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<1>
Accession Number
630600451
Title
Efficacy of paravertebral block techniques in thoracic surgery: Systematic
literature review.
Source
Colombian Journal of Anesthesiology. 48 (1) (pp 20-29), 2020. Date of
Publication: 01 Jan 2020.
Author
Cadavid-Puentes A.M.; Casas-Arroyave F.D.; Palacio-Montoya L.M.;
Valencia-Gallon E.
Institution
(Cadavid-Puentes, Casas-Arroyave) Anesthesiology and Reanimation Division,
Universidad de Antioquia, Hospital Universitario San Vicente Fundacion,
Calle 64 No. 51D-154, Medellin, Colombia
(Palacio-Montoya, Valencia-Gallon) IPS Universitaria, Universidad de
Antioquia, Medellin, Colombia
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction:Postoperative pain in thoracic surgery in adults is usually
severe, and to control it there are many analgesic methods that include
paravertebral blockade (PVB). Until now, there is no clarity on which is
the most effective technique to perform this blockade.
 Objective(s):To describe the different PVB techniques and its
analgesic effect in thoracic surgery. Method(s):A systematic review
of the literature was performed. We included studies that analyzed
patients in open chest surgery and used PVB as analgesic technique. The
Cochrane and Grading of Recommendation Assessment, Development and
Evaluation strategies were used to analyze biases and evidence. The
results are presented graphically by means of a visual analog scale (VAS)
pain and opioid consumption equivalent to morphine for each technique
found. We summarize the results with a qualitative approach without
meta-analysis. Result(s):A total of 38 articles were analyzed (2188
patients). 13 using PVB guided by surface anatomy (SA-PVB), 7
Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and
the remaining using PVB performed under direct visualization by the
surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and
US-PVB, and greater than 5 in studies with S-PVB; however, opioid
consumption in the postoperative period was similar between the techniques
described. Conclusion(s):PVB can be performed through 4 techniques.
Techniques of US-PVB or SA-PVB have shown better consistency to manage
postoperative acute pain in thoracic surgery. Copyright © 2019
Sociedad Colombiana de Anestesiologia y Reanimacion (S.C.A.R.E.).
Published by Wolters Kluwer.

<2>
Accession Number
628886804
Title
Perioperative use of levosimendan in patients undergoing cardiac surgery:
Systematic review and meta-analysis.
Source
Colombian Journal of Anesthesiology. 47 (3) (pp 142-153), 2019. Date of
Publication: 01 Jul 2019.
Author
Oliveros H.; Garcia H.; Rubio C.; Navarrete J.
Institution
(Oliveros) Universidad de la Sabana, Campus Puente del Comun, Chia,
Cundinamarca, Colombia
(Garcia, Rubio, Navarrete) Hospital Militar Central, Bogota, Colombia
(Garcia, Rubio, Navarrete) Universidad Militar Nueva Granada, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Patients undergoing cardiac surgery frequently develop low
cardiac output syndrome (LCOS). Multiple interventions including
levosimendan have been used in the prevention and treatment of LCOS.
Preliminary studies reported lower mortality respect to placebo or other
inotropes, however, recently, 3 clinical trials found no benefit against
this outcome. Objective(s): Our objective was to evaluate the
evidence of levosimendan on mortality and secondary outcomes in patients
undergoing cardiac surgery, and to determine the sources of heterogeneity.
 Method(s): We conducted a systematic review and meta-analysis of the
clinical trials that evaluated the efficacy of levosimendan in patients
undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality
and other outcomes such as kidney injury with dialysis requirement and
LCOS, using fixed and random effects models. The risk of bias was assessed
and the sources of heterogeneity were explored. Result(s): Of 47
studies identified, 14 studies were selected (n=2752). Regarding the
mortality outcome and use of levosimendan, only a decrease was found in
the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While
high-quality studies, there was no protective effect (OR 0.99, 95% CI
0.70-1.40) with an I2 = 0%. The quality of the studies and
ejection fraction were the main sources of heterogeneity.
 Conclusion(s): In high-quality studies, the use of levosimendan in
patients undergoing cardiovascular surgery has no effect on 30-day
mortality. There was a protective effect on postoperative renal failure
with dialysis. Copyright © 2019 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.).

<3>
Accession Number
624465199
Title
Surgical ablation of atrial fibrillation: A systematic review
andmeta-analysis of randomized controlled trials.
Source
Europace. 20 (9) (pp 1442-1450), 2018. Date of Publication: 01 Sep 2018.
Author
McClure G.R.; Belley-Cote E.P.; Jaffer I.H.; Dvirnik N.; An K.R.; Fortin
G.; Spence J.; Healey J.; Singal R.K.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
1280 Main St W, Hamilton, ON L8S 4L8, Canada
(McClure, Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Healey) Department of Medicine, McMaster University, 1280
Main St W, Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Dvirnik, Healey, Whitlock) Population Health Research
Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
2500 Boulevard de l'Universite, Sherbrooke, QC J1K 2R1, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, 20 Copeland Ave, Hamilton, ON L8L 2X2, Canada
(Jaffer, Dvirnik, Whitlock) Department of Cardiac Surgery, McMaster
University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
(Spence) Department of Anesthesia, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Singal) Department of Surgery, University of Manitoba, 66 Chancellors
Cir, Winnipeg, MB R3T 2N2, Canada
(Singal) I.H. Asper Clinical Research Institute, St. Boniface General
Hospital, 69 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Oxford University Press
Abstract
Aims: The aim of this review was to assess the effect of concomitant
surgical atrial fibrillation (AF) ablation on postoperative freedom from
AF and patient-important outcomes. Methods and Results: We searched
Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016
for randomized controlled trials (RCTs) evaluating surgical AF ablation
using any lesion set vs. no surgical AF ablation in adults with AF
undergoing cardiac surgery. We performed screening, risk-of-bias
evaluation, and data collection independently and in duplicate. We
evaluated risk of bias with the modified Cochrane tool, quality of
evidence using GRADE framework, and pooled data with a random-effects
model. Of the 23 included studies, only one was considered at low risk of
bias. Surgical AF ablation was associated with more freedom from AF at 12
months [relative risk (RR) = 2.32, 95% confidence interval (CI) 1.92-2.80;
P < 0.001, low quality]. However, no significant difference was seen in
mortality (RR = 1.07, 95% CI 0.72-1.52; P = 0.41, moderate quality),
stroke (RR = 1.19, 95% CI 0.59-2.39; P = 0.63, moderate quality), or
pacemaker implantation (RR = 1.28, 95% CI 0.85-1.95; P = 0.24, high
quality). Comparing biatrial and left-sided lesion sets showed no
difference in mortality (P-interaction = 0.60) or stroke (Pinteraction =
0.12). At 12 months, biatrial procedures led to more freedom from AF (RR =
2.80, 95% CI 2.13-3.68; P < 0.0001) when compared with left-sided ablation
(RR = 2.00, 95% CI 1.68-2.39; P < 0.0001) (P-interaction = 0.04) Biatrial
procedures appear to increase the risk for pacemaker (RR = 2.68, 95% CI
1.41-5.11; P = 0.002) compared with no ablation while left-sided ablation
does not (RR = 1.08, 95% CI 0.67-1.74; P = 0.76) (P-interaction = 0.03).
 Conclusion(s): Surgical AF ablation during cardiac surgery improves
freedom from AF. However, impact on patient-important outcomes including
mortality and stroke has not shown statistical significance in current RCT
evidence. Biatrial compared with left-sided lesion sets showed no
difference in mortality or stroke but were associated with significantly
increased freedom from AF and risk for pacemaker
requirement. Copyright © 2017 The Author(s).

<4>
Accession Number
622037763
Title
Amaze: A double-blind, multicentre randomised controlled trial to
investigate the clinical effectiveness and cost-effectiveness of adding an
ablation device-based maze procedure as an adjunct to routine cardiac
surgery for patients with pre-existing atrial fibrillation.
Source
Health Technology Assessment. 22 (19) (pp 1-132), 2018. Date of
Publication: April 2018.
Author
Sharples L.; Everett C.; Singh J.; Mills C.; Spyt T.; Abu-Omar Y.; Fynn
S.; Thorpe B.; Stoneman V.; Goddard H.; Fox-Rushby J.; Nashef S.
Institution
(Sharples) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Everett, Thorpe) Leeds Institute of Clinical Trials Research, University
of Leeds, Leeds, United Kingdom
(Singh) Health Economics Research Group (HERG), Brunel University London,
London, United Kingdom
(Mills, Stoneman, Goddard) Papworth Trials Unit Collaboration, Papworth
Hospital, Cambridge, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Abu-Omar, Fynn, Nashef) Department of Cardiology and Department of
Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
Publisher
NIHR Journals Library
Abstract
Background: Atrial fibrillation (AF) can be treated using a maze procedure
during planned cardiac surgery, but the effect on clinical patient
outcomes, and the cost-effectiveness compared with surgery alone, are
uncertain. Objective(s): To determine whether or not the maze
procedure is safe, improves clinical and patient outcomes and is
cost-effective for the NHS in patients with AF. Design(s):
Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised
controlled trial. Patients were randomised on a 1: 1 basis using random
permuted blocks, stratified for surgeon and planned procedure.
 Setting(s): Eleven acute NHS specialist cardiac surgical centres.
 Participant(s): Patients aged >= 18 years, scheduled for elective or
in-house urgent cardiac surgery, with a documented history (> 3 months) of
AF. Intervention(s): Routine cardiac surgery with or without an
adjunct maze procedure administered by an AF ablation device. Main
Outcome Measure(s): The primary outcomes were return to sinus rhythm (SR)
at 12 months and quality-adjusted life-years (QALYs) over 2 years after
randomisation. Secondary outcomes included return to SR at 2 years,
overall and stroke-free survival, drug use, quality of life (QoL),
cost-effectiveness and safety. Result(s): Between 25 February 2009
and 6 March 2014, 352 patients were randomised to the control (n = 176) or
experimental (n = 176) arms. The odds ratio (OR) for return to SR at 12
months was 2.06 [95% confidence interval (CI) 1.20 to 3.54; p = 0.0091].
The mean difference (95% CI) in QALYs at 2 years between the two trial
arms (maze/control) was -0.025 (95% CI 0.129 to 0.078; p = 0.6319). The OR
for SR at 2 years was 3.24 (95% CI 1.76 to 5.96). The number of patients
requiring anticoagulant drug use was significantly lower in the maze arm
from 6 months after the procedure. There were no significant differences
between the two arms in operative or overall survival, stroke-free
survival, need for cardioversion or permanent pacemaker implants, New York
Heart Association Functional Classification (for heart failure), EuroQol-5
Dimensions, three-level version score and Short Form questionnaire-36
items score at any time point. Sixty per cent of patients in each trial
arm had a serious adverse event (p = 1.000); most events were mild, but 71
patients (42.5%) in the maze arm and 84 patients (45.5%) in the control
arm had moderately severe events; 31 patients (18.6%) in the maze arm and
38 patients (20.5%) in the control arm had severe events. The mean
additional cost of the maze procedure was 3533 (95% CI 1321 to 5746); the
mean difference in QALYs was -0.022 (95% CI -0.1231 to 0.0791). The maze
procedure was not cost-effective at 30,000 per QALY over 2 years in any
analysis. In a small substudy, the active left atrial ejection fraction
was smaller than that of the control patients (mean difference of -8.03,
95% CI -12.43 to -3.62), but within the predefined clinically equivalent
range. Limitation(s): Low recruitment, early release of trial
summaries and intermittent resource-use collection may have introduced
bias and imprecise estimates. Conclusion(s): Ablation can be
practised safely in routine NHS cardiac surgical settings and increases
return to SR rates, but not survival or QoL up to 2 years after surgery.
Lower anticoagulant drug use and recovery of left atrial function support
anticoagulant drug withdrawal provided that good atrial function is
confirmed. Copyright © Queen's Printer and Controller of HMSO
2018.

<5>
Accession Number
610521584
Title
The UK lung cancer screening trial: A pilot randomised controlled trial of
low-dose computed tomography screening for the early detection of lung
cancer.
Source
Health Technology Assessment. 20 (40) (pp 1-146), 2016. Date of
Publication: May 2016.
Author
Field J.K.; Duffy S.W.; Baldwin D.R.; Brain K.E.; Devaraj A.; Eisen T.;
Green B.A.; Holemans J.A.; Kavanagh T.; Kerr K.M.; Ledson M.; Lifford
K.J.; McRonald F.E.; Nair A.; Page R.D.; Parmar M.K.B.; Rintoul R.C.;
Screaton N.; Wald N.J.; Weller D.; Whynes D.K.; Williamson P.R.;
Yadegarfar G.; Hansell D.M.
Institution
(Field, Green, McRonald, Yadegarfar) Department of Molecular and Clinical
Cancer Medicine, Institute of Translational Medicine, University of
Liverpool, Liverpool, United Kingdom
(Duffy) Centre for Cancer Prevention, Wolfson Institute of Preventive
Medicine, Queen Mary University of London, London, United Kingdom
(Baldwin) Respiratory Medicine Unit, David Evans Research Centre,
Department of Respiratory Medicine, Nottingham University Hospitals,
Nottingham, United Kingdom
(Brain, Lifford) Division of Population Medicine, College of Biomedical
and Life Sciences, Cardiff University, Cardiff, United Kingdom
(Devaraj, Hansell) Department of Radiology, Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Eisen) Department of Oncology, University of Cambridge, Cambridge, United
Kingdom
(Holemans) Department of Radiology, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Kavanagh) Lung Cancer Patient Advocate, Liverpool, United Kingdom
(Kerr) Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United
Kingdom
(Ledson) Department of Respiratory Medicine, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Nair) Department of Radiology, Guy's and St Thomas' NHS Foundation Trust,
London, United Kingdom
(Page) Department of Thoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Parmar) MRC Clinical Trials Unit, University College London, London,
United Kingdom
(Rintoul) Department of Thoracic Oncology, Papworth Hospital NHS
Foundation Trust, Cambridge, United Kingdom
(Screaton) Department of Radiology, Papworth Hospital NHS Foundation
Trust, Cambridge, United Kingdom
(Wald) Centre for Environmental and Preventive Medicine, Wolfson Institute
of Preventive Medicine, Queen Mary University of London, London, United
Kingdom
(Weller) School of Clinical Sciences and Community Health, University of
Edinburgh, Edinburgh, United Kingdom
(Whynes) School of Economics, University of Nottingham, Nottingham, United
Kingdom
(Williamson) Department of Biostatistics, Institute of Translational
Medicine, University of Liverpool, Liverpool, United Kingdom
Publisher
NIHR Journals Library
Abstract
Background: Lung cancer kills more people than any other cancer in the UK
(5-year survival < 13%). Early diagnosis can save lives. The USA-based
National Lung Cancer Screening Trial reported a 20% relative reduction in
lung cancer mortality and 6.7% all-cause mortality in low-dose computed
tomography (LDCT)-screened subjects. Objective(s): To (1) analyse
LDCT lung cancer screening in a high-risk UK population, determine optimum
recruitment, screening, reading and care pathway strategies; and (2)
assess the psychological consequences and the health-economic implications
of screening. Design(s): A pilot randomised controlled trial
comparing intervention with usual care. A population-based risk
questionnaire identified individuals who were at high risk of developing
lung cancer (>=5% over 5 years). Setting(s): Thoracic centres with
expertise in lung cancer imaging, respiratory medicine, pathology and
surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth
Hospital, Cambridgeshire. Participant(s): Individuals aged 50-75
years, at high risk of lung cancer, in the primary care trusts adjacent to
the centres. Intervention(s): A thoracic LDCT scan. Follow-up
computed tomography (CT) scans as per protocol. Referral to
multidisciplinary team clinics was determined by nodule size criteria.
 Main Outcome Measure(s): Population-based recruitment based on risk
stratification; management of the trial through web-based database;
optimal characteristics of CT scan readers (radiologists vs.
radiographers); characterisation of CT-detected nodules utilising
volumetric analysis; prevalence of lung cancer at baseline;
sociodemographic factors affecting participation; psychosocial measures
(cancer distress, anxiety, depression, decision satisfaction); and
cost-effectiveness modelling. Result(s): A total of 247,354
individuals were approached to take part in the trial; 30.7% responded
positively to the screening invitation. Recruitment of participants
resulted in 2028 in the CT arm and 2027 in the control arm. A total of
1994 participants underwent CT scanning: 42 participants (2.1%) were
diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected
cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical
resection as their primary treatment. Lung cancer was more common in the
lowest socioeconomic group. Short-term adverse psychosocial consequences
were observed in participants who were randomised to the intervention arm
and in those who had a major lung abnormality detected, but these
differences were modest and temporary. Rollout of screening as a service
or design of a full trial would need to address issues of outreach. The
health-economic analysis suggests that the intervention could be
cost-effective but this needs to be confirmed using data on actual lung
cancer mortality. Conclusion(s): The UK Lung Cancer Screening (UKLS)
pilot was successfully undertaken with 4055 randomised individuals. The
data from the UKLS provide evidence that adds to existing data to suggest
that lung cancer screening in the UK could potentially be implemented in
the 60-75 years age group, selected via the Liverpool Lung Project risk
model version 2 and using CT volumetry-based management
protocols. Copyright © Queen's Printer and Controller of HMSO
2016.

<6>
Accession Number
600593143
Title
Systematic review and modelling of the cost-effectiveness of cardiac
magnetic resonance imaging compared with current existing testing pathways
in ischaemic cardiomyopathy.
Source
Health Technology Assessment. 18 (59) (pp 1-120), 2014. Date of
Publication: 2014.
Author
Campbell F.; Thokala P.; Uttley L.C.; Sutton A.; Sutton A.J.; Al-Mohammad
A.; Thomas S.M.
Institution
(Campbell, Thokala, Uttley, Sutton, Thomas) School of Health and Related
Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
(Sutton) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Al-Mohammad, Thomas) Sheffield Teaching Hospitals, Sheffield, United
Kingdom
Publisher
NIHR Journals Library
Abstract
Conclusions: All the diagnostic pathways are a cost-effective use of NHS
resources. Given the uncertainty in the mortality rates, the
cost-effectiveness analysis was performed using a set of scenarios. The
cost-effectiveness analyses suggest that CE CMR and revascularising
everyone were the optimal strategies. Future research should look at
implementation costs for this type of imaging service, provide guidance on
consistent reporting of diagnostic testing data for viability assessment,
and focus on the impact of revascularisation or best medical therapy in
this group of high-risk patients.
Background: Cardiac magnetic resonance imaging (CMR) is increasingly used
to assess patients for myocardial viability prior to revascularisation.
This is important to ensure that only those likely to benefit are
subjected to the risk of revascularisation.
Objectives: To assess current evidence on the accuracy and
cost-effectiveness of CMR to test patients prior to revascularisation in
ischaemic cardiomyopathy; to develop an economic model to assess
cost-effectiveness for different imaging strategies; and to identify areas
for further primary research.
Limitations: Definitions and techniques assessing viability were highly
variable, making data extraction and comparisons difficult. Lack of
evidence meant assumptions were made in the model leading to uncertainty;
differing scenarios were generated around key assumptions.
Data sources: Databases searched were: MEDLINE including MEDLINE
In-Process & Other Non-Indexed Citations Initial searches were conducted
in March 2011 in the following databases with dates: MEDLINE including
MEDLINE In-Process & Other Non-Indexed Citations via Ovid (1946 to March
2011); Bioscience Information Service (BIOSIS) Previews via Web of Science
(1969 to March 2011); EMBASE via Ovid (1974 to March 2011); Cochrane
Database of Systematic Reviews via The Cochrane Library (1996 to March
2011); Cochrane Central Register of Controlled Trials via The Cochrane
Library 1998 to March 2011; Database of Abstracts of Reviews of Effects
via The Cochrane Library (1994 to March 2011); NHS Economic Evaluation
Database via The Cochrane Library (1968 to March 2011); Health Technology
Assessment Database via The Cochrane Library (1989 to March 2011); and the
Science Citation Index via Web of Science (1900 to March 2011). Additional
searches were conducted from October to November 2011 in the following
databases with dates: MEDLINE including MEDLINE In-Process & Other
Non-Indexed Citations via Ovid (1946 to November 2011); BIOSIS Previews
via Web of Science (1969 to October 2011); EMBASE via Ovid (1974 to
November 2011); Cochrane Database of Systematic Reviews via The Cochrane
Library (1996 to November 2011); Cochrane Central Register of Controlled
Trials via The Cochrane Library (1998 to November 2011); Database of
Abstracts of Reviews of Effects via The Cochrane Library (1994 to November
2011); NHS Economic Evaluation Database via The Cochrane Library (1968 to
November 2011); Health Technology Assessment Database via The Cochrane
Library (1989 to November 2011); and the Science Citation Index via Web of
Science (1900 to October 2011). Electronic databases were searched
March-November 2011.
Review methods: The systematic review selected studies that assessed the
clinical effectiveness and cost-effectiveness of CMR to establish the role
of CMR in viability assessment compared with other imaging techniques:
stress echocardiography, single-photon emission computed tomography
(SPECT) and positron emission tomography (PET). Studies had to have an
appropriate reference standard and contain accuracy data or sufficient
details so that accuracy data could be calculated. Data were extracted by
two reviewers and discrepancies resolved by discussion. Quality of studies
was assessed using the QUADAS II tool (University of Bristol, Bristol,
UK). A rigorous diagnostic accuracy systematic review assessed clinical
and cost-effectiveness of CMR in viability assessment. A health economic
model estimated costs and quality-adjusted life-years (QALYs) accrued by
diagnostic pathways for identifying patients with viable myocardium in
ischaemic cardiomyopathy with a view to revascularisation. The pathways
involved CMR, stress echocardiography, SPECT, PET alone or in combination.
Strategies of no testing and revascularisation were included to determine
the most cost-effective strategy.
Results: Twenty-four studies met the inclusion criteria. All were
prospective. Participant numbers ranged from 8 to 52. The mean left
ventricular ejection fraction in studies reporting this outcome was
24-62%. CMR approaches included stress CMR and late gadolinium-enhanced
cardiovascular magnetic resonance imaging (CE CMR). Recovery following
revascularisation was the reference standard. Twelve studies assessed
diagnostic accuracy of stress CMR and 14 studies assessed CE CMR. A
bivariate regression model was used to calculate the sensitivity and
specificity of CMR. Summary sensitivity and specificity for stress CMR was
82.2% [95% confidence interval (CI) 73.2% to 88.7%] and 87.1% (95% CI
80.4% to 91.7%) and for CE CMR was 95.5% (95% CI 94.1% to 96.7%) and 53%
(95% CI 40.4% to 65.2%) respectively. The sensitivity and specificity of
PET, SPECT and stress echocardiography were calculated using data from 10
studies and systematic reviews. The sensitivity of PET was 94.7% (95% CI
90.3% to 97.2%), of SPECT was 85.1% (95% CI 78.1% to 90.2%) and of stress
echocardiography was 77.6% (95% CI 70.7% to 83.3%). The specificity of PET
was 68.8% (95% CI 50% to 82.9%), of SPECT was 62.1% (95% CI 52.7% to
70.7%) and of stress echocardiography was 69.6% (95% CI 62.4% to 75.9%).
All currently used diagnostic strategies were cost-effective compared with
no testing at current National Institute for Health and Care Excellence
thresholds. If the annual mortality rates for non-viable patients were
assumed to be higher for revascularised patients, then testing with CE CMR
was most cost-effective at a threshold of 20,000/QALY. The proportion of
model runs in which each strategy was most cost-effective, at a threshold
of 20,000/QALY, was 40% for CE CMR, 42% for PET and 16.5% for
revascularising everyone. The expected value of perfect information at
20,000/QALY was 620 per patient. If all patients (viable or not) gained
benefit from revascularisation, then it was most cost-effective to
revascularise all patients. Copyright © Queen's Printer and
Controller of HMSO 2014.

<7>
Accession Number
373903638
Title
Hemodynamic effects of sevoflurane versus dexmedetomidine.
Source
Bahrain Medical Bulletin. 36 (3) (pp 154-158), 2014. Date of Publication:
2014.
Author
Mohamed A.A.; Attia A.R.; Abdelfattah M.M.
Institution
(Attia, Abdelfattah) Mansoura University, Egypt
Publisher
Bahrain Medical Bulletin
Abstract
Background: Cardiac catheterization procedures produce challenges for the
anesthetist because of the increased need to provide support in sedating
and/or anesthetizing patients. Objective(s): To compare pulmonary and
systemic hemodynamics of two anesthetic regimens: sevoflurane as volatile
induction maintenance anesthesia and dexmedetomidine as total intravenous
anesthesia in pediatric patients suffering from congenital heart disease
with left-to-right intracardiac shunt. Design(s): A Prospective
Randomized Study. Setting(s): Mansoura University Children Hospital
(MUCH), Egypt. Method(s): Sixty pediatric patients of both sexes were
referred for elective cardiac catheterization. Patients were randomly
allocated into two equal groups, consisted of 30 patients. In the first
group, the patients received volatile induction maintenance anesthesia
(VIMA) with sevoflurane (GS group) while in the second, the patients
received total intravenous anesthesia (TIVA) with dexmedetomidine (1
mug/kg) intravenous bolus dose over 10 minutes, anesthesia was maintained
by intravenous infusion of dexmedetomidine at a rate of 1-2 mug/kg/hour
(GD group). Result(s): The present study showed that the heart rate
(HR), Pulmonary blood flow index (QpI), Systemic blood flow index (QsI)
and Qp/Qs ratio were comparable in both groups. Pulmonary vascular
resistance index (PVRI) and Systemic vascular resistance index (SVRI) were
significantly lower in GS group after induction of general anesthesia (GA)
if compared with the basal value maintaining PVR/SVR at baseline value.
However, PVRI and SVRI were insignificantly higher in GD group after
induction of GA if compared with the basal value; thus, maintaining
PVR/SVR. The Systemic Mean arterial blood pressure (MAP) decreased in both
groups. Conclusion(s): Total intravenous anesthesia with
dexmedetomidine provided hemodynamic stability. It is comparable to
volatile induction and maintenance of anesthesia with sevoflurane when
administered to pediatric patients suffering from congenital heart disease
with left-to-right intracardiac shunt during cardiac catheterization.

<8>
Accession Number
634475735
Title
Influence of Left Atrial Appendage Amputation on Natriuretic Peptides-A
Randomized Controlled Trial.
Source
Thoracic and Cardiovascular Surgeon. 69 (2) (pp 117-123), 2021. Date of
Publication: 01 Mar 2021.
Author
Grieshaber P.; Arneth B.; Steinsberger F.; Niemann B.; Oswald I.; Renz H.;
Boning A.
Institution
(Grieshaber, Steinsberger, Niemann, Oswald, Boning) Department of Adult
and Pediatric Cardiovascular Surgery, Giessen University Hospital,
Giessen, Germany
(Arneth, Renz) Institute for Laboratory Medicine and Pathobiochemistry,
Giessen University Hospital, Giessen, Germany
Publisher
Georg Thieme Verlag
Abstract
Background: Closure or amputation of the left atrial appendage (LAA) is a
common therapy for atrial fibrillation (AF). As the LAA is a
hormone-producing organ, however, amputation is still somewhat
controversial. We examined patients after surgical AF therapy with or
without LAA amputation to determine the influence of LAA amputation on
pro-atrial natriuretic peptide (proANP) and B-type natriuretic peptide
(BNP) plasma levels and on clinical severity of heart failure.
 Method(s): Twenty-one consecutive patients were prospectively
randomized to either undergo LAA amputation (n = 10) or no LAA amputation
(n = 11) between 05/2015 and 10/2015. All patients underwent coronary
and/or valve surgery and concomitant AF surgery with either cryoablation
(n = 3) or radio frequency ablation (n = 17). ProANP and BNP levels were
measured preoperatively and until 800 days postoperatively.
 Result(s): Baseline proANP values were comparable between the groups
(without LAA amputation: 4.2 +/- 2.1 nmol/L, with LAA amputation: 5.6 +/-
3.6 nmol/L). Postoperatively, proANP levels rose markedly in both groups.
Even after LAA amputation, proANP levels remained elevated for 7 days
postoperatively but fell to baseline levels at day 31 and remained on
baseline level at 800 days postoperatively. ProANP levels in the LAA
amputation group (5.8-9.7 nmol/L) were not significantly lower than in the
group without LAA amputation (9.2-14.1 nmol/L; p = 0.357). BNP levels also
rose after surgery in both groups until day 7. At 800 days after surgery,
BNP levels were back at baseline levels in both groups. Clinical follow-up
at 2 years postoperatively showed no difference in heart failure symptoms
or need for heart failure medication between the groups.
 Conclusion(s): In contrast to commonly held beliefs about the
endocrine and reservoir functions of the LAA, there seems to be no
clinically relevant detrimental effect of LAA amputation on natriuretic
peptide levels and severity of heart failure until up to 2 years
postoperatively. Copyright © 2021 Georg Thieme Verlag. All rights
reserved.

<9>
Accession Number
2006754661
Title
Direct comparison of predictive performance of PRECISE-DAPT versus PARIS
versus CREDO-Kyoto: a subanalysis of the ReCre8 trial.
Source
Netherlands Heart Journal. 29 (4) (pp 201-214), 2021. Date of Publication:
April 2021.
Author
Rozemeijer R.; van Bezouwen W.P.; van Hemert N.D.; Damen J.A.; Koudstaal
S.; Stein M.; Leenders G.E.; Timmers L.; Kraaijeveld A.O.; Roes K.;
Agostoni P.; Doevendans P.A.; Stella P.R.; Voskuil M.
Institution
(Rozemeijer, van Bezouwen, van Hemert, Koudstaal, Stein, Leenders,
Timmers, Kraaijeveld, Doevendans, Stella, Voskuil) Department of
Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
(Damen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(Koudstaal) Farr Institute of Health Informatics, University College
London, London, United Kingdom
(Stein) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
(Timmers) St. Antonius Hospital, Nieuwegein, Netherlands
(Roes) Department of Biostatistics and Research Support, University
Medical Center Utrecht, Utrecht, Netherlands
(Agostoni) Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk
Antwerpen Middelheim, Antwerp, Belgium
(Doevendans) Netherlands Heart Institute, Utrecht, Netherlands
(Doevendans) Central Military Hospital, Utrecht, Netherlands
Publisher
Bohn Stafleu van Loghum
Abstract
Background: Multiple scores have been proposed to guide risk
stratification after percutaneous coronary intervention. This study
assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk
scores to predict post-discharge ischaemic or bleeding events.
 Method(s): A total of 1491 patients treated with latest-generation
drug-eluting stent implantation were evaluated. Risk scores for
post-discharge ischaemic or bleeding events were calculated and directly
compared. Prognostic performance of both risk scores was assessed with
calibration, Harrell's c-statistics net reclassification index and
decision curve analyses. Result(s): Post-discharge ischaemic events
occurred in 56 patients (3.8%) and post-discharge bleeding events in 34
patients (2.3%) within the first year after the invasive procedure.
C-statistics for the PARIS ischaemic risk score was marginal (0.59, 95%
confidence interval (CI) 0.51-0.68), whereas the CREDO-Kyoto ischaemic
risk score was moderate (0.68, 95% CI 0.60-0.75). With regard to
post-discharge bleeding events, CREDO-Kyoto displayed moderate
discrimination (c-statistic 0.67, 95% CI 0.56-0.77), whereas PRECISE-DAPT
(0.59, 95% CI 0.48-0.69) and PARIS (0.55, 95% CI 0.44-0.65) had a marginal
discriminative capacity. Net reclassification index and decision curve
analysis favoured CREDO-Kyoto-derived bleeding risk assessment.
 Conclusion(s): In this contemporary all-comer population, PARIS and
PRECISE-DAPT risk scores were not resilient to independent testing for
post-discharge bleeding events. CREDO-Kyoto-derived risk stratification
was associated with a moderate predictive capability for post-discharge
ischaemic or bleeding events. Future studies are warranted to improve risk
stratification with more focus on robustness and rigorous
testing. Copyright © 2020, The Author(s).

<10>
Accession Number
2008449767
Title
Treating diabetic all-comers with contemporary drug-eluting stents:
Prespecified comparisons from the BIO-RESORT and the BIONYX randomized
trials.
Source
International Journal of Cardiology. 325 (pp 37-44), 2021. Date of
Publication: 15 Feb 2021.
Author
Ploumen E.H.; Buiten R.A.; Kok M.M.; Doggen C.J.M.; Roguin A.; Jessurun
G.A.J.; Schotborgh C.E.; Danse P.W.; Benit E.; Aminian A.; van Houwelingen
K.G.; Stoel M.G.; Scholte M.; Hartmann M.; Linssen G.C.M.; Zocca P.; von
Birgelen C.
Institution
(Ploumen, Buiten, Kok, van Houwelingen, Stoel, Hartmann, Zocca, von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Ploumen, Buiten, Kok, Doggen, Zocca, von Birgelen) Department of Health
Technology and Services Research, Faculty of Behavioural, Management and
Social Sciences, Technical Medical Centre, University of Twente, Enschede,
Netherlands
(Roguin) Department of Cardiology, Hillel Yaffe Medical Center, Hadera and
B. Rappaport-Faculty of Medicine, Israel Institute of Technology, Haifa,
Israel
(Jessurun) Department of Cardiology, Treant Zorggroep, Scheper Hospital,
Emmen, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Benit) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Scholte) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
(Linssen) Department of Cardiology, Hospital Group Twente, and Hengelo,
Almelo, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background: Patients with diabetes have more extensive coronary disease,
resulting in higher risks of adverse clinical events following stenting.
In all-comer patients, contemporary DES have shown excellent safety and
efficacy, but data on diabetic patients are scarce. Separately for the
BIO-RESORT and BIONYX trials, we assessed the 2-year clinical outcomes of
diabetic patients, treated with various contemporary drug-eluting stents
(DES). Method(s): We performed two prespecified secondary analyses of
two randomized DES trials, which both stratified for diabetes. The main
endpoint was target vessel failure (TVF), a composite of cardiac death,
target vessel myocardial infarction, or target vessel revascularization.
Follow-up was finished before the COVID-19 pandemic. Result(s): In
BIO-RESORT, 624/3514 (17.8%) had diabetes: 211 received Orsiro
sirolimus-eluting stents (SES), 203 Synergy everolimus-eluting stents
(EES), and 210 Resolute Integrity zotarolimus-eluting stents (RI-ZES). TVF
did not differ between SES (10.2%) and EES (10.0%) versus RI-ZES (12.7%)
(SES vs. RI-ZES HR:0.78, 95%-CI [0.44-1.40]; p = 0.40, EES vs. RI-ZES
HR:0.79, 95%-CI [0.44-1.40]; p = 0.42). In BIONYX, 510/2488 (20.5%)
patients had diabetes: 250 received SES and 260 Resolute Onyx
zotarolimus-eluting stents (RO-ZES). There was no difference in TVF
between SES (10.7%) versus RO-ZES (12.2%) (HR:0.88, 95%-CI [0.52-1.48]; p
= 0.63). Conclusion(s): There was no difference in 2-year clinical
outcome among patients with diabetes, who were treated with SES, or EES,
versus RI-ZES. In addition there was no difference in clinical outcome in
diabetic patients, who were treated with SES versus RO-ZES. These findings
may be considered as a signal of safety and efficacy of the studied DES in
patients with diabetes. Copyright © 2020 The Author(s)

<11>
Accession Number
2007554031
Title
Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter
Aortic Valve Replacement.
Source
Structural Heart. 5 (1) (pp 24-38), 2021. Date of Publication: 2021.
Author
Sreedharan S.; Sellers S.L.; Ihdayhid A.R.; Landes U.; Blanke P.; Allen
K.B.; Chhatriwalla A.K.; Pibarot P.; Wood D.A.; Webb J.G.; Leipsic J.A.;
Sathananthan J.
Institution
(Sreedharan, Sellers, Ihdayhid, Landes, Blanke, Leipsic) Department of
Radiology, St. Paul's Hospital and University of British Columbia,
Vancouver, Canada
(Sellers, Leipsic) Centre for Heart Lung Innovation, St. Paul's Hospital
and University of British Columbia, Vancouver, Canada
(Sellers, Wood, Webb, Leipsic, Sathananthan) Centre for Cardiovascular
Innovation, University of British Columbia, Vancouver, Canada
(Allen, Chhatriwalla) Saint Luke's Mid America Heart Institute and
University of Missouri-Kansas City School of Medicine, Kansas City, MO,
United States
(Pibarot) Quebec Heart Lung Institute, Laval University, Quebec City,
Canada
(Wood, Webb, Leipsic, Sathananthan) Centre for Heart Valve Innovation, St.
Paul's Hospital, Vancouver, Canada
Publisher
Bellwether Publishing, Ltd.
Abstract
Degeneration of surgical bioprosthetic heart valves (BPVs) occurs in up to
one third of surviving patients within a decade of implantation and is a
common cause of cardiovascular morbidity. Valve-in-valve transcatheter
aortic valve replacement (VIV TAVR) is a safe and effective treatment for
patients with failed BPVs who are unsuitable for reoperation. However,
there may be patient-prosthesis mismatch (PPM) following VIV TAVR,
particularly in patients with small BPVs. This may influence both
morbidity and mortality. Bioprosthetic valve fracture (BVF) has emerged as
a novel technique to prevent PPM. It involves high-pressure inflation of a
non-compliant balloon to fracture the ring of the BPV, allowing for
further expansion of the implanted transcatheter heart valve (THV) and
thereby reducing residual transvalvular gradients. Early experience with
this technique has been promising. This review will describe the
procedural technique of BVF, explore the lessons learned from bench
testing and early clinical experience, and discuss the limitations of the
current literature as well as future directions. Abbreviations: ACn:
ACURATE neo; BPV: Bioprosthetic heart valve; BVF: Bioprosthetic valve
fracture; BVR: Bioprosthetic valve remodeling; EOA: Effective orifice
area; NYHA: New York Heart Association; PPM: Patient-prosthesis mismatch;
PWI: Pin-wheeling index; S3: Sapien 3; SAVR: Surgical aortic valve
replacement; TAVR: Transcatheter aortic valve replacement; TPVR:
Transcatheter pulmonary valve replacement; THV: Transcatheter heart valve;
VIV: Valve-in-valve. Copyright © 2020 Cardiovascular Research
Foundation.

<12>
Accession Number
2007371725
Title
Techniques for blood loss estimation in major non-cardiac surgery: a
systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 68 (2) (pp 245-255), 2021. Date of
Publication: February 2021.
Author
Tran A.; Heuser J.; Ramsay T.; McIsaac D.I.; Martel G.
Institution
(Tran, Heuser, Martel) Department of Surgery, University of Ottawa,
Ottawa, ON, Canada
(Ramsay, McIsaac, Martel) Ottawa Hospital Research Institute, The Ottawa
Hospital - General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
(McIsaac) Department of Anesthesiology, University of Ottawa, Ottawa, ON,
Canada
Publisher
Springer
Abstract
Purpose: Estimated blood loss (EBL) is an important tool in clinical
decision-making and surgical outcomes research. It guides perioperative
transfusion practice and serves as a key predictor of short-term
perioperative risks and long-term oncologic outcomes. Despite its
widespread clinical and research use, there is no gold standard for blood
loss estimation. We sought to systematically review and compare techniques
for intraoperative blood loss estimation in major non-cardiac surgery with
the objective of informing clinical estimation and research standards.
Source: A structured search strategy was applied to Ovid Medline, Embase,
and Cochrane Library databases from inception to March 2020, to identify
studies comparing methods of intraoperative blood loss in adult patients
undergoing major non-cardiac surgery. We summarized agreement between
groups of pairwise comparisons as visual estimation vs formula estimation,
visual estimation vs other, and formula estimation vs other. For each of
these comparisons, we described tendencies for higher or lower EBL values,
consistency of findings, pooled mean differences, standard deviations, and
confidence intervals. Principle findings: We included 26 studies involving
3,297 patients in this review. We found that visual estimation is the most
frequently studied technique. In addition, visual techniques tended to
provide lower EBL values than formula-based estimation or other
techniques, though this effect was not statistically significant in pooled
analyses likely due to sample size limitations. When accounting for the
contextual mean blood loss, similar case-to-case variation exists for all
estimation techniques. Conclusion(s): We found that significant
case-by-case variation exists for all methods of blood loss evaluation and
that there is significant disagreement between techniques. Given the
importance placed on EBL, particularly for perioperative prognostication
models, clinicians should consider the universal adoption of a practical
and reproducible method for blood loss evaluation. Trial registration:
PROSPERO (CRD42015029439); registered: 18 November 2015.PROSPERO
(CRD42015029439); registered: 18 November 2015. Copyright © 2020,
Canadian Anesthesiologists' Society.

<13>
Accession Number
2012008231
Title
Comparison of High-Flow Humidified Oxygen With Conventional Continuous
Positive Airway Pressure in Nonventilated Lungs During Thoracic Surgery: A
Randomized Cross-Over Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Sawasdiwipachai P.; Weerayutwattana R.; Thongcharoen P.; Suksompong S.
Institution
(Sawasdiwipachai, Suksompong) Department of Anesthesiology, Faculty of
Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Weerayutwattana) Department of Anesthesiology, Faculty of Medicine,
Vajira Hospital, Bangkok, Thailand
(Thongcharoen) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Publisher
W.B. Saunders
Abstract
Objective: This study assessed the efficacy of high-flow humidified oxygen
(HFHO) as an alternative to continuous positive airway pressure (CPAP) for
improving oxygenation while preserving nonventilated lung collapse during
one-lung ventilation. Design(s): A prospective randomized cross-over
trial. Setting(s): A tertiary medical center. Participant(s):
The study comprised 28 patients undergoing elective thoracotomy with
one-lung ventilation using a double-lumen endobronchial tube placement.
 Intervention(s): The patients received prophylactic CPAP or HFHO to
the nonventilated lung for 20 minutes and were then crossedover to the
other oxygenation modality for 20 minutes, with a 20-minute recovery
interval between the two modalities. Measurements and Main Results:
Changes in respiratory parameters and lung deflation quality were
recorded. Both CPAP and HFHO increased the partial pressure of arterial
oxygen in either sequence in both groups, ranging from 31.8-to-66.0 mmHg.
However, the increments from these two interventions were not
statistically significant (95% confidence interval -12.84 to 21.87; p =
0.597). There were no differences in other parameters. Half the patients
receiving CPAP experienced worsening of the surgical condition, whereas
the HFHO patients experienced no change or reported a better lung
deflation (p < 0.001). Conclusion(s): HFHO could be an alternative
method to CPAP for improving arterial oxygenation while preserving lung
deflation during one-lung ventilation. However, additional studies are
warranted in regard to its cost-effectiveness and establishment as a
routine treatment. Copyright © 2021 Elsevier Inc.

<14>
Accession Number
2011519288
Title
The ongoing impact of COVID-19 on adult cardiac surgery and suggestions
for safe continuation throughout the pandemic: a review of expert
opinions.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Kirkley K.; Benedetto U.; Caputo M.; Angelini G.D.; Vohra H.A.
Institution
(Kirkley, Benedetto, Caputo, Angelini, Vohra) Department of Cardiac
Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of
Bristol, Bristol, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Objectives: To establish the impact of the COVID-19 pandemic on adult
cardiac surgery by reviewing current data and use this to establish
methods for safely continuing to carry out surgery. Method(s):
Conduction of a literature search via PubMed using the search terms:
'(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR
sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective
OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR
2019 novel coronavirus OR pandemic)'. Thirty-two articles were selected.
 Result(s): Cardiac surgery patients have an increased risk of
complications from COVID-19 and require vital finite resources such as
intensive care beds, also required by COVID-19 patients. Thus reducing
their admission and potential hospital-acquired infection with COVID-19 is
paramount. During the peak, only emergencies such as acute aortic
dissections were treated, triaging patients according to surgical priority
and cancelling all elective procedures. Screening and 2-week quarantine
prior to admission were essential changes, alongside additional levels of
PPE. Focus was on reducing length of stay and switching to day-cases to
reduce post-operative transmission risk, whilst several hospitals adopted
'hot' and 'cold' operating theatres for covid-confirmed and covid-negative
patients. Conclusion(s): This paper suggests a 'CARDIO' approach for
reintroducing elective procedures: 'Care, Assess, Re-Evaluate, Develop,
Implement, Overcome'; prioritising the mental and physical health of the
workforce, learning from and sharing experiences and objectively
prioritising patients to improve case load. Copyright © The
Author(s) 2021.

<15>
Accession Number
635029591
Title
Effects of dexmedetomidine on neurocognitive disturbance after elective
non-cardiac surgery in senile patients: a systematic review and
meta-analysis.
Source
The Journal of international medical research. 49 (5) (pp
3000605211014294), 2021. Date of Publication: 01 May 2021.
Author
Bi X.; Wei J.; Zhang X.
Institution
(Bi) Department of Anesthesiology, Affiliated Hospital of Southwest
Medical University, Sichuan Province, China
(Wei) Department of Pharmacology, Sixth People's Hospital of Chengdu,
Sichuan China, Chengdu, China
(Zhang) Department of Neonatology, Affiliated Hospital of Southwest
Medical University, Sichuan Province, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Senile patients often experience neurocognitive disturbance
after non-cardiac surgery. Several clinical trials have investigated if
the perioperative intravenous use of dexmedetomidine has a positive effect
on the prevention of neurocognitive dysfunction, but the results have been
inconsistent. We performed a meta-analysis to investigate the effects of
dexmedetomidine on neurocognitive disturbance after elective non-cardiac
surgery in senile patients. METHOD(S): The PubMed, Cochrane Library,
EMBASE and China National Knowledge Infrastructure databases were
comprehensively searched for all randomized controlled trials published
before 1 February 2020 that investigated the efficacy of dexmedetomidine
in the prevention of postoperative delirium (POD) or postoperative
cognitive dysfunction (POCD). RESULT(S): Sixteen studies involving
4376 patients were included in this meta-analysis. Compared with the
control (i.e., saline), the perioperative intravenous use of
dexmedetomidine significantly reduced the incidence of POD and POCD.
However, patients in the dexmedetomidine group were more likely to develop
bradycardia and hypotension during the administration of dexmedetomidine
than patients in the control group. There were no differences between the
two groups in the incidence of nausea and vomiting or mortality rate.
 CONCLUSION(S): Dexmedetomidine has a positive effect on the
prevention of neurocognitive disturbance in senile patients after elective
non-cardiac surgery.

<16>
Accession Number
626540941
Title
Ischemia and perioperative infarction.
Source
Colombian Journal of Anesthesiology. 46 (Supplement 2) (pp 39-45), 2018.
Date of Publication: 01 Mar 2018.
Author
Navarro-Vargas J.R.; Borrero L.M.G.
Institution
(Navarro-Vargas) School of Medicine, Universidad Nacional de Colombia,
Bogota, Colombia
(Navarro-Vargas) Hospital Universitario de Colombia, Universidad Nacional
de Colombia, Bogota, Colombia
(Borrero) Sindicato Antioqueno de Anestesiologia (Anestesiar), Medellin,
Colombia
(Navarro-Vargas) National Resuscitation Committee, Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.), Carrera 15a No. 120-74, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Perioperative medicine has provided anesthetists with a
proactive role in the prevention of perioperative complications, in
particular cardiovascular events such as myocardial injury after
non-cardiac surgery. Objective(s): Using cardiovascular risk
concepts, pre-operative assessment for non-cardiac surgery, optimization
of the hemodynamic status, determination of differences between elective
and urgent patients, monitoring, close follow-up after surgery, and
measurements of ultrasensitive troponin in the first 48 hours
postoperatively, anesthetists are now able to identify and address early
clinical manifestations of perioperative ischemia and myocardial
infarction (MI) in patients at risk. Material(s) and Method(s):
Narrative review: Queries in various databases on perioperative ischemia
and non-fatal infarction in Pubmed, Science Direct, and Ovid.
 Result(s): The analysis of cardiac troponin levels is of the utmost
importance in the prognosis of perioperative MI. Diagnosis can be made
earlier, and it has been shown that the majority of these perioperative
events have their onset within the first 48 hours of the postoperative
period, when the physiological stress is highest in patients taken to
non-cardiac surgery. Copyright © 2018 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.). Published by Wolters Kluwer.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

<17>
Accession Number
2012040440
Title
Quantitative angiographic assessment of aortic regurgitation after
transcatheter aortic valve implantation among three balloon-expandable
valves.
Source
Global Heart. 16 (1) (no pagination), 2021. Article Number: 20. Date of
Publication: 19 Mar 2021.
Author
Kawashima H.; Wang R.; Mylotte D.; Jagielak D.; De Marco F.; Ielasi A.;
Onuma Y.; Den Heijer P.; Terkelsen C.J.; Wijns W.; Serruys P.W.; Soliman
O.
Institution
(Kawashima, Wang, Mylotte, Onuma, Wijns, Serruys, Soliman) Department of
Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
(Kawashima) Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Wang) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Jagielak) Department of Cardiac and Vascular Surgery, Medical University
of Gdansk, Gdansk, Poland
(De Marco) Clinical and Interventional Cardiology Department, IRCCS
Policlinico San Donato, San Donato Milanese, Italy
(Ielasi) Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio,
Milan, Italy
(Den Heijer) Department of Cardiology, Amphia Ziekenhuis, Breda,
Netherlands
(Terkelsen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Kawashima, Wang, Mylotte, Onuma, Wijns, Serruys, Soliman) CORRIB Corelab
and Center for Research and Imaging, Ireland
Publisher
Ubiquity Press
Abstract
Objectives: The aim of the present analysis is to compare the quantitative
angiographic aortic regurgitation (AR) after transcatheter aortic valve
implantation (TAVI) among three balloon-expandable valves.
 Background(s): Quantitative videodensitometric aortography is an
objective, accurate, and reproducible tool for adjudication of AR
following TAVI. Method(s): This is a retrospective corelab analysis,
independent from industry, of aortograms from patients treated with TAVI
using the balloon-expandable Myval transcatheter heart valve (THV) (Meril
Life Sciences Pvt. Ltd., India), Sapien 3, and XT THVs (Edwards
Lifesciences, Irvine, CA, USA). The study comprised of 108 analyzable
aortograms from consecutive patients in a multicenter European registry
who underwent Myval THV implantation. The results of quantitative
assessment of AR in the Sapien 3 THV (n = 397) and Sapien XT THV (n = 239)
were retrieved from a published pooled database. Result(s): The Myval
THV had the lowest proportion of patients with moderate or severe
angiographic quantitative AR (2.8%) compared to the Sapien 3 THV (8.3%; p
= 0.049) and Sapien XT THV (10.9%; p = 0.012). Furthermore, the Myval THV
had the lowest mean angiographic quantitative AR (6.3 +/- 6.3%), followed
by Sapien 3 THV (7.6 +/- 7.1%) and Sapien XT THV (8.8 +/- 7.5%), and it
was significantly lower than that of the Sapien XT THV (p = 0.006), but
not significantly different from Sapien 3 THV (p = 0.246).
 Conclusion(s): The Myval THV, in comparison with other BEV's analyzed
in our database, showed a lower occurrence of moderate or severe AR after
TAVI. These results should be confirmed in prospective cohorts of
randomized patients with head-to-head THV comparisons. Copyright
© 2021 Elsevier B.V.. All rights reserved.

<18>
Accession Number
2012040438
Title
Pregnancy associated spontaneous coronary artery dissection: A case report
and review of literature.
Source
World Journal of Cardiology. 13 (4) (pp 103-110), 2021. Date of
Publication: 26 Apr 2021.
Author
Prudhvi K.; Jonnadula J.; Rokkam V.R.P.; Sridharan G.K.
Institution
(Prudhvi) Division of Critical Care Medicine, Mercy Hospital, Saint Louis
University School of Medicine, St. Louis, MO 63141, United States
(Jonnadula) Department of Geriatric Medicine, Barnes Jewish Hospital,
Washington University, St. Louis, MO 63110, United States
(Rokkam, Sridharan) Division of Inpatient Medicine, University of Arizona,
Banner University Medical Center, Tucson, AZ 85719, United States
Publisher
Baishideng Publishing Group Co
Abstract
BACKGROUND Pregnancy-associated spontaneous coronary artery dissection
(PSCAD) is an important cause of chest pain and acute myocardial
infarction in pregnant and postpartum women. Pregnancy is considered an
isolated risk factor for spontaneous coronary artery dissection. The
etiology, pathogenesis, and incidence of PSCAD are not known. CASE SUMMARY
We present a case of a 33-year-old postpartum female who presented with
sudden onset chest pain and was diagnosed with spontaneous coronary artery
dissection and needed urgent catheterization revealing left anterior
descending coronary artery dissection. She underwent emergent coronary
artery bypass graft surgery with good post-operative recovery. CONCLUSION
Most patients with PSCAD can be managed conservatively with medical
management and have good outcomes. Patients with high-risk presentations
benefit from the invasive approach. Coronary artery bypass graft may be
required in select few patients based on angiography findings. Due to the
risk of recurrent spontaneous coronary artery dissection, subsequent
pregnancies are discouraged. Copyright ©The Author(s) 2021.
Published by Baishideng Publishing Group Inc. All rights reserved.

<19>
Accession Number
2007165305
Title
Current status of cardiac rehabilitation in Argentina.
Source
Revista Argentina de Cardiologia. 89 (1) (pp 37-41), 2021. Date of
Publication: 2021.
Author
Zeballos C.; Iglesias D.; Paz I.; Bustamante J.; Naya E.G.; Castiello G.;
Davolos I.
Institution
(Zeballos, Iglesias, Paz, Bustamante, Naya, Castiello, Davolos) Member of
the Exercise in Cardiology Council of the Argentine Society of Cardiology,
Argentina
(Zeballos, Paz) Cardiac Rehabilitation Service, Instituto Cardiovascular
de Buenos Aires (ICBA), Argentina
(Iglesias) Department of Cardiology, Hospital Italiano de Buenos Aires,
Argentina
(Bustamante) Cardiac Rehabilitation Service, Hospital Austral, Argentina
(Naya) Cardiac Rehabilitation Service, Instituto Argentino de Diagnostico
y Tratamiento (IADT), Argentina
(Castiello) Department of Cardiology, Hospital Argerich and Instituto
Argentino de Diagnostico y Tratamiento (IADT), Argentina
(Davolos) Department of Cardiology, Hospital de Clinicas Jose de San
Martin and Sanatorio Juncal, Temperley, Argentina
(Zeballos) Rehabilitacion Cardiovascular en ICBA, Buenos Aires, Argentina
Publisher
Sociedad Argentina de Cardiologia
Abstract
Background: Cardiac rehabilitation is a well-known strategy for secondary
prevention in several heart diseases and includes a set of strategies
based on education of a healthy lifestyle, management of cardiovascular
risk factors, psychosocial counseling, and pres-cription of supervised
physical exercise. Several clinical trials, systematic reviews and
meta-analyses have documented its efficacy and safety. Nevertheless,
cardiac rehabilitation remains underused. There is information available
describing the current status of cardiac rehabilitation and the
characteristics of centers in some European countries and North America.
There are pooled data from South America in 2014, along with reports from
Brazil, Colombia, and Uruguay, but there are few data from our country.
Therefore, the aim of this study was to determine the current status of
cardiac rehabilitation programs in Argentina. Method(s): We conducted
a descriptive study using a virtual questionnaire to evaluate the
structure and characteristics of rehabilitation programs in our country
and the potential barriers to achieve efficient rehabilitation.
 Result(s): Seventy-two centers responded. The main results show a
high concentration of centers in urban areas (69.23% in AMBA),
predominance of private centers (66.67%), inclusion of patients with the
so-called classic cardiovascular diseases (coronary artery disease, heart
failure, postoperative heart valve surgery, peripheral vascular disease,
and after cardiac transplantation and device implantation), and a majority
of centers with an exercise-centered strategy. The main difficulty for the
inclusion of patients in the centers was poor referral of candidates.
 Conclusion(s): The data from this survey allow for a diagnosis of the
situation and can be the starting point for developing improvement
strategies to implement quality standards and future accreditation
programs for the centers. Copyright © 2021, Sociedad Argentina de
Cardiologia. All rights reserved.

<20>
Accession Number
635029742
Title
The opioid sparing effect of erector spinae plane block for various
surgeries: a meta-analysis of randomized-controlled trials.
Source
Minerva anestesiologica. (no pagination), 2021. Date of Publication: 13
May 2021.
Author
Fanelli A.; Torrano V.; Cozowicz C.; Mariano E.R.; Balzani E.
Institution
(Fanelli) Anesthesia and Pain Medicine Unit, Department of Emergency and
Urgency, Policlinico S.Orsola-Malpighi Hospital, Bologna, Italy
(Torrano) Anesthesia and Intensive Care Unit 1, Department of Emergency
and Urgency, ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan,
Italy
(Cozowicz) Department of Anesthesiology, Perioperative Medicine and
Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
(Mariano) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, USA
(Mariano) Anesthesiology and Perioperative Care Service, Veterans Affairs
Palo Alto Health Care System, Palo Alto, CA, USA
(Balzani) Department of Medicine and Surgery, University of Turin, Turin,
Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The erector spinae plane block (ESPB) is a newer fascial
plane block which has been broadly applied for postoperative analgesia
after various surgeries, but the effectiveness in these populations is not
well established. EVIDENCE ACQUISITION: A systematic database search was
conducted in PubMed, PMC, Embase, and Scopus for randomized controlled
trials (RCTs) comparing ESPB with control, placebo, or other blocks. The
primary outcome was intravenous opioid consumption in milligram morphine
equivalents 24 h after surgery. Standardized mean differences (SMDs) with
95% confidence intervals (CI) were calculated using a randomeffects model.
EVIDENCE SYNTHESIS: A total of 29 RCTs were included. An analysis was
conducted by subgroups differentiated by surgery type, 'no block' vs.
ESPB, and other blocks vs. ESPB. ESPB was effective in reducing opioid
consumption against no block for breast surgery (SMD -1.13; CI 95%),
thoracic surgery (SMD -3.00; CI 95%), and vertebral surgery (SMD -1.78; CI
95%). ESPB was effective against alternative blocks for breast surgery
(vs. paravertebral, SMD -1.07; CI 95%) and abdominal surgery (SMD -1.77;
CI 95%). ESPB showed moderate effect in thoracic surgery against
paravertebral (SMD 0.58; CI 95%) and against no block in abdominal surgery
(SMD 0.80; CI 95%). In only one case did ESPB perform worse than another
block: vs. PECS block for breast surgery (SMD 1.66; CI 95%).
 CONCLUSION(S): ESPB may be a useful addition to the multimodal
analgesic regimen for a variety of surgeries especially when the
alternative is no block. Unanswered questions include determining of the
mechanism of action, refining of the EPSB technique, and establishing
recommended local anesthetic dose and volume.

<21>
Accession Number
635028879
Title
Impact of lower vs higher LDL cholesterol targets on cardiovascular events
after ischemic stroke in diabetic patients.
Source
Diabetes. (no pagination), 2021. Date of Publication: 12 May 2021.
Author
Amarenco P.; Kim J.S.; Labreuche J.; Charles H.; Giroud M.; Lee B.-C.;
Lavallee P.C.; Mahagne M.-H.; Meseguer E.; Nighoghossian N.; Steg P.G.;
Vicaut E.; Bruckert E.
Institution
(Amarenco, Charles, Lavallee, Meseguer) APHP, Department of Neurology and
Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of
Paris, Paris, France
(Kim) Asan Medical Center, Seoul, South Korea
(Labreuche) Universite Lille, EA 2694 - Sante publique : epidemiologie et
qualite des soins, CHU Lille, Lille F-59000, France
(Giroud) Department of Neurology, University Hospital of Dijon, Dijon
Stroke Registry, University of Burgundy, UBFC, EA 7460, Spain
(Lee) Department of Neurology, Hallym University Sacred Heart Hospital,
Anyang, South Korea
(Mahagne) Stroke Unit, Pasteur Hospital, Nice, France
(Nighoghossian) Hospices Civils de Lyon, Department of Neurology and
Stroke Center, Lyon University, Lyon, France
(Steg) Universite de Paris, INSERM LVTS-U1148, F-75018, Paris, France,
AP-HP, Hopital Bichat, F-765018 Paris, France
(Vicaut) APHP, Department of Biostatistics, Universite Paris-Diderot,
Fernand Widal hospital, Sorbonne-Paris Cite, Paris, France
Publisher
NLM (Medline)
Abstract
After an ischemic stroke with evidence of atherosclerosis, lipid lowering
treatment with a target LDL cholesterol of less than 70 mg/dL compared to
100+/-10 mg/dL, reduced the risk of subsequent cardiovascular events. In
this analysis, we explored the effect in the diabetic compared to
nondiabetic subgroup and newly diagnosed diabetes.Patients with ischemic
stroke in the previous 3 months or TIA within the previous 15 days and
evidence of cerebrovascular or coronary artery atherosclerosis were
randomly assigned in a 1:1 ratio to a target LDL cholesterol of less than
70 mg/dL or 100+/-10 mg/dL, using statin or ezetimibe. The primary outcome
was the composite of ischemic stroke, myocardial infarction, new symptoms
requiring urgent coronary or carotid revascularization and vascular death.
We did a pre specified analysis to evaluate the effect in diabetic
patients.Among 2,860 patients enrolled, 643 were diabetic at baseline with
a mean age of 66.2 years and baseline LDL cholesterol of 127 mg/dL and
were followed for a median of 3 years. The primary composite endpoint
occurred in 27/328 (8.2%) patients in the lower target group and in 44/315
(14.0%) patients in the higher target group (adjusted hazard ratio, 0.56
[95% CI, 0.34 to 0.89]; P=0.016), while hazard ratio was 0.87 (95% CI,
0.66 to 1.14; P=0.31) in nondiabetic patients (Pinteraction=0.15). In
diabetics, there were 3 intracranial hemorrhages in both randomization
groups (0.9% vs. 1.0%, respectively). Newly diagnosed diabetes occurred in
98/1070 (9.2%) and in 80/1085 (7.4%) patients in the lower and higher
target group, respectively (HR=1.27 [95% CI, 0.94 to 1.71], P=0.11) and
baseline higher HbAIc was the unique multivariable predictor.In
conclusions, after an ischemic stroke with evidence of atherosclerosis,
targeting an LDL cholesterol of less than 70 mg/dL compared to 100+/-10
mg/dL consistently reduced the risk of subsequent stroke and other major
vascular events in diabetic and nondiabetic patients, but the higher risk
in diabetic patients yielded a higher absolute risk reduction with an NNT
of 17 (ClinicalTrials.gov NCT01252875- EUDRACT Identifier number
2009-A01280-57). Copyright © 2021 by the American Diabetes
Association.

<22>
Accession Number
635028513
Title
Efficacy and Safety of Long-Term Evolocumab Use Among Asian Subjects- A
Subgroup Analysis of the Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) Trial.
Source
Circulation journal : official journal of the Japanese Circulation
Society. (no pagination), 2021. Date of Publication: 12 May 2021.
Author
Keech A.C.; Oyama K.; Sever P.S.; Tang M.; Murphy S.A.; Hirayama A.; Lu
C.; Tay L.; Deedwania P.C.; Siu C.-W.; Lira Pineda A.; Choi D.; Charng
M.-J.; Amerena J.; Wan Ahmad W.A.; Chopra V.K.; Pedersen T.R.; Giugliano
R.P.; Sabatine M.S.
Institution
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney
(Oyama, Tang, Murphy, Giugliano, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School
(Oyama) Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London
(Hirayama) Division of Cardiology, Department of Medicine, Nihon
University School of Medicine
(Lu, Lira Pineda) Amgen
(Tay) Cardiology Department, Changi General Hospital
(Deedwania) University of California San Francisco School of Medicine
(Siu) Cardiology Division, Department of Medicine, Li Ka Shing Faculty of
Medicine, University of Hong Kong, Hong Kong SAR
(Choi) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei
University College of Medicine
(Charng) Division of Cardiology, Taipei Veterans General Hospital
(Charng) Faculty of Medicine, School of Medicine, National Yang Ming
University
(Amerena) Geelong Cardiology Research Unit, Barwon Health
(Wan Ahmad) Cardiology Department, University Malaya Medical Center
(Chopra) Department of Cardiology, Max Super Speciality Hospital
(Pedersen) Medical Faculty, Oslo University Hospital Aker
Publisher
NLM (Medline)
Abstract
BACKGROUND: There are concerns that Asian patients respond differently to
some medications. This study evaluated the efficacy and safety of
evolocumab among Asian vs. other subjects in the FOURIER trial, which
randomized stable atherosclerosis patients to receive either evolocumab or
placebo.Methods and Results:Effects of adding evolocumab vs. placebo to
background statin therapy on low-density lipoprotein cholesterol (LDL-C)
reductions, cardiovascular outcomes, and adverse events were compared
among 27,564 participants with atherosclerotic disease, according to
self-reported Asian (n=2,723) vs. other (n=24,841) races followed for a
median of 2.2 years in the FOURIER trial. The primary endpoint was a
composite of cardiovascular death, myocardial infarction, stroke,
hospitalization for unstable angina, or coronary revascularization. At
randomization, Asians had slightly lower LDL-C (median 89 [IQR 78-104]
mg/dL vs. 92 [80-109] mg/dL; P<0.001) and were much less likely to be on a
high-intensity statin (33.3% vs. 73.3%; P<0.001). Evolocumab lowered LDL-C
more in Asians than in others (66% vs. 58%; P<0.001). The effect of
evolocumab on the primary endpoint was similar in Asians (HR, 0.79; 95%
CI, 0.61-1.03) and others (HR, 0.86; 95% CI, 0.79-0.93; P
interaction=0.55). There was no excess of serious adverse events with
evolocumab among Asians over others. CONCLUSION(S): Use of evolocumab
robustly lowers LDL-C and is equally efficacious in lowering the risk of
cardiovascular events and safe in Asians as it is in others.

<23>
Accession Number
635028303
Title
Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A
Scientific Statement From the American Heart Association.
Source
Circulation. (pp CIR0000000000000979), 2021. Date of Publication: 13 May
2021.
Author
Shroff G.R.; Bangalore S.; Bhave N.M.; Chang T.I.; Garcia S.; Mathew R.O.;
Rangaswami J.; Ternacle J.; Thourani V.H.; Pibarot P.
Publisher
NLM (Medline)
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a
clinical challenge. Aortic stenosis is more prevalent and progresses more
rapidly and unpredictably in CKD, and the presence of CKD is associated
with worse short-term and long-term outcomes after aortic valve
replacement. Because patients with advanced CKD and end-stage kidney
disease have been excluded from randomized trials, clinicians need to make
complex management decisions in this population that are based on
retrospective and observational evidence. This statement summarizes the
epidemiological and pathophysiological characteristics of aortic stenosis
in the context of CKD, evaluates the nuances and prognostic information
provided by noninvasive cardiovascular imaging with echocardiography and
advanced imaging techniques, and outlines the special risks in this
population. Furthermore, this statement provides a critical review of the
existing literature pertaining to clinical outcomes of surgical versus
transcatheter aortic valve replacement in this high-risk population to
help guide clinical decision making in the choice of aortic valve
replacement and specific prosthesis. Finally, this statement provides an
approach to the perioperative management of these patients, with special
attention to a multidisciplinary heart-kidney collaborative team-based
approach.

<24>
Accession Number
600294691
Title
Everolimus-eluting stent for the treatment of bare metal in-stent
restenosis: Clinical and angiographic outcomes at nine-month follow-up of
XERES (Xience Evaluation in bare metal stent REStenosis) trial.
Source
EuroIntervention. 10 (6) (pp 700-708), 2014. Date of Publication: 01 Oct
2014.
Author
Carrie D.; Delarche N.; Piot C.; Berland J.; Menneveau N.; Bonello L.; Py
A.; Teiger E.; Leborgne L.; Bayet G.; Wittenberg O.; Schiele F.
Institution
(Carrie) Cardiology B, Cardiovascular and Metabolic Pole, Rangueil
Hospital, Toulouse, France
(Delarche) Cardiology Department, Hospital Centre, Pau, France
(Piot) Cardiology Department, Arnaud de Villeneuve Hospital, Montpellier,
France
(Berland) Cardiology Department, St. Hilaire Clinic, Rouen, France
(Menneveau, Schiele) Cardiology Department, Jean Minjoz Hospital,
Besancon, France
(Bonello) Cardiology Department, North Hospital, Marseille, France
(Py) Cardiology Department, Alexandre Dumas Medical Centre, Amiens, France
(Teiger) Cardiology Department, Henri Mondor Hospital, Creteil, France
(Leborgne) Cardiology Department, North Hospital, Amiens, France
(Bayet) Cardiology Department, Rhone Durance Clinic, Avignon, France
(Wittenberg) Cardiology Department, Beauregard Polyclinic, Marseille,
France
Publisher
Europa Group
Abstract
Aims: Restenosis is a frequent complication of coronary stent
implantation, especially bare metal stent (BMS) implantation. The
everolimus-eluting stent (EES) has previously been shown to be efficacious
in the treatment of de novo lesions. We performed this study to evaluate
clinical, angiographic and IVUS results after EES implantation for the
treatment of BMS ISR.
Methods and results: XERES was a prospective, multicentre, nationwide
study, enrolling 97 consecutive patients with in-stent restenosis (ISR)
after BMS implantation across 20 centres in France. Suitable lesions had a
reference vessel diameter between 2.5 mm and 4 mm, a length <=22 mm and a
diameter stenosis between 50 and 100-. The primary endpoint was
angiographic in-stent late loss (LL) as determined by quantitative
coronary angiography (QCA) at nine-month follow-up. QCA was required to be
performed in each included patient and IVUS was performed in a subgroup of
27 patients. At nine-month follow-up, the in-stent late loss was
0.35+/-0.63 mm. The rate of in-stent binary restenosis was 12.22-,
including two complete occlusions. The average volume of neointimal
hyperplasia was 15.6+/-9.9 mm3. The in-stent percent volume obstruction
was 8.5+/-5.2-. The in-segment percent area and diameter obstruction were
32+/-17- and 27+/-11-, respectively. Two initial malappositions were
persistent and two other patients had late acquired stent malapposition.
The cumulative incidence of major adverse cardiac events (MACE) was 10.1-.
Conclusions: EES for the treatment of bare metal in-stent restenosis
seemed safe and efficacious.

<25>
Accession Number
366308279
Title
EACTS guidelines for the use of patient safety checklists.
Source
European Journal of Cardio-thoracic Surgery. 41 (5) (pp 993-1004), 2012.
Date of Publication: 01 May 2012.
Author
Clark S.C.; Dunning J.; Alfieri O.R.; Elia S.; Hamilton L.R.; Kappetein
P.A.; Lockowandt U.; Sarris G.E.; Kolh P.H.
Institution
(Clark, Hamilton) Department of Cardiothoracic Surgery, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
(Alfieri) Division of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
(Elia) Department of Thoracic Surgery, University Tor Vergata, Rome, Italy
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Lockowandt) Department of Cardiothoracic Surgery, Karolinska University
Hospital, Stockholm, Sweden
(Sarris) Department of Pediatric and Congenital Heart Surgery, Mitera
Children's and Hygeia Hospitals, Athens, Greece
(Kolh) Department of Cardiovascular Surgery, University Hospital of Liege,
Liege, Belgium
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The Safety Checklist concept has been an integral part of many industries
that face high-complexity tasks for many decades and in industries such as
aviation and engineering checklists have evolved from their very
inception. Investigations of the causes of surgical deaths around the
world have repeatedly pointed to medical errors that could be prevented as
an important cause of death and disability. As a result, the World Health
Organisation developed and evaluated a three-stage surgical checklist in
2007 demonstrating that complications were significantly reduced,
including surgical infection rates and even mortality. Together with the
results from other large cohort studies into the utility of the surgical
checklist, many countries have fully implemented the use of surgical
checklists into routine practice. A key factor in the successful
implementation of a surgical checklist is engagement of the staff
implementing the checklist. In surgical specialties such as our own it was
quickly seen that there were many important omissions in the generic
checklist that did not cover issues particular to our specialty, and thus
the European Association for Cardio-Thoracic Surgery embarked on a process
to create a version of the checklist that might be more appropriate and
specific to cardiothoracic surgery, including checks on preparations for
excessive bleeding, perfusion arrangements and ICU preparations, for
example. The guideline presented here summarizes the evidence for the
surgical checklist and also goes through in detail the changes recommended
for our specialty. © The Author 2012. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<26>
Accession Number
2007997996
Title
Emergency Department Resuscitative Thoracotomy: Indications, surgical
procedure and outcome. A narrative review.
Source
American Journal of Surgery. 221 (5) (pp 1082-1092), 2021. Date of
Publication: May 2021.
Author
Aseni P.; Rizzetto F.; Grande A.M.; Bini R.; Sammartano F.; Vezzulli F.;
Vertemati M.
Institution
(Aseni) Department of Emergency, ASST Grande Ospedale Metropolitano
Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
(Aseni, Rizzetto, Vezzulli, Vertemati) Department of Biomedical and
Clinical Sciences "L. Sacco", Universita degli Studi di Milano, via
Giovanni Battista Grassi 74, Milan 20157, Italy
(Rizzetto) Department of Radiology, ASST Grande Ospedale Metropolitano
Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
(Grande) Department of Cardiac Surgery, IRCCS Fondazione Policlinico San
Matteo Pavia, viale Camillo Golgi 19, Pavia 27100, Italy
(Bini, Sammartano) Trauma Center and Metropolitan Trauma Network
Department, Niguarda Hospital, Milan, Italy
(Vertemati) CIMaINa (Interdisciplinary Centre for Nanostructured Materials
and Interfaces), Universita degli Studi di Milano, Milan, Italy
Publisher
Elsevier Inc.
Abstract
Background: Emergency Department Thoracotomy (EDRT) after traumatic
Cardio-pulmonary Arrest (CPR) can be used to salvage select critically
injured patients. Indications of this surgical procedure are widely
debated and changed during last decades. We provide the available
literature about EDRT in the effort to provide a comprehensive synthesis
about the procedure, likelihood of success and patient's outcome in the
different clinical setting, accepted indications and technical details
adopted during the procedure for different trauma injuries.
 Method(s): Literature from 1975 to 2020 was retrieved from multiple
databases and reviewed. Indications, contraindications, total number and
outcome of patients submitted to EDRT were primary endpoints.
 Result(s): A total number of 7236 patients received EDRT, but only
7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest
with the presence of vital signs at the trauma center are the most
favorable conditions to perform EDRT. Conclusion(s): EDRT should be
reserved for acute resuscitation of selected dying trauma patient. Risks
of futility, costs, benefits of the surgical procedure should be carefully
evaluated before performing the surgical procedure. Copyright ©
2020 Elsevier Inc.

<27>
Accession Number
2007174720
Title
Impact of atrial fibrillation on the outcomes of transcatheter mitral
valve repair using MitraClip: a systematic review and meta-analysis.
Source
Heart Failure Reviews. 26 (3) (pp 531-543), 2021. Date of Publication: May
2021.
Author
Shah S.; Raj V.; Abdelghany M.; Mena-Hurtado C.; Riaz S.; Patel S.; Wiener
H.; Chaudhuri D.
Institution
(Shah, Raj, Chaudhuri) Department of Medicine, Division of Cardiology,
State University of New York Upstate Medical University, 750 E Adams
Street, Syracuse, NY 13210, United States
(Abdelghany) Pioneer Valley Cardiology, University of Massachusetts/
Baystate Medical Center, Mercy Medical Center, Springfield, MA, United
States
(Mena-Hurtado) Department of Medicine, Division of Cardiology, Yale
University School of Medicine, New Haven, CT, United States
(Riaz) Department of Medicine, State University of New York Upstate
Medical University, Syracuse, NY, United States
(Patel) Department of Pulmonary, Allergy and Critical care, University of
Alabama at Birmingham, Birmingham, AL, United States
(Wiener) Department of Epidemiology, University of Alabama at Birmingham
School of Public Health, Birmingham, AL, United States
Publisher
Springer
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral
regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In
this systematic review, we aimed to investigate the outcomes of TMVR using
MitraClip in AF patients. We performed a systematic search using PubMed,
SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for
studies that reported outcomes following MitraClip, in patients with AF
versus without AF. Seven studies with a total of 7678 patients met the
inclusion criteria. The risk of 1-year all-cause mortality following TMVR
was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p <= 0.001).
Similarly, the risk of heart failure hospitalization was higher in
patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of
bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p <=
0.001). The risk of procedural failure, in-hospital mortality,
cardiovascular mortality, and stroke was not significantly different
between the two groups. The higher risk of all-cause mortality, HF
hospitalization, and risk of bleeding in AF patients undergoing MitraClip
warrants attention. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<28>
Accession Number
2004697682
Title
Impact of renin-angiotensin system inhibitors on outcomes after
transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 97 (1) (pp E88-E94),
2021. Date of Publication: 01 Jan 2021.
Author
Sun Y.; Li J.; Li G.; Fan R.; Luo J.
Institution
(Sun, Li, Li, Luo) Department of Cardiology, Vascular Center, Guangdong
Cardiovascular Institute, Guangdong Provincial People's Hospital,
Guangdong Academy of Medical Sciences, Guangdong, China
(Fan) Department of Cardiovascular surgery, Vascular Center, Guangdong
Cardiovascular Institute, Guangdong Provincial People's Hospital,
Guangdong Academy of Medical Sciences, Guangdong, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We aimed to evaluate the impact of renin-angiotensin system
(RAS) inhibitors on outcomes after transcatheter aortic valve replacement
(TAVR). Background(s): The impact of RAS inhibitors on outcomes after
TAVR was unclear. Method(s): A systematic review of articles
comparing outcomes of patients using and not using RAS inhibitors after
TAVR was performed through PubMed, Embase, and Cochrane. Primary outcome
was midterm all-cause mortality. Risk ratios (RRs) were calculated with
the corresponding 95% confidence interval using random effect models.
 Result(s): Five studies with 23,319 patients were included. Patients
treated with RAS inhibitors had lower midterm all-cause mortality after
TAVR than those without RAS inhibitors in both the unmatched (13.3 vs.
17.2%, RR 0.77, p =.005) and propensity score matched cohorts (13.5 vs
16.2%, RR 0.83, p <.001). Cardiovascular mortality (10.4 vs. 15.6%, RR
0.68, p <.001), rate of heart failure readmission (12.2 vs. 14.5%, RR
0.80, p =.006), and new-onset atrial fibrillation (14.0 vs. 23.7%, RR
0.73, p =.003) were also lower with RAS inhibitors. No difference was
found between two groups regarding cerebrovascular events, myocardial
infarction, major bleeding, major vascular complications, acute kidney
injury, permanent pacemaker implantation, and moderate/severe paravalvular
aortic regurgitation. Conclusion(s): RAS inhibitors were associated
with lower midterm all-cause mortality after TAVR. Copyright ©
2020 Wiley Periodicals, Inc.

<29>
Accession Number
2001913320
Title
A Comparative Analysis of Mitraclip Versus Mitral Valve-In-Valve
Replacement for High-Risk Patients With Severe Mitral Regurgitation After
Transcatheter Aortic Valve Replacement.
Source
Current Problems in Cardiology. 46 (2) (no pagination), 2021. Article
Number: 100423. Date of Publication: February 2021.
Author
Nanda A.; Bob-Manuel T.; Jefferies J.; Ibebuogu U.; Khouzam R.N.
Publisher
Mosby Inc.

<30>
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.

<31>
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.

<32>
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.

<33>
Accession Number
634948265
Title
Impact of frailty in cardiac surgical patients - Assessment, burden, and
recommendations.
Source
Annals of Cardiac Anaesthesia. 24 (2) (pp 133-139), 2021. Date of
Publication: April-June 2021.
Author
Shanker A.; Upadhyay P.; Rangasamy V.; Muralidhar K.; Subramaniam B.
Institution
(Shanker) Department of Anesthesia, Critical Care, and Pain Medicine,
Lewis Katz School of Medicine, Temple University, 3500 North Broad St.,
Philadelphia, PA, United States
(Shanker, Upadhyay, Rangasamy, Subramaniam) Department of Anesthesia,
Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(Muralidhar) Department of Anesthesia, Narayana Institute of Cardiac
Sciences, Narayana Hrudayalaya Health City, Bengaluru, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Elderly patients undergoing cardiac surgery are at an increased risk of
adverse postoperative outcomes. Frailty, a state of decreased
physiological reserve, is highly prevalent among elderly patients. Despite
being associated with adverse surgical outcomes, no universally accepted
definition or measurement tool for frailty exists. Moreover, regardless of
all the recommendations, a routine perioperative frailty assessment is
often ignored. In addition to complications, frailty increases the burden
to the healthcare system, which is of particular concern in Southeast Asia
due to its socioeconomically disadvantaged and resource limited settings.
This narrative review focuses to develop clinical practice plans for
perioperative frailty assessment in the context of a cardiac surgical
setting. Copyright © 2021 Wolters Kluwer Medknow Publications.
All rights reserved.

<34>
Accession Number
634475740
Title
Preoperative Statin Therapy for Atrial Fibrillation and Renal Failure
after Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. 69 (2) (pp 141-147), 2021. Date of
Publication: 01 Mar 2021.
Author
Kuhn E.W.; Liakopoulos O.J.; Choi Y.-H.; Rahmanian P.; Eghbalzadeh K.;
Slottosch I.; Deppe A.C.; Wahlers T.C.W.
Institution
(Kuhn, Liakopoulos, Choi, Rahmanian, Eghbalzadeh, Slottosch, Deppe,
Wahlers) Department of Cardiothoracic Surgery, Heart Center of the
University Hospital of Cologne, Cologne, Germany
Publisher
Georg Thieme Verlag
Abstract
Background: Performing cardiac surgery in patients with cardiovascular
risk factors incorporates a steady risk for the development of
postoperative complications. Perioperative statin intake was associated
with an improvement of perioperative outcomes in these patients. However,
the European Association for Cardio-Thoracic Surgery guidelines regarding
the perioperative statin treatment were changed recently due to large
studies reporting about relevant adverse effects related to statin
therapy. Method(s): All relevant databases were searched including
the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and
the metaRegister of Controlled Trials. Various registries were screened
(National Research Register, the ClinicalTrials.gov, and gray literature)
with search on online conference indices of relevant scientific meetings.
No language restrictions were applied. Result(s): We identified 10
randomized controlled studies summarizing 3,468 participants undergoing
various kinds of cardiac surgical procedures. All included studies
presented with marked differences regarding study design. Pooled analysis
indicated that statin pretreatment was associated with a formally reduced
incidence of postoperative atrial fibrillation (AF) (odds ratio [OR] 0.63,
95% confidence interval [CI] 0.39-1.00; p = 0.05) but with an increased
incidence of renal failure (OR 1.20, 95% CI 1.01-1.44; p = 0.04) compared
with control. Substantial heterogeneity was observed among studies
reporting about AF. Conclusion(s): Current but sparse evidence
reveals that statin pretreatment is associated with a higher rate of
postoperative renal failure compared with control therapy but is
ineffective to substantially reduce postoperative AF. Given the relevant
heterogeneity among included studies, statin pretreatment cannot be
generally recommended. Copyright © 2021 Georg Thieme Verlag. All
rights reserved.

<35>
Accession Number
633930595
Title
Instantaneous wave-free ratio guided multivessel revascularisation during
percutaneous coronary intervention for acute myocardial infarction: Study
protocol of the randomised controlled iMODERN trial.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: e044035. Date of
Publication: 15 Jan 2021.
Author
Beijnink C.W.H.; Thim T.; Van Der Heijden D.J.; Klem I.; Al-Lamee R.; Vos
J.L.; Koop Y.; DIjkgraaf M.G.W.; Beijk M.A.M.; Kim R.J.; Davies J.; Raposo
L.; Baptista S.B.; Escaned J.; Piek J.J.; Maeng M.; Van Royen N.; Nijveldt
R.
Institution
(Beijnink, Vos, Koop, Van Royen, Nijveldt) Cardiology, Radboudumc,
Nijmegen, Netherlands
(Thim, Maeng) Department of Cardiology, Aarhus University Hospital, Aarhus
N, Denmark
(Van Der Heijden) Cardiology, Medisch Centrum Haaglanden, Den Haag,
Netherlands
(Klem, Kim) Cardiology, Duke University Medical Center, Durham, NC, United
States
(Al-Lamee) Cardiology, Imperial College London Faculty of Medicine,
London, United Kingdom
(DIjkgraaf) Clinical Epidemiology, Biostatistics and Bioinformatics,
Amsterdam UMC - Locatie AMC, Amsterdam, Netherlands
(Beijk, Piek) Cardiology, Amsterdam UMC Locatie AMC, Amsterdam,
Netherlands
(Davies) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Raposo) Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa,
Portugal
(Baptista) Cardiology Department, Hospital Fernando Fonseca, Amadora,
Portugal
(Escaned) Interventional Cardiology, Hospital Clinico Universitario San
Carlos, Madrid, Spain
Publisher
BMJ Publishing Group
Abstract
Introduction Recent randomised clinical trials showed benefit of
non-culprit lesion revascularisation in ST-elevation myocardial infarction
(STEMI) patients. However, it remains unclear whether revascularisation
should be performed at the index procedure or at a later stage. Methods
and analysis The instantaneous wave-free ratio (iFR) Guided Multivessel
Revascularisation During Percutaneous Coronary Intervention for Acute
Myocardial Infarction trial is a multicentre, randomised controlled
prospective open-label trial with blinded evaluation of endpoints. After
successful primary percutaneous coronary intervention (PCI), eligible
STEMI patients with residual non-culprit lesions are randomised, to
instantaneous wave-free ratio guided treatment of non-culprit lesions
during the index procedure versus deferred cardiac MR-guided management
within 4 days to 6 weeks. The primary endpoint of the study is the
combined occurrence of all-cause death, recurrent myocardial infarction
and hospitalisation for heart failure at 12 months follow-up. Clinical
follow-up includes questionnaires at 3 months and outpatient visits at 6
months and 12 months after primary PCI. Furthermore, a cost-effectiveness
analysis will be performed. Ethics and dissemination Permission to conduct
this trial has been granted by the Medical Ethical Committee of the
Amsterdam University Medical Centres (loc. VUmc, ID NL60107.029.16). The
primary results of this trial will be shared in a main article and
subgroup analyses or spin-off studies will be shared in secondary papers.
Trial registration number NCT03298659. Copyright © 2021 BMJ
Publishing Group. All rights reserved.

<36>
Accession Number
633194874
Title
Overall and Cause-Specific Mortality in Randomized Clinical Trials
Comparing Percutaneous Interventions with Coronary Bypass Surgery: A
Meta-analysis.
Source
JAMA Internal Medicine. 180 (12) (pp 1638-1646), 2020. Date of
Publication: December 2020.
Author
Gaudino M.; Hameed I.; Farkouh M.E.; Rahouma M.; Naik A.; Robinson N.B.;
Ruan Y.; Demetres M.; Biondi-Zoccai G.; Angiolillo D.J.; Bagiella E.;
Charlson M.E.; Benedetto U.; Ruel M.; Taggart D.P.; Girardi L.N.; Bhatt
D.L.; Fremes S.E.
Institution
(Gaudino, Hameed, Rahouma, Naik, Robinson, Ruan, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York,
NY 10065, United States
(Hameed) Section of Cardiothoracic Surgery, Yale School of Medicine, New
Haven, CT, United States
(Farkouh) Peter Munk Cardiac Centre, University of Toronto, Toronto, ON,
Canada
(Demetres) Samuel J. Wood Library and C. V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Angiolillo) Division of Cardiology, Department of Medicine, University of
Florida College of Medicine-Jacksonville, Jacksonville, United States
(Bagiella) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Charlson) Division of General Internal Medicine, Weill Cornell Medical
College, New York, NY, United States
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, Oxford, United Kingdom
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
Publisher
American Medical Association
Abstract
Importance: Mortality is a common outcome in trials comparing percutaneous
coronary intervention (PCI) with coronary artery bypass grafting (CABG).
Controversy exists regarding whether all-cause mortality or cardiac
mortality is preferred as a study end point, because noncardiac mortality
should be unrelated to the treatment. Objective(s): To evaluate the
difference in all-cause and cause-specific mortality in randomized
clinical trials (RCTs) comparing PCI with CABG for the treatment of
patients with coronary artery disease. Data Sources: MEDLINE (1946 to
the present), Embase (1974 to the present), and the Cochrane Library (1992
to the present) databases were searched on November 24, 2019. Reference
lists of included articles were also searched, and additional studies were
included if appropriate. Study Selection: Articles were considered for
inclusion if they were in English, were RCTs comparing PCI with
drug-eluting or bare-metal stents and CABG for the treatment of coronary
artery disease, and reported mortality and/or cause-specific mortality.
Trials of PCI involving angioplasty without stenting were excluded. For
each included trial, the publication with the longest follow-up duration
for each outcome was selected. Data Extraction and Synthesis: For data
extraction, all studies were reviewed by 2 independent investigators, and
disagreements were resolved by a third investigator in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
guideline. Data were pooled using fixed-and random-effects models.
 Main Outcomes and Measures: The primary outcomes were all-cause and
cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were
performed for PCI trials using drug-eluting vs bare-metal stents and for
trials involving patients with left main disease. Result(s):
Twenty-three unique trials were included involving 13620 unique patients
(6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study
populations; mean age range, 60.0-71.0 years). The weighted mean (SD)
follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with
a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29)
and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but
also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41).
 Conclusions and Relevance: Percutaneous coronary intervention was
associated with higher all-cause, cardiac, and noncardiac mortality
compared with CABG at 5 years. The significantly higher noncardiac
mortality associated with PCI suggests that even noncardiac deaths after
PCI may be procedure related and supports the use of all-cause mortality
as the end point for myocardial revascularization trials. Copyright
© 2020 American Medical Association. All rights reserved.

<37>
Accession Number
633142656
Title
Effect of Influenza Vaccination Inducing Antibody Mediated Rejection in
Solid Organ Transplant Recipients.
Source
Frontiers in Immunology. 11 (no pagination), 2020. Article Number: 1917.
Date of Publication: 06 Oct 2020.
Author
Cordero E.; Bulnes-Ramos A.; Aguilar-Guisado M.; Gonzalez Escribano F.;
Olivas I.; Torre-Cisneros J.; Gavalda J.; Aydillo T.; Moreno A.; Montejo
M.; Farinas M.C.; Carratala J.; Munoz P.; Blanes M.; Fortun J.;
Suarez-Benjumea A.; Lopez-Medrano F.; Roca C.; Lara R.; Perez-Romero P.
Institution
(Cordero, Bulnes-Ramos, Aguilar-Guisado, Aydillo, Roca) Instituto de
Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocio, CSIC,
University of Seville, Seville, Spain
(Cordero) Department of Medicine, University of Seville, Seville, Spain
(Gonzalez Escribano, Olivas) Servicio de Inmunologia, Instituto de
Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocio, CSIC,
University of Seville, Seville, Spain
(Torre-Cisneros, Lara) Reina Sofia University Hospital, Maimonides
Institute for Biomedical Research (IMIBIC), University of Cordoba (UCO),
Cordoba, Spain
(Gavalda) Vall d'Hebron University Hospital, VHIR, Barcelona, Spain
(Moreno) University Hospital Clinic, Barcelona, Spain
(Montejo) Cruces University Hospital, Bilbao, Spain
(Farinas) University Hospital Marques de Valdecilla, Santander, Spain
(Carratala) Belltvitge University Hospital, IDIBELL, University of
Barcelona, Barcelona, Spain
(Munoz) Department of Clinical Microbiology and Infectious Diseases,
Hospital General Universitario Gregorio Maranon, Madrid, Spain
(Munoz) Instituto de Investigacionn Biomedica Gregorio Maranon, Madrid,
Spain
(Munoz) Department of Medicine, Universidad Complutense de Madrid, Madrid,
Spain
(Munoz) CIBERES, CB06/06/0058), Madrid, Spain
(Blanes) University Hospital La Fe, Valencia, Spain
(Fortun) University Hospital Ramon y Cajal, Madrid, Spain
(Suarez-Benjumea) University Hospital Virgen Macarena, Seville, Spain
(Lopez-Medrano) Unit of Infectious Diseases, University Hospital, 12 de
Octubre, Madrid, Spain
(Lopez-Medrano) Instituto de Investigacion Biomedica imas12, Madrid, Spain
(Lopez-Medrano) Department of Medicine, School of Medicine, Universidad
Complutense de Madrid, Madrid, Spain
(Perez-Romero) National Centre for Microbiology, Instituto de Salud Carlos
III, Madrid, Spain
Publisher
Frontiers Media S.A.
Abstract
Introduction: Our goal was to study whether influenza vaccination induced
antibody mediated rejection in a large cohort of solid organ transplant
recipients (SOTR). Method(s): Serum anti-Human Leukocyte Antigen
(HLA) antibodies were determined using class I and class II
antibody-coated latex beads (FlowPRATM Screening Test) by flow
cytometry. Anti-HLA antibody specificity was determined using the
single-antigen bead flow cytometry (SAFC) assay and assignation of donor
specific antibodies (DSA) was performed by virtual-crossmatch.
 Result(s): We studied a cohort of 490 SOTR that received an influenza
vaccination from 2009 to 2013: 110 (22.4%) received the pandemic
adjuvanted vaccine, 59 (12%) within the first 6 months
post-transplantation, 185 (37.7%) more than 6 months after transplantation
and 136 (27.7%) received two vaccination doses. Overall, no differences of
anti-HLA antibodies were found after immunization in patients that
received the adjuvanted vaccine, within the first 6 months
post-transplantation, or based on the type of organ transplanted. However,
the second immunization dose increased the percentage of patients positive
for anti-HLA class I significantly compared with patients with one dose
(14.6% vs. 3.8%; P = 0.003). Patients with pre-existing antibodies before
vaccination (15.7% for anti-HLA class I and 15.9% for class II) did not
increase reactivity after immunization. A group of 75 (14.4%) patients
developed de novo anti-HLA antibodies, however, only 5 (1.02%) of them
were DSA, and none experienced allograft rejection. Only two (0.4%)
patients were diagnosed with graft rejection with favorable outcomes and
neither of them developed DSA. Conclusion(s): Our results suggest
that influenza vaccination is not associated with graft rejection in this
cohort of SOTR. © Copyright © 2020 Cordero, Bulnes-Ramos,
Aguilar-Guisado, Gonzalez Escribano, Olivas, Torre-Cisneros, Gavalda,
Aydillo, Moreno, Montejo, Farinas, Carratala, Munoz, Blanes, Fortun,
Suarez-Benjumea, Lopez-Medrano, Roca, Lara and Perez-Romero.

<38>
Accession Number
2004623507
Title
Multivessel versus culprit-only PCI in STEMI patients with multivessel
disease: meta-analysis of randomized controlled trials.
Source
Clinical Research in Cardiology. 109 (11) (pp 1381-1391), 2020. Date of
Publication: 01 Nov 2020.
Author
Feistritzer H.-J.; Jobs A.; de Waha-Thiele S.; Eitel I.; Freund A.;
Abdel-Wahab M.; Desch S.; Thiele H.
Institution
(Feistritzer, Jobs, Freund, Abdel-Wahab, Desch, Thiele) Department of
Internal Medicine/Cardiology, Heart Center Leipzig at University of
Leipzig, Strumpellstr. 39, Leipzig 04289, Germany
(Feistritzer, Jobs, Freund, Abdel-Wahab, Desch, Thiele) Leipzig Heart
Institute, Leipzig, Germany
(Jobs, de Waha-Thiele, Eitel) Department of Cardiology, Angiology and
Intensive Care Medicine, University Heart Center Lubeck, University
Hospital Schleswig-Holstein, Lubeck, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: To perform a pairwise meta-analysis of randomized controlled trials
(RCTs) comparing multivessel percutaneous coronary intervention (PCI) and
culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI)
patients without cardiogenic shock. Method(s): We searched MEDLINE,
Cochrane Central Register of Controlled Trials, and Embase for RCTs
comparing multivessel PCI with culprit vessel-only PCI in STEMI patients
without cardiogenic shock and multivessel coronary artery disease. Only
RCTs reporting mortality or myocardial reinfarction after at least 6
months following randomization were included. Hazard ratios (HRs) were
pooled using random-effect models. Result(s): Nine RCTs were included
in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the
combined primary endpoint of death or non-fatal reinfarction. This primary
endpoint was significantly reduced with multivessel PCI compared to
culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43-0.93;
p = 0.03). This finding was driven by a reduction of non-fatal
reinfarction (HR 0.64, 95% CI 0.52-0.79; p = 0.001), whereas no
significant reduction of all-cause death (HR 0.77, 95% CI 0.44-1.35; p =
0.28) or cardiovascular death (HR 0.64, 95% CI 0.37-1.11; p = 0.09) was
observed. Conclusion(s): In STEMI patients without cardiogenic shock
multivessel PCI reduced the risk of death or non-fatal reinfarction
compared to culprit vessel-only PCI. Copyright © 2020, The
Author(s).

<39>
Accession Number
2005891748
Title
Validation and comparison of drug eluting stent to bare metal stent for
restenosis rates following vertebral artery ostium stenting: A
single-center real-world study.
Source
Interventional Neuroradiology. 26 (5) (pp 629-636), 2020. Date of
Publication: 01 Oct 2020.
Author
Li L.; Wang X.; Yang B.; Wang Y.; Gao P.; Chen Y.; Zhu F.; Ma Y.; Chi H.;
Zhang X.; Bai X.; Feng Y.; Dmytriw A.A.; Hong T.; Hua Y.; Jiao L.; Ling F.
Institution
(Li, Wang, Yang, Wang, Gao, Chen, Ma, Zhang, Bai, Feng, Hong, Jiao, Ling)
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University,
Beijing, China
(Gao, Zhu, Jiao, Ling) Department of Interventional Neuroradiology, Xuanwu
Hospital, Capital Medical University, Beijing, China
(Chi) Department of Neurology, Dalian University Affiliated Xinhua
Hospital, Dalian, China
(Dmytriw) Division of Neuroradiology, Department of Medical Imaging,
Toronto Western Hospital, University of Toronto, Toronto, Canada
(Hua) Department of Vascular Ultrasonography, Xuanwu Hospital, Capital
Medical University, Beijing, China
Publisher
SAGE Publications Inc.
Abstract
Background and purpose: While drug-eluting stents (DES) have been widely
applicated in coronary stenosis, uncertainty persists concerning the
relative performance and clinical benefit in patients undergoing vertebral
artery stenting when compared with a bare metal stent (BMS). We sought to
compare in-stent restenosis (ISR) rates of DES and BMS in the treatment of
vertebral artery ostium (VAO) stenosis. Material(s) and Method(s):
This study analyzed a single-center prospective cohort. Over 1.5-year
period (January 2014-June 2015), 137 consecutive patients underwent VAO
stenting involving deployment of 76 DES and 74 BMS. Patient demographics,
comorbidities, stenosis severity, stent diameters and lengths,
periprocedural complications, imaging and duplex ultrasonography follow-up
and recurrent symptoms were assessed. Result(s): Technical success
was achieved in all patients. Mean VAO stenosis at presentation were 82.4
+/- 7.2% in the DES group and 83.3 +/- 7.5% in the BMS group and were
reduced to 12.5 +/- 4.5% and 11.3 +/- 4.0%. Mean stent diameter was 3.53
+/- 0.40 mm in DES and 5.05 +/- 0.40 mm in BMS (p < 0.0001). Mean
follow-up was 12.3 months for DES and 11.7 months for BMS. The use of DES
was associated with significant lower ISR rates compared with BMS (18.4%
vs. 31.1%; OR = 2.628, p = 0.021). Recurrent symptoms rates were similar
in DES vs. BMS (2.6% vs 2.7%, p = 0.680). Stent type and stent diameter
were independent risk factors for ISR (P = 0.026). Conclusion(s): Our
results suggest superior efficacy of deploying DES for the treatment of
VAO stenosis with lower ISR rates as compared to BMS, but do not support
significant differences in periprocedural risk and recurrent symptoms
rate. Copyright © The Author(s) 2020.

<40>
Accession Number
2005800380
Title
The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in
Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot
Study.
Source
Cardiology and Therapy. 9 (2) (pp 493-503), 2020. Date of Publication: 01
Dec 2020.
Author
Seecheran N.; Boodhai B.; Maharaj A.; Ramdeen A.; Debideen N.; Ochalal V.;
Singh R.; Seecheran R.; Seecheran V.; Persad S.; Abdullah H.; Peram L.;
Motilal S.; Tello-Montoliu A.; Schneider D.
Institution
(Seecheran) The University of the West Indies, St. Augustine, Port of
Spain, Trinidad and Tobago
(Boodhai, Maharaj, Ramdeen, Debideen, Ochalal, Singh, Seecheran,
Seecheran, Persad, Abdullah, Peram, Motilal) North Central Regional Health
Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
(Tello-Montoliu) Universidad de Murcia, Murcia, Spain
(Schneider) Cardiovascular Research Institute of Vermont, Colchester, VT,
United States
Publisher
Adis
Abstract
Introduction: This prospective, pharmacodynamic study aimed to explore the
potential applicability of a low-dose ticagrelor regimen in a
heterogeneous Trinidadian subpopulation. Method(s): Patients with
stable coronary artery disease (n = 25) who were actively treated with
dual antiplatelet therapy of aspirin 81 mg daily and clopidogrel 75 mg
daily were recruited. Platelet function was measured with the VerifyNow
P2Y<inf>12</inf> assay (Accriva Diagnostics, San Diego, CA, USA) and
assessed before initiation of and after 14 days of treatment with a
low-dose ticagrelor 45 mg twice daily maintenance dose regimen. Results
were compared with a paired t test. Result(s): The mean
P2Y<inf>12</inf> reaction units (PRU) score on ticagrelor was
significantly less compared to that of clopidogrel (50.4, 95% confidence
interval (CI) 29-73.9; vs. 149.6, 95% CI 129.4-169.9; p value < 0.001). Of
the patients, 4% experienced Medical Research Council class 1 dyspnea, and
Bleeding Academic Research Consortium class 1 bleeding on the ticagrelor
regimen (one patient each). Conclusion(s): Significantly attenuated
platelet reactivity was seen on the low ticagrelor maintenance dose as
compared to clopidogrel. This dedicated pharmacodynamic study could be
applicable and informative for Trinidadian stable coronary artery disease
patients. Further studies are required to confirm these exploratory
findings.(Funded by the University of the West Indies, St. Augustine).
Trial Registration: ClinicalTrials.gov number NCT04206176. Copyright
© 2020, The Author(s).

<41>
Accession Number
2005741763
Title
Safety of stent-assisted coiling for the treatment of wide-necked ruptured
aneurysm: A systematic literature review and meta-analysis of prevalence.
Source
Interventional Neuroradiology. 26 (5) (pp 547-556), 2020. Date of
Publication: 01 Oct 2020.
Author
Bsat S.; Bsat A.; Tamim H.; Chanbour H.; Alomari S.O.; Houshiemy M.N.E.;
Moussalem C.; Omeis I.
Institution
(Bsat, Alomari, Houshiemy, Moussalem, Omeis) Department of Neurosurgery,
American University of Beirut Medical Center, Beirut, Lebanon
(Bsat, Chanbour) Faculty of Medicine, Lebanese University, Beirut, Lebanon
(Tamim) Department of Internal Medicine, American University of Beirut
Medical Center, Beirut, Lebanon
(Omeis) Department of Neurosurgery, Baylor College of Medicine, Houston,
TX, United States
Publisher
SAGE Publications Inc.
Abstract
Background: Stent-assisted coil embolization of ruptured wide-necked
aneurysms is a controversial treatment modality due to concerns on the
peri-procedural safety of anti-platelet therapy in the setting of acute
subarachnoid hemorrhage. Our aim was to systematically review the
literature on stent-assisted coil embolization of acutely ruptured
wide-neck aneurysms to calculate the pooled prevalence of clinical
outcome, thromboembolic and hemorrhagic complication rates and overall
mortality. Method(s): We searched PubMed and Google Scholar for
articles published between 2009 and 2019 and stratified selected articles
based on risk of publication bias. Data on thromboembolic and hemorrhagic
complications, clinical outcomes and mortality rates were analyzed using
quality-effects model and double arcsine transformation. Result(s):
24 articles were included featuring a total of 1582 patients.
Thromboembolic and hemorrhagic complication rates were witnessed in 9.1%
[95% CI: 6.0% - 12.7%; I2 = 72.8%] and 8.7% [95% CI: 5.4 -
12.6%; I2 = 77.2%] of patients, respectively. 245 patients
received external ventricular drains, of which 33 (13.5%) had EVD-related
hemorrhages. Total complication rate was 20.8% [95% CI: 14.2 - 28.1%;
I2 = 87.0%]. 57% of aneurysms were completely occluded and a
favorable clinical outcome was reported in 74.7% [95% CI: 66.4 - 82.2%;
I2 = 86.0] of patients. Overall mortality rate came at 7.8%
[95% CI: 4.8 - 11.6%; I2 = 76.9%]. Conclusion(s):
Stent-assisted coiling of ruptured intracranial aneurysm is a technically
feasible procedure with controlled thromboembolic complication rate but
may be associated with higher hemorrhagic and total complication rates
compared to coiling alone. While stent-assisted coiling of ruptured
wide-necked aneurysm seems to yield a lower rate of favorable clinical
outcome, overall mortality is comparable to that of endovascular coiling
alone. Copyright © The Author(s) 2020.

<42>
Accession Number
2011487984
Title
A meta-analysis of transcarotid versus transfemoral transcatheter aortic
valve replacement.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
McGrath D.P.; Kawabori M.; Wessler B.; Chen F.Y.; Zhan Y.
Institution
(McGrath) Tufts University School of Medicine, Boston, MA, United States
(Kawabori, Chen, Zhan) Division of Cardiac Surgery, CardioVascular Center,
Tufts Medical Center, Boston, MA, United States
(Wessler) Division of Cardiology, CardioVascular Center, Tufts Medical
Center, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Carotid access has shown promise as an excellent delivery
route for transcatheter aortic valve replacement (TAVR). We aimed to
compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by
conducting a search and analysis of the best evidence in the literature to
shed light on its safety and effectiveness. Method(s): The
PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020
were searched to identify articles reporting comparative data on TC versus
TF approaches for TAVR. Patients' baseline characteristics and clinical
outcomes were extracted from the articles and pooled for analysis.
 Result(s): Five studies, including a total of 2470 patients, were
included in the study with 1859 patients in the TF group and 611 patients
in the TC group. The TC group had higher prevalence of peripheral vascular
disease, while the patients in the TF group was older. Meta-analysis
revealed that there was no significant differences between the two groups
with regard to 30-day mortality (p = 0.09), stroke (p = 0.28), new
dialysis (p = 0.58), major bleeding (p = 0.69), or pacemaker implantation
(p = 0.44). The TF group had a higher incidence of vascular complications
(3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p = 0.02).
 Conclusion(s): Compared with the TF approach, TC-TAVR is associated
with comparable procedural and clinical outcomes. Our analysis found a
lower rate of vascular complication in TC access compared with TF access.
This supports consideration of such an alternative access when there are
concerns over the feasibility of TF access. Copyright © 2021
Wiley Periodicals LLC.

<43>
Accession Number
632380536
Title
Accelerated rehabilitation combined with enteral nutrition in the
management of lung cancer surgery patients.
Source
Asia Pacific journal of clinical nutrition. 29 (2) (pp 274-279), 2020.
Date of Publication: 2020.
Author
Ding Q.; Chen W.; Gu Y.; Qi Z.-Y.; Chen Y.-H.; Chen J.; Jiang L.
Institution
(Ding, Chen, Gu, Qi, Chen) Nutrition Department, Shanghai Pulmonary
Hospital Affiliated to Tongji University, Shanghai, China
(Chen) Thoracic Surgery Department, Shanghai Pulmonary Hospital Affiliated
to Tongji University, Shanghai, China
(Jiang) Thoracic Surgery Department, Shanghai Pulmonary Hospital
Affiliated to Tongji University, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND AND OBJECTIVES: To investigate the effect of accelerated
rehabilitation combined with enteral nutrition on surgically treated lung
cancer patients. METHODS AND STUDY DESIGN: In total, 150 lung cancer
patients treated in our hospital from January 2017 to January 2018 were
retrospectively analysed. Sixty-six patients were randomly divided into a
control group with conventional nutrition (Con group) and an accelerated
rehabilitation combined with enteral nutrition group (EN group).
Postoperative drainage; total hospitalization time; total hospitalization
expenses; and albumin, haemoglobin and total lymphocyte counts (TLC)
before and after treatment were compared. RESULT(S): The serum
albumin, prealbumin and haemoglobin in both groups were decreased after
operation and were significantly higher in the EN group (p<0.05) than in
the Con group. The TLC decreased in both groups after operation and were
significantly higher in the EN group than in the con group. The
postoperative drainage volume, total hospitalization time and total
hospitalization expenses were significantly lower in the EN group than in
the Con group (p<0.05). CONCLUSION(S): The effect of accelerated
rehabilitation combined with enteral nutrition in lung cancer surgery
patients is clear. Surgery leads to stress, which enhances catabolism and
reduces the synthesis of carbohydrates, protein, and fat, increasing
patients' nutritional risk. Nutritional support combined with fast-track
minimally invasive thoracic surgery for at-risk lung cancer patients who
undergo preoperative nutritional screening and assessment can reduce
postoperative complications and hospitalization time and improve
nutritional indicators, immunity, respiratory function recovery and
clinical outcomes, leading to socioeconomic benefits.

<44>
Accession Number
2011243402
Title
The effect of preoperative aminophylline on the recovery profile after
major pelvic-abdominal surgeries: a randomized controlled double-blinded
study.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 122.
Date of Publication: December 2021.
Author
Kasim S.A.; Bahr M.H.; Abdelkader M.; Rashwan D.A.E.
Institution
(Kasim, Bahr, Abdelkader, Rashwan) Faculty of Medicine, Beni -Suef
University, Beni - Suef, Egypt
Publisher
BioMed Central Ltd
Abstract
Background: This study compared the effects of premedication with
different doses of aminophylline on the recovery profile after general
anaesthesia. Method(s): Forty-five patients scheduled for
pelvic-abdominal surgeries were divided into 3 groups: Group C: the
patients received 100 ml of IV normal saline, Group A1: the patients
received 2 mg/kg IV aminophylline, and Group A2: the patients received 4
mg/kg IV aminophylline 30 min before induction of general anaesthesia. The
following data were recorded: demographic data, ASA physical status,
duration of anaesthesia and surgery, heart rate, mean arterial blood
pressure, propofol dose, fentanyl dose, times to reach BIS (48 +/- 2)
after induction of anaesthesia and to reach a value of 80 after
discontinuation of sevoflurane anaesthesia, time to recovery of
consciousness and to tracheal extubation and to discharge from the
post-anaesthesia care unit, and side effects of aminophylline.
 Result(s): The time to reach a BIS of 48 +/- 2 was significantly
lower for the control group than group A2 (70.67 +/- 22.50 and 106.67 +/-
34.77 s for groups C and A2, respectively, p -value =0.01). The time to
reach a BIS of 80 was significantly longer for the control group than
group A1 andA2 (5.6 +/- 1.40,3.5 +/- 1.93and 2.53 +/- 1.72 min for groups
C,A1 and A2, respectively, p -value < 0.01). The time to ROC was
significantly longer for the control group than groups A1 and A2 (8.93 +/-
0.92, 5.6 +/- 2.47 and 4.53 +/- 3.33 min for groups C, A1 and A2,
respectively; p -value < 0.01). The extubation time was significantly
longer for the control group than groups A1 and A2 (12.4 +/- 1.08, 7.87
+/- 3.27 and 6.6 +/- 2.47 min for groups C, A1 and A2, respectively; p
-value < 0.01). Conclusion(s): Premedication with aminophylline
enhanced the recovery profile after pelvic-abdominal surgeries under
general anaesthesia without cardiovascular complications. Clinical trial
registration: Name of the registry: Register@ClinicalTrials.gov Trial
registration number: ClinicalTrials.gov Identifier: NCT04151381. Date of
registration, November 5, 2019, 'Retrospectively
registered'. Copyright © 2021, The Author(s).

<45>
Accession Number
2012053601
Title
Informativity of radionuclide renal scintigraphy and biochemical markers
in detection of renal dysfunction in patients undergoing myocardial
revascularization.
Source
Russian Electronic Journal of Radiology. 11 (1) (pp 144-150), 2021. Date
of Publication: 2021.
Author
Vesnina Z.V.; Kozlov B.N.; Lishmanov Y.B.
Institution
(Vesnina, Kozlov, Lishmanov) Cardiology Research Institute, Tomsk National
Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian
Federation
Publisher
I.M. Sechenov First Moscow State Medical University
Abstract
Acute renal injury (AKI) is a common complication of cardiac surgery.
Diagnostic criteria of acute renal dysfunction based on serum creatinine
concentrations do are not suitable for early detection of AKI. Purpose. To
evaluate the diagnostic significance of radionuclide scintigraphy and
biochemical markers in the detection of renal dysfunction in patients with
coronary artery disease (CAD) in the early postoperative period after
coronary artery bypass grafting (CABG). Material and methods. A randomized
controlled trial comprised a total of 108 CAD patients (all men aged 54.94
+/- 0.72 years) who underwent direct myocardial revasculariza-tion by
CABG. All patients received dynamic renal scintigraphy with 99mTc-DTPA and
blood tests measuring serum concentrations of creatinine, lipocalin
(NGAL), and Cystatin C before and after CABG. Results. After CABG, the
mean values of total glomerular filtration rate (GFR) and GFR for each
kidney significantly decreased whereas the serum concentrations of
neutro-phil gelatinase-associated lipocalin (NGAL) and Cystatin C in blood
serum significantly in-creased. In the postoperative period, the
creatinine clearance also significantly decreased. Statistical analysis
revealed direct correlations of cardiopulmonary bypass duration with the
changes in GFR (R = 0.42; P = 0.017) and s-NGAL (R = 0.39, P = 0.02) in
cardiac sur-gery patients. Conclusion. Radionuclide method is not inferior
to testing biochemical markers in the evaluation of early postoperative
renal dysfunction in regard to diagnostic value and
informativeness. Copyright © 2021 Russian Electronic Journal of
Radiology. All rights reserved.

<46>
Accession Number
2012034329
Title
Effect of bilateral internal thoracic artery harvesting on deep sternal
wound infection in diabetic patients: Review of literature.
Source
Annals of Medicine and Surgery. 66 (no pagination), 2021. Article Number:
102382. Date of Publication: June 2021.
Author
Masroor M.; Fu X.; Khan U.Z.; Zhao Y.
Institution
(Masroor, Fu, Zhao) Department of Cardiovascular Surgery, The Second
Xiangya Hospital of Central South University, 139 Renmin Middle Rd,
Changsha 410011, China
(Masroor) Department of Cardiothoracic and Vascular Surgery, Amiri Medical
Complex, Qargha Rd, Afshar, Kabul, Afghanistan
(Khan) Department of General Surgery, The Third Xiangya Hospital of
Central South University, 138 Tongzipo Rd., Changsha 410013, China
Publisher
Elsevier Ltd
Abstract
Instead of its documented superiority of patency and long-term outcomes,
the bilateral internal thoracic artery grafts are underused in the general
population, and its use is controversial and debatable in diabetic
patients due to long surgery duration, post-surgical bleeding, and sternal
wound complications such as sternal wound infection, mediastinitis, and
sternal wound dehiscence. This review article is particularly focused on
deep sternal wound infection (DSWI) of bilateral internal thoracic artery
(BITA) grafts in diabetic patients with comparison to single internal
thoracic artery (SITA) graft. Copyright © 2021

<47>
Accession Number
2012015301
Title
Pulmonary Valve Replacement in Tetralogy of Fallot: An Updated
Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Van den Eynde J.; Sa M.P.B.O.; Vervoort D.; Roever L.; Meyns B.; Budts W.;
Gewillig M.; Ruhparwar A.; Zhigalov K.; Weymann A.
Institution
(Van den Eynde, Meyns) Unit of Cardiac Surgery, Department of
Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
(Sa) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco, PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
(Vervoort) Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
United States
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Minas Gerais, Brazil
(Budts) Congenital and Structural Cardiology University Hospitals Leuven
and Department of Cardiovascular Sciences, Catholic University Leuven,
Leuven, Belgium
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Ruhparwar, Zhigalov, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center, Essen, Germany
Publisher
Elsevier Inc.
Abstract
Background: The benefits of pulmonary valve replacement (PVR) for
pulmonary insufficiency in patients with repaired tetralogy of Fallot are
still incompletely understood, and optimal timing remains challenging.
 Method(s): We systematically reviewed databases (PubMed/MEDLINE,
Embase, Cochrane Central Register of Controlled Trials /Cochrane
Controlled Trials Register, ClinicalTrials.gov, Scientific Electronic
Library Online, Literatura Latino Americana em Ciencias da Saude, and
Google Scholar) and reference lists of relevant articles for studies about
PVR in repaired tetralogy of Fallot patients that reported any of the
following outcomes: mortality and redo PVR rates, right ventricular (RV)
and left ventricular measures, QRS duration, cardiopulmonary exercise test
results, or brain natriuretic peptide. In addition to calculating the
pooled treatment effects using a random-effects meta-analysis, we
evaluated the effect of preoperative measures on PVR outcomes using
meta-regressions. Result(s): Eighty-four studies involving 7544
patients met the eligibility criteria. Pooled mortality at 30 days, 5
years, and 10 years after PVR was 0.87% (63 of 7253 patients, 80 studies),
2.7% (132 of 4952 patients, 37 studies), and 6.2% (510 of 2765 patients,
15 studies), respectively. Pooled 5- and 10-year redo PVR rates were 3.7%
(141 of 3755 patients, 23 studies) and 16.8% (172 of 3035 patients, 16
studies), respectively. The results of the previous meta-analysis could be
confirmed. In addition, we demonstrated that after PVR (1) QRS duration,
cardiopulmonary exercise test results, and RV and left ventricular
measures longitudinal strain do not significantly change; (2) brain
natriuretic peptide decreases; and (3) greater indexed RV end-diastolic
and end-systolic volumes are associated with lower chances of RV volume
normalization after PVR. Conclusion(s): This updated meta-analysis
provides evidence about the benefits of PVR. Copyright © 2021 The
Society of Thoracic Surgeons

<48>
Accession Number
2011519161
Title
Risk factors for Takotsubo syndrome following cardiac surgery: A
case-control study.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Kim Y.S.; Lim J.Y.
Institution
(Kim) Departments of Thoracic and Cardiovascular Surgery, Keimyung
University Dongsan Hospital, Daegu, South Korea
(Lim) Departments of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, The Catholic University of Korea College of Medicine, Seoul,
South Korea
Publisher
Blackwell Publishing Inc.
Abstract
Objective: Takotsubo syndrome following cardiac surgery is a rare
occurrence. However, early diagnosis is essential to prevent treatment
which could increase the left ventricular outflow tract pressure gradient
in patients with Takotsubo syndrome, and lead to cardiogenic shock.
Therefore, our study aimed to identify the incidence of Takotsubo syndrome
after cardiopulmonary bypass and the associated risk factors and
prognosis. Method(s): We retrospectively studied 5773 patients who
underwent cardiopulmonary bypass between February 2007 and July 2017.
Among these, Takotsubo syndrome was diagnosed in 52 (0.9%). To evaluate
the risk factors for Takotsubo syndrome, 104 of the remaining 5721 patient
were randomly selected as the control group (1:2 ratio). Univariate and
multivariate logistic regression analyses were used for risk factor
analysis. Result(s): Majority of patients (69.2%) in the Takotsubo
syndrome group underwent mitral valve surgery, compared with 32.7% in the
control group. The following risk factors of Takotsubo syndrome were
identified: atrio-ventricular valve surgery (odds ratio (OR) 10.5; 95%
confidence interval (CI), 2.6-42.5; p = 0.001); and the immediate
postoperative use of epinephrine (OR, 3.3; 95% CI, 1.0-10.7; p = 0.05) and
dobutamine (OR, 4.8; 95% CI, 1.72-13.3; p = 0.003). Hypertension was a
significant protective factor against Takotsubo syndrome following cardiac
surgery (OR, 0.22; 95% CI, 0.06-0.73; p = 0.01). Conclusion(s):
Takotsubo syndrome following cardiac surgery is rare. Immediate
postoperative use of epinephrine and doputamine, as well as
atrio-ventricular valve surgery were factors associated with the
development of Takotsubo syndrome. Copyright © 2021 Wiley
Periodicals LLC

<49>
Accession Number
2007018001
Title
Robustness of the comparative observational evidence supporting class i
and ii cardiac surgery procedures.
Source
Journal of the American Heart Association. 9 (17) (no pagination), 2020.
Article Number: e016964. Date of Publication: 01 Sep 2020.
Author
Gaudino M.; Hameed I.; Robinson N.B.; Naik A.; Weidenmann V.; Ruan Y.; Tam
D.; Girardi L.N.; Fremes S.
Institution
(Gaudino, Hameed, Robinson, Naik, Weidenmann, Ruan, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science University
of Toronto, Toronto, ON, Canada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Current cardiac surgery guidelines give Class I and II
recommendations to valve-sparing root replacement over the Bentall
procedure, mitral valve (MV) repair over replacement, and multiple
arterial grafting with bilateral internal thoracic artery based on
observational evidence. We evaluated the robustness of the observational
studies supporting these recommendations using the E value, an index of
unmeasured confounding. METHODS AND RESULTS: Observational studies cited
in the guidelines and in the 3 largest meta-analyses comparing the
procedures were evaluated for statistically significant effect measures.
Two E values were calculated: 1 for the effect-size estimate and 1 for the
lower limit of the 95% CI. Thirty-one observational studies were
identified, and E values were computed for 75 effect estimates. The
observed effect estimates for improved clinical outcomes with
valve-sparing root replacement versus the Bentall procedure, MV repair
versus replacement, and grafting with bilateral internal thoracic artery
versus single internal thoracic artery could be explained by an unmeasured
confounder that was associated with both the treatment and outcome by a
risk ratio of more than 16.77, 4.32, and 3.14, respectively. For MV repair
versus replacement and grafting with bilateral internal thoracic artery
versus single internal thoracic artery, the average E values were lower
than the effect sizes of the other measured confounders in 33.3% and 60.9%
of the studies, respectively. For valve-sparing root replacement versus
the Bentall procedure, no study reported effect sizes for associations of
other covariates with outcomes. CONCLUSION(S): The E values for
observational evidence supporting the use of valve-sparing root
replacement, MV repair, and grafting with bilateral internal thoracic
artery over the Bentall procedure, MV replacement, and grafting with
single internal thoracic artery are relatively low. This suggests that
small-to-moderate unmeasured confounding could explain most of the
observed associations for these procedures. Copyright © 2020 The
Authors.

<50>
Accession Number
2007017951
Title
Institutional red blood cell transfusion rates are correlated following
endovascular and surgical cardiovascular procedures: Evidence that local
culture influences transfusion decisions.
Source
Journal of the American Heart Association. 9 (22) (no pagination), 2020.
Article Number: e016232. Date of Publication: 17 Nov 2020.
Author
Apostolidou E.; Kolte D.; Kennedy K.F.; Beale C.E.; Abbott J.D.; Ehsan A.;
Gurm H.S.; Carson J.L.; Mamdani S.; Aronow H.D.
Institution
(Aronow) 593 Eddy Street, APC 730, Providence, RI 02903, United States
(Apostolidou, Abbott, Mamdani, Aronow) Division of Cardiology, Alpert
Medical School of Brown University, Providence, RI, United States
(Kolte) Division of Cardiology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, United States
(Kennedy) Statistical Consultant to the Cardiovascular Institute, Kansas
City, MO, United States
(Beale) St. Anne's Hospital, Fall River, MA, United States
(Ehsan) Division of Cardiothoracic Surgery, Alpert Medical School of Brown
University, Providence, RI, United States
(Gurm) Division of Cardiology, University of Michigan, Ann Arbor, MI,
United States
(Carson) Division of Internal Medicine, Robert Wood Johnson University
Hospital, New Brunswick, NJ, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The relationship between local hospital culture and
transfusion rates following endovascular and surgical cardiovascular
procedures has not been well studied. METHODS AND RESULTS: Patients
undergoing coronary revascularization, aortic valve replacement, lower
extremity peripheral vascular intervention, or carotid artery
revascularization from up to 852 US hospitals in the Nationwide
Readmissions Database were identified. Crude and risk-standardized red
blood cell transfusion rates were determined for each procedure. Pearson
correlation coefficients were calculated between respective procedural
transfusion rates. Median odds ratios were estimated to reflect
between-hospital variability in red blood cell transfusion rates following
the same procedure for a given patient. There was wide variation in red
blood cell transfusion rates across different procedures, from 2%
following carotid endarterectomy to 29% following surgical aortic valve
replacement. For surgical and endovascular modalities, transfusion rates
at the same hospital were highly correlated for aortic valve replacement
(r=0.67; P<0.001), moderately correlated for coronary revascularization
(r=0.56; P<0.001) and peripheral vascular intervention (r=0.51; P<0.001),
and weakly correlated for carotid artery revascularization (r=0.19,
P<0.001). Median odds ratios were all >2, highest for coronary artery
bypass graft surgery and surgical aortic valve replacement, indicating
substantial site variation in transfusion rates. CONCLUSION(S): After
adjustment for patient-related factors, wide variation in red blood cell
transfusion rates remained across surgical and endovascular procedures
employed for the same cardiovascular condition. Transfusion rates
following these procedures are highly correlated at individual hospitals
and vary widely across hospitals. In aggregate, these findings suggest
that local institutional culture significantly influences the decision to
transfuse following invasive cardiovascular procedures and highlight the
need for randomized data to inform such decisions. Copyright ©
2020 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley.

<51>
Accession Number
634837103
Title
Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve
Replacement: Systematic Review and Network Meta-Analysis.
Source
Journal of the American Heart Association. 10 (9) (pp e019490), 2021. Date
of Publication: 04 May 2021.
Author
Kuno T.; Yokoyama Y.; Briasoulis A.; Mori M.; Iwagami M.; Ando T.; Takagi
H.; Bangalore S.
Institution
(Kuno) Department of Medicine Icahn School of Medicine at Mount SinaiMount
Sinai Beth Israel New York NY
(Yokoyama) Department of Surgery St. Luke's University Health Network
Bethlehem PA
(Briasoulis) Division of Cardiology, Heart Failure and Transplantation
University of Iowa Iowa City IA
(Mori) Division of Cardiac Surgery Yale School of Medicine New Haven CT
(Iwagami) Department of Health Services Research University of Tsukuba
Japan
(Ando) Department of Cardiology Kawasaki Saiwai Hospital Kawasaki Japan
(Takagi) Department of Cardiovascular Surgery Shizuoka Medical Center
Shizuoka Japan
(Bangalore) Division of Cardiovascular Medicine New York University School
of Medicine New York NY
Publisher
NLM (Medline)
Abstract
Background Although current guidelines recommend dual antiplatelet therapy
(DAPT) for 3 to 6 months following transcatheter aortic valve replacement
(TAVR), there are no studies directly comparing outcomes of different
durations of DAPT following TAVR. Methods and Results PubMed, EMBASE, and
Cochrane Database were searched through November 2020 to identify clinical
studies that investigated single antiplatelet therapy versus DAPT use
following TAVR. Studies using oral anticoagulants and antiplatelet therapy
concomitantly were excluded. The DAPT group was subdivided by the duration
of DAPT. We extracted the risk ratios (RRs) of major or life-threatening
bleeding, stroke, and all-cause mortality. Four randomized controlled
trials, 2 propensity-score matched studies, and 1 observational study were
identified, yielding a total of 2498 patients who underwent TAVR assigned
to the single antiplatelet therapy group (n=1249), 3-month DAPT group
(n=485), or 6-month DAPT group (n=764). Pooled analyses demonstrated that
when compared with the single antiplatelet therapy group, the rates of
major or life-threatening bleeding were significantly higher in the 3- and
6-month DAPT groups (RR [95% CI]=2.13 [1.33-3.40], P=0.016; RR [95%
CI]=2.54 [1.49-4.33], P=0.007, respectively) with no difference between
the 3-month DAPT versus 6-month DAPT groups. The rates of stroke and
all-cause mortality were similar among the 3 groups. Conclusions In this
network meta-analysis of antiplatelet therapy following TAVR, single
antiplatelet therapy with aspirin had lower bleeding without increasing
stroke or death when compared with either 3- or 6-month DAPT.

<52>
Accession Number
635011925
Title
Outcomes of Balloon Angioplasty and Stenting for Symptomatic Intracranial
Atherosclerotic Stenosis at a High Volume Center.
Source
Acta Neurochirurgica, Supplementum. 132 (pp 63-67), 2021. Date of
Publication: 2021.
Author
Ueda T.; Takada T.; Usuki N.; Takaishi S.; Tokuyama Y.; Tatsuno K.; Hamada
Y.; Yoshie T.
Institution
(Ueda, Takada, Usuki, Takaishi, Tokuyama, Tatsuno, Hamada, Yoshie)
Department of Strokology, Stroke Center, St. Marianna University Toyoko
Hospital, Kawasaki, Japan
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: This study investigated the periprocedural complication rates,
long-term outcome, and restenosis of endovascular treatment for
intracranial atherosclerotic stenosis (ICS) at our hospital.
 Method(s): We retrospectively analyzed the clinical data of 217
patients comprising 256 endovascular treatments for high-grade symptomatic
ICS. The lesion was located in the internal carotid artery in 77, the
middle cerebral artery in 111, the basilar artery in 29, and the vertebral
artery in 39. Patients were divided into two groups, before (early-phase
group, 1999-2013) and after approval of Wingspan (late-phase group,
2014-2017). Result(s): In the early-phase group (n = 163), 157
lesions were treated by balloon angioplasty and 31 (17%) by coronary
stenting. In the late-phase group (n = 54), 33 lesions were treated by
balloon angioplasty and 35 (52%) by Wingspan stenting. Overall technical
success rates were 96% in the balloon angioplasty and 100% in stenting
groups. The 30-day rate of stroke, TIA, and death were 4.8% in the
early-phase group and 4.4% in the late-phase group. There was one minor
stroke and two TIAs during the follow-up period in the late-phase group.
 Conclusion(s): Endovascular treatment for symptomatic ICS in this
study appeared to be safe and effective if patients are properly selected.
However, future well-designed randomized trials with different techniques
and modified patients selection criteria are certainly
warranted. Copyright © The Author(s) 2021.

<53>
Accession Number
635024963
Title
A meta-analysis of the diagnostic accuracy of chest ultrasound for the
diagnosis of occult penetrating cardiac injuries in hemodynamically stable
patients with penetrating thoracic trauma.
Source
Journal of Trauma and Acute Care Surgery. 90 (2) (pp 388-395), 2021. Date
of Publication: 2021.
Author
Manzano-Nunez R.; Gomez A.; Espitia D.; Sierra-Ruiz M.; Gonzalez J.;
Rodriguez-Narvaez J.G.; Castillo A.C.; Gonzalez A.; Orjuela J.;
Orozco-Martin V.; Bernal F.; Giron F.; Rios A.C.; Carranza P.;
Gonzalez-Hadad A.; Garcia-Perdomo H.A.; Garcia A.F.
Institution
(Manzano-Nunez, Espitia, Gonzalez, Rodriguez-Narvaez, Castillo, Gonzalez,
Orjuela, Orozco-Martin, Bernal, Giron) Mederi Hospital Universitario Mayor
(Manzano-Nunez, Espitia, Gonzalez, Rodriguez-Narvaez, Castillo, Gonzalez,
Orjuela, Orozco-Martin, Bernal, Giron) Escuela de Medicina y Ciencias de
la Salud, Universidad del Rosario, Bogota, DC, Colombia
(Gomez, Sierra-Ruiz) Fundacion Valle del Lili, Clinical Research Center,
Cali, Colombia
(Rios, Carranza) Hospital Occidente de Kennedy, Bogota, DC, Colombia
(Gonzalez-Hadad, Garcia-Perdomo) Seccion de Urologia, Departamento de
Cirugia, Universidad del Valle
(Garcia) Department of Surgery, Fundacion Valle del Lili, Cali, Colombia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We performed a systematic review (SR) and meta-analysis (MA)
to determine the diagnostic accuracy of chest ultrasound (US) compared
with a pericardial window (PW) for the diagnosis of occult penetrating
cardiac injuries in hemodynamically stable patients with penetrating
thoracic trauma. Method(s): A literature search in five databases
identified relevant articles for inclusion in this SR and MA. Studies were
eligible if they evaluated the diagnostic accuracy of chest US, compared
with a PW, for the diagnosis of occult penetrating cardiac injuries in
hemodynamically stable patients presenting with penetrating thoracic
trauma. Two investigators independently assessed articles for inclusion
and exclusion criteria and selected studies for final analysis.
Methodological quality was evaluated using Quality Assessment of
Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test
accuracy within the bivariate mixed-effects logistic regression modeling
framework. Result(s): We included five studies in our SR and MA.
These studies included a total of 556 trauma patients. The MA found that,
compared with PW, the US was 79% sensitive and 92% specific for detecting
occult penetrating cardiac injuries in hemodynamically stable patients.
The presence of a concomitant left hemothorax was frequent in patients
with false-negative results. Conclusion(s): This SR and MA found
that, compared with PW, US was 79% sensitive and 92% specific for
detecting occult penetrating cardiac injuries in hemodynamically stable
patients with penetrating thoracic trauma. Caution interpretation of
pericardial US results is suggested in the presence of left hemothorax. In
these cases, a second diagnostic test should be performed. LEVEL OF
EVIDENCE Systematic Review and Meta-analysis, level II. Copyright
© 2021 Wolters Kluwer Health, Inc. All rights reserved.

<54>
Accession Number
635024401
Title
Longitudinal course of depressive, anxiety, and posttraumatic stress
disorder symptoms after heart surgery: A meta-analysis of 94 studies.
Source
Psychosomatic Medicine. 83 (1) (pp 85-93), 2021. Date of Publication:
2021.
Author
Rosson S.; Monaco F.; Miola A.; Cascino G.; Stubbs B.; Correll C.U.; Firth
J.; Ermis C.; Perrotti A.; Marciello F.; Carvalho A.F.; Brunoni A.R.;
Fusar-Poli P.; Fornaro M.; Gentile G.; Granziol U.; Pigato G.; Favaro A.;
Solmi M.
Institution
(Rosson, Miola, Gentile, Favaro, Solmi) Neurosciences Department,
University of Padua, Padua, Italy
(Monaco) Department OfMental Health, Residential Eating Disorder Unit
"mariconda", Asl Salerno, Italy
(Cascino, Marciello) Department OfMedicine, Surgery and Dentistry "scuola
Medica Salernitana", Section of Neurosciences, University of Salerno,
Salerno, Italy
(Stubbs) Physiotherapy Department, South London and Maudsley National
Health Services Foundation Trust, King's College London, London, United
Kingdom
(Stubbs) Department of Psychological Medicine, Institute of Psychiatry
Psychology and Neuroscience, King's College London, London, United Kingdom
(Correll) Department of Psychiatry, The ZuckerHillside Hospital, Northwell
Health, Glen Oaks, NY, United States
(Correll) Department of Psychiatry and Molecular Medicine, Zucker School
OfMedicine at Hofstra/Northwell, Hempstead, NY, United States
(Correll) The Feinstein Institute ForMedical Research, Center for
Psychiatric Neuroscience, Manhasset, NY, United States
(Correll) Department of Child and Adolescent Psychiatry, Charite
Universitatsmedizin Berlin, Berlin, Germany
(Firth) Division of Psychology AndMentalHealth, Faculty of Biology
Medicine and Health, University OfManchester, Manchester, United Kingdom
(Firth) Nicm Health Research Institute, School of Science and Health,
University of Western Sydney, Sydney, Australia
(Firth) Centre for Youth Mental Health, University of Melbourne,
Melbourne, Australia
(Ermis) Department of Child and Adolescent Psychiatry, Dokuz Eylul
University, Izmir, Turkey
(Perrotti) Cardio-Thoracic Surgery Department, University Hospital Jean
Minjoz, Besancon, France
(Perrotti) Ea 3920, University of Franche-Comte, Besancon, France
(Carvalho) Centre for Addiction AndMentalHealth (CAMH), University of
Toronto, Toronto, ON, Canada
(Carvalho) Department of Psychiatry, University of Toronto, Toronto, ON,
Canada
(Brunoni) Department of Psychiatry and Psychotherapy, University Hospital,
Lmu Munich, Munich, Germany
(Brunoni) Service of Interdisciplinary Neuromodulation, Department of
Psychiatry, Laboratory of Neurosciences (LIM-27), National Institute of
Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry,
University of Sao Paulo, Sao Paulo, Brazil
(Brunoni) Hospital Universitario, Departamento de Clinica Medica,
Faculdade de Medicina da Usp, Sao Paulo, Brazil
(Fusar-Poli, Solmi) Early Psychosis: Interventions and Clinical-detection
(EPIC) Laboratory, Department of Psychosis Studies, Institute of
Psychiatry, Psychology and Neuroscience, King's College London, London,
United Kingdom
(Fusar-Poli) Oasis Service, South London and Maudsley Nhs Foundation
Trust, London, United Kingdom
(Fusar-Poli) Department of Brain and Behavioral Sciences, University of
Pavia, Pavia, Italy
(Fusar-Poli) National Institute ForHealth Research, Maudsley Biomedical
Research Centre, South London and Maudsley Nhs Foundation Trust, London,
United Kingdom
(Fornaro) Neuroscience, Reproductive Science and Odontostolmatology,
Section of Psychiatry, University School of Medicine Federico Ii, Naples,
Italy
(Favaro, Solmi) Neuroscience Centre, University of Padua, Padua, Italy
(Granziol) Department of General Psychology, University of Padua, Padua,
Italy
(Pigato) Psychiatry Unit, Padua University Hospital, Padua, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: This study aimed to analyze the longitudinal course of
depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in
patients with cardiac disease after heart surgery (HS). Method(s): We
conducted a systematic review and random-effects meta-analysis of cohort
studies in patients undergoing HS, measuring anxiety, depressive, and PTSD
symptoms before and at least 30 days thereafter. Subgroup and
meta-regression analyses, investigation of publication bias, and quality
assessment were undertaken. Result(s):We included 94 studies relating
to 15,561 patients. HS included coronary artery bypass graft surgery,
valve replacement, implantable cardioverter-defibrillator placement, left
ventricular assist device placement, heart transplantation, and other
types of HS. Across studies, symptoms of depression (g = 0.32; 95%
confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved
after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD
symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The
reduction of depression and anxiety levels was more pronounced for
patients with underlying coronary artery disease and heart failure and
persisted for 1 year after HS, whereas the increase in PTSD symptoms
returned to baseline after 6 months. Depression improvement was inversely
associated with older age, diabetes, hypertension, and dyslipidemia and
positively with baseline heart failure. No additional clinical or
demographic variables were associated with the course of anxiety symptoms.
Quality of included studies was low overall. Publication bias was
nonsignificant. Conclusion(s): Depressive and anxiety symptoms
improve for 1 year after HS, whereas PTSD symptoms might worsen. Older
patients and those withmetabolic comorbidities, valve disease, or
ventricular arrhythmias are at higher risk for continued depressive and
anxiety symptoms and should be monitored closely. Copyright ©
2021 Lippincott Williams and Wilkins. All rights reserved.

<55>
Accession Number
2007118991
Title
Role of perioperative rosuvastatin in preventing post-operative cardiac
complications after non-cardiac surgery in patients with moderate to high
cardiac risk.
Source
World Heart Journal. 12 (3) (pp 269-280), 2020. Date of Publication: 2020.
Author
Mathew S.R.; Mohanan S.; Shamsu A.; Chacko M.P.; Unnikrishnan M.K.; Anil
Babu A.; Sareena A.
Institution
(Mathew) Qatar
(Mohanan) Consultant Interventional Cardiologist, KMCT Medical College,
Department of Cardiology, Kozhikode, Kerala, India
(Shamsu, Chacko, Unnikrishnan, Sareena) National College of Pharmacy,
Department of Pharmacy Practice, Kozhikode, Kerala, India
(Anil Babu) Westfort College of Pharmacy, Department of Pharmacy Practice,
Thrissur, Kerala, India
Publisher
Nova Science Publishers, Inc.
Abstract
Objective: To assess the cardioprotective effect of high dose,
perioperative rosuvastatin therapy in moderate to high cardiac-risk
patients undergoing non-cardiac surgery (NCS). Method(s): The
following was a randomized, prospective interventional study of patients
with moderate to high cardiac risk identified by revised cardiac risk
index (RCRI) and Gupta's criteria during a routine NCS fitness test in the
cardiology department. Patients were randomized into a treatment arm (N =
38), receiving 20mg perioperative rosuvastatin, and control (N = 39)
receiving standard care. The primary outcome was the identification of
elevation of Troponin I (trop I) and creatine kinase-muscle/brain (CK-MB)
levels at 24-hour post-surgery. The secondary outcome included follow-up
at 30 days for cardiac morbidity and mortality in patients.
 Result(s): Among 100 enrolled, 77 patients (54.5% female) completed
the study. Postoperative trop I and CK-MB levels were found to be
significantly lower in the treatment arm (trop I: p < 0.001; CK-MB: p <
0.001) in comparison to the control. The treatment arm had less (13%)
30-day cardiac complications in comparison to control (33.3%). The matched
population (N = 44) also had less cardiac morbidities in the treatment
group (13.64%) than in control (45.5%). The prominent 30-day cardiac
complication was identified as acute coronary syndrome.
 Conclusion(s): Perioperative rosuvastatin therapy provided
significant cardioprotective effect in moderate to high cardiac risk
patients undergoing NCS. The intervention group had decreased elevation of
trop I and CK-MB levels post-surgery and reduced 30-day cardiac morbidity
and mortality. Large randomized trials are required for further assessment
of perioperative rosuvastatin therapy in NCS. Copyright © Nova
Science Publishers, Inc.

<56>
Accession Number
2007028390
Title
Clinical implications of physical function and resilience in patients
undergoing transcatheter aortic valve replacement.
Source
Journal of the American Heart Association. 9 (17) (no pagination), 2020.
Article Number: e017075. Date of Publication: 2020.
Author
Goel K.; O'leary J.M.; Barker C.M.; Levack M.; Rajagopal V.; Makkar R.R.;
Bajwa T.; Kleiman N.; Linke A.; Kereiakes D.J.; Waksman R.; Allocco D.J.;
Rizik D.G.; Reardon M.J.; Lindman B.R.
Institution
(Goel, O'leary, Barker, Levack, Lindman) Structural Heart and Valve
Center, Vanderbilt University Medical Center, Nashville, TN, United States
(Goel, O'leary, Barker, Levack, Lindman) Cardiovascular Medicine Division,
Vanderbilt University Medical Center, Nashville, TN, United States
(Levack) Cardiac Surgery Department, Vanderbilt University Medical Center,
Nashville, TN, United States
(Rajagopal) Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta,
GA, United States
(Makkar) Smidt Heart Institute, Cedars-Sinai Heart Institute, Los Angeles,
CA, United States
(Bajwa) Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's
Medical Centers, Milwaukee, WI, United States
(Kleiman, Reardon) Department of Cardiovascular Surgery, Houston Methodist
DeBakey Heart and Vascular Center, Houston, TX, United States
(Linke) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Technical University of Dresden, Germany
(Kereiakes) The Christ Hospital Heart and Vascular Center, Lindner
Research Center, Cincinnati, OH, United States
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Allocco) Clinical Sciences, Boston Scientific Corp, Marlborough, MA,
United States
(Rizik) HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale,
AZ, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Gait speed is a reliable measure of physical function and
frailty in patients with aortic stenosis undergoing transcatheter aortic
valve replacement (TAVR). Slow gait speed pre-TAVR predicts worse clinical
outcomes post-TAVR. The consequences of improved versus worsened physical
function post-TAVR are unknown. METHODS AND RESULTS: The REPRISE III
(Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through
Implantation of Lotus Valve System-Randomized Clinical Evaluation) trial
randomized high/extreme risk patients to receive a mechanically-expanded
or self-expanding transcatheter heart valve. Of 874 patients who underwent
TAVR, 576 with complete data at baseline and 1 year were included in this
analysis. Slow gait speed in the 5-m walk test was defined as <0.83 m/s. A
clinically meaningful improvement (>=0.1 m/s) in gait speed 1 year after
TAVR occurred in 39% of patients, 35% exhibited no change, and 26%
declined (>=0.1 m/s). Among groups defined by baseline/1-year post-TAVR
gait speeds, 1-to 2-year mortality or hospitalization rates were as
follows: 6.6% (normal/normal), 8.0% (slow/normal), 20.9% (normal/slow),
and 21.5% (slow/ slow). After adjustment, slow gait speed at 1 year
(regardless of baseline speed) was associated with a 3.5-fold increase in
death/hospitalization between 1 and 2 years compared with those with
normal baseline/1-year gait speed. Patients whose slow gait speed
normalized at 1 year had no increased risk. One-year, but not baseline,
gait speed was associated with death or hospitalization between 1 and 2
years (adjusted hazard ratio, 0.83 per 0.1 m/s faster gait; 95% CI,
0.74-0.93, P=0.001). CONCLUSION(S): Marked heterogeneity exists in
the trajectory of physical function after TAVR and this, more than
baseline function, has clinical consequences. Identifying and optimizing
factors associated with physical resilience after TAVR may improve
outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT02202434. Copyright © 2020 The Authors.

<57>
Accession Number
2007018276
Title
Prognostic assessment of right ventricular systolic dysfunction on
post-transcatheter aortic valve replacement short-term outcomes:
Systematic review and meta-analysis.
Source
Journal of the American Heart Association. 9 (12) (no pagination), 2020.
Article Number: e014463. Date of Publication: 16 Jun 2020.
Author
Grevious S.N.; Fernandes M.F.; Annor A.K.; Ibrahim M.; Saint Croix G.R.;
de Marchena E.; Cohen M.G.; Alfonso C.E.
Institution
(Grevious, Ibrahim) Cardiovascular Division, Department of Medicine,
Boston University School of Medicine, Boston, MA, United States
(Fernandes) Cardiovascular Division, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Annor) Department of Medicine, Baylor College of Medicine, Houston, TX,
United States
(Saint Croix, de Marchena, Cohen, Alfonso) Department of Medicine,
University of Miami Miller School of Medicine, Miami, FL, United States
(de Marchena, Cohen, Alfonso) Cardiovascular Division, Department of
Medicine, University of Miami Miller School of Medicine, Miami, FL, United
States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Right ventricular systolic dysfunction (RVSD) is a known risk
factor for adverse outcome in surgical aortic valve replacement.
Transcatheter aortic valve replacement (TAVR), on the other hand, has been
shown to be either beneficial or have no effect on right ventricular
systolic function. However, the prognostic significance of RVSD on TAVR
has not been clearly determined. We conducted a systematic review and
meta-analysis to define the impact of RVSD on outcomes in terms of 1-year
mortality in patients with severe aortic stenosis undergoing TAVR. METHODS
AND RESULTS: An extensive literature review was performed, with an aim to
identify clinical studies that focused on the prognosis and short-term
mortality of patients with severe symptomatic aortic stenosis who
underwent TAVR. A total of 3166 patients from 8 selected studies were
included. RVSD, as assessed with tricuspid annular plane systolic
excursion, fractional area change or ejection fraction, was found to be a
predictor of adverse procedural outcome after TAVR (hazard ratio, 1.31;
95% CI, 1.1-1.55; P=0.002). Overall, we found that RVSD did affect
post-TAVR prognosis in 1-year mortality rate. CONCLUSION(S): Patients
with severe, symptomatic aortic stenosis and concomitant severe RVSD have
a poor 1-year post-TAVR prognosis when compared with patients without
RVSD. Right ventricular dilation and severe tricuspid regurgitation were
associated with increased 1-year morality post-TAVR and should be
considered as independent risk factors. Further evaluations of long-term
morbidity, mortality, as well as sustained improvement in functional class
and symptoms need to be conducted to determine the long-term
effects. Copyright © 2020, American Heart Association Inc.. All
rights reserved.

<58>
Accession Number
2007018215
Title
Combining biomarkers and imaging for short-term assessment of
cardiovascular disease risk in apparently healthy adults.
Source
Journal of the American Heart Association. 9 (15) (no pagination), 2020.
Article Number: e015410. Date of Publication: 04 Aug 2020.
Author
Gore M.O.; Ayers C.R.; Khera A.; Defilippi C.R.; Wang T.J.; Seliger S.L.;
Nambi V.; Selvin E.; Berry J.D.; Hundley W.G.; Budoff M.; Greenland P.;
Drazner M.H.; Ballantyne C.M.; Levine B.D.; de Lemos J.A.
Institution
(Gore) Department of Medicine, University of Colorado Anschutz Medical
Campus, Aurora, CO, United States
(Gore) Department of Medicine, Denver Health and Hospital Authority,
Denver, CO, United States
(Gore) Community Health Department, Colorado Prevention Center, Aurora,
CO, United States
(Ayers, Khera, Wang, Berry, Drazner, Levine, de Lemos) Department of
Medicine, University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Defilippi) Inova Heart and Vascular Institute, Fall Church, VA, United
States
(Seliger) Department of Medicine, University of Maryland School of
Medicine, Baltimore, MD, United States
(Nambi, Ballantyne) Department of Medicine, Baylor College of Medicine,
Houston, TX, United States
(Nambi, Ballantyne) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Nambi) Department of Medicine, Michael E. DeBakey Veterans Affairs
Hospital, Houston, TX, United States
(Selvin) Department of Epidemiology, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
(Hundley) Departments of Medicine and Radiological Sciences, Wake Forest
Health Sciences, Winston-Salem, NC, United States
(Budoff) Los Angeles Biomedical Research Institute, Los Angeles, CA,
United States
(Greenland) Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University, Chicago, IL, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Current strategies for cardiovascular disease (CVD) risk
assessment focus on 10-year or longer timeframes. Shorter-term CVD risk is
also clinically relevant, particularly for high-risk occupations, but is
under-investigated. METHODS AND RESULTS: We pooled data from participants
in the ARIC (Atherosclerosis Risk in Communities study), MESA
(Multi-Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study),
free from CVD at baseline (N=16 581). Measurements included N-terminal
pro-B-type natriuretic peptide (>100 pg/mL prospectively defined as
abnormal); high-sensitivity cardiac troponin T (abnormal >5 ng/L);
high-sensitivity C-reactive protein (abnormal >3 mg/L); left ventricular
hypertrophy by ECG (abnormal if present); carotid intima-media thickness,
and plaque (abnormal >75th percentile for age and sex or presence of
plaque); and coronary artery calcium (abnormal >10 Agatston U). Each
abnormal test result except left ventricular hypertrophy by ECG was
independently associated with increased 3-year risk of global CVD
(myocardial infarction, stroke, coronary revascularization, incident heart
failure, or atrial fibrillation), even after adjustment for traditional
CVD risk factors and the other test results. When a simple integer score
counting the number of abnormal tests was used, 3-year
multivariable-adjusted global CVD risk was increased among participants
with integer scores of 1, 2, 3, and 4, by =2-, 3-, 4.5-and 8-fold,
respectively, when compared with those with a score of 0. Qualitatively
similar results were obtained for atherosclerotic CVD (fatal or non-fatal
myocardial infarction or stroke). CONCLUSION(S): A strategy
incorporating multiple biomarkers and atherosclerosis imaging improved
assessment of 3-year global and atherosclerotic CVD risk compared with a
standard approach using traditional risk factors. Copyright ©
2020 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley.

<59>
Accession Number
2007018160
Title
Infective endocarditis after surgical and transcatheter aortic valve
replacement: A state of the art review.
Source
Journal of the American Heart Association. 9 (16) (no pagination), 2020.
Article Number: e017347. Date of Publication: 16 Aug 2020.
Author
Alexis S.L.; Malik A.H.; George I.; Hahn R.T.; Khalique O.K.; Seetharam
K.; Bhatt D.L.; Tang G.H.L.
Institution
(Alexis, Tang) Department of Cardiovascular Surgery, Mount Sinai Medical
Center, New York, NY, United States
(Malik) Department of Medicine, Westchester Medical Center, Valhalla, NY,
United States
(George) Division of Cardiac Surgery, Columbia University Medical Center,
New York, NY, United States
(Hahn, Khalique) Division of Cardiology, Columbia University Medical
Center, New York, NY, United States
(Seetharam) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
American Heart Association Inc.
Abstract
Prosthetic valve endocarditis (PVE) after surgical aortic valve
replacement and transcatheter aortic valve replacement (TAVR) carries
significant morbidity/mortality. Our review aims to compare incidence,
predisposing factors, microbiology, diagnosis, management, and outcomes of
PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed
and Embase to identify published studies from January 1, 2015 to March 13,
2020. Key words were indexed for original reports, clinical studies, and
reviews. Reports were evaluated by 2 authors against a priori
inclusion/exclusion criteria. Studies were included if they reported
incidence and outcomes related to surgical aortic valve replacement/TAVR
PVE and excluded if they were published pre-2015 or included a small
population. We followed the Cochrane methodology and Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines for all stages
of the design and implementation. Study quality was based on the
Newcastle-Ottawa Scale. Thirty-three studies with 311 to 41025 patients
contained relevant information. The majority found no significant
difference in incidence of surgical aortic valve replacement/TAVR PVE
(reported as 0.3%-1.2% per patient-year versus 0.6%-3.4%), but there were
key differences in pathogenesis. TAVR has a specific set of infection
risks related to entry site, procedure, and device, including
nonstandardized protocols for infection control, valve crimping injury,
paravalvular leak, neo-leaflet stress, intact/calcified native leaflets,
and intracardiac hardware. With the expansion of TAVR to lower risk and
younger patients, a better understanding of pathogenesis, patient
presentation, and guideline-directed treatment is paramount. When
operative intervention is necessary, mortality remains high at 20% to 30%.
Unique TAVR infection risks present opportunities for PVE prevention,
therefore, further investigation is imperative. Copyright © 2020
The Authors. Published on behalf of the American Heart Association, Inc.,
by Wiley.

<60>
Accession Number
2007018087
Title
Association of isolated coronary microvascular dysfunction with mortality
and major adverse cardiac events: A systematic review and meta-analysis of
aggregate data.
Source
Journal of the American Heart Association. 9 (9) (no pagination), 2020.
Article Number: e014954. Date of Publication: 05 May 2020.
Author
Gdowski M.A.; Murthy V.L.; Doering M.; Monroy-Gonzalez A.G.; Slart R.;
Brown D.L.
Institution
(Gdowski, Brown) Cardiovascular Division, Washington University School of
Medicine, St. Louis, MO, United States
(Gdowski, Doering, Brown) Washington University School of Medicine, St.
Louis, MO, United States
(Murthy) Frankel Cardiovascular Center, University of Michigan, Ann Arbor,
MI, United States
(Monroy-Gonzalez, Slart) Medical Imaging Center, Departments of Nuclear
Medicine and Molecular Imaging and Radiology, University of Groningen,
University Medical Center, Groningen, Netherlands
(Slart) TechMed Centre, Department of Biomedical Photonic Imaging,
University of Twente, Enschede, Netherlands
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The impact of coronary microvascular dysfunction (CMD), as
diagnosed by reduced coronary flow reserve, on the outcomes of patients
with symptoms of myocardial ischemia and nonobstructive coronary artery
disease is poorly understood. We performed a systematic review and
meta-analysis of observational studies to determine the association of CMD
with outcomes. METHODS AND RESULTS: We searched online databases for
studies where coronary flow reserve was measured invasively or
noninvasively, clinical events were recorded after determination of
coronary flow reserve, and the frequency of those events was reported for
patients with and without CMD. The primary outcome was all-cause
mortality. The secondary outcome was major adverse cardiac events,
including cardiac or cardiovascular death, nonfatal myocardial infarction,
cardiac hospitalization, or coronary revascularization. Estimates of
effect were calculated from crude event rates with a random-effects model.
There were 122 deaths in the 4661 patients without CMD (2.6%) and 183
deaths in the 1970 patients with CMD (9.3%). The odds ratio for mortality
in patients with CMD compared with those without CMD was 3.93 (95% CI,
2.91-5.30; P<0.001). There were 167 major adverse cardiac events in the
3742 patients without CMD (4.5%) and 245 events in the 1447 patients with
CMD (16.9%). The odds ratio for major adverse cardiac events in patients
with CMD compared with those without CMD was 5.16 (95% CI, 2.81-9.47;
P<0.001). CONCLUSION(S): CMD is associated with a nearly 4-fold
increase in mortality and a 5-fold increase in major adverse cardiac
events. Future studies are needed to identify effective strategies to
diagnose and treat CMD. Copyright © 2020, American Heart
Association Inc.. All rights reserved.

<61>
Accession Number
2007018057
Title
Femoral versus nonfemoral subclavian/ carotid arterial access route for
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 9 (19) (no pagination), 2020.
Article Number: e017460. Date of Publication: 06 Oct 2020.
Author
Faroux L.; Junquera L.; Mohammadi S.; Del Val D.; Muntane-Carol G.; Alperi
A.; Kalavrouziotis D.; Dumont E.; Paradis J.-M.; Delarochelliere R.;
Rodes-Cabau J.
Institution
(Faroux, Junquera, Mohammadi, Del Val, Muntane-Carol, Alperi,
Kalavrouziotis, Dumont, Paradis, Delarochelliere, Rodes-Cabau) Quebec
CityQCCanada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Some concerns remain regarding the safety of transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement. We
aimed to compare the risk of 30-day complications and death in
transcarotid/transsubclavian versus transfemoral transcatheter aortic
valve replacement recipients. METHODS AND RESULTS: Data from 20 studies,
including 79 426 patients (16 studies) and 3992 patients (4 studies) for
the evaluation of the unadjusted and adjusted impact of the arterial
approach were sourced, respectively. The use of a transcarotid/
transsubclavian approach was associated with an increased risk of stroke
when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90-2.72) as
well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05-2.22). The
pooled results deriving from unadjusted data showed an increased risk of
30-day death (RR, 1.46; 95% CI, 1.22-1.74) and bleeding (RR, 1.53; 95% CI,
1.18-1.97) in patients receiving transcatheter aortic valve replacement
through a transcarotid/transsubclavian access (compared with the
transfemoral group), but the associations between the arterial access and
death (OR, 1.22; 95% CI, 0.89-1.69), bleeding (OR, 1.05; 95% CI,
0.68-1.61) were no longer significant when using adjusted data. No
significant effect of the arterial access on vascular complication was
observed in unadjusted (RR, 0.84; 95% CI, 0.66-1.06) and adjusted (OR,
0.79; 95% CI, 0.53-1.17) analyses. CONCLUSION(S): Transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement were
associated with an increased risk of stroke compared with the transfemoral
approach. However, these nonfemoral arterial alternative accesses were not
associated with an increased risk of 30-day death, bleeding, or vascular
complication when taking into account the confounding
factors. Copyright © 2020 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<62>
Accession Number
2007011953
Title
Low-density lipoprotein cholesterol corrected for lipoprotein(A)
cholesterol, risk thresholds, and cardiovascular events.
Source
Journal of the American Heart Association. 9 (23) (no pagination), 2020.
Article Number: e016318. Date of Publication: 01 Dec 2020.
Author
Willeit P.; Yeang C.; Moriarty P.M.; Tschiderer L.; Varvel S.A.; McConnell
J.P.; Tsimikas S.
Institution
(Willeit, Tschiderer) Department of Neurology, Medical University of
Innsbruck, Innsbruck, Austria
(Willeit) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(Yeang, Tsimikas) Division of Cardiovascular Medicine, Sulpizio
Cardiovascular Center, University of California, La Jolla, San Diego, CA,
United States
(Moriarty) Division of Clinical Pharmacology, Department of Internal
Medicine, University of Kansas Medical Center, Kansas City, MO, United
States
(Varvel, McConnell) Salveo Diagnostics, Inc, Richmond, VA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Conventional "low-density lipoprotein cholesterol (LDL-C)"
assays measure cholesterol content in both low-density lipoprotein and
lipoprotein(a) particles. To clarify the consequences of this
methodological limitation for clinical care, our study aimed to compare
associations of "LDL-C" and corrected LDL-C with risk of cardiovascular
disease and to assess the impact of this correction on the classification
of patients into guideline-recommended LDL-C categories. METHODS AND
RESULTS: Lipoprotein(a) cholesterol content was estimated as 30% of
lipoprotein(a) mass and subtracted from "LDL-C" to obtain corrected LDL-C
values (LDL-C<inf>corr30</inf> ). Hazard ratios for cardiovascular disease
(defined as coronary heart disease, stroke, or coronary revascularization)
were quantified by individual-patient-data meta-analysis of 5 statin
landmark trials from the Lipoprotein(a) Studies Collaboration (18 043
patients; 5390 events; 4.7 years median follow-up). When compar-ing top
versus bottom quartiles, the multivariable-adjusted hazard ratio for
cardiovascular disease was significant for "LDL-C" (1.17; 95% CI,
1.05-1.31; P=0.005) but not for LDL-C<inf>corr30</inf> (1.07; 95% CI,
0.93-1.22; P=0.362). In a routine laboratory database involving 531 144
patients, reclassification of patients across guideline-recommended LDL-C
categories when using LDL-C<inf>corr30</inf> was assessed. In "LDL-C"
categories of 70 to <100, 100 to <130, 130 to <190, and >=190 mg/dL,
significant proportions (95% CI) of participants were reassigned to lower
LDL-C categories when LDL-C<inf>corr30</inf> was used: 30.2%
(30.0%-30.4%), 35.1% (34.9%-35.4%), 32.9% (32.6%-33.1%), and 41.1%
(40.0%-42.2%), respectively. CONCLUSION(S): "LDL-C" was associated
with incident cardiovascular disease only when lipoprotein(a) cholesterol
content was included in its measurement. Refinement in techniques to
accurately measure LDL-C, particularly in patients with elevated
lipoprotein(a) levels, is warranted to assign risk to the responsible
lipoproteins. Copyright © 2020 The Authors. Published on behalf
of the American Heart Association, Inc., by Wiley.

<63>
Accession Number
2007011884
Title
Modified glucose-insulin-potassium regimen provides cardioprotection with
improved tissue perfusion in patients undergoing cardiopulmonary bypass
surgery.
Source
Journal of the American Heart Association. 9 (6) (no pagination), 2020.
Article Number: e012376. Date of Publication: 2020.
Author
Zhao K.; Zhang Y.; Li J.; Cui Q.; Zhao R.; Chen W.; Liu J.; Zhao B.; Wan
Y.; Ma X.-L.; Yu S.; Yi D.; Gao F.
Institution
(Zhao, Cui, Zhao, Chen, Liu, Zhao, Yu, Yi) Department of Cardiovascular
Surgery, Fourth Military Medical University, Xi'an, China
(Zhang) Department of Ultrasonic Diagnosis, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
(Zhao, Li, Gao) School of Aerospace Medicine, Fourth Military Medical
University, Xi'an, China
(Wan) Department of Health Statistics (Y. W.) Fourth Military Medical
University, Xi'an, China
(Wan) Department of Health Services, Fourth Military Medical University,
Xi'an, China
(Zhao) Department of Thoracic Surgery, Provincial Cancer Hospital of
Shannxi, Xi'an, China
(Ma) Department of Emergency Medicine, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
American Heart Association Inc.
Abstract
Background--Laboratory studies demonstrate glucose-insulin-potassium (GIK)
as a potent cardioprotective intervention, but clinical trials have
yielded mixed results, likely because of varying formulas and timing of
GIK treatment and different clinical settings. This study sought to
evaluate the effects of modified GIK regimen given perioperatively with an
insulin-glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass
surgery. Methods and Results--In this prospective, randomized,
double-blinded trial with 930 patients referred for cardiac surgery with
cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80
mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg
per hour 10 minutes before anesthesia and continuously for 12.5 hours. The
primary outcome was the incidence of in-hospital major adverse cardiac
events including all-cause death, low cardiac output syndrome, acute
myocardial infarction, cardiac arrest with successful resuscitation,
congestive heart failure, and arrhythmia. GIK therapy reduced the
incidence of major adverse cardiac events and enhanced cardiac function
recovery without increasing perioperative blood glucose compared with the
control group. Mechanistically, this treatment resulted in increased
glucose uptake and less lactate excretion calculated by the differences
between arterial and coronary sinus, and increased phosphorylation of
insulin receptor substrate-1 and protein kinase B in the hearts of
GIK-treated patients. Systemic blood lactate was also reduced in
GIK-treated patients during cardiopulmonary bypass surgery. Conclusions--A
modified GIK regimen administered perioperatively reduces the incidence of
in-hospital major adverse cardiac events in patients undergoing
cardiopulmonary bypass surgery. These benefits are likely a result of
enhanced systemic tissue perfusion and improved myocardial metabolism via
activation of insulin signaling by GIK. Copyright © 2020 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<64>
Accession Number
2007011773
Title
Long-term effects of transcatheter aortic valve implantation on coronary
hemodynamics in patients with concomitant coronary artery disease and
severe aortic stenosis.
Source
Journal of the American Heart Association. 9 (5) (no pagination), 2020.
Article Number: e015133. Date of Publication: 2020.
Author
Vendrik J.; Ahmad Y.; Eftekhari A.; Howard J.P.; Wijntjens G.W.M.;
Stegehuis V.E.; Cook C.; Terkelsen C.J.; Christiansen E.H.; Koch K.T.;
Piek J.J.; Sen S.; Baan J.
Institution
(Vendrik, Wijntjens, Stegehuis, Koch, Piek, Baan) Heart Centre, Amsterdam
UMC, Amsterdam, Netherlands
(Ahmad, Howard, Cook, Sen) National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Eftekhari, Terkelsen, Christiansen) Department of Cardiology, Aarhus
Universitetshospital Skejby, Aarhus, Denmark
Publisher
American Heart Association Inc.
Abstract
Background--As younger patients are being considered for transcatheter
aortic valve implantation (TAVI), the assessment and treatment of
concomitant coronary artery disease is taking on increased importance.
Methods and Results--Thirteen contemporary lower-risk patients with TAVI
with severe aortic stenosis (AS) and moderate-severe coronary lesions were
included. Patients underwent assessment of coronary hemodynamics in the
presence of severe AS (pre-TAVI), in the absence of severe AS (immediately
post-TAVI), and at longer-term follow-up (6 months post-TAVI). Fractional
flow reserve decreased from 0.85 (0.76-0.88) pre-TAVI to 0.79 (0.74-0.83)
post-TAVI, and then to 0.71 (0.65-0.77) at 6-month follow-up (P<0.001 for
all comparisons). Conversely, instantaneous wave-free ratio was not
significantly different: 0.82 (0.80-0.90) pre-TAVI, 0.83 (0.77-0.88)
post-TAVI, and 0.83 (0.73-0.89) at 6 months (P=0.735). These changes are
explained by the underlying coronary flow. Hyperemic whole-cycle coronary
flow (fractional flow reserve flow) increased from 26.36 cm/s (23.82-31.82
cm/s) pre-TAVI to 30.78 cm/s (29.70-34.68 cm/s) post-TAVI (P=0.012), to
40.20 cm/s (32.14-50.00 cm/s) at 6-month follow-up (P<0.001 for both
comparisons). Resting flow during the wave-free period of diastole was not
significantly different: 25.48 cm/s (21.12-33.65 cm/s) pre-TAVI, 24.54
cm/s (20.74-27.88 cm/s) post-TAVI, and 25.89 cm/s (22.57-28.96 cm/s) at 6
months (P=0.500). Conclusions--TAVI acutely improves whole-cycle hyperemic
coronary flow, with ongoing sustained improvements at longer-term
follow-up. This enhanced response to hyperemic stimuli appears to make
fractional flow reserve assessment less suitable for patients with severe
AS. Conversely, resting diastolic flow is not significantly influenced by
the presence of severe AS. Resting indices of coronary stenosis severity,
therefore, appear to be more appropriate for this patient population,
although large-scale prospective randomized trials will be required to
determine the role of coronary physiology in patients with severe
AS. Copyright © 2020 The Authors.

<65>
Accession Number
635019332
Title
Effect of Recruitment Maneuvers and PEEP on Respiratory Failure After
Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial.
Source
Respiratory care. (no pagination), 2021. Date of Publication: 11 May 2021.
Author
Amaru P.; Delannoy B.; Genty T.; Desebbe O.; Laverdure F.;
Rezaiguia-Delclaux S.; Stephan F.
Institution
(Amaru, Genty, Rezaiguia-Delclaux) Cardiothoracic ICU, Department of
Anesthesiology and ICU, Hopital Marie Lannelongue, Le Plessis Robinson,
France
(Delannoy, Desebbe, Rezaiguia-Delclaux) Anesthesiology, Clinique de la
Sauvegarde, Lyon, France
(Laverdure) Anesthesiology, Department of Anesthesiology and ICU, Hopital
Marie Lannelongue, Le Plessis Robinson, France
(Stephan) Cardiothoracic ICU, Department of Anesthesiology and ICU,
Hopital Marie Lannelongue, Le Plessis Robinson, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Obesity may increase the risk of respiratory failure after
cardiothoracic surgery. A recruitment maneuver followed by PEEP might
decrease the risk of respiratory failure in obese subjects. We
hypothesized that the routine use after heart surgery of a recruitment
maneuver followed by high or low PEEP level would decrease the frequency
of respiratory failure in obese subjects. METHOD(S): In a pragmatic,
randomized controlled trial, we assigned obese subjects (ie, with body
mass index [BMI] >= 30 kg/m2) in the immediate postoperative period of
cardiothoracic surgery to either volume control ventilation with 5 cm H2O
of PEEP (control group) or a recruitment maneuver followed by 5 or 10 cm
H2O of PEEP in the intervention arms (RM5 and RM10 groups, respectively).
The primary outcome was the proportion of subjects with postextubation
respiratory failure, defined as the need for re-intubation, bi-level
positive airway pressure, or high-flow nasal cannula within the first 48
h. RESULT(S): The study included 192 subjects: 65 in the control
group (BMI 33.5 +/- 3.2 kg/m2), 66 in the RM5 group (BMI 34.5 +/- 3.2
kg/m2, and 61 in RM10 group (BMI 33.8 +/- 4.8 kg/m2). Postextubation
respiratory failure occurred in 14 subjects in the control group (21.5%
[95% CI 13.3-35.3]), 21 subjects in the RM5 group (31.8% [95% CI
21.2-44.6]), and 9 subjects in the RM10 group (14.7% [95% CI 7.4-26.7]) (P
= .07). The recruitment maneuver was stopped prematurely due to severe
hypotension in 8 (12.1%) RM5 subjects and in 4 (6.6%) RM10 subjects (P =
.28). There were no significant differences between the 3 groups for the
frequencies of atelectasis, pneumonia, and death in the ICU.
 CONCLUSION(S): The routine use after heart surgery of a recruitment
maneuver followed by 5 or 10 cm H2O of PEEP did not decrease the frequency
of respiratory failure in obese subjects. A recruitment maneuver followed
by 5 cm H2O of PEEP is inappropriate. Copyright © 2021 by
Daedalus Enterprises.

<66>
Accession Number
635018957
Title
Aortic valve replacement vs. balloon-expandable and self-expandable
transcatheter implantation: A network meta-analysis.
Source
International journal of cardiology. (no pagination), 2021. Date of
Publication: 08 May 2021.
Author
D'Ascenzo F.; Bruno F.; Baldetti L.; De Filippo O.; Marengo G.; Breviario
S.; Melillo F.; Thyregod H.G.H.; Thiele H.; Sondergaard L.; Popma J.J.;
Kodali S.; Franchin L.; Annaratone M.; Marruncheddu L.; Gallone G.; Crimi
G.; La Torre M.; Rinaldi M.; Omede P.; Conrotto F.; Salizzoni S.; De
Ferrari G.M.
Institution
(D'Ascenzo) Division of Cardiology, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital and University of
Turin, Italy
(Bruno, De Filippo, Marengo, Breviario, Franchin, Gallone, Omede,
Conrotto, De Ferrari) Division of Cardiology, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital and University of
Turin, Italy
(Baldetti) Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific
Institute, Italy
(Melillo) Unit of echocardiography, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Thyregod) Departments of cardiothoracic and cardiology, Rigshospitalet,
Copenhagen University Hospital, Denmark
(Thiele) Heart Center Leipzig, University of Leipzig, Germany
(Sondergaard, Popma) Beth Israel Deaconess Boston, United States of
America United States
(Kodali) Columbia University Medical Center (SKK), United States
(Annaratone) Politecnico di Torino, Turin, Italy
(Marruncheddu) Department of Clinical Internal, Anesthesiological and
Cardiovascular Science, Sapienza University of Rome, Rome, Italy
(Crimi) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(La Torre, Rinaldi, Salizzoni) Cardiovascular and Thoracic Department,
Citta della Salute e della Scienza Hospital and University of Turin, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Recently, observational data have raised concerns about
safety of selfexpandable (SE) compared to balloon-expandable (BE) valves
in TAVI, although potentially limited by patient selection bias.
 METHOD(S): All Randomized Controlled Trials (RCTs) 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 were the primary endpoints, stroke, rates of permanent
pacemaker implantation (PPI), moderate/severe paravalvular leak (PVL) and
reintervention were the secondary endpoints. Results We obtained data from
11 RCTs, encompassing 9752 patients. After one and two years, no
significant differences for allcause and CV mortality were observed.
Compared to surgical bioprostheses, 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). 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 1year (OR 0.40; CI 95%
0.30-0.55) as compared to SE TAVI. Conclusions A TAVI strategy,
independently from BE or SE prostheses, offers a midterm survival
comparable to AVR. The 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 Elsevier Ireland Ltd. All rights
reserved.

<67>
Accession Number
634837253
Title
The effects of showering in 48-72 h after coronary artery bypass graft
surgery through median sternotomy on wound infection, pain, comfort, and
satisfaction: randomized controlled trial.
Source
European journal of cardiovascular nursing : journal of the Working Group
on Cardiovascular Nursing of the European Society of Cardiology. (no
pagination), 2021. Date of Publication: 19 Apr 2021.
Author
Gok F.; Demir Korkmaz F.; Emrecan B.
Institution
(Gok) Faculty of Health Sciences, Department of Surgical Diseases Nursing,
Pamukkale University, Denizli 20020, Turkey
(Demir Korkmaz) Faculty of Nursing, Department of Surgical Diseases
Nursing, Ege University, 35100 Izmir, Turkey
(Emrecan) Faculty of Medicine, Department of Cardiac Surgery, Pamukkale
University, Denizli 20020, Turkey
Publisher
NLM (Medline)
Abstract
AIMS : Time of showering after surgery is still a controversial issue for
surgical patients and health professionals. We evaluated the effects of
showering in 48-72h after median sternotomy on sternal wound infections,
pain due to sternotomy, patient comfort, and satisfaction levels. METHODS
AND RESULTS : The study was a randomized controlled clinical trial.
Fifty-one patients were randomly allocated (1:1) to the shower (n=26) or
non-shower group (n=25). The patients in the shower group (intervention
group) showered in the first 48-72h after surgery and the patients in the
non-shower group (control group) were not allowed to shower until their
chest tube sutures were removed. They were instructed to shower on the
next day after removal of the chest tube sutures. The rate of sternal
wound infections was significantly lower in the shower group (n=2, 7.7%)
than in the non-shower group patients (n=8, 32.0%; P=0.038). A logistic
regression analysis showed that early post-operative showering was
protective and significantly reduced the risk of sternal wound infections
independently of other variables [odds ratio (OR): 0.177; 95% confidence
interval (CI): 0.033-0.940; P=0.042]. The pain severity score was
significantly lower in the shower group patients. Also, comfort and
satisfaction scores were significantly higher in this group (P<0.05).
CONCLUSION : Early showering after sternotomy was found to be protective
against sternal wound infections and had a positive effect on pain,
comfort, and satisfaction. TRIAL REGISTRATION : Clinical Trials.gov
registration number NCT04250961
(https://clinicaltrials.gov/ct2/show/NCT04250961). Copyright Published
on behalf of the European Society of Cardiology. All rights reserved.
© The Author(s) 2021. For permissions, please email:
journals.permissions@oup.com.

<68>
Accession Number
608824876
Title
Randomized trial of combination cytokine and adult autologous bone marrow
progenitor cell administration in patients with non-ischaemic dilated
cardiomyopathy: The REGENERATEDCM clinical trial.
Source
European Heart Journal. 36 (44) (pp 3061-3069), 2015. Date of Publication:
21 Nov 2015.
Author
Hamshere S.; Arnous S.; Choudhury T.; Choudry F.; Mozid A.; Yeo C.;
Barrett C.; Saunders N.; Gulati A.; Knight C.; Locca D.; Davies C.; Cowie
M.R.; Prasad S.; Parmar M.; Agrawal S.; Jones D.; Martin J.; McKenna W.;
Mathur A.
Institution
(Hamshere, Arnous, Choudhury, Choudry, Mozid, Yeo, Barrett, Knight, Locca,
Davies, Jones, Mathur) Department of Cardiology, St Bartholomew's
Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United
Kingdom
(Saunders, Agrawal) Stem Cell Laboratory, Barts Health NHS Trust and
Blizard Institute, Queen Mary University of London, London, United Kingdom
(Gulati, Prasad) Cardiovascular Magnetic Resonance Unit, Royal Brompton
Hospital, Imperial College London, Sydney Street, London SW3 6NP, United
Kingdom
(Davies, Mathur) Barts Health NIHR Cardiovascular Biomedical Research
Unit, London Chest Hospital, Barts Health NHS Trust, London E2 9JX, United
Kingdom
(Cowie) Imperial College London, Royal Brompton Hospital, London SW3 6NP,
United Kingdom
(Parmar) Cancer Division, Medical Research Council, Clinical Trials Unit,
London, United Kingdom
(Martin) British Heart Foundation Laboratories, Department of Medicine,
University College London, London WC1E 6JJ, United Kingdom
(McKenna) Institute of Cardiovascular Science, University College London,
Heart Hospital, UCLH, 16-18 Westmoreland Street, London W1G 8PH, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims The REGENERATE-DCM trial is the first phase II randomized,
placebo-controlled trial aiming to assess if granulocyte
colony-stimulating factor (G-CSF) administration with or without
adjunctive intracoronary (IC) delivery of autologous bone marrow-derived
cells (BMCs) improves global left ventricular (LV) function in patients
with dilated cardiomyopathy (DCM) and significant cardiac dysfunction.
Methods and results Sixty patients with DCM and left ventricular ejection
fraction (LVEF) at referral of =45%, New York Heart Association (NYHA)
classification =2 and no secondary cause for the cardiomyopathy were
randomized equally into four groups: peripheral placebo (saline),
peripheral G-CSF, peripheral G-CSF and IC serum, and peripheral G-CSF and
IC BMC. All patients, except the peripheral placebo group, received 5 days
of G-CSF. In the IC groups, this was followed by bone marrow harvest and
IC infusion of cells or serum on Day 6. The primary endpoint was LVEF
change from baseline to 3 months, determined by advanced cardiac imaging.
At 3 months, peripheral G-CSF combined with IC BMC therapy was associated
with a 5.37% point increase in LVEF (38.30% +/- 12.97 from 32.93% +/-
16.46 P = 0.0138), which was maintained to 1 year. This was associated
with a decrease in NYHA classification, reduced NT-pro BNP, and improved
exercise capacity and quality of life. No significant change in LVEF was
seen in the remaining treatment groups. Conclusion This is the first
randomized, placebo-controlled trial with a novel combination of G-CSF and
IC cell therapy that demonstrates an improvement in cardiac function,
symptoms, and biochemical parameters in patients with DCM. Copyright
© 2015 The Author.

<69>
Accession Number
359503928
Title
The effect of remote ischaemic preconditioning on myocardial injury in
patients undergoing off-pump coronary artery bypass graft surgery.
Source
Anaesthesia and Intensive Care. 38 (5) (pp 924-929), 2010. Date of
Publication: September 2010.
Author
Hong D.M.; Min J.J.; Kim J.H.; Sohn I.S.; Lim T.W.; Lim Y.J.; Bahk J.-H.;
Jeon Y.
Institution
(Hong, Min, Kim, Sohn, Lim, Lim, Bahk, Jeon) Department of Anaesthesiology
and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
Publisher
Australian Society of Anaesthetists
Abstract
In several recent clinical trials on cardiac surgery patients, remote
ischaemic preconditioning (RIPC) showed a powerful myocardial protective
effect. However, the effect of RIPC has not been studied in patients
undergoing off-pump coronary artery bypass graft surgery. We evaluated
whether RIPC could induce myocardial protection in off-pump coronary
artery bypass graft surgery patients. Patients undergoing elective
off-pump coronary artery bypass graft surgery were randomly allocated to
the RIPC (n=65) or control group (n=65). After induction of anaesthesia,
RIPC was induced by four cycles of five-minute ischaemia and reperfusion
on the upper limb using a pneumatic cuff. Anaesthesia was maintained with
sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed
by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after
surgery. There were no statistical differences in troponin I levels
between RIPC and control groups (P=0.172). Although RIPC reduced the total
amount of troponin I (area under the curve of troponin increase) by 26%,
it did not reach statistical significance (RIPC group 53.2+/-72.9
hours.ng/ml vs control group 67.4+/-97.7 hours.ng/ml, P=0.281). In this
study, RIPC by upper limb ischaemia reduced the postoperative myocardial
enzyme elevation in off-pump coronary artery bypass graft surgery
patients, but this did not reach statistical significance. Further study
with a larger number of patients may be needed to fully evaluate the
clinical effect of RIPC in off-pump coronary artery bypass graft surgery
patients.

<70>
Accession Number
2008362882
Title
Remote ischemic preconditioning in isolated valve intervention. A pooled
meta-analysis.
Source
International Journal of Cardiology. 324 (pp 146-151), 2021. Date of
Publication: 01 Feb 2021.
Author
Moscarelli M.; Angelini G.D.; Emanueli C.; Suleiman S.; Pepe M.;
Contegiacomo G.; Punjabi P.P.
Institution
(Moscarelli, Emanueli, Punjabi) Imperial College London, National Heart
Lung Institute, United Kingdom
(Angelini, Suleiman) Clinical Sciences, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
(Contegiacomo) Dept of Cardiovascular surgery, GVM Care&Research, Bari,
Italy
(Pepe) Cardiology Unit, Department of Emergency and Organ Transplantation,
University of Bari Aldo Moro, Bari, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Recent studies have shown no benefits from remote ischemic
preconditioning (RIPC) in patients undergoing coronary artery bypass
surgery. One possible explanation is that given previous exposure to
angina and ischemia/reperfusion injury these patients, may be already
'naturally preconditioned'. The role of RIPC in a context of isolated
valve intervention, both surgical and particularly transcatheter is less
clear and remains under investigated, with few high-quality studies.
 Method(s): A systematic literature review identified 8 candidate
studies that met the meta-analysis criteria. We analyzed outcomes of 610
subjects (312 RIPC and 298 SHAM) with random effects modeling. Each study
was assessed for heterogeneity. The primary outcome was the extent of
periprocedural myocardial injury, as reflected by the area under the curve
for serum troponin concentration. Secondary endpoints included relevant
intra- and post-operative outcomes; sensitivity and high-quality subgroup
analysis was also carried out. Result(s): Six and two studies
reported the effect of RIPC in surgical and transcatheter valve
intervention. There was a significant difference between-group in terms of
periprocedural Troponin release (standardized mean difference (SMD: 0.74
[95% CI: 0.52; 0.95], p = 0.02) with no heterogeneity (chi2
2.40, I2 0%, p = 0.88). RIPC was not associated with any
improvement in post-operative outcomes. No serious adverse RIPC related
events were reported. Conclusion(s): RIPC seems to elicit overall
periprocedural cardioprotection in patients undergoing valvular
intervention, yet with no benefit on early clinical
outcomes. Copyright © 2020 Elsevier B.V.

<71>
Accession Number
2008396493
Title
Revascularization versus medical therapy for the treatment of stable
coronary artery disease: A meta-analysis of contemporary randomized
controlled trials.
Source
International Journal of Cardiology. 324 (pp 13-21), 2021. Date of
Publication: 01 Feb 2021.
Author
Laukkanen J.A.; Kunutsor S.K.
Institution
(Laukkanen) Institute of Clinical Medicine, Department of Medicine,
University of Eastern Finland, Kuopio, Finland
(Laukkanen) Central Finland Health Care District, Department of Medicine,
Jyvaskyla, Finland
(Laukkanen) Institute of Public Health and Clinical Nutrition, University
of Eastern Finland, Kuopio, Finland
(Kunutsor) National Institute for Health Research Bristol Biomedical
Research Centre, University Hospitals Bristol and Weston NHS Foundation
Trust and the University of Bristol, Bristol, United Kingdom
(Kunutsor) Translational Health Sciences, Bristol Medical School,
University of Bristol, Southmead Hospital, Learning & Research Building
(Level 1), Bristol, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: We conducted a systematic review and meta-analysis of
contemporary randomized controlled trials (RCTs) to compare clinical
outcomes among stable coronary artery disease (CAD) patients treated with
revascularization [percutaneous coronary intervention (PCI),
coronary-artery bypass grafting (CABG) or both] plus medical therapy (MT)
versus MT alone. Method(s): Prospective RCTs were sought from
MEDLINE, Embase, The Cochrane Library, and Web of Science up to April
2020. Data was extracted on study characteristics, methods, and outcomes.
Relative risks (RRs) with 95% confidence intervals (CIs) were pooled for
the composite of all-cause mortality, myocardial infarction (MI),
revascularizations, rehospitalizations, or stroke; its individual
components and other cardiovascular endpoints. Result(s): Twelve
unique RCTs comprising of 15,774 patients were included. There was no
significant difference in all-cause mortality risk (0.95, 95% CI:
0.86-1.06); however, revascularization plus MT reduced the risk of the
composite outcome of all-cause mortality, MI, revascularizations,
rehospitalizations, or stroke (0.69, 95% CI: 0.55-0.87); unplanned
revascularization (0.53, 95% CI: 0.40-0.71); and fatal MI (0.65, 95% CI:
0.49-0.84). Revascularization plus MT reduced the risk of stroke at 1 year
(0.44, 95% CI: 0.30-0.65) and unplanned revascularization and the
composite outcome of all-cause mortality, MI, revascularizations,
rehospitalizations, or stroke at 2-5 years. Conclusion(s):
Revascularization plus MT does not confer survival advantage beyond that
of MT among patients with stable CAD. However, revascularization plus MT
may reduce the overall risk of the combined outcome of mortality, MI,
revascularizations, rehospitalizations, or stroke, which could be driven
by a decrease in the risk of unplanned revascularizations or fatal
MI. Copyright © 2020 Elsevier B.V.

<72>
Accession Number
634378365
Title
Systematic review of endovascular stent grafting versus open surgical
repair for the elective treatment of arch/descending thoracic aortic
aneurysms.
Source
BMJ Open. 11 (3) (no pagination), 2021. Article Number: e043323. Date of
Publication: 04 Mar 2021.
Author
McCarthy A.; Gray J.; Sastry P.; Sharples L.; Vale L.; Cook A.; McMeekin
P.; Freeman C.; Catarino P.; Large S.
Institution
(McCarthy, Gray, McMeekin) Health and Life Sciences, Northumbria
University, Newcastle upon Tyne, United Kingdom
(Sastry) Cardiothoracic Surgery, John Radcliffe Hospital, Oxford,
Oxfordshire, United Kingdom
(Sharples) Medical Statistics, London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Vale) Health Economics Group, Population Health Sciences Institute,
Newcastle University, Tyne and Wear, Newcastle upon Tyne, United Kingdom
(Cook) Wessex Institute, University of Southampton, Southampton,
Hampshire, United Kingdom
(Cook) Southampton Clinical Trials Unit, University of Southampton,
Southampton, Hampshire, United Kingdom
(Cook) University Hospital Southampton NHS Foundation Trust, Southampton,
United Kingdom
(Freeman) Papworth Trials Unit Collaboration, Papworth Hospital NHS
Foundation Trust, Cambridge, United Kingdom
(Catarino, Large) Cardiac Surgery, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective To review comparisons of the effectiveness of endovascular stent
grafting (ESG) against open surgical repair (OSR) for treatment of chronic
arch or descending thoracic aortic aneurysms (TAA). Design Systematic
review and meta-analysis Data sources MEDLINE, EMBASE, CENTRAL, WHO
International Clinical Trials Routine data collection, current controlled
trials, clinical trials and the NIHR portfolio were searched from January
1994 to March 2020. Eligibility criteria for selective studies All
identified studies that compared ESG and OSR, including randomised
controlled trials (RCTs), quasi-randomised and non-RCTs, comparative
cohort studies and case-control studies matched on main outcomes were
sought. Participants had to receive elective treatments for
arch/descending (TAA). Studies were excluded where other thoracic aortic
conditions (eg, rupture or dissection) were reported, unless results for
patients receiving elective treatment for arch/descending TAA reported
separately. Data extraction and synthesis Data were extracted by one
reviewer and checked by another. Risk of Bias was assessed using the
ROBINS-I tool. Meta-analysis was conducted using random effects. Where
meta-analysis not appropriate, results were reported narratively. Results
Five comparative cohort studies met inclusion criteria, reporting 3955 ESG
and 21 197 OSR patients. Meta-analysis of unadjusted short-term (30 day)
all-cause mortality favoured ESG (OR 0.75; 95% CI 0.55 to 1.03)).
Heterogeneity identified between larger and smaller studies. Sensitivity
analysis of four studies including only descending TAA showed no
statistical significance (OR 0.73, 95% CI 0.45 to 1.18)), moderate
heterogeneity. Meta-analysis of adjusted short-term all-cause mortality
favoured ESG (OR 0.71, 95% CI 0.51 to 0.98)), no heterogeneity.
Longer-term (beyond 30 days) survival from all-cause mortality favoured
OSR in larger studies and ESG in smaller studies. Freedom from
reintervention in the longer-term favoured OSR. Studies reporting
short-term non-fatal complications suggest fewer events following ESG.
Conclusions There is limited and increasingly dated evidence on the
comparison of ESG and OSR for treatment of arch/descending TAA. PROSPERO
registration number CRD42017054565. Copyright © Author(s) (or
their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

<73>
Accession Number
634392612
Title
An assessment of the effectiveness of regional analgesia after VATS
measured by an objective method for assessing testosterone, cortisol,
alpha-amylase, sIgA, and beta-endorphin levels - a randomised controlled
trial.
Source
Endokrynologia Polska. 72 (2) (pp 133-142), 2021. Date of Publication:
2021.
Author
Bialka S.; Sliwczynska M.; Marciniak A.; Czyzewski D.; Misiolek H.
Institution
(Bialka, Sliwczynska, Marciniak, Misiolek) Department of Anaesthesiology,
Intensive Care, Emergency Medicine, Faculty of Medical Sciences in Zabrze,
Medical University of Silesia, Zabrze, Poland
(Czyzewski) Chair and Department of Thoracic Surgery, Faculty of Medical
Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Thoracic surgeries are associated with intense postoperative
pain. General opioid analgesia is still the main anaesthetic method. Due
to the large number of opioid-induced side effects, alternative methods of
pain relief are sought. One of them is the use of balanced analgesia,
which consists of regional analgesia, non-opioid painkillers, and small
doses of opioids. MATERIAL AND METHODS: The objective of this study was to
assess the effectiveness of preoperative thoracic paravertebral block
(ThPVB) in the treatment of postoperative pain after video-assisted
thoracic surgery (VATS) by measuring hormone levels in blood serum or
saliva. It was a randomised, open-label study conducted in a single
university hospital setting between May 2018 and September 2019. In total,
119 patients were scheduled for elective video-assisted thoracic surgery.
Performed interventions included: preoperative thoracic paravertebral
block with 0.5% bupivacaine, followed by postoperative oxycodone combined
with nonopioid analgesics. Follow-up period comprised first 24 hours and
one, two, and six months after surgery. Main outcomes were measured by
pain intensity assessed using the Numerical Rating Scale (NRS) and the
levels of the following hormones: testosterone, cortisol, alpha-amylase
activity, sIgA, and beta-endorphin. RESULT(S): A total of 119
patients were randomised into two groups and, of these, 49 were
subsequently excluded from the analysis. The final analysis included 37
patients from the study group and 33 from the control group. There were no
statistically significant differences in the analysed parameters the
relative change T1-T0. There was a tendency towards statistical
significance in the relative change T2-T0 in testosterone levels. At rest,
no statistically significant differences were found between groups and
time in the percentage of patients with NRS >= 1. During cough, the
percentage of patients with NRS >= 1 was higher at T1 and T2 time points
in the ThPVB group. Of the factors considered, only alpha-amylase levels
statistically significantly increased the chance for higher NRS score
after a month [OR = 1.013; 95% PU: 1.001-1.025; p < 0.01].
 CONCLUSION(S): ThPVB is effective and safe for patients undergoing
VATS. It can be an effective alternative for general anaesthesia using
high doses of opioids.

<74>
Accession Number
634154940
Title
Oncological outcomes of unsuspected pN2 in patients with non-small-cell
lung cancer: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 32 (5) (pp 727-736),
2021. Date of Publication: 10 May 2021.
Author
IJsseldijk M.A.; Ten Broek R.P.G.; Wiering B.; Hekma E.; de Roos M.A.J.
Institution
(IJsseldijk, Ten Broek) Division of Surgery, Radboud University Medical
Center, Nijmegen, Netherlands
(IJsseldijk, Ten Broek, Wiering) Division of Surgery, Slingeland
Ziekenhuis, Doetinchem, Netherlands
(Hekma, de Roos) Division of Surgery, Rijnstate Hospital, Arnhem,
Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Optimal treatment of stage IIIA (N2) non-small-cell lung
cancer (NSCLC) is controversial. Guidelines advise induction therapy
before surgical resection. A proportion of patients with cN0 NSCLC are
postoperatively upstaged due to unsuspected N2 disease. Survival of
unsuspected N2 NSCLC treated with surgery varies and technical feasibility
of video-assisted thoracic surgery (VATS) is unknown. The purpose of this
study was to assess prevalence and survival of unsuspected N2 NSCLC
treated with thoracotomy or VATS. METHOD(S): A systematic review and
meta-analysis was performed of all available literatures through Pubmed,
Cochrane, EMBASE, Web of Science, Trials registries and System for
Information on Grey Literature (SIGLE) from 2000 to 2019. Outcomes of
interest were prevalence, overall survival (OS) and disease-free survival
of unsuspected N2 NSCLC. Secondary outcomes were number of harvested lymph
nodes, postoperative complications and survival of unsuspected N2 NSCLC
treated with VATS. RESULT(S): Seventeen studies with patients with
clinical stage N0-1 and unsuspected pN2 NSCLC were included. Prevalence of
unsuspected pN2 was 8.6%. Three- and 5-year OS was 58% [95% confidence
interval (CI) 37-78%) (N=4337] and 35% (95% CI 28-43%) (N=4337). Three-
and 5-y ear disease-free survival was 48% (95% CI 30-66%) (N=109) and 35%
(95% CI 24-46%) (N=517). VATS resulted in a low complication rate with
similar 5-year OS as thoracotomy. CONCLUSION(S): In patients with
cN0-1 NSCLC, a minority has unsuspected pN2 NSCLC. Even for these
patients, 5-year OS and disease-free survival are reasonable. VATS with
adequate lymph node dissection is the treatment of choice when in
experienced hands. Adjuvant therapy should be provided in absence of
relevant comorbidity. Copyright © The Author(s) 2021. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<75>
Accession Number
634090445
Title
Modified ultrafiltration reduces postoperative blood loss and transfusions
in adult cardiac surgery: a meta-analysis of randomized controlled trials.
Source
Interactive cardiovascular and thoracic surgery. 32 (5) (pp 671-682),
2021. Date of Publication: 10 May 2021.
Author
Low Z.K.; Gao F.; Sin K.Y.K.; Yap K.H.
Institution
(Low, Yap) Department of Cardiothoracic Surgery, KK Women's and Children's
Hospital, Singapore
(Gao) Department of Biostatistics, National Heart Centre Singapore,
Singapore
(Gao) Duke-NUS Medical School, Singapore
(Sin, Yap) Department of Cardiothoracic Surgery, National Heart Centre
Singapore, Singapore
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Cardiopulmonary bypass in cardiac surgery has been associated
with several deleterious effects including haemodilution and systemic
inflammation. Modified ultrafiltration (MUF) has been well established in
paediatric cardiac surgery in counteracting postperfusion syndrome.
However, MUF is less commonly used in adult cardiac surgery. In this
meta-analysis, we compared clinical outcomes in adult patients who
underwent cardiopulmonary bypass with and without MUF. METHOD(S):
Electronic searches were performed using Pubmed, Ovid Medline, EMBASE and
the Cochrane Library until April 2020. Selection criteria were randomized
studies of adult cardiac surgery patients comparing MUF versus no MUF.
Primary outcomes were postoperative mortality, haematocrit, blood
transfusion, chest tube drainage, duration of intensive care unit (ICU)
stay and duration of mechanical ventilation. RESULT(S): Thirteen
randomized controlled trials were included, comprising 626 patients in the
MUF group, and 610 patients in the control (no-MUF) group. There was a
significantly improved postoperative haematocrit [mean difference 2.70,
95% confidence interval (CI) 0.68-4.73, P=0.009], lower chest tube
drainage (mean difference -105 ml, 95% CI -202 to -7 ml, P=0.032), lower
postoperative blood transfusion rate (mean difference -0.73 units, 95% CI
-0.98 to -0.47 units, P<0.0001) and shorter duration of ICU stay (mean
difference -0.13days, 95% CI -0.27 to -0.00days, P=0.048) in the MUF
group. There was no difference in ventilation time (mean difference
-0.47h, 95% CI -2.05 to 1.12h, P=0.56) or mortality rates (odds ratio
0.62, 95% CI 0.28-1.33, P=0.22). There were no reported complications
associated with MUF. CONCLUSION(S): MUF is a safe and feasible option
in adult cardiac patients, with significant benefits including improved
postoperative haematocrit, as well as reduced postoperative chest tube
bleeding, transfusion requirements and duration of ICU stay. Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<76>
Accession Number
2010842047
Title
Serum potassium levels provide prognostic information in symptomatic heart
failure beyond traditional clinical variables.
Source
ESC Heart Failure. 8 (3) (pp 2133-2143), 2021. Date of Publication: June
2021.
Author
Toledo C.C.; Vellosa Schwartzmann P.; Miguel Silva L.; da Silva Ferreira
G.; Bianchini Cardoso F.; Citelli Ribeiro V.; Paim L.R.; Antunes-Correa
L.M.; Carvalho Sposito A.; Matos Souza J.R.; Modolo R.; Nadruz W.;
Fernandes de Carvalho L.S.; Coelho-Filho O.R.
Institution
(Toledo, Miguel Silva, da Silva Ferreira, Bianchini Cardoso, Citelli
Ribeiro, Paim, Antunes-Correa, Carvalho Sposito, Matos Souza, Modolo,
Nadruz, Fernandes de Carvalho, Coelho-Filho) Faculty of Medical Science,
University of Campinas, Sao Paulo, Brazil
(Antunes-Correa) School of Physical Education, University of Campinas, Sao
Paulo, Brazil
(Vellosa Schwartzmann) Cardiology Unit, Unimed Hospital, Ribeirao Preto,
Sao Paulo, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Aims: Despite of recent advances in the pharmacological treatment, heart
failure (HF) maintains significant morbidity and mortality rates. While
serum potassium disorders are common and associated with adverse outcomes,
the exact recommended potassium level for patients with HF are not
entirely established. We aimed to investigate the prognostic role of
potassium levels on a cohort of patients with symptomatic chronic HF.
 Methods and Results: Patients with symptomatic chronic HF were
identified at the referral to 6 min walking test (6MWT) and were
prospectively followed up for cardiovascular events. Clinical and
laboratorial data were retrospectively obtained. The primary endpoint was
the composite of cardiovascular death, hospitalization due to HF, and
heart transplantation. The cohort included 178 patients with HF with the
mean age of 51 +/- 12.76 years, 39% were female, 85% of non-ischaemic
cardiomyopathy, and 38% had New York Heart Association Class III with a
relatively high Meta-Analysis Global Group in Chronic Heart Failure
(MAGGIC) score (12.91 +/- 6.6). The mean left ventricular ejection
fraction was 39.98 +/- 15.79%, and the mean 6MWT distance was 353 +/- 136
m. After a median follow-up of 516 days, there were 22 major
cardiovascular events (4 cardiovascular deaths, 13 HF admissions, and 5
heart transplants). Patients were stratified according to cut-point level
of serum potassium of 4.7 mmol/L to predict combined cardiac events based
on receiver operating characteristic analysis. Individuals with higher
potassium levels had worse renal function (glomerular filtration rate, K
<= 4.7: 102.8 +/- 32.2 mL/min/1.73 m2 vs. K > 4.7: 85.42 +/-
36.2 mL/min/1.73 m2, P = 0.004), higher proportion of New York
Heart Association Class III patients (K <= 4.7: 28% vs. K > 4.7: 48%, P =
0.0029), and also higher MAGGIC score (K <= 4.7: 12.08 +/- 5.7 vs. K >
4.7: 14.9 +/- 7.9, P = 0.0089), without significant differences on the
baseline pharmacological HF treatment. Both potassium levels [hazard ratio
(HR) 4.26, 95% confidence interval (CI) 1.59-11.421, P = 0.003] and 6MWT
distance (HR 0.99, 95% CI 0.993-0.999, P = 0.01) were independently
associated with the primary outcome. After adjustments for MAGGIC score
and 6MWT distance, potassium levels > 4.7 mmol/L maintained a significant
association with outcomes (HR 3.57, 95% CI 1.305-9.807, P = 0.013).
Patients with K > 4.7 mmol/L were more likely to present clinical events
during the follow-up (log rank = 0.005). Adding potassium levels to the
model including 6MWT and MAGGIC significantly improved the prediction of
events over 2 years (integrated discrimination index 0.105, 95% CI
0.018-0.281, P = 0.012 and net reclassification index 0.447, 95% CI
0.077-0.703, P = 0.028). Conclusion(s): Potassium levels were
independently associated with worse outcomes in patients with chronic
symptomatic HF, also improving the accuracy model for prognostic
prediction when added to MAGGIC score and 6MWT distance. The potassium
levels above 4.7 mmol/L might identify those patients at an increased risk
of cardiovascular events. Copyright © 2021 The Authors. ESC Heart
Failure published by John Wiley & Sons Ltd on behalf of European Society
of Cardiology.

<77>
Accession Number
633377302
Title
Association of Circulating Monocyte Chemoattractant Protein-1 Levels with
Cardiovascular Mortality: A Meta-analysis of Population-Based Studies.
Source
JAMA Cardiology. 6 (5) (pp 587-592), 2021. Date of Publication: May 2021.
Author
Georgakis M.K.; De Lemos J.A.; Ayers C.; Wang B.; Bjorkbacka H.; Pana
T.A.; Thorand B.; Sun C.; Fani L.; Malik R.; Dupuis J.; Engstrom G.;
Orho-Melander M.; Melander O.; Boekholdt S.M.; Zierer A.; Elhadad M.A.;
Koenig W.; Herder C.; Hoogeveen R.C.; Kavousi M.; Ballantyne C.M.; Peters
A.; Myint P.K.; Nilsson J.; Benjamin E.J.; Dichgans M.
Institution
(Georgakis, Malik, Dichgans) Institute for Stroke and Dementia Research,
University Hospital, Ludwig-Maximilians-University, Feodor-Lynen-Str. 17,
Munich 81377, Germany
(Georgakis) Graduate School for Systemic Neurosciences,
Ludwig-Maximilians-University, Munich, Germany
(De Lemos, Ayers) Division of Cardiology, University of Texas,
Southwestern Medical Center, Dallas, United States
(Wang, Dupuis) Department of Biostatistics, Boston University, School of
Public Health, Boston, MA, United States
(Bjorkbacka, Engstrom, Orho-Melander, Melander, Nilsson) Department of
Clinical Sciences Malmo, Lund University, Malmo, Sweden
(Pana, Myint) Institute of Applied Health Sciences, School of Medicine,
Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United
Kingdom
(Thorand, Elhadad) Research Unit of Molecular Epidemiology, Helmholtz
Zentrum Munchen, German Research Center for Environmental Health,
Neuherberg, Germany
(Thorand, Herder, Peters) German Center for Diabetes Research,
Munchen-Neuherberg, Germany
(Sun, Hoogeveen, Ballantyne) Department of Medicine, Baylor College of
Medicine, Houston, TX, United States
(Fani, Kavousi) Department of Epidemiology, Erasmus MC University Medical
Center, Rotterdam, Netherlands
(Boekholdt) Amsterdam UMC, University of Amsterdam, Department of
Cardiology, Amsterdam, Netherlands
(Zierer, Elhadad, Peters) Institute of Epidemiology, Helmholtz Zentrum
Munchen, German Research Center for Environmental Health, Neuherberg,
Germany
(Elhadad, Koenig, Peters) German Research Center for Cardiovascular
Disease, Partner Site of Munich Heart Alliance, Munich, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Ulm, Germany
(Herder) Institute for Clinical Diabetology, German Diabetes Center,
Leibniz Center for Diabetes Research at Heinrich Heine University
Dusseldorf, Dusseldorf, Germany
(Herder) Department of Endocrinology and Diabetology, Medical Faculty,
Heinrich Heine University Dusseldorf, Dusseldorf, Germany
(Peters) Institute of Medical Information Sciences, Biometry and
Epidemiology, Ludwig-Maximilians-University, Munich, Germany
(Benjamin) Section of Cardiovascular Medicine and Preventive Medicine,
Department of Medicine, Boston University, School of Medicine, Boston, MA,
United States
(Benjamin) Department of Epidemiology, Boston University, School of Public
Health, Boston, MA, United States
(Benjamin) Framingham Heart Study, National Heart, Lung, and Blood
Institute, Boston University, Framingham, MA, United States
(Dichgans) Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
(Dichgans) German Centre for Neurodegenerative Diseases, Munich, Germany
Publisher
American Medical Association
Abstract
Importance: Human genetics and studies in experimental models support a
key role of monocyte-chemoattractant protein-1 (MCP-1) in atherosclerosis.
Yet, the associations of circulating MCP-1 levels with risk of coronary
heart disease and cardiovascular death in the general population remain
largely unexplored. Objective(s): To explore whether circulating
levels of MCP-1 are associated with risk of incident coronary heart
disease, myocardial infarction, and cardiovascular mortality in the
general population. Data Sources and Selection: Population-based cohort
studies, identified through a systematic review, that have examined
associations of circulating MCP-1 levels with cardiovascular end points.
Data Extraction and Synthesis: Using a prespecified harmonized analysis
plan, study-specific summary data were obtained from Cox regression models
after excluding individuals with overt cardiovascular disease at baseline.
Derived hazard ratios (HRs) were synthesized using random-effects
meta-analyses. Main Outcomes and Measures: Incident coronary heart
disease (myocardial infarction, coronary revascularization, and unstable
angina), nonfatal myocardial infarction, and cardiovascular death (from
cardiac or cerebrovascular causes). Result(s): The meta-analysis
included 7 cohort studies involving 21401 individuals (mean [SD] age, 53.7
[10.2] years; 10012 men [46.8%]). Mean (SD) follow-up was 15.3 (4.5) years
(326392 person-years at risk). In models adjusting for age, sex, and
race/ethnicity, higher MCP-1 levels at baseline were associated with
increased risk of coronary heart disease (HR per 1-SD increment in MCP-1
levels: 1.06 [95% CI, 1.01-1.11]; P =.01), nonfatal myocardial infarction
(HR, 1.07 [95% CI, 1.01-1.13]; P =.02), and cardiovascular death (HR, 1.12
[95% CI, 1.05-1.20]; P <.001). In analyses comparing MCP-1 quartiles,
these associations followed dose-response patterns. After additionally
adjusting for vascular risk factors, the risk estimates were attenuated,
but the associations of MCP-1 levels with cardiovascular death remained
statistically significant, as did the association of MCP-1 levels in the
upper quartile with coronary heart disease. There was no significant
heterogeneity; the results did not change in sensitivity analyses
excluding events occurring in the first 5 years after MCP-1 measurement,
and the risk estimates were stable after additional adjustments for
circulating levels of interleukin-6 and high-sensitivity C-reactive
protein. Conclusions and Relevance: Higher circulating MCP-1 levels
are associated with higher long-term cardiovascular mortality in
community-dwelling individuals free of overt cardiovascular disease. These
findings provide further support for a key role of MCP-1-signaling in
cardiovascular disease.. Copyright © 2021 American Medical
Association. All rights reserved.

<78>
Accession Number
635015599
Title
A state-of-the-art review of the current role of cardioprotective
techniques in cardiac transplantation.
Source
Interactive cardiovascular and thoracic surgery. 32 (5) (pp 683-694),
2021. Date of Publication: 10 May 2021.
Author
Cullen P.P.; Tsui S.S.; Caplice N.M.; Hinchion J.A.
Institution
(Cullen, Hinchion) Department of Cardiothoracic Surgery, Cork University
Hospital, Cork, Ireland
(Tsui) Department of Transplantation, Royal Papworth Hospital NHS
Foundation Trust, Cambridge, United Kingdom
(Caplice) Centre for Research in Vascular Biology, Biosciences Institute,
University College Cork, Cork, Ireland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The use of 'extended criteria' donor hearts and reconditioned
hearts from donation after circulatory death has corresponded with an
increase in primary graft dysfunction, with ischaemia-reperfusion injury
being a major contributing factor in its pathogenesis. Limiting
ischaemia-reperfusion injury through optimising donor heart preservation
may significantly improve outcomes. We sought to review the literature to
evaluate the evidence for this. METHOD(S): A review of the published
literature was performed to assess the potential impact of organ
preservation optimisation on cardiac transplantation outcomes.
 RESULT(S): Ischaemia-reperfusion injury is a major factor in
myocardial injury during transplantation with multiple potential
therapeutic targets. Innate survival pathways have been identified, which
can be mimicked with pharmacological conditioning. Although incompletely
understood, discoveries in this domain have yielded extremely encouraging
results with one of the most exciting prospects being the synergistic
effect of selected agents. Ex situ heart perfusion is an additional
promising adjunct. CONCLUSION(S): Cardiac transplantation presents a
unique opportunity to perfuse the whole heart before, or immediately
after, the onset of ischaemia, thus maximising the potential for global
cardioprotection while limiting possible systemic side effects. While
clinical translation in the setting of myocardial infarction has often
been disappointing, cardiac transplantation may afford the opportunity for
cardioprotection to finally deliver on its preclinical
promise. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<79>
Accession Number
2012041488
Title
Incidence, Risk Factors, and Outcomes of Perioperative Atrial Fibrillation
following Noncardiothoracic Surgery: A Systematic Review and
Meta-Regression Analysis of Observational Studies.
Source
Anesthesiology Research and Practice. 2021 (no pagination), 2021. Article
Number: 5527199. Date of Publication: 2021.
Author
Subramani Y.; El Tohamy O.; Jalali D.; Nagappa M.; Yang H.; Fayad A.
Institution
(Subramani, Nagappa, Yang, Fayad) Department of Anesthesia and
Perioperative Medicine, London Health Sciences Centre and St. Joseph
Health Care, Western University, Schulich School of Medicine and
Dentistry, London, ON, Canada
(El Tohamy, Jalali) Department of Medical Sciences, Western University,
London, ON, Canada
Publisher
Hindawi Limited
Abstract
Background. Atrial fibrillation (AF) occurs in 16-30% of patients after
cardiac and thoracic surgery and can lead to serious complications like
hypoperfusion of vital organs, pulmonary edema, and myocardial infarction.
The evidence on risk factors and complications associated with
perioperative AF after noncardiothoracic surgery is limited. Methods. The
primary objective was to determine demographic and clinical risk factors
for new-onset atrial fibrillation associated with noncardiothoracic
surgery. A secondary aim was to identify the incidence and odds of
perioperative complications associated with the new-onset atrial
fibrillation. A systematic search within multiple databases was conducted
for studies that explicitly reported on new-onset atrial fibrillation
after noncardiothoracic surgery. We reported data on demographics,
comorbidities, and perioperative complications as mean difference (MD) or
odds ratios (OR) and corresponding 95% confidence interval (CI) using
random effects models. A two-sided P value of less than 0.05 was
considered significant. We performed meta-regression and sensitivity
analysis of various subgroups to confirm the inference of our findings.
Results. Eleven studies reporting on 121,517 patients were included, of
whom 2,944 developed perioperative AF (incidence rate: 3.7%; 95% CI: 2.3%
- 6.2%). Advanced age (AF group versus control group: 69.36 +/- 10.5
versus 64.37 +/- 9.53 years; MD: 4.06; 95% CI: 1.67 - 6.44; P=0.0009),
male gender (52.85% versus 43.59%; OR: 1.08; 95% CI: 0.54 to 1.62; I2:
84%; P<0.0001), preoperative hypertension (60.42% versus 56.51%; OR: 1.15;
95% CI: 1.08 to 1.23; I2: 0%; P<0.00001), diabetes mellitus (22.6% versus
23.04%; OR: 0.97; 95% CI: 0.89 to 1.05; I2: 0; P<0.00001), and cardiac
disease (30.64% versus 8.49%; OR: 2.3; 95% CI: 0.28 to 4.31; I2: 93%;
P=0.03) were found to be significant predictors for perioperative AF. The
AF group was at increased odds of developing postoperative cardiac
complications (34.1% versus 5%; OR: 5.44; 95% CI: 0.49 to 10.39; I2: 82%;
P=0.03), postoperative stroke (0.5% versus 0.1%; OR: 3; 95% CI: 0.65 to
5.35; I2: 0%; P=0.01), and mortality (7.40% versus 1.92%; OR: 3.58; 95%
CI: 0.14 to 7.02; I2: 0%; P=0.04). Study quality assessment by
meta-regression and sensitivity analysis of the various subgroups did not
affect the final inference of the results. Conclusion. We identified
advanced age, male gender, preoperative hypertension, diabetes mellitus,
and cardiac disease as important risk factors for perioperative atrial
fibrillation. The atrial fibrillation group was at increased odds for
postoperative cardiac complications, stroke, and higher mortality,
emphasizing the need for risk stratification and close
monitoring. Copyright © 2021 Yamini Subramani et al.

<80>
Accession Number
635012706
Title
Efficacy and Safety of Nonvitamin K Oral Anticoagulants following Cardiac
Valve Replacement.
Source
Southern Medical Journal. 114 (1) (pp 46-50), 2021. Date of Publication:
2021.
Author
Stuart M.K.; Blackwell S.B.; Holder H.B.; Wood E.L.; Starr J.A.
Institution
(Stuart, Blackwell, Holder, Wood, Starr) Department of Pharmacy Services,
Princeton Baptist Medical Center, Birmingham, AL, United States
(Stuart, Blackwell, Holder, Wood, Starr) Department of Pharmacy Services,
Vanderbilt Wilson County Hospital, Lebanon, TN, United States
(Stuart, Blackwell, Holder, Wood, Starr) Department of Pharmacy Practice,
Harrison School of Pharmacy, Auburn University, Auburn, AL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective To compare the efficacy and safety of nonvitamin K oral
anticoagulants (NOACs) and vitamin K antagonists (VKAs) following
bioprosthetic cardiac valve replacement. Methods This was a retrospective
analysis conducted at a community teaching hospital in the southeastern
United States between August 2015 and August 2018. Patients 18 years of
age and older who underwent cardiac valve replacement and were prescribed
oral anticoagulation were screened for inclusion. Patients were excluded
if they had a mechanical valve replacement, experienced a venous
thromboembolism, cerebrovascular accident, or acute coronary syndrome
within 1 month before valve replacement, changed oral anticoagulation
during the study period, were lost to follow-up, or declined to
participate in the follow-up survey. The primary outcome was a composite
of thromboembolic events within 90 days following bioprosthetic cardiac
valve replacement. The safety outcome was major bleeding within 180 days
of bioprosthetic cardiac valve replacement. Results The primary outcome of
a composite of thromboembolic events within 90 days following
bioprosthetic cardiac valve replacement occurred in 1 patient (4.3%) in
the VKA group and 4 patients (7.4%) in the NOAC group. Major bleeding
occurred in 2 patients (8.7%) in the VKA group and 0 patients in the NOAC
group. Conclusion Our study is the first to report the efficacy and safety
of NOACs compared with VKA therapy following bioprosthetic cardiac valve
replacement irrespective of an atrial fibrillation diagnosis. Notably, two
of the thromboembolic events in the NOAC group occurred while therapy was
held or inappropriately dosed; when these events are removed, the rate of
thromboembolism is 3.8%. This rate is consistent with the VKA group. Our
study adds to a small pool of literature regarding the use of NOACs
following bioprosthetic cardiac valve replacement and suggests that NOACs
may have similar efficacy and improved safety as compared with VKA
therapy. Large randomized controlled trials are warranted to confirm our
observations. Copyright © Lippincott Williams & Wilkins.

<81>
Accession Number
635012586
Title
A prospective randomized clinical study of perioperative oral thyroid
hormone treatment for children undergoing surgery for congenital heart
diseases.
Source
Annals of Pediatric Cardiology. 14 (2) (pp 170-177), 2021. Date of
Publication: April-June 2021.
Author
Kumar A.; Tiwari N.; Ramamurthy H.; Kumar V.; Kumar G.
Institution
(Kumar) Department of Cardiothoracic Anaesthesia, Army Hospital RandR, New
Delhi, India
(Tiwari) Department of Cardiothoracic Surgery, Army Hospital RandR, New
Delhi, India
(Ramamurthy, Kumar) Department of Pediatric Cardiology and Grown Up
Congenital Heart Diseases, Army Hospital RandR, New Delhi, India
(Kumar) Department of Pediatric Cardiothoracic Surgery, Fortis Escorts
Heart Institute, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Context : Thyroid hormone deficiency is known to occur after cardiac
surgery and known as nonthyroid illness (NTI). The beneficial role
perioperative thyroid hormone supplementation in children has been
debatable more so with oral supplementation. Aims : The aim is to evaluate
the role of pre-operative oral thyroid hormone therapy in preventing NTI.
To assess its effect on post-operative thyroid hormone levels, hemodynamic
parameters, and cardiac function of infants and small children undergoing
pediatric cardiac surgery. Settings and Design : Prospective randomized,
double-blinded controlled trial at a tertiary level pediatric
cardiothoracic center. Materials and Methods : Sixty-five children aged
under 18 months undergoing corrective surgeries on cardiopulmonary bypass
were included. Patients were randomized into two equal groups: placebo
group (given placebo) and thyroxine group (given thyroxine tablet 10
mug/kg) orally once a day starting on the preoperative evening till the
fifth postoperative day. The postoperative hemodynamics, inotropic
requirement, ventilatory requirement, and cardiac function on
echocardiography were observed. Statistical Tests : Shapiro-Wilk test,
Mann-Whitney/t-test, Chi-square test, ANOVA with Tukey correction were
used. Results : Serum triiodothyronine and thyroxine levels
postoperatively were significantly higher in the thyroxine group than in
the placebo group. There was no significant difference in left ventricular
ejection fraction, hemodynamic variables, extubation time, and length of
intensive care unit (ICU) stay between the two groups. Conclusions : In
infants and small children undergoing corrective cardiac surgery,
perioperative oral thyroid hormone therapy reduces the severity of
postoperative NTI. It increases the serum level of thyroid hormones but
the therapy does not translate to better hemodynamics, reduced inotropic
requirement, reduced ventilatory requirement, improved myocardial function
or reduced ICU stay when compared to placebo. Copyright © 2021
Wolters Kluwer Medknow Publications. All rights reserved.

<82>
Accession Number
2007134768
Title
High flow oxygen therapy at two initial flow settings versus conventional
oxygen therapy in cardiac surgery patients with postextubation hypoxemia:
A single-center, unblinded, randomized, controlled trial.
Source
Journal of Clinical Medicine. 10 (10) (no pagination), 2021. Article
Number: 2079. Date of Publication: 02 May 2021.
Author
Theologou S.; Ischaki E.; Zakynthinos S.G.; Charitos C.; Michopanou N.;
Patsatzis S.; Mentzelopoulos S.D.
Institution
(Theologou, Charitos, Michopanou, Patsatzis) Department of Cardiac
Surgery, Evaggelismos General Hospital, Athens 10675, Greece
(Ischaki, Zakynthinos, Mentzelopoulos) First Department of Intensive Care
Medicine, National and Kapodistrian University of Athens Medical School,
Evaggelismos General Hospital, Athens 10675, Greece
Publisher
MDPI AG
Abstract
In cardiac surgery patients with pre-extubation PaO<inf>2</inf> /inspired
oxygen fraction (FiO<inf>2</inf> ) < 200 mmHg, the possible benefits and
optimal level of high-flow nasal cannula (HFNC) support are still unclear;
therefore, we compared HFNC support with an initial gas flow of 60 or 40
L/min and conventional oxygen therapy. Ninety nine patients were randomly
allocated (respective ratio: 1:1:1) to I = intervention group 1 (HFNC
initial flow = 60 L/min, FiO<inf>2</inf> = 0.6), intervention group 2
(HFNC initial flow = 40 L/min, FiO<inf>2</inf> = 0.6), or control group
(Venturi mask, FiO<inf>2</inf> = 0.6). The primary outcome was occurrence
of treatment failure. The baseline characteristics were similar. The
hazard for treatment failure was lower in intervention group 1 vs. control
(hazard ratio (HR): 0.11, 95% CI: 0.03-0.34) and intervention group 2 vs.
control (HR: 0.30, 95% CI: 0.12-0.77). During follow-up, the probability
of peripheral oxygen saturation (SpO<inf>2</inf> ) > 92% and respiratory
rate within 12-20 breaths/min was 2.4-3.9 times higher in intervention
group 1 vs. the other 2 groups. There was no difference in PaO<inf>2</inf>
/FiO<inf>2</inf>, patient comfort, intensive care unit or hospital stay,
or clinical course complications or adverse events. In hypoxemic cardiac
surgery patients, postextubation HFNC with an initial gas flow of 60 or 40
L/min resulted in less frequent treatment failure vs. conventional
therapy. The results in terms of SpO<inf>2</inf> /respiratory rate targets
favored an initial HFNC flow of 60 L/min. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<83>
Accession Number
2007122403
Title
Effect of preoperative respiratory rehabilitation in patients undergoing
cardiac surgery.
Source
Acta Clinica Croatica. 59 (4) (pp 597-604), 2020. Date of Publication:
2020.
Author
Nejkov S.; Bokan-Mirkovic V.; Dukic-Macut N.; Vukovic M.
Institution
(Nejkov, Bokan-Mirkovic, Vukovic) Clinical Center of Montenegro,
Department of Physical Medicine and Rehabilitation, Podgorica, Serbia
(Bokan-Mirkovic, Vukovic) Faculty of Medicine, University of Montenegro,
Podgorica, Serbia
(Dukic-Macut) Faculty of Medicine, University of Prishtina, Kosovska,
Mitrovica, Serbia
Publisher
Dr. Mladen Stojanovic University Hospital
Abstract
The aim of the study was to evaluate the effects of preoperative
respiratory rehabilitation on functional capacity, length of stay in
intensive care unit (ICU), duration of mechanical ventilation (MV) and
total hospitalization, as well as to estimate arterial blood gas (ABG)
values in patients undergoing cardiac surgery. Nineteen patients were
included in the randomized observational study, divided into two groups:
group A (intervention) and B (control). Preoperative and postoperative
rehabilitation was performed in group A, and only postoperative
rehabilitation in group B. Rehabilitation was carried out according to a
predefined protocol. We used ABG to evaluate respiratory function,
two-minute walk test (2MWT) and sit-to-stand test to assess functional
capacity. The following data were obtained from medical documentation:
duration of MV, length of stay at ICU, occurrence of postoperative
pulmonary complications, and length of total hospitalization in both
groups. Significant between-group difference was found for the length of
total hospitalization and duration of MV (p<0.05 both). Analysis of the
mean values of 2MWT on the last day of hospitalization (p=0.005),
sit-to-stand test before surgery (p=0.022) and on the last day of
hospitalization (p=0.008) showed statistically significant differences.
The length of hospital stay significantly corre-lated with preoperative
rehabilitation in group A (r=0.885; p<0.0001). There was no difference in
ABG parameters between the groups. The study showed that preoperative
respiratory rehabilitation had an effect on reducing duration of MV and
length of total hospitalization, and improved functional
capacity. Copyright © 2020, Dr. Mladen Stojanovic University
Hospital. All rights reserved.

<84>
Accession Number
635008804
Title
Impact of early (<7 days) pacemaker implantation after cardiac surgery on
long-term pacemaker dependency.
Source
Pacing and clinical electrophysiology : PACE. (no pagination), 2021. Date
of Publication: 09 May 2021.
Author
Badoz M.; Favoulet B.; Serzian G.; Ecarnot F.; Guillon B.; Chopard R.;
Meneveau N.
Institution
(Badoz, Favoulet, Serzian, Ecarnot, Guillon, Chopard, Meneveau) Department
of Cardiology, University Hospital Besancon, Boulevard Fleming, Besancon
25000, France
(Badoz, Ecarnot, Chopard, Meneveau) EA3920, University of Burgundy
Franche-Comte, 19 rue Ambroise Pare, Besancon, 25000, France
Publisher
NLM (Medline)
Abstract
OBJECTIVE: We aimed to investigate pacemaker dependency after at least 1
year in patients with early (<7 days) implantation, compared to those who
received a pacemaker >=7 days after surgery. Secondary endpoints were
length of hospital stay and in-hospital complications. METHOD(S):
Retrospective analysis of 108 consecutive patients who received a
pacemaker after cardiac surgery between 06/2012 and 06/2018.
Characteristics and outcomes were compared between patients with early (<7
days) and late (>=7 days) implantation. Patients were followed up with
evaluation of pacemaker dependency between April and June 2019. We
identified predictors of dependency by logistic regression.
 RESULT(S): In total, 63.9% were men, average age 71.9+/-11.8 years;
32 (29.6%) had early implantation, and 76 (70.4%) late implantation. After
a median 3.2 years [IQR 1.9, 4.5] of follow-up, 30 patients (27.8%) had
died, and there was no difference in pacemaker dependency among survivors
(66.7% vs 46.5%, early vs standard respectively, p = 0.15). Patients in
the early group had a shorter length of stay (11.5 [9.0, 14.0] vs 15.0
[11.5, 20] days, p = 0.002) and less often had new-onset atrial
fibrillation post-surgery (22.7% vs 47.8%, p = 0.05). The only significant
predictor of dependency was aortic valve replacement surgery (OR = 4.66,
95%CI [1.32-18.47]). CONCLUSION(S): Early implantation of a permanent
pacemaker (<7 days after cardiac surgery) does not impact on the
proportion of patients with long-term (>12 months) pacemaker dependency,
but is associated with shorter length of stay and less frequent new-onset
atrial fibrillation. These findings warrant prospective confirmation in
randomized trials. This article is protected by copyright. All rights
reserved.

<85>
Accession Number
635004881
Title
Reply to: Levosimendan or dobutamine in patients with low cardiac output
syndrome: Results from meta-analysis.
Source
International journal of cardiology. (no pagination), 2021. Date of
Publication: 06 May 2021.
Author
Putzu A.; Belletti A.; Clivio S.; Cassina T.
Institution
(Putzu, Clivio) Department of Acute Medicine, Geneva University Hospitals,
Geneva, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Cassina) Department of Cardiovascular Anesthesia and Intensive Care,
Cardiocentro Ticino, Lugano, Switzerland
Publisher
NLM (Medline)

<86>
Accession Number
635004678
Title
Does a balanced colloid decrease perioperative blood loss in paediatric
cardiac surgery: A double-blinded randomized controlled trial?.
Source
European journal of anaesthesiology. (no pagination), 2021. Date of
Publication: 06 May 2021.
Author
Willems A.; De Groote F.; Schmartz D.; Fils J.-F.; Van der Linden P.
Institution
(Willems) From the Paediatric Intensive Care Unit, Department of Intensive
Care, Leiden University Medical Centre, Leiden, The Netherlands (AW),
Department of Anaesthesiology, University Hospital Brugmann and Queen
Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS,
P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Unbalanced fluid solutions cause metabolic acidosis and could
be associated with impaired coagulation and increased blood loss.
 OBJECTIVE(S): To investigate whether the use of a balanced colloid
compared with a saline colloid for peri-operative fluid therapy in
children undergoing cardiac surgery is associated with decreased blood
loss and exposure to blood products. DESIGN: Double-blinded randomised
controlled trial. SETTING: Tertiary children's hospital from 2013 to 2016.
PATIENTS: Children older than 29 days and younger than 3 years admitted
for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria
were emergency cardiac surgery, moribund (American Society of
Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure,
liver injury, intracranial haemorrhage and electrolyte disturbances. From
the 128 patients eligible, 88 were included in the study. INTERVENTION:
Random assignment of patients to either a saline colloid (6% hydroxyethyl
starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6%
hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and
intra- and postoperative fluid therapy during the first postoperative 48
h. MAIN OUTCOME MEASURE: The primary outcome measure was calculated blood
loss until the third postoperative day (POD3). RESULT(S): A total of
44 patients were included in each study arm. Calculated blood loss at POD3
was not significantly different between the groups (saline colloid 19.9
[IQR 13.8 to 26.1] ml kg-1 versus balanced colloid 15.9 [IQR 9.0 to 25.3
ml kg-1], P = 0.409). Secondary outcomes related to bleeding, exposure to
blood products and coagulation were not different between groups. There
was also no difference in length of mechanical ventilation, intensive care
and hospital length of stay between groups. CONCLUSION(S): The use of
a balanced colloid for peri-operative fluid therapy compared with a saline
one is not associated with decreased blood loss or exposure to blood
products. TRIAL REGISTRATION: EudraCT identifier: 2012-006034-17 and
ClinicalTrial.gov identifier: NCT02584868. Copyright © 2021
European Society of Anaesthesiology.

<87>
Accession Number
635002949
Title
Lowering cholesterol, blood pressure, or both to prevent cardiovascular
events: results of 8.7 years of follow-up of Heart Outcomes Evaluation
Prevention (HOPE)-3 study participants.
Source
European heart journal. (no pagination), 2021. Date of Publication: 08 May
2021.
Author
Bosch J.; Lonn E.M.; Jung H.; Zhu J.; Liu L.; Lopez-Jaramillo P.; Pais P.;
Xavier D.; Diaz R.; Dagenais G.; Dans A.; Avezum A.; Piegas L.S.;
Parkhomenko A.; Keltai K.; Keltai M.; Sliwa K.; Held C.; Peters R.J.G.;
Lewis B.S.; Jansky P.; Yusoff K.; Khunti K.; Toff W.D.; Reid C.M.; Varigos
J.; Joseph P.; Leiter L.A.; Yusuf S.
Institution
(Bosch, Lonn, Jung, Joseph, Yusuf) The Population Health Research
Institute, Hamilton Health Sciences, 237 Barton Street East, Hamilton,
Ontario L8L 2X2, Canada
(Bosch, Joseph, Yusuf) School of Rehabilitation Science, McMaster
University, IAHS, Room 403, 1400 Main St. West, Hamilton, Canada
(Lonn) Department of Medicine, McMaster University, 1200 Main St. West,
Hamilton, Canada
(Zhu, Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking
Union Medical College, 9 Dongdan 3rd Alley ,Dong Dan ,Dongcheng, Beijing,
China
(Lopez-Jaramillo) Instituto Masira, Facultad de Salud, Universidad de
Santander, Calle 70 No 55-210, Bucaramanga, Colombia
(Pais, Xavier) St. John's Research Institute, 100 Feet Rd ,Koramangala
,Bangalore, Karnataka 560034, India
(Xavier) St. John's Medical College, Sarjarpur Road ,Bangalore, Karnataka
560034, India
(Diaz) Instituto Cardiovascular de Rosario, DSR, S2000 Rosario, Santa Fe,
Argentina
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, 2725 Ch Ste-Foy, Quebec, Canada
(Dans) College of Medicine, University of the Philippines, Pedro Gil
Street, Taft Ave, Ermita, Manila, 1000 Metro Manila, Philippines
(Avezum) Dante Pazzanese Institute of Cardiology and Sao Paulo University,
Av. Dr. Dante Pazzanese, 500 - Vila Mariana, Sao Paulo - SP, 04012-909,
Brazil
(Piegas) HCor-Hospital do Coracao, Des. Eliseu Guilherme, 147 - Paraiso
Sao Paulo - SP, Brazil
(Parkhomenko) Institute of Cardiology, Narodnoho Opolchennya St, Ukraine
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Sliwa) Department of Medicine, Hatter Institute for Cardiovascular
Research, University of Cape Town, Soweto Cardiovascular Research Group,
4th, Chris Barnard Building Faculty of Health Sciences, 5th and 6th
FloorPrivate Bag X3 7935, Cape Town, South Africa
(Held) Uppsala Clinical Research Centre and Institute for Medical
Sciences, Cardiology, Uppsala University, Uppsala Academic Hospital,
Uppsala 752 37, Sweden
(Peters) Department of Cardiology, Academic Medical Center, Meibergdreef
9, AZ Amsterdam 1105, Netherlands
(Lewis) Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School
of Medicine, Technion-Israel Institute of Technology, Efron St 1, Haifa,
Israel
(Jansky) University Hospital Motol, V Uvalu 84Czechia, 150 06 Praha 5
(Yusoff) Universiti Teknologi Majlis Amansh Rakyat, Jalan Ilmu 1/1, Shah
Alam, Selangor 40450, Malaysia
(Yusoff) University College Sedaya International University, UCSI Heights,
Taman Connaught, Wilayah Persekutuan Kuala Lumpur, Jalan Puncak Menara
Gading56000 Cheras, Malaysia
(Khunti) Leicester Diabetes Centre, Gwendolen Rd, Leicester LE5 4PW,
United Kingdom
(Toff) Department of Cardiovascular Sciences, University of Leicester,
University Rd, Leicester LE1 7RH, United Kingdom
(Toff) UK and National Institute for Health Research, Leicester Biomedical
Research Centre, Glenfield Hospital ,Groby Road, Leicester LE3 9QP, United
Kingdom
(Reid, Varigos) School of Public Health and Preventive Medicine, Monash
University, 553 St. Kilda Rd., Melbourne, VIC 3004, Australia
(Reid) School of Public Health, Curtin University, Kent St, WA 6102,
Australia
(Leiter) Li Ka Shing Knowledge Institute and Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto, 209
Victoria St, Toronto, Canada
Publisher
NLM (Medline)
Abstract
AIMS: Rosuvastatin (10 mg per day) compared with placebo reduced major
adverse cardiovascular (CV) events by 24% in 12 705 participants at
intermediate CV risk after 5.6 years. There was no benefit of blood
pressure (BP) lowering treatment in the overall group, but a reduction in
events in the third of participants with elevated systolic BP. After
cessation of all the trial medications, we examined whether the benefits
observed during the active treatment phase were sustained, enhanced, or
attenuated. METHODS AND RESULTS: After the randomized treatment period
(5.6 years), participants were invited to participate in 3.1 further years
of observation (total 8.7 years). The first co-primary outcome for the
entire length of follow-up was the composite of myocardial infarction,
stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the
second was MACE-1 plus resuscitated cardiac arrest, heart failure, or
coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994
surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented
to participate in extended follow-up. During 3.1 years of post-trial
observation (total follow-up of 8.7 years), participants originally
randomized to rosuvastatin compared with placebo had a 20% additional
reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17%
additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7
years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90,
P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002).
There was no benefit of BP lowering in the overall study either during the
active or post-trial observation period, however, a 24% reduction in
MACE-1 was observed over 8.7 years. CONCLUSION(S): The CV benefits of
rosuvastatin, and BP lowering in those with elevated systolic BP, compared
with placebo continue to accrue for at least 3 years after cessation of
randomized treatment in individuals without cardiovascular disease
indicating a legacy effect. TRIAL REGISTRATION NUMBER:
NCT00468923. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<88>
Accession Number
608458691
Title
New-onset atrial fibrillation following coronary bypass surgery predicts
long-term mortality: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 48 (6) (pp 817-824), 2015.
Date of Publication: December 2015.
Author
Phan K.; Ha H.S.; Phan S.; Medi C.; Thomas S.P.; Yan T.D.
Institution
(Phan, Phan, Yan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan, Medi, Thomas) Department of Cardiology, Westmead Hospital, Sydney,
Australia
(Phan, Ha) St Vincent's Clinical School, The University of New South
Wales, Sydney, Australia
(Yan) Department of Cardiothoracic Surgery and Cardiology, Royal Prince
Alfred Hospital, University of Sydney, Sydney, Australia
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Atrial fibrillation (AF) is one of the most common postoperative
complications following cardiac surgery. Recent evidence suggests that
postoperative atrial fibrillation (POAF) may be more 'malignant' than
previously thought, associated with follow-up mortality and morbidity. To
evaluate the long-term survival of POAF versus No-POAF cohorts following
coronary bypass surgery, the current meta-analysis with reconstructed
individual patient data was performed. Electronic searches were performed
using six databases from their inception to August 2014. Relevant studies
with long-term survival data presented for POAF versus No-POAF were
identified. Data were extracted by two independent reviewers and analysed
according to predefined clinical endpoints. The pooled hazard ratio (HR)
significantly favoured higher survival in No-POAF over POAF (HR 1.28; 95%
CI, 1.19-1.37; I2 = 96%; P < 0.00001). Individual patient data
of 69 518 patients were available for inverted Kaplan-Meier survival curve
analysis. Analysis of aggregate data using Kaplan-Meier curve methods for
POAF versus No-POAF groups determined survival rates at the 1-year (95.7
vs 98%), 2-year (92.3 vs 95.4%), 3-year (88.7 vs 93.9%), 5-year (82.6 vs
89.4%) and 10-year (65.5 vs 75.3%) follow-up. Other complications
including 30-day mortality, strokes, respiratory failure, pneumonia and
hospitalization were significantly higher in the POAF group. New-onset AF
following coronary bypass surgery is associated with significantly higher
risk of mortality in short- and long-term follow-up. Current evidence
suggests the need for stricter surveillance and monitoring of POAF
following coronary bypass surgery.

<89>
Accession Number
372905825
Title
The role of myocardial ischaemic preconditioning during beating heart
surgery: Biological aspect and clinical outcome.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (1) (pp 68-71), 2012.
Date of Publication: 01 Jan 2012.
Author
Apostolakis E.; Baikoussis N.G.; Papakonstantinou N.A.
Institution
(Apostolakis, Baikoussis, Papakonstantinou) Department of Cardiac Surgery,
University of Ioannina, School of Medicine, Ioannina, Greece
Publisher
Oxford University Press
Abstract
Short periods of ischaemia consecutive to reperfusion periods before a
sustained ischaemic condition, the so-called ischaemic preconditioning
(IP), aim to protect myocardial cells against prolonged ischaemia. IP
appears as a considerable endogenous cardioprotective mechanism decreasing
the infarct size after total occlusion in either experimental models or
humans. Angina periods before an acute coronary syndrome limit the
myocardial infarction being protective for the myocardium. Our report aims
to review the international bibliography of the IP during off-pump
coronary artery bypass grafting. © 2011 The Author 2011. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<90>
Accession Number
366299994
Title
Incidence, predictors and outcomes of incomplete revascularization after
percutaneous coronary intervention and coronary artery bypass grafting: A
subgroup analysis of 3-year SYNTAX data.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 535-541), 2012.
Date of Publication: 01 Mar 2012.
Author
Head S.J.; Mack M.J.; Holmes Jr. D.R.; Mohr F.W.; Morice M.-C.; Serruys
P.W.; Kappetein A.P.
Institution
(Head, Kappetein) Department of Cardio-thoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mack) The Heart Hospital, Baylor Health Care System, Plano, TX, United
States
(Holmes Jr.) Department of Cardiovascular Disease, Mayo Clinic Rochester,
Rochester, MN, United States
(Mohr) Department of Cardiac Surgery, Heart Cente, University Leipzig,
Leipzig, Germany
(Morice) Department of Cardiology, Institut Hospitalier Jacques Cartier,
Massy, France
(Serruys) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objective: To assess whether incomplete revascularization by percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG) has
an effect on long-term outcomes. Method(s): During a heart team
discussion to evaluate whether patients were eligible for randomization in
the SYNTAX trial, both the cardiologist and surgeon agreed on which
vessels needed revascularization. This statement was compared with the
actual revascularization after treatment. Incomplete revascularization was
defined as when a preoperatively identified vessel with a lesion was not
revascularized. Outcomes were major adverse cardiac or cerebrovascular
events (MACCE), the composite safety endpoint of death/ stroke/myocardial
infarction (MI), and individual MACCE components death, MI and repeat
revascularization at 3 years. Predictors of incomplete revascularization
were explored. Result(s): Incomplete revascularization was found in
43.3% (388/896) PCI and 36.8% (320/870) CABG patients. Patients with
complete revascularization by PCI had lower rates of MACCE (66.5 versus
76.2%, P<0.001), the composite safety endpoint (83.4 versus 87.9%,P=0.05)
and repeat revascularization (75.5 versus 83.9%, P<0.001), but not death
and MI. In the CABG group, no difference in outcomes was seen between
incomplete and complete revascularization groups. Incomplete
revascularization was identified as independent predictor of MACCE in PCI
(HR=1.55, 95% CI 1.15-2.08,P=0.004) but not CABG patients. Independent
predictors of incomplete revascularization by PCI were hyperlipidaemia
(OR=1.59, 95% CI 1.04-2.42, P=0.031), a total occlusion (OR=2.46, 95% CI
1.66-3.64, P< 0.001) and the number of vessels (OR =1.58, 95% CI
1.41-1.77, P< 0.001). Independent predictors of incomplete
revascularization by CABG were unstable angina (OR =1.42, 95% CI
1.02-1.98,P=0.038), diffuse disease or narrowed (<2 mm) segment distal to
the lesion (OR=1.87, 95% CI 1.31-2.69,P =0.001) and the number of vessels
(OR =1.70, 95% CI 1.53-1.89, P < 0.001). Conclusion(s): Despite the
hypothesis-generating nature of this data, this study demonstrates that
incomplete revascularization is associated with adverse events during
follow-up after PCI but not CABG. © The Author 2011. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<91>
Accession Number
634378356
Title
Measurement and prognosis of frail patients undergoing transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
BMJ Open. 11 (3) (no pagination), 2021. Article Number: e040459. Date of
Publication: 04 Mar 2021.
Author
Li Z.; Dawson E.; Moodie J.; Martin J.; Bagur R.; Cheng D.; Kiaii B.;
Hashi A.; Bi R.; Yeschin M.; John-Baptiste A.
Institution
(Li, Dawson, Martin, Bagur, Cheng, Yeschin, John-Baptiste) Department of
Epidemiology and Biostatistics, Western University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Department of
Anesthesia and Perioperative Medicine, Western University, London, ON,
Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Western
University, London, ON, Canada
(Cheng) Department of Medicine, Division of Critical Care Medicine, London
Health Sciences Centre, London, ON, Canada
(Kiaii) Department of Surgery, Division of Cardiac Surgery, London Health
Sciences Centre, London, ON, Canada
(Hashi) Faculty of Sciences, Western University, London, ON, Canada
(Bi, John-Baptiste) Schulich Interfaculty Program in Public Health,
Western University, London, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Objectives Our objectives were to review the literature to identify
frailty instruments in use for transcatheter aortic valve implantation
(TAVI) recipients and synthesise prognostic data from these studies, in
order to inform clinical management of frail patients undergoing TAVI.
Methods We systematically reviewed the literature published in 2006 or
later. We included studies of patients with aortic stenosis, diagnosed as
frail, who underwent a TAVI procedure that reported mortality or clinical
outcomes. We categorised the frailty instruments and reported on the
prevalence of frailty in each study. We summarised the frequency of
clinical outcomes and pooled outcomes from multiple studies. We explored
heterogeneity and performed subgroup analysis, where possible. We also
used Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) to assess the overall certainty of the estimates. Results Of 49
included studies, 21 used single-dimension measures to assess frailty, 3
used administrative data-based measures, and 25 used multidimensional
measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was
the most commonly used single-dimension frailty measure and the Fried or
modified Fried phenotype were the most commonly used multidimensional
measures. Meta-analyses of studies that used either the Fried or modified
Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to
11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The
GRADE system suggests very low certainty of the respective estimates.
Conclusions Frailty instruments varied across studies, leading to a wide
range of frailty prevalence estimates for TAVI recipients and substantial
heterogeneity. The results provide clinicians, patients and healthcare
administrators, with potentially useful information on the prognosis of
frail patients undergoing TAVI. This review highlights the need for
standardisation of frailty measurement to promote consistency. PROSPERO
registration number CRD42018090597. Copyright © Author(s) (or
their employer(s)) 2021.

<92>
Accession Number
634295315
Title
Understanding parents' decision-making on participation in clinical trials
in children's heart surgery: A qualitative study.
Source
BMJ Open. 11 (2) (no pagination), 2021. Article Number: e044896. Date of
Publication: 23 Feb 2021.
Author
Drury N.E.; Menzies J.C.; Taylor C.J.; Jones T.J.; Lavis A.C.
Institution
(Drury, Jones) Paediatric Cardiac Surgery, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Drury, Jones) Institute of Cardiovascular Sciences, University of
Birmingham, Birmingham, United Kingdom
(Menzies) Paediatric Intensive Care, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Taylor) Nuffield Department of Primary Care Health Sciences, University
of Oxford, Oxford, United Kingdom
(Lavis) Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives Few children undergoing heart surgery are recruited to clinical
trials and little is known about the views and attitudes of parents
towards trials. This study explored parents' perspectives on
decision-making about their child's participation in a clinical trial
during their elective cardiac surgery. Design Qualitative interview study.
Setting Single-centre substudy of a multicentre, double-blind, randomised
controlled trial to investigate the effects of remote ischaemic
preconditioning in children undergoing cardiac surgery. Participants
Parents of children approached to participate in the trial, both
consenters and decliners. Methods Semistructured interviews were conducted
face-to-face or by telephone following discharge, digitally
audio-recorded, transcribed and thematically analysed. Results Of 46
patients approached for the trial, 24 consenting and 2 declining parents
agreed to participate in an interview (21 mothers, 5 fathers). Parental
decision-making about research was influenced by (1) potential risks or
additional procedures; (2) personal benefit and altruism for the a
cardiac community'; (3) information, preparation, timing and approach; and
(4) trust in the clinical team and collaboration with researchers. All of
these were placed within the context of their understanding of the trial
and knowledge of research. Conclusions Parents of children undergoing
cardiac surgery attach value to clinical research and are supportive of
clinical trials when there is no or minimal perceived additional risk.
These findings enhance our understanding of the factors that influence
parents' decision-making and should be used to inform the design and
conduct of future paediatric surgical trials. Trial registration number
ISRCTN12923441; Pre-results. Copyright © Author(s) (or their
employer(s)) 2021.

<93>
Accession Number
634095505
Title
Mini-sternotomy versus conventional sternotomy for aortic valve
replacement: A randomised controlled trial.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: e041398. Date of
Publication: 29 Jan 2021.
Author
Hancock H.C.; Maier R.H.; Kasim A.; Mason J.; Murphy G.; Goodwin A.; Owens
W.A.; Akowuah E.
Institution
(Hancock, Maier) Newcastle Clinical Trials Unit, Newcastle University,
Newcastle Upon Tyne, Tyne and Wear, United Kingdom
(Kasim) Wolfson Research Institute for Health and Wellbeing, Durham
University, Stockton-on-Tees, Durham, United Kingdom
(Mason) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
(Murphy) Dept. of Cardiovasc. Sciences and Nihr Leicester Biomedical
Research Unit in Cardiovascular Medicine, University of Leicester,
Leicester, United Kingdom
(Goodwin, Owens, Akowuah) Department of Cardiothoracic Surgery, James Cook
Hospital, South Tees Hospitals Nhs Foundation Trust, Middlesbrough, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective To compare clinical and health economic outcomes after
manubrium-limited mini-sternotomy (intervention) and conventional median
sternotomy (usual care). Design A single-blind, randomised controlled
trial. Setting Single centre UK National Health Service tertiary hospital.
Participants Adult patients undergoing aortic valve replacement (AVR)
surgery. Interventions Intervention was manubrium-limited mini-sternotomy
performed using a 5-7 cm midline incision. Usual care was median
sternotomy performed using a midline incision from the sternal notch to
the xiphisternum. Primary and secondary outcome measures The primary
outcome was the proportion of patients who received a red cell transfusion
postoperatively and within 7 days of index surgery. Secondary outcomes
included proportion of patients receiving a non-red cell blood component
transfusion and number of units transfused within 7 days and during index
hospital stay, quality of life and cost-effectiveness analyses. Results
270 patients were randomised, received surgery and contributed to the
intention to treat analysis. No difference between mini and conventional
sternotomy in red-cell transfusion within 7 days was found; 23/135
patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0)
and risk difference 0.0 (95% CI -0.1 to 0.1). Mini-sternotomy reduced
chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306.9
mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size
and postoperative valve function were comparable between mini-sternotomy
and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe
aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in
longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp
times (64.1 min (SD 17.1) vs 46.3 min (SD 10.7)). Conventional sternotomy
was more cost-effective with only a 5.8% probability of mini-sternotomy
being cost-effective at a willingness to pay of 20 000/QALY (Quality
Adjusted Life Years). Conclusions AVR via mini-sternotomy did not reduce
red blood cell transfusion within 7 days following surgery when compared
with conventional sternotomy. Trial registration number ISRCTN29567910;
Results. Copyright ©

<94>
Accession Number
634095499
Title
Randomised controlled trial protocol for the PROTECT-CS Study: PROTein to
Enhance outComes of (pre)frail paTients undergoing Cardiac Surgery.
Source
BMJ Open. 11 (1) (no pagination), 2021. Article Number: ee037240. Date of
Publication: 29 Jan 2021.
Author
Rose A.V.; Duhamel T.; Hyde C.; Kent D.E.; Afilalo J.; Schultz A.S.H.;
Chudyk A.; Kehler D.S.; Dave M.; Arora R.C.
Institution
(Rose, Duhamel, Hyde, Kent, Dave) Faculty of Kinesiology and Recreation
Management, University of Manitoba, Winnipeg, MN, Canada
(Duhamel) Health, Leisure and Human Performance Research Institute,
University of Manitoba, Winnipeg, MN, Canada
(Duhamel, Arora) Institute of Cardiovascular Sciences, St. Boniface
General Hospital Albrechtsen Research Centre, Winnipeg, MN, Canada
(Kent, Dave, Arora) Cardiac Science Manitoba, St. Boniface Hospital,
Winnipeg, MN, Canada
(Afilalo) Department of Medicine, McGill University, Montreal, QC, Canada
(Schultz) College of Nursing, University of Manitoba, Winnipeg, MN, Canada
(Chudyk) Department of Family Medicine, University of Manitoba, Winnipeg,
MN, Canada
(Kehler) Department of Physiotherapy, Dalhousie University, Halifax, NS,
Canada
(Arora) Department of Surgery, University of Manitoba, Winnipeg, MN,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction In the past 20 years, the increasing burden of heart disease
in an ageing population has resulted in cardiac surgery (CS) being offered
to more frail and older patients with multiple comorbidities. Frailty and
malnutrition are key geriatric syndromes that impact postoperative
outcomes, including morbidity, mortality and prolonged hospital length of
stay. Enhanced recovery protocols (ERPs), such as prehabilitation, have
been associated with a reduction in complications after CS in vulnerable
patients. The use of nutritional ERPs may enhance short-term and long-term
recovery and mitigate frailty progression while improving patient-reported
outcomes. Methods and analysis This trial is a two-centre, double-blinded,
placebo, randomised controlled trial with blinded endpoint assessment and
intention-to-treat analysis. One-hundred and fifty CS patients will be
randomised to receive either a leucine-rich protein supplement or a
placebo with no supplemented protein. Patients will consume their assigned
supplement two times per day for approximately 2 weeks pre-procedure,
during in-hospital postoperative recovery and for 8 weeks following
discharge. The primary outcome will be the Short Physical Performance
Battery score. Data collection will occur at four time points including
baseline, in-hospital (pre-discharge), 2-month and 6-month time points
post-surgery. Ethics and dissemination The University of Manitoba
Biomedical Research Ethics Board (20 March 2018) and the St Boniface
Hospital Research Review Committee (28 June 2019) approved the trial
protocol for the primary site in Winnipeg, Manitoba, Canada. The second
site's (Montreal, Quebec) ethics has been submitted and pending approval
from the Research Ethics and New Technology Development Committee for the
Montreal Heart Institute (December 2020). Recruitment for the primary site
started February 2020 and the second site will begin January 2021. Data
gathered from the PROTein to Enhance outComes of (pre)frail paTients
undergoing Cardiac Surgery Study will be published in peer-reviewed
journals and presented at national and international conferences.
Knowledge translation strategies will be created to share findings with
stakeholders who are positioned to implement evidence-informed change.
Potential study impact Malnutrition and frailty play a crucial role in
post-CS recovery. Nutritional ERPs are increasingly being recognised as a
clinically relevant aspect of perioperative care. As such, this trial is
to determine if leucine-rich protein supplementation at key intervals can
mitigate frailty progression and facilitate enhanced postoperative
recovery. Trial registration number ClinicalTrials.gov Registry
(NCT04038294). Copyright ©

<95>
Accession Number
2005781340
Title
Normoxic management of cardiopulmonary bypass reduces myocardial oxidative
stress in adult patients undergoing coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). 36 (3) (pp 261-268), 2021. Date of
Publication: April 2021.
Author
Topcu A.C.; Bolukcu A.; Ozeren K.; Kavasoglu T.; Kayacioglu I.
Institution
(Topcu, Bolukcu, Ozeren, Kayacioglu) Department of Cardiovascular Surgery,
Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research
Hospital, Istanbul, Turkey
(Kavasoglu) Department of Anesthesiology and Reanimation, Dr. Siyami Ersek
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Publisher
SAGE Publications Ltd
Abstract
Introduction: We aimed to investigate whether normoxic cardiopulmonary
bypass would limit myocardial oxidative stress in adults undergoing
coronary artery bypass grafting. Method(s): Patients scheduled to
undergo elective isolated on-pump coronary artery bypass grafting were
randomized to normoxia and hyperoxia groups. The normoxia group received
35% oxygen during anesthetic induction, 35% during hypothermic bypass, and
45% during rewarming. The hyperoxia group received 70%, 50%, and 70%
oxygen, respectively. Coronary sinus blood samples were taken prior to
initiation of cardiopulmonary bypass and after reperfusion for myocardial
total oxidant and antioxidant status measurements. The primary endpoint
was myocardial total oxidant status. Secondary endpoints were myocardial
total antioxidant status and length of intensive care unit and hospital
stay. Result(s): Forty-eight patients were included. Twenty-two
received normoxic management. Mean +/- standard deviation of age was 58
+/- 9.07 years. Groups were balanced in terms of demographics, risk
factors, and operative data. Myocardial total oxidant status was
significantly lower in the normoxia group following reperfusion (p =
0.03). There was no statistically significant difference regarding
myocardial total antioxidant status and length of intensive care unit and
hospital stay (p = 0.08, p = 0.82, and p = 0.54, respectively).
 Conclusion(s): Normoxic cardiopulmonary bypass is associated with
reduced myocardial oxidative stress compared to hyperoxic cardiopulmonary
bypass in adult coronary artery bypass patients. Copyright © The
Author(s) 2020.

<96>
Accession Number
2008575544
Title
Meta-analysis Evaluating the Utility of Colchicine in Secondary Prevention
of Coronary Artery Disease.
Source
American Journal of Cardiology. 140 (pp 33-38), 2021. Date of Publication:
01 Feb 2021.
Author
Xia M.; Yang X.; Qian C.
Institution
(Xia, Qian) Department of Cardiology, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan Province, China
(Yang) Department of Medical Records, The Central Hospital of Enshi
Autonomous Prefecture, Enshi, Hubei Province, China
Publisher
Elsevier Inc.
Abstract
Colchicine has shown potential therapeutic benefits in cardiovascular
conditions owing to its broad anti-inflammatory properties. Here, we
performed a meta-analysis to determine the efficacy and safety of
colchicine in patients with coronary artery disease (CAD). A systematical
search in electronic databases of PubMed, The Cochrane Library, and Scopus
were carried out to identify eligible studies. Only randomized controlled
trials evaluating the cardiovascular effects of colchicine in CAD patients
were included. Study-level data of cardiovascular outcomes or adverse
events were pooled using random-effect models. We finally included 5
randomized controlled trials with follow-up duration >=6 months,
comprising a total of 11,790 patients with CAD. Compared with placebo or
no treatment, colchicine administration was associated with a
significantly lower incidence of major adverse cardiovascular events
(relative risk [RR] 0.65, 95% confidence interval [CI] 0.52 to 0.82). Such
a benefit was not modified by the clinical phenotype of CAD (p for
interaction = 0.34). Colchicine treatment also decreased the risk of
myocardial infarction (RR 0.73, 95% CI 0.55 to 0.98), coronary
revascularization (RR 0.61, 95% CI 0.42 to 0.89) and stroke (RR 0.47, 95%
CI 0.28 to 0.81) in CAD patients, but with no impact on cardiovascular
mortality. In addition, the rates of common adverse events were generally
similar between colchicine and control groups, including noncardiovascular
deaths (RR 1.50, 95% CI 0.93 to 2.40) and gastrointestinal symptoms (RR
1.05, 95% CI 0.91 to 1.22). In conclusion, the results of our
meta-analysis demonstrated that colchicine treatment may reduce the risk
of future cardiovascular events in CAD patients. Copyright © 2020
Elsevier Inc.

<97>
Accession Number
2010634693
Title
Late gadolinium enhancement in patients with Tetralogy of Fallot: A
systematic review.
Source
European Journal of Radiology. 136 (no pagination), 2021. Article Number:
109521. Date of Publication: March 2021.
Author
Secchi F.; Lastella G.; Monti C.B.; Barbaro U.; Capra D.; Zanardo M.;
Sardanelli F.
Institution
(Secchi, Monti, Capra, Zanardo, Sardanelli) Department of Biomedical
Sciences for Health, Universita degli Studi di Milano, Via Mangiagalli 31,
Milano 20133, Italy
(Secchi, Sardanelli) Department of Radiology, IRCCS Policlinico San
Donato, Via Morandi 30, San Donato Milanese, Milan 20097, Italy
(Lastella) Postgraduation School in Radiodiagnostics, Universita degli
Studi di Milano, Via Festa del Perdono 7, Milano 20122, Italy
(Barbaro) Department of Radiology, IRCCS Centro Neurolesi "Bonino Pulejo",
Viale Europa 45, Messina 98124, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Purpose: The aim of this study is to review the literature concerning
myocardial late gadolinium enhancement (LGE) with cardiac magnetic
resonance in patients with Tetralogy of Fallot (ToF), with regards to its
prevalence, characteristics and clinical relevance. Method(s): We
performed a systematic search, aiming to retrieve original articles that
evaluated LGE in ToF, running a search string on MEDLINE and EMBASE in
November 2019 and November 2020. Papers were then selected by two
independent, blinded readers based on title and abstract, and then on
full-text reading, and articles which did not include LGE evaluation were
excluded. From each included paper two readers extracted descriptive data
concerning technical parameters of LGE acquisition, LGE description and
clinical significance. Result(s): 18 articles were eventually
included in our review. The included studies observed that a higher amount
of right ventricular LGE relates with higher right ventricular volumes,
lower ejection fraction and a higher pulmonary regurgitant fraction, thus
acting as a marker of progressive impairment of myocardial function.
Moreover, LGE in ToF patients correlated with the onset of arrhythmias,
and with serum biomarkers indicative of myocardial stress and fibrosis.
 Conclusion(s): LGE could be used in the follow-up repaired ToF
patients as its appraisal can provide information concerning cardiac
dysfunction. Moreover, it may be ideal to aim towards a common framework
for standardizing assessment and quantification of LGE in ToF
patients. Copyright © 2021 Elsevier B.V.

<98>
Accession Number
2010609290
Title
A primer for managing cardiac transplant patients in the emergency
department setting.
Source
American Journal of Emergency Medicine. 41 (pp 130-138), 2021. Date of
Publication: March 2021.
Author
Long B.; Brady W.J.; Gragossian A.; Koyfman A.; Gottlieb M.
Institution
(Long) Department of Emergency Medicine, Brooke Army Medical Center, Fort
Sam Houston, TX, United States
(Brady) Department of Emergency Medicine, University of Virginia School of
Medicine, Charlottesville, VA, United States
(Gragossian) The Mt Sinai Hospital, Institute for Critical Care Medicine,
New York, NY, United States
(Koyfman) Department of Emergency Medicine, UT Southwestern, Dallas, TX,
United States
(Gottlieb) Department of Emergency Medicine, Rush University Medical
Center, Chicago, IL, United States
Publisher
W.B. Saunders
Abstract
Background: Cardiac transplant is an effective long-term management option
for several severe cardiac diseases. These cardiac transplant patients may
present to the emergency department with a range of issues involving the
cardiac transplantation, including complications due to their transplant
as well as altered presentations of disease resulting from their
transplant. Objective(s): This narrative review provides a focused
guide to the evaluation and management of patients with cardiac
transplantation and its complications. Discussion(s): Cardiac
transplant is an effective therapy for end-stage heart failure. A
transplanted heart varies both anatomically and physiologically from a
native heart. Several significant complications may occur. Graft failure,
rejection, and infection are common causes of morbidity and mortality
within the first year of transplant. As these patients are on significant
immunosuppressive medication regimens, they are at risk of infection, but
inadequate immunosuppression increases the risk of acute rejection. A
variety of dysrhythmias such as atrial fibrillation and ventricular
dysrhythmias may occur. These patients are also at risk of acute coronary
syndrome, cardiac allograft vasculopathy, and medication adverse events.
Importantly, patients with acute coronary syndrome can have an altered
presentation with the so-called "painless" myocardial infarction.
Consultation with the transplant physician is recommended, if available,
for these patients to assist in evaluation and management.
 Conclusion(s): An understanding of the presentations and various
complications that may affect patients with cardiac transplant will assist
emergency clinicians in the care of these patients. Copyright ©
2020

<99>
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

<100>
Accession Number
2005213502
Title
Effect of age on clinical outcomes following on-/off-pump coronary artery
bypass: Meta- analysis and meta-regression.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 797-814), 2020.
Date of Publication: 2020.
Author
Mauldon H.; Dieberg G.; Smart N.; King N.
Institution
(Mauldon, King) University of Plymouth, Ringgold Standard Institution,
Plymouth, United Kingdom
(Dieberg, Smart) University of New England, Ringgold Standard Institution,
Armidale, Australia
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Objective: There is currently much debate about which patients would
benefit more after on- or off-pump coronary artery bypass grafting (CABG).
The aim of this meta-analysis and meta-regression is to investigate the
effect of age on short-term clinical outcomes after these approaches.
 Method(s): To identify potential studies, systematic searches were
carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of
Science, and the Cochrane Central Register of Controlled Trials (CENTRAL).
The search strategy included the key concepts of "cardiopulmonary bypass"
AND "coronary artery bypass grafting" AND "off pump" OR "on pump". This
was followed by a meta-analysis and meta-regression investigating the
effect of age on the incidences of stroke, myocardial infarction (MI), and
mortality. Result(s): Thirty-seven studies including 15,324
participants were analysed. Overall, there was a significant odds
reduction for patients receiving off-pump CABG suffering a stroke (odds
ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048);
however, when patients were subdivided according to different age bands,
this difference disappeared. There were also no significant differences in
the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR
0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no
significant relationship between age and stroke (P=0.652), age and
mortality (P=548), and age and MI (P=0.464). Conclusion(s): Patients
undergoing CABG are becoming older and may suffer from multiple
comorbidities increasing their risk profile. However, with respect to
short-term clinical outcomes, the patient's age does not help in
determining whether off- or on-pump is superior. Copyright ©
2020, Sociedade Brasileira de Cirurgia Cardiovascular. All rights
reserved.

<101>
Accession Number
633365468
Title
Antiplatelet therapy and coronary artery bypass grafting: Protocol for a
systematic review and network meta-analysis.
Source
Medicine (United States). 98 (34) (no pagination), 2019. Article Number:
e16880. Date of Publication: 2019.
Author
Gupta S.; Belley-Cote E.P.; Rochwerg B.; Bozzo A.; Panchal P.; Pandey A.;
Mbuagbaw L.; Mehta S.; Schwalm J.-D.; Whitlock R.P.
Institution
(Gupta, Bozzo, Whitlock) Department of Surgery
(Gupta, Rochwerg, Bozzo, Whitlock) Department of Health Research Methods,
Evidence and Impact
(Belley-Cote, Rochwerg, Mehta, Schwalm) Department of Medicine
(Panchal, Pandey) Faculty of Health Sciences, McMaster University, Canada
(Belley-Cote, Mbuagbaw, Mehta, Schwalm, Whitlock) Population Health
Research Institute, David Braley Cardiac, Vascular and Stroke Research
Institute, 237 Barton St. E, Hamilton, ON L8L 2X2, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction:Saphenous vein graft (SVG) is the most common conduit used
for coronary artery bypass grafting (CABG) surgery. Unfortunately, SVG are
associated with poor long-term patency rates; a significant predictor of
re-operation rates and survival. As such, medical therapy to prevent SVG
narrowing or occlusion is of paramount importance. Aspirin (ASA)
monotherapy is the standard of care after CABG, to improve long-term major
adverse cardiovascular events (MACE) and graft patency. Benefits of dual
antiplatelet therapy (DAPT) have not been well established in all CABG
patients. We present a protocol for a network meta-analysis (NMA)
comparing the effects of various antiplatelet therapy regimens on SVG
patency, mortality, and bleeding among adult patients following CABG.
 Method(s):We will search CENTRAL, MEDLINE, EMBASE, CINAHL ACPJC, and
grey literature sources (AHA, ACC, ESC, and CCC conference proceedings,
ISRCTN Register, and WHO ICTRP) for randomized controlled trials (RCTs)
which fit our criteria. RCTs that evaluate different antiplatelet regimens
at least 3-months after CABG and have any of SVG patency, mortality, MACE,
and major bleeding as outcomes will be selected. We will perform title and
abstract screening, full-text screening, and data extraction independently
and in duplicate. Two independent reviewers will also assess risk of bias
(ROB) for each study, as well as evaluate quality of evidence using the
GRADE framework. We will use R to perform the NMA and use low-dose ASA as
reference within our network. We will report results as odds ratios with
confidence intervals for direct comparisons, and credible intervals for
indirect or mixed comparisons. We will use the surface under the
cumulative ranking curve (SUCRA) to estimate the ranking of interventions.
 Discussion(s):Given the limited direct comparison of various
antiplatelet regimens, a network approach is ideal to clarify the optimum
antiplatelet therapy after CABG. We hope that our NMA will be the largest
quantitative synthesis evaluating antiplatelet regimens among patients
requiring CABG. It should inform clinicians and guideline developers in
selecting the most effective and safest antiplatelet regimen.Systematic
Review registration: International Prospective Register for Systematic
Reviews (PROSPERO) - CRD42019127695. Copyright © 2019 the
Author(s).

<102>
Accession Number
2011448595
Title
The effect of dexmedetomidine on intraoperative blood glucose homeostasis:
secondary analysis of a randomized controlled trial.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 139.
Date of Publication: December 2021.
Author
Li C.-J.; Wang B.-J.; Mu D.-L.; Wang D.-X.
Institution
(Li, Wang, Mu, Wang) Department of Anesthesiology, Peking University First
Hospital, Beijing, China
Publisher
BioMed Central Ltd
Abstract
Purpose: To investigate the effect of dexmedetomidine on intraoperative
blood glucose hemostasis in elderly patients undergoing non-cardiac major
surgery. Method(s): This was secondary analysis of a randomized
controlled trial. Patients in dexmedetomidine group received a loading
dose dexmedetomidine (0.6 mug/kg in 10 min before anaesthesia induction)
followed by a continuous infusion (0.5 mug/kg/hr) till 1 h before the end
of surgery. Patients in control group received volume-matched normal
saline at the same time interval. Primary outcome was the incidence of
intraoperative hyperglycemia (blood glucose higher than 10 mmol/L).
 Result(s): 303 patients in dexmedetomidine group and 306 patients in
control group were analysed. The incidence of intraoperative hyperglycemia
showed no statistical significance between dexmedetomidine group and
control group (27.4% vs. 22.5%, RR = 1.22, 95%CI 0.92-1.60, P = 0.167).
Median value of glycemic variation in dexmedetomidine group (2.5, IQR
1.4-3.7, mmol) was slightly lower than that in control group (2.6, IQR
1.5-4.0, mmol), P = 0.034. In multivariable logistic analysis, history of
diabetes (OR 3.007, 95%CI 1.826-4.950, P < 0.001), higher baseline blood
glucose (OR 1.353, 95%CI 1.174-1.560, P < 0.001) and prolonged surgery
time (OR 1.197, 95%CI 1.083-1.324, P < 0.001) were independent risk
factors of hyperglycaemia. Conclusion(s): Dexmedetomidine presented
no effect on intraoperative hyperglycemia in elderly patients undergoing
major non-cardiac surgery. Trial registration: Present study was
registered at Chinese Clinical Trial Registry on December 1, 2015
(www.chictr.org.cn, registration number
ChiCTR-IPR-15007654). Copyright © 2021, The Author(s).

<103>
Accession Number
634954079
Title
Exercise-based cardiac rehabilitation for adults after heart valve
surgery.
Source
Cochrane Database of Systematic Reviews. 2021 (5) (no pagination), 2021.
Article Number: CD010876. Date of Publication: 07 May 2021.
Author
Abraham L.N.; Sibilitz K.L.; Berg S.K.; Tang L.H.; Risom S.S.; Lindschou
J.; Taylor R.S.; Borregaard B.; Zwisler A.-D.
Institution
(Abraham) Institute of Infection, Immunity and Inflammation, University of
Glasgow, Glasgow, United Kingdom
(Sibilitz, Berg) Department of Cardiology, Centre for Cardiac, Vascular,
Pulmonary and Infectious Diseases, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Tang) The research unit PROgrez, Department of Physiotherapy and
Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse,
Denmark
(Tang) Department of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Risom) Faculty of Health and Medical Sciences, Copenhagen University,
Copenhagen, Denmark
(Risom) The Heart Centre, University Hospital Rigshospitalet, Copenhagen,
Denmark
(Risom) Institute for Nursing and Nutrition, University College
Copenhagen, Copenhagen, Denmark
(Lindschou) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Copenhagen University Hospital, Copenhagen,
Denmark
(Taylor) MRC/CSO Social and Public Health Sciences Unit & Robertson Centre
for Biostatistics, Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom
(Borregaard) Department of Cardiac, Thoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Zwisler) REHPA, The Danish Knowledge Centre for Rehabilitation and
Palliative Care, Odense University Hospital, Nyborg, Denmark
(Zwisler) Department of Clinical Research, University of Southern Denmark,
Odense, Denmark
Publisher
John Wiley and Sons Ltd
Abstract
Background: The impact of exercise-based cardiac rehabilitation (CR)
following heart valve surgery is uncertain. We conducted an update of this
systematic review and a meta-analysis to assess randomised controlled
trial evidence for the use of exercise-based CR following heart valve
surgery. Objective(s): To assess the benefits and harms of
exercise-based CR compared with no exercise training in adults following
heart valve surgery or repair, including both percutaneous and surgical
procedures. We considered CR programmes consisting of exercise training
with or without another intervention (such as an intervention with a
psycho-educational component). Search Method(s): We searched the
Cochrane Central Register of Clinical Trials (CENTRAL), in the Cochrane
Library; MEDLINE (Ovid); Embase (Ovid); the Cumulative Index to Nursing
and Allied Health Literature (CINAHL; EBSCO); PsycINFO (Ovid); Latin
American Caribbean Health Sciences Literature (LILACS; Bireme); and
Conference Proceedings Citation Index-Science (CPCI-S) on the Web of
Science (Clarivate Analytics) on 10 January 2020. We searched for ongoing
trials from ClinicalTrials.gov, Clinical-trials.com, and the World Health
Organization International Clinical Trials Registry Platform on 15 May
2020. Selection Criteria: We included randomised controlled trials
that compared exercise-based CR interventions with no exercise training.
Trial participants comprised adults aged 18 years or older who had
undergone heart valve surgery for heart valve disease (from any cause) and
had received heart valve replacement or heart valve repair. Both
percutaneous and surgical procedures were included. Data Collection
and Analysis: Two review authors independently extracted data. We assessed
the risk of systematic errors ('bias') by evaluating risk domains using
the 'Risk of bias' (RoB2) tool. We assessed clinical and statistical
heterogeneity. We performed meta-analyses using both fixed-effect and
random-effects models. We used the GRADE approach to assess the quality of
evidence for primary outcomes (all-cause mortality, all-cause
hospitalisation, and health-related quality of life). Main Result(s):
We included six trials with a total of 364 participants who have had open
or percutaneous heart valve surgery. For this updated review, we
identified four additional trials (216 participants). One trial had an
overall low risk of bias, and we classified the remaining five trials as
having some concerns. Follow-up ranged across included trials from 3 to 24
months. Based on data at longest follow-up, a total of nine participants
died: 4 CR versus 5 control (relative risk (RR) 0.83, 95% confidence
interval (CI) 0.26 to 2.68; 2 trials, 131 participants; GRADE quality of
evidence very low). No trials reported on cardiovascular mortality. One
trial reported one cardiac-related hospitalisation in the CR group and
none in the control group (RR 2.72, 95% CI 0.11 to 65.56; 1 trial, 122
participants; GRADE quality of evidence very low). We are uncertain about
health-related quality of life at completion of the intervention in CR
compared to control (Short Form (SF)-12/36 mental component: mean
difference (MD) 1.28, 95% CI -1.60 to 4.16; 2 trials, 150 participants;
GRADE quality of evidence very low; and SF-12/36 physical component: MD
2.99, 95% CI -5.24 to 11.21; 2 trials, 150 participants; GRADE quality of
evidence very low), or at longest follow-up (SF-12/36 mental component: MD
-1.45, 95% CI -4.70 to 1.80; 2 trials, 139 participants; GRADE quality of
evidence very low; and SF-12/36 physical component: MD -0.87, 95% CI -3.57
to 1.83; 2 trials, 139 participants; GRADE quality of evidence very low).
Authors' conclusions: Due to lack of evidence and the very low quality of
available evidence, this updated review is uncertain about the impact of
exercise-CR in this population in terms of mortality, hospitalisation, and
health-related quality of life. High-quality (low risk of bias) evidence
on the impact of CR is needed to inform clinical guidelines and routine
practice. Copyright © 2021 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<104>
Accession Number
2011990354
Title
Fat-Secreted Ceramides Regulate Vascular Redox State and Influence
Outcomes in Patients With Cardiovascular Disease.
Source
Journal of the American College of Cardiology. 77 (20) (pp 2494-2513),
2021. Date of Publication: 25 May 2021.
Author
Akawi N.; Checa A.; Antonopoulos A.S.; Akoumianakis I.; Daskalaki E.;
Kotanidis C.P.; Kondo H.; Lee K.; Yesilyurt D.; Badi I.; Polkinghorne M.;
Akbar N.; Lundgren J.; Chuaiphichai S.; Choudhury R.; Neubauer S.; Channon
K.M.; Torekov S.S.; Wheelock C.E.; Antoniades C.
Institution
(Akawi, Antonopoulos, Akoumianakis, Kotanidis, Kondo, Lee, Yesilyurt,
Badi, Polkinghorne, Akbar, Chuaiphichai, Choudhury, Neubauer, Channon,
Antoniades) Division of Cardiovascular Medicine, Radcliffe Department of
Medicine, University of Oxford, Oxford, United Kingdom
(Akawi) Department of Genetics and Genomics, College of Medicine and
Health Sciences, United Arab Emirates University, Al-Ain, United Arab
Emirates
(Checa, Daskalaki, Wheelock) Division of Physiological Chemistry II,
Department of Medical Biochemistry and Biophysics, Karolinska Institute,
Stockholm, Sweden
(Lundgren, Torekov) Novo Nordisk Foundation Center for Basic Metabolic
Research, Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
(Lundgren, Torekov) Department of Biomedical Sciences, Faculty of Health
and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Background: Obesity is associated with increased cardiovascular risk;
however, the potential role of dysregulations in the adipose tissue (AT)
metabolome is unknown. Objective(s): The aim of this study was to
explore the role of dysregulation in the AT metabolome on vascular redox
signaling and cardiovascular outcomes. Method(s): A screen was
conducted for metabolites differentially secreted by thoracic AT (ThAT)
and subcutaneous AT in obese patients with atherosclerosis (n = 48), and
these metabolites were then linked with dysregulated vascular redox
signaling in 633 patients undergoing coronary bypass surgery. The
underlying mechanisms were explored in human aortic endothelial cells, and
their clinical value was tested against hard clinical endpoints.
 Result(s): Because ThAT volume was associated significantly with
arterial oxidative stress, there were significant differences in
sphingolipid secretion between ThAT and subcutaneous AT, with
C16:0-ceramide and derivatives being the most abundant species released
within adipocyte-derived extracellular vesicles. High ThAT sphingolipid
secretion was significantly associated with reduced endothelial nitric
oxide bioavailability and increased superoxide generated in human vessels.
Circulating C16:0-ceramide correlated positively with ThAT ceramides,
dysregulated vascular redox signaling, and increased systemic inflammation
in 633 patients with atherosclerosis. Exogenous C16:0-ceramide directly
increased superoxide via tetrahydrobiopterin-mediated endothelial nitric
oxide synthase uncoupling and dysregulated protein phosphatase 2 in human
aortic endothelial cells. High plasma C16:0-ceramide and its glycosylated
derivative were independently related with increased risk for cardiac
mortality (adjusted hazard ratios: 1.394; 95% confidence interval: 1.030
to 1.886; p = 0.031 for C16:0-ceramide and 1.595; 95% confidence interval:
1.042 to 2.442; p = 0.032 for C16:0-glycosylceramide per 1 SD). In a
randomized controlled clinical trial, 1-year treatment of obese patients
with the glucagon-like peptide-1 analog liraglutide suppressed plasma
C16:0-ceramide and C16:0-glycosylceramide changes compared with control
subjects. Conclusion(s): These results demonstrate for the first time
in humans that AT-derived ceramides are modifiable regulators of vascular
redox state in obesity, with a direct impact on cardiac mortality in
advanced atherosclerosis. (The Interaction Between Appetite Hormones;
NCT02094183) Copyright © 2021 The Authors

<105>
Accession Number
2011834610
Title
Microcirculatory effects of landiolol: a double-blind, randomised,
controlled study after cardiac surgery.
Source
British Journal of Anaesthesia. 126 (6) (pp e212-e214), 2021. Date of
Publication: June 2021.
Author
Ferraris A.; Jacquet-Lagreze M.; Cazenave L.; Fornier W.; Jalalzai W.;
Rousseau-Saine N.; Allaouchiche B.; Junot S.; Pozzi M.; Fellahi J.-L.
Institution
(Ferraris, Jacquet-Lagreze, Cazenave, Fornier, Jalalzai, Rousseau-Saine,
Fellahi) Service d'Anesthesie-Reanimation, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
(Ferraris, Jacquet-Lagreze, Cazenave, Fellahi) Laboratoire CarMeN, Inserm
UMR 1060, Universite Claude Bernard Lyon 1, Lyon, France
(Allaouchiche, Junot) VetAgro Sup, Universite de Lyon, Unite APCSe, Campus
Veterinaire de Lyon, Marcy l'Etoile, France
(Pozzi) Service de Chirurgie Cardiaque, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
Publisher
Elsevier Ltd

<106>
Accession Number
634964882
Title
Effect of the Addition of Human Milk Fortifier to Breast Milk on the Early
Recovery of Infants After Congenital Cardiac Surgery.
Source
Frontiers in Pediatrics. 9 (no pagination), 2021. Article Number: 661927.
Date of Publication: 27 Apr 2021.
Author
Yu X.-R.; Xie W.-P.; Liu J.-F.; Wang L.-W.; Cao H.; Chen Q.
Institution
(Yu, Xie, Liu, Wang, Cao, Chen) Department of Cardiac Surgery, Fujian
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Yu, Xie, Liu, Wang, Cao, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
(Yu, Xie, Liu, Wang, Cao, Chen) Fujian Branch of Shanghai Children's
Medical Center, Fuzhou, China
(Yu, Xie, Liu, Wang, Cao, Chen) Fujian Children's Hospital, Fuzhou, China
Publisher
Frontiers Media S.A.
Abstract
Objective: This article studied the effect of breast milk supplemented
with human milk fortifier (HMF) on the early recovery of infants after
congenital cardiac surgery. Method(s): Infants undergoing congenital
cardiac surgery were randomly divided into an intervention group (n = 27)
and a control group (n = 27). Infants in the intervention group received
HMF, and those in the control group were exclusively breastfed. The
nutritional indicators at discharge, the postoperative recovery status,
and nutritional-related complications were recorded. Result(s):
Compared with the control group at the time of discharge, the weight and
albumin and prealbumin levels of the intervention group were significantly
increased (P < 0.05). The length of hospital stay of the intervention
group was significantly reduced compared with that of the control group (P
< 0.05). Although the length of ICU stay for the intervention group was
shorter than that of the control group, the difference was not significant
(P > 0.05). No significant difference in the incidence of postoperative
nutrition-related complications was noted between the two groups (P >
0.05). Conclusion(s): Compared with breastfeeding alone, with HMF can
improve postoperative weight gains, reduce the length of stay, and promote
infants' early recovery after congenital cardiac surgery. ©
Copyright © 2021 Yu, Xie, Liu, Wang, Cao and Chen.

<107>
Accession Number
2011488061
Title
Impact of anemia on short-term outcomes after TAVR: A subgroup analysis
from the BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Razuk V.; Camaj A.; Cao D.; Nicolas J.; Hengstenberg C.; Sartori S.; Zhang
Z.; Power D.; Beerkens F.; Chiarito M.; Meneveau N.; Tron C.; Dumonteil
N.; Widder J.D.; Ferrari M.; Violini R.; Stella P.R.; Jeger R.;
Anthopoulos P.; Mehran R.; Dangas G.D.
Institution
(Razuk, Camaj, Cao, Nicolas, Sartori, Zhang, Power, Beerkens, Chiarito,
Mehran, Dangas) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Hengstenberg) Department of Internal Medicine II, Division of Cardiology,
Medical University of Vienna, Vienna, Austria
(Meneveau) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(Tron) Division of Cardiology, Rouen University Hospital, Rouen, France
(Dumonteil) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Ferrari) Interventional Cardiology, Helios Dr. Horst Schmidt Kliniken
Wiesbaden, Wiesbaden, Germany
(Violini) Interventional Cardiology Unit, San Camillo Hospital, Rome,
Italy
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Jeger) Department of Cardiology, University Hospital Basel, University of
Basel, Switzerland
(Anthopoulos) European Medical, Arena Pharmaceuticals Inc, Zurich,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To determine the prognostic impact of anemia in patients
randomized to bivalirudin or unfractionated heparin (UFH) during
transcatheter aortic valve replacement (TAVR). Background(s): Whether
the periprocedural use of bivalirudin as compared with UFH in anemic
patients undergoing TAVR has an impact on outcomes remains unknown.
 Method(s): The BRAVO-3 trial compared the use of bivalirudin versus
UFH in 802 high risk patients undergoing transfemoral TAVR for severe
symptomatic aortic stenosis. Patients were stratified according to the
presence (defined as hemoglobin levels <13 g/dl in men and <12 g/dl in
women) or absence of anemia. The primary outcomes were net adverse cardiac
events (NACE; a composite of all-cause mortality, myocardial infarction,
stroke, or bleeding) and major bleeding (Bleeding Academic Research
Consortium >=3b) at 30 days. Result(s): Among 798 patients with
available baseline hemoglobin levels, 427 (54%) were anemic of whom 221
(52%) received bivalirudin. There were no significant differences in NACE
and major bleeding at 30 days between patients with and without anemia,
irrespective of the type of anticoagulant used (p<inf>interaction</inf> =
0.71 for NACE, p<inf>interaction</inf> = 1.0 for major bleeding). However,
anemic patients had a higher risk of major vascular complications
(adjusted OR 2.43, 95% CI 1.42-4.16, p = 0.001), and acute kidney injury
(adjusted OR 1.74, 95% CI 1.16-2.59, p = 0.007) compared to non-anemic
patients at 30 days. Conclusion(s): Anemia was not associated with a
higher risk of NACE or major bleeding at 30 days after TAVR without
modification of the treatment effects of periprocedural anticoagulation
with bivalirudin versus UFH. Copyright © 2021 Wiley Periodicals
LLC.

<108>
Accession Number
635002758
Title
Low dose of methylprednisolone for pain and immune function after thoracic
surgery.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 04 May 2021.
Author
Li X.; Song B.; Teng X.; Li Y.; Yang Y.; Zhu J.
Institution
(Li, Teng, Li, Yang, Zhu) Department of Anesthesiology, Shengjing Hospital
of China Medical University, Shenyang, Liaoning, China
(Song) Department of Anesthesiology, Shengjing Hospital of China Medical
University, Shenyang, Liaoning, P.R. China; Department of Anesthesiology,
Beijing Friendship Hospital of Capital Medical University, Beijing, P.R.
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose of this study was to evaluate the effects of
single low-dose preoperative methylprednisolone (MP) on the immunological
function and postoperative pain of patients undergoing elective
video-assisted thoracoscopic surgery under general anesthesia.
 METHOD(S): Eighty-one patients who underwent elective video-assisted
thoracoscopic surgery were randomly assigned to the MP Group or the
Control Group. The T lymphocyte subsets of CD3+, CD4+, and CD8+, the
CD4+/CD8+ ratio at T0 (before anesthesia), T1 (after surgery), and T2 (24
h after surgery) were all recorded. Postoperative rest and cough pain
scores, as well as postoperative adverse effects and surgery complications
were also recorded. RESULT(S): Compared to T0, the levels of CD3+ and
CD4+ subsets and CD4+/CD8+ were significantly decreased, the level of CD8+
were increased after surgery in both groups. There was no significant
difference in the variation of CD3+, CD4+, CD8+, and CD4+/CD8+ between the
MP Group and the Control Group. Both the rest and cough pain of patients
in the MP Group were significantly lower as compared to the Control Group
at 2, 4, 6 and 24 hours after surgery. And the incidences of nausea and
vomiting and dizziness were also significantly higher in the Control Group
than those in the MP Group. CONCLUSION(S): Preoperative single
low-dose of MP (1 mg/kg) has no effect on immune function. Preoperative
single low dose of MP (1 mg/kg) had effective analgesic effects and could
reduce the incidence of dizziness and postoperative nausea and
vomiting. Copyright © 2021. Published by Elsevier Inc.

<109>
Accession Number
629252264
Title
What is the best graft to supplement the bilateral internal thoracic
artery to the left coronary system? A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 56 (1) (pp 21-29), 2019. Date
of Publication: 01 Jul 2019.
Author
Di Mauro M.; Lorusso R.; Di Franco A.; Foschi M.; Rahouma M.; Soletti G.;
Calafiore A.M.; Gaudino M.
Institution
(Di Mauro, Foschi) Heart Department, SS Annunziata Hospital, Via dei
Vestini, Chieti 66100, Italy
(Lorusso) Cardiac Surgery Department, Maastricht University Medical
Center, Maastricht, Netherlands
(Di Franco, Rahouma, Soletti, Gaudino) Cardiothoracic Surgery Department,
New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY,
United States
(Calafiore) Cardiac Surgery Department, Fondazione 'Papa Giovanni Paolo
II', Campobasso, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
This meta-analysis was designed to assess the effect of the use of
arterial conduits (ACs) versus great saphenous vein (GSV) grafts as a
third conduit for revascularization of the right coronary artery system,
in addition to the bilateral internal mammary artery on the left coronary
artery. PubMed and OVID's version of MEDLINE were searched from January
2000 to September 2017 for relevant publications. The primary end point
was the long-term mortality rate. The secondary end point was early
mortality, defined as either in-hospital death or death within 30 days
after the operation. Meta-regression was used to evaluate the effect of
female gender and diabetes on the primary and secondary outcomes. A total
of 10 studies (4121 patients) were selected for the systematic review and
meta-analysis comparing ACs (1619) versus the GSV (2502), 6 (2548)
comparing the GSV (2548) versus the right gastroepiploic artery (1023) and
5 comparing the GSV (2548) versus the radial artery (596). The pooled
analysis did not show any difference between ACs and the GSV in terms of
long-term mortality rates [hazard ratio (HR) = 0.75, 95% confidence
interval (CI) = 0.56-1.01; P = 0.061]. When using the leave-one-out
analysis, after the exclusion of 1 study (outlier), ACs were significantly
associated with lower long-term mortality rates (HR = 0.67, 95% CI =
0.54-0.83; P < 0.001). When the results were stratified according to the
type of study, no differences with regard to long-term results were found
between ACs and the GSV, either in the pooled analysis of the 6 propensity
score-matched studies (HR = 0.69, 95% CI = 0.43-1.08; P = 0.107) or in the
pooled analysis of the 4 non-propensity score-matched studies (HR = 0.88,
95% CI = 0.62-1.23; P = 0.438). Again, when the outlier was excluded, the
pooled analysis of the propensity score-matched studies confirmed that ACs
were associated with lower long-term mortality rates (HR = 0.58, 95% CI =
0.43-0.80; P < 0.001). Comparisons between the GSV and either the right
gastroepiploic artery or the radial artery showed similar results. No
publication bias was found. This meta-analysis is the first to compare the
GSV to the radial artery and the right gastroepiploic artery for right
coronary artery grafting in patients receiving a bilateral internal
mammary artery to left coronary artery. The choice of a third AC seems to
be preferable in order to achieve better long-term survival. Copyright
© 2019 The Author(s). Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<110>
Accession Number
605172181
Title
Searching for the second best graft for coronary artery bypass surgery: A
network meta-analysis of randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 47 (1) (pp 59-65), 2015. Date
of Publication: 01 Jan 2015.
Author
Benedetto U.; Raja S.G.; Albanese A.; Amrani M.; Biondi-Zoccai G.; Frati
G.
Institution
(Benedetto, Raja, Albanese, Amrani) Department of Cardiac Surgery,
Harefield Hospital, London, United Kingdom
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Frati) Department of AngioCardio Neurology, IRCCS NeuroMed, Pozzilli,
Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: There is a lack of unequivocal evidence basis for selecting
the best second conduit in coronary artery bypass grafting (CABG). We thus
aimed to perform head-to-head relative effect estimate on angiographic
outcomes for second conduits, including the right internal mammary artery
(RIMA), radial artery (RA), right gastroepiploic artery (RGEA) and
saphenous vein graft (SVG) by means of network meta-analysis of randomized
controlled trials (RCTs). METHOD(S): Databases were searched for RCTs
comparing angiographic outcomes (>=4 weeks) of second conduits in CABG.
Odds ratios (95% confidence intervals) were computed with Markov Chain
Monte Carlo simulation. RESULT(S): A total of nine RCTs were
identified, including 2780 patients and 1620 angiographic results
available for analysis to compare RIMA (n = 145) versus RA (n = 871)
versus RGEA (n = 92) versus SVG (n = 845). The mean time to angiographic
follow-up ranged from 1 to 7.7 years. An SVG was significantly associated
with a 4-fold (1.67-16.00) and 3-fold (0.78-22.20) increased risk of late
(>=4 years) functional graft occlusion when compared with the RIMA and RA,
respectively. A RIMA was associated with a non-significant 27% absolute
risk reduction for functional graft occlusion when compared with the RA.
 CONCLUSION(S): The present network meta-analysis consistently
demonstrated an angiographic superiority of RIMA and RA over SVG. The RIMA
is expected to achieve a better patency rate than the RA, but further
studies are needed. Copyright © The Author 2014. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<111>
Accession Number
2010930550
Title
Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An
Individual Patient-Level Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14 (4) (pp 444-456), 2021. Date of
Publication: 22 Feb 2021.
Author
Valgimigli M.; Mehran R.; Franzone A.; da Costa B.R.; Baber U.; Piccolo
R.; McFadden E.P.; Vranckx P.; Angiolillo D.J.; Leonardi S.; Cao D.;
Dangas G.D.; Mehta S.R.; Serruys P.W.; Gibson C.M.; Steg G.P.; Sharma
S.K.; Hamm C.; Shlofmitz R.; Liebetrau C.; Briguori C.; Janssens L.; Huber
K.; Ferrario M.; Kunadian V.; Cohen D.J.; Zurakowski A.; Oldroyd K.G.;
Yaling H.; Dudek D.; Sartori S.; Kirkham B.; Escaned J.; Windecker S.;
Pocock S.; Juni P.; Serruys P.; Mehta S.; Gibson M.C.; Kastrati A.;
Krucoff M.; Ohman M.E.; Gurbel P.; Henry T.D.; Moliterno D.; Heg D.;
McFadden E.; Marx S.O.; Darrow B.; Corvaja N.; DeStefano D.; Ghodsi N.;
Meller J.; Franklin-Bond T.; Cha J.Y.; Waseem Z.; Weisz G.; Kornowski R.;
Oldroyd K.; Kaul U.; Witzenbichler B.; Dzavik V.; Gil R.; Sardella G.;
Benit E.; Diletti R.; Dominici M.; Slagboom T.; Buszman P.; Bolognese L.;
Tumscitz C.; Bryniarski K.; Aminian A.; Vrolix M.; Petrov I.; Garg S.;
Naber C.; Prokopczuk J.; Steg P.G.
Institution
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Lugano, Switzerland
(Mehran, Baber, Cao, Dangas, Sharma, Sartori) Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Franzone, Piccolo) Department of Advanced Biomedical Sciences, University
of Naples Federico II, Naples, Italy
(da Costa, Kirkham, Juni) Applied Health Research Centre of the Li Ka
Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(McFadden) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(McFadden) Department of Cardiology, Cork University Hospital, Cork,
Ireland
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Angiolillo, Ferrario) Division of Cardiology, University of Florida
College of Medicine, Jacksonville, FL, United States
(Leonardi) University of Pavia and Fondazione IRCCS Policlinico S. Matteo,
Pavia, Italy
(Mehta) McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College, London, United Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Steg) Universite de Paris and Hopital Bichat, Assistance
Publique-Hopitaux de Paris, Paris, France
(Hamm, Liebetrau) German Center for Cardiovascular Research, partner site
RheinMain, Frankfurt am Main, Germany
(Hamm, Liebetrau) Department of Cardiology, Kerckhoff Heart and Thorax
Center, Bad Nauheim, Germany
(Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Briguori) Clinica Mediterranea, Naples, Italy
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Huber) 3rd Medical Department, Cardiology and Intensive Care Medicine,
Wilhelminen Hospital, and Sigmund Freud University Medical School, Vienna,
Austria
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman
Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle
upon Tyne, United Kingdom
(Cohen) Cardiovascular Research, Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Zurakowski) Department of Interventional Cardiology Chrzanow, Andrzej
Frycz Modrzewski Krakow University, Krakow, Poland
(Oldroyd) The West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Yaling) General Hospital of Northern Theater Command, Shenyang, Liaoning,
China
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Dudek) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
(Escaned) Instituto de Investigacion Sanitaria del Hospital Clinico San
Carlos and Complutense University, Madrid, Spain
(Heg) Clinical Trials Unit, London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare ticagrelor monotherapy
with dual-antiplatelet therapy (DAPT) after percutaneous coronary
intervention (PCI) with drug-eluting stents. Background(s): The role
of abbreviated DAPT followed by an oral P2Y<inf>12</inf> inhibitor after
PCI remains uncertain. Method(s): Two randomized trials, including
14,628 patients undergoing PCI, comparing ticagrelor monotherapy with
standard DAPT on centrally adjudicated endpoints were identified, and
individual patient data were analyzed using 1-step fixed-effect models.
The protocol was registered in PROSPERO (CRD42019143120). The primary
outcomes were the composite of Bleeding Academic Research Consortium type
3 or 5 bleeding tested for superiority and, if met, the composite of
all-cause death, myocardial infarction, or stroke at 1 year, tested for
noninferiority against a margin of 1.25 on a hazard ratio (HR) scale.
 Result(s): Bleeding Academic Research Consortium type 3 or 5 bleeding
occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%,
respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p <
0.001). The composite of all-cause death, myocardial infarction, or stroke
occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%)
with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority).
Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI:
0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to
0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs.
2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke
(0.47% vs. 0.36%; p = 0.30) were similar. Conclusion(s): Ticagrelor
monotherapy was associated with a lower risk for major bleeding compared
with standard DAPT, without a concomitant increase in ischemic
events. Copyright © 2021 American College of Cardiology
Foundation

<112>
Accession Number
2008368781
Title
Pulmonary lobectomy for cancer: Systematic review and network
meta-analysis comparing open, video-assisted thoracic surgery, and robotic
approach.
Source
Surgery (United States). 169 (2) (pp 436-446), 2021. Date of Publication:
February 2021.
Author
Aiolfi A.; Nosotti M.; Micheletto G.; Khor D.; Bonitta G.; Perali C.;
Marin J.; Biraghi T.; Bona D.
Institution
(Aiolfi, Bonitta, Perali, Marin, Biraghi, Bona) Department of Biomedical
Science for Health, Division of General Surgery, University of Milan,
Istitituto Clinico Sant'Ambrogio, Milan, Italy
(Nosotti) Department of Pathophysiology and Transplantation, Thoracic
Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda - Ospedale
Maggiore Policlinico, Milan, Italy
(Micheletto) Department of Pathophysiology and Transplantation, INCO and
Department of General Surgery, University of Milan, Istituto Clinico
Sant'Ambrogio, Milan, Italy
(Khor) University of Maryland Medical Center, Baltimore, MD, United States
Publisher
Mosby Inc.
Abstract
Background: Although minimally invasive lobectomy has gained worldwide
interest, there has been debate on perioperative and oncological outcomes.
The purpose of this study was to compare outcomes among open lobectomy,
video-assisted thoracic surgery lobectomy, and robotic lobectomy.
 Method(s): PubMed, EMBASE, and Web of Science databases were
consulted. A fully Bayesian network meta-analysis was performed.
 Result(s): Thirty-four studies (183,426 patients) were included;
88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted
thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. Compared
with open lobectomy, video-assisted thoracic surgery, lobectomy and
robotic lobectomy had significantly reduced 30-day mortality (risk ratio =
0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95%
credible intervals, 0.36-0.71), pulmonary complications (risk ratio =
0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95%
credible intervals, 0.51-0.88), and overall complications (risk ratio =
0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95%
credible intervals, 0.67-0.91). Compared with video-assisted thoracic
surgery lobectomy, open lobectomy, and robotic lobectomy had a
significantly higher total number of harvested lymph nodes (mean
difference = 1.46; 95% credible intervals, 0.30, 2.64 and mean difference
= 2.18; 95% credible intervals, 0.52-3.92) and lymph nodes stations (mean
difference = 0.37; 95% credible intervals, 0.08-0.65 and mean difference =
0.93; 95% credible intervals, 0.47-1.40). Positive resection margin and
5-year overall survival were similar across treatments. Intraoperative
blood loss, postoperative transfusion, hospital length of stay, and 30-day
readmission were significantly reduced for minimally invasive approaches.
 Conclusion(s): Compared with open lobectomy, video-assisted thoracic
surgery lobectomy, and robotic lobectomy seem safer with reduced 30-day
mortality, pulmonary, and overall complications with equivalent oncologic
outcomes and 5-year overall survival. Minimally invasive techniques may
improve outcomes and surgeons should be encouraged, when feasible, to
adopt video-assisted thoracic surgery lobectomy, or robotic lobectomy in
the treatment of lung cancer. Copyright © 2020 Elsevier Inc.

<113>
Accession Number
2004306363
Title
Sequential multidetector computed tomography assessments after venous
graft treatment solution in coronary artery bypass grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. 161 (1) (pp 96-106.e2),
2021. Date of Publication: January 2021.
Author
Perrault L.P.; Carrier M.; Voisine P.; Olsen P.S.; Noiseux N.; Jeanmart
H.; Cardemartiri F.; Veerasingam D.; Brown C.; Guertin M.-C.;
Satishchandran V.; Goeken T.; Emmert M.Y.
Institution
(Perrault, Carrier, Noiseux, Cardemartiri) Department of Surgery, Montreal
Heart Institute, Montreal, Quebec, Canada
(Voisine) Institut Universitaire de Cardiologie et de Pneumologie, Quebec
City, Quebec, Canada
(Olsen) Rigshopitalet University of Copenhagen, Copenhagen, Denmark
(Jeanmart) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Cardemartiri) SDN IRCCS, Naples, Italy
(Veerasingam) Galway University Hospital, Galway, Ireland
(Brown) New Brunswick Heart Centre, Saint John, NB, Canada
(Guertin) Montreal Health Innovations Coordinating Center, Montreal,
Quebec, Canada
(Satishchandran, Goeken) Somahlution, Jupiter, Fla, United States
(Emmert) Department of Cardiovascular Surgery, Charite Universitatsmedizin
Berlin, Berlin, Germany
(Emmert) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
Publisher
Mosby Inc.
Abstract
Objectives: To assess the effect of DuraGraft (Somahlution Inc, Jupiter,
Fla), an intraoperative graft treatment, on saphenous vein grafts in
patients undergoing isolated coronary artery bypass grafting.
 Method(s): Within patients, 2 saphenous vein grafts were randomized
to DuraGraft or heparinized saline. Multidetector computed tomography
angiography at 1, 3, and 12 months assessed change in wall thickness
(primary end point at 3 months), lumen diameter, and maximum narrowing for
the whole graft and the proximal 5-cm segment. Safety end points included
graft occlusion, death, myocardial infarction, and repeat
revascularization. Result(s): At 3 months, no significant changes
were observed between DuraGraft- and saline-treated grafts (125 each) for
wall thickness, lumen diameter, and maximum narrowing. At 12 months,
DuraGraft-treated grafts demonstrated smaller mean wall thickness, overall
(0.12 +/- 0.06 vs 0.20 +/- 0.31 mm; P =.02) and in the proximal segment
(0.11 +/- 0.03 vs 0.21 +/- 0.33 mm; P =.01). Changes in wall thickness
were greater in the proximal segment of saline-treated grafts (0.09 +/-
0.29 vs 0.00 +/- 0.03 mm; P =.04). Increase in maximum graft narrowing was
larger in the proximal segment in the saline-treated grafts (4.7% +/-
12.7% vs 0.2% +/- 3.8%; P =.01). Nine DuraGraft and 11 saline grafts had
occluded or thrombosed. One myocardial infarction was associated with a
saline graft occlusion. No deaths or revascularizations were observed.
 Conclusion(s): DuraGraft demonstrated a favorable effect on wall
thickness at 12 months, particularly in the proximal segment. Longer-term
follow-up in larger studies is needed to evaluate the effect on clinical
outcomes. Copyright © 2019 The American Association for Thoracic
Surgery

<114>
Accession Number
2004140308
Title
Performance of the Hypotension Prediction Index with non-invasive arterial
pressure waveforms in non-cardiac surgical patients.
Source
Journal of Clinical Monitoring and Computing. 35 (1) (pp 71-78), 2021.
Date of Publication: February 2021.
Author
Maheshwari K.; Buddi S.; Jian Z.; Settels J.; Shimada T.; Cohen B.;
Sessler D.I.; Hatib F.
Institution
(Maheshwari) Department of General Anesthesiology, Anesthesiology
Institute, Cleveland Clinic, Cleveland, OH, United States
(Buddi, Jian, Settels, Hatib) Edwards Lifesciences Critical Care, Irvine,
CA, United States
(Maheshwari, Shimada, Cohen, Sessler) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
(Shimada) Department of Anesthesiology, National Defense Medical College,
Tokorozawa, Saitama, Japan
(Cohen) Division of Anesthesia, Critical Care, and Pain Medicine, Tel-Aviv
Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel
Aviv, Israel
Publisher
Springer Science and Business Media B.V.
Abstract
An algorithm derived from machine learning uses the arterial waveform to
predict intraoperative hypotension some minutes before episodes, possibly
giving clinician's time to intervene and prevent hypotension. Whether the
Hypotension Prediction Index works well with noninvasive arterial pressure
waveforms remains unknown. We therefore evaluated sensitivity,
specificity, and positive predictive value of the Index based on
non-invasive arterial waveform estimates. We used continuous hemodynamic
data measured from ClearSight (formerly Nexfin) noninvasive finger blood
pressure monitors in surgical patients. We re-evaluated data from a trial
that included 320 adults >= 45 years old designated ASA physical status 3
or 4 who had moderate-to-high-risk non-cardiac surgery with general
anesthesia. We calculated sensitivity and specificity for predicting
hypotension, defined as mean arterial pressure <= 65 mmHg for at least 1
min, and characterized the relationship with receiver operating
characteristics curves. We also evaluated the number of hypotensive events
at various ranges of the Hypotension Prediction Index. And finally, we
calculated the positive predictive value for hypotension episodes when the
Prediction Index threshold was 85. The algorithm predicted hypotension 5
min in advance, with a sensitivity of 0.86 [95% confidence interval 0.82,
0.89] and specificity 0.86 [0.82, 0.89]. At 10 min, the sensitivity was
0.83 [0.79, 0.86] and the specificity was 0.83 [0.79, 0.86]. And at 15
min, the sensitivity was 0.75 [0.71, 0.80] and the specificity was 0.75
[0.71, 0.80]. The positive predictive value of the algorithm prediction at
an Index threshold of 85 was 0.83 [0.79, 0.87]. A Hypotension Prediction
Index of 80-89 provided a median of 6.0 [95% confidence interval 5.3, 6.7]
minutes warning before mean arterial pressure decreased to < 65 mmHg. The
Hypotension Prediction Index, which was developed and validated with
invasive arterial waveforms, predicts intraoperative hypotension
reasonably well from non-invasive estimates of the arterial waveform.
Hypotension prediction, along with appropriate management, can potentially
reduce intraoperative hypotension. Being able to use the non-invasive
pressure waveform will widen the range of patients who might benefit.
Clinical Trial Number: ClinicalTrials.gov NCT02872896. Copyright
© 2020, The Author(s).

<115>
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)

<116>
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.

<117>
Accession Number
2005213496
Title
Cardiac shock wave therapy for coronary heart disease: An updated
meta-analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 741-756), 2020.
Date of Publication: 2020.
Author
Yang H.-T.; Xie X.; Hou X.-G.; Xiu W.-J.; Wu T.-T.
Institution
(Yang, Xie, Xiu, Wu) Department of Cardiology, First Affiliated Hospital
of Xinjiang Medical University, Urumchi, China
(Hou) Department of Cardiology, Changji Hui Autonomous Prefecture Peoples
Hospital, China
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: The aim of this article is to study the efficacy and safety
of cardiac shock wave therapy (CSWT) in the treatment of coronary heart
disease (CAD). Method(s): A comprehensive search of electronic
databases and a manual search of conference papers and abstracts were
performed until September 30, 2018. The studies using RevMan 5.3 and STATA
14.0 softwares were reviewed, and meta-analyses were performed on 13
indicators, such as a six-min walking distance test (6MWT), New York Heart
Association (NYHA) functional class, Seattle Angina Questionnaire (SAQ)
score, angina class (Canadian Cardiology Society [CCS]), etc.
 Result(s): A total of 26 articles were included. The total patient
population was 855, of which 781 patients were treated with CSWT.
Meta-analyses indicated that 6MWT (mean difference [MD] 75.64, 95%
confidence interval [CI] 49.03, 102.25, P<0.00001) and NYHA (MD -0.70, 95%
CI -0.92) in the CSWT group were comparable to those in the conventional
revascularization group (MD -0.70, 95% CI -0.92, -0.49, P<0.00001). SAQ
(MD 10.75, 95% CI 6.66, 14.83, P<0.00001), CCS (MD -0.99, 95% CI -1.13,
-0.84, P<0.00001), nitrate dosage (MD -1.84, 95% CI -2.77, -1.12,
P<0.00001), LVEF (MD 3.77, 95% CI 2.17, 5.37, P<0.00001), and SSS (MD
-4.29, 95% CI -5.61, -2.96, P<0.00001), SRS (MD -2.90, 95% CI -4.85,
-0.95, P=0.004), and the exercise test (standard mean difference 0.57, 95%
CI 0.12, 1. 02, P=0.01) all showed significant differences.
 Conclusion(s): CSWT may offer beneficial effects to patients with
CAD, but more large-scale clinical studies are needed to further verify
its therapeutic effect. Copyright © 2020, Sociedade Brasileira de
Cirurgia Cardiovascular. All rights reserved.

<118>
Accession Number
2005213483
Title
Comparison between the effects of bretschneiders htk solution and cold
blood cardioplegia on systemic endothelial functions in patients who
undergo coronary artery bypass surgery: A prospective randomized and
controlled trial.
Source
Brazilian Journal of Cardiovascular Surgery. 35 (5) (pp 634-643), 2020.
Date of Publication: 2020.
Author
Mercan I.; Dereli Y.; Topcu C.; Tanyeli O.; Isik M.; Gormus N.; Ozturk
E.Y.
Institution
(Mercan) Department of Cardiovascular Surgery, Konya Training and Research
Hospital, Konya, Turkey
(Dereli, Tanyeli, Isik, Gormus) Department of Cardiovascular Surgery,
Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
(Topcu) Department of Biochemistry, Necmettin Erbakan University, Meram
Faculty of Medicine, Konya, Turkey
(Ozturk) Department of Public Health, Necmettin Erbakan University, Meram
Faculty of Medicine, Konya, Turkey
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Objective: To investigate the effects of Bretschneiders
histidine-tryptophan-ketoglutarate (HTK) solution and cold blood
cardioplegia on systemic endothelial functions. Method(s): A total of
50 patients who underwent isolated coronary artery bypass surgery between
March 2018 and May 2018 were randomly divided into two groups -group 1
(Bretschneiders HTK solution, n=25) and group 2 (cold blood cardioplegia,
n=25). Data related to the indicators of endothelial dysfunction were
recorded. Flow-mediated dilation was measured together with the assessment
of the values of endothelin-1, von Willebrand factor, and asymmetric
dimethylarginine to identify endothelial dysfunction. Then, the two groups
were compared regarding these values. Result(s): The most significant
result of our study was that the endothelin-1 level was significantly
higher in group 2 than in group 1 (P<0.001). The value of flow-mediated
dilation was found to increase to a lesser degree on the postoperative
days compared to the value at the day of admission in group 1 (P=0.002 and
P=0.030, respectively). Conclusion(s): Cardiopulmonary bypass leads
to endothelial dysfunction. Our results revealed that Bretschneiders HTK
solution causes less severe endothelial injury than cold blood
cardioplegia. Copyright © 2020, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<119>
Accession Number
2011181830
Title
Navigating inferior vena cava filters in invasive cardiology procedures: A
systematic review.
Source
Journal of Cardiovascular Electrophysiology. 32 (5) (pp 1440-1448), 2021.
Date of Publication: May 2021.
Author
Shah K.; Patel S.; Hanson I.; Williamson B.; Kutinsky I.; Dixon S.; Haines
D.E.; Mehta N.K.
Institution
(Shah, Hanson, Williamson, Kutinsky, Dixon, Haines, Mehta) Department of
Cardiovascular Medicine, Beaumont Hospital, Oakland University William
Beaumont School of Medicine, Royal Oak, MI, United States
(Patel) Department of Cardiovascular Medicine, Henry Ford Hospital,
Detroit, MI, United States
(Mehta) Department of Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: Transfemoral venous access (TFV) is the cornerstone of
minimally invasive cardiac procedures. Although the presence of inferior
vena cava filters (IVCFs) was considered a relative contraindication to
TFV procedures, small experiences have suggested safety. We conducted a
systematic review of the available literature on cardiac procedural
success of TFV with IVCF in-situ. Method(s): Two independent
reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from
inception to October 2020 for studies that reported outcomes in patients
with IVCFs undergoing TFV for invasive cardiac procedures. We investigated
a primary outcome of acute procedural success and reviewed the pooled data
for patient demographics, procedural complications, types of IVCF, IVCF
dwell time, and procedural specifics. Result(s): Out of the 120
studies initially screened, 8 studies were used in the final analysis with
a total of 100 patients who underwent 110 procedures. The most common IVCF
was the Greenfield Filter (36%), 60% of patients were males and the mean
age was 67.8 years. The overall pooled incidence of acute procedural
success was 95.45% (95% confidence interval = 89.54-98.1) with no
heterogeneity (I2 = 0%, p = 1) and there were no reported
filter-related complications. Conclusion(s): This systematic review
is the largest study of its kind to demonstrate the safety and feasibility
of TFV access in a variety of cardiac procedures in the presence of
IVCF. Copyright © 2021 Wiley Periodicals LLC

<120>
Accession Number
2010803854
Title
Predictors of permanent pacemaker insertion after TAVR: A systematic
review and updated meta-analysis.
Source
Journal of Cardiovascular Electrophysiology. 32 (5) (pp 1411-1420), 2021.
Date of Publication: May 2021.
Author
Mahajan S.; Gupta R.; Malik A.H.; Mahajan P.; Aedma S.K.; Aronow W.S.;
Mehta S.S.; Lakkireddy D.R.
Institution
(Mahajan, Mahajan, Aedma) Department of Internal Medicine, Carle
Foundation Hospital, Urbana, IL, United States
(Gupta) Department of Cardiology, Lehigh Valley Heart Institute, Lehigh
Valley Health Network, Allentown, PA, United States
(Malik, Aronow) Department of Cardiology, Westchester Medical Center and
New York Medical College, Valhalla, NY, United States
(Mehta) Department of Cardiology, Heart and Vascular Institute, Carle
Foundation Hospital, Urbana, IL, United States
(Lakkireddy) Department of Cardiology, Kansas City Heart Rhythm Institute
and Research Foundation, Overland Park, KS, United States
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: The aim of this analysis was to evaluate the predictors
associated with increased risk of permanent pacemaker implantation (PPMI)
following transcatheter aortic valve replacement (TAVR).
 Background(s): While TAVR has evolved as the standard of care for
patients with severe aortic stenosis, conduction abnormalities leading to
the need for PPMI is one of the most common postprocedural complications.
 Method(s): A systematic literature search was performed to identify
relevant trials from inception to May 2020. Summary effects were
calculated using a DerSimonian and Laird random-effects model as odds
ratio with 95% confidence intervals for all the clinical endpoints.
 Result(s): Thirty-seven observational studies with 71 455 patients
were identified. The incidence of PPMI following TAVR was 22%. Risk was
greater in men and increased with age. Patients with diabetes mellitus,
presence of right bundle branch block, baseline atrioventricular
conduction block, and left anterior fascicular block were noted to be at
higher risk. Other significant predictors include the presence of high
calcium volume in the area below the left coronary cusp and noncoronary
cusp, use of self-expandable valve over balloon-expandable valve, depth of
implant, valve size/annulus size, predilatation balloon valvuloplasty, and
postimplant balloon dilation. Conclusion(s): Fourteen factors were
found to be associated with increased risk of PPMI after TAVR, suggesting
early identification of high-risk populations and targeting modifiable
risk factors may aid in reducing the need for this post TAVR
PPMI. Copyright © 2021 Wiley Periodicals LLC

<121>
Accession Number
2006119034
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients with Left Ventricular Systolic Dysfunction.
Source
Cardiovascular Drugs and Therapy. 35 (3) (pp 575-585), 2021. Date of
Publication: June 2021.
Author
Khan M.R.; Kayani W.T.; Pelton J.; Ansari A.; Paniagua D.; Khalid U.;
Denktas A.; Changezi H.U.; Munir A.; Jimenez E.; Alam M.; Jneid H.
Institution
(Khan, Changezi, Munir) Division of Cardiology, McLaren-Flint/Michigan
State University, Flint, MI, United States
(Kayani, Pelton, Ansari, Paniagua, Khalid, Denktas, Alam, Jneid) Section
of Cardiology, Department of Internal Medicine, Baylor College of
Medicine, Houston, TX 77030, United States
(Khalid, Jimenez, Jneid) Division of Cardiology, Michael E. DeBakey
Veterans Affairs Medical Center, Houston, TX 77030, United States
(Jimenez) Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans
Affairs Medical Center, Houston, TX, United States
Publisher
Springer
Abstract
Purpose: There is a paucity of comparative data examining the optimal
revascularization strategy in patients with left ventricular systolic
dysfunction (LVD). Method(s): We performed an aggregate data
meta-analysis of clinical outcomes comparing percutaneous coronary
intervention (PCI) versus coronary artery bypass (CABG) in patients with
LVD (left ventricle ejection fraction (LVEF) of <= 40%), using the random
effects model. Effects size is reported as odds ratio (OR) and a 95%
confidence interval. Outcomes included all-cause mortality, myocardial
infarction, stroke, repeat revascularization, and a composite of major
adverse cardiac and cerebrovascular events (MACCE) at 30-day, 3-year, and
long-term (6.3 +/- 0.9 years) follow-ups. Seventeen studies (16
observational, 1 randomized) and 18,599 patients (CABG 9651; PCI 8948)
were included. Result(s): PCI and CABG had comparable all-cause
mortality at 30 days (OR 0.78, 95% CI 0.49-1.23) and 3 years (OR 1.05, 95%
CI 0.91-1.21); however, PCI was associated with increased long-term
morality after a mean follow-up of 6.3 +/- 0.9 years (31.6% vs. 24.3%, OR
1.41, 95% CI 1.21-1.64). A similar mortality trend was observed in the
subgroup of patients with EF <= 35%. PCI had a higher rate of repeat
revascularization at 3-year and long-term follow-ups. The long-term rates
of stroke and MI were comparable. PCI, on the other hand, had lower rates
of stroke at 30-day and 3-year follow-ups. Conclusion(s): CABG was
associated with lower rates of long-term mortality and revascularization
but higher rate of upfront stroke in patients with LVD. However, the data
included consisted predominantly of observational studies, highlighting
the paucity and need for randomized trials. Copyright © 2020,
Springer Science+Business Media, LLC, part of Springer Nature.

<122>
Accession Number
634988539
Title
Subgroup analysis of icosapent ethyl for hypertriglyceridemia in
prevention of non-fatal stroke and overall mortality.
Source
Stroke. Conference: American Stroke Association International Stroke
Conference, ISC 2021. Virtual. 52 (SUPPL 1) (no pagination), 2021. Date of
Publication: March 2021.
Author
Assad S.; Zahid M.; Malik S.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Purpose: Often in clinical practice, stroke patients with
elevated triglycerides more than 150 mg/dl are seen despite being treated
with moderate to high-intensity statins and with even in settings of
low-density lipoprotein (LDL) <70 mg per deciliter (mg/dl). This analysis
aims to understand the role of icosapent ethyl (IPE) for controlling the
elevated triglycerides in cardiovascular and cerebrovascular high-risk
populations. Method(s): We performed the subgroup analysis of the
REDUCE-IT double-blinded controlled study. The patient population included
had either established cardiovascular disease or diabetes and other risk
factors, who had been receiving statin therapy and who had a fasting
triglyceride level of 135 to 499 mg/dl and a low-density lipoprotein
cholesterol level of 41 to 100 mg/dl. The patients were randomly assigned
to receive 2 g of IPE twice daily (total daily dose, 4 g) or placebo. The
primary outcomes assessed as nonfatal myocardial infarction, nonfatal
stroke, coronary revascularization, or unstable angina. The secondary
outcomes were death from any cause, cardiovascular, or cerebrovascular
related mortality. Result(s): Almost 8179 patients were studied
(70.7%) for secondary prevention of cardiovascular and cerebrovascular
events and were followed for a median of 4.9 years. The rate of death from
any cause was 6.7% in the IPE group and 7.6% in the placebo group (hazard
ratio [HR], 0.87; 95% confidence interval [CI] 0.74 to 1.02). The time to
event analysis over 4.5 years follow up showed better primary outcomes by
17.2% in the IPE group than 22% in placebo, HR 0.75; 95% CI, 0.68 to 0.83;
p<0.001). The secondary outcomes in terms of overall mortality from
cerebrovascular or cardiovascular accidents were reduced by 25% in IPE
compared to placebo (HR: 0.74; 95% CI 0.65-0.83; p<0.001).
 Conclusion(s): The combination therapy of IPE with moderate to high
dose statins reduces the overallrisk of cardiovascular and cerebrovascular
accidents and mortality. The better primary andsecondary outcomes were
achieved irrespective of triglyceride levels at one year and it does
explainthe other metabolic effects of IPE.

<123>
Accession Number
634988478
Title
Reduction in ischemic stroke with icosapent ethyl-insights from reduce-it.
Source
Stroke. Conference: American Stroke Association International Stroke
Conference, ISC 2021. Virtual. 52 (SUPPL 1) (no pagination), 2021. Date of
Publication: March 2021.
Author
Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.; Ketchum S.;
Juliano R.; Jiao L.; Doyle R.; Granowitz C.; Tardif J.-C.; Gregson J.;
Gibson C.M.; Leary M.C.; Ballantyne C.M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In patients at elevated cardiovascular risk, statins reduce
the occurrence of ischemic stroke. However, residual stroke risk persists.
 Method(s): REDUCE-IT, a multinational, double-blind trial, randomized
8179 statin-treated patients with controlled low-density lipoprotein
cholesterol, elevated triglycerides, and risk for, or evidence of,
atherosclerosis to icosapent ethyl (IPE), a purified, stable ethyl ester
of eicosapentaenoic acid (4 grams/day), or placebo. IPE reduced the
primary composite endpoint (CV death, myocardial infarction (MI), stroke,
coronary revascularization, hospitalization for unstable angina) and the
key secondary composite endpoint (CV death, MI, stroke) by 25% and 26%,
respectively, (each p<0.000001). Total (first and recurrent) ischemic
events were reduced by 32% (p<0.000001). We examined additional
prespecified and post hoc stroke endpoints. Result(s): Event rates
for time to first fatal or nonfatal stroke were 2.4% vs. 3.3% for IPE vs.
placebo; hazard ratio (HR) (95% CI) = 0.72 (0.55-0.93); P=0.01; the
relative risk reduction (RRR) was 28%, absolute risk reduction (ARR) 0.9%,
and number needed to treat (NNT) 114. For every 1,000 patients treated for
5 years with IPE, approximately 14 strokes (fatal or nonfatal) were
averted; rate ratio (RR) (95%CI) = 0.68 (0.52-0.91); P=0.008 (Figure).
Ischemic stroke time to first event rates were 2.0% vs 3.0% for IPE vs
placebo a 36% reduction [HR=0.64 (0.49-0.85); P=0.002]. Hemorrhagic stroke
occurred at low rates with no significant difference for IPE vs. placebo
(0.3% vs 0.2%; P=0.55). Conclusion(s): In REDUCE-IT, icosapent ethyl
significantly reduced the risk of ischemic stroke, with no excess in
hemorrhagic stroke, in statin-treated patients with elevated triglycerides
and atherosclerosis or diabetes.

<124>
Accession Number
634942844
Title
Preoperative physical therapy for elective cardiac surgery patients.
Source
Cochrane Database of Systematic Reviews. 2021 (5) (no pagination), 2012.
Article Number: CD010118. Date of Publication: 14 Nov 2012.
Author
Hulzebos E.H.J.; Smit Y.; Helders P.P.J.M.; van Meeteren N.L.U.
Institution
(Hulzebos) Department of Child Development and Exercise Center, University
Children's Hospital and Medical Center Utrecht, Utrecht, Netherlands
(Smit) c/o Cochrane Heart Group, London, United Kingdom
(Helders) Department of Pediatric Physical Therapy & Exercise Physiology,
University Medical Center Utrecht, Utrecht, Netherlands
(van Meeteren) Innovation area Healthy for Life, Netherlands Organisation
for Applied Scientific Research TNO, Leiden, Netherlands
Publisher
John Wiley and Sons Ltd
Abstract
Background: After cardiac surgery, physical therapy is a routine procedure
delivered with the aim of preventing postoperative pulmonary
complications. Objective(s): To determine if preoperative physical
therapy with an exercise component can prevent postoperative pulmonary
complications in cardiac surgery patients, and to evaluate which type of
patient benefits and which type of physical therapy is most effective.
 Search Method(s): Searches were run on the Cochrane Central Register
of Controlled Trials (CENTRAL) on the Cochrane Library (2011, Issue 12);
MEDLINE (1966 to 12 December 2011); EMBASE (1980 to week 49, 2011); the
Physical Therapy Evidence Database (PEDro) (to 12 December 2011) and
CINAHL (1982 to 12 December 2011). Selection Criteria: Randomised
controlled trials or quasi-randomised trials comparing preoperative
physical therapy with no preoperative physical therapy or sham therapy in
adult patients undergoing elective cardiac surgery. Data Collection
and Analysis: Data were collected on the type of study, participants,
treatments used, primary outcomes (postoperative pulmonary complications
grade 2 to 4: atelectasis, pneumonia, pneumothorax, mechanical ventilation
> 48 hours, all-cause death, adverse events) and secondary outcomes
(length of hospital stay, physical function measures, health-related
quality of life, respiratory death, costs). Data were extracted by one
review author and checked by a second review author. Review Manager 5.1
software was used for the analysis. Main Result(s): Eight randomised
controlled trials with 856 patients were included. Three studies used a
mixed intervention (including either aerobic exercises or breathing
exercises); five studies used inspiratory muscle training. Only one study
used sham training in the controls. Patients that received preoperative
physical therapy had a reduced risk of postoperative atelectasis (four
studies including 379 participants, relative risk (RR) 0.52; 95% CI 0.32
to 0.87; P = 0.01) and pneumonia (five studies including 448 participants,
RR 0.45; 95% CI 0.24 to 0.83; P = 0.01) but not of pneumothorax (one study
with 45 participants, RR 0.12; 95% CI 0.01 to 2.11; P = 0.15) or
mechanical ventilation for > 48 hours after surgery (two studies with 306
participants, RR 0.55; 95% CI 0.03 to 9.20; P = 0.68). Postoperative death
from all causes did not differ between groups (three studies with 552
participants, RR 0.66; 95% CI 0.02 to 18.48; P = 0.81). Adverse events
were not detected in the three studies that reported on them. The length
of postoperative hospital stay was significantly shorter in experimental
patients versus controls (three studies with 347 participants, mean
difference -3.21 days; 95% CI -5.73 to -0.69; P = 0.01). One study
reported an increased physical function measure on the six-minute walking
test in experimental patients compared to controls. One other study
reported a better health-related quality of life in experimental patients
compared to controls. Postoperative death from respiratory causes did not
differ between groups (one study with 276 participants, RR 0.14; 95% CI
0.01 to 2.70; P = 0.19). Cost data were not reported on. Authors'
conclusions: Evidence derived from small trials suggests that preoperative
physical therapy reduces postoperative pulmonary complications
(atelectasis and pneumonia) and length of hospital stay in patients
undergoing elective cardiac surgery. There is a lack of evidence that
preoperative physical therapy reduces postoperative pneumothorax,
prolonged mechanical ventilation or all-cause deaths. Copyright ©
2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<125>
Accession Number
634990065
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. (no pagination), 2021. Article Number: 1451. Date
of Publication: 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, PO Box 17969, Durham, NC
27715, United States
(Hornik, Hill) Duke Clinical Research Institute, Duke University, School
of Medicine, Durham, NC, United States
Publisher
Cambridge University Press
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. Copyright
© The Author(s), 2021. Published by Cambridge University Press.

<126>
Accession Number
634984620
Title
In patients with multi-vessel coronary artery diseases, does hybrid
revascularization provide similar outcomes to conventional coronary artery
bypass grafting?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 07 May 2021.
Author
Maskell P.; Graham C.; Roberts L.; Harky A.
Institution
(Maskell) Department of Surgery, Cambridge University NHS Foundation
Trust, Cambridge, United Kingdom
(Graham, Roberts) School of Clinical Medicine, University of Cambridge,
Cambridge, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In [patients with
multivessel coronary artery diseases (CAD)] is [hybrid revascularization
(HCR)] equal to [coronary artery bypass grafting (CABG)] in regard to
[mortality, myocardial infarction, stroke and target vessel
revascularization (TVR)]? Three-hundred and fifty-five papers were found
using the reported search, of which 8 represented the best evidence to
answer the question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. The studies included 4
observational studies, 3 randomized controlled trials (RCTs) and 1
meta-analysis. The meta-analysis consisted of predominantly observational
data with 1 randomized controlled trial and suggested non-significant
differences in all major clinical outcomes. The observational studies
generally cited benefit towards hybrid revascularization on the basis of
equivalent major clinical outcomes rates compared to coronary artery
bypass grafting, yet favourable in-hospital outcomes. One randomized
controlled trial provided robust evidence of equivalent 5-year outcomes;
however, the others were insufficiently powered for an effective
comparison. There is a paucity of robustly designed studies to answer our
clinical question effectively, given hybrid procedures are not routine in
clinical practice. On the basis of mostly observational and small
randomized cohorts with relatively short follow-up intervals, we conclude
that current evidence suggests similar mid-term rates of major clinical
outcomes after hybrid revascularization and coronary artery bypass
grafting. However, without longer-term follow-up, the comparison of the
two techniques, particularly relating to repeat revascularization, is
still very much uncertain. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

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