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<1>
Accession Number
2007499317
Title
Relationship between interleukin-1beta gene expression in epicardial
adipose tissue and coronary atherosclerosis based on computed tomographic
analysis.
Source
Journal of Cardiovascular Computed Tomography. 15 (2) (pp 175-179), 2021.
Date of Publication: 01 Mar 2021.
Author
Kitagawa T.; Hattori T.; Sentani K.; Senoo A.; Fujii Y.; Takahashi S.;
Yasui W.; Nakano Y.; Kihara Y.
Institution
(Kitagawa, Senoo, Fujii, Nakano, Kihara) Department of Cardiovascular
Medicine, Hiroshima University Graduate School of Biomedical and Health
Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8551, Japan
(Hattori, Sentani, Yasui) Department of Molecular Pathology, Hiroshima
University Institute of Biomedical and Health Sciences, 1-2-3 Kasumi,
Minami-Ku, Hiroshima 734-8551, Japan
(Hattori) Department of Pathology, National Hospital Organization
Higashi-Hiroshima Medical Center, 513 Saijojike, Higashi, Hiroshima
739-0041, Japan
(Takahashi) Department of Cardiovascular Surgery, Hiroshima University
Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8551, Japan
(Kihara) Kobe City Medical Center General Hospital, 2-1-1
Minatojimaminamimachi, Chuo-Ku, Kobe 650-0047, Japan
Publisher
Elsevier Inc.
Abstract
Background: Anti-inflammatory therapy targeting interleukin (IL)-1beta
reduced cardiovascular events in a randomized trial. We evaluated the
relationship between IL-1beta mRNA expression in epicardial adipose tissue
(EAT) and clinically-assessed coronary atherosclerosis on computed
tomography (CT). Method(s): We studied 45 patients before cardiac
surgery (coronary artery bypass grafting [CABG], n = 18; non-CABG, n =
27). EAT volume, the coronary calcium score (CCS), and the presence of
non- and/or partially-calcified coronary plaques (NCPs) and high-risk
coronary plaques (HRPs; minimum CT density <30 Hounsfield units and
vascular remodeling index >1.1) on CT angiography were assessed. EAT
samples were obtained during cardiac surgery. IL-1beta mRNA expression in
EAT was measured using quantitative real-time PCR and normalized to that
of beta-actin in each patient. Result(s): There was no difference in
IL-1beta mRNA levels between patients who were scheduled for CABG and
non-CABG surgery or among subgroups based on the CCS. However, patients
with NCPs (median [interquartile range], 4.1[2.0-11.6]E-4 versus
1.8[0.6-4.5]E-4, p = 0.024) and HRP (7.6[3.0-20.4]E-4 versus
1.9[0.7-4.3]E-4, p = 0.0023) had higher IL-1beta mRNA levels than those
without these plaques. On multivariate analysis adjusted for age, sex,
coronary risk factors, statin therapy, CCS, and EAT volume, the presence
of HRPs was significantly correlated with elevated IL-1beta mRNA levels in
EAT (beta = 0.39, p = 0.047). Conclusion(s): Our data suggest a
contribution of EAT to coronary atherosclerosis through molecular
behavior, such as IL-1beta gene expression, which may be a new therapeutic
target. Copyright © 2020 Society of Cardiovascular Computed
Tomography

<2>
Accession Number
2011132228
Title
Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in
Patients With ST-Elevation Myocardial Infarction: Results From a Study in
Mexico City.
Source
CJC Open. 3 (4) (pp 409-418), 2021. Date of Publication: April 2021.
Author
Araiza-Garaygordobil D.; Gopar-Nieto R.; Cabello-Lopez A.;
Martinez-Amezcua P.; Eid-Lidt G.; Baeza-Herrera L.A.; Gonzalez-Pacheco H.;
Briseno-De la Cruz J.L.; Sierra-Lara Martinez D.; Mendoza-Garcia S.;
Altamirano-Castillo A.; Arias-Mendoza A.
Institution
(Araiza-Garaygordobil, Gopar-Nieto, Baeza-Herrera, Gonzalez-Pacheco,
Briseno-De la Cruz, Sierra-Lara Martinez, Mendoza-Garcia,
Altamirano-Castillo, Arias-Mendoza) Cardiovascular Critical Care Unit,
Instituto Nacional de Cardiologia "Ignacio Chavez,", Mexico City, Mexico,
Mexico
(Cabello-Lopez) Occupational Health Research Unit, Centro Medico Nacional
Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico,
Mexico
(Martinez-Amezcua) Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, United States
(Eid-Lidt) Department of Interventional Cardiology, Instituto Nacional de
Cardiologia "Ignacio Chavez,", Mexico City, Mexico, Mexico
Publisher
Elsevier Inc.
Abstract
Background: A low proportion of patients with ST-elevation myocardial
infarction (STEMI) in low- to middle-income countries receive reperfusion
therapy. Although primary percutaneous coronary intervention (PCI) is the
method of choice, a pharmacoinvasive strategy (PIs) is reasonable when
primary PCI cannot be delivered on a timely basis. The aim of our study
was to assess the efficacy and safety of a PIs compared with primary PCI
in a real-world setting. Method(s): This was a prospective registry
that included patients with STEMI who received reperfusion during the
first 12 hours from symptom onset. The primary composite end point was the
occurrence of cardiovascular death, cardiogenic shock, recurrent
myocardial infarction, or congestive heart failure at 30 days according to
the reperfusion strategy used. The key safety end point was major bleeding
(Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days.
 Result(s): We included 579 patients with STEMI, 49.7% underwent
primary PCI and 50.2% received PIs. Those who received a PIs approach were
more likely to present with Killip class > 1 and to have a history of
diabetes but were less likely to have a previous cardiovascular disease
diagnosis. No statistically significant difference was shown in the
primary composite end point according to reperfusion strategy (hazard
ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21; P = 0.24). Major
bleeding was not different among groups (hazard ratio for PIs, 0.92; 95%
confidence interval, 0.45-1.86; P = 0.81). Two patients in the PIs group
(0.6%) and no patients in the PCI group had intracranial bleeding (P =
0.15). Conclusion(s): In this prospective real-world registry, major
cardiovascular outcomes and bleeding were not different among patients who
underwent a PIs or primary PCI. The study suggests that a PIs is an
effective and safe option for patients with STEMI when access to primary
PCI is limited. Copyright © 2020 Canadian Cardiovascular Society

<3>
Accession Number
2005899379
Title
Long-term outcomes in the management of left main disease: An updated
meta-analysis of randomized controlled trials.
Source
Hellenic Journal of Cardiology. 62 (1) (pp 87-88), 2021. Date of
Publication: 01 Jan 2021.
Author
Terentes-Printzios D.; Kotronias R.A.; De Maria G.L.; Scarsini R.; Banning
A.P.
Institution
(Terentes-Printzios, Kotronias, De Maria, Scarsini, Banning) Oxford Heart
Centre, NIHR Biomedical Research Centre, Oxford University Hospitals,
Oxford, United Kingdom
Publisher
Hellenic Cardiological Society

<4>
Accession Number
2005827157
Title
Postoperative renal morbidity and mortality after volume replacement with
hydroxyethyl starch 130/0.4 or albumin during surgery: a propensity
score-matched study.
Source
Journal of Anesthesia. 34 (6) (pp 881-891), 2020. Date of Publication:
December 2020.
Author
Miyao H.; Kotake Y.
Institution
(Miyao) Department of Anesthesiology, Saitama Medical Center, Saitama
Medical University, 1981, Kamoda, Kawagoe, Saitama 350-8550, Japan
(Kotake) Department of Anesthesiology, Toho University Ohashi Medical
Center, 2-22-36, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
Publisher
Springer Japan
Abstract
Purpose: We aimed to compare retrospectively the rates of renal morbidity
and mortality in surgical patients receiving 6% HES 130/0.4 to those
receiving albumin. Method(s): From a Japanese nationwide medical
database between 2014 and 2016, we identified adults who received HES
130/0.4 (HES group) or albumin (albumin group) as a single colloid
solution on the day of surgery. After propensity score matching, the two
groups were analyzed with chi2 or Mann Whitney U test. The
primary outcome was the incidence of acute kidney injury (AKI). Secondary
outcomes included the incidence of renal-replacement therapy, hospital
length of stay, in-hospital 30-day mortality, the use of vasoactive
agents, and the fluid requirement on the day of surgery. Result(s):
Of 76,048 patients in the database, propensity score matching identified
289 matched pairs. There was no statistically significant difference in
the incidence of AKI between the HES and the albumin group (15.2% vs.
20.8%, respectively: P = 0.08). The secondary outcomes did not differ
between groups except the following. Median hospital stay was 5 days
shorter in the HES group (18 vs. 23 days; P < 0.001), and the median net
fluid requirement on the day of surgery was 15 mL/kg lower in the HES
group (140 vs. 155 mL/kg, respectively; P = 0.01). Conclusion(s):
Postoperative renal morbidity and mortality did not differ between
patients receiving HES 130/0.4 and those receiving albumin. HES 130/0.4
was associated with shorter hospital stay and less fluid requirement
compared to albumin. These findings support the use of 6% HES 130/0.4 for
perioperative volume replacement as an alternative to albumin. Trial
registration: UMIN000027896 and the date of registration was June 30, 2017
at https://www.umin.ac.jp/ctr/index-j.html. Copyright © 2020, The
Author(s).

<5>
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. Design(s): Randomized
controlled trial. Setting(s): Single-center study in a tertiary
teaching hospital. 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%. 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. 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. 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. Copyright ©
2021 The Authors

<6>
Accession Number
2011071048
Title
Surgical aortic valve replacement in small aortic annulus.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Vaidya Y.P.; Cavanaugh S.M.; Sandhu A.A.
Institution
(Vaidya, Cavanaugh) Department of Surgery, SUNY Upstate Medical
University, Syracuse, NY, United States
(Sandhu) Department of Cardiothoracic Surgery, SUNY Upstate Medical
University, Syracuse, NY, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Although aortic valve replacement (AVR) has been the standard
of treatment for severe aortic stenosis, a small aortic annulus (SAA)
poses significant challenges. Improvements in valve designs and evolution
in surgical techniques have led to improved outcomes, however, the ideal
prosthetic valve remains elusive. Method(s): We performed a
comprehensive literature review to discuss the surgical management of
aortic stenosis, with a special focus on patients with SAA.
 Result(s): Stentless valves and root replacement techniques have been
shown to overcome the hemodynamic challenges associated with conventional
stented bioprostheses, but are technically challenging and require longer
cross-clamp times. Sutureless and rapid deployment valves mitigate the
long operative time while maintaining the hemodynamic advantages. The use
of transcatheter AVR has emerged as another reasonable alternative and has
shown promise among patients with SAA, however, long-term outcomes are
awaited. Conclusion(s): There is no consensus regarding the type of
valve prosthesis or replacement technique among patients with SAA.
Consideration of patient comorbidities and valvular anatomy is paramount
in planning the optimal strategy for AVR. Further long-term clinical
trials are necessary to assess outcomes and achieve progress toward the
development of the ideal prosthesis. Copyright © 2021 Wiley
Periodicals LLC

<7>
Accession Number
634752864
Title
Baseline low-density lipoprotein cholesterol predicts the benefit of
adding ezetimibe on statin in statin-naive acute coronary syndrome.
Source
Scientific reports. 11 (1) (pp 7480), 2021. Date of Publication: 05 Apr
2021.
Author
Im J.; Kawada-Watanabe E.; Yamaguchi J.; Arashi H.; Otsuki H.; Matsui Y.;
Sekiguchi H.; Fujii S.; Mori F.; Ogawa H.; Hagiwara N.
Institution
(Im, Kawada-Watanabe, Yamaguchi, Arashi, Otsuki, Matsui, Sekiguchi, Ogawa,
Hagiwara) Department of Cardiology, Heart Institute of Japan, Tokyo
Women's Medical University, Kawada-cho ,Shinjuku, Tokyo 162-8666, Japan
(Im, Fujii) Department of Cardiology, Cardiovascular Center of Sendai,
Miyagi, Japan
(Matsui, Mori) Department of Cardiology, Yokohama Medical Center,
Kanagawa, Japan
Publisher
NLM (Medline)
Abstract
We aimed to evaluate the effect of baseline low-density lipoprotein
cholesterol (LDL-C) on the outcomes of patients with the acute coronary
syndrome (ACS) receiving pitavastatin monotherapy or the combination of
pitavastatin+ezetimibe. In the HIJ-PROPER study, 1734 ACS patients with
dyslipidemia were randomly assigned to receive pitavastatin or
pitavastatin+ezetimibe therapy. Statin-naive participants (n=1429) were
divided into two groups based on the median LDL-C level (131 mg/dL) at
enrollment. The primary endpoint was a composite of all-cause death,
non-fatal myocardial infarction, non-fatal stroke, unstable angina, and
ischemia-driven coronary revascularization. The median follow-up was 3.2
years. In the<131 mg/dL group (n=686), LDL-C changes were -34.0% and
-49.8% in the pitavastatin monotherapy and pitavastatin+ezetimibe-treated
groups (P<0.0001), respectively; in the>=131 mg/dL group (n=743), LDL-C
changes were -42.9% and -56.4% (P<0.0001, respectively. Kaplan-Meier
analyses revealed that the primary endpoint was not significantly
different between the treatment groups for the<131 mg/dL group, however,
it was significantly lower in patients treated with pitavastatin+ezetimibe
in the>=131 mg/dL group (Hazard ratio=0.72, 95% confidence
interval=0.56-0.91, P=0.007, P value for interaction=0.012). Statin-naive
ACS patients with baseline LDL-C<131 mg/dL did not clinically benefit from
pitavastatin+ezetimibe, while patients with baseline LDL-C>=131 mg/dL
treated with pitavastatin+ezetimibe showed better clinical results than
those treated with pitavastatin monotherapy.Clinical Trial Registration:
Original HIJ PROPER study; URL: http://www.umin.ac.jp/ctr . Unique
Identifier; UMIN000002742, registered as an International Standard
Randomized Controlled Trial.

<8>
Accession Number
2011657114
Title
Colchicine for Secondary Prevention of Cardiovascular Disease: A
Systematic Review and Meta-analysis of Randomized Controlled Trials.
Source
Canadian Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Samuel M.; Tardif J.-C.; Bouabdallaoui N.; Khairy P.; Dube M.-P.; Blondeau
L.; Guertin M.-C.
Institution
(Samuel, Tardif, Bouabdallaoui, Khairy, Dube) Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(Blondeau, Guertin) Montreal Health Innovations Coordinating Center,
Montreal, Quebec, Canada
Publisher
Elsevier Inc.
Abstract
Background: Reduction of inflammation with colchicine has emerged as a
therapeutic option for secondary prevention of cardiovascular disease
(CVD) in patients with coronary artery disease (CAD). Our objective was to
consolidate evidence from randomized controlled trials (RCTs) evaluating
the efficacy and safety of low-dose colchicine for secondary prevention of
CVD among patients with CAD on standard medical therapy. Method(s):
RCTs comparing the incidence of cardiovascular (CV) events between
patients with clinically manifest CAD randomized to colchicine vs placebo
(or no colchicine) were included. The primary composite efficacy endpoint
included CV mortality, myocardial infarction (MI), ischemic stroke, and
urgent coronary revascularization. The DerSimonian and Laird
random-effects model was used to calculate pooled hazard ratios (HRs) and
95% confidence intervals (CIs). Result(s): Four RCTs, with a pooled
sample size of 11,594 patients, were included (colchicine n = 5774;
placebo/no colchicine n = 5820). Included RCTs studied populations with
stable CAD (N = 2) and acute coronary syndrome (N = 2). Compared with
placebo or no colchicine, colchicine was associated with a statistically
significant reduction in the incidence of the primary composite endpoint
(pooled HR, 0.68; 95% CI, 0.54-0.81; I2 = 37.7%). The reduction
in CV events among patients randomized to colchicine was driven by
statistically significant reductions in MIs, ischemic strokes, and urgent
coronary revascularizations (P < 0.05 for all) and was relatively
consistent among subgroups. The incidence of safety outcomes did not
differ between groups (P > 0.05). Conclusion(s): In secondary
prevention of CV events, the addition of low-dose colchicine to standard
medical therapy reduces the incidence of major CV events-except CV
mortality-when compared with standard medical therapy alone. Copyright
© 2020 Canadian Cardiovascular Society

<9>
Accession Number
634743520
Title
Ivabradine Versus Amiodarone in the Management of Postoperative Junctional
Ectopic Tachycardia: A Randomized, Open-Label, Noninferiority Study.
Source
JACC. Clinical electrophysiology. (no pagination), 2021. Date of
Publication: 25 Mar 2021.
Author
Arvind B.; Kothari S.S.; Juneja R.; Saxena A.; Ramakrishnan S.; Gupta
S.K.; Chowdhury U.K.; Devagourou V.; Talwar S.; Hote M.P.; Rajashekar P.;
Sahu M.K.; Singh S.P.
Institution
(Arvind, Kothari, Juneja, Saxena, Ramakrishnan, Gupta) Department of
Cardiology, All India Institute of Medical Sciences, New Delhi, India
(Chowdhury, Devagourou, Talwar, Hote, Rajashekar, Sahu, Singh) Department
of Cardiothoracic and Vascular Surgery, All India Institute of Medical
Sciences, New Delhi, India
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to compare the efficacy of ivabradine and
amiodarone in the management of postoperative junctional ectopic
tachycardia (JET) after cardiac surgery in children. BACKGROUND: JET is a
serious arrhythmia occurring in children after cardiac surgery and
requires aggressive management. Amiodarone has been conventionally used in
its treatment. Recent studies have reported the utility of ivabradine in
this regard. METHOD(S): In this open-label randomized controlled
trial, 94 children (age <=18 years) who developed postoperative JET were
allocated to receive either amiodarone or ivabradine. The primary end
point was restoration of normal sinus rhythm. RESULT(S): Sinus rhythm
was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group
and 46 out of the 48 patients (95.8%) in the ivabradine group (mean
difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to
11.5%). The median (interquartile range) time taken to achieve sinus
rhythm conversion was similar in both the groups: 21.5 (17-30.2) versus 22
(13.4-38.5) hours (p = 0.36)]. The time taken to rate control of JET was
significantly less in the amiodarone group: median 7.0 (5.5-9.5) versus
8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse events were
observed in the ivabradine group. CONCLUSION(S): Oral ivabradine is
not inferior to intravenous amiodarone in converting postoperative JET to
sinus rhythm. There was no difference in time taken to sinus rhythm
conversion between the groups, although the rate control was earlier in
patients who received amiodarone. Monotherapy with ivabradine may be
considered as an alternative to amiodarone in the management of
postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in
the Management of Junctional Ectopic Tachycardia, an Abnormality in
Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery:
CTRI/2018/08/015182). Copyright © 2021 American College of
Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<10>
Accession Number
2011026181
Title
Comparison of short-term outcomes between transthoracic and robot-assisted
transmediastinal radical surgery for esophageal cancer: a prospective
study.
Source
BMC Cancer. 21 (1) (no pagination), 2021. Article Number: 338. Date of
Publication: December 2021.
Author
Yoshimura S.; Mori K.; Ri M.; Aikou S.; Yagi K.; Yamagata Y.; Nishida M.;
Yamashita H.; Nomura S.; Seto Y.
Institution
(Yoshimura, Ri, Aikou, Yagi, Nishida, Yamashita, Nomura, Seto) Department
of Gastrointestinal Surgery, Graduate School of Medicine, The University
of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
(Mori) Department of Gastrointestinal Surgery, Mitsui Memorial Hospital, 1
Kanda Izumi, Chiyoda-ku, Tokyo 101-8643, Japan
(Yamagata) Department of Gastric Surgery, National Cancer Center Hospital,
5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
Publisher
BioMed Central Ltd
Abstract
Background: The present study aimed to assess the lower invasiveness of
robot-assisted transmediastinal radical esophagectomy by prospectively
comparing this procedure with transthoracic esophagectomy in terms of
perioperative outcomes, serum cytokine levels, and respiratory function
after surgery for esophageal cancer. Method(s): Patients who
underwent a robot-assisted transmediastinal esophagectomy or transthoracic
esophagectomy between April 2015 and March 2017 were included. The
perioperative outcomes, preoperative and postoperative serum IL-6, IL-8,
and IL-10 levels, and respiratory function measured preoperatively and at
6 months postoperatively were compared in patients with a robot-assisted
transmediastinal esophagectomy and those with a transthoracic
esophagectomy. Result(s): Sixty patients with esophageal cancer were
enrolled. The transmediastinal esophagectomy group had a significantly
lower incidence of postoperative pneumonia (p = 0.002) and a significantly
shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on
postoperative days 1, 3, 5, and 7 were significantly lower in the
transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020,
respectively). In the latter group, the serum IL-8 level was significantly
lower immediately after surgery and on postoperative day 1 (p = 0.003,
0.001, respectively) while the serum IL-10 level was significantly lower
immediately after surgery (p = 0.041). The reduction in vital capacity,
percent vital capacity, forced vital capacity, and forced expiratory
volume at 1.0 s 6 months after surgery was significantly greater in the
transthoracic esophagectomy group (p < 0.0001 for all four measurements).
 Conclusion(s): Although further, large-scale studies are needed to
confirm our findings, robot-assisted transmediastinal esophagectomy may
confer short-term benefits in radical surgery for esophageal cancer. Trial
registration: This trial was registered in the UMIN Clinical Trial
Registry (UMIN000017565 14/05/2015). Copyright © 2021, The
Author(s).

<11>
Accession Number
2010080288
Title
Fundamental knowledge about the physical and chemical properties of
commercial albumin and its application in clinical practice.
Source
International Medicine. 1 (3) (pp 116-121), 2020. Date of Publication:
2020.
Author
Belousov A.
Institution
(Belousov) Laboratory of Applied Nanotechnology of Belousov, Ukraine
(Belousov) Kharkov Medical Academy of Postgraduate Education, Ukraine
(Belousov) Laboratory of Applied Nanotechnology of Belousov, Ukraine
Publisher
Editorial Board of International Medicine

<12>
Accession Number
2004851609
Title
Preventive effect of low-dose landiolol on postoperative atrial
fibrillation study (PELTA study).
Source
General Thoracic and Cardiovascular Surgery. 68 (11) (pp 1240-1251), 2020.
Date of Publication: 01 Nov 2020.
Author
Sasaki K.; Kumagai K.; Maeda K.; Akiyama M.; Ito K.; Matsuo S.; Katahira
S.; Suzuki T.; Suzuki Y.; Kaiho Y.; Sugawara Y.; Tsuji I.; Saiki Y.
Institution
(Sasaki, Maeda, Akiyama, Ito, Matsuo, Katahira, Suzuki, Suzuki, Saiki)
Division of Cardiovascular Surgery, Tohoku University Graduate School of
Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
(Kumagai, Saiki) Research Division of Sciences for Aortic Disease, Tohoku
University Graduate School of Medicine, Sendai, Japan
(Kaiho, Sugawara, Tsuji) Division of Epidemiology, Department of Health
Informatics and Public Health, Tohoku University School of Public Health,
Graduate School of Medicine, Sendai, Japan
Publisher
Springer Japan
Abstract
Objective: To investigate the efficacy of prophylactic administration of
low-dose landiolol on postoperative atrial fibrillation (POAF) in patients
after cardiovascular surgery. Method(s): Consecutive 150 patients
over 70 years of age who underwent cardiovascular surgery for valvular,
ischemic heart, and aortic diseases were enrolled in this single-center
prospective randomized control study from 2010 to 2014. They were assigned
to three treatment groups: 1gamma group (landiolol at 1 mug/kg/min),
2gamma group (landiolol at 2 mug/kg/min), or control group (no landiolol).
In the two landiolol groups, landiolol hydrochloride was intravenously
administered for a period of 4 days postoperatively. Electrocardiography
was continuously monitored during the study period, and cardiologists
eventually assessed whether POAF occurred or not. Result(s): POAF
occurred in 24.4% of patients in the control group, 18.2% in 1gamma group,
and 11.1% in 2gamma group (p = 0.256). Multivariate logistic regression
analysis showed that the incidence of POAF tended to decrease depending on
the dose of landiolol (trend-p = 0.120; 1gamma group: OR = 0.786, 95% CI
0.257-2.404; 2gamma group: OR = 0.379, 95% CI 0.112-1.287). Subgroup
analysis showed a significant dose-dependent reduction in POAF among
categories of female sex, non-use of angiotensin II receptor blockers
(ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and
0.004). Conclusion(s): These findings indicate that prophylactic
administration of low-dose landiolol may not be effective for preventing
the occurrence of POAF in overall patients after cardiovascular surgery,
but the administration could be beneficial to female patients, patients
not using ARBs preoperatively, and those after valvular
surgery. Copyright © 2020, The Author(s).

<13>
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.
 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. 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). 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. Copyright © 2021

<14>
Accession Number
2011079994
Title
Safety and Efficacy of Non-Vitamin K Oral Anticoagulant Use Early After
Cardiac Surgery: A Systematic Review.
Source
Annals of Pharmacotherapy. (no pagination), 2021. Date of Publication:
2021.
Author
Wang E.H.Z.; Ye J.; Turgeon R.
Institution
(Wang, Ye, Turgeon) University of British Columbia, Vancouver, BC, Canada
Publisher
SAGE Publications Inc.
Abstract
Objective: To determine the safety and efficacy of non-vitamin K oral
anticoagulants (NOACs) initiated early after cardiac surgery. Data
Sources:: Cochrane Central Register of Controlled Trials, EMBASE, and
MEDLINE (database inception to January 20, 2021), www.clinicaltrials.gov,
www.who.int/ictrp/search/en/, NOAC trial registries, and bibliographies of
relevant guidelines and other reviews were used. Study Selection and Data
Extraction: Observational studies and randomized controlled trials (RCTs)
that initiated NOACs within the index hospitalization and that reported
bleeding for the primary outcome were included. Data Synthesis: A
total of 6 cohort studies, 1 RCT, and 3 ongoing RCTs were included. Most
studies were single-centered, limited to postoperative atrial fibrillation
after coronary artery bypass grafting, and with 30-day follow-up; few
studies included patients with isolated bioprosthetic valve replacement or
valve repair. Bleeding risk varied (0%-28.6%), and all but one study
showed no significantly higher risk with NOAC compared with warfarin.
Relevance to Patient Care and Clinical Practice: Overall, NOACs were used
in 26% to 37.5% of patients early after cardiac surgery. Starting a NOAC
on postoperative day 4 appeared to have similar bleeding rates compared
with warfarin, but clinical application is limited by heterogeneity of
outcome definitions, confounding, and bias. Compared with warfarin, NOACs
may have similar thromboembolism risk, reduced length of stay, and cost.
 Conclusion(s): There is limited evidence to guide NOAC use early
after cardiac surgery. Three ongoing randomized trials will add to the
literature and provide guidance for clinicians on whether, in whom, when,
and how to use NOACs safely early after cardiac surgery. Copyright
© The Author(s) 2021.

<15>
Accession Number
2010693429
Title
Clinical manifestations and outcomes of coronavirus disease-19 in heart
transplant recipients: a multicentre case series with a systematic review
and meta-analysis.
Source
Transplant International. 34 (4) (pp 721-731), 2021. Date of Publication:
April 2021.
Author
Granger C.; Guedeney P.; Arnaud C.; Guendouz S.; Cimadevilla C.; Kerneis
M.; Kerneis C.; Zeitouni M.; Verdonk C.; Legeai C.; Lebreton G.; Leprince
P.; Desire E.; Sorrentino S.; Silvain J.; Montalescot G.; Hazan F.;
Varnous S.; Dorent R.
Institution
(Granger, Guedeney, Kerneis, Zeitouni, Silvain, Montalescot) ACTION Study
Group, INSERM UMRS_1166, Institut de Cardiologie, Pitie Salpetriere,
Assistance Publique-Hopitaux de Paris, Sorbonne Universite, Paris, France
(Arnaud, Cimadevilla, Kerneis, Verdonk, Dorent) Departement de Chirurgie
Cardiaque, Hopital Bichat, Assistance Publique-Hopitaux de Paris,
Universite de Paris, Paris, France
(Guendouz) Departement de Cardiologie, Hopital Henri-Mondor, Assistance
Publique-Hopitaux de Paris, Creteil, France
(Legeai, Dorent) Agence de la Biomedecine, Direction Prelevement Greffe
Organes-Tissus, Saint Denis La Plaine, France
(Lebreton, Leprince, Desire, Hazan, Varnous) Departement de Chirurgie
Cardiaque, Institut de Cardiologie, Pitie Salpetriere Assistance
Publique-Hopitaux de Paris, Sorbonne Universite, Paris, France
(Sorrentino) Division of Cardiology, Department of Medical and Surgical
Sciences, URT National Research Council (CNR), Magna Graecia University,
Catanzaro, Italy
Publisher
Blackwell Publishing Ltd
Abstract
Available data on clinical presentation and mortality of coronavirus
disease-2019 (COVID-19) in heart transplant (HT) recipients remain
limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT
recipients from 3 French heart transplant centres (mean age 54.4 +/- 14.8
years; 66.7% males). Hospital admission was required for 35 (89.7%) cases
including 14/39 (35.9%) cases being admitted in intensive care unit.
Immunosuppressive medications were reduced or discontinued in 74.4% of the
patients. After a median follow-up of 54 (19-80) days, death and death or
need for mechanical ventilation occurred in 25.6% and 33.3% of patients,
respectively. Elevated C-reactive protein and lung involvement >=50% on
chest computed tomography (CT) at admission were associated with an
increased risk of death or need for mechanical ventilation. Mortality rate
from March to June in the entire 3-centre HT recipient cohort was 56%
higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P =
0.15). In a meta-analysis including 4 studies, pre-existing diabetes
mellitus (OR 3.60, 95% CI 1.43-9.06, I2 = 0%, P = 0.006) and
chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39-10.31,
I2 = 0%, P = 0.009) were associated with increased mortality.
These findings highlight the aggressive clinical course of COVID-19 in HT
recipients. Copyright © 2021 Steunstichting ESOT. Published by
John Wiley & Sons Ltd

<16>
Accession Number
2007174720
Title
Impact of atrial fibrillation on the outcomes of transcatheter mitral
valve repair using MitraClip: a systematic review and meta-analysis.
Source
Heart Failure Reviews. 26 (3) (pp 531-543), 2021. Date of Publication: May
2021.
Author
Shah S.; Raj V.; Abdelghany M.; Mena-Hurtado C.; Riaz S.; Patel S.; Wiener
H.; Chaudhuri D.
Institution
(Shah, Raj, Chaudhuri) Department of Medicine, Division of Cardiology,
State University of New York Upstate Medical University, 750 E Adams
Street, Syracuse, NY 13210, United States
(Abdelghany) Pioneer Valley Cardiology, University of Massachusetts/
Baystate Medical Center, Mercy Medical Center, Springfield, MA, United
States
(Mena-Hurtado) Department of Medicine, Division of Cardiology, Yale
University School of Medicine, New Haven, CT, United States
(Riaz) Department of Medicine, State University of New York Upstate
Medical University, Syracuse, NY, United States
(Patel) Department of Pulmonary, Allergy and Critical care, University of
Alabama at Birmingham, Birmingham, AL, United States
(Wiener) Department of Epidemiology, University of Alabama at Birmingham
School of Public Health, Birmingham, AL, United States
Publisher
Springer
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral
regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In
this systematic review, we aimed to investigate the outcomes of TMVR using
MitraClip in AF patients. We performed a systematic search using PubMed,
SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for
studies that reported outcomes following MitraClip, in patients with AF
versus without AF. Seven studies with a total of 7678 patients met the
inclusion criteria. The risk of 1-year all-cause mortality following TMVR
was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p <= 0.001).
Similarly, the risk of heart failure hospitalization was higher in
patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of
bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p <=
0.001). The risk of procedural failure, in-hospital mortality,
cardiovascular mortality, and stroke was not significantly different
between the two groups. The higher risk of all-cause mortality, HF
hospitalization, and risk of bleeding in AF patients undergoing MitraClip
warrants attention. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<17>
Accession Number
634737617
Title
Performance of a CT-based screening protocol in routine use of the
sentinel cerebral protection device in transcatheter aortic valve
implantation.
Source
Acta Cardiologica. Conference: 40th Annual Congress of the Belgian Society
of Cardiology. Virtual. 76 (SUPPL 1) (pp 49-50), 2021. Date of
Publication: 2021.
Author
Von Kemp M.; Flore V.; Provenier F.; Cornelis K.
Institution
(Von Kemp, Flore, Provenier, Cornelis) AZ Maria Middelares
Publisher
Taylor and Francis Ltd.
Abstract
Aims: Our centre has been routinely applying the Sentinel Cerebral
protection system (Boston Scientific, Marlborough, Massachusetts) when
performing transcatheter aortic valve replacement (TAVR) since November
2018. We aim to evaluate the use of a CT-based screening protocol, for
routine use of the Sentinel-device in all patients. Methods and
Results: We have performed 74 TAVR-procedures since the routine
implementation of Sentinel. Using a CTbased screening protocol, 20% of
patients were considered anatomically unsuitable for Sentinel. After the
CT screening, Sentinel proved technically feasible in 94% of intended
cases. The screening protocol was systematically reviewed and illustrated.
When comparing procedures with versus without Sentinel, procedure length
and fluoroscopy length were significantly increased (p <0.001) in Sentinel
procedures. We compared adverse events and overall survival between 56
procedures with Sentinel and 55 without Sentinel. Two events of fatal
stroke occurred during short-term follow-up in the non-Sentinel group,
versus none in the Sentinel group. There was no statistically significant
difference in adverse events nor survival. Conclusion(s): Routine
deployment of Sentinel is a feasible and safe addition to the
TAVR-procedure. Pre-procedural CT allows to identify the 94% of
non-suitable anatomies. Preliminary results regarding protection from
stroke are positive.

<18>
Accession Number
634725365
Title
A platform for real-3d visualization and planning of left atrial appendage
occlusion through mixed reality.
Source
European Heart Journal Cardiovascular Imaging. Conference: EACVI - Best of
Imaging 2020. Online. 22 (SUPPL 1) (pp i286), 2021. Date of Publication:
January 2021.
Author
Pappalardo O.; Pasquali M.; Maltagliati A.; Rossini G.; Italiano G.;
Fusini L.; Penso M.; Tamborini G.; Andreini D.; Redaelli A.; Pepi M.
Institution
(Pappalardo, Pasquali, Rossini) Artiness, Milano, Italy
(Maltagliati, Italiano, Fusini, Penso, Tamborini, Andreini, Pepi) IRCCS
Centro Cardiologico Monzino, Milan, Italy
(Redaelli) Politecnico di Milano, Dipartimento di Elettronica,
Informazione e Bioingegneria, Milano, Italy
Publisher
Oxford University Press
Abstract
Background: In left atrial appendage occlusion (LAAO), pre-procedural
computed tomography (CT) is pivotal to describe the complex and highly
variable LAA anatomy and to guide the operator in accurate planning of the
intervention. Multiplanar reconstruction and 3D rendering are used for the
navigation and analysis of the 3D datasets but they share some limitations
that are due to the use of 2D screens; Mixed Reality (MxR) technology aims
at overcoming such limitations by allowing for real-3D visualizations with
holographic replicas of anatomical models while preserving a sense of
presence within the true physical environment by the operator.
 Purpose(s): To develop and test a MxR platform that provides a more
intuitive and informative tool for the morphological analysis during the
planning phase of LAAO. Method(s): Patients (n = 4) were randomly
selected among those referred for a CT scan prior to transcatheter aortic
valve replacement, each one characterized by a specific LAA morphology
(cauliflower, bilobular, chicken wing, wind-sock). CT scans were performed
in diastole at 75% of the R-R interval on a 64-slice scanner, with
in-plane resolution 0.38-0.64 mm and slice thickness 0.62 mm. Firstly, the
acquisition was cropped to contain the left atrium, the circumflex artery,
the left upper pulmonary ridge. Subsequently, an isosurface with high
coincidence between the blood cavity border and the endocardium was
identified by the user and processed using a marching cube algorithm to
obtain the 3D model. Finally, the 3D model was optimized for a MxR
platform that allows for moving, zooming and cutting the model, measuring
the main LAA linear dimensions and simulating the implant of a virtual
replica of a transcatheter occluder. Result(s): The workflow was
successfully applied for all the patients independently from the
morphology. All the models were successfully uploaded in the MxR platform
(Fig 1.a) and for all the patients the morphological analysis was
performed (Fig 1.b) in less than 10 minutes. The four different
morphologies of the LAA were correctly identified allowing a very detailed
holographic modeling of the structure, including the neck, the landing
zone, the curvature and the position and size of lobes. For both the
identified ostium and landing planes, using a dedicated measuring tool
(Fig. 1.c), the operator measured the minimum and maximum diameters, which
were later used to define the size of the occluder device to be used in
the virtual implant simulation (Fig. 1.d). Conclusion(s): The tested
MxR platform suggested the potential to overcome the limits of the
standard technologies in planning of LAAO thanks to the real-3D
perception, potentially leading to a more accurate and faster planning
phase. Furthermore, the use of MxR technology may enhance the ability to
predict the optimal device size and position within the anatomy to obtain
LAA complete sealing.

<19>
Accession Number
634725186
Title
Coronary computed tomography angiography vs functional testing for stable
coronary artery disease: Long-term outcomes meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. Conference: EACVI - Best of
Imaging 2020. Online. 22 (SUPPL 1) (pp i279), 2021. Date of Publication:
January 2021.
Author
De Campos D.; Saleiro C.; Puga L.; Lopes J.; M Gomes A.R.; Sousa J.P.;
Goncalves L.; Teixeira R.
Institution
(De Campos, Saleiro, Puga, Lopes, M Gomes, Sousa, Goncalves, Teixeira)
University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background The emerging role of coronary computed tomography angiography
(CCTA) has been acknowledged in the 2019 Guidelines of the European
Society of Cardiology recommending it's as the initial diagnostic strategy
for most patients with suspected stable coronary artery disease (CAD).
However, it is unclear how CCTA performs compared with the standard
approach of functional testing (FT). We performed an updated meta-analysis
to clarify the question, analyzing outcomes beyond one year of follow-up.
METHODS We searched PubMed for studies comparing clinical outcomes with
>=1 year of follow-up between initial CCTA vs FT strategy in patients with
suspected stable CAD. Occurrence of all-cause mortality and non-fatal
acute coronary syndrome (ACS) was the combined primary outcome. Secondary
outcomes included non-fatal myocardial infarction (MI), the use of
longer-term investigations, revascularization procedures and new
medication use. RESULTS A total of 29,579 patients underwent either CCTA
(n = 14,457) or FT (n = 15,122) and were followed for a mean of 1.75
years. CCTA was associated with a comparable all-cause mortality and
non-fatal ACS to FT (2.64% vs 2.65%; risk ratio [RR], 0.97; 95% CI,
0.76-1.22). However, a 41% reduction in non-fatal MI was evident after
CCTA testing (RR 0.59, 95% CI 0.41-0.83; P = 0.003). Compared with FT,
patients undergoing CCTA were less likely to downstream additional testing
(28.85% vs 33.86%; odds ratio [OR], 0.47, 95%CI 0.21-1.01; P = 0.05) and
more prone to pursue coronary revascularization (OR 1.72; 95%CI 1.11-2.66;
P = 0.01). Significant heterogeneity for invasive coronary angiography and
revascularization was noted. CCTA patients had a non significant increase
in new medication use, namely aspirin or statin therapy. CONCLUSIONS In
patients with suspected stable CAD, initial evaluation with CCTA was
associated with a long-term 41% decrease in nonfatal MI and 53% reduction
in downstream testing. Despite these differences, CCTA strategy was
associated with a similar risk of long-term all-cause mortality and
non-fatal ACS.

<20>
Accession Number
634724737
Title
Prognostic significance of cardiac amyloidosis in patients with aortic
stenosis: A systematic review and meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. Conference: EACVI - Best of
Imaging 2020. Online. 22 (SUPPL 1) (pp i429), 2021. Date of Publication:
January 2021.
Author
Ricci F.; Ceriello L.; Khanji M.Y.; Dangas G.; Bucciarelli Ducci C.; Di
Mauro M.; Fedorowski A.; Zimarino M.; Gallina S.
Institution
(Ricci, Gallina) G. DAnnunzio University, Department of Neuroscience,
Imaging and Clinical Sciences, Chieti, Italy
(Ceriello) G. D'Annunzio University, Institute of Cardiology, Center of
Excellence on Aging, Chieti, Italy
(Khanji) Queen Mary University of London, London, United Kingdom
(Dangas) Icahn School of Medicine at Mount Sinai, New York, United States
(Bucciarelli Ducci) Bristol Heart Institute, Bristol, United Kingdom
(Di Mauro) Maastricht University Medical Centre (MUMC), Maastricht,
Netherlands
(Fedorowski) Lund University, Malmo, Sweden
(Zimarino) SS. Annunziata Hospital, Chieti, Italy
Publisher
Oxford University Press
Abstract
Background: Cardiac amyloidosis (CA) has been increasingly recognized in
elderly patients with aortic stenosis (AS), but with uncertain prognostic
significance. Objective(s): We performed a systematic review and
meta-analysis to clarify whether concurrent CA portends excess mortality
in patients with aortic stenosis AS. Method(s): Our systematic review
of the literature published through June 2020, sought observational
studies reporting summary-level outcome data of all-cause mortality in AS
patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel
odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was
assessed as the primary endpoint. We performed subgroup analysis
stratified by severity of left ventricular hypertrophy (LVH) and
study-level meta-regression analysis to explore the effect of covariates
on summary effect size and to address statistical heterogeneity.
 Result(s): We identified 4 studies including 609 AS patients (9%
AS-CA; 69% men; age, 84 +/- 5 years). The average follow-up was 20 +/- 5
months. Compared with lone AS, AS-CA was associated with 2-fold increase
in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%).
When analysed according to LVH severity, pooled ORs (95% CI) for all-cause
mortality were 1.29 (0.65-2.22) for mild LVH (<=16 mm), and 4.81
(2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis
confirmed a stronger relationship proportional to the degree of LVH,
regardless of age and aortic valve replacement, explaining between-study
heterogeneity variance. Conclusion(s): CA heralds significantly
higher risk of all-cause death in elderly patients with AS. Severity of
LVH appears to be a major prognostic determinant in patients with dual
AS-CA pathology.

<21>
Accession Number
634731471
Title
Bartonella quintana Endocarditis, A Case Series.
Source
Open Forum Infectious Diseases. Conference: Infectious Diseases Week,
IDWeek 2020. Virtual. 7 (SUPPL 1) (pp S400), 2020. Date of Publication:
October 2020.
Author
Dieringer T.D.; Huang G.; Allyn P.R.; Klausner J.
Institution
(Dieringer) University of California Los Angeles, Los Angeles, CA, United
States
(Huang, Allyn, Klausner) UCLA, Los Angeles, CA, United States
Publisher
Oxford University Press
Abstract
Background: Homelessness has been a growing issue in the United States and
worldwide. Bartonella quintana, the causative agent of "Trench fever", is
a well known illness among homeless populations in urban centers. While
many cases of B. quintana are self limited, the disease can have advanced
presentations including endocarditis. We present a short case series of
three cases of B. quintana infective endocarditis (IE) in homeless
individuals in Los Angeles and review the literature of cases of B.
quintana IE in the homeless population. Method(s): Here we report
three cases of B. quintana IE encountered in homeless individuals at the
University of California, Los Angeles (UCLA) hospital system. A literature
review was also conducted. PubMed was searched for published cases of
human IE secondary to B. quintana in homeless individuals. Result(s):
All three patients were male with ages ranging from 39 to 57 years old
with a history of homelessness and alcohol use. Presentations were
subacute to chronic in nature consisting of constitutional symptoms as
well as a range of symptoms corresponding with heart and renal failure.
Each patient was found to have varying degrees of aortic insufficiency
with either identified aortic valve vegetation or valvular thickening.
Diagnosis was made with a combination of Bartonella serologies and whole
genome sequencing PCR. All three patient's courses were complicated by
renal failure at varying points limiting the use of gentamicin for the
full treatment course. Two patients ultimately underwent aortic valve
replacement due to severe aortic insufficiency and completed therapy with
doxycycline and rifampin. A single patient was discharged with plan to
complete doxycycline and rifampin therapy however was lost to follow up. A
literature review of 10 manuscripts describing 13 cases of B. quintana IE
were identified. All the patients were male and the median age was 45. Six
of the cases were in Europe and eight were in North America. All cases had
left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No
cases of right sided IE were identified. Conclusion(s): B. quintana
IE should be considered in homeless patients with a clinical presentation
concerning for IE. A combination of serology and PCR testing can be useful
in diagnosis of this uncommon cause of infective endocarditis.

<22>
Accession Number
2011412244
Title
Tricuspid valve replacement: Mechanical or biological prostheses? A
systematic review and meta-analysis.
Source
Heart Surgery Forum. 24 (2) (pp E209-E214), 2021. Date of Publication: 03
Mar 2021.
Author
Cheng Z.; Fang T.; Wang D.; Guo Y.
Institution
(Cheng, Guo) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Fang) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, Sichuan 610041, China
(Wang) First School of Clinical Medicine, Lanzhou University, Lanzhou
730000, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Tricuspid valve replacement (TVR) is seldom performed in
cardiac valve surgery, and there currently are no clinical guidelines as
to which type of prostheses is better in tricuspid valve position. This
meta-analysis was performed to compare the results of mechanical and
biological prostheses for TVR. Method(s): We searched the Pubmed,
Cochrane, and Embase clinical trial databases to collect all related
studies published from January 1, 2000 to July 31, 2020. A random-effects
model was used to evaluate the odds ratios (OR) and its 95% confidence
intervals (CI) of time-to-event related effects of the surgical
procedures; every study's quality was evaluated by the Newcastle-Ottawa
Scale (NOS). Result(s): A total of 13 retrospective studies,
including 1453 patients were analyzed. There were no statistically
differences between mechanical and biological prostheses with respect to
prosthetic valve failure [OR = 0.84, 95% CI(0.54, 1.28), P = .41],
bleeding [OR = 0.84, 95% CI(0.54,1.28), P = .41], reoperation [OR = 1.02,
95% CI(0.58,1.78), P = .95], early mortality [OR = 1.35, 95%
CI(0.82,2.25), P = .24] and longtime survival [OR = 1.09, 95% CI(0.70,
1.69), P = .70], but a significant difference can be seen in mechanical
prostheses with a higher risk of thrombosis [OR = 0.17, 95% CI(0.05,
0.60), P = .006, I2 = 0%]. Conclusion(s): In tricuspid
valve position, mechanical valve prostheses have a higher risk of
thrombosis than biological prostheses, but no statistical differences
between mechanical and biological prostheses with respect to prosthetic
valve failure, bleeding, reoperation, early mortality, and long-term
survival. The valve disease and patient's age and risk factors are the
most important considerations in the decision-making process. The more
specific conclusion needs to be further proved by large-sample,
multi-center, randomized, double-blind and control trials. Copyright
© 2021 Forum Multimedia Publishing LLC. All rights reserved.

<23>
Accession Number
2010858279
Title
Multilevel Hemilaminotomy Windows for the Surgical Management of Spinal
Epidural Lipomatosis Causing Syringomyelia: Technical Note and Literature
Review.
Source
World Neurosurgery. 148 (pp 4-12), 2021. Date of Publication: April 2021.
Author
Martinez Santos J.L.; Saway B.; Damon A.C.; Varma A.
Institution
(Martinez Santos, Saway, Varma) Department of Neurological Surgery,
Medical University of South Carolina, Charleston, SC, United States
(Martinez Santos, Damon) Department of Neurological Surgery, Mayo Clinic
Florida, Jacksonville, FL, United States
Publisher
Elsevier Inc.
Abstract
Background: Spinal epidural lipomatosis (SEL) is the excessive
accumulation of extradural adipose tissue. Severe cases could result in
myelopathy, and very rarely, in syringomyelia formation. Surgery has been
associated with high morbidity and mortality, and no proven long-term
benefits. The objective was to provide a technical description of an
efficient and cost-effective procedure for multilevel thoracic
decompression without requiring spinal instrumentation. Method(s): A
technique of multilevel hemilaminotomy windows is described in a patient
with severe thoracic SEL causing syringomyelia. A 3-dimensional spine
model was created to illustrate the technique and working angles. We
performed a literature review by searching PubMed, Ovid Embase, and Scopus
electronic databases with the predetermined inclusion criteria of cases
with spinal lipomatosis and a fluid cavity within the spinal cord.
 Result(s): The patient's deficit and syringomyelia resolved
postoperatively. A review of the literature revealed only 3 cases of
syringomyelia secondary to SEL. Syringomyelia expansion occurred in all
cases leading to progressive neurologic decline, and surgery with removal
of the excessive adipose tissue resolved the syringomyelia and improved
the neurologic functioning in all cases. Conclusion(s): This
technique of multilevel alternating hemilaminotomy "windows" allows for
safe and effective decompression and resection of the excessive adipose
tissue with reduced operative time and without requiring spine
instrumentation. The technique maintains the integrity of the posterior
column, thus reducing the risk of postdecompression deformity. Careful
bipolar electrocoagulation of internal vertebral veins and meticulous
hemostasis is key for minimizing the intraoperative blood loss and
avoiding postoperative hematoma formation. Copyright © 2021
Elsevier Inc.

<24>
Accession Number
2010804677
Title
Granulomatosis With Polyangiitis (Wegener's Granulomatosis) Complicated by
Pericarditis: Our Experience of Two Cases and Comparative Review of
Literature.
Source
CASE. 5 (2) (pp 126-136), 2021. Date of Publication: April 2021.
Author
Ahmed T.; Meredith D.; Klein A.L.
Institution
(Ahmed, Meredith, Klein) Center for the Diagnosis and Treatment of
Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland
Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.

<25>
Accession Number
2011628979
Title
Operating bedside cardiac ultrasound program in emergency medicine
residency: A retrospective observation study from the perspective of
performance improvement.
Source
PLoS ONE. 16 (4 April) (no pagination), 2021. Article Number: e0248710.
Date of Publication: April 2021.
Author
Kim K.H.; Jung J.Y.; Park J.W.; Lee M.S.; Lee Y.H.
Institution
(Kim, Jung, Park, Lee, Lee) Department of Emergency Medicine, Seoul
National University Hospital, Seoul, South Korea
Publisher
Public Library of Science
Abstract
Background Point-of-care ultrasound is one of useful diagnostic tools in
emergency medicine practice and considerably depends on physician's
performance. This study was performed to evaluate performance improvements
and favorable attitudes through structured cardiac ultrasound program for
emergency medicine residents. Methods Retrospective observational study
using the point-of-care ultrasound (PoCUS) database in one tertiary
academic-teaching hospital emergency department has been conducted.
Cardiac ultrasound education and rotation program has been implemented in
emergency medicine residency program. Structured evaluation sheet for
cardiac ultrasound and questionnaire toward PoCUS have been developed. An
early-phase and a late-phase case were selected randomly for each
participant. Two emergency medicine specialists with expertise in PoCUS
evaluated saved images independently. We used a paired t-test to compare
the performance score of each phase and the results of the questionnaire.
Multivariable linear regression analysis was conducted to evaluate the
association between the characteristics of participants and performance
improvements. Results During the study period, a total of 1,652 bedside
cardiac ultrasounds were administered. Forty-six examinations conducted by
23 emergency medicine residents were randomly selected for analysis. The
performance score increased from 39.5 to 56.1 according to expert A and
45.3 to 62.9 according to expert B (p-value <0.01 for both). The average
questionnaire score, which was analyzed for 17 participants, showed
improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear
regression analysis, younger age, higher early-phase score and higher
confidence had a negative association with a greater improvement of
performance, while the number of examinations had a positive association.
Conclusions Bedside cardiac ultrasound performance and attitudes toward
PoCUS have been improved through structured residency
program. Copyright: © 2021 Kim et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<26>
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.
 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. 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.
 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. Copyright © 2021 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<27>
Accession Number
2011055764
Title
The music video therapy in postoperative analgesia in preschool children
after cardiothoracic surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Huang Y.-L.; Lei Y.-Q.; Liu J.-F.; Cao H.; Yu X.-R.; Chen Q.
Institution
(Huang, Lei, Liu, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Huang, Lei, Liu, Cao, Yu, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
(Huang, Lei, Liu, Cao, Yu, Chen) Department of Cardiac surgery, Fujian
Branch of Shanghai Children's Medical Center, Affiliated to Shanghai
Jiaotong University School of Medicine, Fuzhou, China
(Huang, Lei, Liu, Cao, Yu, Chen) Department of Cardiac surgery, Fujian
Children's Hospital, Fuzhou, China
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: To observe the effect of music video (MV) therapy on early
postoperative pain in preschool children after cardiothoracic surgery.
 Method(s): 116 preschool children undergoing cardiothoracic surgery
were randomly divided into the MV and control groups from June 2019 to
March 2020. The related vital signs parameters, the Wong-Baker FACES pain
rating scale, the FLACC scale, the number of postoperative PCA press and
the cumulants of sufentanil use were recorded and analyzed.
 Result(s): There were no statistically significant differences in
general characteristics and preintervention data between the two groups.
However, there were significantly lower in the heart rate, mean arterial
pressure, respiratory rate, the number of postoperative PCA press, and the
dosage of sufentanil in the MV group than those in the control group after
the intervention. The Wong-Baker FACES and FLACC scales in the MV group
were significantly lower than those in the control group at the time point
of immediately after the first intervention, 1 day, and 2 days after the
intervention. The two pain scores showed a downward trend over time, and
the corresponding scores in the MV group were better than those in the
control group. Conclusion(s): MV therapy can be an effective
nonpharmaceutical intervention in the clinical to relieve children's
postoperative pain after cardiothoracic surgery. Copyright © 2021
Wiley Periodicals LLC

<28>
[Use Link to view the full text]
Accession Number
634596851
Title
Impact of time factor and patient characteristics on the efficacy of PCI
vs CABG for left main coronary disease: A meta-analysis.
Source
Medicine. 100 (10) (pp e25057), 2021. Date of Publication: 12 Mar 2021.
Author
Qiu M.; Ding L.; Zhan Z.; Zhou H.
Institution
(Qiu, Zhou) Department of General Medicine, Shenzhen Longhua District
Central Hospital, Shenzhen, China
(Ding) Department of Cardiology, First Affiliated Hospital of Yangtze
University, Jingzhou, China
(Zhan) Class 3, Clinical medicine, Second Clinical Medical College,
Southern Medical University
Publisher
NLM (Medline)
Abstract
BACKGROUND: The impact of time factor and patient characteristics on the
efficacy of percutaneous coronary intervention (PCI) with drug-eluting
stents vs. coronary-artery bypass grafting (CABG) for left main coronary
disease is unclear. METHOD(S): We searched PubMed and Embase for
related trials. Two outcomes of interest were major adverse cardiac or
cerebrovascular events (MACCE, defined as a composite of all-cause
mortality, myocardial infarction, stroke, or unplanned revascularization)
and a composite of all-cause mortality, myocardial infarction, or stroke.
We conducted random-effects meta-analysis stratified by follow-up duration
and 7 factors of interest related to patient characteristics.
Random-effects meta-regression was performed to calculate P values for
trend and those for subgroup differences. RESULT(S): We included 11
articles from 5 trials. Compared with CABG, PCI increased MACCE at the end
of 3-year (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.04-1.40,
I2 = 0) and 5-year (HR 1.33, 95% CI 1.20-1.48, I2 = 0) follow-up, but did
not increase all-cause mortality, myocardial infarction, or stroke. The
logarithm of HR of PCI vs CABG for MACCE increased as follow-up duration
increased (beta = 0.057, P = .025). PCI vs CABG consistently increased
5-year MACCE across various subgroups defined by 7 factors of interest
(Psubgroup ranged from .156 to .830). CONCLUSION(S): The long-term
benefit of CABG vs PCI on MACCE in patients with left main coronary
disease is consistent across patients with different clinical
characteristics. The relative benefit of CABG on MACCE is driven by that
of CABG on unplanned revascularization, and becomes greater as time goes
on. Copyright © 2021 the Author(s). Published by Wolters Kluwer
Health, Inc.

<29>
Accession Number
634709990
Title
Surgical sutureless and sutured aortic valve replacement in low-risk
patients.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 29 Mar 2021.
Author
Lam K.Y.; Reardon M.J.; Yakubov S.J.; Modine T.; Fremes S.; Tonino P.A.L.;
Tan M.E.; Gleason T.G.; Harrison J.K.; Hughes G.C.; Oh J.K.; Head S.J.;
Huang J.; Deeb G.M.
Institution
(Lam, Tonino, Tan) Department of Cardiothoracic Surgery, Catharina
Hospital Eindhoven, Eindhoven, Netherlands
(Reardon) Department of Cardiovascular Surgery, Houston Methodist Debakey
Heart and Vascular Center, TX, Houston
(Yakubov) Department of Cardiology, Riverside Methodist - Ohio Health,
Columbus, OH
(Modine) Department of Cardiac Surgery, Lille University Hospital, Lille,
France
(Fremes) Department of Surgery, Sunnybrook Health Sciences Centre,
Toronto, Canada
(Gleason) University of Pittsburgh Medical Center, Pittsburg, United
States
(Harrison, Hughes) Duke University Medical Center, Durham
(Oh) Department of Cardiovascular Medicine, Mayo Clinic, MN, Rochester
(Head, Huang) Medtronic, MN, Minneapolis, United States
(Deeb) Departments of Cardiac Surgery, University of Michigan Hospitals,
MI, Ann Arbor, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomized clinical trials have shown that transcatheter
aortic valve replacement (TAVR) is noninferior to surgery in low surgical
risk patients. We compared outcomes in patients treated with a sutured
(stented or stentless) or sutureless surgical valve from the Evolut Low
Risk Trial. METHOD(S): The Evolut Low Risk Trial enrolled patients
with severe aortic stenosis and low surgical risk. Patients were
randomized to self-expanding TAVR or surgery. Use of sutureless or sutured
valves was at the surgeons' discretion. RESULT(S): There were 680
patients who underwent surgical aortic valve implantation (205 sutureless,
475 sutured). The VARC-2 30-day safety composite endpoint was similar in
the sutureless and sutured group (10.8% vs 11.0%, P=.93). All-cause
mortality between groups was similar between groups at 30 days (0.5% vs
1.5%, P=.28) and 1 year (3.3% vs 2.6%, P=.74). Disabling stroke was also
similar at 30 days (2.0% vs 1.5%, P=.65) and 1 year (2.6% vs 2.2%, P=.76).
Permanent pacemaker implantation at 30 days was significantly higher in
the sutureless compared with the sutured group (14.4% vs 2.9%, P<.001).
AV-related hospitalizations occurred more often at 1 year with sutureless
valves (9.1% vs 5.1%, P=.04). Mean gradients 1 year after sutureless and
sutured AVR were 9.9+/-4.2 vs 11.7+/-4.7mm Hg (P<.001).
 CONCLUSION(S): Among low-risk patients, sutureless versus sutured
valve use did not demonstrate a benefit in terms of 30-day complications
and produced marginally better hemodynamics, but with an increased rate of
pacemaker implantation and valve-related hospitalizations. Copyright
© 2021. Published by Elsevier Inc.

<30>
Accession Number
634712844
Title
COVID-19 and Heart Transplant: A Case Series and Review of the Literature.
Source
Transplantation proceedings. (no pagination), 2021. Date of Publication:
25 Feb 2021.
Author
Ballout J.A.; Ahmed T.; Kolodziej A.R.
Institution
(Ballout, Kolodziej) Gill Heart Institute, University of Kentucky,
Lexington, KY, United States
(Ahmed) Department of Internal Medicine, University of Kentucky,
Lexington, KY, United States
Publisher
NLM (Medline)
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in many challenges in
patient care, especially among high-risk populations such as heart
transplant recipients. Patients with heart transplant experience a
significantly higher mortality rate with COVID-19 infection, and
management is based on extrapolation from clinical trials done on
nontransplant patients and from clinical experience. Here we report 4
cases of patients with heart transplant who presented with COVID-19
infection in late 2020. Patients presented with symptoms similar to those
seen in the general population. All 4 patients were admitted to the
hospital, and they were all treated with dexamethasone. In addition, 2
patients received remdesivir. Immunosuppressive medications were adjusted
to maintain adequate levels of immunosuppression but at the same time
allow for an adequate immune response against the infection. All patients
were discharged alive from the hospital. We then performed a literature
review on studies that included heart transplant patients who developed
the infection and developed suggestions for a standardized management
approach, which we share in this article. Copyright © 2021
Elsevier Inc. All rights reserved.

<31>
Accession Number
2011425386
Title
Everolimus for the Prevention of Calcineurin-Inhibitor-Induced Left
Ventricular Hypertrophy After Heart Transplantation (RADTAC Study).
Source
JACC: Heart Failure. 9 (4) (pp 301-313), 2021. Date of Publication: April
2021.
Author
Anthony C.; Imran M.; Pouliopoulos J.; Emmanuel S.; Iliff J.W.; Moffat
K.J.; Ross J.; Graham R.M.; Kotlyar E.; Muthiah K.; Keogh A.M.; Hayward
C.S.; Macdonald P.; Jabbour A.
Institution
(Anthony, Imran, Pouliopoulos, Emmanuel, Iliff, Graham, Kotlyar, Muthiah,
Keogh, Hayward, Macdonald, Jabbour) Heart and Lung Transplant Unit, St.
Vincent's Hospital, Sydney, Australia
(Pouliopoulos, Graham, Hayward, Macdonald, Jabbour) Victor Chang Cardiac
Research Institute
(Moffat, Ross) Medical Imaging Department, St. Vincent's Hospital, Sydney,
Australia
(Graham, Kotlyar, Muthiah, Keogh, Hayward, Macdonald, Jabbour) Faculty of
Medicine, University of New South Wales, Sydney, New South Wales,
Australia
Publisher
Elsevier Inc.
Abstract
Objectives: This study aimed to determine the safety and efficacy of
combined low-dose everolimus and low-dose tacrolimus compared with
standard-dose tacrolimus in attenuating left ventricular hypertrophy (LVH)
after orthotopic heart transplantation (OHT). Background(s):
Calcineurin inhibitors (CNIs) such as tactrolimus are important in
preventing cardiac allograft rejection and reducing mortality after OHT.
However CNIs are causatively linked to the development of LVH, and are
associated with nephrotoxicity and vasculopathy. CNI-sparing agents such
as everolimus have been hypothesized to inhibit adverse effects of CNIs.
 Method(s): In this prospective, randomized, open-label study, OHT
recipients were randomized at 12 weeks after OHT to a combination of
low-dose everolimus and tacrolimus (the RADTAC group) or standard-dose
tacrolimus (the TAC group), with both groups coadministered mycophenolate
and prednisolone. The primary endpoint was LVH indexed as the change in
left ventricular mass (DELTALVM) by cardiovascular magnetic resonance
(CMR) imaging from 12 to 52 weeks. Secondary endpoints included CMR-based
myocardial performance, T1 fibrosis mapping, blood pressure, and renal
function. Safety endpoints included episodes of allograft rejection and
infection. Result(s): Forty stable OHT recipients were randomized.
Recipients in the RADTAC group had significantly lower tacrolimus levels
compared with the TAC group (6.5 +/- 3.5 mug/l vs. 8.6 +/- 2.8 mug/l; p =
0.02). The mean everolimus level in the RADTAC group was 4.2 +/- 1.7
mug/l. A significant reduction in LVM was observed in the RADTAC group
compared with an increase in LVM in the TAC group (DELTALVM = -13.0 +/-
16.8 g vs. 2.1 +/- 8.4 g; p < 0.001). Significant differences were also
noted in secondary endpoints measuring function and fibrosis (DELTA
circumferential strain = -2.9 +/- 2.8 vs. 2.1 +/- 2.3; p < 0.001; DELTAT1
mapping values = -32.7 +/- 51.3 ms vs. 26.3 +/- 90.4 ms; p = 0.003). No
significant differences were observed in blood pressure (DELTA mean
arterial pressure = 4.2 +/- 18.8 mm Hg vs. 2.8 +/- 13.8 mm Hg; p = 0.77),
renal function (DELTA creatinine = 3.1 +/- 19.9 mumol/l vs. 9 +/- 21.8
mumol/l; p = 0.31), frequency of rejection episodes (p = 0.69), or
frequency of infections (p = 0.67) between groups. Conclusion(s): The
combination of low-dose everolimus and tacrolimus compared with
standard-dose tacrolimus safely attenuates LVH in the first year after
cardiac transplantation with an observed reduction in CMR-measured
fibrosis and an improvement in myocardial strain. Copyright ©
2021 American College of Cardiology Foundation

<32>
Accession Number
633122328
Title
Effect of Tropisetron on Prevention of Emergence Delirium in Patients
after Noncardiac Surgery: A Trial Protocol.
Source
JAMA Network Open. 3 (10) (no pagination), 2020. Article Number: 13443.
Date of Publication: October 2020.
Author
Sun Y.; Lin D.; Wang J.; Geng M.; Xue M.; Lang Y.; Cui L.; Hao Y.; Mu S.;
Wu D.; Liang L.; Wu A.
Institution
(Sun, Lin, Wang, Geng, Xue, Hao, Mu, Wu, Wu) Department of Anesthesiology,
Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu,
Chaoyang District, Beijing 100020, China
(Lang) Department of Anesthesiology, Beijing Civil Aviation General
Hospital, Beijing, China
(Cui) Department of Anesthesiology, Beijing Huairou District Hospital of
Traditional Chinese Medicine, Beijing, China
(Liang) Department of Clinical Epidemiology and Tobacco Dependence
Treatment Research, Beijing Chaoyang Hospital, Capital Medical University,
Beijing Institute of Respiratory Medicine, No. 8 Gongti Nanlu, Chaoyang
District, Beijing 100020, China
Publisher
American Medical Association
Abstract
Importance: Postoperative delirium is a frequent disorder for patients
undergoing surgery and is associated with poor outcomes. Delirium may
occur in the immediate period after anesthesia administration and surgery.
Tropisetron, which is frequently administrated for postoperative nausea
and vomiting, is also a partial agonist of alpha7 nicotinic acetylcholine
receptors associated with neuroprotective effects. Tropisetron may be the
potential pharmacological treatment to decrease delirium after noncardiac
surgery. Objective(s): To perform a randomized clinical trial to
determine the efficacy and safety of tropisetron for prevention of
emergence delirium in patients undergoing noncardiac surgery. Design,
Setting, and Participant(s): This single-center, 2-arm randomized,
double-blind, placebo-controlled trial will include 1508 patients
undergoing noncardiac surgery. The intervention group will receive 5 mg of
intravenous tropisetron before anesthesia induction, and patients in the
control group will receive a placebo. The primary end point is the
incidence of emergence delirium within 1 hour after tracheal tube removal,
measured by the Confusion Assessment Method for the Intensive Care Unit
score. The main secondary outcome is the incidence of postoperative
delirium measured at 3 days of follow-up. An intention-to-treat principle
will be used for all analyses. Discussion(s): Delirium remains the
most common neuropsychiatric complication for patients after surgery. This
will be the first randomized clinical study to evaluate whether
tropisetron is effective in preventing emergence delirium. Results from
this study will provide evidence for alteration of daily practice. Trial
Registration: ClinicalTrials.gov Identifier: NCT04027751. Copyright
© 2020Sun Y et al. JAMA Network Open.

<33>
Accession Number
632810945
Title
Effect of Intramyocardial Grafting Collagen Scaffold with Mesenchymal
Stromal Cells in Patients with Chronic Ischemic Heart Disease: A
Randomized Clinical Trial.
Source
JAMA Network Open. 3 (9) (no pagination), 2020. Article Number: e2016236.
Date of Publication: September 2020.
Author
He X.; Wang Q.; Zhao Y.; Zhang H.; Wang B.; Pan J.; Li J.; Yu H.; Wang L.;
Dai J.; Wang D.
Institution
(He, Wang, Zhang, Pan, Wang) Department of Thoracic and Cardiovascular
Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical
School, 321 Zhongshan Rd, Nanjing 210008, China
(Zhao, Dai) Key Laboratory of Molecular Developmental Biology, Institute
of Genetics and Developmental Biology, Chinese Academy of Sciences,
Beijing 100101, China
(Wang, Wang) Center for Clinical Stem Cell Research, Affiliated Drum Tower
Hospital of Nanjing University Medical School, Nanjing, China
(Li) Department of Cardiology, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Nanjing, China
(Yu) Department of Radiology, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Nanjing, China
Publisher
American Medical Association
Abstract
Importance: Cell therapy may be helpful for cardiac disease but has been
fraught with poor cell retention and survival after transplantation.
 Objective(s): To determine whether cell-laden hydrogel treatment is
safe and feasible for patients with chronic ischemic heart disease (CIHD).
 Design, Setting, and Participant(s): This randomized, double-blind
clinical trial was conducted between March 1, 2016, and August 31, 2019,
at a single hospital in Nanjing, China. Among 115 eligible patients with
CIHD, 50 patients with left ventricular ejection fraction of 45% or less
were selected to receive elective coronary artery bypass grafting (CABG)
and additionally randomized to cell-plus-collagen treatment (collagen/cell
group), cell treatment alone (cell group), or a control group. Sixty-five
patients were excluded because of severe comorbidities or unwillingness to
participate. Forty-four participants (88%) completed the study. The last
patient completed 12 months of follow-up in August 2019. Analyses were
prespecified and included all patients with available data.
 Intervention(s): During CABG, patients in the collagen/cell group
were treated with human umbilical cord-derived mesenchymal stromal cell
(hUC-MSC)-laden collagen hydrogel intramyocardial injection, and the cell
group was treated with hUC-MSCs alone. Patients in the control group
underwent CABG alone. Main Outcomes and Measures: The primary outcome
was safety of the cell-laden collagen hydrogel assessed by the incidence
of serious adverse events. The secondary end point was the efficacy of
treatment, according to cardiovascular magnetic resonance imaging-based
left ventricular ejection fraction and infarct size. Result(s): Fifty
patients (mean [SD] age, 62.6 [8.3] years; 38 men [76%]) were enrolled, of
whom 18 were randomized to the collagen/cell group, 17 to the cell group,
and 15 to the control group. Patient characteristics did not differ among
groups at baseline. For the primary end point, no significant differences
in serious adverse events, myocardial damage markers, and renal or liver
function were observed among all groups after treatment; the collagen/cell
and cell groups each had 1 case of hospitalization because of heart
failure, and no serious adverse events were seen in the control group. At
12 months after treatment, the mean infarct size percentage change
was-3.1% (95% CI,-6.20% to-0.02%; P =.05) in the collagen/cell group,
5.19% (-1.85% to 12.22%, P =.35) in the cell group, and 8.59% (-3.06% to
20.25%, P =.21) in the control group. Conclusions and Relevance: This
study provides, to our knowledge, the first clinical evidence that the use
of collagen hydrogel is safe and feasible for cell delivery. These
findings provide a basis for larger clinical studies. Trial Registration:
ClinicalTrials.gov Identifier: NCT02635464. Copyright © 2020
American Medical Association. All rights reserved.

<34>
Accession Number
632022763
Title
Association of Neurodevelopmental Outcomes with Environmental Exposure to
Cyclohexanone during Neonatal Congenital Cardiac Operations: A Secondary
Analysis of a Randomized Clinical Trial.
Source
JAMA Network Open. 3 (5) (no pagination), 2020. Article Number: e204070.
Date of Publication: May 2020.
Author
Everett A.D.; Buckley J.P.; Ellis G.; Yang J.; Graham D.; Griffiths M.;
Bembea M.; Graham E.M.
Institution
(Everett, Yang, Griffiths) Division of Pediatric Cardiology, Department of
Pediatrics, Johns Hopkins University, 1800 Orleans St, Room M2303,
Baltimore, MD 21287, United States
(Buckley) Johns Hopkins Bloomberg School of Public Health, Department of
Environmental Health and Engineering, Johns Hopkins University, Baltimore,
MD, United States
(Graham, Bembea) Department of Anesthesia and Critical Care Medicine,
Johns Hopkins University, Baltimore, MD, United States
(Ellis, Graham) Molecular Determinants Core, Johns Hopkins All Children's
Hospital, St Petersburg, FL, United States
(Graham) Department of Pediatrics, Division of Cardiology, Medical
University of South Carolina, Charleston, United States
Publisher
American Medical Association
Abstract
Importance: Cyclohexanone is an industrial solvent used as a coupling
agent in medical plastics. Perioperative exposure to cyclohexanone could
play a role in lower scores on measures of neurodevelopmental outcomes
after neonatal cardiac operations. Objective(s): To examine the
presence and association of serum cyclohexanone level with neonatal
cardiac operations and neurodevelopmental outcomes. Design, Setting,
and Participant(s): This ad hoc secondary analysis used data from the
Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass
randomized clinical trial. The cohort included neonates younger than 31
days and with at least 37 weeks postgestational age at surgical treatment
who were enrolled at a single center between June 1, 2012, and October 31,
2016, and who had completed a neurodevelopmental assessment at age 12
months. Data were analyzed from July 8 to August 20, 2019. Exposures:
Serum cyclohexanone and its metabolites were measured preoperatively
(prior to skin incision), postoperatively (immediately after the surgical
procedure was completed), and 12 hours postoperatively. Cyclohexanone and
the molar sum of its metabolites were examined at each point and as a
geometric mean of all 3 points. Main Outcomes and Measures:
Neurodevelopment was assessed at age 12 months with the Bayley Scales of
Infant and Toddler Development III, assessing cognitive, language, and
motor function composite scores standardized to a population mean (SD) of
100 (15). Linear regression models were used to determine
covariate-adjusted differences in 12-month cognitive, language, and motor
composite scores per interquartile range increase in cyclohexanone level
or summed metabolite molar concentrations. Result(s): Among 85
included neonates, mean (SD) age at surgical treatment was 9.7 (5.3) days,
49 (58%) were boys, and 54 (64%) underwent corrective repair. Mean (SD)
Bayley Scales of Infant and Toddler Development III composite scores were
108.2 (12.2) for cognitive function, 104.7 (11.0) for language function,
and 94.7 (15.7) for motor function. Median (interquartile range)
cyclohexanone levels increased approximately 3-fold from immediately prior
to surgical treatment to immediately after surgical treatment (572
[389-974] vs 1744 [1469-2291] mug/L; P =.001). In adjusted analyses,
higher geometric mean cyclohexanone levels were associated with
significantly lower composite scores for cognitive (-4.23; 95% CI,-7.39
to-1.06; P =.01) and language (-3.65; 95% CI,-6.41 to-0.88; P =.01)
function. The difference in composite scores for motor function among
infants with higher geometric mean cyclohexanone levels was not
statistically significant(-3.93, 95% CI:-8.19 to 0.33, P =.07).
 Conclusions and Relevance: The findings of this secondary analysis of
a randomized clinical trial suggest that infants who underwent neonatal
cardiac surgical treatment with cardiopulmonary bypass had substantial
cyclohexanone levels, which were associated with adverse
neurodevelopmental function at age 12 months. Copyright © 2020
Everett AD et al.

<35>
Accession Number
2004888468
Title
Landiolol hydrochloride for prevention of atrial fibrillation during
esophagectomy: a randomized controlled trial.
Source
JA Clinical Reports. 6 (1) (no pagination), 2020. Article Number: 34. Date
of Publication: 01 Dec 2020.
Author
Aoki Y.; Kawasaki Y.; Ide K.; Shimizu Y.; Sato S.; Yokoyama J.
Institution
(Aoki) Department of Anesthesiology and Intensive Care Medicine, Hamamatsu
University School of Medicine, 1-20-1 Handayama, Higashi-Ku,
Hamamatsu-shi, Shizuoka 431-3192, Japan
(Aoki, Shimizu, Yokoyama) Department of Anesthesiology, Shizuoka General
Hospital, Shizuoka, Japan
(Kawasaki) Biostatistics Section, Clinical Research Centre, Chiba
University Hospital, Chiba, Japan
(Kawasaki) Faculty of Nursing, Japanese Red Cross College of Nursing,
Tokyo, Japan
(Ide) Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell
Research and Application, Kyoto University, Kyoto, Japan
(Sato) Department of Gastroenterological Surgery, Shizuoka General
Hospital, Shizuoka, Japan
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: Landiolol hydrochloride reduces the incidence of
perioperative atrial fibrillation (AF) in cardiac surgery; however, little
evidence is available regarding its effects in other types of surgery,
including esophagectomy. We assessed the hypothesis that landiolol reduces
perioperative AF and other complications associated with esophagectomy.
 Method(s): This single-center, randomized, double-blind,
parallel-group study enrolled patients scheduled for esophagectomy.
Patients were divided into those given landiolol at 3 mug/kg/min or
placebo for 24 h. The primary outcome was the proportion of patients who
developed AF within 96 h starting at 9:00 am on the day of surgery. The
secondary outcomes were the proportion of patients whose AF appeared
within 24 h, other complications based on the Clavien-Dindo
classification, and the intensive care unit and hospital stays.
 Result(s): Despite early study termination, 80 patients were
screened, and 56 were enrolled (28/group) from September 2016 to June
2018. AF occurred within 96 h of surgery in six (21.4%) patients in the
landiolol group and five (17.9%) patients in the placebo group (odds
ratio, 1.26; 95% confidence interval, 0.33-4.7) and within 24 h of surgery
in three (10.7%) patients in the landiolol group and two (7.1%) patients
in the placebo group. There were no significant differences in the
incidence of complications or in the number of intensive care unit or
hospital stays between the groups. Conclusion(s): Although our small
sample size prevents definitive conclusions, landiolol might not reduce
the occurrence of AF or other complications. Trial registration: UMIN,
UMIN000024040. Registered 13 September 2016,
http://www.umin.ac.jp/ctr/index/htm. Copyright © 2020, The
Author(s).

<36>
Accession Number
629190689
Title
Association of preoperative renin-angiotensin system inhibitors with
prevention of postoperative atrial fibrillation and adverse Events A
Systematic Review and Meta-analysis.
Source
JAMA Network Open. 2 (5) (no pagination), 2019. Article Number: e194934.
Date of Publication: May 2019.
Author
Chen S.; Acou W.-J.; Kiuchi M.G.; Meyer C.; Sommer P.; Martinek M.;
Schratter A.; Andrea B.R.; Ling Z.; Liu S.; Yin Y.; Hindricks G.;
Purerfellner H.; Krucoff M.W.; Schmidt B.; Julian Chun K.R.
Institution
(Chen, Schmidt, Julian Chun) Cardioangiologisches Centrum Bethanien,
Frankfurt Academy for Arrhythmias, Agaplesion Markus Krankenhaus,
Wilhelm-Epstein Strase 4, Frankfurt am Main 60431, Germany
(Acou) Department of Cardiology, AZ Delta, Roeselare, Belgium
(Kiuchi) School of Medicine, Royal Perth Hospital Unit, University of
Western Australia, Perth, Australia
(Meyer) Klinik fur Kardiologie mit Schwerpunkt Elektrophysiologie,
Universitares Herzzentrum Hamburg, Universitatsklinikum Hamburg-Eppendorf,
Hamburg, Germany
(Meyer) German Centre for Cardiovascular Research, Partner Site
Hamburg/Kiel, Lubeck, Germany
(Sommer) Klinik fur Elektrophysiologie/ Rhythmologie, Herz- und
Diabeteszentrum Nordrhein-Westfalen, Universitatsklinik der
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Sommer, Hindricks) Abteilung der Elektrophysiologie, Herzzentrum
Universitat Leipzig, Leipzig, Germany
(Martinek, Purerfellner) Abteilung der Kardiologie, Akademisches
Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen,
Linz, Austria
(Schratter) Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing
Wien, Vienna, Austria
(Andrea) Department of Cardiology, Sul Fluminense University Hospital,
Vassouras, Brazil
(Ling, Yin) Department of Cardiology, Second Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Liu) Shanghai General Hospital, Shanghai Jiao Tong University, School of
Medicine, Shanghai, China
(Krucoff) Department of Medicine and Cardiology, Duke University Medical
Center, Duke Clinical Research Institute, Durham, NC, United States
Publisher
American Medical Association
Abstract
IMPORTANCE Postoperative atrial fibrillation (POAF) is a well-known
complication after cardiac surgery. Renin-angiotensin system inhibitors
(RASIs) have been suggested as an upstream therapy for selected patients
with AF; however, evidence in the surgical setting is limited. OBJECTIVE
To evaluate the role of preoperative RASIs in prevention of POAF and
adverse events for patients undergoing cardiac surgery. DATA SOURCES The
PubMed database and the Cochrane Library from inception until December 31,
2018, were searched by using the keywords renin-angiotensin system
inhibitors OR angiotensinconverting enzyme inhibitors OR angiotensin
receptor blocker OR aldosterone antagonist AND cardiac surgery.
ClinicalTrials.gov was searched from inception until December 31, 2018, by
using the keywords postoperative atrial fibrillation. STUDY SELECTION
Randomized clinical trials (RCTs) and observational studies comparing the
association between preoperative RASI treatment vs no preoperative RASI
treatment (control group) and the incidence of POAF were identified.
Eleven unique studiesmet the selection criteria. DATA EXTRACTION AND
SYNTHESIS Pooled analysis was performed using a random-effects model.
Sensitivity and subgroup analyses of RCTs were performed to test the
stability of the overall effect. Metaregression was conducted to explore
potential risk of bias. MAIN OUTCOMES AND MEASURES The primary outcome was
POAF, and the secondary outcomes included rates of stroke and mortality
and duration of hospitalization. RESULTS Eleven unique studies involving
27 885 unique patients (74.4%male; median age, 65 years [range, 58.5-74.5
years]) were included. Compared with the control group, the RASI group did
not have a significantly reduced risk of POAF (odds ratio [OR], 1.04;
95%CI, 0.91-1.19; P = .55; z = 0.60), stroke (OR, 0.86; 95%CI, 0.62-1.19;
P = .37; z = 0.90; without significant heterogeneity, P = .11), death (OR,
1.07; 95%CI, 0.85-1.35; P = .56; z = 0.59; without significant
heterogeneity, P = .12), composite adverse cardiac events (OR, 1.04;
95%CI, 0.91-1.18; P = .58; z = 0.56), or a reduced hospital stay (weighted
mean difference, -0.04; 95%CI, -1.05 to 0.98; P = .94; z = 0.07) using a
random-effects model. Pooled analysis focusing on RCTs showed consistent
results. The primary overall effect was maintained in sensitivity and
subgroup analyses. Metaregression showed that male sex was significantly
associated with POAF (tau2 = 0.0065; z = 3.47; Q = 12.047; P <
.001) and that use of beta-blockers was associated with a significantly
reduced risk in developing POAF (tau2 = 0.018; z = -2.24; Q =
5.0091; P = .03). CONCLUSIONS AND RELEVANCE The findings from this study
suggest that preoperative RASI treatment does not offer additional benefit
in reducing the risk of POAF, stroke, death, and hospitalization in the
setting of cardiac surgery. The results provide no support for
conventional use of RASIs for the possible prevention of POAF and adverse
events in patients undergoing cardiac surgery; further randomized data,
particularly among those patients with heart failure, are
needed. Copyright © 2019 JAMA Network Open.All right reserved.

<37>
Accession Number
2010859014
Title
Cardiovascular magnetic resonance and transesophageal echocardiography in
patients with prosthetic valve paravalvular leaks: towards an accurate
quantification and stratification.
Source
Journal of Cardiovascular Magnetic Resonance. 23 (1) (no pagination),
2021. Article Number: 31. Date of Publication: December 2021.
Author
Haberka M.; Malczewska M.; Pysz P.; Kozlowski M.; Wojakowski W.; Smolka G.
Institution
(Haberka) Department of Cardiology, Medical University of Silesia, Ziolowa
45/47, Katowice 40-635, Poland
(Malczewska, Pysz, Kozlowski, Wojakowski, Smolka) Department of Cardiology
and Structural Heart Diseases, Medical University of Silesia, Katowice,
Poland
(Pysz) Department of Cardiac Rehabilitation, Treatment and Rehabilitation
Center, Long-Term Care Hospital, Jaworze, Poland
Publisher
BioMed Central Ltd
Abstract
Background: Objective assessment of prosthetic paravalvular leak (PVL) is
complex and challenging even in transesophageal echocardiography (TEE).
Our aim was to assess the value of cardiovascular magnetic resonance (CMR)
in quantifying PVL in aortic (AVR) or mitral valve (MVR) replacement.
 Method(s): Thirty-one patients (62 +/- 15.1 years, 63% males) with a
preliminary diagnosis of significant PVL (AVR, n-23; MVR, n = 8) were
recruited. The TEE PVL grading was based on the semi-quantitative (SQ) TEE
according to the VARC II PVL classification (%PVL: mild < 10%; moderate
10%-30%; severe > 30%). Non-contrast CMR studies were acquired at 1.5 T
with a quantitative approach (phase-contrast velocity encoded imaging).
The CMR PVL severity was classified according to regurgitant fraction (RF:
(1) mild <= 20%, (2) moderate 21%-39%, or (3) severe >= 40%).
 Result(s): All patients revealed symptoms of heart failure (71%: New
York Heart Association [NYHA] II; 91%: N-terminal pro-B-type natriuretic
peptide [NT-proBNP] > 150 pg/ml) and typical cardiovascular disease risk
factors. The SQ-TEE results revealed several categories: (1) mild (n = 5;
16%), (2) moderate (n = 21; 67%), and (3) severe (n = 5; 16%) PVL.
However, CMR PVL RF reclassified the severity of PVL: (1) mild to moderate
(in 80%), (2) moderate to severe (in 47%), and (3) severe to moderate (in
40%). The receiver operating characteristic analysis showed that SQ-TEE
and CMR PVL-vol and -RF predicted the upper tertile of NT-proBNP (> 2000
pg/ml) with the best sensitivity for CMR parameters. Conclusion(s):
The SQ-TEE showed moderate agreement with CMR and underestimated a
considerable number of AVR or MVR-PVL. Copyright © 2021, The
Author(s).

<38>
Accession Number
2005688873
Title
Virtual reality for acute and chronic pain management in adult patients: a
narrative review.
Source
Anaesthesia. 76 (5) (pp 695-704), 2021. Date of Publication: May 2021.
Author
Chuan A.; Zhou J.J.; Hou R.M.; Stevens C.J.; Bogdanovych A.
Institution
(Chuan, Hou) Faculty of Medicine, University of New South Wales Sydney and
Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
(Chuan, Zhou) Department of Anaesthesia, Liverpool Hospital, Sydney, NSW,
Australia
(Stevens) MARCS Institute for Brain, Behaviour and Development, Western
Sydney University, Sydney, NSW, Australia
(Bogdanovych) MARCS Institute for Brain, Behaviour and Development,
Western Sydney University, Sydney, Australia
Publisher
Blackwell Publishing Ltd
Abstract
Virtual reality is a computer-generated environment that immerses the user
in an interactive artificial world. This ability to distract from reality
has been utilised for the purposes of providing pain relief from noxious
stimuli. As technology rapidly matures, there is potential for
anaesthetists and pain physicians to incorporate virtual reality devices
as non-pharmacological therapy in a multimodal pain management strategy.
This systematic narrative review evaluates clinical studies that used
virtual reality in adult patients for management of acute and chronic
pain. A literature search found 690 citations, out of which 18 studies
satisfied the inclusion criteria. Studies were assessed for quality using
the Jadad and Nottingham-Ottawa Scales. Agreement on scores between
independent assessors was 0.87 (95%CI 0.73-0.94). Studies investigated
virtual reality use: intra-operatively; for labour analgesia; for wound
dressing changes; and in multiple chronic pain conditions. Twelve studies
showed reduced pain scores in acute or chronic pain with virtual reality
therapy, five studies showed no superiority to control treatment arms and
in one study, the virtual reality exposure group had a worsening of acute
pain scores. Studies were heterogeneous in: methods; patient population;
and type of virtual reality used. These limitations suggest the
evidence-base in adult patients is currently immature and more rigorous
studies are required to validate the use of virtual reality as a
non-pharmacological adjunct in multimodal pain management. Copyright
© 2020 Association of Anaesthetists

<39>
Accession Number
2005671983
Title
Pre-operative optimisation for chronic obstructive pulmonary disease: a
narrative review.
Source
Anaesthesia. 76 (5) (pp 681-694), 2021. Date of Publication: May 2021.
Author
Lee A.H.Y.; Snowden C.P.; Hopkinson N.S.; Pattinson K.T.S.
Institution
(Lee, Pattinson) Nuffield Department of Clinical Neurosciences, University
of Oxford, United Kingdom
(Snowden) Newcastle Hospitals NHS Trust, Newcastle, United Kingdom
(Snowden) Newcastle University, Newcastle, United Kingdom
(Hopkinson) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Hopkinson) The Royal Brompton Hospital, London, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Chronic obstructive pulmonary disease is a condition commonly present in
older people undergoing surgery and confers an increased risk of
postoperative complications and mortality. Although predominantly a
respiratory disease, it frequently has extra-pulmonary manifestations and
typically occurs in the context of other long-term conditions. Patients
experience a range of symptoms that affect their quality of life,
functional ability and clinical outcomes. In this review, we discuss the
evidence for techniques to optimise the care of people with chronic
obstructive pulmonary disease in the peri-operative period, and address
potential new interventions to improve outcomes. The article centres on
pulmonary rehabilitation, widely available for the treatment of stable
chronic obstructive pulmonary disease, but less often used in a
peri-operative setting. Current evidence is largely at high risk of bias,
however. Before surgery it is important to ensure that what have been
called the 'five fundamentals' of chronic obstructive pulmonary disease
treatment are achieved: smoking cessation; pulmonary rehabilitation;
vaccination; self-management; and identification and optimisation of
co-morbidities. Pharmacological treatment should also be optimised, and
some patients may benefit from lung volume reduction surgery.
Psychological and behavioural factors are important, but are currently
poorly understood in the peri-operative period. Considerations of the risk
and benefits of delaying surgery to ensure the recommended measures are
delivered depends on patient characteristics and the nature and urgency of
the planned intervention. Copyright © 2020 The Authors.
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists

<40>
Accession Number
2011594310
Title
Preoperative exercise training to prevent postoperative pulmonary
complications in adults undergoing major surgery: A systematic review and
meta-analysis with trial sequential analysis.
Source
Annals of the American Thoracic Society. 18 (4) (pp 678-688), 2021. Date
of Publication: April 2021.
Author
Assouline B.; Cools E.; Schorer R.; Kayser B.; Elia N.; Licker M.
Institution
(Assouline, Cools, Schorer, Elia, Licker) Department of Anesthesiology,
Clinical Pharmacology, Intensive Care and Emergency Medicine, University
Hospitals Geneva, University of Geneva, Geneva, Switzerland
(Elia, Licker) Faculty of Medicine, University of Geneva, Geneva,
Switzerland
(Kayser) Institute of Sport Sciences, Synathlon, Uni-Centre, Lausanne,
Switzerland
Publisher
American Thoracic Society
Abstract
Rationale: Poor preoperative physical fitness and respiratory muscle
weakness are associated with postoperative pulmonary complications (PPCs)
that result in prolonged hospital length of stay and increased mortality.
 Objective(s): To examine the effect of preoperative exercise training
on the risk of PPCs across different surgical settings. Method(s): We
searched MEDLINE, Web of Science, Embase, the Physiotherapy Evidence
Database, and the Cochrane Central Register, without language
restrictions, for studies from inception to July 2020. We included
randomized controlled trials that compared patients receiving exercise
training with those receiving usual care or sham training before cardiac,
lung, esophageal, or abdominal surgery. PPCs were the main outcome;
secondary outcomes were preoperative functional changes and postoperative
mortality, cardiovascular complications, and hospital length of stay. The
study was registered with PROSPERO (International Prospective Register of
Systematic Reviews). Result(s): From 29 studies, 2,070 patients were
pooled for meta-analysis. Compared with the control condition,
preoperative exercise training was associated with a lower incidence of
PPCs (23 studies, 1,864 patients; relative risk, 0.52; 95% confidence
interval [CI], 0.41 to 0.66; grading of evidence, moderate); Trial
Sequential Analysis confirmed effectiveness, and there was no evidence of
difference of effect across surgeries, type of training (respiratory
muscles, endurance or combined), or preoperative duration of training. At
the end of the preoperative period, exercise training resulted in
increased peak oxygen uptake (weighted mean difference [WMD], 12 ml/kg/
min; 99% CI, 0.3 to 3.7) and higher maximal inspiratory pressure (WMD,
112.2 cm H<inf>2</inf>O; 99% CI, 6.3 to 18.2). Hospital length of stay was
shortened (WMD, 22.3 d; 99% CI, 23.82 to 20.75) in the intervention group,
whereas no difference was found in postoperative mortality.
 Conclusion(s): Preoperative exercise training improves physical
fitness and reduces the risk of developing PPCs while minimizing hospital
resources use, regardless of the type of intervention and surgery
performed. Copyright © 2021 by the American Thoracic Society

<41>
Accession Number
2011548637
Title
Surgical management for unruptured sinus of Valsalva aneurysms: A
narrative review of the literature.
Source
Journal of Thoracic Disease. 13 (3) (pp 1833-1850), 2021. Date of
Publication: March 2021.
Author
Nguyen Q.; Vervoort D.; Phan K.; Luc J.G.Y.
Institution
(Nguyen) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(Vervoort) John Hopkins Bloomberg School of Public Health, Baltimore, MD,
United States
(Phan) NeuroSpine Surgery Research Group, Prince of Wales Private
Hospital, Sydney, Australia
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
Publisher
AME Publishing Company
Abstract
Unruptured sinus of Valsalva aneurysms (SVAs) are rare cardiac lesions
that arise due to congenital or acquired etiologies. They could be
asymptomatic or cause various clinical manifestations as a consequence of
their mass effect on the coronary arteries, heart valves, and other
adjacent structures. While the factors predicting SVA rupture are not
fully understood, ruptured SVAs carry a high complication and mortality
rate, highlighting the need for early recognition and management of
unruptured SVAs. Imaging modalities such as echocardiography, computed
tomography (CT), angiography, and magnetic resonance imaging (MRI) are
essential in identifying and characterizing the aneurysm as well as
associated cardiac anomalies. However, there are no specific guidelines
for the diagnosis and management of SVAs. Herein, we performed a
contemporary systematic review to examine the presentation, diagnostic
tests and findings, as well as outcomes for surgical intervention of
unruptured SVAs. We demonstrate that surgical repair remains the preferred
method of treatment in order to prevent complications such as rupture or
thrombus formation. Surgery should be prompted in patients with
symptomatic, large, or rapidly expanding unruptured SVAs, as well as those
unruptured SVAs that contain intraluminal thrombi, have a mass effect on
surrounding structures, or are recurrent. Surgical outcomes are generally
good with favourable prognosis and minimal recurrence. Copyright
© Journal of Thoracic Disease. All rights reserved.

<42>
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. 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. 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). 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. Copyright
© Journal of Thoracic Disease. All rights reserved.

<43>
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.
 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. 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).
 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. Copyright © Journal
of Thoracic Disease. All rights reserved.

<44>
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. 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. 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. 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. Copyright © 2021 AME Publishing Company. All
rights reserved.

<45>
Accession Number
2005154667
Title
Will high-dose heparin affect blood loss and inflammatory response in
patients undergoing cardiopulmonary bypass?.
Source
Perfusion (United Kingdom). 36 (1) (pp 63-69), 2021. Date of Publication:
January 2021.
Author
Braatz E.; Sesartic V.; Liska J.
Institution
(Braatz, Sesartic) Department of Perioperative Medicine Intensive Care,
Karolinska University Hospital, Stockholm, Sweden
(Liska) Department of Cardiothoracic Surgery, Karolinska University
Hospital, Stockholm, Sweden
Publisher
SAGE Publications Ltd
Abstract
Introduction: We performed a randomized study to investigate if a high
versus a standard dose of heparin dose during cardiopulmonary bypass could
affect intra- and post-operative bleeding and reduce the inflammatory
response. Method(s): A total of 30 patients undergoing elective
coronary artery bypass grafting were randomized into high or standard dose
of heparin during cardiopulmonary bypass. Blood loss was documented peri-
and post-operatively, and interleukin-6, tumor necrosis factor-alpha, and
C3 were measured in conjunction with cardiopulmonary bypass.
 Result(s): Data from 29 patients were analyzed after exclusion of one
patient. The mean initial bolus and total heparin doses were 43,000 +/-
5,800 IU versus 35,000 +/- 4,100 IU, (p < 0.001), and 58,000 +/- 9,500 IU
versus 45,000 +/- 7,900 IU, (p < 0.001) in the intervention and the
control group, respectively. The median intra-operative bleeding was 150
mL (interquartile range 100-325) in the control versus 225 mL (IQR
200-350) in the intervention group, p = 0.15. The median chest tube blood
loss 12 hour post-operatively was 300 mL (interquartile range 250-385) in
the control versus 450 mL (IQR 315-505) in the intervention group, p =
0.029. There was no significant difference between the control group and
the intervention group during cardiopulmonary bypass for the measured
inflammatory markers interleukin-6 (p = 0.98), tumor necrosis factor-alpha
(p = 0.72), or C3 (p = 0.13). Conclusion(s): This small study showed
a small increase of post-operative bleeding associated with higher heparin
dosage in conjunction with cardiopulmonary bypass but did not demonstrate
an effect of heparin on the inflammatory response to cardiopulmonary
bypass. Copyright © The Author(s) 2020.

<46>
Accession Number
632535903
Title
Platelet inhibition with ticagrelor versus clopidogrel in diabetic
patients after percutaneous coronary intervention for chronic coronary
syndromes.
Source
Thrombosis and Haemostasis. 120 (8) (pp 1221-1229), 2020. Date of
Publication: 01 Aug 2020.
Author
Liu Z.; Tian R.; Wang Y.; Chen Q.; Li J.; Xu L.; Zhang S.
Institution
(Liu, Tian, Li, Zhang) Department of Cardiology, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Wang) Medical Research and Biometrics Center, Fu-Wai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
(Chen) Department of Laboratory Medicine, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Xu) Clinical Pharmacology Research Center, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
Publisher
Georg Thieme Verlag
Abstract
Background Clopidogrel is currently the only P2Y <inf>12</inf>inhibitor
with class I recommendation in patients after percutaneous coronary
intervention (PCI) for chronic coronary syndromes (CCS). Diabetic patients
have reduced therapeutic response to clopidogrel. Purpose This study
assessed the antiplatelet effect of ticagrelor versus clopidogrel in
diabetic patients after recent PCI for CCS. Methods Eligible patients were
randomly assigned to receive ticagrelor 90 mg twice daily or clopidogrel
75 mg once daily, in addition to aspirin 100 mg once daily for 15 days.
P2Y <inf>12</inf>reaction unit (PRU) and percent inhibition were measured
by VerifyNow P2Y <inf>12</inf>assay. High on-treatment platelet reactivity
(HOPR) was defined as PRU > 208. Bleeding was assessed by the Platelet
Inhibition and Patient Outcomes criteria. Cardiac ischemic events were
evaluated as adverse events. Results The baseline characteristics of the
patients (n = 39) were well balanced between the two groups. Both before
and 2 to 4 hours after the final study dose on day 15, PRU was lower (41.3
+/- 35.8 vs. 192.6 +/- 49.5, p < 0.001; 36.6 +/- 25.8 vs. 187.6 +/- 70.9,
p < 0.001), percent inhibition was higher (83.0% [70.5%, 96.0%] vs. 16.0%
[0%, 25.0%], p < 0.001; 85.0% [76.0%, 96.5%] vs. 25.0% [0%, 39.0%], p <
0.001), and HOPR occurred less frequently (0% [0/20] vs. 26.3% [5/19], p =
0.020; 0% [0/20] vs. 31.6% [6/19], p = 0.008) in the ticagrelor group (n =
20) compared with the clopidogrel group (n = 19). No major or minor
bleeding, or serious adverse events occurred in both groups. Conclusion
Ticagrelor achieved greater peak and trough platelet inhibition than did
clopidogrel in diabetic patients after recent PCI for CCS, which suggests
the potential use of ticagrelor in this clinical setting. Copyright
© 2020 Georg Thieme Verlag. All rights reserved.

<47>
Accession Number
2004935770
Title
Optimal antithrombotic treatment of patients with atrial fibrillation
early after an acute coronary syndrome-triple therapy, dual antithrombotic
therapy with an anticoagulant ... or, rather, temporary dual antiplatelet
therapy?.
Source
Journal of Clinical Medicine. 9 (8) (pp 1-11), 2020. Article Number: 2673.
Date of Publication: August 2020.
Author
Limbruno U.; de Sensi F.; Cresti A.; Picchi A.; Lena F.; de Caterina R.
Institution
(Limbruno, de Sensi, Cresti, Picchi) Cardioneurovascular Department,
Azienda USL Toscana Sudest, Grosseto 58100, Italy
(Lena) Pharmacy Department, Azienda USL Toscana Sudest, Grosseto 58100,
Italy
(de Caterina) Cardio-Thoracic and Vascular Department, Pisa University
Hospital and University of Pisa, Pisa 56124, Italy
(de Caterina) Fondazione VillaSerena per la Ricerca, Citta Sant'Angelo,
Pescara 65013, Italy
Publisher
MDPI AG
Abstract
The combination of atrial fibrillation (AF) and acute coronary syndrome
(ACS) is a complex situation in which a three-dimensional
risk-cardioembolic, coronary, and hemorrhagic-has to be carefully managed.
Triple antithrombotic therapy (TAT) is burdened with a high risk of
serious bleeding, while dual antithrombotic therapy with an anticoagulant
(DAT) likely provides only suboptimal coronary protection early after
stent implantation. Moreover, TAT precludes the advantages provided by the
use of the latest and more potent P2Y<inf>12</inf> inhibitors in ACS
patients. Here, we aimed to simulate and compare the expected coronary,
cardioembolic, and hemorrhagic outcomes offered by DAT, TAT, or modern
dual antiplatelet therapy (DAPT) with aspirin plus one of the latest
P2Y<inf>12</inf> inhibitors in AF patients early after an ACS. The
comparison of numbers needed to treat to prevent major adverse events with
the various antithrombotic regimens suggests that AF-ACS patients at high
ischemic and hemorrhagic risk and at moderately low embolic risk
(CHA<inf>2</inf> DS<inf>2</inf> VASc score 2-4) might safely withhold
anticoagulation after revascularization for one month taking advantage of
a modern DAPT, with a favorable risk-to-benefit ratio. In conclusion, this
strategy, not sufficiently addressed in recent European and North American
guidelines or consensus documents, adds to the spectrum of treatment
options in these difficult patients; it might be the best choice in a
substantial number of patients; and should be prospectively tested in a
randomized controlled trial. Copyright © 2020 by the authors.
Licensee MDPI, Basel, Switzerland.

<48>
Accession Number
633970976
Title
Effectiveness, cost-effectiveness and safety of gabapentin versus placebo
as an adjunct to multimodal pain regimens in surgical patients: Protocol
of a placebo controlled randomised controlled trial with blinding (GAP
study).
Source
BMJ Open. 10 (11) (no pagination), 2020. Article Number: e041176. Date of
Publication: 20 Nov 2020.
Author
Baos S.; Rogers C.A.; Abbadi R.; Alzetani A.; Casali G.; Chauhan N.;
Collett L.; Culliford L.; De Jesus S.E.; Edwards M.; Goddard N.; Lamb J.;
McKeon H.; Molyneux M.; Stokes E.A.; Wordsworth S.; Gibbison B.; Pufulete
M.
Institution
(Baos, Rogers, Collett, Culliford, De Jesus, Lamb, McKeon, Pufulete)
Bristol Trials Centre, Clinical Trials and Evaluation Unit, Bristol
Medical School, University of Bristol, Bristol, United Kingdom
(Abbadi, Casali) Department of Surgery, University Hospitals Bristol and
Weston Nhs Foundation Trust, Bristol, United Kingdom
(Alzetani) Department of Surgery, University Hospital Southampton Nhs
Foundation Trust, Southampton, United Kingdom
(Chauhan, Molyneux, Gibbison) Department of Anaesthesia, University
Hospitals Bristol and Weston Nhs Foundation Trust, Bristol, United Kingdom
(Edwards, Goddard) Department of Anaesthesia, University Hospital
Southampton Nhs FoundationTrust, Southampton, United Kingdom
(Edwards) Acute Critical and Perioperative Care Research Group, Nihr
Biomedical Research Centre, University Hospital Southampton Nhs Foundation
Trust, University of Southampton, Southampton, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, University of
Oxford, Oxford, United Kingdom
(Gibbison) Bristol Medical School, University of Bristol, Bristol, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction Gabapentin is an antiepileptic drug currently licensed to
treat epilepsy and neuropathic pain but has been used off-label to treat
acute postoperative pain. The GAP study will compare the effectiveness,
cost-effectiveness and safety of gabapentin as an adjunct to standard
multimodal analgesia versus placebo for the management of pain after major
surgery. Methods and analysis The GAP study is a multicentre,
double-blind, randomised controlled trial in patients aged 18 years and
over, undergoing different types of major surgery (cardiac, thoracic or
abdominal). Patients will be randomised in a 1:1 ratio to receive either
gabapentin (600 mg just before surgery and 600 mg/day for 2 days after
surgery) or placebo in addition to usual pain management for each type of
surgery. Patients will be followed up daily until hospital discharge and
then at 4 weeks and 4 months after surgery. The primary outcome is length
of hospital stay following surgery. Secondary outcomes include pain, total
opioid use, adverse health events, health related quality of life and
costs. Ethics and dissemination This study has been approved by the
Research Ethics Committee. Findings will be shared with participating
hospitals and disseminated to the academic community through peer-reviewed
publications and presentation at national and international meetings.
Patients will be informed of the results through patient organisations and
participant newsletters. Copyright © Author(s) (or their
employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

<49>
Accession Number
634493053
Title
Effectiveness of Standard Local Anesthetic Bupivacaine and Liposomal
Bupivacaine for Postoperative Pain Control in Patients Undergoing Truncal
Incisions: A Randomized Clinical Trial.
Source
JAMA Network Open. (no pagination), 2021. Article Number: e210753. Date of
Publication: 2021.
Author
Sandhu H.K.; Miller C.C.; Tanaka A.; Estrera A.L.; Charlton-Ouw K.M.
Institution
(Sandhu, Miller, Tanaka, Estrera, Charlton-Ouw) McGovern Medical School,
University of Texas Health Science Center, Houston, United States
(Tanaka, Estrera) Memorial Hermann Hospital, Texas Medical Center,
Houston, United States
(Charlton-Ouw) HCA Houston Healthcare, Gulf Coast Division, Houston, TX,
United States
(Charlton-Ouw) Department of Clinical Sciences, University of Houston,
College of Medicine, 1200 Binz St, Houston, TX 77004, United States
Publisher
American Medical Association
Abstract
Importance: Liposomal bupivacaine for pain relief is purported to last 3
days compared with 8 hours with standard bupivacaine. However, its
effectiveness is unknown in truncal incisions for cardiothoracic or
vascular operations. Objective(s): To compare the effectiveness of
single-administration standard bupivacaine vs liposomal bupivacaine in
patients undergoing truncal incisions. Design, Setting, and
Participant(s): This randomized clinical trial enrolled patients
undergoing sternotomy, thoracotomy, minithoracotomy, and laparotomy from a
single cardiovascular surgery department in an academic medical center
between November 2012 and June 2018. The study was powered to detect a
Cohen effect size of 0.35 with a power of greater than 80%. Data analysis
was performed from July to December 2018. Intervention(s): Patients
were randomized to standard bupivacaine or liposomal bupivacaine.
 Main Outcomes and Measures: Pain was assessed over 3 postoperative
days by the Numeric Rating Scale (NRS). Adjunctive opioids were converted
to morphine equivalents units (MEU). NRS scores were compared using
Wilcoxon rank-sum (3-day area under the curve) and 2-way nonparametric
mixed models (daily scale score) to assess time-by-group interaction.
Secondary outcomes included cumulative opioid consumption. Result(s):
A total of 280 patients were analyzed, with 140 in each group
(single-administration standard bupivacaine vs liposomal bupivacaine).
Mean (SD) age was 60.2 (14.4) years, and 101 of 280 patients (36%) were
women. Irrespective of treatment assignment, pain decreased by a mean of
approximately 1 point per day over 3 days (beta = -0.87; SE = 0.11; mixed
model regression P <.001). Incision type was associated with pain with
patients undergoing thoracotomy (including minithoracotomy) reporting
highest median (interquartile range [IQR]) pain scores on postoperative
days 1 (liposomal vs standard bupivacaine, 6 [4-8] vs 5 [3-7]; P =.049,
Wilcoxon rank-sum) and 2 (liposomal vs standard bupivacaine, 5 [4-7] vs 4
[2-6]; P =.003, Wilcoxon rank-sum) but not day 3 (liposomal vs standard
bupivacaine, 3 [2-6] vs 3 [1-5]; P =.10, Wilcoxon rank-sum), irrespective
of treatment group. Median (IQR) 3-day cumulative NRS was 12.0 (8.0-16.5)
for bupivacaine and 13.5 (9.0-17.0) for liposomal bupivacaine (P =.15,
Wilcoxon rank-sum) Furthermore, use of opioids was greater following
liposomal bupivacaine compared with standard bupivacaine (median [IQR],
41.5 [21.3-73.8] MEU vs 33.0 [17.8-62.5] MEU; P =.03, Wilcoxon rank-sum).
On multivariable analysis, no interaction by incision type was observed
for mean pain scores or opioid use. Conclusions and Relevance: In
this randomized clinical trial involving truncal incisions for
cardiovascular procedures, liposomal bupivacaine did not provide improved
pain control and did not reduce adjunctive opioid use compared with
conventional bupivacaine formulation over 3 postoperative days. Trial
Registration: ClinicalTrials.gov Identifier: NCT02111746. Copyright
© 2021 American Medical Association. All rights reserved.

<50>
Accession Number
634492872
Title
Intermediate-Term Outcomes of Endoscopic or Open Vein Harvesting for
Coronary Artery Bypass Grafting: The REGROUP Randomized Clinical Trial.
Source
JAMA Network Open. (no pagination), 2021. Date of Publication: 2021.
Author
Zenati M.A.; Bhatt D.L.; Stock E.M.; Hattler B.; Wagner T.H.; Bakaeen
F.G.; Biswas K.
Institution
(Zenati) Division of Cardiac Surgery, Department of Surgery, Veterans
Affairs Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, 1400 VFWPkwy, Boston, MA 02132, United States
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Stock) Cooperative Studies Program, Perry Point/Baltimore Coordinating
Center, Office of Research and Development, US Department of Veterans
Affairs, Perry Point, MD, United States
(Hattler) VA Eastern Colorado Healthcare System, Denver, United States
(Wagner) VA Health Economics Resource Center, Department of Surgery,
Stanford University, Palo Alto, CA, United States
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Biswas) Perry Point Cooperative Studies Program Coordinating Center,
Office of Research and Development, US Department of Veterans Affairs,
Perry Point, MD, United States
(Biswas) Department of Epidemiology and Public Health, University of
Maryland, School of Medicine, Baltimore, United States
Publisher
American Medical Association

<51>
Accession Number
634696162
Title
Update on coronary artery bioresorbable vascular scaffolds in percutaneous
coronary revascularization.
Source
Reviews in cardiovascular medicine. 22 (1) (pp 137-145), 2021. Date of
Publication: 30 Mar 2021.
Author
Azzi N.; Shatila W.
Institution
(Azzi) Department of Cardiology, Lebanese American University - Rizk
Hospital, Beirut 1100, Lebanon
(Shatila) Department of Cardiology, Texas Heart Institute, Houston TX
77030, United States
(Shatila) Baylor College of Medicine, Houston TX 77030, United States
Publisher
NLM (Medline)
Abstract
Coronary angioplasty was first introduced in 1977. From plain old balloon
angioplasty to the introduction of bare metal stents in 1986 and dual
antiplatelet therapy in 1992 to much more later on. Due to the
unacceptable rate of stent restenosis, drug eluting stents (DES) were
introduced in 2000. The first generation showed an increase in late stent
thrombosis which led to the introduction of the second generation DES with
biocompatible or biodegradable polymers and thinner platforms. However
very late stent thrombosis and late restenosis might still pose problems
in the latter. Furthermore, there has been major debate regarding the
impact of long-term vessel caging on normal vasomotricity and long-term
positive remodeling. To resolve these issues, the bioresorbable vascular
scaffolds (BVS) were launched into the real world in 2011, showing
promising initial results. Multiple randomized trials, meta-analyses, and
registries were performed, mainly with the Absorb Bioresorbable Vascular
Scaffold System (Abbott Vascular, Chicago, IL, USA). This new technology
is hindered by certain features, such as the BVS radial strength, its
strut thickness, and the inflammatory process related to scaffold
degradation. Moreover, there is known data indicating higher thrombosis
rate with the Absorb BVS compared with the new generation of DES, despite
similar cardiovascular death. In this review, we discuss the clinical
procedural and technical evidence on BVS, with emphasis on their clinical
impact. We finally tackle the future directions on device and procedural
improvement while asking: is the bioresorbable technology still the way to
the future? Copyright © 2021 The Authors. Published by IMR Press.

<52>
Accession Number
2011084680
Title
Meta-Analysis of Usefulness of Cerebral Embolic Protection During
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 146 (pp 69-73), 2021. Date of Publication:
01 May 2021.
Author
Ahmad Y.; Howard J.P.
Institution
(Ahmad) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Howard) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
One of the most feared complications of transcatheter aortic valve
implantation (TAVI) is stroke, with increased mortality and disability
observed in patients suffering a stroke after TAVI. There has been no
significant decline in stroke rates seen over the last 5 years; attention
has therefore been given to strategies for cerebral embolic protection.
With the emergence of new randomized trial data, we sought to perform an
updated systematic review and meta-analysis to examine the effect of
cerebral embolic protection during TAVI both on clinical outcomes and on
neuroimaging parameters. We performed a random-effects meta-analysis of
randomized clinical trials of cerebral embolic protection during TAVI. The
primary end point was the risk of stroke. The risk of stroke was not
significantly different with the use of cerebral embolic protection:
relative risk (RR) 0.88, 95% confidence interval (CI) 0.57 to 1.36, p =
0.566. Nor was there a significant reduction in the risk of disabling
stroke, non-disabling stroke or death. There was no significant difference
in total lesion volume on MRI with cerebral embolic protection: mean
difference -74.94, 95% CI -174.31 to 24.4, p = 0.139. There was also not a
significant difference in the number of new ischemic lesions on MRI: mean
difference -2.15, 95% -5.25 to 0.96, p = 0.176, although there was
significant heterogeneity for the neuroimaging outcomes. In conclusion,
cerebral embolic protection during TAVI is safe but there is no evidence
of a statistically significant benefit on clinical outcomes or
neuroimaging parameters. Copyright © 2021 The Author(s)

<53>
Accession Number
2011047119
Title
Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation
Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic
Aortic Valve.
Source
American Journal of Cardiology. 146 (pp 74-81), 2021. Date of Publication:
01 May 2021.
Author
Al-abcha A.; Saleh Y.; Boumegouas M.; Prasad R.; Herzallah K.; Baloch
Z.Q.; Abdelkarim O.; Rayamajhi S.; Abela G.S.
Institution
(Al-abcha, Boumegouas, Prasad, Rayamajhi) Department of Internal Medicine,
Michigan State University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist DeBakey Heart &
Vascular Center, Houston, TX, United States
(Herzallah) Department of Cardiology, Tufts Medical Center, Boston,
Massachusetts, Boston, United States
(Baloch, Abela) Department of Cardiology, Michigan State University, East
Lansing, MI, United States
(Saleh, Abdelkarim) Department of Cardiology, Alexandria University, Egypt
Publisher
Elsevier Inc.
Abstract
This meta-analysis was conducted to compare clinical outcomes of
valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-surgical aortic valve replacement (Redo-SAVR) in failed bioprosthetic
aortic valves. We conducted a comprehensive review of previous
publications of all relevant studies through August 2020. Twelve
observational studies were included with a total of 8,430 patients, and a
median-weighted follow-up period of 1.74 years. A pooled analysis of the
data showed no significant difference in all-cause mortality (OR 1.15; 95%
CI 0.93 to 1.43; p = 0.21), cardiovascular mortality, myocardial
infarction, permanent pacemaker implantation, and the rate of moderate to
severe paravalvular leakage between ViV-TAVI and Redo-SAVR groups. The
rate of major bleeding (OR 0.36; 95% CI 0.16 to 0.83, p = 0.02),
procedural mortality (OR 0.41; 95% CI 0.18 to 0.96, p = 0.04), 30-day
mortality (OR 0.58; 95% CI 0.45 to 0.74, p <0.0001), and the rate of
stroke (OR 0.65; 95% CI 0.52 to 0.81, p = 0.0001) were significantly lower
in the ViV- TAVI arm when compared with Redo-SAVR arm. The mean
transvalvular pressure gradient was significantly higher post-implantation
in the ViV-TAVI group when compared with the Redo-SAVR arm (Mean
difference 3.92; 95% CI 1.97 to 5.88, p < 0.0001). In conclusion, compared
with Redo-SAVR, ViV-TAVI is associated with a similar risk of all-cause
mortality, cardiovascular mortality, myocardial infarction, permanent
pacemaker implantation, and the rate of moderate to severe paravalvular
leakage. However, the rate of major bleeding, stroke, procedural mortality
and 30-day mortality were significantly lower in the ViV-TAVI group when
compared with Redo-SAVR. Copyright © 2021 Elsevier Inc.

<54>
Accession Number
2010942184
Title
Meta-Analysis of Population Characteristics and Outcomes of Patients
Undergoing Pericardiectomy for Constrictive Pericarditis.
Source
American Journal of Cardiology. 146 (pp 120-127), 2021. Date of
Publication: 01 May 2021.
Author
Tzani A.; Doulamis I.P.; Tzoumas A.; Avgerinos D.V.; Koudoumas D.; Siasos
G.; Vavuranakis M.; Klein A.; Kampaktsis P.N.
Institution
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Tzoumas) Medical School, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Avgerinos) Onassis Cardiac Surgery Center, Athens, Greece
(Koudoumas) Department of Surgery, Division of Cardiothoracic Surgery,
University of Utah, Salt lake city, UT, United States
(Siasos, Vavuranakis) 1st Cardiology Clinic, National and Kapodistrian
University of Athens Medical School, Greece
(Klein) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Kampaktsis) Division of Cardiology, New York University Langone Medical
Center, NY, NY, United States
Publisher
Elsevier Inc.
Abstract
We sought to systematically describe the epidemiology, etiology, clinical
and operative characteristics as well as outcomes of patients who
underwent pericardiectomy for constrictive pericarditis in the
contemporary era. We conducted a systematic search of the MEDLINE, Embase,
and Cochrane databases from their inception to April 1, 2020 for studies
assessing the outcomes of pericardiectomy in patients with constrictive
pericarditis. Studies with patients enrolled before 1985, pediatric
patients or studies including >10% tuberculous pericarditis were excluded.
The impact of pericarditis etiology on outcomes was evaluated with a
meta-analysis. We analyzed 27 eligible studies and 2,114 patients.
Etiology was most commonly idiopathic (50.2%), followed by after-cardiac
surgery (26.2%) and radiation (6.9%). Patients were mostly men (76%), mean
age 58 and with advanced symptoms (NYHA III/IV 70.1%). Total
pericardiectomy was preferred (85.8%) and concomitant cardiac surgery was
relatively common (23.8%). Operative mortality was 6.9% and 5-year
mortality was 32.7%. Radiation and after-cardiac surgery patients had 3
and 2 times higher long-term risk for mortality respectively compared with
idiopathic. A sensitivity analysis did not result in changes in the
results. Thirty percent of included studies had more than low bias
primarily originating from follow up and selection. Pericardiectomy is
therefore performed mostly in middle-aged men with advanced symptoms and
low co-morbidity burden and still caries significant operative mortality.
Radiation and after-cardiac surgery patients have a significantly higher
mortality risk compared with idiopathic. Several methodological issues and
significant heterogeneity limit the generalization of these data and
randomized controlled trials may have to be considered. Copyright
© 2021 Elsevier Inc.

<55>
Accession Number
632222692
Title
The tenets of intrathoracic packing during damage control thoracic surgery
for trauma patients: a systematic review.
Source
European journal of trauma and emergency surgery : official publication of
the European Trauma Society. 47 (2) (pp 423-434), 2021. Date of
Publication: 01 Apr 2021.
Author
Manzano-Nunez R.; Chica J.; Gomez A.; Naranjo M.P.; Chaves H.; Munoz L.E.;
Rengifo J.E.; Caicedo-Holguin I.; Puyana J.C.; Garcia A.F.
Institution
(Manzano-Nunez, Chica, Gomez, Naranjo) Clinical Research Center, Fundacion
Valle del Lili, Cali, Colombia
(Manzano-Nunez, Chica, Garcia) Department of Surgery, Fundacion Valle del
Lili, Cali, Colombia
(Chaves, Munoz, Garcia) Department of Surgery, Universidad del Valle,
Cali, Colombia
(Rengifo) Department of Radiology, Universidad Autonoma de Bucaramanga,
Bucaramanga, Colombia
(Caicedo-Holguin) Facultad de Medicina, Universidad del Rosario, Bogota,
Colombia
(Puyana) Department of Surgery, University of Pittsburgh, Pittsburgh,
United States
Publisher
NLM (Medline)
Abstract
PURPOSE: Although Damage Control Thoracic Surgery (DCTS) has become a
provocative alternative to treat patients with chest injuries who are
critically ill and physiologically depleted, the management approaches of
chest-packing and the measurement of clinically relevant outcomes are not
well established. In this paper, we systematically reviewed the available
knowledge and evidence about intra-thoracic packing during DCTS for trauma
patients. We furthermore inform on the management approaches, surgical
strategies, and mortality associated with this intervention.
 METHOD(S): We identified articles in MEDLINE and SCOPUS. We reviewed
all studies that included trauma patients with chest injuries and managed
with intrathoracic packing during DCTS. Studies were eligible if the use
of intrathoracic packing in trauma populations was reported.
 RESULT(S): We identified 14 studies with a total of 211 patients.
Overall, intrathoracic packing was used in 131 trauma patients. Packing
was most commonly used to arrest persistent coagulopathic bleeding or
oozing either from raw surfaces or repaired structures and in conjunction
with other operative techniques. Pneumonectomy was a deadly intervention;
however, one study reported survivors when pneumonectomy was deferred.
 CONCLUSION(S): Packing is a feasible, reliable and potentially
effective complementary method for hemorrhage control. Therefore, we
recommend that packing can be used liberally as a complement to rapid
lung-sparing techniques.

<56>
Accession Number
633831896
Title
Association of Sickle Cell Trait with Incidence of Coronary Heart Disease
among African American Individuals.
Source
JAMA Network Open. (no pagination), 2021. Article Number: e2030435. Date
of Publication: 2021.
Author
Hyacinth H.I.; Franceschini N.; Seals S.R.; Irvin M.R.; Chaudhary N.; Naik
R.P.; Alonso A.; Carty C.L.; Burke G.L.; Zakai N.A.; Winkler C.A.; David
V.A.; Kopp J.B.; Judd S.E.; Adams R.J.; Gee B.E.; Longstreth W.T.; Egede
L.; Lackland D.T.; Greenberg C.S.; Taylor H.; Manson J.E.; Key N.S.;
Derebail V.K.; Kshirsagar A.V.; Folsom A.R.; Konety S.H.; Howard V.;
Allison M.; Wilson J.G.; Correa A.; Zhi D.; Arnett D.K.; Howard G.; Reiner
A.P.; Cushman M.; Safford M.M.
Institution
(Hyacinth, Gee) Aflac Cancer and Blood Disorder Center, Department of
Pediatrics, Emory University, School of Medicine, 2015 Uppergate Dr,
Atlanta, GA 30322, United States
(Franceschini) Department of Epidemiology, University of North Carolina,
Chapel Hill, United States
(Seals) Department of Mathematics and Statistics, University of West
Florida, Pensacola, United States
(Irvin, Chaudhary, Judd) School of Public Health, University of Alabama at
Birmingham, Birmingham, United States
(Naik) Division of Hematology, Department of Medicine, Johns Hopkins
University, Baltimore, MD, United States
(Alonso) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Carty) Fred Hutchinson Cancer Research Center, Seattle, WA, United States
(Burke) Department of Public Health Sciences, Wake Forest University,
Winston-Salem, NC, United States
(Zakai, Cushman) Department of Medicine and Pathology and Laboratory
Medicine, University of Vermont, Burlington, United States
(Winkler, David) Basic Science Laboratory, National Cancer Institute,
Frederick National Laboratory, Leidos Biomedical Research, Frederick, MD,
United States
(Kopp) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Adams, Lackland) Stroke Center, Department of Neurology, Medical
University of South Carolina, Charleston, United States
(Longstreth) Department of Neurology, University of Washington, Seattle,
United States
(Longstreth) Department of Epidemiology, University of Washington,
Seattle, United States
(Egede) Division of General Internal Medicine, Medical College of
Wisconsin, Milwaukee, United States
(Greenberg) Division of Hematology-Oncology, Medical University of South
Carolina, Charleston, United States
(Taylor) Cardiovascular Research Institute, Morehouse School of Medicine,
Atlanta, GA, United States
(Manson) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Key) Division of Hematology/Oncology, University of North Carolina at
Chapel Hill, Chapel Hill, United States
(Derebail, Kshirsagar) University of North Carolina Kidney Center,
University of North Carolina at Chapel Hill, Chapel Hill, United States
(Folsom) Division of Epidemiology and Community Health, University of
Minnesota, School of Public Health, Minneapolis, United States
(Konety) Division of Cardiology, University of Minnesota Medical Center,
Minneapolis, United States
(Howard) Department of Epidemiology, School of Public Health, University
of Alabama at Birmingham, Birmingham, United States
(Allison) Department of Family Medicine and Public Health, University of
California San Diego, San Diego, United States
(Wilson) Department of Physiology and Biophysics, University of
Mississippi Medical Center, Jackson, United States
(Correa) Jackson Heart Study, University of Mississippi Medical Center,
Jackson, United States
(Zhi) Department of Biostatistics, School of Public Health, University of
Alabama at Birmingham, Birmingham, United States
(Arnett) College of Public Health, University of Kentucky, Lexington,
United States
(Howard) Department of Biostatistics, School of Public Health, University
of Alabama at Birmingham, Birmingham, United States
(Reiner) University of Washington, Fred Hutchinson Cancer Research Center,
Seattle, United States
(Safford) Division of General Internal Medicine, Weill Cornell Medicine,
New York, NY, United States
Publisher
American Medical Association
Abstract
Importance: The incidence of and mortality from coronary heart disease
(CHD) are substantially higher among African American individuals compared
with non-Hispanic White individuals, even after adjusting for traditional
factors associated with CHD. The unexplained excess risk might be due to
genetic factors related to African ancestry that are associated with a
higher risk of CHD, such as the heterozygous state for the sickle cell
variant or sickle cell trait (SCT). Objective(s): To evaluate whether
there is an association between SCT and the incidence of myocardial
infarction (MI) or composite CHD outcomes in African American individuals.
 Design, Setting, and Participant(s): This cohort study included 5
large, prospective, population-based cohorts of African American
individuals in the Women's Health Initiative (WHI) study, the Reasons for
Geographic and Racial Differences in Stroke (REGARDS) study, the
Multi-Ethnic Study of Atherosclerosis (MESA), the Jackson Heart Study
(JHS), and the Atherosclerosis Risk in Communities (ARIC) study. The
follow-up periods included in this study were 1993 and 1998 to 2014 for
the WHI study, 2003 to 2014 for the REGARDS study, 2002 to 2016 for the
MESA, 2002 to 2015 for the JHS, and 1987 to 2016 for the ARIC study. Data
analysis began in October 2013 and was completed in October 2020.
Exposures: Sickle cell trait status was evaluated by either direct
genotyping or high-quality imputation of rs334 (the sickle cell variant).
Participants with sickle cell disease and those with a history of CHD were
excluded from the analyses. Main Outcomes and Measures: Incident MI,
defined as adjudicated nonfatal or fatal MI, and incident CHD, defined as
adjudicated nonfatal MI, fatal MI, coronary revascularization procedures,
or death due to CHD. Cox proportional hazards regression models were used
to estimate the hazard ratio for incident MI or CHD comparing SCT carriers
with noncarriers. Models were adjusted for age, sex (except for the WHI
study), study site or region of residence, hypertension status or systolic
blood pressure, type 1 or 2 diabetes, serum high-density lipoprotein
level, total cholesterol level, and global ancestry (estimated from
principal components analysis). Result(s): A total of 23197 African
American men (29.8%) and women (70.2%) were included in the combined
sample, of whom 1781 had SCT (7.7% prevalence). Mean (SD) ages at baseline
were 61.2 (6.9) years in the WHI study (n = 5904), 64.0 (9.3) years in the
REGARDS study (n = 10714), 62.0 (10.0) years in the MESA (n = 1556), 50.3
(12.0) years in the JHS (n = 2175), and 53.2 (5.8) years in the ARIC study
(n = 2848). There were no significant differences in the distribution of
traditional factors associated with cardiovascular disease by SCT status
within cohorts. A combined total of 1034 participants (76 with SCT) had
incident MI, and 1714 (137 with SCT) had the composite CHD outcome. The
meta-analyzed crude incidence rate of MI did not differ by SCT status and
was 3.8 per 1000 person-years (95% CI, 3.3-4.5 per 1000 person-years)
among those with SCT and 3.6 per 1000 person-years (95% CI, 2.7-5.1 per
1000 person-years) among those without SCT. For the composite CHD outcome,
these rates were 7.3 per 1000 person-years (95% CI, 5.5-9.7 per 1000
person-years) among those with SCT and 6.0 per 1000 person-years (95% CI,
4.9-7.4 per 1000 person-years) among those without SCT. Meta-analysis of
the 5 study results showed that SCT status was not significantly
associated with MI (hazard ratio, 1.03; 95% CI, 0.81-1.32) or the
composite CHD outcome (hazard ratio, 1.16; 95% CI, 0.92-1.47).
 Conclusions and Relevance: In this cohort study, there was not an
association between SCT and increased risk of MI or CHD in African
American individuals. These disorders may not be associated with sickle
cell trait-related sudden death in this population.. Copyright ©
2021 Thieme Medical Publishers, Inc.. All rights reserved.

<57>
Accession Number
633374433
Title
Risk Factors for Delirium and Cognitive Decline Following Coronary Artery
Bypass Grafting Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 9 (22) (pp e017275), 2020. Date
of Publication: 17 Nov 2020.
Author
Greaves D.; Psaltis P.J.; Davis D.H.J.; Ross T.J.; Ghezzi E.S.; Lampit A.;
Smith A.E.; Keage H.A.D.
Institution
(Greaves, Ross, Ghezzi, Smith, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, Justice and Society Academic Unit University of
South Australia Adelaide Australia
(Psaltis) Vascular Research Centre Lifelong Health Theme South Australian
Health and Medical Research Institute Adelaide Australia
(Psaltis) Adelaide Medical School University of Adelaide Adelaide
Australia
(Psaltis) Department of Cardiology Royal Adelaide Hospital Central
Adelaide Local Health Network Adelaide Australia
(Davis) Medical Reasearch Council Unit for Lifelong Health and Ageing Unit
at UCL London United Kingdom
(Lampit) Academic Unit for Psychiatry of Old Age Department of Psychiatry
University of Melbourne Melbourne Australia
(Lampit) Department of Neurology Charite-Universitatsmedizin Berlin Berlin
Germany
(Smith) Alliance for Research in Exercise, Nutrition and Activity Allied
Health and Human Performance Academic Unit University of South Australia
Adelaide Australia
Publisher
NLM (Medline)
Abstract
Background Coronary artery bypass grafting (CABG) is known to improve
heart function and quality of life, while rates of surgery-related
mortality are low. However, delirium and cognitive decline are common
complications. We sought to identify preoperative, intraoperative, and
postoperative risk or protective factors associated with delirium and
cognitive decline (across time) in patients undergoing CABG. Methods and
Results We conducted a systematic search of Medline, PsycINFO, EMBASE, and
Cochrane (March 26, 2019) for peer-reviewed, English publications
reporting post-CABG delirium or cognitive decline data, for at least one
risk factor. Random-effects meta-analyses estimated pooled odds ratio for
categorical data and mean difference or standardized mean difference for
continuous data. Ninety-seven studies, comprising data from 60 479
patients who underwent CABG, were included. Moderate to large and
statistically significant risk factors for delirium were as follows: (1)
preoperative cognitive impairment, depression, stroke history, and higher
European System for Cardiac Operative Risk Evaluation (EuroSCORE) score,
(2) intraoperative increase in intubation time, and (3) postoperative
presence of arrythmia and increased days in the intensive care unit;
higher preoperative cognitive performance was protective for delirium.
Moderate to large and statistically significant risk factors for acute
cognitive decline were as follows: (1) preoperative depression and older
age, (2) intraoperative increase in intubation time, and (3) postoperative
presence of delirium and increased days in the intensive care unit.
Presence of depression preoperatively was a moderate risk factor for
midterm (1-6 months) post-CABG cognitive decline. Conclusions This
meta-analysis identified several key risk factors for delirium and
cognitive decline following CABG, most of which are nonmodifiable. Future
research should target preoperative risk factors, such as depression or
cognitive impairment, which are potentially modifiable. Registration URL:
https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020149276.

<58>
Accession Number
632489500
Title
Association of Gender and Race with Allocation of Advanced Heart Failure
Therapies.
Source
JAMA Network Open. (no pagination), 2020. Date of Publication: 2020.
Author
Breathett K.; Yee E.; Pool N.; Hebdon M.; Crist J.D.; Yee R.H.; Knapp
S.M.; Solola S.; Luy L.; Herrera-Theut K.; Zabala L.; Stone J.; McEwen
M.M.; Calhoun E.; Sweitzer N.K.
Institution
(Breathett, Sweitzer) Sarver Heart Center, Division of Cardiology,
Department of Medicine, University of Arizona, 1501 N Campbell Ave,
Tucson, AZ 85724, United States
(Yee, Yee) Sarver Heart Center, Clinical Research Office, University of
Arizona, Tucson, United States
(Pool, Crist, McEwen) College of Nursing, University of Arizona, Tucson,
United States
(Hebdon) College of Nursing, University of Utah, Salt Lake City, United
States
(Knapp) Statistics Consulting Lab, Bio5 Institute, University of Arizona,
Tucson, United States
(Solola) Department of Medicine, University of Arizona, Tucson, United
States
(Luy) University of Rochester, New York, United States
(Herrera-Theut) University of Arizona Medical School, Tucson, United
States
(Zabala) Department of Medicine, University of California, Los Angeles,
United States
(Stone) Department of Psychology, University of Arizona, Tucson, United
States
(Calhoun) Center for Population Health Sciences, University of Arizona,
Tucson, United States
Publisher
American Medical Association
Abstract
Importance: Racial bias is associated with the allocation of advanced
heart failure therapies, heart transplants, and ventricular assist
devices. It is unknown whether gender and racial biases are associated
with the allocation of advanced therapies among women. Objective(s):
To determine whether the intersection of patient gender and race is
associated with the decision-making of clinicians during the allocation of
advanced heart failure therapies. Design, Setting, and
Participant(s): In this qualitative study, 46 US clinicians attending a
conference for an international heart transplant organization in April
2019 were interviewed on the allocation of advanced heart failure
therapies. Participants were randomized to examine clinical vignettes that
varied 1:1 by patient race (African American to white) and 20:3 by gender
(women to men) to purposefully target vignettes of women patients to
compare with a prior study of vignettes of men patients. Participants were
interviewed about their decision-making process using the think-aloud
technique and provided supplemental surveys. Interviews were analyzed
using grounded theory methodology, and surveys were analyzed with Wilcoxon
tests. Exposure: Randomization to clinical vignettes. Main Outcomes
and Measures: Thematic differences in allocation of advanced therapies by
patient race and gender. Result(s): Among 46 participants (24 [52%]
women, 20 [43%] racial minority), participants were randomized to the
vignette of a white woman (20 participants [43%]), an African American
woman (20 participants [43%]), a white man (3 participants [7%]), and an
African American man (3 participants [7%]). Allocation differences
centered on 5 themes. First, clinicians critiqued the appearance of the
women more harshly than the men as part of their overall impressions.
Second, the African American man was perceived as experiencing more severe
illness than individuals from other racial and gender groups. Third, there
was more concern regarding appropriateness of prior care of the African
American woman compared with the white woman. Fourth, there were greater
concerns about adequacy of social support for the women than for the men.
Children were perceived as liabilities for women, particularly the African
American woman. Family dynamics and finances were perceived to be greater
concerns for the African American woman than for individuals in the other
vignettes; spouses were deemed inadequate support for women. Last,
participants recommended ventricular assist devices over transplantation
for all racial and gender groups. Surveys revealed no statistically
significant differences in allocation recommendations for African American
and white women patients. Conclusions and Relevance: This national
study of health care professionals randomized to clinical vignettes that
varied only by gender and race found evidence of gender and race bias in
the decision-making process for offering advanced therapies for heart
failure, particularly for African American women patients, who were judged
more harshly by appearance and adequacy of social support. There was no
associated between patient gender and race and final recommendations for
allocation of advanced therapies. However, it is possible that bias may
contribute to delayed allocation and ultimately inequity in the allocation
of advanced therapies in a clinical setting. Copyright © 2020 S.
Karger AG. All rights reserved.

<59>
Accession Number
633195584
Title
Comparison of Heart Team vs Interventional Cardiologist Recommendations
for the Treatment of Patients with Multivessel Coronary Artery Disease.
Source
JAMA Network Open. (no pagination), 2020. Article Number: e2012749. Date
of Publication: 2020.
Author
Tsang M.B.; Schwalm J.D.; Gandhi S.; Sibbald M.G.; Gafni A.; Mercuri M.;
Salehian O.; Lamy A.; Pericak D.; Jolly S.; Sheth T.; Ainsworth C.;
Velianou J.; Valettas N.; Mehta S.; Pinilla N.; Yanagawa B.; Zhang L.; Chu
V.; Parry D.; Whitlock R.; Dyub A.; Cybulsky I.; Semelhago L.; Ioannou K.;
Hameed A.; Wright D.; Mulji A.; Darvish-Kazem S.; Gupta N.; Alshatti A.;
Natarajan M.K.
Institution
(Tsang, Schwalm, Sibbald, Salehian, Lamy, Jolly, Sheth, Ainsworth,
Velianou, Valettas, Mehta, Pinilla, Ioannou, Hameed, Wright, Mulji,
Darvish-Kazem, Alshatti, Natarajan) Division of Cardiology, Department of
Medicine, McMaster University, 1200 Fourth Ave, St Catharines, ON L2S 0A9,
Canada
(Gandhi, Gupta) Division of Cardiology, Department of Medicine, University
of Toronto, Toronto, ON, Canada
(Gandhi) Trillium Health Partners, Mississauga, ON, Canada
(Gafni) Center for Health Economics and Policy Analysis, Department of
Health Research Methods, Evidence and Impact, McMaster University,
Hamilton, ON, Canada
(Mercuri, Pericak, Zhang, Chu, Parry, Whitlock, Dyub, Cybulsky, Semelhago)
Division of Cardiovascular Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Yanagawa) Division of Cardiovascular Surgery, St Michael's Hospital,
Toronto, ON, Canada
(Yanagawa) Division of Cardiac Surgery, Department of Surgery, University
of Toronto, Toronto, ON, Canada
(Parry) Dunedin Hospital, Otago, New Zealand
(Ioannou) Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada
(Darvish-Kazem) Brampton Civic Hospital, William Osler Health System,
Brampton, ON, Canada
Publisher
American Medical Association
Abstract
Importance: Although the heart team approach is recommended in
revascularization guidelines, the frequency with which heart team
decisions differ from those of the original treating interventional
cardiologist is unknown. Objective(s): To examine the difference in
decisions between the heart team and the original treating interventional
cardiologist for the treatment of patients with multivessel coronary
artery disease. Design, Setting, and Participant(s): In this
cross-sectional study, 245 consecutive patients with multivessel coronary
artery disease were recruited from 1 high-volume tertiary care referral
center (185 patients were enrolled through a screening process, and 60
patients were retrospectively enrolled from the center's database). A
total of 237 patients were included in the final virtual heart team
analysis. Treatment decisions (which comprised coronary artery bypass
grafting, percutaneous coronary intervention, and medication therapy) were
made by the original treating interventional cardiologists between March
15, 2012, and October 20, 2014. These decisions were then compared with
pooled-majority treatment decisions made by 8 blinded heart teams using
structured online case presentations between October 1, 2017, and October
15, 2018. The randomized members of the heart teams comprised experts from
3 domains, with each team containing 1 noninvasive cardiologist, 1
interventional cardiologist, and 1 cardiovascular surgeon. Cases in which
all 3 of the heart team members disagreed and cases in which procedural
discordance occurred (eg, 2 members chose coronary artery bypass grafting
and 1 member chose percutaneous coronary intervention) were discussed in a
face-to-face heart team review in October 2018 to obtain pooled-majority
decisions. Data were analyzed from May 6, 2019, to April 22, 2020.
 Main Outcomes and Measures: The Cohen kappa coefficient between the
treatment recommendation from the heart team and the treatment
recommendation from the original treating interventional cardiologist.
 Result(s): Among 234 of 237 patients (98.7%) in the analysis for whom
complete data were available, the mean (SD) age was 67.8 (10.9) years; 176
patients (75.2%) were male, and 191 patients (81.4%) had stenosis in 3
epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI,
24.5%-36.7%) in treatment decisions between the heart team and the
original treating interventional cardiologist occurred, with a Cohen kappa
of 0.478 (95% CI, 0.336-0.540; P =.006). The heart team decision was more
frequently unanimous when it was concordant with the decision of the
original treating interventional cardiologist (109 of 163 cases [66.9%])
compared with when it was discordant (28 of 71 cases [39.4%]; P <.001).
When the heart team agreed with the original treatment decision, there was
more agreement between the heart team interventional cardiologist and the
original treating interventional cardiologist (138 of 163 cases [84.7%])
compared with when the heart team disagreed with the original treatment
decision (14 of 71 cases [19.7%]); P <.001). Those with an original
treatment of coronary artery bypass grafting, percutaneous coronary
intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71
patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a
different treatment recommendation from the heart team than the original
treating interventional cardiologist; the difference across the 3 groups
was statistically significant (P =.002). Conclusions and Relevance:
The heart team's recommended treatment for patients with multivessel
coronary artery disease differed from that of the original treating
interventional cardiologist in up to 30% of cases. This subset of cases
was associated with a lower frequency of unanimous decisions within the
heart team and less concordance between the interventional cardiologists;
discordance was more frequent when percutaneous coronary intervention or
medication therapy were considered. Further research is needed to evaluate
whether heart team decisions are associated with improvements in outcomes
and, if so, how to identify patients for whom the heart team approach
would be beneficial.. Copyright © 2020 BMJ Publishing Group. All
rights reserved.

<60>
Accession Number
2011576266
Title
TCTAP A-012 The Real World Usage of Rota Floppy Vs. Rota Extra Support
Wire in Asia.
Source
Journal of the American College of Cardiology. Conference: 26th
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). Virtual, Online. 77 (14 Supplement) (pp S10-S11), 2021.
Date of Publication: 13 Apr 2021.
Author
Ang A.S.; Low R.L.; Ong P.
Institution
(Ang) Tan Tock Seng Hospital, Singapore
(Low) Woodlands Health Campus, Singapore
(Ong) Heart Specialist International, Singapore
Publisher
Elsevier Inc.
Abstract
Background: Asian interventionists are taking on more complex coronary
angioplasty due to an increasing incidence of diabetes, aging population
and general aversion to bypass surgery. Coronary heart disease with
heavily calcified lesions is frequently encountered and there is
widespread adoption of rotational atherectomy in high volume PCI centers
in Asia to treat these patients. In rotablation, the operators can choose
between the RotaWire Floppy (F) and the RotaWire Extra-support wires (ES)
(Boston Scientific, USA). The decision of which wire to use is frequently
brought up in meetings and remains very much a topic of debate. We aim to
review the distribution figures of these wires to gain insight into the
real world preference of these wires when performing rotablation in the
Asia-Pacific region. Method(s): We analyzed the distribution figures
of the F and ES in 7 countries in the Asia-Pacific Region (Singapore,
Malaysia, Thailand, Philippines, Japan, Korea and Hongkong) from 2018-19.
 Result(s): The distribution ratio of the F to ES is approximately 3:1
for the last 2 years (Malaysia being the highest at 19:1 and Korea being
the lowest at 2:1) All countries imported more F than ES. There was no
significant change in the distribution ratio between the 2 years. [Formula
presented] [Formula presented] [Formula presented] Conclusion(s):
While identical in dimension, the two wires have key differences. The F
being more flexible and torque-able, is designed to reduce vessel
straightening and minimize guidewire bias. This facilities ablation of
lesions at the greater curvatures of angulated segments. However, as a
result it is easier to kink, hence requiring more care in manipulation.
The ES is stiffer and offers more support for delivery and may in some
cases allow experienced operator to bias the wire towards the eccentric
calcified plaque for more optimal contact between the burr and the lesion,
particularly plaques at the lesser curvature of angulations. A literature
search did not turn up any robust safety and efficacy data supporting the
use of one guidewire over the other. The current distribution ratio of
wires reflects most Asian operators considering the softer F to be a safer
routine choice. Randomized trial or larger registry may be needed to guide
future practice. Copyright © 2021

<61>
Accession Number
2011576143
Title
TCTAP A-017 Long-term Outcomes of Percutaneous Coronary Intervention
Versus Coronary Artery Bypass Surgery in Elderly Patients with Multivessel
and/or Left Main Coronary Artery Disease and Diabetes Mellitus: A
Systematic Review and Meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 26th
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). Virtual, Online. 77 (14 Supplement) (pp S12-S13), 2021.
Date of Publication: 13 Apr 2021.
Author
Zheng J.; Lou X.
Institution
(Zheng, Zheng) Fuwai Hospital, China
(Lou) Cancer Hospital, China
Publisher
Elsevier Inc.
Abstract
Background: This meta-analysis was performed to compare two methods of
superior revascularization strategies coronary artery bypass grafting
(CABG) and percutaneous coronary intervention (PCI) in patients with
multivessel and/or left main coronary artery disease for elderly patients'
diabetes mellitus. Method(s): An electronic search of recent studies
(2009-2019) was carried out using "diabetes mellitus", "coronary artery
bypass surgery", and "percutaneous coronary intervention" as the main
search terms. Stata software (version 15.0) was used to calculate relative
risk (RR) and 95% confidence intervals (CIs). Result(s): Among those
observational studies, PCI and CABG patients did not differ significantly
in their rates of stroke/cerebrovascular events(CVE)/cerebrovascular
accident(CVA) (RR 0.98 95% CI 0.87-1.10;P=0.697 ) and cardiac death (RR
1.22 95% CI 0.95-1.57;P=0.118 ). However, rates of major adverse of
cardiac and cerebral events(MACCEs), all-cause death, myocardial
infraction(MI) and any repeat revascularization were significantly higher
in the PCI group. Although there was no significant difference of MI (RR
1.26 95% CI 0.90-1.77;P=0.173) and stroke/CVE/CVA (RR 0.52 95% CI
0.26-1.03;P=0.061) among those RCT studies, the CABG significantly had
lower all-cause death, cardiac death and any repeat revascularization.
[Formula presented] [Formula presented] Conclusion(s): Despite the
high potential risk of stroke/CVE/CVA, CABG was better than PCI for
diabetic elderly patients with multivessel and/or left main coronary
artery disease in clinical practice. Copyright © 2021

<62>
Accession Number
2011565949
Title
Efficacy and safety of percutaneous mitral balloon valvotomy in patients
with mitral stenosis: A systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 33 (no pagination), 2021. Article Number:
100765. Date of Publication: April 2021.
Author
Abu Rmilah A.A.; Tahboub M.A.; Alkurashi A.K.; Jaber S.A.; Yagmour A.H.;
Al-Souri D.; Lewis B.R.; Nkomo V.T.; Erwin P.J.; Reeder G.S.
Institution
(Abu Rmilah, Tahboub) William J. von Liebig Center for Transplantation and
Clinical, Regeneration Mayo Clinic, Rochester, MN, United States
(Abu Rmilah, Alkurashi, Nkomo, Reeder) Department of Cardiovascular
Medicine, Mayo Clinic, Rochester, MN, United States
(Jaber) Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi
Arabia
(Yagmour) Al Quds University School of Medicine, Palestine
(Al-Souri) Department of Internal Medicine, Med Star Washington Hospital
Center, Washington DC, United States
(Lewis) Department of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Erwin) Department of Library Services, Mayo Clinic, Rochester, MN, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Percutaneous mitral balloon valvotomy PMBV is an acceptable
alternative to Mitral valve surgery for patients with mitral stenosis. The
purpose of this study was to explore the immediate results of PMBV with
respect to echocardiographic changes, outcomes, and complications, using a
meta-analysis approach. Method(s): MEDLINE, and EMBASE databases were
searched (01/2012 to 10/2018) for original research articles regarding the
efficacy and safety of PMBV. Two reviewers independently screened
references for inclusion and abstracted data including article details and
echocardiographic parameters before and 24-72 h after PMBV, follow-up
duration, and acute complications. Disagreements were resolved by third
adjudicator. Quality of all included studies was evaluated using the
Newcastle-Ottawa Scale NOS. Result(s): 44/990 references met the
inclusion criteria representing 6537 patients. Our findings suggest that
PMBV leads to a significant increase in MVA (MD = 0.81 cm2;
0.76-0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52-3.26, p = 0.007),
LVEDV EDV (MD = 5.81 ml; 2.65-8.97, p = 0.0003) and decrease in MPG (MD =
-7.96 mmHg; -8.73 to -7.20, p < 0.00001), LAP (MD = -10.09 mmHg; -11.06 to
-9.12, p < 0.00001), and SPAP (MD = -15.55 mmHg; -17.92 to -13.18, p <
0.00001). On short term basis, the pooled overall incidence estimates of
repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV
stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7%%
respectively. On long term basis, the pooled overall incidence estimates
of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV
stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7%
respectively Conclusion(s): PMBV represents a successful approach for
patients with mitral stenosis as evidenced by improvement in
echocardiographic parameters and low rate of complications. Copyright
© 2021

<63>
Accession Number
2011228554
Title
Meta-Analysis of Prospective Studies of Risk stratification by Syntax
Score for Unprotected Left Main Coronary Artery Revascularization.
Source
American Journal of Cardiology. 146 (pp 138-139), 2021. Date of
Publication: 01 May 2021.
Author
Qureshi W.T.; Mir T.; Uddin M.M.; Nasir U.B.
Institution
(Qureshi) Division of Cardiology, University of Massachusetts School of
Medicine, Worcester, MA, United States
(Mir, Uddin) Internal Medicine, Detroit Medical Center Wayne State
University, Detroit, United States
(Nasir) Department of Internal Medicine, University of Connecticut,
Hartford, CT, United States
Publisher
Elsevier Inc.

<64>
Accession Number
2011621400
Title
A Randomized Double-Blind Controlled Trial to Assess the Efficacy of
Ultrasound-Guided Erector Spinae Plane Block in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Athar M.; Parveen S.; Yadav M.; Siddiqui O.A.; Nasreen F.; Ali S.; Haseen
M.A.
Institution
(Athar, Parveen, Siddiqui, Nasreen, Ali) Department of Anaesthesiology and
Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim
University, Aligarh, Uttar Pradesh, India
(Yadav, Haseen) Department of Cardiothoracic and Vascular Surgery,
Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh,
Uttar Pradesh, India
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgical pain is of moderate-to-severe intensity.
Ineffective pain control may lead to increased cardiopulmonary
complications and poor surgical outcomes. This study aimed to assess the
efficacy of ultrasound-guided erector spinae plane block in providing
analgesia in adult cardiac surgeries. Design(s): Prospective,
randomized, double-blinded clinical trial. Setting(s): Single-center,
tertiary care hospital with university affiliation. Participant(s):
Thirty patients of either sex, aged 18-to-60 years, body mass index
19-to-30 kg/m2, undergoing elective on-pump single-vessel
coronary artery bypass grafting or valve replacement under general
anesthesia. Intervention(s): Patients were randomly categorized into
two groups of 15 patients each to receive bilateral erector spinae plane
block with 20 mL per side of 0.25% levobupivacaine (group E) or sham block
with 20 mL of normal saline (group C). Main Result(s): Mean analgesic
requirement in terms of fentanyl equivalents (microg) in the first 24
hours postoperatively was 225 +/- 112 in group E and 635 +/- 145 in group
C (95% confidence interval, 313.10-506.90; p < 0.05). Mean time to first
rescue analgesia was 356.9 +/- 34.5 in group E and 123.9 +/- 13.1 minutes
in group C (p < 0.05). Cox proportional hazard ratio for rescue analgesic
requirement in group E-to-group C was 5.0. Duration of mechanical
ventilation was 88.4 +/- 17 and 103.5 +/- 18 minutes in groups E and C,
respectively (p < 0.05). Ramsay sedation score at six hours postextubation
was 1.45 +/- 0.53 in group E and 3.19 +/- 0.62 in group C (p < 0.05). Mean
numerical rating score was 3.67 +/- 1.41 in group E and 4.50 +/- 1.00 in
group C (p = 0.17). No significant differences were observed in the
incidences of postoperative nausea vomiting, pruritus, and erector spinae
plane block-related infection and pneumothorax. Conclusion(s):
Single-shot erector spinae plane block provides superior analgesia as
compared with sham block. It decreased the first 24-hour postoperative
analgesic consumption by 64.5% and risk of pain by five times in the
authors' population. It also reduced the sedation and duration of
mechanical ventilation in postcardiac surgery patients. Copyright
© 2021 Elsevier Inc.

<65>
Accession Number
2011609085
Title
Double Blind Pilot Randomized Trial Comparing Extended Anticoagulation to
Placebo Following Major Lung Resection for Cancer.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Shargall Y.; Schneider L.; Linkins L.-A.; Crowther M.; Farrokhyar F.;
Waddell T.K.; de Perrot M.; Douketis J.; Lopez-Hernandez Y.; Schnurr T.;
Haider E.; Agzarian J.; Hanna W.C.; Finley C.
Institution
(Shargall, Schneider, Farrokhyar, Lopez-Hernandez, Schnurr, Agzarian,
Hanna, Finley) Division of Thoracic Surgery, Department of Surgery,
McMaster University, Hamilton, ON, Canada
(Linkins, Crowther, Douketis) Division of Hematology and Thromboembolism,
Department of Medicine, McMaster University, Hamilton, ON, Canada
(Haider) Department of Radiology, McMaster University, Hamilton, ON,
Canada
(Shargall, Waddell, de Perrot) Division of Thoracic Surgery, Department of
Surgery, University of Toronto, Toronto, ON, Canada
(Shargall, Douketis, Agzarian, Hanna, Finley) Division of Thoracic
Surgery, St. Joseph's Healthcare Hamilton, Firestone Institute for
Respiratory Health, Hamilton, ON, Canada
Publisher
W.B. Saunders
Abstract
Venous thromboembolism (VTE), which comprises pulmonary embolus (PE) and
deep vein thrombosis (DVT), is a significant cause of postoperative
morbidity and mortality. This pilot randomized control trial (RCT)
evaluated the feasibility of a full-scale RCT investigating extended
thromboprophylaxis in patients undergoing oncological lung resections.
Patients undergoing oncological lung resections in 2 tertiary centers
received in-hospital, thromboprophylaxis and were randomized to receive
post-discharge low-molecular-weight heparin (LMWH) or placebo injections
once-daily for 30 days. At 30 days postoperatively, all patients underwent
chest computed tomography with PE protocol and bilateral leg venous
ultrasound. Primary outcomes included feasibility and safety; VTE
incidence and 90-day survival were secondary outcomes. Between December
2015 and June 2018, 619 patients were screened, of whom 62.7% (165/263) of
eligible patients consented to participate, and 133 (81%) were randomized.
One-hundred and 3 patients, (77.4%), completed the 90-day study follow-up.
Reasons for non-participation pre-randomization included patient
discomfort and LMWH/placebo administration challenges. Post-randomization
withdrawals were due to patient preference, surgeon preference and minor
adverse events. Six asymptomatic VTE events (5 PE and 1 DVT) were detected
within 30 days (3 in each group), for an overall incidence of 7%. There
were 3 minor and no major adverse events. This study is the first to
demonstrate the feasibility and safety of a full-scale extended
thromboprophylaxis RCT in thoracic surgical oncology. Our results
demonstrate that, while recruitment and retention rates were modest, the
study design is feasible and with minimal adverse events and no
intervention-related mortality. Copyright © 2021 Elsevier Inc.

<66>
Accession Number
634693217
Title
Optimal Threshold of Left Ventricular Ejection Fraction for Aortic Valve
Replacement in Asymptomatic Severe Aortic Stenosis: A Systematic Review
and Meta-Analysis.
Source
Journal of the American Heart Association. (pp e020252), 2021. Date of
Publication: 31 Mar 2021.
Author
Perry A.S.; Li S.
Institution
(Perry, Li) Division of Cardiology University of Washington School of
Medicine Seattle WA
Publisher
NLM (Medline)
Abstract
Background The optimal threshold of left ventricular ejection fraction
(LVEF) that should prompt aortic valve replacement (AVR) in asymptomatic
patients with high-gradient severe aortic stenosis (AS) is controversial.
The aim of this study was to assess the relationship between LVEF and
mortality benefit in comparing early AVR versus watchful waiting in
asymptomatic patients with severe AS. Methods and Results MEDLINE, Embase,
Web of Science, and Google Scholar were searched for observational studies
and randomized controlled trials on adults with asymptomatic severe AS.
Severe AS was defined by a peak aortic velocity >=4 m/s and/or mean aortic
valve gradient >=40 mm Hg and/or calculated aortic valve area <1.0 cm2 or
an indexed valve area <0.6 cm2. Studies comparing AVR with conservative
management were included and meta-analysis on all-cause mortality was
performed. Ten eligible studies were identified with a total of 3332
patients. In 5 observational studies comparing early AVR versus watchful
waiting, our meta-analysis showed early AVR was associated with lower
mortality with a hazard ratio (HR) of 0.41 (CI, 0.23-0.71; P<0.01). In 4
observational studies comparing AVR versus no AVR, our meta-analysis
showed AVR was associated with lower mortality with a HR of 0.31 (CI,
0.17-0.58; P<0.001). In a meta-regression analysis pooling all 10 studies,
there was no statistically significant correlation between study mean LVEF
and the size of mortality benefit of AVR (P=0.83). Conclusions Among
asymptomatic patients with high-gradient severe AS, AVR was associated
with a mortality benefit across the spectrum of LVEF. Our study calls into
question the need of an LVEF threshold for recommending AVR in this
patient population.

<67>
Accession Number
2007554192
Title
Safety and efficacy of coronary intravascular lithotripsy for calcified
coronary arteries- a systematic review and meta-analysis.
Source
Expert Review of Cardiovascular Therapy. 19 (1) (pp 89-98), 2021. Date of
Publication: 2021.
Author
Sattar Y.; Ullah W.; Mir T.; Biswas S.; Titus A.; Darmoch F.; Pacha H.M.;
Mohamed M.O.; Kwok C.S.; Fischman D.L.; Bagur R.; Mamas M.A.; Alraies M.C.
Institution
(Sattar) Internal Medicine, Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Ullah) Internal Medicine, Abington Health, Abington, PA, United States
(Mir, Alraies) Department of Internal Medicine, Detroit Heart center/Wayne
State University, Detroit, MI, United States
(Biswas) Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
(Titus) Internal Medicine, New York University, New York, NY, United
States
(Darmoch) Cardiology, Beth Israel Hospital, Harvard University, Cambridge,
MA, United States
(Pacha) Department of Cardiology, University of Texas Health Science
Center, Houston, TX, United States
(Mohamed, Kwok, Bagur, Mamas) Keele Cardiovascular Research Group, Keele
University, Stoke-on-Trent, United Kingdom
(Mohamed, Kwok, Bagur, Mamas) Department of Cardiology, Royal Stoke
University Hospital, Stoke-on-Trent, United Kingdom
(Fischman) Department of Cardiology, Jefferson University, Philadelphia,
PA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: Intravascular lithotripsy (IVL) clinical efficacy and safety
in the treatment of calcified coronary artery disease (CAC) is not well
known. We sought to assess IVL safety and efficacy in CAC. Method(s):
A comprehensive online databases search were performed to identify
intravascular lithotripsy studies in patients with coronary artery
disease. The primary outcome was IVL related change in the mean pre and
post-procedural diameter of the coronary artery. Result(s): A total
of 4 studies with 282 patients were included. The mean pre-IVL coronary
diameter for all patients was 1.01 mm, while the mean post-IVL coronary
diameter was 2.70 mm. The mean pre-post IVL diameter difference of
coronary arteries on the pooled analysis was significantly lower by 4.08
mm (95% CI -4.94 to -3.30, p <= 0.00001). The Overall increase in the
post-IVL lumen diameter was significantly higher than the pre-IVL diameter
with a mean difference of -4.16 (95% CI -5.08 to -3.24, p = 0.000001).
However, compared to pre-IVL, there was a significant reduction in the
overall mean difference of luminal calcium angle after IVL of the stented
coronary arteries (0.09, 95% CI 0.002-0.16, p = 0.01). Conclusion(s):
Intravascular lithotripsy can offer a significant improvement in the
vessel lumen to facilitate coronary stent delivery and deployments in
severely calcified coronary arteries. Copyright © 2020 Informa UK
Limited, trading as Taylor & Francis Group.

<68>
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.
 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. 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). 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. Copyright © 2021

<69>
Accession Number
632236963
Title
The effect of a structured patient education intervention on the quality
of life for coronary artery bypass grafting patients: A prospective
randomised controlled study.
Source
Journal of perioperative practice. 31 (4) (pp 124-131), 2021. Date of
Publication: 01 Apr 2021.
Author
Ozdemir B.; Onler E.
Institution
(Ozdemir, Onler) School of Health, Nursing Division, Department of
Surgical Nursing, Tekirdag Namik Kemal University, Tekirdag, Turkey
Publisher
NLM (Medline)
Abstract
This study aimed to determine the effectiveness of structured patient
education on the quality of life for coronary artery bypass grafting
patients. The research included 80 patients (40 control, 40 experimental)
who underwent coronary artery bypass graft surgery at the cardiovascular
surgery ward of a university hospital in Western Turkey and met the
criteria to be included in the sample. The following documents were used
to collect data: Patient Information Form, Knowledge Level Form and SF36
Quality of Life Scale. It was determined that the structured planned
patient education for coronary artery bypass grafting patients effectively
improved the patients' knowledge level and quality of life.

<70>
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).
 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. 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).
 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. Copyright © The
Author(s) 2021.

<71>
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).
 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. 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. 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. Copyright © 2021 The
Author(s). Published by Informa UK Limited, trading as Taylor & Francis
Group.

<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. 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.
 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). 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. Copyright © 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. 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. 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. 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. Copyright © 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. Copyright © 2021 Wiley Periodicals LLC

<75>
[Use Link to view the full text]
Accession Number
634597667
Title
Effects of corticosteroids on new-onset atrial fibrillation after cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Medicine. 100 (11) (pp e25130), 2021. Date of Publication: 19 Mar 2021.
Author
Liu L.; Jing F.-Y.; Wang X.-W.; Li L.-J.; Zhou R.-Q.; Zhang C.; Wu Q.-C.
Institution
(Liu, Li, Zhou, Zhang) Department of Cardiothoracic Surgery ICU
(Jing, Wu) Department of Cardiology
(Wang) Department of Cardiothoracic Surgery, First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Zhang) Centre for Clinical Pharmacology, William Harvey Research
Institute, Queen Mary University of London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) occurs commonly after
cardiac surgery. Studies suggest that corticosteroid can reduce the
incident of POAF. However, the results remain controversial. This
meta-analysis aimed to evaluate the efficacy and safety corticosteroid on
the prevention of POAF following cardiac surgery. METHOD(S):
Randomized controlled trials were identified through a systematic
literature search. Two investigators independently searched articles,
extracted data, and assessed the quality of included studies. Primary
outcome was the incidence of POAF as well as length of hospital stay and
intensive care unit stay, wound and other infection, mortality, duration
of ventilation, myocardial infarction, gastrointestinal complications,
high blood sugar, stroke, and postoperative bleeding. RESULT(S):
Fourteen studies with 13,803 patients were finally involved in the present
study. Overall, corticosteroid significantly decreased the risk of POAF
(relative risk [RR], 0.7; 95% confidence interval [CI], 0.55-0.89; P =
.003). There were no significant differences in the incidence of length of
intensive care unit stay (RR, -2.32; 95% CI, -5.44 to 0.80; P = .14) and
hospital stay (RR, -0.43; 95% CI, -0.84 to -0.02; P = .04), infections
(RR, 1.01; 95% CI, 0.83-1.23; P = .9), mortality (RR, 0.87; 95% CI,
0.71-1.06; P = .16), duration of ventilation (RR, -0.29; 95% CI, -0.65 to
0.07; P = .12), gastrointestinal complications (RR, 1.26; 95% CI,
0.91-1.76; P = .16), high blood sugar (RR, 1.98; 95% CI, 0.91-4.31; P =
.09), stroke (RR, 0.9; 95% CI, 0.69-1.18; P = .45), postoperative bleeding
(RR -44.54; 95% CI, -115.28 to 26.20; P = .22) and myocardial infarction
(RR, 1.71; 95% CI, 0.96-1.43; P = .12). CONCLUSION(S): Our review
suggests that the efficacy of corticosteroid might be beneficial to POAF
development in patients undergoing cardiac surgery. The strength of this
association remains uncertain because of statistical and clinical
heterogeneity among the included studies. Copyright © 2021 the
Author(s). Published by Wolters Kluwer Health, Inc.

<76>
Accession Number
633318176
Title
Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac
surgery patients: systematic review and meta-analysis.
Source
BMJ open. 10 (10) (pp e038364), 2020. Date of Publication: 31 Oct 2020.
Author
Norhayati M.N.; Shaiful Bahari I.; Zaharah S.; Nik Hazlina N.H.; Mohammad
Aimanazrul Z.; Irfan M.
Institution
(Norhayati) Department of Family Medicine, School of Medical Sciences,
University Sains Malaysia, Health CampusKubang Kerian, Malaysia
(Shaiful Bahari, Mohammad Aimanazrul) Department of Family Medicine,
School of Medical Sciences, University Sains Malaysia, Health CampusKubang
Kerian, Malaysia
(Zaharah, Nik Hazlina, Irfan) Women's Health Development Unit, School of
Medical Sciences, University Sains Malaysia, Health CampusKubang Kerian,
Malaysia
(Irfan) Department of Zoology, Pir Mehr Ali Shah, Arid Agriculture
University, Rawalpindi, Pakistan
Publisher
NLM (Medline)
Abstract
PURPOSE: Postoperative atrial fibrillation (POAF) is a potentially lethal
and morbid complication after open heart surgery. This systematic review
and meta-analysis aimed to investigate metoprolol compared with other
treatments for prophylaxis against POAF. METHOD(S): We searched
CENTRAL, MEDLINE, EMBASE and trial registries for randomised controlled
trials that evaluated metoprolol for preventing the occurrence of POAF
after surgery against other treatments or placebo. Random-effects model
was used for estimating the risk ratios (RRs) and mean differences with
95% CIs. RESULT(S): Nine trials involving 1570 patients showed
metoprolol reduced POAF compared with placebo (416 patients; RR 0.46, 95%
CI 0.33 to 0.66; I2=21%; risk difference (RD) -0.19, 95% CI -0.28 to
-0.10). However, metoprolol increased the risk of POAF compared with
carvedilol (159 patients; RR 1.59, 95% CI 1.20 to 2.12; I2=4%; RD 0.13,
95% CI 0.06 to 0.20). There was no difference when compared with sotalol
or amiodarone. The occurrence of cardiovascular conditions after drugs
administration or death between the groups was not different. The overall
quality of evidence was moderate to high. Subgroup analysis and funnel
plot were not performed. CONCLUSION(S): Metoprolol is effective in
preventing POAF compared with placebo and showed no difference with class
III antiarrhythmic drugs. Death and thromboembolism are associated with
open heart surgery, but not significant in relation to the use of
metoprolol. PROSPERO REGISTRATION NUMBER: CRD42019131585. Copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC
BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

<77>
Accession Number
632508010
Title
Ubiquinol supplementation in elderly patients undergoing aortic valve
replacement: biochemical and clinical aspects.
Source
Aging. 12 (15) (pp 15514-15531), 2020. Date of Publication: 31 Jul 2020.
Author
Orlando P.; Sabbatinelli J.; Silvestri S.; Marcheggiani F.; Cirilli I.;
Dludla P.V.; Molardi A.; Nicolini F.; Tiano L.
Institution
(Orlando, Silvestri, Marcheggiani, Cirilli, Dludla, Tiano) Department of
Life and Environmental Sciences, Universita Politecnica delle Marche, Via
Brecce Bianche, Ancona 60100, Italy
(Sabbatinelli) Department of Clinical and Molecular Sciences, DISCLIMO,
Universita Politecnica delle Marche, Ancona 60100, Italy
(Dludla) Biomedical Research and Innovation Platform, South African
Medical Research Council, Tygerberg 7505, South Africa
(Molardi, Nicolini) Cardiac Surgery Department, Parma University Hospital,
Parma 43126, Italy
Publisher
NLM (Medline)
Abstract
Epidemiological data show a rise in the mean age of patients affected by
heart disease undergoing cardiac surgery. Senescent myocardium reduces the
tolerance to ischemic stress and there are indications about
age-associated deficit in post-operative cardiac performance. Coenzyme Q10
(CoQ10), and more specifically its reduced form ubiquinol (QH), improve
several conditions related to bioenergetic deficit or increased exposure
to oxidative stress. This trial (Eudra-CT 2009-015826-13) evaluated the
clinical and biochemical effects of ubiquinol in 50 elderly patients
affected by severe aortic stenosis undergoing aortic valve replacement and
randomized to either placebo or 400 mg/day ubiquinol from 7 days before to
5 days after surgery. Plasma and cardiac tissue CoQ10 levels and oxidative
status, circulating troponin I, CK-MB (primary endpoints), IL-6 and S100B
were assessed. Moreover, main cardiac adverse effects, NYHA class,
contractility and myocardial hypertrophy (secondary endpoints) were
evaluated during a 6-month follow-up visit. Ubiquinol treatment
counteracted the post-operative plasma CoQ10 decline (p<0.0001) and
oxidation (p=0.038) and curbed the post-operative increase in troponin I
(QH, 1.90 [1.47-2.48] ng/dL; placebo, 4.03 [2.45-6.63] ng/dL; p=0.007)
related to cardiac surgery. Moreover, ubiquinol prevented the adverse
outcomes that might have been associated with defective left ventricular
ejection fraction recovery in elderly patients.

<78>
Accession Number
634676233
Title
Is there a renoprotective value to leukodepletion during heart valve
surgery? A randomized controlled trial (ROLO).
Source
Journal of cardiothoracic surgery. 16 (1) (pp 58), 2021. Date of
Publication: 26 Mar 2021.
Author
Khoshbin E.; Spencer S.; Solomon L.; Tang A.; Clark S.; Stokes E.;
Wordsworth S.; Dabner L.; Edwards J.; Reeves B.; Rogers C.
Institution
(Khoshbin, Clark) Department of Cardiothoracic Surgery, Freeman Hospital,
High Heaton, Newcastle upon Tyne NE7 7DN, United Kingdom
(Spencer) School of Health and Medicine, Lancaster University, Bailing,
Upper Market Street, Lancaster, Lancashire, LA1 4YW, UK
(Solomon) Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust,
Sharoe Green Lane, Fulwood, Preston, Lancashire, PR2 9HT, UK
(Tang) Department of Cardiothoracic Surgery, Blackpool Victoria Hospital,
Blackpool FY3 8NR, United Kingdom
(Stokes, Wordsworth) Department of Public Health, University of Oxford,
Rosemary Rue Building, Old Road Campus ,Headington, Oxford OX3 7LF, United
Kingdom
(Dabner, Edwards, Reeves, Rogers) Clinical Trials and Evaluation Unit,
Bristol Medical School, University of Bristol, Bristol BS2 8HW, United
Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute Kidney Injury (AKI) adversely affects outcomes after
cardiac surgery. A major mediator of AKI is the activation of leukocytes
through exposure to the cardiopulmonary bypass circuit. We evaluate the
use of leukodepletion filters throughout bypass to protect against
post-operative AKI by removing activated leukocytes during cardiac
surgery. METHOD(S): This is a single-centre, double-blind, randomized
controlled trial comparing the use of leukodepletion versus a standard
arterial filter throughout bypass. Elective adult patients undergoing
heart valve surgery with or without concomitant procedures were
investigated. The primary clinical outcome measured was the development of
AKI according to the KDIGO criteria. Secondary measures included
biomarkers of renal tubular damage (urinary Retinol Binding Protein and
Kidney Injury Molecule-1), glomerular kidney injury (urinary Micro Albumin
and serum Cystatin C) and urinary Neutrophil Gelatinase Associated
Lipocalin, as well as the length of hospital stay and quality of life
measures through EQ-5D-5L questionnaires. RESULT(S): The ROLO trial
randomized 64 participants with a rate of recruitment higher than
anticipated (57% achieved, 40% anticipated). The incidence of AKI was
greater in the leukodepletion filter group (44% versus 23%, risk
difference 21, 95% CI -2 to 44%). This clinical finding was supported by
biomarker levels especially by a tendency toward glomerular insult at 48h,
demonstrated by a raised serum Cystatin C (mean difference 0.11, 95% CI
0.00 to 0.23, p =0.068) in the leukodepleted group. There was however no
clear association between the incidence or severity of AKI and length of
hospital stay. On average, health related quality of life returned to
pre-operative levels in both groups within 3months of surgery.
 CONCLUSION(S): Leukocyte depletion during cardiopulmonary bypass does
not significantly reduce the incidence of AKI after valvular heart
surgery. Other methods to ameliorate renal dysfunction after cardiac
surgery need to be investigated. TRIAL REGISTRATION: The trial was
registered by the International Standard Randomized Controlled Trial
Number Registry ISRCTN42121335 . Registered on the 18 February 2014. The
trial was run by the Bristol Clinical Trials and Evaluation Unit. This
trial was financially supported by the National Institute of Health
Research (Research for Patient Benefit), award ID: PB-PG-0711-25,090.

<79>
Accession Number
2011594788
Title
Outcome of cardiac rehabilitation in improving quality of life among women
having IHD: A randomized controlled trail.
Source
Pakistan Journal of Medical and Health Sciences. 15 (1) (pp 488-490),
2021. Date of Publication: January 2021.
Author
Mustansar A.; Noor R.; Mahmood S.; Yaqoob T.; Latif W.; Laique T.
Institution
(Mustansar, Mahmood) Department of Physiotherapy, UHS, Lahore, Pakistan
(Noor) Department of Physiotherapy, Riphah University, Islamabad, Pakistan
(Yaqoob) Department of Public Health, UHS, Lahore, Pakistan
(Latif) Department of Statistics, University of Health Sciences, Lahore,
Pakistan
(Laique) Department of Pharmacology, Allama Iqbal Medical College, Lahore,
Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Background: Cardiac rehabilitation deals with optimizing function in
patients with heart disease or current cardiac surgery. Aim(s): To
determine the outcome of cardiac rehabilitation in improving quality of
life in women of ischemic heart disease. Study design: Randomized
controlled trial. Methodology: Patients (n=74) were enrolled in present
study held at University Teaching Hospital, University of Lahore & Punjab
Institute of Cardiology, as a reference placement for 6 months. Informed
consent was taken from all of them. Data analyzed by SPSS 22.0v.
 Result(s): The mean age of the patients was 49.11+/-3.96 years. The
mean post back depression inventory score in cardiac rehabilitation group
was 10.24+/-6.19 while in conventional group was 19.57+/-7.08
(p-value=<0.001). Among cardiac rehabilitation group the mean post SF 36
was 66.43+/-9.69 while in conventional group was 56.22+/-10.88
(p-value=<0.001). Conclusion(s): This study concluded that cardiac
rehabilitation greatly improves the quality of life of patients with
ischemic heart disease following traditional rehabilitation compared to
the conventional group. Copyright © 2021 Lahore Medical And
Dental College. All rights reserved.

<80>
Accession Number
2006861263
Title
Angiographic patency of coronary artery bypass conduits: A network
meta-analysis of randomized trials.
Source
Journal of the American Heart Association. 10 (6) (no pagination), 2021.
Article Number: e019206. Date of Publication: 2021.
Author
Gaudino M.; Hameed I.; Bryce Robinson N.; Ruan Y.; Rahouma M.; Naik A.;
Weidenmann V.; Demetres M.; Tam D.Y.; Hare D.L.; Girardi L.N.;
Biondi-Zoccai G.; Fremes S.E.
Institution
(Gaudino, Hameed, Bryce Robinson, Ruan, Rahouma, Naik, Weidenmann,
Girardi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Centre, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science University
of Toronto, Toronto, ON, Canada
(Hare) Department of Cardiology, Austin Health, Melbourne, Australia
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Several randomized trials have compared the patency of
coronary artery bypass conduits. All of the published studies, however,
have performed pairwise comparisons and a comprehensive evaluation of the
patency rates of all conduits has yet to be published. We set out to
investigate the angiographic patency rates of all conduits used in
coronary bypass surgery by performing a network meta-analysis of the
current available randomized evidence. METHODS AND RESULTS: A systematic
literature search was conducted for randomized controlled trials comparing
the angiographic patency rate of the conventionally harvested saphenous
vein, the no-touch saphenous vein, the radial artery (RA), the right
internal thoracic artery, or the gastroepiploic artery. The primary
outcome was graft occlusion. A total of 4160 studies were retrieved of
which 14 were included with 3651 grafts analyzed. The weighted mean
angiographic follow-up was 5.1 years. Compared with the conventionally
harvested saphenous vein, both the RA (incidence rate ratio [IRR] 0.54;
95% CI, 0.35-0.82) and the no-touch saphenous vein (IRR 0.55; 95% CI,
0.39-0.78) were associated with lower graft occlusion. The RA ranked as
the best conduit (rank score for RA 0.87 versus 0.85 for no-touch
saphenous vein, 0.23 for right internal thoracic artery, 0.29 for
gastroepiploic artery, and 0.25 for the conventionally harvested saphenous
vein). CONCLUSION(S): Compared with the conventionally harvested
saphenous vein, only the RA and no-touch saphenous vein grafts are
associated with significantly lower graft occlusion rates. The RA ranks as
the best conduit. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero;
Unique identifier: CRD42020164492. Copyright © 2021 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<81>
Accession Number
634682570
Title
Randomized comparison of the clinical Outcome of single versus Multiple
Arterial grafts: Quality of Life (ROMA:QOL) - Rationale and Study
Protocol.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2021. Date of Publication: 29 Mar 2021.
Author
Masterson Creber R.; Safford M.; Ballman K.; Myers A.; Fremes S.; Gaudino
M.
Institution
(Masterson Creber, Ballman, Myers) Department of Population Health
Sciences, Division of Health Informatics, Weill Cornell Medicine, NY, NY,
United States
(Safford) Department of Medicine, Division of General Internal Medicine,
Weill Cornell Medicine, NY, NY, United States
(Fremes) Schulich Heart Centre, Sunnybrook Health Science, University of
Toronto, ON, Toronto, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
NY, NY, United States
Publisher
NLM (Medline)
Abstract
The objective of the Randomized comparison of the Outcome of single vs
Multiple Arterial grafts: Quality of Life (ROMA:QOL) trial is to evaluate
the impact of coronary artery bypass graft surgery (CABG) on quality of
life (QOL). The primary hypothesis of ROMA:QOL is that participants in the
multiple arterial group (MAG) will report time-varying changes in QOL that
will be lower in the post-operative recovery period and higher after 12
months compared to patients in the single arterial group (SAG). The
secondary hypotheses are that both groups will have improvements in
symptoms at 12 months, and that compared to the SAG group, participants in
the MAG group will experience better physical functioning and physical and
mental health symptoms. An estimated 2,111 participants will be enrolled
from the parent ROMA trial from 13 countries. Outcome assessments include
the Seattle Angina Questionnaire (SAQ) (primary outcome), Short Form-12v2,
EQ-5D-5L, PROMIS-29 and PROMIS Neuropathic Pain measured at baseline,
first post-operative visit, 6, 12, 24, 36, 48 and 60- months. The analysis
for the primary outcome, the change in the SAQ from baseline to 12-
months, will be compared across all time-points between the two treatment
arms. The ROMA:QOL trial will answer whether there are differences in QOL,
physical and mental health symptoms overall for CABG, by MAG and SAG
intervention arms, by sex, and between patients with and without
diabetes. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2021. For
permissions please email: journals.permissions@oup.com.

<82>
Accession Number
634682544
Title
Efficacy and safety of colchicine for the prevention of major
cardiovascular and cerebrovascular events in patients with coronary artery
disease: a systematic review and meta-analysis on 12 869 patients.
Source
European journal of preventive cardiology. (no pagination), 2021. Date of
Publication: 29 Mar 2021.
Author
Andreis A.; Imazio M.; Piroli F.; Avondo S.; Casula M.; Paneva E.; De
Ferrari G.M.
Institution
(Andreis, Imazio, Piroli, Avondo, Casula, Paneva, De Ferrari) Department
of Cardiovascular and Thoracic, University Cardiology, A.O.U. Citta della
Salute e della Scienza di Torino ,Corso Bramante 88, Turin 10126, Italy
Publisher
NLM (Medline)
Abstract
AIMS: The key role of inflammation in the pathogenesis of coronary artery
disease (CAD) is an urgent call for innovative treatments. Several trials
have proposed colchicine as a therapeutic option for secondary prevention
in CAD patients but its utilization is hampered by fears about
drug-related adverse events (DAEs) and conflicting evidences. The aim of
this meta-analysis was to consolidate evidence on the efficacy and safety
of colchicine for secondary prevention in patients with CAD. METHODS AND
RESULTS: A systematic search in electronic bibliographic databases of
Medline, Scopus, Embase, and the Cochrane Library was performed to
identify randomized controlled trials (RCTs) assessing the cardiovascular
effects of colchicine in CAD patients, compared with placebo. Outcomes of
interest were the occurrence of major adverse cardiovascular and
cerebrovascular events (MACCE) and DAEs. Estimates were pooled using
inverse-variance random-effects model. A total of 11 RCTs, including 12
869 patients, were identified as eligible. A total of 6501 patients
received colchicine, while 6368 received placebo. After a median follow-up
of 6months (interquartile range, 1-16), patients receiving colchicine had
a lower risk of MACCE [6% vs. 8.8%, relative risk (RR) = 0.67, 95%
confidence interval (CI) 0.56-0.80, I2=19%], myocardial infarction (3.3%
vs. 4.3%, RR=0.76, 95% CI 0.61-0.96, I2=17%), coronary revascularization
(2.9% vs. 4.2%, RR=0.61, 95% CI 0.42-0.89, I2=40%), stroke (0.4% vs. 0.9%,
RR=0.48, 95% CI 0.30-0.77, I2=0%), hospitalization for cardiovascular
cause (0.9% vs. 2.9%, RR=0.32, 95% CI 0.12-0.87, I2=0%). Colchicine was
associated with an increased risk of gastrointestinal DAEs (11% vs. 9.2%,
RR=1.67, 95% CI 1.20-2.34, I2=76%), myalgia (18% vs. 16%, RR = 1.16, 95%
CI 1.02-1.32, I2=0%) and DAEs-related discontinuation (4.1% vs. 3%, RR =
1.54, 95% CI 1.02-2.32, I2=65%). However, gastrointestinal DAEs and
discontinuation may be prevented with a lower daily dose. Colchicine did
not increase the risk of cardiovascular death (0.7% vs. 1%, RR=0.73, 95%
CI 0.45-1.21, I2=14%), all-cause death (2% vs. 1.9%, RR=1.01, 95% CI
0.71-1.43, I2=16%), or other DAEs. CONCLUSION(S): The use of
colchicine in patients with CAD is safe and efficacious for MACCE
prevention. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2021. For
permissions, please email: journals.permissions@oup.com.

<83>
Accession Number
634681695
Title
Do Women Require Less Permanent Pacemaker After Transcatheter Aortic Valve
Implantation? A Meta-Analysis and Meta-Regression.
Source
Journal of the American Heart Association. (pp e019429), 2021. Date of
Publication: 27 Mar 2021.
Author
Ravaux J.M.; Di Mauro M.; Vernooy K.; Van't Hof A.W.; Veenstra L.; Kats
S.; Maessen J.G.; Lorusso R.
Institution
(Ravaux, Di Mauro, Kats, Maessen, Lorusso) Department of Cardio-Thoracic
Surgery Heart and Vascular Centre Maastricht University Medical Centre
(MUMC) Maastricht The Netherlands
(Di Mauro, Vernooy, Van't Hof, Veenstra, Lorusso) Cardiovascular Research
Institute Maastricht (CARIM)Maastricht University Medical Center
Maastricht The Netherlands
(Vernooy, Van't Hof, Maessen) Department of Cardiology Maastricht
University Medical Centre (MUMC) Maastricht The Netherlands
(Vernooy) Department of cardiology Radboud University Medical Center
(Radboudumc) Nijmegen The Netherlands
Publisher
NLM (Medline)
Abstract
Background Limited clinical evidence and literature are available about
the potential impact of sex on permanent pacemaker implantation (PPI)
after transcatheter aortic valve implantation (TAVI). The aim of this work
was to evaluate the relationship between sexes and atrioventricular
conduction disturbances requiring PPI after TAVI. Methods and Results Data
were obtained from 46 studies from PubMed reporting information about the
impact of patient sex on PPI after TAVI. Total proportions with 95% Cls
were reported. Funnel plot and Egger test were used for estimation of
publication bias. The primary end point was 30-day or in-hospital PPI
after TAVI, with odds ratios and 95% CIs extracted. A total of 70 313
patients were included, with a cumulative proportion of 51.5% of women (35
691 patients; 95% CI, 50.2-52.7). The proportion of women undergoing TAVI
dropped significantly over time (P<0.0001). The cumulative PPI rate was
15.6% (95% CI, 13.3-18.3). The cumulative rate of PPI in women was 14.9%
(95% CI, 12.6-17.6), lower than in men (16.6%; 95% CI, 14.2-19.4). The
risk for post-TAVI PPI was lower in women (odds ratio, 0.90; 95% CI,
0.84-0.96 [P=0.0022]). By meta-regression analysis, age (P=0.874) and
ventricular function (P=0.302) were not significantly associated with PPI
among the sexes. Balloon-expandable TAVI significantly decrease the
advantage of women for PPI, approaching the same rate as in men
(P=0.0061). Conclusions Female sex is associated with a reduced rate of
PPI after TAVI, without influence of age or ventricular function.
Balloon-expandable devices attenuate this advantage in favor of women.
Additional investigations are warranted to elucidate sex-based differences
in developing conduction disturbances after TAVI.

<84>
Accession Number
634678773
Title
Long-Term Outcomes Comparing Medical Therapy versus Revascularization for
Spontaneous Coronary Artery Dissection: A Systematic Review and
Meta-Analysis.
Source
The American journal of medicine. (no pagination), 2021. Date of
Publication: 24 Mar 2021.
Author
Krittanawong C.; Nazir S.; Hassan Virk H.; Hahn J.; Wang Z.; Fogg S.E.;
Sharma S.K.; Alam M.; Jneid H.
Institution
(Krittanawong, Hahn, Jneid) Michael E. DeBakey VA Medical Center, Houston,
TX; Section of Cardiology, Baylor School of Medicine, Houston, TX
(Nazir) Department of Cardiology, University of Toledo, OH, Toledo, Belize
(Hassan Virk) Harrington Heart & Vascular Institute, Case Western Reserve
University, University Hospitals Cleveland Medical Center, Cleveland, OH
(Wang) Robert D. and Patricia E. Kern Center for the Science of Health
Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy
and Research, Department of Health Sciences Research, Mayo Clinic,
Rochester, MN
(Fogg) Texas Heart Institute, TX, Houston
(Sharma) Cardiac Catheterization Laboratory of the Cardiovascular
Institute, Mount Sinai Hospital, NY, NY
(Alam) Section of Cardiology, Baylor School of Medicine, Houston, TX;
Texas Heart Institute, Houston, TX
Publisher
NLM (Medline)
Abstract
The ideal management of spontaneous coronary artery dissection (SCAD) has
yet to be clearly defined. We conducted a comprehensive search of Ovid
MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews,
Scopus, and Web of Science from database inception from 1966 through
September 2020 for all original studies (randomized controlled trials and
observational studies) that evaluated patients with SCAD. Study groups
were defined by allocation to medical therapy (medical therapy) vs
invasive therapy (invasive therapy) (i.e., percutaneous coronary
intervention or coronary artery bypass grafting). The risk of death (RR=
0.753, 95% CI: 0.21 to 2.73; I2= 21.1%, p=0.61), recurrence of SCAD
(RR=1.09; 95% CI: 0.61 to 1.93; I2=0.0%, p=0.74), and repeat
revascularization (RR=0.64; 95% CI: 0.21 to 1.94; I2= 57.6%; p=0.38) were
not statistically different between medical therapy and invasive therapy
for a follow up ranging from 4 months to 3 years. In conclusion, in this
meta-analysis of observational studies, the long-term risk of death,
recurrent SCAD, and repeat revascularization did not significantly differ
among SCAD patient treated with medical therapy compared to those treated
with invasive therapy. These findings support the current expert consensus
that patients should be treated with medical therapy when clinically
stable and no high-risk features present. Further large-scale studies
including RCTs are needed to confirm these findings. Copyright ©
2021. Published by Elsevier Inc.

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