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<1>
Accession Number
626288117
Title
Comparison of balloon-expandable vs. self-expandable valves in patients
undergoing transfemoral transcatheter aortic valve implantation: From the
CENTER-collaboration.
Source
European Heart Journal. 40 (5) (pp 456-465), 2019. Date of Publication: 01
Feb 2019.
Author
Vlastra W.; Chandrasekhar J.; Munoz-Garcia A.J.; Tchetche D.; De Brito
F.S.; Barbanti M.; Kornowski R.; Latib A.; D'Onofrio A.; Ribichini F.;
Baan J.; Tijssen J.G.P.; Trillo-Nouche R.; Dumonteil N.; Abizaid A.;
Sartori S.; D'Errigo P.; Tarantini G.; Lunardi M.; Orvin K.; Pagnesi M.;
Del Valle R.; Modine T.; Dangas G.; Mehran R.; Piek J.J.; Delewi R.
Institution
(Vlastra, Chandrasekhar, Baan, Tijssen, Piek, Delewi) Department of
Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC,
University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, Netherlands
(Chandrasekhar, Sartori, Dangas, Mehran) Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1
Gustave L. Levy Place, New York, NY 10029-6574, United States
(Munoz-Garcia) Department of Cardiology, Hospital Universitario Virgen de
la Victoria, Campus de Teatinos, Malaga 29010, Spain
(Tchetche, Dumonteil) Clinique Pasteur, 45 Avenue de Lombez, Toulouse
31076, France
(De Brito) Heart Institute (InCor), University of Sao Paulo Medical
School, Av. Dr. Eneas Carvalho de Aguiar, Sao Paulo - SP 05403-900, Brazil
(Barbanti) Division of Cardiology, Policlinico-Vittorio Emanuele Hospital,
University of Catania, Via Salvatore Citelli, 6, Catania CT 95123, Italy
(Kornowski, Orvin) Cardiology Department, Rabin Medical Center, Ze'ev
Jabotinsky St 39, Petah Tikva 4941492, Israel
(Latib, Pagnesi) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Via Olgettina Milano, 58, Milano MI 20132, Italy
(D'Onofrio, Tarantini) Department of Cardiac, Thoracic and Vascular
Sciences, Interventional Cardiology Unit, University of Padova, Via Nicolo
Giustiniani, 2, Padova PD 35128, Italy
(Ribichini, Lunardi) Division of Cardiology, Department of Medicine,
University of Verona, Policlinico Gb Rossi, Piazzale L.A. Scuro 10, Verona
37134, Italy
(Trillo-Nouche) Servicio de Cardiologia, Complejo Hospitalario
Universitario de Santiago de Compostela, Santiago de Compostela, Rua da
Choupana, s/n, Santiago de Compostela, A Coruna 15706, Spain
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante
Pazzanese, 500 - Vila Mariana, Sao Paulo - SP 04012-909, Brazil
(D'Errigo) National Centre for Global Helath, Istituto Superiore di
Sanita, Viale Regina Elena, 299, Roma RM 00161, Italy
(Del Valle) Hospital Universitario Central de Asturias, Julian Claveria.
S/N, Oviedo, Asturias 33011, Spain
(Modine) Centre Hospitalier Universitaire, 2, avenue Oscar Lambret, Lille
59037, France
(Tchetche, Dumonteil) Clinique Pasteur, Toulouse 31300, France
Publisher
Oxford University Press
Abstract
Aims: The aim of this study was to compare clinical outcomes of patients
undergoing transfemoral transcatheter aortic valve implantation (TAVI)
with balloon-expandable (BE) valves vs. self-expandable (SE) valves.
Transcatheter aortic valve implantation is a minimally invasive and
lifesaving treatment in patients with aortic valve stenosis. Even though
BE-valves and SE-valves are both commonly used on a large scale,
adequately sized trials comparing clinical outcomes in patients with
severe aortic valve stenosis treated with BE-valves compared with
SE-valves are lacking. Methods and Results: In this
CENTER-collaboration, data from 10 registries or clinical trials, selected
through a systematic search, were pooled and analysed. Propensity score
methodology was used to reduce treatment selection bias and potential
confounding. The primary endpoints were mortality and stroke at 30 days
follow-up in patients treated with BEvalves compared with SE-valves.
Secondary endpoints included clinical outcomes, e.g. bleeding during
hospital admission. All outcomes were split for early-generation BE-valves
compared with early-generation SE-valves and new-generation BE-valves with
new-generation SE-valves. The overall patient population (N= 12 381)
included 6239 patients undergoing TAVI with BE-valves and 6142 patients
with SE-valves. The propensity matched population had a mean age of 81 +/-
7 years and a median STS-PROM score or 6.5% [interquartile range (IQR)
4.0-13.0%]. At 30-day follow-up, the mortality rate was not statistically
different in patients undergoing TAVI with BE-valves compared with
SE-valves [BE: 5.3% vs. SE: 6.2%, relative risk (RR) 0.9; 95% confidence
interval (CI) 0.7-1.0, P = 0.10]. Stroke occurred less frequently in
patients treated with BE-valves (BE: 1.9% vs. SE: 2.6%, RR 0.7; 95% CI
0.5-1.0, P = 0.03). Also, patients treated with BE-valves had a three-fold
lower risk of requiring pacemaker implantation (BE: 7.8% vs. SE: 20.3%, RR
0.4; 95% CI 0.3-0.4, P < 0.001). In contrast, patients treated with
new-generation BE-valves more frequently experienced major and
life-threatening bleedings compared with new-generation SEvalves (BE: 4.8%
vs. SE: 2.1%, RR 2.3; 95% CI 1.6-3.3, P < 0.001). Conclusion(s): In
this study, which is the largest study to compare valve types in TAVI, we
demonstrated that the incidence of stroke and pacemaker implantation was
lower in patients undergoing transfemoral TAVI with BE-valves compared
with SE-valves. In contrast, patients treated with new-generation
BE-valves more often suffered from major or life-threatening bleedings
than patients with new-generation SE-valves. Mortality at 30-days was not
statistically different in patients treated with BE-valves compared with
SE-valves. This study was a propensity-matched analysis generated from
observational data, accordingly current outcomes will have to be confirmed
in a large scale randomized controlled trial. Copyright © 2018
The Author(s). All rights reserved.

<2>
Accession Number
606305860
Title
Preventive analgesia in thoracic surgery: Controlled, randomized,
double-blinded study.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 428-434), 2015.
Date of Publication: 01 Sep 2015.
Author
Nosotti M.; Rosso L.; Tosi D.; Palleschi A.; Mendogni P.; Righi I.;
Marenghi C.; Santambrogio L.
Institution
(Nosotti, Rosso, Tosi, Palleschi, Mendogni, Righi, Santambrogio) Thoracic
Surgery and Lung Transplant Unit, Fondazione IRCCS Ca Granda Ospedale
Maggiore Policlinico, University of Milan, Milan, Italy
(Marenghi) Department of Anesthesia and Intensive Care, Fondazione IRCCS
Ca Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Preventive analgesia is defined as a treatment that is
commenced before the surgical procedure in order to diminish the
physiological consequences of afferent nociceptive transmission caused by
the procedure and prevent central sensitization. The analysis of
randomized studies of preventive analgesia is controversial. The aim of
this study was to check the analgesic efficacy of preoperative
administration of dextromethorphan associated with intercostal nerve block
with levobupivacaine in thoracotomy patients who refused or had a
contraindication to epidural analgesia. METHOD(S): This study was a
four-arm, double-blinded, randomized placebo-controlled trial. Patients
were allocated following close block randomization into four arms: 'Group
A' preoperative dextromethorphan and preoperative intercostal block (IB),
'Group B' preoperative placebo and preoperative IB, 'Group C' preoperative
dextromethorphan and postoperative IB, 'Group D' preoperative placebo and
postoperative block. The primary end-point was the cumulative morphine
consumption (CMC) within the first 14 days after surgery. RESULT(S):
A total of 400 patients were enrolled and 395 completed the study. There
were no statistical differences among the groups in terms of demographic
and surgical data; in contrast, preoperative quality-of-life scores were
heterogeneous. The mean CMCs were as follows: Group A 111.4 mg, Group B
121.5 mg, Group C 126.8 mg, Group D 138.3 mg. Group A mean was lower than
the maximum (P = 0.0001). The CMC value did not correlate with age, sex,
body mass index, education, type of surgery, length or width of the
incision and rib fracture. Postoperative functional data and
post-thoracotomy syndrome prevalence were homogeneous; female gender
resulted predictive for post-thoracotomy syndrome. CONCLUSION(S):
Results indicate that preoperative administration of dextromethorphan
associated with preoperative IB with levobupivacaine provided preventive
analgesia, decreasing analgesic administration during the early
postoperative period compared with placebo and/or postoperative IB. This
study failed in detecting any effect of preventive analgesia on functional
items and post-thoracotomy syndrome. Copyright © The Author 2015.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<3>
Accession Number
2011900532
Title
Does a thoracoscopic approach provide better outcomes for pulmonary
metastases?.
Source
Journal of Thoracic Disease. 13 (4) (pp 2692-2697), 2021. Date of
Publication: April 2021.
Author
Rusidanmu A.; Chin W.; Xu J.; Wang L.; He Z.; Lv X.; Hu J.
Institution
(Rusidanmu, Xu, Wang, He, Lv, Hu) Department of Thoracic Surgery, First
Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun
Road, Hangzhou, China
(Chin) Division of Hepatobiliary and Pancreatic Surgery, Department of
Surgery, First Affiliated Hospital, Zhejiang University School of
Medicine, Hangzhou, China
Publisher
AME Publishing Company
Abstract
Traditional open thoracotomy (OT) is the gold standard treatment for
patients with pulmonary metastases. However, it remains controversial
whether video-assisted thoracic surgery (VATS) can provide comparable
outcomes to OT. We conducted this review to compare the outcomes of VATS
with OT in pulmonary metastasectomy (PM). Relevant studies published up to
November 2019 were identified from PubMed data base and screened. Studies
were then selected by the researchers based on our selection criteria.
Data including the type of study, patient groups, outcomes and key results
were extracted from the included studies and summarized. Screening of
2,788 papers identified 9 that were relevant to our research question. The
authors, dates of publication, journal details, type of study, patient
groups, outcomes and key results from these papers were summarized. All 9
studies documented the survival rate (1-, 3- and 5-year survival).
Metastases from colorectal cancer were investigated in three studies, and
metastases from sarcoma were investigated in one study. The overall
survival rate of VATS was not inferior to that of OT in patients with
pulmonary metastases. VATS was also associated with better perioperative
results compared with OT. In conclusion, VATS is suitable as an
alternative surgical technique for PM. Copyright © Journal of
Thoracic Disease. All rights reserved.

<4>
Accession Number
2011900484
Title
Direct comparison of rapid deployment versus sutureless aortic valve
replacement: A meta-Analysis.
Source
Journal of Thoracic Disease. 13 (4) (pp 2203-2215), 2021. Date of
Publication: April 2021.
Author
Sohn S.H.; Kang Y.; Kim J.S.; Choi J.W.; Jang M.-J.; Hwang H.Y.
Institution
(Sohn, Kang, Kim, Choi, Hwang) Department of Thoracic and Cardiovascular
Surgery, Seoul National University Hospital, Seoul National University
College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, 101 Daehak-ro,
Jongno-gu, Seoul 03080, South Korea
Publisher
AME Publishing Company
Abstract
Background: This meta-Analysis was conducted to compare the procedural and
early outcomes of aortic valve replacement (AVR) using rapid deployment
valve (RD group) versus sutureless valve (SU group). Method(s): A
literature search of 5 online databases was conducted. The primary
outcomes were mean transvalvular pressure gradient (MPG) after AVR, the
incidence of paravalvular leak (PVL) and the need for a permanent
pacemaker implantation (PPI). The secondary outcomes included aortic
cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, early mortality
and other postoperative complications, such as atrial fibrillation,
bleeding reoperation and stroke. Result(s): Eight articles were
included, and all outcomes except MPG after AVR in matched valve sizes
were extracted from 7 studies (RD group =842 patients and SU group =1,386
patients). The pooled analysis demonstrated a lower MPG in the RD group
than in the SU group, with mean difference (MD) of 2.64 mmHg. The pooled
risk ratios of any PVL and grade =2 (or moderate) PVL were not
significantly different between the groups; however, the incidence of PPI
was significantly lower in the RD group than in the SU group, with a risk
ratio of 0.69. The pooled analyses showed that the ACC and CPB times were
significantly longer in the RD group than in the SU group, with weighted
MDs of 8.74 (P<0.001) and 9.94 (P<0.001) minutes, respectively. The risks
of early mortality and other postoperative complications were not
significantly different between the groups Conclusion(s): AVR using
RD valve was associated with better valve hemodynamics in terms of the MPG
than AVR using SU valve, and better outcomes were observed in the RD group
regarding PPI. Procedural times were longer in AVR using RD valve than SU
valve. Early clinical outcomes showed no difference between RD and SU
valve. Copyright © Journal of Thoracic Disease. All rights
reserved.

<5>
Accession Number
2011900474
Title
Minimally-invasive-perventricular-device-occlusion versus surgical-closure
for treating perimembranous-ventricular-septal-defect: 3-year outcomes of
a multicenter randomized clinical trial.
Source
Journal of Thoracic Disease. 13 (4) (pp 2106-2115), 2021. Date of
Publication: April 2021.
Author
Lu W.; Zhang F.; Fan T.; Zhao T.; Han Y.; Hu X.; Li Q.; Shi H.; Pan X.
Institution
(Lu, Zhang, Hu, Li, Shi, Pan) Structural Heart Disease Center, National
Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of
Medical Sciences and Peking Union Medical College, No. 167, North Lishi
Street, Beijing 100037, China
(Fan, Han) Heart Center of Henan Provincial People's Hospital, Central
China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
(Zhao) Central South University, Changsha, China
Publisher
AME Publishing Company
Abstract
Background: Minimally-invasive-perventricular-device-occlusion (MIPDO)
combined superiority of surgical-repair and percutaneous-device-closure in
treating perimembranous-ventricular-septal-defect (pmVSD). This study was
to evaluate the efficacy and safety of MIPDO for treating pmVSD, comparing
with surgical-repair. Method(s): Patients aged =3 months with
isolated pmVSDs were randomized to undergo either surgical or MIPDO
procedure, with the median follow-up time of 49 months. The primary
outcome was the rate of complete pmVSD closure at discharge. The secondary
outcomes included the adverse events during hospitalization and follow-up,
chest tube output volume, blood transfusion volume, procedural duration,
ventilation time, hospitalization duration and hospitalization cost. Also,
perioperative cardiac performance and systemic conditions were evaluated.
 Result(s): Of the 313 patients (9 months to 42 years old; median, 4
years old) with pmVSDs recruited from 3 centers, 100 were finally enrolled
and randomly allocated 1:1 into two groups. The non-inferiority (non
inferiority margin -8.0%) of MIPDO to surgical closure regarding efficacy
was shown in both intention-To treat (0, 95% CI: -0.055 to 0.055) and
per-protocol populations (0.02, 95% CI: -0.018 to 0.058). Although the
rate of adverse events was similar between groups, the MIPDO group showed
superiority in procedural duration, ventilation time, chest tube output
volume, postoperative hospitalization time and hospitalization cost
compared with surgical group (P<0.05) Moreover, MIPDO method showed
comparable perioperative cardiac performance with milder change of
systemic condition. Conclusion(s): In patients with pmVSDs, MIPDO
method showed non-inferiority to surgical closure in efficacy for both
intention-To-Treat and per-protocol population with easier perioperative
recovery, economic benefit and promising outcomes. Copyright ©
Journal of Thoracic Disease. All rights reserved.

<6>
Accession Number
2005207204
Title
Comparison of the effectiveness of allopurinol and methylprednisolone in
reducing reperfusion injury in coronary artery bypass surgery.
Source
Journal of Drug and Alcohol Research. 9 (pp 1-6), 2020. Article Number:
2360102. Date of Publication: 2020.
Author
Kurniawan H.; Perdana A.; Alatas A.; Nasution A.H.
Institution
(Kurniawan) Fellow of cardiac anesthesia, University of Indonesia,
Indonesia
(Perdana, Alatas) Cardiovascular Anesthesiologist, University of
Indonesia, Indonesia
(Nasution) Cardiovascular Anesthesiologist, University of Sumatera Utara,
Indonesia
Publisher
Ashdin Publishing
Abstract
Background: Reperfusion injury due to the release of ROS when using CPB
and the return of oxygen-rich blood flow to ischemic myocardium after the
release of aortic clamps, can cause myocardial dysfunction. Allopurinol as
an inhibitor of xanthine oxidase and methylprednisolone is used to reduce
the effects of inflammation and reperfusion injury. Method(s): A
double-blind randomized clinical trial study was conducted on 42 patients
undergoing coronary artery bypass surgery using CPB between October 2019
and March 2020, which was allocated to the allopurinol group or the
methylprednisolone group. Examination of biomarkers of reperfusion injury
is carried out by examination of a blood sample of MDA which is performed
shortly after the installation of a central venous catheter and 5 minutes
after the aortic clamp are removed. MDA examination is done by the ELISA
method. Assessment of VIS was carried out in the first 24 hours of
postsurgical treatment. While the assessment of the incidence of
postoperative arial fibrilation was performed during the first 48 hours
after surgery. Result(s): MDA post reperfusion levels increased
significantly in the administration of methylprednisolone (p=0.041) and
increased not significantly in the administration of allopurinol
(p=0.251). The postoperative VIS value in the administration of
allopurinol was significantly lower than in the administration of
methylprednisolone (median 6 vs. 22, p = 0.009). The incidence of POAF in
the two groups showed no differences were statistically significant (p =
0.231). Conclusion(s): Allopurinol is more effective than
methylprednisolone and can be used in efforts to reduce reperfusion injury
in coronary artery bypass surgery. Copyright © 2020 Heru
Kurniawan, et al.

<7>
Accession Number
2011934093
Title
Atrial fibrillation after cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Caldonazo T.; Kirov H.; Rahouma M.; Robinson N.B.; Demetres M.; Gaudino
M.; Doenst T.; Dobrev D.; Borger M.A.; Kiehntopf M.; Skoloff K.
Institution
(Caldonazo, Kirov, Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University Jena, Jena, Germany
(Rahouma, Robinson, Gaudino) Department of Cardiothoracic Surgery at New
York Presbyterian, Weill Cornell Medical Center, New York, NY, United
States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medical Center, New York, NY, United States
Publisher
Mosby Inc.
Abstract
Objective: New-onset postoperative atrial fibrillation (POAF) after
cardiac surgery is common, with rates up to 60%. POAF has been associated
with early and late stroke, but its association with other cardiovascular
outcomes is less known. The objective was to perform a meta-analysis of
the studies reporting the association of POAF with perioperative and
long-term outcomes in patients with cardiac surgery. Method(s): We
performed a systematic review and a meta-analysis of studies that
presented outcomes for cardiac surgery on the basis of the presence or
absence of POAF. MEDLINE, EMBASE, and the Cochrane Library were assessed;
57 studies (246,340 patients) were selected. Perioperative mortality was
the primary outcome. Inverse variance method and random model were
performed. Leave-one-out analysis, subgroup analyses, and metaregression
were conducted. Result(s): POAF was associated with perioperative
mortality (odds ratio [OR], 1.92; 95% confidence interval [CI],
1.58-2.33), perioperative stroke (OR, 2.17; 95% CI, 1.90-2.49),
perioperative myocardial infarction (OR, 1.28; 95% CI, 1.06-1.54),
perioperative acute renal failure (OR, 2.74; 95% CI, 2.42-3.11), hospital
(standardized mean difference, 0.80; 95% CI, 0.53-1.07) and intensive care
unit stay (standardized mean difference, 0.55; 95% CI, 0.24-0.86),
long-term mortality (incidence rate ratio [IRR], 1.54; 95% CI, 1.40-1.69),
long-term stroke (IRR, 1.33; 95% CI, 1.21-1.46), and longstanding
persistent atrial fibrillation (IRR, 4.73; 95% CI, 3.36-6.66).
 Conclusion(s): The results suggest that POAF after cardiac surgery is
associated with an increased occurrence of most short- and long-term
cardiovascular adverse events. However, the causality of this association
remains to be established. Copyright © 2021 The American
Association for Thoracic Surgery

<8>
Accession Number
2011933593
Title
Does bariatric surgery improve cardiac autonomic modulation assessed by
heart rate variability? A systematic review.
Source
Surgery for Obesity and Related Diseases. (no pagination), 2021. Date of
Publication: 2021.
Author
Benjamim C.J.R.; Pontes Y.M.D.M.; de Sousa Junior F.W.; Porto A.A.; Bueno
Junior C.R.; Marcelino da Silva A.A.; Ferro Cavalcante T.C.; Garner D.M.;
Valenti V.E.
Institution
(Benjamim, Marcelino da Silva, Ferro Cavalcante) Development, Nutrition,
Phytotherapy and Hygiene Research Group, University of Pernambuco,
Petrolina, Brazil
(Benjamim, Porto, Valenti) Autonomic Nervous System Center, Sao Paulo
State University, Marilia, Brazil
(Pontes, de Sousa Junior) Physiological and Collective Sciences Nucleus,
School of Juazeiro do Norte, Juazeiro do Norte, Brazil
(Porto) Department of Physical Therapy, Faculty of Sciences and
Technologies, UNESP, Presidente Prudente, Brazil
(Bueno Junior) Ribeirao Preto Medical School, Department of Medical
Clinic, University of Sao Paulo, Ribeirao Preto, Brazil
(Garner) Cardiorespiratory Research Group, Department of Biological and
Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes
University, Headington Campus, Oxford, United Kingdom
Publisher
Elsevier Inc.
Abstract
Our study aimed to explore the influence of bariatric surgery (BS) on
heart rate (HR) variability (HRV) through a systematic review. Manuscripts
were selected based on electronic searches of the MEDLINE, EMBASE, and
CINAHL databases from the inception of each database up to year 2020, and
followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) protocol. Searching of these studies was
systematized using the Population Intervention Comparison Outcome Study
Design strategy. We selected randomized and nonrandomized controlled
trials and cohorts from prospective studies that reported the influence of
BS on HRV. We assessed the quality rating using the Black and Downs
questionnaire. Following the screening and eligibility stages, 14 studies
were included in the review. All studies agreed that BS promotes an
increase in parasympathetic HR control and HRV and a decrease in HR. Yet
the literature does not provide evidence that these outcomes are directly
caused by the surgical procedure. There is limited evidence to support
that patients with type 2 diabetes have greater improvement in HRV as an
interim measure, to individuals without. The decrease in insulin
resistance was correlated with the increase in HRV in some studies, but,
other studies are unsupportive of this outcome. Improvements in 2
metabolic parameters (e.g., leptin, N-terminal pro B-type natriuretic
peptide) were connected with superior increases in HRV. This review
demonstrated that BS promotes an increase in HRV, indicating improved
autonomic control of HR. Copyright © 2021 American Society for
Bariatric Surgery

<9>
Accession Number
2011445282
Title
The expansion of no-touch harvesting sequential vein graft after off-pump
coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Hou X.; Zhang K.; Liu T.; Li Y.; Zhao Y.; Song B.; Huang Z.; Xu S.; Zheng
J.; Dong R.
Institution
(Hou, Zhang, Liu, Li, Zhao, Song, Huang, Xu, Zheng, Dong) Department of
Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University,
Beijing, China
Publisher
Blackwell Publishing Inc.
Abstract
Background and Aim of the Study: Many studies support that the no-touch
(NT) procedure can improve the patency rate of vein grafts. However, it is
not clear that the sequential vein graft early expansion in the NT
technique during off-pump coronary artery bypass grafting (CABG). This
study will explore this issue. Method(s): This was a prospective
single-center randomized controlled clinical trial. A total of 100
patients undergoing off-pump CABG with the sequential saphenous graft were
randomly assigned to two groups: the NT and conventional (CON) groups.
Perioperative and postoperative data were collected during the hospital
stay. The mean diameter of sequential grafts was measured using cardiac
computed tomography angiography 3 months after the operation.
 Result(s): There was a significant difference in the average diameter
of sequential grafts between the two groups (NT: [2.98 +/- 0.42], CON:
[3.26 +/- 0.51], p =.005). There was no difference in occlusion of
sequential venous grafts between the two groups (NT: 4/48 [8.3%], CON:
5/49 [10.2%], p = 1.000). There were differences in surgery time between
the two groups (NT: 220 [188,240], CON: 190 [175,230], p =.009).
 Conclusion(s): The sequential graft early expansion in the NT
technique is not as pronounced as that in the conventional technique,
which may have a long-term protective effect on the grafts. Copyright
© 2021 The Authors. Journal of Cardiac Surgery Published by Wiley
Periodicals LLC

<10>
Accession Number
2011445027
Title
The effect of peri-operative dexmedetomidine on the incidence of
postoperative delirium in cardiac and non-cardiac surgical patients: a
randomised, double-blind placebo-controlled trial.
Source
Anaesthesia. (no pagination), 2021. Date of Publication: 2021.
Author
van Norden J.; Spies C.D.; Borchers F.; Mertens M.; Kurth J.; Heidgen J.;
Pohrt A.; Mueller A.
Institution
(van Norden, Spies, Borchers, Mertens, Kurth, Heidgen) Department of
Anaesthesia and Intensive Care Medicine, Institute of Biometry and
Clinical Epidemiology, Charite - Universitatsmedizin Berlin, Freie
Universitat Berlin, Humboldt-Universitat zu Berlin, Berlin Institute of
Health, Berlin, Germany
(Pohrt, Mueller) Institute of Biometry and Clinical Epidemiology, Charite
- Universitatsmedizin Berlin, Freie Universitat Berlin,
Humboldt-Universitat zu Berlin, Berlin Institute of Health, Berlin,
Germany
Publisher
Blackwell Publishing Ltd
Abstract
Delirium occurs commonly following major non-cardiac and cardiac surgery
and is associated with: postoperative mortality; postoperative
neurocognitive dysfunction; increased length of hospital stay; and major
postoperative complications and morbidity. The aim of this study was to
investigate the effect of peri-operative administration of dexmedetomidine
on the incidence of postoperative delirium in non-cardiac and cardiac
surgical patients. In this randomised, double-blind placebo-controlled
trial we included 63 patients aged >= 60 years undergoing major open
abdominal surgery or coronary artery bypass graft surgery with
cardiopulmonary bypass. The primary outcome was the incidence of
postoperative delirium, as screened for with the Confusion Assessment
Method. Delirium assessment was performed twice daily until postoperative
day 5, at the time of discharge from hospital or until postoperative day
14. We found that dexmedetomidine was associated with a reduced incidence
of postoperative delirium within the first 5 postoperative days, 43.8% vs.
17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care
Delirium Screening Checklist, was comparable in both groups, with a mean
maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the
dexmedetomidine group died while five (15.6%) patients in the placebo
group died, p = 0.029. For patients aged >= 60 years undergoing major
cardiac or non-cardiac surgery, we conclude that the peri-operative
administration of dexmedetomidine is associated with a lower incidence of
postoperative delirium. Copyright © 2021 The Authors. Anaesthesia
published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<11>
Accession Number
2011418092
Title
The use of semi-compliant versus non-compliant balloon systems for
predilatation during the implantation of self-expandable transcatheter
aortic valves: Data from the VIenna CardioThOracic Aortic Valve RegistrY
(VICTORY).
Source
European Journal of Clinical Investigation. (no pagination), 2021. Date of
Publication: 2021.
Author
Mach M.; Szalkiewicz P.; Poschner T.; Hasan W.; Andreas M.; Winkler B.;
Hasimbegovic E.; Steinkellner T.; Strouhal A.; Adlbrecht C.; Delle-Karth
G.; Grabenwoger M.
Institution
(Mach, Szalkiewicz, Poschner, Andreas, Hasimbegovic) Department of Cardiac
Surgery, Medical University of Vienna - Vienna General Hospital, Vienna,
Austria
(Mach, Szalkiewicz, Winkler, Grabenwoger) Heart Team Vienna, Department of
Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner
Institute for Cardio-Vascular Research, Vienna, Austria
(Hasan) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Hasimbegovic) Division of Cardiology, Department of Internal Medicine II,
Medical University of Vienna - Vienna General Hospital, Vienna, Austria
(Steinkellner) Division of Anatomy, Center of Anatomy and Cell Biology,
Medical University of Vienna - Vienna General Hospital, Vienna, Austria
(Strouhal, Adlbrecht, Delle-Karth) Department of Cardiology, Clinic
Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and
Critical Care Research, Vienna, Austria
(Adlbrecht) Imed19-privat, private clinical research center, Vienna,
Austria
(Grabenwoger) Medical faculty, Sigmund Freud University, Vienna, Austria
Publisher
Blackwell Publishing Ltd
Abstract
Background: This study aimed to evaluate the differences in outcome
arising from the use of semi-compliant (SCB) versus non-compliant balloon
(NCB) systems for predilatation during self-expanding transcatheter aortic
valve replacement (TAVR). Method(s): 251 TAVR procedures with the
implantation of self-expanding valves after predilatation were analyzed.
SCB systems were used in 166 and NCB systems in 85 patients. The primary
endpoint was defined as device success, a composite endpoint comprising
the absence of procedural mortality, correct valve positioning, adequate
valve performance and the absence of more than a mild paravalvular leak.
The secondary endpoints were chosen in accordance with the valve academic
research consortium (VARC-2) endpoint definitions. Result(s): No
significant differences were observed with regard to procedural device
success between the SCB- and NCB cohort (SCB: 142 [85.5%%] vs. NCB: 77
[90.6%]; P =.257). There was a notable difference between the rates of
conversion to open surgery and the postdilatation rate, both of which were
higher for the NCB group (SCB: 1 [0.6%] vs. NCB: 4 [5.1%]; P =.042; SCB:
30 [18.1%] vs. NCB: 34 [40%]; P <.001). In a multivariate logistic
regression analysis, the use of semi-compliant balloon systems for
predilatation was associated with a lower risk for postdilatation (OR:
0.296; 95% CI: 0.149-0.588) and conversion to open surgery (OR: 0.205; 95%
CI: 0.085-0.493; P =.001) but not for device success. Conclusion(s):
While the balloon compliance did not affect the procedural mortality,
device success or the rate of paravalvular leakage, the use of
semi-compliant balloons for predilatation during TAVR should be
investigated in larger randomized trials in the light of the lower rates
of postdilatation and conversion to open surgery compared to their
non-compliant counterparts. Copyright © 2021 The Authors.
European Journal of Clinical Investigation published by John Wiley & Sons
Ltd on behalf of Stichting European Society for Clinical Investigation
Journal Foundation

<12>
Accession Number
2007586431
Title
Prevention of pressure injury in the operating room: Heels operating room
pressure injury trial.
Source
International Wound Journal. 18 (3) (pp 359-366), 2021. Date of
Publication: June 2021.
Author
Eberhardt T.D.; de Lima S.B.S.; de Avila Soares R.S.; Silveira L.B.T.D.;
Rossarola Pozzebon B.; Reis C.R.; dos Santos K.P.P.; Alves P.J.P.
Institution
(Eberhardt, de Lima, Silveira, Rossarola Pozzebon, Reis, dos Santos)
Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa
Maria, RS, Brazil
(Eberhardt) Instituto de Ciencias Biologicas, Universidade de Passo Fundo,
Passo Fundo, RS, Brazil
(de Avila Soares) Colegio Politecnico, Universidade Federal de Santa
Maria, Santa Maria, RS, Brazil
(Alves) Instituto de Ciencias da Saude, Universidade Catolica Portuguesa,
Porto, Portugal
Publisher
Blackwell Publishing Ltd
Abstract
The objective was to evaluate the efficacy of multi-layered silicone foam
(intervention) compared with transparent polyurethane film (control) in
preventing heel pressure injuries caused by surgical positioning of
individuals undergoing elective surgery. It was designed an intra-patient,
open, parallel, randomised controlled trial was conducted in a university
hospital in southern Brazil, from March 2019 to February 2020, with
patients undergoing elective surgeries of cardiac and gastrointestinal
specialties. The patients who met the selection criteria constituted,
simultaneously, a single group receiving the intervention and active
control, through paired analysis of the cutaneous sites (right heel and
left heel). The outcome was the occurrence of PI, within the follow-up
period was 72 hours. Brazilian Registry of Clinical Trials: RBR-5GKNG5.
There was analysis of 135 patients/270 heels, with an overall incidence of
36.7%. The pressure injury incidence was significantly lower in the
intervention group (26.7%), compared with the control group (P =.001);
relative risk of 0.57. In the intervention group, the estimated pressure
injury-free time (survival) was 57.5 hours and in the control group, 43.9
hours. It was concluded that Multi-layered silicone foam (intervention) is
more efficacious than transparent polyurethane film (control) in the
prevention of pressure injuries caused by surgical positioning of
individuals undergoing elective surgery. Copyright © 2020 The
Authors. International Wound Journal published by Medicalhelplines.com Inc
(3M) and John Wiley & Sons Ltd.

<13>
Accession Number
2011981519
Title
Noninvasive cardiovascular imaging for myocardial necrosis, viability,
stunning and hibernation: Evidence from an umbrella review encompassing 12
systematic reviews, 286 studies, and 201,680 patients.
Source
Minerva Cardiology and Angiology. 69 (2) (pp 191-200), 2021. Date of
Publication: April 2021.
Author
Nudi F.; Iskandrian A.E.; Schillaci O.; Nudi A.; Di Belardino N.; Frati
G.; Biondi Zoccai G.
Institution
(Nudi, Nudi) Service of Hybrid Cardio Imaging, Madonna della Fiducia
Clinic, Rome, Italy
(Nudi) Replycare, Rome, Italy
(Iskandrian) Division of Cardiovascular Diseases, Department of Medicine,
University of Alabama at Birmingham, Birmingham, AL, United States
(Schillaci) Department of Biomedicine and Prevention, Tor Vergata
University, Rome, Italy
(Di Belardino) Unit of Cardiology, Ospedali Riuniti di Anzio-Nettuno,
Anzio, Rome, Italy
(Frati, Biondi Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Rome, Italy
(Frati) IRCCS Neuromed, Pozzilli, Isernia, Italy
(Biondi Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The concomitant presence of myocardial necrosis with
myocardial ischemia, stunning or hibernation may complicates appraisal of
left ventricular (LV) function and patient management. Several imaging
modalities have been proposed for the accurate assessment of myocardial
necrosis, viability, stunning and hibernation, with mixed results. We
aimed to review the evidence base on myocardial necrosis, stunning and
hibernation by conducting an umbrella review (i.e. overview of systematic
reviews). EVIDENCE ACQUISITION: We searched PubMed and The Cochrane
Library for meta-analyses focusing on the diagnostic, prognostic, or
management appraisal of myocardial necrosis, viability, stunning and
hibernation. Diagnostic test accuracy, prognostic yield, and clinical
outcomes were systematically abstracted from shortlisted reviews. EVIDENCE
SYNTHESIS: From an initial set of 6069 citations, 12 systematic reviews
were finally included, encompassing 286 studies and 201,680 patients.
Cardiac magnetic resonance imaging (CMR) had favorable results in 4
reviews that focused on the diagnosis of myocardial stunning or
hibernation in patients followed for 6+/-4 months after coronary
revascularization (sensitivity 96% and specificity 91%). Positron emission
tomography (PET), single photon emission tomography (SPECT) and CMR in 6
meta-analyses had each a significant and independent prognostic role for
the prediction of fatal and non-fatal cardiovascular events in patients
with follow-up of 2.8+/-1.7 years. Finally, 2 reviews with 2.3+/-1.1 years
of follow-up showed moderate quality evidence in favor of coronary
revascularization in patients with objective signs of myocardial
viability. CONCLUSION(S): The appraisal of myocardial necrosis and
residual viability remains a cornerstone of the modern management of
patients with CAD. Current imaging modalities (echocardiography, PET,
SPECT and CMR) are widely used. Further trials using contemporary methods
are warranted to further clarify the impact of viability assessment on
patient management, and the cumulative risk of morbidity and mortality.
 Copyright © 2020 EDIZIONI MINERVA MEDICA.

<14>
Accession Number
2011981514
Title
Effects of treprostinil on pulmonary arterial hypertension during surgery
for congenital heart disease complicated with severe pulmonary arterial
hypertension.
Source
Minerva Cardiology and Angiology. 69 (2) (pp 154-160), 2021. Date of
Publication: April 2021.
Author
Jiang H.; Yu X.; Zhang L.; Wang M.
Institution
(Jiang, Wang) Department of Ultrasonography, Weihai Central Hospital,
Weihai, China
(Yu) Blood Purification Center, Weihai Central Hospital, Weihai, China
(Zhang) Penglai People's Hospital, Yantai, China
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: The aim of this study is to evaluate the effects of
treprostinil injection on the control of pulmonary blood pressure in
children with congenital heart disease (CHD) complicated by severe
pulmonary arterial hypertension (PAH). METHOD(S): Eighty children
with CHD complicated by severe pulmonary arterial hypertension admitted to
our hospital from January 2015 to June 2018 were selected and randomly
divided into a control group (N.=40) and a treatment group (N.=40). Based
on standard treatment, the treatment group was intravenously infused with
8-12 ng/kg.min treprostinil, while the control group received the same
dose of normal saline. Hemodynamic parameters such as BP, AP, P and SpO2%
were monitored before anesthesia induction (T0), before cardiopulmonary
bypass (T1), 1 h after cardiopulmonary bypass (T2) and at the end of
cardiopulmonary bypass (T3). Pulmonary arterial pressure parameters (PASP,
PADP and PAMP) were measured at T1, T2 and T3 by transesophageal
echocardiography. RESULT(S): For the treatment group, the HR values
at T2 and T3 were lower than that at T0 (P<0.05). For the control group,
HR at T3 was lower than that at T0 (P<0.05). HR at T3 of the treatment
group was lower than that of the control group (P<0.05). SpO2 of the
treatment group was higher than that of the control group at T3 (P<0.05).
At T2 and T3, PASP, PADP and PAMP of both groups were lower than those
before surgery (P<0.05), and the values of the treatment group were lower
than those of the control group (P<0.05). CONCLUSION(S): Treprostinil
can improve cardiac function and reduce pulmonary circulation resistance
in PAH children. Copyright © 2020 EDIZIONI MINERVA MEDICA.

<15>
Accession Number
2011978960
Title
Randomized Clinical Trial of Surgical Versus Percutaneous Versus Hybrid
Multivessel Coronary Revascularization: 3 Years' Follow-Up.
Source
JACC: Cardiovascular Interventions. 14 (10) (pp 1163-1165), 2021. Date of
Publication: 24 May 2021.
Author
Ganyukov V.I.; Kochergin N.A.; Shilov A.A.; Tarasov R.S.; Skupien J.;
Kozyrin K.A.; Barbarash O.L.; Musialek P.
Publisher
Elsevier Inc.

<16>
Accession Number
2011983152
Title
Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in
Patients with Heart Failure with Secondary Mitral Regurgitation: The COAPT
Trial.
Source
Journal of the American Society of Echocardiography. (no pagination),
2021. Date of Publication: 2021.
Author
Medvedofsky D.; Milhorini Pio S.; 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, Weissman, Asch) MedStar Health Research Institute,
Washington, DC, United States
(Milhorini Pio, Namazi, Delgado, Bax) Department of Cardiology, Leiden
University Medical Center, Leiden, Netherlands
(Weissman, Asch) Georgetown University, Washington, DC, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Lerakis, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Zhou, Liu, Alu, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University
Medical Center, Columbus, OH, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
Publisher
Mosby Inc.
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 who would have a better
prognosis and are more likely to benefit from edge-to-edge transcatheter
mitral valve repair with the MitraClip. The aim of this study was to
assess the prognostic utility of baseline LV GLS during 2-year follow-up
of patients with HF with secondary mitral regurgitation enrolled in the
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients with Functional Mitral Regurgitation trial.
 Method(s): Patients with symptomatic HF with moderate to severe or
severe secondary mitral regurgitation who remained symptomatic despite
maximally tolerated guideline-directed medical therapy (GDMT) were
randomized to transcatheter mitral valve repair plus GDMT or GDMT alone.
Speckle-tracking-derived LV GLS from baseline echocardiograms was obtained
in 565 patients and categorized in tertiles. Death and HF hospitalization
at 2-year follow-up were the principal outcomes of interest.
 Result(s): Patients with better baseline LV GLS 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 LV GLS. However,
the rate of death or HF hospitalization between 10 and 24 months was lower
in patients with better LV GLS (P =.03), with no differences before 10
months. There was no interaction between GLS tertile and treatment group
with respect to 2-year clinical outcomes. Conclusion(s): Baseline LV
GLS did not predict death or HF hospitalization throughout 2-year
follow-up, but it did predict outcomes after 10 months. The benefit of
transcatheter mitral valve repair over GDMT alone was consistent in all
subgroups irrespective of baseline LV GLS. Copyright © 2021
American Society of Echocardiography

<17>
Accession Number
2011983011
Title
Long-term Healthcare Expenditures Over Time for Tissue and Mechanical
Aortic Valve Replacement.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Nguyen T.C.; Walker T.; Gunnarsson C.; Moore M.; Keuffel E.L.
Institution
(Nguyen) Memorial Hermann Medical Center, University of Texas, Houston,
TX, United States
(Walker, Moore) Edwards Lifesciences, Irvine, California, United States
(Gunnarsson) Gunnarsson Consulting, Jupiter, Florida, United States
(Keuffel) Health Finance & Access Initiative, Bryn Mawr, Pennsylvania,
United States
Publisher
Elsevier Inc.
Abstract
Background: Guidelines currently indicate the use of surgical aortic valve
replacement (SAVR) to treat severe cases of aortic stenosis, particularly
for low- to medium-risk patients. Although several studies have compared
health outcomes of tissue and mechanical SAVR, this economic simulation
model estimates the difference in long-term healthcare costs associated
with tissue relative to mechanical SAVR. Method(s): The deterministic
and Monte Carlo simulation models used literature-based epidemiologic and
cost inputs to calculate annual expenditures related to SAVR for up to 25
years after initial surgery. A series of 3 cohort studies across different
age groups provided the health outcome probabilities for tissue valve
patients. Outcome probabilities for mechanical valve patients were based
on relative risks reported in comparative meta-analyses or large cohort
studies. Result(s): Relative to mechanical SAVR the expected net
discounted savings for a patient receiving tissue SAVR at ages 45, 55, and
65 years were $12,266, $15,462, and $16,008, respectively (based on 2018
US dollars) over a 25-year horizon (95% confidence intervals exceed $0).
For a 45-year-old tissue SAVR patient, the estimated per-patient cost
difference (relative to mechanical SAVR) of reoperation over 25 years
($16,201) were offset by expected savings on anticoagulation monitoring
($26,257) over the same period. In a sensitivity analysis in which
mortality risk was assumed equal, significant long-term savings associated
with tissue SAVR still accrued in each of the 3 age cohorts.
 Conclusion(s): Payers, providers, and the healthcare system may
financially benefit from the use of tissue valves because significant
savings were associated with the use of tissue valves relative to
mechanical valves for SAVR. Copyright © 2021

<18>
Accession Number
2011465986
Title
Diagnostic accuracy of stroke volume variation for predicting fluid
responsiveness in children undergoing cardiac surgery: A systematic review
and meta-analysis.
Source
Paediatric Anaesthesia. (no pagination), 2021. Date of Publication: 2021.
Author
Luo D.; Liu F.; Dai W.; Zhang J.; Shao Q.; Tao W.; Xiao R.; Feng X.; Qian
K.
Institution
(Luo, Liu, Zhang, Shao, Tao, Xiao, Qian) Department of Intensive Care
Unit, The First Affiliated Hospital of Nanchang University, Nanchang,
China
(Luo, Dai) Department of Intensive Care Unit, The Fifth Dongxin's Hospital
of Shangrao City, Shangrao, China
(Feng) Department of Anesthesiology, The Second Affiliated Hospital of
Nanchang University, Nanchang, China
Publisher
Blackwell Publishing Ltd
Abstract
Background: Stroke volume variation appears to be reliable for predicting
fluid responsiveness in adults, and its predictive value in pediatric
patients has been recently reported. However, its predictive value in
children undergoing cardiac surgery is unclear. Method(s): A review
and meta-analysis were performed on the diagnostic utility of stroke
volume variation for predicting fluid responsiveness in children
undergoing cardiac surgery. All relevant articles for prospective research
assessing the value of stroke volume variation were searched in the
Embase, MEDLINE (PubMed), and Cochrane databases through March 2020. The
primary outcome was the accuracy of stroke volume variation for predicting
fluid responsiveness in children. The combined data were analyzed by a
meta-analysis. Publication quality was assessed using the QUADAS (quality
assessment for studies of diagnostic accuracy, maximum score) standard
guidelines. Result(s): Six articles were included in the
meta-analysis, following the search strategy. A total of 251 children were
included from 6 prospective studies. Fluid therapy for all patients used
crystalloids or colloids. The results of the analysis revealed a pooled
diagnostic odds ratio of 8.23 (95% CI: 3.07-22.11), pooled sensitivity of
0.73 (95% CI: 0.64-0.80), and pooled specificity of 0.66 (95% CI:
0.58-0.74). Additionally, the overall area of the summary receiver
operating characteristic curve was 0.78. There was significant moderate
heterogeneity in these studies (p <.05, I2 = 42.1%) due to
thresholds. Conclusion(s): There was some heterogeneity due to
thresholds in the included studies. An evaluation of stroke volume
variation may represent a reliable predictor of fluid responsiveness in
children undergoing cardiac surgery. After operative cardiac output
optimization, the possible impact of goal-directed fluid treatment
depending on stroke volume variation on the perioperative outcome in the
children population should subsequently be assessed. Copyright ©
2021 John Wiley & Sons Ltd

<19>
[Use Link to view the full text]
Accession Number
634975168
Title
Acupuncture for blunt chest trauma: A protocol for a double-blind
randomized control trial.
Source
Medicine. 100 (18) (pp e25667), 2021. Date of Publication: 07 May 2021.
Author
Kao P.-Y.; Ben-Arie E.; Lu T.-Y.; Ho W.-C.; Lee Y.-C.; Lin Y.-S.; Chen
C.-K.; Chen J.-X.; Huang T.-M.; Chen F.-P.
Institution
(Kao, Lu, Lin, Chen, Chen, Huang) Division of Thoracic Surgery, Department
of Surgery, China Medical University Hospital, Taichung, Taiwan (Republic
of China)
(Kao, Chen) Institute of Traditional Medicine, School of Medicine,
National Yang-Ming University, Taipei, Taiwan (Republic of China)
(Ben-Arie, Lee) Graduate Institute of Acupuncture Science, China Medical
University
(Ho) Department of Public Health, China Medical University
(Lee) Department of Acupuncture, China Medical University Hospital,
Taichung, Taiwan (Republic of China)
(Chen) Center for Traditional Medicine, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Blunt chest trauma (BCT) accounts for up to 65% of
polytrauma patients. In patients with 0 to 2 rib fractures, treatment
interventions are typically limited to oral analgesics and breathing
exercises. Patients suffering from BCT experience symptoms of severe pain,
poor sleep, and inability to perform simple daily life activities for an
extended period of time thereafter. In this trial, we aim to investigate
the efficacy of acupuncture as a functional and reliable treatment option
for blunt chest trauma patients. METHOD(S): The study is designed as
a double-blind randomized control trial. We will include 72 patients
divided into 2 groups; the acupuncture group (Acu) and placebo group
(Con). The acupuncture group will receive true acupuncture using a
uniquely designed press tack needle. The control group will receive
placebo acupuncture treatment through the use of a similarly designed
press tack needle without the needle element. The acupoints selected for
both groups are GB 34, GB 36, LI 4, LU 7, ST 36, and TH 5. Both groups
will receive 1 treatment only following the initial visit to the medical
facility and upon diagnosis of BCT. Patient outcome measurements include:
Numerical Rating Scale, Face Rating Scale, respiratory function flowmeter,
Verran Snyder-Halpern sleep scale, and the total amount of allopathic
medication used. Follow-up time will be scheduled at 4 days, 2 weeks, and
lastly 3 months. EXPECTED OUTCOME: The results of this study can
potentially provide a simple and cost-effective analgesic solution to
blunt chest trauma patients. This novel study design can serve as
supporting evidence for future double-blind studies within the field of
acupuncture. OTHER INFORMATION: The study will be conducted in the
thoracic surgical department and acupuncture department in China Medical
University Hospital, Taichung, Taiwan. The study will be conducted on
blunt chest trauma patients and is anticipated to have minimum risk of
adverse events. Enrollment of the patients and data collection will start
from March 2020. Study completion time is expected in March 2022. PROTOCOL
REGISTRATION: (CMUH109-REC1-002), (NCT04318496). Copyright © 2021
the Author(s). Published by Wolters Kluwer Health, Inc.

<20>
Accession Number
634979249
Title
Coronary artery bypass grafting in a patient with situs inversus totalis
and Hodgkin lymphoma: Three-year follow-up report and systematic
literature review.
Source
Asian journal of surgery. (no pagination), 2021. Date of Publication: 02
May 2021.
Author
Cheng Z.; Zhang J.; Shi J.; Guo Y.
Institution
(Cheng, Zhang, Shi, Guo) Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, Chengdu, Sichuan 610041, China
Publisher
NLM (Medline)

<21>
Accession Number
2011393608
Title
Robot-assisted thoracic surgery versus video-assisted thoracic surgery for
lung lobectomy or segmentectomy in patients with non-small cell lung
cancer: a meta-analysis.
Source
BMC Cancer. 21 (1) (no pagination), 2021. Article Number: 498. Date of
Publication: December 2021.
Author
Ma J.; Li X.; Zhao S.; Wang J.; Zhang W.; Sun G.
Institution
(Ma, Li, Zhao, Wang, Zhang) Student of the College of Basic Medical
Sciences, Naval Medical University, No. 800 Xiangyin Road, Yangpu
District, Shanghai 200433, China
(Sun) Department of Thoracic Surgery, Changzheng Hospital, Naval Medical
University, No. 415 Fengyang Road, Huangpu District, Shanghai 200003,
China
Publisher
BioMed Central Ltd
Abstract
Background: It remains no clear conclusion about which is better between
robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery
(VATS) for the treatment of patients with non-small cell lung cancer
(NSCLC). Therefore, this meta-analysis aimed to compare the short-term and
long-term efficacy between RATS and VATS for NSCLC. Method(s):
Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure
(CNKI), Medline, and Web of Science databases were comprehensively
searched for studies published before December 2020. The quality of the
articles was evaluated using the Newcastle-Ottawa Scale (NOS) and the data
analyzed using the Review Manager 5.3 software. Fixed or random effect
models were applied according to heterogeneity. Subgroup analysis and
sensitivity analysis were conducted. Result(s): A total of 18 studies
including 11,247 patients were included in the meta-analyses, of which
5114 patients were in the RATS group and 6133 in the VATS group. Compared
with VATS, RATS was associated with less blood loss (WMD = - 50.40, 95% CI
-90.32 ~ - 10.48, P = 0.010), lower conversion rate (OR = 0.50, 95% CI
0.43 ~ 0.60, P < 0.001), more harvested lymph nodes (WMD = 1.72, 95% CI
0.63 ~ 2.81, P = 0.002) and stations (WMD = 0.51, 95% CI 0.15 ~ 0.86, P =
0.005), shorter duration of postoperative chest tube drainage (WMD = -
0.61, 95% CI -0.78 ~ - 0.44, P < 0.001) and hospital stay (WMD = - 1.12,
95% CI -1.58 ~ - 0.66, P < 0.001), lower overall complication rate (OR =
0.90, 95% CI 0.83 ~ 0.99, P = 0.020), lower recurrence rate (OR = 0.51,
95% CI 0.36 ~ 0.72, P < 0.001), and higher cost (WMD = 3909.87 USD, 95% CI
3706.90 ~ 4112.84, P < 0.001). There was no significant difference between
RATS and VATS in operative time, mortality, overall survival (OS), and
disease-free survival (DFS). Sensitivity analysis showed that no
significant differences were found between the two techniques in
conversion rate, number of harvested lymph nodes and stations, and overall
complication. Conclusion(s): The results revealed that RATS is a
feasible and safe technique compared with VATS in terms of short-term and
long-term outcomes. Moreover, more randomized controlled trials comparing
the two techniques with rigorous study designs are still essential to
evaluate the value of robotic surgery for NSCLC. Copyright ©
2021, The Author(s).

<22>
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.

<23>
Accession Number
2006792915
Title
A systematic review of guidelines for dual antiplatelet therapy in
coronary artery bypass graft.
Source
European Journal of Clinical Investigation. 51 (1) (no pagination), 2021.
Article Number: e13405. Date of Publication: January 2021.
Author
Zhang Z.-Z.-P.; Zhang S.-Z.; Zhou H.-M.; Fan Y.-Q.; Liu M.-H.; Zhong
X.-B.; Yang D.-Y.; Guo Y.; Zhuang X.-D.; Liao X.-X.
Institution
(Zhang) Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou,
China
(Zhang, Zhou, Fan, Liu, Zhong, Yang, Guo, Zhuang, Liao) Cardiology
Department, First Affiliated Hospital of Sun Yat-Sen University,
Guangzhou, China
(Zhang, Zhou, Fan, Liu, Zhong, Yang, Guo, Zhuang, Liao) NHC Key Laboratory
of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
Publisher
Blackwell Publishing Ltd
Abstract
Background: In most situations, many patients undergoing coronary artery
bypass graft (CABG) are on dual antiplatelet therapy (DAPT), which is also
required after CABG. The adjustment of antiplatelet strategy remains
controversial. In this study, we systematically review current guidelines,
seeking consensus and controversies to facilitate clinical practice.
 Methods and Results: Guidelines are searched in PubMed, Embase, ECRI
Guidelines Trust and websites of guidelines organizations and professional
society. Guidelines with recommendations of DAPT for patients undergo CABG
are included. Two reviewers appraised guidelines with the Appraisal of
Guidelines for Research and Evaluation II (AGREE II). Relevant
recommendations are extracted and summarized. A total of 14 guidelines
meeting inclusion criteria are selected, with average AGREE II scores from
44% to 86%. Most guidelines score high in domains other than
'applicability'. Many guidelines are not detailed enough in reporting
considerations behind recommendations. Current guidelines are consistent
on the management of antiplatelet strategy before elective CABG and using
DAPT after surgery for preventing graft vessel occlusion. Evidence is
still lacking in urgent CABG and resumption of the previous DAPT after
surgery. Conclusion(s): Current guidelines on DAPT in CABG are
generally satisfying. Suspending P2Y12 inhibitors while aspirin continued
before elective CABG is recommended, as well as 12 months of DAPT
following CABG. More evidence is needed to guide antiplatelet therapy in
urgent CABG and to prove the benefits of resuming previous
DAPT. Copyright © 2020 Stichting European Society for Clinical
Investigation Journal Foundation. Published by John Wiley & Sons Ltd

<24>
Accession Number
2011901063
Title
Incidence and impact of primary graft dysfunction in adult heart
transplant recipients: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Buchan T.A.; Moayedi Y.; Truby L.K.; Guyatt G.; Posada J.D.; Ross H.J.;
Khush K.K.; Alba A.C.; Foroutan F.
Institution
(Buchan, Moayedi, Posada, Ross, Alba, Foroutan) Peter Munk Cardiac Center,
Toronto General Hospital-University Health Network, Toronto, Canada
(Buchan, Guyatt, Foroutan) Department of Health Research Methods,
Evidence, and Impact, McMaster University, Ontario, Canada
(Truby) Division of Cardiology, Department of Medicine, Duke University
Medical Center, North Carolina, United States
(Khush) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University, California, United States
Publisher
Elsevier Inc.
Abstract
Purpose: Primary graft dysfunction (PGD) is a leading cause of early
mortality after heart transplant (HTx). To identify PGD incidence and
impact on mortality, and to elucidate risk factors for PGD, we
systematically reviewed studies using the ISHLT 2014 Consensus Report
definition and reporting the incidence of PGD in adult HTx recipients.
 Method(s): We conducted a systematic search in January 2020 including
studies reporting the incidence of PGD in adult HTx recipients. We used a
random effects model to pool the incidence of PGD among HTx recipients
and, for each PGD severity, the mortality rate among those who developed
PGD. For prognostic factors evaluated in >=2 studies, we used random
effects meta-analyses to pool the adjusted odds ratios for development of
PGD. The GRADE framework informed our certainty in the evidence.
 Result(s): Of 148 publications identified, 36 observational studies
proved eligible. With moderate certainty, we observed pooled incidences of
3.5%, 6.6%, 7.7%, and 1.6% and 1-year mortality rates of 15%, 21%, 41%,
and 35% for mild, moderate, severe and isolated right ventricular-PGD,
respectively. Donor factors (female sex, and undersized), recipient
factors (creatinine, and pre-HTx use of amiodarone, and temporary or
durable mechanical support), and prolonged ischemic time proved associated
with PGD post-HTx. Conclusion(s): Our review suggests that the
incidence of PGD may be low but its risk of mortality high, increasing
with PGD severity. Prognostic factors, including undersized donor,
recipient use of amiodarone pre-HTx and recipient creatinine may guide
future studies in exploring donor and/or recipient selection and risk
mitigation strategies. Copyright © 2021 International Society for
Heart and Lung Transplantation

<25>
Accession Number
2011406291
Title
Continuous erector spinae plane block versus thoracic epidural analgesia
in video-assisted thoracic surgery: a study protocol for a prospective
randomized open label non-inferiority trial.
Source
Trials. 22 (1) (no pagination), 2021. Article Number: 321. Date of
Publication: December 2021.
Author
van den Broek R.J.C.; Koopman J.S.H.A.; Postema J.M.C.; Verberkmoes N.J.;
Chin K.J.; Bouwman R.A.; Versyck B.J.B.
Institution
(van den Broek, Bouwman, Versyck) Department of Anesthesiology and Pain
Medicine, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ,
Netherlands
(Koopman, Postema) Department of Anesthesiology and Pain Medicine,
Maasstad Hospital, Maasstadweg 21, Rotterdam 3079 DZ, Netherlands
(Verberkmoes) Heart Center Catharina Hospital, Michelangelolaan 2,
Eindhoven 5623 EJ, Netherlands
(Chin) Department of Anesthesiology and Pain Medicine, Toronto Western
Hospital, University of Toronto, 339 Bathurst St, Toronto, ON M5T 2S8,
Canada
(Versyck) Department of Anesthesiology and Pain Medicine, AZ Turnhout,
Steenweg op Merksplas 44, Turnhout 2300, Belgium
Publisher
BioMed Central Ltd
Abstract
Background: Thoracic epidural analgesia is considered the gold standard
for pain relief in video-assisted thoracoscopic surgery. This neuraxial
technique blocks pain sensation by injecting a local anesthetic agent in
the epidural space near the spinal cord to block spinal nerve roots.
Recently, the erector spinae plane block has been introduced as a
practical alternative to the thoracic epidural. This interfascial regional
anesthesia technique interrupts pain sensation by injecting a local
anesthetic agent in between the muscular layers of the thoracic wall.
Several case series and three RCTs described it as an effective pain
management technique in video-assisted thoracoscopic surgery (Scimia et
al., Reg Anesth Pain Med 42:537, 2017; Adhikary et al., Indian J Anaesth
62:75-8, 2018; Kim, A randomized controlled trial comparing continuous
erector spinae plane block with thoracic epidural analgesia for
postoperative pain management in video-assisted thoracic surgery, n.d.;
Yao et al., J Clin Anesth 63:109783, 2020; Ciftci et al., J Cardiothorac
Vasc Anesth 34:444-9, 2020). The objective of this study is to test the
hypothesis that a continuous erector spinae plane block incorporated into
an opioid-based systemic multimodal analgesia regimen is non-inferior in
terms of the quality of postoperative recovery compared to continuous
thoracic epidural local anesthetic-opioid analgesia in patients undergoing
elective unilateral video-assisted thoracoscopic surgery. Method(s):
This is a prospective randomized open label non-inferiority trial. A total
of 90 adult patients undergoing video-assisted thoracoscopic surgery will
be randomized 1:1 to receive pain treatment with either (1) continuous
erector spinae plane block plus intravenous patient-controlled analgesia
with piritramide (study group) or (2) continuous thoracic epidural
analgesia with a local anesthetic-opioid infusate (control group). All
patients will receive additional systemic multimodal analgesia with
paracetamol and non-steroidal anti-inflammatory drugs. The primary
endpoint is the quality of recovery as measured by the Quality of
Recovery-15 score. Secondary endpoints are postoperative pain as Numerical
Rating Score scores, length of hospital stay, failure of analgesic
technique, postoperative morphine-equivalent consumption, itching, nausea
and vomiting, total operative time, complications related to surgery,
perioperative hypotension, complications related to pain treatment,
duration of bladder catheterization, and time of first assisted
mobilization > 20 m and of mobilization to sitting in a chair.
 Discussion(s): This randomized controlled trial aims to confirm
whether continuous erector spinae plane block plus patient-controlled
opioid analgesia can equal the analgesic effect of a thoracic epidural
local anesthetic-opioid infusion in patients undergoing video-assisted
thoracoscopic surgery. Trial registration: Netherlands Trial Register
NL6433. Registered on 1 March 2018. This trial was prospectively
registered. Copyright © 2021, The Author(s).

<26>
Accession Number
633586461
Title
Interval estimation of the overall treatment effect in random-effects
meta-analyses: Recommendations from a simulation study comparing
frequentist, Bayesian, and bootstrap methods.
Source
Research synthesis methods. 12 (3) (pp 291-315), 2021. Date of
Publication: 01 May 2021.
Author
Weber F.; Knapp G.; Glass A.; Kundt G.; Ickstadt K.
Institution
(Weber, Glass, Kundt) Institute for Biostatistics and Informatics in
Medicine and Ageing Research, Rostock University Medical Center, Rostock,
Germany
(Knapp, Ickstadt) Department of Statistics, TU Dortmund University,
Dortmund, Germany
Publisher
NLM (Medline)
Abstract
There exists a variety of interval estimators for the overall treatment
effect in a random-effects meta-analysis. A recent literature review
summarizing existing methods suggested that in most situations, the
Hartung-Knapp/Sidik-Jonkman (HKSJ) method was preferable. However, a
quantitative comparison of those methods in a common simulation study is
still lacking. Thus, we conduct such a simulation study for continuous and
binary outcomes, focusing on the medical field for application. Based on
the literature review and some new theoretical considerations, a
practicable number of interval estimators is selected for this comparison:
the classical normal-approximation interval using the DerSimonian-Laird
heterogeneity estimator, the HKSJ interval using either the Paule-Mandel
or the Sidik-Jonkman heterogeneity estimator, the Skovgaard higher-order
profile likelihood interval, a parametric bootstrap interval, and a
Bayesian interval using different priors. We evaluate the performance
measures (coverage and interval length) at specific points in the
parameter space, that is, not averaging over a prior distribution. In this
sense, our study is conducted from a frequentist point of view. We confirm
the main finding of the literature review, the general recommendation of
the HKSJ method (here with the Sidik-Jonkman heterogeneity estimator). For
meta-analyses including only two studies, the high length of the HKSJ
interval limits its practical usage. In this case, the Bayesian interval
using a weakly informative prior for the heterogeneity may help. Our
recommendations are illustrated using a real-world meta-analysis dealing
with the efficacy of an intramyocardial bone marrow stem cell
transplantation during coronary artery bypass grafting. Copyright
© 2020 The Authors. Research Synthesis Methods published by John
Wiley & Sons Ltd.

<27>
Accession Number
634961200
Title
A bibliometric analysis of global research output on network
meta-analysis.
Source
BMC medical informatics and decision making. 21 (1) (pp 144), 2021. Date
of Publication: 03 May 2021.
Author
Shi J.; Gao Y.; Ming L.; Yang K.; Sun Y.; Chen J.; Shi S.; Geng J.; Li L.;
Wu J.; Tian J.
Institution
(Shi, Yang) Evidence-Based Nursing Centre, School of Nursing, Lanzhou
University, China
(Gao, Ming, Shi) Evidence-Based Medicine Center, School of Basic Medical
Sciences, Lanzhou University, China
(Sun) School of Nursing, Peking University, Beijing City, China
(Chen) Mianyang hospital of traditional Chinese medicine, China
(Geng) Department of General Surgery, Second Hospital of Lanzhou
University, China
(Li) Second Xiangya Hospital, Central South University, Changsha City,
China
(Wu) Department of Clinical Chinese Pharmacy, School of Chinese Materia
Medica, Beijing University of Chinese Medicine, Beijing City, China
(Tian) Evidence-Based Nursing Centre, School of Nursing, Lanzhou
University, China
(Tian) Evidence-Based Medicine Center, School of Basic Medical Sciences,
Lanzhou University, China
(Tian) Key Laboratory of Evidence-Based Medicine and Knowledge Translation
of Gansu Province, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Network meta-analysis (NMA) has been widely used in the field
of medicine and health, but the research topics and development trends are
still unclear. This study aimed to identify the cooperation of countries
and institutes and explore the hot topics and future prospects in the
field of NMA. METHOD(S): Data of publications were downloaded from
the Web of Science Core Collection. We used CiteSpace V, HistCite 2.1, and
Excel 2016 to analyze literature information, including years, journals,
countries, institutes, authors, keywords, and co-cited references.
 RESULT(S): NMA research developed gradually before 2010 and rapidly
in the following years. 2846 NMA studies were published in 771 journals in
six languages. The PLoS One (110, 3.9%) was the most productive journal,
and N Engl J Med (5904 co-citations) was the most co-cited journal. The
most productive country was the United States (889, 31%) and the most
productive institute was the University of Bristol (113, 4.0%). The active
collaborations were observed between developed countries and between
productive institutes. Of the top 10 authors, four were from the UK, and
among the top 10 co-cited authors, six were from the UK. Randomized
evidence, oral anti-diabetic drugs, coronary artery bypass, certolizumab
pegol, non-valvular atrial fibrillation, and second-line antihyperglycemic
therapy were the hot topics in this field. CONCLUSION(S): NMA studies
have significantly increased over the past decade, especially from 2015 to
2017. Compared with developing countries, developed countries have
contributed more to these publications and have closer cooperation,
indicating that cooperation between developed and developing countries
should be further strengthened. The treatment of diabetes, cardiovascular
diseases, and immune rheumatism are the main hot topics.

<28>
Accession Number
634961615
Title
A systematic review of the evidence supporting post-operative diuretic use
following cardiopulmonary bypass in children with Congenital Heart
Disease.
Source
Cardiology in the young. (pp 1-8), 2021. Date of Publication: 04 May 2021.
Author
Foote H.P.; Hornik C.P.; Hill K.D.; Rotta A.T.; Chamberlain R.; Thompson
E.J.
Institution
(Foote, Hornik, Hill, Rotta, Chamberlain, Thompson) Department of
Pediatrics, Duke University School of Medicine, Durham, United States
(Hornik, Hill) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Paediatric cardiac surgery on cardiopulmonary bypass induces
substantial physiologic changes that contribute to post-operative
morbidity and mortality. Fluid overload and oedema are prevalent
complications, routinely treated with diuretics. The optimal diuretic
choice, timing of initiation, dose, and interval remain largely unknown.
 METHOD(S): To guide clinical practice and future studies, we used
PubMed and EMBASE to systematically review the existing literature of
clinical trials involving diuretics following cardiac surgery from 2000 to
2020 in children aged 0-18 years. Studies were assessed by two reviewers
to ensure that they met eligibility criteria. RESULT(S): We
identified nine studies of 430 children across four medication classes.
Five studies were retrospective, and four were prospective, two of which
included randomisation. All were single centre. There were five primary
endpoints - urine output, acute kidney injury, fluid balance, change in
serum bicarbonate level, and required dose of diuretic. Included studies
showed early post-operative diuretic resistance, suggesting higher initial
doses. Two studies of ethacrynic acid showed increased urine output and
lower diuretic requirement compared to furosemide. Children receiving
peritoneal dialysis were less likely to develop fluid overload than those
receiving furosemide. Chlorothiazide, acetazolamide, and tolvaptan
demonstrated potential benefit as adjuncts to traditional diuretic
regimens. CONCLUSION(S): Early diuretic resistance is seen in
children following cardiopulmonary bypass. Ethacrynic acid appears
superior to furosemide. Adjunct diuretic therapies may provide additional
benefit. Study populations were heterogeneous and endpoints varied.
Standardised, validated endpoints and pragmatic trial designs may allow
investigators to determine the optimal diuretic, timing of initiation,
dose, and interval to improve post-operative outcomes.

<29>
Accession Number
634959921
Title
Impact of Surgical and Transcatheter Aortic Valve Replacement in
Low-Gradient Aortic Stenosis: A Meta-Analysis.
Source
JACC. Cardiovascular interventions. (no pagination), 2021. Date of
Publication: 28 Apr 2021.
Author
Ueyama H.; Kuno T.; Harrington M.; Takagi H.; Krishnamoorthy P.; Sharma
S.K.; Kini A.; Lerakis S.
Institution
(Ueyama) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, USA; Division of Cardiology, Icahn School of
Medicine at Mount Sinai, Mount Sinai Hospital, NY, USA
(Kuno, Harrington) Department of Medicine, Icahn School of Medicine at
Mount Sinai, Mount Sinai Beth Israel, NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Krishnamoorthy, Sharma, Kini, Lerakis) Division of Cardiology, Icahn
School of Medicine at Mount Sinai, Mount Sinai Hospital, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Low-gradient (LG) severe aortic stenosis (AS) encompasses a
wide variety of pathophysiology including classical low-flow, low-gradient
(LF-LG), paradoxical LF-LG, and normal-flow, low-gradient (NF-LG) AS and
uncertainty exists regarding the impact of aortic valve replacement (AVR)
on each sub-class of LGAS. OBJECTIVE(S): We aimed to assess the
impact of AVR on survival in patients with each sub-class of LGAS, and to
compare outcomes following surgical AVR (SAVR) and transcatheter AVR
(TAVR). METHOD(S): PUBMED and EMBASE were queried through October
2020 to identify studies comparing survival of different management (SAVR,
TAVR, and conservative) in LGAS. Pairwise meta-analysis comparing AVR
versus conservative and network meta-analysis comparing SAVR versus TAVR
versus conservative were performed. RESULT(S): Thirty-two studies
with a total of 6,515 patients and a median follow-up time of 24.2
(interquartile range 36.5) months were included. AVR was associated with a
significant decrease in all-cause mortality in classical LF-LG (HR 0.42,
95%CI 0.36-0.48), paradoxical LF-LG (HR 0.41, 95%CI 0.29-0.57), and NF-LG
(HR 0.41, 95%CI 0.27-0.62) compared to conservative management. SAVR and
TAVR were each associated with a decrease in all-cause mortality in
classical LF-LG (HR 0.46, 95%CI 0.38-0.55; HR 0.49, 95%CI 0.37-0.64,
respectively), paradoxical LF-LG (HR 0.42, 95%CI 0.28-0.65; HR 0.42, 95%CI
0.25-0.72, respectively), and NF-LG (HR 0.40, 95%CI 0.21-0.77; HR 0.46,
95%CI 0.26-0.84, respectively) compared to conservative management. No
significant difference was observed between SAVR and TAVR.
 CONCLUSION(S): In all sub-class of LGAS, AVR was associated with a
significant decrease in all-cause mortality regardless of surgical or
transcatheter approach. Copyright © 2021. Published by Elsevier
Inc.

<30>
Accession Number
634101421
Title
Comparison of ringer's lactate and plasmalyte-a as cardiopulmonary bypass
prime for bypass associated acidosis in valve replacement surgeries.
Source
Annals of Cardiac Anaesthesia. 24 (1) (pp 36-41), 2021. Date of
Publication: January-March 2021.
Author
Surabhi S.; Kumar M.
Institution
(Surabhi, Kumar) Department of Anaesthesia and Intensive Care, Vardhman
Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: A wide range of acid base fluctuations are seen during
Cardiopulmonary bypass (CPB) and the development of metabolic acidosis is
well recognized. We conducted a study tocompare the metabolic effects of
Ringer lactate and Plasmalyte-A as CPB prime in causing bypass associated
acidosis in valve replacement surgeries. Method(s): We performed a
prospective, randomized controlled study on a total of 80 adult patients
undergoing CPB for valvular heart surgeries. The patients were randomized
into two groups: Group I (Ringer Lactate) and Group II (Plasmalyte-A).
Arterial blood samples were taken before initiating CPB, 30 minutes after
starting CPB, then every half hourly till termination of CPB and after
half an hour stay in the ICU post operatively to analyze primarily H+
ions, bicarbonates, lactate and strong ion difference. Results and
Discussion: The results were analyzed in a quantitative manner. In Ringer
Lactate group, during CPB, there was reduction in pH from 7.428 +/- 0.029
at T1 to 7.335 +/- 0.06 (P < 0.01) and 7.358 +/- 0.06 (P < 0.01) at T2 and
T3 respectively. Mean bicarbonates decreased in Ringer Lactate group
during CPB from 24.28 +/- 1.65 mEq/L at T1 to 20.98 +/- 2.97 mEq/L at T2
(P < 0.01). In Plasmalyte-A group, mean pH, bicarbonate, strong ion
difference (SID) were comparable at all time intervals (P > 0.05). In
Ringer Lactate group, maximum surge in mean blood lactate levels was seen
from 0.85 +/- 0.35 mmol/l at T1 to 4.29 +/- 1.78 mmol/L (P < 0.01) and
4.17 +/- 1.28 mmol/L (P < 0.01) at T2 and T3, respectively. Such surge was
not seen in Plasmalyte-A group. The mean SID decreased during the CPB in
Ringer Lactate group from 41.102 mEq/L at T1 to 35.66 mEq/L (P = 0.033) at
T2 implying metabolic acidosis. Numbered patients having hypotension and
arrhythmias were also higher in Ringer Lactate group again indicating
higher acidosis. Conclusion(s): The different composition of
Plasmalyte-A and Ringer Lactate have different metabolic implications for
patients undergoing cardiac surgery. Patients who received Plasmalyte-A as
cardiopulmonary bypass prime developed less metabolic acidosis. Hence we
conclude that Plasmalyte-A is the preferred cardiopulmonary bypass prime
in adult patients undergoing valve replacement surgeries. Copyright
© 2021 Wolters Kluwer Medknow Publications. All rights reserved.

<31>
Accession Number
634101417
Title
The synergistic effect of tranexamic acid and ethamsylate combination on
blood loss in pediatric cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 24 (1) (pp 17-23), 2021. Date of
Publication: January-March 2021.
Author
Abd El Baser I.I.; ElBendary H.M.; ElDerie A.
Institution
(Abd El Baser, ElBendary) Departments of Anesthesia and Surgical Intensive
Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
(ElDerie) Departments of Cardiothoracic Surgery, Faculty of Medicine,
Mansoura University, Mansoura, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Pediatric patients are at risk for bleeding after cardiac
surgery. Administration of antifibrinolytic agents reduces postoperative
blood loss. Objective(s): Evaluation of the efficacy of combined
administration of tranexamic acid (TXA) and ethamsylate in the reduction
of postoperative blood loss in pediatric cardiac surgery. Method(s):
This prospective randomized study included 126 children submitted for
cardiac surgery, and they were allocated into three groups: Control group
(n = 42); TXA group (n = 42):- received only TXA; and combined ethamsylate
TXA group (n = 42):- received a combination of TXA and ethamsylate. The
main collected data included sternal closure time, the needs for
intraoperative transfusion of blood and its products, the total amount of
blood loss, and the amount of the whole blood and its products transfused
to the patients in the first 24 postoperative hours. Result(s): Blood
loss volume in the first 24 postoperative hours was significantly smaller
in combined group than the TXA and control groups and was significantly
smaller in the TXA group than the control group. The sternal closure time
was significantly shorter in the combined group than the other 2 groups
and significantly shorter in TXA than the control group. The amount of
whole blood transfused to patients in the combined group during surgery
and in the first postoperative 24 h was significantly smaller than the
other 2 groups and smaller in TXA group than the control group during
surgery. Conclusion(s): Combined administration of ethamsylate and
TXA in pediatric cardiac surgery was more effective in reducing
postoperative blood loss and whole blood transfusion requirements than the
administration of TXA alone. Copyright © 2021 Wolters Kluwer
Medknow Publications. All rights reserved.

<32>
Accession Number
2007465742
Title
Thirty-day incidence of stroke after transfemoral transcatheter aortic
valve implantation: meta-analysis and mixt-treatment comparison of
self-expandable versus balloon-expandable valve prostheses.
Source
Clinical Research in Cardiology. 110 (5) (pp 640-648), 2021. Date of
Publication: May 2021.
Author
Seppelt P.C.; Mas-Peiro S.; De Rosa R.; Dimitriasis Z.; Zeiher A.M.;
Vasa-Nicotera M.
Institution
(Seppelt, Mas-Peiro, De Rosa, Dimitriasis, Zeiher, Vasa-Nicotera) Division
of Cardiology, Department of Medicine III, University Hospital, Goethe
University Frankfurt, Frankfurt am Main, Germany
(Seppelt, Mas-Peiro, Dimitriasis, Zeiher, Vasa-Nicotera) DZHK partner site
Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: Stroke is a major complication after transcatheter aortic valve
implantation (TAVI). Although multifactorial, it remains unknown whether
the valve deployment system itself has an impact on the incidence of early
stroke. We performed a meta- and network analysis to investigate the
30-day stroke incidence of self-expandable (SEV) and balloon-expandable
(BEV) valves after transfemoral TAVI. Methods and Results: Overall,
2723 articles were searched directly comparing the performance of SEV and
BEV after transfemoral TAVI, from which 9 were included (3086 patients).
Random effects models were used for meta- and network meta-analysis based
on a frequentist framework. Thirty-day incidence of stroke was 1.8% in SEV
and 3.1% in BEV (risk ratio of 0.62, 95% confidence interval (CI)
0.49-0.80, p = 0.004). Treatment ranking based on network analysis
(P-score) revealed CoreValve with the best performance for 30-day stroke
incidence (75.2%), whereas SAPIEN had the worst (19.0%). However, network
analysis showed no inferiority of SAPIEN compared with CoreValve (odds
ratio 2.24, 95% CI 0.70-7.2). Conclusion(s): Our analysis indicates
higher 30-day stroke incidence after transfemoral TAVI with BEV compared
to SEV. We could not find evidence for superiority of a specific valve
system. More randomized controlled trials with head-to-head comparison of
SEV and BEV are needed to address this open question. Graphic abstract:
[Figure not available: see fulltext.] Copyright © 2020, The
Author(s).

<33>
Accession Number
2003779290
Title
Long-term survival after xenograft versus homograft aortic root
replacement: Results from a prospective randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 161 (1) (pp 57-65), 2021.
Date of Publication: January 2021.
Author
Melina G.; De Robertis F.; Gaer J.A.; Angeloni E.; El-Hamamsy I.; Bahrami
T.; Pepper J.R.; Takkenberg J.J.M.; Yacoub M.H.
Institution
(Melina, De Robertis, Gaer, Bahrami, Pepper) Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Melina, Angeloni) Department of Cardiac Surgery, Ospedale Sant'Andrea,
"Sapienza" Universita di Roma, Rome, Italy
(El-Hamamsy) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Yacoub) Imperial College, London, United Kingdom
Publisher
Mosby Inc.
Abstract
Objective: The study objective was to investigate the long-term survival
of patients undergoing xenograft versus homograft full root aortic valve
replacement. Method(s): A total of 166 patients requiring aortic
valve surgery were randomized to undergo the Freestyle (Medtronic Inc,
Minneapolis, Minn) bioprosthesis (N = 90) or a homograft (N = 76) full
root aortic valve replacement between 1997 and 2005 in a single
institution. Six patients randomly assigned to the homograft crossed over
to the Freestyle bioprosthesis because of the unavailability of suitably
sized homografts. All surgeons were required to adhere to the standard
surgical technique for homograft root implantation previously described.
Follow-up was 98.5% complete. Result(s): The mean age of the study
population was 65 +/- 8 years. Coronary artery bypass grafting was
associated with root aortic valve replacement in 76 of 166 patients (46%,
P = not significant between groups), and overall hospital mortality was
4.8% (8/166, P = not significant between groups). Median follow-up was
13.8 years (range, 0-21.8 years; 2033 patient-years). The Kaplan-Meier
survival analysis showed that there was no significant difference in
overall survival between the 2 arms at 5, 10, and 15 years. Twenty-year
survival was 28.3% +/- 5% for the Freestyle group versus 25.1% +/- 5.7%
for the homograft group (P =.90), which was comparable to the age- and
sex-matched UK general population. The freedom from aortic valve
reoperation at 20 years was comparable for the Freestyle group versus the
homograft group (67.9% +/- 8.8% vs 67.2% +/- 10.3%, respectively; P =.74).
 Conclusion(s): This is the first study to investigate the long-term
survival of xenograft versus homograft full root aortic valve replacement
from a prospective randomized trial. The observed 20-year overall survival
and freedom from aortic valve reoperation serve as a benchmark for future
studies on interventions for aortic valve disease in the
elderly. Copyright © 2019 The American Association for Thoracic
Surgery

<34>
Accession Number
2007071919
Title
Aspirin alone versus dual antiplatelet therapy after transcatheter aortic
valve implantation: A systematic review and patient-level meta-analysis.
Source
Journal of the American Heart Association. 10 (8) (no pagination), 2021.
Article Number: e019604. Date of Publication: 2021.
Author
Brouwer J.; Nijenhuis V.J.; Rodes-Cabau J.; Stabile E.; Barbanti M.; Costa
G.; Mahmoodi B.K.; Ten Berg J.M.
Institution
(Brouwer, Nijenhuis, Mahmoodi, Ten Berg) Department of Cardiology, St.
Antonius Hospital, Nieuwegein, Netherlands
(Rodes-Cabau) Department of Cardiology, Quebec Heart & Lung Institute,
Laval University, Quebec City, QC, Canada
(Stabile) Department of Advanced Biomedical Sciences, University "Federico
II", Naples, Italy
(Barbanti, Costa) Department of Cardiology, A.O.U. Policlinico "G.
Rodolico - San Marco", Catania, Italy
(Ten Berg) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In patients undergoing transcatheter aortic valve implantation
without an indication for oral anticoagulation, it is unclear whether
single or dual antiplatelet therapy (DAPT) is necessary to minimize both
the bleeding and thromboembolic risk. In this patient-level meta-analysis,
we further investigate the effect of aspirin alone compared with DAPT for
preventing both thromboembolic and bleeding events after transcatheter
aortic valve implantation. METHODS AND RESULTS: We conducted a systematic
review of all available randomized controlled trials comparing aspirin
with DAPT. In total, 1086 patients were included across 4 eligible trials.
The primary outcomes were the composite of all-cause mortality, major or
life-threatening bleeding, stroke or myocardial infarction (first
composite outcome), and the same composite excluding bleeding (second
composite outcome), both tested at 30 days and 3 months. The first
composite outcome occurred significantly less in the aspirin-alone group
at 30 days (10.3% versus 14.7%, odds ratio [OR], 0.67; 95% CI, 0.46-0.97,
P=0.034) and 3 months (11.0% versus 16.5%, hazard ratio [HR], 0.66; 95%
CI, 0.47-0.94, P=0.02), compared with the DAPT group. The second composite
outcome occurred in 5.5% and 6.6% at 30 days (OR, 0.83; 95% CI, 0.50-1.38,
P=0.47) and in 6.9% and 8.5% at 3 months in the aspirin-alone group
compared with the DAPT group (HR, 0.82; 95% CI, 0.52-1.29, P=0.39),
respectively. CONCLUSION(S): In patients without an indication for
oral anticoagulation undergoing transcatheter aortic valve implantation,
aspirin alone significantly reduced the composite of thromboembolic and
bleeding events, and does not increase the composite of thromboembolic
events after transcatheter aortic valve implantation, compared with
DAPT. Copyright © 2021 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<35>
Accession Number
2010066002
Title
Meta-analysis Comparing Outcomes of Percutaneous Coronary Intervention of
Native Artery Versus Bypass Graft in Patients With Prior Coronary Artery
Bypass Grafting.
Source
American Journal of Cardiology. 140 (pp 47-54), 2021. Date of Publication:
01 Feb 2021.
Author
Farag M.; Gue Y.X.; Brilakis E.S.; Egred M.
Institution
(Farag, Egred) Department of Cardiology, Freeman Hospital, Newcastle upon
Tyne, United Kingdom
(Farag, Gue) School of Life and Medical Sciences, University of
Hertfordshire, Hertfordshire, United Kingdom
(Brilakis) Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
(Egred) Institute of Cellular Medicine, Newcastle University, Newcastle
upon Tyne, United Kingdom
Publisher
Elsevier Inc.
Abstract
Percutaneous coronary intervention (PCI) is common in patients with prior
coronary artery bypass graft surgery (CABG), however the data on the
association between the PCI target-vessel and clinical outcomes are not
clear. We aimed to investigate long-term clinical outcomes of patients
with prior CABG who underwent PCI of either bypass graft or native artery.
We performed a systematic review and meta-analysis of observational
studies comparing PCI of either bypass graft or native artery in patients
with prior CABG. Twenty-two studies comprising 40,984 patients were
included. The median follow-up duration was 2 (1 to 3) years. Compared
with bypass graft PCI, native artery PCI was frequent (61% vs 39%) and was
associated with lower major adverse cardiac events (MACE) (odds ratio [OR]
0.51, 95% confidence interval [CI] 0.45 to 0.57, p <0.001), lower
all-cause death (OR 0.65, 95% CI 0.49 to 0.87, p = 0.004), lower
myocardial infarction (OR 0.56, 95% CI 0.45 to 0.69, p <0.001), and lower
target vessel revascularization (TVR) (OR 0.62, 95% CI 0.51to 0.76, p
<0.001). There was no significant difference in the early incidence of
major bleeding or stroke between the 2 cohorts. In 6 studies involving
2,919 patients with ST-elevation myocardial infarction, there was no
significant differences between the 2 cohorts. The increase in TVR risk
with bypass graft PCI was associated with MACE. In conclusion, in
observational studies involving patients with prior CABG, native artery
PCI was associated with lower MACE, all-cause death, myocardial
infarction, and TVR compared with bypass graft PCI at a median follow-up
of 2 years. Native artery PCI might be considered the preferred treatment
for bypass graft failure. Copyright © 2020 Elsevier Inc.

<36>
[Use Link to view the full text]
Accession Number
2010627466
Title
Automated closed-loop versus standard manual oxygen administration after
major abdominal or thoracic surgery: An international multicentre
randomised controlled study.
Source
European Respiratory Journal. 57 (1) (no pagination), 2021. Article
Number: 2000182. Date of Publication: 01 Jan 2021.
Author
L Her E.; Jaber S.; Verzilli D.; Jacob C.; Huiban B.; Futier E.; Kerforne
T.; Pateau V.; Bouchard P.-A.; Consigny M.; Lellouche F.
Institution
(L Her) Medical Intensive Care, Chru de Brest la Cavale Blanche, Brest,
France
(L Her, Pateau) Latim Inserm Umr 1101, Fhu Techsan, Universite de Bretagne
Occidentale, Brest, France
(Jaber, Verzilli) Intensive Care Unit, Dept of Anaesthesiology B, Dar B
Chu de Montpellier, Hopital Saint Eloi, Universite Montpellier 1,
Montpellier, France
(Jacob, Huiban) Anaesthesiology Dept, Chru de Brest la Cavale Blanche,
Brest, France
(Futier) Anaesthesiology Dept, Hopital Estaing, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Kerforne) Anaesthesiology Dept, Chu de Poitiers, Cedex, France
(Pateau) Oxynov Inc., Technopole Brest Iroise, Plouzane, France
(Bouchard, Lellouche) Centre de Recherche de L Institut de Cardiologie et
de Pneumologie de Quebec, QC, Canada
(Consigny) Centre D Investigation Clinique Cic Inserm 1412, Chru Brest la
Cavale Blanche, Brest, France
Publisher
European Respiratory Society
Abstract
Introduction: Hypoxaemia and hyperoxaemia may occur after surgery, with
related complications. This multicentre randomised trial evaluated the
impact of automated closed-loop oxygen administration after high-risk
abdominal or thoracic surgeries in terms of optimising the oxygen
saturation measured by pulse oximetry time within target range.
 Method(s): After extubation, patients with an intermediate to high
risk of post-operative pulmonary complications were randomised to
"standard" or "automated" closed-loop oxygen administration. The primary
outcome was the percentage of time within the oxygenation range, during a
3-day frame. The secondary outcomes were the time with hypoxaemia and
hyperoxaemia under oxygen. Result(s): Among the 200 patients, time
within range was higher in the automated group, both initially (3 h;
91.4+/-13.7% versus 40.2+/-35.1% of time, difference +51.0% (95%
CI-42.8-59.2%); p0.0001) and during the 3-day period (94.0+/-11.3% versus
62.1+/-23.3% of time, difference +31.9% (95% CI 26.3-37.4%); p0.0001).
Periods of hypoxaemia were reduced in the automated group (3 days;
32.6+/-57.8 min (1.2+/-1.9%) versus 370.5+/-594.3 min (5.0+/-11.2%),
difference-10.2% (95% CI-13.9-6.6%); p0.0001), as well as hyperoxaemia
under oxygen (3 days; 5.1+/-10.9 min (4.8+/-11.2%) versus 177.9+/-277.2
min (27.0+/-23.8%), difference-22.0% (95% CI-27.6-16.4%); p0.0001).
Kaplan-Meier analysis depicted a significant difference in terms of
hypoxaemia (p=0.01) and severe hypoxaemia (p=0.0003) occurrence between
groups in favour of the automated group. 25 patients experienced
hypoxaemia for 10% of the entire monitoring time during the 3 days within
the standard group, as compared to the automated group (p0.0001).
 Conclusion(s): Automated closed-loop oxygen administration promotes
greater time within the oxygenation target, as compared to standard manual
administration, thus reducing the occurrence of hypoxaemia and
hyperoxaemia. Copyright © 2021 European Respiratory Society. All
rights reserved.

<37>
Accession Number
2010626006
Title
Early warning of heart disease and knowledge of ecg cardiac thrombosis in
the presence of risk factors surrounding the patient.
Source
Systematic Reviews in Pharmacy. 11 (12) (pp 1068-1077), 2020. Date of
Publication: December 2020.
Author
Kaderomran S.-A.
Institution
(Kaderomran) Al-Muthanna University, college of Medicine, Iraq
Publisher
EManuscript Technologies
Abstract
From the evaluation of the clinical and academic results of the continuous
work of fatal heart diseases and chronic comorbidities that had the most
significant impact on the development of fatal cardiac diseases, we
collected 960 patients randomly, young men, women, men and the elderly, in
addition to the disease history and the collection of patient files in
Samawah General Hospital / and the Specialty Center For endocrinology and
diabetes / in Iraq, for a period of one year (2019-2020), the goal is to
control heart disease before and after injury, early warning, reduce the
mortality rate by setting a mechanism, formula an algorithm, opening the
ECG code, and knowing the location of coronary artery stenosis or
blockage, clotting, and factors leading to exacerbation Cases, to shorten
the distance and speed to complete the diagnosis and treatment for the
doctor to work . and the patient to know his health status, the focus was
on the most common cardiac conditions in our country, angina pectoris,
coronary syndrome, myocardial infarction, and cardiac attack, stroke , The
remnants of war, environmental pollution and psychological stress were
monitored and among the factors referred to, they had an impact . and the
work within a diagnostic, therapeutic counseling program with early
warning was the focus of research on patients who do not complain of
disease but have risk factors for high pressure, high fats and
cholesterol, high urea, uric Acid, Cardiac disorders, coronary artery
contraction, these cases were treated and placed under the control and
according to the periodic review of the patient, but there are more
difficult patients that appear on them with risk factors for disease
development, laboratory, radiological and cardiac analyzes, and we used
various drugs and put them under the control by organizing their
lifestyle, dietary behavior and sports to be Under control and within the
early warning program, As for patients who already have cardiac diseases
and accompanying chronic diseases (bronchial asthma, hypertension,
enlargement of the heart, heart failure, Rinal failure, diabetes mellitus,
these definitely take the most medical effort, care and attention, and
various medications to avoid death and change the lifestyle, especially in
countries. Low and middle income we used the system (ASA) Analysis and
symmetry Algorith:[ SIGMA- Primary PM == Algorithmic ECG analysis +
biomarker analyzes & O2 and pulls + risk factors + x-ray chest + age +
medication]. The first algorithm for cases that show cardiac disease, The
second algorithm formula"(ASA ) Analysis and symmetry Algorithm :[ SIGMA
Secondary SM = ECG Algorithmic Analysis+ biomarker analyses & O2 and
pulls+ Risk factors + chest x- Ray + Age + complications +
medication].Applied to the most serious patients who have heart disease
and chronic disease, risk factors, cardiac catheterization, and open heart
operations (GABG), ( Intensive care unit ) ,In addition to the use of
various life-saving drugs, and according to the pathology, to inform early
heart disease and to warn against exacerbation of cases before and after
the injury, within a rigorous and studied cardiac program, where the
results were satisfactory and significant in controlling heart diseases
and reducing the mortality rate as follows: Therefore, the results were
clear, with a decrease in the overall assessment of cardiac diseases for
youth, women, and men, of different ages in the":(350 patient) youth - 37%
reduction I.H.D ,Myocardial infraction, stable blood pressure, ( RR) 0.70
; 95% CI 0.52 to 0.90 ; p = 00.1), 17% lower risk of stroke, 33 % lower
total risk of CVD, CHD, 22% HbA1C Diabetic mellitus stable , 42% lower
lipid profile, 44% decrease in the incidence of fatal or nonfatal
myocardial infarction , 6% reduction BMI , 72% CAC . As for the women (
250 patient), They were less likely to have heart disease 32% reduction
IHD, MI, Angina ,Bp, lipid profile, 22% reduction stroke (heart ,brain ),
CAC, CHD, D M, As for the men (360 patient ) Those who have heart disease
and chronic diseases and their age is over 50 years 36% decrease I.H.D,
MI, NSTEMI, STEMI, The incidence of fatal Stroke .46% CAC, 32% decrease
Neuropathy, Nephropathy, retinopathy ,HBA1c ,BP, CHD, 52% decrease
mortality and morbidity , 3% PCI coronary revascularizations by (95% CI
16% to 59%) , 0.001% Permanent pacemaker , 21% decrease Heart failure
. Copyright © 2020 EManuscript Technologies. All rights reserved.

<38>
Accession Number
2005459815
Title
Outcomes of Left Main Bifurcation Stenting Depends on Both Length of Dual
Antiplatelet Therapy and Stenting Strategy.
Source
Cardiovascular Revascularization Medicine. 21 (10) (pp 1319-1322), 2020.
Date of Publication: October 2020.
Author
Rigatelli G.; Zuin M.; Vassilev D.; De Ferrari G.M.; D'Ascenzo F.
Institution
(Rigatelli, Zuin) Cardiovascular Diagnosis and Endoluminal Interventions
Unit, Rovigo General Hospital, Rovigo, Italy
(Zuin) University of Ferrara, School of Medicine, Ferrara, Italy
(Vassilev) Department of Cardiology, Alexandrovska University Hospital,
Sofia, Bulgaria
(De Ferrari, D'Ascenzo) Division of Cardiology, Department of Internal
Medicine, Citta della Salute e della Scienza, Turin, Italy
(D'Ascenzo) Department of Cardiovascular Medicine, Nippon Medical School,
Tokyo, Japan
(D'Ascenzo) Division of Cardiology, Universityspirtal of Zurich, Zurich,
Switzerland
Publisher
Elsevier Inc.
Abstract
Data regarding the optimal dual antiplatelet therapy (DAPT) duration in
patients treated with a 1- versus a 2-stent strategy in LM bifurcation PCI
are scant. A literature search based on Cochrane Library, Embase, PubMed
and Google Scholar was performed to locate articles published between
January 2015 and January 2020. The following MeSH terms were used for the
search: "Left Main" AND "DAPT Duration" AND "stent" OR "stenting". The
analysis was conducted following the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement. Occurrence of
major adverse cardiovascular events (MACEs) according to length of DAPT
and stenting strategy was analysed. A total of 256 articles were retrieved
and after evaluation, 3 articles evaluating the results of 8 large
registries were included into the analysis including a final population of
4117 patients [mean age 65.7 years, 3133 (76.0%) males]. A short-term DAPT
resulted in a lower risk of MACEs in patients treated with a single stent
strategy (OR: 0.49, 95% CI [0.33-0.67], p < 0.001, I2 = 0%), whereas a
DAPT >12 months resulted in a significant higher risk of MACEs in the same
group (OR: 7.39, 95% CI [5.09-10.7], p < 0.001, I2 = 61%) compared to
double stent strategy. The available data support the use of short DAPT in
single cross-over LM stenting whereas a long DAPT seems to be more
appropriate after a double stenting strategy in LM bifurcation
PCI. Copyright © 2020 Elsevier Inc.

<39>
Accession Number
2005203629
Title
Listeria pericarditis in a lymphoma patient: Case report and literature
review.
Source
JAMMI. 5 (3) (pp 182-186), 2020. Date of Publication: September 2020.
Author
Findlater A.R.; Haider S.; Leto D.
Institution
(Findlater, Haider, Leto) Division of Infectious Diseases, Hamilton Health
Sciences, Hamilton, ON L8S 4L8, Canada
(Haider, Leto) Department of Medicine, McMaster University, Hamilton, ON,
Canada
Publisher
University of Toronto Press
Abstract
We present a case of pericarditis with pericardial effusion secondary to
Listeria monocytogenes. A 56-year-old man presented with signs of acute
pericarditis, but with prior chronic lymphocytic leukemia treated with
stem cell transplantation, chronic graft-versus-host disease, and a recent
diagnosis of untreated diffuse large B-cell lymphoma. He developed cardiac
tamponade requiring pericar-diocentesis. Blood and pericardial cultures
grew Listeria monocytogenes. He responded to ampicillin but later died
from gram-negative sepsis. A systematic review found 10 other published
English-language cases of pericarditis caused by Listeria. The most common
risk factors were cirrhosis and malignancy. Only three patients survived
both the listeriosis and their underlying infections. Listeria
monocytogenes is a rare and often fatal cause of pericarditis, typically
occurring in immunocompromised patients. Cultures showing gram-positive
bacilli in the context of pericarditis in an immunocompromised patient
should prompt consideration of this rare cause. Copyright © 2020,
University of Toronto Press. All rights reserved.

<40>
Accession Number
2011875444
Title
Economic outcomes of depression screening after acute coronary syndromes:
The CODIACS-QoL randomized clinical trial.
Source
General Hospital Psychiatry. 71 (pp 47-54), 2021. Date of Publication: 01
Jul 2021.
Author
Ladapo J.A.; Davidson K.W.; Moise N.; Chen A.; Clarke G.N.; Dolor R.J.;
Margolis K.L.; Thanataveerat A.; Kronish I.M.
Institution
(Ladapo, Chen) David Geffen School of Medicine at UCLA, Los Angeles, CA,
United States
(Davidson) Center for Personalized Health, Feinstein Institutes for
Medical Research, Northwell Health, Manhasset, NY, United States
(Moise, Thanataveerat, Kronish) Columbia University Irving Medical Center,
New York, NY, United States
(Clarke) Kaiser Permanente, Portland, OR, United States
(Dolor) Duke University School of Medicine, Durham, NC, United States
(Margolis) HealthPartners Institute, Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Objective: To evaluate the cost-effectiveness of screening for depression
in patients with acute coronary syndrome (ACS) and no history of
depression. Method(s): Cost-effectiveness analysis of a randomized
trial enrolling 1500 patients with ACS between 2013 and 2017. Patients
were randomized to no screening, screening and notifying the primary care
provider (PCP), and screening, notifying the PCP, and providing enhanced
depression treatment. Outcomes measured were Healthcare utilization,
costs, and incremental cost-effectiveness ratios. Result(s): 7.1% of
patients screened positive for depressive symptoms. There was no
significant difference in usage of mental health services, cardiovascular
tests and procedures, and medications. Mean total costs in No Screen group
($7440), in Screen, Notify, and Treat group ($6745), and in Screen and
Notify group ($6204). The difference was only significant in the Screen
and Notify group versus the No Screen group (-$1236, 95% confidence
interval -$2388 to -$96). Because mean QALYs were higher (+0.003 QALY in
Screen and Notify; +0.004 QALYs in Screen, Notify, and Treat) and mean
total costs were lower in both intervention groups, these interventions
were cost-effective. There was substantial uncertainty because confidence
intervals around cost differences were wide and QALY effects were small.
 Conclusion(s): Depression screening strategies for patients with ACS
may be modestly cost-effective. Copyright © 2021

<41>
Accession Number
634637704
Title
Effect of perioperative mechanical ventilation strategies on postoperative
pulmonary complications in patients undergoing thoracic surgery:a
Meta-analysis.
Source
Asian journal of surgery. 44 (5) (pp 776-777), 2021. Date of Publication:
01 May 2021.
Author
Zhu Y.; Chen X.; Wang F.; Gao J.
Institution
(Zhu) Dalian Medical University, Dalian 116044, China
(Chen) Northern Jiangsu People's Hospital, Yangzhou 225001, China
(Wang) Dalian Medical University, Dalian 116044, China
(Gao) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Clinical Medical College, Yangzhou University, China
Publisher
NLM (Medline)

<42>
Accession Number
2011938912
Title
Type D personality as a risk factor for adverse outcome in patients with
cardiovascular disease: An individual patient data meta-analysis.
Source
Journal of Psychosomatic Research. Conference: Eighth Annual Scientific
Conference of the European Association of Psychosomatic Medicine (EAPM).
Virtual, Online. 145 (no pagination), 2021. Article Number: 110455. Date
of Publication: June 2021.
Author
Lodder P.; Kupper N.; Wicherts J.
Institution
(Lodder, Kupper, Wicherts) Tilburg University, Netherlands
Publisher
Elsevier Inc.
Abstract
Objective: Type D personality, a joint tendency toward negative
affectivity (NA) and social inhibition (SI), has been linked to adverse
events in cardiovascular disease patients. However, several studies did
not replicate earlier findings. Many earlier studies used a subgroup
operationalisation of Type D personality, which risks falsely concluding a
Type D effect when only NA or SI is related to the outcome. Here, we aim
to shed light on these inconsistencies using an individual patient-data
meta-analysis of 18 earlier published prospective cohort studies (N =
10,759). Method(s): For each outcome (all-cause mortality, cardiac
mortality, myocardial infarction, coronary artery bypass grafting (CABG),
percutaneous coronary intervention (PCI), major adverse cardiac event
(MACE), any adverse event), we estimated Type D effects using Bayesian
Multilevel Logistic Regressions. We investigated the moderating influence
of age and gender. Type D personality was operationalised according the
continuous method. Result(s): Evidence for a Type D effect in terms
of the Bayes factor (BF) was strong for the outcomes MACE (BF = 42.5) and
any adverse event (BF = 129.4), and substantial for CABG (BF = 4.2) and
PCI (BF = 5.1). Strong evidence against a Type D effect was found for
all-cause mortality (BF = 45.9), cardiac mortality (BF = 23.7) and
myocardial infarction (BF = 16.9). Positive NA effects were found on both
cardiac mortality and all-cause mortality, the latter being more
pronounced for males than females. Conclusion(s): Across 18 published
prospective cohort studies, Type D predicts CABG, PCI, MACE and any
adverse event in cardiovascular disease patients. The mortality of such
patients is not affected by Type D personality but by NA. Copyright
© 2021

<43>
Accession Number
634948347
Title
Validated tool for quality assessment of anesthesia services by cardiac
surgeons.
Source
Annals of Cardiac Anaesthesia. 24 (2) (pp 190-196), 2021. Date of
Publication: April-June 2021.
Author
Guhabiswas R.; Chowdhury S.; Narayan P.
Institution
(Guhabiswas, Chowdhury) Department of Cardiac Anaesthesia, Nh Rabindranath
Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal,
India
(Narayan) Department of Cardiac Surgery, Nh Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, West Bengal, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aim: The role of the cardiac anaesthesiologists extends
beyond mere patient wellbeing to diagnostic input and active participation
in decision making during cardiac surgery. The quality of service
provision should therefore be judged not only by patient satisfaction but
also by the satisfaction of cardiac surgeons. Unfortunately,
quantification of cardiac surgeon satisfaction remains a challenge due to
the absence of a reliable and validated tool. We therefore attempted to
develop a robust, validated, pilot psychometric questionnaire, to measure
satisfaction of cardiac surgeons' to cardiac anesthesia services.
 Method(s): The questionnaire was developed with the help of senior
cardiac anesthesiologist, cardiac surgeon and statistician with database
search in PubMed and the Cochrane Library. The questionnaire was tested
for content validity, comprehensibility, and identification of new items.
This generated the second version of the questionnaire with nine
socio-demographic and professional questions, 46 Likert type questions, an
abridged Marlowe Crowne Social Desirability scale and one open ended
question. This questionnaire was e-mailed to 100 cardiac surgeons
requesting them to participate via a web-based survey application.
 Result(s): Content validity of the responses was tested by Aiken's
content validity coefficient (V). Internal consistency was tested with
Chronbach's alpha. Fifty-two cardiac surgeons participated in the survey.
Twelve Likert type questions were deleted due to low V values. Excellent
Chronbach's alpha (0.94) was obtained in the remaining 34 items.
 Conclusion(s): We have developed a questionnaire that includes 34
variables and allows quantifying surgeon satisfaction in a reliable
fashion and is validated for the purpose. Copyright © 2021
Wolters Kluwer Medknow Publications. All rights reserved.

<44>
Accession Number
634950161
Title
Application and effects of an early childhood education machine on
analgesia and sedation in children after cardiothoracic surgery.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 118), 2021. Date of
Publication: 01 May 2021.
Author
Chen L.-L.; Lei Y.-Q.; Liu J.-F.; Cao H.; Yu X.-R.; Chen Q.
Institution
(Chen, Lei, Liu, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Chen, Lei, Liu, Cao, Yu, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
(Chen, Lei, Liu, Cao, Yu, Chen) Fujian Branch of Shanghai Children's
Medical Center, Fuzhou, China
(Chen, Lei, Liu, Cao, Yu, Chen) Fujian Children's Hospital, Fuzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To study the effect of an early childhood education machine on
sedation and analgesia in children after cardiothoracic surgery.
 METHOD(S): A prospective randomized controlled study was conducted in
a provincial hospital in China. Fifty-two patients (aged from 1 to 5years)
underwent cardiothoracic surgery (including: ventricular septal defect,
patent ductus arteriosus, atrial septal defect, pulmonary stenosis,
pulmonary sequestration and congenital cystic adenomatoid lung
malformation) were divided into the study group (n=26) and the control
group (n=26). The patients in the study group underwent intervention with
an early childhood education machine (uniform type) in addition to routine
standard treatment and nursing, while the patients in the control group
only received routine standard treatment and nursing. Richmond agitation
sedation score (RASS) and face, legs, activity, cry, consolability (FLACC)
score of all of the patients were evaluated, and the negative emotions
(self-rating anxiety scale (SAS) score and self-rating depression scale
(SDS) score) of the parents of the two groups were compared.
 RESULT(S): There was no significant difference in the general
clinical data between the two groups. The RASS and FLACC scores in the
study group were significantly lower than those in the control group, and
the SAS and SDS scores of the parents in the study group were
significantly lower than those in the control group. CONCLUSION(S):
The application of an early childhood education machine for children after
cardiothoracic surgery can effectively reduce postoperative agitation,
improve sedation and analgesia of the patients, and ease the pessimistic
mood of the patients' parents.

<45>
Accession Number
634948380
Title
Clinical efficacy of levosimendan vs milrinone in preventing low cardiac
output syndrome following pediatric cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 24 (2) (pp 217-223), 2021. Date of
Publication: April-June 2021.
Author
Jothinath K.; Balakrishnan S.; Raju V.; Menon S.; Osborn J.
Institution
(Jothinath, Balakrishnan) Department of Cardiac Anesthesiology, G
Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
(Raju, Menon) Department of Cardiac Surgery, G Kuppuswamy Naidu Memorial
Hospital, Coimbatore, Tamil Nadu, India
(Osborn) Department of Community Medicine, Psg Institute of Medical
Science and Research, Coimbatore, Tamil Nadu, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Prophylactic milrinone is commonly used to prevent Low Cardiac
Output Syndrome (LCOS) after pediatric cardiac surgery. This study
compares the use of levosimendan with milrinone when used as the primary
inotrope following pediatric cardiac surgery. Subjects and Methods: Forty
infants undergoing corrective surgery for congenital heart disease were
recruited during the study and randomized into two groups (group L and
group M). During rewarming, a loading dose of levosimendan or milrinone
was administered followed by a 24-hour infusion of the chosen inotrope.
Echocardiographic variables were measured postoperatively. Statistical
analysis was done with SPSS-20 computer package. Association between the
variables was found by independent t test. P < 0.05 was considered
statistically significant. Result(s): Mean age and weight of the
patient in Group L was 8.55 +/- 5.83 months and 6.05 +/- 2.09 kgs, while
that in group M was 6.85 +/- 3.57 months and 5.26 +/- 2.11 kgs. 4 patients
(20%) treated with levosimendan had LCOS in comparison with 6 (30%)
patients in those treated with milrinone. Echocardiographic parameters in
both groups L and M were comparable (cardiac index 3.47 +/- 0.76 vs 3.72
+/- 1.05 L/min/m2, EF 66.10 +/- 7.82% vs 59.34 +/- 10.74%,
stroke volume index 25.4 +/- 6.3 vs 27.74 +/- 10.35 mL/m2). The
duration of ventilation, ICU stay and hospital stay were lesser in group L
(12.75 +/- 9.69, 35.95 +/- 12.11, 119.10 +/- 46.397 vs 23.60 +/- 22.03,
51.20 +/- 29.92, 140.20 +/- 52.65 hours). Conclusion(s): The
incidence of LCOS was lesser in those patients treated with levosimendan,
when compared with those treated with milrinone. Cardiac index and stroke
volume index were comparable between the two groups. Thus, levosimendan
provides a non-inferior alternative to milrinone when used as the primary
inotrope following pediatric cardiac surgery. Copyright © 2021
Wolters Kluwer Medknow Publications. All rights reserved.

<46>
Accession Number
634948371
Title
Evaluation of high-dose atorvastatin pretreatment influence in patients
preconditioning of post coronary artery bypass graft surgery: A
prospective triple blind randomized clinical trial.
Source
Annals of Cardiac Anaesthesia. 24 (2) (pp 209-216), 2021. Date of
Publication: April-June 2021.
Author
Bastani M.; Khosravi M.; Shafa M.; Azemati S.; Maghsoodi B.; Asadpour E.
Institution
(Bastani, Khosravi, Azemati, Maghsoodi, Asadpour) Anesthesiology and
Critical Care Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications
Abstract
Context: Atorvastatin is considered as lipid reductive drugs with
anti-inflammatory and pleotherapic effects in coronary artery bypass graph
(CABG). Aim(s): This study is conducted to evaluate the effects of
atorvastatin in CABG. Setting and Design: Patients with a coronary bypass
graph procedure in Nemazee hospital in Shiraz were divided into two
50-groups receiving high-dose (80 mg) and low-dose (20 mg) atorvastatin.
 Material(s) and Method(s): Troponin I, creatinine kinase-MB (CK-MB),
atrial fibrillation (AF) after CABG, duration of mechanical ventilation,
inotrope duration of consumption, blood sugar profile, liver and renal
function, death during 30 days of CABG, MACE (major advance cardiac
events) during admission in ICU, and 1 month follow up were surveyed.
Statistical Analysis: Collected data were analyzed by independent and
paired t-test and Chi square. Result(s): AST was increased, ALT,
ALK-P after CABG were decreased, and urine volume in the second day of
admission in ICU was increased in the high-dose group. There was an
increase and following decrease in blood sugar of patients in the
high-dose after CABG. An inflammatory marker after CABG was raised in both
groups, ck-mb had an increase, and then followed by a reduction. Troporin
had no significant differences between groups. Patients with high-dose
atorvastatin had better glomerular filtration rate and renal performance.
Along with decreasing AF in the case group, hemodynamics' disorder reduced
and there was less bleeding. Conclusion(s): According to the above,
it seems that a short-time prescription of high dose of atorvastatin in
CABG can lead to better renal function, decreasing of arrhythmia and
AF. Copyright © 2021 Wolters Kluwer Medknow Publications. All
rights reserved.

<47>
Accession Number
634948324
Title
A comparison of sevoflurane versus sevoflurane-propofol combination on
renal function in patients undergoing valvular heart surgery - A
prospective randomized controlled pilot study.
Source
Annals of Cardiac Anaesthesia. 24 (2) (pp 172-177), 2021. Date of
Publication: April-June 2021.
Author
Jose R.; Damayanathi D.; Unnikrishnan K.; Suneel P.
Institution
(Jose) Department of Cardiac Anaesthesia, Amrita Institute of Medical
Sciences, Ernakulam, Kerala, India
(Damayanathi) Department of Biochemistry, Sree Chitra Tirunal Institute of
Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
(Unnikrishnan, Suneel) Department of Cardiothoracic and Vascular
Anaesthesia, Sree Chitra Tirunal Institute of Medical Sciences and
Technology, Thiruvananthapuram, Kerala, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Aim: The objective of the present study was to compare the effect of
sevoflurane with the sevoflurane-propofol combination on renal function in
patients undergoing valvular heart surgery. The renal protective effect
was assessed using a novel marker called neutrophil gelatinase-associated
lipocalin (NGAL). Material(s) and Method(s): This was a prospective
randomized controlled pilot study conducted at a tertiary care center in
India. The study enrolled 36 patients undergoing elective valvular heart
surgery, but only 31 were included. All the patients were randomized into
two groups, that is, 15 in the sevoflurane group (S-group) and 16 in the
sevoflurane-propofol group (SP-group). The baseline NGAL level and test
NGAL level at 4 h after cardiopulmonary bypass were measured.
 Result(s): There was a significant rise in the test NGAL levels
compared to baseline in both the groups. The test NGAL level in the
S-group was significantly high compared to that of the SP-group (P =
0.034). The number of patients with acute kidney injury was less in the
SP-group without reaching statistical significance (P = 0.210).
 Conclusion(s): Renal function was better preserved in patients
anesthetized with a combination of sevoflurane and propofol. This could be
due to the enhanced protective effect on renal function by both
sevoflurane and propofol. Copyright © 2021 Wolters Kluwer Medknow
Publications. All rights reserved.

<48>
Accession Number
2011969705
Title
Dexmedetomidine attenuates acute kidney injury in children undergoing
congenital heart surgery with cardiopulmonary bypass by inhibiting the
TLR3/NF-kappaB signaling pathway.
Source
American Journal of Translational Research. 13 (4) (pp 2763-2773), 2021.
Date of Publication: 2021.
Author
Xie Y.; Jiang W.; Cao J.; Xie H.
Institution
(Xie, Cao, Xie) Department of Anesthesiology and Critical Care, The Second
Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
(Xie, Jiang) Department of Anesthesiology, Suzhou Hospital Affiliated to
Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu
Province, China
Publisher
E-Century Publishing Corporation
Abstract
Objective: To investigate the effect of dexmedetomidine (DMED) on acute
kidney injury in children undergoing congenital heart surgery (CHS) with
cardiopulmonary bypass (CPB). Method(s): The children undergoing CHS
with CPB were randomized to the control and the DMED groups. The children
in the DMED group were injected with DMED (1 mug/kg) followed by DMED
infusion (0.5 mug/kg/h) until 12 h after operation; the controls received
normal saline. Markers were detected before operation (T0), 30 min after
anesthesia induction (T1), and at 24 h, 48 h, and 72 h after operation
(T2, T3, T4). Result(s): The heart rate and mean arterial pressure in
the DMED group decreased at T1 and differed from controls at T1-T3 (all
P<0.05). No intergroup differences were observed in the central venous
pressure and caspase-3 level (all P>0.05). The DMED group had higher
central venous pressure at T3 than at T0 (P<0.05). At T2-T4, the DMED
group had lower percentages of TLR3+cells than the controls
(all P<0.05). In the DMED group, the percentagesof TLR3+cells
decreased with time; whereas in the control group, the percentage
increased with time (all P<0.05). Compared with the controls, the DMED
group had lower levels of NF-kappaB and TLR3 at T2-T4, lower levels of
sCr, IL-1beta, and TNF-a at T3-T4, and lower incidence of AKI at T3 (all
P=0.01). Conclusion(s): DMED can reduce the risk of AKI in children
undergoing CHS with CPB, which may be because DMED can inhibit
TLR3/NF-kappaB signaling and its downstream inflammatory
mediators. Copyright © 2021 E-Century Publishing Corporation. All
rights reserved.

<49>
Accession Number
2007107680
Title
Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as
biomarkers for cardiovascular surgery procedures: A literature review.
Source
Reviews on Recent Clinical Trials. 16 (2) (pp 173-179), 2021. Date of
Publication: 2021.
Author
Serra R.; Ielapi N.; Licastro N.; Provenzano M.; Andreucci M.; Bracale
U.M.; Jiritano F.; de Franciscis S.; Mastroroberto P.; Serraino G.F.
Institution
(Serra, Ielapi, Licastro, de Franciscis) Interuniversity Center of
Phlebolymphology (CIFL), International Research and Educational Program in
Clinical and Experimental Biotechnology", Department of Surgical and
Medical Sciences, University Magna Graecia of Catanzaro, Viale Europa,
Catanzaro 88100, Italy
(Serra, de Franciscis) Department of Medical and Surgical Sciences,
University of Catanzaro, Italy
(Ielapi) Department of Public Health and Infectious Disease, Sapienza"
University of Rome, Rome, Italy
(Licastro, Bracale) Department of Public Health, University of Naples
"Federico II", Naples, Italy
(Provenzano, Andreucci) Department of Health Sciences, University of
Catanzaro, Catanzaro, Italy
(Jiritano, Mastroroberto, Serraino) Department of Experimental and
Clinical Medicine, University of Catanzaro, Catanzaro, Italy
(Serra, Ielapi) Interuniversity Center of Phlebolymphology (CIFL),
International Research and Educational Program in Clinical and
Experimental Biotechnology", Department of Surgical and Medical Sciences,
University Magna Graecia of Catanzaro, Viale Europa Localita Germaneto,
Catanzaro 88100, Italy
Publisher
Bentham Science Publishers
Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR) and the
platelet-to-lymphocyte ratio (PLR) have been studied so far as prognostic
factors of cardiovascular diseases. Their role interplayed with
endothelial inflammation has emerged as optimal predictors for major
cardiovascular disease events and prognostic factors for post-procedural
outcomes. Method(s): A review of the current literature was
undertaken to investigate the relationship between NLR and PLR with
percutaneous, cardiac surgery, and vascular surgery procedures.
 Result(s): Our findings show that perioperative NLR and PLR levels
are significantly correlated with patient morbidity and mortality rates.
 Conclusion(s): These biomarkers have several attractive
characteristics, as they are inexpensive and quickly available, and they
can contribute to the early identification of patients at high risk for
periprocedural adverse events. Copyright © 2021 Bentham Science
Publishers.

<50>
Accession Number
2007107570
Title
Current utility of sequential organ failure assessment score: A literature
review and future directions.
Source
Open Respiratory Medicine Journal. 15 (1) (pp 1-6), 2021. Date of
Publication: 2021.
Author
Kashyap R.; Sherani K.M.; Dutt T.; Gnanapandithan K.; Sagar M.;
Vallabhajosyula S.; Vakil A.P.; Surani S.
Institution
(Kashyap) Department of Anesthesiology and Perioperative Medicine, Mayo
Clinic, Rochester, MN 55905, United States
(Sherani) Department of Internal Medicine, Jamaica Hospital Medical
Center, Jamaica, NY 11418, United States
(Sherani, Surani) Corpus Christi Medical Center, Corpus Christi, TX 78411,
United States
(Dutt) Department of Neurology, Mayo Clinic College of Medicine, Mayo
Clinic, Rochester, MN, United States
(Dutt) Hennepin County Medical Center, Minneapolis, MN 55905, United
States
(Gnanapandithan) Department of Internal Medicine, Yale-New Haven Hospital
and Yale University School of Medicine, New Haven, CT 06510, United States
(Sagar, Vakil) Department of Pediatrics, McLane Children's Hospital,
Baylor Scott and White Health, Temple, TX 76502, United States
(Vallabhajosyula, Vakil) Critical Care Medicine, Mayo Clinic College of
Medicine, Mayo Clinic, Rochester, MN 55905, United States
(Surani) Texas A&M University System Health Science Center, Bryan, TX
77807, United States
Publisher
Bentham Science Publishers
Abstract
The Sequential Organ Failure Assessment (SOFA) score is commonly used in
the Intensive Care Unit (ICU) to evaluate, prognosticate and assess
patients. Since its validation, the SOFA score has served in various
settings, including medical, trauma, surgical, cardiac, and neurological
ICUs. It has been a strong mortality predictor and literature over the
years has documented the ability of the SOFA score to accurately
distinguish survivors from non-survivors on admission. Over the years,
multiple variations have been proposed to the SOFA score, which have led
to the evolution of alternate validated scoring models replacing one or
more components of the SOFA scoring system. Various SOFA based models have
been used to evaluate specific clinical populations, such as patients with
cardiac dysfunction, hepatic failure, renal failure, different races and
public health illnesses, etc. This study is aimed to conduct a review of
modifications in SOFA score in the past several years. We review the
literature evaluating various modifications to the SOFA score such as
modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal
SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid
quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with
Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ
systems, their relevant scoring and the proposed modifications in each of
these systems are presented in detail. There is a need to incorporate the
most recent literature into the SOFA scoring system to make it more
relevant and accurate in this rapidly evolving critical care environment.
For future directions, we plan to put together most if not all updates in
SOFA score and probably validate it in a large database a single
institution and validate it in multisite data base. Copyright ©
2021 Kashyap et al.

<51>
Accession Number
2011326702
Title
Redefining the Risk of Surgery for Clinical Stage IIIA (N2) Non-Small Cell
Lung Cancer: A Pooled Analysis of the STS GTSD and ESTS Registry.
Source
Lung. (no pagination), 2021. Date of Publication: 2021.
Author
Arndt A.T.; Brunelli A.; Cicconi S.; Falcoz P.-E.; Salati M.; Kozower B.;
Liptay M.J.; Rocco G.; Karush J.M.; Geissen N.; Basu S.; Seder C.W.
Institution
(Liptay, Karush, Geissen, Basu, Seder) Department of Cardiovascular and
Thoracic Surgery, Rush University Medical Center, Chicago, IL 60612,
United States
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Cicconi) Molecular and Clinical Cancer Medicine, University of Liverpool,
Liverpool, United Kingdom
(Falcoz) Department of Thoracic Surgery, Nouvel Hopital Civil, Strasbourg,
France
(Salati) Unit of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
(Kozower) Division of Cardiothoracic Surgery, Washington University School
of Medicine, St. Louis, MO, United States
(Rocco) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
(Arndt) Department of Cardiovascular and Thoracic Surgery, Rush University
Medical Center, Professional Building, Suite 774, Chicago, IL 60612,
United States
Publisher
Springer
Abstract
Background: Management of clinical stage IIIA-N2 (cIIIA-N2) non-small cell
lung cancer (NSCLC) remains controversial. We evaluated treatment
strategies and outcomes in cIIIA-N2 NSCLC patients who underwent pulmonary
resection in The Society of Thoracic Surgeons General Thoracic Surgery
Database (STS GTSD) and the European Society of Thoracic Surgeons (ESTS)
Registry. Method(s): The STS GTSD and ESTS Registry were queried for
patients who underwent pulmonary resection for cIIIA-N2 NSCLC between 2012
and 2016. Demographic variables, treatment strategies, and outcome
measures were collected and analyzed. Significance of differences was
determined using the chi2 test for categorical variables and
the Wilcoxon rank sum test for continuous variables. Result(s):
Pulmonary resection was performed in 4279 cIIIA-N2 NSCLC patients (2928
STS GTSD; 1351 ESTS). Induction therapy was administered to 49%. Lobectomy
was performed in 67.1% and pneumonectomy in 13%. Lobectomy was associated
with 19.2% major morbidity and 1.6% operative mortality, while
pneumonectomy was associated with 34.1% and 5%, respectively. Induction
therapy was associated with a higher rate of major morbidity or mortality
than upfront surgery (23.2% vs 19.5%, p = 0.004), driven by pneumonectomy
(40.7% vs 30.3%, p = 0.012) rather than lobectomy (20.3% vs 18.8%, p =
0.31). Conclusion(s): Pulmonary resection for cIIIA-N2 NSCLC is
associated with low rates of operative morbidity and mortality, with
lobectomy having lower morbidity and mortality than pneumonectomy.
Induction therapy, particularly chemoradiotherapy, is associated with a
higher rate of composite morbidity or mortality than upfront surgery in
pneumonectomy patients but not lobectomy patients. Copyright ©
2021, The Author(s), under exclusive licence to Springer Science+Business
Media, LLC, part of Springer Nature.

<52>
Accession Number
634952749
Title
Extracorporeal Cytokine Adsorption Therapy As a Preventive Measure in
Cardiac Surgery and As a Therapeutic Add-On Treatment in Sepsis: An Update
Systematic Review of Comparative Efficacy and Safety.
Source
Critical care medicine. (no pagination), 2021. Date of Publication: 03 May
2021.
Author
Goetz G.; Hawlik K.; Wild C.
Institution
(Goetz) HTA Austria-Austrian Institute for Health Technology Assessment
GmbH (Former: Ludwig Boltzmann Institute for HTA), Vienna, Austria
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Evaluating whether there is a clinical benefit of using
extracorporeal cytokine adsorption therapy in two indications. DESIGN:
Systematic review. SETTING: Search on four databases, Medline, Embase, The
Cochrane Library, and the European Network for Health Technology
Assessment planned and ongoing projects database. PATIENTS: Patients with
sepsis/septic shock; patients undergoing cardiac surgery. INTERVENTIONS:
Cytokine adsorption. MEASUREMENTS AND MAIN RESULTS: Randomized controlled
trials and prospective studies with concurrent control were eligible for
the evidence synthesis. The quality of the individual studies and the
strength of the available evidence were assessed using the Cochrane risk
of bias tool and the Grading of Recommendations, Assessment, Development,
and Evaluation approach, respectively. For the preventive treatment of
extracorporeal cytokine adsorption therapy in patients undergoing cardiac
surgery, we found very low-quality inconclusive evidence for mortality
(five randomized controlled trials, n = 163), length of stay in the ICU
(five randomized controlled trials, n = 163), and length of
hospitalization (three randomized controlled trials, n = 101). Very
low-quality inconclusive evidence was found for (serious) adverse events
(four randomized controlled trials, n = 148). For the therapeutic
treatment of extracorporeal cytokine adsorption therapy in patients with
sepsis/septic shock, we found very low-quality inconclusive evidence for
mortality up to 60-day follow-up (two randomized controlled trials, n =
117), organ function (two randomized controlled trials, n = 117) and
length of stay in the ICU (one randomized controlled trial, n = 20). Very
low-quality inconclusive evidence was found for (serious) adverse events
(two randomized controlled trials, n = 117). CONCLUSION(S): Given the
available evidence, the efficacy and safety of extracorporeal cytokine
adsorption therapy in combination with standard care in the investigated
indications was not established. We strongly recommend considering
well-powered studies with patient-relevant endpoints instead of investing
further research funds on studies that may not shed light on the clinical
benefit of extracorporeal cytokine adsorption therapy. Copyright
© by 2021 by the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. All Rights Reserved.

<53>
Accession Number
634952520
Title
Volatile anesthetics versus intravenous anesthetics for noncardiac
thoracic surgery: a systematic review and meta-analysis.
Source
Minerva anestesiologica. (no pagination), 2021. Date of Publication: 03
May 2021.
Author
Fan Y.; Yu D.; Liang X.
Institution
(Fan) Department of Anesthesiology, Sichuan Cancer Center, Sichuan Cancer
Hospital & Institute, School of Medicine, University of Electronic
Science and Technology of China, Chengdu, China
(Yu) Department of Anesthesiology, Second People's Hospital of Yibin,
China
(Liang) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: We performed this meta-analysis of randomised controlled
trials (RCTs) to investigate two types of anesthetics for noncardiac
thoracic surgery regarding their effects on clinical outcomes and the
inflammatory response. EVIDENCE ACQUISITION: We searched Cochrane Library,
PubMed and EMBASE for RCTs comparing volatile anesthetics to intravenous
anesthetics for noncardiac thoracic surgery. EVIDENCE SYNTHESIS: This
study reviewed 16 RCTs with 1467 patients. Volatile anesthetics reduced
postoperative complications and the length of intensive care unit stay for
lung surgery. They also lowered the concentrations of interleukin
(IL)-1beta, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-alpha) in the
airways of patients undergoing noncardiac thoracic surgery. However, there
was no difference in short-term mortality; postoperative complications
after esophagectomy; IL-1beta, IL-6, IL-8 or TNF-alpha concentrations in
the blood; IL-10 level in either the airway or the blood; overall monocyte
chemoattractant protein-1. CONCLUSION(S): In lung surgery, but not
esophagectomy, volatile anesthetics may be a better choice than
intravenous anesthetics, possibly because volatile anesthetics reduce
airway inflammation.

<54>
Accession Number
2010580606
Title
Yoga for secondary prevention of coronary heart disease: A systematic
review and meta-analysis.
Source
Complementary Therapies in Medicine. 57 (no pagination), 2021. Article
Number: 102643. Date of Publication: March 2021.
Author
Li J.; Gao X.; Hao X.; Kantas D.; Mohamed E.A.; Zheng X.; Xu H.; Zhang L.
Institution
(Li, Hao, Zheng, Zhang) Department of Cardiology, Dongzhimen Hospital,
Beijing University of Chinese Medicine, Beijing 100700, China
(Li, Kantas, Mohamed) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN 55902, United States
(Gao) Internal Medicine Division, Tieying Hospital of Fengtai District,
Beijing 100078, China
(Xu) Cardiovascular Diseases Centre, Xiyuan Hospital, China Academy of
Chinese Medical Sciences, National Clinical Research Centre for Chinese
Medicine Cardiology, Beijing 100091, China
Publisher
Churchill Livingstone
Abstract
Objectives: Yoga has been widely practiced and has recently shown benefits
in patients with coronary heart disease (CHD), however, evidence is
inconsistent. Method(s): We conducted a systematic review and
meta-analysis by searching PubMed/Medline, the Cochrane Central Register
of Controlled Trials (CENTRAL), EMBASE and Web of Science from inception
to May 31, 2020 for randomised controlled trials (RCTs) comparing yoga
with usual care or non-pharmacological interventions in patients with CHD.
The primary outcomes were all-cause mortality and health related quality
of life (HR-QoL). Secondary outcomes were a composite cardiovascular
outcome, exercise capacity and cardiovascular risk factors (blood
pressure, lipid profiles and body mass index). Result(s): Seven RCTs
with a total of 4671 participants were included. Six RCTs compared yoga
with usual care and one compared yoga with designed exercise. The mean age
of the participants ranged from 51.0-60.7 years and the majority of them
were men (85.4 %). Pooled results showed that compared with usual care,
yoga had no effect on all-cause mortality (RR, 1.02; 95 % CI, 0.75-1.39),
but it significantly improved HR-QoL (SMD, 0.07; 95 % CI, 0.01 - 0.14). A
non-significant reduction of the composite cardiovascular outcome was
observed (133 vs. 154; RR, 0.63; 95 % CI, 0.15-2.59). Serum level of
triglyceride and high density lipoprotein cholesterol, blood pressure and
body mass index were also significantly improved. The study comparing yoga
with control exercise also reported significantly better effects of yoga
on HR-QoL (85.75 vs. 75.24, P < 0.001). No severe adverse events related
to yoga were reported. Conclusion(s): Yoga might be a promising
alternative for patients with CHD as it is associated with improved
quality of life, less number of composite cardiovascular events, and
improved cardiovascular risk factors. Copyright © 2020

<55>
Accession Number
2010580298
Title
Meta-Analysis Comparing the Safety and Efficacy of Dual Versus Single
Antiplatelet Therapy After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiovascular Drugs. 21 (3) (pp 373-376), 2021. Date
of Publication: May 2021.
Author
Shahid I.; Nizam M.A.; Usman M.S.; Khan M.S.; Fudim M.; Michos E.D.
Institution
(Shahid, Nizam) Department of Medicine, Ziauddin Medical University,
Shahra-e-Ghalib, Clifton, Karachi, Pakistan
(Usman) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan) Department of Medicine, University of Mississippi Medical Center,
Jackson, MS, United States
(Fudim) Division of Cardiology, Duke University Medical Center, Durham,
NC, United States
(Michos) Division of Cardiology, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
Adis

<56>
Accession Number
2010511778
Title
A Literature Review of Cannabis and Myocardial Infarction-What Clinicians
May Not Be Aware Of.
Source
CJC Open. 3 (1) (pp 12-21), 2021. Date of Publication: January 2021.
Author
Chetty K.; Lavoie A.; Deghani P.
Institution
(Chetty) University of Calgary, Calgary, AB, Canada
(Lavoie, Deghani) Department of Cardiology, University of Saskatchewan,
Saskatoon, SK, Canada
Publisher
Elsevier Inc.
Abstract
Increasing legalization and expanding medicinal use have led to a
significant rise in global cannabis consumption. With this development, we
have seen a growing number of case reports describing adverse
cardiovascular events, specifically, cannabis-induced myocardial
infarction (MI). However, there are considerable knowledge gaps on this
topic among health care providers. This review aims to provide an
up-to-date review of the current literature, as well as practical
recommendations for clinicians. We also focus on proposed mechanisms
implicating cannabis as a risk factor for MI. We performed a comprehensive
literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing
and Allied Health Literature (CINAHL), and Turning Research into Practice
(TRIP) PRO databases for articles published between 2000 and 2018. A total
of 92 articles were included. We found a significant number of reports
describing cannabis-induced MI. This was especially prevalent among young
healthy patients, presenting shortly after use. The most commonly proposed
mechanisms included increased autonomic stimulation, altered platelet
function, vasospasm, and direct toxic effects of smoke constituents.
However, it is likely that the true pathogenesis is multifactorial. We
should increase our pretest probability for MI in young patients
presenting with chest pain. We also recommend against cannabis use in
patients with known coronary artery disease, especially if they have
stable angina. Finally, if patients are adamant about using cannabis,
health care providers should recommend against smoking cannabis, avoidance
of concomitant tobacco use, and use of the lowest
delta-9-tetrahydrocannabinol dose possible. Data quality is limited to
that of observational studies and case report data. Therefore, more
clinical trials are needed to determine a definitive cause-and-effect
relationship. Copyright © 2020

<57>
Accession Number
2006958463
Title
Comparative effects of etelcalcetide and maxacalcitol on serum
calcification propensity in secondary hyperparathyroidism a randomized
clinical trial.
Source
Clinical Journal of the American Society of Nephrology. 16 (4) (pp
599-612), 2021. Date of Publication: 07 Apr 2021.
Author
Shoji T.; Nakatani S.; Kabata D.; Mori K.; Shintani A.; Yoshida H.;
Takahashi K.; Ota K.; Fujii H.; Ueda S.; Nishi S.; Nakatani T.; Yoshiyama
M.; Goto K.; Hamada T.; Imanishi M.; Ishimura E.; Kagitani S.; Kato Y.;
Kumeda Y.; Maekawa K.; Matsumura T.; Nagayama H.; Obi Y.; Ohno Y.; Sai Y.;
Sakurai M.; Sasaki S.; Shidara K.; Shoji S.; Tsujimoto Y.; Yamakawa K.;
Yasuda H.; Yodoi S.; Inaba M.; Emoto M.
Institution
(Shoji) Department of Vascular Medicine, Osaka City University Graduate
School of Medicine, Osaka, Japan
(Shoji, Inaba, Emoto) Vascular Science Center for Translational Research,
Osaka City University Graduate School of Medicine, Osaka, Japan
(Nakatani, Inaba, Emoto) Department of Metabolism, Endocrinology and
Molecular Medicine, Osaka City University Graduate School of Medicine,
Osaka, Japan
(Kabata, Shintani, Yoshida, Takahashi) Department of Medical Statistics,
Osaka City University Graduate School of Medicine, Osaka, Japan
(Mori, Inaba, Emoto) Department of Nephrology, Osaka City University
Graduate School of Medicine, Osaka, Japan
(Ota) Center for Clinical Research and Innovation, Osaka City University
Hospital, Osaka, Japan
(Fujii) Department of Drug and Food Evaluation, Osaka City University
Graduate School of Medicine, Osaka, Japan
(Ueda) Department of Clinical Pharmacology and Therapeutics, University of
the Ryukyus, Okinawa, Japan
(Nishi) Division of Nephrology and Kidney Center, Kobe University Graduate
School of Medicine, Kobe, Japan
(Nakatani) Department of Urology, Osaka City University Graduate School of
Medicine, Osaka, Japan
(Yoshiyama) Department of Cardiovascular Medicine, Osaka City University
Graduate School of Medicine, Osaka, Japan
(Goto) Ono Naika Clinic, Osaka, Japan
(Hamada) Marie Clinic, Higashi Osaka, Japan
(Imanishi) Ishikiri Seiki Hospital, Higashi Osaka, Japan
(Ishimura) Meijibashi Hospital, Matsubara, Japan
(Kagitani) Kawamura Clinic, Osaka, Japan
(Kato) Shirasagi Minami Clinic, Osaka, Japan
(Kumeda) Minami Osaka Clinic, Osaka, Japan
(Maekawa) Fujiidera Shirasagi Clinic, Fujiidera, Japan
(Matsumura) Ikeda Hospital, Higashi Osaka, Japan
(Nagayama) Nagayama Clinic, Sennan-gun, Japan
(Obi) Obi Clinic, Osaka, Japan
(Ohno) Ohno Memorial Hospital, Osaka, Japan
(Sai) Suminodo Clinic, Daito, Japan
(Sakurai) Jurakukai Clinic, Osaka, Japan
(Sasaki) Sasaki Medical Clinic, Osaka, Japan
(Shidara) Ikeda Clinic, Higashi Osaka, Japan
(Shoji) Shirasagi Hospital, Osaka, Japan
(Tsujimoto) Aijinkai Healthcare Corporation Inoue Hospital, Suita, Japan
(Yamakawa) Shirasagi Clinic, Osaka, Japan
(Yasuda) Okada Clinic, Osaka, Japan
(Yodoi) Yodoi Hospital, Osaka, Japan
Publisher
American Society of Nephrology
Abstract
Background and objectives Vitamin D receptor activators and calcimimetics
(calcium-sensing receptor agonists) are two major options for medical
treatment of secondary hyperparathyroidism. A higher serum calcification
propensity (a shorter T<inf>50</inf> value) is a novel surrogate marker of
calcification stress and mortality in patients with CKD. We tested a
hypothesis that a calcimimetic agent etelcalcetide is more effective in
increasing T<inf>50</inf> value than a vitamin D receptor activator
maxacalcitol. Copyright © 2021 by the American Society of
Nephrology.

<58>
Accession Number
2010165473
Title
Single Anti-platelet Versus Dual Anti-platelet Therapy After Transcatheter
Aortic Valve Implantation: A Meta-Analysis of Randomized Trials.
Source
American Journal of Cardiology. 140 (pp 152-154), 2021. Date of
Publication: 01 Feb 2021.
Author
Elbadawi A.; Thakker R.; Abuzaid A.A.; Khalife W.; Goel S.S.; Gilani S.;
Alasnag M.; Elgendy I.Y.
Institution
(Elbadawi, Khalife, Gilani) Department of Cardiovascular Medicine,
University of Texas Medical Branch, Galveston, TX, United States
(Thakker) Division of Internal Medicine, University of Texas Medical
Branch, Galveston, TX, United States
(Abuzaid) Division of Cardiology, University of California San Francisco,
San Francisco, CA, United States
(Goel) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
(Alasnag) Cardiac Center-King Fahd Armed Forces Hospital, Jeddah, Saudi
Arabia
(Elgendy) Division of Cardiology, Weill Cornell Medicine-Qatar, Doha,
Qatar
Publisher
Elsevier Inc.

<59>
Accession Number
2010113112
Title
Sex differences in patients with out-of-hospital cardiac arrest without
ST-segment elevation: A COACT trial substudy.
Source
Resuscitation. 158 (pp 14-22), 2021. Date of Publication: January 2021.
Author
Spoormans E.M.; Lemkes J.S.; Janssens G.N.; van der Hoeven N.W.; Jewbali
L.S.D.; Dubois E.A.; van de Ven P.M.; Meuwissen M.; Rijpstra T.A.; Bosker
H.A.; Blans M.J.; Bleeker G.B.; Baak R.; Vlachojannis G.J.; Eikemans
B.J.W.; der Harst P.V.; van der Horst I.C.C.; Voskuil M.; van der Heijden
J.J.; Beishuizen A.; Stoel M.; Camaro C.; van der Hoeven H.; Henriques
J.P.; Vlaar A.P.J.; Vink M.A.; van den Bogaard B.; Heestermans T.A.C.M.;
de Ruijter W.; Delnoij T.S.R.; Crijns H.J.G.M.; Jessurun G.A.J.;
Oemrawsingh P.V.; Gosselink M.T.M.; Plomp K.; Magro M.; Elbers P.W.G.;
Appelman Y.; van Royen N.
Institution
(Spoormans, Lemkes, Janssens, van der Hoeven, Appelman, van Royen)
Department of Cardiology, Amsterdam University Medical Centre, location
VUmc, Amsterdam, Netherlands
(Jewbali, Dubois) Thorax Centre, Erasmus Medical Centre, Rotterdam,
Netherlands
(van de Ven) Department of Epidemiology and Data Science, Amsterdam
University Medical Centre, location VUmc, Amsterdam, Netherlands
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Rijpstra) Department of Intensive care medicine, Amphia Hospital, Breda,
Netherlands
(Bosker) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Blans) Department of Intensive care medicine, Rijnstate Hospital, Arnhem,
Netherlands
(Bleeker) Department of Cardiology, HAGA Hospital, Den Haag, Netherlands
(Baak) Department of Intensive care medicine, HAGA Hospital, Den Haag,
Netherlands
(Vlachojannis) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Eikemans) Department of Intensive care medicine, Maasstad Hospital,
Rotterdam, Netherlands
(der Harst) University of Groningen, University Medical Centre Groningen,
Department of Cardiology, Groningen, Netherlands
(van der Horst) University of Groningen, University Medical Centre
Groningen, Department of Intensive care medicine, Groningen, Netherlands
(Vlachojannis, der Harst, Voskuil) Department of Cardiology, University
Medical Centre Utrecht, Netherlands
(van der Heijden) Department of Intensive care medicine, University
Medical Centre Utrecht, Netherlands
(Beishuizen) Department of Intensive care medicine, Medisch Spectrum
Twente, Enschede, Netherlands
(Stoel) Department of Cardiology, Medisch Spectrum Twente, Enschede,
Netherlands
(Camaro, van Royen) Department of Cardiology, Radboud University Medical
Centre, Nijmegen, Netherlands
(van der Hoeven) Department of Intensive care medicine, Radboud University
Medical Centre, Nijmegen, Netherlands
(Henriques) Department of Cardiology, Amsterdam University Medical Centre,
location AMC, Amsterdam, Netherlands
(Vlaar) Department of Intensive care medicine, Amsterdam University
Medical Centre, location AMC, Amsterdam, Netherlands
(Vink) Department of Cardiology, OLVG, Amsterdam, Netherlands
(van den Bogaard) Department of Intensive care medicine, OLVG, Amsterdam,
Netherlands
(Heestermans) Department of Cardiology, Noord West Ziekenhuisgroep,
Alkmaar, Netherlands
(de Ruijter) Department of Intensive care medicine, Noord West
Ziekenhuisgroep, Alkmaar, Netherlands
(van der Horst, Delnoij) Department of Intensive care medicine, Maastricht
University Medical Centre, University Maastricht, Maastricht, Netherlands
(Crijns) Department of Cardiology, Maastricht University Medical Centre,
Maastricht, Netherlands
(Jessurun) Department of Cardiology, Scheper Hospital, Emmen, Netherlands
(Oemrawsingh) Department of Cardiology, Haaglanden Medical Centre, Den
Haag, Netherlands
(Gosselink) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Plomp) Department of Cardiology, Tergooi Hospital, Blaricum, Netherlands
(Magro) Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg,
Netherlands
(Elbers) Department of Intensive care medicine, Amsterdam University
Medical Centre, location VUmc, Amsterdam, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background: Whether sex is associated with outcomes of out-of-hospital
cardiac arrest (OHCA) is unclear. Objective(s): This study examined
sex differences in survival in patients with OHCA without ST-segment
elevation myocardial infarction (STEMI). Method(s): Using data from
the randomized controlled Coronary Angiography after Cardiac Arrest
(COACT) trial, the primary point of interest was sex differences in
OHCA-related one-year survival. Secondary points of interest included the
benefit of immediate coronary angiography compared to delayed angiography
until after neurologic recovery, angiographic and clinical outcomes.
 Result(s): In total, 522 patients (79.1% men) were included. Overall
one-year survival was 59.6% in women and 63.4% in men (HR 1.18; 95% CI:
0.76-1.81;p = 0.47). No cardiovascular risk factors were found that
modified survival. Women less often had significant coronary artery
disease (CAD) (37.0% vs. 71.3%;p < 0.001), but when present, they had a
worse prognosis than women without CAD (HR 3.06; 95% CI 1.31-7.19;p =
0.01). This was not the case for men (HR 1.05; 95% CI 0.67-1.65;p = 0.83).
In both sexes, immediate coronary angiography did not improve one-year
survival compared to delayed angiography (women, odds ratio (OR) 0.87; 95%
CI 0.58-1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45-2.09;p = 0.93).
 Conclusion(s): In OHCA patients without STEMI, we found no sex
differences in overall one-year survival. Women less often had significant
CAD, but when CAD was present they had worse survival than women without
CAD. This was not the case for men. Both sexes did not benefit from a
strategy of immediate coronary angiography as compared to delayed strategy
with respect to one-year survival. Clinical trial registration number:
Netherlands trial register (NTR) 4973. Copyright © 2020

<60>
Accession Number
2010044042
Title
Rationale and design of a randomized clinical trial comparing safety and
efficacy of myval transcatheter heart valve versus contemporary
transcatheter heart valves in patients with severe symptomatic aortic
valve stenosis: The LANDMARK trial.
Source
American Heart Journal. 232 (pp 23-38), 2021. Date of Publication:
February 2021.
Author
Kawashima H.; Soliman O.; Wang R.; Ono M.; Hara H.; Gao C.; Zeller E.;
Thakkar A.; Tamburino C.; Bedogni F.; Neumann F.-J.; Thiele H.;
Abdel-Wahab M.; Morice M.-C.; Webster M.; Rosseel L.; Mylotte D.; Onuma
Y.; Wijns W.; Baumbach A.; Serruys P.W.
Institution
(Kawashima, Soliman, Wang, Ono, Hara, Gao, Zeller, Rosseel, Mylotte,
Onuma, Wijns, Serruys) Department of Cardiology, National University of
Ireland, Galway (NUIG), Galway, Ireland
(Kawashima, Ono, Hara) Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
(Wang, Gao) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Thakkar) Meril Life Sciences Pvt. Ltd., India
(Tamburino) Ferrarotto Hospital, Policlinico Hospital and University of
Catania, Catania, Italy
(Bedogni) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Neumann) Department of Cardiology & Angiology II, University Heart Center
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Thiele, Abdel-Wahab) Heart Center Leipzig at University of Leipzig and
Leipzig Heart Institute, Leipzig, Germany
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud,
Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy, France
(Webster) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Baumbach) William Harvey Research Institute, Queen Mary University of
London, and Barts Heart Centre, London, United Kingdom
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Mosby Inc.
Abstract
Background: The recent approval of transcatheter aortic valve replacement
(TAVR) in patients with low operative risk has paved the way for the
introduction of novel and potentially improved technologies. The safety
and efficacy of these novel technologies should be investigated in
randomized control trials against the contemporary TAVR devices. The
objective of the LANDMARK trial is to compare the balloon-expandable Myval
transcatheter heart valve (THV) series with contemporary THV (SAPIEN THV
and Evolut THV series) series in patients with severe symptomatic native
aortic stenosis. Methods/Design: The LANDMARK trial
(ClinicalTrials.govNCT04275726, EudraCT number 2020-000,137-40) is a
prospective, randomized, multinational, multicenter, open-label, and
noninferiority trial of approximately 768 patients treated with TAVR via
the transfemoral approach. Patients will be allocated in a 1:1
randomization to Myval THV series (n = 384) or to contemporary THV (n =
384) (either of SAPIEN THV or Evolut THV series). The primary combined
safety and efficacy endpoint is a composite of all-cause mortality, all
stroke (disabling and nondisabling), bleeding (life-threatening or
disabling), acute kidney injury (stage 2 or 3), major vascular
complications, prosthetic valve regurgitation (moderate or severe), and
conduction system disturbances (requiring new permanent pacemaker
implantation), according to the Valve Academic Research Consortium-2
criteria at 30-day follow-up. All patients will have follow-up to 10 years
following TAVR. The LANDMARK trial is the first randomized head-to-head
trial comparing Myval THV series to commercially available THVs in
patients indicated for TAVR. We review prior data on head-to-head
comparisons of TAVR devices and describe the rationale and design of the
LANDMARK trial. Copyright © 2020 The Authors

<61>
Accession Number
2011414032
Title
Intravenous infusion of lidocaine can accelerate postoperative early
recovery in patients undergoing surgery for obstructive sleep apnea.
Source
Medical Science Monitor. 27 (no pagination), 2021. Article Number:
e926990. Date of Publication: 02 Feb 2021.
Author
Xie C.; Wang Q.; Huai D.
Institution
(Xie, Wang) Department of Anesthesiology, The Affiliated Huaian Hospital
of Xuzhou Medical University, Huaian Second People's Hospital, Huaian,
Jiangsu, China
(Huai) Department of Ear, Nose and Throat, The Affiliated Huaian Hospital,
Xuzhou Medical University, Huaian Second People's Hospital, Huaian,
Jiangsu, China
Publisher
International Scientific Information, Inc.
Abstract
Obstructive sleep apnea (OSA) is defined by intermittent and recurrent
episodes of partial or complete obstruction of the upper airway during
sleep. Intermittent and recurrent hypoxia/reoxygenation is the main
pathophysiological mechanism of OSA. Its consequences include systemic
inflammation, activation of the sympathetic nervous system, and release of
oxygen free radicals. Infusion of intravenous (IV) lidocaine has
anti-inflammatory, antihyperalgesic, and analgesic properties, supporting
its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or
cardiovascular responses to surgical stress, as well as postoperative pain
and/or analgesic requirements. Because of the high prevalence of OSA in
obese patients, the use of opioids to manage postoperative pain in that
population is often accompanied by the development of adverse respiratory
events, such as hypoventilation and hypoxemia. IV infusion of lidocaine
has been shown to enhance the quality of early recovery after laparoscopic
bariatric and upper airway surgery. However, limited evidence exists
regarding its use in patients undergoing surgery for OSA. In addition,
whether IV infusion of lidocaine can improve postoperative early recovery
in patients undergoing surgery for OSA remains unknown. Therefore, we
hypothesized that IV infusion of lidocaine can improve postoperative early
recovery in patients undergoing surgery for OSA. Perioperative infusion
also may be a promising analgesic adjunct to enhanced recovery after
surgery (ERAS) protocols. Copyright © Med Sci Monit 2021.

<62>
Accession Number
2011084680
Title
Meta-Analysis of Usefulness of Cerebral Embolic Protection During
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 146 (pp 69-73), 2021. Date of Publication:
01 May 2021.
Author
Ahmad Y.; Howard J.P.
Institution
(Ahmad) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Howard) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
One of the most feared complications of transcatheter aortic valve
implantation (TAVI) is stroke, with increased mortality and disability
observed in patients suffering a stroke after TAVI. There has been no
significant decline in stroke rates seen over the last 5 years; attention
has therefore been given to strategies for cerebral embolic protection.
With the emergence of new randomized trial data, we sought to perform an
updated systematic review and meta-analysis to examine the effect of
cerebral embolic protection during TAVI both on clinical outcomes and on
neuroimaging parameters. We performed a random-effects meta-analysis of
randomized clinical trials of cerebral embolic protection during TAVI. The
primary end point was the risk of stroke. The risk of stroke was not
significantly different with the use of cerebral embolic protection:
relative risk (RR) 0.88, 95% confidence interval (CI) 0.57 to 1.36, p =
0.566. Nor was there a significant reduction in the risk of disabling
stroke, non-disabling stroke or death. There was no significant difference
in total lesion volume on MRI with cerebral embolic protection: mean
difference -74.94, 95% CI -174.31 to 24.4, p = 0.139. There was also not a
significant difference in the number of new ischemic lesions on MRI: mean
difference -2.15, 95% -5.25 to 0.96, p = 0.176, although there was
significant heterogeneity for the neuroimaging outcomes. In conclusion,
cerebral embolic protection during TAVI is safe but there is no evidence
of a statistically significant benefit on clinical outcomes or
neuroimaging parameters. Copyright © 2021 The Author(s)

<63>
Accession Number
2011047119
Title
Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation
Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic
Aortic Valve.
Source
American Journal of Cardiology. 146 (pp 74-81), 2021. Date of Publication:
01 May 2021.
Author
Al-abcha A.; Saleh Y.; Boumegouas M.; Prasad R.; Herzallah K.; Baloch
Z.Q.; Abdelkarim O.; Rayamajhi S.; Abela G.S.
Institution
(Al-abcha, Boumegouas, Prasad, Rayamajhi) Department of Internal Medicine,
Michigan State University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist DeBakey Heart &
Vascular Center, Houston, TX, United States
(Herzallah) Department of Cardiology, Tufts Medical Center, Boston,
Massachusetts, Boston, United States
(Baloch, Abela) Department of Cardiology, Michigan State University, East
Lansing, MI, United States
(Saleh, Abdelkarim) Department of Cardiology, Alexandria University, Egypt
Publisher
Elsevier Inc.
Abstract
This meta-analysis was conducted to compare clinical outcomes of
valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-surgical aortic valve replacement (Redo-SAVR) in failed bioprosthetic
aortic valves. We conducted a comprehensive review of previous
publications of all relevant studies through August 2020. Twelve
observational studies were included with a total of 8,430 patients, and a
median-weighted follow-up period of 1.74 years. A pooled analysis of the
data showed no significant difference in all-cause mortality (OR 1.15; 95%
CI 0.93 to 1.43; p = 0.21), cardiovascular mortality, myocardial
infarction, permanent pacemaker implantation, and the rate of moderate to
severe paravalvular leakage between ViV-TAVI and Redo-SAVR groups. The
rate of major bleeding (OR 0.36; 95% CI 0.16 to 0.83, p = 0.02),
procedural mortality (OR 0.41; 95% CI 0.18 to 0.96, p = 0.04), 30-day
mortality (OR 0.58; 95% CI 0.45 to 0.74, p <0.0001), and the rate of
stroke (OR 0.65; 95% CI 0.52 to 0.81, p = 0.0001) were significantly lower
in the ViV- TAVI arm when compared with Redo-SAVR arm. The mean
transvalvular pressure gradient was significantly higher post-implantation
in the ViV-TAVI group when compared with the Redo-SAVR arm (Mean
difference 3.92; 95% CI 1.97 to 5.88, p < 0.0001). In conclusion, compared
with Redo-SAVR, ViV-TAVI is associated with a similar risk of all-cause
mortality, cardiovascular mortality, myocardial infarction, permanent
pacemaker implantation, and the rate of moderate to severe paravalvular
leakage. However, the rate of major bleeding, stroke, procedural mortality
and 30-day mortality were significantly lower in the ViV-TAVI group when
compared with Redo-SAVR. Copyright © 2021 Elsevier Inc.

<64>
Accession Number
2005179600
Title
Harnessing mechanosensation in next generation cardiovascular tissue
engineering.
Source
Biomolecules. 10 (10) (pp 1-20), 2020. Article Number: 1419. Date of
Publication: October 2020.
Author
Garoffolo G.; Ferrari S.; Rizzi S.; Barbuto M.; Bernava G.; Pesce M.
Institution
(Garoffolo, Ferrari, Rizzi, Barbuto, Bernava, Pesce) Unita di Ingegneria
Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan
20138, Italy
(Garoffolo) Translational and Molecular Medicine-DIMET, Universita di
Milano-Bicocca, Milan 20126, Italy
(Ferrari) Translational Medicine, Universita degli studi di Pavia, Pavia
27100, Italy
Publisher
MDPI AG
Abstract
The ability of the cells to sense mechanical cues is an integral component
of "social" cell behavior inside tissues with a complex architecture.
Through "mechanosensation" cells are in fact able to decrypt motion,
geometries and physical information of surrounding cells and extracellular
matrices by activating intracellular pathways converging onto gene
expression circuitries controlling cell and tissue homeostasis.
Additionally, only recently cell mechanosensation has been integrated
systematically as a crucial element in tissue pathophysiology. In the
present review, we highlight some of the current efforts to assess the
relevance of mechanical sensing into pathology modeling and manufacturing
criteria for a next generation of cardiovascular tissue
implants. Copyright © 2020 by the authors. Licensee MDPI, Basel,
Switzerland.

<65>
Accession Number
2011452215
Title
RenalGuard system and conventional hydration for preventing
contrast-associated acute kidney injury in patients undergoing cardiac
interventional procedures: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 333 (pp 83-89), 2021. Date of
Publication: 15 Jun 2021.
Author
Wang Y.; Guo Y.
Institution
(Wang, Guo) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: Contrast-associated acute kidney injury (CA-AKI) can increase
the mortality of patients undergoing transcatheter aortic valve
replacement (TAVR) or percutaneous coronary intervention (PCI). The
purpose of this paper was to compare the efficacy of the RenalGuard System
and conventional hydration regimen in preventing CA-AKI in patients with
TAVR or PCI. Method(s): We searched PubMed, Embase, Web of Science,
and the Cochrane Central Register of Clinical Trials (last updated July
11, 2020) for suitable reports. The primary outcome was the occurrence of
CA-AKI. The secondary outcomes were renal replacement therapy (RRT), major
cardiovascular events (MACEs), and other adverse complications.
 Result(s): The search strategy yielded 270 studies (with data for
2067 participants). In the subgroup of PCI, low incidence of CA-AKI (6.7%
vs 15.7%; 95%CI: 0.27 to 0.54; I2 = 8%; P < 0.00001) associate
with RenalGuard group (RG) rather than control group (CG). Similarly, in
the subgroup of TAVR, a low incidence of CA-AKI (15.6% vs 26.9%; 95%CI:
0.35 to 0.82; I2 = 88%; P = 0.004) relates to RG. However, this
result is highly heterogeneous. Compare with conventional hydration,
RenalGuard significantly reduce the incidence of pulmonary edema
(1.5%vs4.1%; 95%CI: 0.18 to 0.72; I2 = 0%; P = 0.004).
 Conclusion(s): RenalGuard System can lessen the risk of CA-AKI and
RRT in patients undergoing PCI. But for patients experiencing TAVR, due to
unique hemodynamic effects, the role of RenalGuard remains questionable.
RenalGuard is more secure than conventional hydration. Future work should
elucidate the feasibility and safety of this prophylactic intervention in
cardiac interventional therapy. Copyright © 2021

<66>
Accession Number
2010963257
Title
Anticoagulation management of postoperative atrial fibrillation after
cardiac surgery: A systematic review.
Source
Journal of Cardiac Surgery. 36 (6) (pp 2081-2094), 2021. Date of
Publication: June 2021.
Author
Yao R.J.R.; Hawkins N.M.; Lavaie Y.; Deyell M.W.; Andrade J.G.; Bashir J.
Institution
(Yao, Lavaie) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Hawkins, Deyell, Andrade) Division of Cardiology, University of British
Columbia, Vancouver, BC, Canada
(Bashir) Division of Cardiovascular Surgery, University of British
Columbia, Vancouver, BC, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) often complicates
cardiac surgery and is associated with increased mortality and risk of
thromboembolism. However, the optimal oral anticoagulation (OAC) strategy
is uncertain. We performed a systematic review to examine the OAC practice
patterns and efficacy in these circumstances. Method(s): MEDLINE and
EMBASE were searched from 2000 to 2019 using the search terms cardiac
surgical procedures, cardiac surgery, postoperative complications, atrial
fibrillation, atrial flutter, and terms for anticoagulants. Collected data
included anticoagulation patterns (time of initiation, type, and duration)
and outcomes (stroke, bleeding, and mortality). Result(s): From 763
records, 4 prospective and 13 retrospective studies were included totaling
44,908 patients with 8929 (19.9%) who developed POAF. Anticoagulation
rates ranged from 4% to 43% (mean 21% overall). Sixteen studies used
warfarin, 3 nonvitamin K OAC (NOAC), and 2 both. Four studies reported the
use of bridging unfractionated or low-molecular-weight heparin.
Concomitant antiplatelet therapy was reported in half the studies, ranging
from 80% to 99%. OAC use was associated with lower risk of thromboembolic
events in two retrospective studies (including a national Danish cohort
with 2108 patients with POAF). Patients discharged on warfarin experienced
reduced mortality in a large, single center, retrospective analysis, but
no association was observed in the Danish cohort. Conclusion(s):
There is wide practice variation in the uptake, timing of initiation,
duration, and choice of OAC for POAF following cardiac surgery. The
evidence is largely retrospective and insufficient to assess the efficacy
of different OAC strategies. Further studies are warranted to guide
clinical practice. Copyright © 2021 Wiley Periodicals LLC

<67>
Accession Number
2010778812
Title
Comparison of alternate preparative techniques on wall thickness in
coronary artery bypass grafts: The HArVeST randomized controlled trial.
Source
Journal of Cardiac Surgery. 36 (6) (pp 1985-1995), 2021. Date of
Publication: June 2021.
Author
Angelini G.D.; Johnson T.; Culliford L.; Murphy G.; Ashton K.; Harris T.;
Edwards J.; Clayton G.; Kim Y.; Newby A.C.; Reeves B.C.; Rogers C.A.
Institution
(Angelini, Johnson, Newby) Bristol Heart Institute, University of Bristol,
Bristol, United Kingdom
(Culliford, Ashton, Harris, Reeves, Rogers) Clinical Trials and Evaluation
Unit, Bristol Trials Centre, University of Bristol, Bristol, United
Kingdom
(Murphy) MRC Integrative Epidemiology Unit, University of Bristol,
Bristol, United Kingdom
(Edwards) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Clayton) School of Health and Related Research, University of Sheffield,
Sheffield, United Kingdom
(Kim) Yongin Severance Hospital, Yonsei University College of Medicine,
Seoul, South Korea
Publisher
Blackwell Publishing Inc.
Abstract
Background: The success of coronary artery bypass grafting surgery (CABG)
is dependent on long-term graft patency, which is negatively related to
early wall thickening. Avoiding high-pressure distension testing for leaks
and preserving the surrounding pedicle of fat and adventitia during vein
harvesting may reduce wall thickening. Method(s): A single-centre,
factorial randomized controlled trial was carried out to compare the
impact of testing for leaks under high versus low pressure and harvesting
the vein with versus without the pedicle in patients undergoing CABG. The
primary outcomes were graft wall thickness, as indicator of medial-intimal
hyperplasia, and lumen diameter assessed using intravascular ultrasound
after 12 months. Result(s): Ninety-six eligible participants were
recruited. With conventional harvest, low-pressure testing tended to yield
a thinner vessel wall compared with high-pressure (mean difference [MD;
low minus high] -0.059 mm, 95% confidence interval (CI) -0.12, +0.0039, p
=.066). With high pressure testing, veins harvested with the pedicle fat
tended to have a thinner vessel wall than those harvested conventionally
(MD [pedicle minus conventional] -0.057 mm, 95% CI: -0.12, +0.0037, p
=.066, test for interaction p =.07). Lumen diameter was similar across
groups (harvest comparison p =.81; pressure comparison p =.24).
Low-pressure testing was associated with fewer hospital admissions in the
12 months following surgery (p =.0008). Harvesting the vein with the
pedicle fat was associated with more complications during the index
admission (p =.0041). Conclusion(s): Conventional saphenous vein
graft preparation with low-pressure distension and harvesting the vein
with a surrounding pedicle yielded similar graft wall thickness after 12
months, but low pressure was associated with fewer adverse
events. Copyright © 2021 The Authors. Journal of Cardiac Surgery
Published by Wiley Periodicals LLC

<68>
Accession Number
2010636470
Title
The best approach for functional tricuspid regurgitation: A network
meta-analysis.
Source
Journal of Cardiac Surgery. 36 (6) (pp 2072-2080), 2021. Date of
Publication: June 2021.
Author
Di Mauro M.; Lorusso R.; Parolari A.; Ravaux J.M.; Bonalumi G.; Guarracini
S.; Ricci F.; Benedetto U.; Calafiore A.M.
Institution
(Di Mauro, Lorusso, Ravaux) Cardio-Thoracic Surgery Unit, Heart and
Vascular Centre, Maastricht University Medical Centre (MUMC),
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Parolari) IRCCS Policlinic S. Donato and Department of Biomedical
Sciences for Health, UOC of University Cardiac Surgery and Translational
Research, University of Milan, Milan, Italy
(Bonalumi) Department of Cardiac Surgery, Centro Cardiologico
Monzino-IRCCS, Milan, Italy
(Guarracini) Department of Cardiovascular Disease, "Pierangeli" Hospital,
Pescara, Italy
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences, "G.
d'Annunzio" University, Chieti, Italy
(Ricci) Department of Clinical Sciences, Lund University, Malmo, Sweden
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
Bristol University, Bristol, United Kingdom
(Calafiore) Department of Cardiac Surgery, Gemelli Molise, Campobasso,
Italy
Publisher
Blackwell Publishing Inc.
Abstract
Objective: For many years, functional tricuspid regurgitation (FTR) was
considered negligible after treatment of left-sided heart valve surgery.
The aim of the present network meta-analysis is to summarize the results
of four approaches to establish the possible gold standard.
 Method(s): A systematic search was performed to identify all
publications reporting the outcomes of four approaches for FTR, not
tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA),
rigid rings (RRA). All studies reporting at least one the four endpoints
(early and late mortality, early and late moderate or more TFR) were
included in a Bayesian network meta-analysis. Result(s): There were
31 included studies with 9663 patients. Aggregate early mortality was 5.3%
no TA, 7.2% SA, 6.6% FRA, and 6.4% RRA; early TR moderate-or-more was
9.6%, 4.8%, 4.6%, and 3.8%; late mortality was 22.5%, 18.2%, 11.9%, and
11.9%; late TR moderate-or-more was 27.9%, 18.3%, 14.3%, and 6.4%. Rigid
or semirigid ring annuloplasty was the most effective approach for
decreasing the risk of late moderate or more FTR (-85% vs. no TA; -64% vs.
SA; -32% vs. FRA). Concerning late mortality, no significant differences
were found among different surgical approaches; however, flexible or rigid
rings reduced significantly the risk of late mortality (78% and 47%,
respectively) compared with not performing TA mortality. No differences
were found for early outcomes. Conclusion(s): Ring annuloplasty seems
to offer better late outcomes compare to either suture annuloplasty or not
performing TA. In particular rigid or semirigid rings provide more stable
FTR across time. Copyright © 2021 Wiley Periodicals LLC

<69>
Accession Number
2010318801
Title
Surgical Atrial Fibrillation Ablation With and Without Left Atrium
Reduction for Patients Scheduled for Mitral Valve Surgery: A Prospective
Randomised Study.
Source
Heart Lung and Circulation. 30 (6) (pp 922-931), 2021. Date of
Publication: June 2021.
Author
Bogachev-Prokophiev A.V.; Ovcharov M.A.; Lavinykov S.O.; Pivkin A.N.;
Sharifulin R.M.; Afanasyev A.V.; Sapegin A.V.; Zheleznev S.I.
Institution
(Bogachev-Prokophiev, Ovcharov, Lavinykov, Pivkin, Sharifulin, Afanasyev,
Sapegin, Zheleznev) Heart Valves Surgery Department, E. Meshalkin National
Medical Research Center, Novosibirsk, Russian Federation
Publisher
Elsevier Ltd
Abstract
Background: The influence of left atrium (LA) enlargement on atrial
arrhythmia recurrence (AAR) after surgical ablation in patients with
mitral valve (MV) disease remains unresolved. Objective(s): Left
atrial size is critical to the success of concomitant atrial fibrillation
(AF) ablation in patients scheduled for MV surgery. However, a large LA
should not be a limiting factor when evaluating surgical candidates with
AF if they receive appropriate treatment during concomitant ablation. This
randomised study assessed whether adding LA reduction (LAR) to the maze
procedure for MV surgery patients can improve freedom from AAR.
 Method(s): From September 2014 to September 2017, 140 patients were
randomly assigned into two groups. The maze group underwent MV surgery
with concomitant surgical AF ablation (n=70). The maze + LA reduction
group underwent MV surgery with concomitant AF ablation and LA reduction
procedure (n=70). Rhythm outcomes were estimated by Holter monitoring,
according to Heart Rhythm Society guidelines. Result(s): The
concomitant LA reduction procedure did not increase early mortality and
complications rates. Significant differences in freedom from AAR were
observed at 24 months (maze, 78.4%; maze + LAR group, 92.3%; p=0.025). A
significant difference in LA volume was detected at discharge (p<0.0001);
however, it was not significantly different at 24 months (p=0.182).
 Conclusion(s): Adding LA reduction to the maze procedure led to
improvements in freedom from AAR for patients with AF and LA enlargement
scheduled for MV surgery. A concomitant LA reduction procedure did not
increase mortality and perioperative risk. Copyright © 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<70>
Accession Number
2010166536
Title
Does Blood Transfusion Have an Effect on Outcomes After Aortic Valve
Replacement Surgery?.
Source
Heart Lung and Circulation. 30 (6) (pp 909-916), 2021. Date of
Publication: June 2021.
Author
Bayliss C.D.; Maier R.; Kasim A.; Hancock H.; Akowuah E.
Institution
(Bayliss, Akowuah) Department of Cardiothoracic Surgery, The James Cook
University Hospital, Middlesbrough, United Kingdom
(Maier, Hancock) Newcastle Clinical Trials Unit, Newcastle University,
Newcastle upon Tyne, United Kingdom
(Kasim) Department of Anthropology, Durham University, Durham, United
Kingdom
Publisher
Elsevier Ltd
Abstract
Objective: Long-term outcomes following surgical aortic valve replacement
(AVR) are excellent. However, there is a significant early morbidity
burden. Red cell transfusion is common in the perioperative period and
deleterious effects of receiving a transfusion on early postoperative
morbidity are well described in observational studies. This study aimed to
assess the effect of transfusion on ischaemic or infective outcomes after
aortic valve replacement. Method(s): Data from 270 patients enrolled
in the Manubrium-limited ministernotomy versus conventional sternotomy for
aortic valve replacement (MAVRIC) randomised controlled trial was used to
create two cohorts, patients that received red cell transfusions following
AVR and those that did not. Propensity score matching was performed to
limit the effect of confounding variables. Strict transfusion thresholds
were maintained, with patients receiving a transfusion if haemoglobin
concentration fell below 80 g/L, or if significant bleeding or
haemodynamic instability occurred. The primary outcome was a composite of
ischaemic event (myocardial infarction, permanent stroke, gut ischaemia or
acute kidney injury) or serious infection (sepsis, endocarditis,
respiratory tract or wound infection). Patients were followed for 12 weeks
following surgery. Result(s): Sixty-three (63) of 270 patients
received a red cell transfusion (23.3%). Transfused patients had
significantly lower body mass index (BMI), a higher proportion of females,
a lower preoperative haemoglobin and haematocrit, a higher EuroSCORE II
score, worse renal function and were more likely to have undergone urgent
surgery compared to the unadjusted control cohort. Once matched, there was
no difference in the primary outcome between cohorts. There was a
significantly increased length of hospital stay in the transfused group
(median 7 days transfused, median 5 days not-transfused, p=0.001).
 Conclusion(s): Red cell transfusion, using a transfusion threshold of
80 g/L, does not appear to be associated with adverse ischaemic or
infective outcomes after aortic valve replacement. Copyright ©
2020

<71>
Accession Number
2007327871
Title
Impact of advanced clinical fellowship training on future research
productivity and career advancement in adult cardiac surgery.
Source
Surgery (United States). 169 (5) (pp 1221-1227), 2021. Date of
Publication: May 2021.
Author
Wang H.; Bajaj S.S.; Williams K.M.; Pickering J.M.; Heiler J.C.;
Manjunatha K.; O'Donnell C.T.; Sanchez M.; Boyd J.H.
Institution
(Wang, Bajaj, Williams, Pickering, Heiler, Manjunatha, O'Donnell, Sanchez,
Boyd) Department of Cardiothoracic Surgery, Stanford University, Stanford,
CA, United States
Publisher
Mosby Inc.
Abstract
Background: Advanced clinical fellowships are important for training
surgeons with a niche expertise. Whether this additional training impacts
future academic achievement, however, remains unknown. Here, we
investigated the impact of advanced fellowship training on research
productivity and career advancement among active, academic cardiac
surgeons. We hypothesized that advanced fellowships do not significantly
boost future academic achievement. Method(s): Using online sources
(eg, department webpages, CTSNet, Scopus, Grantome), we studied adult
cardiac surgeons who are current faculty at accredited United States
cardiothoracic surgery training programs, and who have practiced only at
United States academic centers since 1986 (n = 227). Publicly available
data regarding career advancement, research productivity, and grant
funding were collected. Data are expressed as counts or medians.
 Result(s): In our study, 78 (34.4%) surgeons completed an advanced
clinical fellowship, and 149 (65.6%) did not. Surgeons who pursued an
advanced fellowship spent more time focused on surgical training (P <
.0001), and those who did not were more likely to have completed a
dedicated research fellowship (P = .0482). Both groups exhibited similar
cumulative total publications (P = .6862), H-index (P = .6232), frequency
of National Institutes of Health grant funding (P = .8708), and time to
achieve full professor rank (P = .7099). After stratification by current
academic rank, or by whether surgeons pursued a dedicated research
fellowship, completion of an advanced clinical fellowship was not
associated with increased research productivity or accelerated career
advancement. Conclusion(s): Academic adult cardiac surgeons who
pursue advanced clinical fellowships exhibit similar research productivity
and similar career advancement as those who do not pursue additional
clinical training. Copyright © 2020 Elsevier Inc.

<72>
Accession Number
634493053
Title
Effectiveness of standard local anesthetic bupivacaine and liposomal
bupivacaine for postoperative pain control in patients undergoing truncal
incisions: A randomized clinical trial.
Source
JAMA Network Open. 4 (3) (no pagination), 2021. Article Number: e210753.
Date of Publication: 16 Mar 2021.
Author
Sandhu H.K.; Miller C.C.; Tanaka A.; Estrera A.L.; Charlton-Ouw K.M.
Institution
(Sandhu, Miller, Tanaka, Estrera, Charlton-Ouw) McGovern Medical School,
University of Texas Health Science Center at Houston, United States
(Tanaka, Estrera) Memorial Hermann Hospital, Texas Medical Center,
Houston, United States
(Charlton-Ouw) HCA Houston Healthcare, Gulf Coast Division, Houston, TX,
United States
(Charlton-Ouw) Department of Clinical Sciences, University of Houston
College of Medicine, Houston, TX, United States
Publisher
American Medical Association
Abstract
Importance: Liposomal bupivacaine for pain relief is purported to last 3
days compared with 8 hours with standard bupivacaine. However, its
effectiveness is unknown in truncal incisions for cardiothoracic or
vascular operations. Objective(s): To compare the effectiveness of
single-administration standard bupivacaine vs liposomal bupivacaine in
patients undergoing truncal incisions. Design, Setting, and
Participant(s): This randomized clinical trial enrolled patients
undergoing sternotomy, thoracotomy, minithoracotomy, and laparotomy from a
single cardiovascular surgery department in an academic medical center
between November 2012 and June 2018. The study was powered to detect a
Cohen effect size of 0.35 with a power of greater than 80%. Data analysis
was performed from July to December 2018. Intervention(s): Patients
were randomized to standard bupivacaine or liposomal bupivacaine.
 Main Outcomes and Measures: Pain was assessed over 3 postoperative
days by the Numeric Rating Scale (NRS). Adjunctive opioids were converted
to morphine equivalents units (MEU). NRS scores were compared using
Wilcoxon rank-sum (3-day area under the curve) and 2-way nonparametric
mixed models (daily scale score) to assess time-by-group interaction.
Secondary outcomes included cumulative opioid consumption. Result(s):
A total of 280 patients were analyzed, with 140 in each group
(single-administration standard bupivacaine vs liposomal bupivacaine).
Mean (SD) age was 60.2 (14.4) years, and 101 of 280 patients (36%) were
women. Irrespective of treatment assignment, pain decreased by a mean of
approximately 1 point per day over 3 days (beta = -0.87; SE = 0.11; mixed
model regression P <.001). Incision type was associated with pain with
patients undergoing thoracotomy (including minithoracotomy) reporting
highest median (interquartile range [IQR]) pain scores on postoperative
days 1 (liposomal vs standard bupivacaine, 6 [4-8] vs 5 [3-7]; P =.049,
Wilcoxon rank-sum) and 2 (liposomal vs standard bupivacaine, 5 [4-7] vs 4
[2-6]; P =.003, Wilcoxon rank-sum) but not day 3 (liposomal vs standard
bupivacaine, 3 [2-6] vs 3 [1-5]; P =.10, Wilcoxon rank-sum), irrespective
of treatment group. Median (IQR) 3-day cumulative NRS was 12.0 (8.0-16.5)
for bupivacaine and 13.5 (9.0-17.0) for liposomal bupivacaine (P =.15,
Wilcoxon rank-sum) Furthermore, use of opioids was greater following
liposomal bupivacaine compared with standard bupivacaine (median [IQR],
41.5 [21.3-73.8] MEU vs 33.0 [17.8-62.5] MEU; P =.03, Wilcoxon rank-sum).
On multivariable analysis, no interaction by incision type was observed
for mean pain scores or opioid use. Conclusions and Relevance: In
this randomized clinical trial involving truncal incisions for
cardiovascular procedures, liposomal bupivacaine did not provide improved
pain control and did not reduce adjunctive opioid use compared with
conventional bupivacaine formulation over 3 postoperative days. Trial
Registration: ClinicalTrials.gov Identifier: NCT02111746. Copyright
© 2021 American Medical Association. All rights reserved.

<73>
Accession Number
2011774367
Title
Abstract No. 572 Use of the steerable guide catheter in the periphery.
Source
Journal of Vascular and Interventional Radiology. Conference: SIR 2021
Annual Scientific Meeting. Virtual, Online. 32 (5 Supplement) (pp
S159-S160), 2021. Date of Publication: May 2021.
Author
Gutti S.; Iyer D.; Scher D.; Kantharia S.; Sarin S.
Institution
(Gutti, Iyer) The George Washington University School of Medicine and
Health Sciences
(Scher, Kantharia) The George Washington University Hospital
(Sarin) George Washington University
Publisher
Elsevier Inc.
Abstract
Purpose: The steerable catheter has become an exceedingly popular device
in recent years. A systematic review of steerable catheters in
endovascular procedures reported a 95.5% technical success rate with no
complications. The device is most commonly used in cardiac procedures,
including cardiac mapping, ablation, and valve repair. However, outside of
case reports and animal studies, there is little data describing use of
the device in periphery. The purpose of this study is to characterize the
efficacy of steerable catheters in various types of peripheral
endovascular procedures. Material(s) and Method(s): Candidates for
this retrospective study included all patients between the ages of 18-95
who have undergone procedures at the GWU Hospital IR department involving
a steerable catheter produced by Medtronic/Aptus TourGuide or Morph from
September 2017 to September 2020 (n = 29). Procedure details were gathered
from our institution's EMR. Variables of interest included procedure type,
fluoroscopy exposure time (min), radiation dose area product
(mGycm2), and complexity of the case. Complexity was rated by a
board-certified interventional radiologist based on details of the patient
note. Result(s): Average values were calculated within each procedure
type. Total weighted averages were calculated to summarize data across
procedure types. In this sample for which the steerable catheter was
determined to be the optimal intervention, most cases were rated as high
complexity (51.72%) or medium complexity (44.83%). By using the steerable
catheter, operators were able to achieve an average fluoro time of 33.33
min and average radiation dose area product of 498,594.24
mGycm2. Conclusion(s): The steerable catheter has
demonstrated great success in cardiac procedures, and additionally, it has
significant potential for use in endovascular procedures of the periphery.
We found that using this device can be considered as a first-line option
for various types of medium- tohigh-complexity cases, potentially
resulting in shorter procedure time and less radiation
exposure. Copyright © 2021

<74>
Accession Number
2011751996
Title
RECURRENT AND INCESSANT PERICARDITIS CAUSED BY PROPIONIBACTERIUM ACNES
COMPLICATED BY HEMORRHAGIC PERICARDIAL EFFUSION: A CASE REPORT AND REVIEW
OF LITERATURE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 2266), 2021. Date of
Publication: 11 May 2021.
Author
Kahai P.; Hafeez S.
Institution
(Kahai, Hafeez) United Health Services Hospitals - Wilson Medical Center,
Johnson City, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Recurrent pericarditis is rarely caused by purulent infection
due to anaerobe bacteria. We present a rare case of a mixed recurrent and
incessant pericarditis complicated by hemorrhagic effusion caused by
Propionibacterium in a young, immunocompetent male patient without any
comorbidities or identifiable exposure. Case A 30-year-old male was
admitted to our hospital in December 2017 with left-sided chest pain for
two days associated with shortness of breath made worse by deep
inspiration and lying flat. He had no significant past medical history.
Electrocardiogram (EKG) revealed diffuse ST-elevations consistent with
pericarditis but no elevated troponins. An echocardiogram did not show any
pericardial effusion. Cardiology recommended continuing two weeks of
indomethacin and three months of colchicine with outpatient follow-up. The
patient had two additional recurrences of pericarditis. After a third
Emergency Department (ED) visit in May 2018 and appropriate medical
management, the patient was scheduled for pericardial biopsy to further
elucidate the etiology of recurrent pericarditis. Decision-making Prior to
the pericardial biopsy, the patient presented to the ED in early June 2018
with high grade fever, chest pain, and shortness of breath. EKG showed
sinus tachycardia, incomplete right bundle branch block, and nonspecific
changes in ST-T waves. Transthoracic echocardiogram showed ejection
fraction 55-60%, moderate 1.3 cm pericardial effusion without tamponade
physiology, and possible constrictive pericarditis. The patient was
admitted, started on IV ceftriaxone, underwent pericardial window
creation, evacuation of hemorrhagic pericardial effusion, and placement of
a 24 French Blake chest tube. Conclusion Per Infectious Disease, the
patient was treated with intravenous ceftriaxone 2g daily for 6 six weeks
as he was allergic to penicillin. He was discharged with colchicine 0.6 mg
twice daily for 3 months and indomethacin 50 mg three times daily for 2
weeks. The patient has remained asymptomatic since
discharge. Copyright © 2021 American College of Cardiology
Foundation

<75>
Accession Number
2011748580
Title
CLINICAL OUTCOMES OF P2Y12 INHIBITOR MONOTHERAPY IN PATIENTS UNDERGOING
TRANSCATHETER AORTIC VALVE REPLACEMENT: LESS IS MORE!.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1173), 2021. Date of
Publication: 11 May 2021.
Author
Ibrahim H.; Staniloae C.; Fuentes J.; Gonzalez-Lengua C.; Vidal S.; Gaudio
S.; Tovar J.; Jilaihawi H.; Querijero M.; Neuburger P.; Williams M.
Institution
(Ibrahim, Staniloae, Fuentes, Gonzalez-Lengua, Vidal, Gaudio, Tovar,
Jilaihawi, Querijero, Neuburger, Williams) NYU Langone Health, New York
City, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Aspirin alone is associated with reduction in bleeding compared
with dual antiplatelet therapy (DAPT) in patients who underwent TAVR and
no indication for anticoagulation (AC). However, the role of P2Y12
inhibitor alone in this population has not been elucidated. Methods In
2017 our center changed antithrombotic strategy for patients undergoing
TAVR. Patients with no indication for AC or DAPT were treated with P2Y12
inhibitor alone, patients with indication for AC were treated with AC
without antiplatelet, and patients with indication for AC and antiplatelet
(AP) were treated with AC and single AP. This study reports bleeding and
ischemic events at 30 days and 1 year for these groups. Primary endpoint
was all-cause death or any bleeding at 1 year, secondary endpoint was a
composite of all-cause death, stroke and myocardial infarction at 1 year.
Results 539 patients underwent TAVR between Jan 2017 and Dec 2018, we
excluded patients who did not receive any antithrombotic therapy or triple
therapy (n=23). 263 patients were discharged on P2Y12 inhibitor
monotherapy, 97 patients on DAPT, 109 patients on anticoagulation
monotherapy, and 47 patients on AC+AP. Event rates at 30 days and 1 year
are shown in the table b> Conclusion In patients undergoing TAVR who do
not require anticoagulation, P2Y12 inhibitor monotherapy is associated
with significantly lower rates of bleeding at 30 days and one year.
Randomized studies comparing aspirin monotherapy and P2Y12 inhibitors
monotherapy are warranted. [Formula presented] Copyright © 2021
American College of Cardiology Foundation

<76>
Accession Number
2011748511
Title
META ANALYSIS OF CARDIOVASCULAR OUTCOMES OF ETHYL EICOSAPENTAENOIC ACID IN
DIABETES MELLITUS AND CORONARY ARTERY DISEASE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1188), 2021. Date of
Publication: 11 May 2021.
Author
Sattar Y.; Arshad J.; Ahmad B.; Suleiman A.-R.; Ullah W.; Alhatemi G.;
Alhajri N.; Alraies M.C.
Institution
(Sattar, Arshad, Ahmad, Suleiman, Ullah, Alhatemi, Alhajri, Alraies) Icahn
School of Medicine at Mount Sinai - Elmhurst Hospital, New York City, NY,
United States
(Sattar, Arshad, Ahmad, Suleiman, Ullah, Alhatemi, Alhajri, Alraies)
Detroit Medical Center, Wayne State University, Detroit, MI, United States
Publisher
Elsevier Inc.
Abstract
Background The efficacy of ethyl eicosapentaenoic acid (EPA) in patients
with a history of diabetes mellitus (DM) and prior coronary artery disease
(CAD) is controversial. Methods PubMed, Ovid, Embase, and Cochrane
databases were queried with Boolean operators to search for articles that
include cardiovascular mortality, all cause mortality, and prevention of
CAD using EPA in comparison to placebo. Unadjusted odds ratios were
calculated using STATA software (version 16, StataCorp, College Station,
Texas) through a random effect model. Results Nine studies met the study
eligibility criteria of which included a total of 57,177 patients with the
EPA group consisting of 28,622 patients and the placebo group of 28,555
patients. The mean age of both groups was 66.3 years and hypertension was
the most common comorbidity. The odds of EPA use as primary or secondary
prevention of cardiovascular mortality favors EPA when compared to placebo
(OR 0.87 95% CI 0.80-0.95, p-0.001). However, prevention of fatal or
nonfatal myocardial infarction (MI), unstable angina (UA), need for urgent
coronary revascularization, and all cause mortality remained identical
between both groups. Conclusion Patients with EPA use can have lower
cardiovascular mortality as compared to placebo in diabetes mellitus and
prior stable coronary artery disease. [Formula presented] Copyright
© 2021 American College of Cardiology Foundation

<77>
Accession Number
2011747597
Title
NON-VITAMIN K ANTAGONISTS SHOULD BE PREFERRED OVER WARFARIN IN PATIENTS
WITH ATRIAL FIBRILLATION AND BIOPROSTHETIC VALVES: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1693), 2021. Date of
Publication: 11 May 2021.
Author
Cardoso R.; Ternes C.M.P.; Knijnik L.; Fernandes A.; Fernandez V.N.;
Justino G.B.; d'Avila A.; Lopes R.
Institution
(Cardoso, Ternes, Knijnik, Fernandes, Fernandez, Justino, d'Avila, Lopes)
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Cardoso, Ternes, Knijnik, Fernandes, Fernandez, Justino, d'Avila, Lopes)
Duke Clinical Research Institute, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Background Patients with atrial fibrillation (AF) and bioprosthetic valves
are at high risk for thromboembolic events. The pooled efficacy and safety
of NOACs, as a class, relative to warfarin in this population are not
known. Methods We systematically searched PubMed, Scopus and Cochrane
database for RCTs comparing NOACs to warfarin in patients with AF and
bioprosthetic valves. We pooled outcomes for stroke or systemic embolism;
ischemic stroke; hemorrhagic stroke; and major bleeding. Heterogeneity was
examined with I2 statistics. Results We included 4 trials with
1,321 patients, of whom 665 (50.3%) received a NOAC. Mean follow-up ranged
from 90 days to 2.8 years. In the pooled analysis, stroke or systemic
embolism was significantly lower in patients treated with NOACs (1.5%)
compared to warfarin (3.5%) (OR 0.40; 95% CI 0.19-0.85; p=0.02; figure
1A). Ischemic stroke (OR 0.71; 95% CI 0.27-1.90; figure 1B), hemorrhagic
stroke (OR 0.18; 95% CI 0.03-1.05), cardiovascular death (OR 0.78; 95% CI
0.38-1.62), and all-cause mortality (OR 0.94; 95% CI 0.55-1.62) were not
significantly different between groups. Major bleeding was less common in
the NOAC group (2.8%) compared to warfarin (4.7%) (OR 0.56; 95% CI
0.31-1.01; p=0.05; figure 1C). Conclusion As a class, NOACs are associated
with a reduced incidence of thromboembolic events and a trend towards less
major bleeding compared to warfarin in patients with AF who have
bioprosthetic valves. Thus, NOACs should be a preferred option for this
patient population. [Formula presented] Copyright © 2021 American
College of Cardiology Foundation

<78>
Accession Number
2011747513
Title
DIRECT IMPLANTATION OF A SUPRA-ANNULAR SELF-EXPANDING BIOPROSTHESES HAS NO
IMPACT ON ONE-YEAR ECHOCARDIOGRAPHIC OUTCOMES.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1346), 2021. Date of
Publication: 11 May 2021.
Author
Benetos G.; Karmpalioti M.; Drakopoulou M.; Stathogiannis K.; Xanthopoulou
M.; Latsios G.; Synetos A.; Bei E.; Voudris V.; Kosmas E.; Katsimagklis
G.; Zeniou V.; Danenberg H.; Vavuranakis M.; Tousoulis D.; Tsioufis K.;
Toutouzas K.
Institution
(Benetos, Karmpalioti, Drakopoulou, Stathogiannis, Xanthopoulou, Latsios,
Synetos, Bei, Voudris, Kosmas, Katsimagklis, Zeniou, Danenberg,
Vavuranakis, Tousoulis, Tsioufis, Toutouzas) National & Kapodistrian
University of Athens, School of Medicine, First Department of Cardiology,
Athens, Greece
Publisher
Elsevier Inc.
Abstract
Background The DIRECT trial was a multicenter, randomized, non-inferiority
trial designed to compare the safety and efficacy of TAVI with or without
balloon aortic valvuloplasty (BAV) using a self-expanding prosthesis in
patients with symptomatic, severe aortic valve stenosis. The aim of this
study was the comparison of one-year echocardiographic findings among
patients with (pre-BAV) and without pre-dilatation (no-BAV). Methods One
hundred seventy one consecutive patients with severe aortic stenosis were
randomly assigned at 4 tertiary centers to undergo TAVI with the use of
self-expanding prosthesis with or without pre-dilatation. All patients
underwent echocardiographic follow-up at one year. Results Of 171
patients,86 patients were allocated to pre-BAV group and 85 patients to
no-BAV group. In one year follow up there was no significant difference
between pre-BAV and no BAV group in aortic valve area
(1.84+/-0.39cm2 vs. 1.85+/-0.44cm2, p=0.79), peak
aortic valve gradient (15.95+/-9.97 mmHg vs. 14.51+/-6.6 mmHg, p=0.43),
mean aortic valve gradient (8.37+/-5.01 mmHg vs. 7.98+/-4.03 mmHg, p=0.72)
and aortic valve peak velocity (1.90+/-0.51 m/s vs. 1.80+/-0.42m/s,
p=0.17). The incidence of moderate or severe paravalvular regurgitation
(PVL) at 1 year was not different between the 2 study groups (figure).
Conclusion Direct implantation of a self-expanding valve in TAVI procedure
has no impact one-year prosthesis function and paravalvular regurgitation.
[Formula presented] Copyright © 2021 American College of
Cardiology Foundation

<79>
Accession Number
2011746950
Title
INTRAOPERATIVE INDUCIBILITY OF ATRIAL FIBRILLATION IMPROVES RISK
STRATIFICATION AND REDUCES POST-OPERATIVE ATRIAL FIBRILLATION.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1592), 2021. Date of
Publication: 11 May 2021.
Author
Pong T.; Cyr K.; Carlton C.; Niesen J.; Aparicio-Valenzuela J.; Fischbein
M.; Woo Y.; Boyd J.; Lee A.
Institution
(Pong, Cyr, Carlton, Niesen, Aparicio-Valenzuela, Fischbein, Woo, Boyd,
Lee) Stanford University School of Medicine, Stanford, CA, United States
Publisher
Elsevier Inc.
Abstract
Background Post-operative atrial fibrillation (POAF) after cardiac surgery
is a common complication associated with increased risk of thromboembolic
events, hospital stay, and mortality. Innovative strategies that can
identify and direct treatment towards at-risk patients are needed to
reduce the burden of POAF. Methods This randomized clinical trial
evaluated the use of novel intraoperative AF inducibility as a screening
tool to identify and treat patients at risk of developing POAF. A total of
201 patients underwent intraoperative rapid atrial pacing prior to
initiation of cardiopulmonary bypass to test for inducible AF. Patients
with inducible AF were randomized to prophylactic amiodarone treatment,
started in the operating room, versus standard post-operative care. A risk
score for postoperative AF (InduceAF score) was derived and validated.
Results 111 patients (55%) screened positive for inducible AF versus 90
patients (45%) who were non-inducible. Prophylactic amiodarone treatment
reduced the rate of POAF to 20 of 62 patients (32%) compared to 29 of 49
patients (59%) treated with standard post-operative care (P<0.001), a
number needed to treat of 4. In the derivation of the InduceAF risk score,
AF inducibility, NSAID use, left atrial enlargement, and heart failure
were independent predictors of POAF. The InduceAF score was effective for
predicting POAF: C-statistic 0.77 (0.69 to 0.86). Conclusion Novel
Intraoperative AF inducibility can be used as an effective screening tool
to identify patients at increased risk of developing POAF after cardiac
surgery. The combination of intraoperative AF inducibility screening and
prophylactic amiodarone therapy is effective at reducing post-operative
atrial fibrillation and readmissions for AF after cardiac
surgery. Copyright © 2021 American College of Cardiology
Foundation

<80>
Accession Number
2011746802
Title
MORBIDITY AND MORTALITY IN PULMONARY HYPERTENSION AFTER NON-CARDIAC
SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1678), 2021. Date of
Publication: 11 May 2021.
Author
Wang M.K.; Binbraik Y.; Riekki T.; Devereaux P.J.
Institution
(Wang, Binbraik, Riekki, Devereaux) McMaster University, Hamilton, Canada
Publisher
Elsevier Inc.
Abstract
Background An appreciable number of patients with pulmonary hypertension
(PH) undergo non-cardiac surgery. Observational studies have suggested
that PH confers an increased risk of developing postoperative cardiac,
respiratory, and thromboembolic complications; however, there has been no
systematic assessment of these reported associations. The goal of this
systematic review and meta-analysis was to assess the impact of PH on
mortality and morbidity after non-cardiac surgery (NCS). Methods We
searched MEDLINE and EMBASE between Jan 1970 and Sep 2020 for studies
evaluating an association between PH and postoperative morbidity
(cardiovascular, respiratory, and thromboembolic) and mortality after NCS.
Minor procedures were excluded. Study eligibility and data extraction were
conducted independently and in duplicate. Study quality was assessed using
the Newcastle Ottawa Scale. We conducted a random-effects meta-analysis to
calculate summary risk ratios. Results Fourteen studies met eligibility
criteria and included 19,325,035 patients. The overall prevalence of PH
was 1.0%. PH was associated with an increased risk of mortality compared
to patients with no PH (adjusted OR 2.01, 95% CI 1.37 - 2.96;
I2 = 98%; 7 studies). Results remained similar in a sensitivity
analysis of high-quality studies. PH was associated with increased lengths
of hospital stay (mean difference +1.97 days, 95% CI 0.81 - 3.12;
I2 = 99%; 5 studies), as well as a higher risk of postoperative
myocardial infarction (OR 1.49, 95% CI 1.44-1.54; I2 = 0%; 4
studies), delayed extubation (OR 5.98, 95% CI 1.70 - 21.02; I2
= 3%; 3 studies), deep vein thrombosis (OR 4.02, 95% CI 2.14 - 7.54;
I2 = 85%; 3 studies) and pulmonary embolism (OR 4.16, 95% CI
3.23 - 5.36; I2 = 69%; 6 studies). PH was associated with a
decreased risk of stroke (OR 0.93, 95% CI 0.88-0.98, I2 =0%; 3
studies). PH was not associated with arrhythmia events (5 studies).
Conclusion PH is associated with increased morbidity and mortality after
NCS. Further studies are needed to establish methods to reduce the risk of
postoperative events in this high-risk population. Copyright ©
2021 American College of Cardiology Foundation

<81>
Accession Number
2011746356
Title
EFFICACY AND SAFETY OF DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K
ANTAGONISTS IN PATIENTS WITH ATRIAL FIBRILLATION AND BIOPROSTHETIC VALVES:
A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1727), 2021. Date of
Publication: 11 May 2021.
Author
Patel N.; Elzanaty A.; Patel M.; Elsheikh E.
Institution
(Patel, Elzanaty, Patel, Elsheikh) The University of Toledo, Toledo, OH,
United States
Publisher
Elsevier Inc.
Abstract
Background Patients with atrial fibrillation (AF) and bioprosthetic valves
(BPV) require long-term anticoagulation and current recommendations
support the use of vitamin K antagonists (VKA). There is limited data
regarding the use of direct oral anticoagulants (DOAC) in patients with AF
and BPV. Methods We performed a literature search using PubMed, Embase,
and Cochrane Library from inception through November 2020 to investigate
the efficacy and safety of DOAC compared to VKA in patients with AF and
BPV. The primary outcomes were MACE (MI, stroke, and CV death) and
composite of stroke and systemic embolic event (SEE). Secondary outcomes
were all-cause mortality and major bleeding (BARC 3-5, TIMI major).
Results 5 studies (4 randomized controlled trials, 1 observational study)
involving 1755 patients were included in the meta-analysis. Compared to
VKA, the DOAC group had significantly lower rate of composite stroke and
SEE (risk ratio (RR) 0.47; 95% confidence interval (CI) 0.24, 0.92; P =
0.03) and major bleeding (RR 0.57; 95% CI 0.35, 0.93; P = 0.02). However,
no significant difference existed between DOAC and VKA in terms of MACE
(RR 0.6; 95% CI 0.35,1.05; P = 0.07) or all-cause mortality (RR 0.93; 95%
CI 0.56, 1.54; P = 0.77) [Figure 1]. Conclusion DOAC are more effective
compared to VKA at preventing stroke/SEE and major bleeding in patients
with AF and BPV; however, there was no significant difference in MACE or
all-cause mortality. Further trials with large sample sizes are needed to
confirm our findings. [Formula presented] Copyright © 2021
American College of Cardiology Foundation

<82>
Accession Number
2011746135
Title
ASPIRIN VERSUS ASPIRIN PLUS CLOPIDOGREL AS ANTITHROMBOTIC TREATMENT
FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION- A SYSTEMATIC REVIEW AND
META ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1164), 2021. Date of
Publication: 11 May 2021.
Author
Razzack A.A.; Pothuru S.; Pusa M.; Challa K.T.; Hassan S.A.; Yasmin F.;
Siddiqui T.J.
Institution
(Razzack, Pothuru, Pusa, Challa, Hassan, Yasmin, Siddiqui) Dr. N.T.R
University of Health Sciences, Vijawayada, India
Publisher
Elsevier Inc.
Abstract
Background Bleeding and thromboembolic events are common in patients after
transcatheter aortic-valve implantation (TAVI). Although current
guidelines recommend dual antiplatelet therapy with Aspirin and
Clopidogrel, it has been generally associated to a higher rate of
bleeding. It remains controversial with regard to the correlation between
the effects of double antiplatelet therapy and ischemic events. Methods
Electronic databases (Medline, Scopus, Embase, Cochrane) were searched
until 18th November 2020. Using dichotomous data for select values, the
unadjusted odds ratios were calculated applying Mantel Haenszel (M-H)
random-effects Results No statistically significant differences were
observed in all cause mortality in all the time periods.(OR-0.95, 95%CI
0.70-1.29, P=0.76). However, Patients receiving SAPT were less prone to
experience any bleeding complications (OR-0.95, 95%CI O.70-1.25, P=0.76)
The occurence of stroke, myocardial infarction and Transient Ischemic
attacks also occured less frequenty in the ASA group (OR- 0.72, 95%
CI-0.46-1.11, P=0.61) Conclusion Among patients undergoing TAVI who did
not have an indication for oral anticoagulation, Antiplatelet therapy with
Aspirin is noninferior to combined therapy with Aspirin and Clopidogrel.
SAPT reduced the risk for major or life-threatening events while not
increasing the risk for MI or stroke. [Formula presented] Copyright
© 2021 American College of Cardiology Foundation

<83>
Accession Number
2011746021
Title
PREGNANCY-ASSOCIATED SPONTANEOUS CORONARY ARTERY DISSECTION IN THE THIRD
TRIMESTER: A CASE SERIES AND LITERATURE REVIEW.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 3386), 2021. Date of
Publication: 11 May 2021.
Author
Wen S.; Ha T.K.; Chen J.; Ellis J.
Institution
(Wen, Ha, Chen, Ellis) Emory University, Atlanta, GA, United States
Publisher
Elsevier Inc.
Abstract
Background Pregnancy-associated spontaneous coronary artery dissection
(P-SCAD) is a rare condition associated with severe morbidity and
mortality. While P-SCAD most commonly occurs in the postpartum period, a
considerable portion occurs in the third trimester. Data on the management
and outcomes of third trimester P-SCAD is limited. Methods Our case series
and PubMed literature review identified 30 cases of third trimester P-SCAD
from August 1972 to November 2020. Results The mean gestational age of
third trimester P-SCAD was 32.5 weeks, with the greatest prevalence in
women >=30 years (21/30, 70%) (Table 1). Nearly half were >=35 years
(14/30, 47%). The most frequent presentation was STEMI (22/30, 73%). The
left anterior descending artery was the most frequently involved vessel
(20/30, 67%) with multivessel dissection in 43% (13/30). Most were treated
with medical management exclusively (14/26, 54%). Coronary artery bypass
graft and percutaneous intervention with stenting were pursued in 31%
(8/26) and 15% (4/26) respectively. Cesarean was the preferred mode of
delivery (18/19, 95%). Maternal and fetal mortality was 20% (6/30) and 7%
(2/30) respectively. [Formula presented] Conclusion P-SCAD should be
considered in women presenting with chest pain and STEMI in pregnancy. Our
review emphasizes the high maternal mortality of 20% in third trimester
P-SCAD. Early diagnosis and a multi-disciplinary approach to management
are critical to mitigate the risks of severe maternal and fetal morbidity
and mortality. Copyright © 2021 American College of Cardiology
Foundation

<84>
Accession Number
2011745589
Title
THREE-YEAR OUTCOMES AFTER REVASUCLARIZATON IN PATIENTS WITH UNPROTECTED
LEFT MAIN CORONARY ARTERY DISEASE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1220), 2021. Date of
Publication: 11 May 2021.
Author
Mushiake K.; Ohya M.; Fujii C.; Tada T.; Tanaka H.; Fuku Y.; Kadota K.
Institution
(Mushiake, Ohya, Fujii, Tada, Tanaka, Fuku, Kadota) Kurashiki Central
Hospital, Kurashiki-Shi, Japan
Publisher
Elsevier Inc.
Abstract
Background Recent meta-analysis from randomized clinical trials
demonstrated the similar long-term mortality and major adverse and
cerebrovascular events (MACCE) after percutaneous coronary intervention
(PCI) and coronary artery bypass grafting (CABG) for left main coronary
artery disease (LMCAD). However, there are scarce data in the real world
practice. Methods We retrospectively collected consecutive 555 patients
treated with newer-generation drug-eluting stents (375 patients) or CABG
(180 patients) for unprotected LMCAD between 2010 and 2016, excluding the
patients with acute coronary syndrome. The primary outcome measures were
defined as the 3-year cumulative incidence of mortality and MACCE. The
definition of MACCE was a composite of cardiac death, myocardial
infarction (MI), and stroke. MI was included in the procedural (CK-MB>= 10
times for upper limit normal) and spontaneous MI. The adjusted risk for
MACCE was evaluated by the Cox proportion hazard model, which was
expressed as hazard ratio (HR) and 95% confidence interval (CI). Results
The mean age and the rate of female were 71+/-10 years old and 20%,
respectively. The rate of patients with intermediate and high SYNTAX score
was 81%. The 3-year cumulative inidences of all-cause death and MACCE were
13.1% and 6.7%, respectively. The crude risk of 3-year mortality was
significantly higher in the patients with older age (>=75 years old),
diabetes with insulin, and hemodialysis. The crude risk of 3-year MACCE
was significantly higher in the patients with CABG [crude HR 1.97 (95% CI
1.01-3.82), P=0.046]. The multivariate analysis showed the independent
predictors for mortality were patients with older age (>=75 years old) and
hemodialysis. The risk of PCI relative to CABG was neutral for 3-year
mortality [adjusted HR 1.34 (95% CI 0.78-2.29), P=0.29], however that for
3-year MACCE was significantly higher in the patients with CABG [adjusted
HR 2.06 (1.05-4.06), P=0.036]. Conclusion The risks of 3-year MACCE for
patients with unprotected LMCAD after PCI using newer-generation
drug-eluting stents relative to CABG might be lower in the real world
practice. Copyright © 2021 American College of Cardiology
Foundation

<85>
Accession Number
2011745385
Title
META-ANALYSIS OF DIRECT ORAL ANTICOAGULANT VERSUS VITAMIN K ANTAGONIST IN
PATIENTS WITH ATRIAL FIBRILLATION AFTER TRANSCATHETER AORTIC VALVE
REPLACEMENT.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1170), 2021. Date of
Publication: 11 May 2021.
Author
Abusnina W.; Al-Abdouh A.; Gill G.S.; Bizanti A.; Houssein A.; Smer A.
Institution
(Abusnina, Al-Abdouh, Gill, Bizanti, Houssein, Smer) Creighton University,
Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
Background The optimal anticoagulation regimen for patients with Atrial
fibrillation (AF) following transcatheter aortic valve replacement (TAVR)
remains unclear. Methods We searched EMBASE, PubMed, and Cochrane Library
(inception through December 1st, 2020) for studies evaluating
direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKA) in
patients with AF post TAVR. We used Mantel-Haenszel method with
Paule-Mandel estimator of tau2 and Hartung-Knapp-Sidik-Jonkman
adjustment to calculate risk ratio (RR) with 95% confidence interval (CI).
Results Four observational studies with a total of 2,202 patients were
included in this analysis (682 in DOACs arm, 1,520 in VKA arm). The mean
age of overall population was 82.5 +/- 6.6 years and 45.4% was female. At
mean follow up of 26 months, there was no significant difference between
DOACs and VKA in terms of all-cause mortality [RR: 0.77; 95%CI: 0.30;
1.95; I2:71%] [Figure], ischemic stroke [RR: 1.31; 95%CI: 0.59;
2.92; I2:0%], and all-bleeding events [RR: 0.90; 95%CI: 0.40;
2.01; I2:30%].] Conclusion This meta-analysis shows that DOACs
are non-inferior to VKA in patients with AF post TAVR in terms of
all-cause mortality, ischemic stroke, and all-bleeding events. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<86>
Accession Number
2011745321
Title
MANAGING TRICUSPID VALVE INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUG USERS:
IS IT TIME TO ENDORSE THE CONSERVATIVE APPROACH?.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1698), 2021. Date of
Publication: 11 May 2021.
Author
Ruhr R.; Alnabelsi T.; Sinner G.; Leung S.
Institution
(Ruhr, Alnabelsi, Sinner, Leung) University of Kentucky, Lexington, KY,
United States
Publisher
Elsevier Inc.
Abstract
Background Guidelines for treating tricuspid valve (TV) infective
endocarditis (IE) remain without clear indications for procedural
intervention, particularly in intravenous drug use (IVDU) patients.
Methods Medical records of 195 IVDU patients with isolated, native, TV IE
were retrospectively reviewed. Outcomes were compared between those who
underwent surgical valve replacement, debulking with AngioVac, and medical
therapy alone. All patients had at least one surgical indication:
persistent bacteremia, severe valve dysfunction with heart failure, and/or
prevention of embolic phenomena with vegetations > 2cm. The mean duration
of follow-up was 17 months. Results The average age of patients (32 years)
and proportion of females (two thirds) was similar across groups (Table
1). The Charlson comorbidity index score and the proportion of patients
requiring non-invasive or mechanical ventilation were also similar. There
was no difference in 30-day mortality, overall mortality, or hospital
readmission for IE amongst the groups. Those in the valve replacement
group had a longer hospital stay and cost the hospital 2.5 times more than
the medical therapy group whereas the AngioVac group was twice as costly
as medical therapy. [Formula presented] Conclusion Procedural intervention
for TV IE is a costlier management option with no benefit on mortality or
readmission rates compared to medical therapy. Randomized controlled
trials are warranted to determine the most effective management option for
TV IE in IVDU patients. Copyright © 2021 American College of
Cardiology Foundation

<87>
Accession Number
2011744625
Title
MITRAL VALVE REPAIR WITH LEAFLET PRESERVATION VS. LEAFLET RESECTION AND
VENTRICULAR REMODELING - A SUB-ANALYSIS OF THE RANDOMIZED CAMRA STUDY -.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1748), 2021. Date of
Publication: 11 May 2021.
Author
Hibino M.; Leong-Poi H.; Verma S.; Mazine A.; Mazer C.D.; Ali F.; Quan A.;
Ruel M.; de Varennes B.; Gregory A.; Bouchard D.; Whitlock R.P.; Chu M.;
Mesana T.; Latter D.A.; Tsang W.; Chan V.; Connelly K.
Institution
(Hibino, Leong-Poi, Verma, Mazine, Mazer, Ali, Quan, Ruel, de Varennes,
Gregory, Bouchard, Whitlock, Chu, Mesana, Latter, Tsang, Chan, Connelly)
St Michael Hospital, Toronto, Canada
(Hibino, Leong-Poi, Verma, Mazine, Mazer, Ali, Quan, Ruel, de Varennes,
Gregory, Bouchard, Whitlock, Chu, Mesana, Latter, Tsang, Chan, Connelly)
University of Toronto, Toronto, Canada
Publisher
Elsevier Inc.
Abstract
Background In the Canadian Mitral Research Alliance Cardiolink-2 study, we
compared leaflet resection repair with preservation for mitral
regurgitation (MR). The primary outcomes were mean mitral gradient at peak
exercise 12-months following repair, for which there was no difference.
The purpose of this sub-analysis was to evaluate the impact of the two
strategies upon left ventricular reverse remodeling (LVRR) after repair.
Methods 104 patients were randomly assigned to resection and preservation
for posterior leaflet prolapse. Echocardiograms were performed at
baseline, pre discharge and at 12 months, and the analyses were blinded to
repair allocation. Results All patients underwent successful mitral
repair. Three persons (3%) demonstrated moderate MR at discharge, whilst
the remainder showed mild or less MR. End diastolic diameter/volume were
reduced at discharge (p<0.0001), which were further reduced at 12 months
(P<0.001). In contrast, end systolic diameter/volume was not improved at
discharge (p=0.32), but improved at 12 months (p<0.0001) (Table). Ejection
fraction decreased at discharge (p<0.0001), and increased by 12 months,
but not to baseline values (p<0.0001). The repair methods did not impact
LVRR. Conclusion Leaflet resection versus preservation did not influence
LVRR. End diastolic dimension improved during admission, whilst end
systolic dimension was improved only at 12 months. These findings have
implications for appropriate remodeling responses post mitral repair.
[Formula presented] Copyright © 2021 American College of
Cardiology Foundation

<88>
Accession Number
2011903771
Title
Cardiac rehabilitation outcome after transcatheter aortic valve
implantation.
Source
Monaldi Archives for Chest Disease. 91 (2) (no pagination), 2021. Article
Number: 1621. 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, Incorvaia, Mollo, Lietti, Gatto, Stefanelli, Centeleghe,
Talarico, Mori, Franzelli, Ratti, Ponticelli, Febo) Cardiac/Pulmonary
Rehabilitation, ASST Pini-CTO Hospital, Milan, Italy
(Ridolo) Allergy and Clinical Immunology, Medicine and Surgery Department,
University of Parma, Italy
Publisher
Page Press Publications
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. © Copyright: the Author(s), 2021

<89>
Accession Number
2011815556
Title
Low Tidal Volume Mechanical Ventilation Against No Ventilation During
Cardiopulmonary Bypass in Heart Surgery (MECANO): A Randomized Controlled
Trial.
Source
Chest. 159 (5) (pp 1843-1853), 2021. Date of Publication: May 2021.
Author
Nguyen L.S.; Estagnasie P.; Merzoug M.; Brusset A.; Law Koune J.-D.;
Aubert S.; Waldmann T.; Naudin C.; Grinda J.-M.; Gibert H.; Squara P.
Institution
(Nguyen, Estagnasie, Brusset, Squara) Critical Care Department, CMC
Ambroise Pare, Neuilly-sur-Seine, France
(Nguyen, Estagnasie, Merzoug, Brusset, Law Koune, Aubert, Waldmann,
Naudin, Grinda, Gibert, Squara) Research & Innovation Department, CMC
Ambroise Pare, Neuilly-sur-Seine, France
(Law Koune, Gibert) Anesthesiology Department, CMC Ambroise Pare,
Neuilly-sur-Seine, France
(Aubert, Waldmann, Grinda) Cardiothoracic Surgery Department, CMC Ambroise
Pare, Neuilly-sur-Seine, France
Publisher
Elsevier Inc.
Abstract
Background: Postoperative pulmonary complications are common after cardiac
surgery and have been related to lung collapse during cardiopulmonary
bypass (CPB). No consensus exists regarding the effects of maintaining
mechanical ventilation during CPB to decrease these complications.
Research Question: To determine whether maintaining low-tidal ventilation
(3 mL/kg 5 times/min, with positive end expiratory pressure of 5 cm
H<inf>2</inf>O) during CPB (ventilation strategy) was superior to a
resting-lung strategy with no ventilation (no ventilation strategy)
regarding postoperative pulmonary complications, including mortality.
Study Design and Methods: In a randomized controlled trial, patients
undergoing cardiac surgery at a single center from May 2017 through August
2019 were randomized to the ventilation or no ventilation strategy during
CPB (1:1 ratio). Apart from the CPB phase, perioperative ventilation
procedures were standardized. Result(s): The study included 1,501
patients (mean age, 68.8 +/- 10.3 years; 1,152 (76.7%) men; mean EuroSCORE
II, 2.3 +/- 2.7). Seven hundred fifty-six patients were in the ventilation
strategy group, and no differences existed in baseline characteristics and
types of procedures between the two groups. An intention-to-treat analysis
yielded no significant difference between the ventilation and no
ventilation groups regarding incidence of the primary composite outcome
combining death, early respiratory failure, ventilation support beyond day
2, and reintubation, with 112 of 756 patients (14.8%) in the ventilation
group vs 133 of 745 patients (17.9%) in the no ventilation group (OR,
0.80; 95% CI, 0.61-1.05; P =.11). Strict per-protocol analyses of 1,338
patients (89.1%) with equally distributed preoperative characteristics
yielded similar results (OR, 0.81; 95% CI, 0.60-1.09; P =.16). Post hoc
analysis of the subgroup who underwent isolated coronary artery bypass
graft procedures (n = 725) showed that the ventilation strategy was
superior to the no ventilation strategy regarding the primary outcome (OR,
0.56; 95% CI, 0.37-0.84; P =.005). Interpretation(s): Among patients
undergoing cardiac surgery with CPB, continuation of low tidal volume
ventilation was not superior to no ventilation during CPB with respect to
postoperative complications, including death, early respiratory failure,
ventilation support beyond day 2, and reintubation. Trial Registry:
ClinicalTrials.gov; No.: NCT03098524; URL:
www.clinicaltrials.gov Copyright © 2020 American College of Chest
Physicians

<90>
Accession Number
2011939840
Title
Design and rationale of the randomized trial of comprehensive lifestyle
modification, optimal pharmacological treatment and utilizing PET imaging
for quantifying and managing stable coronary artery disease (the CENTURY
study).
Source
American Heart Journal. 237 (pp 135-146), 2021. Date of Publication: July
2021.
Author
Kitkungvan D.; Johnson N.P.; Kirkeeide R.; Haynie M.; Carter C.; Patel
M.B.; Bui L.; Madjid M.; Mendoza P.; Roby A.E.; Hood S.; Zhu H.; Lai D.;
Sdringola S.; Gould K.L.
Institution
(Kitkungvan, Johnson, Patel, Bui, Madjid, Sdringola) Division of
Cardiology, McGovern Medical School, University of Texas, Houston, TX,
United States
(Kirkeeide, Haynie, Carter, Mendoza, Roby, Hood) Weatherhead PET Center,
McGovern Medical School, University of Texas, Houston, TX, United States
(Zhu, Lai) Department of Biostatistics and Data Science, School of Public
Health, University of Texas, Houston, TX, United States
(Gould) PET Center for Preventing and Reversing Atherosclerosis, McGovern
Medical School, University of Texas, Houston, TX, United States
Publisher
Mosby Inc.
Abstract
Background: The literature reports no randomized trial in chronic coronary
artery disease (CAD) of a comprehensive management strategy integrating
intense lifestyle management, maximal medical treatment to specific goals
and high precision quantitative cardiac positron emission tomography (PET)
for identifying high mortality risk patients needing essential invasive
procedures. We hypothesize that this comprehensive strategy achieves
greater risk factor reduction, lower major adverse cardiovascular events
and fewer invasive procedures than standard practice. Method(s): The
CENTURY Study (NCT00756379) is a randomized-controlled-trial study in
patients with stable or at high risk for CAD. Patients are randomized to
standard of care (Standard group) or intense comprehensive
lifestyle-medical treatment to targets and PET guided interventions
(Comprehensive group). Comprehensive Group patients are regularly
consulted by the CENTURY team implementing diet/lifestyle/exercise program
and medical treatment to target risk modification. Cardiac PET at
baseline, 24-, and 60-months quantify the physiologic severity of CAD and
guide interventions in the Comprehensive group while patients and
referring physicians of the Standard group are blinded to PET results. The
primary end-point is the CENTURY risk score reduction during 5 years
follow-up. The secondary endpoint is a composite of death, non-fatal
myocardial infarction, stroke, and coronary revascularization.
 Conclusion(s): The CENTURY Study is the first study in stable CAD to
test the incremental benefit of a comprehensive strategy integrating
intense lifestyle modification, medical treatment to specific goals, and
high-precision quantitative myocardial perfusion imaging to guide
revascularization. A total of 1028 patients have been randomized, and the
5 years follow-up will conclude in 2022. Copyright © 2021
Elsevier Inc.

<91>
Accession Number
2011907149
Title
Narrative review of the contemporary surgical treatment of unicuspid
aortic valve disease.
Source
Cardiovascular Diagnosis and Therapy. 11 (2) (pp 503-517), 2021. Date of
Publication: April 2021.
Author
von Stumm M.; Sequeira-Gross T.; Petersen J.; Naito S.; Muller L.; Sinning
C.; Girdauskas E.
Institution
(von Stumm, Sequeira-Gross, Petersen, Naito, Muller, Girdauskas)
Department of Cardiovascular Surgery, University Heart and Vascular
Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Sinning) Department of Cardiology, University Heart and Vascular Center,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Publisher
AME Publishing Company
Abstract
Unicuspid aortic valve disease (UAVD) is a frequent and long-lasting
challenge for adult congenital heart disease centers. UAVD patients become
usually symptomatic in their twenties or thirties and require a surgical
treatment plan which should respect their complete lifespan combined with
an adequate quality of life. Unfortunately, all current surgical
strategies of congenital aortic valve disease bear some important
limitations: (I) Aortic valve replacement using bioprosthetic valves is
associated with early structural degeneration and leads frequently to
re-operations. (II) Mechanical valves are commonly associated with
lifelong risk of severe bleeding due to oral anticoagulation. (III) Using
a pulmonary autograft (i.e., Ross procedure) for aortic valve replacement
is associated with excellent long-term results in non-elderly patients.
However, failure of pulmonary autograft or pulmonary homograft may require
re-operations. (IV) Aortic valve repair or Ozaki procedure is only
performed in a few heart centers worldwide and is associated with a
limited reproducibility and early patch degeneration, suture dehiscence or
increased risk of endocarditis. In contrast to degenerative tricuspid
aortic valve disease, UAVD remains relatively understudied and reports on
UAVD treatment are rare and usually limited to retrospective single-center
observations. For this review, we searched PubMed for papers in the
English language by using the search words unicuspid aortic valve,
congenital aortic valve, Ross procedure, Ozaki procedure, aortic valve
repair, mechanical/bioprosthetic aortic replacement, homograft. We read
the abstracts of relevant titles to confirm their relevance, and the full
papers were then extracted. References from extracted papers were checked
for additional relevant reports. This review summarizes current surgical
treatment strategies for UAVD including aortic valve replacement using
bioprosthetic or mechanical valves, homografts, pulmonary autografts
(i.e., Ross procedure) and aortic valve repair techniques for UAV.
Furthermore, Ozaki procedure will be discussed. Copyright ©
Cardiovascular Diagnosis and Therapy. All rights reserved.

<92>
Accession Number
2011902131
Title
Comparing the rate of fiberoptic bronchoscopy use with a video double
lumen tube versus a conventional double lumen tube - A randomized
controlled trial.
Source
Journal of Thoracic Disease. 12 (11) (pp 6533-6541), 2020. Date of
Publication: November 2020.
Author
Onifade A.; Lemon-Riggs D.; Smith A.; Pak T.; Pruszynski J.; Reznik S.;
Moon T.S.
Institution
(Onifade, Lemon-Riggs, Smith, Pak, Moon) Department of Anesthesia and Pain
Management, University of Texas, Southwestern Medical Center, 5323 Harry
Hines Boulevard, Dallas, TX 75390-9068, United States
(Pruszynski, Reznik) Department of Cardiothoracic Surgery, University of
Texas, Southwestern Medical Center, Dallas, TX, United States
Publisher
AME Publishing Company
Abstract
Background: Double lumen endotracheal tubes (DLT) are commonly used to
provide single lung ventilation during thoracic surgery. A fiberoptic
bronchoscope (FOB) is typically used to confirm accurate DLT placement.
Accounting for initial purchase, maintenance, repair and cleaning, the use
of an FOB can cost as much as $312 per procedure. The VivaSight DLT
(VS-DLT) incorporates a built-in camera, which is aimed at reducing FOB
use and its associated costs. In this study, we compared the rate of FOB
use when intubating using either a VS-DLT or a conventional DLT (c-DLT).
 Method(s): This is a randomized controlled comparative study
performed at a public county teaching hospital. A total of 50 patients
were enrolled and randomly assigned to either a c-DLT (n=25) or a VS-DLT
(n=25). The primary outcome was the rate of FOB use. Secondary outcomes
included time to correct tube placement and incidence of malposition
during surgery. Result(s): Use of the VS-DLT required significantly
less FOB use (28%) compared to use of the c-DLT (100%). While there was no
difference in the ease of intubation, the time to correct tube placement
was significantly faster using a VS-DLT (54 vs. 156 s, P0.001).
Additionally, the incidence of tube malposition was significantly reduced
in the VS-DLT group. Conclusion(s): This study demonstrated a
significantly lower rate of FOB use when using a VS-DLT compared to a
c-DLT. Placement of the VS-DLT was significantly quicker and malposition
during surgery occurred significantly less than with the c-DLT. While
intubating with a VS-DLT provides clinical benefits, it may not result in
significant cost reductions when compared to a c-DLT. Copyright ©
2020 Journal of Thoracic Disease. All rights reserved.

<93>
Accession Number
2011934044
Title
Impact of Different Annuloplasty Methods for Tricuspid Regurgitation: A
Network Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Although moderate to severe tricuspid valve regurgitation (TR)
is an independent risk factor for progressive heart failure and increased
mortality, the best method for tricuspid valve repair remains
controversial. Therefore, this study conducted a network meta-analysis to
compare early and late outcomes for suture, flexible band, and rigid ring
as tricuspid annuloplasty (TAP) in patients with TR. Method(s):
Medline and EMBASE were searched through February 15, 2020 to identify
randomized controlled trials and observational trials that investigated
early and late outcomes after TAP for TR. The outcomes of interest were
perioperative mortality, all-cause mortality, and TR recurrence with more
than 1-year follow-up. TR recurrence was defined as at least moderate (TR
grade 2) on serial echocardiograms. Result(s): Two randomized
controlled trials and 15 observational trials were identified, including
6138 patients who underwent TAP. The median follow-up period was 1 to 7.4
years. There were no significant differences of perioperative and
all-cause mortality among 3 TAP methods. Rigid ring TAP was associated
with a significant reduction in TR recurrence compared with suture TAP
(hazard ratio, 0.42; 95% confidence interval, 0.23 to 0.78; P =.005).
There were no significant differences in TR recurrence were observed
between flexible band and suture TAP or flexible band and rigid ring TAP.
 Conclusion(s): This network meta-analysis demonstrated significant
reduction in TR recurrence for rigid ring TAP compared with suture TAP,
although no significant differences were observed between suture and
flexible band TAP or between flexible band and rigid ring TAP. There were
no significant mortality differences among suture, flexible band, and
rigid ring TAP procedures. Copyright © 2021

<94>
Accession Number
2011320305
Title
A device category economic model of electrosurgery technologies across
procedure types: a U.S. hospital budget impact analysis.
Source
Journal of Medical Economics. 24 (1) (pp 524-535), 2021. Date of
Publication: 2021.
Author
Ferko N.; Wright G.W.J.; Syed I.; Naoumtchik E.; Tommaselli G.A.; Gangoli
G.
Institution
(Ferko, Wright, Syed) EVERSANA, Burlington, Canada
(Naoumtchik, Tommaselli, Gangoli) Johnson & Johnson Medical Devices
Companies, Cincinnati, OH, United States
Publisher
Taylor and Francis Ltd.
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. Copyright ©
2021 The Author(s). Published by Informa UK Limited, trading as Taylor &
Francis Group.

<95>
Accession Number
2005604918
Title
Safety and efficacy of minimum-or zero-contrast ivus-guided percutaneous
coronary interventions in chronic kidney disease patients: A systematic
review.
Source
Journal of Clinical Medicine. 10 (9) (no pagination), 2021. Article
Number: 1996. Date of Publication: 01 May 2021.
Author
Burlacu A.; Tinica G.; Brinza C.; Crisan-Dabija R.; Popa I.V.; Covic A.
Institution
(Burlacu, Tinica, Brinza) Institute of Cardiovascular Diseases "Prof. Dr.
George I.M. Georgescu", Iasi 700503, Romania
(Burlacu, Tinica, Crisan-Dabija, Popa, Covic) Faculty of Medicine,
University of Medicine and Pharmacy "Grigore T Popa", Iasi 700115, Romania
(Burlacu, Covic) Medical Sciences Academy, Bucharest 030167, Romania
(Crisan-Dabija) Pulmonology Department, Clinic of Pulmonary Diseases, Iasi
700115, Romania
(Covic) Nephrology Clinic, Dialysis, Renal Transplant Center, C.I. Parhon"
University Hospital, Iasi 700503, Romania
Publisher
MDPI AG
Abstract
Conventional percutaneous coronary interventions (PCIs) frequently cause
severe complications in chronic kidney disease (CKD) patients. Low-to-zero
contrast intravascular ultrasound (IVUS) guided PCIs are promising
alternatives in the CKD setting. We aim to systematically review
up-to-date literature that have reported data and outcomes of low-to-zero
contrast PCIs performed in CKD patients. We searched Embase, PubMed, and
Cochrane databases for full-text articles that reported original data
regarding efficacy and/or safety outcomes of IVUSguided PCIs in patients
with CKD. The quality of non-randomized trials included was assessed using
the Newcastle-Ottawa scale. Six papers were included in the present
systematic review: One non-randomized trial, two case series, and three
case reports. Given the literature reported so far, contrast-free and
IVUS-guided PCI procedures in patients with CKD appear to be safe (both in
cardiac and renal outcomes) with a comparable efficacy to the conventional
procedure, even in complex atherosclerotic lesions. No patient included in
the mentioned studies showed renal function deterioration and did not need
renal replacement therapy after the zero-contrast IVUSguided percutaneous
procedures. From a cardiovascular point of view, this technique proved to
be safe in terms of cardiovascular outcomes. The undesirable consequences
of conventional PCI in the CKD population might soon be effectively
hampered by safer low-to-zero contrast IVUS-guided PCI procedures after a
mandatory and rigorous evidence-based validation in long-awaited
randomized controlled trials. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<96>
Accession Number
634943207
Title
Safety and Efficacy of Different Antithrombotic Strategies After
Transcatheter Aortic Valve Implantation: A Network Meta-Analysis.
Source
Thrombosis and haemostasis. (no pagination), 2021. Date of Publication: 30
Apr 2021.
Author
Navarese E.P.; Grisafi L.; Spinoni E.; Mennuni M.G.; Rognoni A.; Ratajczak
J.; Podhajski P.; Koni E.; Kubica J.; Patti G.
Institution
(Navarese, Kubica) Collegium Medicum, Nicolaus Copernicus University in
Torun Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
(Grisafi) University of Eastern Piedmont Amedeo Avogadro School of
Medicine, Novara, Italy
(Grisafi, Spinoni, Patti) Dipartimento Toraco-Cardio-Vascolare, Hospital
Maggiore della Carita, Novara, Italy
(Spinoni) University of Eastern Piedmont Amedeo Avogadro School of
Medicine, Novara, Italy
(Mennuni, Rognoni) Gastroenterology, Azienda Ospedaliero-Universitaria
Maggiore della Carita, Novara, Italy
(Ratajczak) Department of Health Promotion, Nicolaus Copernicus University
in Torun Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
(Ratajczak, Podhajski) Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum
in Bydgoszcz, Bydgoszcz, Poland
(Koni) Department of Interventional Cardiology, Hospital Santa Corona
Pietra Ligure, Pietra Ligure, Italy
(Patti) Chair of Cardiology, University of Eastern Piedmont Amedeo
Avogadro School of Medicine, Novara, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal pharmacological therapy after transcatheter aortic
valve implantation (TAVI) remains uncertain. We compared efficacy and
safety of various antiplatelet and anticoagulant approaches after TAVI by
a network meta-analysis. METHOD(S): A total of 14 studies (both
observational and randomized) were considered, with 24,119 patients
included. Primary safety endpoint was the incidence of any bleeding
complications during follow-up. Secondary safety endpoint was major
bleeding. Efficacy endpoints were stroke, myocardial infarction and
cardiovascular mortality. A frequentist network meta-analysis was
conducted with a random-effects model. The following strategies were
compared: dual antiplatelet therapy (DAPT), single antiplatelet therapy
(SAPT), oral anticoagulation (OAC), OAC+SAPT. Mean follow-up was 15
months. RESULT(S): In comparison to DAPT, SAPT was associated with a
44% risk reduction of any bleeding (OR, 0.56 [95% CI, 0.39-0.80]). SAPT
was ranked as the safest strategy for the prevention of any bleeding
(P-score, 0.704), followed by OAC alone (P-score, 0.476) and DAPT
(P-score, 0.437). Consistent results were observed for major bleeding. The
incidence of cardiovascular death and secondary ischemic endpoints did not
differ among the tested antithrombotic approaches. In patients with
indication for long-term anticoagulation, OAC alone showed similar rates
of stroke (OR 0.92 [95% CI 0.41-2.05], p=0.83) and reduced occurrence of
any bleeding (OR 0.49 [95% CI 0.37-0.66], p<0.01) vs OAC+SAPT.
 CONCLUSION(S): The present network meta-analysis supports after TAVI
the use of SAPT in patients without indication for OAC and OAC alone in
those needing long-term anticoagulation. Copyright Thieme. All rights
reserved.

<97>
Accession Number
634942815
Title
10-year results of mitral repair and coronary bypass for ischemic
regurgitation: a randomized trial.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 27 Apr 2021.
Author
Fattouch K.; Dioguardi P.; Guccione F.; Nogara A.; Salardino M.;
Sampognaro R.; Bacarella D.; Moscarelli M.
Institution
(Fattouch, Moscarelli) GVM Care&Research, Dept of Cardiovascular Surgery,
Maria Eleonora Hospital, Palermo (PA), Italy; GVM Care&Research, Maria
Cecilia Hospital, Cotignola (RA), Italy
(Dioguardi, Guccione, Nogara, Salardino, Sampognaro, Bacarella) Dept of
Cardiovascular Surgery, Maria Eleonora Hospital, Palermo (PA), Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The decision to treat moderate ischemic mitral regurgitation
(IMR) at the time of coronary artery bypass surgery (CABG) remains
controversial. We previously conducted a prospective randomized trial that
showed a benefit of adding restricted annuloplasty to bypass surgery
(CABG-Ring group) in terms of ischemic mitral regurgitation (IMR) grade,
NYHA classification, and left ventricle reverse remodeling. Here, we
present the long-term (>10 years) follow-up data from this randomized
trial. METHOD(S): The original trial arms accounted for 54 patients
in the CABG-alone and 48 in the CABG-Ring group; patients were
re-contacted for follow-up to obtain relevant clinical and
echocardiographic information. RESULT(S): The mean follow-up was
160.4+/-45.5 months. Survival probabilities in the CABG-alone and
CABG-Ring groups were 96% vs. 93% at 3 years, 85% vs. 89% at 6 years, 79%
vs. 85% at 9 years, 77% vs. 83% at 12 years, and 72% vs. 80% at 15 years,
respectively (p=0.18) Freedom from at least moderate IMR or
re-intervention at last follow-up was also higher in the CABG-Ring group
(p<0.001). Compared to the CABG-alone group, the CABG-Ring group had a
higher degree of left ventricular reverse remodeling (54.7+/-6.9 mm vs.
51.6+/-6 mm, respectively; p=0.03), lower NYHA class (p<0.001), and a
lower rate of re-hospitalization (p=0.002). CONCLUSION(S): Long-term
follow-up data from our randomized trial further support the utility of
performing restricted annuloplasty at the time of CABG to prevent further
progression of IMR, mitral re-intervention, and left ventricle remodeling.
Untreated IMR was associated with significantly higher NYHA class and
re-hospitalization. Copyright © 2021. Published by Elsevier Inc.

<98>
Accession Number
634929808
Title
Antifibrinolytics reduces blood loss in thoracic surgery: a systematic
review and meta-analysis.
Source
ANZ journal of surgery. (no pagination), 2021. Date of Publication: 29 Apr
2021.
Author
Leow L.; Ng J.; Luo H.D.; Choong A.M.T.L.; Mithiran H.; Kofidis T.; Tam
J.K.C.
Institution
(Leow, Luo, Choong, Mithiran, Kofidis, Tam) Department of Cardiac,
Thoracic and Vascular Surgery, National University Heart Centre Singapore,
National University Hospital Singapore, Singapore
(Ng) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong, Tam) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose of this systematic review is to evaluate the
efficacy of antifibrinolytics in non-cardiac thoracic surgery.
 METHOD(S): We searched for all randomized controlled trials on this
topic. A set of strict inclusion and exclusion criteria was developed. Six
studies were meta-analysed together then in subgroups of topical
tranexamic acid and intravenous aprotinin. We compared postoperative chest
drain output, transfusions requirements and duration of hospital stay
where available to determine the efficacy of topical tranexamic acid or
intravenous aprotinin in reducing blood loss. RESULT(S): The use of
antifibrinolytics reduces 24-h chest drain output (-290.21mL [-524.75,
-55.66], P =0.02, I2 =98%), red blood cell transfusion requirements
(-1.27units [-2.24, -0.30], P =0.01, I2 =100%) and shortened duration of
hospital stay (-1.81days [-3.25, -0.36], P =0.01, I2 =96%). The subgroup
analysis also supported this trend. CONCLUSION(S): We conclude that
the use of antifibrinolytics appears to reduce postoperative blood loss by
reducing chest drain output, transfusion requirements and length of stay
after thoracic surgery. Copyright © 2021 Royal Australasian
College of Surgeons.

<99>
Accession Number
634922717
Title
Reassessing the July Effect: 30 Years of Evidence Show No Difference in
Outcomes.
Source
Annals of surgery. (no pagination), 2021. Date of Publication: 25 Feb
2021.
Author
Zogg C.K.; Metcalfe D.; Sokas C.M.; Dalton M.K.; Hirji S.A.; Davis K.A.;
Haider A.H.; Cooper Z.; Lichtman J.H.
Institution
(Zogg) *Yale School of Medicine, New Haven, CT +Center for Surgery and
Public Health: Department of Surgery, Brigham and Women's Hospital,
Harvard Medical School, and Harvard T.H. Chan School of Public Health,
Boston, MA ++Yale School of Public Health, New Haven, CT Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences,
University of Oxford, Oxford, United Kingdom PThe Aga Khan University
Medical College, Karachi, Pakistan
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To critically evaluate whether admission at the
beginning-versus-end of the academic year is associated with increased
risk of major adverse outcomes. SUMMARY BACKGROUND DATA: The hypothesis
that the arrival of new residents and fellows is associated with increases
in adverse patient outcomes has been the subject of numerous research
studies since 1989. METHOD(S): We conducted a systematic review and
random-effects meta-analysis of July Effect studies published prior to
December 20, 2019, for differences in mortality, major morbidity, and
readmission. Given a paucity of studies reporting readmission, we further
analyzed 7 years of data from the Nationwide Readmissions Database to
assess for differences in 30-day readmission for US patients admitted to
urban teaching-versus-non-teaching hospitals with 3 common medical (acute
myocardial infarction, acute ischemic stroke, and pneumonia) and 4
surgical (elective coronary artery bypass graft surgery, elective
colectomy, craniotomy, and hip fracture) conditions using risk-adjusted
logistic difference-in-difference regression. RESULT(S): A total of
113 studies met inclusion criteria; 92 (81.4%) reported no evidence of a
July Effect. Among the remaining studies, results were mixed and commonly
pointed toward system-level discrepancies in efficiency. Meta-analyses of
mortality (OR[95%CI]: 1.01[0.98-1.05]) and major morbidity
(1.01[0.99-1.04]) demonstrated no evidence of a July Effect, no
differences between specialties or countries, and no change in the effect
over time. A total of 5.98 million patient encounters were assessed for
readmission. No evidence of a July Effect on readmission was found for any
of the 7 conditions. CONCLUSION(S): The preponderance of negative
results over the past 30 years suggests that it may be time to reconsider
the need for similarly-themed studies and instead focus on system-level
factors to improve hospital efficiency and optimize patient outcomes.

<100>
Accession Number
2007807162
Title
Comparison of Hemodynamic Responses to Administration of Vasopressin and
Norepinephrine Under General Anesthesia: A Systematic Review and
Meta-analysis of Randomized Controlled Trials with Trial Sequential
Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (1) (pp 61-69),
2021. Date of Publication: January 2021.
Author
Hoshijima H.; Mihara T.; Denawa Y.; Shiga T.; Mizuta K.
Institution
(Hoshijima, Mizuta) Division of Dento-Oral Anesthesiology, Tohoku
University Graduate School of Dentistry, Miyagi, Japan
(Mihara) Department of Anesthesiology and Critical Care Medicine, Yokohama
City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
(Denawa) Department of Anesthesiology, Perioperative and Pain Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Shiga) Department of Anesthesiology and Intensive Care Medicine,
International University of Health and Welfare, School of Medicine, Chiba,
Japan
Publisher
W.B. Saunders
Abstract
Objective: The authors performed a meta-analysis to determine if
vasopressin improves hypotension more than norepinephrine under general
anesthesia. Design(s): Meta-analysis. Setting(s): Operating
room. Patient(s): Patients who underwent surgery, with general
anesthesia. Intervention(s): Administration of vasopressin or
norepinephrine in order to increase blood pressure. Measurements and
Main Results: The primary outcome of this study was to determine if
vasopressin increased mean blood pressure more effectively compared with
norepinephrine for patients under general anesthesia. The secondary
outcome was to see if vasopressin increased heart rate (HR), central
venous pressure (CVP), cardiac output (CO), and cardiac index (CI) more
significantly compared with norepinephrine under general anesthesia. The
authors calculated the weighted mean difference, with 95% confidence
interval (CI) using the random-effects model, and calculated the required
information size (RIS) by performing trial sequential analysis (TSA). The
authors selected 6 studies for analysis. Vasopressin did not improve
hypotension compared with norepinephrine under general anesthesia.
(weighted mean difference = -0.84 mmHg, 95% CI: -5.90 to 4.23, p = 0.75,
Cochran Q = 24.6, I2 = 84%) In TSA, only 35.5% of RIS was
achieved. Similarly, vasopressin and norepinephrine were not significantly
different in terms of HR, CVP, CO, and CI. In TSA, only 23.7% of the RIS
was reached for HR but RIS was almost achieved for CVP and CO.
 Conclusion(s): Vasopressin did not improve hypotension compared with
norepinephrine under general anesthesia. The RIS was not reached in TSA,
and Grading of Recommendations Assessment, Development and Evaluation is
very low. Therefore, further research is needed to reach more robust
conclusions. Copyright © 2020 Elsevier Inc.

<101>
Accession Number
2007636617
Title
Treatment With Angiotensin II Is Associated With Rapid Blood Pressure
Response and Vasopressor Sparing in Patients With Vasoplegia After Cardiac
Surgery: A Post-Hoc Analysis of Angiotensin II for the Treatment of
High-Output Shock (ATHOS-3) Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (1) (pp 51-58),
2021. Date of Publication: January 2021.
Author
Klijian A.; Khanna A.K.; Reddy V.S.; Friedman B.; Ortoleva J.; Evans A.S.;
Panwar R.; Kroll S.; Greenfeld C.R.; Chatterjee S.
Institution
(Klijian) Department of Cardiothoracic Surgery, Sharp and Scripps
Healthcare, San Diego, CA, United States
(Khanna) Department of Anesthesiology, Section on Critical Care Medicine,
Wake Forest School of Medicine, Wake Forest Baptist Medical Center,
Winston-Salem, NC, United States
(Reddy) TriStar Cardiovascular Surgery, Nashville, TN, United States
(Friedman) JM Still Burn Center, Doctor's Hospital, Augusta, GA, United
States
(Ortoleva) Department of Anesthesiology and Perioperative Medicine, Tufts
Medical Center, Boston, MA, United States
(Evans) ASE Consulting, LLC, Tenafly, NJ, United States
(Panwar) John Hunter Hospital, Newcastle, Australia
(Panwar) School of Medicine and Public Health, University of Newcastle,
Newcastle, Australia
(Kroll, Greenfeld) La Jolla Pharmaceutical Company, San Diego, CA, United
States
(Chatterjee) Divisions of General and Cardiothoracic Surgery, Michael E.
DeBakey Department of Surgery, Baylor College of Medicine, Department of
Cardiovascular Surgery, Texas Heart Institute, Houston, TX, United States
(Khanna) Outcomes Research Consortium, Texas Heart Institute, Cleveland,
OH, United States
Publisher
W.B. Saunders
Abstract
Objective: The present study investigated outcomes in patients with
vasoplegia after cardiac surgery treated with angiotensin II plus
standard-of-care vasopressors. Vasoplegia is a common complication in
cardiac surgery with cardiopulmonary bypass and is associated with
significant morbidity and mortality. Approximately 250,000 cardiac
surgeries with cardiopulmonary bypass are performed in the United States
annually, with vasoplegia occurring in 20%to-27% of patients.
 Design(s): Post-hoc analysis of the Angiotensin II for the Treatment
of High-Output Shock (ATHOS-3) study. Setting(s): Multicenter,
multinational study. Participant(s): Sixteen patients with vasoplegia
after cardiac surgery with cardiopulmonary bypass were enrolled.
 Intervention(s): Angiotensin II plus standard-of-care vasopressors (n
= 9) compared with placebo plus standard-of-care vasopressors (n = 7).
 Measurements and Main Results: The primary endpoint was mean arterial
pressure response (mean arterial pressure >=75 mmHg or an increase from
baseline of >=10 mmHg at hour 3 without an increase in the dose of
standard-of-care vasopressors). Vasopressor sparing and safety also were
assessed. Mean arterial pressure response was achieved in 8 (88.9%)
patients in the angiotensin II group compared with 0 (0%) patients in the
placebo group (p = 0.0021). At hour 12, the median standard-of-care
vasopressor dose had decreased from baseline by 76.5% in the angiotensin
II group compared with an increase of 7.8% in the placebo group (p =
0.0013). No venous or arterial thrombotic events were reported.
 Conclusion(s): Patients with vasoplegia after cardiac surgery with
cardiopulmonary bypass rapidly responded to angiotensin II, permitting
significant vasopressor sparing. Copyright © 2020 The Authors

<102>
Accession Number
2007593692
Title
Pectointercostal Fascial Block (PIFB) as a Novel Technique for
Postoperative Pain Management in Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (1) (pp 116-122),
2021. Date of Publication: January 2021.
Author
Kumar A.K.; Chauhan S.; Bhoi D.; Kaushal B.
Institution
(Kumar, Chauhan, Kaushal) Department of Cardiac Anesthesiology, CN Center,
All India Institute of Medical Sciences, New Delhi, India
(Bhoi) Department of Anesthesiology, Pain Medicine and Critical Care, All
India Institute of Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To determine the efficacy of pectointercostal fascial block in
relieving postoperative pain in patients undergoing cardiac surgery.
 Design(s): Single-blinded, prospective, randomized controlled trial.
 Setting(s): Single-center tertiary care teaching hospital.
 Participant(s): A total 40 participants undergoing cardiac surgery
aged 18 to 80 years. Intervention(s): Subjects were categorized into
2 groups of 20 each. In group 2 participants (interventional group),
bilateral pectointercostal fascial block was given using ropivacaine
injection 0.25% after completion of surgery, before shifting to the
intensive care unit. Measurements and Main Results: Postoperative
pain was measured after extubation at 0, 3, 6, and 12 hours, using a
numeric rating scale. Pain in group 2 was significantly less and lasted
for a longer duration than in group 1. Fentanyl requirement was
significantly higher in group 1 (1.06 +/- 0.12 micro/kg) than in group 2
(0.82 +/- 0.19 micro/kg). Conclusion(s): Pectointercostal fascial
block is an easy and efficient technique to reduce postoperative pain
after cardiac surgery. Copyright © 2020 Elsevier Inc.

<103>
Accession Number
2010210726
Title
Effect of family presence on stress response after bypass surgery.
Source
Heart and Lung. 50 (2) (pp 193-201), 2021. Date of Publication: 01 Mar
2021.
Author
Koyuncu A.; Yava A.; Yamak B.; Orhan N.
Institution
(Koyuncu, Yava) Nursing Department, Hasan Kalyoncu University, Faculty of
HealthSciences, Gaziantep, Turkey
(Yamak, Orhan) Gaziantep Medikal Park Hospital, Gaziantep, Turkey
Publisher
Mosby Inc.
Abstract
Background: Coronary artery bypass grafting (CABG) is a major surgery that
may cause severe surgical stress response (SR). Although the presence of
family members in intensive care unit (ICU) is known to benefit intensive
care patients socially and emotionally, its effects on surgical SR are
unknown. Objective(s): To investigate the effect of an informed
family member (IFM)'s presence in the awakening process in ICU on
patients' SR after CABG. Method(s): A nonrandomized controlled
clinical study was completed with a total of 73 patients: 37 patients in
the control (CG) and 36 in the intervention group (IG) underwent CABG
surgery. In the CG patients, no family members were taken into the ICU
during the awakening process and routine care and treatment practices were
continued. In the IG patients, besides routine care and treatment
practices, an IFM was taken into the ICU during the awakening process in
accordance with the research method. Groups were statistically compared in
terms of serum cortisol level which is the one of the main indicators of
surgical SR, state anxiety, sedative drug requirements, and duration of
intubation, sedation, and ICU stay. A p value <0.05 was accepted as
statistically significant. Result(s): Presence of an IFM in the ICU
was found to be effective in decreasing serum cortisol level, state
anxiety, sedative drug requirements, and the duration of intubation,
sedation, and ICU stay (p<0.05). Conclusion(s): In CABG, the presence
of IFM in ICU is effective in reducing SR. Copyright © 2020

<104>
Accession Number
633417269
Title
Efficacy and safety of regenerated cellulose topical gauze haemostats in
managing secondary haemostasis: A randomised control trial.
Source
Journal of Wound Care. 29 (11) (pp 670-677), 2020. Date of Publication: 02
Nov 2020.
Author
Develle R.; Schaerf R.; Najibi S.; Conrad J.; Abate G.
Institution
(Develle, Abate) United Health Products, Henderson, NV, United States
(Schaerf, Najibi, Conrad) Department of Surgery, Providence St. Joseph
Medical Center, Burbank, CA, United States
Publisher
MA Healthcare Ltd

<105>
Accession Number
2005955195
Title
Closed-incision negative-pressure wound management in surgery-literature
review and recommendations.
Source
European Surgery - Acta Chirurgica Austriaca. 52 (6) (pp 249-267), 2020.
Date of Publication: December 2020.
Author
Smolle M.A.; Nischwitz S.P.; Hutan M.; Trunk P.; Lumenta D.; Bernhardt
G.A.
Institution
(Smolle, Bernhardt) Department of Orthopaedics and Trauma, Medical
University of Graz, Auenbruggerplatz 5, Graz 8036, Austria
(Nischwitz, Lumenta) Division of Plastic, Aesthetic and Reconstructive
Surgery, Medical University of Graz, Graz, Austria
(Hutan) Department of Surgery, Landesklinikum Hainburg, Hainburg/Donau,
Austria
(Trunk) Department of Cardiovascular Surgery, Ljubljana University Medical
Centre, Ljubljana, Slovenia
(Nischwitz) COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM
RESEARCH Forschungsgesellschaft mbH, Graz, Austria
Publisher
Springer
Abstract
Background: Wound healing deficits and subsequent surgical site infections
are potential complications after surgical procedures, resulting in
increased morbidity and treatment costs. Closed-incision negative-pressure
wound therapy (ciNPWT) systems seem to reduce postoperative wound
complications by sealing the wound and reducing tensile forces.
 Material(s) and Method(s): We conducted a collaborative English
literature review in the PubMed database including publications from 2009
to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and
trauma, general surgery, plastic surgery, cardiac surgery and vascular
surgery). With literature reviews, case reports and expert opinions
excluded, the remaining 59 studies were critically summarized and
evaluated with regard to their level of evidence. Result(s): Of nine
studies analysed in orthopaedics and trauma, positive results of ciNPWT
were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10
(100%) of studies analysed in plastic, vascular and general surgery,
respectively, a positive effect of ciNPWT was observed. On the contrary,
only 4 of 12 studies from cardiac surgery discovered positive effects of
ciNPWT (33.3%). Conclusion(s): ciNPWT is a promising treatment
modality to improve postoperative wound healing, notably when facing
increased tensile forces. To optimise ciNPWT benefits, indications for its
use should be based on patient- and procedure-related risk
factors. Copyright © 2020, The Author(s).

<106>
Accession Number
2011740748
Title
The Use of Radial Artery for CABG: An Update.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
5528006. Date of Publication: 2021.
Author
Nappi F.; Bellomo F.; Nappi P.; Chello C.; Iervolino A.; Chello M.; Acar
C.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Bellomo, Nappi) Department of Clinical and Experimental Medicine,
University of Messina, Italy
(Chello) Regenerative Medicine, Universita Campus Bio-Medico di Roma, Rome
00128, Italy
(Iervolino) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCSS, Italy
(Chello) Cardiovascular Surgery, Universita Campus Bio-Medico di Roma,
Rome 00128, Italy
(Acar) Department of Cardiac Surgery, La Pitie Salpetriere Hospital,
Paris, France
Publisher
Hindawi Limited
Abstract
We used the radial artery as a second target conduit for coronary artery
bypass grafting since 1971. However, randomized clinical studies have
demonstrated differences in clinical outcomes between the radial artery
and other grafts because these trials are underpowered. As we proceed
toward 50 years of experience with radial artery grafting, we examined the
literature to define the best second-best target vessel for coronary
artery bypass grafting. The literature was reviewed with emphasis, and a
large number of randomized controlled trials, propensity-matched
observational series, and meta-analyses were identified with a large
patient population who received arterial conduit and saphenous vein
grafts. The radial artery has been shown to be effective and safe when
used as a second target conduit for coronary artery bypass grafting.
Results and patency rates were superior to those for saphenous vein
grafting. It has also been shown that the radial artery is a safe and
effective graft as a third conduit into the territory of the artery right
coronary artery. However, there is little evidence based on a few
comparable series limiting the use of the gastroepiploic artery. In its
fifth decade of use, we can finally deduced that the aorto-to-coronary
radial bypass graft is the conduit of choice for coronary operations after
the left internal thoracic artery to the left anterior descending artery.
 Copyright © 2021 Francesco Nappi et al.

<107>
Accession Number
2011731500
Title
Impact of Anesthesia Strategy and Valve Type on Clinical Outcomes After
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 77 (17) (pp 2204-2215),
2021. Date of Publication: 04 May 2021.
Author
Feistritzer H.-J.; Kurz T.; Stachel G.; Hartung P.; Lurz P.; Eitel I.;
Marquetand C.; Nef H.; Doerr O.; Vigelius-Rauch U.; Lauten A.; Landmesser
U.; Treskatsch S.; Abdel-Wahab M.; Sandri M.; Holzhey D.; Borger M.; Ender
J.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.; Wienbergen H.; Fach
A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Funkat A.-K.;
Berggreen A.E.; Heringlake M.; Desch S.; de Waha-Thiele S.; Thiele H.
Institution
(Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri, Holzhey,
Borger, Ender, Desch, Thiele) Heart Center Leipzig at University of
Leipzig, Leipzig, Germany
(Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri, Holzhey,
Borger, Ender, Funkat, Desch, Thiele) Leipzig Heart Institute, Leipzig,
Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, Berggreen, Heringlake, de
Waha-Thiele) University Clinic Schleswig-Holstein and University Heart
Center Lubeck, Lubeck, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Konig, Desch,
de Waha-Thiele) German Center for Cardiovascular Research (DZHK), Lubeck,
Germany
(Nef, Doerr, Vigelius-Rauch) Medizinische Klinik I, Abteilung fur
Kardiologie, Universitatsklinikum Marburg/Giesen, Giesen, Germany
(Lauten, Landmesser, Treskatsch) Universitatsklinikum Charite, Campus
Benjamin Franklin, Berlin, Germany
(Ince, Oner) Medizinische Klinik I im Zentrum fur Innere Medizin,
Universitatsklinikum Rostock, Rostock, Germany
(Hambrecht, Wienbergen, Fach, Augenstein) Klinikum Links der Weser,
Herzzentrum Bremen, Bremen, Germany
(Frey) Department of Cardiology, Angiology and Pulmology, University
Hospital Heidelberg, Heidelberg, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
University of Lubeck, Lubeck, Germany
(Vonthein) Institut fur Statistik, Ludwig-Maximilians-Universitat Munchen,
Munich, Germany
Publisher
Elsevier Inc.
Abstract
Background: The randomized SOLVE-TAVI (compariSon of secOnd-generation
seLf-expandable vs. balloon-expandable Valves and gEneral vs. local
anesthesia in Transcatheter Aortic Valve Implantation) trial compared
newer-generation self-expanding valves (SEV) and balloon-expandable valves
(BEV) as well as local anesthesia with conscious sedation (CS) and general
anesthesia (GA) in patients undergoing transfemoral transcatheter aortic
valve replacement (TAVR). Both strategies showed similar outcomes at 30
days. Objective(s): The purpose of this study was to compare clinical
outcomes during 1-year follow-up in the randomized SOLVE-TAVI trial.
 Method(s): Using a 2 x 2 factorial design 447 intermediate- to
high-risk patients with severe, symptomatic aortic stenosis were randomly
assigned to transfemoral TAVR using either the SEV (Evolut R, Medtronic
Inc., Minneapolis, Minnesota) or the BEV (Sapien 3, Edwards Lifesciences,
Irvine, California) as well as CS or GA at 7 sites. Result(s): In the
valve-comparison strategy, rates of the combined endpoint of all-cause
mortality, stroke, moderate or severe paravalvular leakage, and permanent
pacemaker implantation were similar between the BEV and SEV group (n = 84,
38.3% vs. n = 87, 40.4%; hazard ratio: 0.94; 95% confidence interval: 0.70
to 1.26; p = 0.66) at 1 year. Regarding the anesthesia comparison, the
combined endpoint of all-cause mortality, stroke, myocardial infarction,
and acute kidney injury occurred with similar rates in the GA and CS
groups (n = 61, 25.7% vs. n = 54, 23.8%; hazard ratio: 1.09; 95%
confidence interval: 0.76 to 1.57; p = 0.63). Conclusion(s): In
intermediate- to high-risk patients undergoing transfemoral TAVR,
newer-generation SEV and BEV as well as CS and GA showed similar clinical
outcomes at 1 year using a combined clinical endpoint. (SecOnd-generation
seLf-expandable Versus Balloon-expandable Valves and gEneral Versus Local
Anesthesia in TAVI [SOLVE-TAVI]; NCT02737150) Copyright © 2021
American College of Cardiology Foundation

<108>
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. 110 (5) (pp 649-657), 2021. Date of
Publication: May 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.

<109>
Accession Number
2007157422
Title
Rivaroxaban Versus Warfarin in Patients with Mechanical Heart Valves:
Open-Label, Proof-of-Concept trial-The RIWA study.
Source
American Journal of Cardiovascular Drugs. 21 (3) (pp 363-371), 2021. Date
of Publication: May 2021.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Schonhofen I.S.; Travassos K.S.O.;
Pereira L.V.; Filho J.A.L.; Neto M.G.; Junior R.A.; Roever L.
Institution
(Duraes, Neto, Junior) PPGMS/Federal University of Bahia, UFBA, Bahia,
Salvador, Brazil
(Duraes, de Souza Lima Bitar, Junior) Medical School, Federal University
of Bahia, FAMEB/UFBA, Largo do Terreiro de Jesus, XV de Novembro Square,
s/n, Salvador, Bahia CEP 40026-010, Brazil
(Schonhofen, Filho) General Hospital Roberto Santos/SUS-Bahia, Salvador,
Bahia, Brazil
(Travassos) Bahiana School of Medicine and Public Health, EBMSP, Salvador,
Bahia, Brazil
(Pereira) Nursing School, Federal University of Bahia, UFBA, Salvador,
Bahia, Brazil
(Roever) Federal University of Uberlandia, Minas Gerais, Uberlandia, Minas
Gerais, Brazil
Publisher
Adis
Abstract
Background and Purpose: To date, vitamin K antagonists are the only
available oral anticoagulants in patients with mechanical heart valves. In
this way, we developed a pilot trial with rivaroxaban. Method(s): The
RIWA study was a proof-of-concept, open-label, randomized clinical trial
and was designed to assess the incidence of thromboembolic and bleeding
events of the rivaroxaban-based strategy (15 mg twice daily) in comparison
to dose-adjusted warfarin. Patients were randomly assigned in a 1:1 ratio
and were followed prospectively for 90 days. Result(s): A total of 72
patients were enrolled in the present study. Of these, 44 patients were
randomized: 23 patients were allocated to the rivaroxaban group and 21 to
the warfarin group. After 90 days of follow-up, the primary outcome
occurred in one patient (4.3%) in the rivaroxaban group and three patients
(14.3%) in the warfarin group (risk ratio [RR] 0.27; 95% confidence
interval [CI] 0.02-2.85; P = 0.25). Minor bleeding (without
discontinuation of medical therapy) occurred in six patients (26.1%) in
the rivaroxaban group versus six patients (28.6%) in the warfarin group
(RR 0.88; 95% CI 0.23-3.32; P = 0.85). One patient in the warfarin group
died from myocardial infarction. No cases of hemorrhagic stroke, valve
thrombosis, peripheral embolic events, or new intracardiac thrombus were
related in both groups. Conclusion(s): In this pilot study,
rivaroxaban 15 mg twice daily had thromboembolic and bleeding events
similar to warfarin in patients with mechanical heart valves. These data
confirm the authors' proof-of-concept and suggest that a larger trial with
a similar design is not unreasonable. ClinicalTrial.gov identifier:
NCT03566303. Copyright © 2020, Springer Nature Switzerland AG.

<110>
Accession Number
634492872
Title
Intermediate-Term Outcomes of Endoscopic or Open Vein Harvesting for
Coronary Artery Bypass Grafting: The REGROUP Randomized Clinical Trial.
Source
JAMA Network Open. 4 (3) (no pagination), 2021. Article Number: 1439. Date
of Publication: 15 Mar 2021.
Author
Zenati M.A.; Bhatt D.L.; Stock E.M.; Hattler B.; Wagner T.H.; Bakaeen
F.G.; Biswas K.
Institution
(Zenati) Division of Cardiac Surgery, Department of Surgery, Veterans
Affairs Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, 1400 VFW Pkwy, Boston, MA 02132, United States
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Stock) Cooperative Studies Program, Perry Point/Baltimore Coordinating
Center, Office of Research and Development, US Department of Veterans
Affairs, Perry Point, MD, United States
(Hattler) VA Eastern Colorado Healthcare System, Denver, United States
(Wagner) VA Health Economics Resource Center, Department of Surgery,
Stanford University, Palo Alto, CA, United States
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Biswas) Perry Point Cooperative Studies Program Coordinating Center,
Office of Research and Development, US Department of Veterans Affairs,
Perry Point, MD, United States
(Biswas) Department of Epidemiology and Public Health, University of
Maryland, School of Medicine, Baltimore, United States
Publisher
American Medical Association

<111>
Accession Number
633884405
Title
Long-term and short-term outcomes of robot- versus video-assisted anatomic
lung resection in lung cancer: a systematic review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 59 (4) (pp 732-740),
2021. Date of Publication: 29 Apr 2021.
Author
Wu H.; Jin R.; Yang S.; Park B.J.; Li H.
Institution
(Wu, Jin, Yang, Li) Department of Thoracic Surgery, Ruijin Hospital,
Shanghai Jiaotong University School of Medicine, Shanghai, China
(Park) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, NY, NY, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Minimally invasive thoracic surgery has evolved with the
introduction of robotic platforms. This study aimed to compare the
long-term and short-term outcomes of the robot-assisted thoracic surgery
(RATS) and video-assisted thoracic surgery (VATS) for anatomic lung
resection. METHOD(S): We searched published studies that investigated
RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free
survival and overall survival) and short-term outcomes (30-day mortality,
postoperative complications, conversion rate to open surgery and lymph
node upstaging) were extracted. The features were compared and tested as
hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval
(CI). RESULT(S): Twenty-five studies with 50 404 patients (7135 for
RATS and 43 269 for VATS) were included. The RATS group had a longer
disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59-0.97;
P=0.03), and the overall survival showed a similar trend but was not
statistically significant (HR: 0.77; 95% CI: 0.57-1.05; P=0.10). The RATS
group showed a significantly lower 30-day mortality (OR: 0.55; 95% CI:
0.38-0.81; P=0.002). No significant difference was found in postoperative
complications (OR: 1.01; 95% CI: 0.87-1.16; P=0.94), the conversion rate
to open surgery (OR: 0.92; 95% CI: 0.56-1.52; P=0.75) and lymph node
upstaging (OR: 0.89; 95% CI: 0.52-1.54; P=0.68). CONCLUSION(S): RATS
has comparable short-term outcomes and potential long-term survival
benefits for anatomic lung resection compared with VATS. Copyright
© The Author(s) 2020. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<112>
Accession Number
2011756719
Title
IN-HOSPITAL OUTCOMES OF CONCOMITANT USE OF CEREBROEMBOLIC PROTECTION
DEVICES DURING TAVR, TRENDS FROM THE NATIONAL INPATIENT SAMPLE DATABASE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1133), 2021. Date of
Publication: 11 May 2021.
Author
Mohiuddin I.; Celli D.; Rengifo-Moreno P.; Colombo R.; Mendoza C.E.
Institution
(Mohiuddin, Celli, Rengifo-Moreno, Colombo, Mendoza) University of Miami,
Miami, FL, United States
(Mohiuddin, Celli, Rengifo-Moreno, Colombo, Mendoza) Jackson Memorial
Hospital, Miami, FL, United States
Publisher
Elsevier Inc.
Abstract
Background Transcatheter aortic valve replacement (TAVR) has become a
feasible and widely accessible option for treatment of symptomatic severe
aortic stenosis (AS). During valve deployment, disruptions in the aortic
root and arch may lead to embolic phenomena. Recent studies in patients
undergoing TAVR with dual filter embolic protection devices described
captured debris in 75% of patients. Although not broadly used by
operators, cerebral embolic protection devices (CEPD) have been designed
to prevent disabling embolic events. A recent meta-analysis of TAVR trials
using CEPD showed a trend towards lower risk of death and stroke,
suggesting they may still prove to be a clinically relevant adjunctive
strategy. Methods The NIS database was queried by utilizing ICD-10 codes
to identify all patients with severe AS undergoing TAVR with and without
concomitant use of CEPD during 2017. Outcomes included all-cause
in-hospital mortality, new ischemic stroke, transient ischemia attack
(TIA), and myocardial infarction (MI). Descriptive statistics were
evaluated for patient and procedural confounders. Results Among the 8728
patients undergoing TAVR in 2017, only 126 (1.44%) utilized CEPD.
In-hospital all-cause mortality was 0.8% (n=1) in CEPD group compared to
1.5% (n=129) in TAVR-only group (, (p= 0.78). The rate of stroke was
similar in both groups (1.6%, n=2 in CEPD vs 1.8%, n =157 in TAVR-only
group, p=1). There was no difference in new TIA or acute MI between CEPD
and TAVR-only groups (0.8% vs 0.2%; p=0.74) and (4.0% vs 2.4%; p=0.39),
respectively. Comorbidities were equally distributed between groups
including hypertension, CKD, hyperlipidemia, CAD, heart failure, atrial
fibrillation/flutter, diabetes, and liver and vascular disease; however,
the CEPD group had a higher prevalence of carotid artery disease (17.5%,
n=22 vs 6.7% n=576). Conclusion CEPD are being continuously developed,
with newer generations allowing for extra coverage of cerebral vessels and
whole-body protection. In this small cohort of patients receiving
concomitant CEPD during TAVR, there was no demonstrable stroke protection
benefit, however larger trials are required to better evaluate embolic
outcomes. Copyright © 2021 American College of Cardiology
Foundation

<113>
Accession Number
2011751826
Title
ACUPUNCTURE TREATMENT FOR ATRIAL FIBRILLATION IN THE POST-OPERATIVE
CARDIO-THORACIC SETTING- A FEASIBILITY PILOT STUDY.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 366), 2021. Date of Publication:
11 May 2021.
Author
Locker C.; Mallory M.J.; Bauer B.A.; Friedman P.A.; Dearani J.; King K.S.;
Erdman M.; Deshmukh A.; Wittwer E.D.; Crestanello J.A.; Schaff H.
Institution
(Locker, Mallory, Bauer, Friedman, Dearani, King, Erdman, Deshmukh,
Wittwer, Crestanello, Schaff) Mayo Clinic, Rochester, MN, United States
Publisher
Elsevier Inc.
Abstract
Background Post-operative atrial fibrillation (POAF) after cardiac surgery
increases morbidity and mortality, and prolongs hospital stay. Acupuncture
may be a useful adjunct treatment. We examined the safety, feasibility,
and effectiveness of acupuncture for the treatment of POAF. Methods A
randomized clinical trial was conducted between July 2017 and August 2019
in a single tertiary medical center. Prospectively enrolled were 138
patients undergoing coronary bypass grafting, valve operations, and/or
septal myectomies or pericardiectomies, of whom 47 developed POAF, and
were randomly assigned to standard care (n=23) or standard care with up to
3 consecutive acupuncture treatments, 1 per day for 30 minutes (n=24;4
withdrew). Providers assessed feasibility for acupuncture. Differences
between the 2 groups were compared with Wilcoxon rank sum and
Fisher's exact tests; Anxiety, pain and tension before and after
acupuncture, by Visual Analog Scale (VAS) questionnaire, and heart rate
and blood pressure, with Wilcoxon signed rank tests. Was It Worth It
(WIWI) questionnaire was completed by patients undergoing acupuncture.
Results Seventeen of 43 patients (39.5%) were females, median age was 64
(IQR, 58-71). Average time from surgery to first POAF was 2.4 days (IQR,
1.6-3.4; P=0.73) and lasted 8.5 hours (IQR, 2.2-21.9; P=0.92), and length
of stay was 7 days (IQR, 6-8; P=0.83), similar in both groups. POAF
recurrence rate was not statistically different, however, the POAF burden
was significantly shorter in acupuncture patients (5.2 versus 26.4 hours,
P=0.041). VAS scores were similar in pretreatment versus control groups,
whereas acupuncture decreased anxiety (4.5 to 1.5; P=0.003), pain (3.5 to
2.0; P=0.005) and tension (4.0 to 2.0; P=0.003) scores after the first and
consecutive treatments. The average diastolic blood pressure (74.5 to
69.5mm/hg; P=0.048) and heart rate (74.5 to 72.5bpm; P<0.001) were reduced
in patients after acupuncture. Eighteen of 19 (95%) acupuncture patients
stated it was worth participating. Conclusion Acupuncture treatment is
feasible and safe, and significantly reduces POAF burden, blood pressure,
and heart rate. It is associated with patient satisfaction. Copyright
© 2021 American College of Cardiology Foundation

<114>
Accession Number
2011751243
Title
DILATED CARDIOMYOPATHY AS THE INITIAL PRESENTATION OF BECKER MUSCULAR
DYSTROPHY: A SYSTEMATIC REVIEW OF PUBLISHED CASES.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 623), 2021. Date of Publication:
11 May 2021.
Author
Del Rio-Pertuz G.; Morataya C.; Parmar K.; Abohelwa M.; Elmassry M.; Dubay
S.; Paz P.; Argueta E.
Institution
(Del Rio-Pertuz, Morataya, Parmar, Abohelwa, Elmassry, Dubay, Paz,
Argueta) Department of Internal Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
Publisher
Elsevier Inc.
Abstract
Background There are scarce publications regarding the presentation of
Becker muscular dystrophy (BMD) in adulthood and their outcome when
idiopathic dilated cardiomyopathy (DCM) is the initial disease
manifestation. Methods A systematic review of the literature using
Medline, Embase, Cochrane, and Scopus was performed to identify cases of
adults with Idiopathic DCM who were subsequently diagnosed with BMD from
inception through August 2020. Data is reported using descriptive
statistics. Results Six cases were found (Table 1). DCM as the initial
presentation of BMD was identified in young males (Median age: 26 years).
Most patients initiated with congestive heart failure symptoms (5/6, 83%),
with a median left ventricular (LV) ejection fraction of 23%. None
described musculoskeletal symptoms at presentation, but one had calf
pseudohypertrophy. Musculoskeletal symptoms appeared from one to six years
after the DCM. Heart transplantation was the most common management
strategy (4/6, 67%). An LV assisted device was used in one case as a
bridge to heart transplant. The longest reported survival was 21 years
after their initial presentation. All cases had genetic testing.
Conclusion DCM can be the initial presentation of BMD in adult patients in
their third to the fourth decade of life. Musculoskeletal symptoms can be
subclinical. Creatinine kinase levels and ancillary genetic testing could
be useful in disease identification. Heart transplantation was the most
common management strategy found. [Formula presented] Copyright ©
2021 American College of Cardiology Foundation

<115>
Accession Number
2011751156
Title
FIVE-YEAR OUTCOMES COMPARING SURGICAL VERSUS TRANSCATHETER AORTIC VALVE
REPLACEMENT IN INTERMEDIATE-RISK PATIENTS WITH CHRONIC KIDNEY DISEASE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1128), 2021. Date of
Publication: 11 May 2021.
Author
Garcia S.; Cubeddu R.; Asher C.; Pibarot P.; Hahn R.; Kapadia S.; Kodali
S.; Thourani V.; Ternacle J.; Jaber W.; Elmariah S.; Makkar R.; Webb J.;
Herrmann H.; Lu M.; Devireddy C.; Malaisrie S.C.; Smith C.; Mack M.; Leon
M.
Institution
(Garcia, Cubeddu, Asher, Pibarot, Hahn, Kapadia, Kodali, Thourani,
Ternacle, Jaber, Elmariah, Makkar, Webb, Herrmann, Lu, Devireddy,
Malaisrie, Smith, Mack, Leon) Minneapolis Heart Institute, Minneapolis,
MN, United States
(Garcia, Cubeddu, Asher, Pibarot, Hahn, Kapadia, Kodali, Thourani,
Ternacle, Jaber, Elmariah, Makkar, Webb, Herrmann, Lu, Devireddy,
Malaisrie, Smith, Mack, Leon) Cleveland Clinic Florida, Weston, FL, United
States
Publisher
Elsevier Inc.
Abstract
Background Few data exist comparing transcatheter aortic valve replacement
(TAVR) to surgical AVR (SAVR) for patients with severe aortic stenosis
(AS) and chronic kidney disease (CKD). Methods We conducted a pooled
analysis of intermediate-risk patients with severe AS and moderate-severe
CKD (eGFR < 60 ml/m/m2) enrolled in the Placement of Aortic Transcatheter
Valves (PARTNER) 2A trial (patients were randomly assigned to either
SAPIEN XT TAVR or SAVR) and SAPIEN 3 Intermediate Risk Registry (patients
received TAVR with the SAPIEN 3). The primary outcome was a composite of
death, stroke, hospital readmission and dialysis 5 years after SAVR or
TAVR. The restricted mean survival time approach was used and adjusted for
sex, eGFR and STS score. Results Of the 1,524 patients with severe AS and
moderate-severe CKD included for analysis, 1,045 underwent TAVR and 479
had SAVR. No differences in mean age, median eGFR or mean STS score were
observed. At 5 years, no significant differences were observed between
TAVR and SAVR for the primary endpoint (p=0.76) (Figure). Dialysis rates
through 5 years were comparable for both cohorts (5.8% at 5 years for TAVR
and SAVR, p=0.47), with no significant differences in death, stroke or
hospital readmissions. Conclusion In patients with severe AS and
moderate-severe CKD, there is no late negative impact on hard clinical
endpoints through 5 years for patients treated with TAVR versus SAVR.
[Formula presented] Copyright © 2021 American College of
Cardiology Foundation

<116>
Accession Number
2011750588
Title
ASSOCIATION BETWEEN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR AND SURVIVAL IN
PATIENTS AWAITING HEART TRANSPLANTATION: A META-ANALYSIS AND SYSTEMATIC
REVIEW.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 630), 2021. Date of Publication:
11 May 2021.
Author
Lin A.; Duran J.; Urey M.; Hsu J.; Adler E.; Birgersdotter-Green U.
Institution
(Lin, Duran, Urey, Hsu, Adler, Birgersdotter-Green) University of
California San Diego, La Jolla, CA, United States
Publisher
Elsevier Inc.
Abstract
Background Patients with end-stage heart failure (HF) are at high risk of
sudden cardiac death. However, implantable cardioverter-defibrillator
(ICD) is not routinely recommended given the high competing risk of pump
failure. A unique population worth separate consideration are patients
with end-stage HF awaiting heart transplantation (HT) as prolonged
survival improves the chances of receiving HT given the long wait times.
Methods We performed an extensive literature search and systematic review
of studies that compared HF patients with and without an ICD awaiting
heart transplantation. We separately assessed the rates of total
mortality, sudden cardiac death (SCD), non-SCD, and HT. Risk ratio (RR)
95% confidence intervals were measured using the Mantel-Haenszel method.
The random effects model was used due to heterogeneity across study
cohorts. Results Ten studies with a total of 36,205 patients were
included. 62% of patients had an ICD implanted. Patients with an ICD had
decreased total mortality (9.7% vs 17.1%, RR 0.62, 95% CI 0.52 - 0.73, p <
0.0001), SCD (1.0% vs 10.1%, RR 0.27, 95% CI 0.12 - 0.59, p = 0.001), and
increased rates of heart transplantation (64.4% vs 58.9%, RR 1.10, 95% CI
1.05 - 1.15, p < 0.0001). There was no difference in prevalence of non-SCD
(16.5% vs 16.9%, RR 0.76, 95% CI 0.51 - 1.13, p = 0.17). Conclusion ICD
implantation in HF patients awaiting HT was associated with improved
outcomes, characterized by lower total mortality and SCD in addition to
higher rates of HT. [Formula presented] Copyright © 2021 American
College of Cardiology Foundation

<117>
Accession Number
2011749823
Title
IMPACT OF SURGICAL AND TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS
WITH LOW-GRADIENT AORTIC STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 992), 2021. Date of Publication:
11 May 2021.
Author
Ueyama H.; Kuno T.; Harrington M.; Takagi H.; Krishnamoorthy P.M.; Sharma
S.; Kini A.; Lerakis S.
Institution
(Ueyama, Kuno, Harrington, Takagi, Krishnamoorthy, Sharma, Kini, Lerakis)
Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Low-gradient (LG) severe aortic stenosis (AS) encompass wide
variety of pathophysiology including classical low-flow, low-gradient
(LF-LG), paradoxical LF-LG, and normal-flow, low-gradient (NF-LG) AS.
Uncertainty exists regarding the impact of aortic valve replacement (AVR)
on each sub-class of LG AS. We aimed to assess the impact of AVR,
including surgical AVR (SAVR) and transcatheter AVR (TAVR), on survival of
patients with each sub-class of LG AS. Methods PUBMED and EMBASE were
queried through October 2020 to identify studies comparing survival of
different management (SAVR, TAVR, and conservative) in LG AS. Pairwise
meta-analysis comparing AVR versus conservative management and network
meta-analysis comparing SAVR versus TAVR versus conservative management
were performed. Results Thirty-two observational studies with a total of
6,551 patients were included in the analysis. AVR was associated with a
significant decrease in all-cause mortality in classical LF-LG (HR 0.42,
95% CI 0.36-0.48), paradoxical LF-LG (HR 0.39, 95% CI 0.28-0.54), and
NF-LG (HR 0.39, 95% CI 0.26-0.59) compared to conservative management.
SAVR and TAVR were each associated with a decrease in all-cause mortality
in classical LF-LG (HR 0.46, 95% CI 0.38-0.55; HR 0.49, 95% CI 0.37-0.64,
respectively), paradoxical LF-LG (HR 0.42, 95% CI 0.28-0.65; HR 0.42, 95%
CI 0.25-0.72, respectively), and NF-LG (HR 0.29, 95% CI 0.15-0.55; HR
0.50, 95% CI 0.28-0.89, respectively) compared to conservative management.
No significant difference in all-cause mortality was observed between SAVR
and TAVR. Conclusion Patients with all sub-classes of LG AS who underwent
AVR demonstrated a decrease in all-cause mortality compared to those who
received conservative management. There was no difference in all-cause
mortality between SAVR and TAVR. Copyright © 2021 American
College of Cardiology Foundation

<118>
Accession Number
2011749725
Title
DUAL ANTIPLATELET THERAPY FOR 1 TO 3 MONTHS IS SUPERIOR TO 12 MONTHS AFTER
CORONARY STENTING.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1071), 2021. Date of
Publication: 11 May 2021.
Author
Knijnik L.M.; Fernandes M.; Cardoso R.; Montanez-Valverde R.; Maza M.R.;
Goyal A.; Liberman H.; Cohen M.; Sperling L.; McDaniel M.
Institution
(Knijnik, Fernandes, Cardoso, Montanez-Valverde, Maza, Goyal, Liberman,
Cohen, Sperling, McDaniel) Emory University, Atlanta, GA, United States
(Knijnik, Fernandes, Cardoso, Montanez-Valverde, Maza, Goyal, Liberman,
Cohen, Sperling, McDaniel) University of Miami, Miami, FL, United States
Publisher
Elsevier Inc.
Abstract
Background The optimal dual antiplatelet therapy (DAPT) duration after
percutaneous coronary intervention (PCI) to balance thrombotic and
bleeding risks is not entirely understood. Methods PubMed, Scopus, and
Cochrane Central were searched for randomized controlled trials comparing
different antiplatelet durations of 12 months or less. Results Fourteen
randomized clinical trials were included, with a total of 50,552
participants. Around half of the patients had ACS. The mean age was 64
years, and the follow-up was 12 months. Most studies in the 3-month DAPT
arm used ticagrelor alone. DAPT for 1 to 3 months had a lower incidence of
major bleeding compared to 12-month DAPT (1.52% vs 2.07%; OR 0.64; 95% CI
0.48-0.85; P=0.002; I2=59). Additionally, DAPT for 1 to 3 months did not
increase all-cause mortality, myocardial infarction, major adverse
cardiovascular events, or stroke. Conclusion A shorter DAPT duration of 1
to 3 months appears to be the antiplatelet regimen with the most favorable
net clinical benefit in a broad population of ischemic heart disease after
stenting. [Formula presented] Copyright © 2021 American College
of Cardiology Foundation

<119>
Accession Number
2011749668
Title
A COMPARISON OF THE TRANSRADIAL AND TRANSFEMORAL APPROACHES AMONG POST
CORONARY ARTERY BYPASS GRAFT PATIENTS UNDERGOING ANGIOGRAPHY AND
INTERVENTION.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1055), 2021. Date of
Publication: 11 May 2021.
Author
Iftikhar M.J.; Jaumdally R.; Ashraf A.
Institution
(Iftikhar, Jaumdally, Ashraf) Walsall Healthcare NHS Trust, Walsall,
United Kingdom
Publisher
Elsevier Inc.
Abstract
Background Purpose of this trial is to compare transradial approach
coronary angiography performed versus transfemoral approach in patients
presented with post CABG angina in terms of 1.procedural success in terms
of obtaining venous access and catherizationof each coronary artery 2.
Complications and 3. Hospital stay in terms of hours Methods Study design:
Retroprospectivestudy Results During the study period, 209 patients were
screened for participation. Of these, 138 patients were excluded (Fig. 1),
leaving a total of 71 patients for enrollment and randomization (13 to TR
access and 58 to TF access). Nearly all (71) study patients underwent
diagnostic angiography, whereas only 2 patients underwent PCI in our study
total 71 patients were enrolled in Cardiology Department, Walsall Health
Care NHS Trust and Royal Wolverhampton NHS trust. Procedural outcomes for
diagnostic coronary angiography Angiographic and procedural data for
diagnostic coronary angiography (n = 94) are depicted in 5. Compared with
TF access, patients undergoing cardiac catheterization via TR access had
higher contrast use (142 +/- 39 ml vs. 171 +/- 72 ml, p < 0.01), longer
procedure duration (21.9 +/- 6.8 min vs. 34.2 +/- 14.7 min, p < 0.01),
increased fluoroscopy time (8.5 +/- 4.7 min vs. 12.7 +/- 6.6 min, p <
0.01), and The arterial access crossover rates was 0% for TR and 5% for TF
(p < 0.01). No of lesion treated were given in mean value 3 +/-1 for TR
access 3 +/-1 for TF access and 4 patient of TR approaches underwent for
LIMA graft and 55 patient of TF approaches' underwent for LIMA graft.
Table no 5 Conclusion In patients who had previously undergone CABG
surgery, transradial diagnostic coronary angiography was associated with
greater contrast use, longer procedure time, and greater access crossover
and operator radiation exposure compared with transfemoral angiography.
(RADIAL VersusFemoral Access for Coronary Artery Bypass Graft Angiography
and Intervention Copyright © 2021 American College of Cardiology
Foundation

<120>
Accession Number
2011749476
Title
CONSISTENT EFFICACY OF COLCHICINE OVER TIME IN PATIENTS WITH RECENT VERSUS
REMOTE PRIOR ACUTE CORONARY SYNDROME - A LODOCO2 SUBSTUDY.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 9), 2021. Date of Publication:
11 May 2021.
Author
Opstal T.; Fiolet A.T.L.; Mosterd A.; Eikelboom J.; Nidorf S.; Thompson
P.; Budgeon C.; Tijssen J.; El Messaoudi S.; Cornel J.H.
Institution
(Opstal, Fiolet, Mosterd, Eikelboom, Nidorf, Thompson, Budgeon, Tijssen,
El Messaoudi, Cornel) Radboud University Medical Centre, Nijmegen,
Netherlands
(Opstal, Fiolet, Mosterd, Eikelboom, Nidorf, Thompson, Budgeon, Tijssen,
El Messaoudi, Cornel) Dutch Network for Cardiovascular Research (WCN),
Utrecht, Netherlands
Publisher
Elsevier Inc.
Abstract
Background Colchicine reduces cardiovascular risk in patients with
coronary disease. This study seeks to investigate whether the efficacy of
colchicine differs between patients with recent or remote history of acute
coronary syndrome (ACS), and whether the efficacy of colchicine holds over
time. Methods The Low-Dose Colchicine 2 (LoDoCo2) trial randomly allocated
patients with chronic coronary disease to colchicine 0.5mg once daily or
placebo on a background of optimal medical therapy. The rate of the
primary end point, a composite of cardiovascular death, myocardial
infarction, ischemic stroke, and ischemia-driven coronary
revascularization, were compared between patients with a recent, remote or
very remote history of ACS. Additionally, colchicine efficacy was analyzed
at yearly landmarks. Results In the LoDoCo2 trial 5,522 patients were
randomized and followed for a median of 28 months. Of these, 1479 patients
had a history of ACS 6 to 24 months, 1582 patients 2 to 7 years, and 1597
patients >7 years prior to randomization. The reduction of the primary end
point by colchicine treatment did not differ between these groups, with no
interaction between colchicine treatment effect and prior ACS status (p =
0.59, Figure A). In addition, colchicine efficacy was consistent between
the first year of trial, second year, and third year until end of study
(Figure B). Conclusion The efficacy of colchicine is similar between
patients with a recent and remote history of ACS and is consistent over
time. [Formula presented] Copyright © 2021 American College of
Cardiology Foundation

<121>
Accession Number
2011749419
Title
SINGLE ANTIPLATELET VERSUS DUAL ANTIPLATELET THERAPY IN PATIENTS AFTER
TRANSCATHETER AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 942), 2021. Date of Publication:
11 May 2021.
Author
Patel M.; Patel N.; Elzanaty A.; Burmeister C.; Tomcho J.; Bhuta S.; Patel
S.; Patel A.; Singh S.
Institution
(Patel, Patel, Elzanaty, Burmeister, Tomcho, Bhuta, Patel, Patel, Singh)
University of Toledo, Toledo, OH, United States
(Patel, Patel, Elzanaty, Burmeister, Tomcho, Bhuta, Patel, Patel, Singh)
Promedica Health System, Toledo, OH, United States
Publisher
Elsevier Inc.
Abstract
Background There have been many studies evaluating the safety and efficacy
of aspirin (SAPT) versus aspirin & clopidogrel (DAPT) after transcatheter
aortic valve replacement (TAVR). The optimal antiplatelet regimen post
TAVR has been under continuous debate with DAPT showing better thrombotic
outcomes in the expense of increased bleeding events. We aim to
systematically review and meta-analyse available evidence pertaining SAPT
and DAPT in this population. Methods We searched PubMed, Embase, and
Cochrane Libraries for all studies evaluating SAPT vs. DAPT after TAVR.
The primary outcomes compared all-cause mortality, stroke, myocardial
infarction (MI), and major bleeding (MB) events in patients receiving SAPT
vs. DAPT. These events were measured at intervals of 30 days and long term
follow up greater than 3 months. Results A total of 3474 patients from 9
RCTs (3474 total patients) were included in the final analysis. Compared
to DAPT, SAPT had decreased 30 day all-cause mortality (RR 0.97; CI [0.96,
0.99]; P=0.001; I2=0%), 30-day MB (RR 0.92; CI [0.87, 0.97];
P=0.004; I2=59%), and major bleeding events past 3 months (RR
0.96; CI [0.92, 0.99]; P=0.01; I2=75%). There were no
statistically increased rates of stroke or MI in SAPT compared to DAPT
after TAVR. Conclusion This meta-analysis suggests that compared to DAPT,
SAPT after TAVR decreases 30-day all-cause mortality and major bleeding
events without increasing risk of stroke or MI. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<122>
Accession Number
2011749353
Title
CLINICAL CHARACTERISTICS, OUTCOMES AND IMMUNOSUPPRESSION STRATEGIES OF
HEART TRANSPLANT RECIPIENTS INFECTED WITH COVID-19.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 828), 2021. Date of Publication:
11 May 2021.
Author
Ilonze O.J.; Ballut K.; Jones M.; Rao R.; Guglin M.
Institution
(Ilonze, Ballut, Jones, Rao, Guglin) Indiana University, Indianapolis, IN,
United States
Publisher
Elsevier Inc.
Abstract
Background Clinical characteristics, management of immunosuppression and
outcomes of heart transplant recipients infected with COVID-19 are
uncertain. Literature is limited to isolated case reports and series.
Methods We analyzed the literature on COVID-19 (2020) and systematically
reviewed the case reports and series where individual patient data were
presented. We searched Pubmed and Google Scholar for "coronavirus",
COVID-19, SARS-CoV-2 in combination with "heart transplant" and
"heart-kidney transplant". Results We identified 39 patients with a
history of heart, 35 (89.8%)) and heart-kidney transplants, 4 (10.3%)
diagnosed with COVID-19. Median age was 59 (49.5-66.5), patients were
predominantly male 33 (84.6%) and almost half (48.7%) were >60 years of
age. 34 patients (87.1%) were hospitalized and 3 (7.6%) treated as
outpatients. The median time from transplant was 6.5 years with 79.4%
being more than 1-year post-transplant. The predominant syndrome on
clinical presentation was febrile viral illness with respiratory symptoms
(66.7%), cough (64.1%) and dyspnea (48.7%), but few patients, 5 (12.8%)
presented with new left ventricular dysfunction and no rejection,
diagnosed with myocarditis. Overall mortality was 10.2%. Immunosuppression
was unchanged in 17.9% of cases, but in 70% of cases antimetabolites were
discontinued (38%) or the dose was reduced (32%). Survival in hospitalized
patients was 88% but only 33% in patients requiring ICU admission.
Conclusion Patients with heart transplants and COVID-19 have a similar
presentation as the general population, with an overall mortality of
10.2%. Cases of myocarditis were reported and should be recognized. The
predominant strategy of immunosuppression management was reduction or
cessation of antimetabolites in 70% of patients. Copyright © 2021
American College of Cardiology Foundation

<123>
Accession Number
2011749258
Title
BIOMARKER PREDICTION OF MAJOR CORONARY EVENTS AND COMPLEX
REVASCULARIZATION PROCEDURES IN PATIENTS WITH STABLE ATHEROSCLEROSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 2), 2021. Date of Publication:
11 May 2021.
Author
Fagundes A.; Morrow D.; Oyama K.; Furtado R.; Zelniker T.; Tang M.; Kuder
J.; Murphy S.A.; Hamer A.; Keech A.; Sever P.; Giugliano R.; Sabatine M.;
Bergmark B.
Institution
(Fagundes, Morrow, Oyama, Furtado, Zelniker, Tang, Kuder, Murphy, Hamer,
Keech, Sever, Giugliano, Sabatine, Bergmark) Brigham and Women's Hospital,
Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background The ability of CV biomarkers to predict coronary events,
particularly revascularization procedures, is not well defined. We
explored the associations of hsTnI (myocardial injury), NT-proBNP
(ventricular strain), GDF-15 (inflammation/fibrosis), and hsCRP
(inflammation) with coronary events including revascularization. Methods
FOURIER was a randomized trial of the PCSK9 inhibitor evolocumab vs
placebo in 27,564 pts with stable ASCVD. We analyzed adjusted associations
(Fig for model) between baseline biomarker concentrations and MCE
(coronary death, MI, coronary revascularization) individually and using a
multimarker score with one point assigned for each elevated biomarker.
Clinical documentation was blindly reviewed for procedural details.
Complex revascularization was the composite of CABG or complex PCI (Fig
for definition). Results Patients with higher concentrations of each
biomarker were at higher risk of MCE (P<inf>trend</inf><.0001 for each).
When patients were grouped by number of elevated biomarkers (0: N=9656; 1
or 2: N=15,088; 3 or 4: N=2804), there was a significant graded
association between the number of elevated biomarkers and risk of MCE,
including complex revascularization (Fig) and its components
(P<inf>trend</inf><.05 for each). These associations were consistent for
elective and urgent revascularizations. Conclusion A biomarker-based
strategy identifies stable patients at risk for major coronary events,
including complex coronary revascularization procedures. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<124>
Accession Number
2011749017
Title
PREDICTORS OF PERMANENT PACEMAKER IMPLANTATION IN PATIENTS UNDERGOING
TRANSCATHER AORTIC VALVE REPLACEMENT - A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 981), 2021. Date of Publication:
11 May 2021.
Author
Ullah W.; Zahid S.; Zaidi R.; Haq S.; Roomi S.; Sarvepalli D.; Mukhtar M.;
Khan A.; Gowda S.N.; Ruggiero N.; Vishnevsky A.; Fischman D.
Institution
(Ullah, Zahid, Zaidi, Haq, Roomi, Sarvepalli, Mukhtar, Khan, Gowda,
Ruggiero, Vishnevsky, Fischman) Abington Jefferson Health, Abington, PA,
United States
Publisher
Elsevier Inc.
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology
expands to healthy and lower-risk populations, the burden and predictors
of procedure-related complications including the need for permanent
pacemaker (PPM) implantation needs to be identified. Methods Digital
databases were systematically searched to identify studies reporting the
incidence of PPM implantation after TAVR. A random-effect model was used
to calculate unadjusted odds ratios (OR) for all predictors. Stratified
analyses based on the study design, valve type and access site were also
performed. Results A total of 71 studies, recruiting 30,191 patients were
included in the final analysis. Overall, 5920 patients required a PPM,
with a net rate ranging from 1.5% to 51% for each study. The pooled
estimates indicated significantly higher odds of post-TAVR PPM
implantation for men (OR 1.38, 95% CI 1.11-1.7, p=0.003); patients with
baseline mobitz type-1 second-degree atrioventricular (AV) block (OR 7.48,
95% CI 3.21-17.42, p=<0.0001), left anterior hemiblock (OR 1.63, 95% CI
1.21-2.2, p=0.001), bifascicular block (OR 4.04, 95% CI 1.16-14.10,
p=0,03) and right bundle branch block (OR 4.63,95% CI 3.37-6.34,
p=<0.0001); and for intraprocedural AV block (OR 7.12,95% CI 4.05-12.52,
p=<0.0001). Conclusion Male gender, baseline AV conduction delays,
intraprocedural AV block and use of mechanical- and self-expanding
prosthesis served as positive predictors of PPM implantation in patients
undergoing TAVR. [Formula presented] Copyright © 2021 American
College of Cardiology Foundation

<125>
Accession Number
2011748801
Title
HYBRID CORONARY REVASCULARIZATION VERSUS CORONARY ARTERY BYPASS GRAFT IN
PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1042), 2021. Date of
Publication: 11 May 2021.
Author
Zghouzi M.; Ullah W.; Sandhyavenu H.; Pacha H.M.; Al-Khadra Y.; Ahmad B.;
Sattar Y.; Suleiman A.-R.; Garcia S.; Bagur R.; Ali O.; Gardi D.; Hakim
Z.; Mohamed M.; Rashid M.; Mamas M.; Alraies M.C.
Institution
(Zghouzi, Ullah, Sandhyavenu, Pacha, Al-Khadra, Ahmad, Sattar, Suleiman,
Garcia, Bagur, Ali, Gardi, Hakim, Mohamed, Rashid, Mamas, Alraies)
Abington Jefferson Health, Abington, PA, United States
(Zghouzi, Ullah, Sandhyavenu, Pacha, Al-Khadra, Ahmad, Sattar, Suleiman,
Garcia, Bagur, Ali, Gardi, Hakim, Mohamed, Rashid, Mamas, Alraies) Detroit
Medical Center, Detroit, MI, United States
Publisher
Elsevier Inc.
Abstract
Background Hybrid coronary artery revascularization (HCR) refers to
complete or near complete revascularization using the combination of
single vessel CABG and PCI of other significant coronary lesions. The
short-term outcomes of HCR compared to CABG alone is unknown. Methods
Online databases were queried with various combinations of keywords to
identify relevant articles. Major adverse cardiovascular events (MACE) and
its components were compared using a random effect model to calculate
unadjusted odds ratios (OR). Results A total of 36 studies comprising
213,053 patients (HCR 4,276, CABG 208,777) were included. The odds of MACE
(OR 1.22; 95% CI 0.86-1.74; P=0.27), repeat MI (OR 1.02; 95% CI 0.66-1.60;
P=0.91), cerebrovascular events (OR 0.82; 95% CI 0.55-1.24; P=0.35), all
cause mortality (OR 1.13; 95% CI 0.72-1.79; P=0.59), AKI (OR 1.09; 95% CI
0.55-2.19; P=0.8), hemodialysis (OR 0.49; 95% CI 0.14-1.66; P=0.25),
postoperative Afib (OR 0.76; 95% CI 0.53-1.09; P=0.13), complete
revascularization (OR 0.97; 95% CI 0.62-1.52; P=0.9), and TVR (OR 2.68;
95% CI 0.47-15.25; P=0.27) were not different between the two groups.
Although the odds of blood transfusion requirement was significantly lower
in the HCR group (OR 0.37; 95% CI 0.31-0.44; P<0.001), the need for repeat
operation due to bleeding was similar between the two groups (OR 1.03; 95%
CI 0.75-1.42; P=0.84). Conclusion Clinical outcomes of HCR and CABG were
comparable for patients with MCAD, with no difference in mortality or
major adverse events. [Formula presented] Copyright © 2021
American College of Cardiology Foundation

<126>
Accession Number
2011748540
Title
IMPACT OF ACUTE KIDNEY INJURY AFTER SURGICAL AND TRANSCATHETER AORTIC
VALVE REPLACEMENT IN INTERMEDIATE-RISK PATIENTS WITH CHRONIC KIDNEY
DISEASE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1138), 2021. Date of
Publication: 11 May 2021.
Author
Cubeddu R.J.; Garcia S.; Pibarot P.; Hahn R.; Ternacle J.; Asher C.;
Kapadia S.; Kodali S.; Thourani V.; Jaber W.; Goessl M.; Elmariah S.;
Makkar R.; Webb J.; Herrmann H.; Lu M.; Devireddy C.; Malaisrie S.C.;
Smith C.; Mack M.; Leon M.
Institution
(Cubeddu, Garcia, Pibarot, Hahn, Ternacle, Asher, Kapadia, Kodali,
Thourani, Jaber, Goessl, Elmariah, Makkar, Webb, Herrmann, Lu, Devireddy,
Malaisrie, Smith, Mack, Leon) Cleveland Clinic Florida, Weston, FL, United
States
(Cubeddu, Garcia, Pibarot, Hahn, Ternacle, Asher, Kapadia, Kodali,
Thourani, Jaber, Goessl, Elmariah, Makkar, Webb, Herrmann, Lu, Devireddy,
Malaisrie, Smith, Mack, Leon) Minneapolis Heart Institute, Minneapolis,
MN, United States
Publisher
Elsevier Inc.
Abstract
Background Patients with chronic kidney disease (CKD) are at increased
risk of acute kidney injury (AKI) after surgical (SAVR) and transcatheter
aortic valve replacement (TAVR). Comparative data regarding incidence of
AKI in patients with CKD are lacking. Methods We conducted a pooled
analysis of intermediate-risk patients with severe AS and moderate-severe
CKD (eGFR < 60 ml/m/m2) enrolled in the Placement of Aortic Transcatheter
Valves (PARTNER) 2A trial (randomly assigned to either SAPIEN XT TAVR or
SAVR) and SAPIEN 3 Intermediate Risk Registry. The primary outcome was a
composite of death, stroke and hospital readmission 5 years after SAVR or
TAVR in patients with and without perioperative AKI as defined by the
Valve Academic Research Consortium 2 (VARC-2) criteria. Results Of the
1,524 patients with severe aortic stenosis and moderate-severe CKD
included for analysis, 1,045 underwent TAVR and 479 had SAVR. Among
patients with CKD, 10.4% of patients undergoing TAVR and 26.5% of patients
undergoing SAVR developed perioperative AKI (p<0.001) (Figure A). At 5
years, patients with AKI in the perioperative period had increased risk of
death, stroke and hospital readmission after TAVR and SAVR (p<0.001,
Figure B) with similar risk of permanent hemodialysis (both 5.8%, p=0.47).
Conclusion In patients with CKD, perioperative AKI is more common after
SAVR than TAVR. Perioperative AKI is independently associated with
long-term outcomes. [Formula presented] Copyright © 2021 American
College of Cardiology Foundation

<127>
Accession Number
2011748291
Title
PREDICTORS OF LEFT BUNDLE BRANCH BLOCK AFTER TRANSCATHETER AORTIC VALVE
REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1123), 2021. Date of
Publication: 11 May 2021.
Author
Elajami T.; Urina D.; Elajami M.; Bahmad H.; Ghssein G.; Salami A.;
Escolar E.; Mihos C.; Beohar N.
Institution
(Elajami, Urina, Elajami, Bahmad, Ghssein, Salami, Escolar, Mihos, Beohar)
Columbia University Division of Cardiology at Mount Sinai Medical Center,
Miami Beach, FL, United States
Publisher
Elsevier Inc.
Abstract
Background Left bundle branch block (LBBB) is the most common conduction
abnormality that might complicate transcatheter aortic valve replacement
(TAVR) and progress to advanced atrioventricular blocks. Several factors
have been proposed to predict post-TAVR LBBB, but data remain limited. Our
objective was to summarize predictors of post-TAVR LBBB. Methods
Systematic literature search was performed to identify studies that
reported predictors of new-onset post-TAVR LBBB. Data on patient factors,
electrocardiographic (ECG) and anatomic parameters, besides device-factors
were abstracted. Random-effects model was utilized to calculate crude risk
ratios (RRs), difference in means, and 95% confidence intervals of
predictors. Results Out of 397 articles, a total of 15 studies including
5,917 patients were included. Of those, 26.4% developed post-TAVR LBBB.
Results indicated an increased risk of post-TAVR LBBB among patients with
diabetes (RR: 1.24; 95% CI, 1.10-1.39; p=0.000) and previous cardiac
surgery (RR: 3.00; 95% CI, 1.69-5.33; p=0.000). Other predictors included:
membranous septal length (MSL) < 6.5 mm (RR: 1.68; 95% CI, 1.13-2.52;
p=0.01), non- coronary cusp depth >= 3 mm (RR: 1.97; 95% CI, 1.15-3.38;
p=0.02), usage of 29 mm valve (RR: 1.76; 95% CI, 1.31-2.37; p=0.000), 34
mm valve (RR: 1.75; 95% CI,1.13-2.72; p=0.01), mechanically expandable
valve (RR: 1.97; 95% CI, 1.67-2.33; p=0.000), and Medtronic CoreValve (RR:
2.25; 95% CI, 1.25-4.08; p=0.007). Results also showed a significant
difference in means of number of diseased coronary arteries,
interventricular septal thickness, MSL, left ventricular outflow tract
diameter, and PR duration between LBBB and non-LBBB groups. Conclusion
Diabetes, previous cardiac surgery, MSL, non-coronary cusp depth, the size
and type of prosthesis increased risk of post-TAVR LBBB. Identification of
post-TAVR LBBB predictors may help reduce the incidence of advanced degree
atrioventricular blocks and improve clinical outcomes. Copyright
© 2021 American College of Cardiology Foundation

<128>
Accession Number
2011747519
Title
SYSTEMATIC REVIEW OF BIAS IN NON-RANDOMIZED STUDIES ON THE OPTIMAL TIMING
OF CORONARY ARTERY BYPASS GRAFTING FOLLOWING ACUTE CORONARY SYNDROME.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 145), 2021. Date of Publication:
11 May 2021.
Author
Weigel F.; Krakowski G.; Nudy M.; Foy A.
Institution
(Weigel, Krakowski, Nudy, Foy) Penn State Milton S Hershey Medical Center,
Hershey, PA, United States
Publisher
Elsevier Inc.
Abstract
Background The optimal timing of coronary artery bypass grafting (CABG) in
patients with acute myocardial infarction (MI) is unknown. We performed a
systematic review and bias assessment of studies comparing mortality in
patients undergoing CABG at different time intervals following acute MI.
Methods Studies were identified using MEDLINE, published between January
1, 2000 and August 11, 2020. Bias assessment was completed using the Risk
of Bias in Non-Randomized Studies of Intervention assessment tool. Results
17 retrospective studies that included a total of 110,449 patients were
identified. Of those, 5 used multi-center registries and 12 were based on
a single center. The risk of bias in "pre-intervention" domains was
determined to be moderate to severe in all studies (Table 1). No study
accounted for immortal time bias which resulted in serious risk for
selection bias. Confounding was found to be a serious risk in 7/17 (41%)
studies and moderate risk in those remaining (59%). Confounding was caused
by lack of accounting for MI severity, type of MI, or other verified
cardiac risk factors. "Intervention" domain was deemed moderate risk, as
intervention groups were determined retrospectively. "Post-intervention"
domains were judged to be low risk for bias. [Formula presented]
Conclusion The current literature comparing timing of CABG following MI is
at moderate to serious risk of bias due to patient selection and
confounding. Randomized studies are needed to inform best practices on the
optimal timing of CABG after acute MI. Copyright © 2021 American
College of Cardiology Foundation

<129>
Accession Number
2011747440
Title
TRANSCATHETER AORTIC VALVE REPLACEMENT IN LOW-RISK BICUSPID AND TRICUSPID
PATIENTS - A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL TRIALS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1116), 2021. Date of
Publication: 11 May 2021.
Author
Medranda G.; Rogers T.; Doros G.; Case B.; Yerasi C.; Waksman R.
Institution
(Medranda, Rogers, Doros, Case, Yerasi, Waksman) MedStar Washington
Hospital Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background Patients with bicuspid aortic stenosis (AS) have been excluded
from most U.S. pivotal transcatheter aortic valve replacement (TAVR)
trials. Prospective data in low-risk bicuspid patients is lacking. This
study aimed to compare the safety and efficacy of TAVR in low-risk
patients with bicuspid AS to those with tricuspid AS, incorporating data
from prospective trials. Methods Prospective low-risk TAVR trials in the
U.S. that contained a bicuspid arm, were selected for meta-analysis. We
examined outcomes at 30 days. Study results were pooled using a
hierarchical Bayesian random-effects model. Results Included were 3 Food
and Drug Administration (FDA)-approved investigational device exemption
(IDE) trials (PARTNER 3, Evolut Low Risk, LRT) that enrolled a total of
1,810 low-risk patients for TAVR. We compared 380 with severe bicuspid AS
to 1,430 with severe tricuspid AS. Event rates at 30 days overall were
low, with similar mortality (odd ratio [OR], 0.38; 95% confidence interval
[CI], 0.08, 1.78; I2, 0%), non-disabling stroke (OR, 0.45; 95%
CI, 0.15, 1.07; I2, 9%), major vascular complications (OR,
1.45; 95% CI, 0.63, 3.74; I2, 0%) and permanent pacemaker
implantation (OR, 0.86; 95% CI, 0.41, 1.47; I2, 59%). There
were statistically significant differences in disabling stroke (OR, 0.16;
95% CI, 0.01, 0.90; I2, NA%) and coronary obstruction (OR,
0.21; 95% CI, 0.05, 0.91) that disappeared after sensitivity analysis by
adding a single event to the tricuspid arm. At 30-day there were no
differences in mean gradient, aortic valve area or significant
paravalvular leak. Conclusion Preliminary data from the FDA-approved IDE
trials in the U.S., of low-risk patients with bicuspid AS undergoing TAVR,
demonstrated 30-day outcomes comparable to low-risk tricuspid patients,
with the exception of a trend towards higher stroke in bicuspid patients.
More studies are warranted to assess the safety of TAVR in patients with
Sievers type 0 bicuspid valves and heavily calcified
anatomy. Copyright © 2021 American College of Cardiology
Foundation

<130>
Accession Number
2011746965
Title
IMPACT OF PRE-PROCEDURAL TRICUSPID REGURGITATION ON OUTCOMES IN TMVR: A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1088), 2021. Date of
Publication: 11 May 2021.
Author
Dave P.; Abunassar J.; Abuzeid W.
Institution
(Dave, Abunassar, Abuzeid) Queen's University, Kingston, Canada
Publisher
Elsevier Inc.
Abstract
Background Tricuspid Regurgitation (TR) is commonly associated with
functional Mitral Regurgitation (MR). The coexistence of Severe TR and MR
is often seen in heart failure patients and is linked with increased
mortality. While some studies have shown worse outcomes for patients with
significant TR at baseline undergoing Transcatheter Mitral Valve Repair
(TMVr), other studies did not find this to be significant. We sought to
clarify the impact of significant pre-procedural TR on long-term outcomes.
Methods We conducted a systematic review and meta-analysis of clinical
trials and observational studies reporting on 1-year mortality outcomes in
TMVr patients stratified by pre-procedural TR. We searched three databases
on the Ovid platform (Ovid MEDLINE, EMBASE, EBM reviews) until November
2020. A random-effects model was used to estimate the pooled odds ratio
across the included studies. Results We identified 779 articles of which 7
articles were included based on pre-specified inclusion criteria. A total
of 4673 patients undergoing TMVr from 2013 to 2018 were included in
analysis. There were 905 patients (20%) identified as having moderate or
severe TR at baseline. Moderate or severe TR at baseline was associated
with increased 12-month mortality as compared to mild TR at baseline,
Figure (OR: 2.59, [95%CI 2.12, 3.17] p<0.001). Conclusion Moderate or
severe pre-procedural TR is strongly associated with increased mortality
compared to mild TR at 12 months in patients undergoing TMVr. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<131>
Accession Number
2011745899
Title
THE IMPACT OF COGNITIVE IMPAIRMENT IN ACUTE CORONARY SYNDROME: A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 76), 2021. Date of Publication:
11 May 2021.
Author
Prasitlumkum N.; Ding K.; Doyle K.; Natarajan B.; Pai R.
Institution
(Prasitlumkum, Ding, Doyle, Natarajan, Pai) University of California
Riverside, San Bernadino, CA, United States
Publisher
Elsevier Inc.
Abstract
Background Cognitive impairment (CI) has been known associated with
negative health impacts. Several studies recently demonstrated
inconsistent outcomes amongst cognitively impaired patients with acute
coronary syndrome (ACS). Our study was to determine the impact of CI onto
patients with ACS Methods Databases were searched through October 2020.
Studies that reported rates of revascularization, short and long-term
mortality amongst cognitively impaired patients with ACS were included.
Effect estimates from the individual studies were extracted and combined
using random-effect, generic inverse variance method of DerSimonian and
Laird. Results 11 observational studies were included in the analysis
consisting of 810,122 ACS patients. Our analysis suggested that CI was
statistically associated with increased 30-day mortality (OR 1.34, 95% CI
1.14 - 1.57, I2 = 83.1%, p < 0.001), and long-term mortality (OR 1.80, 95%
CI 1.04 - 3.11, I2 = 36.3% p = 0.034). In addition, CI was associated with
lower rates of percutaneous coronary intervention (PCI) (OR 0.63, 95% CI
0.42 - 0.96, I2 = 98.5%, p =0.033) (Figure 2) as well as coronary artery
bypass surgery (CABG) (OR 0.37, 95% CI 0.20 - 0.68, I2 = 96.2%, p =0.002)
Conclusion Our study demonstrated that CI was not only associated with
increased 30-day and long-term mortality but also correlated with lower
rates of revascularization (both PCI and CABG). [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<132>
Accession Number
2011745771
Title
AORTIC VALVE REINTERVENTION AFTER TRANSCATHETER AND SURGICAL AORTIC VALVE
REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 920), 2021. Date of Publication:
11 May 2021.
Author
Buda K.; Megaly M.; Garcia S.
Institution
(Buda, Megaly, Garcia) Hennepin Healthcare, Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Background Despite the expanding indications for transcatheter aortic
valve replacement (TAVR), data regarding aortic valve reintervention rates
after TAVR and SAVR are lacking. Methods We performed a systematic review
and meta-analysis of studies reporting the outcomes of TAVR vs. surgical
aortic valve replacement (SAVR) with >= five years of follow-up. The
primary endpoint was the composite of reintervention and death. Results
Four RCTs involving 3,755 patients (1,889 TAVR and 1,866 SAVR) were
included. Surgical risk as assessed by STS score was high in two trials
and intermediate and low in the other two (39%, 54%, and 7% of patients,
respectively). There were 344 Sapien, 1,011 Sapien XT, and 550 CoreValve.
During a median follow-up of 5 years (range 5-6 years), TAVR was
associated with higher rates reintervention (odds ratio (OR) 3.74; 95% CI:
[1.79, 7.84], p<0.001, I2=0%) and the composite of
reintervention and death (OR 1.34; 95% CI: [1.16, 1.55], p<0.001,
I2=0%) compared to SAVR. Conclusion Despite comparable short
and medium-term results, TAVR with early generation THV is associated with
higher rates of reintervention and the composite of reintervention and
death than SAVR at long-term follow-up. [Formula presented] Copyright
© 2021 American College of Cardiology Foundation

<133>
Accession Number
2011745302
Title
POSTPROCEDURAL MONOTHERAPY WITH ASPIRIN VS DAPT AFTER TAVI - AN UPDATED
META-ANALYSIS OF RANDOMIZED, CONTROL TRIALS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 978), 2021. Date of Publication:
11 May 2021.
Author
Cerrud-Rodriguez R.; Wiley K.; Villablanca-Spinetto P.; Wiley J.
Institution
(Cerrud-Rodriguez, Wiley, Villablanca-Spinetto, Wiley) Montefiore Medical
Center, Bronx, NY, United States
(Cerrud-Rodriguez, Wiley, Villablanca-Spinetto, Wiley) Henry Ford Health
System, Detroit, MI, United States
Publisher
Elsevier Inc.
Abstract
Background Multiple studies have evaluated whether monotherapy with
aspirin is superior to DAPT in patients who have undergone transcatheter
aortic valve implantation (TAVI) Methods A systematic review of Medline,
Cochrane, and Embase was performed for RCTs that reported outcomes of
patients undergoing TAVI who received post-procedural aspirin only vs
those who received DAPT. Four RCTs met the eligibility criteria Results
This meta-analysis includes 1,086 patients with a mean age 80.0+/-0.75
years; 50.3% were male. After a mean follow-up of 9.0+/-3.5 months, there
was a significant benefit in the aspirin only group, when compared with
the DAPT group, in all bleeding events (Risk Ratio [RR] 0.58, 95%
Confidence Interval [CI] 0.44-0.76, p<0.0001, relative risk reduction
[RRR] 42%, absolute risk reduction [ARR] 9.1%). No statistically
significant differences between groups were found in the other outcomes:
all-cause mortality (RR 1.01, 95% CI 0.63-1.61, p=0.97), cardiovascular
mortality (RR 1.07, 95% CI 0.54-2.12, p=0.84) or all stroke (RR 0.93, 95%
CI 0.54-1.61, p=0.79) Conclusion Monotherapy with aspirin following TAVI
is associated with a lower risk of all bleeding events when compared with
post-procedural DAPT. No differences between groups were seen in the other
studied outcomes. However, the short mean follow-up period is an important
limitation of the present study. Further studies with longer follow-up
periods are needed before changes are implemented in the current TAVI
guidelines% [Formula presented] Copyright © 2021 American College
of Cardiology Foundation

<134>
Accession Number
2011745170
Title
ONE-YEAR CLINICAL OUTCOMES OF DIRECT IMPLANTATION OF A SUPRA-ANNULAR
SELF-EXPANDING VALVE.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 975), 2021. Date of Publication:
11 May 2021.
Author
Benetos G.; Karmpalioti M.; Drakopoulou M.; Stathogiannis K.; Xanthopoulou
M.; Latsios G.; Synetos A.; Bei E.; Voudris V.; Kosmas E.; Katsimagklis
G.; Zeniou V.; Danenberg H.; Vavuranakis M.; Tousoulis D.; Tsioufis K.;
Toutouzas K.
Institution
(Benetos, Karmpalioti, Drakopoulou, Stathogiannis, Xanthopoulou, Latsios,
Synetos, Bei, Voudris, Kosmas, Katsimagklis, Zeniou, Danenberg,
Vavuranakis, Tousoulis, Tsioufis, Toutouzas) National & Kapodistrian
University of Athens, School of Medicine, First Department of Cardiology,
Athens, Greece
Publisher
Elsevier Inc.
Abstract
Background Mid-term clinical data regarding the safety and efficacy of
direct implantation of a self-expanding valve without balloon aortic
valvuloplasty (BAV) in patients with symptomatic, severe aortic valve
stenosis are scarce. In this study we aimed to investigate the impact of
direct TAVI on one-year clinical outcomes. Methods DIRECT trial randomized
171 consecutive patients with severe aortic stenosis at 4 tertiary centers
to undergo TAVI with the use of self-expanding prostheses with (pre-BAV)
or without pre-dilatation (no-BAV). The primary endpoint was device
success according to the VARC-2 criteria. All-cause and cardiac mortality,
stroke, heart failure hospitalization and new pacemaker implantation were
recorded at one year and compared between the two groups using
Kaplan-Meier plots. Results Of 171 patients, 86 patients were randomized
to pre-BAV group and 85 to no-BAV group. The device success according to
the VARC-2 criteria was non-inferior in the no-BAV group compared to the
pre-BAV group (65/85 - 76.5% for no-BAV versus 64/86 - 74.4% for pre-BAV,
mean difference=2.1%, 90% CI -8.9 to 13). In the no-BAV group 25 (29.4%)
patients underwent post balloon dilatation and in the pre-BAV group 13
patients (15.1%) (p=0.03). At one year 4 deaths were recorded in pre-BAV
group (4.7%) and 3 deaths in no-BAV group (3.5%). There was no difference
in Kaplan-Meier plots between the two groups in all-cause mortality
(log-rank p=0.72). Similarly, there was no difference in one-year
incidence of stroke (log-rank p=0.55), cardiac death (log-rank p=0.66),
non-cardiac death (log-rank p=0.98) and heart failure hospitalizations
(log-rank p=0.31). Lastly, there was no difference in the incidence of
permanent pacemaker implantation between the two groups at one year (27/67
in no-BAV group versus 20/69 in pre-BAV group, log-rank p=0.24). Of note
the depth of implantation was similar between the two groups (no-BAV:
6.16+/-1.86 mm versus pre-BAV: 5.56+/-1.98 mm, p=0.06) Conclusion Direct
implantation of a self-expanding valve is noninferior to pre-dilatation
procedure and has no impact on one-year clinical outcomes. Copyright
© 2021 American College of Cardiology Foundation

<135>
Accession Number
2011745125
Title
AORTIC VALVE REPLACEMENT VS BALLOON-EXPANDABLE AND SELF-EXPANDABLE
TRANSCATHETER IMPLANTATION: A NETWORK META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1157), 2021. Date of
Publication: 11 May 2021.
Author
Bruno F.; D'Ascenzo F.; Baldetti L.; Franchin L.; Marengo G.; Breviario
S.; Melillo F.; Gallone G.; De Filippo O.; La Torre M.; Rinaldi M.; Omede
P.; Conrotto F.; Salizzoni S.; De Ferrari G.
Institution
(Bruno, D'Ascenzo, Baldetti, Franchin, Marengo, Breviario, Melillo,
Gallone, De Filippo, La Torre, Rinaldi, Omede, Conrotto, Salizzoni, De
Ferrari) A.O.U. Citta della Salute e della Scienza, Torino, Turin, Italy
Publisher
Elsevier Inc.
Abstract
Background While clinical equipoise has been demonstrated for surgery and
transcatheter aortic valve interventions (TAVI) in appropriate candidates
with severe aortic stenosis, observational data have raised concerns about
safety of self-expandable (SE) compared to balloon-expandable (BE) valves
in TAVI, although potentially limited by patient selection bias. Methods
All Randomized Controlled Trials comparing BE vs. SE TAVI or/and vs.
aortic valve replacement (AVR) were included and compared through Network
Meta-Analysis (NMA). All-cause and cardiovascular (CV) mortality during
follow up were the primary endpoints, while stroke, rates of permanent
pacemaker implantation (PPI), moderate/severe paravalvular leak (PVL) and
re-intervention were the secondary endpoints. Results We obtained data
from 11 studies, encompassing 9752 patients (3 with patients at low, 3
with patients at intermediate and 5 with patients at high surgical risk).
After one and two years, no significant differences were noted for
all-cause and CV mortality between BE, SE and surgical bioprosthetic
valves. Compared to AVR, both BE and SE TAVI reduced the risk of acute
kidney injury (OR 0.42; CI 95% 0.30-0.60 and OR 0.44; CI 95% 0.32-0.60),
new-onset atrial fibrillation (OR 0.24; CI 95% 0.14-0.42 and OR 0.21; CI
95% 0.13-0.34) and major bleedings (OR 0.32; CI 95% 0.16-0.65 and OR 0.47;
CI 95% 0.25-0.89) but were associated with increased risk of vascular
complications (OR 2.29; CI 95% 1.37-3.85 for BE and OR 2.76; CI 95%
1.66-4.61 for SE). The BE prostheses reduced the risk of moderate/severe
PVL at 30-day (OR 0.31; CI 95% 0.17-0.55) and of PPI both at 30-day (OR
0.51; CI 95% 0.33-0.79) and 1 year (OR 0.40; CI 95% 0.30-0.55) as compared
to SE TAVI. Aortic valve reintervention was increased in SE prostheses
compared to surgery (OR 3.13; CI 95% 1.47-6.64), while in BE prostheses
were not (OR 2.26; CI 95% 0.93-5.47). Conclusion A TAVI strategy,
independently from BE or SE prostheses, offers a survival benefits
comparable to AVR. BE prostheses are associated with a reduction of PPI
and PVL compared to SE prostheses without any differences in all-cause and
CV mortality during two years of follow up. PROSPERO ID
CRD42020182407 Copyright © 2021 American College of Cardiology
Foundation

<136>
Accession Number
2011744984
Title
COMPARISON OF CLINICAL OUTCOMES IN TRANSCATHETER AORTIC VALVE REPLACEMENT
WITH MECHANICALLY EXPANDED VALVE VERSUS SELF-EXPANDABLE VALVE: A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 1118), 2021. Date of
Publication: 11 May 2021.
Author
Akhtar K.H.; Hafeez H.; Akhtar H.H.; Nasir Y.; Jafry A.; Hawkins B.;
Rousan T.
Institution
(Akhtar, Hafeez, Akhtar, Nasir, Jafry, Hawkins, Rousan) University of
Oklahoma Health Sciences Center, Oklahoma City, OK, United States
Publisher
Elsevier Inc.
Abstract
Background Mechanically expanded valve (MEV) has been recalled due to
complications with device delivery system, leaving uncertainty around its
implications in patients who have already received the device. We have
compared clinical outcomes of Transcatheter aortic valve replacement
(TAVR) with Mechanically expanded valve versus Self-expandable valve
(SEV). Methods A systematic search was conducted by 2 independent
researchers in MEDLINE and EMBASE for studies comparing clinical outcomes
of MEV and SEV. 1 randomized controlled trial, and 11 observational
studies met the inclusion criteria. Mantel-Haenszel odds ratios (random
effects model) were calculated and for heterogeneity I2
statistics were reported Results A total of 12 studies with 5043 patients
were included. MEV and SEV were implanted in 1072 and 3971 patients
respectively. MEV showed statistically significant increase in permanent
pacemaker implantation (PPM) at 30-days (OR: 1.52; 95% CI: 1.11-2.10; p =
0.010), and at 1-year interval (OR: 1.95; 95% CI: 1.18-3.23; p = 0.010)
(Figure-1). There was no statistically significant difference in 30-day
cardiovascular mortality (OR: 1.34; CI: 0.50-3.60), stroke (OR: 2.72; CI:
0.98-7.53), major vascular complications (OR: 0.78; CI: 0.30-2.05) and
1-year All-cause mortality (OR: 0.90, CI: 0.61-1.33) (Figure-1).
Conclusion While MEV and SEV had similar clinical outcomes, patients
undergoing TAVR with MEV had statistically significant increase in PPM
implantation. [Formula presented] Copyright © 2021 American
College of Cardiology Foundation

<137>
Accession Number
2011744707
Title
DAYS AT HOME AFTER TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT
IN INTERMEDIATE-RISK PATIENTS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 990), 2021. Date of Publication:
11 May 2021.
Author
Chung M.; Faridi K.; Kazi D.; Burke L.; Wadhera R.; Butala N.; Almarzooq
Z.; Liu D.; Song Y.; Baron S.; Shen C.; Yeh R.
Institution
(Chung, Faridi, Kazi, Burke, Wadhera, Butala, Almarzooq, Liu, Song, Baron,
Shen, Yeh) Massachusetts General Hospital, Boston, MA, United States
(Chung, Faridi, Kazi, Burke, Wadhera, Butala, Almarzooq, Liu, Song, Baron,
Shen, Yeh) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background Days at Home (DAH), an emerging patient-centered outcome that
quantifies time spent at home after a medical event, has not been fully
described in trials evaluating transcatheter aortic valve replacement
(TAVR). We sought to compare 1-year DAH (DAH<inf>365</inf>) among
intermediate-risk patients participating in a randomized trial of TAVR
with a self-expanding bioprosthesis versus surgical aortic valve
replacement (SAVR). Methods We linked data from the SURTAVI (Surgical or
Transcatheter Aortic-Valve Replacement in Intermediate Risk Patients)
trial to Medicare claims in 1005 patients (507 TAVR, 498 SAVR).
DAH<inf>365</inf> was calculated as the number of days alive and spent
outside of a hospital, skilled nursing facility (SNF), rehabilitation
facility, long-term acute care hospital (LTAC), emergency department (ED),
or observation stay. Results Mean DAH<inf>365</inf> was higher in patients
who underwent TAVR compared with SAVR (339.3+/-63.7 vs. 330.5+/-64.8;
p=0.03). Compared with SAVR, TAVR patients had a shorter index length of
stay (5.4+/-2.8 vs. 9.1+/-4.4, p<0.001) and fewer days in a facility after
discharge from the index hospitalization (7.9+/-18.7 vs. 13.7+/-24.5,
p<0.001) including fewer SNF (3.4+/-12.1 vs. 7.7+/-18.5, p<0.001) and
rehabilitation days (0.2+/-1.9 vs. 0.5+/-2.7, p=0.02). Both groups had
similar readmission (3.6+/-8.1 vs. 4.5+/-9.2, p=0.11), LTAC (0.2+/-2.7 vs.
0.4+/-3.4, p=0.30), ED (0.3+/-0.8 vs. 0.4+/-1.1, p=0.26), and observation
days (0.1+/-0.5 vs. 0.1+/-0.5, p=0.79). Conclusion In the SURTAVI trial
linked to Medicare, intermediate-risk patients undergoing TAVR have 8.8
more DAH<inf>365</inf> compared with SAVR due to shorter index
hospitalizations and fewer days in SNFs and rehabilitation. Use of
DAH<inf>365</inf> may complement traditional outcomes to inform
decision-making for invasive procedures. Copyright © 2021
American College of Cardiology Foundation

<138>
Accession Number
2011744487
Title
NETWORK META-ANALYSIS OF REVASCULARIZATION STRATEGIES FOR PATIENTS WITH
CORONARY ARTERY DISEASE AND REDUCED EJECTION FRACTION.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 75), 2021. Date of Publication:
11 May 2021.
Author
Yokoyama Y.; Fukuhara S.; Mori M.; Noguchi M.; Takagi H.; Briasoulis A.;
Kuno T.
Institution
(Yokoyama, Fukuhara, Mori, Noguchi, Takagi, Briasoulis, Kuno) St. Luke's
University Health Network, Bethlehem, PA, United States
Publisher
Elsevier Inc.
Abstract
Background Optimal treatment for patients with coronary artery disease
(CAD) and reduced left ventricular ejection fraction (EF) remains
controversial. Methods Pubmed and EMBASE were searched to identify
randomized controlled trials and propensity-score matched studies that
investigated the outcomes of coronary artery bypass graft (CABG),
percutaneous coronary intervention (PCI), and optimal medical treatment
(OMT) for patients with CAD with reduced EF (<=50%). The primary outcome
was all-cause mortality and the secondary outcomes were the rates of major
adverse cardiac and cerebrovascular events (MACCE), myocardial infarction
(MI), stroke, and revascularization. Results Three randomized controlled
trials and 10 propensity-score matched studies were identified. Pooled
analyses demonstrated that all-cause mortality and the rates of MACCE and
MI were significantly lower in patients with CABG compared with those with
PCI or OMT. The rates of revascularization were higher in PCI compared
with CABG. In contrast, the rates of stroke were similar among the three
groups. There were no significant differences among any of the outcomes
between PCI and OMT. Conclusion In this network meta-analysis of three
treatment strategies for patients with CAD and reduced EF, the rates of
all-cause death, MACCE, and MI were significantly lower in patients
treated with CABG than those treated with PCI or OMT. The rates of
revascularization were higher in PCI compared with CABG. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<139>
Accession Number
2011744402
Title
USE OF COLCHICINE FOR SECONDARY PREVENTION OF CARDIOVASCULAR EVENTS:
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 24), 2021. Date of Publication:
11 May 2021.
Author
Kassab K.; Chuy K.L.; Vij A.
Institution
(Kassab, Chuy, Vij) Cook County Health, Chicago, IL, United States
Publisher
Elsevier Inc.
Abstract
Background The anti-inflammatory properties of colchicine render it a
novel therapeutic option for secondary cardiovascular prevention in
patients with coronary artery disease (CAD). We performed a comprehensive
meta-analysis to assess the efficacy and safety of addition of colchicine
vs. placebo to standard medical therapy for secondary cardiovascular
prevention among patients with CAD. Methods A systematic literature search
was performed for randomized controlled trials meeting our inclusion
criteria. Three trials (COLCOT, COPS, LoDoCo2) were included for analysis.
We analyzed 11,062 patients (5,524 in colchicine arm and 5,538 in placebo
therapy arm). Primary outcome was MACE which was a composite of
cardiovascular (CV) death, myocardial infarction (MI), urgent coronary
revascularization (CR) and stroke (MACE). Secondary outcomes included CV
death, MI, urgent CR and stroke. Results There was statistically
significant lower rates of primary outcome in colchicine arm compared to
placebo arm [odds ratio (OR) = 0.71; 95% CI (confidence interval 0.62 to
0.81; p <0.001]. There was significantly lower rate of MI, stroke, and
urgent CR in colchicine arm but no significant difference in CV death
between the two arms. Conclusion Addition of low-dose colchicine to
standard medical therapy reduces the incidence of major cardiovascular
events including MI and stroke and urgent CR. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<140>
Accession Number
2011744395
Title
STRUCTURAL VALVE DETERIORATION OF TRANSCATHETER VERSUS SURGICAL AORTIC
VALVES IN PATIENTS WITH CHRONIC KIDNEY DISEASE: INSIGHTS FROM THE PARTNER
2A TRIAL AND SAPIEN 3 INTERMEDIATE RISK REGISTRY.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 916), 2021. Date of Publication:
11 May 2021.
Author
Garcia S.; Cubeddu R.; Hahn R.; Ternacle J.; Kapadia S.; Kodali S.;
Thourani V.; Jaber W.; Asher C.; Elmariah S.; Makkar R.; Webb J.; Herrmann
H.; Lu M.; Devireddy C.; Malaisrie S.C.; Smith C.; Mack M.; Cavalcante J.;
Leon M.; Pibarot P.
Institution
(Garcia, Cubeddu, Hahn, Ternacle, Kapadia, Kodali, Thourani, Jaber, Asher,
Elmariah, Makkar, Webb, Herrmann, Lu, Devireddy, Malaisrie, Smith, Mack,
Cavalcante, Leon, Pibarot) Minneapolis Heart Institute, Minneapolis, MN,
United States
(Garcia, Cubeddu, Hahn, Ternacle, Kapadia, Kodali, Thourani, Jaber, Asher,
Elmariah, Makkar, Webb, Herrmann, Lu, Devireddy, Malaisrie, Smith, Mack,
Cavalcante, Leon, Pibarot) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec (IUCPQ) - Universite Laval, Canada
Publisher
Elsevier Inc.
Abstract
Background Patients with severe aortic stenosis (AS) and chronic kidney
disease (CKD) preferentially receive bioprosthetic valves. Controversy
exists as to the long-term durability of surgical versus transcatheter
heart valves, particularly among patients with CKD. Methods We conducted a
pooled sub-group analysis of intermediate-risk patients with severe AS and
moderate-severe CKD (eGFR < 60 ml/m/m2) enrolled in the Placement of
Aortic Transcatheter Valves (PARTNER) 2A trial (patients were randomly
assigned to either SAPIEN XT TAVR or SAVR) and SAPIEN 3 Intermediate Risk
Registry. A core-lab adjudicated analysis of structural valve
deterioration (SVD) and bioprosthetic valve failure (BVF), as defined by
the Valve Academic Research Consortium 3 (VARC-3) criteria, was performed.
Results Of the 1,524 patients with severe AS and moderate-severe CKD
included in the analysis, 1,045 underwent TAVR and 479 had SAVR. Rates of
Stage 2 or 3 SVD, SVD-related BVF, and all-cause BVF at 5 years are
presented in the Table. Compared to SAVR, SVD Stage 2 or 3 (0.2% vs 2.4%,
p = 0.04) and all-cause BVF (0.8% vs 4.0%, p = 0.02) were significantly
greater in the SAPIEN XT cohort; however, there were no significant
differences between SAVR and TAVR with the SAPIEN 3 valve. Conclusion In
patients with severe AS and moderate-severe CKD, rates of SVD and BVF were
low at 5 years in both SAVR and TAVR cohorts; and, comparable durability
was observed between SAVR and the third generation SAPIEN 3 transcatheter
heart valve. [Formula presented] Copyright © 2021 American
College of Cardiology Foundation

<141>
Accession Number
2011744236
Title
TRENDS, PREDICTORS, AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION
COMPLICATED BY IN-HOSPITAL CARDIAC ARREST.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 203), 2021. Date of Publication:
11 May 2021.
Author
Abe T.; Olanipekun T.; Effoe V.S.; Igwe J.; Egbuche O.; Ogunbayo G.; Amah
C.; Chang A.; Morkeh P.; Huynh K.; Echols M.; Onwuanyi A.
Institution
(Abe, Olanipekun, Effoe, Igwe, Egbuche, Ogunbayo, Amah, Chang, Morkeh,
Huynh, Echols, Onwuanyi) Morehouse School of Medicine, Atlanta, GA, United
States
Publisher
Elsevier Inc.
Abstract
Background Data on the incidence, predictors, and outcomes of sudden
cardiac arrest (SCA) in the immediate post-percutaneous coronary
intervention (PCI) period are limited. In this study, we investigate the
trends in the incidence of SCA occurring within 48 hours post-PCI,
predictors of SCA in this time frame, and in-hospital and 30-day
post-discharge mortality among these patients. Methods We systematically
reviewed and extracted data from the electronic medical records of 1492
patients who underwent PCI for acute myocardial infarction (AMI) at Grady
Memorial Hospital in Atlanta, Georgia, between January 2014 to December
2019. We excluded 220 patients with incomplete data, those with elective
PCI or referred for emergent coronary artery bypass graft surgery. The
incidence and predictors of SCA 48 hours post-PCI was determined. We
compared in-hospital mortality and 30-day post-discharge mortality between
propensity-matched patients with and without SCA 48 hours post-PCI.
Results 1,272 patients who underwent PCI for AMI were identified; 60 (5%)
had SCA within 48 hours post-PCI. For the total study population, SCA
incidence within 48 hours post-PCI decreased from 6% in 2014 and 3% in
2019; p=0.85. In patients with ST-elevation myocardial infarction (STEMI),
the incidence decreased from 22% in 2014 to 8% in 2019; p=0.03 and
unchanged in non-STEMI from 1.1% in 2014 to 1.1% 2019; p=0.15.
Out-of-hospital cardiac arrest prior to hospitalization, cardiogenic
shock, left anterior descending coronary artery disease, and left anterior
descending artery PCI, were significant SCA predictors. After propensity
matching, in-hospital mortality (45% vs 9.1%; p<0.0001) and 30-day
post-discharge mortality (20% vs 3.7%; p<0.0001) were significantly higher
in patients with SCA. Similar findings were observed in in-hospital
mortality stratified by STEMI (65% vs 9.1%; p=0.001) and Non-STEMI (25% vs
9.1%; p=0.001). In-hospital mortality in patients with SCA decreased from
71% in 2014 to 40% in 2019; p=0.58. Conclusion We identified essential
factors associated with SCA within 48 hours post-PCI. Future studies are
needed to devise effective strategies to decrease SCA's risk in the
early post-PCI period. Copyright © 2021 American College of
Cardiology Foundation

<142>
Accession Number
2011743943
Title
DUAL ANTI-PLATELET THERAPY AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION-
A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 944), 2021. Date of Publication:
11 May 2021.
Author
Upadhaya S.; Madala S.; Tiwari K.
Institution
(Upadhaya, Madala, Tiwari) Vidant Roanoke-Chowan Hospital, Ahoskie, NC,
United States
Publisher
Elsevier Inc.
Abstract
Background Transcatheter aortic valve implantation (TAVI) is considered
standard treatment modality for symptomatic AS. There is paucity of
evidence regarding the antiplatelets therapy after TAVI especially in
patients with no indication for dual antiplatelet therapy (DAPT) and
anticoagulation. Methods Systematic electronic search of PubMed and EMBASE
databases was performed for randomized studies that compared aspirin with
DAPT for patients who underwent TAVI. The efficacy outcomes were major or
disabling stroke, myocardial infarction (MI) and all-cause mortality, and
the primary safety outcome was incidence of major or life-threatening
bleeding. Results Four randomized controlled studies comparing DAPT with
aspirin (1446 patients in DAPT group and 1448 in aspirin group) were
included in our study. Use of DAPT did not lead to significant decrease in
major or disabling stroke (OR: 1.53 [0.60-3.94], I2 =0%, p
value = 0.38), MI (OR:0.50 [0.17-1.41], I2 =0%, p value =
0.19)(Figure 1) and all-cause mortality (OR: 1.01[0.61-1.68],
I2 = 0%, p value = 0.96) However, use of DAPT was associated
with significant increase in rates of major or life threatening bleeding
(OR: 0.48 [0.30-0.77, I2 = 0%, p value = 0.002). Conclusion
This meta-analysis showed similar pooled major or disabling stroke, MI and
all-cause mortality rates in patient being treated with DAPT, whereas
higher rate of major or life-threatening bleeding. DAPT has similar
efficacy and worse safety profile compared with aspirin alone. [Formula
presented] Copyright © 2021 American College of Cardiology
Foundation

<143>
Accession Number
2011743761
Title
DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONIST AFTER TRANSCATHETER
AORTIC VALVE REPLACEMENT IN PATIENT WITH ATRIAL FIBRILLATION: A
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 1) (pp 945), 2021. Date of Publication:
11 May 2021.
Author
Vutthikraivit W.; Rattanawong P.; Putthapiban P.; Pachariyanon P.; Bedanie
G.; Parmar K.; Hanna E.
Institution
(Vutthikraivit, Rattanawong, Putthapiban, Pachariyanon, Bedanie, Parmar,
Hanna) University of Iowa, Iowa City, IA, United States
Publisher
Elsevier Inc.
Abstract
Background Atrial fibrillation (AF) is highly prevalent among patients
undergoing transcatheter aortic valve replacement (TAVR). Optimal
anticoagulation strategy, whether vitamin K antagonist (VKA) or direct
oral anticoagulant (DOAC), is controversial in this population. Methods We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to Dec 2020. Included studies were published cohort that
compared clinical outcomes between DOAC-treated and VKA-treated after TAVR
in patients with atrial fibrillation. Primary outcome is all-cause
mortality. Secondary outcomes are major and/or life-threatening bleeding
and stroke. Data from each study were combined using the random-effects
model. Results Six cohort studies were included involving 3,490 patients
with AF who underwent TAVR (2,328 received VKA and 1,162 received DOAC).
There was no significant difference in primary outcome between 2 groups
([OR] 0.88, 95% CI 0.55-1.40, I2=74.7%, p=0.584) (Figure 1).
There was also no significant difference found in the secondary outcomes
of major and/or life-threatening bleeding and stroke ([OR] 0.85, 95% CI
0.66-1.09, I2=0.0%, p=0.754, and [OR] 1.43, 95% CI 0.90-2.30,
I2=0.0%, p=0.872, respectively) (Figure 1). There was no
publication bias observed in Funnel plot. Conclusion Our study showed that
DOAC was associated with similar clinical outcomes to VKA in TAVR patients
with AF. DOAC could be considered as an alternative treatment in this
setting. [Formula presented] Copyright © 2021 American College of
Cardiology Foundation

<144>
Accession Number
2011718717
Title
DO REPORTED HEALTH BENEFITS OF MODERATE ALCOHOL USE INFLUENCE DRINKING
BEHAVIOR IN PATIENTS WITH HEART DISEASE?.
Source
Journal of the American College of Cardiology. Conference: ACC.21.
Virtual, Online. 77 (18 Supplement 2) (pp 9), 2021. Date of Publication:
11 May 2021.
Author
Medling T.; Gobeil K.; Sawalha K.; Abozenah M.; Tavares P.; Friedman P.;
Naimi T.; Pack Q.
Institution
(Medling, Gobeil, Sawalha, Abozenah, Tavares, Friedman, Naimi, Pack)
Baystate Medical Center, Springfield, MA, United States
Publisher
Elsevier Inc.
Abstract
Background Over the past two decades, multiple media reports have cited a
variety of observational studies and meta-analyses to promote a
cardiovascular benefit of moderate alcohol consumption. However, it is
unclear if these reports have influenced public opinion and drinking
behavior among patients with established heart disease. Methods We
performed a single-center, 35-question, cross-sectional, patient-level
anonymous survey among patients hospitalized for acute cardiac illnesses
including cardiac surgery, heart failure, or myocardial infarction from
June to September 2019. We assessed patient drinking behavior using
validated survey instruments and assessed patient opinion towards the
health effects of alcohol. We then analyzed the associations between these
two. Results Of 300 patients approached, 290 (97%) patients completed the
survey (33% never-drinkers, age 69 +/- 11 years, 70% male). A majority of
patients (69%) reported having previously heard that moderate alcohol use
is heart healthy from one or more media sources including: TV (61%),
friends/family (33%), and newspapers (21%), although many fewer (19%)
actually believed that moderate alcohol use conferred a cardiovascular
benefit. Importantly, based on reported heart health benefits of alcohol,
6% of drinkers increased their alcohol consumption and another 6% drank
more alcohol than they otherwise thought they should. There was a strong
association [OR 5.2, (95% CI 1.5, 17.5), p = 0.008] between binge drinking
behavior and increasing alcohol intake due to perceived heart health
benefits. As a result of hospitalization, 28% of drinkers intended to
reduce alcohol use while only 2% planned to increase alcohol consumption.
Conclusion Among patients hospitalized with heart disease, a majority
report having heard that moderate alcohol use is heart healthy. In
addition, we identified a strong association between binge drinking
behavior and those justifying increased alcohol use as heart healthy.
Given the known cardiotoxic effects of alcohol, particularly in large
doses, strategies aimed at population-based education regarding the
cardiovascular impact of alcohol use is needed, particularly among binge
drinkers. Copyright © 2021 American College of Cardiology
Foundation

<145>
Accession Number
2011900511
Title
Perioperative identifications of non-palpable pulmonary nodules: A
narrative review.
Source
Journal of Thoracic Disease. 13 (4) (pp 2524-2531), 2021. Date of
Publication: April 2021.
Author
Imperatori A.; Nardecchia E.; Cattoni M.; Mohamed S.; Di Natale D.; Righi
I.; Mendogni P.; Diotti C.; Rotolo N.; Dominioni L.; Rosso L.
Institution
(Imperatori, Nardecchia, Cattoni, Di Natale, Rotolo, Dominioni) Center for
Thoracic Surgery and Center for Minimally Invasive Surgery, Department of
Medicine and Surgery, University of Insubria, Varese, Italy
(Mohamed, Righi, Mendogni, Diotti, Rosso) Thoracic Surgery and Lung
Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Via F. Sforza 35, Milan 20122, Italy
Publisher
AME Publishing Company
Abstract
Early detection of lung cancer is the key to improving treatment and
prognosis of this disease, and the advent of advances in computed
tomography (CT) imaging and national screening programs have improved the
detection rate of very small pulmonary lesions. As such, the management of
this sub-centimetric and often sub-solid lesions has become quite
challenging for clinicians, especially for choosing the most suitable
diagnostic method. In clinical practice, to fulfill this diagnostic yield,
transthoracic needle biopsy (TTNB) is often the first choice especially
for peripheral nodules. For lesions for which TTNB could present technical
difficulties or failed, other diagnostic strategies are needed. In this
case, video-assisted thoracic surgery (VATS) is the gold standard to reach
the diagnosis of lung nodules suspect of being malignant. Nonetheless it's
often not easy the identification of such lesions during VATS because of
their little dimensions, non-firm consistency, deep localization. In
literature various marking techniques have been described, in order to
improve intraoperative nodules detection and to reduce conversion rate to
thoracotomy: CT-guided hookwire positioning, methylene blue staining,
intra-operative ultrasound and electromagnetic navigation bronchoscopy are
the most used. The scientific evidence on this matter is weak because
there are no randomized clinical trials but only case series on single
techniques with no comparison on efficacy, so there are no guidelines to
refer. From this standing, in this article we conducted a narrative review
of the existing literature on the subject, with the aim of outlining a
framework as complete as possible. We analyzed strengths and weaknesses of
the main techniques reported, so as to allow the clinician to orient
himself with greater ease. Copyright © Journal of Thoracic
Disease. All rights reserved.

<146>
Accession Number
634920883
Title
Do existing real-world data sources generate suitable evidence for the HTA
of medical devices in Europe? Mapping and critical appraisal.
Source
International Journal of Technology Assessment in Health Care. (no
pagination), 2021. Article Number: e62. Date of Publication: 2021.
Author
Pongiglione B.; Torbica A.; Blommestein H.; De Groot S.; Ciani O.; Walker
S.; Dams F.; Blankart R.; Mollenkamp M.; Kovacs S.; Tarricone R.; Drummond
M.
Institution
(Pongiglione, Torbica, Ciani, Tarricone) Centre for Research on Health and
Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi
University, Milano, Italy
(Blommestein, De Groot) Erasmus School of Health Policy and Management,
Erasmus University Rotterdam, Rotterdam, Netherlands
(Ciani) College of Medicine and Health, Institute of Health Research,
University of Exeter, Exeter, United Kingdom
(Walker) Exeter University, Exeter, United Kingdom
(Dams, Blankart) KPM Center for Public Management, University of Bern,
Bern, Switzerland
(Blankart) Sitem-insel AG, Swiss Institute for Translational and
Entrepreneurial Medicine, Bern, Switzerland
(Mollenkamp) Hamburg Center for Health Economics, Universitat Hamburg,
Hamburg, Germany
(Kovacs) Syreon Research Institute, Budapest, Hungary
(Drummond) Centre for Health Economics, University of York, York, United
Kingdom
Publisher
Cambridge University Press
Abstract
Aim Technological and computational advancements offer new tools for the
collection and analysis of real-world data (RWD). Considering the
substantial effort and resources devoted to collecting RWD, a greater
return would be achieved if real-world evidence (RWE) was effectively used
to support Health Technology Assessment (HTA) and decision making on
medical technologies. A useful question is: To what extent are RWD
suitable for generating RWE? Methods We mapped existing RWD sources in
Europe for three case studies: hip and knee arthroplasty, transcatheter
aortic valve implantation (TAVI) and mitral valve repair (TMVR), and
robotic surgery procedures. We provided a comprehensive assessment of
their content and appropriateness for conducting the HTA of medical
devices. The identification of RWD sources was performed combining a
systematic search on PubMed with gray literature scoping, covering fifteen
European countries. Results We identified seventy-one RWD sources on
arthroplasties; ninety-five on TAVI and TMVR; and seventy-seven on robotic
procedures. The number, content, and integrity of the sources varied
dramatically across countries. Most sources included at least one health
outcome (97.5%), with mortality and rehospitalization/reoperation the most
common; 80% of sources included resource outcomes, with length of stay the
most common, and comparators were available in almost 70% of sources.
Conclusions RWD sources bear the potential for the HTA of medical devices.
The main challenges are data accessibility, a lack of standardization of
health and economic outcomes, and inadequate comparators. These findings
are crucial to enabling the incorporation of RWD into decision making and
represent a readily available tool for getting acquainted with existing
information sources. Copyright © The Author(s), 2021. Published
by Cambridge University Press.

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