EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010728039
Title
Transcatheter Mitral Valve Implantation Systematic Review: Focus on
Transseptal Approach and Mitral Annulus Calcification.
Source
Current Cardiology Reports. 23 (4) (no pagination), 2021. Article Number:
37. Date of Publication: April 2021.
Author
Ben-Ali W.; Ibrahim R.; Rodes-Cabeau J.; von Bardeleben R.S.; Mylotte D.;
Granada J.; Modine T.
Institution
(Ben-Ali, Modine) Service Medico-Chirurgical: Valvulopathies- Chirurgie
Cardiaque - Cardiologie Interventionelle Structurelle, Hopital
Cardiologique de Haut Leveque, Bordeauc, France
(Ben-Ali, Ibrahim) Structural Valve Program, Montreal Heart Institute,
Montreal, Canada
(Ben-Ali) Service de Chirurgie, Cardio-vasculaire Hopital haut Leveque,
Avenue de Magellan 33604, Pessac Cedex, France
(Rodes-Cabeau) Quebec Heart and Lung Institute, Laval University, Quebec
City, Canada
(von Bardeleben) Heart Valve Center Mainz, Universitatsmedizin, Mainz,
Germany
(Mylotte) Department of Cardiology, University Hospital of Galway, Galway,
Ireland
(Granada) Cardiovascular Research Foundation, CRF Skirball Center for
Innovation, Columbia University Medical Center, New York, United States
Publisher
Springer
Abstract
Introduction: This systematic review was performed to evaluate the results
of transcatheter mitral valve implantation (TMVI) in the native mitral
valve. <br/>Evidence Acquisition: Medline, EMBASE, and the Cochrane
Central register were systematically searched for studies that reported
results of TMVI in mitral valve regurgitation and/or stenosis and mitral
annular calcification. To improve the sensitivity of the literature
search, we performed citation chasing in Google Scholar, Scopus, and Web
of Science. <br/>Evidence Synthesis: Twelve studies reporting results of
TMVI in mitral regurgitation were retrieved and included 347 patients. The
transseptal approach represented 28% of cases. Secondary mitral
regurgitation was the predominant indication in 63% of cases. Thirty-day
mortality was 11% and was lowered with the transseptal approach (7%).
Technical success was 92%. Surgical conversion was needed in 5% of
patients. Only one patient presented moderate to severe mitral
regurgitation. These hemodynamic results were sustainable up to one year
of follow-up. Three series focused on results of TMVI in mitral annulus
calcification including 167 patients. Only nine patients were treated with
TMVI dedicated prosthesis. Eighty-seven patients had their prosthesis
delivered through a transseptal approach. Mitral stenosis was present in
63% of cases. Thirty-day mortality was 24%, and none with TMVI prosthesis.
Technical success was achieved in 71% of cases and was improved by using
TMVI prosthesis (89%). The main complication was left ventricular outflow
tract obstruction (20%). Post procedural moderate to severe mitral
regurgitation was observed in 4% of cases. <br/>Conclusion(s): TMVI seems
to be feasible, achieving good technical success and predictable and
durable MR reduction.<br/>Copyright &#xa9; 2021, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC part of Springer
Nature.

<2>
Accession Number
2007093852
Title
Bioprosthetic Valve Thrombosis: Insights from Transcatheter and Surgical
Implants.
Source
Structural Heart. 4 (5) (pp 382-388), 2020. Date of Publication: 02 Sep
2020.
Author
Dangas G.; Chiarito M.; O'Gara P.; Makkar R.; Gurbel P.; Leipsic J.;
Batchelor W.; Holmes D.R.; Poppas A.; Carroll J.; Kapadia S.; Mack M.;
Leon M.B.; Thourani V.H.
Institution
(Dangas, Chiarito) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United
States
(O'Gara) Cardiovascular Division, Department of Medicine, Brigham &
Women's Hospital, Boston, MA, United States
(Makkar) Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles,
CA, United States
(Gurbel) Sinai Center for Thrombosis Research and Drug Development, Sinai
Hospital of Baltimore, Baltimore, MD, United States
(Leipsic) Department of Medical Imaging and Division of Cardiology, St.
Paul's Hospital, Vancouver, BC, Canada
(Batchelor) Inova Center of Outcomes Research, Inova Heart and Vascular
Institute, Falls Church, VA, United States
(Holmes) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Poppas) American College of Cardiology, Washington, DC, United States
(Carroll) UCHealth Structural Heart and Valve Clinic-Anschutz, Aurora, CO,
United States
(Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Mack) Cardiovascular Service Line, Baylor Scott & White Health, Plano,
TX, United States
(Leon) Department of Medicine, Columbia University Irving Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Thourani) Department of Cardiovascular Surgery, Marcus Valve Center,
Piedmont Heart Institute, Atlanta, GA, United States
Publisher
Bellwether Publishing, Ltd.
Abstract
Although aortic valve replacement with implantation of a bioprosthesis has
been widely performed for more than 50 years, appreciation of the
development of bioprosthetic leaflet thrombosis has increased recently
with the emergence of transcatheter aortic valve replacement (TAVR) and
the use of advanced imaging modalities, such as 4-dimensional computed
tomographic angiography. Recent observational and randomized studies have
demonstrated how this condition could affect patients treated with either
TAVR or surgical aortic valve replacement (SAVR). The clinical relevance
of bioprosthetic valve thrombosis and the optimal antithrombotic
strategies to prevent this condition in patients treated with SAVR or TAVR
are still a matter of debate, while anticoagulation is considered
effective treatment to address bioprosthetic valve thrombosis once it is
diagnosed. This review provides an overview on timing and mechanism of
bioprosthetic valve thrombosis, its prevalence and clinical impact in
patients treated with TAVR or SAVR, and how the different designs of
various types of bioprostheses could influence the risk of
thrombosis.<br/>Copyright &#xa9; 2020 Cardiovascular Research Foundation.

<3>
Accession Number
2005089038
Title
Application of flow diverters in the treatment of aneurysms in the
internal carotid artery bifurcation region.
Source
Neuroradiology Journal. 33 (4) (pp 297-305), 2020. Date of Publication: 01
Aug 2020.
Author
Mahmoud M.; Farag A.; Farid M.; Elserwi A.; Abdelsamad A.; Guergues W.;
Hassan F.
Institution
(Mahmoud, Farag, Farid, Elserwi, Abdelsamad, Guergues) Radiology
Department, Ain Shams University Hospital, Egypt
(Hassan) Radiology Department, Cairo University, Egypt
Publisher
SAGE Publications Inc.
Abstract
Introduction: The treatment of aneurysms in the internal carotid
bifurcation region (ICABR), including aneurysms of the true internal
carotid artery (ICA) terminus, those inclined on the proximal A1 or M1
segments or at the most distal pre-bifurcation (ICA) segment, is often
challenging in microsurgical clipping and endovascular surgery. Few
reports had discussed flow diversion as a therapeutic option for this
group. <br/>Method(s): This was a retrospective study analysing flow
diversion in treating ICABR aneurysms. Seven patients harbouring eight
aneurysms in the ICABR were treated with flow diversion. Five aneurysms
were inclined on the proximal A1 segment, and three were located at the
most distal pre-bifurcation segment. Patients' demographics, presentation,
procedure technical description, angiographic and clinical follow-up were
recorded. PubMed and Ovid MEDLINE were also reviewed for articles
published in English, including case series or case reports, for ICABR
aneurysms treated with flow diverters. <br/>Result(s): All patients except
one underwent angiographic follow-up. The Karman-Byrne occlusion scale was
used to determine the occlusion rate. All six patients with documented
angiographic follow-up had a class IV occlusion score. No permanent or
transient neurological or non-neurological complications were encountered
in this study. <br/>Conclusion(s): Treating ICABR aneurysms using flow
diversion is feasible, with a promising angiographic occlusion rate.
Further studies are needed to analyse long-term clinical and angiographic
results.<br/>Copyright &#xa9; The Author(s) 2020.

<4>
Accession Number
2004812641
Title
General anesthesia or conscious sedation for transfemoral aortic valve
replacement with the sapien 3 transcatheter heart valve.
Source
International Heart Journal. 61 (4) (pp 713-719), 2020. Date of
Publication: 2020.
Author
Neumann F.-J.; Redwood S.; Abdel-Wahab M.; Lefevre T.; Frank D.;
Eltchaninoff H.; Caussin C.; Stella P.R.; Hovorka T.; Baumgartner H.;
Tarantini G.; Wendler O.; Treede H.
Institution
(Neumann) University Heart Centre Freiburg/Bad Krozingen, University of
Freiburg, Bad Krozingen, Germany
(Redwood) King's Health Partners, London, United Kingdom
(Abdel-Wahab) Leipzig Heart Center, Leipzig, Germany
(Lefevre) Institut Cardiovasculaire Paris Sud, Hopital prive Jacques
Cartier, Massy, France
(Frank) University Hospital, Kiel, Schleswig-Holstein, Germany
(Frank) DZHK, German Center for Cardiovascular Research,
Kiel/Lubeck/Hamburg, Germany
(Eltchaninoff) Department of Cardiology, Rouen University Hospital, FHU
REMOD-VHF, Rouen F76000, France
(Caussin) Institut Mutualiste Montsouris, Paris, France
(Stella) University Medical Center, Utrecht, Netherlands
(Hovorka) Statistics Department, Edwards Lifesciences, Prague, Czechia
(Baumgartner) Department of Cardiology III, University Hospital, Adult
Congenital & Valvular Heart Disease, Munster, Germany
(Tarantini) Padova Hospital, Italy
(Wendler) King's College Hospital, London, United Kingdom
(Treede) University Heart Center, Hamburg, Germany
Publisher
International Heart Journal Association
Abstract
Differences in the benefits of conscious sedation (CS) and general
anesthesia (GA) during transfemoral aortic valve implantation (TAVI) are
unclear. We aimed to assess differences in procedural and clinical
outcomes based on the type of anesthesia received during TAVI. We analyzed
SOURCE 3 Registry data for patients who received the SAPIEN 3 valve by
type of anesthesia used during TAVI. Of the 1694 TAVI patients, 1027
received CS and 667 received GA. Patients were similar at baseline (81.5
years; Society of Thoracic Surgeons risk score 7.0). Compared with the GA
group, the CS group had fewer intra-procedural transesophageal
echocardiography (TEE) and post implantation dilatations performed, and
less contrast medium was used. The CS group had significantly less kidney
injury at 7 days post-procedure than the GA group (0.4% versus 1.5%, P =
0.014). Moderate paravalvular leaks (PVL) occurred more frequently in the
CS group versus the GA group (2.2% versus 0.8%; P = 0.041). No severe PVL
were reported. Median total hospital length of stay (LOS) after TAVI was
10 days in the CS group and 11 days in the GS group. At 30 days, all-cause
death was 2.1% in CS and 1.7% in GS (P = 0.47), and myocardial infarction
was 0.2% in CS and 0.1% in GS (P = 0.83). Our analyses found no
significant major outcome differences between CS and GA during
TAVI.<br/>Copyright &#xa9; 2020, International Heart Journal Association.
All rights reserved.

<5>
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.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<6>
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. <br/>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). <br/>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. <br/>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.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<7>
Accession Number
2006861292
Title
Reoperative mitral surgery versus transcatheter mitral valve replacement:
A systematic review.
Source
Journal of the American Heart Association. 10 (6) (no pagination), 2021.
Article Number: e019854. Date of Publication: 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, United States
(Yazdchi, Percy, Premkumar, Hirji, Kaneko) Division of Cardiac Surgery,
Brigham and Women's Hospital, Boston, MA, United States
(Bapat) Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
(Bhatt) Brigham and Women's Heart & Vascular Center, Harvard Medical
School, Boston, MA, United States
Publisher
American Heart Association Inc.
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.<br/>Copyright
&#xa9; 2021 The Authors. Published on behalf of the American Heart
Association, Inc., by Wiley.

<8>
Accession Number
2006861291
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) (no pagination), 2021.
Article Number: e019512. Date of Publication: 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
American Heart Association Inc.
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]). <br/>CONCLUSION(S): 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.<br/>Copyright &#xa9; 2021 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<9>
Accession Number
2006861288
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) (no pagination), 2021.
Article Number: e018744. Date of Publication: 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, United States
(Butala) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Faridi, Curtis) Section of Cardiovascular Medicine, Department of
Medicine, Yale School of Medicine, New Haven, CT, United States
(Song, Gibson, Yeh) Baim Institute for Clinical Research, Boston, MA,
United States
Publisher
American Heart Association Inc.
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
unad-justed 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).
<br/>CONCLUSION(S): In addition to trial-adjudicated events, claims
identified additional clinically meaningful ischemic and bleeding events
that were prognostically significant for death.<br/>Copyright &#xa9; 2021
The Authors. Published on behalf of the American Heart Association, Inc.,
by Wiley.

<10>
Accession Number
2011578414
Title
Outcomes of surgical treatment for carcinoid heart disease: A systematic
review and meta-analysis.
Source
Surgery (United States). (no pagination), 2021. Date of Publication: 2021.
Author
O'Malley T.J.; Jimenez D.C.; Saxena A.; Weber M.P.; Samuels L.E.;
Entwistle J.W.; Guy T.S.; Massey H.T.; Morris R.J.; Tchantchaleishvili V.
Institution
(O'Malley, Jimenez, Saxena, Weber, Samuels, Entwistle, Guy, Massey,
Morris, Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
Publisher
Mosby Inc.
Abstract
Background: Carcinoid heart disease (CaHD) develops from vasoactive
substances released by neuroendocrine tumors, which can cause significant
patient morbidity and mortality without surgical intervention. We
performed a systematic review and meta-analysis to elucidate granular
perioperative details and long-term outcomes in these patients.
<br/>Method(s): Electronic search of Ovid, Scopus, Cumulative Index of
Nursing and Allied Health Literature, and Cochrane Controlled Trials
Register was performed to examine surgical treatment of carcinoid disease.
Nine articles comprising 416 patients were selected. Study-level data were
extracted and pooled for meta-analysis. <br/>Result(s): Mean patient age
was 63 years (95% confidence interval, 57-70) with 53% (95% confidence
interval, 46-61) of patients being male. In addition, 75% (95% confidence
interval, 54-96) of neuroendocrine tumors originated from the small bowel
or colon and 98% (95% confidence interval, 93-100) had liver metastases.
Right heart failure was present in 48% (95% confidence interval, 14-81).
Moderate or severe regurgitation was present in 97% (95% confidence
interval, 95-99) of tricuspid and 72% (95% confidence interval, 58-83) of
pulmonary valves. In addition, 99% (95% confidence interval, 98-100) of
tricuspid and 59% (95% confidence interval, 38-79) of pulmonary valves
were replaced. Bioprosthetic valves were used in 80% (95% confidence
interval, 68-93) of tricuspid positions. Mean hospital duration of stay
was 16 days (95% confidence interval, 7-25). Thirty-day mortality was 9%
(95% confidence interval, 6-12). Mean follow-up was 25 months (95%
confidence interval, 11-39). Median survival was 3 years (95% confidence
interval, 2.5-3.5). <br/>Conclusion(s): For patients >18 years of age,
surgical treatment of carcinoid heart disease can be performed with a
reasonable safety profile. However, overall survival appears to have
ongoing effects of the primary disease.<br/>Copyright &#xa9; 2021

<11>
Accession Number
2011577522
Title
High Versus Normal Blood Pressure Targets in Relation to Right Ventricular
Dysfunction After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Bootsma I.T.; de Lange F.; Scheeren T.W.L.; Jainandunsing J.S.; Boerma
E.C.
Institution
(Bootsma, de Lange, Boerma) Department of Intensive Care, Medical Center
Leeuwarden, Leeuwarden, Netherlands
(Scheeren, Jainandunsing) Department of Anesthesiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Management of right ventricular (RV) dysfunction is
challenging. Current practice predominantly is based on data from
experimental and small uncontrolled studies and includes augmentation of
blood pressure. However, whether such intervention is effective in the
clinical setting of cardiac surgery is unknown. <br/>Design(s): Randomized
controlled trial. <br/>Setting(s): Single-center study in a tertiary
teaching hospital. <br/>Participant(s): The study comprised 78 patients
equipped with a pulmonary artery catheter (PAC), classified according to
PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of <20%,
and 34 patients had an RVEF between >=20% and <30%. <br/>Intervention(s):
Patients randomly were assigned to either a normal target group (mean
arterial pressure 65 mmHg) or a high target group [mean arterial pressure
85 mmHg]). The primary end- point was the change in RVEF over a one-hour
study period. <br/>Measurements and Main Results: There was no significant
between-group difference in change of RVEF <20% (-1% [-3.3 to 1.8] in the
normal-target group v 0.5% [-1 to 4] in the high-target group; p = 0.159).
There was no significant between-group difference in change in RVEF
20%-to-30% (-1% [-3 to 0] in the normal-target group v 1% [-1 to 3] in the
high-target group; p = 0.074). These results were in line with the
simultaneous observation that echocardiographic variables of RV and left
ventricular function also remained unaltered over time, irrespective of
either baseline RVEF or treatment protocol. <br/>Conclusion(s): In a mixed
cardiac surgery population with RV dysfunction, norepinephrine-mediated
high blood pressure targets did not result in an increase in PAC-derived
RVEF compared with normal blood pressure targets.<br/>Copyright &#xa9;
2021 The Authors

<12>
Accession Number
634681482
Title
Tailored anaesthesia for thoracoscopic surgery promoting enhanced
recovery: the state of the art.
Source
Anaesthesia, critical care & pain medicine. (pp 100846), 2021. Date of
Publication: 24 Mar 2021.
Author
Elsayed H.H.; Moharram A.A.
Institution
(Elsayed) Thoracic Surgery Department, Ain Shams University, Cairo, Egypt
(Moharram) Anaesthesia Department, Ain Shams University, Cairo, Egypt
Publisher
NLM (Medline)
Abstract
PURPOSE OF THE REVIEW: The current review focuses on precise anaesthesia
for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced
recovery. The main aim of an enhanced recovery program after thoracic
surgery is to reduce postoperative stress response, protect from
postoperative pulmonary complications, give hospitals a better financial
option and improve overall patient outcome. This can ultimately reduce
hospital stay and increase patient satisfaction. With advances in
endoscopic, robotic and endovascular techniques, video-assisted
thoracoscopic surgery (VATS) can be performed in a minimally invasive way
in managing most pulmonary, pleural and mediastinal diseases. As a
minimally invasive technique, video-assisted thoracoscopic surgery (VATS)
represents an important element of enhanced recovery program in thoracic
surgery as it can achieve most of its goals. Anaesthetic management during
preoperative, intraoperative and postoperative period is essential for the
establishment of a successful enhanced recovery program. In the era of
enhanced recovery protocols, non-intubated thoracoscopic procedures
present a step forward. This article focuses on the key anaesthetic
elements of the enhanced recovery program during all phases of
thoracoscopic surgery. Having reviewed recent literature, a systematic
review of literature will highlight successful ERAS protocols published
for thoracoscopic surgery.<br/>Copyright &#xa9; 2021. Published by
Elsevier Masson SAS.

<13>
Accession Number
634676627
Title
Navigating Inferior Vena Cava Filters in Invasive Cardiology Procedures: A
Systematic Review.
Source
Journal of cardiovascular electrophysiology. (no pagination), 2021. Date
of Publication: 26 Mar 2021.
Author
Shah K.; Patel S.; Hanson I.; Williamson B.; Kutinsky I.; Dixon S.; Haines
D.; Mehta N.
Institution
(Shah, Hanson, Williamson, Kutinsky, Dixon, Haines, Mehta) Department of
Cardiovascular Medicine, Beaumont Hospital, Oakland University William
Beaumont School of Medicine, Royal Oak, MI
(Patel) Department of Cardiovascular Medicine, Henry Ford Hospital,
Detroit, MI, United States
(Mehta) Department of Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transfemoral venous access (TFV) is the cornerstone of
minimally invasive cardiac procedures. Although the presence of inferior
vena cava filters (IVCF) was considered a relative contraindication to TFV
procedures, small experiences have suggested safety. We conducted a
systematic review of the available literature on cardiac procedural
success of TFV with IVCF in-situ. <br/>METHOD(S): Two independent
reviewers searched PubMed, EMBASE, SCOPUS and Google Scholar from
inception to October 2020 for studies that reported outcomes in patients
with IVCFs undergoing TFV for invasive cardiac procedures. We investigated
a primary outcome of acute procedural success and reviewed the pooled data
for patient demographics, procedural complications, types of IVCF, IVCF
dwell time and procedural specifics. <br/>RESULT(S): Of the 120 studies
initially screened, 8 studies were used in the final analysis with a total
of 100 patients who underwent 110 procedures. The most common IVCF was the
Greenfield Filter (36%), 60% of patients were males and the mean age was
67.8 years. The overall pooled incidence of acute procedural success was
95.45% (95% confidence interval 89.54. - 98.1) with no heterogeneity (I2 =
0%, p = 1) and there were no reported filter related complications.
<br/>CONCLUSION(S): This systematic review is the largest study of its
kind to demonstrate the safety and feasibility of TFV access in a variety
of cardiac procedures in the presence of IVCF. This article is protected
by copyright. All rights reserved.

<14>
Accession Number
2004664348
Title
Cost-Effectiveness of Transcatheter Aortic Valve Intervention (TAVI)
Compared to Surgical Aortic Valve Replacement (SAVR) in Low- to
Intermediate-Surgical-Risk Patients.
Source
Cardiovascular Revascularization Medicine. 21 (9) (pp 1164-1168), 2020.
Date of Publication: September 2020.
Author
Azraai M.; Gao L.; Ajani A.E.
Institution
(Azraai, Ajani) Royal Melbourne Hospital, Melbourne, Australia
(Azraai, Ajani) University of Melbourne, Melbourne, Australia
(Gao) Deakin University, Melbourne, Australia
(Ajani) NHMRC Centre of Clinical Research Excellence in Therapeutics,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
Publisher
Elsevier Inc.
Abstract
Introduction: Transcatheter aortic valve intervention (TAVI) is known to
be non-inferior to surgical aortic valve replacement (SAVR) in
low-intermediate surgical risk patients. This present systematic review
was conducted to analyse the cost-effectiveness of TAVI in this patient
population. <br/>Method(s): Four electronic databases from January 2010 to
November 2019 were used to identify relevant cost-effectiveness studies of
TAVI versus SAVR in low-intermediate risk patients. The primary endpoints
were the incremental cost-effectiveness ratio (ICER) and the probability
of cost effectiveness. The eligible studies for the present systematic
review included those in which the cost-effectiveness data were measured
or projected for TAVI and SAVR. <br/>Result(s): Eight studies were
included in this review, where six studies involved intermediate risk
patients and two studies with low risk patients. The reported ICER for
TAVI compared to SAVR in low-intermediate risk patients were below the
ICER threshold of acceptability in all studies. The probability of TAVI
being cost-effective compared to SAVR ranged from 78%-97%.
<br/>Conclusion(s): TAVI is likely to be a cost-effective alternative to
SAVR in low-intermediate risk patients. More studies on low risk patients
is needed.<br/>Copyright &#xa9; 2020

<15>
Accession Number
634510332
Title
The history of light therapy in hospital physiotherapy and medicine with
emphasis on Australia: Evolution into novel areas of practice.
Source
Physiotherapy theory and practice. 37 (3) (pp 389-400), 2021. Date of
Publication: 01 Mar 2021.
Author
Liebert A.; Kiat H.
Institution
(Liebert) Fox Valley Medical Centre, NSW, Australia
(Kiat) Cardiac Health Institute Wahroonga, Sydney Adventist Hospital, NSW,
Australia
Publisher
NLM (Medline)
Abstract
Objective: The objective of this narrative review was to investigate the
history of light therapy in hospital settings, with reference to
physiotherapy and particularly in an Australian context.Types of articles
and search method:a review of available literature was conducted on
PubMed, Medline and Google Scholar using keywords light therapy,
photobiomodulation, physiotherapy, low-level laser, heliotherapy.
Physiotherapy textbooks from Sydney University Library were searched.
Historical records were accessed from the San Hospital library. Interviews
were conducted with the San Hospital Chief Librarian and a retired former
Head Physiotherapist from Royal Prince Alfred Hospital. <br/>Summary:
Historically, light treatment has been used in both medical and
physiotherapy practice. From its roots in ancient Egypt, India, and
Greece, through to medieval times, the modern renaissance in 'light as
therapy ' was begun by Florence Nightingale who, in the 1850s, advocated
the use of clean air and an abundance of sunlight to restore health.
Modern light therapy (phototherapy) had a marked uptake in use in medicine
in Scandinavia, America, and Australia from 1903, following the pioneering
work of Niels Finsen in the late 19th century, which culminated in Dr
Finsen receiving the Nobel Prize for Medicine for the treatment of
tuberculosis scarring with ultraviolet (UV) light, and treatment of
smallpox scarring with red light. Treatment with light, especially UVB
light, has been widely applied by physiotherapists in hospitals for
dermatological conditions since the 1950s, particularly in Australia,
Scandinavia, USA, England and Canada. In parallel, light treatment in
hospitals for hyperbilirubinemia was used for neonatal jaundice. Since the
1980s light was also used in the medical specialties of ophthalmology,
dermatology, and cardiology. In more recent years in physiotherapy, light
was mostly used as an adjunct to the management of
orthopedic/rheumatological conditions. Since the 1990s, there has been
global use of light, in the form of photobiomodulation for the management
of lymphedema, including in supportive cancer care. Photobiomodulation in
the form of low-level laser has been used by physiotherapists and pain
doctors since the 1990s in the management of chronic pain. The use of
light as therapy is exemplified by its use in the San Hospital in Sydney,
where light therapy was introduced in 1903 (after Dr. John Harvey Kellogg
visited Niels Finsen in Denmark) and is practiced by nurses,
physiotherapists and doctors until the present day. The use of light has
expanded into new and exciting practices including supportive cancer care,
and treatment of depression, oral mucositis, retinopathy of prematurity,
and cardiac surgery complications. Light is also being used in the
treatment of neurological diseases, such as Parkinson's disease, traumatic
brain injury, and multiple sclerosis. The innovative uses of light in
physiotherapy treatment would not be possible without the previous
experience of successful application of light treatment.
<br/>Conclusion(s): Light therapy has had a long tradition in medicine and
physiotherapy. Although it has fallen somewhat out of favour over the past
decades, there has been a renewed interest using modern techniques in
recent times. There has been continuous use of light as a therapy in
hospitals in Australia, most particularly the San Hospital in Sydney where
it has been in use for almost 120 years.

<16>
Accession Number
2011411474
Title
Oral Pregabalin in Cardiac Surgery: A Systematic Review and Meta-Analysis
of Randomized Controlled Trials.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
8835891. Date of Publication: 2021.
Author
Wang X.-X.; Dai J.; Hu X.-G.; Zhou A.-G.; Pan D.-B.
Institution
(Wang, Dai, Zhou, Pan) Department of Anesthesiology, First People's
Hospital of Changde City, Changde, Hunan, China
(Hu) Department of Anesthesiology, Taoyuan County People's Hospital,
Changde, Hunan, China
Publisher
Hindawi Limited
Abstract
Background. Pregabalin has received wide clinical attention as a new type
of analgesic. We undertake a systematic review and meta-analysis to
evaluate the effect of pregabalin on postoperative pain in patients
undergoing cardiac surgery. Methods. We searched PubMed, Embase, and
Cochrane Library (from inception to July 2020) for eligible studies. The
primary outcomes were the total morphine consumption at 24 h. A secondary
outcome was intraoperative fentanyl consumption, extubation time
postoperative, and length of stay in hospital. We calculated pooled
weighted mean difference (WMD) or odds ratio (OR) and 95% CIs using
random- or fixed-effects models. Results. Seven trials involving 463
patients were listed. Meta-analysis showed that the total morphine
consumption at 24 h in the pregabalin group was significantly less than
the control group (WMD: -5.44, 95% CI: -10.42-0.46, P=0.03). We found that
there is no significant difference between the two groups in
intraoperative fentanyl consumption. Compared with the control group, the
length of stay in hospital in the pregabalin group was significantly
shorter (WMD = -0.87, 95% CI: -1.42-0.32, P=0.002). And we found that
there were no significant differences between the two groups in extubation
time (WMD: 17.24, 95% CI: -24.36-58.84, P=0.42). Conclusions. Oral
pregabalin for cardiac surgery patients can effectively reduce the
patient's 24-hour morphine consumption after surgery, shorten the
patient's hospital stay, and is more conducive to early postoperative
recovery. <br/>Copyright &#xa9; 2021 Xian-xue Wang et al.

<17>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9;
2021, The Author(s), under exclusive licence to Springer-Verlag GmbH
Germany, part of Springer Nature.

<18>
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). <br/>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). <br/>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.
<br/>Conclusion(s): Absence of ECG LVH was associated with poor outcome in
patients undergoing TAVR.<br/>Copyright &#xa9; 2021 The Authors. Journal
of Cardiac Surgery published by Wiley Periodicals LLC

<19>
[Use Link to view the full text]
Accession Number
634665027
Title
Approach to stable angina in patients with advanced chronic kidney
disease.
Source
Current opinion in nephrology and hypertension. 30 (3) (pp 339-345), 2021.
Date of Publication: 01 May 2021.
Author
Arif H.; Yadav A.
Institution
(Arif) Division of Nephrology, Sidney Kimmel Medical School at Thomas
Jefferson University, Philadelphia, PA, United States
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Chronic kidney disease is one of the major risk factors
for coronary artery disease. Both end-stage renal disease (ESRD) and
advanced chronic kidney disease patients have atypical presentations of
coronary artery disease (CAD) due to modifications in cardinal symptoms
and clinical presentation. Data on evaluation and management of coronary
artery or stable angina is limited in advanced chronic kidney disease
(CKD) patients due to a limited number of trials. There are sparse data
supporting either percutaneous coronary intervention (PCI) or coronary
artery bypass graft in advanced CKD patients. RECENT FINDINGS: The
ISCHEMIA-CKD trial to date is the most extensive prospective randomized
study looking at advanced CKD patients study looking at advanced CKD stage
4/5 patients randomized to medical treatment alone vs. invasive strategy
for moderate to severe myocardial ischemia. There was no evidence found
that an initial invasive strategy compared with conservative strategy with
maximal medical management resulted in reduced risk of death or nonfatal
myocardial infarction in patients with advanced CKD and coronary artery
disease with stable angina. SUMMARY: In this review, we will discuss the
existing data on assessment and management of stable coronary artery
disease/stable angina. And how this extrapolates to the application in
advanced CKD patients awaiting kidney transplant.<br/>Copyright &#xa9;
2021 Wolters Kluwer Health, Inc. All rights reserved.

<20>
Accession Number
634662399
Title
Effects of three pulmonary ventilation regimes in patients undergoing
coronary artery bypass graft surgery: a randomized clinical trial.
Source
Scientific reports. 11 (1) (pp 6730), 2021. Date of Publication: 24 Mar
2021.
Author
Amin R.; Alaparthi G.K.; Samuel S.R.; Bairapareddy K.C.; Raghavan H.;
Vaishali K.
Institution
(Amin, Samuel) Department of Physiotherapy, Kasturba Medical College,
Manipal Academy of Higher Education, Mangalore 575004, India
(Alaparthi, Bairapareddy) Department of Physiotherapy, College of Health
Sciences, University of Sharjah, Sharjah, United Arab Emirates
(Raghavan) Department of Cardiothoracic Surgery, Kasturba Medical
Hospital, Mangalore 575004, India
(Vaishali) Department of Physiotherapy, Manipal College of Health
Professions, Manipal Academy of Higher Education, Manipal 576104, India
Publisher
NLM (Medline)
Abstract
The aim was to compare the effect of diaphragmatic breathing exercise
(DBE), flow- (FIS) and volume-oriented incentive spirometry (VIS) on
pulmonary function- (PFT), functional capacity-6-Minute Walk Test (6 MWT)
and Functional Difficulties Questionnaire (FDQ) in subjects undergoing
Coronary Artery Bypass Graft surgery (CABG). The purpose of incorporating
pulmonary ventilator regimes is to improve ventilation and avoid
post-operative pulmonary complications. CABG patients (n=72) were
allocated to FIS, VIS and DBE groups (n=24 each) by block randomization.
Preoperative and postoperative values for PFT were taken until day 7 for
all three groups. On 7th postoperative day, 6 MWT and FDQ was analyzed
using ANOVA and post-hoc analysis. PFT values were found to be decreased
on postoperative day 1(Forced Vital Capacity (FVC)=FIS group-65%, VIS
group-47%, DBE group-68%) compared to preoperative day (p<0.001). PFT
values for all 3 groups recovered until postoperative day 7 (FVC=FIS
group-67%, VIS group-95%, DBE group-59%) but was found to reach the
baseline in VIS group (p<0.001). When compared between 3 groups,
statistically significant improvement was observed in VIS group (p<0.001)
in 6 MWT and FDQ assessment. In conclusion, VIS was proven to be more
beneficial in improving the pulmonary function (FVC), functional capacity
and FDQ when compared to FIS and DBE.

<21>
Accession Number
2011564158
Title
The EXCEL trial: The interventionalists' perspective.
Source
European Cardiology Review. 16 (no pagination), 2021. Article Number: e01.
Date of Publication: March 2021.
Author
Hunter G.W.; Sharma V.; Varma C.; Connolly D.
Institution
(Hunter, Sharma, Varma, Connolly) Department of Cardiology, Sandwell and
West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
Publisher
Radcliffe Cardiology
Abstract
Left main stem (LMS) disease is identified in up to 5% of diagnostic
angiography cases, and is associated with significant morbidity and
mortality due to the proportion of myocardium it subtends. In the past 10
years, there has been a significant change in the way we contemplate
treating lesions in the LMS due to evolving experience and evidence in
percutaneous coronary intervention (PCI) strategies and technologies. This
has been reflected in recent changes in European and International
guidance on managing patients with this lesion subset. Here, the authors
provide an overview of the current literature regarding the management of
LMS disease using PCI in light of new developments and emerging concepts
in this field, specifically looking at the recent EXCEL
trial.<br/>Copyright &#xa9; Open Access: This work is open access under
the CC-BY-NC 4.0 License which allows users to copy, redistribute and make
derivative works for non-commercial purposes, provided the original work
is cited correctly.

<22>
Accession Number
2011548646
Title
Minimally invasive aortic valve surgery.
Source
Journal of Thoracic Disease. 13 (3) (pp 1945-1959), 2021. Date of
Publication: March 2021.
Author
Di Bacco L.; Miceli A.; Glauber M.
Institution
(Di Bacco, Miceli, Glauber) U.O. Cardiochirurgia Mininvasiva, Istituto
Clinico sant'Ambrogio, Gruppo San Donato, Milano, Italy
Publisher
AME Publishing Company
Abstract
Since their introduction, it has been demonstrated that minimally invasive
aortic valve replacement (MIAVR) approaches are safe and effective for the
treatment of aortic valve diseases. To date, the main advantage of these
approaches is represented by the reduced surgical trauma, with a
subsequent reduced complication rate and faster recovery. This makes such
approaches an appealing choice also for frail patients [obese, aged,
chronic obstructive pulmonary disease (COPD)]. The standardization of the
minimally invasive techniques, together with the implementation of
preoperative workup and anesthesiological intra-and post-operative care,
led to an amelioration of surgical results and reduction of surgical
times. Moreover, the improvement of surgical technology and the
introduction of new devices such as sutureless and rapid deployment (SURD)
valves, has helped the achievement of comparable results to traditional
surgery. However, transcatheter technologies are nowadays more and more
important in the treatment of aortic valve disease, also in low risk
patients. For this reason surgeons should put new efforts for further
reducing the surgical trauma in the future, even taking inspiration from
other disciplines. In this review, we aim to present a review of
literature evidences regarding minimally invasive treatment of aortic
diseases, also reflecting our personal experience with MIAVR techniques.
This review could represent a tool for a well-structured patient
assessment and preoperative planning, in order to safely carrying out an
MIAVR procedure with satisfactory outcomes.<br/>Copyright &#xa9; Journal
of Thoracic Disease. All rights reserved.

<23>
Accession Number
2011548644
Title
From less invasive to minimal invasive extracorporeal circulation.
Source
Journal of Thoracic Disease. 13 (3) (pp 1909-1921), 2021. Date of
Publication: March 2021.
Author
Anastasiadis K.; Antonitsis P.; Deliopoulos A.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Deliopoulos, Argiriadou) Cardiothoracic
Department, AHEPA University Hospital, Thessaloniki, Greece
Publisher
AME Publishing Company
Abstract
Development of minimally invasive cardiac surgery (MICS) served the
purpose of performing surgery while avoiding the surgical stress triggered
by a full median sternotomy. Minimizing surgical trauma is associated with
improved cosmesis and enhanced recovery leading to reduced morbidity.
However, it has to be primarily appreciated that the extracorporeal
circulation (ECC) stands for the basis of nearly all MICS procedures. With
some fundamental modification and advancement in perfusion techniques, the
use of ECC has become the enabling technology for the development of MICS.
Less invasive cardiopulmonary bypass (CPB) techniques are based on remote
cannulation and optimization of perfusion techniques with assisted venous
drainage and use of centrifugal pump, so as to facilitate the demanding
surgical maneuvers, rather than minimizing the invasiveness of the CPB.
This is reflected in the increased duration of CPB required for MICS
procedures. Minimal invasive Extracorporeal Circulation (MiECC) represents
a major breakthrough in perfusion. It integrates all contemporary
technological advancements that facilitate best applying cardiovascular
physiology to intraoperative perfusion. Consequently, MiECC use translates
to improved end-organ protection and clinical outcome, as evidenced in
multiple clinical trials and meta-analyses. MICS performed with MiECC
provides the basis for developing a multidisciplinary intraoperative
strategy towards a "more physiologic"cardiac surgery by combining small
surgical trauma with minimum body's physiology derangement. Integration of
MiECC can advance MICS from non-full sternotomy for selected patients to a
"more physiologic"surgery, which represents the real face of modern
cardiac surgery in the transcatheter era.<br/>Copyright &#xa9; Journal of
Thoracic Disease. All rights reserved.

<24>
Accession Number
2011548643
Title
Endoscopic vein harvesting.
Source
Journal of Thoracic Disease. 13 (3) (pp 1899-1908), 2021. Date of
Publication: March 2021.
Author
Akowuah E.; Burns D.; Zacharias J.; Kirmani B.H.
Institution
(Akowuah) Department of Cardiac Surgery, James Cook University Hospital,
South Tees NHS, Foundation Trust, Middlesbrough, United Kingdom
(Burns, Kirmani) Department of Cardiac Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Zacharias) Department of Cardiothoracic Surgery, Blackpool Victoria
Hospital, Blackpool, United Kingdom
Publisher
AME Publishing Company
Abstract
Coronary artery bypass grafting is the most common cardiac surgical
procedure performed worldwide and the long saphenous vein the most common
conduit for this. When performed as an open vein harvest (OVH), the
incision on each leg can be up to 85cm long, making it the longest
incision of any routine procedure. This confers a high degree of morbidity
to the procedure. Endoscopic vein harvest (EVH) methods were popularised
over two decades ago, demonstrating significant benefits over OVH in terms
of leg wound complications including surgical site infections. They also
appeared to hasten return to usual activities and wound healing and became
popular particularly in North America. Subgroup analyses of two trials
designed for other purposes created a period of uncertainty between
2009-2013 while the impact of endoscopic vein harvesting on vein graft
patency and major adverse cardiac events was scrutinised. Large
observational studies debunked the findings of increased mortality in the
short-term, allowing practitioners and governing bodies to regain some
confidence in the procedure. A well designed, adequately powered,
randomised controlled trial published in 2019 also definitively
demonstrated that there was no increase in death, myocardial infarction or
repeat revascularisation with endoscopic vein harvest. Endoscopic vein
harvest is a Class IIa indication in European Association of
Cardio-Thoracic Surgery (EACTS) and a Class I indication in International
Society of Minimally Invasive Cardiac Surgery (ISMICS)
guidelines.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<25>
Accession Number
2011548625
Title
Aspirin plus ticagrelor or clopidogrel on graft patency one year after
coronary bypass grafting: A single-center, randomized, controlled trial.
Source
Journal of Thoracic Disease. 13 (3) (pp 1697-1705), 2021. Date of
Publication: March 2021.
Author
Tang Y.; Fan X.; Zhang B.; Zhang J.; Xue Q.; Xu Z.; Han L.
Institution
(Tang, Fan, Zhang, Zhang, Xue, Xu, Han) Department of Cardiothoracic
Surgery, Changhai Hospital, The Second Military Medical University,
Shanghai, China
Publisher
AME Publishing Company
Abstract
Background: Dual antiplatelet therapy (DAPT) improves early post-operative
graft patency, but the optimal DAPT strategy for the patients after
coronary artery bypass grafting (CABG) has not been confirmed. We sought
to evaluate the effect of aspirin plus ticagrelor versus aspirin plus
clopidogrel on saphenous vein graft (SVG) patency within 1 year after
CABG. <br/>Method(s): Between October 2017 and December 2018, 147
consecutive patients undergoing elective CABG at Changhai Hospital were
randomized into two groups: group AT, receiving aspirin 100 mg/d plus
ticagrelor 2x90 mg/d; group AC, receiving aspirin 100 mg/d plus
clopidogrel 75 mg/d. Both DAPTs should be administered within 24 h when
clinical stability was ensured. 64-multislice computed tomography
angiography (MSCTA) was used to assess the graft patency at 12 months
after CABG.CYP2C19 gene variants were measured to assess the clopidogrel
efficacy on graft patency. <br/>Result(s): Among the 147 participants who
completed the study, one (0.7%) patient from the AC group died at 5 weeks
after surgery due to severe infection. All other patients were treated
with DAPT for 12 months and underwent 64-MSCTA according to schedule.
There were no significant differences in pre-operative characteristics and
intraoperative transit-time flow measurement findings between the two
groups. Besides, no significant differences in the incidence of major
adverse cardiac events (MACEs) and major bleeding were observed. A
64-MSCTA showed that SVG patency was 91.0% (141 of 155) in the AT group
and 89.9% (161 of 179) in the AC group (P=0.751). No significant
associations were found between different CYP2C19 genotypes and SVG
patency (P>0.05). <br/>Conclusion(s): Either aspirin plus ticagrelor or
aspirin plus clopidogrel can maintain a fairly high graft patency rate in
the early phase after CABG, regardless of CYP2C19 genotypes.
<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights reserved.

<26>
Accession Number
2011548623
Title
Minimally-invasive versus transcatheter aortic valve implantation:
Systematic review with meta-analysis of propensity-matched studies.
Source
Journal of Thoracic Disease. 13 (3) (pp 1671-1683), 2021. Date of
Publication: March 2021.
Author
Doyle M.P.; Woldendorp K.; Ng M.; Vallely M.P.; Wilson M.K.; Yan T.D.;
Bannon P.G.
Institution
(Doyle, Woldendorp, Ng, Yan, Bannon) The Royal Prince Alfred Hospital,
Sydney, Australia
(Doyle, Woldendorp, Bannon) The Baird Institute of Applied Heart and Lung
Surgical Research, Sydney, Australia
(Doyle) University of Wollongong School of Medicine, Keiraville, Australia
(Woldendorp, Ng, Bannon) The University of Sydney Medical School,
Camperdown, Australia
(Vallely) Ohio State University Wexner Medical Centre, Columbus, United
States
(Wilson, Yan) Macquarie University Hospital, Macquarie University, Sydney,
Australia
(Yan) Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
Publisher
AME Publishing Company
Abstract
Background: Minimally invasive aortic valve replacement (MiAVR) and
transcatheter aortic valve implantation (TAVI) provide aortic valve
replacement (AVR) by less invasive methods than conventional surgical AVR,
by avoiding complete sternotomy. This study directly compares and analyses
the available evidence for early outcomes between these two AVR methods.
<br/>Method(s): Electronic databases were searched from inception until
August 2019 for studies comparing MiAVR to TAVI, according to predefined
search criteria. Propensity-matched studies with sufficient data were
included in a meta-analysis. <br/>Result(s): Eight studies with 9,744
patients were included in the quantitative analysis. Analysis of
riskmatched patients showed no difference in early mortality (RR 0.76, 95%
CI, 0.37-1.54, P=0.44). MiAVR had a signal towards lower rate of
postoperative stroke, although this did not reach statistical significance
(OR 0.42, 95% CI, 0.13-1.29, P=0.13). MiAVR had significantly lower rates
of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16-0.52, P<0.0001)
and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR
0.05, 95% CI, 0.01-0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI,
0.13-1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR
compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25-4.16, P=0.007).
<br/>Conclusion(s): In patients of equivalent surgical risk scores, MiAVR
may be performed with lower rates of postoperative PPM requirement and
AI/PVL, higher rates of AKI and no statistical difference in postoperative
stroke or short-term mortality, compared to TAVI. Further prospective
trials are needed to validate these results. <br/>Copyright &#xa9; Journal
of Thoracic Disease. All rights reserved.

<27>
Accession Number
2011548619
Title
A comparison of non-intubated video-assisted thoracic surgery with
spontaneous ventilation and intubated video-assisted thoracic surgery: A
meta-analysis based on 14 randomized controlled trials.
Source
Journal of Thoracic Disease. 13 (3) (pp 1624-1640), 2021. Date of
Publication: March 2021.
Author
Zhang X.-X.; Song C.-T.; Gao Z.; Zhou B.; Wang H.-B.; Gong Q.; Li B.; Guo
Q.; Li H.-F.
Institution
(Zhang, Song, Gao, Zhou, Wang, Gong, Li, Guo, Li) Department of Thoracic
Surgery, Affiliated Hospital of Hebei University, Baoding, China
Publisher
AME Publishing Company
Abstract
Background: Video-assisted thoracic surgery (VATS) generally involves
endotracheal intubation under general anesthesia. However, inevitably,
this may cause intubation-related complications and prolong the
postoperative recovery process. Gradually, non-intubated video-assisted
thoracic surgery (NIVATS) is increasingly being utilized. However, its
safety and efficacy remain controversial. <br/>Method(s): Randomized
controlled trials (RCTs) published up to August 2020 were selected from
the Cochrane Library, Web of Science, PubMed, Embase, and
ClinicalTrials.gov databases and included in this study according to the
inclusion criteria. Two reviewers screened these RCTs and independently
extracted the relevant data. After assessing the risk of bias in these
RCTs, a meta-analysis was performed using Review Manager 5.3. Pooled data
were meta-analyzed using a random-effects model. <br/>Result(s):
Meta-analysis data demonstrated that the mean difference (MD) in the
length of hospital stay between non-intubated patients and intubated
patients was -1.41 days, with a 95% confidence interval (CI) of -2.47 to
-0.34 (P=0.01). The visual analogue scale (VAS) score between the two
groups showed a MD of -0.34 (95% CI: -0.58 to -0.10; P=0.006). Patients
who underwent NIVATS presented with lower rates of overall complications
[odds ratio (OR) 0.41; 95% CI: 0.25 to 0.67; P=0.0004], air leak (OR 0.45;
95% CI: 0.24 to 0.87; P=0.02), pharyngeal discomfort (OR 0.08; 95% CI:
0.04 to 0.17; P<0.00001), hoarseness (OR 0.06; 95% CI: 0.02 to 0.21;
P<0.00001), and gastrointestinal reactions (OR 0.23; 95% CI: 0.10 to 0.53;
P=0.0005) compared to intubated patients. The anesthesia satisfaction
scores in the NIVATS group were significantly higher than those of the
VATS group (MD 0.50; 95% CI: 0.12 to 0.88; P=0.009). However, there were
no statistically significant differences in the length of operation time
(MD 0.90 hours; 95% CI: -0.23 to 2.03; P=0.12) and surgical field
satisfaction (1 point) (OR 0.73; 95% CI: 0.34 to 1.59; P=0.43) between the
two groups. <br/>Conclusion(s): NIVATS is a safe and feasible form of
intervention that can reduce the postoperative pain and complications of
various systems and shorten hospital stay duration without prolonging the
operation time.<br/>Copyright &#xa9; 2021 AME Publishing Company. All
rights reserved.

<28>
Accession Number
2011555600
Title
Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus
On-Pump Techniques in a Large Cohort of Patients.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Tzoumas A.; Giannopoulos S.; Kakargias F.; Kokkinidis D.G.; Giannakoulas
G.; Faillace R.T.; Bakoyiannis C.; Doulamis I.P.; Avgerinos D.V.
Institution
(Tzoumas, Kakargias) Aristotle University of Thessaloniki, Thessaloniki,
Greece
(Giannopoulos) Division of Cardiology, Rocky Mountain Regional VA Medical
Center, University of Colorado, Denver, CO, United States
(Kokkinidis, Faillace) Department of Medicine, Jacobi Medical Center,
Albert Einstein College of Medicine, Bronx, NY, United States
(Giannakoulas) Department of Cardiology, Aristotle University of
Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
(Bakoyiannis) First Department of Surgery, National and Kapodistrian
University of Athens, Laikon General Hospital, Athens, Greece
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian, New York, NY, United States
Publisher
Elsevier Ltd
Abstract
Background: Redo coronary artery bypass grafting (CABG) can be performed
with either the off-pump (OPCAB) or the on-pump (ONCAB) technique.
<br/>Method(s): Following the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety
and efficacy of OPCAB versus ONCAB redo CABG. <br/>Result(s): Twenty-three
(23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245).
Off-pump CABG significantly reduced the risk of perioperative death
(defined as in-hospital or 30-day death rate), myocardial infarction,
atrial fibrillation, and acute kidney injury. The two treatment approaches
were comparable regarding 30-day stroke and late all-cause mortality.
<br/>Conclusion(s): Off-pump redo CABG resulted in lower perioperative
death and periprocedural complication rates. No difference was observed in
perioperative stroke rates and long-term survival between the two
techniques.<br/>Copyright &#xa9; 2021 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<29>
Accession Number
2011452014
Title
Atrial Fibrillation and Outcomes After Transcatheter or Surgical Aortic
Valve Replacement (from the PARTNER 3 Trial).
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Shahim B.; Malaisrie S.C.; George I.; Thourani V.H.; Biviano A.B.; Russo
M.J.; Brown D.L.; Babaliaros V.; Guyton R.A.; Kodali S.K.; Nazif T.M.;
McCabe J.M.; Williams M.R.; Genereux P.; Lu M.; Yu X.; Alu M.C.; Webb
J.G.; Mack M.J.; Leon M.B.; Kosmidou I.
Institution
(Shahim, Alu, Leon, Kosmidou) Cardiovascular Research Foundation, New
York, NY, United States
(Malaisrie) Division of Cardiac Surgery, Northwestern University, Chicago,
IL, United States
(George, Biviano, Kodali, Nazif, Alu, Leon, Kosmidou) NewYork-Presbyterian
Hospital/Columbia University Irving Medical Center, New York, NY, United
States
(Thourani) Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta,
Georgia, United States
(Russo) Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical
School, New Brunswick, NJ, United States
(Brown, Mack) Baylor Scott & White Health, Plano, TX, United States
(Babaliaros, Guyton) Emory University Medical Center, Atlanta, Georgia,
United States
(McCabe) University of Washington, Seattle, WA, United States
(Williams) NYU Langone, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Lu, Yu) Edwards Lifesciences, Irvine, CA, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
Publisher
Elsevier Inc.
Abstract
The prognostic impact of preexisting atrial fibrillation or flutter (AF)
in low-risk patients with severe aortic stenosis treated with
transcatheter (TAVR) or surgical aortic valve replacement (SAVR) remains
unknown. In this sub-analysis of the PARTNER 3 trial of patients with
severe aortic stenosis at low surgical risk randomized 1:1 to TAVR versus
SAVR, clinical outcomes were analyzed at 2 years according to AF status.
Among 948 patients included in the analysis (452 [47.7%] in the SAVR vs
496 [52.3%] in the TAVR arm), 168 (17.6%) patients had AF [88/452 (19.5%)
and 80/496 (16.1%) treated with SAVR and TAVR, respectively]. At 2 years,
patients with AF had higher unadjusted rates of the composite outcome of
death, stroke or rehospitalization (21.2% vs 12.9%, p = 0.007) and
rehospitalization alone (15.3% vs 9.4%, p = 0.03) but not all cause death
(3.8% vs 2.6%, p = 0.45) or stroke (4.8% vs 2.6%, p = 0.12). In adjusted
analyses, patients with AF had a higher risk for the composite outcome of
death, stroke or rehospitalization (hazard ratio [HR] 1.80, 95% confidence
interval [CI] 1.20-2.71, p = 0.0046) and rehospitalization alone (HR 1.8,
95% CI 0.12-2.9, p = 0.015), but not death or stroke. There was no
interaction between treatment modality and AF on the composite outcome
(Pinter = 0.83). In conclusion, preexisting AF in patients with severe AS
at low surgical risk was associated with increased risk of the composite
outcome of death, stroke or rehospitalization at 2 years, irrespective of
treatment modality.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<30>
Accession Number
634667273
Title
Efficacy and safety of low-dose colchicine in patients with coronary
disease: a systematic review and meta-analysis of randomized trials.
Source
European heart journal. (no pagination), 2021. Date of Publication: 26 Mar
2021.
Author
Fiolet A.T.L.; Opstal T.S.J.; Mosterd A.; Eikelboom J.W.; Jolly S.S.;
Keech A.C.; Kelly P.; Tong D.C.; Layland J.; Nidorf S.M.; Thompson P.L.;
Budgeon C.; Tijssen J.G.P.; Cornel J.H.
Institution
(Fiolet) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Fiolet, Mosterd, Cornel) Dutch Network for Cardiovascular Research (WCN),
Utrecht, Netherlands
(Opstal, Cornel) Department of Cardiology, Northwest Clinics, Alkmaar,
Netherlands
(Opstal, Cornel) Department of Cardiology, Radboud University Medical
Centre, Nijmegen, Netherlands
(Mosterd) Department of Cardiology, Meander Medical Centre, Amersfoort,
Netherlands
(Mosterd) Julius Centre for Health Sciences and Primary Care, Utrecht
University Medical Centre, Utrecht, Netherlands
(Eikelboom) Department of Medicine, McMaster University, ON, Hamilton,
Canada
(Jolly) Division of Cardiology, Department of Medicine, Population Health
Research Institute, McMaster University, ON, Hamilton, Canada
(Keech) Sydney Medical School, National Health and Medical Research
Council (NHMRC) Clinical Trials Centre, University of Sydney, Australia
(Kelly) Mater University and Health Research Board (HRB) Stroke Clinical
Trials Network Ireland, University College Dublin, Ireland
(Tong, Layland) Department of Medicine, St. Vincent's Hospital Melbourne,
VIC, Australia
(Tong, Layland) Department of Cardiology, St. Vincent's Hospital
Melbourne, VIC, Australia
(Layland) Peninsula Clinical School, Central Clinical School, Monash
University, VIC, Australia
(Nidorf, Thompson) Heart and Vascular Research Institute of Western
Australia, Perth, Australia
(Nidorf) GenesisCare Western Australia, Perth, Australia
(Thompson) Sir Charles Gairdner Hospital, Perth, Australia
(Thompson, Budgeon) School of Population and Global Health, University of
Western Australia, Perth, Australia
(Tijssen) Department of Cardiology, Amsterdam University Medical Centre,
Amsterdam, Netherlands
(Tijssen) Cardialysis BV, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Recent randomized trials demonstrated a benefit of low-dose
colchicine added to guideline-based treatment in patients with recent
myocardial infarction or chronic coronary disease. We performed a
systematic review and meta-analysis to obtain best estimates of the
effects of colchicine on major adverse cardiovascular events (MACE).
METHODS AND RESULTS: We searched the literature for randomized clinical
trials of long-term colchicine in patients with atherosclerosis published
up to 1 September 2020. The primary efficacy endpoint was MACE, the
composite of myocardial infarction, stroke, or cardiovascular death. We
combined the results of five trials that included 11 816 patients. The
primary endpoint occurred in 578 patients. Colchicine reduced the risk for
the primary endpoint by 25% [relative risk (RR) 0.75, 95% confidence
interval (CI) 0.61-0.92; P=0.005], myocardial infarction by 22% (RR 0.78,
95% CI 0.64-0.94; P=0.010), stroke by 46% (RR 0.54, 95% CI 0.34-0.86;
P=0.009), and coronary revascularization by 23% (RR 0.77, 95% CI
0.66-0.90; P<0.001). We observed no difference in all-cause death (RR
1.08, 95% CI 0.71-1.62; P=0.73), with a lower incidence of cardiovascular
death (RR 0.82, 95% CI 0.55-1.23; P=0.34) counterbalanced by a higher
incidence of non-cardiovascular death (RR 1.38, 95% CI 0.99-1.92;
P=0.060). <br/>CONCLUSION(S): Our meta-analysis indicates that low-dose
colchicine reduced the risk of MACE as well as that of myocardial
infarction, stroke, and the need for coronary revascularization in a broad
spectrum of patients with coronary disease. There was no difference in
all-cause mortality and fewer cardiovascular deaths were counterbalanced
by more non-cardiovascular deaths.<br/>Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2021. For permissions, please email:
journals.permissions@oup.com.

<31>
Accession Number
634660836
Title
Design and Rationale of The Randomized Trial of Comprehensive LifEstyle
ModificatioN, Optimal Pharmacological Treatment and Utilizing PET Imaging
for Quantifying and Managing Stable CoronaRy ArterY Disease (The CENTURY
Study).
Source
American heart journal. (no pagination), 2021. Date of Publication: 21 Mar
2021.
Author
Kitkungvan D.; Johnson N.P.; Kirkeeide R.; Haynie M.; Carter C.; Patel
M.B.; Bui L.; Madjid M.; Mendoza P.; Roby A.E.; Hood S.; Zhu H.; Lai D.;
Sdringola S.; Gould K.L.
Institution
(Kitkungvan, Bui, Madjid) Division of Cardiology, McGovern Medical School,
University of Texas, Houston
(Johnson) Weatherhead Distinguished Chair of Heart Disease, Division of
Cardiology, McGovern Medical School, University of Texas, Houston
(Kirkeeide) Weatherhead PET Center, Director of Database Management,
McGovern Medical School, University of Texas, Houston
(Haynie) Weatherhead PET Center, McGovern Medical School, University of
Texas, Houston
(Carter) Research Coordinator, Weatherhead PET Center, McGovern Medical
School, University of Texas, Houston
(Patel) Division of Cardiology, McGovern Medical School, University of
Texas, Houston
(Mendoza) Director of Nutrition, Weatherhead PET Center, McGovern Medical
School, University of Texas, Houston
(Roby) Technical Director of PET Imaging, Weatherhead PET Center, McGovern
Medical School, University of Texas, Houston
(Hood) Senior Administrative Manager, Weatherhead PET Center, McGovern
Medical School, University of Texas, Houston
(Zhu) Department of Biostatistics and Data Science, School of Public
Health, University of Texas, Houston
(Lai) Department of Biostatistics and Data Science, School of Public
Health, University of Texas, Houston
(Sdringola) Professor of Medicine, Division of Cardiology, McGovern
Medical School, University of Texas, Houston
(Gould) Martin Bucksbaum Distinguished University Chair, Professor of
Cardiovascular Medicine and Executive Director, Weatherhead P.E.T. Center
for Preventing and Reversing Atherosclerosis, McGovern Medical School,
University of Texas, Houston
Publisher
NLM (Medline)
Abstract
BACKGROUND: The literature reports no randomized trial in chronic coronary
artery disease (CAD) of a comprehensive management strategy integrating
intense lifestyle management, maximal medical treatment to specific goals
and high precision quantitative cardiac positron emission tomography (PET)
for identifying high mortality risk patients needing essential invasive
procedures. We hypothesize that this comprehensive strategy achieves
greater risk factor reduction, lower major adverse cardiovascular events
and fewer invasive procedures than standard practice. <br/>METHOD(S): The
CENTURY Study (NCT00756379) is a randomized-controlled-trial study in
patients with stable or at high risk for CAD. Patients are randomized to
standard of care (Standard group) or intense comprehensive
lifestyle-medical treatment to targets and PET guided interventions
(Comprehensive group). Comprehensive Group patients are regularly
consulted by the CENTURY team implementing diet/lifestyle/exercise program
and medical treatment to target risk modification. Cardiac PET at
baseline, 24-, and 60-months quantify the physiologic severity of CAD and
guide interventions in the Comprehensive group while patients and
referring physicians of the Standard group are blinded to PET results. The
primary end-point is the CENTURY risk score reduction during 5 years
follow-up. The secondary endpoint is a composite of death, non-fatal
myocardial infarction, stroke, and coronary revascularization.
<br/>CONCLUSION(S): The CENTURY Study is the first study in stable CAD to
test the incremental benefit of a comprehensive strategy integrating
intense lifestyle modification, medical treatment to specific goals, and
high-precision quantitative myocardial perfusion imaging to guide
revascularization. A total of 1028 patients have been randomized, and the
5 years follow-up will conclude in 2022.<br/>Copyright &#xa9; 2021.
Published by Elsevier Inc.

<32>
Accession Number
634660418
Title
Extreme Cooling Rates in Avalanche Victims: Case Report and Narrative
Review.
Source
High altitude medicine & biology. (no pagination), 2021. Date of
Publication: 24 Mar 2021.
Author
Mittermair C.; Foidl E.; Wallner B.; Brugger H.; Paal P.
Institution
(Mittermair) Department of Surgery, Hospitallers Brothers Hospital,
Paracelsus Medical University, Salzburg, Austria
(Foidl) Department of Anaesthesiology and Intensive Care Medicine,
Kufstein Hospital, Kufstein, Austria
(Wallner) Department of Anaesthesiology and General Intensive Care
Medicine, Medical University of Innsbruck, Innsbruck, Austria
(Wallner, Brugger) Institute of Mountain Emergency Medicine, Eurac
Research, Bolzano, Italy
(Brugger, Paal) International Commission of Mountain Emergency Medicine
(ICAR MEDCOM), Kloten, Switzerland
(Paal) Department of Anaesthesiology and Intensive Care Medicine,
Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg,
Austria
Publisher
NLM (Medline)
Abstract
Mittermair, Christof, Eva Foidl, Bernd Wallner, Hermann Brugger, and Peter
Paal. Extreme cooling rates in avalanche victims: case report and
narrative review. High Alt Med Biol 00:000-000, 2021. <br/>Background(s):
We report a 25-year-old female backcountry skier who was buried by an
avalanche during ascent. A cooling rate of 8.5degreeC/h from burial to
hospital is the fastest reported in a person with persistent circulation.
<br/>Method(s): A case report according to the CARE guidelines is
presented. A literature search with the keywords "avalanche" AND
"hypothermia" was performed and yielded 96 results, and the last update
was on October 25, 2020. A narrative review complements this work.
<br/>Result(s): A literature search revealed four avalanche patients with
extreme cooling rates (>5degree/h). References of included articles were
searched for further relevant studies. Nineteen additional pertinent
articles were included. Overall, 32 studies were included in this work.
<br/>Discussion(s): An avalanche patient cools in different phases, and
every phase may have different cooling rates: (1) during burial, (2) with
postburial exposure on-site, and (3) during transport. It is important to
measure the core temperature correctly, ideally with an esophageal probe.
Contributing factors to fast cooling are sweating, impaired consciousness,
no shivering, wearing thin monolayer clothing and head and hands
uncovered, an air pocket, and development of hypercapnia, being slender.
<br/>Conclusion(s): Rescuers should be prepared to encounter severely
hypothermic subjects (<30degreeC) even after burials of <60 minutes.
Subjects rescued from an avalanche may cool extremely fast the more
contributing factors for rapid cooling exist. After avalanche burial (>=60
minutes) and unwitnessed cardiac arrest, chances of neurologically intact
survival are small and depend on rapid cooling and onset of severe
hypothermia (<30degreeC) before hypoxia-induced cardiac arrest.

<33>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9;
2021 Elsevier Inc.

<34>
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.
<br/>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. <br/>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%]. <br/>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.<br/>Copyright
&#xa9; 2021, The Author(s).

<35>
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.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<36>
Accession Number
2011487469
Title
Obesity and diabetes: Similar respiratory mechanical but different gas
exchange defects.
Source
American Journal of Physiology - Lung Cellular and Molecular Physiology.
320 (3) (pp L368-L376), 2021. Date of Publication: March 2021.
Author
Sudy R.; Petak F.; Kiss L.; Balogh A.L.; Fodor G.H.; Korsos A.; Schranc
A.; Babik B.
Institution
(Sudy, Kiss, Balogh, Korsos, Babik) Department of Anaesthesiology and
Intensive Therapy, University of Szeged, Szeged, Hungary
(Sudy, Petak, Kiss, Balogh, Fodor, Schranc) Department of Medical Physics
and Informatics, University of Szeged, Szeged, Hungary
Publisher
American Physiological Society
Abstract
Diabetes mellitus increases smooth muscle tone and causes tissue
remodeling, affecting elastin and collagen. Although the lung is dominated
by these elements, diabetes is expected to modify the airway function and
respiratory tissue mechanics. Therefore, we characterized the respiratory
function in patients with diabetes with and without associated obesity.
Mechanically ventilated patients with normal body shapes were divided into
the control nondiabetic (n = 73) and diabetic (n = 31) groups. The other
two groups included obese patients without diabetes (n = 43) or with
diabetes (n = 30). The mechanical properties of the respiratory system
were determined by forced oscillation technique. Airway resistance (Raw),
tissue damping (G), and tissue elastance (H) were assessed by forced
oscillation. Capnography was applied to determine phase 3 slopes and dead
space indices. The intrapulmonary shunt fraction (Qs/Qt) and the lung
oxygenation index (PaO<inf>2</inf>/FIO<inf>2</inf>) were estimated from
arterial and central venous blood samples. Compared with the corresponding
control groups, diabetes alone increased the Raw (7.6 +/- 6
cmH<inf>2</inf>O.s/l vs. 3.1 +/- 1.9 cmH2O.s/l), G (11.7 +/- 5.5
cmH<inf>2</inf>O/l vs. 6.5 +/- 2.8 cmH<inf>2</inf>O/l), and H (31.5 +/-
11.8 cmH<inf>2</inf>O/l vs. 24.2 +/- 7.2 cmH<inf>2</inf>O/l (P < 0.001 for
all). Diabetes increased the capnographic phase 3 slope, whereas
PaO<inf>2</inf>/FIO<inf>2</inf>or Qs/Qt was not affected. Obesity alone
caused similar detrimental changes in respiratory mechanics and alveolar
heterogeneity, but these alterations also compromised gas exchange. We
conclude that diabetes-induced intrinsic mechanical abnormalities are
counterbalanced by hypoxic pulmonary vasoconstriction, which maintained
intrapulmonary shunt fraction and oxygenation ability of the
lungs.<br/>Copyright &#xa9; 2021 American Physiological Society. All
rights reserved.

<37>
Accession Number
2006893055
Title
Ultrasound versus thoracoscopic-guided paravertebral block during
thoracotomy.
Source
Asian Cardiovascular and Thoracic Annals. 29 (2) (pp 98-104), 2021. Date
of Publication: February 2021.
Author
Hegazy M.A.; Awad G.; Abdellatif A.; Saleh M.E.; Sanad M.
Institution
(Hegazy) Department of Anesthesia and Intensive Care, Faculty of Medicine,
Mansoura University, Egypt
(Awad, Abdellatif, Saleh, Sanad) Department of Cardiothoracic Surgery,
Faculty of Medicine, Mansoura University, Egypt
Publisher
SAGE Publications Inc.
Abstract
Background: Paravertebral block can be performed with the aid of surgical
landmarks, ultrasound, or a thoracoscope. This study was designed to
compare ultrasound-guided paravertebral block with the thoracoscopic
technique. <br/>Method(s): This prospective randomized comparative study
included 40 adults scheduled for elective thoracic surgery. Study
participants were randomized to an ultrasound group or a thoracoscope
group. A catheter for paravertebral block was inserted prior to
thoracotomy with real-time ultrasound visualization in the ultrasound
group, and under thoracoscopic guidance in the thoracoscope group. Total
analgesic consumption, visual analogue pain score, technical difficulties,
and complications were compared between the 2 groups. <br/>Result(s):
Total analgesic consumption in the first 24 hours was less in the
ultrasound group than in the thoracoscope group (rescue intravenous
fentanyl 121.25 +/- 64.01 microg in the ultrasound group vs. 178.75 +/-
91.36 microg in the thoracoscope group; p = 0.027). Total paravertebral
bupivacaine consumption was 376.00 +/- 33.779 mg in the ultrasound group
and 471.50 +/- 64.341 mg in the thoracoscope group (p < 0.001). Technical
difficulties and complications in terms of time consumed during the
maneuver, more than one needle pass, and pleural puncture were
significantly lower in the ultrasound group than in the thoracoscope
group. <br/>Conclusion(s): Ultrasound-guided paravertebral catheter
insertion is more effective, technically easier, and safer than the
thoracoscope-assisted technique.<br/>Copyright &#xa9; The Author(s) 2020.

<38>
Accession Number
2011406767
Title
Hydrodynamic performance of a novel suturelessprosthetic aortic valve.
Source
Vestnik Transplantologii i Iskusstvennykh Organov. 22 (2) (pp 99-104),
2020. Date of Publication: 2020.
Author
Klyshnikov K.Y.; Ovcharenko E.A.; Kudryavtseva Y.A.; Barbarash L.S.
Institution
(Klyshnikov, Ovcharenko, Kudryavtseva, Barbarash) Research Institute for
Complex Issues of Cardiovascular Diseases, 6, Sosnovy Boulevard, Kemerovo
650002, Russian Federation
Publisher
Russian Transplant Society
Abstract
The aim of the study was an in vitro hydrodynamic study of the developed
prosthetic heart valve of the second generation, designed to carry out an
implantation using "valve-in-valve" method. Material and methods. Pro
totypes of the developed prosthesis were studied under simulated
physiological conditions of the heart using a Vivitro Labs pulse
duplicator (Canada) in a comparative aspect with "UniLine" clinical
commercial aortic valve bioprosthesis (Russia). Samples were tested by
simulating sutureless implantation procedure. Results. The deve loped
valves showed satisfactory hydrodynamic characteristics - for all cases of
"implantation" from the position of the average trans-prosthetic gradient
(6.1-11.1 mm Hg) and the effective orifice area (1.60-1.81 cm2 ). The
analysis of the regurgitation fraction allowed us to determine the optimal
sizes for implantation using "valve in-valve" method, which subsequently
will form the basis of sizing guidelines for size selection. A qualitative
analysis of the leaflets work demonstrated the presence of slight
asymmetry for a number of prostheses - in case of mismatch of sizes when
simulating "valve-in-valve" procedure. Conclusion. The tests demonstrate
the viability of the developed design from the standpoint of hydrodynamic
efficiency and determines the basic rules of selecting a prosthesis for
reimplantation relative to the primary valve.<br/>Copyright &#xa9; 2020
Russian Transplant Society. All rights reserved.

<39>
Accession Number
2006741376
Title
Frailty and the risk of all-cause mortality and hospitalization in chronic
heart failure: a meta-analysis.
Source
ESC Heart Failure. 7 (6) (pp 3427-3437), 2020. Date of Publication:
December 2020.
Author
Uchmanowicz I.; Lee C.S.; Vitale C.; Manulik S.; Denfeld Q.E.; Uchmanowicz
B.; Rosinczuk J.; Drozd M.; Jaroch J.; Jankowska E.A.
Institution
(Uchmanowicz, Manulik, Uchmanowicz, Rosinczuk, Drozd, Jaroch, Jankowska)
Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw
Medical University, Bartla 5, Wroclaw 51-618, Poland
(Lee) William F. Connell School of Nursing, Boston College, Boston, MA,
United States
(Vitale) Centre for Clinical and Basic Research, IRCCS San Raffaele
Pisana, Rome, Italy
(Denfeld) Oregon Health and Science University School of Nursing,
Portland, OR, United States
(Drozd, Jankowska) Centre for Heart Diseases, Wroclaw Medical University,
Wroclaw, Poland
Publisher
Wiley-Blackwell
Abstract
To estimate the risk of all-cause mortality and hospitalization in frail
patients with chronic heart failure (HF), a systematic search and
meta-analysis was carried out to identify all prospective cohort studies
conducted among adults with HF where frailty was quantified and related to
the primary endpoints of all-cause mortality and/or hospitalization.
Twenty-nine studies reporting the link between frailty and all-cause
mortality in 18 757 patients were available for the meta-analysis, along
with 11 studies, with 13 525 patients, reporting the association between
frailty and hospitalization. Frailty was a predictor of all-cause
mortality and hospitalization with summary hazard ratios (HRs) of 1.48
[95% confidence interval (CI): 1.31-1.65, P < 0.001] and 1.40 (95% CI:
1.27-1.54, P < 0.001), respectively. Summary HRs for all-cause mortality
among frail inpatients undergoing ventricular assist device implantation,
inpatients hospitalized for HF, and outpatients were 1.46 (95% CI:
1.18-1.73, P < 0.001), 1.58 (95% CI: 0.94-2.22, P = not significant), and
1.53 (95% CI: 1.28-1.78, P < 0.001), respectively. Summary HRs for
all-cause mortality and frailty based on Fried's phenotype were 1.48 (95%
CI: 1.03-1.93, P < 0.001) and 1.42 (95% CI: 1.05-1.79, P < 0.001) for
inpatients and outpatients, respectively, and based on other frailty
measures were 1.42 (95% CI: 1.12-1.72, P < 0.001) and 1.60 (95% CI:
1.43-1.77, P < 0.001) for inpatients and outpatients, respectively. Across
clinical contexts, frailty in chronic HF is associated with an average of
48% and 40% increase in the hazard of all-cause mortality and
hospitalization, respectively. The relationship between frailty and
all-cause mortality is similar across clinical settings and comparing
measurement using Fried's phenotype or other measures.<br/>Copyright
&#xa9; 2020 The Authors. ESC Heart Failure published by John Wiley & Sons
Ltd on behalf of the European Society of Cardiology

<40>
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). <br/>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.
<br/>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).
<br/>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. <br/>Copyright
&#xa9; Author(s) (or their employer(s)) 2021. No commercial re-use. See
rights and permissions. Published by BMJ.

<41>
[Use Link to view the full text]
Accession Number
634053935
Title
Myocardial Ischemia in the Management of Chronic Coronary Artery Disease:
Past and Present.
Source
Circulation. Cardiovascular imaging. 14 (1) (pp e011615), 2021. Date of
Publication: 01 Jan 2021.
Author
Gibbons R.J.
Institution
(Gibbons) Department of Cardiovascular Medicine, Mayo Clinic, MN,
Rochester
Publisher
NLM (Medline)
Abstract
For many years, stress-induced myocardial ischemia has been considered
important in the management of chronic coronary artery disease. Early
evidence focused on the exercise ECG and the Duke treadmill score. In the
1970s, randomized clinical trials, which compared coronary artery bypass
surgery to medical therapy, enrolled patients who were very different from
contemporary practice and had inconsistent results. Surgery appeared to be
of greatest benefit in high-risk patients defined by anatomy (such as left
main disease) or stress-induced ischemia. However, randomized clinical
trials of revascularization versus contemporary medical therapy over the
past 20 years have been surprisingly negative. Nuclear cardiology
substudies from these trials reported inconsistent results. Two
observational studies from a single-center provided the best evidence for
the use of stress-induced ischemia to identify patients who were most
likely to benefit from revascularization. The recently completed ISCHEMIA
trial (International Study of Comparative Health Effectiveness With
Medical and Invasive Approaches) was designed to test the hypothesis that
revascularization would improve outcomes in patients with moderate-severe
ischemia on stress testing. Unfortunately, 14.2% of the randomized
patients had either mild or no ischemia on core lab review. Nearly
one-quarter of the patients were randomized on the basis of an exercise
ECG without imaging. The negative results of the trial reflect the
long-term population decline in coronary artery disease and abnormal
stress tests, as well as improvements in patient outcome due to optimal
medical therapy. Topics requiring further research are presented. The
implications of the trial for the use of both stress imaging and coronary
computed tomography angiography in clinical practice are examined.

<42>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<43>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright
&#xa9; 2021, The Author(s), under exclusive licence to Springer Nature
B.V.

<44>
Accession Number
634645544
Title
The effect of conventional and distal radial access techniques on radial
artery structure and vascular functions.
Source
Anatolian Journal of Cardiology. Conference: 36th Turkish Cardiology
Congress, TSC 2020. 24 (SUPPL 1) (pp 37), 2020. Date of Publication:
December 2020.
Author
Ozkan C.; Cayhan V.; Kiziltunc E.; Yakici I.E.; Cetin M.; Korkmaz A.;
Doganay B.; Ornek E.
Institution
(Ozkan, Kiziltunc, Yakici, Cetin, Korkmaz, Doganay, Ornek) Department of
Cardiology, Ankara Numune Training and Resarch Hospital, Ankara, Turkey
(Cayhan) Department of Radiology, Ankara Numune Training and Resarch
Hospital, Ankara, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: The transradial (TRA) approach has gained increasing
popularity in the world of invasive cardiology in recent years, as it
offers many advantages to the patient and operator compared to the
transfemoral (TFR) intervention. Yet, transradial intervention also has
complications such as radial artery (RA) spasm, RA stenosis, RA
occlusion.Also in the previous studies,decreases in RA diameter and
functions have been detected after TRA intervention. Radial arteries need
to be protected for coronary artery bypass graft (CABG) surgery,
hemodialysis fistula preparation and repeated percutaneous coronary
interventions. For reasons aforementioned, distal transradial (DTRA)
intervention appears as a promising venture. The purpose of this study is
to investigate and compare RA diameters, intimal thickness values and
vascular functions in patients with conventional RA and distal RA(DRA)
cannulation before and after the procedure. <br/>Method(s): A total of 40
patients who underwent coronary angiography (CAG) between April 2019 and
September 2019 were included in the study. Conventional TRA(TRA) technique
was used for 20 patients and DTRA access technique for the other 20.
Patients were taken and randomized to the one of the two methods
respectively and consecutively. RA flow rates, diameters, intimal
thickness values, flow-mediated dilation responses (FMD) were recorded
before and after the procedure, using the first day and the first month RA
ultrasonography (USG) and Doppler parameters. The success of both
procedures and their effects on complications were investigated.
<br/>Result(s): It was found that the number of punctures were
significantly higher in the procedures performed with the distal
transradial route compared to conventional TRA. When the radial artery
intimal thickness values were compared, basal and 1st day intimal
thickness values were similar; but in the 1st month, the intimal thickness
in the CTRA group was found to be statistically significantly higher than
in the DTRA group.In the study, the radial artery occlusion (RAO) was
detected in 3 (15%) patients in the CTRA intervention group in the 1st
month, and in none of the patients in the DTRA group. However, there was
no statistically significant difference due to the insufficient number of
patients. <br/>Conclusion(s): It can be said that DTRA intervention is
better in terms of radial artery health. Based on our findings and the
studies showing that the patency of the radial artery grafts decreased
after catheterization, it can be said that interventional cardiologists
should be careful in accessing the radial artery during coronary
catheterization in patients who may be suitable for radial artery grafts
when a CABG surgery is indicated. This study showed that RA intima
thickness increase, RAO ratio, and FMD-evaluated endothelial dysfunction
were higher in the CTRA group compared to the DTRA group. DTRA technique
should be preferred to CTRA technique in patients who may need
intervention with bypass graft, hemodialysis fistula and RA access again
in the future.

<45>
Accession Number
634650910
Title
Active clearance vs conventional management of chest tubes after cardiac
surgery: a randomized controlled study.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 44), 2021. Date of
Publication: 23 Mar 2021.
Author
St-Onge S.; Chauvette V.; Hamad R.; Bouchard D.; Jeanmart H.; Lamarche Y.;
Perrault L.P.; Demers P.
Institution
(St-Onge, Chauvette, Hamad, Bouchard, Lamarche, Perrault, Demers)
Department of Surgery, Faculty of Medicine, Montreal Heart Institute,
Universite de Montreal ,5000 Belanger Street, Montreal, QC H1T1C8, Canada
(Jeanmart) Department of Surgery, Faculty of Medicine, Hopital du
Sacre-Coeur de Montreal, Universite de Montreal, Montreal, QC, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Chest tubes are routinely used after cardiac surgery to
evacuate shed mediastinal blood. Incomplete chest drainage due to chest
tube clogging can lead to retained blood after cardiac surgery. This can
include cardiac tamponade, hemothorax, bloody effusions and postoperative
atrial fibrillation (POAF). Prior published non randomized studies have
demonstrated that active tube clearance (ATC) of chest tubes can reduce
retained blood complications prompting the ERAS Cardiac Society guidelines
to recommend this modality. <br/>OBJECTIVE(S): A randomized prospective
trial to evaluate whether an ATC protocol aimed at improving chest tube
patency without breaking the sterile field could efficiently reduce
complications related to retained blood after cardiac surgery.
<br/>METHOD(S): This was a pragmatic, single-blinded, parallel randomized
control trial held from November 2015 to June 2017 including a 30-day post
index surgery follow-up. The setting was two academic centers affiliated
with the Universite de Montreal School of Medicine; the Montreal Heart
Institute and the Hopital du Sacre-Coeur de Montreal. Adult patients
admitted for non-emergent coronary bypass grafting and/or valvular heart
surgery through median sternotomy, in sinus rhythm for a minimum of 30days
prior to the surgical intervention were eligible for inclusion. In the
active tube clearance group (ATC), a 28F PleuraFlow device was positioned
within the mediastinum. In the standard drainage group, a conventional
chest tube (Teleflex Inc.) was used. Other chest tubes were left at the
discretion of the operating surgeon. <br/>RESULT(S): A total of 520 adult
patients undergoing cardiac surgery were randomized to receive either ATC
(n=257) or standard drainage (n=263). ATC was associated with a 72%
reduction in re-exploration for bleeding (5.7% vs 1.6%, p=.01) and an 89%
reduction in complete chest tube occlusion (2% vs 19%, p=.01). There was
an 18% reduction in POAF between the ATC and control group that was not
statistically significant (31% vs 38%, p=.08). CONCLUSIONS AND RELEVANCE:
In this RCT, the implementation of active clearance of chest tubes reduced
re-exploration and chest tube clogging in patients after cardiac surgery
further supporting recommendations to consider this modality
postoperatively. TRIAL REGISTRATION: Clinical Trials NCT02808897 .
Retrospectively registered 22 June 2016.

<46>
Accession Number
634650616
Title
Long non-coding RNA SPRY4-IT1 as a promising indicator for three field
lymph-node dissection of thoracic esophageal carcinoma.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 48), 2021. Date of
Publication: 23 Mar 2021.
Author
Qie P.; Yin Q.; Xun X.; Song Y.; Zhou S.; Liu H.; Feng J.; Tian Z.
Institution
(Qie) Hebei Medical University, Hebei Province, Shijiazhuang 050017, China
(Yin, Xun, Song, Zhou, Liu) Hebei General Hospital, 348,West He-Ping Road,
Shijiazhuang, 050051, Hebei Province, People's Republic of China
(Feng) Hebei Chest Hospital, Hebei Province, Shijiazhuang 050041, China
(Tian) Hebei Medical University Fourth Affiliated Hospital and Hebei
Provincial Tumor Hospital, Hebei Province, Shijiazhuang 050035, China
(Tian) Thoracic Surgery, Fourth Hospital of Hebei Medical University,
Hebei Province, Shijiazhuang 050035, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Esophageal squamous cell carcinoma(ESCC) is one of the most
common tumors worldwide. Esophagectomy with three-field lymph node
dissection(3FLND) is the radical surgical procedure for esophageal cancer.
However, 3FLND is not widely used due to it's higher mortality rate and
higher incidence of postoperative complications. There is an urgent need
to identify novel biomarkers that can guide the most proper lymph-node
dissection in esophageal cancer patients. <br/>METHOD(S): Ninety-two
patients with thoracic ESCC undergoing 3FLND were enrolled into our study
from the Department of Thoracic Surgery of the Fourth Hospital affiliated
to the Hebei Medical University and Hebei General Hospital between Jun
2011 and Dec 2015. Retrospectively collected data from these 92 patients
was used to explore the relationship between the lymph-node
metastasisrecurrence and the SPRY4-IT1 expression level and to determine
whether 3FLND should be performed in patients with thoracic ESCC.
<br/>RESULT(S): The findings revealed that the SPRY4-IT1 expression was
significantly higher in esophageal cancer tissues than in adjacent
noncancerous tissues. (P <0.01). Furthermore, the high expression of
SPRY4-IT1 was significantly correlated with tumor differentiation (P
=0.029), T classification (P =0.013), lymph node metastasis(P =0.022) and
pathological stage (P =0.001). The increased expression of SPRY4-IT1 was
associated with a higher risk of cervical and superior mediastinal
lymph-node metastasis(P =0.039).However, no significant association was
observed between the risk of cervical and superior mediastinal lymph-node
recurrence and the SPRY4-IT1 expression level in the thoracic ESCC
patients performed 3FLND(P =0.509). <br/>CONCLUSION(S): Our data support
the assumption that the high expression of SPRY4-IT1 is associated with a
high risk of lymph node metastasis and it has potential application as a
indicator for guiding on three-field lymph node dissection in patients
with thoracic ESCC. Randomized controlled trials with a large cohort of
patients will be needed to confirm this conclusion in the future.

<47>
[Use Link to view the full text]
Accession Number
634636922
Title
One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding With a
Balloon-Expandable Transcatheter Aortic Valve.
Source
Circulation. 143 (12) (pp 1267-1269), 2021. Date of Publication: 23 Mar
2021.
Author
Kim W.-K.; Walther T.; Burgdorf C.; Mollmann H.; Linke A.; Redwood S.;
Thilo C.; Hilker M.; Joner M.; Thiele H.; Conzelmann L.; Conradi L.;
Kerber S.; Schymik G.; Prendergast B.; Husser O.; Blumenstein J.;
Stortecky S.; Heg D.; Kunzi A.; Juni P.; Windecker S.; Pilgrim T.; Lanz J.
Institution
(Kim, Husser) Department of Cardiology, Kerckhoff Heart and Thorax Center,
Germany (W.-K.K.), Bad Nauheim, Germany
(Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery,
University Hospital Frankfurt, Germany (T.W.)
(Burgdorf) Heart and Vascular Center, Germany (C.B.), Bad Bevensen,
Germany
(Mollmann, Blumenstein) Department of Internal Medicine I,
St-Johannes-Hospital, Dortmund, Germany (H.M., O.H., J.B.)
(Linke) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Germany (A.L.), Technische Universitat Dresden
(Redwood, Prendergast) Department of Cardiology, United Kingdom (S.R., St
Thomas' Hospital, London
(Thilo) Department of Cardiology, Klinikum Augsburg, Germany (C.T.)
(Hilker) Department of Cardiothoracic Surgery, University Medical Center,
Germany (M.H.), Regensburg, Germany
(Joner) Deutsches Herzzentrum Munchen, Cardiology and Technische
Universitat Munchen and German Center for Cardiovascular Research (DZHK),
Germany (M.J.), partner site Munich Heart Alliance
(Thiele) Heart Center Leipzig at University of Leipzig and Leipzig Heart
Institute, Germany (H.T.)
(Conzelmann) Department of Cardiac Surgery, Helios Klinik, Germany (L.
Conzelmann), Karlsruhe, Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Germany (L. Conradi)
(Kerber) Department of Cardiology, Cardiovascular Center Bad Neustadt,
Germany (S.K.)
(Schymik) Department of Cardiology, Stadtisches Klinikum Karlsruhe,
Germany (G.S.)
(Stortecky, Windecker, Pilgrim, Lanz) Department of Cardiology,
Inselspital, Bern University Hospital, S.W.
(Heg, Kunzi) Clinical Trials Unit, University of Bern
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, Department of Medicine and Institute of Health
Policy, Management and Evaluation, University of Toronto, ON
Publisher
NLM (Medline)

<48>
Accession Number
634651024
Title
Effectiveness of music on anxiety and pain among cardiac surgery patients:
A quantitative systematic review and meta-analysis of randomized
controlled trials.
Source
International journal of nursing practice. (pp e12928), 2021. Date of
Publication: 23 Mar 2021.
Author
Chandrababu R.; Ramesh J.; Sanatombi Devi E.; Nayak B.S.; George A.
Institution
(Chandrababu, Sanatombi Devi, Nayak, George) Manipal College of Nursing,
Manipal Academy of Higher Education, Manipal, Karnataka, India
(Ramesh) Udupi College of Nursing, Shree Krishna Educational Trust,
Manipal, Karnataka, India
Publisher
NLM (Medline)
Abstract
AIM: The aim of this study is to evaluate the effectiveness of music on
anxiety and pain among patients following cardiac surgery. BACKGROUND:
Cardiac surgery affects patients physically, psychologically and socially.
Anxiety and pain are the usual problems among patients following cardiac
surgery. DESIGN: The study design is a systematic review and
meta-analysis. DATA SOURCES: The Medical Literature Analysis and Retrieval
System Online (MEDLINE), Cumulative Index to Nursing and Allied Health
Literature (CINAHL), Cochrane Central Register of Controlled Trials
(CENTRAL), Excerpta Medica database (EMBASE) and Web of Science databases
were searched for randomized controlled trials from January 2000 to
December 2017. REVIEW METHODS: The Cochrane collaboration guidelines were
followed and reported using the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement. The Grading of
Recommendations, Assessment, Development, and Evaluations (GRADE) approach
was used to summarize the quality of evidence. <br/>RESULT(S): Fourteen
studies were included in systematic review and 13 in meta-analysis. The
meta-analysis revealed that there was a significant reduction in anxiety
and pain among patients who received musical intervention compared with
those who did not. <br/>CONCLUSION(S): Music has positive benefits on
anxiety and pain. However, well-designed and high-quality trials are
needed to generate higher quality evidence.<br/>Copyright &#xa9; 2021 John
Wiley & Sons Australia, Ltd.

<49>
Accession Number
634650698
Title
Clinical implications and debates on the ISCHEMIA trial.
Source
Cardiology in review. (no pagination), 2021. Date of Publication: 19 Mar
2021.
Author
Saito Y.; Nishi T.; Saito K.; Kitahara H.; Kawase Y.; Matsuo H.; Kobayashi
Y.
Institution
(Saito) Department of Cardiovascular Medicine, Chiba University Graduate
School of Medicine, Chiba, Japan Department of Cardiovascular Medicine,
Gifu Heart Center, Gifu, Japan
Publisher
NLM (Medline)
Abstract
The ISCHEMIA was eagerly awaited study in the field of ischemic heart
disease. Following the presentation and publication of ISCHEMIA, multiple
opinions and viewpoints get complicated. The ongoing debates have been
including the relevance of coronary revascularization, non-invasive
diagnostic methods, and invasive ischemic testing in patients with stable
ischemic heart disease (SIHD). Prior to ISCHEMIA, observational studies
indicated the potential of coronary revascularization for improving
clinical outcomes, while the randomized COURAGE trial did not support the
plausible concept. Although the FAME 2 trial implied the superiority of
percutaneous coronary intervention over medical therapy alone, the
clinical relevance of coronary revascularization to improve outcomes and
quality of life has been questioned. As a consequence, the ISCHEMIA trial
did not demonstrate clear benefits in reducing clinical events but showed
antianginal effects of revascularization. This landmark trial also
suggested the difficulties of non-invasive ischemia testing rather than
computed tomography angiography. Despite the complex results, the ISCHEMIA
trial may simplify the clinical indications of coronary revascularization
in patients with SIHD. Future publications from the ISCHEMIA trial and
debates on the results will sharpen our thinking and
understanding.<br/>Copyright &#xa9; 2021 Wolters Kluwer Health, Inc. All
rights reserved.

<50>
Accession Number
634639605
Title
Effect of Availability of Transcatheter Aortic-Valve Implantation on
Survival For All Patients with Severe Aortic Stenosis.
Source
The American journal of cardiology. (no pagination), 2021. Date of
Publication: 19 Mar 2021.
Author
Chao A.; Picard M.H.; Passeri J.J.; Cui J.; Nethery R.C.; Wasfy J.H.
Institution
(Chao) Department of Biostatistics, Yale School of Public Health, CT, New
Haven, United States
(Picard, Passeri, Cui, Wasfy) Cardiology Division, Department of Medicine,
Massachusetts General Hospital, MA, Boston, United States
(Nethery) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, MA, Boston, United States
Publisher
NLM (Medline)
Abstract
Clinical outcomes for the overall severe aortic stenosis (AS) patient
population are not well described because those medically managed are not
included in procedural registries, and AS severity is not identifiable
from administrative data. We aim to assess whether transcatheter aortic
valve implantation (TAVI) availability has been associated with overall
changes in survival for the whole AS patient population. This is important
because patients with AS in real-world practice may differ from those
included in randomized controlled trials, potentially attenuating the
purported treatment efficacy estimated in trials. Classic severe AS
patients (mean gradient >=40 mmHg) were identified from an
echocardiography database. Survival was defined as time since severe AS
diagnosis until death. We first compared survival among all patients
before and after TAVI availability in 2008. To further understand
mechanism, we then assessed whether any survival changes were attributable
to TAVI with extended Cox regression models comparing survival among TAVI,
surgical aortic valve replacement (SAVR), and medically managed patients.
3663 classic severe AS patients were included in the study. Median
survival years for all patients were greater during the TAVI-era than
Pre-TAVI-era (>11.5 vs. 6.8, 5-year-HR=0.8, time-varying effect p<0.0001),
and increased median survival was greatest for patients age 65-74 (>11.5
vs. 9.5, 5-year-HR=0.7, time-varying effect p=0.045). TAVI patients age
65-74 had the lowest risk of death compared to medically managed patients
(HR=0.2, 95% CI=[0.1, 0.3], p<0.0001). In conclusion, in the TAVI-era,
overall survival for patients with severe AS has doubled. This improvement
is most marked for patients 65-74 years of age.<br/>Copyright &#xa9; 2021.
Published by Elsevier Inc.

<51>
Accession Number
634637704
Title
Effect of perioperative mechanical ventilation strategies on postoperative
pulmonary complications in patients undergoing thoracic surgery:a
Meta-analysis.
Source
Asian journal of surgery. (no pagination), 2021. Date of Publication: 20
Mar 2021.
Author
Zhu Y.; Chen X.; Wang F.; Gao J.
Institution
(Zhu) Dalian Medical University, Dalian 116044, China
(Chen) Northern Jiangsu People's Hospital, Yangzhou 225001, China
(Wang) Dalian Medical University, Dalian 116044, China
(Gao) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Clinical Medical College, Yangzhou University, China
Publisher
NLM (Medline)

<52>
Accession Number
634636694
Title
Management of Aortic Stenosis: A Systematic Review of Clinical Practice
Guidelines and Recommendations.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2021. Date of Publication: 05 Mar 2021.
Author
Khanji M.Y.; Ricci F.; Galusko V.; Sekar B.; Chahal C.A.A.; Ceriello L.;
Gallina S.; Kennon S.; Awad W.I.; Ionescu A.
Institution
(Khanji) Newham University Hospital, Barts Health NHS Trust, London E13
8SL, United Kingdom
(Khanji, Chahal, Kennon, Awad) Barts Heart Centre, Barts Health NHS Trust,
London, West Smithfield, EC1A 7BE, UK
(Khanji) NIHR Barts Biomedical Research Centre, William Harvey Research
Institute, Queen Mary University of London EC1A 7BE, United Kingdom
(Ricci, Ceriello, Gallina) Institute of Advanced Biomedical Technologies,
Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio"
University, Chieti 66100, Italy
(Ricci) Department of Clinical Sciences, Lund University, Malmo, Sweden
(Ricci) Casa di Cura Villa Serena, 65013 Citta Sant'Angelo, Pescara, Italy
(Galusko) Department of Cardiology, King's College Hospital, London SE5
9RS, United Kingdom
(Sekar, Ionescu) Morriston Cardiac Regional Centre, Swansea Bay Health
Board, Swansea SA6 6NL, United Kingdom
(Chahal) University of Pennsylvania, Department of Cardiology,
Philadelphia, United States
(Chahal) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
NY, MN 55902 USA
Publisher
NLM (Medline)
Abstract
AIMS: Multiple guidelines exist for the management of aortic stenosis
(AS). We systematically reviewed current guidelines and recommendations,
developed by national or international medical organizations, on
management of AS to aid clinical decision making. METHODS AND RESULTS:
Publications in MEDLINE and EMBASE between June 1st, 2010 and January
15th, 2021 were identified. Additionally, the International Guideline
Library, National Guideline Clearinghouse, National Library for Health
Guidelines Finder, Canadian Medical Association Clinical Practice
Guidelines Infobase, and websites of relevant organizations were searched.
Two reviewers independently screened titles and abstracts. Two reviewers
assessed rigor of guideline development and extracted the
recommendations.Of the 7 guidelines and recommendations retrieved, 5
showed considerable rigor of development. Those rigorously developed,
agreed on the definition of severe AS and diverse hemodynamic phenotypes,
indications and contraindications for intervention in symptomatic severe
AS, surveillance intervals in asymptomatic severe AS, and the importance
of multidisciplinary teams (MDT) and shared decision-making.Discrepancies
exist in age and surgical risk cut-offs for recommending surgical (SAVR)
vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers
and complementary multimodality imaging for decision-making in
asymptomatic patients and surveillance intervals for non-severe AS.
<br/>CONCLUSION(S): Contemporary guidelines for aortic stenosis management
agree on the importance of MDT involvement and shared decision-making for
individualized treatment and unanimously indicate valve replacement in
severe, symptomatic AS. Discrepancies exist in thresholds for age and
procedural risk used in choosing between SAVR and TAVI, role of biomarkers
and complementary imaging modalities to define AS severity and risk of
progression in asymptomatic patients.<br/>Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. &#xa9; The
Author(s) 2021. For permissions please email:
journals.permissions@oup.com.

<53>
Accession Number
634636368
Title
The association between preoperative length of hospital stay and deep
sternal wound infection: A scoping review.
Source
Australian critical care : official journal of the Confederation of
Australian Critical Care Nurses. (no pagination), 2021. Date of
Publication: 06 Mar 2021.
Author
Storey A.; MacDonald B.; Rahman M.A.
Institution
(Storey) Alfred Heart & Lung, The Alfred Hospital, 55 Commercial Road,
Melbourne, VIC 3004, Australia; School of Nursing and Midwifery, La Trobe
University, Plenty Rd & Kingsbury Dr, Bundoora, Melbourne, VIC 3086,
Australia
(MacDonald) Alfred Heart & Lung, The Alfred Hospital, 55 Commercial Road,
Melbourne, VIC 3004, Australia; Ward 2.2, Box Hill Hospital, Eastern
Health, 8 Arnold St, Box Hill, Melbourne, Victoria, 3128, Australia
(Rahman) School of Health, Federation University Australia, Berwick,
Melbourne, VIC 3806, Australia; Australian Institute of Primary Care and
Ageing, La Trobe University, Melbourne, VIC 3086, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Deep sternal wound infection (DSWI) is a serious complication
of cardiac surgery, associated with a significantly longer hospital stay,
an increased mortality, and an almost doubling of treatment costs. The
preoperative length of hospital stay has been suggested in a small number
of studies as a modifiable risk factor yet is not included in surgical
site infection prevention guidelines. The aim of this scoping review was
to review the existing evidence on the association between preoperative
length of hospital stay and DSWI, and to identify established risk factors
for DSWI. <br/>METHOD(S): A literature search of six electronic databases
yielded 2297 results. Titles concerning risk factors for DSWI, sternal or
surgical wound infection, or poststernotomy complications were included.
Abstracts relating to preoperative length of stay as a risk factor for
DSWI proceeded to full article review. Articles regarding paediatric
surgery, DSWI management or unavailable in English were excluded.
<br/>RESULT(S): The review identified 11 observational cohort studies.
DSWI prevalence was between 0.9% and 6.8%. Preoperative length of stay
ranged from 0-15.5 days and was found to be associated with DSWI in all
studies. Preoperative length of stay and DSWI were inconsistently defined.
Other risk factors for DSWI included diabetes, obesity, respiratory
disease, heart failure, renal impairment, complex surgery, and reoperation
(p < 0.05). <br/>CONCLUSION(S): In this scoping review, an association
between preoperative length of stay and the development of DSWI following
cardiac surgery was identified. Thus, preoperative length of stay as a
modifiable risk factor for DSWI should be considered for inclusion in
cardiothoracic surgical infection prevention guidelines.<br/>Copyright
&#xa9; 2021 Australian College of Critical Care Nurses Ltd. Published by
Elsevier Ltd. All rights reserved.

<54>
Accession Number
2011542431
Title
Spontaneous versus mechanical ventilation during video-assisted
thoracoscopic surgery for spontaneous pneumothorax: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Liu J.; Liang H.; Cui F.; Liu H.; Zhu C.; Liang W.; He J.; Wang W.; Jiang
S.; Dong Q.; Liang L.; Yang H.; Jin J.; Shen J.; Dai T.; He K.; Cai K.;
Feng S.; Wang H.; Zhang Z.; Huang H.; Cheng C.; Liu Z.; Qiao K.; Xia Z.;
Liu X.; Wang G.; Huang T.; Xu S.; Shen Q.; Tan W.; Ding J.; Liu Y.; Ye J.;
Yu J.; Zhang H.; Feng X.; Ma M.; Duan Z.; Li Y.; Ma H.; Ng C.S.H.;
Gonzalez-Rivas D.; Pompeo E.; Daley E.; Flores R.M.; Shargall Y.; Ismail
M.; Ang K.-L.; Ambrogi V.; Elkhouly A.
Institution
(Liu, Liang, Cui, Liang, He) National Clinical Research Center for
Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical
University, Guangzhou, China
(Liu, Liang, Cui, Liang, He) Department of Thoracic Surgery, the First
Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
(Liu) Department of Anesthesia, the First Affiliated Hospital of Guangzhou
Medical University, Guangzhou, China
(Zhu) Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
(He) Southern Medical University, Guangzhou, China
Publisher
Mosby Inc.
Abstract
Objective: Spontaneous ventilation video-assisted thoracic surgery
(SV-VATS) is reported to have superior or equal efficacy on postoperative
recovery to mechanical ventilation VATS (MV-VATS). However, perioperative
safety of the SV-VATS blebectomy is not entirely demonstrated.
<br/>Method(s): We performed a noninferiority, randomized controlled trial
(No. NCT03016858) for primary spontaneous pneumothorax patients aged 16 to
50 years undergoing a SV-VATS and the MV-VATS procedure. The trial was
conducted at 10 centers in China from April 2017 to January 2019. The
primary outcome was the comparison of intra- and postoperative
complications between SV-VATS and MV-VATS procedures. Secondary outcomes
included total analgesia dose, change of vital sign during surgery,
procedural duration, recovery time, postoperative visual analog pain
scores, and hospitalization length. <br/>Result(s): In this study, 335
patients were included. There was no significant difference between the
SV-VATS group and the MV-VATS group in the intra- and postoperative
complication rates (17.90% vs 22.09%; relative risk, 0.81; 95% confidence
interval, 0.52-1.26; P = .346). The SV-VATS group was associated with
significantly decreased total dose of intraoperative opioid agents; that
is, sufentanil (11.37 mug vs 20.92 mug; P < .001) and remifentanil (269.78
mug vs 404.96 mug; P < .001). The SV-VATS procedure was also associated
with shorter extubation time (12.28 minutes vs 17.30 minutes; P < .001),
postanesthesia care unit recovery time (25.43 minutes vs 30.67 minutes; P
= .02) and food intake time (346.07 minute vs 404.02 minutes; P = .002).
Moreover, the SV-VATS procedure deceased the anesthesia cost compared with
the MV-VATS ($297.81 vs $399.81; P < .001). <br/>Conclusion(s): SV-VATS
was shown to be noninferior to MV-VATS in term of complication rate and in
selected patients undergoing blebectomy for primary spontaneous
pneumothorax.<br/>Copyright &#xa9; 2021

<55>
Accession Number
634470428
Title
Effectiveness of social network interventions to support cardiac
rehabilitation and secondary prevention in the management of people with
heart disease.
Source
Cochrane Database of Systematic Reviews. 2020 (12) (no pagination), 2021.
Article Number: CD013820. Date of Publication: 05 Jan 2021.
Author
Purcell C.; Smillie S.; Hilton Boon M.; Simpson S.A.; Taylor R.S.
Institution
(Purcell, Smillie, Hilton Boon, Simpson) MRC/CSO Social and Public Health
Sciences Unit, University of Glasgow, Glasgow, United Kingdom
(Taylor) MRC/CSO Social and Public Health Sciences Unit & Robertson Centre
for Biostatistics, Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To assess the effectiveness of social network
and social support interventions to support cardiac rehabilitation and
secondary prevention in the management of people with heart disease. As a
secondary output of this review, and to assist in conceptualising future
research focused on social network and social support interventions, we
aim to develop a logic model theorising the relationship between social
networks or social support and heart disease outcomes. We will draw on
existing models of social support for health (e.g. Berkman 2000), as well
as established approaches to theorising and implementing behaviour change
(e.g. Michie 2011).<br/>Copyright &#xa9; 2020 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<56>
Accession Number
2011412218
Title
Comparison of transcatheter mitral-valve repair and surgical mitral-valve
repair in elderly patients with mitral regurgitation.
Source
Heart Surgery Forum. 24 (1) (pp E108-E115), 2021. Date of Publication: 13
Jan 2021.
Author
Yuan H.; Wei T.; Wu Z.; Lu T.; Chen J.; Zeng Y.; Tan L.; Huang C.
Institution
(Yuan, Wu, Lu, Chen, Zeng, Tan, Huang) Department of Cardiovascular
Surgery, The Second Xiangya Hospital, Central South University, Changsha,
Hunan, China
(Yuan, Wu, Lu, Tan, Huang) Engineering Laboratory of Hunan Province for
Cardiovascular Biomaterials, Hunan, China
(Wei) Department of Pediatrics, Hunan Provincial Maternal and Child Health
Care Hospital, Hunan, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Purpose: To summarize comparative studies of MitraClip versus surgical
repair in typical, real-world elderly patients with severe mitral
regurgitation (MR) and analyze the safety and effectiveness of these
therapeutic options. <br/>Method(s): PubMed, Medline, Embase, and Cochrane
Controlled Register of Trials (CENTRAL) were searched for comparative
studies of transcatheter mitral-valve repair (TMVR) versus surgical
mitral-valve repair (SMVR) in elderly patients with severe MR from January
2000 to June 2020. Statistical pooling for incidence estimates was
performed according to a random-effects model with generic
inverse-variance weighting, computing risk estimates with 95% confidence
intervals (CIs), using RevMan 5.3. <br/>Result(s): A total of 14 reports
comparing MitraClip with SMVR, enrolling 3355 patients with severe MR,
were included in this study. Mean age, Logistic EuroSCORE, and incidence
of diabetes mellitus (DM) were significantly higher in the MitraClip
group, except the rate of patients with New York Heart Association (NYHA)
class of >II and mean value of ejection fraction (EF). The arithmetic mean
of freedom from acute mobility was similar. The 2 groups had equal
all-cause mortality at 30 days, but different at 1 year (14% versus 9%)
and 3 years in 7 studies (37% versus 25%). The freedom from recurrent MR
>=3+ was 88% and 97.3% at 30 days, 76.0% and 90.0% at 1 year, and 79% and
95% at 3 years in the MitraClip and surgical repair group, respectively.
<br/>Conclusion(s): Although MitraClip is safe and effective in selected
high-risk patients, the surgery may be the only gold standard for "gray"
patients. Further studies are needed to determine whether MitraClip should
be recommended.<br/>Copyright &#xa9; 2021 Forum Multimedia Publishing LLC.
All rights reserved.

<57>
Accession Number
2011210335
Title
Mini or full sternotomy for aortic valve repair? Asystematic review of the
literature.
Source
Journal of Cardiovascular Surgery. 62 (1) (pp 19-24), 2021. Date of
Publication: February 2021.
Author
MURANA G.; PACINI D.
Institution
(MURANA, PACINI) Unit of Cardiac Surgery, Cardio-Thoracic-Vascular
Department, S. Orsola Hospital, Alma Mater Studiorum - University of
Bologna, Bologna, Italy
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Minimally invasive aortic valve replacement is becoming a
standard treatment. The possibility of extending this approach to more
demanding aortic root pathologies is being debated with limited evidence.
Attaining comfort in a complex aortic repair is a "dogma" that should
always be achieved. Perhaps, the patient's condition, the aortic anatomy
and the expertise creates the fundamental principles that achieve stable
results over time. EVIDENCEACQUISITION: Selection of literature articles
was performed using PubMed databases from inception to July 2020. We
excluded editorials and expert opinions, review articles, congenital heart
disease, and other types of valve repair. According to the limited studies
available, case reports were included. EVIDENCE SYNTHESIS: We identified 7
studies from 2015 to 2020 with the number of patients spanning 1 to 117
from single centers' experiences. Three were case reports with aortic
repair of a bicuspid aortic valve. A total of 259 mini-AVr patients were
analyzed. <br/>CONCLUSION(S): In this review article, we sought to analyze
and report the experience and results of a currently available series on
aortic valve repair (with or without associated aortic root procedures)
using mini sternotomy. Early- and long-term data will be reported and
discussed in terms of survival and aortic valve function.<br/>Copyright
&#xa9; 2021 Edizioni Minerva Medica. All rights reserved.

<58>
Accession Number
2008574731
Title
Meta-analysis Comparing Early Outcomes Following Transcatheter Aortic
Valve Implantation With the Evolut Versus Sapien 3 Valves.
Source
American Journal of Cardiology. 139 (pp 87-96), 2021. Date of Publication:
15 Jan 2021.
Author
Alperi A.; Faroux L.; Muntane-Carol G.; Rodes-Cabau J.
Institution
(Alperi, Faroux, Muntane-Carol, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, QC, Canada
Publisher
Elsevier Inc.
Abstract
We aimed to compare the early (in-hospital/30-day) outcomes (major
periprocedural complications, device success/valve performance, and
mortality) following transcatheter aortic valve implantation with the
Sapien 3 versus Evolut transcatheter valve systems. This was a systematic
review from PubMed and EMBASE databases for studies reporting raw data or
estimates. The outcomes analyzed were (1) in-hospital/30-day major
periprocedural complications, (2) device success and valve performance,
and (3) mortality. The outcomes were defined according to VARC-2 criteria.
A total of 24,628 transcatheter aortic valve implantation patients from 9
studies (1 randomized, 8 observational [5 case- or propensity-matched
analyses]) were included: 12,411 and 12,217 patients had Sapien 3 and
Evolut valve implantation, respectively. There were no differences between
devices regarding in-hospital/30-day stroke (risk ratio [RR] 0.95, 95%
confidence interval [CI] 0.34 to 2.66), major vascular complications (RR
1.03, 95% CI 0.63 to 1.68), acute kidney injury (RR 1.17, 95% CI 0.78 to
1.77), device success (RR 1.00, 95% CI 0.97 to 1.04) and moderate-severe
residual aortic regurgitation (RR 0.49, 95% CI 0.20 to 1.17). Sapien 3
recipients exhibited lower risk of permanent pacemaker implantation (RR
0.66, 95% CI 0.55 to 0.80), a higher risk of life-threatening bleeding (RR
1.82, 95% CI 1.18 to 2.80), and higher residual transvalvular gradients
(mean difference 3.95 mmHg, 95% CI 3.37 to 4.56). A lower risk of
in-hospital/30-day mortality was observed for Sapien 3 (RR 0.79, 95% CI
0.69 to 0.90). In conclusion, the similarities in device success rate and
major periprocedural complications (except for a higher and lower risk of
permanent pacemaker implantation and life-threatening bleeding,
respectively, with the Evolut system) support the lack of a valve type
effect accounting for the increased mortality risk observed with the
Evolut valve.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<59>
Accession Number
2008461055
Title
Meta-Analysis of Cerebral Embolic Protection During Transcatheter Aortic
Valve Replacement.
Source
American Journal of Cardiology. 139 (pp 138-139), 2021. Date of
Publication: 15 Jan 2021.
Author
Nazir S.; Zafrullah F.; Virk H.U.H.; Sandhu C.S.; Ameen M.; Ahuja K.R.
Institution
(Nazir, Zafrullah) Division of Cardiology, University of Toledo Medical
Center, Toledo, OH, United States
(Virk) Division of Cardiology, Case Western Reserve University/University
Hospitals Cleveland Medical Center, Cleveland, OH, United States
(Sandhu, Ameen, Ahuja) Division of Cardiology, Reading Hospital-Tower
Health System, West Reading, United States
Publisher
Elsevier Inc.

<60>
Accession Number
2004383245
Title
Developmental outcomes after early surgery for complex congenital heart
disease: a systematic review and meta-analysis.
Source
Developmental Medicine and Child Neurology. 63 (1) (pp 29-46), 2021. Date
of Publication: January 2021.
Author
Huisenga D.; La Bastide-Van Gemert S.; Van Bergen A.; Sweeney J.;
Hadders-Algra M.
Institution
(Huisenga, Van Bergen) Department of Pediatric Rehabilitation and
Development, Advocate Children's Hospital, Oak Lawn, IL, United States
(Huisenga, Hadders-Algra) University of Groningen, University Medical
Center Groningen, Department of Paediatrics, Division of Developmental
Neurology, Groningen, Netherlands
(La Bastide-Van Gemert) University of Groningen, University Medical Center
Groningen, Department of Epidemiology, Groningen, Netherlands
(Van Bergen) Advocate Children's Heart Institute Division of Pediatric
Cardiac Critical Care, Advocate Children's Hospital, Oak Lawn, IL, United
States
(Sweeney) Pediatric Science Doctoral Program, Rocky Mountain University of
Health Professions, Provo, UT, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aim: (1) To systematically review the literature on developmental outcomes
from infancy to adolescence of children with complex congenital heart
disease (CHD) who underwent early surgery; (2) to run a meta-regression
analysis on the Bayley Scales of Infant Development, Second Edition Mental
Developmental Index and Psychomotor Developmental Index (PDI) of infants
up to 24 months and IQs of preschool-aged children to adolescents; (3) to
assess associations between perioperative risk factors and outcomes.
<br/>Method(s): We searched pertinent literature (January 1990 to January
2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included
infants with complex CHD who had primary surgery within the first 9 weeks
of life. Methodological quality, including risk of bias and internal
validity, were assessed. <br/>Result(s): In total, 185 papers met the
inclusion criteria; the 100 with high to moderate methodological quality
were analysed in detail. Substantial heterogeneity in the group with CHD
and in methodology existed. The outcome of infants with single-ventricle
CHD was inferior to those with two-ventricle CHD (respectively: average
scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative
risk factors were inconsistently associated with developmental outcomes.
<br/>Interpretation(s): The literature on children undergoing surgery in
early infancy suggests that infants with a single ventricle are at highest
risk of adverse developmental outcomes.<br/>Copyright &#xa9; 2020 The
Authors. Developmental Medicine & Child Neurology published by John Wiley
& Sons Ltd on behalf of Mac Keith Press

<61>
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.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<62>
Accession Number
634558302
Title
Prophylactic use of inotropic agents for the prevention of low cardiac
output syndrome and mortality in adults undergoing cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2020 (11) (no pagination), 2020.
Article Number: CD013781. Date of Publication: 09 Nov 2020.
Author
Tongers J.; Efremov L.; Mikolajczyk R.; Sedding D.; Schumann J.
Institution
(Tongers, Sedding) Cardiology, Angiology and Intensive Care Medicine,
University Hospital Halle (Saale), Halle (Saale), Germany
(Efremov, Mikolajczyk) Institute for Medical Epidemiology, Biometrics and
Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical
School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale),
Germany
(Schumann) Department of Anaesthesiology and Surgical Intensive Care,
Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To assess the efficacy and safety of the
prophylactic use of any inotropic drug for the prevention of low cardiac
output states and associated morbidity and mortality, in adults undergoing
cardiac surgery.<br/>Copyright &#xa9; 2020 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<63>
Accession Number
2010172651
Title
Impact of COPD on Outcomes After MitraClip for Secondary Mitral
Regurgitation: The COAPT Trial.
Source
JACC: Cardiovascular Interventions. 13 (23) (pp 2795-2803), 2020. Date of
Publication: 14 Dec 2020.
Author
Saxon J.T.; Cohen D.J.; Chhatriwalla A.K.; Kotinkaduwa L.N.; Kar S.; Lim
D.S.; Abraham W.T.; Lindenfeld J.; Mack M.J.; Arnold S.V.; Stone G.W.
Institution
(Saxon, Chhatriwalla, Arnold) Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Saxon, Cohen, Chhatriwalla, Arnold) University of Missouri-Kansas City,
Kansas City, MO, United States
(Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to examine the relationship between
chronic obstructive pulmonary disease (COPD) and outcomes after
transcatheter mitral valve repair (TMVr) for severe secondary mitral
regurgitation. <br/>Background(s): TMVr with the MitraClip improves
clinical and health-status outcomes in patients with heart failure and
severe (3+ to 4+) secondary mitral regurgitation. Whether these benefits
are modified by COPD is unknown. <br/>Method(s): COAPT (Cardiovascular
Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart
Failure Patients With Functional Mitral Regurgitation) was an open-label,
multicenter, randomized trial of TMVr plus guideline-directed medical
therapy (GDMT) versus GDMT alone. Patients on corticosteroids or
continuous oxygen were excluded. Multivariable models were used to examine
the associations of COPD with mortality, heart failure hospitalization
(HFH), and health status and to test whether COPD modified the benefit of
TMVr compared with GDMT. <br/>Result(s): Among 614 patients, 143 (23.2%)
had COPD. Among patients treated with TMVr, unadjusted analyses
demonstrated increased 2-year mortality in those with COPD (hazard ratio
[HR]: 2.08; 95% confidence interval [CI]: 1.33 to 3.26), but this
association was attenuated after risk adjustment (adjusted HR: 1.48; 95%
CI: 0.87 to 2.52). Although TMVr led to reduced 2-year mortality among
patients without COPD (adjusted HR: 0.47; 95% CI: 0.33 to 0.67), for
patients with COPD, 2-year all-cause mortality was similar after TMVr
versus GDMT alone (adjusted HR: 0.94; 95% CI: 0.54 to 1.65;
p<inf>int</inf> = 0.04), findings that reflect offsetting effects on
cardiovascular and noncardiovascular mortality. In contrast, TMVr reduced
HFH (adjusted HR: 0.48 [95% CI: 0.28 to 0.83] vs. 0.46 [95% CI: 0.34 to
0.63]; p<inf>int</inf> = 0.89) and improved both generic and
disease-specific health status to a similar extent compared with GDMT
alone in patients with and without COPD (p<inf>int</inf> >0.30 for all
scales). <br/>Conclusion(s): In the COAPT trial, COPD was associated with
attenuation of the survival benefit of TMVr versus GDMT compared with
patients without COPD. However, the benefits of TMVr on both HFH and
health status were similar regardless of COPD. (Cardiovascular Outcomes
Assessment of the MitraClip Percutaneous Therapy for Heart Failure
Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT];
NCT01626079)<br/>Copyright &#xa9; 2020 American College of Cardiology
Foundation

<64>
Accession Number
2010606836
Title
Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary
Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus
Suffering from Left Main Coronary Disease: A Meta-Analysis.
Source
Diabetes Therapy. 12 (4) (pp 1041-1054), 2021. Date of Publication: April
2021.
Author
Wang H.; Wei Y.; Li X.; Jhummun V.; Ahmed M.A.
Institution
(Wang, Wang, Wei, Li) Department of Cardiology, The People's Hospital of
Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
(Jhummun) Nanjing Medical University, Nanjing, Jiangsu, China
(Ahmed) Department of Cardiology, Peking University People's Hospital,
Beijing, China
Publisher
Adis
Abstract
Introduction: In this meta-analysis, we aimed to systematically compare
the 10-year outcomes of percutaneous coronary intervention (PCI) versus
coronary artery bypass grafting (CABG) in patients with type 2 diabetes
mellitus (T2DM) suffering from left main coronary artery disease (LMCD).
<br/>Method(s): Medical Literature Analysis and Retrieval System Online
(MEDLINE), http://www.ClinicalTrials.gov, Excerpta Medica dataBASE
(EMBASE), Cochrane Central, Web of Science, and Google scholar were
searched for publications comparing 10-year outcomes of PCI versus CABG in
patients with T2DM suffering from LMCD. Cardiovascular outcomes were
considered as the clinical endpoints. Statistical analysis was carried out
using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence
intervals (CI) were used to represent the data after analysis.
<br/>Result(s): Eight studies (three randomized trials and five
observational studies) with a total number of 3835 participants with T2DM
were included in this analysis; 2340 participants were assigned to the PCI
group and 1495 participants were assigned to the CABG group. Results of
this analysis showed that mortality (RR 0.85, 95% CI 0.73-1.00; P = 0.05),
myocardial infarction (RR 0.53, 95% CI 0.35-0.80; P = 0.002), repeated
revascularization (RR 0.34, 95% CI 0.26-0.46; P = 0.00001), and target
vessel revascularization (RR 0.26, 95% CI 0.18-0.38; P = 0.00001) were
significantly higher with PCI when compared to CABG in these patients with
diabetes and LMCD. Major adverse cardiac and cerebrovascular events were
also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49-0.92;
P = 0.01). However, CABG was associated with a significantly higher risk
of stroke (RR 2.16, 95% CI 1.39-3.37; P = 0.0007). <br/>Conclusion(s):
During a long-term follow-up time period of 10 years, PCI was associated
with worse clinical outcomes compared to CABG in these patients with T2DM
suffering from LMCD. However, a significantly higher risk of stroke was
observed with CABG. This piece of information might be vital in order to
carefully choose and prevent complications following revascularization in
such patients.<br/>Copyright &#xa9; 2021, The Author(s).

<65>
Accession Number
2010564282
Title
Renin-angiotensin system inhibition and outcome after coronary artery
bypass grafting: A population-based study from the SWEDEHEART registry.
Source
International Journal of Cardiology. 331 (pp 40-45), 2021. Date of
Publication: 15 May 2021.
Author
Martinsson A.; Nielsen S.J.; Bjorklund E.; Pivodic A.; Malm C.J.; Hansson
E.C.; Jeppsson A.
Institution
(Martinsson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Martinsson, Nielsen, Bjorklund, Malm, Hansson, Jeppsson) Department of
Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg
University, Sweden
(Nielsen, Malm, Hansson, Jeppsson) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Bjorklund) Department of Medicine, South Alvsborg Hospital, Boras, Sweden
(Pivodic) Statistiska konsultgruppen, Gothenburg, Sweden
(Pivodic) Department of Ophthalmology, Institute of Neuroscience and
Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
Publisher
Elsevier Ireland Ltd
Abstract
Background: Renin-angiotensin system (RAS) inhibitors are recommended
postoperatively to coronary artery bypass grafting (CABG) patients with
reduced left ventricular function, diabetes, hypertension or previous
myocardial infarction, but not to remaining patients. The aim of the study
was to assess the long-term utilization of RAS inhibitors after CABG in
patients with and without indication for treatment, and its association
with outcome. <br/>Method(s): All patients (n = 28,782) not meeting
exclusion criterion in Sweden who underwent isolated first time CABG from
2006 to 2015 were included using nationwide registries. The association
between treatment and outcome was assessed using adjusted Cox regression
models with time-updated data on medications. The primary outcome was
major adverse cardiovascular events (MACE), defined as all-cause
mortality, stroke and/or myocardial infarction. <br/>Result(s): At
baseline 26,284 (91.3%) of the patients had at least one indication for
RAS inhibition while 2498 (8.7%) had not. RAS inhibitors were dispensed to
77.0% and 29.7% of patients with and without indication respectively.
Dispense declined over time. RAS inhibition was associated with a
reduction in MACE in the whole study population (adjusted hazard ratio
(aHR) 0.88, 95% confidence interval (95% CI) 0.83-0.93, p < 0.0001), and
in patients with (aHR 0.87 95% CI: 0.82-0.93, p < 0.0001) and without
indication (aHR 0.75, 95% CI: 0.58-0.98, p = 0.034). <br/>Conclusion(s):
RAS inhibition is underutilized after CABG. The use of RAS inhibitors was
associated with a reduction in MACE, both in patients with and without
indication for treatment. The results suggest that RAS inhibition is
beneficial for all CABG patients. Randomized controlled trials are
necessary to confirm this hypothesis.<br/>Copyright &#xa9; 2021 The
Authors

<66>
Accession Number
2007794510
Title
Impact of Proportionality of Secondary Mitral Regurgitation on Outcome
After Transcatheter Mitral Valve Repair.
Source
JACC: Cardiovascular Imaging. 14 (4) (pp 715-725), 2021. Date of
Publication: April 2021.
Author
Karam N.; Lubos E.; Kalbacher D.; Braun D.; Deseive S.; Neuss M.; Butter
C.; Praz F.; Kassar M.; Petrescu A.; Pfister R.; Iliadis C.; Unterhuber
M.; Lurz P.; Thiele H.; Baldus S.; Stephan von Bardeleben R.; Blankenberg
S.; Massberg S.; Windecker S.; Hausleiter J.; Stolz L.; Orban M.; Nabauer
M.; Puscas T.; Tence N.; Latremouille C.; Westermann D.; Schofer N.;
Ludwig S.; Bannehr M.; Kucken T.; Edlinger C.; Hahnel V.; Brugger N.;
Pilgrim T.; Winkel M.G.; von Bardeleben S.; Korber M.; Mauri V.; Wosten
M.; Stephan Baldus C.M.; Noack T.; Borger M.; Blazek S.; Desch S.
Institution
(Orban, Braun, Deseive, Massberg, Hausleiter) Medizinische Klinik und
Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany
(Orban, Massberg, Hausleiter) Munich Heart Alliance, Partner Site German
Center for Cardiovascular Disease, Munich, Germany
(Karam) Department of Cardiology, European Hospital Georges Pompidou and
Paris Cardiovascular Research Center, INSERM U970, Paris, France
(Lubos, Kalbacher, Blankenberg) UKE Hamburg, Klinik und Poliklinik fur
Allgemeine und Interventionelle Kardiologie, Hamburg, Germany
(Neuss, Butter) Herzzentrum Brandenburg, Medizinische Hochschule
Brandenburg Theodor Fontane, Bernau, Germany
(Praz, Kassar, Windecker) Universitatsklinik fur Kardiologie, Inselspital,
Bern, Switzerland
(Petrescu, Stephan von Bardeleben) Zentrum fur Kardiologie, Johannes
Gutenberg-Universitat, Mainz, Germany
(Pfister, Iliadis, Baldus) Department III of Internal Medicine, Heart
Center, University of Cologne, Cologne, Germany
(Unterhuber, Lurz, Thiele) Department of Cardiology, Heart Center Leipzig
at University of Leipzig, Leipzig, Germany
Publisher
Elsevier Inc.
Abstract
Objectives: The purpose of this paper was to evaluate the impact of
proportionality of secondary mitral regurgitation (SMR) in a large
real-world registry of transcatheter edge-to-edge mitral valve repair
(TMVr) Background: Differences in the outcomes of recent randomized trials
of TMVr for SMR may be explained by the proportionality of SMR severity to
left ventricular (LV) volume. <br/>Method(s): The ratio of pre-procedural
effective regurgitant orifice area (EROA) to LV end-diastolic volume
(LVEDV) was retrospectively assessed in patients undergoing TMVr for
severe SMR between 2008 and 2019 from the EuroSMR registry. A recently
proposed SMR proportionality scheme was adapted to stratify patients
according to EROA/LVEDV ratio in 3 groups: MR-dominant (MD),
MR-LV-co-dominant (MLCD), and LV-dominant (LD). All-cause mortality was
assessed as a primary outcome, secondary heart failure (HF) outcomes
included hospitalization for HF (HHF), New York Heart Association (NYHA)
functional class, N-terminal pro-B-type natriuretic peptide (NT-proBNP),
6-min-walk distance, quality of life and MR grade. <br/>Result(s): A total
of 1,016 patients with an EROA/LVEDV ratio were followed for 22 months
after TMVr. MR was reduced to grade <=2+ in 92%, 96%, and 94% of patients
(for MD, MLCD, and LD, respectively; p = 0.18). After adjustment for
covariates including age, sex, diabetes, kidney function, body surface
area, LV ejection fraction, and procedural MR reduction (grade <=2+),
adjusted rates of 2-year mortality in MD patients did not differ from
those for MLCD patients (17% vs. 18%, respectively), whereas it was higher
in LD patients (23%; p = 0.02 for comparison vs. MD+MLCD). The adjusted
first HHF rate differed between groups (44% in MD, 56% in MLCD, 29% in LD;
p = 0.01) as did the adjusted time for first death or HHF rate (66% in MD,
82% in MLCD, 68% in LD; p = 0.02). Improvement of NYHA functional class
was seen in all groups (p < 0.001). Values for 6-min-walk distances,
quality of life and NT-proBNP improved in most patients.
<br/>Conclusion(s): MD and MLCD patients had a comparable, adjusted 2-year
mortality rate after TMVr which was slightly better than that of LD
patients. Patients treated with TMVr had symptomatic improvement
regardless of EROA/LVEDV ratio.<br/>Copyright &#xa9; 2021 American College
of Cardiology Foundation

<67>
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.
<br/>Copyright &#xa9;

<68>
Accession Number
634189689
Title
Comparison of major bleeding in patients with acute coronary syndrome that
underwent coronary artery bypass grafting treated with clopidogrel or
ticagrelor: A systematic review and meta-analysis.
Source
F1000Research. 9 (no pagination), 2020. Article Number: 99. Date of
Publication: 2020.
Author
Tamara F.; Heriansyah T.; Pikir B.S.; Fajar J.K.; Rohman M.S.; Purnamasari
Y.; Ilmawan M.; Mahdi B.A.; Mahendra A.I.; Mazen M.; Yamin M.
Institution
(Rohman) Brawijaya Cardiovascular Research Center, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya, Malang, East Java 65145, Indonesia
(Purnamasari, Ilmawan) Faculty of Medicine, Universitas Brawijaya, Malang,
East Java 65145, Indonesia
(Mahdi) Department of Internal Medicine, Faculty of Medicine, Universitas
Airlangga, Surabaya, East Java 60115, Indonesia
(Tamara, Fajar, Mahendra, Mazen) Brawijaya Internal Medicine Research
Center, Department of Internal Medicine, Faculty of Medicine, Universitas
Brawijaya, Malang, East Java 65145, Indonesia
(Heriansyah) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
(Yamin) Division of Cardiovascular Medicine, Department of Internal
Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Jakarta
16424, Indonesia
(Pikir) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Airlangga, Surabaya, East Java 60115, Indonesia
Publisher
F1000 Research Ltd
Abstract
Background: There is controversy among physicians regarding the use of
dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients
treated with coronary artery bypass grafting (CABG). Moreover, the
evidence of previous studies about this topic remained inconclusive. This
study aimed to perform a meta-analysis concerning the relation between the
risk of major bleeding and the use of different DAPT (clopidogrel or
ticagrelor) in ACS patients treated with CABG. <br/>Method(s): A
meta-analysis was conducted during March to October 2019. Searches were
carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor
covariate in our present study was DAPT (clopidogrel or ticagrelor), and
the outcome measure was the risk of major bleeding. Sub-group analysis was
also performed, where data were classified into pre- and post-CABG.
Furthermore, to determine the correlation and effect estimation, data were
analyzed using fixed or random effect model. <br/>Result(s): A total of 13
studies consisting 34,015 patients treated with clopidogrel and 32,661
patients treated with ticagrelor was included in our study. Our pooled
calculation revealed that the incidence of major bleeding was not
different significantly between clopidogrel and ticagrelor. In pre- and
post-CABG sub-groups, our results also found no significant difference in
major bleeding incidence between clopidogrel and ticagrelor groups.
<br/>Conclusion(s): Our meta-analysis clarifies that clopidogrel, compared
to ticagrelor, or vice versa, is not associated with the risk of major
bleeding in ACS patients treated with CABG.<br/>Copyright &#xa9; 2020
Rohman MS et al.

<69>
Accession Number
2011020683
Title
Survival outcomes and adverse events in patients with chronic kidney
disease after coronary artery bypass grafting and percutaneous coronary
intervention: a meta-analysis of propensity score-matching studies.
Source
Renal Failure. 43 (1) (pp 606-616), 2021. Date of Publication: 2021.
Author
Yang Y.-G.; Li N.; Chen M.-H.
Institution
(Yang, Chen) Department of Intensive Care Medicine, The Second Affiliated
Hospital of Guangxi Medical University, Nanning, China
(Li) Guangxi Medical University, Nanning, China
Publisher
Taylor and Francis Ltd.
Abstract
Background: The present meta-analysis of propensity score-matching studies
aimed to compare the long-term survival outcomes and adverse events
associated with coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI) in patients with chronic kidney disease (CKD).
<br/>Method(s): Electronic databases were searched for studies comparing
CABG and PCI in patients with CKD. The search period extended to 13
February 2021. The primary outcome was all-cause mortality, and the
secondary endpoints included myocardial infarction, revascularization, and
stroke. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence
intervals (CIs) were used to express the pooled effect. Study quality was
assessed using the Newcastle-Ottawa scale. The analyses were performed
using RevMan 5.3. <br/>Result(s): Thirteen studies involving 18,005
patients were included in the meta-analysis. Long-term mortality risk was
significantly lower in the CABG group than in the PCI group (HR: 0.76, 95%
CI: 0.70-0.83, p <.001), and similar results were observed in the subgroup
analysis of patients undergoing dialysis and for different estimated
glomerular filtration rate ranges. The incidence rates of myocardial
infarction (OR: 0.25, 95% CI: 0.12-0.54, p <.001) and revascularization
(OR: 0.17, 95% CI: 0.08-0.35, p <.001) were lower in the CABG group than
in the PCI group, although there were no significant differences in the
incidence of stroke between the two groups (OR: 1.24; 95% CI: 0.89-1.73, p
>.05). Subgroup analysis among patients on dialysis yielded similar
results. <br/>Conclusion(s): Our propensity score matching analysis
revealed that, based on long-term follow-up outcomes, CABG remains
superior to PCI in patients with CKD.<br/>Copyright &#xa9; 2021 The
Author(s). Published by Informa UK Limited, trading as Taylor & Francis
Group.

<70>
Accession Number
2010980700
Title
Bilateral continuous erector spinae block versus multimodal intravenous
analgesia in coronary bypass surgery. A Randomized Trial.
Source
Egyptian Journal of Anaesthesia. 37 (1) (pp 152-158), 2021. Date of
Publication: 2021.
Author
Wasfy S.F.; Kamhawy G.A.; Omar A.H.; Abd El Aziz H.F.
Institution
(Wasfy, Abd El Aziz) Lecturer of Anesthesia, Faculty of Medicine, Ain
Shams University, Cairo, Egypt
(Kamhawy) Faculty of Medicine, Suez Canal University, Ismailia, Egypt
(Omar) Faculty of Medicine, Ain Shams University, Cairo, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Multiple studies have confirmed that erector spinae block is effective in
thoracic and breast surgeries. However, studies which investigate the
efficacy of this block in cardiac surgery are scarce. This study aimed to
compare continuous erector spinae block with multimodal intravenous
analgesia in coronary bypass surgery. <br/>Method(s): Forty patients
undergoing coronary bypass surgery were divided into either group A (IV)
(n = 20) who received multimodal intravenous analgesia or group B (ES) (n
= 20) who had continuous erector spinae block. We compared the two groups
regarding Visual Analog Scale (VAS) till 48 h after extubation, total
perioperative opioid consumption, post-extubation peak inspiratory flow,
duration of mechanical ventilation and ICU stay. <br/>Result(s): Group B
showed a significantly lower VAS score than group A. intraoperative
fentanyl was significantly less in group B (403.75 +/- 44.63) versus (685
+/- 99.47) in group A, p = 0.00. Postoperative morphine doses were 50%
less in group B; (15.9 +/- 2.63) versus (32.3 +/- 5.04) in group A, p =
0.00. Peak inspiratory flow was significantly higher in group B after
extubation. Duration of ventilation was shorter in group B (4.96 +/- 0.71
h) versus (6.08 +/- 0.69) in group A, p = 0.00. In addition, ICU stay was
also shorter in group B (35.52 +/- 3.87 h) versus (47.06 +/- 5.08 h) in
group A, p = 0.00. No clinically significant adverse effects were
recorded. <br/>Conclusion(s): Ultrasound-guided bilateral continuous
erector spinae block produced safe and effective analgesia for 48 h after
extubation following coronary bypass surgery. It also reduced
perioperative opioid consumption and allowed early tracheal extubation
without major adverse effects.<br/>Copyright &#xa9; 2021 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<71>
Accession Number
2011023358
Title
Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A
Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2021. Date of Publication: 2021.
Author
Hage A.; Hage F.; Al-Amodi H.; Gupta S.; Papatheodorou S.I.; Hawkins R.;
Ailawadi G.; Mittleman M.A.; Chu M.W.A.
Institution
(Hage, Hage, Al-Amodi, Chu) Western University, London, ON, Canada
(Hage, Hage, Gupta, Papatheodorou, Mittleman) Department of Epidemiology,
Harvard T.H. Chan School of Public Health, Boston, MA, United States
(Hawkins, Ailawadi) University of Virginia, Charlottesville, VA, United
States
Publisher
SAGE Publications Ltd
Abstract
Objective: The safety of minimally invasive mitral valve surgery (MIMVS)
in elderly patients is still debated. Our objective was to perform a
systematic review and meta-analysis of studies comparing MIMVS with
conventional sternotomy (CS) in elderly patients (>=65 years old).
<br/>Method(s): We searched PubMed, EMBASE, Web of Science,
clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for
trials and observational studies comparing MIMVS with CS in patients >=65
years old presenting for mitral valve surgery. We performed a
random-effects meta-analysis of all outcomes. <br/>Result(s): The MIMVS
group had lower odds of acute renal failure (odds ratio [OR] 0.27; 95% CI
0.10 to 0.78), prolonged intubation (>48 h; OR 0.47; 95% CI 0.31 to 0.70),
less blood product transfusion (weighted mean difference [WMD] -0.82
units; 95% CI -1.29 to -0.34 units), shorter ICU length of stay (LOS; WMD
-2.57 days; 95% CI -3.24 to -1.90 days) and hospital LOS (WMD -4.06 days;
95% CI -5.19 to -2.94 days). There were no significant differences in the
odds of mortality, stroke, respiratory infection, reoperation for
bleeding, and postoperative atrial fibrillation. MIMVS was associated with
longer cross-clamp (WMD 11.8 min; 95% CI 3.5 to 20.1 min) and
cardiopulmonary bypass times (WMD 23.0 min; 95% CI 10.4 to 35.6 min).
<br/>Conclusion(s): MIMVS in elderly patients is associated with lower
postoperative complications, blood transfusion, shorter ICU, and hospital
LOS, and longer cross-clamp and bypass times.<br/>Copyright &#xa9; The
Author(s) 2021.

<72>
Accession Number
2010983563
Title
Benefits of mitral valve repair over replacement in the elderly: a
systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Di Tommaso E.; Rapetto F.; Guida G.A.; Zakkar M.; Bruno V.D.
Institution
(Di Tommaso, Bruno) Bristol Medical School, Translational Health Science,
University of Bristol, Bristol, United Kingdom
(Rapetto, Guida) Bristol Heart Institute, University Hospital Bristol and
Weston NHS Foundation Trust, Bristol, United Kingdom
(Zakkar) Department of Cardiovascular Sciences, Clinical Sciences Wing,
Glenfield General Hospital, University of Leicester, Leicester, United
Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: Mitral valve (MV) repair has demonstrated excellent short- and
long-term outcomes, however, its merit in the elderly population is still
debated. We conducted a meta-analysis of studies that have compared the MV
repair to replacement in the elderly population. <br/>Method(s): A
systematic literature search was conducted for any study published on MV
surgery on elderly patients (>=75 years old). A pooled risk-ratio
meta-analysis was done to evaluate short-term mortality, postoperative
complications, surgical timings, and long-term survival rates.
<br/>Result(s): A total of nine retrospective observational studies were
included in the quantitative meta-analysis. Pooled meta-analysis showed a
reduced risk of short-term mortality for the MV repair group (risk ratio
[RR] = 0.41 [0.24-0.71], p-value =.005). Postoperative neurological
complications were in favor of repair, although not significantly (RR =
0.49 [0.21-1.11], p-value =.07). Operative timings (cardiopulmonary bypass
and crossclamp time) were not different between the groups although no
data were available on the complexity of the repairs. Long-term survival
rates were in favor of the repairs (pooled treatment effect of -0.47
[-0.64; -0.29], p =.005). <br/>Conclusion(s): MV surgery is a safe and
effective procedure for the elderly. MV repair demonstrated better
short-term outcomes compared to replacement. Long-term survival rates are
significantly better after repair.<br/>Copyright &#xa9; 2021 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals LLC

<73>
Accession Number
2010983405
Title
Global longitudinal strain to determine optimal timing for surgery in
primary mitral regurgitation: A systematic review.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Modaragamage Dona A.C.; Afoke J.; Punjabi P.P.; Kanaganayagam G.S.
Institution
(Modaragamage Dona) Faculty of Medicine, Imperial College London, London,
United Kingdom
(Afoke, Punjabi) Department of Cardiothoracic Surgery, National Heart and
Lung Institute, Imperial College London, Imperial College Healthcare NHS
Trust, Hammersmith Hospital, London, United Kingdom
(Kanaganayagam) Department of Cardiology, National Heart and Lung
Institute, Imperial College London, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
Publisher
Blackwell Publishing Inc.
Abstract
Background: Primary mitral regurgitation (PMR) results in adverse
remodeling changes and left ventricular (LV) dysfunction. Assessing LV
function has prognostic value in predicting morbidity and mortality.
Indications for surgery include parameters such as LV ejection fraction
(LVEF) and systolic dimensions. Current guidelines are limited in
identifying patients at optimal time for surgery. Impaired postoperative
LVEF indicates poor prognostic outcomes and subsequent heart failure.
Global longitudinal strain (GLS) via speckle tracking echocardiography
(STE) presents as a promising parameter to detect subclinical dysfunction
in asymptomatic patients. <br/>Method(s): Following PRISMA guidelines, a
literature search was conducted with Cochrane Library, PudMed, SCOPUS, and
Web of Science. Key MeSH terms included "mitral regurgitation," "mitral
valve insufficiency," "global longitudinal strain," "deformation,"
"LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe
PMR, (2) mixed population of symptomatic and asymptomatic patients, (3)
standardized methods in assessing LV systolic function using 2D-STE, (4)
valve repair or replacement surgery, and (5) patient outcomes measured
after surgery. Search returned 234 papers, 12 of which met the inclusion
criteria and were subsequently reviewed. <br/>Result(s): Baseline GLS is
an independent predictor of postoperative outcomes, ranging from -17.9 to
-21.7% GLS. A significant negative correlation was observed between
preoperative GLS and postoperative LVEF. Impaired baseline GLS was
associated with higher mortality rates. Better long-term survival rates
were seen in patients who underwent early surgery. <br/>Conclusion(s): GLS
shows sensitivity in predicting long-term postoperative outcomes. Further
analysis is required to determine preoperative GLS threshold to identify
asymptomatic patients at the optimal time for mitral valve
surgery.<br/>Copyright &#xa9; 2021 The Authors. Journal of Cardiac Surgery
Published by Wiley Periodicals LLC

<74>
Accession Number
2010983387
Title
Mitral valve repair for mitral regugitation in the elderly: Yes, we have
to, but look at the etiologies!.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Calafiore A.M.; Di Marco M.; Guarracini S.; Katsavrias K.; Di Mauro M.
Institution
(Calafiore) Department of Cardiovascular Sciences, Gemelli Molise,
Campobasso, Italy
(Di Marco) Department of Cardiology, "Santo Spirito" Hospital, Pescara,
Italy
(Guarracini) Department of Cardiology, "Pierangeli" Hospital, Pescara,
Italy
(Katsavrias) Department of Cardiac Surgery, Henry Durant Hospital, Athens,
Greece
(Di Mauro) Cardio-Thoracic Surgery Unit, Heart and Vascular Centre,
Maastricht University Medical Centre (MUMC), Cardiovascular Research
Institute Maastricht (CARIM), Maastricht, Netherlands
Publisher
Blackwell Publishing Inc.
Abstract
The meta-analysis by Di Tommaso et al. demonstrated as elderly patients
with mitral regurgitation (MR) undergoing mitral valve repair had lower
short-term mortality and higher long-term survival with respect to
patients undergoing mitral valve replacement. The benefit of repair is
such, that initial surgical strategy is advisable in the elderly even in
case of mild symptoms if compared with conservative management. However,
even if repair can be performed in presence of some specific etiologies,
as degenerative MR or secondary MR, there are always cases where a
replacement can be an acceptable solution compared to a repair with
uncertain future, regardless of our believes and our technical
ability.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<75>
Accession Number
630834764
Title
Postpericardiotomy syndrome after cardiac operations.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30 (1) (pp
62-66), 2020. Date of Publication: 01 Jan 2020.
Author
Yuan S.-M.
Institution
(Yuan) Division of Cardiac Surgery, Department of Cardiothoracic Surgery,
First Hospital of Putian, Teaching Hospital, Fujian Medical University,
Chengxiang District, Fujian Province, China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
The postpericardiotomy syndrome (PPS) is an important cause of morbidity
and mortality following heart operation. This systematic review reviewed
the literature regarding PPS. It was found to occur on day 18.3 +/-15.9
after cardiac operations, most often after coronary artery bypass
grafting, and mitral valve replacement. The most common symptoms were
new/worsening pericardial effusions, pleuritic chest pain, and fever. The
inflammation markers, such as C-reactive protein and erythrocyte
sedimentation rate, were found to increase significantly in each patient
who had these parameters examined. The subjects were managed
conservatively in 472 (83.5%) patients, by surgical pericardial drainage
in 85 (15.0%) patients, by thora-/pericardio-centesis in 3 (0.5%)
patients, and were under surveillance without being treated in 5 (0.9%)
patients. Conservative treatment was likely to be associated with a higher
recovery rate. Surgical trauma and cardiopulmonary bypass trigger the
systemic inflammatory response, which results in antiheart autoantigen
release, and the deposited immune complex could be found in the
pericardial, pleural, and lung tissues, thereby provoking the occurrence
of PPS. Therapeutic options for the refractory cases are long-term oral
corticoids or pericardiectomy. Surgical intervention was warranted in 2.6%
of the cases due to cardiac tamponade.<br/>Copyright &#xa9; 2020 College
of Physicians and Surgeons Pakistan. All rights reserved.

<76>
Accession Number
2011210337
Title
Transesophageal echocardiography during endovascular procedures for
thoracic aorta diseases: Sensitivity and specificity analysis.
Source
Journal of Cardiovascular Surgery. 62 (1) (pp 79-86), 2021. Date of
Publication: February 2021.
Author
NANA P.N.; BROTIS A.G.; TSOLAKI V.; SPANOS K.; MPATZALEXIS K.; ZAKYNTHINOS
E.; GIANNOUKAS A.D.; KOUVELOS G.N.
Institution
(NANA, SPANOS, MPATZALEXIS, GIANNOUKAS, KOUVELOS) Department of Vascular
Surgery, Faculty of Medicine, School of Health Sciences, University of
Thessaly, Larissa University Hospital, Larissa, Greece
(BROTIS) Department of Neurosurgery, Faculty of Medicine, School of Health
Sciences, University of Thessaly, Larissa University Hospital, Larissa,
Greece
(TSOLAKI, ZAKYNTHINOS) Intensive Care Unit, Faculty of Medicine, School of
Health Sciences, Larissa University Hospital, University of Thessaly,
Larissa, Greece
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The widespread use of endovascular repair in thoracic aorta
(TEVAR) pathologies has ameliorated postoperative outcomes. This
meta-analysis was designed to investigate the intra-operative use of
transesophageal echocardiography (TEE) compared to angiography in patients
undergoing TEVAR. EVIDENCEACQUISITION: The meta-analysis was conducted
using the Preferred Reporting Items for Systematic Reviews and
Meta-Analysis statement (PRISMA) guidelines. Adata search of the English
literature was conducted, using PubMed, EMBASEand CENTRALdatabases, until
November 30, 2019. The Grading of Recommendations, Assessment, Development
and Evaluation (GRADE) approach was used to evaluate the quality of
evidence and the summary of findings for each of the included outcomes.
EVIDENCE SYNTHESIS: The final analysis included 7 articles (183 patients).
All patients underwent TEVAR using intra-operative TEE and angiography.
The sensitivity and specificity rates of entry points were 0.624 (95% CI:
0.145-0.97) and 0.377 (95% CI: 0.029-0.856), respectively. Regarding the
detection of adequate guidewire advancement, the sensitivity was 0.778
(95% CI: 0.288-939) and specifity 0.346 (95% CI: 0.019-0.844). TEE could
detect endograft incomplete deployment within acceptable rates of
sensitivity and specifity, estimated at 0.616 (95% CI: 0.141-0.971) and
0.365 (95% CI: 0.028-0.845), respectively. The intra-operative detection
of endoleaks presented a sensitivity estimated at 0.875 (0.51-0.998) and
specificity at 0.698 (95% CI: 0.284-0.904). <br/>CONCLUSION(S): Despite
the limitations of this analysis, TEEmay be evaluated in the current
endovascular era, as a useful tool, providing adequate information, on
graft deployment and early endoleaks.<br/>Copyright &#xa9; 2021 Edizioni
Minerva Medica. All rights reserved.

<77>
Accession Number
2010583967
Title
Impact of Myocardial Scar on Prognostic Implication of Secondary Mitral
Regurgitation in Heart Failure.
Source
JACC: Cardiovascular Imaging. 14 (4) (pp 812-822), 2021. Date of
Publication: April 2021.
Author
Tayal B.; Debs D.; Nabi F.; Malahfji M.; Little S.H.; Reardon M.; Zoghbi
W.; Kleiman N.; Shah D.J.
Institution
(Tayal, Debs, Nabi, Malahfji, Little, Reardon, Zoghbi, Kleiman, Shah)
Houston Methodist DeBakey Heart and Vascular Center, Division of
Cardiovascular Imaging, Houston, TX, United States
(Tayal) Aalborg University Hospital, Department of Cardiology, Aalborg,
Denmark
Publisher
Elsevier Inc.
Abstract
Objectives: The objective of the present study was to use cardiovascular
magnetic resonance (CMR) to examine the natural history of secondary MR
severity and the implication of left ventricular (LV) scar on its
prognostic significance. <br/>Background(s): There is a need for further
understanding of the prognostic implication of secondary mitral
regurgitation (MR) given the heterogeneous findings of the 2 recent
randomized trials on percutaneous mitral intervention in patients with
secondary MR. <br/>Method(s): Patients with heart failure were enrolled
into a prospective observational registry between 2008 and 2019. Outcomes
were a composite of all-cause death, heart transplantation, or LV assist
device implantation at follow-up. CMR was used to quantify the mitral
regurgitation volume and mitral regurgitation fraction (MRF) along with
scar burden utilizing late gadolinium enhancement. Patients were
categorized into 4 subgroups based on presence and tertiles of scar
extent: no scar, limited scar (scar burden 1% to 4%), intermediate scar
(scar burden 5% to 20%), and extensive scar (scar burden >20%).
<br/>Result(s): Among patients (n = 441) included in the study (age 59 +/-
14 years, 43% with ischemic etiology), 85 (19%) experienced an adverse
event. MRF >=30% was associated with increased risk of events among the
study group (hazard ratio: 1.74; 95% confidence interval: 1.10 to 2.76; p
= 0.02). When stratified by presence or absence of scar, MRF >=30% was
associated with events only among patients with scar (hazard ratio: 1.67;
95% confidence interval: 1.02 to 2.76; p = 0.04) but not among patients
without scar. On further classification of patients with scar, the
prognostic significance of secondary MR was observed primarily among
patients with intermediate scar burden. <br/>Conclusion(s): The natural
history of secondary MR is complex, and outcomes are affected by severity
of MR and vary depending upon the extent of scar. (DeBakey Cardiovascular
Magnetic Resonance Study [DEBAKEY-CMR]; NCT04281823)<br/>Copyright &#xa9;
2021 American College of Cardiology Foundation

<78>
Accession Number
2007884736
Title
Sugammadex for Fast-Track Surgery in Children Undergoing Cardiac Surgery:
A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (5) (pp 1388-1392),
2021. Date of Publication: May 2021.
Author
Li L.; Jiang Y.; Zhang W.
Institution
(Li) Department of Anesthesiology, Wenzhou Central Hospital, Wenzhou,
China
(Jiang) Department of Anesthesiology, Shanghai Children's Hospital,
Shanghai Jiao Tong University, Shanghai, China
(Zhang) Department of Anesthesiology, Women and Children's Hospital of
Jiaxing University, Jiaxing, China
Publisher
W.B. Saunders
Abstract
Objective: The purpose of this study was to evaluate the safety and
efficacy of sugammadex for fast-track surgery in children undergoing
cardiac surgery. <br/>Design(s): This was a prospective, randomized,
controlled clinical study. <br/>Setting(s): University hospital.
<br/>Participant(s): The study comprised 60 children undergoing cardiac
surgery. <br/>Intervention(s): The children in group S received
sugammadex, 4 mg/kg, for reversal of neuromuscular block, and the children
in group N received neostigmine, 30 microg/kg, and atropine, 15 microg/kg.
<br/>Measurements and Main Results: The recovery time to a train-of-four
of 0.9 and extubation time were significantly shorter in the group S than
in group N (3.4 +/- 1.2 min v 76.2 +/- 20.5 min and 31.0 +/- 6.4 min v
125.2 +/- 21.6 min, respectively; p < 0.01). The heart rate after drug
administration was higher in group S than in group N (102.7 +/- 9.4
beats/min v 96.9 +/- 8.5 beats/min; p = 0.03), whereas the mean arterial
pressure after drug administration was similar in both groups. The length
of hospital stay was shorter in group S (5.8 +/- 1.0 v 6.5 +/- 0.9 days; p
= 0.03), and the hospitalization expenses were decreased in group S
compared with that of group N ($1,036 +/- $114 v $1,286 +/- $187; p <
0.01). The incidence of postoperative atelectasis was less in group S than
in group N (0 v 20%; p = 0.024). <br/>Conclusion(s): Sugammadex can
shorten the extubation time and reduce the incidence of postoperative
atelectasis, with fewer adverse events, in children undergoing cardiac
surgery. It may be beneficial to use sugammadex for fast-track surgery in
children undergoing cardiac surgery.<br/>Copyright &#xa9; 2020 Elsevier
Inc.

<79>
Accession Number
2011498754
Title
Native Aortic Root Thrombosis After Norwood Palliation for Hypoplastic
Left Heart Syndrome.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Rajab T.K.; Mitchell M.B.
Institution
(Rajab) Section of Pediatric Cardiothoracic Surgery, Medical University of
South Carolina, Charleston, SC, United States
(Mitchell) Section of Congenital Cardiac Surgery, University of Colorado,
Aurora, CO, United States
Publisher
Elsevier Inc.
Abstract
Background: Norwood palliation for hypoplastic left heart syndrome
typically results in retrograde perfusion of the native aortic root. This
may predispose to native aortic root thrombosis (NART). <br/>Method(s):
Patients who underwent stage 1 Norwood palliation at Children's Hospital
Colorado between 2003 and 2019 were retrospectively reviewed for NART.
Additional patients were identified by a systematic literature review.
Patient factors, operative details, presentation, diagnostic methods,
treatments, and outcomes were analyzed. <br/>Result(s): Three patients
with NART were identified among 241 patients who had undergone stage 1
Norwood palliation at Children's Hospital Colorado (mean follow-up, 48
months). A fourth patient identified at Children's Hospital Colorado had
undergone stage 1 palliation elsewhere. The systematic literature review
identified 12 additional patients. Among the 16 patients, patients
presented with new arrhythmias (38% [n = 6]), evidence of ischemia (31% [n
= 5]), incidentally (19% [n = 3]), inability to wean from postoperative
support (6% [n = 1]), and cardiac arrest (6% [n = 1). The diagnosis was
made by transthoracic echocardiography (TTE) in 50% (n = 8),
transesophageal echocardiography in 19% (n = 3), cardiac catheterization
in 25% (n = 4), and cardiac computed tomography in 6% (n = 1).
Importantly, 44% (n = 7) of patients were missed by TTE and subsequently
diagnosed by other methods. Treatment strategies were surgical
thrombectomy in 38% (n = 6), anticoagulation alone in 38% (n = 6), direct
catheter thrombolysis in 19% (n = 3), and systemic thrombolysis in 6% (n =
1). The rate of mortality or transplant listing was 44% (n = 7).
<br/>Conclusion(s): NART is an underappreciated complication of Norwood
palliation with high mortality. There should be a high index of suspicion
for NART in patients after Norwood palliation with an unexplained
complicated clinical course. Importantly, NART is frequently missed by
TTE.<br/>Copyright &#xa9; 2021