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<1>
Accession Number
2011655439
Title
A systematic review and meta-analysis of post-operative urinary retention
with anaesthetic and analgesic modalities.
Source
Journal of Clinical Anesthesia. 72 (no pagination), 2021. Article Number:
110280. Date of Publication: September 2021.
Author
Dwyer-Hemmings L.; Hampson A.; Fairhead C.; Moss S.; Prasad V.;
Gowrie-Mohan S.; Vasdev N.
Institution
(Dwyer-Hemmings) Institute of Medical and Biomedical Education, St
George's (University of London), London, United Kingdom
(Hampson) The Royal Liverpool and Broadgreen University Hospitals,
Department of Urology, Liverpool, United Kingdom
(Fairhead) Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital,
London, United Kingdom
(Moss) Milton Keynes University Hospital NHS Foundation Trust, Department
of Anaesthesia and Critical Care, Milton Keynes University Hospital,
Milton Keynes, United Kingdom
(Prasad, Gowrie-Mohan) East and North Hertfordshire NHS Trust, Department
of Anaesthesia, Lister Hospital, Stevenage, United Kingdom
(Vasdev) School of Life and Medical Sciences, University of Hertfordshire,
Hatfield, United Kingdom
(Vasdev) East and North Hertfordshire NHS Trust, Department of Urology,
Lister Hospital, Stevenage, United Kingdom
Publisher
Elsevier Inc.

<2>
Accession Number
623030717
Title
A systematic review and critical analysis of cost-effectiveness studies
for coronary artery disease treatment.
Source
F1000Research. 7 (no pagination), 2018. Article Number: 77. Date of
Publication: 2018.
Author
McCreanor V.; Graves N.; Barnett A.G.; Parsonage W.; Merlo G.
Institution
(McCreanor, Graves, Barnett, Parsonage, Merlo) Institute of Health and
Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
4059, Australia
(McCreanor) Capital Markets Cooperative Research Centre, Sydney, NSW 2000,
Australia
(Parsonage) Royal Brisbane and Women's Hospital, Brisbane, QLD 4029,
Australia
Publisher
F1000 Research Ltd
Abstract
Background: Cardiovascular disease remains the primary cause of death
among Australians, despite dramatic improvements in overall cardiovascular
health since the 1980s. Treating cardiovascular disease continues to place
a significant economic strain on the Australian health care system, with
direct healthcare costs exceeding those of any other disease. Coronary
artery disease accounts for nearly one third of these costs and spending
continues to rise. A range of treatments is available for coronary artery
disease yet evidence of cost-effectiveness is missing, particularly for
the Australian context. Cost-effectiveness evidence can signal waste and
inefficiency and so is essential for an efficient allocation of healthcare
resources. Method(s): We used systematic review methods to search the
literature across several electronic databases for economic evaluations of
treatments for stable coronary artery disease. We critically appraised the
literature found in searches, both against the CHEERS statement for
quality reporting of economic evaluations and in terms of its usefulness
for policy and decision-makers. Result(s): We retrieved a total of
308 references, 229 once duplicates were removed. Of these, 26 were
excluded as they were not full papers (letters, editorials etc.), 55 were
review papers, 50 were not cost-effectiveness analyses and 93 related to a
highly specific patient sub-group or did not consider all treatment
options. This left five papers to be reviewed in full. Conclusion(s):
The current cost-effectiveness evidence does not support the increased use
of PCI that has been seen in Australia and internationally. Due to
problems with accessibility, clarity and relevance to policy and
decision-makers, some otherwise very scientifically rigorous analyses have
failed to generate any policy changes. Copyright © 2018 McCreanor
V et al.

<3>
Accession Number
2003604729
Title
Hypotheses, rationale, design, and methods for evaluation of a randomized
controlled trial using tocotrienol, an isomer of vitamin e derived from
palm oil, on the prevention of atrial fibrillation after coronary artery
bypass grafting surgery.
Source
F1000Research. 7 (no pagination), 2018. Article Number: 215. Date of
Publication: 2018.
Author
Musa A.F.; Dillon J.; Md Taib M.E.; Yunus A.M.; Nordin R.B.; Hay Y.K.
Institution
(Musa, Nordin) Jeffrey Cheah School of Medicine and Health Sciences,
Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
(Dillon, Md Taib, Yunus) Department of Cardiothoracic Surgery, National
Heart Institute, Kuala Lumpur, Malaysia
(Hay) School of Pharmaceutical Sciences, Universiti Sains Malaysia,
Penang, Malaysia
Publisher
F1000 Research Ltd
Abstract
Background: One of the most common complications following coronary artery
bypass grafting (CABG) surgery is atrial fibrillation (AF), which
contributes towards increasing morbidity and mortality, length of hospital
stay (LoHS) and reduced quality of life (QoL) of patients.
 Objective(s): To determine whether the intake of Tocotrienol, a
Vitamin E isomer derived from palm oil, before and immediately following
CABG prevents AF, reduces LoHS, and improves the QoL of patients.
Protocol: The study is registered with the National Medical Research
Register with a trial number NMRR-17-1994-34963 and designed as a
prospective, randomized controlled trial (RCT) with parallel groups. The
experimental group will receive two 200mg Tocotrienol capsules each day,
while the control group will receive two identical placebo (palm Super
Olein) capsules per day. ECG readings will be used to detect AF post
operatively, LoHS will be measured by checking the records from the
National Heart Institute Hospital register, and the health-related Quality
of Life (HRQoL) analysis (the Malay version of the Short Form 36
Questionnaire) will be used to analyse QoL. The sample size was calculated
to be 140 in each arm of the RCT for a power of 0.8 and a significance
level of 0.05. Copyright © 2018 Musa AF et al.

<4>
Accession Number
604480427
Title
Impact of access site choice on outcomes of patients with cardiogenic
shock undergoing percutaneous coronary intervention: A systematic review
and meta-analysis.
Source
American Heart Journal. 170 (2) (pp 353-361.e6), 2015. Date of
Publication: 01 Aug 2015.
Author
Pancholy S.B.; Palamaner Subash Shantha G.; Romagnoli E.; Kedev S.; Bernat
I.; Rao S.V.; Jolly S.; Bertrand O.F.; Patel T.M.
Institution
(Pancholy) Wright Center for Graduate Medical Education, Commonwealth
Medical College, Scranton, PA, United States
(Palamaner Subash Shantha) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Romagnoli) Interventional Cardiology Unit, Ospedale Belcolle, Viterbo,
Italy
(Kedev) University Clinic of Cardiology, Skopje, North Macedonia
(Bernat) University Hospital, Faculty of Medicine, Pilsen, Czechia
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Jolly) Population Health Research Institute, Hamilton, ON, Canada
(Bertrand) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Patel) Apex Heart Institute, Ahmedabad, India
Publisher
Mosby Inc.
Abstract
Background The benefit of transradial access (TRA) in patients with
cardiogenic shock (CS) is uncertain. We sought to determine the benefits
of TRA in patients with CS undergoing coronary angiography/intervention.
Methods MEDLINE, Embase, Cochrane Central, and electronic databases were
searched for studies that assessed the following: (1) patients with CS who
underwent percutaneous coronary intervention (PCI) and (2) the association
between choice of arterial access, 30-day all-cause mortality, and 30-day
major adverse cardiac and cerebral events (MACCEs) using random-effects
model. Results From 3,652 retrieved citations, 8 studies involving 8,131
patients with CS undergoing PCI (via TRA: 2,321 patients, via TFA: 5,810
patients) were included. Transradial access was associated with
significantly reduced risk for all-cause mortality (unadjusted: risk ratio
[RR] 0.60, 95% CI 0.52-0.71, P <.001, I2 = 29%, 8 included
studies; adjusted: RR 0.55, 95% CI 0.46-0.65, P <.001, I2 = 0%,
6 included studies) and MACCE (unadjusted: RR 0.68, 95% CI 0.63-0.73, P
<.001, I2 = 0%, 6 included studies; adjusted: RR 0.63, 95% CI
0.52-0.75, P <.001, I2 = 0%, 4 included studies) at 30 days
when compared with TFA. Conclusions Transradial access is associated with
reduced mortality and MACCE at 30 days in patients with CS undergoing PCI.
Considering the possible influence of selection bias on the effect
estimate in our analysis, randomized controlled trials are needed to
better assess this association. Copyright © 2015 Elsevier Inc.
All rights reserved.

<5>
Accession Number
603720871
Title
Prognostic value of serial b-type natriuretic peptide measurement in
transcatheter aortic valve replacement (from the PARTNER Trial).
Source
American Journal of Cardiology. 115 (9) (pp 1265-1272), 2015. Date of
Publication: 01 May 2015.
Author
O'Neill B.P.; Guerrero M.; Thourani V.H.; Kodali S.; Heldman A.; Williams
M.; Xu K.; Pichard A.; Mack M.; Babaliaros V.; Herrmann H.C.; Webb J.;
Douglas P.S.; Leon M.B.; O'Neill W.W.
Institution
(O'Neill) Temple University, Philadelphia, PA, United States
(O'Neill, Heldman) University of Miami, Miami, FL, United States
(Guerrero, O'Neill) Henry Ford Health System, Detroit, MI, United States
(Thourani, Babaliaros) Emory University School of Medicine, Atlanta, GA,
United States
(Kodali, Williams, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, NY, United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
(Pichard) MedStar Washington Hospital Center, Washington, DC, United
States
(Mack) Baylor Healthcare System, Plano, TX, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Douglas) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
B-type natriuretic peptide (BNP) levels have shown a correlation with
outcomes in studies of aortic valve surgery. Results from multicenter
trials of BNP in transcatheter aortic valve surgery (TAVR) are lacking.
The aim of this study was to investigate the prognostic role of serial
measurement of BNP in transfemoral TAVR. A total of 1,097 patients who
underwent TAVR via transfemoral access were analyzed by tertile of
baseline BNP. Of those, 933 with BNP levels at 30 days were divided into 2
groups on the basis of increases (334 patients) or decreases or no change
(599 patients) in BNP compared with baseline. Patients in the low-tertile
BNP group had a lower rate of death at 1 year than those in the higher
tertile group (15.0% vs 23.0%, p <0.01) which was not significant in
multivariate analysis. Over 1 year, BNP decreased from 1,258.13 +/-
2,988.33 to 594.37 +/- 1,087.30 (p <0.01) in the entire group. Patients in
the BNP-rise group had higher rates of death at 1 year (20.3% vs 11.4%, p
<0.01) and an overall increase in moderate or severe aortic regurgitation
over 1 year (p <0.01). Multivariate predictors of 1-year mortality were
moderate or severe aortic regurgitation (hazard ratio 2.04, 95% confidence
interval 1.36 to 3.05, p <0.01), increase in BNP at 30 days (hazard ratio
1.82, 95% confidence interval 1.26 to 2.62, p <0.01) and Society of
Thoracic Surgeons score (hazard ratio 1.05, 95% confidence interval 1.01
to 1.10, p = 0.03). In conclusion, increase in BNP at 30 days from
baseline and moderate or severe aortic regurgitation at 30 days in
patients who undergo transfemoral TAVR are independently associated with
1-year mortality. Increase in BNP at 30 days should prompt evaluation for
causes of elevated wall stress, including aortic
regurgitation. Copyright © 2015 Elsevier Inc. All rights
reserved.

<6>
Accession Number
365093252
Title
Use of >= 1 antihypertensive drug at bedtime reduced CV events more than
use of all drugs in the morning in CKD.
Source
Annals of Internal Medicine. 156 (12) (pp JC6-JC8), 2012. Date of
Publication: 19 Jun 2012.
Author
Hermida R.C.
Institution
(Hermida) Bioengineering and Chronobiology Laboratories, Vigo, Spain
Publisher
American College of Physicians
Abstract
Question Does taking >= 1 antihypertensive medication at bedtime reduce
cardiovascular (CV) events in patients with chronic kidney disease (CKD)
more than taking all antihypertensive medications in the morning? Methods
Design: Randomized controlled trial. ClinicalTrials.gov NCT00295542.
Allocation: {Concealed}*.+ Blinding: Blinded+ (outcome assessors, {data
analysts, and safety committee}*). Follow-up period:Median 5.4 years.
 Setting(s): {Tertiary hospital in Spain}*. Patient(s): 661
patients >= 18 years of age (mean age 59 y, 60% men) who had hypertension
(mean awake blood pressure [BP] >= 135/85 mm Hg or mean asleep BP >=
120/70 mm Hg) and CKD (estimated glomerular filtration rate < 60
mL/min/1.73 m2 and/or urinary albumin excretion >= 30 mg/24-h
urine on >= 2 occasions >= 3 mo apart). Exclusion criteria included night
or shift work. Intervention(s): >= 1 antihypertensive medication
taken at bedtime (n = 329) or all antihypertensive medications taken upon
wakening (n = 332). 48-hour ambulatory BP and wrist activity were
monitored annually or 3 months after any change in treatment.
 Outcome(s): Primary outcome was total CV morbidity and mortality
(composite of all-cause mortality, myocardial infarction, angina, coronary
revascularization, heart failure, acute arterial occlusion of lower
extremities, thrombotic occlusion of the retinal artery, stroke, and
transient ischemic attack). Secondary outcome was major CV events
(composite of CV death, myocardial infarction, and stroke). Patient
follow-up: 100% (intention-to-treat analysis). Main results The main
results are in the Table. Conclusion In patients with chronic kidney
disease, taking >= 1 antihypertensive medication at bedtime reduced
cardiovascular events compared with taking all medications in the morning.
© 2012 American College of Physicians.

<7>
Accession Number
2005471687
Title
A novel cross-species model of Barlow's disease to biomechanically analyze
repair techniques in an ex vivo left heart simulator.
Source
Journal of Thoracic and Cardiovascular Surgery. 161 (5) (pp 1776-1783),
2021. Date of Publication: May 2021.
Author
Imbrie-Moore A.M.; Paulsen M.J.; Zhu Y.; Wang H.; Lucian H.J.; Farry J.M.;
MacArthur J.W.; Ma M.; Woo Y.J.
Institution
(Imbrie-Moore, Paulsen, Zhu, Wang, Lucian, Farry, MacArthur, Ma, Woo)
Department of Cardiothoracic Surgery, Stanford University, Stanford,
Calif, United States
(Imbrie-Moore) Department of Mechanical Engineering, Stanford University,
Stanford, Calif, United States
(Zhu, Woo) Department of Bioengineering, Stanford University, Stanford,
Calif, United States
Publisher
Mosby Inc.
Abstract
Objective: Barlow's disease remains challenging to repair, given the
complex valvular morphology and lack of quantitative data to compare
techniques. Although there have been recent strides in ex vivo evaluation
of cardiac mechanics, to our knowledge, there is no disease model that
accurately simulates the morphology and pathophysiology of Barlow's
disease. The purpose of this study was to design such a model.
 Method(s): To simulate Barlow's disease, a cross-species ex vivo
model was developed. Bovine mitral valves (n = 4) were sewn into a porcine
annulus mount to create excess leaflet tissue and elongated chordae. A
heart simulator generated physiologic conditions while hemodynamic data,
high-speed videography, and chordal force measurements were collected. The
regurgitant valves were repaired using nonresectional repair techniques
such as neochord placement. Result(s): The model successfully
imitated the complexities of Barlow's disease, including redundant,
billowing bileaflet tissues with notable regurgitation. After repair,
hemodynamic data confirmed reduction of mitral leakage volume (25.9 +/-
2.9 vs 2.1 +/- 1.8 mL, P < .001) and strain gauge analysis revealed lower
primary chordae forces (0.51 +/- 0.17 vs 0.10 +/- 0.05 N, P < .001). In
addition, the maximum rate of change of force was significantly lower
postrepair for both primary (30.80 +/- 11.38 vs 8.59 +/- 4.83 N/s, P <
.001) and secondary chordae (33.52 +/- 10.59 vs 19.07 +/- 7.00 N/s, P =
.006). Conclusion(s): This study provides insight into the
biomechanics of Barlow's disease, including sharply fluctuating force
profiles experienced by elongated chordae prerepair, as well as
restoration of primary chordae forces postrepair. Our disease model
facilitates further in-depth analyses to optimize the repair of Barlow's
disease. Copyright © 2020 The American Association for Thoracic
Surgery

<8>
Accession Number
634768335
Title
Minimally invasive versus conventional sternotomy for Mitral valve repair:
Protocol for a multicentre randomised controlled trial (UK Mini Mitral).
Source
BMJ Open. 11 (4) (no pagination), 2021. Article Number: e047676. Date of
Publication: 14 Apr 2021.
Author
Maier R.H.; Kasim A.S.; Zacharias J.; Vale L.; Graham R.; Walker A.;
Laskawski G.; Deshpande R.; Goodwin A.; Kendall S.; Murphy G.J.; Zamvar
V.; Pessotto R.; Lloyd C.; Dalrymple-Hay M.; Casula R.; Vohra H.A.; Ciulli
F.; Caputo M.; Stoica S.; Baghai M.; Niranjan G.; Punjabi P.P.; Wendler
O.; Marsay L.; Fernandez-Garcia C.; Modi P.; Kirmani B.H.; Pullan M.D.;
Muir A.D.; Pousios D.; Hancock H.C.; Akowuah E.
Institution
(Maier, Marsay, Hancock) Newcastle Clinical Trials Unit, Newcastle
University, Newcastle upon Tyne, United Kingdom
(Kasim) Department of Anthropology, Durham University, Durham, United
Kingdom
(Zacharias, Walker, Laskawski) The Lancashire Cardiac Centre, Blackpool
Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
(Vale, Fernandez-Garcia) Health Economics Group, Population Health
Sciences Institute, Newcastle University, Newcastle, United Kingdom
(Graham, Goodwin, Kendall, Akowuah) Cardiothoracic Surgery, South Tees
Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
(Deshpande, Baghai, Wendler) Cardiothoracic Surgery, King's College
Hospital NHS Foundation Trust, London, United Kingdom
(Murphy) Department of Cardiovascular Sciences and NIHR Leicester
Biomedical Research Unit in Cardiovascular Medicine, University of
Leicester, Leicester, United Kingdom
(Zamvar, Pessotto) Cardiothoracic Surgery, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
(Lloyd, Dalrymple-Hay) Cardiothoracic Surgery, University Hospitals
Plymouth NHS Trust, Plymouth, United Kingdom
(Casula, Punjabi) Cardiothoracic Surgery, Imperial College Healthcare NHS
Trust, London, United Kingdom
(Vohra, Ciulli, Stoica) Cardiothoracic Surgery, University Hospitals
Bristol NHS Foundation Trust, Bristol, United Kingdom
(Caputo) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
(Niranjan) Cardiac Surgery, Liverpool Heart and Chest Hospital NHS
Foundation Trust, Liverpool, United Kingdom
(Modi, Kirmani, Pullan, Muir, Pousios) Cardiothoracic Surgery, Liverpool
Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Numbers of patients undergoing mitral valve repair (MVr) surgery for
severe mitral regurgitation have grown and will continue to rise. MVr is
routinely performed via median sternotomy; however, there is a move
towards less invasive surgical approaches. There is debate within the
clinical and National Health Service (NHS) commissioning community about
widespread adoption of minimally invasive MVr surgery in the absence of
robust research evidence; implementation requires investment in staff and
infrastructure. The UK Mini Mitral trial will provide definitive evidence
comparing patient, NHS and clinical outcomes in adult patients undergoing
MVr surgery. It will establish the best surgical approach for MVr, setting
a standard against which emerging percutaneous techniques can be measured.
Findings will inform optimisation of cost-effective practice. UK Mini
Mitral is a multicentre, expertise based randomised controlled trial of
minimally invasive thoracoscopically guided right minithoracotomy versus
conventional sternotomy for MVr. The trial is taking place in NHS
cardiothoracic centres in the UK with established minimally invasive
mitral valve surgery programmes. In each centre, consenting and eligible
patients are randomised to receive surgery performed by consultant
surgeons who meet protocol-defined surgical expertise criteria. Patients
are followed for 1year, and consent to longer term follow-up. Primary
outcome is physical functioning 12 weeks following surgery, measured by
change in Short Form Health Survey (SF-36v2) physical functioning scale.
Early and 1year echo data will be reported by a core laboratory. Estimates
of key clinical and health economic outcomes will be reported up to 5
years. The primary economic outcome is cost effectiveness, measured as
incremental cost per quality-adjusted life year gained over 52 weeks
following index surgery. A favourable opinion was given by Wales REC 6
(16/WA/0156). Trial findings will be disseminated to patients, clinicians,
commissioning groups and through peer reviewed publication.
ISRCTN13930454. Copyright © Author(s) (or their employer(s))
2021. Re-use permitted under CC BY. Published by BMJ.

<9>
Accession Number
2011046958
Title
Lung recruitment in the prone position after cardiac surgery: a randomised
controlled study.
Source
British Journal of Anaesthesia. 126 (5) (pp 1067-1074), 2021. Date of
Publication: May 2021.
Author
Martinsson A.; Houltz E.; Wallinder A.; Lindgren S.; Thoren A.
Institution
(Martinsson, Houltz, Lindgren, Thoren) Department of Anaesthesiology and
Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Wallinder) Department of Cardiothoracic Surgery, Sahlgrenska Academy,
University of Gothenburg, Sahlgrenska University Hospital, Gothenburg,
Sweden
Publisher
Elsevier Ltd
Abstract
Background: Atelectasis after cardiac surgery is common and promotes
ventilation/perfusion mismatch, infection, and delayed discharge from
critical care. Recruitment manoeuvres are often performed to reduce
atelectasis. In severe respiratory failure, recruitment manoeuvres in the
prone position may increase oxygenation, survival, or both. We compared
the effects of recruitment manoeuvres in the prone vs supine position on
lung aeration and oxygenation in cardiac surgical patients.
 Method(s): Subjects were randomised to recruitment manoeuvres (40 cm
H<inf>2</inf>O peak inspiratory pressure and 20 cm H<inf>2</inf>O PEEP for
30 s) in either the prone or supine position after uncomplicated cardiac
surgery. The co-primary endpoints were lung aeration (end-expiratory lung
volume measured by electrical impedance tomography (arbitrary units
[a.u.]) and lung oxygenation (ratio of arterial oxygen partial pressure to
fractional inspired oxygen [PaO<inf>2</inf>/FiO<inf>2</inf> ratio]).
Secondary outcomes included postoperative oxygen requirement and adverse
events. Result(s): Thirty subjects (27% female; age, 48-81 yr) were
recruited. Dorsal lung tidal volume was higher after prone recruitment
manoeuvres (363 a.u.; 95% confidence intervals [CI], 283-443; n=15) after
extubation, compared with supine recruitment manoeuvres (212 a.u.; 95% CI,
170-254; n=15; P<0.001). Prone recruitment manoeuvres increased dorsal
end-expiratory lung volume by 724 a.u. (95% CI, 456-992) after extubation,
compared with 163 a.u. decrease (95% CI, 73-252) after supine recruitment
manoeuvres (P<0.001). The PaO<inf>2</inf>/FiO<inf>2</inf> ratio after
extubation was higher after prone recruitment manoeuvres (46.6; 95% CI,
40.7-53.0) compared with supine recruitment manoeuvres (39.3; 95% CI,
34.8-43.8; P=0.04). Oxygen therapy after extubation was shorter after
prone (33 h [13]) vs supine recruitment manoeuvres (52 h [22]; P=0.01). No
adverse events occurred. Conclusion(s): Recruitment manoeuvres in the
prone position after cardiac surgery improve lung aeration and
oxygenation. Clinical trial registration: NCT03009331. Copyright
© 2021 British Journal of Anaesthesia

<10>
Accession Number
2003815061
Title
Causes and predictors of readmission after transcatheter aortic valve
implantation: A meta-analysis and systematic review.
Source
Herz. 46 (Supplement 1) (no pagination), 2021. Date of Publication: April
2021.
Author
Li Y.-M.; Mei F.-Y.; Yao Y.-J.; Tsauo J.-Y.; Peng Y.; Chen M.
Institution
(Li, Tsauo, Peng, Chen) Department of Cardiology, West China Hospital,
Sichuan University, 37 Guoxue Street, Chengdu 610041, China
(Mei) Zhejiang Provincial People's Hospital, Hangzhou, China
(Yao) West China School of Medicine, Sichuan University, Chengdu, China
Publisher
Springer Medizin
Abstract
Background: Since readmission rate is an important clinical index to
determine the quality of inpatient care and hospital performance, the aim
of this study was to explain the causes and predictors of readmission
following transcatheter aortic valve implantation (TAVI) at short-term and
mid-term follow-up. Methods and Results: A systematic review and
meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and
Ovid was carried out. In all, 10 studies including 52,702 patients were
identified. The pooled estimate for the overall event rate was 0.15, and
cardiovascular causes were the main reason for 30-day readmission (0.42,
95% confidence interval [CI]: 0.39-0.45). In addition, the pooled
incidence of 1-year readmission was 0.31, and cardiovascular events were
still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and
life-threatening bleeding, new permanent pacemaker implantation, and
clinical heart failure were associated with a high risk for early
readmission after TAVI. Moreover, an advanced (>=3) New York Heart
Association classification, acute kidney injury, paravalvular leak, mitral
regurgitation (>= moderate), and major bleeding predicted unfavorable
outcome to 1-year readmission. Female gender and transfemoral TAVI was
associated with a lower risk for unplanned rehospitalization.
 Conclusion(s): This meta-analysis found cardiovascular factors to be
the main causes for both 30-day and 1-year rehospitalization. Heart
failure represented the most common cardiovascular event at both
short-term and mid-term follow-up. Several baseline characteristics and
procedure-related factors were deemed unfavorable predictors of
readmission. Importantly, transfemoral access and female gender were
associated with a lower risk of readmission. Copyright © 2019,
Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<11>
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Accession Number
634799852
Title
A systematic review and meta-analysis of the effects of early mobilization
therapy in patients after cardiac surgery.
Source
Medicine. 100 (15) (pp e25314), 2021. Date of Publication: 16 Apr 2021.
Author
Chen B.; Xie G.; Lin Y.; Chen L.; Lin Z.; You X.; Xie X.; Dong D.; Zheng
X.; Li D.; Lin W.
Institution
(Chen, Lin, Chen, Lin, You, Xie, Dong, Zheng, Li, Lin) Affiliated People's
Hospital of Fujian University of Traditional Chinese Medicine
(Chen, Lin) National Clinical Research Base of Traditional Chinese
Medicine, Fujian Province, Fuzhou 350004, China
(Xie) Yunnan University of Traditional Chinese Medicine, Yunnan Province,
Kunming 650500, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Prolonged hospitalization and immobility of critical care
patients elevate the risk of long-term physical and cognitive impairments.
However, the therapeutic effects of early mobilization have been difficult
to interpret due to variations in study populations, interventions, and
outcome measures. We conducted a meta-analysis to assess the effects of
early mobilization therapy on cardiac surgery patients in the intensive
care unit (ICU). METHOD(S): PubMed, Excerpta Medica database
(EMBASE), Cumulative Index of Nursing and Allied Health Literature
(CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane
Library were comprehensively searched from their inception to September
2018. Randomized controlled trials were included if patients were adults
(>=18 years) admitted to any ICU for cardiac surgery due to cardiovascular
disease and who were treated with experimental physiotherapy initiated in
the ICU (pre, post, or peri-operative). Data were extracted by 2 reviewers
independently using a pre-constructed data extraction form. Length of ICU
and hospital stay was evaluated as the primary outcomes. Physical function
and adverse events were assessed as the secondary outcomes. Review Manager
5.3 (RevMan 5.3) was used for statistical analysis. For all dichotomous
variables, relative risks or odds ratios with 95% confidence intervals
(CI) were presented. For all continuous variables, mean differences (MDs)
or standard MDs with 95% CIs were calculated. RESULT(S): The 5
studies with a total of 652 patients were included in the data synthesis
final meta-analysis. While a slight favorable effect was detected in 3 out
of the 5 studies, the overall effects were not significant, even after
adjusting for heterogeneity. CONCLUSION(S): This population-specific
evaluation of the efficacy of early mobilization to reduce hospitalization
duration suggests that intervention may not universally justify the labor
barriers and resource costs in patients undergoing non-emergency cardiac
surgery. PROSPERO RESEARCH REGISTRATION IDENTIFYING NUMBER:
CRD42019135338. Copyright © 2021 the Author(s). Published by
Wolters Kluwer Health, Inc.

<12>
[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.

<13>
Accession Number
2011729846
Title
Evaluation of liver function tests after coronary artery bypass surgery
(CABG).
Source
Caspian Journal of Internal Medicine. 12 (1) (pp 45-52), 2021. Date of
Publication: 2021.
Author
Zakeri S.; Vafaey H.; Banihashem N.; Alijanpour A.; Gholinia H.; Behzad C.
Institution
(Zakeri) Student Research Committee, Babol University of Medical Sciences,
Babol, Iran, Islamic Republic of
(Vafaey, Banihashem, Gholinia) Clinical Research Development Unit of
Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran,
Islamic Republic of
(Alijanpour) Department of Surgery, Babol University of Medical Sciences,
Babol, Iran, Islamic Republic of
(Behzad) Department of Internal Medicine, Babol University of Medical
Sciences Babol, Iran, Islamic Republic of
Publisher
Babol University of Medical Sciences
Abstract
Background: Coronary artery bypass graft surgery (CABG) may have systemic
effects on the body organs as liver. The purpose of present study was to
evaluate changes in liver function tests(LFT) after on-pump CABG surgery
and risk factors associated with LFT changes.Also, the incidence of acute
liver injury after on-pump CABG is determined. Method(s): 385
patients who underwent on-pump CABG surgery were randomly
selected.Preoperative and intraoperative risk factors were obtained from
their medical records .Postoperative liver function tests at 24, 48 and 72
hours following surgery and discharge time were compared with the
preoperative ones. A univariate linear regression analysis was used to
assess the possible relationships between these changes and the
preoperative and intraoperative risk factors. Result(s): Statisitcal
analysis revealed direct and significant relationship between LFT changes
and pump time, aortic cross-clamp clamp time and use of intra-aortic
balloon pump(IABP). Also a medical history of previous myocardia
infarction was significantly related to the changes in direct bilirubin in
the first 48 hours following surgery.level of preoperative left ventricle
ejection fraction,smoking and using opium had significant correlation with
postoperative AST changes in different days.In 12.9% of patients, the
aminotransferases levels increased to more than three folds over normal
upper limit but the probability for incidence of acute ischemic liver
injury (transient increase in aminotransferases to over 500IU/L) was
0.77%. Conclusion(s): Using techniques to reduce clamp and pump time
when possible is important during CABG. Probable liver injuries post
inserting IABP should be expected for appropriate monitoring and
treatment. Copyright © 2020, Babol University of Medical
Sciences.

<14>
Accession Number
2011719130
Title
3D CT airway evaluation-guided intraluminal placement of endobronchial
blocker in pediatric patients: a randomized controlled study.
Source
Translational Pediatrics. 10 (3) (pp 625-634), 2021. Date of Publication:
March 2021.
Author
Xu Y.; Li L.; Hou J.; Zhang N.; Zeng M.; Qiu Q.; Liang Y.; Wei W.; Tan Y.
Institution
(Xu, Zhang, Zeng, Qiu, Wei, Tan) Department of Anesthesiology, Guangzhou
Women and Children's Medical Center, Guangzhou Medical University,
Guangzhou, China
(Li) Department of Pediatric Surgery, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Hou) Department of Radiology, Guangzhou Women and Children's Medical
Center, Guangzhou Medical University, Guangzhou, China
(Liang) Pediatric Intensive Care Unit, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
Publisher
AME Publishing Company
Abstract
Background: The aim of the present study was to propose a new approach for
3D computed tomography (CT) airway evaluation-guided endobronchial blocker
placement in pediatric patients, and to determine its efficiency in
clinical application. Method(s): A total of 127 pediatric patients
aged 0.5-3 years who were scheduled for elective thoracic surgery using
one-lung ventilation (OLV) were randomized into the bronchoscopy (BRO)
group and the CT group. The degree of lung collapse, postoperative airway
mucosal injury, pulmonary infection within 72 h after surgery, and
hoarseness after tracheal extubation; duration of postoperative mechanical
ventilation, intensive care unit (ICU) stay and hospitalization; success
rate of first blocker positioning; and required time and repositioning for
successful blocker placement were compared between the 2 groups.
 Result(s): The degree of lung collapse, postoperative airway mucosal
injury, pulmonary infection within 72 h after surgery, and hoarseness
after tracheal extubation; duration of postoperative mechanical
ventilation, ICU stay and hospitalization; success rate of first blocker
positioning; and required time and repositioning for successful blocker
placement were similar between the 2 groups (all P>0.05).
 Conclusion(s): For pediatric patients undergoing surgery with OLV,
preoperative 3D CT airway evaluation could be used to guide endobronchial
blocker placement, with a blocking efficiency similar to that of
BRO-guided blocker placement. Copyright © 2021 AME Publishing
Company. All rights reserved.

<15>
Accession Number
2011718219
Title
The effect of incentive spirometry on pulmonary function recovery and
satisfaction with physical therapy of cardiac surgery patients.
Source
Advances in Rehabilitation. 35 (1) (pp 9-16), 2021. Date of Publication:
2021.
Author
Vitomskyi V.; Hawamdeh K.A.; Vitomska M.; Lazarieva O.; Haidai O.
Institution
(Vitomskyi, Hawamdeh, Vitomska, Lazarieva) National University of Ukraine,
Physical Education and Sport, Ukraine
(Haidai) Bogomolets National Medical University, Ukraine
Publisher
Termedia Publishing House Ltd.
Abstract
Introduction: The assessment of patient satisfaction with the received
physical therapy (PT) is a necessary part of PT system analysis. The
purpose of the study was to investigate the effect of incentive spirometry
on pulmonary function recovery and the level of satisfaction with PT in
patients undergoing cardiac surgery. Material(s) and Method(s): 70
patients of both sexes were randomly divided into control group (CG) and
training group (TG). Both groups received standardized PT (early
mobilization, therapeutic exercises, coughing). TG patients also used
Tri-Ball breathing exerciser (flow-oriented incentive spirometry). Outcome
Measures: The indicators of pulmonary function and satisfaction with PT
results on the 7th postoperative day. Result(s): Pulmonary function
results were statistically the same in CG and TG both before the surgery
and on the seventh postoperative day. According to the results of the
assessment of patient satisfaction with PT, none of the groups showed
advantages in any of the seventeen items. Both groups of patients showed
high scores in all items of PT satisfaction questionnaire. The overall
score had no statistical difference in the groups as well: 82.5 (79; 85)
points in CG and 80.5 (74.75; 85) points in TG (p = 0.315) out of a
maximum of 85 points. Conclusion(s): The investigation of pulmonary
function and patient satisfaction with the received physical therapy did
not confirm the effect of flow-oriented incentive spirometry included in
the physical therapy program on the level of satisfaction and pulmonary
function test results. Copyright © 2021 American Society of
Clinical Oncology. All rights reserved.

<16>
Accession Number
2011708714
Title
Efficacy, Safety, and Strategies for Recombinant-Activated Factor VII in
Cardiac Surgical Bleeding: A Narrative Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Kidd B.; Sutherland L.; Jabaley C.S.; Flynn B.
Institution
(Kidd, Flynn) Division of Critical Care Medicine, Department of
Anesthesiology, University of Kansas Medical Center, Kansas City, KS,
United States
(Sutherland) Division of Critical Care Medicine, Department of
Anesthesiology, Columbia University, New York, NY, United States
(Jabaley) Division of Critical Care Medicine, Department of
Anesthesiology, Emory University, Atlanta, GA, United States
(Jabaley) Emory Critical Care Center, Atlanta, GA, United States
Publisher
W.B. Saunders
Abstract
As perioperative bleeding continues to be a major source of morbidity and
mortality in cardiac surgery, the search continues for an ideal hemostatic
agent for use in this patient population. Transfusion of blood products
has been associated both with increased costs and risks, such as
infection, prolonged mechanical ventilation, increased length of stay, and
decreased survival. Recombinant-activated factor VII (rFVIIa) first was
approved for the US market in 1999 and since that time has been used in a
variety of clinical settings. This review summarizes the existing
literature pertaining to perioperative rFVIIa, in addition to society
recommendations and current guidelines regarding its use in cardiac
surgery. Copyright © 2021 Elsevier Inc.

<17>
Accession Number
634806009
Title
Cardiac rehabilitation outcome after transcatheter aortic valve
implantation.
Source
Monaldi archives for chest disease = Archivio Monaldi per le malattie del
torace. 91 (2) (no pagination), 2021. Date of Publication: 13 Apr 2021.
Author
Penati C.; Incorvaia C.; Mollo V.; Lietti F.; Gatto G.; Stefanelli M.;
Centeleghe P.; Talarico G.; Mori I.; Franzelli C.; Ratti F.; Ponticelli
M.P.; Ridolo E.; Febo O.C.
Institution
(Penati, Mollo, Lietti, Gatto, Stefanelli, Centeleghe, Talarico, Mori,
Franzelli, Ratti, Ponticelli, Febo) Cardiac/Pulmonary Rehabilitation, ASST
Pini-CTO, Milan, United States
(Incorvaia) Cardiac/Pulmonary Rehabilitation, ASST PINI-CTO
(Ridolo) Allergy and Clinical Immunology, Medicine and Surgery Department,
University of Parma.
Publisher
NLM (Medline)
Abstract
Patients with severe aortic stenosis are increasingly treated with
transcatheter aortic valve implantation (TAVI) as a safer option to
surgical aortic valve replacement (sAVR). Similar to many other heart
diseases, after the specific therapeutic intervention patients are
eligible for cardiac rehabilitation (CR) for the purpose of functional
recovery. Thus far, CR after both sAVR and TAVI has been used to a limited
extent, as shown by the availability of only two meta-analyses including 5
studies and 6 studies, respectively. Recent observational studies reported
a significant improvement in functional indexes such as the Barthel scale
and the 6-minute walk test (6MWT). We evaluated the outcome of CR in
patients after TAVI treatment by measuring changes in the commonly used
Barthel scale and 6MWT and adding the short physical performance battery
(SPPB) scale as an index to assess lower extremity function. All indexes
demonstrated a significant improvement, namely p<0.001 with the Barthel
scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm
the significant improvement of the Barthel scale and 6MWT reported in the
previous meta-analysis and suggest the utility of SPPB as a further index
of efficacy of CR in patients with severe aortic stenosis treated with
TAVI.

<18>
Accession Number
634760331
Title
Development of a core outcome set for congenital pulmonary airway
malformations: Study protocol of an international Delphi survey.
Source
BMJ Open. 11 (4) (no pagination), 2021. Article Number: e044544. Date of
Publication: 12 Apr 2021.
Author
Hermelijn S.; Kersten C.; Mullassery D.; Muthialu N.; Cobanoglu N.;
Gartner S.; Bagolan P.; Mesas Burgos C.; Sgro A.; Heyman S.; Till H.;
Suominen J.; Schurink M.; Desender L.; Losty P.; Ertresvag K.; Tiddens
H.A.W.M.; Wijnen R.M.H.; Schnater M.
Institution
(Hermelijn, Kersten, Wijnen, Schnater) Pediatric Surgery, Erasmus MC
Sophia Children's Hospital, Rotterdam, Netherlands
(Mullassery, Muthialu) Pediatric Surgery, Great Ormond Street Hospital for
Children, London, United Kingdom
(Cobanoglu) Pediatric Pulmonology, Ankara University Faculty of Medicine,
Ankara, Turkey
(Gartner) Pediatric Pulmonology, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
(Bagolan) Department of Medical and Surgical Neonatology, Ospedale
Pediatrico Bambino Gesu, Roma, Italy
(Mesas Burgos) Pediatric Surgery, Karolinska Institutet, Stockholm, Sweden
(Sgro) Pediatric Surgery, Padua University Hospital, Padova, Italy
(Heyman) Pediatric Surgery, ZNA-GZA Paola Children's Hospital, Antwerp,
Belgium
(Till) Pediatric Surgery, Medical University of Graz, Graz, Austria
(Suominen) Pediatric Surgery, University of Helsinki Children's Hospital,
Helsinki, Finland
(Schurink) Pediatric Surgery, Radboud University Medical Centre Amalia
Children's Hospital, Nijmegen, Netherlands
(Desender) Pediatric Surgery, Ghent University Faculty of Medicine and
Health Sciences, Gent, Belgium
(Losty) Pediatric Surgery, University of Liverpool, Liverpool, United
Kingdom
(Ertresvag) Pediatric Surgery, Oslo University Hospital, Oslo, Norway
(Tiddens) Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital,
Rotterdam, Netherlands
Publisher
BMJ Publishing Group
Abstract
Introduction A worldwide lack of consensus exists on the optimal
management of asymptomatic congenital pulmonary airway malformation (CPAM)
even though the incidence is increasing. Either a surgical resection is
performed or a wait-and-see policy is employed, depending on the treating
physician. Management is largely based on expert opinion and scientific
evidence is scarce. Wide variations in outcome measures are seen between
studies making comparison difficult thus highlighting the lack of
universal consensus in outcome measures as well. We aim to define a core
outcome set which will include the most important core outcome parameters
for paediatric patients with an asymptomatic CPAM. Methods and analysis
This study will include a critical appraisal of the current literature
followed by a three-stage Delphi process with two stakeholder groups. One
surgical group including paediatric as well as thoracic surgeons, and a
non-surgeon group including paediatric pulmonologists, intensive care and
neonatal specialists. All participants will score outcome parameters
according to their level of importance and the most important parameters
will be determined by consensus. Ethics and dissemination Electronic
informed consent will be obtained from all participants. Ethical approval
is not required. After the core outcome set has been defined, we intend to
design an international randomised controlled trial: the COllaborative
Neonatal NEtwork for the first CPAM Trial, which will be aimed at
determining the optimal management of patients with asymptomatic
CPAM. Copyright © 2021 BMJ Publishing Group. All rights reserved.

<19>
Accession Number
2011690850
Title
Conduits' Biology Regulates the Outcomes of Coronary Artery Bypass
Grafting.
Source
JACC: Basic to Translational Science. 6 (4) (pp 388-396), 2021. Date of
Publication: April 2021.
Author
Gharibeh L.; Ferrari G.; Ouimet M.; Grau J.B.
Institution
(Gharibeh, Ouimet, Grau) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(Gharibeh, Ouimet) Department of Biochemistry, Microbiology and
Immunology, University of Ottawa, Ottawa, ON, Canada
(Gharibeh, Ouimet) Research Department, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Ferrari) Department of Surgery and Biomedical Engineering, Columbia
University, New York, NY, United States
(Grau) Department of Cardiovascular Surgery, The Valley Hospital,
Ridgewood, NJ, United States
Publisher
Elsevier Inc.
Abstract
Coronary artery bypass graft (CABG) is the gold standard for coronary
surgical revascularization. Retrospective, prospective, and meta-analysis
studies looking into long-term outcomes of using different conduits have
pointed to the superiority of arterial grafts over veins and have placed
the internal mammary artery as the standard conduit of choice for CABG.
The superiority of the internal mammary artery over other conduits could
be attributable to its intrinsic characteristics; however, little is known
regarding the features that render some conduits atherosclerosis-prone and
others atherosclerosis-resistant. Here, an overview is provided of the
available data on the most commonly used conduits in CABG (internal
mammary artery, saphenous vein, radial artery, gastroepiploic artery),
highlighting the differences in their cellular biology, mechanical,
biochemical, and vasoconstrictive properties. This information should help
in furthering our understanding of the clinical outcomes observed for each
of these conduits. Copyright © 2020

<20>
Accession Number
2011127386
Title
Clinical practice patterns and ascertainment bias for cardiovascular
events in a randomized trial: A survey of investigators in the BEST-CLI
trial.
Source
Vascular Medicine (United Kingdom). 26 (2) (pp 180-186), 2021. Date of
Publication: April 2021.
Author
Albaghdadi M.S.; Young M.N.; Chowdhury M.M.; Assmann S.; Hamza T.; Siami
S.; Villarreal M.; Strong M.; Menard M.; Farber A.; Rosenfield K.
Institution
(Albaghdadi, Rosenfield) Division of Cardiology and Section of Vascular
Medicine, Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Albaghdadi) Department of Medicine, Division of Cardiology, University of
Toronto, Toronto, ON, Canada
(Young) Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel
School of Medicine at Dartmouth, NH, United States
(Chowdhury) Department of Vascular and Endovascular Surgery, Department of
Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge,
United Kingdom
(Assmann, Hamza, Siami) HealthCore-New England Research Institutes, Inc,
Watertown, MA, United States
(Villarreal) Department of Vascular Surgery, Boston Medical Center, Boston
University, Boston, MA, United States
(Strong, Menard, Farber) Department of Vascular Surgery, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
Publisher
SAGE Publications Ltd
Abstract
Ascertainment bias is a well-recognized source of bias in research, but
few studies have systematically analyzed sources of ascertainment bias in
randomized trials in which blinding is not possible and endpoint
assessment is not protocolized. In the current study, we sought to
evaluate differences in the clinical practice patterns of trial
investigators with respect to bias in the ascertainment of
pre-revascularization patient risk and the incidence of secondary
endpoints post-revascularization. We conducted a cross-sectional survey of
active investigators (n = 936) from the Best Endovascular Versus Best
Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI)
trial. The total survey response rate was 19.6% (183/936). Vascular
surgeons were more likely than nonsurgical interventionalists to order
tests for cardiac complications after both surgical bypass (p < 0.001) and
endovascular revascularization (p = 0.038). Post-procedure, investigators
were more likely to order additional testing for cardiac complications in
open surgery versus endovascular cases (7% vs 16% never, 41% vs 65%
rarely, 43% vs 17% sometimes, 9% vs 2% always, respectively; p < 0.0001).
Significant variation in practice patterns exist in the pre- and
post-procedure assessment of cardiac risk and events for patients with CLI
undergoing revascularization. Variation in the ascertainment of risk and
outcomes according to the type of revascularization procedure and
physician specialty should be considered when interpreting the results of
clinical studies, such as the BEST-CLI trial. ClinicalTrials.gov
Identifier: NCT02060630 Copyright © The Author(s) 2021.

<21>
Accession Number
2011541098
Title
COVID-19 and Heart Transplant: A Case Series and Review of the Literature.
Source
Transplantation Proceedings. (no pagination), 2021. Date of Publication:
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
Elsevier Inc.
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.

<22>
Accession Number
2011117206
Title
Systematic Review of Minimally Invasive Surgery for Mitral Valve Infective
Endocarditis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2021. Date of Publication: 2021.
Author
Shih E.; Squiers J.J.; DiMaio J.M.
Institution
(Shih, Squiers, DiMaio) Baylor Scott White Research Institute, The Heart
Hospital Baylor Plano, Plano, TX, United States
(Shih, Squiers) Department of Surgery, Baylor University Medical Center,
Dallas, TX, United States
(DiMaio) Department of Cardiothoracic Surgery, The Heart Hospital, Baylor
Scott and White, Plano, TX, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: The scope of application of minimally invasive mitral valve
surgery is expanding. However, the safety and efficacy of minimally
invasive mitral valve surgery in the setting of infective endocarditis is
not well known. We sought to identify the best evidence available to
support a minimally invasive surgical approach for mitral valve infective
endocarditis. Method(s): A systematic review of minimally invasive
mitral valve surgery for infective endocarditis was conducted according to
the Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA) guidelines. Result(s): A total of 6 manuscripts describing
271 patients were identified. Mean age was 60.4 +/- 14.9 years old, and
60.1% patients were male. Mean EuroSCORE II was 24.6 +/- 23.2. Mitral
valve repair was achieved in 32.4% of cases. The average in-hospital
mortality was 9.4%, and average length of hospital stay was 21.6 days.
Survival was 89.1% at 30 days, and 1-year survival was 79.3%. Rate of
conversion to sternotomy was 1.8%. Postoperative complications included:
6.9% postoperative bleeding, 9.3% new postoperative dialysis, 2.3%
postoperative stroke, and 3.4% recurrence of endocarditis. Reoperation
over the long-term was required in 9.3% of cases. Conclusion(s):
Minimally invasive mitral valve surgery for infective endocarditis has
acceptable perioperative morbidity as well as short- and intermediate-term
mortality at experienced centers. Minimally invasive mitral valve surgery
may be an acceptable alternative approach to infective endocarditis and
warrants further study. Copyright © The Author(s) 2021.

<23>
Accession Number
634807496
Title
A device category economic model of electrosurgery technologies across
procedure types: A U.S. hospital budget impact analysis.
Source
Journal of medical economics. (pp 1), 2021. Date of Publication: 14 Apr
2021.
Author
Ferko N.; Wright G.W.J.; Syed I.; Naoumtchik E.; Tommaselli G.A.; Gangoli
G.
Institution
(Ferko, Wright, Syed) ON, Burlington, Canada
(Naoumtchik, Tommaselli, Gangoli) Johnson & Johnson Medical Devices
Companies, Cincinnati, OH, United States
Publisher
NLM (Medline)
Abstract
AIMS: The electrosurgical technology category is used widely, with a
diverse spectrum of devices designed for different surgical needs.
Historically, hospitals are supplied with electrosurgical devices from
several manufacturers, and those devices are often evaluated separately;
it may be more efficient to evaluate the category holistically. This study
assessed the health economic impact of adopting an electrosurgical
device-category from a single manufacturer. METHOD(S): A budget
impact model was developed from a U.S. hospital perspective. The uptake of
electrosurgical devices from EES (Ethicon Electrosurgery), including
ultrasonic, advanced bipolar, smoke evacuators, and reusable -dispersive
electrodes were compared with similar MED (Medical Energy Devices) from
multiple manufacturers. It was assumed that an average hospital performed
10,000 annual procedures 80% of which involved electrosurgery. Current
utilization assumed 100% MED use, including advanced energy, conventional
smoke mitigation options (e.g., ventilation, masks), and single-use
disposable dispersive electrode devices. Future utilization assumed 100%
EES use, including advanced energy devices, smoke evacuators (i.e., 80%
uptake), and reusable dispersive electrodes. Surgical specialties included
colorectal, bariatric, gynecology, thoracic and general surgery.
Systematic reviews, network meta-analyses, and meta-regressions informed
operating room (OR) time, hospital stay, and transfusion model inputs.
Costs were assigned to model parameters, and price parity was assumed for
advanced energy devices. The costs of disposables for dispersive
electrodes and smoke-evacuators were included. RESULT(S): The
base-case analysis, which assessed the adoption of EES instead of MED for
an average U.S. hospital predicted an annual savings of $824,760 ($101 per
procedure). Savings were attributable to associated reductions with EES in
OR time, days of hospital stay, and volume of disposable electrodes.
Sensitivity analyses were consistent with these base-case findings.
 CONCLUSION(S): Category-wide adoption of electrosurgical devices from
a single manufacturer demonstrated economic advantages compared with
disaggregated product uptake. Future research should focus on informing
comparisons of innovative electrosurgical devices.

<24>
Accession Number
634806186
Title
Age-Stratified Outcome in Treatment of Left Main Coronary Artery Stenosis:
A NOBLE Trial Substudy.
Source
Cardiology. (pp 1-10), 2021. Date of Publication: 13 Apr 2021.
Author
Steigen T.; Holm N.R.; Myrmel T.; Endresen P.C.; Trovik T.; Makikallio T.;
Lindsay M.; Spence M.S.; Erglis A.; Menown I.B.A.; Kumsars I.; Kellerth
T.; Davidavicius G.; Linder R.; Anttila V.; Juul Hune Mogensen L.; Hostrup
Nielsen P.; Graham A.N.J.; Hildick-Smith D.; Thuesen L.; Christiansen E.H.
Institution
(Steigen, Myrmel) Cardiovascular Research Group, UiT The Arctic University
of Norway, Tromso, Norway
(Steigen, Trovik) Department of Cardiology, University Hospital of North
Norway, Tromso, Norway
(Holm, Juul Hune Mogensen, Christiansen) Department of Cardiology, Aarhus
University Hospital, Skejby ,Aarhus, Denmark
(Myrmel, Endresen) Department of Cardiovascular Surgery, University of
Northern Norway, Tromso, Norway
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Lindsay) Department of Cardiology, Golden Jubilee National Hospital,
Clydebank, United Kingdom
(Spence, Graham) Belfast Heart Centre, Belfast Trust, Belfast, United
Kingdom
(Erglis, Kumsars) Latvia Centre of Cardiology, Paul Stradins Clinical
Hospital, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, United Kingdom
(Kellerth) Department of Cardiology, Orebro University Hospital, Sweden
(Davidavicius) Department of Cardiology, Vilnius University Hospital,
Vilnius, Lithuania
(Linder) Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
(Anttila) Department of Cardiac Surgery, Oulu University Hospital, Oulu,
Finland
(Hostrup Nielsen) Department of Cardiac Surgery, Aarhus University
Hospital, Skejby ,Aarhus, Denmark
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospital, Brighton, United Kingdom
(Thuesen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the treatment of left main coronary artery (LMCA) disease,
patients' age may affect the clinical outcome after percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG). This study
stratified the clinical outcome according to the age of patients treated
for LMCA stenosis with PCI or CABG in the Nordic-Baltic-British Left Main
Revascularization (NOBLE) study. METHOD(S): Patients with LMCA
disease were enrolled in 36 centers in northern Europe and randomized 1:1
to treatment by PCI or CABG. Eligible patients had stable angina pectoris,
unstable angina pectoris, or non-ST elevation myocardial infarction. The
primary endpoint was major adverse cardiac or cerebrovascular events
(MACCEs), a composite of all-cause mortality, nonprocedural myocardial
infarction, any repeat coronary revascularization, and stroke.
Age-stratified analysis was performed for the groups younger and older
than 67 years and for patients older than 80 years. RESULT(S): For
patients >=67 years, the 5-year MACCEs were 35.7 versus 22.3% (hazard
ratio [HR] 1.72 [95% confidence interval [CI] 1.27-2.33], p = 0.0004) for
PCI versus CABG. The difference in MACCEs was driven by more myocardial
infarctions (10.8 vs. 3.8% HR 3.01 [95% CI 1.52-5.96], p = 0.0009) and
more repeat revascularizations (19.5 vs. 10.0% HR 2.01 [95% CI 1.29-3.12],
p = 0.002). In patients younger than 67 years, MACCE was 20.5 versus 15.3%
(HR 1.38 [95% CI 0.93-2.06], p = 0.11 for PCI versus CABG. All-cause
mortality was similar after PCI and CABG in both age-groups. On
multivariate analysis, age was a predictor of MACCE, along with PCI,
diabetes, and SYNTAX score. CONCLUSION(S): As the overall NOBLE
results show revascularization of LMCA disease, age of 67 years or older
was associated with lower 5-year MACCE after CABG compared to PCI.
Clinical outcomes were not significantly different in the subgroup younger
than 67 years, although no significant interaction was present between age
and treatment. Mortality was similar for all subgroups (ClinicalTrials.gov
identifier: NCT01496651). Copyright © 2021 S. Karger AG, Basel.

<25>
Accession Number
634799706
Title
Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on
Lower Urinary Tract Symptoms in Males.
Source
Obesity surgery. (no pagination), 2021. Date of Publication: 13 Apr 2021.
Author
Stefanova I.; Currie A.C.; Newton R.C.; Albon L.; Slater G.; Birnie A.;
Hawkins W.; Pring C.
Institution
(Stefanova) Department of General Surgery, East Surrey Hospital, Redhill,
United Kingdom
(Currie) Department of Bariatric Surgery, Ashford and St Peters Hospital
Trust, Guildford Street, Chertsey KT16 0PZ, United Kingdom
(Newton, Slater, Hawkins, Pring) Department of Bariatric Surgery, St
Richard's Hospital, Chichester, United Kingdom
(Albon) Department of Bariatric Surgery and Diabetes, St Richard's
Hospital, Chichester, United Kingdom
(Birnie) Department of Urology, St Richard's Hospital, Chichester, United
Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Obesity is a chronic disease with multisystem morbidity. There
are multiple studies reporting the effect of bariatric surgery on
cardiovascular and metabolic disease, but few examine its impact on lower
urinary tract symptoms. This article aims to perform a systematic review
with meta-analysis, to determine the effects of bariatric surgery on lower
urinary tract symptoms in male patients. METHOD(S): Medline, Embase,
conference proceedings, and reference lists were searched for studies
reporting the quantitative measurement of lower urinary tract symptoms
score pre- and postweight loss surgery. The primary outcome was
International Prostate Symptom Score (IPSS) before and after bariatric
surgery. Secondary outcomes were changed in body mass index (BMI) and
total body weight (TBW). Weighted mean differences (MD) were calculated
for continuous outcomes. RESULT(S): Seven studies were included in
the analysis of 334 patients undergoing bariatric surgery. Mean study
follow-up was between 3 and 36 months. IPSS score ranged from 3-12.7
preoperatively and 1.9-6.9 postoperatively. There was a statistically
significant improvement in the IPSS score following bariatric surgery (MD
2.82, 95% CI 0.96 to 4.69, p=0.003). Bariatric surgery also resulted in
statistically significant reduction of BMI and TBW. CONCLUSION(S):
Bariatric surgery produces a significant improvement on lower urinary
tract symptoms in men with obesity. This may be due to improvement of
insulin sensitivity, testosterone levels or lipid profile associated with
weight loss.

<26>
Accession Number
634795761
Title
2020 ACC/AHA guideline for the management of patients with valvular heart
disease: Executive summary a report of the American College of
Cardiology/American Heart Association joint committee on clinical practice
guidelines.
Source
Circulation. (pp E35-E71), 2021. Date of Publication: 2021.
Author
Otto C.M.; Nishimura R.A.; Bonow R.O.; Carabello B.A.; Erwin J.P.; Jneid
H.; Krieger E.V.; Mack M.; McLeod C.; Rigolin V.H.; Sundt T.M.; Thompson
A.; Toly C.; O'Gara P.T.; Beckman J.A.; Levine G.N.; Al-Khatib S.M.;
Armbruster A.; Birtcher K.K.; Ciggaroa J.; Deswal A.; Dixon D.L.; Fleisher
L.A.; de las Fuentes L.; Gentile F.; Goldberger Z.D.; Gorenek B.; Haynes
N.; Hernandez A.F.; Hlatky M.A.; Joglar J.A.; Jones W.S.; Marine J.E.;
Mark D.; Palaniappan L.; Piano M.R.; Spatz E.S.; Tamis-Holland J.;
Wijeysundera D.N.; Woo Y.J.
Publisher
Lippincott Williams and Wilkins
Abstract
AIM: This executive summary of the valvular heart disease guideline
provides recommendations for clinicians to diagnose and manage valvular
heart disease as well as supporting documentation to encourage their use.
 METHOD(S): A comprehensive literature search was conducted from
January 1, 2010, to March 1, 2020, encompassing studies, reviews, and
other evidence conducted on human subjects that were published in English
from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality
Reports, and other selected database relevant to this guideline.
STRUCTURE: Many recommendations from the earlier valvular heart disease
guidelines have been updated with new evidence and provides newer options
for diagnosis and treatment of valvular heart disease. This summary
includes only the recommendations from the full guideline which focus on
diagnostic work-up, the timing and choice of surgical and catheter
interventions, and recommendations for medical therapy. The reader is
referred to the full guideline for graphical flow charts, text, and tables
with additional details about the rationale for and implementation of each
recommendation, and the evidence tables detailing the data considered in
developing these guidelines. Copyright © 2020 by the American
College of Cardiology Foundation and the American Heart Association, Inc.
https://www.ahajournals.org/journal/circ

<27>
[Use Link to view the full text]
Accession Number
634795242
Title
One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding with a
Balloon-Expandable Transcatheter Aortic Valve.
Source
Circulation. (pp 1267-1269), 2021. Date of Publication: 2021.
Author
Kim W.-K.; Walther T.; Burgdorf C.; MAllmann H.; Linke A.; Redwood S.;
Thilo C.; Hilker M.; Joner M.; Thiele H.; Conzelmann L.; Conradi L.;
Kerber S.; Schymik G.; Prendergast B.; Husser O.; Blumenstein J.;
Stortecky S.; Heg D.; KAnzi A.; JAni P.; Windecker S.; Pilgrim T.; Lanz J.
Institution
(Kim, Husser) Department of Cardiology, Kerckhoff Heart and Thorax Center,
Bad Nauheim, Germany
(Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery,
University Hospital Frankfurt, Germany
(Burgdorf) Heart and Vascular Center, Bad Bevensen, Germany
(MAllmann, Blumenstein) Department of Internal Medicine i,
St-Johannes-Hospital, Dortmund, Germany
(Linke) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Technische UniversitAt Dresden, Germany
(Redwood, Prendergast) Department of Cardiology, St Thomas' Hospital,
London, United Kingdom
(Thilo) Department of Cardiology, Klinikum Augsburg, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Center,
Regensburg, Germany
(Joner) Deutsches Herzzentrum MAnchen, Cardiol. and TU MAnchen and German
Center for Cardiovascular Research (DZHK), Partner Site Munich Heart
Alliance, Germany
(Thiele) Heart Center Leipzig at University of Leipzig and Leipzig Heart
Institute, Germany
(Conzelmann) Department of Cardiac Surgery, Helios Klinik, Karlsruhe,
Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Germany
(Kerber) Department of Cardiology, Cardiovascular Center Bad Neustadt,
Germany
(Schymik) Department of Cardiology, StAdtisches Klinikum Karlsruhe,
Germany
(Stortecky, Windecker, Pilgrim, Lanz) Department of Cardiology,
Inselspital, Bern University Hospital, Switzerland
(Heg, KAnzi) Clinical Trials Unit, University of Bern, Switzerland
(JAni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, Department of Medicine and Institute of Health
Policy, Management and Evaluation, University of Toronto, Ontario, Canada
Publisher
Lippincott Williams and Wilkins

<28>
[Use Link to view the full text]
Accession Number
634795228
Title
Restrictive Transfusion Strategy after Cardiac Surgery: Role of Central
Venous Oxygen Saturation Trigger: A Randomized Controlled Trial.
Source
Anesthesiology. (pp 370-380), 2021. Date of Publication: 2021.
Author
Zeroual N.; Blin C.; Saour M.; David H.; Aouinti S.; Picot M.-C.; Colson
P.H.; Gaudard P.
Institution
(Zeroual, Blin, Saour, David, Colson, Gaudard) Department of
Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic
Hospital, Montpellier University, 371 Avenue Doyen Giraud, Montpellier
Cedex 5 34295, France
(Aouinti, Picot) Clinical Research and Epidemiology Unit, University
Hospital of Montpellier, Montpellier, France
(Colson) Institute of Functional Genomics
(Gaudard) PhyMedExp, Montpellier University, National Institute of Health
and Medical Research, National Center for Scientific Research,
Montpellier, France
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Recent guidelines on transfusion in cardiac surgery suggest
that hemoglobin might not be the only criterion to trigger transfusion.
Central venous oxygen saturation (Svo<inf>2</inf>), which is related to
the balance between tissue oxygen delivery and consumption, may help the
decision process of transfusion. We designed a randomized study to test
whether central Svo<inf>2</inf>-guided transfusion could reduce
transfusion incidence after cardiac surgery. Method(s): This single
center, single-blinded, randomized controlled trial was conducted on adult
patients after cardiac surgery in the intensive care unit (ICU) of a
tertiary university hospital. Patients were screened preoperatively and
were assigned randomly to two study groups (control or Svo<inf>2</inf>) if
they developed anemia (hemoglobin less than 9 g/dl), without active
bleeding, during their ICU stay. Patients were transfused at each anemia
episode during their ICU stay except the Svo<inf>2</inf>patients who were
transfused only if the pretransfusion central Svo<inf>2</inf>was less than
or equal to 65%. The primary outcome was the proportion of patients
transfused in the ICU. The main secondary endpoints were (1) number of
erythrocyte units transfused in the ICU and at study discharge, and (2)
the proportion of patients transfused at study discharge. Result(s):
Among 484 screened patients, 100 were randomized, with 50 in each group.
All control patients were transfused in the ICU with a total of 94
transfused erythrocyte units. In the Svo<inf>2</inf>group, 34 (68%)
patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P <
0.001 vs. controls), with a total of 65 erythrocyte units. At study
discharge, eight patients of the Svo<inf>2</inf>group remained
nontransfused and the cumulative count of erythrocyte units was 96 in the
Svo<inf>2</inf>group and 126 in the control group. Conclusion(s): A
restrictive transfusion strategy adjusted with central Svo<inf>2</inf>may
allow a significant reduction in the incidence of
transfusion. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
634794542
Title
Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove
Cytokines, Chemokines, and Cell-derived Microvesicles: A Clinical
Feasibility Study.
Source
Anesthesiology. (pp 395-404), 2021. Date of Publication: 2021.
Author
Welsby I.J.; Norris P.J.; Mauermann W.J.; Podgoreanu M.V.; Conn C.M.;
Meade L.; Cannon T.; Keating S.M.; Silliman C.C.; Kehler M.; Schulte P.J.;
Kor D.J.
Institution
(Welsby, Podgoreanu, Cannon) Department of Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Norris, Keating) Vitalant Research Institute, Departments of Laboratory
Medicine and Medicine, University of California, San Francisco, San
Francisco, CA, United States
(Mauermann, Meade, Kor) Department of Anesthesiology and Perioperative
Medicine
(Conn) Transfusion Medicine Services
(Schulte) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Silliman, Kehler) Vitalant Research Institute, Departments of Pediatrics
and Surgery, School of Medicine, University of Colorado, Aurora, CO,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Removal of cytokines, chemokines, and microvesicles from the
supernatant of allogeneic erythrocytes may help mitigate adverse
transfusion reactions. Blood bank-based washing procedures present
logistical difficulties; therefore, we tested the hypothesis that
on-demand bedside washing of allogeneic erythrocyte units is capable of
removing soluble factors and is feasible in a clinical setting.
 Method(s): There were in vitro and prospective, observation cohort
components to this a priori planned substudy evaluating bedside allogeneic
erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory
data were collected from the first 75 washed units given to a subset of
patients nested in the intervention arm of a parent clinical trial. Paired
pre- and postwash samples from the blood unit bags were centrifuged. The
supernatant was aspirated and frozen at -70degreeC, then batch-tested for
cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and
neutral lipids (all previously associated with transfusion reactions) and
cell-free hemoglobin (possibly increased by washing). From the entire
cohort randomized to the intervention arm of the trial, bedside washing
was defined as feasible if at least 75% of prescribed units were washed
per protocol. Result(s): Paired data were available for 74 units.
Washing reduced soluble CD40 ligand (median [interquartile range]; from
143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to
2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90
[4.10 to 20.0] to 0.83 [0.33 to 2.80] x 106), while cell-free
hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to
210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on
neutral lipids. Bedside washing was determined as feasible for 80 of 81
patients (99%); overall, 293 of 314 (93%) units were washed per protocol.
 Conclusion(s): Bedside erythrocyte washing was clinically feasible
and greatly reduced concentrations of soluble factors thought to be
associated with transfusion-related adverse reactions, increasing
concentrations of cell-free hemoglobin while maintaining acceptable (less
than 0.8%) hemolysis. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<30>
Accession Number
632408231
Title
Does the Presence of Significant Mitral Regurgitation prior to
Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact
Mortality? - Meta-Analysis and Systematic Review.
Source
Cardiology (Switzerland). 145 (7) (pp 428-438), 2020. Date of Publication:
01 Jul 2020.
Author
Sethi A.; Kodumuri V.; Prasad V.; Chaudhary A.; Coromilas J.; Kassotis J.
Institution
(Sethi, Chaudhary, Coromilas, Kassotis) Division of Cardiology, Rutgers
Robert Wood Johnson Medical School, New Brunswick, NJ, United States
(Kodumuri) John H. Stroger Hospital of Cook County, Chicago, IL, United
States
(Prasad) Division of Cardiology, Loma Linda University, Loma Linda, CA,
United States
Publisher
S. Karger AG
Abstract
Background: Mitral regurgitation (MR) is commonly encountered in patients
with severe aortic stenosis (AS). However, its independent impact on
mortality in patients undergoing transcatheter aortic valve implantation
(TAVI) has not been established. Method(s): We performed a systematic
search for studies reporting characteristics and outcome of patients with
and without significant MR and/or adjusted mortality associated with MR
post-TAVI. We conducted a meta-analysis of quantitative data.
 Result(s): Seventeen studies with 20,717 patients compared outcomes
and group characteristics. Twenty-one studies with 32,257 patients
reported adjusted odds of mortality associated with MR. Patients with MR
were older, had a higher Society of Thoracic Surgeons score, lower left
ventricular ejection fraction, a higher incidence of prior myocardial
infarction, atrial fibrillation, and a trend towards higher NYHA class
III/IV, but had similar mean gradient, gender, and chronic kidney disease.
The MR patients had a higher unadjusted short-term (RR = 1.46, 95% CI
1.30-1.65) and long-term mortality (RR = 1.40, 95% CI 1.18-1.65). However,
16 of 21 studies with 27,777 patients found no association between MR and
mortality after adjusting for baseline variables. In greater than half of
the patients (0.56, 95% CI 0.45-0.66) MR improved by at least one grade
following TAVI. Conclusion(s): The patients with MR undergoing TAVI
have a higher burden of risk factors which can independently impact
mortality. There is a lack of robust evidence supporting an increased
mortality in MR patients, after adjusting for other compounding variables.
MR tends to improve in the majority of patients post-TAVI. Copyright
© 2020

<31>
Accession Number
2005961590
Title
Randomized trial of bupivacaine with epinephrine versus bupivacaine
liposome suspension in patients undergoing minimally invasive lung
resection.
Source
Journal of Thoracic and Cardiovascular Surgery. 161 (5) (pp 1652-1661),
2021. Date of Publication: May 2021.
Author
Weksler B.; Sullivan J.L.; Schumacher L.Y.
Institution
(Weksler, Schumacher) Division of Thoracic and Esophageal Surgery,
Department of Thoracic and Cardiovascular Surgery, Allegheny General
Hospital, Pittsburgh, Pa, United States
(Sullivan) Division of Thoracic Surgery, Department of Surgery, Sinai
Hospital, Baltimore, Md, United States
Publisher
Mosby Inc.
Abstract
Objectives: Thoracic surgery can cause significant pain, and multiple
strategies have been developed to control pain after surgery. We compared
2 bupivacaine formulations given intraoperatively: bupivacaine with
epinephrine (1,200,000) or liposomal bupivacaine. Method(s): This was
a randomized, open-label study (NCT03560362). Eligible patients were
adults scheduled for a minimally invasive lung procedure. Incision sites
were injected with bupivacaine with epinephrine or liposomal bupivacaine
before incision, and each intercostal space was injected with 1 mL of
bupivacaine with epinephrine or liposomal bupivacaine entering the
thoracic cavity. Patient-controlled analgesia was initiated in the
recovery room. Pain was recorded using a visual analog scale. The primary
outcome was the amount of narcotics taken during the postoperative
hospital stay. Result(s): We recruited 50 patients; 25 received
bupivacaine with epinephrine, and 25 received liposomal bupivacaine. The
treatment groups were similar in age, histology, and procedure performed.
There were no statistical differences between the treatment groups in the
amount of narcotics required during the hospital stay (36.3 mg for
bupivacaine and 38 mg for liposomal bupivacaine) or in pain assessed the
day of surgery (5 and 5), the first day (3.5 and 2.3), second day (3 and
2.6), 2 weeks (0 and 1), or 3 months (0 and 0) postoperatively. Hospital
length of stay and complications were also similar. Conclusion(s): In
a small, randomized study, we did not find significant differences between
bupivacaine with epinephrine or liposomal bupivacaine in mitigating pain
after minimally invasive lung resection. We currently favor using the less
expensive nonliposomal bupivacaine preparations until additional data are
available. Copyright © 2020 The American Association for Thoracic
Surgery

<32>
Accession Number
2011659721
Title
Effect of Mitral Valve Gradient After MitraClip on Outcomes in Secondary
Mitral Regurgitation: Results From the COAPT Trial.
Source
JACC: Cardiovascular Interventions. 14 (8) (pp 879-889), 2021. Date of
Publication: 26 Apr 2021.
Author
Halaby R.; Herrmann H.C.; Gertz Z.M.; Lim S.; Kar S.; Lindenfeld J.;
Abraham W.T.; Grayburn P.A.; Naidu S.; Asch F.M.; Weissman N.J.; Zhang Y.;
Mack M.J.; Stone G.W.
Institution
(Halaby, Herrmann, Naidu) Cardiovascular Division, Department of Medicine,
University of Pennsylvania, Philadelphia, PA, United States
(Gertz) Division of Cardiology, Department of Internal Medicine, Virginia
Commonwealth University Medical Center, Richmond, VA, United States
(Lim) Division of Cardiovascular Medicine, University of Virginia Health
System Hospital, University of Virginia, Charlottesville, VA, United
States
(Kar) Interventional Cardiology, Los Robles Regional Medical Center,
Thousand Oaks, CA, United States
(Lindenfeld) Division of Cardiovascular Medicine, Department of Medicine,
Vanderbilt University Medical Center, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, Department of Internal
Medicine, Ohio State University, Columbus, OH, United States
(Grayburn, Mack) Division of Cardiology, Baylor Scott & White Heart and
Vascular Hospital, Dallas, TX, United States
(Asch, Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Zhang, Stone) Cardiovascular Research Foundation, New York, NY, United
States
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The authors sought to evaluate the association between mean
mitral valve gradient (MVG) and clinical outcomes among patients who
underwent MitraClip treatment for secondary mitral regurgitation (SMR) in
the COAPT (Cardiovascular Outcomes Assessment of the MitraClip
Percutaneous Therapy for Heart Failure Patients with Functional Mitral
Regurgitation) trial. Background(s): In the COAPT trial, patients
with heart failure (HF) and severe SMR who remained symptomatic despite
guideline-directed medical therapy had marked 2-year reductions in
mortality and HF hospitalizations after treatment with MitraClip.
 Method(s): MitraClip-treated patients were divided into quartiles (Q)
based on discharge echocardiographic MVG (n = 250). Endpoints including
all-cause mortality, HF hospitalization, and health status measures at 2
years were compared between quartiles. Result(s): Mean MVG after
MitraClip was 2.1 +/- 0.4 mm Hg, 3.0 +/- 0.2 mm Hg, 4.2 +/- 0.5 mm Hg, and
7.2 +/- 2.0 mm Hg in Q1 (n = 63), Q2 (n = 61), Q3 (n = 62), and Q4 (n =
64), respectively. There was no difference across quartiles in the 2-year
composite endpoint of all-cause mortality or HF hospitalization (43.2%,
49.2%, 40.6%, and 40.9%, respectively; p = 0.80), nor in improvements in
New York Heart Association functional class, Kansas City Cardiomyopathy
Questionnaire score, or 6-min walk time. Results were similar after
adjustment for baseline clinical and echocardiographic characteristics,
post-procedure MR grade, and number of clips (all-cause mortality or HF
hospitalization Q4 [44.6%] vs. Q1 to Q3 [40.3%]; adjusted hazard ratio:
1.23, 95% confidence interval: 0.60 to 2.51; p = 0.57).
 Conclusion(s): Among HF patients with severe SMR, higher MVGs on
discharge did not adversely affect clinical outcomes following MitraClip.
These findings suggest that in select patients with HF and SMR otherwise
meeting the COAPT inclusion criteria, the benefits of MR reduction may
outweigh the effects of mild-to-moderate mitral stenosis after
MitraClip. Copyright © 2021 American College of Cardiology
Foundation

<33>
Accession Number
2004671110
Title
Network Analysis of Outcomes in Patients Undergoing Transcatheter Aortic
Valve Replacement for Stenotic Bicuspid Aortic Valves According to Valve
Type.
Source
Cardiovascular Revascularization Medicine. 21 (9) (pp 1076-1085), 2020.
Date of Publication: September 2020.
Author
Quintana R.A.; Monlezun D.; Davogustto G.; Saenz H.; Lugo Baruqui D.;
Denktas A.E.; Jneid H.; Paniagua D.
Institution
(Quintana) Andreas Gruentzig Cardiovascular Center, Division of
Cardiology, Department of Medicine, Emory University School of Medicine,
Atlanta, GA, United States
(Monlezun) Department of Internal Medicine, McGovern Medical School,
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Davogustto) Division of Cardiology, Department of Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
(Saenz) Division of Geriatrics, Department of Internal Medicine,
University of California San Diego, San Diego, CA, United States
(Lugo Baruqui) Department of Internal Medicine, Mount Sinai Medical
Center, Miami, FL, United States
(Denktas, Jneid, Paniagua) Division of Cardiology, Department of Medicine,
Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: It is currently unknown if outcomes after transcatheter aortic
valve replacement (TAVR) differ according to the prosthetic valve deployed
in patients with bicuspid aortic valves (BAV). Objective(s): This
study evaluated valve-specific outcomes post-TAVR in patients with BAV.
 Method(s): Literature search was performed using the Cochrane
databases, PubMed, ClinicalTrials, SCOPUS and EMBASE databases from
inception until July 2018. We computed risk ratios and their 95%
confidence intervals for all outcomes of interest. For each outcome, the
data were pooled using a multivariate random-effects meta-analysis
including multiple treatment as well as direct and indirect comparisons.
 Result(s): Ten studies enrolling a total of 1547 BAV patients
undergoing TAVR using 6 different prosthetic valve types were analyzed.
There were no significant differences in 30-day all-cause mortality,
life-threatening bleeding and device success among the diverse prosthetic
valve types implanted. However, 2nd generation balloon-expandable valves
had consistently lower risk of moderate-to-severe prosthetic valve
regurgitation. Conclusion(s): In patients with BAV, there were no
significant differences in 30-day all-cause mortality after TAVR among the
various prosthetic valve types. Copyright © 2020 Elsevier Inc.

<34>
Accession Number
2010098341
Title
Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left
Bundle Branch Block After Transcatheter Aortic Valve Replacement.
Source
Cardiovascular Revascularization Medicine. 21 (10) (pp 1299-1304), 2020.
Date of Publication: October 2020.
Author
Megaly M.; Abraham B.; Abdelsalam M.; Saad M.; Omer M.; Elbadawi A.;
Mentias A.; Narayanan M.A.; Gafoor S.; Brilakis E.S.; Goessl M.;
Cavalcante J.L.; Garcia S.; Kapadia S.; Pershad A.; Sorajja P.; Sengupta
J.
Institution
(Megaly, Omer, Brilakis, Goessl, Cavalcante, Garcia, Sorajja, Sengupta)
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis,
MN, United States
(Megaly, Omer, Goessl, Cavalcante, Garcia, Sorajja) Valve Science Center,
Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
(Megaly, Omer) Division of Cardiovascular Medicine, Hennepin Healthcare,
Minneapolis, MN, United States
(Abraham) Division of Internal Medicine, Ascension St. John Hospital,
Detroit, MI, United States
(Abdelsalam) Division of Internal Medicine, Temple University/Conemaugh
Memorial Medical Center, Johnstown, PA, United States
(Saad) Division of Cardiovascular Medicine, The Warren Alpert School of
Medicine at Brown University, Providence, RI, United States
(Saad) Division of Cardiology, Ain Shams University, Cairo, Egypt
(Elbadawi) Division of Cardiology, University of Texas Medical Branch,
Galveston, TX, United States
(Mentias) Division of Cardiovascular Medicine, Roy and Lucille J. Carver
College of Medicine, University of Iowa Hospitals and Clinics, Iowa City,
IA, United States
(Narayanan) Division of Vascular Medicine, Yale-New Haven Hospital, New
Haven, CT, United States
(Gafoor) Heart and Vascular Institute, Swedish Medical Centre, Seattle,
WA, United States
(Kapadia) Division of Cardiology, Cleveland Clinic Foundation, Cleveland,
OH, United States
(Pershad) Division of Cardiology, Banner University Medical Center,
Phoenix, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: The impact of new-onset persistent left bundle branch block
(LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause
mortality has been controversial. Method(s): We conducted a
systematic review and meta-analysis of eleven studies (7398 patients)
comparing the short- and long- outcomes in patients who had new-onset LBBB
after TAVR vs. those who did not. Result(s): During a mean follow-up
of 20.5 +/- 14 months, patients who had new-onset persistent LBBB after
TAVR had a higher incidence of all-cause mortality (29.7% vs. 23.6%; OR
1.28 (1.04-1.58), p = 0.02), rehospitalization for heart failure (HF)
(19.5% vs. 17.3%; OR 1.4 (1.13-1.73), p = 0.002), and permanent pacemaker
implantation (PPMi) (19.7% vs. 7.1%; OR 2.4 (1.64-3.52), p < 0.001)
compared with those who did not. Five studies (4180 patients) reported
adjusted hazard ratios (HR) for all-cause mortality; new LBBB remained
associated with a higher risk of mortality (adjusted HR 1.43 (1.08-1.9), p
< 0.01, I2 = 81%). Conclusion(s): Post-TAVR persistent
LBBB is associated with higher PPMi, HF hospitalizations, and all-cause
mortality. While efforts to identify patients who need post-procedural
PPMi are warranted, more studies are required to evaluate the best
follow-up and treatment strategies, including the type of pacing device if
required, to improve long-term outcomes in these patients. Copyright
© 2020 Elsevier Inc.

<35>
Accession Number
2010777994
Title
Effects of Bariatric Surgery on Heart Rhythm Disorders: a Systematic
Review and Meta-Analysis.
Source
Obesity Surgery. 31 (5) (pp 2278-2290), 2021. Date of Publication: May
2021.
Author
Sanches E.E.; Topal B.; de Jongh F.W.; Cagiltay E.; Celik A.; Sundbom M.;
Ribeiro R.; Parmar C.; Ugale S.; Mahawar K.; Buise M.P.; Dekker L.R.;
Ramnarain D.; Pouwels S.
Institution
(Sanches) Department of Surgery, Haaglanden Medical Center, The Hague,
Netherlands
(Topal) Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(de Jongh) Department of Plastic Surgery, Haaglanden Medical Center, The
Hague, Netherlands
(Cagiltay) Department of Endocrinology and Metabolic Diseases, University
of Health Sciences Turkey, Sultan Abdulhamid Han Education and Research
Hospital, Istanbul, Turkey
(Celik) Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
(Sundbom) Department of Surgical Sciences, Uppsala University, Uppsala,
Sweden
(Ribeiro) Centro Multidisciplinar da Doenca Metabolica, Clinica de Santo
Antonio, Reboleira, Lisbon, Portugal
(Parmar) Department of Surgery, Whittington Hospital, London, United
Kingdom
(Ugale) Bariatric & Metabolic Surgery Clinic, Virinchi Hospitals,
Hyderabad, India
(Mahawar) Bariatric Unit, Sunderland Royal Hospital, Sunderland, United
Kingdom
(Buise) Department of Anesthesiology, Intensive Care and Pain Medicine,
Catharina Hospital, Eindhoven, Netherlands
(Dekker) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Ramnarain, Pouwels) Department of Intensive Care Medicine,
Elisabeth-Tweesteden Hospital, P.O. Box 9051, Tilburg 5000 LC, Netherlands
Publisher
Springer
Abstract
The aim of this systematic review is to provide an overview of the
literature on the effects of bariatric surgery on obesity-associated
electrocardiogram (ECG) abnormalities and cardiac arrhythmias. Fourteen
studies were included with a methodological quality ranging from poor to
good. Majority of the studies showed a significant decrease of QT interval
and related measures after bariatric surgery. Seven studies were included
in the meta-analysis on effects of bariatric surgery on QTc interval and a
significant decrease in QTc interval of - 33.6 ms, 95%CI [- 49.8 to -
17.4] was seen. Bariatric surgery results in significant decrease in QTc
interval and P-wave dispersion, i.e., a normalization of initial
pathology. The effects on atrial fibrillation are conflicting and not yet
fully understood. Graphical abstract: [Figure not available: see
fulltext.] Copyright © 2021, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<36>
Accession Number
2007397634
Title
Percutaneous balloon mitral valvotomy during pregnancy: A systematic
review and meta-analysis.
Source
Acta Obstetricia et Gynecologica Scandinavica. 100 (4) (pp 666-675), 2021.
Date of Publication: April 2021.
Author
Sreerama D.; Surana M.; Moolchandani K.; Chaturvedula L.; Keepanasseril
A.; Pillai A.A.; Nair N.S.
Institution
(Sreerama, Surana, Moolchandani, Chaturvedula, Keepanasseril) Department
of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical
Education & Research (JIPMER), Puducherry, India
(Keepanasseril) School of Dentistry, Amrita Institute of Medical Sciences,
Kochi, India
(Keepanasseril) Department of Medicine, McMaster University, Hamilton,
Canada
(Pillai) Department of Cardiology, Jawaharlal Institute of Postgraduate
Medical Education & Research (JIPMER), Puducherry, India
(Nair) Biostatistics, Jawaharlal Institute of Postgraduate Medical
Education & Research (JIPMER), Puducherry, India
Publisher
John Wiley and Sons Inc
Abstract
Introduction: The objective of this study was to systematically review the
maternal and fetal outcomes in pregnant women who underwent percutaneous
balloon mitral valvuloplasty (PBMV) during pregnancy. Material(s) and
Method(s): A search was conducted on MEDLINE and Embase databases to
identify studies published between 2000 and 2018 that reported on maternal
and fetal outcomes following PBMV performed in pregnancy. Randomized
controlled trials, cohort studies, case-control studies, cross-sectional
studies and case series with four or more pregnancies in which PBMV was
performed during pregnancy were included. Reference lists from relevant
articles were also hand-searched for relevant citations. A successful
procedure was defined as one where there was a reported improvement in the
valve area or reduction in the mitral valve gradient. A random effects
model was used to derive pooled estimates of various outcomes and the
final estimates were reported as percentages with a 95% confidence
interval (95% CI). Result(s): Twenty-one observational studies
reporting 745 pregnancies were included in the review, all of them having
reported outcomes without a comparison group. Most of the studies fell
into the low-risk category as determined using the Joanna Briggs Institute
(JBI) critical appraisal checklist for case series. Most of the studies
(86%) were reported from low- to middle-income countries and PBMV was
mostly performed during the second trimester of pregnancy. Forty-three
procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported
among women with the severe subvalve disease (Wilkins subvalve score 3 or
more). There were 11 maternal deaths among those with suboptimal valve
anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation
was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%),
followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of
cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95%
CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4%
(95% CI 0.2%-14.7%). Conclusion(s): PBMV may be an effective and safe
procedure for optimizing outcomes in pregnant women with mitral stenosis
in the absence of severe subvalve disease. Copyright © 2020
Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
Published by John Wiley & Sons Ltd

<37>
Accession Number
2006953192
Title
Perspectives of Surgeons from Atlanta, USA.
Source
Journal of Cardiac Surgery. 36 (5) (pp 1693-1695), 2021. Date of
Publication: May 2021.
Author
Mohamed Ahmed E.; Chen E.P.
Institution
(Mohamed Ahmed, Chen) Division of Cardiothoracic Surgery, Department of
Surgery, Emory School of Medicine, Atlanta, GA, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: The COVID-19 pandemic in late 2019 quickly stretched health
care system across the globe. Mortalities, shortages in health care system
capacity, and lack of experience in similar circumstances required
innovation in the way health care is delivered. Health care systems
changed operating schedules, staff work pattern, and how patients are
cared for. The effects of these changes reached patients, staff and
training in different ways. Method(s): We searched the Pubmed and
EMBASE for articles related to COVID-19. We also searched local emails and
information provided to staff during the pandemic. Result(s): The
COVID-19 pandemic affected organizations, patients, and staff. The
organizations and staff had to adapt to the times to provide a safe and
appropriate service to our patients. Conclusion(s): The pandemic
challenged and changed the way we work as health care providers, and how
we train the future surgeons. Changes in the system were
effective. Copyright © 2020 Wiley Periodicals LLC

<38>
Accession Number
2006821220
Title
Acute aortic dissection during pregnancy: Trials and tribulations.
Source
Journal of Cardiac Surgery. 36 (5) (pp 1799-1805), 2021. Date of
Publication: May 2021.
Author
Rimmer L.; Heyward-Chaplin J.; South M.; Gouda M.; Bashir M.
Institution
(Rimmer, Heyward-Chaplin, South, Bashir) Vascular Surgery Department,
Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United
Kingdom
(Gouda) Department of Vascular and Endovascular Surgery, Mataria Teaching
Hospital, Cairo, Egypt
Publisher
Blackwell Publishing Inc.
Abstract
Background: Type A acute aortic dissection (TAAD) during pregnancy is a
life-threatening event for both the mother and the unborn baby. Pregnancy
has been recognized as an independent risk factor for TAAD, postulated to
be due to physiological changes that cause hyperdynamic circulation. This
review seeks to outline the current controversies around this unique
group. Method(s): A comprehensive literature search was carried out
across large databases to assimilate relevant papers regarding acute
aortic dissection in pregnant women. Result(s): The presentation can
be atypical in many cases and further concern from clinicians of fetal
radiation exposure can result in missed or delayed diagnoses.
Investigation via the quickest form of imaging, whether computed
tomography, magnetic resonance imaging, or transesophageal
echocardiography, should be carried out promptly due to the high risk of
mortality. Surgical management of TAAD in pregnancy revolves primarily
around the decision to deliver the fetus concomitantly or to perform the
aortic repair with the fetus in utero. Conclusion(s): Management of
this group includes rapid and dynamic assessment without delay. From
conception to postpartum, there are multiple stages in which to manage
these women. Challenges in carrying out management in the form of
operative techniques and cardiopulmonary bypass place the fetus at risk
and must be approached with caution, particularly as there is little
evidence-base for many of these decisions. Further research into reducing
maternal and fetal mortality is necessary. Copyright © 2020 Wiley
Periodicals LLC

<39>
Accession Number
2005781340
Title
Normoxic management of cardiopulmonary bypass reduces myocardial oxidative
stress in adult patients undergoing coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). 36 (3) (pp 261-268), 2021. Date of
Publication: April 2021.
Author
Topcu A.C.; Bolukcu A.; Ozeren K.; Kavasoglu T.; Kayacioglu I.
Institution
(Topcu, Bolukcu, Ozeren, Kayacioglu) Department of Cardiovascular Surgery,
Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research
Hospital, Istanbul, Turkey
(Kavasoglu) Department of Anesthesiology and Reanimation, Dr. Siyami Ersek
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Publisher
SAGE Publications Ltd
Abstract
Introduction: We aimed to investigate whether normoxic cardiopulmonary
bypass would limit myocardial oxidative stress in adults undergoing
coronary artery bypass grafting. Method(s): Patients scheduled to
undergo elective isolated on-pump coronary artery bypass grafting were
randomized to normoxia and hyperoxia groups. The normoxia group received
35% oxygen during anesthetic induction, 35% during hypothermic bypass, and
45% during rewarming. The hyperoxia group received 70%, 50%, and 70%
oxygen, respectively. Coronary sinus blood samples were taken prior to
initiation of cardiopulmonary bypass and after reperfusion for myocardial
total oxidant and antioxidant status measurements. The primary endpoint
was myocardial total oxidant status. Secondary endpoints were myocardial
total antioxidant status and length of intensive care unit and hospital
stay. Result(s): Forty-eight patients were included. Twenty-two
received normoxic management. Mean +/- standard deviation of age was 58
+/- 9.07 years. Groups were balanced in terms of demographics, risk
factors, and operative data. Myocardial total oxidant status was
significantly lower in the normoxia group following reperfusion (p =
0.03). There was no statistically significant difference regarding
myocardial total antioxidant status and length of intensive care unit and
hospital stay (p = 0.08, p = 0.82, and p = 0.54, respectively).
 Conclusion(s): Normoxic cardiopulmonary bypass is associated with
reduced myocardial oxidative stress compared to hyperoxic cardiopulmonary
bypass in adult coronary artery bypass patients. Copyright © The
Author(s) 2020.

<40>
Accession Number
633530666
Title
Reduction in acute kidney injury post cardiac surgery using balanced
forced diuresis: a randomized, controlled trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 59 (3) (pp 562-569),
2021. Date of Publication: 13 Apr 2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Cardiothoracic Surgeon, American Hospital, Dubai, United Arab
Emirates
(Giri) Cardiothoracic Anaesthesiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Wrigley) Interventional Cardiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Specialist Registrar Cardiothoracic Surgery, Heart
and Lung Centre, Wolverhampton, United Kingdom
(Sharman) Research and Development Department, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Beare) Senior Clinical Perfusionist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nevill) Statistics, Faculty of Education, Health and Wellbeing,
University of Wolverhampton, Wolverhampton, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Our goal was to investigate the efficacy of balanced forced
diuresis in reducing the rate of acute kidney injury (AKI) in cardiac
surgical patients requiring cardiopulmonary bypass (CPB), using the
RenalGuard (RG) system. METHOD(S): Patients at risk of developing AKI
(history of diabetes and/or anaemia; estimated glomerular filtration rate
20-60ml/min/1.73 m2; anticipated CPB time >120min; log EuroSCORE > 5) were
randomized to the RG system group (n=110) or managed according to current
practice (control = 110). The primary end point was the development of AKI
within the first 3 postoperative days as defined by the RIFLE (Risk,
Injury, Failure, Loss of kidney function, End-stage renal disease)
criteria. RESULT(S): There were no significant differences in
preoperative and intraoperative characteristics between the 2 groups.
Postoperative AKI rates were significantly lower in the RG system group
compared to the control group [10% (11/110) vs 20.9% (23/110); P=0.025].
This effect persisted even after controlling for a number of potential
confounders (odds ratio 2.82, 95% confidence interval 1.20-6.60; P=0.017)
when assessed by binary logistic regression analysis. The mean volumes of
urine produced during surgery and within the first 24h postoperatively
were significantly higher in the RG system group (P<0.001). There were no
significant differences in the incidence of blood transfusions, atrial
fibrillation and infections and in the median duration of intensive care
unit stays between the groups. The number needed to treat with the RG
system to prevent AKI was 9 patients (95% confidence interval 6.0-19.2).
 CONCLUSION(S): In patients at risk for AKI who had cardiac surgery
with CPB, the RS RG system significantly reduced the incidence of AKI and
can be used safely and reproducibly. Larger studies are required to
confirm cost benefits. CLINICAL TRIAL REGISTRATION NUMBER:
NCT02974946. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<41>
Accession Number
2011141904
Title
Advances in Clinical Cardiology 2020: A Summary of Key Clinical Trials.
Source
Advances in Therapy. (no pagination), 2021. Date of Publication: 2021.
Author
Kearney A.; Linden K.; Savage P.; Menown I.B.A.
Institution
(Kearney, Linden, Savage, Menown) Craigavon Cardiac Centre, Southern
Health and Social Care Trust, Craigavon, United Kingdom
Publisher
Adis
Abstract
Introduction: Despite the challenge of a global pandemic, 2020 has been an
invaluable year in cardiology research with numerous important clinical
trials published or presented virtually at major international meetings.
This article aims to summarise these trials and place them in clinical
context. Method(s): The authors reviewed clinical trials presented at
major cardiology conferences during 2020 including the American College of
Cardiology, European Association for Percutaneous Cardiovascular
Interventions, European Society of Cardiology, Transcatheter
Cardiovascular Therapeutics and the American Heart Association. Trials
with a broad relevance to the cardiology community and those with
potential to change current practice were included. Result(s): A
total of 87 key cardiology clinical trials were identified for inclusion.
New interventional and structural cardiology data included trials
evaluating bifurcation percutaneous coronary intervention (PCI)
techniques, intravascular ultrasound (IVUS)-guided PCI, instantaneous
wave-free (iFR) physiological assessment, new generation stents (DynamX
bioadaptor), transcatheter aortic valve implantation (TAVI) in low-risk
patients, and percutaneous mitral or tricuspid valve interventions.
Preventative cardiology data included new data with proprotein convertase
subtilisin-kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab),
omega-3 supplements, evinacumab and colchicine in the setting of chronic
coronary artery disease. Antiplatelet data included trials evaluating both
the optimal length of course following PCI and combination of antiplatelet
agents and regimes including combination antithrombotic therapies for
patients with atrial fibrillation (AF). Heart failure data included the
use of sodium-glucose cotransporter 2 (SGLT2) inhibitors (sotagliflozin,
empagliflozin and dapagliflozin) and mavacamten in hypertrophic
cardiomyopathy. Electrophysiology trials included early rhythm control in
AF and screening for AF. Conclusion(s): This article presents a
summary of key clinical cardiology trials during the past year and should
be of relevance to both clinicians and cardiology
researchers. Copyright © 2021, Crown.

<42>
Accession Number
634797311
Title
Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in
Heart Failure Patients with Secondary Mitral Regurgitation: The COAPT
Trial.
Source
Journal of the American Society of Echocardiography : official publication
of the American Society of Echocardiography. (no pagination), 2021. Date
of Publication: 09 Apr 2021.
Author
Medvedofsky D.; Pio S.M.; Weissman N.J.; Namazi F.; Delgado V.; Grayburn
P.A.; Kar S.; Lim D.S.; Lerakis S.; Zhou Z.; Liu M.; Alu M.C.; Kapadia
S.R.; Lindenfeld J.; Abraham W.T.; Mack M.J.; Bax J.J.; Stone G.W.; Asch
F.M.
Institution
(Medvedofsky) Medstar Health Research Institute, DC, WA
(Pio, Namazi, Delgado, Bax) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
(Weissman, Asch) Medstar Health Research Institute, Washington, DC;
Georgetown University, Washington, DC
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, TX, Dallas, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA; Bakersfield
Heart Hospital, Bakersfield, CA
(Lim) Division of Cardiology, University of Virginia, VA, Charlottesville,
United States
(Lerakis) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, NY, NY
(Zhou, Liu, Alu) Clinical Trials Center, Cardiovascular Research
Foundation, NY, NY
(Kapadia) Cleveland Clinic, Cleveland, OH
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, TN, Nashville, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University
Medical Center, Columbus, OH
(Mack) Baylor Scott & White Health, TX, Plano, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY; Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY
Publisher
NLM (Medline)
Abstract
BACKGROUND: Left ventricular (LV) global longitudinal strain (GLS) is a
sensitive marker of LV function and may help identify patients with heart
failure (HF) and secondary mitral regurgitation (SMR) who would have a
better prognosis and are more likely to benefit from edge-to-edge
transcatheter mitral valve repair (TMVr) with the MitraClip. We sought to
assess the prognostic utility of baseline LVGLS during 2-year follow-up of
HF patients with SMR enrolled in the COAPT trial. METHOD(S):
Symptomatic HF patients with moderate-to-severe or severe SMR who remained
symptomatic despite maximally-tolerated guideline directed medical therapy
(GDMT) were randomized to TMVr plus GDMT or GDMT alone. Speckle
tracking-derived LVGLS from baseline echocardiograms was obtained in 565
patients and categorized by tertiles. Death and HF hospitalization (HFH)
at 2-year follow-up were the principal outcomes of interest.
 RESULT(S): Patients with better baseline LVGLS had higher blood
pressure, greater LV ejection fraction and stroke volume, lower levels of
B-type natriuretic peptide and smaller LV size. No significant difference
in outcomes at 2-year follow-up were noted according to LVGLS. However,
the rate of death or HFH between 10 and 24 months was lower in patients
with better LVGLS (p=0.03), with no differences before 10 months. There
was no interaction between GLS tertiles and treatment group with respect
to 2-year clinical outcomes. CONCLUSION(S): Baseline LVGLS did not
predict death or HFH throughout 2-year follow-up, but it did predict
outcomes after 10 months. The benefit of TMVr over GDMT alone was
consistent in all sub-groups irrespective of baseline LVGLS. Copyright
© 2021. Published by Elsevier Inc.

<43>
[Use Link to view the full text]
Accession Number
634795606
Title
Assessing Left Ventricular Early Diastolic Velocities with Tissue Doppler
and Speckle Tracking by Transesophageal and Transthoracic
Echocardiography.
Source
Anesthesia and Analgesia. (pp 1400-1409), 2021. Date of Publication: 2021.
Author
Mauermann E.; Bouchez S.; Bove T.; Vandenheuvel M.; Wouters P.
Institution
(Mauermann, Bouchez, Vandenheuvel, Wouters) Department of Anesthesiology
and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
(Mauermann) Department for Anesthesia, Surgical Intensive Care,
Prehospital Emergency Medicine and Pain Therapy, Basel University
Hospital, Basel, Switzerland
(Bove) Department of Cardiac Surgery, Ghent University Hospital, Ghent,
Belgium
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Assessing diastolic dysfunction is essential and should be
part of every routine echocardiography examination. However, clinicians
routinely observe lower mitral annular velocities by transesophageal
echocardiography (TEE) under anesthesia than described by awake
transthoracic echocardiography (TTE). It would be important to know
whether this difference persists under constant loading conditions. We
hypothesized that mean early diastolic mitral annular velocity, measured
by tissue Doppler imaging (TDI,) would be different in the midesophageal
4-chamber (ME 4Ch) than in the apical 4-chamber (AP 4Ch) view under
unchanged or constant loading conditions. Secondarily we examined (1) in
an alternative transesophageal view with presumed superior Doppler beam
alignment, the deep transgastric view (DTG), compared to those in the AP
4Ch, and (2) early diastolic speckle tracking-based strain rate (), in the
ME 4Ch and in the AP 4Ch. METHOD(S): Twenty-five consecutive adult
patients undergoing on-pump cardiac surgery from February 2017 to July
2017 were included. Both TTE and TEE measurements were obtained under
anesthesia in a randomized order in the AP 4Ch, ME 4Ch, and DTG views.
Within-patient average values were compared by paired t tests with a
Bonferroni adjustment. Box plots, correlation, and agreement by
Bland-Altman were examined for all 3 comparisons. A second
echocardiographer independently acquired and analyzed images; images were
reanalyzed after 4 weeks. Image quality and reproducibility were also
reported. RESULT(S): Averaged measurements were lower in the ME 4Ch
than in the AP 4Ch (6.6 +/- 1.7 cm/s vs 7.0 +/- 1.5 cm, P =.028;
within-patient difference mean +/- standard deviation: 0.6 +/- 1.2 cm/s).
An alternative TEE view for, the DTG, also exhibited lower mean values
(6.0 +/- 1.6 cm/s, P =.006; within-patient difference mean +/- standard
deviation: 1.1 +/- 1.8 cm/s). strain rate showed a low degree of bias, but
greater variability (ME 4Ch: 0.87 +/- 0.32%/s vs AP 4Ch: 0.73 +/- 0.18%/s,
P =.078; within-patient difference mean +/- standard deviation: -0.1 +/-
0.2%/s). CONCLUSION(S): This study confirms that TEE modestly
underestimates but not to a clinically relevant extent. While in the DTG
is not a promising alternative, the future role for speckle tracking-based
early diastolic strain rate is unknown. Copyright © 2022 American
Society of Mechanical Engineers (ASME). All rights reserved.

<44>
[Use Link to view the full text]
Accession Number
634780675
Title
A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff
Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A
Prospective Randomized Controlled Study.
Source
Anesthesia and Analgesia. (pp 827-835), 2021. Date of Publication: 2021.
Author
Yamada Y.; Tanabe K.; Nagase K.; Ishihara T.; Iida H.
Institution
(Yamada, Tanabe, Nagase, Iida) Department of Anesthesiology and Pain
Medicine, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu
501-1194, Japan
(Ishihara) Gifu University Hospital Innovative, Clinical Research
Promotion Center, Gifu University, Gifu, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Double-lumen endobronchial tubes (DLTs) are used for one-lung
ventilation (OLV) during thoracic surgery. Overinflation into the
bronchial cuff causes damage to the tracheobronchial mucosa, whereas
underinflation leads to an incomplete collapse of the nonventilated lung
or incomplete ventilation of the ventilated lung. However, how to
determine the appropriate bronchial cuff volume and pressure during OLV is
unclear. The objective of this study is to compare the required bronchial
cuff volume for lung separation obtained by 2 different cuff inflation
methods under closed- and open-chest conditions. METHOD(S): A total
of 64 patients scheduled to undergo elective thoracic surgery requiring
OLV were recruited. Left DLTs were used for both right- and left-sided
surgery. The patients were randomly assigned to 1 of 2 inflation-type
groups to estimate the bronchial cuff volume. In the capnogram
waveform-guided bronchial cuff inflation group (capno group, n = 27), the
bronchial cuff was inflated until a capnometer sampling gas containing
CO2from the nonventilated lung displayed a flat line. The
corresponding bronchial cuff volume and pressure were then recorded. In
the pressure-guided bronchial cuff inflation group (pressure group, n =
29), the bronchial cuff was inflated by a cuff inflator to a pressure of
20 cm H<inf>2</inf>O. Lung separation was confirmed when a flat line of a
capnometer was observed after gas sampling from the nonventilated lung.
 RESULT(S): Under closed-chest conditions, the bronchial cuff sealing
volume for the capno group was significantly lower than that for the
pressure group (mean [standard deviation {SD}], 1.00 [0.65] mL vs 1.44
[0.59] mL, mean difference, -0.44; 97.5% confidence interval [CI], -0.78
to -0.11; P =.010). Under open-chest conditions, the bronchial cuff
sealing volume for the capno group was also significantly lower than that
for the pressure group (mean [SD], 0.65 [0.66] mL vs 1.22 [0.45] mL, mean
difference, -0.58; 97.5% CI, -0.88 to -0.27; P <.001). CONCLUSION(S):
The lowest cuff volume providing an air-tight bronchial seal was obtained
by the capnogram waveform-guided bronchial cuff inflation method. Since
the cuff volume required to achieve an air-tight seal decreases after
opening the chest, readjustment of the bronchial cuff volume to prevent
bronchial cuff damage to the tracheobronchial mucosa after opening the
chest may be advisable. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<45>
Accession Number
2011030719
Title
Closure or medical therapy of patent foramen ovale in cryptogenic stroke:
prospective case series.
Source
Neurological Research and Practice. 3 (1) (no pagination), 2021. Article
Number: 16. Date of Publication: December 2021.
Author
Poli S.; Siebert E.; Mbroh J.; Poli K.; Krumbholz M.; Mengel A.; Greulich
S.; Hartig F.; Muller K.A.L.; Bocksch W.; Gawaz M.; Ziemann U.; Zuern C.S.
Institution
(Poli, Mbroh, Poli, Krumbholz, Mengel, Hartig, Ziemann, Zuern) Department
of Neurology & Stroke, Eberhard-Karls University, Hoppe-Seyler-Str. 3,
Tubingen 72076, Germany
(Poli, Mbroh, Poli, Krumbholz, Mengel, Hartig, Ziemann) Hertie Institute
for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
(Siebert, Greulich, Muller, Bocksch, Gawaz, Zuern) Department of
Cardiology, Eberhard-Karls University, Tuebingen, Germany
(Zuern) Cardiology Division, Department of Medicine, University Hospital,
and Cardiovascular Research Institute, Basel, Switzerland
Publisher
BioMed Central Ltd
Abstract
Background: Results of randomized controlled trials (RCT) do not provide
definite guidance for secondary prevention after ischemic stroke
(IS)/transient ischemic attack (TIA) attributed to patent foramen ovale
(PFO). No recommendations can be made for patients > 60 years. We aimed to
compare interventional and medical PFO-management in cryptogenic IS/TIA
patients, including patients > 60 years. Method(s): Prospective case
series including consecutive cryptogenic IS/TIA patients with PFO at
Tuebingen university stroke unit, Germany. 'PFO-closure' was recommended
in patients <=70 years when featuring high-risk PFO (i.e., with atrial
septal aneurysm, spontaneous, or high-grade right-to-left shunt during
Valsalva). Primary (recurrent IS/intracranial hemorrhage) and secondary
endpoints (e.g., disability) were assessed during >=1-year follow-up;
planned subgroup analyses of patients <=60/> 60 years. Result(s):
Among 236 patients with median age of 58 (range 18-88) years, 38.6% were
females and median presenting National Institutes of Health Stroke Scale
score was 1 (IQR 0-4). Mean follow-up was 2.8 +/- 1.3 years. No
intracranial hemorrhage was observed. Recurrent IS rate after
'PFO-closure' was 2.9% (95%CI 0-6.8%) and 7% (4-16.4) in high-risk PFO
patients <=60 (n = 103) and > 60 years (n = 43), respectively, versus 4%
(0-11.5) during 'medical therapy alone' MTA (n = 28). 42 low-risk PFO
patients treated with MTA experienced no recurrent IS/TIA.
 Conclusion(s): In our real-world study, IS recurrence rate in
'PFO-closure' high-risk PFO patients <=60 years was comparable to that
observed in recent RCT. High-risk PFO patients > 60 years who underwent
PFO-closure had similar IS recurrence rates than those who received MTA.
MTA seems the appropriate treatment for low-risk PFO. Trial registration:
ClinicalTrials.gov, registration number: NCT04352790, registered on: April
20, 2020 - retrospectively registered. Copyright © 2021, The
Author(s).

<46>
Accession Number
2006013888
Title
Intravascular Imaging to Guide Lithotripsy in Concentric and Eccentric
Calcific Coronary Lesions.
Source
Cardiovascular Revascularization Medicine. 21 (9) (pp 1099-1105), 2020.
Date of Publication: September 2020.
Author
Mattesini A.; Nardi G.; Martellini A.; Sorini Dini C.; Hamiti B.; Stolcova
M.; Meucci F.; Di Mario C.
Institution
(Mattesini, Nardi, Martellini, Sorini Dini, Hamiti, Stolcova, Meucci, Di
Mario) Structural Interventional Cardiology, Careggi University Hospital,
Florence, Italy
Publisher
Elsevier Inc.
Abstract
Background: Calcified coronary lesions still represent a challenge for
coronary angioplasty, with sub-optimal acute PCI results causing more
frequent late stent failure. Purpose(s): The study aimed at the
evaluation of the immediate procedural outcome in a real-world consecutive
population of a selective use of lithotripsy based on the intravascular
imaging assessment with IVUS or OCT. Methods and Results: Thirty-one
calcified stenoses (28 patients) out of a total of 455 lesions (370
patients) treated between November 2018 and May 2019 received IVL under
intravascular imaging guidance. The majority of the IVL lesions had
angiographically severe calcifications and were selected after
intravascular imaging. A smaller group was identified by poor expansion
after high-pressure balloon dilatation, in one case despite preliminary
small burr Rotablation. After IVL, when OCT was performed calcium
fractures were observed in 71% of cases. After OCT/IVUS guided stent
optimization a satisfactory lumen enlargement (minimal stent area 7.09 +/-
2.77 mm2) was observed with good stent expansion (residual area
stenosis<20% in 29 lesions, 93.5%) Peri-procedural complications were
limited to one dissection at the distal edge requiring an additional stent
and 3 peri-procedural myocardial infarctions. There were no periprocedural
coronary perforations or pericardial effusions, and no in-hospital or 30
days stent thrombosis. When patients were divided into two subgroups
according to a calcium arc <=180degree (Group A: 10 lesions, calcium arc
140 +/- 24degree; Group B: 21 lesions, calcium arc 289 +/- 53degree), at
OCT Group B presented also a higher number of calcium fractures post IVL
than group A (group A: 38% vs group B: 92%, p = 0.03). The in-stent
minimum lumen diameter (MSD), the in stent minimal lumen area (MSA) and
the acute gain, however, were similar between the two groups (acute gain
group A: 1.22 +/- 0.29 mm; group B: 1.31 +/- 0.52 mm, p = 0.63).
 Conclusion(s): A standardized algorithm applying intravascular
imaging guidance of IVL facilitated second generation DES expansion
delivers excellent immediate lumen expansion and patient outcome, both in
concentric and eccentric calcifications. Copyright © 2020

<47>
Accession Number
2007013479
Title
The effects of monocusp valve implantation and transannular patch
angioplasty on pulmonary regurgitation and right ventricular failure after
total correction of tetralogy of fallot.
Source
Biomedical Research and Therapy. 7 (5) (pp 3799-3806), 2020. Date of
Publication: 26 May 2020.
Author
Samadi M.; Khoshfetrat M.; Keykha A.; Javadi S.H.
Institution
(Samadi) Department of Paediatric Cardiology, School of Medicine, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Khoshfetrat) Department of Anaesthesiology and Critical Care,
Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences,
Zahedan, Iran, Islamic Republic of
(Keykha) Department of Nursing, School of Nursing and Midwifery, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Javadi) Department of Paediatrics, School of Medicine, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
Publisher
BiomedPress
Abstract
Background: Pulmonary regurgitation (PR) is often known as an acquired
condition after surgical correction of tetralogy of Fallot (TOF).
Therefore, the present study aimed to compare the use of monocusp valve
(MV) implantation and transannular patch (TAP) angioplasty on PR and right
ventricular (RV) failure following surgery to repair TOF. Method(s):
This prospective randomized clinical trial (RCT) was performed on a total
number of 60 patients undergoing reconstructive surgery on TOF. For this
purpose, TAPs without and with monocusp reconstruction were used in Group
I (n = 30 patients) and Group II (n = 30 patients), respectively. Then,
echocardiographic parameters, mortality rates, and clinical data from
pediatric intensive care unit (PICU) were evaluated during a follow-up
period for both groups. Result(s): Out of the 60 patients undergoing
surgery and evaluated, 39 individuals were male (65%) and the rest were
female (n = 21 patients, 35%). No significant difference was observed in
terms of age, body weight, body surface area (BSA), mortality rate, and
ejection fraction (EF) between the two study groups. The findings revealed
that the number of patients with severe PR was higher in the group
receiving TAP angioplasty. Furthermore, the difference between the two
groups with regards to severity of PR was significant (p = 0.012).
 Conclusion(s): It was concluded that MV reconstruction of TOF is
effective in reducing pulmonary artery (PA) and pulmonary valve (PV)
insufficiency. Copyright © 2020 Biomedpress.

<48>
Accession Number
2011652785
Title
Oxygen delivery-guided perfusion for the prevention of acute kidney
injury: A randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Mukaida H.; Matsushita S.; Yamamoto T.; Minami Y.; Sato G.; Asai T.; Amano
A.
Institution
(Mukaida, Minami, Sato) Department of Clinical Engineering, Juntendo
University Hospital, Tokyo, Japan
(Mukaida, Matsushita, Yamamoto, Asai, Amano) Department of Cardiovascular
Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
Publisher
Mosby Inc.
Abstract
Objectives: The reduction of postoperative acute kidney injury in patients
undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided
perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass
management compared with a fixed flow perfusion (conventional strategy)
remains controversial. The purpose of this study was to determine whether
a oxygen delivery strategy would reduce the incidence of postoperative
acute kidney injury in patients undergoing cardiopulmonary bypass surgery.
 Method(s): We randomly enrolled 300 patients undergoing
cardiopulmonary bypass surgery. Patients were randomly assigned to a
oxygen delivery strategy (maintaining a oxygen delivery index value >300
mL/min/m2 through pump flow adjustments during cardiopulmonary
bypass) or a conventional strategy (a target pump flow was determined on
the basis of the body surface area). The primary end point was the
development of acute kidney injury. Secondary end points were the red
blood cell transfusion rate and number of red blood cell units, intubation
time, postoperative length of stay in the intensive care unit and the
hospital, predischarge estimated glomerular filtration rate, and hospital
mortality. Result(s): Acute kidney injury occurred in 20 patients
(14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%)
receiving the conventional strategy (relative risk, 0.48; 95% confidence
interval, 0.30-0.77; P = .002). The secondary end points were not
significantly different between strategies. In a prespecified subgroup
analysis of patients who had nadir hematocrit less than 23% or body
surface area less than 1.40 m2, the oxygen delivery strategy
seemed to be superior to the conventional strategy and the existence of
quantitative interactions was suggested. Conclusion(s): An oxygen
delivery strategy for cardiopulmonary bypass management was superior to a
conventional strategy with respect to preventing the development of acute
kidney injury. Copyright © 2021 The American Association for
Thoracic Surgery

<49>
Accession Number
2011131007
Title
Incidence, predictors, and outcomes associated with acute kidney injury in
patients undergoing transcatheter aortic valve replacement: from the
BRAVO-3 randomized trial.
Source
Clinical Research in Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Chandrasekhar J.; Sartori S.; Mehran R.; Aquino M.; Vogel B.; Asgar A.W.;
Webb J.G.; Tchetche D.; Dumonteil N.; Colombo A.; Windecker S.; Claessen
B.E.; ten Berg J.M.; Hildick-Smith D.; Wijngaard P.; Lefevre T.;
Deliargyris E.N.; Hengstenberg C.; Anthopoulos P.; Dangas G.D.
Institution
(Chandrasekhar, Sartori, Mehran, Aquino, Vogel, Claessen, Dangas) The Zena
and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine
at Mount Sinai, New York, United States
(Chandrasekhar) Department of Cardiology, Box Hill Hospital, Eastern
Health Clinical School, Monash University, Melbourne, Australia
(Mehran, Dangas) Mount Sinai Medical Center, One Gustave L. Levy Place,
Box 1030, New York, NY 10029, United States
(Asgar) Institut de Cardiologie de Montreal, Montreal, Canada
(Webb) St. Paul's Hospital, Vancouver, Canada
(Tchetche, Dumonteil) Clinic Pasteur of Toulouse, Toulouse, France
(Colombo) San Raffaele Hospital of Milan (IRCCS), Milan, Italy
(Windecker) Bern University Hospital, Bern, Switzerland
(ten Berg) St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Hildick-Smith) Sussex Cardiac Centre, Brighton, United Kingdom
(Wijngaard, Anthopoulos) The Medicines Company, Zurich, Switzerland
(Lefevre) Hopital Prive Jacques Cartier, Massy, France
(Deliargyris) The Medicines Company, Parsippany, NJ, United States
(Hengstenberg) Munich Heart Alliance, Munich, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Acute kidney injury (AKI) is not uncommon in patients
undergoing transcatheter aortic valve replacement (TAVR).
 Objective(s): We examined the incidence, predictors, and outcomes of
AKI from the BRAVO 3 randomized trial. Method(s): The BRAVO-3 trial
included 802 patients undergoing transfemoral TAVR randomized to
bivalirudin vs. unfractionated heparin (UFH). The primary endpoint of the
trial was Bleeding Academic Research Consortium (BARC) type >= 3b bleeding
at 48 h. Total follow-up was to 30 days. AKI was adjudicated using the
modified RIFLE (Valve Academic Research Consortium, VARC 1) criteria
through 30-day follow-up, and in a sensitivity analysis AKI was assessed
at 7 days (modified VARC-2 criteria). We examined the incidence,
predictors, and 30-day outcomes associated with diagnosis of AKI. We also
examined the effect of procedural anticoagulant (bivalirudin or
unfractionated heparin, UFH) on AKI within 48 h after TAVR.
 Result(s): The trial population had a mean age of 82.3 +/- 6.5 years
including 48.8% women with mean EuroScore I 17.05 +/- 10.3%. AKI occurred
in 17.0% during 30-day follow-up and was associated with greater adjusted
risk of 30-day death (13.0% vs. 3.5%, OR 5.84, 95% CI 2.62-12.99) and a
trend for more BARC >= 3b bleeding (15.1% vs. 8.6%, OR 1.80, 95% CI
0.99-3.25). Predictors of 30-day AKI were baseline hemoglobin, body
weight, and pre-existing coronary disease. AKI occurred in 10.7% at 7 days
and was associated with significantly greater risk of 30-day death (OR
6.99, 95% CI 2.85-17.15). Independent predictors of AKI within 7 days
included pre-existing coronary or cerebrovascular disease, chronic kidney
disease (CKD), and transfusion which increased risk, whereas post-dilation
was protective. The incidence of 48-h AKI was higher with bivalirudin
compared to UFH in the intention to treat cohort (10.9% vs. 6.5%, p =
0.03), but not in the per-protocol assessment (10.7% vs. 7.1%, p = 0.08).
 Conclusion(s): In the BRAVO 3 trial, AKI occurred in 17% at 30 days
and in 10.7% at 7 days. AKI was associated with a significantly greater
adjusted risk for 30-day death. Multivariate predictors of AKI at 30 days
included baseline hemoglobin, body weight, and prior coronary artery
disease, and predictors at 7 days included pre-existing vascular disease,
CKD, transfusion, and valve post-dilation. Bivalirudin was associated with
greater AKI within 48 h in the intention to treat but not in the
per-protocol analysis. Graphic abstract: [Figure not available: see
fulltext.] Copyright © 2021, Springer-Verlag GmbH Germany, part
of Springer Nature.

<50>
Accession Number
2011115966
Title
Association between frailty and postoperative delirium: a meta-analysis of
cohort study.
Source
Aging Clinical and Experimental Research. (no pagination), 2021. Date of
Publication: 2021.
Author
Fu D.; Tan X.; Zhang M.; Chen L.; Yang J.
Institution
(Fu, Zhang, Chen, Yang) Intensive Care Unit, Chongqing General Hospital,
University of Chinese Academy of Sciences, No. 118 Xingguang Avenue,
Liangjiang New Area, Chongqing 400010, China
(Tan) Department of Urology, Chongqing University Central Hospital,
Chongqing 400010, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Frailty has been suggested as a possible risk factor for
postoperative delirium (POD). However, results of previous studies were
not consistent. We performed a meta-analysis of cohort study to evaluate
the above association. Method(s): Relevant studies were obtained via
systematic search of PubMed, Embase, SCOPUS, and Web of Science databases.
Only studies with multivariate analysis were included. A random-effect
model incorporating the potential heterogeneity was used to combine the
results. Result(s): Fifteen cohort studies including 3250 adult
patients who underwent surgery were included, and the prevalence of
frailty was 27.1% (880/3250) before surgeries. Overall, POD occurred in
513 patients (15.8%). Pooled results showed that frailty was associated
with a higher risk of POD (adjusted odds ratio [OR]: 3.23, 95% confidence
interval [CI]: 2.56-4.07, P < 0.001) without significant heterogeneity (P
for Cochrane's Q test = 0.25, I2 = 18%). Subgroup analyses
showed a more remarkable association between frailty and POD in
prospective cohort studies (OR: 3.64, 95% CI: 2.95-4.49, P < 0.001) than
that in retrospective cohort studies (OR: 2.32, 95% CI: 1.60-3.35, P <
0.001; P for subgroup difference = 0.04). Moreover, the association was
not affected by country of the study, age group of the patient, elective
or emergency surgeries, cardiac and non-cardiac surgeries, evaluation
instruments for frailty, diagnostic methods for POD, or quality score of
the study (P for subgroup difference all > 0.05). Conclusion(s):
Frailty may be associated with a higher risk of POD in adult
population. Copyright © 2021, The Author(s), under exclusive
licence to Springer Nature Switzerland AG.

<51>
[Use Link to view the full text]
Accession Number
634772874
Title
Pilot randomized controlled trial on early and late remote ischemic
preconditioning prior to complex cardiac surgery in young infants:
Long-term outcomes.
Source
Pediatric Critical Care Medicine. Conference: 10th World Congress of the
World Federation of Pediatric Intensive and Critical Care Societies,
WFPICCS 2020. Virtual. 22 (SUPPL 1) (pp 20), 2021. Date of Publication:
March 2021.
Author
Garcia Guerra G.; Joffe A.; Seal R.; Phillipos E.; Hajihosseini M.; Dinu
I.; Duff J.; Rebeyka I.; Robertson C.
Institution
(Garcia Guerra, Joffe, Phillipos, Duff) University of Alberta, Stollery
Children's Hospital, Pediatrics, Edmonton, Canada
(Seal) University of Alberta, Anesthesia and Pain Medicine, Edmonton,
Canada
(Hajihosseini, Dinu) University of Alberta, School Public Health,
Edmonton, Canada
(Rebeyka) University of Alberta, Surgery, Edmonton, Canada
(Robertson) University of Alberta, Pediatrics, Edmonton, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
AIMS & OBJECTIVES: To demonstrate feasibility of an early and late remote
ischemic preconditioning (RIPC) randomized controlled trial (RCT) and to
obtain information to plan a larger trial on the effect of RIPC on
long-term outcomes of infants after surgery for congenital heart disease
(CHD). METHOD(S): Double-blind, parallel, RCT of RIPC vs. control
(Sham-RIPC) in infants going for surgery for CHD at the Stollery
Children's Hospital between March 2012 and 2014. RIPC was performed 24-48
h preoperatively and immediately prior to cardiopulmonary bypass. RIPC
stimulus was conducted with blood pressure cuffs around the thighs.
Secondary long-terms outcomes were Balyley III and General Adaptive
Composite (GAC) scores at 2 years (Primary/shortterm outcomes have been
published). RESULT(S): Fifty-two patients were randomized but seven
became ineligible after randomization, leaving 45 for inclusion. Survival
at 2 years was: RIPC 19 (86%) vs. Sham 22 (96%), P-value = 0.238. Five
patients (11%) were lost to follow-up before the 2-year assessment (Sham 3
vs. RIPC 2). Bayley III mean (SD) scores were higher for the RIPC vs. Sham
group: Cognitive 98.8 (10.9) vs. 90.7 (13.7), P-value = 0.063; Motor 92.5
(14.2) vs. 87.8 (16.0), P-value = 0.262; Language 92.5 (14.2) vs. 80.9
(19.0), P-value = 0.048. The mean (SD) GAC score was slightly higher in
the RIPC group: 93.5 (14.2) vs. 88.8 (17.4), P-value = 0.381.
 CONCLUSION(S): Our pilot RCT on early and late RIPC in infants with
CHD proved to be feasible but did not find any significant difference in
long-term outcomes. A larger trial may be necessary.

<52>
[Use Link to view the full text]
Accession Number
634772818
Title
Effects of inhaled nitric oxide on hemodynamics and gas exchange in
children after having undergone cardiac surgery utilizing cardiopulmonary
bypass.
Source
Pediatric Critical Care Medicine. Conference: 10th World Congress of the
World Federation of Pediatric Intensive and Critical Care Societies,
WFPICCS 2020. Virtual. 22 (SUPPL 1) (pp 175), 2021. Date of Publication:
March 2021.
Author
Villarreal E.; Flores S.; Loomba R.; Aiello S.
Institution
(Villarreal) Texas Children's Hospital - Baylor College of Medicine,
Cardiac Intensive Care Unit, Section of Critical Care and Cardiology,
Houston, TX, United States
(Flores) Texas Children's Hospital - Baylor College of Medicine, Cardiac
Intensive Care Unit, Section of Critical Care and Cardiology, Houston,
United States
(Loomba) Chicago Medical School, Rosalind Franklin University of Medicine
and Science, Pediatrics, Chicago, United States
(Aiello) Chicago Medical School, Rosalind Franklin University of Medicine
and Science, Resuscitation Institute, Chicago, United States
Publisher
Lippincott Williams and Wilkins
Abstract
AIMS & OBJECTIVES: For congenital heart defect patients undergoing
corrective surgery utilizing cardiopulmonary bypass, post-operative
inhaled nitric oxide has been administered to alleviate pulmonary
hypertension. We performed a systematic review and meta-analyses to
determine the effect of inhaled nitric oxide on hemodynamics, gas
exchange, and hospitalization characteristics in children immediately
after cardiopulmonary bypass. METHOD(S): A systematic review of the
literature was performed to identify full text manuscripts in English.
PubMed, EMBASE, and the Cochrane databases from 1980 to 2018. The
following search terms were used individually and various combinations to
query these databases: "inhaled nitric oxide", "cardiopulmonary bypass",
"cardiac surgery", "pediatric", "congenital heart disease",
"hemodynamics", "gas exchange". RESULT(S): There were significant
differences with decreases in mean pulmonary artery pressure of -6.82mmHg,
left atrial pressure of -1.16mmHg, arteriovenous oxygen difference of
-1.63, arterial carbon dioxide concentration of -2.41 mmHg, mechanical
ventilation duration of -8.56 hours, and length of cardiac intensive care
unit stay duration of -0.91 days. All significant variables achieved
p<0.001. CONCLUSION(S): Inhaled nitric oxide in children immediately
after cardiopulmonary bypass decreases mean pulmonary artery pressure
significantly and decreases the arterial carbon dioxide concentration
significantly without significantly altering other hemodynamic parameters.
This results in a statistically shorter duration of mechanical ventilation
and cardiac intensive care unit length of stay without altering overall
hospital length of stay.

<53>
[Use Link to view the full text]
Accession Number
634772782
Title
Does a balanced colloid decrease perioperative blood loss in pediatric
cardiac surgery: A double-blinded randomized controlled trial?.
Source
Pediatric Critical Care Medicine. Conference: 10th World Congress of the
World Federation of Pediatric Intensive and Critical Care Societies,
WFPICCS 2020. Virtual. 22 (SUPPL 1) (pp 15), 2021. Date of Publication:
March 2021.
Author
Willems A.; De Groote F.; Schmartz D.; Van Der Linden P.
Institution
(Willems) Leids Universitair Medisch Centrum, Pediatric Intensive Care
Unit, Leiden, Netherlands
(De Groote) Hopital Universitaire des Enfants Reine Fabiola,
Anesthesiology, Brussels, Belgium
(Schmartz, Van Der Linden) CHU Brugmann, Anesthesiology, Brussels, Belgium
Publisher
Lippincott Williams and Wilkins
Abstract
AIMS & OBJECTIVES: Unbalanced fluid solutions cause metabolic acidosis and
could therefore be associated with impaired coagulation and increased
blood loss. Our hypothesis is that the use of a balanced colloid for
perioperative fluid therapy compared to a saline colloid is associated
with decreased blood loss and exposure to blood products. METHOD(S):
This double blinded randomized controlled trial was conducted at a
tertiary children hospital. Children older than 29 days and younger than 3
years admitted for cardiac surgery with cardiopulmonary bypass (CPB).
Exclusion criteria were: emergency surgery; moribund, Jehovah witnesses,
coagulopathy, renal or liver failure, intracranial hemorrhage, and
electrolyte disturbances. Patients were randomly assigned to either a
saline colloid (6% hydroxyethyl starch in NaCl 0.9%) or a balanced colloid
(6% hydroxyethyl starch in an isotonic solution) for CPB priming and
intra- and postoperative fluid therapy during the first postoperative 48
hours. RESULT(S): Eighty-nine patients were included in the study (45
in the Saline colloid and 44 in the Balanced colloid group). The primary
outcome measure, calculated blood loss at postoperative day (POD3) was not
significantly different between the two groups [Saline colloid: 20.7
(14.3-27.6) ml kg-1 versus Balanced colloid: 17.6 (8.6-26.0); P=0.236].
Secondary outcomes related to bleeding, exposure to blood products and
coagulation were not different between groups. There was also no
difference in length of mechanical ventilation, intensive care and
hospital length of stay between groups. CONCLUSION(S): The use of a
balanced colloid for perioperative fluid therapy compared to a saline one
is not associated with decreased blood loss and exposure to blood
products.

<54>
Accession Number
634777466
Title
Quantitative Angiographic Assessment of Aortic Regurgitation after
Transcatheter Aortic Valve Implantation among Three Balloon-Expandable
Valves.
Source
Global heart. 16 (1) (pp 20), 2021. Date of Publication: 19 Mar 2021.
Author
Kawashima H.; Wang R.; Mylotte D.; Jagielak D.; De Marco F.; Ielasi A.;
Onuma Y.; den Heijer P.; Terkelsen C.J.; Wijns W.; Serruys P.W.; Soliman
O.
Institution
(Kawashima, Wang, Mylotte, Onuma, Wijns, Serruys, Soliman) Department of
Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
and CORRIB Corelab and Center for Research and Imaging, IE
(Kawashima) University of Amsterdam, Amsterdam, United States
(Wang) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Jagielak) Department of Cardiac and Vascular Surgery, Medical University
of Gdansk, PL, Gdansk, Poland
(De Marco) Clinical and Interventional Cardiology Department, IT, IRCCS
Policlinico San Donato, San Donato Milanese, Italy
(Ielasi) Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio,
IT, Milan, United States
(den Heijer) Department of Cardiology, Amphia Ziekenhuis, Breda, Italy
(Terkelsen) Department of Cardiology, Aarhus University Hospital, Aarhus
(Serruys) NHLI, Imperial College London, London
Publisher
NLM (Medline)
Abstract
Objectives: The aim of the present analysis is to compare the quantitative
angiographic aortic regurgitation (AR) after transcatheter aortic valve
implantation (TAVI) among three balloon-expandable valves.
 Background(s): Quantitative videodensitometric aortography is an
objective, accurate, and reproducible tool for adjudication of AR
following TAVI. Method(s): This is a retrospective corelab analysis,
independent from industry, of aortograms from patients treated with TAVI
using the balloon-expandable Myval transcatheter heart valve (THV) (Meril
Life Sciences Pvt. Ltd., India), Sapien 3, and XT THVs (Edwards
Lifesciences, Irvine, CA, USA). The study comprised of 108 analyzable
aortograms from consecutive patients in a multicenter European registry
who underwent Myval THV implantation. The results of quantitative
assessment of AR in the Sapien 3 THV (n = 397) and Sapien XT THV (n = 239)
were retrieved from a published pooled database. Result(s): The Myval
THV had the lowest proportion of patients with moderate or severe
angiographic quantitative AR (2.8%) compared to the Sapien 3 THV (8.3%; p
= 0.049) and Sapien XT THV (10.9%; p = 0.012). Furthermore, the Myval THV
had the lowest mean angiographic quantitative AR (6.3 +/- 6.3%), followed
by Sapien 3 THV (7.6 +/- 7.1%) and Sapien XT THV (8.8 +/- 7.5%), and it
was significantly lower than that of the Sapien XT THV (p = 0.006), but
not significantly different from Sapien 3 THV (p = 0.246).
 Conclusion(s): The Myval THV, in comparison with other BEV's analyzed
in our database, showed a lower occurrence of moderate or severe AR after
TAVI. These results should be confirmed in prospective cohorts of
randomized patients with head-to-head THV comparisons. Copyright:
© 2021 The Author(s).

<55>
Accession Number
634775646
Title
Depression as a predictor of postoperative delirium after cardiac surgery:
a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 371-379),
2021. Date of Publication: 08 Apr 2021.
Author
Falk A.; Kahlin J.; Nymark C.; Hultgren R.; Stenman M.
Institution
(Falk, Hultgren, Stenman) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Falk, Kahlin, Stenman) Perioperative Medicine and Intensive Care
Function, Karolinska University Hospital, Stockholm, Sweden
(Kahlin) Department of Physiology and Pharmacology, Karolinska Institutet,
Stockholm, Sweden
(Nymark) Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Stockholm, Sweden
(Nymark, Hultgren) Heart and Vascular Theme, Karolinska University
Hospital, Stockholm, Sweden
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Depression is common in patients with cardiac disease. The
importance of preoperative depression for development of postoperative
delirium (POD) following cardiac surgery is not well known. The aim is to
provide a summary estimate of depression as a predictor of POD following
cardiac surgery. METHOD(S): Systematic search of MEDLINE, EMBASE,
Cochrane Library, Web of Science Core Collection and Psycinfo (Ovid) was
performed from inception to October 2019, including cohort studies
reporting odds ratios (ORs) and 95% confidence intervals (CIs) for POD
following cardiac surgery in patients with preoperative depression
compared to patients without depression. ORs and 95% CIs for POD were
calculated using random-effects meta-analyses. Subgroup and sensitivity
analyses were performed. RESULT(S): Seven studies were included with
a combined study population of 2066 patients. The pooled prevalence of POD
in the combined study population was 26% and preoperative depression was
present in ~9% of the total study population. All studies showed a
positive association between preoperative depression and POD; and in 5
studies, the association was statistically significant. Patients with
depression had a pooled OR of 2.31 (95% CI 1.37-3.90) for POD.
 CONCLUSION(S): This systematic review and meta-analysis confirm the
findings that the previous association between preoperative depression and
increased risk for developing POD reported for other patient groups is
found also in cardiac surgery. Depression screening prior to cardiac
surgery may be effective in identifying patients at higher risk for
POD. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<56>
Accession Number
634775575
Title
Comparison of early postoperative cytokine changes in patients undergoing
intubated and non-intubated thoracic surgery: a randomized controlled
trial.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 343-350),
2021. Date of Publication: 08 Apr 2021.
Author
Jeon J.; Sung S.; Moon Y.; Koo J.; Hyun K.; Han K.; Hwang W.
Institution
(Jeon) Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's
Hospital, College of Medicine, Catholic University of Korea, Seoul, South
Korea
(Sung) Department of Thoracic and Cardiovascular Surgery, Ewha Womans
University Seoul Hospital, Seoul, South Korea
(Moon) Department of Thoracic and Cardiovascular Surgery, Eunpyeong St.
Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul,
South Korea
(Koo, Hwang) Department of Anesthesia and Pain Medicine, Seoul St. Mary's
Hospital, College of Medicine, Catholic University of Korea, Seoul, South
Korea
(Hyun) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, Catholic University of Korea, Seoul, South
Korea
(Han) Department of Statistics and Actuarial Science, Soongsil University,
Seoul, South Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The inflammatory response after surgery is associated with
patient prognosis. Patients who undergo thoracic surgery exhibit a
profound systemic inflammatory response due to the surgical procedures
used and application of one-lung ventilation. The aim of this study was to
compare perioperative inflammatory changes in patients after intubated and
non-intubated thoracic surgery for primary lung cancer resection.
 METHOD(S): This prospective randomized controlled study included
forty patients who underwent surgical resection for stage I non-small-cell
lung cancer. Blood samples for cytokine analysis were collected just
before induction, at 1 and 24h after surgery. Levels of the
pro-inflammatory cytokine and anti-inflammatory cytokines were measured
using quantitative sandwich enzyme immunoassay kits. RESULT(S): The
basal values of cytokines were comparable between 2 groups. Within each
group, the postoperative levels of interleukin (IL)-1, IL-6 and tumour
necrosis factor-alpha increased, while those of IL-4 and IL-10 did not
change significantly. The levels of IL-6 and tumour necrosis factor-alpha
were significantly lower in group NI at 1 and 24h postoperatively. Other
cytokines did not differ in both groups during postoperative period. The
IL-6/IL-10 ratio at 1h after surgery was lower in non-intubated patients
than in intubated patients, but there was no difference at 24h after
surgery. CONCLUSION(S): Non-intubated thoracic surgery may attenuate
the early inflammatory cytokine changes following major resection for
primary lung cancer compared with intubated conventional surgery. CLINICAL
TRIAL REGISTRATION: ClinicalTrials.gov registry number
NCT04007354. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<57>
Accession Number
2011683155
Title
Minimal invasive aortic valve replacement through right mini-thoracotomy
versus conventional approach in the egypt.
Source
Systematic Reviews in Pharmacy. 12 (3) (pp 88-95), 2021. Date of
Publication: March 2021.
Author
Salama A.M.; Eid A.M.; Adel W.; Mortada K.; Elsharkawy A.
Institution
(Salama, Eid, Adel, Mortada, Elsharkawy) Cardiothoracic surgery
Department, Kasr alainy Faculty of medicine, Cairo University, Egypt
Publisher
EManuscript Technologies
Abstract
Background: Full median sternotomy was established a long time ago as the
standard approach for all varieties of heart surgery. Although that, it
may cause significant surgical trauma and morbidity, so minimally invasive
cardiac surgery for aortic valve replacement via partial sternotomy,
para-sternal approach and anterior mini-thoracotomy is used trying to
improve the outcome . Objective(s): To check the outcome of minimally
invasive aortic valve surgery through a right mini-thoracotomy, and its
rule in minimizing the surgical access, achieving better wound appearance,
decreasing post-operative discomfort and better postoperative recovery
with the same safety and results like conventional surgery .
 Method(s): Our study was performed in the Armed Forces Hospitals El
Maddi& El Galaa and kobry elkobba, Egypt. Between January 2015 to March
2017, sixty patients were diagnosed with AVD requiring aortic valve
surgery were randomly selected, of them Thirty patients had aortic valve
surgery through full median sternotomy with aorto-right atrial cannulation
and the other thirty patients had right mini-thoracotomy with femoral
cannulation . Results# Minimally invasive aortic valve replacement (MIAVR)
was associated with reduced morbidity and mortality, where there was a
safer approach in case of reoperation, better cosmetic outcome, less
bleeding post-operative, lower number of blood products usage, less
intensive care unit and hospital stays, decreased time until return to
full activity and avoiding the incidence of sternal wound infection. That
good results were also achievable in high-risk patients .
 Conclusion(s): Minimal Invasive Aortic Valve Replacement Through
Right Minithoracotomy is an acceptable alternative to Full median
sternotomy, has reduced morbidity and potential mortality and good
clinical outcome, with two concerns which are the operative cost and the
relatively long bypass and cross clamp time which are related to the
learning curve of the surgeons . Copyright © 2021 EManuscript
Technologies. All rights reserved.

<58>
Accession Number
2006951957
Title
Effects of problem-solving skills training on the anxiety and sleep
quality of patients after coronary artery bypass graft surgery.
Source
Journal of Kermanshah University of Medical Sciences. 25 (1) (no
pagination), 2021. Article Number: e107638. Date of Publication: March
2021.
Author
Omidi S.; Kakabaraee K.; Amiripour A.
Institution
(Omidi, Kakabaraee) Department of Psychology, Kermanshah Branch, Islamic
Azad University, Kermanshah, Iran, Islamic Republic of
(Amiripour) Imam Ali Heart Research Center, Medical Science University,
Kermanshah, Iran, Islamic Republic of
Publisher
Kermanshah University of Medical Sciences
Abstract
Background: Cardiovascular diseases are the leading cause of mortality
worldwide, and sleep disturbance and anxiety play a key role in the
prognosis of these patients. Objective(s): The present study aimed to
evaluate the effects of problem-solving skills training (PSST) on the
anxiety and sleep disturbance of cardiac patients. Method(s): This
quasi-experimental study was carried out in three stages before, after,
and during a two-month follow-up after eight PSST sessions (one hour
each). Sample population included 20 male patients with heart failure who
had undergone coronary artery bypass graft (CABG) surgery at Imam Ali
Hospital of Kermanshah, Iran. The patients were randomly divided into the
experimental (n = 10) and control groups (n = 10). Data were collected
using Spielberger's state-trait anxiety inventory (STAI) and Pittsburgh
sleep quality index (PSQI). Data analysis was performed in SPSS using the
analysis of covariance to compare the groups. Result(s): MANCOVA and
Tukey's post-hoc test indicated a significant difference in the sleep
quality score of the patients at the posttest (P = 0.001) and follow-up (P
= 0.017), as well as in the score of anxiety at the posttest (P = 0.01)
and after the PSST intervention. However, no significant differences were
observed in the scores of the control group at different stages of the
study (P > 0.05). Conclusion(s): According to the results, PSST could
improve anxiety and sleep quality in patients with heart failure.
Therefore, it is recommended that such training be provided to cardiac
patients. Copyright © 2021, Journal of Kermanshah University of
Medical Sciences.

<59>
Accession Number
2011668736
Title
Low-temperature electrocautery reduces adverse effects from secondary
cardiac implantable electronic device procedures: Insights from the
WRAP-IT trial.
Source
Heart Rhythm. (no pagination), 2021. Date of Publication: 2021.
Author
Mittal S.; Wilkoff B.L.; Poole J.E.; Kennergren C.; Wright D.J.; Berman
B.J.; Riggio D.; Sholevar D.P.; Martinez-Arraras J.; Moubarak J.B.;
Schaller R.D.; Love J.C.; Pickett R.A.; Philippon F.; Eldadah Z.; Lande
J.D.; Lexcen D.R.; Holbrook R.; Tarakji K.G.
Institution
(Mittal) Valley Health System, Ridgewood, NJ, United States
(Wilkoff, Tarakji) Cleveland Clinic, Cleveland, OH, United States
(Poole) University of Washington School of Medicine, Seattle, WA, United
States
(Kennergren) Sahlgrenska University Hospital, Goteborg, Sweden, Sweden
(Wright) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Berman) Chula Vista Cardiac Center, Chula Vista, CA, United States
(Riggio) Arizona Arrhythmia Consultants, Scottsdale, AZ, United States
(Sholevar) Virtua Health System, Camden, NJ, United States
(Martinez-Arraras) Amarrillo Heart Group, Amarillo, TX, United States
(Moubarak) Hamot Medical Center, Erie, PA, United States
(Schaller) University of Pennsylvania, Philadelphia, PA, United States
(Love) Maine Medical Center, Portland, ME, United States
(Pickett) Saint Thomas Research Institute, LLC Thomas, Nashville, TN,
United States
(Philippon) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec, Canada
(Eldadah) MedStar Heart and Vascular Institute, Washington, DC, United
States
(Lande, Lexcen, Holbrook) Medtronic, Mounds View, MN, United States
Publisher
Elsevier B.V.
Abstract
Background: Cardiac device procedures require tissue dissection to free
existing device lead(s). Common techniques include blunt dissection,
standard electrocautery, and low-temperature electrocautery (PlasmaBlade,
Medtronic); however, data on the type of electrosurgical tool used and the
development of procedure- or lead-related adverse events are limited.
 Objective(s): The purpose of this study was to determine whether
standard or low-temperature electrocautery impacts the development of an
adverse event. Method(s): We evaluated patients enrolled in WRAP-IT
(Worldwide Randomized Antibiotic EnveloPe Infection PrevenTion Trial)
undergoing cardiac implantable electronic device (CIED) revision, upgrade,
or replacement. All adverse events were adjudicated by an independent
physician committee. Data were analyzed using Cox proportional hazard
regression modeling. Result(s): In total, 5641 patients underwent
device revision/upgrade/replacement. Electrocautery was used in 5205
patients (92.3%) (mean age 70.6 +/- 12.7 years; 28.8% female), and
low-temperature electrocautery was used in 1866 patients (35.9%). Compared
to standard electrocautery, low-temperature electrocautery was associated
with a 23% reduction in the incidence of a procedure- or lead-related
adverse event through 3 years of follow up (hazard ratio [HR] 0.77; 95%
confidence interval [CI] 0.65-0.91; P =.002). After controlling for the
number of active leads, degree of capsulectomy, degree of lead dissection,
and renal dysfunction, low-temperature electrocautery was associated with
a 32% lower risk of lead-related adverse events (HR 0.68; 95% CI
0.52-0.89; P =.004). These effects were consistent across a spectrum of
lead-related adverse event types. Conclusion(s): This study
represents one of the largest assessments of electrocautery use in
patients undergoing CIED revision, upgrade, or replacement procedures.
Compared to standard electrocautery, low-temperature electrocautery
significantly reduces adverse effects from these procedures. Copyright
© 2021 Heart Rhythm Society

<60>
Accession Number
634785638
Title
A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative
Fluid Management Strategy Compared with Usual Care in Participants after
Cardiac Surgery: The Fluids after Bypass Study*.
Source
Critical Care Medicine. (pp 449-461), 2021. Date of Publication: 2021.
Author
Parke R.L.; Gilder E.; Gillham M.J.; Walker L.J.C.; Bailey M.J.;
McGuinness S.P.
Institution
(Parke, Gilder, Gillham, Walker, McGuinness) Cardiothoracic and Vascular
ICU, Auckland City Hospital, Auckland, New Zealand
(Parke) School of Nursing, Faculty of Medical and Health Sciences,
University of Auckland, Auckland, New Zealand
(Parke) Medical Research Institute of New Zealand, Wellington, New Zealand
(Parke, Bailey) ANZIC-Research Centre, Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: There is little evidence to guide fluid administration to
patients admitted to the ICU following cardiac surgery. This study aimed
to determine if a protocolized strategy known to reduce fluid
administration when compared with usual care reduced ICU length of stay
following cardiac surgery. DESIGN: Prospective, multicenter,
parallel-group, randomized clinical trial. SETTING: Five cardiac surgical
centers in New Zealand conducted from November 2016 to December 2018 with
final follow-up completed in July 2019. PATIENTS: Seven-hundred fifteen
patients undergoing cardiac surgery; 358 intervention and 357 usual care.
INTERVENTIONS: Randomization to protocol-guided strategy utilizing stroke
volume variation to guide administration of bolus fluid or usual care
fluid administration until desedation or up to 24 hours. Primary outcome
was length of stay in ICU. Organ dysfunction, mortality, process of care
measures, patient-reported quality of life, and disability-free survival
were collected up to day 180. MEASUREMENTS AND MAIN RESULTS: Overall 666
of 715 (93.1%) received at least one fluid bolus. Patients in the
intervention group received less bolus fluid (median [interquartile
range], 1,000 mL [250-2,000 mL] vs 1,500 mL [500-2,500 mL]; p < 0.0001)
and had a lower overall fluid balance (median [interquartile range], 319
mL [-284 to 1,274 mL] vs 673 mL [38-1,641 mL]; p < 0.0001) in the
intervention period. There was no difference in ICU length of stay between
the two groups (27.9 hr [21.8-53.5 hr] vs 25.6 hr [21.9-64.6 hr]; p =
0.95). There were no differences seen in development of organ dysfunction,
quality of life, or disability-free survival at any time points. Hospital
mortality was higher in the intervention group (4% vs 1.4%; p = 0.04).
 CONCLUSION(S): A protocol-guided strategy utilizing stroke volume
variation to guide administration of bolus fluid when compared with usual
care until desedation or up to 24 hours reduced the amount of fluid
administered but did not reduce the length of stay in ICU. Copyright
© 2021 Lippincott Williams and Wilkins. All rights reserved.

<61>
[Use Link to view the full text]
Accession Number
634773849
Title
Exposure-Response Relationship of Tranexamic Acid in Cardiac Surgery: A
Model-based Meta-analysis.
Source
Anesthesiology. (pp 165-178), 2021. Article Number: 003633. Date of
Publication: 2021.
Author
Zufferey P.J.; Lanoiselee J.; Graouch B.; Vieille B.; Delavenne X.; Ollier
E.
Institution
(Zufferey, Lanoiselee, Delavenne, Ollier) Institut National de la Sante et
de la Recherche Medicale (INSERM), U1059, Vascular Dysfunction and
Hemostasis, Saint-Etienne, France
(Zufferey, Lanoiselee, Graouch, Vieille) Department of Anesthesiology and
Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne cedex
02 42055, France
(Zufferey, Delavenne, Ollier) Clinical Pharmacology Department, University
Hospital of Saint-Etienne, Saint-Etienne, France
(Delavenne, Ollier) University of Lyon, Saint-Etienne, France
Publisher
Lippincott Williams and Wilkins
Abstract
Background: It is unclear whether high-dose regimens of tranexamic acid in
cardiac surgery (total dose, 80 to 100 mg/kg) confer a clinical advantage
over low-dose regimens (total dose, approximately 20 mg/kg), particularly
as tranexamic acid-associated seizure may be dose-related. The authors'
aim was to characterize the exposure-response relationship of this drug.
 Method(s): Databases were searched for randomized controlled trials
of intravenous tranexamic acid in adult patients undergoing
cardiopulmonary bypass surgery. Observational studies were added for
seizure assessment. Tranexamic acid concentrations were predicted in each
arm of each study using a population pharmacokinetic model. The
exposure-response relationship was evaluated by performing a model-based
meta-analysis using nonlinear mixed-effect models. Result(s):
Sixty-four randomized controlled trials and 18 observational studies
(49,817 patients) were included. Seventy-three different regimens of
tranexamic acid were identified, with the total dose administered ranging
from 5.5 mg/kg to 20 g. The maximum effect of tranexamic acid for
postoperative blood loss reduction was 40% (95% credible interval, 34 to
47%), and the EC50 was 5.6 mg/l (95% credible interval, 0.7 to 11 mg/l).
Exposure values with low-dose regimens approached the 80% effective
concentration, whereas with high-dose regimens, they exceeded the 90%
effective concentration. The predicted cumulative blood loss up to 48 h
postsurgery differed by 58 ml between the two regimens, and the absolute
difference in erythrocyte transfusion rate was 2%. Compared to no
tranexamic acid, low-dose and high-dose regimens increased the risk of
seizure by 1.2-fold and 2-fold, respectively. However, the absolute risk
increase was only clinically meaningful in the context of prolonged
open-chamber surgery. Conclusion(s): In cardiopulmonary bypass
surgery, low-dose tranexamic acid seems to be an appropriate regimen for
reducing bleeding outcomes. This meta-analysis has to be interpreted with
caution because the results are observational and dependent on the lack of
bias of the predicted tranexamic acid exposures and the quality of the
included studies. Copyright © 2020, the American Society of
Anesthesiologists, Inc. All Rights Reserved.

<62>
Accession Number
2010596137
Title
Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical
Aortic Valve Replacement: An Updated Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14 (2) (pp 211-220), 2021. Date of
Publication: 25 Jan 2021.
Author
Sa M.P.B.O.; Van den Eynde J.; Simonato M.; Cavalcanti L.R.P.; Doulamis
I.P.; Weixler V.; Kampaktsis P.N.; Gallo M.; Laforgia P.L.; Zhigalov K.;
Ruhparwar A.; Weymann A.; Pibarot P.; Clavel M.-A.
Institution
(Sa, Cavalcanti) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife,
Brazil
(Van den Eynde) Department of Cardiovascular Diseases, Research Unit of
Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
(Van den Eynde) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Simonato) Division of Cardiac Surgery, Escola Paulista de
Medicina-UNIFESP, Sao Paulo, Brazil
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Weixler) German Heart Center, Berlin, Germany
(Kampaktsis) NYU Langone Medical Center, New York, NY, United States
(Gallo) Department of Cardiac Surgery, Cardiocentro Ticino, Lugano,
Switzerland
(Laforgia) I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan,
Italy
(Zhigalov, Ruhparwar, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
(Pibarot, Clavel) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Pibarot, Clavel) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, Quebec, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to evaluate early results of
valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus
redo surgical aortic valve replacement (SAVR) for structural valve
degeneration (SVD). Background(s): ViV TAVR has been increasingly
used for SVD, but it remains unknown whether it produces better or at
least comparable results as redo SAVR. Method(s): Observational
studies comparing ViV TAVR and redo SAVR were identified in a systematic
search of published research. Random-effects meta-analysis was performed,
comparing clinical outcomes between the 2 groups. Result(s): Twelve
publications including a total of 16,207 patients (ViV TAVR, n = 8,048;
redo SAVR, n = 8,159) were included from studies published from 2015 to
2020. In the pooled analysis, ViV TAVR was associated with lower rates of
30-day mortality overall (odds ratio [OR]: 0.53; 95% confidence interval
[CI]: 0.32 to 0.87; p = 0.017) and for matched populations (OR: 0.419; 95%
CI: 0.278 to 0.632; p = 0.003), stroke (OR: 0.65; 95% CI: 0.55 to 0.76; p
< 0.001), permanent pacemaker implantation (OR: 0.73; 95% CI: 0.22 to
2.43; p = 0.536), and major bleeding (OR: 0.49; 95% CI: 0.26 to 0.93; p =
0.034), as well as with shorter hospital stay (OR: -3.30; 95% CI: -4.52 to
-2.08; p < 0.001). In contrast, ViV TAVR was associated with higher rates
of myocardial infarction (OR: 1.50; 95% CI: 1.01 to 2.23; p = 0.045) and
severe patient-prosthesis mismatch (OR: 4.63; 95% CI: 3.05 to 7.03; p <
0.001). The search revealed an important lack of comparative studies with
long-term results. Conclusion(s): ViV TAVR is a valuable option in
the treatment of patients with SVD because of its lower incidence of
post-operative complications and better early survival compared with redo
SAVR. However, ViV TAVR is associated with higher rates of myocardial
infarction and severe patient-prosthesis mismatch. Copyright ©
2021 American College of Cardiology Foundation

<63>
Accession Number
2002329811
Title
Preemptive alveolar recruitment maneuver followed by PEEP in obese
patients undergoing laparoscopic gastric banding. Does it make a
difference? a randomized controlled clinical study.
Source
Open Anesthesia Journal. 13 (1) (pp 31-39), 2019. Date of Publication:
2019.
Author
Elokda S.A.; Farag H.M.
Institution
(Elokda, Farag) Department of Anesthesia, Intensive Care, and Pain
Management, Ain Shams University, Cairo, Egypt
Abstract
Background: Impaired respiratory functions during general anesthesia are
commonly caused by lung atelectasis more in morbidly obese patients. This
occurs more frequently with laparoscopic surgery due to trendelenburg
position and pneumoperitoneum. Preemptive recruitment maneuver + PEEP
results in the prevention of these changes. Aim(s): To quantitate the
effects of RM and PEEP on intraoperative hypoxemia and respiratory
mechanics during laparoscopic gastric banding in obese patients.
 Study Design: A randomized, double-blinded, controlled study. Method
and Materials: Fifty adults ASA I-II, BMI (40-50 kg/m2) for
elective laparoscopic gastric banding were randomized into, groups C, and
RM, 25 patients each. Group C patients received standard ventilation, VT 6
ml/kg, I: E ratio 1: 2 PEEP 5 cm H<inf>2</inf> O, and respiratory rate
10-12 breaths/ min. RM patients received standard ventilation with one
alveolar recruitment maneuver after mechanical ventilation with PEEP of 15
cm H<inf>2</inf> O till the end of the surgery. Heart rate, mean blood
pressure, respiratory mechanical parameters: peak airway pressure, plateau
pressure and end-expiratory lung volume, PaO<inf>2</inf>,
PaO<inf>2</inf>/FiO<inf>2</inf> and (SpO<inf>2</inf>) were assessed.
 Result(s): PaO<inf>2</inf> and PaO<inf>2</inf> /FiO<inf>2</inf> ratio
increased significantly in the RM group after RM from T2 (before
pneumoperitoneum) to T6 (end of surgery) compared with group C (P <
0.001). Peak and plateau airway pressures increased significantly in group
C from T2 till T5 (60 min after pneumoperitoneum) compared with the RM
group (P < 0.001). End-expiratory lung volume increased significantly in
the RM group after RM compared with group C (P<0.001). Conclusion(s):
Preemptive RM with PEEP of 15 cm H<inf>2</inf> O was effective in
preventing pneumoperitoneum-induced intraoperative hypoxemia and
respiratory mechanics changes. Copyright © 2019 Elokda and Farag.

<64>
Accession Number
608458702
Title
Electronic versus traditional chest tube drainage following lobectomy: A
randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 48 (6) (pp 893-898), 2015.
Date of Publication: 01 Dec 2015.
Author
Lijkendijk M.; Licht P.B.; Neckelmann K.
Institution
(Lijkendijk, Licht, Neckelmann) Department of Cardiothoracic Surgery,
Odense University Hospital, Odense, Denmark
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Electronic drainage systems have shown superiority compared
with traditional (water seal) drainage systems following lung resections,
but the number of studies is limited. As part of a medico-technical
evaluation, before change of practice to electronic drainage systems for
routine thoracic surgery, we conducted a randomized controlled trial (RCT)
investigating chest tube duration and length of hospitalization.
 METHOD(S): Patients undergoing lobectomy were included in a
prospective open label RCT. A strict algorithm was designed for early
chest tube removal, and this decision was delegated to staff nurses. Data
were analysed by Cox proportional hazard regression model adjusting for
lung function, gender, age, BMI, video-assisted thoracic surgery (VATS) or
open surgery and presence of incomplete fissure or pleural adhesions. Time
was distinguished as possible (optimal) and actual time for chest tube
removal, as well as length of hospitalization. RESULT(S): A total of
105 patients were randomized. We found no significant difference between
the electronic group and traditional group in optimal chest tube duration
(HR = 0.83; 95% CI: 0.55-1.25; P = 0.367), actual chest tube duration (HR
= 0.84; 95% CI: 0.55-1.26; P = 0.397) or length of hospital stay (HR =
0.91; 95% CI: 0.59-1.39; P = 0.651). No chest tubes had to be reinserted.
Presence of pleural adhesions or an incomplete fissure was a significant
predictor of chest tube duration (HR = 1.72; 95% CI: 1.15-2.77; P =
0.014). CONCLUSION(S): Electronic drainage systems did not reduce
chest tube duration or length of hospitalization significantly compared
with traditional water seal drainage when a strict algorithm for chest
tube removal was used. This algorithm allowed delegation of chest tube
removal to staff nurses, and in some patients chest tubes could be removed
safely on the day of surgery.

<65>
Accession Number
362699026
Title
Preoperative glutamine infusion improves glycemia in heart surgery
patients.
Source
Acta Cirurgica Brasileira. 26 (SUPPL. 1) (pp 77-81), 2011. Date of
Publication: 2011.
Author
Hissa M.N.; de Vasconcelos R.C.; Guimaraes S.B.; Silva R.P.; Garcia
J.H.P.; de Vasconcelos P.R.L.
Institution
(Hissa, Silva, de Vasconcelos) Department of Surgery, UFC, Ceara, Brazil
(de Vasconcelos) UFC, Ceara, Brazil
(Guimaraes) Department of Surgery, LABCEX, UFC, Ceara, Brazil
(Garcia) Department of Clinical Medicine, UFC, Ceara, Brazil
Publisher
Sociedade Brasileira para o Desenvolvimento de Pesquisa em Cirurgia
Abstract
PURPOSE: To evaluate the effects of pre-operative L-alanyl-glutamine
(L-Ala-Gln) on blood glucose control in patients with coronary
obstruction, selected for myocardial revascularization. METHOD(S):
Twenty-two patients (63+/-8 years) were randomly assigned to receive 250ml
of L-Ala-Gln 20% plus saline 750 ml (Group L- Ala-Gln, n=11) or saline
1000 ml (Group Saline, n=11) over 3 hours before operation. Pre-operative
blood samples were collected 3h before (T-1) and at the beginning of the
surgical procedure (T-2). Intra-operative samples were collected
immediately before the start (T-3) and the end of extra-corporeal
perfusion (T- 4). Post-operative samples were collected 12h (T-12) and 24h
later (T-24). RESULT(S): Glycemia decreased significantly in
L-Ala-Gln treated patients during the intraoperative period. The same
effect did not occur in saline patients. As the rate of insulin infusion,
administered routinely to patients undergoing surgery with extracorporeal
circulation was constant in both groups during surgery, the reduction of
blood glucose in group L-Ala-Gln does not seem to be related to exogenous
insulin. CONCLUSION(S): Pre-operative use of L-Ala-Gln improves
glycemic control in patients with coronary artery occlusion, submitted to
myocardial revascularization.

<66>
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.

<67>
Accession Number
2007444114
Title
Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain
Management in Cardiac Surgery: A Prospective, Randomized,
Placebo-Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (3) (pp 896-903),
2021. Date of Publication: March 2021.
Author
Khera T.; Murugappan K.R.; Leibowitz A.; Bareli N.; Shankar P.; Gilleland
S.; Wilson K.; Oren-Grinberg A.; Novack V.; Venkatachalam S.; Rangasamy
V.; Subramaniam B.
Institution
(Khera, Murugappan, Leibowitz, Shankar, Gilleland, Wilson, Oren-Grinberg,
Novack, Venkatachalam, Rangasamy, Subramaniam) Center for Anesthesia and
Research Excellence, Department of Anesthesia Critical Care and Pain
Medicine, Beth Israel Deaconess Medical Center, Boston, MA
(Murugappan, Leibowitz, Oren-Grinberg, Subramaniam) Harvard Medical
School, Boston, MA, United States
(Bareli) Clinical Research Center, Soroka University Medical Center,
Beer-Sheva, Israel
Publisher
W.B. Saunders
Abstract
Objective: To explore the effect of pecto-intercostal fascial plane block
(PIFB) on postoperative opioid requirements, pain scores, lengths of
intensive care unit and hospital stays and incidence of postoperative
delirium in cardiac surgical patients. Design(s): Single- center,
prospective, randomized (1:1), quadruple- blinded, placebo-controlled
trial. Setting(s): Single center, tertiary- care center.
 Participant(s): The study comprised 80 adult cardiac surgical
patients (age >18 y) requiring median sternotomy. Intervention(s):
Patients were randomly assigned to receive ultrasound-guided PIFB, with
either 0.25% bupivacaine or placebo, on postoperative days 0 and 1.
 Measurements and Main Results: Of the 80 patients randomized, the
mean age was 65.78 +/- 8.73 in the bupivacaine group and 65.70 +/- 9.86 in
the placebo group (p = 0.573). Patients receiving PIFB with 0.25%
bupivacaine showed a statistically significant reduction in visual analog
scale scores (4.8 +/- 2.7 v 5.1 +/- 2.6; p < 0.001), but the 48-hour
cumulative opioid requirement computed as morphine milligram equivalents
was similar (40.8 +/- 22.4 mg v 49.1 +/- 26.9 mg; p = 0.14). There was no
difference in the incidence of postoperative delirium between the groups
evaluated using the 3-minute diagnostic Confusion Assessment Method (3/40
[7.5%] v 5/40 [12.5%] placebo; p = 0.45). Conclusion(s): Patients who
received PIFB with bupivacaine showed a decline in cumulative opioid
consumption postoperatively, but this difference between the groups was
not statistically significant. Low incidence of complications and
improvement in visual analog scale pain scores suggested that the PIFB can
be performed safely in this population and warrants additional studies
with a larger sample size. Copyright © 2020 Elsevier Inc.

<68>
Accession Number
2005871223
Title
Interventions to Improve Clinical Outcomes in Older Adults Admitted to a
Surgical Service: A Systematic Review and Meta-analysis.
Source
Journal of the American Medical Directors Association. 21 (12) (pp
1833-1843.e20), 2020. Date of Publication: December 2020.
Author
Thillainadesan J.; Yumol M.F.; Hilmer S.; Aitken S.J.; Naganathan V.
Institution
(Thillainadesan, Yumol, Naganathan) Department of Geriatric Medicine,
Concord Hospital, Sydney, New South Wales, Australia
(Thillainadesan, Aitken, Naganathan) Concord Clinical School, Faculty of
Medicine and Health, University of Sydney, Sydney, New South Wales,
Australia
(Thillainadesan, Aitken, Naganathan) Centre for Education and Research on
Ageing, Sydney, New South Wales, Australia
(Thillainadesan, Aitken, Naganathan) Ageing and Alzheimer's Institute,
Sydney, New South Wales, Australia
(Hilmer) Kolling Institute of Medical Research, Sydney Medical School,
University of Sydney, Sydney, New South Wales, Australia
(Hilmer) Royal North Shore Hospital, Sydney, New South Wales, Australia
(Aitken) Concord Institute of Academic Surgery, Vascular Surgery
Department, Concord Hospital, Sydney, New South Wales, Australia
Publisher
Elsevier Inc.
Abstract
Objectives: Managing older patients with surgical conditions is a major
challenge for hospitals. There is therefore a growing interest in
providing geriatric perioperative services. The aim of this systematic
review and meta-analysis was to characterize and assess the impact of
targeted perioperative geriatric interventions on clinical outcomes of
older adults admitted to nonorthopedic surgical teams. Design, Setting and
Participants: A systematic review and meta-analysis of studies of
perioperative geriatric interventions in older adults hospitalized under
nonorthopedic surgical teams. Method(s): Ovid MEDLINE, EMBASE,
PsycINFO, Scopus, Cochrane Central Register of Controlled Trials, CINAHL,
and trial registry databases were searched. Primary outcomes were change
in functional status and length of stay (LOS). Result(s): Fifteen
randomized controlled trials (RCTs) and 9 prospective before-and-after
studies met the inclusion criteria (n = 3026 participants). Perioperative
geriatric interventions included preoperative comprehensive geriatric
assessment and management (CGA) (5 studies), multicomponent inpatient
geriatric programs (8 studies), cognitive training (1 study), exercise (5
studies), and prehabilitation (5 studies). Exercise therapy [mean
difference (MD) -1.90, 95% confidence interval (CI) -3.01, -0.80],
multicomponent inpatient geriatric programs (MD -1.98, 95% CI -3.09,
-0.88), and prehabilitation (MD -1.32, 95% CI -2.75, 0.11) reduced LOS.
Functional decline was highly heterogeneous, with 4 of 8 studies reporting
significantly less functional decline. Geriatric perioperative
interventions reduced complications [exercise therapy risk ratio (RR)
0.74, 95% CI 0.48, 1.15; prehabilitation RR 0.61, 95% CI 0.47, 0.80] and
delirium (multicomponent inpatient geriatric programs RR 0.49, 95% CI
0.27, 0.90; preoperative CGA RR 0.54, 95% CI 0.33, 0.89). There was no
significant impact on mortality or readmissions. Conclusions and
Implications: Perioperative geriatric interventions targeted at older
nonorthopedic surgical patients improve some clinically relevant outcomes.
There is a need for these interventions to be further evaluated in
high-quality studies, and future research should explore how to
effectively implement these interventions within complex health care
systems. Copyright © 2020 AMDA - The Society for Post-Acute and
Long-Term Care Medicine

<69>
Accession Number
2008414463
Title
Fibrinogen and fibrin degradation products' levels in cardiopulmonary
bypass with mild-hypothermia versus normothermia.
Source
Journal of Cellular and Molecular Anesthesia. 5 (3) (pp 157-163), 2020.
Date of Publication: July 2020.
Author
Ghasemzade B.; Ghodrati M.; Kachuian N.; Banakar Y.; Gorjipour F.; Zarei
A.A.; Zaree H.
Institution
(Ghasemzade) Department of Cardiac Surgery, Shahid Faghihi Hospital,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ghodrati) Department of Anesthesiology and Critical Care, Shahid Beheshti
Hospital, Qom University of Medical Sciences, Qom, Iran, Islamic Republic
of
(Kachuian) Department of Cardiac Surgery, Imam Hussein a.s. Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Banakar) MRI Hospital, Shiraz University of Medical Sciences, Shiraz,
Iran, Islamic Republic of
(Gorjipour) Department of Perfusion, Imam Hussein a.s. Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Zarei) Physiology Department, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Zaree) Department of Anesthesiology and Critical Care, Shahid Faghihi
hospital, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center
Abstract
Background: Coagulation cascades are activated during Cardiopulmonary
Bypass (CPB) and their proper monitoring and maintenance determine the
outcomes of operation to a big extent. Here, we assessed serum fibrinogen
and Fibrin Degradation Products (FDP) in adult patients undergoing CABG
with using CPB, either with hypothermia or normothermia. Material(s)
and Method(s): In a cross-sectional study, 80 adult patients' candidate
for elective CABG were randomly assigned into two groups: hypothermia and
normothermia to assess fibrinogen and FDP, perioperatively.
 Result(s): Patients included 32 men (80%) in the hypothermia group
and 26 men (60%) in the normothermia with the mean age of 61.43 +/- 12.64
years. The mean temperature in the hypothermia group was 32.33 +/- 1.44
and 35.33 +/- 0.71 in the normothermic group. Differences in fibrinogen
levels between the two groups were not significant (Fib before CPB,
P=0.893, and Fib after declamping, P=0.057). The serum level of FDP before
and during CPB was not significantly different in hypothermia and
normothermia groups (P=0.412, P=0.778, respectively). Conclusion(s):
During cardiac surgery in hypothermia and normothermia conditions rate of
fibrinogen decreased 25% after declamping in each group; this decrease
seems to be due to hemodilution. FDP levels were similar in both
groups. Copyright © 2020 IOP Publishing Ltd

<70>
Accession Number
2008414462
Title
The effect of oral triiodothyronine in outcome of pediatric congenital
cardiac surgery.
Source
Journal of Cellular and Molecular Anesthesia. 5 (3) (pp 150-156), 2020.
Date of Publication: July 2020.
Author
Tehrani R.B.; Farzin A.O.; Fani K.; Heidarpour A.
Institution
(Tehrani, Farzin) Department of Cardiovascular Surgery, Shahid Modarres
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Fani) Anesthesiology Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Heidarpour) Obstetrician and Gynecologist, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center
Abstract
Background: Cardiac surgery especially in small children is associated
with a marked decrease in thyroid hormone levels consistent with the
phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of
the present study was to determine if oral triiodothyronine could reduce
the length of ICU stay, vasoactive inotropic score (VIS), and promote
ejection fraction in infants and children undergoing cardiac surgery with
CPB. Material(s) and Method(s): In a double-blind clinical trial, one
hundred and twenty children aged 6 to 60 months and scheduled for
different types of cardiac surgery with CPB, were randomized into two
groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5%
dextrose water (placebo group), immediately after anesthesia and 24 hours
after surgery. The perioperative serum thyroid hormone levels and
hemodynamic variables were determined. The intubation time, ICU stay
length, ICU inotropic use, and cardiac ejection fraction was recorded.
 Result(s): The basic demographic data were comparable in two groups.
No significant side effects or adverse reactions were seen due to hormone
therapy. Intubation time, ICU stay, and VIS values were significantly
shorter between the two groups. Conclusion(s): In children undergoing
cardiac surgery with CPB, perioperative oral small-dose triiodothyronine
therapy could improve clinical indices of perioperative
care. Copyright © 2020 IOP Publishing Ltd

<71>
Accession Number
2010354953
Title
Sex and transcatheter aortic valve implantation: Impact of female sex on
clinical outcomes.
Source
Interventional Cardiology Review. 14 (3) (pp 137-141), 2019. Date of
Publication: December 2019.
Author
Laricchia A.; Bellini B.; Romano V.; Khawaja S.; Montorfano M.; Chieffo A.
Institution
(Laricchia) Interventional Cardiology Unit, GVM Care and Research, Maria
Cecilia Hospital, Cotignola, Italy
(Laricchia, Bellini, Romano, Khawaja, Montorfano, Chieffo) Interventional
Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
Publisher
Radcliffe Cardiology
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an
alternative treatment for severe symptomatic aortic stenosis in patients
who are not suitable for surgery or are at high surgical risk.
Approximately 50% of patients undergoing TAVI are female and this is
reflected by a higher inclusion rate of women in TAVI trials. However,
women undergoing TAVI have different baseline clinical characteristics in
comparison to men, with fewer comorbidities and a more preserved left
ventricular ejection fraction. This translates into favourable outcomes
after TAVI, despite a higher rate of peri-procedural complications. This
article discusses gender differences in terms of presentation, procedural
characteristics and post-procedural results in patients with aortic
stenosis undergoing TAVI, with particular focus on possible sex-specific
factors affecting outcome. Copyright © 2019 Radcliffe Group Ltd.
All rights reserved.

<72>
Accession Number
633850367
Title
Does routine topical antimicrobial administration prevent sternal wound
infection after cardiac surgery?.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 452-456),
2021. Date of Publication: 08 Apr 2021.
Author
Magro P.L.; Sousa Uva M.
Institution
(Magro, Sousa Uva) Department of Cardio-thoracic Surgery, Hospital de
Santa Cruz, Carnaxide, Portugal
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does routine topical
antimicrobial administration prevent sternal wound infection (SWI) after
cardiac surgery? Altogether >238 papers were found using the reported
search, of which 11 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. Several different antimicrobial agents, dosages and
application protocols were found in the literature. Regarding topical
vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76%
risk reduction in any SWI. Collagen-gentamicin sponge application was
associated with a 38% risk reduction in SWI in another meta-analysis by
Kowalewski et al., which included 4 randomized control trials and >23 000
patients. Lower evidence observational studies found benefit in the use of
different regimes, including: combination of vancomycin paste and
subcutaneous gentamycin; combined cefazoline and gentamicin spray;
isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We
conclude that, in light of the body of evidence available, topical
antibiotic application prevents SWI, including both superficial and deep
SWI. The strongest evidence, derived from 2 meta-analyses, is related to
the use of gentamicin-collagen sponges and topical vancomycin.
Heterogeneity throughout studies regarding antibiotic agents, dosages,
application protocols and SWI definition makes providing general
recommendations challenging. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<73>
Accession Number
633663479
Title
In patients undergoing coronary artery bypass grafting, is endoscopic
harvesting superior to open radial artery harvesting?.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 447-451),
2021. Date of Publication: 08 Apr 2021.
Author
Lei J.J.H.; Ravendren A.; Snosi M.; Harky A.
Institution
(Lei, Ravendren) School of Medicine, Imperial College London, London,
United Kingdom
(Snosi, Harky) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Health and Life
Science, University of Liverpool, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, Liverpool Heart and
Chest Hospital and University of Liverpool, Liverpool, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In patients undergoing
coronary artery bypass grafting, is endoscopic radial artery harvesting
(ERAH) superior to open radial artery harvesting in terms of postoperative
complications, mortality, graft quality and patency rates?'. Altogether
130 papers were found using the reported search, of which 5 represented
the best evidence to answer the clinical question. Two studies were
meta-analyses and 3 were randomized trials. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. In terms of graft
quality, 2 randomized studies showed preserved endothelial integrity and
vasoreactivity with ERAH, whereas 1 randomized study found superior
endothelial function with open radial artery harvesting. Importantly, 3
studies showed graft patency was not compromised with ERAH. One
meta-analysis reported no differences in graft patency between groups at
1year [odds ratio (OR) 1.24] and up to 3-5-years follow-up (OR 1.81), as
well as similar perioperative myocardial infarction rates (OR 0.80). Two
meta-analyses found similar mortality in the perioperative period (OR
0.62-0.78) and up to 5years (OR 0.64-0.67); ERAH reduced the incidence of
perioperative wound complications (P-values 0.001-0.03); however, harvest
times were increased with ERAH (P < 0.0005). We conclude that ERAH is
non-inferior to open radial artery harvesting in terms of mortality, graft
quality and patency rates, but superior in terms of reducing perioperative
wound complications, with good cosmetic effect. However, these benefits
come at the cost of increased harvesting time. Copyright © The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<74>
Accession Number
633570710
Title
A systematic review of risk prediction models for perioperative mortality
after thoracic surgery.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 333-342),
2021. Date of Publication: 08 Apr 2021.
Author
Taylor M.; Hashmi S.F.; Martin G.P.; Shackcloth M.; Shah R.; Booton R.;
Grant S.W.
Institution
(Taylor, Hashmi, Shah) Department of Cardiothoracic Surgery, Wythenshawe
Hospital, Manchester University Hospital Foundation Trust, Manchester,
United Kingdom
(Martin) Division of Informatics, Imaging and Data Science, Faculty of
Biology, Medicine and Health, Manchester Academic Heath Science Centre,
University of Manchester, Manchester, United Kingdom
(Shackcloth) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Booton) Department of Respiratory Medicine, Wythenshawe Hospital,
Manchester University Hospital Foundation Trust, Manchester, United
Kingdom
(Grant) Division of Cardiovascular Sciences, University of Manchester,
ERC, Manchester University Hospitals Foundation Trust, Manchester, United
Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Guidelines advocate that patients being considered for
thoracic surgery should undergo a comprehensive preoperative risk
assessment. Multiple risk prediction models to estimate the risk of
mortality after thoracic surgery have been developed, but their quality
and performance has not been reviewed in a systematic way. The objective
was to systematically review these models and critically appraise their
performance. METHOD(S): The Cochrane Library and the MEDLINE database
were searched for articles published between 1990 and 2019. Studies that
developed or validated a model predicting perioperative mortality after
thoracic surgery were included. Data were extracted based on the checklist
for critical appraisal and data extraction for systematic reviews of
prediction modelling studies. RESULT(S): A total of 31 studies
describing 22 different risk prediction models were identified. There were
20 models developed specifically for thoracic surgery with two developed
in other surgical specialties. A total of 57 different predictors were
included across the identified models. Age, sex and pneumonectomy were the
most frequently included predictors in 19, 13 and 11 models, respectively.
Model performance based on either discrimination or calibration was
inadequate for all externally validated models. The most recent data
included in validation studies were from 2018. Risk of bias (assessed
using Prediction model Risk Of Bias ASsessment Tool) was high for all
except two models. CONCLUSION(S): Despite multiple risk prediction
models being developed to predict perioperative mortality after thoracic
surgery, none could be described as appropriate for contemporary thoracic
surgery. Contemporary validation of available models or new model
development is required to ensure that appropriate estimates of operative
risk are available for contemporary thoracic surgical
practice. Copyright © The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<75>
Accession Number
633507094
Title
Mitral valve surgery after a failed MitraClip procedure.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 380-385),
2021. Date of Publication: 08 Apr 2021.
Author
Melillo F.; Baldetti L.; Beneduce A.; Agricola E.; Margonato A.; Godino C.
Institution
(Melillo, Baldetti, Beneduce, Agricola, Margonato, Godino)
Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
(Agricola, Margonato) Vita-Salute San Raffaele University, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Among patients undergoing transcatheter mitral valve repair
with the MitraClip device, a relevant proportion (2-6%) requires open
mitral valve surgery within 1year after unsuccessful clip implantation.
The goal of this review is to pool data from different reports to provide
a comprehensive overview of mitral valve surgery outcomes after the
MitraClip procedure and estimate in-hospital and follow-up mortality.
 METHOD(S): All published clinical studies reporting on surgical
intervention for a failed MitraClip procedure were evaluated for inclusion
in this meta-analysis. The primary study outcome was in-hospital
mortality. Secondary outcomes were in-hospital adverse events and
follow-up mortality. Pooled estimate rates and 95% confidence intervals
(CIs) of study outcomes were calculated using a DerSimionian-Laird binary
random-effects model. To assess heterogeneity across studies, we used the
Cochrane Q statistic to compute I2 values. RESULT(S): Overall, 20
reports were included, comprising 172 patients. Mean age was 70.5years
(95% CI 67.2-73.7years). The underlying mitral valve disease was
functional mitral regurgitation in 50% and degenerative mitral
regurgitation in 49% of cases. The indication for surgery was persistent
or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas
6% of patients presented with mitral stenosis. At the time of the
operation, 80% of patients presented in New York Heart Association
functional class III-IV. Despite favourable intraoperative results,
in-hospital mortality was 15%. The rate of periprocedural cerebrovascular
accidents was 6%. At a mean follow-up of 12months, all-cause death was
26.5%. Mitral valve replacement was most commonly required because the
possibility of valve repair was jeopardized, likely due to severe valve
injury after clip implantation. CONCLUSION(S): Surgical intervention
after failed transcatheter mitral valve intervention is burdened by high
in-hospital and 1-year mortality, which reflects reflecting the high-risk
baseline profile of the patients. Mitral valve replacement is usually
required due to leaflet injury. Copyright © The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<76>
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.

<77>
Accession Number
2010403630
Title
Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood
Cardioplegia: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 30 (5) (pp 642-655), 2021. Date of
Publication: May 2021.
Author
Misra S.; Srinivasan A.; Jena S.S.; Bellapukonda S.
Institution
(Misra, Jena, Bellapukonda) Department of Anesthesiology and Critical
Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar,
Odisha, India
(Srinivasan) Department of Pharmacology, All India Institute of Medical
Sciences (AIIMS), Bhubaneswar, Odisha, India
Publisher
Elsevier Ltd
Abstract
Background: Myocardial protection in adult cardiac surgery is commonly
achieved with either multidose blood cardioplegia or single-dose del Nido
crystalloid cardioplegia. Aim(s): The aim of this systematic review
and meta-analysis was to compare the outcomes of del Nido cardioplegia
versus blood cardioplegia in adult cardiac surgery. Method(s): All
English-language articles were searched in MEDLINE (PubMed), the Cochrane
Central Register of Controlled Trials (CENTRAL), and Google Scholar up to
March 2020, to identify randomised control trials, prospective
observational studies, and retrospective analyses (with or without
propensity matching) reporting any or all of the primary and secondary
endpoints. The primary endpoint was all-cause mortality. Secondary
endpoints included cardiopulmonary bypass (CPB) and aortic cross-clamp
(AoX) time; cardioplegia volume; need for defibrillation after AoX
release; intraoperative glucose; postoperative myocardial enzyme release;
postoperative left ventricular ejection fraction (LVEF); incidence of
postoperative acute kidney injury (AKI), atrial fibrillation (AF), stroke,
and low cardiac output syndrome (LCOS); postoperative blood transfusion;
duration of mechanical ventilation; and length of intensive care unit
(ICU) and hospital stay. Result(s): Twenty-nine (29) studies were
included. There was no difference in the primary outcome of mortality
between the two groups (odds ratio [OR], 1.18; 95% confidence interval
[CI], 0.82-1.72 [p=0.37]). del Nido cardioplegia was associated with
significantly shorter CPB (mean difference [MD], -7.42 minutes; 95% CI,
-12.53 to -2.31 [p=0.004]) and AoX times (MD, -6.39 minutes; 95% CI,
-10.30 to -2.48 [p=0.001]), and lower cardioplegia volumes. Significantly
fewer patients required defibrillation after AoX release in the del Nido
group. Intraoperative glucose homeostasis was better preserved in the del
Nido group. Postoperative cardiac troponin T release and the number of
patients needing transfusions were less in the del Nido group. No
differences were seen in postoperative LVEF, or in the incidence of AKI,
stroke, AF, and LCOS. Duration of mechanical ventilation, and length of
ICU and hospital stay were similar. Conclusion(s): Although this
meta-analysis failed to find any mortality benefits with del Nido
cardioplegia, significant benefits were seen in a number of intraoperative
and postoperative variables. del Nido cardioplegia is a safe and
favourable alternative to blood cardioplegia in adult cardiac
surgery. Copyright © 2020 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<78>
Accession Number
2008398361
Title
Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity
Score Analysis.
Source
Heart Lung and Circulation. 30 (5) (pp 758-764), 2021. Date of
Publication: May 2021.
Author
Ali U.S.; Lan N.S.R.; Gilfillan M.; Ho K.; Pavey W.; Dwivedi G.; Slimani
E.K.; Edelman J.; Merry C.; Larbalestier R.
Institution
(Ali, Gilfillan, Pavey, Slimani, Edelman, Merry, Larbalestier) Department
of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia
(Lan, Dwivedi) Department of Cardiology, Fiona Stanley Hospital, Perth,
WA, Australia
(Ho) Medical School, University of Western Australia, School of Veterinary
& Life Sciences, Murdoch University and Intensive Care Unit, Royal Perth
Hospital, Perth, WA, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: The role of intra-aortic balloon pumps (IABP) in high-risk
patients undergoing coronary artery bypass graft (CABG) surgery remains
controversial. We report the 5-year experience from a new Australian
centre. Method(s): We retrospectively analysed 690 patients
undergoing urgent isolated CABG surgery at a Western Australian tertiary
centre from February 2015 to May 2020. De-identified data was obtained
from the Australia & New Zealand Society of Cardiothoracic Surgeons
database. Patients were stratified according to preoperative IABP use. A
propensity score was created for the probability of IABP use and a
propensity adjusted analysis was performed using logistic regression. The
primary outcome was 30-day mortality. Secondary outcomes were
postoperative inhospital outcomes. Result(s): Preoperative IABP was
used in 78 patients (11.3%). After propensity score adjustment, in a
subgroup of patients with reduced ejection fraction or left main disease,
30-day mortality (7.0% vs 2.0%, OR 6.03, 95% CI 1.89-19.28, p=0.002) was
significantly higher in the IABP group. Red blood cell transfusions (19.7%
vs 12.6%, OR 1.86, 95% CI 1.02-3.35, p=0.039), prolonged inotrope use
(78.9% vs 50.9%, OR 6.11, 95% CI 2.77-13.48, p<0.001), prolonged invasive
ventilation (28.2% vs 3.4%, OR 20.2, 95% CI 8.24-49.74, p<0.001),
mesenteric ischaemia (2.8% vs 0%, OR 4.52, 95% CI 1.15-17.77, p=0.031) and
multisystem organ failure (1.3% vs 0.7%, OR 25.68, 95% CI 2.55-258.34,
p=0.006) were significantly higher in the IABP group. Conclusion(s):
In patients undergoing isolated CABG surgery, preoperative IABP use was
associated with increased 30-day mortality and adverse outcomes. Large
randomised controlled trials are required to confirm our
findings. Copyright © 2020

<79>
Accession Number
2004261542
Title
The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ
Transplant Recipients.
Source
Sexual Medicine Reviews. 9 (2) (pp 331-339), 2021. Date of Publication:
April 2021.
Author
Payne K.; Popat S.; Lipshultz L.I.; Thirumavalavan N.
Institution
(Payne) Baylor College of Medicine, Houston, TX, United States
(Popat, Lipshultz) Scott Department of Urology, Baylor College of
Medicine, Houston, TX, United States
(Thirumavalavan) Urology Institute, University Hospitals/Case Western
Reserve University School of Medicine, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Erectile dysfunction (ED) is a prevalent and
under-recognized complaint among male solid organ transplant recipients.
Most research on this topic has focused on kidney transplant recipients
alone. In this review, we integrate current research on ED across all
types of solid organ transplant recipients and assess the success of
current methods of ED treatment in transplant populations. Aim(s): To
review the current literature addressing the prevalence and treatment of
ED in the male solid organ transplant population. Method(s): A
literature search was conducted using PubMed to identify relevant studies.
Search terms included "organ transplant" and "erectile dysfunction."
Titles and abstracts were reviewed for relevance. References from
identified articles were also searched and included, if appropriate.
 Main Outcome Measure(s): Review of peer-reviewed literature.
 Result(s): The prevalence of ED among transplant recipients is higher
than that in the general population: 39.8-86.2% in liver transplant
recipients, 54-66% in renal transplant recipients, 71-78% in heart
transplant recipients, and 79% in simultaneous pancreas-kidney transplant
recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in
treating ED in kidney transplant recipients. Intracavernosal injections
have been used with success rates of 60-70% in cardiac and renal
transplant recipients. Penile prostheses have also been shown to be safe
and effective across transplant types. A low incidence of infection has
been reported in several case series, although there is concern for an
increased rate of mechanical complications in pelvic organ transplant
recipients. Accordingly, placement of a two-piece or malleable prosthesis
or ectopic reservoir placement with a three-piece inflatable prosthesis is
suggested in this population. Conclusion(s): ED is highly prevalent
among male solid organ transplant recipients and should be routinely
screened in this population. Current modalities of ED treatment used in
the general population are safe and effective in solid organ transplant
recipients, although success rates are often lower than those in the
general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence
and Treatment of Erectile Dysfunction in Male Solid Organ Transplant
Recipients. Sex Med Rev 2021;9:331-339. Copyright © 2019
International Society for Sexual Medicine

<80>
Accession Number
632091991
Title
Association of poor sleep quality with risk factors after coronary artery
bypass graft surgery-A prospective cohort study.
Source
Journal of vascular nursing : official publication of the Society for
Peripheral Vascular Nursing. 38 (2) (pp 83-92), 2020. Date of Publication:
01 Jun 2020.
Author
Muthukrishnan A.; Muralidharan T.R.; Subash J.; Lathamangeswari C.
Institution
(Muthukrishnan) School of Nursing, College of Pharmacy and Nursing,
University of Nizwa, Sultanate of Oman
(Muralidharan) Professor & Head, Department of Cardiology, Sri Ramachandra
Institute of Higher Education & Research (Deemed to be University),
Chennai, Tamil Nadu, India
(Subash) Principal, Rani Meyyammai College of Nursing, Annamalai
University, Chidambaram, Tamil Nadu, India
(Lathamangeswari) Principal, Jothi College of Management Science &
Technology, Bareilly, India
Publisher
NLM (Medline)
Abstract
Fragmented sleep is a daunting experience and a common health problem with
high prevalence among patients 3 months after coronary artery bypass
grafting (CABG). However, the potential predictors on poor seep quality
remains unexplored. The main purpose of this study was to determine the
predictors of poor sleep quality among patients 3 months after CABG. A
prospective cohort study is a part of the randomized controlled trial
between 2012 and 2013 in which 400 adult patients undergoing elective CABG
were being randomly sampled as per the inclusion criteria followed up at 3
months after CABG surgery in the cardiovascular outpatient clinic of a
tertiary-care hospital. The study was conducted according to the
Declaration of Helsinki and was approved by the institutional ethical
committee. All participants gave written informed consent on having
received detailed information on the study. Demographic and clinical data
were obtained from medical records at the time of CABG. The data on sleep
quality were collected by using the Pittsburgh Sleep Quality Index and
state anxiety was evaluated utilizing state-trait anxiety inventory
(STAI-YI fo3rm). Multivariable logistic regression examined the
association between the postoperative poor sleep quality and clinical,
preoperative state anxiety, and angina. The significant variables are
chosen based on the P-value associated with the significant level of model
that lies on alpha = 0.05. Logit determination and the correlation between
the variables are also discussed for further analysis. A total of 187
patients (mean age 55.6 +/- 12.05 years) completed the questionnaire. Most
patients (78%) reported poor sleep quality (4.23 +/- 1.24) (PQSI score of
less than 5). There was a strong relationship between PQSI and state
anxiety. The higher state anxiety among 68% of patients with the mean
score (53.51 +/- 9.55) had 6.42 (95% CI 3.04-9.61) times the odds of being
classified as high risk for sleep disturbance. There are 3 factors that
most significant of the 8 factors tested were identified as having
influence significantly on the poor sleep quality. These factors are
diabetes (OR 1.186, 95% CI 1.016-1.097, P > .01), body mass index > 30
kg/m2 (OR 2.36, 95% CI 1.041-1.172, P > .05), sedentary lifestyle (OR
1.091, 95% CI 1.016-1.159, P > .01), and preoperative state anxiety (OR
1.186, 95% CI 1.074-1.115, P > .01). Even though the body mass index>30
kg/m2, sedentary lifestyle, and diabetes were significantly associated
with sleep quality, the only factor with more significantly related to
poor sleep quality was preoperative state anxiety which is the strong
predictor of poor sleep quality. Hence, early recognition of predictors
and careful management of poor sleep quality is warranted. Copyright
© 2020 Society for Vascular Nursing. Published by Elsevier Inc. All
rights reserved.

<81>
Accession Number
634770934
Title
A new role for circulatory support devices to limit ischaemia-reperfusion
injury.
Source
Interventional Cardiology Review. Conference: 5th Annual Acute Cardiac
Unloading and Recovery Symposium, A-CURE 2020. Virtual. 16 (SUPPL 2) (pp
8-9), 2021. Date of Publication: 2021.
Author
Kapur N.
Institution
(Kapur) The CardioVascular Center for Research and Innovation, Tufts
Medical Center, Boston, MA, United States
Publisher
Radcliffe Cardiology
Abstract
Dr Kapur began his talk by describing the global burden of heart failure
(HF), which affects over 23 million individuals worldwide. Acute
decompensated HF is currently the leading cause of hospital admissions and
rehospitalisation for persons over the age of 65 years in the US.1,2
Approximately 1.8 million people are admitted for HF each year, with
annual treatment and readmission costs of US$31 billion and US$7 billion,
respectively.3-6 Patients who have a heart attack are at high risk for
developing HF, generating a major healthcare burden. Rapid coronary
reperfusion or opening a blocked artery after acute MI can reduce the risk
of HF. However, the size of the infarct impacts the magnitude of potential
benefit from reperfusion. Larger infarcts drive mortality and HF. Data
from patients receiving primary reperfusion after a heart attack indicate
that 18% of total left ventricular mass remains infarcted after
reperfusion.7 The same dataset also demonstrated that 1-year all-cause
mortality and hospitalisation for HF increase by approximately 20% for
every 5% increase in myocardial infarct size. Time to treatment is also
critical for ST-segment elevation MI (STEMI). Every minute of delay from
symptoms of chest pain to the point that a coronary artery is opened with
angioplasty counts towards mortality, as well as infarct size. Every
30-minute delay in total ischaemic time, or time from symptom onset to
reperfusion, is associated with a 7.5% increase in 1-year mortality and a
30% increase in infarct size.8,9 Rapid reperfusion is one option to try to
terminate ischaemic injury, yet may contribute to approximately 50% of
myocardial damage in the setting of a heart attack.10 As a result, a
significant volume of research has been conducted to identify the
molecular mechanism(s) of reperfusion injury. Activation of the
reperfusion injury salvage kinase and survivor activating factor
enhancement signalling pathways prevents reperfusion injury in cardiac
muscle cells by protecting mitochondria.11 Mitochondria provide energy to
the cell, thus protection of mitochondria prevents energy loss and
subsequent cell death. Ischaemia disrupts these pathways, reducing
mitochondrial structural and functional integrity to produce reperfusion
injury.12 Clinical trials to identify cardioprotective pharmacological
agents targeting the ischaemia-reperfusion injury cascade remain
inconclusive.13 Dr Kapur's research hypothesis is that primary mechanical
unloading could be a potential cardioprotective strategy to reduce
ischaemia-reperfusion injury. In the past 15 years, his team demonstrated
that mechanical devices, such as the Impella CP transvalvular pump, unload
the heart, decreasing stress during a heart attack and reduce infarct size
by approximately 50% in preclinical models. Dr Kapur also demonstrated
that 30 minutes of left ventricular (LV) unloading before reperfusion is
necessary and sufficient to reduce infarct size.14 In addition, a
meta-analysis of preclinical studies from around the world over the past
40 years established that LV unloading reduces infarct size using a
variety of different pump configurations.15 Reperfusion without unloading
is the current MI standard of care. Dr Kapur's STEMI-Door-to-Unload (DTU)
pilot clinical trial was designed to assess whether mechanical unloading
for 30 minutes prior to reperfusion would increase or decrease infarct
size.16 Fifty anterior STEMI patients received an Impella CP device to
assess device safety and feasibility during a heart attack. The patients
were randomised to receive unloading with immediate reperfusion or
unloading for 30 minutes prior to reperfusion. The results confirmed the
safety, feasibility and technical performance of the Impella CP in STEMI
patients, and demonstrated that unloading with delayed reperfusion by 30
minutes limits infarct size, irrespective of the MI area at risk.
Additional data from the STEMI-DTU pilot trial indicated that mechanical
unloading reduces myocardial ischaemia prior to reperfusion. Increased
exposure time to unloading prior to reperfusion time correlated with a
decrease in infarct size in patients with large anterior MI.16,17 These
data correlate with anecdotal evidence of chest pain resolution and
decreased ST-segment elevation after mechanical unloading. These
encouraging data from the STEMI-DTU pilot trial enabled the initiation of
Dr Kapur's currently enrolling STEMI-DTU pivotal randomised clinical trial
to compare the impact of unloading and delayed reperfusion against
reperfusion without unloading on infarct size in a larger patient
population. Dr Kapur's team is currently investigating the mechanism by
which LV unloading improves blood flow, reduces ischaemic injury and
protects cell function to promote heart recovery after infarction.
Hypoxia, or lack of oxygen, characterises the ischaemic phase of a heart
attack before reperfusion. Dr Kapur's team demonstrated that, LV unloading
with Impella CP prior to reperfusion in a preclinical ischaemic model of
coronary artery occlusion, improves myocardial oxygen delivery by
decreasing levels of hypoxia-inducible factor-1 alpha.17 Further data,
pending publication, indicate that mechanical unloading reduces infarct
size, both with and without subsequent reperfusion. Mitochondrial function
is also improved with or without reperfusion, as indicated by retention of
mitochondrial structural integrity, increased levels of critical complex I
proteins, increased adenosine triphosphate production and stabilised
calcium handling.17 LV unloading also increases microcirculatory
collateral flow and reduces the area at risk in acute MI models
pre-reperfusion.1 Interestingly, the protective effects of mechanical
unloading against ischaemia-reperfusion injury differ according to pump
type. Comparison of the Impella CP transvalvular pump to the venoarterial
(VA)-extracorporeal membrane oxygenation (ECMO) pump demonstrated that use
of ECMO was associated with increased infarct size and did not provide
mitochondrial structural protection prior to reperfusion.17 This suggests
that transvalvular unloading with Impella protects mitochondrial function
in acute MI, whereas VA-ECMO does not. Unpublished data from Dr Kapur's
laboratory, in collaboration with Dr Divaka Perrara, also suggest that
VA-ECMO decreases coronary blood flow and increases myocardial oxygen
consumption, resulting in increased infarct size, vascular pressure,
vascular injury and poor myocardial recovery. Dr Kapur's laboratory will
continue to advance the field of mechanical circulatory support and LV
unloading as a vital approach to prevent ischaemia-reperfusion injury. At
the forefront of these efforts is the STEMI-DTU pivotal trial, a landmark
study to further understand the benefits of transvalvular unloading in
patients with acute MI.

<82>
[Use Link to view the full text]
Accession Number
634767644
Title
Comparison of cisatracurium versus rocuronium on time to extubation in
post-cabg patients.
Source
Critical Care Medicine. Conference: 50th Critical Care Congress. Virtual.
49 (1 SUPPL 1) (pp 265), 2021. Date of Publication: January 2021.
Author
Ragoonanan D.; Allen B.; Cannon C.; Forsyth R.
Institution
(Ragoonanan) Tampa General Hospital, Tampa, FL, United States
(Allen, Cannon) JacksonvilleFLUnited States
(Forsyth) Ascension St. Vincent's, Jacksonville, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cisatracurium and rocuronium are neuromuscular blockers
which act on nicotinic receptors thereby inhibiting action potential
depolarization. Cisatracurium has been shown to have faster recovery
compared to rocuronium, possibly due to the shorter half-life and
metabolism via Hoffman elimination. Evidence suggests that mechanical
ventilation may be the strongest predictor of mortality among patients
undergoing coronary artery bypass graft (CABG) surgery (p=0.0001). The
purpose of this study was to evaluate the impact of cisatracurium versus
rocuronium on ventilation duration in patients undergoing CABG procedures.
 METHOD(S): This single-centered, retrospective, observational study
was conducted at Ascension St. Vincent's. Adults admitted from July 1,
2019 to February 29, 2020 undergoing CABG were evaluated. The primary
outcome evaluated the time-to-extubation. Secondary outcomes included ICU
length of stay (LOS) and proportion of patients extubated within 6 hours
and 24 hours from the start of anesthesia. Safety outcomes included the
incidence of bradycardia (HR < 50 beats/minute) and aspiration pneumonia.
A post-hoc analysis was conducted to determine the impact of anesthesia
duration on ventilator duration. RESULT(S): A total of 212 patients
were identified for inclusion in this cohort; 110 subjects received
cisatracurium and 112 subjects received rocuronium. Time-to-extubation was
similar when comparing cisatracurium and rocuronium (8.82 hours vs 9.32
hours; p=0.114). In addition, cisatracurium was not associated with a
significantly shorter ICU length of stay compared to rocuronium (68 hours
vs 87 hours; p=0.378). However, the post-hoc analysis showed a
significantly shorter anesthesia duration in the cisatracurium group (3.78
vs 4.53; p=0.004). Furthermore, anesthesia duration was shown to have a
directly proportional association with ventilator duration. No significant
adverse events were reported. CONCLUSION(S): Cisatracurium did not
have significant reductions in time-to-extubation or ICU length of stay
when compared to rocuronium. Cisatracurium was associated with decreased
anesthesia duration which was independently associated with reduced
time-to-extubation. Therefore, a larger, randomized controlled study may
be needed to identify the impact of cisatracurium on ventilation duration.

<83>
[Use Link to view the full text]
Accession Number
634766336
Title
Acute airway obstruction due to endotracheal clot following inhaled
tranexamic acid.
Source
Critical Care Medicine. Conference: 50th Critical Care Congress. Virtual.
49 (1 SUPPL 1) (pp 505), 2021. Date of Publication: January 2021.
Author
Espinosa R.; Soriano S.M.
Institution
(Espinosa, Soriano) University of Illinois, College of Medicine at Peoria,
Peoria, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic agent used to
control bleeding. Typically, it is used orally or intravenously. After a
few positive case reports/series, topical, or inhaled, application of TXA
has seen an increase in use. Recently, a randomized controlled trial (RCT)
of 47 patients comparing inhaled TXA 500mg TID vs saline demonstrated
faster resolution of hemoptysis and shorter hospital stay. Subsequently, a
meta-analysis of 4 RCTs did not demonstrate a difference in bleeding
duration or resolution, but did show improvements in bleeding volume,
hospital stay and need for further intervention. So far, complications
following inhaled TXA have not been well documented. We describe a case of
acute airway obstruction following inhaled TXA administration.
 METHOD(S): A 34-year-old male with history of tracheostomy dependence
from chronic respiratory failure due to Duchenne Muscular Dystrophy
presented with large volume hemoptysis. Family reported frequent at home
tracheostomy changes and suctioning recently. He was admitted to the ICU
for respiratory monitoring and required red blood cell transfusion for a
hemoglobin of 5.9. A CT angiogram ruled out tracheoinnominate arterial
fistula. Due to persistent hemoptysis inhaled TXA 500mg TID was
prescribed. Immediately following the initial TXA treatment, the patient
reported an increase in dyspnea. An emergent bronchoscopy was performed
which revealed a near circumferential endotracheal clot 2cm below level of
tracheostomy, and the decision was made to not advance past the clot to
avoid risk of spontaneous mucosal rupture. With the assistance from
cardiothoracic surgery, an 18-French catheter was used to suction out the
clot and the patient experienced immediately relief. The most likely cause
of hemoptysis was bronchial vessel erosion from frequent tracheostomy
changes and suctioning. RESULT(S): The increasing use of inhaled TXA
for massive hemoptysis has demonstrated benefit. However, complications
not been fully characterized. This case describes a potentially
life-threatening complication of inhaled TXA, which may prove difficult to
distinguish clinically from the symptoms of hemoptysis itself. Therefore,
we advocate for the administration of TXA only where emergent therapeutic
bronchoscopy can be performed.

<84>
Accession Number
2011687821
Title
Global prevalence and predictors of postoperative delirium among
non-cardiac surgical patients: A systematic review and meta-analysis.
Source
International Journal of Surgery Open. 32 (no pagination), 2021. Article
Number: 100334. Date of Publication: May 2021.
Author
Abate S.M.; Checkole Y.A.; Mantedafro B.; Basu B.; Aynalem A.E.
Institution
(Abate, Basu) Department of Anesthesiology, College of Health Sciences and
Medicine, Dilla University, Dilla, Ethiopia
(Checkole, Aynalem) Department of Mental Health and Psychiatry, College of
Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
(Mantedafro) Department of Internal Medicine, College of Health Sciences
and Medicine, Dilla University, Dilla, Ethiopia
Publisher
Elsevier Ltd
Abstract
Background: Postoperative delirium is a recent health problem among the
elderly which is associated with delayed functional recovery, longer
hospital stays, increased morbidity and mortality, and incurs a
significant financial cost. Body of evidence is lacking on the global
prevalence of postoperative delirium and its determinants. Therefore, this
study aimed to provide evidence on the prevalence of postoperative
delirium. Method(s): A comprehensive search was conducted in
PubMed/Medline; Science direct and LILACS from December 2010 to August
2020 without language restriction. The Heterogeneity among the included
studies was checked with forest plot, chi2 test, I2 test, and the
p-values. All observational studies reporting the prevalence of
postoperative delirium were included. Result(s): A total of 930
articles were identified from different databases and 70 articles were
selected for evaluation after the successive screening. Forty-three
articles with 13,179 participants were included. The Meta-Analysis
revealed that the global prevalence of postoperative delirium was 20% (95%
confidence interval (CI):17 to 24). The systematic review showed that
postoperative delirium was approximately 3 times more likely in patients
undergoing surgery under general anesthesia, OR = 2.68 (95% confidence
interval (CI): 1.10 to 6.54). Conclusion(s): The Meta-Analysis
revealed that postoperative delirium among surgical patients is strongly
associated with different modifiable risk factors. Therefore, the
perioperative mitigating strategic protocol should be employed to prevent
postoperative delirium and its undesirable outcomes. Registration: This
systematic review and meta-analysis was registered research registry with
the registration number (UIN: reviewregistry979). Copyright ©
2021 The Author(s)

<85>
Accession Number
2011661723
Title
Tailored anaesthesia for thoracoscopic surgery promoting enhanced
recovery: The state of the art.
Source
Anaesthesia Critical Care and Pain Medicine. 40 (2) (no pagination), 2021.
Article Number: 100846. Date of Publication: April 2021.
Author
Elsayed H.H.; Moharram A.A.
Institution
(Elsayed) Thoracic Surgery Department, Ain Shams University, Cairo, Egypt
(Moharram) Department of Anaesthesia, Intensive Care and Pain Management,
Ain Shams University, Cairo, Egypt
Publisher
Elsevier Masson s.r.l.
Abstract
Purpose of the review: The current review focuses on precise anaesthesia
for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced
recovery. The main aim of an enhanced recovery program after thoracic
surgery is to reduce postoperative stress response, protect from
postoperative pulmonary complications, give hospitals a better financial
option and improve overall patient outcome. This can ultimately reduce
hospital stay and increase patient satisfaction. With advances in
endoscopic, robotic and endovascular techniques, video-assisted
thoracoscopic surgery (VATS) can be performed in a minimally invasive way
in managing most pulmonary, pleural and mediastinal diseases. As a
minimally invasive technique, video-assisted thoracoscopic surgery (VATS)
represents an important element of enhanced recovery program in thoracic
surgery as it can achieve most of its goals. Anaesthetic management during
preoperative, intraoperative and postoperative period is essential for the
establishment of a successful enhanced recovery program. In the era of
enhanced recovery protocols, non-intubated thoracoscopic procedures
present a step forward. This article focuses on the key anaesthetic
elements of the enhanced recovery program during all phases of
thoracoscopic surgery. Having reviewed recent literature, a systematic
review of literature will highlight successful ERAS protocols published
for thoracoscopic surgery. Copyright © 2021 Societe francaise
d'anesthesie et de reanimation (Sfar)

<86>
Accession Number
2011659251
Title
Mucormycosis after Coronavirus disease 2019 infection in a heart
transplant recipient - Case report and review of literature.
Source
Journal of Medical Mycology. 31 (2) (no pagination), 2021. Article Number:
101125. Date of Publication: June 2021.
Author
Khatri A.; Chang K.-M.; Berlinrut I.; Wallach F.
Institution
(Khatri, Chang, Berlinrut, Wallach) Division of Infectious Diseases,
Department of Medicine, Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell Health, 400 Community Drive, Infectious Diseases Suite,
Manhasset, NY 11030, United States
Publisher
Elsevier Masson s.r.l.
Abstract
Mucormycosis is an invasive fungal infection (IFI) due to several species
of saprophytic fungi, occurring in patients with underlying co-morbidities
(including organ transplantation). During the ongoing Coronavirus disease
2019 (COVID-19) pandemic, there have been increasing reports of bacterial
and fungal co-infections occurring in COVID-19 patients, including
COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of
mucormycosis occurring after COVID-19, in an individual who received a
recent heart transplant for severe heart failure. Two months after heart
transplant, our patient developed upper respiratory and systemic symptoms
and was diagnosed with COVID-19. He was managed with convalescent plasma
therapy and supportive care. Approximately three months after COVID-19
diagnosis, he developed cutaneous mucormycosis at an old intravascular
device site. He underwent extensive surgical interventions, combined with
broad-spectrum antifungal therapy. Despite the aggressive therapeutic
measures, he died after a prolonged hospital stay. In this case report, we
also review the prior well-reported cases of mucormycosis occurring in
COVID-19 patients and discuss potential mechanisms by which COVID-19 may
predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need
to be evaluated as an emerging disease association. Clinicians should be
vigilant to evaluate for invasive fungal infections such as mucormycosis
in patients with COVID-19 infection. Copyright © 2021 Elsevier
Masson SAS

<87>
[Use Link to view the full text]
Accession Number
2011109567
Title
Mitral valve surgery: current status and future prospects of the minimally
invasive approach.
Source
Expert Review of Medical Devices. (no pagination), 2021. Date of
Publication: 2021.
Author
Van Praet K.M.; Kempfert J.; Jacobs S.; Stamm C.; Akansel S.; Kofler M.;
Sundermann S.H.; Nazari Shafti T.Z.; Jakobs K.; Holzendorf S.; Unbehaun
A.; Falk V.
Institution
(Van Praet, Kempfert, Jacobs, Stamm, Akansel, Kofler, Sundermann, Nazari
Shafti, Unbehaun, Falk) Department of Cardiothoracic and Vascular Surgery,
German Heart Center Berlin, Berlin, Germany
(Van Praet, Kempfert, Sundermann, Nazari Shafti, Unbehaun, Falk) German
Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin,
Germany
(Sundermann, Falk) Department of Cardiothoracic Surgery, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Nazari Shafti, Falk) Berlin Institute of Health (BIH), Berlin, Germany
(Jakobs) Institute for Anesthesiology, German Heart Center Berlin, Berlin,
Germany
(Holzendorf) Department of Perfusion, German Heart Center Berlin, Berlin,
Germany
(Falk) Department of Health Sciences, ETH Zurich, Translational
Cardiovascular Technologies, Switzerland
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: During the past five years the approach to procedural
planning, operative techniques and perfusion strategies for minimally
invasive mitral valve surgery (MIMVS) has evolved. With the goal to
provide a maximum of patient safety the procedure has been modified
according to individual patient characteristics and is largely based on
preoperative imaging. Areas covered: In this review article we describe
the important factors in image based therapy planning and simulation,
different access strategies, the operative key-steps, a rationale use of
devices, and highlight a few future developments in the field of MIMVS.
Published studies were identified through pearl growing, citation chasing,
a search of PubMed using the systematic review methods filter, and the
authors' topic knowledge. Expert opinion: With the help of expert teams
including surgeons specialized in mitral repair, anesthesiologists and
perfusionists a broad spectrum of mitral valve pathologies and related
pathologies can be treated with excellent functional outcomes. Avoiding
procedure related complications is the key for success for any MIMVS
program. Copyright © 2021 Informa UK Limited, trading as Taylor &
Francis Group.

<88>
[Use Link to view the full text]
Accession Number
634770247
Title
Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery
Patients.
Source
Pediatric Critical Care Medicine. (pp 68-78), 2021. Date of Publication:
2021.
Author
Staveski S.L.; Pickler R.H.; Khoury P.R.; Ollberding N.J.; Donnellan A.L.;
Mauney J.A.; Lincoln P.A.; Baird J.D.; Gilliland F.L.; Merritt A.D.;
Presnell L.B.; Lanese A.R.; Lisanti A.J.; Large B.J.; Fineman L.D.; Gibson
K.H.; Mohler L.A.; Callow L.; Barnes S.S.; Whalen R.L.; Grant M.J.C.;
Sheppard C.; Kline-Tilford A.M.; Steadman P.W.; Shafland H.C.; Corlett
K.M.; Kelly S.P.; Ortman L.A.; Peyton C.E.; Hagstrom S.K.; Shields A.M.;
Nye T.; Alvarez T.C.E.; Justice L.B.; Kidwell S.T.; Redington A.N.; Curley
M.A.Q.
Institution
(Staveski) University of California San Francisco, School of Nursing, San
Francisco, CA, United States
(Pickler) Ohio State University College of Nursing, Columbus, OH, United
States
(Khoury, Donnellan, Justice, Kidwell) Cincinnati Children's Hospital
Medical Center, Heart Institute, Cincinnati, OH, United States
(Ollberding) Division of Biostatistics and Epidemiology, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
(Mauney) Department of Pediatrics, Critical Care Baylor College of
Medicine, Houston, TX, United States
(Lincoln) Cardiac Intensive Care Unit, Department of Nursing, Boston
Children's Hospital, Boston, MA, United States
(Baird) Institute for Nursing and Interprofessional Research, Children's
Hospital Los Angeles, Los Angeles, CA, United States
(Gilliland) Cardiovascular Intensive Care Unit, Department of Nursing,
John Hopkins All Children's Hospital, St. Petersburg, FL, United States
(Merritt) Cardiac Intensive Care Unit, Department of Nursing, Children's
National Health Systems, Washington, DC, United States
(Presnell) Cardiovascular Intensive Care Unit, Department of Nursing,
Lucile Packard Children's Hospital, Palo Alto, CA, United States
(Lanese) Department of Child Health Evaluative Sciences, Hospital for Sick
Children, Toronto, ON, Canada
(Lisanti) Cardiac Nursing, Department of Nursing, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Large) Division of Cardiovascular Intensive Care, Phoenix Children's
Hospital, Phoenix, AZ, United States
(Fineman) Pediatric Intensive Care Unit, Department of Nursing, Ucsf
Benioff Children's Hospital, San Francisco, CA, United States
(Gibson) Cardiac Intensive Care Unit, Department of Nursing, Children's
Healthcare of Atlanta, Atlanta, GA, United States
(Mohler) Cardiovascular Intensive Care Unit, Department of Nursing,
Children's Hospital of Orange County, Orange, CA, United States
(Callow) Pediatric Cardiac Surgery, Department of Nursing, Congenital
Heart Center, Mott Children's Hospital, Ann Arbor, MI, United States
(Barnes) Department of Anesthesiology and Critical Care Medicine, John
Hopkins Hospital, Baltimore, MD, United States
(Whalen) Cardiac Care Center, Heart Program, Nicklaus Children's Hospital,
Miami, FL, United States
(Grant) Pediatric Critical Care Services, Primary Children's Hospital,
Salt Lake City, UT, United States
(Sheppard) Pediatric Pulmonary Hypertension, Stollery Children's Hospital,
Edmonton, AB, Canada
(Kline-Tilford) Cardiovascular Surgery, Children's Hospital of Michigan,
Detroit, MI, United States
(Steadman) Cardiac Care Unit, Ann and Robert H. Lurie Children's Hospital
of Chicago, Chicago, IL, United States
(Shafland) Cardiovascular Intensive Care Unit, Department of Nursing,
Children's Minnesota, Minneapolis, MN, United States
(Corlett) Cardiac Intensive Care Unit, Department of Nursing, Seattle
Children's Hospital, Seattle, WA, United States
(Kelly) Pediatric Critical Care, Department of Nursing, Doernbecher
Children's Hospital, Portland, OR, United States
(Ortman) Division of Critical Care, Department of Pediatrics, Omaha
Children's Hospital and Medical Center, Omaha, NE, United States
(Peyton) Department of Nursing, Children's Hospital Heart Institute,
Children's Hospital Colorado, Aurora, CO, United States
(Hagstrom) Pediatric Critical Care, Department of Nursing, University of
Minnesota Masonic Children's Hospital, Minneapolis, MN, United States
(Shields) Cardiac Intensive Care, Department of Nursing, Upmc Children's
Hospital of Pittsburgh, Pittsburgh, PA, United States
(Nye) Department of Nursing, Advocate Children's Hospital, Oak Lawn, IL,
United States
(Alvarez) Research in Patient Services, Department of Nursing, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
(Redington) Cardiology Clinic, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States
(Curley) Family and Community Health, Department of Nursing, University of
Pennsylvania School of Nursing, Philadelphia, PA, United States
(Curley) Anesthesia and Critical Care Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Curley) Research Institute, Children's Hospital of Philadelphia,
Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: The objective of this study was to determine the prevalence of
ICU delirium in children less than 18 years old that underwent cardiac
surgery within the last 30 days. The secondary aim of the study was to
identify risk factors associated with ICU delirium in postoperative
pediatric cardiac surgical patients. Design(s): A 1-day, multicenter
point-prevalence study of delirium in pediatric postoperative cardiac
surgery patients. Setting(s): Twenty-seven pediatric cardiac and
general critical care units caring for postoperative pediatric cardiac
surgery patients in North America. Patient(s): All children less than
18 years old hospitalized in the cardiac critical care units at 06:00 on a
randomly selected, study day. Intervention(s): Eligible children were
screened for delirium using the Cornell Assessment of Pediatric Delirium
by the study team in collaboration with the bedside nurse. Measurement and
Main Results: Overall, 181 patients were enrolled and 40% (n = 73)
screened positive for delirium. There were no statistically significant
differences in patient demographic information, severity of defect or
surgical procedure, past medical history, or postoperative day between
patients screening positive or negative for delirium. Our bivariate
analysis found those patients screening positive had a longer duration of
mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive
support (55% vs 26%; p = 0.0009); and had a higher number of invasive
catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients
received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine
equivalents; p < 0.001), did not have an ambulation or physical therapy
schedule (p = 0.02), had not been out of bed in the previous 24 hours (p <
0.0002), and parents were not at the bedside at time of data collection (p
= 0.008). In the mixed-effects logistic regression analysis of modifiable
risk factors, the following variables were associated with a positive
delirium screen: 1) pain score, per point increase (odds ratio, 1.3;
1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio,
1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4)
pain medication or sedative administered in the previous 4 hours (odds
ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation
schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6)
parents not at bedside at time of data collection (odds ratio, 2.31;
1.01-5.31). Conclusion(s): We found delirium to be a common problem
after cardiac surgery with several important modifiable risk
factors. Copyright © 2021 Lippincott Williams and Wilkins. All
rights reserved.

<89>
Accession Number
627895159
Title
Intravenous iron does not effectively correct preoperative anaemia in
cardiac surgery: A pilot randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 447-454),
2019. Date of Publication: 01 Mar 2019.
Author
Padmanabhan H.; Siau K.; Nevill A.M.; Morgan I.; Cotton J.; Ng A.; Brookes
M.J.; Luckraz H.
Institution
(Padmanabhan, Siau, Brookes) Department of Gastroenterology, Royal
Wolverhampton NHS Trust, Wolverhampton WV10 0QP, United Kingdom
(Nevill) Faculty of Education, Health and Wellbeing, University of
Wolverhampton, Wolverhampton, United Kingdom
(Morgan, Luckraz) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Cotton) Department of Cardiology, Heart and Lung Centre, Wolverhampton,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre,
Wolverhampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Preoperative anaemia is a strong predictor of blood
transfusion requirements and must be assessed for appropriate optimization
before elective surgery. Iron therapy is a transfusion-sparing approach
effective for increasing haemoglobin concentrations. However, its role in
elective cardiac surgery and the optimal route of administration remain
unknown. This single-centre, non-blinded, randomized, controlled trial
compared the effectiveness of intravenous ferric carboxymaltose therapy
with oral iron for anaemic patients undergoing elective cardiac surgery.
 Method(s): Fifty anaemic patients scheduled for elective cardiac
surgery were randomized to receive either oral or intravenous iron therapy
3-8 weeks preoperatively. Changes in haemoglobin concentration were
measured. Blood transfusion and postoperative outcome data were collected.
 Result(s): Preoperative median increases in haemoglobin were 1.0 g/l
(interquartile range -3.25 to 7.25 g/l) and 3.0 g/l (interquartile range
-1.25 to 6.25 g/l) for patients receiving intravenous and oral iron,
respectively (P = 0.42). The median first 12-h blood loss was
significantly higher in the intravenous group (655 ml; interquartile range
162-1540 ml) compared to the oral group (313 ml; interquartile range
150-1750 ml; P < 0.007). Median increments in serum ferritin were superior
for the intravenous group (median difference 313 mug/l; interquartile
range 228-496) compared to the oral group (median difference 5.5 mug/l;
interquartile range -1.4 to 19.4; P < 0.001). Conclusion(s):
Increases in ferritin after intravenous iron administration were
significantly greater than those after oral iron administration. There was
no significant difference in haemoglobin increments between groups.
Despite significantly higher intraoperative blood loss in the group
receiving intravenous iron, blood transfusion requirements for both groups
were not statistically different. Copyright © The Author(s) 2018.

<90>
Accession Number
2005198278
Title
Clinical outcomes associated with retrograde arterial perfusion in
minimally invasive mitral valve surgery: a systematic review.
Source
Perfusion (United Kingdom). 36 (1) (pp 11-20), 2021. Date of Publication:
January 2021.
Author
Burns D.J.P.; Birla R.; Vohra H.A.
Institution
(Burns) Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland,
OH, United States
(Birla) Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne, United
Kingdom
(Vohra) Cardiac Surgery, University Hospitals Bristol NHS Foundation
Trust, Bristol, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Introduction: Given several reports of an increased neurologic risk with
retrograde arterial perfusion in minimally invasive mitral valve surgery,
we sought to identify and synthesize the best available evidence on the
influence of perfusion strategy on post-operative clinical outcomes in
this population. Method(s): A systematic search of PubMed, EMBASE,
MEDLINE, and Cochrane library databases was performed to identify
publications comparing clinical outcomes associated with antegrade and
retrograde arterial perfusion in minimally invasive mitral valve surgery.
Pre-specified outcomes of interest were neurologic events, mortality, and
renal failure. The search was performed by two independent reviewers, with
data abstraction following. Result(s): Seven observational studies
were included in this review, with a total patient population of 5,385.
Six were retrospective cohort in design, with a single small prospective
cohort study identified. When available, adjusted publication-specific
risk estimates were abstracted and included preferentially over unadjusted
or reviewer-derived risk estimates. Meta-analysis was felt to be heavily
flawed in the context of few small studies identified and was not
performed. In adjusted estimates, there appeared to be an increased risk
of neurologic complications with retrograde arterial perfusion. There was
a null pattern apparent between arterial perfusion strategy and each of
30-day mortality and renal failure. Conclusion(s): Retrograde
arterial perfusion in minimally invasive mitral valve surgery may be
associated with an increased risk of neurologic events, without affecting
the risk of 30-day mortality or renal failure. Although these patterns
were identified, an overall paucity of evidence justifies further
study. Copyright © The Author(s) 2020.

<91>
Accession Number
2005973364
Title
Desflurane and sevoflurane concentrations in blood passing through the
oxygenator during cardiopulmonary bypass: a randomized prospective pilot
study.
Source
Journal of Anesthesia. 34 (6) (pp 904-911), 2020. Date of Publication:
December 2020.
Author
Tamura T.; Mori A.; Ishii A.; Ando M.; Kubo Y.; Nishiwaki K.
Institution
(Tamura, Nishiwaki) Department of Anesthesiology, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya 466-8550,
Japan
(Mori) Department of Perioperative Management System, Nagoya University
Graduate School of Medicine, Nagoya, Japan
(Ishii) Department of Legal Medicine and Bioethics, Nagoya University
Graduate School of Medicine, Nagoya, Japan
(Ando) Center for Advanced Medicine and Clinical Research, Nagoya
University Hospital, Nagoya, Japan
(Kubo) Department of Preventive Medicine, Nagoya University Graduate
School of Medicine, Nagoya, Japan
Publisher
Springer Japan
Abstract
Purpose: Volatile anesthetics (VAs) protect myocardial cells in
cardiovascular surgery. A recent clinical trial of cardiopulmonary bypass
(CPB) surgery reported no significant difference in mortality rates
between the use of VAs and total intravenous anesthetics at 1 year
postoperatively. However, oxygenator function may affect the VA
pharmacokinetics. Thus, we measured the VA blood concentrations during CPB
in patients managed with four different microporous polypropylene hollow
fiber membrane oxygenators. Method(s): Twenty-four patients scheduled
for elective CPB were randomly allocated to one of the two VA groups
(desflurane and sevoflurane groups) and, then, randomly divided into one
of four oxygenator groups: Terumo, LivaNova, Medtronic, and Senko (n = 3).
Additionally, in each VA group, three patients were randomly selected and
redundantly allocated to the human lung group (for control blood VA
concentration without oxygenator). Blood samples collected 20 min after
starting 6.0 vol% desflurane or 1.7 vol% sevoflurane were analyzed using
gas chromatography. Oxygenator-related complications and structural
changes in the membrane surface of each oxygenator after surgery were
evaluated. Result(s): The mean (standard deviation) concentrations of
desflurane and sevoflurane in the human lung were 182.4 (23.2) and 54.0
(9.6) mug/ml, respectively; not significantly different from those in the
four oxygenator groups. No oxygenator-related complications occurred.
Structural changes in membrane fibers did not occur after clinical use,
except for difficulty in image acquisition with Senko products.
 Conclusion(s): Our results demonstrated that the blood concentrations
of desflurane and sevoflurane passing through oxygenators used during CPB
were similar to those in the human lung control. Copyright ©
2020, Japanese Society of Anesthesiologists.

<92>
Accession Number
2005686839
Title
Comparison of colloid and crystalloid using goal-directed fluid therapy
protocol in non-cardiac surgery: a meta-analysis of randomized controlled
trials.
Source
Journal of Anesthesia. 34 (6) (pp 865-875), 2020. Date of Publication:
December 2020.
Author
Tyagi A.; Maitra S.; Bhattacharjee S.
Institution
(Tyagi, Maitra, Bhattacharjee) Department of Anaesthesiology, Pain
Medicine and Critical Care, All India Institute of Medical Sciences, Room
No: 5013, 5th Floor Teaching Block, New Delhi 110029, India
Publisher
Springer Japan
Abstract
Purpose: A few randomized controlled trials (RCTs) have compared
crystalloid-based goal-directed fluid therapy (GDFT) with starch-based
GDFT in patients undergoing major surgical procedures with conflicting
results. In this meta-analysis, colloid-based GDFT was compared with
crystalloid-based GDFT. Method(s): In this meta-analysis, RCTs
comparing colloid- and crystalloid-based GDFT in patients undergoing
non-cardiac surgery were included. Binary outcomes were reported as risk
ratio (RR) and continuous outcomes were reported as mean difference (MD)
with 95% confidence interval (95% CI). PubMed, PubMed central, The
Cochrane Library database and EMBASE were searched for potentially
eligible trials from inception to 28 February 2020. Result(s): Data
of 2392 patients from nine RCTs were included in this meta-analysis.
Mortality at the longest available follow-up [RR (95% CI) 1.44 (0.88,
2.34); p = 0.15], postoperative kidney dysfunction [RR (95% CI) 1.07
(0.72, 1.60); p = 0.73], postoperative length of hospital stay [MD (95%
CI) - 0.29 (- 1.25, 0.66) d; p = 0.55], cardiovascular complications [RR
(95% CI) 1.20 (0.50, 2.88); p = 0.68], wound complications [RR (95% CI)
1.08 (0.76, 1.54); p = 0.66], pulmonary complications [RR (95% CI) 0.90
(0.71, 1.140); p = 0.40] and bleeding [RR (95% CI) 1.24 (0.77, 1.99); p =
0.37] were similar in both the groups. Postoperative major complications
were also similar between patients who received colloid and crystalloid
[RR (95% CI) 0.79 (0.48, 1.29); p = 0.34]. Conclusion(s): Colloids in
goal-directed fluid therapy protocol does not offer any benefit over
crystalloid-based goal-directed fluid therapy protocol in patients
undergoing major non-cardiac surgical procedure. Copyright ©
2020, Japanese Society of Anesthesiologists.

<93>
Accession Number
2005576609
Title
Investigation of the safety and feasibility of AAV1/SERCA2a gene transfer
in patients with chronic heart failure supported with a left ventricular
assist device - the SERCA-LVAD TRIAL.
Source
Gene Therapy. 27 (12) (pp 579-590), 2020. Date of Publication: December
2020.
Author
Lyon A.R.; Babalis D.; Morley-Smith A.C.; Hedger M.; Suarez Barrientos A.;
Foldes G.; Couch L.S.; Chowdhury R.A.; Tzortzis K.N.; Peters N.S.;
Rog-Zielinska E.A.; Yang H.-Y.; Welch S.; Bowles C.T.; Rahman Haley S.;
Bell A.R.; Rice A.; Sasikaran T.; Johnson N.A.; Falaschetti E.;
Parameshwar J.; Lewis C.; Tsui S.; Simon A.; Pepper J.; Rudy J.J.; Zsebo
K.M.; Macleod K.T.; Terracciano C.M.; Hajjar R.J.; Banner N.; Harding S.E.
Institution
(Lyon, Morley-Smith, Foldes, Couch, Chowdhury, Tzortzis, Peters,
Rog-Zielinska, Yang, Welch, Simon, Pepper, Macleod, Terracciano, Harding)
National Heart and Lung Institute, Imperial College London, London, United
Kingdom
(Lyon, Morley-Smith, Hedger, Suarez Barrientos, Welch, Bowles, Rahman
Haley, Simon, Pepper, Banner) NIHR Cardiovascular Biomedical Research
Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, United
Kingdom
(Babalis, Sasikaran, Johnson, Falaschetti) Imperial Clinical Trials Unit
(ICTU), School of Public Health, Imperial College London, London, United
Kingdom
(Rog-Zielinska) Institute for Experimental Cardiovascular Medicine,
University Heart Center, Medical Center, University of Freiburg, Freiburg,
Germany
(Bell, Rice) Department of Histopathology, Royal Brompton and Harefield
Hospitals NHS Trust, Freiburg, Germany
(Parameshwar, Lewis, Tsui) Royal Papworth Hospital NHS Trust, Cambridge,
United Kingdom
(Rudy, Zsebo) Celladon Corporation, San Diego, CA, United States
(Hajjar) Phospholamban Foundation, Amsterdam, Netherlands
Publisher
Springer Nature
Abstract
The SERCA-LVAD trial was a phase 2a trial assessing the safety and
feasibility of delivering an adeno-associated vector 1 carrying the
cardiac isoform of the sarcoplasmic reticulum calcium ATPase
(AAV1/SERCA2a) to adult chronic heart failure patients implanted with a
left ventricular assist device. The SERCA-LVAD trial was one of a program
of AAV1/SERCA2a cardiac gene therapy trials including CUPID1, CUPID 2 and
AGENT trials. Enroled subjects were randomised to receive a single
intracoronary infusion of 1 x 1013 DNase-resistant AAV1/SERCA2a
particles or a placebo solution in a double-blinded design, stratified by
presence of neutralising antibodies to AAV. Elective endomyocardial biopsy
was performed at 6 months unless the subject had undergone cardiac
transplantation, with myocardial samples assessed for the presence of
exogenous viral DNA from the treatment vector. Safety assessments
including ELISPOT were serially performed. Although designed as a 24
subject trial, recruitment was stopped after five subjects had been
randomised and received infusion due to the neutral result from the CUPID
2 trial. Here we describe the results from the 5 patients at 3 years
follow up, which confirmed that viral DNA was delivered to the failing
human heart in 2 patients receiving gene therapy with vector detectable at
follow up endomyocardial biopsy or cardiac transplantation. Absolute
levels of detectable transgene DNA were low, and no functional benefit was
observed. There were no safety concerns in this small cohort. This trial
identified some of the challenges of performing gene therapy trials in
this LVAD patient cohort which may help guide future trial
design. Copyright © 2020, The Author(s).

<94>
Accession Number
634599174
Title
Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular
Calcification: A Systematic Review.
Source
Journal of the American Heart Association. 10 (7) (pp e018514), 2021. Date
of Publication: 06 Apr 2021.
Author
Alexis S.L.; Malik A.H.; El-Eshmawi A.; George I.; Sengupta A.; Kodali
S.K.; Hahn R.T.; Khalique O.K.; Zaid S.; Guerrero M.; Bapat V.N.; Leon
M.B.; Adams D.H.; Tang G.H.L.
Institution
(Alexis, El-Eshmawi, Sengupta, Adams, Tang) Department of Cardiovascular
Surgery Mount Sinai Health System New York NY
(Malik) Department of Medicine Westchester Medical Center Valhalla NY
(George) Division of Cardiac Surgery New York Presbyterian
Hospital/Columbia University Medical Center New York NY
(Kodali, Hahn, Khalique, Leon) Division of Cardiology New York
Presbyterian Hospital/Columbia University Medical Center New York NY
(Zaid) Department of Cardiology Westchester Medical Center Valhalla NY
(Guerrero) Division of Cardiology Mayo Clinic Rochester MN
(Bapat) Department of Cardiothoracic Surgery, Minneapolis Heart Institute
Abbott Northwestern Hospital Minneapolis MN
Publisher
NLM (Medline)
Abstract
Mitral annular calcification with mitral valve disease is a challenging
problem that could necessitate surgical mitral valve replacement (SMVR).
Transcatheter mitral valve replacement (TMVR) is emerging as a feasible
alternative in high-risk patients with appropriate anatomy. PubMed,
Embase, and Cochrane Central Register of Controlled Trials were searched
from inception to December 25, 2019 for studies discussing SMVR or TMVR in
patients with mitral annular calcification; 27 of 1539 articles were
selected for final review. TMVR was used in 15 studies. Relevant data were
available on 82 patients who underwent hybrid transatrial TMVR, and 354
patients who underwent transapical or transseptal TMVR. Outcomes on SMVR
were generally reported as small case series (447 patients from 11
studies); however, 1 large study recently reported outcomes in 9551
patients. Patients who underwent TMVR had a shorter median follow-up of 9
to 12 months (range, in-hospital-19 months) compared with patients with
SMVR (54 months; range, in-hospital-120 months). Overall, those undergoing
TMVR were older and had higher Society of Thoracic Surgeons risk scores.
SMVR showed a wide range of early (0%-27%; median 6.3%) and long-term
mortality (0%-65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years,
62.4%). The median in-hospital, 30-day, and 1-year mortality rates were
16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and
9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular
calcification is a complex disease and TMVR, with a versatile option of
transatrial approach in patients with challenging anatomy, offers a
promising alternative to SMVR in high-risk patients. However, further
studies are needed to improve technology, patient selection, operative
expertise, and long-term outcomes.

<95>
Accession Number
634295922
Title
Comparison of the analgesic effect of quadratus lumborum block and
epidural block in open uterine surgery: a randomized controlled trial.
Source
Minerva anestesiologica. 87 (4) (pp 414-422), 2021. Date of Publication:
01 Apr 2021.
Author
She H.; Jiang P.; Zhu J.; Zhou Y.; Wang Y.; Kan M.; Wu J.
Institution
(She, Jiang, Zhu, Wang, Kan) Department of Anesthesiology, Affiliated
Hospital of Jiangsu University, Zhenjiang, China
(Zhou) Department of Surgery, Affiliated Hospital of Jiangsu University,
Zhenjiang, China
(Wu) Department of Anesthesiology, Affiliated Hospital of Jiangsu
University, Zhenjiang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Effective regional analgesia during open surgery could reduce
opioid consumption and enhance early recovery. We compared the effects of
the newly developed quadratus lumborum block (QLB) and the traditional
epidural block (EB) in open uterine surgery. METHOD(S): In this
randomized controlled trial, we included patients scheduled for elective
open uterine surgery during May - September 30, 2019. Patients received
QLB or EB for perioperative pain relief before general anesthesia.
Perioperative opioid consumption, and numeric rating scale (NRS: 0-10)
pain scores after surgery, heart rate (HR), mean arterial pressure (MAP),
ephedrine and urapidil use during surgery, lower limb muscle strength,
timing of first flatus and defecation, nausea, vomiting, and other
complications within 24 h post-surgery, were the primary and secondary
outcomes, respectively. RESULT(S): Data of 72 (86%; 36/group) of 83
eligible patients were analyzed. Remifentanil consumption during surgery
was higher in the QLB than in the EB group, while cumulative sufentanil
consumption within 24 h post-surgery was similar between both groups. NRS
pain scores at rest and during activity were higher at 1 h post-surgery,
and MAP was higher at 5-, 15-, and 30-min postincision in the QLB than in
the EB group; HR was similar between groups. Lower ephedrine requirements,
higher lower limb muscle strength at 1 h post-surgery, and lower nausea
incidence were observed in the QLB group. CONCLUSION(S): QLB produces
a less intense but longer block and fewer side effects in the first 24 h
after open uterine surgery than those produced by EB.

<96>
[Use Link to view the full text]
Accession Number
633936304
Title
Protective effect of sevoflurane on vascular endothelial glycocalyx in
patients undergoing heart valve surgery: A randomised controlled trial.
Source
European journal of anaesthesiology. 38 (5) (pp 477-486), 2021. Date of
Publication: 01 May 2021.
Author
Fang F.-Q.; Sun J.-H.; Wu Q.-L.; Feng L.-Y.; Fan Y.-X.; Ye J.-X.; Gao W.;
He G.-L.; Wang W.-J.
Institution
(Fang) From the The First Affiliated Hospital, Zhejiang University School
of Medicine, Hangzhou (FQ-F) and The First Affiliated Hospital of Wenzhou
Medical University, China (JH-S, Wenzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The glycocalyx plays an important physiological role and may
be damaged during cardiopulmonary bypass. Sevoflurane can protect the
glycocalyx; however, its relevance in a clinical setting is unknown.
 OBJECTIVE(S): Glycocalyx degradation during cardiopulmonary bypass in
patients was investigated. On the basis of the available experimental
data, we hypothesised that sevoflurane-based anaesthesia would confer
additional protection against cardiopulmonary bypass-induced glycocalyx
damage. DESIGN: Randomised controlled study. SETTING: Clinical study at
The First Affiliated Hospital of Wenzhou Medical University between June
2018 and March 2019. PATIENTS: Fifty-one patients. INTERVENTIONS: After
intubation and mechanical ventilation, patients undergoing elective heart
valve surgery were maintained under general anaesthesia with either
propofol or sevoflurane during surgery. MAIN OUTCOME MEASURES: Glycocalyx
markers (such as syndecan-1, heparan sulphate and hyaluronan), sheddases
responsible for the degradation of the endothelial glycocalyx (such as
matrix metalloproteinase-9 and cathepsin-B), urine albumin-to-creatinine
ratio and levels of lactic acid and myocardial enzymes were all measured.
Postoperative mechanical ventilation time and length of stay in the
cardiac care unit and hospital were also measured. Morbidity and mortality
after 30 days and 1 year were evaluated. RESULT(S): The vascular
endothelial glycocalyx was damaged during cardiopulmonary bypass. The
glycocalyx damage in the sevoflurane group was less extensive than that in
the propofol group. The urine albumin-to-creatinine ratio increased in
both groups but was lower in the sevoflurane group. Enzymes including
matrix metalloproteinase-9 and cathepsin-B were positively correlated with
glycocalyx marker concentrations. After operation, the sevoflurane group
showed lower levels of lactic acid and myocardial enzyme, as well as
shorter duration of postoperative mechanical ventilation than the propofol
group. CONCLUSION(S): Sevoflurane can decrease glycocalyx degradation
in patients undergoing heart valve surgery under cardiopulmonary bypass.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, chictr.org.cn,
identifier: ChiCTR1800016367. Copyright © 2021 European Society
of Anaesthesiology and Intensive Care. Unauthorized reproduction of this
article is prohibited.

<97>
Accession Number
2007357205
Title
Cost-effectiveness analysis of mitral valve repair with the MitraClip
delivery system for patients with mitral regurgitation: a systematic
review.
Source
Heart Failure Reviews. 26 (3) (pp 587-601), 2021. Date of Publication: May
2021.
Author
Rezapour A.; Azari S.; Arabloo J.; Pourasghari H.; Behzadifar M.; Alipour
V.; Omidi N.; Sadeghian S.; Aghajani H.; Bragazzi N.L.
Institution
(Rezapour, Azari, Arabloo, Alipour) Health Management and Economics
Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Azari, Pourasghari) Hospital Management Research Center, Iran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Behzadifar) Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Omidi) Department of Cardiology, Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sadeghian, Aghajani) Department of Interventional Cardiology, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Bragazzi) Laboratory for Industrial and Applied Mathematics (LIAM),
Department of Mathematics and Statistics, York University, Toronto, Canada
Publisher
Springer
Abstract
To assess the cost-effectiveness of mitral valve repair with the MitraClip
delivery system for patients with mitral regurgitation and heart failure,
a systematic literature search was conducted in various electronic
databases to January 3, 2020. Eligibility criteria are the population
(patients with mitral regurgitation (MR)), intervention (transcatheter
mitral valve repair using the MitraClip), comparator (conventional medical
treatment), outcomes, and designs (Model-based or trial-based full
economic evaluations).The quality of included studies was assessed using
the CHEERS checklist. Mortality and survival rate, quality-adjusted life
year (QALY), life years gained (LYG), total cost, and the incremental
cost-effectiveness ratio (ICER) regarding the use of MitraClip System were
considered as the key outcomes. Eight articles were eligible for full-text
assessment. Ultimately, a total of seven studies were considered in the
current systematic review. Results demonstrated that MitraClip reduces
mortality rate and increases survival rate. The mortality rate at 1 year
and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively.
Total cost data based on 2019 USD show that the MitraClip has the highest
cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The
results showed that in all selected countries, willingness-to-pay (WTP)
thresholds are upper than the cost per QALY; also, the highest ICER for
the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy
($10,616/QALY). To conclude, evidence from this systematic review suggests
that MitraClip Delivery System improved both life expectancy and QALY
compared with medical treatment in patients at high surgical risk and it
was also a cost-effective treatment option for patients with mitral
regurgitation. Copyright © 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<98>
Accession Number
632614992
Title
Are the Current Cardiac Rehabilitation Programs Optimized to Improve
Cardiorespiratory Fitness in Patients? A Meta-Analysis.
Source
Journal of aging and physical activity. 29 (2) (pp 327-342), 2020. Date of
Publication: 14 Aug 2020.
Author
Manresa-Rocamora A.; Sarabia J.M.; Sanchez-Meca J.; Oliveira J.;
Vera-Garcia F.J.; Moya-Ramon M.
Publisher
NLM (Medline)
Abstract
Previous meta-analyses have shown that high-intensity interval training
(HIIT) is more suitable than moderate continuous training (MCT) for
improving peak oxygen uptake (VO2peak) in patients with coronary artery
disease. However, none of these meta-analyses have tried to explain the
heterogeneity of the empirical studies in optimizing cardiac
rehabilitation programs. Therefore, our aims were (a) to estimate the
effect of MCT and HIIT on VO2peak, and (b) to find the potential moderator
variables. A search was conducted in PubMed, Scopus, and ScienceDirect.
Out of the 3,110 references retrieved, 29 studies fulfilled the selection
criteria to be included in our meta-analysis. The mean difference was used
as the effect size index. Our results showed significant enhancements in
VO2peak after cardiac rehabilitation based on MCT and HIIT (mean
difference = 3.23; 95% confidence interval [2.81, 3.65] ml.kg-1.min-1 and
mean difference = 4.61; 95% confidence interval [4.02, 5.19]
ml.kg-1.min-1, respectively), with greater increases after HIIT (p <
.001). Heterogeneity analyses reached statistical significance with
moderate heterogeneity for MCT (p < .001; I2 = 67.0%), whereas no
heterogeneity was found for the effect of HIIT (p = .220; I2 = 22.0%).
Subgroup analyses showed significant between-group heterogeneity of the
MCT-induced effect based on the training mode (p < .001; I2 = 90.4%), the
risk of a new event (p = .010; I2 = 77.4%), the type of cardiovascular
event (p = .009; I2 = 84.8%), the wait time to start cardiac
rehabilitation (p = .010; I2 = 76.6%), and participant allocation (p =
.002; I2 = 89.9%). Meta-regressions revealed that the percentages of
patients undergoing a revascularization procedure (B = -0.022; p = .041)
and cardiorespiratory fitness at baseline (B = -0.103; p = .025) were
inversely related to the MCT-induced effect on the VO2peak.

<99>
Accession Number
634750264
Title
Therapeutic approach comparison in bicuspid aortic valve aortopathy and
clinical practice implications.
Source
Romanian journal of morphology and embryology = Revue roumaine de
morphologie et embryologie. 61 (3) (pp 863-870), 2020. Date of
Publication: 01 Jul 2020.
Author
Dima C.N.; Streian C.G.; Gaspar M.; Suciu S.C.; Caraion C.; Boldu E.O.;
Cerbu S.; Iacob E.R.; Luca C.T.; Petrescu L.
Institution
(Dima) Department of Pediatric Surgery, Department of Radiology and
Medical Imaging, Victor Babes University of Medicine and Pharmacy,
Timisoara, Romania; radueiacob@umft.ro, radueiacob@yahoo.com,
cerbusimona@yahoo.com
Publisher
NLM (Medline)
Abstract
Bicuspid aortic valve (BAV) is the most common heart valve malformation,
and it may be associated with the development of long-term complications,
such as aortic stenosis (AS) secondary to valvular calcification and
aortic insufficiency (AI), with or without ascending aortic aneurysm
(AAA). This study was performed at the Institute of Cardiovascular
Diseases, Timisoara, Romania, from 2015 through 2018 and included a total
of 105 patients with BAV. Out of the 105 BAV patients, 14 displayed AAA,
alongside either AS or AI, and were selected undergo aortic valve
replacement (AVR) alongside surgical replacement or aortoplasty of the
ascending aorta, and the elastic fiber loss in the ascending aortic wall
was evaluated for each patient. Two surgical interventions used alongside
AVR in BAV patients with AAA and AS or AI were compared in this study:
reduction ascending aortoplasty (RAA) and ascending aorta replacement
(AAR). Postoperative follow-ups have shown RAA is useful short-term but
that, in contrast to AAR, it leads to aortic redilatation over time. These
results can contribute to a major future meta-analysis with the goal of
improving the current clinical practice guidelines for BAV aortopathy.

<100>
Accession Number
2006943570
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. 10 (7) (no pagination), 2021.
Article Number: e019429. Date of Publication: 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), P. Debyelaan, 25, Maastricht 6202 AZ, Netherlands
(Di Mauro, Vernooy, Van'T Hof, Veenstra, Lorusso) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University Medical Center,
Maastricht, Netherlands
(Vernooy, Van'T Hof, Maessen) Department of Cardiology, Maastricht
University Medical Centre (MUMC), Maastricht, Netherlands
(Vernooy) Department of cardiology, Radboud University Medical Center
(Radboudumc), Nijmegen, Netherlands
Publisher
American Heart Association Inc.
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). CONCLUSION(S): 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. Copyright ©
2021 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley.

<101>
Accession Number
2011022301
Title
Randomized, placebo-controlled trial of orally administered vitamin K1 for
warfarin-associated coagulopathy in Chinese patients with mechanical heart
valves.
Source
European Journal of Clinical Pharmacology. (no pagination), 2021. Date of
Publication: 2021.
Author
Zhang H.; Li M.; Ao X.-L.; Dong Y.-J.; Dong L.
Institution
(Zhang, Li, Dong) Department of Cardiovascular Surgery, West China
Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China
(Ao) Department of Ultrasound, West China Hospital of Sichuan University,
Chengdu, China
(Dong) Department of Thoracic Neoplasm, West China Hospital of Sichuan
University, Chengdu, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Warfarin-associated coagulopathy commonly occurs in patients
undergoing treatment with this anticoagulant. This trial aimed to
determine the efficacy of using low-dose orally administered vitamin
K<inf>1</inf> to lower international normalized ratio (INR) values into
the target range in a cohort of Chinese patients with mechanical heart
valves. Method(s): This was a double-blind, placebo-controlled,
randomized trial. Chinese patients with mechanical heart valves who were
undergoing warfarin treatment and who had INR values from 4.0 to 10.0
without bleeding were the subjects of this study. These patients were
randomized into two treatment groups and were orally administered either
vitamin K<inf>1</inf> (2.5 mg) or placebo. Warfarin was discontinued in
both groups until INR values were <= 2.5. INR values on the day following
treatment were the primary study outcome, with INR values on the following
days and adverse clinical events over a 3-month follow-up serving as
secondary study outcomes. Result(s): In total, 80 patients were
enrolled in the present study, and 40 patients each were assigned to the
placebo and vitamin K1 treatment groups. Patients administered vitamin
K<inf>1</inf> exhibited a quick reduction in INR values relative to
patients administered placebo (29 of 40 [72.5%] vs. 0 of 44 [0%] patients
exhibiting INR values from 1.5-2.5 on the day following treatment,
respectively, p = 0.000). Lower bleeding incidence was observed among
patients administered vitamin K<inf>1</inf> relative to those administered
placebo during follow-up (4 [10%] vs. 12 [30%] patients, respectively, p =
0.045). There were no instances of thromboembolic complications or
warfarin resistance in either group. Conclusion(s): Low-dose oral
vitamin K<inf>1</inf> can be effectively administered to Chinese patients
with mechanical heart valves taking warfarin to rapidly reduce elevated
INR values. Copyright © 2021, The Author(s), under exclusive
licence to Springer-Verlag GmbH Germany, part of Springer Nature.

<102>
Accession Number
634757868
Title
Applications of head-mounted displays and smart glasses in vascular
surgery.
Source
Annals of vascular surgery. (no pagination), 2021. Date of Publication: 03
Apr 2021.
Author
Lareyre F.; Chaudhuri A.; Adam C.; Carrier M.; Mialhe C.; Raffort J.
Institution
(Lareyre) Department of Vascular Surgery, Hospital of
Antibes-Juan-les-Pins, France; Universite Cote d'Azur, CHU, Inserm U1065,
C3M, Nice, France
(Chaudhuri) Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire
Hospitals NHS Foundation Trust, Bedford, United Kingdom
(Adam, Carrier) Laboratory of Applied Mathematics and Computer Science
(MICS), CentraleSupelec, Universite Paris-Saclay, France
(Mialhe) Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco,
Monaco
(Raffort) Universite Cote d'Azur, CHU, Inserm U1065, C3M, Nice, France;
Clinical Chemistry Laboratory, University Hospital of Nice, France
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Advances in virtual, augmented and mixed reality have led to
the development of wearable technologies including head mounted displays
(HMD) and smart glasses. While there is a growing interest on their
potential applications in health, only a few studies have addressed so far
their use in vascular surgery. The aim of this review was to summarize the
fundamental notions associated with these technologies and to discuss
potential applications and current limits for their use in vascular
surgery. METHOD(S): A comprehensive literature review was performed
to introduce the fundamental concepts and provide an overview of
applications of HMD and smart glasses in surgery. RESULT(S): HMD and
smart glasses demonstrated a potential interest for the education of
surgeons including anatomical teaching, surgical training, teaching and
telementoring. Applications for pre-surgical planning have been developed
in general and cardiac surgery and could be transposed for a use in
vascular surgery. The use of wearable technologies in the operating room
has also been investigated in both general and cardiovascular surgery and
demonstrated its potential interest for image-guided surgery and data
collection. CONCLUSION(S): Studies performed so far represent a proof
of concept of the interest of HMD and smart glasses in vascular surgery
for education of surgeons and for surgical practice. Although these
technologies exhibited encouraging results for applications in vascular
surgery, technical improvements and further clinical research in large
series are required before hoping using them in daily clinical
practice. Copyright © 2021. Published by Elsevier Inc.

<103>
Accession Number
634754014
Title
The effects of Nurse Led Transitional Care Model on elderly patients
undergoing open heart surgery: a randomized controlled trial.
Source
European journal of cardiovascular nursing : journal of the Working Group
on Cardiovascular Nursing of the European Society of Cardiology. (no
pagination), 2021. Date of Publication: 02 Apr 2021.
Author
Coskun S.; Duygulu S.
Institution
(Coskun) Bolu Abant Izzet Baysal University, Faculty of Health Sciences,
Nursing Department
(Duygulu) Hacettepe University, Faculty of Nursing, 06100 S?hhiye/ Ankara
/ Turkey
Publisher
NLM (Medline)
Abstract
AIMS : Rate and number of successful cases in open heart surgery has been
increasing due to the advances in medical technology and surgery. To
improve patient convalescence results and reduce rate of post-discharge
readmission to hospital and unplanned post-discharge rehospitalization,
home-care and follow-up process of patients should be managed
successfully. To evaluate the effectiveness of Nurse Led Transitional Care
Model on the functional autonomy, quality of life, readmission, and
rehospitalization rates of elderly patients undergoing open heart surgery.
A randomized controlled trial was conducted from November 2017 to December
2018 and performed according to the CONSORT Guidelines. METHODS AND
RESULTS : Sixty-six elderly patients were randomly allocated to the
intervention (n: 33) and control (n: 33) groups. Patients in intervention
group were given care based on the Transitional Care Model until the
post-discharge 9th week starting from date of hospitalization. Patients in
control group were given standard care services. Functional autonomy,
quality of life levels, and repeated admission/re-hospitalization rates to
the clinic were evaluated. The Functional Autonomy Measurement System and
SF-36 Quality of Life Scale scores of the intervention group were higher
than that of the control group at the 9th week (P < 0.05). In addition,
rate of readmission and rehospitalization during the follow-up period
(6months) of patients in the intervention group was found to be lower than
the patients in the control group (P<0.05). CONCLUSION : Care services
offered under the Transitional Care Model improved functional autonomy and
quality of life and decreased post-discharge hospital readmission and
rehospitalization rates of patients. TRIAL REGISTRATION: The study was
registered on ClinicalTrials.gov (ID: NCT04384289). 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.

<104>
Accession Number
634752311
Title
Ticagrelor or aspirin after coronary artery bypass in patients with
chronic kidney disease.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 02 Apr 2021.
Author
Sandner S.E.; Schunkert H.; Kastrati A.; Milojevic M.; Boning A.; Zimpfer
D.; Zellmer S.; Wiedemann D.; Laufer G.; von Scheidt M.
Institution
(Sandner, Zimpfer, Wiedemann, Laufer) Department of Cardiac Surgery,
Medical University of Vienna, Austria
(Schunkert, Kastrati, Zellmer, von Scheidt) Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Germany; German Center for Cardiovascular
Research (DZHK), Munich Heart Alliance, Germany
(Milojevic) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, The Netherlands; Department of Cardiac Surgery and
Cardiovascular Research, Dedinje Cardiovascular Institute, Serbia
(Boning) Department of Cardiovascular Surgery, University Hospital
Giessen, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal antiplatelet therapy for patients with chronic
kidney disease (CKD) undergoing coronary artery bypass grafting (CABG)
remains unknown. METHOD(S): This post hoc analysis of the Ticagrelor
in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety
of ticagrelor versus aspirin in patients with or without CKD. Primary
endpoint was the composite of cardiovascular death, stroke, myocardial
infarction or revascularization (MACCE) at 1 year after CABG. Secondary
endpoints included individual components of the primary endpoint,
all-cause death, and major bleeding. RESULT(S): CKD was present in
276 of 1,843 randomized patients (15.0%). Patients with CKD versus those
without CKD had higher 1-year rates of MACCE (13.0% vs. 8.3%, HR 1.63, 95%
CI 1.12-2.39, P=0.01) and major bleeding (5.6% vs. 3.1%, HR 1.84, 95% CI
1.03-3.28, P=0.04). The 1-year rate of MACCE was increased with ticagrelor
versus aspirin in patients with CKD (18.2% vs. 8.9%, HR 2.15, 95% CI
1.08-4.30, P=0.03), but not in patients without CKD (8.5% vs. 8.1%, HR
1.05, 95% CI 0.74-1.49, P=0.79) (Pinteraction=0.067). There was no
difference in the 1-year rate of major bleeding with ticagrelor versus
aspirin in patients with CKD (6.6% vs. 4.7%, HR 1.44, 95% CI 0.52-3.97,
P=0.48) and without CKD (3.3% vs. 2.9%, HR 1.14, 95% CI 0.64-2.01,
P=0.65). CONCLUSION(S): In patients with CKD and CABG, those who
received ticagrelor had a higher incidence of MACCE but a similar
incidence of major bleeding compared to those who received
aspirin. Copyright © 2021. Published by Elsevier Inc.

<105>
Accession Number
2011044231
Title
Valve-in-valve transcatheter aortic valve replacement versus redo surgical
aortic valve replacement: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Ahmed A.; Levy K.H.
Institution
(Ahmed, Levy) CUNY School of Medicine, New York, NY, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background/Aim: With the growing contemporary use of bioprosthetic valves,
whose limited long-term durability has been well-documented, an increase
in the need for reintervention is expected. We perform a meta-analysis to
compare the current standard of care, redo surgical aortic valve
replacement (Redo SAVR) with the less invasive alternative, valve-in-valve
transcatheter aortic valve replacement (ViV TAVR) for treating structural
valve deterioration. Method(s): After a comprehensive literature
search, studies comparing ViV TAVR to Redo SAVR were pooled to perform a
pairwise meta-analysis using the random-effects model. Primary outcomes
were 30-day and follow-up mortality. Result(s): A total of nine
studies including 9127 patients were included. ViV TAVR patients were
significantly older (mean difference [MD], 5.82; p =.0002) and more
frequently had hypercholesterolemia (59.7 vs. 60.0%; p =.0006), coronary
artery disease (16.1 vs. 16.1%; p =.04), periphery artery disease (15.4
vs. 5.7%; p =.004), chronic obstructive pulmonary disease (29.3 vs. 26.2%;
p =.04), renal failure (30.2 vs. 24.0%; p =.009), and >1 previous cardiac
surgery (23.6 vs. 15.9%; p =.004). Despite this, ViV TAVR was associated
with decreased 30-day mortality (OR, 0.56; p <.0001). Conversely, Redo
SAVR had lower 30-day paravalvular leak (OR, 6.82; p =.04), severe
patient-prosthesis mismatch (OR, 3.77; p <.0001), and postoperative aortic
valve gradients (MD, 5.37; p <.0001). There was no difference in follow-up
mortality (HR, 1.02; p =.86). Conclusion(s): Despite having patients
with an increased baseline risk, ViV TAVR was associated with lower 30-day
mortality, while Redo SAVR had lower paravalvular leak, severe
patient-prosthesis mismatch, and postoperative gradients. Although ViV
TAVR remains a feasible treatment option in high-risk patients, randomized
trials are necessary to elucidate its efficacy over Redo
SAVR. Copyright © 2021 Wiley Periodicals LLC

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