randomized clinical trial study. METHOD(S): The study
included 80 patients undergoing CABG surgery in January 2020. Samples were
selected by convenience sampling and were randomly divided into
intervention and control groups. The control group received only routine
training, whereas the intervention group received two additional training
sessions on home care. Data were collected using the Spielberger
situational anxiety questionnaire and a checklist of vital signs, and then
analyzed using descriptive and inferential statistics. FINDINGS: Results
showed that before the intervention, the mean anxiety scores, heart rate,
respiratory rate, temperature, and systolic and diastolic blood pressure
between the two groups were not significantly different (P > .05).
However, after the intervention, the mean anxiety score, heart rate,
respiratory rate, and systolic and diastolic blood pressure in the
intervention group was significantly (P < .05) lower than the control
group, but the mean temperature of the two groups showed no significant
difference (P > .05). CONCLUSION(S): Home care training before
surgery reduces anxiety and improves vital signs. The use of home care
training before surgery is recommended for this patient
population. Copyright © 2020 American Society of PeriAnesthesia
Nurses. Published by Elsevier Inc. All rights reserved.

<114>
Accession Number
634565155
Title
Double blind pilot randomized trial comparing extended anticoagulation to
placebo following major lung resection for cancer.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2021.
Date of Publication: 10 Mar 2021.
Author
Shargall Y.; Schneider L.; Linkins L.-A.; Crowther M.; Farrokhyar F.;
Waddell T.K.; de Perrot M.; Douketis J.; Lopez-Hernandez Y.; Schnurr T.;
Haider E.; Agzarian J.; Hanna W.C.; Finley C.
Institution
(Shargall) McMaster University, Department of Surgery, Division of
Thoracic Surgery; University of Toronto, Department of Surgery, Division
of Thoracic Surgery; St. Joseph's Healthcare Hamilton, Firestone Institute
for Respiratory Health, Division of Thoracic Surgery. Electronic address:
shargal@mcmaster.ca
(Schneider, Farrokhyar, Lopez-Hernandez, Schnurr) McMaster University,
Department of Surgery, Division of Thoracic Surgery
(Linkins, Crowther) McMaster University, Department of Medicine, Division
of Hematology and Thromboembolism
(Waddell, de Perrot) University of Toronto, Department of Surgery,
Division of Thoracic Surgery
(Douketis) McMaster University, Department of Medicine, Division of
Hematology and Thromboembolism; St. Joseph's Healthcare Hamilton,
Firestone Institute for Respiratory Health, Division of Thoracic Surgery
(Haider) McMaster University, Department of Radiology
(Agzarian, Hanna, Finley) McMaster University, Department of Surgery,
Division of Thoracic Surgery; St. Joseph's Healthcare Hamilton, Firestone
Institute for Respiratory Health, Division of Thoracic Surgery
Publisher
NLM (Medline)
Abstract
Venous Thromboembolism (VTE), which comprises pulmonary embolus (PE) and
deep vein thrombosis (DVT), is a significant cause of postoperative
morbidity and mortality. This pilot randomized control trial (RCT)
evaluated the feasibility of a full-scale RCT investigating extended
thromboprophylaxis in patients undergoing oncological lung resections.
Patients undergoing oncological lung resections in two tertiary centers
received in-hospital, thromboprophylaxis and were randomized to receive
post-discharge low-molecular-weight heparin (LMWH) or placebo injections
once-daily for 30 days. At 30 days postoperatively, all patients underwent
chest computed tomography with PE protocol and bilateral leg venous
ultrasound. Primary outcomes included feasibility and safety; VTE
incidence and 90-day survival were secondary outcomes. Between December
2015 and June 2018, 619 patients were screened, of whom 62.7% (165/263) of
eligible patients consented to participate, and 133 (81%) were randomized.
One-hundred and three patients, (77.4%), completed the 90-day study
follow-up. Reasons for non-participation pre-randomization included
patient discomfort and LMWH/placebo administration challenges.
Post-randomization withdrawals were due to patient preference, surgeon
preference and minor adverse events. Six asymptomatic VTE events (5 PE and
1 DVT) were detected within 30 days (3 in each group), for an overall
incidence of 7%. There were 3 minor and no major adverse events. This
study is the first to demonstrate the feasibility and safety of a
full-scale extended thromboprophylaxis RCT in thoracic surgical oncology.
Our results demonstrate that, while recruitment and retention rates were
modest, the study design is feasible and with minimal adverse events and
no intervention-related mortality. Copyright © 2021. Published by
Elsevier Inc.

<115>
Accession Number
634578782
Title
Ischaemic breast necrosis following coronary artery bypass grafting using
left internal mammary artery: understanding the risks.
Source
ANZ journal of surgery. (no pagination), 2021. Date of Publication: 16 Mar
2021.
Author
B S.; Khanna A.; Song C.
Institution
(B, Khanna, Song) Department of Plastic Surgery, Fiona Stanley Hospital,
Perth, WA, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is a common procedure
performed commonly using left internal mammary artery (LIMA). We report a
case of sternal wound dehiscence and breast necrosis following LIMA
harvest in a 55-year-old obese lady with macromastia, diabetes mellitus,
hypertension and end stage renal disease requiring dialysis. We also
review the existing literature. METHOD(S): Publications were
identified from Medline All, Web of Science Core Collection, Google
Scholar and Cochrane Central Register of Controlled Trial between 1974 and
2 January 2020. We assessed patient co-morbidities, presentation time
frame, quadrant of breast necrosis and reconstruction option utilized.
 RESULT(S): There were 18 cases of breast necrosis reported post-CABG.
The patients were aged 50 or over, morbidly obese and had large tubular
breasts. Other risk factors included chronic renal insufficiency, diabetes
and hypertension. The presentation was delayed with necrosis only evident
7days or more after CABG. All the reported cases had necrosis at lower
inner quadrant of the left breast with nipple-areola complex.
 CONCLUSION(S): Blood supply to the breast is segmental with
considerable overlap, however, this overlap is reduced in large breasts.
Patients with macromastia and multiple co-morbidities need preoperative
imaging (computed tomography angiogram) to evaluate breast vascularity
prior to CABG. Risk of breast necrosis needs to be explained during the
informed consent. Surgical management of the hypermastia (breast reduction
or amputation) may be a factor in facilitating the CABG procedure if
indeed the LIMA is absolutely indicated considering the risks and
benefits. Copyright © 2021 Royal Australasian College of
Surgeons.

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